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"content": "\u003cp>Before the 1980s, clinicians actually performed surgery on newborns \u003ca href=\"https://gizmodo.com/why-are-so-many-newborns-still-being-denied-pain-relief-1755495866\">without giving them anaesthetics or pain medications\u003c/a>. This wasn’t because they thought babies were completely incapable of feeling pain. But they didn’t know how much pain the newborns could experience and feared that the medications may be too dangerous to warrant use.\u003c/p>\n\u003caside class=\"pullquote alignright\">We may be underestimating how much pain babies feel when they are under stress.\u003c/aside>\n\u003cp>Luckily we are better informed today. As babies can’t tell us how much pain they are in, scientists have invented several ingenious methods to try and work out what they are feeling. But there’s still a remarkable amount we don’t understand. And our new study, \u003ca href=\"http://www.cell.com/current-biology/fulltext/S0960-9822(17)31400-8\">published in \u003cem>Current Biology\u003c/em>\u003c/a>, shows that we may be underestimating how much pain babies feel when they are under stress.\u003c/p>\n\u003cp>The reason progress has been relatively slow is that there was for a long time no agreed method for reliably measuring babies’ pain perception. It’s only in the last few decades scientists have made increasing efforts to do this – and the results may be applicable to other people who are unable to communicate too.\u003c/p>\n\u003cp>The first clues came from animal models in the early 1980s. These showed that the structural and functional connections within the nervous system required to perceive a painful event \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/15995722\">are present from birth\u003c/a>. However, we still do not know whether these connections are sufficiently mature for infants to experience pain in quite the same way as adults.\u003c/p>\n\u003cp>[contextly_sidebar id=\"BJ3pqNXoimP8bsBlSfB7ESqz7mKXi3rn\"]At the same time, clinical investigators started exploring ways of measuring pain in human infants. Following a painful procedure, such as the heel stick used for blood tests (much like a finger prick used for adult blood tests), \u003ca href=\"http://europepmc.org/abstract/med/9409099\">infants show several significant responses\u003c/a>. These range from physiological (changes in heart rate or breathing) and hormonal (release of the “stress hormone” cortisol) to behavioural (crying or grimacing).\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Extensive research in this area suggested that infant pain should be evaluated with a combination of these measures, leading to the development of neonatal clinical pain scoring systems, such as the \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/8722730\">Premature Infant Pain Profile\u003c/a>.\u003c/p>\n\u003cp>\u003cstrong>Pain in the brain\u003c/strong>\u003cbr>\nAnother big advance in the field came from the Fitzgerald lab here at University College London, which moved away from solely using observations of behavior and physiological responses to measure pain. Instead, it turned to the brain. We know that the perception of pain is generated by the central nervous system, so these researchers aimed to directly measure the activity of neurons (brain cells) that are responsible for the sensation of pain.\u003c/p>\n\u003cp>To do this, they used non-invasive measures like \u003ca href=\"http://www.uhs.nhs.uk/OurServices/Brainspineandneuromuscular/Clinicalneurophysiology/Electromyography.aspx\">electromyography\u003c/a>(EMG) and \u003ca href=\"https://www.nhs.uk/conditions/electroencephalogram/\">electroencephalography\u003c/a> (EEG), which measure the electrical activity generated by muscles and brain cells, following a painful event. This method has the advantage of being both objective and quantitative, as it does not depend on observational scoring.\u003c/p>\n\u003cp>These studies confirmed that infants do process pain in the brain, but that they differ in their experiences with age. First, the lab recorded spinal reflexes – such as the withdrawal reflex, which is intended to protect the body from damaging stimuli – and found that premature infants are \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/8159446\">more sensitive to sensory stimulation\u003c/a> than older infants. They subjected babies to repeated non-painful touches, and found that younger infants moved their limbs following lighter touches than older infants. In fact, the older infants got used to the repeated touches and eventually stopped moving their limbs.\u003c/p>\n\u003cp>[contextly_sidebar id=\"t4QP70bYEJJe0X6Osa1q4RPSKJ8fEsXS\"]They also found that premature infants responded to both painful and non-painful touch with whole body movements. In older babies (at term age, around 40 weeks) this matured into more a purposeful withdrawal of the stimulated limb, \u003ca href=\"http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0076470\">becoming more specific to pain\u003c/a> rather than any touch.\u003c/p>\n\u003cp>An important next step was to record activity in the brain, which is where pain perception occurs. They did this with EEG, which uses electrodes placed on the scalp to track and record brain waves. They found that premature infants exhibited large bursts of brain activity which, as with early reflexes, are not specific to pain (a simple tap could produce a similar effect as a heel prick). Towards normal term age (a few weeks prior), infants were \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/21906948\">more likely to show a clear pain-specific brainwave\u003c/a>similar to that seen in adults.\u003c/p>\n\u003cp>However, while this was a direct read out of what was happening in the nervous system after a painful event, you shouldn’t assume it was a direct reflection of what the baby was feeling. This is because the feeling of pain requires an \u003ca href=\"https://theconversation.com/pain-is-more-than-a-physical-process-now-a-study-in-mice-suggests-it-may-even-be-socially-transferable-67479\">emotional component as well as a sensory part\u003c/a>, and although we can measure the sensory aspect, we can not measure or make assumptions about the emotional processing in a newborn.\u003c/p>\n\u003cp>\u003cstrong>Stress and pain\u003c/strong>\u003cbr>\nIn our latest research, my colleagues and I at the Fitzgerald lab focused on stress and pain. Many infants experience physiological stress as a result of necessary clinical procedures. For example, hospitalized babies often require several painful procedures a day as part of their care, and those who do not will likely experience events such as being weighed or loud noises (alarms) as stressful.\u003c/p>\n\u003cp>For the first time, we measured both pain and stress at the same time as a single, clinically required blood test. In 56 hospitalised newborns, the pain-related brain activity and behavioural response was measured following the blood test, while the babies’ background level of stress was measured using the concentration of a stress hormone (cortisol) in the saliva and heart rate patterns.\u003c/p>\n\u003cp>[contextly_sidebar id=\"0wjAsSlSUcsEOQMQ6W9PhNBBMGzmlLPs\"]The results show that for babies who are not stressed, a painful procedure \u003ca href=\"http://www.cell.com/current-biology/fulltext/S0960-9822(17)31400-8\">will often result\u003c/a> in a coordinated increase in brain activity and behaviour, in the form of facial expressions. Babies who are more stressed have an even larger response in the brain following a painful procedure, but, importantly, this is no longer matched by changes in behaviour. In other words, a stressed baby may have strong pain-related activity in their brain, but you could not tell that from simply observing their behaviour.\u003c/p>\n\u003cp>Since increased levels of stress can increase the amount of pain-related brain activity, it is clear that we should monitor and control the stress levels of hospitalized babies. Stressed babies may not seem to respond to pain although their brain is still processing it. The phenomenon has been seen in premature babies who sometimes “tune out” and become unresponsive when they are overwhelmed. But that doesn’t mean they are not experiencing something. Importantly, this means that doctors and nurses may underestimate their pain.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>Given its huge importance, it may seem surprising that we know so little about what newborns actually feel. Thankfully, research is unravelling the mystery with impressive speed.\u003c/p>\n\n",
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We know that the perception of pain is generated by the central nervous system, so these researchers aimed to directly measure the activity of neurons (brain cells) that are responsible for the sensation of pain.\u003c/p>\n\u003cp>To do this, they used non-invasive measures like \u003ca href=\"http://www.uhs.nhs.uk/OurServices/Brainspineandneuromuscular/Clinicalneurophysiology/Electromyography.aspx\">electromyography\u003c/a>(EMG) and \u003ca href=\"https://www.nhs.uk/conditions/electroencephalogram/\">electroencephalography\u003c/a> (EEG), which measure the electrical activity generated by muscles and brain cells, following a painful event. This method has the advantage of being both objective and quantitative, as it does not depend on observational scoring.\u003c/p>\n\u003cp>These studies confirmed that infants do process pain in the brain, but that they differ in their experiences with age. First, the lab recorded spinal reflexes – such as the withdrawal reflex, which is intended to protect the body from damaging stimuli – and found that premature infants are \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/8159446\">more sensitive to sensory stimulation\u003c/a> than older infants. They subjected babies to repeated non-painful touches, and found that younger infants moved their limbs following lighter touches than older infants. In fact, the older infants got used to the repeated touches and eventually stopped moving their limbs.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>They also found that premature infants responded to both painful and non-painful touch with whole body movements. In older babies (at term age, around 40 weeks) this matured into more a purposeful withdrawal of the stimulated limb, \u003ca href=\"http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0076470\">becoming more specific to pain\u003c/a> rather than any touch.\u003c/p>\n\u003cp>An important next step was to record activity in the brain, which is where pain perception occurs. They did this with EEG, which uses electrodes placed on the scalp to track and record brain waves. They found that premature infants exhibited large bursts of brain activity which, as with early reflexes, are not specific to pain (a simple tap could produce a similar effect as a heel prick). Towards normal term age (a few weeks prior), infants were \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/21906948\">more likely to show a clear pain-specific brainwave\u003c/a>similar to that seen in adults.\u003c/p>\n\u003cp>However, while this was a direct read out of what was happening in the nervous system after a painful event, you shouldn’t assume it was a direct reflection of what the baby was feeling. This is because the feeling of pain requires an \u003ca href=\"https://theconversation.com/pain-is-more-than-a-physical-process-now-a-study-in-mice-suggests-it-may-even-be-socially-transferable-67479\">emotional component as well as a sensory part\u003c/a>, and although we can measure the sensory aspect, we can not measure or make assumptions about the emotional processing in a newborn.\u003c/p>\n\u003cp>\u003cstrong>Stress and pain\u003c/strong>\u003cbr>\nIn our latest research, my colleagues and I at the Fitzgerald lab focused on stress and pain. Many infants experience physiological stress as a result of necessary clinical procedures. For example, hospitalized babies often require several painful procedures a day as part of their care, and those who do not will likely experience events such as being weighed or loud noises (alarms) as stressful.\u003c/p>\n\u003cp>For the first time, we measured both pain and stress at the same time as a single, clinically required blood test. In 56 hospitalised newborns, the pain-related brain activity and behavioural response was measured following the blood test, while the babies’ background level of stress was measured using the concentration of a stress hormone (cortisol) in the saliva and heart rate patterns.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>The results show that for babies who are not stressed, a painful procedure \u003ca href=\"http://www.cell.com/current-biology/fulltext/S0960-9822(17)31400-8\">will often result\u003c/a> in a coordinated increase in brain activity and behaviour, in the form of facial expressions. Babies who are more stressed have an even larger response in the brain following a painful procedure, but, importantly, this is no longer matched by changes in behaviour. In other words, a stressed baby may have strong pain-related activity in their brain, but you could not tell that from simply observing their behaviour.\u003c/p>\n\u003cp>Since increased levels of stress can increase the amount of pain-related brain activity, it is clear that we should monitor and control the stress levels of hospitalized babies. Stressed babies may not seem to respond to pain although their brain is still processing it. The phenomenon has been seen in premature babies who sometimes “tune out” and become unresponsive when they are overwhelmed. But that doesn’t mean they are not experiencing something. Importantly, this means that doctors and nurses may underestimate their pain.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>Christina Farr was the first host of KQED Future of You, but today she’s better known as a technology and health \u003ca href=\"https://www.cnbc.com/christina-farr/\" target=\"_blank\" rel=\"noopener\">reporter\u003c/a> for CNBC, where she continues to break \u003ca href=\"https://www.cnbc.com/2017/07/26/amazon-1492-secret-health-tech-project.html\" target=\"_blank\" rel=\"noopener\">stories\u003c/a>. She’s been covering digital health for years, and she's one of the more influential media voices on this beat -- in 2016, venture fund Rock Health named her \u003ca href=\"https://rockhealth.com/where-are-the-2016-top-50-in-digital-health-now/\" target=\"_blank\" rel=\"noopener\">digital health reporter of the year\u003c/a>.\u003c/p>\n\u003cp>As Chrissy's successor at this site, I thought it would be cool to get back to our roots and pick her brain on where digital health is going and where it's been. I interviewed her at CNBC’s San Francisco office, located in skyscraping Salesforce Tower. Here’s our chat, edited for length and clarity.\u003c/p>\n\u003cp>\u003cstrong>First off, how should we define digital health?\u003c/strong>\u003c/p>\n\u003caside class=\"pullquote alignright\">On wearables: 'I'm really still quite bullish. It’s not just millennials and the \"worried well\" that are using these devices; a lot of seniors love them.'\u003c/aside>\n\u003cp>People have attempted to come up with a good working definition, and sometimes it ends up sounding very vague, like \"the intersection of health and technology.\"\u003c/p>\n\u003cp>I think the term will forever be associated with \u003ca href=\"https://ww2.kqed.org/futureofyou/tag/wearables/\" target=\"_blank\" rel=\"noopener\">wearables\u003c/a> and \u003ca href=\"https://ww2.kqed.org/futureofyou/tag/telemedicine/\" target=\"_blank\" rel=\"noopener\">telemedicine\u003c/a>, and now AI and a couple of other trends. I don't really see a problem with that, because it's still connected with innovation in a lot of people's minds.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cstrong>What have been some of the successes in the digital health space?\u003c/strong>\u003c/p>\n\u003cp>I see a lot of potential in digital therapeutics. Companies like Propeller Health and \u003ca href=\"https://ww2.kqed.org/futureofyou/2016/06/23/expanding-digital-health-beyond-the-rich/\" target=\"_blank\" rel=\"noopener\">Omada Health\u003c/a> are studying the effect of apps that attempt to change behavior for purposes of disease prevention and management. Propeller Health, for example, is thinking about \u003ca href=\"https://ww2.kqed.org/futureofyou/2017/06/13/inhalers-plus-smartphones-meant-fewer-trips-to-er-hospital/\" target=\"_blank\" rel=\"noopener\">connected inhalers\u003c/a> and how to combine them with data like the weather to figure out when a person with asthma should take medicine.\u003c/p>\n\u003caside class=\"pullquote alignright\">Disappointments? Telehealth and artificial intelligence.\u003c/aside>\n\u003cp>Virta Health is going after Type 2 diabetes reversal with a\u003ca href=\"https://www.medscape.com/viewarticle/890090\" target=\"_blank\" rel=\"noopener\"> digital system\u003c/a> that encourages a massive behavior change around diet, which it thinks could actually replace medicines.\u003c/p>\n\u003cp>AliveCor is a super-interesting company. They have a \u003ca href=\"https://ww2.kqed.org/futureofyou/2016/03/17/mobile-ekg-on-a-watchband-is-useful-for-some-say-docs/\" target=\"_blank\" rel=\"noopener\">mobile EKG\u003c/a> that a lot of doctors really like. I think it's something that a lot of seniors will use when they find out they're at risk for \u003ca href=\"http://www.heart.org/HEARTORG/Conditions/Arrhythmia/AboutArrhythmia/What-is-Atrial-Fibrillation-AFib-or-AF_UCM_423748_Article.jsp#.VusMvOIrKUk\" target=\"_blank\" rel=\"noopener\">atrial fibrillation\u003c/a>, because it means they can check on their heart from home and not have to go to the doctor every few months.\u003c/p>\n\u003cp>\u003cstrong>You mentioned wearables, like Fitbit and Apple Watch. How's that business going? \u003c/strong>\u003c/p>\n\u003cp>I‘m really still quite bullish on wearables, and I think they have become mainstream. It's not just millennials and the \"\u003ca href=\"http://www.telegraph.co.uk/lifestyle/wellbeing/diet/10977877/Are-you-one-of-the-rising-numbers-of-the-worried-well.html\" target=\"_blank\" rel=\"noopener\">worried well\u003c/a>\" that are using these devices; a lot of seniors love them. You're also starting to see insurance companies think about partnering with companies like Apple, and the reason they're doing that isn't necessarily to get their already healthy populations to exercise more; it's about getting to those really sick and costly people that have multiple chronic conditions.\u003c/p>\n\u003cp>\u003cstrong>Do you think investors in the digital health space are more circumspect after the \u003ca href=\"https://ww2.kqed.org/futureofyou/2016/10/13/the-rise-and-fall-of-theranos-a-cartoon-history/\" target=\"_blank\" rel=\"noopener\">Theranos debacle\u003c/a>?\u003c/strong>\u003c/p>\n\u003cp>Some are. Others don't necessarily want companies to invest the time into building a base of evidence before they start selling the product; these investors are looking for their money back in three to five years, like they would get with a consumer internet company.\u003c/p>\n\u003caside class=\"pullquote alignright\">'In a lot of ways, Theranos is just the worst example.'\u003c/aside>\n\u003cp>It's hard to find another company like Theranos, which put patients \u003ca href=\"http://tucson.com/news/local/theranos-to-pay-m-to-arizonans-over-blood-tests-that/article_dacc3bd1-54e0-58dd-92b3-18dec8eb8854.html\" target=\"_blank\" rel=\"noopener\">in danger\u003c/a>. But in a lot of ways, Theranos is just the worst example. More companies are still failing to provide proper evidence. Often they say, \"We're wellness. We're not making claims around disease, so we don't need to bother.\"\u003c/p>\n\u003cp>\u003cstrong>What's the biggest disappointment of the digital health era to date?\u003c/strong>\u003c/p>\n\u003cp>This is going to be controversial, but I don't think telemedicine has panned out to the extent people expected it would by this time. People thought it was going to revolutionize all health care. But I'm not seeing every physician say this is something they want to incorporate into their medical practice, because there's a perception they're not going to get paid as much.\u003c/p>\n\u003cp>Also pretty overhyped in terms of what we're actually seeing out there: AI and big data. \u003ca href=\"https://ww2.kqed.org/futureofyou/2015/08/20/this-robo-eye-doctor-may-help-patients-with-diabetes-keep-sight/\" target=\"_blank\" rel=\"noopener\">Diabetic retinopathy\u003c/a>, for example, is an area where you see a lot of people investing in AI research. Could we take a pile of medical images that have been labeled as showing diabetic retinopathy or not, and then you train AI to do that job in triage?\u003c/p>\n\u003cp>There's been some great results, but that does not mean we're on the cusp of a robo eye doctor, because an actual eye doctor would\u003ca href=\"https://ww2.kqed.org/futureofyou/2016/11/07/will-computers-ever-be-able-to-make-diagnoses-as-well-as-physicians/\" target=\"_blank\" rel=\"noopener\"> need to know\u003c/a> every single medical condition out there that could be affecting this person. I think we’ve been too quick to look at one disease and one use case and say, well, this is evidence that doctors will be replaced.\u003c/p>\n\u003cp>\u003cb>Do you think the Food and Drug Administration and other regulators can keep up with all this? And does the industry \u003cem>want\u003c/em> them to keep up?\u003c/b>\u003c/p>\n\u003cfigure id=\"attachment_437841\" class=\"wp-caption alignright\" style=\"max-width: 640px\">\u003ca href=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/12/chrissymum.jpg\">\u003cimg class=\"wp-image-437841 size-large\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/12/chrissymum-1020x591.jpg\" alt=\"\" width=\"640\" height=\"371\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/12/chrissymum-1020x591.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/chrissymum-160x93.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/chrissymum-800x463.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/chrissymum-768x445.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/chrissymum-1180x683.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/chrissymum-960x556.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/chrissymum-240x139.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/chrissymum-375x217.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/chrissymum-520x301.jpg 520w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/chrissymum.jpg 1613w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Chrissy Farr discussing Fitbit vs. Apple Watch with her mom, for a CNBC segment. (CNBC)\u003c/figcaption>\u003c/figure>\n\u003cp>I think at the birth of this digital health movement, people thought of the FDA as the big bad wolf. The prevailing narrative was that it's obstructing innovation. Now there seems to be more nuance around that; people recognize that the FDA does have an important role to play. Many of the digital therapeutics companies, for instance, see the FDA as a potential stamp of approval that sets them ahead of a mass of apps that are making false claims and essentially peddling snake oil.\u003c/p>\n\u003cp>So there needs to be a watchdog, but that's not the FDA's role. They're not out there policing companies and investing time into looking through the app store and thinking, \"This dermatology app doesn't look quite right.\"\u003c/p>\n\u003cp>As a result, you get this huge quality variation, and I do sometimes fear that doctors will start prescribing or patients will start using apps that are of lower quality. I think someone needs to step into that role in 2018 so we have a better way of figuring out which apps work and which don't.\u003c/p>\n\u003cp>\u003cstrong>Last question: Occasionally you hear the complaint about digital health that these are primarily tools for young, rich people. Do you think that's valid?\u003c/strong>\u003c/p>\n\u003cp>The true problems of health care, which are particularly an issue for underrepresented groups and minorities, are around how it's paid for. We need massive payment reforms. There's also a lack of investment around social determinants, things like social services and affordable housing, which improve outcomes. \u003cspan style=\"font-weight: 400\">All of these problems are not going to be solved with an AI Band-Aid or by handing someone a Fitbit.\u003c/span>\u003c/p>\n\u003cp>That said, I don't think it's fair to label this entire group of companies as purely helping the rich, wealthy, paranoid types who are just \u003ca href=\"https://www.youtube.com/watch?v=hBA0AH-LSbo\" target=\"_blank\" rel=\"noopener\">dying to live forever\u003c/a>.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>A lot of these companies are going after Medicaid populations, and that absolutely makes sense; that's more than 12 million people in California alone. Even Apple, which hasn't traditionally been a health care player, is working with Aetna on a study with Stanford about whether or not they can use the Apple Watch to detect \u003ca href=\"http://www.heart.org/HEARTORG/Conditions/Arrhythmia/AboutArrhythmia/What-is-Atrial-Fibrillation-AFib-or-AF_UCM_423748_Article.jsp#.VusMvOIrKUk\" rel=\"noopener\">afib\u003c/a>. That's not something a young or healthy person would necessarily worry about at all. It's something that over-65, more vulnerable populations with a history of stroke are more at risk for. So you can see even Apple saying this is a tool that we expected would be mostly about consumer delight, but we've found that it can help save lives.