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"bio": "Lesley McClurg is a health correspondent and fill-in host whose work is regularly rebroadcast on NPR and PBS programs. She’s earned multiple regional Emmy awards, a national and a regional Edward R. Murrow award, and was named Best Beat Reporter by the Association of Health Care Journalists. The Society of Professional Journalists has recognized her work several times, and the Society of Environmental Journalists spotlighted her coverage of California’s historic drought.\r\n\r\nBefore joining KQED in 2016, Lesley covered food and sustainability for Capital Public Radio, environmental issues for Colorado Public Radio, and reported for KUOW and KCTS 9 in Seattle. Away from the newsroom, she loves skiing with her daughter, mountain biking with her partner, and playing with Ollie, the family’s goldendoodle. On deadline, she runs almost entirely on chocolate chips.\r\n\r\n ",
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"disqusTitle": "What a 23andMe Disease Risk Report Can Tell You and What It Can't",
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"content": "\u003cp class=\"danger-zone\">The genetic testing company 23andMe received \u003ca href=\"https://www.statnews.com/2017/04/06/genetic-test-alzheimers/\">approval\u003c/a> this week from regulators to sell genetic reports on an individual’s risk for 10 diseases, most prominently Alzheimer’s and Parkinson’s. Before you send in your saliva sample and $199, here’s what you should know:\u003c/p>\n\u003ch2 class=\"danger-zone\">What will a genetic test actually tell me?\u003c/h2>\n\u003cp class=\"danger-zone\">At most, that you carry a DNA variant that, according to research, is associated with a higher risk of a disease. For the rare clotting disorder hereditary thrombophilia, for instance, the report will say that you do or do not carry a variant called Factor V Leiden in the F5 gene and a variant called Prothrombin G20210A in the F2 gene.\u003c/p>\n\u003caside class=\"pullquote alignright\">'It’s important for people to know that even if they have a mutation in the genes [associated with Parkinson’s that 23andMe will test for], by and large they won’t get Parkinson’s disease.'\u003c/aside>\n\u003cp>23and me is still fine-tuning the reports, but its tests will also tell you how the presence (or absence) of variants affects risk. If there’s enough science to quantify that, the report will specify a percentage, like “your risk is 3 percent.” If not, it will just say there’s an (unspecified) increased risk. Of course, you can also look it up. For Alzheimer’s, carrying two copies of the Apoe4 variant (one from each parent), as \u003ca href=\"https://science.education.nih.gov/supplements/nih9/bioethics/guide/pdf/Master_4-2.pdf\">1 to 2 percent\u003c/a> of the population does, raises the risk of the disease to as much as 87 percent, for instance, compared to about \u003ca href=\"https://www.statnews.com/2016/11/21/dementia-rate-decline/\">9 percent\u003c/a> in the general population.\u003c/p>\n\u003ch2 class=\"danger-zone\">What diseases can 23andMe tell me about?\u003c/h2>\n\u003cp class=\"danger-zone\">This month, late-onset Alzheimer’s disease, Parkinson’s disease, the clotting disorder alpha-1 antitrypsin deficiency, and Gaucher disease. Soon — the company hasn’t said exactly when — it will also test for genetic variants linked to factor XI deficiency (excessive bleeding), celiac disease, anemia-causing G6PD deficiency, the movement disorder early-onset primary dystonia, and the blood illness hereditary hemochromatosis.\u003c/p>\n\u003ch2>Will the test tell me if I’m doomed to get one of these terrible disorders?\u003c/h2>\n\u003cp>No. None of the genetic variants that 23andMe tests for is what’s called “fully penetrant,” meaning that 100 percent of those who carry the variant develop the disease. By not “fully,” we mean \u003cem>really\u003c/em> not fully, as in the risk might be measured in the single-digit percentages. “It’s important for people to know that even if they have a mutation in the genes [associated with Parkinson’s that 23andMe will test for], by and large they won’t get Parkinson’s disease,” said James Beck, chief scientific officer of the Parkinson’s Foundation. The N370S variant in the GBA gene, for instance, triples the risk of Parkinson’s, Beck said, but with a baseline risk of 0.3 percent that means about a 1 percent risk.\u003c/p>\n\u003ch2>Do these tests work better for some ethnic groups than others?\u003c/h2>\n\u003cp>Geneticists have studied more people of European descent than other groups, so they have more data on white people. 23andMe knows this, so its reports will include warnings such as that the test results are “most relevant for people of European descent” (for Alzheimer’s), “. . . for people of European, Ashkenazi Jewish, and North African Berber descent” (for Parkinson’s), and “. . . for people of Ashkenazi Jewish descent” (Factor XI Deficiency). With Alzheimer’s, the effect of the ApoE4 variant is weaker in African-Americans, for instance.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>\u003cspan style=\"font-weight: 400\">This \u003ca href=\"https://www.statnews.com/2017/04/07/genetic-analysis-need-to-know/\" 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/span>\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp class=\"danger-zone\">The genetic testing company 23andMe received \u003ca href=\"https://www.statnews.com/2017/04/06/genetic-test-alzheimers/\">approval\u003c/a> this week from regulators to sell genetic reports on an individual’s risk for 10 diseases, most prominently Alzheimer’s and Parkinson’s. Before you send in your saliva sample and $199, here’s what you should know:\u003c/p>\n\u003ch2 class=\"danger-zone\">What will a genetic test actually tell me?\u003c/h2>\n\u003cp class=\"danger-zone\">At most, that you carry a DNA variant that, according to research, is associated with a higher risk of a disease. For the rare clotting disorder hereditary thrombophilia, for instance, the report will say that you do or do not carry a variant called Factor V Leiden in the F5 gene and a variant called Prothrombin G20210A in the F2 gene.\u003c/p>\n\u003caside class=\"pullquote alignright\">'It’s important for people to know that even if they have a mutation in the genes [associated with Parkinson’s that 23andMe will test for], by and large they won’t get Parkinson’s disease.'\u003c/aside>\n\u003cp>23and me is still fine-tuning the reports, but its tests will also tell you how the presence (or absence) of variants affects risk. If there’s enough science to quantify that, the report will specify a percentage, like “your risk is 3 percent.” If not, it will just say there’s an (unspecified) increased risk. Of course, you can also look it up. For Alzheimer’s, carrying two copies of the Apoe4 variant (one from each parent), as \u003ca href=\"https://science.education.nih.gov/supplements/nih9/bioethics/guide/pdf/Master_4-2.pdf\">1 to 2 percent\u003c/a> of the population does, raises the risk of the disease to as much as 87 percent, for instance, compared to about \u003ca href=\"https://www.statnews.com/2016/11/21/dementia-rate-decline/\">9 percent\u003c/a> in the general population.\u003c/p>\n\u003ch2 class=\"danger-zone\">What diseases can 23andMe tell me about?\u003c/h2>\n\u003cp class=\"danger-zone\">This month, late-onset Alzheimer’s disease, Parkinson’s disease, the clotting disorder alpha-1 antitrypsin deficiency, and Gaucher disease. Soon — the company hasn’t said exactly when — it will also test for genetic variants linked to factor XI deficiency (excessive bleeding), celiac disease, anemia-causing G6PD deficiency, the movement disorder early-onset primary dystonia, and the blood illness hereditary hemochromatosis.\u003c/p>\n\u003ch2>Will the test tell me if I’m doomed to get one of these terrible disorders?\u003c/h2>\n\u003cp>No. None of the genetic variants that 23andMe tests for is what’s called “fully penetrant,” meaning that 100 percent of those who carry the variant develop the disease. By not “fully,” we mean \u003cem>really\u003c/em> not fully, as in the risk might be measured in the single-digit percentages. “It’s important for people to know that even if they have a mutation in the genes [associated with Parkinson’s that 23andMe will test for], by and large they won’t get Parkinson’s disease,” said James Beck, chief scientific officer of the Parkinson’s Foundation. The N370S variant in the GBA gene, for instance, triples the risk of Parkinson’s, Beck said, but with a baseline risk of 0.3 percent that means about a 1 percent risk.\u003c/p>\n\u003ch2>Do these tests work better for some ethnic groups than others?\u003c/h2>\n\u003cp>Geneticists have studied more people of European descent than other groups, so they have more data on white people. 23andMe knows this, so its reports will include warnings such as that the test results are “most relevant for people of European descent” (for Alzheimer’s), “. . . for people of European, Ashkenazi Jewish, and North African Berber descent” (for Parkinson’s), and “. . . for people of Ashkenazi Jewish descent” (Factor XI Deficiency). With Alzheimer’s, the effect of the ApoE4 variant is weaker in African-Americans, for instance.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"disqusTitle": "Want to Quit Smoking? Find Someone to Pay You. It May Work",
"title": "Want to Quit Smoking? Find Someone to Pay You. It May Work",
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"content": "\u003cp>Cigarette smoking in the U.S. has dropped dramatically since the landmark publication of the \u003ca href=\"https://profiles.nlm.nih.gov/ps/access/NNBBMQ.pdf\">1964 U.S. Surgeon General’s report\u003c/a> on smoking and health. This has led to improved health for millions of Americans.\u003c/p>\n\u003cp>Those reductions, however, are unevenly distributed. Smoking remains \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/26902875\">prevalent among impoverished groups\u003c/a>, those with other substance-use disorders or mental illness, certain ethnic/racial minorities, and gender/sexual minorities. In some populations, such as disadvantaged women, smoking \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/26123717\">rates have actually increased\u003c/a> during this period.\u003c/p>\n\u003cp>There are few silver bullets when it comes to serious health challenges like cigarette smoking. However, research has shown something that works: Financial incentives, in the form of vouchers, to \u003ca href=\"http://www.sciencedirect.com/science/article/pii/S0091743512001478\">promote smoking cessation\u003c/a> and other health-related behavior change works especially well among vulnerable populations.\u003c/p>\n\u003cp>Considering that cigarette smoking still kills about \u003ca href=\"https://www.cdc.gov/tobacco/data_statistics/fact_sheets/fast_facts/index.htm\">480,000 people in the U.S.\u003c/a> annually and \u003ca href=\"http://www.who.int/mediacentre/factsheets/fs339/en/\">five million globally\u003c/a> – and accounts for nearly \u003ca href=\"https://www.cdc.gov/tobacco/data_statistics/fact_sheets/fast_facts/\">$170 billion in direct medical care\u003c/a> for American adults – using financial incentives to decrease smoking merits serious consideration.\u003c/p>\n\u003cp>As public health researchers, one of whom has worked with vulnerable populations on these issues since the 1980s, we have seen how financial incentives can promote health-related behavior changes.\u003c/p>\n\u003ch2>A brief history of financial incentives\u003c/h2>\n\u003cp>\u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/8031230\">Financial incentives gained recognition\u003c/a> in the early 1990s through studies on outpatient treatment of cocaine dependence. With intensive counseling, an intervention offering vouchers exchangeable for retail items helped keep people off cocaine.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The vouchers were contingent on objective evidence of cocaine abstinence. They proved to be the only intervention among many tested, such as counseling and the use of medications, to work in controlled studies.[contextly_sidebar id=\"ekvaj6MbJrMcnfWc2ZgOL4Oe1PFq7d0O\"]\u003c/p>\n\u003cp>The benefits lasted not only during the 12 weeks the incentives were used but also for at least two years beyond. Because incentives worked when virtually everything else tried failed, researchers studied the treatment model \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/27514250\">across a wide range of drug use and other health problems\u003c/a>.\u003c/p>\n\u003cp>One large-scale development that grew out of this work is known as \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/17954541\">Conditional Cash Transfers\u003c/a>. This program was underwritten by the World Bank where financial incentives are used to reduce chronic poverty in developing countries.\u003c/p>\n\u003cp>As just one example of that effort, Brazil has seen a widespread conditional cash transfer program \u003ca href=\"http://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(13)60715-1.pdf\">lead to a significant reduction in child mortality rates\u003c/a>.\u003c/p>\n\u003cp>Financial incentives in the form of vouchers exchangeable for goods or services are also now part of routine care for drug use disorders in U.S. \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/24724876\">Veteran Administration Hospital systems\u003c/a> and for smoking cessation and other health-related behavior changes in \u003ca href=\"http://www.rand.org/pubs/research_reports/RR254.html\">employee wellness programs\u003c/a>.\u003c/p>\n\u003cp>These types of incentives are not yet being used widely, however, in U.S. publicly supported programs to promote smoking cessation and other health-related behavior changes.\u003c/p>\n\u003cfigure id=\"attachment_366357\" class=\"wp-caption aligncenter\" style=\"max-width: 594px\">\u003cimg class=\"size-full wp-image-366357\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/04/Cigarettes1.jpg\" alt=\" A man smokes in a Times Square pedestrian island on September 16, 2010 in New York City. \" width=\"594\" height=\"396\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/04/Cigarettes1.jpg 594w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Cigarettes1-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Cigarettes1-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Cigarettes1-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Cigarettes1-520x347.jpg 520w\" sizes=\"(max-width: 594px) 100vw, 594px\">\u003cfigcaption class=\"wp-caption-text\">A man smokes in a Times Square pedestrian island on September 16, 2010 in New York City. \u003ccite>(Spencer Platt/Getty Images)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003ca href=\"http://www.rand.org/pubs/research_reports/RR254.html\">Smoking during pregnancy\u003c/a> provides a great example of a problem for which vouchers contingent on evidence of smoking abstinence (e.g., clean urine samples) can help women quit smoking and improve the health of their infants. Smoking during pregnancy can cause catastrophic pregnancy complications and can also harm fetal development and infant health. It can also cause later-in-life disease risk among exposed offspring.\u003c/p>\n\u003cp>Smoking during pregnancy is largely a problem \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/19442460\">among economically disadvantaged women\u003c/a>, due to greater prevalence, higher nicotine dependence, and greater difficulties in quitting smoking upon becoming pregnant, compared to more affluent women. The search for effective treatments dates back to 1984 and has entailed more than \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/24154953\">77 controlled trials involving 29,000 women\u003c/a>.\u003c/p>\n\u003cp>However, most interventions to date produce unacceptably small treatment effects that, on average, only increase cessation rates by about six percent above controls. The exception to that is financial incentives, which produce an average \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/25983287\">24 percent increase in cessation rates\u003c/a> compared to control groups, along with \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/27158581\">improvements in birth outcomes\u003c/a>.\u003c/p>\n\u003ch2>Financial incentives for pregnant smokers\u003c/h2>\n\u003cp>At the \u003ca href=\"http://www.med.uvm.edu/behaviorandhealth/home\">University of Vermont’s Center on Behavior and Health \u003c/a>, we have conducted a series of clinical trials examining the effectiveness of financial incentives (e.g., vouchers in the form of gift cards to restaurants, movies, baby stores) for quitting smoking during pregnancy.\u003c/p>\n\u003cp>Participants in our studies were smokers recruited from clinics in the greater Burlington area. They were assigned to one of two conditions: In the incentives condition, women earned vouchers redeemable for retail items for providing urine samples indicating that they were not smoking.\u003c/p>\n\u003cp>In the control condition, women earned vouchers of equal value regardless of their smoking status. This control condition allowed the researchers to ensure that any differences between the two conditions were due to vouchers being contingent on objective evidence of smoking abstinence rather than the provision of extra resources.\u003c/p>\n\u003cp>Women in the incentives condition received a voucher worth $6.25 for the first urine sample that they provided which indicated no smoking. The vouchers escalated in value for each consecutive negative sample – as measured by urine toxicology testing on a weekly basis by research staff - to a maximum of $45, where they were maintained through 12-weeks postpartum.\u003c/p>\n\u003cp>For participants who provided urine specimens indicating that they had smoked, the voucher value went back to $6.25. This “reset” - as the researchers refer to it - reinforces sustained abstinence and discourages brief relapses.\u003c/p>\n\u003cp>To encourage women to keep trying to abstain following a relapse, the voucher was returned to its prior value if a woman provided two consecutive negative tests following the reset. Women could earn incentives from the date they enrolled in the study up through 12-weeks postpartum. Women who abstained throughout the 9-month intervention could earn $1,180.\u003c/p>\n\u003cp>On average, those who received incentives were more successful at quitting. Among those who received incentives, 34 percent of those in late pregnancy through 12 weeks after birth were able to stop smoking, compared to 7 percent who did not receive incentives.\u003c/p>\n\u003cp>And, for those who received incentives, 14 percent were still not smoking up to 12 weeks after the incentives were discontinued. This compared to 1 percent who did not receive incentives and remained cigarette-free.\u003c/p>\n\u003cp>Average earnings in both conditions – those who stopped 12 weeks post-partum and those who did not smoke after the incentives were discontinued – were about $450.\u003c/p>\n\u003cfigure id=\"attachment_366356\" class=\"wp-caption aligncenter\" style=\"max-width: 594px\">\u003cimg class=\"size-full wp-image-366356\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/04/Cigarettes2.jpg\" alt=\"Leftover cigarettes on a bus stop waste basket in Copenhagen, Denmark. \" width=\"594\" height=\"391\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/04/Cigarettes2.jpg 594w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Cigarettes2-160x105.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Cigarettes2-240x158.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Cigarettes2-375x247.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Cigarettes2-520x342.jpg 520w\" sizes=\"(max-width: 594px) 100vw, 594px\">\u003cfigcaption class=\"wp-caption-text\">Leftover cigarettes on a bus stop waste basket in Copenhagen, Denmark. \u003ccite>(Francis Joseph Dean/Deanpictures/Getty Images)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>We found that the mean birth weight was about 200 grams greater among infants born to mothers who received the financial incentives, as was mean gestational age at delivery (by nearly a week).\u003c/p>\n\u003cp>\u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/20339141\">Women treated with incentives also breastfed longer\u003c/a> and were \u003ca href=\"https://academic.oup.com/ntr/article-lookup/doi/10.1093/ntr/ntu193\">less likely to experience postpartum depressive symptoms\u003c/a>.\u003c/p>\n\u003cp>A research study currently under way at UVM includes a clinical trial to determine the cost-effectiveness of financial incentives, relative to usual care, in improving infant health outcomes among maternal smokers. The trial will be complete by 2018.\u003c/p>\n\u003ch2>Financial incentives and vulnerable populations\u003c/h2>\n\u003cp>There have been a number of studies to assess whether these types of financial incentives help vulnerable populations, more generally, quit smoking. There are 31 controlled studies, published between January 1995 through October 2016, examining efficacy.\u003c/p>\n\u003cp>Incentives produced a significant treatment effect in \u003ca href=\"http://journals.sagepub.com/doi/full/10.1177/2372732216683518\">28 of those 31 (90 percent) studies\u003c/a>. That evidence should be considered in the context of a total of 176 controlled studies on financial incentives targeting a broad range of substance-use disorders, of which \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/27514250\">151 (86 percent) studies demonstrated efficacy\u003c/a>.\u003c/p>\n\u003cp>While there is plenty of room for improvements, a striking amount of evidence indicates that financial incentives are as effective, if not more effective, than any other smoking cessation intervention for vulnerable populations. That being said, the effectiveness of financial incentives depends on certain features of how they are delivered. For example, incentives-based interventions are most effective when the incentives are delivered immediately following evidence of behavior change, and when the magnitude of the incentives is higher.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>Importantly, the potential utility and efficacy of financial incentives extends beyond smoking to a broad range of challenging health problems in vulnerable populations including \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3052960/\">prevention of unplanned pregnancies among opioid-dependent\u003c/a> women and the increasing participation of \u003ca href=\"http://www.sciencedirect.com/science/article/pii/S0091743516000712\">economically disadvantaged cardiac patients in cardiac rehabilitation\u003c/a>.\u003c/p>\n\n",
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"excerpt": "An average voucher of $450, plus urine testing, was enough to get pregnant mothers to quit smoking over 12 weeks, according to one study. ",
