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The best way to prevent this deadly cancer is to remove multiple organs. And I’m about to do it.

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Out of 100 people with ovarian cancer, 46 will be alive 5 years after diagnosis. (National Cancer Institute)


These ideas have recently started filtering through to the wider public. Earlier this year, the US-based Ovarian Cancer Research Alliance, one of the largest advocacy organizations for this cancer, had a major shift from an emphasis on early detection; it is now recommending genetic testing, both for diagnosed patients and for other people who know they’re at risk. It now also counsels prophylactic organ removal: opportunistic salpingectomy for anyone at even “average” risk for the cancer; or, if you’re at increased risk, a salpingectomy whether or not it coincides with another procedure, as well as removal of the ovaries.

But this emphasis on genetic testing as a preventive measure hasn’t necessarily been welcomed across the ovarian cancer community, says Sarah DeFeo, the chief program officer at the Ovarian Cancer Research Alliance. “There is this strong attachment to the importance of symptom awareness. And there is this real focus on the promise of early detection,” she says. “And we know that does not work.”

“We need to focus on what does work and what we can do,” she adds. “And we encourage people to know their risk.”

What prevention really looks like 

As for me, after I got my test results, I dragged my heels on a decision. After seeing the genetic counselor, I eventually found my way to a gynecological oncologist at New York–Presbyterian. There, I was told that the recommendation for high-risk women my age—approaching 50—is to have the ovaries as well as the fallopian tubes removed as a preventive measure.

This week, shortly before my 49th birthday, I’ll have this surgery, which will instantly trigger menopause—“surgical” or “forced” menopause are the correct and depressing terms. It fills me with dread, frankly. In an effort to prepare, I find myself going back to googling “what to expect,” and the list is astonishing: menopause can bring hot flashes, brittle bones, heart palpitations, memory loss, insomnia, joint pain, depression, vaginal discomfort, bladder issues, hair loss … I usually don’t make it all the way to the end of these lists. 

This is where we’re at: a huge advance—finally—in science and technology has shined light on a cancer that has long been in the dark, and has been outsmarting us this entire time. But prevention comes at a price. I’m going to be a walking example of prevention very soon, and it does make me wonder: if you have a gene mutation like mine, it seems that the best way to not get ovarian cancer … is to not have ovaries (or fallopian tubes) at all, which tells me a lot about how powerful this disease really is. 

I put that to Miller, who has spent the better part of her career with a full awareness of the disease she was trying to outsmart as a scientist. “I can’t disagree with you,” she replied. “But it’s really the best we have for right now. Is it perfect? Absolutely not, for exactly the reasons that you said. But on the other hand, having watched too many women die of ovarian cancer over my career, I just think we have to do something. And there’s something we can do without increasing the morbidity to women.”

So even as I turn back to googling, there comes a point when I remind myself that surgical menopause is a better outcome than even the possibility of ovarian cancer. It doesn’t take prisoners, this cancer. 

Golda Arthur is an audio journalist and podcast producer. She has launched and run podcasts at Vox Media, MIT Technology Review, and Marketplace, and has reported, edited, and produced for the BBC and the CBC. She lives in New York City.

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The hunter-gatherer groups at the heart of a microbiome gold rush

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The hunter-gatherer groups at the heart of a microbiome gold rush


The first step to finding out is to catalogue what microbes we might have lost. To get as close to ancient microbiomes as possible, microbiologists have begun studying multiple Indigenous groups. Two have received the most attention: the Yanomami of the Amazon rainforest and the Hadza, in northern Tanzania. 

Researchers have made some startling discoveries already. A study by Sonnenburg and his colleagues, published in July, found that the gut microbiomes of the Hadza appear to include bugs that aren’t seen elsewhere—around 20% of the microbe genomes identified had not been recorded in a global catalogue of over 200,000 such genomes. The researchers found 8.4 million protein families in the guts of the 167 Hadza people they studied. Over half of them had not previously been identified in the human gut.

Plenty of other studies published in the last decade or so have helped build a picture of how the diets and lifestyles of hunter-gatherer societies influence the microbiome, and scientists have speculated on what this means for those living in more industrialized societies. But these revelations have come at a price.

A changing way of life

The Hadza people hunt wild animals and forage for fruit and honey. “We still live the ancient way of life, with arrows and old knives,” says Mangola, who works with the Olanakwe Community Fund to support education and economic projects for the Hadza. Hunters seek out food in the bush, which might include baboons, vervet monkeys, guinea fowl, kudu, porcupines, or dik-dik. Gatherers collect fruits, vegetables, and honey.

Mangola, who has met with multiple scientists over the years and participated in many research projects, has witnessed firsthand the impact of such research on his community. Much of it has been positive. But not all researchers act thoughtfully and ethically, he says, and some have exploited or harmed the community.

One enduring problem, says Mangola, is that scientists have tended to come and study the Hadza without properly explaining their research or their results. They arrive from Europe or the US, accompanied by guides, and collect feces, blood, hair, and other biological samples. Often, the people giving up these samples don’t know what they will be used for, says Mangola. Scientists get their results and publish them without returning to share them. “You tell the world [what you’ve discovered]—why can’t you come back to Tanzania to tell the Hadza?” asks Mangola. “It would bring meaning and excitement to the community,” he says.

