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"content": "\u003cp>People with a brain injury or dementia often struggle to remember simple things, like names or places. In research published recently in the journal \u003cem>Current Biology, \u003c/em>scientists have shown it may be possible to improve this sort of memory using tiny pulses of electricity — if they're properly timed.\u003c/p>\n\u003cp>A typical person's ability to remember things tends to vary a lot, says \u003ca href=\"http://memory.psych.upenn.edu/Michael_J._Kahana\">Michael Kahana,\u003c/a> who directs the computational memory lab at the University of Pennsylvania.\u003c/p>\n\u003cp>\"Some days we're at the top of our game,\" he says, \"and some days we're just off our game.\"\u003c/p>\n\u003cp>That's also true for people whose memory has been impaired — by a brain injury or disease. So Kahana wondered whether there might be some way to help these people perform at their peak level all the time.\u003c/p>\n\u003cp>\"If they could just move their game up so that every day was their best day, then it would really significantly change their quality of life,\" Kahana says.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>He and a team of researchers thought they might be able to do this by stimulating memory circuits in the brain. They tried the approach with a group of patients who had severe epilepsy.\u003c/p>\n\u003cp>These people already had electrodes temporarily implanted in their brains as part of their treatment. And that gave the scientists a way to deliver tiny pulses of electricity to areas deep in the brain.\u003c/p>\n\u003cp>Unfortunately, Kahana says, the stimulation made things worse.\u003c/p>\n\u003cp>\"Not only were we not able to enhance memory,\" he says, \"but we actually reliably and consistently \u003cem>impaired\u003c/em> memory in those patients.\"\u003c/p>\n\u003cp>So the team began studying more epilepsy patients to figure out why. This time, though, they used the electrodes to monitor brain activity as the volunteers did memory tasks — and the scientists were able to identify electrical patterns that predicted whether a person was going to remember something or not.\u003c/p>\n\u003cp>Then, the team tried another stimulation experiment, and this one yielded a breakthrough.\u003c/p>\n\u003cp>\"When memory was predicted to be poor,\" he explains, \"brain stimulation enhanced memory, and when it was predicted to be good, brain stimulation impaired memory.\"\u003c/p>\n\u003cp>In other words, on a bad memory day, stimulation helped. On a good day, it hurt.\u003c/p>\n\u003cp>When stimulation was delivered to the right place at the right time, the researchers found, it could improve memory performance among the patients by as much as 50 percent.\u003c/p>\n\u003cp>The research was funded by the Defense Advanced Research Projects Agency or \u003ca href=\"http://www.npr.org/2017/03/28/521779864/inside-darpa-the-pentagon-agency-whose-technology-has-changed-the-world\">DARPA\u003c/a>. Several years ago, DARPA launched an ambitious effort to help the troops who were returning from Iraq and Afghanistan with memory problems caused by \u003ca href=\"https://www.cdc.gov/traumaticbraininjury/\">traumatic brain injuries\u003c/a>.\u003c/p>\n\u003cp>\u003ca href=\"http://www.darpa.mil/staff/dr-justin-sanchez\">Justin Sanchez\u003c/a>, who is in charge of the program, says Kahana's work shows DARPA's investment is paying off.\u003c/p>\n\u003cp>\"When I first heard about these results, my mind was absolutely blown,\" Sanchez says. \"It's like the impossible happened.\"\u003c/p>\n\u003cp>A medical device based on this research could eventually do for an injured brain what a prosthetic limb does for an injured body, he says. There's a long research road ahead — brain stimulation still has way to go, before it can be proved useful as a memory aid. But it's a start.\u003c/p>\n\u003cp>\"Over 270,000 military personnel are living with traumatic brain injuries and the options for them are very few,\" Sanchez says. Now we can offer them some hope for the future.\"\u003c/p>\n\u003cp>And if the approach pans out, it might help people with a wide range of memory problems, Kahana suggests.\u003c/p>\n\u003cp>\"Traumatic brain injury is certainly high on our list,\" he says. \"But we're also thinking very much about Alzheimer's disease and the other dementias that affect memory.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Alzheimer's alone affects more than 5 million Americans.\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=Electrical+Stimulation+To+Boost+Memory%3A+Maybe+It%27s+All+In+The+Timing&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>He and a team of researchers thought they might be able to do this by stimulating memory circuits in the brain. They tried the approach with a group of patients who had severe epilepsy.\u003c/p>\n\u003cp>These people already had electrodes temporarily implanted in their brains as part of their treatment. And that gave the scientists a way to deliver tiny pulses of electricity to areas deep in the brain.\u003c/p>\n\u003cp>Unfortunately, Kahana says, the stimulation made things worse.\u003c/p>\n\u003cp>\"Not only were we not able to enhance memory,\" he says, \"but we actually reliably and consistently \u003cem>impaired\u003c/em> memory in those patients.\"\u003c/p>\n\u003cp>So the team began studying more epilepsy patients to figure out why. This time, though, they used the electrodes to monitor brain activity as the volunteers did memory tasks — and the scientists were able to identify electrical patterns that predicted whether a person was going to remember something or not.\u003c/p>\n\u003cp>Then, the team tried another stimulation experiment, and this one yielded a breakthrough.\u003c/p>\n\u003cp>\"When memory was predicted to be poor,\" he explains, \"brain stimulation enhanced memory, and when it was predicted to be good, brain stimulation impaired memory.\"\u003c/p>\n\u003cp>In other words, on a bad memory day, stimulation helped. On a good day, it hurt.\u003c/p>\n\u003cp>When stimulation was delivered to the right place at the right time, the researchers found, it could improve memory performance among the patients by as much as 50 percent.\u003c/p>\n\u003cp>The research was funded by the Defense Advanced Research Projects Agency or \u003ca href=\"http://www.npr.org/2017/03/28/521779864/inside-darpa-the-pentagon-agency-whose-technology-has-changed-the-world\">DARPA\u003c/a>. Several years ago, DARPA launched an ambitious effort to help the troops who were returning from Iraq and Afghanistan with memory problems caused by \u003ca href=\"https://www.cdc.gov/traumaticbraininjury/\">traumatic brain injuries\u003c/a>.\u003c/p>\n\u003cp>\u003ca href=\"http://www.darpa.mil/staff/dr-justin-sanchez\">Justin Sanchez\u003c/a>, who is in charge of the program, says Kahana's work shows DARPA's investment is paying off.\u003c/p>\n\u003cp>\"When I first heard about these results, my mind was absolutely blown,\" Sanchez says. \"It's like the impossible happened.\"\u003c/p>\n\u003cp>A medical device based on this research could eventually do for an injured brain what a prosthetic limb does for an injured body, he says. There's a long research road ahead — brain stimulation still has way to go, before it can be proved useful as a memory aid. But it's a start.\u003c/p>\n\u003cp>\"Over 270,000 military personnel are living with traumatic brain injuries and the options for them are very few,\" Sanchez says. Now we can offer them some hope for the future.\"\u003c/p>\n\u003cp>And if the approach pans out, it might help people with a wide range of memory problems, Kahana suggests.\u003c/p>\n\u003cp>\"Traumatic brain injury is certainly high on our list,\" he says. \"But we're also thinking very much about Alzheimer's disease and the other dementias that affect memory.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Alzheimer's alone affects more than 5 million Americans.\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=Electrical+Stimulation+To+Boost+Memory%3A+Maybe+It%27s+All+In+The+Timing&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Scientists have come up with a way to translate your DNA into a potential risk factor for developing the most common form of dementia, late-onset Alzheimer’s.\u003c/p>\n\u003cp>As you might guess from its name, this form of dementia is very age-dependent. Our risk for developing the disease increases as we get older.\u003c/p>\n\u003cp>But not everyone has the same level of risk, and numerous studies (reviewed \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/27943641\">here\u003c/a>) have shown that genetics plays a big role.\u003c/p>\n\u003cp>In a recent \u003ca href=\"http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002258\">study\u003c/a> published in PLOS Medicine, a group of researchers were able to identify the most telling DNA markers associated with late-onset Alzheimer’s.\u003c/p>\n\u003cp>A DNA marker is a location in someone’s DNA associated with a trait. The researchers, from the University of California, San Francisco, UC San Diego and other institutions, found multiple pieces of DNA associated with either an increased or decreased risk for late-onset Alzheimer's.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The researchers compared the DNA of 17,008 people with and 37,154 people without Alzheimer's to create, for the first time, what's called a polygenic hazard score for late-onset Alzheimer's. This means they calculated the risk based on multiple DNA markers -- 32, to be exact -- rather than a single marker.\u003c/p>\n\u003cp>They then tested their new predictors on thousands of other Alzheimer’s patients as well as older people who did not have the disease, and found that the tool worked well for predicting when people of European descent would develop the disease.\u003c/p>\n\u003cp>While this method will not provide each person with a definitive answer as to their risk for late-onset Alzheimer's, it is the most promising predictor to date.\u003c/p>\n\u003cp>\u003cstrong>How the Science Works \u003c/strong>\u003c/p>\n\u003cp>The tool's risk estimate is derived from the sum of someone's DNA markers. So maybe you have an increased risk from marker 1, a decreased risk from marker 2, and so on.\u003c/p>\n\u003cp>Here’s what this might mean for a 65-year-old woman with no signs of dementia. According to the study, if she has a high-risk set of DNA with regard to late-onset Alzheimer’s, then she has around a 20 percent chance of developing the disease by age 85 and a whopping 90 percent chance by age 95.\u003c/p>\n\u003cp>If this same woman had been lucky enough to be born with a protective set of DNA, then her risk by age 85 would be less than 1 percent, and her risk by age 95 a bit under 3 percent.\u003c/p>\n\u003cp>These are the extremes. For the vast majority of people who reach age 65 without any symptoms, the range for getting late-onset Alzheimer’s by age 85 is 1.5 to 5 percent and by age 95, 6 to 22 percent.\u003c/p>\n\u003cp>Scientists have been relying on just a few DNA markers to estimate late-onset Alzheimer's risk. The most useful are the DNA markers in the APOE gene (APOE2, APOE3, and APOE4). These markers form the basis of the new FDA-approved, direct to consumer genetic test offered by \u003ca href=\"https://futurism.com/23andme-can-now-tell-you-if-your-dna-puts-you-at-a-higher-risk-for-diseases/\">23andMe\u003c/a>.\u003c/p>\n\u003cp>\u003cstrong>DNA is Not Destiny\u003c/strong>\u003c/p>\n\u003cp>It is important to keep in mind that none of this means someone will develop Alzheimer’s or be protected from it. These DNA markers just indicate someone is more or less likely to get Alzheimer’s. Even in the highest risk group, around 80 percent of those who do not get Alzheimer’s by age 65 still won’t have it by 85.\u003c/p>\n\u003cp>It is also important to note that in its current form, the researchers do not know how accurate this tool is for people who are not of European descent. There were not enough non-white people in the study to determine if the same DNA markers affect their risk similarly. Follow-up studies are needed to determine if this genetic predictor works for them or if it will need to be tweaked.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Dr. Barry Starr is a scientist in the\u003ca href=\"https://med.stanford.edu/genetics.html\"> Department of Genetics\u003c/a> at Stanford University. He runs the\u003ca href=\"https://med.stanford.edu/genetics/tech.html\"> Stanford at The Tech\u003c/a> program and the\u003ca href=\"http://genetics.thetech.org/\"> Understanding Genetics\u003c/a> website with\u003ca href=\"https://www.thetech.org/\"> The Tech Museum of Innovation\u003c/a> in San Jose, California. \u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Scientists have come up with a way to translate your DNA into a potential risk factor for developing the most common form of dementia, late-onset Alzheimer’s.\u003c/p>\n\u003cp>As you might guess from its name, this form of dementia is very age-dependent. Our risk for developing the disease increases as we get older.\u003c/p>\n\u003cp>But not everyone has the same level of risk, and numerous studies (reviewed \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/27943641\">here\u003c/a>) have shown that genetics plays a big role.\u003c/p>\n\u003cp>In a recent \u003ca href=\"http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002258\">study\u003c/a> published in PLOS Medicine, a group of researchers were able to identify the most telling DNA markers associated with late-onset Alzheimer’s.\u003c/p>\n\u003cp>A DNA marker is a location in someone’s DNA associated with a trait. The researchers, from the University of California, San Francisco, UC San Diego and other institutions, found multiple pieces of DNA associated with either an increased or decreased risk for late-onset Alzheimer's.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The researchers compared the DNA of 17,008 people with and 37,154 people without Alzheimer's to create, for the first time, what's called a polygenic hazard score for late-onset Alzheimer's. This means they calculated the risk based on multiple DNA markers -- 32, to be exact -- rather than a single marker.\u003c/p>\n\u003cp>They then tested their new predictors on thousands of other Alzheimer’s patients as well as older people who did not have the disease, and found that the tool worked well for predicting when people of European descent would develop the disease.\u003c/p>\n\u003cp>While this method will not provide each person with a definitive answer as to their risk for late-onset Alzheimer's, it is the most promising predictor to date.\u003c/p>\n\u003cp>\u003cstrong>How the Science Works \u003c/strong>\u003c/p>\n\u003cp>The tool's risk estimate is derived from the sum of someone's DNA markers. So maybe you have an increased risk from marker 1, a decreased risk from marker 2, and so on.\u003c/p>\n\u003cp>Here’s what this might mean for a 65-year-old woman with no signs of dementia. According to the study, if she has a high-risk set of DNA with regard to late-onset Alzheimer’s, then she has around a 20 percent chance of developing the disease by age 85 and a whopping 90 percent chance by age 95.\u003c/p>\n\u003cp>If this same woman had been lucky enough to be born with a protective set of DNA, then her risk by age 85 would be less than 1 percent, and her risk by age 95 a bit under 3 percent.\u003c/p>\n\u003cp>These are the extremes. For the vast majority of people who reach age 65 without any symptoms, the range for getting late-onset Alzheimer’s by age 85 is 1.5 to 5 percent and by age 95, 6 to 22 percent.\u003c/p>\n\u003cp>Scientists have been relying on just a few DNA markers to estimate late-onset Alzheimer's risk. The most useful are the DNA markers in the APOE gene (APOE2, APOE3, and APOE4). These markers form the basis of the new FDA-approved, direct to consumer genetic test offered by \u003ca href=\"https://futurism.com/23andme-can-now-tell-you-if-your-dna-puts-you-at-a-higher-risk-for-diseases/\">23andMe\u003c/a>.\u003c/p>\n\u003cp>\u003cstrong>DNA is Not Destiny\u003c/strong>\u003c/p>\n\u003cp>It is important to keep in mind that none of this means someone will develop Alzheimer’s or be protected from it. These DNA markers just indicate someone is more or less likely to get Alzheimer’s. Even in the highest risk group, around 80 percent of those who do not get Alzheimer’s by age 65 still won’t have it by 85.\u003c/p>\n\u003cp>It is also important to note that in its current form, the researchers do not know how accurate this tool is for people who are not of European descent. There were not enough non-white people in the study to determine if the same DNA markers affect their risk similarly. Follow-up studies are needed to determine if this genetic predictor works for them or if it will need to be tweaked.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Dr. Barry Starr is a scientist in the\u003ca href=\"https://med.stanford.edu/genetics.html\"> Department of Genetics\u003c/a> at Stanford University. He runs the\u003ca href=\"https://med.stanford.edu/genetics/tech.html\"> Stanford at The Tech\u003c/a> program and the\u003ca href=\"http://genetics.thetech.org/\"> Understanding Genetics\u003c/a> website with\u003ca href=\"https://www.thetech.org/\"> The Tech Museum of Innovation\u003c/a> in San Jose, California. \u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>A selfie reveals more than whether it's a good hair day. Facial lines and contours, droops and dark spots could indicate how well you're aging, and, when paired with other data, could someday help determine whether you qualify for life insurance.\u003c/p>\n\u003caside class=\"pullquote alignright\">'Your face is something you wear all your life, and it tells a very unique story about you.'\u003c/aside>\n\u003cp>\"Your face is something you wear all your life, and it tells a very unique story about you,\" says Karl Ricanek Jr., co-founder and chief data scientist at Lapetus Solutions Inc. in Wilmington, North Carolina.\u003c/p>\n\u003cp>Several life insurance companies are testing Lapetus technology that uses facial analytics and other data to estimate life expectancy, he says. (Lapetus would not disclose the names of companies testing its product.) Insurers use life expectancy estimates to make policy approval and pricing decisions. Lapetus says its product, Chronos, would enable a customer to buy life insurance online in as little as 10 minutes without taking a life insurance medical exam .\u003c/p>\n\u003cp>Life insurers already gather other data with your permission to get insight beyond the information you supply on the application. For example, they often pull motor vehicle records, prescription drug histories and reports from an insurance industry database of certain information disclosed on past individual life and health insurance applications.\u003c/p>\n\u003cp>Many life insurance companies are exploring how to use additional data, statistical models, artificial intelligence and other techniques to help make quick decisions to ease the policy buying process and boost sales. Consumers don't like the wait on the typical application process, which can take weeks and often requires a medical exam.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Time and testing will tell which new approaches prove effective, says Robert Kerzner, president and CEO of LIMRA, a life insurance trade group. \"This one may or may not meet the vetting process to make carriers comfortable,\" he says.\u003c/p>\n\u003cp>It's important for the consumer to feel comfortable, too. It's one thing to post a selfie on Instagram, another to send it to an insurer for analysis. And it's crucial for consumers that any technology an insurer uses works. Their claims may not be fully paid if insurers make inaccurate predictions and go belly up.\u003c/p>\n\u003cp>\u003cstrong>Written All Over Your Face\u003c/strong>\u003c/p>\n\u003cp>If Chronos is adopted by an insurer - which would need to get regulatory approval from states to use it in the underwriting process - here's generally how it would work.\u003c/p>\n\u003cp>You'd upload a selfie to the insurer online and answer health and other questions. The facial analytics technology would scan hundreds of points on your face and extract certain information, including your body mass index, physiological age (in layman's terms, how old you look) and whether you're aging faster or slower than your actual age.\u003c/p>\n\u003cp>Ricanek says the program can detect makeup, but not plastic surgery. It verifies identity by comparing the photo to the one on your driver's license.\u003c/p>\n\u003cp>The insurer would combine the results with your application answers and, if it chooses, any other information it typically pulls. If approved for coverage, you could buy a policy immediately online.\u003c/p>\n\u003cp>Several of the largest life insurers contacted for this story declined to comment on the Lapetus product or the potential use of facial analytics in the underwriting process.\u003c/p>\n\u003cp>Ricanek worked on facial recognition technology for the FBI's Biometric Center of Excellence and is a computer science professor at the University of North Carolina at Wilmington. He started Lapetus with S. Jay Olshansky, a public health professor at the University of Illinois at Chicago. Lapetus launched Chronos, its first product, in November 2015.\u003c/p>\n\u003cp>\u003cstrong>Shortening the Wait\u003c/strong>\u003c/p>\n\u003cp>Insurers are in a tough spot because consumers are used to buying products instantly. But it can take a month or longer to approve coverage if the insurer requires a medical exam.\u003c/p>\n\u003cp>Exams cost insurers money, says Samantha Chow, a life insurance and annuities senior analyst for Aite Group, a research and advisory firm in Boston.\u003c/p>\n\u003cp>And fewer people are buying. In 2016, an estimated 9.4 million individual policies were sold, down from 17.7 million individual policies in 1984, according to LIMRA.\u003c/p>\n\u003cp>Consumers don't like waiting. Only 42 percent of consumers said it was OK to wait a month for policy approval, and less than 18 percent said waiting for two months was acceptable, according to a 2015 study by LIMRA and Life Happens, another trade group.\u003c/p>\n\u003cp>Chow tested the Lapetus platform as part of research of automated underwriting for Aite. She says the ease of the process could appeal to consumers who want a quick way to buy coverage.\u003c/p>\n\u003cp>\u003cstrong>Photo Ops\u003c/strong>\u003c/p>\n\u003cp>Ricanek says his company's market research found that consumers are willing to share photos with insurers if they get something back, such as the opportunity to buy coverage quickly.\u003c/p>\n\u003cp>Amy Bach, executive director of consumer advocacy group United Policyholders, says such technology could be good for consumers if it makes the application process easier.\u003c/p>\n\u003cp>But she says she is concerned that insurers may rely too heavily on new technology and find later that their risk projections were off.\u003cbr>\nMeanwhile, Lapetus is exploring how facial analytics may identify early signs of diseases such as diabetes, heart disease or dementia. And it's developing a feature that it says will be able to tell whether someone ever smoked. Among the clues are early signs of crow's feet around the eyes and under-eye bagging.\u003c/p>\n\u003cp>\"Smoking is going to be written on your face,\" Ricanek says. \"Even if you stopped smoking, once it's written, it's there.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This article was provided to The Associated Press by the personal finance website NerdWallet. Email staff writer Barbara Marquand: bmarquand@nerdwallet.com. Twitter: @barbaramarquand.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>A selfie reveals more than whether it's a good hair day. Facial lines and contours, droops and dark spots could indicate how well you're aging, and, when paired with other data, could someday help determine whether you qualify for life insurance.\u003c/p>\n\u003caside class=\"pullquote alignright\">'Your face is something you wear all your life, and it tells a very unique story about you.'\u003c/aside>\n\u003cp>\"Your face is something you wear all your life, and it tells a very unique story about you,\" says Karl Ricanek Jr., co-founder and chief data scientist at Lapetus Solutions Inc. in Wilmington, North Carolina.\u003c/p>\n\u003cp>Several life insurance companies are testing Lapetus technology that uses facial analytics and other data to estimate life expectancy, he says. (Lapetus would not disclose the names of companies testing its product.) Insurers use life expectancy estimates to make policy approval and pricing decisions. Lapetus says its product, Chronos, would enable a customer to buy life insurance online in as little as 10 minutes without taking a life insurance medical exam .\u003c/p>\n\u003cp>Life insurers already gather other data with your permission to get insight beyond the information you supply on the application. For example, they often pull motor vehicle records, prescription drug histories and reports from an insurance industry database of certain information disclosed on past individual life and health insurance applications.\u003c/p>\n\u003cp>Many life insurance companies are exploring how to use additional data, statistical models, artificial intelligence and other techniques to help make quick decisions to ease the policy buying process and boost sales. Consumers don't like the wait on the typical application process, which can take weeks and often requires a medical exam.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Time and testing will tell which new approaches prove effective, says Robert Kerzner, president and CEO of LIMRA, a life insurance trade group. \"This one may or may not meet the vetting process to make carriers comfortable,\" he says.\u003c/p>\n\u003cp>It's important for the consumer to feel comfortable, too. It's one thing to post a selfie on Instagram, another to send it to an insurer for analysis. And it's crucial for consumers that any technology an insurer uses works. Their claims may not be fully paid if insurers make inaccurate predictions and go belly up.\u003c/p>\n\u003cp>\u003cstrong>Written All Over Your Face\u003c/strong>\u003c/p>\n\u003cp>If Chronos is adopted by an insurer - which would need to get regulatory approval from states to use it in the underwriting process - here's generally how it would work.\u003c/p>\n\u003cp>You'd upload a selfie to the insurer online and answer health and other questions. The facial analytics technology would scan hundreds of points on your face and extract certain information, including your body mass index, physiological age (in layman's terms, how old you look) and whether you're aging faster or slower than your actual age.\u003c/p>\n\u003cp>Ricanek says the program can detect makeup, but not plastic surgery. It verifies identity by comparing the photo to the one on your driver's license.\u003c/p>\n\u003cp>The insurer would combine the results with your application answers and, if it chooses, any other information it typically pulls. If approved for coverage, you could buy a policy immediately online.\u003c/p>\n\u003cp>Several of the largest life insurers contacted for this story declined to comment on the Lapetus product or the potential use of facial analytics in the underwriting process.\u003c/p>\n\u003cp>Ricanek worked on facial recognition technology for the FBI's Biometric Center of Excellence and is a computer science professor at the University of North Carolina at Wilmington. He started Lapetus with S. Jay Olshansky, a public health professor at the University of Illinois at Chicago. Lapetus launched Chronos, its first product, in November 2015.\u003c/p>\n\u003cp>\u003cstrong>Shortening the Wait\u003c/strong>\u003c/p>\n\u003cp>Insurers are in a tough spot because consumers are used to buying products instantly. But it can take a month or longer to approve coverage if the insurer requires a medical exam.\u003c/p>\n\u003cp>Exams cost insurers money, says Samantha Chow, a life insurance and annuities senior analyst for Aite Group, a research and advisory firm in Boston.\u003c/p>\n\u003cp>And fewer people are buying. In 2016, an estimated 9.4 million individual policies were sold, down from 17.7 million individual policies in 1984, according to LIMRA.\u003c/p>\n\u003cp>Consumers don't like waiting. Only 42 percent of consumers said it was OK to wait a month for policy approval, and less than 18 percent said waiting for two months was acceptable, according to a 2015 study by LIMRA and Life Happens, another trade group.\u003c/p>\n\u003cp>Chow tested the Lapetus platform as part of research of automated underwriting for Aite. She says the ease of the process could appeal to consumers who want a quick way to buy coverage.\u003c/p>\n\u003cp>\u003cstrong>Photo Ops\u003c/strong>\u003c/p>\n\u003cp>Ricanek says his company's market research found that consumers are willing to share photos with insurers if they get something back, such as the opportunity to buy coverage quickly.\u003c/p>\n\u003cp>Amy Bach, executive director of consumer advocacy group United Policyholders, says such technology could be good for consumers if it makes the application process easier.\u003c/p>\n\u003cp>But she says she is concerned that insurers may rely too heavily on new technology and find later that their risk projections were off.\u003cbr>\nMeanwhile, Lapetus is exploring how facial analytics may identify early signs of diseases such as diabetes, heart disease or dementia. And it's developing a feature that it says will be able to tell whether someone ever smoked. Among the clues are early signs of crow's feet around the eyes and under-eye bagging.\u003c/p>\n\u003cp>\"Smoking is going to be written on your face,\" Ricanek says. \"Even if you stopped smoking, once it's written, it's there.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This article was provided to The Associated Press by the personal finance website NerdWallet. Email staff writer Barbara Marquand: bmarquand@nerdwallet.com. Twitter: @barbaramarquand.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Always Exhausted? How to Know When You Should Talk to Your Doctor",
"title": "Always Exhausted? How to Know When You Should Talk to Your Doctor",
