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"disqusTitle": "Birth Control Apps Find a Big Market in 'Contraception Deserts'",
"title": "Birth Control Apps Find a Big Market in 'Contraception Deserts'",
"headTitle": "Women’s Health | Future of You | KQED Future of You | KQED Science",
"content": "\u003cp>[audio mp3=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/03/20180326_me_birth_control_apps_find_a_big_market_in_contraception_deserts_.mp3\" autoplay=\"true\" preload=\"auto\"][/audio]\u003c/p>\n\u003cp>Rachel Ralph works long hours at an accounting firm in Oakland, Calif., and coordinates much of her life via the apps on her phone.\u003c/p>\n\u003cp>So when she first heard several months ago that she could order her usual brand of birth control pills \u003ca href=\"https://www.kqed.org/futureofyou/425267/mobile-app-designed-to-prevent-pregnancy-gets-eu-approval\" target=\"_blank\" rel=\"noopener\">via an app\u003c/a>, and have them delivered to her doorstep in a day or two, it seemed perfect. She was working 12-hour days.[contextly_sidebar id=\"BZOrcpBR3skDDUzwXqFtMkYivLh8tU2K\"]\u003c/p>\n\u003cp>\"Food was delivered, dinner was often delivered,\" Ralph says. \"Anything I could get sent to my house with little effort — the better.\"\u003c/p>\n\u003cp>Ralph ordered a three-month supply of pills via the app of a San Francisco-based company called \u003ca href=\"https://www.nurx.com/\" target=\"_blank\" rel=\"noopener\">NURX\u003c/a>. It's one of several digital ventures, including \u003ca href=\"https://www.mavenclinic.com/\" target=\"_blank\" rel=\"noopener\">Maven\u003c/a> and \u003ca href=\"https://www.lemonaidhealth.com/\" target=\"_blank\" rel=\"noopener\">Lemonaid Health\u003c/a>, that now provide several types of hormonal contraception without requiring a live visit to a doctor or other health care provider.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Women using these services in cities say they like the speed and no-hassle privacy they get by making a purchase through the app. And in some rural areas where women's health clinics are few and far between, being able \u003ca href=\"https://www.newsdeeply.com/water/articles/2018/03/26/report-how-los-angeles-could-source-its-water-locally%20https://www.apnews.com/870b745abdfe41dfa3bb79b49d60f117/Self-taught-rocket-scientist-blasts-off-into-California-sky%20https://www.apnews.com/870b745abdfe41dfa3bb79b49d60f117/Self-taught-rocket-scientist-blasts-off-into-California-sky%20https://www.npr.org/sections/goatsandsoda/2018/03/23/596435463/how-fast-can-an-outbreak-be-detected%20https://khn.org/news/trump-immigration-policies-put-immigrant-caregivers-and-elderly-patients-at-risk/\" target=\"_blank\" rel=\"noopener\">to buy prescription\u003c/a> contraceptives online — starting at around $15 for a month's supply — can be not only much more private, but much more affordable and less time-consuming than driving an hour or more to the closest clinic, or paying for a doctor's appointment.[contextly_sidebar id=\"8UyELd0sdLCUnKJd2rRKJEDknWqS1wDA\"]\u003c/p>\n\u003cp>NURX is now available in 18 states. It's popular in Texas, where many women live in what some health policy analysts call \"\u003ca href=\"https://www.washingtonpost.com/news/monkey-cage/wp/2016/09/26/contraception-deserts-are-what-you-get-when-you-cut-off-this-little-known-federal-program/?utm_term=.2c000aedfece\" target=\"_blank\" rel=\"noopener\">contraception deserts\u003c/a>\" — places that lack easy access to women's health services.\u003c/p>\n\u003cp>The company's process is pretty simple. After users log in to the NURX app, they fill out a questionnaire.\u003c/p>\n\u003cp>\"They tell us about their medical history,\" says Jessica Horowitz, a nurse practitioner with NURX who consults with patients via online chats. \"They give us a blood-pressure check.\"\u003c/p>\n\u003cp>A clinician like Horowitz then reviews the answers and, based on that, makes a suggestion about what type of hormonal contraception might be best for that individual — a pill, a ring or a patch are available, as well as emergency contraception\u003cstrong>.\u003c/strong> If the patient has a question about the product they're considering, they can send an instant message or call to chat with a provider.\u003c/p>\n\u003cp>\"It doesn't matter what time of day it is,\" Horowitz says. \"Someone responds.\"\u003c/p>\n\u003cp>Then NURX sends a prescription to a pharmacy and the drugs are mailed out via priority mail, or faster for emergency contraception. The cost of a month's supply of prescription birth control is often free to the patient, if they have health insurance, Horowitz says, and otherwise starts at $15 out-of-pocket for a month's supply, depending on the brand.[contextly_sidebar id=\"GekufaWZutErmbxmWrMVqC5SIpjD8lih\"]\u003c/p>\n\u003cp>For Claire Hammons, who lives and works in Llano, Texas, about 90 minutes outside of Austin, the low cost of the pills was as important as the convenience.\u003c/p>\n\u003cp>Hammons loves many aspects of life in her small town. \"There is a population of 3,000 people,\" she says. \"But we have a lot going on. We are a huge art town. We have the Llano River. We are surrounded by state parks.\"\u003c/p>\n\u003cp>Still, living there has its drawbacks, she says. There's only one doctor in town and there are no clinics nearby. This means getting health care isn't easy. And for Hammons, the main medicine she needs are birth control pills.\u003c/p>\n\u003cp>\"I've been taking birth control since I was 16 because of endometriosis,\" she explains.\u003c/p>\n\u003cp>If she can't get the pills, Hammons is in a lot of pain every month. A while back, she had a particularly hard time getting a prescription, because she lost her health insurance, and her out-of-pocket cost for a doctor's visit in Llano would have been $140.\u003c/p>\n\u003cp>\"I really did not have — literally — have the money to go to the doctor. Period,\" she says.\u003c/p>\n\u003cp>Hammons says she also couldn't afford to pay out of pocket to pick up the pills every month at a pharmacy.\u003c/p>\n\u003cp>Then, about six months ago, she went online and found NURX. The cost-savings, she says, was \"really amazing and ... saved me a lot.\"[contextly_sidebar id=\"93eYfIv1ZOkr9FnHiToO84fR8I08e0No\"]\u003c/p>\n\u003cp>Texas has become a big market for the app. Dr. Brook Randal, an emergency medicine physician in Austin who works as a provider for NURX, says her patients come from different backgrounds and use the app for different reasons.\u003c/p>\n\u003cp>\"A lot of them are low-income women who may not have a low-cost clinic available to them in the communities where they live,\" she says. \"And so we provide an important service for those women.\"\u003c/p>\n\u003cp>In 2013, the state \u003ca href=\"https://www.kqed.org/futureofyou/440262/landmark-report-concludes-abortion-in-u-s-is-safe\" target=\"_blank\" rel=\"noopener\">passed an abortion\u003c/a> bill that led half of all Texas clinics that performed abortions to close – clinics that often also provided birth control and other medical services to low-income women.\u003c/p>\n\u003cp>\"Many of those women will tell us that they would have had to drive a really long distance in order to get to a clinic where they can get birth control economically,\" Randal says.\u003c/p>\n\u003cp>And their access to birth control got even worse when Texas lawmakers cut funding for the state's family planning program, says \u003ca href=\"https://forabettertexas.org/meetourstaff.html\" target=\"_blank\" rel=\"noopener\">Stacey Pogue\u003c/a>, a health policy analyst with the \u003ca href=\"https://forabettertexas.org/whatwedoandwhy.html\" target=\"_blank\" rel=\"noopener\">Center for Public Policy Priorities\u003c/a> in Austin. The cuts came at a time when the state's population was growing and more women were seeking services, Pogue notes.\u003c/p>\n\u003cp>\"The ability of our safety net system to meet those needs and deliver health care — to actually get health care to women who are looking for contraceptives and well-woman exams — that has certainly been diminished,\" she says.\u003c/p>\n\u003cp>Apps like NURX that give women access to at least some types of contraceptives are definitely helpful, she says. But they aren't a comprehensive solution.\u003c/p>\n\u003cp>Some of the most effective types of birth control — IUDs and implants — aren't available through the apps, Pogue notes, because they require a visit to a health provider. And apps will never substitute for the missing medical clinics — places where, beyond contraception, women could also get life-saving services, such as pap smears, breast exams and cervical cancer screenings.\u003c/p>\n\u003cp>Texas is one of two states (Indiana is the other) where minors can't buy prescription birth control through NURX because of laws restricting minors' access to contraception.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003ca href=\"https://www.kqed.org/author/lesleymcclurg\" target=\"_blank\" rel=\"noopener\">\u003cem>Lesley McClurg\u003c/em>\u003c/a>\u003cem> covers mental health and consumer health stories for \u003c/em>\u003ca href=\"https://www.kqed.org/\" target=\"_blank\" rel=\"noopener\">KQED\u003c/a>\u003cem> in San Francisco, Calif. \u003c/em>\u003ca href=\"http://kut.org/people/ashley-lopez\" target=\"_blank\" rel=\"noopener\">\u003cem>Ashley Lopez\u003c/em>\u003c/a>\u003cem> reports on health care and politics for \u003ca href=\"http://kut.org/people/ashley-lopez\" target=\"_blank\" rel=\"noopener\">KUT\u003c/a>\u003c/em>\u003cem>, in Austin, Texas.\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Birth+Control+Apps+Find+A+Big+Market+In+%27Contraception+Deserts%27+&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"excerpt": "Women all over the country are trapped in places with no access to birth control. Now they can get it over the counter with an app. ",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Rachel Ralph works long hours at an accounting firm in Oakland, Calif., and coordinates much of her life via the apps on her phone.\u003c/p>\n\u003cp>So when she first heard several months ago that she could order her usual brand of birth control pills \u003ca href=\"https://www.kqed.org/futureofyou/425267/mobile-app-designed-to-prevent-pregnancy-gets-eu-approval\" target=\"_blank\" rel=\"noopener\">via an app\u003c/a>, and have them delivered to her doorstep in a day or two, it seemed perfect. She was working 12-hour days.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\"Food was delivered, dinner was often delivered,\" Ralph says. \"Anything I could get sent to my house with little effort — the better.\"\u003c/p>\n\u003cp>Ralph ordered a three-month supply of pills via the app of a San Francisco-based company called \u003ca href=\"https://www.nurx.com/\" target=\"_blank\" rel=\"noopener\">NURX\u003c/a>. It's one of several digital ventures, including \u003ca href=\"https://www.mavenclinic.com/\" target=\"_blank\" rel=\"noopener\">Maven\u003c/a> and \u003ca href=\"https://www.lemonaidhealth.com/\" target=\"_blank\" rel=\"noopener\">Lemonaid Health\u003c/a>, that now provide several types of hormonal contraception without requiring a live visit to a doctor or other health care provider.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Women using these services in cities say they like the speed and no-hassle privacy they get by making a purchase through the app. And in some rural areas where women's health clinics are few and far between, being able \u003ca href=\"https://www.newsdeeply.com/water/articles/2018/03/26/report-how-los-angeles-could-source-its-water-locally%20https://www.apnews.com/870b745abdfe41dfa3bb79b49d60f117/Self-taught-rocket-scientist-blasts-off-into-California-sky%20https://www.apnews.com/870b745abdfe41dfa3bb79b49d60f117/Self-taught-rocket-scientist-blasts-off-into-California-sky%20https://www.npr.org/sections/goatsandsoda/2018/03/23/596435463/how-fast-can-an-outbreak-be-detected%20https://khn.org/news/trump-immigration-policies-put-immigrant-caregivers-and-elderly-patients-at-risk/\" target=\"_blank\" rel=\"noopener\">to buy prescription\u003c/a> contraceptives online — starting at around $15 for a month's supply — can be not only much more private, but much more affordable and less time-consuming than driving an hour or more to the closest clinic, or paying for a doctor's appointment.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>NURX is now available in 18 states. It's popular in Texas, where many women live in what some health policy analysts call \"\u003ca href=\"https://www.washingtonpost.com/news/monkey-cage/wp/2016/09/26/contraception-deserts-are-what-you-get-when-you-cut-off-this-little-known-federal-program/?utm_term=.2c000aedfece\" target=\"_blank\" rel=\"noopener\">contraception deserts\u003c/a>\" — places that lack easy access to women's health services.\u003c/p>\n\u003cp>The company's process is pretty simple. After users log in to the NURX app, they fill out a questionnaire.\u003c/p>\n\u003cp>\"They tell us about their medical history,\" says Jessica Horowitz, a nurse practitioner with NURX who consults with patients via online chats. \"They give us a blood-pressure check.\"\u003c/p>\n\u003cp>A clinician like Horowitz then reviews the answers and, based on that, makes a suggestion about what type of hormonal contraception might be best for that individual — a pill, a ring or a patch are available, as well as emergency contraception\u003cstrong>.\u003c/strong> If the patient has a question about the product they're considering, they can send an instant message or call to chat with a provider.\u003c/p>\n\u003cp>\"It doesn't matter what time of day it is,\" Horowitz says. \"Someone responds.\"\u003c/p>\n\u003cp>Then NURX sends a prescription to a pharmacy and the drugs are mailed out via priority mail, or faster for emergency contraception. The cost of a month's supply of prescription birth control is often free to the patient, if they have health insurance, Horowitz says, and otherwise starts at $15 out-of-pocket for a month's supply, depending on the brand.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>For Claire Hammons, who lives and works in Llano, Texas, about 90 minutes outside of Austin, the low cost of the pills was as important as the convenience.\u003c/p>\n\u003cp>Hammons loves many aspects of life in her small town. \"There is a population of 3,000 people,\" she says. \"But we have a lot going on. We are a huge art town. We have the Llano River. We are surrounded by state parks.\"\u003c/p>\n\u003cp>Still, living there has its drawbacks, she says. There's only one doctor in town and there are no clinics nearby. This means getting health care isn't easy. And for Hammons, the main medicine she needs are birth control pills.\u003c/p>\n\u003cp>\"I've been taking birth control since I was 16 because of endometriosis,\" she explains.\u003c/p>\n\u003cp>If she can't get the pills, Hammons is in a lot of pain every month. A while back, she had a particularly hard time getting a prescription, because she lost her health insurance, and her out-of-pocket cost for a doctor's visit in Llano would have been $140.\u003c/p>\n\u003cp>\"I really did not have — literally — have the money to go to the doctor. Period,\" she says.\u003c/p>\n\u003cp>Hammons says she also couldn't afford to pay out of pocket to pick up the pills every month at a pharmacy.\u003c/p>\n\u003cp>Then, about six months ago, she went online and found NURX. The cost-savings, she says, was \"really amazing and ... saved me a lot.\"\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Texas has become a big market for the app. Dr. Brook Randal, an emergency medicine physician in Austin who works as a provider for NURX, says her patients come from different backgrounds and use the app for different reasons.\u003c/p>\n\u003cp>\"A lot of them are low-income women who may not have a low-cost clinic available to them in the communities where they live,\" she says. \"And so we provide an important service for those women.\"\u003c/p>\n\u003cp>In 2013, the state \u003ca href=\"https://www.kqed.org/futureofyou/440262/landmark-report-concludes-abortion-in-u-s-is-safe\" target=\"_blank\" rel=\"noopener\">passed an abortion\u003c/a> bill that led half of all Texas clinics that performed abortions to close – clinics that often also provided birth control and other medical services to low-income women.\u003c/p>\n\u003cp>\"Many of those women will tell us that they would have had to drive a really long distance in order to get to a clinic where they can get birth control economically,\" Randal says.\u003c/p>\n\u003cp>And their access to birth control got even worse when Texas lawmakers cut funding for the state's family planning program, says \u003ca href=\"https://forabettertexas.org/meetourstaff.html\" target=\"_blank\" rel=\"noopener\">Stacey Pogue\u003c/a>, a health policy analyst with the \u003ca href=\"https://forabettertexas.org/whatwedoandwhy.html\" target=\"_blank\" rel=\"noopener\">Center for Public Policy Priorities\u003c/a> in Austin. The cuts came at a time when the state's population was growing and more women were seeking services, Pogue notes.\u003c/p>\n\u003cp>\"The ability of our safety net system to meet those needs and deliver health care — to actually get health care to women who are looking for contraceptives and well-woman exams — that has certainly been diminished,\" she says.\u003c/p>\n\u003cp>Apps like NURX that give women access to at least some types of contraceptives are definitely helpful, she says. But they aren't a comprehensive solution.\u003c/p>\n\u003cp>Some of the most effective types of birth control — IUDs and implants — aren't available through the apps, Pogue notes, because they require a visit to a health provider. And apps will never substitute for the missing medical clinics — places where, beyond contraception, women could also get life-saving services, such as pap smears, breast exams and cervical cancer screenings.\u003c/p>\n\u003cp>Texas is one of two states (Indiana is the other) where minors can't buy prescription birth control through NURX because of laws restricting minors' access to contraception.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"https://www.kqed.org/author/lesleymcclurg\" target=\"_blank\" rel=\"noopener\">\u003cem>Lesley McClurg\u003c/em>\u003c/a>\u003cem> covers mental health and consumer health stories for \u003c/em>\u003ca href=\"https://www.kqed.org/\" target=\"_blank\" rel=\"noopener\">KQED\u003c/a>\u003cem> in San Francisco, Calif. \u003c/em>\u003ca href=\"http://kut.org/people/ashley-lopez\" target=\"_blank\" rel=\"noopener\">\u003cem>Ashley Lopez\u003c/em>\u003c/a>\u003cem> reports on health care and politics for \u003ca href=\"http://kut.org/people/ashley-lopez\" target=\"_blank\" rel=\"noopener\">KUT\u003c/a>\u003c/em>\u003cem>, in Austin, Texas.\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Birth+Control+Apps+Find+A+Big+Market+In+%27Contraception+Deserts%27+&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Doctors and Drugmakers May Be Looking at Your Social Media",
"title": "Doctors and Drugmakers May Be Looking at Your Social Media",
"headTitle": "KQED Future of You | KQED Science",
"content": "\u003cp>When Allison Ruddick was diagnosed with stage 3 colorectal cancer in October 2014, she turned to the world of hashtags.\u003c/p>\n\u003cp>After her initial diagnosis it wasn't clear if the cancer had metastasized, so she was in for a nerve-wracking wait, she says. She wanted outside advice. \"But they don't really give you a handbook, so you search kind of anywhere for answers,\" Ruddick says. \"Social media was one of the first places I went.\"\u003c/p>\n\u003cp>Under the hashtags #colorectalcancer and #nevertooyoung on Facebook, Twitter and Instagram, other patients were sharing a fuller picture of their experience with cancer treatments.[contextly_sidebar id=\"cdQjHydnnhf1qm80VAQ5VOhZ1zDgEbZ8\"]\u003c/p>\n\u003cp>Later she found even more advice on specialized message boards. Patients posted everything from the details of their surgeries to the ice packs they liked best as they recovered. \"These weren't things that my doctor could tell me, and as much as I appreciate their expertise, it's also really limited by the fact that they've never really experienced any of this themselves,\" Ruddick says.\u003c/p>\n\u003cp>Partly because of that experience gap, doctors and drug companies are keen to learn from online communities, too. They're analyzing social networks to get a faster, wider look into how patients react to drugs, sometimes picking up information about side effects that clinical trials missed.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cstrong>The Rule of Three\u003c/strong>\u003c/p>\n\u003cp>Stanford University dermatologist \u003ca href=\"https://profiles.stanford.edu/bernice-kwong\">Bernice Kwong\u003c/a> specializes in skin conditions that tag along with cancer treatments. In her practice and on patient message boards, she's constantly on the lookout for symptoms that could be drug reactions.\u003c/p>\n\u003cp>In January 2017, a patient came to Kwong's office with an unusual complaint\u003cstrong>. \u003c/strong>\"I've noticed that when I work out, I just get really hot,\" he told Kwong. \"I don't sweat anymore, and I used to sweat so much.\" He was taking a drug called Tarceva, or erlotinib, that's used against lung cancer.[contextly_sidebar id=\"YV4ALpzrjOrylquldVmESZ1WsJYER2Bg\"]\u003c/p>\n\u003cp>At first, Kwong thought the problem might be hormonal. But soon after, two more of her patients at Stanford on the same drug reported that they'd also stopped sweating. \"Anytime something hits three, I think, OK, I gotta look into this a little bit more,\" she says.\u003c/p>\n\u003cp>But she hadn't seen any reports before of a lack of sweating — hypohidrosis — as a side effect for Tarceva. Her sample size of three patients was small. She'd need more data to figure things out.\u003c/p>\n\u003cp>From talking with patients and perusing online forums, Kwong knew people discussed their treatments and side effects online. In fact, hundreds of thousands of people participate in support groups and communities she'd looked at on the website \u003ca href=\"https://www.inspire.com/\">Inspire\u003c/a>. She partnered with the site with the idea that its trove of patient reports could connect more dots between hypohidrosis and Tarceva.\u003c/p>\n\u003cp>\u003cstrong>A Sharper Data Set\u003c/strong>\u003c/p>\n\u003cp>Inspire's focused groups are filled with patients' experiences with diseases and treatment, so analyzing posts requires less filtering than Facebook or Twitter data would, says \u003ca href=\"https://profiles.stanford.edu/nigam-shah\">Nigam Shah\u003c/a>, a Stanford University bioinformatics specialist who collaborated with Kwong. It also helped that the skin reactions they were interested in are relatively easy for patients to describe.\u003c/p>\n\u003cp>Still, the posts on Inspire's boards are less precise than insurance claims and health records typically used for studies on side effects.\u003c/p>\n\u003cp>Take loss of sweating. Most doctors would refer to that as hypohidrosis, so a records-based study could focus on that phrase. In online message boards there's a lot of variety. One person's \"I can't sweat anymore\" might be another's \"I'm overheating.\"[contextly_sidebar id=\"b60xAgKbNdenisEddidkCVcmMXTjd0Aj\"]\u003c/p>\n\u003cp>Kwong, Shah and their colleagues used a deep learning algorithm to process the phrases surrounding reports of symptoms, basically finding contextual clues to identify the different ways patients referred to side effects.\u003c/p>\n\u003cp>In 8 million posts on Inspire from a 10-year period, 4,909 users mentioned Tarceva, or erlotinib generically. Although clinical reports don't link the drug and hypohidrosis, 23 patients wrote about the medicine and loss of sweating in the same post — a statistically significant connection, Kwong says. The research group's findings \u003ca href=\"https://jamanetwork.com/journals/jamaoncology/article-abstract/2673831?redirect=true\" target=\"_blank\" rel=\"noopener\">were published\u003c/a> in \u003cem>JAMA Oncology\u003c/em> in March.\u003c/p>\n\u003cp>Using the same approach to monitor posts about a different class of immunotherapy cancer drugs, the researchers found mentions of autoimmune blistering that also predated the clinical reports of the side effect.\u003c/p>\n\u003cp>Given the stakes of cancer treatment, Kwong says she's inclined to help patients manage side effects instead of stopping a given drug. But earlier alerts from systems like this could have made a difference in her practice. \"If we had had this program already, I would've been looking out for [blistering] sooner and maybe I would've noticed it earlier in some patients,\" Kwong says.\u003c/p>\n\u003cp>\u003cstrong>How Clinical Trials Miss Side Effects\u003c/strong>\u003c/p>\n\u003cp>From numbers alone, it's no surprise that clinical trials for drugs don't pick up every side effect. The Food and Drug Administration first \u003ca href=\"https://www.accessdata.fda.gov/drugsatfda_docs/nda/2004/21-743_Tarceva_StatR.PDF\">approved\u003c/a> Tarceva in 2004 on the basis of a trial that enrolled 731 patients, 488 of whom received the drug. Uncommon effects might not show up in a group that size.\u003c/p>\n\u003cp>On Inspire's message boards, more than 10 times as many patients reported using Tarceva, so it's reasonable to imagine that online posts could include reports of rarer side effects.\u003c/p>\n\u003cp>And while drug trials do collect data on side effects, their overriding goal is to find out whether or not a drug works, says \u003ca href=\"http://bioethics.hms.harvard.edu/person/faculty-members/aaron-kesselheim\">Dr. Aaron Kesselheim\u003c/a>, a professor of medicine at Harvard University. \"After a drug is approved, it is absolutely essential to continue to observe, follow and study the drug rigorously as it's used in a larger population to try to really get a handle on the safety of the drug,\" he says.