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"content": "\u003cp>Fresh evidence that the body's immune system interacts directly with the brain could lead to a new understanding of diseases from multiple sclerosis to Alzheimer's.\u003c/p>\n\u003cp>A study of human and monkey brains found lymphatic vessels — a key part of the body's immune system — in a membrane that surrounds the brain and nervous system, a team \u003ca href=\"https://elifesciences.org/articles/29738\" target=\"_blank\" rel=\"noopener\">reported\u003c/a> this month in the online journal eLife.\u003c/p>\n\u003cp>Lymphatic vessels are a part of the lymphatic system, which extends throughout the body much like our network of veins and arteries. Instead of carrying blood, though, these vessels carry a clear fluid called lymph, which contains both immune cells and waste products.\u003c/p>\n\u003cp>The new finding bolsters recent \u003ca href=\"http://www.nature.com/nature/journal/v523/n7560/full/nature14432.html?foxtrotcallback=true\" target=\"_blank\" rel=\"noopener\">evidence\u003c/a> in rodents that the brain interacts with the body's lymphatic system to help fend off diseases and remove waste. Until a few years ago, scientists believed that the brain's immune and waste removal systems operated independently.\u003c/p>\n\u003cp>The discovery of lymphatic vessels near the surface of the brain could lead to a better understanding of multiple sclerosis, which seems to be triggered by a glitch in the immune system, says \u003ca href=\"https://neuroscience.nih.gov/ninds/Faculty/Profile/daniel-reich.aspx\">Dr. Daniel Reich\u003c/a>, an author of the study and a senior investigator at the National Institute of Neurological Disorders and Stroke.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"How the immune system interacts with the brain is fundamental to how multiple sclerosis develops and how we treat multiple sclerosis,\" Reich says.\u003c/p>\n\u003cp>Current treatments for multiple sclerosis often involve drugs that suppress the immune system.\u003c/p>\n\u003cp>The research also has implications for diseases like Parkinson's and Alzheimer's.\u003c/p>\n\u003cp>These diseases occur as certain toxic waste products accumulate in the brain. And lymphatic vessels appear to be part of the system that usually removes these waste products.\u003c/p>\n\u003cp>\"The discovery of a lymphatic system in the brain raises the possibility that a disorder of the lymphatic system is somehow involved in the causation of Alzheimer's disease,\" says \u003ca href=\"http://profiles.ucsf.edu/michael.weiner\">Dr. Michael Weiner\u003c/a>, a professor of radiology at UCSF, who was not connected with the study.\u003c/p>\n\u003cp>That sort of thinking is a radical change from just a few years ago, Reich says.\u003c/p>\n\u003cp>For centuries, most scientists believed that the body's lymphatic system didn't connect to the brain, Reich says. \"The brain is thought to be what is called immune-privileged,\" he says. \"It has a different immune system from the rest of the body.\"\u003c/p>\n\u003cp>So Reich was intrigued when he heard a talk in 2015 by \u003ca href=\"https://med.virginia.edu/neuroscience/faculty/primary-faculty/jonathan-kipnis-ph-d/\">Jonathan Kipnis\u003c/a>, who directs the neuroscience department at the University of Virginia.\u003c/p>\n\u003cp>\"He showed very clearly in this talk that there are lymph vessels in the head, which I had learned in medical school didn't exist,\" Reich says.\u003c/p>\n\u003cp>But the evidence was in mice. So Reich and a team of scientists used MRI to study the brains of several human volunteers.\u003c/p>\n\u003cp>The scientists injected a special dye into the bloodstream, then watched to see where it went. They focused on the dura mater, the outermost membrane that protects the brain and nervous system.\u003c/p>\n\u003cp>As expected, the team saw some of the dye leak out of blood vessels in the dura mater. But then they could see that the leaked dye was being collected by different vessels – which is exactly what happens in the lymphatic system.\u003c/p>\n\u003cp>\"That gave us some evidence that there are vessels here that are behaving different from blood vessels,\" Reich says. \"But we weren't sure that they were lymphatic vessels.\"\u003c/p>\n\u003cp>To be certain, Reich's team spent years perfecting a technique to reveal the lymphatic vessels in the dura mater of brains taken from human cadavers. This allowed the scientists to confirm the presence of these vessels near the surface of the brain. And it strongly suggested that the lymphatic system interacts directly with the brain.\u003c/p>\n\u003cp>The results extend the findings of a landmark \u003ca href=\"http://www.npr.org/sections/health-shots/2013/10/18/236211811/brains-sweep-themselves-clean-of-toxins-during-sleep\">study\u003c/a> published in 2013. It found that the brain appears to flush out waste products during sleep.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>But it wasn't clear how these waste products were draining out of the head. Now it appears that at least some of the waste might be exiting through the lymphatic system.\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=Brain%27s+Link+To+Immune+System+Might+Help+Explain+Alzheimer%27s&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"How the immune system interacts with the brain is fundamental to how multiple sclerosis develops and how we treat multiple sclerosis,\" Reich says.\u003c/p>\n\u003cp>Current treatments for multiple sclerosis often involve drugs that suppress the immune system.\u003c/p>\n\u003cp>The research also has implications for diseases like Parkinson's and Alzheimer's.\u003c/p>\n\u003cp>These diseases occur as certain toxic waste products accumulate in the brain. And lymphatic vessels appear to be part of the system that usually removes these waste products.\u003c/p>\n\u003cp>\"The discovery of a lymphatic system in the brain raises the possibility that a disorder of the lymphatic system is somehow involved in the causation of Alzheimer's disease,\" says \u003ca href=\"http://profiles.ucsf.edu/michael.weiner\">Dr. Michael Weiner\u003c/a>, a professor of radiology at UCSF, who was not connected with the study.\u003c/p>\n\u003cp>That sort of thinking is a radical change from just a few years ago, Reich says.\u003c/p>\n\u003cp>For centuries, most scientists believed that the body's lymphatic system didn't connect to the brain, Reich says. \"The brain is thought to be what is called immune-privileged,\" he says. \"It has a different immune system from the rest of the body.\"\u003c/p>\n\u003cp>So Reich was intrigued when he heard a talk in 2015 by \u003ca href=\"https://med.virginia.edu/neuroscience/faculty/primary-faculty/jonathan-kipnis-ph-d/\">Jonathan Kipnis\u003c/a>, who directs the neuroscience department at the University of Virginia.\u003c/p>\n\u003cp>\"He showed very clearly in this talk that there are lymph vessels in the head, which I had learned in medical school didn't exist,\" Reich says.\u003c/p>\n\u003cp>But the evidence was in mice. So Reich and a team of scientists used MRI to study the brains of several human volunteers.\u003c/p>\n\u003cp>The scientists injected a special dye into the bloodstream, then watched to see where it went. They focused on the dura mater, the outermost membrane that protects the brain and nervous system.\u003c/p>\n\u003cp>As expected, the team saw some of the dye leak out of blood vessels in the dura mater. But then they could see that the leaked dye was being collected by different vessels – which is exactly what happens in the lymphatic system.\u003c/p>\n\u003cp>\"That gave us some evidence that there are vessels here that are behaving different from blood vessels,\" Reich says. \"But we weren't sure that they were lymphatic vessels.\"\u003c/p>\n\u003cp>To be certain, Reich's team spent years perfecting a technique to reveal the lymphatic vessels in the dura mater of brains taken from human cadavers. This allowed the scientists to confirm the presence of these vessels near the surface of the brain. And it strongly suggested that the lymphatic system interacts directly with the brain.\u003c/p>\n\u003cp>The results extend the findings of a landmark \u003ca href=\"http://www.npr.org/sections/health-shots/2013/10/18/236211811/brains-sweep-themselves-clean-of-toxins-during-sleep\">study\u003c/a> published in 2013. It found that the brain appears to flush out waste products during sleep.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>But it wasn't clear how these waste products were draining out of the head. Now it appears that at least some of the waste might be exiting through the lymphatic system.\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=Brain%27s+Link+To+Immune+System+Might+Help+Explain+Alzheimer%27s&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>[audio src=https://www.kqed.org/.stream/anon/radio/science/2017/10/FIrefightersFreeMassages.mp3 program=\"KQED Science\" title=\"Healers Offer Firefighters Free Massage and Acupuncture. And They're Loving It\" image=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2017/10/IMG_4233.jpeg\"]\u003c/p>\n\u003cp>The volunteer response to the wildfires in Sonoma County has a distinctly California flavor. Thousands of alternative-medicine practitioners like naturopaths, chiropractors — even aroma-therapists are donating treatment to anyone affected by the fires.\u003c/p>\n\u003cp>Sessions happened at dozens of pop-up spas in parking lots, relief centers and emergency shelters during the brunt of the disaster. There are still about a half a dozen open.\u003c/p>\n\u003cp>At one Red Cross shelter on the Sonoma County fairgrounds, a young man lays down on the gym floor with a blue towel under his head. Amidst a cacophony of evacuees calling friends and family, a sound healer kneeling on a silk Asian blanket begins ringing quartz bowls arranged in a semi-circle. The therapy is intended to calm the patient’s frazzled nerves.\u003c/p>\n\u003cfigure id=\"attachment_1917108\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-1917108 size-medium\" src=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2017/10/IMG_4253-800x600.jpeg\" alt=\"\" width=\"800\" height=\"600\">\u003cfigcaption class=\"wp-caption-text\">Tuning forks radiate the sound from quartz bowls to help calm the nervous system. \u003ccite>(Lesley McClurg/ KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Outside under a red and white striped plastic tent, a group of firefighters and national guardsmen wait patiently on folding metal chairs.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Jamie Sheppard, a Truckee-based firefighter is next in line. He’s beat after shouldering a 60-pound back for grueling 24-hour shifts over the past 10 days.\u003c/p>\n\u003cp>“My neck hurts, my back hurts, my left shoulder hurts,” says Sheppard. “And breathing in a lot of smoke of course, the lungs hurt.”\u003c/p>\n\u003cp>He climbs up on a massage table and a therapist gently places her hands on his temples. After twenty minutes of gentle massage and Reiki, a Japanese technique for stress reduction and relaxation, Sheppard slowly rises to stand up.\u003c/p>\n\u003cfigure id=\"attachment_1917109\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-1917109 size-medium\" src=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2017/10/IMG_4228-800x600.jpeg\" alt=\"\" width=\"800\" height=\"600\">\u003cfigcaption class=\"wp-caption-text\">Firefighter Jamie Sheppard receives energy work, or Reiki, after numerous long shifts on the front lines of the North Bay fires. \u003ccite>(Lesley McClurg/ KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“I feel much, much more relaxed,” said Sheppard. “Looser and nimble.” This is his second massage in a week. He says it doesn’t just help his body. “It also just kind of helps you unwind and power down and get ready for the next day.”\u003cstrong>\u003cbr>\n\u003c/strong>\u003c/p>\n\u003cp>But it’s not just the firefighters who are working long hours. Dan Cortright is a volunteer who has offered massages for about ten hours each day for six days in a row.\u003c/p>\n\u003cp>Sweat drips down Cortright’s forehead as he digs his elbow into the back of a burly national guard soldier. Cortright says he’s volunteering to show his gratitude to the emergency responders. “It’s the least I can do to pay them back for all they’ve done to save our town, our whole community.”\u003c/p>\n\u003cp>A few blocks away stacks of donated boxes of herbs and healing remedies are arriving from all over the country to \u003ca href=\"http://farmacopia.net/\" target=\"_blank\" rel=\"noopener\">Farmacopia\u003c/a>, an alternative healing clinic in Santa Rosa. Lily Mazarella, the owner, says she can’t keep up with all the shipments.\u003c/p>\n\u003cp>“We’ve gotten everything from organic mushroom powder for the immune system to homemade \u003ca href=\"https://www.webmd.com/vitamins-supplements/ingredientmono-959-osha.aspx?activeingredientid=959&\" target=\"_blank\" rel=\"noopener\">osha syrup\u003c/a> for respiratory distress to to big bottles of sleep syrup,” said Mazarella. She gave a lot away last week at another pop-up clinic nestled beneath huge trees, Alliance Redwoods Conference Grounds, about thirty minutes east of Santa Rosa.\u003c/p>\n\u003cp>Helicopters circled above Alliance’s blue basketball court that was lined with massage tables until Sunday. A few hundred firefighters stayed at this facility between shifts.\u003c/p>\n\u003cp>Volunteers handed out “Manzanita Magic” – a folk remedy for poison oak. A white plastic table was lined with tinctures and syrups for respiratory support, stress, sleep and immune support.\u003c/p>\n\u003cp>Some firefighters sniffed essential oils like eucalyptus to soothe their smoke-filled lungs. Or drank throat comfort tea to ease raspy coughs.\u003c/p>\n\u003cfigure id=\"attachment_1917134\" class=\"wp-caption aligncenter\" style=\"max-width: 720px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-1917134 size-full\" src=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2017/10/IMG_0445-1.jpeg\" alt=\"\" width=\"720\" height=\"479\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2017/10/IMG_0445-1.jpeg 720w, https://cdn.kqed.org/wp-content/uploads/sites/35/2017/10/IMG_0445-1-160x106.jpeg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2017/10/IMG_0445-1-240x160.jpeg 240w, https://cdn.kqed.org/wp-content/uploads/sites/35/2017/10/IMG_0445-1-375x249.jpeg 375w, https://cdn.kqed.org/wp-content/uploads/sites/35/2017/10/IMG_0445-1-520x346.jpeg 520w\" sizes=\"(max-width: 720px) 100vw, 720px\">\u003cfigcaption class=\"wp-caption-text\">Firefighters inhale the smell of eucalyptus oil to soothe dry smoke-filled lungs. \u003ccite>(Misha Miller)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Jen Riegle helped to coordinate shifts at more than two dozen shelters throughout Sonoma County. She’s a \u003ca href=\"https://nccih.nih.gov/health/naturopathy\" target=\"_blank\" rel=\"noopener\">naturopathic doctor\u003c/a> in Santa Rosa. Riegle says she’s truly touched by the feedback she’s received.\u003c/p>\n\u003cp>“There have been so many soldiers and firemen and evacuees who have told us that they’ve never, ever received this kind of work before!” Riegle exclaims.\u003cstrong>\u003cbr>\n\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>A Facebook \u003ca href=\"https://www.facebook.com/groups/696852613840190/?multi_permalinks=701379526720832¬if_id=1508569523334276¬if_t=group_highlights\" target=\"_blank\" rel=\"noopener\">page\u003c/a> about the volunteer effort now has more than 2,000 members, and a \u003ca href=\"https://integrativehealersactionnetwork.com/\" target=\"_blank\" rel=\"noopener\">website\u003c/a> to keep the momentum going recently went live. Riegle hopes the outpouring of support can become a model that’s easily replicated when disaster strikes another community.\u003c/p>\n\n",
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"excerpt": "Thousands of alternative practitioners are donating treatment sessions to those affected by the wildfires. ",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The volunteer response to the wildfires in Sonoma County has a distinctly California flavor. Thousands of alternative-medicine practitioners like naturopaths, chiropractors — even aroma-therapists are donating treatment to anyone affected by the fires.\u003c/p>\n\u003cp>Sessions happened at dozens of pop-up spas in parking lots, relief centers and emergency shelters during the brunt of the disaster. There are still about a half a dozen open.\u003c/p>\n\u003cp>At one Red Cross shelter on the Sonoma County fairgrounds, a young man lays down on the gym floor with a blue towel under his head. Amidst a cacophony of evacuees calling friends and family, a sound healer kneeling on a silk Asian blanket begins ringing quartz bowls arranged in a semi-circle. The therapy is intended to calm the patient’s frazzled nerves.\u003c/p>\n\u003cfigure id=\"attachment_1917108\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-1917108 size-medium\" src=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2017/10/IMG_4253-800x600.jpeg\" alt=\"\" width=\"800\" height=\"600\">\u003cfigcaption class=\"wp-caption-text\">Tuning forks radiate the sound from quartz bowls to help calm the nervous system. \u003ccite>(Lesley McClurg/ KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Outside under a red and white striped plastic tent, a group of firefighters and national guardsmen wait patiently on folding metal chairs.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Jamie Sheppard, a Truckee-based firefighter is next in line. He’s beat after shouldering a 60-pound back for grueling 24-hour shifts over the past 10 days.\u003c/p>\n\u003cp>“My neck hurts, my back hurts, my left shoulder hurts,” says Sheppard. “And breathing in a lot of smoke of course, the lungs hurt.”\u003c/p>\n\u003cp>He climbs up on a massage table and a therapist gently places her hands on his temples. After twenty minutes of gentle massage and Reiki, a Japanese technique for stress reduction and relaxation, Sheppard slowly rises to stand up.\u003c/p>\n\u003cfigure id=\"attachment_1917109\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-1917109 size-medium\" src=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2017/10/IMG_4228-800x600.jpeg\" alt=\"\" width=\"800\" height=\"600\">\u003cfigcaption class=\"wp-caption-text\">Firefighter Jamie Sheppard receives energy work, or Reiki, after numerous long shifts on the front lines of the North Bay fires. \u003ccite>(Lesley McClurg/ KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“I feel much, much more relaxed,” said Sheppard. “Looser and nimble.” This is his second massage in a week. He says it doesn’t just help his body. “It also just kind of helps you unwind and power down and get ready for the next day.”\u003cstrong>\u003cbr>\n\u003c/strong>\u003c/p>\n\u003cp>But it’s not just the firefighters who are working long hours. Dan Cortright is a volunteer who has offered massages for about ten hours each day for six days in a row.\u003c/p>\n\u003cp>Sweat drips down Cortright’s forehead as he digs his elbow into the back of a burly national guard soldier. Cortright says he’s volunteering to show his gratitude to the emergency responders. “It’s the least I can do to pay them back for all they’ve done to save our town, our whole community.”\u003c/p>\n\u003cp>A few blocks away stacks of donated boxes of herbs and healing remedies are arriving from all over the country to \u003ca href=\"http://farmacopia.net/\" target=\"_blank\" rel=\"noopener\">Farmacopia\u003c/a>, an alternative healing clinic in Santa Rosa. Lily Mazarella, the owner, says she can’t keep up with all the shipments.\u003c/p>\n\u003cp>“We’ve gotten everything from organic mushroom powder for the immune system to homemade \u003ca href=\"https://www.webmd.com/vitamins-supplements/ingredientmono-959-osha.aspx?activeingredientid=959&\" target=\"_blank\" rel=\"noopener\">osha syrup\u003c/a> for respiratory distress to to big bottles of sleep syrup,” said Mazarella. She gave a lot away last week at another pop-up clinic nestled beneath huge trees, Alliance Redwoods Conference Grounds, about thirty minutes east of Santa Rosa.\u003c/p>\n\u003cp>Helicopters circled above Alliance’s blue basketball court that was lined with massage tables until Sunday. A few hundred firefighters stayed at this facility between shifts.\u003c/p>\n\u003cp>Volunteers handed out “Manzanita Magic” – a folk remedy for poison oak. A white plastic table was lined with tinctures and syrups for respiratory support, stress, sleep and immune support.\u003c/p>\n\u003cp>Some firefighters sniffed essential oils like eucalyptus to soothe their smoke-filled lungs. Or drank throat comfort tea to ease raspy coughs.\u003c/p>\n\u003cfigure id=\"attachment_1917134\" class=\"wp-caption aligncenter\" style=\"max-width: 720px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-1917134 size-full\" src=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2017/10/IMG_0445-1.jpeg\" alt=\"\" width=\"720\" height=\"479\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2017/10/IMG_0445-1.jpeg 720w, https://cdn.kqed.org/wp-content/uploads/sites/35/2017/10/IMG_0445-1-160x106.jpeg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2017/10/IMG_0445-1-240x160.jpeg 240w, https://cdn.kqed.org/wp-content/uploads/sites/35/2017/10/IMG_0445-1-375x249.jpeg 375w, https://cdn.kqed.org/wp-content/uploads/sites/35/2017/10/IMG_0445-1-520x346.jpeg 520w\" sizes=\"(max-width: 720px) 100vw, 720px\">\u003cfigcaption class=\"wp-caption-text\">Firefighters inhale the smell of eucalyptus oil to soothe dry smoke-filled lungs. \u003ccite>(Misha Miller)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Jen Riegle helped to coordinate shifts at more than two dozen shelters throughout Sonoma County. She’s a \u003ca href=\"https://nccih.nih.gov/health/naturopathy\" target=\"_blank\" rel=\"noopener\">naturopathic doctor\u003c/a> in Santa Rosa. Riegle says she’s truly touched by the feedback she’s received.\u003c/p>\n\u003cp>“There have been so many soldiers and firemen and evacuees who have told us that they’ve never, ever received this kind of work before!” Riegle exclaims.\u003cstrong>\u003cbr>\n\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>A Facebook \u003ca href=\"https://www.facebook.com/groups/696852613840190/?multi_permalinks=701379526720832¬if_id=1508569523334276¬if_t=group_highlights\" target=\"_blank\" rel=\"noopener\">page\u003c/a> about the volunteer effort now has more than 2,000 members, and a \u003ca href=\"https://integrativehealersactionnetwork.com/\" target=\"_blank\" rel=\"noopener\">website\u003c/a> to keep the momentum going recently went live. Riegle hopes the outpouring of support can become a model that’s easily replicated when disaster strikes another community.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Gene Therapy is Here, and It's Expensive. Who Will Pay for It?",
"title": "Gene Therapy is Here, and It's Expensive. Who Will Pay for It?",
"headTitle": "KQED Future of You | KQED Science",