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"nprByline": "\u003cstrong>Stephen Higgins, Allison Kurti, Danielle R. Davis\u003cBR />The Conversation\u003c/strong>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Cigarette smoking in the U.S. has dropped dramatically since the landmark publication of the \u003ca href=\"https://profiles.nlm.nih.gov/ps/access/NNBBMQ.pdf\">1964 U.S. Surgeon General’s report\u003c/a> on smoking and health. This has led to improved health for millions of Americans.\u003c/p>\n\u003cp>Those reductions, however, are unevenly distributed. Smoking remains \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/26902875\">prevalent among impoverished groups\u003c/a>, those with other substance-use disorders or mental illness, certain ethnic/racial minorities, and gender/sexual minorities. In some populations, such as disadvantaged women, smoking \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/26123717\">rates have actually increased\u003c/a> during this period.\u003c/p>\n\u003cp>There are few silver bullets when it comes to serious health challenges like cigarette smoking. However, research has shown something that works: Financial incentives, in the form of vouchers, to \u003ca href=\"http://www.sciencedirect.com/science/article/pii/S0091743512001478\">promote smoking cessation\u003c/a> and other health-related behavior change works especially well among vulnerable populations.\u003c/p>\n\u003cp>Considering that cigarette smoking still kills about \u003ca href=\"https://www.cdc.gov/tobacco/data_statistics/fact_sheets/fast_facts/index.htm\">480,000 people in the U.S.\u003c/a> annually and \u003ca href=\"http://www.who.int/mediacentre/factsheets/fs339/en/\">five million globally\u003c/a> – and accounts for nearly \u003ca href=\"https://www.cdc.gov/tobacco/data_statistics/fact_sheets/fast_facts/\">$170 billion in direct medical care\u003c/a> for American adults – using financial incentives to decrease smoking merits serious consideration.\u003c/p>\n\u003cp>As public health researchers, one of whom has worked with vulnerable populations on these issues since the 1980s, we have seen how financial incentives can promote health-related behavior changes.\u003c/p>\n\u003ch2>A brief history of financial incentives\u003c/h2>\n\u003cp>\u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/8031230\">Financial incentives gained recognition\u003c/a> in the early 1990s through studies on outpatient treatment of cocaine dependence. With intensive counseling, an intervention offering vouchers exchangeable for retail items helped keep people off cocaine.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The vouchers were contingent on objective evidence of cocaine abstinence. They proved to be the only intervention among many tested, such as counseling and the use of medications, to work in controlled studies.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>The benefits lasted not only during the 12 weeks the incentives were used but also for at least two years beyond. Because incentives worked when virtually everything else tried failed, researchers studied the treatment model \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/27514250\">across a wide range of drug use and other health problems\u003c/a>.\u003c/p>\n\u003cp>One large-scale development that grew out of this work is known as \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/17954541\">Conditional Cash Transfers\u003c/a>. This program was underwritten by the World Bank where financial incentives are used to reduce chronic poverty in developing countries.\u003c/p>\n\u003cp>As just one example of that effort, Brazil has seen a widespread conditional cash transfer program \u003ca href=\"http://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(13)60715-1.pdf\">lead to a significant reduction in child mortality rates\u003c/a>.\u003c/p>\n\u003cp>Financial incentives in the form of vouchers exchangeable for goods or services are also now part of routine care for drug use disorders in U.S. \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/24724876\">Veteran Administration Hospital systems\u003c/a> and for smoking cessation and other health-related behavior changes in \u003ca href=\"http://www.rand.org/pubs/research_reports/RR254.html\">employee wellness programs\u003c/a>.\u003c/p>\n\u003cp>These types of incentives are not yet being used widely, however, in U.S. publicly supported programs to promote smoking cessation and other health-related behavior changes.\u003c/p>\n\u003cfigure id=\"attachment_366357\" class=\"wp-caption aligncenter\" style=\"max-width: 594px\">\u003cimg class=\"size-full wp-image-366357\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/04/Cigarettes1.jpg\" alt=\" A man smokes in a Times Square pedestrian island on September 16, 2010 in New York City. \" width=\"594\" height=\"396\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/04/Cigarettes1.jpg 594w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Cigarettes1-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Cigarettes1-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Cigarettes1-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Cigarettes1-520x347.jpg 520w\" sizes=\"(max-width: 594px) 100vw, 594px\">\u003cfigcaption class=\"wp-caption-text\">A man smokes in a Times Square pedestrian island on September 16, 2010 in New York City. \u003ccite>(Spencer Platt/Getty Images)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003ca href=\"http://www.rand.org/pubs/research_reports/RR254.html\">Smoking during pregnancy\u003c/a> provides a great example of a problem for which vouchers contingent on evidence of smoking abstinence (e.g., clean urine samples) can help women quit smoking and improve the health of their infants. Smoking during pregnancy can cause catastrophic pregnancy complications and can also harm fetal development and infant health. It can also cause later-in-life disease risk among exposed offspring.\u003c/p>\n\u003cp>Smoking during pregnancy is largely a problem \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/19442460\">among economically disadvantaged women\u003c/a>, due to greater prevalence, higher nicotine dependence, and greater difficulties in quitting smoking upon becoming pregnant, compared to more affluent women. The search for effective treatments dates back to 1984 and has entailed more than \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/24154953\">77 controlled trials involving 29,000 women\u003c/a>.\u003c/p>\n\u003cp>However, most interventions to date produce unacceptably small treatment effects that, on average, only increase cessation rates by about six percent above controls. The exception to that is financial incentives, which produce an average \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/25983287\">24 percent increase in cessation rates\u003c/a> compared to control groups, along with \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/27158581\">improvements in birth outcomes\u003c/a>.\u003c/p>\n\u003ch2>Financial incentives for pregnant smokers\u003c/h2>\n\u003cp>At the \u003ca href=\"http://www.med.uvm.edu/behaviorandhealth/home\">University of Vermont’s Center on Behavior and Health \u003c/a>, we have conducted a series of clinical trials examining the effectiveness of financial incentives (e.g., vouchers in the form of gift cards to restaurants, movies, baby stores) for quitting smoking during pregnancy.\u003c/p>\n\u003cp>Participants in our studies were smokers recruited from clinics in the greater Burlington area. They were assigned to one of two conditions: In the incentives condition, women earned vouchers redeemable for retail items for providing urine samples indicating that they were not smoking.\u003c/p>\n\u003cp>In the control condition, women earned vouchers of equal value regardless of their smoking status. This control condition allowed the researchers to ensure that any differences between the two conditions were due to vouchers being contingent on objective evidence of smoking abstinence rather than the provision of extra resources.\u003c/p>\n\u003cp>Women in the incentives condition received a voucher worth $6.25 for the first urine sample that they provided which indicated no smoking. The vouchers escalated in value for each consecutive negative sample – as measured by urine toxicology testing on a weekly basis by research staff - to a maximum of $45, where they were maintained through 12-weeks postpartum.\u003c/p>\n\u003cp>For participants who provided urine specimens indicating that they had smoked, the voucher value went back to $6.25. This “reset” - as the researchers refer to it - reinforces sustained abstinence and discourages brief relapses.\u003c/p>\n\u003cp>To encourage women to keep trying to abstain following a relapse, the voucher was returned to its prior value if a woman provided two consecutive negative tests following the reset. Women could earn incentives from the date they enrolled in the study up through 12-weeks postpartum. Women who abstained throughout the 9-month intervention could earn $1,180.\u003c/p>\n\u003cp>On average, those who received incentives were more successful at quitting. Among those who received incentives, 34 percent of those in late pregnancy through 12 weeks after birth were able to stop smoking, compared to 7 percent who did not receive incentives.\u003c/p>\n\u003cp>And, for those who received incentives, 14 percent were still not smoking up to 12 weeks after the incentives were discontinued. This compared to 1 percent who did not receive incentives and remained cigarette-free.\u003c/p>\n\u003cp>Average earnings in both conditions – those who stopped 12 weeks post-partum and those who did not smoke after the incentives were discontinued – were about $450.\u003c/p>\n\u003cfigure id=\"attachment_366356\" class=\"wp-caption aligncenter\" style=\"max-width: 594px\">\u003cimg class=\"size-full wp-image-366356\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/04/Cigarettes2.jpg\" alt=\"Leftover cigarettes on a bus stop waste basket in Copenhagen, Denmark. \" width=\"594\" height=\"391\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/04/Cigarettes2.jpg 594w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Cigarettes2-160x105.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Cigarettes2-240x158.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Cigarettes2-375x247.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Cigarettes2-520x342.jpg 520w\" sizes=\"(max-width: 594px) 100vw, 594px\">\u003cfigcaption class=\"wp-caption-text\">Leftover cigarettes on a bus stop waste basket in Copenhagen, Denmark. \u003ccite>(Francis Joseph Dean/Deanpictures/Getty Images)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>We found that the mean birth weight was about 200 grams greater among infants born to mothers who received the financial incentives, as was mean gestational age at delivery (by nearly a week).\u003c/p>\n\u003cp>\u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/20339141\">Women treated with incentives also breastfed longer\u003c/a> and were \u003ca href=\"https://academic.oup.com/ntr/article-lookup/doi/10.1093/ntr/ntu193\">less likely to experience postpartum depressive symptoms\u003c/a>.\u003c/p>\n\u003cp>A research study currently under way at UVM includes a clinical trial to determine the cost-effectiveness of financial incentives, relative to usual care, in improving infant health outcomes among maternal smokers. The trial will be complete by 2018.\u003c/p>\n\u003ch2>Financial incentives and vulnerable populations\u003c/h2>\n\u003cp>There have been a number of studies to assess whether these types of financial incentives help vulnerable populations, more generally, quit smoking. There are 31 controlled studies, published between January 1995 through October 2016, examining efficacy.\u003c/p>\n\u003cp>Incentives produced a significant treatment effect in \u003ca href=\"http://journals.sagepub.com/doi/full/10.1177/2372732216683518\">28 of those 31 (90 percent) studies\u003c/a>. That evidence should be considered in the context of a total of 176 controlled studies on financial incentives targeting a broad range of substance-use disorders, of which \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/27514250\">151 (86 percent) studies demonstrated efficacy\u003c/a>.\u003c/p>\n\u003cp>While there is plenty of room for improvements, a striking amount of evidence indicates that financial incentives are as effective, if not more effective, than any other smoking cessation intervention for vulnerable populations. That being said, the effectiveness of financial incentives depends on certain features of how they are delivered. For example, incentives-based interventions are most effective when the incentives are delivered immediately following evidence of behavior change, and when the magnitude of the incentives is higher.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Importantly, the potential utility and efficacy of financial incentives extends beyond smoking to a broad range of challenging health problems in vulnerable populations including \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3052960/\">prevention of unplanned pregnancies among opioid-dependent\u003c/a> women and the increasing participation of \u003ca href=\"http://www.sciencedirect.com/science/article/pii/S0091743516000712\">economically disadvantaged cardiac patients in cardiac rehabilitation\u003c/a>.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Microbiologist Turned Astronaut Confronts Bacteria In Space",
"title": "Microbiologist Turned Astronaut Confronts Bacteria In Space",
"headTitle": "KQED Future of You | KQED Science",
"content": "\u003cp>A few months ago, at her office in Houston, Kate Rubins was feeling weird.\u003c/p>\n\u003cp>She was dizzy, she says — \"staggering around like a 2-year-old who had just learned to walk.\" She was constantly looking at her desk to make sure the objects on top weren't floating away.\u003c/p>\n\u003cp>Rubins wasn't going nuts. She was just readjusting to Earth after living without gravity for four months, hundreds of miles above the planet's surface.\u003c/p>\n\u003cp>Floating around up there, with blood rushing to her head like she was hanging upside-down on monkey bars, had been disorienting at first, though she eventually learned to move around using all four limbs.\u003c/p>\n\u003cp>Coming back to Earth's gravity at the end of October was even more disorienting.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>But Rubins is used to drastic transitions. Oddly enough, her journey to space had started years before, in central Africa.\u003c/p>\n\u003cp>\"If you put your finger on a map in the middle of Africa, that's about where our field site was located,\" says Rubins, a microbiologist as well as an astronaut.\u003c/p>\n\u003cp>It was 2007, and an airplane touching down on a grass runway in the Democratic Republic of the Congo had brought Rubins and her colleagues to study a nasty outbreak of \u003ca href=\"https://www.cdc.gov/poxvirus/monkeypox/\">monkey pox\u003c/a> in a remote village. She'd already spent time studying HIV, Ebola and smallpox in the lab.\u003c/p>\n\u003cp>This time the airplane wouldn't be back for six weeks.\u003c/p>\n\u003cfigure id=\"attachment_365534\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-365534\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/04/Rubins4-800x532.jpg\" alt=\"Rubins donned a spacesuit to install equipment on the outside of the International Space Station.\" width=\"800\" height=\"532\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/04/Rubins4-800x532.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Rubins4-160x106.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Rubins4-768x511.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Rubins4-1020x678.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Rubins4-1180x785.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Rubins4-960x638.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Rubins4-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Rubins4-375x249.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Rubins4-520x346.jpg 520w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Rubins4.jpg 1200w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Rubins donned a spacesuit to install equipment on the outside of the International Space Station. \u003ccite>(NASA Johnson/Flickr )\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Rubins didn't know it at the time, but that remote expedition gave her experience she'd eventually draw on during a much bigger journey — to outer space.\u003c/p>\n\u003cp>After the work in Africa, Rubins returned to Cambridge, Mass., and \u003ca href=\"http://wi.mit.edu/news/archive/2007/new-whitehead-fellow-kate-rubins-studies-infectious-disease\">a fellowship\u003c/a> at the Whitehead Institute for Biomedical Research, where she spent a lot of time writing grants.\u003c/p>\n\u003cp>All that paperwork was \"mind-numbing,\" Rubins says. Just to get a break, a colleague suggested they try filling out a different sort of application — to become NASA astronauts.\u003c/p>\n\u003cp>\"So, I found the application online,\" Rubins says, and filled it out on a lark. \"I'll take this chance,\" she figured, \"and maybe it'll be a good story someday of how I applied to be an astronaut.\"\u003c/p>\n\u003cp>A few months later, she got a call from Houston asking her to come down for an interview.\u003c/p>\n\u003caside class=\"pullquote alignright\">'The world of sequencing and molecular biology has opened up to us on the space station.'\u003ccite>Kate Rubins, NASA astronaut\u003c/cite>\u003c/aside>\n\u003cp>Rubins doesn't fit the normal astronaut profile. Many start out as military pilots, engineers or doctors — not microbiologists studying viruses. But she got the job.\u003c/p>\n\u003cp>\"There's been a lot of growth in people's interest in doing biological research on the space station,\" explains \u003ca href=\"https://www.nasa.gov/content/julie-robinson-videos\">Julie Robinson\u003c/a>, NASA's chief scientist for the International Space Station program.\u003c/p>\n\u003cp>Before the shuttle program ended in 2011, Robinson says, \"our commanders and our pilots had to be ready to land the shuttle, so that implied a really strong piloting [and] aerospace background, and that isn't as important now.\"\u003c/p>\n\u003cp>But once NASA's \u003ca href=\"http://www.npr.org/sections/thetwo-way/2011/07/21/138564226/atlantis-on-schedule-for-landing-in-florida\">shuttle program ended\u003c/a> and U.S. astronauts started hitching rides to space on Russian rockets, the focus for the American personnel shifted away from piloting skills — they no longer have to be counted on to land the shuttle.\u003c/p>\n\u003cp>\"What's more important now is the time they spend in orbit, when they're carrying out a variety of experiments,\" says Robinson. \"We can take what we learn in space to help us understand aging, disease processes, and even the basic biology of cells.\"\u003c/p>\n\u003cp>There's another reason it's useful to have molecular biologists and microbiologists in space: While there aren't viruses like Ebola or monkeypox on the space station (astronauts get quarantined before liftoff to make sure of that), space travel has never been sterile.\u003c/p>\n\u003cp>Take this moment from the Apollo 10 mission in 1969, for example, when three astronauts on board notice a loose turd floating through their spacecraft.\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe src=\"https://www.npr.org/player/embed/511891419/519751684\" width=\"100%\" height=\"290\" frameborder=\"0\" scrolling=\"no\" title=\"NPR embedded audio player\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003cp>Back then, a few astronauts were sealed in a small capsule for a few days. But now there's the space station — \u003ca href=\"https://www.nasa.gov/feature/facts-and-figures\">a habitat\u003c/a> the size of a six-bedroom house that circles the Earth, about 200 miles above our heads.\u003c/p>\n\u003cp>The station may have started out pristine, but its astronaut crews didn't.\u003c/p>\n\u003cp>\"We cannot send up a sterile crew,\" says \u003ca href=\"http://www.spacefoundation.org/media/space-watch/new-gen-spotlight-not-your-typical-space-careers\">Sarah Castro-Wallace\u003c/a>, a microbiologist at NASA Johnson Space Center. Astronauts need their gut bacteria and other \u003ca href=\"http://www.npr.org/series/218987212/microbiome\">friendly microbes\u003c/a> to help keep them healthy.\u003c/p>\n\u003cp>And for 16 years straight, crew after crew has been sweating, pooping and puking inside the space station. The microbes they release tend to stick around, because the station is essentially sealed — like an airplane that never gets opened.\u003c/p>\n\u003cp>Today, it's teeming with non-human life. It has its own \u003ca href=\"http://www.jcvi.org/cms/research/projects/astronaut-microbiome/overview/\">unique microbiome\u003c/a>.\u003c/p>\n\u003cp>\"\u003cem>Staphylococcus aureus\u003c/em> we'll find once in a while; \u003cem>Staphylococcus epidermidis\u003c/em> all the time,\" says Castro-Wallace, running down a list of resident space station microorganisms. There's also \u003cem>Staphylococcus hominis \u003c/em>(usually harmless)\u003cem>, Micrococcus luteus \u003c/em>(lives in the mouth and throat)\u003cem>, Burkholderia \u003c/em>(common in soil; some types can cause lung infection)\u003cem>, Sphingomonas \u003c/em>(common in water, and rarely harmful)\u003cem>, Penicillium\u003c/em> (the fungus we find in bread mold) and \u003cem>Aspergillus\u003c/em> (more mold), just to name a few.\u003c/p>\n\u003cp>Recently, an entire wall panel of the station turned green with mold.\u003c/p>\n\u003cp>\"Imagine your shower curtain at its worst,\" says Castro-Wallace, pointing out that the wall of mold happened on the Russian side of the space station.\u003c/p>\n\u003cp>She's particularly interested in \u003cem>Staph. aureus; \u003c/em>a strain of the bacterium that's resistant to multiple drugs is \u003ca href=\"https://www.cdc.gov/mrsa/healthcare/\">a particular problem in hospitals,\u003c/a> and can turn something as simple as a paper cut dangerous.\u003c/p>\n\u003cp>\"If it got into a cut, it could be life threatening,\" Castro-Wallace says.\u003c/p>\n\u003cp>It's become clear that scientists need to know what else is living up there, she says — particularly because \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4524529/\">research suggests\u003c/a> that microgravity can change gene expression in certain bacteria and make them \u003ca href=\"http://aem.asm.org/content/68/11/5408.full\">more virulent\u003c/a>. (Castro-Wallace has found that \u003cem>Staph. aureus\u003c/em> changes color in simulated microgravity, an indicator that the bacterium might act differently in space than on Earth.)\u003c/p>\n\u003cp>Right now, astronauts swab surfaces of the station and send samples back to Houston for identification. But that can take weeks or months.\u003c/p>\n\u003cp>It's a big reason why NASA hired Kate Rubins — and shot her into the sky.\u003c/p>\n\u003cfigure id=\"attachment_365539\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-365539\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/04/Rubins2-800x532.jpg\" alt=\"Rubins works on an experiment inside the station's glovebox. Prior research has suggested that the microgravity of space can change gene expression in certain bacteria and make them more virulent. \" width=\"800\" height=\"532\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/04/Rubins2.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Rubins2-160x106.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Rubins2-768x511.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Rubins2-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Rubins2-375x249.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Rubins2-520x346.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Rubins works on an experiment inside the station's glovebox. Prior research has suggested that the microgravity of space can change gene expression in certain bacteria and make them more virulent. \u003ccite>(NASA Johnson/Flickr )\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Last July, after seven years of training at NASA — working at Mission Control, doing mock space expeditions underwater and flying supersonic fighter jets to keep her reflexes sharp — Rubins blasted off from Kazakhstan aboard a Russian rocket.\u003c/p>\n\u003cp>She had 115 days to help set up a microbiology lab on the station. She drew on her earlier experience studying viruses — working quickly in a remote place, with minimal equipment.\u003c/p>\n\u003cp>\"There's actually an incredible amount of parallels between working in central Congo in a remote, isolated village and doing research aboard the space station,\" Rubins says.\u003c/p>\n\u003cp>When I called her in space, while she was on the station last fall, Rubins had just gotten the lab up and running and was really excited about it.\u003c/p>\n\u003cp>\"It's absolutely a working laboratory,\" she told me, as she floated around, describing the scene. \"We have experiments all over the place.\"\u003c/p>\n\u003cp>Just weeks before, Rubins had \u003ca href=\"https://www.nasa.gov/mission_pages/station/research/news/dna_sequencing\">sequenced DNA \u003c/a>in space — the first time anyone had ever done that. The fact that the technology worked in microgravity showed that, in the near future, it should be possible to swab a moldy wall, for example, and immediately determine the type of mold.\u003c/p>\n\u003cp>She'd also grown stem cells into heart cells without gravity, and — peering through a microscope that she'd set up — watched them beat in unison.[contextly_sidebar id=\"muVELSNI1O0wS0Y6K8AgzoKVvZe3SIUx\"]\u003c/p>\n\u003cp>Rubins has proved that it's possible to do molecular biology at least 200 miles beyond Earth — and maybe 200 million miles away, too.\u003c/p>\n\u003cp>\"The world of sequencing and molecular biology has opened up to us on the space station,\" she says.\u003c/p>\n\u003cp>She and NASA's Julie Robinson are the kind of people who start sentences with the words \"When we go to Mars,\" as if the journey to that planet is as inevitable as their next trip to the grocery store.\u003c/p>\n\u003cp>\"It's the plan,\" says Robinson. \"Absolutely,\" says Rubins, who is now Deputy Director of Human Health and Performance at Johnson Space Center.\u003c/p>\n\u003cp>When \u003cstrong>--\u003c/strong> or if \u003cstrong>--\u003c/strong> that expedition happens, Mars-based biology labs will be crucial resources for astronauts there. They'll need the tools of molecular biology to identify non-human life, so these emissaries from Earth can make sure that they aren't contaminating Mars with their own microbes, and to be able to detect any new life forms they might encounter. They'll also need the labs to diagnose sick space travelers, so they don't waste precious antibiotics or antivirals.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>And, of course, they'll need the technology to figure out what's growing on their walls. Because one thing is for sure: Any human-built Mars habitat will soon become at least as gross as the International Space Station.\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=A+Microbe+Hunter+Plies+Her+Trade+In+Space&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>A few months ago, at her office in Houston, Kate Rubins was feeling weird.\u003c/p>\n\u003cp>She was dizzy, she says — \"staggering around like a 2-year-old who had just learned to walk.\" She was constantly looking at her desk to make sure the objects on top weren't floating away.\u003c/p>\n\u003cp>Rubins wasn't going nuts. She was just readjusting to Earth after living without gravity for four months, hundreds of miles above the planet's surface.\u003c/p>\n\u003cp>Floating around up there, with blood rushing to her head like she was hanging upside-down on monkey bars, had been disorienting at first, though she eventually learned to move around using all four limbs.\u003c/p>\n\u003cp>Coming back to Earth's gravity at the end of October was even more disorienting.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>But Rubins is used to drastic transitions. Oddly enough, her journey to space had started years before, in central Africa.\u003c/p>\n\u003cp>\"If you put your finger on a map in the middle of Africa, that's about where our field site was located,\" says Rubins, a microbiologist as well as an astronaut.\u003c/p>\n\u003cp>It was 2007, and an airplane touching down on a grass runway in the Democratic Republic of the Congo had brought Rubins and her colleagues to study a nasty outbreak of \u003ca href=\"https://www.cdc.gov/poxvirus/monkeypox/\">monkey pox\u003c/a> in a remote village. She'd already spent time studying HIV, Ebola and smallpox in the lab.\u003c/p>\n\u003cp>This time the airplane wouldn't be back for six weeks.\u003c/p>\n\u003cfigure id=\"attachment_365534\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-365534\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/04/Rubins4-800x532.jpg\" alt=\"Rubins donned a spacesuit to install equipment on the outside of the International Space Station.\" width=\"800\" height=\"532\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/04/Rubins4-800x532.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Rubins4-160x106.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Rubins4-768x511.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Rubins4-1020x678.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Rubins4-1180x785.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Rubins4-960x638.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Rubins4-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Rubins4-375x249.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Rubins4-520x346.jpg 520w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Rubins4.jpg 1200w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Rubins donned a spacesuit to install equipment on the outside of the International Space Station. \u003ccite>(NASA Johnson/Flickr )\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Rubins didn't know it at the time, but that remote expedition gave her experience she'd eventually draw on during a much bigger journey — to outer space.