FDA Approves Obizur [Antihemophilic Factor (Recombinant)] for Acquired Hemophilia A


The U.S. Food and Drug Administration yesterday approved Obizur [Antihemophilic Factor (Recombinant), Porcine Sequence] for the treatment of bleeding episodes in adults with acquired hemophilia A (acquired Factor VIII [FVIII] deficiency).

 Acquired hemophilia A is a rare, but potentially life threatening, bleeding disorder caused by the development of antibodies (immune system proteins) directed against the body’s own FVIII, a protein important for blood clotting. When FVIII is inactivated by these autoantibodies, a person’s blood doesn’t clot normally, resulting in excessive bleeding that can occur spontaneously or following an event such as injury or surgery.

Unlike inherited hemophilia, acquired hemophilia A is not a genetic disorder and affects both males and females. The development of acquired hemophilia A has been related to other medical conditions or health states, such as pregnancy, cancer, or the use of certain medications. However, in about half of the cases, no underlying cause can be found. Diagnosis of this condition can be difficult and the severity of the bleeding can make treatment challenging.

“The approval of this product provides an important therapeutic option for use in the care of patients with this rare disease,” said Karen Midthun, MD, director of FDA’s Center for Biologics Evaluation and Research.

Obizur contains a recombinant analogue of porcine (pig) FVIII. Porcine FVIII is used because it is similar enough to human FVIII to be effective in blood clotting, but is less likely to be affected by the antibodies against human FVIII that are present in people with acquired hemophilia A.

The safety and efficacy of Obizur was evaluated in a clinical trial of 29 adults with acquired hemophilia A who received Obizur to treat a serious bleeding episode. The trial demonstrated the effectiveness of Obizur in the treatment of bleeding episodes. No safety concerns were identified in the trial.

Obizur received orphan drug designation by the FDA because the drug is intended for use in treatment of a rare disease or condition.

Obizur is manufactured by Baxter Healthcare Corporation, Westlake Village, California.

Source: FDA

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Team discovers how microbes build a powerful antibiotic .


Researchers have made a breakthrough in understanding how a powerful antibiotic agent is made in nature. Their discovery solves a decades-old mystery, and opens up new avenues of research into thousands of similar molecules, many of which are likely to be medically useful.
University of Illinois graduate research assistant Manuel A. Ortega, chemistry professor Wilfred van der Donk, graduate student Yue Hao, biochemistry professor Satish Nair and postdoctoral researcher Mark Walker solved a decades-old mystery into how a broad class of natural antibiotics are made.
Credit: L. Brian Stauffer

Researchers report in the journal Nature that they have made a breakthrough in understanding how a powerful antibiotic agent is made in nature. Their discovery solves a decades-old mystery, and opens up new avenues of research into thousands of similar molecules, many of which are likely to be medically useful.The team focused on a class of compounds that includes dozens with antibiotic properties. The most famous of these is nisin, a natural product in milk that can be synthesized in the lab and is added to foods as a preservative. Nisin has been used to combat food-borne pathogens since the late 1960s.

Researchers have long known the sequence of the nisin gene, and they can assemble the chain of amino acids (called a peptide) that are encoded by this gene. But the peptide undergoes several modifications in the cell after it is made, changes that give it its final form and function. Researchers have tried for more than 25 years to understand how these changes occur.

“Peptides are a little bit like spaghetti; they’re too flexible to do their jobs,” said University of Illinois chemistry professor Wilfred van der Donk, who led the research with biochemistry professor Satish K. Nair. “So what nature does is it starts putting knobs in, or starts making the peptide cyclical.”

Special enzymes do this work. For nisin, an enzyme called a dehydratase removes water to help give the antibiotic its final, three-dimensional shape. This is the first step in converting the spaghetti-like peptide into a five-ringed structure, van der Donk said.

The rings are essential to nisin’s antibiotic function: Two of them disrupt the construction of bacterial cell walls, while the other three punch holes in bacterial membranes. This dual action is especially effective, making it much more difficult for microbes to evolve resistance to the antibiotic.

Previous studies showed that the dehydratase was involved in making these modifications, but researchers have been unable to determine how it did so. This lack of insight has prevented the discovery, production and study of dozens of similar compounds that also could be useful in fighting food-borne diseases or dangerous microbial infections, van der Donk said.

Through a painstaking process of elimination, Manuel Ortega, a graduate student in van der Donk’s lab, established that the amino acid glutamate was essential to nisin’s transformation.

