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"content": "\u003cp>\u003cem>This story is part of CNET's \"\u003ca href=\"https://www.cnet.com/tech-enabled/\" target=\"_blank\">Tech Enabled\u003c/a>\" series about the role technology plays in helping the disability community.\u003c/em>\u003c/p>\n\u003cp>Virtual reality and augmented reality are often associated with gaming. For many people, the allure has to do with the ability to visit an alien world or an exotic location -- to go someplace or do something they couldn't do otherwise. Bridging worlds seems to be a sweet spot for these technologies.\u003c/p>\n\u003cp>But VR and AR don't necessarily have to take users to far-off or fictional places. They also can better connect people with vision issues to the everyday world. Most take for granted the ability to sit at a computer at work and read the text on the screen, or freely and confidently walk around their home or office. These technologies aim to help people reclaim some of the vision they may have lost and to make it easier to function in the world.\u003c/p>\n\u003cp>The World Health Organization estimates that 246 million people have low vision, which includes blurry vision, tunnel vision or blind spots that can't be corrected. The WHO also estimates that 90 percent of those who have vision problems, not just low vision, tend to have low incomes.\u003c/p>\n\u003cp>Frank Werblin, professor of neuroscience at the University of California, Berkeley, is working to bring a lower-cost vision aid to the low-vision community. About a year and a half ago, he realized he could do this by piggybacking on virtual-reality technology.\u003c/p>\n\u003cfigure id=\"attachment_284322\" class=\"wp-caption aligncenter\" style=\"max-width: 719px\">\u003ca href=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/11/GearVR.png\">\u003cimg class=\"size-full wp-image-284322\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/11/GearVR.png\" alt=\"IrisVision is an app that magnifies whatever the user is looking at. It can be used with a Samsung Gear VR headset, pictured.. \" width=\"719\" height=\"477\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2016/11/GearVR.png 719w, https://ww2.kqed.org/app/uploads/sites/13/2016/11/GearVR-160x106.png 160w, https://ww2.kqed.org/app/uploads/sites/13/2016/11/GearVR-240x159.png 240w, https://ww2.kqed.org/app/uploads/sites/13/2016/11/GearVR-375x249.png 375w, https://ww2.kqed.org/app/uploads/sites/13/2016/11/GearVR-520x345.png 520w\" sizes=\"(max-width: 719px) 100vw, 719px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">IrisVision is an app that magnifies whatever the user is looking at. It can be used with a Samsung Gear VR headset, pictured.. \u003ccite>(Sarah Tew/CNET)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>IrisVision is an app that uses a Samsung Gear VR headset. It's responsive to the wearer's head movements and will magnify whatever they're directly looking at, while still providing a wide field of view. It's meant to help users better see the world, even read on a computer.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>One of the biggest challenges he's trying to address is cost. Wearable vision aids can go as high as $15,000.\u003c/p>\n\u003cp>\"There's a huge price gap between a magnifying glass, which you could buy for $25 or $50, and what these people could really use, which is a wearable portable device, which is many thousands of dollars,\" he said.\u003c/p>\n\u003cp>IrisVision is available online for $2,500, and in certain clinics around the country on an experimental basis. The price includes the software, headset and phone needed to power the Gear VR. Werblin, who for 44 years has been studying the way the retina functions, even took it to the California School for the Blind in Fremont, California.\u003c/p>\n\u003cp>\u003cstrong>Lazy Eye No More\u003c/strong>\u003c/p>\n\u003cp>Werblin's not the first to use virtual-reality hardware. James Blaha had dealt with amblyopia, or lazy eye, his whole life. In the process of researching the condition and tinkering with an early Oculus Rift VR headset, the now-founder and CEO of Vivid Vision, a company that makes therapy solutions for the condition, discovered he could strengthen his weaker eye using virtual reality.\u003c/p>\n\u003cp>Amblyopia occurs when one eye is far less effective than the other, and the brain tries to suppress it. This creates problems with depth perception that can make it hard to cross a busy street or drive, among other things. Conventional wisdom in the medical field has held that if the problem isn't fixed by the age of 8, it won't be fixed at all.\u003c/p>\n\u003cp>Blaha is proving that idea wrong. By cranking up the brightness in the goggles for just his weaker eye, he essentially forced his brain to stop suppressing the eye. He started seeing in 3D for the first time in his life, including seeing the keys on his keyboard in relief. These days, he has 90 percent normal depth perception.\u003c/p>\n\u003cp>\"We're sort of outside the context of VR, particularly for the patients who use it, and definitely for the doctors who are not playing any of the VR games, typically,\" Blaha said of his company, which now has ties to about 50 clinics in the US and Canada, plus a few in Europe and Australia.\u003c/p>\n\u003cp>Vivid Vision is also working with UC Berkeley on improving depth perception in adults.\u003c/p>\n\u003cp>\u003cstrong>Finding Your Way\u003c/strong>\u003c/p>\n\u003cp>Then there are the people who have difficulty seeing at all.\u003c/p>\n\u003cp>OxSight, formerly known as VA-ST, is a startup out of the University of Oxford that makes applications for those with vision problems. Its SmartSpecs headset is built as a portable device for those who are legally blind or partially sighted.\u003c/p>\n\u003cp>SmartSpecs, which don't have a price just yet, boost the visibility of objects and faces by accentuating those objects and their edges against a darkened background. They even work in darkness, helping users find doorways or navigate around furniture. SmartSpecs' algorithms look for things like faces, including facial expressions, and text in real time.\u003c/p>\n\u003cp>\"I think the real trick is coming up with ways of delivering relevant information to the user without bombarding them with irrelevant info,\" said co-founder Stephen Hicks, who is also a university research lecturer and Royal Academy of Engineering enterprise fellow at Oxford.\u003c/p>\n\u003cp>SmartSpecs wants to give users more confidence and independence. It's set to launch mid 2017.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"We have the potential,\" he said, \"to make a dent in this feeling of isolation and helplessness that many visually impaired individuals experience.\"\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cem>This story is part of CNET's \"\u003ca href=\"https://www.cnet.com/tech-enabled/\" target=\"_blank\">Tech Enabled\u003c/a>\" series about the role technology plays in helping the disability community.\u003c/em>\u003c/p>\n\u003cp>Virtual reality and augmented reality are often associated with gaming. For many people, the allure has to do with the ability to visit an alien world or an exotic location -- to go someplace or do something they couldn't do otherwise. Bridging worlds seems to be a sweet spot for these technologies.\u003c/p>\n\u003cp>But VR and AR don't necessarily have to take users to far-off or fictional places. They also can better connect people with vision issues to the everyday world. Most take for granted the ability to sit at a computer at work and read the text on the screen, or freely and confidently walk around their home or office. These technologies aim to help people reclaim some of the vision they may have lost and to make it easier to function in the world.\u003c/p>\n\u003cp>The World Health Organization estimates that 246 million people have low vision, which includes blurry vision, tunnel vision or blind spots that can't be corrected. The WHO also estimates that 90 percent of those who have vision problems, not just low vision, tend to have low incomes.\u003c/p>\n\u003cp>Frank Werblin, professor of neuroscience at the University of California, Berkeley, is working to bring a lower-cost vision aid to the low-vision community. About a year and a half ago, he realized he could do this by piggybacking on virtual-reality technology.\u003c/p>\n\u003cfigure id=\"attachment_284322\" class=\"wp-caption aligncenter\" style=\"max-width: 719px\">\u003ca href=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/11/GearVR.png\">\u003cimg class=\"size-full wp-image-284322\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/11/GearVR.png\" alt=\"IrisVision is an app that magnifies whatever the user is looking at. It can be used with a Samsung Gear VR headset, pictured.. \" width=\"719\" height=\"477\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2016/11/GearVR.png 719w, https://ww2.kqed.org/app/uploads/sites/13/2016/11/GearVR-160x106.png 160w, https://ww2.kqed.org/app/uploads/sites/13/2016/11/GearVR-240x159.png 240w, https://ww2.kqed.org/app/uploads/sites/13/2016/11/GearVR-375x249.png 375w, https://ww2.kqed.org/app/uploads/sites/13/2016/11/GearVR-520x345.png 520w\" sizes=\"(max-width: 719px) 100vw, 719px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">IrisVision is an app that magnifies whatever the user is looking at. It can be used with a Samsung Gear VR headset, pictured.. \u003ccite>(Sarah Tew/CNET)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>IrisVision is an app that uses a Samsung Gear VR headset. It's responsive to the wearer's head movements and will magnify whatever they're directly looking at, while still providing a wide field of view. It's meant to help users better see the world, even read on a computer.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>One of the biggest challenges he's trying to address is cost. Wearable vision aids can go as high as $15,000.\u003c/p>\n\u003cp>\"There's a huge price gap between a magnifying glass, which you could buy for $25 or $50, and what these people could really use, which is a wearable portable device, which is many thousands of dollars,\" he said.\u003c/p>\n\u003cp>IrisVision is available online for $2,500, and in certain clinics around the country on an experimental basis. The price includes the software, headset and phone needed to power the Gear VR. Werblin, who for 44 years has been studying the way the retina functions, even took it to the California School for the Blind in Fremont, California.\u003c/p>\n\u003cp>\u003cstrong>Lazy Eye No More\u003c/strong>\u003c/p>\n\u003cp>Werblin's not the first to use virtual-reality hardware. James Blaha had dealt with amblyopia, or lazy eye, his whole life. In the process of researching the condition and tinkering with an early Oculus Rift VR headset, the now-founder and CEO of Vivid Vision, a company that makes therapy solutions for the condition, discovered he could strengthen his weaker eye using virtual reality.\u003c/p>\n\u003cp>Amblyopia occurs when one eye is far less effective than the other, and the brain tries to suppress it. This creates problems with depth perception that can make it hard to cross a busy street or drive, among other things. Conventional wisdom in the medical field has held that if the problem isn't fixed by the age of 8, it won't be fixed at all.\u003c/p>\n\u003cp>Blaha is proving that idea wrong. By cranking up the brightness in the goggles for just his weaker eye, he essentially forced his brain to stop suppressing the eye. He started seeing in 3D for the first time in his life, including seeing the keys on his keyboard in relief. These days, he has 90 percent normal depth perception.\u003c/p>\n\u003cp>\"We're sort of outside the context of VR, particularly for the patients who use it, and definitely for the doctors who are not playing any of the VR games, typically,\" Blaha said of his company, which now has ties to about 50 clinics in the US and Canada, plus a few in Europe and Australia.\u003c/p>\n\u003cp>Vivid Vision is also working with UC Berkeley on improving depth perception in adults.\u003c/p>\n\u003cp>\u003cstrong>Finding Your Way\u003c/strong>\u003c/p>\n\u003cp>Then there are the people who have difficulty seeing at all.\u003c/p>\n\u003cp>OxSight, formerly known as VA-ST, is a startup out of the University of Oxford that makes applications for those with vision problems. Its SmartSpecs headset is built as a portable device for those who are legally blind or partially sighted.\u003c/p>\n\u003cp>SmartSpecs, which don't have a price just yet, boost the visibility of objects and faces by accentuating those objects and their edges against a darkened background. They even work in darkness, helping users find doorways or navigate around furniture. SmartSpecs' algorithms look for things like faces, including facial expressions, and text in real time.\u003c/p>\n\u003cp>\"I think the real trick is coming up with ways of delivering relevant information to the user without bombarding them with irrelevant info,\" said co-founder Stephen Hicks, who is also a university research lecturer and Royal Academy of Engineering enterprise fellow at Oxford.\u003c/p>\n\u003cp>SmartSpecs wants to give users more confidence and independence. It's set to launch mid 2017.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"We have the potential,\" he said, \"to make a dent in this feeling of isolation and helplessness that many visually impaired individuals experience.\"\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Experimental Vaginal Ring Can Prevent HIV, But Stigma an Issue",
