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I think to some extent that extends to this very day. But ... I think having a living will, having an advanced directive, or perhaps most importantly, having a designated healthcare proxy, someone who can help transmit your decisions to the team when you're not able to do so, is perhaps the most important thing that we can do for ourselves as patients and as human beings.\u003c/p>\n\u003cp>\u003cstrong>On giving CPR and knowing when to stop giving CPR\u003c/strong>\u003c/p>\n\u003cp>One of the things about CPR, Terry, is that almost everyone in medicine knows how to start CPR, when to start CPR, really what to do in CPR under even complex situations, but the one thing that almost no one really teaches us, and there are no guidelines for, is when to stop CPR. I think in some ways that is one of the biggest challenges that we in medicine face all the time. ...\u003c/p>\n\u003cp>I was actually working in the hospital last night and it was about three in the morning and I was called by one of my other colleagues who was another cardiology fellow, he asked me, \"Haider, I need your help. I have a patient that we are doing CPR on,\" and he wanted some help from me. So I walked over to the intensive care unit, and the patient was in her 60s. ... There was an entire team in the room doing chest compressions on this woman, and they had been doing it for an hour and a half at that point, much, much, much longer than most CPRs last. ...\u003c/p>\n\u003cp>At the same time while this CPR was ongoing, the patient's family member, her daughter, was outside the room, and she was crying. ... Even though we could give her all the information ... that wasn't perhaps what she was looking for, because what we were asking her to think about or to do was one of the hardest things anyone has to ever bear, which was, \"Do you want us to stop CPR?\" And that's the type of thing that I don't think any of us can ever prepare for, especially when it's our parent that's involved.\u003c/p>\n\u003cp>\u003cstrong>On why he wrote a book about dying\u003c/strong>\u003c/p>\n\u003cp>I really wanted to find answers to some very, very basic questions, like what are the implications of the sort of life extension that we have achieved? What is the role of religion, not only a patient's religion but a physician's religion when it comes to dealing with the end of life? 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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>One of the biggest problems that we face in not only modern society, but in societies of olden times as well, is that people have always been very afraid to talk about death. In many cultures it is considered bad luck to talk about death and it is thought to be a bad omen. I think to some extent that extends to this very day. But ... I think having a living will, having an advanced directive, or perhaps most importantly, having a designated healthcare proxy, someone who can help transmit your decisions to the team when you're not able to do so, is perhaps the most important thing that we can do for ourselves as patients and as human beings.\u003c/p>\n\u003cp>\u003cstrong>On giving CPR and knowing when to stop giving CPR\u003c/strong>\u003c/p>\n\u003cp>One of the things about CPR, Terry, is that almost everyone in medicine knows how to start CPR, when to start CPR, really what to do in CPR under even complex situations, but the one thing that almost no one really teaches us, and there are no guidelines for, is when to stop CPR. I think in some ways that is one of the biggest challenges that we in medicine face all the time. ...\u003c/p>\n\u003cp>I was actually working in the hospital last night and it was about three in the morning and I was called by one of my other colleagues who was another cardiology fellow, he asked me, \"Haider, I need your help. I have a patient that we are doing CPR on,\" and he wanted some help from me. So I walked over to the intensive care unit, and the patient was in her 60s. ... There was an entire team in the room doing chest compressions on this woman, and they had been doing it for an hour and a half at that point, much, much, much longer than most CPRs last. ...\u003c/p>\n\u003cp>At the same time while this CPR was ongoing, the patient's family member, her daughter, was outside the room, and she was crying. ... Even though we could give her all the information ... that wasn't perhaps what she was looking for, because what we were asking her to think about or to do was one of the hardest things anyone has to ever bear, which was, \"Do you want us to stop CPR?\" And that's the type of thing that I don't think any of us can ever prepare for, especially when it's our parent that's involved.\u003c/p>\n\u003cp>\u003cstrong>On why he wrote a book about dying\u003c/strong>\u003c/p>\n\u003cp>I really wanted to find answers to some very, very basic questions, like what are the implications of the sort of life extension that we have achieved? What is the role of religion, not only a patient's religion but a physician's religion when it comes to dealing with the end of life? How is social media affecting how people experience the end of life? ...\u003c/p>\n\u003cp>So many times I've found myself in the room where there are people who were so much more experienced in life than I was, yet knew so little about death and dying. And so I wanted to write a book so that people could go into those really, really difficult places and feel like they're armed with information, that this isn't a completely foreign territory for them and that in some way could help them navigate and deal with the sort of difficult situations that lay ahead for them.\u003c/p>\n\u003cp>\u003cstrong>On the possible repeal of the \u003ca href=\"http://www.npr.org/tags/131849999/affordable-care-act\">Affordable Care Act\u003c/a>\u003c/strong>\u003c/p>\n\u003cp>It is very unfortunate that health is so politicized in this country, because it doesn't have to be. Health and wellness aren't red or blue, and they shouldn't be, but unfortunately that is where we are. I hope that when policies are being enacted in DC, patient's voices, those who have benefited from the ACA, those who have gained insurance, those voices are not lost in the midst of all of this political activity.\u003c/p>\n\u003cp>\u003cstrong>On immigrating to the U.S. from Pakistan\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>I came to the United States in 2010 and [until now] have only lived in an America in which Barack Obama was the president. I think in some ways Trump's victory has really shaken me, because of how invested I was in the idea that America is a special place, it's a truly multicultural society. And I'm still trying to understand, I think like so many others, just exactly what happened. Especially as a writer and as a physician I've tried to separate myself from my identity as a Muslim. I'd rather be known as a physician/scientist/writer who happens to be Pakistani, rather than a young Pakistani Muslim immigrant who happens to be a doctor and a writer, but I don't know. Given how things are changing, I'm not even sure if I'll be able to set that narrative for myself. That's a scary thought — to live an identity that is so politicized even when you wish for it to not be.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 Fresh Air. To see more, visit \u003ca href=\"http://www.npr.org/programs/fresh-air/\">Fresh Air\u003c/a>.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Doctor+Considers+The+Pitfalls+Of+Extending+Life+And+Prolonging+Death&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Cancer researchers are testing whether a generic drug that has been used for more than 40 years to treat parasitic infections may also help fight cancer.\u003c/p>\n\u003cp>The tests of mebendazole are part of a growing effort to take a fresh look at old medicines to see if they can be repurposed for new uses.\u003c/p>\n\u003cp>I first learned about mebendazole several years back when my son came home from camp with a gross but common infection: \u003ca href=\"https://medlineplus.gov/pinworms.html\">pinworms\u003c/a>.\u003c/p>\n\u003cp>My pediatrician prescribed two doses of mebendazole, and two weeks later the infection was gone.\u003c/p>\n\u003cp>Flash-forward a couple of years, and I was surprised to find on \u003ca href=\"https://clinicaltrials.gov/ct2/results?term=mebendazole&pg=1\">clinicaltrials.gov\u003c/a>, the federal database of medical trials, that mebendazole was being investigated as a potential cancer drug.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Curious, I contacted \u003ca href=\"http://www.hopkinsmedicine.org/profiles/results/directory/profile/8711584/gregory-riggins\">Gregory Riggins\u003c/a>, a cancer researcher at Johns Hopkins University who is testing the safety of mebendazole as a potential cancer treatment. He invited me to his lab in Baltimore.\u003c/p>\n\u003cp>Riggins took me inside and showed me cages of cancer research mice. A few years back, he said, his idea to test mebendazole started here.\u003c/p>\n\u003cp>Some of the lab animals got infected with pinworms, the same parasite my son had. The veterinarian at Johns Hopkins treated the whole colony of mice with an animal version of mebendazole.\u003c/p>\n\u003cp>The drug staved off the parasite, but it also did something surprising. Before the mice were treated for pinworms, Riggins and his team had implanted cancer cells into the animals' brains.\u003c/p>\n\u003cp>But after the mice got the pinworm drug, the cancers never developed. \"Our medulloblastoma stopped growing,\" Riggins says. He found out that other researchers were conducting animal studies to see if the drug had effects on lung cancer and melanoma.\u003c/p>\n\u003cp>So he got funding to do two Phase 1 studies to test whether mebendazole is safe to use in brain cancer patients, one in children and another in adults. So far the drug appears to be safe and well tolerated by patients, Riggins says. That would be expected, given that it has been used for decades around the world to treat pinworms.\u003c/p>\n\u003cp>\"Based on the preclinical studies it looks like it has promise,\" says \u003ca href=\"http://www.massgeneral.org/doctors/doctor.aspx?id=17882\">Tracy Batchelor\u003c/a>, director of the division of neuro-oncology at Massachusetts General Hospital, who is not involved in the research. \"The next step is to look for a benefit in a Phase 2 trial.\" That would test whether mebendazole has any effect on cancer in people. Riggins hopes to conduct that sort of trial in adult brain cancer patients.\u003c/p>\n\u003cp>At a time when it can cost a billion dollars to develop a new drug, the idea of repurposing existing drugs is appealing, according to \u003ca href=\"http://cureswithinreach.org/about-us/staff\">Bruce Bloom\u003c/a>. He's the president and chief science officer of \u003ca href=\"http://www.cureswithinreach.org/\">Cures Within Reach\u003c/a>, which has helped to fund Riggins' research.\u003c/p>\n\u003cp>Bloom points to \u003ca href=\"https://www.cancer.gov/about-cancer/causes-prevention/research/metformin\">research on metformin\u003c/a>, a diabetes drug that's being looked at as a potential treatment for a dozen different kinds of cancer and also tuberculosis. A common blood pressure drug, \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4504645/\">propranolol\u003c/a>, is also being studied.\u003c/p>\n\u003cp>\"It's not likely that mebendazole or any other single repurposed drug is ever going to cure cancer,\" Bloom says. But he envisions the possibility that combinations of repurposed drugs might help the body to manage cancer.\u003c/p>\n\u003cp>Any use of mebendazole as a cancer drug would be years away, if it proves to work at all. Most drugs that emerge from Phase 1 trials never deliver the hoped-for benefits.\u003c/p>\n\u003cp>And in an odd twist to a complicated story, the cost of mebendazole in the U.S. has skyrocketed in recent years. Though it remains very affordable in most countries, the wholesale cost of a 100 mg tablet in the U.S. has risen from $4.50 in 2011 to $369 in 2016, according to Truven Health Analytics.\u003c/p>\n\u003cp>The dynamics that led to the price hike were in play before interest rose in the drug as a potential cancer treatment, analysts say. In 2013, \u003ca href=\"http://www.amedrapharma.com/\">Amedra Pharmaceuticals\u003c/a> bought marketing rights to mebendazole from Teva Pharmaceuticals. It already owned rights to another key generic antiparasitic drug, albendazole.\u003c/p>\n\u003cp>\"At that point, anyone who has had a high school or undergraduate economics course would be able to explain the price hike,\" says \u003ca href=\"http://faculty.rx.umaryland.edu/tmattingly/\">Joey Mattingly\u003c/a>, an assistant professor in the department of pharmacy practice and science at the University of Maryland School of Pharmacy who studies generic drug pricing.\u003c/p>\n\u003cp>That leaves people with pinworm infections with the choice of two expensive prescription medications or cheaper over-the-counter options.\u003c/p>\n\u003cp>\"Pinworms are exceedingly common,\" says \u003ca href=\"http://pediatrics.wustl.edu/Faculty/orscheln_r\">Rachel Orscheln\u003c/a>, an assistant professor of pediatric infectious diseases at Washington University and St. Louis Children's Hospital. The CDC \u003ca href=\"https://www.cdc.gov/dpdx/enterobiasis/\">estimates\u003c/a> 40 million people are infected in the U.S. annually. Orscheln says the people most likely to be infected are children and people who are living in group settings such as nursing homes.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"There are certain cases where we do need to prescribe this medication,\" says Orscheln. But at the higher price, she says, \"I'm very disinclined to prescribe [it].\" She says over-the-counter drugs such as \u003ca href=\"http://www.webmd.com/drugs/2/drug-10346-6119/pin-x-oral/pyrantel-suspension%E2%80%94-oral/details\">Pin-X\u003c/a> or pyrantel, can work just as well in children, so \"I'm very likely to steer people in that direction.\"\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=A+Pinworm+Medication+Is+Being+Tested+As+A+Potential+Anti-Cancer+Drug&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Cancer researchers are testing whether a generic drug that has been used for more than 40 years to treat parasitic infections may also help fight cancer.\u003c/p>\n\u003cp>The tests of mebendazole are part of a growing effort to take a fresh look at old medicines to see if they can be repurposed for new uses.\u003c/p>\n\u003cp>I first learned about mebendazole several years back when my son came home from camp with a gross but common infection: \u003ca href=\"https://medlineplus.gov/pinworms.html\">pinworms\u003c/a>.\u003c/p>\n\u003cp>My pediatrician prescribed two doses of mebendazole, and two weeks later the infection was gone.\u003c/p>\n\u003cp>Flash-forward a couple of years, and I was surprised to find on \u003ca href=\"https://clinicaltrials.gov/ct2/results?term=mebendazole&pg=1\">clinicaltrials.gov\u003c/a>, the federal database of medical trials, that mebendazole was being investigated as a potential cancer drug.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Curious, I contacted \u003ca href=\"http://www.hopkinsmedicine.org/profiles/results/directory/profile/8711584/gregory-riggins\">Gregory Riggins\u003c/a>, a cancer researcher at Johns Hopkins University who is testing the safety of mebendazole as a potential cancer treatment. He invited me to his lab in Baltimore.\u003c/p>\n\u003cp>Riggins took me inside and showed me cages of cancer research mice. A few years back, he said, his idea to test mebendazole started here.\u003c/p>\n\u003cp>Some of the lab animals got infected with pinworms, the same parasite my son had. The veterinarian at Johns Hopkins treated the whole colony of mice with an animal version of mebendazole.\u003c/p>\n\u003cp>The drug staved off the parasite, but it also did something surprising. Before the mice were treated for pinworms, Riggins and his team had implanted cancer cells into the animals' brains.\u003c/p>\n\u003cp>But after the mice got the pinworm drug, the cancers never developed. \"Our medulloblastoma stopped growing,\" Riggins says. He found out that other researchers were conducting animal studies to see if the drug had effects on lung cancer and melanoma.\u003c/p>\n\u003cp>So he got funding to do two Phase 1 studies to test whether mebendazole is safe to use in brain cancer patients, one in children and another in adults. So far the drug appears to be safe and well tolerated by patients, Riggins says. That would be expected, given that it has been used for decades around the world to treat pinworms.\u003c/p>\n\u003cp>\"Based on the preclinical studies it looks like it has promise,\" says \u003ca href=\"http://www.massgeneral.org/doctors/doctor.aspx?id=17882\">Tracy Batchelor\u003c/a>, director of the division of neuro-oncology at Massachusetts General Hospital, who is not involved in the research. \"The next step is to look for a benefit in a Phase 2 trial.\" That would test whether mebendazole has any effect on cancer in people. Riggins hopes to conduct that sort of trial in adult brain cancer patients.\u003c/p>\n\u003cp>At a time when it can cost a billion dollars to develop a new drug, the idea of repurposing existing drugs is appealing, according to \u003ca href=\"http://cureswithinreach.org/about-us/staff\">Bruce Bloom\u003c/a>. He's the president and chief science officer of \u003ca href=\"http://www.cureswithinreach.org/\">Cures Within Reach\u003c/a>, which has helped to fund Riggins' research.\u003c/p>\n\u003cp>Bloom points to \u003ca href=\"https://www.cancer.gov/about-cancer/causes-prevention/research/metformin\">research on metformin\u003c/a>, a diabetes drug that's being looked at as a potential treatment for a dozen different kinds of cancer and also tuberculosis. A common blood pressure drug, \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4504645/\">propranolol\u003c/a>, is also being studied.\u003c/p>\n\u003cp>\"It's not likely that mebendazole or any other single repurposed drug is ever going to cure cancer,\" Bloom says. But he envisions the possibility that combinations of repurposed drugs might help the body to manage cancer.\u003c/p>\n\u003cp>Any use of mebendazole as a cancer drug would be years away, if it proves to work at all. Most drugs that emerge from Phase 1 trials never deliver the hoped-for benefits.\u003c/p>\n\u003cp>And in an odd twist to a complicated story, the cost of mebendazole in the U.S. has skyrocketed in recent years. Though it remains very affordable in most countries, the wholesale cost of a 100 mg tablet in the U.S. has risen from $4.50 in 2011 to $369 in 2016, according to Truven Health Analytics.\u003c/p>\n\u003cp>The dynamics that led to the price hike were in play before interest rose in the drug as a potential cancer treatment, analysts say. In 2013, \u003ca href=\"http://www.amedrapharma.com/\">Amedra Pharmaceuticals\u003c/a> bought marketing rights to mebendazole from Teva Pharmaceuticals. It already owned rights to another key generic antiparasitic drug, albendazole.\u003c/p>\n\u003cp>\"At that point, anyone who has had a high school or undergraduate economics course would be able to explain the price hike,\" says \u003ca href=\"http://faculty.rx.umaryland.edu/tmattingly/\">Joey Mattingly\u003c/a>, an assistant professor in the department of pharmacy practice and science at the University of Maryland School of Pharmacy who studies generic drug pricing.\u003c/p>\n\u003cp>That leaves people with pinworm infections with the choice of two expensive prescription medications or cheaper over-the-counter options.\u003c/p>\n\u003cp>\"Pinworms are exceedingly common,\" says \u003ca href=\"http://pediatrics.wustl.edu/Faculty/orscheln_r\">Rachel Orscheln\u003c/a>, an assistant professor of pediatric infectious diseases at Washington University and St. Louis Children's Hospital. The CDC \u003ca href=\"https://www.cdc.gov/dpdx/enterobiasis/\">estimates\u003c/a> 40 million people are infected in the U.S. annually. Orscheln says the people most likely to be infected are children and people who are living in group settings such as nursing homes.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"There are certain cases where we do need to prescribe this medication,\" says Orscheln. But at the higher price, she says, \"I'm very disinclined to prescribe [it].\" She says over-the-counter drugs such as \u003ca href=\"http://www.webmd.com/drugs/2/drug-10346-6119/pin-x-oral/pyrantel-suspension%E2%80%94-oral/details\">Pin-X\u003c/a> or pyrantel, can work just as well in children, so \"I'm very likely to steer people in that direction.\"\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=A+Pinworm+Medication+Is+Being+Tested+As+A+Potential+Anti-Cancer+Drug&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp class=\"big-cap-wrap danger-zone\">\u003cspan class=\"big-cap\">T\u003c/span>he Iranian scientist was a catch: a prize-winning young pharmacologist with \u003ca href=\"https://www.researchgate.net/profile/Seyed_Soheil_Saeedi_Saravi\" target=\"_blank\">over 40\u003c/a> publications to his name.\u003c/p>\n\u003cp class=\"danger-zone\">“He is exactly the kind of person we would like to bring to the United States,” said Dr. Thomas Michel, who hired Seyed Soheil Saeedi Saravi as a postdoctoral fellow in his lab at Harvard-affiliated Brigham and Women’s Hospital.\u003c/p>\n\u003cp class=\"danger-zone\">But not only would Saravi spend his time in Boston trying to figure out how diabetes affects a heart’s ability to beat; he would also be acting as a kind of scientific diplomat.\u003c/p>\n\u003caside class=\"pullquote alignright\">Travel restrictions aren’t just a problem for individual researchers or labs, scientists say. They threaten cross-border collaboration that taps talent and ideas.\u003c/aside>\n\u003cp class=\"danger-zone\">“This would have led to a collaboration between my lab and the lab of his mentor in Tehran,” said Michel, a cardiologist and biochemist.\u003c/p>\n\u003cp class=\"danger-zone\">That plan was scuttled by President Trump’s executive order on immigration, which barred nationals from seven majority-Muslim countries, including Iran, from entering the United States. Saravi was supposed to fly to Boston from his native Iran this month, but his visa was suspended because of last Friday’s order. On Wednesday, because there is no \u003ca href=\"https://ir.usembassy.gov/tehran/\" target=\"_blank\">US embassy or consulate\u003c/a> in Iran, he went to the consulate in Dubai — over 2,000 miles away from his home in Tehran — to try to get answers. But a security guard wouldn’t even let him enter the office, Saravi told STAT.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp class=\"danger-zone\">For Saravi, the whole process has been nightmarish. But travel restrictions aren’t just a problem for individual researchers like him, or for the labs where they were slated to work. They threaten cross-border collaborations that tap talent and ideas from elsewhere and hasten discoveries, scientists said.\u003c/p>\n\u003cp>Many of those kinds of collaborations begin with an encounter at a scientific conference, or, as this one would have, with a student or postdoc coming to train in the United States, and then going elsewhere to start another lab. By working with a different team — or multiple teams around the world — scientists may entertain hypotheses they might not have considered, and can enlist patients from other countries who would not have been able to participate in their study.\u003c/p>\n\u003cp>The ban affects more researchers from Iran and Iraq than from the other five countries, in part because more Iranians and Iraqis come to the United States every year on the types of visas given to scientists. In the 2015 fiscal year, there were 847 Iraqis and 820 Iranians here on a \u003ca href=\"https://www.statnews.com/2017/01/31/visas-doctors-scientists-patients/\" target=\"_blank\">J1 visa\u003c/a>, which is given to postdocs and medical residents, while there were only 122 from Syria, and even fewer from the other countries.\u003c/p>\n\u003cp>“About 50 percent of our members are located outside of the US; the reason for this is that science is global,” said Stefano Bertuzzi, executive director of the American Society for Microbiology, who was adamant that his organization is nonpartisan and willing to work with the new administration. But to him, the travel ban sends a message that is dangerous for science.\u003c/p>\n\u003cp>“You can’t find all your expertise in one country, even in a country that is the size of a continent, like the United States,” he said. “Our work is on preventing, curing, and diagnosing infectious diseases. If we don’t work together on that, the whole society will collapse, or at least take a big hit.”\u003c/p>\n\u003cp>His inbox has exploded with emails from organizers and attendees of the ASM Microbe meeting in New Orleans this coming June who are worried about the ban.\u003c/p>\n\u003cp>“I’ve been inundated,” Bertuzzi said. Even those who would be able to get into the country are telling him they won’t come to the United States until Trump’s order is no longer in effect.\u003c/p>\n\u003cp>“I can tell you I have received emails saying, ‘We have already collected abstracts from people from these countries’ … ‘I don’t want to organize a meeting in the US,’ ‘I want to withdraw my abstract.'”\u003c/p>\n\u003cp>Dr. Mehdi Farokhnia is a postdoc who studies alcohol addiction at the National Institutes of Health. His work depends on being able to meet and exchange ideas with scientists at conferences. Last year, that took him to Scotland, Japan, and Canada. And even though he has American citizenship, he’s also a citizen of Iran, and now he won’t leave the United States for fear of not being let back in.\u003c/p>\n\u003cp>“I’m a dual citizen, so I am somehow lucky in this situation, but it’s very, very stressful,” he said. “I don’t feel confident now to leave the country because I’m a dual citizen and nothing is clear.”\u003c/p>\n\u003cp>Many worry about the ban affecting the quality of clinical studies, by making it harder to include patients with different genetic backgrounds, experiences, and environmental exposures.\u003c/p>\n\u003cp>“By decreasing diversity in science, the bias in science will increase,” said Dr. Elmira Hassanzadeh, an Iranian radiology resident at the University of Illinois at Chicago who spent the last two years as a researcher at Harvard. “If I’m an Iranian … I will collaborate with my Iranian peers. If there is a hospital that is doing the same kind of project, I can just pool our population and we can run a multi-center study. These are considered a very strong sort of data. If I’m not welcome here, my resources back home will also not be welcome here, and that will affect collaboration.”\u003c/p>\n\u003cp>One public health professor at a major American university, who didn’t want to be identified for fear of being targeted by the government for speaking out against the ban, is worried about collaborations like her own. While she was a postdoc at Harvard, she met some graduate students from one of the countries covered by the travel ban. After they took faculty positions in their home country, the team kept up discussions about public health, and in the last decade or so, that friendship has allowed them to coauthor eight to 10 scientific papers.\u003c/p>\n\u003cp>She worries not only that the executive order could interrupt her own fruitful collaboration — “It hinders our ability to interact and communicate in person,” she said — but also that it will stop other potential teams from meeting each other in the first place.\u003c/p>\n\u003cp>Saravi is devastated. Doing research at Harvard was a “childhood dream,” he said, and he spent 16 months trying to secure his visa.\u003c/p>\n\u003cp>But Michel sees this as a loss for Americans as much as it is for Saravi: “This is really the lifeblood of Boston biomedicine, foreign nationals who represent the best and brightest of their nation.”\u003c/p>\n\u003cp>\u003cem>Kate Sheridan contributed reporting.\u003c/em>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This \u003ca href=\"https://www.statnews.com/2017/02/03/travel-ban-trump-scientific-collaboration/\">story\u003c/a> was originally published by STAT, an online publication of Boston Globe Media that covers health, medicine, and scientific discovery.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp class=\"big-cap-wrap danger-zone\">\u003cspan class=\"big-cap\">T\u003c/span>he Iranian scientist was a catch: a prize-winning young pharmacologist with \u003ca href=\"https://www.researchgate.net/profile/Seyed_Soheil_Saeedi_Saravi\" target=\"_blank\">over 40\u003c/a> publications to his name.\u003c/p>\n\u003cp class=\"danger-zone\">“He is exactly the kind of person we would like to bring to the United States,” said Dr. Thomas Michel, who hired Seyed Soheil Saeedi Saravi as a postdoctoral fellow in his lab at Harvard-affiliated Brigham and Women’s Hospital.\u003c/p>\n\u003cp class=\"danger-zone\">But not only would Saravi spend his time in Boston trying to figure out how diabetes affects a heart’s ability to beat; he would also be acting as a kind of scientific diplomat.\u003c/p>\n\u003caside class=\"pullquote alignright\">Travel restrictions aren’t just a problem for individual researchers or labs, scientists say. They threaten cross-border collaboration that taps talent and ideas.\u003c/aside>\n\u003cp class=\"danger-zone\">“This would have led to a collaboration between my lab and the lab of his mentor in Tehran,” said Michel, a cardiologist and biochemist.\u003c/p>\n\u003cp class=\"danger-zone\">That plan was scuttled by President Trump’s executive order on immigration, which barred nationals from seven majority-Muslim countries, including Iran, from entering the United States. Saravi was supposed to fly to Boston from his native Iran this month, but his visa was suspended because of last Friday’s order. On Wednesday, because there is no \u003ca href=\"https://ir.usembassy.gov/tehran/\" target=\"_blank\">US embassy or consulate\u003c/a> in Iran, he went to the consulate in Dubai — over 2,000 miles away from his home in Tehran — to try to get answers. But a security guard wouldn’t even let him enter the office, Saravi told STAT.