NEWS | IN DEPTH
1162 5 DECEMBER 2014 • VOL 346 ISSUE 6214
sciencemag.org SCIENCE
Houston, Texas, estimates that the study
will need to include about 700 children, at a
cost of $5 million to $10 million—which the
Smart Tots leadership hopes will come from
government sources in the United States
and abroad.
Planning the trial and navigating ethical concerns “has been daunting, to say
the least,” says IARS Executive Director
Thomas Cooper, who manages the SmartTots initiative. Despite the scientific appeal of a randomized study, investigators
are obligated to not place children into a
treatment group that may increase the risk
of harm, he says, or give care that deviates
from what is already accepted as safe and
effective.
Because dexmedetomidine hasn’t been
widely used or studied in children, SmartTots collaborators are preparing a preliminary study in 50 kids to check that it’s
suitable for long surgeries; warning signs
would include slowed heartbeat, low blood
pressure, or a child who stirs too much
while “under,” Andropoulos says. He also
anticipates a nonhuman primate study to
scrutinize the drug’s effects on the brain.
Warner, also an adviser on the project,
notes that because the preliminary study
would be on a tightly controlled population—children getting urological procedures is one favored option—any findings
might not apply to kids getting anesthesia
under other circumstances. “You would, in
theory, need to do a different trial in every
group of kids, which nobody’s going to do.”
With even this limited evidence years
away, SmartTots is crafting a short “
consensus statement,” planned for December
release, to convey current knowledge about
risks of childhood anesthesia. A draft, unlike its 2012 predecessor, explicitly suggests
delaying or postponing surgical procedures
that require full anesthesia if possible.
That suggestion sparked lively discussion among the FDA science board. “
Post-ponement is really bad medicine,” argued
pediatric orthopedic surgeon Laura Tosi
of Children’s National Health System in
Washington, D.C. With surgeries for congenital defects, she said, any delay can lead
to worse outcomes.
Several advisers supported the idea of a
new FDA warning on the anesthetics that
have been called into question. But others,
including Tosi, vehemently opposed adding
the most severe “black box” warning, which
signifies a risk of serious adverse effects.
Some parents wary of cognitive damage
are already resisting necessary procedures
for their children, Tosi noted. “We have to
be very careful about how we present that
data,” she said. “I think the fear of anesthesia in the public is already out there.” ■
By Andrew Lawler, in San Diego, California
More than 4000 years ago, the Bronze Age metropolis of Mari on the banks of the Euphrates River bustled with trade and boasted a half-dozen temples and a royal pal- ace. But for millennia since then, its
eroding walls and buried artifacts remained
undisturbed until French archaeologists be-
gan excavating in the 1930s.
Today, this Syrian site just 10 kilometers from the Iraqi border is once again a
busy place. A satellite image of Mari taken
on 11 November shows alarming signs of
massive, orchestrated looting, according
to Scott Branting, an archaeologist at the
Boston-based American Schools of Oriental Research (ASOR). Trucks and backhoes
traverse the site, systematically uncovering
artifacts while destroying the ancient structures. Looters have even built what may be
a large storage depot for sorting and storing
the valuable goods before they are exported
for sale abroad.
Such destruction is widespread across
Syria and northern Iraq, Branting and
other researchers lamented at ASOR’s annual meeting here. Part of the ancient
Fertile Crescent, the region holds archaeological riches spanning thousands of years.
Since 2011, however, it has also been a battleground, fought over by the Syrian government and opposition groups, the radical
Islamists of the Islamic State group, and
their various opponents including Iraqi,
Kurdish, and U.S. forces.
In an initiative funded by the U.S. State
Department, ASOR is monitoring and as-
sessing the damage. Recent satellite photos,
as well as reports from observers on the
ground, indicate that the artifacts and sites
face multiple perils: Islamists who destroy
ancient sites for religious reasons, system-
atic looters like those threatening Mari, and
the collateral damage of war. “It is all seem-
ingly never-ending and disheartening,” says
Michael Danti, a Boston University archae-
ologist who helps lead the ASOR project.
Shut out of a region plagued with competing armies, humanitarian crises, and hostile
ideologies, archaeologists have largely been
distant and anguished bystanders to the
wave of ruin. But by tracking the damage,
the ASOR researchers hope they can help
raise a global outcry and lay the foundation for salvage and reconstruction when
the wars end. “Even if what we are doing is
largely ineffectual, it is better than sitting on
our hands,” Branting said at a special 23 November session on the crisis.
The Islamic State group has emerged as
a particular threat, making concerted efforts to destroy the sacred sites of groups it
views as heretical. The group has publicized
its intentional destruction of dozens of sacred sites online or in its glossy magazine,
Dabiq. “A soldier of the Islamic state clarifies
to the people the obligation to demolish the
tombs,” states one caption in a recent issue
that includes images of exploding shrines.
“It is all very choreographed,” Danti says.
He adds that the biggest spike in destruction took place in May, with nearly 20 sites
demolished, followed by a half-dozen or so
incidents each month thereafter. Almost
half of the destroyed sites are associated
with Shia Muslims, while the remainder are
places sacred to Sufis, a mystical branch of
Islam, as well as Christians and Yazidis, an
ancient ethnic group centered in northern
Iraq. More than 15% are statues and buildings predating Islam; images on the Internet, for example, show a yellow front loader
toppling and pulverizing two massive black
stone lions dating to the 9th century B.C.E.
in the Islamic State provisional capital of
Raqqa in northern Syria.
But researchers say that even more damage to archaeologically important sites stems
from military action by all parties in the conflict, including the Syrian government and
perhaps Iraqi and U.S. forces. “There is a lot
of damage from military garrisoning,” says
Jesse Casana, an archaeologist at the University of Arkansas, Fayetteville, who is part of
the ASOR team and has been closely examining dozens of Syrian sites. Tells, remnants of
ancient settlements that dot the Syrian and
Iraqi landscape, offer high ground for mili-
Satellites track heritage loss
across Syria and Iraq
Vandalism, looting, and collateral damage erase history
ARCHAEOLOGY
“It is all seemingly never-
ending and disheartening.”
Michael Danti, Boston University