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Christina Farr was the first host of KQED Future of You, but today she’s better known as a technology and health \u003ca href=\"https://www.cnbc.com/christina-farr/\" target=\"_blank\" rel=\"noopener\">reporter\u003c/a> for CNBC, where she continues to break \u003ca href=\"https://www.cnbc.com/2017/07/26/amazon-1492-secret-health-tech-project.html\" target=\"_blank\" rel=\"noopener\">stories\u003c/a>. She’s been covering digital health for years, and she's one of the more influential media voices on this beat -- in 2016, venture fund Rock Health named her \u003ca href=\"https://rockhealth.com/where-are-the-2016-top-50-in-digital-health-now/\" target=\"_blank\" rel=\"noopener\">digital health reporter of the year\u003c/a>.\u003c/p>\n\u003cp>As Chrissy's successor at this site, I thought it would be cool to get back to our roots and pick her brain on where digital health is going and where it's been. I interviewed her at CNBC’s San Francisco office, located in skyscraping Salesforce Tower. Here’s our chat, edited for length and clarity.\u003c/p>\n\u003cp>\u003cstrong>First off, how should we define digital health?\u003c/strong>\u003c/p>\n\u003caside class=\"pullquote alignright\">On wearables: 'I'm really still quite bullish. It’s not just millennials and the \"worried well\" that are using these devices; a lot of seniors love them.'\u003c/aside>\n\u003cp>People have attempted to come up with a good working definition, and sometimes it ends up sounding very vague, like \"the intersection of health and technology.\"\u003c/p>\n\u003cp>I think the term will forever be associated with \u003ca href=\"https://ww2.kqed.org/futureofyou/tag/wearables/\" target=\"_blank\" rel=\"noopener\">wearables\u003c/a> and \u003ca href=\"https://ww2.kqed.org/futureofyou/tag/telemedicine/\" target=\"_blank\" rel=\"noopener\">telemedicine\u003c/a>, and now AI and a couple of other trends. I don't really see a problem with that, because it's still connected with innovation in a lot of people's minds.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cstrong>What have been some of the successes in the digital health space?\u003c/strong>\u003c/p>\n\u003cp>I see a lot of potential in digital therapeutics. Companies like Propeller Health and \u003ca href=\"https://ww2.kqed.org/futureofyou/2016/06/23/expanding-digital-health-beyond-the-rich/\" target=\"_blank\" rel=\"noopener\">Omada Health\u003c/a> are studying the effect of apps that attempt to change behavior for purposes of disease prevention and management. Propeller Health, for example, is thinking about \u003ca href=\"https://ww2.kqed.org/futureofyou/2017/06/13/inhalers-plus-smartphones-meant-fewer-trips-to-er-hospital/\" target=\"_blank\" rel=\"noopener\">connected inhalers\u003c/a> and how to combine them with data like the weather to figure out when a person with asthma should take medicine.\u003c/p>\n\u003caside class=\"pullquote alignright\">Disappointments? Telehealth and artificial intelligence.\u003c/aside>\n\u003cp>Virta Health is going after Type 2 diabetes reversal with a\u003ca href=\"https://www.medscape.com/viewarticle/890090\" target=\"_blank\" rel=\"noopener\"> digital system\u003c/a> that encourages a massive behavior change around diet, which it thinks could actually replace medicines.\u003c/p>\n\u003cp>AliveCor is a super-interesting company. They have a \u003ca href=\"https://ww2.kqed.org/futureofyou/2016/03/17/mobile-ekg-on-a-watchband-is-useful-for-some-say-docs/\" target=\"_blank\" rel=\"noopener\">mobile EKG\u003c/a> that a lot of doctors really like. I think it's something that a lot of seniors will use when they find out they're at risk for \u003ca href=\"http://www.heart.org/HEARTORG/Conditions/Arrhythmia/AboutArrhythmia/What-is-Atrial-Fibrillation-AFib-or-AF_UCM_423748_Article.jsp#.VusMvOIrKUk\" target=\"_blank\" rel=\"noopener\">atrial fibrillation\u003c/a>, because it means they can check on their heart from home and not have to go to the doctor every few months.\u003c/p>\n\u003cp>\u003cstrong>You mentioned wearables, like Fitbit and Apple Watch. How's that business going? \u003c/strong>\u003c/p>\n\u003cp>I‘m really still quite bullish on wearables, and I think they have become mainstream. It's not just millennials and the \"\u003ca href=\"http://www.telegraph.co.uk/lifestyle/wellbeing/diet/10977877/Are-you-one-of-the-rising-numbers-of-the-worried-well.html\" target=\"_blank\" rel=\"noopener\">worried well\u003c/a>\" that are using these devices; a lot of seniors love them. You're also starting to see insurance companies think about partnering with companies like Apple, and the reason they're doing that isn't necessarily to get their already healthy populations to exercise more; it's about getting to those really sick and costly people that have multiple chronic conditions.\u003c/p>\n\u003cp>\u003cstrong>Do you think investors in the digital health space are more circumspect after the \u003ca href=\"https://ww2.kqed.org/futureofyou/2016/10/13/the-rise-and-fall-of-theranos-a-cartoon-history/\" target=\"_blank\" rel=\"noopener\">Theranos debacle\u003c/a>?\u003c/strong>\u003c/p>\n\u003cp>Some are. Others don't necessarily want companies to invest the time into building a base of evidence before they start selling the product; these investors are looking for their money back in three to five years, like they would get with a consumer internet company.\u003c/p>\n\u003caside class=\"pullquote alignright\">'In a lot of ways, Theranos is just the worst example.'\u003c/aside>\n\u003cp>It's hard to find another company like Theranos, which put patients \u003ca href=\"http://tucson.com/news/local/theranos-to-pay-m-to-arizonans-over-blood-tests-that/article_dacc3bd1-54e0-58dd-92b3-18dec8eb8854.html\" target=\"_blank\" rel=\"noopener\">in danger\u003c/a>. But in a lot of ways, Theranos is just the worst example. More companies are still failing to provide proper evidence. Often they say, \"We're wellness. We're not making claims around disease, so we don't need to bother.\"\u003c/p>\n\u003cp>\u003cstrong>What's the biggest disappointment of the digital health era to date?\u003c/strong>\u003c/p>\n\u003cp>This is going to be controversial, but I don't think telemedicine has panned out to the extent people expected it would by this time. People thought it was going to revolutionize all health care. But I'm not seeing every physician say this is something they want to incorporate into their medical practice, because there's a perception they're not going to get paid as much.\u003c/p>\n\u003cp>Also pretty overhyped in terms of what we're actually seeing out there: AI and big data. \u003ca href=\"https://ww2.kqed.org/futureofyou/2015/08/20/this-robo-eye-doctor-may-help-patients-with-diabetes-keep-sight/\" target=\"_blank\" rel=\"noopener\">Diabetic retinopathy\u003c/a>, for example, is an area where you see a lot of people investing in AI research. Could we take a pile of medical images that have been labeled as showing diabetic retinopathy or not, and then you train AI to do that job in triage?\u003c/p>\n\u003cp>There's been some great results, but that does not mean we're on the cusp of a robo eye doctor, because an actual eye doctor would\u003ca href=\"https://ww2.kqed.org/futureofyou/2016/11/07/will-computers-ever-be-able-to-make-diagnoses-as-well-as-physicians/\" target=\"_blank\" rel=\"noopener\"> need to know\u003c/a> every single medical condition out there that could be affecting this person. I think we’ve been too quick to look at one disease and one use case and say, well, this is evidence that doctors will be replaced.\u003c/p>\n\u003cp>\u003cb>Do you think the Food and Drug Administration and other regulators can keep up with all this? And does the industry \u003cem>want\u003c/em> them to keep up?\u003c/b>\u003c/p>\n\u003cfigure id=\"attachment_437841\" class=\"wp-caption alignright\" style=\"max-width: 640px\">\u003ca href=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/12/chrissymum.jpg\">\u003cimg class=\"wp-image-437841 size-large\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/12/chrissymum-1020x591.jpg\" alt=\"\" width=\"640\" height=\"371\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/12/chrissymum-1020x591.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/chrissymum-160x93.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/chrissymum-800x463.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/chrissymum-768x445.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/chrissymum-1180x683.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/chrissymum-960x556.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/chrissymum-240x139.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/chrissymum-375x217.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/chrissymum-520x301.jpg 520w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/chrissymum.jpg 1613w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Chrissy Farr discussing Fitbit vs. Apple Watch with her mom, for a CNBC segment. (CNBC)\u003c/figcaption>\u003c/figure>\n\u003cp>I think at the birth of this digital health movement, people thought of the FDA as the big bad wolf. The prevailing narrative was that it's obstructing innovation. Now there seems to be more nuance around that; people recognize that the FDA does have an important role to play. Many of the digital therapeutics companies, for instance, see the FDA as a potential stamp of approval that sets them ahead of a mass of apps that are making false claims and essentially peddling snake oil.\u003c/p>\n\u003cp>So there needs to be a watchdog, but that's not the FDA's role. They're not out there policing companies and investing time into looking through the app store and thinking, \"This dermatology app doesn't look quite right.\"\u003c/p>\n\u003cp>As a result, you get this huge quality variation, and I do sometimes fear that doctors will start prescribing or patients will start using apps that are of lower quality. I think someone needs to step into that role in 2018 so we have a better way of figuring out which apps work and which don't.\u003c/p>\n\u003cp>\u003cstrong>Last question: Occasionally you hear the complaint about digital health that these are primarily tools for young, rich people. Do you think that's valid?\u003c/strong>\u003c/p>\n\u003cp>The true problems of health care, which are particularly an issue for underrepresented groups and minorities, are around how it's paid for. We need massive payment reforms. There's also a lack of investment around social determinants, things like social services and affordable housing, which improve outcomes. \u003cspan style=\"font-weight: 400\">All of these problems are not going to be solved with an AI Band-Aid or by handing someone a Fitbit.\u003c/span>\u003c/p>\n\u003cp>That said, I don't think it's fair to label this entire group of companies as purely helping the rich, wealthy, paranoid types who are just \u003ca href=\"https://www.youtube.com/watch?v=hBA0AH-LSbo\" target=\"_blank\" rel=\"noopener\">dying to live forever\u003c/a>.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>A lot of these companies are going after Medicaid populations, and that absolutely makes sense; that's more than 12 million people in California alone. Even Apple, which hasn't traditionally been a health care player, is working with Aetna on a study with Stanford about whether or not they can use the Apple Watch to detect \u003ca href=\"http://www.heart.org/HEARTORG/Conditions/Arrhythmia/AboutArrhythmia/What-is-Atrial-Fibrillation-AFib-or-AF_UCM_423748_Article.jsp#.VusMvOIrKUk\" rel=\"noopener\">afib\u003c/a>. That's not something a young or healthy person would necessarily worry about at all. It's something that over-65, more vulnerable populations with a history of stroke are more at risk for. So you can see even Apple saying this is a tool that we expected would be mostly about consumer delight, but we've found that it can help save lives.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Ask Edith Smith, a proud 103-year-old, about her friends, and she’ll give you an earful.\u003c/p>\n\u003cp>There’s Johnetta, 101, whom she’s known for 70 years and who has Alzheimer’s disease. “I call her every day and just say ‘Hi, how are you doing?’ She never knows, but she says hi back, and I tease her,” Smith said.\u003c/p>\n\u003cp>There’s Katie, 93, whom Smith met during a long teaching career with the Chicago Public Schools. “Every day we have a good conversation. She’s still driving and lives in her own house, and she tells me what’s going on.”\u003c/p>\n\u003cp>[contextly_sidebar id=\"n7PadCScyIHCxbTGW7giMlyxz5OzMzXV\"]Then there’s Rhea, 90, whom Smith visits regularly at a retirement facility. And Mary, 95, who doesn’t leave her house anymore, “so I fix her a basket about once a month of jelly and little things I make and send it over by cab.” And fellow residents at Smith’s Chicago senior community, whom she recognizes with a card and a treat on their birthdays.\u003c/p>\n\u003cp>“I’m a very friendly person,” Smith said, when asked to describe herself.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>That may be one reason why this lively centenarian has an extraordinary memory for someone her age, suggests a \u003ca href=\"http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0186413\">recent study\u003c/a> by researchers at Northwestern University highlighting a notable link between brain health and positive relationships.\u003c/p>\n\u003cp>For nine years, these experts have been examining “SuperAgers” — men and women over age 80 whose memories are as good — or better — than people 20 to 30 years younger. Every couple of years, the group fills out surveys about their lives and gets a battery of neuropsychological tests, brain scans and a neurological examination, among other evaluations.\u003c/p>\n\u003cp>“When we started this project, we weren’t really sure we could find these individuals,” said Emily Rogalski, an associate professor at the \u003ca href=\"http://www.brain.northwestern.edu/\">Cognitive Neurology and Alzheimer’s Disease Center\u003c/a> at Northwestern’s Feinberg School of Medicine.\u003c/p>\n\u003cp>[contextly_sidebar id=\"4U4sS7Bw111D7XkndosbllDfiF6jmbgc\"]But find them they did: Thirty-one older men and women with exceptional memories, mostly from Illinois and surrounding states, are currently participating in the project. “Part of the goal is to characterize them — who are they, what are they like,” Rogalski said.\u003c/p>\n\u003cp>\u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/23198888\">Previous research\u003c/a> by the Northwestern group provided tantalizing clues, showing that SuperAgers have distinctive brain features: thicker cortexes, a resistance to age-related atrophy and a larger left anterior cingulate (a part of the brain important to attention and working memory).\u003c/p>\n\u003cp>But brain structure alone doesn’t fully account for SuperAgers’ unusual mental acuity, Rogalski suggested. “It’s likely there are a number of critical factors that are implicated,” she said.\u003c/p>\n\u003cp>For their new study, the researchers asked 31 SuperAgers and 19 cognitively “normal” older adults to fill out a 42-item questionnaire about their psychological well-being. The SuperAgers stood out in one area: the degree to which they reported having satisfying, warm, trusting relationships. (In other areas, such as having a purpose in life or retaining autonomy, they were much like their “normal” peers.)\u003c/p>\n\u003cp>“Social relationships are really important” to this group and might play a significant role in preserving their cognition, Rogalski said.\u003c/p>\n\u003cp>That finding is consistent with \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/12048221\">other research\u003c/a> linking positive relationships to a reduced risk of cognitive decline, mild cognitive impairment and dementia. Still, researchers haven’t examined how SuperAgers sustain these relationships and whether their experiences might include lessons for others.\u003c/p>\n\u003cp>Smith, one of the SuperAgers, has plenty of thoughts about that. At her retirement community, she’s one of nine people who welcome new residents and try to help make them feel at home. “I have a smile for everybody,” she said. “I try to learn someone’s name as soon as they come in, and if I see them it’s ‘Good morning, how do you do?’”\u003c/p>\n\u003cp>“Many old people, all they do is tell you the same story over and over,” she said. “And sometimes, all they do is complain and not show any interest in what you have to say. That’s terrible. You have to listen to what people have to say.”\u003c/p>\n\u003cp>[contextly_sidebar id=\"9X5WvOeRrI52w9EmejSKTOzSrtdJp7Hn\"]Brian Fenwick, administrator of the Bethany Retirement Community where Smith lives, calls Smith a “leader in the community” and explains that “she’s very involved. She keeps us in line. She notices what’s going on and isn’t afraid to speak out.”\u003c/p>\n\u003cp>Fifteen years ago, Smith became a caregiver for her husband, who passed away in 2013. “All the time he was ill, I was still doing things for me,” she recalls. “You cannot drop everything and expect to be able to pick it up. You can’t drop your friends and expect them to be there when you’re ready.”\u003c/p>\n\u003cp>What she does every day, she said, is “show people I care.”\u003c/p>\n\u003cp>William “Bill“ Gurolnick, 86, another SuperAger in the study, realized the value of becoming more demonstrative after he retired from a sales and marketing position in 1999. “Men aren’t usually inclined to talk about their feelings, and I was a keep-things-inside kind of person,” he explained. “But opening up to other people is one of the things that I learned to do.”\u003c/p>\n\u003cp>With a small group of other men who’d left the work world behind, Gurolnick helped found a men’s group, Men Enjoying Leisure, which now has nearly 150 members and has spawned four similar groups in the Chicago suburbs. Every month, the group meets for two hours, including one hour they spend discussing personal issues — divorce, illness, children who can’t find jobs, and more.\u003c/p>\n\u003cp>“We learn people aren’t alone in the problems they’re dealing with,” Gurolnick said, adding that a dozen or so of the men have become good friends.\u003c/p>\n\u003cp>“Bill is the glue that holds the whole group together,” said Buddy Kalish, 80, a member of the group in Northbrook, Ill., a Chicago suburb. “He’s very, very caring — the first one to send out a thank-you note, the first one to send out a notice when there’s been a death in the family.”\u003c/p>\n\u003cp>Activities are another way of cultivating relationships for Gurolnick. On Mondays, he bikes 20 to 30 miles with more than a dozen older men — many of them from his men’s group — followed by lunch. On Tuesdays, he’s part of a walking group, followed by coffee. On Wednesdays, he goes to the Wenger Jewish Community Center in Northbrook for two hours of water volleyball. On Thursdays, it’s back to the JCC for pickleball, a racquet sport.\u003c/p>\n\u003cp>“You really get a sense of still being alive,” Gurolnick said, when asked what he takes away from these interactions. “You get a sense of not being alone.”\u003c/p>\n\u003cp>Without her best friend, Grayce, whom she’s known since high school, and friends who live in her condominium complex, Evelyn Finegan, 88, might have become isolated. Another SuperAger, Finegan is hard of hearing and has macular degeneration in both eyes, but otherwise is astonishingly healthy.\u003c/p>\n\u003cp>“It’s very important to keep up with your friends — to pick up the phone and call,” said Finegan, who talks to Grayce almost daily and chats with four other friends from high school on a regular basis.\u003c/p>\n\u003cp>Today, the staples of Finegan’s life are her church; a monthly book club; volunteering at a resale shop in Oak Park, Ill.; socializing with a few people in her building; attending a club of Welsh women; and seeing her daughter, her son-in-law and grandchildren, who live in Oregon, whenever she can.\u003c/p>\n\u003cp>“It’s so nice to spend time with Evelyn,” said her upstairs neighbor, June Witzl, 91, who often drives Finegan to doctors’ appointments. “She’s very kind and very generous. And she tells you what she believes so you really feel like you know her, instead of wondering what’s on her mind.”\u003c/p>\n\u003cp>\u003cem>We’re eager to hear from readers about questions you’d like answered, problems you’ve been having with your care and advice you need in dealing with the health care system. Visit \u003ca href=\"http://khn.org/columnists\">khn.org/columnists\u003c/a> to submit your requests or tips.\u003c/em>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This story was produced by \u003ca href=\"http://khn.org/\" target=\"_blank\" rel=\"noopener\">Kaiser Health News\u003c/a>, an editorially independent program of the \u003ca href=\"http://kff.org/\">Kaiser Family Foundation\u003c/a>.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Ask Edith Smith, a proud 103-year-old, about her friends, and she’ll give you an earful.\u003c/p>\n\u003cp>There’s Johnetta, 101, whom she’s known for 70 years and who has Alzheimer’s disease. “I call her every day and just say ‘Hi, how are you doing?’ She never knows, but she says hi back, and I tease her,” Smith said.\u003c/p>\n\u003cp>There’s Katie, 93, whom Smith met during a long teaching career with the Chicago Public Schools. “Every day we have a good conversation. She’s still driving and lives in her own house, and she tells me what’s going on.”\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>Then there’s Rhea, 90, whom Smith visits regularly at a retirement facility. And Mary, 95, who doesn’t leave her house anymore, “so I fix her a basket about once a month of jelly and little things I make and send it over by cab.” And fellow residents at Smith’s Chicago senior community, whom she recognizes with a card and a treat on their birthdays.\u003c/p>\n\u003cp>“I’m a very friendly person,” Smith said, when asked to describe herself.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>That may be one reason why this lively centenarian has an extraordinary memory for someone her age, suggests a \u003ca href=\"http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0186413\">recent study\u003c/a> by researchers at Northwestern University highlighting a notable link between brain health and positive relationships.\u003c/p>\n\u003cp>For nine years, these experts have been examining “SuperAgers” — men and women over age 80 whose memories are as good — or better — than people 20 to 30 years younger. Every couple of years, the group fills out surveys about their lives and gets a battery of neuropsychological tests, brain scans and a neurological examination, among other evaluations.\u003c/p>\n\u003cp>“When we started this project, we weren’t really sure we could find these individuals,” said Emily Rogalski, an associate professor at the \u003ca href=\"http://www.brain.northwestern.edu/\">Cognitive Neurology and Alzheimer’s Disease Center\u003c/a> at Northwestern’s Feinberg School of Medicine.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>But find them they did: Thirty-one older men and women with exceptional memories, mostly from Illinois and surrounding states, are currently participating in the project. “Part of the goal is to characterize them — who are they, what are they like,” Rogalski said.\u003c/p>\n\u003cp>\u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/23198888\">Previous research\u003c/a> by the Northwestern group provided tantalizing clues, showing that SuperAgers have distinctive brain features: thicker cortexes, a resistance to age-related atrophy and a larger left anterior cingulate (a part of the brain important to attention and working memory).\u003c/p>\n\u003cp>But brain structure alone doesn’t fully account for SuperAgers’ unusual mental acuity, Rogalski suggested. “It’s likely there are a number of critical factors that are implicated,” she said.\u003c/p>\n\u003cp>For their new study, the researchers asked 31 SuperAgers and 19 cognitively “normal” older adults to fill out a 42-item questionnaire about their psychological well-being. The SuperAgers stood out in one area: the degree to which they reported having satisfying, warm, trusting relationships. (In other areas, such as having a purpose in life or retaining autonomy, they were much like their “normal” peers.)\u003c/p>\n\u003cp>“Social relationships are really important” to this group and might play a significant role in preserving their cognition, Rogalski said.\u003c/p>\n\u003cp>That finding is consistent with \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/12048221\">other research\u003c/a> linking positive relationships to a reduced risk of cognitive decline, mild cognitive impairment and dementia. Still, researchers haven’t examined how SuperAgers sustain these relationships and whether their experiences might include lessons for others.