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp class=\"danger-zone\">For Saravi, the whole process has been nightmarish. But travel restrictions aren’t just a problem for individual researchers like him, or for the labs where they were slated to work. They threaten cross-border collaborations that tap talent and ideas from elsewhere and hasten discoveries, scientists said.\u003c/p>\n\u003cp>Many of those kinds of collaborations begin with an encounter at a scientific conference, or, as this one would have, with a student or postdoc coming to train in the United States, and then going elsewhere to start another lab. By working with a different team — or multiple teams around the world — scientists may entertain hypotheses they might not have considered, and can enlist patients from other countries who would not have been able to participate in their study.\u003c/p>\n\u003cp>The ban affects more researchers from Iran and Iraq than from the other five countries, in part because more Iranians and Iraqis come to the United States every year on the types of visas given to scientists. In the 2015 fiscal year, there were 847 Iraqis and 820 Iranians here on a \u003ca href=\"https://www.statnews.com/2017/01/31/visas-doctors-scientists-patients/\" target=\"_blank\">J1 visa\u003c/a>, which is given to postdocs and medical residents, while there were only 122 from Syria, and even fewer from the other countries.\u003c/p>\n\u003cp>“About 50 percent of our members are located outside of the US; the reason for this is that science is global,” said Stefano Bertuzzi, executive director of the American Society for Microbiology, who was adamant that his organization is nonpartisan and willing to work with the new administration. But to him, the travel ban sends a message that is dangerous for science.\u003c/p>\n\u003cp>“You can’t find all your expertise in one country, even in a country that is the size of a continent, like the United States,” he said. “Our work is on preventing, curing, and diagnosing infectious diseases. If we don’t work together on that, the whole society will collapse, or at least take a big hit.”\u003c/p>\n\u003cp>His inbox has exploded with emails from organizers and attendees of the ASM Microbe meeting in New Orleans this coming June who are worried about the ban.\u003c/p>\n\u003cp>“I’ve been inundated,” Bertuzzi said. Even those who would be able to get into the country are telling him they won’t come to the United States until Trump’s order is no longer in effect.\u003c/p>\n\u003cp>“I can tell you I have received emails saying, ‘We have already collected abstracts from people from these countries’ … ‘I don’t want to organize a meeting in the US,’ ‘I want to withdraw my abstract.'”\u003c/p>\n\u003cp>Dr. Mehdi Farokhnia is a postdoc who studies alcohol addiction at the National Institutes of Health. His work depends on being able to meet and exchange ideas with scientists at conferences. Last year, that took him to Scotland, Japan, and Canada. And even though he has American citizenship, he’s also a citizen of Iran, and now he won’t leave the United States for fear of not being let back in.\u003c/p>\n\u003cp>“I’m a dual citizen, so I am somehow lucky in this situation, but it’s very, very stressful,” he said. “I don’t feel confident now to leave the country because I’m a dual citizen and nothing is clear.”\u003c/p>\n\u003cp>Many worry about the ban affecting the quality of clinical studies, by making it harder to include patients with different genetic backgrounds, experiences, and environmental exposures.\u003c/p>\n\u003cp>“By decreasing diversity in science, the bias in science will increase,” said Dr. Elmira Hassanzadeh, an Iranian radiology resident at the University of Illinois at Chicago who spent the last two years as a researcher at Harvard. “If I’m an Iranian … I will collaborate with my Iranian peers. If there is a hospital that is doing the same kind of project, I can just pool our population and we can run a multi-center study. These are considered a very strong sort of data. If I’m not welcome here, my resources back home will also not be welcome here, and that will affect collaboration.”\u003c/p>\n\u003cp>One public health professor at a major American university, who didn’t want to be identified for fear of being targeted by the government for speaking out against the ban, is worried about collaborations like her own. While she was a postdoc at Harvard, she met some graduate students from one of the countries covered by the travel ban. After they took faculty positions in their home country, the team kept up discussions about public health, and in the last decade or so, that friendship has allowed them to coauthor eight to 10 scientific papers.\u003c/p>\n\u003cp>She worries not only that the executive order could interrupt her own fruitful collaboration — “It hinders our ability to interact and communicate in person,” she said — but also that it will stop other potential teams from meeting each other in the first place.\u003c/p>\n\u003cp>Saravi is devastated. Doing research at Harvard was a “childhood dream,” he said, and he spent 16 months trying to secure his visa.\u003c/p>\n\u003cp>But Michel sees this as a loss for Americans as much as it is for Saravi: “This is really the lifeblood of Boston biomedicine, foreign nationals who represent the best and brightest of their nation.”\u003c/p>\n\u003cp>\u003cem>Kate Sheridan contributed reporting.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"disqusTitle": "Despite Disappointing Results, Alzheimer's Research Plows On",
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"content": "\u003cp>Despite a 99 percent failure rate and another major setback last month, Alzheimer’s researchers are plowing ahead with hundreds of experiments — and a boost in federal money — to try to a crack a deadly disease that has flummoxed them for decades.\u003c/p>\n\u003cp>A \u003ca href=\"http://www.npr.org/sections/health-shots/2016/12/02/504139105/winners-and-losers-if-21st-century-cures-bill-becomes-law\" target=\"_blank\">law\u003c/a> passed by Congress in December and signed by President Obama sets aside $3 billion over 10 years to fund research of brain diseases and precision medicine, a shot in the arm for Alzheimer’s research. The law, called the 21st Century Cures Act, also includes prize money to encourage Alzheimer’s experiments.\u003c/p>\n\u003cp>But billions of dollars have so far made little progress in decoding the memory-robbing disease, which affects 5 million Americans. Alzheimer’s is currently the nation’s sixth leading cause of death. Decades of research have not produced a single drug that alters the disease’s course.\u003c/p>\n\u003cp>December began with another major setback: Eli Lilly shared disappointing results of a late-stage clinical trial of its experimental drug solanezumab, which failed to significantly slow Alzheimer’s progression.\u003c/p>\n\u003cp>But scientists aren’t giving up on the main hypothesis behind Eli Lilly’s trial: that Alzheimer’s can be defeated by using drugs to attack amyloid “plaques” that build up in the brain of Alzheimer’s patients. Some scientists believe these cause the disease.\u003c/p>\n\u003cfigure class=\"related\">\u003c/figure>\n\u003cp>Many observers still hold out hope for another promising anti-amyloid drug, Biogen’s aducanumab, which in an early trial \u003ca href=\"http://www.nature.com/nature/journal/v537/n7618/full/nature19323.html\" target=\"_blank\">improved cognitive decline\u003c/a> in a small number of patients.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Other potentially groundbreaking research aims to intervene before patients even feel any symptoms. Using PET scans, scientists can now identify amyloid plaques building up in a patient’s brain years before they develop Alzheimer’s. The \u003ca href=\"http://a4study.org/about/\" target=\"_blank\">A4 study\u003c/a>, for instance, is testing solanezumab in adults who are accumulating amyloid plaques, but showing no outward signs of Alzheimer’s, such as memory loss or cognitive decline.\u003c/p>\n\u003cp>Other scientists are targeting what they believe is the true culprit, the protein tau, which creates “tangles” in the brain, the disease’s other primary marker.\u003c/p>\n\u003cp>The experiments continue against a bleak backdrop: No new Alzheimer’s therapies have won federal approval since 2003, and Alzheimer’s clinical trials have had a \u003ca href=\"http://alzres.biomedcentral.com/articles/10.1186/alzrt269#B13\" target=\"_blank\">99 percent failure rate\u003c/a>. Patients can access only four Food and Drug Administration-approved Alzheimer’s drugs that alleviate symptoms but do not prevent, slow or reverse brain damage.\u003c/p>\n\u003cp>“The history of clinical trials results has been a history of disappointment,” said Keith Fargo, director of scientific programs and outreach at the Alzheimer’s Association.\u003c/p>\n\u003cp>Still, 77 Alzheimer’s drugs are currently being investigated or developed, according to the trade group PhRMA. And other experiments seek to repurpose FDA-approved drugs for other conditions, such as diabetes or cancer, to see if they can help Alzheimer’s patients — and cut several years from the drug development process.\u003c/p>\n\u003caside class=\"pullquote alignright\">Despite failures, 'there's still more optimism in Alzheimer's research right now than there has been for 10 years.'\u003ccite>Keith Fargo, director of scientific programs and outreach at the Alzheimer’s Association\u003c/cite>\u003c/aside>\n\u003cp>Non-pharmaceutical solutions are also being explored. Observational studies have shown that people who exercise more and have healthier diets seem to get the disease later in life. Researchers are now conducting trials to more closely measure the effects of exercise and diet. One randomized trial underway at Wake Forest University, \u003ca href=\"https://clinicaltrials.gov/ct2/show/NCT02814526\" target=\"_blank\">dubbed EXERT\u003c/a>, is testing the effects of high-intensity aerobic exercise on adults with mild cognitive impairment by enrolling them in exercise programs at a YMCA.\u003c/p>\n\u003cp>Even before last month’s passage of the 21st Century Cures Act, public funding for Alzheimer’s research has been rising. The National Institutes of Health allocated almost $1 billion to Alzheimer’s research in fiscal 2016 — a $350 million increase over the previous year, according to Laurie Ryan, chief of NIH’s Dementias of Aging Branch. There are 468 open clinical trials related to Alzheimer’s, and over a hundred more in progress, \u003ca href=\"https://clinicaltrials.gov/ct2/results?term=alzheimer%27s&Search=Search\" target=\"_blank\">listed on the\u003c/a> government database ClinicalTrials.gov.\u003c/p>\n\u003cp>Meanwhile, Alzheimer’s advocates still grapple with a basic question: Is the rate of Alzheimer’s actually going down? A \u003ca href=\"http://khn.org/news/dementia-rates-decline-sharply-among-senior-citizens/\">study\u003c/a> in JAMA in November found that even as scientists have made no progress in changing Alzheimer’s course, overall dementia rates, which include Alzheimer’s and other dementias, appear to be dramatically declining. The paper cast doubt over a major talking point of the Alzheimer’s lobby: That as baby boomers age, the number of Americans living with Alzheimer’s will explode from the current 5 million \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/23390181\" target=\"_blank\">to 14 million\u003c/a> in 2050. The study also suggested that lifestyle changes may make a difference.\u003c/p>\n\u003cp>While some heralded that as good news, others downplayed the finding.\u003c/p>\n\u003cp>Even if dementia rates drop, Alzheimer’s remains a major killer, and the number of afflicted people will likely still rise, because the US population is aging so rapidly, predicted Fargo. He also questioned the study’s methods, which relied largely on telephone interviews.\u003c/p>\n\u003cp>“It’s not time to let our foot up off the gas,” Fargo said.\u003c/p>\n\u003cp>Eli Lilly’s closely watched trial, dubbed Expedition 3, was the latest potential breakthrough to fall flat. In 2,100 people with mild dementia, solanezumab failed to show significant results compared to a placebo.\u003c/p>\n\u003cp>Some critics said the failure casts doubt on the hotly disputed hypothesis that Alzheimer’s is triggered by the buildup of amyloid plaques.\u003c/p>\n\u003cp>But Eli Lilly spokeswoman Nicole Hebert said more work is needed to test the hypothesis, because the trial explored just one method of removing amyloid, on one subgroup of people. She said the company is pursuing seven other lines of attack.\u003c/p>\n\u003cp>“Rumors of the death of the amyloid hypothesis have been around for many years, and they’re probably premature,” Fargo agreed.\u003c/p>\n\u003cp>Fargo noted that brain imaging has shown that amyloid plaques start to build up 15 to 20 years before signs of dementia appear. So to really test the amyloid hypothesis, he said, scientists may have to intervene earlier than they did in Expedition 3.\u003c/p>\n\u003cp>Despite the latest failure, Fargo said, “there’s still more optimism in Alzheimer’s research right now than there has been for 10 years.”\u003c/p>\n\u003cp>The answer to Alzheimer’s, Ryan said, is not going to be one “magic bullet,” but an array of solutions tailored to different patients.\u003c/p>\n\u003cp>Will scientists ever find a cure?\u003c/p>\n\u003cp>Dr. Ron Petersen, director of the Alzheimer’s Disease Research Center at the Mayo Clinic, isn’t betting on it. But there’s still “a lot going on to be hopeful about,” he said.\u003c/p>\n\u003cp>“I think slowing the progression and/or delaying the onset, are realistic goals.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>KHN’s coverage of end-of-life and serious illness issues is supported by \u003ca href=\"https://www.moore.org/\" target=\"_blank\">The Gordon and Betty Moore Foundation\u003c/a>.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Despite a 99 percent failure rate and another major setback last month, Alzheimer’s researchers are plowing ahead with hundreds of experiments — and a boost in federal money — to try to a crack a deadly disease that has flummoxed them for decades.\u003c/p>\n\u003cp>A \u003ca href=\"http://www.npr.org/sections/health-shots/2016/12/02/504139105/winners-and-losers-if-21st-century-cures-bill-becomes-law\" target=\"_blank\">law\u003c/a> passed by Congress in December and signed by President Obama sets aside $3 billion over 10 years to fund research of brain diseases and precision medicine, a shot in the arm for Alzheimer’s research. The law, called the 21st Century Cures Act, also includes prize money to encourage Alzheimer’s experiments.\u003c/p>\n\u003cp>But billions of dollars have so far made little progress in decoding the memory-robbing disease, which affects 5 million Americans. Alzheimer’s is currently the nation’s sixth leading cause of death. Decades of research have not produced a single drug that alters the disease’s course.\u003c/p>\n\u003cp>December began with another major setback: Eli Lilly shared disappointing results of a late-stage clinical trial of its experimental drug solanezumab, which failed to significantly slow Alzheimer’s progression.\u003c/p>\n\u003cp>But scientists aren’t giving up on the main hypothesis behind Eli Lilly’s trial: that Alzheimer’s can be defeated by using drugs to attack amyloid “plaques” that build up in the brain of Alzheimer’s patients. Some scientists believe these cause the disease.\u003c/p>\n\u003cfigure class=\"related\">\u003c/figure>\n\u003cp>Many observers still hold out hope for another promising anti-amyloid drug, Biogen’s aducanumab, which in an early trial \u003ca href=\"http://www.nature.com/nature/journal/v537/n7618/full/nature19323.html\" target=\"_blank\">improved cognitive decline\u003c/a> in a small number of patients.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Other potentially groundbreaking research aims to intervene before patients even feel any symptoms. Using PET scans, scientists can now identify amyloid plaques building up in a patient’s brain years before they develop Alzheimer’s. The \u003ca href=\"http://a4study.org/about/\" target=\"_blank\">A4 study\u003c/a>, for instance, is testing solanezumab in adults who are accumulating amyloid plaques, but showing no outward signs of Alzheimer’s, such as memory loss or cognitive decline.\u003c/p>\n\u003cp>Other scientists are targeting what they believe is the true culprit, the protein tau, which creates “tangles” in the brain, the disease’s other primary marker.\u003c/p>\n\u003cp>The experiments continue against a bleak backdrop: No new Alzheimer’s therapies have won federal approval since 2003, and Alzheimer’s clinical trials have had a \u003ca href=\"http://alzres.biomedcentral.com/articles/10.1186/alzrt269#B13\" target=\"_blank\">99 percent failure rate\u003c/a>. Patients can access only four Food and Drug Administration-approved Alzheimer’s drugs that alleviate symptoms but do not prevent, slow or reverse brain damage.\u003c/p>\n\u003cp>“The history of clinical trials results has been a history of disappointment,” said Keith Fargo, director of scientific programs and outreach at the Alzheimer’s Association.\u003c/p>\n\u003cp>Still, 77 Alzheimer’s drugs are currently being investigated or developed, according to the trade group PhRMA. And other experiments seek to repurpose FDA-approved drugs for other conditions, such as diabetes or cancer, to see if they can help Alzheimer’s patients — and cut several years from the drug development process.\u003c/p>\n\u003caside class=\"pullquote alignright\">Despite failures, 'there's still more optimism in Alzheimer's research right now than there has been for 10 years.'\u003ccite>Keith Fargo, director of scientific programs and outreach at the Alzheimer’s Association\u003c/cite>\u003c/aside>\n\u003cp>Non-pharmaceutical solutions are also being explored. Observational studies have shown that people who exercise more and have healthier diets seem to get the disease later in life. Researchers are now conducting trials to more closely measure the effects of exercise and diet. One randomized trial underway at Wake Forest University, \u003ca href=\"https://clinicaltrials.gov/ct2/show/NCT02814526\" target=\"_blank\">dubbed EXERT\u003c/a>, is testing the effects of high-intensity aerobic exercise on adults with mild cognitive impairment by enrolling them in exercise programs at a YMCA.\u003c/p>\n\u003cp>Even before last month’s passage of the 21st Century Cures Act, public funding for Alzheimer’s research has been rising. The National Institutes of Health allocated almost $1 billion to Alzheimer’s research in fiscal 2016 — a $350 million increase over the previous year, according to Laurie Ryan, chief of NIH’s Dementias of Aging Branch. There are 468 open clinical trials related to Alzheimer’s, and over a hundred more in progress, \u003ca href=\"https://clinicaltrials.gov/ct2/results?term=alzheimer%27s&Search=Search\" target=\"_blank\">listed on the\u003c/a> government database ClinicalTrials.gov.\u003c/p>\n\u003cp>Meanwhile, Alzheimer’s advocates still grapple with a basic question: Is the rate of Alzheimer’s actually going down? A \u003ca href=\"http://khn.org/news/dementia-rates-decline-sharply-among-senior-citizens/\">study\u003c/a> in JAMA in November found that even as scientists have made no progress in changing Alzheimer’s course, overall dementia rates, which include Alzheimer’s and other dementias, appear to be dramatically declining. The paper cast doubt over a major talking point of the Alzheimer’s lobby: That as baby boomers age, the number of Americans living with Alzheimer’s will explode from the current 5 million \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/23390181\" target=\"_blank\">to 14 million\u003c/a> in 2050. The study also suggested that lifestyle changes may make a difference.\u003c/p>\n\u003cp>While some heralded that as good news, others downplayed the finding.\u003c/p>\n\u003cp>Even if dementia rates drop, Alzheimer’s remains a major killer, and the number of afflicted people will likely still rise, because the US population is aging so rapidly, predicted Fargo. He also questioned the study’s methods, which relied largely on telephone interviews.\u003c/p>\n\u003cp>“It’s not time to let our foot up off the gas,” Fargo said.\u003c/p>\n\u003cp>Eli Lilly’s closely watched trial, dubbed Expedition 3, was the latest potential breakthrough to fall flat. In 2,100 people with mild dementia, solanezumab failed to show significant results compared to a placebo.\u003c/p>\n\u003cp>Some critics said the failure casts doubt on the hotly disputed hypothesis that Alzheimer’s is triggered by the buildup of amyloid plaques.\u003c/p>\n\u003cp>But Eli Lilly spokeswoman Nicole Hebert said more work is needed to test the hypothesis, because the trial explored just one method of removing amyloid, on one subgroup of people. She said the company is pursuing seven other lines of attack.\u003c/p>\n\u003cp>“Rumors of the death of the amyloid hypothesis have been around for many years, and they’re probably premature,” Fargo agreed.\u003c/p>\n\u003cp>Fargo noted that brain imaging has shown that amyloid plaques start to build up 15 to 20 years before signs of dementia appear. So to really test the amyloid hypothesis, he said, scientists may have to intervene earlier than they did in Expedition 3.\u003c/p>\n\u003cp>Despite the latest failure, Fargo said, “there’s still more optimism in Alzheimer’s research right now than there has been for 10 years.”\u003c/p>\n\u003cp>The answer to Alzheimer’s, Ryan said, is not going to be one “magic bullet,” but an array of solutions tailored to different patients.\u003c/p>\n\u003cp>Will scientists ever find a cure?\u003c/p>\n\u003cp>Dr. Ron Petersen, director of the Alzheimer’s Disease Research Center at the Mayo Clinic, isn’t betting on it. But there’s still “a lot going on to be hopeful about,” he said.\u003c/p>\n\u003cp>“I think slowing the progression and/or delaying the onset, are realistic goals.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>KHN’s coverage of end-of-life and serious illness issues is supported by \u003ca href=\"https://www.moore.org/\" target=\"_blank\">The Gordon and Betty Moore Foundation\u003c/a>.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Much has been written about the \u003ca href=\"https://aspe.hhs.gov/sites/default/files/pdf/187551/ACA2010-2016.pdf\">20 million people\u003c/a> who gained health insurance under the Affordable Care Act, and \u003ca href=\"http://www.npr.org/sections/health-shots/2017/01/24/511413971/arizona-children-could-lose-health-coverage-under-obamacare-repeal\">what could happen\u003c/a> to these patients if the ACA is repealed without a replacement. But some people don’t realize that hospitals nationwide could take a big financial hit on several fronts, too.\u003c/p>\n\u003cp>First, it’s likely that fewer patients would be able to pay their hospital bills, health policy analysts say, so the institutions would be stuck with that bad debt, as they were before Obamacare.\u003c/p>\n\u003cp>“If the Medicaid expansion goes away wholesale, and things go back to the way they were before this expansion was in place, a lot of those hospitals would see an increase in their uncompensated care costs,” says \u003ca href=\"http://kff.org/person/rachel-garfield/\">Rachel Garfield\u003c/a>, an analyst with the Kaiser Family Foundation. The American Hospital Association estimates that hospitals across the U.S. could \u003ca href=\"http://www.aha.org/content/16/impact-repeal-aca-exec-summary.pdf\">lose\u003c/a> more than $160 billion from the reduction in Medicaid revenue and the increase in unpaid medical bills.\u003c/p>\n\u003cp>Then there’s this: The ACA has used financial incentives to encourage hospitals to experiment with ways to improve their care of patients, while reducing health care’s cost. That sort of experimentation has included a sizable upfront investment by many hospitals.\u003c/p>\n\u003cp>Massachusetts General Hospital in Boston, for example, signed \u003ca href=\"http://www.partners.org/For-Patients/ACO/\">agreements\u003c/a> with physicians and insurers to create \u003ca href=\"http://www.npr.org/2011/04/01/132937232/accountable-care-organizations-explained\">accountable care organizations\u003c/a>, in hopes of saving money in the long run. With an ACO, insurers pay doctors for making sure the patient is getting the best and most appropriate care, instead of paying for every test and procedure a doctor does.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“We have now more than 20 different programs,” says \u003ca href=\"http://www.massgeneral.org/children/doctors/doctor.aspx?id=16933\">Dr. Timothy Ferris\u003c/a>, an internist and medical director of the Mass General Physicians Organization. “Video visits, electronic consultation with specialists, home hospitalization, [and] programs for patients with diabetes and heart disease. I would be worried that a repeal of the ACA would undermine our ability to invest in services for our patients.”\u003c/p>\n\u003cp>Ferris acknowledges that most of those experiments \u003ca href=\"http://www.npr.org/sections/health-shots/2015/09/14/440240225/medicare-fails-to-save-money-so-far-on-cooperative-care-experiment\">haven’t yet\u003c/a> saved money. But they need more time to work out the kinks safely, he says.\u003c/p>\n\u003cp>“One of the things that it’s difficult for people outside of health care to appreciate — particularly politicians — is how long it takes to make significant improvements in the delivery of care,” Ferris says. “You have to be very careful when you make changes.”\u003c/p>\n\u003cp>Ferris says the threatened repeal of the ACA makes him worry “that the progress we’ve made over the past five years would be threatened.”\u003c/p>\n\u003cp>Many other \u003ca href=\"http://healthaffairs.org/blog/2016/04/21/accountable-care-organizations-in-2016-private-and-public-sector-growth-and-dispersion/\">hospitals across the country\u003c/a> have invested in accountable care organizations — often overhauling their medical records systems, hiring staff and creating new services. \u003ca href=\"http://www.carenewengland.org/about/board-of-directors/dennis-keefe.cfm\">Dennis Keefe\u003c/a>, head of a large hospital chain called \u003ca href=\"http://www.carenewengland.org/\">Care New England\u003c/a> in Rhode Island, says he, too, worries about the future of his ACO, \u003ca href=\"http://www.integracare.org/\">Integra\u003c/a>.\u003c/p>\n\u003cp>“I think, if there’s a real change in direction away from these alternative payment models, we will be assuming risk to care for a population,” Keefe says.”We have invested enormously to be successful in this area.”\u003c/p>\n\u003cp>But these seismic changes in the way hospitals do business were predicated, he adds, on long-term support from the federal government — support that might disappear if the ACA is repealed.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This story is part of NPR’s reporting partnership with NPR, Rhode Island Public Radio and Kaiser Health News. The Kaiser Family Foundation supports Kaiser Health News, an editorially independent program that produces news reports heard on NPR and published on \u003c/em>\u003ca href=\"http://NPR.org\">NPR.org\u003c/a>.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 Rhode Island Public Radio. To see more, visit \u003ca href=\"http://www.ripr.org/\">Rhode Island Public Radio\u003c/a>.\u003cimg decoding=\"async\" src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Hospitals+Worry+Repeal+Of+Obamacare+Would+Jeopardize+Innovations+In+Care&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Much has been written about the \u003ca href=\"https://aspe.hhs.gov/sites/default/files/pdf/187551/ACA2010-2016.pdf\">20 million people\u003c/a> who gained health insurance under the Affordable Care Act, and \u003ca href=\"http://www.npr.org/sections/health-shots/2017/01/24/511413971/arizona-children-could-lose-health-coverage-under-obamacare-repeal\">what could happen\u003c/a> to these patients if the ACA is repealed without a replacement. But some people don’t realize that hospitals nationwide could take a big financial hit on several fronts, too.\u003c/p>\n\u003cp>First, it’s likely that fewer patients would be able to pay their hospital bills, health policy analysts say, so the institutions would be stuck with that bad debt, as they were before Obamacare.\u003c/p>\n\u003cp>“If the Medicaid expansion goes away wholesale, and things go back to the way they were before this expansion was in place, a lot of those hospitals would see an increase in their uncompensated care costs,” says \u003ca href=\"http://kff.org/person/rachel-garfield/\">Rachel Garfield\u003c/a>, an analyst with the Kaiser Family Foundation. The American Hospital Association estimates that hospitals across the U.S. could \u003ca href=\"http://www.aha.org/content/16/impact-repeal-aca-exec-summary.pdf\">lose\u003c/a> more than $160 billion from the reduction in Medicaid revenue and the increase in unpaid medical bills.\u003c/p>\n\u003cp>Then there’s this: The ACA has used financial incentives to encourage hospitals to experiment with ways to improve their care of patients, while reducing health care’s cost. That sort of experimentation has included a sizable upfront investment by many hospitals.\u003c/p>\n\u003cp>Massachusetts General Hospital in Boston, for example, signed \u003ca href=\"http://www.partners.org/For-Patients/ACO/\">agreements\u003c/a> with physicians and insurers to create \u003ca href=\"http://www.npr.org/2011/04/01/132937232/accountable-care-organizations-explained\">accountable care organizations\u003c/a>, in hopes of saving money in the long run. With an ACO, insurers pay doctors for making sure the patient is getting the best and most appropriate care, instead of paying for every test and procedure a doctor does.