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"content": "\u003cp>When I ask friends how they're doing, \"tired\" is often part of the response. A 2015 YouGov.com poll \u003ca href=\"https://today.yougov.com/news/2015/06/02/sleep-and-dreams/\">found\u003c/a> 38 percent of Americans were poorly rested at least four days of the week. Research from the U.S. Centers for Disease Control and Prevention from a few years earlier \u003ca href=\"https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6214a5.htm\">found\u003c/a> that 15 percent of women and 10 percent of men said they were \"very tired or exhausted\" most days or every day of the week.\u003c/p>\n\u003cp>\"It's very, very common,\" says \u003ca href=\"https://www.siuhealthcare.org/doctor/susan-t-hingle.html\">Susan Hingle\u003c/a>, chair of the board of regents for the American College of Physicians and an internist at Southern Illinois University School of Medicine.\u003c/p>\n\u003cp>If you're tired all the time, should you worry? It can be hard not to, since a Google search will show you that fatigue can be a symptom of a host of diseases, including serious ones.\u003c/p>\n\u003cp>Before you go there, consider the most obvious problem, especially if you're young and otherwise healthy: Maybe you're not sleeping enough. The CDC \u003ca href=\"https://www.cdc.gov/media/releases/2016/p0215-enough-sleep.html\">reported last year\u003c/a> that one-third of Americans aren't getting seven or more hours of sleep per day. Some studies put that percentage \u003ca href=\"http://www.npr.org/sections/health-shots/2016/04/26/475287202/many-grouchy-error-prone-workers-just-need-more-sleep\">even higher\u003c/a>. If you are a woman with children, each kid increases the odds of insufficient sleep by 50 percent, according to a \u003ca href=\"https://www.aan.com/PressRoom/Home/GetDigitalAsset/12346\">study presented\u003c/a> at the recent meeting of the American Academy of Neurology. The study did not find the same result for men with kids.\u003c/p>\n\u003caside class=\"pullquote alignright\">Feeling exhausted all the time? Don't blow it off.\u003c/aside>\n\u003cp>It doesn't mean you should blow off your tiredness, but it does mean it might be helped by what sleep experts call \"\u003ca href=\"https://sleepfoundation.org/sleep-topics/sleep-hygiene\">sleep hygiene\u003c/a>.\" That means working backwards from the time you need to wake up and setting a bedtime so you get sufficient sleep, then sticking to it. Limit daytime napping if you don't fall asleep until late at night. Cut out the caffeine and alcohol close to bedtime. Exercise regularly. And keep screens — televisions, smartphones and tablets — out of the bedroom if possible, and stop using them an hour or two before bedtime. The light they emit and the stimulation they provide may contribute to sleep problems.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>If it doesn't seem to just be a matter of getting an hour or so more of sleep, talk to your doctor. There are a wide range of medical conditions associated with feeling tired all the time, some more serious than others.\u003c/p>\n\u003cp>\"We try to get [people] to define what they mean by 'tired',\" says Hingle. For example, are you sleepy during the day? Or has your ability to get around and exercise without becoming exhausted or out of breath changed? \u003ca href=\"http://www.aafp.org/about/governance/board-directors/john-meigs1.html\">John Meigs Jr.\u003c/a> a family physician in Centreville, Ala. and president of the American Academy of Family Physicians, says he has a patient who reported a decline in his stamina for turkey hunting from last season to this one. \"He couldn't walk,\" he says. \"That's a pretty big change in a year.\" That kind of exhaustion is a common sign of heart disease, he says, so it's important to get it checked out.\u003c/p>\n\u003cp>Other potentially serious ailments include sleep apnea, which can cause people to feel tired all the time even if they're getting the recommended number of sleep hours per day, says Hingle. In addition to not feeling rested despite sufficient sleep, symptoms include snoring or gasping for air at night. Sleep apnea can \u003ca href=\"http://www.npr.org/sections/health-shots/2016/01/06/462152276/cholesterol-provide-a-clue-about-heart-risks-from-sleep-apnea\">increase the risk of heart disease\u003c/a> and needs to be taken seriously, so bring it up with your doctor. According to the American College of Physicians, \u003ca href=\"https://www.acponline.org/acp-newsroom/american-college-of-physicians-releases-new-recommendations-for-treating-obstructive-sleep-apnea\">treatments for sleep apnea\u003c/a> can include weight loss, if appropriate, or a \u003ca href=\"https://www.fda.gov/ForConsumers/ConsumerUpdates/ucm330932.htm\">CPAP device\u003c/a>.\u003c/p>\n\u003cp>One condition many people have heard of is \u003ca href=\"http://www.npr.org/sections/health-shots/2015/11/04/454335755/chronic-fatigue-syndrome-research-gains-funding-and-controversy\">chronic fatigue syndrome\u003c/a>, which is a serious disease that leads to more than everyday tiredness. \u003ca href=\"http://www.npr.org/sections/health-shots/2015/02/11/385465667/panel-says-chronic-fatigue-syndrome-is-a-disease-and-renames-it\">According to the latest definition\u003c/a>, it includes profound fatigue that lasts for at least six months, cognitive impairment and total exhaustion after even minor exertion. Those symptoms require medical attention. The Institute of Medicine \u003ca href=\"http://www.nationalacademies.org/hmd/Reports/2015/ME-CFS.aspx\">estimates\u003c/a> between 836,000 and 2.5 million Americans suffer from the disease.\u003c/p>\n\u003cp>Some people may be tired because they're anemic from losing blood, says Hingle. That might happen in women who have heavy menstrual periods, which can occur around menopause. A physician may advise you to take \u003ca href=\"http://www.aafp.org/afp/2013/0115/p98-s1.html\">iron supplements\u003c/a>, but you should be checked out to rule out any other causes of anemia. Colon cancer can also produce blood loss in the stool that leads to anemia, so for some people the resulting tiredness can be an early indication that they need to be tested for the disease.\u003c/p>\n\u003cp>There is no medical evidence supporting a diagnosis of \"adrenal fatigue,\" a term that has been used to describe a group of symptoms including tiredness, \u003ca href=\"http://www.hormone.org/diseases-and-conditions/adrenal/adrenal-fatigue\">according to the Endocrine Society\u003c/a>.\u003c/p>\n\u003cp>Type 2 diabetes can also produce fatigue, though it would be unusual for that to be the only symptom, says Hingle. (You'd likely also be peeing a lot and thirsty all the time.) Same with hypothyroidism; it may make you tired, but you'd also probably notice changes in your skin and hair, as well as constipation, she says. Fatigue is also linked to depression and anxiety, so if you're experiencing signs of those, or have noticed your sleepiness comes on the heels of stressful life events, talk to a physician, says Meigs.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Katherine Hobson is a freelance health and science writer based in Brooklyn, N.Y. She's on Twitter: \u003c/em>\u003ca href=\"https://twitter.com/katherinehobson\">\u003cem>@katherinehobson\u003c/em>\u003c/a>\u003cem>.\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=We%27re+All+Tired.+But+When+Could+Fatigue+Mean+a+Medical+Problem%3F&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"excerpt": "Avoiding your phone and TV at night and setting a firm bedtime might solve your problem if you feel tired a lot. But fatigue can also be a sign of disease.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>When I ask friends how they're doing, \"tired\" is often part of the response. A 2015 YouGov.com poll \u003ca href=\"https://today.yougov.com/news/2015/06/02/sleep-and-dreams/\">found\u003c/a> 38 percent of Americans were poorly rested at least four days of the week. Research from the U.S. Centers for Disease Control and Prevention from a few years earlier \u003ca href=\"https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6214a5.htm\">found\u003c/a> that 15 percent of women and 10 percent of men said they were \"very tired or exhausted\" most days or every day of the week.\u003c/p>\n\u003cp>\"It's very, very common,\" says \u003ca href=\"https://www.siuhealthcare.org/doctor/susan-t-hingle.html\">Susan Hingle\u003c/a>, chair of the board of regents for the American College of Physicians and an internist at Southern Illinois University School of Medicine.\u003c/p>\n\u003cp>If you're tired all the time, should you worry? It can be hard not to, since a Google search will show you that fatigue can be a symptom of a host of diseases, including serious ones.\u003c/p>\n\u003cp>Before you go there, consider the most obvious problem, especially if you're young and otherwise healthy: Maybe you're not sleeping enough. The CDC \u003ca href=\"https://www.cdc.gov/media/releases/2016/p0215-enough-sleep.html\">reported last year\u003c/a> that one-third of Americans aren't getting seven or more hours of sleep per day. Some studies put that percentage \u003ca href=\"http://www.npr.org/sections/health-shots/2016/04/26/475287202/many-grouchy-error-prone-workers-just-need-more-sleep\">even higher\u003c/a>. If you are a woman with children, each kid increases the odds of insufficient sleep by 50 percent, according to a \u003ca href=\"https://www.aan.com/PressRoom/Home/GetDigitalAsset/12346\">study presented\u003c/a> at the recent meeting of the American Academy of Neurology. The study did not find the same result for men with kids.\u003c/p>\n\u003caside class=\"pullquote alignright\">Feeling exhausted all the time? Don't blow it off.\u003c/aside>\n\u003cp>It doesn't mean you should blow off your tiredness, but it does mean it might be helped by what sleep experts call \"\u003ca href=\"https://sleepfoundation.org/sleep-topics/sleep-hygiene\">sleep hygiene\u003c/a>.\" That means working backwards from the time you need to wake up and setting a bedtime so you get sufficient sleep, then sticking to it. Limit daytime napping if you don't fall asleep until late at night. Cut out the caffeine and alcohol close to bedtime. Exercise regularly. And keep screens — televisions, smartphones and tablets — out of the bedroom if possible, and stop using them an hour or two before bedtime. The light they emit and the stimulation they provide may contribute to sleep problems.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>If it doesn't seem to just be a matter of getting an hour or so more of sleep, talk to your doctor. There are a wide range of medical conditions associated with feeling tired all the time, some more serious than others.\u003c/p>\n\u003cp>\"We try to get [people] to define what they mean by 'tired',\" says Hingle. For example, are you sleepy during the day? Or has your ability to get around and exercise without becoming exhausted or out of breath changed? \u003ca href=\"http://www.aafp.org/about/governance/board-directors/john-meigs1.html\">John Meigs Jr.\u003c/a> a family physician in Centreville, Ala. and president of the American Academy of Family Physicians, says he has a patient who reported a decline in his stamina for turkey hunting from last season to this one. \"He couldn't walk,\" he says. \"That's a pretty big change in a year.\" That kind of exhaustion is a common sign of heart disease, he says, so it's important to get it checked out.\u003c/p>\n\u003cp>Other potentially serious ailments include sleep apnea, which can cause people to feel tired all the time even if they're getting the recommended number of sleep hours per day, says Hingle. In addition to not feeling rested despite sufficient sleep, symptoms include snoring or gasping for air at night. Sleep apnea can \u003ca href=\"http://www.npr.org/sections/health-shots/2016/01/06/462152276/cholesterol-provide-a-clue-about-heart-risks-from-sleep-apnea\">increase the risk of heart disease\u003c/a> and needs to be taken seriously, so bring it up with your doctor. According to the American College of Physicians, \u003ca href=\"https://www.acponline.org/acp-newsroom/american-college-of-physicians-releases-new-recommendations-for-treating-obstructive-sleep-apnea\">treatments for sleep apnea\u003c/a> can include weight loss, if appropriate, or a \u003ca href=\"https://www.fda.gov/ForConsumers/ConsumerUpdates/ucm330932.htm\">CPAP device\u003c/a>.\u003c/p>\n\u003cp>One condition many people have heard of is \u003ca href=\"http://www.npr.org/sections/health-shots/2015/11/04/454335755/chronic-fatigue-syndrome-research-gains-funding-and-controversy\">chronic fatigue syndrome\u003c/a>, which is a serious disease that leads to more than everyday tiredness. \u003ca href=\"http://www.npr.org/sections/health-shots/2015/02/11/385465667/panel-says-chronic-fatigue-syndrome-is-a-disease-and-renames-it\">According to the latest definition\u003c/a>, it includes profound fatigue that lasts for at least six months, cognitive impairment and total exhaustion after even minor exertion. Those symptoms require medical attention. The Institute of Medicine \u003ca href=\"http://www.nationalacademies.org/hmd/Reports/2015/ME-CFS.aspx\">estimates\u003c/a> between 836,000 and 2.5 million Americans suffer from the disease.\u003c/p>\n\u003cp>Some people may be tired because they're anemic from losing blood, says Hingle. That might happen in women who have heavy menstrual periods, which can occur around menopause. A physician may advise you to take \u003ca href=\"http://www.aafp.org/afp/2013/0115/p98-s1.html\">iron supplements\u003c/a>, but you should be checked out to rule out any other causes of anemia. Colon cancer can also produce blood loss in the stool that leads to anemia, so for some people the resulting tiredness can be an early indication that they need to be tested for the disease.\u003c/p>\n\u003cp>There is no medical evidence supporting a diagnosis of \"adrenal fatigue,\" a term that has been used to describe a group of symptoms including tiredness, \u003ca href=\"http://www.hormone.org/diseases-and-conditions/adrenal/adrenal-fatigue\">according to the Endocrine Society\u003c/a>.\u003c/p>\n\u003cp>Type 2 diabetes can also produce fatigue, though it would be unusual for that to be the only symptom, says Hingle. (You'd likely also be peeing a lot and thirsty all the time.) Same with hypothyroidism; it may make you tired, but you'd also probably notice changes in your skin and hair, as well as constipation, she says. Fatigue is also linked to depression and anxiety, so if you're experiencing signs of those, or have noticed your sleepiness comes on the heels of stressful life events, talk to a physician, says Meigs.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Katherine Hobson is a freelance health and science writer based in Brooklyn, N.Y. She's on Twitter: \u003c/em>\u003ca href=\"https://twitter.com/katherinehobson\">\u003cem>@katherinehobson\u003c/em>\u003c/a>\u003cem>.\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=We%27re+All+Tired.+But+When+Could+Fatigue+Mean+a+Medical+Problem%3F&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Boy? Girl? Both? Neither? A New Generation Overthrows Gender",
"title": "Boy? Girl? Both? Neither? A New Generation Overthrows Gender",
"headTitle": "KQED Future of You | KQED Science",
"content": "\u003cp>\u003cspan style=\"font-size: 4.6875em;float: left;line-height: 0.733em;padding: 0.05em 0.1em 0 0;font-family: times, serif, georgia\">M\u003c/span>ax, age 13, does not identify as male. Ordinarily, working through the process of elimination, that should be enough to deduce Max's gender.\u003c/p>\n\u003caside class=\"alignright\">Update: \u003ca href=\"https://ww2.kqed.org/futureofyou/2017/10/15/california-third-gender-nonbinary/\" target=\"_blank\" rel=\"noopener\">California Recognizes a Third Gender\u003c/a>\u003c/aside>\n\u003cp>But Max does not identify as female, either. Max is agender. When referring to Max, you don't use \"he\" or \"she;\" you use \"they.\"\u003c/p>\n\u003cp>Once strictly\u003cstrong> \u003c/strong>a pronoun of the plural variety, “they” is now doing double duty as \u003ca href=\"https://www.washingtonpost.com/news/wonk/wp/2016/01/08/donald-trump-may-win-this-years-word-of-the-year/?utm_term=.4a34699bdbdf\" target=\"_blank\" rel=\"noopener\">singular\u003c/a>, referring to individuals, like Max, who do not see gender as an either/or option.\u003c/p>\n\u003cp>This can be awkward.\u003c/p>\n\u003cp>“I can’t expect anyone to use the right pronouns for me because it’s not a thing that people know,” Max says. “It’s been great being myself, but it’s also been really hard for people to get it, and for even family to get pronouns and stuff.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>We’re talking in Max’s room, where posters on the wall showcase Max's appearance in school theatrical productions: \"Peter Pan,” “Tarzan,” “The Pirates of Penzance.” Max is old enough now to make use of a makeup area—blush, foundation, lipstick—but young enough to enjoy going with their mom to see “Willy Wonka & The Chocolate Factory.\" (The review from Max: Gene Wilder's great!)\u003c/p>\n\u003cp>From these surroundings, you wouldn't think the room's occupant is someone who has poked and prodded at the most fundamental sense of who they are. Really, this is just a kid's room.\u003c/p>\n\u003cp>What does \"agender\" mean? I need to ask that kid.\u003c/p>\n\u003cp>\"What it means is I’m neither guy or girl, and that’s how I feel, which is different than terms like 'gender fluid'—which means you feel like a guy or girl at different times—because I don’t feel like I’m both guy and girl; I’m neither.\"\u003c/p>\n\u003cp>Max sounds a bit didactic, here, teaching me Nonbinary Gender 101. A crash course for someone who never considered that gender didn't mean just male and female.\u003c/p>\n\u003caside class=\"pullquote alignright\">'We are seeing more and more kids saying, ‘You know what? What’s with this either/or business? What’s with this boy-girl and you have to fit in one box or the other?’”\u003ccite>Diane Ehrensaft,\u003cbr>\nChild and Adolescent Gender Center,\u003cbr>\nUCSF Benioff Children’s Hospital\u003c/cite>\u003c/aside>\n\u003cp>Outside Max's room, out in the world, being nonbinary means having to do a lot of explaining.\u003c/p>\n\u003cp>When did you first feel different? I ask.\u003c/p>\n\u003cp>\"I’ve been feeling different than just a boy for all my life, really.\"\u003c/p>\n\u003cp>Max frames the transition from who they (that is, Max) were to who they are as a journey of self-discovery. In elementary school, there were girl friends and dressing in pink boas. That, Max says, was \"awesome.\"\u003c/p>\n\u003cp>But two years ago, someone at school called Max a \"girl-boy.\" Later, Max walked upstairs to the third floor of the house and stepped out onto the balcony, weighing whether or not to jump.\u003c/p>\n\u003cp>More than 40 percent of transgender or \"gender non-conforming\" people have attempted suicide, according to \u003ca href=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/02/AFSP-Williams-Suicide-Report-Final.pdf\">surveys\u003c/a>, with school bullying playing a significant role.\u003c/p>\n\u003cp>Why, I ask, did that particular insult hit so deeply that you would think about ending your life?\u003c/p>\n\u003cp>Max answers in spare, even-toned summation.\u003c/p>\n\u003cp>“I felt like no one loved me.”\u003c/p>\n\u003ch2>Leaping the Gender Boundary\u003c/h2>\n\u003cp>\u003cspan style=\"font-size: 4.6875em;float: left;line-height: 0.733em;padding: 0.05em 0.1em 0 0;font-family: times, serif, georgia\">T\u003c/span>hat day, on the balcony, Max had summoned up the presence of mind to call a transgender hotline. A counselor talked Max back into the house, to continue a struggle that appears remarkably profound.\u003c/p>\n\u003caside class=\"alignright\">Gender vs. Sexual Orientation vs. Biology\n\u003chr>\n\u003cp>“Gender identity is different from gender expression, being different from biology,” says Adam Chang, a consultant with Berkeley's \u003ca href=\"https://www.genderspectrum.org/\" target=\"_blank\" rel=\"noopener\">Gender Spectrum\u003c/a>, a provider of gender identity resources and services. “Identity is what you know in your heart and mind, and expression is external—hair, makeup, the roles you take on in society.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Biology, of course, means the physical attributes that have always been used as a proxy for gender. And all of those are different from sexual orientation.“Gender is the way you express yourself to the world, and your sexual orientation is who do you go to bed with,” says Davi Mühlinghaus-Anderson, 20, who identifies as gender neutral. “They’re different things but they do cross paths a little bit.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Chang puts it this way: “Sexuality is in and of itself not enough information to reveal a person’s gender identity.”\u003c/p>\n\u003c/aside>\n\u003cp>If same-sex marriage was yesterday’s battle to redefine gender roles and privileges, and transgender rights today's, we just may be on the cusp of the most transformational stage yet. This you-ain’t-seen-nothin’-yet development involves the splintering of what heretofore has been one of the most resilient organizing principles of American society—the division of the entire human race into male and female.\u003c/p>\n\u003cp>Those who now erase that line may identify as both male and female, as neither male nor female, or as sometimes male and sometimes female. \"They\" is often the pronoun of choice. These individuals may use any number of terms to describe their gender identity: genderqueer, gender-fluid, gender-creative, gender-expansive. While definitions fluctuate, \"nonbinary gender\" has emerged as an umbrella description.\u003c/p>\n\u003cp>“I think we're seeing a new gender revolution,\" says clinical psychologist Diane Ehrensaft. \"It's erased boxes and created gender infinity instead.”\u003c/p>\n\u003cp>Ehrensaft directs mental health at the Child and Adolescent Gender Center at the UCSF Benioff Children’s Hospital in San Francisco. At 70, she has been practicing her profession for some time.\u003c/p>\n\u003cp>“We are seeing more and more kids saying, ‘You know what? What’s with this either/or business? What’s with this boy-girl and you have to fit in one box or the other?’”\u003c/p>\n\u003cfigure id=\"attachment_329380\" class=\"wp-caption alignright\" style=\"max-width: 393px\">\u003cimg class=\"wp-image-329380\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2020/01/genderphoto2-1-800x1067.jpg\" alt='Cypress, 14, who identifies as gender fluid, with her mother, Christine Chrisman. \". I’ve never really felt all the way over on one side of the spectrum,\" Cypress says.' width=\"393\" height=\"524\">\u003cfigcaption class=\"wp-caption-text\">Cypress, 14, who identifies as gender fluid, with her mother, Christine Chrisman. \"I’ve never really felt all the way over on one side of the spectrum,\" Cypress says. \u003ccite>(Jon Brooks/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>How widespread is the nonbinary phenomenon? The results of the most recent \u003ca href=\"http://www.ustranssurvey.org/report\" target=\"_blank\" rel=\"noopener\">survey\u003c/a> by the National Center for Transgender Equality attest to how many transgender people are opting to identify this way. Out of almost 28,000 respondents, more than a third chose “nonbinary/genderqueer” when given a choice of terms to best describe themselves.\u003c/p>\n\u003cp>While the number of transgender clients seeking help has swollen into a \"tsunami,\" according to Ehrensaft, the number who want to transition to the opposite sex has been steadily dropping.\u003c/p>\n\u003cp>A much greater percentage, she says, say they're \"kind of the person that matches the sex on my birth certificate, but kind of not, as well. I'm going to use 'they' instead of 'he' or 'she' because those are not choices that fit me at all.' \"\u003c/p>\n\u003cp>And there is growing evidence that even those outside the transgender community are buying in.\u003c/p>\n\u003cp>A January 2015 general population \u003ca href=\"http://fusion.net/series/massive-millennial-poll/\" target=\"_blank\" rel=\"noopener\">survey\u003c/a> of 1,000 people age 18-34, conducted for Fusion media, \u003ca href=\"https://fusiondotnet.files.wordpress.com/2015/02/fusion-poll-gender-spectrum.pdf\" target=\"_blank\" rel=\"noopener\">found\u003c/a> just 46 percent agreed that “there are only two genders, male and female.” Fifty percent, meanwhile, said “gender is a spectrum, and some people fall outside conventional categories.”\u003c/p>\n\u003cp>A 2016 \u003ca href=\"https://www.glaad.org/files/aa/2017_GLAAD_Accelerating_Acceptance.pdf\" target=\"_blank\" rel=\"noopener\">online survey\u003c/a> by Harris Poll, commissioned by the LGBTQ advocacy group GLAAD, found that a startling 12 percent identified as either transgender or some form of nonbinary identity, like gender fluid or genderqueer\u003c/p>\n\u003cp>[contextly_sidebar id=\"xTf7Hze2Ir3HytynFurybpKeyTnmr3pe\"]As more people redefine their gender identity in nonbinary terms, schools, governments, workplaces and parents are having to adapt.\u003c/p>\n\u003cp>Christine Chrisman, 46, has a 14-year-old, Cypress, who identifies as gender-fluid. Chrisman says she was fully aware of transgender people who wanted to transition completely to the opposite sex. But, she says, “It didn’t really occur to me you could just hang out in the neutral, the in-between spot.”\u003c/p>\n\u003cp>“I don’t know what to think about it,” she says, adding that she knows a lot of parents who feel similarly. “Everybody seems sort of bewildered.”\u003cstrong>\u003cbr>\n\u003c/strong>\u003c/p>\n\u003ch2>Legal Recognition\u003c/h2>\n\u003cp>\u003cspan style=\"font-size: 4.6875em;float: left;line-height: 0.733em;padding: 0.05em 0.1em 0 0;font-family: times, serif, georgia\">H\u003c/span>ere in this state, the \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160AB329\" target=\"_blank\" rel=\"noopener\">California Healthy Youth Act\u003c/a>, signed into law in 2015, requires comprehensive sex education for grades 7-12 to \"teach pupils about gender, gender expression, gender identity, and explore the harm of negative gender stereotypes.” A \u003ca href=\"http://ccsesa.org/wp-content/uploads/2016/11/LGBTQ-and-Gender-Checklist.pdf\" target=\"_blank\" rel=\"noopener\">checklist\u003c/a> from the California County of Superintendents, designed for school systems to evaluate their compliance with the law, includes this definition of gender identity:\u003c/p>\n\u003cp>“One’s internal, deeply-held sense of being male, female, \u003cem>neither of these, both, or other gender(s)\u003c/em>. All people have a gender identity.” (Emphasis ours.)\u003c/p>\n\u003cp>https://www.youtube.com/watch?v=QszfBJEBoW8&ab_channel=ABC10News\u003c/p>\n\u003cp>Phyllida Burlingame of the ACLU of Northern California calls the law the nation’s first of its kind. She says districts are currently working to come into compliance with it.\u003c/p>\n\u003cp>Official recognition of nonbinary gender appears to be accelerating. Last June, a county circuit court judge in Oregon, in what transgender advocates believed was a first in the U.S., affirmed the \u003ca href=\"http://www.oregonlive.com/portland/index.ssf/2016/06/oregon_court_allows_person_to.html\" target=\"_blank\" rel=\"noopener\">legal change\u003c/a> of 52-year-old Jamie Shupe’s gender from female to \"nonbinary.\"\u003c/p>\n\u003cp>Then, in September, a judge in Santa Cruz, California issued an order recognizing \u003ca href=\"http://www.nbcnews.com/feature/nbc-out/californian-becomes-second-us-citizen-granted-non-binary-gender-status-n654611\" target=\"_blank\" rel=\"noopener\">\"nonbinary\" as the legal gender\u003c/a> of 55-year-old Sara Kelly Keenan. Since then, California courts have granted nonbinary status to at least 11 more people, according to the \u003ca href=\"http://www.intersexrecognition.org/litigation.html\">Gendersex and Queer Recognition project\u003c/a>.\u003c/p>\n\u003cp>Meanwhile, \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201720180SB179\" target=\"_blank\" rel=\"noopener\">Senate Bill 179\u003c/a>, which would make the state the first to recognize \"nonbinary\" as a legal gender on official documents, is making its way through the Legislature. If passed, California would join a growing number of national and sub-national jurisdictions \u003ca href=\"https://en.wikipedia.org/wiki/Legal_recognition_of_non-binary_gender\" target=\"_blank\" rel=\"noopener\">around the world\u003c/a> that recognize genders other than male or female. (Update Oct. 17, 2017: The bill has now been signed into law.)\u003c/p>\n\u003cp>And an Oregon school district last year \u003ca href=\"http://www.oregonlive.com/education/index.ssf/2016/05/gresham_barlow_transgender_tea.html\" target=\"_blank\" rel=\"noopener\">settled\u003c/a> with a nonbinary-identified fifth-grade teacher for $60,000 after the teacher complained of harassment, partly due to coworkers refusing to refer to the teacher as “they” and “them.”\u003cstrong>\u003cbr>\n\u003c/strong>\u003c/p>\n\u003ch2>Hanging Out in 'the In-Between'\u003c/h2>\n\u003cp>\u003cspan style=\"font-size: 4.6875em;float: left;line-height: 0.733em;padding: 0.05em 0.1em 0 0;font-family: times, serif, georgia\">T\u003c/span>hink about this: Max, at 13, has already shed not only a gender identity of origin—male—but also one that turned out to be temporary—transgender female.\u003c/p>\n\u003cfigure id=\"attachment_329392\" class=\"wp-caption alignright\" style=\"max-width: 392px\">\u003ca href=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2020/01/genderphoto11.jpg\">\u003cimg class=\"wp-image-329392\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2020/01/genderphoto11-800x1067.jpg\" alt=\"genderphoto11\" width=\"392\" height=\"523\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Max and family. “I was taken very much by surprise in terms of gender. It came from left field, I knew nothing, I was scared,” says Max's mom. (Jon\u003c/figcaption>\u003c/figure>\n\u003cp>Max lives with their mother, father and brother in a roomy East Bay home. Two years ago, after first coming out as someone who identified as a girl, Max learned on Tumblr about terms like “nonbinary,” “gender neutral,” and “agender.\"\u003c/p>\n\u003cp>“I was like, you know what? This describes me a little better than ‘girl,’” Max says. “I’ve been rolling with that for over a year.”\u003c/p>\n\u003cp>Max’s mother, Margaret, 52, acknowledges she was clueless about gender issues when Max came out. “Sexuality--no big deal,” she says, explaining the commitment she and Max's father, BZ, have always made to gay and lesbian rights. “We’re super lefties.” (She asked we not use last names due to online threats against other transgender families.)\u003c/p>\n\u003cp>But Max’s nonbinary identity definitely threw her. “I was taken very much by surprise in terms of gender. It came from left field, I knew nothing, I was scared.”\u003c/p>\n\u003cp>Even here, in the ultra-progressive San Francisco Bay Area, a region that rarely meets an iconoclastic idea it won't embrace, Max has felt isolated.\u003c/p>\n\u003cp>\"I think it’s a lot harder as nonbinary than trans,\" Max says. \"I'm not saying it’s not hard as trans, but you can’t really say 'Oh I’m not a boy, I’m a girl.' If you say 'I’m not a boy, I’m not a girl'—so what’s left? It's hard to define what that means.\"\u003c/p>\n\u003caside class=\"pullquote alignright\">'Being in the middle, what does that mean about your body?'\u003ccite>Margaret, Max's mother\u003c/cite>\u003c/aside>\n\u003cp>That is an existential quandary with real-world implications.\u003c/p>\n\u003cp>“I think we were at a mall somewhere,” Margaret, says, “and there was the men’s room to the right and the women’s room to the left, and Max walked right into the wall, in the middle, to make a point. Because where do you go to the bathroom? Where do you feel comfortable?”\u003c/p>\n\u003cp>While the question of who can go to the bathroom where may sound prosaic, about a third of transgender people have \u003ca href=\"http://www.ustranssurvey.org/preliminary-findings/\" target=\"_blank\" rel=\"noopener\">reported\u003c/a> abstaining from eating or drinking in order to avoid using one, because of frequent harassment and confrontations.\u003c/p>\n\u003cp>At school, Max would use the boy's room only during class, when it was less crowded, and only when desperate. The girls room was not an option, either.\u003c/p>\n\u003cp>“It would just feel like ‘I’m in the wrong place, I’m not supposed to be here,\" Max says. \"Something in your stomach—this just doesn’t feel right.”\u003c/p>\n\u003cfigure id=\"attachment_329386\" class=\"wp-caption alignright\" style=\"max-width: 800px\">\u003ca href=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2020/01/genderphoto6-e1486745816629.jpg\">\u003cimg class=\"size-medium wp-image-329386\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2020/01/genderphoto6-800x1067.jpg\" alt=\"Davi Mühlinghaus-Anderson, 20, identifies as gender neutral. \" width=\"800\" height=\"1067\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Davi Mühlinghaus-Anderson, 20, identifies as gender neutral. (Jon Brooks/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>The family lobbied Oakland School for the Arts, where Max is in the 8th grade, for a gender-neutral bathroom. It took awhile, but the school converted a faculty restroom, which can now be used by anyone.\u003c/p>\n\u003cp>The other issue that comes up daily is being referred to in the wrong way, as he or she. Max says it hurts to be misgendered.\u003c/p>\n\u003cp>“It means I’m not passing, especially when people use he/him, it really makes me feel like I’m not doing enough,\" Max says with some passion, \"and I’m never going to look the right way.”\u003c/p>\n\u003cp>Max's father says pronouns have been difficult for him.\u003c/p>\n\u003cp>\"It has taken awhile to get those right,\" BZ says. \"Max was born male. I’ve had 11 years of ‘he.’”\u003c/p>\n\u003cp>Dealing with other people is only part of Max's struggle as a nonbinary youth. Max must also wrestle with the decision of whether to go through male or female puberty.\u003c/p>\n\u003cp>“Max is on this exploration, but it’s harder [than], like, ‘I’m absolutely a girl, I’m absolutely a boy,” Margaret says. “Being in the middle, what does that mean about your body?”\u003c/p>\n\u003cp>Right now, taking \u003ca href=\"https://ww2.kqed.org/futureofyou/2016/08/19/transgender-youth-using-puberty-blockers/\" target=\"_blank\" rel=\"noopener\">medication\u003c/a> that prevents the emergence of secondary sex characteristics, such as breasts or facial hair, has bought Max more time to grapple with the choice.