\u003c/p>\n\u003cp>Smith, one of the SuperAgers, has plenty of thoughts about that. At her retirement community, she’s one of nine people who welcome new residents and try to help make them feel at home. “I have a smile for everybody,” she said. “I try to learn someone’s name as soon as they come in, and if I see them it’s ‘Good morning, how do you do?’”\u003c/p>\n\u003cp>“Many old people, all they do is tell you the same story over and over,” she said. “And sometimes, all they do is complain and not show any interest in what you have to say. That’s terrible. You have to listen to what people have to say.”\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>Brian Fenwick, administrator of the Bethany Retirement Community where Smith lives, calls Smith a “leader in the community” and explains that “she’s very involved. She keeps us in line. She notices what’s going on and isn’t afraid to speak out.”\u003c/p>\n\u003cp>Fifteen years ago, Smith became a caregiver for her husband, who passed away in 2013. “All the time he was ill, I was still doing things for me,” she recalls. “You cannot drop everything and expect to be able to pick it up. You can’t drop your friends and expect them to be there when you’re ready.”\u003c/p>\n\u003cp>What she does every day, she said, is “show people I care.”\u003c/p>\n\u003cp>William “Bill“ Gurolnick, 86, another SuperAger in the study, realized the value of becoming more demonstrative after he retired from a sales and marketing position in 1999. “Men aren’t usually inclined to talk about their feelings, and I was a keep-things-inside kind of person,” he explained. “But opening up to other people is one of the things that I learned to do.”\u003c/p>\n\u003cp>With a small group of other men who’d left the work world behind, Gurolnick helped found a men’s group, Men Enjoying Leisure, which now has nearly 150 members and has spawned four similar groups in the Chicago suburbs. Every month, the group meets for two hours, including one hour they spend discussing personal issues — divorce, illness, children who can’t find jobs, and more.\u003c/p>\n\u003cp>“We learn people aren’t alone in the problems they’re dealing with,” Gurolnick said, adding that a dozen or so of the men have become good friends.\u003c/p>\n\u003cp>“Bill is the glue that holds the whole group together,” said Buddy Kalish, 80, a member of the group in Northbrook, Ill., a Chicago suburb. “He’s very, very caring — the first one to send out a thank-you note, the first one to send out a notice when there’s been a death in the family.”\u003c/p>\n\u003cp>Activities are another way of cultivating relationships for Gurolnick. On Mondays, he bikes 20 to 30 miles with more than a dozen older men — many of them from his men’s group — followed by lunch. On Tuesdays, he’s part of a walking group, followed by coffee. On Wednesdays, he goes to the Wenger Jewish Community Center in Northbrook for two hours of water volleyball. On Thursdays, it’s back to the JCC for pickleball, a racquet sport.\u003c/p>\n\u003cp>“You really get a sense of still being alive,” Gurolnick said, when asked what he takes away from these interactions. “You get a sense of not being alone.”\u003c/p>\n\u003cp>Without her best friend, Grayce, whom she’s known since high school, and friends who live in her condominium complex, Evelyn Finegan, 88, might have become isolated. Another SuperAger, Finegan is hard of hearing and has macular degeneration in both eyes, but otherwise is astonishingly healthy.\u003c/p>\n\u003cp>“It’s very important to keep up with your friends — to pick up the phone and call,” said Finegan, who talks to Grayce almost daily and chats with four other friends from high school on a regular basis.\u003c/p>\n\u003cp>Today, the staples of Finegan’s life are her church; a monthly book club; volunteering at a resale shop in Oak Park, Ill.; socializing with a few people in her building; attending a club of Welsh women; and seeing her daughter, her son-in-law and grandchildren, who live in Oregon, whenever she can.\u003c/p>\n\u003cp>“It’s so nice to spend time with Evelyn,” said her upstairs neighbor, June Witzl, 91, who often drives Finegan to doctors’ appointments. “She’s very kind and very generous. And she tells you what she believes so you really feel like you know her, instead of wondering what’s on her mind.”\u003c/p>\n\u003cp>\u003cem>We’re eager to hear from readers about questions you’d like answered, problems you’ve been having with your care and advice you need in dealing with the health care system. Visit \u003ca href=\"http://khn.org/columnists\">khn.org/columnists\u003c/a> to submit your requests or tips.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>This story was produced by \u003ca href=\"http://khn.org/\" target=\"_blank\" rel=\"noopener\">Kaiser Health News\u003c/a>, an editorially independent program of the \u003ca href=\"http://kff.org/\">Kaiser Family Foundation\u003c/a>.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "California Issues Guidelines to Reduce Potential Harm From Cellphones",
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"content": "\u003cp>The California Department of Public Health Wednesday released a new set of \u003ca href=\"https://www.cdph.ca.gov/Programs/CCDPHP/DEODC/EHIB/CDPH%20Document%20Library/Cell-Phone-Guidance.pdf\" target=\"_blank\" rel=\"noopener\">guidelines\u003c/a> concerning the use of cellphones and radiation risk.\u003cstrong> \u003c/strong>\u003c/p>\n\u003cp>Some studies have suggested that long-term use could be linked to brain or salivary gland cancer, lower sperm count, and headaches, the department said. And a\u003ca href=\"https://www.nature.com/articles/s41598-017-16623-8\" target=\"_blank\" rel=\"noopener\"> study\u003c/a> from Kaiser Permanente published this week in\u003cem> Scientific Reports\u003c/em> found an association between exposure to the type of radiation emitted by cellphones and other sources and a higher rate of miscarriage. But the department was cautious in its framing of the potential harm:\u003c/p>\n\u003cp>\"These studies do not establish the link definitely, however, and scientists disagree about whether cellphones cause these health problems and how great the risks might be,\" the guidelines state. \"This document is intended to provide guidance for those people who want to reduce their own and their families’ exposures to RF [radio frequency] energy from cellphones, despite this uncertainty.\"\u003c/p>\n\u003cp>The creation of the guidelines was spurred by the exploding use of cell phones in recent years, said CDPH Director Dr. Karen Smith.\u003c/p>\n\u003cp>\"We're finding that many more children are using cellphones and they're using them at earlier ages,\" Smith said.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The average age when children get their first phone is now just over 10, according to one 2016 \u003ca href=\"https://techcrunch.com/2016/05/19/the-average-age-for-a-child-getting-their-first-smartphone-is-now-10-3-years/\" target=\"_blank\" rel=\"noopener\">study\u003c/a>.\u003c/p>\n\u003cp>Activists have spent years campaigning for consumer warnings, despite pushback from industry groups. In May, the San Francisco Chronicle\u003ca href=\"http://www.sfchronicle.com/health/article/New-records-show-how-state-reworked-secret-cell-11160254.php\" target=\"_blank\" rel=\"noopener\"> reported \u003c/a>the California health department had worked on cellphone guidelines over five years and 27 revisions, \"abandoning the efforts without ever making their concerns public until ordered by a judge.\" The order camein response to a lawsuit by a UC Berkeley public health researcher.\u003c/p>\n\u003cp>A \u003ca href=\"https://www.nbcbayarea.com/news/local/Berkeleys-Right-to-Know-Cell-Phone-Radiation-Warning-Ordinance-Now-in-Effect-373027781.html\" target=\"_blank\" rel=\"noopener\">Berkeley law\u003c/a> requiring cellphone health warnings in stores was \u003ca href=\"http://www.sfgate.com/bayarea/article/Berkeley-cell-phone-warning-law-upheld-by-federal-11090621.php\" target=\"_blank\" rel=\"noopener\">upheld\u003c/a> by a U.S. federal appeals court in April.\u003c/p>\n\u003cp>Some suggestions from the health department if you're concerned about health hazards from your phone:\u003c/p>\n\u003cul>\n\u003cli>When you talk on your phone, avoid holding it to your head; use the speakerphone or a headset instead.\u003c/li>\n\u003cli>Send text messages in place of engaging in phone conversations.\u003c/li>\n\u003cli>Reduce use when there's a weak signal.\u003c/li>\n\u003cli>Don't carry your phone in your pocket, bra or belt holster.\u003c/li>\n\u003cli>Reduce or avoid use of your phone when it is sending out high levels of RF energy, which occurs mainly when the signal is weak, you're in a fast-moving vehicle, and you are streaming media or downloading or sending large files. In these circumstances, try to keep the phone away from your head and body.\u003c/li>\n\u003c/ul>\n\u003cp>\u003c/p>\n\u003cp>In a statement to \u003ca href=\"http://www.capradio.org/articles/2017/12/13/keep-your-cell-phone-away-from-your-body-new-state-guidelines-warn/\" target=\"_blank\" rel=\"noopener\">Capitol Public Radio\u003c/a>, CTIA, the cellphone industry trade group, said, \"The Federal Communications Commission monitors scientific research on a regular basis, and its standard for RF exposure is based on recommended guidelines adopted by U.S. and international standard-setting bodies. That’s why the FCC has determined that all wireless phones legally sold in the United States are ‘safe.’ ”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The California Department of Public Health Wednesday released a new set of \u003ca href=\"https://www.cdph.ca.gov/Programs/CCDPHP/DEODC/EHIB/CDPH%20Document%20Library/Cell-Phone-Guidance.pdf\" target=\"_blank\" rel=\"noopener\">guidelines\u003c/a> concerning the use of cellphones and radiation risk.\u003cstrong> \u003c/strong>\u003c/p>\n\u003cp>Some studies have suggested that long-term use could be linked to brain or salivary gland cancer, lower sperm count, and headaches, the department said. And a\u003ca href=\"https://www.nature.com/articles/s41598-017-16623-8\" target=\"_blank\" rel=\"noopener\"> study\u003c/a> from Kaiser Permanente published this week in\u003cem> Scientific Reports\u003c/em> found an association between exposure to the type of radiation emitted by cellphones and other sources and a higher rate of miscarriage. But the department was cautious in its framing of the potential harm:\u003c/p>\n\u003cp>\"These studies do not establish the link definitely, however, and scientists disagree about whether cellphones cause these health problems and how great the risks might be,\" the guidelines state. \"This document is intended to provide guidance for those people who want to reduce their own and their families’ exposures to RF [radio frequency] energy from cellphones, despite this uncertainty.\"\u003c/p>\n\u003cp>The creation of the guidelines was spurred by the exploding use of cell phones in recent years, said CDPH Director Dr. Karen Smith.\u003c/p>\n\u003cp>\"We're finding that many more children are using cellphones and they're using them at earlier ages,\" Smith said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The average age when children get their first phone is now just over 10, according to one 2016 \u003ca href=\"https://techcrunch.com/2016/05/19/the-average-age-for-a-child-getting-their-first-smartphone-is-now-10-3-years/\" target=\"_blank\" rel=\"noopener\">study\u003c/a>.\u003c/p>\n\u003cp>Activists have spent years campaigning for consumer warnings, despite pushback from industry groups. In May, the San Francisco Chronicle\u003ca href=\"http://www.sfchronicle.com/health/article/New-records-show-how-state-reworked-secret-cell-11160254.php\" target=\"_blank\" rel=\"noopener\"> reported \u003c/a>the California health department had worked on cellphone guidelines over five years and 27 revisions, \"abandoning the efforts without ever making their concerns public until ordered by a judge.\" The order camein response to a lawsuit by a UC Berkeley public health researcher.\u003c/p>\n\u003cp>A \u003ca href=\"https://www.nbcbayarea.com/news/local/Berkeleys-Right-to-Know-Cell-Phone-Radiation-Warning-Ordinance-Now-in-Effect-373027781.html\" target=\"_blank\" rel=\"noopener\">Berkeley law\u003c/a> requiring cellphone health warnings in stores was \u003ca href=\"http://www.sfgate.com/bayarea/article/Berkeley-cell-phone-warning-law-upheld-by-federal-11090621.php\" target=\"_blank\" rel=\"noopener\">upheld\u003c/a> by a U.S. federal appeals court in April.\u003c/p>\n\u003cp>Some suggestions from the health department if you're concerned about health hazards from your phone:\u003c/p>\n\u003cul>\n\u003cli>When you talk on your phone, avoid holding it to your head; use the speakerphone or a headset instead.\u003c/li>\n\u003cli>Send text messages in place of engaging in phone conversations.\u003c/li>\n\u003cli>Reduce use when there's a weak signal.\u003c/li>\n\u003cli>Don't carry your phone in your pocket, bra or belt holster.\u003c/li>\n\u003cli>Reduce or avoid use of your phone when it is sending out high levels of RF energy, which occurs mainly when the signal is weak, you're in a fast-moving vehicle, and you are streaming media or downloading or sending large files. In these circumstances, try to keep the phone away from your head and body.\u003c/li>\n\u003c/ul>\n\u003cp>\u003c/p>\n\u003cp>In a statement to \u003ca href=\"http://www.capradio.org/articles/2017/12/13/keep-your-cell-phone-away-from-your-body-new-state-guidelines-warn/\" target=\"_blank\" rel=\"noopener\">Capitol Public Radio\u003c/a>, CTIA, the cellphone industry trade group, said, \"The Federal Communications Commission monitors scientific research on a regular basis, and its standard for RF exposure is based on recommended guidelines adopted by U.S. and international standard-setting bodies. That’s why the FCC has determined that all wireless phones legally sold in the United States are ‘safe.’ ”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "In Rural India, a 'Best Practices' Checklist Not Enough to Reduce Infant Deaths",
"title": "In Rural India, a 'Best Practices' Checklist Not Enough to Reduce Infant Deaths",
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"content": "\u003cp>It was supposed to be a breakthrough moment in global health.\u003c/p>\n\u003cp>Atul Gawande, the physician and writer, was applying a simple tool he championed — the checklist — to improve birth outcomes in a rural part of India with some of the world’s highest infant mortality rates.\u003c/p>\n\u003cp>[contextly_sidebar id=\"7uW2CYIOWXM4DmkLYOiL8AGjF8wTpOA1\"]But his closely watched study, the \u003ca href=\"https://www.ariadnelabs.org/areas-of-work/better-birth/\" target=\"_blank\" rel=\"noopener\">BetterBirth Trial\u003c/a>, has produced a disappointing result: Despite increased adherence to best practices, outcomes for babies and mothers did not improve with the use of a checklist and coaching on its implementation, according to \u003ca href=\"http://www.nejm.org/doi/full/10.1056/NEJMoa1701075\" target=\"_blank\" rel=\"noopener\">data\u003c/a> published Wednesday in the New England Journal of Medicine.\u003c/p>\n\u003cp>“The improvement in quality was part of the answer, but it was not enough,” Gawande said. “We need to understand what more needs to be added to get to the endpoint everyone wants.”\u003c/p>\n\u003cp>The idea of the checklist is to get caregivers to consistently follow best practices in medicine, rooting out memory lapses and sloppiness that can harm patients. Gawande, author of a best-selling book titled “The Checklist Manifesto,” has posited in his research and writings that its use in an array of settings could dramatically improve quality and save lives.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Its failure to accomplish that latter goal for mothers and babies in India does not necessarily mean that the checklist is faulty, or that it cannot ultimately help patients. But it does indicate that the solution to this particular problem might require more than just a checklist alone.\u003c/p>\n\u003caside class=\"pullquote alignright\">'The results are really disappointing because they were borne of such a place of hope and because they were based on a lot of strong evidence.' \u003ccite>Katy Kozhimannil, University of Minnesota\u003c/cite>\u003c/aside>\n\u003ch3>\u003cstrong>Best practices run into real-world problems\u003c/strong>\u003c/h3>\n\u003cp>The trial, funded by the Bill and Melinda Gates Foundation, was carried out in Uttar Pradesh, India’s most populous state. It has more than 200 million people and an infant mortality rate of 47 per 1,000 births, compared to about 6 per 1,000 births in the United States.\u003c/p>\n\u003cp>The study applied a list of best practices, such as handwashing and blood pressure monitoring, to reduce deaths and complications — and make headway in addressing one of the world’s most vexing public health problems. Experts said its failure to do so underscores both the complexity of the problem and the need for a more comprehensive approach that may extend beyond the walls of the hospital.\u003c/p>\n\u003cp>“The results are really disappointing because they were borne of such a place of hope and because they were based on a lot of strong evidence,” said Katy Kozhimannil, a rural health researcher at the University of Minnesota who was not involved in the trial. “Sometimes when you put evidence-based practices into the world, the world is stronger than those practices.”\u003c/p>\n\u003cp>Gawande and his colleagues at Ariadne Labs in Boston developed the checklist in consultation the World Health Organization, which is using it to improve obstetric care in dozens of countries across the world. It is meant to increase adherence to \u003ca href=\"http://www.who.int/patientsafety/implementation/checklists/childbirth/en/\" target=\"_blank\" rel=\"noopener\">28 essential practices\u003c/a> that have been shown to prevent the biggest killers of mothers and babies in active labor and immediately after birth.\u003c/p>\n\u003cp>Though the checklist has produced positive results in some parts of the world, the BetterBirth Trial was the largest and most rigorous effort yet to test its effectiveness. The randomized controlled trial involved more than 300,000 mothers and newborns who received care between 2014 and 2016. It compared outcomes in 60 facilities that received an eight-month coaching program on the checklist with those that did not receive the intervention.\u003c/p>\n\u003cp>It turned out that Gawande’s hypothesis — that a checklist would improve adherence to best practices and reduce complications and deaths — was half right. The trial did result in a significant increase in the use of best practices: After two months of coaching, birth attendants at the intervention sites completed 73 percent of the items on the checklist, compared to 42 percent in the control group.\u003c/p>\n\u003cp>[contextly_sidebar id=\"GXLixcndp0btjktOBEvNWUDESk0bGgek\"]In several key areas, the gap was even larger. Administration of oxytocin, used to prevent maternal hemorrhage, was 80 percent in the intervention sites, versus 21 percent in control facilities. On maternal blood pressure monitoring, the split was 68 percent to just 7 percent. Initiation of breastfeeding was 70 percent to 4 percent.\u003c/p>\n\u003cp>“That itself was a substantial accomplishment,” said Gawande, “because it hadn’t been demonstrated in these very low-income environments, at this kind of scale, that you could generate such substantial improvements in the quality of delivery.”\u003c/p>\n\u003ch3>\u003cstrong>The search for an explanation\u003c/strong>\u003c/h3>\n\u003cp>But despite adherence to the key practices, the intervention sites did not reduce stillbirths or seven-day death rates for mothers and babies.\u003c/p>\n\u003cp>Gawande said multiple factors might explain why the results fell short of expectations.\u003c/p>\n\u003cp>Health centers in Uttar Pradesh, he said, are a far cry from hospitals in the United States. They are cramped and lack basics such as running water and clean towels. They cannot provide blood transfusions and there are no surgical facilities for performing caesarean sections. In addition, most births are attended by practitioners with nurse-level training, not doctors or midwives.\u003c/p>\n\u003cp>Another possible explanation is that the checklist intervention was not long enough. The coaching tapered off after eight months, and follow-up checks revealed that, by one year, hospitals’ adherence to the checklist items had slipped from 73 percent to 62 percent, possibly eroding quality gains.\u003c/p>\n\u003cp>Gawande said his work implementing a different checklist, to improve \u003ca href=\"http://www.who.int/patientsafety/safesurgery/Surgical_Safety_Checklist.pdf\" target=\"_blank\" rel=\"noopener\">surgical outcomes\u003c/a>, showed that multiple years of coaching, combined with mandatory participation enforced by hospital leaders, produced better results. In Scotland, for example, the surgical checklist program resulted in a 26 percent reduction in deaths.\u003c/p>\n\u003cp>In India and elsewhere, Gawande said, reducing mother and infant deaths might require more systemic buy-in, to ensure that the effort is prioritized at all levels, from government overseers to hospital leaders and caregivers.\u003c/p>\n\u003cp>“In the next places rolling it out, they are testing if you combine it with skills training or push more supplies to the front line — and do that as a commitment of the health system — will that drive better results?” Gawande said. “I think it could.”\u003c/p>\n\u003cp>Meanwhile, in Uttar Pradesh, caregivers fight through the daily challenges of ensuring safety for moms and babies. In some clinics, a staffer must fetch water from a local well to make sure birth attendants can wash their hands before every delivery. Staff sometimes use diluted bleach to scrub and re-use their gloves, a practice that cannot get them fully clean, or sterile. Some facilities struggle to maintain a supply of blood pressure cuffs to make sure mothers could be properly monitored during labor.\u003c/p>\n\u003cp>Each problem erects another small barrier, taking more time and requiring more effort to help mothers and babies who, as a consequence of their location in the world, face a much higher probability of death.\u003c/p>\n\u003ch3>\u003cstrong>A reason for hope\u003c/strong>\u003c/h3>\n\u003cp>Even if the trial did not improve this region’s odds, Gawande said, he glimpsed moments when it helped them overcome.\u003c/p>\n\u003cp>He was visiting a clinic in the region when a woman in her 20s arrived for her third birth. Her water broke almost immediately upon entering, and active labor quickly followed. She was hustled to the delivery room and caregivers began working through their checks — they applied the blood pressure cuffs and took her temperature; they checked for the fetal heart rate.\u003c/p>\n\u003cp>The baby, a girl, came swiftly and did not look right. She wasn’t breathing.\u003c/p>\n\u003cp>It is a problem that occurs in 10 percent of births and is a leading cause of newborn death. The caregivers went to their equipment tray and grabbed a clean towel. They dried the baby and began to jostle her, to try to stimulate breathing.\u003c/p>\n\u003cp>No response. The baby was limp and blue.\u003c/p>\n\u003cp>One of the attendants grabbed a nasal suction. She put the tubing in her mouth and began sucking out the baby’s nasal passages. A green glob of meconium emerged from the baby’s airway.\u003c/p>\n\u003cp>Suddenly a breath came, and then another. By following the checklist, and the thought process and coaching that came with it, the caregivers had succeeded.\u003c/p>\n\u003cp>“Within a minute the baby was pink again and screaming and crying,” Gawande said. “And then everybody was breathing again.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This \u003ca href=\"https://www.statnews.com/2017/12/13/who-birth-checklist-fails/\" target=\"_blank\" rel=\"noopener\">story\u003c/a> was originally published by STAT, an online publication of Boston Globe Media that covers health, medicine, and scientific discovery.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>It was supposed to be a breakthrough moment in global health.\u003c/p>\n\u003cp>Atul Gawande, the physician and writer, was applying a simple tool he championed — the checklist — to improve birth outcomes in a rural part of India with some of the world’s highest infant mortality rates.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>But his closely watched study, the \u003ca href=\"https://www.ariadnelabs.org/areas-of-work/better-birth/\" target=\"_blank\" rel=\"noopener\">BetterBirth Trial\u003c/a>, has produced a disappointing result: Despite increased adherence to best practices, outcomes for babies and mothers did not improve with the use of a checklist and coaching on its implementation, according to \u003ca href=\"http://www.nejm.org/doi/full/10.1056/NEJMoa1701075\" target=\"_blank\" rel=\"noopener\">data\u003c/a> published Wednesday in the New England Journal of Medicine.\u003c/p>\n\u003cp>“The improvement in quality was part of the answer, but it was not enough,” Gawande said. “We need to understand what more needs to be added to get to the endpoint everyone wants.”