[contextly_sidebar id=\"JGYGYdpwADzgX2U5wdZePXnIkUOkoc8q\"]\u003c/p>\n\u003cp>Collecting data about a drug from insurance claims and health records typically happens with quite a time lag. So mining the Internet and social media for casual patient reports is tempting, Kesselheim says, because of its potential scale and speed. But the approach also has drawbacks. \"You just get this tidal wave of data, and it's hard to know how to assess it in a rigorous and thoughtful fashion,\" he says.\u003c/p>\n\u003cp>That hasn't stopped drug companies from wading in. Roche has \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/29446035\">sampled\u003c/a> mentions of their products from Twitter, Tumblr, Facebook and blogs to learn more about drug safety. GlaxoSmithKline has tried it too, \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/26798054\">analyzing\u003c/a> millions of mentions of drugs from Twitter and Facebook.\u003c/p>\n\u003cp>Much of the work published so far has focused on drug reactions. But scraping public social media data isn't just a matter of product safety. The company \u003ca href=\"https://www.synthesio.com/social-listening-pharma-healthcare/\">Synthesio\u003c/a> touts its social data services for drugmakers as a way to answer customer questions, conduct market research and influence purchasing.\u003c/p>\n\u003cp>\u003cstrong>Surfing Responsibly\u003c/strong>\u003c/p>\n\u003cp>In terms of extending studies to mine even bigger networks, like Twitter or Facebook, for potential side effects, Kesselheim points to issues of representation and privacy. As with any analysis, a deep learning model like the one Shah used on the Inspire message boards can only make conclusions about the information it \u003cem>sees\u003c/em>.\u003c/p>\n\u003cp>And it's hard to guarantee that message boards and social media represent all patients. In 2012, researchers gave 231 breast cancer patients in rural Michigan and Wisconsin computers, Internet access and training to use an online cancer support group. The researchers \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3556823/\">found\u003c/a> that white women were much more likely to log on and post in the group than black women. Younger women were also more likely to post information.\u003c/p>\n\u003cp>While the long-standing approach to post-approval drug studies — using health records and claims data — may be slower, Kesselheim says, they're more established. \"There are methodologies and tools that you can use in claims data to try to make sure that you are making conclusions that can be generalizable across different races and ethnicity and genders and parts of America,\" he says.\u003c/p>\n\u003cp>There's also the issue of privacy — patients' health records are protected by the Health Insurance Portability and Accountability Act of 1996, whereas public data online aren't, Kesselheim says.\u003c/p>\n\u003cp>For Stanford researcher Shah, this wasn't an issue. Inspire's privacy statement tells patients their posts may be used for research if they're not private, and Shah feels comfortable following common sense rules when using public data. \"As in, if somebody did [something] with my data and I would be upset, don't do that with someone else's data,\" he says.\u003c/p>\n\u003cp>But the newness of social media makes Kesselheim wary. \"There are big questions that remain about how patient privacy is upheld in those social media contexts, and I think that's a really big issue to think about moving forward as people are trying to use those outlets to provide insight into drug safety and side effects.\"\u003c/p>\n\u003cp>As a patient, Ruddick isn't bothered by the idea of researchers and pharmaceutical companies studying data from social media and patient message boards, as long as the data are public or there's mention of data sharing in a privacy statement.\u003c/p>\n\u003cp>She works as a communications director in New York City, so she's thought a lot about the nature of information online. \"If I'm putting something out there on the Internet, it's for the Internet. I know the world is going to see it,\" Ruddick says.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>She knows other patients might feel differently, but she's optimistic that analyzing patients' interactions online could improve the treatments available. \"It's one thing, being in a lab and developing these drugs,\" she says. \"But it's a completely different thing to see how they're being used out there in the world, and to see how they're affecting somebody's life.\"\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=How+Social+Media+Can+Reveal+Overlooked+Drug+Reactions&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>When Allison Ruddick was diagnosed with stage 3 colorectal cancer in October 2014, she turned to the world of hashtags.\u003c/p>\n\u003cp>After her initial diagnosis it wasn't clear if the cancer had metastasized, so she was in for a nerve-wracking wait, she says. She wanted outside advice. \"But they don't really give you a handbook, so you search kind of anywhere for answers,\" Ruddick says. \"Social media was one of the first places I went.\"\u003c/p>\n\u003cp>Under the hashtags #colorectalcancer and #nevertooyoung on Facebook, Twitter and Instagram, other patients were sharing a fuller picture of their experience with cancer treatments.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Later she found even more advice on specialized message boards. Patients posted everything from the details of their surgeries to the ice packs they liked best as they recovered. \"These weren't things that my doctor could tell me, and as much as I appreciate their expertise, it's also really limited by the fact that they've never really experienced any of this themselves,\" Ruddick says.\u003c/p>\n\u003cp>Partly because of that experience gap, doctors and drug companies are keen to learn from online communities, too. They're analyzing social networks to get a faster, wider look into how patients react to drugs, sometimes picking up information about side effects that clinical trials missed.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cstrong>The Rule of Three\u003c/strong>\u003c/p>\n\u003cp>Stanford University dermatologist \u003ca href=\"https://profiles.stanford.edu/bernice-kwong\">Bernice Kwong\u003c/a> specializes in skin conditions that tag along with cancer treatments. In her practice and on patient message boards, she's constantly on the lookout for symptoms that could be drug reactions.\u003c/p>\n\u003cp>In January 2017, a patient came to Kwong's office with an unusual complaint\u003cstrong>. \u003c/strong>\"I've noticed that when I work out, I just get really hot,\" he told Kwong. \"I don't sweat anymore, and I used to sweat so much.\" He was taking a drug called Tarceva, or erlotinib, that's used against lung cancer.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>At first, Kwong thought the problem might be hormonal. But soon after, two more of her patients at Stanford on the same drug reported that they'd also stopped sweating. \"Anytime something hits three, I think, OK, I gotta look into this a little bit more,\" she says.\u003c/p>\n\u003cp>But she hadn't seen any reports before of a lack of sweating — hypohidrosis — as a side effect for Tarceva. Her sample size of three patients was small. She'd need more data to figure things out.\u003c/p>\n\u003cp>From talking with patients and perusing online forums, Kwong knew people discussed their treatments and side effects online. In fact, hundreds of thousands of people participate in support groups and communities she'd looked at on the website \u003ca href=\"https://www.inspire.com/\">Inspire\u003c/a>. She partnered with the site with the idea that its trove of patient reports could connect more dots between hypohidrosis and Tarceva.\u003c/p>\n\u003cp>\u003cstrong>A Sharper Data Set\u003c/strong>\u003c/p>\n\u003cp>Inspire's focused groups are filled with patients' experiences with diseases and treatment, so analyzing posts requires less filtering than Facebook or Twitter data would, says \u003ca href=\"https://profiles.stanford.edu/nigam-shah\">Nigam Shah\u003c/a>, a Stanford University bioinformatics specialist who collaborated with Kwong. It also helped that the skin reactions they were interested in are relatively easy for patients to describe.\u003c/p>\n\u003cp>Still, the posts on Inspire's boards are less precise than insurance claims and health records typically used for studies on side effects.\u003c/p>\n\u003cp>Take loss of sweating. Most doctors would refer to that as hypohidrosis, so a records-based study could focus on that phrase. In online message boards there's a lot of variety. One person's \"I can't sweat anymore\" might be another's \"I'm overheating.\"\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Kwong, Shah and their colleagues used a deep learning algorithm to process the phrases surrounding reports of symptoms, basically finding contextual clues to identify the different ways patients referred to side effects.\u003c/p>\n\u003cp>In 8 million posts on Inspire from a 10-year period, 4,909 users mentioned Tarceva, or erlotinib generically. Although clinical reports don't link the drug and hypohidrosis, 23 patients wrote about the medicine and loss of sweating in the same post — a statistically significant connection, Kwong says. The research group's findings \u003ca href=\"https://jamanetwork.com/journals/jamaoncology/article-abstract/2673831?redirect=true\" target=\"_blank\" rel=\"noopener\">were published\u003c/a> in \u003cem>JAMA Oncology\u003c/em> in March.\u003c/p>\n\u003cp>Using the same approach to monitor posts about a different class of immunotherapy cancer drugs, the researchers found mentions of autoimmune blistering that also predated the clinical reports of the side effect.\u003c/p>\n\u003cp>Given the stakes of cancer treatment, Kwong says she's inclined to help patients manage side effects instead of stopping a given drug. But earlier alerts from systems like this could have made a difference in her practice. \"If we had had this program already, I would've been looking out for [blistering] sooner and maybe I would've noticed it earlier in some patients,\" Kwong says.\u003c/p>\n\u003cp>\u003cstrong>How Clinical Trials Miss Side Effects\u003c/strong>\u003c/p>\n\u003cp>From numbers alone, it's no surprise that clinical trials for drugs don't pick up every side effect. The Food and Drug Administration first \u003ca href=\"https://www.accessdata.fda.gov/drugsatfda_docs/nda/2004/21-743_Tarceva_StatR.PDF\">approved\u003c/a> Tarceva in 2004 on the basis of a trial that enrolled 731 patients, 488 of whom received the drug. Uncommon effects might not show up in a group that size.\u003c/p>\n\u003cp>On Inspire's message boards, more than 10 times as many patients reported using Tarceva, so it's reasonable to imagine that online posts could include reports of rarer side effects.\u003c/p>\n\u003cp>And while drug trials do collect data on side effects, their overriding goal is to find out whether or not a drug works, says \u003ca href=\"http://bioethics.hms.harvard.edu/person/faculty-members/aaron-kesselheim\">Dr. Aaron Kesselheim\u003c/a>, a professor of medicine at Harvard University. \"After a drug is approved, it is absolutely essential to continue to observe, follow and study the drug rigorously as it's used in a larger population to try to really get a handle on the safety of the drug,\" he says.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Collecting data about a drug from insurance claims and health records typically happens with quite a time lag. So mining the Internet and social media for casual patient reports is tempting, Kesselheim says, because of its potential scale and speed. But the approach also has drawbacks. \"You just get this tidal wave of data, and it's hard to know how to assess it in a rigorous and thoughtful fashion,\" he says.\u003c/p>\n\u003cp>That hasn't stopped drug companies from wading in. Roche has \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/29446035\">sampled\u003c/a> mentions of their products from Twitter, Tumblr, Facebook and blogs to learn more about drug safety. GlaxoSmithKline has tried it too, \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/26798054\">analyzing\u003c/a> millions of mentions of drugs from Twitter and Facebook.\u003c/p>\n\u003cp>Much of the work published so far has focused on drug reactions. But scraping public social media data isn't just a matter of product safety. The company \u003ca href=\"https://www.synthesio.com/social-listening-pharma-healthcare/\">Synthesio\u003c/a> touts its social data services for drugmakers as a way to answer customer questions, conduct market research and influence purchasing.\u003c/p>\n\u003cp>\u003cstrong>Surfing Responsibly\u003c/strong>\u003c/p>\n\u003cp>In terms of extending studies to mine even bigger networks, like Twitter or Facebook, for potential side effects, Kesselheim points to issues of representation and privacy. As with any analysis, a deep learning model like the one Shah used on the Inspire message boards can only make conclusions about the information it \u003cem>sees\u003c/em>.\u003c/p>\n\u003cp>And it's hard to guarantee that message boards and social media represent all patients. In 2012, researchers gave 231 breast cancer patients in rural Michigan and Wisconsin computers, Internet access and training to use an online cancer support group. The researchers \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3556823/\">found\u003c/a> that white women were much more likely to log on and post in the group than black women. Younger women were also more likely to post information.\u003c/p>\n\u003cp>While the long-standing approach to post-approval drug studies — using health records and claims data — may be slower, Kesselheim says, they're more established. \"There are methodologies and tools that you can use in claims data to try to make sure that you are making conclusions that can be generalizable across different races and ethnicity and genders and parts of America,\" he says.\u003c/p>\n\u003cp>There's also the issue of privacy — patients' health records are protected by the Health Insurance Portability and Accountability Act of 1996, whereas public data online aren't, Kesselheim says.\u003c/p>\n\u003cp>For Stanford researcher Shah, this wasn't an issue. Inspire's privacy statement tells patients their posts may be used for research if they're not private, and Shah feels comfortable following common sense rules when using public data. \"As in, if somebody did [something] with my data and I would be upset, don't do that with someone else's data,\" he says.\u003c/p>\n\u003cp>But the newness of social media makes Kesselheim wary. \"There are big questions that remain about how patient privacy is upheld in those social media contexts, and I think that's a really big issue to think about moving forward as people are trying to use those outlets to provide insight into drug safety and side effects.\"\u003c/p>\n\u003cp>As a patient, Ruddick isn't bothered by the idea of researchers and pharmaceutical companies studying data from social media and patient message boards, as long as the data are public or there's mention of data sharing in a privacy statement.\u003c/p>\n\u003cp>She works as a communications director in New York City, so she's thought a lot about the nature of information online. \"If I'm putting something out there on the Internet, it's for the Internet. I know the world is going to see it,\" Ruddick says.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>She knows other patients might feel differently, but she's optimistic that analyzing patients' interactions online could improve the treatments available. \"It's one thing, being in a lab and developing these drugs,\" she says. \"But it's a completely different thing to see how they're being used out there in the world, and to see how they're affecting somebody's life.\"\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=How+Social+Media+Can+Reveal+Overlooked+Drug+Reactions&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>A mobile app was able to detect irregular heart rhythms with 97 percent accuracy, a finding by UC San Francisco researchers that could lead to life-saving \u003ca href=\"https://www.kqed.org/futureofyou/266349/how-reliable-are-smartphones-and-wearables-for-monitoring-your-heart\" target=\"_blank\" rel=\"noopener\">preventative screenings.\u003c/a>\u003c/p>\n\u003cp>One in four adults over the age of 40 is at risk for a heart condition known as \u003ca href=\"https://www.mayoclinic.org/diseases-conditions/atrial-fibrillation/symptoms-causes/syc-20350624\" target=\"_blank\" rel=\"noopener\">atrial fibrillation\u003c/a> (AF). It's one of the leading causes of stroke and often goes undetected until it's too late.\u003c/p>\n\u003cp>The study, which relied on an app specifically designed for the Apple Watch, is reportedly the first to use a smartwatch to detect abnormal heart rhythms.\u003c/p>\n\u003cp>“By identifying candidates for appropriate anti-coagulation treatment, we might ultimately leverage common wearable devices to reduce ... complications, even death,\" said Gregory Marcus, director of clinical research in the UCSF Division of Cardiology and lead author of the study.\u003c/p>\n\u003cp>AF occurs when electrical impulses in the the upper chambers of the heart become erratic, causing the atrium's walls to quiver as blood passes through, potentially triggering blood clots.[contextly_sidebar id=\"sQ9MJSaMtUHbSJHSKfj37aKsbqwOOxmZ\"]\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Researchers say the findings, published in \u003ca href=\"https://jamanetwork.com/journals/jamacardiology/article-abstract/2675364?redirect=true\" target=\"_blank\" rel=\"noopener\">JAMA Cardiology\u003c/a>, could lead to the development of more effective screenings. And with nearly 6 million people in the U.S. estimated to develop AF by 2050, the app could prevent large numbers of strokes and death.\u003c/p>\n\u003cp>With a 97 percent accuracy rate, the app performed better than a competing \u003ca href=\"http://www.abstractsonline.com/pp8/#!/4496/presentation/41378\" target=\"_blank\" rel=\"noopener\">FDA-approved product sold as Kardia Band.\u003c/a>\u003c/p>\n\u003cp>The UCSF-tested app, designed by Cardiogram, relies on deep neural networks, a type of sophisticated machine-learning algorithm that provides a continuous stream of data. More than 139 million measurements of heart rates and step counts were collected from 9,750 participants. [contextly_sidebar id=\"C27bFTVwLpXMdavOJy6PlXm3e5jXCR7Q\"]\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Researchers cited certain limitations to their study, including a number of participants who failed to link their Cardiogram accounts. In addition, researchers focused on those with known AF and did not look into the app's ability to identify undiagnosed conditions.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>A mobile app was able to detect irregular heart rhythms with 97 percent accuracy, a finding by UC San Francisco researchers that could lead to life-saving \u003ca href=\"https://www.kqed.org/futureofyou/266349/how-reliable-are-smartphones-and-wearables-for-monitoring-your-heart\" target=\"_blank\" rel=\"noopener\">preventative screenings.\u003c/a>\u003c/p>\n\u003cp>One in four adults over the age of 40 is at risk for a heart condition known as \u003ca href=\"https://www.mayoclinic.org/diseases-conditions/atrial-fibrillation/symptoms-causes/syc-20350624\" target=\"_blank\" rel=\"noopener\">atrial fibrillation\u003c/a> (AF). It's one of the leading causes of stroke and often goes undetected until it's too late.\u003c/p>\n\u003cp>The study, which relied on an app specifically designed for the Apple Watch, is reportedly the first to use a smartwatch to detect abnormal heart rhythms.\u003c/p>\n\u003cp>“By identifying candidates for appropriate anti-coagulation treatment, we might ultimately leverage common wearable devices to reduce ... complications, even death,\" said Gregory Marcus, director of clinical research in the UCSF Division of Cardiology and lead author of the study.\u003c/p>\n\u003cp>AF occurs when electrical impulses in the the upper chambers of the heart become erratic, causing the atrium's walls to quiver as blood passes through, potentially triggering blood clots.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Researchers say the findings, published in \u003ca href=\"https://jamanetwork.com/journals/jamacardiology/article-abstract/2675364?redirect=true\" target=\"_blank\" rel=\"noopener\">JAMA Cardiology\u003c/a>, could lead to the development of more effective screenings. And with nearly 6 million people in the U.S. estimated to develop AF by 2050, the app could prevent large numbers of strokes and death.\u003c/p>\n\u003cp>With a 97 percent accuracy rate, the app performed better than a competing \u003ca href=\"http://www.abstractsonline.com/pp8/#!/4496/presentation/41378\" target=\"_blank\" rel=\"noopener\">FDA-approved product sold as Kardia Band.\u003c/a>\u003c/p>\n\u003cp>The UCSF-tested app, designed by Cardiogram, relies on deep neural networks, a type of sophisticated machine-learning algorithm that provides a continuous stream of data. More than 139 million measurements of heart rates and step counts were collected from 9,750 participants. \u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Researchers cited certain limitations to their study, including a number of participants who failed to link their Cardiogram accounts. In addition, researchers focused on those with known AF and did not look into the app's ability to identify undiagnosed conditions.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "A Dietary Supplement Makes Old Mice Youthful. Will It Work in People?",
"title": "A Dietary Supplement Makes Old Mice Youthful. Will It Work in People?",
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"content": "\u003cp>Transfusing \u003ca href=\"https://www.statnews.com/2018/03/02/young-blood-anti-aging-study/\" target=\"_blank\" rel=\"noopener\">young blood\u003c/a> and freezing heads may get most of the anti-aging and life-extension buzz, but don’t count out the molecule hunters: After setbacks and stumbles and what critics called \u003ca href=\"http://blogs.sciencemag.org/pipeline/archives/2010/01/12/the_sirtris_compounds_worthless_really\" target=\"_blank\" rel=\"noopener\">debacles\u003c/a>, these scientists are figuring out which biochemicals might potentially, possibly be fountains of youth in pill form.[contextly_sidebar id=\"YaFBEqHshnjDvp4XR5pAEiDxJjAI7Fx4\"]\u003c/p>\n\u003cp>In the latest advance, biologists \u003ca href=\"http://www.cell.com/cell/fulltext/S0092-8674(18)30152-1\" target=\"_blank\" rel=\"noopener\">reported\u003c/a> on Thursday that a molecule already sold by supplement makers (even as scientists scramble to understand it) restored youthfulness to blood vessels in 20-month-old mice, an age comparable to 70 years in people. The research supports the idea that boosting certain genes and molecules that fade with age could keep people functional, resilient, and even spry well into their 80s, even without living longer.\u003c/p>\n\u003cp>“I think it’s quite an important paper,” said Dr. Eric Verdin, of the California-based Buck Institute for Research on Aging, who was not involved in the\u003ca href=\"https://www.kqed.org/futureofyou/439750/superagers-maintain-memory-into-80s-and-90s\" target=\"_blank\" rel=\"noopener\"> new research\u003c/a>. “It’s probably not the magic pill everyone is looking for, but it’s one more brick in our efforts to understand aging and healthspan,” or how long people can stay biologically young(ish) even as their birthday candles proliferate.[contextly_sidebar id=\"Vl0Meh1Zh9UAHnk3RIGR5S5B5rBQ0sSW\"]\u003c/p>\n\u003cp>Others were more skeptical, calling the advance at best “incremental” (and asking to remain anonymous so as not to antagonize colleagues). And science is littered with examples of compounds that worked in mice but not people. “It’s hard to tell how significant any contribution is until it has been replicated and extended” by other labs, said David Harrison of the Jackson Lab, an expert on the molecular \u003ca href=\"https://www.kqed.org/futureofyou/440080/hearts-get-younger-even-at-middle-age-with-exercise\" target=\"_blank\" rel=\"noopener\">mechanisms of aging.\u003c/a>\u003c/p>\n\u003caside>\u003c/aside>\n\u003cp>The new study, in Cell, found that boosting mice’s levels of the naturally occurring molecule NMN, which humans also have, increased levels of another called NAD+. That, in turn, raised levels of a famous anti-aging enzyme called SIRT1, which has been the focus of nearly 30 years of research.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>After two months of NMN, more blood vessels sprouted in the old mice’s muscles. The density of the smallest vessels — capillaries — became comparable to that of young mice. Blood flow increased, and the animals’ endurance, measured by how long they could run on a treadmill before becoming exhausted, was 56 percent to 80 percent greater than that of untreated old mice: 1,400 feet compared to 780 feet.[contextly_sidebar id=\"8Tmsn0Ufo1g8AeUi0b3OJ5Td2G7sq49c\"]\u003c/p>\n\u003cp>The treated mice also benefitted from exercise like mice half their age. In young animals, exercise spurs the creation of new blood vessels and boosts muscle mass, but that effect weakens with age in both people and mice. NMN restored the blood-vessel- and muscle-boosting effects of a good treadmill run, basically “reversing vascular aging in the mice,” said study co-leader David Sinclair of Harvard Medical School.\u003c/p>\n\u003cp>\u003cimg class=\"aligncenter wp-image-440373 size-medium\" title=\"iStock\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/03/iStock-639071970-800x588.jpg\" alt=\"\" width=\"800\" height=\"588\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-639071970-800x588.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-639071970-160x118.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-639071970-768x564.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-639071970-1020x749.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-639071970-1920x1411.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-639071970-1180x867.