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“We have now more than 20 different programs,” says \u003ca href=\"http://www.massgeneral.org/children/doctors/doctor.aspx?id=16933\">Dr. Timothy Ferris\u003c/a>, an internist and medical director of the Mass General Physicians Organization. “Video visits, electronic consultation with specialists, home hospitalization, [and] programs for patients with diabetes and heart disease. I would be worried that a repeal of the ACA would undermine our ability to invest in services for our patients.”\u003c/p>\n\u003cp>Ferris acknowledges that most of those experiments \u003ca href=\"http://www.npr.org/sections/health-shots/2015/09/14/440240225/medicare-fails-to-save-money-so-far-on-cooperative-care-experiment\">haven’t yet\u003c/a> saved money. But they need more time to work out the kinks safely, he says.\u003c/p>\n\u003cp>“One of the things that it’s difficult for people outside of health care to appreciate — particularly politicians — is how long it takes to make significant improvements in the delivery of care,” Ferris says. “You have to be very careful when you make changes.”\u003c/p>\n\u003cp>Ferris says the threatened repeal of the ACA makes him worry “that the progress we’ve made over the past five years would be threatened.”\u003c/p>\n\u003cp>Many other \u003ca href=\"http://healthaffairs.org/blog/2016/04/21/accountable-care-organizations-in-2016-private-and-public-sector-growth-and-dispersion/\">hospitals across the country\u003c/a> have invested in accountable care organizations — often overhauling their medical records systems, hiring staff and creating new services. \u003ca href=\"http://www.carenewengland.org/about/board-of-directors/dennis-keefe.cfm\">Dennis Keefe\u003c/a>, head of a large hospital chain called \u003ca href=\"http://www.carenewengland.org/\">Care New England\u003c/a> in Rhode Island, says he, too, worries about the future of his ACO, \u003ca href=\"http://www.integracare.org/\">Integra\u003c/a>.\u003c/p>\n\u003cp>“I think, if there’s a real change in direction away from these alternative payment models, we will be assuming risk to care for a population,” Keefe says.”We have invested enormously to be successful in this area.”\u003c/p>\n\u003cp>But these seismic changes in the way hospitals do business were predicated, he adds, on long-term support from the federal government — support that might disappear if the ACA is repealed.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This story is part of NPR’s reporting partnership with NPR, Rhode Island Public Radio and Kaiser Health News. The Kaiser Family Foundation supports Kaiser Health News, an editorially independent program that produces news reports heard on NPR and published on \u003c/em>\u003ca href=\"http://NPR.org\">NPR.org\u003c/a>.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 Rhode Island Public Radio. To see more, visit \u003ca href=\"http://www.ripr.org/\">Rhode Island Public Radio\u003c/a>.\u003cimg decoding=\"async\" src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Hospitals+Worry+Repeal+Of+Obamacare+Would+Jeopardize+Innovations+In+Care&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Screening for lung cancer using low-dose CT scans can save lives, but at a cost: Tests frequently produce anxiety-producing false alarms and prompt unnecessary procedures.\u003c/p>\n\u003cp>A study from the Veterans Health Administration lays out the considerable effort required by both patients and doctors to undertake screening.\u003c/p>\n\u003cp>\"I have heard people say 'what's the big deal, it's just a CT,' \" says Dr. Linda Kinsinger, who ran the study at the VA. \"But I think what we tried to show is it's a lot more than just a CT.\"\u003c/p>\n\u003cp>Federal officials and other medical groups \u003ca href=\"https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/lung-cancer-screening\">recommend\u003c/a> low-dose CT scans to look for lung cancer among people at risk, generally those over the age of 55 who have smoked at least the equivalent of two packs a day for 15 years. The tests typically cost $300, and they aren't always covered by insurance.\u003c/p>\n\u003cp>Screening does identify cancers, but in the vast majority of cases the test produces false alarms.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>In the VA \u003ca href=\"http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2599437\">study\u003c/a>, which was published Monday in \u003cem>JAMA Internal Medicine\u003c/em>, 4,246 patients were eligible for screening. About half of them declined to take the test, even though it was offered at no cost.\u003c/p>\n\u003cp>Of those who took the test, about 55 percent of them were told that they had lung nodules, which often involved follow-up appointments and further scans. But very few of those nodules were actually real problems. In the end, the screeners identified 31 cases of lung cancer, about 20 of which were in the early, most treatable stage.\u003c/p>\n\u003cp>The study involved eight of the 150 or so VA hospitals, and was designed to assess the overall benefits and potential harms of setting up a screening program in a large medical institution.\u003c/p>\n\u003cp>So is it a good idea? \"I think it's a close call,\" Kinsinger says.\u003c/p>\n\u003cp>There was a benefit to the 20 or so patients out of this large initial population who had their cancer detected while it was likely to be treatable. \"But that has to be weighed against the amount of effort on the part of both patients and staff, and the anxiety, the worry, that a false alarm will cause among patients,\" she says.\u003c/p>\n\u003caside class=\"pullquote alignright\">'Very few people are actually helped by screening, and a lot of time there are a number of harms.'\u003ccite>Dr. Rita Redberg, editor of \u003cem>JAMA Internal Medicine\u003c/em>\u003c/cite>\u003c/aside>\n\u003cp>\"I think a lot of people have a much rosier view of screening in general than the facts bear out,\" says Dr. Rita Redberg, editor of \u003cem>JAMA Internal Medicine\u003c/em> and a cardiologist at the University of California, San Francisco who wrote an \u003ca href=\"http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2599435\">editorial\u003c/a> accompanying the study. \"Very few people are actually helped by screening, and a lot of time there are a number of harms.\"\u003c/p>\n\u003cp>Another \u003ca href=\"http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2599436\">study\u003c/a> published in the same issue found that many people getting CT screens are actually at low risk for lung cancer. Dr. Jinhai Huo and colleagues at the MD Anderson Cancer Center compared screening rates before and after 2011, the year of a key study that supported the idea of low-dose CT screening for lung cancer.\u003c/p>\n\u003cp>\"Once a [radiology] center has the ability to do this screening, they like to use their technology to do as many people as possible,\" Redberg says, \"and it seems that low-risk people who are really unlikely to get any benefit and are much more likely to get harmed are getting screened in higher numbers than in the high-risk people who are supposed to be screened.\"\u003c/p>\n\u003cp>Dr. Jorge Gomez, a spokesman for the American Lung Association and an oncologist at Mt. Sinai Hospital in New York, says that while screening low-risk people doesn't make sense on a population basis, it sometimes makes sense for individual patients.\u003c/p>\n\u003cp>And as for the experience at the VA, Gomez says medical teams that have learned to interpret the results of scans can generally weed out false-positive results without resorting to biopsies or other invasive follow-up tests.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"There is a concern for unnecessary procedures at institutions where they don't have the expertise in reading these scans,\" he says. And he acknowledges not everybody has the luxury of going to the top-of-the-line institutions that do this best.\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=Lung+Cancer+Screening+Program+Finds+A+Lot+That%27s+Not+Cancer&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Screening for lung cancer using low-dose CT scans can save lives, but at a cost: Tests frequently produce anxiety-producing false alarms and prompt unnecessary procedures.\u003c/p>\n\u003cp>A study from the Veterans Health Administration lays out the considerable effort required by both patients and doctors to undertake screening.\u003c/p>\n\u003cp>\"I have heard people say 'what's the big deal, it's just a CT,' \" says Dr. Linda Kinsinger, who ran the study at the VA. \"But I think what we tried to show is it's a lot more than just a CT.\"\u003c/p>\n\u003cp>Federal officials and other medical groups \u003ca href=\"https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/lung-cancer-screening\">recommend\u003c/a> low-dose CT scans to look for lung cancer among people at risk, generally those over the age of 55 who have smoked at least the equivalent of two packs a day for 15 years. The tests typically cost $300, and they aren't always covered by insurance.\u003c/p>\n\u003cp>Screening does identify cancers, but in the vast majority of cases the test produces false alarms.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>In the VA \u003ca href=\"http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2599437\">study\u003c/a>, which was published Monday in \u003cem>JAMA Internal Medicine\u003c/em>, 4,246 patients were eligible for screening. About half of them declined to take the test, even though it was offered at no cost.\u003c/p>\n\u003cp>Of those who took the test, about 55 percent of them were told that they had lung nodules, which often involved follow-up appointments and further scans. But very few of those nodules were actually real problems. In the end, the screeners identified 31 cases of lung cancer, about 20 of which were in the early, most treatable stage.\u003c/p>\n\u003cp>The study involved eight of the 150 or so VA hospitals, and was designed to assess the overall benefits and potential harms of setting up a screening program in a large medical institution.\u003c/p>\n\u003cp>So is it a good idea? \"I think it's a close call,\" Kinsinger says.\u003c/p>\n\u003cp>There was a benefit to the 20 or so patients out of this large initial population who had their cancer detected while it was likely to be treatable. \"But that has to be weighed against the amount of effort on the part of both patients and staff, and the anxiety, the worry, that a false alarm will cause among patients,\" she says.\u003c/p>\n\u003caside class=\"pullquote alignright\">'Very few people are actually helped by screening, and a lot of time there are a number of harms.'\u003ccite>Dr. Rita Redberg, editor of \u003cem>JAMA Internal Medicine\u003c/em>\u003c/cite>\u003c/aside>\n\u003cp>\"I think a lot of people have a much rosier view of screening in general than the facts bear out,\" says Dr. Rita Redberg, editor of \u003cem>JAMA Internal Medicine\u003c/em> and a cardiologist at the University of California, San Francisco who wrote an \u003ca href=\"http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2599435\">editorial\u003c/a> accompanying the study. \"Very few people are actually helped by screening, and a lot of time there are a number of harms.\"\u003c/p>\n\u003cp>Another \u003ca href=\"http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2599436\">study\u003c/a> published in the same issue found that many people getting CT screens are actually at low risk for lung cancer. Dr. Jinhai Huo and colleagues at the MD Anderson Cancer Center compared screening rates before and after 2011, the year of a key study that supported the idea of low-dose CT screening for lung cancer.\u003c/p>\n\u003cp>\"Once a [radiology] center has the ability to do this screening, they like to use their technology to do as many people as possible,\" Redberg says, \"and it seems that low-risk people who are really unlikely to get any benefit and are much more likely to get harmed are getting screened in higher numbers than in the high-risk people who are supposed to be screened.\"\u003c/p>\n\u003cp>Dr. Jorge Gomez, a spokesman for the American Lung Association and an oncologist at Mt. Sinai Hospital in New York, says that while screening low-risk people doesn't make sense on a population basis, it sometimes makes sense for individual patients.\u003c/p>\n\u003cp>And as for the experience at the VA, Gomez says medical teams that have learned to interpret the results of scans can generally weed out false-positive results without resorting to biopsies or other invasive follow-up tests.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"There is a concern for unnecessary procedures at institutions where they don't have the expertise in reading these scans,\" he says. And he acknowledges not everybody has the luxury of going to the top-of-the-line institutions that do this best.\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=Lung+Cancer+Screening+Program+Finds+A+Lot+That%27s+Not+Cancer&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Has Technology Ruined the Radiology Profession?",
"title": "Has Technology Ruined the Radiology Profession?",
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"content": "\u003cp>\u003cem>This is an edited excerpt from Robert Wachter's \"\u003cem>\u003ca href=\"https://www.amazon.com/Digital-Doctor-Hope-Medicines-Computer/dp/0071849467\" target=\"_blank\" rel=\"noopener\">The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine's Computer Age\u003c/a>\u003c/em>,\" reprinted with permission from McGraw-Hill. Copyright 2015.\u003c/em>\u003c/p>\n\u003cp>\u003cspan style=\"font-size: 4.6875em;float: left;line-height: 0.733em;padding: 0.05em 0.1em 0 0;font-family: times, serif, georgia\">W\u003c/span>hen I was a medical student in the 1980s, the beating heart of the Hospital of the University of Pennsylvania was not the mahogany-lined executive suite, nor the dazzling operating room of L. Henry Edmunds, Jr., HUP's most famed cardiac surgeon. No, it was in the decidedly unglamorous, dimly lit Chest Reading room, where all the X-rays were hung on a moving contraption called an alternator that resembled the one on which the clothes hang at your local dry cleaner. Controlled by a seated radiologist operating a foot pedal, the machine would cycle through panel after panel until it arrived at your films. The radiologist took his foot off the pedal, the machine ground to a halt, and the dark X-ray sheets were brought to life by intense backlighting.\u003c/p>\n\u003cp>At Penn in the 1980s, everybody — and I mean everybody, from the lowliest student to the loftiest transplant surgeon — brought films for deciphering to the late Wallace Miller, Sr., a crusty but endearing professor of radiology and one of the best teachers I've ever known. For students like me, time spent with him was at once exhilarating and terrifying. \"What's this opacity?\" he asked me once, the memory burned into my hippocampus by that cognitive curing process known as overwhelming anxiety. \"A ... a pneumonia?\" I stammered.\u003c/p>\n\u003cp>\"Mooiaaa,\" retorted The Oracle, an unforgettable signature sound uttered as Miller smartly turned his head away in mock disgust. I loved it. We all did.\u003c/p>\n\u003caside class=\"pullquote alignright\">'One day I tried to see if I could go the whole day without speaking to anyone. And that’s what happened—I didn’t speak to a single person.'\u003ccite>A radiologist\u003c/cite>\u003c/aside>\n\u003cp>Today, many of my internal medicine trainees barely know where the radiology department is. Just as your record player and LPs are now long gone, in your local hospital today, the films, the analog X-ray machines, and even those charming film conveyor belts have left the building.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Why? In 2000, only 8 percent of U.S. hospitals had some version of a game-changing computer technology called the Picture Archiving and Communications System, or PACS. By 2008, more than three out of four did.\u003c/p>\n\u003cp>Because radiology was the first medical specialty to computerize, what has happened to it — at once shocking and, in retrospect, entirely predictable — is our canary in the digital coal mine, its experience offering important lessons for patients, clinicians and health care systems.\u003c/p>\n\u003cp>\u003cstrong>The Beauty of PACS\u003c/strong>\u003c/p>\n\u003cp>While the main catalyst for PACS was economic, the quality of the images and the ability to manipulate them were also important. Unlike regular films, CT scans need to be viewed at various contrast levels: One setting is best to look at bones, another to look at lungs, and still another to look at soft tissue like muscle.\u003c/p>\n\u003cp>PACS allowed radiologists to toggle through these views, in the same way that Instagram lets you play with your photos. You can also use a nifty magnifying glass to zoom in on a part of the image. An unexpected benefit was “stacking”: rather than looking at 100 images arrayed in a 10 × 10 grid on a one-dimensional page, the images could be digitally stacked, one on top of another, allowing the radiologist to scroll through them swiftly by rolling a mouse ball. Moreover, computerization let the radiologist look at the images from home, enabling senior experts to weigh in on subtle findings that trainees might flub. And while the images were fuzzy at first, today they’re as crisp as high-definition television.\u003c/p>\n\u003cp>Perhaps most important, PACS obviated the need for maddening searches for prior X-rays. Twenty years ago, when a chest X-ray revealed a lung nodule, the first commandment on the radiologist’s report was to “obtain old films.” The rationale: If the nodule had been unchanged for many years, it could safely be ignored—such stability simply wasn’t consistent with a diagnosis of cancer. But searching for old films was often an exercise in frustration: They were lost, or locked up, or at another institution, or in a filing cabinet in the thoracic surgeon’s garage, behind the golf clubs. When my colleagues and I came up empty-handed, which was more often than not, the patient frequently paid the price in the form of an unnecessary biopsy. But PACS made finding old films a breeze (assuming that they were done at the same hospital or had been scanned into the system); they’re usually just a click away.\u003c/p>\n\u003cp>While PACS was widely anticipated and generally accepted by radiologists, some prescient observers worried that computerization might lead to unbidden effects on the field. In 1999, Stephen Baker, chair of the Department of Radiology at New Jersey Medical School, fretted that PACS might turn radiologists into “disembodied functionaries, more akin to servicing technicians than professional colleagues.” Paul Chang, professor of radiology at the University of Chicago and an early leader in digital radiology, describes the day his father, a retired radiologist, took him to task.\u003c/p>\n\u003cp>“Before PACS, we were the doctor’s doctor,” his father berated him. “Medicine and surgery rounds started in radiology. . . . Every morning the clinicians and the radiologists collaborated.”\u003c/p>\n\u003cp>His father’s less-than-endearing nickname for his famous son: “The Man Who Ruined Radiology.”\u003c/p>\n\u003cp>The advantages of PACS are so vast that few would want to turn back the clock. Yet the effects on those of us who order X-rays and the radiologists who read them have been profound, and they’re not all positive. The fact that we can now review our images without trekking down to radiology means that we rarely do make the trip.\u003c/p>\n\u003cp>https://www.youtube.com/watch?v=fHUzVqoDnts&ab_channel=DoctorKlioze\u003c/p>\n\u003cp>\u003cstrong>An Awkward Trip to Radiology\u003c/strong>\u003c/p>\n\u003cp>A few years ago, when I asked my interns and students to visit the radiology department to review the key films, they looked at me as if I had grown a second head. After my team humored me by accompanying me to the radiology department, I conducted a little sociology experiment. Standing outside my hospital’s chest reading room, I delivered a brief speech:\u003c/p>\n\u003caside class=\"pullquote alignright\">'Did you look at the official report?' he hissed. The unspoken message was clear: Get out of my space; I’m busy.\u003c/aside>\n\u003cp>\"Watch what happens when we enter. Does anybody turn around and welcome us, ask, 'How can I help you?' and seem genuinely enthusiastic? When they go over the X-ray, do they delve a layer deeper than what they said in the formal report? Do they make any teaching points? Does the radiologist suggest courses of action or ask provocative questions?\"\u003c/p>\n\u003cp>I did this because I am deeply concerned that mine is the last generation to have learned the habit of going to the radiology department. Nostalgic for my interactions with Wally Miller and his like, it saddens me that our current trainees will never know how much they can learn from a great radiology teacher, and how much their patients’ care can be improved by actually talking to a real live radiologist. Yet I know that even if I bring my young horses to water, whether they visit the radiology department after I am no longer their wrangler will be determined by the quality of their experience.\u003c/p>\n\u003cp>We entered the chest reading room and were greeted by a wall of radiologists’ backs, their faces trained like lasers on the computer screens in front of them. Not a single head—located atop the shoulders of about eight different radiologists—turned to greet us.\u003c/p>\n\u003cp>After a couple of awkward minutes of crescendo throat-clearing, one of the radiologists grudgingly swiveled around to face my team and me. “Oh, do you need something?” he asked.\u003c/p>\n\u003cp>“Sure; can you help us look at a few films?”\u003c/p>\n\u003cp>He did, kind of, but offered his help in a whisper animated mostly by passive aggressiveness.\u003c/p>\n\u003cp>I thought it couldn’t get any worse, but it did.\u003c/p>\n\u003cp>“What do you think of this area?” I asked him, pointing to a confusing patch of whiteness on one patient’s chest CT scan.\u003c/p>\n\u003cp>“Did you look at the official report?” he hissed. (In other words: \"Perhaps you don’t know how to turn on your computer?\")\u003c/p>\n\u003cp>The unspoken message was clear: Get out of my space; I’m busy.\u003c/p>\n\u003cp>Now, I understand that he might well be busy, and that it has to be annoying having clinicians interrupt you every few minutes to go over images, particularly after you’ve just reviewed them with a different set of specialists and dictated a report. But that is the radiologist’s job. Or at least it used to be.\u003c/p>\n\u003cp>Allison Tillack, a young radiologist and a medical anthropologist whose Ph.D. thesis involved observing the world of radiologists for a year at a prominent academic hospital, has explored how the computerization of radiology has transformed the worlds of radiologists and those who use their services.\u003c/p>\n\u003cp>\"The ability of PACS to alter the accessibility and tempo of medical imaging has resulted in visits to the reading room being viewed now by non-radiology clinicians as a ‘waste of time’ and by radiologists as an ‘interruption,’” she wrote.\u003c/p>\n\u003cp>\u003cstrong>In a Funk\u003c/strong>\u003c/p>\n\u003cp>While I was well aware of the changing perceptions of radiology by nonradiologists, I had not, until I met Tillack, appreciated the degree to which the field of radiology is itself in a PACS-fueled funk.\u003c/p>\n\u003cp>After all, the field remains extremely popular among medical students, as many perceive it as offering the perfect blend of “great lifestyle” (that is, banker’s hours and limited overnight call) and high income, which averaged $340,000 in 2013. In fact, it’s often said that today’s medical students are attracted to the “ROAD specialties”: Radiology, Ophthalmology, Anesthesiology, and Dermatology, all of which are lucrative and none of which involves a lot of contact with those pesky sick people. In her research, Tillack found that the vast majority of radiologists and radiology residents identified the lack of direct patient contact as one of the main attractions of the field.\u003c/p>\n\u003cp>Given all these pluses, many frontline clinicians think of radiologists as having “won the game.” Yet I should have gotten a hint of the field’s handwringing in 2005, when I saw the results of a survey of physicians regarding their satisfaction with their chosen specialty. The happiest doctors were radiation oncologists (the folks who deliver radiation therapy to cancer patients), who do satisfying work, earn a good income, and have predictable hours. The least happy were cardiac surgeons, who train forever and, in recent years, have seen much of their business eroded by stents and other nonsurgical approaches to heart disease.\u003c/p>\n\u003cp>Radiologists show up a bit below the mean on the satisfaction scale—just behind the perennially overwhelmed and undercompensated primary care doctors.\u003c/p>\n\u003cp>In a 2012 paper, Tillack and a colleague described “the loneliness of the long distance radiologist.” One radiologist told them, “Before, I knew the face, name, wife’s name, and kids’ names of all the clinicians, but now I don’t know who you are if you joined the medical staff after we got PACS. . . . Before, when a clinician showed up, I could ask them and find out what’s really going on with the patient.”\u003c/p>\n\u003cp>I hear similar stories from every radiologist I meet. Patrick Luetmer, a Mayo Clinic neuroradiologist, described what happened when his MRI suite was remodeled. The suite was originally configured with two MRI “donuts” (the huge magnets that are responsible for the image) on either side of a central workstation in which Luetmer sat. There, he could monitor the scans as they were being performed, and talk to both the patients and the radiology assistants. Clinicians sometimes wandered down to look at the scans with him.\u003c/p>\n\u003cp>A few years ago, as part of a big efficiency push, Mayo decided that a third MRI machine was a better use of that central area than the radiologist’s air traffic control desk. Luetmer’s workstation was moved to an office a few hundred feet away, where he could follow the scans on his computer monitor and communicate with the techs via a special text messaging system.\u003c/p>\n\u003cp>“One day I tried to see if I could go the whole day without speaking to anyone. And that’s what happened—I didn’t speak to a single person. It was incredibly isolating.”\u003c/p>\n\u003cfigure id=\"attachment_264998\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2019/10/radiology2.jpg\">\u003cimg class=\"size-large wp-image-264998\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2019/10/radiology2-1180x953.jpg\" alt=\"1950s-era radiology at the U.S. Naval Hospital, Charleston, South Carolina.\" width=\"640\" height=\"517\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2019/10/radiology2-1180x953.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2019/10/radiology2-400x323.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2019/10/radiology2-743x600.jpg 743w, https://ww2.kqed.org/app/uploads/sites/13/2019/10/radiology2-768x620.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2019/10/radiology2-1920x1550.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2019/10/radiology2-960x775.jpg 960w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">1950s-era radiology at the U.S. Naval Hospital, Charleston, South Carolina. \u003ccite>(National Library of Medicine)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The radiologists were lonely, sure, but their situation involves something far deeper. Hari Tsoukas, an expert in organizational studies at the University of Cyprus, highlights the distinction between “information” and “knowledge.” Information, he wrote, “consists of objectified, decontextualized, time-less, impersonal, value-free representations,” whereas knowledge is “context-dependent, personalized, time-bound, and infused with values.”\u003c/p>\n\u003cp>Adds Tillack, “Hunches, hypotheses, frustrations with patients or their families, second guessing, judging of colleagues, and similar activities that mark how uncertainty is negotiated on a daily basis in medical practice are rarely reflected in the medical record . . . this knowledge can only circulate in private or semi-private contexts—by its very definition, this knowledge cannot be made a matter of public record.”\u003c/p>\n\u003cp>By purging the informal conversations during which such information was exchanged, the emergence of PACS left radiologists information-rich (Think of all those pixels! And old films just a click away!), but knowledge-poor.\u003c/p>\n\u003cp>\u003cstrong>'Great Case. Next Case.'\u003c/strong>\u003c/p>\n\u003cp>Radiologists’ alienation runs deeper than the lack of collegial exchange and the inability to find out what’s really going on with the patients. It’s also about power, status, and expertise. The fact that the traditional film lived only in the radiology reading room gave radiologists a monopoly over their entire ecosystem. PACS, observes Tillack, created a new normal in which “the ‘right’ to see [the image] is no longer mediated by radiologists, as it was in the reading room,” and has thus “eroded radiologists’ claims for authoritative knowledge over the interpretation of medical images.”\u003c/p>\n\u003cp>Once the radiology department no longer housed the films, the impact was immediate and dramatic. Without any changes in policy or very much forethought, the mid-1990s transition to filmless operations at the Baltimore VA hospital led to an 82 percent decrease in in-person consultation rates for general radiology studies. Today, many clinicians—particularly specialists like neurologists, pulmonologists, and surgeons—look at images themselves and act on their own interpretations; Many don’t even bother to read the radiologist’s formal report (which usually takes several hours, sometimes even a day, to reach the chart) unless they have unanswered questions or judge the study to be particularly challenging.