"content": "\u003cp>Gene therapy has the potential to be a one-shot treatment that could reverse blindness, restore blood-clotting function to hemophiliacs, or even cure rare diseases outright. But what kind of price tag comes with that promise — and who will pay for it?\u003c/p>\n\u003caside class=\"pullquote alignright\">'The fact is, we need to move our 20th-century health care system to meet 21st-century scientific and medical breakthroughs.'\u003ccite>Jeff Marrazzo, Spark Therapeutics\u003c/cite>\u003c/aside>\n\u003cp>The question is no longer academic: Spark Therapeutics has \u003ca href=\"http://www.sciencemag.org/news/2017/10/fda-experts-offer-unanimous-endorsement-pioneering-gene-therapy-blindness\" target=\"_blank\" rel=\"noopener\">won\u003c/a> unanimous support from a Food and Drug Administration advisory panel for its gene therapy drug, Luxturna. It seems likely to win FDA approval in the coming months. But the cost will be hefty: Analysts estimate that Luxturna, which has been shown to restore vision in children with an inherited form of blindness, could cost $1 million per patient.\u003c/p>\n\u003cp>Will private insurers be willing to pay? What about taxpayers, via Medicaid and Medicare? And, importantly: What happens if patients — or insurers — do foot a hefty bill, only to find out the drug simply did not work for them?\u003c/p>\n\u003cp>“These one-shot cases are potentially transformative — but not every patient responds to the same extent with gene therapy,” said Dr. Mark McClellan, a former FDA commissioner who now leads the Duke-Margolis Center for Health Policy. “We’re definitely not all the way there yet.”\u003c/p>\n\u003cp>So McClellan has formed a consortium at Duke to brainstorm better ways to cover the costs. He’s bringing gene therapy companies like Spark, Bluebird Bio, and Pfizer to the table — along with insurers like Harvard Pilgrim and Anthem.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“The fact is, we need to move our 20th-century health care system to meet 21st-century scientific and medical breakthroughs,” said Jeff Marrazzo, CEO of Spark Therapeutics.\u003c/p>\n\u003cp>Gene therapies work by infusing a patient with engineered viruses armed with DNA that helps correct the molecular processes that go awry in an inherited disease. It’s costly, in part, because these viruses are more difficult and time-consuming to manufacture than a standard pharmaceutical drug.\u003c/p>\n\u003cp>On top of that, companies typically spend years in costly research and development before finding an approach that works and can win FDA approval. And in most of these diseases, there’s just a relatively small patient pool.\u003c/p>\n\u003cp>What’s more, when they work, the therapies can save patients and insurers big money down the road. Current hemophilia drugs, for instance, cost hundreds of thousands of dollars each year. If a patient could be cured with a one-time infusion — even one that costs $1 million — that might actually be quite cost-effective.\u003c/p>\n\u003cp>Given all that, companies do have good reason to charge a premium for their gene therapy products, McClellan said.\u003c/p>\n\u003cp>On the other hand, scientific breakthroughs mean nothing if they’re not accessible to patients.\u003c/p>\n\u003cp>“The concern is that if you get enough of these types of expensive therapies to hit the market, they’ll perhaps make the premiums unaffordable,” said Dr. Michael Sherman, chief medical officer of Boston-based insurer Harvard Pilgrim Health Care. “So we have to be creative to find the right balance of access and affordability.”\u003c/p>\n\u003cp>The main concept the consortium is kicking around: value-based payments. They’re a form of money-back guarantee, in that patients or their insurers pay for the therapy only if it actually proves effective in reversing or managing their disease.\u003c/p>\n\u003cp>And to make the cost burden lighter, one idea gaining steam is to break these costs into incremental payments over several years — and make those contingent on a patient’s sustained response. That way, if the treatment stops working for a given patient, he or she might not have to pay the full amount.\u003c/p>\n\u003cp>Novartis is taking a baby step in this direction with its newly approved CAR-T cancer drug, Kymriah. It’s priced at $475,000, but Novartis struck a deal with the Centers for Medicare and Medicaid Services: It gets paid only if Kymriah appears to be sending a patient’s cancer into remission a month after treatment.\u003c/p>\n\u003cp>“Paying for a gene therapy for as long as it’s working makes a tremendous amount of sense — but it comes with some challenges,” said Nick Leschly, CEO of Bluebird Bio, which is working on gene therapies for several rare diseases.\u003c/p>\n\u003cp>Among those challenges: What if the patient changes insurance companies a couple years after her gene therapy? Who foots the bill for the remaining payments? Would she even be able to get a new insurance plan with that kind of bill following her around?\u003c/p>\n\u003cp>Also: What if a patient fails to show up for checkups to determine if the drug is still working? That could be a way for him to evade the installment payments.\u003c/p>\n\u003cp>“If a patient decides not to come in, who shoulders that payment?” Leschly said. “Is it on the insurer to make sure the patient shows up?”\u003c/p>\n\u003cp>Still another challenge: What if a drug like Kymriah seems to be working after a month, triggering the insurer to pay the full amount — but then the next week, the patient’s cancer again gains the upper hand? Is there any mechanism for the insurer to claw back some of its payment?\u003c/p>\n\u003cp>The overarching problem is systemic, experts said: There’s simply no mechanism now for a company to spool out a million-dollar bill over several years while assessing the patient’s health and response to therapy at regular intervals.\u003c/p>\n\u003cp>“If we were to propose a model like this to a single commercial insurer, the financial penalties would be significant,” said Marrazzo, the Spark CEO. “The government’s existing price reporting mechanisms are too rigid — so we can’t financially make sense of doing it.”\u003c/p>\n\u003cp>Marrazzo wouldn’t tip his hand as to the price Spark will set for Luxturna. Typically, that comes only after FDA approval. He also declined to give specifics on potential payment models. But some analysts are predicting a fairly old-school approach: a one-time charge in the high six or seven figures for a one-time treatment.\u003c/p>\n\u003cp>As more gene therapies come on the market, experts say it will take a new level of cooperation between policy makers, drug companies, and insurers to come up with rational payment models.\u003c/p>\n\u003cp>“But we’re confident we can figure it out,” Leschly said. “Because if someone has a very serious disease, and we can cure it, the system will find a way to reward that.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This \u003ca href=\"https://www.statnews.com/2017/10/13/gene-therapy-pricing/\" 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>Gene therapy has the potential to be a one-shot treatment that could reverse blindness, restore blood-clotting function to hemophiliacs, or even cure rare diseases outright. But what kind of price tag comes with that promise — and who will pay for it?\u003c/p>\n\u003caside class=\"pullquote alignright\">'The fact is, we need to move our 20th-century health care system to meet 21st-century scientific and medical breakthroughs.'\u003ccite>Jeff Marrazzo, Spark Therapeutics\u003c/cite>\u003c/aside>\n\u003cp>The question is no longer academic: Spark Therapeutics has \u003ca href=\"http://www.sciencemag.org/news/2017/10/fda-experts-offer-unanimous-endorsement-pioneering-gene-therapy-blindness\" target=\"_blank\" rel=\"noopener\">won\u003c/a> unanimous support from a Food and Drug Administration advisory panel for its gene therapy drug, Luxturna. It seems likely to win FDA approval in the coming months. But the cost will be hefty: Analysts estimate that Luxturna, which has been shown to restore vision in children with an inherited form of blindness, could cost $1 million per patient.\u003c/p>\n\u003cp>Will private insurers be willing to pay? What about taxpayers, via Medicaid and Medicare? And, importantly: What happens if patients — or insurers — do foot a hefty bill, only to find out the drug simply did not work for them?\u003c/p>\n\u003cp>“These one-shot cases are potentially transformative — but not every patient responds to the same extent with gene therapy,” said Dr. Mark McClellan, a former FDA commissioner who now leads the Duke-Margolis Center for Health Policy. “We’re definitely not all the way there yet.”\u003c/p>\n\u003cp>So McClellan has formed a consortium at Duke to brainstorm better ways to cover the costs. He’s bringing gene therapy companies like Spark, Bluebird Bio, and Pfizer to the table — along with insurers like Harvard Pilgrim and Anthem.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“The fact is, we need to move our 20th-century health care system to meet 21st-century scientific and medical breakthroughs,” said Jeff Marrazzo, CEO of Spark Therapeutics.\u003c/p>\n\u003cp>Gene therapies work by infusing a patient with engineered viruses armed with DNA that helps correct the molecular processes that go awry in an inherited disease. It’s costly, in part, because these viruses are more difficult and time-consuming to manufacture than a standard pharmaceutical drug.\u003c/p>\n\u003cp>On top of that, companies typically spend years in costly research and development before finding an approach that works and can win FDA approval. And in most of these diseases, there’s just a relatively small patient pool.\u003c/p>\n\u003cp>What’s more, when they work, the therapies can save patients and insurers big money down the road. Current hemophilia drugs, for instance, cost hundreds of thousands of dollars each year. If a patient could be cured with a one-time infusion — even one that costs $1 million — that might actually be quite cost-effective.\u003c/p>\n\u003cp>Given all that, companies do have good reason to charge a premium for their gene therapy products, McClellan said.\u003c/p>\n\u003cp>On the other hand, scientific breakthroughs mean nothing if they’re not accessible to patients.\u003c/p>\n\u003cp>“The concern is that if you get enough of these types of expensive therapies to hit the market, they’ll perhaps make the premiums unaffordable,” said Dr. Michael Sherman, chief medical officer of Boston-based insurer Harvard Pilgrim Health Care. “So we have to be creative to find the right balance of access and affordability.”\u003c/p>\n\u003cp>The main concept the consortium is kicking around: value-based payments. They’re a form of money-back guarantee, in that patients or their insurers pay for the therapy only if it actually proves effective in reversing or managing their disease.\u003c/p>\n\u003cp>And to make the cost burden lighter, one idea gaining steam is to break these costs into incremental payments over several years — and make those contingent on a patient’s sustained response. That way, if the treatment stops working for a given patient, he or she might not have to pay the full amount.\u003c/p>\n\u003cp>Novartis is taking a baby step in this direction with its newly approved CAR-T cancer drug, Kymriah. It’s priced at $475,000, but Novartis struck a deal with the Centers for Medicare and Medicaid Services: It gets paid only if Kymriah appears to be sending a patient’s cancer into remission a month after treatment.\u003c/p>\n\u003cp>“Paying for a gene therapy for as long as it’s working makes a tremendous amount of sense — but it comes with some challenges,” said Nick Leschly, CEO of Bluebird Bio, which is working on gene therapies for several rare diseases.\u003c/p>\n\u003cp>Among those challenges: What if the patient changes insurance companies a couple years after her gene therapy? Who foots the bill for the remaining payments? Would she even be able to get a new insurance plan with that kind of bill following her around?\u003c/p>\n\u003cp>Also: What if a patient fails to show up for checkups to determine if the drug is still working? That could be a way for him to evade the installment payments.\u003c/p>\n\u003cp>“If a patient decides not to come in, who shoulders that payment?” Leschly said. “Is it on the insurer to make sure the patient shows up?”\u003c/p>\n\u003cp>Still another challenge: What if a drug like Kymriah seems to be working after a month, triggering the insurer to pay the full amount — but then the next week, the patient’s cancer again gains the upper hand? Is there any mechanism for the insurer to claw back some of its payment?\u003c/p>\n\u003cp>The overarching problem is systemic, experts said: There’s simply no mechanism now for a company to spool out a million-dollar bill over several years while assessing the patient’s health and response to therapy at regular intervals.\u003c/p>\n\u003cp>“If we were to propose a model like this to a single commercial insurer, the financial penalties would be significant,” said Marrazzo, the Spark CEO. “The government’s existing price reporting mechanisms are too rigid — so we can’t financially make sense of doing it.”\u003c/p>\n\u003cp>Marrazzo wouldn’t tip his hand as to the price Spark will set for Luxturna. Typically, that comes only after FDA approval. He also declined to give specifics on potential payment models. But some analysts are predicting a fairly old-school approach: a one-time charge in the high six or seven figures for a one-time treatment.\u003c/p>\n\u003cp>As more gene therapies come on the market, experts say it will take a new level of cooperation between policy makers, drug companies, and insurers to come up with rational payment models.\u003c/p>\n\u003cp>“But we’re confident we can figure it out,” Leschly said. “Because if someone has a very serious disease, and we can cure it, the system will find a way to reward that.”\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/2017/10/13/gene-therapy-pricing/\" 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": "North Bay Fires: Yes, Californians Can Now Buy Air Purifiers on Amazon",
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"content": "\u003cp>During\u003cb> \u003c/b>the deadly North Bay wildfires, air quality in the Bay Area has suffered -- a lot. In fact, air monitors have recorded the \u003ca href=\"https://ww2.kqed.org/science/2017/10/11/bay-area-air-quality-worst-on-record-check-out-your-city/\" target=\"_blank\" rel=\"noopener\">worst pollution \u003c/a>since the state started keeping records for small particulates, in 1999. That goes even for areas as far removed from the disaster's epicenter as the South Bay.\u003c/p>\n\u003caside class=\"pullquote alignright\">The California Air Resources Board says HEPA air purifiers can remove almost all of the harmful particles in the air caused by fire.\u003c/aside>\n\u003cp>Naturally, this has left people all over the region worried about pollutant-related health hazards. And not without reason.\u003c/p>\n\u003cp>\"When we breath particulates they bypass the lung system and get into our bloodstream,” Lisa Fasano of the Bay Area Air Quality Management District told KQED's Lesley McClurg last week. \"They exacerbate respiratory conditions like asthma, COPD [Chronic Obstructive Pulmonary Disease], emphysema and other conditions because they are very harmful.”\u003c/p>\n\u003cp>Air quality \u003ca href=\"https://airnow.gov/index.cfm?action=airnow.local_city&cityid=317\" target=\"_blank\" rel=\"noopener\">has improved\u003c/a> this week, and the good news is that as it gets better outside, it will improve indoors as well.\u003c/p>\n\u003caside class=\"alignright\">\n\u003cul>California Consumer Information on Air Cleaners\n\u003cli>\u003ca href=\"https://www.arb.ca.gov/research/indoor/aircleaners/certified.htm\">List of air-cleaning devices that can be sold in California\u003c/a>\u003c/li>\n\u003cli>\u003ca href=\"https://www.arb.ca.gov/research/indoor/acdsumm.pdf\">FAQ: Air cleaning devices for the home\u003c/a>\u003c/li>\n\u003cli>\u003ca href=\"https://www.arb.ca.gov/research/indoor/aircleaners/consumers.htm?_ga=2.103214725.400296666.1508192585-1430501393.1496685106\" target=\"_blank\" rel=\"noopener\">More air-cleaner information for consumers\u003c/a>\u003c/li>\n\u003c/ul>\n\u003c/aside>\n\u003cp>\"Fine particle pollution essentially acts like a gas, so if there is an exchange between outside and indoor air, the indoor pollution will dissipate,\" said CARB Communications Director Stanley Young in an email.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Provided the air outside is clean, the indoor air will clear \"in a matter of hours or days,\" not weeks, Young said.\u003c/p>\n\u003cp>Still, the air resources board definitely recommends purifiers -- portable devices that will clean the air, not just for fire-related pollutants, but for everyday use as well.\u003c/p>\n\u003cp>Peggy Jenkins, who manages the agency's Indoor Air Quality and Personal Exposure Assessment Program, says those air-cleaning devices that use filters designated as high-efficiency particulate air, or HEPA, work best, as they remove very small particles.\u003c/p>\n\u003cp>\"The high-efficiency filters typically are deeper or more dense,\" Jenkins says, \"and they can remove really almost 100 percent of the particles in the air. So we've seen very dramatic reductions in our air quality studies.\"\u003c/p>\n\u003cp>\u003cstrong>High Demand\u003c/strong>\u003c/p>\n\u003cp>But due to the fires, local stores have been selling out of the devices. Eliza Hersh of San Francisco, who recently hosted a Santa Rosa family forced to evacuate their home, has been on the hunt. Before her guests were okayed to go back home, they wanted to buy a purifier to clean the air in both their house and business.\u003c/p>\n\u003cp>[contextly_sidebar id=\"uNJzQt7aM6CcDNCU8aao9oGDi0lPEpNJ\"]\"Every local place was sold out,\" Hersh said. \"[They] were about to drive to Tracy.\"\u003c/p>\n\u003cp>With local stores depleted, Hersh and others naturally turned to an online source. And that usually means Amazon. Except there was a problem: Would-be buyers kept running into this message:\u003c/p>\n\u003cp>\u003ca href=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2027/10/Amazon-message-2.png\">\u003cimg class=\"aligncenter size-full wp-image-436287\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2027/10/Amazon-message-2.png\" alt=\"\" width=\"536\" height=\"83\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2027/10/Amazon-message-2.png 536w, https://ww2.kqed.org/app/uploads/sites/13/2027/10/Amazon-message-2-160x25.png 160w, https://ww2.kqed.org/app/uploads/sites/13/2027/10/Amazon-message-2-240x37.png 240w, https://ww2.kqed.org/app/uploads/sites/13/2027/10/Amazon-message-2-375x58.png 375w, https://ww2.kqed.org/app/uploads/sites/13/2027/10/Amazon-message-2-520x81.png 520w\" sizes=\"(max-width: 536px) 100vw, 536px\">\u003c/a>\u003c/p>\n\u003cp>Many went on Twitter to vent ... . Here's just one of the many tweets:\u003c/p>\n\u003cp>https://twitter.com/wildwestpie/status/918733350994448384\u003c/p>\n\u003cp>\u003cstrong>Ozone Regulation\u003c/strong>\u003c/p>\n\u003cp>Here's the answer to that WTF: Selling air purifiers in California is a little complicated, because of a state \u003ca href=\"https://www.arb.ca.gov/research/indoor/aircleaners/air-cleaner-regulation.pdf\" target=\"_blank\" rel=\"noopener\">regulation\u003c/a> banning certain models that emit ozone. The California Air Resources Board \u003ca href=\"https://www.arb.ca.gov/research/indoor/ozone.htm\" target=\"_blank\" rel=\"noopener\">calls ozone\u003c/a> \"a highly reactive, unstable, toxic gas\" that can irritate and inflame the respiratory system and even cause permanent lung damage. CARB says ozone-generating air purifiers can produce several times the state's allowable levels.\u003c/p>\n\u003cp>Thus, the board maintains a list of potentially hazardous ozone-generating air cleaners that\u003ca href=\"https://www.arb.ca.gov/research/indoor/o3g-list.htm\" target=\"_blank\" rel=\"noopener\"> cannot be sold\u003c/a> in the state, as well as a list of \u003ca href=\"https://www.arb.ca.gov/research/indoor/aircleaners/certified.htm\" target=\"_blank\" rel=\"noopener\">those that can\u003c/a>. CARB updates the lists as frequently as each week.\u003c/p>\n\u003cp>The problem is would-be buyers were stymied even ordering models specifically certified as legal. On Tuesday, SFGate \u003ca href=\"http://www.sfgate.com/bayarea/article/cant-buy-air-purifier-ozone-ca-12276943.php\" target=\"_blank\" rel=\"noopener\">reported\u003c/a> on the issue and got this statement from CARB:\u003c/p>\n\u003cp>\"Amazon, unfortunately, has had problems shipping some CARB-approved air purifiers ... so until Amazon addresses this error, consumers may opt for another company to purchase from.\"\u003c/p>\n\u003cp>So on Wednesday, we asked Amazon: What gives?\u003c/p>\n\u003cp class=\"x_MsoNormal\">“Air filters must meet the California Air Resources Board’s unique restrictions before they can be legally sold into the state,\" Erik Fairleigh, an Amazon spokesman wrote in an email. \"As a result, we require suppliers to provide confirmation that air filters comply with the restrictions in order to be sold into California.”\u003c/p>\n\u003cp>\u003cstrong>Problem (Mostly) Solved\u003c/strong>\u003c/p>\n\u003cp>Well, in light of all this, we decided to run a little test. On Thursday, we selected a sample of 10 top-rated, CARB-approved air purifiers, each with at least 400 reviews from Amazon customers. (Here's the Amazon \u003ca href=\"https://www.amazon.com/s/ref=sr_st_undefined?keywords=hepa+air+purifier&rh=i%3Aaps%2Ck%3Ahepa+air+purifier&qid=1508537823&sort=review-rank\" target=\"_blank\" rel=\"noopener\">search we did\u003c/a> to find our 10.) Then we went through the ordering process for each. Of those 10, Amazon allowed seven to be shipped to a San Francisco address, and only three, all made by Honeywell, evoked the dreaded \"can't ship\" message. Amazon's Fairleigh also sent us a list of about 40 models he said Californians could successfully buy.\u003c/p>\n\u003cp>Meanwhile, Hersh provided us with the links to four Honeywell models she had sent to Amazon last Friday as examples of state-approved models that California customers couldn't get shipped to them. On Thursday -- yesterday -- 2 of the 4 that had been previously unshippable were now good to go. So that is progress.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>If you still can't find an air purifier locally, give it another try online. Even as late as yesterday, purifiers remained a hot item in the region. On the Best Buy website, a small sampling of air purifiers we looked at were listed as available in each and every Bay Area store no sooner than Oct. 28.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>During\u003cb> \u003c/b>the deadly North Bay wildfires, air quality in the Bay Area has suffered -- a lot. In fact, air monitors have recorded the \u003ca href=\"https://ww2.kqed.org/science/2017/10/11/bay-area-air-quality-worst-on-record-check-out-your-city/\" target=\"_blank\" rel=\"noopener\">worst pollution \u003c/a>since the state started keeping records for small particulates, in 1999. That goes even for areas as far removed from the disaster's epicenter as the South Bay.\u003c/p>\n\u003caside class=\"pullquote alignright\">The California Air Resources Board says HEPA air purifiers can remove almost all of the harmful particles in the air caused by fire.\u003c/aside>\n\u003cp>Naturally, this has left people all over the region worried about pollutant-related health hazards. And not without reason.