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"disqusTitle": "The Controversial Research on 'Desistance' in Transgender Youth",
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"content": "\u003cp>The phenomenon of transgender children \"growing out of\" their transgender identity by the time they are adolescents or adults is called “desistance” by gender researchers.\u003c/p>\n\u003cp>For decades, follow-up studies of transgender kids have shown that a substantial majority -- anywhere from 65 to 94 percent -- eventually ceased to identify as transgender.\u003c/p>\n\u003caside class=\"alignright\">One study found that older children, girls, and those kids who reported more intense gender dysphoria were more likely to stick with their transgender identity as adolescents.\u003c/aside>\n\u003cp>These findings have become part and parcel of the \"How young is too young?\" debate over \"social transitioning,\" the term for allowing kids to publicly live as their identified gender in every way short of medical treatment.\u003c/p>\n\u003cp>If most kids will eventually cease to be transgender, some clinicians have reasoned, isn’t it more prudent to take the least disruptive path in coping with a child's gender dysphoria? That way, if or when kids later stop identifying as transgender, they will have less to “undo.”\u003c/p>\n\u003cp>In recent years, though, a new school of thought has emerged. Many gender specialists now believe that the best course for a transgender child is often “social transition,” where kids as young as three are allowed to change their names, pronouns and style of dress to match the gender they identify with.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cstrong>Looking at the Research\u003c/strong>\u003c/p>\n\u003cp>One reason many researchers believe it’s unnecessary to delay the social transition of a child is that they don’t think the research on desistance is valid. In other words, they think the number of children who \"grow out of\" their transgender identity has been vastly overblown.\u003c/p>\n\u003caside class=\"pullquote alignright\">'The only evidence I have from studies and reports in the literature ... is that not all transgender children will persist in their transgender identity'\u003ccite>Thomas Steensma, VU University Medical Center, Center of Expertise on Gender Dysphoria\u003c/cite>\u003c/aside>\n\u003cp>This school of thought holds that because the criteria for a diagnosis of gender dysphoria (previously called gender identity disorder) was less stringent in the past, the earlier desistance studies included a large cohort of children who today would not be diagnosed with gender dysphoria, gay boys who may have been experimenting with different ways of expressing gender but who were never really transgender in the first place.\u003c/p>\n\u003cp>“The methodology of those studies is very flawed, because they didn't study gender identity,” said Diane Ehrensaft, director of mental health at UCSF’s Child and Adolescent Gender Clinic. “Those desistors were, a good majority of them, simply proto-gay boys whose parents were upset because they were boys wearing dresses. They were brought to the clinics because they weren't fitting gender norms.”\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe src=\"//datawrapper.dwcdn.net/8gbLb/1/\" width=\"100%\" height=\"500\" scrolling=\"yes\" class=\"iframe-class\" frameborder=\"0\">\u003c/iframe>\u003c/p>\n\u003cp>In Amsterdam, clinicians at the Center of Expertise on Gender Dysphoria are much more cautious about recommending social transitions because of the statistics on desistance. Thomas Steensma, a researcher and clinician at the center, acknowledges these studies probably included some kids who would not be diagnosed with gender dysphoria today. Nevertheless, despite the problems with the way they classified children, \"the only evidence I have from studies and reports in the literature ... is that not all transgender children will persist in their transgender identity,\" Steensma said.\u003c/p>\n\u003caside class=\"pullquote alignright\">'Why are we asking a child to conform to something that is not them because society hasn't done its learning yet?'\u003ccite>Diane Ehrensaft, UCSF\u003c/cite>\u003c/aside>\n\u003cp>In 2013, Steensma co-authored an oft-cited \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/23702447\" target=\"_blank\" rel=\"noopener\">study\u003c/a> that examined 127 adolescents, all of whom had displayed various levels of gender dysphoria as children. The researchers found that 80 of the children had desisted by the ages of 15 and 16. That works out to 63 percent of kids who basically stopped being transgender -- a lower rate than in previous studies, but still a majority.\u003c/p>\n\u003cp>Some clinicians criticize this study, however, on methodological grounds, because the researchers defined anyone who did not return to their clinic as desisting. Fifty-two of the children classified as desistors or their parents did send back questionnaires showing the subjects' present lack of gender dysphoria. But 28 neither responded nor could be tracked down.\u003c/p>\n\u003cp>“You can't do that in scientific studies,” Ehrensaft said. “You have to have your subjects in front of you and know who they are. You can't just assume somebody is in a category because you don't see them anymore.”\u003c/p>\n\u003cp>In addition, 38 of the 127 kids were originally designated “subthreshold” for gender identity disorder, meaning they did not fulfill all the criteria for meeting the official diagnosis.\u003c/p>\n\u003cp>This, according to Erica Anderson, a gender clinician at UCSF, makes the desistance findings even more suspect.\" [It] begs the question of whether these kids were actually divergent [in their gender identity] before the study selected them,” she said.\u003c/p>\n\u003cp>Steensma stands by the study’s methodology. But interestingly, he added that citing these findings as a measure of desistance is wrongheaded, because the study was never designed with that goal in mind.\u003c/p>\n\u003cp>“Providing these [desistance] numbers will only lead to wrong conclusions,” he said.\u003c/p>\n\u003cfigure id=\"attachment_441933\" class=\"wp-caption alignright\" style=\"max-width: 385px\">\u003ca href=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/05/Ehrensaft.jpg\">\u003cimg class=\" wp-image-441933\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/05/Ehrensaft-1020x1528.jpg\" alt=\"\" width=\"385\" height=\"577\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2018/05/Ehrensaft-1020x1528.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2018/05/Ehrensaft-160x240.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2018/05/Ehrensaft-800x1198.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2018/05/Ehrensaft-768x1150.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2018/05/Ehrensaft-801x1200.jpg 801w, https://ww2.kqed.org/app/uploads/sites/13/2018/05/Ehrensaft.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2018/05/Ehrensaft-1180x1768.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2018/05/Ehrensaft-960x1438.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2018/05/Ehrensaft-240x360.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2018/05/Ehrensaft-375x562.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2018/05/Ehrensaft-520x779.jpg 520w\" sizes=\"(max-width: 385px) 100vw, 385px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Diane Ehrensaft, director of mental health at UCSF's gender clinic. \u003ccite>(Lauren Hanussak/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Rather, he says, the researchers wanted to see if they could find predictors of persistence. Which they did: The study found that transgender children who were older, born female, and reported more intense gender dysphoria were more likely to stick with their transgender identity than younger children, natal boys and those with less pronounced gender dysphoric traits.\u003c/p>\n\u003cp>Steensma and colleagues also culled one very specific indicator of future persistence: When asked when they were children, “Are you a boy or a girl?” those who answered the opposite of their birth sex were found more likely to have retained their gender identity in adolescence. The desistors, on the other hand, tended to merely \u003cem>wish\u003c/em> they were the opposite sex.\u003c/p>\n\u003cp>“(E)xplicitly asking children with GD (gender dysphoria) with which sex they identify seems to be of great value in predicting a future outcome for both boys and girls with GD,” the study says.\u003c/p>\n\u003cp>Today, Steensma cautions that this question is not a litmus test for which children will persist in their transgender identity. He believes that gender identity in kids is still developing, and that it’s responsive to what occurs at different life stages. He also says it’s possible that a social transition could lead to persistence where it otherwise might not have occurred.\u003c/p>\n\u003cp>“That's not something we can answer,” he said. “It's something we have to study and find out.”\u003c/p>\n\u003cp>\u003cstrong>‘It’s Time to Teach Society’\u003c/strong>\u003c/p>\n\u003cp>Another contentious topic in the transgender community is what the literature calls “detransitioning,” or reverting back to one's natal gender.\u003c/p>\n\u003cp>The current Standards of Care written by the World Professional Association for Transgender Health cautions that “a change back to the original gender role can be highly distressing” The guidelines use that assertion as a reason to be cautious about early social transitioning.\u003c/p>\n\u003cp>But the cautionary language, Ehrensaft points out, is based on one qualitative study, coauthored by Steensma, which looked at the dilemma of just two Dutch girls who’d transitioned when they were in elementary school and wanted to switch back. She doesn’t think it’s particularly relevant.\u003c/p>\n\u003cp>“The stress [of detransitioning] comes from microaggressions and lack of acceptance in the environment,” she said. “If we offer social support and opportunities for children over time, we don’t have any evidence that [detransitioning] will be damaging for them.”\u003c/p>\n\u003cp>Ehrensaft believes the conventional treatment of transgender children has been based, for the most part, on traditionally negative views of gender nonconformity. So, she believes, the burden is now on the culture to see transgender children as they really are.\u003c/p>\n\u003cp>“Why are we asking a child to conform to something that is not them because society hasn't done its learning yet?”she says. “It's time to teach society.”\u003c/p>\n\u003cp>\u003cstrong>Toward the Nonbinary\u003c/strong>\u003c/p>\n\u003cp>One of the more interesting takes I heard on persistence and desistance came from UCSF gender clinician Erica Anderson, who is transgender herself. She views the very notion of measuring persistence/desistance as something of a fool’s errand, because such definitions are mediated by changing cultural norms, the self-perceptions of children and the ways that researchers interpret them.\u003c/p>\n\u003cp>“We’ve got kids of varying sophistication levels of language trying to explain to other people who have no experience [being transgender],\" Anderson said, \"and it’s being driven by shifting professional understanding or consensus and culture. You’ve got moving parts. In that context we’ve got a dynamic situation where kids who might say ‘I’m a girl’ might have said five years ago ‘maybe I’m a girl.’ ”\u003c/p>\n\u003cp>Ehrensaft herself doesn’t even like to use the terms persistence and desistance. Those words imply something fixed — a binary state of yes or no. But younger generations of transgender people — and even \u003ca href=\"https://fusiondotnet.files.wordpress.com/2015/02/fusion-poll-gender-spectrum.pdf\" target=\"_blank\" rel=\"noopener\">younger generations\u003c/a> in the general population — see gender as more protean, even customizable. Of nearly 28,000 respondents to the \u003ca href=\"http://www.ustranssurvey.org/\" target=\"_blank\" rel=\"noopener\">2015 U.S. Transgender Survey\u003c/a>, more than one-third said they were some form of \u003ca href=\"https://www.kqed.org/futureofyou/335790/boy-girl-both-neither-a-new-generation-overthrows-gender\" target=\"_blank\" rel=\"noopener\">nonbinary\u003c/a>. That means they may identify as both male and female, neither male nor female, or \u003cem>sometimes\u003c/em> male, \u003cem>sometimes\u003c/em> female.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>This, in theory, could solve a lot of problems. After all, if the gender fluidity trend continues, perhaps many people will have no unitary gender to \"persist\" or \"desist\" from.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cstrong>Looking at the Research\u003c/strong>\u003c/p>\n\u003cp>One reason many researchers believe it’s unnecessary to delay the social transition of a child is that they don’t think the research on desistance is valid. In other words, they think the number of children who \"grow out of\" their transgender identity has been vastly overblown.\u003c/p>\n\u003caside class=\"pullquote alignright\">'The only evidence I have from studies and reports in the literature ... is that not all transgender children will persist in their transgender identity'\u003ccite>Thomas Steensma, VU University Medical Center, Center of Expertise on Gender Dysphoria\u003c/cite>\u003c/aside>\n\u003cp>This school of thought holds that because the criteria for a diagnosis of gender dysphoria (previously called gender identity disorder) was less stringent in the past, the earlier desistance studies included a large cohort of children who today would not be diagnosed with gender dysphoria, gay boys who may have been experimenting with different ways of expressing gender but who were never really transgender in the first place.\u003c/p>\n\u003cp>“The methodology of those studies is very flawed, because they didn't study gender identity,” said Diane Ehrensaft, director of mental health at UCSF’s Child and Adolescent Gender Clinic. “Those desistors were, a good majority of them, simply proto-gay boys whose parents were upset because they were boys wearing dresses. They were brought to the clinics because they weren't fitting gender norms.”\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe src=\"//datawrapper.dwcdn.net/8gbLb/1/\" width=\"100%\" height=\"500\" scrolling=\"yes\" class=\"iframe-class\" frameborder=\"0\">\u003c/iframe>\u003c/p>\n\u003cp>In Amsterdam, clinicians at the Center of Expertise on Gender Dysphoria are much more cautious about recommending social transitions because of the statistics on desistance. Thomas Steensma, a researcher and clinician at the center, acknowledges these studies probably included some kids who would not be diagnosed with gender dysphoria today. Nevertheless, despite the problems with the way they classified children, \"the only evidence I have from studies and reports in the literature ... is that not all transgender children will persist in their transgender identity,\" Steensma said.\u003c/p>\n\u003caside class=\"pullquote alignright\">'Why are we asking a child to conform to something that is not them because society hasn't done its learning yet?'\u003ccite>Diane Ehrensaft, UCSF\u003c/cite>\u003c/aside>\n\u003cp>In 2013, Steensma co-authored an oft-cited \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/23702447\" target=\"_blank\" rel=\"noopener\">study\u003c/a> that examined 127 adolescents, all of whom had displayed various levels of gender dysphoria as children. The researchers found that 80 of the children had desisted by the ages of 15 and 16. That works out to 63 percent of kids who basically stopped being transgender -- a lower rate than in previous studies, but still a majority.\u003c/p>\n\u003cp>Some clinicians criticize this study, however, on methodological grounds, because the researchers defined anyone who did not return to their clinic as desisting. Fifty-two of the children classified as desistors or their parents did send back questionnaires showing the subjects' present lack of gender dysphoria. But 28 neither responded nor could be tracked down.\u003c/p>\n\u003cp>“You can't do that in scientific studies,” Ehrensaft said. “You have to have your subjects in front of you and know who they are. You can't just assume somebody is in a category because you don't see them anymore.”\u003c/p>\n\u003cp>In addition, 38 of the 127 kids were originally designated “subthreshold” for gender identity disorder, meaning they did not fulfill all the criteria for meeting the official diagnosis.\u003c/p>\n\u003cp>This, according to Erica Anderson, a gender clinician at UCSF, makes the desistance findings even more suspect.\" [It] begs the question of whether these kids were actually divergent [in their gender identity] before the study selected them,” she said.\u003c/p>\n\u003cp>Steensma stands by the study’s methodology. But interestingly, he added that citing these findings as a measure of desistance is wrongheaded, because the study was never designed with that goal in mind.\u003c/p>\n\u003cp>“Providing these [desistance] numbers will only lead to wrong conclusions,” he said.\u003c/p>\n\u003cfigure id=\"attachment_441933\" class=\"wp-caption alignright\" style=\"max-width: 385px\">\u003ca href=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/05/Ehrensaft.jpg\">\u003cimg class=\" wp-image-441933\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/05/Ehrensaft-1020x1528.jpg\" alt=\"\" width=\"385\" height=\"577\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2018/05/Ehrensaft-1020x1528.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2018/05/Ehrensaft-160x240.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2018/05/Ehrensaft-800x1198.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2018/05/Ehrensaft-768x1150.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2018/05/Ehrensaft-801x1200.jpg 801w, https://ww2.kqed.org/app/uploads/sites/13/2018/05/Ehrensaft.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2018/05/Ehrensaft-1180x1768.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2018/05/Ehrensaft-960x1438.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2018/05/Ehrensaft-240x360.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2018/05/Ehrensaft-375x562.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2018/05/Ehrensaft-520x779.jpg 520w\" sizes=\"(max-width: 385px) 100vw, 385px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Diane Ehrensaft, director of mental health at UCSF's gender clinic. \u003ccite>(Lauren Hanussak/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Rather, he says, the researchers wanted to see if they could find predictors of persistence. Which they did: The study found that transgender children who were older, born female, and reported more intense gender dysphoria were more likely to stick with their transgender identity than younger children, natal boys and those with less pronounced gender dysphoric traits.\u003c/p>\n\u003cp>Steensma and colleagues also culled one very specific indicator of future persistence: When asked when they were children, “Are you a boy or a girl?” those who answered the opposite of their birth sex were found more likely to have retained their gender identity in adolescence. The desistors, on the other hand, tended to merely \u003cem>wish\u003c/em> they were the opposite sex.\u003c/p>\n\u003cp>“(E)xplicitly asking children with GD (gender dysphoria) with which sex they identify seems to be of great value in predicting a future outcome for both boys and girls with GD,” the study says.\u003c/p>\n\u003cp>Today, Steensma cautions that this question is not a litmus test for which children will persist in their transgender identity. He believes that gender identity in kids is still developing, and that it’s responsive to what occurs at different life stages. He also says it’s possible that a social transition could lead to persistence where it otherwise might not have occurred.\u003c/p>\n\u003cp>“That's not something we can answer,” he said. “It's something we have to study and find out.”\u003c/p>\n\u003cp>\u003cstrong>‘It’s Time to Teach Society’\u003c/strong>\u003c/p>\n\u003cp>Another contentious topic in the transgender community is what the literature calls “detransitioning,” or reverting back to one's natal gender.\u003c/p>\n\u003cp>The current Standards of Care written by the World Professional Association for Transgender Health cautions that “a change back to the original gender role can be highly distressing” The guidelines use that assertion as a reason to be cautious about early social transitioning.\u003c/p>\n\u003cp>But the cautionary language, Ehrensaft points out, is based on one qualitative study, coauthored by Steensma, which looked at the dilemma of just two Dutch girls who’d transitioned when they were in elementary school and wanted to switch back. She doesn’t think it’s particularly relevant.\u003c/p>\n\u003cp>“The stress [of detransitioning] comes from microaggressions and lack of acceptance in the environment,” she said. “If we offer social support and opportunities for children over time, we don’t have any evidence that [detransitioning] will be damaging for them.”\u003c/p>\n\u003cp>Ehrensaft believes the conventional treatment of transgender children has been based, for the most part, on traditionally negative views of gender nonconformity. So, she believes, the burden is now on the culture to see transgender children as they really are.\u003c/p>\n\u003cp>“Why are we asking a child to conform to something that is not them because society hasn't done its learning yet?”she says. “It's time to teach society.”