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-639071970-960x705.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-639071970-240x176.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-639071970-375x275.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-639071970-520x382.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003c/p>\n\u003cp>Opinions differed on how important that is. One expert on the biology of aging said, “So David’s found another molecule that prevents aging?” (Sinclair was a prominent exponent of resveratrol, a compound that slowed aging in mice but proved disappointing in people.) The Jax’s Harrison questioned whether the inbred mice used in the study were representative of humans, who are genetically diverse.\u003c/p>\n\u003cp>New blood vessels could also be a mixed blessing. They support the growth of tumors, which is why anti-angiogenesis molecules have become cancer drugs. The scientists found no excess cancers in the mice given NMR, but “more study is warranted,” they wrote.[contextly_sidebar id=\"EmvIbKqj3sGiXrLYKODcw1UEPJNlCkZr\"]\u003c/p>\n\u003cp>The blood-vessel benefits of NMN didn’t happen if the mice lacked the SIRT1 gene, probably the brightest star in the anti-aging firmament. In the 1990s, it and the six other genes belonging to the family called sirtuins took aging research by storm, as biologists showed that increasing the genes’ activity extended lifespan in yeast, roundworms, and fruit flies by up to 30 percent. When Massachusetts Institute of Technology’s Leonard Guarente, whose lab was sirtuin central, found that the lifespan-extending effect of drastic caloric restriction works by turning up sirtuin genes, it seemed to point the way to slowing aging: Activate sirtuins with a molecule.\u003c/p>\n\u003cp>That proved easier said than done. Some studies, especially in higher animals, contradicted the simple notion that overexpression of sirtuins translated into longer life. The biggest setback involved resveratrol, a compound found in grapes and wine, which activates the SIRT1 gene. After years of hyperbolic headlines and soaring sales, the resveratrol bubble burst. GlaxoSmithKline bought Cambridge, Mass.-based Sirtris Pharmaceuticals, which Sinclair co-founded in 2004 to develop sirtuin-boosting compounds, for $720 million, but within five years essentially shut it down.[contextly_sidebar id=\"FSd7BTxFEMjJhm2kkUJ0cTaJQITZc3CT\"]\u003c/p>\n\u003cp>“Resveratrol is very, very good [at activating SIRT1 and extending lifespan] if you’re a mouse,” said Guarente, who cheerfully acknowledges buying a 10-year supply of micronized resveratrol. Most of it is still in his basement. “But the human trials were all over the place, which was unsettling,” he said.\u003c/p>\n\u003cp>Those failures led scientists to search for other sirtuin-boosting molecules. In 2014, Guarente co-founded Elysium Health, which, for $40 to $60 per month, sells a dietary supplement that boosts NAD+ levels and activates SIRT1. Since levels of NAD+ fall as people age, the hope is that providing the raw material for it will raise those levels, slowing aging. The pills seem to be safe, Guarente and colleagues \u003ca href=\"https://www.nature.com/articles/s41514-017-0016-9\" target=\"_blank\" rel=\"noopener\">reported\u003c/a> last year, and additional human studies are underway to test whether they benefit health.\u003c/p>\n\u003cp>Thanks to \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3188402/\" target=\"_blank\" rel=\"noopener\">negative studies\u003c/a>, the jury is still out on whether anything related to sirtuins will extend lifespan, but the Cell study offers some hope for extending healthspan. If boosting NAD+ promotes blood vessel formation via SIRT1, it might “rescue muscle mass” that otherwise decreases as blood vessels atrophy, Guarente said. That could prevent the bone loss, frailty, and falls that can be fatal in old age.\u003c/p>\n\u003cp>“Anything that contributes to muscle health through vascular health is likely to be quite important,” said the Buck Institute’s Verdin, who takes a daily NAD+ precursor.\u003c/p>\n\u003caside>\u003c/aside>\n\u003cp>Sinclair and his team are now studying whether raising NAD+ might also spur the creation of blood vessels in the brain. There and in other organs, said Sinclair, “the lack of oxygen and buildup of waste products” that results from loss of small blood vessels “sets off a downward spiral of disease and disability.” In the brain, that would include vascular dementia.\u003c/p>\n\u003cp>Sinclair takes NMN to boost NAD+ levels. “In someone my age [49], it’s probably harder to see immediate benefits,” he said, though he said he feels sharper and younger on it. After his 78-year-old father began taking NMN “he started climbing mountains and going whitewater rafting and looking forward to the next five years,” Sinclair said. “It might be psychological, but it isn’t hurting.”\u003c/p>\n\u003cp>Only rigorous human research can determine that. Metro International Biotech, a Michigan-based startup for which Sinclair consults, just finished a clinical trial of the safety of a proprietary version of NMN and hopes to start a trial of the molecule’s efficacy this year, Sinclair said.\u003c/p>\n\u003cp>One concern is that boosting sirtuins could backfire. An excess of the molecules, Verdin said, can promote autoimmunity, which causes diseases such as Crohn’s and rheumatoid arthritis.\u003c/p>\n\u003cp>“That should give us pause about broad claims of what they can do,” he cautioned. “I worry sometimes that [with NAD+-boosting pills already on the market] the field is getting ahead of itself.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This story was originally published by\u003ca href=\"https://www.statnews.com/\" target=\"_blank\" rel=\"noopener\"> STAT\u003c/a>, an online publication of Boston Globe Media that covers health, medicine, and scientific discovery.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Transfusing \u003ca href=\"https://www.statnews.com/2018/03/02/young-blood-anti-aging-study/\" target=\"_blank\" rel=\"noopener\">young blood\u003c/a> and freezing heads may get most of the anti-aging and life-extension buzz, but don’t count out the molecule hunters: After setbacks and stumbles and what critics called \u003ca href=\"http://blogs.sciencemag.org/pipeline/archives/2010/01/12/the_sirtris_compounds_worthless_really\" target=\"_blank\" rel=\"noopener\">debacles\u003c/a>, these scientists are figuring out which biochemicals might potentially, possibly be fountains of youth in pill form.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>In the latest advance, biologists \u003ca href=\"http://www.cell.com/cell/fulltext/S0092-8674(18)30152-1\" target=\"_blank\" rel=\"noopener\">reported\u003c/a> on Thursday that a molecule already sold by supplement makers (even as scientists scramble to understand it) restored youthfulness to blood vessels in 20-month-old mice, an age comparable to 70 years in people. The research supports the idea that boosting certain genes and molecules that fade with age could keep people functional, resilient, and even spry well into their 80s, even without living longer.\u003c/p>\n\u003cp>“I think it’s quite an important paper,” said Dr. Eric Verdin, of the California-based Buck Institute for Research on Aging, who was not involved in the\u003ca href=\"https://www.kqed.org/futureofyou/439750/superagers-maintain-memory-into-80s-and-90s\" target=\"_blank\" rel=\"noopener\"> new research\u003c/a>. “It’s probably not the magic pill everyone is looking for, but it’s one more brick in our efforts to understand aging and healthspan,” or how long people can stay biologically young(ish) even as their birthday candles proliferate.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Others were more skeptical, calling the advance at best “incremental” (and asking to remain anonymous so as not to antagonize colleagues). And science is littered with examples of compounds that worked in mice but not people. “It’s hard to tell how significant any contribution is until it has been replicated and extended” by other labs, said David Harrison of the Jackson Lab, an expert on the molecular \u003ca href=\"https://www.kqed.org/futureofyou/440080/hearts-get-younger-even-at-middle-age-with-exercise\" target=\"_blank\" rel=\"noopener\">mechanisms of aging.\u003c/a>\u003c/p>\n\u003caside>\u003c/aside>\n\u003cp>The new study, in Cell, found that boosting mice’s levels of the naturally occurring molecule NMN, which humans also have, increased levels of another called NAD+. That, in turn, raised levels of a famous anti-aging enzyme called SIRT1, which has been the focus of nearly 30 years of research.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>After two months of NMN, more blood vessels sprouted in the old mice’s muscles. The density of the smallest vessels — capillaries — became comparable to that of young mice. Blood flow increased, and the animals’ endurance, measured by how long they could run on a treadmill before becoming exhausted, was 56 percent to 80 percent greater than that of untreated old mice: 1,400 feet compared to 780 feet.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>The treated mice also benefitted from exercise like mice half their age. In young animals, exercise spurs the creation of new blood vessels and boosts muscle mass, but that effect weakens with age in both people and mice. NMN restored the blood-vessel- and muscle-boosting effects of a good treadmill run, basically “reversing vascular aging in the mice,” said study co-leader David Sinclair of Harvard Medical School.\u003c/p>\n\u003cp>\u003cimg class=\"aligncenter wp-image-440373 size-medium\" title=\"iStock\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/03/iStock-639071970-800x588.jpg\" alt=\"\" width=\"800\" height=\"588\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-639071970-800x588.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-639071970-160x118.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-639071970-768x564.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-639071970-1020x749.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-639071970-1920x1411.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-639071970-1180x867.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-639071970-960x705.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-639071970-240x176.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-639071970-375x275.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-639071970-520x382.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003c/p>\n\u003cp>Opinions differed on how important that is. One expert on the biology of aging said, “So David’s found another molecule that prevents aging?” (Sinclair was a prominent exponent of resveratrol, a compound that slowed aging in mice but proved disappointing in people.) The Jax’s Harrison questioned whether the inbred mice used in the study were representative of humans, who are genetically diverse.\u003c/p>\n\u003cp>New blood vessels could also be a mixed blessing. They support the growth of tumors, which is why anti-angiogenesis molecules have become cancer drugs. The scientists found no excess cancers in the mice given NMR, but “more study is warranted,” they wrote.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>The blood-vessel benefits of NMN didn’t happen if the mice lacked the SIRT1 gene, probably the brightest star in the anti-aging firmament. In the 1990s, it and the six other genes belonging to the family called sirtuins took aging research by storm, as biologists showed that increasing the genes’ activity extended lifespan in yeast, roundworms, and fruit flies by up to 30 percent. When Massachusetts Institute of Technology’s Leonard Guarente, whose lab was sirtuin central, found that the lifespan-extending effect of drastic caloric restriction works by turning up sirtuin genes, it seemed to point the way to slowing aging: Activate sirtuins with a molecule.\u003c/p>\n\u003cp>That proved easier said than done. Some studies, especially in higher animals, contradicted the simple notion that overexpression of sirtuins translated into longer life. The biggest setback involved resveratrol, a compound found in grapes and wine, which activates the SIRT1 gene. After years of hyperbolic headlines and soaring sales, the resveratrol bubble burst. GlaxoSmithKline bought Cambridge, Mass.-based Sirtris Pharmaceuticals, which Sinclair co-founded in 2004 to develop sirtuin-boosting compounds, for $720 million, but within five years essentially shut it down.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>“Resveratrol is very, very good [at activating SIRT1 and extending lifespan] if you’re a mouse,” said Guarente, who cheerfully acknowledges buying a 10-year supply of micronized resveratrol. Most of it is still in his basement. “But the human trials were all over the place, which was unsettling,” he said.\u003c/p>\n\u003cp>Those failures led scientists to search for other sirtuin-boosting molecules. In 2014, Guarente co-founded Elysium Health, which, for $40 to $60 per month, sells a dietary supplement that boosts NAD+ levels and activates SIRT1. Since levels of NAD+ fall as people age, the hope is that providing the raw material for it will raise those levels, slowing aging. The pills seem to be safe, Guarente and colleagues \u003ca href=\"https://www.nature.com/articles/s41514-017-0016-9\" target=\"_blank\" rel=\"noopener\">reported\u003c/a> last year, and additional human studies are underway to test whether they benefit health.\u003c/p>\n\u003cp>Thanks to \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3188402/\" target=\"_blank\" rel=\"noopener\">negative studies\u003c/a>, the jury is still out on whether anything related to sirtuins will extend lifespan, but the Cell study offers some hope for extending healthspan. If boosting NAD+ promotes blood vessel formation via SIRT1, it might “rescue muscle mass” that otherwise decreases as blood vessels atrophy, Guarente said. That could prevent the bone loss, frailty, and falls that can be fatal in old age.\u003c/p>\n\u003cp>“Anything that contributes to muscle health through vascular health is likely to be quite important,” said the Buck Institute’s Verdin, who takes a daily NAD+ precursor.\u003c/p>\n\u003caside>\u003c/aside>\n\u003cp>Sinclair and his team are now studying whether raising NAD+ might also spur the creation of blood vessels in the brain. There and in other organs, said Sinclair, “the lack of oxygen and buildup of waste products” that results from loss of small blood vessels “sets off a downward spiral of disease and disability.” In the brain, that would include vascular dementia.\u003c/p>\n\u003cp>Sinclair takes NMN to boost NAD+ levels. “In someone my age [49], it’s probably harder to see immediate benefits,” he said, though he said he feels sharper and younger on it. After his 78-year-old father began taking NMN “he started climbing mountains and going whitewater rafting and looking forward to the next five years,” Sinclair said. “It might be psychological, but it isn’t hurting.”\u003c/p>\n\u003cp>Only rigorous human research can determine that. Metro International Biotech, a Michigan-based startup for which Sinclair consults, just finished a clinical trial of the safety of a proprietary version of NMN and hopes to start a trial of the molecule’s efficacy this year, Sinclair said.\u003c/p>\n\u003cp>One concern is that boosting sirtuins could backfire. An excess of the molecules, Verdin said, can promote autoimmunity, which causes diseases such as Crohn’s and rheumatoid arthritis.\u003c/p>\n\u003cp>“That should give us pause about broad claims of what they can do,” he cautioned. “I worry sometimes that [with NAD+-boosting pills already on the market] the field is getting ahead of itself.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>This story was originally published by\u003ca href=\"https://www.statnews.com/\" target=\"_blank\" rel=\"noopener\"> STAT\u003c/a>, an online publication of Boston Globe Media that covers health, medicine, and scientific discovery.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "As Towns Lose Their Newspapers, Disease Detectives Left Flying Blind",
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"content": "\u003cp>Maia Majumder was on Twitter earlier this month when she saw a map that terrified her.\u003c/p>\n\u003cp>The map recorded the number of local newspapers in each county across the United States. Large swaths were shaded light pink, denoting a county that had no local newspaper at all. As a record of the decline of the American newspaper industry, it was disconcerting.\u003c/p>\n\u003cp>But Majumder, a scientist who specializes in mathematical modeling, saw something different in the splotches of light pink: a disaster for infectious disease surveillance.\u003c/p>\n\u003cp>Epidemiologists rely on all kinds of data to detect the spread of disease, including reports from local and state agencies and social media. But local newspapers are critical to identifying outbreaks and forecasting their trajectories.\u003c/p>\n\u003caside class=\"pullquote alignright\">'“Local media is the bedrock of internet surveillance.’ \u003ccite>John Brownstein, Healthmap\u003c/cite>\u003c/aside>\n\u003cp>On the map, Majumder saw every county without a local newspaper as a community where health officials and disease researchers could be flying blind.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“We rely very heavily on local news. And I think what this will probably mean is that there are going to be pockets of the U.S. where we’re just not going to have a particularly good signal anymore,” said Majumder, a Ph.D. candidate at the Massachusetts Institute of Technology.\u003c/p>\n\u003cp>Majumder is a computational epidemiology research fellow at HealthMap, a 12-year-old disease detection project run by researchers from Boston Children’s Hospital. The website uses nontraditional data sources — reports from local news outlets and social media platforms among them— to track global infectious disease activity in real time.\u003c/p>\n\u003cp>\u003cimg class=\"size-medium wp-image-295309 aligncenter\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2050/12/newspapers-800x533.gif\" alt=\"\" width=\"800\" height=\"533\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2050/12/newspapers-800x533.gif 800w, https://ww2.kqed.org/app/uploads/sites/13/2050/12/newspapers-160x107.gif 160w, https://ww2.kqed.org/app/uploads/sites/13/2050/12/newspapers-768x512.gif 768w, https://ww2.kqed.org/app/uploads/sites/13/2050/12/newspapers-1020x680.gif 1020w, https://ww2.kqed.org/app/uploads/sites/13/2050/12/newspapers-1920x1280.gif 1920w, https://ww2.kqed.org/app/uploads/sites/13/2050/12/newspapers-1180x787.gif 1180w, https://ww2.kqed.org/app/uploads/sites/13/2050/12/newspapers-960x640.gif 960w, https://ww2.kqed.org/app/uploads/sites/13/2050/12/newspapers-240x160.gif 240w, https://ww2.kqed.org/app/uploads/sites/13/2050/12/newspapers-375x250.gif 375w, https://ww2.kqed.org/app/uploads/sites/13/2050/12/newspapers-520x347.gif 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">The information HealthMap gathers is used not only by public health authorities, but by researchers around the world who are studying things like the changing geographic distribution of diseases — think Zika — and the impact of climate change on disease patterns, said John Brownstein, one of the co-founders of the site.\u003c/p>\n\u003cp>“Local media is the bedrock of internet surveillance — the kind of work that we do in terms of scouring the web looking for early signs of something taking place in a community,” explained Brownstein, chief innovation officer at Boston Children’s and a pioneer in the field of using sources other than public health data to do this type of work.\u003c/p>\n\u003cp>He pointed to the 2009 H1N1 influenza pandemic as an example of a case in which local reporting helped to bring an emerging disease threat to global attention.\u003c/p>\n\u003cp>\u003cstrong>Tracking an Outbreak\u003c/strong>\u003cbr>\nThe Centers for Disease Control and Prevention was the first agency to detect that two young children in California had been infected with a flu strain circulated in pigs. As officials were trying to figure out if the cases were blips or part of something bigger, however, disease detectives began crawling through recent media reports to determine whether unusual numbers of people with flu-like illness in Mexico had also been sickened by the new virus. It turned out they had been. The new virus was spreading.[contextly_sidebar id=\"eRWHDjM3IMP7OEH2GlfugYXA5fly6vp3\"]\u003c/p>\n\u003cp>“It makes sense that if we see a reduction in local reporting, you’re not going to have that early signaling of something in a community,” Brownstein said.\u003c/p>\n\u003cp>Without local reporting, it’s also harder to follow an outbreak and assess its progress. Majumder used the example of the massive 2016-2017 mumps outbreak in northwestern Arkansas to illustrate the point.\u003c/p>\n\u003cp>She and colleagues were trying to figure out why the outbreak was so large — nearly 3,000 cases all told. Had the virus simply found its way into an area with lots of unvaccinated children? Or was something else driving transmission?\u003c/p>\n\u003cp>That’s the kind of information that is hugely helpful to public health authorities struggling to control an outbreak. But Majumder found she couldn’t easily get her hands on key data; the Arkansas Department of Public Health issued regular updates, but the agency did not archive previous updates on its website. Getting access to official data can be a time-consuming process.\u003c/p>\n\u003cp>“There is a lot of red tape to get data sharing privileges, even around something as simple as cumulative case counts over time,” she said.\u003c/p>\n\u003cp>The Northwest Arkansas Democrat-Gazette, however, was covering the outbreak closely, and its coverage provided important context for Majumder’s research. Some of the paper’s stories noted that the vaccine refusal rate in that region was higher than anywhere else in the state; others made clear disease was spreading in a local community of people from the Marshall Islands who had been vaccinated.\u003c/p>\n\u003cp>\u003cimg class=\"size-medium wp-image-440343 aligncenter\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/03/iStock-691796746-800x533.jpg\" alt=\"\" width=\"800\" height=\"533\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-691796746-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-691796746-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-691796746-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-691796746-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-691796746-1920x1280.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-691796746-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-691796746-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-691796746-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-691796746-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-691796746-520x347.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">Both those factors proved key in helping public health officials better understand what was driving the outbreak, Majumder said.\u003c/p>\n\u003cp>The World Health Organization urges countries to augment their official disease surveillance efforts — which draw information from networks of doctor’s offices, hospitals, and public health laboratories — with what’s known as “event-based surveillance,” said Dr. Larry Madoff, editor of ProMED, the Program for Monitoring Emerging Diseases. The internet-based outbreak reporting system — which reports on human, animal, and plant disease outbreaks — operates under the auspices of the International Society for Infectious Diseases.\u003c/p>\n\u003cp>Event-based surveillance is more informal and relies on systems that pick up on media reports, rumors on social media, and the like. That’s the way news of the 2003 SARS outbreak emerged. Internet chatter about a disease that was sickening and killing people in China made its way to the WHO before Chinese authorities eventually disclosed the existence of an outbreak that had been raging for several months.[contextly_sidebar id=\"pHkMIHqxoK7nvOZ2Rw6M77aUOBH1WSHD\"]\u003c/p>\n\u003cp>“It is well-known that event-based surveillance depends on healthy, local journalism,” said Madoff, who is also director of the Massachusetts Department of Health’s division of epidemiology and immunization. “So it would be a reasonable assumption that the loss of local sources would increase the time required to discover an outbreak.”\u003c/p>\n\u003cp>Like HealthMap, ProMED casts its net globally. In some countries, there are not many local media sources, or if there are, those news sources aren’t available on the internet. In those places, ProMED has to rely on word-of-mouth — which may become the case in parts of the U.S. as local news outlets are shuttered, Madoff said.\u003c/p>\n\u003cp>He’s not sure if ProMED is starting to miss things because of the shrinking number of local news sources. “There’s a huge volume of information and we get what we get. So it’s hard to say what we’re missing, necessarily. But I can easily imagine that we might,” he said.\u003c/p>\n\u003cp>\u003cstrong>Social Media\u003c/strong>\u003c/p>\n\u003cp>Newspapers, of course, aren’t the only source of local news. But a town that can’t support a newspaper may not have radio and television stations either. Radio and TV stations may not archive their reports online, or those reports may not be archived in print form, meaning their archives are harder to search, Majumder said.\u003c/p>\n\u003cp>Social media cannot fill the gap created by the declining local news coverage, she and others involved in this type of research argued. “With Twitter … you are picking up a signal, but that signal might not be precise,” said Alessandro Vespignani, a professor at Northeastern University whose research focuses on modeling of epidemics. And social media reports can be simply wrong, he said — either by accident or design. News coverage “anchors” the signals picked up on social media, Vespignani said.