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"content": "\u003cp>Maia Majumder was on Twitter earlier this month when she saw a map that terrified her.\u003c/p>\n\u003cp>The map recorded the number of local newspapers in each county across the United States. Large swaths were shaded light pink, denoting a county that had no local newspaper at all. As a record of the decline of the American newspaper industry, it was disconcerting.\u003c/p>\n\u003cp>But Majumder, a scientist who specializes in mathematical modeling, saw something different in the splotches of light pink: a disaster for infectious disease surveillance.\u003c/p>\n\u003cp>Epidemiologists rely on all kinds of data to detect the spread of disease, including reports from local and state agencies and social media. But local newspapers are critical to identifying outbreaks and forecasting their trajectories.\u003c/p>\n\u003caside class=\"pullquote alignright\">'“Local media is the bedrock of internet surveillance.’ \u003ccite>John Brownstein, Healthmap\u003c/cite>\u003c/aside>\n\u003cp>On the map, Majumder saw every county without a local newspaper as a community where health officials and disease researchers could be flying blind.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“We rely very heavily on local news. And I think what this will probably mean is that there are going to be pockets of the U.S. where we’re just not going to have a particularly good signal anymore,” said Majumder, a Ph.D. candidate at the Massachusetts Institute of Technology.\u003c/p>\n\u003cp>Majumder is a computational epidemiology research fellow at HealthMap, a 12-year-old disease detection project run by researchers from Boston Children’s Hospital. The website uses nontraditional data sources — reports from local news outlets and social media platforms among them— to track global infectious disease activity in real time.\u003c/p>\n\u003cp>\u003cimg class=\"size-medium wp-image-295309 aligncenter\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2050/12/newspapers-800x533.gif\" alt=\"\" width=\"800\" height=\"533\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2050/12/newspapers-800x533.gif 800w, https://ww2.kqed.org/app/uploads/sites/13/2050/12/newspapers-160x107.gif 160w, https://ww2.kqed.org/app/uploads/sites/13/2050/12/newspapers-768x512.gif 768w, https://ww2.kqed.org/app/uploads/sites/13/2050/12/newspapers-1020x680.gif 1020w, https://ww2.kqed.org/app/uploads/sites/13/2050/12/newspapers-1920x1280.gif 1920w, https://ww2.kqed.org/app/uploads/sites/13/2050/12/newspapers-1180x787.gif 1180w, https://ww2.kqed.org/app/uploads/sites/13/2050/12/newspapers-960x640.gif 960w, https://ww2.kqed.org/app/uploads/sites/13/2050/12/newspapers-240x160.gif 240w, https://ww2.kqed.org/app/uploads/sites/13/2050/12/newspapers-375x250.gif 375w, https://ww2.kqed.org/app/uploads/sites/13/2050/12/newspapers-520x347.gif 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">The information HealthMap gathers is used not only by public health authorities, but by researchers around the world who are studying things like the changing geographic distribution of diseases — think Zika — and the impact of climate change on disease patterns, said John Brownstein, one of the co-founders of the site.\u003c/p>\n\u003cp>“Local media is the bedrock of internet surveillance — the kind of work that we do in terms of scouring the web looking for early signs of something taking place in a community,” explained Brownstein, chief innovation officer at Boston Children’s and a pioneer in the field of using sources other than public health data to do this type of work.\u003c/p>\n\u003cp>He pointed to the 2009 H1N1 influenza pandemic as an example of a case in which local reporting helped to bring an emerging disease threat to global attention.\u003c/p>\n\u003cp>\u003cstrong>Tracking an Outbreak\u003c/strong>\u003cbr>\nThe Centers for Disease Control and Prevention was the first agency to detect that two young children in California had been infected with a flu strain circulated in pigs. As officials were trying to figure out if the cases were blips or part of something bigger, however, disease detectives began crawling through recent media reports to determine whether unusual numbers of people with flu-like illness in Mexico had also been sickened by the new virus. It turned out they had been. The new virus was spreading.[contextly_sidebar id=\"eRWHDjM3IMP7OEH2GlfugYXA5fly6vp3\"]\u003c/p>\n\u003cp>“It makes sense that if we see a reduction in local reporting, you’re not going to have that early signaling of something in a community,” Brownstein said.\u003c/p>\n\u003cp>Without local reporting, it’s also harder to follow an outbreak and assess its progress. Majumder used the example of the massive 2016-2017 mumps outbreak in northwestern Arkansas to illustrate the point.\u003c/p>\n\u003cp>She and colleagues were trying to figure out why the outbreak was so large — nearly 3,000 cases all told. Had the virus simply found its way into an area with lots of unvaccinated children? Or was something else driving transmission?\u003c/p>\n\u003cp>That’s the kind of information that is hugely helpful to public health authorities struggling to control an outbreak. But Majumder found she couldn’t easily get her hands on key data; the Arkansas Department of Public Health issued regular updates, but the agency did not archive previous updates on its website. Getting access to official data can be a time-consuming process.\u003c/p>\n\u003cp>“There is a lot of red tape to get data sharing privileges, even around something as simple as cumulative case counts over time,” she said.\u003c/p>\n\u003cp>The Northwest Arkansas Democrat-Gazette, however, was covering the outbreak closely, and its coverage provided important context for Majumder’s research. Some of the paper’s stories noted that the vaccine refusal rate in that region was higher than anywhere else in the state; others made clear disease was spreading in a local community of people from the Marshall Islands who had been vaccinated.\u003c/p>\n\u003cp>\u003cimg class=\"size-medium wp-image-440343 aligncenter\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/03/iStock-691796746-800x533.jpg\" alt=\"\" width=\"800\" height=\"533\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-691796746-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-691796746-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-691796746-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-691796746-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-691796746-1920x1280.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-691796746-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-691796746-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-691796746-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-691796746-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-691796746-520x347.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">Both those factors proved key in helping public health officials better understand what was driving the outbreak, Majumder said.\u003c/p>\n\u003cp>The World Health Organization urges countries to augment their official disease surveillance efforts — which draw information from networks of doctor’s offices, hospitals, and public health laboratories — with what’s known as “event-based surveillance,” said Dr. Larry Madoff, editor of ProMED, the Program for Monitoring Emerging Diseases. The internet-based outbreak reporting system — which reports on human, animal, and plant disease outbreaks — operates under the auspices of the International Society for Infectious Diseases.\u003c/p>\n\u003cp>Event-based surveillance is more informal and relies on systems that pick up on media reports, rumors on social media, and the like. That’s the way news of the 2003 SARS outbreak emerged. Internet chatter about a disease that was sickening and killing people in China made its way to the WHO before Chinese authorities eventually disclosed the existence of an outbreak that had been raging for several months.[contextly_sidebar id=\"pHkMIHqxoK7nvOZ2Rw6M77aUOBH1WSHD\"]\u003c/p>\n\u003cp>“It is well-known that event-based surveillance depends on healthy, local journalism,” said Madoff, who is also director of the Massachusetts Department of Health’s division of epidemiology and immunization. “So it would be a reasonable assumption that the loss of local sources would increase the time required to discover an outbreak.”\u003c/p>\n\u003cp>Like HealthMap, ProMED casts its net globally. In some countries, there are not many local media sources, or if there are, those news sources aren’t available on the internet. In those places, ProMED has to rely on word-of-mouth — which may become the case in parts of the U.S. as local news outlets are shuttered, Madoff said.\u003c/p>\n\u003cp>He’s not sure if ProMED is starting to miss things because of the shrinking number of local news sources. “There’s a huge volume of information and we get what we get. So it’s hard to say what we’re missing, necessarily. But I can easily imagine that we might,” he said.\u003c/p>\n\u003cp>\u003cstrong>Social Media\u003c/strong>\u003c/p>\n\u003cp>Newspapers, of course, aren’t the only source of local news. But a town that can’t support a newspaper may not have radio and television stations either. Radio and TV stations may not archive their reports online, or those reports may not be archived in print form, meaning their archives are harder to search, Majumder said.\u003c/p>\n\u003cp>Social media cannot fill the gap created by the declining local news coverage, she and others involved in this type of research argued. “With Twitter … you are picking up a signal, but that signal might not be precise,” said Alessandro Vespignani, a professor at Northeastern University whose research focuses on modeling of epidemics. And social media reports can be simply wrong, he said — either by accident or design. News coverage “anchors” the signals picked up on social media, Vespignani said.[contextly_sidebar id=\"67Do4Phey2ezXlhxwIvDAmFbf798Cd3r\"]\u003c/p>\n\u003cp>“When you combine data from multiple data sources … including data collected from news alerts, we can gain a better handle on the situational awareness in a given community or country,” agreed Mauricio Santillana, an assistant professor at Harvard Medical School whose research focuses on use of novel data sources to track and forecast disease outbreaks.\u003c/p>\n\u003cp>Majumder said she and colleagues would like to look at whether the growth of “news deserts” — communities without local news sources — has already had an impact on the amount of data HealthMap has been harvesting from under-covered parts of the United States.\u003c/p>\n\u003cp>One of the reasons the news desert map scared her, she said, was because she realized many of the places without local papers are also places where voters have been complaining of being left behind.\u003c/p>\n\u003cp>“What that means is they lose access to news which is very, very vital for knowing what’s going on in your town,” Majumder said. “But also from the public health surveillance point of view, we’re losing access to knowing what they need.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This \u003ca href=\"https://www.statnews.com/2018/03/20/news-deserts-infectious-disease/\" target=\"_blank\" rel=\"noopener\">story\u003c/a> was originally published by \u003ca href=\"https://www.statnews.com/\" target=\"_blank\" rel=\"noopener\">STAT, \u003c/a>an online publication of Boston Globe Media that covers health, medicine, and scientific discovery.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Maia Majumder was on Twitter earlier this month when she saw a map that terrified her.\u003c/p>\n\u003cp>The map recorded the number of local newspapers in each county across the United States. Large swaths were shaded light pink, denoting a county that had no local newspaper at all. As a record of the decline of the American newspaper industry, it was disconcerting.\u003c/p>\n\u003cp>But Majumder, a scientist who specializes in mathematical modeling, saw something different in the splotches of light pink: a disaster for infectious disease surveillance.\u003c/p>\n\u003cp>Epidemiologists rely on all kinds of data to detect the spread of disease, including reports from local and state agencies and social media. But local newspapers are critical to identifying outbreaks and forecasting their trajectories.\u003c/p>\n\u003caside class=\"pullquote alignright\">'“Local media is the bedrock of internet surveillance.’ \u003ccite>John Brownstein, Healthmap\u003c/cite>\u003c/aside>\n\u003cp>On the map, Majumder saw every county without a local newspaper as a community where health officials and disease researchers could be flying blind.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“We rely very heavily on local news. And I think what this will probably mean is that there are going to be pockets of the U.S. where we’re just not going to have a particularly good signal anymore,” said Majumder, a Ph.D. candidate at the Massachusetts Institute of Technology.\u003c/p>\n\u003cp>Majumder is a computational epidemiology research fellow at HealthMap, a 12-year-old disease detection project run by researchers from Boston Children’s Hospital. The website uses nontraditional data sources — reports from local news outlets and social media platforms among them— to track global infectious disease activity in real time.\u003c/p>\n\u003cp>\u003cimg class=\"size-medium wp-image-295309 aligncenter\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2050/12/newspapers-800x533.gif\" alt=\"\" width=\"800\" height=\"533\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2050/12/newspapers-800x533.gif 800w, https://ww2.kqed.org/app/uploads/sites/13/2050/12/newspapers-160x107.gif 160w, https://ww2.kqed.org/app/uploads/sites/13/2050/12/newspapers-768x512.gif 768w, https://ww2.kqed.org/app/uploads/sites/13/2050/12/newspapers-1020x680.gif 1020w, https://ww2.kqed.org/app/uploads/sites/13/2050/12/newspapers-1920x1280.gif 1920w, https://ww2.kqed.org/app/uploads/sites/13/2050/12/newspapers-1180x787.gif 1180w, https://ww2.kqed.org/app/uploads/sites/13/2050/12/newspapers-960x640.gif 960w, https://ww2.kqed.org/app/uploads/sites/13/2050/12/newspapers-240x160.gif 240w, https://ww2.kqed.org/app/uploads/sites/13/2050/12/newspapers-375x250.gif 375w, https://ww2.kqed.org/app/uploads/sites/13/2050/12/newspapers-520x347.gif 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">The information HealthMap gathers is used not only by public health authorities, but by researchers around the world who are studying things like the changing geographic distribution of diseases — think Zika — and the impact of climate change on disease patterns, said John Brownstein, one of the co-founders of the site.\u003c/p>\n\u003cp>“Local media is the bedrock of internet surveillance — the kind of work that we do in terms of scouring the web looking for early signs of something taking place in a community,” explained Brownstein, chief innovation officer at Boston Children’s and a pioneer in the field of using sources other than public health data to do this type of work.\u003c/p>\n\u003cp>He pointed to the 2009 H1N1 influenza pandemic as an example of a case in which local reporting helped to bring an emerging disease threat to global attention.\u003c/p>\n\u003cp>\u003cstrong>Tracking an Outbreak\u003c/strong>\u003cbr>\nThe Centers for Disease Control and Prevention was the first agency to detect that two young children in California had been infected with a flu strain circulated in pigs. As officials were trying to figure out if the cases were blips or part of something bigger, however, disease detectives began crawling through recent media reports to determine whether unusual numbers of people with flu-like illness in Mexico had also been sickened by the new virus. It turned out they had been. The new virus was spreading.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>“It makes sense that if we see a reduction in local reporting, you’re not going to have that early signaling of something in a community,” Brownstein said.\u003c/p>\n\u003cp>Without local reporting, it’s also harder to follow an outbreak and assess its progress. Majumder used the example of the massive 2016-2017 mumps outbreak in northwestern Arkansas to illustrate the point.\u003c/p>\n\u003cp>She and colleagues were trying to figure out why the outbreak was so large — nearly 3,000 cases all told. Had the virus simply found its way into an area with lots of unvaccinated children? Or was something else driving transmission?\u003c/p>\n\u003cp>That’s the kind of information that is hugely helpful to public health authorities struggling to control an outbreak. But Majumder found she couldn’t easily get her hands on key data; the Arkansas Department of Public Health issued regular updates, but the agency did not archive previous updates on its website. Getting access to official data can be a time-consuming process.\u003c/p>\n\u003cp>“There is a lot of red tape to get data sharing privileges, even around something as simple as cumulative case counts over time,” she said.\u003c/p>\n\u003cp>The Northwest Arkansas Democrat-Gazette, however, was covering the outbreak closely, and its coverage provided important context for Majumder’s research. Some of the paper’s stories noted that the vaccine refusal rate in that region was higher than anywhere else in the state; others made clear disease was spreading in a local community of people from the Marshall Islands who had been vaccinated.\u003c/p>\n\u003cp>\u003cimg class=\"size-medium wp-image-440343 aligncenter\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/03/iStock-691796746-800x533.jpg\" alt=\"\" width=\"800\" height=\"533\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-691796746-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-691796746-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-691796746-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-691796746-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-691796746-1920x1280.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-691796746-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-691796746-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-691796746-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-691796746-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-691796746-520x347.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">Both those factors proved key in helping public health officials better understand what was driving the outbreak, Majumder said.\u003c/p>\n\u003cp>The World Health Organization urges countries to augment their official disease surveillance efforts — which draw information from networks of doctor’s offices, hospitals, and public health laboratories — with what’s known as “event-based surveillance,” said Dr. Larry Madoff, editor of ProMED, the Program for Monitoring Emerging Diseases. The internet-based outbreak reporting system — which reports on human, animal, and plant disease outbreaks — operates under the auspices of the International Society for Infectious Diseases.\u003c/p>\n\u003cp>Event-based surveillance is more informal and relies on systems that pick up on media reports, rumors on social media, and the like. That’s the way news of the 2003 SARS outbreak emerged. Internet chatter about a disease that was sickening and killing people in China made its way to the WHO before Chinese authorities eventually disclosed the existence of an outbreak that had been raging for several months.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>“It is well-known that event-based surveillance depends on healthy, local journalism,” said Madoff, who is also director of the Massachusetts Department of Health’s division of epidemiology and immunization. “So it would be a reasonable assumption that the loss of local sources would increase the time required to discover an outbreak.”\u003c/p>\n\u003cp>Like HealthMap, ProMED casts its net globally. In some countries, there are not many local media sources, or if there are, those news sources aren’t available on the internet. In those places, ProMED has to rely on word-of-mouth — which may become the case in parts of the U.S. as local news outlets are shuttered, Madoff said.\u003c/p>\n\u003cp>He’s not sure if ProMED is starting to miss things because of the shrinking number of local news sources. “There’s a huge volume of information and we get what we get. So it’s hard to say what we’re missing, necessarily. But I can easily imagine that we might,” he said.\u003c/p>\n\u003cp>\u003cstrong>Social Media\u003c/strong>\u003c/p>\n\u003cp>Newspapers, of course, aren’t the only source of local news. But a town that can’t support a newspaper may not have radio and television stations either. Radio and TV stations may not archive their reports online, or those reports may not be archived in print form, meaning their archives are harder to search, Majumder said.\u003c/p>\n\u003cp>Social media cannot fill the gap created by the declining local news coverage, she and others involved in this type of research argued. “With Twitter … you are picking up a signal, but that signal might not be precise,” said Alessandro Vespignani, a professor at Northeastern University whose research focuses on modeling of epidemics. And social media reports can be simply wrong, he said — either by accident or design. News coverage “anchors” the signals picked up on social media, Vespignani said.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>“When you combine data from multiple data sources … including data collected from news alerts, we can gain a better handle on the situational awareness in a given community or country,” agreed Mauricio Santillana, an assistant professor at Harvard Medical School whose research focuses on use of novel data sources to track and forecast disease outbreaks.\u003c/p>\n\u003cp>Majumder said she and colleagues would like to look at whether the growth of “news deserts” — communities without local news sources — has already had an impact on the amount of data HealthMap has been harvesting from under-covered parts of the United States.\u003c/p>\n\u003cp>One of the reasons the news desert map scared her, she said, was because she realized many of the places without local papers are also places where voters have been complaining of being left behind.\u003c/p>\n\u003cp>“What that means is they lose access to news which is very, very vital for knowing what’s going on in your town,” Majumder said. “But also from the public health surveillance point of view, we’re losing access to knowing what they need.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"disqusTitle": "Black And Latino Children Are Often Overlooked When It Comes To Autism",
"title": "Black And Latino Children Are Often Overlooked When It Comes To Autism",
"headTitle": "Future of You | KQED Future of You | KQED Science",
