"What I really want to produce is that little sob in the spine of the artist-reader”

Vladimir Nabokov on Lolita (Part 1):

“I don’t wish to touch hearts, I don’t even want to affect minds very much. What I really want to produce is that little sob in the spine of the artist-reader.”

Vladimir Nabokov on Lolita (Part 2):

Academic Publisher Unveils New Journal Which Prevents All Access To Its Content

AMSTERDAM - Academic publishers are currently under attack by scientists, governments and the general public for hiding the majority of published research articles behind paywalls. Readers have to pay either a one-time access fee of up to $50 to read one article or obtain an annual subscription to the journal in order to access the research findings. The access fees for research articles generate multi-billion dollar profits for academic publishers, but this lucrative industry is having a hard time justifying the fees. Since the bulk of research is funded through government grants, most people feel that the research articles which summarize and document the public-funded research should be freely available to the public. Some academic publishers are gradually giving in to these demands and are now offering "open access" publishing. In this model, researchers pay a fee to cover the publication costs, but the publications are then available without any fees to all readers.

Not all academic publishers agree with this approach. Else Beer, the CEO of the prominent academic publisher Elsebeer, has condemned the open access approach and is instead betting on a new line of closed-access journals. Beer unveiled the new closed-access journal "Facts of Life" at a press conference.

"We realize that there is a big push towards open access publishing in science, but few people think about the problems that come with open access. If everyone is able to access a scientific paper, it is far more likely that they will read the paper and perhaps even try to replicate the results. This is a huge problem for scientists who routinely publish irreproducible results, as well as for scientists who want to keep their tools and scientific methods secret."

Unlike previous closed access journals in which articles are hidden behind a paywall and can be accessed after paying a fee, "Facts of Life" guarantees that nobody other than the author can access the published article. This allows scientists to include the article as a published paper on their CV and cite their work, without ever having to worry that someone else might read the article. Beer expects that this new concept will be embraced by many researchers

The physician-scientist and poet Yuri Zhivago is among the first researchers to submit manuscripts to the new journal. "It is a blessing to have this journal", Zhivago commented, "I have at least three manuscripts that contain experiments that cannot be replicated.  Now I can publish them without having to worry about my tenure committee criticizing me for having too few publications. If I published them in an open access journal, I would eventually have to retract the papers and this would could damage my reputation as a researcher. By publishing in "Facts of Life", I can be sure that nobody will ever be able to accuse me of publishing fraudulent data."

Beer is confident that there are many other Zhivagos out there who need a completely closed-access journal. "We are taking closed access publishing to a new level and we think that we provide a much-needed forum for all the researchers want to publish but have no sound data." She is convinced that other publishers will follow suit when they see the success of the "completely closed access" model.    

The Writer's Secret Is Not Inspiration

An excerpt from Orhan Pamuk's 2006 Nobel lecture:

"The writer's secret is not inspiration – for it is never clear where it comes from – it is his stubbornness, his patience. That lovely Turkish saying – to dig a well with a needle – seems to me to have been said with writers in mind. In the old stories, I love the patience of Ferhat, who digs through mountains for his love – and I understand it, too. In my novel, My Name is Red, when I wrote about the old Persian miniaturists who had drawn the same horse with the same passion for so many years, memorising each stroke, that they could recreate that beautiful horse even with their eyes closed, I knew I was talking about the writing profession, and my own life.

If a writer is to tell his own story – tell it slowly, and as if it were a story about other people – if he is to feel the power of the story rise up inside him, if he is to sit down at a table and patiently give himself over to this art – this craft – he must first have been given some hope. The angel of inspiration (who pays regular visits to some and rarely calls on others) favours the hopeful and the confident, and it is when a writer feels most lonely, when he feels most doubtful about his efforts, his dreams, and the value of his writing – when he thinks his story is only his story – it is at such moments that the angel chooses to reveal to him stories, images and dreams that will draw out the world he wishes to build.

If I think back on the books to which I have devoted my entire life, I am most surprised by those moments when I have felt as if the sentences, dreams, and pages that have made me so ecstatically happy have not come from my own imagination – that another power has found them and generously presented them to me."

The complete Nobel lecture can be found here.