[contextly_sidebar id=\"67Do4Phey2ezXlhxwIvDAmFbf798Cd3r\"]\u003c/p>\n\u003cp>“When you combine data from multiple data sources … including data collected from news alerts, we can gain a better handle on the situational awareness in a given community or country,” agreed Mauricio Santillana, an assistant professor at Harvard Medical School whose research focuses on use of novel data sources to track and forecast disease outbreaks.\u003c/p>\n\u003cp>Majumder said she and colleagues would like to look at whether the growth of “news deserts” — communities without local news sources — has already had an impact on the amount of data HealthMap has been harvesting from under-covered parts of the United States.\u003c/p>\n\u003cp>One of the reasons the news desert map scared her, she said, was because she realized many of the places without local papers are also places where voters have been complaining of being left behind.\u003c/p>\n\u003cp>“What that means is they lose access to news which is very, very vital for knowing what’s going on in your town,” Majumder said. “But also from the public health surveillance point of view, we’re losing access to knowing what they need.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This \u003ca href=\"https://www.statnews.com/2018/03/20/news-deserts-infectious-disease/\" target=\"_blank\" rel=\"noopener\">story\u003c/a> was originally published by \u003ca href=\"https://www.statnews.com/\" target=\"_blank\" rel=\"noopener\">STAT, \u003c/a>an online publication of Boston Globe Media that covers health, medicine, and scientific discovery.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Maia Majumder was on Twitter earlier this month when she saw a map that terrified her.\u003c/p>\n\u003cp>The map recorded the number of local newspapers in each county across the United States. Large swaths were shaded light pink, denoting a county that had no local newspaper at all. As a record of the decline of the American newspaper industry, it was disconcerting.\u003c/p>\n\u003cp>But Majumder, a scientist who specializes in mathematical modeling, saw something different in the splotches of light pink: a disaster for infectious disease surveillance.\u003c/p>\n\u003cp>Epidemiologists rely on all kinds of data to detect the spread of disease, including reports from local and state agencies and social media. But local newspapers are critical to identifying outbreaks and forecasting their trajectories.\u003c/p>\n\u003caside class=\"pullquote alignright\">'“Local media is the bedrock of internet surveillance.’ \u003ccite>John Brownstein, Healthmap\u003c/cite>\u003c/aside>\n\u003cp>On the map, Majumder saw every county without a local newspaper as a community where health officials and disease researchers could be flying blind.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“We rely very heavily on local news. And I think what this will probably mean is that there are going to be pockets of the U.S. where we’re just not going to have a particularly good signal anymore,” said Majumder, a Ph.D. candidate at the Massachusetts Institute of Technology.\u003c/p>\n\u003cp>Majumder is a computational epidemiology research fellow at HealthMap, a 12-year-old disease detection project run by researchers from Boston Children’s Hospital. The website uses nontraditional data sources — reports from local news outlets and social media platforms among them— to track global infectious disease activity in real time.\u003c/p>\n\u003cp>\u003cimg class=\"size-medium wp-image-295309 aligncenter\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2050/12/newspapers-800x533.gif\" alt=\"\" width=\"800\" height=\"533\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2050/12/newspapers-800x533.gif 800w, https://ww2.kqed.org/app/uploads/sites/13/2050/12/newspapers-160x107.gif 160w, https://ww2.kqed.org/app/uploads/sites/13/2050/12/newspapers-768x512.gif 768w, https://ww2.kqed.org/app/uploads/sites/13/2050/12/newspapers-1020x680.gif 1020w, https://ww2.kqed.org/app/uploads/sites/13/2050/12/newspapers-1920x1280.gif 1920w, https://ww2.kqed.org/app/uploads/sites/13/2050/12/newspapers-1180x787.gif 1180w, https://ww2.kqed.org/app/uploads/sites/13/2050/12/newspapers-960x640.gif 960w, https://ww2.kqed.org/app/uploads/sites/13/2050/12/newspapers-240x160.gif 240w, https://ww2.kqed.org/app/uploads/sites/13/2050/12/newspapers-375x250.gif 375w, https://ww2.kqed.org/app/uploads/sites/13/2050/12/newspapers-520x347.gif 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">The information HealthMap gathers is used not only by public health authorities, but by researchers around the world who are studying things like the changing geographic distribution of diseases — think Zika — and the impact of climate change on disease patterns, said John Brownstein, one of the co-founders of the site.\u003c/p>\n\u003cp>“Local media is the bedrock of internet surveillance — the kind of work that we do in terms of scouring the web looking for early signs of something taking place in a community,” explained Brownstein, chief innovation officer at Boston Children’s and a pioneer in the field of using sources other than public health data to do this type of work.\u003c/p>\n\u003cp>He pointed to the 2009 H1N1 influenza pandemic as an example of a case in which local reporting helped to bring an emerging disease threat to global attention.\u003c/p>\n\u003cp>\u003cstrong>Tracking an Outbreak\u003c/strong>\u003cbr>\nThe Centers for Disease Control and Prevention was the first agency to detect that two young children in California had been infected with a flu strain circulated in pigs. As officials were trying to figure out if the cases were blips or part of something bigger, however, disease detectives began crawling through recent media reports to determine whether unusual numbers of people with flu-like illness in Mexico had also been sickened by the new virus. It turned out they had been. The new virus was spreading.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>“It makes sense that if we see a reduction in local reporting, you’re not going to have that early signaling of something in a community,” Brownstein said.\u003c/p>\n\u003cp>Without local reporting, it’s also harder to follow an outbreak and assess its progress. Majumder used the example of the massive 2016-2017 mumps outbreak in northwestern Arkansas to illustrate the point.\u003c/p>\n\u003cp>She and colleagues were trying to figure out why the outbreak was so large — nearly 3,000 cases all told. Had the virus simply found its way into an area with lots of unvaccinated children? Or was something else driving transmission?\u003c/p>\n\u003cp>That’s the kind of information that is hugely helpful to public health authorities struggling to control an outbreak. But Majumder found she couldn’t easily get her hands on key data; the Arkansas Department of Public Health issued regular updates, but the agency did not archive previous updates on its website. Getting access to official data can be a time-consuming process.\u003c/p>\n\u003cp>“There is a lot of red tape to get data sharing privileges, even around something as simple as cumulative case counts over time,” she said.\u003c/p>\n\u003cp>The Northwest Arkansas Democrat-Gazette, however, was covering the outbreak closely, and its coverage provided important context for Majumder’s research. Some of the paper’s stories noted that the vaccine refusal rate in that region was higher than anywhere else in the state; others made clear disease was spreading in a local community of people from the Marshall Islands who had been vaccinated.\u003c/p>\n\u003cp>\u003cimg class=\"size-medium wp-image-440343 aligncenter\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/03/iStock-691796746-800x533.jpg\" alt=\"\" width=\"800\" height=\"533\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-691796746-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-691796746-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-691796746-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-691796746-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-691796746-1920x1280.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-691796746-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-691796746-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-691796746-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-691796746-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-691796746-520x347.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">Both those factors proved key in helping public health officials better understand what was driving the outbreak, Majumder said.\u003c/p>\n\u003cp>The World Health Organization urges countries to augment their official disease surveillance efforts — which draw information from networks of doctor’s offices, hospitals, and public health laboratories — with what’s known as “event-based surveillance,” said Dr. Larry Madoff, editor of ProMED, the Program for Monitoring Emerging Diseases. The internet-based outbreak reporting system — which reports on human, animal, and plant disease outbreaks — operates under the auspices of the International Society for Infectious Diseases.\u003c/p>\n\u003cp>Event-based surveillance is more informal and relies on systems that pick up on media reports, rumors on social media, and the like. That’s the way news of the 2003 SARS outbreak emerged. Internet chatter about a disease that was sickening and killing people in China made its way to the WHO before Chinese authorities eventually disclosed the existence of an outbreak that had been raging for several months.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>“It is well-known that event-based surveillance depends on healthy, local journalism,” said Madoff, who is also director of the Massachusetts Department of Health’s division of epidemiology and immunization. “So it would be a reasonable assumption that the loss of local sources would increase the time required to discover an outbreak.”\u003c/p>\n\u003cp>Like HealthMap, ProMED casts its net globally. In some countries, there are not many local media sources, or if there are, those news sources aren’t available on the internet. In those places, ProMED has to rely on word-of-mouth — which may become the case in parts of the U.S. as local news outlets are shuttered, Madoff said.\u003c/p>\n\u003cp>He’s not sure if ProMED is starting to miss things because of the shrinking number of local news sources. “There’s a huge volume of information and we get what we get. So it’s hard to say what we’re missing, necessarily. But I can easily imagine that we might,” he said.\u003c/p>\n\u003cp>\u003cstrong>Social Media\u003c/strong>\u003c/p>\n\u003cp>Newspapers, of course, aren’t the only source of local news. But a town that can’t support a newspaper may not have radio and television stations either. Radio and TV stations may not archive their reports online, or those reports may not be archived in print form, meaning their archives are harder to search, Majumder said.\u003c/p>\n\u003cp>Social media cannot fill the gap created by the declining local news coverage, she and others involved in this type of research argued. “With Twitter … you are picking up a signal, but that signal might not be precise,” said Alessandro Vespignani, a professor at Northeastern University whose research focuses on modeling of epidemics. And social media reports can be simply wrong, he said — either by accident or design. News coverage “anchors” the signals picked up on social media, Vespignani said.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>“When you combine data from multiple data sources … including data collected from news alerts, we can gain a better handle on the situational awareness in a given community or country,” agreed Mauricio Santillana, an assistant professor at Harvard Medical School whose research focuses on use of novel data sources to track and forecast disease outbreaks.\u003c/p>\n\u003cp>Majumder said she and colleagues would like to look at whether the growth of “news deserts” — communities without local news sources — has already had an impact on the amount of data HealthMap has been harvesting from under-covered parts of the United States.\u003c/p>\n\u003cp>One of the reasons the news desert map scared her, she said, was because she realized many of the places without local papers are also places where voters have been complaining of being left behind.\u003c/p>\n\u003cp>“What that means is they lose access to news which is very, very vital for knowing what’s going on in your town,” Majumder said. “But also from the public health surveillance point of view, we’re losing access to knowing what they need.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>This \u003ca href=\"https://www.statnews.com/2018/03/20/news-deserts-infectious-disease/\" target=\"_blank\" rel=\"noopener\">story\u003c/a> was originally published by \u003ca href=\"https://www.statnews.com/\" target=\"_blank\" rel=\"noopener\">STAT, \u003c/a>an online publication of Boston Globe Media that covers health, medicine, and scientific discovery.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Black And Latino Children Are Often Overlooked When It Comes To Autism",
"title": "Black And Latino Children Are Often Overlooked When It Comes To Autism",
"headTitle": "Future of You | KQED Future of You | KQED Science",
"content": "\u003cp>Sherry Alvarez says she knew there was \u003ca href=\"https://www.kqed.org/futureofyou/357617/sesame-street-to-introduce-muppet-with-autism\" target=\"_blank\" rel=\"noopener\">something different\u003c/a> about her son since he was about 9 months old. Back then Sherry says his pediatrician told her there was nothing to worry about, \" 'Boys are a little slower than girls, so let's just wait until his second birthday.' \" We aren't using Sherry's son's name to protect his privacy.\u003c/p>\n\u003cp>By her son's second birthday, Sherry says she was getting desperate. She didn't know why he wasn't talking yet or showing affection like other kids. At 2 1/2, he was referred to Children's Hospital Los Angeles.[contextly_sidebar id=\"HF94QtAhJ0QaonfGcwoc1BDmUjMCZqvd\"]\u003c/p>\n\u003cp>There, after four hours of tests, Sherry says the doctor handed her a 20-page report explaining his autism spectrum disorder diagnosis, among others. She says she was paralyzed by emotion.\u003c/p>\n\u003cp>ASD is a disease that affects people of all races and ethnicities, but \u003ca href=\"http://www.jaacap.com/article/S0890-8567(09)60739-5/abstract\" target=\"_blank\" rel=\"noopener\">research \u003c/a>shows that African-American and Latino children with autism are diagnosed at older ages than white children, giving them less of an opportunity for proper intervention and treatment.\u003c/p>\n\u003cp>This is especially true of minimally verbal kids like Sherry's son and there are many possible reasons for a late diagnosis. Some families face healthcare access issues and prohibitive costs for treatment, and some families just don't know how important it is to \u003ca href=\"https://www.kqed.org/futureofyou/436442/cdc-app-tells-parents-when-to-be-concerned-about-child-development\" target=\"_blank\" rel=\"noopener\">get diagnosed to move on\u003c/a> to the treatment phase. The dialog between doctors and minority families during the diagnosis process is critical.[contextly_sidebar id=\"i6RhCi4DH3w2V0Rp0zM5OR4cXRLu6ZFc\"]\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/29100475\" target=\"_blank\" rel=\"noopener\">A recent study\u003c/a> from Georgia State University found that African-American parents reported fewer concerns about behaviors like delayed speech and repetitive behaviors, even though their children showed a greater severity with these symptoms, overall. But, of course, it isn't all up to parents.\u003c/p>\n\u003cp>\"There are very likely parent aspects of this and very likely clinician aspects of this,\" says Meghan Rose Donohue, a lead researcher on the study. Perhaps families, like Sherry's, don't have the information necessary to really push physicians, but it is also possible that doctors don't take these cases seriously enough from the beginning.\u003c/p>\n\u003cp>\u003cstrong>Misdiagnosis\u003c/strong>\u003cbr>\nFamilies and doctors, alike, can mistake ASD for simple bad behavior, especially in boys, as research has shown over the past couple of decades. \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/11575603\" target=\"_blank\" rel=\"noopener\">A 2001 study\u003c/a> at McGill University in Montreal found that doctors were more hesitant to diagnose ASD in minority families.[contextly_sidebar id=\"z5QvKJ1QNa5Nn1EGXEj633LNkljonhOJ\"]\u003c/p>\n\u003cp>In 2007, \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/17160456\" target=\"_blank\" rel=\"noopener\">a study\u003c/a> by a team at the Center for Autism and Developmental Disabilities Research and Epidemiology, University of Pennsylvania, found that African-American children were 5.1 times more likely to be misdiagnosed with conduct disorders before being diagnosed with ASD.\u003c/p>\n\u003cp>When Sherry was growing up, she had a cousin who the family thought of as \"different,\" she says. \"He was basically hidden. We didn't talk about it as a community.\" He had autism. \"We have to retrain ourselves. It's not OK to hide our kids.\"\u003c/p>\n\u003cp>\u003ca href=\"http://www.dds.ca.gov/RC/\" target=\"_blank\" rel=\"noopener\">Regional Centers\u003c/a> in Los Angeles, which offer services to the developmentally disabled, are now starting to look at the \u003ca href=\"https://www.kqed.org/futureofyou/245794/researchers-hunt-for-the-microbiome-of-autism\" target=\"_blank\" rel=\"noopener\">diagnosis disparity problem\u003c/a>. Westside Regional Center in Culver City just received a grant from the state to look at how autism diagnosis disparities manifest within their intake and treatment programs.[contextly_sidebar id=\"nMqm3DUyCpzzodOPiyxyxYVgb9M171ki\"]\u003c/p>\n\u003cp>\"We've implemented a series of trainings with intake counselors on cultural awareness and sensitivity, and we're starting to have a lot of conversations about biases,\" says Tom Kelly, Westside's chief psychologist.\u003c/p>\n\u003cp>One of the apparent biases among intake counselors at the center stems from the difference in the documentation that arrives with each new child. African-American families tend to arrive at the center with lots of documentation detailing behavior issues from their child's school or social services. With all those official papers sitting in front of them, it's much easier for a counselor to think \"behavior disease\" rather than \"autism,\" says Kelly.\u003c/p>\n\u003cp>\u003cstrong>Economic Disparities\u003c/strong>\u003cbr>\nAnd that disparity exists in dollars spent, as well. As reported in \u003ca href=\"https://issuu.com/publiccounsel/docs/assuring_equitable_funding_of_servi?e=29495352/49041713\" target=\"_blank\" rel=\"noopener\">a 2017 survey\u003c/a>, South Central Regional Center spends $8,000 less per client than the Westside location and the racial disparity \u003ca href=\"http://www.calhealthreport.org/2016/12/12/marked-racial-disparities-in-money-spent-to-help-disabled/\" target=\"_blank\" rel=\"noopener\">persists statewide\u003c/a>.\u003c/p>\n\u003cp>But there are more resources for minority families today than compared to when Sherry's son was young. The Autism Society of Los Angeles runs a hotline to help parents navigate the diagnosis and healthcare landscape and Children's Hospital Los Angeles now employs liaisons to help families connect with the right resources. But, the spending gap persists.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Today, Sherry says her now 15-year-old son is happy. He attends Hamilton High School and communicates almost solely through a typing device. \"This is the time in his life where those early treatments could have made a difference,\" she laments.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Black+And+Latino+Children+Are+Often+Overlooked+When+It+Comes+To+Autism&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Sherry Alvarez says she knew there was \u003ca href=\"https://www.kqed.org/futureofyou/357617/sesame-street-to-introduce-muppet-with-autism\" target=\"_blank\" rel=\"noopener\">something different\u003c/a> about her son since he was about 9 months old. Back then Sherry says his pediatrician told her there was nothing to worry about, \" 'Boys are a little slower than girls, so let's just wait until his second birthday.' \" We aren't using Sherry's son's name to protect his privacy.\u003c/p>\n\u003cp>By her son's second birthday, Sherry says she was getting desperate. She didn't know why he wasn't talking yet or showing affection like other kids. At 2 1/2, he was referred to Children's Hospital Los Angeles.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>There, after four hours of tests, Sherry says the doctor handed her a 20-page report explaining his autism spectrum disorder diagnosis, among others. She says she was paralyzed by emotion.\u003c/p>\n\u003cp>ASD is a disease that affects people of all races and ethnicities, but \u003ca href=\"http://www.jaacap.com/article/S0890-8567(09)60739-5/abstract\" target=\"_blank\" rel=\"noopener\">research \u003c/a>shows that African-American and Latino children with autism are diagnosed at older ages than white children, giving them less of an opportunity for proper intervention and treatment.\u003c/p>\n\u003cp>This is especially true of minimally verbal kids like Sherry's son and there are many possible reasons for a late diagnosis. Some families face healthcare access issues and prohibitive costs for treatment, and some families just don't know how important it is to \u003ca href=\"https://www.kqed.org/futureofyou/436442/cdc-app-tells-parents-when-to-be-concerned-about-child-development\" target=\"_blank\" rel=\"noopener\">get diagnosed to move on\u003c/a> to the treatment phase. The dialog between doctors and minority families during the diagnosis process is critical.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/29100475\" target=\"_blank\" rel=\"noopener\">A recent study\u003c/a> from Georgia State University found that African-American parents reported fewer concerns about behaviors like delayed speech and repetitive behaviors, even though their children showed a greater severity with these symptoms, overall. But, of course, it isn't all up to parents.\u003c/p>\n\u003cp>\"There are very likely parent aspects of this and very likely clinician aspects of this,\" says Meghan Rose Donohue, a lead researcher on the study. Perhaps families, like Sherry's, don't have the information necessary to really push physicians, but it is also possible that doctors don't take these cases seriously enough from the beginning.\u003c/p>\n\u003cp>\u003cstrong>Misdiagnosis\u003c/strong>\u003cbr>\nFamilies and doctors, alike, can mistake ASD for simple bad behavior, especially in boys, as research has shown over the past couple of decades. \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/11575603\" target=\"_blank\" rel=\"noopener\">A 2001 study\u003c/a> at McGill University in Montreal found that doctors were more hesitant to diagnose ASD in minority families.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>In 2007, \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/17160456\" target=\"_blank\" rel=\"noopener\">a study\u003c/a> by a team at the Center for Autism and Developmental Disabilities Research and Epidemiology, University of Pennsylvania, found that African-American children were 5.1 times more likely to be misdiagnosed with conduct disorders before being diagnosed with ASD.\u003c/p>\n\u003cp>When Sherry was growing up, she had a cousin who the family thought of as \"different,\" she says. \"He was basically hidden. We didn't talk about it as a community.\" He had autism. \"We have to retrain ourselves. It's not OK to hide our kids.\"\u003c/p>\n\u003cp>\u003ca href=\"http://www.dds.ca.gov/RC/\" target=\"_blank\" rel=\"noopener\">Regional Centers\u003c/a> in Los Angeles, which offer services to the developmentally disabled, are now starting to look at the \u003ca href=\"https://www.kqed.org/futureofyou/245794/researchers-hunt-for-the-microbiome-of-autism\" target=\"_blank\" rel=\"noopener\">diagnosis disparity problem\u003c/a>. Westside Regional Center in Culver City just received a grant from the state to look at how autism diagnosis disparities manifest within their intake and treatment programs.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\"We've implemented a series of trainings with intake counselors on cultural awareness and sensitivity, and we're starting to have a lot of conversations about biases,\" says Tom Kelly, Westside's chief psychologist.\u003c/p>\n\u003cp>One of the apparent biases among intake counselors at the center stems from the difference in the documentation that arrives with each new child. African-American families tend to arrive at the center with lots of documentation detailing behavior issues from their child's school or social services. With all those official papers sitting in front of them, it's much easier for a counselor to think \"behavior disease\" rather than \"autism,\" says Kelly.\u003c/p>\n\u003cp>\u003cstrong>Economic Disparities\u003c/strong>\u003cbr>\nAnd that disparity exists in dollars spent, as well. As reported in \u003ca href=\"https://issuu.com/publiccounsel/docs/assuring_equitable_funding_of_servi?e=29495352/49041713\" target=\"_blank\" rel=\"noopener\">a 2017 survey\u003c/a>, South Central Regional Center spends $8,000 less per client than the Westside location and the racial disparity \u003ca href=\"http://www.calhealthreport.org/2016/12/12/marked-racial-disparities-in-money-spent-to-help-disabled/\" target=\"_blank\" rel=\"noopener\">persists statewide\u003c/a>.\u003c/p>\n\u003cp>But there are more resources for minority families today than compared to when Sherry's son was young. The Autism Society of Los Angeles runs a hotline to help parents navigate the diagnosis and healthcare landscape and Children's Hospital Los Angeles now employs liaisons to help families connect with the right resources. But, the spending gap persists.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Today, Sherry says her now 15-year-old son is happy. He attends Hamilton High School and communicates almost solely through a typing device. \"This is the time in his life where those early treatments could have made a difference,\" she laments.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Black+And+Latino+Children+Are+Often+Overlooked+When+It+Comes+To+Autism&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "New Diabetes Monitors Require Fewer Pricks, Less Guessing",