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"content": "\u003cp>An experimental vaginal ring that continuously releases the anti-HIV drug dapivirine has the potential to save lives.\u003c/p>\n\u003cp>But what's it going to do to sex lives?\u003c/p>\n\u003cp>That's a question researchers posed as part of the \u003ca href=\"https://www.nih.gov/news-events/news-releases/women-report-vaginal-ring-preventing-hiv-had-little-effect-sexual-intercourse\">ASPIRE study,\u003c/a> which tested the flexible silicone rings with women ages 18 to 45 living in Malawi, South Africa, Uganda and Zimbabwe. And it's a practical one, explains \u003ca href=\"https://www.niaid.nih.gov/about/director\">Dr. Anthony Fauci\u003c/a>, director of the National Institute of Allergy and Infectious Diseases, which funded ASPIRE. The less obtrusive a form of prevention is, the easier it is to convince people to use it.\u003c/p>\n\u003cp>\"Something not noticeable is great,\" Fauci says.\u003c/p>\n\u003cp>The encouraging news, gleaned from ASPIRE staff interviews with 214 of the 2,629 participants, is that sex with the ring wasn't much different — at least physically.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>What happens in people's bedrooms, however, is also psychological. Some women reported worrying about what would happen if their partners felt or discovered the ring, which is 2.2 inches in diameter and a third of an inch thick. They feared being interrogated in the middle of sex, despite the fact that Fauci notes, \"That's not what happens. It's less obvious than a diaphragm.\" But because of this anxiety, several women slipped out the ring prior to intimate contact, while others avoided certain positions.\u003c/p>\n\u003cp>Understanding these real world concerns is critical, says \u003ca href=\"http://www.ipmglobal.org/about/ipm-executive-leadership/zeda-f-rosenberg-ceo\">Zeda Rosenberg\u003c/a>, CEO of the nonprofit International Partnership for Microbicides (IPM), which developed the ring. From earlier studies, IPM learned that women could use the rings without a problem, and that they don't cause irritation or make the user more susceptible to yeast infections.\u003c/p>\n\u003cp>While the point of the ring is to help women gain control over their sexual health, what their partners think — or could think — also matters.\u003c/p>\n\u003cp>Indeed, virtually every option for HIV prevention comes with some partner baggage.\u003c/p>\n\u003cp>\"Condoms are problematic for women,\" Fauci explains. \"When women demand use of a condom, they can be subject to partner violence or rejection or stigma.\" Or their partners might flat out refuse to wear one. \"The man gets insulted and says he doesn't have HIV. That's baloney because sometimes men are infected,\" Fauci adds.\u003c/p>\n\u003cp>Different challenges have emerged with the rollout of oral pre-exposure prophylaxis (or PrEP). \"It's so easy to take a single pill every day,\" Fauci says. \"But some people don't want to do it, even though it's 98, maybe 100 percent effective.\" One reason? \"Maybe the partner finds the pills,\" he says. That can lead to questions about what the meds are for, and whether the women on them might already be HIV positive.\u003c/p>\n\u003cp>The ring, when used as directed, is inserted just once a month and left in place\u003cstrong>, \u003c/strong>then taken out and replaced with a new ring for the next month. So that will hopefully make it an appealing option for women, Rosenberg says, adding that her group is already working on the next generation of ring. It will also provide contraception, which may help women make a stronger case for using it. \"Partners might be more forgiving because it's not necessarily passing judgment on the man,\" she explains. Women can claim they're trying to avoid pregnancy rather than infection.\u003c/p>\n\u003cp>Because, as Rosenberg says, \"there are going to be as many scenarios as there are people,\" the most important thing is to offer choices — and as much information as possible.\u003c/p>\n\u003cp>That will require more research. Overall results from ASPIRE showed that among the entire group of participants using a dapivirine ring, the risk of HIV infection dropped 27 percent. But when researchers separated out the participants who had used the ring consistently, they got much more impressive numbers: Risk of HIV infection fell by around 75 percent.\u003c/p>\n\u003cp>It was not hard to tell who kept the ring in and who didn't. When participants came in for their monthly visit, researchers could see how much of the drug was left in the ring, Rosenberg explains. The more dapivirine, the less time it was inside a woman's vagina.\u003c/p>\n\u003cp>\"We think it works much better if you use it all of the time,\" Rosenberg says.\u003c/p>\n\u003cp>But she understands why only about 25 percent of ASPIRE participants did that. \"In trials and real life, people are not perfectly adherent,\" she says, noting that's particularly true of healthy populations, who don't have the same incentives for following doctor's orders. And women in ASPIRE didn't know whether they had an active ring or a placebo.\u003c/p>\n\u003cp>As for the 25 percent who barely used it at all? Rosenberg suspects that they may have signed up for ASPIRE to receive the other benefits, which included high quality health care without long waits.\u003c/p>\n\u003cp>Other HIV researchers find these results promising, says \u003ca href=\"https://www.mailman.columbia.edu/people/our-faculty/jj2158\">Dr. Jessica Justman\u003c/a>, an associate professor of epidemiology at Columbia University's Mailman School of Public Health. \"If you don't use something, it doesn't work. That's not a surprise,\" says Justman, who has learned through her clinical research studies that it takes time for people to accept something that's different.\u003c/p>\n\u003cp>Ideally, the ring would have offered full protection even in the cases where women just removed it occasionally, but that doesn't seem to be the case. \"The ring isn't designed to be taken in and out. That needs to be part of the messaging,\" Justman says.\u003c/p>\n\u003cp>And it will be, Rosenberg notes. Research on the ring continues in Africa with the HOPE study, which began this summer and is also funded by NIAID. The difference, Rosenberg explains, is that this is an \"open-label\" study, which means women will be told there are no placebos in the mix.\u003c/p>\n\u003cp>Under these conditions, Rosenberg expects more participants will use the ring consistently. There will still be some who don't, she adds. \"If I were a woman in the study and my partner went away for a month, I might take it out,\" she says.\u003c/p>\n\u003cp>There will likely be other women who continue to remove it during sex. Researchers don't yet know exactly how long the drugs will stay in the vaginal tissue, and it's virtually impossible to pinpoint the moment of infection.\u003c/p>\n\u003cp>It's also tough to say when the ring will be available to the general public, but Rosenberg is hopeful for a 2019 rollout.\u003c/p>\n\u003cp>Expect to see a host of HIV prevention options on the market within the next five years, says Justman, who has been working on studies to see if anti-HIV injections are safe. A long-acting shot would have some of the same benefits as the ring — namely, that a user doesn't need to remember to do something every day or right before sexual contact. For women anxious about their partner's response, the fact that it's virtually undetectable might be appealing.\u003c/p>\n\u003cp>\"But some people don't like needles,\" Justman says. Plus, a shot will require a clinic visit, while women can insert a ring by themselves.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>So Justman sees a place for both choices, as well as a continued need to study sexual behavior. That means researchers will need to talk to a lot more women — and men — about their most intimate interactions.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Experimental+Vaginal+Ring+Fights+HIV%2C+But+Will+Women+Wear+It%3F&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>An experimental vaginal ring that continuously releases the anti-HIV drug dapivirine has the potential to save lives.\u003c/p>\n\u003cp>But what's it going to do to sex lives?\u003c/p>\n\u003cp>That's a question researchers posed as part of the \u003ca href=\"https://www.nih.gov/news-events/news-releases/women-report-vaginal-ring-preventing-hiv-had-little-effect-sexual-intercourse\">ASPIRE study,\u003c/a> which tested the flexible silicone rings with women ages 18 to 45 living in Malawi, South Africa, Uganda and Zimbabwe. And it's a practical one, explains \u003ca href=\"https://www.niaid.nih.gov/about/director\">Dr. Anthony Fauci\u003c/a>, director of the National Institute of Allergy and Infectious Diseases, which funded ASPIRE. The less obtrusive a form of prevention is, the easier it is to convince people to use it.\u003c/p>\n\u003cp>\"Something not noticeable is great,\" Fauci says.\u003c/p>\n\u003cp>The encouraging news, gleaned from ASPIRE staff interviews with 214 of the 2,629 participants, is that sex with the ring wasn't much different — at least physically.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>What happens in people's bedrooms, however, is also psychological. Some women reported worrying about what would happen if their partners felt or discovered the ring, which is 2.2 inches in diameter and a third of an inch thick. They feared being interrogated in the middle of sex, despite the fact that Fauci notes, \"That's not what happens. It's less obvious than a diaphragm.\" But because of this anxiety, several women slipped out the ring prior to intimate contact, while others avoided certain positions.\u003c/p>\n\u003cp>Understanding these real world concerns is critical, says \u003ca href=\"http://www.ipmglobal.org/about/ipm-executive-leadership/zeda-f-rosenberg-ceo\">Zeda Rosenberg\u003c/a>, CEO of the nonprofit International Partnership for Microbicides (IPM), which developed the ring. From earlier studies, IPM learned that women could use the rings without a problem, and that they don't cause irritation or make the user more susceptible to yeast infections.\u003c/p>\n\u003cp>While the point of the ring is to help women gain control over their sexual health, what their partners think — or could think — also matters.\u003c/p>\n\u003cp>Indeed, virtually every option for HIV prevention comes with some partner baggage.\u003c/p>\n\u003cp>\"Condoms are problematic for women,\" Fauci explains. \"When women demand use of a condom, they can be subject to partner violence or rejection or stigma.\" Or their partners might flat out refuse to wear one. \"The man gets insulted and says he doesn't have HIV. That's baloney because sometimes men are infected,\" Fauci adds.\u003c/p>\n\u003cp>Different challenges have emerged with the rollout of oral pre-exposure prophylaxis (or PrEP). \"It's so easy to take a single pill every day,\" Fauci says. \"But some people don't want to do it, even though it's 98, maybe 100 percent effective.\" One reason? \"Maybe the partner finds the pills,\" he says. That can lead to questions about what the meds are for, and whether the women on them might already be HIV positive.\u003c/p>\n\u003cp>The ring, when used as directed, is inserted just once a month and left in place\u003cstrong>, \u003c/strong>then taken out and replaced with a new ring for the next month. So that will hopefully make it an appealing option for women, Rosenberg says, adding that her group is already working on the next generation of ring. It will also provide contraception, which may help women make a stronger case for using it. \"Partners might be more forgiving because it's not necessarily passing judgment on the man,\" she explains. Women can claim they're trying to avoid pregnancy rather than infection.\u003c/p>\n\u003cp>Because, as Rosenberg says, \"there are going to be as many scenarios as there are people,\" the most important thing is to offer choices — and as much information as possible.\u003c/p>\n\u003cp>That will require more research. Overall results from ASPIRE showed that among the entire group of participants using a dapivirine ring, the risk of HIV infection dropped 27 percent. But when researchers separated out the participants who had used the ring consistently, they got much more impressive numbers: Risk of HIV infection fell by around 75 percent.\u003c/p>\n\u003cp>It was not hard to tell who kept the ring in and who didn't. When participants came in for their monthly visit, researchers could see how much of the drug was left in the ring, Rosenberg explains. The more dapivirine, the less time it was inside a woman's vagina.\u003c/p>\n\u003cp>\"We think it works much better if you use it all of the time,\" Rosenberg says.\u003c/p>\n\u003cp>But she understands why only about 25 percent of ASPIRE participants did that. \"In trials and real life, people are not perfectly adherent,\" she says, noting that's particularly true of healthy populations, who don't have the same incentives for following doctor's orders. And women in ASPIRE didn't know whether they had an active ring or a placebo.