"content": "\u003cp>Sherry Alvarez says she knew there was \u003ca href=\"https://www.kqed.org/futureofyou/357617/sesame-street-to-introduce-muppet-with-autism\" target=\"_blank\" rel=\"noopener\">something different\u003c/a> about her son since he was about 9 months old. Back then Sherry says his pediatrician told her there was nothing to worry about, \" 'Boys are a little slower than girls, so let's just wait until his second birthday.' \" We aren't using Sherry's son's name to protect his privacy.\u003c/p>\n\u003cp>By her son's second birthday, Sherry says she was getting desperate. She didn't know why he wasn't talking yet or showing affection like other kids. At 2 1/2, he was referred to Children's Hospital Los Angeles.[contextly_sidebar id=\"HF94QtAhJ0QaonfGcwoc1BDmUjMCZqvd\"]\u003c/p>\n\u003cp>There, after four hours of tests, Sherry says the doctor handed her a 20-page report explaining his autism spectrum disorder diagnosis, among others. She says she was paralyzed by emotion.\u003c/p>\n\u003cp>ASD is a disease that affects people of all races and ethnicities, but \u003ca href=\"http://www.jaacap.com/article/S0890-8567(09)60739-5/abstract\" target=\"_blank\" rel=\"noopener\">research \u003c/a>shows that African-American and Latino children with autism are diagnosed at older ages than white children, giving them less of an opportunity for proper intervention and treatment.\u003c/p>\n\u003cp>This is especially true of minimally verbal kids like Sherry's son and there are many possible reasons for a late diagnosis. Some families face healthcare access issues and prohibitive costs for treatment, and some families just don't know how important it is to \u003ca href=\"https://www.kqed.org/futureofyou/436442/cdc-app-tells-parents-when-to-be-concerned-about-child-development\" target=\"_blank\" rel=\"noopener\">get diagnosed to move on\u003c/a> to the treatment phase. The dialog between doctors and minority families during the diagnosis process is critical.[contextly_sidebar id=\"i6RhCi4DH3w2V0Rp0zM5OR4cXRLu6ZFc\"]\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/29100475\" target=\"_blank\" rel=\"noopener\">A recent study\u003c/a> from Georgia State University found that African-American parents reported fewer concerns about behaviors like delayed speech and repetitive behaviors, even though their children showed a greater severity with these symptoms, overall. But, of course, it isn't all up to parents.\u003c/p>\n\u003cp>\"There are very likely parent aspects of this and very likely clinician aspects of this,\" says Meghan Rose Donohue, a lead researcher on the study. Perhaps families, like Sherry's, don't have the information necessary to really push physicians, but it is also possible that doctors don't take these cases seriously enough from the beginning.\u003c/p>\n\u003cp>\u003cstrong>Misdiagnosis\u003c/strong>\u003cbr>\nFamilies and doctors, alike, can mistake ASD for simple bad behavior, especially in boys, as research has shown over the past couple of decades. \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/11575603\" target=\"_blank\" rel=\"noopener\">A 2001 study\u003c/a> at McGill University in Montreal found that doctors were more hesitant to diagnose ASD in minority families.[contextly_sidebar id=\"z5QvKJ1QNa5Nn1EGXEj633LNkljonhOJ\"]\u003c/p>\n\u003cp>In 2007, \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/17160456\" target=\"_blank\" rel=\"noopener\">a study\u003c/a> by a team at the Center for Autism and Developmental Disabilities Research and Epidemiology, University of Pennsylvania, found that African-American children were 5.1 times more likely to be misdiagnosed with conduct disorders before being diagnosed with ASD.\u003c/p>\n\u003cp>When Sherry was growing up, she had a cousin who the family thought of as \"different,\" she says. \"He was basically hidden. We didn't talk about it as a community.\" He had autism. \"We have to retrain ourselves. It's not OK to hide our kids.\"\u003c/p>\n\u003cp>\u003ca href=\"http://www.dds.ca.gov/RC/\" target=\"_blank\" rel=\"noopener\">Regional Centers\u003c/a> in Los Angeles, which offer services to the developmentally disabled, are now starting to look at the \u003ca href=\"https://www.kqed.org/futureofyou/245794/researchers-hunt-for-the-microbiome-of-autism\" target=\"_blank\" rel=\"noopener\">diagnosis disparity problem\u003c/a>. Westside Regional Center in Culver City just received a grant from the state to look at how autism diagnosis disparities manifest within their intake and treatment programs.[contextly_sidebar id=\"nMqm3DUyCpzzodOPiyxyxYVgb9M171ki\"]\u003c/p>\n\u003cp>\"We've implemented a series of trainings with intake counselors on cultural awareness and sensitivity, and we're starting to have a lot of conversations about biases,\" says Tom Kelly, Westside's chief psychologist.\u003c/p>\n\u003cp>One of the apparent biases among intake counselors at the center stems from the difference in the documentation that arrives with each new child. African-American families tend to arrive at the center with lots of documentation detailing behavior issues from their child's school or social services. With all those official papers sitting in front of them, it's much easier for a counselor to think \"behavior disease\" rather than \"autism,\" says Kelly.\u003c/p>\n\u003cp>\u003cstrong>Economic Disparities\u003c/strong>\u003cbr>\nAnd that disparity exists in dollars spent, as well. As reported in \u003ca href=\"https://issuu.com/publiccounsel/docs/assuring_equitable_funding_of_servi?e=29495352/49041713\" target=\"_blank\" rel=\"noopener\">a 2017 survey\u003c/a>, South Central Regional Center spends $8,000 less per client than the Westside location and the racial disparity \u003ca href=\"http://www.calhealthreport.org/2016/12/12/marked-racial-disparities-in-money-spent-to-help-disabled/\" target=\"_blank\" rel=\"noopener\">persists statewide\u003c/a>.\u003c/p>\n\u003cp>But there are more resources for minority families today than compared to when Sherry's son was young. The Autism Society of Los Angeles runs a hotline to help parents navigate the diagnosis and healthcare landscape and Children's Hospital Los Angeles now employs liaisons to help families connect with the right resources. But, the spending gap persists.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Today, Sherry says her now 15-year-old son is happy. He attends Hamilton High School and communicates almost solely through a typing device. \"This is the time in his life where those early treatments could have made a difference,\" she laments.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Black+And+Latino+Children+Are+Often+Overlooked+When+It+Comes+To+Autism&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Sherry Alvarez says she knew there was \u003ca href=\"https://www.kqed.org/futureofyou/357617/sesame-street-to-introduce-muppet-with-autism\" target=\"_blank\" rel=\"noopener\">something different\u003c/a> about her son since he was about 9 months old. Back then Sherry says his pediatrician told her there was nothing to worry about, \" 'Boys are a little slower than girls, so let's just wait until his second birthday.' \" We aren't using Sherry's son's name to protect his privacy.\u003c/p>\n\u003cp>By her son's second birthday, Sherry says she was getting desperate. She didn't know why he wasn't talking yet or showing affection like other kids. At 2 1/2, he was referred to Children's Hospital Los Angeles.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>There, after four hours of tests, Sherry says the doctor handed her a 20-page report explaining his autism spectrum disorder diagnosis, among others. She says she was paralyzed by emotion.\u003c/p>\n\u003cp>ASD is a disease that affects people of all races and ethnicities, but \u003ca href=\"http://www.jaacap.com/article/S0890-8567(09)60739-5/abstract\" target=\"_blank\" rel=\"noopener\">research \u003c/a>shows that African-American and Latino children with autism are diagnosed at older ages than white children, giving them less of an opportunity for proper intervention and treatment.\u003c/p>\n\u003cp>This is especially true of minimally verbal kids like Sherry's son and there are many possible reasons for a late diagnosis. Some families face healthcare access issues and prohibitive costs for treatment, and some families just don't know how important it is to \u003ca href=\"https://www.kqed.org/futureofyou/436442/cdc-app-tells-parents-when-to-be-concerned-about-child-development\" target=\"_blank\" rel=\"noopener\">get diagnosed to move on\u003c/a> to the treatment phase. The dialog between doctors and minority families during the diagnosis process is critical.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/29100475\" target=\"_blank\" rel=\"noopener\">A recent study\u003c/a> from Georgia State University found that African-American parents reported fewer concerns about behaviors like delayed speech and repetitive behaviors, even though their children showed a greater severity with these symptoms, overall. But, of course, it isn't all up to parents.\u003c/p>\n\u003cp>\"There are very likely parent aspects of this and very likely clinician aspects of this,\" says Meghan Rose Donohue, a lead researcher on the study. Perhaps families, like Sherry's, don't have the information necessary to really push physicians, but it is also possible that doctors don't take these cases seriously enough from the beginning.\u003c/p>\n\u003cp>\u003cstrong>Misdiagnosis\u003c/strong>\u003cbr>\nFamilies and doctors, alike, can mistake ASD for simple bad behavior, especially in boys, as research has shown over the past couple of decades. \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/11575603\" target=\"_blank\" rel=\"noopener\">A 2001 study\u003c/a> at McGill University in Montreal found that doctors were more hesitant to diagnose ASD in minority families.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>In 2007, \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/17160456\" target=\"_blank\" rel=\"noopener\">a study\u003c/a> by a team at the Center for Autism and Developmental Disabilities Research and Epidemiology, University of Pennsylvania, found that African-American children were 5.1 times more likely to be misdiagnosed with conduct disorders before being diagnosed with ASD.\u003c/p>\n\u003cp>When Sherry was growing up, she had a cousin who the family thought of as \"different,\" she says. \"He was basically hidden. We didn't talk about it as a community.\" He had autism. \"We have to retrain ourselves. It's not OK to hide our kids.\"\u003c/p>\n\u003cp>\u003ca href=\"http://www.dds.ca.gov/RC/\" target=\"_blank\" rel=\"noopener\">Regional Centers\u003c/a> in Los Angeles, which offer services to the developmentally disabled, are now starting to look at the \u003ca href=\"https://www.kqed.org/futureofyou/245794/researchers-hunt-for-the-microbiome-of-autism\" target=\"_blank\" rel=\"noopener\">diagnosis disparity problem\u003c/a>. Westside Regional Center in Culver City just received a grant from the state to look at how autism diagnosis disparities manifest within their intake and treatment programs.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\"We've implemented a series of trainings with intake counselors on cultural awareness and sensitivity, and we're starting to have a lot of conversations about biases,\" says Tom Kelly, Westside's chief psychologist.\u003c/p>\n\u003cp>One of the apparent biases among intake counselors at the center stems from the difference in the documentation that arrives with each new child. African-American families tend to arrive at the center with lots of documentation detailing behavior issues from their child's school or social services. With all those official papers sitting in front of them, it's much easier for a counselor to think \"behavior disease\" rather than \"autism,\" says Kelly.\u003c/p>\n\u003cp>\u003cstrong>Economic Disparities\u003c/strong>\u003cbr>\nAnd that disparity exists in dollars spent, as well. As reported in \u003ca href=\"https://issuu.com/publiccounsel/docs/assuring_equitable_funding_of_servi?e=29495352/49041713\" target=\"_blank\" rel=\"noopener\">a 2017 survey\u003c/a>, South Central Regional Center spends $8,000 less per client than the Westside location and the racial disparity \u003ca href=\"http://www.calhealthreport.org/2016/12/12/marked-racial-disparities-in-money-spent-to-help-disabled/\" target=\"_blank\" rel=\"noopener\">persists statewide\u003c/a>.\u003c/p>\n\u003cp>But there are more resources for minority families today than compared to when Sherry's son was young. The Autism Society of Los Angeles runs a hotline to help parents navigate the diagnosis and healthcare landscape and Children's Hospital Los Angeles now employs liaisons to help families connect with the right resources. But, the spending gap persists.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Today, Sherry says her now 15-year-old son is happy. He attends Hamilton High School and communicates almost solely through a typing device. \"This is the time in his life where those early treatments could have made a difference,\" she laments.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Black+And+Latino+Children+Are+Often+Overlooked+When+It+Comes+To+Autism&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Are There Risks From Secondhand Marijuana Smoke? Early Science Says Yes",
"title": "Are There Risks From Secondhand Marijuana Smoke? Early Science Says Yes",
"headTitle": "Heart health | KQED Future of You | KQED Science",
"content": "\u003cp>The inspiration arrived in a haze at a Paul McCartney concert a few years ago in San Francisco.\u003c/p>\n\u003cp>\"People in front of me started lighting up and then other people started lighting up,\" says \u003ca href=\"http://profiles.ucsf.edu/matthew.springer#toc-id3\" target=\"_blank\" rel=\"noopener\">Matthew Springer\u003c/a>, a biologist and professor in the division of cardiology at the University of California, San Francisco. \"And for a few naive split seconds I was thinking to myself, 'Hey, they can't smoke in AT&T Park! I'm sure that's not allowed.' And then I realized that it was all marijuana.\"[contextly_sidebar id=\"scVZwwMNYQudoK8prX8E6gEPhMsaZ644\"]\u003c/p>\n\u003cp>Recreational pot was not legal yet in the state, but that stopped no one. \"Paul McCartney actually stopped between numbers and sniffed the air and said, 'There's something in the air — must be San Francisco!' \" Springer recalls.\u003c/p>\n\u003cp>As the visible cloud of pot smoke took shape, so did Springer's idea to study the effects of secondhand marijuana smoke.\u003c/p>\n\u003cp>He started thinking: San Franciscans would \u003cem>never \u003c/em>tolerate those levels of cigarette smoke in a public place anymore. So why were they OK with smoke from burning pot? Did people just assume that cannabis smoke isn't harmful the way tobacco smoke is?\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Springer was already researching the \u003ca href=\"https://www.cdc.gov/tobacco/data_statistics/fact_sheets/secondhand_smoke/health_effects/index.htm\" target=\"_blank\" rel=\"noopener\">health effects of secondhand tobacco smoke\u003c/a> on rats at \u003ca href=\"http://cardiolab.ucsf.edu/molcardiolab/lab.html\" target=\"_blank\" rel=\"noopener\">his lab\u003c/a> at UCSF. He decided to run the same tests using joints.[contextly_sidebar id=\"IPYfhnbHrZbMpqTxNYHTDnd84sz97o9x\"]\u003c/p>\n\u003cp>\"By the time I left the concert, I was resolved to at least try to make this happen,\" he says.\u003c/p>\n\u003cp>He knew it would be difficult. Marijuana is still an \u003ca href=\"https://www.dea.gov/druginfo/drug_data_sheets/Marijuana.pdf\" target=\"_blank\" rel=\"noopener\">illegal drug\u003c/a> under federal law, and Springer's research uses federal funds; so he has to purchase \u003ca href=\"https://www.ncbi.nlm.nih.gov/books/NBK425757/\" target=\"_blank\" rel=\"noopener\">specially approved\u003c/a> government cannabis for study. He also can't test it on humans; hence, the rats.\u003c/p>\n\u003cp>In the lab, Springer puts a cigarette or a joint in a plexiglass box. Then he lights it, and lets the chamber fill with smoke, where an anesthetized rat is exposed to the smoke.\u003c/p>\n\u003cp>So far, Springer and his colleagues have published \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/27464788\" target=\"_blank\" rel=\"noopener\">research\u003c/a> demonstrating that secondhand smoke makes it harder for the rats' arteries to expand and allow a healthy flow of blood.[contextly_sidebar id=\"by0xGD9nRAvOmUvjFCkfel0dvDsXCIrW\"]\u003c/p>\n\u003cp>With tobacco products, this effect lasts about 30 minutes, and then the arteries recover their normal function. But if it happens over and over — as when a person is smoking cigarette after cigarette, for example — the arterial walls can become permanently damaged, and that damage can cause blood clots, heart attack or stroke.\u003c/p>\n\u003cp>Springer demonstrated that, at least in rats, the same physiological effect occurs after inhaling secondhand smoke from marijuana. And, the arteries take 90 minutes to recover compared to the 30 minutes with cigarette smoke.\u003c/p>\n\u003cp>Springer's discovery about the effect on blood vessels describes just one harmful impact for nonsmokers who are exposed to marijuana. Statewide sampling surveys of cannabis products sold in marijuana dispensaries have shown that cannabis products may contain \u003ca href=\"http://www.sacbee.com/news/local/health-and-medicine/article131391629.html\" target=\"_blank\" rel=\"noopener\">dangerous bacteria or mold\u003c/a>, or residues from \u003ca href=\"http://www.montereyherald.com/article/NF/20170926/NEWS/170929857\" target=\"_blank\" rel=\"noopener\">pesticides and solvents\u003c/a>.\u003c/p>\n\u003cp>California law requires testing for these contaminants, and those regulations are being initiated in \u003ca href=\"http://bcc.ca.gov/about_us/documents/17-261_required_testing_chart.pdf\" target=\"_blank\" rel=\"noopener\">three phases\u003c/a> over the course of 2018. Because much of the marijuana being sold now was harvested in 2017, consumers will have to wait until early 2019 before they can purchase products that have been fully tested according to state standards.\u003c/p>\n\u003cp>\"People think cannabis is fine because it's 'natural,' \" Springer says. \"I hear this a lot. I don't know what it means.\" He concedes that tightly regulated marijuana, which has been fully tested, doesn't have as many chemical additives as cigarettes.\u003c/p>\n\u003cp>But even if the cannabis tests clean, Springer says, smoke itself is bad for the lungs, heart and blood vessels. Other researchers are exploring the possible relationship between marijuana smoke and long-term cancer risk.[contextly_sidebar id=\"dllcUYeImG1KAcPQ7nMg7I05Na6rlHp2\"]\u003c/p>\n\u003cp>Certainly, living with a smoker is worse for your health than just going to a smoky concert hall. But, Springer says, the less you inhale any kind of smoke, the better.\u003c/p>\n\u003cp>\"People should think of this not as an anti-THC conclusion,\" he says, referencing \u003ca href=\"https://www.drugabuse.gov/publications/research-reports/marijuana/how-does-marijuana-produce-its-effects\" target=\"_blank\" rel=\"noopener\">the active ingredient in marijuana\u003c/a>, \"but an anti-smoke conclusion.\"\u003c/p>\n\u003cp>So is the solution simply to avoid smoke from combustion? In other words, is it safer to eat cannabis-infused products, or use \"smokeless\" e-cigarettes or vaping devices?\u003c/p>\n\u003cp>Springer still urges caution on that score because vaping, for example, can have its own health effects. Vaping devices don't produce smoke from combustion, but they do release a cloud of aerosolized chemicals. Springer is studying the health effects of those chemicals, too.\u003c/p>\n\u003cp>All this research takes time. Meanwhile, Springer worries that people might come to the wrong conclusion — that the absence of research means the secondhand smoke is OK.\u003c/p>\n\u003cp>\"We in the public health community have been telling them for decades to avoid inhaling secondhand smoke from tobacco,\" Springer says. \"We have not been telling them to avoid inhaling secondhand smoke from marijuana, and that's not because it's not bad for you — it's because we just haven't known. The experiments haven't been done.\"\u003c/p>\n\u003cp>Antismoking campaigners say we can't afford to wait until the research is complete. Recreational pot is already \u003ca href=\"http://www.governing.com/gov-data/state-marijuana-laws-map-medical-recreational.html\" target=\"_blank\" rel=\"noopener\">a reality\u003c/a>.\u003c/p>\n\u003cp>\u003ca href=\"https://nonsmokersrights.org/cynthia-hallett\" target=\"_blank\" rel=\"noopener\">Cynthia Hallett\u003c/a> is the president of Americans for Nonsmokers' Rights, based in Berkeley, Calif. The organization was established in 1976, before there was a lot known about the health effects of secondhand smoke from tobacco.\u003c/p>\n\u003cp>Now that cannabis is becoming more common across the country — more than 20 cities or states have legalized it in some form — her organization is taking on the issue of secondhand marijuana smoke, too.\u003c/p>\n\u003cp>Hallett says some of the arguments being made in support of cannabis remind her of the arguments made on behalf of tobacco decades ago.\u003c/p>\n\u003cp>\"I'm seeing a parallel between this argument that, 'Gee, we just don't have a lot of science and so, therefore, let's wait and see,' \" Hallett says. \"The tobacco companies used to say the same thing about tobacco cigarettes.\"\u003c/p>\n\u003cp>In California, smoking cannabis is prohibited anywhere tobacco smoking is prohibited — including schools, airplanes and most workplaces. Hallett is worried that the legalization of pot could be used to erode those rules.\u003c/p>\n\u003cp>It starts with the premise of decriminalization, she says, and then, over time, there's \"a chipping away at strong policies.\"\u003c/p>\n\u003cp>Some cannabis advocates want to see pot regulated like alcohol — cities would issue permits for specialized smoking lounges, similar to wine bars.\u003c/p>\n\u003cp>But Hallett points out that smoke drifts, and it affects workers in a way that alcohol doesn't.\u003c/p>\n\u003cp>\"The difference is, if I were to spill my beer on you in a bar, it wouldn't affect your long-term health,\" she says. \"If I choose to smoke, it can affect the health of the person near me.\"\u003c/p>\n\u003cp>Pot is more like tobacco in that respect, and Hallett believes it should be regulated that way.\u003c/p>\n\u003cp>She says this era of California culture brings to mind a similar period in the 1970s and '80s, when Americans started demanding more regulations for secondhand smoke, and a new etiquette around smoking took form.\u003c/p>\n\u003cp>When it comes to marijuana, Hallett says, \"it is \u003cem>still\u003c/em> polite for you to say: 'Would you mind not smoking around me?' \"\u003c/p>\n\u003cp>At \u003ca href=\"http://www.magnoliawellness.org/menu\" target=\"_blank\" rel=\"noopener\">Magnolia\u003c/a>, a cannabis dispensary in Oakland, Calif., pot smokers talk about what responsibilities — if any — they should have when it comes to nearby nonsmokers.[contextly_sidebar id=\"CIXiXPyRL9W3vNu1EFy9gUkuRjmKUj8z\"]\u003c/p>\n\u003cp>\"This is the first time that I have heard secondhand smoke in reference to cannabis,\" admits Lee Crow, a patient-services clerk at Magnolia. \"I've tried to be courteous — just common courtesy, like with anything.\"\u003c/p>\n\u003cp>The dispensary's director of clinical services, \u003ca href=\"http://www.magnoliawellness.org/news/2016/5/19/meet-barbara-blaser-magnolias-director-of-clinical-wellness\" target=\"_blank\" rel=\"noopener\">Barbara Blaser\u003c/a>, admits she thinks a lot about secondhand smoke from cigarettes, but not pot.\u003c/p>\n\u003cp>\"Both of my parents died of lung cancer!\" she says. \"I will stop a stranger and say, 'You shouldn't be smoking. My dad died of that!' \"\u003c/p>\n\u003cp>California's \u003ca href=\"https://ballotpedia.org/California_Proposition_64,_Marijuana_Legalization_(2016)\" target=\"_blank\" rel=\"noopener\">Proposition 64\u003c/a>, approved by state voters in 2016, requires that some of the state tax revenue from the sale of marijuana to be distributed to cannabis researchers. In addition, the state's Occupational Safety and Health Standards Board is examining workplace hazards that are specific to the cannabis industry.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This story is part of NPR's reporting partnership, local member stations and \u003c/em>\u003ca href=\"http://www.kaiserhealthnews.org\" target=\"_blank\" rel=\"noopener\">\u003cem>Kaiser Health News\u003c/em>\u003c/a>\u003cem>.\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 KALW. To see more, visit \u003ca href=\"http://www.kalw.org/\" target=\"_blank\" rel=\"noopener\">KALW\u003c/a>.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Are+There+Risks+From+Secondhand+Marijuana+Smoke%3F+Early+Science+Says+Yes&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The inspiration arrived in a haze at a Paul McCartney concert a few years ago in San Francisco.\u003c/p>\n\u003cp>\"People in front of me started lighting up and then other people started lighting up,\" says \u003ca href=\"http://profiles.ucsf.edu/matthew.springer#toc-id3\" target=\"_blank\" rel=\"noopener\">Matthew Springer\u003c/a>, a biologist and professor in the division of cardiology at the University of California, San Francisco. \"And for a few naive split seconds I was thinking to myself, 'Hey, they can't smoke in AT&T Park! I'm sure that's not allowed.' And then I realized that it was all marijuana.\"\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Recreational pot was not legal yet in the state, but that stopped no one. \"Paul McCartney actually stopped between numbers and sniffed the air and said, 'There's something in the air — must be San Francisco!' \" Springer recalls.\u003c/p>\n\u003cp>As the visible cloud of pot smoke took shape, so did Springer's idea to study the effects of secondhand marijuana smoke.\u003c/p>\n\u003cp>He started thinking: San Franciscans would \u003cem>never \u003c/em>tolerate those levels of cigarette smoke in a public place anymore. So why were they OK with smoke from burning pot? Did people just assume that cannabis smoke isn't harmful the way tobacco smoke is?\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Springer was already researching the \u003ca href=\"https://www.cdc.gov/tobacco/data_statistics/fact_sheets/secondhand_smoke/health_effects/index.htm\" target=\"_blank\" rel=\"noopener\">health effects of secondhand tobacco smoke\u003c/a> on rats at \u003ca href=\"http://cardiolab.ucsf.edu/molcardiolab/lab.html\" target=\"_blank\" rel=\"noopener\">his lab\u003c/a> at UCSF. He decided to run the same tests using joints.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\"By the time I left the concert, I was resolved to at least try to make this happen,\" he says.\u003c/p>\n\u003cp>He knew it would be difficult. Marijuana is still an \u003ca href=\"https://www.dea.gov/druginfo/drug_data_sheets/Marijuana.pdf\" target=\"_blank\" rel=\"noopener\">illegal drug\u003c/a> under federal law, and Springer's research uses federal funds; so he has to purchase \u003ca href=\"https://www.ncbi.nlm.nih.gov/books/NBK425757/\" target=\"_blank\" rel=\"noopener\">specially approved\u003c/a> government cannabis for study. He also can't test it on humans; hence, the rats.\u003c/p>\n\u003cp>In the lab, Springer puts a cigarette or a joint in a plexiglass box. Then he lights it, and lets the chamber fill with smoke, where an anesthetized rat is exposed to the smoke.\u003c/p>\n\u003cp>So far, Springer and his colleagues have published \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/27464788\" target=\"_blank\" rel=\"noopener\">research\u003c/a> demonstrating that secondhand smoke makes it harder for the rats' arteries to expand and allow a healthy flow of blood.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>With tobacco products, this effect lasts about 30 minutes, and then the arteries recover their normal function. But if it happens over and over — as when a person is smoking cigarette after cigarette, for example — the arterial walls can become permanently damaged, and that damage can cause blood clots, heart attack or stroke.\u003c/p>\n\u003cp>Springer demonstrated that, at least in rats, the same physiological effect occurs after inhaling secondhand smoke from marijuana. And, the arteries take 90 minutes to recover compared to the 30 minutes with cigarette smoke.\u003c/p>\n\u003cp>Springer's discovery about the effect on blood vessels describes just one harmful impact for nonsmokers who are exposed to marijuana. Statewide sampling surveys of cannabis products sold in marijuana dispensaries have shown that cannabis products may contain \u003ca href=\"http://www.sacbee.com/news/local/health-and-medicine/article131391629.html\" target=\"_blank\" rel=\"noopener\">dangerous bacteria or mold\u003c/a>, or residues from \u003ca href=\"http://www.montereyherald.com/article/NF/20170926/NEWS/170929857\" target=\"_blank\" rel=\"noopener\">pesticides and solvents\u003c/a>.\u003c/p>\n\u003cp>California law requires testing for these contaminants, and those regulations are being initiated in \u003ca href=\"http://bcc.ca.gov/about_us/documents/17-261_required_testing_chart.pdf\" target=\"_blank\" rel=\"noopener\">three phases\u003c/a> over the course of 2018. Because much of the marijuana being sold now was harvested in 2017, consumers will have to wait until early 2019 before they can purchase products that have been fully tested according to state standards.