\u003c/p>\n\u003caside class=\"pullquote alignright\">'We were trained to see a certain reality, and now we see it everywhere and we can’t not see it until we work to untrain ourselves.'\u003ccite>Dot Brauer, director LGBTQA Center, University of Vermont\u003c/cite>\u003c/aside>\n\u003cp>Ehrensaft’s clinic now sees a growing number of people, mostly teenagers, who want to transform their bodies in ways that don’t fit a binary model. One client, Ehrensaft says, doesn’t want testosterone or a lower voice or facial hair, but doesn’t want breasts either.\u003c/p>\n\u003cp>Davi Mühlinghaus-Anderson, a soft-spoken 20-year-old who identifies as gender neutral and uses plural pronouns, is someone who has taken that route, having their breasts removed but with no plans to have genital reconstruction surgery or to take hormones.\u003c/p>\n\u003cp>Anderson says removing their breasts wasn’t a hard decision. “When puberty hit, when my breasts started to develop, that was very defining. It was just dead weight to my body.”\u003cstrong>\u003cbr>\n\u003c/strong>\u003c/p>\n\u003ch2>In the Gender Vanguard\u003c/h2>\n\u003cp>\u003cspan style=\"font-size: 4.6875em;float: left;line-height: 0.733em;padding: 0.05em 0.1em 0 0;font-family: times, serif, georgia\">A\u003c/span>t Oakland School for the Arts, I'm talking gender with principal Mike Oz and creative writing teacher Jordan Karnes, who also runs the Gender and Sexuality Club.\u003c/p>\n\u003cp>The interview is not what I expect. Neither Oz nor Karnes, both in their 30s, speak as if slowly crafting a press release, something journalists often come up against when interviewing anyone in an official capacity. The conversation is one we might have in a café about an extremely interesting topic.\u003c/p>\n\u003cfigure id=\"attachment_337545\" class=\"wp-caption alignright\" style=\"max-width: 800px\">\u003ca href=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/02/15272134_1204340009611881_6162750522408542844_o.jpg\">\u003cimg class=\"size-medium wp-image-337545\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/02/15272134_1204340009611881_6162750522408542844_o-800x533.jpg\" alt=\"Oakland School of the Arts High School Principal Mike Oz\" width=\"800\" height=\"533\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/02/15272134_1204340009611881_6162750522408542844_o-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2017/02/15272134_1204340009611881_6162750522408542844_o-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/02/15272134_1204340009611881_6162750522408542844_o-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2017/02/15272134_1204340009611881_6162750522408542844_o-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2017/02/15272134_1204340009611881_6162750522408542844_o-1920x1280.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2017/02/15272134_1204340009611881_6162750522408542844_o-1180x786.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2017/02/15272134_1204340009611881_6162750522408542844_o-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2017/02/15272134_1204340009611881_6162750522408542844_o-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/02/15272134_1204340009611881_6162750522408542844_o-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/02/15272134_1204340009611881_6162750522408542844_o-520x347.jpg 520w, https://ww2.kqed.org/app/uploads/sites/13/2017/02/15272134_1204340009611881_6162750522408542844_o.jpg 2048w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Oakland School for the Arts High School Principal Mike Oz \u003ccite>(Oakland School for the Arts)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Oz does seem sensitive about one thing, though: that the school might be portrayed as “that transgender school,” obscuring everything else it has to offer. That worry is not without some foundation. Some OSA parents do seem to feel that for better or worse, the school is on the cutting edge of the gender revolution.\u003c/p>\n\u003cp>Oz recounts how these conversations often start: “‘I hear your school is a place that turns boys into girls.”\u003c/p>\n\u003cp>Karnes hasn't heard that before now.\u003c/p>\n\u003cp>“There’s something about gender that people find so threatening,\" she says. \"It’s telling that we have a small portion of students that may be nonbinary or trans, that [we] would earn a reputation like that.”\u003c/p>\n\u003cp>She says she has one or two transgender or nonbinary students in each of her classes.\u003c/p>\n\u003cp>But many more have begun to reject the male/female dichotomy, Oz says, simply to support their fellow students. That's not something he saw coming. “That’s the most beautiful piece of this,” he says.\u003c/p>\n\u003caside class=\"pullquote alignright\">'I really don’t feel like it’s a trend. I feel like it’s the future.'\u003ccite>Jordan Karnes,\u003cbr>\nOakland School for the Arts\u003c/cite>\u003c/aside>\n\u003cp>Besides the gender-neutral bathroom, the school accommodates both nonbinary and binary transgender students by changing their email addresses to reflect the new names they have chosen.\u003c/p>\n\u003cp>Parents are not always on board. Karnes has been at school events, she says, in which students and teachers call transgender students by their new name and pronoun, while parents do not.\u003c/p>\n\u003cp>There's one question, impolitic as it is, I’ve wanted to ask:\u003c/p>\n\u003cp>Is nonbinary identity a trend? A passing fad?\u003c/p>\n\u003cp>“I really don’t feel like it’s a trend,” Karnes says. “I feel like it’s the future.”\u003cstrong>\u003cbr>\n\u003c/strong>\u003c/p>\n\u003ch2>'Trained to See a Certain Reality'\u003c/h2>\n\u003cp>\u003cspan style=\"font-size: 4.6875em;float: left;line-height: 0.733em;padding: 0.05em 0.1em 0 0;font-family: times, serif, georgia\">T\u003c/span>he acceptable rules and privileges within a binary male-female gender system have long been challenged, and ultimately expanded, by feminists and LGBT activists. And while the concept of other genders may be novel to Americans, it's nothing new to many cultures around the world.\u003c/p>\n\u003cp>https://www.google.com/maps/d/viewer?mid=1zDWxhBN5aOofwpE-FkZWQsiFDlE&ll=22.971037270290903%2C151.89697199999998&z=2\u003c/p>\n\u003cp>The biologist Ann Fausto Sterling titled her seminal 1993 \u003ca href=\"http://capone.mtsu.edu/phollowa/5sexes.html\" target=\"_blank\" rel=\"noopener\">essay\u003c/a> about individuals who are born with \u003ca href=\"https://www.google.com/search?q=intersex\" target=\"_blank\" rel=\"noopener\">ambiguous sex characteristics\u003c/a> “The Five Sexes: Why Male and Female Are Not Enough.”\u003c/p>\n\u003cp>“If the state and the legal system have an interest in maintaining a two-party sexual system, they are in defiance of nature,” she wrote. \"\u003cspan style=\"font-weight: 400\">For, biologically speaking, there are many gradations running from female to male.\"\u003c/span>\u003c/p>\n\u003cp>If that is so, one may well imagine a number of these \"gradations\" applying to those who identify as nonbinary. Sari Van Enders, an endocrinology researcher and gender theorist, says while some \u003ca href=\"http://transcience-project.org/brain_sex.html\" target=\"_blank\" rel=\"noopener\">physiological research\u003c/a> has been done on binary transgender people (including studies showing the brains of transgender individuals more closely resemble those of the gender they adopt), she has not come across any addressing people who are nonbinary.\u003c/p>\n\u003cp>“My sense is [therapists] have been thinking about this longer than scientists and researchers have,” Van Enders says.\u003c/p>\n\u003cp>Underlying the nonbinary phenomenon is the belief that gender is a social construct, a \u003ca href=\"https://www.amherst.edu/system/files/media/1650/butler_performative_acts.pdf\" target=\"_blank\" rel=\"noopener\">theory\u003c/a> most famously posited by the philosopher and gender theorist \u003ca href=\"http://vcresearch.berkeley.edu/faculty/judith-butler\" target=\"_blank\" rel=\"noopener\">Judith Butler\u003c/a>. This view sees the duality of gender, so entrenched in human society, as not a fundamental truth, but a perspective.\u003c/p>\n\u003cp>https://www.youtube.com/watch?v=Bo7o2LYATDc&ab_channel=BigThink\u003c/p>\n\u003cp>Gender researcher Dot Brauer, director of the LGBTQA Center at the University of Vermont, agrees. “We were trained to see a certain reality, and now we see it everywhere and we can’t not see it until we work to untrain ourselves. It’s not unlike a lot of other social frames that have shifted in our lifetime.”\u003c/p>\n\u003cp>“For all of us, gender is complexly biopsychosocial,” says Meg-John Barker, a UK academic, psychotherapist and author. “That means that it's really impossible to completely tease apart which elements of our gender experience come from our genetic makeup, which from our life experiences, and which from the wider social forces around us.”\u003cstrong>\u003cbr>\n\u003c/strong>\u003c/p>\n\u003ch2>'Not Hiding Myself'\u003c/h2>\n\u003cp>\u003cspan style=\"font-size: 4.6875em;float: left;line-height: 0.733em;padding: 0.05em 0.1em 0 0;font-family: times, serif, georgia\">I\u003c/span>t’s virtually impossible to sit listening to the experiences of young people like Max and Davi Mühlinghaus-Anderson without feeling their deep longing to communicate the truth of who they are, and without experiencing their bravery in continuing to do it.\u003c/p>\n\u003cp>While the 2010s may yet become the decade that binary gender broke, it's interesting to note that many of my baby-boomer cohort have not necessarily noticed, preoccupied as we are with refinancing mortgages and herniating discs. While reporting this story, I noticed more than one of my friends who no longer recognize the bands on \"Saturday Night Live\" rolling their eyes when I told them the menu of gender options, traditionally limited but at least easy to understand, had expanded. I myself had been so out of the loop on these developments that I realized that a lifelong predilection for new ideas may have finally met its match. Here, now, was a notion with good potential to turn me into my father, who met the provocative social changes of the 1960s and '70s by retreating into the refuge of mockery.\u003c/p>\n\u003cp>Did I now hear an echo of the man in my talks with nonbinary youth? As I sputtered to one interviewee, \"You gotta understand, this wasn’t even a \u003cem>thing\u003c/em> when I was growing up.”\u003c/p>\n\u003cp>No matter how organic and authentic the nonbinary movement is, might we assume, in this time of great economic and social dislocation, that once it shows up at the offices and high schools of the great mass of Americans, many are—to say the least—not going to like it?\u003c/p>\n\u003cfigure id=\"attachment_359539\" class=\"wp-caption aligncenter\" style=\"max-width: 719px\">\u003cimg class=\"size-full wp-image-359539\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/02/jost.jpg\" alt=\"Colin Jost of 'Saturday Night Live' was criticized for this joke about gender identities after the election.\" width=\"719\" height=\"798\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/02/jost.jpg 719w, https://ww2.kqed.org/app/uploads/sites/13/2017/02/jost-160x178.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/02/jost-240x266.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/02/jost-375x416.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/02/jost-520x577.jpg 520w\" sizes=\"(max-width: 719px) 100vw, 719px\">\u003cfigcaption class=\"wp-caption-text\">Colin Jost of 'Saturday Night Live' was criticized for this joke making fun of gender identities after the election. \u003ccite>(Saturday Night Live)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>On this, some of my interviewees, most of them transgender, agree.\u003c/p>\n\u003cp>“I think you’re absolutely right,” says Dot Brauer, the University of Vermont academic. “And at the same time I think one of the reasons it has gained as much of a foothold as it has is that while politically and in terms of social norms it is revolutionary and radical, inside of people it’s always been there.”\u003c/p>\n\u003cp>Charlotte Tate, a psychology professor and gender researcher at San Francisco State University, expects some amount of backlash against nonbinary identity. Her research has shown non-transgender (cisgender, in the parlance), heterosexual people are more negative toward nonbinary people than they are toward transgender males and females.\u003c/p>\n\u003cp>\"Looking at cisgender, heterosexual respondents, they seem to exist in a world that has two suppositions,\" Tate says. \"The first is that everyone is static in their gender category. The other supposition is that there are only two of those gender categories.\"\u003c/p>\n\u003cp>While transgender men and women violate the first, nonbinary individuals shatter both.\u003c/p>\n\u003cp>\u003cstrong>'Happier as a Being and Not Hiding Myself'\u003c/strong>\u003c/p>\n\u003cp>Still, considering the current trend, one might ask whether the arc of history will bend toward \"infinite\" gender categories, as Diane Ehrensaft predicts.\u003c/p>\n\u003cp>On this score, a 2014 \u003ca href=\"http://people.socsci.tau.ac.il/mu/daphnajoel/files/2014/11/Joel_gender_identity_2013.pdf\" target=\"_blank\" rel=\"noopener\">Israeli study\u003c/a> is provocative. Researchers gave 2,135 heterosexual, non-transgender men and women a questionnaire designed to gauge sexual identity. Among the results, significant percentages reported sometimes feeling like the opposite gender, sometimes wishing to be the opposite gender, and sometimes disliking their body because it was male or female.\u003c/p>\n\u003caside class=\"pullquote alignright\">'It’s a journey and it’s fun. It’s rewarding but it’s also difficult. But it’s worth it.'\u003ccite>Max, 13\u003c/cite>\u003c/aside>\n\u003cp>\"We conclude that the current view of gender identity as binary and unitary does not reflect the experience of many individuals, and call for a new conceptualisation of gender, which relates to multiplicity and fluidity in the experience of gender,\" the researchers wrote.\u003c/p>\n\u003cp>I thought about that after experiencing a moment of sadness during my interview with Dot Brauer. We'd been talking about the stringent gender roles both of us had grown up with, and I flashed back to my schoolyard years, when the smallest deviation from acceptable male behavior—backing out of a fight or wearing the wrong color shirt—could prompt insinuations of insufficient masculinity, if you were lucky, a pronouncement of “faggot” if you were not.\u003c/p>\n\u003cp>Really, it was quite oppressive—we kids, acting as unwitting enforcers in a kind of gender prison camp. So I wonder: As a veil against such rigid scrutiny, which unacceptable parts of myself had been forever disowned?\u003c/p>\n\u003cp>Many of those strictures, in some parts of the country, at least, have all but faded. (All hail the rise of the \u003ca href=\"http://www.yourtango.com/2013185939/signs-your-boyfriend-metrosexual\">metrosexual\u003c/a>.) After such a steady dismantling of strict gender codes, you might say binary gender's lone remaining bulwark against collapse has been biology. If we really are witnessing the first cracks in that wall as well, one wonders if its failure is really a matter of when, not if. (Diane Ehrensaft wishes she could live another 50 years to see it, she said. )\u003c/p>\n\u003cp>For the current generation of nonbinary pioneers, though, the issue isn't the ultimate success or not of a breakthrough vision of gender, it's a matter of simple truthfulness and dignity. At the end of our interview, I asked gender-neutral Davi Mühlinghaus-Anderson how things have been going since coming out.\u003c/p>\n\u003cp>\"Sometimes I feel like I don’t exist because I have to fight my way through the world,\" Davi said. \"But I certainly feel happier as a being and not hiding myself.\"\u003c/p>\n\u003cp>Says Max, covering all the bases: \"It’s a journey and it’s fun. It’s rewarding but it’s also difficult. But it’s worth it.\"\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This post has been updated.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cspan style=\"font-size: 4.6875em;float: left;line-height: 0.733em;padding: 0.05em 0.1em 0 0;font-family: times, serif, georgia\">M\u003c/span>ax, age 13, does not identify as male. Ordinarily, working through the process of elimination, that should be enough to deduce Max's gender.\u003c/p>\n\u003caside class=\"alignright\">Update: \u003ca href=\"https://ww2.kqed.org/futureofyou/2017/10/15/california-third-gender-nonbinary/\" target=\"_blank\" rel=\"noopener\">California Recognizes a Third Gender\u003c/a>\u003c/aside>\n\u003cp>But Max does not identify as female, either. Max is agender. When referring to Max, you don't use \"he\" or \"she;\" you use \"they.\"\u003c/p>\n\u003cp>Once strictly\u003cstrong> \u003c/strong>a pronoun of the plural variety, “they” is now doing double duty as \u003ca href=\"https://www.washingtonpost.com/news/wonk/wp/2016/01/08/donald-trump-may-win-this-years-word-of-the-year/?utm_term=.4a34699bdbdf\" target=\"_blank\" rel=\"noopener\">singular\u003c/a>, referring to individuals, like Max, who do not see gender as an either/or option.\u003c/p>\n\u003cp>This can be awkward.\u003c/p>\n\u003cp>“I can’t expect anyone to use the right pronouns for me because it’s not a thing that people know,” Max says. “It’s been great being myself, but it’s also been really hard for people to get it, and for even family to get pronouns and stuff.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>We’re talking in Max’s room, where posters on the wall showcase Max's appearance in school theatrical productions: \"Peter Pan,” “Tarzan,” “The Pirates of Penzance.” Max is old enough now to make use of a makeup area—blush, foundation, lipstick—but young enough to enjoy going with their mom to see “Willy Wonka & The Chocolate Factory.\" (The review from Max: Gene Wilder's great!)\u003c/p>\n\u003cp>From these surroundings, you wouldn't think the room's occupant is someone who has poked and prodded at the most fundamental sense of who they are. Really, this is just a kid's room.\u003c/p>\n\u003cp>What does \"agender\" mean? I need to ask that kid.\u003c/p>\n\u003cp>\"What it means is I’m neither guy or girl, and that’s how I feel, which is different than terms like 'gender fluid'—which means you feel like a guy or girl at different times—because I don’t feel like I’m both guy and girl; I’m neither.\"\u003c/p>\n\u003cp>Max sounds a bit didactic, here, teaching me Nonbinary Gender 101. A crash course for someone who never considered that gender didn't mean just male and female.\u003c/p>\n\u003caside class=\"pullquote alignright\">'We are seeing more and more kids saying, ‘You know what? What’s with this either/or business? What’s with this boy-girl and you have to fit in one box or the other?’”\u003ccite>Diane Ehrensaft,\u003cbr>\nChild and Adolescent Gender Center,\u003cbr>\nUCSF Benioff Children’s Hospital\u003c/cite>\u003c/aside>\n\u003cp>Outside Max's room, out in the world, being nonbinary means having to do a lot of explaining.\u003c/p>\n\u003cp>When did you first feel different? I ask.\u003c/p>\n\u003cp>\"I’ve been feeling different than just a boy for all my life, really.\"\u003c/p>\n\u003cp>Max frames the transition from who they (that is, Max) were to who they are as a journey of self-discovery. In elementary school, there were girl friends and dressing in pink boas. That, Max says, was \"awesome.\"\u003c/p>\n\u003cp>But two years ago, someone at school called Max a \"girl-boy.\" Later, Max walked upstairs to the third floor of the house and stepped out onto the balcony, weighing whether or not to jump.\u003c/p>\n\u003cp>More than 40 percent of transgender or \"gender non-conforming\" people have attempted suicide, according to \u003ca href=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/02/AFSP-Williams-Suicide-Report-Final.pdf\">surveys\u003c/a>, with school bullying playing a significant role.\u003c/p>\n\u003cp>Why, I ask, did that particular insult hit so deeply that you would think about ending your life?\u003c/p>\n\u003cp>Max answers in spare, even-toned summation.\u003c/p>\n\u003cp>“I felt like no one loved me.”\u003c/p>\n\u003ch2>Leaping the Gender Boundary\u003c/h2>\n\u003cp>\u003cspan style=\"font-size: 4.6875em;float: left;line-height: 0.733em;padding: 0.05em 0.1em 0 0;font-family: times, serif, georgia\">T\u003c/span>hat day, on the balcony, Max had summoned up the presence of mind to call a transgender hotline. A counselor talked Max back into the house, to continue a struggle that appears remarkably profound.\u003c/p>\n\u003caside class=\"alignright\">Gender vs. Sexual Orientation vs. Biology\n\u003chr>\n\u003cp>“Gender identity is different from gender expression, being different from biology,” says Adam Chang, a consultant with Berkeley's \u003ca href=\"https://www.genderspectrum.org/\" target=\"_blank\" rel=\"noopener\">Gender Spectrum\u003c/a>, a provider of gender identity resources and services. “Identity is what you know in your heart and mind, and expression is external—hair, makeup, the roles you take on in society.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Biology, of course, means the physical attributes that have always been used as a proxy for gender. And all of those are different from sexual orientation.“Gender is the way you express yourself to the world, and your sexual orientation is who do you go to bed with,” says Davi Mühlinghaus-Anderson, 20, who identifies as gender neutral. “They’re different things but they do cross paths a little bit.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Chang puts it this way: “Sexuality is in and of itself not enough information to reveal a person’s gender identity.”\u003c/p>\n\u003c/aside>\n\u003cp>If same-sex marriage was yesterday’s battle to redefine gender roles and privileges, and transgender rights today's, we just may be on the cusp of the most transformational stage yet. This you-ain’t-seen-nothin’-yet development involves the splintering of what heretofore has been one of the most resilient organizing principles of American society—the division of the entire human race into male and female.\u003c/p>\n\u003cp>Those who now erase that line may identify as both male and female, as neither male nor female, or as sometimes male and sometimes female. \"They\" is often the pronoun of choice. These individuals may use any number of terms to describe their gender identity: genderqueer, gender-fluid, gender-creative, gender-expansive. While definitions fluctuate, \"nonbinary gender\" has emerged as an umbrella description.\u003c/p>\n\u003cp>“I think we're seeing a new gender revolution,\" says clinical psychologist Diane Ehrensaft. \"It's erased boxes and created gender infinity instead.”\u003c/p>\n\u003cp>Ehrensaft directs mental health at the Child and Adolescent Gender Center at the UCSF Benioff Children’s Hospital in San Francisco. At 70, she has been practicing her profession for some time.\u003c/p>\n\u003cp>“We are seeing more and more kids saying, ‘You know what? What’s with this either/or business? What’s with this boy-girl and you have to fit in one box or the other?’”\u003c/p>\n\u003cfigure id=\"attachment_329380\" class=\"wp-caption alignright\" style=\"max-width: 393px\">\u003cimg class=\"wp-image-329380\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2020/01/genderphoto2-1-800x1067.jpg\" alt='Cypress, 14, who identifies as gender fluid, with her mother, Christine Chrisman. \". I’ve never really felt all the way over on one side of the spectrum,\" Cypress says.' width=\"393\" height=\"524\">\u003cfigcaption class=\"wp-caption-text\">Cypress, 14, who identifies as gender fluid, with her mother, Christine Chrisman. \"I’ve never really felt all the way over on one side of the spectrum,\" Cypress says. \u003ccite>(Jon Brooks/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>How widespread is the nonbinary phenomenon? The results of the most recent \u003ca href=\"http://www.ustranssurvey.org/report\" target=\"_blank\" rel=\"noopener\">survey\u003c/a> by the National Center for Transgender Equality attest to how many transgender people are opting to identify this way. Out of almost 28,000 respondents, more than a third chose “nonbinary/genderqueer” when given a choice of terms to best describe themselves.\u003c/p>\n\u003cp>While the number of transgender clients seeking help has swollen into a \"tsunami,\" according to Ehrensaft, the number who want to transition to the opposite sex has been steadily dropping.\u003c/p>\n\u003cp>A much greater percentage, she says, say they're \"kind of the person that matches the sex on my birth certificate, but kind of not, as well. I'm going to use 'they' instead of 'he' or 'she' because those are not choices that fit me at all.' \"\u003c/p>\n\u003cp>And there is growing evidence that even those outside the transgender community are buying in.\u003c/p>\n\u003cp>A January 2015 general population \u003ca href=\"http://fusion.net/series/massive-millennial-poll/\" target=\"_blank\" rel=\"noopener\">survey\u003c/a> of 1,000 people age 18-34, conducted for Fusion media, \u003ca href=\"https://fusiondotnet.files.wordpress.com/2015/02/fusion-poll-gender-spectrum.pdf\" target=\"_blank\" rel=\"noopener\">found\u003c/a> just 46 percent agreed that “there are only two genders, male and female.” Fifty percent, meanwhile, said “gender is a spectrum, and some people fall outside conventional categories.”\u003c/p>\n\u003cp>A 2016 \u003ca href=\"https://www.glaad.org/files/aa/2017_GLAAD_Accelerating_Acceptance.pdf\" target=\"_blank\" rel=\"noopener\">online survey\u003c/a> by Harris Poll, commissioned by the LGBTQ advocacy group GLAAD, found that a startling 12 percent identified as either transgender or some form of nonbinary identity, like gender fluid or genderqueer\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>As more people redefine their gender identity in nonbinary terms, schools, governments, workplaces and parents are having to adapt.\u003c/p>\n\u003cp>Christine Chrisman, 46, has a 14-year-old, Cypress, who identifies as gender-fluid. Chrisman says she was fully aware of transgender people who wanted to transition completely to the opposite sex. But, she says, “It didn’t really occur to me you could just hang out in the neutral, the in-between spot.”\u003c/p>\n\u003cp>“I don’t know what to think about it,” she says, adding that she knows a lot of parents who feel similarly. “Everybody seems sort of bewildered.”\u003cstrong>\u003cbr>\n\u003c/strong>\u003c/p>\n\u003ch2>Legal Recognition\u003c/h2>\n\u003cp>\u003cspan style=\"font-size: 4.6875em;float: left;line-height: 0.733em;padding: 0.05em 0.1em 0 0;font-family: times, serif, georgia\">H\u003c/span>ere in this state, the \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160AB329\" target=\"_blank\" rel=\"noopener\">California Healthy Youth Act\u003c/a>, signed into law in 2015, requires comprehensive sex education for grades 7-12 to \"teach pupils about gender, gender expression, gender identity, and explore the harm of negative gender stereotypes.” A \u003ca href=\"http://ccsesa.org/wp-content/uploads/2016/11/LGBTQ-and-Gender-Checklist.pdf\" target=\"_blank\" rel=\"noopener\">checklist\u003c/a> from the California County of Superintendents, designed for school systems to evaluate their compliance with the law, includes this definition of gender identity:\u003c/p>\n\u003cp>“One’s internal, deeply-held sense of being male, female, \u003cem>neither of these, both, or other gender(s)\u003c/em>. All people have a gender identity.” (Emphasis ours.)\u003c/p>\u003c/p>\u003cp>\u003cspan class='utils-parseShortcode-shortcodes-__youtubeShortcode__embedYoutube'>\n \u003cspan class='utils-parseShortcode-shortcodes-__youtubeShortcode__embedYoutubeInside'>\n \u003ciframe\n loading='lazy'\n class='utils-parseShortcode-shortcodes-__youtubeShortcode__youtubePlayer'\n type='text/html'\n src='//www.youtube.com/embed/QszfBJEBoW8'\n title='//www.youtube.com/embed/QszfBJEBoW8'\n allowfullscreen='true'\n style='border:0;'>\u003c/iframe>\n \u003c/span>\n \u003c/span>\u003c/p>\u003cp>\u003cp>Phyllida Burlingame of the ACLU of Northern California calls the law the nation’s first of its kind. She says districts are currently working to come into compliance with it.\u003c/p>\n\u003cp>Official recognition of nonbinary gender appears to be accelerating. Last June, a county circuit court judge in Oregon, in what transgender advocates believed was a first in the U.S., affirmed the \u003ca href=\"http://www.oregonlive.com/portland/index.ssf/2016/06/oregon_court_allows_person_to.html\" target=\"_blank\" rel=\"noopener\">legal change\u003c/a> of 52-year-old Jamie Shupe’s gender from female to \"nonbinary.\"\u003c/p>\n\u003cp>Then, in September, a judge in Santa Cruz, California issued an order recognizing \u003ca href=\"http://www.nbcnews.com/feature/nbc-out/californian-becomes-second-us-citizen-granted-non-binary-gender-status-n654611\" target=\"_blank\" rel=\"noopener\">\"nonbinary\" as the legal gender\u003c/a> of 55-year-old Sara Kelly Keenan. Since then, California courts have granted nonbinary status to at least 11 more people, according to the \u003ca href=\"http://www.intersexrecognition.org/litigation.html\">Gendersex and Queer Recognition project\u003c/a>.\u003c/p>\n\u003cp>Meanwhile, \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201720180SB179\" target=\"_blank\" rel=\"noopener\">Senate Bill 179\u003c/a>, which would make the state the first to recognize \"nonbinary\" as a legal gender on official documents, is making its way through the Legislature. If passed, California would join a growing number of national and sub-national jurisdictions \u003ca href=\"https://en.wikipedia.org/wiki/Legal_recognition_of_non-binary_gender\" target=\"_blank\" rel=\"noopener\">around the world\u003c/a> that recognize genders other than male or female. (Update Oct. 17, 2017: The bill has now been signed into law.)\u003c/p>\n\u003cp>And an Oregon school district last year \u003ca href=\"http://www.oregonlive.com/education/index.ssf/2016/05/gresham_barlow_transgender_tea.html\" target=\"_blank\" rel=\"noopener\">settled\u003c/a> with a nonbinary-identified fifth-grade teacher for $60,000 after the teacher complained of harassment, partly due to coworkers refusing to refer to the teacher as “they” and “them.”\u003cstrong>\u003cbr>\n\u003c/strong>\u003c/p>\n\u003ch2>Hanging Out in 'the In-Between'\u003c/h2>\n\u003cp>\u003cspan style=\"font-size: 4.6875em;float: left;line-height: 0.733em;padding: 0.05em 0.1em 0 0;font-family: times, serif, georgia\">T\u003c/span>hink about this: Max, at 13, has already shed not only a gender identity of origin—male—but also one that turned out to be temporary—transgender female.\u003c/p>\n\u003cfigure id=\"attachment_329392\" class=\"wp-caption alignright\" style=\"max-width: 392px\">\u003ca href=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2020/01/genderphoto11.jpg\">\u003cimg class=\"wp-image-329392\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2020/01/genderphoto11-800x1067.jpg\" alt=\"genderphoto11\" width=\"392\" height=\"523\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Max and family. “I was taken very much by surprise in terms of gender. It came from left field, I knew nothing, I was scared,” says Max's mom. (Jon\u003c/figcaption>\u003c/figure>\n\u003cp>Max lives with their mother, father and brother in a roomy East Bay home. Two years ago, after first coming out as someone who identified as a girl, Max learned on Tumblr about terms like “nonbinary,” “gender neutral,” and “agender.\"\u003c/p>\n\u003cp>“I was like, you know what? This describes me a little better than ‘girl,’” Max says. “I’ve been rolling with that for over a year.”\u003c/p>\n\u003cp>Max’s mother, Margaret, 52, acknowledges she was clueless about gender issues when Max came out. “Sexuality--no big deal,” she says, explaining the commitment she and Max's father, BZ, have always made to gay and lesbian rights. “We’re super lefties.” (She asked we not use last names due to online threats against other transgender families.)\u003c/p>\n\u003cp>But Max’s nonbinary identity definitely threw her. “I was taken very much by surprise in terms of gender. It came from left field, I knew nothing, I was scared.”\u003c/p>\n\u003cp>Even here, in the ultra-progressive San Francisco Bay Area, a region that rarely meets an iconoclastic idea it won't embrace, Max has felt isolated.\u003c/p>\n\u003cp>\"I think it’s a lot harder as nonbinary than trans,\" Max says. \"I'm not saying it’s not hard as trans, but you can’t really say 'Oh I’m not a boy, I’m a girl.' If you say 'I’m not a boy, I’m not a girl'—so what’s left? It's hard to define what that means.