"title": "New Diabetes Monitors Require Fewer Pricks, Less Guessing",
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"content": "\u003ch3>\u003cem>Continuous glucose monitors have been around for over a decade, but reductions in cost and improvements in quality have enticed more patients and doctors to try them out.\u003c/em>\u003c/h3>\n\u003cp>For Melissa Lee, the worst part of diabetes isn’t pricking her finger to check her glucose level or changing her diet to keep her blood sugar in check. Rather, it’s the constant worry and mental calculations.\u003c/p>\n\u003caside class=\"pullquote alignright\">'In a perfect world, everybody with diabetes would benefit from some form of this technology.'\u003ccite>Kathleen Dungan, Ohio State University\u003c/cite>\u003c/aside>\n\u003cp>“You have to think about what did I eat last, how much insulin did I take for that, where is my blood sugar now, which direction is it trending, and then based on that, what am I going to eat?” she says. “You’re making these educated guesses about how much of a really volatile hormone [insulin] to take, and that is mentally exhausting.”\u003c/p>\n\u003cp>Lee, 38, who was diagnosed with Type 1 diabetes when she was 10, recounts ruined dates, missed flights and abandoned excursions, all because she was worried about her glucose level or forgot to bring a replacement for her insulin pump.\u003c/p>\n\u003cp>“You can go from being okay to being really not okay in a moment’s notice,” says Lee, who lives in Milpitas, California and works as the director of community relations at Bigfoot Biomedical.\u003c/p>\n\u003cp>To relieve some of the burden for the estimated 9.3 million people who use insulin to regulate diabetes, medical device makers have introduced new ways to monitor glucose and administer insulin.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cstrong>Better Glucose Management\u003c/strong>\u003c/p>\n\u003cfigure id=\"attachment_440097\" class=\"wp-caption aligncenter\" style=\"max-width: 539px\">\u003cimg class=\"wp-image-440097 size-full\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/03/RS29282_LIBRE_020718_002-sfi.jpg\" alt=\"FreeStyle Libre\" width=\"539\" height=\"360\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2018/03/RS29282_LIBRE_020718_002-sfi.jpg 539w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/RS29282_LIBRE_020718_002-sfi-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/RS29282_LIBRE_020718_002-sfi-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/RS29282_LIBRE_020718_002-sfi-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/RS29282_LIBRE_020718_002-sfi-520x347.jpg 520w\" sizes=\"(max-width: 539px) 100vw, 539px\">\u003cfigcaption class=\"wp-caption-text\">Melissa Lee displays the components of the FreeStyle Libre, her blood glucose monitor. \u003ccite>(Lauren Hanussak/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Continuous glucose monitors, or CGMs, have been around for over a decade, but poor quality and high costs have been barriers to use, says Irl Hirsch, who holds the Diabetes Treatment and Teaching Chair at the University of Washington School of Medicine. But improvements on both fronts lead him to believe that CGMs will soon become the standard of care. At his own clinic, 60 percent of patients use one.\u003c/p>\n\u003cp>“The financial impact and the insurance coverage is not the barrier that it used to be,” Hirsch says. What’s more, “The quality and the accuracy of these things have just gotten better.”\u003c/p>\n\u003cp>CGMs measure glucose levels not in blood but in the interstitial fluid, which surrounds the cells just underneath the skin. A sensor sticks onto the body, typically on the upper arm or abdomen, with a small, flexible needle that penetrates the skin. The sensor takes a reading every 5 to 15 minutes and transmits that information to a separate receiver or a smartphone app, which patients can check at any time. The reading shows their current glucose level and a trend graph for the last eight hours. If the number is high and rising, the patient can bring their glucose down using insulin; if it’s low and dropping, they need to eat some sugar, fast.\u003c/p>\n\u003cp>“It's very exciting technology. I think it's really revolutionizing diabetes care,” says Kathleen Dungan, an associate professor of medicine at Ohio State University who runs the school’s endocrine clinical trials unit. “In a perfect world, everybody with diabetes would benefit from some form of this technology.”\u003c/p>\n\u003cp>\u003cstrong>Too Little Insulin\u003c/strong>\u003c/p>\n\u003cp>Every time you eat, your pancreas pumps out insulin to help your cells extract glucose from the blood and use it for fuel. In Type I diabetes, the pancreas stops producing insulin, while in Type II the cells can’t utilize the hormone properly. In either case, too little insulin causes excessive blood glucose levels. Chronic high blood sugar, or hyperglycemia, can lead to heart disease, kidney disease, stroke, nerve damage, blindness and loss of limbs.\u003c/p>\n\u003cfigure id=\"attachment_440099\" class=\"wp-caption aligncenter\" style=\"max-width: 539px\">\u003cimg class=\"size-full wp-image-440099\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/03/RS29281_LIBRE_020718_001-sfi.jpg\" alt=\"Melissa Lee, who was diagnosed with type one diabetes at 10 years old, models the FreeStyle Libre in Hayward, Calif.\" width=\"539\" height=\"360\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2018/03/RS29281_LIBRE_020718_001-sfi.jpg 539w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/RS29281_LIBRE_020718_001-sfi-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/RS29281_LIBRE_020718_001-sfi-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/RS29281_LIBRE_020718_001-sfi-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/RS29281_LIBRE_020718_001-sfi-520x347.jpg 520w\" sizes=\"(max-width: 539px) 100vw, 539px\">\u003cfigcaption class=\"wp-caption-text\">Melissa Lee, who was diagnosed with Type 1 diabetes at 10 years old, models the FreeStyle Libre, \u003ccite>(Lauren Hanussak/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>In contrast, too much insulin results in low blood sugar, or hypoglycemia, which can cause weakness, dizzy spells, seizures, shaking, fainting and even death.\u003c/p>\n\u003cp>Patients typically use blood glucose meters that measure sugar levels in a drop of blood to determine if they need to take more insulin or not. However, having to prick your finger and draw blood to check your glucose level can be a major hurdle for maintaining normal blood sugar. Some patients may have aversions to needles, while others may have difficulty creating a sterile environment in which to take a reading.\u003c/p>\n\u003cp>\u003cstrong>Popular CGMs\u003c/strong>\u003c/p>\n\u003cp>CGMs aim to ease that pain and inconvenience. Dexcom and Abbott are two of the largest producers of CGMs, with Abbott’s FreeStyle Libre the newest device approved by the FDA, in September 2017.\u003c/p>\n\u003cp>The Libre sensors last for 10 days and cost $59 each. Sensors for Dexcom’s G4 or G5 system are $350 for a pack of four and have to be replaced every seven days. Patients also have to purchase a receiver, about $60 for the Libre versus $465 for the Dexcom G5. Finally, Dexcom requires a separate transmitter to send the glucose information to the receiver, another $595. Both companies’ devices are covered by major insurance providers and Medicare, so the actual cost to patients varies.\u003c/p>\n\u003cfigure id=\"attachment_440100\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003cimg class=\"size-large wp-image-440100\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/03/IMG_0829-1020x680.jpg\" alt=\"Ken Reutell of Petaluma, Calif. displays his MiniMed 670G\" width=\"640\" height=\"427\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0829-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0829-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0829-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0829-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0829-1920x1280.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0829-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0829-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0829-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0829-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0829-520x347.jpg 520w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003cfigcaption class=\"wp-caption-text\">Ken Reutell of Petaluma, Calif. displays his MiniMed 670G. \u003ccite>(Danielle Venton/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The Libre is the only monitor that doesn’t have to be calibrated daily with a traditional blood glucose reading, meaning patients never have to prick their fingers.\u003c/p>\n\u003cp>Studies show that patients who use a CGM have \u003ca href=\"http://care.diabetesjournals.org/content/40/Supplement_1/S48\" target=\"_blank\" rel=\"noopener\">better control over their diabetes\u003c/a> than patients who use traditional blood glucose tests. Doctors recommend patients check their glucose between \u003ca href=\"https://www.mayoclinic.org/diseases-conditions/diabetes/in-depth/blood-sugar/art-20046628\" target=\"_blank\" rel=\"noopener\">4 and 10 times per day\u003c/a>, but in reality, only \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/14999899\" target=\"_blank\" rel=\"noopener\">one-third of patients\u003c/a> test themselves as often as they should. Abbott says patients using its device easily exceed this standard, checking on average 16 times a day.\u003c/p>\n\u003cp>Lee, who uses the FreeStyle Libre, says being able to easily check her blood glucose helps her know how it's affected by her diet. “You suddenly have this insight into how actions you took actually affected some kind of diabetes outcome,” she says.\u003c/p>\n\u003cp>Another Type 1 diabetes patient, Lisa Trahan, 33, yses the Dexcom G4 and says it’s “terrific.” Trahan, a clinical psychologist based in San Marcos, Texas, says the frequent readings provide her with more peace of mind, especially before exercising or eating. However, she still doesn’t trust the device enough to forego pricking her finger to double check the numbers.\u003c/p>\n\u003cfigure id=\"attachment_440101\" class=\"wp-caption alignright\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-440101\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/03/IMG_0816-800x533.jpg\" alt=\"A man's hand holds a small gaget.\" width=\"800\" height=\"533\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0816-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0816-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0816-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0816-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0816-1920x1280.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0816-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0816-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0816-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0816-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0816-520x347.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Ken Reutell's MiniMed 670G means he spends less time pricking himself to monitor his blood glucose levels. \u003ccite>(Danielle Venton/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“I can trust the CGM reading of my Dexcom G4 to be within 20 percent in either direction of my actual blood sugar reading,” she explains. But, she says, that range can make a big difference when tinkering with blood sugar or insulin. “I use the alert as a suggestion to check my blood sugar and go from there.”\u003c/p>\n\u003cp>\u003cstrong>Smarter Insulin Pumps\u003c/strong>\u003c/p>\n\u003cp>Besides checking blood sugar, the other part of managing diabetes is taking insulin, either with an injection or an insulin pump.\u003c/p>\n\u003cp>Traditional insulin pumps are preset to deliver different doses at certain times of the day. However, it can be difficult to match the correct dose to fluctuations in glucose levels that occur naturally throughout the day or because of diet or exercise. A patient or doctor can adjust the levels manually, but it requires complex calculations and typically isn’t done every day.\u003c/p>\n\u003cp>Medtronic’s MiniMed 670G, the first integrated CGM-insulin pump system approved by the FDA in 2016, aims to solve that problem. The 670G can vary the amount of insulin it delivers as often as every five minutes, in response to input from an integrated glucose monitor.\u003c/p>\n\u003cp>The only calculation patients have to make is to manually deliver a boost of insulin every time they eat that is proportionate to the number of carbohydrates in the meal. They also need to prick their fingers three times a day to calibrate the system.\u003c/p>\n\u003cp>Despite the excitement over the 670G, the price can be prohibitive, running between $6,000 and $9,000. Medtronic says some of the cost is covered by insurance.\u003c/p>\n\u003cp>\u003cstrong>A Debate Over Alarms\u003c/strong>\u003c/p>\n\u003cp>Because low glucose levels can be so dangerous, most monitors have built-in alarms that go off when a patient’s glucose has dropped too low. However, Abbott’s FreeStyle Libre does not. Hirsch, the diabetes expert from the University of Washington, says because of this he recommends Dexcom’s CGM, even though the Libre is less expensive and easier to use.\u003c/p>\n\u003cp>The MiniMed 670G also has an alarm, and to patient Ken Reutell, 67, from Petaluma, California, this is a great feature. In the past he’s had to call 911 and has even passed out because his blood sugar had dropped so low. He's used the 670G for six months and says the alarm alerts him well before he gets to that point. Other users, however, have \u003ca href=\"https://www.reddit.com/r/diabetes_t1/comments/7sjpsi/just_placed_on_order_for_the_medtronic_790/dt5oh0l/\" target=\"_blank\" rel=\"noopener\">complained\u003c/a> that the 670G’s alarm is loud and goes off too frequently.\u003c/p>\n\u003cp>And while the device can alert a patient to a dangerously low glucose level, it can’t do anything about it because it doesn’t administer glucose.\u003c/p>\n\u003cp>“(W)hen you get too low, your liver starts pumping out more glucose. That’s something that insulin pumps don’t do yet,” Reutell laments.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>Something for the next generation of devices, perhaps.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003ch3>\u003cem>Continuous glucose monitors have been around for over a decade, but reductions in cost and improvements in quality have enticed more patients and doctors to try them out.\u003c/em>\u003c/h3>\n\u003cp>For Melissa Lee, the worst part of diabetes isn’t pricking her finger to check her glucose level or changing her diet to keep her blood sugar in check. Rather, it’s the constant worry and mental calculations.\u003c/p>\n\u003caside class=\"pullquote alignright\">'In a perfect world, everybody with diabetes would benefit from some form of this technology.'\u003ccite>Kathleen Dungan, Ohio State University\u003c/cite>\u003c/aside>\n\u003cp>“You have to think about what did I eat last, how much insulin did I take for that, where is my blood sugar now, which direction is it trending, and then based on that, what am I going to eat?” she says. “You’re making these educated guesses about how much of a really volatile hormone [insulin] to take, and that is mentally exhausting.”\u003c/p>\n\u003cp>Lee, 38, who was diagnosed with Type 1 diabetes when she was 10, recounts ruined dates, missed flights and abandoned excursions, all because she was worried about her glucose level or forgot to bring a replacement for her insulin pump.\u003c/p>\n\u003cp>“You can go from being okay to being really not okay in a moment’s notice,” says Lee, who lives in Milpitas, California and works as the director of community relations at Bigfoot Biomedical.\u003c/p>\n\u003cp>To relieve some of the burden for the estimated 9.3 million people who use insulin to regulate diabetes, medical device makers have introduced new ways to monitor glucose and administer insulin.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cstrong>Better Glucose Management\u003c/strong>\u003c/p>\n\u003cfigure id=\"attachment_440097\" class=\"wp-caption aligncenter\" style=\"max-width: 539px\">\u003cimg class=\"wp-image-440097 size-full\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/03/RS29282_LIBRE_020718_002-sfi.jpg\" alt=\"FreeStyle Libre\" width=\"539\" height=\"360\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2018/03/RS29282_LIBRE_020718_002-sfi.jpg 539w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/RS29282_LIBRE_020718_002-sfi-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/RS29282_LIBRE_020718_002-sfi-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/RS29282_LIBRE_020718_002-sfi-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/RS29282_LIBRE_020718_002-sfi-520x347.jpg 520w\" sizes=\"(max-width: 539px) 100vw, 539px\">\u003cfigcaption class=\"wp-caption-text\">Melissa Lee displays the components of the FreeStyle Libre, her blood glucose monitor. \u003ccite>(Lauren Hanussak/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Continuous glucose monitors, or CGMs, have been around for over a decade, but poor quality and high costs have been barriers to use, says Irl Hirsch, who holds the Diabetes Treatment and Teaching Chair at the University of Washington School of Medicine. But improvements on both fronts lead him to believe that CGMs will soon become the standard of care. At his own clinic, 60 percent of patients use one.\u003c/p>\n\u003cp>“The financial impact and the insurance coverage is not the barrier that it used to be,” Hirsch says. What’s more, “The quality and the accuracy of these things have just gotten better.”\u003c/p>\n\u003cp>CGMs measure glucose levels not in blood but in the interstitial fluid, which surrounds the cells just underneath the skin. A sensor sticks onto the body, typically on the upper arm or abdomen, with a small, flexible needle that penetrates the skin. The sensor takes a reading every 5 to 15 minutes and transmits that information to a separate receiver or a smartphone app, which patients can check at any time. The reading shows their current glucose level and a trend graph for the last eight hours. If the number is high and rising, the patient can bring their glucose down using insulin; if it’s low and dropping, they need to eat some sugar, fast.\u003c/p>\n\u003cp>“It's very exciting technology. I think it's really revolutionizing diabetes care,” says Kathleen Dungan, an associate professor of medicine at Ohio State University who runs the school’s endocrine clinical trials unit. “In a perfect world, everybody with diabetes would benefit from some form of this technology.”\u003c/p>\n\u003cp>\u003cstrong>Too Little Insulin\u003c/strong>\u003c/p>\n\u003cp>Every time you eat, your pancreas pumps out insulin to help your cells extract glucose from the blood and use it for fuel. In Type I diabetes, the pancreas stops producing insulin, while in Type II the cells can’t utilize the hormone properly. In either case, too little insulin causes excessive blood glucose levels. Chronic high blood sugar, or hyperglycemia, can lead to heart disease, kidney disease, stroke, nerve damage, blindness and loss of limbs.\u003c/p>\n\u003cfigure id=\"attachment_440099\" class=\"wp-caption aligncenter\" style=\"max-width: 539px\">\u003cimg class=\"size-full wp-image-440099\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/03/RS29281_LIBRE_020718_001-sfi.jpg\" alt=\"Melissa Lee, who was diagnosed with type one diabetes at 10 years old, models the FreeStyle Libre in Hayward, Calif.\" width=\"539\" height=\"360\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2018/03/RS29281_LIBRE_020718_001-sfi.jpg 539w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/RS29281_LIBRE_020718_001-sfi-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/RS29281_LIBRE_020718_001-sfi-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/RS29281_LIBRE_020718_001-sfi-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/RS29281_LIBRE_020718_001-sfi-520x347.jpg 520w\" sizes=\"(max-width: 539px) 100vw, 539px\">\u003cfigcaption class=\"wp-caption-text\">Melissa Lee, who was diagnosed with Type 1 diabetes at 10 years old, models the FreeStyle Libre, \u003ccite>(Lauren Hanussak/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>In contrast, too much insulin results in low blood sugar, or hypoglycemia, which can cause weakness, dizzy spells, seizures, shaking, fainting and even death.\u003c/p>\n\u003cp>Patients typically use blood glucose meters that measure sugar levels in a drop of blood to determine if they need to take more insulin or not. However, having to prick your finger and draw blood to check your glucose level can be a major hurdle for maintaining normal blood sugar. Some patients may have aversions to needles, while others may have difficulty creating a sterile environment in which to take a reading.\u003c/p>\n\u003cp>\u003cstrong>Popular CGMs\u003c/strong>\u003c/p>\n\u003cp>CGMs aim to ease that pain and inconvenience. Dexcom and Abbott are two of the largest producers of CGMs, with Abbott’s FreeStyle Libre the newest device approved by the FDA, in September 2017.\u003c/p>\n\u003cp>The Libre sensors last for 10 days and cost $59 each. Sensors for Dexcom’s G4 or G5 system are $350 for a pack of four and have to be replaced every seven days. Patients also have to purchase a receiver, about $60 for the Libre versus $465 for the Dexcom G5. Finally, Dexcom requires a separate transmitter to send the glucose information to the receiver, another $595. Both companies’ devices are covered by major insurance providers and Medicare, so the actual cost to patients varies.\u003c/p>\n\u003cfigure id=\"attachment_440100\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003cimg class=\"size-large wp-image-440100\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/03/IMG_0829-1020x680.jpg\" alt=\"Ken Reutell of Petaluma, Calif. displays his MiniMed 670G\" width=\"640\" height=\"427\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0829-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0829-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0829-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0829-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0829-1920x1280.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0829-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0829-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0829-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0829-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0829-520x347.jpg 520w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003cfigcaption class=\"wp-caption-text\">Ken Reutell of Petaluma, Calif. displays his MiniMed 670G. \u003ccite>(Danielle Venton/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The Libre is the only monitor that doesn’t have to be calibrated daily with a traditional blood glucose reading, meaning patients never have to prick their fingers.\u003c/p>\n\u003cp>Studies show that patients who use a CGM have \u003ca href=\"http://care.diabetesjournals.org/content/40/Supplement_1/S48\" target=\"_blank\" rel=\"noopener\">better control over their diabetes\u003c/a> than patients who use traditional blood glucose tests. Doctors recommend patients check their glucose between \u003ca href=\"https://www.mayoclinic.org/diseases-conditions/diabetes/in-depth/blood-sugar/art-20046628\" target=\"_blank\" rel=\"noopener\">4 and 10 times per day\u003c/a>, but in reality, only \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/14999899\" target=\"_blank\" rel=\"noopener\">one-third of patients\u003c/a> test themselves as often as they should. Abbott says patients using its device easily exceed this standard, checking on average 16 times a day.\u003c/p>\n\u003cp>Lee, who uses the FreeStyle Libre, says being able to easily check her blood glucose helps her know how it's affected by her diet. “You suddenly have this insight into how actions you took actually affected some kind of diabetes outcome,” she says.\u003c/p>\n\u003cp>Another Type 1 diabetes patient, Lisa Trahan, 33, yses the Dexcom G4 and says it’s “terrific.” Trahan, a clinical psychologist based in San Marcos, Texas, says the frequent readings provide her with more peace of mind, especially before exercising or eating. However, she still doesn’t trust the device enough to forego pricking her finger to double check the numbers.\u003c/p>\n\u003cfigure id=\"attachment_440101\" class=\"wp-caption alignright\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-440101\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/03/IMG_0816-800x533.jpg\" alt=\"A man's hand holds a small gaget.\" width=\"800\" height=\"533\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0816-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0816-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0816-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0816-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0816-1920x1280.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0816-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0816-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0816-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0816-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0816-520x347.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Ken Reutell's MiniMed 670G means he spends less time pricking himself to monitor his blood glucose levels. \u003ccite>(Danielle Venton/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“I can trust the CGM reading of my Dexcom G4 to be within 20 percent in either direction of my actual blood sugar reading,” she explains. But, she says, that range can make a big difference when tinkering with blood sugar or insulin. “I use the alert as a suggestion to check my blood sugar and go from there.”\u003c/p>\n\u003cp>\u003cstrong>Smarter Insulin Pumps\u003c/strong>\u003c/p>\n\u003cp>Besides checking blood sugar, the other part of managing diabetes is taking insulin, either with an injection or an insulin pump.\u003c/p>\n\u003cp>Traditional insulin pumps are preset to deliver different doses at certain times of the day. However, it can be difficult to match the correct dose to fluctuations in glucose levels that occur naturally throughout the day or because of diet or exercise. A patient or doctor can adjust the levels manually, but it requires complex calculations and typically isn’t done every day.\u003c/p>\n\u003cp>Medtronic’s MiniMed 670G, the first integrated CGM-insulin pump system approved by the FDA in 2016, aims to solve that problem. The 670G can vary the amount of insulin it delivers as often as every five minutes, in response to input from an integrated glucose monitor.\u003c/p>\n\u003cp>The only calculation patients have to make is to manually deliver a boost of insulin every time they eat that is proportionate to the number of carbohydrates in the meal. They also need to prick their fingers three times a day to calibrate the system.\u003c/p>\n\u003cp>Despite the excitement over the 670G, the price can be prohibitive, running between $6,000 and $9,000. Medtronic says some of the cost is covered by insurance.\u003c/p>\n\u003cp>\u003cstrong>A Debate Over Alarms\u003c/strong>\u003c/p>\n\u003cp>Because low glucose levels can be so dangerous, most monitors have built-in alarms that go off when a patient’s glucose has dropped too low. However, Abbott’s FreeStyle Libre does not. Hirsch, the diabetes expert from the University of Washington, says because of this he recommends Dexcom’s CGM, even though the Libre is less expensive and easier to use.\u003c/p>\n\u003cp>The MiniMed 670G also has an alarm, and to patient Ken Reutell, 67, from Petaluma, California, this is a great feature. In the past he’s had to call 911 and has even passed out because his blood sugar had dropped so low. He's used the 670G for six months and says the alarm alerts him well before he gets to that point. Other users, however, have \u003ca href=\"https://www.reddit.com/r/diabetes_t1/comments/7sjpsi/just_placed_on_order_for_the_medtronic_790/dt5oh0l/\" target=\"_blank\" rel=\"noopener\">complained\u003c/a> that the 670G’s alarm is loud and goes off too frequently.\u003c/p>\n\u003cp>And while the device can alert a patient to a dangerously low glucose level, it can’t do anything about it because it doesn’t administer glucose.\u003c/p>\n\u003cp>“(W)hen you get too low, your liver starts pumping out more glucose. That’s something that insulin pumps don’t do yet,” Reutell laments.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Something for the next generation of devices, perhaps.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Landmark Report Concludes Abortion in U.S. is Safe",