\u003c/p>\n\u003cp>\"People think cannabis is fine because it's 'natural,' \" Springer says. \"I hear this a lot. I don't know what it means.\" He concedes that tightly regulated marijuana, which has been fully tested, doesn't have as many chemical additives as cigarettes.\u003c/p>\n\u003cp>But even if the cannabis tests clean, Springer says, smoke itself is bad for the lungs, heart and blood vessels. Other researchers are exploring the possible relationship between marijuana smoke and long-term cancer risk.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Certainly, living with a smoker is worse for your health than just going to a smoky concert hall. But, Springer says, the less you inhale any kind of smoke, the better.\u003c/p>\n\u003cp>\"People should think of this not as an anti-THC conclusion,\" he says, referencing \u003ca href=\"https://www.drugabuse.gov/publications/research-reports/marijuana/how-does-marijuana-produce-its-effects\" target=\"_blank\" rel=\"noopener\">the active ingredient in marijuana\u003c/a>, \"but an anti-smoke conclusion.\"\u003c/p>\n\u003cp>So is the solution simply to avoid smoke from combustion? In other words, is it safer to eat cannabis-infused products, or use \"smokeless\" e-cigarettes or vaping devices?\u003c/p>\n\u003cp>Springer still urges caution on that score because vaping, for example, can have its own health effects. Vaping devices don't produce smoke from combustion, but they do release a cloud of aerosolized chemicals. Springer is studying the health effects of those chemicals, too.\u003c/p>\n\u003cp>All this research takes time. Meanwhile, Springer worries that people might come to the wrong conclusion — that the absence of research means the secondhand smoke is OK.\u003c/p>\n\u003cp>\"We in the public health community have been telling them for decades to avoid inhaling secondhand smoke from tobacco,\" Springer says. \"We have not been telling them to avoid inhaling secondhand smoke from marijuana, and that's not because it's not bad for you — it's because we just haven't known. The experiments haven't been done.\"\u003c/p>\n\u003cp>Antismoking campaigners say we can't afford to wait until the research is complete. Recreational pot is already \u003ca href=\"http://www.governing.com/gov-data/state-marijuana-laws-map-medical-recreational.html\" target=\"_blank\" rel=\"noopener\">a reality\u003c/a>.\u003c/p>\n\u003cp>\u003ca href=\"https://nonsmokersrights.org/cynthia-hallett\" target=\"_blank\" rel=\"noopener\">Cynthia Hallett\u003c/a> is the president of Americans for Nonsmokers' Rights, based in Berkeley, Calif. The organization was established in 1976, before there was a lot known about the health effects of secondhand smoke from tobacco.\u003c/p>\n\u003cp>Now that cannabis is becoming more common across the country — more than 20 cities or states have legalized it in some form — her organization is taking on the issue of secondhand marijuana smoke, too.\u003c/p>\n\u003cp>Hallett says some of the arguments being made in support of cannabis remind her of the arguments made on behalf of tobacco decades ago.\u003c/p>\n\u003cp>\"I'm seeing a parallel between this argument that, 'Gee, we just don't have a lot of science and so, therefore, let's wait and see,' \" Hallett says. \"The tobacco companies used to say the same thing about tobacco cigarettes.\"\u003c/p>\n\u003cp>In California, smoking cannabis is prohibited anywhere tobacco smoking is prohibited — including schools, airplanes and most workplaces. Hallett is worried that the legalization of pot could be used to erode those rules.\u003c/p>\n\u003cp>It starts with the premise of decriminalization, she says, and then, over time, there's \"a chipping away at strong policies.\"\u003c/p>\n\u003cp>Some cannabis advocates want to see pot regulated like alcohol — cities would issue permits for specialized smoking lounges, similar to wine bars.\u003c/p>\n\u003cp>But Hallett points out that smoke drifts, and it affects workers in a way that alcohol doesn't.\u003c/p>\n\u003cp>\"The difference is, if I were to spill my beer on you in a bar, it wouldn't affect your long-term health,\" she says. \"If I choose to smoke, it can affect the health of the person near me.\"\u003c/p>\n\u003cp>Pot is more like tobacco in that respect, and Hallett believes it should be regulated that way.\u003c/p>\n\u003cp>She says this era of California culture brings to mind a similar period in the 1970s and '80s, when Americans started demanding more regulations for secondhand smoke, and a new etiquette around smoking took form.\u003c/p>\n\u003cp>When it comes to marijuana, Hallett says, \"it is \u003cem>still\u003c/em> polite for you to say: 'Would you mind not smoking around me?' \"\u003c/p>\n\u003cp>At \u003ca href=\"http://www.magnoliawellness.org/menu\" target=\"_blank\" rel=\"noopener\">Magnolia\u003c/a>, a cannabis dispensary in Oakland, Calif., pot smokers talk about what responsibilities — if any — they should have when it comes to nearby nonsmokers.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\"This is the first time that I have heard secondhand smoke in reference to cannabis,\" admits Lee Crow, a patient-services clerk at Magnolia. \"I've tried to be courteous — just common courtesy, like with anything.\"\u003c/p>\n\u003cp>The dispensary's director of clinical services, \u003ca href=\"http://www.magnoliawellness.org/news/2016/5/19/meet-barbara-blaser-magnolias-director-of-clinical-wellness\" target=\"_blank\" rel=\"noopener\">Barbara Blaser\u003c/a>, admits she thinks a lot about secondhand smoke from cigarettes, but not pot.\u003c/p>\n\u003cp>\"Both of my parents died of lung cancer!\" she says. \"I will stop a stranger and say, 'You shouldn't be smoking. My dad died of that!' \"\u003c/p>\n\u003cp>California's \u003ca href=\"https://ballotpedia.org/California_Proposition_64,_Marijuana_Legalization_(2016)\" target=\"_blank\" rel=\"noopener\">Proposition 64\u003c/a>, approved by state voters in 2016, requires that some of the state tax revenue from the sale of marijuana to be distributed to cannabis researchers. In addition, the state's Occupational Safety and Health Standards Board is examining workplace hazards that are specific to the cannabis industry.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>This story is part of NPR's reporting partnership, local member stations and \u003c/em>\u003ca href=\"http://www.kaiserhealthnews.org\" target=\"_blank\" rel=\"noopener\">\u003cem>Kaiser Health News\u003c/em>\u003c/a>\u003cem>.\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 KALW. To see more, visit \u003ca href=\"http://www.kalw.org/\" target=\"_blank\" rel=\"noopener\">KALW\u003c/a>.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Are+There+Risks+From+Secondhand+Marijuana+Smoke%3F+Early+Science+Says+Yes&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "New Diabetes Monitors Require Fewer Pricks, Less Guessing",
"title": "New Diabetes Monitors Require Fewer Pricks, Less Guessing",
"headTitle": "KQED Future of You | KQED Science",
"content": "\u003ch3>\u003cem>Continuous glucose monitors have been around for over a decade, but reductions in cost and improvements in quality have enticed more patients and doctors to try them out.\u003c/em>\u003c/h3>\n\u003cp>For Melissa Lee, the worst part of diabetes isn’t pricking her finger to check her glucose level or changing her diet to keep her blood sugar in check. Rather, it’s the constant worry and mental calculations.\u003c/p>\n\u003caside class=\"pullquote alignright\">'In a perfect world, everybody with diabetes would benefit from some form of this technology.'\u003ccite>Kathleen Dungan, Ohio State University\u003c/cite>\u003c/aside>\n\u003cp>“You have to think about what did I eat last, how much insulin did I take for that, where is my blood sugar now, which direction is it trending, and then based on that, what am I going to eat?” she says. “You’re making these educated guesses about how much of a really volatile hormone [insulin] to take, and that is mentally exhausting.”\u003c/p>\n\u003cp>Lee, 38, who was diagnosed with Type 1 diabetes when she was 10, recounts ruined dates, missed flights and abandoned excursions, all because she was worried about her glucose level or forgot to bring a replacement for her insulin pump.\u003c/p>\n\u003cp>“You can go from being okay to being really not okay in a moment’s notice,” says Lee, who lives in Milpitas, California and works as the director of community relations at Bigfoot Biomedical.\u003c/p>\n\u003cp>To relieve some of the burden for the estimated 9.3 million people who use insulin to regulate diabetes, medical device makers have introduced new ways to monitor glucose and administer insulin.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cstrong>Better Glucose Management\u003c/strong>\u003c/p>\n\u003cfigure id=\"attachment_440097\" class=\"wp-caption aligncenter\" style=\"max-width: 539px\">\u003cimg class=\"wp-image-440097 size-full\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/03/RS29282_LIBRE_020718_002-sfi.jpg\" alt=\"FreeStyle Libre\" width=\"539\" height=\"360\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2018/03/RS29282_LIBRE_020718_002-sfi.jpg 539w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/RS29282_LIBRE_020718_002-sfi-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/RS29282_LIBRE_020718_002-sfi-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/RS29282_LIBRE_020718_002-sfi-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/RS29282_LIBRE_020718_002-sfi-520x347.jpg 520w\" sizes=\"(max-width: 539px) 100vw, 539px\">\u003cfigcaption class=\"wp-caption-text\">Melissa Lee displays the components of the FreeStyle Libre, her blood glucose monitor. \u003ccite>(Lauren Hanussak/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Continuous glucose monitors, or CGMs, have been around for over a decade, but poor quality and high costs have been barriers to use, says Irl Hirsch, who holds the Diabetes Treatment and Teaching Chair at the University of Washington School of Medicine. But improvements on both fronts lead him to believe that CGMs will soon become the standard of care. At his own clinic, 60 percent of patients use one.\u003c/p>\n\u003cp>“The financial impact and the insurance coverage is not the barrier that it used to be,” Hirsch says. What’s more, “The quality and the accuracy of these things have just gotten better.”\u003c/p>\n\u003cp>CGMs measure glucose levels not in blood but in the interstitial fluid, which surrounds the cells just underneath the skin. A sensor sticks onto the body, typically on the upper arm or abdomen, with a small, flexible needle that penetrates the skin. The sensor takes a reading every 5 to 15 minutes and transmits that information to a separate receiver or a smartphone app, which patients can check at any time. The reading shows their current glucose level and a trend graph for the last eight hours. If the number is high and rising, the patient can bring their glucose down using insulin; if it’s low and dropping, they need to eat some sugar, fast.\u003c/p>\n\u003cp>“It's very exciting technology. I think it's really revolutionizing diabetes care,” says Kathleen Dungan, an associate professor of medicine at Ohio State University who runs the school’s endocrine clinical trials unit. “In a perfect world, everybody with diabetes would benefit from some form of this technology.”\u003c/p>\n\u003cp>\u003cstrong>Too Little Insulin\u003c/strong>\u003c/p>\n\u003cp>Every time you eat, your pancreas pumps out insulin to help your cells extract glucose from the blood and use it for fuel. In Type I diabetes, the pancreas stops producing insulin, while in Type II the cells can’t utilize the hormone properly. In either case, too little insulin causes excessive blood glucose levels. Chronic high blood sugar, or hyperglycemia, can lead to heart disease, kidney disease, stroke, nerve damage, blindness and loss of limbs.\u003c/p>\n\u003cfigure id=\"attachment_440099\" class=\"wp-caption aligncenter\" style=\"max-width: 539px\">\u003cimg class=\"size-full wp-image-440099\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/03/RS29281_LIBRE_020718_001-sfi.jpg\" alt=\"Melissa Lee, who was diagnosed with type one diabetes at 10 years old, models the FreeStyle Libre in Hayward, Calif.\" width=\"539\" height=\"360\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2018/03/RS29281_LIBRE_020718_001-sfi.jpg 539w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/RS29281_LIBRE_020718_001-sfi-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/RS29281_LIBRE_020718_001-sfi-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/RS29281_LIBRE_020718_001-sfi-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/RS29281_LIBRE_020718_001-sfi-520x347.jpg 520w\" sizes=\"(max-width: 539px) 100vw, 539px\">\u003cfigcaption class=\"wp-caption-text\">Melissa Lee, who was diagnosed with Type 1 diabetes at 10 years old, models the FreeStyle Libre, \u003ccite>(Lauren Hanussak/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>In contrast, too much insulin results in low blood sugar, or hypoglycemia, which can cause weakness, dizzy spells, seizures, shaking, fainting and even death.\u003c/p>\n\u003cp>Patients typically use blood glucose meters that measure sugar levels in a drop of blood to determine if they need to take more insulin or not. However, having to prick your finger and draw blood to check your glucose level can be a major hurdle for maintaining normal blood sugar. Some patients may have aversions to needles, while others may have difficulty creating a sterile environment in which to take a reading.\u003c/p>\n\u003cp>\u003cstrong>Popular CGMs\u003c/strong>\u003c/p>\n\u003cp>CGMs aim to ease that pain and inconvenience. Dexcom and Abbott are two of the largest producers of CGMs, with Abbott’s FreeStyle Libre the newest device approved by the FDA, in September 2017.\u003c/p>\n\u003cp>The Libre sensors last for 10 days and cost $59 each. Sensors for Dexcom’s G4 or G5 system are $350 for a pack of four and have to be replaced every seven days. Patients also have to purchase a receiver, about $60 for the Libre versus $465 for the Dexcom G5. Finally, Dexcom requires a separate transmitter to send the glucose information to the receiver, another $595. Both companies’ devices are covered by major insurance providers and Medicare, so the actual cost to patients varies.\u003c/p>\n\u003cfigure id=\"attachment_440100\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003cimg class=\"size-large wp-image-440100\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/03/IMG_0829-1020x680.jpg\" alt=\"Ken Reutell of Petaluma, Calif. displays his MiniMed 670G\" width=\"640\" height=\"427\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0829-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0829-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0829-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0829-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0829-1920x1280.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0829-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0829-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0829-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0829-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0829-520x347.jpg 520w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003cfigcaption class=\"wp-caption-text\">Ken Reutell of Petaluma, Calif. displays his MiniMed 670G. \u003ccite>(Danielle Venton/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The Libre is the only monitor that doesn’t have to be calibrated daily with a traditional blood glucose reading, meaning patients never have to prick their fingers.\u003c/p>\n\u003cp>Studies show that patients who use a CGM have \u003ca href=\"http://care.diabetesjournals.org/content/40/Supplement_1/S48\" target=\"_blank\" rel=\"noopener\">better control over their diabetes\u003c/a> than patients who use traditional blood glucose tests. Doctors recommend patients check their glucose between \u003ca href=\"https://www.mayoclinic.org/diseases-conditions/diabetes/in-depth/blood-sugar/art-20046628\" target=\"_blank\" rel=\"noopener\">4 and 10 times per day\u003c/a>, but in reality, only \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/14999899\" target=\"_blank\" rel=\"noopener\">one-third of patients\u003c/a> test themselves as often as they should. Abbott says patients using its device easily exceed this standard, checking on average 16 times a day.\u003c/p>\n\u003cp>Lee, who uses the FreeStyle Libre, says being able to easily check her blood glucose helps her know how it's affected by her diet. “You suddenly have this insight into how actions you took actually affected some kind of diabetes outcome,” she says.\u003c/p>\n\u003cp>Another Type 1 diabetes patient, Lisa Trahan, 33, yses the Dexcom G4 and says it’s “terrific.” Trahan, a clinical psychologist based in San Marcos, Texas, says the frequent readings provide her with more peace of mind, especially before exercising or eating. However, she still doesn’t trust the device enough to forego pricking her finger to double check the numbers.\u003c/p>\n\u003cfigure id=\"attachment_440101\" class=\"wp-caption alignright\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-440101\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/03/IMG_0816-800x533.jpg\" alt=\"A man's hand holds a small gaget.\" width=\"800\" height=\"533\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0816-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0816-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0816-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0816-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0816-1920x1280.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0816-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0816-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0816-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0816-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0816-520x347.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Ken Reutell's MiniMed 670G means he spends less time pricking himself to monitor his blood glucose levels. \u003ccite>(Danielle Venton/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“I can trust the CGM reading of my Dexcom G4 to be within 20 percent in either direction of my actual blood sugar reading,” she explains. But, she says, that range can make a big difference when tinkering with blood sugar or insulin. “I use the alert as a suggestion to check my blood sugar and go from there.”\u003c/p>\n\u003cp>\u003cstrong>Smarter Insulin Pumps\u003c/strong>\u003c/p>\n\u003cp>Besides checking blood sugar, the other part of managing diabetes is taking insulin, either with an injection or an insulin pump.\u003c/p>\n\u003cp>Traditional insulin pumps are preset to deliver different doses at certain times of the day. However, it can be difficult to match the correct dose to fluctuations in glucose levels that occur naturally throughout the day or because of diet or exercise. A patient or doctor can adjust the levels manually, but it requires complex calculations and typically isn’t done every day.\u003c/p>\n\u003cp>Medtronic’s MiniMed 670G, the first integrated CGM-insulin pump system approved by the FDA in 2016, aims to solve that problem. The 670G can vary the amount of insulin it delivers as often as every five minutes, in response to input from an integrated glucose monitor.\u003c/p>\n\u003cp>The only calculation patients have to make is to manually deliver a boost of insulin every time they eat that is proportionate to the number of carbohydrates in the meal. They also need to prick their fingers three times a day to calibrate the system.\u003c/p>\n\u003cp>Despite the excitement over the 670G, the price can be prohibitive, running between $6,000 and $9,000. Medtronic says some of the cost is covered by insurance.\u003c/p>\n\u003cp>\u003cstrong>A Debate Over Alarms\u003c/strong>\u003c/p>\n\u003cp>Because low glucose levels can be so dangerous, most monitors have built-in alarms that go off when a patient’s glucose has dropped too low. However, Abbott’s FreeStyle Libre does not. Hirsch, the diabetes expert from the University of Washington, says because of this he recommends Dexcom’s CGM, even though the Libre is less expensive and easier to use.\u003c/p>\n\u003cp>The MiniMed 670G also has an alarm, and to patient Ken Reutell, 67, from Petaluma, California, this is a great feature. In the past he’s had to call 911 and has even passed out because his blood sugar had dropped so low. He's used the 670G for six months and says the alarm alerts him well before he gets to that point. Other users, however, have \u003ca href=\"https://www.reddit.com/r/diabetes_t1/comments/7sjpsi/just_placed_on_order_for_the_medtronic_790/dt5oh0l/\" target=\"_blank\" rel=\"noopener\">complained\u003c/a> that the 670G’s alarm is loud and goes off too frequently.\u003c/p>\n\u003cp>And while the device can alert a patient to a dangerously low glucose level, it can’t do anything about it because it doesn’t administer glucose.\u003c/p>\n\u003cp>“(W)hen you get too low, your liver starts pumping out more glucose. That’s something that insulin pumps don’t do yet,” Reutell laments.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>Something for the next generation of devices, perhaps.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003ch3>\u003cem>Continuous glucose monitors have been around for over a decade, but reductions in cost and improvements in quality have enticed more patients and doctors to try them out.\u003c/em>\u003c/h3>\n\u003cp>For Melissa Lee, the worst part of diabetes isn’t pricking her finger to check her glucose level or changing her diet to keep her blood sugar in check. Rather, it’s the constant worry and mental calculations.\u003c/p>\n\u003caside class=\"pullquote alignright\">'In a perfect world, everybody with diabetes would benefit from some form of this technology.'\u003ccite>Kathleen Dungan, Ohio State University\u003c/cite>\u003c/aside>\n\u003cp>“You have to think about what did I eat last, how much insulin did I take for that, where is my blood sugar now, which direction is it trending, and then based on that, what am I going to eat?” she says. “You’re making these educated guesses about how much of a really volatile hormone [insulin] to take, and that is mentally exhausting.”\u003c/p>\n\u003cp>Lee, 38, who was diagnosed with Type 1 diabetes when she was 10, recounts ruined dates, missed flights and abandoned excursions, all because she was worried about her glucose level or forgot to bring a replacement for her insulin pump.\u003c/p>\n\u003cp>“You can go from being okay to being really not okay in a moment’s notice,” says Lee, who lives in Milpitas, California and works as the director of community relations at Bigfoot Biomedical.\u003c/p>\n\u003cp>To relieve some of the burden for the estimated 9.3 million people who use insulin to regulate diabetes, medical device makers have introduced new ways to monitor glucose and administer insulin.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cstrong>Better Glucose Management\u003c/strong>\u003c/p>\n\u003cfigure id=\"attachment_440097\" class=\"wp-caption aligncenter\" style=\"max-width: 539px\">\u003cimg class=\"wp-image-440097 size-full\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/03/RS29282_LIBRE_020718_002-sfi.jpg\" alt=\"FreeStyle Libre\" width=\"539\" height=\"360\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2018/03/RS29282_LIBRE_020718_002-sfi.jpg 539w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/RS29282_LIBRE_020718_002-sfi-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/RS29282_LIBRE_020718_002-sfi-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/RS29282_LIBRE_020718_002-sfi-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/RS29282_LIBRE_020718_002-sfi-520x347.jpg 520w\" sizes=\"(max-width: 539px) 100vw, 539px\">\u003cfigcaption class=\"wp-caption-text\">Melissa Lee displays the components of the FreeStyle Libre, her blood glucose monitor. \u003ccite>(Lauren Hanussak/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Continuous glucose monitors, or CGMs, have been around for over a decade, but poor quality and high costs have been barriers to use, says Irl Hirsch, who holds the Diabetes Treatment and Teaching Chair at the University of Washington School of Medicine. But improvements on both fronts lead him to believe that CGMs will soon become the standard of care. At his own clinic, 60 percent of patients use one.\u003c/p>\n\u003cp>“The financial impact and the insurance coverage is not the barrier that it used to be,” Hirsch says. What’s more, “The quality and the accuracy of these things have just gotten better.”\u003c/p>\n\u003cp>CGMs measure glucose levels not in blood but in the interstitial fluid, which surrounds the cells just underneath the skin. A sensor sticks onto the body, typically on the upper arm or abdomen, with a small, flexible needle that penetrates the skin. The sensor takes a reading every 5 to 15 minutes and transmits that information to a separate receiver or a smartphone app, which patients can check at any time. The reading shows their current glucose level and a trend graph for the last eight hours. If the number is high and rising, the patient can bring their glucose down using insulin; if it’s low and dropping, they need to eat some sugar, fast.\u003c/p>\n\u003cp>“It's very exciting technology. I think it's really revolutionizing diabetes care,” says Kathleen Dungan, an associate professor of medicine at Ohio State University who runs the school’s endocrine clinical trials unit. “In a perfect world, everybody with diabetes would benefit from some form of this technology.”\u003c/p>\n\u003cp>\u003cstrong>Too Little Insulin\u003c/strong>\u003c/p>\n\u003cp>Every time you eat, your pancreas pumps out insulin to help your cells extract glucose from the blood and use it for fuel. In Type I diabetes, the pancreas stops producing insulin, while in Type II the cells can’t utilize the hormone properly. In either case, too little insulin causes excessive blood glucose levels. Chronic high blood sugar, or hyperglycemia, can lead to heart disease, kidney disease, stroke, nerve damage, blindness and loss of limbs.