\"\u003c/p>\n\u003caside class=\"pullquote alignright\">'Being in the middle, what does that mean about your body?'\u003ccite>Margaret, Max's mother\u003c/cite>\u003c/aside>\n\u003cp>That is an existential quandary with real-world implications.\u003c/p>\n\u003cp>“I think we were at a mall somewhere,” Margaret, says, “and there was the men’s room to the right and the women’s room to the left, and Max walked right into the wall, in the middle, to make a point. Because where do you go to the bathroom? Where do you feel comfortable?”\u003c/p>\n\u003cp>While the question of who can go to the bathroom where may sound prosaic, about a third of transgender people have \u003ca href=\"http://www.ustranssurvey.org/preliminary-findings/\" target=\"_blank\" rel=\"noopener\">reported\u003c/a> abstaining from eating or drinking in order to avoid using one, because of frequent harassment and confrontations.\u003c/p>\n\u003cp>At school, Max would use the boy's room only during class, when it was less crowded, and only when desperate. The girls room was not an option, either.\u003c/p>\n\u003cp>“It would just feel like ‘I’m in the wrong place, I’m not supposed to be here,\" Max says. \"Something in your stomach—this just doesn’t feel right.”\u003c/p>\n\u003cfigure id=\"attachment_329386\" class=\"wp-caption alignright\" style=\"max-width: 800px\">\u003ca href=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2020/01/genderphoto6-e1486745816629.jpg\">\u003cimg class=\"size-medium wp-image-329386\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2020/01/genderphoto6-800x1067.jpg\" alt=\"Davi Mühlinghaus-Anderson, 20, identifies as gender neutral. \" width=\"800\" height=\"1067\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Davi Mühlinghaus-Anderson, 20, identifies as gender neutral. (Jon Brooks/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>The family lobbied Oakland School for the Arts, where Max is in the 8th grade, for a gender-neutral bathroom. It took awhile, but the school converted a faculty restroom, which can now be used by anyone.\u003c/p>\n\u003cp>The other issue that comes up daily is being referred to in the wrong way, as he or she. Max says it hurts to be misgendered.\u003c/p>\n\u003cp>“It means I’m not passing, especially when people use he/him, it really makes me feel like I’m not doing enough,\" Max says with some passion, \"and I’m never going to look the right way.”\u003c/p>\n\u003cp>Max's father says pronouns have been difficult for him.\u003c/p>\n\u003cp>\"It has taken awhile to get those right,\" BZ says. \"Max was born male. I’ve had 11 years of ‘he.’”\u003c/p>\n\u003cp>Dealing with other people is only part of Max's struggle as a nonbinary youth. Max must also wrestle with the decision of whether to go through male or female puberty.\u003c/p>\n\u003cp>“Max is on this exploration, but it’s harder [than], like, ‘I’m absolutely a girl, I’m absolutely a boy,” Margaret says. “Being in the middle, what does that mean about your body?”\u003c/p>\n\u003cp>Right now, taking \u003ca href=\"https://ww2.kqed.org/futureofyou/2016/08/19/transgender-youth-using-puberty-blockers/\" target=\"_blank\" rel=\"noopener\">medication\u003c/a> that prevents the emergence of secondary sex characteristics, such as breasts or facial hair, has bought Max more time to grapple with the choice.\u003c/p>\n\u003caside class=\"pullquote alignright\">'We were trained to see a certain reality, and now we see it everywhere and we can’t not see it until we work to untrain ourselves.'\u003ccite>Dot Brauer, director LGBTQA Center, University of Vermont\u003c/cite>\u003c/aside>\n\u003cp>Ehrensaft’s clinic now sees a growing number of people, mostly teenagers, who want to transform their bodies in ways that don’t fit a binary model. One client, Ehrensaft says, doesn’t want testosterone or a lower voice or facial hair, but doesn’t want breasts either.\u003c/p>\n\u003cp>Davi Mühlinghaus-Anderson, a soft-spoken 20-year-old who identifies as gender neutral and uses plural pronouns, is someone who has taken that route, having their breasts removed but with no plans to have genital reconstruction surgery or to take hormones.\u003c/p>\n\u003cp>Anderson says removing their breasts wasn’t a hard decision. “When puberty hit, when my breasts started to develop, that was very defining. It was just dead weight to my body.”\u003cstrong>\u003cbr>\n\u003c/strong>\u003c/p>\n\u003ch2>In the Gender Vanguard\u003c/h2>\n\u003cp>\u003cspan style=\"font-size: 4.6875em;float: left;line-height: 0.733em;padding: 0.05em 0.1em 0 0;font-family: times, serif, georgia\">A\u003c/span>t Oakland School for the Arts, I'm talking gender with principal Mike Oz and creative writing teacher Jordan Karnes, who also runs the Gender and Sexuality Club.\u003c/p>\n\u003cp>The interview is not what I expect. Neither Oz nor Karnes, both in their 30s, speak as if slowly crafting a press release, something journalists often come up against when interviewing anyone in an official capacity. The conversation is one we might have in a café about an extremely interesting topic.\u003c/p>\n\u003cfigure id=\"attachment_337545\" class=\"wp-caption alignright\" style=\"max-width: 800px\">\u003ca href=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/02/15272134_1204340009611881_6162750522408542844_o.jpg\">\u003cimg class=\"size-medium wp-image-337545\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/02/15272134_1204340009611881_6162750522408542844_o-800x533.jpg\" alt=\"Oakland School of the Arts High School Principal Mike Oz\" width=\"800\" height=\"533\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/02/15272134_1204340009611881_6162750522408542844_o-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2017/02/15272134_1204340009611881_6162750522408542844_o-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/02/15272134_1204340009611881_6162750522408542844_o-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2017/02/15272134_1204340009611881_6162750522408542844_o-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2017/02/15272134_1204340009611881_6162750522408542844_o-1920x1280.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2017/02/15272134_1204340009611881_6162750522408542844_o-1180x786.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2017/02/15272134_1204340009611881_6162750522408542844_o-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2017/02/15272134_1204340009611881_6162750522408542844_o-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/02/15272134_1204340009611881_6162750522408542844_o-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/02/15272134_1204340009611881_6162750522408542844_o-520x347.jpg 520w, https://ww2.kqed.org/app/uploads/sites/13/2017/02/15272134_1204340009611881_6162750522408542844_o.jpg 2048w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Oakland School for the Arts High School Principal Mike Oz \u003ccite>(Oakland School for the Arts)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Oz does seem sensitive about one thing, though: that the school might be portrayed as “that transgender school,” obscuring everything else it has to offer. That worry is not without some foundation. Some OSA parents do seem to feel that for better or worse, the school is on the cutting edge of the gender revolution.\u003c/p>\n\u003cp>Oz recounts how these conversations often start: “‘I hear your school is a place that turns boys into girls.”\u003c/p>\n\u003cp>Karnes hasn't heard that before now.\u003c/p>\n\u003cp>“There’s something about gender that people find so threatening,\" she says. \"It’s telling that we have a small portion of students that may be nonbinary or trans, that [we] would earn a reputation like that.”\u003c/p>\n\u003cp>She says she has one or two transgender or nonbinary students in each of her classes.\u003c/p>\n\u003cp>But many more have begun to reject the male/female dichotomy, Oz says, simply to support their fellow students. That's not something he saw coming. “That’s the most beautiful piece of this,” he says.\u003c/p>\n\u003caside class=\"pullquote alignright\">'I really don’t feel like it’s a trend. I feel like it’s the future.'\u003ccite>Jordan Karnes,\u003cbr>\nOakland School for the Arts\u003c/cite>\u003c/aside>\n\u003cp>Besides the gender-neutral bathroom, the school accommodates both nonbinary and binary transgender students by changing their email addresses to reflect the new names they have chosen.\u003c/p>\n\u003cp>Parents are not always on board. Karnes has been at school events, she says, in which students and teachers call transgender students by their new name and pronoun, while parents do not.\u003c/p>\n\u003cp>There's one question, impolitic as it is, I’ve wanted to ask:\u003c/p>\n\u003cp>Is nonbinary identity a trend? A passing fad?\u003c/p>\n\u003cp>“I really don’t feel like it’s a trend,” Karnes says. “I feel like it’s the future.”\u003cstrong>\u003cbr>\n\u003c/strong>\u003c/p>\n\u003ch2>'Trained to See a Certain Reality'\u003c/h2>\n\u003cp>\u003cspan style=\"font-size: 4.6875em;float: left;line-height: 0.733em;padding: 0.05em 0.1em 0 0;font-family: times, serif, georgia\">T\u003c/span>he acceptable rules and privileges within a binary male-female gender system have long been challenged, and ultimately expanded, by feminists and LGBT activists. And while the concept of other genders may be novel to Americans, it's nothing new to many cultures around the world.\u003c/p>\n\u003cp>https://www.google.com/maps/d/viewer?mid=1zDWxhBN5aOofwpE-FkZWQsiFDlE&ll=22.971037270290903%2C151.89697199999998&z=2\u003c/p>\n\u003cp>The biologist Ann Fausto Sterling titled her seminal 1993 \u003ca href=\"http://capone.mtsu.edu/phollowa/5sexes.html\" target=\"_blank\" rel=\"noopener\">essay\u003c/a> about individuals who are born with \u003ca href=\"https://www.google.com/search?q=intersex\" target=\"_blank\" rel=\"noopener\">ambiguous sex characteristics\u003c/a> “The Five Sexes: Why Male and Female Are Not Enough.”\u003c/p>\n\u003cp>“If the state and the legal system have an interest in maintaining a two-party sexual system, they are in defiance of nature,” she wrote. \"\u003cspan style=\"font-weight: 400\">For, biologically speaking, there are many gradations running from female to male.\"\u003c/span>\u003c/p>\n\u003cp>If that is so, one may well imagine a number of these \"gradations\" applying to those who identify as nonbinary. Sari Van Enders, an endocrinology researcher and gender theorist, says while some \u003ca href=\"http://transcience-project.org/brain_sex.html\" target=\"_blank\" rel=\"noopener\">physiological research\u003c/a> has been done on binary transgender people (including studies showing the brains of transgender individuals more closely resemble those of the gender they adopt), she has not come across any addressing people who are nonbinary.\u003c/p>\n\u003cp>“My sense is [therapists] have been thinking about this longer than scientists and researchers have,” Van Enders says.\u003c/p>\n\u003cp>Underlying the nonbinary phenomenon is the belief that gender is a social construct, a \u003ca href=\"https://www.amherst.edu/system/files/media/1650/butler_performative_acts.pdf\" target=\"_blank\" rel=\"noopener\">theory\u003c/a> most famously posited by the philosopher and gender theorist \u003ca href=\"http://vcresearch.berkeley.edu/faculty/judith-butler\" target=\"_blank\" rel=\"noopener\">Judith Butler\u003c/a>. This view sees the duality of gender, so entrenched in human society, as not a fundamental truth, but a perspective.\u003c/p>\u003c/p>\u003cp>\u003cspan class='utils-parseShortcode-shortcodes-__youtubeShortcode__embedYoutube'>\n \u003cspan class='utils-parseShortcode-shortcodes-__youtubeShortcode__embedYoutubeInside'>\n \u003ciframe\n loading='lazy'\n class='utils-parseShortcode-shortcodes-__youtubeShortcode__youtubePlayer'\n type='text/html'\n src='//www.youtube.com/embed/Bo7o2LYATDc'\n title='//www.youtube.com/embed/Bo7o2LYATDc'\n allowfullscreen='true'\n style='border:0;'>\u003c/iframe>\n \u003c/span>\n \u003c/span>\u003c/p>\u003cp>\u003cp>Gender researcher Dot Brauer, director of the LGBTQA Center at the University of Vermont, agrees. “We were trained to see a certain reality, and now we see it everywhere and we can’t not see it until we work to untrain ourselves. It’s not unlike a lot of other social frames that have shifted in our lifetime.”\u003c/p>\n\u003cp>“For all of us, gender is complexly biopsychosocial,” says Meg-John Barker, a UK academic, psychotherapist and author. “That means that it's really impossible to completely tease apart which elements of our gender experience come from our genetic makeup, which from our life experiences, and which from the wider social forces around us.”\u003cstrong>\u003cbr>\n\u003c/strong>\u003c/p>\n\u003ch2>'Not Hiding Myself'\u003c/h2>\n\u003cp>\u003cspan style=\"font-size: 4.6875em;float: left;line-height: 0.733em;padding: 0.05em 0.1em 0 0;font-family: times, serif, georgia\">I\u003c/span>t’s virtually impossible to sit listening to the experiences of young people like Max and Davi Mühlinghaus-Anderson without feeling their deep longing to communicate the truth of who they are, and without experiencing their bravery in continuing to do it.\u003c/p>\n\u003cp>While the 2010s may yet become the decade that binary gender broke, it's interesting to note that many of my baby-boomer cohort have not necessarily noticed, preoccupied as we are with refinancing mortgages and herniating discs. While reporting this story, I noticed more than one of my friends who no longer recognize the bands on \"Saturday Night Live\" rolling their eyes when I told them the menu of gender options, traditionally limited but at least easy to understand, had expanded. I myself had been so out of the loop on these developments that I realized that a lifelong predilection for new ideas may have finally met its match. Here, now, was a notion with good potential to turn me into my father, who met the provocative social changes of the 1960s and '70s by retreating into the refuge of mockery.\u003c/p>\n\u003cp>Did I now hear an echo of the man in my talks with nonbinary youth? As I sputtered to one interviewee, \"You gotta understand, this wasn’t even a \u003cem>thing\u003c/em> when I was growing up.”\u003c/p>\n\u003cp>No matter how organic and authentic the nonbinary movement is, might we assume, in this time of great economic and social dislocation, that once it shows up at the offices and high schools of the great mass of Americans, many are—to say the least—not going to like it?\u003c/p>\n\u003cfigure id=\"attachment_359539\" class=\"wp-caption aligncenter\" style=\"max-width: 719px\">\u003cimg class=\"size-full wp-image-359539\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/02/jost.jpg\" alt=\"Colin Jost of 'Saturday Night Live' was criticized for this joke about gender identities after the election.\" width=\"719\" height=\"798\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/02/jost.jpg 719w, https://ww2.kqed.org/app/uploads/sites/13/2017/02/jost-160x178.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/02/jost-240x266.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/02/jost-375x416.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/02/jost-520x577.jpg 520w\" sizes=\"(max-width: 719px) 100vw, 719px\">\u003cfigcaption class=\"wp-caption-text\">Colin Jost of 'Saturday Night Live' was criticized for this joke making fun of gender identities after the election. \u003ccite>(Saturday Night Live)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>On this, some of my interviewees, most of them transgender, agree.\u003c/p>\n\u003cp>“I think you’re absolutely right,” says Dot Brauer, the University of Vermont academic. “And at the same time I think one of the reasons it has gained as much of a foothold as it has is that while politically and in terms of social norms it is revolutionary and radical, inside of people it’s always been there.”\u003c/p>\n\u003cp>Charlotte Tate, a psychology professor and gender researcher at San Francisco State University, expects some amount of backlash against nonbinary identity. Her research has shown non-transgender (cisgender, in the parlance), heterosexual people are more negative toward nonbinary people than they are toward transgender males and females.\u003c/p>\n\u003cp>\"Looking at cisgender, heterosexual respondents, they seem to exist in a world that has two suppositions,\" Tate says. \"The first is that everyone is static in their gender category. The other supposition is that there are only two of those gender categories.\"\u003c/p>\n\u003cp>While transgender men and women violate the first, nonbinary individuals shatter both.\u003c/p>\n\u003cp>\u003cstrong>'Happier as a Being and Not Hiding Myself'\u003c/strong>\u003c/p>\n\u003cp>Still, considering the current trend, one might ask whether the arc of history will bend toward \"infinite\" gender categories, as Diane Ehrensaft predicts.\u003c/p>\n\u003cp>On this score, a 2014 \u003ca href=\"http://people.socsci.tau.ac.il/mu/daphnajoel/files/2014/11/Joel_gender_identity_2013.pdf\" target=\"_blank\" rel=\"noopener\">Israeli study\u003c/a> is provocative. Researchers gave 2,135 heterosexual, non-transgender men and women a questionnaire designed to gauge sexual identity. Among the results, significant percentages reported sometimes feeling like the opposite gender, sometimes wishing to be the opposite gender, and sometimes disliking their body because it was male or female.\u003c/p>\n\u003caside class=\"pullquote alignright\">'It’s a journey and it’s fun. It’s rewarding but it’s also difficult. But it’s worth it.'\u003ccite>Max, 13\u003c/cite>\u003c/aside>\n\u003cp>\"We conclude that the current view of gender identity as binary and unitary does not reflect the experience of many individuals, and call for a new conceptualisation of gender, which relates to multiplicity and fluidity in the experience of gender,\" the researchers wrote.\u003c/p>\n\u003cp>I thought about that after experiencing a moment of sadness during my interview with Dot Brauer. We'd been talking about the stringent gender roles both of us had grown up with, and I flashed back to my schoolyard years, when the smallest deviation from acceptable male behavior—backing out of a fight or wearing the wrong color shirt—could prompt insinuations of insufficient masculinity, if you were lucky, a pronouncement of “faggot” if you were not.\u003c/p>\n\u003cp>Really, it was quite oppressive—we kids, acting as unwitting enforcers in a kind of gender prison camp. So I wonder: As a veil against such rigid scrutiny, which unacceptable parts of myself had been forever disowned?\u003c/p>\n\u003cp>Many of those strictures, in some parts of the country, at least, have all but faded. (All hail the rise of the \u003ca href=\"http://www.yourtango.com/2013185939/signs-your-boyfriend-metrosexual\">metrosexual\u003c/a>.) After such a steady dismantling of strict gender codes, you might say binary gender's lone remaining bulwark against collapse has been biology. If we really are witnessing the first cracks in that wall as well, one wonders if its failure is really a matter of when, not if. (Diane Ehrensaft wishes she could live another 50 years to see it, she said. )\u003c/p>\n\u003cp>For the current generation of nonbinary pioneers, though, the issue isn't the ultimate success or not of a breakthrough vision of gender, it's a matter of simple truthfulness and dignity. At the end of our interview, I asked gender-neutral Davi Mühlinghaus-Anderson how things have been going since coming out.\u003c/p>\n\u003cp>\"Sometimes I feel like I don’t exist because I have to fight my way through the world,\" Davi said. \"But I certainly feel happier as a being and not hiding myself.\"\u003c/p>\n\u003cp>Says Max, covering all the bases: \"It’s a journey and it’s fun. It’s rewarding but it’s also difficult. But it’s worth it.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"disqusTitle": "Post-Theranos, Can Silicon Valley and Biomed Get Along?",
"title": "Post-Theranos, Can Silicon Valley and Biomed Get Along?",
"headTitle": "Startup Culture | KQED Future of You | KQED Science",
"content": "\u003cp>Oil and water. Plaid and polka dots. Fish and peanut butter. We all know these things don't go together.\u003c/p>\n\u003cp>It's worth asking how well the \"get in hard, cash out fast\" tech ethos \u003cem>du jour\u003c/em> fits in with the plodding, regulation-heavy culture of health care. It's a valid question in the wake of the \u003ca href=\"https://ww2.kqed.org/futureofyou/2016/07/14/the-rise-and-fall-of-theranos-a-cartoon-history/\">Theranos flameout,\u003c/a> in which a Silicon Valley entrepreneur with no medical background, lots of hype and very little scientific scrutiny raised copious venture backing to revolutionize blood testing, only to see the technology fail in market.\u003c/p>\n\u003cp>Tech culture rewards disruptors. And those who can pivot on a dime.\u003c/p>\n\u003cp>But the process of getting a new drug or medical device to market is long and convoluted, a necessary drag. There's the academic papers subject to peer review, the many stages of clinical testing and government approval. Yes, it all takes years, but\u003ca href=\"http://www.slate.com/articles/health_and_science/science/2017/04/science_is_not_a_free_market_endeavor.html\"> it makes the science transparent\u003c/a>.\u003c/p>\n\u003cp>By contrast, Theranos CEO Elizabeth Holmes was secretive about how the company's technology worked, and the venture firms that pumped millions into Theranos either didn't have the details, or weren't scientifically literate enough to ask the questions that might have raised red flags.\u003c/p>\n\u003caside class=\"pullquote alignright\">'I think Silicon Valley is used to this kind of thing: take an idea that isn’t fully formed and get it out into the world without validation, and maybe it fails later on.'\u003ccite>Dr. Norman Paradis, Darmouth College\u003c/cite>\u003c/aside>\n\u003cp>Stanford professor Dr. John Ioannidis \u003ca href=\"https://www.washingtonpost.com/news/to-your-health/wp/2015/07/03/the-insanely-influential-stanford-professor-behind-biotech-firms-push-to-get-fda-approval-it-probably-doesnt-need/?utm_term=.386a29abd2f8\">saw the red flags early on\u003c/a> --some that even non-scientists could have discovered.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"So the first thing that I did as a researcher, as a scientist, is check the scientific literature,\" he recently\u003ca href=\"http://www.npr.org/sections/alltechconsidered/2016/05/02/475972922/biotechs-theranos-offers-a-cautionary-tale-for-silicon-valley\"> told NPR.\u003c/a> \"How much do we know about what they [Theranos] do? And I couldn't find even a single paper.\"\u003c/p>\n\u003cp>Dr. Norman Paradis is a professor of medicine at Dartmouth College who works as a consultant for diagnostic startups. He has given presentations to venture firms, and he says the fact that Theranos got hundreds of millions of dollars and went to market without proving itself makes it \"a Silicon Valley event, and not a biomedical event.\"\u003c/p>\n\u003cp>\"I think Silicon Valley is used to this kind of thing: take an idea that isn’t fully formed and get it out into the world without validation, and maybe it fails later on.\" Whereas in the biomedical field you almost always need to have data early on.\u003c/p>\n\u003cp>So what happened? The wrong people were asking the questions, says Paradis. \"If you look at the list of who invested in Theranos, none of the venture capitalists who regularly do biomedical diagnostics were investors,\" he says. The firms with relevant medical expertise steered clear. \"Normally you show up to present an idea to these firms, they really know what you're talking about,\" he added.\u003c/p>\n\u003cp>At a conference it hosted in January, The Economist asked a panel of venture capitalists about the broader perception of a culture clash between scientists and Silicon Valley entrepreneurs ... and the Theranos example, specifically. The panelists represented three firms that invest in life science and healthcare ventures: Lisa Suennen from\u003ca href=\"https://www.geventures.com/\"> GE Ventures\u003c/a>, David Sabow from\u003ca href=\"https://www.svb.com/\"> Silicon Valley Bank\u003c/a>, and Emily Melton from \u003ca href=\"https://dfj.com/\">DFJ Venture Capital\u003c/a>.\u003c/p>\n\u003cp>Here's the full video:\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe width=\"560\" height=\"315\" src=\"https://www.youtube.com/embed/6GAZcb9jyT0\" frameborder=\"0\" scrolling=\"yes\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003cp>The panelists agreed that some of the accepted rules that govern much of today's startup development and commercialization seem to run counter to those of science-based startups in medicine and biotech. And that there is a tension between the two sides.\u003c/p>\n\u003cp>\"It's a solution sell versus a product sell,\" said Melton from DFJ. \"Investors think of things as products, whereas people on the health care side think of solutions.\"[contextly_sidebar id=\"MhTn4bRZadvdRBhNxWpIi87Ako9TIWSD\"]\u003c/p>\n\u003cp>Suennen from GE Ventures agreed. \"On the tech side, people are practically allergic to providing services,\" she said. But in the case of health care, \"You can’t take the people out of caring for people.\"\u003c/p>\n\u003cp>And, said Suennen, the timelines involved are vastly different.\u003cstrong>\u003cbr>\n\u003c/strong>\u003c/p>\n\u003cp>\"In the health care world, the time horizon for investments to mature and exit is pretty long compared to other marketplaces – usually 7 to 10 years,\" Suennen added.\u003c/p>\n\u003cp>Melton noted that won't deter some venture firms from investing in health care. \"We’re willing to be more patient if we feel like there’s a great opportunity at the end,\" she said, adding that, \"We do need to have a clear path to commercialization.\"\u003c/p>\n\u003cp>Of course a startup can't come to market without jumping through the hoops -- specifically, the FDA approval process. That's why these panelists said regulation is a -- gasp! -- \u003cem>good\u003c/em> thing. \"You need regulation in health care, for the most part, to make the market grow,\" Suennen said.\u003c/p>\n\u003cp>Everyone on the panel agreed that the next big thing in digital health or biomedicine will not emerge until tech innovators and medical experts work together: venture companies need the new ideas from the tech side combined with the health care knowledge. And that's starting to happen.\u003c/p>\n\u003cp>Since most biomedical startups are still in early funding stages, it will take a few years to see a new model of collaboration emerge and produce significant breakthroughs in biomed.\u003c/p>\n\u003cp>\"You need that life sciences perspective to understand how has it been done, what works, what doesn’t -- in order to totally revolutionize it,\" said Sabow, from Silicon Valley Bank. \"People who are trying to do it without that multidimensional perspective are going to spend a lot of money, get a lot of buzz, but not necessarily have the revolutionary impact they’re hoping for.\"\u003c/p>\n\u003cp>There was some awkwardness when Melton was asked about Theranos. Her firm, DFJ, pumped $500,000 in seed money into the venture early on. Interestingly, she all but said that her firm did not have access to data from Theranos when they cut the check.\u003c/p>\n\u003cp>\"I think transparency is critical. You can’t mess around with people’s lives and you can’t put products out there without being very transparent about what you’re doing. Data is very critical, and letting people have access to the data.\"\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>The Theranos debacle has a \"tragic\" element that goes beyond hundreds of lost jobs and lost investment, says Paradis. For \u003ca href=\"https://www.forbes.com/sites/petercohan/2016/04/15/can-theranos-raise-new-capital/#6b421282406b\">$750 million\u003c/a>, you could have funded at least seven good startups, he says. \"It's almost impossible to get a complete new diagnostic test developed, because funders are so conservative [when it comes to medical products],\" he says. \"That’s even less likely to happen now.\"\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Oil and water. Plaid and polka dots. Fish and peanut butter. We all know these things don't go together.\u003c/p>\n\u003cp>It's worth asking how well the \"get in hard, cash out fast\" tech ethos \u003cem>du jour\u003c/em> fits in with the plodding, regulation-heavy culture of health care. It's a valid question in the wake of the \u003ca href=\"https://ww2.kqed.org/futureofyou/2016/07/14/the-rise-and-fall-of-theranos-a-cartoon-history/\">Theranos flameout,\u003c/a> in which a Silicon Valley entrepreneur with no medical background, lots of hype and very little scientific scrutiny raised copious venture backing to revolutionize blood testing, only to see the technology fail in market.\u003c/p>\n\u003cp>Tech culture rewards disruptors. And those who can pivot on a dime.\u003c/p>\n\u003cp>But the process of getting a new drug or medical device to market is long and convoluted, a necessary drag. There's the academic papers subject to peer review, the many stages of clinical testing and government approval. Yes, it all takes years, but\u003ca href=\"http://www.slate.com/articles/health_and_science/science/2017/04/science_is_not_a_free_market_endeavor.html\"> it makes the science transparent\u003c/a>.\u003c/p>\n\u003cp>By contrast, Theranos CEO Elizabeth Holmes was secretive about how the company's technology worked, and the venture firms that pumped millions into Theranos either didn't have the details, or weren't scientifically literate enough to ask the questions that might have raised red flags.\u003c/p>\n\u003caside class=\"pullquote alignright\">'I think Silicon Valley is used to this kind of thing: take an idea that isn’t fully formed and get it out into the world without validation, and maybe it fails later on.'\u003ccite>Dr. Norman Paradis, Darmouth College\u003c/cite>\u003c/aside>\n\u003cp>Stanford professor Dr. John Ioannidis \u003ca href=\"https://www.washingtonpost.com/news/to-your-health/wp/2015/07/03/the-insanely-influential-stanford-professor-behind-biotech-firms-push-to-get-fda-approval-it-probably-doesnt-need/?utm_term=.386a29abd2f8\">saw the red flags early on\u003c/a> --some that even non-scientists could have discovered.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"So the first thing that I did as a researcher, as a scientist, is check the scientific literature,\" he recently\u003ca href=\"http://www.npr.org/sections/alltechconsidered/2016/05/02/475972922/biotechs-theranos-offers-a-cautionary-tale-for-silicon-valley\"> told NPR.\u003c/a> \"How much do we know about what they [Theranos] do? And I couldn't find even a single paper.\"\u003c/p>\n\u003cp>Dr. Norman Paradis is a professor of medicine at Dartmouth College who works as a consultant for diagnostic startups. He has given presentations to venture firms, and he says the fact that Theranos got hundreds of millions of dollars and went to market without proving itself makes it \"a Silicon Valley event, and not a biomedical event.\"\u003c/p>\n\u003cp>\"I think Silicon Valley is used to this kind of thing: take an idea that isn’t fully formed and get it out into the world without validation, and maybe it fails later on.\" Whereas in the biomedical field you almost always need to have data early on.\u003c/p>\n\u003cp>So what happened? The wrong people were asking the questions, says Paradis. \"If you look at the list of who invested in Theranos, none of the venture capitalists who regularly do biomedical diagnostics were investors,\" he says. The firms with relevant medical expertise steered clear. \"Normally you show up to present an idea to these firms, they really know what you're talking about,\" he added.\u003c/p>\n\u003cp>At a conference it hosted in January, The Economist asked a panel of venture capitalists about the broader perception of a culture clash between scientists and Silicon Valley entrepreneurs ... and the Theranos example, specifically. The panelists represented three firms that invest in life science and healthcare ventures: Lisa Suennen from\u003ca href=\"https://www.geventures.com/\"> GE Ventures\u003c/a>, David Sabow from\u003ca href=\"https://www.svb.com/\"> Silicon Valley Bank\u003c/a>, and Emily Melton from \u003ca href=\"https://dfj.com/\">DFJ Venture Capital\u003c/a>.\u003c/p>\n\u003cp>Here's the full video:\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe width=\"560\" height=\"315\" src=\"https://www.youtube.com/embed/6GAZcb9jyT0\" frameborder=\"0\" scrolling=\"yes\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003cp>The panelists agreed that some of the accepted rules that govern much of today's startup development and commercialization seem to run counter to those of science-based startups in medicine and biotech. And that there is a tension between the two sides.\u003c/p>\n\u003cp>\"It's a solution sell versus a product sell,\" said Melton from DFJ. \"Investors think of things as products, whereas people on the health care side think of solutions.\"\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Suennen from GE Ventures agreed. \"On the tech side, people are practically allergic to providing services,\" she said. But in the case of health care, \"You can’t take the people out of caring for people.\"\u003c/p>\n\u003cp>And, said Suennen, the timelines involved are vastly different.\u003cstrong>\u003cbr>\n\u003c/strong>\u003c/p>\n\u003cp>\"In the health care world, the time horizon for investments to mature and exit is pretty long compared to other marketplaces – usually 7 to 10 years,\" Suennen added.\u003c/p>\n\u003cp>Melton noted that won't deter some venture firms from investing in health care. \"We’re willing to be more patient if we feel like there’s a great opportunity at the end,\" she said, adding that, \"We do need to have a clear path to commercialization.\"\u003c/p>\n\u003cp>Of course a startup can't come to market without jumping through the hoops -- specifically, the FDA approval process. That's why these panelists said regulation is a -- gasp! -- \u003cem>good\u003c/em> thing. \"You need regulation in health care, for the most part, to make the market grow,\" Suennen said.\u003c/p>\n\u003cp>Everyone on the panel agreed that the next big thing in digital health or biomedicine will not emerge until tech innovators and medical experts work together: venture companies need the new ideas from the tech side combined with the health care knowledge. And that's starting to happen.\u003c/p>\n\u003cp>Since most biomedical startups are still in early funding stages, it will take a few years to see a new model of collaboration emerge and produce significant breakthroughs in biomed.\u003c/p>\n\u003cp>\"You need that life sciences perspective to understand how has it been done, what works, what doesn’t -- in order to totally revolutionize it,\" said Sabow, from Silicon Valley Bank. \"People who are trying to do it without that multidimensional perspective are going to spend a lot of money, get a lot of buzz, but not necessarily have the revolutionary impact they’re hoping for.\"\u003c/p>\n\u003cp>There was some awkwardness when Melton was asked about Theranos. Her firm, DFJ, pumped $500,000 in seed money into the venture early on. Interestingly, she all but said that her firm did not have access to data from Theranos when they cut the check.\u003c/p>\n\u003cp>\"I think transparency is critical. You can’t mess around with people’s lives and you can’t put products out there without being very transparent about what you’re doing. Data is very critical, and letting people have access to the data.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The Theranos debacle has a \"tragic\" element that goes beyond hundreds of lost jobs and lost investment, says Paradis. For \u003ca href=\"https://www.forbes.com/sites/petercohan/2016/04/15/can-theranos-raise-new-capital/#6b421282406b\">$750 million\u003c/a>, you could have funded at least seven good startups, he says. \"It's almost impossible to get a complete new diagnostic test developed, because funders are so conservative [when it comes to medical products],\" he says. \"That’s even less likely to happen now.\"\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Human Umbilical Cord Blood Helps Aging Mice Remember, Study Finds",