\u003c/p>\n\u003cp>As for the 25 percent who barely used it at all? Rosenberg suspects that they may have signed up for ASPIRE to receive the other benefits, which included high quality health care without long waits.\u003c/p>\n\u003cp>Other HIV researchers find these results promising, says \u003ca href=\"https://www.mailman.columbia.edu/people/our-faculty/jj2158\">Dr. Jessica Justman\u003c/a>, an associate professor of epidemiology at Columbia University's Mailman School of Public Health. \"If you don't use something, it doesn't work. That's not a surprise,\" says Justman, who has learned through her clinical research studies that it takes time for people to accept something that's different.\u003c/p>\n\u003cp>Ideally, the ring would have offered full protection even in the cases where women just removed it occasionally, but that doesn't seem to be the case. \"The ring isn't designed to be taken in and out. That needs to be part of the messaging,\" Justman says.\u003c/p>\n\u003cp>And it will be, Rosenberg notes. Research on the ring continues in Africa with the HOPE study, which began this summer and is also funded by NIAID. The difference, Rosenberg explains, is that this is an \"open-label\" study, which means women will be told there are no placebos in the mix.\u003c/p>\n\u003cp>Under these conditions, Rosenberg expects more participants will use the ring consistently. There will still be some who don't, she adds. \"If I were a woman in the study and my partner went away for a month, I might take it out,\" she says.\u003c/p>\n\u003cp>There will likely be other women who continue to remove it during sex. Researchers don't yet know exactly how long the drugs will stay in the vaginal tissue, and it's virtually impossible to pinpoint the moment of infection.\u003c/p>\n\u003cp>It's also tough to say when the ring will be available to the general public, but Rosenberg is hopeful for a 2019 rollout.\u003c/p>\n\u003cp>Expect to see a host of HIV prevention options on the market within the next five years, says Justman, who has been working on studies to see if anti-HIV injections are safe. A long-acting shot would have some of the same benefits as the ring — namely, that a user doesn't need to remember to do something every day or right before sexual contact. For women anxious about their partner's response, the fact that it's virtually undetectable might be appealing.\u003c/p>\n\u003cp>\"But some people don't like needles,\" Justman says. Plus, a shot will require a clinic visit, while women can insert a ring by themselves.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>So Justman sees a place for both choices, as well as a continued need to study sexual behavior. That means researchers will need to talk to a lot more women — and men — about their most intimate interactions.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Experimental+Vaginal+Ring+Fights+HIV%2C+But+Will+Women+Wear+It%3F&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Is Your Company Wasting Food? App Makes Donations Easy",
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"content": "\u003cp>https://www.youtube.com/watch?v=472-xQt3Lws&feature=youtu.be\u003c/p>\n\u003cp>The latest effort to get excess food to people who need it is an app that arranges for donations from Bay Are companies and organizations that would ordinarily toss leftover lunches or catering trays of cheese and crackers.\u003c/p>\n\u003cp>Why is this important?\u003c/p>\n\u003cp>The U.S. Dept. of Agriculture defines \"\u003ca href=\"http://www.ers.usda.gov/topics/food-nutrition-assistance/food-security-in-the-us/key-statistics-graphics.aspx#foodsecure\" target=\"_blank\">food insecurity\u003c/a>\" as a household's uncertainty over whether there will be enough for everyone to eat.\u003c/p>\n\u003cp>This is not something people always think about--it has never even crossed my mind that I or anyone in my family might have to go without food for any period of time. But for tens of millions of Americans, that kind of stability may sound like an unattainable luxury.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>According to the USDA, 15.8 million households were food insecure in 2015. About 6.3 million of those had to limit the amount of food household members ate. While adults usually bear the burden of disruptions in meals, 274,000 households last year included one or more children who, at some point, had to go without food.\u003c/p>\n\u003cp>Which brings us to the app, called Copia. Komal Ahmad, 26, the company's founder, told KQED Newsroom's Thuy Vu on Friday (see the video above) that the idea came to her a few years ago. Seems she was walking down Telegraph Avenue in Berkeley, California, when she saw a homeless man begging for food. So she bought him lunch -- turned out he was back from his second tour in Iraq and had been waiting weeks for his VA benefits to kick in.\u003c/p>\n\u003cp>\"Right across the street,\" Ahmad, 26, says, \"(UC) Berkeley's dining hall is throwing away thousands of pounds of edible food.\" She calls that ironic proximity the world's \"largest and dumbest problem,\" a matter of distribution, not scarcity. So she created Copia, which allows a company or nonprofit with extra food on its hands to connect with an organization that will distribute it to those in need.\u003c/p>\n\u003cp>\"If you're Google and you have a bunch of food at the end of the day, you would take a picture of the food,\" Ahmad told Vu, describing the donation processs. The company then specifies a time for pickup, with the donation sent to a virtual marketplace to be matched with the nearest food nonprofit. Copia sends a driver to cart the food from donor to donee, and later sends data and analytics to the former; that can help reduce future overpurchasing and disposal costs, Ahmad said.\u003c/p>\n\u003cp>Copia charges businesses $25 per pickup on an on-demand basis . For a recurring pick up, the price is .30-.50 cents per pound, with lower prices charged for more regular donations.\u003c/p>\n\u003cp>Donors are provided with a receipt that can be used for tax reduction. Ahmad said the financial benefit from the deduction is more than the cost of the service, making it \"money you otherwise would have left on the table or worse, in the trash.\"\u003c/p>\n\u003cp>Dana Gunders, a scientist with the Natural Resources Defense Council, \u003ca href=\"https://ww2.kqed.org/news/2015/12/25/big-think-making-food-waste-a-social-taboo/\">told KQED \u003c/a>last year that food waste should, like smoking, become \"a social taboo.\" Her 2012 \u003ca href=\"https://www.nrdc.org/sites/default/files/wasted-food-IP.pdf\" target=\"_blank\">report\u003c/a> on the topic detailed the ways that up to 40 percent of food in America, \"from farm to fork to landfill,\" goes uneaten. The report recommended encouraging \"innovation in online solutions and new technologies\" to help solve the problem.\u003c/p>\n\u003cp>Copia has certainly done that. But as the \u003ca href=\"http://www.sfchronicle.com/business/article/Copia-Food-Runners-recover-leftovers-to-feed-the-6871225.php\" target=\"_blank\">San Francisco Chronicle \u003c/a>noted earlier this year, many local groups, such as one called\u003ca href=\"http://www.foodrunners.org/\" target=\"_blank\"> Food Runners\u003c/a>, will pick up donated food for free.\u003c/p>\n\u003cp>And as Joel Berg, executive director of Hunger Free America, told the Chronicle, a tech solution doesn't get to the root causes of hunger: not enough jobs, low wages and an inadequate safety net.\u003c/p>\n\u003cp>\"There’s a tendency of tech people to think they can fix every possible problem with a snappy new app,\" he said. \"It’s false to think this is as simple as Silicon Valley fixing a taxi-hailing problem.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Meanwhile, Copia's Ahmad says hundreds of businesses and nonprofits have used the company's platform to feed 1 million people across the Bay Area. She said the company has received more than 60,000 requests from around the world to expand its service into areas outside its home turf.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\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/472-xQt3Lws'\n title='//www.youtube.com/embed/472-xQt3Lws'\n allowfullscreen='true'\n style='border:0;'>\u003c/iframe>\n \u003c/span>\n \u003c/span>\u003c/p>\u003cp>\u003cp>The latest effort to get excess food to people who need it is an app that arranges for donations from Bay Are companies and organizations that would ordinarily toss leftover lunches or catering trays of cheese and crackers.\u003c/p>\n\u003cp>Why is this important?\u003c/p>\n\u003cp>The U.S. Dept. of Agriculture defines \"\u003ca href=\"http://www.ers.usda.gov/topics/food-nutrition-assistance/food-security-in-the-us/key-statistics-graphics.aspx#foodsecure\" target=\"_blank\">food insecurity\u003c/a>\" as a household's uncertainty over whether there will be enough for everyone to eat.\u003c/p>\n\u003cp>This is not something people always think about--it has never even crossed my mind that I or anyone in my family might have to go without food for any period of time. But for tens of millions of Americans, that kind of stability may sound like an unattainable luxury.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>According to the USDA, 15.8 million households were food insecure in 2015. About 6.3 million of those had to limit the amount of food household members ate. While adults usually bear the burden of disruptions in meals, 274,000 households last year included one or more children who, at some point, had to go without food.\u003c/p>\n\u003cp>Which brings us to the app, called Copia. Komal Ahmad, 26, the company's founder, told KQED Newsroom's Thuy Vu on Friday (see the video above) that the idea came to her a few years ago. Seems she was walking down Telegraph Avenue in Berkeley, California, when she saw a homeless man begging for food. So she bought him lunch -- turned out he was back from his second tour in Iraq and had been waiting weeks for his VA benefits to kick in.\u003c/p>\n\u003cp>\"Right across the street,\" Ahmad, 26, says, \"(UC) Berkeley's dining hall is throwing away thousands of pounds of edible food.\" She calls that ironic proximity the world's \"largest and dumbest problem,\" a matter of distribution, not scarcity. So she created Copia, which allows a company or nonprofit with extra food on its hands to connect with an organization that will distribute it to those in need.\u003c/p>\n\u003cp>\"If you're Google and you have a bunch of food at the end of the day, you would take a picture of the food,\" Ahmad told Vu, describing the donation processs. The company then specifies a time for pickup, with the donation sent to a virtual marketplace to be matched with the nearest food nonprofit. Copia sends a driver to cart the food from donor to donee, and later sends data and analytics to the former; that can help reduce future overpurchasing and disposal costs, Ahmad said.\u003c/p>\n\u003cp>Copia charges businesses $25 per pickup on an on-demand basis . For a recurring pick up, the price is .30-.50 cents per pound, with lower prices charged for more regular donations.\u003c/p>\n\u003cp>Donors are provided with a receipt that can be used for tax reduction. Ahmad said the financial benefit from the deduction is more than the cost of the service, making it \"money you otherwise would have left on the table or worse, in the trash.\"\u003c/p>\n\u003cp>Dana Gunders, a scientist with the Natural Resources Defense Council, \u003ca href=\"https://ww2.kqed.org/news/2015/12/25/big-think-making-food-waste-a-social-taboo/\">told KQED \u003c/a>last year that food waste should, like smoking, become \"a social taboo.\" Her 2012 \u003ca href=\"https://www.nrdc.org/sites/default/files/wasted-food-IP.pdf\" target=\"_blank\">report\u003c/a> on the topic detailed the ways that up to 40 percent of food in America, \"from farm to fork to landfill,\" goes uneaten. The report recommended encouraging \"innovation in online solutions and new technologies\" to help solve the problem.\u003c/p>\n\u003cp>Copia has certainly done that. But as the \u003ca href=\"http://www.sfchronicle.com/business/article/Copia-Food-Runners-recover-leftovers-to-feed-the-6871225.php\" target=\"_blank\">San Francisco Chronicle \u003c/a>noted earlier this year, many local groups, such as one called\u003ca href=\"http://www.foodrunners.org/\" target=\"_blank\"> Food Runners\u003c/a>, will pick up donated food for free.\u003c/p>\n\u003cp>And as Joel Berg, executive director of Hunger Free America, told the Chronicle, a tech solution doesn't get to the root causes of hunger: not enough jobs, low wages and an inadequate safety net.\u003c/p>\n\u003cp>\"There’s a tendency of tech people to think they can fix every possible problem with a snappy new app,\" he said. \"It’s false to think this is as simple as Silicon Valley fixing a taxi-hailing problem.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Meanwhile, Copia's Ahmad says hundreds of businesses and nonprofits have used the company's platform to feed 1 million people across the Bay Area. She said the company has received more than 60,000 requests from around the world to expand its service into areas outside its home turf.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>A divorced man and woman must mutually consent to using embryos that were frozen and stored while married, a Missouri appellate court has ruled in declaring the embryos marital property, not humans with constitutional rights.