“They discovered that the dehydratase did two things,” Nair said. “One is that it added glutamate (to the nisin peptide), and the second thing it did was it eliminated glutamate. But how does one enzyme have two different activities?”

To help answer this question, Yue Hao, a graduate student in Nair’s lab, used X-ray crystallography to visualize how the dehydratase bound to the nisin peptide. She found that the enzyme interacted with the peptide in two ways: It grasped one part of the peptide and held it fast, while a different part of the dehydratase helped install the ring structures.

“There’s a part of the nisin precursor peptide that is held steady, and there’s a part that is flexible. And the flexible part is actually where the chemistry is carried out,” Nair said.

Ortega also made another a surprising discovery: transfer-RNA, a molecule best known for its role in protein production, supplies the glutamate that allows the dehydratase to help shape the nisin into its final, active form.

“In this study, we solve a lot of questions that people have had about how dehydration works on a chemical level,” van der Donk said. “And it turns out that in nature a fairly large number of natural products — many of them with therapeutic potential — are made in a similar fashion. This really is like turning on a light where it was dark before, and now we and other labs can do all kinds of things that we couldn’t do previously.”


Story Source:

The above story is based on materials provided by University of Illinois at Urbana-Champaign. Note: Materials may be edited for content and length.


Journal Reference:

  1. Manuel A. Ortega, Yue Hao, Qi Zhang, Mark C. Walker, Wilfred A. van der Donk, Satish K. Nair. Structure and mechanism of the tRNA-dependent lantibiotic dehydratase NisB. Nature, 2014; DOI: 10.1038/nature13888

Long Term Cholesterol Drug Use Doubles Risk of Breast Cancer


Long Term Cholesterol Drug Use Doubles Risk of Breast Cancer

A new study published in the journal Cancer Epidemiology, Biomarkers & Prevention indicates that women who are long-term users of statin drugs have between 83-143% increased risk of breast cancer.[1]

The population-based case-control study utilized data from women in the Seattle-Puget Sound region, which included 916 invasive ductal carcinoma (IDC) and 1,068 invasive lobular carcinoma (ILC) cases of 55-74 years of age diagnosed between 2000 and 2008, and a control of 902 women.

Whereas recent publicity on statin drugs has focused on their potential use for cancer prevention or as anti-cancer agents, this study found exactly the opposite with current users of statins for 10 years or longer having a 1.83-fold increased risk of invasive ductal carcinoma (IDC) and a 1.97-fold increased risk of invasive lobular carcinoma (ILC) compared to never users of statins.

Additionally, among women diagnosed with hypercholesterolemia, a condition marked by high levels of lipids and lipoproteins in the blood, current users of statins for 10 years or longer had more than double the risk of both IDC [an average of 104% increased risk] and ILC [an average of 143% increased risk] compared to never users.

Of course, the discovery of a correlation between higher statin drug use and higher breast cancer risk does not necessarily imply causation. For instance, women who are on statins are obviously compliant with conventional blood lipid screening recommendations and therefore are more likely to be complaint with breast screening guidelines as well. Given that recent estimates show that breast screenings have resulted in over 1.3 million US women being misdiagnosed and overtreated for breast cancerin the past 30 years, simply being complaint with breast screening guidelines will result in significantly increased risk of being diagnosed with breast cancer regardless of whether the diagnosis is accurate or not. [2]

On the other hand, this latest study could indicate a more serious problem, namely, that cholesterol-lowering drugs and statin drugs in particular are carcinogenic. Statin drugs, in fact, have long been suspected to increase the risk of certain cancers, including prostate,[3] colorectal,[4] and kidney;[5]conversely, low cholesterol has been found to increase the risk of cancer at all sites, further implicating these cholesterol-lowering agents as possible carcinogens.[i][6]

At the least, this new study raises doubt as to whether the recent push to identify statin drugs as possible chemopreventive or chemotherapeutic agents can be validated by independent science, especially considering that this class of cholesterol-lowering medications have been linked to over 300 adverse health effects in the published literature.

This latest finding is all the more reason why natural dietary and nutritional interventions should be considered a first line defense against elevated blood lipids, and why the very question of whether cholesterol is a primary contributing factor in heart disease should be examined more carefully.

Learn more at our Health Guides: Statin Drugs and Heart Health.