Image Credit: Orhan Pamuk by David Shankbone 2009, Via Wikimedia - Creative Commons license

Accuracy of Medical Information on the Internet

We can just Google it!” is becoming our standard response to unanswered questions in life. Whether we are looking for the title of an irritating 80s song, a restaurant serving authentic Icelandic food or the quickest bus route to the Star Trek convention, the Internet usually offers the long-sought answers. However, when we enter key words in a search engine such as Google, we end up with thousands of websites – many of which are barely relevant to what we are looking for or are rife with inaccuracies.

Portrait of Dr. Gachet, by Vincent van Gogh, 

public domain

Identifying the websites with the most accurate and relevant information are critical skills that are necessary for navigating our way in the digital information jungle, but unfortunately, these skills are rarely taught. In most cases, inaccurate or irrelevant information on the internet merely delays us for a few minutes until we do find the answer to what we are looking for. However, when it comes to medical information, inaccurate or irrelevant information could potentially have a major detrimental impact on our well-being. Patients and their family members are increasingly using the internet as a major source of advice regarding their illnesses, treatment options, dietary advice and disease prevention. 

However, little is known about the accuracy of medical advice obtained via the internet. A study entitled “Safe Infant Sleep Recommendations on the Internet: Let’s Google It” by Dr. Rachel Moon and colleagues (published online in the Journal of Pediatrics on August 2, 2012) addresses this question by focusing on the question of sleep safety in infants. The American Academy of Pediatrics (AAP) has published guidelines for reducing the risk of sudden infant death syndrome (SIDS), suffocation or other accidental sleep-related infant deaths. Since such guidelines are written for clinical professionals, they often contain medical jargon that cannot be easily understood by concerned parents that want practical advice regarding how to ensure the sleep safety of their infants. Thus, instead of reading the AAP guidelines, most parents probably enter key phrases related to infant sleep safety into an internet search engine and may follow the advice displayed on the sites identified by the search engine.

Google Girls, by Defluiter at Wikimedia Commons

Dr. Moon and colleagues tested the accuracy of such websites by entering thirteen search phrases such as ” Infant sleep position”, ” Infant co-sleeping” or ” Pacifier sleeping” into the Google search engine, and then cross-checked the medical information offered in the search results with the AAP recommendations, which was used as the standard for medical accuracy.

Since most parents would probably read the first few pages of the Google search results, the researchers only analyzed the first 100 websites identified by each of the thirteen Google searches (total of 1300 websites). Only 43.5% of these 1300 websites contained recommendations that were in line with the AAP recommendations, while 28.1% contained inaccurate information and 28.4% of the websites were not medically relevant. The accuracy was highly dependent on the type of question asked. The search phrase “infant cigarette smoking”, for example, yielded 82% accurate results, while the search phrase “infant home monitors” resulted in only 18% accuracy.

Of note, the researchers also categorized the results by the organization or group that had generated the website. Out of the 1300 websites identified by the searches, 246 (19%) were retail product review site websites and 250 (19%) were websites associated with specific companies or interest groups. Product review retail websites were also the ones which had the lowest level of medical accuracy (8.5%). On the other hand, government websites and websites of national organizations (as identified by URL ending in .org) had the highest level of accuracy (80.9% and 72.5%, respectively).

Surprisingly, educational websites (universities or other websites with URL’s ending in .edu, ebooks, peer-reviewed articles) only had 50.2% accurate medical information, possibly due to the fact that either some of the information was not updated or that a number of the linked articles required a subscription and thus could not be accessed. The majority of the books found by the search engine either provided outdated or irrelevant information, which may have also contributed to the low accuracy rate of educational websites. Blogs and websites of individuals also had very low rates of medical accuracy (25.7% and 30.3%).

This study highlights the opportunities and pitfalls of using the internet to communicate medical information. The internet is providing an opportunity for patients and family members to obtain additional medical information that they did not receive from their physicians, as well as to address questions that may arise and do not warrant a visit to a physician. On the other hand, the study also demonstrates that the quality of medical information on the internet varies widely. Searches for certain key phrases can unwittingly lead a user to websites that promote certain products or treatments without taking the medical evidence and professional guidelines into account.

One key factor to help address this pitfall is for physicians and other healthcare professionals to actively guide patients or family members to website that are likely to have information with high levels of medical accuracy. Instead of placing the burden of discriminating between accurate and inaccurate information on patients, healthcare professionals could advise patients or parents as to what websites should be used to address medical questions that they might have.

Furthermore, government institutions, organizations and educational websites need to realize the importance of maintaining up-to-date and accessible medical information on their websites. Concerted efforts between government or educational institutions, professional organizations and healthcare professionals are necessary so that patients can maximally benefit from the information opportunities afforded by the internet.

