TIME

BRCA Gene Can Be A Cancer Triple Whammy, Study Finds

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Ingram Publishing—Getty Images/Vetta

BRCA already boosts risks of breast and ovarian cancer, and now there’s evidence that it may contribute to lung tumors too

In research published in Nature Genetics, scientists report that a version of the BRCA2 gene, which, when mutated, can increase the risk of developing breast and ovarian cancers, also raises the risk of lung cancer.

Led by Dr. Christopher Amos, professor of community and family medicine at Geisel School of Medicine at Dartmouth College, the study included genetic data from 75,750 lung cancer patients and controls. Those with a relatively rare version of BRCA2 found in about 2% of the population, had a 26% increased risk of developing breast cancer, but an 85% higher chance of getting any type of lung cancer, and a 2.5-fold increased risk of developing an aggressive, hard-to-treat lung cancer known as squamous cell carcinoma. The lung cancer risk, says Amos, appears to an independent effect of BRCA on lung tissue, apart from its influence on the breast.

MORE: Lessons From the Woman Who Discovered the BRCA Cancer Gene

“We didn’t see an association to lung cancer with other BRCA2 variants, only this particular one,” says Amos. “What we found is a new effect of BRCA2 on lung cancer.”

Current tests for the BRCA 1 or 2 mutations, which account for about 5% of breast cancer cases in the U.S., already include this variant, so most women will know from their results whether they are at higher risk of developing lung cancer, much in the same way that BRCA mutations confer a higher risk of ovarian cancer.

MORE: The Angelina Effect

For now, however, there aren’t any effective treatments for squamous cell lung cancer. Smokers with the variant have twice the risk of getting lung cancer than those with the BRCA2 version who don’t smoke, so kicking the habit is one way to lower risk. But there are promising studies involving a class of drugs called PARP inhibitors, which is currently being studied to treat BRCA-related breast cancers. These drugs work by preventing tumor cells from repairing damage to their DNA, and given the newly discovered connection between BRCA2 and lung cancers, they might also be effective in treating squamous lung tumors. “It raises the question about how we can do a better job of allocating people to screening, and if [this variant] should become part of a panel for screening,” says Amos. Because squamous cell cancers are so hard to treat, such early detection of potential tumors might become a life-saver.

TIME Cancer

Lessons From the Woman Who Discovered the BRCA Cancer Gene

Mary Claire King presents at World Science Festival 2014 in New York City Courtesy of the World Science Festival

The legendary researcher on work-life balance, the importance of trusting hunches, and her stunning scientific discovery

Sometimes the most stunning advances in science are based on a hunch that a dedicated investigator just can’t shake.

That was the case with Mary-Claire King, professor of genome sciences and of medicine at University of Washington. King discovered the region on the genome that eventually became known as BRCA1, the first gene linked to a higher than average chance of developing breast cancer and ovarian cancer. While it seems obvious now that genes can be tied to cancer, at the time King conducted her studies, the idea was too radical to have many supporters.

MORE: Angelina Jolie’s Double Mastectomy: What We Know About BRCA Mutations and Breast Cancer

But King was used to being unusual. As a graduate student at the University of California Berkeley, where she first studied mathematics and then switched to genetics, she petitioned the university protesting the U.S.’s invasion of Cambodia during the Vietnam War. When the National Guard removed demonstrating students, King dropped out and helped consumer rights advocate Ralph Nader to study how pesticides affected farm workers.

She returned to Berkeley and contributed to groundbreaking genetic work that showed humans and chimps shared 99% of the same DNA.

Today, BRCA1 and the related BRCA2 are responsible for about 5% of breast cancer cases in the U.S., or up to 25% of inherited breast cancer, and screening for changes in the genes can help steer women toward potentially lifesaving treatments. The Supreme Court recently ruled that BRCA1 and BRCA2 are not patentable, since they are products of nature, a decision that King supports so that more companies can now devise tests for the cancer-causing mutation.

We spoke with King when she was in New York for the World Science Festival. Here’s what we learned:

On how she discovered BRCA1, and the importance of believing in your gut instincts:

“If we cast our minds back to the 1970s, when my work [on BRCA] began, the mainstream theory was that breast cancer was viral. And some cancers are, so it wasn’t a crazy theory.