\u003c/p>\n\u003cp>\u003cstrong>Toward the Nonbinary\u003c/strong>\u003c/p>\n\u003cp>One of the more interesting takes I heard on persistence and desistance came from UCSF gender clinician Erica Anderson, who is transgender herself. She views the very notion of measuring persistence/desistance as something of a fool’s errand, because such definitions are mediated by changing cultural norms, the self-perceptions of children and the ways that researchers interpret them.\u003c/p>\n\u003cp>“We’ve got kids of varying sophistication levels of language trying to explain to other people who have no experience [being transgender],\" Anderson said, \"and it’s being driven by shifting professional understanding or consensus and culture. You’ve got moving parts. In that context we’ve got a dynamic situation where kids who might say ‘I’m a girl’ might have said five years ago ‘maybe I’m a girl.’ ”\u003c/p>\n\u003cp>Ehrensaft herself doesn’t even like to use the terms persistence and desistance. Those words imply something fixed — a binary state of yes or no. But younger generations of transgender people — and even \u003ca href=\"https://fusiondotnet.files.wordpress.com/2015/02/fusion-poll-gender-spectrum.pdf\" target=\"_blank\" rel=\"noopener\">younger generations\u003c/a> in the general population — see gender as more protean, even customizable. Of nearly 28,000 respondents to the \u003ca href=\"http://www.ustranssurvey.org/\" target=\"_blank\" rel=\"noopener\">2015 U.S. Transgender Survey\u003c/a>, more than one-third said they were some form of \u003ca href=\"https://www.kqed.org/futureofyou/335790/boy-girl-both-neither-a-new-generation-overthrows-gender\" target=\"_blank\" rel=\"noopener\">nonbinary\u003c/a>. That means they may identify as both male and female, neither male nor female, or \u003cem>sometimes\u003c/em> male, \u003cem>sometimes\u003c/em> female.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>This, in theory, could solve a lot of problems. After all, if the gender fluidity trend continues, perhaps many people will have no unitary gender to \"persist\" or \"desist\" from.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Sherry Young just wanted to be able to walk without pain.\u003c/p>\n\u003cp>About three years ago, she began to experience sharp pain in her left foot. Her big toe had become crooked and constantly rubbed up against the adjacent toe, making it painful to run, walk or even stand. \"I could not walk without intense pain unless I had a pad underneath my toes for cushioning,\" Young said.\u003c/p>\n\u003cp>An orthopedic surgeon told her that he could fix her problem for good. \"He thought my foot was hitting the ground too hard and causing pain,\" said Young. \"That's what he was trying to correct.\"\u003c/p>\n\u003cp>Though Young had had several orthopedic surgeries, she had always had good insurance and never scrutinized her bills.\u003c/p>\n\u003cp>At the time of her foot surgery, Young of course knew nothing about hospital charges for surgical screws, medical saws and other hardware used in the operating room.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Then the bill came.\u003c/p>\n\u003cp>\u003cstrong>Patient: \u003c/strong>Sherry Young, 57, a retired librarian on disability and a mother of two in Lawton, Okla.\u003c/p>\n\u003cp>\u003cstrong>Total bill:\u003c/strong> $115,527 for a three-day hospital stay, including $15,076 for four tiny screws — measuring 2.8 millimeters wide and no more than 14 millimeters long — placed in the two middle toes of her left foot.\u003c/p>\n\u003cp>\u003cstrong>Service provider:\u003c/strong> OU Medical Center, located at the University of Oklahoma Health Science Center in Oklahoma City\u003c/p>\n\u003cp>\u003cstrong>Medical treatment:\u003c/strong> Young underwent two operations on the same day in June 2017. One surgeon addressed an injury in Young's shoulder, caused by arthritis and overuse. A second surgeon performed several procedures on her foot, including removing a \u003ca href=\"https://www.footeducation.com/page/great-toe-cheilectomy-bone-spur-removal\" target=\"_blank\" rel=\"noopener\">bone spur.\u003c/a> To better align Young's middle toes, the doctor removed a slice of bone from the center of each toe, and then reconnected the two ends with surgical screws made by \u003ca href=\"https://www.arthrex.com/\" target=\"_blank\" rel=\"noopener\">Arthrex,\u003c/a> a medical device manufacturer based in Naples, Fla.\u003c/p>\n\u003cp>\u003cstrong>What gives:\u003c/strong> Two weeks after surgery, Young received a letter from her insurance plan, BlueCross BlueShield of Oklahoma, stating that it had not approved her hospital stay. Staying overnight was not \"medically necessary,\" according to the letter, because foot and shoulder surgery are typically performed as outpatient procedures.\u003c/p>\n\u003cp>The letter \"put me in a panic,\" said Young, who was suddenly worried that she would have to pay the entire $115,000 bill herself. That's about how much her home is worth, and five times her annual income.\u003c/p>\n\u003cp>Faced with the astronomical cost, Young asked for an itemized copy of her bill and began checking every charge.\u003c/p>\n\u003cp>She was floored by the price of the screws, each of which cost more than a high-end computer.\u003c/p>\n\u003cp>\"Unless the metal [was] mined on an asteroid, I do not know why it should cost that amount,\" Young said.\u003c/p>\n\u003cp>She repeatedly asked officials at OU Medical Center for part numbers for the screws, so she could find out how much they cost the hospital. Hospital officials never provided the information, Young said.\u003c/p>\n\u003cp>John Schmieding, senior vice president and general counsel for Arthrex, declined to tell Kaiser Health News exactly how much his company charges hospitals for the type of screws implanted in Young's foot. But he did offer ballpark figures: \"Our sale price for screws used in foot and ankle procedures would be below $300 per screw, with the most expensive around $1,000.\"\u003c/p>\n\u003cp>As for what the hospital charges, Schmieding said, \"We do not direct or control how a facility bills for their procedure.\" Based on the numbers Schmieding provided, the hospital markup on Young's screws could range from roughly 275 percent to upwards of 1,150 percent.\u003c/p>\n\u003cp>\"It's mind-boggling,\" said Dr. James Rickert, an orthopedic surgeon in Bedford, Ind., and president of the Society for Patient Centered Orthopedics, which advocates for affordable health care. \"We are talking about little pieces of metal.\"\u003c/p>\n\u003cp>Yet such steep markups are common at hospitals, said Rickert, who was not involved in Young's care.\u003c/p>\n\u003cp>Clearly, the screws used in Young's surgery are more sophisticated than those sold at the local hardware store. Many of the screws in Arthrex's online catalog are made of titanium, which is popular for surgery because it's strong and durable. The screws are also hollow, designed to fit over a guidewire so that doctors can place them in precisely the right place.\u003c/p>\n\u003cp>Surgical device manufacturers also must comply with strict regulations, said Steve Lichtenthal, vice president of business development at the Orthopaedic Implant Co., based in Reno, Nev., which makes surgical supplies.\u003c/p>\n\u003cp>But even the fanciest screw is still pretty simple, Lichtenthal said. Tiny screws cost only about $30 to manufacture, and the technology hasn't changed much in decades, he said. About half the cost of a surgical implant goes toward paying sales and marketing staff, who develop close relationships with doctors and sometimes even attend surgery, Lichtenthal said.\u003c/p>\n\u003cp>Screws weren't the only expensive devices figuring into Young's bill. A drill bit, used for making holes in bone, carried a charge of $4,265; a tool for removing and cauterizing tissue was $5,047; a saw blade, $619.\u003c/p>\n\u003cp>While screws can be used only once, there's no reason that other surgical equipment, such as saw blades, should be disposable, Rickert said. Hospitals routinely sterilize tools such as scalpels and scissors, then use them again.\u003c/p>\n\u003cp>A hospital spokesman declined to comment on the specifics of Young's bill, as did the surgeon who operated on her foot.\u003c/p>\n\u003cp>OU Medical Center issued a statement that said: \"OU Medical Center provides the highest-quality patient care. We are focused on acquiring the latest tools, treatments and technology, while diligently making sure we have the resources to maintain this commitment our patients deserve. We strive to keep costs down and focus investment on where it really matters — our patients.\"\u003c/p>\n\u003cp>In the statement, OU Medical Center said few patients pay the full price. Instead, insurance companies typically negotiate discounts with hospitals, allowing them to pay less than the amount on the list of charges.\u003c/p>\n\u003cp>Yet, as Young learned, people who are uninsured — or whose insurance plan refuses to pay — get no discount.\u003c/p>\n\u003cp>\u003cstrong>Resolution:\u003c/strong> Young is now off the hook. In a statement in response to a reporter's questions, BlueCross BlueShield of Oklahoma said it never actually denied Young's insurance claim but simply needed \"additional information from the provider in order to process it correctly.\"\u003c/p>\n\u003cp>According to Young's most recent billing statement from OU Medical Center, she does not owe anything for her hospital stay. However, her latest statement from the hospital includes a $413 charge for an \"appeal denied.\"\u003c/p>\n\u003cp>Surgery relieved the chronic pain in her shoulder and alleviated some but not all of the pain in her foot, Young said.\u003c/p>\n\u003cp>\u003cstrong>The takeaway:\u003c/strong> Companies can charge big prices for small surgical supplies, and hospitals can mark them up at will.\u003c/p>\n\u003cp>If you want to know exactly why your bill is so high, ask for an itemized list of charges. Since patients have no ability to shop around for different screws before the surgery, it's important to complain loudly to the hospital, your insurer and your employer if you see charges that seem outrageous.\u003c/p>\n\u003chr>\n\u003cp>\u003ca href=\"http://khn.org/\">Kaiser Health News\u003c/a>\u003cem> is a nonprofit news service covering health issues. It is an editorially independent program of the Kaiser Family Foundation that is not affiliated with Kaiser Permanente. \u003c/em>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>Jane Greenhalgh produced and edited the interview with Elisabeth Rosenthal for broadcast. Jackie Fortier from StateImpact Oklahoma reported from Lawton, Okla. Member station KGOU is part of StateImpact Oklahoma, a multistation reporting collaboration. KGOU is owned by the University of Oklahoma, which also owns and operates OU Medical Center.\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 Kaiser Health News. To see more, visit \u003ca href=\"http://www.kaiserhealthnews.org/\">Kaiser Health News\u003c/a>.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Sticker+Shock+Jolts+Oklahoma+Patient%3A+%2415%2C076+For+4+Tiny+Screws&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Sherry Young just wanted to be able to walk without pain.\u003c/p>\n\u003cp>About three years ago, she began to experience sharp pain in her left foot. Her big toe had become crooked and constantly rubbed up against the adjacent toe, making it painful to run, walk or even stand. \"I could not walk without intense pain unless I had a pad underneath my toes for cushioning,\" Young said.\u003c/p>\n\u003cp>An orthopedic surgeon told her that he could fix her problem for good. \"He thought my foot was hitting the ground too hard and causing pain,\" said Young. \"That's what he was trying to correct.\"\u003c/p>\n\u003cp>Though Young had had several orthopedic surgeries, she had always had good insurance and never scrutinized her bills.\u003c/p>\n\u003cp>At the time of her foot surgery, Young of course knew nothing about hospital charges for surgical screws, medical saws and other hardware used in the operating room.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Then the bill came.\u003c/p>\n\u003cp>\u003cstrong>Patient: \u003c/strong>Sherry Young, 57, a retired librarian on disability and a mother of two in Lawton, Okla.\u003c/p>\n\u003cp>\u003cstrong>Total bill:\u003c/strong> $115,527 for a three-day hospital stay, including $15,076 for four tiny screws — measuring 2.8 millimeters wide and no more than 14 millimeters long — placed in the two middle toes of her left foot.\u003c/p>\n\u003cp>\u003cstrong>Service provider:\u003c/strong> OU Medical Center, located at the University of Oklahoma Health Science Center in Oklahoma City\u003c/p>\n\u003cp>\u003cstrong>Medical treatment:\u003c/strong> Young underwent two operations on the same day in June 2017. One surgeon addressed an injury in Young's shoulder, caused by arthritis and overuse. A second surgeon performed several procedures on her foot, including removing a \u003ca href=\"https://www.footeducation.com/page/great-toe-cheilectomy-bone-spur-removal\" target=\"_blank\" rel=\"noopener\">bone spur.\u003c/a> To better align Young's middle toes, the doctor removed a slice of bone from the center of each toe, and then reconnected the two ends with surgical screws made by \u003ca href=\"https://www.arthrex.com/\" target=\"_blank\" rel=\"noopener\">Arthrex,\u003c/a> a medical device manufacturer based in Naples, Fla.\u003c/p>\n\u003cp>\u003cstrong>What gives:\u003c/strong> Two weeks after surgery, Young received a letter from her insurance plan, BlueCross BlueShield of Oklahoma, stating that it had not approved her hospital stay. Staying overnight was not \"medically necessary,\" according to the letter, because foot and shoulder surgery are typically performed as outpatient procedures.\u003c/p>\n\u003cp>The letter \"put me in a panic,\" said Young, who was suddenly worried that she would have to pay the entire $115,000 bill herself. That's about how much her home is worth, and five times her annual income.\u003c/p>\n\u003cp>Faced with the astronomical cost, Young asked for an itemized copy of her bill and began checking every charge.\u003c/p>\n\u003cp>She was floored by the price of the screws, each of which cost more than a high-end computer.\u003c/p>\n\u003cp>\"Unless the metal [was] mined on an asteroid, I do not know why it should cost that amount,\" Young said.\u003c/p>\n\u003cp>She repeatedly asked officials at OU Medical Center for part numbers for the screws, so she could find out how much they cost the hospital. Hospital officials never provided the information, Young said.\u003c/p>\n\u003cp>John Schmieding, senior vice president and general counsel for Arthrex, declined to tell Kaiser Health News exactly how much his company charges hospitals for the type of screws implanted in Young's foot. But he did offer ballpark figures: \"Our sale price for screws used in foot and ankle procedures would be below $300 per screw, with the most expensive around $1,000.\"\u003c/p>\n\u003cp>As for what the hospital charges, Schmieding said, \"We do not direct or control how a facility bills for their procedure.\" Based on the numbers Schmieding provided, the hospital markup on Young's screws could range from roughly 275 percent to upwards of 1,150 percent.\u003c/p>\n\u003cp>\"It's mind-boggling,\" said Dr. James Rickert, an orthopedic surgeon in Bedford, Ind., and president of the Society for Patient Centered Orthopedics, which advocates for affordable health care. \"We are talking about little pieces of metal.\"\u003c/p>\n\u003cp>Yet such steep markups are common at hospitals, said Rickert, who was not involved in Young's care.\u003c/p>\n\u003cp>Clearly, the screws used in Young's surgery are more sophisticated than those sold at the local hardware store. Many of the screws in Arthrex's online catalog are made of titanium, which is popular for surgery because it's strong and durable. The screws are also hollow, designed to fit over a guidewire so that doctors can place them in precisely the right place.\u003c/p>\n\u003cp>Surgical device manufacturers also must comply with strict regulations, said Steve Lichtenthal, vice president of business development at the Orthopaedic Implant Co., based in Reno, Nev., which makes surgical supplies.\u003c/p>\n\u003cp>But even the fanciest screw is still pretty simple, Lichtenthal said. Tiny screws cost only about $30 to manufacture, and the technology hasn't changed much in decades, he said. About half the cost of a surgical implant goes toward paying sales and marketing staff, who develop close relationships with doctors and sometimes even attend surgery, Lichtenthal said.\u003c/p>\n\u003cp>Screws weren't the only expensive devices figuring into Young's bill. A drill bit, used for making holes in bone, carried a charge of $4,265; a tool for removing and cauterizing tissue was $5,047; a saw blade, $619.\u003c/p>\n\u003cp>While screws can be used only once, there's no reason that other surgical equipment, such as saw blades, should be disposable, Rickert said. Hospitals routinely sterilize tools such as scalpels and scissors, then use them again.\u003c/p>\n\u003cp>A hospital spokesman declined to comment on the specifics of Young's bill, as did the surgeon who operated on her foot.\u003c/p>\n\u003cp>OU Medical Center issued a statement that said: \"OU Medical Center provides the highest-quality patient care. We are focused on acquiring the latest tools, treatments and technology, while diligently making sure we have the resources to maintain this commitment our patients deserve. We strive to keep costs down and focus investment on where it really matters — our patients.\"\u003c/p>\n\u003cp>In the statement, OU Medical Center said few patients pay the full price. Instead, insurance companies typically negotiate discounts with hospitals, allowing them to pay less than the amount on the list of charges.\u003c/p>\n\u003cp>Yet, as Young learned, people who are uninsured — or whose insurance plan refuses to pay — get no discount.\u003c/p>\n\u003cp>\u003cstrong>Resolution:\u003c/strong> Young is now off the hook. In a statement in response to a reporter's questions, BlueCross BlueShield of Oklahoma said it never actually denied Young's insurance claim but simply needed \"additional information from the provider in order to process it correctly.\"\u003c/p>\n\u003cp>According to Young's most recent billing statement from OU Medical Center, she does not owe anything for her hospital stay. However, her latest statement from the hospital includes a $413 charge for an \"appeal denied.\"\u003c/p>\n\u003cp>Surgery relieved the chronic pain in her shoulder and alleviated some but not all of the pain in her foot, Young said.\u003c/p>\n\u003cp>\u003cstrong>The takeaway:\u003c/strong> Companies can charge big prices for small surgical supplies, and hospitals can mark them up at will.\u003c/p>\n\u003cp>If you want to know exactly why your bill is so high, ask for an itemized list of charges. Since patients have no ability to shop around for different screws before the surgery, it's important to complain loudly to the hospital, your insurer and your employer if you see charges that seem outrageous.\u003c/p>\n\u003chr>\n\u003cp>\u003ca href=\"http://khn.org/\">Kaiser Health News\u003c/a>\u003cem> is a nonprofit news service covering health issues. It is an editorially independent program of the Kaiser Family Foundation that is not affiliated with Kaiser Permanente. \u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>Jane Greenhalgh produced and edited the interview with Elisabeth Rosenthal for broadcast. Jackie Fortier from StateImpact Oklahoma reported from Lawton, Okla. Member station KGOU is part of StateImpact Oklahoma, a multistation reporting collaboration. KGOU is owned by the University of Oklahoma, which also owns and operates OU Medical Center.\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 Kaiser Health News. To see more, visit \u003ca href=\"http://www.kaiserhealthnews.org/\">Kaiser Health News\u003c/a>.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Sticker+Shock+Jolts+Oklahoma+Patient%3A+%2415%2C076+For+4+Tiny+Screws&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "New Snail Research Could Shake Up Our Understanding of Memory",