\u003c/p>\n\u003cp>PACS was to increase efficiency, but that virtue has also become a curse, as radiologists increasingly feel like Lucy and Ethel on the assembly line of the chocolate factory. Among teleradiologists (radiologists reading x-rays from a distant site, often covering emergency departments at night while the hospital’s own radiologists are sleeping), there’s a well-known adage that captures the relentless objectification of their modern predicament: “Great case. Next case.\" As with so many other aspects of our modern digital lives, PACS sped up the clock, and did so without mercy.\u003c/p>\n\u003cp>That clock is constantly ticking. “Instead of waiting for films to be acquired, printed, sorted, and hung, radiologists now are always playing catch-up, looking at more ‘stuff’ in less time,” observed Tillack. That miraculous access to old films also creates an obligation for the radiologist to actually review them.\u003c/p>\n\u003cp>And it’s not just the old films that need to be examined; PACS makes vast amounts of information available with every study. In the early days of CT, the output of a scan might have been about 12 “slices,” each one representing a ¼-inch section through the thorax or abdomen, akin to a thick slice of deli-cut salami. But today’s ultra-fast CT scanners can produce images of more than 50 slices per inch of the human body, more like ultra-thin cuts of prosciutto. And PACS, with its massive memory bank and blazingly fast transmission speeds,can easily display every slice, which means that the radiologist has to scroll through hundreds of images in order to read a single CT study. This combination of more information in each scan, more old studies to compare, and more time pressure is unremitting.\u003c/p>\n\u003cp>The clock is ticking for other reasons as well. Since the image is available to the ordering clinician the moment it is created, radiologists feel obliged to perform their review quickly lest their reading seem like old news, like an afternoon newspaper in the Age of Twitter. Piling on, after recognizing the efficiency of PACS, insurance companies and Medicare slashed the reimbursement for each interpretation, pushing radiologists to read more films in less time in order to maintain their incomes. Said one radiologist, “With PACS, work is busier now. We have 70 percent more cases to read than 10 years ago. . . . At the end of the day . . . I’m fried.”\u003c/p>\n\u003cp>On top of this, there are even greater threats to radiologists’ livelihoods and happiness. One of them flows from the growing pressure on health care systems to slash their costs. Currently, virtually every X-ray performed at a U.S. hospital is sent for a formal reading by a radiologist, who is paid a fee by an insurance company. In today’s cost-cutting environment, it’s probably only a matter of time before some health care systems permit their frontline specialists to officially read certain films, reserving radiologist “overreads” for those images that the clinicians have questions about or the ones with super-high malpractice risk if they are misread. Radiologists can be counted on to fight such a move by frantically waving the banner of quality, but they will need to demonstrate that the value of having them review every film is worth the considerable expense.\u003c/p>\n\u003cp>Moreover, a major theme of Obama-era health reform is a shift from our historical fee-for-service, piecework payment model to one that dispenses a single payment to a hospital and doctors to manage all the care for a group of patients (“accountable care organizations,” ACOs for short) or a given episode of disease (“bundled payments”). Under such systems, the risk for the cost of care shifts from the insurer to the providers, and it’s up to the latter to decide how to divvy up the cash. Ron Arenson, chairman of the department of radiology at the University of California, San Francisco, sees this as the greatest threat to his field.\u003c/p>\n\u003cp>“If the world moves to bundled payments, we won’t do well,” he said. “We’re not very high in the pecking order.”\u003c/p>\n\u003cp>Some nonradiologists, particularly ER doctors working nights and weekends, have little sympathy for their colleagues’ new predicament. In fact, they have begun to wonder why radiologists should be compensated for next-day readings when they’ve already looked at the images themselves, acted on their interpretations, and assumed the risk of being sued if anything goes wrong. In a 2011 editorial entitled “The Life Cycle of a Parasitic Specialist,” ER physician William Mallon took off the gloves.\u003c/p>\n\u003cblockquote>\u003cp>[On Monday morning] these parasites will commence to feed on the financial juices of the lowly unfortunate emergency physicians, who had to work the entire weekend without radiologic support or backup. . . . The radiologist arrives well rested, café latte in hand, and promptly installs himself in a dark room to re-read and bill for all the films the emergency physicians read over the weekend. . . . Never has a specialty done so little for so many and been paid so much.\u003c/p>\u003c/blockquote>\n\u003cp>Ouch.\u003c/p>\n\u003cp>Another challenge to radiology made possible by the death of film has come in the form of teleradiology. Once X-rays went digital, it was no longer crucial for radiologists to be in the same building as the patient or the treating clinicians. As a result, many multihospital systems consolidated their reading rooms, particularly on weekends and nights, with centralized radiologists supporting multiple sites. Predictably, once the technical challenges of connectivity were solved, teleradiology companies emerged to fill this need. As is often the case with contented “legacy” providers (in health care and other industries), traditional radiologists were only too happy to have their colleagues read their films during off-hours. Who wouldn’t be?\u003c/p>\n\u003cp>The playing field soon expanded across national borders, as radiologists in Zurich, Israel, and Singapore began to read nighttime X-rays for American hospitals during their own local daytimes. Hundreds of hospitals now use these \"nighthawks,\" and everybody seems happy about it, including the domestic radiologists, who are sleeping soundly while the overnight images are read half a world away.\u003c/p>\n\u003cp>But one wonders whether this is the start of so-called disruptive innovation, the concept made famous by Harvard’s Clay Christensen. Disruption often begins with a fat and happy incumbent content to preserve its existing enviable position in a market. In industries ranging from commercial aviation to steel manufacturing, an upstart comes in and grabs an unattractive part of the market (in this case, nights and weekends). But once a low-cost company has squeezed through a crack to capture a slice of a previously locked franchise, it is rarely content to stay put. With the average U.S. radiologist earning about $350,000 per year and the average Indian radiologist earning less than one-tenth of that, one wonders whether the same World-is-Flat forces that have revolutionized other industries but mostly bypassed health care will be unleashed.\u003c/p>\n\u003cp>This is where radiologists’ loss of trust and collegiality with other clinicians may exact its heaviest toll. “Some people see teleradiology as a big threat, but I don’t,” UCSF’s Arenson told me. “I think that relationships with radiologists are important.” I do too, which is why I believe he may have his head in the sand: If physicians don’t get much out of visiting the radiology department or have even forgotten where it is located, we have little reason to fight to keep it in our buildings. Or, for that matter, our country.\u003c/p>\n\u003cp>Like all legacy providers faced with a technological or global workforce threat, radiologists can be counted on to argue that quality would take a huge hit if we outsourced their work to less expensive providers, domestic or foreign. The degree to which the field has accepted nighttime readings from non-U.S. radiologists will, of course, undermine this argument. It’s hard to make the claim that a Bangalore-based teleradiologist is sufficiently competent to read an image for your hospital at 3 a.m., but not at 3 p.m.\u003c/p>\n\u003cp>\u003cstrong>The Ultimate Threat\u003c/strong>\u003c/p>\n\u003cp>Finally, there is the ultimate threat: replacement by the machine. Of course, this issue is marbled throughout health care as we enter the digital age. To date, most claims that “this technology will replace doctors” (in areas ranging from diagnostic reasoning to robotic surgery) have proven to be hype.\u003c/p>\n\u003cp>However, in fields that are primarily about visual pattern recognition, the promise (or, if you’re a radiologist, the threat) is much more real. Studies have shown that computers can detect significant numbers of breast cancers and pulmonary emboli missed by radiologists, although nobody has yet taken the bold step of having the computers completely supplant the humans, partly because there are armadas of malpractice attorneys waiting to pounce, and partly because, at least for now, the combination of human and machine seems to perform better than either alone.\u003c/p>\n\u003cp>But over the long haul, I wouldn’t bet on the humans here, particularly since one of the hottest areas in artificial intelligence research is “deep learning”—research that has created computers that are reasonably skilled at “reading,” “hearing,” and, yes, “seeing.” The same kind of software that now allows Facebook to guess that a certain collection of pixels is a picture of you, or that alerts the casino’s security guards to keep an eye on that guy, is likely to eventually crack the code in radiology, and in similar areas such as dermatology and pathology.\u003c/p>\n\u003cp>Slowly, radiologists are waking up to their peril. Rather than isolating themselves from clinical care, some are now relocating their reading stations in clinical areas, such as the ER and the ICU, to be in the line of sight of their clinician colleagues. Others are resurrecting interdisciplinary conferences and training their staff in customer service. Technological solutions that allow radiologists and frontline clinicians to communicate through PACS and the electronic health record are springing up (through programs that create a mash-up of a Skype-like communication tool and a John Madden–style telestrator).\u003c/p>\n\u003cp>Said Paul Chang, the University of Chicago radiologist whose advocacy of PACS so upset his father, “We have to go beyond isolating ourselves and concentrating on messages in a bottle, where we just write a report and are done with it, but instead fostering collaboration.”\u003c/p>\n\u003cp>Since radiology represents such a large segment of health care expenditures (and also a source of harm through the risk of radiation), some health care systems are even putting radiologists in the position of being gatekeepers to their own technology. It’s a role they might not have accepted in the past, but, faced with an existential threat, many now welcome it. Said David Levin, a radiologist at Thomas Jefferson University, “We have to act more like consulting physicians . . . to look at the appropriateness of the requests for advanced imaging studies . . . rather than just going ahead and doing the study.”\u003c/p>\n\u003cp>Radiology’s experience over the past 15 years offers a crystal ball for the rest of the health care system. The speed with which computerization unleashed a series of forces that completely transformed an established field would be all too familiar to travel agents, journalists, and others who have been run over by the digital bulldozer, but it has shocked many health care observers, even astute ones.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>Will the computerization of the rest of medicine similarly upend the lives of other kinds of doctors, as well as their patients? The early returns are in, and the answer is yes.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cem>This is an edited excerpt from Robert Wachter's \"\u003cem>\u003ca href=\"https://www.amazon.com/Digital-Doctor-Hope-Medicines-Computer/dp/0071849467\" target=\"_blank\" rel=\"noopener\">The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine's Computer Age\u003c/a>\u003c/em>,\" reprinted with permission from McGraw-Hill. Copyright 2015.\u003c/em>\u003c/p>\n\u003cp>\u003cspan style=\"font-size: 4.6875em;float: left;line-height: 0.733em;padding: 0.05em 0.1em 0 0;font-family: times, serif, georgia\">W\u003c/span>hen I was a medical student in the 1980s, the beating heart of the Hospital of the University of Pennsylvania was not the mahogany-lined executive suite, nor the dazzling operating room of L. Henry Edmunds, Jr., HUP's most famed cardiac surgeon. No, it was in the decidedly unglamorous, dimly lit Chest Reading room, where all the X-rays were hung on a moving contraption called an alternator that resembled the one on which the clothes hang at your local dry cleaner. Controlled by a seated radiologist operating a foot pedal, the machine would cycle through panel after panel until it arrived at your films. The radiologist took his foot off the pedal, the machine ground to a halt, and the dark X-ray sheets were brought to life by intense backlighting.\u003c/p>\n\u003cp>At Penn in the 1980s, everybody — and I mean everybody, from the lowliest student to the loftiest transplant surgeon — brought films for deciphering to the late Wallace Miller, Sr., a crusty but endearing professor of radiology and one of the best teachers I've ever known. For students like me, time spent with him was at once exhilarating and terrifying. \"What's this opacity?\" he asked me once, the memory burned into my hippocampus by that cognitive curing process known as overwhelming anxiety. \"A ... a pneumonia?\" I stammered.\u003c/p>\n\u003cp>\"Mooiaaa,\" retorted The Oracle, an unforgettable signature sound uttered as Miller smartly turned his head away in mock disgust. I loved it. We all did.\u003c/p>\n\u003caside class=\"pullquote alignright\">'One day I tried to see if I could go the whole day without speaking to anyone. And that’s what happened—I didn’t speak to a single person.'\u003ccite>A radiologist\u003c/cite>\u003c/aside>\n\u003cp>Today, many of my internal medicine trainees barely know where the radiology department is. Just as your record player and LPs are now long gone, in your local hospital today, the films, the analog X-ray machines, and even those charming film conveyor belts have left the building.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Why? In 2000, only 8 percent of U.S. hospitals had some version of a game-changing computer technology called the Picture Archiving and Communications System, or PACS. By 2008, more than three out of four did.\u003c/p>\n\u003cp>Because radiology was the first medical specialty to computerize, what has happened to it — at once shocking and, in retrospect, entirely predictable — is our canary in the digital coal mine, its experience offering important lessons for patients, clinicians and health care systems.\u003c/p>\n\u003cp>\u003cstrong>The Beauty of PACS\u003c/strong>\u003c/p>\n\u003cp>While the main catalyst for PACS was economic, the quality of the images and the ability to manipulate them were also important. Unlike regular films, CT scans need to be viewed at various contrast levels: One setting is best to look at bones, another to look at lungs, and still another to look at soft tissue like muscle.\u003c/p>\n\u003cp>PACS allowed radiologists to toggle through these views, in the same way that Instagram lets you play with your photos. You can also use a nifty magnifying glass to zoom in on a part of the image. An unexpected benefit was “stacking”: rather than looking at 100 images arrayed in a 10 × 10 grid on a one-dimensional page, the images could be digitally stacked, one on top of another, allowing the radiologist to scroll through them swiftly by rolling a mouse ball. Moreover, computerization let the radiologist look at the images from home, enabling senior experts to weigh in on subtle findings that trainees might flub. And while the images were fuzzy at first, today they’re as crisp as high-definition television.\u003c/p>\n\u003cp>Perhaps most important, PACS obviated the need for maddening searches for prior X-rays. Twenty years ago, when a chest X-ray revealed a lung nodule, the first commandment on the radiologist’s report was to “obtain old films.” The rationale: If the nodule had been unchanged for many years, it could safely be ignored—such stability simply wasn’t consistent with a diagnosis of cancer. But searching for old films was often an exercise in frustration: They were lost, or locked up, or at another institution, or in a filing cabinet in the thoracic surgeon’s garage, behind the golf clubs. When my colleagues and I came up empty-handed, which was more often than not, the patient frequently paid the price in the form of an unnecessary biopsy. But PACS made finding old films a breeze (assuming that they were done at the same hospital or had been scanned into the system); they’re usually just a click away.\u003c/p>\n\u003cp>While PACS was widely anticipated and generally accepted by radiologists, some prescient observers worried that computerization might lead to unbidden effects on the field. In 1999, Stephen Baker, chair of the Department of Radiology at New Jersey Medical School, fretted that PACS might turn radiologists into “disembodied functionaries, more akin to servicing technicians than professional colleagues.” Paul Chang, professor of radiology at the University of Chicago and an early leader in digital radiology, describes the day his father, a retired radiologist, took him to task.\u003c/p>\n\u003cp>“Before PACS, we were the doctor’s doctor,” his father berated him. “Medicine and surgery rounds started in radiology. . . . Every morning the clinicians and the radiologists collaborated.”\u003c/p>\n\u003cp>His father’s less-than-endearing nickname for his famous son: “The Man Who Ruined Radiology.”\u003c/p>\n\u003cp>The advantages of PACS are so vast that few would want to turn back the clock. Yet the effects on those of us who order X-rays and the radiologists who read them have been profound, and they’re not all positive. The fact that we can now review our images without trekking down to radiology means that we rarely do make the trip.\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/fHUzVqoDnts'\n title='//www.youtube.com/embed/fHUzVqoDnts'\n allowfullscreen='true'\n style='border:0;'>\u003c/iframe>\n \u003c/span>\n \u003c/span>\u003c/p>\u003cp>\u003cp>\u003cstrong>An Awkward Trip to Radiology\u003c/strong>\u003c/p>\n\u003cp>A few years ago, when I asked my interns and students to visit the radiology department to review the key films, they looked at me as if I had grown a second head. After my team humored me by accompanying me to the radiology department, I conducted a little sociology experiment. Standing outside my hospital’s chest reading room, I delivered a brief speech:\u003c/p>\n\u003caside class=\"pullquote alignright\">'Did you look at the official report?' he hissed. The unspoken message was clear: Get out of my space; I’m busy.\u003c/aside>\n\u003cp>\"Watch what happens when we enter. Does anybody turn around and welcome us, ask, 'How can I help you?' and seem genuinely enthusiastic? When they go over the X-ray, do they delve a layer deeper than what they said in the formal report? Do they make any teaching points? Does the radiologist suggest courses of action or ask provocative questions?\"\u003c/p>\n\u003cp>I did this because I am deeply concerned that mine is the last generation to have learned the habit of going to the radiology department. Nostalgic for my interactions with Wally Miller and his like, it saddens me that our current trainees will never know how much they can learn from a great radiology teacher, and how much their patients’ care can be improved by actually talking to a real live radiologist. Yet I know that even if I bring my young horses to water, whether they visit the radiology department after I am no longer their wrangler will be determined by the quality of their experience.\u003c/p>\n\u003cp>We entered the chest reading room and were greeted by a wall of radiologists’ backs, their faces trained like lasers on the computer screens in front of them. Not a single head—located atop the shoulders of about eight different radiologists—turned to greet us.\u003c/p>\n\u003cp>After a couple of awkward minutes of crescendo throat-clearing, one of the radiologists grudgingly swiveled around to face my team and me. “Oh, do you need something?” he asked.\u003c/p>\n\u003cp>“Sure; can you help us look at a few films?”\u003c/p>\n\u003cp>He did, kind of, but offered his help in a whisper animated mostly by passive aggressiveness.\u003c/p>\n\u003cp>I thought it couldn’t get any worse, but it did.\u003c/p>\n\u003cp>“What do you think of this area?” I asked him, pointing to a confusing patch of whiteness on one patient’s chest CT scan.\u003c/p>\n\u003cp>“Did you look at the official report?” he hissed. (In other words: \"Perhaps you don’t know how to turn on your computer?\")\u003c/p>\n\u003cp>The unspoken message was clear: Get out of my space; I’m busy.\u003c/p>\n\u003cp>Now, I understand that he might well be busy, and that it has to be annoying having clinicians interrupt you every few minutes to go over images, particularly after you’ve just reviewed them with a different set of specialists and dictated a report. But that is the radiologist’s job. Or at least it used to be.\u003c/p>\n\u003cp>Allison Tillack, a young radiologist and a medical anthropologist whose Ph.D. thesis involved observing the world of radiologists for a year at a prominent academic hospital, has explored how the computerization of radiology has transformed the worlds of radiologists and those who use their services.\u003c/p>\n\u003cp>\"The ability of PACS to alter the accessibility and tempo of medical imaging has resulted in visits to the reading room being viewed now by non-radiology clinicians as a ‘waste of time’ and by radiologists as an ‘interruption,’” she wrote.\u003c/p>\n\u003cp>\u003cstrong>In a Funk\u003c/strong>\u003c/p>\n\u003cp>While I was well aware of the changing perceptions of radiology by nonradiologists, I had not, until I met Tillack, appreciated the degree to which the field of radiology is itself in a PACS-fueled funk.\u003c/p>\n\u003cp>After all, the field remains extremely popular among medical students, as many perceive it as offering the perfect blend of “great lifestyle” (that is, banker’s hours and limited overnight call) and high income, which averaged $340,000 in 2013. In fact, it’s often said that today’s medical students are attracted to the “ROAD specialties”: Radiology, Ophthalmology, Anesthesiology, and Dermatology, all of which are lucrative and none of which involves a lot of contact with those pesky sick people. In her research, Tillack found that the vast majority of radiologists and radiology residents identified the lack of direct patient contact as one of the main attractions of the field.\u003c/p>\n\u003cp>Given all these pluses, many frontline clinicians think of radiologists as having “won the game.” Yet I should have gotten a hint of the field’s handwringing in 2005, when I saw the results of a survey of physicians regarding their satisfaction with their chosen specialty. The happiest doctors were radiation oncologists (the folks who deliver radiation therapy to cancer patients), who do satisfying work, earn a good income, and have predictable hours. The least happy were cardiac surgeons, who train forever and, in recent years, have seen much of their business eroded by stents and other nonsurgical approaches to heart disease.\u003c/p>\n\u003cp>Radiologists show up a bit below the mean on the satisfaction scale—just behind the perennially overwhelmed and undercompensated primary care doctors.\u003c/p>\n\u003cp>In a 2012 paper, Tillack and a colleague described “the loneliness of the long distance radiologist.” One radiologist told them, “Before, I knew the face, name, wife’s name, and kids’ names of all the clinicians, but now I don’t know who you are if you joined the medical staff after we got PACS. . . . Before, when a clinician showed up, I could ask them and find out what’s really going on with the patient.”\u003c/p>\n\u003cp>I hear similar stories from every radiologist I meet. Patrick Luetmer, a Mayo Clinic neuroradiologist, described what happened when his MRI suite was remodeled. The suite was originally configured with two MRI “donuts” (the huge magnets that are responsible for the image) on either side of a central workstation in which Luetmer sat. There, he could monitor the scans as they were being performed, and talk to both the patients and the radiology assistants. Clinicians sometimes wandered down to look at the scans with him.\u003c/p>\n\u003cp>A few years ago, as part of a big efficiency push, Mayo decided that a third MRI machine was a better use of that central area than the radiologist’s air traffic control desk. Luetmer’s workstation was moved to an office a few hundred feet away, where he could follow the scans on his computer monitor and communicate with the techs via a special text messaging system.\u003c/p>\n\u003cp>“One day I tried to see if I could go the whole day without speaking to anyone. And that’s what happened—I didn’t speak to a single person. It was incredibly isolating.”\u003c/p>\n\u003cfigure id=\"attachment_264998\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2019/10/radiology2.jpg\">\u003cimg class=\"size-large wp-image-264998\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2019/10/radiology2-1180x953.jpg\" alt=\"1950s-era radiology at the U.S. Naval Hospital, Charleston, South Carolina.\" width=\"640\" height=\"517\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2019/10/radiology2-1180x953.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2019/10/radiology2-400x323.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2019/10/radiology2-743x600.jpg 743w, https://ww2.kqed.org/app/uploads/sites/13/2019/10/radiology2-768x620.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2019/10/radiology2-1920x1550.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2019/10/radiology2-960x775.jpg 960w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">1950s-era radiology at the U.S. Naval Hospital, Charleston, South Carolina. \u003ccite>(National Library of Medicine)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The radiologists were lonely, sure, but their situation involves something far deeper. Hari Tsoukas, an expert in organizational studies at the University of Cyprus, highlights the distinction between “information” and “knowledge.” Information, he wrote, “consists of objectified, decontextualized, time-less, impersonal, value-free representations,” whereas knowledge is “context-dependent, personalized, time-bound, and infused with values.”\u003c/p>\n\u003cp>Adds Tillack, “Hunches, hypotheses, frustrations with patients or their families, second guessing, judging of colleagues, and similar activities that mark how uncertainty is negotiated on a daily basis in medical practice are rarely reflected in the medical record . . . this knowledge can only circulate in private or semi-private contexts—by its very definition, this knowledge cannot be made a matter of public record.”\u003c/p>\n\u003cp>By purging the informal conversations during which such information was exchanged, the emergence of PACS left radiologists information-rich (Think of all those pixels! And old films just a click away!), but knowledge-poor.\u003c/p>\n\u003cp>\u003cstrong>'Great Case. Next Case.'\u003c/strong>\u003c/p>\n\u003cp>Radiologists’ alienation runs deeper than the lack of collegial exchange and the inability to find out what’s really going on with the patients. It’s also about power, status, and expertise. The fact that the traditional film lived only in the radiology reading room gave radiologists a monopoly over their entire ecosystem. PACS, observes Tillack, created a new normal in which “the ‘right’ to see [the image] is no longer mediated by radiologists, as it was in the reading room,” and has thus “eroded radiologists’ claims for authoritative knowledge over the interpretation of medical images.”\u003c/p>\n\u003cp>Once the radiology department no longer housed the films, the impact was immediate and dramatic. Without any changes in policy or very much forethought, the mid-1990s transition to filmless operations at the Baltimore VA hospital led to an 82 percent decrease in in-person consultation rates for general radiology studies. Today, many clinicians—particularly specialists like neurologists, pulmonologists, and surgeons—look at images themselves and act on their own interpretations; Many don’t even bother to read the radiologist’s formal report (which usually takes several hours, sometimes even a day, to reach the chart) unless they have unanswered questions or judge the study to be particularly challenging.\u003c/p>\n\u003cp>PACS was to increase efficiency, but that virtue has also become a curse, as radiologists increasingly feel like Lucy and Ethel on the assembly line of the chocolate factory. Among teleradiologists (radiologists reading x-rays from a distant site, often covering emergency departments at night while the hospital’s own radiologists are sleeping), there’s a well-known adage that captures the relentless objectification of their modern predicament: “Great case. Next case.\" As with so many other aspects of our modern digital lives, PACS sped up the clock, and did so without mercy.\u003c/p>\n\u003cp>That clock is constantly ticking. “Instead of waiting for films to be acquired, printed, sorted, and hung, radiologists now are always playing catch-up, looking at more ‘stuff’ in less time,” observed Tillack. That miraculous access to old films also creates an obligation for the radiologist to actually review them.