\u003c/p>\n\u003cp>After the work in Africa, Rubins returned to Cambridge, Mass., and \u003ca href=\"http://wi.mit.edu/news/archive/2007/new-whitehead-fellow-kate-rubins-studies-infectious-disease\">a fellowship\u003c/a> at the Whitehead Institute for Biomedical Research, where she spent a lot of time writing grants.\u003c/p>\n\u003cp>All that paperwork was \"mind-numbing,\" Rubins says. Just to get a break, a colleague suggested they try filling out a different sort of application — to become NASA astronauts.\u003c/p>\n\u003cp>\"So, I found the application online,\" Rubins says, and filled it out on a lark. \"I'll take this chance,\" she figured, \"and maybe it'll be a good story someday of how I applied to be an astronaut.\"\u003c/p>\n\u003cp>A few months later, she got a call from Houston asking her to come down for an interview.\u003c/p>\n\u003caside class=\"pullquote alignright\">'The world of sequencing and molecular biology has opened up to us on the space station.'\u003ccite>Kate Rubins, NASA astronaut\u003c/cite>\u003c/aside>\n\u003cp>Rubins doesn't fit the normal astronaut profile. Many start out as military pilots, engineers or doctors — not microbiologists studying viruses. But she got the job.\u003c/p>\n\u003cp>\"There's been a lot of growth in people's interest in doing biological research on the space station,\" explains \u003ca href=\"https://www.nasa.gov/content/julie-robinson-videos\">Julie Robinson\u003c/a>, NASA's chief scientist for the International Space Station program.\u003c/p>\n\u003cp>Before the shuttle program ended in 2011, Robinson says, \"our commanders and our pilots had to be ready to land the shuttle, so that implied a really strong piloting [and] aerospace background, and that isn't as important now.\"\u003c/p>\n\u003cp>But once NASA's \u003ca href=\"http://www.npr.org/sections/thetwo-way/2011/07/21/138564226/atlantis-on-schedule-for-landing-in-florida\">shuttle program ended\u003c/a> and U.S. astronauts started hitching rides to space on Russian rockets, the focus for the American personnel shifted away from piloting skills — they no longer have to be counted on to land the shuttle.\u003c/p>\n\u003cp>\"What's more important now is the time they spend in orbit, when they're carrying out a variety of experiments,\" says Robinson. \"We can take what we learn in space to help us understand aging, disease processes, and even the basic biology of cells.\"\u003c/p>\n\u003cp>There's another reason it's useful to have molecular biologists and microbiologists in space: While there aren't viruses like Ebola or monkeypox on the space station (astronauts get quarantined before liftoff to make sure of that), space travel has never been sterile.\u003c/p>\n\u003cp>Take this moment from the Apollo 10 mission in 1969, for example, when three astronauts on board notice a loose turd floating through their spacecraft.\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe src=\"https://www.npr.org/player/embed/511891419/519751684\" width=\"100%\" height=\"290\" frameborder=\"0\" scrolling=\"no\" title=\"NPR embedded audio player\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003cp>Back then, a few astronauts were sealed in a small capsule for a few days. But now there's the space station — \u003ca href=\"https://www.nasa.gov/feature/facts-and-figures\">a habitat\u003c/a> the size of a six-bedroom house that circles the Earth, about 200 miles above our heads.\u003c/p>\n\u003cp>The station may have started out pristine, but its astronaut crews didn't.\u003c/p>\n\u003cp>\"We cannot send up a sterile crew,\" says \u003ca href=\"http://www.spacefoundation.org/media/space-watch/new-gen-spotlight-not-your-typical-space-careers\">Sarah Castro-Wallace\u003c/a>, a microbiologist at NASA Johnson Space Center. Astronauts need their gut bacteria and other \u003ca href=\"http://www.npr.org/series/218987212/microbiome\">friendly microbes\u003c/a> to help keep them healthy.\u003c/p>\n\u003cp>And for 16 years straight, crew after crew has been sweating, pooping and puking inside the space station. The microbes they release tend to stick around, because the station is essentially sealed — like an airplane that never gets opened.\u003c/p>\n\u003cp>Today, it's teeming with non-human life. It has its own \u003ca href=\"http://www.jcvi.org/cms/research/projects/astronaut-microbiome/overview/\">unique microbiome\u003c/a>.\u003c/p>\n\u003cp>\"\u003cem>Staphylococcus aureus\u003c/em> we'll find once in a while; \u003cem>Staphylococcus epidermidis\u003c/em> all the time,\" says Castro-Wallace, running down a list of resident space station microorganisms. There's also \u003cem>Staphylococcus hominis \u003c/em>(usually harmless)\u003cem>, Micrococcus luteus \u003c/em>(lives in the mouth and throat)\u003cem>, Burkholderia \u003c/em>(common in soil; some types can cause lung infection)\u003cem>, Sphingomonas \u003c/em>(common in water, and rarely harmful)\u003cem>, Penicillium\u003c/em> (the fungus we find in bread mold) and \u003cem>Aspergillus\u003c/em> (more mold), just to name a few.\u003c/p>\n\u003cp>Recently, an entire wall panel of the station turned green with mold.\u003c/p>\n\u003cp>\"Imagine your shower curtain at its worst,\" says Castro-Wallace, pointing out that the wall of mold happened on the Russian side of the space station.\u003c/p>\n\u003cp>She's particularly interested in \u003cem>Staph. aureus; \u003c/em>a strain of the bacterium that's resistant to multiple drugs is \u003ca href=\"https://www.cdc.gov/mrsa/healthcare/\">a particular problem in hospitals,\u003c/a> and can turn something as simple as a paper cut dangerous.\u003c/p>\n\u003cp>\"If it got into a cut, it could be life threatening,\" Castro-Wallace says.\u003c/p>\n\u003cp>It's become clear that scientists need to know what else is living up there, she says — particularly because \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4524529/\">research suggests\u003c/a> that microgravity can change gene expression in certain bacteria and make them \u003ca href=\"http://aem.asm.org/content/68/11/5408.full\">more virulent\u003c/a>. (Castro-Wallace has found that \u003cem>Staph. aureus\u003c/em> changes color in simulated microgravity, an indicator that the bacterium might act differently in space than on Earth.)\u003c/p>\n\u003cp>Right now, astronauts swab surfaces of the station and send samples back to Houston for identification. But that can take weeks or months.\u003c/p>\n\u003cp>It's a big reason why NASA hired Kate Rubins — and shot her into the sky.\u003c/p>\n\u003cfigure id=\"attachment_365539\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-365539\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/04/Rubins2-800x532.jpg\" alt=\"Rubins works on an experiment inside the station's glovebox. Prior research has suggested that the microgravity of space can change gene expression in certain bacteria and make them more virulent. \" width=\"800\" height=\"532\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/04/Rubins2.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Rubins2-160x106.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Rubins2-768x511.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Rubins2-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Rubins2-375x249.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Rubins2-520x346.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Rubins works on an experiment inside the station's glovebox. Prior research has suggested that the microgravity of space can change gene expression in certain bacteria and make them more virulent. \u003ccite>(NASA Johnson/Flickr )\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Last July, after seven years of training at NASA — working at Mission Control, doing mock space expeditions underwater and flying supersonic fighter jets to keep her reflexes sharp — Rubins blasted off from Kazakhstan aboard a Russian rocket.\u003c/p>\n\u003cp>She had 115 days to help set up a microbiology lab on the station. She drew on her earlier experience studying viruses — working quickly in a remote place, with minimal equipment.\u003c/p>\n\u003cp>\"There's actually an incredible amount of parallels between working in central Congo in a remote, isolated village and doing research aboard the space station,\" Rubins says.\u003c/p>\n\u003cp>When I called her in space, while she was on the station last fall, Rubins had just gotten the lab up and running and was really excited about it.\u003c/p>\n\u003cp>\"It's absolutely a working laboratory,\" she told me, as she floated around, describing the scene. \"We have experiments all over the place.\"\u003c/p>\n\u003cp>Just weeks before, Rubins had \u003ca href=\"https://www.nasa.gov/mission_pages/station/research/news/dna_sequencing\">sequenced DNA \u003c/a>in space — the first time anyone had ever done that. The fact that the technology worked in microgravity showed that, in the near future, it should be possible to swab a moldy wall, for example, and immediately determine the type of mold.\u003c/p>\n\u003cp>She'd also grown stem cells into heart cells without gravity, and — peering through a microscope that she'd set up — watched them beat in unison.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Rubins has proved that it's possible to do molecular biology at least 200 miles beyond Earth — and maybe 200 million miles away, too.\u003c/p>\n\u003cp>\"The world of sequencing and molecular biology has opened up to us on the space station,\" she says.\u003c/p>\n\u003cp>She and NASA's Julie Robinson are the kind of people who start sentences with the words \"When we go to Mars,\" as if the journey to that planet is as inevitable as their next trip to the grocery store.\u003c/p>\n\u003cp>\"It's the plan,\" says Robinson. \"Absolutely,\" says Rubins, who is now Deputy Director of Human Health and Performance at Johnson Space Center.\u003c/p>\n\u003cp>When \u003cstrong>--\u003c/strong> or if \u003cstrong>--\u003c/strong> that expedition happens, Mars-based biology labs will be crucial resources for astronauts there. They'll need the tools of molecular biology to identify non-human life, so these emissaries from Earth can make sure that they aren't contaminating Mars with their own microbes, and to be able to detect any new life forms they might encounter. They'll also need the labs to diagnose sick space travelers, so they don't waste precious antibiotics or antivirals.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>And, of course, they'll need the technology to figure out what's growing on their walls. Because one thing is for sure: Any human-built Mars habitat will soon become at least as gross as the International Space Station.\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=A+Microbe+Hunter+Plies+Her+Trade+In+Space&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Old-School Chemo Can Harness the Immune System - Not Just Attack It",
"title": "Old-School Chemo Can Harness the Immune System - Not Just Attack It",
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"content": "\u003cp>Chemotherapy remains one of the mainstays of cancer treatment, but these harsh drugs are slowly being edged aside in medical research, as new treatments, like immunotherapy, grab the spotlight.\u003c/p>\n\u003cp>Still, this is not the end of the road for chemotherapy. For one thing, doctors are coming to realize that some of these drugs are useful for more than just killing cancer cells.\u003c/p>\n\u003cp>\u003ca href=\"http://www.cancertrialshelp.org/aboutus_content/aboutusMainContent.aspx?intAppMode=20\">Dr. Robert Comis\u003c/a>, a professor and oncologist at Drexel University, had the first inkling of this phenomenon 30 years ago, after he ran a test involving radiation therapy along with just two cycles of chemotherapy — far too few cycles to be truly effective. Even so, the patients did much better than he'd expected.\u003c/p>\n\u003cp>\"The only explanation was there was this large effect that involved the whole body,\" says Comis, who also co-leads the \u003ca href=\"http://ecog-acrin.org/about-us/ecog-acrin-leadership/robert-comis\">ECOG-ACRIN Cancer Research Group\u003c/a> in Philadelphia. Chemotherapy wasn't simply killing cancer cells, he realized; apparently it was stimulating the immune system, too.\u003c/p>\n\u003cp>And that meant these old-fashioned drugs could play a new role.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>To be sure, chemotherapy is still used a lot for its ability to kill cancer cells, even in clinical trials that involve newer treatments like immunotherapy.\u003c/p>\n\u003caside class=\"pullquote alignright\">'We can't lose sight of the fact that cytotoxic chemotherapy has cured many, many patients.'\u003ccite>Dr. Robert Comis, professor and oncologist, Drexel University\u003c/cite>\u003c/aside>\n\u003cp>Sometimes, fast-acting chemotherapy can help slow an aggressive cancer, for instance, and give the slower-acting immunotherapy treatments a chance to work. Chemo is also sometimes paired with still-unproven treatments to improve their odds of success.\u003c/p>\n\u003cp>That was the case for 69-year-old Deborah Mazia, who ended up at the Johns Hopkins Bloomberg-Kimmel Institute in Baltimore after being diagnosed with breast cancer around Thanksgiving of last year.\u003c/p>\n\u003cp>The news was bad. Mazia's doctor told her that she had \u003ca href=\"https://www.mdanderson.org/publications/cancerwise/2015/04/triple-negative-breast-cancer-5-things-you-should-know.html\">triple-negative breast cancer\u003c/a>, a malignancy that tends to respond poorly to conventional treatment.\u003c/p>\n\u003cp>\"So, [the doctor] held my hand,\" Mazia recalls, \"and she says, 'Listen. It's Stage 4. And if you want to do anything, do it now.'\"\u003c/p>\n\u003cp>Mazia didn't hesitate. She enrolled in \u003ca href=\"https://clinicaltrials.gov/ct2/show/NCT02425891?term=NCT02425891&rank=1\">a study\u003c/a> that combines a potent chemotherapy drug with either an immunotherapy agent or a placebo. She still doesn't know whether she's getting the experimental treatment or not.\u003c/p>\n\u003cp>\"But I don't care,\" she says. \"I'm excited, because this is where I think things are going research-wise, so I'm thrilled.\"\u003c/p>\n\u003cfigure id=\"attachment_365499\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-365499\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/03/Deborah-Mazia-chemo-treatment-800x531.jpg\" alt=\"Deborah Mazia enrolled in a clinical trial after being diagnosed with triple-negative breast cancer last fall.\" width=\"800\" height=\"531\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/03/Deborah-Mazia-chemo-treatment.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2017/03/Deborah-Mazia-chemo-treatment-160x106.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/03/Deborah-Mazia-chemo-treatment-768x510.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2017/03/Deborah-Mazia-chemo-treatment-240x159.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/03/Deborah-Mazia-chemo-treatment-375x249.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/03/Deborah-Mazia-chemo-treatment-520x345.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Deborah Mazia enrolled in a clinical trial after being diagnosed with triple-negative breast cancer last fall. \u003ccite>(Meredith Rizzo/NPR )\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Immunotherapy sometimes produces dramatic results, but most of the time it doesn't work. So for a clinical trial like this, it makes sense to give standard chemotherapy along with the experimental treatment.\u003c/p>\n\u003cp>\u003ca href=\"http://www.hopkinsmedicine.org/profiles/results/directory/profile/0011782/leisha-emens\">Dr. Leisha Emens\u003c/a>, the oncologist running the study at Hopkins, says this is just one way she continues to use chemotherapy in clinical trials. She and her colleagues are also exploring an underappreciated role of chemotherapy — its ability to directly affect the immune system.\u003c/p>\n\u003cp>\"In fact, it can either help or hurt the immune response to cancer,\" Emens says. She's interested in the helpful part, of course. For instance, certain chemotherapy drugs can kill a type of T-cell that makes cancers more resistant to treatment.\u003c/p>\n\u003cp>It also appears that after chemotherapy kills cancer cells, the debris that's left can sometimes stimulate an immune reaction. That leftover material is like a vaccine, in that it trains the immune system to recognize and attack remaining cancer cells.\u003c/p>\n\u003cp>And in some cases, Emens says, doctors can use lower doses of these highly toxic and often unpleasant drugs to harness the immune system. That interplay is an active area of research, she says.\u003c/p>\n\u003cp>The National Cancer Institute is focusing research dollars on that very issue, as it phases out traditional studies that involve only chemotherapy drugs. For decades, the institute has been funding research to find new combinations and doses, and made incremental improvements in cancer treatments. But those studies are disappearing.\u003c/p>\n\u003cp>\u003ca href=\"https://ctep.cancer.gov/branches/idb/bios/sharon_elad.htm\">Dr. Elad Sharon\u003c/a> at the NCI says there's been a natural shift, instead, toward the next frontier of cancer treatment — so-called targeted therapies. Unlike chemotherapy, these targeted drugs don't blindly kill fast-growing cells, but instead home in on specific vulnerabilities within malignant cells. Immunotherapy is one type of targeted therapy.\u003c/p>\n\u003cp>\"That's something that has really captured the imagination of the field,\" Sharon says. As time goes on, he says, \"definitely we're seeing more and more of these targeted agents become the standard that people expect to receive.\"\u003c/p>\n\u003cp>But this is hardly the end of the road for traditional chemo.\u003c/p>\n\u003cp>\"I think there are some diseases where chemotherapy has really been very effective, and has led to significant cures,\" Sharon says. It's \"probably going to be very hard for any targeted agents to beat them.\"[contextly_sidebar id=\"9GTLnSMXL7TkiveWVKT9k1LTiVo7Bk0Y\"]\u003c/p>\n\u003cp>Comis agrees. \"We're in a transition state right now where the types of available treatments are changing,\" he says. \"But we can't lose sight of the fact that cytotoxic chemotherapy has cured many, many patients.\"\u003c/p>\n\u003cp>And there are still ways to make these old standby drugs more effective, Comis says, sometimes by using them in combination.\u003c/p>\n\u003cp>\"We just completed \u003ca href=\"http://www.nejm.org/doi/full/10.1056/NEJMoa1503747\">a study\u003c/a> which showed that, in metastatic prostate cancer, the addition of a chemotherapy drug, God forbid, increased survival by 18 months in the highest risk groups,\" he says. \"Eighteen months!\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>That's much better than the improvements reported for most targeted treatments. In an ideal world, highly toxic chemo would give way altogether to gentler and more effective medicines for patients like Deborah Mazia. But Comis, for one, doesn't see that day coming anytime soon.\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=Old-Style+Chemo+Is+Still+A+Mainstay+In+The+Age+Of+Targeted+Cancer+Therapy&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Chemotherapy remains one of the mainstays of cancer treatment, but these harsh drugs are slowly being edged aside in medical research, as new treatments, like immunotherapy, grab the spotlight.\u003c/p>\n\u003cp>Still, this is not the end of the road for chemotherapy. For one thing, doctors are coming to realize that some of these drugs are useful for more than just killing cancer cells.\u003c/p>\n\u003cp>\u003ca href=\"http://www.cancertrialshelp.org/aboutus_content/aboutusMainContent.aspx?intAppMode=20\">Dr. Robert Comis\u003c/a>, a professor and oncologist at Drexel University, had the first inkling of this phenomenon 30 years ago, after he ran a test involving radiation therapy along with just two cycles of chemotherapy — far too few cycles to be truly effective. Even so, the patients did much better than he'd expected.\u003c/p>\n\u003cp>\"The only explanation was there was this large effect that involved the whole body,\" says Comis, who also co-leads the \u003ca href=\"http://ecog-acrin.org/about-us/ecog-acrin-leadership/robert-comis\">ECOG-ACRIN Cancer Research Group\u003c/a> in Philadelphia. Chemotherapy wasn't simply killing cancer cells, he realized; apparently it was stimulating the immune system, too.\u003c/p>\n\u003cp>And that meant these old-fashioned drugs could play a new role.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>To be sure, chemotherapy is still used a lot for its ability to kill cancer cells, even in clinical trials that involve newer treatments like immunotherapy.\u003c/p>\n\u003caside class=\"pullquote alignright\">'We can't lose sight of the fact that cytotoxic chemotherapy has cured many, many patients.'\u003ccite>Dr. Robert Comis, professor and oncologist, Drexel University\u003c/cite>\u003c/aside>\n\u003cp>Sometimes, fast-acting chemotherapy can help slow an aggressive cancer, for instance, and give the slower-acting immunotherapy treatments a chance to work. Chemo is also sometimes paired with still-unproven treatments to improve their odds of success.\u003c/p>\n\u003cp>That was the case for 69-year-old Deborah Mazia, who ended up at the Johns Hopkins Bloomberg-Kimmel Institute in Baltimore after being diagnosed with breast cancer around Thanksgiving of last year.\u003c/p>\n\u003cp>The news was bad. Mazia's doctor told her that she had \u003ca href=\"https://www.mdanderson.org/publications/cancerwise/2015/04/triple-negative-breast-cancer-5-things-you-should-know.html\">triple-negative breast cancer\u003c/a>, a malignancy that tends to respond poorly to conventional treatment.\u003c/p>\n\u003cp>\"So, [the doctor] held my hand,\" Mazia recalls, \"and she says, 'Listen. It's Stage 4. And if you want to do anything, do it now.'\"\u003c/p>\n\u003cp>Mazia didn't hesitate. She enrolled in \u003ca href=\"https://clinicaltrials.gov/ct2/show/NCT02425891?term=NCT02425891&rank=1\">a study\u003c/a> that combines a potent chemotherapy drug with either an immunotherapy agent or a placebo. She still doesn't know whether she's getting the experimental treatment or not.\u003c/p>\n\u003cp>\"But I don't care,\" she says. \"I'm excited, because this is where I think things are going research-wise, so I'm thrilled.\"\u003c/p>\n\u003cfigure id=\"attachment_365499\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-365499\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/03/Deborah-Mazia-chemo-treatment-800x531.jpg\" alt=\"Deborah Mazia enrolled in a clinical trial after being diagnosed with triple-negative breast cancer last fall.\" width=\"800\" height=\"531\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/03/Deborah-Mazia-chemo-treatment.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2017/03/Deborah-Mazia-chemo-treatment-160x106.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/03/Deborah-Mazia-chemo-treatment-768x510.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2017/03/Deborah-Mazia-chemo-treatment-240x159.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/03/Deborah-Mazia-chemo-treatment-375x249.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/03/Deborah-Mazia-chemo-treatment-520x345.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Deborah Mazia enrolled in a clinical trial after being diagnosed with triple-negative breast cancer last fall. \u003ccite>(Meredith Rizzo/NPR )\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Immunotherapy sometimes produces dramatic results, but most of the time it doesn't work. So for a clinical trial like this, it makes sense to give standard chemotherapy along with the experimental treatment.\u003c/p>\n\u003cp>\u003ca href=\"http://www.hopkinsmedicine.org/profiles/results/directory/profile/0011782/leisha-emens\">Dr. Leisha Emens\u003c/a>, the oncologist running the study at Hopkins, says this is just one way she continues to use chemotherapy in clinical trials. She and her colleagues are also exploring an underappreciated role of chemotherapy — its ability to directly affect the immune system.\u003c/p>\n\u003cp>\"In fact, it can either help or hurt the immune response to cancer,\" Emens says. She's interested in the helpful part, of course. For instance, certain chemotherapy drugs can kill a type of T-cell that makes cancers more resistant to treatment.\u003c/p>\n\u003cp>It also appears that after chemotherapy kills cancer cells, the debris that's left can sometimes stimulate an immune reaction. That leftover material is like a vaccine, in that it trains the immune system to recognize and attack remaining cancer cells.\u003c/p>\n\u003cp>And in some cases, Emens says, doctors can use lower doses of these highly toxic and often unpleasant drugs to harness the immune system. That interplay is an active area of research, she says.\u003c/p>\n\u003cp>The National Cancer Institute is focusing research dollars on that very issue, as it phases out traditional studies that involve only chemotherapy drugs. For decades, the institute has been funding research to find new combinations and doses, and made incremental improvements in cancer treatments. But those studies are disappearing.\u003c/p>\n\u003cp>\u003ca href=\"https://ctep.cancer.gov/branches/idb/bios/sharon_elad.htm\">Dr. Elad Sharon\u003c/a> at the NCI says there's been a natural shift, instead, toward the next frontier of cancer treatment — so-called targeted therapies. Unlike chemotherapy, these targeted drugs don't blindly kill fast-growing cells, but instead home in on specific vulnerabilities within malignant cells. Immunotherapy is one type of targeted therapy.\u003c/p>\n\u003cp>\"That's something that has really captured the imagination of the field,\" Sharon says. As time goes on, he says, \"definitely we're seeing more and more of these targeted agents become the standard that people expect to receive.\"\u003c/p>\n\u003cp>But this is hardly the end of the road for traditional chemo.\u003c/p>\n\u003cp>\"I think there are some diseases where chemotherapy has really been very effective, and has led to significant cures,\" Sharon says. It's \"probably going to be very hard for any targeted agents to beat them.\"\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Comis agrees. \"We're in a transition state right now where the types of available treatments are changing,\" he says. \"But we can't lose sight of the fact that cytotoxic chemotherapy has cured many, many patients.\"\u003c/p>\n\u003cp>And there are still ways to make these old standby drugs more effective, Comis says, sometimes by using them in combination.\u003c/p>\n\u003cp>\"We just completed \u003ca href=\"http://www.nejm.org/doi/full/10.1056/NEJMoa1503747\">a study\u003c/a> which showed that, in metastatic prostate cancer, the addition of a chemotherapy drug, God forbid, increased survival by 18 months in the highest risk groups,\" he says. \"Eighteen months!\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>That's much better than the improvements reported for most targeted treatments. In an ideal world, highly toxic chemo would give way altogether to gentler and more effective medicines for patients like Deborah Mazia. But Comis, for one, doesn't see that day coming anytime soon.\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=Old-Style+Chemo+Is+Still+A+Mainstay+In+The+Age+Of+Targeted+Cancer+Therapy&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Common Blood Tests May Help Predict Chronic Disease Risk",