My thinking—and, believe me, this was not a theory in the field but just a notion I had—was that there was good evidence that there were some families in which breast cancer was especially common. There was no evidence of a smoking gun. That opened the possibility that there was something else. That went side by side in my mind with the logical way of thinking about cancer, that all cancer is genetic in the sense that it’s a consequence of changes in DNA. That also was not mainstream thinking at the time. But that was the basis of my own thinking, and I’m a stubborn person, so it allowed me to keep pushing my little idea in a very quiet way.”

MORE: 4 Ways The Supreme Court Gene Patent Decision Will Change Medicine

On seeing her little idea become a big one:

“I was absolutely convinced that cancer had to be genetic. I did not see any other way the relationship between a tumor and host could possibly persist. But I honestly didn’t appreciate at all how important and directly useful the inherited component would be. The idea that oncologists and medical geneticists would take that information and systematically be able to put into place screening programs that enable women to learn that they had mutations, and do something about it to save their lives, wasn’t the way I thought. If somebody had said that this was possible, I would have said, ‘Golly, maybe it was.’ But nobody said that to me.”

 

On whether every woman 30-plus should have a BRCA1 and BRCA2 screening:

“I am increasingly convinced that it is both feasible and a good idea to offer a blood test, a sequencing test for BRCA1 and BRCA2 and some of their sister genes for every woman after about age 30. Once a young woman reaches 30 or so, if she has a mutation in one of the genes, she should know about it. … These mutations are inherited from fathers half the time, and from mothers half the time. Because families in America are so small, we did a study that showed that in exactly half of women who had BRCA1 or BRCA2 mutations, there was no family history that would have led them or anyone in their family to think they carried the mutation. All of these women inherited the mutation from their father, and their fathers either didn’t have sisters or had sister who didn’t inherit the mutation.

Sequencing is now cheap, prices are coming down and the quality is going up. So there’s no reason not to do this. The point is to have a process that is benign enough to the individual—a blood draw—and inexpensive enough to identify people who are really at high genetic risk and then move them into very good screening programs to enable them to make a plan about preventive surgery or other options.”

On how being a woman in science has changed, and remained the same:

“I always assumed I would be an assistant to someone else, because there have always been women in those roles. I always assumed I would work for someone else. And I assumed implicitly that ‘someone else’ would be a man. There are obviously many more women in the field now. Acceptance in principle of women in the field is completely different and that’s absolutely fabulous; it’s just splendid.

The thing that hasn’t changed is the number of hours in a day. The coincidence of one’s child-bearing years with exactly the time one needs to build a career—that’s challenging. Science is also a very demanding child—you can’t just walk away from either. That hasn’t changed. It’s not realistic to say one can drop out of science and drop back in.

Really good child care is incredibly important. Creating a context in which young women scientists have child care they can rely on, and can afford, and that’s close enough to where they work, is enormously difficult, and institutions are working on it. One thing I try to do is run a family-friendly lab. I think it’s the responsibility of those of us whose children are now grown to remember what it was like, and to run family-friendly labs. When women in my lab get pregnant, we know they simply will not be there for a while. But you need the infrastructure in place so their experiments won’t rot when they’re not there, and so they can come back when they are ready.”

On being a mother and being a scientist:

“You never get over the guilt. My daughter would come into the lab when she was six or seven, and she had an area in my office with books, picture books and toys. She made posters that went on the door to my office. One was the First Mommy to Walk on Land. Another was the Sister of the First Mommy to Walk on Land. And there was the Brother of the First Mommy to Walk on Land. When I asked her why she was making the posters, she said, ‘They are to keep people happy while they have to wait for you.’

You have to have an environment in which it’s clear that having children is a part of life, and welcomed. You have to recognize that a scientific career can be very long, and you need to go into the business of being there for your child when you have a child. It’s possible. It’s not possible to do and get enough sleep, but it’s possible to do.”

TIME

Being Bilingual Keeps You Sharper As You Get Older

Picking up a second language, even later in life, can have benefits for the brain

People who speak more than one language tend to score higher on memory and other cognitive function tests as they get older, but researchers haven’t been able to credit bilingualism as the definitive reason for their sharper intellects. It wasn’t clear, for example, whether people who spoke multiple languages have higher childhood intelligence, or whether they share some other characteristics, such as higher education overall, that could explain their higher scores.