\u003c/p>\n\u003cp>\"When we breath particulates they bypass the lung system and get into our bloodstream,” Lisa Fasano of the Bay Area Air Quality Management District told KQED's Lesley McClurg last week. \"They exacerbate respiratory conditions like asthma, COPD [Chronic Obstructive Pulmonary Disease], emphysema and other conditions because they are very harmful.”\u003c/p>\n\u003cp>Air quality \u003ca href=\"https://airnow.gov/index.cfm?action=airnow.local_city&cityid=317\" target=\"_blank\" rel=\"noopener\">has improved\u003c/a> this week, and the good news is that as it gets better outside, it will improve indoors as well.\u003c/p>\n\u003caside class=\"alignright\">\n\u003cul>California Consumer Information on Air Cleaners\n\u003cli>\u003ca href=\"https://www.arb.ca.gov/research/indoor/aircleaners/certified.htm\">List of air-cleaning devices that can be sold in California\u003c/a>\u003c/li>\n\u003cli>\u003ca href=\"https://www.arb.ca.gov/research/indoor/acdsumm.pdf\">FAQ: Air cleaning devices for the home\u003c/a>\u003c/li>\n\u003cli>\u003ca href=\"https://www.arb.ca.gov/research/indoor/aircleaners/consumers.htm?_ga=2.103214725.400296666.1508192585-1430501393.1496685106\" target=\"_blank\" rel=\"noopener\">More air-cleaner information for consumers\u003c/a>\u003c/li>\n\u003c/ul>\n\u003c/aside>\n\u003cp>\"Fine particle pollution essentially acts like a gas, so if there is an exchange between outside and indoor air, the indoor pollution will dissipate,\" said CARB Communications Director Stanley Young in an email.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Provided the air outside is clean, the indoor air will clear \"in a matter of hours or days,\" not weeks, Young said.\u003c/p>\n\u003cp>Still, the air resources board definitely recommends purifiers -- portable devices that will clean the air, not just for fire-related pollutants, but for everyday use as well.\u003c/p>\n\u003cp>Peggy Jenkins, who manages the agency's Indoor Air Quality and Personal Exposure Assessment Program, says those air-cleaning devices that use filters designated as high-efficiency particulate air, or HEPA, work best, as they remove very small particles.\u003c/p>\n\u003cp>\"The high-efficiency filters typically are deeper or more dense,\" Jenkins says, \"and they can remove really almost 100 percent of the particles in the air. So we've seen very dramatic reductions in our air quality studies.\"\u003c/p>\n\u003cp>\u003cstrong>High Demand\u003c/strong>\u003c/p>\n\u003cp>But due to the fires, local stores have been selling out of the devices. Eliza Hersh of San Francisco, who recently hosted a Santa Rosa family forced to evacuate their home, has been on the hunt. Before her guests were okayed to go back home, they wanted to buy a purifier to clean the air in both their house and business.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\"Every local place was sold out,\" Hersh said. \"[They] were about to drive to Tracy.\"\u003c/p>\n\u003cp>With local stores depleted, Hersh and others naturally turned to an online source. And that usually means Amazon. Except there was a problem: Would-be buyers kept running into this message:\u003c/p>\n\u003cp>\u003ca href=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2027/10/Amazon-message-2.png\">\u003cimg class=\"aligncenter size-full wp-image-436287\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2027/10/Amazon-message-2.png\" alt=\"\" width=\"536\" height=\"83\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2027/10/Amazon-message-2.png 536w, https://ww2.kqed.org/app/uploads/sites/13/2027/10/Amazon-message-2-160x25.png 160w, https://ww2.kqed.org/app/uploads/sites/13/2027/10/Amazon-message-2-240x37.png 240w, https://ww2.kqed.org/app/uploads/sites/13/2027/10/Amazon-message-2-375x58.png 375w, https://ww2.kqed.org/app/uploads/sites/13/2027/10/Amazon-message-2-520x81.png 520w\" sizes=\"(max-width: 536px) 100vw, 536px\">\u003c/a>\u003c/p>\n\u003cp>Many went on Twitter to vent ... . Here's just one of the many tweets:\u003c/p>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\n\u003cp>\u003cstrong>Ozone Regulation\u003c/strong>\u003c/p>\n\u003cp>Here's the answer to that WTF: Selling air purifiers in California is a little complicated, because of a state \u003ca href=\"https://www.arb.ca.gov/research/indoor/aircleaners/air-cleaner-regulation.pdf\" target=\"_blank\" rel=\"noopener\">regulation\u003c/a> banning certain models that emit ozone. The California Air Resources Board \u003ca href=\"https://www.arb.ca.gov/research/indoor/ozone.htm\" target=\"_blank\" rel=\"noopener\">calls ozone\u003c/a> \"a highly reactive, unstable, toxic gas\" that can irritate and inflame the respiratory system and even cause permanent lung damage. CARB says ozone-generating air purifiers can produce several times the state's allowable levels.\u003c/p>\n\u003cp>Thus, the board maintains a list of potentially hazardous ozone-generating air cleaners that\u003ca href=\"https://www.arb.ca.gov/research/indoor/o3g-list.htm\" target=\"_blank\" rel=\"noopener\"> cannot be sold\u003c/a> in the state, as well as a list of \u003ca href=\"https://www.arb.ca.gov/research/indoor/aircleaners/certified.htm\" target=\"_blank\" rel=\"noopener\">those that can\u003c/a>. CARB updates the lists as frequently as each week.\u003c/p>\n\u003cp>The problem is would-be buyers were stymied even ordering models specifically certified as legal. On Tuesday, SFGate \u003ca href=\"http://www.sfgate.com/bayarea/article/cant-buy-air-purifier-ozone-ca-12276943.php\" target=\"_blank\" rel=\"noopener\">reported\u003c/a> on the issue and got this statement from CARB:\u003c/p>\n\u003cp>\"Amazon, unfortunately, has had problems shipping some CARB-approved air purifiers ... so until Amazon addresses this error, consumers may opt for another company to purchase from.\"\u003c/p>\n\u003cp>So on Wednesday, we asked Amazon: What gives?\u003c/p>\n\u003cp class=\"x_MsoNormal\">“Air filters must meet the California Air Resources Board’s unique restrictions before they can be legally sold into the state,\" Erik Fairleigh, an Amazon spokesman wrote in an email. \"As a result, we require suppliers to provide confirmation that air filters comply with the restrictions in order to be sold into California.”\u003c/p>\n\u003cp>\u003cstrong>Problem (Mostly) Solved\u003c/strong>\u003c/p>\n\u003cp>Well, in light of all this, we decided to run a little test. On Thursday, we selected a sample of 10 top-rated, CARB-approved air purifiers, each with at least 400 reviews from Amazon customers. (Here's the Amazon \u003ca href=\"https://www.amazon.com/s/ref=sr_st_undefined?keywords=hepa+air+purifier&rh=i%3Aaps%2Ck%3Ahepa+air+purifier&qid=1508537823&sort=review-rank\" target=\"_blank\" rel=\"noopener\">search we did\u003c/a> to find our 10.) Then we went through the ordering process for each. Of those 10, Amazon allowed seven to be shipped to a San Francisco address, and only three, all made by Honeywell, evoked the dreaded \"can't ship\" message. Amazon's Fairleigh also sent us a list of about 40 models he said Californians could successfully buy.\u003c/p>\n\u003cp>Meanwhile, Hersh provided us with the links to four Honeywell models she had sent to Amazon last Friday as examples of state-approved models that California customers couldn't get shipped to them. On Thursday -- yesterday -- 2 of the 4 that had been previously unshippable were now good to go. So that is progress.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>If you still can't find an air purifier locally, give it another try online. Even as late as yesterday, purifiers remained a hot item in the region. On the Best Buy website, a small sampling of air purifiers we looked at were listed as available in each and every Bay Area store no sooner than Oct. 28.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "It's Treatment Before Trial in Experimental Opioid Court",
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"content": "\u003cp>There's about 10 feet between Judge Craig Hannah's courtroom bench and the place where a defendant stands to be arraigned here in Buffalo City Court.\u003c/p>\n\u003cp>But for 26-year-old Caitlyn Stein, it has been a long, arduous 10 feet.\u003c/p>\n\u003cp>\"This is your first day back! Good to see you!\" Judge Hannah says as he greets her.\u003c/p>\n\u003cp>\"Good to see you,\" Stein says, smiling.\u003c/p>\n\u003cp>\"We've got to do that \u003cem>after \u003c/em>picture. We did the \u003cem>before\u003c/em>,\" Judge Hannah reminds her.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>It's 10 feet of space where Stein began to walk back 10 years of crippling intravenous heroin addiction and its sordid aftermath: burned bridges with family and friends, and a stream of lies and criminality to support her drug habit.\u003c/p>\n\u003cp>Today is Stein's first day back before Hannah after a month of inpatient treatment in Buffalo's new opioid intervention court.\u003c/p>\n\u003cp>Stein shows the judge a folder full of awards and certificates earned during her recovery.\u003c/p>\n\u003cp>\"Oh, you've also been a positive peer mentor. Wow. You really did your thing down there. Congratulations,\" Hannah says, looking Stein in the eyes. \"How many days clean?\"\u003c/p>\n\u003cp>\"Twenty-nine today, judge.\"\u003c/p>\n\u003cp>\"Keep up the good work, that's awesome.\"\u003c/p>\n\u003cp>\"I will.\"\u003c/p>\n\u003cp>\u003cstrong>'See Another Christmas'\u003c/strong>\u003c/p>\n\u003cp>Federal, county and city court officials are looking hard at Buffalo, N.Y.'s new opioid crisis intervention court as one potential model solution to the epidemic of heroin and opioid overdoses that continue to devastate families and communities across America, taxing local governments, first responders and the nation's criminal justice system.\u003c/p>\n\u003cp>\"Right now we're trying to save them. I'm trying to save their life,\" says Judge Hannah, who presides over this first-in-the-nation experiment that aims to fast-track addicts into wraparound treatment before adjudicating their criminal cases. \"I want them to have another sunset, another time with their family, to see another Christmas.\"\u003c/p>\n\u003cp>Buffalo's opiate court is, essentially, an iteration of the traditional drug court where an addicted nonviolent offender is channeled into recovery as an alternative to jail and a chance at a reduced sentence.\u003c/p>\n\u003cp>When Stein first appeared before Judge Hannah, she was dressed in an orange city jail jumpsuit and shackled in handcuffs and chains. She was pounds thinner with dark circles under her eyes and heroin track marks on her arms.\u003c/p>\n\u003cp>Today she looks alert and upbeat, dressed in jeans and a casual top.\u003c/p>\n\u003cp>And now she gets to walk right up to Judge Hannah's bench, to cross those 10 feet and talk face-to-face.\u003c/p>\n\u003cp>\"How do you feel?\"\u003c/p>\n\u003cp>\"I feel like me again and it's awesome,\" Stein replies.\u003c/p>\n\u003cp>\"You know you have to see me every day after treatment right, unless you're in group?\"\u003c/p>\n\u003cp>\"OK, yeah I know,\" she says.\u003c/p>\n\u003cp>In that moment, Hannah seems more like a friend than the black-robed judge who could order Stein to jail if she runs — again — from treatment.\u003c/p>\n\u003cp>The first go-around Stein bolted from her detox bed and the serious heroin possession charges hanging over her.\u003c/p>\n\u003cp>She wanted to get high.\u003c/p>\n\u003cp>After Stein was rearrested in August, Judge Hannah gave her another chance to get clean and a second chance to maybe get those criminal charges reduced.\u003c/p>\n\u003cp>\u003cstrong>'Put the Clock on Hold'\u003c/strong>\u003c/p>\n\u003cp>The necessity for a special opiate court underscores the crippling severity of the nation's drug overdose and addiction crisis, which \u003ca href=\"https://www.cdc.gov/nchs/data/health_policy/monthly-drug-overdose-death-estimates.pdf\">killed some 64,000 Americans\u003c/a> from February 2016 to February 2017, according to preliminary data from the CDC.\u003c/p>\n\u003cp>The big difference here is speed: If the defendant wants help to kick heroin or opioids, Judge Hannah and his team quickly hit \"pause\" on the criminal charges to get the person into treatment fast, often within hours or the next morning.\u003c/p>\n\u003cp>\"Right from arraignment, we put the clock on hold. We turn off the court reporter, everything's off the record, and we're talking about getting you help,\" Hannah says. \"And once we get you help and get you stabilized, we put the criminal case back on the calendar.\"\u003c/p>\n\u003cp>Usually that's on the calendar of the city's long-established drug court with a chance to get the criminal charges reduced or even dismissed. But often in traditional drug courts it can take weeks or longer to get a defendant into a detox or an inpatient treatment center.\u003c/p>\n\u003cp>And with opioid addicts, that delay can prove fatal, particularly with heroin and fentanyl.\u003c/p>\n\u003cp>\"We couldn't wait three or four weeks until we got the individuals into a treatment program or plan,\" says John Flynn, the district attorney for Erie County, N.Y., which includes Buffalo. \"Because they didn't get it right away, they were going back out in the streets, shooting up fentanyl, and dying.\"\u003c/p>\n\u003cp>Erie County is on track this year to record the highest opiate overdose death total in its history.\u003c/p>\n\u003cp>\"We average just over one overdose death per day,\" says Mary St. Mary with the county's Department of Health.\u003c/p>\n\u003cp>\u003cstrong>Rigorous Treatment \u003c/strong>\u003c/p>\n\u003cp>The court's program includes random, regular drug testing and a nightly curfew. Defendants have to check in at 8 p.m. and \"ping\" their location to a court staffer.\u003c/p>\n\u003cp>Participants are also channeled into one-on-one and group counseling among other support services.\u003c/p>\n\u003cp>So Judge Hannah knows fast if someone's using again or didn't show up for counseling or curfew.\u003c/p>\n\u003cp>\"Addicts are very good at lying, at manipulating and having them finally take accountability\" is vital, says Brooke Crouse, the opioid court liaison for Horizon Health Services, a main provider of the court's addiction treatment services.\u003c/p>\n\u003cp>\"We have someone who finished the program in June and he still calls in every night at 8 just for that accountability, to stay focused,\" Crouse says.\u003c/p>\n\u003cp>And after a 30-day inpatient detox, participants enter 30 days of outpatient treatment.\u003c/p>\n\u003cp>And every weekday at 11 a.m. during that treatment, every recovering addict has to check in with Hannah. To sit in court, wait for his or her name to be called, and walk up close to his bench for a one-on-one talk.\u003c/p>\n\u003cp>Any slip-up is usually addressed within hours at the next morning's one-on-one.\u003c/p>\n\u003cp>\"If they don't go to group, it's addressed at 11. If they skip out on curfew, it's addressed at 11,\" Crouse says.\u003c/p>\n\u003cp>If, however, an opiate court participant — Hannah prefers that term to defendant — fails to show up, he issues a warrant for their arrest.\u003c/p>\n\u003cp>\u003cstrong>'Put Eyes on Them'\u003c/strong>\u003c/p>\n\u003cp>A stern talking-to by Judge Hannah or his compassion or the possibility of an arrest warrant is not always enough.\u003c/p>\n\u003cp>\"It's easier once those cuffs come off to run out the door and go get high instead of going to get treatment to get better,\" Crouse says.\u003c/p>\n\u003cp>No one gets indefinitely kicked out of the program for minor infractions, and Hannah will let you restart your treatment multiple times. And given the reality of relapse during recovery, many participants are on their second time through the court.\u003c/p>\n\u003cp>It's 28-year-old Amanda Davis' second time attempting the program. She landed here after getting arrested for drug possession and petty larceny. She was stealing store items including energy drinks and selling them on the street to feed her heroin habit.\u003c/p>\n\u003cp>\"I started on pills — Percocet, oxy, morphine — anything I could get my hands on. And moved to heroin,\" Davis says. A Colorado native, Davis says she moved to Buffalo to try to get away from addiction. She could not. \"I was using every single day, as much as I could.\" She says her life completely fell apart during her eight years of drug abuse, which also saw several family members die because of opioid and alcohol abuse.\u003c/p>\n\u003cp>After washing out of the program the first time, she asked to come back. She now believes she's finally on track to stay clean.\u003c/p>\n\u003cp>\"Judge Hannah has been the most helpful, useful person I've had in my life in the last eight years,\" Davis says. \"If I wasn't here I think I'd be dead. I've lost three siblings to this.\"\u003c/p>\n\u003cp>At a recent morning session, Hannah wasn't tolerating any more excuses and spin from a middle-aged man who earlier in the week failed his drug test.\u003c/p>\n\u003cp>\"I just need you to be honest with me so I can help you,\" he tells the man, who didn't want his name used. \"Right now you are \u003cem>outside\u003c/em> the circle of trust,\" Hannah tells him. \"You're gonna have to work hard to get back inside the circle. OK?\"\u003c/p>\n\u003cp>The man says he's heading off to group therapy and then a job fair at a local church.\u003c/p>\n\u003cp>\"OK, your test is negative today, so keep up the good work,\" Hannah tells him. \"Looks like you're starting to get back on track.\"\u003c/p>\n\u003cp>\"I thank God for this at the end of the day,\" the man says. \"For you, the court. Something good's going to come out of this, I know it.\"\u003c/p>\n\u003cp>Judge Hannah says the close-in talking, closing that gap between the podium and his bench, is not for show.\u003c/p>\n\u003cp>\"If you don't put eyes on them and have that face-to-face continual contact, and also to reassure them that we're actually working and caring for them, I think a lot of people get lost and they fall off in their recovery,\" he says.\u003c/p>\n\u003cp>The public defender's office here is an enthusiastic backer of the opioid court. Flynn, the Erie County DA, says local law enforcement are supportive as well. It's dumb, Flynn says, to keep arresting, jailing and prosecuting repeat offenders who are, first and foremost, opioid addicts in need of help.\u003c/p>\n\u003cp>\"If an individual doesn't get the help they need, they are going to be a perpetual criminal. They're going to be committing petty larcenies every day,\" Flynn says. \"They're going to be engaging in prostitution, perhaps, in drug possession, perhaps drug sales to further their habit. They are a revolving door within our criminal justice system. And the police don't want that.\"\u003c/p>\n\u003cp>\u003cstrong>A National Model?\u003c/strong>\u003c/p>\n\u003cp>Buffalo's program, in which criminal addicts are immediately assessed and referred for treatment within hours, is generating attention. \"This fast-tracking (in Buffalo) is really unique and generating a lot of interest out there,\" says Christopher Deutsch with the \u003ca href=\"http://www.nadcp.org/\">National Association of Drug Court Professionals\u003c/a>.\u003c/p>\n\u003cp>\"That's a big piece of it,\" Bureau of Justice Assistance policy adviser Gregory Torain says of the city's rapid-response model. \"That's very new.\"\u003c/p>\n\u003cp>The opiate court was created in May of this year with the help of a $300,000 grant from the Justice Department. It's too soon to draw big conclusions.\u003c/p>\n\u003cp>But Torain says the Bureau of Justice Assistance is \"encouraged by what we've seen so far, what they've been able to do.\" He says the bureau will continue to assess and support the court's efforts.\u003c/p>\n\u003cp>So far the numbers show that Buffalo may be on to something: Of the roughly 140 participants, only four have washed out of the program.\u003c/p>\n\u003cp>\"I'm very happy with that number,\" says Jeffrey Smith, project director of New York's 8th Judicial District and a prime mover behind creation of the court. \"And zero deaths (in the program). I'm ecstatic about that number.\"\u003c/p>\n\u003cp>Richard Baum, acting director of the office of National Drug Control Policy, colloquially called the drug czar, recently visited the opioid court to examine how the federal goverment might help replicate the idea in other heroin-damaged cities across the country.\u003c/p>\n\u003cp>County and city court officials from all over the country are also calling and emailing about the program, court officials say.\u003c/p>\n\u003cp>Health professionals agree heroin and opioid addicts are particularly vulnerable to overdose during the detox phase and the period right after. And the courts \"really need to be aware of that and all the stakeholders — judges, prosecutors, law enforcement — all need to be communicating with each other about that,\" Deutsch says, adding that \"Buffalo really is out in front in adapting that model.\"\u003c/p>\n\u003cp>The interest in Buffalo's experiment comes as a committee created by the National Governors Association is studying how states could expand drug treatment within the criminal justice system.\u003c/p>\n\u003cp>\u003cstrong>'People Are Going to Slip Up'\u003c/strong>\u003c/p>\n\u003cp>Part of the opioid court's success, so far, might be the fact that Judge Hannah knows firsthand about addiction.\u003c/p>\n\u003cp>For a time in his youth, Hannah says, he struggled with cocaine dependency.\u003c/p>\n\u003cp>\"I know that you can have every intention of trying to stay clean, but at 2 o'clock in the morning when that demon calls, and no one's around and no one's looking, a lot of people are going to slip up,\" he says. \"You can't lock up an addiction, because the addiction is still there.\"\u003c/p>\n\u003cp>In the court's hallway, recovering addict Caitlyn Stein says if Judge Hannah hadn't given her a second chance she'd likely be in prison or dead.\u003c/p>\n\u003cp>\"Having someone who understands and doesn't judge me for it, knows that, like, no one is exempt from this disease. If it'd been another judge, I'm not sure I'd be here today clean.\"\u003c/p>\n\u003cp>She always wanted to get clean, she says, since starting to shoot up heroin at 16.\u003c/p>\n\u003cp>\"Been in jail a couple times but only stayed clean for a short period of time. This has completely changed everything for me,\" Stein says. \"I can finally live again. It feels good to laugh, like belly laugh, and I cry, but I'm OK with crying now. Where before I was just a zombie, is the best way to put it. Use to live and live to use. I don't ever want to go back to that.\"\u003c/p>\n\u003cp>Then, just a few days later, a few days into her outpatient treatment, Stein failed to show up for her daily check-in with Judge Hannah.\u003c/p>\n\u003cp>A warrant has been issued for her arrest.\u003c/p>\n\u003cp>And the next time Stein sees Hannah, she is likely to be in handcuffs and behind that wooden podium about 10 feet from his bench.\u003c/p>\n\u003cp>And in the court's eyes, anyway, it will be back to Day 1 of her recovery.\u003c/p>\n\u003cp>Court officials say she's been in touch via phone and always promises to turn herself in the next day.\u003c/p>\n\u003cp>So far, she has not.