[1] Jean A McDougall, Kathleen E Malone, Janet R Daling, Kara L Cushing-Haugen, Peggy L Porter, Christopher I Li. Long-term statin use and risk of ductal and lobular breast cancer among women 55-74 years of age. Cancer Epidemiol Biomarkers Prev. 2013 Jul 5. Epub 2013 Jul 5.

[3] Chih-Ching Chang, Shu-Chen Ho, Hui-Fen Chiu, Chun-Yuh Yang. Statins increase the risk of prostate cancer: A population-based case-control study. Prostate. 2011 Dec ;71(16):1818-24. Epub 2011 Apr 7.

[4] Fatim Lakha, Evropi Theodoratou, Susan M Farrington, Albert Tenesa, Roseanne Cetnarskyj, Farhat Vn Din, Mary E Porteous, Malcolm G Dunlop, Harry Campbell. Statin use and association with colorectal cancer survival and risk: case control study with prescription data linkage. BMC Cancer. 2012 Oct 22 ;12(1):487. Epub 2012 Oct 22.

[5] Hui-Fen Chiu, Chien-Chun Kuo, Hsin-Wei Kuo, I-Ming Lee, Chien-Te Lee, Chun-Yuh Yang. Statin use and the risk of kidney cancer: a population-based case-control study. Expert Opin Drug Saf. 2012 Jul ;11(4):543-9. Epub 2012 Apr 16.

[6] GreenMedInfo.com, Low Cholesterol Cancer link (8 abstracts)

Canberra drug trial hopes to ‘kick legs out’ from under cancer – ABC News (Australian Broadcasting Corporation)


http://mobile.abc.net.au/news/2014-10-27/cancer-drug-trial-to-start-in-canberra/5842910

From the desk of Zedie.

Eyeball link to Alzheimer’s studied


Eyeball link to Alzheimer’s studied http://www.bbc.co.uk/news/uk-scotland-tayside-central-29758311

From the desk of Zedie.

Paper test can detect Ebola strains


Paper test can detect Ebola strains http://www.bbc.co.uk/news/science-environment-29780942

From the desk of Zedie.

This jelly-filled human tank could help people with pacemakers have life-saving MRI scans


A new device has been developed that will allow scientists to create implants that can safely go through MRI machines without harming their owner – and it eerily looks like a person.

shutterstock_130445687web

Image: sfam_photo/Shutterstock

Researchers at the University of Waikato in New Zealand have created a human-shaped fish tank that’s filled with jelly, and they’re sticking implants into it in order to create medical devices that can travel through MRI machines.

Right now, people with implants such as pacemakers, cochlear implants and spinal cord pain relief implants, can’t go near an MRI machine due to its magnetic force. Not only does it risk pulling their implants out, it also has 10 times the radio frequency of a microwave oven, and can cook tissue surrounding any devices containing an electrode in the body.

However, MRIs are an important part of diagnosing diseases such as cancer, so right now scientists are urgently trying to develop devices that will help doctors to better treat patients with implants. That’s where this human fish tank, named the phantom case, comes in.

“So many people are fitted with medical equipment such as spinal cord, deep brain and cochlear implants and pacemakers, but if you have one of these devices, you can’t go into an MRI machine because of the electromagnetic and magnetic risks,” said engineering professor Jonathan Scott from the University of Waikato in a press release. “Our goal is to find a non-magnetic material for the electrode that that won’t be affected by the [radio frequency] fields.”

Scott became involved in the project after hearing about recipients of spinal cord implants who couldn’t undergo potentially life-saving MRI scans.

“I’d never heard of this before,” said Scott in the release. “They told me they’d love to be able to use electrodes that were MRI-safe, but that nothing like this had been developed before. I knew I just had to follow that up.”

But even if someone had come up with alternatives to today’s electrodes, there was a problem in getting them approved for use – how would you test them without risking cooking human tissue?

Scott and PhD student Steven McCabe have now solved this problem by creating the phantom case (pictured with them below). It’s filled with a phosphate-buffered saline jelly, which responds to MRI scan the same way as human flesh.

JonathanStevePhantom-Oct14web2

This means that the phantom case can have implants inserted into it and then undergo MRI scanned, and the resulting damage or heat stress on the surrounding tissue can be measured.

The team is now working the University of Waikato’s Science and Engineering Workshop to develop a range of electrode prototypes, which they’ll soon begin testing.

“We will try out a number of ideas in the hope of finding something that works, something that has a clever twist to it. We’re very excited about being involved in solving this problem as it will open up MRI scans for people who can’t have them at the moment,” said Scott.