\u003c/p>\n\u003cp>The idea of the checklist is to get caregivers to consistently follow best practices in medicine, rooting out memory lapses and sloppiness that can harm patients. Gawande, author of a best-selling book titled “The Checklist Manifesto,” has posited in his research and writings that its use in an array of settings could dramatically improve quality and save lives.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Its failure to accomplish that latter goal for mothers and babies in India does not necessarily mean that the checklist is faulty, or that it cannot ultimately help patients. But it does indicate that the solution to this particular problem might require more than just a checklist alone.\u003c/p>\n\u003caside class=\"pullquote alignright\">'The results are really disappointing because they were borne of such a place of hope and because they were based on a lot of strong evidence.' \u003ccite>Katy Kozhimannil, University of Minnesota\u003c/cite>\u003c/aside>\n\u003ch3>\u003cstrong>Best practices run into real-world problems\u003c/strong>\u003c/h3>\n\u003cp>The trial, funded by the Bill and Melinda Gates Foundation, was carried out in Uttar Pradesh, India’s most populous state. It has more than 200 million people and an infant mortality rate of 47 per 1,000 births, compared to about 6 per 1,000 births in the United States.\u003c/p>\n\u003cp>The study applied a list of best practices, such as handwashing and blood pressure monitoring, to reduce deaths and complications — and make headway in addressing one of the world’s most vexing public health problems. Experts said its failure to do so underscores both the complexity of the problem and the need for a more comprehensive approach that may extend beyond the walls of the hospital.\u003c/p>\n\u003cp>“The results are really disappointing because they were borne of such a place of hope and because they were based on a lot of strong evidence,” said Katy Kozhimannil, a rural health researcher at the University of Minnesota who was not involved in the trial. “Sometimes when you put evidence-based practices into the world, the world is stronger than those practices.”\u003c/p>\n\u003cp>Gawande and his colleagues at Ariadne Labs in Boston developed the checklist in consultation the World Health Organization, which is using it to improve obstetric care in dozens of countries across the world. It is meant to increase adherence to \u003ca href=\"http://www.who.int/patientsafety/implementation/checklists/childbirth/en/\" target=\"_blank\" rel=\"noopener\">28 essential practices\u003c/a> that have been shown to prevent the biggest killers of mothers and babies in active labor and immediately after birth.\u003c/p>\n\u003cp>Though the checklist has produced positive results in some parts of the world, the BetterBirth Trial was the largest and most rigorous effort yet to test its effectiveness. The randomized controlled trial involved more than 300,000 mothers and newborns who received care between 2014 and 2016. It compared outcomes in 60 facilities that received an eight-month coaching program on the checklist with those that did not receive the intervention.\u003c/p>\n\u003cp>It turned out that Gawande’s hypothesis — that a checklist would improve adherence to best practices and reduce complications and deaths — was half right. The trial did result in a significant increase in the use of best practices: After two months of coaching, birth attendants at the intervention sites completed 73 percent of the items on the checklist, compared to 42 percent in the control group.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>In several key areas, the gap was even larger. Administration of oxytocin, used to prevent maternal hemorrhage, was 80 percent in the intervention sites, versus 21 percent in control facilities. On maternal blood pressure monitoring, the split was 68 percent to just 7 percent. Initiation of breastfeeding was 70 percent to 4 percent.\u003c/p>\n\u003cp>“That itself was a substantial accomplishment,” said Gawande, “because it hadn’t been demonstrated in these very low-income environments, at this kind of scale, that you could generate such substantial improvements in the quality of delivery.”\u003c/p>\n\u003ch3>\u003cstrong>The search for an explanation\u003c/strong>\u003c/h3>\n\u003cp>But despite adherence to the key practices, the intervention sites did not reduce stillbirths or seven-day death rates for mothers and babies.\u003c/p>\n\u003cp>Gawande said multiple factors might explain why the results fell short of expectations.\u003c/p>\n\u003cp>Health centers in Uttar Pradesh, he said, are a far cry from hospitals in the United States. They are cramped and lack basics such as running water and clean towels. They cannot provide blood transfusions and there are no surgical facilities for performing caesarean sections. In addition, most births are attended by practitioners with nurse-level training, not doctors or midwives.\u003c/p>\n\u003cp>Another possible explanation is that the checklist intervention was not long enough. The coaching tapered off after eight months, and follow-up checks revealed that, by one year, hospitals’ adherence to the checklist items had slipped from 73 percent to 62 percent, possibly eroding quality gains.\u003c/p>\n\u003cp>Gawande said his work implementing a different checklist, to improve \u003ca href=\"http://www.who.int/patientsafety/safesurgery/Surgical_Safety_Checklist.pdf\" target=\"_blank\" rel=\"noopener\">surgical outcomes\u003c/a>, showed that multiple years of coaching, combined with mandatory participation enforced by hospital leaders, produced better results. In Scotland, for example, the surgical checklist program resulted in a 26 percent reduction in deaths.\u003c/p>\n\u003cp>In India and elsewhere, Gawande said, reducing mother and infant deaths might require more systemic buy-in, to ensure that the effort is prioritized at all levels, from government overseers to hospital leaders and caregivers.\u003c/p>\n\u003cp>“In the next places rolling it out, they are testing if you combine it with skills training or push more supplies to the front line — and do that as a commitment of the health system — will that drive better results?” Gawande said. “I think it could.”\u003c/p>\n\u003cp>Meanwhile, in Uttar Pradesh, caregivers fight through the daily challenges of ensuring safety for moms and babies. In some clinics, a staffer must fetch water from a local well to make sure birth attendants can wash their hands before every delivery. Staff sometimes use diluted bleach to scrub and re-use their gloves, a practice that cannot get them fully clean, or sterile. Some facilities struggle to maintain a supply of blood pressure cuffs to make sure mothers could be properly monitored during labor.\u003c/p>\n\u003cp>Each problem erects another small barrier, taking more time and requiring more effort to help mothers and babies who, as a consequence of their location in the world, face a much higher probability of death.\u003c/p>\n\u003ch3>\u003cstrong>A reason for hope\u003c/strong>\u003c/h3>\n\u003cp>Even if the trial did not improve this region’s odds, Gawande said, he glimpsed moments when it helped them overcome.\u003c/p>\n\u003cp>He was visiting a clinic in the region when a woman in her 20s arrived for her third birth. Her water broke almost immediately upon entering, and active labor quickly followed. She was hustled to the delivery room and caregivers began working through their checks — they applied the blood pressure cuffs and took her temperature; they checked for the fetal heart rate.\u003c/p>\n\u003cp>The baby, a girl, came swiftly and did not look right. She wasn’t breathing.\u003c/p>\n\u003cp>It is a problem that occurs in 10 percent of births and is a leading cause of newborn death. The caregivers went to their equipment tray and grabbed a clean towel. They dried the baby and began to jostle her, to try to stimulate breathing.\u003c/p>\n\u003cp>No response. The baby was limp and blue.\u003c/p>\n\u003cp>One of the attendants grabbed a nasal suction. She put the tubing in her mouth and began sucking out the baby’s nasal passages. A green glob of meconium emerged from the baby’s airway.\u003c/p>\n\u003cp>Suddenly a breath came, and then another. By following the checklist, and the thought process and coaching that came with it, the caregivers had succeeded.\u003c/p>\n\u003cp>“Within a minute the baby was pink again and screaming and crying,” Gawande said. “And then everybody was breathing again.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>This \u003ca href=\"https://www.statnews.com/2017/12/13/who-birth-checklist-fails/\" target=\"_blank\" rel=\"noopener\">story\u003c/a> was originally published by STAT, an online publication of Boston Globe Media that covers health, medicine, and scientific discovery.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Here's What a Backlash Against #MeToo Might Look Like",
"title": "Here's What a Backlash Against #MeToo Might Look Like",
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"content": "\u003cp>The flurry of #MeToo tales that followed the sexual assault accusations against Hollywood producer Harvey Weinstein have propelled America into what appears to be a social revolution in the workplace.\u003c/p>\n\u003caside class=\"pullquote alignright\">'I mean this is something women have been experiencing for decades. And it’s part of the reason that so few victims come forward.'\u003ccite>Michele Dauber, Stanford University\u003c/cite>\u003c/aside>\n\u003cp>Accusations of verbal abuse, inappropriate groping and molestation have left many \u003ca href=\"https://www.nbcnews.com/storyline/sexual-misconduct/weinstein-here-s-growing-list-men-accused-sexual-misconduct-n816546\" target=\"_blank\" rel=\"noopener\">high-profile men\u003c/a> apologetic and shame-faced, albeit \u003ca href=\"https://www.wmagazine.com/story/worst-apologies-by-men-harvey-weinstein-kevin-spacey-charlie-rose\">not always in a way\u003c/a> some women would like. And some cases have included allegations of rape, which none of the accused men has yet to confess to.\u003c/p>\n\u003cp>Despite this wrenching period of conflict between the sexes, when a Google News search on “\u003ca href=\"https://www.google.com/search?q=%22sexual+harassment%22\" target=\"_blank\" rel=\"noopener\">sexual harassment\u003c/a>\" yields over 2 million-and-counting results, the national conversation has unfolded with a fair degree of civility and a general acknowledgment that the status quo is unacceptable.\u003c/p>\n\u003cp>[audio src=\"https://www.kqed.org/.stream/anon/radio/science/2017/12/McClurgMaleSpin.mp3\" Title=\"LISTEN: Here's What a Backlash Against #MeToo Might Look Like\" program=\"Future of You\"]\u003c/p>\n\u003cp>And yet, feminist leaders and \u003ca href=\"http://theweek.com/articles/734903/sexual-assault-backlash-coming-heres-how-respond\" target=\"_blank\" rel=\"noopener\">commentators\u003c/a> have begun to \u003ca href=\"http://www.cnn.com/2017/11/27/opinions/sexual-harassment-assault-backlash-opinion-costello/index.html\" target=\"_blank\" rel=\"noopener\">warn\u003c/a> that an attempt to change the current narrative is \u003ca href=\"http://www.slate.com/articles/news_and_politics/interrogation/2017/11/rebecca_traister_on_the_coming_backlash_to_this_sexual_harassment_moment.html\" target=\"_blank\" rel=\"noopener\">inevitable\u003c/a>.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>In other words, a \u003ca href=\"https://www.reuters.com/article/us-women-metoo-backlash/could-fear-of-metoo-backlash-silence-womens-voices-idUSKBN1E61Y3\" target=\"_blank\" rel=\"noopener\">\u003cspan style=\"font-weight: 400\">backlash \u003c/span>\u003c/a>is coming.\u003c/p>\n\u003cp>Rumblings of discontent have already cropped up on Twitter. For example, here’s Swedish author and TV personality Alexander Bard:\u003c/p>\n\u003cp>\u003cimg class=\"aligncenter size-full wp-image-437699\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/12/Screen-Shot-2017-12-13-at-5.00.37-PM.png\" alt=\"\" width=\"575\" height=\"147\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/12/Screen-Shot-2017-12-13-at-5.00.37-PM.png 575w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/Screen-Shot-2017-12-13-at-5.00.37-PM-160x41.png 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/Screen-Shot-2017-12-13-at-5.00.37-PM-240x61.png 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/Screen-Shot-2017-12-13-at-5.00.37-PM-375x96.png 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/Screen-Shot-2017-12-13-at-5.00.37-PM-520x133.png 520w\" sizes=\"(max-width: 575px) 100vw, 575px\">\u003c/p>\n\u003cp>There \u003ca href=\"https://twitter.com/search?f=tweets&q=lies%20sexual%20harassment&src=typd\" target=\"_blank\" rel=\"noopener\">are\u003c/a> plenty \u003ca href=\"https://twitter.com/search?f=tweets&vertical=default&q=false%20claims%20sexual%20harassment&src=typd\" target=\"_blank\" rel=\"noopener\">more\u003c/a> like that.\u003c/p>\n\u003cp>\u003cb>Familiar Tactics\u003c/b>\u003c/p>\n\u003cp>Let’s be clear: As of yet, there are no public examples of “careers destroyed over merely saying a flattering comment.”\u003c/p>\n\u003cp>Michele Dauber, a law professor at Stanford University, calls this sort of straw-woman accusation \"vile.\"\u003c/p>\n\u003cp>\"He's using some pretty standard strategies by calling women neurotic or that this is a gossip incident,\" says Dauber. \"This is just a way of undermining the credibility of women coming forward.\"\u003c/p>\n\u003cp>Dauber says a random tweet may not do much harm, but it’s a different story when it comes from someone who wields power and influence. Many \u003ca href=\"https://www.usatoday.com/story/opinion/2017/12/12/trump-lows-ever-hit-rock-bottom-editorials-debates/945947001/\" target=\"_blank\" rel=\"noopener\">commentators\u003c/a>, as well as \u003ca href=\"https://twitter.com/SenWarren/status/940615748988342273?ref_src=twsrc%5Etfw&ref_url=https%3A%2F%2Fwww.gq.com%2Fstory%2Felizabeth-warren-slut-shame-tweet\" target=\"_blank\" rel=\"noopener\">political opponents\u003c/a>, have interpreted a recent tweet by President Trump about Sen. Kirsten Gillibrand as a clear case of “\u003ca href=\"https://en.wikipedia.org/wiki/Slut-shaming\" target=\"_blank\" rel=\"noopener\">\u003cspan style=\"font-weight: 400\">slut-shaming\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">.”\u003c/span>\u003c/p>\n\u003cp>\u003cimg class=\"aligncenter size-full wp-image-437702\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/12/Screen-Shot-2017-12-13-at-5.14.41-PM.png\" alt=\"\" width=\"590\" height=\"153\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/12/Screen-Shot-2017-12-13-at-5.14.41-PM.png 590w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/Screen-Shot-2017-12-13-at-5.14.41-PM-160x41.png 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/Screen-Shot-2017-12-13-at-5.14.41-PM-240x62.png 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/Screen-Shot-2017-12-13-at-5.14.41-PM-375x97.png 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/Screen-Shot-2017-12-13-at-5.14.41-PM-520x135.png 520w\" sizes=\"(max-width: 590px) 100vw, 590px\">\u003c/p>\n\u003cp>“It’s much more worrying when you see the president of the United States using a similar strategy,” Dauber says. (The administration \u003ca href=\"https://www.politico.com/story/2017/12/12/sarah-sanders-trump-gillibrand-tweet-292732\" target=\"_blank\" rel=\"noopener\">denies\u003c/a> Trump was making a sexual reference.)\u003c/p>\n\u003cp>\u003cb>Typical Ploys to Silence Victims\u003c/b>\u003c/p>\n\u003cp>Psychologists like Jennifer Freyd, a professor at the University of Oregon, have studied the \u003ca href=\"http://www.tandfonline.com/doi/full/10.1080/10926771.2017.1320777\" target=\"_blank\" rel=\"noopener\">strategies\u003c/a> used to discredit victims of sexual harassment. Usually the first tactic is simple denial, which is followed by attacks, which can take the form of \u003ca href=\"https://www.urbandictionary.com/define.php?term=Gaslighting\" target=\"_blank\" rel=\"noopener\">gaslighting\u003c/a>.\u003c/p>\n\u003cp>“You’re a liar. You’re crazy. You’re not a reliable person,\" Freyd says. \"You have some ulterior motive.”\u003c/p>\n\u003cp>[contextly_sidebar id=\"UL0lZereojRxEqLTwQV78idjCtbFoVy9\"]The last step taken by perpetrators or those defending them is trying to make victims feel guilty: “ 'You are hurting my reputation. You’re destroying me.' ”\u003c/p>\n\u003cp>Dauber says she’s watched predators twist the story time and again.\u003c/p>\n\u003cp>“I mean this is something women have been experiencing for decades,\" she says. \"And it’s part of the reason that so few victims come forward.”\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003cstrong>Anita Hill's Story\u003c/strong>\u003cbr>\n\u003c/span>\u003c/p>\n\u003cp>Freyd says some of the most obvious public examples of these tactics were evident in the U.S. Senate confirmation hearings for Clarence Thomas as Supreme Court justice, in 1991. Thomas’ former colleague, Anita Hill, accused him of making unwelcome sexual comments. Republican senators, as well as witnesses in support of Thomas, \u003ca href=\"http://www.nytimes.com/1991/10/14/us/thomas-nomination-parade-witnesses-support-hill-s-story-thomas-s-integrity.html?pagewanted=all\" target=\"_blank\" rel=\"noopener\">\u003cspan style=\"font-weight: 400\">raised the possibility\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> that Hill was prone to fantasizing about her relationships with men. Here's a clip of someone who knew Hill and had been a classmate of Thomas, stating he believes she expressed an unrequited romantic interest in him:\u003c/span>\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe width=\"600\" height=\"338\" src=\"//www.c-span.org/video/standalone/?c4699492\" frameborder=\"0\" scrolling=\"no\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003cp>Thomas denied any wrongdoing and was confirmed by the Senate 52-48.\u003c/p>\n\u003cp>Freyd believes Hill was telling the truth. \"It is hard to imagine someone being more credible in that situation. And yet the [attack] seemed effective.\"\u003c/p>\n\u003cp>\u003cstrong>Anticipating Tactics\u003c/strong>\u003c/p>\n\u003cp>After watching Hill's ordeal, Freyd created the acronym\u003ca href=\"http://dynamic.uoregon.edu/jjf/defineDARVO.html\" target=\"_blank\" rel=\"noopener\"> DARVO, \u003c/a>for \"Deny, Attack, Reverse Victim to Offender,\" to help victims remember and anticipate the tactics of predators.\u003c/p>\n\u003cp>\"My hope is that if we can identify the behavior pattern and call it out, [then] we can make it less disorienting and confusing -- we can defang it some,\" she said in an email.\u003c/p>\n\u003cp>Yet people should also be careful not to assume someone accused of sexual misconduct is guilty just because he is using DARVO tactics, she cautions.\u003c/p>\n\u003cp>“A truly innocent person may deny an accusation, attack the person making the accusation, or claim the victim role,” she writes on her website. “Future research may be able to determine the probability of a DARVO response as a function of guilt or innocence.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Jon Brooks contributed to this post.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The flurry of #MeToo tales that followed the sexual assault accusations against Hollywood producer Harvey Weinstein have propelled America into what appears to be a social revolution in the workplace.\u003c/p>\n\u003caside class=\"pullquote alignright\">'I mean this is something women have been experiencing for decades. And it’s part of the reason that so few victims come forward.'\u003ccite>Michele Dauber, Stanford University\u003c/cite>\u003c/aside>\n\u003cp>Accusations of verbal abuse, inappropriate groping and molestation have left many \u003ca href=\"https://www.nbcnews.com/storyline/sexual-misconduct/weinstein-here-s-growing-list-men-accused-sexual-misconduct-n816546\" target=\"_blank\" rel=\"noopener\">high-profile men\u003c/a> apologetic and shame-faced, albeit \u003ca href=\"https://www.wmagazine.com/story/worst-apologies-by-men-harvey-weinstein-kevin-spacey-charlie-rose\">not always in a way\u003c/a> some women would like. And some cases have included allegations of rape, which none of the accused men has yet to confess to.\u003c/p>\n\u003cp>Despite this wrenching period of conflict between the sexes, when a Google News search on “\u003ca href=\"https://www.google.com/search?q=%22sexual+harassment%22\" target=\"_blank\" rel=\"noopener\">sexual harassment\u003c/a>\" yields over 2 million-and-counting results, the national conversation has unfolded with a fair degree of civility and a general acknowledgment that the status quo is unacceptable.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>And yet, feminist leaders and \u003ca href=\"http://theweek.com/articles/734903/sexual-assault-backlash-coming-heres-how-respond\" target=\"_blank\" rel=\"noopener\">commentators\u003c/a> have begun to \u003ca href=\"http://www.cnn.com/2017/11/27/opinions/sexual-harassment-assault-backlash-opinion-costello/index.html\" target=\"_blank\" rel=\"noopener\">warn\u003c/a> that an attempt to change the current narrative is \u003ca href=\"http://www.slate.com/articles/news_and_politics/interrogation/2017/11/rebecca_traister_on_the_coming_backlash_to_this_sexual_harassment_moment.html\" target=\"_blank\" rel=\"noopener\">inevitable\u003c/a>.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>In other words, a \u003ca href=\"https://www.reuters.com/article/us-women-metoo-backlash/could-fear-of-metoo-backlash-silence-womens-voices-idUSKBN1E61Y3\" target=\"_blank\" rel=\"noopener\">\u003cspan style=\"font-weight: 400\">backlash \u003c/span>\u003c/a>is coming.\u003c/p>\n\u003cp>Rumblings of discontent have already cropped up on Twitter. For example, here’s Swedish author and TV personality Alexander Bard:\u003c/p>\n\u003cp>\u003cimg class=\"aligncenter size-full wp-image-437699\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/12/Screen-Shot-2017-12-13-at-5.00.37-PM.png\" alt=\"\" width=\"575\" height=\"147\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/12/Screen-Shot-2017-12-13-at-5.00.37-PM.png 575w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/Screen-Shot-2017-12-13-at-5.00.37-PM-160x41.png 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/Screen-Shot-2017-12-13-at-5.00.37-PM-240x61.png 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/Screen-Shot-2017-12-13-at-5.00.37-PM-375x96.png 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/Screen-Shot-2017-12-13-at-5.00.37-PM-520x133.png 520w\" sizes=\"(max-width: 575px) 100vw, 575px\">\u003c/p>\n\u003cp>There \u003ca href=\"https://twitter.com/search?f=tweets&q=lies%20sexual%20harassment&src=typd\" target=\"_blank\" rel=\"noopener\">are\u003c/a> plenty \u003ca href=\"https://twitter.com/search?f=tweets&vertical=default&q=false%20claims%20sexual%20harassment&src=typd\" target=\"_blank\" rel=\"noopener\">more\u003c/a> like that.\u003c/p>\n\u003cp>\u003cb>Familiar Tactics\u003c/b>\u003c/p>\n\u003cp>Let’s be clear: As of yet, there are no public examples of “careers destroyed over merely saying a flattering comment.”\u003c/p>\n\u003cp>Michele Dauber, a law professor at Stanford University, calls this sort of straw-woman accusation \"vile.\"\u003c/p>\n\u003cp>\"He's using some pretty standard strategies by calling women neurotic or that this is a gossip incident,\" says Dauber. \"This is just a way of undermining the credibility of women coming forward.\"\u003c/p>\n\u003cp>Dauber says a random tweet may not do much harm, but it’s a different story when it comes from someone who wields power and influence. Many \u003ca href=\"https://www.usatoday.com/story/opinion/2017/12/12/trump-lows-ever-hit-rock-bottom-editorials-debates/945947001/\" target=\"_blank\" rel=\"noopener\">commentators\u003c/a>, as well as \u003ca href=\"https://twitter.com/SenWarren/status/940615748988342273?ref_src=twsrc%5Etfw&ref_url=https%3A%2F%2Fwww.gq.com%2Fstory%2Felizabeth-warren-slut-shame-tweet\" target=\"_blank\" rel=\"noopener\">political opponents\u003c/a>, have interpreted a recent tweet by President Trump about Sen. Kirsten Gillibrand as a clear case of “\u003ca href=\"https://en.wikipedia.org/wiki/Slut-shaming\" target=\"_blank\" rel=\"noopener\">\u003cspan style=\"font-weight: 400\">slut-shaming\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">.”\u003c/span>\u003c/p>\n\u003cp>\u003cimg class=\"aligncenter size-full wp-image-437702\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/12/Screen-Shot-2017-12-13-at-5.14.41-PM.png\" alt=\"\" width=\"590\" height=\"153\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/12/Screen-Shot-2017-12-13-at-5.14.41-PM.png 590w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/Screen-Shot-2017-12-13-at-5.14.41-PM-160x41.png 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/Screen-Shot-2017-12-13-at-5.14.41-PM-240x62.png 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/Screen-Shot-2017-12-13-at-5.14.41-PM-375x97.png 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/Screen-Shot-2017-12-13-at-5.14.41-PM-520x135.png 520w\" sizes=\"(max-width: 590px) 100vw, 590px\">\u003c/p>\n\u003cp>“It’s much more worrying when you see the president of the United States using a similar strategy,” Dauber says. (The administration \u003ca href=\"https://www.politico.com/story/2017/12/12/sarah-sanders-trump-gillibrand-tweet-292732\" target=\"_blank\" rel=\"noopener\">denies\u003c/a> Trump was making a sexual reference.)