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"content": "\u003cp>A score based on common blood tests may someday help people gauge their risk of developing a chronic disease like diabetes or dementia within three years of taking the test.\u003c/p>\n\u003cp>The Intermountain Chronic Disease Risk Score was 77 to 78 percent accurate in predicting whether someone would be diagnosed with diabetes, kidney failure, coronary artery disease and dementia, among other illnesses. It's based on the results of a \u003ca href=\"https://medlineplus.gov/ency/article/003468.htm\">comprehensive metabolic panel\u003c/a>, which includes tests for blood glucose and liver function, and \u003ca href=\"https://medlineplus.gov/bloodcounttests.html#summary\">complete blood count\u003c/a>, which measures the quantity of different types of blood cells.\u003c/p>\n\u003caside class=\"pullquote alignright\">'They may be on to something, but it’s too early to say for sure.'\u003ccite>Wayne Dysinger,\u003cbr>\nLifestyle Medicine Solutions\u003c/cite>\u003c/aside>\n\u003cp>The hope is that the score could eventually help physicians better allocate their time and resources, says \u003ca href=\"https://intermountainhealthcare.org/services/heart-care/heart-institute/research-and-clinical-trials/research-team/epidemiologists/heidi-may/\">Heidi May\u003c/a>, a cardiovascular epidemiologist with the Intermountain Medical Center Heart Institute in Salt Lake City, and principal investigator of the study. For example, a patient whose score puts her in the high-risk group might get more intense patient education about lifestyle or other prevention measures, and a follow-up visit in six months rather than a year.\u003c/p>\n\u003cp>The tests used in the score are commonly performed at checkups, and the score itself can be calculated by the hospital's electronic health record, making it easier for doctors to use. \"Clinicians are so busy and have to worry about so many things,\" says May. The so-called ICHRON score is similar to \u003ca href=\"https://intermountainhealthcare.org/about/transforming-healthcare/innovation/intermountain-risk-scores/risk-scores/\">risk scores\u003c/a> previously developed and now used by Intermountain Healthcare, a nonprofit hospital system, to predict the future risk of death, hospital readmission and serious disease.\u003c/p>\n\u003cp>The research was presented last month at a meeting of the American College of Cardiology.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"It's a fascinating concept,\" says \u003ca href=\"http://provider.kareo.com/dr-wayne-dysinger-1\">Wayne Dysinger\u003c/a>, a preventive and family medicine physician and CEO of Lifestyle Medicine Solutions, a primary care practice in southern California, who wasn't involved in the study. \"They may be on to something, but it's too early to say for sure.\"\u003c/p>\n\u003cp>[contextly_sidebar id=\"4FJC8XHrFm7lnXNkyhtLENB2eXu8G8oh\"]For one thing, the score would have to be shown to be accurate in a more general population outside Utah, which is largely white and has lower rates of smoking and obesity than other states.\u003c/p>\n\u003cp>The score was developed based on the data in one group of primary care patients and then tested again in another group, and it is gender-specific. Among the more than 144,000 patients studied, 7 percent of women and 9 percent of men were diagnosed with at least one chronic disease in the next three years, most commonly diabetes or coronary artery disease.\u003c/p>\n\u003cp>Among women, those with a high ICHRON score were 11 times more likely to be diagnosed with a chronic disease than those with a low score. Women with a moderate score were three times more likely to be diagnosed. Men with a high score were 14 times more likely to be diagnosed than those with a low score, and those with a moderate score more than five times more likely to be diagnosed.\u003c/p>\n\u003cp>Dysinger notes the prediction isn't perfect, and that people don't have to wait to be identified as at-risk to change their lifestyle, starting with turning away from processed foods to whole foods. \u003ca href=\"http://www.who.int/chp/chronic_disease_report/part1/en/index11.html\">According to the World Health Organization\u003c/a>, 80 percent of premature heart disease, stroke and diabetes can be prevented through lifestyle measures like avoiding tobacco use, keeping weight at a healthy level and exercise.\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\">\n\u003cp>Copyright 2017 \u003ca href=\"http://www.npr.org\" target=\"_blank\">NPR\u003c/a>.\u003c/p>\n\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>A score based on common blood tests may someday help people gauge their risk of developing a chronic disease like diabetes or dementia within three years of taking the test.\u003c/p>\n\u003cp>The Intermountain Chronic Disease Risk Score was 77 to 78 percent accurate in predicting whether someone would be diagnosed with diabetes, kidney failure, coronary artery disease and dementia, among other illnesses. It's based on the results of a \u003ca href=\"https://medlineplus.gov/ency/article/003468.htm\">comprehensive metabolic panel\u003c/a>, which includes tests for blood glucose and liver function, and \u003ca href=\"https://medlineplus.gov/bloodcounttests.html#summary\">complete blood count\u003c/a>, which measures the quantity of different types of blood cells.\u003c/p>\n\u003caside class=\"pullquote alignright\">'They may be on to something, but it’s too early to say for sure.'\u003ccite>Wayne Dysinger,\u003cbr>\nLifestyle Medicine Solutions\u003c/cite>\u003c/aside>\n\u003cp>The hope is that the score could eventually help physicians better allocate their time and resources, says \u003ca href=\"https://intermountainhealthcare.org/services/heart-care/heart-institute/research-and-clinical-trials/research-team/epidemiologists/heidi-may/\">Heidi May\u003c/a>, a cardiovascular epidemiologist with the Intermountain Medical Center Heart Institute in Salt Lake City, and principal investigator of the study. For example, a patient whose score puts her in the high-risk group might get more intense patient education about lifestyle or other prevention measures, and a follow-up visit in six months rather than a year.\u003c/p>\n\u003cp>The tests used in the score are commonly performed at checkups, and the score itself can be calculated by the hospital's electronic health record, making it easier for doctors to use. \"Clinicians are so busy and have to worry about so many things,\" says May. The so-called ICHRON score is similar to \u003ca href=\"https://intermountainhealthcare.org/about/transforming-healthcare/innovation/intermountain-risk-scores/risk-scores/\">risk scores\u003c/a> previously developed and now used by Intermountain Healthcare, a nonprofit hospital system, to predict the future risk of death, hospital readmission and serious disease.\u003c/p>\n\u003cp>The research was presented last month at a meeting of the American College of Cardiology.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"It's a fascinating concept,\" says \u003ca href=\"http://provider.kareo.com/dr-wayne-dysinger-1\">Wayne Dysinger\u003c/a>, a preventive and family medicine physician and CEO of Lifestyle Medicine Solutions, a primary care practice in southern California, who wasn't involved in the study. \"They may be on to something, but it's too early to say for sure.\"\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>For one thing, the score would have to be shown to be accurate in a more general population outside Utah, which is largely white and has lower rates of smoking and obesity than other states.\u003c/p>\n\u003cp>The score was developed based on the data in one group of primary care patients and then tested again in another group, and it is gender-specific. Among the more than 144,000 patients studied, 7 percent of women and 9 percent of men were diagnosed with at least one chronic disease in the next three years, most commonly diabetes or coronary artery disease.\u003c/p>\n\u003cp>Among women, those with a high ICHRON score were 11 times more likely to be diagnosed with a chronic disease than those with a low score. Women with a moderate score were three times more likely to be diagnosed. Men with a high score were 14 times more likely to be diagnosed than those with a low score, and those with a moderate score more than five times more likely to be diagnosed.\u003c/p>\n\u003cp>Dysinger notes the prediction isn't perfect, and that people don't have to wait to be identified as at-risk to change their lifestyle, starting with turning away from processed foods to whole foods. \u003ca href=\"http://www.who.int/chp/chronic_disease_report/part1/en/index11.html\">According to the World Health Organization\u003c/a>, 80 percent of premature heart disease, stroke and diabetes can be prevented through lifestyle measures like avoiding tobacco use, keeping weight at a healthy level and exercise.\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\">\n\u003cp>Copyright 2017 \u003ca href=\"http://www.npr.org\" target=\"_blank\">NPR\u003c/a>.\u003c/p>\n\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Psychoanalysts Fight to Stave Off Extinction",
"title": "Psychoanalysts Fight to Stave Off Extinction",
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"content": "\u003cp>After more than a century mining the unconscious, psychoanalysis is really showing its age.\u003c/p>\n\u003cp class=\"danger-zone\">But analysts aren’t ready to give up on Sigmund yet.\u003c/p>\n\u003cp class=\"danger-zone\">Determined to reinvigorate their profession, they’re seeking to train a new and more diverse generation of therapists. They’re introducing the concepts underlying analysis to schoolkids. They’re holding public talks, including \u003ca href=\"http://dasunbehagen.org/event/crazy-like-fox-evil-not-psychiatric-illness-talk-steven-reisner-new-school/\" target=\"_blank\">recent\u003c/a> \u003ca href=\"https://www.nypsi.org/#Event/45565\" target=\"_blank\">ones\u003c/a> taking an analytical view of \u003ca href=\"https://www.statnews.com/2017/01/30/trump-mental-health/\" target=\"_blank\">President Trump\u003c/a>. They’re opening their field to more rigorous research, sometimes in collaboration with neuroscientists.\u003c/p>\n\u003caside class=\"pullquote alignright\">Approximately 1 in 5 adults in the U.S. will experience mental health issues, yet psychoanalysis is now rarely covered by insurance — or considered a viable treatment option.\u003c/aside>\n\u003cp class=\"\">And they’re working to persuade a skeptical public that psychoanalysis is relevant. Yes, busts of Sigmund Freud stare down anyone who enters the New York Psychoanalytic Society & Institute, the oldest training center in the United States. But analysts say they’re not unduly fixated on his stages of psychosexual development or his ideas on the id, ego, and superego.\u003c/p>\n\u003cp class=\"\">“People say, ‘Oh, does that mean you’re Freudian?’” said Adele Tutter, a psychoanalyst in Manhattan. “That’s kind of like asking a modern-day nuclear physicist whether he’s Copernican. Much of what Copernicus said was not true, but it helped. It was the foundation.”\u003c/p>\n\u003cfigure id=\"attachment_361679\" class=\"wp-caption alignright\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-361679\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/03/Sigmund_Freud_Veranda-800x1034.jpg\" alt=\"Sigmund Freud on the patio of his apartment in Vienna, 1912.\" width=\"800\" height=\"1034\">\u003cfigcaption class=\"wp-caption-text\">Sigmund Freud on the patio of his apartment in Vienna, 1912. \u003ccite>(Sigmund Freud Museum)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The foundation for psychoanalysis starts with the unconscious. Freud theorized that humans act in order to satisfy needs they don’t know exist. If patients in therapy could speak whatever came to mind — a concept known as “free association” — he thought they’d eventually push to the surface subconscious feelings that can lead to self-destructive behavior.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Now, practitioners are trying to make the case that such ideas have power beyond the analyst’s couch.\u003c/p>\n\u003cp>“We’ve started applying psychoanalytic ideas outside of our offices — in schools, in agencies, in business,” said Mark Smaller, the immediate past president of the American Psychoanalytic Association. “We’ve made social issues much more on the minds of our membership.”\u003c/p>\n\u003cp>Smaller, for instance, has been bringing psychoanalysis to at-risk teenagers at Morton Alternative School in Cicero, Ill. Now in its 12th year, Project Realize has treated more than 400 students who were expelled from regular high school for aggressive and dysfunctional behavior. Smaller said the program has helped lower violence and improve graduation rates.\u003c/p>\n\u003caside class=\"pullquote alignright\">\"People say, ‘Oh, does that mean you’re Freudian?' That’s kind of like asking a modern-day nuclear physicist whether he’s Copernican.\"\u003ccite>Psychoanalyst Adele Tutter, on the public's association of modern psychoanalysis with the ideas of its founder, Sigmund Freud\u003c/cite>\u003c/aside>\n\u003cp>Another form of public engagement comes from an experimental psychoanalytic group called \u003ca href=\"http://dasunbehagen.org/\" target=\"_blank\">Das Unbehagen\u003c/a>. It holds public readings and performances — often on edgy topics — in hopes of drawing an audience that may be receptive to Freudian ideas.“Talking about the arts or the occult is helpful,” said Vanessa Sinclair, a clinical psychologist and psychoanalyst in New York and a cofounder of the group. “I get younger people who are interested, and then I can throw psychoanalysis at them. It makes sense intuitively to a lot of people.”\u003c/p>\n\u003ch2>The struggle to get more patients on the couch\u003c/h2>\n\u003cp>Is the outreach working?\u003c/p>\n\u003cp>Perhaps, if the goal is public awareness. In January, the Library of Congress unveiled a digitized archive of Freud’s psychoanalytic and personal papers. \u003ca href=\"https://www.theguardian.com/books/2017/mar/01/cold-war-freud-an-intellectual-biography-dagmar-herzog-joel-whitebook\" target=\"_blank\">Two new books\u003c/a> on Freud — one a study, the other a biography — have been published within the past six months. Essays claiming to “psychoanalyze” figures like Kanye West and Donald Trump are routinely shared across social media.\u003c/p>\n\u003cp>But analysts acknowledge it will be an uphill battle to get more patients on their couches. Approximately 1 in 5 adults in the U.S. will \u003ca href=\"http://www.nami.org/Learn-More/Mental-Health-By-the-Numbers\" target=\"_blank\">experience mental health issues\u003c/a>, yet psychoanalysis is rarely covered by insurance — or considered a viable treatment option.\u003c/p>\n\u003cp>“There’s much more emphasis on medication,” said Lisa Deutscher, vice president of the 106-year-old New York Psychoanalytic Society & Institute. “Even in a rather privileged stratum of society, there are shifts away from the idea that it would be useful to spend your time doing therapy. There are greater pressures, like the fact people are on call for their jobs 24/7. It makes other commitments in life that much harder.”\u003c/p>\n\u003cp>It can even be hard for would-be analysts to find the time to train. They can’t start until they’ve earned an MD, a PhD, or a license to practice clinical social work. After that, they must complete four years of coursework in psychoanalysis and 200 hours of clinical training.\u003c/p>\n\u003cp>On top of all that, they have to undergo analysis for at least two years — for at least four sessions per week.\u003c/p>\n\u003cp>“They’re requirements that fit the 1950s, when every psychologist wanted to be an analyst,” said Jamieson Webster, a psychoanalyst with a private practice in downtown Manhattan. “If you’re doing a M.D. or a Ph.D. or an L.C.S.W, the conditions of starting a private practice and having a job don’t fit with analytic training anymore. Candidates find their analytic voice at 50. That’s nuts.”\u003c/p>\n\u003cp>It may also help explain why 52 percent of members in the American Psychoanalytic Association are between 60 and 80 years old.\u003c/p>\n\u003cp>“We are an aging organization,” said Smaller, who runs the school program in Illinois. “When I became president-elect at age 62, it was scary that I might have been considered a Young Turk.”\u003c/p>\n\u003cp>To bring in a new generation of analysts, training centers have embraced a mode of treatment called “psychoanalytic psychotherapy.” It incorporates Freudian ideas about motivation and the unconscious, yet requires only two years to learn, making it an easier and cheaper route for new candidates to join the profession.\u003c/p>\n\u003cp>And last year for the first time, the American Psychoanalytic Association offered two “diversity grants” to help training institutes develop programs to encourage diversity among their students. (The grants, however, were tiny: Just $2,500 each to the St. Louis Psychoanalytic Institute and the Psychoanalysis Institute at Emory University.)\u003c/p>\n\u003ch2>A tentative embrace of neuroscience\u003c/h2>\n\u003cp>Perhaps the most radical move for psychoanalysis is to actively embrace scientific research in a quest to see how applying Freud’s theory of the mind affects the physical brain.\u003c/p>\n\u003cp>Analysis “needs to open these concepts up to new evidence, to new terminologies, to new methods,” said Mark Solms, chair of neuropsychology at the University of Cape Town and research chair of the International Psychoanalytical Association. Blending analysis with neuroscience, he said, “is the way forward.”\u003c/p>\n\u003cp>The concept sparked considerable resistance when Solms first proposed it in the mid-’80s. Now, though, it’s gaining acceptance.\u003c/p>\n\u003cp>“Psychoanalysis, as I see it over the last few years, is right back at the table of science,” said Smaller.\u003c/p>\n\u003cp>A 2010 \u003ca href=\"https://www.apa.org/pubs/journals/releases/amp-65-2-98.pdf\" target=\"_blank\">meta-analysis\u003c/a> assessing the recent body of research found that psychoanalysis is more powerful for some patients than medication and about as effective as cognitive behavior therapy, a short-term course of therapy that seeks to give patients practical tools to control conditions such as anxiety. But analysts say more rigorous research is needed.\u003c/p>\n\u003cp>“We have to be open to the fact that undoubtedly some of the things we think work don’t work,” Deutscher said. “We have to know that if we’re testing our ideas, some will be proven and some will be disproven.”\u003c/p>\n\u003cp>One key side effect of research: banishing a reputation that analysts are arrogant and aloof — and not willing to partner with other health care professionals.\u003c/p>\n\u003cp>“It’s only in recent years that psychoanalysts started being willing to do randomized control trials and actually measure the outcomes of their treatments,” Solms said. “As that information is accumulating, it’s up to us to advertise. You must remember what we’re up against. The pharmaceutical industry is enormous and has enormous resources. It’s going to be an uphill battle, but the evidence speaks for itself.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003cem>This \u003ca href=\"https://www.statnews.com/2017/03/15/psychoanalyst-freud-relevant/\" 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/span>\u003c/p>\n\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>After more than a century mining the unconscious, psychoanalysis is really showing its age.\u003c/p>\n\u003cp class=\"danger-zone\">But analysts aren’t ready to give up on Sigmund yet.\u003c/p>\n\u003cp class=\"danger-zone\">Determined to reinvigorate their profession, they’re seeking to train a new and more diverse generation of therapists. They’re introducing the concepts underlying analysis to schoolkids. They’re holding public talks, including \u003ca href=\"http://dasunbehagen.org/event/crazy-like-fox-evil-not-psychiatric-illness-talk-steven-reisner-new-school/\" target=\"_blank\">recent\u003c/a> \u003ca href=\"https://www.nypsi.org/#Event/45565\" target=\"_blank\">ones\u003c/a> taking an analytical view of \u003ca href=\"https://www.statnews.com/2017/01/30/trump-mental-health/\" target=\"_blank\">President Trump\u003c/a>. They’re opening their field to more rigorous research, sometimes in collaboration with neuroscientists.\u003c/p>\n\u003caside class=\"pullquote alignright\">Approximately 1 in 5 adults in the U.S. will experience mental health issues, yet psychoanalysis is now rarely covered by insurance — or considered a viable treatment option.\u003c/aside>\n\u003cp class=\"\">And they’re working to persuade a skeptical public that psychoanalysis is relevant. Yes, busts of Sigmund Freud stare down anyone who enters the New York Psychoanalytic Society & Institute, the oldest training center in the United States. But analysts say they’re not unduly fixated on his stages of psychosexual development or his ideas on the id, ego, and superego.\u003c/p>\n\u003cp class=\"\">“People say, ‘Oh, does that mean you’re Freudian?’” said Adele Tutter, a psychoanalyst in Manhattan. “That’s kind of like asking a modern-day nuclear physicist whether he’s Copernican. Much of what Copernicus said was not true, but it helped. It was the foundation.”\u003c/p>\n\u003cfigure id=\"attachment_361679\" class=\"wp-caption alignright\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-361679\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/03/Sigmund_Freud_Veranda-800x1034.jpg\" alt=\"Sigmund Freud on the patio of his apartment in Vienna, 1912.\" width=\"800\" height=\"1034\">\u003cfigcaption class=\"wp-caption-text\">Sigmund Freud on the patio of his apartment in Vienna, 1912. \u003ccite>(Sigmund Freud Museum)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The foundation for psychoanalysis starts with the unconscious. Freud theorized that humans act in order to satisfy needs they don’t know exist. If patients in therapy could speak whatever came to mind — a concept known as “free association” — he thought they’d eventually push to the surface subconscious feelings that can lead to self-destructive behavior.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Now, practitioners are trying to make the case that such ideas have power beyond the analyst’s couch.\u003c/p>\n\u003cp>“We’ve started applying psychoanalytic ideas outside of our offices — in schools, in agencies, in business,” said Mark Smaller, the immediate past president of the American Psychoanalytic Association. “We’ve made social issues much more on the minds of our membership.”\u003c/p>\n\u003cp>Smaller, for instance, has been bringing psychoanalysis to at-risk teenagers at Morton Alternative School in Cicero, Ill. Now in its 12th year, Project Realize has treated more than 400 students who were expelled from regular high school for aggressive and dysfunctional behavior. Smaller said the program has helped lower violence and improve graduation rates.\u003c/p>\n\u003caside class=\"pullquote alignright\">\"People say, ‘Oh, does that mean you’re Freudian?' That’s kind of like asking a modern-day nuclear physicist whether he’s Copernican.\"\u003ccite>Psychoanalyst Adele Tutter, on the public's association of modern psychoanalysis with the ideas of its founder, Sigmund Freud\u003c/cite>\u003c/aside>\n\u003cp>Another form of public engagement comes from an experimental psychoanalytic group called \u003ca href=\"http://dasunbehagen.org/\" target=\"_blank\">Das Unbehagen\u003c/a>. It holds public readings and performances — often on edgy topics — in hopes of drawing an audience that may be receptive to Freudian ideas.“Talking about the arts or the occult is helpful,” said Vanessa Sinclair, a clinical psychologist and psychoanalyst in New York and a cofounder of the group. “I get younger people who are interested, and then I can throw psychoanalysis at them. It makes sense intuitively to a lot of people.”\u003c/p>\n\u003ch2>The struggle to get more patients on the couch\u003c/h2>\n\u003cp>Is the outreach working?\u003c/p>\n\u003cp>Perhaps, if the goal is public awareness. In January, the Library of Congress unveiled a digitized archive of Freud’s psychoanalytic and personal papers. \u003ca href=\"https://www.theguardian.com/books/2017/mar/01/cold-war-freud-an-intellectual-biography-dagmar-herzog-joel-whitebook\" target=\"_blank\">Two new books\u003c/a> on Freud — one a study, the other a biography — have been published within the past six months. Essays claiming to “psychoanalyze” figures like Kanye West and Donald Trump are routinely shared across social media.\u003c/p>\n\u003cp>But analysts acknowledge it will be an uphill battle to get more patients on their couches. Approximately 1 in 5 adults in the U.S. will \u003ca href=\"http://www.nami.org/Learn-More/Mental-Health-By-the-Numbers\" target=\"_blank\">experience mental health issues\u003c/a>, yet psychoanalysis is rarely covered by insurance — or considered a viable treatment option.