"title": "Human Umbilical Cord Blood Helps Aging Mice Remember, Study Finds",
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"content": "\u003cp>Decades ago, scientists \u003ca href=\"http://onlinelibrary.wiley.com/doi/10.1111/j.2164-0947.1972.tb02712.x/abstract\">surgically attached\u003c/a> pairs of rats to each other and noticed that old rats tended to live longer if they shared a bloodstream with young rats.\u003c/p>\n\u003cp>It was the beginning of a peculiar and ambitious scientific endeavor to understand how certain materials from young bodies, when transplanted into older ones, can sometimes improve or rejuvenate them.\u003c/p>\n\u003cp>From the beginning, the findings were exciting, complex and, sometimes, contradictory. For example, scientists \u003ca href=\"https://www.nature.com/nature/journal/v433/n7027/full/nature03260.html\">have shown\u003c/a> that young blood can restore cell activity in the muscles and livers of aging mice. They've also \u003ca href=\"http://www.cell.com/abstract/S0092-8674(13)00456-X\">found that\u003c/a> linking old mice to young ones helped reverse heart muscle thickening.\u003c/p>\n\u003cp>On the other hand, researchers \u003ca href=\"http://circres.ahajournals.org/content/118/7/1143.long\">weren't able to replicate\u003c/a> those findings and \u003ca href=\"https://www.nature.com/articles/ncomms13363\">another study\u003c/a> concluded that, in mice that swapped blood without being connected surgically, the negative effects of being exposed to old blood outweighed the benefits of getting young blood.\u003c/p>\n\u003cp>What was clear was that, like humans, as mice age their bodies and their behavior change on a fundamental level. For example, older mice stop building nests, and they tend to become forgetful, taking a long time to remember how to escape from a maze, for example.\u003c/p>\n\u003caside class=\"pullquote alignright\">Researchers wondered, would young human blood aid aging mice?\u003c/aside>\n\u003cp>\"We see a pretty dramatic difference between young and aged mice in terms of their performance,\" says \u003ca href=\"https://profiles.stanford.edu/joseph-castellano\">Joe Castellano\u003c/a>, a neuroscientist at Stanford University School of Medicine.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Castellano and his colleagues wondered if young human blood might have beneficial effects for aging mice.\u003c/p>\n\u003cp>Now, they \u003ca href=\"https://www.nature.com/articles/doi:10.1038/nature22067\">report\u003c/a> in the journal \u003cem>Nature\u003c/em> that they've found a protein in human umbilical cord blood that improved learning and memory in aging mice. It's an exciting find in the field of regenerative medicine.\u003c/p>\n\u003cp>But, scientists caution, it does not mean people should start ordering umbilical cord blood online. There is no indication that it would work in humans.\u003c/p>\n\u003cp>For their study, Castellano and his colleagues collected plasma, which is the watery part of blood, from people of different ages. Some were in their sixties and seventies, others in their twenties. They also collected plasma from human umbilical cords.\u003c/p>\n\u003cp>Then, they injected human plasma from those different age groups and from umbilical cord blood into mice several times over the course of a couple weeks.\u003c/p>\n\u003cp>The mice were 12 and 14 months old, which is approximately the mouse equivalent of being in your late 50s or 60s.\u003c/p>\n\u003cp>When they dissected the mouse brains and inspected the hippocampi, they found that certain genes linked to making new memories had been turned on in some of the mice.\u003c/p>\n\u003cp>\"So, we had a hint early on that one of these donor groups, specifically the [umbilical] cord plasma, might be having an effect on the brain itself,\" he says.\u003c/p>\n\u003cp>Next, they injected more aging mice with human plasma and tested the animals' ability to remember things.\u003c/p>\n\u003cp>For example, they watched how long it took the mice to escape from a maze the mice had done before, using visual cues to choose an exit that would lead to safety.\u003c/p>\n\u003cp>Castellano says it's basically like observing a person try to navigate through a crowded garage to locate their parked car.\u003c/p>\n\u003cp>Before being injected with umbilical cord blood, Castellano says, \"their performance wasn't very impressive.\" It took them a long time to learn and remember the location of the escape hole, and some of them didn't manage at all. \"But after cord plasma treatment, both the time [it took to] find it, the rate at which they'd find it and the fact that they \u003cem>do\u003c/em> find it was improved and changing,\" he says.\u003c/p>\n\u003cp>Similarly, mice treated with human umbilical cord blood performed better on a second memory test. That test involved introducing mice to a chamber and then delivering a little shock to their feet. Mice that remembered the unpleasant experience would, when re-introduced to the chamber, freeze in anticipation of the shock. A forgetful mouse, on the other hand, would go about its usual business.\u003c/p>\n\u003cp>Castellano says the mice that had received umbilical cord plasma froze more often.\u003c/p>\n\u003cp>\"We were, first of all, surprised and excited that there was something in human plasma, and more specifically there's something exciting about cord plasma,\" he says.\u003c/p>\n\u003cp>After a series of other experiments, Castellano and his colleagues concluded that one protein, called TIMP2, in human umbilical cord blood was likely responsible for the improvement.\u003c/p>\n\u003cp>When they removed TIMP2 from cord plasma and injected the plasma into mice, they didn't observe any improvement on the memory tests. And when they injected plasma containing TIMP2 into elderly mice, they again observed improvement in memory and learning tasks.\u003c/p>\n\u003cp>\"The really exciting thing about this study, and previous studies that have come before it, is that we've sort of tapped into previously unappreciated potential of our blood — our plasma — and what it can do for reversing the harmful effects of aging on the brain,\" says Castellano.\u003c/p>\n\u003cp>It's an intriguing hint at how potential therapies might someday work to prevent age-related illness, including Alzheimer's disease, from developing.\u003c/p>\n\u003cp>\"The desired outcome is overall whole body rejuvenation,\" says \u003ca href=\"http://www.sens.org/about/leadership/executive-team\">Aubrey de Grey\u003c/a>, a biomedical gerontologist who founded the \u003ca href=\"http://www.sens.org/\">SENS Research Foundation\u003c/a>.\u003c/p>\n\u003cp>The study by Castellano and colleagues, he says, is an \"excellent\" starting point.\u003c/p>\n\u003cp>\"The only thing, of course, is that it's a mouse experiment and mouse experiments often don't actually translate faithfully into the human setting,\" he says.\u003c/p>\n\u003cp>And Castellano agrees that this finding does not mean that people should start sprinkling TIMP2 protein on their cereal or signing up for an umbilical cord transfusions.\u003c/p>\n\u003cp>First off, he says, there's no evidence that elderly humans would experience the same effects as the mice did in this study. It's also unclear what would happen to mice if they received the plasma for more than just a few weeks.\u003c/p>\n\u003cp>There's also the nagging worry that, while proteins like TIMP2 may be beneficial for developing babies, they could be harmful in older humans.\u003c/p>\n\u003cp>\"Maybe there's a reason that older brains aren't exposed to certain proteins any longer,\" says Castellano.\u003c/p>\n\u003cp>And \u003ca href=\"http://vcresearch.berkeley.edu/faculty/irina-conboy\">Irina Conboy\u003c/a>, who studies aging and degenerative diseases at the University of California, Berkeley, points out that the TIMP2 protein is actually present in \u003ca href=\"http://www.jns-journal.com/article/S0022-510X(02)00398-2/abstract\">higher levels\u003c/a> in people with Alzheimer's disease.\u003c/p>\n\u003cp>That runs counter to the argument made by Castellano and colleagues that TIMP2 is associated with improved memory and learning, and that TIMP2 levels would drop as people age.\u003c/p>\n\u003cp>\"TIMP2 is a very well-known protein,\" she says. She also notes that one of Castellano's co-authors, Tony Wyss-Coray, is the board chair for a company called Alkahest, which has separately \u003ca href=\"https://clinicaltrials.gov/ct2/show/NCT02256306\">studied\u003c/a> plasma injections as a potential treatment for Alzheimer's.\u003c/p>\n\u003cp>And, Conboy says, there is no indication that the TIMP2 Castellano and colleagues detected in mouse brains actually came from the injections of human plasma. It's unclear, she says, if a protein in plasma could actually make its way from a mouse's bloodstream into its brain, or that, once there, it could actually impact brain function.\u003c/p>\n\u003cp>Last year, Conboy \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5121415/\">published a study\u003c/a> in which she and colleagues swapped half of the blood in old mice with that of young mice, and vice versa. They saw signs of regeneration in the muscles and liver.\u003c/p>\n\u003cp>But, says Conboy, \"There was zero positive effect on the brain. The mice were not smarter. They did not learn better.\"\u003c/p>\n\u003cp>Such conflicting results reflect two fundamentally different ways of thinking about aging.\u003c/p>\n\u003cp>From the point of view of Castellano and colleagues, aging involves a loss of beneficial materials; for example, diminishing amounts of proteins that were once present in the plasma.\u003c/p>\n\u003cp>To Conboy, however, \"The problem is not that you run out of positive things, but that you accumulate negative things.\"\u003c/p>\n\u003cp>She and others hold that proteins likely accumulate with old age, sometimes inhibiting certain functions, including the growth of new cells.\u003c/p>\n\u003cp>\"We have hundreds of proteins that change with age,\" she says, and finding a way to reduce the effects of aging will likely require tinkering with a huge bouquet of them.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\"If you are looking for miracles, it will not come from [injecting] bodily fluids,\" she says. \"There will not be one silver bullet.\"\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=Human+Umbilical+Cord+Blood+Helps+Aging+Mice+Remember%2C+Study+Finds&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Decades ago, scientists \u003ca href=\"http://onlinelibrary.wiley.com/doi/10.1111/j.2164-0947.1972.tb02712.x/abstract\">surgically attached\u003c/a> pairs of rats to each other and noticed that old rats tended to live longer if they shared a bloodstream with young rats.\u003c/p>\n\u003cp>It was the beginning of a peculiar and ambitious scientific endeavor to understand how certain materials from young bodies, when transplanted into older ones, can sometimes improve or rejuvenate them.\u003c/p>\n\u003cp>From the beginning, the findings were exciting, complex and, sometimes, contradictory. For example, scientists \u003ca href=\"https://www.nature.com/nature/journal/v433/n7027/full/nature03260.html\">have shown\u003c/a> that young blood can restore cell activity in the muscles and livers of aging mice. They've also \u003ca href=\"http://www.cell.com/abstract/S0092-8674(13)00456-X\">found that\u003c/a> linking old mice to young ones helped reverse heart muscle thickening.\u003c/p>\n\u003cp>On the other hand, researchers \u003ca href=\"http://circres.ahajournals.org/content/118/7/1143.long\">weren't able to replicate\u003c/a> those findings and \u003ca href=\"https://www.nature.com/articles/ncomms13363\">another study\u003c/a> concluded that, in mice that swapped blood without being connected surgically, the negative effects of being exposed to old blood outweighed the benefits of getting young blood.\u003c/p>\n\u003cp>What was clear was that, like humans, as mice age their bodies and their behavior change on a fundamental level. For example, older mice stop building nests, and they tend to become forgetful, taking a long time to remember how to escape from a maze, for example.\u003c/p>\n\u003caside class=\"pullquote alignright\">Researchers wondered, would young human blood aid aging mice?\u003c/aside>\n\u003cp>\"We see a pretty dramatic difference between young and aged mice in terms of their performance,\" says \u003ca href=\"https://profiles.stanford.edu/joseph-castellano\">Joe Castellano\u003c/a>, a neuroscientist at Stanford University School of Medicine.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Castellano and his colleagues wondered if young human blood might have beneficial effects for aging mice.\u003c/p>\n\u003cp>Now, they \u003ca href=\"https://www.nature.com/articles/doi:10.1038/nature22067\">report\u003c/a> in the journal \u003cem>Nature\u003c/em> that they've found a protein in human umbilical cord blood that improved learning and memory in aging mice. It's an exciting find in the field of regenerative medicine.\u003c/p>\n\u003cp>But, scientists caution, it does not mean people should start ordering umbilical cord blood online. There is no indication that it would work in humans.\u003c/p>\n\u003cp>For their study, Castellano and his colleagues collected plasma, which is the watery part of blood, from people of different ages. Some were in their sixties and seventies, others in their twenties. They also collected plasma from human umbilical cords.\u003c/p>\n\u003cp>Then, they injected human plasma from those different age groups and from umbilical cord blood into mice several times over the course of a couple weeks.\u003c/p>\n\u003cp>The mice were 12 and 14 months old, which is approximately the mouse equivalent of being in your late 50s or 60s.\u003c/p>\n\u003cp>When they dissected the mouse brains and inspected the hippocampi, they found that certain genes linked to making new memories had been turned on in some of the mice.\u003c/p>\n\u003cp>\"So, we had a hint early on that one of these donor groups, specifically the [umbilical] cord plasma, might be having an effect on the brain itself,\" he says.\u003c/p>\n\u003cp>Next, they injected more aging mice with human plasma and tested the animals' ability to remember things.\u003c/p>\n\u003cp>For example, they watched how long it took the mice to escape from a maze the mice had done before, using visual cues to choose an exit that would lead to safety.\u003c/p>\n\u003cp>Castellano says it's basically like observing a person try to navigate through a crowded garage to locate their parked car.\u003c/p>\n\u003cp>Before being injected with umbilical cord blood, Castellano says, \"their performance wasn't very impressive.\" It took them a long time to learn and remember the location of the escape hole, and some of them didn't manage at all. \"But after cord plasma treatment, both the time [it took to] find it, the rate at which they'd find it and the fact that they \u003cem>do\u003c/em> find it was improved and changing,\" he says.\u003c/p>\n\u003cp>Similarly, mice treated with human umbilical cord blood performed better on a second memory test. That test involved introducing mice to a chamber and then delivering a little shock to their feet. Mice that remembered the unpleasant experience would, when re-introduced to the chamber, freeze in anticipation of the shock. A forgetful mouse, on the other hand, would go about its usual business.\u003c/p>\n\u003cp>Castellano says the mice that had received umbilical cord plasma froze more often.\u003c/p>\n\u003cp>\"We were, first of all, surprised and excited that there was something in human plasma, and more specifically there's something exciting about cord plasma,\" he says.\u003c/p>\n\u003cp>After a series of other experiments, Castellano and his colleagues concluded that one protein, called TIMP2, in human umbilical cord blood was likely responsible for the improvement.\u003c/p>\n\u003cp>When they removed TIMP2 from cord plasma and injected the plasma into mice, they didn't observe any improvement on the memory tests. And when they injected plasma containing TIMP2 into elderly mice, they again observed improvement in memory and learning tasks.\u003c/p>\n\u003cp>\"The really exciting thing about this study, and previous studies that have come before it, is that we've sort of tapped into previously unappreciated potential of our blood — our plasma — and what it can do for reversing the harmful effects of aging on the brain,\" says Castellano.\u003c/p>\n\u003cp>It's an intriguing hint at how potential therapies might someday work to prevent age-related illness, including Alzheimer's disease, from developing.\u003c/p>\n\u003cp>\"The desired outcome is overall whole body rejuvenation,\" says \u003ca href=\"http://www.sens.org/about/leadership/executive-team\">Aubrey de Grey\u003c/a>, a biomedical gerontologist who founded the \u003ca href=\"http://www.sens.org/\">SENS Research Foundation\u003c/a>.\u003c/p>\n\u003cp>The study by Castellano and colleagues, he says, is an \"excellent\" starting point.\u003c/p>\n\u003cp>\"The only thing, of course, is that it's a mouse experiment and mouse experiments often don't actually translate faithfully into the human setting,\" he says.\u003c/p>\n\u003cp>And Castellano agrees that this finding does not mean that people should start sprinkling TIMP2 protein on their cereal or signing up for an umbilical cord transfusions.\u003c/p>\n\u003cp>First off, he says, there's no evidence that elderly humans would experience the same effects as the mice did in this study. It's also unclear what would happen to mice if they received the plasma for more than just a few weeks.\u003c/p>\n\u003cp>There's also the nagging worry that, while proteins like TIMP2 may be beneficial for developing babies, they could be harmful in older humans.\u003c/p>\n\u003cp>\"Maybe there's a reason that older brains aren't exposed to certain proteins any longer,\" says Castellano.\u003c/p>\n\u003cp>And \u003ca href=\"http://vcresearch.berkeley.edu/faculty/irina-conboy\">Irina Conboy\u003c/a>, who studies aging and degenerative diseases at the University of California, Berkeley, points out that the TIMP2 protein is actually present in \u003ca href=\"http://www.jns-journal.com/article/S0022-510X(02)00398-2/abstract\">higher levels\u003c/a> in people with Alzheimer's disease.\u003c/p>\n\u003cp>That runs counter to the argument made by Castellano and colleagues that TIMP2 is associated with improved memory and learning, and that TIMP2 levels would drop as people age.\u003c/p>\n\u003cp>\"TIMP2 is a very well-known protein,\" she says. She also notes that one of Castellano's co-authors, Tony Wyss-Coray, is the board chair for a company called Alkahest, which has separately \u003ca href=\"https://clinicaltrials.gov/ct2/show/NCT02256306\">studied\u003c/a> plasma injections as a potential treatment for Alzheimer's.\u003c/p>\n\u003cp>And, Conboy says, there is no indication that the TIMP2 Castellano and colleagues detected in mouse brains actually came from the injections of human plasma. It's unclear, she says, if a protein in plasma could actually make its way from a mouse's bloodstream into its brain, or that, once there, it could actually impact brain function.\u003c/p>\n\u003cp>Last year, Conboy \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5121415/\">published a study\u003c/a> in which she and colleagues swapped half of the blood in old mice with that of young mice, and vice versa. They saw signs of regeneration in the muscles and liver.\u003c/p>\n\u003cp>But, says Conboy, \"There was zero positive effect on the brain. The mice were not smarter. They did not learn better.\"\u003c/p>\n\u003cp>Such conflicting results reflect two fundamentally different ways of thinking about aging.\u003c/p>\n\u003cp>From the point of view of Castellano and colleagues, aging involves a loss of beneficial materials; for example, diminishing amounts of proteins that were once present in the plasma.\u003c/p>\n\u003cp>To Conboy, however, \"The problem is not that you run out of positive things, but that you accumulate negative things.\"\u003c/p>\n\u003cp>She and others hold that proteins likely accumulate with old age, sometimes inhibiting certain functions, including the growth of new cells.\u003c/p>\n\u003cp>\"We have hundreds of proteins that change with age,\" she says, and finding a way to reduce the effects of aging will likely require tinkering with a huge bouquet of them.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"If you are looking for miracles, it will not come from [injecting] bodily fluids,\" she says. \"There will not be one silver bullet.\"\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=Human+Umbilical+Cord+Blood+Helps+Aging+Mice+Remember%2C+Study+Finds&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Theranos Will Pay Millions to Arizonans, Settles With Feds",
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"content": "\u003cp>Embattled diagnostics startup Theranos said it will return $4.65 million to Arizona residents for the blood testing services they received between 2013 and 2016.\u003c/p>\n\u003cp>“Everyone who paid for a test will receive a full refund, period,” Arizona Attorney General Mark Brnovich said in a statement. Some 1.5 million blood tests were performed on 175,000 customers — and more than 10 percent were ultimately voided.\u003c/p>\n\u003cp>The deal, made with the Arizona attorney general’s office, is Theranos’s second for the week: The Silicon Valley company also told the Centers for Medicare and Medicaid Services that it wouldn’t conduct any blood testing for at least two years, in exchange for pared-down penalties from federal health authorities.\u003c/p>\n\u003cp>As part of the new deal, Theranos also agreed to not operate a CLIA-certified lab in Arizona for two years, starting March 28, 2017. It will pay the attorney general’s office $200,000 in civil penalties, and $25,000 in legal fees.\u003c/p>\n\u003cp>Theranos, launched in 2003 by CEO Elizabeth Holmes, once had grand plans to revolutionize the diagnostics industry. The company claimed that its technology could run hundreds of lab tests with a single drop of blood. It partnered with Walgreens to create a network of Wellness Centers across Arizona and California, aiming to expand the direct-to-consumer diagnostics market.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>But a series of damning media reports, beginning in late 2015, reversed the course of the once-promising diagnostics startup — and last summer, CMS found that Theranos’s practices in its California lab led to “immediate jeopardy to patient health and safety.” Federal health authorities banned Holmes from owning or operating a lab for two years, and Walgreens ended its partnership with Theranos — closing down the 40 Wellness Centers in Arizona and California.\u003c/p>\n\u003cp>It has since switched gears, and is developing a “miniLab” device that it claims will miniaturize the entire diagnostics process into a small, table-top device.\u003c/p>\n\u003cp>In January, the Arizona attorney general’s office began gearing up to launch a lawsuit against Theranos and its subsidiaries, alleging consumer fraud. It claimed that Theranos violated the Arizona Consumer Fraud Act, thanks to a “long-running scheme of deceptive acts and misrepresentations relating to the capabilities of Theranos blood testing equipment.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This \u003ca href=\"https://www.statnews.com/2017/04/18/theranos-return-every-dollar-made-tests-arizona/\" target=\"_blank\">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>Embattled diagnostics startup Theranos said it will return $4.65 million to Arizona residents for the blood testing services they received between 2013 and 2016.\u003c/p>\n\u003cp>“Everyone who paid for a test will receive a full refund, period,” Arizona Attorney General Mark Brnovich said in a statement. Some 1.5 million blood tests were performed on 175,000 customers — and more than 10 percent were ultimately voided.\u003c/p>\n\u003cp>The deal, made with the Arizona attorney general’s office, is Theranos’s second for the week: The Silicon Valley company also told the Centers for Medicare and Medicaid Services that it wouldn’t conduct any blood testing for at least two years, in exchange for pared-down penalties from federal health authorities.\u003c/p>\n\u003cp>As part of the new deal, Theranos also agreed to not operate a CLIA-certified lab in Arizona for two years, starting March 28, 2017. It will pay the attorney general’s office $200,000 in civil penalties, and $25,000 in legal fees.\u003c/p>\n\u003cp>Theranos, launched in 2003 by CEO Elizabeth Holmes, once had grand plans to revolutionize the diagnostics industry. The company claimed that its technology could run hundreds of lab tests with a single drop of blood. It partnered with Walgreens to create a network of Wellness Centers across Arizona and California, aiming to expand the direct-to-consumer diagnostics market.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>But a series of damning media reports, beginning in late 2015, reversed the course of the once-promising diagnostics startup — and last summer, CMS found that Theranos’s practices in its California lab led to “immediate jeopardy to patient health and safety.” Federal health authorities banned Holmes from owning or operating a lab for two years, and Walgreens ended its partnership with Theranos — closing down the 40 Wellness Centers in Arizona and California.\u003c/p>\n\u003cp>It has since switched gears, and is developing a “miniLab” device that it claims will miniaturize the entire diagnostics process into a small, table-top device.\u003c/p>\n\u003cp>In January, the Arizona attorney general’s office began gearing up to launch a lawsuit against Theranos and its subsidiaries, alleging consumer fraud. It claimed that Theranos violated the Arizona Consumer Fraud Act, thanks to a “long-running scheme of deceptive acts and misrepresentations relating to the capabilities of Theranos blood testing equipment.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This \u003ca href=\"https://www.statnews.com/2017/04/18/theranos-return-every-dollar-made-tests-arizona/\" target=\"_blank\">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": "After Compulsively Watching YouTube, Teen Girl Lands in Rehab",