New nanodevice to improve cancer treatment monitoring


In less than a minute, a miniature device developed at the University of Montreal can measure a patient’s blood for methotrexate, a commonly used but potentially toxic cancer drug. Just as accurate and ten times less expensive than equipment currently used in hospitals, this nanoscale device has an optical system that can rapidly gauge the optimal dose of methotrexate a patient needs, while minimizing the drug’s adverse effects. The research was led by Jean-François Masson and Joelle Pelletier of the university’s Department of Chemistry.

Methotrexate has been used for many years to treat certain cancers, among other diseases, because of its ability to block the enzyme dihydrofolate reductase (DHFR). This enzyme is active in the synthesis of DNA precursors and thus promotes the proliferation of cancer cells. “While effective, methotrexate is also highly toxic and can damage the healthy cells of patients, hence the importance of closely monitoring the drug’s concentration in the serum of treated individuals to adjust the dosage,” Masson explained.

Until now, monitoring has been done in hospitals with a device using fluorescent bioassays to measure light polarization produced by a drug sample. “The operation of the current device is based on a cumbersome, expensive platform that requires experienced personnel because of the many samples that need to be manipulated,” Masson said.

Six years ago, Joelle Pelletier, a specialist of the DHFR enzyme, and Jean-François Masson, an expert in biomedical instrument design, investigated how to simplify the measurement of methotrexate concentration in patients.

Gold nanoparticles on the surface of the receptacle change the colour of the light detected by the instrument. The detected colour reflects the exact concentration of the drug in the blood sample. In the course of their research, they developed and manufactured a miniaturized device that works by . Roughly, it measures the concentration of serum (or blood) methotrexate through gold nanoparticles on the surface of a receptacle. In “competing” with to block the enzyme, the change the colour of the light detected by the instrument. And the colour of the light detected reflects the exact concentration of the drug in the .

New nanodevice to improve cancer treatment monitoring
As preicse yet 10 times less expensive than current hospital equipment, this little device contains an optical system that enables it to rapidly identify the dose of methotrexate that a cancer requires, minimising the drugs undesirable side effects. Credit: University of Montreal

The accuracy of the measurements taken by the new device were compared with those produced by equipment used at the Maisonneuve-Rosemont Hospital in Montreal. “Testing was conclusive: not only were the measurements as accurate, but our device took less than 60 seconds to produce results, compared to 30 minutes for current devices,” Masson said. Moreover, the comparative tests were performed by laboratory technicians who were not experienced with surface plasmon resonance and did not encounter major difficulties in operating the new equipment or obtaining the same conclusive results as Masson and his research team.

In addition to producing results in real time, the device designed by Masson is small and portable and requires little manipulation of samples. “In the near future, we can foresee the device in doctors’ offices or even at the bedside, where patients would receive individualized and optimal doses while minimizing the risk of complications,” Masson said. Another benefit, and a considerable one: “While traditional equipment requires an investment of around $100,000, the new mobile would likely cost ten times less, around $10,000.”

Innovations in Heart Rhythm Technology


The field of electrophysiology is abuzz with technological developments. Five recent advances have the potential to improve patient outcomes and make procedures safer.

Two of these innovations—subcutaneous ICDs and contact force ablation catheters—recently received FDA approval. Cleveland Clinic electrophysiologists remain involved in clinical trials of other techniques and technologies that are expected to improve medical practice: leadless pacemakers, a vagal nerve stimulator and a left atrial appendage occlusion device.

“It’s exciting to be part of these clinical trials. As a physician, you always want to serve your patients in ways that are better and safer,” says Cleveland Clinic electrophysiologist Daniel Cantillon, MD.

Leadless pacing

With the lead and the surgical pocket being the weakest links in any pacing system,leadless pacemakers are expected to lower complication rates.

More than 116 patients in the U.S. and Canada—six at Cleveland Clinic—have received St. Jude Medical’s single-chamber Nanostim device to date through the LEADLESS II trial.

“Our experience at Cleveland Clinic has been quite favorable, but it’s still early,” says Dr. Cantillon, who serves on the steering committee for the North American trial and as principal site investigator. “Our endpoint is six months’ freedom from complications. Since our first Nanostim was implanted on Valentine’s Day, we are just approaching that six-month mark.”

Cleveland Clinic will also participate in clinical trials of a second leadless pacemaker, Medtronic’s single-chamber Micra device, with Bruce Wilkoff, MD, as site investigator. Patient enrollment should begin soon.