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"content": "\u003cp>Abortions in the United States are safe and have few complications, according to a landmark new study by the National Academies of Sciences, Engineering and Medicine.\u003c/p>\n\u003cp>The \u003ca href=\"https://www.nap.edu/catalog/24950/the-safety-and-quality-of-abortion-care-in-the-united-states\">report\u003c/a>, called \"The Safety and Quality of Abortion Care in the United States,\" examined the four major methods used for abortions — medication, aspiration, dilation and evacuation, and induction — and examined women's care from before they had the procedure through their follow-up care.[contextly_sidebar id=\"jMTkDIjBqWWCgCakps1aEu2Qa7NrZakX\"]\u003c/p>\n\u003cp>\"I would say the main takeaway is that abortions that are provided in the United States are safe and effective,\" says \u003ca href=\"http://www.coloradotrust.org/content/ned-calonge-md-mph\" target=\"_blank\" rel=\"noopener\">Ned Calonge\u003c/a>, the co-chair of the committee that wrote the study. He is an associate professor of family medicine and epidemiology at the University of Colorado and CEO of \u003ca href=\"http://www.coloradotrust.org/\" target=\"_blank\" rel=\"noopener\">The Colorado Trust\u003c/a>.\u003c/p>\n\u003cp>Calonge says the researchers found that about 90 percent of all abortions happen in the first 12 weeks of pregnancy. And complications for all abortions are \"rare,\" the report says.\u003c/p>\n\u003cp>But the report did find that state laws and regulations can interfere with safe abortions.[contextly_sidebar id=\"zTJU1sTa18fez3ecDq44jqN6KfYhyHGL\"]\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"Abortion-specific regulations in many states create barriers to safe and effective care,\" the report says.\u003c/p>\n\u003cp>Calonge says those rules often have no basis in medical research.\u003c/p>\n\u003cp>\"There are some requirements that require clinicians to misinform women of the health risks, that say you have to inform a woman that an abortion will increase her risk of breast cancer,\" he says.\u003c/p>\n\u003cp>There is no evidence that breast cancer follows abortion, for example, but \u003ca href=\"https://www.guttmacher.org/gpr/2006/10/misinformed-consent-medical-accuracy-state-developed-abortion-counseling-materials\">five states\u003c/a> require doctors to tell women there is a link, according to the Guttmacher Institute, a research group that focuses on reproductive and sexual health.\u003c/p>\n\u003cp>\"There are policies that mandate clinically unnecessary services like pre-abortion ultrasounds, separate inpatient counseling. There are required waiting periods,\" Calonge says.\u003c/p>\n\u003cp>According to Guttmacher, 27 states make women wait at least 24 hours for an abortion and 11 states require women to have an ultrasound before they can terminate their pregnancy.\u003c/p>\n\u003cp>And there are state laws that dictate who can perform abortions and where they can do them. Some require all abortions to happen in the equivalent of a hospital or surgery center. Others require a doctor to have admitting privileges at a nearby hospital.\u003c/p>\n\u003cp>The National Academies report says waiting periods and requirements for unnecessary tests can result in long delays because women may have to travel to get care and have trouble getting appointments.\u003c/p>\n\u003cp>\"Delays put the patient at greater risk of an adverse event,\" the report says.\u003c/p>\n\u003cp>Hal Lawrence, the CEO of the American College of Obstetricians and Gynecologists, says the report settles the debate over abortion-restricting laws and regulations.\u003c/p>\n\u003cp>\"Those sorts of laws have been totally debunked,\" he says.\u003c/p>\n\u003cp>He says the study shows most of those laws do nothing to improve women's health.\u003c/p>\n\u003cp>\"Abortion is safer when it's performed earlier in gestation,\" Lawrence says. \"And so delaying and making people wait and go through hoops of unnecessary, extra procedures does not improve the safety. And actually by having them delay can actually worsen the safety.\"\u003c/p>\n\u003cp>The U.S. Supreme Court in 2016 voided some state abortion laws when it ruled that Texas' strict rules around abortion facilities impose an undue burden on women. But other laws remain in place even without any backing in medical research.\u003c/p>\n\u003cp>Still, Donna Harrison says there are good reasons for the requirements.\u003c/p>\n\u003cp>\"The tendency to look at abortion as though it were not a serious medical procedure is irresponsible. I mean, we all know that the fetus is killed during an abortion but women can be harmed by irresponsible medical care,\" says Harrison, the executive director of the \u003ca href=\"http://aaplog.org/\" target=\"_blank\" rel=\"noopener\">American Association of Pro-Life Obstetricians and Gynecologists\u003c/a>.\u003c/p>\n\u003cp>She says data on complications from abortion is incomplete because doctors and patients don't always report it accurately, or at all.\u003c/p>\n\u003cp>\u003cem>\"\u003c/em>There is no good data collection — and when you have garbage in, and you have garbage out,\" she says.\u003c/p>\n\u003cp>And she says waiting periods are important so that women can give fully informed consent before they undergo what she says is a sometimes dangerous, surgical procedure.\u003c/p>\n\u003cp>The new report — which runs more than 200 pages — addresses most aspects of abortion care, including the use of the abortion pill \u003ca href=\"https://www.accessdata.fda.gov/drugsatfda_docs/label/2000/20687lbl.htm\" target=\"_blank\" rel=\"noopener\">mifepristone\u003c/a>.\u003c/p>\n\u003cp>For example, it concludes that the strict requirements on how doctors can administer mifepristone may need review. The researchers say the rules may be erecting unnecessary barriers.\u003c/p>\n\u003cp>The report also says nurse practitioners and physician assistants can perform abortions just as safely as physicians.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Also, abortions have no long-term consequences on women's physical and mental health, the report says.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit \u003ca href=\"http://www.npr.org/\" target=\"_blank\" rel=\"noopener\">http://www.npr.org/\u003c/a>.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Landmark+Report+Concludes+Abortion+In+U.S.+Is+Safe+&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Abortions in the United States are safe and have few complications, according to a landmark new study by the National Academies of Sciences, Engineering and Medicine.\u003c/p>\n\u003cp>The \u003ca href=\"https://www.nap.edu/catalog/24950/the-safety-and-quality-of-abortion-care-in-the-united-states\">report\u003c/a>, called \"The Safety and Quality of Abortion Care in the United States,\" examined the four major methods used for abortions — medication, aspiration, dilation and evacuation, and induction — and examined women's care from before they had the procedure through their follow-up care.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\"I would say the main takeaway is that abortions that are provided in the United States are safe and effective,\" says \u003ca href=\"http://www.coloradotrust.org/content/ned-calonge-md-mph\" target=\"_blank\" rel=\"noopener\">Ned Calonge\u003c/a>, the co-chair of the committee that wrote the study. He is an associate professor of family medicine and epidemiology at the University of Colorado and CEO of \u003ca href=\"http://www.coloradotrust.org/\" target=\"_blank\" rel=\"noopener\">The Colorado Trust\u003c/a>.\u003c/p>\n\u003cp>Calonge says the researchers found that about 90 percent of all abortions happen in the first 12 weeks of pregnancy. And complications for all abortions are \"rare,\" the report says.\u003c/p>\n\u003cp>But the report did find that state laws and regulations can interfere with safe abortions.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"Abortion-specific regulations in many states create barriers to safe and effective care,\" the report says.\u003c/p>\n\u003cp>Calonge says those rules often have no basis in medical research.\u003c/p>\n\u003cp>\"There are some requirements that require clinicians to misinform women of the health risks, that say you have to inform a woman that an abortion will increase her risk of breast cancer,\" he says.\u003c/p>\n\u003cp>There is no evidence that breast cancer follows abortion, for example, but \u003ca href=\"https://www.guttmacher.org/gpr/2006/10/misinformed-consent-medical-accuracy-state-developed-abortion-counseling-materials\">five states\u003c/a> require doctors to tell women there is a link, according to the Guttmacher Institute, a research group that focuses on reproductive and sexual health.\u003c/p>\n\u003cp>\"There are policies that mandate clinically unnecessary services like pre-abortion ultrasounds, separate inpatient counseling. There are required waiting periods,\" Calonge says.\u003c/p>\n\u003cp>According to Guttmacher, 27 states make women wait at least 24 hours for an abortion and 11 states require women to have an ultrasound before they can terminate their pregnancy.\u003c/p>\n\u003cp>And there are state laws that dictate who can perform abortions and where they can do them. Some require all abortions to happen in the equivalent of a hospital or surgery center. Others require a doctor to have admitting privileges at a nearby hospital.\u003c/p>\n\u003cp>The National Academies report says waiting periods and requirements for unnecessary tests can result in long delays because women may have to travel to get care and have trouble getting appointments.\u003c/p>\n\u003cp>\"Delays put the patient at greater risk of an adverse event,\" the report says.\u003c/p>\n\u003cp>Hal Lawrence, the CEO of the American College of Obstetricians and Gynecologists, says the report settles the debate over abortion-restricting laws and regulations.\u003c/p>\n\u003cp>\"Those sorts of laws have been totally debunked,\" he says.\u003c/p>\n\u003cp>He says the study shows most of those laws do nothing to improve women's health.\u003c/p>\n\u003cp>\"Abortion is safer when it's performed earlier in gestation,\" Lawrence says. \"And so delaying and making people wait and go through hoops of unnecessary, extra procedures does not improve the safety. And actually by having them delay can actually worsen the safety.\"\u003c/p>\n\u003cp>The U.S. Supreme Court in 2016 voided some state abortion laws when it ruled that Texas' strict rules around abortion facilities impose an undue burden on women. But other laws remain in place even without any backing in medical research.\u003c/p>\n\u003cp>Still, Donna Harrison says there are good reasons for the requirements.\u003c/p>\n\u003cp>\"The tendency to look at abortion as though it were not a serious medical procedure is irresponsible. I mean, we all know that the fetus is killed during an abortion but women can be harmed by irresponsible medical care,\" says Harrison, the executive director of the \u003ca href=\"http://aaplog.org/\" target=\"_blank\" rel=\"noopener\">American Association of Pro-Life Obstetricians and Gynecologists\u003c/a>.\u003c/p>\n\u003cp>She says data on complications from abortion is incomplete because doctors and patients don't always report it accurately, or at all.\u003c/p>\n\u003cp>\u003cem>\"\u003c/em>There is no good data collection — and when you have garbage in, and you have garbage out,\" she says.\u003c/p>\n\u003cp>And she says waiting periods are important so that women can give fully informed consent before they undergo what she says is a sometimes dangerous, surgical procedure.\u003c/p>\n\u003cp>The new report — which runs more than 200 pages — addresses most aspects of abortion care, including the use of the abortion pill \u003ca href=\"https://www.accessdata.fda.gov/drugsatfda_docs/label/2000/20687lbl.htm\" target=\"_blank\" rel=\"noopener\">mifepristone\u003c/a>.\u003c/p>\n\u003cp>For example, it concludes that the strict requirements on how doctors can administer mifepristone may need review. The researchers say the rules may be erecting unnecessary barriers.\u003c/p>\n\u003cp>The report also says nurse practitioners and physician assistants can perform abortions just as safely as physicians.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Also, abortions have no long-term consequences on women's physical and mental health, the report says.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit \u003ca href=\"http://www.npr.org/\" target=\"_blank\" rel=\"noopener\">http://www.npr.org/\u003c/a>.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Landmark+Report+Concludes+Abortion+In+U.S.+Is+Safe+&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Prospective Parents in Limbo After 2 Accidents Destroy Fertility Clinic Embryos",
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"content": "\u003cp>Two refrigeration failures at fertility clinics in different states, coincidentally occurring on March 4, are raising questions about oversight of the industry and triggered several lawsuits.\u003c/p>\n\u003caside class=\"pullquote alignright\">'We know something has happened but we don't know if our four embryos are alive still.'\u003c/aside>\n\u003cp>In San Francisco, the Pacific Fertility Center says it is still assessing the extent of the damage to the embryos and eggs it stores, said San Francisco Chronicle reporter Catherine Ho on KQED's \u003ca href=\"https://www.kqed.org/forum/2010101864351/woman-sues-fertility-center-after-equipment-failure-destroys-her-eggs\" target=\"_blank\" rel=\"noopener\">Forum program\u003c/a> Friday.\u003c/p>\n\u003cp>One of those clients includes Bill Taroli, who told Forum host Mina Kim he first learned about the malfunction on the evening news. After contacting the center, he and his partner were informed their frozen embryos were in the impacted tank. But it will take at least another week before they learn whether their vials were damaged.\u003c/p>\n\u003cp>\"It's like waiting for any major test. 'Do we have cancer?' We're in this limbo,\" said Taroli, who said he spent $50,000 for the procedure. \"We know something has happened but we don't know if our four embryos are alive still.\"\u003c/p>\n\u003cp>The problem was discovered during a routine check by a senior embryologist who noticed that the liquid nitrogen levels in one tank had dipped to very low levels, affecting thousands of frozen eggs and embryos belonging to about 500 clients.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The tanks rely on liquid nitrogen to keep the frozen vials at the correct storage temperature.\u003c/p>\n\u003cp>The clinic has not yet announced the number of people impacted, said Ho. In a statement, Pacific Fertility Center said, \"The vast majority of the eggs and embryos in the lab were unaffected.\"\u003c/p>\n\u003cp>One of the company's clients includes an unnamed woman who learned on Sunday that her frozen eggs were destroyed. She has since filed a class action lawsuit against the company, seeking $5 million in damages for gross negligence stemming from a failure to properly maintain equipment. That figure is the minimum required to file a class-action suit in federal court.\u003c/p>\n\u003cp>Steven Tindall, the attorney for the woman, told Forum the facility lacked a real-time monitoring system that could have immediately alerted staff of a drop in nitrogen levels.\u003c/p>\n\u003cp>In a statement issued Wednesday, the company said it took immediate action once the malfunction was discovered:\u003c/p>\n\u003cblockquote>\u003cp>On March 4, a single piece of equipment in our cryogenic storage lab lost liquid nitrogen for a brief period of time. We do know that there is viable tissue from this tank. The rest of the tanks were not affected and the equipment was immediately retired. The vast majority of the eggs and embryos in the lab were unaffected and the facility is operating securely. As soon as the issue was discovered, our most senior embryologist took immediate action to transfer those tissues from the affected equipment to a new piece of equipment. And we have brought independent experts and are conducting a full investigation. We are truly sorry this happened and for the anxiety that this will surely cause.\u003c/p>\u003c/blockquote>\n\u003cp>The cost of storing frozen eggs or embryos is $600 a year, according to the center's website. But the entire process can cost anywhere between $10,000 to $100,000, said the Chronicle's Ho. Aside from the financial costs, the process can be emotionally draining for prospective parents.\u003c/p>\n\u003cp>Some of the clinic's clients include former cancer patients who had their eggs taken out in advance of cancer treatments, Tindall said.\u003c/p>\n\u003cp>\"Those people may have lost their opportunity to have biological children.\"\u003c/p>\n\u003cp>\u003cstrong>Ohio Incident\u003c/strong>\u003c/p>\n\u003cp>In a bizarre coincidence, a similar tank malfunction occurred at a Cleveland-based fertility clinic on the same day as the accident in San Francisco. The\u003ca href=\"http://www.cleveland.com/healthfit/index.ssf/2018/03/university_hospitals_notifies.html\" target=\"_blank\" rel=\"noopener\"> Cleveland Plain-Dealer\u003c/a> reported that the University Hospitals Fertility Center lost frozen eggs and embryos from 700 patients. Lawsuits have been filed in this incident as well, according to \u003ca href=\"https://www.washingtonpost.com/news/to-your-health/wp/2018/03/14/class-action-lawsuit-filed-against-pacific-fertility-for-loss-of-up-to-thousands-of-embryos-and-eggs/?utm_term=.705a90a7aa98\" target=\"_blank\" rel=\"noopener\">The Washington Post\u003c/a>.\u003c/p>\n\u003cp>The loss of potentially thousands of eggs and embryos from both clinics mark the biggest such loss on record in the U.S.\u003c/p>\n\u003cp>Regulations for oversight of fertility clinics vary by state. California, for example, requires clinics to be accredited by the Laboratory Field Services division of the California Department of Public Health. Ohio has no such licensing requirement.\u003c/p>\n\u003cp>\"The United States is the Wild West of the fertility industry,” Marcy Darnovsky, executive director of the Center for Genetics and Society told the Pew Charitable Trust's \u003ca href=\"http://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2015/3/18/states-not-eager-to-regulate-fertility-industry\" target=\"_blank\" rel=\"noopener\">Stateline\u003c/a> in 2015.\u003c/p>\n\u003cp>Data shows that 1.5 percent of all infants born in the U.S. are conceived using assisted reproductive technology, according to the \u003ca href=\"https://www.cdc.gov/art/artdata/index.html\" target=\"_blank\" rel=\"noopener\">Centers for Disease Control and Prevention. \u003c/a>More than 60,000 U.S. births in 2015 resulted from such methods.\u003c/p>\n\u003cp>The American Society for Reproductive Medicine does issue guidelines for fertility clinics, but they are not mandatory. The center has been accused of prioritizing the business interests of its members.\u003c/p>\n\u003cp>“It’s a field characterized by strong antiregulatory sentiment because it evolved as a business, not a research enterprise,” Arthur Caplan, director of the division of Medical Ethics at New York University’s School of Medicine, told Pew Charitable Trust.\u003c/p>\n\u003cp>For Taroli, the question of liability doesn't change how the experience has affected him and his partner.\u003c/p>\n\u003cp>\"The reality is ... we've all been affected. Even if it turns out that our embryos are okay,\" he says, \"we're still going through this madness right now of not knowing and we’re worried about whether or not they're still alive.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>The Associated Press contributed to this report.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Two refrigeration failures at fertility clinics in different states, coincidentally occurring on March 4, are raising questions about oversight of the industry and triggered several lawsuits.\u003c/p>\n\u003caside class=\"pullquote alignright\">'We know something has happened but we don't know if our four embryos are alive still.'\u003c/aside>\n\u003cp>In San Francisco, the Pacific Fertility Center says it is still assessing the extent of the damage to the embryos and eggs it stores, said San Francisco Chronicle reporter Catherine Ho on KQED's \u003ca href=\"https://www.kqed.org/forum/2010101864351/woman-sues-fertility-center-after-equipment-failure-destroys-her-eggs\" target=\"_blank\" rel=\"noopener\">Forum program\u003c/a> Friday.\u003c/p>\n\u003cp>One of those clients includes Bill Taroli, who told Forum host Mina Kim he first learned about the malfunction on the evening news. After contacting the center, he and his partner were informed their frozen embryos were in the impacted tank. But it will take at least another week before they learn whether their vials were damaged.\u003c/p>\n\u003cp>\"It's like waiting for any major test. 'Do we have cancer?' We're in this limbo,\" said Taroli, who said he spent $50,000 for the procedure. \"We know something has happened but we don't know if our four embryos are alive still.\"\u003c/p>\n\u003cp>The problem was discovered during a routine check by a senior embryologist who noticed that the liquid nitrogen levels in one tank had dipped to very low levels, affecting thousands of frozen eggs and embryos belonging to about 500 clients.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The tanks rely on liquid nitrogen to keep the frozen vials at the correct storage temperature.\u003c/p>\n\u003cp>The clinic has not yet announced the number of people impacted, said Ho. In a statement, Pacific Fertility Center said, \"The vast majority of the eggs and embryos in the lab were unaffected.\"\u003c/p>\n\u003cp>One of the company's clients includes an unnamed woman who learned on Sunday that her frozen eggs were destroyed. She has since filed a class action lawsuit against the company, seeking $5 million in damages for gross negligence stemming from a failure to properly maintain equipment. That figure is the minimum required to file a class-action suit in federal court.\u003c/p>\n\u003cp>Steven Tindall, the attorney for the woman, told Forum the facility lacked a real-time monitoring system that could have immediately alerted staff of a drop in nitrogen levels.\u003c/p>\n\u003cp>In a statement issued Wednesday, the company said it took immediate action once the malfunction was discovered:\u003c/p>\n\u003cblockquote>\u003cp>On March 4, a single piece of equipment in our cryogenic storage lab lost liquid nitrogen for a brief period of time. We do know that there is viable tissue from this tank. The rest of the tanks were not affected and the equipment was immediately retired. The vast majority of the eggs and embryos in the lab were unaffected and the facility is operating securely. As soon as the issue was discovered, our most senior embryologist took immediate action to transfer those tissues from the affected equipment to a new piece of equipment. And we have brought independent experts and are conducting a full investigation. We are truly sorry this happened and for the anxiety that this will surely cause.