\u003c/p>\n\u003cfigure id=\"attachment_440099\" class=\"wp-caption aligncenter\" style=\"max-width: 539px\">\u003cimg class=\"size-full wp-image-440099\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/03/RS29281_LIBRE_020718_001-sfi.jpg\" alt=\"Melissa Lee, who was diagnosed with type one diabetes at 10 years old, models the FreeStyle Libre in Hayward, Calif.\" width=\"539\" height=\"360\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2018/03/RS29281_LIBRE_020718_001-sfi.jpg 539w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/RS29281_LIBRE_020718_001-sfi-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/RS29281_LIBRE_020718_001-sfi-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/RS29281_LIBRE_020718_001-sfi-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/RS29281_LIBRE_020718_001-sfi-520x347.jpg 520w\" sizes=\"(max-width: 539px) 100vw, 539px\">\u003cfigcaption class=\"wp-caption-text\">Melissa Lee, who was diagnosed with Type 1 diabetes at 10 years old, models the FreeStyle Libre, \u003ccite>(Lauren Hanussak/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>In contrast, too much insulin results in low blood sugar, or hypoglycemia, which can cause weakness, dizzy spells, seizures, shaking, fainting and even death.\u003c/p>\n\u003cp>Patients typically use blood glucose meters that measure sugar levels in a drop of blood to determine if they need to take more insulin or not. However, having to prick your finger and draw blood to check your glucose level can be a major hurdle for maintaining normal blood sugar. Some patients may have aversions to needles, while others may have difficulty creating a sterile environment in which to take a reading.\u003c/p>\n\u003cp>\u003cstrong>Popular CGMs\u003c/strong>\u003c/p>\n\u003cp>CGMs aim to ease that pain and inconvenience. Dexcom and Abbott are two of the largest producers of CGMs, with Abbott’s FreeStyle Libre the newest device approved by the FDA, in September 2017.\u003c/p>\n\u003cp>The Libre sensors last for 10 days and cost $59 each. Sensors for Dexcom’s G4 or G5 system are $350 for a pack of four and have to be replaced every seven days. Patients also have to purchase a receiver, about $60 for the Libre versus $465 for the Dexcom G5. Finally, Dexcom requires a separate transmitter to send the glucose information to the receiver, another $595. Both companies’ devices are covered by major insurance providers and Medicare, so the actual cost to patients varies.\u003c/p>\n\u003cfigure id=\"attachment_440100\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003cimg class=\"size-large wp-image-440100\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/03/IMG_0829-1020x680.jpg\" alt=\"Ken Reutell of Petaluma, Calif. displays his MiniMed 670G\" width=\"640\" height=\"427\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0829-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0829-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0829-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0829-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0829-1920x1280.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0829-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0829-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0829-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0829-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0829-520x347.jpg 520w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003cfigcaption class=\"wp-caption-text\">Ken Reutell of Petaluma, Calif. displays his MiniMed 670G. \u003ccite>(Danielle Venton/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The Libre is the only monitor that doesn’t have to be calibrated daily with a traditional blood glucose reading, meaning patients never have to prick their fingers.\u003c/p>\n\u003cp>Studies show that patients who use a CGM have \u003ca href=\"http://care.diabetesjournals.org/content/40/Supplement_1/S48\" target=\"_blank\" rel=\"noopener\">better control over their diabetes\u003c/a> than patients who use traditional blood glucose tests. Doctors recommend patients check their glucose between \u003ca href=\"https://www.mayoclinic.org/diseases-conditions/diabetes/in-depth/blood-sugar/art-20046628\" target=\"_blank\" rel=\"noopener\">4 and 10 times per day\u003c/a>, but in reality, only \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/14999899\" target=\"_blank\" rel=\"noopener\">one-third of patients\u003c/a> test themselves as often as they should. Abbott says patients using its device easily exceed this standard, checking on average 16 times a day.\u003c/p>\n\u003cp>Lee, who uses the FreeStyle Libre, says being able to easily check her blood glucose helps her know how it's affected by her diet. “You suddenly have this insight into how actions you took actually affected some kind of diabetes outcome,” she says.\u003c/p>\n\u003cp>Another Type 1 diabetes patient, Lisa Trahan, 33, yses the Dexcom G4 and says it’s “terrific.” Trahan, a clinical psychologist based in San Marcos, Texas, says the frequent readings provide her with more peace of mind, especially before exercising or eating. However, she still doesn’t trust the device enough to forego pricking her finger to double check the numbers.\u003c/p>\n\u003cfigure id=\"attachment_440101\" class=\"wp-caption alignright\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-440101\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/03/IMG_0816-800x533.jpg\" alt=\"A man's hand holds a small gaget.\" width=\"800\" height=\"533\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0816-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0816-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0816-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0816-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0816-1920x1280.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0816-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0816-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0816-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0816-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0816-520x347.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Ken Reutell's MiniMed 670G means he spends less time pricking himself to monitor his blood glucose levels. \u003ccite>(Danielle Venton/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“I can trust the CGM reading of my Dexcom G4 to be within 20 percent in either direction of my actual blood sugar reading,” she explains. But, she says, that range can make a big difference when tinkering with blood sugar or insulin. “I use the alert as a suggestion to check my blood sugar and go from there.”\u003c/p>\n\u003cp>\u003cstrong>Smarter Insulin Pumps\u003c/strong>\u003c/p>\n\u003cp>Besides checking blood sugar, the other part of managing diabetes is taking insulin, either with an injection or an insulin pump.\u003c/p>\n\u003cp>Traditional insulin pumps are preset to deliver different doses at certain times of the day. However, it can be difficult to match the correct dose to fluctuations in glucose levels that occur naturally throughout the day or because of diet or exercise. A patient or doctor can adjust the levels manually, but it requires complex calculations and typically isn’t done every day.\u003c/p>\n\u003cp>Medtronic’s MiniMed 670G, the first integrated CGM-insulin pump system approved by the FDA in 2016, aims to solve that problem. The 670G can vary the amount of insulin it delivers as often as every five minutes, in response to input from an integrated glucose monitor.\u003c/p>\n\u003cp>The only calculation patients have to make is to manually deliver a boost of insulin every time they eat that is proportionate to the number of carbohydrates in the meal. They also need to prick their fingers three times a day to calibrate the system.\u003c/p>\n\u003cp>Despite the excitement over the 670G, the price can be prohibitive, running between $6,000 and $9,000. Medtronic says some of the cost is covered by insurance.\u003c/p>\n\u003cp>\u003cstrong>A Debate Over Alarms\u003c/strong>\u003c/p>\n\u003cp>Because low glucose levels can be so dangerous, most monitors have built-in alarms that go off when a patient’s glucose has dropped too low. However, Abbott’s FreeStyle Libre does not. Hirsch, the diabetes expert from the University of Washington, says because of this he recommends Dexcom’s CGM, even though the Libre is less expensive and easier to use.\u003c/p>\n\u003cp>The MiniMed 670G also has an alarm, and to patient Ken Reutell, 67, from Petaluma, California, this is a great feature. In the past he’s had to call 911 and has even passed out because his blood sugar had dropped so low. He's used the 670G for six months and says the alarm alerts him well before he gets to that point. Other users, however, have \u003ca href=\"https://www.reddit.com/r/diabetes_t1/comments/7sjpsi/just_placed_on_order_for_the_medtronic_790/dt5oh0l/\" target=\"_blank\" rel=\"noopener\">complained\u003c/a> that the 670G’s alarm is loud and goes off too frequently.\u003c/p>\n\u003cp>And while the device can alert a patient to a dangerously low glucose level, it can’t do anything about it because it doesn’t administer glucose.\u003c/p>\n\u003cp>“(W)hen you get too low, your liver starts pumping out more glucose. That’s something that insulin pumps don’t do yet,” Reutell laments.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Something for the next generation of devices, perhaps.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Landmark Report Concludes Abortion in U.S. is Safe",
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"content": "\u003cp>Abortions in the United States are safe and have few complications, according to a landmark new study by the National Academies of Sciences, Engineering and Medicine.\u003c/p>\n\u003cp>The \u003ca href=\"https://www.nap.edu/catalog/24950/the-safety-and-quality-of-abortion-care-in-the-united-states\">report\u003c/a>, called \"The Safety and Quality of Abortion Care in the United States,\" examined the four major methods used for abortions — medication, aspiration, dilation and evacuation, and induction — and examined women's care from before they had the procedure through their follow-up care.[contextly_sidebar id=\"jMTkDIjBqWWCgCakps1aEu2Qa7NrZakX\"]\u003c/p>\n\u003cp>\"I would say the main takeaway is that abortions that are provided in the United States are safe and effective,\" says \u003ca href=\"http://www.coloradotrust.org/content/ned-calonge-md-mph\" target=\"_blank\" rel=\"noopener\">Ned Calonge\u003c/a>, the co-chair of the committee that wrote the study. He is an associate professor of family medicine and epidemiology at the University of Colorado and CEO of \u003ca href=\"http://www.coloradotrust.org/\" target=\"_blank\" rel=\"noopener\">The Colorado Trust\u003c/a>.\u003c/p>\n\u003cp>Calonge says the researchers found that about 90 percent of all abortions happen in the first 12 weeks of pregnancy. And complications for all abortions are \"rare,\" the report says.\u003c/p>\n\u003cp>But the report did find that state laws and regulations can interfere with safe abortions.[contextly_sidebar id=\"zTJU1sTa18fez3ecDq44jqN6KfYhyHGL\"]\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"Abortion-specific regulations in many states create barriers to safe and effective care,\" the report says.\u003c/p>\n\u003cp>Calonge says those rules often have no basis in medical research.\u003c/p>\n\u003cp>\"There are some requirements that require clinicians to misinform women of the health risks, that say you have to inform a woman that an abortion will increase her risk of breast cancer,\" he says.\u003c/p>\n\u003cp>There is no evidence that breast cancer follows abortion, for example, but \u003ca href=\"https://www.guttmacher.org/gpr/2006/10/misinformed-consent-medical-accuracy-state-developed-abortion-counseling-materials\">five states\u003c/a> require doctors to tell women there is a link, according to the Guttmacher Institute, a research group that focuses on reproductive and sexual health.\u003c/p>\n\u003cp>\"There are policies that mandate clinically unnecessary services like pre-abortion ultrasounds, separate inpatient counseling. There are required waiting periods,\" Calonge says.\u003c/p>\n\u003cp>According to Guttmacher, 27 states make women wait at least 24 hours for an abortion and 11 states require women to have an ultrasound before they can terminate their pregnancy.\u003c/p>\n\u003cp>And there are state laws that dictate who can perform abortions and where they can do them. Some require all abortions to happen in the equivalent of a hospital or surgery center. Others require a doctor to have admitting privileges at a nearby hospital.\u003c/p>\n\u003cp>The National Academies report says waiting periods and requirements for unnecessary tests can result in long delays because women may have to travel to get care and have trouble getting appointments.\u003c/p>\n\u003cp>\"Delays put the patient at greater risk of an adverse event,\" the report says.\u003c/p>\n\u003cp>Hal Lawrence, the CEO of the American College of Obstetricians and Gynecologists, says the report settles the debate over abortion-restricting laws and regulations.\u003c/p>\n\u003cp>\"Those sorts of laws have been totally debunked,\" he says.\u003c/p>\n\u003cp>He says the study shows most of those laws do nothing to improve women's health.\u003c/p>\n\u003cp>\"Abortion is safer when it's performed earlier in gestation,\" Lawrence says. \"And so delaying and making people wait and go through hoops of unnecessary, extra procedures does not improve the safety. And actually by having them delay can actually worsen the safety.\"\u003c/p>\n\u003cp>The U.S. Supreme Court in 2016 voided some state abortion laws when it ruled that Texas' strict rules around abortion facilities impose an undue burden on women. But other laws remain in place even without any backing in medical research.\u003c/p>\n\u003cp>Still, Donna Harrison says there are good reasons for the requirements.\u003c/p>\n\u003cp>\"The tendency to look at abortion as though it were not a serious medical procedure is irresponsible. I mean, we all know that the fetus is killed during an abortion but women can be harmed by irresponsible medical care,\" says Harrison, the executive director of the \u003ca href=\"http://aaplog.org/\" target=\"_blank\" rel=\"noopener\">American Association of Pro-Life Obstetricians and Gynecologists\u003c/a>.\u003c/p>\n\u003cp>She says data on complications from abortion is incomplete because doctors and patients don't always report it accurately, or at all.\u003c/p>\n\u003cp>\u003cem>\"\u003c/em>There is no good data collection — and when you have garbage in, and you have garbage out,\" she says.\u003c/p>\n\u003cp>And she says waiting periods are important so that women can give fully informed consent before they undergo what she says is a sometimes dangerous, surgical procedure.\u003c/p>\n\u003cp>The new report — which runs more than 200 pages — addresses most aspects of abortion care, including the use of the abortion pill \u003ca href=\"https://www.accessdata.fda.gov/drugsatfda_docs/label/2000/20687lbl.htm\" target=\"_blank\" rel=\"noopener\">mifepristone\u003c/a>.\u003c/p>\n\u003cp>For example, it concludes that the strict requirements on how doctors can administer mifepristone may need review. The researchers say the rules may be erecting unnecessary barriers.\u003c/p>\n\u003cp>The report also says nurse practitioners and physician assistants can perform abortions just as safely as physicians.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Also, abortions have no long-term consequences on women's physical and mental health, the report says.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit \u003ca href=\"http://www.npr.org/\" target=\"_blank\" rel=\"noopener\">http://www.npr.org/\u003c/a>.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Landmark+Report+Concludes+Abortion+In+U.S.+Is+Safe+&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Abortions in the United States are safe and have few complications, according to a landmark new study by the National Academies of Sciences, Engineering and Medicine.\u003c/p>\n\u003cp>The \u003ca href=\"https://www.nap.edu/catalog/24950/the-safety-and-quality-of-abortion-care-in-the-united-states\">report\u003c/a>, called \"The Safety and Quality of Abortion Care in the United States,\" examined the four major methods used for abortions — medication, aspiration, dilation and evacuation, and induction — and examined women's care from before they had the procedure through their follow-up care.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\"I would say the main takeaway is that abortions that are provided in the United States are safe and effective,\" says \u003ca href=\"http://www.coloradotrust.org/content/ned-calonge-md-mph\" target=\"_blank\" rel=\"noopener\">Ned Calonge\u003c/a>, the co-chair of the committee that wrote the study. He is an associate professor of family medicine and epidemiology at the University of Colorado and CEO of \u003ca href=\"http://www.coloradotrust.org/\" target=\"_blank\" rel=\"noopener\">The Colorado Trust\u003c/a>.\u003c/p>\n\u003cp>Calonge says the researchers found that about 90 percent of all abortions happen in the first 12 weeks of pregnancy. And complications for all abortions are \"rare,\" the report says.\u003c/p>\n\u003cp>But the report did find that state laws and regulations can interfere with safe abortions.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"Abortion-specific regulations in many states create barriers to safe and effective care,\" the report says.\u003c/p>\n\u003cp>Calonge says those rules often have no basis in medical research.\u003c/p>\n\u003cp>\"There are some requirements that require clinicians to misinform women of the health risks, that say you have to inform a woman that an abortion will increase her risk of breast cancer,\" he says.\u003c/p>\n\u003cp>There is no evidence that breast cancer follows abortion, for example, but \u003ca href=\"https://www.guttmacher.org/gpr/2006/10/misinformed-consent-medical-accuracy-state-developed-abortion-counseling-materials\">five states\u003c/a> require doctors to tell women there is a link, according to the Guttmacher Institute, a research group that focuses on reproductive and sexual health.\u003c/p>\n\u003cp>\"There are policies that mandate clinically unnecessary services like pre-abortion ultrasounds, separate inpatient counseling. There are required waiting periods,\" Calonge says.\u003c/p>\n\u003cp>According to Guttmacher, 27 states make women wait at least 24 hours for an abortion and 11 states require women to have an ultrasound before they can terminate their pregnancy.\u003c/p>\n\u003cp>And there are state laws that dictate who can perform abortions and where they can do them. Some require all abortions to happen in the equivalent of a hospital or surgery center. Others require a doctor to have admitting privileges at a nearby hospital.\u003c/p>\n\u003cp>The National Academies report says waiting periods and requirements for unnecessary tests can result in long delays because women may have to travel to get care and have trouble getting appointments.\u003c/p>\n\u003cp>\"Delays put the patient at greater risk of an adverse event,\" the report says.\u003c/p>\n\u003cp>Hal Lawrence, the CEO of the American College of Obstetricians and Gynecologists, says the report settles the debate over abortion-restricting laws and regulations.\u003c/p>\n\u003cp>\"Those sorts of laws have been totally debunked,\" he says.\u003c/p>\n\u003cp>He says the study shows most of those laws do nothing to improve women's health.\u003c/p>\n\u003cp>\"Abortion is safer when it's performed earlier in gestation,\" Lawrence says. \"And so delaying and making people wait and go through hoops of unnecessary, extra procedures does not improve the safety. And actually by having them delay can actually worsen the safety.\"\u003c/p>\n\u003cp>The U.S. Supreme Court in 2016 voided some state abortion laws when it ruled that Texas' strict rules around abortion facilities impose an undue burden on women. But other laws remain in place even without any backing in medical research.\u003c/p>\n\u003cp>Still, Donna Harrison says there are good reasons for the requirements.\u003c/p>\n\u003cp>\"The tendency to look at abortion as though it were not a serious medical procedure is irresponsible. I mean, we all know that the fetus is killed during an abortion but women can be harmed by irresponsible medical care,\" says Harrison, the executive director of the \u003ca href=\"http://aaplog.org/\" target=\"_blank\" rel=\"noopener\">American Association of Pro-Life Obstetricians and Gynecologists\u003c/a>.\u003c/p>\n\u003cp>She says data on complications from abortion is incomplete because doctors and patients don't always report it accurately, or at all.\u003c/p>\n\u003cp>\u003cem>\"\u003c/em>There is no good data collection — and when you have garbage in, and you have garbage out,\" she says.\u003c/p>\n\u003cp>And she says waiting periods are important so that women can give fully informed consent before they undergo what she says is a sometimes dangerous, surgical procedure.\u003c/p>\n\u003cp>The new report — which runs more than 200 pages — addresses most aspects of abortion care, including the use of the abortion pill \u003ca href=\"https://www.accessdata.fda.gov/drugsatfda_docs/label/2000/20687lbl.htm\" target=\"_blank\" rel=\"noopener\">mifepristone\u003c/a>.\u003c/p>\n\u003cp>For example, it concludes that the strict requirements on how doctors can administer mifepristone may need review. The researchers say the rules may be erecting unnecessary barriers.\u003c/p>\n\u003cp>The report also says nurse practitioners and physician assistants can perform abortions just as safely as physicians.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Also, abortions have no long-term consequences on women's physical and mental health, the report says.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit \u003ca href=\"http://www.npr.org/\" target=\"_blank\" rel=\"noopener\">http://www.npr.org/\u003c/a>.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Landmark+Report+Concludes+Abortion+In+U.S.+Is+Safe+&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Prospective Parents in Limbo After 2 Accidents Destroy Fertility Clinic Embryos",
"title": "Prospective Parents in Limbo After 2 Accidents Destroy Fertility Clinic Embryos",
"headTitle": "Future of You | KQED Future of You | KQED Science",