This article first appeared on the Scientific American Guest Blog

Chung M, Oden RP, Joyner BL, Sims A, & Moon RY (2012). Safe infant sleep recommendations on the Internet: let's Google it. The Journal of pediatrics, 161 (6), 1080-4 PMID: 22863258

"I think it may be taken as the rule among primitive men, that they both fear and hate whatever is unfamiliar."

An excerpt from Bertrand Russell's 1950 Nobel lecture:

"Interwoven with many other political motives are two closely related passions to which human beings are regrettably prone: I mean fear and hate. It is normal to hate what we fear, and it happens frequently, though not always, that we fear what we hate. I think it may be taken as the rule among primitive men, that they both fear and hate whatever is unfamiliar. They have their own herd, originally a very small one. And within one herd, all are friends, unless there is some special ground of enmity. Other herds are potential or actual enemies; a single member of one of them who strays by accident will be killed. An alien herd as a whole will be avoided or fought according to circumstances. It is this primitive mechanism which still controls our instinctive reaction to foreign nations. The completely untravelled person will view all foreigners as the savage regards a member of another herd. But the man who has travelled, or who has studied international politics, will have discovered that, if his herd is to prosper, it must, to some degree, become amalgamated with other herds. If you are English and someone says to you, «The French are your brothers», your first instinctive feeling will be, «Nonsense. They shrug their shoulders, and talk French. And I am even told that they eat frogs.» If he explains to you that we may have to fight the Russians, that, if so, it will be desirable to defend the line of the Rhine, and that, if the line of the Rhine is to be defended, the help of the French is essential, you will begin to see what he means when he says that the French are your brothers. But if some fellow-traveller were to go on to say that the Russians also are your brothers, he would be unable to persuade you, unless he could show that we are in danger from the Martians. We love those who hate our enemies, and if we had no enemies there would be very few people whom we should love."

The complete 1950 Nobel lecture of Bertrand Russell can be found here.

Image: Photo of Bertrand Russell/Wikimedia

"To oppression, plundering and abandonment, we respond with life"

An excerpt from the 1982 Nobel lecture given by Gabriel García Márquez:

"Latin America neither wants, nor has any reason, to be a pawn without a will of its own; nor is it merely wishful thinking that its quest for independence and originality should become a Western aspiration. However, the navigational advances that have narrowed such distances between our Americas and Europe seem, conversely, to have accentuated our cultural remoteness. Why is the originality so readily granted us in literature so mistrustfully denied us in our difficult attempts at social change? Why think that the social justice sought by progressive Europeans for their own countries cannot also be a goal for Latin America, with different methods for dissimilar conditions? No: the immeasurable violence and pain of our history are the result of age-old inequities and untold bitterness, and not a conspiracy plotted three thousand leagues from our home. But many European leaders and thinkers have thought so, with the childishness of old-timers who have forgotten the fruitful excess of their youth as if it were impossible to find another destiny than to live at the mercy of the two great masters of the world. This, my friends, is the very scale of our solitude.

 In spite of this, to oppression, plundering and abandonment, we respond with life. Neither floods nor plagues, famines nor cataclysms, nor even the eternal wars of century upon century, have been able to subdue the persistent advantage of life over death. An advantage that grows and quickens: every year, there are seventy-four million more births than deaths, a sufficient number of new lives to multiply, each year, the population of New York sevenfold. Most of these births occur in the countries of least resources - including, of course, those of Latin America. Conversely, the most prosperous countries have succeeded in accumulating powers of destruction such as to annihilate, a hundred times over, not only all the human beings that have existed to this day, but also the totality of all living beings that have ever drawn breath on this planet of misfortune."

The complete 1982 Nobel lecture of Gabriel García Márquez can be found here.

Image: Photo of Gabriel García Márquez via Jose Lara/Wikimedia

NRA Says Hansel and Gretel Should Have Had Guns

WASHINGTON, December 22, 2012 - The National Rifle-Manufacturer Association (NRA) held a press conference in Washington, D.C. to offer "meaningful contributions" in the debate about education reform.  This highly anticipated press conference was chaired by Charlton TheRock, president and Grand Wizard of the NRA. TheRock read out a prepared press statement to an audience of over 100 journalists:

"Members of the mainstream media are quick to condemn the NRA, but their hateful rhetoric ignores what the NRA really stands for: caring about the future of American children. We have noticed that American education system is broken. Children are not taught traditional American values any more. Instead, they are becoming godless and unpatriotic creatures who spend most of their time surfing websites such as YouSpace, MyTube and Tweeter. Our generation used to read books, while today's generation facebooks.The main causes of America's education crisis are the hateful anti-gun rhetoric and the removal of guns from children's books. If children were exposed to gun friendly statements by teachers and to guns in children's books, they would be able to take pride in the American tradition of gun-ownership. They would also learn that guns are important problem-solving tools and could incorporate guns into their daily lives."