\u003c/p>\n\u003cp>The Missouri Court of Appeals' 2-1 ruling Tuesday upheld a St. Louis County judge's 2015 finding that Jalesia \"Jasha\" McQueen and Justin Gadberry maintain joint custody of the embryos, which have been frozen since 2007. The couple separated in 2010 and divorced last year; dissolution proceedings were drawn out by their dispute over the embryos.\u003c/p>\n\u003cp>McQueen and her attorney said Wednesday they will appeal, first seeking a rehearing by the appellate court and, if necessary, taking the matter to the Missouri Supreme Court.\u003c/p>\n\u003cp>McQueen, 44, sued Gadberry because she wanted to use embryos to have more children. But her 34-year-old former spouse doesn't want to have any more children with McQueen, doesn't believe he should be required to reproduce and has said through his attorney he would be willing to donate the embryos for research or to an infertile couple or have them destroyed.\u003c/p>\n\u003cp>The majority ruling, written by Appeals Judge Robert Clayton III, said the court \"recognizes the sensitive nature of this case and the differing personal beliefs it evokes — ethical, religious and philosophical — pertaining to scientific advancements in reproductive technology, procreation choice, and the age-old and disputed question of when life begins.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"We are only required to decide whether frozen pre-embryos have the legal status of children under our dissolution of marriage statutes,\" Clayton wrote.\u003c/p>\n\u003cp>He also noted that McQueen's bid to apply Missouri law defining life as beginning at conception is at odds with U.S. Supreme Court decisions protecting Gadberry's rights to privacy, freedom from government interference and not to procreate.\u003c/p>\n\u003cp>Awarding joint custody, Clayton concluded, \"subjects neither party to any unwarranted governmental intrusion but leaves the intimate decision of whether to potentially have more children to the parties alone.\"\u003c/p>\n\u003cp>Dissenting Judge James Dowd countered that \"Missouri law makes one thing abundantly clear: The two embryos at issue in this case are human beings with protectable interests in life, health and well-being.\"\u003c/p>\n\u003cp>\"Further, I disagree with the majority's presumption that Gadberry's interests outweigh those of his unborn children,\" Dowd added.\u003c/p>\n\u003cp>McQueen, a lawyer who with Gadberry had twin 9-year-old boys through in vitro fertilization, said the ruling left her \"somewhat disgusted.\"\u003c/p>\n\u003cp>It \"ignored Missouri statutes that say life begins at conception, and I think that's a disgrace for the judicial arena and for the people it's affecting, like me,\" she told The Associated Press. \"All of the statutes point to one thing — the preservation of life. For them to say otherwise is counter to the point.\"\u003c/p>\n\u003cp>Her attorney, Steve Clark, said the two judges who ruled against McQueen \"essentially created law out of thin air\" by casting the embryos as property, and \"they do not and cannot point to any holding of the U.S Supreme Court that says there's some sort of right not to procreate.\"\u003c/p>\n\u003cp>Gadberry's attorney countered that \"my client should not be forced to become a parent against his will.\" Compelling a frozen embryo to be implanted without consent of both people who created it, Tim Schlesinger added, \"subjects private citizens to unwarranted governmental intrusion.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"What about the people who have six, eight or 10 frozen embryos? Are they required to have six, eight or 10 children?\" he said.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>A divorced man and woman must mutually consent to using embryos that were frozen and stored while married, a Missouri appellate court has ruled in declaring the embryos marital property, not humans with constitutional rights.\u003c/p>\n\u003cp>The Missouri Court of Appeals' 2-1 ruling Tuesday upheld a St. Louis County judge's 2015 finding that Jalesia \"Jasha\" McQueen and Justin Gadberry maintain joint custody of the embryos, which have been frozen since 2007. The couple separated in 2010 and divorced last year; dissolution proceedings were drawn out by their dispute over the embryos.\u003c/p>\n\u003cp>McQueen and her attorney said Wednesday they will appeal, first seeking a rehearing by the appellate court and, if necessary, taking the matter to the Missouri Supreme Court.\u003c/p>\n\u003cp>McQueen, 44, sued Gadberry because she wanted to use embryos to have more children. But her 34-year-old former spouse doesn't want to have any more children with McQueen, doesn't believe he should be required to reproduce and has said through his attorney he would be willing to donate the embryos for research or to an infertile couple or have them destroyed.\u003c/p>\n\u003cp>The majority ruling, written by Appeals Judge Robert Clayton III, said the court \"recognizes the sensitive nature of this case and the differing personal beliefs it evokes — ethical, religious and philosophical — pertaining to scientific advancements in reproductive technology, procreation choice, and the age-old and disputed question of when life begins.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"We are only required to decide whether frozen pre-embryos have the legal status of children under our dissolution of marriage statutes,\" Clayton wrote.\u003c/p>\n\u003cp>He also noted that McQueen's bid to apply Missouri law defining life as beginning at conception is at odds with U.S. Supreme Court decisions protecting Gadberry's rights to privacy, freedom from government interference and not to procreate.\u003c/p>\n\u003cp>Awarding joint custody, Clayton concluded, \"subjects neither party to any unwarranted governmental intrusion but leaves the intimate decision of whether to potentially have more children to the parties alone.\"\u003c/p>\n\u003cp>Dissenting Judge James Dowd countered that \"Missouri law makes one thing abundantly clear: The two embryos at issue in this case are human beings with protectable interests in life, health and well-being.\"\u003c/p>\n\u003cp>\"Further, I disagree with the majority's presumption that Gadberry's interests outweigh those of his unborn children,\" Dowd added.\u003c/p>\n\u003cp>McQueen, a lawyer who with Gadberry had twin 9-year-old boys through in vitro fertilization, said the ruling left her \"somewhat disgusted.\"\u003c/p>\n\u003cp>It \"ignored Missouri statutes that say life begins at conception, and I think that's a disgrace for the judicial arena and for the people it's affecting, like me,\" she told The Associated Press. \"All of the statutes point to one thing — the preservation of life. For them to say otherwise is counter to the point.\"\u003c/p>\n\u003cp>Her attorney, Steve Clark, said the two judges who ruled against McQueen \"essentially created law out of thin air\" by casting the embryos as property, and \"they do not and cannot point to any holding of the U.S Supreme Court that says there's some sort of right not to procreate.\"\u003c/p>\n\u003cp>Gadberry's attorney countered that \"my client should not be forced to become a parent against his will.\" Compelling a frozen embryo to be implanted without consent of both people who created it, Tim Schlesinger added, \"subjects private citizens to unwarranted governmental intrusion.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"What about the people who have six, eight or 10 frozen embryos? Are they required to have six, eight or 10 children?\" he said.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Not to beat a dead unicorn, but this is a pretty interesting story from \u003ca href=\"http://www.wsj.com/articles/theranos-whistleblower-shook-the-companyand-his-family-1479335963\" target=\"_blank\">The Wall Street Journal\u003c/a>, identifying the Theranos employee who squealed to the newspaper and to New York state officials by alleging company manipulation of blood test results. He's Tyler Shultz, 26-year-old grandson of Republican éminence grise George Shultz, the U.S. Secretary of State under Ronald Reagan. The elder Shultz was a Theranos board member from 2011-15, until he was shifted to an advisory position as part of the company's shift from high-profile bigwigs on its board to people with actual medical experience.\u003c/p>\n\u003cp>The Journal reports Tyler Shultz found that the company's test results \"varied widely when tests were rerun with the same blood samples. To reduce that variability, Theranos routinely discarded outlying values from validation reports it compiled, he says.\"\u003c/p>\n\u003cp>Shultz told the Journal he first complained about the practice to CEO Elizabeth Holmes. She referred him to a VP in charge of biostatistics, who told him the ambiguous results were later clarified by subsequent tests. After Shultz filed a complaint with New York State, under an alias, Theranos accused him of leaking trade secrets and violating his non-disclosure agreement. It also sent lawyers to pressure him to identify other employee whistleblowers, and hired private investigators to follow him, he said.\u003c/p>\n\u003cp>Shultz said he and his family have spent more than $400,000 in legal fees. The Journal says he is cooperating with a federal investigation of Theranos.\u003c/p>\n\u003cp>Theranos, a blood testing company that rode to prominence on the claims of its ability to perform dozens of blood tests from a few drops of blood, is now approaching Enron-level status, at least as a brand name. It's been forced to exit the consumer blood-testing business on the heels of severe government penalties for deficiencies and inaccuracies at its lab; it's the subject of a multitude of lawsuits by its former customers, as well as one by former business partner Walgreens; and it's under investigation by several government agencies.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>We reached out to Theranos and to p.r. firm Hill & Knowlton, which is working with the company, but both declined to comment.\u003c/p>\n\u003cp>Read the entire Wall Street Journal article below. Here's our\u003ca href=\"https://ww2.kqed.org/futureofyou/2016/07/14/the-rise-and-fall-of-theranos-a-cartoon-history/\" target=\"_blank\"> cartoon history of Theranos i\u003c/a>f you want some background. And by the way, there's still at least \u003ca href=\"http://www.cnbc.com/2016/11/15/theranos-ceo-elizabeth-holmes-is-a-victim-venture-capitalist-tim-draper-says.html\" target=\"_blank\">one true believer left\u003c/a> in the Theranos camp ...\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>http://www.wsj.com/articles/theranos-whistleblower-shook-the-companyand-his-family-1479335963\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Not to beat a dead unicorn, but this is a pretty interesting story from \u003ca href=\"http://www.wsj.com/articles/theranos-whistleblower-shook-the-companyand-his-family-1479335963\" target=\"_blank\">The Wall Street Journal\u003c/a>, identifying the Theranos employee who squealed to the newspaper and to New York state officials by alleging company manipulation of blood test results. He's Tyler Shultz, 26-year-old grandson of Republican éminence grise George Shultz, the U.S. Secretary of State under Ronald Reagan. The elder Shultz was a Theranos board member from 2011-15, until he was shifted to an advisory position as part of the company's shift from high-profile bigwigs on its board to people with actual medical experience.\u003c/p>\n\u003cp>The Journal reports Tyler Shultz found that the company's test results \"varied widely when tests were rerun with the same blood samples. To reduce that variability, Theranos routinely discarded outlying values from validation reports it compiled, he says.\"\u003c/p>\n\u003cp>Shultz told the Journal he first complained about the practice to CEO Elizabeth Holmes. She referred him to a VP in charge of biostatistics, who told him the ambiguous results were later clarified by subsequent tests. After Shultz filed a complaint with New York State, under an alias, Theranos accused him of leaking trade secrets and violating his non-disclosure agreement. It also sent lawyers to pressure him to identify other employee whistleblowers, and hired private investigators to follow him, he said.\u003c/p>\n\u003cp>Shultz said he and his family have spent more than $400,000 in legal fees. The Journal says he is cooperating with a federal investigation of Theranos.\u003c/p>\n\u003cp>Theranos, a blood testing company that rode to prominence on the claims of its ability to perform dozens of blood tests from a few drops of blood, is now approaching Enron-level status, at least as a brand name. It's been forced to exit the consumer blood-testing business on the heels of severe government penalties for deficiencies and inaccuracies at its lab; it's the subject of a multitude of lawsuits by its former customers, as well as one by former business partner Walgreens; and it's under investigation by several government agencies.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>We reached out to Theranos and to p.r. firm Hill & Knowlton, which is working with the company, but both declined to comment.\u003c/p>\n\u003cp>Read the entire Wall Street Journal article below. Here's our\u003ca href=\"https://ww2.kqed.org/futureofyou/2016/07/14/the-rise-and-fall-of-theranos-a-cartoon-history/\" target=\"_blank\"> cartoon history of Theranos i\u003c/a>f you want some background. And by the way, there's still at least \u003ca href=\"http://www.cnbc.com/2016/11/15/theranos-ceo-elizabeth-holmes-is-a-victim-venture-capitalist-tim-draper-says.html\" target=\"_blank\">one true believer left\u003c/a> in the Theranos camp ...