\u003c/p>\n\u003cp>Judge Hannah tells me he's pulling for Stein and all of those cycling through his opioid court experiment.\u003c/p>\n\u003cp>\"I always tell everyone, we play by Vegas rules: What happens here stays here. You tell me what's happening, we're not going to charge you with new charges. We're going to give you the help that you need, because we know that this is an addiction.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\"But we can't help you,\" Hannah adds, \"until you're honest with yourself.\"\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=To+Save+Opioid+Addicts%2C+This+Experimental+Court+Is+Ditching+The+Delays&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>There's about 10 feet between Judge Craig Hannah's courtroom bench and the place where a defendant stands to be arraigned here in Buffalo City Court.\u003c/p>\n\u003cp>But for 26-year-old Caitlyn Stein, it has been a long, arduous 10 feet.\u003c/p>\n\u003cp>\"This is your first day back! Good to see you!\" Judge Hannah says as he greets her.\u003c/p>\n\u003cp>\"Good to see you,\" Stein says, smiling.\u003c/p>\n\u003cp>\"We've got to do that \u003cem>after \u003c/em>picture. We did the \u003cem>before\u003c/em>,\" Judge Hannah reminds her.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>It's 10 feet of space where Stein began to walk back 10 years of crippling intravenous heroin addiction and its sordid aftermath: burned bridges with family and friends, and a stream of lies and criminality to support her drug habit.\u003c/p>\n\u003cp>Today is Stein's first day back before Hannah after a month of inpatient treatment in Buffalo's new opioid intervention court.\u003c/p>\n\u003cp>Stein shows the judge a folder full of awards and certificates earned during her recovery.\u003c/p>\n\u003cp>\"Oh, you've also been a positive peer mentor. Wow. You really did your thing down there. Congratulations,\" Hannah says, looking Stein in the eyes. \"How many days clean?\"\u003c/p>\n\u003cp>\"Twenty-nine today, judge.\"\u003c/p>\n\u003cp>\"Keep up the good work, that's awesome.\"\u003c/p>\n\u003cp>\"I will.\"\u003c/p>\n\u003cp>\u003cstrong>'See Another Christmas'\u003c/strong>\u003c/p>\n\u003cp>Federal, county and city court officials are looking hard at Buffalo, N.Y.'s new opioid crisis intervention court as one potential model solution to the epidemic of heroin and opioid overdoses that continue to devastate families and communities across America, taxing local governments, first responders and the nation's criminal justice system.\u003c/p>\n\u003cp>\"Right now we're trying to save them. I'm trying to save their life,\" says Judge Hannah, who presides over this first-in-the-nation experiment that aims to fast-track addicts into wraparound treatment before adjudicating their criminal cases. \"I want them to have another sunset, another time with their family, to see another Christmas.\"\u003c/p>\n\u003cp>Buffalo's opiate court is, essentially, an iteration of the traditional drug court where an addicted nonviolent offender is channeled into recovery as an alternative to jail and a chance at a reduced sentence.\u003c/p>\n\u003cp>When Stein first appeared before Judge Hannah, she was dressed in an orange city jail jumpsuit and shackled in handcuffs and chains. She was pounds thinner with dark circles under her eyes and heroin track marks on her arms.\u003c/p>\n\u003cp>Today she looks alert and upbeat, dressed in jeans and a casual top.\u003c/p>\n\u003cp>And now she gets to walk right up to Judge Hannah's bench, to cross those 10 feet and talk face-to-face.\u003c/p>\n\u003cp>\"How do you feel?\"\u003c/p>\n\u003cp>\"I feel like me again and it's awesome,\" Stein replies.\u003c/p>\n\u003cp>\"You know you have to see me every day after treatment right, unless you're in group?\"\u003c/p>\n\u003cp>\"OK, yeah I know,\" she says.\u003c/p>\n\u003cp>In that moment, Hannah seems more like a friend than the black-robed judge who could order Stein to jail if she runs — again — from treatment.\u003c/p>\n\u003cp>The first go-around Stein bolted from her detox bed and the serious heroin possession charges hanging over her.\u003c/p>\n\u003cp>She wanted to get high.\u003c/p>\n\u003cp>After Stein was rearrested in August, Judge Hannah gave her another chance to get clean and a second chance to maybe get those criminal charges reduced.\u003c/p>\n\u003cp>\u003cstrong>'Put the Clock on Hold'\u003c/strong>\u003c/p>\n\u003cp>The necessity for a special opiate court underscores the crippling severity of the nation's drug overdose and addiction crisis, which \u003ca href=\"https://www.cdc.gov/nchs/data/health_policy/monthly-drug-overdose-death-estimates.pdf\">killed some 64,000 Americans\u003c/a> from February 2016 to February 2017, according to preliminary data from the CDC.\u003c/p>\n\u003cp>The big difference here is speed: If the defendant wants help to kick heroin or opioids, Judge Hannah and his team quickly hit \"pause\" on the criminal charges to get the person into treatment fast, often within hours or the next morning.\u003c/p>\n\u003cp>\"Right from arraignment, we put the clock on hold. We turn off the court reporter, everything's off the record, and we're talking about getting you help,\" Hannah says. \"And once we get you help and get you stabilized, we put the criminal case back on the calendar.\"\u003c/p>\n\u003cp>Usually that's on the calendar of the city's long-established drug court with a chance to get the criminal charges reduced or even dismissed. But often in traditional drug courts it can take weeks or longer to get a defendant into a detox or an inpatient treatment center.\u003c/p>\n\u003cp>And with opioid addicts, that delay can prove fatal, particularly with heroin and fentanyl.\u003c/p>\n\u003cp>\"We couldn't wait three or four weeks until we got the individuals into a treatment program or plan,\" says John Flynn, the district attorney for Erie County, N.Y., which includes Buffalo. \"Because they didn't get it right away, they were going back out in the streets, shooting up fentanyl, and dying.\"\u003c/p>\n\u003cp>Erie County is on track this year to record the highest opiate overdose death total in its history.\u003c/p>\n\u003cp>\"We average just over one overdose death per day,\" says Mary St. Mary with the county's Department of Health.\u003c/p>\n\u003cp>\u003cstrong>Rigorous Treatment \u003c/strong>\u003c/p>\n\u003cp>The court's program includes random, regular drug testing and a nightly curfew. Defendants have to check in at 8 p.m. and \"ping\" their location to a court staffer.\u003c/p>\n\u003cp>Participants are also channeled into one-on-one and group counseling among other support services.\u003c/p>\n\u003cp>So Judge Hannah knows fast if someone's using again or didn't show up for counseling or curfew.\u003c/p>\n\u003cp>\"Addicts are very good at lying, at manipulating and having them finally take accountability\" is vital, says Brooke Crouse, the opioid court liaison for Horizon Health Services, a main provider of the court's addiction treatment services.\u003c/p>\n\u003cp>\"We have someone who finished the program in June and he still calls in every night at 8 just for that accountability, to stay focused,\" Crouse says.\u003c/p>\n\u003cp>And after a 30-day inpatient detox, participants enter 30 days of outpatient treatment.\u003c/p>\n\u003cp>And every weekday at 11 a.m. during that treatment, every recovering addict has to check in with Hannah. To sit in court, wait for his or her name to be called, and walk up close to his bench for a one-on-one talk.\u003c/p>\n\u003cp>Any slip-up is usually addressed within hours at the next morning's one-on-one.\u003c/p>\n\u003cp>\"If they don't go to group, it's addressed at 11. If they skip out on curfew, it's addressed at 11,\" Crouse says.\u003c/p>\n\u003cp>If, however, an opiate court participant — Hannah prefers that term to defendant — fails to show up, he issues a warrant for their arrest.\u003c/p>\n\u003cp>\u003cstrong>'Put Eyes on Them'\u003c/strong>\u003c/p>\n\u003cp>A stern talking-to by Judge Hannah or his compassion or the possibility of an arrest warrant is not always enough.\u003c/p>\n\u003cp>\"It's easier once those cuffs come off to run out the door and go get high instead of going to get treatment to get better,\" Crouse says.\u003c/p>\n\u003cp>No one gets indefinitely kicked out of the program for minor infractions, and Hannah will let you restart your treatment multiple times. And given the reality of relapse during recovery, many participants are on their second time through the court.\u003c/p>\n\u003cp>It's 28-year-old Amanda Davis' second time attempting the program. She landed here after getting arrested for drug possession and petty larceny. She was stealing store items including energy drinks and selling them on the street to feed her heroin habit.\u003c/p>\n\u003cp>\"I started on pills — Percocet, oxy, morphine — anything I could get my hands on. And moved to heroin,\" Davis says. A Colorado native, Davis says she moved to Buffalo to try to get away from addiction. She could not. \"I was using every single day, as much as I could.\" She says her life completely fell apart during her eight years of drug abuse, which also saw several family members die because of opioid and alcohol abuse.\u003c/p>\n\u003cp>After washing out of the program the first time, she asked to come back. She now believes she's finally on track to stay clean.\u003c/p>\n\u003cp>\"Judge Hannah has been the most helpful, useful person I've had in my life in the last eight years,\" Davis says. \"If I wasn't here I think I'd be dead. I've lost three siblings to this.\"\u003c/p>\n\u003cp>At a recent morning session, Hannah wasn't tolerating any more excuses and spin from a middle-aged man who earlier in the week failed his drug test.\u003c/p>\n\u003cp>\"I just need you to be honest with me so I can help you,\" he tells the man, who didn't want his name used. \"Right now you are \u003cem>outside\u003c/em> the circle of trust,\" Hannah tells him. \"You're gonna have to work hard to get back inside the circle. OK?\"\u003c/p>\n\u003cp>The man says he's heading off to group therapy and then a job fair at a local church.\u003c/p>\n\u003cp>\"OK, your test is negative today, so keep up the good work,\" Hannah tells him. \"Looks like you're starting to get back on track.\"\u003c/p>\n\u003cp>\"I thank God for this at the end of the day,\" the man says. \"For you, the court. Something good's going to come out of this, I know it.\"\u003c/p>\n\u003cp>Judge Hannah says the close-in talking, closing that gap between the podium and his bench, is not for show.\u003c/p>\n\u003cp>\"If you don't put eyes on them and have that face-to-face continual contact, and also to reassure them that we're actually working and caring for them, I think a lot of people get lost and they fall off in their recovery,\" he says.\u003c/p>\n\u003cp>The public defender's office here is an enthusiastic backer of the opioid court. Flynn, the Erie County DA, says local law enforcement are supportive as well. It's dumb, Flynn says, to keep arresting, jailing and prosecuting repeat offenders who are, first and foremost, opioid addicts in need of help.\u003c/p>\n\u003cp>\"If an individual doesn't get the help they need, they are going to be a perpetual criminal. They're going to be committing petty larcenies every day,\" Flynn says. \"They're going to be engaging in prostitution, perhaps, in drug possession, perhaps drug sales to further their habit. They are a revolving door within our criminal justice system. And the police don't want that.\"\u003c/p>\n\u003cp>\u003cstrong>A National Model?\u003c/strong>\u003c/p>\n\u003cp>Buffalo's program, in which criminal addicts are immediately assessed and referred for treatment within hours, is generating attention. \"This fast-tracking (in Buffalo) is really unique and generating a lot of interest out there,\" says Christopher Deutsch with the \u003ca href=\"http://www.nadcp.org/\">National Association of Drug Court Professionals\u003c/a>.\u003c/p>\n\u003cp>\"That's a big piece of it,\" Bureau of Justice Assistance policy adviser Gregory Torain says of the city's rapid-response model. \"That's very new.\"\u003c/p>\n\u003cp>The opiate court was created in May of this year with the help of a $300,000 grant from the Justice Department. It's too soon to draw big conclusions.\u003c/p>\n\u003cp>But Torain says the Bureau of Justice Assistance is \"encouraged by what we've seen so far, what they've been able to do.\" He says the bureau will continue to assess and support the court's efforts.\u003c/p>\n\u003cp>So far the numbers show that Buffalo may be on to something: Of the roughly 140 participants, only four have washed out of the program.\u003c/p>\n\u003cp>\"I'm very happy with that number,\" says Jeffrey Smith, project director of New York's 8th Judicial District and a prime mover behind creation of the court. \"And zero deaths (in the program). I'm ecstatic about that number.\"\u003c/p>\n\u003cp>Richard Baum, acting director of the office of National Drug Control Policy, colloquially called the drug czar, recently visited the opioid court to examine how the federal goverment might help replicate the idea in other heroin-damaged cities across the country.\u003c/p>\n\u003cp>County and city court officials from all over the country are also calling and emailing about the program, court officials say.\u003c/p>\n\u003cp>Health professionals agree heroin and opioid addicts are particularly vulnerable to overdose during the detox phase and the period right after. And the courts \"really need to be aware of that and all the stakeholders — judges, prosecutors, law enforcement — all need to be communicating with each other about that,\" Deutsch says, adding that \"Buffalo really is out in front in adapting that model.\"\u003c/p>\n\u003cp>The interest in Buffalo's experiment comes as a committee created by the National Governors Association is studying how states could expand drug treatment within the criminal justice system.\u003c/p>\n\u003cp>\u003cstrong>'People Are Going to Slip Up'\u003c/strong>\u003c/p>\n\u003cp>Part of the opioid court's success, so far, might be the fact that Judge Hannah knows firsthand about addiction.\u003c/p>\n\u003cp>For a time in his youth, Hannah says, he struggled with cocaine dependency.\u003c/p>\n\u003cp>\"I know that you can have every intention of trying to stay clean, but at 2 o'clock in the morning when that demon calls, and no one's around and no one's looking, a lot of people are going to slip up,\" he says. \"You can't lock up an addiction, because the addiction is still there.\"\u003c/p>\n\u003cp>In the court's hallway, recovering addict Caitlyn Stein says if Judge Hannah hadn't given her a second chance she'd likely be in prison or dead.\u003c/p>\n\u003cp>\"Having someone who understands and doesn't judge me for it, knows that, like, no one is exempt from this disease. If it'd been another judge, I'm not sure I'd be here today clean.\"\u003c/p>\n\u003cp>She always wanted to get clean, she says, since starting to shoot up heroin at 16.\u003c/p>\n\u003cp>\"Been in jail a couple times but only stayed clean for a short period of time. This has completely changed everything for me,\" Stein says. \"I can finally live again. It feels good to laugh, like belly laugh, and I cry, but I'm OK with crying now. Where before I was just a zombie, is the best way to put it. Use to live and live to use. I don't ever want to go back to that.\"\u003c/p>\n\u003cp>Then, just a few days later, a few days into her outpatient treatment, Stein failed to show up for her daily check-in with Judge Hannah.\u003c/p>\n\u003cp>A warrant has been issued for her arrest.\u003c/p>\n\u003cp>And the next time Stein sees Hannah, she is likely to be in handcuffs and behind that wooden podium about 10 feet from his bench.\u003c/p>\n\u003cp>And in the court's eyes, anyway, it will be back to Day 1 of her recovery.\u003c/p>\n\u003cp>Court officials say she's been in touch via phone and always promises to turn herself in the next day.\u003c/p>\n\u003cp>So far, she has not.\u003c/p>\n\u003cp>Judge Hannah tells me he's pulling for Stein and all of those cycling through his opioid court experiment.\u003c/p>\n\u003cp>\"I always tell everyone, we play by Vegas rules: What happens here stays here. You tell me what's happening, we're not going to charge you with new charges. We're going to give you the help that you need, because we know that this is an addiction.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"But we can't help you,\" Hannah adds, \"until you're honest with yourself.\"\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=To+Save+Opioid+Addicts%2C+This+Experimental+Court+Is+Ditching+The+Delays&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Tests that measure a woman’s “ovarian reserve” to estimate how many more years of fertility she has have grown increasingly popular. But a new study finds that levels of the hormones commonly tested aren’t tied to lower chances of getting pregnant.\u003c/p>\n\u003cp class=\"danger-zone\">The new research, published in the \u003cem>Journal of the American Medical Association\u003c/em>, looked at three markers: anti-Müllerian hormone (AMH), follicle-stimulating hormone (FSH), and inhibin B.\u003c/p>\n\u003caside class=\"pullquote alignright\">'Women with low values are going to have unnecessary anxiety, and women with high values may be incorrectly reassured.'\u003ccite>Dr. Anne Steiner, University of North Carolina\u003c/cite>\u003c/aside>\n\u003cp>That’s led to a boom in ovarian reserve testing, both in the clinic and with direct-to-consumer tests from companies. One startup, Modern Fertility, is pre-selling a new $149 fertility test that measures FSH, AMH, and other fertility hormones. The company says physicians will tally all those measures up and calculate a “fertility score.” Previous research has correlated levels of the three hormones with the number of eggs a woman has in her ovaries — a measure known as “ovarian reserve.” Studies have suggested that information could be used to predict how well a woman will respond to in vitro fertilization. But in recent years, as more women are delaying pregnancy until later ages, ovarian reserve tests have begun to be used as a way to test for future fertility.\u003c/p>\n\u003cp>“Women are already using these as fertility tests. Over the years, they’ve worked their way into being in the mainstream without evidence,” said Dr. Anne Steiner, a reproductive endocrinologist at the University of North Carolina and one of the study’s authors.\u003c/p>\n\u003cp>“As we get older, fertility becomes a giant egg-shaped question mark,” the company said in an August blog post announcing the test.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>But the new study finds that looking at levels FSH, AMH, and inhibin B isn’t an answer to the question of fertility.\u003c/p>\n\u003cp>Steiner and her colleagues analyzed data from 750 women between ages 30 and 44 who didn’t have any known fertility problems, had been trying to get pregnant for three months or less, and lived with a male partner. Women who had lower levels of the biomarkers — indicating “diminished ovarian reserve” — weren’t any less likely to get pregnant in the first year than women who had higher levels of the biomarkers.\u003c/p>\n\u003cp>In other words, ovarian reserve tests run the risk of giving women an inaccurate impression of their future chances of having children.\u003c/p>\n\u003cp>“Women with low values are going to have unnecessary anxiety, and women with high values may be incorrectly reassured,” Steiner said. She added that women shouldn’t use the tests to decide whether to freeze their eggs.\u003c/p>\n\u003cp>The caveats: The outcome studied was getting pregnant, not carrying a healthy pregnancy fully to term. It also only followed women for the first year they were trying to get pregnant. And the researchers didn’t run any fertility tests on the partners of the women involved in the study — though Steiner pointed out that direct-to-consumer fertility tests only test women’s levels as well.\u003c/p>\n\u003cp>Dr. Stephen Collins of the Yale Fertility Center, who wasn’t affiliated with the study, said that with this evidence in hand, doctors and the makers of direct-to-consumer tests should be upfront about the evidence for FSH, AMH, and inhibin B tests to predict fertility in the short term.\u003c/p>\n\u003cp>“As practitioners, we need to recognize the limitations of the tests that we’re offering,” he said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>\u003cspan style=\"font-weight: 400\">This \u003ca href=\"https://www.statnews.com/2017/10/10/ovarian-reserve-tests-fertility/\" 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/span>\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Tests that measure a woman’s “ovarian reserve” to estimate how many more years of fertility she has have grown increasingly popular. But a new study finds that levels of the hormones commonly tested aren’t tied to lower chances of getting pregnant.\u003c/p>\n\u003cp class=\"danger-zone\">The new research, published in the \u003cem>Journal of the American Medical Association\u003c/em>, looked at three markers: anti-Müllerian hormone (AMH), follicle-stimulating hormone (FSH), and inhibin B.\u003c/p>\n\u003caside class=\"pullquote alignright\">'Women with low values are going to have unnecessary anxiety, and women with high values may be incorrectly reassured.'\u003ccite>Dr. Anne Steiner, University of North Carolina\u003c/cite>\u003c/aside>\n\u003cp>That’s led to a boom in ovarian reserve testing, both in the clinic and with direct-to-consumer tests from companies. One startup, Modern Fertility, is pre-selling a new $149 fertility test that measures FSH, AMH, and other fertility hormones. The company says physicians will tally all those measures up and calculate a “fertility score.” Previous research has correlated levels of the three hormones with the number of eggs a woman has in her ovaries — a measure known as “ovarian reserve.” Studies have suggested that information could be used to predict how well a woman will respond to in vitro fertilization. But in recent years, as more women are delaying pregnancy until later ages, ovarian reserve tests have begun to be used as a way to test for future fertility.\u003c/p>\n\u003cp>“Women are already using these as fertility tests. Over the years, they’ve worked their way into being in the mainstream without evidence,” said Dr. Anne Steiner, a reproductive endocrinologist at the University of North Carolina and one of the study’s authors.\u003c/p>\n\u003cp>“As we get older, fertility becomes a giant egg-shaped question mark,” the company said in an August blog post announcing the test.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>But the new study finds that looking at levels FSH, AMH, and inhibin B isn’t an answer to the question of fertility.\u003c/p>\n\u003cp>Steiner and her colleagues analyzed data from 750 women between ages 30 and 44 who didn’t have any known fertility problems, had been trying to get pregnant for three months or less, and lived with a male partner. Women who had lower levels of the biomarkers — indicating “diminished ovarian reserve” — weren’t any less likely to get pregnant in the first year than women who had higher levels of the biomarkers.\u003c/p>\n\u003cp>In other words, ovarian reserve tests run the risk of giving women an inaccurate impression of their future chances of having children.