\u003c/p>\n\u003cp>And it’s not just the old films that need to be examined; PACS makes vast amounts of information available with every study. In the early days of CT, the output of a scan might have been about 12 “slices,” each one representing a ¼-inch section through the thorax or abdomen, akin to a thick slice of deli-cut salami. But today’s ultra-fast CT scanners can produce images of more than 50 slices per inch of the human body, more like ultra-thin cuts of prosciutto. And PACS, with its massive memory bank and blazingly fast transmission speeds,can easily display every slice, which means that the radiologist has to scroll through hundreds of images in order to read a single CT study. This combination of more information in each scan, more old studies to compare, and more time pressure is unremitting.\u003c/p>\n\u003cp>The clock is ticking for other reasons as well. Since the image is available to the ordering clinician the moment it is created, radiologists feel obliged to perform their review quickly lest their reading seem like old news, like an afternoon newspaper in the Age of Twitter. Piling on, after recognizing the efficiency of PACS, insurance companies and Medicare slashed the reimbursement for each interpretation, pushing radiologists to read more films in less time in order to maintain their incomes. Said one radiologist, “With PACS, work is busier now. We have 70 percent more cases to read than 10 years ago. . . . At the end of the day . . . I’m fried.”\u003c/p>\n\u003cp>On top of this, there are even greater threats to radiologists’ livelihoods and happiness. One of them flows from the growing pressure on health care systems to slash their costs. Currently, virtually every X-ray performed at a U.S. hospital is sent for a formal reading by a radiologist, who is paid a fee by an insurance company. In today’s cost-cutting environment, it’s probably only a matter of time before some health care systems permit their frontline specialists to officially read certain films, reserving radiologist “overreads” for those images that the clinicians have questions about or the ones with super-high malpractice risk if they are misread. Radiologists can be counted on to fight such a move by frantically waving the banner of quality, but they will need to demonstrate that the value of having them review every film is worth the considerable expense.\u003c/p>\n\u003cp>Moreover, a major theme of Obama-era health reform is a shift from our historical fee-for-service, piecework payment model to one that dispenses a single payment to a hospital and doctors to manage all the care for a group of patients (“accountable care organizations,” ACOs for short) or a given episode of disease (“bundled payments”). Under such systems, the risk for the cost of care shifts from the insurer to the providers, and it’s up to the latter to decide how to divvy up the cash. Ron Arenson, chairman of the department of radiology at the University of California, San Francisco, sees this as the greatest threat to his field.\u003c/p>\n\u003cp>“If the world moves to bundled payments, we won’t do well,” he said. “We’re not very high in the pecking order.”\u003c/p>\n\u003cp>Some nonradiologists, particularly ER doctors working nights and weekends, have little sympathy for their colleagues’ new predicament. In fact, they have begun to wonder why radiologists should be compensated for next-day readings when they’ve already looked at the images themselves, acted on their interpretations, and assumed the risk of being sued if anything goes wrong. In a 2011 editorial entitled “The Life Cycle of a Parasitic Specialist,” ER physician William Mallon took off the gloves.\u003c/p>\n\u003cblockquote>\u003cp>[On Monday morning] these parasites will commence to feed on the financial juices of the lowly unfortunate emergency physicians, who had to work the entire weekend without radiologic support or backup. . . . The radiologist arrives well rested, café latte in hand, and promptly installs himself in a dark room to re-read and bill for all the films the emergency physicians read over the weekend. . . . Never has a specialty done so little for so many and been paid so much.\u003c/p>\u003c/blockquote>\n\u003cp>Ouch.\u003c/p>\n\u003cp>Another challenge to radiology made possible by the death of film has come in the form of teleradiology. Once X-rays went digital, it was no longer crucial for radiologists to be in the same building as the patient or the treating clinicians. As a result, many multihospital systems consolidated their reading rooms, particularly on weekends and nights, with centralized radiologists supporting multiple sites. Predictably, once the technical challenges of connectivity were solved, teleradiology companies emerged to fill this need. As is often the case with contented “legacy” providers (in health care and other industries), traditional radiologists were only too happy to have their colleagues read their films during off-hours. Who wouldn’t be?\u003c/p>\n\u003cp>The playing field soon expanded across national borders, as radiologists in Zurich, Israel, and Singapore began to read nighttime X-rays for American hospitals during their own local daytimes. Hundreds of hospitals now use these \"nighthawks,\" and everybody seems happy about it, including the domestic radiologists, who are sleeping soundly while the overnight images are read half a world away.\u003c/p>\n\u003cp>But one wonders whether this is the start of so-called disruptive innovation, the concept made famous by Harvard’s Clay Christensen. Disruption often begins with a fat and happy incumbent content to preserve its existing enviable position in a market. In industries ranging from commercial aviation to steel manufacturing, an upstart comes in and grabs an unattractive part of the market (in this case, nights and weekends). But once a low-cost company has squeezed through a crack to capture a slice of a previously locked franchise, it is rarely content to stay put. With the average U.S. radiologist earning about $350,000 per year and the average Indian radiologist earning less than one-tenth of that, one wonders whether the same World-is-Flat forces that have revolutionized other industries but mostly bypassed health care will be unleashed.\u003c/p>\n\u003cp>This is where radiologists’ loss of trust and collegiality with other clinicians may exact its heaviest toll. “Some people see teleradiology as a big threat, but I don’t,” UCSF’s Arenson told me. “I think that relationships with radiologists are important.” I do too, which is why I believe he may have his head in the sand: If physicians don’t get much out of visiting the radiology department or have even forgotten where it is located, we have little reason to fight to keep it in our buildings. Or, for that matter, our country.\u003c/p>\n\u003cp>Like all legacy providers faced with a technological or global workforce threat, radiologists can be counted on to argue that quality would take a huge hit if we outsourced their work to less expensive providers, domestic or foreign. The degree to which the field has accepted nighttime readings from non-U.S. radiologists will, of course, undermine this argument. It’s hard to make the claim that a Bangalore-based teleradiologist is sufficiently competent to read an image for your hospital at 3 a.m., but not at 3 p.m.\u003c/p>\n\u003cp>\u003cstrong>The Ultimate Threat\u003c/strong>\u003c/p>\n\u003cp>Finally, there is the ultimate threat: replacement by the machine. Of course, this issue is marbled throughout health care as we enter the digital age. To date, most claims that “this technology will replace doctors” (in areas ranging from diagnostic reasoning to robotic surgery) have proven to be hype.\u003c/p>\n\u003cp>However, in fields that are primarily about visual pattern recognition, the promise (or, if you’re a radiologist, the threat) is much more real. Studies have shown that computers can detect significant numbers of breast cancers and pulmonary emboli missed by radiologists, although nobody has yet taken the bold step of having the computers completely supplant the humans, partly because there are armadas of malpractice attorneys waiting to pounce, and partly because, at least for now, the combination of human and machine seems to perform better than either alone.\u003c/p>\n\u003cp>But over the long haul, I wouldn’t bet on the humans here, particularly since one of the hottest areas in artificial intelligence research is “deep learning”—research that has created computers that are reasonably skilled at “reading,” “hearing,” and, yes, “seeing.” The same kind of software that now allows Facebook to guess that a certain collection of pixels is a picture of you, or that alerts the casino’s security guards to keep an eye on that guy, is likely to eventually crack the code in radiology, and in similar areas such as dermatology and pathology.\u003c/p>\n\u003cp>Slowly, radiologists are waking up to their peril. Rather than isolating themselves from clinical care, some are now relocating their reading stations in clinical areas, such as the ER and the ICU, to be in the line of sight of their clinician colleagues. Others are resurrecting interdisciplinary conferences and training their staff in customer service. Technological solutions that allow radiologists and frontline clinicians to communicate through PACS and the electronic health record are springing up (through programs that create a mash-up of a Skype-like communication tool and a John Madden–style telestrator).\u003c/p>\n\u003cp>Said Paul Chang, the University of Chicago radiologist whose advocacy of PACS so upset his father, “We have to go beyond isolating ourselves and concentrating on messages in a bottle, where we just write a report and are done with it, but instead fostering collaboration.”\u003c/p>\n\u003cp>Since radiology represents such a large segment of health care expenditures (and also a source of harm through the risk of radiation), some health care systems are even putting radiologists in the position of being gatekeepers to their own technology. It’s a role they might not have accepted in the past, but, faced with an existential threat, many now welcome it. Said David Levin, a radiologist at Thomas Jefferson University, “We have to act more like consulting physicians . . . to look at the appropriateness of the requests for advanced imaging studies . . . rather than just going ahead and doing the study.”\u003c/p>\n\u003cp>Radiology’s experience over the past 15 years offers a crystal ball for the rest of the health care system. The speed with which computerization unleashed a series of forces that completely transformed an established field would be all too familiar to travel agents, journalists, and others who have been run over by the digital bulldozer, but it has shocked many health care observers, even astute ones.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Will the computerization of the rest of medicine similarly upend the lives of other kinds of doctors, as well as their patients? The early returns are in, and the answer is yes.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Synthetic DNA Added to Bacteria Creates New Organism",
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"content": "\u003cp>Scientists have created a stable organism containing DNA most likely never seen before on Earth\u003cb>.\u003c/b>\u003c/p>\n\u003cp>The intention was to create \"organisms with wholly unnatural attributes and traits not found elsewhere in nature,” as one of the researchers put it. With more advances, these organisms could potentially be used in the creation of medicines and industrial biologicals.\u003c/p>\n\u003cp>The development is described in a \u003ca href=\"http://www.pnas.org/content/early/2017/01/17/1616443114\" target=\"_blank\">new study\u003c/a> published in Proceedings of the National Academy of Sciences.\u003c/p>\n\u003cp>\u003cstrong>Synthetic DNA\u003c/strong>\u003c/p>\n\u003cp>The building blocks of DNA, and thus of all life on Earth, are represented by a four-letter \"alphabet.\" Each letter represents one of the compounds that form DNA. The letters—A, T, C and G—are used in different combinations to encode the instructions that govern the development and traits of living organisms.\u003c/p>\n\u003caside class=\"pullquote alignright\">'We can now get the light of life to stay on. That suggests that all of life's processes can be subject to manipulation.'\u003c/aside>\n\u003cp>Just as scrawled graffiti, a Harlequin romance and a Shakespeare play are written using the same alphabet, so too are a virus, a pig and a human being written with the same set of four bases.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>That started to change \u003ca href=\"https://ww2.kqed.org/science/2014/05/19/dna-adding-two-letters-to-lifes-alphabet/\" target=\"_blank\">back in 2014\u003c/a>, when a group of researchers at The Scripps Research Institute synthesized two new letters, then managed to coax E.coli bacteria into accepting them\u003cstrong>. \u003c/strong>While that was a significant achievement, the bacteria was not ideal and suffered from multiple problems including a tendency not to pass the new letters on to the next generation. Since the artificial bases were not stable in the DNA, they were lost over time.\u003c/p>\n\u003cp>\u003cstrong>Back to the Beginning for CRISPR\u003c/strong>\u003c/p>\n\u003cfigure id=\"attachment_325792\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-325792\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/01/CRISPR800a-800x533.jpg\" alt=\"Back to basics for CRISPR/Cas9.\" width=\"800\" height=\"533\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/01/CRISPR800a.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/CRISPR800a-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/CRISPR800a-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/CRISPR800a-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/CRISPR800a-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/CRISPR800a-520x346.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Back to basics for CRISPR/Cas9. \u003ccite>(Wikipedia)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>One of the ways these researchers managed to get the bacteria to hold on to these new letters was by using one of the biggest things to hit biology in the last few years—the \u003ca href=\"http://genetics.thetech.org/ask-a-geneticist/why-crispr-revolutionary-and-how-it-works\">gene-editing system CRISPR/Cas9\u003c/a>. This tool provides a way to precisely change the DNA of a living thing. It has already revolutionized science in the lab and may one day revolutionize human health as well.\u003c/p>\n\u003cp>CRISPR/Cas9 has a very humble origin—it works as an immune system for bacteria. It essentially looks for a certain set of bases found in an invading virus's DNA and cuts the viral DNA at that spot. This destroys the virus.\u003c/p>\n\u003cp>In creating their new organism, the researchers have taken CRISPR/Cas9 back to its original use. But instead of cutting the DNA of invading viruses, CRISPR/Cas9 now cuts the bacterial DNA, which kills the bacteria. Sounds self-defeating, except that it only does this if the bacteria has lost its new letters.\u003c/p>\n\u003cp>That means the bacteria that pass on the new letters thrive and continue to divide, while the letter-losing bacteria are wiped out. Now, generation after generation, only bacteria with the new bases are produced.\u003c/p>\n\u003cp>Of course this wouldn’t be all that efficient if the majority of bacteria lost the artificial bases and so died--there wouldn't be enough bacteria to do anything with.\u003c/p>\n\u003cfigure id=\"attachment_325790\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003cimg class=\"size-full wp-image-325790\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/01/DNaM-skeletal.png\" alt=\"Say hello to dNaM, one of DNA's first new letters in 3.5 billion years or so. \" width=\"400\" height=\"436\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/01/DNaM-skeletal.png 400w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/DNaM-skeletal-160x174.png 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/DNaM-skeletal-240x262.png 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/DNaM-skeletal-375x409.png 375w\" sizes=\"(max-width: 400px) 100vw, 400px\">\u003cfigcaption class=\"wp-caption-text\">Say hello to dNaM, one of DNA's first new letters in 3.5 billion years or so. \u003ccite>(Wikipedia)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>To make it more likely that the bacteria hold onto their new bases, these researchers also chemically modified one of the bases to something the bacteria liked better. Now the bacteria are more likely to keep these bases, but if they do lose them, they are eliminated from the population. Such an elegant solution!\u003c/p>\n\u003cp>Though the bacteria has successfully incorporated the new letters, it is not actually using them, because the cellular machinery can’t decipher what the letters mean.\u003c/p>\n\u003cp>Scientists hope that won't always be the case. They intend on tweaking the bacteria so they can make sense of the new letters. Then the new organisms could be crafted into something useful. Down the line, researchers could also figure out how to expand the alphabet of more complex organisms.\u003c/p>\n\u003cp>Even if the bacteria the researchers experimented on isn’t yet ready for primetime, it is very cool in that it probably does things that life on Earth has never done before. Which is still a marvel for all science lovers out there.\u003c/p>\n\u003cp>Said one of the scientists, in a statement:\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"We can now get the light of life to stay on. That suggests that all of life's processes can be subject to manipulation.\"\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Scientists have created a stable organism containing DNA most likely never seen before on Earth\u003cb>.\u003c/b>\u003c/p>\n\u003cp>The intention was to create \"organisms with wholly unnatural attributes and traits not found elsewhere in nature,” as one of the researchers put it. With more advances, these organisms could potentially be used in the creation of medicines and industrial biologicals.\u003c/p>\n\u003cp>The development is described in a \u003ca href=\"http://www.pnas.org/content/early/2017/01/17/1616443114\" target=\"_blank\">new study\u003c/a> published in Proceedings of the National Academy of Sciences.\u003c/p>\n\u003cp>\u003cstrong>Synthetic DNA\u003c/strong>\u003c/p>\n\u003cp>The building blocks of DNA, and thus of all life on Earth, are represented by a four-letter \"alphabet.\" Each letter represents one of the compounds that form DNA. The letters—A, T, C and G—are used in different combinations to encode the instructions that govern the development and traits of living organisms.\u003c/p>\n\u003caside class=\"pullquote alignright\">'We can now get the light of life to stay on. That suggests that all of life's processes can be subject to manipulation.'\u003c/aside>\n\u003cp>Just as scrawled graffiti, a Harlequin romance and a Shakespeare play are written using the same alphabet, so too are a virus, a pig and a human being written with the same set of four bases.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>That started to change \u003ca href=\"https://ww2.kqed.org/science/2014/05/19/dna-adding-two-letters-to-lifes-alphabet/\" target=\"_blank\">back in 2014\u003c/a>, when a group of researchers at The Scripps Research Institute synthesized two new letters, then managed to coax E.coli bacteria into accepting them\u003cstrong>. \u003c/strong>While that was a significant achievement, the bacteria was not ideal and suffered from multiple problems including a tendency not to pass the new letters on to the next generation. Since the artificial bases were not stable in the DNA, they were lost over time.\u003c/p>\n\u003cp>\u003cstrong>Back to the Beginning for CRISPR\u003c/strong>\u003c/p>\n\u003cfigure id=\"attachment_325792\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-325792\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/01/CRISPR800a-800x533.jpg\" alt=\"Back to basics for CRISPR/Cas9.\" width=\"800\" height=\"533\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/01/CRISPR800a.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/CRISPR800a-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/CRISPR800a-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/CRISPR800a-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/CRISPR800a-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/CRISPR800a-520x346.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Back to basics for CRISPR/Cas9. \u003ccite>(Wikipedia)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>One of the ways these researchers managed to get the bacteria to hold on to these new letters was by using one of the biggest things to hit biology in the last few years—the \u003ca href=\"http://genetics.thetech.org/ask-a-geneticist/why-crispr-revolutionary-and-how-it-works\">gene-editing system CRISPR/Cas9\u003c/a>. This tool provides a way to precisely change the DNA of a living thing. It has already revolutionized science in the lab and may one day revolutionize human health as well.\u003c/p>\n\u003cp>CRISPR/Cas9 has a very humble origin—it works as an immune system for bacteria. It essentially looks for a certain set of bases found in an invading virus's DNA and cuts the viral DNA at that spot. This destroys the virus.\u003c/p>\n\u003cp>In creating their new organism, the researchers have taken CRISPR/Cas9 back to its original use. But instead of cutting the DNA of invading viruses, CRISPR/Cas9 now cuts the bacterial DNA, which kills the bacteria. Sounds self-defeating, except that it only does this if the bacteria has lost its new letters.\u003c/p>\n\u003cp>That means the bacteria that pass on the new letters thrive and continue to divide, while the letter-losing bacteria are wiped out. Now, generation after generation, only bacteria with the new bases are produced.\u003c/p>\n\u003cp>Of course this wouldn’t be all that efficient if the majority of bacteria lost the artificial bases and so died--there wouldn't be enough bacteria to do anything with.\u003c/p>\n\u003cfigure id=\"attachment_325790\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003cimg class=\"size-full wp-image-325790\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/01/DNaM-skeletal.png\" alt=\"Say hello to dNaM, one of DNA's first new letters in 3.5 billion years or so. \" width=\"400\" height=\"436\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/01/DNaM-skeletal.png 400w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/DNaM-skeletal-160x174.png 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/DNaM-skeletal-240x262.png 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/DNaM-skeletal-375x409.png 375w\" sizes=\"(max-width: 400px) 100vw, 400px\">\u003cfigcaption class=\"wp-caption-text\">Say hello to dNaM, one of DNA's first new letters in 3.5 billion years or so. \u003ccite>(Wikipedia)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>To make it more likely that the bacteria hold onto their new bases, these researchers also chemically modified one of the bases to something the bacteria liked better. Now the bacteria are more likely to keep these bases, but if they do lose them, they are eliminated from the population. Such an elegant solution!\u003c/p>\n\u003cp>Though the bacteria has successfully incorporated the new letters, it is not actually using them, because the cellular machinery can’t decipher what the letters mean.\u003c/p>\n\u003cp>Scientists hope that won't always be the case. They intend on tweaking the bacteria so they can make sense of the new letters. Then the new organisms could be crafted into something useful. Down the line, researchers could also figure out how to expand the alphabet of more complex organisms.\u003c/p>\n\u003cp>Even if the bacteria the researchers experimented on isn’t yet ready for primetime, it is very cool in that it probably does things that life on Earth has never done before. Which is still a marvel for all science lovers out there.\u003c/p>\n\u003cp>Said one of the scientists, in a statement:\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"We can now get the light of life to stay on. That suggests that all of life's processes can be subject to manipulation.\"\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Ezekiel Emanuel is one of the architects of the Affordable Care Act, aka Obamacare, aka \u003ca href=\"http://www.npr.org/sections/thetwo-way/2017/01/17/510281627/18-million-people-could-lose-insurance-in-first-year-after-partial-obamacare-rep\" target=\"_blank\" rel=\"noopener\">dead-plan-walking\u003c/a>.\u003c/p>\n\u003cp>He's also a \"techno-skeptic,\" as he called himself the other day during an \u003ca href=\"http://audio.californiareport.org/archive/R201701170850/b\" target=\"_blank\" rel=\"noopener\">interview\u003c/a> with KQED health editor Carrie Feibel. When Feibel asked him if there should be any role to play for the \"data gurus of Silicon Valley\" in whatever comes after the ACA, he literally laughed.\u003c/p>\n\u003caside class=\"pullquote alignright\">'I do think there is an important role for tech, but I think the role is probably not what many of the startup companies around here are thinking of.'\u003ccite>Ezekiel Emanuel\u003c/cite>\u003c/aside>\n\u003cp>\"I do think there is an important role for tech, but I think the role is probably not what many of the startup companies around here are thinking of,\" he said, \"around here\" meaning San Francisco and Silicon Valley. Emanuel said tech should play a support role that \"augments\" what health care providers do, providing better data about the patient and where health care funds are spent.\u003c/p>\n\u003cp>\"I am much more skeptical that the computer is going to replace a doctor,\" he said. \"That a computer is going to interface with the patient and take care of them. Not gonna happen.\" (See our posts \"\u003ca href=\"https://ww2.kqed.org/futureofyou/2016/11/07/AI-computers-diagnosis-watson/\" target=\"_blank\" rel=\"noopener\">Will Computers Ever Be as Good as Physicians at Diagnosing Patients\u003c/a>\" and \"\u003ca href=\"https://ww2.kqed.org/futureofyou/2016/02/03/virtual_care_clinic_usc/\" target=\"_blank\" rel=\"noopener\">Would You See a Holographic Doctor?\" \u003c/a>for high hopes surrounding digital docs.)\u003c/p>\n\u003cp>Emanuel said he's also not big on efforts to achieve continuous patient monitoring for health indicators like glucose level and blood pressure. He cited the \u003ca href=\"https://ww2.kqed.org/futureofyou/2016/10/10/fitbit-study/\" target=\"_blank\" rel=\"noopener\">failure of Fitbits and other wearable tech\u003c/a> to improve health outcomes in research studies.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"It’s not that we don’t have information,\" he said. \"The problem is what do you do once you have the information. And there, tech is not going to be the key thing. Medicine fundamentally is about human interaction. That is really the most important challenge, and I don’t think the tech sector has locked onto that part of it.\"\u003c/p>\n\u003cp>This sort of digital contrarianism is not unheard of in the health care biz, even at events and panels where tech-oriented medicine is the focus. Last September, for instance, at the Stanford Medicine X conference, Stephen Downs, the chief technical officer at the Robert Wood Johnson Foundation, said digital health companies\u003ca href=\"https://ww2.kqed.org/futureofyou/2016/09/29/analysis-digital-health-companies-arent-solving-the-right-problems/\" target=\"_blank\" rel=\"noopener\"> weren't focused on solving the right problems\u003c/a>. From a report by KQED's Lesley McClurg:\u003c/p>\n\u003cblockquote>\u003cp>In this age of the Fitbit, Downs said, digital health companies are focused on monitoring the consequences of our \u003ca href=\"http://stateofobesity.org/physical-inactivity/\" target=\"_blank\" rel=\"noopener\">notoriously sedentary lifestyles. \u003c/a>But what is really called for from innovators is to stop treating symptoms and start remedying the roots of the problem.\u003c/p>\n\u003cp>“The system needs to be re-engineered,” said Downs. ... “We don’t need an app that counts steps, because that really just tells you that your day doesn’t naturally incorporate the time and space to walk.”\u003c/p>\u003c/blockquote>\n\u003cp>Instead of a focus on monitoring, he said, engineers and designers need to incorporate solutions --such as enabling urban farming --to core health problems like obesity and heart disease. \u003cstrong>\u003cbr>\n\u003c/strong>\u003c/p>\n\u003cp>\u003cstrong>Policy Versus Scientific Advances\u003c/strong>\u003c/p>\n\u003cp>Several times now at conferences I've witnessed one expert or another--in the midst of a coterie of big data boosters and monitoring mavens, no less--offer up a kind of indirect scolding by cautioning that the best way to improve health is not via smartphones, but smart policy.\u003c/p>\n\u003cp>That dichotomy to some degree echoes a conversation I once had with a longtime health journalist who thought even something as institutionally sanctioned and evidence-based as \u003ca href=\"https://ww2.kqed.org/futureofyou/2017/01/20/time-running-out-california-stem-cell-agency-yet-to-produce-big-results/\" target=\"_blank\" rel=\"noopener\">California's stem cell initiative\u003c/a> was a waste of money, because the funds would have been better directed toward policy prescriptions that address basic health needs.\u003c/p>\n\u003cp>I asked Emanuel to comment on this point, specifically mentioning stem cells.\u003c/p>\n\u003cp>\"Here's a thought experiment,\" he said. \"You know how many lives stem cells have saved? A tiny number compared to the 2.7 million people [in the U.S.] who die each year.\u003c/p>\n\u003cp>\"Now, how many lives have been saved by the ACA?\" he said. \"I don’t know, but it ain’t zero. I intersect with people all the time who happen to recognize me on the street and say I or a family friend got diagnosed with cancer and got therapy or got a heart transplant or something like that.\u003c/p>\n\u003cp>\"In the future, even under a rosy projection, stem cells will not save tons of people,\" he said. \"If you were to cure every single cancer in the U.S.