\u003c/p>\n\u003cp>\u003cb>Typical Ploys to Silence Victims\u003c/b>\u003c/p>\n\u003cp>Psychologists like Jennifer Freyd, a professor at the University of Oregon, have studied the \u003ca href=\"http://www.tandfonline.com/doi/full/10.1080/10926771.2017.1320777\" target=\"_blank\" rel=\"noopener\">strategies\u003c/a> used to discredit victims of sexual harassment. Usually the first tactic is simple denial, which is followed by attacks, which can take the form of \u003ca href=\"https://www.urbandictionary.com/define.php?term=Gaslighting\" target=\"_blank\" rel=\"noopener\">gaslighting\u003c/a>.\u003c/p>\n\u003cp>“You’re a liar. You’re crazy. You’re not a reliable person,\" Freyd says. \"You have some ulterior motive.”\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>The last step taken by perpetrators or those defending them is trying to make victims feel guilty: “ 'You are hurting my reputation. You’re destroying me.' ”\u003c/p>\n\u003cp>Dauber says she’s watched predators twist the story time and again.\u003c/p>\n\u003cp>“I mean this is something women have been experiencing for decades,\" she says. \"And it’s part of the reason that so few victims come forward.”\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003cstrong>Anita Hill's Story\u003c/strong>\u003cbr>\n\u003c/span>\u003c/p>\n\u003cp>Freyd says some of the most obvious public examples of these tactics were evident in the U.S. Senate confirmation hearings for Clarence Thomas as Supreme Court justice, in 1991. Thomas’ former colleague, Anita Hill, accused him of making unwelcome sexual comments. Republican senators, as well as witnesses in support of Thomas, \u003ca href=\"http://www.nytimes.com/1991/10/14/us/thomas-nomination-parade-witnesses-support-hill-s-story-thomas-s-integrity.html?pagewanted=all\" target=\"_blank\" rel=\"noopener\">\u003cspan style=\"font-weight: 400\">raised the possibility\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> that Hill was prone to fantasizing about her relationships with men. Here's a clip of someone who knew Hill and had been a classmate of Thomas, stating he believes she expressed an unrequited romantic interest in him:\u003c/span>\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe width=\"600\" height=\"338\" src=\"//www.c-span.org/video/standalone/?c4699492\" frameborder=\"0\" scrolling=\"no\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003cp>Thomas denied any wrongdoing and was confirmed by the Senate 52-48.\u003c/p>\n\u003cp>Freyd believes Hill was telling the truth. \"It is hard to imagine someone being more credible in that situation. And yet the [attack] seemed effective.\"\u003c/p>\n\u003cp>\u003cstrong>Anticipating Tactics\u003c/strong>\u003c/p>\n\u003cp>After watching Hill's ordeal, Freyd created the acronym\u003ca href=\"http://dynamic.uoregon.edu/jjf/defineDARVO.html\" target=\"_blank\" rel=\"noopener\"> DARVO, \u003c/a>for \"Deny, Attack, Reverse Victim to Offender,\" to help victims remember and anticipate the tactics of predators.\u003c/p>\n\u003cp>\"My hope is that if we can identify the behavior pattern and call it out, [then] we can make it less disorienting and confusing -- we can defang it some,\" she said in an email.\u003c/p>\n\u003cp>Yet people should also be careful not to assume someone accused of sexual misconduct is guilty just because he is using DARVO tactics, she cautions.\u003c/p>\n\u003cp>“A truly innocent person may deny an accusation, attack the person making the accusation, or claim the victim role,” she writes on her website. “Future research may be able to determine the probability of a DARVO response as a function of guilt or innocence.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Jon Brooks contributed to this post.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Why a Pill That's $400 in the U.S. Costs 4 Cents in Tanzania",
"title": "Why a Pill That's $400 in the U.S. Costs 4 Cents in Tanzania",
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"content": "\u003cp>Two pills to wipe out hookworm could cost you 4 cents. Or $400.\u003c/p>\n\u003cp>It just depends where you live.\u003c/p>\n\u003cp>The \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2657832/table/pntd-0000402-t002/\">4 cents is in Tanzania\u003c/a>. That'll cover the two pills it takes to knock out the intestinal parasite. But in the United States, where hookworm has re-emerged, the price for two 200 mg tablets of albendazole can cost \u003ca href=\"https://www.goodrx.com/albendazole?drug-name=albendazole\">as much as $400\u003c/a>.\u003c/p>\n\u003cp>The pill will put an end to the problems hookworm can cause, such as anemia and protein deficiency as well as stunting growth in children.\u003c/p>\n\u003caside class=\"pullquote alignright\">'When there's limited competition in the market, the company that holds the monopoly is able to price [the drug] however they want.'\u003ccite>Dr. Jonathan Alpern, HealthPartners Institute\u003c/cite>\u003c/aside>\n\u003cp>It's not just a problem with the anti-hookworm pill. Drugs for diseases of the developing world, in particular what are known as \"neglected tropical diseases\" like hookworm and \u003ca href=\"https://www.npr.org/sections/goatsandsoda/2016/06/29/483721076/the-aleppo-evil-is-making-a-comeback\">leishmaniasis\u003c/a>, are enormously more expensive in the United States than in the developing world.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"There really is no good reason for this price,\" \u003ca href=\"https://www.healthpartners.com/hprf/investigators/ENTRY_194022\">Dr. Jonathan Alpern\u003c/a> says of the albendazole price tag. Alpern works for the HealthPartners Institute, the research division of a health care organization in Minnesota.\u003c/p>\n\u003cp>[contextly_sidebar id=\"WWHZxql76AEWQSa0dS4fXrjLNFG8AVIY\"]Impax Laboratories is the only pharmaceutical company that offers the drug in the U.S. Impax did not wish to comment on product pricing for this story but stated in an email to NPR: \"Given the very different regulatory regimes in the U.S. versus outside the U.S., pricing is a very awkward comparison.\"\u003c/p>\n\u003cp>Because the drug's patent expired decades ago, other companies can sell the generic version. But for medications that fight neglected tropical diseases, pharmaceutical companies have been slow to jump in and manufacture the medicine.\u003c/p>\n\u003cp>As for those that do: \"[Impax] fits into a category of companies that have taken drugs that have been around for many years, acquired the rights and jacked up the price [for the Western market],\" says Alpern.\u003c/p>\n\u003cp>Indeed, prices for generic drugs that treat neglected tropical diseases \u003ca href=\"http://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0005794\">are skyrocketing in the U.S.\u003c/a>\u003c/p>\n\u003cp>When a disease affects only a small number of patients in the U.S., \"there's less incentive for generic companies to enter the market,\" Alpern explains. That's because there's less potential for profit.\u003c/p>\n\u003cp>Hookworm, which was recently \u003ca href=\"https://www.npr.org/sections/goatsandsoda/2017/09/12/550387650/the-u-s-thought-it-was-rid-of-hookworm-wrong\">discovered in a small community\u003c/a> in the U.S., is just one example of this trend.\u003c/p>\n\u003cp>[contextly_sidebar id=\"COtXc62j0KNxw4adAUKowpuaCpnf5tLX\"]Neurocysticercosis, a parasitic disease that causes seizures and epilepsy, is another example. The disease is rare in the U.S. with an estimated \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4005108/\">1,000 to 5,000 new cases\u003c/a> every year. Either albendazole or praziquantel are used to treat the disease. Praziquantel is also pricey: \u003ca href=\"https://www.goodrx.com/biltricide?drug-name=biltricide\">about $525\u003c/a> for six 600 mg tablets.\u003c/p>\n\u003cp>Leishmaniasis, which affects 700,000 to a million people annually throughout the world, is more expensive to treat in the U.S., too. Though rare in the U.S. — only \u003ca href=\"http://phenomena.nationalgeographic.com/2015/10/19/leishmaniasis-tx/\">13 cases\u003c/a> were uncovered between 2000 and 2007 — the disease can cause disfiguring skin sores or swelling of the spleen or liver depending on the form of the disease that's contracted. Two 50 mg tablets of miltefosine for 28 days can treat the infection; the price of each pill wholesale is $685, according to Alpern's research.\u003c/p>\n\u003cp>\"When there's limited competition in the market, the company that holds the monopoly is able to price [the drug] however they want,\" Alpern says. \"In these cases, we often see companies taking advantage of their market position.\"\u003c/p>\n\u003cp>And some of these disease aren't all that rare. \u003ca href=\"https://www.bcm.edu/people/view/peter-hotez-m-d-ph-d/b1846a47-ffed-11e2-be68-080027880ca6\">Dr. Peter Hotez\u003c/a>, dean of the National School of Tropical Medicine at the Baylor College of Medicine, says certain neglected tropical diseases in the U.S. are surprisingly widespread, especially among those who may not be able to afford treatment.\u003c/p>\n\u003cp>For example, he estimates that \u003ca href=\"http://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0003012\">1.1 million Americans\u003c/a> are annually diagnosed with a parasitic infection called toxoplasmosis. The treatment is Daraprim; four 25 mg tablets currently cost between \u003ca href=\"https://www.goodrx.com/daraprim?drug-name=daraprim&form=tablet&dosage=25mg&quantity=4&days_supply=&label_override=Daraprim\">$3,000 and $3,400\u003c/a> on the U.S. market.\u003c/p>\n\u003cp>\"We have now identified nearly half-a-dozen neglected tropical diseases that are widespread in the U.S. among the poor, especially in the American South,\" says Hotez, who last year published \u003ca href=\"https://jhupbooks.press.jhu.edu/content/blue-marble-health\">\u003cem>Blue Marble Health\u003c/em>\u003c/a>, a book evaluating neglected diseases in America. \"In all, I estimate that 12 million Americans now live in extreme poverty with a neglected tropical disease.\"\u003c/p>\n\u003cp>Some of them are in Lowndes County, Ala., where a community of individuals was recently \u003ca href=\"http://www.ajtmh.org/content/journals/10.4269/ajtmh.17-0396\">discovered to have hookworm\u003c/a>. The average income in the county is just $18,036.\u003c/p>\n\u003cp>If patients don't have health insurance, they must pay the full price for prescriptions or skip treatment altogether.\u003c/p>\n\u003cp>[contextly_sidebar id=\"0rRNuKIWq50sVJE9FBqR0zIOBeqefU8E\"]\"Some of the people in Lowndes County are living off $600 or $700 a month,\" says Catherine Flowers, founder of \u003ca href=\"https://www.acrecdc.com/\">Alabama Center for Rural Enterprise\u003c/a>, a nonprofit that addresses poverty. \"People have told me they sometimes have to choose between buying medication and eating.\"\u003c/p>\n\u003cp>In cases where patients have Medicaid, taxpayers bear the burden.\u003c/p>\n\u003cp>In the years following albendazole's price hike in 2011, Medicaid spending on the drug went from under $100,000 in 2008 to more than \u003ca href=\"http://www.nejm.org/doi/full/10.1056/NEJMp1408376#t=article\">$7.5 million in 2013\u003c/a>. Medicaid spending on Daraprim, another tropical disease drug that just experienced a price hike, went from \u003ca href=\"https://www.washingtonpost.com/news/wonk/wp/2016/11/14/the-drugs-driving-up-medicare-spending/?utm_term=.1c130be6c3e1\">$2.2 million in 2014 to $15.7 million in 2015\u003c/a>.\u003c/p>\n\u003cp>Other times, U.S. patients bypass the system, Alpern says, by asking relatives in other countries to bring them the drug they need. In the United Kingdom, for example, 400 mg of albendazole costs just $2.\u003c/p>\n\u003cp>Why are prices so different in the U.S.?\u003c/p>\n\u003cp>\"In other countries, there are price control methods. The government steps in to ensure drug prices do not increase by a certain amount,\" Alpern says. \"There are no price control mechanisms in the U.S.\"\u003c/p>\n\u003cp>For patients with hookworm, there are few treatment alternatives in the U.S.\u003c/p>\n\u003cp>Mebendazole, which is less than half as effective than albendazole, according to hookworm expert Dr. David Diemert, is considered the second generic line of treatment for hookworm. Impax Laboratories also owns the rights to the drug. Between 2011 and 2016, mebendazole's price jumped more than 8,000 percent, \u003ca href=\"http://www.npr.org/sections/health-shots/2017/01/30/512400204/a-pinworm-medication-is-being-tested-as-a-potential-anti-cancer-drug\">from $4.50 to $369\u003c/a>.\u003c/p>\n\u003cp>Hotez agrees with Alpern's theory that pharmaceutical companies have a profit motive.\u003c/p>\n\u003cp>\"Presumably, small companies see a niche to make some quick cash,\" Hotez says. Meanwhile, in low-income countries, he says, \"many of these drugs are being donated for free [by pharmaceutical companies]. As an example, albendazole is \u003ca href=\"http://www.who.int/mediacentre/news/statements/2011/deworming_tabs_201109_09/en/\">donated by GlaxoSmithKline\u003c/a>.\"\u003c/p>\n\u003cp>According to its website, Impax is \"committed to making ENVERM [mebendazole] more affordable.\" The pharmaceutical company shared an \u003ca href=\"http://www.emverm.com/savings-program/\">online coupon\u003c/a> that can save patients up to $60 for a prescription that would cost more than $369.\u003c/p>\n\u003cp>Alpern hopes to see more companies start manufacturing the generic version of the drug. In his eyes, that's the ultimate solution.\u003c/p>\n\u003chr>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003ca href=\"http://nadiawhitehead.com\">\u003cem>Nadia Whitehead\u003c/em>\u003c/a>\u003cem> is a freelance journalist and a science writer at Texas Tech University Health Sciences Center El Paso. Her work has appeared in \u003c/em>Science\u003cem>, \u003c/em>The Washington Post\u003cem> and NPR. Find her on Twitter \u003c/em>\u003ca href=\"https://twitter.com/nadiamacias\">\u003cem>@NadiaMacias\u003c/em>\u003c/a>\u003cem>.\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Why+A+Pill+That%27s+4+Cents+In+Tanzania+Costs+Up+To+%24400+In+The+U.S.&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"excerpt": "The medication fights hookworm. It's one of several drugs for \"neglected tropical diseases\" that are priced differently in the United States than they are in the developing world.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Two pills to wipe out hookworm could cost you 4 cents. Or $400.\u003c/p>\n\u003cp>It just depends where you live.\u003c/p>\n\u003cp>The \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2657832/table/pntd-0000402-t002/\">4 cents is in Tanzania\u003c/a>. That'll cover the two pills it takes to knock out the intestinal parasite. But in the United States, where hookworm has re-emerged, the price for two 200 mg tablets of albendazole can cost \u003ca href=\"https://www.goodrx.com/albendazole?drug-name=albendazole\">as much as $400\u003c/a>.\u003c/p>\n\u003cp>The pill will put an end to the problems hookworm can cause, such as anemia and protein deficiency as well as stunting growth in children.\u003c/p>\n\u003caside class=\"pullquote alignright\">'When there's limited competition in the market, the company that holds the monopoly is able to price [the drug] however they want.'\u003ccite>Dr. Jonathan Alpern, HealthPartners Institute\u003c/cite>\u003c/aside>\n\u003cp>It's not just a problem with the anti-hookworm pill. Drugs for diseases of the developing world, in particular what are known as \"neglected tropical diseases\" like hookworm and \u003ca href=\"https://www.npr.org/sections/goatsandsoda/2016/06/29/483721076/the-aleppo-evil-is-making-a-comeback\">leishmaniasis\u003c/a>, are enormously more expensive in the United States than in the developing world.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"There really is no good reason for this price,\" \u003ca href=\"https://www.healthpartners.com/hprf/investigators/ENTRY_194022\">Dr. Jonathan Alpern\u003c/a> says of the albendazole price tag. Alpern works for the HealthPartners Institute, the research division of a health care organization in Minnesota.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>Impax Laboratories is the only pharmaceutical company that offers the drug in the U.S. Impax did not wish to comment on product pricing for this story but stated in an email to NPR: \"Given the very different regulatory regimes in the U.S. versus outside the U.S., pricing is a very awkward comparison.\"\u003c/p>\n\u003cp>Because the drug's patent expired decades ago, other companies can sell the generic version. But for medications that fight neglected tropical diseases, pharmaceutical companies have been slow to jump in and manufacture the medicine.\u003c/p>\n\u003cp>As for those that do: \"[Impax] fits into a category of companies that have taken drugs that have been around for many years, acquired the rights and jacked up the price [for the Western market],\" says Alpern.\u003c/p>\n\u003cp>Indeed, prices for generic drugs that treat neglected tropical diseases \u003ca href=\"http://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0005794\">are skyrocketing in the U.S.\u003c/a>\u003c/p>\n\u003cp>When a disease affects only a small number of patients in the U.S., \"there's less incentive for generic companies to enter the market,\" Alpern explains. That's because there's less potential for profit.\u003c/p>\n\u003cp>Hookworm, which was recently \u003ca href=\"https://www.npr.org/sections/goatsandsoda/2017/09/12/550387650/the-u-s-thought-it-was-rid-of-hookworm-wrong\">discovered in a small community\u003c/a> in the U.S., is just one example of this trend.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>Neurocysticercosis, a parasitic disease that causes seizures and epilepsy, is another example. The disease is rare in the U.S. with an estimated \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4005108/\">1,000 to 5,000 new cases\u003c/a> every year. Either albendazole or praziquantel are used to treat the disease. Praziquantel is also pricey: \u003ca href=\"https://www.goodrx.com/biltricide?drug-name=biltricide\">about $525\u003c/a> for six 600 mg tablets.\u003c/p>\n\u003cp>Leishmaniasis, which affects 700,000 to a million people annually throughout the world, is more expensive to treat in the U.S., too. Though rare in the U.S. — only \u003ca href=\"http://phenomena.nationalgeographic.com/2015/10/19/leishmaniasis-tx/\">13 cases\u003c/a> were uncovered between 2000 and 2007 — the disease can cause disfiguring skin sores or swelling of the spleen or liver depending on the form of the disease that's contracted. Two 50 mg tablets of miltefosine for 28 days can treat the infection; the price of each pill wholesale is $685, according to Alpern's research.\u003c/p>\n\u003cp>\"When there's limited competition in the market, the company that holds the monopoly is able to price [the drug] however they want,\" Alpern says. \"In these cases, we often see companies taking advantage of their market position.\"\u003c/p>\n\u003cp>And some of these disease aren't all that rare. \u003ca href=\"https://www.bcm.edu/people/view/peter-hotez-m-d-ph-d/b1846a47-ffed-11e2-be68-080027880ca6\">Dr. Peter Hotez\u003c/a>, dean of the National School of Tropical Medicine at the Baylor College of Medicine, says certain neglected tropical diseases in the U.S. are surprisingly widespread, especially among those who may not be able to afford treatment.\u003c/p>\n\u003cp>For example, he estimates that \u003ca href=\"http://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0003012\">1.1 million Americans\u003c/a> are annually diagnosed with a parasitic infection called toxoplasmosis. The treatment is Daraprim; four 25 mg tablets currently cost between \u003ca href=\"https://www.goodrx.com/daraprim?drug-name=daraprim&form=tablet&dosage=25mg&quantity=4&days_supply=&label_override=Daraprim\">$3,000 and $3,400\u003c/a> on the U.S. market.\u003c/p>\n\u003cp>\"We have now identified nearly half-a-dozen neglected tropical diseases that are widespread in the U.S. among the poor, especially in the American South,\" says Hotez, who last year published \u003ca href=\"https://jhupbooks.press.jhu.edu/content/blue-marble-health\">\u003cem>Blue Marble Health\u003c/em>\u003c/a>, a book evaluating neglected diseases in America. \"In all, I estimate that 12 million Americans now live in extreme poverty with a neglected tropical disease.\"\u003c/p>\n\u003cp>Some of them are in Lowndes County, Ala., where a community of individuals was recently \u003ca href=\"http://www.ajtmh.org/content/journals/10.4269/ajtmh.17-0396\">discovered to have hookworm\u003c/a>. The average income in the county is just $18,036.\u003c/p>\n\u003cp>If patients don't have health insurance, they must pay the full price for prescriptions or skip treatment altogether.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\"Some of the people in Lowndes County are living off $600 or $700 a month,\" says Catherine Flowers, founder of \u003ca href=\"https://www.acrecdc.com/\">Alabama Center for Rural Enterprise\u003c/a>, a nonprofit that addresses poverty. \"People have told me they sometimes have to choose between buying medication and eating.\"\u003c/p>\n\u003cp>In cases where patients have Medicaid, taxpayers bear the burden.\u003c/p>\n\u003cp>In the years following albendazole's price hike in 2011, Medicaid spending on the drug went from under $100,000 in 2008 to more than \u003ca href=\"http://www.nejm.org/doi/full/10.1056/NEJMp1408376#t=article\">$7.5 million in 2013\u003c/a>. Medicaid spending on Daraprim, another tropical disease drug that just experienced a price hike, went from \u003ca href=\"https://www.washingtonpost.com/news/wonk/wp/2016/11/14/the-drugs-driving-up-medicare-spending/?utm_term=.1c130be6c3e1\">$2.2 million in 2014 to $15.7 million in 2015\u003c/a>.\u003c/p>\n\u003cp>Other times, U.S. patients bypass the system, Alpern says, by asking relatives in other countries to bring them the drug they need. In the United Kingdom, for example, 400 mg of albendazole costs just $2.\u003c/p>\n\u003cp>Why are prices so different in the U.S.?\u003c/p>\n\u003cp>\"In other countries, there are price control methods. The government steps in to ensure drug prices do not increase by a certain amount,\" Alpern says. \"There are no price control mechanisms in the U.S.\"\u003c/p>\n\u003cp>For patients with hookworm, there are few treatment alternatives in the U.S.\u003c/p>\n\u003cp>Mebendazole, which is less than half as effective than albendazole, according to hookworm expert Dr. David Diemert, is considered the second generic line of treatment for hookworm. Impax Laboratories also owns the rights to the drug. Between 2011 and 2016, mebendazole's price jumped more than 8,000 percent, \u003ca href=\"http://www.npr.org/sections/health-shots/2017/01/30/512400204/a-pinworm-medication-is-being-tested-as-a-potential-anti-cancer-drug\">from $4.50 to $369\u003c/a>.\u003c/p>\n\u003cp>Hotez agrees with Alpern's theory that pharmaceutical companies have a profit motive.\u003c/p>\n\u003cp>\"Presumably, small companies see a niche to make some quick cash,\" Hotez says. Meanwhile, in low-income countries, he says, \"many of these drugs are being donated for free [by pharmaceutical companies]. As an example, albendazole is \u003ca href=\"http://www.who.int/mediacentre/news/statements/2011/deworming_tabs_201109_09/en/\">donated by GlaxoSmithKline\u003c/a>.\"\u003c/p>\n\u003cp>According to its website, Impax is \"committed to making ENVERM [mebendazole] more affordable.\" The pharmaceutical company shared an \u003ca href=\"http://www.emverm.com/savings-program/\">online coupon\u003c/a> that can save patients up to $60 for a prescription that would cost more than $369.\u003c/p>\n\u003cp>Alpern hopes to see more companies start manufacturing the generic version of the drug. In his eyes, that's the ultimate solution.\u003c/p>\n\u003chr>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"http://nadiawhitehead.com\">\u003cem>Nadia Whitehead\u003c/em>\u003c/a>\u003cem> is a freelance journalist and a science writer at Texas Tech University Health Sciences Center El Paso. Her work has appeared in \u003c/em>Science\u003cem>, \u003c/em>The Washington Post\u003cem> and NPR. Find her on Twitter \u003c/em>\u003ca href=\"https://twitter.com/nadiamacias\">\u003cem>@NadiaMacias\u003c/em>\u003c/a>\u003cem>.\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Why+A+Pill+That%27s+4+Cents+In+Tanzania+Costs+Up+To+%24400+In+The+U.S.&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Sexual Harassment Allegations Part Revolt Against Workplace Hierarchy: Experts",