Now, scientists think they can say with more certainty that speaking a second language may indeed help to improve memory and other intellectual skills later in life. Working with a unique population of 853 people born in 1936 who were tested and followed until 2008-2010, when they were in their 70s, researchers found that those who picked up a second language, whether during childhood or as adults, were more likely to score higher on general intelligence, reading and verbal abilities than those who spoke one language their entire lives. Because the participants, all of whom were born and lived near Edinburgh, Scotland, took aptitude tests when they were 11, the investigators could see that the effect held true even after they accounted for the volunteers’ starting levels of intelligence.

Reporting in the Annals of Neurology, they say that those who began with higher intellect scores did show more benefit from being bilingual, but the improvements were significant for all of the participants. That’s because, the authors suspect, learning a second language activates neurons in the frontal or executive functions of the brain that are generally responsible for skills such as reasoning, planning and organizing information.

Even more encouraging, not all of the bilingual people were necessarily fluent in their second language. All they needed was enough vocabulary and grammar skills in order to communicate on a basic level. So it’s never too late to learn another language – and you’ll be sharper for it later in life.

TIME Infectious Disease

Here’s What’s Lurking In the Pool Water

Heading to the pool? It turns out that people aren’t the only ones who find that cool water inviting when the temperatures soar.

Microbes, including bacteria that live on our skin and in our noses, get dropped into the pool whenever we take a dip. Not all of them make us sick, and chlorine can kill germs, but sometimes it takes days for that to happen. And if your pool smells like chemicals, that’s not a sign that it’s clean. In fact, the stronger the odor, the harder the chlorine is working to eliminate things like urine, sweat, dirt, poop and other things that swimmers trail in.

Here’s a handy (and slightly scary) rundown of the bugs and other things that every swimmer brings into the pool, from the Centers for Disease Control. Their advice? Take a dip and enjoy your swim. But shower before you jump in. And don’t drink the water.

 

14_247050-B_Healthy Swimming final

TIME Weight loss

Good News! You Weigh Less Than You Think

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Dkal Inc.—Getty Images

Call it the clothing effect, or the clothing discount – we all do it. We make allowances for the fact our clothes are probably pretty heavy

As swim suit season gets underway, more of us are probably stepping on the scale and squinting at the number that flashes back at us. Then, we do some quick mental math and adjust for the fact that we’re wearing jeans, maybe a robe, and oh, yes, that heavy sweater. So, minus 5lbs?

It turns out that scientists have actually done a real study, published in the International Journal of Obesity, to figure out how many pounds we should be subtracting for what we wear. Led by a team at University of North Dakota (because it gets really cold there, and they’re probably pretty bundled up when they step on a scale), not only did they set up an experiment to weigh people, both clothed and nearly nude, at various times of the year, they also wanted to answer the critical question of whether weighing yourself in the winter gives you more leeway to do this kind of math than in the summer, when we tend to wear less.

It turns out that, as with so many things, men and women are different when it comes to how much our clothes weigh. Men, it seems, prefer to swathe themselves in heavier garments while women tend to adorn themselves more lightly. Men can lop off nearly 2.5 lbs to account for their clothing while women can only subtract around 2. And this holds true, unfortunately, no matter what the weather outside.

So no more making allowances for that thick wool sweater. Now you know exactly how much your clothes weigh.

TIME Cancer

Some Chemotherapy Is More Toxic Than Others

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Getty Images

Chemotherapy is a necessary evil for most breast cancer patients, but some are worse than others when it comes to side effects

Researchers at the University of Texas MD Anderson Cancer Center compared six breast cancer chemotherapy regimens to determine which caused more toxic side effects by requiring the patients to be hospitalized for infections, fever, dehydration or low blood counts.