\u003c/p>\n\u003cp>“Women with low values are going to have unnecessary anxiety, and women with high values may be incorrectly reassured,” Steiner said. She added that women shouldn’t use the tests to decide whether to freeze their eggs.\u003c/p>\n\u003cp>The caveats: The outcome studied was getting pregnant, not carrying a healthy pregnancy fully to term. It also only followed women for the first year they were trying to get pregnant. And the researchers didn’t run any fertility tests on the partners of the women involved in the study — though Steiner pointed out that direct-to-consumer fertility tests only test women’s levels as well.\u003c/p>\n\u003cp>Dr. Stephen Collins of the Yale Fertility Center, who wasn’t affiliated with the study, said that with this evidence in hand, doctors and the makers of direct-to-consumer tests should be upfront about the evidence for FSH, AMH, and inhibin B tests to predict fertility in the short term.\u003c/p>\n\u003cp>“As practitioners, we need to recognize the limitations of the tests that we’re offering,” he said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>\u003cspan style=\"font-weight: 400\">This \u003ca href=\"https://www.statnews.com/2017/10/10/ovarian-reserve-tests-fertility/\" 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/span>\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>It was 1:30 a.m., and Anna was trying to keep her mind off her ex-boyfriend, with whom she had ended a painful relationship hours earlier. It was too late to call the therapist she was seeing to cope with low self-esteem and homesickness, and too late to stop by a friend’s house.\u003c/p>\n\u003cp>So, she turned to social media. “I’m having a really hard time right now,” Anna — who asked to be identified by a pseudonym — posted on Facebook. “Is there anyone I can call and talk to until I feel better?”\u003c/p>\n\u003caside class=\"alignright\">Some academics and therapists are proposing a counterintuitive view of social media: It helps improve mental health by boosting self-esteem and providing a source of emotional support.\u003c/aside>\n\u003cp>Almost immediately, three people responded with offers to talk. They were friends she had met playing Quidditch, a sport based on the Harry Potter fantasy books, and she kept in touch with them online. Anna talked to two of them until she was able to fall sleep.\u003c/p>\n\u003cp>“I used to be very shy about posting personal stuff on Facebook because I didn’t want people judging me,” said Anna, 26. “But that night, I was in such a bad place; I was desperate, and I thought anything would help.”\u003c/p>\n\u003cp>The negative effects of social media on young people’s mental health are well-documented by researchers and the press. Social media \u003ca href=\"http://www.sciencedirect.com/science/article/pii/S0747563214005767\">can drive envy\u003c/a> and depression, \u003ca href=\"http://onlinelibrary.wiley.com/doi/10.1111/j.1467-9450.2007.00611.x/full\">enable cyberbullying\u003c/a> and \u003ca href=\"http://onlinelibrary.wiley.com/doi/10.1111/j.1469-7610.2011.02416.x/full\">spread thoughts of suicide\u003c/a>.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>But some academics and therapists are proposing a counterintuitive view: They have found that social media may also help improve mental health by \u003ca href=\"http://onlinelibrary.wiley.com/doi/10.1111/j.1083-6101.2007.00367.x/full\">boosting self-esteem\u003c/a> and providing a source of \u003ca href=\"http://www.sciencedirect.com/science/article/pii/S0747563217303643\">emotional support\u003c/a>. These benefits have attracted too little attention from journalists and parents, they say.\u003c/p>\n\u003cp>“Yes, social media is contributing to a new era of adolescent (and adult) social stress, but when we accept that it is here to stay, we can also see it as a new opportunity for connection and mindfulness,” according to an online advice column published by the University of California-Berkeley’s Greater Good Science Center.\u003c/p>\n\u003cp>“We need to think about social media as not being absolutely good or bad,” said \u003ca href=\"http://mediaschool.indiana.edu/profile/?p=gonzaamy\">Amy Gonzales\u003c/a>, an assistant professor who studies social media and health at Indiana University’s Media School. “We need to think about how to come up with appropriate uses of this stuff.”\u003c/p>\n\u003cp>Social media have become integral to the lives of young adults and teens: \u003ca href=\"https://www.commonsensemedia.org/sites/default/files/uploads/research/census_executivesummary.pdf\">45 percent of teenagers\u003c/a> say they use apps such as Facebook, Twitter and Instagram every day.\u003c/p>\n\u003cp>In research published by the National Center for Biotechnology Information, Gonzales found that college students who viewed their own Facebook \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/21329447\">profiles enjoyed a boost in self-esteem afterward\u003c/a>.\u003c/p>\n\u003cp>By curating their online personas to reflect their best traits — choosing flattering pictures and sharing exciting experiences — users remember what they like best about themselves.\u003c/p>\n\u003cp>“It’s like the way you might feel good about yourself when you check yourself out in the mirror before a date,” Gonzales explained.\u003c/p>\n\u003cp>Other \u003ca href=\"http://online.liebertpub.com/doi/abs/10.1089/cyber.2010.0374\">studies\u003c/a> reveal that people feel more social support when they present themselves honestly on social media, and tend to feel less stressed after they do so.\u003c/p>\n\u003cp>“You get much broader affirmation by posting on social media than from calling a relative,” Anna said. “It’s one thing if you text a friend; it’s another thing if you have a bunch of people trying to help you out.”\u003c/p>\n\u003cp>\u003ca href=\"http://www.mountsinai.org/profiles/matthew-oransky\">Matthew Oransky\u003c/a>, an assistant professor of adolescent psychiatry at Mount Sinai Hospital in New York City and a practicing therapist, said many of his patients find social connections online they could not find elsewhere. This is particularly true of marginalized teens, such as kids in foster homes and LGBT adolescents.\u003c/p>\n\u003cp>“I’ve seen some of the really big positives, which is that kids who are isolated can find a community,” Oransky said. “They’re often first able to come out to online friends.” In a 2013 survey, 50 percent of LGBT youth \u003ca href=\"https://www.glsen.org/press/study-finds-lgbt-youth-face-greater-harassment-online\">reported\u003c/a> having at least one close friend they knew only from online interactions.\u003c/p>\n\u003cp>Young adults with serious mental illness such as schizophrenia and bipolar disorder can also \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/26744309\">find social support\u003c/a> via social media, according to a study published in 2016. “These people are openly discussing their illness online,” said \u003ca href=\"http://www.hprcd.org/john-naslund-mph/\">John Naslund\u003c/a>, a research fellow at the Dartmouth Institute for Health Policy and Clinical Practice.\u003c/p>\n\u003cp>Social media postings can help \u003ca href=\"https://link.springer.com/article/10.1007/s00127-013-0815-7\">foster greater acceptance\u003c/a> of mental health problems. “It’s definitely real that there’s hostility online,” Naslund said. “But we’ve found that comments related to mental health are overwhelmingly positive. People can learn how to cope with symptoms and how to find the right support.”\u003c/p>\n\u003cp>But parents can and should help their children use social media wisely, experts say. Oransky suggests, for instance, that parents talk with kids about the privacy consequences of posting compromising material, such as revealing pictures or personal details that might affect their job prospects. Naslund recommends that people start cautiously on social media by using pseudonyms.\u003c/p>\n\u003cp>Anna uses filters to keep co-workers from seeing her mental health posts. But she views social media as a way to act on her therapist’s recommendation to reach out for support when she needs it. “If you trust your friends,” she said, “I don’t see why you shouldn’t embrace the social media option.”\u003c/p>\n\u003cp>\u003cem>This story was produced by \u003ca href=\"https://khn.org/\">Kaiser Health News\u003c/a>, which publishes \u003ca href=\"http://www.californiahealthline.org/\">California Healthline\u003c/a>, an editorially independent service of the \u003ca href=\"http://www.chcf.org/\">California Health Care Foundation\u003c/a>.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>\u003ca href=\"http://www.kaiserhealthnews.org/\">Kaiser Health News\u003c/a> (KHN) is a national health policy news service. It is an editorially independent program of the \u003ca href=\"http://www.kff.org/\">Henry J. Kaiser Family Foundation\u003c/a>.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>It was 1:30 a.m., and Anna was trying to keep her mind off her ex-boyfriend, with whom she had ended a painful relationship hours earlier. It was too late to call the therapist she was seeing to cope with low self-esteem and homesickness, and too late to stop by a friend’s house.\u003c/p>\n\u003cp>So, she turned to social media. “I’m having a really hard time right now,” Anna — who asked to be identified by a pseudonym — posted on Facebook. “Is there anyone I can call and talk to until I feel better?”\u003c/p>\n\u003caside class=\"alignright\">Some academics and therapists are proposing a counterintuitive view of social media: It helps improve mental health by boosting self-esteem and providing a source of emotional support.\u003c/aside>\n\u003cp>Almost immediately, three people responded with offers to talk. They were friends she had met playing Quidditch, a sport based on the Harry Potter fantasy books, and she kept in touch with them online. Anna talked to two of them until she was able to fall sleep.\u003c/p>\n\u003cp>“I used to be very shy about posting personal stuff on Facebook because I didn’t want people judging me,” said Anna, 26. “But that night, I was in such a bad place; I was desperate, and I thought anything would help.”\u003c/p>\n\u003cp>The negative effects of social media on young people’s mental health are well-documented by researchers and the press. Social media \u003ca href=\"http://www.sciencedirect.com/science/article/pii/S0747563214005767\">can drive envy\u003c/a> and depression, \u003ca href=\"http://onlinelibrary.wiley.com/doi/10.1111/j.1467-9450.2007.00611.x/full\">enable cyberbullying\u003c/a> and \u003ca href=\"http://onlinelibrary.wiley.com/doi/10.1111/j.1469-7610.2011.02416.x/full\">spread thoughts of suicide\u003c/a>.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>But some academics and therapists are proposing a counterintuitive view: They have found that social media may also help improve mental health by \u003ca href=\"http://onlinelibrary.wiley.com/doi/10.1111/j.1083-6101.2007.00367.x/full\">boosting self-esteem\u003c/a> and providing a source of \u003ca href=\"http://www.sciencedirect.com/science/article/pii/S0747563217303643\">emotional support\u003c/a>. These benefits have attracted too little attention from journalists and parents, they say.\u003c/p>\n\u003cp>“Yes, social media is contributing to a new era of adolescent (and adult) social stress, but when we accept that it is here to stay, we can also see it as a new opportunity for connection and mindfulness,” according to an online advice column published by the University of California-Berkeley’s Greater Good Science Center.\u003c/p>\n\u003cp>“We need to think about social media as not being absolutely good or bad,” said \u003ca href=\"http://mediaschool.indiana.edu/profile/?p=gonzaamy\">Amy Gonzales\u003c/a>, an assistant professor who studies social media and health at Indiana University’s Media School. “We need to think about how to come up with appropriate uses of this stuff.”\u003c/p>\n\u003cp>Social media have become integral to the lives of young adults and teens: \u003ca href=\"https://www.commonsensemedia.org/sites/default/files/uploads/research/census_executivesummary.pdf\">45 percent of teenagers\u003c/a> say they use apps such as Facebook, Twitter and Instagram every day.\u003c/p>\n\u003cp>In research published by the National Center for Biotechnology Information, Gonzales found that college students who viewed their own Facebook \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/21329447\">profiles enjoyed a boost in self-esteem afterward\u003c/a>.\u003c/p>\n\u003cp>By curating their online personas to reflect their best traits — choosing flattering pictures and sharing exciting experiences — users remember what they like best about themselves.\u003c/p>\n\u003cp>“It’s like the way you might feel good about yourself when you check yourself out in the mirror before a date,” Gonzales explained.\u003c/p>\n\u003cp>Other \u003ca href=\"http://online.liebertpub.com/doi/abs/10.1089/cyber.2010.0374\">studies\u003c/a> reveal that people feel more social support when they present themselves honestly on social media, and tend to feel less stressed after they do so.\u003c/p>\n\u003cp>“You get much broader affirmation by posting on social media than from calling a relative,” Anna said. “It’s one thing if you text a friend; it’s another thing if you have a bunch of people trying to help you out.”\u003c/p>\n\u003cp>\u003ca href=\"http://www.mountsinai.org/profiles/matthew-oransky\">Matthew Oransky\u003c/a>, an assistant professor of adolescent psychiatry at Mount Sinai Hospital in New York City and a practicing therapist, said many of his patients find social connections online they could not find elsewhere. This is particularly true of marginalized teens, such as kids in foster homes and LGBT adolescents.\u003c/p>\n\u003cp>“I’ve seen some of the really big positives, which is that kids who are isolated can find a community,” Oransky said. “They’re often first able to come out to online friends.” In a 2013 survey, 50 percent of LGBT youth \u003ca href=\"https://www.glsen.org/press/study-finds-lgbt-youth-face-greater-harassment-online\">reported\u003c/a> having at least one close friend they knew only from online interactions.\u003c/p>\n\u003cp>Young adults with serious mental illness such as schizophrenia and bipolar disorder can also \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/26744309\">find social support\u003c/a> via social media, according to a study published in 2016. “These people are openly discussing their illness online,” said \u003ca href=\"http://www.hprcd.org/john-naslund-mph/\">John Naslund\u003c/a>, a research fellow at the Dartmouth Institute for Health Policy and Clinical Practice.\u003c/p>\n\u003cp>Social media postings can help \u003ca href=\"https://link.springer.com/article/10.1007/s00127-013-0815-7\">foster greater acceptance\u003c/a> of mental health problems. “It’s definitely real that there’s hostility online,” Naslund said. “But we’ve found that comments related to mental health are overwhelmingly positive. People can learn how to cope with symptoms and how to find the right support.”\u003c/p>\n\u003cp>But parents can and should help their children use social media wisely, experts say. Oransky suggests, for instance, that parents talk with kids about the privacy consequences of posting compromising material, such as revealing pictures or personal details that might affect their job prospects. Naslund recommends that people start cautiously on social media by using pseudonyms.\u003c/p>\n\u003cp>Anna uses filters to keep co-workers from seeing her mental health posts. But she views social media as a way to act on her therapist’s recommendation to reach out for support when she needs it. “If you trust your friends,” she said, “I don’t see why you shouldn’t embrace the social media option.”\u003c/p>\n\u003cp>\u003cem>This story was produced by \u003ca href=\"https://khn.org/\">Kaiser Health News\u003c/a>, which publishes \u003ca href=\"http://www.californiahealthline.org/\">California Healthline\u003c/a>, an editorially independent service of the \u003ca href=\"http://www.chcf.org/\">California Health Care Foundation\u003c/a>.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>\u003ca href=\"http://www.kaiserhealthnews.org/\">Kaiser Health News\u003c/a> (KHN) is a national health policy news service. It is an editorially independent program of the \u003ca href=\"http://www.kff.org/\">Henry J. Kaiser Family Foundation\u003c/a>.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "California Now Recognizes a Third Gender",
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"content": "\u003cp>Gender is no longer either male or female, according to the state of California.\u003c/p>\n\u003caside class=\"pullquote alignright\">'It means that when somebody looks at my license, it's not going to be as confusing to them.'\u003c/aside>\n\u003cp>Gov. Jerry Brown on Sunday signed into law \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201720180SB179\" target=\"_blank\" rel=\"noopener\">legislation\u003c/a> that recognizes a third gender option. Starting Jan. 1, Californians will be able to apply to change their birth certificates from male or female to \"nonbinary.\" In 2019, Californians will be able to identify themselves as nonbinary on driver's licenses.\u003c/p>\n\u003cp>The bill was one of \u003ca href=\"https://www.gov.ca.gov/news.php?id=20027\" target=\"_blank\" rel=\"noopener\">many\u003c/a> Brown left to the last day of the Oct. 15 deadline to either sign or veto.\u003c/p>\n\u003cp>California joins Oregon and Washington D.C. in creating the third gender option on driver's licenses. New York state may \u003ca href=\"https://www.nbcnews.com/feature/nbc-out/lawmakers-new-york-d-c-propose-third-sex-driver-s-n774741\" target=\"_blank\" rel=\"noopener\">follow suit\u003c/a>. Unlike California, Oregon and Washington have not passed an actual law enacting the change, and neither accommodates a revision on birth certificates. \u003ca href=\"https://en.wikipedia.org/wiki/Legal_recognition_of_non-binary_gender\" target=\"_blank\" rel=\"noopener\">Countries\u003c/a> that recognize a third gender include Australia, Germany and India.\u003c/p>\n\u003cp>[contextly_sidebar id=\"KjrmGaNfPZB7ShxMWOYSoqqYzOWGS4B2\"]The legislation, \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201720180SB179\" target=\"_blank\" rel=\"noopener\">SB 179\u003c/a>, from state Sen. Toni Atkins (D-San Diego) and Scott Wiener (D-San Francisco), also rescinds the requirement that individuals who want to change their gender must submit a sworn statement from a physician declaring they have undergone clinical treatment. That change takes effect Sept. 1, 2018.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"With Governor Brown’s signature on this bill, transgender and non-binary people will now be able to identify themselves as they are, not as who society tells them they should be,\" said Wiener, in a statement.\u003c/p>\n\u003cp>The new law not only addresses the experience of inter-sex people — those individuals born with ambiguous sexual characteristics — but also codifies a \u003ca href=\"https://ww2.kqed.org/futureofyou/2017/04/24/boy-girl-both-neither-a-new-generation-overthrows-gender/\" target=\"_blank\" rel=\"noopener\">growing trend\u003c/a> among transgender youth who eschew a traditional gender identity, decoupling it from not only their innate physiology, but from the notion that only males and females exist.\u003c/p>\n\u003cp>A 2015 \u003ca href=\"http://www.ustranssurvey.org/report\" target=\"_blank\" rel=\"noopener\">survey\u003c/a> by the National Center for Transgender Equality found a third of the almost 28,000 respondents chose \"nonbinary/genderqueer” when given a choice of terms to best describe themselves.\u003c/p>\n\u003cp>\"The binary gender designations of female and male fail to adequately represent the diversity of human experience,\" SB 179 states. \"Nonbinary is an umbrella term for people with gender identities that fall somewhere outside of the traditional conceptions of strictly either female or male. \"\u003c/p>\n\u003cp>Courts in Oregon and California have already granted requests by residents to change their gender to a third type. In California, dozens of people have petitioned courts to make the change.\u003c/p>\n\u003cp>One person who will benefit from the law is Jak Kazmarek, a KQED employee who has identified as nonbinary for 17 years. Kazmarek uses the pronoun \"they\" instead of \"he\" or \"she,\" something many nonbinary people do to reflect a gender identification outside the traditional male or female.\u003c/p>\n\u003cp>Kazmarek says they were the 25th person in California to petition a court for a gender change to nonbinary, a request the court granted in May. But the change had no practical effect -- there is currently no option to list your gender as anything other than male or female on a driver's license.\u003c/p>\n\u003cp>\"Right now, when somebody looks at an ID and they look at me, they don't see female,\" Kazmarek said. \"They also don't see male, though. That exposes me to a lot of questions. It's a really vulnerable place to be.\"\u003c/p>\n\u003cp>Kazmarek said that the state's sanction of nonbinary identity is \"huge.\"\u003c/p>\n\u003cp>\"It means that when somebody looks at my license, it's not going to be as confusing to them.\"\u003c/p>\n\u003cp>Ending the requirement that a physician sign off on someone's change of gender will also have a big effect, Kazmarek said.\u003c/p>\n\u003cp>\"I've been very privileged because I live in an area where people support me. There's a lot of people that live in other areas where it's difficult to find a doctor that's willing to write that note.\"\u003c/p>\n\u003cp>Opposition to the bill has come mostly from \u003ca href=\"http://www.californiafamily.org/2017/gender-change-anti-religious-liberty-bills-nearing-final-approval-2/\" target=\"_blank\" rel=\"noopener\">Christian groups\u003c/a>. It did not appear to have much effect: The bill passed the Senate 26-12 and the Assembly 57-21.\u003c/p>\n\u003cp>The issue of whether or not to recognize a third gender is headed for a day of reckoning on the federal level, too. Last November, Colorado U.S. District Court Judge R. Brooke Jackson remanded the case of Dana Zzyym back to the U.S. State Department after Lambda Legal, on behalf of Zzyym, \u003ca href=\"https://www.lambdalegal.org/news/us_20151026_zzyym-intersex-denied-passport\" target=\"_blank\" rel=\"noopener\">sued\u003c/a> the department for denying Zzyym's application for a passport. The agency rejected the request because Zzyym did not choose male or female on the application.\u003c/p>\n\u003cp>“I find that the administrative record contains no evidence that the Department followed a rational decision-making process in deciding to implement its binary-only gender passport policy,\" Jackson wrote in his decision. \"Therefore, the proper next step is to remand the case to the Department to give it an opportunity either to shore up the record, if it can, or reconsider its policy.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>But the State Department declined Zzyym's application again, in May. The court then granted a motion to \u003ca href=\"https://www.washingtonpost.com/news/post-nation/wp/2017/06/28/a-navy-veteran-who-identifies-as-neither-male-nor-female-cant-get-a-passport-that-could-change/?utm_term=.26879130b6c5\" target=\"_blank\" rel=\"noopener\">reopen\u003c/a> the case.