"content": "\u003cp>Two refrigeration failures at fertility clinics in different states, coincidentally occurring on March 4, are raising questions about oversight of the industry and triggered several lawsuits.\u003c/p>\n\u003caside class=\"pullquote alignright\">'We know something has happened but we don't know if our four embryos are alive still.'\u003c/aside>\n\u003cp>In San Francisco, the Pacific Fertility Center says it is still assessing the extent of the damage to the embryos and eggs it stores, said San Francisco Chronicle reporter Catherine Ho on KQED's \u003ca href=\"https://www.kqed.org/forum/2010101864351/woman-sues-fertility-center-after-equipment-failure-destroys-her-eggs\" target=\"_blank\" rel=\"noopener\">Forum program\u003c/a> Friday.\u003c/p>\n\u003cp>One of those clients includes Bill Taroli, who told Forum host Mina Kim he first learned about the malfunction on the evening news. After contacting the center, he and his partner were informed their frozen embryos were in the impacted tank. But it will take at least another week before they learn whether their vials were damaged.\u003c/p>\n\u003cp>\"It's like waiting for any major test. 'Do we have cancer?' We're in this limbo,\" said Taroli, who said he spent $50,000 for the procedure. \"We know something has happened but we don't know if our four embryos are alive still.\"\u003c/p>\n\u003cp>The problem was discovered during a routine check by a senior embryologist who noticed that the liquid nitrogen levels in one tank had dipped to very low levels, affecting thousands of frozen eggs and embryos belonging to about 500 clients.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The tanks rely on liquid nitrogen to keep the frozen vials at the correct storage temperature.\u003c/p>\n\u003cp>The clinic has not yet announced the number of people impacted, said Ho. In a statement, Pacific Fertility Center said, \"The vast majority of the eggs and embryos in the lab were unaffected.\"\u003c/p>\n\u003cp>One of the company's clients includes an unnamed woman who learned on Sunday that her frozen eggs were destroyed. She has since filed a class action lawsuit against the company, seeking $5 million in damages for gross negligence stemming from a failure to properly maintain equipment. That figure is the minimum required to file a class-action suit in federal court.\u003c/p>\n\u003cp>Steven Tindall, the attorney for the woman, told Forum the facility lacked a real-time monitoring system that could have immediately alerted staff of a drop in nitrogen levels.\u003c/p>\n\u003cp>In a statement issued Wednesday, the company said it took immediate action once the malfunction was discovered:\u003c/p>\n\u003cblockquote>\u003cp>On March 4, a single piece of equipment in our cryogenic storage lab lost liquid nitrogen for a brief period of time. We do know that there is viable tissue from this tank. The rest of the tanks were not affected and the equipment was immediately retired. The vast majority of the eggs and embryos in the lab were unaffected and the facility is operating securely. As soon as the issue was discovered, our most senior embryologist took immediate action to transfer those tissues from the affected equipment to a new piece of equipment. And we have brought independent experts and are conducting a full investigation. We are truly sorry this happened and for the anxiety that this will surely cause.\u003c/p>\u003c/blockquote>\n\u003cp>The cost of storing frozen eggs or embryos is $600 a year, according to the center's website. But the entire process can cost anywhere between $10,000 to $100,000, said the Chronicle's Ho. Aside from the financial costs, the process can be emotionally draining for prospective parents.\u003c/p>\n\u003cp>Some of the clinic's clients include former cancer patients who had their eggs taken out in advance of cancer treatments, Tindall said.\u003c/p>\n\u003cp>\"Those people may have lost their opportunity to have biological children.\"\u003c/p>\n\u003cp>\u003cstrong>Ohio Incident\u003c/strong>\u003c/p>\n\u003cp>In a bizarre coincidence, a similar tank malfunction occurred at a Cleveland-based fertility clinic on the same day as the accident in San Francisco. The\u003ca href=\"http://www.cleveland.com/healthfit/index.ssf/2018/03/university_hospitals_notifies.html\" target=\"_blank\" rel=\"noopener\"> Cleveland Plain-Dealer\u003c/a> reported that the University Hospitals Fertility Center lost frozen eggs and embryos from 700 patients. Lawsuits have been filed in this incident as well, according to \u003ca href=\"https://www.washingtonpost.com/news/to-your-health/wp/2018/03/14/class-action-lawsuit-filed-against-pacific-fertility-for-loss-of-up-to-thousands-of-embryos-and-eggs/?utm_term=.705a90a7aa98\" target=\"_blank\" rel=\"noopener\">The Washington Post\u003c/a>.\u003c/p>\n\u003cp>The loss of potentially thousands of eggs and embryos from both clinics mark the biggest such loss on record in the U.S.\u003c/p>\n\u003cp>Regulations for oversight of fertility clinics vary by state. California, for example, requires clinics to be accredited by the Laboratory Field Services division of the California Department of Public Health. Ohio has no such licensing requirement.\u003c/p>\n\u003cp>\"The United States is the Wild West of the fertility industry,” Marcy Darnovsky, executive director of the Center for Genetics and Society told the Pew Charitable Trust's \u003ca href=\"http://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2015/3/18/states-not-eager-to-regulate-fertility-industry\" target=\"_blank\" rel=\"noopener\">Stateline\u003c/a> in 2015.\u003c/p>\n\u003cp>Data shows that 1.5 percent of all infants born in the U.S. are conceived using assisted reproductive technology, according to the \u003ca href=\"https://www.cdc.gov/art/artdata/index.html\" target=\"_blank\" rel=\"noopener\">Centers for Disease Control and Prevention. \u003c/a>More than 60,000 U.S. births in 2015 resulted from such methods.\u003c/p>\n\u003cp>The American Society for Reproductive Medicine does issue guidelines for fertility clinics, but they are not mandatory. The center has been accused of prioritizing the business interests of its members.\u003c/p>\n\u003cp>“It’s a field characterized by strong antiregulatory sentiment because it evolved as a business, not a research enterprise,” Arthur Caplan, director of the division of Medical Ethics at New York University’s School of Medicine, told Pew Charitable Trust.\u003c/p>\n\u003cp>For Taroli, the question of liability doesn't change how the experience has affected him and his partner.\u003c/p>\n\u003cp>\"The reality is ... we've all been affected. Even if it turns out that our embryos are okay,\" he says, \"we're still going through this madness right now of not knowing and we’re worried about whether or not they're still alive.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>The Associated Press contributed to this report.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Two refrigeration failures at fertility clinics in different states, coincidentally occurring on March 4, are raising questions about oversight of the industry and triggered several lawsuits.\u003c/p>\n\u003caside class=\"pullquote alignright\">'We know something has happened but we don't know if our four embryos are alive still.'\u003c/aside>\n\u003cp>In San Francisco, the Pacific Fertility Center says it is still assessing the extent of the damage to the embryos and eggs it stores, said San Francisco Chronicle reporter Catherine Ho on KQED's \u003ca href=\"https://www.kqed.org/forum/2010101864351/woman-sues-fertility-center-after-equipment-failure-destroys-her-eggs\" target=\"_blank\" rel=\"noopener\">Forum program\u003c/a> Friday.\u003c/p>\n\u003cp>One of those clients includes Bill Taroli, who told Forum host Mina Kim he first learned about the malfunction on the evening news. After contacting the center, he and his partner were informed their frozen embryos were in the impacted tank. But it will take at least another week before they learn whether their vials were damaged.\u003c/p>\n\u003cp>\"It's like waiting for any major test. 'Do we have cancer?' We're in this limbo,\" said Taroli, who said he spent $50,000 for the procedure. \"We know something has happened but we don't know if our four embryos are alive still.\"\u003c/p>\n\u003cp>The problem was discovered during a routine check by a senior embryologist who noticed that the liquid nitrogen levels in one tank had dipped to very low levels, affecting thousands of frozen eggs and embryos belonging to about 500 clients.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The tanks rely on liquid nitrogen to keep the frozen vials at the correct storage temperature.\u003c/p>\n\u003cp>The clinic has not yet announced the number of people impacted, said Ho. In a statement, Pacific Fertility Center said, \"The vast majority of the eggs and embryos in the lab were unaffected.\"\u003c/p>\n\u003cp>One of the company's clients includes an unnamed woman who learned on Sunday that her frozen eggs were destroyed. She has since filed a class action lawsuit against the company, seeking $5 million in damages for gross negligence stemming from a failure to properly maintain equipment. That figure is the minimum required to file a class-action suit in federal court.\u003c/p>\n\u003cp>Steven Tindall, the attorney for the woman, told Forum the facility lacked a real-time monitoring system that could have immediately alerted staff of a drop in nitrogen levels.\u003c/p>\n\u003cp>In a statement issued Wednesday, the company said it took immediate action once the malfunction was discovered:\u003c/p>\n\u003cblockquote>\u003cp>On March 4, a single piece of equipment in our cryogenic storage lab lost liquid nitrogen for a brief period of time. We do know that there is viable tissue from this tank. The rest of the tanks were not affected and the equipment was immediately retired. The vast majority of the eggs and embryos in the lab were unaffected and the facility is operating securely. As soon as the issue was discovered, our most senior embryologist took immediate action to transfer those tissues from the affected equipment to a new piece of equipment. And we have brought independent experts and are conducting a full investigation. We are truly sorry this happened and for the anxiety that this will surely cause.\u003c/p>\u003c/blockquote>\n\u003cp>The cost of storing frozen eggs or embryos is $600 a year, according to the center's website. But the entire process can cost anywhere between $10,000 to $100,000, said the Chronicle's Ho. Aside from the financial costs, the process can be emotionally draining for prospective parents.\u003c/p>\n\u003cp>Some of the clinic's clients include former cancer patients who had their eggs taken out in advance of cancer treatments, Tindall said.\u003c/p>\n\u003cp>\"Those people may have lost their opportunity to have biological children.\"\u003c/p>\n\u003cp>\u003cstrong>Ohio Incident\u003c/strong>\u003c/p>\n\u003cp>In a bizarre coincidence, a similar tank malfunction occurred at a Cleveland-based fertility clinic on the same day as the accident in San Francisco. The\u003ca href=\"http://www.cleveland.com/healthfit/index.ssf/2018/03/university_hospitals_notifies.html\" target=\"_blank\" rel=\"noopener\"> Cleveland Plain-Dealer\u003c/a> reported that the University Hospitals Fertility Center lost frozen eggs and embryos from 700 patients. Lawsuits have been filed in this incident as well, according to \u003ca href=\"https://www.washingtonpost.com/news/to-your-health/wp/2018/03/14/class-action-lawsuit-filed-against-pacific-fertility-for-loss-of-up-to-thousands-of-embryos-and-eggs/?utm_term=.705a90a7aa98\" target=\"_blank\" rel=\"noopener\">The Washington Post\u003c/a>.\u003c/p>\n\u003cp>The loss of potentially thousands of eggs and embryos from both clinics mark the biggest such loss on record in the U.S.\u003c/p>\n\u003cp>Regulations for oversight of fertility clinics vary by state. California, for example, requires clinics to be accredited by the Laboratory Field Services division of the California Department of Public Health. Ohio has no such licensing requirement.\u003c/p>\n\u003cp>\"The United States is the Wild West of the fertility industry,” Marcy Darnovsky, executive director of the Center for Genetics and Society told the Pew Charitable Trust's \u003ca href=\"http://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2015/3/18/states-not-eager-to-regulate-fertility-industry\" target=\"_blank\" rel=\"noopener\">Stateline\u003c/a> in 2015.\u003c/p>\n\u003cp>Data shows that 1.5 percent of all infants born in the U.S. are conceived using assisted reproductive technology, according to the \u003ca href=\"https://www.cdc.gov/art/artdata/index.html\" target=\"_blank\" rel=\"noopener\">Centers for Disease Control and Prevention. \u003c/a>More than 60,000 U.S. births in 2015 resulted from such methods.\u003c/p>\n\u003cp>The American Society for Reproductive Medicine does issue guidelines for fertility clinics, but they are not mandatory. The center has been accused of prioritizing the business interests of its members.\u003c/p>\n\u003cp>“It’s a field characterized by strong antiregulatory sentiment because it evolved as a business, not a research enterprise,” Arthur Caplan, director of the division of Medical Ethics at New York University’s School of Medicine, told Pew Charitable Trust.\u003c/p>\n\u003cp>For Taroli, the question of liability doesn't change how the experience has affected him and his partner.\u003c/p>\n\u003cp>\"The reality is ... we've all been affected. Even if it turns out that our embryos are okay,\" he says, \"we're still going through this madness right now of not knowing and we’re worried about whether or not they're still alive.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>The Associated Press contributed to this report.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>The world of artificial intelligence has exploded in recent years. Computers armed with AI do everything from drive cars to pick movies you'll probably like. Some have warned we're putting too much trust in computers that appear to do wondrous things.\u003c/p>\n\u003cp>But what exactly do people mean when they talk about artificial intelligence?\u003c/p>\n\u003cp>It's hard to find a universally accepted \u003ca href=\"https://ai100.stanford.edu/2016-report/section-i-what-artificial-intelligence/defining-ai\" target=\"_blank\" rel=\"noopener\">definition\u003c/a> of artificial intelligence. Basically it's about getting a computer to be smart — getting it to do something that in the past only humans could do.\u003c/p>\n\u003cp>One key to artificial intelligence is machine learning. Instead of telling a computer how to do something, you write a program that lets the computer figure out how to do something all on its own.\u003c/p>\n\u003cp>For example, let's say you'd like a computer to be able to pick out one conversation in a crowded restaurant.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"This is a problem that's been around for a long time,\" says computer scientist John Hershey, now at Google. \"When people start to lose their hearing this is one of the first things to go — the ability to separate one voice from another.\"\u003c/p>\n\u003cp>Hershey says nobody knows how our brains are able to separate voices, so it's difficult to tell a computer how to do it. But when he worked at the \u003ca href=\"http://www.merl.com/\" target=\"_blank\" rel=\"noopener\">Mitsubishi Electric Research Laboratory\u003c/a> in Cambridge, Mass., Hershey and his colleague Jonathan Le Roux used a technique called deep learning that allowed a computer, over time, to learn how to separate voices.[contextly_sidebar id=\"aSSAepQzkEyDhphKPsyhusdnA5B9qugK\"]\u003c/p>\n\u003cp>\u003ca href=\"https://www.npr.org/sections/alltechconsidered/2014/02/20/280232074/deep-learning-teaching-computers-to-tell-things-apart\">Deep learning\u003c/a> is all the rage in AI these days. It works something like this. You give the computer some input, in this case, the sound of people talking. To the computer, this is at first just meaningless noise. But then you give the computer a transcript of what the people were saying.\u003c/p>\n\u003cp>Like a baby learning new words, the computer figures out what sounds go with what words.\u003c/p>\n\u003cp>Once it has practiced, and practiced, and practiced, it can apply what it has learned to voices it's never heard before.\u003c/p>\n\u003cp>Hershey invited me to send him voices to see if his program could separate them from each other. I sent him a 10-second clip of NPR's Kelly McEvers and Ari Shapiro speaking simultaneously.\u003c/p>\n\u003cp>Here's what I sent.\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe src=\"https://www.npr.org/player/embed/583321707/583325732\" width=\"100%\" height=\"290\" frameborder=\"0\" scrolling=\"no\" title=\"NPR embedded audio player\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003cp>And here's what the computer came up with.\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe src=\"https://www.npr.org/player/embed/583321707/583333152\" width=\"100%\" height=\"290\" frameborder=\"0\" scrolling=\"no\" title=\"NPR embedded audio player\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003cp>In the separated recording you can clearly hear what Kelly is saying, but there's still a bit of Ari's voice in the background.\u003c/p>\n\u003cp>Hershey says the computer's flubs may be because Kelly's and Ari's voices are quite different from the voices used in the computer's training.\u003c/p>\n\u003cp>And that's a problem, according to critics of the deep learning approach.\u003c/p>\n\u003cp>\"You still need a lot of data to make this technique work,\" says New York University psychologist \u003ca href=\"http://www.psych.nyu.edu/gary/\" target=\"_blank\" rel=\"noopener\">Gary Marcus\u003c/a>, who works on artificial intelligence.\u003c/p>\n\u003cp>Deep learning in computers resembles how scientists think the human brain works. The brain is made up of about 100 billion or so neurons. Researchers say the connections among these neurons change as people learn a new task. Something similar is going on inside a computer.\u003c/p>\n\u003cp>But human brains learn a lot of stuff on their own. Marcus says for deep learning, you need a lot of data to train the computer.\u003c/p>\n\u003cp>\"And sometimes you can't find that data,\" he says.\u003c/p>\n\u003cp>Marcus worries people may be too enthralled with this approach to see its limitations.\u003c/p>\n\u003cp>\"One of the key questions right now is how risky is it if I make a crazy error?\" he says.\u003c/p>\n\u003cp>So let's say the computer in a driver-less car sees someone wearing a T-shirt with a picture on it of a highway receding into the distance. It's just possible the computer would be misled that the road on the shirt was a real road.\u003c/p>\n\u003cp>\"They make a mistake. They're not perfect. And the question is how much does that cost you?\" Marcus says.\u003c/p>\n\u003cp>He notes that if you're using artificial intelligence to pick a song people might like, an error is hardly catastrophic. \"But if you made a pedestrian detector that's 99 percent correct that sounds good,\" he says, \"... then you do the math and think about how many people would die every day if you had a fleet of those cars and it's really not very good at all.\"\u003c/p>\n\u003cp>But computer scientist \u003ca href=\"http://www.astroteller.net/\" target=\"_blank\" rel=\"noopener\">Astro Teller\u003c/a> is more positive about what AI can do. He heads a Google spinoff company \u003ca href=\"https://x.company/\" target=\"_blank\" rel=\"noopener\">called X\u003c/a>. First of all, he says, car-driving computers are already getting it right more than 99 percent of the time. He says even if they don't \u003cem>always\u003c/em> get it right, cars equipped with AI computers are likely to do way better than humans in unexpected situations.\u003c/p>\n\u003cp>But he also believes deep learning has its limits.\u003c/p>\n\u003cp>\"Most people in the field of artificial intelligence are excited about deep learning, and the progress that it's making but I think very few of them think that it's going to be the whole nut,\" Teller says.\u003c/p>\n\u003cp>He's convinced that researchers will come up with new AI techniques that will make computers much smarter than they are today.\u003c/p>\n\u003cp>\"I don't think there are any inherent limits in the kinds of problems computers can solve,\" Teller says. \"And I hope that there aren't any limits.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Of course, having no limits poses its own set of interesting questions.\u003c/p>\n\u003chr>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Can+Computers+Learn+Like+Humans%3F&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The world of artificial intelligence has exploded in recent years. Computers armed with AI do everything from drive cars to pick movies you'll probably like. Some have warned we're putting too much trust in computers that appear to do wondrous things.\u003c/p>\n\u003cp>But what exactly do people mean when they talk about artificial intelligence?\u003c/p>\n\u003cp>It's hard to find a universally accepted \u003ca href=\"https://ai100.stanford.edu/2016-report/section-i-what-artificial-intelligence/defining-ai\" target=\"_blank\" rel=\"noopener\">definition\u003c/a> of artificial intelligence. Basically it's about getting a computer to be smart — getting it to do something that in the past only humans could do.\u003c/p>\n\u003cp>One key to artificial intelligence is machine learning. Instead of telling a computer how to do something, you write a program that lets the computer figure out how to do something all on its own.\u003c/p>\n\u003cp>For example, let's say you'd like a computer to be able to pick out one conversation in a crowded restaurant.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"This is a problem that's been around for a long time,\" says computer scientist John Hershey, now at Google. \"When people start to lose their hearing this is one of the first things to go — the ability to separate one voice from another.\"\u003c/p>\n\u003cp>Hershey says nobody knows how our brains are able to separate voices, so it's difficult to tell a computer how to do it. But when he worked at the \u003ca href=\"http://www.merl.com/\" target=\"_blank\" rel=\"noopener\">Mitsubishi Electric Research Laboratory\u003c/a> in Cambridge, Mass., Hershey and his colleague Jonathan Le Roux used a technique called deep learning that allowed a computer, over time, to learn how to separate voices.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"https://www.npr.org/sections/alltechconsidered/2014/02/20/280232074/deep-learning-teaching-computers-to-tell-things-apart\">Deep learning\u003c/a> is all the rage in AI these days. It works something like this. You give the computer some input, in this case, the sound of people talking. To the computer, this is at first just meaningless noise. But then you give the computer a transcript of what the people were saying.\u003c/p>\n\u003cp>Like a baby learning new words, the computer figures out what sounds go with what words.\u003c/p>\n\u003cp>Once it has practiced, and practiced, and practiced, it can apply what it has learned to voices it's never heard before.\u003c/p>\n\u003cp>Hershey invited me to send him voices to see if his program could separate them from each other. I sent him a 10-second clip of NPR's Kelly McEvers and Ari Shapiro speaking simultaneously.\u003c/p>\n\u003cp>Here's what I sent.\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe src=\"https://www.npr.org/player/embed/583321707/583325732\" width=\"100%\" height=\"290\" frameborder=\"0\" scrolling=\"no\" title=\"NPR embedded audio player\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003cp>And here's what the computer came up with.\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe src=\"https://www.npr.org/player/embed/583321707/583333152\" width=\"100%\" height=\"290\" frameborder=\"0\" scrolling=\"no\" title=\"NPR embedded audio player\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003cp>In the separated recording you can clearly hear what Kelly is saying, but there's still a bit of Ari's voice in the background.\u003c/p>\n\u003cp>Hershey says the computer's flubs may be because Kelly's and Ari's voices are quite different from the voices used in the computer's training.\u003c/p>\n\u003cp>And that's a problem, according to critics of the deep learning approach.\u003c/p>\n\u003cp>\"You still need a lot of data to make this technique work,\" says New York University psychologist \u003ca href=\"http://www.psych.nyu.edu/gary/\" target=\"_blank\" rel=\"noopener\">Gary Marcus\u003c/a>, who works on artificial intelligence.\u003c/p>\n\u003cp>Deep learning in computers resembles how scientists think the human brain works. The brain is made up of about 100 billion or so neurons. Researchers say the connections among these neurons change as people learn a new task. Something similar is going on inside a computer.\u003c/p>\n\u003cp>But human brains learn a lot of stuff on their own. Marcus says for deep learning, you need a lot of data to train the computer.\u003c/p>\n\u003cp>\"And sometimes you can't find that data,\" he says.\u003c/p>\n\u003cp>Marcus worries people may be too enthralled with this approach to see its limitations.\u003c/p>\n\u003cp>\"One of the key questions right now is how risky is it if I make a crazy error?\" he says.\u003c/p>\n\u003cp>So let's say the computer in a driver-less car sees someone wearing a T-shirt with a picture on it of a highway receding into the distance. It's just possible the computer would be misled that the road on the shirt was a real road.\u003c/p>\n\u003cp>\"They make a mistake. They're not perfect. And the question is how much does that cost you?\" Marcus says.\u003c/p>\n\u003cp>He notes that if you're using artificial intelligence to pick a song people might like, an error is hardly catastrophic. \"But if you made a pedestrian detector that's 99 percent correct that sounds good,\" he says, \"... then you do the math and think about how many people would die every day if you had a fleet of those cars and it's really not very good at all.\"\u003c/p>\n\u003cp>But computer scientist \u003ca href=\"http://www.astroteller.net/\" target=\"_blank\" rel=\"noopener\">Astro Teller\u003c/a> is more positive about what AI can do. He heads a Google spinoff company \u003ca href=\"https://x.company/\" target=\"_blank\" rel=\"noopener\">called X\u003c/a>. First of all, he says, car-driving computers are already getting it right more than 99 percent of the time. He says even if they don't \u003cem>always\u003c/em> get it right, cars equipped with AI computers are likely to do way better than humans in unexpected situations.\u003c/p>\n\u003cp>But he also believes deep learning has its limits.\u003c/p>\n\u003cp>\"Most people in the field of artificial intelligence are excited about deep learning, and the progress that it's making but I think very few of them think that it's going to be the whole nut,\" Teller says.\u003c/p>\n\u003cp>He's convinced that researchers will come up with new AI techniques that will make computers much smarter than they are today.\u003c/p>\n\u003cp>\"I don't think there are any inherent limits in the kinds of problems computers can solve,\" Teller says. \"And I hope that there aren't any limits.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Of course, having no limits poses its own set of interesting questions.\u003c/p>\n\u003chr>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Can+Computers+Learn+Like+Humans%3F&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Biologists Trace Genetic Roots Of Evolution, One Cell at a Time",