\u003c/p>\n\u003cp>“There’s much more emphasis on medication,” said Lisa Deutscher, vice president of the 106-year-old New York Psychoanalytic Society & Institute. “Even in a rather privileged stratum of society, there are shifts away from the idea that it would be useful to spend your time doing therapy. There are greater pressures, like the fact people are on call for their jobs 24/7. It makes other commitments in life that much harder.”\u003c/p>\n\u003cp>It can even be hard for would-be analysts to find the time to train. They can’t start until they’ve earned an MD, a PhD, or a license to practice clinical social work. After that, they must complete four years of coursework in psychoanalysis and 200 hours of clinical training.\u003c/p>\n\u003cp>On top of all that, they have to undergo analysis for at least two years — for at least four sessions per week.\u003c/p>\n\u003cp>“They’re requirements that fit the 1950s, when every psychologist wanted to be an analyst,” said Jamieson Webster, a psychoanalyst with a private practice in downtown Manhattan. “If you’re doing a M.D. or a Ph.D. or an L.C.S.W, the conditions of starting a private practice and having a job don’t fit with analytic training anymore. Candidates find their analytic voice at 50. That’s nuts.”\u003c/p>\n\u003cp>It may also help explain why 52 percent of members in the American Psychoanalytic Association are between 60 and 80 years old.\u003c/p>\n\u003cp>“We are an aging organization,” said Smaller, who runs the school program in Illinois. “When I became president-elect at age 62, it was scary that I might have been considered a Young Turk.”\u003c/p>\n\u003cp>To bring in a new generation of analysts, training centers have embraced a mode of treatment called “psychoanalytic psychotherapy.” It incorporates Freudian ideas about motivation and the unconscious, yet requires only two years to learn, making it an easier and cheaper route for new candidates to join the profession.\u003c/p>\n\u003cp>And last year for the first time, the American Psychoanalytic Association offered two “diversity grants” to help training institutes develop programs to encourage diversity among their students. (The grants, however, were tiny: Just $2,500 each to the St. Louis Psychoanalytic Institute and the Psychoanalysis Institute at Emory University.)\u003c/p>\n\u003ch2>A tentative embrace of neuroscience\u003c/h2>\n\u003cp>Perhaps the most radical move for psychoanalysis is to actively embrace scientific research in a quest to see how applying Freud’s theory of the mind affects the physical brain.\u003c/p>\n\u003cp>Analysis “needs to open these concepts up to new evidence, to new terminologies, to new methods,” said Mark Solms, chair of neuropsychology at the University of Cape Town and research chair of the International Psychoanalytical Association. Blending analysis with neuroscience, he said, “is the way forward.”\u003c/p>\n\u003cp>The concept sparked considerable resistance when Solms first proposed it in the mid-’80s. Now, though, it’s gaining acceptance.\u003c/p>\n\u003cp>“Psychoanalysis, as I see it over the last few years, is right back at the table of science,” said Smaller.\u003c/p>\n\u003cp>A 2010 \u003ca href=\"https://www.apa.org/pubs/journals/releases/amp-65-2-98.pdf\" target=\"_blank\">meta-analysis\u003c/a> assessing the recent body of research found that psychoanalysis is more powerful for some patients than medication and about as effective as cognitive behavior therapy, a short-term course of therapy that seeks to give patients practical tools to control conditions such as anxiety. But analysts say more rigorous research is needed.\u003c/p>\n\u003cp>“We have to be open to the fact that undoubtedly some of the things we think work don’t work,” Deutscher said. “We have to know that if we’re testing our ideas, some will be proven and some will be disproven.”\u003c/p>\n\u003cp>One key side effect of research: banishing a reputation that analysts are arrogant and aloof — and not willing to partner with other health care professionals.\u003c/p>\n\u003cp>“It’s only in recent years that psychoanalysts started being willing to do randomized control trials and actually measure the outcomes of their treatments,” Solms said. “As that information is accumulating, it’s up to us to advertise. You must remember what we’re up against. The pharmaceutical industry is enormous and has enormous resources. It’s going to be an uphill battle, but the evidence speaks for itself.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003cem>This \u003ca href=\"https://www.statnews.com/2017/03/15/psychoanalyst-freud-relevant/\" 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/span>\u003c/p>\n\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Yes, Stress Really Can Cause Disease. But Don’t Stress! You Can Do Something About It",
"title": "Yes, Stress Really Can Cause Disease. But Don’t Stress! You Can Do Something About It",
"headTitle": "KQED Future of You | KQED Science",
"content": "\u003cp>Have you ever envied a friend who looks 20 years younger than their age?\u003c/p>\n\u003cp>How do they do it?\u003c/p>\n\u003caside class=\"pullquote alignright\">'You can do a lot to improve your DNA without having to buy expensive genetic tests, like changing the way you eat, relax and sleep.'\u003c/aside>\n\u003cp>The secret could lie in their telomeres, the tiny caps on the ends of their chromosomes\u003cspan style=\"font-weight: 400\">—\u003c/span>kind of like the plastic wraps at the end of shoelaces. Nobel Laureate Elizabeth Blackburn, \u003cspan class=\"guests\">\u003cspan class=\"guest\">the\u003c/span> \u003cspan class=\"guest-bio\">president of the \u003ca href=\"http://www.salk.edu/\" target=\"_blank\">Salk Institute for Biological Studies\u003c/a>, \u003c/span>\u003c/span>used this metaphor recently when she was a guest on KQED's \u003ca href=\"https://ww2.kqed.org/forum/2017/03/06/using-the-telomere-effect-to-protect-your-dna-and-stave-off-disease/\" target=\"_blank\">Forum\u003c/a>, along with UCSF psychologist Elissa Epel. The two, who have researched telomeres, discussed their new book, \"The Telomere Effect: A Revolutionary Approach to Living Younger, Healthier, Longer.\"\u003c/p>\n\u003cp>\"Picture a shoelace and remember the little plastic tips at the end,\" said Blackburn. \"If you don't have those at the end of your shoelace, they will start fraying away, and the shoelaces will stop working well. Now imagine the shoelaces are actually the chromosomes that carry our genetic material. ... When those telomeres wear down, which they do over the many, many decades of human life, then the consequences are severe. Cells will stop in their tracks and start malfunctioning, and they start becoming inflammatory. \"\u003c/p>\n\u003cp>The good news, Blackburn says, is that minimizing stress will keep your shoelace tips (telomeres) in better shape, helping to prevent disease and maybe even the effects of aging.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Below are excerpts from the conversation, edited for length and clarity. Answers from both authors are combined.\u003c/p>\n\u003cfigure id=\"attachment_360074\" class=\"wp-caption alignright\" style=\"max-width: 800px\">\u003cimg class=\"wp-image-360074 size-medium\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/03/EPEL-And-Blackburn-800x617.jpg\" alt=\"Psychologist Elissa Epel, PhD (left) and Nobel Laureate Elizabeth Blackburn, PhD (right) in a lab at the University of California San Francisco.\" width=\"800\" height=\"617\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/03/EPEL-And-Blackburn-800x617.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2017/03/EPEL-And-Blackburn-160x123.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/03/EPEL-And-Blackburn-768x593.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2017/03/EPEL-And-Blackburn-1020x787.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2017/03/EPEL-And-Blackburn-1920x1482.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2017/03/EPEL-And-Blackburn-1180x911.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2017/03/EPEL-And-Blackburn-960x741.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2017/03/EPEL-And-Blackburn-240x185.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/03/EPEL-And-Blackburn-375x289.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/03/EPEL-And-Blackburn-520x401.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Psychologist Elissa Epel, PhD (left) and Nobel Laureate Elizabeth Blackburn, PhD (right) in a lab at the University of California San Francisco. \u003ccite>(UCSF)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>Telomeres Connected to the Big Killers\u003c/strong>\u003c/p>\n\u003cp>When telomeres fray at the tips, the DNA inside a cell is no longer able to protect its genetic material, because the telomeres don't work well. Again, think of shoelaces. When the tips are frayed, it's difficult to thread them through your shoes. The same is true if your telomeres wear down.\u003cstrong>\u003cbr>\n\u003c/strong>\u003c/p>\n\u003cp>When chromosomes are no longer protected by the telomeres, it sets off alarm signals inside the cells. Over the years, this process of deterioration is what leads to the major diseases of aging like cardiovascular disease, dementia and cancer, because the body isn't protecting itself well.\u003c/p>\n\u003cp>Telomere attrition—causing negative damage to the cells\u003cspan style=\"font-weight: 400\">—\u003c/span>is one of the contributors that lead to these major killers. So the more we stave off attrition of telomeres, the more we extend both our lifespan and our healthspan (the years in which we enjoy a high quality of life where our health is concerned.)\u003c/p>\n\u003cp>\u003cstrong>A Mystery Solved\u003cbr>\n\u003c/strong>\u003c/p>\n\u003cp>We knew that telomeres gradually wear down over the years. We also knew these protective tips build back up, but we didn't know how.\u003c/p>\n\u003cp>Then we discovered a biological indicator, an enzyme called telomerase, which protects our genetic heritage. The enzyme is one of many factors that helps the telomeres build back up again and pass DNA successfully from generation to generation.\u003c/p>\n\u003cp>\u003cstrong>Telomere Length Depends on Mind-Body Connection\u003cbr>\n\u003c/strong>\u003c/p>\n\u003cp>There is a well-established correlation between chronic stress and our health, not only in accelerating chronic diseases but also the short-term effects on the immune system. We wanted to find out how stress affects telomeres, and the results surprised us.\u003cstrong>\u003cbr>\n\u003c/strong>\u003c/p>\n\u003cp>We found a strong relationship between perceived stress\u003cspan style=\"font-weight: 400\">—\u003c/span>the feeling that you can't cope with all that's on your plate\u003cspan style=\"font-weight: 400\">—\u003c/span>and shorter telomeres, and in turn we found lower levels of telomerase in patients who were in a state of overwhelm.\u003c/p>\n\u003cp>Active exercise, good nutrition and deep sleep all play a role in helping to lower stress, but we also found that our community, our neighborhood and our social and psychological lives are also shaping our telomere length throughout our lifespan. For example, the trust we feel or don't feel in our neighbors are all related to telomeres.\u003c/p>\n\u003cp>Any time you get a group of people together, you have social connection and support, which is powerful. And, we are starting to see that emotional support groups can reduce stress just as well as meditation and mindfulness training. For example, the research on knitting , Christian prayer and other repetitive behaviors like chanting look pretty darn good when you study their mind-body effects.\u003c/p>\n\u003cp>So what's very interesting about telomeres is how much control one has over the net attrition rate, which is the sum of many, many \u003cstrong>i\u003c/strong>nfluences. You can quantify it and then say, \"Wow this statistically relates to a lot of these things.\"\u003c/p>\n\u003cp>\u003cstrong>Telomeres: A Key Pathway in Aging\u003c/strong>\u003c/p>\n\u003cp>Part of the reason we know so much about telomeres is that we can now study human DNA so easily. The number of studies that have been done on large populations all over the world is phenomenal. Granted, telomere research is only one factor of aging, but it is a pathway that is illuminated and that we know a lot about.\u003c/p>\n\u003cp>There are other discoveries that are gaining scientists' attention, like the epigenetic clock, which is another predictor of our longevity and our health. But it's a totally different, independent pathway. Our goal in focusing on telomeres is to empower people to see all the ways they can improve their health on their own. You can do a lot to improve your DNA without having to buy expensive genetic tests, like changing the way you eat, relax and sleep.\u003c/p>\n\u003cp>\u003cstrong>Don't Fall For Pills that Make Big Promises\u003c/strong>\u003c/p>\n\u003cp>Don't take supplements promising to improve your telomeres. They are completely unproven. The creams you put on the outside of the body are really not going to seep down to the deeper layers and change the cell aging system. We suggest changes in small daily habits that add up over time. For example, nutrition is a powerful way to reduce oxidative stress, reduce inflammation and possibly boost telomerase. New studies will likely show that changes in diet eventually affect the skin and beyond.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>Blackburn and Epel offer a \u003ca href=\"http://www.hachettebookgroup.com/features/the-telomere-effect/resources.html\" target=\"_blank\">list of practices\u003c/a> to strengthen the health of your telomeres.\u003c/em>\u003c/p>\n\n",
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"excerpt": "A Nobel laureate and a UCSF psychologist team up to discuss how the health of your chromosome tips are affected by stress and is one key to a healthy life as you age.",
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"description": "A Nobel laureate and a UCSF psychologist team up to discuss how the health of your chromosome tips are affected by stress and is one key to a healthy life as you age.",
"title": "Yes, Stress Really Can Cause Disease. But Don’t Stress! You Can Do Something About It | KQED",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Have you ever envied a friend who looks 20 years younger than their age?\u003c/p>\n\u003cp>How do they do it?\u003c/p>\n\u003caside class=\"pullquote alignright\">'You can do a lot to improve your DNA without having to buy expensive genetic tests, like changing the way you eat, relax and sleep.'\u003c/aside>\n\u003cp>The secret could lie in their telomeres, the tiny caps on the ends of their chromosomes\u003cspan style=\"font-weight: 400\">—\u003c/span>kind of like the plastic wraps at the end of shoelaces. Nobel Laureate Elizabeth Blackburn, \u003cspan class=\"guests\">\u003cspan class=\"guest\">the\u003c/span> \u003cspan class=\"guest-bio\">president of the \u003ca href=\"http://www.salk.edu/\" target=\"_blank\">Salk Institute for Biological Studies\u003c/a>, \u003c/span>\u003c/span>used this metaphor recently when she was a guest on KQED's \u003ca href=\"https://ww2.kqed.org/forum/2017/03/06/using-the-telomere-effect-to-protect-your-dna-and-stave-off-disease/\" target=\"_blank\">Forum\u003c/a>, along with UCSF psychologist Elissa Epel. The two, who have researched telomeres, discussed their new book, \"The Telomere Effect: A Revolutionary Approach to Living Younger, Healthier, Longer.\"\u003c/p>\n\u003cp>\"Picture a shoelace and remember the little plastic tips at the end,\" said Blackburn. \"If you don't have those at the end of your shoelace, they will start fraying away, and the shoelaces will stop working well. Now imagine the shoelaces are actually the chromosomes that carry our genetic material. ... When those telomeres wear down, which they do over the many, many decades of human life, then the consequences are severe. Cells will stop in their tracks and start malfunctioning, and they start becoming inflammatory. \"\u003c/p>\n\u003cp>The good news, Blackburn says, is that minimizing stress will keep your shoelace tips (telomeres) in better shape, helping to prevent disease and maybe even the effects of aging.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Below are excerpts from the conversation, edited for length and clarity. Answers from both authors are combined.\u003c/p>\n\u003cfigure id=\"attachment_360074\" class=\"wp-caption alignright\" style=\"max-width: 800px\">\u003cimg class=\"wp-image-360074 size-medium\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/03/EPEL-And-Blackburn-800x617.jpg\" alt=\"Psychologist Elissa Epel, PhD (left) and Nobel Laureate Elizabeth Blackburn, PhD (right) in a lab at the University of California San Francisco.\" width=\"800\" height=\"617\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/03/EPEL-And-Blackburn-800x617.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2017/03/EPEL-And-Blackburn-160x123.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/03/EPEL-And-Blackburn-768x593.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2017/03/EPEL-And-Blackburn-1020x787.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2017/03/EPEL-And-Blackburn-1920x1482.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2017/03/EPEL-And-Blackburn-1180x911.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2017/03/EPEL-And-Blackburn-960x741.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2017/03/EPEL-And-Blackburn-240x185.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/03/EPEL-And-Blackburn-375x289.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/03/EPEL-And-Blackburn-520x401.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Psychologist Elissa Epel, PhD (left) and Nobel Laureate Elizabeth Blackburn, PhD (right) in a lab at the University of California San Francisco. \u003ccite>(UCSF)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>Telomeres Connected to the Big Killers\u003c/strong>\u003c/p>\n\u003cp>When telomeres fray at the tips, the DNA inside a cell is no longer able to protect its genetic material, because the telomeres don't work well. Again, think of shoelaces. When the tips are frayed, it's difficult to thread them through your shoes. The same is true if your telomeres wear down.\u003cstrong>\u003cbr>\n\u003c/strong>\u003c/p>\n\u003cp>When chromosomes are no longer protected by the telomeres, it sets off alarm signals inside the cells. Over the years, this process of deterioration is what leads to the major diseases of aging like cardiovascular disease, dementia and cancer, because the body isn't protecting itself well.\u003c/p>\n\u003cp>Telomere attrition—causing negative damage to the cells\u003cspan style=\"font-weight: 400\">—\u003c/span>is one of the contributors that lead to these major killers. So the more we stave off attrition of telomeres, the more we extend both our lifespan and our healthspan (the years in which we enjoy a high quality of life where our health is concerned.)\u003c/p>\n\u003cp>\u003cstrong>A Mystery Solved\u003cbr>\n\u003c/strong>\u003c/p>\n\u003cp>We knew that telomeres gradually wear down over the years. We also knew these protective tips build back up, but we didn't know how.\u003c/p>\n\u003cp>Then we discovered a biological indicator, an enzyme called telomerase, which protects our genetic heritage. The enzyme is one of many factors that helps the telomeres build back up again and pass DNA successfully from generation to generation.\u003c/p>\n\u003cp>\u003cstrong>Telomere Length Depends on Mind-Body Connection\u003cbr>\n\u003c/strong>\u003c/p>\n\u003cp>There is a well-established correlation between chronic stress and our health, not only in accelerating chronic diseases but also the short-term effects on the immune system. We wanted to find out how stress affects telomeres, and the results surprised us.\u003cstrong>\u003cbr>\n\u003c/strong>\u003c/p>\n\u003cp>We found a strong relationship between perceived stress\u003cspan style=\"font-weight: 400\">—\u003c/span>the feeling that you can't cope with all that's on your plate\u003cspan style=\"font-weight: 400\">—\u003c/span>and shorter telomeres, and in turn we found lower levels of telomerase in patients who were in a state of overwhelm.\u003c/p>\n\u003cp>Active exercise, good nutrition and deep sleep all play a role in helping to lower stress, but we also found that our community, our neighborhood and our social and psychological lives are also shaping our telomere length throughout our lifespan. For example, the trust we feel or don't feel in our neighbors are all related to telomeres.\u003c/p>\n\u003cp>Any time you get a group of people together, you have social connection and support, which is powerful. And, we are starting to see that emotional support groups can reduce stress just as well as meditation and mindfulness training. For example, the research on knitting , Christian prayer and other repetitive behaviors like chanting look pretty darn good when you study their mind-body effects.\u003c/p>\n\u003cp>So what's very interesting about telomeres is how much control one has over the net attrition rate, which is the sum of many, many \u003cstrong>i\u003c/strong>nfluences. You can quantify it and then say, \"Wow this statistically relates to a lot of these things.\"\u003c/p>\n\u003cp>\u003cstrong>Telomeres: A Key Pathway in Aging\u003c/strong>\u003c/p>\n\u003cp>Part of the reason we know so much about telomeres is that we can now study human DNA so easily. The number of studies that have been done on large populations all over the world is phenomenal. Granted, telomere research is only one factor of aging, but it is a pathway that is illuminated and that we know a lot about.\u003c/p>\n\u003cp>There are other discoveries that are gaining scientists' attention, like the epigenetic clock, which is another predictor of our longevity and our health. But it's a totally different, independent pathway. Our goal in focusing on telomeres is to empower people to see all the ways they can improve their health on their own. You can do a lot to improve your DNA without having to buy expensive genetic tests, like changing the way you eat, relax and sleep.\u003c/p>\n\u003cp>\u003cstrong>Don't Fall For Pills that Make Big Promises\u003c/strong>\u003c/p>\n\u003cp>Don't take supplements promising to improve your telomeres. They are completely unproven. The creams you put on the outside of the body are really not going to seep down to the deeper layers and change the cell aging system. We suggest changes in small daily habits that add up over time. For example, nutrition is a powerful way to reduce oxidative stress, reduce inflammation and possibly boost telomerase. New studies will likely show that changes in diet eventually affect the skin and beyond.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>Blackburn and Epel offer a \u003ca href=\"http://www.hachettebookgroup.com/features/the-telomere-effect/resources.html\" target=\"_blank\">list of practices\u003c/a> to strengthen the health of your telomeres.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Strong Progress for Paralyzed Patients After Stem Cell Therapy, Company Says",
"title": "Strong Progress for Paralyzed Patients After Stem Cell Therapy, Company Says",
"headTitle": "KQED Future of You | KQED Science",