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Gender is no longer either male or female, according to the state of California.\u003c/p>\n\u003caside class=\"pullquote alignright\">'It means that when somebody looks at my license, it's not going to be as confusing to them.'\u003c/aside>\n\u003cp>Gov. Jerry Brown on Sunday signed into law \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201720180SB179\" target=\"_blank\" rel=\"noopener\">legislation\u003c/a> that recognizes a third gender option. Starting Jan. 1, Californians will be able to apply to change their birth certificates from male or female to \"nonbinary.\" In 2019, Californians will be able to identify themselves as nonbinary on driver's licenses.\u003c/p>\n\u003cp>The bill was one of \u003ca href=\"https://www.gov.ca.gov/news.php?id=20027\" target=\"_blank\" rel=\"noopener\">many\u003c/a> Brown left to the last day of the Oct. 15 deadline to either sign or veto.\u003c/p>\n\u003cp>California joins Oregon and Washington D.C. in creating the third gender option on driver's licenses. New York state may \u003ca href=\"https://www.nbcnews.com/feature/nbc-out/lawmakers-new-york-d-c-propose-third-sex-driver-s-n774741\" target=\"_blank\" rel=\"noopener\">follow suit\u003c/a>. Unlike California, Oregon and Washington have not passed an actual law enacting the change, and neither accommodates a revision on birth certificates. \u003ca href=\"https://en.wikipedia.org/wiki/Legal_recognition_of_non-binary_gender\" target=\"_blank\" rel=\"noopener\">Countries\u003c/a> that recognize a third gender include Australia, Germany and India.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>The legislation, \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201720180SB179\" target=\"_blank\" rel=\"noopener\">SB 179\u003c/a>, from state Sen. Toni Atkins (D-San Diego) and Scott Wiener (D-San Francisco), also rescinds the requirement that individuals who want to change their gender must submit a sworn statement from a physician declaring they have undergone clinical treatment. That change takes effect Sept. 1, 2018.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"With Governor Brown’s signature on this bill, transgender and non-binary people will now be able to identify themselves as they are, not as who society tells them they should be,\" said Wiener, in a statement.\u003c/p>\n\u003cp>The new law not only addresses the experience of inter-sex people — those individuals born with ambiguous sexual characteristics — but also codifies a \u003ca href=\"https://ww2.kqed.org/futureofyou/2017/04/24/boy-girl-both-neither-a-new-generation-overthrows-gender/\" target=\"_blank\" rel=\"noopener\">growing trend\u003c/a> among transgender youth who eschew a traditional gender identity, decoupling it from not only their innate physiology, but from the notion that only males and females exist.\u003c/p>\n\u003cp>A 2015 \u003ca href=\"http://www.ustranssurvey.org/report\" target=\"_blank\" rel=\"noopener\">survey\u003c/a> by the National Center for Transgender Equality found a third of the almost 28,000 respondents chose \"nonbinary/genderqueer” when given a choice of terms to best describe themselves.\u003c/p>\n\u003cp>\"The binary gender designations of female and male fail to adequately represent the diversity of human experience,\" SB 179 states. \"Nonbinary is an umbrella term for people with gender identities that fall somewhere outside of the traditional conceptions of strictly either female or male. \"\u003c/p>\n\u003cp>Courts in Oregon and California have already granted requests by residents to change their gender to a third type. In California, dozens of people have petitioned courts to make the change.\u003c/p>\n\u003cp>One person who will benefit from the law is Jak Kazmarek, a KQED employee who has identified as nonbinary for 17 years. Kazmarek uses the pronoun \"they\" instead of \"he\" or \"she,\" something many nonbinary people do to reflect a gender identification outside the traditional male or female.\u003c/p>\n\u003cp>Kazmarek says they were the 25th person in California to petition a court for a gender change to nonbinary, a request the court granted in May. But the change had no practical effect -- there is currently no option to list your gender as anything other than male or female on a driver's license.\u003c/p>\n\u003cp>\"Right now, when somebody looks at an ID and they look at me, they don't see female,\" Kazmarek said. \"They also don't see male, though. That exposes me to a lot of questions. It's a really vulnerable place to be.\"\u003c/p>\n\u003cp>Kazmarek said that the state's sanction of nonbinary identity is \"huge.\"\u003c/p>\n\u003cp>\"It means that when somebody looks at my license, it's not going to be as confusing to them.\"\u003c/p>\n\u003cp>Ending the requirement that a physician sign off on someone's change of gender will also have a big effect, Kazmarek said.\u003c/p>\n\u003cp>\"I've been very privileged because I live in an area where people support me. There's a lot of people that live in other areas where it's difficult to find a doctor that's willing to write that note.\"\u003c/p>\n\u003cp>Opposition to the bill has come mostly from \u003ca href=\"http://www.californiafamily.org/2017/gender-change-anti-religious-liberty-bills-nearing-final-approval-2/\" target=\"_blank\" rel=\"noopener\">Christian groups\u003c/a>. It did not appear to have much effect: The bill passed the Senate 26-12 and the Assembly 57-21.\u003c/p>\n\u003cp>The issue of whether or not to recognize a third gender is headed for a day of reckoning on the federal level, too. Last November, Colorado U.S. District Court Judge R. Brooke Jackson remanded the case of Dana Zzyym back to the U.S. State Department after Lambda Legal, on behalf of Zzyym, \u003ca href=\"https://www.lambdalegal.org/news/us_20151026_zzyym-intersex-denied-passport\" target=\"_blank\" rel=\"noopener\">sued\u003c/a> the department for denying Zzyym's application for a passport. The agency rejected the request because Zzyym did not choose male or female on the application.\u003c/p>\n\u003cp>“I find that the administrative record contains no evidence that the Department followed a rational decision-making process in deciding to implement its binary-only gender passport policy,\" Jackson wrote in his decision. \"Therefore, the proper next step is to remand the case to the Department to give it an opportunity either to shore up the record, if it can, or reconsider its policy.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>But the State Department declined Zzyym's application again, in May. The court then granted a motion to \u003ca href=\"https://www.washingtonpost.com/news/post-nation/wp/2017/06/28/a-navy-veteran-who-identifies-as-neither-male-nor-female-cant-get-a-passport-that-could-change/?utm_term=.26879130b6c5\" target=\"_blank\" rel=\"noopener\">reopen\u003c/a> the case.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Journalist Franklin Foer worries that we're all losing our minds as big tech companies infiltrate every aspect of our lives.\u003c/p>\n\u003cp>In his new book, \u003cem>World Without Mind: The Existential Threat of Big Tech\u003c/em>, Foer compares the way we feel about technology now to the way people felt about pre-made foods, like TV dinners, when they were first invented.\u003c/p>\n\u003cp>\"And we thought that they were brilliant because they did away with pots and pans — we didn't have to go to the store to go shopping every day — and then we woke up 50 years later and realize that these products had been basically engineered to make us fat,\" Foer says. \"And I worry that the same thing is happening now to the things that we ingest through our mind.\"\u003c/p>\n\u003chr>\n\u003ch3>Interview Highlights\u003c/h3>\n\u003cp>\u003cstrong>On why tech companies' control of the market is problematic \u003c/strong>\u003c/p>\n\u003cp>They pose as these neutral marketplaces, yet when they have their own things to sell, they give them special advantages. We saw this with Yelp and Google, where Yelp was this great way to get recommendations about what restaurant to go to, and it used to be when you type in a restaurant name into Google, the Yelp review was the first thing that came up. Well, Google saw that this was a good business to be in and so they started to publish their own user reviews of restaurants, and suddenly, those leap-frogged over Yelp.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>And so I think we accept these platforms as being neutral, they pose as neutral. Even if you look at their looks — a search engine seems like it's a mechanical thing, but it's not a mechanical thing. It imposes the economic interests of these companies on the platform, and it imposes their values on the platform as well.\u003c/p>\n\u003cp>\u003cstrong>On how tech companies' algorithms are not impartial \u003c/strong>\u003c/p>\n\u003cp>All these algorithms are constructed by human beings to serve human purposes. They're systems, and these systems are devised in order to create certain outcomes. And so the fact that they're so invisible, I think actually enhances their power because most people have the dimmest awareness, if any awareness at all, that Facebook is being patterned to try to give them some information above others.\u003c/p>\n\u003cp>Right now, Facebook is obsessed with promoting video because that's where money is to be had. So right now, Facebook is loading up your News Feed in order to give you much more video. And there are all these media companies — I bet NPR is one of them — that makes certain commitments to certain editorial processes and investments in certain editorial apparatus in order to achieve certain results on Facebook because Facebook brings a lot of traffic. It's where users are. And then when Facebook, somewhat capriciously, decides to change its strategy, it hurts all of the organizations that are dependent upon Facebook.\u003c/p>\n\u003cp>\u003cem>Disclosure: Facebook pays NPR and other leading news organizations to produce live video streams that run on the site.\u003c/em>\u003c/p>\n\u003cp>\u003cstrong>On why the threat of big tech companies is an existential one\u003c/strong>\u003c/p>\n\u003cp>If you're of a certain age, you have a good appreciation for the ways in which we've all become a little bit cyborg. I grew up using maps and having a sense of direction, and now I have a phone. I used to try to remember numbers, and now I ... can just call them up instantly. And that's great. But what's happening right now is that we're in a phase of human evolution where we're merging with machines.\u003c/p>\n\u003cp>It's not necessarily a bad thing, but we're not just merging with machines. We've been merging with tools since the beginning of human evolution and arguably, that's one of the things that makes us human beings. But what we're merging with [now] are machines that are run by companies that act as filters for the way in which we interact and process the world.\u003c/p>\n\u003cp>And so the values of those companies become our values. We become dependent on these companies in a way in which we've never really been dependent on companies before. And this could all work out in a utopian, beautiful sort of way, or it could unfold as a dystopian, sci-fi nightmare. And I just think that because the stakes are so high, we have to be extra skeptical.\u003c/p>\n\u003cp>\u003cstrong>On the lack of regulation to limit the influence of tech companies\u003c/strong>\u003c/p>\n\u003cp>The Internet was invented in an age when our entire approach to regulation has been extremely lax, and so you'd think, \"OK, there might be a law on the books that governs how these corporations can handle our data.\"\u003c/p>\n\u003cp>Well, you could kind of pull pieces of [legal] code ... that shows maybe instances where companies could potentially cross boundaries, but there really isn't a coherent approach that we have to regulating these companies, and so they have an incredible amount of freedom. ...\u003c/p>\n\u003cp>There's this proud American tradition of worrying about the power of communication companies. That going all the way back to the founding, we've tried to limit the power of monopolies that played a role in our democracy. And so even with the U.S. Postal Service to take the first communications monopoly in the United States, we didn't let them get into the telegraph business. And when Western Union got a monopoly in the telegraph business, we were careful not to let them get into telephony.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>And this extends even into our own era back up into the Clinton administration when they put pressure on Microsoft, and really hemmed them in it came to the browser. And were it not for the case that the United States brought against Microsoft, Google probably would've been strangled in its crib.\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=%27World+Without+Mind%27%3A+How+Tech+Companies+Pose+An+Existential+Threat&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Journalist Franklin Foer worries that we're all losing our minds as big tech companies infiltrate every aspect of our lives.\u003c/p>\n\u003cp>In his new book, \u003cem>World Without Mind: The Existential Threat of Big Tech\u003c/em>, Foer compares the way we feel about technology now to the way people felt about pre-made foods, like TV dinners, when they were first invented.\u003c/p>\n\u003cp>\"And we thought that they were brilliant because they did away with pots and pans — we didn't have to go to the store to go shopping every day — and then we woke up 50 years later and realize that these products had been basically engineered to make us fat,\" Foer says. \"And I worry that the same thing is happening now to the things that we ingest through our mind.\"\u003c/p>\n\u003chr>\n\u003ch3>Interview Highlights\u003c/h3>\n\u003cp>\u003cstrong>On why tech companies' control of the market is problematic \u003c/strong>\u003c/p>\n\u003cp>They pose as these neutral marketplaces, yet when they have their own things to sell, they give them special advantages. We saw this with Yelp and Google, where Yelp was this great way to get recommendations about what restaurant to go to, and it used to be when you type in a restaurant name into Google, the Yelp review was the first thing that came up. Well, Google saw that this was a good business to be in and so they started to publish their own user reviews of restaurants, and suddenly, those leap-frogged over Yelp.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>And so I think we accept these platforms as being neutral, they pose as neutral. Even if you look at their looks — a search engine seems like it's a mechanical thing, but it's not a mechanical thing. It imposes the economic interests of these companies on the platform, and it imposes their values on the platform as well.\u003c/p>\n\u003cp>\u003cstrong>On how tech companies' algorithms are not impartial \u003c/strong>\u003c/p>\n\u003cp>All these algorithms are constructed by human beings to serve human purposes. They're systems, and these systems are devised in order to create certain outcomes. And so the fact that they're so invisible, I think actually enhances their power because most people have the dimmest awareness, if any awareness at all, that Facebook is being patterned to try to give them some information above others.\u003c/p>\n\u003cp>Right now, Facebook is obsessed with promoting video because that's where money is to be had. So right now, Facebook is loading up your News Feed in order to give you much more video. And there are all these media companies — I bet NPR is one of them — that makes certain commitments to certain editorial processes and investments in certain editorial apparatus in order to achieve certain results on Facebook because Facebook brings a lot of traffic. It's where users are. And then when Facebook, somewhat capriciously, decides to change its strategy, it hurts all of the organizations that are dependent upon Facebook.\u003c/p>\n\u003cp>\u003cem>Disclosure: Facebook pays NPR and other leading news organizations to produce live video streams that run on the site.\u003c/em>\u003c/p>\n\u003cp>\u003cstrong>On why the threat of big tech companies is an existential one\u003c/strong>\u003c/p>\n\u003cp>If you're of a certain age, you have a good appreciation for the ways in which we've all become a little bit cyborg. I grew up using maps and having a sense of direction, and now I have a phone. I used to try to remember numbers, and now I ... can just call them up instantly. And that's great. But what's happening right now is that we're in a phase of human evolution where we're merging with machines.\u003c/p>\n\u003cp>It's not necessarily a bad thing, but we're not just merging with machines. We've been merging with tools since the beginning of human evolution and arguably, that's one of the things that makes us human beings. But what we're merging with [now] are machines that are run by companies that act as filters for the way in which we interact and process the world.\u003c/p>\n\u003cp>And so the values of those companies become our values. We become dependent on these companies in a way in which we've never really been dependent on companies before. And this could all work out in a utopian, beautiful sort of way, or it could unfold as a dystopian, sci-fi nightmare. And I just think that because the stakes are so high, we have to be extra skeptical.\u003c/p>\n\u003cp>\u003cstrong>On the lack of regulation to limit the influence of tech companies\u003c/strong>\u003c/p>\n\u003cp>The Internet was invented in an age when our entire approach to regulation has been extremely lax, and so you'd think, \"OK, there might be a law on the books that governs how these corporations can handle our data.\"\u003c/p>\n\u003cp>Well, you could kind of pull pieces of [legal] code ... that shows maybe instances where companies could potentially cross boundaries, but there really isn't a coherent approach that we have to regulating these companies, and so they have an incredible amount of freedom. ...\u003c/p>\n\u003cp>There's this proud American tradition of worrying about the power of communication companies. That going all the way back to the founding, we've tried to limit the power of monopolies that played a role in our democracy. And so even with the U.S. Postal Service to take the first communications monopoly in the United States, we didn't let them get into the telegraph business. And when Western Union got a monopoly in the telegraph business, we were careful not to let them get into telephony.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>And this extends even into our own era back up into the Clinton administration when they put pressure on Microsoft, and really hemmed them in it came to the browser. And were it not for the case that the United States brought against Microsoft, Google probably would've been strangled in its crib.\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=%27World+Without+Mind%27%3A+How+Tech+Companies+Pose+An+Existential+Threat&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>The House Ethics Committee said Thursday it was extending its review of Republican Rep. Chris Collins of New York, whose stock market trades prompted an advocacy group to request an investigation for possible violation of insider trading or conflict of interest.\u003c/p>\n\u003cp>Collins, who has denied any wrongdoing, was the largest shareholder of Australia's Innate Immunotherapeutics Limited and sat on the company's board of directors. Advocacy groups had said Collins sponsored legislation that could potentially benefit the company.\u003c/p>\n\u003cp>As part of its extension, the Ethics Committee also released the findings of the independent Office of Congressional Ethics. The OCE had referred the Collins case to the committee in July. Its 29-page report was made public for the first time.\u003c/p>\n\u003cp>The OCE reviewed three allegations:\u003c/p>\n\u003cp>— Collins may have shared material, nonpublic information about Innate Immunotherapeutics in the purchase of the company's stock.\u003cbr>\n— Collins attended a meeting at the National Institutes of Health in November 2013 and in that meeting requested an NIH employee meet with Innate employees to assist in drug trial designs.\u003cbr>\n— Collins may have purchased stock unavailable to the public and that was offered to him based on his status as a member of the House.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The OCE's board recommended the committee further review the first two allegations because there was \"substantial reason to believe\" Collins shared nonpublic information in the purchase of Innate stock and that he took official actions or requested official actions that would assist a single entity in which he had a significant financial interest.\u003c/p>\n\u003cp>The board recommended the dismissal of the allegation that Collins purchase discounted stock unavailable to the public and offered to him based on his status as a lawmaker.\u003c/p>\n\u003cp>\"Throughout my tenure in Congress I have followed all rules and ethical guidelines when it comes to my personal investments,\" Collins said upon the release of the OCE's report. \"I was elected to Congress based upon my success in the private sector, and my willingness to use that experience every day to facilitate an environment that creates economic opportunity and jobs.\"\u003c/p>\n\u003cp>Collins thanked the committee for its review in the case and \"for the tough work they do to hold all members of Congress accountable to the highest standards of conduct.\"\u003c/p>\n\u003cp>Innate Immunotherapeutics stock value has tanked by more than 94 percent during recent months and now trades for pennies a share. The company's prospects tanked after its multiple sclerosis drug failed to demonstrate a meaningful benefit for patients.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>A source close to the congressman, who spoke on condition of anonymity to discuss private actions, said Collins invested about $5 million in the company over the years and did not sell any of his shares.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The House Ethics Committee said Thursday it was extending its review of Republican Rep. Chris Collins of New York, whose stock market trades prompted an advocacy group to request an investigation for possible violation of insider trading or conflict of interest.\u003c/p>\n\u003cp>Collins, who has denied any wrongdoing, was the largest shareholder of Australia's Innate Immunotherapeutics Limited and sat on the company's board of directors. Advocacy groups had said Collins sponsored legislation that could potentially benefit the company.\u003c/p>\n\u003cp>As part of its extension, the Ethics Committee also released the findings of the independent Office of Congressional Ethics. The OCE had referred the Collins case to the committee in July. Its 29-page report was made public for the first time.\u003c/p>\n\u003cp>The OCE reviewed three allegations:\u003c/p>\n\u003cp>— Collins may have shared material, nonpublic information about Innate Immunotherapeutics in the purchase of the company's stock.\u003cbr>\n— Collins attended a meeting at the National Institutes of Health in November 2013 and in that meeting requested an NIH employee meet with Innate employees to assist in drug trial designs.