"Just look at how fairy-tales such as the story of Hansel and Gretel are taught at schools. The parents of Hansel and Gretel cannot afford to feed their children and are forced to abandon them in a forest. Hansel and Gretel accidentally wander into the house of an evil atheist witch who captures them and intends to eat them. During a moment of luck, Gretel manages to push the witch into the oven and escape with her brother Hansel.When liberals read the story, they are quick to blame the parents for abandoning Hansel and Gretel. This was not the mistake that Hansel and Gretel's parents made. The real mistake was that they left them in the forest without giving them any guns. If either Hansel or Gretel had been carrying guns, they could have shot the witch upon first contact, right after they took their first bite of the gingerbread house."

"We reconstructed the Hansel and Gretel story in our Civil War Reenactment Center and identified nine points in the story during which Hansel and Gretel had a clear line of fire and could have killed the witch if either of them had carried a gun.   In today's communist, fascist and gay economy, we could all be faced with a situation in which we have to abandon our children in a forest. We do not want our children to depend on luck. If you have to leave your children in a forest, please give them guns. It is the opinion of the NRA that providing firearms to children would protect them from witches, goblins, communists, gnomes, environmentalists, feminists and other evil entities. Our Founding Fathers would have wanted Hansel and Gretel to carry firearms. To help clarify this point and to educate children, parents and teachers, the NRA will soon  publish an annotated edition of Grimm's fairy-tales in which we will point out all the opportunities to evade evil with the help of guns." 

After listening to the statement, multiple journalists raised their hands to ask questions.  TheRock dismissed those requests and said, "We will not be taking any questions. Too many people in America have asked too many questions. Now is the time for answers and not for questions."

Image Credit: Hänsel und Gretel, Mein erstes Märchenbuch, Verlag Wilh. Effenberger, Stuttgart, end of the 19th century. The painting is in the public domain, via Wikimedia Commons.

Recent Study Raises Questions About Using Adult Stem Cells for Chronic Heart Disease

A recent clinical study (POSEIDON Randomized Trial) investigated the effects of transplanting bone marrow derived adult stem cells into patients with known heart disease. The results were presented at the 2012 American Heart Association (AHA) meeting in Los Angeles and also published in the article "Comparison of Allogeneic vs Autologous Bone Marrow–Derived Mesenchymal Stem Cells Delivered by Transendocardial Injection in Patients With Ischemic Cardiomyopathy: The POSEIDON Randomized Trial". The article by Dr. Joshua Hare and colleagues appeared in the online edition of the Journal of the American Medical Association on November 6, 2012.
 

 The primary goal of the study was to compare whether adult stem cells from other donors (allogeneic cells) are just as safe as the stem cells derived from the patients' own bone marrow (autologous cells). Thirty patients with a prior heart attack and reduced cardiac function received either allogeneic or autologous cells. The injected cells were mesenchymal stem cells (MSCs), an adult stem cell type that resides within the bone marrow and primarily gives rise to bone, fat or cartilage tissue. MSCs are quite distinct from hematopoietic stem cells (HSCs) which are also present in the bone marrow but give rise to blood cells. In the POSEIDON study, patients underwent a cardiac catheterization and the MSCs were directly injected into the heart muscle. Various measurements of safety and cardiac function were performed before and up to one year after the cell injection.

 The good news is that in terms of safety, there was no significant difference when either autologous or allogeneic MSCs were used. Within the first month after the cell injection, only one patient in each group was hospitalized for what may have been a major treatment related side effect. In the long-run, the number of adverse events was very similar in both groups. The implication of this finding is potentially significant. It suggests that one can use off-the-shelf adult stem cells from a healthy donor to treat a patient with heart disease. This is much more practical than having to isolate the bone marrow from a patient and wait for 4-8 weeks to expand his or her own bone marrow stem cells.