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"content": "\u003cp>When her youngest daughter, Olivia, was in middle school, Mary watched her disappear behind a screen. (Names have been changed to protect the family's identities). Her once bubbly daughter went from hanging out with a few close friends after school to isolating in her room for hours at a time.\u003c/p>\n\u003cp>\"She started just laying there not moving and just being on the phone,\" says Mary. \"I was at a loss about what to do.\"\u003c/p>\n\u003caside class=\"pullquote alignright\">'I got the idea to overdose online. I was researching how many pills I had to take to die.'\u003ccite>Olivia, 13\u003c/cite>\u003c/aside>\n\u003cp>Olivia had always been kind of a nerd, a straight-A student who sang in a competitive choir. But she desperately wanted to be popular, and the cool kids talked \u003cem>a lot\u003c/em> about their latest YouTube favorites.\u003c/p>\n\u003cp>“I started trying to watch as many videos as I could, so, like, I knew as much as they did,” says Olivia. “The second I got out of school, I was checking my phone.”\u003c/p>\n\u003cp>At her house in the Oakland hills, Olivia would dart to her room, where she’d curl up until after dark, watching video after video. When she finally emerged, she says, she was often bleary-eyed, hazy and slightly wired.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Mary says she was walking on eggshells around her daughter; Olivia was often in a foul mood and quick to anger after staring at her small screen for hours.\u003c/p>\n\u003cp>\u003cstrong>Videos Turn Violent\u003c/strong>\u003c/p>\n\u003cp>Over time, Olivia started watching videos of girls fighting each other. They'd pull each other's hair, scratch violently and sometimes knock each other out. Olivia and her friends rooted for certain fighters.\u003c/p>\n\u003cp>\"I think it was just fun to watch because they would make me laugh,\" Olivia recalls. \"And at that time I was having a pretty hard time dealing with depression and anxiety.”\u003c/p>\n\u003cp>Olivia’s parents were arguing a lot and she wasn’t connecting with her dad at all. Then her grandmother died. For the first time in her life, it was tough to keep up with school.\u003c/p>\n\u003cp>[contextly_sidebar id=\"GyRdLxMHzfLU2EZ6BrI84PTmEB6oG8LQ\"]“She woke up one morning really depressed, and I brought her to the hospital,\" Mary says, lowering her eyes. Olivia had received a poor grade on a test and told her mom she wanted to hang herself, so she spent nearly a week at a psychiatric hospital under suicide watch.\u003c/p>\n\u003cp>When she was released, she started clicking on how-to videos about ways to commit suicide. “I got the idea to overdose online,\" says Olivia. \"I was researching how many pills I had to take to die.\"\u003c/p>\n\u003cp>Three weeks later, she ended up in the hospital again after downing a bottle of Tylenol.\u003c/p>\n\u003cp>\"She was home alone and we had been told to lock it up, but we just didn’t think this would ever happen,\" says Mary, who is now in tears.\u003c/p>\n\u003cp>Olivia's parents were shattered, and desperate to find a way to help their daughter.\u003c/p>\n\u003cfigure id=\"attachment_375516\" class=\"wp-caption alignright\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-375516\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/04/Olivia-800x533.jpg\" alt=\"Olivia plugged in to all her devices. \" width=\"800\" height=\"533\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/04/Olivia-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Olivia-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Olivia-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Olivia-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Olivia-1920x1280.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Olivia-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Olivia-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Olivia-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Olivia-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Olivia-520x347.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Olivia, plugged in to all her devices. \u003ccite>(Paradigm)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>Road to Recovery \u003c/strong>\u003c/p>\n\u003cp>When Olivia was released from her second hospital stay, her family checked her into an addiction recovery center for teens called \u003ca href=\"http://paradigmsanfrancisco.com/\" target=\"_blank\" rel=\"noopener noreferrer\">Paradigm\u003c/a>. The high-end facility is a converted mansion at the end of a winding road in San Rafael. The family is tapping their retirement accounts to pay the $60,000 fee for Olivia’s six-week, in-patient stay.\u003c/p>\n\u003cp>Jeff Nalin, head psychologist and co-founder of Paradigm, has been treating teens for substance abuse for more than 20 years. In the last few, he says, he’s seen an increasing number of cases similar to Olivia's. She was diagnosed with depression that led to compulsive internet use.\u003c/p>\n\u003cp>The teens are using smartphones and tablets for the same reasons they’d turn to hard drugs \u003cspan style=\"font-weight: 400\">— \u003c/span>\u003cspan style=\"line-height: 1.5\">to numb themselves from what’s really going on inside, he said. \u003c/span>\u003c/p>\n\u003cp>\"I describe a lot of the kids that we see as having just stuck a cork in the volcano,” says Nalin. “Underneath there's this rumbling going on, but it just rumbles and rumbles until it blows. And it blows with the emergence of a depression or it emerges with a suicide attempt.”\u003c/p>\n\u003cp>Most teens come to Paradigm because they've hit bottom in the same way an addict will. But the treatment for internet addiction is trickier, because you can’t really function in today's society without interacting with the digital world.\u003c/p>\n\u003cp>“The best analogy is when you have something like an eating disorder,\" says Nalin. \"You cannot be clean and sober from food. So, you have to learn the skills to deal with it.”\u003c/p>\n\u003cp>\u003cstrong>When Does Obsession Become Addiction?\u003cbr>\n\u003c/strong>\u003c/p>\n\u003cp>Digital addictions, whether to social media, video games, texting, shopping or pornography, are not official mental disorders listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM). But researchers see the same patterns in digital addictions as in other substance abuse.\u003c/p>\n\u003cp>“Addiction begins with intermittent to recreational use, then progresses into daily use, and then progresses into consequential use, which in some cases will progress to life-threatening use,” says Anna Lembke, a Stanford University psychiatrist and addiction expert. “That’s followed by a pattern of consequences like insomnia, dysfunctional relationships and absent days at work or school. That’s the natural narrative arc of any addiction, and the same is true with an internet addiction.”\u003c/p>\n\u003caside class=\"pullquote alignright\">'There are studies that have looked at people's brains while they're online, and their brains start looking like those of someone who has a substance use disorder. Similar pathways seem activated.'\u003ccite>Elias Aboujaoude,\u003cbr>\nStanford University\u003c/cite>\u003c/aside>\n\u003cp>China has labeled internet addiction as a mental disorder, and that's surprising \u003cspan style=\"font-weight: 400\">— \u003c/span>historically the Chinese have called addiction a moral failing rather than a clinical disorder.\u003c/p>\n\u003cp>Some experts attribute China's change in attitude to the widespread involvement of middle- and upper-class Chinese adolescents in addictive behavior. “A little like our opioid addiction here,\" says Lembke. \"People say no one cared about the opioid epidemic until it affected white suburban kids.”\u003c/p>\n\u003cp>Lembke predicts internet addiction will become a validated clinical diagnosis in the U.S. as more and more cases mirror Olivia’s.\u003c/p>\n\u003cp>Dr. Elias Aboujaoude, a psychiatrist and the director of Stanford's Obsessive Compulsive Disorder Clinic, says there’s also increasing physiological evidence that the internet is addictive. “There are studies that have looked at people's brains while they're online, and their brains start looking like those of someone who has a substance abuse disorder. Similar pathways seem activated.”\u003c/p>\n\u003cp>He also says feel-good brain chemicals like dopamine that spike in a heroin addict also become elevated in people who compulsively use the internet. Tolerance also builds, says Aboujaoude, just as it does with hard drugs. “People needing more and more time on a particular online video game, for example, to get the same kind of euphoric feeling.”\u003c/p>\n\u003cp>Psychologists are still studying whether it is the internet itself that is addictive or specific behaviors people engage in while online, like shopping, video games, pornography and gambling.\u003c/p>\n\u003cp>\"My view is that it is both,\" says Aboujaoude. \"These behaviors have long been known to be addictive, but the internet, in part by making them so easily accessible, changes the equation and increases the likelihood that they will become addictive.\"\u003c/p>\n\u003cp>Some experts compare internet addiction to gambling addiction. Even though most of the time when you sit in front of a slot machine you don’t win, every once in a while you do. And that intermittent reward is what hooks people.\u003c/p>\n\u003cp>Think about your own devices. Most of the time when your phone dings, the notification is about something trivial, but every once in a while it's meaningful \u003cspan style=\"font-weight: 400\">— \u003c/span>like an alert that someone has tagged you in a Facebook photo. Experts say that kind of message is irresistible.\u003c/p>\n\u003caside class=\"pullquote alignright\">'If we see kids playing video games or watching YouTube videos, in our eyes it’s as if they’re wasting their time and not being productive ... But for that generation, that’s their pixelated playground.\u003ccite>Patrick Markey, professor of psychology, Villanova University\u003c/cite>\u003c/aside>\n\u003cp>Still, not everyone is convinced that \"addiction\" is the right way to think about this compulsion. \u003ca href=\"http://www.stetson.edu/other/faculty/profiles/christopher-ferguson.php\">Chris Ferguson\u003c/a>, a psychologist at Stetson University, believes moral panic is fueling the rush to label the problem an addiction. \"Sometimes with new technology you see these heightened claims of harm, these exaggerated focuses on the detriment of the new media.\"\u003c/p>\n\u003cp>\u003ca href=\"http://interpersonalresearch.weebly.com/dr-patrick-markey.html\">Patrick Markey\u003c/a>, a professor of psychology at Villanova University, agrees that society should go slow in using the \"addiction\" label. He worries some researchers are casting an age bias on younger generations.\u003c/p>\n\u003cp>\"If we see kids playing video games or watching YouTube videos, in our eyes it's as if they're wasting their time and not being productive,\" Markey says. \"We might want them to be outside playing baseball or something, but for that generation that's their pixelated playground. It might not be a sign of a pathological behavior.\"\u003c/p>\n\u003cp>Markey acknowledges it's possible to spend too much time interacting with a screen. But both he and Ferguson believe that spending long hours on the internet falls into the same category as other behaviors that healthy people can overindulge in — like sex, food, exercise, religion and work.\u003c/p>\n\u003cp>\"There's no agreement about whether these pathological behavioral disorders are really the same things as substance abuse addictions,\" says Ferguson. \"But in my opinion they're not comparable to, say, methamphetamine addiction or heroin addiction.\"\u003c/p>\n\u003cp>\u003cstrong>A Crusade for Change\u003c/strong>\u003c/p>\n\u003cp>Even as researchers debate whether the internet is clinically addictive, many if not most of us feel tethered to our devices. That's not a coincidence. Tech companies are invested in hooking people into spending more and more time online, and they're getting better and better at it, says Tristan Harris, a former design ethicist at Google. His job, he says, was to help the company create products that \u003cem>weren't\u003c/em> inherently manipulative.\u003c/p>\n\u003cp>“When you look at the Facebook news feed, it's not just some neutral thing,\" Harris explains. \"That’s powered by massive farms of computers who are calculating with Ph.D.s and large data sets: how I can get you to scroll.”\u003c/p>\n\u003cp>Harris quit Google to form a nonprofit called \u003ca href=\"http://www.timewellspent.io/\" target=\"_blank\" rel=\"noopener noreferrer\">Time Well Spent\u003c/a>, because, he says, he was disgusted by the tech industry’s race for our attention.\u003c/p>\n\u003cp>“Never before in history have a handful of technology designers working at three tech companies influenced how a billion people spend their attention,” Harris says.\u003c/p>\n\u003cp>He's on a crusade to inspire Facebook, Google and Apple to design products that don’t deliberately manipulate kids like Olivia.\u003c/p>\n\u003cp>Back at Paradigm, Olivia is getting ready for a session with her therapist, who will help her integrate her devices back into her life. Olivia says she’s petrified to check her Instagram and Snapchat accounts when she powers up her phone for the first time. “I'm worried about when I do go back on my phone what’s going to be there,\" Olivia says in a trembling voice. \"What have people been sending me?\"\u003c/p>\n\u003cp>When she returns to school this week, Olivia says she doesn't plan to isolate herself again. In fact, she's asked her mom to restrict her phone use, so that she can't use the phone when she's alone. Instead, she’ll be talking to her therapist about what's going in her life, in outpatient treatment after school four days a week, for at least another month.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This post has been edited.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>When her youngest daughter, Olivia, was in middle school, Mary watched her disappear behind a screen. (Names have been changed to protect the family's identities). Her once bubbly daughter went from hanging out with a few close friends after school to isolating in her room for hours at a time.\u003c/p>\n\u003cp>\"She started just laying there not moving and just being on the phone,\" says Mary. \"I was at a loss about what to do.\"\u003c/p>\n\u003caside class=\"pullquote alignright\">'I got the idea to overdose online. I was researching how many pills I had to take to die.'\u003ccite>Olivia, 13\u003c/cite>\u003c/aside>\n\u003cp>Olivia had always been kind of a nerd, a straight-A student who sang in a competitive choir. But she desperately wanted to be popular, and the cool kids talked \u003cem>a lot\u003c/em> about their latest YouTube favorites.\u003c/p>\n\u003cp>“I started trying to watch as many videos as I could, so, like, I knew as much as they did,” says Olivia. “The second I got out of school, I was checking my phone.”\u003c/p>\n\u003cp>At her house in the Oakland hills, Olivia would dart to her room, where she’d curl up until after dark, watching video after video. When she finally emerged, she says, she was often bleary-eyed, hazy and slightly wired.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Mary says she was walking on eggshells around her daughter; Olivia was often in a foul mood and quick to anger after staring at her small screen for hours.\u003c/p>\n\u003cp>\u003cstrong>Videos Turn Violent\u003c/strong>\u003c/p>\n\u003cp>Over time, Olivia started watching videos of girls fighting each other. They'd pull each other's hair, scratch violently and sometimes knock each other out. Olivia and her friends rooted for certain fighters.\u003c/p>\n\u003cp>\"I think it was just fun to watch because they would make me laugh,\" Olivia recalls. \"And at that time I was having a pretty hard time dealing with depression and anxiety.”\u003c/p>\n\u003cp>Olivia’s parents were arguing a lot and she wasn’t connecting with her dad at all. Then her grandmother died. For the first time in her life, it was tough to keep up with school.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>“She woke up one morning really depressed, and I brought her to the hospital,\" Mary says, lowering her eyes. Olivia had received a poor grade on a test and told her mom she wanted to hang herself, so she spent nearly a week at a psychiatric hospital under suicide watch.\u003c/p>\n\u003cp>When she was released, she started clicking on how-to videos about ways to commit suicide. “I got the idea to overdose online,\" says Olivia. \"I was researching how many pills I had to take to die.\"\u003c/p>\n\u003cp>Three weeks later, she ended up in the hospital again after downing a bottle of Tylenol.\u003c/p>\n\u003cp>\"She was home alone and we had been told to lock it up, but we just didn’t think this would ever happen,\" says Mary, who is now in tears.\u003c/p>\n\u003cp>Olivia's parents were shattered, and desperate to find a way to help their daughter.\u003c/p>\n\u003cfigure id=\"attachment_375516\" class=\"wp-caption alignright\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-375516\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/04/Olivia-800x533.jpg\" alt=\"Olivia plugged in to all her devices. \" width=\"800\" height=\"533\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/04/Olivia-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Olivia-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Olivia-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Olivia-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Olivia-1920x1280.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Olivia-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Olivia-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Olivia-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Olivia-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Olivia-520x347.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Olivia, plugged in to all her devices. \u003ccite>(Paradigm)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>Road to Recovery \u003c/strong>\u003c/p>\n\u003cp>When Olivia was released from her second hospital stay, her family checked her into an addiction recovery center for teens called \u003ca href=\"http://paradigmsanfrancisco.com/\" target=\"_blank\" rel=\"noopener noreferrer\">Paradigm\u003c/a>. The high-end facility is a converted mansion at the end of a winding road in San Rafael. The family is tapping their retirement accounts to pay the $60,000 fee for Olivia’s six-week, in-patient stay.\u003c/p>\n\u003cp>Jeff Nalin, head psychologist and co-founder of Paradigm, has been treating teens for substance abuse for more than 20 years. In the last few, he says, he’s seen an increasing number of cases similar to Olivia's. She was diagnosed with depression that led to compulsive internet use.\u003c/p>\n\u003cp>The teens are using smartphones and tablets for the same reasons they’d turn to hard drugs \u003cspan style=\"font-weight: 400\">— \u003c/span>\u003cspan style=\"line-height: 1.5\">to numb themselves from what’s really going on inside, he said. \u003c/span>\u003c/p>\n\u003cp>\"I describe a lot of the kids that we see as having just stuck a cork in the volcano,” says Nalin. “Underneath there's this rumbling going on, but it just rumbles and rumbles until it blows. And it blows with the emergence of a depression or it emerges with a suicide attempt.”\u003c/p>\n\u003cp>Most teens come to Paradigm because they've hit bottom in the same way an addict will. But the treatment for internet addiction is trickier, because you can’t really function in today's society without interacting with the digital world.\u003c/p>\n\u003cp>“The best analogy is when you have something like an eating disorder,\" says Nalin. \"You cannot be clean and sober from food. So, you have to learn the skills to deal with it.”\u003c/p>\n\u003cp>\u003cstrong>When Does Obsession Become Addiction?\u003cbr>\n\u003c/strong>\u003c/p>\n\u003cp>Digital addictions, whether to social media, video games, texting, shopping or pornography, are not official mental disorders listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM). But researchers see the same patterns in digital addictions as in other substance abuse.\u003c/p>\n\u003cp>“Addiction begins with intermittent to recreational use, then progresses into daily use, and then progresses into consequential use, which in some cases will progress to life-threatening use,” says Anna Lembke, a Stanford University psychiatrist and addiction expert. “That’s followed by a pattern of consequences like insomnia, dysfunctional relationships and absent days at work or school. That’s the natural narrative arc of any addiction, and the same is true with an internet addiction.”\u003c/p>\n\u003caside class=\"pullquote alignright\">'There are studies that have looked at people's brains while they're online, and their brains start looking like those of someone who has a substance use disorder. Similar pathways seem activated.'\u003ccite>Elias Aboujaoude,\u003cbr>\nStanford University\u003c/cite>\u003c/aside>\n\u003cp>China has labeled internet addiction as a mental disorder, and that's surprising \u003cspan style=\"font-weight: 400\">— \u003c/span>historically the Chinese have called addiction a moral failing rather than a clinical disorder.\u003c/p>\n\u003cp>Some experts attribute China's change in attitude to the widespread involvement of middle- and upper-class Chinese adolescents in addictive behavior. “A little like our opioid addiction here,\" says Lembke. \"People say no one cared about the opioid epidemic until it affected white suburban kids.”\u003c/p>\n\u003cp>Lembke predicts internet addiction will become a validated clinical diagnosis in the U.S. as more and more cases mirror Olivia’s.\u003c/p>\n\u003cp>Dr. Elias Aboujaoude, a psychiatrist and the director of Stanford's Obsessive Compulsive Disorder Clinic, says there’s also increasing physiological evidence that the internet is addictive. “There are studies that have looked at people's brains while they're online, and their brains start looking like those of someone who has a substance abuse disorder. Similar pathways seem activated.”\u003c/p>\n\u003cp>He also says feel-good brain chemicals like dopamine that spike in a heroin addict also become elevated in people who compulsively use the internet. Tolerance also builds, says Aboujaoude, just as it does with hard drugs. “People needing more and more time on a particular online video game, for example, to get the same kind of euphoric feeling.”\u003c/p>\n\u003cp>Psychologists are still studying whether it is the internet itself that is addictive or specific behaviors people engage in while online, like shopping, video games, pornography and gambling.\u003c/p>\n\u003cp>\"My view is that it is both,\" says Aboujaoude. \"These behaviors have long been known to be addictive, but the internet, in part by making them so easily accessible, changes the equation and increases the likelihood that they will become addictive.\"\u003c/p>\n\u003cp>Some experts compare internet addiction to gambling addiction. Even though most of the time when you sit in front of a slot machine you don’t win, every once in a while you do. And that intermittent reward is what hooks people.\u003c/p>\n\u003cp>Think about your own devices. Most of the time when your phone dings, the notification is about something trivial, but every once in a while it's meaningful \u003cspan style=\"font-weight: 400\">— \u003c/span>like an alert that someone has tagged you in a Facebook photo. Experts say that kind of message is irresistible.\u003c/p>\n\u003caside class=\"pullquote alignright\">'If we see kids playing video games or watching YouTube videos, in our eyes it’s as if they’re wasting their time and not being productive ... But for that generation, that’s their pixelated playground.\u003ccite>Patrick Markey, professor of psychology, Villanova University\u003c/cite>\u003c/aside>\n\u003cp>Still, not everyone is convinced that \"addiction\" is the right way to think about this compulsion. \u003ca href=\"http://www.stetson.edu/other/faculty/profiles/christopher-ferguson.php\">Chris Ferguson\u003c/a>, a psychologist at Stetson University, believes moral panic is fueling the rush to label the problem an addiction. \"Sometimes with new technology you see these heightened claims of harm, these exaggerated focuses on the detriment of the new media.\"\u003c/p>\n\u003cp>\u003ca href=\"http://interpersonalresearch.weebly.com/dr-patrick-markey.html\">Patrick Markey\u003c/a>, a professor of psychology at Villanova University, agrees that society should go slow in using the \"addiction\" label. He worries some researchers are casting an age bias on younger generations.\u003c/p>\n\u003cp>\"If we see kids playing video games or watching YouTube videos, in our eyes it's as if they're wasting their time and not being productive,\" Markey says. \"We might want them to be outside playing baseball or something, but for that generation that's their pixelated playground. It might not be a sign of a pathological behavior.\"\u003c/p>\n\u003cp>Markey acknowledges it's possible to spend too much time interacting with a screen. But both he and Ferguson believe that spending long hours on the internet falls into the same category as other behaviors that healthy people can overindulge in — like sex, food, exercise, religion and work.\u003c/p>\n\u003cp>\"There's no agreement about whether these pathological behavioral disorders are really the same things as substance abuse addictions,\" says Ferguson. \"But in my opinion they're not comparable to, say, methamphetamine addiction or heroin addiction.\"\u003c/p>\n\u003cp>\u003cstrong>A Crusade for Change\u003c/strong>\u003c/p>\n\u003cp>Even as researchers debate whether the internet is clinically addictive, many if not most of us feel tethered to our devices. That's not a coincidence. Tech companies are invested in hooking people into spending more and more time online, and they're getting better and better at it, says Tristan Harris, a former design ethicist at Google. His job, he says, was to help the company create products that \u003cem>weren't\u003c/em> inherently manipulative.\u003c/p>\n\u003cp>“When you look at the Facebook news feed, it's not just some neutral thing,\" Harris explains. \"That’s powered by massive farms of computers who are calculating with Ph.D.s and large data sets: how I can get you to scroll.”\u003c/p>\n\u003cp>Harris quit Google to form a nonprofit called \u003ca href=\"http://www.timewellspent.io/\" target=\"_blank\" rel=\"noopener noreferrer\">Time Well Spent\u003c/a>, because, he says, he was disgusted by the tech industry’s race for our attention.\u003c/p>\n\u003cp>“Never before in history have a handful of technology designers working at three tech companies influenced how a billion people spend their attention,” Harris says.\u003c/p>\n\u003cp>He's on a crusade to inspire Facebook, Google and Apple to design products that don’t deliberately manipulate kids like Olivia.\u003c/p>\n\u003cp>Back at Paradigm, Olivia is getting ready for a session with her therapist, who will help her integrate her devices back into her life. Olivia says she’s petrified to check her Instagram and Snapchat accounts when she powers up her phone for the first time. “I'm worried about when I do go back on my phone what’s going to be there,\" Olivia says in a trembling voice. \"What have people been sending me?\"\u003c/p>\n\u003cp>When she returns to school this week, Olivia says she doesn't plan to isolate herself again. In fact, she's asked her mom to restrict her phone use, so that she can't use the phone when she's alone. Instead, she’ll be talking to her therapist about what's going in her life, in outpatient treatment after school four days a week, for at least another month.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>Scientists at the University of California, Berkeley have filed an appeal to overturn \u003ca href=\"https://ww2.kqed.org/futureofyou/2017/02/16/broad-institute-wins-decision-over-uc-berkeley-in-crispr-patent-battle/\" target=\"_blank\">a decision\u003c/a> by the \u003ca href=\"https://www.broadinstitute.org/\" target=\"_blank\">Patent Trial and Appeal Board\u003c/a> filed in mid-February. The board granted a patent to UC for CRISPR-Cas9 gene-editing in bacterial cells, but awarded a separate a patent to the East-Coast based \u003ca href=\"https://www.broadinstitute.org/\" target=\"_blank\">Broad Institute\u003c/a>, jointly owned by Harvard and MIT, for CRISPR's use in plant and animal cells.\u003c/p>\n\u003cp>UC believes they were the first inventors and should have the patent for use in all applications.\u003c/p>\n\u003cp>\"We expect to establish definitively that the team led by [UC's] Jennifer Doudna and Emmanuelle Charpentier was the first to engineer CRISPR-Cas9 for use in all types of environments, including in non-cellular settings and within plant, animal and even human cells,” said Edward Penhoet, associate dean of biology at UC Berkeley \u003ca href=\"http://news.berkeley.edu/2017/04/13/uc-appeals-u-s-patent-board-decision-on-crispr-cas9/\" target=\"_blank\">in a statement\u003c/a>.\u003c/p>\n\u003cp>In \u003ca href=\"https://www.broadinstitute.org/crispr/journalists-statement-and-background-crispr-patent-process\" target=\"_blank\">a separate statement\u003c/a>, the Broad Institute says they expect the outcome of the appeal to remain the same.\u003c/p>\n\u003cp>Billions are at stake. The patent for CRISPR gene editing will make whoever holds it a powerful player in the biomed industry, university research and the future of medicine.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>For background on the patent dispute, and the new era of gene editing, catch our previous reporting.\u003c/p>\n\u003cp>\u003ca href=\"https://ww2.kqed.org/futureofyou/2016/01/15/crispr-patent-war-billions-at-stake-for-uc-berkeley/\" target=\"_blank\">CRISPR Patent War: Billions at Stake for UC Berkeley\u003c/a> (Jan. 15, 2016 )\u003c/p>\n\u003cp>\u003ca href=\"https://ww2.kqed.org/futureofyou/2017/02/23/crispr-patent-ruling-3-different-takes/\" target=\"_blank\">CRISPR Patent Ruling: 3 Different Takes\u003c/a> (Feb. 23, 2017)\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"https://ww2.kqed.org/futureofyou/2016/04/29/how-a-new-crisprcas9-technique-may-get-us-closer-to-curing-genetic-diseases/\" target=\"_blank\">How New CRISPR/Cas9 Technique Could Be a Game Changer in Curing Genetic Diseases\u003c/a> (Apr. 29, 2016)\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Scientists at the University of California, Berkeley have filed an appeal to overturn \u003ca href=\"https://ww2.kqed.org/futureofyou/2017/02/16/broad-institute-wins-decision-over-uc-berkeley-in-crispr-patent-battle/\" target=\"_blank\">a decision\u003c/a> by the \u003ca href=\"https://www.broadinstitute.org/\" target=\"_blank\">Patent Trial and Appeal Board\u003c/a> filed in mid-February. The board granted a patent to UC for CRISPR-Cas9 gene-editing in bacterial cells, but awarded a separate a patent to the East-Coast based \u003ca href=\"https://www.broadinstitute.org/\" target=\"_blank\">Broad Institute\u003c/a>, jointly owned by Harvard and MIT, for CRISPR's use in plant and animal cells.\u003c/p>\n\u003cp>UC believes they were the first inventors and should have the patent for use in all applications.\u003c/p>\n\u003cp>\"We expect to establish definitively that the team led by [UC's] Jennifer Doudna and Emmanuelle Charpentier was the first to engineer CRISPR-Cas9 for use in all types of environments, including in non-cellular settings and within plant, animal and even human cells,” said Edward Penhoet, associate dean of biology at UC Berkeley \u003ca href=\"http://news.berkeley.edu/2017/04/13/uc-appeals-u-s-patent-board-decision-on-crispr-cas9/\" target=\"_blank\">in a statement\u003c/a>.\u003c/p>\n\u003cp>In \u003ca href=\"https://www.broadinstitute.org/crispr/journalists-statement-and-background-crispr-patent-process\" target=\"_blank\">a separate statement\u003c/a>, the Broad Institute says they expect the outcome of the appeal to remain the same.\u003c/p>\n\u003cp>Billions are at stake. The patent for CRISPR gene editing will make whoever holds it a powerful player in the biomed industry, university research and the future of medicine.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>For background on the patent dispute, and the new era of gene editing, catch our previous reporting.\u003c/p>\n\u003cp>\u003ca href=\"https://ww2.kqed.org/futureofyou/2016/01/15/crispr-patent-war-billions-at-stake-for-uc-berkeley/\" target=\"_blank\">CRISPR Patent War: Billions at Stake for UC Berkeley\u003c/a> (Jan. 15, 2016 )\u003c/p>\n\u003cp>\u003ca href=\"https://ww2.kqed.org/futureofyou/2017/02/23/crispr-patent-ruling-3-different-takes/\" target=\"_blank\">CRISPR Patent Ruling: 3 Different Takes\u003c/a> (Feb. 23, 2017)\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"https://ww2.kqed.org/futureofyou/2016/04/29/how-a-new-crisprcas9-technique-may-get-us-closer-to-curing-genetic-diseases/\" target=\"_blank\">How New CRISPR/Cas9 Technique Could Be a Game Changer in Curing Genetic Diseases\u003c/a> (Apr. 29, 2016)\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Lab Rats are Not Little People -- But Science Assumes That They Are",
"title": "Lab Rats are Not Little People -- But Science Assumes That They Are",