"content": "\u003cp>A small stem cell trial in which patients with severe spinal injuries appeared to make remarkable progress is still showing excellent results, according to the company conducting the research.\u003c/p>\n\u003caside class=\"pullquote alignright\">'This is as good as you could hope at this point.' \u003ccite>Charles Liu, director of the USC Neurorestoration Center\u003c/cite>\u003c/aside>\n\u003cp>\u003cspan style=\"font-weight: 400\">One of the patients in the trial is 21-year-old Kris Boesen, from Bakersfield, California, whose \u003ca href=\"https://ww2.kqed.org/futureofyou/2016/09/12/stem-cells-may-have-restored-use-of-hands-and-arms-in-paralyzed-man/\" target=\"_blank\" rel=\"noopener\">story \u003c/a>we reported on last year. A car crash had left the Bakersfield, California native with \u003c/span>\u003cspan style=\"font-weight: 400\">three crushed vertebrae, almost no feeling below his neck, and a grim\u003c/span>\u003cspan style=\"font-weight: 400\"> prognosis. Doctors believed he would live the rest of his life as a paraplegic.\u003c/span>\u003c/p>\n\u003cp class=\"p1\">\u003cspan style=\"font-weight: 400\">Enter stem cell therapy. Most treatments for serious spinal injuries concentrate on physical therapy to expand the range of the patient's remaining motor skills and to limit further injury, not to reverse the actual damage. But last April, as part of an experimental phase 2 clinical trial called \u003c/span>\u003ca href=\"http://www.scistar-study.com/\" target=\"_blank\" rel=\"noopener\">\u003cspan style=\"font-weight: 400\">SCiStar\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">, researchers injected Boesen with 10 million stem cells. By July, he had recovered use of his hands to the point where he could use a wheelchair, a computer and a cellphone, and could take care of most of his daily living needs.\u003c/span> In recent months his progress has continued, says his father.\u003c/p>\n\u003caside class=\"pullquote alignright\">'It’s certainly interesting, but it’s still early.'\u003ccite>Paul Knoepfler, UC Davis stem cell researcher\u003c/cite>\u003c/aside>\n\u003cp>Boesen is not the only patient to have improved in the trial, according to Asterias Biotherapeutics, which is conducting the research. Boesen is part of a cohort of six patients who were experiencing various levels of paralysis and were injected with the 10 million stem cell dose. In a Jan. 24 \u003ca href=\"http://asteriasbiotherapeutics.com/presentations/Asterias-Biotherapeutics_Investor_Presentation_January-2017.pdf\" target=\"_blank\" rel=\"noopener\">\u003cspan style=\"font-weight: 400\">update\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">, the company said\u003c/span>\u003cspan style=\"font-weight: 400\"> five of those patients had improved either one or two levels on a widely used scale to measure \u003c/span>motor function in spinal injury patients.\u003c/p>\n\u003cp class=\"p1\">\u003cspan style=\"font-weight: 400\">On Tuesday, Asterias issued a new \u003c/span>\u003ca href=\"https://finance.yahoo.com/news/full-six-patient-cohort-confirms-110000936.html\" target=\"_blank\" rel=\"noopener\">\u003cspan style=\"font-weight: 400\">update\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">,\u003c/span> \u003cspan style=\"font-weight: 400\">announcing\u003c/span> \u003cspan style=\"font-weight: 400\"> that the sixth patient in the cohort has experienced a similar improvement. \u003c/span>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp class=\"p1\">While spontaneous recovery for spinal injury patients does occur, the likelihood of all six patients recovering to the degree they have is less likely, researchers say.\u003c/p>\n\u003cp class=\"p1\">“This is as good as you could hope at this point,” said Charles Liu, Boesen’s neurosurgeon and director of the USC Neurorestoration Center. “So far all the evidence is pointing in the right direction.”\u003c/p>\n\u003cp class=\"p1\">To measure improvement in spinal injury patients, researchers use two yardsticks: the Upper Extremity Motor Scale, or UEMS, and the International Standards for Neurological Classification of Spinal Cord Injury, or ISNCSCI. On the UEMS scale, patients are scored from 0 to 5 on their ability to use \u003ca href=\"http://www.nature.com/sc/journal/v45/n3/fig_tab/3102008t1.html\" target=\"_blank\" rel=\"noopener\">five key muscles\u003c/a> in the wrists, elbows and fingers. The \u003ca href=\"http://www.hopkinsmedicine.org/healthlibrary/conditions/physical_medicine_and_rehabilitation/spinal_cord_injury_85,P01180/\" target=\"_blank\" rel=\"noopener\">ISNCSCI scale\u003c/a> assesses where damage has occurred along the different levels of the cervical vertebrae, which generally determines the scope of impairment to the body and the\u003ca href=\"http://www.spinalinjury101.org/details/levels-of-injury\" target=\"_blank\" rel=\"noopener\"> level of care needed\u003c/a>.\u003c/p>\n\u003cp>For instance, if a patient has sustained damage at the fourth cervical vertebra down, known as C-4, at the base of the neck, it generally means that person is paralyzed from the neck down, requiring round-the-clock care and a ventilator to breathe. A patient with a C-5 injury may not be able to move her arms or hands, requiring about 6 to 12 hours per day of assisted care; and at the C-6 level, better motor function may allow a patient to take care of most of her daily living needs on her own.\u003c/p>\n\u003cfigure id=\"attachment_243385\" class=\"wp-caption alignright\" style=\"max-width: 800px\">\u003cimg class=\"wp-image-243385 size-medium\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/09/Neurosurgery-Stem-Cell-spine-patient-Kris-Boesen_04-800x526.jpg\" alt=\"Lifting weights is part of Kris Boesen’s regular program of physical therapy. \" width=\"800\" height=\"526\">\u003cfigcaption class=\"wp-caption-text\">Lifting weights is part of Kris Boesen’s regular program of physical therapy. \u003ccite>(Greg Iger/Keck Medicine of USC))\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Which is all to say that even one level of recovery could substantially improve the daily life of a spinal injury patient.\u003c/p>\n\u003cp class=\"p1\">According to Asterias, all six patients in the 10 million-cell cohort have improved their general UEMS scores, and jumped at least one motor level on the ISNCSCI scale on one or both sides of their body.\u003c/p>\n\u003cp class=\"p1\">Two patients have improved two motor levels on one side; and one patient, Boesen, has improved two motor levels on both sides\u003cb>. \u003c/b>\u003c/p>\n\u003cp>Steve Cartt, president and CEO of Asterias, said another patient, Jake Javier of Danville, California, has gone from partial paralysis to being able to use his hands well enough to consider pursuing a computer science career.\u003c/p>\n\u003cp>\u003cstrong>'Throws Like a Regular Throw'\u003c/strong>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">In September, Boesen’s father, Rod Boesen, told us how excited he was that his son had regained some feeling in one of his feet. Last week, at 11 months post-injection, the elder Boesen said Kris has continued to improve.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“Now he can move his toe and his knee together at the same time,” Boesen said. “They’re about to give him a manual wheelchair now [instead of a motorized one]. He can grip with his hands enough to use a manual one.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Boesen said the movement in his son’s arms and hands has greatly improved since September. \u003c/span>\u003cspan style=\"font-weight: 400\">Kris, a former high school pitcher, had been flinging a ball to his dog “like people throw hand grenades,” Boesen said. “They kind of cradle them – and that’s how Kris would do it. … But now he throws like a regular throw, tosses that ball down the hall, has that release point down, and just wings it.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Asterias is currently recruiting patients for a trial in which they'll receive 20 million stem cells, the optimal dose, according to company researchers. T\u003c/span>\u003cspan style=\"font-weight: 400\">wo patients have already started the 20 million stem cell therapy, and six-month results from those patients will be released in the fall, Cartt said.\u003c/span>\u003c/p>\n\u003cp>Patients who received 2 million stem cells in an earlier phase of the study have not shown much change in their condition, according to the Jan. 24 update.\u003c/p>\n\u003cp>\u003cstrong>Guarded Optimism\u003c/strong>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">While Boesen’s father is impressed with the results, the optimism of researchers inside and outside the study has been guarded. \u003c/span>The trial is still in its early stages, and the sample size is small, said Paul Knoepfler, a cell biology professor and stem cell researcher at UC Davis, who is not involved in the SCiStar study.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\"As a scientist, I still would want to wait for more data,” Knoepfler said. “It’s certainly interesting, but it’s still early. It’s a phase 2 trial.”\u003c/span>\u003c/p>\n\u003cp class=\"p1\">\u003cspan style=\"font-weight: 400\">To address the issue of small sample size, Asterias is looking at historical data to determine the level of improvement for patients in similar circumstances who did not receive stem cell therapy. The company has said it found \"a meaningful difference\" in the recovery of its study patients compared to the norm. \u003c/span>\u003c/p>\n\u003cp class=\"p1\">Liu said one of the most important results is the lack of significant side effects or other negative outcomes resulting from the treatment to date.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\"That’s very significant to me,” Liu said. “That’s the first thing you look for, is anyone hurt from this therapy.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">There was also a concern, he said, that some patients might regress over time, once the initial injection of stem cells wore off. That has yet to occur.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“No one has lost anything they’ve gained,” Liu said. “We were very happy to see that. This is all very promising.\"\u003c/span>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The next step for the SCiStar trial will be to establish a control group, Cartt said.\u003c/span>\u003c/p>\n\n",
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"excerpt": "Among the patients injected with 10 million stem cells is Kris Boesen, who suffered three crushed vertebrae in a car accident last year and was thought by doctors to have little hope of recovery.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>A small stem cell trial in which patients with severe spinal injuries appeared to make remarkable progress is still showing excellent results, according to the company conducting the research.\u003c/p>\n\u003caside class=\"pullquote alignright\">'This is as good as you could hope at this point.' \u003ccite>Charles Liu, director of the USC Neurorestoration Center\u003c/cite>\u003c/aside>\n\u003cp>\u003cspan style=\"font-weight: 400\">One of the patients in the trial is 21-year-old Kris Boesen, from Bakersfield, California, whose \u003ca href=\"https://ww2.kqed.org/futureofyou/2016/09/12/stem-cells-may-have-restored-use-of-hands-and-arms-in-paralyzed-man/\" target=\"_blank\" rel=\"noopener\">story \u003c/a>we reported on last year. A car crash had left the Bakersfield, California native with \u003c/span>\u003cspan style=\"font-weight: 400\">three crushed vertebrae, almost no feeling below his neck, and a grim\u003c/span>\u003cspan style=\"font-weight: 400\"> prognosis. Doctors believed he would live the rest of his life as a paraplegic.\u003c/span>\u003c/p>\n\u003cp class=\"p1\">\u003cspan style=\"font-weight: 400\">Enter stem cell therapy. Most treatments for serious spinal injuries concentrate on physical therapy to expand the range of the patient's remaining motor skills and to limit further injury, not to reverse the actual damage. But last April, as part of an experimental phase 2 clinical trial called \u003c/span>\u003ca href=\"http://www.scistar-study.com/\" target=\"_blank\" rel=\"noopener\">\u003cspan style=\"font-weight: 400\">SCiStar\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">, researchers injected Boesen with 10 million stem cells. By July, he had recovered use of his hands to the point where he could use a wheelchair, a computer and a cellphone, and could take care of most of his daily living needs.\u003c/span> In recent months his progress has continued, says his father.\u003c/p>\n\u003caside class=\"pullquote alignright\">'It’s certainly interesting, but it’s still early.'\u003ccite>Paul Knoepfler, UC Davis stem cell researcher\u003c/cite>\u003c/aside>\n\u003cp>Boesen is not the only patient to have improved in the trial, according to Asterias Biotherapeutics, which is conducting the research. Boesen is part of a cohort of six patients who were experiencing various levels of paralysis and were injected with the 10 million stem cell dose. In a Jan. 24 \u003ca href=\"http://asteriasbiotherapeutics.com/presentations/Asterias-Biotherapeutics_Investor_Presentation_January-2017.pdf\" target=\"_blank\" rel=\"noopener\">\u003cspan style=\"font-weight: 400\">update\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">, the company said\u003c/span>\u003cspan style=\"font-weight: 400\"> five of those patients had improved either one or two levels on a widely used scale to measure \u003c/span>motor function in spinal injury patients.\u003c/p>\n\u003cp class=\"p1\">\u003cspan style=\"font-weight: 400\">On Tuesday, Asterias issued a new \u003c/span>\u003ca href=\"https://finance.yahoo.com/news/full-six-patient-cohort-confirms-110000936.html\" target=\"_blank\" rel=\"noopener\">\u003cspan style=\"font-weight: 400\">update\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">,\u003c/span> \u003cspan style=\"font-weight: 400\">announcing\u003c/span> \u003cspan style=\"font-weight: 400\"> that the sixth patient in the cohort has experienced a similar improvement. \u003c/span>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp class=\"p1\">While spontaneous recovery for spinal injury patients does occur, the likelihood of all six patients recovering to the degree they have is less likely, researchers say.\u003c/p>\n\u003cp class=\"p1\">“This is as good as you could hope at this point,” said Charles Liu, Boesen’s neurosurgeon and director of the USC Neurorestoration Center. “So far all the evidence is pointing in the right direction.”\u003c/p>\n\u003cp class=\"p1\">To measure improvement in spinal injury patients, researchers use two yardsticks: the Upper Extremity Motor Scale, or UEMS, and the International Standards for Neurological Classification of Spinal Cord Injury, or ISNCSCI. On the UEMS scale, patients are scored from 0 to 5 on their ability to use \u003ca href=\"http://www.nature.com/sc/journal/v45/n3/fig_tab/3102008t1.html\" target=\"_blank\" rel=\"noopener\">five key muscles\u003c/a> in the wrists, elbows and fingers. The \u003ca href=\"http://www.hopkinsmedicine.org/healthlibrary/conditions/physical_medicine_and_rehabilitation/spinal_cord_injury_85,P01180/\" target=\"_blank\" rel=\"noopener\">ISNCSCI scale\u003c/a> assesses where damage has occurred along the different levels of the cervical vertebrae, which generally determines the scope of impairment to the body and the\u003ca href=\"http://www.spinalinjury101.org/details/levels-of-injury\" target=\"_blank\" rel=\"noopener\"> level of care needed\u003c/a>.\u003c/p>\n\u003cp>For instance, if a patient has sustained damage at the fourth cervical vertebra down, known as C-4, at the base of the neck, it generally means that person is paralyzed from the neck down, requiring round-the-clock care and a ventilator to breathe. A patient with a C-5 injury may not be able to move her arms or hands, requiring about 6 to 12 hours per day of assisted care; and at the C-6 level, better motor function may allow a patient to take care of most of her daily living needs on her own.\u003c/p>\n\u003cfigure id=\"attachment_243385\" class=\"wp-caption alignright\" style=\"max-width: 800px\">\u003cimg class=\"wp-image-243385 size-medium\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/09/Neurosurgery-Stem-Cell-spine-patient-Kris-Boesen_04-800x526.jpg\" alt=\"Lifting weights is part of Kris Boesen’s regular program of physical therapy. \" width=\"800\" height=\"526\">\u003cfigcaption class=\"wp-caption-text\">Lifting weights is part of Kris Boesen’s regular program of physical therapy. \u003ccite>(Greg Iger/Keck Medicine of USC))\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Which is all to say that even one level of recovery could substantially improve the daily life of a spinal injury patient.\u003c/p>\n\u003cp class=\"p1\">According to Asterias, all six patients in the 10 million-cell cohort have improved their general UEMS scores, and jumped at least one motor level on the ISNCSCI scale on one or both sides of their body.\u003c/p>\n\u003cp class=\"p1\">Two patients have improved two motor levels on one side; and one patient, Boesen, has improved two motor levels on both sides\u003cb>. \u003c/b>\u003c/p>\n\u003cp>Steve Cartt, president and CEO of Asterias, said another patient, Jake Javier of Danville, California, has gone from partial paralysis to being able to use his hands well enough to consider pursuing a computer science career.\u003c/p>\n\u003cp>\u003cstrong>'Throws Like a Regular Throw'\u003c/strong>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">In September, Boesen’s father, Rod Boesen, told us how excited he was that his son had regained some feeling in one of his feet. Last week, at 11 months post-injection, the elder Boesen said Kris has continued to improve.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“Now he can move his toe and his knee together at the same time,” Boesen said. “They’re about to give him a manual wheelchair now [instead of a motorized one]. He can grip with his hands enough to use a manual one.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Boesen said the movement in his son’s arms and hands has greatly improved since September. \u003c/span>\u003cspan style=\"font-weight: 400\">Kris, a former high school pitcher, had been flinging a ball to his dog “like people throw hand grenades,” Boesen said. “They kind of cradle them – and that’s how Kris would do it. … But now he throws like a regular throw, tosses that ball down the hall, has that release point down, and just wings it.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Asterias is currently recruiting patients for a trial in which they'll receive 20 million stem cells, the optimal dose, according to company researchers. T\u003c/span>\u003cspan style=\"font-weight: 400\">wo patients have already started the 20 million stem cell therapy, and six-month results from those patients will be released in the fall, Cartt said.\u003c/span>\u003c/p>\n\u003cp>Patients who received 2 million stem cells in an earlier phase of the study have not shown much change in their condition, according to the Jan. 24 update.\u003c/p>\n\u003cp>\u003cstrong>Guarded Optimism\u003c/strong>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">While Boesen’s father is impressed with the results, the optimism of researchers inside and outside the study has been guarded. \u003c/span>The trial is still in its early stages, and the sample size is small, said Paul Knoepfler, a cell biology professor and stem cell researcher at UC Davis, who is not involved in the SCiStar study.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\"As a scientist, I still would want to wait for more data,” Knoepfler said. “It’s certainly interesting, but it’s still early. It’s a phase 2 trial.”\u003c/span>\u003c/p>\n\u003cp class=\"p1\">\u003cspan style=\"font-weight: 400\">To address the issue of small sample size, Asterias is looking at historical data to determine the level of improvement for patients in similar circumstances who did not receive stem cell therapy. The company has said it found \"a meaningful difference\" in the recovery of its study patients compared to the norm. \u003c/span>\u003c/p>\n\u003cp class=\"p1\">Liu said one of the most important results is the lack of significant side effects or other negative outcomes resulting from the treatment to date.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\"That’s very significant to me,” Liu said. “That’s the first thing you look for, is anyone hurt from this therapy.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">There was also a concern, he said, that some patients might regress over time, once the initial injection of stem cells wore off. That has yet to occur.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“No one has lost anything they’ve gained,” Liu said. “We were very happy to see that. This is all very promising.\"\u003c/span>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>An electronic program launched in 2012 by Los Angeles County’s health care system has reduced wait times for specialty care and eliminated the need for some safety-net patients to see specialists at all, according to a new \u003ca href=\"http://content.healthaffairs.org/content/36/3/492.abstract\" target=\"_blank\">study\u003c/a> in the journal Health Affairs.\u003c/p>\n\u003cp>The program, eConsult, allows primary care doctors to get specialists’ advice for their patients and expedite referrals for those who need in-person appointments. About a quarter of the requests included in the study were resolved without patients needing to see an advanced-care doctor, though there was variation among the specialties.\u003c/p>\n\u003cp>“It completely changed how specialty care was delivered in a safety net system,” said Michael Barnett, an assistant professor of health policy and management at Harvard T.H. Chan School of Public Health and lead author of the study.\u003c/p>\n\u003cp>The Los Angeles County Department of Health Services provides care for about 670,000 patients each year in a system that includes four hospitals, 19 health centers and dozens of community providers. The system serves a low-income population — mostly uninsured or covered by Medi-Cal — who traditionally have had difficulty getting access to specialty care.\u003c/p>\n\u003cp>The eConsult system handles over 17,000 requests each month. About 4,500 providers from more than 400 clinics use the system, according to the county. In 2016, the program served about 130,000 patients.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>One of the major benefits of the eConsult system is that it centralizes requests for care from specialists such as cardiologists, neurologists or gynecologists, Barnett said.\u003c/p>\n\u003cp>Primary care doctors using eConsult have access to a secure, web-based portal to make requests for assistance from specialists. A specialist “reviewer” responds and helps the primary care physician decide how best to manage the patient’s condition.\u003c/p>\n\u003cp>That may mean giving advice, suggesting a specific treatment or recommending the patient see a specialist. If a patient needs a visit right away, the system allows for an expedited appointment.\u003c/p>\n\u003cp>In many cases, primary care doctors can resolve clinical issues with their patients simply by having a conversation, Barnett said. “Many referrals are for issues that could be resolved pretty easily if a primary care doctor could get a specialist’s attention,” he said.\u003c/p>\n\u003cp>That means those patients wouldn’t need to take another day off work, figure out transportation across town and wait to see a specialist, said Paul Giboney, director of specialty care for the Los Angeles County Department of Health Services. Instead, the care could be delivered in the offices of their primary care doctors.\u003c/p>\n\u003cp>About 30 percent of patients who needed a face-to-face visit with a specialist in 2015 were able to get one within 30 days, up from 24 percent in 2014.\u003c/p>\n\u003cp>Difficulty getting appointments with specialists is a challenge for low-income patients across the United States. Without timely access, patients may get sicker and turn to the emergency room for care.\u003c/p>\n\u003cp>That was happening on a large scale in L.A. County before the implementation of the eConsult program. Some patients had to wait more than nine months for an appointment with a urologist or a gastroenterologist, for example, the study said.\u003c/p>\n\u003cp>The eConsult program started as an experiment to reduce the backlog, but Giboney said the county’s public health care system is now using it “day in and day out.”\u003c/p>\n\u003cp>Despite the size and complexity of the Los Angeles County health care system, the eConsult program works efficiently, suggesting that “specialty access is not an intractable problem,” the study said.\u003c/p>\n\u003cp>Giboney said the results show that electronic conversations between primary care doctors and specialists can improve the way business is done.\u003c/p>\n\u003cp>“Within a day, the specialist is already engaged and adding something to the patient’s care,” he said. “We are a public system that is delivering a speed of specialty care that is really unmatched.”\u003c/p>\n\u003cp>Since eConsult was rolled out in L.A. County, Giboney said he has talked to providers from Colorado, Illinois and Connecticut about starting similar programs.\u003c/p>\n\u003cp>Despite the efficiency of the system, Barnett said, there is still room for improvement on the wait times. The average amount of time it took for a patient to see a specialist in 2015 was still 52 days, though it had dropped about 17 percent from 63 days in 2014.\u003c/p>\n\u003cp>Patients who needed ear, nose and throat doctors and those who had kidney problems, cancer or blood diseases saw the most dramatic reductions in waiting time. The wait to see an ear, nose and throat specialist, for example, dropped from 72 to 44 days.\u003c/p>\n\u003cp>Wait times increased in only one of the dozen specialties examined: Patients had to wait on average 75 days in 2015 to see a podiatrist, up from 65 the previous year.\u003c/p>\n\u003cp>Barnett said the next step is to study the impact of the program on quality of care.\u003c/p>\n\u003cp>Giboney said he isn’t satisfied with the wait times either, despite the reduction, but he noted that sometimes doctors want patients to wait a few weeks to see if a treatment is working before going to see a specialist.\u003c/p>\n\u003cp>“It is not always about reducing the wait time,” Giboney said. “It’s about delivering the right specialty care at the right time.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>KHN’s coverage in California is funded in part by \u003ca href=\"http://www.blueshieldcafoundation.org/\" target=\"_blank\">Blue Shield of California Foundation\u003c/a>.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>An electronic program launched in 2012 by Los Angeles County’s health care system has reduced wait times for specialty care and eliminated the need for some safety-net patients to see specialists at all, according to a new \u003ca href=\"http://content.healthaffairs.org/content/36/3/492.abstract\" target=\"_blank\">study\u003c/a> in the journal Health Affairs.\u003c/p>\n\u003cp>The program, eConsult, allows primary care doctors to get specialists’ advice for their patients and expedite referrals for those who need in-person appointments. About a quarter of the requests included in the study were resolved without patients needing to see an advanced-care doctor, though there was variation among the specialties.\u003c/p>\n\u003cp>“It completely changed how specialty care was delivered in a safety net system,” said Michael Barnett, an assistant professor of health policy and management at Harvard T.H. Chan School of Public Health and lead author of the study.\u003c/p>\n\u003cp>The Los Angeles County Department of Health Services provides care for about 670,000 patients each year in a system that includes four hospitals, 19 health centers and dozens of community providers. The system serves a low-income population — mostly uninsured or covered by Medi-Cal — who traditionally have had difficulty getting access to specialty care.\u003c/p>\n\u003cp>The eConsult system handles over 17,000 requests each month. About 4,500 providers from more than 400 clinics use the system, according to the county. In 2016, the program served about 130,000 patients.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>One of the major benefits of the eConsult system is that it centralizes requests for care from specialists such as cardiologists, neurologists or gynecologists, Barnett said.\u003c/p>\n\u003cp>Primary care doctors using eConsult have access to a secure, web-based portal to make requests for assistance from specialists. A specialist “reviewer” responds and helps the primary care physician decide how best to manage the patient’s condition.\u003c/p>\n\u003cp>That may mean giving advice, suggesting a specific treatment or recommending the patient see a specialist. If a patient needs a visit right away, the system allows for an expedited appointment.\u003c/p>\n\u003cp>In many cases, primary care doctors can resolve clinical issues with their patients simply by having a conversation, Barnett said. “Many referrals are for issues that could be resolved pretty easily if a primary care doctor could get a specialist’s attention,” he said.\u003c/p>\n\u003cp>That means those patients wouldn’t need to take another day off work, figure out transportation across town and wait to see a specialist, said Paul Giboney, director of specialty care for the Los Angeles County Department of Health Services. Instead, the care could be delivered in the offices of their primary care doctors.\u003c/p>\n\u003cp>About 30 percent of patients who needed a face-to-face visit with a specialist in 2015 were able to get one within 30 days, up from 24 percent in 2014.\u003c/p>\n\u003cp>Difficulty getting appointments with specialists is a challenge for low-income patients across the United States. Without timely access, patients may get sicker and turn to the emergency room for care.\u003c/p>\n\u003cp>That was happening on a large scale in L.A. County before the implementation of the eConsult program. Some patients had to wait more than nine months for an appointment with a urologist or a gastroenterologist, for example, the study said.\u003c/p>\n\u003cp>The eConsult program started as an experiment to reduce the backlog, but Giboney said the county’s public health care system is now using it “day in and day out.”\u003c/p>\n\u003cp>Despite the size and complexity of the Los Angeles County health care system, the eConsult program works efficiently, suggesting that “specialty access is not an intractable problem,” the study said.\u003c/p>\n\u003cp>Giboney said the results show that electronic conversations between primary care doctors and specialists can improve the way business is done.\u003c/p>\n\u003cp>“Within a day, the specialist is already engaged and adding something to the patient’s care,” he said. “We are a public system that is delivering a speed of specialty care that is really unmatched.”\u003c/p>\n\u003cp>Since eConsult was rolled out in L.A. County, Giboney said he has talked to providers from Colorado, Illinois and Connecticut about starting similar programs.\u003c/p>\n\u003cp>Despite the efficiency of the system, Barnett said, there is still room for improvement on the wait times. The average amount of time it took for a patient to see a specialist in 2015 was still 52 days, though it had dropped about 17 percent from 63 days in 2014.\u003c/p>\n\u003cp>Patients who needed ear, nose and throat doctors and those who had kidney problems, cancer or blood diseases saw the most dramatic reductions in waiting time. The wait to see an ear, nose and throat specialist, for example, dropped from 72 to 44 days.\u003c/p>\n\u003cp>Wait times increased in only one of the dozen specialties examined: Patients had to wait on average 75 days in 2015 to see a podiatrist, up from 65 the previous year.\u003c/p>\n\u003cp>Barnett said the next step is to study the impact of the program on quality of care.\u003c/p>\n\u003cp>Giboney said he isn’t satisfied with the wait times either, despite the reduction, but he noted that sometimes doctors want patients to wait a few weeks to see if a treatment is working before going to see a specialist.\u003c/p>\n\u003cp>“It is not always about reducing the wait time,” Giboney said. “It’s about delivering the right specialty care at the right time.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>KHN’s coverage in California is funded in part by \u003ca href=\"http://www.blueshieldcafoundation.org/\" target=\"_blank\">Blue Shield of California Foundation\u003c/a>.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Is It Ethical to Keep Human Embryo Alive in a Dish For More Than 2 Weeks?",