\u003c/p>\u003c/blockquote>\n\u003cp>The cost of storing frozen eggs or embryos is $600 a year, according to the center's website. But the entire process can cost anywhere between $10,000 to $100,000, said the Chronicle's Ho. Aside from the financial costs, the process can be emotionally draining for prospective parents.\u003c/p>\n\u003cp>Some of the clinic's clients include former cancer patients who had their eggs taken out in advance of cancer treatments, Tindall said.\u003c/p>\n\u003cp>\"Those people may have lost their opportunity to have biological children.\"\u003c/p>\n\u003cp>\u003cstrong>Ohio Incident\u003c/strong>\u003c/p>\n\u003cp>In a bizarre coincidence, a similar tank malfunction occurred at a Cleveland-based fertility clinic on the same day as the accident in San Francisco. The\u003ca href=\"http://www.cleveland.com/healthfit/index.ssf/2018/03/university_hospitals_notifies.html\" target=\"_blank\" rel=\"noopener\"> Cleveland Plain-Dealer\u003c/a> reported that the University Hospitals Fertility Center lost frozen eggs and embryos from 700 patients. Lawsuits have been filed in this incident as well, according to \u003ca href=\"https://www.washingtonpost.com/news/to-your-health/wp/2018/03/14/class-action-lawsuit-filed-against-pacific-fertility-for-loss-of-up-to-thousands-of-embryos-and-eggs/?utm_term=.705a90a7aa98\" target=\"_blank\" rel=\"noopener\">The Washington Post\u003c/a>.\u003c/p>\n\u003cp>The loss of potentially thousands of eggs and embryos from both clinics mark the biggest such loss on record in the U.S.\u003c/p>\n\u003cp>Regulations for oversight of fertility clinics vary by state. California, for example, requires clinics to be accredited by the Laboratory Field Services division of the California Department of Public Health. Ohio has no such licensing requirement.\u003c/p>\n\u003cp>\"The United States is the Wild West of the fertility industry,” Marcy Darnovsky, executive director of the Center for Genetics and Society told the Pew Charitable Trust's \u003ca href=\"http://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2015/3/18/states-not-eager-to-regulate-fertility-industry\" target=\"_blank\" rel=\"noopener\">Stateline\u003c/a> in 2015.\u003c/p>\n\u003cp>Data shows that 1.5 percent of all infants born in the U.S. are conceived using assisted reproductive technology, according to the \u003ca href=\"https://www.cdc.gov/art/artdata/index.html\" target=\"_blank\" rel=\"noopener\">Centers for Disease Control and Prevention. \u003c/a>More than 60,000 U.S. births in 2015 resulted from such methods.\u003c/p>\n\u003cp>The American Society for Reproductive Medicine does issue guidelines for fertility clinics, but they are not mandatory. The center has been accused of prioritizing the business interests of its members.\u003c/p>\n\u003cp>“It’s a field characterized by strong antiregulatory sentiment because it evolved as a business, not a research enterprise,” Arthur Caplan, director of the division of Medical Ethics at New York University’s School of Medicine, told Pew Charitable Trust.\u003c/p>\n\u003cp>For Taroli, the question of liability doesn't change how the experience has affected him and his partner.\u003c/p>\n\u003cp>\"The reality is ... we've all been affected. Even if it turns out that our embryos are okay,\" he says, \"we're still going through this madness right now of not knowing and we’re worried about whether or not they're still alive.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>The Associated Press contributed to this report.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>The Tsimane people are among the most isolated people in Bolivia. They number about 16,000 and live in 80 mostly riverbank villages of 50 to several hundred people scattered across about 3,000 square miles of Amazon jungle. They are forager-farmers who fish, hunt, cut down jungle trees with machetes and produce an \u003ca href=\"http://www.anth.ucsb.edu/people/michael-gurven\" target=\"_blank\" rel=\"noopener\">average of nine children per family,\u003c/a> says \u003ca href=\"http://www.anth.ucsb.edu/gurvenlab/\" target=\"_blank\" rel=\"noopener\">Michael Gurven\u003c/a>, chair of the Integrated Anthropological Sciences Unit at the University of California at Santa Barbara.[contextly_sidebar id=\"09DUGAe9ia3Jjr77ebYOxlbZOLjB4H3E\"]\u003c/p>\n\u003cp>Gurven has visited and studied the Tsimane people for 16 years. Last month, he and colleagues published a paper in the journal \u003ca href=\"https://www.sciencedirect.com/science/article/pii/S0277953618300170?via%3Dihub\" target=\"_blank\" rel=\"noopener\">\u003cem>Social Science & Medicine\u003c/em>\u003c/a> on why these impoverished people, who live an average of just over 50 years (compared to the \u003ca href=\"http://www.who.int/gho/mortality_burden_disease/life_tables/situation_trends/en/\" target=\"_blank\" rel=\"noopener\">world average of 71.5\u003c/a>), often won't take advantage of medical care, even when it's free and offered by people they've come to trust.\u003c/p>\n\u003cp>What the researchers found offers some clues about why many of us resist going to the doctor when things like rashes, coughs and pains make it pretty clear that we should. \u003ca href=\"https://www.jhsph.edu/faculty/directory/profile/1450/lisa-a-cooper\" target=\"_blank\" rel=\"noopener\">Dr. Lisa Cooper\u003c/a>, professor of medicine at Johns Hopkins University School of Medicine, is not connected with the social science study, but she studies medical adherence and preventive care in the U.S. She says the study shows that while providing medical services is important, it's not enough to ensure good health.[contextly_sidebar id=\"3WXNkyKOIWInX4REHuJ8jcJx7knSTAAA\"]\u003c/p>\n\u003cp>\"We also have to deal with belief systems, with world view, with spiritual beliefs,\" she says. \"We've got to take a much broader view of health.\"\u003c/p>\n\u003cp>When Gurven and his team made trips to Bolivia over the years, they brought medical teams to the most remote villages. \"We'd set up a camp and provide health care,\" he says. \"If there were 100 people in the village, maybe 70 would come. And every time, it would be the same people. I wondered: Were they the sickest? Why didn't others come? We didn't charge them, so money wasn't the reason. We were right there, so they didn't have to travel anywhere.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cstrong>Fatalism\u003c/strong>\u003cbr>\nIn less remote villages closer to bigger towns, health clinics existed. But in these villages as well, a lot of sick people didn't go for health care.\u003c/p>\n\u003cp>To find out why, researchers asked 690 people, ages 40 to 89, about their priorities, their perceptions about health, their knowledge of medical care. But they also probed deeper, looking into people's beliefs about the extent to which their actions mattered.\u003c/p>\n\u003cp>\"We tried to get at what they think,\" says Gurven. \"If they think they're in charge of what happens to them, that what they put into their body or what they do effects what happens, they're more likely to go to the doctor. With that feeling of control, they're likely to believe that medical treatment will help heal them, or that they might be able to prevent getting sick in the first place.[contextly_sidebar id=\"OQgAwOmNgvR0qCTeiOSMMaCmMZzhxqD5\"]\u003c/p>\n\u003cp>But people who think outside forces are in charge — fate or chance — are less likely to seek out care. They believe that nothing they do will matter, or matters far less than the forces of nature or the whims of others, so why bother, says Sarah Alami, a graduate student in anthropology at UC Santa Barbara and lead author of the study. It turned out that the Tsimane people largely believed that forces outside their control — like a mosquito bite that results in a deadly fever or a neighbor who puts a curse on them — mattered more than things within their control.\u003c/p>\n\u003cp>Alami has spent eight months in Bolivia, working with the Tsimane people. She's seen active people in good health: men felling tall trees, children using the jungle as a playground, women juggling a couple of kids while breastfeeding and fishing.\u003c/p>\n\u003cp>But she's also seen their ill health. A villager she met a few weeks ago might be gone on her next visit, having succumbed to dengue fever. \"You can see they're heavily burdened by parasites,\" she says. \"You see open sores that are infected, and they might not go for help. For something they know will kill them, like a snake bite, they'll try to go for help.\" But where it gets trickier, she says, is a less immediately urgent problem, like a cough that might be tuberculosis.[contextly_sidebar id=\"cdlKRlLfAt4DKi3kH575qPWqNDUsVBiC\"]\u003c/p>\n\u003cp>The researchers concluded that, from the point of view of a Tsimane villager, not taking advantage of medical care might be a rational decision. They know, Gurven says, that while they might get relief from a parasitic infection by going to a clinic, they also know that they're quite likely to get reinfected right away. Or maybe they'll be bitten by a snake on the way home, so they shouldn't risk venturing as far away as a health clinic.\u003c/p>\n\u003cp>The same kind of thinking in the U.S. keeps people from medical care, Cooper says. \"I liken it to what I see in disadvantaged communities where things are chaotic and people believe their circumstances are controlled by chance,\" she says. \"You go in for care, and the doctor tells you to eat better and exercise.\" But you can't afford to join a fitness center, and you live miles from any store that sells fresh fruits and vegetables. \"People living in chaotic environments might think that they don't have control over what's happening today, so why worry about what might happen in the future,\" she says.[contextly_sidebar id=\"KANLlW97Nqu1xraacTt3S4hyzVXssZqH\"]\u003c/p>\n\u003cp>Like the Tsimane, poor people in the U.S. might decide to skip medical care, she says. And from their point of view, it's a rational decision.\u003c/p>\n\u003cp>Even among middle-class people in the developed world, fears of losing control can lead people avoid medical care. \"People are afraid they're going to be diagnosed with something that will limit their employment, or that their disease is so serious, treatment won't work,\" Cooper says. So again, why bother.\u003c/p>\n\u003cp>Avoiding trips to the doctor happens all over the world. But a couple of things have worked to get the indigenous Bolivians to the clinic. \"We don't just explain the illness, and how a treatment will have an effect. Medical knowledge isn't the answer,\" Gurven says. \"We try to get them thinking that it matters to their family that they get treated. We get them thinking about their lives in the future. We ask them about their children's lives five years from now.\"\u003c/p>\n\u003cp>It's the line spouses all over the world use, Gurven says, to get their mates to the doctor: If you won't do it for yourself, think of the kids.\u003c/p>\n\u003chr>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>Susan Brink is a freelance writer who covers health and medicine. She is the author of \u003c/em>The Fourth Trimester\u003cem> and co-author of \u003c/em>A Change of Heart.\u003c/p>\n\u003chr>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=How+To+Get+People+To+See+A+Doctor+When+They+Don%27t+Want+To&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The Tsimane people are among the most isolated people in Bolivia. They number about 16,000 and live in 80 mostly riverbank villages of 50 to several hundred people scattered across about 3,000 square miles of Amazon jungle. They are forager-farmers who fish, hunt, cut down jungle trees with machetes and produce an \u003ca href=\"http://www.anth.ucsb.edu/people/michael-gurven\" target=\"_blank\" rel=\"noopener\">average of nine children per family,\u003c/a> says \u003ca href=\"http://www.anth.ucsb.edu/gurvenlab/\" target=\"_blank\" rel=\"noopener\">Michael Gurven\u003c/a>, chair of the Integrated Anthropological Sciences Unit at the University of California at Santa Barbara.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Gurven has visited and studied the Tsimane people for 16 years. Last month, he and colleagues published a paper in the journal \u003ca href=\"https://www.sciencedirect.com/science/article/pii/S0277953618300170?via%3Dihub\" target=\"_blank\" rel=\"noopener\">\u003cem>Social Science & Medicine\u003c/em>\u003c/a> on why these impoverished people, who live an average of just over 50 years (compared to the \u003ca href=\"http://www.who.int/gho/mortality_burden_disease/life_tables/situation_trends/en/\" target=\"_blank\" rel=\"noopener\">world average of 71.5\u003c/a>), often won't take advantage of medical care, even when it's free and offered by people they've come to trust.\u003c/p>\n\u003cp>What the researchers found offers some clues about why many of us resist going to the doctor when things like rashes, coughs and pains make it pretty clear that we should. \u003ca href=\"https://www.jhsph.edu/faculty/directory/profile/1450/lisa-a-cooper\" target=\"_blank\" rel=\"noopener\">Dr. Lisa Cooper\u003c/a>, professor of medicine at Johns Hopkins University School of Medicine, is not connected with the social science study, but she studies medical adherence and preventive care in the U.S. She says the study shows that while providing medical services is important, it's not enough to ensure good health.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\"We also have to deal with belief systems, with world view, with spiritual beliefs,\" she says. \"We've got to take a much broader view of health.\"\u003c/p>\n\u003cp>When Gurven and his team made trips to Bolivia over the years, they brought medical teams to the most remote villages. \"We'd set up a camp and provide health care,\" he says. \"If there were 100 people in the village, maybe 70 would come. And every time, it would be the same people. I wondered: Were they the sickest? Why didn't others come? We didn't charge them, so money wasn't the reason. We were right there, so they didn't have to travel anywhere.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cstrong>Fatalism\u003c/strong>\u003cbr>\nIn less remote villages closer to bigger towns, health clinics existed. But in these villages as well, a lot of sick people didn't go for health care.\u003c/p>\n\u003cp>To find out why, researchers asked 690 people, ages 40 to 89, about their priorities, their perceptions about health, their knowledge of medical care. But they also probed deeper, looking into people's beliefs about the extent to which their actions mattered.\u003c/p>\n\u003cp>\"We tried to get at what they think,\" says Gurven. \"If they think they're in charge of what happens to them, that what they put into their body or what they do effects what happens, they're more likely to go to the doctor. With that feeling of control, they're likely to believe that medical treatment will help heal them, or that they might be able to prevent getting sick in the first place.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>But people who think outside forces are in charge — fate or chance — are less likely to seek out care. They believe that nothing they do will matter, or matters far less than the forces of nature or the whims of others, so why bother, says Sarah Alami, a graduate student in anthropology at UC Santa Barbara and lead author of the study. It turned out that the Tsimane people largely believed that forces outside their control — like a mosquito bite that results in a deadly fever or a neighbor who puts a curse on them — mattered more than things within their control.\u003c/p>\n\u003cp>Alami has spent eight months in Bolivia, working with the Tsimane people. She's seen active people in good health: men felling tall trees, children using the jungle as a playground, women juggling a couple of kids while breastfeeding and fishing.\u003c/p>\n\u003cp>But she's also seen their ill health. A villager she met a few weeks ago might be gone on her next visit, having succumbed to dengue fever. \"You can see they're heavily burdened by parasites,\" she says. \"You see open sores that are infected, and they might not go for help. For something they know will kill them, like a snake bite, they'll try to go for help.\" But where it gets trickier, she says, is a less immediately urgent problem, like a cough that might be tuberculosis.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>The researchers concluded that, from the point of view of a Tsimane villager, not taking advantage of medical care might be a rational decision. They know, Gurven says, that while they might get relief from a parasitic infection by going to a clinic, they also know that they're quite likely to get reinfected right away. Or maybe they'll be bitten by a snake on the way home, so they shouldn't risk venturing as far away as a health clinic.\u003c/p>\n\u003cp>The same kind of thinking in the U.S. keeps people from medical care, Cooper says. \"I liken it to what I see in disadvantaged communities where things are chaotic and people believe their circumstances are controlled by chance,\" she says. \"You go in for care, and the doctor tells you to eat better and exercise.\" But you can't afford to join a fitness center, and you live miles from any store that sells fresh fruits and vegetables. \"People living in chaotic environments might think that they don't have control over what's happening today, so why worry about what might happen in the future,\" she says.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Like the Tsimane, poor people in the U.S. might decide to skip medical care, she says. And from their point of view, it's a rational decision.\u003c/p>\n\u003cp>Even among middle-class people in the developed world, fears of losing control can lead people avoid medical care. \"People are afraid they're going to be diagnosed with something that will limit their employment, or that their disease is so serious, treatment won't work,\" Cooper says. So again, why bother.\u003c/p>\n\u003cp>Avoiding trips to the doctor happens all over the world. But a couple of things have worked to get the indigenous Bolivians to the clinic. \"We don't just explain the illness, and how a treatment will have an effect. Medical knowledge isn't the answer,\" Gurven says. \"We try to get them thinking that it matters to their family that they get treated. We get them thinking about their lives in the future. We ask them about their children's lives five years from now.\"\u003c/p>\n\u003cp>It's the line spouses all over the world use, Gurven says, to get their mates to the doctor: If you won't do it for yourself, think of the kids.\u003c/p>\n\u003chr>\n\u003cp>\u003c/p>\u003c/div>",
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"disqusTitle": "Theranos and Elizabeth Holmes Charged With 'Massive Fraud' by SEC",
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"content": "\u003cp>It started as a massive success story — a wunderkind female college dropout disrupting the blood-testing industry and empowering patients to take charge of their own health.\u003c/p>\n\u003cp>[contextly_sidebar id=\"ga0lyGeskUZhaMZ1G6m0viMzWzc3RBPU\"]It ended as an almost archetypal cautionary tale about Silicon Valley hubris and its incompatibility with the slow developmental cycles of biomedicine.\u003c/p>\n\u003cp>The Securities and Exchange Commission today charged Bay Area-based Theranos, its founder and CEO Elizabeth Holmes, and former president Sunny Balwani with \"massive fraud,\" in the \u003ca href=\"https://www.sec.gov/news/press-release/2018-41\" target=\"_blank\" rel=\"noopener\">words\u003c/a> of the SEC.\u003c/p>\n\u003cp>Theranos' trangressions included \"raising more than $700 million from investors through an elaborate, years-long fraud in which they exaggerated or made false statements about the company's technology, business, and financial performance,\" according to the federal agency.\u003c/p>\n\u003cp>Holmes has agreed to give up her majority voting control of the company and to a reduction in her equity, the SEC said. Holmes also agreed to pay a $500,000 penalty and is now barred from serving as an officer or director of a public company for 10 years. As part of the settlement, both she and the company neither admitted nor denied wrongdoing.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Bulwani, apparently, has not settled. The SEC said it will litigate the charges against him in Northern California federal district court. Balwani's attorney told \u003ca href=\"https://www.cnbc.com/2018/03/14/theranos-ceo-holmes-and-former-president-balwani-charged-with-massive-fraud.html\" target=\"_blank\" rel=\"noopener\">CNBC\u003c/a> that the SEC action was \"unwarranted,\" and that Balwani \"accurately represented Theranos to investors to the best of his ability,\" taking on \"significant financial risk.\"\u003c/p>\n\u003cp>Theranos still faces a \u003ca href=\"https://www.nytimes.com/2016/04/19/business/theranos-sec-justice-department-investigation.html\" target=\"_blank\" rel=\"noopener\">criminal investigation\u003c/a> by the U.S. Attorney's Office in San Francisco.\u003c/p>\n\u003cp>\u003cb>Hundreds of Blood Tests From a Few Drops of Blood\u003c/b>\u003c/p>\n\u003cp>The crux of the charges against Theranos are that it made \"numerous false and misleading statements\" to investors that it had found a way to conduct hundreds of blood tests from just a few drops of blood, which would have revolutionized the blood-testing industry. But in reality, according to the SEC, Theranos could only perform a small number of tests this way, with the vast majority completed on standard commercial equipment.\u003c/p>\n\u003cp>The SEC also charges Theranos with claiming its technology was used by the military in Afghanistan, and that it would take in more than $100 million in revenue in 2014.\u003c/p>\n\u003cp>\"In truth, Theranos' technology was never deployed by the U.S. Department of Defense and generated a little more than $100,000 in revenue in 2014,\" the SEC said.\u003c/p>\n\u003cp>Theranos had been flying high that year, with Forbes valuing the company at $9 billion, and Holmes stake worth half that. Holmes had also attracted glowing media attention from the tech and business press.\u003c/p>\n\u003cp>But the story changed abruptly with the publication of a \u003ca href=\"https://www.wsj.com/articles/theranos-has-struggled-with-blood-tests-1444881901\" target=\"_blank\" rel=\"noopener\">Wall Street Journal investigation in 2015\u003c/a>. Reporter John Carreyrou alleged that the company had failed to report tests that showed its proprietary blood-testing equipment may not be accurate, and that it was not using its own technology for most tests, anyway.\u003c/p>\n\u003cp>Theranos responded by stating the Journal's reporting was inaccurate. \"First they think you're crazy. Then they fight you. And then all of a sudden you change the world,\" was Holmes' retort on Jim Cramer's CNBC show.\u003c/p>\n\u003cp>But the Journal's investigation proved to be only the start of Theranos' woes. Soon, the federal government charged that deficiencies at the company's Newark, California lab put patients in \"immediate jeopardy,\" likely to cause \"serious injury or harm, or death.\" The government said that Theranos' own quality control tests had showed alarming rates of failure. The complaint led to Holmes' banishment from owning or operating a lab for two years.\u003c/p>\n\u003cp>Theranos also had to correct tens of thousands of blood tests. A high-profile alliance with Walgreens which put blood-testing centers in dozens of stores, collapsed.\u003c/p>\n\u003cp>The company exited the consumer blood-testing business, lawsuits and more investigations ensued. and Theranos has been treading water ever since.\u003c/p>\n\u003cp>In 2016, Theranos tried to remake itself as the manufacturer of a portable device that could process small volumes of blood remotely and send the data back to a centralized location.\u003c/p>\n\u003cp>But the unveiling of the device, in front of a couple of thousand skeptical laboratory scientists, was mostly a \u003ca href=\"https://www.kqed.org/futureofyou/210797/theranos-elizabeth-holmes-will-face-1000-scientists-monday-can-she-say-anything-to-gain-their-trust\" target=\"_blank\" rel=\"noopener\">dud, \u003c/a>with some expressing the opinion that it was nothing new.\u003c/p>\n\u003cp>The company's \"Newsroom\" page pretty much tells the story at this point. Lots of \u003ca href=\"https://news.theranos.com/\" target=\"_blank\" rel=\"noopener\">press releases\u003c/a> about reaching settlements with various entities — the\u003ca href=\"https://news.theranos.com/2018/03/14/theranos-ceo-reach-settlement-sec/\" target=\"_blank\" rel=\"noopener\"> SEC\u003c/a>, the Centers for Medicare & Medicaid Services, Walgreens, the Arizona attorney general — and nary a word about any product.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp> \u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>It started as a massive success story — a wunderkind female college dropout disrupting the blood-testing industry and empowering patients to take charge of their own health.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>It ended as an almost archetypal cautionary tale about Silicon Valley hubris and its incompatibility with the slow developmental cycles of biomedicine.\u003c/p>\n\u003cp>The Securities and Exchange Commission today charged Bay Area-based Theranos, its founder and CEO Elizabeth Holmes, and former president Sunny Balwani with \"massive fraud,\" in the \u003ca href=\"https://www.sec.gov/news/press-release/2018-41\" target=\"_blank\" rel=\"noopener\">words\u003c/a> of the SEC.\u003c/p>\n\u003cp>Theranos' trangressions included \"raising more than $700 million from investors through an elaborate, years-long fraud in which they exaggerated or made false statements about the company's technology, business, and financial performance,\" according to the federal agency.