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"content": "\u003cp>The long and growing list of high-profile men losing their jobs amid sexual-harassment allegations speaks to a big cultural sea change. But is that shift driven by generational differences in how sexual harassment is viewed, or by bigger changes in the workplace?\u003c/p>\n\u003caside class=\"pullquote alignright\">Younger workers today expect the power dynamic at work to be more egalitarian, with less top-down management.\u003c/aside>\n\u003cp>Seattle executive consultant Kim Arellano has taught classes on generational differences, and says sexual harassment makes for the liveliest discussions.\u003c/p>\n\u003cp>Typically baby boomer women — some of whose careers predate the 1964 civil rights laws barring sex discrimination — say they \"just put up with it,\" Arellano says. \"Smiled, giggled, and just moved on and tried to get your work done and avoid any embarrassing situations because the only other recourse was to leave.\"\u003c/p>\n\u003cp>Their daughters — members of Generation X — were taught the rules and regulations governing sexual harassment, but seldom used them to report problems, Arellano says. At 47, she includes herself in that cohort.\u003c/p>\n\u003cp>That stands in contrast to the youngest workers today. Arellano recalls the horrified reaction of a young, 20-something listening to the older women: \"She crossed her arms and she says, 'I cannot believe that any of you would put up with that in the workplace.' \"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The dozens of recent high-profile cases, including among male executives at NPR, prompted Arellano to rethink those conversations and wonder: Are the swift dismissals happening at institutions today a result of a shift in generational thinking?\u003c/p>\n\u003cp>There's little academic research on the subject of generational attitudes and sexual harassment. But Arellano says she suspects the change isn't that younger women today perceive sexual harassment differently.\u003c/p>\n\u003cp>Rather, it's that younger workers today expect the power dynamic at work to be more egalitarian, with less top-down management. And that is changing the dynamic for all workers.\u003c/p>\n\u003cp>\"The newest generation looks at the work environment really as a partnership, and engage differently as opposed to the hierarchical structures that we've been so used to in the past, really is an evolution of the workplace,\" she says.\u003c/p>\n\u003cp>In fact, many experts agree on this point.\u003c/p>\n\u003cp>Phyllis Hartman, a human resource consultant near Pittsburgh in her late 60s, says that early in her career, hierarchy was closely intertwined with gender politics.\u003c/p>\n\u003cp>\"When I was coming up, men were worried about women taking their jobs, and so it was like, 'Well, we're not gonna let them tell us what to do; we're just gonna behave the way we've always behaved,' \" she says.\u003c/p>\n\u003cp>Could a woman alleging harassment back then have been able to demand her harasser be fired? Hartman says she didn't believe that was an option.\u003c/p>\n\u003cp>She says one big difference now is that more workers these days — both women and men — don't feel beholden to their employer; they expect to move up, or they'll move out.\u003c/p>\n\u003cp>\"And so the expectations ... are different than both men and women in my generation, where people were given to believe that you had to work your way up and you had to play the game,\" Hartman says.\u003c/p>\n\u003cp>Last month, a women's job review website called Fairygodboss released \u003ca href=\"https://fairygodboss.com/research/sexual-harassment-2017\">a survey\u003c/a> on sexual harassment.\u003c/p>\n\u003cp>The site's founder, Georgene Huang, says the most disturbing finding is that — despite what news reports about top executives might suggest — women are more often sexually harassed by their peers (57 percent) than by their bosses (about 36 percent). And the harassers are predominantly men under the age of 40.\u003c/p>\n\u003cp>That, Huang says, underscores how pervasive the problem remains.\u003c/p>\n\u003cp>At 37, Huang considers herself an older millennial, and would like to think her generation is less tolerant of harassment. But as a young intern on Capitol Hill, she says she and her colleagues stayed silent about rampant sexual harassment.\u003c/p>\n\u003cp>\"The fact that we openly talked about that as a class of interns, and didn't really think to do anything or to complain,\" she says, has been a common experience shared by all generations.\u003c/p>\n\u003cp>It's the breaking of the silence that's changed, says Elizabeth McLeod, a 24-year-old workplace consultant in Atlanta.\u003c/p>\n\u003cp>\"I don't know if it's as much a generational difference as it is how technology has impacted the conversation around sexual harassment,\" she says. \"Now there's this constant conversation about it online. So it's much less isolating, which kind of brings it to everyone's attention.\"\u003c/p>\n\u003cp>She sees women her own age and her mother's age breaking their silence — all at the same time.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"The rising conversation has given voice to a lot of experiences that were just pushed beneath the surface for 20, 30 years,\" McLeod says.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Are+There+Generational+Differences+When+It+Comes+To+Sexual+Harassment+At+Work%3F&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The long and growing list of high-profile men losing their jobs amid sexual-harassment allegations speaks to a big cultural sea change. But is that shift driven by generational differences in how sexual harassment is viewed, or by bigger changes in the workplace?\u003c/p>\n\u003caside class=\"pullquote alignright\">Younger workers today expect the power dynamic at work to be more egalitarian, with less top-down management.\u003c/aside>\n\u003cp>Seattle executive consultant Kim Arellano has taught classes on generational differences, and says sexual harassment makes for the liveliest discussions.\u003c/p>\n\u003cp>Typically baby boomer women — some of whose careers predate the 1964 civil rights laws barring sex discrimination — say they \"just put up with it,\" Arellano says. \"Smiled, giggled, and just moved on and tried to get your work done and avoid any embarrassing situations because the only other recourse was to leave.\"\u003c/p>\n\u003cp>Their daughters — members of Generation X — were taught the rules and regulations governing sexual harassment, but seldom used them to report problems, Arellano says. At 47, she includes herself in that cohort.\u003c/p>\n\u003cp>That stands in contrast to the youngest workers today. Arellano recalls the horrified reaction of a young, 20-something listening to the older women: \"She crossed her arms and she says, 'I cannot believe that any of you would put up with that in the workplace.' \"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The dozens of recent high-profile cases, including among male executives at NPR, prompted Arellano to rethink those conversations and wonder: Are the swift dismissals happening at institutions today a result of a shift in generational thinking?\u003c/p>\n\u003cp>There's little academic research on the subject of generational attitudes and sexual harassment. But Arellano says she suspects the change isn't that younger women today perceive sexual harassment differently.\u003c/p>\n\u003cp>Rather, it's that younger workers today expect the power dynamic at work to be more egalitarian, with less top-down management. And that is changing the dynamic for all workers.\u003c/p>\n\u003cp>\"The newest generation looks at the work environment really as a partnership, and engage differently as opposed to the hierarchical structures that we've been so used to in the past, really is an evolution of the workplace,\" she says.\u003c/p>\n\u003cp>In fact, many experts agree on this point.\u003c/p>\n\u003cp>Phyllis Hartman, a human resource consultant near Pittsburgh in her late 60s, says that early in her career, hierarchy was closely intertwined with gender politics.\u003c/p>\n\u003cp>\"When I was coming up, men were worried about women taking their jobs, and so it was like, 'Well, we're not gonna let them tell us what to do; we're just gonna behave the way we've always behaved,' \" she says.\u003c/p>\n\u003cp>Could a woman alleging harassment back then have been able to demand her harasser be fired? Hartman says she didn't believe that was an option.\u003c/p>\n\u003cp>She says one big difference now is that more workers these days — both women and men — don't feel beholden to their employer; they expect to move up, or they'll move out.\u003c/p>\n\u003cp>\"And so the expectations ... are different than both men and women in my generation, where people were given to believe that you had to work your way up and you had to play the game,\" Hartman says.\u003c/p>\n\u003cp>Last month, a women's job review website called Fairygodboss released \u003ca href=\"https://fairygodboss.com/research/sexual-harassment-2017\">a survey\u003c/a> on sexual harassment.\u003c/p>\n\u003cp>The site's founder, Georgene Huang, says the most disturbing finding is that — despite what news reports about top executives might suggest — women are more often sexually harassed by their peers (57 percent) than by their bosses (about 36 percent). And the harassers are predominantly men under the age of 40.\u003c/p>\n\u003cp>That, Huang says, underscores how pervasive the problem remains.\u003c/p>\n\u003cp>At 37, Huang considers herself an older millennial, and would like to think her generation is less tolerant of harassment. But as a young intern on Capitol Hill, she says she and her colleagues stayed silent about rampant sexual harassment.\u003c/p>\n\u003cp>\"The fact that we openly talked about that as a class of interns, and didn't really think to do anything or to complain,\" she says, has been a common experience shared by all generations.\u003c/p>\n\u003cp>It's the breaking of the silence that's changed, says Elizabeth McLeod, a 24-year-old workplace consultant in Atlanta.\u003c/p>\n\u003cp>\"I don't know if it's as much a generational difference as it is how technology has impacted the conversation around sexual harassment,\" she says. \"Now there's this constant conversation about it online. So it's much less isolating, which kind of brings it to everyone's attention.\"\u003c/p>\n\u003cp>She sees women her own age and her mother's age breaking their silence — all at the same time.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"The rising conversation has given voice to a lot of experiences that were just pushed beneath the surface for 20, 30 years,\" McLeod says.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Are+There+Generational+Differences+When+It+Comes+To+Sexual+Harassment+At+Work%3F&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "In The U.S., Flu Season Could Be Unusually Harsh This Year",
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"content": "\u003cp>Health officials are warning that the United States may have an unusually harsh flu season this year.\u003c/p>\n\u003cp>But they stress that flu seasons are notoriously difficult to predict, and it's far too early to know for sure what may happen.\u003c/p>\n\u003cp>The concern stems from several factors, including signs that the season started a few weeks earlier than usual. \"When you have an early start with regional outbreaks, that is generally not a good sign,\" says \u003ca href=\"https://www.niaid.nih.gov/about/director\">Anthony Fauci\u003c/a>, who directs the National Institute of Allergy and Infectious Diseases. \"Sometimes that's the forerunner of a serious season.\"\u003c/p>\n\u003cp>[contextly_sidebar id=\"kQiTPGVQfgsOwkWWvQK3JQStc3Tj5f9c\"]An early start could mean a longer season, which could mean more people end up getting infected with the \u003ca href=\"https://www.cdc.gov/flu/index.htm\">flu\u003c/a>.\u003c/p>\n\u003cp>Another reason for concern is that Australia had a severe flu season this year.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"We generally follow in our season what happened in the Southern Hemisphere, such as in Australia,\" Fauci says. \"And Australia had a particularly bad influenza season for a number of reasons.\"\u003c/p>\n\u003cp>A major reason for Australia's struggle is that the main strain of flu circulating there was one known as H3N2. That kind of flu virus tends to make people sicker than other strains, especially the elderly.\u003c/p>\n\u003cp>To make things worse, the flu vaccine appears to have been only about 10 percent effective against that strain in Australia. Part of the reason for that is that flu strains are constantly changing and the H3N2 strain used to make the vaccine mutated during production of the vaccine. This weakened the shot's effectiveness.\u003c/p>\n\u003cp>\"The mutation just happened to be in a very bad spot on the virus to make it essentially be a mismatch for the vaccine,\" Fauci says.\u003c/p>\n\u003cp>The United States is using the same vaccine, and an H3N2 strain appears to be dominating outbreaks in this country so far too.\u003c/p>\n\u003cp>[contextly_sidebar id=\"63g4SLVhAYg2wb0bQ3dtFmDxdKZiDDkH\"]\"It looks like not only are we using the same vaccine, but the virus that was circulating in Australia appears to be the same virus that we're starting to see now in the outbreaks in the United States,\" Fauci says.\u003c/p>\n\u003cp>But it could also turn out that the vaccine could be far more effective in the United States than it was in Australia, according to \u003ca href=\"http://dcp-3.org/author/brendan-flannery\">Brendan Flannery\u003c/a>, an epidemiologist at the influenza division at the Centers for Disease Control and Prevention.\u003c/p>\n\u003cp>That's because a slightly different H3N2 strain could end up dominating in this country, for example. Another possibility is that other flu strains could become more common. The vaccine provides stronger protection against those.\u003c/p>\n\u003cp>\"It could be that we're going to have a severe season — and we have to prepare for that,\" Flannery says. \"But it's early to make a prediction for this season.\"\u003c/p>\n\u003cp>U.S. officials also think they have a better system than Australia for estimating vaccine effectiveness. Last year, the vaccine was 32 percent effective against the H3N2 flu strain in the United States.\u003c/p>\n\u003cp>Another factor in America's favor is that \"the U.S. population overall is more highly vaccinated than the Australian population,\" says \u003ca href=\"https://cdc.confex.com/cdc/phi2011/webprogram/Person29911.html\">Lynnette Brammer\u003c/a>, another CDC epidemiologist. \"So you may get some indirect effects of more people being vaccinated here.\"\u003c/p>\n\u003cp>\u003ca href=\"https://sph.umich.edu/faculty-profiles/monto-arnold.html\">Arnold Monto\u003c/a>, a professor of epidemiology at the University of Michigan School of Public Health, also noted that there's evidence that Australia didn't use antiviral drugs as aggressively as it could have when treating the flu.\u003c/p>\n\u003cp>Regardless of what happens this year in the United States, infectious disease experts say it remains crucial that as many people get vaccinated as possible.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"They need to get it not only to protect themselves but so that they don't spread it around to other people — their loved ones, folks at the gym, and at work and at religious services — who are more vulnerable,\" says \u003ca href=\"https://medicine.mc.vanderbilt.edu/node/451\">William Schaffner\u003c/a>, an infectious disease specialist at the Vanderbilt University Medical Center in Nashville, Tenn. \"No one wants to be a dreaded spreader.\"\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=In+The+U.S.%2C+Flu+Season+Could+Be+Unusually+Harsh+This+Year&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Health officials are warning that the United States may have an unusually harsh flu season this year.\u003c/p>\n\u003cp>But they stress that flu seasons are notoriously difficult to predict, and it's far too early to know for sure what may happen.\u003c/p>\n\u003cp>The concern stems from several factors, including signs that the season started a few weeks earlier than usual. \"When you have an early start with regional outbreaks, that is generally not a good sign,\" says \u003ca href=\"https://www.niaid.nih.gov/about/director\">Anthony Fauci\u003c/a>, who directs the National Institute of Allergy and Infectious Diseases. \"Sometimes that's the forerunner of a serious season.\"\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>An early start could mean a longer season, which could mean more people end up getting infected with the \u003ca href=\"https://www.cdc.gov/flu/index.htm\">flu\u003c/a>.\u003c/p>\n\u003cp>Another reason for concern is that Australia had a severe flu season this year.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"We generally follow in our season what happened in the Southern Hemisphere, such as in Australia,\" Fauci says. \"And Australia had a particularly bad influenza season for a number of reasons.\"\u003c/p>\n\u003cp>A major reason for Australia's struggle is that the main strain of flu circulating there was one known as H3N2. That kind of flu virus tends to make people sicker than other strains, especially the elderly.\u003c/p>\n\u003cp>To make things worse, the flu vaccine appears to have been only about 10 percent effective against that strain in Australia. Part of the reason for that is that flu strains are constantly changing and the H3N2 strain used to make the vaccine mutated during production of the vaccine. This weakened the shot's effectiveness.\u003c/p>\n\u003cp>\"The mutation just happened to be in a very bad spot on the virus to make it essentially be a mismatch for the vaccine,\" Fauci says.\u003c/p>\n\u003cp>The United States is using the same vaccine, and an H3N2 strain appears to be dominating outbreaks in this country so far too.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\"It looks like not only are we using the same vaccine, but the virus that was circulating in Australia appears to be the same virus that we're starting to see now in the outbreaks in the United States,\" Fauci says.\u003c/p>\n\u003cp>But it could also turn out that the vaccine could be far more effective in the United States than it was in Australia, according to \u003ca href=\"http://dcp-3.org/author/brendan-flannery\">Brendan Flannery\u003c/a>, an epidemiologist at the influenza division at the Centers for Disease Control and Prevention.\u003c/p>\n\u003cp>That's because a slightly different H3N2 strain could end up dominating in this country, for example. Another possibility is that other flu strains could become more common. The vaccine provides stronger protection against those.\u003c/p>\n\u003cp>\"It could be that we're going to have a severe season — and we have to prepare for that,\" Flannery says. \"But it's early to make a prediction for this season.\"\u003c/p>\n\u003cp>U.S. officials also think they have a better system than Australia for estimating vaccine effectiveness. Last year, the vaccine was 32 percent effective against the H3N2 flu strain in the United States.\u003c/p>\n\u003cp>Another factor in America's favor is that \"the U.S. population overall is more highly vaccinated than the Australian population,\" says \u003ca href=\"https://cdc.confex.com/cdc/phi2011/webprogram/Person29911.html\">Lynnette Brammer\u003c/a>, another CDC epidemiologist. \"So you may get some indirect effects of more people being vaccinated here.\"\u003c/p>\n\u003cp>\u003ca href=\"https://sph.umich.edu/faculty-profiles/monto-arnold.html\">Arnold Monto\u003c/a>, a professor of epidemiology at the University of Michigan School of Public Health, also noted that there's evidence that Australia didn't use antiviral drugs as aggressively as it could have when treating the flu.\u003c/p>\n\u003cp>Regardless of what happens this year in the United States, infectious disease experts say it remains crucial that as many people get vaccinated as possible.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"They need to get it not only to protect themselves but so that they don't spread it around to other people — their loved ones, folks at the gym, and at work and at religious services — who are more vulnerable,\" says \u003ca href=\"https://medicine.mc.vanderbilt.edu/node/451\">William Schaffner\u003c/a>, an infectious disease specialist at the Vanderbilt University Medical Center in Nashville, Tenn. \"No one wants to be a dreaded spreader.\"\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=In+The+U.S.%2C+Flu+Season+Could+Be+Unusually+Harsh+This+Year&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "The Man Who Was Nearly Cured of HIV",
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"content": "\u003cp>The cases of Clark Hawley, 54, and Luis Canales, 31, presented at the \u003ca href=\"http://www.curecountdown.org/research-index/2017/9/12/2017-hiv-cure-summit\" target=\"_blank\" rel=\"noopener\">amfAR HIV Cure Summit \u003c/a>in San Francisco last November, provided at least a temporary answer to a big question: Can very early treatment after exposure to HIV lead to complete eradication of the virus — an actual cure?\u003c/p>\n\u003cp>No.\u003c/p>\n\u003cp>But almost.\u003c/p>\n\u003caside class=\"pullquote alignright\">Early antitretroviral treatment brings about a striking period of long-term remission, also called a 'functional cure,' in an HIV patient. \u003c/aside>\n\u003cp>In Hawley’s case, nearly immediate treatment did usher in a striking period of long-term remission, also called a \"functional cure,\" in which zero trace of HIV was detected in his blood or tissue samples, without the benefit of drugs.\u003c/p>\n\u003cp>The men were recruited as part of an ongoing observational UCSF study. Both were given an initial dose of the antiretroviral combination Truvada, also known as pre-exposure prophylaxis, or PrEP, within two weeks after their suspected exposure to the virus. The treatment came so soon after infection that their immune systems had yet to generate an antibody response. In Hawley’s case, only a more sensitive genetic test called PCR, which measures an individual’s \u003ca href=\"https://www.aidsmap.com/Viral-load/page/1327496/\" target=\"_blank\" rel=\"noopener\">viral load\u003c/a>, showed signs of HIV. After the initial treatment, both men were switched to a daily four-drug antiviral regimen, which drove the virus below detectable levels.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>What happened next is a mystery.\u003c/p>\n\u003cp>[contextly_sidebar id=\"6nfWarjopr6zyonYcblrTOe4VSljxsdZ\"]As reported Nov. 7 in \u003cem> \u003ca href=\"https://protect-us.mimecast.com/s/8JwmB0iVvmacp?domain=journals.plos.org\" target=\"_blank\" rel=\"noopener\">PloS Medicine\u003c/a>\u003c/em>, a UCSF team led by Drs. Timothy Henrich and Steven Deeks said it failed to detect any trace of HIV in Hawley’s blood or tissue for the two years he remained on medication. Typically individuals on successful HIV therapy are classified as “undetectable” when drugs drive viral activity below observable levels in the blood. But it’s known that a small amount of residual virus called the HIV reservoir may be found in tissue using sensitive PCR tests. These came up negative.\u003c/p>\n\u003cp>Hawley then went off the drugs, a step that was part of the study design. About seven months later, the virus rebounded, quickly multiplying into an active infection. He immediately resumed antiretroviral treatment, which again rendered the virus undetectable.\u003c/p>\n\u003cfigure id=\"attachment_437571\" class=\"wp-caption alignright\" style=\"max-width: 1000px\">\u003ca href=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/12/deeks-and-volberding.jpg\">\u003cimg class=\"wp-image-437571 size-full\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/12/deeks-and-volberding.jpg\" alt=\"\" width=\"1000\" height=\"754\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/12/deeks-and-volberding.jpg 1000w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/deeks-and-volberding-160x121.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/deeks-and-volberding-800x603.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/deeks-and-volberding-768x579.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/deeks-and-volberding-960x724.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/deeks-and-volberding-240x181.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/deeks-and-volberding-375x283.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/deeks-and-volberding-520x392.jpg 520w\" sizes=\"(max-width: 1000px) 100vw, 1000px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Dr. Steven Deeks, right, who talked about the results of early intervention after exposure to the HIV virus, at amfAR's 2017 HIV Cure Summit. On the left is long-time HIV researcher Dr. Paul Volberding. \u003ccite>(amfAR)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>But what puzzled scientists was that his body still showed no sign of an antibody response. That suggested his immune system had never had sufficient time to generate a defense because the drugs had worked so quickly that they halted the initial infection. Yet, they knew he still had HIV from the results of a viral load test. More genetic tests confirmed the resuscitated virus was the same strain he was initially exposed to.\u003c/p>\n\u003caside class=\"pullquote alignright\">'We got close; we may have been off by a day or two.'\u003ccite>Dr. Steven Deeks, UCSF\u003c/cite>\u003c/aside>\n\u003cp>Deeks said Hawley probably has a small latent reservoir of HIV somewhere in his body, which hasn’t grown due to Truvada’s suppression of the virus’s initial spread. His status is now in a kind of limbo, somewhere between having HIV and not.