\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>http://www.wsj.com/articles/theranos-whistleblower-shook-the-companyand-his-family-1479335963\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>When the abortion pills arrived in her mailbox this summer, she felt anxious but also in control, knowing she could end her pregnancy entirely in the privacy of her own home.\u003c/p>\n\u003caside class=\"pullquote alignright\">'I was happy that I was going to be able to do it myself and I did not have a nurse there or doctors there staring at me and judging me.'\u003c/aside>\n\u003cp>“I was happy that I was going to be able to do it myself and I did not have a nurse there or doctors there staring at me and judging me,” she said, asking to be identified only by her middle name, Marie, because she did not want people outside her immediate family to know about her abortion.\u003c/p>\n\u003cp>Marie is part of a small but closely watched research effort to determine whether medical abortions — those induced by medicine instead of surgery — can be done safely through an online consultation with a doctor and drugs mailed to a woman’s home.\u003c/p>\n\u003cp>At a time when access to abortion is being restricted on many fronts, advocates say being able to terminate a pregnancy through telemedicine and mail-order drugs would provide a welcome new option for women. Opponents of abortion find the concept dangerous and deeply disturbing.\u003c/p>\n\u003cp>The idea builds on a trend that is helping women obtain birth control more easily. A growing number of smartphone apps and websites now make it possible to get prescription contraceptives without visiting a doctor’s office first. The pills Marie and the other women received through the study are not allowed for sale in pharmacies and are usually available only at hospitals and abortion clinics.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Australia and the Canadian province of British Columbia allow women to get abortion pills by mail after consulting with a physician or other health care provider via phone or the internet. Several international organizations offer mail service in countries where abortion is otherwise unavailable or severely restricted. The oldest group, Women on Web, based in the Netherlands, has provided abortion medications to about 50,000 women in 130 countries since 2006. The service is not available in the United States, and the Food and Drug Administration warns against buying the drugs over the internet.\u003c/p>\n\u003cp>Having the pills delivered to her home in Hawaii meant that Marie could avoid the cost and time of traveling by plane to the nearest abortion clinic, over 100 miles away in Honolulu or Maui. Once she received them, she set the package aside for a week in her bedroom, waiting until she could schedule time off from her job at McDonald’s.\u003c/p>\n\u003cp>\u003cstrong>Over in Three Hours\u003c/strong>\u003c/p>\n\u003cp>The first pill, as expected, had little effect. The next morning, with her mother at her home to watch her toddler, she took the second. Almost immediately, the bleeding and cramping began. Within three hours, her eight-week pregnancy was over. She described the pain as a five on a 10-point scale. That night she cooked dinner for her family, and the next day she went back to work.\u003c/p>\n\u003cp>The study Marie participated in is being conducted in four states — Hawaii, New York, Oregon and Washington. It is being funded and organized by Gynuity Health Projects, a nonprofit research group focused on reproductive health services that seeks to improve women’s access to medical abortions. The FDA has allowed the experiment. Women learn about it when contacting the abortion clinics in the study and other health providers who are aware of the trial and the website telabortion.org.\u003c/p>\n\u003cp>Danco Laboratories, the company that makes the pills, has no plans to seek wider distribution of the medication either through mail-order pharmacies or physical pharmacies, a spokeswoman said. It would have to seek the FDA’s permission to do so; the agency can also ask companies to change how their drugs are distributed.\u003c/p>\n\u003cp>“Abortion is a politically charged issue in this country, and there is an extra degree of caution,” said the spokeswoman, Abby Long, explaining that research would be needed to support changing the drug’s distribution.\u003c/p>\n\u003cp>Of the first 12 women who participated in the study, all in Hawaii, 11 reported they had no complications and one did not take the pills, researchers said. Ten who completed surveys afterward said they were satisfied with the service and would recommend it to a friend, according to the researchers.\u003c/p>\n\u003cp>“It’s absolutely an important step forward to expanding access to abortion that is safe and effective and creating options for women,” said Susan Wood, director of the Jacobs Institute of Women’s Health at George Washington University, in Washington, D.C. She was not involved in the study.\u003c/p>\n\u003cp>\u003cstrong>Outraged\u003c/strong>\u003c/p>\n\u003cp>Anti-abortion groups are outraged by the experiment.\u003c/p>\n\u003cp>“We have grave concerns about handing out dangerous, life-ending drugs without medical supervision because women face great risks for chemical abortions,” said Kristi Hamrick, spokeswoman for Americans United for Life.\u003c/p>\n\u003cp>Carol Tobias, president of the National Right to Life Committee, also raised safety concerns.\u003c/p>\n\u003cp>“If pills are sent through the mail, who are they supposed to call if they have a problem?” she said.\u003c/p>\n\u003cp>“There are serious downsides from the pills,” she said, adding, “and just talking to someone over a computer and sending pills in the mail, to me, that is just reckless.”\u003c/p>\n\u003cp>The process does not allow women to avoid the doctor’s office entirely. Using a video hookup on a home computer, a woman first consults with a doctor (or other clinician such as a nurse practitioner) at one of three participating abortion clinics who evaluates her medical history and explains how to take abortion pills and what to expect afterward. She must then get medical tests including ultrasound and bloodwork.\u003c/p>\n\u003cp>If the tests show she is eligible for the study, the clinic sends her a package with pills and instructions via overnight mail. After taking them, she has some additional tests, such as an ultrasound to verify that the abortion is complete and also a phone consultation to review the results.\u003c/p>\n\u003cp>\u003cstrong>Declining Access\u003c/strong>\u003c/p>\n\u003cp>Access to abortion has been declining steadily in the United States as dozens of clinics have been forced to close under new state restrictions. In Texas, the number of clinics fell to 18 in 2015 from 41 in 2012. Five states have just one clinic that offers abortions.\u003c/p>\n\u003cp>Medical abortions require women to take two drugs that together induce a miscarriage. The first, mifepristone (marketed as Mifeprex), is typically taken in a doctor’s office or clinic while the second, misoprostol, is given to the woman to take at home the next day.\u003c/p>\n\u003cp>In the United States, the FDA has approved medical abortion pills for use only in the first 10 weeks of pregnancy, while surgical abortions can be done later than that.\u003c/p>\n\u003cp>Medical abortions make up a quarter of all abortions in the country. About 2.8 million women in the United States have used mifepristone to terminate a pregnancy since the drug’s approval in 2000, according to Danco Laboratories, its manufacturer.\u003c/p>\n\u003cp>The American abortion study using overnight mail comes nearly a decade after Iowa became the first state to offer medical abortion counseling via telemedicine from a physician. But in Iowa and the three states that followed — Alaska, Maine and Minnesota — women must still go to a clinic that stocks mifepristone to receive the pills.\u003c/p>\n\u003cp>If the study shows the telemedicine and mail approach works, that could encourage the FDA to stop restrictions on mifepristone, Gynuity’s principal investigator, Dr. Elizabeth Raymond, said.\u003c/p>\n\u003cp>“All kinds of dangerous drugs are prescribed and available at pharmacies, including drugs for heart disease and Viagra,” she said. “There is no justification for why this safe drug should not be in pharmacies now.”\u003c/p>\n\u003cp>But even if the FDA were to lift its restriction on where abortion pills are dispensed, 19 states ban the use of telemedicine for abortion and require a physician to be physically present when consulting a woman, according to the Guttmacher Institute, a reproductive rights research group.\u003c/p>\n\u003cp>“While this has the potential for being the future of abortion delivery for a good segment of the population, that vision might not be fulfilled due to the politics around the issue and restrictions in many states,” said Jessica Arons, president and chief executive of the Reproductive Health Technologies Project in Washington, an advocacy group.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This story was produced by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>When the abortion pills arrived in her mailbox this summer, she felt anxious but also in control, knowing she could end her pregnancy entirely in the privacy of her own home.\u003c/p>\n\u003caside class=\"pullquote alignright\">'I was happy that I was going to be able to do it myself and I did not have a nurse there or doctors there staring at me and judging me.'\u003c/aside>\n\u003cp>“I was happy that I was going to be able to do it myself and I did not have a nurse there or doctors there staring at me and judging me,” she said, asking to be identified only by her middle name, Marie, because she did not want people outside her immediate family to know about her abortion.\u003c/p>\n\u003cp>Marie is part of a small but closely watched research effort to determine whether medical abortions — those induced by medicine instead of surgery — can be done safely through an online consultation with a doctor and drugs mailed to a woman’s home.\u003c/p>\n\u003cp>At a time when access to abortion is being restricted on many fronts, advocates say being able to terminate a pregnancy through telemedicine and mail-order drugs would provide a welcome new option for women. Opponents of abortion find the concept dangerous and deeply disturbing.\u003c/p>\n\u003cp>The idea builds on a trend that is helping women obtain birth control more easily. A growing number of smartphone apps and websites now make it possible to get prescription contraceptives without visiting a doctor’s office first. The pills Marie and the other women received through the study are not allowed for sale in pharmacies and are usually available only at hospitals and abortion clinics.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Australia and the Canadian province of British Columbia allow women to get abortion pills by mail after consulting with a physician or other health care provider via phone or the internet. Several international organizations offer mail service in countries where abortion is otherwise unavailable or severely restricted. The oldest group, Women on Web, based in the Netherlands, has provided abortion medications to about 50,000 women in 130 countries since 2006. The service is not available in the United States, and the Food and Drug Administration warns against buying the drugs over the internet.\u003c/p>\n\u003cp>Having the pills delivered to her home in Hawaii meant that Marie could avoid the cost and time of traveling by plane to the nearest abortion clinic, over 100 miles away in Honolulu or Maui. Once she received them, she set the package aside for a week in her bedroom, waiting until she could schedule time off from her job at McDonald’s.\u003c/p>\n\u003cp>\u003cstrong>Over in Three Hours\u003c/strong>\u003c/p>\n\u003cp>The first pill, as expected, had little effect. The next morning, with her mother at her home to watch her toddler, she took the second. Almost immediately, the bleeding and cramping began. Within three hours, her eight-week pregnancy was over. She described the pain as a five on a 10-point scale. That night she cooked dinner for her family, and the next day she went back to work.\u003c/p>\n\u003cp>The study Marie participated in is being conducted in four states — Hawaii, New York, Oregon and Washington. It is being funded and organized by Gynuity Health Projects, a nonprofit research group focused on reproductive health services that seeks to improve women’s access to medical abortions. The FDA has allowed the experiment. Women learn about it when contacting the abortion clinics in the study and other health providers who are aware of the trial and the website telabortion.org.\u003c/p>\n\u003cp>Danco Laboratories, the company that makes the pills, has no plans to seek wider distribution of the medication either through mail-order pharmacies or physical pharmacies, a spokeswoman said. It would have to seek the FDA’s permission to do so; the agency can also ask companies to change how their drugs are distributed.