Neuromodulation for heart failure

With new treatments for heart failure few and far between, all eyes are focused on CardioFit. This pacemaker-style device is the first to successfully activate the autonomic nervous system in order to improve heart failure.

The device is implanted under the skin, with one electrode leading to the vagus nerve and the other secured in the heart muscle. The device senses heart rate and delivers a stimulus to the vagus nerve to mitigate harmful changes that occur as part of the heart failure disease process. In a European pilot study, the system improved 6-minute walk distance, left ventricular ejection fraction and heart failure symptoms (NYHA class) for the patients who received this device.

A randomized trial called INOVATE HF is now underway in the U.S. and Canada comparing CardioFit plus optimal medical care to medical care alone. Outcomes include heart-failure hospitalization and all-cause mortality.

The trial is unique in two ways: Patients with pre-existing ICDs may be enrolled, and each site must have a neurosurgeon as co-principal investigator.

“The CardioFit system requires the skill set of both specialists. If the device receives FDA approval, a neurosurgeon and electrophysiologist will have to work together on these patients,” says Dr. Cantillon, who is serving as principal site co-investigator with his neurosurgery colleague Andre Machado, MD. Randall Starling, MD, head of the Section of Heart Failure, is on the steering committee for North America.

Left atrial appendage closure (LAAC) device

Data from clinical trials of the WATCHMAN left atrial appendage (LAA) occlusion device are now being reviewed by the FDA. If the device is approved, “it will change practice by making it possible to wall off the LAA in a catheter-based procedure to reduce the risk of stroke,” Dr. Cantillon explains.

Cleveland Clinic was one of 65 centers that participated in the PROTECT AF trial. When compared with warfarin, the WATCHMAN reduced the rate of stroke 40 percent, cardiovascular death 60 percent and all-cause mortality 35 percent.

A better ablation catheter

The Contact Force ablation catheter provides better, more consistent contact with tissue during ablation for atrial fibrillation, thereby producing greater freedom from arrhythmias. Its pressure sensor measures and displays contact force in real time, allowing the operator to avoid excess pressure that would increase the risk of tissue perforation. Cleveland Clinic was one of 22 centers participating in studies of the device that led to its FDA approval.

“I was not an investigator, but I became a fast adopter of this technology and now use it for almost all complex ablations,” says Dr. Cantillon.

Subcutaneous ICDs

Like pacemaker leads, ICD leads cause more than their share of complications. While the public was shocked by lead failures and fractures that led to high-profile recalls, physicians were also concerned about endovascular infections requiring extraction and complications and deaths from lead extraction procedures requiring laser tools to remove damaged or infected leads ingrown in the body.

For these reasons, FDA approval of the S-ICD, a leadless, subcutaneous ICD, was welcome news.  The device has no leads and is not vulnerable to transvenous lead failures. Because it is implanted in soft tissue, it can be removed easily and safely if needed.

The S-ICD does have drawbacks, however, in that it does not have pacing capability or offer anti-tachycardia pacing. It’s also currently a little larger than a traditional ICD.

“These are important limitations,” says Dr. Cantillon. “However, the S-ICD is an excellent option for some patients, such as those with heritable conditions that render them vulnerable to sudden death at a young age, like Brugada syndrome.”

Someday, this device might be combined with a leadless pacemaker to create a safer ICD that could maintain pacing capabilities.

“I can foresee that future ICD platforms may supply some degree of pacing support without using leads,” says Dr. Cantillon.

Philosophy begins where physics ends, and physics begins where philosophy ends


Physicist Sean Carroll has some words of wisdom for physicists who might have less than complimentary things to say about philosophy. The most recent altercation between a physicist and philosophy came from Neil deGrasse Tyson who casuallydisparaged philosophy in a Q&A session, saying that it can be a time sink and it doesn’t actually provide any concrete answers to scientific questions. Now I am willing to give Tyson the benefit of doubt since his comment was probably a throwaway remark; plus it’s always easy for scientists to take potshots at philosophers in a friendly sort of way, much like the Yale football team would take potshots at its Harvard counterpart.

But Tyson’s response was only the latest in a series of run ins that the two disciplines have had over the past few years. For instance in 2012 philosopher David Albertcastigated physicist Lawrence Krauss for purportedly claiming in his most recent book that physics had settled or at least given plausible answers to the fundamental question of existence. In reply Krauss called Albert “moronic” which didn’t help much to bridge the divide between the two fields. Stephen Hawking also had some harsh words for philosophers, saying that he thought “philosophy is dead”, and going further back, Richard Feynman was famously disdainful of philosophy which he called “dopey”.