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"content": "\u003cp>UCLA neuroscientists reported Monday that they have transferred a memory from one animal to another via injections of RNA, a startling result that challenges the widely held view of where and how memories are stored in the brain. [contextly_sidebar id=\"li8sZlyeZueTl33XPD1EtLOaLArCiTWy\"]\u003c/p>\n\u003cp>The finding from the lab of David Glanzman hints at the potential for new RNA-based treatments to one day restore lost memories and, if correct, could shake up the field of memory and learning.\u003c/p>\n\u003cp>“It’s pretty shocking,” said Dr. Todd Sacktor, a neurologist and memory researcher at SUNY Downstate Medical Center in Brooklyn, N.Y. “The big picture is we’re working out the basic alphabet of how memories are stored for the first time.” He was not involved in the research, which was \u003ca href=\"http://www.eneuro.org/content/early/2018/05/14/ENEURO.0038-18.2018\" target=\"_blank\" rel=\"noopener\">published in eNeuro\u003c/a>, the \u003ca href=\"http://www.eneuro.org/\" target=\"_blank\" rel=\"noopener\">online journal\u003c/a> of the Society for Neuroscience.\u003c/p>\n\u003cp>Many scientists are expected to view the research more cautiously. The work is in snails, animals that have proven a powerful model organism for neuroscience but whose simple brains work far differently than those of humans. The experiments will need to be replicated, including in animals with more complex brains. And the results fly in the face of a massive amount of evidence supporting the deeply entrenched idea that memories are stored through changes in the strength of connections, or synapses, between neurons.\u003c/p>\n\u003cp>“If he’s right, this would be absolutely earth-shattering,” said Tomás Ryan, an assistant professor at Trinity College Dublin, whose lab hunts for engrams, or the physical traces of memory. “But I don’t think it’s right.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Glanzman knows his unceremonial demotion of the synapse is not going to go over well in the field. “I expect a lot of astonishment and skepticism,” he said. “I don’t expect people are going to have a parade for me at the next Society for Neuroscience meeting.”\u003c/p>\n\u003cp>Even his own colleagues were dubious. “It took me a long time to convince the people in my lab to do the experiment,” he said. “They thought it was nuts.”\u003c/p>\n\u003cp>Glanzman’s experiments — funded by the National Institutes of Health and the National Science Foundation — involved giving mild electrical shocks to the marine snail Aplysia californica. Shocked snails learn to withdraw their delicate siphons and gills for nearly a minute as a defense when they subsequently receive a weak touch; snails that have not been shocked withdraw only briefly.[contextly_sidebar id=\"hBHp5EEY5u6iaZayEtFqvfhgpnNXWkKq\"]\u003c/p>\n\u003cp>The researchers extracted RNA from the nervous systems of snails that had been shocked and injected the material into unshocked snails. RNA’s primary role is to serve as a messenger inside cells, carrying protein-making instructions from its cousin DNA. But when this RNA was injected, these naive snails withdrew their siphons for extended periods of time after a soft touch. Control snails that received injections of RNA from snails that had not received shocks did not withdraw their siphons for as long.\u003c/p>\n\u003cp>“It’s as if we transferred a memory,” Glanzman said.\u003c/p>\n\u003cp>Glanzman’s group went further, showing that Aplysia sensory neurons in Petri dishes were more excitable, as they tend to be after being shocked, if they were exposed to RNA from shocked snails. Exposure to RNA from snails that had never been shocked did not cause the cells to become more excitable.\u003c/p>\n\u003cdiv>\n\u003cdiv>\n\u003cdiv>\n\u003cp>The results, said Glanzman, suggest that memories may be stored within the nucleus of neurons, where RNA is synthesized and can act on DNA to turn genes on and off. He said he thought memory storage involved these epigenetic changes — changes in the activity of genes and not in the DNA sequences that make up those genes — that are mediated by RNA.\u003c/p>\n\u003c/div>\n\u003c/div>\n\u003c/div>\n\u003cp>This view challenges the widely held notion that memories are stored by enhancing synaptic connections between neurons. Rather, Glanzman sees synaptic changes that occur during memory formation as flowing from the information that the RNA is carrying.\u003c/p>\n\u003cp>“This idea is radical and definitely challenges the field,” said Li-Huei Tsai, a neuroscientist who directs the Picower Institute for Learning and Memory at the Massachusetts Institute of Technology. Tsai, who recently co-authored a \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4874022/\" target=\"_blank\" rel=\"noopener\">major review on memory formation\u003c/a>, called Glanzman’s study “impressive and interesting” and said a number of studies support the notion that epigenetic mechanisms play some role in memory formation, which is likely a complex and multifaceted process. But she said she strongly disagreed with Glanzman’s notion that synaptic connections do not play a key role in memory storage.\u003c/p>\n\u003cp>Trinity College’s Ryan, like Glanzman, stands with a minority of neuroscientists — some call them rebels — who \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/28548457\" target=\"_blank\" rel=\"noopener\">question the idea\u003c/a> that memory is stored through synaptic strength. In 2015, Ryan was lead author of a Science paper with MIT Nobelist Susumu Tonegawa that showed \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/26023136\" target=\"_blank\" rel=\"noopener\">memories could be retrieved\u003c/a> even after synapse strengthening was blocked. Ryan said he is pursuing the idea that memories are stored through ensembles of neurons bound together by new synaptic connections, not by strengthening of existing connections.[contextly_sidebar id=\"U81WeRFYsnSgGUp9A3OIFy9mt8TlGFLL\"]\u003c/p>\n\u003cp>Ryan knows Glanzman and trusts his work. He said he believes the data in the new paper. But he doesn’t think the behavior of the snails, or the cells, proves that RNA is transferring memories. He said he doesn’t understand how RNA, which works on a time scale of minutes to hours, could be causing memory recall that is almost instantaneous, or how RNA could connect numerous parts of the brain, like the auditory and visual systems, that are involved in more complex memories.\u003c/p>\n\u003cp>But Glanzman said he is convinced RNA is playing a role that eclipses the synapse. In 2014, his lab showed that \u003ca href=\"https://elifesciences.org/articles/03896\" target=\"_blank\" rel=\"noopener\">memories of shocks that had been lost\u003c/a> in snails due to a series of experimental procedures could be recovered — but the synapse patterns that were lost with the memory reformed in random ways when the memories were recovered, suggesting memories were not stored there. Glanzman’s lab and others have also shown that long-term memory formation can be blocked by preventing epigenetic changes, even when synapse formation or strengthening is not altered.\u003c/p>\n\u003cp>“Synapses can come and go, but the memory can still be there,” he said, saying he sees synapses as merely the “reflection of knowledge held in the nucleus.”\u003c/p>\n\u003cp>Glanzman has studied memory for more than three decades. He did postdoctoral work with none other than Eric Kandel — the neuroscientist who shared the 2000 Nobel prize for research on Aplysia, probing the role of the synapse in memory — and he said he has spent most of his career believing that synaptic change was the key to memory storage.\u003c/p>\n\u003cp>But he said a series of findings from other labs and his own in recent years have led him to start questioning the synaptic dogma. He calls himself “a recovering synaptologist.”\u003c/p>\n\u003cp>The skepticism over Glanzman’s research may be in part because the work harkens back to an unnerving episode in science involving an unconventional psychologist, James V. McConnell, who spent years at the University of Michigan attempting to prove that something outside the brain — a factor he called “memory RNA” — could transfer memories. In the ’50s and ’60s, McConnell trained flatworms and then fed the bodies of trained worms to untrained worms. The untrained worms then appeared to exhibit the behavior of the trained worms they’d cannibalized, suggesting that memories were somehow transferred. He also showed that trained worms that were beheaded could remember their training after they grew new heads.[contextly_sidebar id=\"F5HcwGf5fX0A2ZqbT4U7VYdgDDaJshog\"]\u003c/p>\n\u003cp>Though the work was replicated by some other labs, McConnell’s work was largely ridiculed and is often described as a cautionary tale because so much time and money was spent by other labs trying, often unsuccessfully, to replicate the work. (McConnell died in 1990, five years after he’d been a target of the Unabomber Theodore Kaczynski.)\u003c/p>\n\u003cp>Recently, developmental biologist Michael Levin at Tufts has \u003ca href=\"https://www.theverge.com/2015/3/18/8225321/memory-research-flatworm-cannibalism-james-mcconnell-michael-levin\" target=\"_blank\" rel=\"noopener\">replicated McConnell’s experiments\u003c/a> on headless worms under more controlled settings and thinks McConnell may have indeed been correct.\u003c/p>\n\u003cp>Glanzman said one of McConnell’s students, Al Jacobson, demonstrated the transfer of memories between flatworms via RNA injections, coincidentally while an assistant professor at UCLA. The work was \u003ca href=\"http://www.nature.com/articles/209599a0\" target=\"_blank\" rel=\"noopener\">published in Nature in 1966\u003c/a> but Jacobsen never received tenure, perhaps because of doubts about his findings. The experiment was, however, \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC224185/\" target=\"_blank\" rel=\"noopener\">replicated in rats\u003c/a> shortly afterward.\u003c/p>\n\u003cp>Glanzman learned about McConnell’s work — and his satirical journal “Worm Runner’s Digest” — while he was a psychology undergraduate at Indiana University but never took the results seriously. Now, while he’s still not convinced McConnell was exactly right about being able to transfer memories, he does think both McConnell and Jacobson were onto something.\u003c/p>\n\u003cp>Working in the memory field can be tough for those who challenge the status quo. SUNY’s Sacktor, for example, has \u003ca href=\"https://www.statnews.com/2016/06/23/memory-research-neuroscience/\">spent more than 25 years\u003c/a> — despite the skepticism, rejection, and outright derision of fellow scientists — chasing down a single molecule, PKMzeta, that he believes is critical to the formation of long-term memories and may be connected to the RNA mechanisms that Glanzman has uncovered.\u003c/p>\n\u003cp>The stakes in the field are high because memory is so key to our sense of self and many scientists feel understanding the workings of memory is something that should have been figured out by now. “It’s the last of the great 20th-century questions in biology,” Sacktor said. “Some aspect has made it difficult for neuroscientists to figure out.”\u003c/p>\n\u003cp>The difficulty may be due in part to the overwhelming focus on synaptic strength. Some 12,000 papers have been published on synaptic strength without providing a good explanation for how memories are stored, Ryan noted, adding that he applauds Glanzman for opening up a new path, radical as it is, to explore.\u003c/p>\n\u003cp>“The reality is we know so little about memory,” Ryan said. “I’m excited about any new vistas and avenues.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This \u003ca href=\"https://www.statnews.com/2018/05/14/memory-transfer-between-snails-challenges-standard-theory/\" target=\"_blank\" rel=\"noopener\">story\u003c/a> was originally published by STAT, 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>UCLA neuroscientists reported Monday that they have transferred a memory from one animal to another via injections of RNA, a startling result that challenges the widely held view of where and how memories are stored in the brain. \u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>The finding from the lab of David Glanzman hints at the potential for new RNA-based treatments to one day restore lost memories and, if correct, could shake up the field of memory and learning.\u003c/p>\n\u003cp>“It’s pretty shocking,” said Dr. Todd Sacktor, a neurologist and memory researcher at SUNY Downstate Medical Center in Brooklyn, N.Y. “The big picture is we’re working out the basic alphabet of how memories are stored for the first time.” He was not involved in the research, which was \u003ca href=\"http://www.eneuro.org/content/early/2018/05/14/ENEURO.0038-18.2018\" target=\"_blank\" rel=\"noopener\">published in eNeuro\u003c/a>, the \u003ca href=\"http://www.eneuro.org/\" target=\"_blank\" rel=\"noopener\">online journal\u003c/a> of the Society for Neuroscience.\u003c/p>\n\u003cp>Many scientists are expected to view the research more cautiously. The work is in snails, animals that have proven a powerful model organism for neuroscience but whose simple brains work far differently than those of humans. The experiments will need to be replicated, including in animals with more complex brains. And the results fly in the face of a massive amount of evidence supporting the deeply entrenched idea that memories are stored through changes in the strength of connections, or synapses, between neurons.\u003c/p>\n\u003cp>“If he’s right, this would be absolutely earth-shattering,” said Tomás Ryan, an assistant professor at Trinity College Dublin, whose lab hunts for engrams, or the physical traces of memory. “But I don’t think it’s right.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Glanzman knows his unceremonial demotion of the synapse is not going to go over well in the field. “I expect a lot of astonishment and skepticism,” he said. “I don’t expect people are going to have a parade for me at the next Society for Neuroscience meeting.”\u003c/p>\n\u003cp>Even his own colleagues were dubious. “It took me a long time to convince the people in my lab to do the experiment,” he said. “They thought it was nuts.”\u003c/p>\n\u003cp>Glanzman’s experiments — funded by the National Institutes of Health and the National Science Foundation — involved giving mild electrical shocks to the marine snail Aplysia californica. Shocked snails learn to withdraw their delicate siphons and gills for nearly a minute as a defense when they subsequently receive a weak touch; snails that have not been shocked withdraw only briefly.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>The researchers extracted RNA from the nervous systems of snails that had been shocked and injected the material into unshocked snails. RNA’s primary role is to serve as a messenger inside cells, carrying protein-making instructions from its cousin DNA. But when this RNA was injected, these naive snails withdrew their siphons for extended periods of time after a soft touch. Control snails that received injections of RNA from snails that had not received shocks did not withdraw their siphons for as long.\u003c/p>\n\u003cp>“It’s as if we transferred a memory,” Glanzman said.\u003c/p>\n\u003cp>Glanzman’s group went further, showing that Aplysia sensory neurons in Petri dishes were more excitable, as they tend to be after being shocked, if they were exposed to RNA from shocked snails. Exposure to RNA from snails that had never been shocked did not cause the cells to become more excitable.\u003c/p>\n\u003cdiv>\n\u003cdiv>\n\u003cdiv>\n\u003cp>The results, said Glanzman, suggest that memories may be stored within the nucleus of neurons, where RNA is synthesized and can act on DNA to turn genes on and off. He said he thought memory storage involved these epigenetic changes — changes in the activity of genes and not in the DNA sequences that make up those genes — that are mediated by RNA.\u003c/p>\n\u003c/div>\n\u003c/div>\n\u003c/div>\n\u003cp>This view challenges the widely held notion that memories are stored by enhancing synaptic connections between neurons. Rather, Glanzman sees synaptic changes that occur during memory formation as flowing from the information that the RNA is carrying.\u003c/p>\n\u003cp>“This idea is radical and definitely challenges the field,” said Li-Huei Tsai, a neuroscientist who directs the Picower Institute for Learning and Memory at the Massachusetts Institute of Technology. Tsai, who recently co-authored a \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4874022/\" target=\"_blank\" rel=\"noopener\">major review on memory formation\u003c/a>, called Glanzman’s study “impressive and interesting” and said a number of studies support the notion that epigenetic mechanisms play some role in memory formation, which is likely a complex and multifaceted process. But she said she strongly disagreed with Glanzman’s notion that synaptic connections do not play a key role in memory storage.\u003c/p>\n\u003cp>Trinity College’s Ryan, like Glanzman, stands with a minority of neuroscientists — some call them rebels — who \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/28548457\" target=\"_blank\" rel=\"noopener\">question the idea\u003c/a> that memory is stored through synaptic strength. In 2015, Ryan was lead author of a Science paper with MIT Nobelist Susumu Tonegawa that showed \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/26023136\" target=\"_blank\" rel=\"noopener\">memories could be retrieved\u003c/a> even after synapse strengthening was blocked. Ryan said he is pursuing the idea that memories are stored through ensembles of neurons bound together by new synaptic connections, not by strengthening of existing connections.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Ryan knows Glanzman and trusts his work. He said he believes the data in the new paper. But he doesn’t think the behavior of the snails, or the cells, proves that RNA is transferring memories. He said he doesn’t understand how RNA, which works on a time scale of minutes to hours, could be causing memory recall that is almost instantaneous, or how RNA could connect numerous parts of the brain, like the auditory and visual systems, that are involved in more complex memories.\u003c/p>\n\u003cp>But Glanzman said he is convinced RNA is playing a role that eclipses the synapse. In 2014, his lab showed that \u003ca href=\"https://elifesciences.org/articles/03896\" target=\"_blank\" rel=\"noopener\">memories of shocks that had been lost\u003c/a> in snails due to a series of experimental procedures could be recovered — but the synapse patterns that were lost with the memory reformed in random ways when the memories were recovered, suggesting memories were not stored there. Glanzman’s lab and others have also shown that long-term memory formation can be blocked by preventing epigenetic changes, even when synapse formation or strengthening is not altered.\u003c/p>\n\u003cp>“Synapses can come and go, but the memory can still be there,” he said, saying he sees synapses as merely the “reflection of knowledge held in the nucleus.”\u003c/p>\n\u003cp>Glanzman has studied memory for more than three decades. He did postdoctoral work with none other than Eric Kandel — the neuroscientist who shared the 2000 Nobel prize for research on Aplysia, probing the role of the synapse in memory — and he said he has spent most of his career believing that synaptic change was the key to memory storage.\u003c/p>\n\u003cp>But he said a series of findings from other labs and his own in recent years have led him to start questioning the synaptic dogma. He calls himself “a recovering synaptologist.”\u003c/p>\n\u003cp>The skepticism over Glanzman’s research may be in part because the work harkens back to an unnerving episode in science involving an unconventional psychologist, James V. McConnell, who spent years at the University of Michigan attempting to prove that something outside the brain — a factor he called “memory RNA” — could transfer memories. In the ’50s and ’60s, McConnell trained flatworms and then fed the bodies of trained worms to untrained worms. The untrained worms then appeared to exhibit the behavior of the trained worms they’d cannibalized, suggesting that memories were somehow transferred. He also showed that trained worms that were beheaded could remember their training after they grew new heads.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Though the work was replicated by some other labs, McConnell’s work was largely ridiculed and is often described as a cautionary tale because so much time and money was spent by other labs trying, often unsuccessfully, to replicate the work. (McConnell died in 1990, five years after he’d been a target of the Unabomber Theodore Kaczynski.)\u003c/p>\n\u003cp>Recently, developmental biologist Michael Levin at Tufts has \u003ca href=\"https://www.theverge.com/2015/3/18/8225321/memory-research-flatworm-cannibalism-james-mcconnell-michael-levin\" target=\"_blank\" rel=\"noopener\">replicated McConnell’s experiments\u003c/a> on headless worms under more controlled settings and thinks McConnell may have indeed been correct.\u003c/p>\n\u003cp>Glanzman said one of McConnell’s students, Al Jacobson, demonstrated the transfer of memories between flatworms via RNA injections, coincidentally while an assistant professor at UCLA. The work was \u003ca href=\"http://www.nature.com/articles/209599a0\" target=\"_blank\" rel=\"noopener\">published in Nature in 1966\u003c/a> but Jacobsen never received tenure, perhaps because of doubts about his findings. The experiment was, however, \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC224185/\" target=\"_blank\" rel=\"noopener\">replicated in rats\u003c/a> shortly afterward.\u003c/p>\n\u003cp>Glanzman learned about McConnell’s work — and his satirical journal “Worm Runner’s Digest” — while he was a psychology undergraduate at Indiana University but never took the results seriously. Now, while he’s still not convinced McConnell was exactly right about being able to transfer memories, he does think both McConnell and Jacobson were onto something.\u003c/p>\n\u003cp>Working in the memory field can be tough for those who challenge the status quo. SUNY’s Sacktor, for example, has \u003ca href=\"https://www.statnews.com/2016/06/23/memory-research-neuroscience/\">spent more than 25 years\u003c/a> — despite the skepticism, rejection, and outright derision of fellow scientists — chasing down a single molecule, PKMzeta, that he believes is critical to the formation of long-term memories and may be connected to the RNA mechanisms that Glanzman has uncovered.\u003c/p>\n\u003cp>The stakes in the field are high because memory is so key to our sense of self and many scientists feel understanding the workings of memory is something that should have been figured out by now. “It’s the last of the great 20th-century questions in biology,” Sacktor said. “Some aspect has made it difficult for neuroscientists to figure out.”\u003c/p>\n\u003cp>The difficulty may be due in part to the overwhelming focus on synaptic strength. Some 12,000 papers have been published on synaptic strength without providing a good explanation for how memories are stored, Ryan noted, adding that he applauds Glanzman for opening up a new path, radical as it is, to explore.\u003c/p>\n\u003cp>“The reality is we know so little about memory,” Ryan said. “I’m excited about any new vistas and avenues.