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"content": "\u003cp>Ali Brivanlou slides open a glass door at the Rockefeller University in New York to show off his latest experiments probing the mysteries of the human embryo.\u003c/p>\n\u003cp>\"As you can see, all my lab is glass — just to make sure there is nothing that happens in some dark rooms that gives people some weird ideas,\" says \u003ca href=\"http://www.rockefeller.edu/research/faculty/labheads/AliBrivanlou/#content\">Brivanlou\u003c/a>, perhaps only half joking.\u003c/p>\n\u003cp>Brivanlou knows that some of his research makes some people uncomfortable. That's one reason he has agreed to give me a look at what's going on.\u003c/p>\n\u003cp>His lab and one other \u003ca href=\"http://www.npr.org/sections/health-shots/2016/05/04/476539552/advance-in-human-embryo-research-rekindles-ethical-debate\">discovered\u003c/a> how to keep human embryos alive in lab dishes longer than ever before — at least 14 days. That has triggered an international debate about a long-standing convention (one that's legally binding in some countries, though not in the U.S.) that prohibits studying human embryos that have developed \u003cem>beyond \u003c/em>the two-week stage.\u003c/p>\n\u003cp>And in other experiments, he's using \u003ca href=\"https://www.cirm.ca.gov/patients/stem-cell-key-terms\">human stem cells\u003c/a> to create entities that resemble certain aspects of primitive embryos. Though Brivanlou doesn't think these \"embryoids\" would be capable of developing into fully formed embryos, their creation has stirred debate about whether embryoids should be subject to the 14-day rule.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Brivanlou says he welcomes these debates. But he hopes society can reach a consensus to permit his work to continue, so he can answer some of humanity's most fundamental questions.\u003c/p>\n\u003cp>\"If I can provide a glimpse of, 'Where did we come from? What happened to us, for us to get here?' I think that, to me, is a strong enough rationale to continue pushing this,\" he says.\u003c/p>\n\u003cp>For decades, scientists thought the longest an embryo could survive outside the womb was only about a week. But Brivanlou's lab, and one in Britain, \u003ca href=\"http://www.npr.org/sections/health-shots/2016/05/04/476539552/advance-in-human-embryo-research-rekindles-ethical-debate\">announced\u003c/a> last year in the journals \u003ca href=\"http://www.npr.org/sections/health-shots/2016/05/04/476539552/be%20http:/nature.com/articles/doi:10.1038/nature17948\">Nature\u003c/a> and \u003ca href=\"http://nature.com/articles/doi:10.1038/ncb3347\">Nature Cell Biology\u003c/a> that they had kept human embryos alive for two weeks for the first time.\u003c/p>\n\u003cp>That enabled the scientists to study living human embryos at a crucial point in their development, a time when they're usually hidden in a woman's womb.\u003c/p>\n\u003cp>\"Women don't even know they are pregnant at that stage. So it has always been a big black box,\" \u003ca href=\"http://www.rockefeller.edu/research/faculty/labheads/AliBrivanlou/#content\">Brivanlou\u003c/a> says.\u003c/p>\n\u003cp>\u003ca href=\"http://xenopus.rockefeller.edu/about/Gist_Croft\">Gist Croft\u003c/a>, a stem cell biologist in Brivanlou's lab, shows me some samples, starting with one that's 12 days old.\u003c/p>\n\u003cp>\"So you can see this with the naked eye,\" Croft says, pointing to a dish. \"In the middle of this well, if you look down, there's a little white speck — it looks like a grain of sand or a piece of dust.\"\u003c/p>\n\u003cp>Under a microscope, the embryo looks like a fragile ball of overlapping bubbles shimmering in a silvery light — with thin hairlike structures extending from all sides.\u003c/p>\n\u003cp>Croft and Brivanlou explain that those willowy structures are what embryos would normally extend at this stage to search for a place to implant inside the uterus. Scientists used to think embryos could do that only if they were receiving instructions from the mother's body.\u003c/p>\n\u003cp>\"The amazing thing is that it's doing its thing without any information from mom,\" Brivanlou says. \"It just has all the information already in it. That was mind-blowing to me.\"\u003c/p>\n\u003cp>The embryos they managed to keep alive in the lab dish beyond seven days of development have also started secreting hormones and organizing themselves to form the cells needed to create all the tissues and organs in the human body.\u003c/p>\n\u003cp>The two scientists think studying embryos at this and later stages could lead to discoveries that might point to new ways to stop miscarriages, treat infertility and prevent birth defects.\u003c/p>\n\u003cp>\"The only way to understand what goes wrong is to understand what happens normally, or as normally as we can, so we can prevent all of this,\" Brivanlou says.\u003c/p>\n\u003cp>\u003cstrong>The 14-day cutoff\u003c/strong>\u003c/p>\n\u003cp>But Brivanlou isn't keeping these embryos alive longer than 14 days because of the rule.\u003c/p>\n\u003cp>\"The decision about pulling the plug was probably the toughest decision I've made in my scientific career,\" he says. \"It was sad for me.\"\u003c/p>\n\u003cp>The 14-day rule was developed decades ago to avoid raising too many ethical questions about experimenting on human embryos.\u003c/p>\n\u003cp>Two weeks is usually the moment when the central nervous system starts to appear in the embryo in a structure known as the \"primitive streak.\"\u003c/p>\n\u003cp>It's also roughly the stage at which an embryo can no longer split into twins. The idea behind the rule is, that's when an embryo becomes a unique individual.\u003c/p>\n\u003cp>But the rule was initiated when no one thought it would ever be possible to keep embryos growing in a lab beyond two weeks. Brivanlou thinks it's time to rethink the 14-day rule.\u003c/p>\n\u003cp>\"This is the moment,\" he says.\u003c/p>\n\u003cp>Scientists, bioethicists and others are debating the issue in the U.S., Britain and other countries. The rule is law in Britain and other countries and incorporated into widely followed guidelines in the United States.\u003c/p>\n\u003cp>\u003ca href=\"https://case.edu/medicine/bioethics/about/faculty--staff/hyun.html\">Insoo Hyun\u003c/a>, a bioethicist at Case Western Reserve University, advocates revisiting the rule. It would allow more research to be done on embryos that are destined to be destroyed anyway, he says — embryos donated by couples who have finished infertility treatment.\u003c/p>\n\u003cp>\"Given that it has to be destroyed,\" Hyun says, \"some would argue that it's best to get as much information as possible scientifically from it before you destroy it.\"\u003c/p>\n\u003cp>But others find it morally repugnant to use human embryos for research at any stage of their development — and argue that lifting the 14-day rule would make matters worse.\u003c/p>\n\u003cp>\"Pushing it beyond 14 days only aggravates what is the primary problem, which is using human life in its earliest stages solely for experimental purposes,\" says \u003ca href=\"https://kennedyinstitute.georgetown.edu/people/daniel-sulmasy/\">Dr. Daniel Sulmasy\u003c/a>, a Georgetown University bioethicist.\u003c/p>\n\u003cp>The idea of extending the 14-day rule even makes some people who support embryo research queasy, especially without first finding another clear stopping point.\u003c/p>\n\u003cp>\u003ca href=\"https://law.stanford.edu/directory/henry-t-greely/\">Hank Greely\u003c/a>, a Stanford University bioethicist, worries that going beyond 14 days could \"really draws into question whether we're using humans or things that are well along the path to humans purely as guinea pigs and purely as experimental animals.\"\u003c/p>\n\u003cp>\u003cstrong>Embryo alternative: \"Embryoids\"\u003c/strong>\u003c/p>\n\u003cp>So as that debate continues, Brivanlou and his colleagues are trying to develop another approach. The scientists are attempting to coax human embryonic stem cells to organize themselves into entities that resemble human embryos. They are also using induced pluripotent stem (iPS) cells, which are cells that behave like embryonic stem cells, but can be made from any cell in the body.\u003c/p>\n\u003cp>Brivanlou's lab has already \u003ca href=\"http://www.nature.com/nprot/journal/v11/n11/abs/nprot.2016.131.html\">shown\u003c/a> that these \"embryo-like structures\" — or \"embryoids\" — can create the three fundamental cell types in the human body.\u003c/p>\n\u003cp>But the scientists have only been able to go so far using flat lab dishes. So the researchers are now trying to grow these embryonic-like structures in three dimensions by placing stem cells in a gel.\u003c/p>\n\u003cp>\"Essentially, we're trying to, in a way, to re-create a human embryo in a dish starting from stem cells,\" says \u003ca href=\"https://scholar.google.com/citations?user=fSUga9YAAAAJ&hl=en\">Mijo Simunovic\u003c/a>, another of Brivanlou's colleagues.\u003c/p>\n\u003cp>In early experiments, Simunovic says, he has been able to get stem cells to \"spontaneously\" form a ball with a \"cavity in its center.\" That's significant because that's what early human embryos do in the uterus.\u003c/p>\n\u003cp>Simunovic says it's unclear how close these structures could become to human embryos\u003cstrong> — \u003c/strong>entities that have the capability to develop into babies.\u003c/p>\n\u003cp>\"At the moment, we don't know. That's something that's very hot for us right now to try to understand,\" Simunovic says.\u003c/p>\n\u003cp>Simunovic argues the scientists are not \"ethically limited to studying these cells and studying these structures\" by the 14-day rule.\u003c/p>\n\u003cp>There's a debate about that, however.\u003c/p>\n\u003cp>\"At what point is your model of an embryo basically an embryo?\" asks Hyun, especially when the model seems to have \"almost like this inner, budding life.\"\u003c/p>\n\u003cp>\"Are we creating life that, in the right circumstances, if you were to transfer this to the womb it would continue its journey?\" he asks.\u003c/p>\n\u003cp>\u003ca href=\"https://daley.med.harvard.edu/\">Dr. George Daley\u003c/a>, the dean of the Harvard Medical School and a leading stem cell researcher, says scientists have been preparing for the day when stem-cell research might raise such questions.\u003c/p>\n\u003cp>\"I think what prospects people are concerned about are the kinds of dystopian worlds that were written about by Aldous Huxley in \u003cem>Brave New World,\" \u003c/em>Daley says. \"Where human reproduction is done on a highly mechanized scale in a petri dish.\"\u003c/p>\n\u003cp>Daley stresses scientists are nowhere near that, and may never get there. But science moves quickly. So Daley says it's important scientists move carefully with close ethical scrutiny.\u003c/p>\n\u003cp>The latest \u003ca href=\"http://www.isscr.org/docs/default-source/guidelines/isscr-guidelines-for-stem-cell-research-and-clinical-translation.pdf?sfvrsn=2\">guidelines\u003c/a> issued by the \u003ca href=\"http://www.isscr.org/\">International Society for Stem Cell Research\u003c/a> call for intensive ethical review, Daley notes.\u003c/p>\n\u003cp>Brivanlou acknowledges that some of his experiments have produced early signs of the primitive streak. But that's a very long way from being able to develop a spinal cord, or flesh and bones, let alone a brain. He dismisses the notion that the research on embryoids would ever lead to scientists creating humans in a lab dish.\u003c/p>\n\u003cp>\"They will not get up start walking around. I can assure you that,\" he says, noting that full human embryonic development is a highly complex process that requires just the right mix of the biology, physics, geometry and other factors.\u003c/p>\n\u003cp>Nevertheless, Brivanlou says all of his experiments go through many layers of review. And he's convinced the research should continue.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\"It would be a travesty,\" he says, \"to decide that, somehow, ignorance is bliss.\"\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Embryo+Experiments+Reveal+Earliest+Human+Development%2C+But+Stir+Ethical+Debate&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Ali Brivanlou slides open a glass door at the Rockefeller University in New York to show off his latest experiments probing the mysteries of the human embryo.\u003c/p>\n\u003cp>\"As you can see, all my lab is glass — just to make sure there is nothing that happens in some dark rooms that gives people some weird ideas,\" says \u003ca href=\"http://www.rockefeller.edu/research/faculty/labheads/AliBrivanlou/#content\">Brivanlou\u003c/a>, perhaps only half joking.\u003c/p>\n\u003cp>Brivanlou knows that some of his research makes some people uncomfortable. That's one reason he has agreed to give me a look at what's going on.\u003c/p>\n\u003cp>His lab and one other \u003ca href=\"http://www.npr.org/sections/health-shots/2016/05/04/476539552/advance-in-human-embryo-research-rekindles-ethical-debate\">discovered\u003c/a> how to keep human embryos alive in lab dishes longer than ever before — at least 14 days. That has triggered an international debate about a long-standing convention (one that's legally binding in some countries, though not in the U.S.) that prohibits studying human embryos that have developed \u003cem>beyond \u003c/em>the two-week stage.\u003c/p>\n\u003cp>And in other experiments, he's using \u003ca href=\"https://www.cirm.ca.gov/patients/stem-cell-key-terms\">human stem cells\u003c/a> to create entities that resemble certain aspects of primitive embryos. Though Brivanlou doesn't think these \"embryoids\" would be capable of developing into fully formed embryos, their creation has stirred debate about whether embryoids should be subject to the 14-day rule.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Brivanlou says he welcomes these debates. But he hopes society can reach a consensus to permit his work to continue, so he can answer some of humanity's most fundamental questions.\u003c/p>\n\u003cp>\"If I can provide a glimpse of, 'Where did we come from? What happened to us, for us to get here?' I think that, to me, is a strong enough rationale to continue pushing this,\" he says.\u003c/p>\n\u003cp>For decades, scientists thought the longest an embryo could survive outside the womb was only about a week. But Brivanlou's lab, and one in Britain, \u003ca href=\"http://www.npr.org/sections/health-shots/2016/05/04/476539552/advance-in-human-embryo-research-rekindles-ethical-debate\">announced\u003c/a> last year in the journals \u003ca href=\"http://www.npr.org/sections/health-shots/2016/05/04/476539552/be%20http:/nature.com/articles/doi:10.1038/nature17948\">Nature\u003c/a> and \u003ca href=\"http://nature.com/articles/doi:10.1038/ncb3347\">Nature Cell Biology\u003c/a> that they had kept human embryos alive for two weeks for the first time.\u003c/p>\n\u003cp>That enabled the scientists to study living human embryos at a crucial point in their development, a time when they're usually hidden in a woman's womb.\u003c/p>\n\u003cp>\"Women don't even know they are pregnant at that stage. So it has always been a big black box,\" \u003ca href=\"http://www.rockefeller.edu/research/faculty/labheads/AliBrivanlou/#content\">Brivanlou\u003c/a> says.\u003c/p>\n\u003cp>\u003ca href=\"http://xenopus.rockefeller.edu/about/Gist_Croft\">Gist Croft\u003c/a>, a stem cell biologist in Brivanlou's lab, shows me some samples, starting with one that's 12 days old.\u003c/p>\n\u003cp>\"So you can see this with the naked eye,\" Croft says, pointing to a dish. \"In the middle of this well, if you look down, there's a little white speck — it looks like a grain of sand or a piece of dust.\"\u003c/p>\n\u003cp>Under a microscope, the embryo looks like a fragile ball of overlapping bubbles shimmering in a silvery light — with thin hairlike structures extending from all sides.\u003c/p>\n\u003cp>Croft and Brivanlou explain that those willowy structures are what embryos would normally extend at this stage to search for a place to implant inside the uterus. Scientists used to think embryos could do that only if they were receiving instructions from the mother's body.\u003c/p>\n\u003cp>\"The amazing thing is that it's doing its thing without any information from mom,\" Brivanlou says. \"It just has all the information already in it. That was mind-blowing to me.\"\u003c/p>\n\u003cp>The embryos they managed to keep alive in the lab dish beyond seven days of development have also started secreting hormones and organizing themselves to form the cells needed to create all the tissues and organs in the human body.\u003c/p>\n\u003cp>The two scientists think studying embryos at this and later stages could lead to discoveries that might point to new ways to stop miscarriages, treat infertility and prevent birth defects.\u003c/p>\n\u003cp>\"The only way to understand what goes wrong is to understand what happens normally, or as normally as we can, so we can prevent all of this,\" Brivanlou says.\u003c/p>\n\u003cp>\u003cstrong>The 14-day cutoff\u003c/strong>\u003c/p>\n\u003cp>But Brivanlou isn't keeping these embryos alive longer than 14 days because of the rule.\u003c/p>\n\u003cp>\"The decision about pulling the plug was probably the toughest decision I've made in my scientific career,\" he says. \"It was sad for me.\"\u003c/p>\n\u003cp>The 14-day rule was developed decades ago to avoid raising too many ethical questions about experimenting on human embryos.\u003c/p>\n\u003cp>Two weeks is usually the moment when the central nervous system starts to appear in the embryo in a structure known as the \"primitive streak.\"\u003c/p>\n\u003cp>It's also roughly the stage at which an embryo can no longer split into twins. The idea behind the rule is, that's when an embryo becomes a unique individual.\u003c/p>\n\u003cp>But the rule was initiated when no one thought it would ever be possible to keep embryos growing in a lab beyond two weeks. Brivanlou thinks it's time to rethink the 14-day rule.\u003c/p>\n\u003cp>\"This is the moment,\" he says.\u003c/p>\n\u003cp>Scientists, bioethicists and others are debating the issue in the U.S., Britain and other countries. The rule is law in Britain and other countries and incorporated into widely followed guidelines in the United States.\u003c/p>\n\u003cp>\u003ca href=\"https://case.edu/medicine/bioethics/about/faculty--staff/hyun.html\">Insoo Hyun\u003c/a>, a bioethicist at Case Western Reserve University, advocates revisiting the rule. It would allow more research to be done on embryos that are destined to be destroyed anyway, he says — embryos donated by couples who have finished infertility treatment.\u003c/p>\n\u003cp>\"Given that it has to be destroyed,\" Hyun says, \"some would argue that it's best to get as much information as possible scientifically from it before you destroy it.\"\u003c/p>\n\u003cp>But others find it morally repugnant to use human embryos for research at any stage of their development — and argue that lifting the 14-day rule would make matters worse.\u003c/p>\n\u003cp>\"Pushing it beyond 14 days only aggravates what is the primary problem, which is using human life in its earliest stages solely for experimental purposes,\" says \u003ca href=\"https://kennedyinstitute.georgetown.edu/people/daniel-sulmasy/\">Dr. Daniel Sulmasy\u003c/a>, a Georgetown University bioethicist.\u003c/p>\n\u003cp>The idea of extending the 14-day rule even makes some people who support embryo research queasy, especially without first finding another clear stopping point.\u003c/p>\n\u003cp>\u003ca href=\"https://law.stanford.edu/directory/henry-t-greely/\">Hank Greely\u003c/a>, a Stanford University bioethicist, worries that going beyond 14 days could \"really draws into question whether we're using humans or things that are well along the path to humans purely as guinea pigs and purely as experimental animals.\"\u003c/p>\n\u003cp>\u003cstrong>Embryo alternative: \"Embryoids\"\u003c/strong>\u003c/p>\n\u003cp>So as that debate continues, Brivanlou and his colleagues are trying to develop another approach. The scientists are attempting to coax human embryonic stem cells to organize themselves into entities that resemble human embryos. They are also using induced pluripotent stem (iPS) cells, which are cells that behave like embryonic stem cells, but can be made from any cell in the body.\u003c/p>\n\u003cp>Brivanlou's lab has already \u003ca href=\"http://www.nature.com/nprot/journal/v11/n11/abs/nprot.2016.131.html\">shown\u003c/a> that these \"embryo-like structures\" — or \"embryoids\" — can create the three fundamental cell types in the human body.\u003c/p>\n\u003cp>But the scientists have only been able to go so far using flat lab dishes. So the researchers are now trying to grow these embryonic-like structures in three dimensions by placing stem cells in a gel.\u003c/p>\n\u003cp>\"Essentially, we're trying to, in a way, to re-create a human embryo in a dish starting from stem cells,\" says \u003ca href=\"https://scholar.google.com/citations?user=fSUga9YAAAAJ&hl=en\">Mijo Simunovic\u003c/a>, another of Brivanlou's colleagues.\u003c/p>\n\u003cp>In early experiments, Simunovic says, he has been able to get stem cells to \"spontaneously\" form a ball with a \"cavity in its center.\" That's significant because that's what early human embryos do in the uterus.\u003c/p>\n\u003cp>Simunovic says it's unclear how close these structures could become to human embryos\u003cstrong> — \u003c/strong>entities that have the capability to develop into babies.\u003c/p>\n\u003cp>\"At the moment, we don't know. That's something that's very hot for us right now to try to understand,\" Simunovic says.\u003c/p>\n\u003cp>Simunovic argues the scientists are not \"ethically limited to studying these cells and studying these structures\" by the 14-day rule.\u003c/p>\n\u003cp>There's a debate about that, however.\u003c/p>\n\u003cp>\"At what point is your model of an embryo basically an embryo?\" asks Hyun, especially when the model seems to have \"almost like this inner, budding life.\"\u003c/p>\n\u003cp>\"Are we creating life that, in the right circumstances, if you were to transfer this to the womb it would continue its journey?\" he asks.\u003c/p>\n\u003cp>\u003ca href=\"https://daley.med.harvard.edu/\">Dr. George Daley\u003c/a>, the dean of the Harvard Medical School and a leading stem cell researcher, says scientists have been preparing for the day when stem-cell research might raise such questions.\u003c/p>\n\u003cp>\"I think what prospects people are concerned about are the kinds of dystopian worlds that were written about by Aldous Huxley in \u003cem>Brave New World,\" \u003c/em>Daley says. \"Where human reproduction is done on a highly mechanized scale in a petri dish.\"\u003c/p>\n\u003cp>Daley stresses scientists are nowhere near that, and may never get there. But science moves quickly. So Daley says it's important scientists move carefully with close ethical scrutiny.\u003c/p>\n\u003cp>The latest \u003ca href=\"http://www.isscr.org/docs/default-source/guidelines/isscr-guidelines-for-stem-cell-research-and-clinical-translation.pdf?sfvrsn=2\">guidelines\u003c/a> issued by the \u003ca href=\"http://www.isscr.org/\">International Society for Stem Cell Research\u003c/a> call for intensive ethical review, Daley notes.