\u003c/p>\n\u003cp>“Abortion is a politically charged issue in this country, and there is an extra degree of caution,” said the spokeswoman, Abby Long, explaining that research would be needed to support changing the drug’s distribution.\u003c/p>\n\u003cp>Of the first 12 women who participated in the study, all in Hawaii, 11 reported they had no complications and one did not take the pills, researchers said. Ten who completed surveys afterward said they were satisfied with the service and would recommend it to a friend, according to the researchers.\u003c/p>\n\u003cp>“It’s absolutely an important step forward to expanding access to abortion that is safe and effective and creating options for women,” said Susan Wood, director of the Jacobs Institute of Women’s Health at George Washington University, in Washington, D.C. She was not involved in the study.\u003c/p>\n\u003cp>\u003cstrong>Outraged\u003c/strong>\u003c/p>\n\u003cp>Anti-abortion groups are outraged by the experiment.\u003c/p>\n\u003cp>“We have grave concerns about handing out dangerous, life-ending drugs without medical supervision because women face great risks for chemical abortions,” said Kristi Hamrick, spokeswoman for Americans United for Life.\u003c/p>\n\u003cp>Carol Tobias, president of the National Right to Life Committee, also raised safety concerns.\u003c/p>\n\u003cp>“If pills are sent through the mail, who are they supposed to call if they have a problem?” she said.\u003c/p>\n\u003cp>“There are serious downsides from the pills,” she said, adding, “and just talking to someone over a computer and sending pills in the mail, to me, that is just reckless.”\u003c/p>\n\u003cp>The process does not allow women to avoid the doctor’s office entirely. Using a video hookup on a home computer, a woman first consults with a doctor (or other clinician such as a nurse practitioner) at one of three participating abortion clinics who evaluates her medical history and explains how to take abortion pills and what to expect afterward. She must then get medical tests including ultrasound and bloodwork.\u003c/p>\n\u003cp>If the tests show she is eligible for the study, the clinic sends her a package with pills and instructions via overnight mail. After taking them, she has some additional tests, such as an ultrasound to verify that the abortion is complete and also a phone consultation to review the results.\u003c/p>\n\u003cp>\u003cstrong>Declining Access\u003c/strong>\u003c/p>\n\u003cp>Access to abortion has been declining steadily in the United States as dozens of clinics have been forced to close under new state restrictions. In Texas, the number of clinics fell to 18 in 2015 from 41 in 2012. Five states have just one clinic that offers abortions.\u003c/p>\n\u003cp>Medical abortions require women to take two drugs that together induce a miscarriage. The first, mifepristone (marketed as Mifeprex), is typically taken in a doctor’s office or clinic while the second, misoprostol, is given to the woman to take at home the next day.\u003c/p>\n\u003cp>In the United States, the FDA has approved medical abortion pills for use only in the first 10 weeks of pregnancy, while surgical abortions can be done later than that.\u003c/p>\n\u003cp>Medical abortions make up a quarter of all abortions in the country. About 2.8 million women in the United States have used mifepristone to terminate a pregnancy since the drug’s approval in 2000, according to Danco Laboratories, its manufacturer.\u003c/p>\n\u003cp>The American abortion study using overnight mail comes nearly a decade after Iowa became the first state to offer medical abortion counseling via telemedicine from a physician. But in Iowa and the three states that followed — Alaska, Maine and Minnesota — women must still go to a clinic that stocks mifepristone to receive the pills.\u003c/p>\n\u003cp>If the study shows the telemedicine and mail approach works, that could encourage the FDA to stop restrictions on mifepristone, Gynuity’s principal investigator, Dr. Elizabeth Raymond, said.\u003c/p>\n\u003cp>“All kinds of dangerous drugs are prescribed and available at pharmacies, including drugs for heart disease and Viagra,” she said. “There is no justification for why this safe drug should not be in pharmacies now.”\u003c/p>\n\u003cp>But even if the FDA were to lift its restriction on where abortion pills are dispensed, 19 states ban the use of telemedicine for abortion and require a physician to be physically present when consulting a woman, according to the Guttmacher Institute, a reproductive rights research group.\u003c/p>\n\u003cp>“While this has the potential for being the future of abortion delivery for a good segment of the population, that vision might not be fulfilled due to the politics around the issue and restrictions in many states,” said Jessica Arons, president and chief executive of the Reproductive Health Technologies Project in Washington, an advocacy group.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>This story was produced by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Monkeys Regain Control Of Paralyzed Legs With Help Of An Implant (Video)",
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"content": "\u003cp>[http_redir]\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe width=\"600\" height=\"338\" src=\"http://www.npr.org/templates/event/embeddedVideo.php?storyId=501029887&mediaId=501203372\" frameborder=\"0\" scrolling=\"no\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003cp>A few months ago, neurosurgeon Jocelyne Bloch emerged from a 10-hour surgery that she hadn't done before.\u003c/p>\n\u003cp>\"Most of my patients are humans,\" says Bloch, who works at the Lausanne University Hospital in Switzerland.\u003c/p>\n\u003cp>This patient was a rhesus macaque.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The monkey's spinal cord had been partially cut. So while his brain was fine and his legs were fine, the two couldn't communicate.\u003c/p>\n\u003cp>\"Normally, the brain is giving commands, and the legs are responding to the commands through the spinal cord. When you have a spinal cord lesion, then this command is interrupted,\" says \u003ca href=\"http://www.chuv.ch/neurochirurgie/nch_home/nch-le-service-en-bref/nch-notre-equipe/nch-nos-medecins/nch-notre-equipe-nos-medecins-bio-jocelyne-bloch.htm\">Bloch\u003c/a>.\u003c/p>\n\u003cp>Bloch and her colleagues were testing a device that might circumvent the injured nerves and help the brain talk to the legs another way.\u003c/p>\n\u003cp>She placed electrodes in the part of the monkey's brain that controls leg movement, and docked a wireless transmitter on the outside of his skull. Then, she put another set of electrodes along the spinal cord, below the injury. She also implanted an instrument in one leg so they could record muscle activity there.\u003c/p>\n\u003cp>Six days later, Bloch and her colleagues switched on a device to pick up signals from the electrodes in the monkey's brain, pass them through a computer, and then send them to the electrodes in the spine.\u003c/p>\n\u003cp>\"In a few seconds you saw the leg moving, and that's something that would not have happened naturally,\" she says. Without the procedure, it would've likely taken months before the leg was able to move at all, Bloch says. Within a few days, the monkey was back on its feet.\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe width=\"600\" height=\"338\" src=\"http://www.npr.org/templates/event/embeddedVideo.%20php?storyId=501029887&mediaId=501203372\" frameborder=\"0\" scrolling=\"no\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003cp>Its balance wasn't so good, but its brain and leg were communicating enough for the monkey to walk on a treadmill. Bloch did the same surgery in a second monkey, with similar results after two weeks.\u003c/p>\n\u003cp>The findings were \u003ca href=\"http://nature.com/articles/doi:10.1038/nature20118\">published\u003c/a> Wednesday in the journal \u003cem>Nature\u003c/em>.\u003c/p>\n\u003cp>In the past, researchers have focused on getting brain signals to control machines, \u003ca href=\"http://www.nature.com/news/mind-controlled-robot-arms-show-promise-1.10652\">like a robotic arm\u003c/a>, but this experiment was about re-establishing control over the body itself.\u003c/p>\n\u003cp>The group worked with rodents for 10 years before moving to experiments in monkeys for another seven years.\u003c/p>\n\u003cp>\"Here they're kind of closing the loop, where they're driving that stimulation based on activity decoded from the brain,\" says \u003ca href=\"http://www.rehabmedicine.pitt.edu/people/bios/collinger_2016.html\">Jen Collinger\u003c/a>, a bioengineer at the University of Pittsburgh whose work focuses on getting paralyzed patients to operate robotic arms.\u003c/p>\n\u003cp>\"It seems the principles learned in rats are now translating into primates,\" says Collinger, who was not involved in the study. \"And that gives more confidence that it might also translate into humans.\" But, she says, there are still some major hoops to jump through. For example, it's unclear if the technology would work long-term, or if it would support the balance and weight-bearing required with walking on two feet.\u003c/p>\n\u003cp>Researchers in the Swiss study agree.\u003c/p>\n\u003cp>\"It will take at least another decade in order to achieve the full translation in humans, with no guarantee whatsoever that it will be a successful endeavor,\" says \u003ca href=\"http://courtine-lab.epfl.ch/\">Gregoire Courtine\u003c/a>, a neuroscientist at the Swiss Federal Institute of Technology and a co-author of the study.\u003c/p>\n\u003cp>In an accompanying commentary\u003cem>,\u003c/em> \u003ca href=\"http://www.ncl.ac.uk/ion/staff/profile/andrewjackson.html#research\">Andrew Jackson \u003c/a>of the Institute of Neuroscience at Newcastle University in the U.K. pointed out that researchers have recently come up with some pretty incredible devices — like those allowing people to control computers and robots with their thoughts — but have not been able to create a self-contained, wireless connection between human brain and limb.\u003c/p>\n\u003cp>Still, Jackson points out, the pace of translating technology like this from primates to humans has been remarkably quick.\u003c/p>\n\u003cp>\"It is therefore not unreasonable to speculate that we could see the first clinical demonstrations of interfaces between the brain and spinal cord by the end of the decade,\" Jackson wrote, especially because the components described in the study already are approved for human use in Switzerland.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The Swiss group has started a clinical trial in eight people with partial leg paralysis. Two participants are now recovering from surgery where, like the monkeys, they received electrode implants in the spinal cord. Researchers want to know if the electrodes could help speed up or augment natural recovery in people with partially damaged nerve connections.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Monkeys+Regain+Control+Of+Paralyzed+Legs+With+Help+Of+An+Implant&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>[http_redir]\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe width=\"600\" height=\"338\" src=\"http://www.npr.org/templates/event/embeddedVideo.php?storyId=501029887&mediaId=501203372\" frameborder=\"0\" scrolling=\"no\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003cp>A few months ago, neurosurgeon Jocelyne Bloch emerged from a 10-hour surgery that she hadn't done before.\u003c/p>\n\u003cp>\"Most of my patients are humans,\" says Bloch, who works at the Lausanne University Hospital in Switzerland.\u003c/p>\n\u003cp>This patient was a rhesus macaque.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The monkey's spinal cord had been partially cut. So while his brain was fine and his legs were fine, the two couldn't communicate.\u003c/p>\n\u003cp>\"Normally, the brain is giving commands, and the legs are responding to the commands through the spinal cord. When you have a spinal cord lesion, then this command is interrupted,\" says \u003ca href=\"http://www.chuv.ch/neurochirurgie/nch_home/nch-le-service-en-bref/nch-notre-equipe/nch-nos-medecins/nch-notre-equipe-nos-medecins-bio-jocelyne-bloch.htm\">Bloch\u003c/a>.\u003c/p>\n\u003cp>Bloch and her colleagues were testing a device that might circumvent the injured nerves and help the brain talk to the legs another way.\u003c/p>\n\u003cp>She placed electrodes in the part of the monkey's brain that controls leg movement, and docked a wireless transmitter on the outside of his skull. Then, she put another set of electrodes along the spinal cord, below the injury. She also implanted an instrument in one leg so they could record muscle activity there.\u003c/p>\n\u003cp>Six days later, Bloch and her colleagues switched on a device to pick up signals from the electrodes in the monkey's brain, pass them through a computer, and then send them to the electrodes in the spine.\u003c/p>\n\u003cp>\"In a few seconds you saw the leg moving, and that's something that would not have happened naturally,\" she says. Without the procedure, it would've likely taken months before the leg was able to move at all, Bloch says. Within a few days, the monkey was back on its feet.\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe width=\"600\" height=\"338\" src=\"http://www.npr.org/templates/event/embeddedVideo.