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>Author Michael Pollan had always been curious about psychoactive plants, but his interest skyrocketed when he heard about a \u003ca href=\"https://www.npr.org/sections/health-shots/2016/12/03/504136736/how-a-psychedelic-drug-helps-cancer-patients-overcome-anxiety\" target=\"_blank\" rel=\"noopener\">research study\u003c/a> in which people with terminal cancer were given a psychedelic called \u003ca href=\"https://www.npr.org/tags/140958387/psilocybin\" target=\"_blank\" rel=\"noopener\">psilocybin \u003c/a>— the active ingredient in \"magic mushrooms\" — to help them deal with their distress.\u003c/p>\n\u003cp>\"This seemed like such a crazy idea that I began looking into it,\" Pollan says. \"Why should a drug from a mushroom help people deal with their mortality?\"\u003c/p>\n\u003cp>Pollan, whose previous books include \u003ca href=\"https://www.npr.org/books/titles/137946336/the-omnivores-dilemma-a-natural-history-of-four-meals\" target=\"_blank\" rel=\"noopener\">The Omnivore's Dilemma\u003c/a> and \u003ca href=\"https://www.npr.org/templates/story/story.php?storyId=17725932\" target=\"_blank\" rel=\"noopener\">In Defense Of Food\u003c/a>, started researching different experimental therapeutic uses of psychedelics, and found that the drugs were being used to treat depression, addiction and the fear of death.\u003c/p>\n\u003cp>Then he decided to go one step further: A self-described \"reluctant psychonaut,\" Pollan enlisted guides to help him experiment with LSD, psilocybin and 5-MeO-DMT, a substance in the venom of the Sonoran Desert toad.\u003c/p>\n\u003cp>Each of Pollan's experiences with psychedelics was preceded by worry and self-doubt. But, he says, \"I realized later that was my ego trying to convince me not to do this thing that was going to challenge my ego.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Pollan's new book, \u003cem>How to Change Your Mind: What the New Science of Psychedelics Teaches Us About Consciousness, Dying, Addiction, Depression, and Transcendence\u003c/em>, recounts his experiences with the drugs and also examines the history of psychedelics as well as their possible therapeutic uses.\u003c/p>\n\u003chr>\n\u003cp>\u003cstrong>Interview Highlights\u003c/strong>\u003c/p>\n\u003cp>\u003cstrong>On how the psychedelic psilocybin is administered in therapy for depression \u003c/strong>\u003c/p>\n\u003cp>The way [psilocybin is] being used is in a very controlled or guided setting. ... They don't just give you a pill and send you home; you're in a room. You're with two guides, one male, one female. You're lying down on a comfortable couch. You're wearing headphones listening to a really carefully curated playlist of music — instrumental compositions for the most part — and you're wearing eyeshades, all of which is to encourage a very inward journey.\u003c/p>\n\u003cp>Someone is kind of looking out for you, and they prepare you very carefully in advance. They give you a set of \"flight instructions,\" as they call them, which is what to do if you get really scared or you're beginning to have a bad trip. If you see a monster, for example, don't try to run away. Walk right up to it, plant your feet and say, \"What do you have to teach me? What are you doing in my mind?\" And if you do that, according to the flight instructions, your fear will morph into something much more positive very quickly.\u003c/p>\n\u003cp>\u003cstrong>On how psychedelics can help change the stories we tell about ourselves \u003c/strong>\u003c/p>\n\u003cp>The drugs foster new perspectives on old problems. One of the things our mind does is tell stories about ourselves. If you're depressed, you're being told a story perhaps that you're worthless, that no one could possibly love you, you're not worthy of love, that life will not get better. And these stories — which are enforced by our egos really — trap us in these ruminative loops that are very hard to get out of. They're very destructive patterns of thought.\u003c/p>\n\u003cp>What the drugs appear to do is disable for a period of time the part of the brain where the self talks to itself. It's called the \u003ca href=\"https://www.npr.org/tags/482443062/default-mode-network\" target=\"_blank\" rel=\"noopener\">default mode network\u003c/a>, and it's a group of structures that connect parts of the cortex — the evolutionarily most recent part of the brain — to deeper levels where emotion and memory reside. And it's a very important hub in the brain and lots of important things happen there: self-reflection and rumination, time travel. It's where we go to think about the future or the past, and theory of mind, the ability to imagine the mental states of other beings and, I think, most importantly, the autobiographical self. It's the part of the brain, it appears, where we incorporate things that happen to us, new information, with a sense of who we are, who we were and who we want to be. And that's where these stories get generated. And these stories can be really destructive, they trap us. ...\u003c/p>\n\u003cp>This network is downregulated [with psychedelics], it sort of goes offline for a period of time. And that's why you experience this dissolution of self or ego, which can be a terrifying or liberating thing, depending on your mindset. This is what allows people, I think, to have those new perspectives on themselves, to realize that they needn't be trapped in those stories and they might actually be able to write some new stories about themselves. That's what's liberating, I think, about the experience when it works.\u003c/p>\n\u003cp>\u003cstrong>On how psychedelics can help dying people face their deaths \u003c/strong>\u003c/p>\n\u003cp>\u003ca href=\"https://www.npr.org/tags/125941537/prozac\">Prozac\u003c/a> doesn't help when you're confronting your mortality. But here we have something that occasions an experience in people — a mystical experience — that somehow makes it easier to let go. And I think some of it has to do with the fact that you do experience the \"extinction\" of yourself and it's kind of a rehearsal for death. And I think that may be part of what helps people, that they expand their sense of what is your self-interest and your self-interest is something larger than what is contained by your skin. And when you have that recognition, I think dying becomes a little easier. ...\u003c/p>\n\u003cp>There's no way to prove this, obviously, and it's a question that really troubled me as an old-fashioned materialist skeptical journalist. It's like, \"What if these drugs are inducing an illusion in people?\" I got a variety of answers to that question from the researchers. One was, \"Who cares if it helps them?\" And I can see the point of that. The other was, \"Hey, this is beyond my pay grade; none of us know what happens after we die.\" And others say, \"Well, this is an open frontier.\" ...\u003c/p>\n\u003cp>The experiences that people have are very real to them — they're psychological facts. And one of the really interesting qualities of psychedelic experience is that the insights you have on them have a durability ... This isn't just an opinion, this is revealed truth, so the confidence people have is hard to shake, actually.\u003c/p>\n\u003cp>\u003cstrong>On a \u003c/strong>\u003ca href=\"https://www.hopkinsmedicine.org/news/stories/mushrooms_quit_smoking.html\" target=\"_blank\" rel=\"noopener\">\u003cstrong>Johns Hopkins study\u003c/strong>\u003c/a>\u003cstrong> on the use of psilocybin to help people quit smoking \u003c/strong>\u003c/p>\n\u003cp>Smoking is a very hard addiction to break. It's one of the hardest addictions to break. [I wanted to understand] how, after a single psilocybin trip, they could decide \"I'm never going to smoke again\" based on the perspective they had achieved. And they would say things like, \"Well, I had this amazing experience. I died three times. I sprouted wings. I flew through European histories. I beheld all these wonders. I saw my body on a funeral pyre on the Ganges. And I realized, the universe is so amazing and there's so much to do in it that killing myself seemed really stupid.\" And that was the insight. Yes, killing yourself is really stupid — but it had an authority it had never had. And that, I think, is the gift of these psychedelics.\u003c/p>\n\u003cp>\u003cstrong>On his own experience tripping on mushrooms \u003c/strong>\u003c/p>\n\u003cp>I had an experience that was by turns frightening and ecstatic and weird. ... I found myself in this place where I could no longer control my perceptions at all, and I felt my sense of self scatter to the wind — almost as if a pile of post-its had been released to the wind — but I was fine with it. I didn't feel any desire to pile the papers back together into my customary self ...\u003c/p>\n\u003cp>Then I looked out and saw myself spread over the landscape like a coat of paint or butter. I was outside myself, beside myself, literally, and the consciousness that beheld this ... was not my normal consciousness, it was completely unperturbed. It was dispassionate. It was content, as I watched myself dissolve over the landscape.\u003c/p>\n\u003cp>What I brought back from that experience was that I'm not identical to my ego, that there is another ground on which to plant our feet and that our ego is kind of this character that is chattering neurotically in our minds. And it's good for lots of things. I mean, the ego got the book written, but it also can be very harsh, and it's liberating to have some distance on it. And that was a great gift, I think.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>Sam Briger and Seth Kelley produced and edited this interview for broadcast. Bridget Bentz, Molly Seavy-Nesper and Scott Hensley adapted it for the Web.\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 Fresh Air. To see more, visit \u003ca href=\"http://www.npr.org/programs/fresh-air/\" target=\"_blank\" rel=\"noopener\">Fresh Air\u003c/a>.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=%27Reluctant+Psychonaut%27+Michael+Pollan+Embraces+The+%27New+Science%27+Of+Psychedelics+&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Author Michael Pollan had always been curious about psychoactive plants, but his interest skyrocketed when he heard about a \u003ca href=\"https://www.npr.org/sections/health-shots/2016/12/03/504136736/how-a-psychedelic-drug-helps-cancer-patients-overcome-anxiety\" target=\"_blank\" rel=\"noopener\">research study\u003c/a> in which people with terminal cancer were given a psychedelic called \u003ca href=\"https://www.npr.org/tags/140958387/psilocybin\" target=\"_blank\" rel=\"noopener\">psilocybin \u003c/a>— the active ingredient in \"magic mushrooms\" — to help them deal with their distress.\u003c/p>\n\u003cp>\"This seemed like such a crazy idea that I began looking into it,\" Pollan says. \"Why should a drug from a mushroom help people deal with their mortality?\"\u003c/p>\n\u003cp>Pollan, whose previous books include \u003ca href=\"https://www.npr.org/books/titles/137946336/the-omnivores-dilemma-a-natural-history-of-four-meals\" target=\"_blank\" rel=\"noopener\">The Omnivore's Dilemma\u003c/a> and \u003ca href=\"https://www.npr.org/templates/story/story.php?storyId=17725932\" target=\"_blank\" rel=\"noopener\">In Defense Of Food\u003c/a>, started researching different experimental therapeutic uses of psychedelics, and found that the drugs were being used to treat depression, addiction and the fear of death.\u003c/p>\n\u003cp>Then he decided to go one step further: A self-described \"reluctant psychonaut,\" Pollan enlisted guides to help him experiment with LSD, psilocybin and 5-MeO-DMT, a substance in the venom of the Sonoran Desert toad.\u003c/p>\n\u003cp>Each of Pollan's experiences with psychedelics was preceded by worry and self-doubt. But, he says, \"I realized later that was my ego trying to convince me not to do this thing that was going to challenge my ego.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Pollan's new book, \u003cem>How to Change Your Mind: What the New Science of Psychedelics Teaches Us About Consciousness, Dying, Addiction, Depression, and Transcendence\u003c/em>, recounts his experiences with the drugs and also examines the history of psychedelics as well as their possible therapeutic uses.\u003c/p>\n\u003chr>\n\u003cp>\u003cstrong>Interview Highlights\u003c/strong>\u003c/p>\n\u003cp>\u003cstrong>On how the psychedelic psilocybin is administered in therapy for depression \u003c/strong>\u003c/p>\n\u003cp>The way [psilocybin is] being used is in a very controlled or guided setting. ... They don't just give you a pill and send you home; you're in a room. You're with two guides, one male, one female. You're lying down on a comfortable couch. You're wearing headphones listening to a really carefully curated playlist of music — instrumental compositions for the most part — and you're wearing eyeshades, all of which is to encourage a very inward journey.\u003c/p>\n\u003cp>Someone is kind of looking out for you, and they prepare you very carefully in advance. They give you a set of \"flight instructions,\" as they call them, which is what to do if you get really scared or you're beginning to have a bad trip. If you see a monster, for example, don't try to run away. Walk right up to it, plant your feet and say, \"What do you have to teach me? What are you doing in my mind?\" And if you do that, according to the flight instructions, your fear will morph into something much more positive very quickly.\u003c/p>\n\u003cp>\u003cstrong>On how psychedelics can help change the stories we tell about ourselves \u003c/strong>\u003c/p>\n\u003cp>The drugs foster new perspectives on old problems. One of the things our mind does is tell stories about ourselves. If you're depressed, you're being told a story perhaps that you're worthless, that no one could possibly love you, you're not worthy of love, that life will not get better. And these stories — which are enforced by our egos really — trap us in these ruminative loops that are very hard to get out of. They're very destructive patterns of thought.\u003c/p>\n\u003cp>What the drugs appear to do is disable for a period of time the part of the brain where the self talks to itself. It's called the \u003ca href=\"https://www.npr.org/tags/482443062/default-mode-network\" target=\"_blank\" rel=\"noopener\">default mode network\u003c/a>, and it's a group of structures that connect parts of the cortex — the evolutionarily most recent part of the brain — to deeper levels where emotion and memory reside. And it's a very important hub in the brain and lots of important things happen there: self-reflection and rumination, time travel. It's where we go to think about the future or the past, and theory of mind, the ability to imagine the mental states of other beings and, I think, most importantly, the autobiographical self. It's the part of the brain, it appears, where we incorporate things that happen to us, new information, with a sense of who we are, who we were and who we want to be. And that's where these stories get generated. And these stories can be really destructive, they trap us. ...\u003c/p>\n\u003cp>This network is downregulated [with psychedelics], it sort of goes offline for a period of time. And that's why you experience this dissolution of self or ego, which can be a terrifying or liberating thing, depending on your mindset. This is what allows people, I think, to have those new perspectives on themselves, to realize that they needn't be trapped in those stories and they might actually be able to write some new stories about themselves. That's what's liberating, I think, about the experience when it works.\u003c/p>\n\u003cp>\u003cstrong>On how psychedelics can help dying people face their deaths \u003c/strong>\u003c/p>\n\u003cp>\u003ca href=\"https://www.npr.org/tags/125941537/prozac\">Prozac\u003c/a> doesn't help when you're confronting your mortality. But here we have something that occasions an experience in people — a mystical experience — that somehow makes it easier to let go. And I think some of it has to do with the fact that you do experience the \"extinction\" of yourself and it's kind of a rehearsal for death. And I think that may be part of what helps people, that they expand their sense of what is your self-interest and your self-interest is something larger than what is contained by your skin. And when you have that recognition, I think dying becomes a little easier. ...\u003c/p>\n\u003cp>There's no way to prove this, obviously, and it's a question that really troubled me as an old-fashioned materialist skeptical journalist. It's like, \"What if these drugs are inducing an illusion in people?\" I got a variety of answers to that question from the researchers. One was, \"Who cares if it helps them?\" And I can see the point of that. The other was, \"Hey, this is beyond my pay grade; none of us know what happens after we die.\" And others say, \"Well, this is an open frontier.\" ...\u003c/p>\n\u003cp>The experiences that people have are very real to them — they're psychological facts. And one of the really interesting qualities of psychedelic experience is that the insights you have on them have a durability ... This isn't just an opinion, this is revealed truth, so the confidence people have is hard to shake, actually.\u003c/p>\n\u003cp>\u003cstrong>On a \u003c/strong>\u003ca href=\"https://www.hopkinsmedicine.org/news/stories/mushrooms_quit_smoking.html\" target=\"_blank\" rel=\"noopener\">\u003cstrong>Johns Hopkins study\u003c/strong>\u003c/a>\u003cstrong> on the use of psilocybin to help people quit smoking \u003c/strong>\u003c/p>\n\u003cp>Smoking is a very hard addiction to break. It's one of the hardest addictions to break. [I wanted to understand] how, after a single psilocybin trip, they could decide \"I'm never going to smoke again\" based on the perspective they had achieved. And they would say things like, \"Well, I had this amazing experience. I died three times. I sprouted wings. I flew through European histories. I beheld all these wonders. I saw my body on a funeral pyre on the Ganges. And I realized, the universe is so amazing and there's so much to do in it that killing myself seemed really stupid.\" And that was the insight. Yes, killing yourself is really stupid — but it had an authority it had never had. And that, I think, is the gift of these psychedelics.\u003c/p>\n\u003cp>\u003cstrong>On his own experience tripping on mushrooms \u003c/strong>\u003c/p>\n\u003cp>I had an experience that was by turns frightening and ecstatic and weird. ... I found myself in this place where I could no longer control my perceptions at all, and I felt my sense of self scatter to the wind — almost as if a pile of post-its had been released to the wind — but I was fine with it. I didn't feel any desire to pile the papers back together into my customary self ...\u003c/p>\n\u003cp>Then I looked out and saw myself spread over the landscape like a coat of paint or butter. I was outside myself, beside myself, literally, and the consciousness that beheld this ... was not my normal consciousness, it was completely unperturbed. It was dispassionate. It was content, as I watched myself dissolve over the landscape.\u003c/p>\n\u003cp>What I brought back from that experience was that I'm not identical to my ego, that there is another ground on which to plant our feet and that our ego is kind of this character that is chattering neurotically in our minds. And it's good for lots of things. I mean, the ego got the book written, but it also can be very harsh, and it's liberating to have some distance on it. And that was a great gift, I think.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>Sam Briger and Seth Kelley produced and edited this interview for broadcast. Bridget Bentz, Molly Seavy-Nesper and Scott Hensley adapted it for the Web.\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 Fresh Air. To see more, visit \u003ca href=\"http://www.npr.org/programs/fresh-air/\" target=\"_blank\" rel=\"noopener\">Fresh Air\u003c/a>.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=%27Reluctant+Psychonaut%27+Michael+Pollan+Embraces+The+%27New+Science%27+Of+Psychedelics+&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "New Type Of Drug To Prevent Migraines Heads To Market",