\u003c/p>\n\u003cp>Brivanlou acknowledges that some of his experiments have produced early signs of the primitive streak. But that's a very long way from being able to develop a spinal cord, or flesh and bones, let alone a brain. He dismisses the notion that the research on embryoids would ever lead to scientists creating humans in a lab dish.\u003c/p>\n\u003cp>\"They will not get up start walking around. I can assure you that,\" he says, noting that full human embryonic development is a highly complex process that requires just the right mix of the biology, physics, geometry and other factors.\u003c/p>\n\u003cp>Nevertheless, Brivanlou says all of his experiments go through many layers of review. And he's convinced the research should continue.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"It would be a travesty,\" he says, \"to decide that, somehow, ignorance is bliss.\"\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Embryo+Experiments+Reveal+Earliest+Human+Development%2C+But+Stir+Ethical+Debate&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Okay, we thought big data folks had really turned it \u003ca href=\"https://en.wikipedia.org/wiki/Up_to_eleven\" target=\"_blank\">up to 11\u003c/a> with the Institute for Health Metrics and Evaluation's comprehensive \u003ca href=\"https://ww2.kqed.org/futureofyou/2017/01/31/find-life-expectancy-map/\" target=\"_blank\">U.S. Health Map\u003c/a>, which categorizes each and every U.S. death by each and every U.S. county. The map can tell you which areas of the country have the lowest life expectancy (parts of Appalachia and the South don't look good); which suffer the highest rates of binge drinking (Wisconsin, Montana, North Dakota) and suicide (the Kusilvak Census Area in Alaska; South Dakota Native American reservations); and lots of other information that will satisfy even the most voracious consumer of death and morbidity data.\u003c/p>\n\u003cp>But when it comes to urban areas, the Centers for Disease Control and Prevention may have gone the IHME's tool one better \u003cspan style=\"font-weight: 400\">— \u003c/span>turned it up to 12, if you will \u003cspan style=\"font-weight: 400\">— \u003c/span>with its recently introduced health data map, part of its \u003ca href=\"https://chronicdata.cdc.gov/health-area/500-cities\" target=\"_blank\">500 Cities\u003c/a> project.\u003c/p>\n\u003cp>\"The project identifies, analyzes, and reports on 27 chronic disease measures focusing on conditions, behaviors, and risk factors that have a substantial effect on people’s health,\" according to the CDC, which launched the map in partnership with the CDC Foundation and the Robert Woods Johnson Foundation.\u003c/p>\n\u003cdiv class=\"show-for-small-only\">\n\u003cp>\u003cem>Click on the image to be taken to the map.\u003c/em>\u003c/p>\n\u003cp>\u003ca href=\"https://www.cdc.gov/500cities/\">\u003cimg class=\"aligncenter size-full wp-image-346557\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/03/cdcmap-1.jpg\" alt=\"cdcmap\" width=\"713\" height=\"507\">\u003c/a>\u003c/p>\n\u003c/div>\n\u003cdiv align=\"center\">\n\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe width=\"850\" height=\"1000\" src=\"https://nccd.cdc.gov/500_Cities/rdPage.aspx?rdReport=DPH_500_Cities.InteractiveMap&islCategories=HLTHOUT&islMeasures=ARTHRITIS&islStates=59\" frameborder=\"0\" scrolling=\"no\" class=\"iframe-class\">\u003c/iframe>\n\u003c/div>\n\u003cp> \u003c/p>\n\u003cp>But wait, there's more\u003cb> \u003c/b> \u003cspan style=\"font-weight: 400\">— \u003c/span> the map doesn't just drill down to the city level; it homes in on each census tract, which is, \u003cspan style=\"font-weight: 400\">basically, \u003c/span>your neighborhood.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>We clicked ourselves down to the city level for San Francisco, where KQED is based, then all the way into different patches of blocks, checking out health outcomes like asthma, diabetes and cancer. The prevention data displays rates for dental visits, annual checkups and lack of health insurance, among other measures, and the stats for \"unhealthy behaviors\" include the numbers on smoking, obesity and lack of sleep. (View the \u003ca href=\"https://www.cdc.gov/500cities/measure-definitions.htm\" target=\"_blank\">definitions of each measure here\u003c/a>.)\u003c/p>\n\u003cp>Some of these are self-reported, we're relieved to find out. (Still, what's next -- unhealthy behaviors broken out by each room in your apartment?)\u003c/p>\n\u003cp>The data, from as recently as 2014, comes from the Behavioral Risk Factor Surveillance System (which is collected through telephone surveys, despite its high-tech and ominous-sounding name), U.S. Census Bureau \u003ca href=\"https://www.census.gov/topics/population/data.html\" target=\"_blank\">population data\u003c/a>, and the bureau's \u003ca href=\"https://www.census.gov/programs-surveys/acs/\" target=\"_blank\">American Community Survey\u003c/a>.\u003c/p>\n\u003cp>Keep in mind these numbers represent estimates, derived from \"small area estimation techniques.\" These statistical methods use data from big surveys pertaining to larger geographical areas, then apply that data to smaller areas, said James Holt, the CDC's team leader for analytic methods in the Division of Population Health.\u003c/p>\n\u003cp>All well and good. But we did notice one thing: The residents in San Francisco's Golden Gate Park do a relatively heavy amount of binge drinking, according to the map. What, do the the squirrels have an alcohol problem?\u003c/p>\n\u003cp>\"The area that contains Golden Gate Park is census tract 060759803,\" wrote a CDC spokesperson, in response to a question that didn't mention squirrels. \"According to the 2010 US Census, this census tract had a 2010 resident population of 171. We did suppress estimates for census tracts that had fewer than 50 residents, to avoid the issue of interpretation, but Golden Gate Park is in a tract that exceeds that threshold.\"\u003c/p>\n\u003cp>Okay, then.\u003c/p>\n\u003cp>The CDC anticipates this trove of data will be used by local health officials, to help them \"target health interventions to areas within their cities at highest need,\" Holt said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Enjoy, data nerds, enjoy.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Okay, we thought big data folks had really turned it \u003ca href=\"https://en.wikipedia.org/wiki/Up_to_eleven\" target=\"_blank\">up to 11\u003c/a> with the Institute for Health Metrics and Evaluation's comprehensive \u003ca href=\"https://ww2.kqed.org/futureofyou/2017/01/31/find-life-expectancy-map/\" target=\"_blank\">U.S. Health Map\u003c/a>, which categorizes each and every U.S. death by each and every U.S. county. The map can tell you which areas of the country have the lowest life expectancy (parts of Appalachia and the South don't look good); which suffer the highest rates of binge drinking (Wisconsin, Montana, North Dakota) and suicide (the Kusilvak Census Area in Alaska; South Dakota Native American reservations); and lots of other information that will satisfy even the most voracious consumer of death and morbidity data.\u003c/p>\n\u003cp>But when it comes to urban areas, the Centers for Disease Control and Prevention may have gone the IHME's tool one better \u003cspan style=\"font-weight: 400\">— \u003c/span>turned it up to 12, if you will \u003cspan style=\"font-weight: 400\">— \u003c/span>with its recently introduced health data map, part of its \u003ca href=\"https://chronicdata.cdc.gov/health-area/500-cities\" target=\"_blank\">500 Cities\u003c/a> project.\u003c/p>\n\u003cp>\"The project identifies, analyzes, and reports on 27 chronic disease measures focusing on conditions, behaviors, and risk factors that have a substantial effect on people’s health,\" according to the CDC, which launched the map in partnership with the CDC Foundation and the Robert Woods Johnson Foundation.\u003c/p>\n\u003cdiv class=\"show-for-small-only\">\n\u003cp>\u003cem>Click on the image to be taken to the map.\u003c/em>\u003c/p>\n\u003cp>\u003ca href=\"https://www.cdc.gov/500cities/\">\u003cimg class=\"aligncenter size-full wp-image-346557\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/03/cdcmap-1.jpg\" alt=\"cdcmap\" width=\"713\" height=\"507\">\u003c/a>\u003c/p>\n\u003c/div>\n\u003cdiv align=\"center\">\n\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe width=\"850\" height=\"1000\" src=\"https://nccd.cdc.gov/500_Cities/rdPage.aspx?rdReport=DPH_500_Cities.InteractiveMap&islCategories=HLTHOUT&islMeasures=ARTHRITIS&islStates=59\" frameborder=\"0\" scrolling=\"no\" class=\"iframe-class\">\u003c/iframe>\n\u003c/div>\n\u003cp> \u003c/p>\n\u003cp>But wait, there's more\u003cb> \u003c/b> \u003cspan style=\"font-weight: 400\">— \u003c/span> the map doesn't just drill down to the city level; it homes in on each census tract, which is, \u003cspan style=\"font-weight: 400\">basically, \u003c/span>your neighborhood.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>We clicked ourselves down to the city level for San Francisco, where KQED is based, then all the way into different patches of blocks, checking out health outcomes like asthma, diabetes and cancer. The prevention data displays rates for dental visits, annual checkups and lack of health insurance, among other measures, and the stats for \"unhealthy behaviors\" include the numbers on smoking, obesity and lack of sleep. (View the \u003ca href=\"https://www.cdc.gov/500cities/measure-definitions.htm\" target=\"_blank\">definitions of each measure here\u003c/a>.)\u003c/p>\n\u003cp>Some of these are self-reported, we're relieved to find out. (Still, what's next -- unhealthy behaviors broken out by each room in your apartment?)\u003c/p>\n\u003cp>The data, from as recently as 2014, comes from the Behavioral Risk Factor Surveillance System (which is collected through telephone surveys, despite its high-tech and ominous-sounding name), U.S. Census Bureau \u003ca href=\"https://www.census.gov/topics/population/data.html\" target=\"_blank\">population data\u003c/a>, and the bureau's \u003ca href=\"https://www.census.gov/programs-surveys/acs/\" target=\"_blank\">American Community Survey\u003c/a>.\u003c/p>\n\u003cp>Keep in mind these numbers represent estimates, derived from \"small area estimation techniques.\" These statistical methods use data from big surveys pertaining to larger geographical areas, then apply that data to smaller areas, said James Holt, the CDC's team leader for analytic methods in the Division of Population Health.\u003c/p>\n\u003cp>All well and good. But we did notice one thing: The residents in San Francisco's Golden Gate Park do a relatively heavy amount of binge drinking, according to the map. What, do the the squirrels have an alcohol problem?\u003c/p>\n\u003cp>\"The area that contains Golden Gate Park is census tract 060759803,\" wrote a CDC spokesperson, in response to a question that didn't mention squirrels. \"According to the 2010 US Census, this census tract had a 2010 resident population of 171. We did suppress estimates for census tracts that had fewer than 50 residents, to avoid the issue of interpretation, but Golden Gate Park is in a tract that exceeds that threshold.\"\u003c/p>\n\u003cp>Okay, then.\u003c/p>\n\u003cp>The CDC anticipates this trove of data will be used by local health officials, to help them \"target health interventions to areas within their cities at highest need,\" Holt said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Enjoy, data nerds, enjoy.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Sesame Street to Introduce Muppet With Autism (Video)",
"title": "Sesame Street to Introduce Muppet With Autism (Video)",
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"content": "\u003cp>https://www.youtube.com/watch?v=1FeuSdL61MY\u003c/p>\n\u003cp>Folks on Sesame Street have a way of making everyone feel accepted.\u003c/p>\n\u003cp>That certainly goes for Julia, a Muppet youngster with blazing red hair, bright green eyes — and autism. Rather than being treated like an outsider, which too often is the plight of kids on the spectrum, Julia is one of the gang.\u003c/p>\n\u003cp>Look: On this friendliest of streets (actually Studio J at New York's Kaufman Astoria Studios, where \"Sesame Street\" lives) Julia is about to play a game with Oscar, Abby and Grover. In this scene being taped for airing next season, these Muppet chums have been challenged to spot objects shaped like squares or circles or triangles.\u003c/p>\n\u003cp>\"You're lucky,\" says Abby to Grover. \"You have Julia on your team, and she is really good at finding shapes!\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>With that, they skedaddle, an exit that calls for the six Muppeteers squatted out of sight below them to scramble accordingly. Joining her pals, Julia (performed by Stacey Gordon) takes off hunting.\u003c/p>\n\u003cp>For more than a year, Julia has existed in print and digital illustrations as the centerpiece of a multifaceted initiative by Sesame Workshop called \"Sesame Street and Autism: See Amazing in All Children.\"\u003c/p>\n\u003cp>She has been the subject of a storybook released along with videos, e-books, an app and website. The goal is to promote a better understanding of what the Autism Speaks advocacy group describes as \"a range of conditions characterized by challenges with social skills, repetitive behaviors, speech and nonverbal communication, as well as by unique strengths and differences.\"\u003c/p>\n\u003cp>But now Julia has been brought to life in fine Muppet fettle. She makes her TV debut on \"Sesame Street\" in the \"Meet Julia\" episode airing April 10 on both PBS and HBO. Additional videos featuring Julia will be available online.\u003c/p>\n\u003cp>https://www.youtube.com/watch?v=M8QQRtA0hVA\u003c/p>\n\u003cp>Developing Julia and all the other components of this campaign has required years of consultation with organizations, experts and families within the autism community, according to Jeanette Betancourt, Sesame Workshop's senior vice president of U.S. Social Impact.\u003c/p>\n\u003cp>\"In the U.S., one in 68 children is diagnosed with autism spectrum disorder,\" she says. \"We wanted to promote a better understanding and reduce the stigma often found around these children. We're modeling the way both children and adults can look at autism from a strength-based perspective: finding things that all children share.\"\u003c/p>\n\u003cp>Julia is at the heart of this effort. But while she represents the full range of children on the spectrum, she isn't meant to typify each one of them: \"Just as we look at all children as being unique, we should do the same thing when we're looking at children with autism,\" Betancourt says.\u003c/p>\n\u003cp>It was with keen interest that Stacey Gordon first learned of Julia more than a year ago. \"I said, 'If she's ever a puppet, I want to BE Julia!'\"\u003c/p>\n\u003cp>No wonder. Gordon is a Phoenix-based puppeteer who performs, conducts classes and workshops, and creates whimsical puppets for sale to the public.\u003c/p>\n\u003cp>She also has a son with autism, and, before she started her family, was a therapist to youngsters on the spectrum.\u003c/p>\n\u003cp>Although she figured her chances of landing the dream role of Julia were nil, her contacts in the puppet world paid off: Two friends who worked as Muppeteers on \"Sesame Street\" dropped her name to the producers. After submitting tapes, then coming to New York for an audition, she was hired.\u003c/p>\n\u003cp>In the introductory segment, Julia is having fun with Abby and Elmo when Big Bird walks up. He wants to be her new friend, but she doesn't speak to him. He thinks she doesn't like him.\u003c/p>\n\u003cp>\"She does things just a little differently, in a Julia sort of way,\" Abby informs him.\u003c/p>\n\u003cp>Julia, chuckling, then displays a different-but-fun way of playing tag, and everyone joins in. But when a siren wails, she covers her ears and looks stricken.\u003c/p>\n\u003cp>\"She needs to take a break,\" Big Bird's human friend Alan calmly explains. 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I don't want to let the autism community down.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe width=\"600\" height=\"338\" src=\"https://www.npr.org/player/embed/520577117/520788209\" frameborder=\"0\" scrolling=\"no\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\n",
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"excerpt": "Julia, a Muppet with autism, will make her TV debut on a 'Sesame Street' episode airing April 10 on PBS and HBO. ",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>With that, they skedaddle, an exit that calls for the six Muppeteers squatted out of sight below them to scramble accordingly. Joining her pals, Julia (performed by Stacey Gordon) takes off hunting.\u003c/p>\n\u003cp>For more than a year, Julia has existed in print and digital illustrations as the centerpiece of a multifaceted initiative by Sesame Workshop called \"Sesame Street and Autism: See Amazing in All Children.\"\u003c/p>\n\u003cp>She has been the subject of a storybook released along with videos, e-books, an app and website. The goal is to promote a better understanding of what the Autism Speaks advocacy group describes as \"a range of conditions characterized by challenges with social skills, repetitive behaviors, speech and nonverbal communication, as well as by unique strengths and differences.\"\u003c/p>\n\u003cp>But now Julia has been brought to life in fine Muppet fettle. She makes her TV debut on \"Sesame Street\" in the \"Meet Julia\" episode airing April 10 on both PBS and HBO. Additional videos featuring Julia will be available online.\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/M8QQRtA0hVA'\n title='//www.youtube.com/embed/M8QQRtA0hVA'\n allowfullscreen='true'\n style='border:0;'>\u003c/iframe>\n \u003c/span>\n \u003c/span>\u003c/p>\u003cp>\u003cp>Developing Julia and all the other components of this campaign has required years of consultation with organizations, experts and families within the autism community, according to Jeanette Betancourt, Sesame Workshop's senior vice president of U.S. Social Impact.\u003c/p>\n\u003cp>\"In the U.S., one in 68 children is diagnosed with autism spectrum disorder,\" she says. \"We wanted to promote a better understanding and reduce the stigma often found around these children. We're modeling the way both children and adults can look at autism from a strength-based perspective: finding things that all children share.\"\u003c/p>\n\u003cp>Julia is at the heart of this effort. But while she represents the full range of children on the spectrum, she isn't meant to typify each one of them: \"Just as we look at all children as being unique, we should do the same thing when we're looking at children with autism,\" Betancourt says.\u003c/p>\n\u003cp>It was with keen interest that Stacey Gordon first learned of Julia more than a year ago. \"I said, 'If she's ever a puppet, I want to BE Julia!'\"\u003c/p>\n\u003cp>No wonder. Gordon is a Phoenix-based puppeteer who performs, conducts classes and workshops, and creates whimsical puppets for sale to the public.\u003c/p>\n\u003cp>She also has a son with autism, and, before she started her family, was a therapist to youngsters on the spectrum.\u003c/p>\n\u003cp>Although she figured her chances of landing the dream role of Julia were nil, her contacts in the puppet world paid off: Two friends who worked as Muppeteers on \"Sesame Street\" dropped her name to the producers. After submitting tapes, then coming to New York for an audition, she was hired.\u003c/p>\n\u003cp>In the introductory segment, Julia is having fun with Abby and Elmo when Big Bird walks up. He wants to be her new friend, but she doesn't speak to him. He thinks she doesn't like him.\u003c/p>\n\u003cp>\"She does things just a little differently, in a Julia sort of way,\" Abby informs him.\u003c/p>\n\u003cp>Julia, chuckling, then displays a different-but-fun way of playing tag, and everyone joins in. But when a siren wails, she covers her ears and looks stricken.\u003c/p>\n\u003cp>\"She needs to take a break,\" Big Bird's human friend Alan calmly explains. 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"info": "What kind of no sabo word is Hyphenación? For us, it’s about living within a hyphenation. Like being a third-gen Mexican-American from the Texas border now living that Bay Area Chicano life. Like Xorje! Each week we bring together a couple of hyphenated Latinos to talk all about personal life choices: family, careers, relationships, belonging … everything is on the table. ",
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"info": "Our flagship program, helmed by Kai Ryssdal, examines what the day in money delivered, through stories, conversations, newsworthy numbers and more. Updated Monday through Friday at about 3:30 p.m. PT.",
"airtime": "MON-FRI 4pm-4:30pm, MON-WED 6:30pm-7pm",
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"masters-of-scale": {
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},
"mindshift": {
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"info": "The MindShift podcast explores the innovations in education that are shaping how kids learn. Hosts Ki Sung and Katrina Schwartz introduce listeners to educators, researchers, parents and students who are developing effective ways to improve how kids learn. We cover topics like how fed-up administrators are developing surprising tactics to deal with classroom disruptions; how listening to podcasts are helping kids develop reading skills; the consequences of overparenting; and why interdisciplinary learning can engage students on all ends of the traditional achievement spectrum. This podcast is part of the MindShift education site, a division of KQED News. KQED is an NPR/PBS member station based in San Francisco. You can also visit the MindShift website for episodes and supplemental blog posts or tweet us \u003ca href=\"https://twitter.com/MindShiftKQED\">@MindShiftKQED\u003c/a> or visit us at \u003ca href=\"/mindshift\">MindShift.KQED.org\u003c/a>",
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"order": 12
},
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM1NzY0NjAwNDI5",
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"tagline": "Deeply-reported investigative journalism",
"info": "For decades, the process for how police police themselves has been inconsistent – if not opaque. In some states, like California, these proceedings were completely hidden. After a new police transparency law unsealed scores of internal affairs files, our reporters set out to examine these cases and the shadow world of police discipline. On Our Watch brings listeners into the rooms where officers are questioned and witnesses are interrogated to find out who this system is really protecting. Is it the officers, or the public they've sworn to serve?",
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"on-the-media": {
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"title": "On The Media",
"info": "Our weekly podcast explores how the media 'sausage' is made, casts an incisive eye on fluctuations in the marketplace of ideas, and examines threats to the freedom of information and expression in America and abroad. For one hour a week, the show tries to lift the veil from the process of \"making media,\" especially news media, because it's through that lens that we see the world and the world sees us",
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},
"pbs-newshour": {
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},
"perspectives": {
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"order": 14
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"info": "The economy explained. Imagine you could call up a friend and say, Meet me at the bar and tell me what's going on with the economy. Now imagine that's actually a fun evening.",
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"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/planetmoney.jpg",
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},
"link": "/radio/program/planet-money",
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},
"politicalbreakdown": {
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"title": "Political Breakdown",
"tagline": "Politics from a personal perspective",
"info": "Political Breakdown is a new series that explores the political intersection of California and the nation. Each week hosts Scott Shafer and Marisa Lagos are joined with a new special guest to unpack politics -- with personality — and offer an insider’s glimpse at how politics happens.",
"airtime": "THU 6:30pm-7pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Political-Breakdown-2024-Podcast-Tile-703x703-1.jpg",
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"order": 5
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"possible": {
"id": "possible",
"title": "Possible",
"info": "Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. Together in Possible, Hoffman and Finger lead enlightening discussions about building a brighter collective future. The show features interviews with visionary guests like Trevor Noah, Sam Altman and Janette Sadik-Khan. Possible paints an optimistic portrait of the world we can create through science, policy, business, art and our shared humanity. It asks: What if everything goes right for once? How can we get there? Each episode also includes a short fiction story generated by advanced AI GPT-4, serving as a thought-provoking springboard to speculate how humanity could leverage technology for good.",
"airtime": "SUN 2pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Possible-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.possible.fm/",
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"source": "Possible"
},
"link": "/radio/program/possible",
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"spotify": "https://open.spotify.com/show/730YpdUSNlMyPQwNnyjp4k"
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},
"pri-the-world": {
"id": "pri-the-world",
"title": "PRI's The World: Latest Edition",
"info": "Each weekday, host Marco Werman and his team of producers bring you the world's most interesting stories in an hour of radio that reminds us just how small our planet really is.",
"airtime": "MON-FRI 2pm-3pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/The-World-Podcast-Tile-360x360-1.jpg",
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},
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},
"radiolab": {
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