\u003cbr>\n— Collins may have purchased stock unavailable to the public and that was offered to him based on his status as a member of the House.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The OCE's board recommended the committee further review the first two allegations because there was \"substantial reason to believe\" Collins shared nonpublic information in the purchase of Innate stock and that he took official actions or requested official actions that would assist a single entity in which he had a significant financial interest.\u003c/p>\n\u003cp>The board recommended the dismissal of the allegation that Collins purchase discounted stock unavailable to the public and offered to him based on his status as a lawmaker.\u003c/p>\n\u003cp>\"Throughout my tenure in Congress I have followed all rules and ethical guidelines when it comes to my personal investments,\" Collins said upon the release of the OCE's report. \"I was elected to Congress based upon my success in the private sector, and my willingness to use that experience every day to facilitate an environment that creates economic opportunity and jobs.\"\u003c/p>\n\u003cp>Collins thanked the committee for its review in the case and \"for the tough work they do to hold all members of Congress accountable to the highest standards of conduct.\"\u003c/p>\n\u003cp>Innate Immunotherapeutics stock value has tanked by more than 94 percent during recent months and now trades for pennies a share. The company's prospects tanked after its multiple sclerosis drug failed to demonstrate a meaningful benefit for patients.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>A source close to the congressman, who spoke on condition of anonymity to discuss private actions, said Collins invested about $5 million in the company over the years and did not sell any of his shares.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>In any given year, nearly 1 in 5 adults in the U.S. suffer from a mental illness, yet fewer than half of those suffering receive treatment.\u003c/p>\n\u003caside class=\"alignright\">Signs of depression in the human voice might help to diagnose mental health problems\n\u003cul>\n\u003cli>Speaking lower, flatter and softer\u003c/li>\n\u003cli>Sounding labored, with more pauses, starts and stops\u003c/li>\n\u003cli>Sounding strained or breathy\u003c/li>\n\u003c/ul>\n\u003c/aside>\n\u003cp>In an attempt to fill that gap, companies are developing digital technology to help doctors diagnose, monitor and treat psychiatric disorders.\u003c/p>\n\u003cp>The behavioral health startup Ellipsis Health, based in San Francisco, uses machine learning to analyze audio recordings of conversations between doctors and patients during exams. The software works as a screening tool to flag patients whose speech matches the voice patterns of depressed individuals, alerting clinicians to follow up with a full diagnostic interview.\u003c/p>\n\u003cp>Meanwhile, Boston's \u003ca href=\"http://www.cogitocorp.com/\" target=\"_blank\" rel=\"noopener\">Cogito\u003c/a> has developed an app to use metadata from patients' phones to alert health care providers about sudden changes in behavior that might be linked to mental health.\u003c/p>\n\u003cp>\u003cstrong>Difficulty of Diagnosis\u003c/strong>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>One reason for the lack of treatment for mental illness is that conditions like depression, anxiety and post‐traumatic stress disorder are difficult to diagnose.\u003c/p>\n\u003cp>There are no biological markers of mental illness that can be picked up in a blood test or a brain scan, so physicians must rely on patients’ self‐reports of their symptoms and on mental health questionnaires.\u003c/p>\n\u003cp>But self‐reporting and doctor observations can be highly subjective. Low energy, for example, can be a sign of depression, a normal response to a busy schedule, or an indicator of hypothyroidism. Subsequently, many physicians miss or misdiagnose psychiatric disorders; one \u003ca href=\"http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)60879-5/abstract\" target=\"_blank\" rel=\"noopener\">study \u003c/a>found that primary care doctors correctly identify depression in patients only 50 percent of the time.\u003c/p>\n\u003cp>However, there are a few consistent physiological changes that take place in the body when something is off in your brain. Some researchers think these types of changes could be used as objective flags for mental illness.\u003c/p>\n\u003cp>\u003cstrong>It’s Not What You Say, But How You Say It\u003c/strong>\u003c/p>\n\u003cp>When someone is depressed, their range of pitch and volume drop, so they tend to speak \u003ca href=\"http://ieeexplore.ieee.org/document/7117386/?reload=true\" target=\"_blank\" rel=\"noopener\">lower, flatter and softer\u003c/a>. Speech also sounds labored, with more pauses, starts and stops. Another key indicator is the tension or relaxation of the vocal cords, which can make speech sound strained or breathy. Too much tension or relaxation has been linked to depression and \u003ca href=\"http://ieeexplore.ieee.org/document/7384418/\" target=\"_blank\" rel=\"noopener\">suicide risk\u003c/a>. Depressed patients’ tongues and breath may also become uncoordinated, resulting in a slight slurring of speech.\u003c/p>\n\u003cp>These types of vocal traits — called paraverbal features — are detectable in other mental illnesses too, including bipolar and post‐traumatic stress disorder.\u003c/p>\n\u003cp>Researchers have been studying these different paraverbal patterns for over a decade, but they’ve only recently been able to make use of them with the rise of advanced computer analytics. Some of the qualities are noticeable to a trained ear, but others are more subtle.\u003c/p>\n\u003cp>Computer algorithms can pick up on differences in tone that a human might miss, and they can also quantify them. This technology helps clinicians track patients over time by comparing individuals to their own baselines, particularly important if a person has a naturally deep or breathy voice that is not indicative of depression.\u003c/p>\n\u003cp>“There’s no doubt that paraverbal features can be helpful in making clinical diagnoses,” says Danielle Ramo, an assistant professor of psychiatry at UCSF who is not affiliated with either company. “To the extent that machines are able to take advantage of paraverbal features in communication, that is a step forward in using machines to inform clinical diagnoses or treatment planning.”\u003c/p>\n\u003cp>Ellipsis used these vocal traits to create its tool. The program was initially trained by taking millions of conversations between nondepressed individuals and mining them for key features in speech patterns, such as pitch, cadence and enunciation. Data scientists then added conversations, data from mental health questionnaires and clinical information, all from depressed patients. That trained the software to identify vocal features indicative of depression.\u003c/p>\n\u003cp>One potential benefit of the Ellipsis program is that it could alert physicians if their patients may be depressed, even if that’s not the reason they went to the doctor in the first place.\u003c/p>\n\u003cp>“There are a lot of problems in the process of screening for mental health disorders,\" says Mark Richman, medical director of the Disease Management Program at Northwell Health, a health network in Long Island and New York City that is in talks with Ellipsis to use its program. \"Some of that has to do with limited sensitivity of the tools that are used to do that, some of it has to do with limited time to address and identify mental health disorders.”\u003c/p>\n\u003cp>Richman says he hopes a tool like the one from Ellipsis will help doctors catch patients who might otherwise fall through the cracks, but without taking up valuable face time in the exam room.\u003c/p>\n\u003cp>Ellipsis founder and CEO Mainul Mondal says that making doctor appointments more efficient was a key focus for the company.\u003c/p>\n\u003cp>“People like talking to their health teams. They feel loyalty\u003cbr>\nand the trust is there, and they’re already having the conversations,” he says.\u003c/p>\n\u003cp>By capturing and utilizing the conversation — with the patient’s consent — clinicians could screen every patient for depression without taking up extra time, following up with only those who are flagged as high risk.\u003c/p>\n\u003cp>Integrating the software into the normal flow of a doctor’s visit is the next step, says Elizabeth Shriberg, the Ellipsis chief scientific officer. Including Northwell, Ellipsis is now in talks with other large health care providers around the country to introduce the program into exam rooms, the company says.\u003c/p>\n\u003cp>\u003cstrong>Monitoring From Afar\u003c/strong>\u003c/p>\n\u003cp>Other physicians want to use voice and behavior analysis technology to learn more about what happens to patients when they’re \u003cem>outside\u003c/em> the exam room.\u003c/p>\n\u003cfigure id=\"attachment_436000\" class=\"wp-caption alignright\" style=\"max-width: 248px\">\u003ca href=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/10/companion-2-0-android-Home-1.png\">\u003cimg class=\"wp-image-436000 \" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/10/companion-2-0-android-Home-1-800x1422.png\" alt=\"\" width=\"248\" height=\"441\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/10/companion-2-0-android-Home-1-800x1422.png 800w, https://ww2.kqed.org/app/uploads/sites/13/2017/10/companion-2-0-android-Home-1-160x284.png 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/10/companion-2-0-android-Home-1-768x1365.png 768w, https://ww2.kqed.org/app/uploads/sites/13/2017/10/companion-2-0-android-Home-1-1020x1813.png 1020w, https://ww2.kqed.org/app/uploads/sites/13/2017/10/companion-2-0-android-Home-1-1180x2098.png 1180w, https://ww2.kqed.org/app/uploads/sites/13/2017/10/companion-2-0-android-Home-1-960x1707.png 960w, https://ww2.kqed.org/app/uploads/sites/13/2017/10/companion-2-0-android-Home-1-240x427.png 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/10/companion-2-0-android-Home-1-375x667.png 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/10/companion-2-0-android-Home-1-520x924.png 520w, https://ww2.kqed.org/app/uploads/sites/13/2017/10/companion-2-0-android-Home-1.png 1440w\" sizes=\"(max-width: 248px) 100vw, 248px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Image from the dashboard of Cogito's Companion app, meant to diagnose depression and other mental health conditions. \u003ccite>(Cogito)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“We often get data only when people come into a clinic … and we know that there's a lot that goes on, obviously, outside of the clinic walls,” says David Ahern, director of the program in Behavioral Informatics and eHealth at Brigham and Women’s Hospital in Boston. “It's this huge unmet need of both understanding the nature of a … mental health disorder as it evolves over time and the experience of patients over time.”\u003c/p>\n\u003cp>Ahern leads a \u003ca href=\"https://clinicaltrials.gov/ct2/show/NCT02167373?term=cogito&rank=1\" target=\"_blank\" rel=\"noopener\">clinical trial\u003c/a> testing the efficacy of Cogito's Companion app. Cogito was founded eight years ago as a spin-off from the MIT Media Lab in Boston. In addition to Companion, it makes software that gives real‐time feedback to customer call centers.\u003c/p>\n\u003cp>With patients' consent, the Companion app mines background metadata from their phone, including text frequency, call logs and geolocation. Using this data, the program creates a daily score for each patient, which is sent to their care team, alerting them if sudden changes in behavior might be linked to a decline in mental health. For example, if a patient starts to text less and has fewer or shorter calls, it may signal that they’re isolating themselves. Their caregiver can then reach out immediately to see if they are all right rather than having to wait until the next visit.\u003c/p>\n\u003cp>Patients also record a short audio diary a few times a week, which the app analyzes for nonverbal markers of depression, such as tenseness or breathiness, low pitch, volume or range. These results are also included in the patient’s daily score, giving the care team several objective measures of their mental state. In addition to depression, the app is also being \u003ca href=\"https://clinicaltrials.gov/ct2/show/NCT02742064?term=cogito&rank=2\" target=\"_blank\" rel=\"noopener\">tested\u003c/a> on patients with bipolar disorder and post‐traumatic disorder, with the goal of predicting the onset of acute psychiatric episodes and suicide risk.\u003c/p>\n\u003cp>Skyler Place, vice president of behavioral science at Cogito, says he hopes doctors will use the system to be more proactive, not just in patients’ mental health care, but in their overall quality of life. In another trial for veterans at risk for post‐traumatic stress disorder and suicide, clinicians were able to detect major lifestyle changes through the app, as when one person lost his job and another became homeless.\u003c/p>\n\u003cp>“While the original goal was suicide prevention, in addition to being able to capture that risk, it’s really able to provide an overall risk score for the veteran population, and the clinicians are able to then provide the right service to these veterans in the moment when they need them.”\u003c/p>\n\u003cp>\u003cstrong>Replacing Clinicians? Not so Fast\u003c/strong>\u003c/p>\n\u003cp>As with the adoption of many new technologies, users may be reasonably concerned about privacy. Both Cogito and Ellipsis say that all the proper precautions are taken to store and protect the data, and in many cases the content of the conversations or voice recordings is irrelevant and even discarded.\u003c/p>\n\u003cp>The voice screening software is also not perfect; Cogito’s is currently about 75 percent accurate at flagging mental illness\u003cstrong> \u003c/strong>as compared to clinical interviews with mental health professionals. Ellipsis declined to state how accurate its software is.\u003c/p>\n\u003cp>Adam Miner, a clinical psychologist and instructor at\u003cbr>\nStanford University, says that, “Clinicians regularly take into account patient's tone and vocal patterns when making diagnostic decisions. If a new technology can help measure, or compare patterns over time, there is the potential to add value.” However, he cautions, there are “risks in oversimplifying the complexity of medical diagnoses.”\u003c/p>\n\u003cp>The two companies were quick to emphasize that the technology is not a replacement for human clinicians, but simply an aid or tool, akin to a blood test or an electrocardiogram.\u003c/p>\n\u003cp>“It's a buddy for health teams,” says Mondal. “It is an adviser for behavioral health; you flag patients so health systems can intervene.” After a patient is flagged as needing additional attention, either before or after diagnosis, it is still up to the clinician to administer care, an interaction that hasn’t been disrupted by artificial intelligence.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>Yet.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>In any given year, nearly 1 in 5 adults in the U.S. suffer from a mental illness, yet fewer than half of those suffering receive treatment.\u003c/p>\n\u003caside class=\"alignright\">Signs of depression in the human voice might help to diagnose mental health problems\n\u003cul>\n\u003cli>Speaking lower, flatter and softer\u003c/li>\n\u003cli>Sounding labored, with more pauses, starts and stops\u003c/li>\n\u003cli>Sounding strained or breathy\u003c/li>\n\u003c/ul>\n\u003c/aside>\n\u003cp>In an attempt to fill that gap, companies are developing digital technology to help doctors diagnose, monitor and treat psychiatric disorders.\u003c/p>\n\u003cp>The behavioral health startup Ellipsis Health, based in San Francisco, uses machine learning to analyze audio recordings of conversations between doctors and patients during exams. The software works as a screening tool to flag patients whose speech matches the voice patterns of depressed individuals, alerting clinicians to follow up with a full diagnostic interview.\u003c/p>\n\u003cp>Meanwhile, Boston's \u003ca href=\"http://www.cogitocorp.com/\" target=\"_blank\" rel=\"noopener\">Cogito\u003c/a> has developed an app to use metadata from patients' phones to alert health care providers about sudden changes in behavior that might be linked to mental health.\u003c/p>\n\u003cp>\u003cstrong>Difficulty of Diagnosis\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>One reason for the lack of treatment for mental illness is that conditions like depression, anxiety and post‐traumatic stress disorder are difficult to diagnose.\u003c/p>\n\u003cp>There are no biological markers of mental illness that can be picked up in a blood test or a brain scan, so physicians must rely on patients’ self‐reports of their symptoms and on mental health questionnaires.\u003c/p>\n\u003cp>But self‐reporting and doctor observations can be highly subjective. Low energy, for example, can be a sign of depression, a normal response to a busy schedule, or an indicator of hypothyroidism. Subsequently, many physicians miss or misdiagnose psychiatric disorders; one \u003ca href=\"http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)60879-5/abstract\" target=\"_blank\" rel=\"noopener\">study \u003c/a>found that primary care doctors correctly identify depression in patients only 50 percent of the time.\u003c/p>\n\u003cp>However, there are a few consistent physiological changes that take place in the body when something is off in your brain. Some researchers think these types of changes could be used as objective flags for mental illness.\u003c/p>\n\u003cp>\u003cstrong>It’s Not What You Say, But How You Say It\u003c/strong>\u003c/p>\n\u003cp>When someone is depressed, their range of pitch and volume drop, so they tend to speak \u003ca href=\"http://ieeexplore.ieee.org/document/7117386/?reload=true\" target=\"_blank\" rel=\"noopener\">lower, flatter and softer\u003c/a>. Speech also sounds labored, with more pauses, starts and stops. Another key indicator is the tension or relaxation of the vocal cords, which can make speech sound strained or breathy. Too much tension or relaxation has been linked to depression and \u003ca href=\"http://ieeexplore.ieee.org/document/7384418/\" target=\"_blank\" rel=\"noopener\">suicide risk\u003c/a>. Depressed patients’ tongues and breath may also become uncoordinated, resulting in a slight slurring of speech.\u003c/p>\n\u003cp>These types of vocal traits — called paraverbal features — are detectable in other mental illnesses too, including bipolar and post‐traumatic stress disorder.\u003c/p>\n\u003cp>Researchers have been studying these different paraverbal patterns for over a decade, but they’ve only recently been able to make use of them with the rise of advanced computer analytics. Some of the qualities are noticeable to a trained ear, but others are more subtle.\u003c/p>\n\u003cp>Computer algorithms can pick up on differences in tone that a human might miss, and they can also quantify them. This technology helps clinicians track patients over time by comparing individuals to their own baselines, particularly important if a person has a naturally deep or breathy voice that is not indicative of depression.\u003c/p>\n\u003cp>“There’s no doubt that paraverbal features can be helpful in making clinical diagnoses,” says Danielle Ramo, an assistant professor of psychiatry at UCSF who is not affiliated with either company. “To the extent that machines are able to take advantage of paraverbal features in communication, that is a step forward in using machines to inform clinical diagnoses or treatment planning.”\u003c/p>\n\u003cp>Ellipsis used these vocal traits to create its tool. The program was initially trained by taking millions of conversations between nondepressed individuals and mining them for key features in speech patterns, such as pitch, cadence and enunciation. Data scientists then added conversations, data from mental health questionnaires and clinical information, all from depressed patients. That trained the software to identify vocal features indicative of depression.\u003c/p>\n\u003cp>One potential benefit of the Ellipsis program is that it could alert physicians if their patients may be depressed, even if that’s not the reason they went to the doctor in the first place.\u003c/p>\n\u003cp>“There are a lot of problems in the process of screening for mental health disorders,\" says Mark Richman, medical director of the Disease Management Program at Northwell Health, a health network in Long Island and New York City that is in talks with Ellipsis to use its program. \"Some of that has to do with limited sensitivity of the tools that are used to do that, some of it has to do with limited time to address and identify mental health disorders.”\u003c/p>\n\u003cp>Richman says he hopes a tool like the one from Ellipsis will help doctors catch patients who might otherwise fall through the cracks, but without taking up valuable face time in the exam room.\u003c/p>\n\u003cp>Ellipsis founder and CEO Mainul Mondal says that making doctor appointments more efficient was a key focus for the company.\u003c/p>\n\u003cp>“People like talking to their health teams. They feel loyalty\u003cbr>\nand the trust is there, and they’re already having the conversations,” he says.\u003c/p>\n\u003cp>By capturing and utilizing the conversation — with the patient’s consent — clinicians could screen every patient for depression without taking up extra time, following up with only those who are flagged as high risk.\u003c/p>\n\u003cp>Integrating the software into the normal flow of a doctor’s visit is the next step, says Elizabeth Shriberg, the Ellipsis chief scientific officer. Including Northwell, Ellipsis is now in talks with other large health care providers around the country to introduce the program into exam rooms, the company says.\u003c/p>\n\u003cp>\u003cstrong>Monitoring From Afar\u003c/strong>\u003c/p>\n\u003cp>Other physicians want to use voice and behavior analysis technology to learn more about what happens to patients when they’re \u003cem>outside\u003c/em> the exam room.