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"content": "\u003cp>Most potential new drugs fail when they're tested in people. These failures are not only a major disappointment, they sharply drive up the cost of developing new drugs.\u003c/p>\n\u003cp>A major reason for these failures is that most new drugs are first tested out in mice, rats or other animals. Often those animal studies show great promise.\u003c/p>\n\u003cp>But mice aren't simply furry little people, so these studies often lead science astray. Some scientists are now rethinking animal studies to make them more effective for human health.\u003c/p>\n\u003cp>When scientists first started using animals in research over a century ago, the animals were not regarded as human stand-ins. Scientists studying rats were initially trying to understand rats, says \u003ca href=\"http://www.yerkes.emory.edu/research/divisions/neuropharmacology_neurologic_diseases/preuss_todd.html\">Todd Preuss\u003c/a>, an anthropologist at the Yerkes National Primate Research Center at Emory University.\u003c/p>\n\u003cp>\"As this process went on, people stopped seeing them as specialized animals and started seeing them more and more as prototypical mammals,\" Preuss says.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>But is a rat really a generic mammal? Preuss says emphatically no. But that's how rodents were pitched when they became products sold to scientists.\u003c/p>\n\u003cp>\"It wasn't strictly a financial interest,\" he says. The sellers \"really believed that you could do almost anything\" with these animals. \"You could learn about almost any feature of human organization, you could cure almost any disease by studying these animals.\"\u003c/p>\n\u003cfigure id=\"attachment_370925\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-370925\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/04/lab-rats-800x575.jpg\" alt=\"The rat holding facility at Hazelton Laboratories in Washington, D.C., in 1967.\" width=\"800\" height=\"575\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/04/lab-rats.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/lab-rats-160x115.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/lab-rats-768x552.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/lab-rats-240x173.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/lab-rats-375x270.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/lab-rats-520x374.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">The rat holding facility at Hazelton Laboratories in Washington, D.C., in 1967. \u003ccite>(Fox Photos/Getty Images)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>That was a dangerous assumption. Rats and humans have been on their own evolutionary paths for tens of millions of years. We've developed our own unique features, and so have the rodents.\u003c/p>\n\u003cp>So it should come as no surprise that a drug that works in a mouse often doesn't work in a person. Even so, Preuss says there's tremendous momentum to keep using animals as human substitutes. Entire scientific communities are built up around rats, mice and other lab animals.\u003c/p>\n\u003cp>\"Once these communities exist, then you have an infrastructure of knowledge: how to raise the animals, how to keep them healthy,\" Preuss says. \"You have companies that spring up to provide you with specialized equipment to study these animals.\"\u003c/p>\n\u003cp>Chances are, people studying the same disease study the same tailor-made strain of animal. Journals and funding agencies actually expect it.\u003c/p>\n\u003cp>\"So there's a whole institution that develops,\" Preuss says.\u003c/p>\n\u003cp>And it's hard to interrupt that culture. (Preuss spoke about this subject in a \u003ca href=\"https://videocast.nih.gov/summary.asp?Live=17982&bhcp=1\">2016 talk\u003c/a> at the National Institutes of Health.)\u003c/p>\n\u003cp>You can get a glimpse of the scale of this enterprise by passing through one of hundreds of facilities nationwide devoted to the care and feeding of mice. On the Stanford University campus, attendants roll supply carts through fluorescent-lit hallways and past row after row of doors at an expansive mouse facility.\u003c/p>\n\u003cp>I'm guided through the labyrinth by \u003ca href=\"https://profiles.stanford.edu/joseph-garner\">Joseph Garner\u003c/a>, a behavioral scientist at the Stanford University Medical Center. We go into a windowless room stacked floor to ceiling with seemingly identical plastic cages full of mice. The philosophy behind mouse research has been to make everything as uniform as possible, so results from one facility would be the same as the identical experiment elsewhere.\u003c/p>\n\u003caside class=\"pullquote alignright\">'Maybe we need to stop thinking of animals as these little furry test tubes that can be or even should be controlled. And maybe instead we should think of them as patients.'\u003ccite>Joseph Garner, behavioral scientist, Stanford University\u003c/cite>\u003c/aside>\n\u003cp>But despite extensive efforts to be consistent, this setup hides a huge amount of variation. Bedding may differ from one facility to the next. So might the diet. Mice respond strongly to individual human handlers. Mice also react differently depending on whether their cage is up near the fluorescent lights or hidden down in the shadows.\u003c/p>\n\u003cp>Garner and colleagues tried to run identical experiments in six different mouse facilities, scattered throughout research centers in Europe. Even using genetically identical mice of the same age, the \u003ca href=\"http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0016461\">results\u003c/a> varied all over the map.\u003c/p>\n\u003cp>Garner says scientists shouldn't even be trying to do experiments this way.\u003c/p>\n\u003cp>\"Imagine you were doing a human drug trial and you said to the FDA, 'OK, I'm going to do this trial in 43-year-old white males in one small town in California,'\" Garner says — a town where everyone lives in identical ranch homes, with the same monotonous diets and the same thermostat set to the same temperature.\u003c/p>\n\u003cp>\"Which is too cold, and they can't change it,\" he goes on. \"And oh, they all have the same grandfather!\"\u003c/p>\n\u003cp>The FDA would laugh that off as an insane setup, Garner says.\u003c/p>\n\u003cp>\"But that's exactly what we do in animals. We try to control everything we can possibly think of, and as a result we learn absolutely nothing.\"\u003c/p>\n\u003cp>Garner argues that research based on mice would be more reliable if it were set up more like experiments in humans — recognizing that variation is inevitable, and designing to embrace it rather than ignore it. He and his colleagues have \u003ca href=\"http://www.labanimal.com/laban/journal/v46/n4/pdf/laban.1224.pdf\">recently published a manifesto\u003c/a>, urging colleagues in the field to look at animals in this new light.\u003c/p>\n\u003cp>\"Maybe we need to stop thinking of animals as these little furry test tubes that can be or even should be controlled,\" he says. \"And maybe instead we should think of them as patients.\"\u003c/p>\n\u003cp>That could solve some of the problems with animal research, but by no means all.\u003c/p>\n\u003cp>Scientists make far too many assumptions about the underlying biology of disease when creating animal models of those illnesses, says \u003ca href=\"http://vivo.med.cornell.edu/display/cwid-gpetsko\">Gregory Petsko\u003c/a>, who studies Alzheimer's disease and other neurological disorders at the Weill Cornell Medical School.\u003c/p>\n\u003cp>\"It's probably only when you get to try your treatments in people that you're really going to have any idea how right those assumptions were,\" Petsko says.\u003c/p>\n\u003cp>In his field, the assumptions are often poor, or downright misleading. And Petsko says this mindset has been counterproductive. Scientists in his field have \"been led astray for many years by relying so heavily on animal models,\" he says.\u003c/p>\n\u003cp>For many years that was simply the best that science could do, Petsko says. So he doesn't fault his colleagues for trying.\u003c/p>\n\u003cp>\"What I am saying is at some point you have to cut your losses. You have to say, 'OK, this took us as far as it could take us, quite some time ago.'\"\u003c/p>\n\u003cp>For neurological diseases, Petsko says, scientists might learn more from studying human cells than whole animals. Animals are still useful for studying the safety of potential new treatments, but beyond that, he says, don't count on them.\u003c/p>\n\u003cp>Preuss at Emory agrees that using animals as models of disease is a big reason that many results in biomedical research aren't readily reproducible. \"I think that we have means to resolve that, though.\"\u003c/p>\n\u003cp>How? \"You have to think outside of the model box,\" he says. Mice and rats aren't simplified humans. Scientists should stop thinking they are.\u003c/p>\n\u003cp>But Preuss says scientists can still learn a lot about biology and disease by studying animals — for example, by comparing how humans and other animals differ, or where they share common traits. Those can reveal a lot about biology without assuming that what's true in a rat is likely true in a human.\u003c/p>\n\u003cp>\"Scientists need to break out of a culture that is hampering progress,\" Preuss says. That's tough to do right now, in a world where science funding is on the chopping block. Many scientists are reluctant to take a risk that could backfire. But the upside could benefit us all, in the form of a better understanding of disease, and effective new drugs.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>Richard Harris did some of the reporting for this story while researching his book\u003c/em> \u003ca href=\"https://shop.npr.org/search?q=rigor+mortis\">Rigor Mortis: How Sloppy Science Creates Worthless Cures, Crushes Hope, and Wastes Billions.\u003c/a> \u003cem>You can contact him at rharris@npr.org.\u003c/em>\u003c/p>\n\u003chr>\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=Drugs+That+Work+In+Mice+Often+Fail+When+Tried+In+People&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Most potential new drugs fail when they're tested in people. These failures are not only a major disappointment, they sharply drive up the cost of developing new drugs.\u003c/p>\n\u003cp>A major reason for these failures is that most new drugs are first tested out in mice, rats or other animals. Often those animal studies show great promise.\u003c/p>\n\u003cp>But mice aren't simply furry little people, so these studies often lead science astray. Some scientists are now rethinking animal studies to make them more effective for human health.\u003c/p>\n\u003cp>When scientists first started using animals in research over a century ago, the animals were not regarded as human stand-ins. Scientists studying rats were initially trying to understand rats, says \u003ca href=\"http://www.yerkes.emory.edu/research/divisions/neuropharmacology_neurologic_diseases/preuss_todd.html\">Todd Preuss\u003c/a>, an anthropologist at the Yerkes National Primate Research Center at Emory University.\u003c/p>\n\u003cp>\"As this process went on, people stopped seeing them as specialized animals and started seeing them more and more as prototypical mammals,\" Preuss says.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>But is a rat really a generic mammal? Preuss says emphatically no. But that's how rodents were pitched when they became products sold to scientists.\u003c/p>\n\u003cp>\"It wasn't strictly a financial interest,\" he says. The sellers \"really believed that you could do almost anything\" with these animals. \"You could learn about almost any feature of human organization, you could cure almost any disease by studying these animals.\"\u003c/p>\n\u003cfigure id=\"attachment_370925\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-370925\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/04/lab-rats-800x575.jpg\" alt=\"The rat holding facility at Hazelton Laboratories in Washington, D.C., in 1967.\" width=\"800\" height=\"575\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/04/lab-rats.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/lab-rats-160x115.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/lab-rats-768x552.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/lab-rats-240x173.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/lab-rats-375x270.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/lab-rats-520x374.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">The rat holding facility at Hazelton Laboratories in Washington, D.C., in 1967. \u003ccite>(Fox Photos/Getty Images)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>That was a dangerous assumption. Rats and humans have been on their own evolutionary paths for tens of millions of years. We've developed our own unique features, and so have the rodents.\u003c/p>\n\u003cp>So it should come as no surprise that a drug that works in a mouse often doesn't work in a person. Even so, Preuss says there's tremendous momentum to keep using animals as human substitutes. Entire scientific communities are built up around rats, mice and other lab animals.\u003c/p>\n\u003cp>\"Once these communities exist, then you have an infrastructure of knowledge: how to raise the animals, how to keep them healthy,\" Preuss says. \"You have companies that spring up to provide you with specialized equipment to study these animals.\"\u003c/p>\n\u003cp>Chances are, people studying the same disease study the same tailor-made strain of animal. Journals and funding agencies actually expect it.\u003c/p>\n\u003cp>\"So there's a whole institution that develops,\" Preuss says.\u003c/p>\n\u003cp>And it's hard to interrupt that culture. (Preuss spoke about this subject in a \u003ca href=\"https://videocast.nih.gov/summary.asp?Live=17982&bhcp=1\">2016 talk\u003c/a> at the National Institutes of Health.)\u003c/p>\n\u003cp>You can get a glimpse of the scale of this enterprise by passing through one of hundreds of facilities nationwide devoted to the care and feeding of mice. On the Stanford University campus, attendants roll supply carts through fluorescent-lit hallways and past row after row of doors at an expansive mouse facility.\u003c/p>\n\u003cp>I'm guided through the labyrinth by \u003ca href=\"https://profiles.stanford.edu/joseph-garner\">Joseph Garner\u003c/a>, a behavioral scientist at the Stanford University Medical Center. We go into a windowless room stacked floor to ceiling with seemingly identical plastic cages full of mice. The philosophy behind mouse research has been to make everything as uniform as possible, so results from one facility would be the same as the identical experiment elsewhere.\u003c/p>\n\u003caside class=\"pullquote alignright\">'Maybe we need to stop thinking of animals as these little furry test tubes that can be or even should be controlled. And maybe instead we should think of them as patients.'\u003ccite>Joseph Garner, behavioral scientist, Stanford University\u003c/cite>\u003c/aside>\n\u003cp>But despite extensive efforts to be consistent, this setup hides a huge amount of variation. Bedding may differ from one facility to the next. So might the diet. Mice respond strongly to individual human handlers. Mice also react differently depending on whether their cage is up near the fluorescent lights or hidden down in the shadows.\u003c/p>\n\u003cp>Garner and colleagues tried to run identical experiments in six different mouse facilities, scattered throughout research centers in Europe. Even using genetically identical mice of the same age, the \u003ca href=\"http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0016461\">results\u003c/a> varied all over the map.\u003c/p>\n\u003cp>Garner says scientists shouldn't even be trying to do experiments this way.\u003c/p>\n\u003cp>\"Imagine you were doing a human drug trial and you said to the FDA, 'OK, I'm going to do this trial in 43-year-old white males in one small town in California,'\" Garner says — a town where everyone lives in identical ranch homes, with the same monotonous diets and the same thermostat set to the same temperature.\u003c/p>\n\u003cp>\"Which is too cold, and they can't change it,\" he goes on. \"And oh, they all have the same grandfather!\"\u003c/p>\n\u003cp>The FDA would laugh that off as an insane setup, Garner says.\u003c/p>\n\u003cp>\"But that's exactly what we do in animals. We try to control everything we can possibly think of, and as a result we learn absolutely nothing.\"\u003c/p>\n\u003cp>Garner argues that research based on mice would be more reliable if it were set up more like experiments in humans — recognizing that variation is inevitable, and designing to embrace it rather than ignore it. He and his colleagues have \u003ca href=\"http://www.labanimal.com/laban/journal/v46/n4/pdf/laban.1224.pdf\">recently published a manifesto\u003c/a>, urging colleagues in the field to look at animals in this new light.\u003c/p>\n\u003cp>\"Maybe we need to stop thinking of animals as these little furry test tubes that can be or even should be controlled,\" he says. \"And maybe instead we should think of them as patients.\"\u003c/p>\n\u003cp>That could solve some of the problems with animal research, but by no means all.\u003c/p>\n\u003cp>Scientists make far too many assumptions about the underlying biology of disease when creating animal models of those illnesses, says \u003ca href=\"http://vivo.med.cornell.edu/display/cwid-gpetsko\">Gregory Petsko\u003c/a>, who studies Alzheimer's disease and other neurological disorders at the Weill Cornell Medical School.\u003c/p>\n\u003cp>\"It's probably only when you get to try your treatments in people that you're really going to have any idea how right those assumptions were,\" Petsko says.\u003c/p>\n\u003cp>In his field, the assumptions are often poor, or downright misleading. And Petsko says this mindset has been counterproductive. Scientists in his field have \"been led astray for many years by relying so heavily on animal models,\" he says.\u003c/p>\n\u003cp>For many years that was simply the best that science could do, Petsko says. So he doesn't fault his colleagues for trying.\u003c/p>\n\u003cp>\"What I am saying is at some point you have to cut your losses. You have to say, 'OK, this took us as far as it could take us, quite some time ago.'\"\u003c/p>\n\u003cp>For neurological diseases, Petsko says, scientists might learn more from studying human cells than whole animals. Animals are still useful for studying the safety of potential new treatments, but beyond that, he says, don't count on them.\u003c/p>\n\u003cp>Preuss at Emory agrees that using animals as models of disease is a big reason that many results in biomedical research aren't readily reproducible. \"I think that we have means to resolve that, though.\"\u003c/p>\n\u003cp>How? \"You have to think outside of the model box,\" he says. Mice and rats aren't simplified humans. Scientists should stop thinking they are.\u003c/p>\n\u003cp>But Preuss says scientists can still learn a lot about biology and disease by studying animals — for example, by comparing how humans and other animals differ, or where they share common traits. Those can reveal a lot about biology without assuming that what's true in a rat is likely true in a human.\u003c/p>\n\u003cp>\"Scientists need to break out of a culture that is hampering progress,\" Preuss says. That's tough to do right now, in a world where science funding is on the chopping block. Many scientists are reluctant to take a risk that could backfire. But the upside could benefit us all, in the form of a better understanding of disease, and effective new drugs.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>Richard Harris did some of the reporting for this story while researching his book\u003c/em> \u003ca href=\"https://shop.npr.org/search?q=rigor+mortis\">Rigor Mortis: How Sloppy Science Creates Worthless Cures, Crushes Hope, and Wastes Billions.\u003c/a> \u003cem>You can contact him at rharris@npr.org.\u003c/em>\u003c/p>\n\u003chr>\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=Drugs+That+Work+In+Mice+Often+Fail+When+Tried+In+People&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Transgender Clinics See Surge in Demand From Youth Seeking Early Treatment",
"title": "Transgender Clinics See Surge in Demand From Youth Seeking Early Treatment",
"headTitle": "KQED Future of You | KQED Science",
"content": "\u003cp>Los Angeles pediatrician Dr. Johanna Olson-Kennedy uses a stethoscope and otoscope, of course. But running a clinic for transgender youth means her pediatric medical supplies also include a selection of silicone penises and chest-flattening binders.\u003c/p>\n\u003cp>Thanks to the openness of \u003ca href=\"https://www.statnews.com/2016/06/29/caitlyn-jenner-trangender-health/\" target=\"_blank\">Caitlyn Jenner\u003c/a> and others, public awareness of transgenderism — and demand for trans-specific medical care like counseling, hormone treatments, and genital surgery — is exploding, even for the youngest of patients. At the \u003ca href=\"http://www.hrc.org/resources/interactive-map-clinical-care-programs-for-gender-nonconforming-childr\" target=\"_blank\">30-plus clinics\u003c/a> for transgender youth across the US, doctors like Olson-Kennedy can barely keep up with the demand.\u003c/p>\n\u003cp>Chicago’s Lurie Children’s Hospital, for example, opened its trans clinic just four years ago but already has 500 patients — and a four-month waiting list. Seattle Children’s Hospital opened its clinic in October and immediately got scores of calls. Olson-Kennedy’s clinic, the Center for Transyouth Health and Development at Children’s Hospital Los Angeles, is the country’s largest, treating 725 trans youth from across the western US. Five hundred of those patients are Olson-Kennedy’s.\u003c/p>\n\u003cp>Her youngest patient is 3.\u003c/p>\n\u003caside class=\"pullquote alignright\">'I’ve had mothers call me who say their child tries to kill themselves every time they have their period.'\u003ccite>Los Angeles pediatrician Dr. Johanna Olson-Kennedy, who treats transgender youth\u003c/cite>\u003c/aside>\n\u003cp>What her patients share is the strong, almost certain, belief that they have been born into the wrong body. Their brains tell them they are one gender, their bodies another. Too often, Olson-Kennedy said, these kids have no one to help guide them or ease their pain or even offer routine medical care without disparaging them. “You sit in this room with these young people and see their distress so clearly,” said Olson, a 47-year-old California native. “It’s not OK to do nothing.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>So Olson-Kennedy battles. She fights with insurance companies, tangles with pediatric colleagues who think children are too young to transition, and persuades reluctant parents to help their distressed kids. She’s even taken on the authors of “What to Expect When You’re Expecting” for not including a section on transgender children. And now, just as her fledgling field is beginning to gain medical and mainstream acceptance, she’s got a new adversary: President Donald Trump, who many fear will erode the recent gains of the transgender community and cut access to the health care they need to transition.\u003c/p>\n\u003cp>“It’s my number one concern right now,” Olson-Kennedy said. “I’m very worried.”\u003c/p>\n\u003cp>But there are also signs of hope. Olson-Kennedy is helping lead the first National Institutes of Health grant for research on transgender youth, now in its second year. And she and others hope that data will help win out over discrimination.\u003c/p>\n\u003cp>Olson-Kennedy’s clinic sits on the fourth floor of a bank building on a busy stretch of Sunset Boulevard. In her office with a view of the iconic Hollywood sign, she counsels patients and their parents — a good many of whom have driven or flown from distant states to see her. She can spend hours getting to know a patient before beginning any medical treatment.\u003c/p>\n\u003cp>The youngest patients receive no medical interventions, just counseling. Olson-Kennedy describes one 18-month-old, born a girl, who understood her gender before her grammar. “I a boy,” she repeatedly told her parents. Many young children who experiment with gender roles end up reverting to their birth gender.\u003c/p>\n\u003cp>But when the gender discomfort persists into adolescence, said Olson-Kennedy, it’s usually there to stay. And puberty, when secondary sex characteristics develop, can be a dangerous trigger.\u003c/p>\n\u003cp>“I’ve had mothers call me who say their child tries to kill themselves every time they have their period,” Olson-Kennedy said. “Parents come in saying, ‘My kid tried to cut off his penis with dental floss.’”\u003c/p>\n\u003cp>Olson-Kennedy’s first line of treatment for adolescents is stopping puberty so children and their parents can buy time to sort out what they want to do. Puberty blockers, GnRh agonists like the injectable Lupron or the implant Supprelin, suppress puberty by modifying hormone release. Such drugs have been used off-label safely for more than 30 years to stop early puberty.\u003c/p>\n\u003cp>Trans doctors say it’s critical to stop puberty before the body morphs in ways that are difficult to change — the broadening of shoulders for men, for example, or the rounded hips of women. “Even 14 or 15 is too late,” said Dr. Norman Spack, an endocrinologist who founded the country’s first transgender youth clinic at Boston Children’s Hospital.\u003c/p>\n\u003cp>Once children are ready to make a permanent change, they can stop puberty blockers and use masculinizing or feminizing hormones. Some trans youth go on to have surgery to remove breast tissue or add breast contours or alter their genitals. Others forego surgery and use binders and packers to alter their body shape.\u003c/p>\n\u003cp>While some religious groups oppose the process of transitioning — and radio host Laura Ingraham, in the running to be Donald Trump’s press secretary, told her listeners to wear adult diapers rather than use public bathrooms with people who are trans — Olson-Kennedy and her colleagues mostly ignore the flack. They say the care they are providing is not only reducing emotional distress but saving lives. Without support and treatment, Olson-Kennedy said, trans kids are a risk for almost everything: depression, self harm, substance abuse, homelessness, HIV and \u003ca href=\"http://williamsinstitute.law.ucla.edu/wp-content/uploads/AFSP-Williams-Suicide-Report-Final.pdf\" target=\"_blank\">suicide\u003c/a>.\u003c/p>\n\u003cp>\u003cstrong>A Sense of Urgency \u003c/strong>\u003c/p>\n\u003cp>Athena Fenstermacher was born male, but identified as a girl from her earliest days. “As soon as she could pick colors. As soon as she could talk,” said her mother, Jill. “There are pictures of me with a buzzcut and plastic heels and a Barbie,” Fenstermacher said. “I just knew I wasn’t born into the right body.”\u003c/p>\n\u003cp>Now 18, Fenstermacher is a petite and pretty blonde, demure, graceful and mature beyond her years. Living in nearby Long Beach, she found Olson-Kennedy at 15, after years of confusion and deciding she must be a gay male. “I didn’t even know transitioning existed until I was 14,” she said. “Everyone told me, ‘We don’t know what to do.’” Her treatment was further delayed by counselors who told her she had to undergo months of therapy before they would give her a referral to Olson-Kennedy. (While Olson-Kennedy said therapy is important, she said it should not be used as a roadblock to seeing a physician.)\u003c/p>\n\u003cp>Fenstermacher’s transition was excruciating. She attempted suicide, she said, after enduring extended bullying through high school and dealing with issues like trying to find a bathroom she could use comfortably. A 2015 study by the National Center for Transgender Equality found a majority of transgender Americans avoid using public bathrooms, even going so far as to limit their food and water intake when away from home. For 8 percent of people surveyed, this led to urinary tract or kidney infections.\u003c/p>\n\u003caside class=\"pullquote alignright\">'There are pictures of me with a buzzcut and plastic heels and a Barbie. I just knew I wasn’t born into the right body.'\u003ccite>Trans youth Athena Fenstermacher, who was born male\u003c/cite>\u003c/aside>\n\u003cp>It all took a toll: Fenstermacher went from an honors student with a stellar GPA to barely passing. She ended up earning her degree at home. Now, she fights constant loneliness and a sense she’s always being stared at and appraised. She hasn’t been swimming in seven years and says her slightly wider shoulders make her feel like a linebacker. She’s wistful when she describes watching her younger sister develop into the body she wishes she could have had. And she’s angry at her own genetics and a world that won’t accept her.\u003c/p>\n\u003cp>Fenstermacher is willing to discuss her experience and care because she’s so appreciative of Olson-Kennedy and because she wants people to understand the intense pain that comes with struggling with your birth gender. But she flinches every time her physician says the word “trans.” That word, Fenstermacher said, sets people to gawking, making judgements, and scrutinizing.\u003c/p>\n\u003cp>“I don’t feel like a trans woman.” Fenstermacher said. “I feel like a woman.” The word trans, she said, conjures up extremes: the flamboyant models of “Strut” or wealthy trans women like Caitlyn Jenner who order up any medical or cosmetic treatment they want. “The battle is a little different when you can just walk out the door and get facial feminization surgery,” said Fenstermacher, who dresses simply in jeans and T-shirts and, with her mother, has struggled to pay for therapy, treatment, hormones, and the surgery she recently underwent at a private clinic in San Francisco.\u003c/p>\n\u003cp>Athena’s mother fully supported the transition. “When you see their pain, you do what you have to do,” she said. Divorced and a waitress, Jill Fenstermacher literally had to scrape and borrow to get the money for Athena’s care, which was only partially covered by insurance. The costs of getting a legal name change, changing Athena’s driver’s license, it all adds up. “I told her, ‘I don’t care if I have to sleep in my car, I’m helping you do this.’” She’s battled so much: school districts, insurance companies, therapists, doctors. “I’m like the front line for her,” Jill Fenstermacher said. “I try to protect her, but there’s so much discrimination.”\u003c/p>\n\u003cp>Not all doctors agree with the approach of Olson-Kennedy and her colleagues. Some think young patients will grow out of their gender dysphoria, or that children should wait until they are 18 to make critical gender decisions. Many would simply like to see data on whether delaying puberty and allowing children to transition at younger ages is safe and healthy for them in the long run.\u003c/p>\n\u003cp>Olson-Kennedy is hoping to oblige. In 2015, she and three other leading trans youth doctors received the first NIH grant given to study transgender youth. The $5.7 million, five-year study will look at nearly 300 youth, some who received puberty-blocking hormones and others who took masculinizing or feminizing hormones after puberty. Teams at children’s hospitals in L.A., San Francisco, Boston, and Chicago have recruited patients and are now collecting data to evaluate the effect of treatment on mental health and determine how safe the treatments are.\u003c/p>\n\u003cfigure id=\"attachment_370177\" class=\"wp-caption aligncenter\" style=\"max-width: 594px\">\u003cimg class=\"size-full wp-image-370177\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/04/Trans-teen.jpg\" alt=\"Isaac Barnett, a transgender 18-year-old, left, talks with his doctor, Jill Jacobson, Jan. 20, 2014, at Children's' Mercy South in Overland Park, Kan.\" width=\"594\" height=\"400\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/04/Trans-teen.jpg 594w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Trans-teen-160x108.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Trans-teen-240x162.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Trans-teen-375x253.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Trans-teen-520x350.jpg 520w\" sizes=\"(max-width: 594px) 100vw, 594px\">\u003cfigcaption class=\"wp-caption-text\">Isaac Barnett, a transgender 18-year-old, left, talks with his doctor, Jill Jacobson, Jan. 20, 2014, at Children's' Mercy South in Overland Park, Kan. \u003ccite>(Allison Long/Kansas City Star/MCT via Getty Images)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The doctors think the study will prove that early treatment and puberty-blocking lead to far better long-term outcomes, making it easier for doctors and parents to accept that approach.\u003c/p>\n\u003cp>“It’s an imperfect field with regards to decisions we are asking these families to make,” acknowledged Dr. Robert Garofalo, who co-directs the Center for Gender, Sexuality and HIV Prevention at Chicago’s Lurie Children’s Hospital and is also working on the transgender youth study. Garofalo hopes the team will be able to study patients far beyond the current five-year term to address a host of questions that currently have no answers. Does hormone use in trans youth increase breast cancer risk? How well do adults who have transitioned as teens grapple with their loss of fertility? “These are things that are entirely unknown,” Garofalo said.\u003c/p>\n\u003cp>And the researchers are hopeful that more data will help to combat misconceptions, both publicly and within the medical profession itself.\u003c/p>\n\u003caside class=\"pullquote alignright\">'Even 14 or 15 is too late.'\u003ccite>Dr. Norman Spack, an endocrinologist who founded the country’s first transgender youth clinic at Boston Children’s Hospital\u003c/cite>\u003c/aside>\n\u003cp>Olson-Kennedy points to the stories she hears of pediatricians who say they don’t believe in providing trans care. “You don’t have people opting out of diabetes care because they don’t believe in treating diabetes,” she said.\u003c/p>\n\u003cp>Insurance companies also prove a roadblock for many of her patients. But with California law making it illegal to deny care for gender dysphoria and with her healthy appetite for a fight, Olson-Kennedy usually gets her way. “I have template letters for 100 different denials,” she said. “I just fax in a 100-page appeal and tell them if they deny me, I’m going to fax in 200 pages.”