-- no one in America ever dies again of cancer--we add three years to the average life expectancy. It’s a big improvement but it is not anything close to [gains achieved by] doing the basics.\"\u003c/p>\n\u003cp>The two most effective goals for increasing longevity, he said, would be to reduce smoking even further and to control blood pressure.\u003c/p>\n\u003cp>\"We’re not talking high tech,\" he said. \"There is nothing you can do that is going to come close to those two interventions.\"\u003c/p>\n\u003cp>Of course, medical value depends on your perspective, and Emanuel's is a public health view. Someone suffering from any number of horrendous diseases that stem cell research is targeting is not going to be thinking: \"Boy, what a waste to be chasing stem cell cures. I sure wish they'd divert that money to anti-smoking programs.\"\u003c/p>\n\u003cp>And even on the health tech front, some doctors have come around to viewing digital monitoring devices like \u003ca href=\"https://ww2.kqed.org/futureofyou/2016/03/17/mobile-ekg-on-a-watchband-is-useful-for-some-say-docs/\" target=\"_blank\" rel=\"noopener\">mobile EKGs\u003c/a> as useful.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>As for computers versus doctors, physician and author Bob Wachter, has written that radiology may be the \u003ca href=\"https://ww2.kqed.org/futureofyou/2016/10/25/technology-radiology/\" target=\"_blank\" rel=\"noopener\">canary in the coal mine\u003c/a> in terms of algorithms replacing humans.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Ezekiel Emanuel is one of the architects of the Affordable Care Act, aka Obamacare, aka \u003ca href=\"http://www.npr.org/sections/thetwo-way/2017/01/17/510281627/18-million-people-could-lose-insurance-in-first-year-after-partial-obamacare-rep\" target=\"_blank\" rel=\"noopener\">dead-plan-walking\u003c/a>.\u003c/p>\n\u003cp>He's also a \"techno-skeptic,\" as he called himself the other day during an \u003ca href=\"http://audio.californiareport.org/archive/R201701170850/b\" target=\"_blank\" rel=\"noopener\">interview\u003c/a> with KQED health editor Carrie Feibel. When Feibel asked him if there should be any role to play for the \"data gurus of Silicon Valley\" in whatever comes after the ACA, he literally laughed.\u003c/p>\n\u003caside class=\"pullquote alignright\">'I do think there is an important role for tech, but I think the role is probably not what many of the startup companies around here are thinking of.'\u003ccite>Ezekiel Emanuel\u003c/cite>\u003c/aside>\n\u003cp>\"I do think there is an important role for tech, but I think the role is probably not what many of the startup companies around here are thinking of,\" he said, \"around here\" meaning San Francisco and Silicon Valley. Emanuel said tech should play a support role that \"augments\" what health care providers do, providing better data about the patient and where health care funds are spent.\u003c/p>\n\u003cp>\"I am much more skeptical that the computer is going to replace a doctor,\" he said. \"That a computer is going to interface with the patient and take care of them. Not gonna happen.\" (See our posts \"\u003ca href=\"https://ww2.kqed.org/futureofyou/2016/11/07/AI-computers-diagnosis-watson/\" target=\"_blank\" rel=\"noopener\">Will Computers Ever Be as Good as Physicians at Diagnosing Patients\u003c/a>\" and \"\u003ca href=\"https://ww2.kqed.org/futureofyou/2016/02/03/virtual_care_clinic_usc/\" target=\"_blank\" rel=\"noopener\">Would You See a Holographic Doctor?\" \u003c/a>for high hopes surrounding digital docs.)\u003c/p>\n\u003cp>Emanuel said he's also not big on efforts to achieve continuous patient monitoring for health indicators like glucose level and blood pressure. He cited the \u003ca href=\"https://ww2.kqed.org/futureofyou/2016/10/10/fitbit-study/\" target=\"_blank\" rel=\"noopener\">failure of Fitbits and other wearable tech\u003c/a> to improve health outcomes in research studies.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"It’s not that we don’t have information,\" he said. \"The problem is what do you do once you have the information. And there, tech is not going to be the key thing. Medicine fundamentally is about human interaction. That is really the most important challenge, and I don’t think the tech sector has locked onto that part of it.\"\u003c/p>\n\u003cp>This sort of digital contrarianism is not unheard of in the health care biz, even at events and panels where tech-oriented medicine is the focus. Last September, for instance, at the Stanford Medicine X conference, Stephen Downs, the chief technical officer at the Robert Wood Johnson Foundation, said digital health companies\u003ca href=\"https://ww2.kqed.org/futureofyou/2016/09/29/analysis-digital-health-companies-arent-solving-the-right-problems/\" target=\"_blank\" rel=\"noopener\"> weren't focused on solving the right problems\u003c/a>. From a report by KQED's Lesley McClurg:\u003c/p>\n\u003cblockquote>\u003cp>In this age of the Fitbit, Downs said, digital health companies are focused on monitoring the consequences of our \u003ca href=\"http://stateofobesity.org/physical-inactivity/\" target=\"_blank\" rel=\"noopener\">notoriously sedentary lifestyles. \u003c/a>But what is really called for from innovators is to stop treating symptoms and start remedying the roots of the problem.\u003c/p>\n\u003cp>“The system needs to be re-engineered,” said Downs. ... “We don’t need an app that counts steps, because that really just tells you that your day doesn’t naturally incorporate the time and space to walk.”\u003c/p>\u003c/blockquote>\n\u003cp>Instead of a focus on monitoring, he said, engineers and designers need to incorporate solutions --such as enabling urban farming --to core health problems like obesity and heart disease. \u003cstrong>\u003cbr>\n\u003c/strong>\u003c/p>\n\u003cp>\u003cstrong>Policy Versus Scientific Advances\u003c/strong>\u003c/p>\n\u003cp>Several times now at conferences I've witnessed one expert or another--in the midst of a coterie of big data boosters and monitoring mavens, no less--offer up a kind of indirect scolding by cautioning that the best way to improve health is not via smartphones, but smart policy.\u003c/p>\n\u003cp>That dichotomy to some degree echoes a conversation I once had with a longtime health journalist who thought even something as institutionally sanctioned and evidence-based as \u003ca href=\"https://ww2.kqed.org/futureofyou/2017/01/20/time-running-out-california-stem-cell-agency-yet-to-produce-big-results/\" target=\"_blank\" rel=\"noopener\">California's stem cell initiative\u003c/a> was a waste of money, because the funds would have been better directed toward policy prescriptions that address basic health needs.\u003c/p>\n\u003cp>I asked Emanuel to comment on this point, specifically mentioning stem cells.\u003c/p>\n\u003cp>\"Here's a thought experiment,\" he said. \"You know how many lives stem cells have saved? A tiny number compared to the 2.7 million people [in the U.S.] who die each year.\u003c/p>\n\u003cp>\"Now, how many lives have been saved by the ACA?\" he said. \"I don’t know, but it ain’t zero. I intersect with people all the time who happen to recognize me on the street and say I or a family friend got diagnosed with cancer and got therapy or got a heart transplant or something like that.\u003c/p>\n\u003cp>\"In the future, even under a rosy projection, stem cells will not save tons of people,\" he said. \"If you were to cure every single cancer in the U.S.-- no one in America ever dies again of cancer--we add three years to the average life expectancy. It’s a big improvement but it is not anything close to [gains achieved by] doing the basics.\"\u003c/p>\n\u003cp>The two most effective goals for increasing longevity, he said, would be to reduce smoking even further and to control blood pressure.\u003c/p>\n\u003cp>\"We’re not talking high tech,\" he said. \"There is nothing you can do that is going to come close to those two interventions.\"\u003c/p>\n\u003cp>Of course, medical value depends on your perspective, and Emanuel's is a public health view. Someone suffering from any number of horrendous diseases that stem cell research is targeting is not going to be thinking: \"Boy, what a waste to be chasing stem cell cures. I sure wish they'd divert that money to anti-smoking programs.\"\u003c/p>\n\u003cp>And even on the health tech front, some doctors have come around to viewing digital monitoring devices like \u003ca href=\"https://ww2.kqed.org/futureofyou/2016/03/17/mobile-ekg-on-a-watchband-is-useful-for-some-say-docs/\" target=\"_blank\" rel=\"noopener\">mobile EKGs\u003c/a> as useful.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>As for computers versus doctors, physician and author Bob Wachter, has written that radiology may be the \u003ca href=\"https://ww2.kqed.org/futureofyou/2016/10/25/technology-radiology/\" target=\"_blank\" rel=\"noopener\">canary in the coal mine\u003c/a> in terms of algorithms replacing humans.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>It can be difficult to know what to say when a friend is struggling. The conversation is hard to even start. Maya Cohen, a first-year student at Tulane University, says she knows better how to intervene after playing a video game created to help people learn how to recognize signs of psychological distress like depression, anxiety and substance abuse, and get them professional help.\u003c/p>\n\u003cp>Like all incoming students at Tulane, Cohen had to participate in an online conversation simulation game titled \"At-Risk For College Students.\" The purpose is to teach empathetic conversation skills. In the game, you play Jesse, a friend of Travis, a depressed young man who's been failing his classes. Jesse notices that Travis hasn't been the same lately, and goes to his apartment to see how he's doing.\u003c/p>\n\u003cp>Checking in is the kind of supportive effort that friends ideally do for one another, and the game is supposed to encourage more of that. We hear out each other's burdens. Friends are the first bulwark of support when times are a little rough or when something's deeply wrong. We might pride ourselves on the advice we give, the shoulders we offer, the general \"being there\" for our friends.\u003c/p>\n\u003cp>But our skill at doing that varies, says \u003ca href=\"http://www.baruch.cuny.edu/wsas/academics/psychology/galbright.htm\">Glenn Albright\u003c/a>, a psychologist at Baruch College at the City University of New York and cofounder of \u003ca href=\"http://www.kognito.com\">Kognito\u003c/a>, the company that developed the game. \"It's the sad reality that a lot of people don't know how to help people,\" he says. \"How to identify those who are struggling, to approach them, talk to them and give them a level of comfort.\"\u003c/p>\n\u003caside class=\"pullquote alignright\">Checking in is the kind of supportive effort that friends ideally do for one another, and the game is supposed to encourage more of that.\u003c/aside>\n\u003cp>Albright thought that the right conversational training program could help people help those around them. \"You're talking about 40 percent of college students reporting systems of depression where they say it's interfering with their functioning,\" Albright says. Kognito's first simulation, released in 2009, focused on faculty-student conversations. The company has since developed over a dozen simulations.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Many focus on peer conversations, like the game that Cohen played; others address patient-doctor or family interactions. At the end of the conversation, participants get examples of how to sensitively suggest mental health services. In simulations for medical professionals, that might mean managing care collaboratively with other health professionals.\u003c/p>\n\u003cp>Kognito grounds all of these simulations in psychological counseling methods such as motivational interviewing, which stresses conversation techniques like using open-ended questions and listening and reflecting on what someone says during a conversation.\u003c/p>\n\u003cp>\"[This] is really trying to engage the other person in dialogue, understand what's happening and what's influencing their behavior,\" says \u003ca href=\"https://sph.uth.edu/faculty/\">Marlyn Allicock\u003c/a>, a health behaviorist at the University of Texas in Dallas who is not involved with Kognito. \"Those skills are really grounded in empathy.\"\u003c/p>\n\u003cp>In the game that Cohen played, when Jesse relates to the things his friend is saying, Travis responds much more warmly. If Jesse is brusque during the conversation, Travis clams up. \"They've done a really nice job modeling a person's behavior,\" Allicock says.\u003c/p>\n\u003cp>The games also shows things that might push people apart, Allicock notes. Giving unwarranted advice, for example, might give the impression that you think you know better than your friend. \"Those are things that push people away,\" Allicock says. \"I'm not going to open up to you if you're saying, 'You're not doing this right.' \"\u003c/p>\n\u003cp>Cohen says she didn't realize any of this until she started playing through the Kognito simulation. \"A speech bubble came up with tips,\" she says. One says using \"I\" statements is good, but not when a judgment is attached. That reminded Cohen that when a friend of hers would complain about something, Cohen would make a judgment. \"I would approach her and be like, 'I think you're overreacting,' \" she says.\u003c/p>\n\u003cp>Cohen, 19, says she kept thinking back to one time last year when she feels she really should have talked to her friend. She got a screenshot of text messages that her friend Angie had sent to her boyfriend. We aren't using her last name to protect her privacy. The reason will become clear later in this story. \"[Angie] was texting her boyfriend saying, 'I feel none of my friends care about me. Would anybody even notice if I was gone?' \" Cohen says. She was worried, and wanted to ask Angie about it. \"I just didn't know how to start that conversation. And once I did I wouldn't know how to continue it.\"\u003c/p>\n\u003cp>Instead, Cohen brought the text to her school counselor, who pulled Angie out of class. \"At the time I was really mad because I was like, so depressed, and now you're making my life harder,\" Angie says now. \"They added this entire like new situation.\"\u003c/p>\n\u003cp>Angie, 18, says that at the time she was considering killing herself. The counselor's intervention got her the help she needed, but the fact that none of her friends tried talking to her first made her upset. Cohen feels like it put a strain on their relationship, even after they made amends. \"We could never go back to how we were before,\" Cohen says.\u003c/p>\n\u003cp>After the Kognito training, Cohen says she'd been thinking a lot about how she could have handled the situation better. At the very least, she says, she could have gone to Angie first to check in on her, talk to her and find a way to get her help, but with her consent. \"That would have been more inclusive of Angie,\" Cohen says.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Angus Chen is a freelance writer based in New York. Find him on Twitter \u003ca href=\"https://twitter.com/angrchen\">@angrchen\u003c/a>.\u003c/em>\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=Can+An+Online+Game+Help+You+Learn+To+Help+Struggling+Friends%3F+&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>It can be difficult to know what to say when a friend is struggling. The conversation is hard to even start. Maya Cohen, a first-year student at Tulane University, says she knows better how to intervene after playing a video game created to help people learn how to recognize signs of psychological distress like depression, anxiety and substance abuse, and get them professional help.\u003c/p>\n\u003cp>Like all incoming students at Tulane, Cohen had to participate in an online conversation simulation game titled \"At-Risk For College Students.\" The purpose is to teach empathetic conversation skills. In the game, you play Jesse, a friend of Travis, a depressed young man who's been failing his classes. Jesse notices that Travis hasn't been the same lately, and goes to his apartment to see how he's doing.\u003c/p>\n\u003cp>Checking in is the kind of supportive effort that friends ideally do for one another, and the game is supposed to encourage more of that. We hear out each other's burdens. Friends are the first bulwark of support when times are a little rough or when something's deeply wrong. We might pride ourselves on the advice we give, the shoulders we offer, the general \"being there\" for our friends.\u003c/p>\n\u003cp>But our skill at doing that varies, says \u003ca href=\"http://www.baruch.cuny.edu/wsas/academics/psychology/galbright.htm\">Glenn Albright\u003c/a>, a psychologist at Baruch College at the City University of New York and cofounder of \u003ca href=\"http://www.kognito.com\">Kognito\u003c/a>, the company that developed the game. \"It's the sad reality that a lot of people don't know how to help people,\" he says. \"How to identify those who are struggling, to approach them, talk to them and give them a level of comfort.\"\u003c/p>\n\u003caside class=\"pullquote alignright\">Checking in is the kind of supportive effort that friends ideally do for one another, and the game is supposed to encourage more of that.\u003c/aside>\n\u003cp>Albright thought that the right conversational training program could help people help those around them. \"You're talking about 40 percent of college students reporting systems of depression where they say it's interfering with their functioning,\" Albright says. Kognito's first simulation, released in 2009, focused on faculty-student conversations. The company has since developed over a dozen simulations.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Many focus on peer conversations, like the game that Cohen played; others address patient-doctor or family interactions. At the end of the conversation, participants get examples of how to sensitively suggest mental health services. In simulations for medical professionals, that might mean managing care collaboratively with other health professionals.\u003c/p>\n\u003cp>Kognito grounds all of these simulations in psychological counseling methods such as motivational interviewing, which stresses conversation techniques like using open-ended questions and listening and reflecting on what someone says during a conversation.\u003c/p>\n\u003cp>\"[This] is really trying to engage the other person in dialogue, understand what's happening and what's influencing their behavior,\" says \u003ca href=\"https://sph.uth.edu/faculty/\">Marlyn Allicock\u003c/a>, a health behaviorist at the University of Texas in Dallas who is not involved with Kognito. \"Those skills are really grounded in empathy.\"\u003c/p>\n\u003cp>In the game that Cohen played, when Jesse relates to the things his friend is saying, Travis responds much more warmly. If Jesse is brusque during the conversation, Travis clams up. \"They've done a really nice job modeling a person's behavior,\" Allicock says.\u003c/p>\n\u003cp>The games also shows things that might push people apart, Allicock notes. Giving unwarranted advice, for example, might give the impression that you think you know better than your friend. \"Those are things that push people away,\" Allicock says. \"I'm not going to open up to you if you're saying, 'You're not doing this right.' \"\u003c/p>\n\u003cp>Cohen says she didn't realize any of this until she started playing through the Kognito simulation. \"A speech bubble came up with tips,\" she says. One says using \"I\" statements is good, but not when a judgment is attached. That reminded Cohen that when a friend of hers would complain about something, Cohen would make a judgment. \"I would approach her and be like, 'I think you're overreacting,' \" she says.\u003c/p>\n\u003cp>Cohen, 19, says she kept thinking back to one time last year when she feels she really should have talked to her friend. She got a screenshot of text messages that her friend Angie had sent to her boyfriend. We aren't using her last name to protect her privacy. The reason will become clear later in this story. \"[Angie] was texting her boyfriend saying, 'I feel none of my friends care about me. Would anybody even notice if I was gone?' \" Cohen says. She was worried, and wanted to ask Angie about it. \"I just didn't know how to start that conversation. And once I did I wouldn't know how to continue it.\"\u003c/p>\n\u003cp>Instead, Cohen brought the text to her school counselor, who pulled Angie out of class. \"At the time I was really mad because I was like, so depressed, and now you're making my life harder,\" Angie says now. \"They added this entire like new situation.\"\u003c/p>\n\u003cp>Angie, 18, says that at the time she was considering killing herself. The counselor's intervention got her the help she needed, but the fact that none of her friends tried talking to her first made her upset. Cohen feels like it put a strain on their relationship, even after they made amends. \"We could never go back to how we were before,\" Cohen says.\u003c/p>\n\u003cp>After the Kognito training, Cohen says she'd been thinking a lot about how she could have handled the situation better. At the very least, she says, she could have gone to Angie first to check in on her, talk to her and find a way to get her help, but with her consent. \"That would have been more inclusive of Angie,\" Cohen says.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Angus Chen is a freelance writer based in New York. Find him on Twitter \u003ca href=\"https://twitter.com/angrchen\">@angrchen\u003c/a>.\u003c/em>\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=Can+An+Online+Game+Help+You+Learn+To+Help+Struggling+Friends%3F+&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Time Running Out, California Stem Cell Agency Yet to Produce Big Results",
"title": "Time Running Out, California Stem Cell Agency Yet to Produce Big Results",
"headTitle": "KQED Future of You | KQED Science",
"content": "\u003cp>It’s been more than a decade since California launched an unprecedented experiment in medical research by direct democracy, when voters created a $3 billion fund to kick-start the hunt for stem cell therapies.\u003c/p>\n\u003cp>The bold plan, a response to federal funding limits for embryonic stem cell research, was sold with a simple pitch: The money would rapidly yield cures for devastating human diseases such as Parkinson’s and ALS.\u003c/p>\n\u003cp>That hasn’t happened.\u003c/p>\n\u003cp>[contextly_sidebar id=\"wiA2OMIATARmkALimTVF9L5bJoRR3eQd\"]A major reason, a STAT examination found, is that the \u003ca href=\"https://www.cirm.ca.gov/\" target=\"_blank\">California Institute for Regenerative Medicine\u003c/a> has been slow to move promising experimental therapies into clinical trials. The National Institutes of Health has supported three and a half times as many human trials of stem cell therapies, dollar for dollar, as the California agency has funded since it started making grants in 2006. Just two of its clinical trials have been completed.\u003c/p>\n\u003cp>“I am floored by the disparity,” said Jim Lott, a health care consultant and member of the state board that monitors the agency, known as CIRM. If the numbers are correct, he told STAT, “that doesn’t settle well with me as a voter. That doesn’t settle well with me as a taxpayer. That doesn’t settle well with me as a member of the oversight committee.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>CIRM has used most of the $2.2 billion in grants it has distributed so far to build labs and pay for basic research at public and private universities, such as Stanford and the University of Southern California, and private companies.\u003c/p>\n\u003cp>It has given more than $300 million to 27 projects that include clinical trials — though much of that funding also supported preclinical work. Meanwhile, the agency has committed about $540 million to new labs and buildings.\u003c/p>\n\u003cp>In part, that’s because its directors chose to focus on infrastructure early on, as well as bench experiments and animal studies given that the biology of embryonic stem cells was not well-understood and there are formidable roadblocks to moving into human studies. Much more is known about the bone marrow stem cells that are the focus of many NIH-funded clinical trials.\u003c/p>\n\u003cp>But critics have noted that many top grantees come from institutions that hold seats on CIRM’s governing board. The respected Institute of Medicine, in a 2013 \u003ca href=\"https://www.nap.edu/catalog/13523/the-california-institute-for-regenerative-medicine-science-governance-and-the\" target=\"_blank\">review\u003c/a>, said institutionalized conflicts of interest have raised questions about “the integrity and independence of some of CIRM’s decisions.” CIRM later enacted reforms that barred board members from voting directly on grants for their institutions. But the changes didn’t prevent other financial \u003ca href=\"http://www.latimes.com/business/hiltzik/la-fi-hiltzik-20140720-column.html\" target=\"_blank\">conflicts\u003c/a> involving \u003ca href=\"http://californiastemcellreport.blogspot.com/2016/09/alan-trounson-former-ceo-of-california.html\" target=\"_blank\">CIRM officers and grantees\u003c/a>, and the flow of funds to board members’ institutions continued unabated.\u003c/p>\n\u003cfigure id=\"attachment_322983\" class=\"wp-caption aligncenter\" style=\"max-width: 979px\">\u003ca href=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/01/CIRM.jpg\">\u003cimg class=\"wp-image-322983 size-full\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/01/CIRM.jpg\" alt=\"CIRM\" width=\"979\" height=\"462\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/01/CIRM.jpg 979w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/CIRM-160x76.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/CIRM-800x378.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/CIRM-768x362.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/CIRM-960x453.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/CIRM-240x113.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/CIRM-375x177.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/CIRM-520x245.jpg 520w\" sizes=\"(max-width: 979px) 100vw, 979px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Sources: California Institute for Regenerative Medicine, National Institutes of Health. \u003cspan class=\"media-source\">*Several CIRM trials included here were announced shortly after Sept. 30, 2016, the cut-off for the NIH data. **NIH spending for 2006 and 2007 is estimated because exact figures were unavailable.\u003c/span>NATALIA BRONSHTEIN/STAT\u003c/figcaption>\u003c/figure>\n\u003cp>“You could make an argument that California taxpayer money should go to build new facilities on state university campuses,” said Marcy Darnovsky, who directs the Berkeley-based Center for Genetics and Society, a public affairs nonprofit. “But I don’t see an argument for Stanford getting fancy new buildings from California taxpayer money.”\u003c/p>\n\u003cp>Stanford, whose endowment is among the top five nationally, and USC have received more than $70\u003cstrong> \u003c/strong>million for major building projects, and hundreds of millions more for labs and research. Stanford alone has been favored with $1 out of every $7 CIRM has approved.\u003c/p>\n\u003cp>But scientists outside California said CIRM’s record is a strong one. CIRM-funded researchers have published nearly 2,000 scholarly papers. That output has helped vault California into the top ranks of stem cell science, said Dr. George Daley, the new dean of Harvard Medical School and a leading stem cell scientist who describes himself as an informal adviser and cheerleader for CIRM. “When I look at the progress my colleagues have made in California, I am duly awed,” he said.\u003c/p>\n\u003cp>The institute announced a year ago that it would reinvent itself to emphasize clinical research until it runs out of money in 2020 — unless voters grant a new infusion of cash. CIRM plans to fund 50 new trials with its remaining $692 million, of which 10 were announced in 2016. Just 17 trials were funded in its first decade of grants.\u003c/p>\n\u003cp>C. Randal Mills, CIRM’s CEO since 2014 and architect of its new strategy, said he welcomed comparisons that help benchmark CIRM’s progress. Mills, former head of Osiris Therapeutics, the first company to commercialize an approved stem cell treatment, declined to comment on STAT’s specific findings, but defended the initial emphasis on labs and basic science as underpinning future clinical work.\u003c/p>\n\u003cp>“We’re running our own race. … What we have to do is just continually get better” to benefit patients, Mills said in an interview. “If we’re behind [NIH], we’re going to get better.”\u003c/p>\n\u003cp>Lott’s teenage daughter was paralyzed in an automobile crash and he hopes for a stem cell cure. He supports the goals of CIRM and applauds much of its work, but he now has second thoughts about the governance structure, which allows board members’ institutions to benefit from CIRM grants, as well as its financing. The ballot question that created CIRM, Proposition 71, authorized bond sales to pay for the agency’s budget, raising the total cost for taxpayers to $6 billion including interest. Financial experts, however, said that relatively low interest rates paid on long-term bonds can offer advantages over funding so large a venture directly from state coffers.\u003c/p>\n\u003cp>Asked whether he would support a similar ballot measure today, Lott said, “We were all caught up in the time, and the events were different when we first looked at this. But not today. Not at all.”\u003c/p>\n\u003cp>\u003cstrong>'Lives Will Be Saved'\u003c/strong>\u003c/p>\n\u003cp>Californians emphatically supported CIRM, creating the stem cell colossus with 59 percent of the vote in 2004. Many were upset that President George W. Bush had sharply limited federal funding for work with embryonic stem cells, which are derived from early human embryos and able to develop into any type of tissue or organ.