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"content": "\u003cp>The Food and Drug Administration has approved a first-of-its-kind drug that reduces the number of migraines among people prone to these sometimes crippling headaches.[contextly_sidebar id=\"eVSpdADwfHP9wNaEEpapPJOooMFjlmTD\"]\u003c/p>\n\u003cp>That's welcome news to some of the millions of Americans who suffer from these \u003ca href=\"https://www.ninds.nih.gov/Disorders/All-Disorders/Migraine-Information-Page\" target=\"_blank\" rel=\"noopener\">potentially debilitating headaches\u003c/a>. Much more common in women than men, these throbbing headaches can also come with nausea, visual disturbances and sensitivity to light. People who suffer them frequently sometimes find themselves anxious, depressed and even disabled.\u003c/p>\n\u003cp>Most of the drugs on the market today are used to control the symptoms of migraine.\u003c/p>\n\u003cp>The new drug, Aimovig was \u003ca href=\"https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm608120.htm\" target=\"_blank\" rel=\"noopener\">approved by the FDA on Thursday\u003c/a>. It's the first medicine in a new class that's designed to reduce the number of migraines among people who suffer them frequently. The medicine, known generically as erenumab-aooe, is being sold by Amgen in the U.S.\u003c/p>\n\u003cp>Aimovig and several other migraine drugs in development are based on research begun in the 1980s. Scientists found people having migraine attacks have high levels of something called \"calcitonin gene–related peptide,\" or CGRP, in their blood, as Lauren Gravitz \u003ca href=\"https://www.npr.org/sections/health-shots/2018/02/03/581092093/gone-with-a-shot-hopeful-new-signs-of-relief-for-migraine-sufferers\" target=\"_blank\" rel=\"noopener\">reported for Shots in February\u003c/a>.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>When the peptide was injected in people prone to migraines, it triggered headaches. People not prone to migraines were unaffected by the peptide injections.\u003c/p>\n\u003cp>With this insight in hand, drugmakers worked to make antibodies to block the peptide's activity inside the body as a way to prevent migraines.\u003c/p>\n\u003cp>In \u003ca href=\"https://www.nejm.org/doi/full/10.1056/NEJMoa1705848\" target=\"_blank\" rel=\"noopener\">one of the large studies\u003c/a> that set the stage for FDA approval of Aimovig, the number of migraines per month dropped from eight to fewer than five, on average. Patients taking dummy \"placebo\" shots also had fewer migraines.\u003c/p>\n\u003cp>Patients in Aimovig studies reported generally mild side effects, though any long-term or rarer risks from Aimovig could come to light only over time.[contextly_sidebar id=\"qA38kZhQPznYkiyYxVV7PlTRdiD9ko0z\"]\u003c/p>\n\u003cp>People inject the drug themselves using a pen-like device, like those used for insulin.\u003c/p>\n\u003cp>Aimovig is an expensive type of medication called a monoclonal antibody. Antibodies are produced in living cells rather than in a chemical laboratory.\u003c/p>\n\u003cp>Drugmaker \u003ca href=\"https://www.amgen.com/media/news-releases/2018/05/fda-approves-aimovig-erenumabaooe-a-novel-treatment-developed-specifically-for-migraine-prevention/\" target=\"_blank\" rel=\"noopener\">Amgen says is has set the list price\u003c/a> at $6,900 a year.\u003c/p>\n\u003cp>Some analysts had expected the initial price of this drug to be set substantially higher – at $10,000 a year or more. But high prices have recently been generating political backlash, and \u003ca href=\"https://www.statnews.com/2016/10/28/cholesterol-drug-failure/\" target=\"_blank\" rel=\"noopener\">some expensive drugs have fizzled\u003c/a> after insurance companies sharply limited which patients they would cover.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>With the new migraine drug, those questions will come to the fore quickly, as Amgen says it's ready to put the drug on the market within a week, and has programs in place to help ease the cost to some patients.\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=New+Type+Of+Drug+To+Prevent+Migraines+Heads+To+Market&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"excerpt": "An antibody-based drug reduces the frequency of migraine headaches, according to data reviewed by the Food and Drug Administration. The agency approved Aimovig, priced at about $6,900 a year.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The Food and Drug Administration has approved a first-of-its-kind drug that reduces the number of migraines among people prone to these sometimes crippling headaches.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>That's welcome news to some of the millions of Americans who suffer from these \u003ca href=\"https://www.ninds.nih.gov/Disorders/All-Disorders/Migraine-Information-Page\" target=\"_blank\" rel=\"noopener\">potentially debilitating headaches\u003c/a>. Much more common in women than men, these throbbing headaches can also come with nausea, visual disturbances and sensitivity to light. People who suffer them frequently sometimes find themselves anxious, depressed and even disabled.\u003c/p>\n\u003cp>Most of the drugs on the market today are used to control the symptoms of migraine.\u003c/p>\n\u003cp>The new drug, Aimovig was \u003ca href=\"https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm608120.htm\" target=\"_blank\" rel=\"noopener\">approved by the FDA on Thursday\u003c/a>. It's the first medicine in a new class that's designed to reduce the number of migraines among people who suffer them frequently. The medicine, known generically as erenumab-aooe, is being sold by Amgen in the U.S.\u003c/p>\n\u003cp>Aimovig and several other migraine drugs in development are based on research begun in the 1980s. Scientists found people having migraine attacks have high levels of something called \"calcitonin gene–related peptide,\" or CGRP, in their blood, as Lauren Gravitz \u003ca href=\"https://www.npr.org/sections/health-shots/2018/02/03/581092093/gone-with-a-shot-hopeful-new-signs-of-relief-for-migraine-sufferers\" target=\"_blank\" rel=\"noopener\">reported for Shots in February\u003c/a>.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>When the peptide was injected in people prone to migraines, it triggered headaches. People not prone to migraines were unaffected by the peptide injections.\u003c/p>\n\u003cp>With this insight in hand, drugmakers worked to make antibodies to block the peptide's activity inside the body as a way to prevent migraines.\u003c/p>\n\u003cp>In \u003ca href=\"https://www.nejm.org/doi/full/10.1056/NEJMoa1705848\" target=\"_blank\" rel=\"noopener\">one of the large studies\u003c/a> that set the stage for FDA approval of Aimovig, the number of migraines per month dropped from eight to fewer than five, on average. Patients taking dummy \"placebo\" shots also had fewer migraines.\u003c/p>\n\u003cp>Patients in Aimovig studies reported generally mild side effects, though any long-term or rarer risks from Aimovig could come to light only over time.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>People inject the drug themselves using a pen-like device, like those used for insulin.\u003c/p>\n\u003cp>Aimovig is an expensive type of medication called a monoclonal antibody. Antibodies are produced in living cells rather than in a chemical laboratory.\u003c/p>\n\u003cp>Drugmaker \u003ca href=\"https://www.amgen.com/media/news-releases/2018/05/fda-approves-aimovig-erenumabaooe-a-novel-treatment-developed-specifically-for-migraine-prevention/\" target=\"_blank\" rel=\"noopener\">Amgen says is has set the list price\u003c/a> at $6,900 a year.\u003c/p>\n\u003cp>Some analysts had expected the initial price of this drug to be set substantially higher – at $10,000 a year or more. But high prices have recently been generating political backlash, and \u003ca href=\"https://www.statnews.com/2016/10/28/cholesterol-drug-failure/\" target=\"_blank\" rel=\"noopener\">some expensive drugs have fizzled\u003c/a> after insurance companies sharply limited which patients they would cover.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>With the new migraine drug, those questions will come to the fore quickly, as Amgen says it's ready to put the drug on the market within a week, and has programs in place to help ease the cost to some patients.\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=New+Type+Of+Drug+To+Prevent+Migraines+Heads+To+Market&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Mounting Evidence Shows Diet Soda May Be Hurting Your Diet — Here's How",
"title": "Mounting Evidence Shows Diet Soda May Be Hurting Your Diet — Here's How",
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"content": "\u003cp>Artificial sweeteners are everywhere, but the jury is still out on whether these chemicals are harmless. Also called non-nutritive sweeteners, these can be synthetic – such as saccharin and aspartame – or naturally derived, such as steviol, which comes from the Stevia plant. To date, the U.S. Food and Drug Administration has approved \u003ca href=\"https://www.fda.gov/Food/IngredientsPackagingLabeling/FoodAdditivesIngredients/ucm397725.htm\" target=\"_blank\" rel=\"noopener\">six types of artificial and two types of natural non-nutritive sweeteners\u003c/a> for use in food.[contextly_sidebar id=\"9cHOWFJBVWEQQfvraluyBJ45Elnnkn5i\"]\u003c/p>\n\u003cp>That’s been great news for those working hard to curb their sugar consumption. \u003ca href=\"https://doi.org/10.3945/ajcn.111.030833\" target=\"_blank\" rel=\"noopener\">Aspartame\u003c/a>, for example, is found in more than 6,000 foods worldwide, and about 5,000-5,500 tons are consumed every year in the United States alone.\u003c/p>\n\u003cp>The American Diabetes Association – the most well-respected professional group focusing on diabetes – \u003ca href=\"http://www.diabetes.org/food-and-fitness/food/what-can-i-eat/making-healthy-food-choices/what-can-i-drink.html\" target=\"_blank\" rel=\"noopener\">officially recommends diet soda as an alternative\u003c/a> to sugar-sweetened beverages. To date, seven U.S. municipalities have imposed a sugary beverage tax to discourage consumption.\u003c/p>\n\u003cp>However, recent medical studies suggest that policymakers eager to implement a soda tax may also want to include diet drinks because these sweeteners may be contributing to chronic diabetes and cardiovascular diseases as well.\u003c/p>\n\u003cp>\u003cstrong>Why Are These Sweeteners Calorie-Free?\u003c/strong>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The key to these virtually calorie-free sweeteners is that they are not broken down during digestion into natural sugars like glucose, fructose and galactose, which are then either used for energy or converted into fat.\u003c/p>\n\u003cp>Non-nutritive sweeteners have different byproducts that are not converted into calories. Aspartame, for example, undergoes a different metabolic process that doesn’t yield simple sugars. Others such as saccharin and sucralose are not broken down at all, but instead are absorbed directly into the bloodstream and excreted in the urine.\u003c/p>\n\u003cp>Theoretically, these sweeteners should be a “better” choice than sugar for diabetics. Glucose stimulates release of insulin, a hormone that regulates blood sugar levels. Type 2 diabetes occurs when the body no longer responds as well to insulin as it should, leading to higher levels of glucose in the blood that damages the nerves, kidneys, blood vessels and heart. Since non-nutritive sweeteners aren’t actually sugar, they should sidestep this problem.\u003c/p>\n\u003cp>\u003cstrong>Artificial Sweeteners, Your Brain and Your Microbiome\u003c/strong>\u003c/p>\n\u003cp>However, there is growing evidence over the last decade that these sweeteners can alter healthy metabolic processes in other ways, specifically in the gut.\u003c/p>\n\u003cp>Long-term use of these sweeteners has \u003ca href=\"https://doi.org/10.2337/dc08-1799\" target=\"_blank\" rel=\"noopener\">been associated with a higher risk of Type 2 diabetes\u003c/a>. Sweeteners, such as saccharin, have been shown to \u003ca href=\"http://doi.org/10.1038/nature13793\" target=\"_blank\" rel=\"noopener\">change the type and function of the gut microbiome\u003c/a>, the community of microorganisms that live in the intestine. Aspartame \u003ca href=\"https://doi.org/10.1139/apnm-2016-0346\" target=\"_blank\" rel=\"noopener\">decreases the activity of a gut enzyme\u003c/a> that is normally protective against Type 2 diabetes. Furthermore, this response may be exacerbated by the “mismatch” between the body perceiving something as tasting sweet and the expected associated calories. The greater the discrepancy between the sweetness and actual caloric content, the \u003ca href=\"http://doi.org/10.1016/j.cub.2017.07.018\" target=\"_blank\" rel=\"noopener\">greater the metabolic dysregulation\u003c/a>.[contextly_sidebar id=\"1WiRRvjeXSgRFmENuLBZhCvtglNEvId8\"]\u003c/p>\n\u003cp>Sweeteners have also been shown to change brain activity associated with eating sweet foods. A functional MRI exam, which studies brain activity by measuring blood flow, has shown that sucralose, compared to regular sugar, \u003ca href=\"https://doi.org/10.1016/j.appet.2011.12.001\">decreases activity in the amygdala\u003c/a>, a part of the brain involved with taste perception and the experience of eating.\u003c/p>\n\u003cp>Another study revealed that longer-term and higher diet soda consumption are linked to \u003ca href=\"https://doi.org/10.1016/j.physbeh.2012.05.006\">lower activity in the brain’s “caudate head,”\u003c/a> a region that mediates the reward pathway and is necessary for generating a feeling of satisfaction. Researchers have hypothesized that this decreased activity could lead a diet soda drinker to compensate for the lack of pleasure they now derive from the food by increasing their consumption of all foods, not just soda.\u003c/p>\n\u003cp>Together these cellular and brain studies may explain why people who consume sweeteners still have a \u003ca href=\"https://doi.org/10.1371/journal.pone.0167241\">higher risk of obesity\u003c/a> than individuals who don’t consume these products.\u003c/p>\n\u003cp>\u003ca href=\"https://doi.org/10.1503/cmaj.161390\">As this debate on the pros and cons of these sugar substitutes rages on\u003c/a>, we must view these behavioral studies with a grain of salt (or sugar) because many diet soda drinkers – or any health-conscious individual who consumes zero-calorie sweeteners – already has the risk factors for obesity, diabetes, hypertension or heart disease. Those who are already overweight or obese may turn toward low-calorie drinks, making it look as though the diet sodas are causing their weight gain.\u003c/p>\n\u003cp>This same group may also be less likely to moderate their consumption. For example, those people may think that having a diet soda multiple times a week is much healthier than drinking one case of soda with sugar.[contextly_sidebar id=\"nPADPRMuF9gHM8AprlV1Wgo1Jciefs8f\"]\u003c/p>\n\u003cp>These findings signal that consumers and health practitioners all need to check our assumptions about the health benefits of these products. Sweeteners are everywhere, from beverages to salad dressing, from cookies to yogurt, and we must recognize that there is no guarantee that these chemicals won’t increase the burden of metabolic diseases in the future.\u003c/p>\n\u003cp>As a physician of internal medicine specializing in general prevention and public health, I would like to be able to tell my patients what the true risks and benefits are if they drink diet soda instead of water.\u003c/p>\n\u003cp>Legislators considering soda taxes to encourage better dietary habits perhaps should think about including foods with non-nutritive sweeteners. Of course, there is an argument to be made for being realistic and pursuing the lesser of two evils. But even if the negative consequences of sugar substitutes doesn’t sway our tax policy – for now – at least the medical community should be honest with the public about what they stand to lose or gain, consuming these foods.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>\u003cspan class=\"fn author-name\">Eunice Zhang is a c\u003c/span>linical fellow of preventive medicine at the University of Michigan. This article was originally published on \u003ca href=\"https://theconversation.com/diet-soda-may-be-hurting-your-diet-96181\" target=\"_blank\" rel=\"noopener\">The Conversation\u003c/a>.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Artificial sweeteners are everywhere, but the jury is still out on whether these chemicals are harmless. Also called non-nutritive sweeteners, these can be synthetic – such as saccharin and aspartame – or naturally derived, such as steviol, which comes from the Stevia plant. To date, the U.S. Food and Drug Administration has approved \u003ca href=\"https://www.fda.gov/Food/IngredientsPackagingLabeling/FoodAdditivesIngredients/ucm397725.htm\" target=\"_blank\" rel=\"noopener\">six types of artificial and two types of natural non-nutritive sweeteners\u003c/a> for use in food.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>That’s been great news for those working hard to curb their sugar consumption. \u003ca href=\"https://doi.org/10.3945/ajcn.111.030833\" target=\"_blank\" rel=\"noopener\">Aspartame\u003c/a>, for example, is found in more than 6,000 foods worldwide, and about 5,000-5,500 tons are consumed every year in the United States alone.\u003c/p>\n\u003cp>The American Diabetes Association – the most well-respected professional group focusing on diabetes – \u003ca href=\"http://www.diabetes.org/food-and-fitness/food/what-can-i-eat/making-healthy-food-choices/what-can-i-drink.html\" target=\"_blank\" rel=\"noopener\">officially recommends diet soda as an alternative\u003c/a> to sugar-sweetened beverages. To date, seven U.S. municipalities have imposed a sugary beverage tax to discourage consumption.\u003c/p>\n\u003cp>However, recent medical studies suggest that policymakers eager to implement a soda tax may also want to include diet drinks because these sweeteners may be contributing to chronic diabetes and cardiovascular diseases as well.\u003c/p>\n\u003cp>\u003cstrong>Why Are These Sweeteners Calorie-Free?\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The key to these virtually calorie-free sweeteners is that they are not broken down during digestion into natural sugars like glucose, fructose and galactose, which are then either used for energy or converted into fat.\u003c/p>\n\u003cp>Non-nutritive sweeteners have different byproducts that are not converted into calories. Aspartame, for example, undergoes a different metabolic process that doesn’t yield simple sugars. Others such as saccharin and sucralose are not broken down at all, but instead are absorbed directly into the bloodstream and excreted in the urine.\u003c/p>\n\u003cp>Theoretically, these sweeteners should be a “better” choice than sugar for diabetics. Glucose stimulates release of insulin, a hormone that regulates blood sugar levels. Type 2 diabetes occurs when the body no longer responds as well to insulin as it should, leading to higher levels of glucose in the blood that damages the nerves, kidneys, blood vessels and heart. Since non-nutritive sweeteners aren’t actually sugar, they should sidestep this problem.\u003c/p>\n\u003cp>\u003cstrong>Artificial Sweeteners, Your Brain and Your Microbiome\u003c/strong>\u003c/p>\n\u003cp>However, there is growing evidence over the last decade that these sweeteners can alter healthy metabolic processes in other ways, specifically in the gut.\u003c/p>\n\u003cp>Long-term use of these sweeteners has \u003ca href=\"https://doi.org/10.2337/dc08-1799\" target=\"_blank\" rel=\"noopener\">been associated with a higher risk of Type 2 diabetes\u003c/a>. Sweeteners, such as saccharin, have been shown to \u003ca href=\"http://doi.org/10.1038/nature13793\" target=\"_blank\" rel=\"noopener\">change the type and function of the gut microbiome\u003c/a>, the community of microorganisms that live in the intestine. Aspartame \u003ca href=\"https://doi.org/10.1139/apnm-2016-0346\" target=\"_blank\" rel=\"noopener\">decreases the activity of a gut enzyme\u003c/a> that is normally protective against Type 2 diabetes. Furthermore, this response may be exacerbated by the “mismatch” between the body perceiving something as tasting sweet and the expected associated calories. The greater the discrepancy between the sweetness and actual caloric content, the \u003ca href=\"http://doi.org/10.1016/j.cub.2017.07.018\" target=\"_blank\" rel=\"noopener\">greater the metabolic dysregulation\u003c/a>.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Sweeteners have also been shown to change brain activity associated with eating sweet foods. A functional MRI exam, which studies brain activity by measuring blood flow, has shown that sucralose, compared to regular sugar, \u003ca href=\"https://doi.org/10.1016/j.appet.2011.12.001\">decreases activity in the amygdala\u003c/a>, a part of the brain involved with taste perception and the experience of eating.\u003c/p>\n\u003cp>Another study revealed that longer-term and higher diet soda consumption are linked to \u003ca href=\"https://doi.org/10.1016/j.physbeh.2012.05.006\">lower activity in the brain’s “caudate head,”\u003c/a> a region that mediates the reward pathway and is necessary for generating a feeling of satisfaction. Researchers have hypothesized that this decreased activity could lead a diet soda drinker to compensate for the lack of pleasure they now derive from the food by increasing their consumption of all foods, not just soda.\u003c/p>\n\u003cp>Together these cellular and brain studies may explain why people who consume sweeteners still have a \u003ca href=\"https://doi.org/10.1371/journal.pone.0167241\">higher risk of obesity\u003c/a> than individuals who don’t consume these products.\u003c/p>\n\u003cp>\u003ca href=\"https://doi.org/10.1503/cmaj.161390\">As this debate on the pros and cons of these sugar substitutes rages on\u003c/a>, we must view these behavioral studies with a grain of salt (or sugar) because many diet soda drinkers – or any health-conscious individual who consumes zero-calorie sweeteners – already has the risk factors for obesity, diabetes, hypertension or heart disease. Those who are already overweight or obese may turn toward low-calorie drinks, making it look as though the diet sodas are causing their weight gain.\u003c/p>\n\u003cp>This same group may also be less likely to moderate their consumption. For example, those people may think that having a diet soda multiple times a week is much healthier than drinking one case of soda with sugar.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>These findings signal that consumers and health practitioners all need to check our assumptions about the health benefits of these products. Sweeteners are everywhere, from beverages to salad dressing, from cookies to yogurt, and we must recognize that there is no guarantee that these chemicals won’t increase the burden of metabolic diseases in the future.\u003c/p>\n\u003cp>As a physician of internal medicine specializing in general prevention and public health, I would like to be able to tell my patients what the true risks and benefits are if they drink diet soda instead of water.\u003c/p>\n\u003cp>Legislators considering soda taxes to encourage better dietary habits perhaps should think about including foods with non-nutritive sweeteners. Of course, there is an argument to be made for being realistic and pursuing the lesser of two evils. But even if the negative consequences of sugar substitutes doesn’t sway our tax policy – for now – at least the medical community should be honest with the public about what they stand to lose or gain, consuming these foods.