 The disappointing news from this study is that one year following the stem cell injection, there was minimal improvement in the cardiac function of the patients. The ejection fraction of the heart is an indicator of how well the heart contracts and the normal range for healthy patients is roughly 55-60%. In the current study, patients who received allogeneic cells started out with an average ejection fraction of 27.9% and the value increased to 29.5% one year after the cell injection. The patients who received autologous cells had a mean ejection fraction of 26.2% prior to the cell transplantation and a mean ejection fraction of 28.5% one year after the stem cell therapy. In both groups, the improvement was minimal and not statistically significant. A different measure of the functional capacity of the heart is the assessment of the peak oxygen consumption. This measurement correlates well with the survival of a patient and is also used to help decide if a patient needs a heart transplant. There was no significant change in the peak oxygen consumption in either of the two groups of patients, one year after the treatment. Some other measures did indicate a minor improvement, such as the reduction of the heart attack scar size in both patient groups but this was apparently not enough to improve the ejection fraction or oxygen consumption.

 One of the key issues in interpreting the results is the fact that there was no placebo control group. The enrollment in a research study and the cell injection procedure itself could have contributed to minor non-specific or placebo benefits that were unrelated to the stem cell treatments. One odd finding was that the patient sub-group which showed a statistically significant improvement in ejection fraction was the group which received the least stem cells. If the observed minor benefits were indeed the result of the injected cells turning into cardiac cells, one would expect that more cells would lead to greater functional improvement. The efficacy of the lowest number of cells points to non-specific effects from the cell injection or to an unknown mechanism by which the injected cells activate cardiac repair without necessarily becoming cardiac cells themselves.

 The results of this study highlight some key problems with current attempts to use adult stem cells in cardiovascular patients. Many studies have shown that adult stem cells have a very limited differentiation potential and that they do not really turn into beating, functional heart cells. Especially in patients with established, long-standing heart disease, the utility of adult stem cells may be very limited. The damage that the heart of these patients has suffered is probably so severe that they need stem cells which can truly regenerate the heart. Examples of such regenerative stem cells are embryonic stem cells or induced pluripotent stem cells which have a very broad differentiation potential. Cardiac stem cells, which exist in very low numbers within the heart itself, are also able to become functional heart cells. Each of these three cell types is challenging to use in patients, which is why many current studies have resorted to using the more convenient adult bone marrow stem cells.

 Human embryonic stem cells can develop into functional heart cells, but there have been numerous ethical and regulatory concerns about using them. Induced pluripotent stem cells (iPSCs) appear to have the capacity to become functional heart cells, similar to what has been observed for human embryonic stem cells. However, iPSCs were only discovered six years ago and we still have a lot to learn more about how they work. Lastly, cardiac stem cells are very promising but isolating them from the heart requires an additional biopsy procedure which can also carry some risks for the patients. Hopefully, the fact that adult bone marrow stem cells showed only minimal benefits in the POSEIDON study will encourage researchers to use these alternate stem cells (even if they are challenging to use) instead of adult bone marrow stem cells for future studies in patients with chronic heart disease.

 One factor that makes it difficult to interpret the POSEIDON trial is the lack of a placebo control group. This is a major problem for many stem cell studies, because it is not easy to ethically justify a placebo group for invasive procedures such as a stem cell implantation. The placebo patients would also have to receive a cardiac catheterization and injections into the heart tissue, but instead of stem cells, the injections would just contain a cell-free liquid solution. Scientifically, such a placebo control group is necessary to determine whether the stem cells are effective, but this scientific need has to be weighed against the ethics of a “placebo” heart catheterization. Even if one were to ethically justify a “placebo” heart catheterization, it may not be easy to recruit volunteer patients for the study if they knew that they had a significant chance of receiving "empty" injections into their heart muscle.

 There is one ongoing study which is very similar in design to the POSEIDON trial and it does contain a placebo group: The TAC-HFT trial. The results of this trial are not yet available, but they may have a major impact on whether or not bone marrow stem cells have a clinical future. If the TAC-HFT trial shows that the bone marrow stem cell treatment for patients with chronic heart disease has no benefits or only minor benefits when compared to the placebo group, it will become increasingly difficult to justify the use of these cells in heart patients.

 In summary, the POSEIDON trial has shown that treating chronic heart disease patients with bone marrow derived stem cells is not yet ready for prime time. Bone marrow cells from strangers may be just as safe as one’s own cells, but if bone marrow stem cells are not very effective for treating chronic heart disease, than it may just be a moot point.