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"content": "\u003cp>Genetic mutations are the driving force of evolution, and now scientists have managed to study the effect of mutations in exquisite detail by watching what happens as they pop up in single cells.\u003c/p>\n\u003cp>Only about one percent of mutations were bad enough to kill off the cell, according to a \u003ca href=\"http://science.sciencemag.org/cgi/doi/10.1126/science.aan0797\" target=\"_blank\" rel=\"noopener\">report\u003c/a> published Thursday in \u003cem>Science\u003c/em>. Most of the time, these small changes in its DNA appeared to have no effect at all.[contextly_sidebar id=\"kvnKbnjyKwJnWuLsgRUewEIFcd5eTbqG\"]\u003c/p>\n\u003cp>Mutations have been studied for centuries, says \u003ca href=\"https://www.micalis.fr/micalis_eng/Poles-and-teams/Pole-Biosys/AJ-Aymerich-Jules/SyBER-group-Jules/SyBER-members/Lydia-Robert\" target=\"_blank\" rel=\"noopener\">Lydia Robert\u003c/a>, a researcher at INRA, an agricultural research institute in Paris, France, who notes that they can have medical impacts ranging from antibiotic resistance to cancer.\u003c/p>\n\u003cp>But research on mutations basically has focused on large-scale effects in populations.\u003c/p>\n\u003cp>\"You have a test tube with millions of bacteria, for instance, and you try to measure some property which is an average of all the cells in the population,\" says Robert.[contextly_sidebar id=\"B1EJ5qXFqZz59odJ0F4Nzqz7Z0w5fjPW\"]\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>In contrast, she and her colleagues wanted to study mutations in single cells.\u003c/p>\n\u003cp>So they turned to a so-called \"mother machine\" — a microfluidics device equipped with hundreds of tiny tubes, each no wider than a single E. coli bacterium.\u003c/p>\n\u003cp>\u003cstrong>'Mother Machine'\u003c/strong>\u003cbr>\nThey trapped a single bacterial cell in each tube, and spied on them with a microscope. Every time the bacterial cell divided into two, to reproduce itself, its genetic material got copied. If that copying process went awry and made a mistake, producing a mutation, this error got flagged by a fluorescent tag. The research team tracked about 20,000 mutations over hundreds of generations.\u003c/p>\n\u003cp>The researchers first checked to see if some cells might have an increased mutation rate compared to others.\u003c/p>\n\u003cp>\"We were surprised that in fact it was not the case,\" says Robert, explaining that, under their experimental conditions, all the cells seemed to share the same probability of acquiring mutations, and these genetic changes seemed to occur at a steady rate.\u003c/p>\n\u003cp>\"Many, many of them had no effect at all. This was a bit of a surprise to me,\" Robert says. \"I would have expected a lot of mutations to be slightly bad, and they are not even bad at all.\"\u003c/p>\n\u003cp>Just one percent of the time, a mutation killed the cell outright. And a mutation was very harmful to a cell (but not lethal) about 0.2 percent of the time.\u003c/p>\n\u003cp>\"Most of the time it's really neutral. The cell gets a mutation but it does nothing to the cell,\" says Robert.\u003c/p>\n\u003cp>\u003cstrong>Study Conditions\u003c/strong>\u003cbr>\nIn this study, the bacteria in the little tubes were living under good conditions and weren't exposed to any natural selection or competition—so the researchers could not determine how often mutations produced a beneficial effect that enhanced the bacterial cells' growth and survival.\u003c/p>\n\u003cp>Future studies could start to explore that. \"We're going to change, basically, the environment and see what it changes,\" Robert says. \"What happens if the environment is harsher? Is it going to change the way mutations occur, or are they going to kill more of the cells or less of the cells?\"\u003c/p>\n\u003cp>Already, what the researchers have observed so far confirms a lot of the core thinking that goes into evolutionary biology, says \u003ca href=\"http://myxo.css.msu.edu/\">Richard Lenski\u003c/a>, a biologist at Michigan State University who has spent the last three decades following the evolution of bacteria populations living in flasks in his lab.\u003c/p>\n\u003cp>\"What's exciting about this paper is the technical elegance of it, the rigorous quantification,\" says Lenski, \"This is another nice demonstration that random mutation really has this kind of clock-like dynamic, and that, absent natural selection, populations will, in fact, not only not be able to hold their own, but will tend to decay over time,\" because most mutations are either neutral or deleterious.[contextly_sidebar id=\"KsUxGvhivFMcATApHvyB6fQZaguGW0J5\"]\u003c/p>\n\u003cp>Looking at mutations without any natural selection is very artificial, Lenski says, \"but that allows them to really focus on the underlying process of mutation.\"\u003c/p>\n\u003cp>Some people study evolution in the real world, in all its gory detail, he says. But there's also value in studying genetic changes in this kind of controlled setting that can give a cleaner answers.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"Fitting those two together is always a challenge,\" says Lenski, \"but that's the way science works.\"\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=Biologists+Trace+Genetic+Roots+Of+Evolution%2C+One+Cell+At+A+Time&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"excerpt": "\u003cem>E.coli\u003c/em> bacteria are giving researchers the chance to study single genetic mutations. ",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Genetic mutations are the driving force of evolution, and now scientists have managed to study the effect of mutations in exquisite detail by watching what happens as they pop up in single cells.\u003c/p>\n\u003cp>Only about one percent of mutations were bad enough to kill off the cell, according to a \u003ca href=\"http://science.sciencemag.org/cgi/doi/10.1126/science.aan0797\" target=\"_blank\" rel=\"noopener\">report\u003c/a> published Thursday in \u003cem>Science\u003c/em>. Most of the time, these small changes in its DNA appeared to have no effect at all.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Mutations have been studied for centuries, says \u003ca href=\"https://www.micalis.fr/micalis_eng/Poles-and-teams/Pole-Biosys/AJ-Aymerich-Jules/SyBER-group-Jules/SyBER-members/Lydia-Robert\" target=\"_blank\" rel=\"noopener\">Lydia Robert\u003c/a>, a researcher at INRA, an agricultural research institute in Paris, France, who notes that they can have medical impacts ranging from antibiotic resistance to cancer.\u003c/p>\n\u003cp>But research on mutations basically has focused on large-scale effects in populations.\u003c/p>\n\u003cp>\"You have a test tube with millions of bacteria, for instance, and you try to measure some property which is an average of all the cells in the population,\" says Robert.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>In contrast, she and her colleagues wanted to study mutations in single cells.\u003c/p>\n\u003cp>So they turned to a so-called \"mother machine\" — a microfluidics device equipped with hundreds of tiny tubes, each no wider than a single E. coli bacterium.\u003c/p>\n\u003cp>\u003cstrong>'Mother Machine'\u003c/strong>\u003cbr>\nThey trapped a single bacterial cell in each tube, and spied on them with a microscope. Every time the bacterial cell divided into two, to reproduce itself, its genetic material got copied. If that copying process went awry and made a mistake, producing a mutation, this error got flagged by a fluorescent tag. The research team tracked about 20,000 mutations over hundreds of generations.\u003c/p>\n\u003cp>The researchers first checked to see if some cells might have an increased mutation rate compared to others.\u003c/p>\n\u003cp>\"We were surprised that in fact it was not the case,\" says Robert, explaining that, under their experimental conditions, all the cells seemed to share the same probability of acquiring mutations, and these genetic changes seemed to occur at a steady rate.\u003c/p>\n\u003cp>\"Many, many of them had no effect at all. This was a bit of a surprise to me,\" Robert says. \"I would have expected a lot of mutations to be slightly bad, and they are not even bad at all.\"\u003c/p>\n\u003cp>Just one percent of the time, a mutation killed the cell outright. And a mutation was very harmful to a cell (but not lethal) about 0.2 percent of the time.\u003c/p>\n\u003cp>\"Most of the time it's really neutral. The cell gets a mutation but it does nothing to the cell,\" says Robert.\u003c/p>\n\u003cp>\u003cstrong>Study Conditions\u003c/strong>\u003cbr>\nIn this study, the bacteria in the little tubes were living under good conditions and weren't exposed to any natural selection or competition—so the researchers could not determine how often mutations produced a beneficial effect that enhanced the bacterial cells' growth and survival.\u003c/p>\n\u003cp>Future studies could start to explore that. \"We're going to change, basically, the environment and see what it changes,\" Robert says. \"What happens if the environment is harsher? Is it going to change the way mutations occur, or are they going to kill more of the cells or less of the cells?\"\u003c/p>\n\u003cp>Already, what the researchers have observed so far confirms a lot of the core thinking that goes into evolutionary biology, says \u003ca href=\"http://myxo.css.msu.edu/\">Richard Lenski\u003c/a>, a biologist at Michigan State University who has spent the last three decades following the evolution of bacteria populations living in flasks in his lab.\u003c/p>\n\u003cp>\"What's exciting about this paper is the technical elegance of it, the rigorous quantification,\" says Lenski, \"This is another nice demonstration that random mutation really has this kind of clock-like dynamic, and that, absent natural selection, populations will, in fact, not only not be able to hold their own, but will tend to decay over time,\" because most mutations are either neutral or deleterious.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Looking at mutations without any natural selection is very artificial, Lenski says, \"but that allows them to really focus on the underlying process of mutation.\"\u003c/p>\n\u003cp>Some people study evolution in the real world, in all its gory detail, he says. But there's also value in studying genetic changes in this kind of controlled setting that can give a cleaner answers.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"Fitting those two together is always a challenge,\" says Lenski, \"but that's the way science works.\"\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=Biologists+Trace+Genetic+Roots+Of+Evolution%2C+One+Cell+At+A+Time&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>The Tsimane people are among the most isolated people in Bolivia. They number about 16,000 and live in 80 mostly riverbank villages of 50 to several hundred people scattered across about 3,000 square miles of Amazon jungle. They are forager-farmers who fish, hunt, cut down jungle trees with machetes and produce an \u003ca href=\"http://www.anth.ucsb.edu/people/michael-gurven\" target=\"_blank\" rel=\"noopener\">average of nine children per family,\u003c/a> says \u003ca href=\"http://www.anth.ucsb.edu/gurvenlab/\" target=\"_blank\" rel=\"noopener\">Michael Gurven\u003c/a>, chair of the Integrated Anthropological Sciences Unit at the University of California at Santa Barbara.[contextly_sidebar id=\"09DUGAe9ia3Jjr77ebYOxlbZOLjB4H3E\"]\u003c/p>\n\u003cp>Gurven has visited and studied the Tsimane people for 16 years. Last month, he and colleagues published a paper in the journal \u003ca href=\"https://www.sciencedirect.com/science/article/pii/S0277953618300170?via%3Dihub\" target=\"_blank\" rel=\"noopener\">\u003cem>Social Science & Medicine\u003c/em>\u003c/a> on why these impoverished people, who live an average of just over 50 years (compared to the \u003ca href=\"http://www.who.int/gho/mortality_burden_disease/life_tables/situation_trends/en/\" target=\"_blank\" rel=\"noopener\">world average of 71.5\u003c/a>), often won't take advantage of medical care, even when it's free and offered by people they've come to trust.\u003c/p>\n\u003cp>What the researchers found offers some clues about why many of us resist going to the doctor when things like rashes, coughs and pains make it pretty clear that we should. \u003ca href=\"https://www.jhsph.edu/faculty/directory/profile/1450/lisa-a-cooper\" target=\"_blank\" rel=\"noopener\">Dr. Lisa Cooper\u003c/a>, professor of medicine at Johns Hopkins University School of Medicine, is not connected with the social science study, but she studies medical adherence and preventive care in the U.S. She says the study shows that while providing medical services is important, it's not enough to ensure good health.[contextly_sidebar id=\"3WXNkyKOIWInX4REHuJ8jcJx7knSTAAA\"]\u003c/p>\n\u003cp>\"We also have to deal with belief systems, with world view, with spiritual beliefs,\" she says. \"We've got to take a much broader view of health.\"\u003c/p>\n\u003cp>When Gurven and his team made trips to Bolivia over the years, they brought medical teams to the most remote villages. \"We'd set up a camp and provide health care,\" he says. \"If there were 100 people in the village, maybe 70 would come. And every time, it would be the same people. I wondered: Were they the sickest? Why didn't others come? We didn't charge them, so money wasn't the reason. We were right there, so they didn't have to travel anywhere.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cstrong>Fatalism\u003c/strong>\u003cbr>\nIn less remote villages closer to bigger towns, health clinics existed. But in these villages as well, a lot of sick people didn't go for health care.\u003c/p>\n\u003cp>To find out why, researchers asked 690 people, ages 40 to 89, about their priorities, their perceptions about health, their knowledge of medical care. But they also probed deeper, looking into people's beliefs about the extent to which their actions mattered.\u003c/p>\n\u003cp>\"We tried to get at what they think,\" says Gurven. \"If they think they're in charge of what happens to them, that what they put into their body or what they do effects what happens, they're more likely to go to the doctor. With that feeling of control, they're likely to believe that medical treatment will help heal them, or that they might be able to prevent getting sick in the first place.[contextly_sidebar id=\"OQgAwOmNgvR0qCTeiOSMMaCmMZzhxqD5\"]\u003c/p>\n\u003cp>But people who think outside forces are in charge — fate or chance — are less likely to seek out care. They believe that nothing they do will matter, or matters far less than the forces of nature or the whims of others, so why bother, says Sarah Alami, a graduate student in anthropology at UC Santa Barbara and lead author of the study. It turned out that the Tsimane people largely believed that forces outside their control — like a mosquito bite that results in a deadly fever or a neighbor who puts a curse on them — mattered more than things within their control.\u003c/p>\n\u003cp>Alami has spent eight months in Bolivia, working with the Tsimane people. She's seen active people in good health: men felling tall trees, children using the jungle as a playground, women juggling a couple of kids while breastfeeding and fishing.\u003c/p>\n\u003cp>But she's also seen their ill health. A villager she met a few weeks ago might be gone on her next visit, having succumbed to dengue fever. \"You can see they're heavily burdened by parasites,\" she says. \"You see open sores that are infected, and they might not go for help. For something they know will kill them, like a snake bite, they'll try to go for help.\" But where it gets trickier, she says, is a less immediately urgent problem, like a cough that might be tuberculosis.[contextly_sidebar id=\"cdlKRlLfAt4DKi3kH575qPWqNDUsVBiC\"]\u003c/p>\n\u003cp>The researchers concluded that, from the point of view of a Tsimane villager, not taking advantage of medical care might be a rational decision. They know, Gurven says, that while they might get relief from a parasitic infection by going to a clinic, they also know that they're quite likely to get reinfected right away. Or maybe they'll be bitten by a snake on the way home, so they shouldn't risk venturing as far away as a health clinic.\u003c/p>\n\u003cp>The same kind of thinking in the U.S. keeps people from medical care, Cooper says. \"I liken it to what I see in disadvantaged communities where things are chaotic and people believe their circumstances are controlled by chance,\" she says. \"You go in for care, and the doctor tells you to eat better and exercise.\" But you can't afford to join a fitness center, and you live miles from any store that sells fresh fruits and vegetables. \"People living in chaotic environments might think that they don't have control over what's happening today, so why worry about what might happen in the future,\" she says.[contextly_sidebar id=\"KANLlW97Nqu1xraacTt3S4hyzVXssZqH\"]\u003c/p>\n\u003cp>Like the Tsimane, poor people in the U.S. might decide to skip medical care, she says. And from their point of view, it's a rational decision.\u003c/p>\n\u003cp>Even among middle-class people in the developed world, fears of losing control can lead people avoid medical care. \"People are afraid they're going to be diagnosed with something that will limit their employment, or that their disease is so serious, treatment won't work,\" Cooper says. So again, why bother.\u003c/p>\n\u003cp>Avoiding trips to the doctor happens all over the world. But a couple of things have worked to get the indigenous Bolivians to the clinic. \"We don't just explain the illness, and how a treatment will have an effect. Medical knowledge isn't the answer,\" Gurven says. \"We try to get them thinking that it matters to their family that they get treated. We get them thinking about their lives in the future. We ask them about their children's lives five years from now.\"\u003c/p>\n\u003cp>It's the line spouses all over the world use, Gurven says, to get their mates to the doctor: If you won't do it for yourself, think of the kids.\u003c/p>\n\u003chr>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>Susan Brink is a freelance writer who covers health and medicine. She is the author of \u003c/em>The Fourth Trimester\u003cem> and co-author of \u003c/em>A Change of Heart.\u003c/p>\n\u003chr>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=How+To+Get+People+To+See+A+Doctor+When+They+Don%27t+Want+To&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The Tsimane people are among the most isolated people in Bolivia. They number about 16,000 and live in 80 mostly riverbank villages of 50 to several hundred people scattered across about 3,000 square miles of Amazon jungle. They are forager-farmers who fish, hunt, cut down jungle trees with machetes and produce an \u003ca href=\"http://www.anth.ucsb.edu/people/michael-gurven\" target=\"_blank\" rel=\"noopener\">average of nine children per family,\u003c/a> says \u003ca href=\"http://www.anth.ucsb.edu/gurvenlab/\" target=\"_blank\" rel=\"noopener\">Michael Gurven\u003c/a>, chair of the Integrated Anthropological Sciences Unit at the University of California at Santa Barbara.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Gurven has visited and studied the Tsimane people for 16 years. Last month, he and colleagues published a paper in the journal \u003ca href=\"https://www.sciencedirect.com/science/article/pii/S0277953618300170?via%3Dihub\" target=\"_blank\" rel=\"noopener\">\u003cem>Social Science & Medicine\u003c/em>\u003c/a> on why these impoverished people, who live an average of just over 50 years (compared to the \u003ca href=\"http://www.who.int/gho/mortality_burden_disease/life_tables/situation_trends/en/\" target=\"_blank\" rel=\"noopener\">world average of 71.5\u003c/a>), often won't take advantage of medical care, even when it's free and offered by people they've come to trust.\u003c/p>\n\u003cp>What the researchers found offers some clues about why many of us resist going to the doctor when things like rashes, coughs and pains make it pretty clear that we should. \u003ca href=\"https://www.jhsph.edu/faculty/directory/profile/1450/lisa-a-cooper\" target=\"_blank\" rel=\"noopener\">Dr. Lisa Cooper\u003c/a>, professor of medicine at Johns Hopkins University School of Medicine, is not connected with the social science study, but she studies medical adherence and preventive care in the U.S. She says the study shows that while providing medical services is important, it's not enough to ensure good health.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\"We also have to deal with belief systems, with world view, with spiritual beliefs,\" she says. \"We've got to take a much broader view of health.\"\u003c/p>\n\u003cp>When Gurven and his team made trips to Bolivia over the years, they brought medical teams to the most remote villages. \"We'd set up a camp and provide health care,\" he says. \"If there were 100 people in the village, maybe 70 would come. And every time, it would be the same people. I wondered: Were they the sickest? Why didn't others come? We didn't charge them, so money wasn't the reason. We were right there, so they didn't have to travel anywhere.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cstrong>Fatalism\u003c/strong>\u003cbr>\nIn less remote villages closer to bigger towns, health clinics existed. But in these villages as well, a lot of sick people didn't go for health care.\u003c/p>\n\u003cp>To find out why, researchers asked 690 people, ages 40 to 89, about their priorities, their perceptions about health, their knowledge of medical care. But they also probed deeper, looking into people's beliefs about the extent to which their actions mattered.\u003c/p>\n\u003cp>\"We tried to get at what they think,\" says Gurven. \"If they think they're in charge of what happens to them, that what they put into their body or what they do effects what happens, they're more likely to go to the doctor. With that feeling of control, they're likely to believe that medical treatment will help heal them, or that they might be able to prevent getting sick in the first place.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>But people who think outside forces are in charge — fate or chance — are less likely to seek out care. They believe that nothing they do will matter, or matters far less than the forces of nature or the whims of others, so why bother, says Sarah Alami, a graduate student in anthropology at UC Santa Barbara and lead author of the study. It turned out that the Tsimane people largely believed that forces outside their control — like a mosquito bite that results in a deadly fever or a neighbor who puts a curse on them — mattered more than things within their control.\u003c/p>\n\u003cp>Alami has spent eight months in Bolivia, working with the Tsimane people. She's seen active people in good health: men felling tall trees, children using the jungle as a playground, women juggling a couple of kids while breastfeeding and fishing.\u003c/p>\n\u003cp>But she's also seen their ill health. A villager she met a few weeks ago might be gone on her next visit, having succumbed to dengue fever. \"You can see they're heavily burdened by parasites,\" she says. \"You see open sores that are infected, and they might not go for help. For something they know will kill them, like a snake bite, they'll try to go for help.\" But where it gets trickier, she says, is a less immediately urgent problem, like a cough that might be tuberculosis.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>The researchers concluded that, from the point of view of a Tsimane villager, not taking advantage of medical care might be a rational decision. They know, Gurven says, that while they might get relief from a parasitic infection by going to a clinic, they also know that they're quite likely to get reinfected right away. Or maybe they'll be bitten by a snake on the way home, so they shouldn't risk venturing as far away as a health clinic.\u003c/p>\n\u003cp>The same kind of thinking in the U.S. keeps people from medical care, Cooper says. \"I liken it to what I see in disadvantaged communities where things are chaotic and people believe their circumstances are controlled by chance,\" she says. \"You go in for care, and the doctor tells you to eat better and exercise.\" But you can't afford to join a fitness center, and you live miles from any store that sells fresh fruits and vegetables. \"People living in chaotic environments might think that they don't have control over what's happening today, so why worry about what might happen in the future,\" she says.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Like the Tsimane, poor people in the U.S. might decide to skip medical care, she says. And from their point of view, it's a rational decision.\u003c/p>\n\u003cp>Even among middle-class people in the developed world, fears of losing control can lead people avoid medical care. \"People are afraid they're going to be diagnosed with something that will limit their employment, or that their disease is so serious, treatment won't work,\" Cooper says. So again, why bother.\u003c/p>\n\u003cp>Avoiding trips to the doctor happens all over the world. But a couple of things have worked to get the indigenous Bolivians to the clinic. \"We don't just explain the illness, and how a treatment will have an effect. Medical knowledge isn't the answer,\" Gurven says. \"We try to get them thinking that it matters to their family that they get treated. We get them thinking about their lives in the future. We ask them about their children's lives five years from now.\"\u003c/p>\n\u003cp>It's the line spouses all over the world use, Gurven says, to get their mates to the doctor: If you won't do it for yourself, think of the kids.\u003c/p>\n\u003chr>\n\u003cp>\u003c/p>\u003c/div>",
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"disqusTitle": "Theranos and Elizabeth Holmes Charged With 'Massive Fraud' by SEC",
"title": "Theranos and Elizabeth Holmes Charged With 'Massive Fraud' by SEC",