\u003c/p>\n\u003cp>“The whole excitement around Clark is that we were able to initiate therapy so early that we were hoping to prevent the establishing of latency,” says Deeks. “But it did not happen. We got close; we may have been off by a day or two. We did not achieve a real cure.”\u003c/p>\n\u003cp>Even if Hawley had been permanently freed of HIV, the problem with any protocol based on such early treatment is that doctors rarely detect a patient’s infection in the first days after exposure. Rather, the case is significant due to the milestone of pushing a patient into long-term remission free of medication, and because it might offer new clues on how to induce a permanent state of HIV dormancy.\u003c/p>\n\u003cp>\u003cstrong>Dramatically Reducing HIV Reservoirs\u003c/strong>\u003c/p>\n\u003cp>Canales’ case is also tantalizing. He was given a PrEP dose of Truvada 12 days after exposure, and for two years showed no sign of HIV in blood or tissue samples on both viral load and PCR tests. Because of Hawley’s relapse experience after stopping therapy, doctors kept him on the treatment. The only way they could detect signs of the virus in Canales was by transferring some of his cells into mice bred with a copycat human immune system. They were able to intermittently spy a virus particle here or there upon removing the cells from the mice. As with Hawley, early treatment had dramatically limited the amount of virus that would later coalesce into a dormant pool in his body.\u003c/p>\n\u003cp>“I think we have proven to ourselves that early treatment will never be curative,” Deeks said, referring to complete eradication of the virus within someone’s body. When pressed whether he really meant “never,” he amended his answer: “No, not yet.”\u003c/p>\n\u003cp>“But we can definitely shift the balance in favor of the patient,” he went on, “because the reservoir is reduced a hundred- to a million-fold.”\u003c/p>\n\u003cp>Deeks and his team are now investigating a series of HIV vaccines aimed at providing an immune booster to control the pieces of virus that remain in a patient’s body, the final step in sending HIV patients into remission — no medication required. Beyond that, if such tools could wipe out the last pockets of HIV, medical science would have finally achieved its ultimate goal in the fight against AIDS — an actual cure.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Anne-christine d’Adesky is a longtime chronicler of HIV research. Her 90s-era AIDS memoir, “The Pox Lover,” was published in June.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The cases of Clark Hawley, 54, and Luis Canales, 31, presented at the \u003ca href=\"http://www.curecountdown.org/research-index/2017/9/12/2017-hiv-cure-summit\" target=\"_blank\" rel=\"noopener\">amfAR HIV Cure Summit \u003c/a>in San Francisco last November, provided at least a temporary answer to a big question: Can very early treatment after exposure to HIV lead to complete eradication of the virus — an actual cure?\u003c/p>\n\u003cp>No.\u003c/p>\n\u003cp>But almost.\u003c/p>\n\u003caside class=\"pullquote alignright\">Early antitretroviral treatment brings about a striking period of long-term remission, also called a 'functional cure,' in an HIV patient. \u003c/aside>\n\u003cp>In Hawley’s case, nearly immediate treatment did usher in a striking period of long-term remission, also called a \"functional cure,\" in which zero trace of HIV was detected in his blood or tissue samples, without the benefit of drugs.\u003c/p>\n\u003cp>The men were recruited as part of an ongoing observational UCSF study. Both were given an initial dose of the antiretroviral combination Truvada, also known as pre-exposure prophylaxis, or PrEP, within two weeks after their suspected exposure to the virus. The treatment came so soon after infection that their immune systems had yet to generate an antibody response. In Hawley’s case, only a more sensitive genetic test called PCR, which measures an individual’s \u003ca href=\"https://www.aidsmap.com/Viral-load/page/1327496/\" target=\"_blank\" rel=\"noopener\">viral load\u003c/a>, showed signs of HIV. After the initial treatment, both men were switched to a daily four-drug antiviral regimen, which drove the virus below detectable levels.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>What happened next is a mystery.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>As reported Nov. 7 in \u003cem> \u003ca href=\"https://protect-us.mimecast.com/s/8JwmB0iVvmacp?domain=journals.plos.org\" target=\"_blank\" rel=\"noopener\">PloS Medicine\u003c/a>\u003c/em>, a UCSF team led by Drs. Timothy Henrich and Steven Deeks said it failed to detect any trace of HIV in Hawley’s blood or tissue for the two years he remained on medication. Typically individuals on successful HIV therapy are classified as “undetectable” when drugs drive viral activity below observable levels in the blood. But it’s known that a small amount of residual virus called the HIV reservoir may be found in tissue using sensitive PCR tests. These came up negative.\u003c/p>\n\u003cp>Hawley then went off the drugs, a step that was part of the study design. About seven months later, the virus rebounded, quickly multiplying into an active infection. He immediately resumed antiretroviral treatment, which again rendered the virus undetectable.\u003c/p>\n\u003cfigure id=\"attachment_437571\" class=\"wp-caption alignright\" style=\"max-width: 1000px\">\u003ca href=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/12/deeks-and-volberding.jpg\">\u003cimg class=\"wp-image-437571 size-full\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/12/deeks-and-volberding.jpg\" alt=\"\" width=\"1000\" height=\"754\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/12/deeks-and-volberding.jpg 1000w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/deeks-and-volberding-160x121.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/deeks-and-volberding-800x603.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/deeks-and-volberding-768x579.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/deeks-and-volberding-960x724.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/deeks-and-volberding-240x181.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/deeks-and-volberding-375x283.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/deeks-and-volberding-520x392.jpg 520w\" sizes=\"(max-width: 1000px) 100vw, 1000px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Dr. Steven Deeks, right, who talked about the results of early intervention after exposure to the HIV virus, at amfAR's 2017 HIV Cure Summit. On the left is long-time HIV researcher Dr. Paul Volberding. \u003ccite>(amfAR)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>But what puzzled scientists was that his body still showed no sign of an antibody response. That suggested his immune system had never had sufficient time to generate a defense because the drugs had worked so quickly that they halted the initial infection. Yet, they knew he still had HIV from the results of a viral load test. More genetic tests confirmed the resuscitated virus was the same strain he was initially exposed to.\u003c/p>\n\u003caside class=\"pullquote alignright\">'We got close; we may have been off by a day or two.'\u003ccite>Dr. Steven Deeks, UCSF\u003c/cite>\u003c/aside>\n\u003cp>Deeks said Hawley probably has a small latent reservoir of HIV somewhere in his body, which hasn’t grown due to Truvada’s suppression of the virus’s initial spread. His status is now in a kind of limbo, somewhere between having HIV and not.\u003c/p>\n\u003cp>“The whole excitement around Clark is that we were able to initiate therapy so early that we were hoping to prevent the establishing of latency,” says Deeks. “But it did not happen. We got close; we may have been off by a day or two. We did not achieve a real cure.”\u003c/p>\n\u003cp>Even if Hawley had been permanently freed of HIV, the problem with any protocol based on such early treatment is that doctors rarely detect a patient’s infection in the first days after exposure. Rather, the case is significant due to the milestone of pushing a patient into long-term remission free of medication, and because it might offer new clues on how to induce a permanent state of HIV dormancy.\u003c/p>\n\u003cp>\u003cstrong>Dramatically Reducing HIV Reservoirs\u003c/strong>\u003c/p>\n\u003cp>Canales’ case is also tantalizing. He was given a PrEP dose of Truvada 12 days after exposure, and for two years showed no sign of HIV in blood or tissue samples on both viral load and PCR tests. Because of Hawley’s relapse experience after stopping therapy, doctors kept him on the treatment. The only way they could detect signs of the virus in Canales was by transferring some of his cells into mice bred with a copycat human immune system. They were able to intermittently spy a virus particle here or there upon removing the cells from the mice. As with Hawley, early treatment had dramatically limited the amount of virus that would later coalesce into a dormant pool in his body.\u003c/p>\n\u003cp>“I think we have proven to ourselves that early treatment will never be curative,” Deeks said, referring to complete eradication of the virus within someone’s body. When pressed whether he really meant “never,” he amended his answer: “No, not yet.”\u003c/p>\n\u003cp>“But we can definitely shift the balance in favor of the patient,” he went on, “because the reservoir is reduced a hundred- to a million-fold.”\u003c/p>\n\u003cp>Deeks and his team are now investigating a series of HIV vaccines aimed at providing an immune booster to control the pieces of virus that remain in a patient’s body, the final step in sending HIV patients into remission — no medication required. Beyond that, if such tools could wipe out the last pockets of HIV, medical science would have finally achieved its ultimate goal in the fight against AIDS — an actual cure.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Anne-christine d’Adesky is a longtime chronicler of HIV research. Her 90s-era AIDS memoir, “The Pox Lover,” was published in June.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>https://youtu.be/PMotykw0SIk\u003c/p>\n\u003cp>You might want to post this on Facebook.\u003c/p>\n\u003cp>Actually, you might not want to post this on Facebook.\u003c/p>\n\u003cp class=\"p1\">Video of a former executive of the social media company that ate the world is making the rounds on the internet today.\u003c/p>\n\u003cp>Chamath Palihapitiya, whose \u003ca href=\"https://www.linkedin.com/in/chamath\" target=\"_blank\" rel=\"noopener\">LinkedIn page\u003c/a> says he was Facebook's vice president of user growth for mobile and international, said in an interview at the Stanford Graduate School of Business that social media is eroding civil society around the world.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp class=\"p1\">[contextly_sidebar id=\"So6uXBYvpPvYGdV1Uz7IHJ486LHGxQ6C\"]\"I feel tremendous guilt,\" said Palihapitiya. \"I think we have created tools that are ripping apart the social fabric of how society works. ... No civil discourse, no cooperation; misinformation, mistruth.\"\u003c/p>\n\u003cp class=\"p1\">The problem goes beyond the Russians buying pro-Trump ads, he said. \"This is a global problem.\"\u003c/p>\n\u003cp class=\"p1\">Palihapitiya, who post-Facebook became the founder and CEO of the venture capital firm Social Capital, also discusses a \u003ca href=\"http://www.bgr.in/news/fake-whatsapp-messages-lead-to-killing-of-7-alleged-kidnappers-in-jharkhand/\" target=\"_blank\" rel=\"noopener\">recent incident in India\u003c/a> where fake WhatsApp messages warning of hoax kidnappings lead to the death of seven innocent people by lynching.\u003c/p>\n\u003cp class=\"p1\">[contextly_sidebar id=\"Lw5Mvc0G9zydFy9AasACIr6hIbvOYYlz\"]\"It is eroding the core foundations of how people behave by and between each other.\"\u003c/p>\n\u003cp>He recommended people take a \"hard break\" from social media.\u003c/p>\n\u003cp class=\"p1\">Start watching from roughly 21:21. It may cause you to question your relationship to a world of \"likes,\" \"hearts\" and \"thumbs ups.\"\u003c/p>\n\u003cp> \u003c/p>\n\u003cp>\u003c/p>\n\u003cp class=\"p1\">\n\u003c/p>\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp class=\"p1\">\u003c/p>\u003cp>\u003c/p>\u003cp>\"I feel tremendous guilt,\" said Palihapitiya. \"I think we have created tools that are ripping apart the social fabric of how society works. ... No civil discourse, no cooperation; misinformation, mistruth.\"\u003c/p>\n\u003cp class=\"p1\">The problem goes beyond the Russians buying pro-Trump ads, he said. \"This is a global problem.\"\u003c/p>\n\u003cp class=\"p1\">Palihapitiya, who post-Facebook became the founder and CEO of the venture capital firm Social Capital, also discusses a \u003ca href=\"http://www.bgr.in/news/fake-whatsapp-messages-lead-to-killing-of-7-alleged-kidnappers-in-jharkhand/\" target=\"_blank\" rel=\"noopener\">recent incident in India\u003c/a> where fake WhatsApp messages warning of hoax kidnappings lead to the death of seven innocent people by lynching.\u003c/p>\n\u003cp class=\"p1\">\u003c/p>\u003cp>\u003c/p>\u003cp>\"It is eroding the core foundations of how people behave by and between each other.\"\u003c/p>\n\u003cp>He recommended people take a \"hard break\" from social media.\u003c/p>\n\u003cp class=\"p1\">Start watching from roughly 21:21. It may cause you to question your relationship to a world of \"likes,\" \"hearts\" and \"thumbs ups.\"\u003c/p>\n\u003cp> \u003c/p>\n\u003cp>\u003c/p>\n\u003cp class=\"p1\">\n\u003c/p>\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Last February Baxter Bailey injured himself trying to break into his own home when he couldn’t find his key. Crawling through a window leading to the utility room, he slipped and fell, hitting his head on the concrete floor.\u003c/p>\n\u003cp>He was unconscious for about an hour.\u003c/p>\n\u003cp>“My skull, my forehead was bloody, bruised and banged,” says the 77-year-old architect from Richmond, Virginia. “And I had blood all over my shirt, my pants and underwear.”\u003c/p>\n\u003cp>At the hospital, “Doctors told me that my brain moved inside the skull,” Baxter says. But a small hemorrhage in the brain visible through scans wasn’t bad enough to keep him as an inpatient for more than a day. Baxter was diagnosed with a concussion, or what medical professionals call a mild traumatic brain injury, and released.\u003c/p>\n\u003caside class=\"pullquote alignright\">'Unlike other neurological diseases, one cannot pinpoint the area of injury in concussion.'\u003ccite>Teena Shetty, neurologist\u003c/cite>\u003c/aside>\n\u003cp>“Within two weeks, the abrasion on my head got healed, and you couldn’t tell that anything ever happened to me if you looked at me,” says Baxter.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>But his troubles were just starting. Two months later, Baxter was in the emergency room again. He had started losing control of his left side. He found lifting his leg to get into a car difficult. Walking caused him trouble. This time the scans showed a chronic hematoma — swelling and bruising — on the right side of his skull.\u003c/p>\n\u003cp>“It was like 3 inches long and an inch thick and I could see that my brain literally was off center and my cerebellum was misaligned,” says Baxter. Doctors told him he needed immediate surgery. The plan was to drill a little hole in his head the size of a dime.\u003c/p>\n\u003cp>“I thought, ‘My lord, is this the end of me?’ ”\u003c/p>\n\u003cp>\u003cstrong>A Lot of Brain Injuries\u003c/strong>\u003c/p>\n\u003cp>Each year, about \u003ca href=\"https://www.cdc.gov/mmwr/volumes/66/ss/ss6609a1.htm\" target=\"_blank\" rel=\"noopener\">2.5 million people in the United States\u003c/a> are admitted to emergency rooms with traumatic brain injuries, according to the Centers for Disease Control and Prevention.\u003c/p>\n\u003cp>The difficulties of studying concussions, with their vague symptoms and hidden physical damage, have turned brain injury into a “silent epidemic,” in the words of \u003ca href=\"http://profiles.ucsf.edu/pratik.mukherjee\" target=\"_blank\" rel=\"noopener\">Pratik Mukherjee\u003c/a>, a neuroradiologist at UCSF.\u003c/p>\n\u003cp>\u003ca href=\"https://www.hss.edu/physicians_shetty-teena.asp\" target=\"_blank\" rel=\"noopener\">Teena Shetty\u003c/a>, a neurologist at New York City's Hospital for Special Surgery, agrees. “Unlike other neurological diseases, one cannot pinpoint the area of injury in concussion,” she says.\u003c/p>\n\u003cp>Doctors are not even in agreement about how to treat concussions. Some advise resuming daily activities as soon as possible, others suggest avoiding demanding work and staying away from bright lights and loud sounds.\u003c/p>\n\u003cp>Existing guidelines are not backed by evidence, according to \u003ca href=\"https://www.urmc.rochester.edu/people/20187378-jeffrey-j-bazarian\" target=\"_blank\" rel=\"noopener\">Jeff Bazarian\u003c/a>, professor of emergency medicine at the University of Rochester Medical Center, in New York.\u003c/p>\n\u003cfigure id=\"attachment_437557\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003cimg class=\"size-large wp-image-437557\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/12/16463775_10154204797011497_6888461288485270646_o-1020x765.jpg\" alt=\"\" width=\"640\" height=\"480\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/12/16463775_10154204797011497_6888461288485270646_o-1020x765.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/16463775_10154204797011497_6888461288485270646_o-160x120.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/16463775_10154204797011497_6888461288485270646_o-800x600.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/16463775_10154204797011497_6888461288485270646_o-768x576.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/16463775_10154204797011497_6888461288485270646_o-960x720.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/16463775_10154204797011497_6888461288485270646_o-240x180.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/16463775_10154204797011497_6888461288485270646_o-375x281.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/16463775_10154204797011497_6888461288485270646_o-520x390.jpg 520w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/16463775_10154204797011497_6888461288485270646_o.jpg 1024w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003cfigcaption class=\"wp-caption-text\">Tom Gal, 37-year old entrepreneur from San Francisco, recovering from a car accident at Zuckerberg San Francisco General Hospital and Trauma Center. \u003ccite>(Courtesy Tom Gal)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>A New Approach Tracks Patients in Detail\u003c/strong>\u003c/p>\n\u003cp>Predicting which concussion patients will fully recover and which will be permanently debilitated is more or less a guessing game.\u003c/p>\n\u003cp>Tom Gal, a 37-year old entrepreneur from San Francisco, spent almost two days in a coma after being hit by a car last August. He woke up with no memory of what happened and had to learn the details from his medical report. But eight months after the injury, he says he is doing just fine. In contrast, 29-year-old bread baker Ana Diaz, from Richmond, Virginia, complains about short-term memory lapses and increased anxiety six months after a biking accident that left her with no signs of head trauma on a CT scan.\u003c/p>\n\u003cp>In light of such counter-intuitive outcomes, many researchers feel it is now time to make the diagnosis and prognosis of concussions more precise and evidence-based.\u003c/p>\n\u003cp>According to Mukherjee, \u003ca href=\"https://link.springer.com/article/10.1186/s12245-014-0031-6\" target=\"_blank\" rel=\"noopener\">15 to 30 percent of concussion patients\u003c/a> will experience \u003ca href=\"http://www.neurosymptoms.org/post-concussion-syndrome/4582101276\" target=\"_blank\" rel=\"noopener\">worsening brain function\u003c/a> later on, including problems with thinking, memory, attention and decision-making. Patients can also experience sleep disorders and headaches that persist for weeks, months or years. In the severest cases, people can develop epilepsy and seizures, with increased risk of Alzheimer’s disease.\u003c/p>\n\u003cp>As a result, about 3 to 5 million people live with the long-term physical, cognitive and psychological health disabilities of traumatic brain injury. Estimated annual direct and indirect costs are over $75 billion, \u003ca href=\"https://www.cdc.gov/traumaticbraininjury/severe.html\" target=\"_blank\" rel=\"noopener\">according to\u003c/a> the Centers for Disease Control and Prevention.\u003c/p>\n\u003cp>What’s needed, some researchers believe, is a large study focused on improving how doctors measure concussions and predict the long-term effects on patients.\u003c/p>\n\u003cp>Baxter, Gal and Diaz may have found one. While recovering from their injuries, they signed up for a study called \u003ca href=\"https://tracktbi.ucsf.edu/\" target=\"_blank\" rel=\"noopener\">TRACK TBI, \u003c/a>for Transforming Research in Clinical Knowledge in Traumatic Brain Injury.\u003c/p>\n\u003cp>TRACK TBI, spearheaded at UCSF, started in 2014 with just 75 enrolled patients. The cohort has now expanded to include over 2,000, with the goal of enrolling 1,000 more. The study spans 19 research centers across the country, and major funding comes from the National Institutes of Health and the Department of Defense. TRACK TBI is also partnering with CENTER TBI, a European sister-trial, monitoring 10,000 concussion patients.\u003c/p>\n\u003cp>Study researchers want to analyze the results of blood analysis, MRI scans and cognitive tests to find which patients are at higher risk of developing long-term cognitive problems after suffering concussions.\u003c/p>\n\u003cfigure id=\"attachment_437556\" class=\"wp-caption alignnone\" style=\"max-width: 640px\">\u003cimg class=\"wp-image-437556 size-large\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/12/Pratik-with-brain-image-1020x574.jpg\" alt=\"\" width=\"640\" height=\"360\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/12/Pratik-with-brain-image-1020x574.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/Pratik-with-brain-image-160x90.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/Pratik-with-brain-image-800x450.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/Pratik-with-brain-image-768x432.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/Pratik-with-brain-image.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/Pratik-with-brain-image-1180x664.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/Pratik-with-brain-image-960x540.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/Pratik-with-brain-image-240x135.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/Pratik-with-brain-image-375x211.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/Pratik-with-brain-image-520x293.jpg 520w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003cfigcaption class=\"wp-caption-text\">Pratik Mukherjee, neuroradiologist at UCSF, looking at a brain image. \u003ccite>(Julia Vassey/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>Getting a Closer Look\u003c/strong>\u003c/p>\n\u003cp>The problem with diagnosing concussions starts in the emergency room. The majority of patients with mild, non-life-threatening traumatic brain injuries get released from ER without any follow-up evaluation.\u003c/p>\n\u003cp>“And that is a mistake,” says Mukherjee, who is also one of TRACK TBI’s principal investigators.\u003c/p>\n\u003cp>CT scans in the ERs across the country can miss subtle brain damage, as occurred in Baxter’s first CT scan. These diagnostics can only detect structural changes or internal bleeding in the brain, like the hemorrhage Baxter eventually developed.\u003c/p>\n\u003cp>Even following severe traumatic brain injuries, as Gal suffered, neither CT nor standard MRI can detect microstructural changes and alterations in brain functioning.\u003c/p>\n\u003cp>But it is these subtle changes that may predict the likelihood of lasting problems, including impaired focus, attention, memory and decision-making.\u003c/p>\n\u003cp>TRACK TBI researchers are looking for biochemical signals that could ensure reliable, speedy diagnoses and good predictions of whether patients will suffer long-term effects.\u003c/p>\n\u003cp>Mapping is another focus of TRACK TBI. Powerful MRI scanners with software that allows precise reconstruction of high resolution MRI images could help scientists create brain maps.\u003c/p>\n\u003cp>The study is using the latest MRI scanners, at least twice as powerful as the ones installed in many of the country’s hospitals and imaging centers, to peer deeper into the brain and search for abnormalities in the fine-grain structure of the brain’s “white matter.” If this is damaged, it can disrupt brain functions like imprinting memories, maintaining focus and making decisions.\u003c/p>\n\u003cp>Patients enrolled in the TRACK TBI study get scanned two weeks after their head injury and then again six months later to reveal the presence of any chronic effects.\u003c/p>\n\u003cp>Researchers are also scanning for the presence of specific types of proteins in the blood that can be detected in brain-injury patients. TRACK TBI is particularly focusing on GFAP (glial fibrillary acidic protein) and Tau protein.