Hare JM, Fishman JE, Gerstenblith G, Difede Velazquez DL, Zambrano JP, Suncion VY, Tracy M, Ghersin E, Johnston PV, Brinker JA, Breton E, Davis-Sproul J, Schulman IH, Byrnes J, Mendizabal AM, Lowery MH, Rouy D, Altman P, Wong Po Foo C, Ruiz P, Amador A, Da Silva J, McNiece IK, & Heldman AW (2012). Comparison of Allogeneic vs Autologous Bone Marrow-Derived Mesenchymal Stem Cells Delivered by Transendocardial Injection in Patients With Ischemic Cardiomyopathy: The POSEIDON Randomized Trial. JAMA : the journal of the American Medical Association, 1-11 PMID: 23117550


  Image credit: Wikipedia

This article was originally published on the Scilogs Stem Cells Blog: The Next Regeneration

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David Sedaris on Undecided Voters

David Sedaris on undecided voters in a 2008 New Yorker article:

"I don’t know that it was always this way, but, for as long as I can remember, just as we move into the final weeks of the Presidential campaign the focus shifts to the undecided voters. “Who are they?” the news anchors ask. “And how might they determine the outcome of this election?”
Then you’ll see this man or woman— someone, I always think, who looks very happy to be on TV. “Well, Charlie,” they say, “I’ve gone back and forth on the issues and whatnot, but I just can’t seem to make up my mind!” Some insist that there’s very little difference between candidate A and candidate B. Others claim that they’re with A on defense and health care but are leaning toward B when it comes to the economy.
I look at these people and can’t quite believe that they exist. Are they professional actors? I wonder. Or are they simply laymen who want a lot of attention?
To put them in perspective, I think of being on an airplane. The flight attendant comes down the aisle with her food cart and, eventually, parks it beside my seat. “Can I interest you in the chicken?” she asks. “Or would you prefer the platter of shit with bits of broken glass in it?”
To be undecided in this election is to pause for a moment and then ask how the chicken is cooked.
I mean, really, what’s to be confused about?"

The complete piece by David Sedaris can be read here

Study Reveals That Cold-Hearted People May Have A Slightly Higher Cardiac Temperature

NOVEMBER 5, 2012 - LOS ANGELES, California - A sensational new study was presented at the   Annual Conference of the American Society for Innovative Cardiologists. In a study conducted by the cardiologist Dr. Baskin at the Klondike Bar University, fifty-two participants were enrolled for an evaluation of their cardiac temperature. 

Each study participant was individually taken to an examination room in the university hospital and given a Nutella sandwich. Before the participants were able to eat the sandwich, they were asked to walk across a hallway to sign a document in the conference room. Unbeknownst to the study participants, a five year old child was waiting in the hallway for each of the study participants. Upon encountering each participant, the child began crying and demanded to have a bite of the Nutella sandwich. Study participants who gave the child either the whole sandwich or part of it were classified as warm-hearted. On the other hand, participants who ignored the child were considered cold-hearted. Based on these interactions, 39 of the fifty-two participants were cold-hearted while 11 participants showed signs of warm-heartedness. Two subjects had to be excluded  from the study because the child tripped them and removed the Nutella sandwich from the participants before the research team could ascertain whether or not the participants would voluntarily share the sandwich.

Following this initial portion of the study, the participants then underwent a cardiac catheterization performed by Dr. Robbins, another lead investigator in the research team. In this procedure, a catheter containing a temperature probe was advanced via the femoral artery into the aorta and then the left chamber of the heart. Measurements of the actual heart temperature were conducted in at least five different areas of the heart. 

To the surprise of the researchers, the average temperature of the heart in the cold-hearted participant group was slightly higher (37.1 degrees Celsius) than the temperature in the warm-hearted group (36.9 degrees Celsius), although this difference was not statistically significant. At a press conference, Dr. Robbins stated that these findings may represent a major paradigm shift in how the expressions "warm-hearted" and "cold-hearted" are used:

"Our data suggest that there is actually a trend for so-called 'warm-hearted' people to have a lower heart temperature. Even though this is not yet statistically significant, we believe that by increasing the number of study participants, we may soon be able to demonstrate that the 'warm-hearted' people need to be re-classified as 'cold-hearted'. This represents a semantic paradigm shift." 

Some novelists have expressed concerns about these findings and vowed to continue using the  terms "warm-hearted" and "cold-hearted" in the conventional sense, even if the scientific data contradicts this usage.