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"content": "\u003cp>It started as a massive success story — a wunderkind female college dropout disrupting the blood-testing industry and empowering patients to take charge of their own health.\u003c/p>\n\u003cp>[contextly_sidebar id=\"ga0lyGeskUZhaMZ1G6m0viMzWzc3RBPU\"]It ended as an almost archetypal cautionary tale about Silicon Valley hubris and its incompatibility with the slow developmental cycles of biomedicine.\u003c/p>\n\u003cp>The Securities and Exchange Commission today charged Bay Area-based Theranos, its founder and CEO Elizabeth Holmes, and former president Sunny Balwani with \"massive fraud,\" in the \u003ca href=\"https://www.sec.gov/news/press-release/2018-41\" target=\"_blank\" rel=\"noopener\">words\u003c/a> of the SEC.\u003c/p>\n\u003cp>Theranos' trangressions included \"raising more than $700 million from investors through an elaborate, years-long fraud in which they exaggerated or made false statements about the company's technology, business, and financial performance,\" according to the federal agency.\u003c/p>\n\u003cp>Holmes has agreed to give up her majority voting control of the company and to a reduction in her equity, the SEC said. Holmes also agreed to pay a $500,000 penalty and is now barred from serving as an officer or director of a public company for 10 years. As part of the settlement, both she and the company neither admitted nor denied wrongdoing.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Bulwani, apparently, has not settled. The SEC said it will litigate the charges against him in Northern California federal district court. Balwani's attorney told \u003ca href=\"https://www.cnbc.com/2018/03/14/theranos-ceo-holmes-and-former-president-balwani-charged-with-massive-fraud.html\" target=\"_blank\" rel=\"noopener\">CNBC\u003c/a> that the SEC action was \"unwarranted,\" and that Balwani \"accurately represented Theranos to investors to the best of his ability,\" taking on \"significant financial risk.\"\u003c/p>\n\u003cp>Theranos still faces a \u003ca href=\"https://www.nytimes.com/2016/04/19/business/theranos-sec-justice-department-investigation.html\" target=\"_blank\" rel=\"noopener\">criminal investigation\u003c/a> by the U.S. Attorney's Office in San Francisco.\u003c/p>\n\u003cp>\u003cb>Hundreds of Blood Tests From a Few Drops of Blood\u003c/b>\u003c/p>\n\u003cp>The crux of the charges against Theranos are that it made \"numerous false and misleading statements\" to investors that it had found a way to conduct hundreds of blood tests from just a few drops of blood, which would have revolutionized the blood-testing industry. But in reality, according to the SEC, Theranos could only perform a small number of tests this way, with the vast majority completed on standard commercial equipment.\u003c/p>\n\u003cp>The SEC also charges Theranos with claiming its technology was used by the military in Afghanistan, and that it would take in more than $100 million in revenue in 2014.\u003c/p>\n\u003cp>\"In truth, Theranos' technology was never deployed by the U.S. Department of Defense and generated a little more than $100,000 in revenue in 2014,\" the SEC said.\u003c/p>\n\u003cp>Theranos had been flying high that year, with Forbes valuing the company at $9 billion, and Holmes stake worth half that. Holmes had also attracted glowing media attention from the tech and business press.\u003c/p>\n\u003cp>But the story changed abruptly with the publication of a \u003ca href=\"https://www.wsj.com/articles/theranos-has-struggled-with-blood-tests-1444881901\" target=\"_blank\" rel=\"noopener\">Wall Street Journal investigation in 2015\u003c/a>. Reporter John Carreyrou alleged that the company had failed to report tests that showed its proprietary blood-testing equipment may not be accurate, and that it was not using its own technology for most tests, anyway.\u003c/p>\n\u003cp>Theranos responded by stating the Journal's reporting was inaccurate. \"First they think you're crazy. Then they fight you. And then all of a sudden you change the world,\" was Holmes' retort on Jim Cramer's CNBC show.\u003c/p>\n\u003cp>But the Journal's investigation proved to be only the start of Theranos' woes. Soon, the federal government charged that deficiencies at the company's Newark, California lab put patients in \"immediate jeopardy,\" likely to cause \"serious injury or harm, or death.\" The government said that Theranos' own quality control tests had showed alarming rates of failure. The complaint led to Holmes' banishment from owning or operating a lab for two years.\u003c/p>\n\u003cp>Theranos also had to correct tens of thousands of blood tests. A high-profile alliance with Walgreens which put blood-testing centers in dozens of stores, collapsed.\u003c/p>\n\u003cp>The company exited the consumer blood-testing business, lawsuits and more investigations ensued. and Theranos has been treading water ever since.\u003c/p>\n\u003cp>In 2016, Theranos tried to remake itself as the manufacturer of a portable device that could process small volumes of blood remotely and send the data back to a centralized location.\u003c/p>\n\u003cp>But the unveiling of the device, in front of a couple of thousand skeptical laboratory scientists, was mostly a \u003ca href=\"https://www.kqed.org/futureofyou/210797/theranos-elizabeth-holmes-will-face-1000-scientists-monday-can-she-say-anything-to-gain-their-trust\" target=\"_blank\" rel=\"noopener\">dud, \u003c/a>with some expressing the opinion that it was nothing new.\u003c/p>\n\u003cp>The company's \"Newsroom\" page pretty much tells the story at this point. Lots of \u003ca href=\"https://news.theranos.com/\" target=\"_blank\" rel=\"noopener\">press releases\u003c/a> about reaching settlements with various entities — the\u003ca href=\"https://news.theranos.com/2018/03/14/theranos-ceo-reach-settlement-sec/\" target=\"_blank\" rel=\"noopener\"> SEC\u003c/a>, the Centers for Medicare & Medicaid Services, Walgreens, the Arizona attorney general — and nary a word about any product.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp> \u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>It started as a massive success story — a wunderkind female college dropout disrupting the blood-testing industry and empowering patients to take charge of their own health.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>It ended as an almost archetypal cautionary tale about Silicon Valley hubris and its incompatibility with the slow developmental cycles of biomedicine.\u003c/p>\n\u003cp>The Securities and Exchange Commission today charged Bay Area-based Theranos, its founder and CEO Elizabeth Holmes, and former president Sunny Balwani with \"massive fraud,\" in the \u003ca href=\"https://www.sec.gov/news/press-release/2018-41\" target=\"_blank\" rel=\"noopener\">words\u003c/a> of the SEC.\u003c/p>\n\u003cp>Theranos' trangressions included \"raising more than $700 million from investors through an elaborate, years-long fraud in which they exaggerated or made false statements about the company's technology, business, and financial performance,\" according to the federal agency.\u003c/p>\n\u003cp>Holmes has agreed to give up her majority voting control of the company and to a reduction in her equity, the SEC said. Holmes also agreed to pay a $500,000 penalty and is now barred from serving as an officer or director of a public company for 10 years. As part of the settlement, both she and the company neither admitted nor denied wrongdoing.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Bulwani, apparently, has not settled. The SEC said it will litigate the charges against him in Northern California federal district court. Balwani's attorney told \u003ca href=\"https://www.cnbc.com/2018/03/14/theranos-ceo-holmes-and-former-president-balwani-charged-with-massive-fraud.html\" target=\"_blank\" rel=\"noopener\">CNBC\u003c/a> that the SEC action was \"unwarranted,\" and that Balwani \"accurately represented Theranos to investors to the best of his ability,\" taking on \"significant financial risk.\"\u003c/p>\n\u003cp>Theranos still faces a \u003ca href=\"https://www.nytimes.com/2016/04/19/business/theranos-sec-justice-department-investigation.html\" target=\"_blank\" rel=\"noopener\">criminal investigation\u003c/a> by the U.S. Attorney's Office in San Francisco.\u003c/p>\n\u003cp>\u003cb>Hundreds of Blood Tests From a Few Drops of Blood\u003c/b>\u003c/p>\n\u003cp>The crux of the charges against Theranos are that it made \"numerous false and misleading statements\" to investors that it had found a way to conduct hundreds of blood tests from just a few drops of blood, which would have revolutionized the blood-testing industry. But in reality, according to the SEC, Theranos could only perform a small number of tests this way, with the vast majority completed on standard commercial equipment.\u003c/p>\n\u003cp>The SEC also charges Theranos with claiming its technology was used by the military in Afghanistan, and that it would take in more than $100 million in revenue in 2014.\u003c/p>\n\u003cp>\"In truth, Theranos' technology was never deployed by the U.S. Department of Defense and generated a little more than $100,000 in revenue in 2014,\" the SEC said.\u003c/p>\n\u003cp>Theranos had been flying high that year, with Forbes valuing the company at $9 billion, and Holmes stake worth half that. Holmes had also attracted glowing media attention from the tech and business press.\u003c/p>\n\u003cp>But the story changed abruptly with the publication of a \u003ca href=\"https://www.wsj.com/articles/theranos-has-struggled-with-blood-tests-1444881901\" target=\"_blank\" rel=\"noopener\">Wall Street Journal investigation in 2015\u003c/a>. Reporter John Carreyrou alleged that the company had failed to report tests that showed its proprietary blood-testing equipment may not be accurate, and that it was not using its own technology for most tests, anyway.\u003c/p>\n\u003cp>Theranos responded by stating the Journal's reporting was inaccurate. \"First they think you're crazy. Then they fight you. And then all of a sudden you change the world,\" was Holmes' retort on Jim Cramer's CNBC show.\u003c/p>\n\u003cp>But the Journal's investigation proved to be only the start of Theranos' woes. Soon, the federal government charged that deficiencies at the company's Newark, California lab put patients in \"immediate jeopardy,\" likely to cause \"serious injury or harm, or death.\" The government said that Theranos' own quality control tests had showed alarming rates of failure. The complaint led to Holmes' banishment from owning or operating a lab for two years.\u003c/p>\n\u003cp>Theranos also had to correct tens of thousands of blood tests. A high-profile alliance with Walgreens which put blood-testing centers in dozens of stores, collapsed.\u003c/p>\n\u003cp>The company exited the consumer blood-testing business, lawsuits and more investigations ensued. and Theranos has been treading water ever since.\u003c/p>\n\u003cp>In 2016, Theranos tried to remake itself as the manufacturer of a portable device that could process small volumes of blood remotely and send the data back to a centralized location.\u003c/p>\n\u003cp>But the unveiling of the device, in front of a couple of thousand skeptical laboratory scientists, was mostly a \u003ca href=\"https://www.kqed.org/futureofyou/210797/theranos-elizabeth-holmes-will-face-1000-scientists-monday-can-she-say-anything-to-gain-their-trust\" target=\"_blank\" rel=\"noopener\">dud, \u003c/a>with some expressing the opinion that it was nothing new.\u003c/p>\n\u003cp>The company's \"Newsroom\" page pretty much tells the story at this point. Lots of \u003ca href=\"https://news.theranos.com/\" target=\"_blank\" rel=\"noopener\">press releases\u003c/a> about reaching settlements with various entities — the\u003ca href=\"https://news.theranos.com/2018/03/14/theranos-ceo-reach-settlement-sec/\" target=\"_blank\" rel=\"noopener\"> SEC\u003c/a>, the Centers for Medicare & Medicaid Services, Walgreens, the Arizona attorney general — and nary a word about any product.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp> \u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "From App Store To Drug Store, Digital Health Is Redefining Pharma",
"title": "From App Store To Drug Store, Digital Health Is Redefining Pharma",
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"content": "\u003cp>The pitches always sounded promising: A new software app could track glucose levels for people with diabetes or soothe the brains of insomniacs. Most pharma executives would politely smile and nod, but then park their money somewhere else.\u003c/p>\n\u003cp>Not anymore.\u003c/p>\n\u003cp>Backed by a growing body of evidence, software is itself becoming a prescription for diseases ranging from depression to heart disease, and drug companies are starting to take notice. In the past couple years, many have quickly ramped up their investments in digital startups, infusing software-based therapies into pipelines once dominated by traditional medicines.[contextly_sidebar id=\"vRMOcUiT66pyiT86wyEK8HoXGjDpcJLk\"]\u003c/p>\n\u003cp>These products, known broadly as digital therapeutics, deliver treatment to patients through video games, smartphone apps, and sensors buried in pills or attached to medication dispensers. They are designed to stimulate changes in behavior — and in some cases brain function — to help patients control a variety of illnesses and chronic conditions.\u003c/p>\n\u003cp>In 2017, global investment in these companies jumped to $11.5 billion, a fivefold increase from 2012, according to StartUp Health, a research firm that tracks the digital health market. The uptick in investment mirrors an increasing focus by many digital companies in achieving scientific backing for their inventions.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>And just as importantly as the money flowing in is the rising stature of digital health products. Specifically, in two key ways they’re starting to be treated as drugs: They’re seeking Food and Drug Administration approval, and they’re being covered by insurers. Increasingly, then, across the industry, digital health is moving from the app store to the drug store.\u003c/p>\n\u003cp>\u003cstrong>A Drug In App’s Clothes\u003c/strong>\u003cbr>\n“We’re a team of drug developers that just happens to be developing digital products,” said Dr. Corey McCann, president of Pear Therapeutics, a maker of apps for substance use disorder, post-traumatic stress, and other diseases. “What we’ve done as a company is to demonstrate that software can produce drug-like efficacy.”\u003c/p>\n\u003cp>In 2017, Pear’s reSET program, designed to treat substance use disorder, became the first digital product to receive FDA approval for the treatment of a specific disease. And last month the company inked a partnership with Novartis to develop prescription software to treat schizophrenia and mental health problems associated with multiple sclerosis.\u003c/p>\n\u003cp>The Novartis deal is one of many that highlights increasing investment in these therapies by prominent drug makers. Among the biggest spenders on digital health are GlaxoSmithKline, Roche, Johnson & Johnson, and Merck, whose $500 million global health innovation fund has invested in 24 companies since 2009.[contextly_sidebar id=\"GamWIkUUy1zvAmx2sFp4vTWRVfsXPCLs\"]\u003c/p>\n\u003cp>Analysts who follow the field say digital products are getting more direct attention from pharma CEOs who now see their development as a business imperative, as opposed to a supplemental service with marginal importance to their companies.\u003c/p>\n\u003cp>“The CEOs are coming to us and saying, ‘I have a strategic problem, which is that my R&D pipeline isn’t as productive as I need it to be and there are adjacent businesses my current [employees] just aren’t focused on,’” said Scott Bechtler-Levin, a director with BCG Digital Ventures, a consulting firm.\u003c/p>\n\u003cp>That is causing many companies to buy stakes in these companies or form partnerships to develop and commercialize their products — either as standalone treatments, or as a complement to existing medicines.\u003c/p>\n\u003cp>\u003cstrong>Honing The Pitch To Insurers\u003c/strong>\u003cbr>\nThe rising investment in digital therapeutics does not guarantee their success. As a whole, the industry is still in its early stages of development, and so is the scientific evidence needed to show these products are safe and effective.\u003c/p>\n\u003cp>But some early entrants are winning over medical societies and insurers, putting themselves on more equal footing with traditional pharmaceutical products.\u003c/p>\n\u003cp>Omada Health, a maker of software to treat \u003ca href=\"https://www.statnews.com/2017/11/16/prediabetes-insurance-counseling-diabetes/\" target=\"_blank\" rel=\"noopener\">pre-diabetes\u003c/a>, obesity, and heart disease, now has contracts with more than 175 employers as well as dozens of insurance plans. Its program costs between $550 and $650 for the first year, with the price tied to the achievement of patient outcomes.[contextly_sidebar id=\"0QmrfLARboHh7FZkmCdqJRZJFkLkOMNT\"]\u003c/p>\n\u003cp>“Our big goal is to get to the point where in 70 percent of the country, if you’re in clinical need for a program like ours, it’s written by default into your insurance design,” said Omada’s co-founder and chief executive, Sean Duffy.\u003c/p>\n\u003cp>Founded in 2011, Omada describes itself as a digital behavior change company. Its pre-diabetes program is essentially a set of clinical prevention strategies wrapped in a digital package. The software tracks patients’ weight, food intake, and activity, as well as glucose and lipid levels, among other measures. It also pairs them with a health coach to help provide education and feedback on progress.\u003c/p>\n\u003cp>The company’s website features nine published studies that report either positive results for patients or a clinical validation of Omada’s programs. Many of the studies are small and observational, owing to the company’s short history and limited reach compared to other providers. But it has helped leverage key victories in the industry: Last year, the American Medical Association decided to issue its first ever billing code to cover digital health services like those provided by Omada.\u003c/p>\n\u003cp>The AMA’s designation is crucial, because it helps digital companies gain coverage for their services from private insurers. “It allows us to be categorized as a proper medical benefit,” Duffy said. “That’s always been the long game of Omada.”[contextly_sidebar id=\"qlS21f91d5rV5InQtLOUoNHm1y7ElbJX\"]\u003c/p>\n\u003cp>Medicare has not yet extended coverage for digital pre-diabetes treatment, but it is \u003ca href=\"https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2017-Fact-Sheet-items/2017-11-02.html\" target=\"_blank\" rel=\"noopener\">inching closer\u003c/a>. It has begun covering the prevention services Omada offers, just not in a digital format. Duffy argues doing so would greatly expand access to care, particularly for people who must travel long distances to see their doctors. “If you’re a Medicare beneficiary, you’re probably willing to drive three hours one time to get a knee replacement,” he said. “But it’s unlikely you’re going to do that for 16 straight weeks of a [diabetes prevention] program.”\u003c/p>\n\u003cp>\u003cstrong>A Scientific Formula For Business Success\u003cbr>\n\u003c/strong>The extent and type of regulatory validation sought by digital health companies varies widely. Some have sought to shield themselves from review, while others have achieved positive results by taking the exact opposite approach.\u003c/p>\n\u003cp>McCann, Pear’s chief executive, said running scientific trials — and ultimately gaining FDA approval — is a crucial part of the company’s business plan. Pear’s current product pipeline includes digital treatments for cancer, Parkinson’s disease, depression and schizophrenia, among others.\u003c/p>\n\u003cp>“If you want to say that something treats schizophrenia … then that’s something that absolutely requires regulatory oversight,” McCann said. “And in these very fragile patient populations, one absolutely needs to demonstrate safety data.”\u003c/p>\n\u003cfigure id=\"attachment_72940\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-72940\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2015/11/ihealth-800x450.jpg\" alt=\"\" width=\"800\" height=\"450\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2015/11/ihealth-800x450.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2015/11/ihealth-400x225.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2015/11/ihealth-960x540.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2015/11/ihealth.jpg 1024w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">A blood pressure monitor from iHealth. \u003ccite>(Juhan Sonin/Flickr)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>That approach has positioned Pear as a direct competitor to traditional pharmaceutical companies, as well as an attractive partner. Its deal with Novartis is designed to further develop its schizophrenia treatment and bring it into clinical use.\u003c/p>\n\u003cp>The product, known as THRIVE, currently consists of a smartphone app that uses branching logic — similar to what one might find in a choose-your-own-adventure game — to help patients identify and counteract delusions and other symptoms. Novartis may contribute by developing complementary drug therapies for schizophrenia patients as well as those with mental health problems arising from multiple sclerosis.\u003c/p>\n\u003cp>Dr. Jay Bradner, president of the Novartis Institutes for BioMedical Research, said Pear’s success in gaining FDA approval for reSET is seen as a model for others in the industry to follow.\u003c/p>\n\u003cp>“It was a heavy lift, but the path that they have carved through the forest is very appealing,” he said. “The proof of concept offered by reSET is indeed encouraging to suggest that other forms of cognitive behavioral therapy might likewise be delivered through digital devices.”[contextly_sidebar id=\"NJID6CERRgAHMSQb34OqsGPaMEPkrsBk\"]\u003c/p>\n\u003cp>The partnership with Pear is part of a broader digital transformation at Novartis. The company has hired a new chief digital officer and is investing in software to allow clinical trials to be carried out in patients’ homes, a move to speed up research and development and reach a more diverse group of patients.\u003c/p>\n\u003cp>“It’s a full reconsideration of the research, development, and commercialization model,” Bradner said, adding that such change is long overdue in an industry famous for its half-hearted embrace of technology.\u003c/p>\n\u003cp>“My mother in her retirement home is running AI when she logs onto the Amazon Prime website, without her even knowing,” he said. “Yet in science and medicine, as sophisticated as these fields have become, there is no pervasive impact of artificial intelligence and deep neural networks, as yet realized.”\u003c/p>\n\u003cp>\u003cem>This story was originally published by \u003ca href=\"https://www.statnews.com/\" target=\"_blank\" rel=\"noopener\">STAT\u003c/a>, an online publication of Boston Globe Media that covers health, medicine, and scientific discovery.intern\u003c/em>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cstrong> \u003c/strong>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The pitches always sounded promising: A new software app could track glucose levels for people with diabetes or soothe the brains of insomniacs. Most pharma executives would politely smile and nod, but then park their money somewhere else.\u003c/p>\n\u003cp>Not anymore.\u003c/p>\n\u003cp>Backed by a growing body of evidence, software is itself becoming a prescription for diseases ranging from depression to heart disease, and drug companies are starting to take notice. In the past couple years, many have quickly ramped up their investments in digital startups, infusing software-based therapies into pipelines once dominated by traditional medicines.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>These products, known broadly as digital therapeutics, deliver treatment to patients through video games, smartphone apps, and sensors buried in pills or attached to medication dispensers. They are designed to stimulate changes in behavior — and in some cases brain function — to help patients control a variety of illnesses and chronic conditions.\u003c/p>\n\u003cp>In 2017, global investment in these companies jumped to $11.5 billion, a fivefold increase from 2012, according to StartUp Health, a research firm that tracks the digital health market. The uptick in investment mirrors an increasing focus by many digital companies in achieving scientific backing for their inventions.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>And just as importantly as the money flowing in is the rising stature of digital health products. Specifically, in two key ways they’re starting to be treated as drugs: They’re seeking Food and Drug Administration approval, and they’re being covered by insurers. Increasingly, then, across the industry, digital health is moving from the app store to the drug store.\u003c/p>\n\u003cp>\u003cstrong>A Drug In App’s Clothes\u003c/strong>\u003cbr>\n“We’re a team of drug developers that just happens to be developing digital products,” said Dr. Corey McCann, president of Pear Therapeutics, a maker of apps for substance use disorder, post-traumatic stress, and other diseases. “What we’ve done as a company is to demonstrate that software can produce drug-like efficacy.”\u003c/p>\n\u003cp>In 2017, Pear’s reSET program, designed to treat substance use disorder, became the first digital product to receive FDA approval for the treatment of a specific disease. And last month the company inked a partnership with Novartis to develop prescription software to treat schizophrenia and mental health problems associated with multiple sclerosis.\u003c/p>\n\u003cp>The Novartis deal is one of many that highlights increasing investment in these therapies by prominent drug makers. Among the biggest spenders on digital health are GlaxoSmithKline, Roche, Johnson & Johnson, and Merck, whose $500 million global health innovation fund has invested in 24 companies since 2009.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Analysts who follow the field say digital products are getting more direct attention from pharma CEOs who now see their development as a business imperative, as opposed to a supplemental service with marginal importance to their companies.\u003c/p>\n\u003cp>“The CEOs are coming to us and saying, ‘I have a strategic problem, which is that my R&D pipeline isn’t as productive as I need it to be and there are adjacent businesses my current [employees] just aren’t focused on,’” said Scott Bechtler-Levin, a director with BCG Digital Ventures, a consulting firm.\u003c/p>\n\u003cp>That is causing many companies to buy stakes in these companies or form partnerships to develop and commercialize their products — either as standalone treatments, or as a complement to existing medicines.\u003c/p>\n\u003cp>\u003cstrong>Honing The Pitch To Insurers\u003c/strong>\u003cbr>\nThe rising investment in digital therapeutics does not guarantee their success. As a whole, the industry is still in its early stages of development, and so is the scientific evidence needed to show these products are safe and effective.\u003c/p>\n\u003cp>But some early entrants are winning over medical societies and insurers, putting themselves on more equal footing with traditional pharmaceutical products.\u003c/p>\n\u003cp>Omada Health, a maker of software to treat \u003ca href=\"https://www.statnews.com/2017/11/16/prediabetes-insurance-counseling-diabetes/\" target=\"_blank\" rel=\"noopener\">pre-diabetes\u003c/a>, obesity, and heart disease, now has contracts with more than 175 employers as well as dozens of insurance plans. Its program costs between $550 and $650 for the first year, with the price tied to the achievement of patient outcomes.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>“Our big goal is to get to the point where in 70 percent of the country, if you’re in clinical need for a program like ours, it’s written by default into your insurance design,” said Omada’s co-founder and chief executive, Sean Duffy.