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>\u003cspan class=\"fn author-name\">Eunice Zhang is a c\u003c/span>linical fellow of preventive medicine at the University of Michigan. This article was originally published on \u003ca href=\"https://theconversation.com/diet-soda-may-be-hurting-your-diet-96181\" target=\"_blank\" rel=\"noopener\">The Conversation\u003c/a>.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Congo’s Ebola outbreak has spread to a crossroads city of more than 1 million people in a troubling turn that marks the first time the vast, impoverished country has encountered the lethal virus in an urban area.\u003c/p>\n\u003cp>“This is a major, major game-changer in the outbreak,” Dr. Peter Salama, the World Health Organization’s deputy director-general of emergency preparedness and response, warned on Thursday.\u003c/p>\n\u003cp>A single case of Ebola was confirmed in Mbandaka, a densely populated provincial capital on the Congo River, Congo’s Health Minister Oly Ilunga said late Wednesday. The city is about 93 miles from Bikoro, the rural area where the outbreak was announced last week.\u003c/p>\n\u003cp>Medical teams rushed to track down anyone thought to have had contact with infected people, while WHO continued shipping thousands of doses of an experimental vaccine.\u003c/p>\n\u003cp>A total of 44 cases of Ebola have been reported in Congo in this outbreak: three confirmed, 20 probable and 21 suspected, according to WHO. Twenty-three of those people have died.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Until now, the outbreak was confined to remote rural areas, where Ebola, which is spread by bodily fluids, travels more slowly.\u003c/p>\n\u003cp>“We’re certainly not trying to cause any panic in the national or international community,” Salama said. But “urban Ebola can result in an exponential increase in cases in a way that rural Ebola struggles to do.”\u003c/p>\n\u003cp>Mbandaka, a city of almost 1.2 million, is in a busy travel corridor in Congo’s northwest Equateur province and is upstream from the capital, Kinshasa, a city of about 10 million. It is an hour’s plane ride from Kinshasa or a four- to seven-day trip by river barge.\u003c/p>\n\u003cp>Salama also noted Mbandaka’s proximity to neighboring countries, including Central African Republic and Republic of Congo.\u003c/p>\n\u003cp>“The scenario has changed, and it has become most serious and worrying, since the disease is now affecting an urban area,” said Henry Gray, emergency coordinator in Mbandaka for Doctors Without Borders.\u003c/p>\n\u003cp>\u003cstrong>Ebola Vaccinations\u003c/strong>\u003cbr>\nThe aid organization said 514 people believed to have been in contact with infected people are being monitored. WHO said it is deploying about 30 more experts to the city.\u003c/p>\n\u003cp>Those exposed will for the first time in Congo receive Ebola vaccinations, the health minister said. WHO has sent 4,000 doses to Congo and said it will dispatch thousands more in the coming days as needed.\u003c/p>\n\u003cp>“This is a concerning development, but we now have better tools than ever before to combat Ebola,” Tedros Adhanom Ghebreyesus, WHO director-general, said of the new urban case.\u003c/p>\n\u003cp>The vaccine has been shown to be highly effective against Ebola. It was tested in Guinea during the outbreak that killed more than 11,300 people in West Africa from 2014 to 2016.\u003c/p>\n\u003cp>WHO has said it will use the “ring vaccination” method. It involves vaccinating contacts of those feared infected, contacts of those contacts, and health care and other front-line workers.\u003c/p>\n\u003cp>This is the ninth Ebola outbreak in Congo since 1976, when the disease was first identified. The virus is initially transmitted to people from wild animals, including bats and monkeys.\u003c/p>\n\u003cp>There is no specific treatment for Ebola. Symptoms include fever, vomiting, diarrhea, muscle pain and at times internal and external bleeding. The virus can be fatal in up to 90 percent of cases, depending on the strain.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp> \u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Congo’s Ebola outbreak has spread to a crossroads city of more than 1 million people in a troubling turn that marks the first time the vast, impoverished country has encountered the lethal virus in an urban area.\u003c/p>\n\u003cp>“This is a major, major game-changer in the outbreak,” Dr. Peter Salama, the World Health Organization’s deputy director-general of emergency preparedness and response, warned on Thursday.\u003c/p>\n\u003cp>A single case of Ebola was confirmed in Mbandaka, a densely populated provincial capital on the Congo River, Congo’s Health Minister Oly Ilunga said late Wednesday. The city is about 93 miles from Bikoro, the rural area where the outbreak was announced last week.\u003c/p>\n\u003cp>Medical teams rushed to track down anyone thought to have had contact with infected people, while WHO continued shipping thousands of doses of an experimental vaccine.\u003c/p>\n\u003cp>A total of 44 cases of Ebola have been reported in Congo in this outbreak: three confirmed, 20 probable and 21 suspected, according to WHO. Twenty-three of those people have died.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Until now, the outbreak was confined to remote rural areas, where Ebola, which is spread by bodily fluids, travels more slowly.\u003c/p>\n\u003cp>“We’re certainly not trying to cause any panic in the national or international community,” Salama said. But “urban Ebola can result in an exponential increase in cases in a way that rural Ebola struggles to do.”\u003c/p>\n\u003cp>Mbandaka, a city of almost 1.2 million, is in a busy travel corridor in Congo’s northwest Equateur province and is upstream from the capital, Kinshasa, a city of about 10 million. It is an hour’s plane ride from Kinshasa or a four- to seven-day trip by river barge.\u003c/p>\n\u003cp>Salama also noted Mbandaka’s proximity to neighboring countries, including Central African Republic and Republic of Congo.\u003c/p>\n\u003cp>“The scenario has changed, and it has become most serious and worrying, since the disease is now affecting an urban area,” said Henry Gray, emergency coordinator in Mbandaka for Doctors Without Borders.\u003c/p>\n\u003cp>\u003cstrong>Ebola Vaccinations\u003c/strong>\u003cbr>\nThe aid organization said 514 people believed to have been in contact with infected people are being monitored. WHO said it is deploying about 30 more experts to the city.\u003c/p>\n\u003cp>Those exposed will for the first time in Congo receive Ebola vaccinations, the health minister said. WHO has sent 4,000 doses to Congo and said it will dispatch thousands more in the coming days as needed.\u003c/p>\n\u003cp>“This is a concerning development, but we now have better tools than ever before to combat Ebola,” Tedros Adhanom Ghebreyesus, WHO director-general, said of the new urban case.\u003c/p>\n\u003cp>The vaccine has been shown to be highly effective against Ebola. It was tested in Guinea during the outbreak that killed more than 11,300 people in West Africa from 2014 to 2016.\u003c/p>\n\u003cp>WHO has said it will use the “ring vaccination” method. It involves vaccinating contacts of those feared infected, contacts of those contacts, and health care and other front-line workers.\u003c/p>\n\u003cp>This is the ninth Ebola outbreak in Congo since 1976, when the disease was first identified. The virus is initially transmitted to people from wild animals, including bats and monkeys.\u003c/p>\n\u003cp>There is no specific treatment for Ebola. Symptoms include fever, vomiting, diarrhea, muscle pain and at times internal and external bleeding. The virus can be fatal in up to 90 percent of cases, depending on the strain.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp> \u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>When I heard about home testing for sexually transmitted diseases, I was intrigued. Who doesn't despise that particularly awkward conversation with their doctor? And who doesn't want to skip the waiting room and long line at the lab?\u003c/p>\n\u003caside class=\"pullquote alignright\">A 15-minute procedure in the privacy of your own home. But the kits can get pricey.\u003c/aside>\n\u003cp>The kit I used is available online for $189 from a company called myLAB Box. Many other companies offer similar tests -- EverlyWell and LetsGetChecked, to name two. The kits cost anywhere from $100 to $400, depending on the number of diseases you're tested for.\u003c/p>\n\u003cp>\u003cstrong>Simple Steps\u003c/strong>\u003c/p>\n\u003cp>After opening my kit, I saw everything I needed packed neatly into a box about the size of my palm. Following the steps outlined in pictures on the instruction sheet, the entire procedure took less than 15 minutes. First I used a giant Q-tip as a vaginal swab. I doused my ring finger with alcohol and pricked it with a plastic lancet, carefully letting droplets of blood land in circles on a white collection card. After sealing both samples in separate biohazard bags, I shipped the specimens off in a prepaid envelope.\u003c/p>\n\u003cfigure id=\"attachment_440848\" class=\"wp-caption alignright\" style=\"max-width: 411px\">\u003ca href=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/04/RS30399_ATHOMETEST_035-e1524194755230.jpg\">\u003cimg class=\" wp-image-440848\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/04/RS30399_ATHOMETEST_035-1020x1528.jpg\" alt=\"\" width=\"411\" height=\"616\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Lesley McClurg uses a lancet to get a blood sample for a home STD test. \u003ccite>(Lauren Hanussak/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>I had ordered tests for chlamydia, gonorrhea, HIV and trichomoniasis -- the basic package. A few days later I received an email confirming that my results were negative. (Unlike \u003ca href=\"https://www.youtube.com/watch?v=bv26dLnbi9g\" target=\"_blank\" rel=\"noopener\">George Costanza\u003c/a>, of \"Seinfeld\" fame, I knew that \"negative\" is good in this context.)\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>If any of the tests had come back positive, myLAB Box would have connected me with a physician for a free telemedicine consultation.\u003c/p>\n\u003cp>\u003cstrong>Accelerating STD Rates\u003c/strong>\u003c/p>\n\u003cp>Health officials think home testing of STDs has the potential to curb accelerating transmission rates. The Centers for Disease Control and Prevention \u003ca href=\"https://www.cdc.gov/std/stats16/default.htm\" target=\"_blank\" rel=\"noopener\">reported\u003c/a> all-time highs for STDs in 2016, and an estimated \u003ca href=\"https://www.cdc.gov/nchhstp/newsroom/docs/factsheets/std-trends-508.pdf\" target=\"_blank\" rel=\"noopener\">20 million Americans\u003c/a> contract an infection through sexual contact every year. Meanwhile, in California, numerous public testing clinics have closed over the past decade, according to the state's Department of Health.\u003c/p>\n\u003caside class=\"pullquote alignright\">'Patient surveys have demonstrated that individuals don't always feel comfortable talking to their regular medical provider about their risk for STD or interest in STD testing.'\u003ccite>California Department of Public Health\u003c/cite>\u003c/aside>\n\u003cp>\"Many people still face significant challenges getting high-quality sexual health services, including STD testing,\" a spokesperson said in an email. \"This is particularly true of youth, males, and sexual minorities. Patient surveys have demonstrated that individuals don't always feel comfortable talking to their regular medical provider about their risk for STD or interest in STD testing.\"\u003c/p>\n\u003cp>Dr. Jennifer Conti, a gynecologist and clinical assistant professor at Stanford University, agrees that home testing increases access. \"I think anyone can prick their finger or pee on a stick,\" she said.\u003c/p>\n\u003cp>Conti recommends testing every six months if you're sexually active with multiple partners. This can get pricey if you're paying out of pocket. Though insurance companies are required to pay for preventative STD screening under the Affordable Care Act, most providers will not reimburse patients for home tests.\u003c/p>\n\u003cp>\u003cstrong>No FDA Approval\u003c/strong>\u003c/p>\n\u003cp>If you do decide to purchase a home test, you should know the Food and Drug Administration has only approved \u003ca href=\"https://www.cdc.gov/hiv/testing/hometests.html\" target=\"_blank\" rel=\"noopener\">two HIV tests\u003c/a> for the home market. Anything beyond that, the quality of different products may vary.\u003c/p>\n\u003cp>“The people who draw your blood in a hospital or in clinic are all trained, and they obtain specimens that have no inconsistency,\" said Dr. Norman Paradis, an emergency room physician who teaches at the Geisel School of Medicine at Dartmouth College. \"But some of the new devices for doing this on yourself at home haven't been validated to the same extent.”\u003c/p>\n\u003cp>The CEO of myLab Box, Lora Ivanova, said results are tested in a lab meeting the standards of the \u003ca href=\"https://www.cms.gov/Regulations-and-Guidance/Legislation/CLIA/index.html?redirect=/CLIA/\" target=\"_blank\" rel=\"noopener\">Clinical Laboratory Improvement Amendments, \u003c/a>used by the federal government to certify labs.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Paradis says the benefits of home testing far outweigh the risks, as long as patients see a doctor when a test comes back positive and when experiencing abnormal symptoms.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>When I heard about home testing for sexually transmitted diseases, I was intrigued. Who doesn't despise that particularly awkward conversation with their doctor? And who doesn't want to skip the waiting room and long line at the lab?\u003c/p>\n\u003caside class=\"pullquote alignright\">A 15-minute procedure in the privacy of your own home. But the kits can get pricey.\u003c/aside>\n\u003cp>The kit I used is available online for $189 from a company called myLAB Box. Many other companies offer similar tests -- EverlyWell and LetsGetChecked, to name two. The kits cost anywhere from $100 to $400, depending on the number of diseases you're tested for.\u003c/p>\n\u003cp>\u003cstrong>Simple Steps\u003c/strong>\u003c/p>\n\u003cp>After opening my kit, I saw everything I needed packed neatly into a box about the size of my palm. Following the steps outlined in pictures on the instruction sheet, the entire procedure took less than 15 minutes. First I used a giant Q-tip as a vaginal swab. I doused my ring finger with alcohol and pricked it with a plastic lancet, carefully letting droplets of blood land in circles on a white collection card. After sealing both samples in separate biohazard bags, I shipped the specimens off in a prepaid envelope.\u003c/p>\n\u003cfigure id=\"attachment_440848\" class=\"wp-caption alignright\" style=\"max-width: 411px\">\u003ca href=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/04/RS30399_ATHOMETEST_035-e1524194755230.jpg\">\u003cimg class=\" wp-image-440848\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/04/RS30399_ATHOMETEST_035-1020x1528.jpg\" alt=\"\" width=\"411\" height=\"616\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Lesley McClurg uses a lancet to get a blood sample for a home STD test. \u003ccite>(Lauren Hanussak/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>I had ordered tests for chlamydia, gonorrhea, HIV and trichomoniasis -- the basic package. A few days later I received an email confirming that my results were negative. (Unlike \u003ca href=\"https://www.youtube.com/watch?v=bv26dLnbi9g\" target=\"_blank\" rel=\"noopener\">George Costanza\u003c/a>, of \"Seinfeld\" fame, I knew that \"negative\" is good in this context.)\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>If any of the tests had come back positive, myLAB Box would have connected me with a physician for a free telemedicine consultation.\u003c/p>\n\u003cp>\u003cstrong>Accelerating STD Rates\u003c/strong>\u003c/p>\n\u003cp>Health officials think home testing of STDs has the potential to curb accelerating transmission rates. The Centers for Disease Control and Prevention \u003ca href=\"https://www.cdc.gov/std/stats16/default.htm\" target=\"_blank\" rel=\"noopener\">reported\u003c/a> all-time highs for STDs in 2016, and an estimated \u003ca href=\"https://www.cdc.gov/nchhstp/newsroom/docs/factsheets/std-trends-508.pdf\" target=\"_blank\" rel=\"noopener\">20 million Americans\u003c/a> contract an infection through sexual contact every year. Meanwhile, in California, numerous public testing clinics have closed over the past decade, according to the state's Department of Health.\u003c/p>\n\u003caside class=\"pullquote alignright\">'Patient surveys have demonstrated that individuals don't always feel comfortable talking to their regular medical provider about their risk for STD or interest in STD testing.'\u003ccite>California Department of Public Health\u003c/cite>\u003c/aside>\n\u003cp>\"Many people still face significant challenges getting high-quality sexual health services, including STD testing,\" a spokesperson said in an email. \"This is particularly true of youth, males, and sexual minorities. Patient surveys have demonstrated that individuals don't always feel comfortable talking to their regular medical provider about their risk for STD or interest in STD testing.\"\u003c/p>\n\u003cp>Dr. Jennifer Conti, a gynecologist and clinical assistant professor at Stanford University, agrees that home testing increases access. \"I think anyone can prick their finger or pee on a stick,\" she said.\u003c/p>\n\u003cp>Conti recommends testing every six months if you're sexually active with multiple partners. This can get pricey if you're paying out of pocket. Though insurance companies are required to pay for preventative STD screening under the Affordable Care Act, most providers will not reimburse patients for home tests.\u003c/p>\n\u003cp>\u003cstrong>No FDA Approval\u003c/strong>\u003c/p>\n\u003cp>If you do decide to purchase a home test, you should know the Food and Drug Administration has only approved \u003ca href=\"https://www.cdc.gov/hiv/testing/hometests.html\" target=\"_blank\" rel=\"noopener\">two HIV tests\u003c/a> for the home market. Anything beyond that, the quality of different products may vary.\u003c/p>\n\u003cp>“The people who draw your blood in a hospital or in clinic are all trained, and they obtain specimens that have no inconsistency,\" said Dr. Norman Paradis, an emergency room physician who teaches at the Geisel School of Medicine at Dartmouth College. \"But some of the new devices for doing this on yourself at home haven't been validated to the same extent.”\u003c/p>\n\u003cp>The CEO of myLab Box, Lora Ivanova, said results are tested in a lab meeting the standards of the \u003ca href=\"https://www.cms.gov/Regulations-and-Guidance/Legislation/CLIA/index.html?redirect=/CLIA/\" target=\"_blank\" rel=\"noopener\">Clinical Laboratory Improvement Amendments, \u003c/a>used by the federal government to certify labs.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Paradis says the benefits of home testing far outweigh the risks, as long as patients see a doctor when a test comes back positive and when experiencing abnormal symptoms.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "FDA Injunctions Send Clear Message: Stem Cell Clinics Beware",
"title": "FDA Injunctions Send Clear Message: Stem Cell Clinics Beware",