In his post Carroll essentially deconstructs the three major criticisms of philosophy seen among physicists: there’s the argument that philosophers don’t really gather data or do experiments, there’s the argument that practicing physicists don’t really use any philosophy in their work, and there’s the refrain that philosophers concern themselves too much with unobservables. Carroll calls the first of these arguments dopey (providing a fitting rejoinder to Feynman), the second frustratingly annoying and the third deeply depressing.

I tend to agree with his take, and I have always had trouble understanding why otherwise smart physicists like Tyson or Hawking seem to neglect both the rich history of interaction between physics and philosophy as well as the fact that they are unconsciously doing philosophy even when they are doing science. For instance, what exactly was the philosophy-hating Feynman talking about when he gave the eloquent Messenger Lectures that became “The Character of Physical Law“? Feynman was talking about the virtues of science, about the methodology of science, about the imperfect march of science toward the truth; in other words he was talking about what most of us would call “the philosophy of science”. There’s also more than a few examples of what could fairly be called philosophical musings even in the technical “Feynman Lectures on Physics”. Even Tyson, when he was talking about the multiverse and quantum entanglement in “Cosmos” was talking philosophically.

I think at least part of the problem here comes from semantics. Most physicists don’t explicitly try to falsify their hypotheses or apply positive heuristics or keep on looking for paradigms shifts in their daily work, but they are doing this unconsciously all the time. In many ways philosophy is simply a kind of meta, higher level look at the way science is done. Now sometimes philosophers of science are guilty of thinking that science in fact fits the simple definitions engendered by this meta level look, but that does not mean these frameworks are completely inapplicable to science, even if they may be messier than what they appear on paper. It’s a bit like saying that Newton’s laws are irrelevant to entities like black holes and chaotic systems because they lose their simple formulations in these domains.

My take on philosophy and physics is very simple: Philosophy begins where physics ends, and physics begins where philosophy ends. And I believe this applies to all of science.

I think there are plenty of episodes in the history of science that support this view. When science was still in a primitive state, almost all musings about it came first from Greek philosophers and later from Asian, Arab and European thinkers who were called “natural philosophers” for a reason. Anyone who contemplated the nature of earthly forces, wondered what the stars were made up of, thought about whether living things change or are always constant or pondered if there is life after death was doing philosophy. But he or she was also squarely thinking about science since we know for a fact that science has been able to answer these philosophical questions in the ensuing five hundred years. In this case philosophy stepped in where the era’s best science ended, and then science again stepped in when it had the capacity to answer these philosophical questions.

As another example, consider the deep philosophical questions about quantum mechanics pondered by the founders of quantum mechanics, profound thinkers like Bohr, Einstein and Heisenberg. These men were brilliant scientists but they were also bona fide philosophers; Heisenberg even wrote a readable book called “Physics and Philosophy“. But the reason why they were philosophers almost by default is because they understood that quantum mechanics was forcing a rethinking about the nature of reality itself that challenged our notions not just about concrete entities like electrons and photons but also about more ethereal ones like consciousness, objectivity and perception. Bohr and Heisenberg realized that they simply could not talk about these far flung implications of physics without speaking philosophically. In fact some of the most philosophical issues that they debated, such as quantum entanglement, were later validated through hard scientific experiments; thus, if nothing else, their philosophical arguments helped keep these important issues alive. Even among the postwar breed of physicists (many of whom were of the philosophy-averse, “shut up and calculate” type) there were prominent philosophers like John Wheeler and David Bohm, and they again realized the value of philosophy not as a tool for calculation or measurement but simply as a guide to thinking about hazy issues at the frontiers of science. In some sense it’s a good sign then when you start talking philosophically about a scientific issue; it means you are really at the cutting edge.

The fact of the matter – and a paradox of sorts – is that science grows fastest at its fringes, but it’s also at the fringes that it is most uncertain and unable to reach concrete conclusions. That is where philosophy steps in. You can think of philosophy as a kind of stand-in that’s exploring the farthest reaches of scientific thinking while science is maturing and retooling itself to understand the nature of reality. Tyson, Hawking, Krauss, and in fact all of us, are philosophers in that respect, and we should all feel the wiser for it.