\u003c/p>\n\u003cp>But Proposition 71 also won because it was shamelessly oversold, consumer advocates and science policy experts said. Desperate patients, Nobel laureates, and A-list celebrities such as \u003ca href=\"https://www.statnews.com/2016/08/30/parkinsons-study-fox-foundation-feud/\" target=\"_blank\">Michael J. Fox\u003c/a> — the Hollywood star and Parkinson’s sufferer — predicted “cures” that would “save millions of lives.”\u003c/p>\n\u003cp>“There are more Americans than … we can count who are sick now, or are going to be sick in the future, whose lives will be saved by Prop 71,” patient advocate Joan Samuelson said in another ad. The sponsors of the measure also predicted that CIRM-generated cures would drastically reduce health care spending. No one made specific promises for the 10-year timeframe initially planned for CIRM’s work, but miracles seemed just around the corner.\u003c/p>\n\u003cp>“You can support embryonic stem cell research, which we do and did, and still be pretty appalled by what was going down,” said Darnovsky. “The airwaves were swamped with guys in white coats who were identified with their academic affiliation even though they were principals of private companies (some of which later got CIRM grants), and basically saying, ‘We’re going to have cures by Christmas.’”\u003c/p>\n\u003cp>Mills, who was not involved at the agency’s genesis, called the idea sold to voters — impending, sweeping breakthroughs — “naïve.” Radical medical change usually takes decades from idea to cure.\u003c/p>\n\u003cp>“But here we are,” he said. “My sole mission is to create as much value for the resources we have left, for the people of California, that I can.”\u003c/p>\n\u003cp>\u003cstrong>California vs. NIH\u003c/strong>\u003c/p>\n\u003cp>Even under Bush-era restrictions — rescinded after President Barack Obama took office — the NIH continued to support substantial stem cell research.\u003c/p>\n\u003cp>Since 2006, it has spent $13.4 billion on stem cell science, six times CIRM’s budget during that period. But NIH fully or partly funded 571 clinical trials, according to STAT’s review — more than 20 times the number backed by California.\u003c/p>\n\u003cp>While NIH in that period funded 50 Phase 3 clinical trials of stem cell therapies — generally the last step before seeking approval to market a product — CIRM has supported just three.\u003c/p>\n\u003cp>One, the study of a treatment for skin cancer involving immune system cells, was terminated by Caladrius Biosciences, the grantee, when it determined that existing treatments had overtaken its approach. The others — testing altered immune cells to treat brain cancer and bioengineered veins to manage vascular problems — show promise, but are still recruiting patients and will not be completed for several years, according to the NIH website, ClinicalTrials.gov.\u003c/p>\n\u003cp>Daley called the NIH comparison “a little unfair,” because that agency emphasized hematopoietic stem cells — blood-forming cells from bone marrow, which had been studied for decades — unlike CIRM’s sharper focus on cutting-edge embryonic stem cells. A little more than half of CIRM’s awards have gone to support research on embryonic or induced pluripotent stem cells, which are created by modifying adult stem cells to act like embryonic ones. It gave about a quarter of its awards to support adult stem cell work, and the rest for other research areas.\u003c/p>\n\u003cp>“In the early days of CIRM, the feeling was that the field needed deep and direct investments in the … fundamental foundation of stem cell biology, because the translational opportunities were not yet mature, certainly not using embryonic or induced pluripotent stem cells,” Daley said.\u003c/p>\n\u003cp>\u003ca href=\"https://www.statnews.com/2016/01/30/paul-knoepfler/\" target=\"_blank\">Paul Knoepfler\u003c/a>, a University of California, Davis, researcher and CIRM grantee who writes a popular \u003ca href=\"http://www.ipscell.com/\" target=\"_blank\">stem cell blog\u003c/a>, agreed. “One almost had to invent a system for figuring out what would be a safe way to proceed with embryonic stem cell clinical trials because those cells are really much more powerful and also have different kinds of risks,” he said.\u003c/p>\n\u003cp>Knoepfler said he expected the basic science to spark clinical breakthroughs in time, citing, for example, promising early work on reversing paralysis from Asterias Biotherapeutics, located in Fremont, southeast of San Francisco. Jake Javier, a patient in a CIRM-supported Asterias trial, lost almost all use of his limbs in an accident diving into a swimming pool. He recently received an injection of a type of cell derived from embryonic stem cells that can help protect nerve cells damaged in spinal cord injuries. Javier has since regained some\u003cstrong> \u003c/strong>use of his arms — one of five patients in early trials who have shown improvement that CIRM and the researchers attribute to the treatment. The results have not yet been published in a peer-reviewed journal.\u003c/p>\n\u003cp>In addition, Mills noted that grants for new labs included provisions that required grantees to raise other funds — to “leverage” economic benefits to taxpayers — and to assist future trials. The institute, for example, gave $30 million to the contract research firm Quintiles to create facilities that will conduct preclinical research, manage regulatory issues, and provide clinical support for CIRM-supported stem cell trials, all at a steep discount.\u003c/p>\n\u003cp>“There is no iPhone 4 without an iPhone 3 or a 2 or a 1,” Mills said. But in a world where technology advances rapidly — Apple is already selling the iPhone 7, after all — voters are still waiting for the promised cures.\u003c/p>\n\u003cfigure id=\"attachment_322991\" class=\"wp-caption alignright\" style=\"max-width: 384px\">\u003ca href=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/01/evangelina.jpg\">\u003cimg class=\"size-full wp-image-322991\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/01/evangelina.jpg\" alt=\"Evangelina Padilla Vaccaro in November 2016.\" width=\"384\" height=\"576\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/01/evangelina.jpg 384w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/evangelina-160x240.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/evangelina-240x360.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/evangelina-375x563.jpg 375w\" sizes=\"(max-width: 384px) 100vw, 384px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Evangelina Padilla Vaccaro in November 2016. \u003ccite>(Nancy Ramos)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>So far, CIRM has one literal poster child to show it can deliver. Four-year-old Evangelina Padilla Vaccaro, featured on the cover of CIRM’s recent \u003ca href=\"https://www.cirm.ca.gov/about-cirm/2016-annual-report\" target=\"_blank\">annual report\u003c/a>, was born with severe combined immunodeficiency. She had no operating immune system. Some such children have been kept alive in sterile isolation tents for a time — hence the term, “bubble baby” — but most have died from infections within a few years. A lucky few who received matching bone-marrow transplants survived.\u003c/p>\n\u003cp>UCLA’s Dr. Donald Kohn, supported by CIRM, cured Evangelina by extracting some of her blood stem cells, altering them to correct the genetic defect, and returning them to her body. She’s now thriving with a robust immune system.\u003c/p>\n\u003cp>That little girl, and 29 children like her, “are getting immunizations, they’re going to school, they’re swimming in public swimming pools, they’re eating dirt, they’re doing all the things that little kids are supposed to do,” said Steven Peckman, associate director of UCLA’s Broad Center of Regenerative Medicine and Stem Cell Research. “They get sick and their own bodies attack those viruses and bacteria. And they survive. If there’s going to be something that’s called a cure, this is it.”\u003c/p>\n\u003cp>That inspiring triumph was partly funded by CIRM, but Kohn’s work took three decades, was well underway long before CIRM existed, and didn’t involve embryonic stem cells — the key gap CIRM was founded to fill. Evangelina was saved by hematopoietic stem cells, the type that NIH has been more focused on.\u003c/p>\n\u003cp>\u003cstrong>Racing the Clock\u003c/strong>\u003c/p>\n\u003cp>As much as Mills defends the old CIRM, last year he announced “CIRM 2.0” — a drastic shift to speed up clinical trials before the organization’s clock runs out.\u003c/p>\n\u003cp>Asked whether Californians are getting good value for their money from CIRM, Mills cited economic gains to the state, then added: “I focus a lot more on the return in relief of human suffering. We’re just starting to lift off the ground on that. I hope in history, in time, the record shows CIRM was a great deal.”\u003c/p>\n\u003cp>To that end, CIRM has said it will focus in 2017 primarily on clinical trials and work it hopes will lay the foundation for such studies.\u003c/p>\n\u003cp>If the studies show clear results, Mills said, “I think it will be self-evident that CIRM should be continued” with new funding.\u003c/p>\n\u003cp>Lott, the state overseer, called CIRM 2.0 long overdue. “They needed to at least create something a little more tangible, more specifically measurable, for the billions of dollars that they’ve allocated,” he said. “But it may be a little too late,” he added, to convince taxpayers that CIRM should get a new infusion of funds, given its governance structure.\u003c/p>\n\u003cp>Even Daley — unbridled in his enthusiasm for CIRM’s work — hesitated when asked if it was a model to emulate, though for a different reason. “I reluctantly endorse it,” he said, “in part because I think it’s another argument that allows the federal government and the NIH to abdicate its responsibility for investments in biomedical research, which benefits us all.”\u003c/p>\n\u003cp>Yet, just as President Bush’s policy on stem cells led to CIRM’s creation, the incoming Trump administration might bail out the institute just in time. The president-elect has not weighed in on federal funding, but Representative Tom Price, his nominee for Health and Human Services secretary, has long opposed federal funding of embryonic stem cell research — a view shared by Vice President-elect Mike Pence.\u003c/p>\n\u003cp>“If the Trump administration takes a hostile mind toward embryonic stem cell research, and perhaps some kinds of important fetal research are restricted as well, it may give another source of energy to CIRM,” said Knoepfler. “I don’t think Californians like to be told what we can or cannot do, research-wise.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This \u003ca href=\"https://www.statnews.com/2017/01/19/california-stem-cell-agency-cirm/\" target=\"_blank\">story\u003c/a> was originally published by STAT, an online publication of Boston Globe Media that covers health, medicine and scientific discovery.\u003c/em>\u003c/p>\n\n",
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"excerpt": "California's $3 billion stem cell initiative was sold to voters with the pitch that the investment would rapidly yield cures for devastating diseases like Parkinson’s and ALS. That hasn’t happened.",
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"description": "California's $3 billion stem cell initiative was sold to voters with the pitch that the investment would rapidly yield cures for devastating diseases like Parkinson’s and ALS. That hasn’t happened.",
"title": "Time Running Out, California Stem Cell Agency Yet to Produce Big Results | KQED",
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"headline": "Time Running Out, California Stem Cell Agency Yet to Produce Big Results",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>It’s been more than a decade since California launched an unprecedented experiment in medical research by direct democracy, when voters created a $3 billion fund to kick-start the hunt for stem cell therapies.\u003c/p>\n\u003cp>The bold plan, a response to federal funding limits for embryonic stem cell research, was sold with a simple pitch: The money would rapidly yield cures for devastating human diseases such as Parkinson’s and ALS.\u003c/p>\n\u003cp>That hasn’t happened.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>A major reason, a STAT examination found, is that the \u003ca href=\"https://www.cirm.ca.gov/\" target=\"_blank\">California Institute for Regenerative Medicine\u003c/a> has been slow to move promising experimental therapies into clinical trials. The National Institutes of Health has supported three and a half times as many human trials of stem cell therapies, dollar for dollar, as the California agency has funded since it started making grants in 2006. Just two of its clinical trials have been completed.\u003c/p>\n\u003cp>“I am floored by the disparity,” said Jim Lott, a health care consultant and member of the state board that monitors the agency, known as CIRM. If the numbers are correct, he told STAT, “that doesn’t settle well with me as a voter. That doesn’t settle well with me as a taxpayer. That doesn’t settle well with me as a member of the oversight committee.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>CIRM has used most of the $2.2 billion in grants it has distributed so far to build labs and pay for basic research at public and private universities, such as Stanford and the University of Southern California, and private companies.\u003c/p>\n\u003cp>It has given more than $300 million to 27 projects that include clinical trials — though much of that funding also supported preclinical work. Meanwhile, the agency has committed about $540 million to new labs and buildings.\u003c/p>\n\u003cp>In part, that’s because its directors chose to focus on infrastructure early on, as well as bench experiments and animal studies given that the biology of embryonic stem cells was not well-understood and there are formidable roadblocks to moving into human studies. Much more is known about the bone marrow stem cells that are the focus of many NIH-funded clinical trials.\u003c/p>\n\u003cp>But critics have noted that many top grantees come from institutions that hold seats on CIRM’s governing board. The respected Institute of Medicine, in a 2013 \u003ca href=\"https://www.nap.edu/catalog/13523/the-california-institute-for-regenerative-medicine-science-governance-and-the\" target=\"_blank\">review\u003c/a>, said institutionalized conflicts of interest have raised questions about “the integrity and independence of some of CIRM’s decisions.” CIRM later enacted reforms that barred board members from voting directly on grants for their institutions. But the changes didn’t prevent other financial \u003ca href=\"http://www.latimes.com/business/hiltzik/la-fi-hiltzik-20140720-column.html\" target=\"_blank\">conflicts\u003c/a> involving \u003ca href=\"http://californiastemcellreport.blogspot.com/2016/09/alan-trounson-former-ceo-of-california.html\" target=\"_blank\">CIRM officers and grantees\u003c/a>, and the flow of funds to board members’ institutions continued unabated.\u003c/p>\n\u003cfigure id=\"attachment_322983\" class=\"wp-caption aligncenter\" style=\"max-width: 979px\">\u003ca href=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/01/CIRM.jpg\">\u003cimg class=\"wp-image-322983 size-full\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/01/CIRM.jpg\" alt=\"CIRM\" width=\"979\" height=\"462\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/01/CIRM.jpg 979w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/CIRM-160x76.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/CIRM-800x378.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/CIRM-768x362.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/CIRM-960x453.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/CIRM-240x113.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/CIRM-375x177.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/CIRM-520x245.jpg 520w\" sizes=\"(max-width: 979px) 100vw, 979px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Sources: California Institute for Regenerative Medicine, National Institutes of Health. \u003cspan class=\"media-source\">*Several CIRM trials included here were announced shortly after Sept. 30, 2016, the cut-off for the NIH data. **NIH spending for 2006 and 2007 is estimated because exact figures were unavailable.\u003c/span>NATALIA BRONSHTEIN/STAT\u003c/figcaption>\u003c/figure>\n\u003cp>“You could make an argument that California taxpayer money should go to build new facilities on state university campuses,” said Marcy Darnovsky, who directs the Berkeley-based Center for Genetics and Society, a public affairs nonprofit. “But I don’t see an argument for Stanford getting fancy new buildings from California taxpayer money.”\u003c/p>\n\u003cp>Stanford, whose endowment is among the top five nationally, and USC have received more than $70\u003cstrong> \u003c/strong>million for major building projects, and hundreds of millions more for labs and research. Stanford alone has been favored with $1 out of every $7 CIRM has approved.\u003c/p>\n\u003cp>But scientists outside California said CIRM’s record is a strong one. CIRM-funded researchers have published nearly 2,000 scholarly papers. That output has helped vault California into the top ranks of stem cell science, said Dr. George Daley, the new dean of Harvard Medical School and a leading stem cell scientist who describes himself as an informal adviser and cheerleader for CIRM. “When I look at the progress my colleagues have made in California, I am duly awed,” he said.\u003c/p>\n\u003cp>The institute announced a year ago that it would reinvent itself to emphasize clinical research until it runs out of money in 2020 — unless voters grant a new infusion of cash. CIRM plans to fund 50 new trials with its remaining $692 million, of which 10 were announced in 2016. Just 17 trials were funded in its first decade of grants.\u003c/p>\n\u003cp>C. Randal Mills, CIRM’s CEO since 2014 and architect of its new strategy, said he welcomed comparisons that help benchmark CIRM’s progress. Mills, former head of Osiris Therapeutics, the first company to commercialize an approved stem cell treatment, declined to comment on STAT’s specific findings, but defended the initial emphasis on labs and basic science as underpinning future clinical work.\u003c/p>\n\u003cp>“We’re running our own race. … What we have to do is just continually get better” to benefit patients, Mills said in an interview. “If we’re behind [NIH], we’re going to get better.”\u003c/p>\n\u003cp>Lott’s teenage daughter was paralyzed in an automobile crash and he hopes for a stem cell cure. He supports the goals of CIRM and applauds much of its work, but he now has second thoughts about the governance structure, which allows board members’ institutions to benefit from CIRM grants, as well as its financing. The ballot question that created CIRM, Proposition 71, authorized bond sales to pay for the agency’s budget, raising the total cost for taxpayers to $6 billion including interest. Financial experts, however, said that relatively low interest rates paid on long-term bonds can offer advantages over funding so large a venture directly from state coffers.\u003c/p>\n\u003cp>Asked whether he would support a similar ballot measure today, Lott said, “We were all caught up in the time, and the events were different when we first looked at this. But not today. Not at all.”\u003c/p>\n\u003cp>\u003cstrong>'Lives Will Be Saved'\u003c/strong>\u003c/p>\n\u003cp>Californians emphatically supported CIRM, creating the stem cell colossus with 59 percent of the vote in 2004. Many were upset that President George W. Bush had sharply limited federal funding for work with embryonic stem cells, which are derived from early human embryos and able to develop into any type of tissue or organ.\u003c/p>\n\u003cp>But Proposition 71 also won because it was shamelessly oversold, consumer advocates and science policy experts said. Desperate patients, Nobel laureates, and A-list celebrities such as \u003ca href=\"https://www.statnews.com/2016/08/30/parkinsons-study-fox-foundation-feud/\" target=\"_blank\">Michael J. Fox\u003c/a> — the Hollywood star and Parkinson’s sufferer — predicted “cures” that would “save millions of lives.”\u003c/p>\n\u003cp>“There are more Americans than … we can count who are sick now, or are going to be sick in the future, whose lives will be saved by Prop 71,” patient advocate Joan Samuelson said in another ad. The sponsors of the measure also predicted that CIRM-generated cures would drastically reduce health care spending. No one made specific promises for the 10-year timeframe initially planned for CIRM’s work, but miracles seemed just around the corner.\u003c/p>\n\u003cp>“You can support embryonic stem cell research, which we do and did, and still be pretty appalled by what was going down,” said Darnovsky. “The airwaves were swamped with guys in white coats who were identified with their academic affiliation even though they were principals of private companies (some of which later got CIRM grants), and basically saying, ‘We’re going to have cures by Christmas.’”\u003c/p>\n\u003cp>Mills, who was not involved at the agency’s genesis, called the idea sold to voters — impending, sweeping breakthroughs — “naïve.” Radical medical change usually takes decades from idea to cure.\u003c/p>\n\u003cp>“But here we are,” he said. “My sole mission is to create as much value for the resources we have left, for the people of California, that I can.”\u003c/p>\n\u003cp>\u003cstrong>California vs. NIH\u003c/strong>\u003c/p>\n\u003cp>Even under Bush-era restrictions — rescinded after President Barack Obama took office — the NIH continued to support substantial stem cell research.\u003c/p>\n\u003cp>Since 2006, it has spent $13.4 billion on stem cell science, six times CIRM’s budget during that period. But NIH fully or partly funded 571 clinical trials, according to STAT’s review — more than 20 times the number backed by California.\u003c/p>\n\u003cp>While NIH in that period funded 50 Phase 3 clinical trials of stem cell therapies — generally the last step before seeking approval to market a product — CIRM has supported just three.\u003c/p>\n\u003cp>One, the study of a treatment for skin cancer involving immune system cells, was terminated by Caladrius Biosciences, the grantee, when it determined that existing treatments had overtaken its approach. The others — testing altered immune cells to treat brain cancer and bioengineered veins to manage vascular problems — show promise, but are still recruiting patients and will not be completed for several years, according to the NIH website, ClinicalTrials.gov.\u003c/p>\n\u003cp>Daley called the NIH comparison “a little unfair,” because that agency emphasized hematopoietic stem cells — blood-forming cells from bone marrow, which had been studied for decades — unlike CIRM’s sharper focus on cutting-edge embryonic stem cells. A little more than half of CIRM’s awards have gone to support research on embryonic or induced pluripotent stem cells, which are created by modifying adult stem cells to act like embryonic ones. It gave about a quarter of its awards to support adult stem cell work, and the rest for other research areas.\u003c/p>\n\u003cp>“In the early days of CIRM, the feeling was that the field needed deep and direct investments in the … fundamental foundation of stem cell biology, because the translational opportunities were not yet mature, certainly not using embryonic or induced pluripotent stem cells,” Daley said.\u003c/p>\n\u003cp>\u003ca href=\"https://www.statnews.com/2016/01/30/paul-knoepfler/\" target=\"_blank\">Paul Knoepfler\u003c/a>, a University of California, Davis, researcher and CIRM grantee who writes a popular \u003ca href=\"http://www.ipscell.com/\" target=\"_blank\">stem cell blog\u003c/a>, agreed. “One almost had to invent a system for figuring out what would be a safe way to proceed with embryonic stem cell clinical trials because those cells are really much more powerful and also have different kinds of risks,” he said.\u003c/p>\n\u003cp>Knoepfler said he expected the basic science to spark clinical breakthroughs in time, citing, for example, promising early work on reversing paralysis from Asterias Biotherapeutics, located in Fremont, southeast of San Francisco. Jake Javier, a patient in a CIRM-supported Asterias trial, lost almost all use of his limbs in an accident diving into a swimming pool. He recently received an injection of a type of cell derived from embryonic stem cells that can help protect nerve cells damaged in spinal cord injuries. Javier has since regained some\u003cstrong> \u003c/strong>use of his arms — one of five patients in early trials who have shown improvement that CIRM and the researchers attribute to the treatment. The results have not yet been published in a peer-reviewed journal.\u003c/p>\n\u003cp>In addition, Mills noted that grants for new labs included provisions that required grantees to raise other funds — to “leverage” economic benefits to taxpayers — and to assist future trials. The institute, for example, gave $30 million to the contract research firm Quintiles to create facilities that will conduct preclinical research, manage regulatory issues, and provide clinical support for CIRM-supported stem cell trials, all at a steep discount.\u003c/p>\n\u003cp>“There is no iPhone 4 without an iPhone 3 or a 2 or a 1,” Mills said. But in a world where technology advances rapidly — Apple is already selling the iPhone 7, after all — voters are still waiting for the promised cures.\u003c/p>\n\u003cfigure id=\"attachment_322991\" class=\"wp-caption alignright\" style=\"max-width: 384px\">\u003ca href=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/01/evangelina.jpg\">\u003cimg class=\"size-full wp-image-322991\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/01/evangelina.jpg\" alt=\"Evangelina Padilla Vaccaro in November 2016.\" width=\"384\" height=\"576\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/01/evangelina.jpg 384w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/evangelina-160x240.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/evangelina-240x360.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/evangelina-375x563.jpg 375w\" sizes=\"(max-width: 384px) 100vw, 384px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Evangelina Padilla Vaccaro in November 2016. \u003ccite>(Nancy Ramos)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>So far, CIRM has one literal poster child to show it can deliver. Four-year-old Evangelina Padilla Vaccaro, featured on the cover of CIRM’s recent \u003ca href=\"https://www.cirm.ca.gov/about-cirm/2016-annual-report\" target=\"_blank\">annual report\u003c/a>, was born with severe combined immunodeficiency. She had no operating immune system. Some such children have been kept alive in sterile isolation tents for a time — hence the term, “bubble baby” — but most have died from infections within a few years. A lucky few who received matching bone-marrow transplants survived.\u003c/p>\n\u003cp>UCLA’s Dr. Donald Kohn, supported by CIRM, cured Evangelina by extracting some of her blood stem cells, altering them to correct the genetic defect, and returning them to her body. She’s now thriving with a robust immune system.\u003c/p>\n\u003cp>That little girl, and 29 children like her, “are getting immunizations, they’re going to school, they’re swimming in public swimming pools, they’re eating dirt, they’re doing all the things that little kids are supposed to do,” said Steven Peckman, associate director of UCLA’s Broad Center of Regenerative Medicine and Stem Cell Research. “They get sick and their own bodies attack those viruses and bacteria. And they survive. If there’s going to be something that’s called a cure, this is it.”\u003c/p>\n\u003cp>That inspiring triumph was partly funded by CIRM, but Kohn’s work took three decades, was well underway long before CIRM existed, and didn’t involve embryonic stem cells — the key gap CIRM was founded to fill. Evangelina was saved by hematopoietic stem cells, the type that NIH has been more focused on.\u003c/p>\n\u003cp>\u003cstrong>Racing the Clock\u003c/strong>\u003c/p>\n\u003cp>As much as Mills defends the old CIRM, last year he announced “CIRM 2.0” — a drastic shift to speed up clinical trials before the organization’s clock runs out.\u003c/p>\n\u003cp>Asked whether Californians are getting good value for their money from CIRM, Mills cited economic gains to the state, then added: “I focus a lot more on the return in relief of human suffering. We’re just starting to lift off the ground on that. I hope in history, in time, the record shows CIRM was a great deal.”\u003c/p>\n\u003cp>To that end, CIRM has said it will focus in 2017 primarily on clinical trials and work it hopes will lay the foundation for such studies.\u003c/p>\n\u003cp>If the studies show clear results, Mills said, “I think it will be self-evident that CIRM should be continued” with new funding.\u003c/p>\n\u003cp>Lott, the state overseer, called CIRM 2.0 long overdue. “They needed to at least create something a little more tangible, more specifically measurable, for the billions of dollars that they’ve allocated,” he said. “But it may be a little too late,” he added, to convince taxpayers that CIRM should get a new infusion of funds, given its governance structure.\u003c/p>\n\u003cp>Even Daley — unbridled in his enthusiasm for CIRM’s work — hesitated when asked if it was a model to emulate, though for a different reason. “I reluctantly endorse it,” he said, “in part because I think it’s another argument that allows the federal government and the NIH to abdicate its responsibility for investments in biomedical research, which benefits us all.”\u003c/p>\n\u003cp>Yet, just as President Bush’s policy on stem cells led to CIRM’s creation, the incoming Trump administration might bail out the institute just in time. The president-elect has not weighed in on federal funding, but Representative Tom Price, his nominee for Health and Human Services secretary, has long opposed federal funding of embryonic stem cell research — a view shared by Vice President-elect Mike Pence.\u003c/p>\n\u003cp>“If the Trump administration takes a hostile mind toward embryonic stem cell research, and perhaps some kinds of important fetal research are restricted as well, it may give another source of energy to CIRM,” said Knoepfler. “I don’t think Californians like to be told what we can or cannot do, research-wise.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"disqusTitle": "Is Virtual Reality an 'Empathy Machine'? Some Charities Think So",