\u003c/p>\n\u003cp>Holmes has agreed to give up her majority voting control of the company and to a reduction in her equity, the SEC said. Holmes also agreed to pay a $500,000 penalty and is now barred from serving as an officer or director of a public company for 10 years. As part of the settlement, both she and the company neither admitted nor denied wrongdoing.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Bulwani, apparently, has not settled. The SEC said it will litigate the charges against him in Northern California federal district court. Balwani's attorney told \u003ca href=\"https://www.cnbc.com/2018/03/14/theranos-ceo-holmes-and-former-president-balwani-charged-with-massive-fraud.html\" target=\"_blank\" rel=\"noopener\">CNBC\u003c/a> that the SEC action was \"unwarranted,\" and that Balwani \"accurately represented Theranos to investors to the best of his ability,\" taking on \"significant financial risk.\"\u003c/p>\n\u003cp>Theranos still faces a \u003ca href=\"https://www.nytimes.com/2016/04/19/business/theranos-sec-justice-department-investigation.html\" target=\"_blank\" rel=\"noopener\">criminal investigation\u003c/a> by the U.S. Attorney's Office in San Francisco.\u003c/p>\n\u003cp>\u003cb>Hundreds of Blood Tests From a Few Drops of Blood\u003c/b>\u003c/p>\n\u003cp>The crux of the charges against Theranos are that it made \"numerous false and misleading statements\" to investors that it had found a way to conduct hundreds of blood tests from just a few drops of blood, which would have revolutionized the blood-testing industry. But in reality, according to the SEC, Theranos could only perform a small number of tests this way, with the vast majority completed on standard commercial equipment.\u003c/p>\n\u003cp>The SEC also charges Theranos with claiming its technology was used by the military in Afghanistan, and that it would take in more than $100 million in revenue in 2014.\u003c/p>\n\u003cp>\"In truth, Theranos' technology was never deployed by the U.S. Department of Defense and generated a little more than $100,000 in revenue in 2014,\" the SEC said.\u003c/p>\n\u003cp>Theranos had been flying high that year, with Forbes valuing the company at $9 billion, and Holmes stake worth half that. Holmes had also attracted glowing media attention from the tech and business press.\u003c/p>\n\u003cp>But the story changed abruptly with the publication of a \u003ca href=\"https://www.wsj.com/articles/theranos-has-struggled-with-blood-tests-1444881901\" target=\"_blank\" rel=\"noopener\">Wall Street Journal investigation in 2015\u003c/a>. Reporter John Carreyrou alleged that the company had failed to report tests that showed its proprietary blood-testing equipment may not be accurate, and that it was not using its own technology for most tests, anyway.\u003c/p>\n\u003cp>Theranos responded by stating the Journal's reporting was inaccurate. \"First they think you're crazy. Then they fight you. And then all of a sudden you change the world,\" was Holmes' retort on Jim Cramer's CNBC show.\u003c/p>\n\u003cp>But the Journal's investigation proved to be only the start of Theranos' woes. Soon, the federal government charged that deficiencies at the company's Newark, California lab put patients in \"immediate jeopardy,\" likely to cause \"serious injury or harm, or death.\" The government said that Theranos' own quality control tests had showed alarming rates of failure. The complaint led to Holmes' banishment from owning or operating a lab for two years.\u003c/p>\n\u003cp>Theranos also had to correct tens of thousands of blood tests. A high-profile alliance with Walgreens which put blood-testing centers in dozens of stores, collapsed.\u003c/p>\n\u003cp>The company exited the consumer blood-testing business, lawsuits and more investigations ensued. and Theranos has been treading water ever since.\u003c/p>\n\u003cp>In 2016, Theranos tried to remake itself as the manufacturer of a portable device that could process small volumes of blood remotely and send the data back to a centralized location.\u003c/p>\n\u003cp>But the unveiling of the device, in front of a couple of thousand skeptical laboratory scientists, was mostly a \u003ca href=\"https://www.kqed.org/futureofyou/210797/theranos-elizabeth-holmes-will-face-1000-scientists-monday-can-she-say-anything-to-gain-their-trust\" target=\"_blank\" rel=\"noopener\">dud, \u003c/a>with some expressing the opinion that it was nothing new.\u003c/p>\n\u003cp>The company's \"Newsroom\" page pretty much tells the story at this point. Lots of \u003ca href=\"https://news.theranos.com/\" target=\"_blank\" rel=\"noopener\">press releases\u003c/a> about reaching settlements with various entities — the\u003ca href=\"https://news.theranos.com/2018/03/14/theranos-ceo-reach-settlement-sec/\" target=\"_blank\" rel=\"noopener\"> SEC\u003c/a>, the Centers for Medicare & Medicaid Services, Walgreens, the Arizona attorney general — and nary a word about any product.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp> \u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "From App Store To Drug Store, Digital Health Is Redefining Pharma",
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"content": "\u003cp>The pitches always sounded promising: A new software app could track glucose levels for people with diabetes or soothe the brains of insomniacs. Most pharma executives would politely smile and nod, but then park their money somewhere else.\u003c/p>\n\u003cp>Not anymore.\u003c/p>\n\u003cp>Backed by a growing body of evidence, software is itself becoming a prescription for diseases ranging from depression to heart disease, and drug companies are starting to take notice. In the past couple years, many have quickly ramped up their investments in digital startups, infusing software-based therapies into pipelines once dominated by traditional medicines.[contextly_sidebar id=\"vRMOcUiT66pyiT86wyEK8HoXGjDpcJLk\"]\u003c/p>\n\u003cp>These products, known broadly as digital therapeutics, deliver treatment to patients through video games, smartphone apps, and sensors buried in pills or attached to medication dispensers. They are designed to stimulate changes in behavior — and in some cases brain function — to help patients control a variety of illnesses and chronic conditions.\u003c/p>\n\u003cp>In 2017, global investment in these companies jumped to $11.5 billion, a fivefold increase from 2012, according to StartUp Health, a research firm that tracks the digital health market. The uptick in investment mirrors an increasing focus by many digital companies in achieving scientific backing for their inventions.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>And just as importantly as the money flowing in is the rising stature of digital health products. Specifically, in two key ways they’re starting to be treated as drugs: They’re seeking Food and Drug Administration approval, and they’re being covered by insurers. Increasingly, then, across the industry, digital health is moving from the app store to the drug store.\u003c/p>\n\u003cp>\u003cstrong>A Drug In App’s Clothes\u003c/strong>\u003cbr>\n“We’re a team of drug developers that just happens to be developing digital products,” said Dr. Corey McCann, president of Pear Therapeutics, a maker of apps for substance use disorder, post-traumatic stress, and other diseases. “What we’ve done as a company is to demonstrate that software can produce drug-like efficacy.”\u003c/p>\n\u003cp>In 2017, Pear’s reSET program, designed to treat substance use disorder, became the first digital product to receive FDA approval for the treatment of a specific disease. And last month the company inked a partnership with Novartis to develop prescription software to treat schizophrenia and mental health problems associated with multiple sclerosis.\u003c/p>\n\u003cp>The Novartis deal is one of many that highlights increasing investment in these therapies by prominent drug makers. Among the biggest spenders on digital health are GlaxoSmithKline, Roche, Johnson & Johnson, and Merck, whose $500 million global health innovation fund has invested in 24 companies since 2009.[contextly_sidebar id=\"GamWIkUUy1zvAmx2sFp4vTWRVfsXPCLs\"]\u003c/p>\n\u003cp>Analysts who follow the field say digital products are getting more direct attention from pharma CEOs who now see their development as a business imperative, as opposed to a supplemental service with marginal importance to their companies.\u003c/p>\n\u003cp>“The CEOs are coming to us and saying, ‘I have a strategic problem, which is that my R&D pipeline isn’t as productive as I need it to be and there are adjacent businesses my current [employees] just aren’t focused on,’” said Scott Bechtler-Levin, a director with BCG Digital Ventures, a consulting firm.\u003c/p>\n\u003cp>That is causing many companies to buy stakes in these companies or form partnerships to develop and commercialize their products — either as standalone treatments, or as a complement to existing medicines.\u003c/p>\n\u003cp>\u003cstrong>Honing The Pitch To Insurers\u003c/strong>\u003cbr>\nThe rising investment in digital therapeutics does not guarantee their success. As a whole, the industry is still in its early stages of development, and so is the scientific evidence needed to show these products are safe and effective.\u003c/p>\n\u003cp>But some early entrants are winning over medical societies and insurers, putting themselves on more equal footing with traditional pharmaceutical products.\u003c/p>\n\u003cp>Omada Health, a maker of software to treat \u003ca href=\"https://www.statnews.com/2017/11/16/prediabetes-insurance-counseling-diabetes/\" target=\"_blank\" rel=\"noopener\">pre-diabetes\u003c/a>, obesity, and heart disease, now has contracts with more than 175 employers as well as dozens of insurance plans. Its program costs between $550 and $650 for the first year, with the price tied to the achievement of patient outcomes.[contextly_sidebar id=\"0QmrfLARboHh7FZkmCdqJRZJFkLkOMNT\"]\u003c/p>\n\u003cp>“Our big goal is to get to the point where in 70 percent of the country, if you’re in clinical need for a program like ours, it’s written by default into your insurance design,” said Omada’s co-founder and chief executive, Sean Duffy.\u003c/p>\n\u003cp>Founded in 2011, Omada describes itself as a digital behavior change company. Its pre-diabetes program is essentially a set of clinical prevention strategies wrapped in a digital package. The software tracks patients’ weight, food intake, and activity, as well as glucose and lipid levels, among other measures. It also pairs them with a health coach to help provide education and feedback on progress.\u003c/p>\n\u003cp>The company’s website features nine published studies that report either positive results for patients or a clinical validation of Omada’s programs. Many of the studies are small and observational, owing to the company’s short history and limited reach compared to other providers. But it has helped leverage key victories in the industry: Last year, the American Medical Association decided to issue its first ever billing code to cover digital health services like those provided by Omada.\u003c/p>\n\u003cp>The AMA’s designation is crucial, because it helps digital companies gain coverage for their services from private insurers. “It allows us to be categorized as a proper medical benefit,” Duffy said. “That’s always been the long game of Omada.”[contextly_sidebar id=\"qlS21f91d5rV5InQtLOUoNHm1y7ElbJX\"]\u003c/p>\n\u003cp>Medicare has not yet extended coverage for digital pre-diabetes treatment, but it is \u003ca href=\"https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2017-Fact-Sheet-items/2017-11-02.html\" target=\"_blank\" rel=\"noopener\">inching closer\u003c/a>. It has begun covering the prevention services Omada offers, just not in a digital format. Duffy argues doing so would greatly expand access to care, particularly for people who must travel long distances to see their doctors. “If you’re a Medicare beneficiary, you’re probably willing to drive three hours one time to get a knee replacement,” he said. “But it’s unlikely you’re going to do that for 16 straight weeks of a [diabetes prevention] program.”\u003c/p>\n\u003cp>\u003cstrong>A Scientific Formula For Business Success\u003cbr>\n\u003c/strong>The extent and type of regulatory validation sought by digital health companies varies widely. Some have sought to shield themselves from review, while others have achieved positive results by taking the exact opposite approach.\u003c/p>\n\u003cp>McCann, Pear’s chief executive, said running scientific trials — and ultimately gaining FDA approval — is a crucial part of the company’s business plan. Pear’s current product pipeline includes digital treatments for cancer, Parkinson’s disease, depression and schizophrenia, among others.\u003c/p>\n\u003cp>“If you want to say that something treats schizophrenia … then that’s something that absolutely requires regulatory oversight,” McCann said. “And in these very fragile patient populations, one absolutely needs to demonstrate safety data.”\u003c/p>\n\u003cfigure id=\"attachment_72940\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-72940\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2015/11/ihealth-800x450.jpg\" alt=\"\" width=\"800\" height=\"450\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2015/11/ihealth-800x450.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2015/11/ihealth-400x225.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2015/11/ihealth-960x540.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2015/11/ihealth.jpg 1024w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">A blood pressure monitor from iHealth. \u003ccite>(Juhan Sonin/Flickr)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>That approach has positioned Pear as a direct competitor to traditional pharmaceutical companies, as well as an attractive partner. Its deal with Novartis is designed to further develop its schizophrenia treatment and bring it into clinical use.\u003c/p>\n\u003cp>The product, known as THRIVE, currently consists of a smartphone app that uses branching logic — similar to what one might find in a choose-your-own-adventure game — to help patients identify and counteract delusions and other symptoms. Novartis may contribute by developing complementary drug therapies for schizophrenia patients as well as those with mental health problems arising from multiple sclerosis.\u003c/p>\n\u003cp>Dr. Jay Bradner, president of the Novartis Institutes for BioMedical Research, said Pear’s success in gaining FDA approval for reSET is seen as a model for others in the industry to follow.\u003c/p>\n\u003cp>“It was a heavy lift, but the path that they have carved through the forest is very appealing,” he said. “The proof of concept offered by reSET is indeed encouraging to suggest that other forms of cognitive behavioral therapy might likewise be delivered through digital devices.”[contextly_sidebar id=\"NJID6CERRgAHMSQb34OqsGPaMEPkrsBk\"]\u003c/p>\n\u003cp>The partnership with Pear is part of a broader digital transformation at Novartis. The company has hired a new chief digital officer and is investing in software to allow clinical trials to be carried out in patients’ homes, a move to speed up research and development and reach a more diverse group of patients.\u003c/p>\n\u003cp>“It’s a full reconsideration of the research, development, and commercialization model,” Bradner said, adding that such change is long overdue in an industry famous for its half-hearted embrace of technology.\u003c/p>\n\u003cp>“My mother in her retirement home is running AI when she logs onto the Amazon Prime website, without her even knowing,” he said. “Yet in science and medicine, as sophisticated as these fields have become, there is no pervasive impact of artificial intelligence and deep neural networks, as yet realized.”\u003c/p>\n\u003cp>\u003cem>This story was originally published by \u003ca href=\"https://www.statnews.com/\" target=\"_blank\" rel=\"noopener\">STAT\u003c/a>, an online publication of Boston Globe Media that covers health, medicine, and scientific discovery.intern\u003c/em>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cstrong> \u003c/strong>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The pitches always sounded promising: A new software app could track glucose levels for people with diabetes or soothe the brains of insomniacs. Most pharma executives would politely smile and nod, but then park their money somewhere else.\u003c/p>\n\u003cp>Not anymore.\u003c/p>\n\u003cp>Backed by a growing body of evidence, software is itself becoming a prescription for diseases ranging from depression to heart disease, and drug companies are starting to take notice. In the past couple years, many have quickly ramped up their investments in digital startups, infusing software-based therapies into pipelines once dominated by traditional medicines.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>These products, known broadly as digital therapeutics, deliver treatment to patients through video games, smartphone apps, and sensors buried in pills or attached to medication dispensers. They are designed to stimulate changes in behavior — and in some cases brain function — to help patients control a variety of illnesses and chronic conditions.\u003c/p>\n\u003cp>In 2017, global investment in these companies jumped to $11.5 billion, a fivefold increase from 2012, according to StartUp Health, a research firm that tracks the digital health market. The uptick in investment mirrors an increasing focus by many digital companies in achieving scientific backing for their inventions.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>And just as importantly as the money flowing in is the rising stature of digital health products. Specifically, in two key ways they’re starting to be treated as drugs: They’re seeking Food and Drug Administration approval, and they’re being covered by insurers. Increasingly, then, across the industry, digital health is moving from the app store to the drug store.\u003c/p>\n\u003cp>\u003cstrong>A Drug In App’s Clothes\u003c/strong>\u003cbr>\n“We’re a team of drug developers that just happens to be developing digital products,” said Dr. Corey McCann, president of Pear Therapeutics, a maker of apps for substance use disorder, post-traumatic stress, and other diseases. “What we’ve done as a company is to demonstrate that software can produce drug-like efficacy.”\u003c/p>\n\u003cp>In 2017, Pear’s reSET program, designed to treat substance use disorder, became the first digital product to receive FDA approval for the treatment of a specific disease. And last month the company inked a partnership with Novartis to develop prescription software to treat schizophrenia and mental health problems associated with multiple sclerosis.\u003c/p>\n\u003cp>The Novartis deal is one of many that highlights increasing investment in these therapies by prominent drug makers. Among the biggest spenders on digital health are GlaxoSmithKline, Roche, Johnson & Johnson, and Merck, whose $500 million global health innovation fund has invested in 24 companies since 2009.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Analysts who follow the field say digital products are getting more direct attention from pharma CEOs who now see their development as a business imperative, as opposed to a supplemental service with marginal importance to their companies.\u003c/p>\n\u003cp>“The CEOs are coming to us and saying, ‘I have a strategic problem, which is that my R&D pipeline isn’t as productive as I need it to be and there are adjacent businesses my current [employees] just aren’t focused on,’” said Scott Bechtler-Levin, a director with BCG Digital Ventures, a consulting firm.\u003c/p>\n\u003cp>That is causing many companies to buy stakes in these companies or form partnerships to develop and commercialize their products — either as standalone treatments, or as a complement to existing medicines.\u003c/p>\n\u003cp>\u003cstrong>Honing The Pitch To Insurers\u003c/strong>\u003cbr>\nThe rising investment in digital therapeutics does not guarantee their success. As a whole, the industry is still in its early stages of development, and so is the scientific evidence needed to show these products are safe and effective.\u003c/p>\n\u003cp>But some early entrants are winning over medical societies and insurers, putting themselves on more equal footing with traditional pharmaceutical products.\u003c/p>\n\u003cp>Omada Health, a maker of software to treat \u003ca href=\"https://www.statnews.com/2017/11/16/prediabetes-insurance-counseling-diabetes/\" target=\"_blank\" rel=\"noopener\">pre-diabetes\u003c/a>, obesity, and heart disease, now has contracts with more than 175 employers as well as dozens of insurance plans. Its program costs between $550 and $650 for the first year, with the price tied to the achievement of patient outcomes.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>“Our big goal is to get to the point where in 70 percent of the country, if you’re in clinical need for a program like ours, it’s written by default into your insurance design,” said Omada’s co-founder and chief executive, Sean Duffy.\u003c/p>\n\u003cp>Founded in 2011, Omada describes itself as a digital behavior change company. Its pre-diabetes program is essentially a set of clinical prevention strategies wrapped in a digital package. The software tracks patients’ weight, food intake, and activity, as well as glucose and lipid levels, among other measures. It also pairs them with a health coach to help provide education and feedback on progress.\u003c/p>\n\u003cp>The company’s website features nine published studies that report either positive results for patients or a clinical validation of Omada’s programs. Many of the studies are small and observational, owing to the company’s short history and limited reach compared to other providers. But it has helped leverage key victories in the industry: Last year, the American Medical Association decided to issue its first ever billing code to cover digital health services like those provided by Omada.\u003c/p>\n\u003cp>The AMA’s designation is crucial, because it helps digital companies gain coverage for their services from private insurers. “It allows us to be categorized as a proper medical benefit,” Duffy said. “That’s always been the long game of Omada.”\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Medicare has not yet extended coverage for digital pre-diabetes treatment, but it is \u003ca href=\"https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2017-Fact-Sheet-items/2017-11-02.html\" target=\"_blank\" rel=\"noopener\">inching closer\u003c/a>. It has begun covering the prevention services Omada offers, just not in a digital format. Duffy argues doing so would greatly expand access to care, particularly for people who must travel long distances to see their doctors. “If you’re a Medicare beneficiary, you’re probably willing to drive three hours one time to get a knee replacement,” he said. “But it’s unlikely you’re going to do that for 16 straight weeks of a [diabetes prevention] program.”\u003c/p>\n\u003cp>\u003cstrong>A Scientific Formula For Business Success\u003cbr>\n\u003c/strong>The extent and type of regulatory validation sought by digital health companies varies widely. Some have sought to shield themselves from review, while others have achieved positive results by taking the exact opposite approach.\u003c/p>\n\u003cp>McCann, Pear’s chief executive, said running scientific trials — and ultimately gaining FDA approval — is a crucial part of the company’s business plan. Pear’s current product pipeline includes digital treatments for cancer, Parkinson’s disease, depression and schizophrenia, among others.\u003c/p>\n\u003cp>“If you want to say that something treats schizophrenia … then that’s something that absolutely requires regulatory oversight,” McCann said. “And in these very fragile patient populations, one absolutely needs to demonstrate safety data.”\u003c/p>\n\u003cfigure id=\"attachment_72940\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-72940\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2015/11/ihealth-800x450.jpg\" alt=\"\" width=\"800\" height=\"450\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2015/11/ihealth-800x450.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2015/11/ihealth-400x225.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2015/11/ihealth-960x540.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2015/11/ihealth.jpg 1024w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">A blood pressure monitor from iHealth. \u003ccite>(Juhan Sonin/Flickr)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>That approach has positioned Pear as a direct competitor to traditional pharmaceutical companies, as well as an attractive partner. Its deal with Novartis is designed to further develop its schizophrenia treatment and bring it into clinical use.\u003c/p>\n\u003cp>The product, known as THRIVE, currently consists of a smartphone app that uses branching logic — similar to what one might find in a choose-your-own-adventure game — to help patients identify and counteract delusions and other symptoms. Novartis may contribute by developing complementary drug therapies for schizophrenia patients as well as those with mental health problems arising from multiple sclerosis.\u003c/p>\n\u003cp>Dr. Jay Bradner, president of the Novartis Institutes for BioMedical Research, said Pear’s success in gaining FDA approval for reSET is seen as a model for others in the industry to follow.\u003c/p>\n\u003cp>“It was a heavy lift, but the path that they have carved through the forest is very appealing,” he said. “The proof of concept offered by reSET is indeed encouraging to suggest that other forms of cognitive behavioral therapy might likewise be delivered through digital devices.”\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>The partnership with Pear is part of a broader digital transformation at Novartis. 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"soldout": {
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