\u003c/p>\n\u003cfigure id=\"attachment_436000\" class=\"wp-caption alignright\" style=\"max-width: 248px\">\u003ca href=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/10/companion-2-0-android-Home-1.png\">\u003cimg class=\"wp-image-436000 \" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/10/companion-2-0-android-Home-1-800x1422.png\" alt=\"\" width=\"248\" height=\"441\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/10/companion-2-0-android-Home-1-800x1422.png 800w, https://ww2.kqed.org/app/uploads/sites/13/2017/10/companion-2-0-android-Home-1-160x284.png 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/10/companion-2-0-android-Home-1-768x1365.png 768w, https://ww2.kqed.org/app/uploads/sites/13/2017/10/companion-2-0-android-Home-1-1020x1813.png 1020w, https://ww2.kqed.org/app/uploads/sites/13/2017/10/companion-2-0-android-Home-1-1180x2098.png 1180w, https://ww2.kqed.org/app/uploads/sites/13/2017/10/companion-2-0-android-Home-1-960x1707.png 960w, https://ww2.kqed.org/app/uploads/sites/13/2017/10/companion-2-0-android-Home-1-240x427.png 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/10/companion-2-0-android-Home-1-375x667.png 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/10/companion-2-0-android-Home-1-520x924.png 520w, https://ww2.kqed.org/app/uploads/sites/13/2017/10/companion-2-0-android-Home-1.png 1440w\" sizes=\"(max-width: 248px) 100vw, 248px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Image from the dashboard of Cogito's Companion app, meant to diagnose depression and other mental health conditions. \u003ccite>(Cogito)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“We often get data only when people come into a clinic … and we know that there's a lot that goes on, obviously, outside of the clinic walls,” says David Ahern, director of the program in Behavioral Informatics and eHealth at Brigham and Women’s Hospital in Boston. “It's this huge unmet need of both understanding the nature of a … mental health disorder as it evolves over time and the experience of patients over time.”\u003c/p>\n\u003cp>Ahern leads a \u003ca href=\"https://clinicaltrials.gov/ct2/show/NCT02167373?term=cogito&rank=1\" target=\"_blank\" rel=\"noopener\">clinical trial\u003c/a> testing the efficacy of Cogito's Companion app. Cogito was founded eight years ago as a spin-off from the MIT Media Lab in Boston. In addition to Companion, it makes software that gives real‐time feedback to customer call centers.\u003c/p>\n\u003cp>With patients' consent, the Companion app mines background metadata from their phone, including text frequency, call logs and geolocation. Using this data, the program creates a daily score for each patient, which is sent to their care team, alerting them if sudden changes in behavior might be linked to a decline in mental health. For example, if a patient starts to text less and has fewer or shorter calls, it may signal that they’re isolating themselves. Their caregiver can then reach out immediately to see if they are all right rather than having to wait until the next visit.\u003c/p>\n\u003cp>Patients also record a short audio diary a few times a week, which the app analyzes for nonverbal markers of depression, such as tenseness or breathiness, low pitch, volume or range. These results are also included in the patient’s daily score, giving the care team several objective measures of their mental state. In addition to depression, the app is also being \u003ca href=\"https://clinicaltrials.gov/ct2/show/NCT02742064?term=cogito&rank=2\" target=\"_blank\" rel=\"noopener\">tested\u003c/a> on patients with bipolar disorder and post‐traumatic disorder, with the goal of predicting the onset of acute psychiatric episodes and suicide risk.\u003c/p>\n\u003cp>Skyler Place, vice president of behavioral science at Cogito, says he hopes doctors will use the system to be more proactive, not just in patients’ mental health care, but in their overall quality of life. In another trial for veterans at risk for post‐traumatic stress disorder and suicide, clinicians were able to detect major lifestyle changes through the app, as when one person lost his job and another became homeless.\u003c/p>\n\u003cp>“While the original goal was suicide prevention, in addition to being able to capture that risk, it’s really able to provide an overall risk score for the veteran population, and the clinicians are able to then provide the right service to these veterans in the moment when they need them.”\u003c/p>\n\u003cp>\u003cstrong>Replacing Clinicians? Not so Fast\u003c/strong>\u003c/p>\n\u003cp>As with the adoption of many new technologies, users may be reasonably concerned about privacy. Both Cogito and Ellipsis say that all the proper precautions are taken to store and protect the data, and in many cases the content of the conversations or voice recordings is irrelevant and even discarded.\u003c/p>\n\u003cp>The voice screening software is also not perfect; Cogito’s is currently about 75 percent accurate at flagging mental illness\u003cstrong> \u003c/strong>as compared to clinical interviews with mental health professionals. Ellipsis declined to state how accurate its software is.\u003c/p>\n\u003cp>Adam Miner, a clinical psychologist and instructor at\u003cbr>\nStanford University, says that, “Clinicians regularly take into account patient's tone and vocal patterns when making diagnostic decisions. If a new technology can help measure, or compare patterns over time, there is the potential to add value.” However, he cautions, there are “risks in oversimplifying the complexity of medical diagnoses.”\u003c/p>\n\u003cp>The two companies were quick to emphasize that the technology is not a replacement for human clinicians, but simply an aid or tool, akin to a blood test or an electrocardiogram.\u003c/p>\n\u003cp>“It's a buddy for health teams,” says Mondal. “It is an adviser for behavioral health; you flag patients so health systems can intervene.” After a patient is flagged as needing additional attention, either before or after diagnosis, it is still up to the clinician to administer care, an interaction that hasn’t been disrupted by artificial intelligence.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>SAN DIEGO — Kerri De Nies received the news this spring from her son’s pediatrician: Her chubby-cheeked toddler had a rare brain disorder.\u003c/p>\n\u003cp>She’d never heard of the disease — adrenoleukodystrophy, or ALD — and she soon felt devastated and overwhelmed.\u003c/p>\n\u003caside class=\"pullquote alignright\">'If you pick it up in the early stages … you are at a much better place in terms of treating it effectively.'\u003ccite>Dr. Florian Eichler, Massachusetts General Hospital\u003c/cite>\u003c/aside>\n\u003cp>“I probably read everything you could possibly read online — every single website,” De Nies said as she cradled her son, Gregory Mac Phee. “It’s definitely hard to think about what could potentially happen. You think about the worst-case scenario.”\u003c/p>\n\u003cp>ALD is a \u003ca href=\"http://myelin.org/ald-adrenoleukodystrophy/\">brain disorder\u003c/a> depicted in the 1992 movie “Lorenzo’s Oil,” about a couple whose son became debilitated by the disease. The most serious form of the illness typically strikes boys between ages 4 and 10. Most are diagnosed too late for treatment to be successful, and they often die before their 10th birthday.\u003c/p>\n\u003cp>The more De Nies learned about ALD, the more she realized how fortunate she and Gregory were to have discovered it so early. Her son’s blood was tested when he was about 10 months old.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>California is one of only a handful of states nationwide that screens babies for the gene mutation that causes the disease — a test that dramatically increases Gregory’s chances of survival.\u003c/p>\n\u003caside class=\"pullquote alignright\">'It’s mind-boggling that not every state is testing.'\u003ccite>Kerri De Nies, mother of child with ALD\u003c/cite>\u003c/aside>\n\u003cp>The state began testing newborns for ALD in September 2016, seven months after the federal government added it to the list of recommended screenings. The testing included all babies born after February of that year.\u003c/p>\n\u003cp>“If you pick it up in the early stages … you are at a much better place in terms of treating it effectively,” said Florian Eichler, a neurologist at Massachusetts General Hospital. “That’s where the newborn screening is so important. It really helps you detect these boys at risk.”\u003c/p>\n\u003cp>Eichler said he has seen many families whose boys were diagnosed late. “Listening to families and their ordeal gives you a real sense of what this has done over generations and how much suffering could be prevented through the screening program,” he said.\u003c/p>\n\u003cp>New York was the first to begin screening, in 2013, followed last year by Connecticut and California. A few other states, including Pennsylvania and Minnesota, have since followed.\u003c/p>\n\u003cp>“It’s mind-boggling that not every state is testing,” said De Nies, who teaches children’s ballet in San Diego. “Families will not know until it could be too late for them.”\u003c/p>\n\u003cp>Advocates, including several moms who lost their sons to the disease, were instrumental in getting the \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140AB1559\">screening law\u003c/a> passed in California. Now they are continuing to lobby legislators and pushing health officials to add ALD to screening panels across the nation.\u003c/p>\n\u003cp>Janis Sherwood said that since her son Sawyer’s death from ALD, she has felt an urgency to educate doctors, families and others about the disease. In the past few years, she turned her attention to newborn screening. She believes that as California collects data on how the boys do in treatment, other states will follow. “I think that we are going to see a domino effect as we get more states on board,” she said.\u003c/p>\n\u003cp>About 1 in every 18,000 people have ALD. Of boys with the genetic defect, about 30 to 40 percent will develop the life-threatening form of the disease, which leads to vision, gait and memory problems — and eventually death. It destroys myelin, the protective surface that surrounds some nerve cells.\u003c/p>\n\u003cp>Technicians draw the blood of newborns in the hospital soon after they are born. In California, state law requires that the blood be tested for about 80 diseases, including cystic fibrosis, severe combined immunodeficiency and primary congenital hypothyroidism.\u003c/p>\n\u003cp>Around the nation, testing kits cost a hospital or birthing facility about $120, said Jeff Botkin, who heads the medical ethics division at the University of Utah. “This is an extraordinarily low cost for this number of tests,” he said in an email. The tests are typically covered by insurers or Medicaid.\u003c/p>\n\u003cp>Some conditions on the screening list are relatively common, but ALD is among the rare disorders the tests ferret out that can lead to serious health issues or even death if not detected and treated, Botkin said.\u003c/p>\n\u003cp>There is no answer to the question of how common a condition should be to merit spending health care dollars to test for it, Botkin said. But many of the conditions for which the federal government recommends screening are rare, which means they could affect 1 in 50,000 babies or fewer. “The major question is whether the condition is treatable,” Botkin said.\u003c/p>\n\u003cp>Both boys and girls get tested for ALD because they can both be carriers of the genetic defect and develop the less serious adult form of the disease. Only boys, however, develop the more serious, ultimately fatal, childhood disease.\u003c/p>\n\u003cp>When doctors know that boys have the mutation, they perform brain MRIs beginning when the boys are toddlers. If an MRI starts to show telltale changes in the brain, doctors can intervene to halt the progression of the disease.\u003c/p>\n\u003cp>The common treatment, a bone marrow transplant, is risky and complicated, but it is often successful if the donor is a good match and the procedure is performed before the children have visible symptoms, UCLA neurologist Raman Sankar said. Doctors are also having some success with gene therapy, in which the children undergo a transplant with their own stem cells rather than a donor’s, Sankar said.\u003c/p>\n\u003cp>The earlier the transplant, the better a child’s chance of survival, he said. “The delay may make the difference between whether he can have a lifesaving treatment or not.”\u003c/p>\n\u003cp>Before newborn screening, boys in the early stages of ALD frequently were incorrectly diagnosed with hyperactivity and other conditions, said Richard Olney, who heads the genetic disease screening program for the California public health department. “Many families had to go through a sort of diagnostic odyssey,” he said. “It only became clear as they developed progressively worse problems that they had a serious genetic condition.”\u003c/p>\n\u003cp>By the time a brain MRI was performed, there was often too much damage to save the child. That’s part of the challenge for clinicians who may not be familiar with ALD: “How do you know when this is a critical brain disease versus just a normal part of development?” Eichler said.\u003c/p>\n\u003cp>Those with the genetic mutation who do not develop the disease in childhood may still have a milder form as adults. People with the mutation also need to be monitored by an endocrinologist, because many will suffer from a condition in which their adrenal glands fail to produce enough of a stress hormone that is needed to fight infections.\u003c/p>\n\u003cp>Gina Cousineau’s 8-year-old son, Evan, was diagnosed with ALD in May 2007 after he came home from swim practice and had a seizure. Though he underwent a bone marrow transplant, Evan died from a secondary infection before he turned 9.\u003c/p>\n\u003cp>Cousineau lives in the southern Orange County city of San Clemente and helped lobby for the California law that requires ALD screening. She said newborn testing benefits infants with ALD and can help families discover that siblings or other relatives have the gene mutation.\u003c/p>\n\u003cp>“Thank God this newborn screening came into effect,” Cousineau said. “Knowledge is power. Had I had the knowledge with my son, Evan, he would be alive today.”\u003c/p>\n\u003cp>De Nies said she worries about Gregory’s future, but she’s confident her son will live a long life. And she credits Cousineau and other mothers whose sons didn’t have the same chance.\u003c/p>\n\u003cp>“Without them, we would never know about the gene mutation,” she said. “I just feel like they are our fairy godmothers.”\u003c/p>\n\u003cp>This story was produced by \u003ca href=\"http://khn.org/\">Kaiser Health News\u003c/a>, an editorially independent program of the \u003ca href=\"http://kff.org/\">Kaiser Family Foundation\u003c/a>.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>\u003ca href=\"http://www.kaiserhealthnews.org/\">Kaiser Health News\u003c/a> (KHN) is a national health policy news service. It is an editorially independent program of the \u003ca href=\"http://www.kff.org/\">Henry J. Kaiser Family Foundation\u003c/a>.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>SAN DIEGO — Kerri De Nies received the news this spring from her son’s pediatrician: Her chubby-cheeked toddler had a rare brain disorder.\u003c/p>\n\u003cp>She’d never heard of the disease — adrenoleukodystrophy, or ALD — and she soon felt devastated and overwhelmed.\u003c/p>\n\u003caside class=\"pullquote alignright\">'If you pick it up in the early stages … you are at a much better place in terms of treating it effectively.'\u003ccite>Dr. Florian Eichler, Massachusetts General Hospital\u003c/cite>\u003c/aside>\n\u003cp>“I probably read everything you could possibly read online — every single website,” De Nies said as she cradled her son, Gregory Mac Phee. “It’s definitely hard to think about what could potentially happen. You think about the worst-case scenario.”\u003c/p>\n\u003cp>ALD is a \u003ca href=\"http://myelin.org/ald-adrenoleukodystrophy/\">brain disorder\u003c/a> depicted in the 1992 movie “Lorenzo’s Oil,” about a couple whose son became debilitated by the disease. The most serious form of the illness typically strikes boys between ages 4 and 10. Most are diagnosed too late for treatment to be successful, and they often die before their 10th birthday.\u003c/p>\n\u003cp>The more De Nies learned about ALD, the more she realized how fortunate she and Gregory were to have discovered it so early. Her son’s blood was tested when he was about 10 months old.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>California is one of only a handful of states nationwide that screens babies for the gene mutation that causes the disease — a test that dramatically increases Gregory’s chances of survival.\u003c/p>\n\u003caside class=\"pullquote alignright\">'It’s mind-boggling that not every state is testing.'\u003ccite>Kerri De Nies, mother of child with ALD\u003c/cite>\u003c/aside>\n\u003cp>The state began testing newborns for ALD in September 2016, seven months after the federal government added it to the list of recommended screenings. The testing included all babies born after February of that year.\u003c/p>\n\u003cp>“If you pick it up in the early stages … you are at a much better place in terms of treating it effectively,” said Florian Eichler, a neurologist at Massachusetts General Hospital. “That’s where the newborn screening is so important. It really helps you detect these boys at risk.”\u003c/p>\n\u003cp>Eichler said he has seen many families whose boys were diagnosed late. “Listening to families and their ordeal gives you a real sense of what this has done over generations and how much suffering could be prevented through the screening program,” he said.\u003c/p>\n\u003cp>New York was the first to begin screening, in 2013, followed last year by Connecticut and California. A few other states, including Pennsylvania and Minnesota, have since followed.\u003c/p>\n\u003cp>“It’s mind-boggling that not every state is testing,” said De Nies, who teaches children’s ballet in San Diego. “Families will not know until it could be too late for them.”\u003c/p>\n\u003cp>Advocates, including several moms who lost their sons to the disease, were instrumental in getting the \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140AB1559\">screening law\u003c/a> passed in California. Now they are continuing to lobby legislators and pushing health officials to add ALD to screening panels across the nation.\u003c/p>\n\u003cp>Janis Sherwood said that since her son Sawyer’s death from ALD, she has felt an urgency to educate doctors, families and others about the disease. In the past few years, she turned her attention to newborn screening. She believes that as California collects data on how the boys do in treatment, other states will follow. “I think that we are going to see a domino effect as we get more states on board,” she said.\u003c/p>\n\u003cp>About 1 in every 18,000 people have ALD. Of boys with the genetic defect, about 30 to 40 percent will develop the life-threatening form of the disease, which leads to vision, gait and memory problems — and eventually death. It destroys myelin, the protective surface that surrounds some nerve cells.\u003c/p>\n\u003cp>Technicians draw the blood of newborns in the hospital soon after they are born. In California, state law requires that the blood be tested for about 80 diseases, including cystic fibrosis, severe combined immunodeficiency and primary congenital hypothyroidism.\u003c/p>\n\u003cp>Around the nation, testing kits cost a hospital or birthing facility about $120, said Jeff Botkin, who heads the medical ethics division at the University of Utah. “This is an extraordinarily low cost for this number of tests,” he said in an email. The tests are typically covered by insurers or Medicaid.\u003c/p>\n\u003cp>Some conditions on the screening list are relatively common, but ALD is among the rare disorders the tests ferret out that can lead to serious health issues or even death if not detected and treated, Botkin said.\u003c/p>\n\u003cp>There is no answer to the question of how common a condition should be to merit spending health care dollars to test for it, Botkin said. But many of the conditions for which the federal government recommends screening are rare, which means they could affect 1 in 50,000 babies or fewer. “The major question is whether the condition is treatable,” Botkin said.\u003c/p>\n\u003cp>Both boys and girls get tested for ALD because they can both be carriers of the genetic defect and develop the less serious adult form of the disease. Only boys, however, develop the more serious, ultimately fatal, childhood disease.\u003c/p>\n\u003cp>When doctors know that boys have the mutation, they perform brain MRIs beginning when the boys are toddlers. If an MRI starts to show telltale changes in the brain, doctors can intervene to halt the progression of the disease.\u003c/p>\n\u003cp>The common treatment, a bone marrow transplant, is risky and complicated, but it is often successful if the donor is a good match and the procedure is performed before the children have visible symptoms, UCLA neurologist Raman Sankar said. Doctors are also having some success with gene therapy, in which the children undergo a transplant with their own stem cells rather than a donor’s, Sankar said.\u003c/p>\n\u003cp>The earlier the transplant, the better a child’s chance of survival, he said. “The delay may make the difference between whether he can have a lifesaving treatment or not.”\u003c/p>\n\u003cp>Before newborn screening, boys in the early stages of ALD frequently were incorrectly diagnosed with hyperactivity and other conditions, said Richard Olney, who heads the genetic disease screening program for the California public health department. “Many families had to go through a sort of diagnostic odyssey,” he said. “It only became clear as they developed progressively worse problems that they had a serious genetic condition.”\u003c/p>\n\u003cp>By the time a brain MRI was performed, there was often too much damage to save the child. That’s part of the challenge for clinicians who may not be familiar with ALD: “How do you know when this is a critical brain disease versus just a normal part of development?” Eichler said.\u003c/p>\n\u003cp>Those with the genetic mutation who do not develop the disease in childhood may still have a milder form as adults. People with the mutation also need to be monitored by an endocrinologist, because many will suffer from a condition in which their adrenal glands fail to produce enough of a stress hormone that is needed to fight infections.\u003c/p>\n\u003cp>Gina Cousineau’s 8-year-old son, Evan, was diagnosed with ALD in May 2007 after he came home from swim practice and had a seizure. Though he underwent a bone marrow transplant, Evan died from a secondary infection before he turned 9.\u003c/p>\n\u003cp>Cousineau lives in the southern Orange County city of San Clemente and helped lobby for the California law that requires ALD screening. She said newborn testing benefits infants with ALD and can help families discover that siblings or other relatives have the gene mutation.\u003c/p>\n\u003cp>“Thank God this newborn screening came into effect,” Cousineau said. “Knowledge is power. Had I had the knowledge with my son, Evan, he would be alive today.”\u003c/p>\n\u003cp>De Nies said she worries about Gregory’s future, but she’s confident her son will live a long life. And she credits Cousineau and other mothers whose sons didn’t have the same chance.\u003c/p>\n\u003cp>“Without them, we would never know about the gene mutation,” she said. “I just feel like they are our fairy godmothers.”\u003c/p>\n\u003cp>This story was produced by \u003ca href=\"http://khn.org/\">Kaiser Health News\u003c/a>, an editorially independent program of the \u003ca href=\"http://kff.org/\">Kaiser Family Foundation\u003c/a>.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"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.",
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"soldout": {
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"title": "SOLD OUT: Rethinking Housing in America",
"tagline": "A new future for housing",
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