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"content": "\u003cp>Media coverage of tragedy — terrorist attacks, homelessness, the refugee crisis — can be so overwhelming it's numbing. Charities say it can also make it harder to get support.\u003c/p>\n\u003cp>[contextly_sidebar id=\"EptXNcfPE3jycvkr9LahlMZvHL93Ccc0\"]Some are hoping a new form of media will be more persuasive — virtual reality or VR, which they think makes people more empathetic.\u003c/p>\n\u003cp>At a recent New York City fundraiser for the International Rescue Committee, attendees could step away from the mingling and have a more direct connection to the people they were there to help. A few seats were set up where the guests could sit down and put on a VR headset.\u003c/p>\n\u003cp>Once they've donned the headset the guest is \u003ca href=\"https://www.rescue.org/four-walls\">immersed in the world of a refugee camp\u003c/a> in Lebanon. Cheryl Henson, an IRC donor, says that via VR she was in a family's tent, watching children play.\u003c/p>\n\u003cp>\"It's a very effective way to feel like you're there in the room because you have a real sense of these are real people,\" she says. \"There's the food, there's the clothes, there's the talk.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>This sense of really being there is why some fans of VR have dubbed it \u003ca href=\"http://www.npr.org/2015/09/11/439199892/what-happens-when-we-step-inside-the-screen\">\"the empathy machine.\"\u003c/a>\u003c/p>\n\u003cp>Henson's reaction was fairly typical of others who have tried the Lebanon experience, says Cathe Neukum, executive producer for the IRC. \"We can't bring donors or people to the field, but we bring the field to donors and our constituents and our supporters,\" she says. \"That's what's so great about VR; that's what makes it, I think, such an important tool for charities.\"\u003c/p>\n\u003cp>Other charities are also trying VR, including \u003ca href=\"http://www.360syria.com/\">Amnesty International\u003c/a> and the \u003ca href=\"https://www.clintonfoundation.org/clinton-global-initiative/inside-impact-east-africa\">Clinton Foundation\u003c/a>.\u003c/p>\n\u003cp>\"The goal ultimately is that when you take the headset off, you have the inspiration to act in real life,\" says Gordon Meyer, director of marketing for \u003ca href=\"https://www.youvisit.com/\">YouVisit\u003c/a>, which created the VR experience for the IRC.\u003c/p>\n\u003cp>No one knows for sure whether VR is a more powerful tool than other media for getting people to act charitably, but it is a subject of serious study.\u003c/p>\n\u003cp>Jeremy Bailenson, the founding director of Stanford University's \u003ca href=\"http://vhil.stanford.edu/\">Virtual Human Interaction Lab\u003c/a>, has been studying VR since its earliest days. He says there is increasing evidence that VR can be more effective than other media in evoking empathy. But it has to be done right.\u003c/p>\n\u003cp>\"What we know how to do well is to create these experiences that really leverage what's called embodied cognition, which is moving through a space, looking around, using your eyes, using your body to interact with the scene and that's what makes VR special,\" Bailenson says.\u003c/p>\n\u003cp>Right now his lab is studying whether VR makes people more empathetic to homeless people than other forms of media do. One group gets a video or some literature and the other group has the VR experience.\u003c/p>\n\u003cp>The VR experience puts you in the shoes of someone who goes through a journey that ends in homelessness.\u003c/p>\n\u003cp>\"You start out in your home and you find out that you've lost your job,\" Bailenson says. \"You struggle to make rent and you use your body to pick items in your home to sell to try to make your rent so you don't get evicted.\"\u003c/p>\n\u003cp>Of course, you do get evicted. And you find yourself living in your car. Your car gets towed and you find yourself trying to sleep on a bus. On the bus, you must guard your backpack from thieves all night long.\u003c/p>\n\u003cp>Journalist Vignesh Ramachandran, who participated in the study, says he's read a lot about homelessness but something about the experience of protecting his stuff on the bus got to him.\u003c/p>\n\u003cp>\"I just remember thinking like, 'Oh my gosh' you just can't imagine having to constantly be looking out for your safety just when you're trying to get a good night's sleep,\" he says. \"That part was like striking to me.\"\u003c/p>\n\u003cp>After the VR experience the participants are asked to sign a petition for housing for the homeless. The study will look at whether they or the people who read material and saw a video are more likely to sign.\u003c/p>\n\u003cp>But using VR to promote empathy has its skeptics. \u003ca href=\"http://bostonreview.net/forum/paul-bloom-against-empathy\">Paul Bloom\u003c/a>, a Yale psychology professor and author of \u003cem>Against Empathy, \u003c/em>thinks that if these kinds of VR experiences become common they will be no more effective than any other media.\u003c/p>\n\u003cp>\"Empathy — feeling the suffering of other people — is fatiguing. It leads to burnout. It leads to withdrawal,\" Bloom says. \"The best therapists, the best doctors, the best philanthropists are people who don't feel the suffering of others. It's just people who care about others want to help, but do it joyously.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Bloom says he may be old school, but he thinks if you really want to get into the head of another human being and understand them, try reading a good novel.\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=Can+Virtual+Reality+Make+You+More+Empathetic%3F&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Media coverage of tragedy — terrorist attacks, homelessness, the refugee crisis — can be so overwhelming it's numbing. Charities say it can also make it harder to get support.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>Some are hoping a new form of media will be more persuasive — virtual reality or VR, which they think makes people more empathetic.\u003c/p>\n\u003cp>At a recent New York City fundraiser for the International Rescue Committee, attendees could step away from the mingling and have a more direct connection to the people they were there to help. A few seats were set up where the guests could sit down and put on a VR headset.\u003c/p>\n\u003cp>Once they've donned the headset the guest is \u003ca href=\"https://www.rescue.org/four-walls\">immersed in the world of a refugee camp\u003c/a> in Lebanon. Cheryl Henson, an IRC donor, says that via VR she was in a family's tent, watching children play.\u003c/p>\n\u003cp>\"It's a very effective way to feel like you're there in the room because you have a real sense of these are real people,\" she says. \"There's the food, there's the clothes, there's the talk.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>This sense of really being there is why some fans of VR have dubbed it \u003ca href=\"http://www.npr.org/2015/09/11/439199892/what-happens-when-we-step-inside-the-screen\">\"the empathy machine.\"\u003c/a>\u003c/p>\n\u003cp>Henson's reaction was fairly typical of others who have tried the Lebanon experience, says Cathe Neukum, executive producer for the IRC. \"We can't bring donors or people to the field, but we bring the field to donors and our constituents and our supporters,\" she says. \"That's what's so great about VR; that's what makes it, I think, such an important tool for charities.\"\u003c/p>\n\u003cp>Other charities are also trying VR, including \u003ca href=\"http://www.360syria.com/\">Amnesty International\u003c/a> and the \u003ca href=\"https://www.clintonfoundation.org/clinton-global-initiative/inside-impact-east-africa\">Clinton Foundation\u003c/a>.\u003c/p>\n\u003cp>\"The goal ultimately is that when you take the headset off, you have the inspiration to act in real life,\" says Gordon Meyer, director of marketing for \u003ca href=\"https://www.youvisit.com/\">YouVisit\u003c/a>, which created the VR experience for the IRC.\u003c/p>\n\u003cp>No one knows for sure whether VR is a more powerful tool than other media for getting people to act charitably, but it is a subject of serious study.\u003c/p>\n\u003cp>Jeremy Bailenson, the founding director of Stanford University's \u003ca href=\"http://vhil.stanford.edu/\">Virtual Human Interaction Lab\u003c/a>, has been studying VR since its earliest days. He says there is increasing evidence that VR can be more effective than other media in evoking empathy. But it has to be done right.\u003c/p>\n\u003cp>\"What we know how to do well is to create these experiences that really leverage what's called embodied cognition, which is moving through a space, looking around, using your eyes, using your body to interact with the scene and that's what makes VR special,\" Bailenson says.\u003c/p>\n\u003cp>Right now his lab is studying whether VR makes people more empathetic to homeless people than other forms of media do. One group gets a video or some literature and the other group has the VR experience.\u003c/p>\n\u003cp>The VR experience puts you in the shoes of someone who goes through a journey that ends in homelessness.\u003c/p>\n\u003cp>\"You start out in your home and you find out that you've lost your job,\" Bailenson says. \"You struggle to make rent and you use your body to pick items in your home to sell to try to make your rent so you don't get evicted.\"\u003c/p>\n\u003cp>Of course, you do get evicted. And you find yourself living in your car. Your car gets towed and you find yourself trying to sleep on a bus. On the bus, you must guard your backpack from thieves all night long.\u003c/p>\n\u003cp>Journalist Vignesh Ramachandran, who participated in the study, says he's read a lot about homelessness but something about the experience of protecting his stuff on the bus got to him.\u003c/p>\n\u003cp>\"I just remember thinking like, 'Oh my gosh' you just can't imagine having to constantly be looking out for your safety just when you're trying to get a good night's sleep,\" he says. \"That part was like striking to me.\"\u003c/p>\n\u003cp>After the VR experience the participants are asked to sign a petition for housing for the homeless. The study will look at whether they or the people who read material and saw a video are more likely to sign.\u003c/p>\n\u003cp>But using VR to promote empathy has its skeptics. \u003ca href=\"http://bostonreview.net/forum/paul-bloom-against-empathy\">Paul Bloom\u003c/a>, a Yale psychology professor and author of \u003cem>Against Empathy, \u003c/em>thinks that if these kinds of VR experiences become common they will be no more effective than any other media.\u003c/p>\n\u003cp>\"Empathy — feeling the suffering of other people — is fatiguing. It leads to burnout. It leads to withdrawal,\" Bloom says. \"The best therapists, the best doctors, the best philanthropists are people who don't feel the suffering of others. It's just people who care about others want to help, but do it joyously.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Bloom says he may be old school, but he thinks if you really want to get into the head of another human being and understand them, try reading a good novel.\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=Can+Virtual+Reality+Make+You+More+Empathetic%3F&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"imageAlt": "KQED The California Report",
"officialWebsiteLink": "/californiareport",
"meta": {
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"source": "kqed",
"order": 8
},
"link": "/californiareport",
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"amazon": "https://music.amazon.com/podcasts/26099305-72af-4542-9dde-ac1807fe36d5/kqed-s-the-california-report",
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}
},
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"id": "californiareportmagazine",
"title": "The California Report Magazine",
"tagline": "Your state, your stories",
"info": "Every week, The California Report Magazine takes you on a road trip for the ears: to visit the places and meet the people who make California unique. The in-depth storytelling podcast from the California Report.",
"airtime": "FRI 4:30pm-5pm, 6:30pm-7pm, 11pm-11:30pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/The-California-Report-Magazine-Podcast-Tile-703x703-1.jpg",
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"officialWebsiteLink": "/californiareportmagazine",
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"order": 10
},
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM3NjkwNjk1OTAz",
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"rss": "https://ww2.kqed.org/news/tag/tcrmag/feed/podcast"
}
},
"city-arts": {
"id": "city-arts",
"title": "City Arts & Lectures",
"info": "A one-hour radio program to hear celebrated writers, artists and thinkers address contemporary ideas and values, often discussing the creative process. Please note: tapes or transcripts are not available",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/05/cityartsandlecture-300x300.jpg",
"officialWebsiteLink": "https://www.cityarts.net/",
"airtime": "SUN 1pm-2pm, TUE 10pm, WED 1am",
"meta": {
"site": "news",
"source": "City Arts & Lectures"
},
"link": "https://www.cityarts.net",
"subscribe": {
"tuneIn": "https://tunein.com/radio/City-Arts-and-Lectures-p692/",
"rss": "https://www.cityarts.net/feed/"
}
},
"closealltabs": {
"id": "closealltabs",
"title": "Close All Tabs",
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"info": "Close All Tabs breaks down how digital culture shapes our world through thoughtful insights and irreverent humor.",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2025/02/CAT_2_Tile-scaled.jpg",
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"officialWebsiteLink": "/podcasts/closealltabs",
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"order": 1
},
"link": "/podcasts/closealltabs",
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"id": "code-switch-life-kit",
"title": "Code Switch / Life Kit",
"info": "\u003cem>Code Switch\u003c/em>, which listeners will hear in the first part of the hour, has fearless and much-needed conversations about race. Hosted by journalists of color, the show tackles the subject of race head-on, exploring how it impacts every part of society — from politics and pop culture to history, sports and more.\u003cbr />\u003cbr />\u003cem>Life Kit\u003c/em>, which will be in the second part of the hour, guides you through spaces and feelings no one prepares you for — from finances to mental health, from workplace microaggressions to imposter syndrome, from relationships to parenting. The show features experts with real world experience and shares their knowledge. Because everyone needs a little help being human.\u003cbr />\u003cbr />\u003ca href=\"https://www.npr.org/podcasts/510312/codeswitch\">\u003cem>Code Switch\u003c/em> offical site and podcast\u003c/a>\u003cbr />\u003ca href=\"https://www.npr.org/lifekit\">\u003cem>Life Kit\u003c/em> offical site and podcast\u003c/a>\u003cbr />",
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"meta": {
"site": "radio",
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"link": "/radio/program/code-switch-life-kit",
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly93d3cubnByLm9yZy9yc3MvcG9kY2FzdC5waHA_aWQ9NTEwMzEy",
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},
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"id": "commonwealth-club",
"title": "Commonwealth Club of California Podcast",
"info": "The Commonwealth Club of California is the nation's oldest and largest public affairs forum. As a non-partisan forum, The Club brings to the public airwaves diverse viewpoints on important topics. The Club's weekly radio broadcast - the oldest in the U.S., dating back to 1924 - is carried across the nation on public radio stations and is now podcasting. Our website archive features audio of our recent programs, as well as selected speeches from our long and distinguished history. This podcast feed is usually updated twice a week and is always un-edited.",
"airtime": "THU 10pm, FRI 1am",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Commonwealth-Club-Podcast-Tile-360x360-1.jpg",
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"meta": {
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"source": "Commonwealth Club of California"
},
"link": "/radio/program/commonwealth-club",
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"google": "https://podcasts.google.com/feed/aHR0cDovL3d3dy5jb21tb253ZWFsdGhjbHViLm9yZy9hdWRpby9wb2RjYXN0L3dlZWtseS54bWw",
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}
},
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"id": "forum",
"title": "Forum",
"tagline": "The conversation starts here",
"info": "KQED’s live call-in program discussing local, state, national and international issues, as well as in-depth interviews.",
"airtime": "MON-FRI 9am-11am, 10pm-11pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Forum-Podcast-Tile-703x703-1.jpg",
"imageAlt": "KQED Forum with Mina Kim and Alexis Madrigal",
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"meta": {
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"source": "kqed",
"order": 9
},
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM5NTU3MzgxNjMz",
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},
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"id": "freakonomics-radio",
"title": "Freakonomics Radio",
"info": "Freakonomics Radio is a one-hour award-winning podcast and public-radio project hosted by Stephen Dubner, with co-author Steve Levitt as a regular guest. It is produced in partnership with WNYC.",
"imageSrc": "https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/05/freakonomicsRadio.png",
"officialWebsiteLink": "http://freakonomics.com/",
"airtime": "SUN 1am-2am, SAT 3pm-4pm",
"meta": {
"site": "radio",
"source": "WNYC"
},
"link": "/radio/program/freakonomics-radio",
"subscribe": {
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"apple": "https://itunes.apple.com/us/podcast/freakonomics-radio/id354668519",
"tuneIn": "https://tunein.com/podcasts/WNYC-Podcasts/Freakonomics-Radio-p272293/",
"rss": "https://feeds.feedburner.com/freakonomicsradio"
}
},
"fresh-air": {
"id": "fresh-air",
"title": "Fresh Air",
"info": "Hosted by Terry Gross, \u003cem>Fresh Air from WHYY\u003c/em> is the Peabody Award-winning weekday magazine of contemporary arts and issues. One of public radio's most popular programs, Fresh Air features intimate conversations with today's biggest luminaries.",
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"link": "/radio/program/fresh-air",
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"apple": "https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=214089682&at=11l79Y&ct=nprdirectory",
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"rss": "https://feeds.npr.org/381444908/podcast.xml"
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"here-and-now": {
"id": "here-and-now",
"title": "Here & Now",
"info": "A live production of NPR and WBUR Boston, in collaboration with stations across the country, Here & Now reflects the fluid world of news as it's happening in the middle of the day, with timely, in-depth news, interviews and conversation. Hosted by Robin Young, Jeremy Hobson and Tonya Mosley.",
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"rss": "https://feeds.npr.org/510051/podcast.xml"
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},
"hidden-brain": {
"id": "hidden-brain",
"title": "Hidden Brain",
"info": "Shankar Vedantam uses science and storytelling to reveal the unconscious patterns that drive human behavior, shape our choices and direct our relationships.",
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"officialWebsiteLink": "https://www.npr.org/series/423302056/hidden-brain",
"airtime": "SUN 7pm-8pm",
"meta": {
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"source": "NPR"
},
"link": "/radio/program/hidden-brain",
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},
"how-i-built-this": {
"id": "how-i-built-this",
"title": "How I Built This with Guy Raz",
"info": "Guy Raz dives into the stories behind some of the world's best known companies. How I Built This weaves a narrative journey about innovators, entrepreneurs and idealists—and the movements they built.",
"imageSrc": "https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/05/howIBuiltThis.png",
"officialWebsiteLink": "https://www.npr.org/podcasts/510313/how-i-built-this",
"airtime": "SUN 7:30pm-8pm",
"meta": {
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"source": "npr"
},
"link": "/radio/program/how-i-built-this",
"subscribe": {
"npr": "https://rpb3r.app.goo.gl/3zxy",
"apple": "https://itunes.apple.com/us/podcast/how-i-built-this-with-guy-raz/id1150510297?mt=2",
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"rss": "https://feeds.npr.org/510313/podcast.xml"
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},
"hyphenacion": {
"id": "hyphenacion",
"title": "Hyphenación",
"tagline": "Where conversation and cultura meet",
"info": "What kind of no sabo word is Hyphenación? For us, it’s about living within a hyphenation. Like being a third-gen Mexican-American from the Texas border now living that Bay Area Chicano life. Like Xorje! Each week we bring together a couple of hyphenated Latinos to talk all about personal life choices: family, careers, relationships, belonging … everything is on the table. ",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2025/03/Hyphenacion_FinalAssets_PodcastTile.png",
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"officialWebsiteLink": "/podcasts/hyphenacion",
"meta": {
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"order": 15
},
"link": "/podcasts/hyphenacion",
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"spotify": "https://open.spotify.com/show/2p3Fifq96nw9BPcmFdIq0o?si=39209f7b25774f38",
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"amazon": "https://music.amazon.com/podcasts/6c3dd23c-93fb-4aab-97ba-1725fa6315f1/hyphenaci%C3%B3n",
"rss": "https://feeds.megaphone.fm/KQINC2275451163"
}
},
"jerrybrown": {
"id": "jerrybrown",
"title": "The Political Mind of Jerry Brown",
"tagline": "Lessons from a lifetime in politics",
"info": "The Political Mind of Jerry Brown brings listeners the wisdom of the former Governor, Mayor, and presidential candidate. Scott Shafer interviewed Brown for more than 40 hours, covering the former governor's life and half-century in the political game – and Brown has some lessons he'd like to share. ",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/The-Political-Mind-of-Jerry-Brown-Podcast-Tile-703x703-1.jpg",
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"officialWebsiteLink": "/podcasts/jerrybrown",
"meta": {
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"source": "kqed",
"order": 18
},
"link": "/podcasts/jerrybrown",
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"apple": "https://itunes.apple.com/us/podcast/id1492194549",
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}
},
"latino-usa": {
"id": "latino-usa",
"title": "Latino USA",
"airtime": "MON 1am-2am, SUN 6pm-7pm",
"info": "Latino USA, the radio journal of news and culture, is the only national, English-language radio program produced from a Latino perspective.",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/latinoUsa.jpg",
"officialWebsiteLink": "http://latinousa.org/",
"meta": {
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"source": "npr"
},
"link": "/radio/program/latino-usa",
"subscribe": {
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"apple": "https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=79681317&at=11l79Y&ct=nprdirectory",
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"rss": "https://feeds.npr.org/510016/podcast.xml"
}
},
"marketplace": {
"id": "marketplace",
"title": "Marketplace",
"info": "Our flagship program, helmed by Kai Ryssdal, examines what the day in money delivered, through stories, conversations, newsworthy numbers and more. Updated Monday through Friday at about 3:30 p.m. PT.",
"airtime": "MON-FRI 4pm-4:30pm, MON-WED 6:30pm-7pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Marketplace-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.marketplace.org/",
"meta": {
"site": "news",
"source": "American Public Media"
},
"link": "/radio/program/marketplace",
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"rss": "https://feeds.publicradio.org/public_feeds/marketplace-pm/rss/rss"
}
},
"masters-of-scale": {
"id": "masters-of-scale",
"title": "Masters of Scale",
"info": "Masters of Scale is an original podcast in which LinkedIn co-founder and Greylock Partner Reid Hoffman sets out to describe and prove theories that explain how great entrepreneurs take their companies from zero to a gazillion in ingenious fashion.",
"airtime": "Every other Wednesday June 12 through October 16 at 8pm (repeats Thursdays at 2am)",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Masters-of-Scale-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://mastersofscale.com/",
"meta": {
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"source": "WaitWhat"
},
"link": "/radio/program/masters-of-scale",
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"apple": "http://mastersofscale.app.link/",
"rss": "https://rss.art19.com/masters-of-scale"
}
},
"mindshift": {
"id": "mindshift",
"title": "MindShift",
"tagline": "A podcast about the future of learning and how we raise our kids",
"info": "The MindShift podcast explores the innovations in education that are shaping how kids learn. Hosts Ki Sung and Katrina Schwartz introduce listeners to educators, researchers, parents and students who are developing effective ways to improve how kids learn. We cover topics like how fed-up administrators are developing surprising tactics to deal with classroom disruptions; how listening to podcasts are helping kids develop reading skills; the consequences of overparenting; and why interdisciplinary learning can engage students on all ends of the traditional achievement spectrum. This podcast is part of the MindShift education site, a division of KQED News. KQED is an NPR/PBS member station based in San Francisco. You can also visit the MindShift website for episodes and supplemental blog posts or tweet us \u003ca href=\"https://twitter.com/MindShiftKQED\">@MindShiftKQED\u003c/a> or visit us at \u003ca href=\"/mindshift\">MindShift.KQED.org\u003c/a>",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Mindshift-Podcast-Tile-703x703-1.jpg",
"imageAlt": "KQED MindShift: How We Will Learn",
"officialWebsiteLink": "/mindshift/",
"meta": {
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"source": "kqed",
"order": 12
},
"link": "/podcasts/mindshift",
"subscribe": {
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM1NzY0NjAwNDI5",
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"stitcher": "https://www.stitcher.com/podcast/kqed/stories-teachers-share",
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}
},
"morning-edition": {
"id": "morning-edition",
"title": "Morning Edition",
"info": "\u003cem>Morning Edition\u003c/em> takes listeners around the country and the world with multi-faceted stories and commentaries every weekday. Hosts Steve Inskeep, David Greene and Rachel Martin bring you the latest breaking news and features to prepare you for the day.",
"airtime": "MON-FRI 3am-9am",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Morning-Edition-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.npr.org/programs/morning-edition/",
"meta": {
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"link": "/radio/program/morning-edition"
},
"onourwatch": {
"id": "onourwatch",
"title": "On Our Watch",
"tagline": "Deeply-reported investigative journalism",
"info": "For decades, the process for how police police themselves has been inconsistent – if not opaque. In some states, like California, these proceedings were completely hidden. After a new police transparency law unsealed scores of internal affairs files, our reporters set out to examine these cases and the shadow world of police discipline. On Our Watch brings listeners into the rooms where officers are questioned and witnesses are interrogated to find out who this system is really protecting. Is it the officers, or the public they've sworn to serve?",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/On-Our-Watch-Podcast-Tile-703x703-1.jpg",
"imageAlt": "On Our Watch from NPR and KQED",
"officialWebsiteLink": "/podcasts/onourwatch",
"meta": {
"site": "news",
"source": "kqed",
"order": 11
},
"link": "/podcasts/onourwatch",
"subscribe": {
"apple": "https://podcasts.apple.com/podcast/id1567098962",
"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5ucHIub3JnLzUxMDM2MC9wb2RjYXN0LnhtbD9zYz1nb29nbGVwb2RjYXN0cw",
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"spotify": "https://open.spotify.com/show/0OLWoyizopu6tY1XiuX70x",
"tuneIn": "https://tunein.com/radio/On-Our-Watch-p1436229/",
"stitcher": "https://www.stitcher.com/show/on-our-watch",
"rss": "https://feeds.npr.org/510360/podcast.xml"
}
},
"on-the-media": {
"id": "on-the-media",
"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",
"airtime": "SUN 2pm-3pm, MON 12am-1am",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/onTheMedia.png",
"officialWebsiteLink": "https://www.wnycstudios.org/shows/otm",
"meta": {
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"source": "wnyc"
},
"link": "/radio/program/on-the-media",
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