Some scientists have talked about the Hadza as if they were living fossils, says Alyssa Crittenden, a nutritional anthropologist and biologist at the University of Nevada in Las Vegas, who has been studying and working with the Hadza for the last two decades.

The Hadza have been described as being “locked in time,” she adds, but characterizations like that don’t reflect reality. She has made many trips to Tanzania and seen for herself how life has changed. Tourists flock to the region. Roads have been built. Charities have helped the Hadza secure land rights. Mangola went abroad for his education: he has a law degree and a master’s from the Indigenous Peoples Law and Policy program at the University of Arizona.

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The Download: a microbiome gold rush, and Eric Schmidt’s election misinformation plan

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The Download: a microbiome gold rush, and Eric Schmidt’s election misinformation plan


Over the last couple of decades, scientists have come to realize just how important the microbes that crawl all over us are to our health. But some believe our microbiomes are in crisis—casualties of an increasingly sanitized way of life. Disturbances in the collections of microbes we host have been associated with a whole host of diseases, ranging from arthritis to Alzheimer’s.

Some might not be completely gone, though. Scientists believe many might still be hiding inside the intestines of people who don’t live in the polluted, processed environment that most of the rest of us share. They’ve been studying the feces of people like the Yanomami, an Indigenous group in the Amazon, who appear to still have some of the microbes that other people have lost. 

But there is a major catch: we don’t know whether those in hunter-gatherer societies really do have “healthier” microbiomes—and if they do, whether the benefits could be shared with others. At the same time, members of the communities being studied are concerned about the risk of what’s called biopiracy—taking natural resources from poorer countries for the benefit of wealthier ones. Read the full story.

—Jessica Hamzelou

Eric Schmidt has a 6-point plan for fighting election misinformation

—by Eric Schmidt, formerly the CEO of Google, and current cofounder of philanthropic initiative Schmidt Futures

The coming year will be one of seismic political shifts. Over 4 billion people will head to the polls in countries including the United States, Taiwan, India, and Indonesia, making 2024 the biggest election year in history.

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Navigating a shifting customer-engagement landscape with generative AI

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Navigating a shifting customer-engagement landscape with generative AI


A strategic imperative

Generative AI’s ability to harness customer data in a highly sophisticated manner means enterprises are accelerating plans to invest in and leverage the technology’s capabilities. In a study titled “The Future of Enterprise Data & AI,” Corinium Intelligence and WNS Triange surveyed 100 global C-suite leaders and decision-makers specializing in AI, analytics, and data. Seventy-six percent of the respondents said that their organizations are already using or planning to use generative AI.

According to McKinsey, while generative AI will affect most business functions, “four of them will likely account for 75% of the total annual value it can deliver.” Among these are marketing and sales and customer operations. Yet, despite the technology’s benefits, many leaders are unsure about the right approach to take and mindful of the risks associated with large investments.

Mapping out a generative AI pathway

One of the first challenges organizations need to overcome is senior leadership alignment. “You need the necessary strategy; you need the ability to have the necessary buy-in of people,” says Ayer. “You need to make sure that you’ve got the right use case and business case for each one of them.” In other words, a clearly defined roadmap and precise business objectives are as crucial as understanding whether a process is amenable to the use of generative AI.

The implementation of a generative AI strategy can take time. According to Ayer, business leaders should maintain a realistic perspective on the duration required for formulating a strategy, conduct necessary training across various teams and functions, and identify the areas of value addition. And for any generative AI deployment to work seamlessly, the right data ecosystems must be in place.

Ayer cites WNS Triange’s collaboration with an insurer to create a claims process by leveraging generative AI. Thanks to the new technology, the insurer can immediately assess the severity of a vehicle’s damage from an accident and make a claims recommendation based on the unstructured data provided by the client. “Because this can be immediately assessed by a surveyor and they can reach a recommendation quickly, this instantly improves the insurer’s ability to satisfy their policyholders and reduce the claims processing time,” Ayer explains.

All that, however, would not be possible without data on past claims history, repair costs, transaction data, and other necessary data sets to extract clear value from generative AI analysis. “Be very clear about data sufficiency. Don’t jump into a program where eventually you realize you don’t have the necessary data,” Ayer says.

The benefits of third-party experience

Enterprises are increasingly aware that they must embrace generative AI, but knowing where to begin is another thing. “You start off wanting to make sure you don’t repeat mistakes other people have made,” says Ayer. An external provider can help organizations avoid those mistakes and leverage best practices and frameworks for testing and defining explainability and benchmarks for return on investment (ROI).

Using pre-built solutions by external partners can expedite time to market and increase a generative AI program’s value. These solutions can harness pre-built industry-specific generative AI platforms to accelerate deployment. “Generative AI programs can be extremely complicated,” Ayer points out. “There are a lot of infrastructure requirements, touch points with customers, and internal regulations. Organizations will also have to consider using pre-built solutions to accelerate speed to value. Third-party service providers bring the expertise of having an integrated approach to all these elements.”

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