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"content": "\u003cp>The Food and Drug Administration is getting serious about reining in stem cell clinics. On Wednesday, the agency \u003ca href=\"https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm607257.htm\" target=\"_blank\" rel=\"noopener\">announced\u003c/a> it wants to bar two of the largest clinic networks in the country from marketing their treatments, which would effectively halt their operations.\u003c/p>\n\u003caside class=\"pullquote alignright\">'The clinic customers are really the guinea pigs here. And they’re paying [up to] $20,000 for that right to be a guinea pig.'\u003ccite>Paul Knoepfler, UC Davis\u003c/cite>\u003c/aside>\n\u003cp>At the FDA’s request, the Department of Justice will seek permanent injunctions to halt the core stem cell therapy used by U.S. Stem Cell Clinic of Sunshine, Florida, as well as the California Stem Cell Treatment Center and its affiliated Cell Surgical Network Corporation, located in Southern California. The two businesses\u003cb> \u003c/b>have affiliations with dozens of other stem cell clinics across the country, and the FDA said their method of stem cell therapy is unapproved, untested, and potentially dangerous for patients.\u003c/p>\n\u003cp>The request for the Florida injunction was prompted by four cases of blindness that occurred after patients received stem cell injections. In the filing against the California stem cell clinics, the FDA pointed to the use of smallpox vaccine to help create and use an unproven cancer therapy.\u003c/p>\n\u003cp>The agency’s action reflects its growing concern over the increase in stem cell clinics — an estimated 700 of them have popped up across the nation, with operations in almost every state.\u003c/p>\n\u003cp>Paul Knoepfler, a cell biology professor at UC Davis, is a stem cell researcher and one of the early critics of what he calls rogue stem cell clinics. These businesses leverage the power and hope resonant in the words “stem cell therapy,” while offering treatments that carry a big price tag and lack regulatory approval, he said.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“The clinic customers are really the guinea pigs here,” Knoepfler said. “And they’re paying [up to] $20,000 for that right to be a guinea pig. These stem cells can do unexpected things, like grow tumors, or grow things where they’re not supposed to – like scar tissue inside someone’s eyeball.”\u003c/p>\n\u003cp>Many stem cell clinics promise cutting‐edge treatment for just about every malady imaginable, from impotence to autism to lymphoma to multiple sclerosis. To get stem cells for the treatment, many clinics suction off a patient’s belly fat, which contains stem cells, then create an extract of those cells to inject into other parts of the body. The theory is some of these cells might promote healing.\u003c/p>\n\u003cp>More traditional stem cell research has produced some impressive cures. But that process involves many levels of clinical trials and proof of efficacy before a treatment goes on the market, something stem cell clinics do not provide.\u003c/p>\n\u003cp>Knoepfler has compiled \u003ca href=\"http://www.cell.com/cms/attachment/2062931415/2065421495/mmc2.xlsx\">a list\u003c/a> of the roughly 700 clinics nationwide. “California is a hotspot state,” he said. “It’s the number one state. It has more than 100 clinics here.”\u003c/p>\n\u003cp>And the epicenter of that stem cell clinic activity is Southern California, and Beverly Hills in particular, which has 18 clinics, Knoepfler said.\u003c/p>\n\u003cp>The FDA began increasing oversight of stem cell clinics in August of last year, when it sent a warning letter to the U.S. Stem Cell Clinic in Florida, and at the same time asked U.S. marshals to conduct a raid on a company called StemImmune in San Diego, seizing vials of smallpox vaccine that were planned for use at two California Stem Cell Treatment Centers in Beverly Hills and Rancho Mirage.\u003c/p>\n\u003cp>And in November last year, the FDA \u003ca href=\"https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm585345.htm\">released tightened rules\u003c/a> for stem cell clinics, making clear that fat-derived stem cell therapies would be classified as a drug and should be subject to FDA approval.\u003c/p>\n\u003cp>The stem cell clinic owners at the two targeted sites said they’ll vigorously fight the requested injunctions. Their argument is that people’s own cells cannot be classified as a drug or drug therapy, and that people should be allowed to use them in any way they want.\u003c/p>\n\u003cp>In a company statement, the Florida-based U.S. Stem Cell said it “believes that the patient and physician have the right to decide whether or not to use a patient’s own cells for a therapeutic purpose without federal government interference.”\u003c/p>\n\u003cp>Knoepfler said the issue should not prompt a philosophical debate; it’s simply about patient safety.\u003c/p>\n\u003cp>“In theory the FDA can invoke criminal consequences, though we haven’t really seen that happen yet,” he said. “But with involvement of the Department of Justice in these particular cases with the injunctions, that to me seems a pretty serious indicator that this is something for stem cell clinics to take seriously.”\u003c/p>\n\u003cp>\u003cstrong>A Bigger Stick?\u003c/strong>\u003c/p>\n\u003cp>There is one more stick, yet to be wielded, that might be used to limit what therapies stem cell clinics can offer, and what claims they can make. The national Federation of State Medical Boards on May 8 released new\u003ca href=\"http://www.fsmb.org/globalassets/advocacy/policies/fsmb-stem-cell-workgroup-report.pdf\"> best-practices guidelines\u003c/a> for stem cell clinics. That’s significant because medical boards hold and can withdraw one of the things physicians value most: their medical license.\u003c/p>\n\u003cp>The recommendations are far-reaching: Medical boards can review and potentially withdraw licenses if stem cell clinics they are affiliated with make unsubstantiated claims, promote therapies not supported by science or use nondisclosure agreements to settle complaints.\u003c/p>\n\u003cp>Fines levied and court action taken by the FDA certainly can get people's attention, Knoepfler said, but the medical board federation's stance could be the real game-changer.\u003c/p>\n\u003cp>If doctors at stem cell clinics lose their medical license, it would cripple their credibility, impact their livelihood and potentially start an exodus of medical professionals out of the industry, he said.\u003c/p>\n\u003cp>“Somehow with the medical board license, for physicians it’s more of a tangible thing to take seriously,” Knoepfler said.\u003c/p>\n\u003cp> \u003c/p>\n\u003cp>\u003c/p>\n\u003cp> \u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The Food and Drug Administration is getting serious about reining in stem cell clinics. On Wednesday, the agency \u003ca href=\"https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm607257.htm\" target=\"_blank\" rel=\"noopener\">announced\u003c/a> it wants to bar two of the largest clinic networks in the country from marketing their treatments, which would effectively halt their operations.\u003c/p>\n\u003caside class=\"pullquote alignright\">'The clinic customers are really the guinea pigs here. And they’re paying [up to] $20,000 for that right to be a guinea pig.'\u003ccite>Paul Knoepfler, UC Davis\u003c/cite>\u003c/aside>\n\u003cp>At the FDA’s request, the Department of Justice will seek permanent injunctions to halt the core stem cell therapy used by U.S. Stem Cell Clinic of Sunshine, Florida, as well as the California Stem Cell Treatment Center and its affiliated Cell Surgical Network Corporation, located in Southern California. The two businesses\u003cb> \u003c/b>have affiliations with dozens of other stem cell clinics across the country, and the FDA said their method of stem cell therapy is unapproved, untested, and potentially dangerous for patients.\u003c/p>\n\u003cp>The request for the Florida injunction was prompted by four cases of blindness that occurred after patients received stem cell injections. In the filing against the California stem cell clinics, the FDA pointed to the use of smallpox vaccine to help create and use an unproven cancer therapy.\u003c/p>\n\u003cp>The agency’s action reflects its growing concern over the increase in stem cell clinics — an estimated 700 of them have popped up across the nation, with operations in almost every state.\u003c/p>\n\u003cp>Paul Knoepfler, a cell biology professor at UC Davis, is a stem cell researcher and one of the early critics of what he calls rogue stem cell clinics. These businesses leverage the power and hope resonant in the words “stem cell therapy,” while offering treatments that carry a big price tag and lack regulatory approval, he said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“The clinic customers are really the guinea pigs here,” Knoepfler said. “And they’re paying [up to] $20,000 for that right to be a guinea pig. These stem cells can do unexpected things, like grow tumors, or grow things where they’re not supposed to – like scar tissue inside someone’s eyeball.”\u003c/p>\n\u003cp>Many stem cell clinics promise cutting‐edge treatment for just about every malady imaginable, from impotence to autism to lymphoma to multiple sclerosis. To get stem cells for the treatment, many clinics suction off a patient’s belly fat, which contains stem cells, then create an extract of those cells to inject into other parts of the body. The theory is some of these cells might promote healing.\u003c/p>\n\u003cp>More traditional stem cell research has produced some impressive cures. But that process involves many levels of clinical trials and proof of efficacy before a treatment goes on the market, something stem cell clinics do not provide.\u003c/p>\n\u003cp>Knoepfler has compiled \u003ca href=\"http://www.cell.com/cms/attachment/2062931415/2065421495/mmc2.xlsx\">a list\u003c/a> of the roughly 700 clinics nationwide. “California is a hotspot state,” he said. “It’s the number one state. It has more than 100 clinics here.”\u003c/p>\n\u003cp>And the epicenter of that stem cell clinic activity is Southern California, and Beverly Hills in particular, which has 18 clinics, Knoepfler said.\u003c/p>\n\u003cp>The FDA began increasing oversight of stem cell clinics in August of last year, when it sent a warning letter to the U.S. Stem Cell Clinic in Florida, and at the same time asked U.S. marshals to conduct a raid on a company called StemImmune in San Diego, seizing vials of smallpox vaccine that were planned for use at two California Stem Cell Treatment Centers in Beverly Hills and Rancho Mirage.\u003c/p>\n\u003cp>And in November last year, the FDA \u003ca href=\"https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm585345.htm\">released tightened rules\u003c/a> for stem cell clinics, making clear that fat-derived stem cell therapies would be classified as a drug and should be subject to FDA approval.\u003c/p>\n\u003cp>The stem cell clinic owners at the two targeted sites said they’ll vigorously fight the requested injunctions. Their argument is that people’s own cells cannot be classified as a drug or drug therapy, and that people should be allowed to use them in any way they want.\u003c/p>\n\u003cp>In a company statement, the Florida-based U.S. Stem Cell said it “believes that the patient and physician have the right to decide whether or not to use a patient’s own cells for a therapeutic purpose without federal government interference.”\u003c/p>\n\u003cp>Knoepfler said the issue should not prompt a philosophical debate; it’s simply about patient safety.\u003c/p>\n\u003cp>“In theory the FDA can invoke criminal consequences, though we haven’t really seen that happen yet,” he said. “But with involvement of the Department of Justice in these particular cases with the injunctions, that to me seems a pretty serious indicator that this is something for stem cell clinics to take seriously.”\u003c/p>\n\u003cp>\u003cstrong>A Bigger Stick?\u003c/strong>\u003c/p>\n\u003cp>There is one more stick, yet to be wielded, that might be used to limit what therapies stem cell clinics can offer, and what claims they can make. The national Federation of State Medical Boards on May 8 released new\u003ca href=\"http://www.fsmb.org/globalassets/advocacy/policies/fsmb-stem-cell-workgroup-report.pdf\"> best-practices guidelines\u003c/a> for stem cell clinics. That’s significant because medical boards hold and can withdraw one of the things physicians value most: their medical license.\u003c/p>\n\u003cp>The recommendations are far-reaching: Medical boards can review and potentially withdraw licenses if stem cell clinics they are affiliated with make unsubstantiated claims, promote therapies not supported by science or use nondisclosure agreements to settle complaints.\u003c/p>\n\u003cp>Fines levied and court action taken by the FDA certainly can get people's attention, Knoepfler said, but the medical board federation's stance could be the real game-changer.\u003c/p>\n\u003cp>If doctors at stem cell clinics lose their medical license, it would cripple their credibility, impact their livelihood and potentially start an exodus of medical professionals out of the industry, he said.\u003c/p>\n\u003cp>“Somehow with the medical board license, for physicians it’s more of a tangible thing to take seriously,” Knoepfler said.\u003c/p>\n\u003cp> \u003c/p>\n\u003cp>\u003c/p>\n\u003cp> \u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>A group of HIV patients based in California filed two separate lawsuits on Wednesday against Bay Area drugmaker Gilead Sciences for promoting a drug they say caused permanent kidney and bone damage. The \u003ca href=\"https://www.aidshealth.org/wp-content/uploads/2018/05/gilead-personal-injury-final.pdf\" target=\"_blank\" rel=\"noopener\">personal injury\u003c/a> and\u003ca href=\"https://www.aidshealth.org/wp-content/uploads/2018/05/class-action-complaint-final.pdf\" target=\"_blank\" rel=\"noopener\"> class action\u003c/a> suits, filed in a Los Angeles district court, accuse the company of shelving a safer version of the drug in order to maximize profits and extend the sales of its existing drug tenofovir disoproxil fumarate.\u003c/p>\n\u003cfigure id=\"attachment_441443\" class=\"wp-caption aligncenter\" style=\"max-width: 796px\">\u003ca href=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/05/viread.png\">\u003cimg class=\" wp-image-441443\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/05/viread.png\" alt=\"\" width=\"796\" height=\"329\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2018/05/viread.png 754w, https://ww2.kqed.org/app/uploads/sites/13/2018/05/viread-160x66.png 160w, https://ww2.kqed.org/app/uploads/sites/13/2018/05/viread-240x99.png 240w, https://ww2.kqed.org/app/uploads/sites/13/2018/05/viread-375x155.png 375w, https://ww2.kqed.org/app/uploads/sites/13/2018/05/viread-520x215.png 520w\" sizes=\"(max-width: 796px) 100vw, 796px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Tenofovir disoproxil fumarate was sold under the brand name Viread. \u003ccite>(U.S. Dept. of Health and Human Services)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Both complaints say the company knew as far back as 2001 that TDF was highly toxic but failed to warn patients of the dangerous side effects. The drug was originally sold under the brand name Viread.\u003c/p>\n\u003cp>\"A company I trusted with my life took advantage of that trust by misrepresenting the side effects of TDF, calling it the ‘Miracle Drug’ and using other deceptive marketing strategies,\" said Michael Lujano, from Los Angeles, one of two plaintiffs in the personal injury suit. \"Gilead shelved a far safer drug called tenofovir alafenamide fumarate simply to increase its long-term profits.\"\u003c/p>\n\u003cp>Another plaintiff in the class action suit, Ricardo Wohler, says he has lost 17 teeth in just three years due to the drug. The 52 year-old real estate agent from Marin took TDF for 12 years and was never made aware of its potential side effects, he said.\u003c/p>\n\u003cp>\"I learned how to smile without opening my mouth, how to speak without showing my teeth. This had an entire impact on my life, my self security, my self esteem, but also on my finances.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Gilead said it is \"thoroughly reviewing the complaints and will not provide comment until that process is complete.\"\u003c/p>\n\u003cp>The suits accuse Gilead of deceptive marketing practices and putting profits before the health of its customers. The complaint says the company made $18 billion in profits in 2015.\u003c/p>\n\u003cp>\"Under these circumstances, the laws must be read to protect public health from corporate greed,” says Liza Brereton, attorney for plaintiffs and in-house counsel for the AIDS Healthcare Foundation.\u003c/p>\n\u003cp>AHF, which filed both lawsuits with co-counsel Rutherford Law, says it is funding the litigation and will not accept any financial recovery in excess of its actual costs.\u003c/p>\n\u003cp>Two other Californians filed a separate class action lawsuit on behalf of all patients living in California who were prescribed the drug from Oct. 26, 2001 through the present and were exposed to Gilead’s alleged misrepresentations, either directly or through their doctor.\u003c/p>\n\u003cp>The Food and Drug Administration reportedly issued two warning letters to Gilead for false misrepresentations about the drug's risks, according to the personal injury complaint.\u003c/p>\n\u003cp>A warning letter issued in 2002 accused a company sales representatives of falsely stating that TDF had “no toxicities” and was “benign” and “extremely safe.\" The company was slapped with another warning letter one year later, requiring Gilead to retrain its sales representatives.\u003c/p>\n\u003cp>The drugmaker began funding research of an alternative drug called TAF in 2001 but suppressed findings that showed it was far less toxic, according to the class action complaint.\u003c/p>\n\u003cp>Faced with a sharp decrease in profits, the complaint says, the drugmaker eventually released those findings in 2014, when Gilead’s patent on TDF was approaching expiration.\u003c/p>\n\u003cp>From the \u003ca href=\"http://www.latimes.com/business/la-fi-gilead-hiv-drug-lawsuit-20180509-story.html\" target=\"_blank\" rel=\"noopener\">Los Angeles Times\u003c/a>:\u003c/p>\n\u003cblockquote>\u003cp>In April 2001, the scientists published research on a different chemical version of the medicine called tenofovir alafenamide fumarate, or TAF.\u003c/p>\n\u003cp>That animal study showed TAF had a thousand-fold greater activity against HIV than the original medicine invented in Europe, raising the possibility that it would have far less toxicity.\u003c/p>\n\u003cp>Gilead then paid doctors across the country to give TAF to patients in small clinical trials. The positive results of those studies were not published for years — secrecy that the lawsuits filed Tuesday say was \"an act of extreme malice.\"\u003c/p>\n\u003cp>Instead, in October 2004, Gilead abruptly announced that it was ending research on TAF after an \"internal business review.\" And it continued to pour money into selling the older drug, which was bringing in billions of dollars each year.\u003c/p>\u003c/blockquote>\n\u003cp>\u003c/p>\n\u003cp>A previous federal lawsuit filed in 2016 is currently pending following the publication of a previous \u003ca href=\"http://www.latimes.com/business/la-fi-gilead-20160529-snap-story.html\" target=\"_blank\" rel=\"noopener\">Los Angeles Times article\u003c/a> that accused the company of stifling development of the safer drug.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>A group of HIV patients based in California filed two separate lawsuits on Wednesday against Bay Area drugmaker Gilead Sciences for promoting a drug they say caused permanent kidney and bone damage. The \u003ca href=\"https://www.aidshealth.org/wp-content/uploads/2018/05/gilead-personal-injury-final.pdf\" target=\"_blank\" rel=\"noopener\">personal injury\u003c/a> and\u003ca href=\"https://www.aidshealth.org/wp-content/uploads/2018/05/class-action-complaint-final.pdf\" target=\"_blank\" rel=\"noopener\"> class action\u003c/a> suits, filed in a Los Angeles district court, accuse the company of shelving a safer version of the drug in order to maximize profits and extend the sales of its existing drug tenofovir disoproxil fumarate.\u003c/p>\n\u003cfigure id=\"attachment_441443\" class=\"wp-caption aligncenter\" style=\"max-width: 796px\">\u003ca href=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/05/viread.png\">\u003cimg class=\" wp-image-441443\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/05/viread.png\" alt=\"\" width=\"796\" height=\"329\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2018/05/viread.png 754w, https://ww2.kqed.org/app/uploads/sites/13/2018/05/viread-160x66.png 160w, https://ww2.kqed.org/app/uploads/sites/13/2018/05/viread-240x99.png 240w, https://ww2.kqed.org/app/uploads/sites/13/2018/05/viread-375x155.png 375w, https://ww2.kqed.org/app/uploads/sites/13/2018/05/viread-520x215.png 520w\" sizes=\"(max-width: 796px) 100vw, 796px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Tenofovir disoproxil fumarate was sold under the brand name Viread. \u003ccite>(U.S. Dept. of Health and Human Services)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Both complaints say the company knew as far back as 2001 that TDF was highly toxic but failed to warn patients of the dangerous side effects. The drug was originally sold under the brand name Viread.\u003c/p>\n\u003cp>\"A company I trusted with my life took advantage of that trust by misrepresenting the side effects of TDF, calling it the ‘Miracle Drug’ and using other deceptive marketing strategies,\" said Michael Lujano, from Los Angeles, one of two plaintiffs in the personal injury suit. \"Gilead shelved a far safer drug called tenofovir alafenamide fumarate simply to increase its long-term profits.\"\u003c/p>\n\u003cp>Another plaintiff in the class action suit, Ricardo Wohler, says he has lost 17 teeth in just three years due to the drug. The 52 year-old real estate agent from Marin took TDF for 12 years and was never made aware of its potential side effects, he said.\u003c/p>\n\u003cp>\"I learned how to smile without opening my mouth, how to speak without showing my teeth. This had an entire impact on my life, my self security, my self esteem, but also on my finances.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Gilead said it is \"thoroughly reviewing the complaints and will not provide comment until that process is complete.\"\u003c/p>\n\u003cp>The suits accuse Gilead of deceptive marketing practices and putting profits before the health of its customers. The complaint says the company made $18 billion in profits in 2015.\u003c/p>\n\u003cp>\"Under these circumstances, the laws must be read to protect public health from corporate greed,” says Liza Brereton, attorney for plaintiffs and in-house counsel for the AIDS Healthcare Foundation.\u003c/p>\n\u003cp>AHF, which filed both lawsuits with co-counsel Rutherford Law, says it is funding the litigation and will not accept any financial recovery in excess of its actual costs.\u003c/p>\n\u003cp>Two other Californians filed a separate class action lawsuit on behalf of all patients living in California who were prescribed the drug from Oct. 26, 2001 through the present and were exposed to Gilead’s alleged misrepresentations, either directly or through their doctor.\u003c/p>\n\u003cp>The Food and Drug Administration reportedly issued two warning letters to Gilead for false misrepresentations about the drug's risks, according to the personal injury complaint.\u003c/p>\n\u003cp>A warning letter issued in 2002 accused a company sales representatives of falsely stating that TDF had “no toxicities” and was “benign” and “extremely safe.\" The company was slapped with another warning letter one year later, requiring Gilead to retrain its sales representatives.\u003c/p>\n\u003cp>The drugmaker began funding research of an alternative drug called TAF in 2001 but suppressed findings that showed it was far less toxic, according to the class action complaint.\u003c/p>\n\u003cp>Faced with a sharp decrease in profits, the complaint says, the drugmaker eventually released those findings in 2014, when Gilead’s patent on TDF was approaching expiration.\u003c/p>\n\u003cp>From the \u003ca href=\"http://www.latimes.com/business/la-fi-gilead-hiv-drug-lawsuit-20180509-story.html\" target=\"_blank\" rel=\"noopener\">Los Angeles Times\u003c/a>:\u003c/p>\n\u003cblockquote>\u003cp>In April 2001, the scientists published research on a different chemical version of the medicine called tenofovir alafenamide fumarate, or TAF.\u003c/p>\n\u003cp>That animal study showed TAF had a thousand-fold greater activity against HIV than the original medicine invented in Europe, raising the possibility that it would have far less toxicity.\u003c/p>\n\u003cp>Gilead then paid doctors across the country to give TAF to patients in small clinical trials. The positive results of those studies were not published for years — secrecy that the lawsuits filed Tuesday say was \"an act of extreme malice.\"\u003c/p>\n\u003cp>Instead, in October 2004, Gilead abruptly announced that it was ending research on TAF after an \"internal business review.\" And it continued to pour money into selling the older drug, which was bringing in billions of dollars each year.\u003c/p>\u003c/blockquote>\n\u003cp>\u003c/p>\n\u003cp>A previous federal lawsuit filed in 2016 is currently pending following the publication of a previous \u003ca href=\"http://www.latimes.com/business/la-fi-gilead-20160529-snap-story.html\" target=\"_blank\" rel=\"noopener\">Los Angeles Times article\u003c/a> that accused the company of stifling development of the safer drug.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"slug": "proposed-california-ban-on-kids-football-sacked-early-and-hard",