In order, from the regimen that caused the most hospitalizations among 12,894 patients who were treated for early stage breast cancer, to the one that caused the fewest, the chemotherapies were:

  • Docetaxel and cyclophosphamide cycled every three weeks (TC)
  • Doxorubicin and cyclophosphamide cycled every three weeks (AC)
  • Docetaxel, doxorubicin and cyclophosphamide cycled every three weeks (TAC)
  • Doxorubicin and cyclophosphamide cycled every three weeks, followed or preceded by docetaxel cycled every three weeks (AC+T)
  • Doxorubicin and cyclophosphamide cycled every two weeks, followed or preceded by paclitaxel cycled every two weeks (ddAC+P)
  • Doxorubicin and cyclophosphamide cycled every three weeks followed or preceded by weekly paclitaxel (AC+wP)

The treatments are interchangeable, says the study’s lead author, Dr. Carlos Barcenas, from the department of Breast Medical Oncology at MD Anderson, so knowing which ones are associated with more toxicity may help some patients and doctors to choose more tolerable therapies. Other factors may also play a role; the TC regimen, for example, is linked to the most hospitalizations but that’s because it involves more intensive doses of chemotherapy in half the time – 12 weeks – of all of the other options, which are spread out over 24 weeks. For women who prefer to have their chemotherapy finished sooner, the higher risk of side effects may be worth the time savings.

Women with heart disease also have to use the TC regimen, since the others include a drug that is toxic to the heart.

The results, published in the Journal of Clinical Oncology, should help patients to be more informed about their chemotherapy options, says Barcenas, and prompt more research into ways that the right treatments can be matched to the right patients.

TIME

You’re Older Than You Think You Are

Thanks to your environment, you may actually be older than you think you are

As much as we try to fight it, we’re aging faster than we’d like, and we can blame our own bad habits for some of that. Researchers at the University of North Carolina (UNC) have developed a way to test for our molecular, or physiologic age, which, it turns out, may have little to do with the number that appears on our driver’s licenses.

This age reflects the various assaults on our bodies that come from things such as smoking, tanning, and stress, as well as exposure to ultraviolet light (every time we step outdoors). Led by senior author Dr. Norman Sharpless, director of the Lineberger Comprehensive Cancer Center at UNC, the scientists developed a litmus test for how quickly a group of immune cells known as T cells aged. As cells near the end of their natural life, they start dividing more slowly and accumulate more DNA damage, and that triggers a certain gene to become more active. Using that gene’s activity as a signal of such cellular senescence, Sharpless and his team started to test how different factors affected this gene.

So far, they report in the journal Trends in Molecular Medicine, cigarette smoke and ultraviolent light drove both mouse and human cells to age faster. No surprise there. Chemotherapy drugs use to treat breast cancer also stressed the cells to wear out sooner.

More surprising, however, was that a high fat diet, which Sharpless assumed would also contribute to aging, didn’t make the mice get much older. “Why we got that unexpected answer is unclear—it may be that the mice are different enough from humans, or it may be that the dose [of the high fat diet] wasn’t sufficient,” he says.

The things he and his team tested have involved agents or behaviors that damage DNA. But Sharpless knows that’s not the only thing that turns young cells old. He’s also aware that cellular senescence isn’t the only marker of a person’s physiologic age. But it does provide a good way to put all of our favorite anti-aging remedies to the test—like green tea, exercise and that glass of red wine with dinner. He also hopes that it can be used to predict which cancer patients may experience faster aging from chemotherapy and guide them toward less damaging drugs.

You won’t be able to do that on your own, since harvesting T cells isn’t something that’s available in a DIY kit, but Sharpless has founded a company that is creating a more user-friendly (and commercial) way to track how quickly we are barreling toward our golden years.

TIME Heart Disease

Who Really Needs To Take a Statin?

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Rosemary Calvert—Getty Images

Changes in the way doctors can prescribe the cholesterol-lowering drugs means millions of healthy people should now be taking the pills. But that may not be such a good idea

Since the first statin hit pharmacy shelves in 1987, the cholesterol-pills have quickly become a best-selling class of medications. So why is there such a pitched battle over making the potentially life-saving drugs available to more people?

There’s no question that statins can help prevent recurrent heart problems in people who already have heart disease, by lowering the risk of heart attack and stroke by up to 40%. That’s not in dispute, and heart experts routinely prescribe the drugs for anyone who has had a heart attack, angina or bypass surgery.

MORE: Statins Have Few Side Effects, But Should More People Be Taking Them?