\u003c/p>\n\u003cdiv>\u003c/div>\n\u003cp>“This is similar to how they diagnose heart attacks,” says Mukherjee. “If you are having a heart attack, the heart will spill particular proteins that can be detected, and provide a good objective test.”\u003c/p>\n\u003cp>In the 1950s and 1960s an electrocardiogram was the only way to measure a patient’s heart for signs of heart disease. But a patient could show a normal-looking EKG even while suffering a heart attack. With time, blood tests measuring proteins have proven to be more reliable. Using a similar approach could transform concussion diagnoses as well.\u003c/p>\n\u003cp>Shetty, who is not involved in the study, believes it has “a tremendous potential to understand relationships between biomarkers, neuroimaging and cognitive data.”\u003c/p>\n\u003cp>\u003ca href=\"https://www2.eecs.berkeley.edu/Faculty/Homepages/chunleiliu.html\" target=\"_blank\" rel=\"noopener\">Chunlei Liu\u003c/a>, an associate professor of the Helen Wills Neuroscience Institute at UC Berkeley, who also has no relationship to the study, is glad to see TRACK TBI’s multipronged approach.\u003c/p>\n\u003cp>Because brain trauma involves systemic changes in different parts of the brain, Liu says, “A single biomarker won't make a definitive answer.”\u003c/p>\n\u003cp>[contextly_sidebar id=\"fpfN1gUvcMM6xziiLMO3LOmy1Q3hTGxh\"]This approach is part of a trend. The \u003ca href=\"http://www.careconsortium.net/\" target=\"_blank\" rel=\"noopener\">CARE Consortium\u003c/a>, funded by the NCAA and the U.S. Department of Defense, is similar in many ways to TRACK TBI, but focuses on student-athletes and military service members. At the University of Pittsburgh. the \u003ca href=\"http://www.adapttrial.org/\" target=\"_blank\" rel=\"noopener\">ADAPT Trial\u003c/a> is focusing on children with severe traumatic brain injury, hoping to determine the best care procedures.\u003c/p>\n\u003cp>If prognostic biomarkers can be identified by TRACK and other studies, it could help scientists resurrect once-promising treatments that were abandoned after failed clinical trials. One of the most disappointing failures was the PROTECT trial, which in 2015 experimented with treating acute traumatic brain injury with progesterone, a steroid found to sometimes have powerful neuroprotective properties.The study showed promising results on lab animals, but it collapsed after moving to phase III human trials.\u003c/p>\n\u003cp>“Currently with the clinical trials, it has been one-size-fits-all for every patient,” says Mukherjee. He says researchers often enroll participants without knowing if they are prone to developing complications. “But this is a mistake, because patients are affected in many different ways, and types of pathologies are different.”\u003c/p>\n\u003cp>If biomarkers can be discovered, researchers can determine exactly which patients will or will not benefit from treatment.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>And patients recovering from brain injuries may be able to face their future with a clearer idea of the path ahead.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Last February Baxter Bailey injured himself trying to break into his own home when he couldn’t find his key. Crawling through a window leading to the utility room, he slipped and fell, hitting his head on the concrete floor.\u003c/p>\n\u003cp>He was unconscious for about an hour.\u003c/p>\n\u003cp>“My skull, my forehead was bloody, bruised and banged,” says the 77-year-old architect from Richmond, Virginia. “And I had blood all over my shirt, my pants and underwear.”\u003c/p>\n\u003cp>At the hospital, “Doctors told me that my brain moved inside the skull,” Baxter says. But a small hemorrhage in the brain visible through scans wasn’t bad enough to keep him as an inpatient for more than a day. Baxter was diagnosed with a concussion, or what medical professionals call a mild traumatic brain injury, and released.\u003c/p>\n\u003caside class=\"pullquote alignright\">'Unlike other neurological diseases, one cannot pinpoint the area of injury in concussion.'\u003ccite>Teena Shetty, neurologist\u003c/cite>\u003c/aside>\n\u003cp>“Within two weeks, the abrasion on my head got healed, and you couldn’t tell that anything ever happened to me if you looked at me,” says Baxter.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>But his troubles were just starting. Two months later, Baxter was in the emergency room again. He had started losing control of his left side. He found lifting his leg to get into a car difficult. Walking caused him trouble. This time the scans showed a chronic hematoma — swelling and bruising — on the right side of his skull.\u003c/p>\n\u003cp>“It was like 3 inches long and an inch thick and I could see that my brain literally was off center and my cerebellum was misaligned,” says Baxter. Doctors told him he needed immediate surgery. The plan was to drill a little hole in his head the size of a dime.\u003c/p>\n\u003cp>“I thought, ‘My lord, is this the end of me?’ ”\u003c/p>\n\u003cp>\u003cstrong>A Lot of Brain Injuries\u003c/strong>\u003c/p>\n\u003cp>Each year, about \u003ca href=\"https://www.cdc.gov/mmwr/volumes/66/ss/ss6609a1.htm\" target=\"_blank\" rel=\"noopener\">2.5 million people in the United States\u003c/a> are admitted to emergency rooms with traumatic brain injuries, according to the Centers for Disease Control and Prevention.\u003c/p>\n\u003cp>The difficulties of studying concussions, with their vague symptoms and hidden physical damage, have turned brain injury into a “silent epidemic,” in the words of \u003ca href=\"http://profiles.ucsf.edu/pratik.mukherjee\" target=\"_blank\" rel=\"noopener\">Pratik Mukherjee\u003c/a>, a neuroradiologist at UCSF.\u003c/p>\n\u003cp>\u003ca href=\"https://www.hss.edu/physicians_shetty-teena.asp\" target=\"_blank\" rel=\"noopener\">Teena Shetty\u003c/a>, a neurologist at New York City's Hospital for Special Surgery, agrees. “Unlike other neurological diseases, one cannot pinpoint the area of injury in concussion,” she says.\u003c/p>\n\u003cp>Doctors are not even in agreement about how to treat concussions. Some advise resuming daily activities as soon as possible, others suggest avoiding demanding work and staying away from bright lights and loud sounds.\u003c/p>\n\u003cp>Existing guidelines are not backed by evidence, according to \u003ca href=\"https://www.urmc.rochester.edu/people/20187378-jeffrey-j-bazarian\" target=\"_blank\" rel=\"noopener\">Jeff Bazarian\u003c/a>, professor of emergency medicine at the University of Rochester Medical Center, in New York.\u003c/p>\n\u003cfigure id=\"attachment_437557\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003cimg class=\"size-large wp-image-437557\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/12/16463775_10154204797011497_6888461288485270646_o-1020x765.jpg\" alt=\"\" width=\"640\" height=\"480\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/12/16463775_10154204797011497_6888461288485270646_o-1020x765.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/16463775_10154204797011497_6888461288485270646_o-160x120.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/16463775_10154204797011497_6888461288485270646_o-800x600.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/16463775_10154204797011497_6888461288485270646_o-768x576.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/16463775_10154204797011497_6888461288485270646_o-960x720.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/16463775_10154204797011497_6888461288485270646_o-240x180.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/16463775_10154204797011497_6888461288485270646_o-375x281.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/16463775_10154204797011497_6888461288485270646_o-520x390.jpg 520w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/16463775_10154204797011497_6888461288485270646_o.jpg 1024w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003cfigcaption class=\"wp-caption-text\">Tom Gal, 37-year old entrepreneur from San Francisco, recovering from a car accident at Zuckerberg San Francisco General Hospital and Trauma Center. \u003ccite>(Courtesy Tom Gal)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>A New Approach Tracks Patients in Detail\u003c/strong>\u003c/p>\n\u003cp>Predicting which concussion patients will fully recover and which will be permanently debilitated is more or less a guessing game.\u003c/p>\n\u003cp>Tom Gal, a 37-year old entrepreneur from San Francisco, spent almost two days in a coma after being hit by a car last August. He woke up with no memory of what happened and had to learn the details from his medical report. But eight months after the injury, he says he is doing just fine. In contrast, 29-year-old bread baker Ana Diaz, from Richmond, Virginia, complains about short-term memory lapses and increased anxiety six months after a biking accident that left her with no signs of head trauma on a CT scan.\u003c/p>\n\u003cp>In light of such counter-intuitive outcomes, many researchers feel it is now time to make the diagnosis and prognosis of concussions more precise and evidence-based.\u003c/p>\n\u003cp>According to Mukherjee, \u003ca href=\"https://link.springer.com/article/10.1186/s12245-014-0031-6\" target=\"_blank\" rel=\"noopener\">15 to 30 percent of concussion patients\u003c/a> will experience \u003ca href=\"http://www.neurosymptoms.org/post-concussion-syndrome/4582101276\" target=\"_blank\" rel=\"noopener\">worsening brain function\u003c/a> later on, including problems with thinking, memory, attention and decision-making. Patients can also experience sleep disorders and headaches that persist for weeks, months or years. In the severest cases, people can develop epilepsy and seizures, with increased risk of Alzheimer’s disease.\u003c/p>\n\u003cp>As a result, about 3 to 5 million people live with the long-term physical, cognitive and psychological health disabilities of traumatic brain injury. Estimated annual direct and indirect costs are over $75 billion, \u003ca href=\"https://www.cdc.gov/traumaticbraininjury/severe.html\" target=\"_blank\" rel=\"noopener\">according to\u003c/a> the Centers for Disease Control and Prevention.\u003c/p>\n\u003cp>What’s needed, some researchers believe, is a large study focused on improving how doctors measure concussions and predict the long-term effects on patients.\u003c/p>\n\u003cp>Baxter, Gal and Diaz may have found one. While recovering from their injuries, they signed up for a study called \u003ca href=\"https://tracktbi.ucsf.edu/\" target=\"_blank\" rel=\"noopener\">TRACK TBI, \u003c/a>for Transforming Research in Clinical Knowledge in Traumatic Brain Injury.\u003c/p>\n\u003cp>TRACK TBI, spearheaded at UCSF, started in 2014 with just 75 enrolled patients. The cohort has now expanded to include over 2,000, with the goal of enrolling 1,000 more. The study spans 19 research centers across the country, and major funding comes from the National Institutes of Health and the Department of Defense. TRACK TBI is also partnering with CENTER TBI, a European sister-trial, monitoring 10,000 concussion patients.\u003c/p>\n\u003cp>Study researchers want to analyze the results of blood analysis, MRI scans and cognitive tests to find which patients are at higher risk of developing long-term cognitive problems after suffering concussions.\u003c/p>\n\u003cfigure id=\"attachment_437556\" class=\"wp-caption alignnone\" style=\"max-width: 640px\">\u003cimg class=\"wp-image-437556 size-large\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/12/Pratik-with-brain-image-1020x574.jpg\" alt=\"\" width=\"640\" height=\"360\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/12/Pratik-with-brain-image-1020x574.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/Pratik-with-brain-image-160x90.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/Pratik-with-brain-image-800x450.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/Pratik-with-brain-image-768x432.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/Pratik-with-brain-image.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/Pratik-with-brain-image-1180x664.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/Pratik-with-brain-image-960x540.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/Pratik-with-brain-image-240x135.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/Pratik-with-brain-image-375x211.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/Pratik-with-brain-image-520x293.jpg 520w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003cfigcaption class=\"wp-caption-text\">Pratik Mukherjee, neuroradiologist at UCSF, looking at a brain image. \u003ccite>(Julia Vassey/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>Getting a Closer Look\u003c/strong>\u003c/p>\n\u003cp>The problem with diagnosing concussions starts in the emergency room. The majority of patients with mild, non-life-threatening traumatic brain injuries get released from ER without any follow-up evaluation.\u003c/p>\n\u003cp>“And that is a mistake,” says Mukherjee, who is also one of TRACK TBI’s principal investigators.\u003c/p>\n\u003cp>CT scans in the ERs across the country can miss subtle brain damage, as occurred in Baxter’s first CT scan. These diagnostics can only detect structural changes or internal bleeding in the brain, like the hemorrhage Baxter eventually developed.\u003c/p>\n\u003cp>Even following severe traumatic brain injuries, as Gal suffered, neither CT nor standard MRI can detect microstructural changes and alterations in brain functioning.\u003c/p>\n\u003cp>But it is these subtle changes that may predict the likelihood of lasting problems, including impaired focus, attention, memory and decision-making.\u003c/p>\n\u003cp>TRACK TBI researchers are looking for biochemical signals that could ensure reliable, speedy diagnoses and good predictions of whether patients will suffer long-term effects.\u003c/p>\n\u003cp>Mapping is another focus of TRACK TBI. Powerful MRI scanners with software that allows precise reconstruction of high resolution MRI images could help scientists create brain maps.\u003c/p>\n\u003cp>The study is using the latest MRI scanners, at least twice as powerful as the ones installed in many of the country’s hospitals and imaging centers, to peer deeper into the brain and search for abnormalities in the fine-grain structure of the brain’s “white matter.” If this is damaged, it can disrupt brain functions like imprinting memories, maintaining focus and making decisions.\u003c/p>\n\u003cp>Patients enrolled in the TRACK TBI study get scanned two weeks after their head injury and then again six months later to reveal the presence of any chronic effects.\u003c/p>\n\u003cp>Researchers are also scanning for the presence of specific types of proteins in the blood that can be detected in brain-injury patients. TRACK TBI is particularly focusing on GFAP (glial fibrillary acidic protein) and Tau protein.\u003c/p>\n\u003cdiv>\u003c/div>\n\u003cp>“This is similar to how they diagnose heart attacks,” says Mukherjee. “If you are having a heart attack, the heart will spill particular proteins that can be detected, and provide a good objective test.”\u003c/p>\n\u003cp>In the 1950s and 1960s an electrocardiogram was the only way to measure a patient’s heart for signs of heart disease. But a patient could show a normal-looking EKG even while suffering a heart attack. With time, blood tests measuring proteins have proven to be more reliable. Using a similar approach could transform concussion diagnoses as well.\u003c/p>\n\u003cp>Shetty, who is not involved in the study, believes it has “a tremendous potential to understand relationships between biomarkers, neuroimaging and cognitive data.”\u003c/p>\n\u003cp>\u003ca href=\"https://www2.eecs.berkeley.edu/Faculty/Homepages/chunleiliu.html\" target=\"_blank\" rel=\"noopener\">Chunlei Liu\u003c/a>, an associate professor of the Helen Wills Neuroscience Institute at UC Berkeley, who also has no relationship to the study, is glad to see TRACK TBI’s multipronged approach.\u003c/p>\n\u003cp>Because brain trauma involves systemic changes in different parts of the brain, Liu says, “A single biomarker won't make a definitive answer.”\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>This approach is part of a trend. The \u003ca href=\"http://www.careconsortium.net/\" target=\"_blank\" rel=\"noopener\">CARE Consortium\u003c/a>, funded by the NCAA and the U.S. Department of Defense, is similar in many ways to TRACK TBI, but focuses on student-athletes and military service members. At the University of Pittsburgh. the \u003ca href=\"http://www.adapttrial.org/\" target=\"_blank\" rel=\"noopener\">ADAPT Trial\u003c/a> is focusing on children with severe traumatic brain injury, hoping to determine the best care procedures.\u003c/p>\n\u003cp>If prognostic biomarkers can be identified by TRACK and other studies, it could help scientists resurrect once-promising treatments that were abandoned after failed clinical trials. One of the most disappointing failures was the PROTECT trial, which in 2015 experimented with treating acute traumatic brain injury with progesterone, a steroid found to sometimes have powerful neuroprotective properties.The study showed promising results on lab animals, but it collapsed after moving to phase III human trials.\u003c/p>\n\u003cp>“Currently with the clinical trials, it has been one-size-fits-all for every patient,” says Mukherjee. He says researchers often enroll participants without knowing if they are prone to developing complications. “But this is a mistake, because patients are affected in many different ways, and types of pathologies are different.”\u003c/p>\n\u003cp>If biomarkers can be discovered, researchers can determine exactly which patients will or will not benefit from treatment.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"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. ",
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"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. ",
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"marketplace": {
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"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",
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"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.",
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},
"mindshift": {
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"info": "The MindShift podcast explores the innovations in education that are shaping how kids learn. Hosts Ki Sung and Katrina Schwartz introduce listeners to educators, researchers, parents and students who are developing effective ways to improve how kids learn. We cover topics like how fed-up administrators are developing surprising tactics to deal with classroom disruptions; how listening to podcasts are helping kids develop reading skills; the consequences of overparenting; and why interdisciplinary learning can engage students on all ends of the traditional achievement spectrum. This podcast is part of the MindShift education site, a division of KQED News. KQED is an NPR/PBS member station based in San Francisco. You can also visit the MindShift website for episodes and supplemental blog posts or tweet us \u003ca href=\"https://twitter.com/MindShiftKQED\">@MindShiftKQED\u003c/a> or visit us at \u003ca href=\"/mindshift\">MindShift.KQED.org\u003c/a>",
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"order": 12
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"info": "For decades, the process for how police police themselves has been inconsistent – if not opaque. In some states, like California, these proceedings were completely hidden. After a new police transparency law unsealed scores of internal affairs files, our reporters set out to examine these cases and the shadow world of police discipline. On Our Watch brings listeners into the rooms where officers are questioned and witnesses are interrogated to find out who this system is really protecting. Is it the officers, or the public they've sworn to serve?",
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"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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"planet-money": {
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"politicalbreakdown": {
"id": "politicalbreakdown",
"title": "Political Breakdown",
"tagline": "Politics from a personal perspective",
"info": "Political Breakdown is a new series that explores the political intersection of California and the nation. Each week hosts Scott Shafer and Marisa Lagos are joined with a new special guest to unpack politics -- with personality — and offer an insider’s glimpse at how politics happens.",
"airtime": "THU 6:30pm-7pm",
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"possible": {
"id": "possible",
"title": "Possible",
"info": "Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. Together in Possible, Hoffman and Finger lead enlightening discussions about building a brighter collective future. The show features interviews with visionary guests like Trevor Noah, Sam Altman and Janette Sadik-Khan. Possible paints an optimistic portrait of the world we can create through science, policy, business, art and our shared humanity. It asks: What if everything goes right for once? How can we get there? Each episode also includes a short fiction story generated by advanced AI GPT-4, serving as a thought-provoking springboard to speculate how humanity could leverage technology for good.",
"airtime": "SUN 2pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Possible-Podcast-Tile-360x360-1.jpg",
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"pri-the-world": {
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"title": "PRI's The World: Latest Edition",
"info": "Each weekday, host Marco Werman and his team of producers bring you the world's most interesting stories in an hour of radio that reminds us just how small our planet really is.",
"airtime": "MON-FRI 2pm-3pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/The-World-Podcast-Tile-360x360-1.jpg",
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},
"radiolab": {
"id": "radiolab",
"title": "Radiolab",
"info": "A two-time Peabody Award-winner, Radiolab is an investigation told through sounds and stories, and centered around one big idea. In the Radiolab world, information sounds like music and science and culture collide. Hosted by Jad Abumrad and Robert Krulwich, the show is designed for listeners who demand skepticism, but appreciate wonder. WNYC Studios is the producer of other leading podcasts including Freakonomics Radio, Death, Sex & Money, On the Media and many more.",
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},
"reveal": {
"id": "reveal",
"title": "Reveal",
"info": "Created by The Center for Investigative Reporting and PRX, Reveal is public radios first one-hour weekly radio show and podcast dedicated to investigative reporting. Credible, fact based and without a partisan agenda, Reveal combines the power and artistry of driveway moment storytelling with data-rich reporting on critically important issues. The result is stories that inform and inspire, arming our listeners with information to right injustices, hold the powerful accountable and improve lives.Reveal is hosted by Al Letson and showcases the award-winning work of CIR and newsrooms large and small across the nation. In a radio and podcast market crowded with choices, Reveal focuses on important and often surprising stories that illuminate the world for our listeners.",
"airtime": "SAT 4pm-5pm",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/reveal300px.png",
"officialWebsiteLink": "https://www.revealnews.org/episodes/",
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"rss": "http://feeds.revealradio.org/revealpodcast"
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},
"rightnowish": {
"id": "rightnowish",
"title": "Rightnowish",
"tagline": "Art is where you find it",
"info": "Rightnowish digs into life in the Bay Area right now… ish. Journalist Pendarvis Harshaw takes us to galleries painted on the sides of liquor stores in West Oakland. We'll dance in warehouses in the Bayview, make smoothies with kids in South Berkeley, and listen to classical music in a 1984 Cutlass Supreme in Richmond. Every week, Pen talks to movers and shakers about how the Bay Area shapes what they create, and how they shape the place we call home.",
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"source": "kqed",
"order": 16
},
"link": "/podcasts/rightnowish",
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},
"science-friday": {
"id": "science-friday",
"title": "Science Friday",
"info": "Science Friday is a weekly science talk show, broadcast live over public radio stations nationwide. Each week, the show focuses on science topics that are in the news and tries to bring an educated, balanced discussion to bear on the scientific issues at hand. Panels of expert guests join host Ira Flatow, a veteran science journalist, to discuss science and to take questions from listeners during the call-in portion of the program.",
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"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Science-Friday-Podcast-Tile-360x360-1.jpg",
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},
"snap-judgment": {
"id": "snap-judgment",
"title": "Snap Judgment",
"tagline": "Real stories with killer beats",
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