%20php?storyId=501029887&mediaId=501203372\" frameborder=\"0\" scrolling=\"no\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003cp>Its balance wasn't so good, but its brain and leg were communicating enough for the monkey to walk on a treadmill. Bloch did the same surgery in a second monkey, with similar results after two weeks.\u003c/p>\n\u003cp>The findings were \u003ca href=\"http://nature.com/articles/doi:10.1038/nature20118\">published\u003c/a> Wednesday in the journal \u003cem>Nature\u003c/em>.\u003c/p>\n\u003cp>In the past, researchers have focused on getting brain signals to control machines, \u003ca href=\"http://www.nature.com/news/mind-controlled-robot-arms-show-promise-1.10652\">like a robotic arm\u003c/a>, but this experiment was about re-establishing control over the body itself.\u003c/p>\n\u003cp>The group worked with rodents for 10 years before moving to experiments in monkeys for another seven years.\u003c/p>\n\u003cp>\"Here they're kind of closing the loop, where they're driving that stimulation based on activity decoded from the brain,\" says \u003ca href=\"http://www.rehabmedicine.pitt.edu/people/bios/collinger_2016.html\">Jen Collinger\u003c/a>, a bioengineer at the University of Pittsburgh whose work focuses on getting paralyzed patients to operate robotic arms.\u003c/p>\n\u003cp>\"It seems the principles learned in rats are now translating into primates,\" says Collinger, who was not involved in the study. \"And that gives more confidence that it might also translate into humans.\" But, she says, there are still some major hoops to jump through. For example, it's unclear if the technology would work long-term, or if it would support the balance and weight-bearing required with walking on two feet.\u003c/p>\n\u003cp>Researchers in the Swiss study agree.\u003c/p>\n\u003cp>\"It will take at least another decade in order to achieve the full translation in humans, with no guarantee whatsoever that it will be a successful endeavor,\" says \u003ca href=\"http://courtine-lab.epfl.ch/\">Gregoire Courtine\u003c/a>, a neuroscientist at the Swiss Federal Institute of Technology and a co-author of the study.\u003c/p>\n\u003cp>In an accompanying commentary\u003cem>,\u003c/em> \u003ca href=\"http://www.ncl.ac.uk/ion/staff/profile/andrewjackson.html#research\">Andrew Jackson \u003c/a>of the Institute of Neuroscience at Newcastle University in the U.K. pointed out that researchers have recently come up with some pretty incredible devices — like those allowing people to control computers and robots with their thoughts — but have not been able to create a self-contained, wireless connection between human brain and limb.\u003c/p>\n\u003cp>Still, Jackson points out, the pace of translating technology like this from primates to humans has been remarkably quick.\u003c/p>\n\u003cp>\"It is therefore not unreasonable to speculate that we could see the first clinical demonstrations of interfaces between the brain and spinal cord by the end of the decade,\" Jackson wrote, especially because the components described in the study already are approved for human use in Switzerland.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The Swiss group has started a clinical trial in eight people with partial leg paralysis. Two participants are now recovering from surgery where, like the monkeys, they received electrode implants in the spinal cord. Researchers want to know if the electrodes could help speed up or augment natural recovery in people with partially damaged nerve connections.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Monkeys+Regain+Control+Of+Paralyzed+Legs+With+Help+Of+An+Implant&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Erik Vance didn't go to a doctor until he was 18; he grew up in California in a family that practiced Christian Science. \"For the first half of my life, I never questioned the power of God to heal me,\" Vance writes in his new book, \u003ca href=\"http://suggestibleyou.com/\">Suggestible You\u003c/a>\u003cem>: Placebos, False Memories, Hypnosis, and the Power of Your Astonishing Brain\u003c/em>.\u003c/p>\n\u003cp>As a young man, Vance left the faith behind, but as he became a science journalist he didn't stop thinking about how people's beliefs and expectations affect their health, whether it's with placebo pills, mystical practices or treatments like acupuncture. The answer, he found, is in our brains.\u003c/p>\n\u003cp>Erik and I chatted about the book while attending a recent meeting of the National Association of Science Writers. Here are highlights of our conversation, edited for length and clarity.\u003c/p>\n\u003chr>\n\u003ch3>\u003cstrong>Interview Highlights\u003c/strong>\u003c/h3>\n\u003cp>\u003cstrong>You point out that even though most of us didn't grow up Christian Scientist, we often use belief to manage our health. \u003c/strong>\u003c/p>\n\u003cp>I've learned from writing this book that there are a lot of people around the world who really rely on expectation and placebos. And I grew up in the most extreme possible group, but it's not that different from seeing a homeopath. You're using faith to manage your body; what a psychologist would call expectation. Having had that experience really prepared me to ask some of these questions.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cstrong>How would your mom take care of you when you were sick?\u003c/strong>\u003c/p>\n\u003cp>As a kid we might have 7UP with orange juice; we might go that far because it made you feel better. But the treatment was to call a practitioner, to call a healer. Mine was named Lameice; she had the most amazing comforting voice ever. You'd call her up and this voice would say, \"How you doing honey, how you feeling?\" And everything would feel OK. You'd talk about the Bible and you'd talk about the writings of Mary Baker Eddy. The key in all this is the belief that you're actually healthy, and once you're able to see that, it will be manifest. And that in psychological terms is actually more powerful — hoping or asking doesn't have as much power in your brain as thinking it's already happened. It's certainty. And that has a big effect on brain chemicals and how your body responds to those chemicals.\u003c/p>\n\u003cp>\u003cstrong>The idea that the mind affects the body isn't new. How has the science changed to help us understand what's going on? \u003c/strong>\u003c/p>\n\u003cp>Saying that going to church will lower your blood pressure or lengthen your life a little bit; that's been known. But my question is, what's the mechanism? I actually didn't clue into this until I was at a conference for brain mapping and I saw a name on the speakers list talking about placebos and I recognized him as a Christian Scientist. I thought, wow, what's a Christian Scientist doing talking at a brain conference? Talking about placebos, which I think of as a very medical thing.\u003c/p>\n\u003cp>Placebo is a connection between the mind and body that can be measured, that can be seen in a brain scan; for the first time we have a tool that we can actually see working.\u003c/p>\n\u003cp>\u003cstrong>We just covered a \u003ca href=\"http://www.npr.org/sections/health-shots/2016/10/27/499475288/is-it-still-a-placebo-when-it-works-and-you-know-its-a-placebo\">study \u003c/a>by Ted Kaptchuk, a professor of medicine at Harvard, that found that even if people know that a placebo was a fake pill, their back pain got better. Is that what you're talking about?\u003c/strong>\u003c/p>\n\u003cp>Yeah, it's called open label. With an earlier, famous study by Kaptchuk, I kind of assumed that they just gave them a form that said placebo somewhere. But then I talked to Ted, and it turns out that the subjects had to tell the researchers they knew it was a placebo. They weren't subtle about it; they were very explicit.\u003c/p>\n\u003cp>But we're also learning now that people can have a placebo response even if they're unaware of any suggestion that they'll get better or worse; it's part of the unconscious brain. It may be a totally different pathway, but it's a very important part of the whole mix.\u003c/p>\n\u003cp>People say, \"I'm not gullible, I don't fall for these things, but echinacea really works.\" The first thing is not true; we're all gullible. And the second thing is, that person probably experienced an unconscious placebo. They think they're way too smart to be fooled. We should just all accept that this is what we do and embrace it. It gives us an honorable way to say, \"This is how it works.\"\u003c/p>\n\u003cp>\u003cstrong>But placebos don't work for everything. When do they help? \u003c/strong>\u003c/p>\n\u003cp>Cancer is one good example. Pain, nausea and the symptoms of chemotherapy respond really well to placebo. Tumors do not respond to placebos, as far as we know. So you can endanger your life very easily by taking a placebo when you have a serious disease and don't seek an active treatment.\u003c/p>\n\u003cp>The actual rules are according to the brain chemical involved, like dopamine, or endogenous opioids. These are internal endorphins that act like morphine, or serotonin, or a bunch of other ones that I don't want to bore you with. Parkinson's disease involves dopamine, so Parkinson's symptoms respond very well to placebos.\u003c/p>\n\u003cp>A lot of these chemicals do double duty; dopamine has like 50 different roles in the body, and some of these chemicals respond to each other, they interact with each other, and they respond differently to drugs. That's one reason why it's been so hard to pin down these effects for so long.\u003c/p>\n\u003cp>\u003cstrong>How do the stories we tell factor into healing? \u003c/strong>\u003c/p>\n\u003cp>Your brain on a very basic level doesn't want to be wrong. It will shift the chemicals involved so it will be right. And we're not scientific creatures; we believe what we believe. The narratives shift to fit the story we want. I think that makes expectation more powerful. When you remember the time you did the acupuncture and immediately everything got better — that can prime your expectation for the next time you go get acupuncture.\u003c/p>\n\u003cp>\u003cstrong>How did you shift your narrative?\u003c/strong>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>Part of it was probably just juvenile rebellion: I'm a rebel — I'm going to have an Advil. I've literally said that. Then fell in love with biology. And that leads you down the path where you have to get into these medical questions. Rather than being mysterious and scary, I found it to be really fascinating, almost as exciting as God's loving hand cradling you from disease. It didn't feel like a really big shift. It's not like I'm rebelling against anything anymore; it's just that the other thing is pretty cool, and the idea of proving things with logic, it just sort of works. I like my new narrative. And my new narrative is in line with evidence.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=How+The+Brain+Powers+Placebos%2C+False+Memories+And+Healing&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cstrong>How would your mom take care of you when you were sick?\u003c/strong>\u003c/p>\n\u003cp>As a kid we might have 7UP with orange juice; we might go that far because it made you feel better. But the treatment was to call a practitioner, to call a healer. Mine was named Lameice; she had the most amazing comforting voice ever. You'd call her up and this voice would say, \"How you doing honey, how you feeling?\" And everything would feel OK. You'd talk about the Bible and you'd talk about the writings of Mary Baker Eddy. The key in all this is the belief that you're actually healthy, and once you're able to see that, it will be manifest. And that in psychological terms is actually more powerful — hoping or asking doesn't have as much power in your brain as thinking it's already happened. It's certainty. And that has a big effect on brain chemicals and how your body responds to those chemicals.\u003c/p>\n\u003cp>\u003cstrong>The idea that the mind affects the body isn't new. How has the science changed to help us understand what's going on? \u003c/strong>\u003c/p>\n\u003cp>Saying that going to church will lower your blood pressure or lengthen your life a little bit; that's been known. But my question is, what's the mechanism? I actually didn't clue into this until I was at a conference for brain mapping and I saw a name on the speakers list talking about placebos and I recognized him as a Christian Scientist. I thought, wow, what's a Christian Scientist doing talking at a brain conference? 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They weren't subtle about it; they were very explicit.\u003c/p>\n\u003cp>But we're also learning now that people can have a placebo response even if they're unaware of any suggestion that they'll get better or worse; it's part of the unconscious brain. It may be a totally different pathway, but it's a very important part of the whole mix.\u003c/p>\n\u003cp>People say, \"I'm not gullible, I don't fall for these things, but echinacea really works.\" The first thing is not true; we're all gullible. And the second thing is, that person probably experienced an unconscious placebo. They think they're way too smart to be fooled. We should just all accept that this is what we do and embrace it. It gives us an honorable way to say, \"This is how it works.\"\u003c/p>\n\u003cp>\u003cstrong>But placebos don't work for everything. When do they help? \u003c/strong>\u003c/p>\n\u003cp>Cancer is one good example. Pain, nausea and the symptoms of chemotherapy respond really well to placebo. 