\u003c/p>\n\u003cp>The most counterintuitive end goal of such specialized transgender youth clinics may be to eventually not even need them.\u003c/p>\n\u003cp>“My goal is to make this absolutely mainstream,” said Dr. Cora Breuner, an orthopedist and pediatrician at Seattle Children’s Hospital who chairs the American Association of Pediatrics committee on adolescence. “People should not have to drive 17 hours for this care.” She thinks more kids would get the care they need if pediatricians — usually the first doctor parents seek out — were more comfortable with trans patients. Sensing urgency, the AAP is currently fast-tracking a statement on care for transgender kids, Breuner said.\u003c/p>\n\u003cp>Many physicians have a long way to go. The Twitter hashtag #transhealthfails chronicles a litany of frustrating experiences, from trans women being forced to take pregnancy tests before X-rays despite their not having uterus, to a doctor saying he couldn’t put a cast on a broken arm because he wasn’t versed in trans health care.\u003c/p>\n\u003cp>Sixteen-year-old Shay Sullivan, a Montana resident, had a series of frustrating medical experiences before the family found Olson-Kennedy four years ago. For years, the Sullivan family had tried to find care closer to home and dealt with a palpably uncomfortable local pediatrician. All the while, Shay was becoming increasingly anxious. The clock was ticking as puberty approached.\u003c/p>\n\u003cp>After the family’s first meeting with Olson-Kennedy, Sullivan’s mom, Shelley, said, “We just looked at each other. We were so relieved. We finally found someone who was going to help us find our way.”[contextly_sidebar id=\"WEqHfKvtKe7dW3iHsSIXRQ0Crw5Vzu9w\"]\u003c/p>\n\u003cp>The family’s insurance covered all but $200 of the cost of Shay’s $17,000 hormone blocking implant and helped cover the gender confirmation\u003cstrong> \u003c/strong>surgery she had at 16. (Most doctors wait until patients are over 18 for such surgery, but Shay was considered exceptionally mature, her mother said.) The family paid for the travel to see Olson-Kennedy and for staying in Arizona for nearly two weeks for the surgery. “We’re fortunate,” said Shelley, a physical therapist. “We both have good jobs and are able to afford it.”\u003c/p>\n\u003cp>Today, Shay is a driven high school junior, earning an International Baccalaureate degree in high school as well as learning several languages and is planning to study abroad during college. She doesn’t travel as much to the Los Angeles clinic now because her pediatrician has agreed to work with Olson-Kennedy to provide her care. Shay volunteers to help other trans teens in Missoula and is having a “pretty good year socially,” she said. One low point: Since entering high school, she’s not allowed to play on girls’ sports teams.\u003c/p>\n\u003cp>\u003cstrong>Federal Policy Changes Afoot? \u003c/strong>\u003c/p>\n\u003cp>Doctors on the front lines of transgender youth care say they are heartened that children are coming in at younger ages and that transgender youth clinics are opening in suburban areas. But they’ve also nervously got their eyes on what Trump may do.\u003c/p>\n\u003cp>“I don’t know if it will be any worse, but I don’t think things will get better,” said Boston Children’s Spack, 73. “I’m old enough to remember when homosexuality was considered a disease. Those ideas die hard.”\u003c/p>\n\u003cp>Garofalo, a self-described optimist, said he hopes medical care for trans kids won’t suffer greatly under the new administration. But he said, “I’d be naive not to be worried.” He said he is definitely “poised to fight,” if needed, to protect his patients and families.\u003c/p>\n\u003cp>Olson-Kennedy already has her sleeves rolled up. She’s worried about policy changes, like a dismantling of the Affordable Care Act, that might remove the insurance coverage trans youth need. But she’s also worried about an emerging ethos that may allow open discrimination and violence against transgender youth and adults.\u003c/p>\n\u003cp>“We’ve made such incredible strides,” she said. “We don’t want to see people going underground again.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This \u003ca href=\"https://www.statnews.com/2016/12/20/transgender-youth-doctors-clinics/\">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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"excerpt": "Clinics for transgender youth are surging with patients who want to transition, even as President Donald Trump rescinds protections for transgender students. ",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Los Angeles pediatrician Dr. Johanna Olson-Kennedy uses a stethoscope and otoscope, of course. But running a clinic for transgender youth means her pediatric medical supplies also include a selection of silicone penises and chest-flattening binders.\u003c/p>\n\u003cp>Thanks to the openness of \u003ca href=\"https://www.statnews.com/2016/06/29/caitlyn-jenner-trangender-health/\" target=\"_blank\">Caitlyn Jenner\u003c/a> and others, public awareness of transgenderism — and demand for trans-specific medical care like counseling, hormone treatments, and genital surgery — is exploding, even for the youngest of patients. At the \u003ca href=\"http://www.hrc.org/resources/interactive-map-clinical-care-programs-for-gender-nonconforming-childr\" target=\"_blank\">30-plus clinics\u003c/a> for transgender youth across the US, doctors like Olson-Kennedy can barely keep up with the demand.\u003c/p>\n\u003cp>Chicago’s Lurie Children’s Hospital, for example, opened its trans clinic just four years ago but already has 500 patients — and a four-month waiting list. Seattle Children’s Hospital opened its clinic in October and immediately got scores of calls. Olson-Kennedy’s clinic, the Center for Transyouth Health and Development at Children’s Hospital Los Angeles, is the country’s largest, treating 725 trans youth from across the western US. Five hundred of those patients are Olson-Kennedy’s.\u003c/p>\n\u003cp>Her youngest patient is 3.\u003c/p>\n\u003caside class=\"pullquote alignright\">'I’ve had mothers call me who say their child tries to kill themselves every time they have their period.'\u003ccite>Los Angeles pediatrician Dr. Johanna Olson-Kennedy, who treats transgender youth\u003c/cite>\u003c/aside>\n\u003cp>What her patients share is the strong, almost certain, belief that they have been born into the wrong body. Their brains tell them they are one gender, their bodies another. Too often, Olson-Kennedy said, these kids have no one to help guide them or ease their pain or even offer routine medical care without disparaging them. “You sit in this room with these young people and see their distress so clearly,” said Olson, a 47-year-old California native. “It’s not OK to do nothing.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>So Olson-Kennedy battles. She fights with insurance companies, tangles with pediatric colleagues who think children are too young to transition, and persuades reluctant parents to help their distressed kids. She’s even taken on the authors of “What to Expect When You’re Expecting” for not including a section on transgender children. And now, just as her fledgling field is beginning to gain medical and mainstream acceptance, she’s got a new adversary: President Donald Trump, who many fear will erode the recent gains of the transgender community and cut access to the health care they need to transition.\u003c/p>\n\u003cp>“It’s my number one concern right now,” Olson-Kennedy said. “I’m very worried.”\u003c/p>\n\u003cp>But there are also signs of hope. Olson-Kennedy is helping lead the first National Institutes of Health grant for research on transgender youth, now in its second year. And she and others hope that data will help win out over discrimination.\u003c/p>\n\u003cp>Olson-Kennedy’s clinic sits on the fourth floor of a bank building on a busy stretch of Sunset Boulevard. In her office with a view of the iconic Hollywood sign, she counsels patients and their parents — a good many of whom have driven or flown from distant states to see her. She can spend hours getting to know a patient before beginning any medical treatment.\u003c/p>\n\u003cp>The youngest patients receive no medical interventions, just counseling. Olson-Kennedy describes one 18-month-old, born a girl, who understood her gender before her grammar. “I a boy,” she repeatedly told her parents. Many young children who experiment with gender roles end up reverting to their birth gender.\u003c/p>\n\u003cp>But when the gender discomfort persists into adolescence, said Olson-Kennedy, it’s usually there to stay. And puberty, when secondary sex characteristics develop, can be a dangerous trigger.\u003c/p>\n\u003cp>“I’ve had mothers call me who say their child tries to kill themselves every time they have their period,” Olson-Kennedy said. “Parents come in saying, ‘My kid tried to cut off his penis with dental floss.’”\u003c/p>\n\u003cp>Olson-Kennedy’s first line of treatment for adolescents is stopping puberty so children and their parents can buy time to sort out what they want to do. Puberty blockers, GnRh agonists like the injectable Lupron or the implant Supprelin, suppress puberty by modifying hormone release. Such drugs have been used off-label safely for more than 30 years to stop early puberty.\u003c/p>\n\u003cp>Trans doctors say it’s critical to stop puberty before the body morphs in ways that are difficult to change — the broadening of shoulders for men, for example, or the rounded hips of women. “Even 14 or 15 is too late,” said Dr. Norman Spack, an endocrinologist who founded the country’s first transgender youth clinic at Boston Children’s Hospital.\u003c/p>\n\u003cp>Once children are ready to make a permanent change, they can stop puberty blockers and use masculinizing or feminizing hormones. Some trans youth go on to have surgery to remove breast tissue or add breast contours or alter their genitals. Others forego surgery and use binders and packers to alter their body shape.\u003c/p>\n\u003cp>While some religious groups oppose the process of transitioning — and radio host Laura Ingraham, in the running to be Donald Trump’s press secretary, told her listeners to wear adult diapers rather than use public bathrooms with people who are trans — Olson-Kennedy and her colleagues mostly ignore the flack. They say the care they are providing is not only reducing emotional distress but saving lives. Without support and treatment, Olson-Kennedy said, trans kids are a risk for almost everything: depression, self harm, substance abuse, homelessness, HIV and \u003ca href=\"http://williamsinstitute.law.ucla.edu/wp-content/uploads/AFSP-Williams-Suicide-Report-Final.pdf\" target=\"_blank\">suicide\u003c/a>.\u003c/p>\n\u003cp>\u003cstrong>A Sense of Urgency \u003c/strong>\u003c/p>\n\u003cp>Athena Fenstermacher was born male, but identified as a girl from her earliest days. “As soon as she could pick colors. As soon as she could talk,” said her mother, Jill. “There are pictures of me with a buzzcut and plastic heels and a Barbie,” Fenstermacher said. “I just knew I wasn’t born into the right body.”\u003c/p>\n\u003cp>Now 18, Fenstermacher is a petite and pretty blonde, demure, graceful and mature beyond her years. Living in nearby Long Beach, she found Olson-Kennedy at 15, after years of confusion and deciding she must be a gay male. “I didn’t even know transitioning existed until I was 14,” she said. “Everyone told me, ‘We don’t know what to do.’” Her treatment was further delayed by counselors who told her she had to undergo months of therapy before they would give her a referral to Olson-Kennedy. (While Olson-Kennedy said therapy is important, she said it should not be used as a roadblock to seeing a physician.)\u003c/p>\n\u003cp>Fenstermacher’s transition was excruciating. She attempted suicide, she said, after enduring extended bullying through high school and dealing with issues like trying to find a bathroom she could use comfortably. A 2015 study by the National Center for Transgender Equality found a majority of transgender Americans avoid using public bathrooms, even going so far as to limit their food and water intake when away from home. For 8 percent of people surveyed, this led to urinary tract or kidney infections.\u003c/p>\n\u003caside class=\"pullquote alignright\">'There are pictures of me with a buzzcut and plastic heels and a Barbie. I just knew I wasn’t born into the right body.'\u003ccite>Trans youth Athena Fenstermacher, who was born male\u003c/cite>\u003c/aside>\n\u003cp>It all took a toll: Fenstermacher went from an honors student with a stellar GPA to barely passing. She ended up earning her degree at home. Now, she fights constant loneliness and a sense she’s always being stared at and appraised. She hasn’t been swimming in seven years and says her slightly wider shoulders make her feel like a linebacker. She’s wistful when she describes watching her younger sister develop into the body she wishes she could have had. And she’s angry at her own genetics and a world that won’t accept her.\u003c/p>\n\u003cp>Fenstermacher is willing to discuss her experience and care because she’s so appreciative of Olson-Kennedy and because she wants people to understand the intense pain that comes with struggling with your birth gender. But she flinches every time her physician says the word “trans.” That word, Fenstermacher said, sets people to gawking, making judgements, and scrutinizing.\u003c/p>\n\u003cp>“I don’t feel like a trans woman.” Fenstermacher said. “I feel like a woman.” The word trans, she said, conjures up extremes: the flamboyant models of “Strut” or wealthy trans women like Caitlyn Jenner who order up any medical or cosmetic treatment they want. “The battle is a little different when you can just walk out the door and get facial feminization surgery,” said Fenstermacher, who dresses simply in jeans and T-shirts and, with her mother, has struggled to pay for therapy, treatment, hormones, and the surgery she recently underwent at a private clinic in San Francisco.\u003c/p>\n\u003cp>Athena’s mother fully supported the transition. “When you see their pain, you do what you have to do,” she said. Divorced and a waitress, Jill Fenstermacher literally had to scrape and borrow to get the money for Athena’s care, which was only partially covered by insurance. The costs of getting a legal name change, changing Athena’s driver’s license, it all adds up. “I told her, ‘I don’t care if I have to sleep in my car, I’m helping you do this.’” She’s battled so much: school districts, insurance companies, therapists, doctors. “I’m like the front line for her,” Jill Fenstermacher said. “I try to protect her, but there’s so much discrimination.”\u003c/p>\n\u003cp>Not all doctors agree with the approach of Olson-Kennedy and her colleagues. Some think young patients will grow out of their gender dysphoria, or that children should wait until they are 18 to make critical gender decisions. Many would simply like to see data on whether delaying puberty and allowing children to transition at younger ages is safe and healthy for them in the long run.\u003c/p>\n\u003cp>Olson-Kennedy is hoping to oblige. In 2015, she and three other leading trans youth doctors received the first NIH grant given to study transgender youth. The $5.7 million, five-year study will look at nearly 300 youth, some who received puberty-blocking hormones and others who took masculinizing or feminizing hormones after puberty. Teams at children’s hospitals in L.A., San Francisco, Boston, and Chicago have recruited patients and are now collecting data to evaluate the effect of treatment on mental health and determine how safe the treatments are.\u003c/p>\n\u003cfigure id=\"attachment_370177\" class=\"wp-caption aligncenter\" style=\"max-width: 594px\">\u003cimg class=\"size-full wp-image-370177\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/04/Trans-teen.jpg\" alt=\"Isaac Barnett, a transgender 18-year-old, left, talks with his doctor, Jill Jacobson, Jan. 20, 2014, at Children's' Mercy South in Overland Park, Kan.\" width=\"594\" height=\"400\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/04/Trans-teen.jpg 594w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Trans-teen-160x108.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Trans-teen-240x162.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Trans-teen-375x253.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Trans-teen-520x350.jpg 520w\" sizes=\"(max-width: 594px) 100vw, 594px\">\u003cfigcaption class=\"wp-caption-text\">Isaac Barnett, a transgender 18-year-old, left, talks with his doctor, Jill Jacobson, Jan. 20, 2014, at Children's' Mercy South in Overland Park, Kan. \u003ccite>(Allison Long/Kansas City Star/MCT via Getty Images)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The doctors think the study will prove that early treatment and puberty-blocking lead to far better long-term outcomes, making it easier for doctors and parents to accept that approach.\u003c/p>\n\u003cp>“It’s an imperfect field with regards to decisions we are asking these families to make,” acknowledged Dr. Robert Garofalo, who co-directs the Center for Gender, Sexuality and HIV Prevention at Chicago’s Lurie Children’s Hospital and is also working on the transgender youth study. Garofalo hopes the team will be able to study patients far beyond the current five-year term to address a host of questions that currently have no answers. Does hormone use in trans youth increase breast cancer risk? How well do adults who have transitioned as teens grapple with their loss of fertility? “These are things that are entirely unknown,” Garofalo said.\u003c/p>\n\u003cp>And the researchers are hopeful that more data will help to combat misconceptions, both publicly and within the medical profession itself.\u003c/p>\n\u003caside class=\"pullquote alignright\">'Even 14 or 15 is too late.'\u003ccite>Dr. Norman Spack, an endocrinologist who founded the country’s first transgender youth clinic at Boston Children’s Hospital\u003c/cite>\u003c/aside>\n\u003cp>Olson-Kennedy points to the stories she hears of pediatricians who say they don’t believe in providing trans care. “You don’t have people opting out of diabetes care because they don’t believe in treating diabetes,” she said.\u003c/p>\n\u003cp>Insurance companies also prove a roadblock for many of her patients. But with California law making it illegal to deny care for gender dysphoria and with her healthy appetite for a fight, Olson-Kennedy usually gets her way. “I have template letters for 100 different denials,” she said. “I just fax in a 100-page appeal and tell them if they deny me, I’m going to fax in 200 pages.”\u003c/p>\n\u003cp>The most counterintuitive end goal of such specialized transgender youth clinics may be to eventually not even need them.\u003c/p>\n\u003cp>“My goal is to make this absolutely mainstream,” said Dr. Cora Breuner, an orthopedist and pediatrician at Seattle Children’s Hospital who chairs the American Association of Pediatrics committee on adolescence. “People should not have to drive 17 hours for this care.” She thinks more kids would get the care they need if pediatricians — usually the first doctor parents seek out — were more comfortable with trans patients. Sensing urgency, the AAP is currently fast-tracking a statement on care for transgender kids, Breuner said.\u003c/p>\n\u003cp>Many physicians have a long way to go. The Twitter hashtag #transhealthfails chronicles a litany of frustrating experiences, from trans women being forced to take pregnancy tests before X-rays despite their not having uterus, to a doctor saying he couldn’t put a cast on a broken arm because he wasn’t versed in trans health care.\u003c/p>\n\u003cp>Sixteen-year-old Shay Sullivan, a Montana resident, had a series of frustrating medical experiences before the family found Olson-Kennedy four years ago. For years, the Sullivan family had tried to find care closer to home and dealt with a palpably uncomfortable local pediatrician. All the while, Shay was becoming increasingly anxious. The clock was ticking as puberty approached.\u003c/p>\n\u003cp>After the family’s first meeting with Olson-Kennedy, Sullivan’s mom, Shelley, said, “We just looked at each other. We were so relieved. We finally found someone who was going to help us find our way.”\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>The family’s insurance covered all but $200 of the cost of Shay’s $17,000 hormone blocking implant and helped cover the gender confirmation\u003cstrong> \u003c/strong>surgery she had at 16. (Most doctors wait until patients are over 18 for such surgery, but Shay was considered exceptionally mature, her mother said.) The family paid for the travel to see Olson-Kennedy and for staying in Arizona for nearly two weeks for the surgery. “We’re fortunate,” said Shelley, a physical therapist. “We both have good jobs and are able to afford it.”\u003c/p>\n\u003cp>Today, Shay is a driven high school junior, earning an International Baccalaureate degree in high school as well as learning several languages and is planning to study abroad during college. She doesn’t travel as much to the Los Angeles clinic now because her pediatrician has agreed to work with Olson-Kennedy to provide her care. Shay volunteers to help other trans teens in Missoula and is having a “pretty good year socially,” she said. One low point: Since entering high school, she’s not allowed to play on girls’ sports teams.\u003c/p>\n\u003cp>\u003cstrong>Federal Policy Changes Afoot? \u003c/strong>\u003c/p>\n\u003cp>Doctors on the front lines of transgender youth care say they are heartened that children are coming in at younger ages and that transgender youth clinics are opening in suburban areas. But they’ve also nervously got their eyes on what Trump may do.\u003c/p>\n\u003cp>“I don’t know if it will be any worse, but I don’t think things will get better,” said Boston Children’s Spack, 73. “I’m old enough to remember when homosexuality was considered a disease. Those ideas die hard.”\u003c/p>\n\u003cp>Garofalo, a self-described optimist, said he hopes medical care for trans kids won’t suffer greatly under the new administration. But he said, “I’d be naive not to be worried.” He said he is definitely “poised to fight,” if needed, to protect his patients and families.\u003c/p>\n\u003cp>Olson-Kennedy already has her sleeves rolled up. She’s worried about policy changes, like a dismantling of the Affordable Care Act, that might remove the insurance coverage trans youth need. But she’s also worried about an emerging ethos that may allow open discrimination and violence against transgender youth and adults.\u003c/p>\n\u003cp>“We’ve made such incredible strides,” she said. “We don’t want to see people going underground again.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"tagline": "Exploring the Bay Area, one question at a time",
"info": "KQED’s new podcast, Bay Curious, gets to the bottom of the mysteries — both profound and peculiar — that give the Bay Area its unique identity. And we’ll do it with your help! You ask the questions. You decide what Bay Curious investigates. And you join us on the journey to find the answers.",
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},
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"info": "KQED’s statewide radio news program providing daily coverage of issues, trends and public policy decisions.",
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"order": 8
},
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"airtime": "SUN 1pm-2pm, TUE 10pm, WED 1am",
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"source": "City Arts & Lectures"
},
"link": "https://www.cityarts.net",
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"order": 1
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"info": "\u003cem>Code Switch\u003c/em>, which listeners will hear in the first part of the hour, has fearless and much-needed conversations about race. Hosted by journalists of color, the show tackles the subject of race head-on, exploring how it impacts every part of society — from politics and pop culture to history, sports and more.\u003cbr />\u003cbr />\u003cem>Life Kit\u003c/em>, which will be in the second part of the hour, guides you through spaces and feelings no one prepares you for — from finances to mental health, from workplace microaggressions to imposter syndrome, from relationships to parenting. The show features experts with real world experience and shares their knowledge. Because everyone needs a little help being human.\u003cbr />\u003cbr />\u003ca href=\"https://www.npr.org/podcasts/510312/codeswitch\">\u003cem>Code Switch\u003c/em> offical site and podcast\u003c/a>\u003cbr />\u003ca href=\"https://www.npr.org/lifekit\">\u003cem>Life Kit\u003c/em> offical site and podcast\u003c/a>\u003cbr />",
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"id": "commonwealth-club",
"title": "Commonwealth Club of California Podcast",
"info": "The Commonwealth Club of California is the nation's oldest and largest public affairs forum. As a non-partisan forum, The Club brings to the public airwaves diverse viewpoints on important topics. The Club's weekly radio broadcast - the oldest in the U.S., dating back to 1924 - is carried across the nation on public radio stations and is now podcasting. Our website archive features audio of our recent programs, as well as selected speeches from our long and distinguished history. This podcast feed is usually updated twice a week and is always un-edited.",
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"source": "Commonwealth Club of California"
},
"link": "/radio/program/commonwealth-club",
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"info": "KQED’s live call-in program discussing local, state, national and international issues, as well as in-depth interviews.",
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"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Forum-Podcast-Tile-703x703-1.jpg",
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"order": 9
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"info": "A live production of NPR and WBUR Boston, in collaboration with stations across the country, Here & Now reflects the fluid world of news as it's happening in the middle of the day, with timely, in-depth news, interviews and conversation. Hosted by Robin Young, Jeremy Hobson and Tonya Mosley.",
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"hidden-brain": {
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"info": "Shankar Vedantam uses science and storytelling to reveal the unconscious patterns that drive human behavior, shape our choices and direct our relationships.",
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"airtime": "SUN 7pm-8pm",
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"source": "NPR"
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"how-i-built-this": {
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"info": "Guy Raz dives into the stories behind some of the world's best known companies. How I Built This weaves a narrative journey about innovators, entrepreneurs and idealists—and the movements they built.",
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"airtime": "SUN 7:30pm-8pm",
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"hyphenacion": {
"id": "hyphenacion",
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"tagline": "Where conversation and cultura meet",
"info": "What kind of no sabo word is Hyphenación? For us, it’s about living within a hyphenation. Like being a third-gen Mexican-American from the Texas border now living that Bay Area Chicano life. Like Xorje! Each week we bring together a couple of hyphenated Latinos to talk all about personal life choices: family, careers, relationships, belonging … everything is on the table. ",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2025/03/Hyphenacion_FinalAssets_PodcastTile.png",
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},
"jerrybrown": {
"id": "jerrybrown",
"title": "The Political Mind of Jerry Brown",
"tagline": "Lessons from a lifetime in politics",
"info": "The Political Mind of Jerry Brown brings listeners the wisdom of the former Governor, Mayor, and presidential candidate. Scott Shafer interviewed Brown for more than 40 hours, covering the former governor's life and half-century in the political game – and Brown has some lessons he'd like to share. ",
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"order": 18
},
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},
"latino-usa": {
"id": "latino-usa",
"title": "Latino USA",
"airtime": "MON 1am-2am, SUN 6pm-7pm",
"info": "Latino USA, the radio journal of news and culture, is the only national, English-language radio program produced from a Latino perspective.",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/latinoUsa.jpg",
"officialWebsiteLink": "http://latinousa.org/",
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},
"link": "/radio/program/latino-usa",
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"apple": "https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=79681317&at=11l79Y&ct=nprdirectory",
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"rss": "https://feeds.npr.org/510016/podcast.xml"
}
},
"marketplace": {
"id": "marketplace",
"title": "Marketplace",
"info": "Our flagship program, helmed by Kai Ryssdal, examines what the day in money delivered, through stories, conversations, newsworthy numbers and more. Updated Monday through Friday at about 3:30 p.m. PT.",
"airtime": "MON-FRI 4pm-4:30pm, MON-WED 6:30pm-7pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Marketplace-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.marketplace.org/",
"meta": {
"site": "news",
"source": "American Public Media"
},
"link": "/radio/program/marketplace",
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"rss": "https://feeds.publicradio.org/public_feeds/marketplace-pm/rss/rss"
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},
"masters-of-scale": {
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"title": "Masters of Scale",
"info": "Masters of Scale is an original podcast in which LinkedIn co-founder and Greylock Partner Reid Hoffman sets out to describe and prove theories that explain how great entrepreneurs take their companies from zero to a gazillion in ingenious fashion.",
"airtime": "Every other Wednesday June 12 through October 16 at 8pm (repeats Thursdays at 2am)",
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"officialWebsiteLink": "https://mastersofscale.com/",
"meta": {
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"source": "WaitWhat"
},
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"rss": "https://rss.art19.com/masters-of-scale"
}
},
"mindshift": {
"id": "mindshift",
"title": "MindShift",
"tagline": "A podcast about the future of learning and how we raise our kids",
"info": "The MindShift podcast explores the innovations in education that are shaping how kids learn. Hosts Ki Sung and Katrina Schwartz introduce listeners to educators, researchers, parents and students who are developing effective ways to improve how kids learn. We cover topics like how fed-up administrators are developing surprising tactics to deal with classroom disruptions; how listening to podcasts are helping kids develop reading skills; the consequences of overparenting; and why interdisciplinary learning can engage students on all ends of the traditional achievement spectrum. This podcast is part of the MindShift education site, a division of KQED News. KQED is an NPR/PBS member station based in San Francisco. You can also visit the MindShift website for episodes and supplemental blog posts or tweet us \u003ca href=\"https://twitter.com/MindShiftKQED\">@MindShiftKQED\u003c/a> or visit us at \u003ca href=\"/mindshift\">MindShift.KQED.org\u003c/a>",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Mindshift-Podcast-Tile-703x703-1.jpg",
"imageAlt": "KQED MindShift: How We Will Learn",
"officialWebsiteLink": "/mindshift/",
"meta": {
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"source": "kqed",
"order": 12
},
"link": "/podcasts/mindshift",
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM1NzY0NjAwNDI5",
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"stitcher": "https://www.stitcher.com/podcast/kqed/stories-teachers-share",
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}
},
"morning-edition": {
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