\u003c/p>\n\u003cp>Founded in 2011, Omada describes itself as a digital behavior change company. Its pre-diabetes program is essentially a set of clinical prevention strategies wrapped in a digital package. The software tracks patients’ weight, food intake, and activity, as well as glucose and lipid levels, among other measures. It also pairs them with a health coach to help provide education and feedback on progress.\u003c/p>\n\u003cp>The company’s website features nine published studies that report either positive results for patients or a clinical validation of Omada’s programs. Many of the studies are small and observational, owing to the company’s short history and limited reach compared to other providers. But it has helped leverage key victories in the industry: Last year, the American Medical Association decided to issue its first ever billing code to cover digital health services like those provided by Omada.\u003c/p>\n\u003cp>The AMA’s designation is crucial, because it helps digital companies gain coverage for their services from private insurers. “It allows us to be categorized as a proper medical benefit,” Duffy said. “That’s always been the long game of Omada.”\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Medicare has not yet extended coverage for digital pre-diabetes treatment, but it is \u003ca href=\"https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2017-Fact-Sheet-items/2017-11-02.html\" target=\"_blank\" rel=\"noopener\">inching closer\u003c/a>. It has begun covering the prevention services Omada offers, just not in a digital format. Duffy argues doing so would greatly expand access to care, particularly for people who must travel long distances to see their doctors. “If you’re a Medicare beneficiary, you’re probably willing to drive three hours one time to get a knee replacement,” he said. “But it’s unlikely you’re going to do that for 16 straight weeks of a [diabetes prevention] program.”\u003c/p>\n\u003cp>\u003cstrong>A Scientific Formula For Business Success\u003cbr>\n\u003c/strong>The extent and type of regulatory validation sought by digital health companies varies widely. Some have sought to shield themselves from review, while others have achieved positive results by taking the exact opposite approach.\u003c/p>\n\u003cp>McCann, Pear’s chief executive, said running scientific trials — and ultimately gaining FDA approval — is a crucial part of the company’s business plan. Pear’s current product pipeline includes digital treatments for cancer, Parkinson’s disease, depression and schizophrenia, among others.\u003c/p>\n\u003cp>“If you want to say that something treats schizophrenia … then that’s something that absolutely requires regulatory oversight,” McCann said. “And in these very fragile patient populations, one absolutely needs to demonstrate safety data.”\u003c/p>\n\u003cfigure id=\"attachment_72940\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-72940\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2015/11/ihealth-800x450.jpg\" alt=\"\" width=\"800\" height=\"450\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2015/11/ihealth-800x450.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2015/11/ihealth-400x225.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2015/11/ihealth-960x540.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2015/11/ihealth.jpg 1024w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">A blood pressure monitor from iHealth. \u003ccite>(Juhan Sonin/Flickr)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>That approach has positioned Pear as a direct competitor to traditional pharmaceutical companies, as well as an attractive partner. Its deal with Novartis is designed to further develop its schizophrenia treatment and bring it into clinical use.\u003c/p>\n\u003cp>The product, known as THRIVE, currently consists of a smartphone app that uses branching logic — similar to what one might find in a choose-your-own-adventure game — to help patients identify and counteract delusions and other symptoms. Novartis may contribute by developing complementary drug therapies for schizophrenia patients as well as those with mental health problems arising from multiple sclerosis.\u003c/p>\n\u003cp>Dr. Jay Bradner, president of the Novartis Institutes for BioMedical Research, said Pear’s success in gaining FDA approval for reSET is seen as a model for others in the industry to follow.\u003c/p>\n\u003cp>“It was a heavy lift, but the path that they have carved through the forest is very appealing,” he said. “The proof of concept offered by reSET is indeed encouraging to suggest that other forms of cognitive behavioral therapy might likewise be delivered through digital devices.”\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>The partnership with Pear is part of a broader digital transformation at Novartis. The company has hired a new chief digital officer and is investing in software to allow clinical trials to be carried out in patients’ homes, a move to speed up research and development and reach a more diverse group of patients.\u003c/p>\n\u003cp>“It’s a full reconsideration of the research, development, and commercialization model,” Bradner said, adding that such change is long overdue in an industry famous for its half-hearted embrace of technology.\u003c/p>\n\u003cp>“My mother in her retirement home is running AI when she logs onto the Amazon Prime website, without her even knowing,” he said. “Yet in science and medicine, as sophisticated as these fields have become, there is no pervasive impact of artificial intelligence and deep neural networks, as yet realized.”\u003c/p>\n\u003cp>\u003cem>This story was originally published by \u003ca href=\"https://www.statnews.com/\" target=\"_blank\" rel=\"noopener\">STAT\u003c/a>, an online publication of Boston Globe Media that covers health, medicine, and scientific discovery.intern\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>It was an ordinary surgery to remove a tumor — until doctors turned off the lights and the patient’s chest started to glow. A spot over his heart shined purplish pink. Another shimmered in a lung.\u003c/p>\n\u003cp>They were hidden cancers revealed by fluorescent dye, an advance that soon may transform how hundreds of thousands of operations are done each year.[contextly_sidebar id=\"Ogmq1UUgKo8aE2IP1lCDvQNXVNYlgDpk\"]\u003c/p>\n\u003cp>Surgery has long been the best way to cure cancer. If the disease recurs, it’s usually because stray tumor cells were left behind or others lurked undetected. Yet there’s no good way for surgeons to tell what is cancer and what is not. They look and feel for defects, but good and bad tissue often seem the same.\u003c/p>\n\u003cp>Now, dyes are being tested to make cancer cells light up so doctors can cut them out and give patients a better shot at survival.\u003c/p>\n\u003cp>With dyes, “it’s almost like we have bionic vision,” said Dr. Sunil Singhal at the University of Pennsylvania. “We can be sure we’re not taking too much or too little.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The dyes are experimental but advancing quickly. Two are in late-stage studies aimed at winning Food and Drug Administration approval. Johnson & Johnson just invested $40 million in one, and federal grants support some of the work.[contextly_sidebar id=\"mm8KBTMxhiMbM8M2Wc9G6n7ZsBv3NyTj\"]\u003c/p>\n\u003cp>“We think this is so important. Patients’ lives will be improved by this,” said Paula Jacobs, an imaging expert at the National Cancer Institute. In five or so years, “there will be a palette of these,” she predicts.\u003c/p>\n\u003cp>\u003cstrong>Making Cells Grow\u003c/strong>\u003cbr>\nSinghal was inspired a decade ago, while pondering a student who died when her lung cancer recurred soon after he thought he had removed it all. He was lying next to his baby, gazing at fluorescent decals.\u003c/p>\n\u003cp>“I looked up and saw all these stars on the ceiling and I thought, how cool if we could make cells light up” so people wouldn’t die from unseen tumors, he said.\u003c/p>\n\u003cp>A dye called ICG had long been used for various medical purposes. Singhal found that when big doses were given by IV a day before surgery, it collected in cancer cells and glowed when exposed to near infrared light. He dubbed it TumorGlow and has been testing it for lung, brain and other tumor types.[contextly_sidebar id=\"oq329fs9BgtV9sHBHKU68jW8lt8YC6F7\"]\u003c/p>\n\u003cp>He used it on Ryan Ciccozzi, a 45-year-old highway worker and father of four from Deptford, New Jersey, and found hidden cancer near Ciccozzi’s heart and in a lung.\u003c/p>\n\u003cp>“The tumor was kind of growing into everything in there,” Ciccozzi said. “Without the dye, I don’t think they would have seen anything” besides the baseball-sized mass visible on CT scans ahead of time.\u003c/p>\n\u003cp>Singhal also is testing a dye for On Target Laboratories, based in the Purdue research park in Indiana, that binds to a protein more common in cancer cells. A late-stage study is underway for ovarian cancer and a mid-stage one for lung cancer.\u003c/p>\n\u003cp>In one study, the dye highlighted 56 of 59 lung cancers seen on scans before surgery, plus nine more that weren’t visible ahead of time.\u003c/p>\n\u003cp>Each year, about 80,000 Americans have surgery for suspicious lung spots. If a dye can show that cancer is confined to a small node, surgeons can remove a wedge instead of a whole lobe and preserve more breathing capacity, said On Target chief Marty Low. No price has been set, but dyes are cheap to make and the cost should fit within rates hospitals negotiate with insurers for these operations, he said.\u003c/p>\n\u003cp>\u003cstrong>Big Promise For Breast Cancer\u003c/strong>\u003cbr>\nDyes may hold the most promise for breast cancer, said the American Cancer Society’s Dr. Len Lichtenfeld. Up to one third of women who have a lump removed need a second operation because margins weren’t clear — an edge of the removed tissue later was found to harbor cancer.\u003c/p>\n\u003cp>“If we drop that down into single digits, the impact is huge,” said Kelly Londy, who heads Lumicell, a suburban Boston company testing a dye paired with a device to scan the lump cavity for stray cancer cells.[contextly_sidebar id=\"HgChWIXMEeuUsIphvB2AB4KmfFFeIuiJ\"]\u003c/p>\n\u003cp>A device called MarginProbe is sold now, but it uses different technology to examine the surface of tissue that’s been taken out, so it can’t pinpoint in the breast where residual disease lurks, said Dr. Barbara Smith, a breast surgeon at Massachusetts General Hospital.\u003c/p>\n\u003cp>She leads a late-stage study of Lumicell’s system in 400 breast cancer patients. In an earlier study of 60 women, it revealed all of the cancers, verified by tissue tests later.\u003c/p>\n\u003cp>But it also gave false alarms in more than a quarter of cases — “there were some areas where normal tissue lit up a little bit,” Smith said.\u003c/p>\n\u003cp>Still, she said, “you would rather take a little extra tissue with the first surgery rather than missing something and have to go back.”\u003c/p>\n\u003cp>\u003cstrong>Other Cancers\u003c/strong>\u003cbr>\nBlaze Bioscience is testing Tumor Paint, patented by company co-founder Dr. Jim Olson of Fred Hutchinson Cancer Research Center and Seattle Children’s Hospital. It’s a combo product — a molecule that binds to cancer and a dye to make it glow.\u003c/p>\n\u003cp>“You can see it down to a few dozen cells or a few hundred cells,” Olson said. “I’ve seen neurosurgeons come out of the operating room with a big smile on their face because they can see the cancer very clearly.”[contextly_sidebar id=\"agci5uStcnYcQL7Fw4mpLFpt9eGGVC9U\"]\u003c/p>\n\u003cp>Early-stage studies have been done for skin, brain and breast cancers in adults, and brain tumors in children.\u003c/p>\n\u003cp>Avelas Biosciences of San Diego has a similar approach — a dye attached to a molecule to carry it into tumor cells. The company is finishing early studies in breast cancer and plans more for colon, head and neck, ovarian and other types.\u003c/p>\n\u003cp>Cancer drugs have had a lot of attention while ways to improve surgery have had far less, said company president Carmine Stengone.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“This was just an overlooked area, despite the high medical need.”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The dyes are experimental but advancing quickly. Two are in late-stage studies aimed at winning Food and Drug Administration approval. Johnson & Johnson just invested $40 million in one, and federal grants support some of the work.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>“We think this is so important. Patients’ lives will be improved by this,” said Paula Jacobs, an imaging expert at the National Cancer Institute. In five or so years, “there will be a palette of these,” she predicts.\u003c/p>\n\u003cp>\u003cstrong>Making Cells Grow\u003c/strong>\u003cbr>\nSinghal was inspired a decade ago, while pondering a student who died when her lung cancer recurred soon after he thought he had removed it all. 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},
"link": "/radio/program/bbc-world-service",
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},
"californiareport": {
"id": "californiareport",
"title": "The California Report",
"tagline": "California, day by day",
"info": "KQED’s statewide radio news program providing daily coverage of issues, trends and public policy decisions.",
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"officialWebsiteLink": "/californiareport",
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"order": 8
},
"link": "/californiareport",
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}
},
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"title": "The California Report Magazine",
"tagline": "Your state, your stories",
"info": "Every week, The California Report Magazine takes you on a road trip for the ears: to visit the places and meet the people who make California unique. The in-depth storytelling podcast from the California Report.",
"airtime": "FRI 4:30pm-5pm, 6:30pm-7pm, 11pm-11:30pm",
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"order": 10
},
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM3NjkwNjk1OTAz",
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},
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"info": "A one-hour radio program to hear celebrated writers, artists and thinkers address contemporary ideas and values, often discussing the creative process. Please note: tapes or transcripts are not available",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/05/cityartsandlecture-300x300.jpg",
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"airtime": "SUN 1pm-2pm, TUE 10pm, WED 1am",
"meta": {
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"source": "City Arts & Lectures"
},
"link": "https://www.cityarts.net",
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}
},
"closealltabs": {
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"order": 1
},
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"info": "\u003cem>Code Switch\u003c/em>, which listeners will hear in the first part of the hour, has fearless and much-needed conversations about race. Hosted by journalists of color, the show tackles the subject of race head-on, exploring how it impacts every part of society — from politics and pop culture to history, sports and more.\u003cbr />\u003cbr />\u003cem>Life Kit\u003c/em>, which will be in the second part of the hour, guides you through spaces and feelings no one prepares you for — from finances to mental health, from workplace microaggressions to imposter syndrome, from relationships to parenting. The show features experts with real world experience and shares their knowledge. Because everyone needs a little help being human.\u003cbr />\u003cbr />\u003ca href=\"https://www.npr.org/podcasts/510312/codeswitch\">\u003cem>Code Switch\u003c/em> offical site and podcast\u003c/a>\u003cbr />\u003ca href=\"https://www.npr.org/lifekit\">\u003cem>Life Kit\u003c/em> offical site and podcast\u003c/a>\u003cbr />",
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"id": "commonwealth-club",
"title": "Commonwealth Club of California Podcast",
"info": "The Commonwealth Club of California is the nation's oldest and largest public affairs forum. As a non-partisan forum, The Club brings to the public airwaves diverse viewpoints on important topics. The Club's weekly radio broadcast - the oldest in the U.S., dating back to 1924 - is carried across the nation on public radio stations and is now podcasting. Our website archive features audio of our recent programs, as well as selected speeches from our long and distinguished history. This podcast feed is usually updated twice a week and is always un-edited.",
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"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Commonwealth-Club-Podcast-Tile-360x360-1.jpg",
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"meta": {
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"source": "Commonwealth Club of California"
},
"link": "/radio/program/commonwealth-club",
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"google": "https://podcasts.google.com/feed/aHR0cDovL3d3dy5jb21tb253ZWFsdGhjbHViLm9yZy9hdWRpby9wb2RjYXN0L3dlZWtseS54bWw",
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"id": "forum",
"title": "Forum",
"tagline": "The conversation starts here",
"info": "KQED’s live call-in program discussing local, state, national and international issues, as well as in-depth interviews.",
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"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Forum-Podcast-Tile-703x703-1.jpg",
"imageAlt": "KQED Forum with Mina Kim and Alexis Madrigal",
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"source": "kqed",
"order": 9
},
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM5NTU3MzgxNjMz",
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"freakonomics-radio": {
"id": "freakonomics-radio",
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"imageSrc": "https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/05/freakonomicsRadio.png",
"officialWebsiteLink": "http://freakonomics.com/",
"airtime": "SUN 1am-2am, SAT 3pm-4pm",
"meta": {
"site": "radio",
"source": "WNYC"
},
"link": "/radio/program/freakonomics-radio",
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"apple": "https://itunes.apple.com/us/podcast/freakonomics-radio/id354668519",
"tuneIn": "https://tunein.com/podcasts/WNYC-Podcasts/Freakonomics-Radio-p272293/",
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},
"fresh-air": {
"id": "fresh-air",
"title": "Fresh Air",
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"apple": "https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=214089682&at=11l79Y&ct=nprdirectory",
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"info": "A live production of NPR and WBUR Boston, in collaboration with stations across the country, Here & Now reflects the fluid world of news as it's happening in the middle of the day, with timely, in-depth news, interviews and conversation. Hosted by Robin Young, Jeremy Hobson and Tonya Mosley.",
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},
"hidden-brain": {
"id": "hidden-brain",
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"info": "Shankar Vedantam uses science and storytelling to reveal the unconscious patterns that drive human behavior, shape our choices and direct our relationships.",
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"airtime": "SUN 7pm-8pm",
"meta": {
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"source": "NPR"
},
"link": "/radio/program/hidden-brain",
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"how-i-built-this": {
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"title": "How I Built This with Guy Raz",
"info": "Guy Raz dives into the stories behind some of the world's best known companies. How I Built This weaves a narrative journey about innovators, entrepreneurs and idealists—and the movements they built.",
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"airtime": "SUN 7:30pm-8pm",
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},
"link": "/radio/program/how-i-built-this",
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"apple": "https://itunes.apple.com/us/podcast/how-i-built-this-with-guy-raz/id1150510297?mt=2",
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"hyphenacion": {
"id": "hyphenacion",
"title": "Hyphenación",
"tagline": "Where conversation and cultura meet",
"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. ",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2025/03/Hyphenacion_FinalAssets_PodcastTile.png",
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"order": 15
},
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},
"jerrybrown": {
"id": "jerrybrown",
"title": "The Political Mind of Jerry Brown",
"tagline": "Lessons from a lifetime in politics",
"info": "The Political Mind of Jerry Brown brings listeners the wisdom of the former Governor, Mayor, and presidential candidate. Scott Shafer interviewed Brown for more than 40 hours, covering the former governor's life and half-century in the political game – and Brown has some lessons he'd like to share. ",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/The-Political-Mind-of-Jerry-Brown-Podcast-Tile-703x703-1.jpg",
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"order": 18
},
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},
"latino-usa": {
"id": "latino-usa",
"title": "Latino USA",
"airtime": "MON 1am-2am, SUN 6pm-7pm",
"info": "Latino USA, the radio journal of news and culture, is the only national, English-language radio program produced from a Latino perspective.",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/latinoUsa.jpg",
"officialWebsiteLink": "http://latinousa.org/",
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},
"link": "/radio/program/latino-usa",
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"apple": "https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=79681317&at=11l79Y&ct=nprdirectory",
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"rss": "https://feeds.npr.org/510016/podcast.xml"
}
},
"marketplace": {
"id": "marketplace",
"title": "Marketplace",
"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.",
"airtime": "MON-FRI 4pm-4:30pm, MON-WED 6:30pm-7pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Marketplace-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.marketplace.org/",
"meta": {
"site": "news",
"source": "American Public Media"
},
"link": "/radio/program/marketplace",
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"rss": "https://feeds.publicradio.org/public_feeds/marketplace-pm/rss/rss"
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},
"masters-of-scale": {
"id": "masters-of-scale",
"title": "Masters of Scale",
"info": "Masters of Scale is an original podcast in which LinkedIn co-founder and Greylock Partner Reid Hoffman sets out to describe and prove theories that explain how great entrepreneurs take their companies from zero to a gazillion in ingenious fashion.",
"airtime": "Every other Wednesday June 12 through October 16 at 8pm (repeats Thursdays at 2am)",
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"officialWebsiteLink": "https://mastersofscale.com/",
"meta": {
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"source": "WaitWhat"
},
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"rss": "https://rss.art19.com/masters-of-scale"
}
},
"mindshift": {
"id": "mindshift",
"title": "MindShift",
"tagline": "A podcast about the future of learning and how we raise our kids",
"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>",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Mindshift-Podcast-Tile-703x703-1.jpg",
"imageAlt": "KQED MindShift: How We Will Learn",
"officialWebsiteLink": "/mindshift/",
"meta": {
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"source": "kqed",
"order": 12
},
"link": "/podcasts/mindshift",
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM1NzY0NjAwNDI5",
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}
},
"morning-edition": {
"id": "morning-edition",
"title": "Morning Edition",
"info": "\u003cem>Morning Edition\u003c/em> takes listeners around the country and the world with multi-faceted stories and commentaries every weekday. Hosts Steve Inskeep, David Greene and Rachel Martin bring you the latest breaking news and features to prepare you for the day.",
"airtime": "MON-FRI 3am-9am",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Morning-Edition-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.npr.org/programs/morning-edition/",
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"link": "/radio/program/morning-edition"
},
"onourwatch": {
"id": "onourwatch",
"title": "On Our Watch",
"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?",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/On-Our-Watch-Podcast-Tile-703x703-1.jpg",
"imageAlt": "On Our Watch from NPR and KQED",
"officialWebsiteLink": "/podcasts/onourwatch",
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"site": "news",
"source": "kqed",
"order": 11
},
"link": "/podcasts/onourwatch",
"subscribe": {
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5ucHIub3JnLzUxMDM2MC9wb2RjYXN0LnhtbD9zYz1nb29nbGVwb2RjYXN0cw",
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"rss": "https://feeds.npr.org/510360/podcast.xml"
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},
"on-the-media": {
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"title": "On The Media",
"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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"info": "One of public radio's most dynamic voices, Sam Sanders helped launch The NPR Politics Podcast and hosted NPR's hit show It's Been A Minute. Now, the award-winning host returns with something brand new, The Sam Sanders Show. Every week, Sam Sanders and friends dig into the culture that shapes our lives: what's driving the biggest trends, how artists really think, and even the memes you can't stop scrolling past. Sam is beloved for his way of unpacking the world and bringing you up close to fresh currents and engaging conversations. The Sam Sanders Show is smart, funny and always a good time.",
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