"title": "California Ban on Kids' Football Sacked Early",
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"content": "\u003cp>A \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201720180AB2108\" target=\"_blank\" rel=\"noopener\">bill\u003c/a> that would have made California the first state to ban youth tackle football was shelved at the end of April, following major \u003ca href=\"https://www.ocregister.com/2018/04/27/law-to-ban-tackle-football-for-california-youth-falls-short-of-committee/\" target=\"_blank\" rel=\"noopener\">pushback\u003c/a> from parents, coaches and football fans.[contextly_sidebar id=”3BKDehAqDVxXqjXF1gjQRNg4qvtqDn2e”]\u003c/p>\n\u003cp>Organizers collected more than 45,000 signatures opposing the ban, according to the \u003ca href=\"https://www.vcstar.com/story/news/2018/04/27/lawmakers-sideline-bill-ban-preteen-tackle-football/560916002/\" target=\"_blank\" rel=\"noopener\">Los Angeles Times\u003c/a>.\u003c/p>\n\u003cp>The \u003ca href=\"https://www.ocregister.com/2018/04/27/law-to-ban-tackle-football-for-california-youth-falls-short-of-committee/\" target=\"_blank\" rel=\"noopener\">Orange County Register\u003c/a> reported …\u003c/p>\n\u003cblockquote>\u003cp>(T)he backlash was swift and unyielding. Coaches and parents flooded phone lines, email boxes and talk radio, condemning the bills and questioning the science behind them. Within weeks, three of five bills were dead or left in legislative purgatory, crushed under the weight of youth football’s influence.\u003c/p>\u003c/blockquote>\n\u003caside class=\"pullquote alignright\">‘I have a problem with the idea that we’re going to take kids that we already know are vulnerable, and we are gonna hit them in the head a few hundred times a year.’ \u003ccite>Christopher Nowinski, co-founder of Boston University’s CTE Center\u003c/cite>\u003c/aside>\n\u003cp> \u003c/p>\n\u003cp>The \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201720180AB2108\" target=\"_blank\" rel=\"noopener\">Safe Youth Football Act\u003c/a> would have barred children below age 12 from playing organized tackle football. The legislation was drafted in consultation with medical professionals who say the ban would protect youth from a degenerative brain disease known as \u003ca href=\"https://www.mayoclinic.org/diseases-conditions/chronic-traumatic-encephalopathy/symptoms-causes/syc-20370921\" target=\"_blank\" rel=\"noopener\">chronic traumatic encephalopathy\u003c/a>.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Those views were bolstered by a \u003ca href=\"https://www.bumc.bu.edu/busm/2018/04/30/youth-tackle-football-linked-to-earlier-onset-of-cognitive-and-emotional-symptoms-in-athletes-diagnosed-with-cte-after-death/\" target=\"_blank\" rel=\"noopener\">study \u003c/a>published April 30 that found playing youth tackle football may lead to earlier onset of cognitive, behavioral and emotional symptoms in later life.\u003c/p>\n\u003cp>Researchers at the Boston University School of Medicine conducted telephone interviews with the friends and relatives of 246 deceased football players and found that those who played tackle football before 12 experienced symptoms on average 13 years earlier than those who started playing at an older age.\u003c/p>\n\u003cp>Researchers took into account different styles of play and forms of protection.\u003c/p>\n\u003cp>“It took looking at 246 brains and seeing this in nearly 90 percent of them to say, ‘Hey, you know what, the research is becoming very clear, that you hit someone in the head too much, you’ll give them this disease,’ ” Christopher Nowinski, co-founder of Boston University’s \u003ca href=\"https://www.bu.edu/cte/\" target=\"_blank\" rel=\"noopener\">CTE Center\u003c/a>, said on \u003ca href=\"https://www.kqed.org/forum/2010101865041/after-california-ban-fails-controversy-persists-over-youth-tackle-football\" target=\"_blank\" rel=\"noopener\">KQED’s Forum program \u003c/a>last week.\u003c/p>\n\u003cp>Joe Rafter, the president of Southern Marin Youth Football who started a group to oppose the ban, disputes those findings and says the sport is “safer than its ever been.”[contextly_sidebar id=”mIxCIh40B3GwZE3hvjgDhmoIUuc7rwZy”]\u003c/p>\n\u003cp>He pointed to revised coaching methods and behavior modification techniques that he argues have made the sport safer.\u003c/p>\n\u003cp>“The game that was played 40 to 50 years ago is no longer played now,” he said. “The techniques that are taught right now in youth football across America are to take the head out of the tackle.”\u003c/p>\n\u003cp>\u003cstrong>Public Health Issue\u003c/strong>\u003c/p>\n\u003cp>But Nowinski, a former football player, says changes made in the sport are not enough to make it safe for youth. The problem is not the occasional major hit to the head, he said, but the repetitive tackling, hitting and blocking.\u003c/p>\n\u003cp>“This is the best data that we are going to have for decades, because we have taken the effort to actually build the world’s largest brain bank of former football players, and we just really struggle to find football players who don’t have CTE who’ve had long careers,” he said. “Even if we diagnose concussions, a concussion happens maybe once out of every couple thousand of times a child is hit in the head. CTE risk is related to those thousands of hits, not to that concussion.”\u003c/p>\n\u003cp>Nowinski says the issue is a matter of public health.\u003c/p>\n\u003cp>“This is about protecting kids from degenerative brain disease. It’s not unlike saying, ‘Let’s take the lead out of the paint in their home because it might rot their brain.’ Let’s not hit them in the head 500 times because it might rot their brain.”\u003c/p>\n\u003cp>But Rafter says eliminating football will affect many children from undeserved communities.\u003c/p>\n\u003cp>“[T]hey come together and experience different communities, different lifestyles through this sport,” he said.\u003c/p>\n\u003cp>Rafter said he’s received phone calls from coaches in poor neighborhoods thanking him for his efforts.\u003c/p>\n\u003cp>“I can tell you I’m getting phone calls and emails from coaches in undeserved communities of Los Angeles thanking us,” he said. “Because if these boys don’t have youth sports, they will get mixed into the wrong path.”\u003c/p>\n\u003cp>Nowinski, however, says football is not the solution to poverty.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“I have a problem with the idea that we’re going to take kids that we already know are vulnerable, and we are going to hit them in the head a few hundred times a year, and open them up to this door of concussions and long-term [brain] disease,” he said. “It’s sort of doubling down on a problem.”\u003c/p>\n\n",
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"excerpt": "A bill that would have made California the first state to ban youth tackle football was shelved, following major pushback from parents, coaches and fans.",
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"title": "California Ban on Kids’ Football Sacked Early",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>A \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201720180AB2108\" target=\"_blank\" rel=\"noopener\">bill\u003c/a> that would have made California the first state to ban youth tackle football was shelved at the end of April, following major \u003ca href=\"https://www.ocregister.com/2018/04/27/law-to-ban-tackle-football-for-california-youth-falls-short-of-committee/\" target=\"_blank\" rel=\"noopener\">pushback\u003c/a> from parents, coaches and football fans.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Organizers collected more than 45,000 signatures opposing the ban, according to the \u003ca href=\"https://www.vcstar.com/story/news/2018/04/27/lawmakers-sideline-bill-ban-preteen-tackle-football/560916002/\" target=\"_blank\" rel=\"noopener\">Los Angeles Times\u003c/a>.\u003c/p>\n\u003cp>The \u003ca href=\"https://www.ocregister.com/2018/04/27/law-to-ban-tackle-football-for-california-youth-falls-short-of-committee/\" target=\"_blank\" rel=\"noopener\">Orange County Register\u003c/a> reported …\u003c/p>\n\u003cblockquote>\u003cp>(T)he backlash was swift and unyielding. Coaches and parents flooded phone lines, email boxes and talk radio, condemning the bills and questioning the science behind them. Within weeks, three of five bills were dead or left in legislative purgatory, crushed under the weight of youth football’s influence.\u003c/p>\u003c/blockquote>\n\u003caside class=\"pullquote alignright\">‘I have a problem with the idea that we’re going to take kids that we already know are vulnerable, and we are gonna hit them in the head a few hundred times a year.’ \u003ccite>Christopher Nowinski, co-founder of Boston University’s CTE Center\u003c/cite>\u003c/aside>\n\u003cp> \u003c/p>\n\u003cp>The \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201720180AB2108\" target=\"_blank\" rel=\"noopener\">Safe Youth Football Act\u003c/a> would have barred children below age 12 from playing organized tackle football. The legislation was drafted in consultation with medical professionals who say the ban would protect youth from a degenerative brain disease known as \u003ca href=\"https://www.mayoclinic.org/diseases-conditions/chronic-traumatic-encephalopathy/symptoms-causes/syc-20370921\" target=\"_blank\" rel=\"noopener\">chronic traumatic encephalopathy\u003c/a>.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Those views were bolstered by a \u003ca href=\"https://www.bumc.bu.edu/busm/2018/04/30/youth-tackle-football-linked-to-earlier-onset-of-cognitive-and-emotional-symptoms-in-athletes-diagnosed-with-cte-after-death/\" target=\"_blank\" rel=\"noopener\">study \u003c/a>published April 30 that found playing youth tackle football may lead to earlier onset of cognitive, behavioral and emotional symptoms in later life.\u003c/p>\n\u003cp>Researchers at the Boston University School of Medicine conducted telephone interviews with the friends and relatives of 246 deceased football players and found that those who played tackle football before 12 experienced symptoms on average 13 years earlier than those who started playing at an older age.\u003c/p>\n\u003cp>Researchers took into account different styles of play and forms of protection.\u003c/p>\n\u003cp>“It took looking at 246 brains and seeing this in nearly 90 percent of them to say, ‘Hey, you know what, the research is becoming very clear, that you hit someone in the head too much, you’ll give them this disease,’ ” Christopher Nowinski, co-founder of Boston University’s \u003ca href=\"https://www.bu.edu/cte/\" target=\"_blank\" rel=\"noopener\">CTE Center\u003c/a>, said on \u003ca href=\"https://www.kqed.org/forum/2010101865041/after-california-ban-fails-controversy-persists-over-youth-tackle-football\" target=\"_blank\" rel=\"noopener\">KQED’s Forum program \u003c/a>last week.\u003c/p>\n\u003cp>Joe Rafter, the president of Southern Marin Youth Football who started a group to oppose the ban, disputes those findings and says the sport is “safer than its ever been.”\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>He pointed to revised coaching methods and behavior modification techniques that he argues have made the sport safer.\u003c/p>\n\u003cp>“The game that was played 40 to 50 years ago is no longer played now,” he said. “The techniques that are taught right now in youth football across America are to take the head out of the tackle.”\u003c/p>\n\u003cp>\u003cstrong>Public Health Issue\u003c/strong>\u003c/p>\n\u003cp>But Nowinski, a former football player, says changes made in the sport are not enough to make it safe for youth. The problem is not the occasional major hit to the head, he said, but the repetitive tackling, hitting and blocking.\u003c/p>\n\u003cp>“This is the best data that we are going to have for decades, because we have taken the effort to actually build the world’s largest brain bank of former football players, and we just really struggle to find football players who don’t have CTE who’ve had long careers,” he said. “Even if we diagnose concussions, a concussion happens maybe once out of every couple thousand of times a child is hit in the head. CTE risk is related to those thousands of hits, not to that concussion.”\u003c/p>\n\u003cp>Nowinski says the issue is a matter of public health.\u003c/p>\n\u003cp>“This is about protecting kids from degenerative brain disease. It’s not unlike saying, ‘Let’s take the lead out of the paint in their home because it might rot their brain.’ Let’s not hit them in the head 500 times because it might rot their brain.”\u003c/p>\n\u003cp>But Rafter says eliminating football will affect many children from undeserved communities.\u003c/p>\n\u003cp>“[T]hey come together and experience different communities, different lifestyles through this sport,” he said.\u003c/p>\n\u003cp>Rafter said he’s received phone calls from coaches in poor neighborhoods thanking him for his efforts.\u003c/p>\n\u003cp>“I can tell you I’m getting phone calls and emails from coaches in undeserved communities of Los Angeles thanking us,” he said. “Because if these boys don’t have youth sports, they will get mixed into the wrong path.”\u003c/p>\n\u003cp>Nowinski, however, says football is not the solution to poverty.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“I have a problem with the idea that we’re going to take kids that we already know are vulnerable, and we are going to hit them in the head a few hundred times a year, and open them up to this door of concussions and long-term [brain] disease,” he said. “It’s sort of doubling down on a problem.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"info": "What kind of no sabo word is Hyphenación? For us, it’s about living within a hyphenation. Like being a third-gen Mexican-American from the Texas border now living that Bay Area Chicano life. Like Xorje! Each week we bring together a couple of hyphenated Latinos to talk all about personal life choices: family, careers, relationships, belonging … everything is on the table. ",
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"marketplace": {
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"info": "Our flagship program, helmed by Kai Ryssdal, examines what the day in money delivered, through stories, conversations, newsworthy numbers and more. Updated Monday through Friday at about 3:30 p.m. PT.",
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"masters-of-scale": {
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"mindshift": {
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"info": "The MindShift podcast explores the innovations in education that are shaping how kids learn. Hosts Ki Sung and Katrina Schwartz introduce listeners to educators, researchers, parents and students who are developing effective ways to improve how kids learn. We cover topics like how fed-up administrators are developing surprising tactics to deal with classroom disruptions; how listening to podcasts are helping kids develop reading skills; the consequences of overparenting; and why interdisciplinary learning can engage students on all ends of the traditional achievement spectrum. This podcast is part of the MindShift education site, a division of KQED News. KQED is an NPR/PBS member station based in San Francisco. You can also visit the MindShift website for episodes and supplemental blog posts or tweet us \u003ca href=\"https://twitter.com/MindShiftKQED\">@MindShiftKQED\u003c/a> or visit us at \u003ca href=\"/mindshift\">MindShift.KQED.org\u003c/a>",
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"order": 12
},
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM1NzY0NjAwNDI5",
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"morning-edition": {
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"tagline": "Deeply-reported investigative journalism",
"info": "For decades, the process for how police police themselves has been inconsistent – if not opaque. In some states, like California, these proceedings were completely hidden. After a new police transparency law unsealed scores of internal affairs files, our reporters set out to examine these cases and the shadow world of police discipline. On Our Watch brings listeners into the rooms where officers are questioned and witnesses are interrogated to find out who this system is really protecting. Is it the officers, or the public they've sworn to serve?",
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"info": "Our weekly podcast explores how the media 'sausage' is made, casts an incisive eye on fluctuations in the marketplace of ideas, and examines threats to the freedom of information and expression in America and abroad. For one hour a week, the show tries to lift the veil from the process of \"making media,\" especially news media, because it's through that lens that we see the world and the world sees us",
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},
"pbs-newshour": {
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},
"perspectives": {
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"order": 14
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"info": "The economy explained. Imagine you could call up a friend and say, Meet me at the bar and tell me what's going on with the economy. Now imagine that's actually a fun evening.",
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"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/planetmoney.jpg",
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"link": "/radio/program/planet-money",
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"politicalbreakdown": {
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"title": "Political Breakdown",
"tagline": "Politics from a personal perspective",
"info": "Political Breakdown is a new series that explores the political intersection of California and the nation. Each week hosts Scott Shafer and Marisa Lagos are joined with a new special guest to unpack politics -- with personality — and offer an insider’s glimpse at how politics happens.",
"airtime": "THU 6:30pm-7pm",
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"order": 5
},
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"possible": {
"id": "possible",
"title": "Possible",
"info": "Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. Together in Possible, Hoffman and Finger lead enlightening discussions about building a brighter collective future. The show features interviews with visionary guests like Trevor Noah, Sam Altman and Janette Sadik-Khan. Possible paints an optimistic portrait of the world we can create through science, policy, business, art and our shared humanity. It asks: What if everything goes right for once? How can we get there? Each episode also includes a short fiction story generated by advanced AI GPT-4, serving as a thought-provoking springboard to speculate how humanity could leverage technology for good.",
"airtime": "SUN 2pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Possible-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.possible.fm/",
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"source": "Possible"
},
"link": "/radio/program/possible",
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"spotify": "https://open.spotify.com/show/730YpdUSNlMyPQwNnyjp4k"
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},
"pri-the-world": {
"id": "pri-the-world",
"title": "PRI's The World: Latest Edition",
"info": "Each weekday, host Marco Werman and his team of producers bring you the world's most interesting stories in an hour of radio that reminds us just how small our planet really is.",
"airtime": "MON-FRI 2pm-3pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/The-World-Podcast-Tile-360x360-1.jpg",
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},
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},
"radiolab": {
"id": "radiolab",
"title": "Radiolab",
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