With the medications’ success in this group, however, doctors are wondering whether more people—healthy people who are at high risk of heart disease—should be taking advantage of the drugs. So in 2013, the American Heart Association and the American College of Cardiology took the unprecedented move of expanding the population who should consider a statin. Their recommendation extended the prescriptions to people with no history of a heart attack or other heart problems, but who had troubling signs that they might in the future – being older, carrying around extra pounds, smoking, having high blood pressure, high cholesterol or diabetes. Under those criteria, millions more people were now eligible for a statin.

But as with all drugs, statins have side effects. And more heart experts are voicing concern that the benefits of statins in preventing the first signs of heart problems don’t outweigh the risks, which include everything from muscle weakness to possible memory issues and even an increased risk of diabetes. Even so, not all doctors agree on how to interpret the studies, as a recent controversy over an analysis that questioned the use of statins in this way and was published in the BMJ showed.

Here is that data, along with the latest studies from leading experts, about the side effects in question—which you should weigh if you haven’t had a heart event but are considering (or are already on) a statin:

1. Statins do not prevent early death or a first heart event.

In a review of statin data published in BMJ, lead author John Abramson of Harvard Medical School says that people who take statins to prevent a first heart event don’t lower their risk of dying from any cause, or from heart disease over 10 years.

Not only do statins not lower the risk of dying early, but they also don’t lower the chances of being hospitalized for a heart problem or other serious heart-related illness. The medication can lower—very slightly—the risk of having a heart attack or stroke. But that benefit is offset by the drugs’ side effects. “For people with a less than 20% risk of having a heart event in 10 years, which is the vast majority for whom the statins would be prescribed under the new guidelines, we are not seeing a net benefit,” Abramson says. The paper, however, included a misinterpretation of data from another study and estimated that 18% to 20% of statin users experienced side effects; the editors of the journal have since retracted that statement. While the overall conclusions of the review aren’t in question, the journal has asked an independent panel to take another look at the results.

What it means for now: There are better, more proven ways of lowering your risk of having a first heart attack or stroke. A healthy diet and exercise aren’t as easy to pick up as a prescription, but they are more effective

MORE: Should I Take a Statin? What You Need to Know About the New Cholesterol Guidelines

2. The Rx drugs may cause muscle weakness.

Statins are known to cause a range of muscle issues, from mild weakness to a rare but serious condition called rhabdomyolysis, in which muscle tissue disintegrates and releases the byproducts into the blood, where they can cause kidney damage. Most of the milder muscle complaints are reversible, and either go away or are reduced with lower doses or by switching to different statins. But, says Dr. Rita Redberg, a cardiologist at University of California San Francisco, “we don’t really know everything about these adverse events.” Some of her patients with muscle weaknesses continue to complain about their symptoms six months after stopping their statin, for example. And many studies that focus just on recording levels of an enzyme linked to muscle breakdown may miss the early signs of muscle problems, since many patients complain of not being able to finish their workouts or complete daily tasks well before their enzymes show signs of deterioration.

What it means for now: There’s still a lot that’s not known about how statins affect the muscles. For now, the risk of muscle problems, even mild ones, aren’t worth the small benefit for the heart.

3. Statins may increase diabetes risk in some people.

In a trial involving more than 17,000 people who were randomly assigned to take a statin or a placebo to prevent a first heart event, people without any risk factors for diabetes who took statins did not see an increased risk of developing diabetes compared to those taking placebo, but those at higher risk of diabetes did show a 28% higher risk of developing diabetes on the drug. The Women’s Health Initiative trial, which included more than 153,000 post-menopausal women, also found that the medications increased the risk of diabetes by 48%. Those results and other evidence were strong enough for the Food and Drug Administration (FDA) to add a warning on statin labels about increased blood sugar and diabetes risk linked to the cholesterol-lowering medications.

What it means for now: Because diabetes can increase heart disease risk, any increase in diabetes associated with statins likely negates the small benefit the drugs may provide in preventing first heart attacks

MORE: FDA Warns Statin Users of Memory Loss and Diabetes Risks

4. The drugs have been linked to cognitive problems.

This is an area that researchers are still investigating, but there are growing reports from statin users that the medications put them in a fog and contribute to memory loss. The FDA has a warning on statin drugs about potential memory loss, but a recent study involving patients followed from one year to 25 years on the drugs found that over the long term, statin-users showed lower levels of dementia. That may have to do with the fact that statins lower the burden of artery-clogging plaques, not just in the heart but in the brain as well.

What it means for now: Stay tuned; more studies are needed to fully understand how statins affect the brain, especially over decades of use.

Taken together, the data suggests that it’s risky to put healthy people on statins. So why did the leading heart experts recommend that these people take them? For one, says Abramson, studies that these groups looked at detailing the side effects of the drugs may be underestimating them; he notes that most doctors don’t ask patients about specific side effects, but rely on patients to report them, and many people don’t, simply because they don’t think a few aches and pains, for example, are related to their heart medication.

MORE: Experimental Cholesterol-Lowering Drug Shows Promise

Second, says Redberg, some of the data on drugs that agencies like the FDA rely on may be skewed to underestimate side effects. Companies often have “run-in’ periods in which they give a candidate group of volunteers their drug for a few weeks and eliminate those with serious side effects. “Of course the event rate [of side effects] is going to be lower because they didn’t allow anyone who complained of adverse effects to stay in the trial,” she says.

That’s not to suggest that lowering cholesterol isn’t an important part of reducing risk of heart disease. It is. It’s just that compared to other strategies that healthy people can take advantage of, popping a pill doesn’t provide that much benefit. “There are much more effective ways—diet, exercise, and not smoking— that can prevent heart disease and help you live longer that are much more worthwhile to focus on,” says Redberg.

TIME Heart Disease

Women Diabetics Have More Heart Problems Than Men

Female diabetics are at higher risk of developing heart disease than males with the disease, and here’s why

Scientists led by Dr. Sanne Peters at the University of Cambridge report that when it comes to how type 2 diabetes affects men and women, the sexes are not created equal. Peters’ colleagues conducted an extensive survey of data going back 50 years, to 1966, that involved more than 858,000 people. While the risk of heart disease among diabetics is well known, the comprehensive study confirms smaller studies that hinted at a difference in risk between the genders.

Even after accounting for the fact that women tend to develop heart disease at different rates than men, the researchers report in Diabetologia that women with diabetes were 44% more likely to develop heart problems than men with the disease. Historically, women aren’t treated for heart risk factors as well as men, partly because their symptoms are different – many women don’t experience the chest pains and shortness of breath that are a hallmark of a heart attack among men, for example. So women may actually have more advanced, untreated heart disease when they are diagnosed with diabetes than men when they are diagnosed.

That suggests that screening for prediabetes in women may help to lower rates of heart disease, and ensuring that their diabetes symptoms are treated may also close the gap between heart disease rates in men and women.

TIME Food & Drink

This Social Media Site Knows What Restaurants Will Make You Sick

New York health officials found cases of food poisoning on Yelp that weren’t reported to the health department

Restaurateurs, beware: People who eat at your joints are brutally honest on Yelp, reporting on bad service, undercooked food, and yes, even diarrhea and vomiting after dining.

So the New York City Department of Health and Mental Hygiene decided to take advantage of those reviews and see if they could find outbreaks of foodborne illness, which are a sign that restaurants aren’t up to sanitation codes. From 294,000 restaurant reviews between 20012 and 2013, 893 were pulled out for containing red flag words like “sick,” “vomit,” “diarrhea” or “food poisoning.” Of these, more than half fit the conditions of a potential foodborne illness, including the fact that more than one patron reported symptoms, the symptoms occurred within 10 hours of the meal, the affected didn’t share any other meals before becoming sick, and so forth.

MORE: Which Will Make You Sicker: Four Star V. Fast Food

Further investigation via phones calls and visits to the restaurants revealed three foodborne illness outbreaks affecting 16 people that were not reported to the health department. (In the study period, only 3% of the potential outbreaks identified by the analysis were actually reported.) In their report, published in the MMWR from the Centers for Disease Control (CDC), investigators found violations in food handling at the three establishments that included workers not washing their hands before handling food, not storing food in the refrigerator, and the presence of mice and roaches.

As tempting as it may be for health departments to start scouring Yelp or other online reviews for health code violations, the investigators say the process isn’t ideal since not all reviewers can be contacted, and having the reports reviewed and coded for further investigation by outbreak specialists is very labor intensive. Still, it shows that online restaurant reviews can be a treasure trove of potentially helpful information, and possibly identify restaurants that may consistently have problems with hygiene. Not to mention those that have terrible service.

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