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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Part of it was probably just juvenile rebellion: I'm a rebel — I'm going to have an Advil. I've literally said that. Then fell in love with biology. And that leads you down the path where you have to get into these medical questions. Rather than being mysterious and scary, I found it to be really fascinating, almost as exciting as God's loving hand cradling you from disease. It didn't feel like a really big shift. It's not like I'm rebelling against anything anymore; it's just that the other thing is pretty cool, and the idea of proving things with logic, it just sort of works. I like my new narrative. And my new narrative is in line with evidence.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=How+The+Brain+Powers+Placebos%2C+False+Memories+And+Healing&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>\u003cem>This is an edited excerpt from Robert Wachter’s “\u003ca href=\"https://www.amazon.com/Digital-Doctor-Hope-Medicines-Computer/dp/0071849467\" target=\"_blank\">The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine’s Computer Age\u003c/a>,” reprinted with permission from McGraw-Hill. Copyright 2015.\u003c/em>\u003c/p>\n\u003cp>Since 2012, Vinod Khosla, a co-founder of Sun Microsystems, has been predicting that most of what physicians currently do can, will, and should be done by computers. “By 2025,” he has written, “more data-driven, automated health care will displace up to 80 percent of physicians’ diagnostic and prescription work.”\u003c/p>\n\u003caside class=\"pullquote alignright\">A computer can’t read a patient’s tone of voice or anxious look. These clues—like one patient saying, “I have chest pain,” and another, “I HAVE CHEST PAIN!!!”—can make all the difference in diagnosis.\u003c/aside>\n\u003cp>Though Khosla’s comments have irked many a physician, I’m not willing to dismiss him as a kooky provocateur or a utopian techno-evangelist. First of all, his investment track record has made him a Silicon Valley rock star. More important, as recently as a decade ago, some very smart and savvy computer engineers and economists believed that another seemingly intractable problem, building a driverless car, was beyond the reach of modern technology. As of April 2014, the Google car had clocked nearly 700,000 miles and been involved in just two accidents.\u003c/p>\n\u003cp>If the driverless car weren’t enough of a challenge to human superiority, who could have watched IBM’s Watson supercomputer defeat the Jeopardy Hall of Famers in 2011 and not fretted about the future of physicians, or any highly skilled workers, for that matter?\u003c/p>\n\u003cp>\"Just as factory jobs were eliminated in the twentieth century by new assembly-line robots,” wrote all-time (human) Jeopardy champion Ken Jennings soon after the lopsided match ended, “Brad [Rutter, the other defeated champ] and I were the first knowledge-industry workers put out of work by the new generation of ‘thinking’ machines. ‘Quiz show contestant’ may be the first job made redundant by Watson, but I’m sure it won’t be the last.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Soon after the well-publicized trouncing, IBM announced that one of its first “use cases” for Watson would be medicine. Sean Hogan, vice president for IBM Healthcare, told me that “health care jumped out as an area whose complexity and nuances would be\u003ca href=\"https://contextly.com/redirect/?id=K8AsBQdj7f:274449:4068:13:::sidebar:5820be532053f2-30720465\" target=\"_blank\"> receptive to what Watson was representing\u003c/a>.”\u003c/p>\n\u003cp>\u003cstrong>Sticking Up for Team Human\u003c/strong>\u003c/p>\n\u003cp>Andy McAfee, coauthor with Erik Brynjolfsson of the terrific book \"The Second Machine Age,\" agrees with Khosla that computers will ultimately take over much of what physicians do, including diagnosis. “I can’t see how that doesn’t happen,” McAfee, a self-described “technology optimist,” told me when we met for lunch near his MIT office. McAfee and Brynjolfsson argue that the confluence of staggering growth in computing power, zetabytes of fully networked information available on the Web, and the “combinatorial power” of innovation mean that areas that seemed like dead ends, such as artificial intelligence in medicine, are now within reach. They liken the speed with which old digital barriers are falling to Hemingway’s observation about how a person goes broke: “gradually, then suddenly.\"\u003c/p>\n\u003cp>In speaking with both McAfee and Khosla, I felt a strange obligation to stick up for my teams: humans and the subset of humans called doctors. I told McAfee that while I was in awe of the driverless car and IBM’s victories in chess (over world champion Garry Kasparov in 1997) and Jeopardy, he just didn’t understand how hard medicine is. Answering questions posed by Alex Trebek like, “While Maltese borrows many words from Italian, it developed from a dialect of this Semitic language” (the correct response is “What is Arabic?”—Watson answered it, and 65 of the 74 other questions it rang in for, correctly) is tricky, sure, but, at the end of the day, one is simply culling a series of databases to find a fact—a single right answer.\u003c/p>\n\u003caside class=\"pullquote alignright\">‘Quiz show contestant’ may be the first job made redundant by Watson, but I’m sure it won’t be the last.'\u003ccite>(Human) 'Jeopardy' champ Ken Jennings\u003c/cite>\u003c/aside>\n\u003cp>Medical diagnosis isn’t like that. For one thing, uncertainty is endemic, so that the “correct” answer is often a surprisingly probabilistic notion. For another, many diagnoses reveal themselves over time. The patient may present with, say, a headache, but not a worrisome one, and so the primary treatment is reassurance, Tylenol, and time. If the headache worsens over the next two weeks—particularly if it is now accompanied by additional symptoms such as weakness or nausea—that’s an entirely different story.\u003c/p>\n\u003cp>McAfee listened sympathetically—he’s obviously heard scores of versions of the \"You just don’t understand; my work is different\" argument—and then said, “I imagine there are a bunch of really smart geeks at IBM taking notes as guys like you describe this situation. In their heads, they’re asking, ‘How do I model that?’”\u003c/p>\n\u003cp>Undaunted, I tried another tack on Khosla when we met in his office in Menlo Park. “Vinod,” I said, “in medicine we have something we call the ‘eyeball test.’ That means I can see two patients whose numbers look the same”—things like temperature, heart rate, and blood counts—“and my training allows me to say, ‘That guy is sick [I pointed to an imaginary person across the imposing conference table] and the other is okay.’” And good doctors are usually right, I told him, as we possess a kind of sixth sense that we acquire from our training, our role models, and a thousand cases of trial and error.\u003c/p>\n\u003cp>Before Khosla could dismiss this as the usual whining from a dinosaur on the edge of extinction, I tossed him an example from his own world. “I’ll bet you have CEOs of start-ups constantly coming through this office pitching their companies,” I said. “I can imagine two companies that look the same on paper: both CEOs have Stanford MBAs; the proposals have similar financials. Your skill is to be able to point to one and say, ‘Winner’ and to the other, ‘Loser,’ and I’m guessing you’re right more often than not. You’re using information that isn’t measurable. Right?”\u003c/p>\n\u003cp>Nice try. He didn’t budge. “The question is, ‘Is it not measurable or is it not being measured?’” he responded. “And, when does your instinct work and when does it mislead? I think if you did a rigorous study, you’d find that your ‘eyeball test’ is far less effective than you think.”\u003c/p>\n\u003cp>https://www.youtube.com/watch?v=P18EdAKuC1U\u003c/p>\n\u003cp>\u003cstrong>Secrets of the Great Diagnosticians\u003c/strong>\u003c/p>\n\u003cp>There is a rich 50-year history of efforts to build artificial intelligence (AI) systems in health care, and it’s not a particularly uplifting story. Even technophiles admit that the quest to replace doctors with computers—or even the more modest ambition of providing them with useful guidance at the point of care—has been overhyped and unproductive. But times have changed. The growing prevalence of electronic health records offers grist for the AI and big data mills, grist that wasn’t available when the records were on paper. And in this, the Age of Watson, we have new techniques, like natural language processing and machine learning, at our disposal. Perhaps this is our “gradually, then suddenly” moment.\u003c/p>\n\u003caside class=\"pullquote alignright\">Early attempts to use computers for diagnosis were like tackling Saturday’s crossword puzzle in the New York Times before first mastering the one in USA Today.\u003c/aside>\n\u003cp>The public worships dynamic, innovative surgeons like Michael DeBakey; passionate, insightful researchers like Jonas Salk; and telegenic show horses like Mehmet Oz. But we seldom hear about those doctors whom other physicians tend to hold in the highest esteem: the great medical diagnosticians. These sages, like the legendary Johns Hopkins professors William Osler and A. McGehee Harvey, had the uncanny ability to deduce the truth from what others found to be a jumble of symptoms, signs, and lab results. In fact, Sir Arthur Conan Doyle, a physician by training, modeled Sherlock Holmes on one of his old professors, Joseph Bell, a renowned diagnostician at Edinburgh’s medical school.\u003c/p>\n\u003cp>For most doctors, diagnosis forms the essence of their practice (and of their professional souls), which may help explain why we find it so painful to believe that this particular skill could be replaced by silicon wafers.\u003c/p>\n\u003cp>In the 1970s, a Tufts kidney specialist named Jerome Kassirer (who later became editor of the New England Journal of Medicine) decided to try to unlock the cognitive secrets of the great diagnosticians. If he succeeded, the rewards could be great. The insights, problem-solving strategies, and reasoning patterns of these medical geniuses might be teachable to other physicians, perhaps even programmed into computers.\u003c/p>\n\u003cp>Kassirer focused first on the differential diagnosis, the method that doctors have long used to inventory and sort through their patients’ problems. The differential diagnosis is to a physician what the building of hypotheses is to a basic scientist: the core work of the professional mind. Let’s say a female patient complains of right lower abdominal pain and fever. We automatically begin to generate “a differential,” including appendicitis, pelvic inflammatory disease, kidney infection, and a host of less common disorders—some of them quite serious. Our job is to weigh the facts at hand in an effort to ultimately “rule in” one diagnosis on the list and “rule out” the others. Sometimes, the information we gather from the history and physical examination is sufficient.\u003c/p>\n\u003cp>More often, particularly when patients are truly ill, we require additional laboratory or radiographic studies to push one of the diagnoses over the “rule in” line. There is considerable skill, and no small amount of art, involved in this process. For one thing, we need to figure out whether the patient’s symptoms are part of a single disease or are manifestations of two or more distinct illnesses. The principle known as\u003ca href=\"http://www.medicinenet.com/script/main/art.asp?articlekey=26739\" target=\"_blank\"> Occam’s Razor\u003c/a> bids us to try to find a unifying diagnosis for all of a patient’s symptoms. But as soon as medical students memorize this so-called Law of Clinical Parsimony, we whipsaw them with \u003ca href=\"http://www.emergencymedicalparamedic.com/what-is-hickams-dictum/\" target=\"_blank\">Hickam’s Dictum\u003c/a>, which counters, irreverently, that “patients can have as many diseases as they damn well please.”\u003c/p>\n\u003cp>[contextly_sidebar id=\"fXsrKyRyGekfunOt3dsmZPdJAbzwHrbd\"]\u003c/p>\n\u003cp>Setting the “rule in” threshold is yet another challenge, since it’s wholly dependent on the context. For diseases with relatively benign treatments and prognoses—let’s say, stomach discomfort with no alarming features—I might make the diagnosis of “nonulcer dyspepsia” if I’m 75 percent certain that this is what’s going on. Why? Dyspepsia is a not-too-serious illness, the other illnesses that might present with the same symptoms aren’t likely to be acutely life-threatening either, and dyspepsia has a safe, inexpensive, and fairly effective treatment. All of this makes a 75 percent threshold high enough for me to try an acid-blocker and see what happens.\u003c/p>\n\u003cp>Now let’s turn to a patient who presents with acute shortness of breath and pleuritic chest pain. In this patient, I’m considering the diagnosis of pulmonary embolism (a blood clot to the lungs), a more serious disorder whose treatment (blood thinners) is riskier. Now, I’d want to be at least 95 percent sure before attaching that diagnostic label. And I won’t rule in a diagnosis of cancer—with its psychological freight, prognostic implications, and toxic treatments—unless I’m close to 100 percent certain, even if it takes a surgical biopsy to achieve this level of confidence.\u003c/p>\n\u003cp>Kassirer and his colleagues observed the diagnostic reasoning of scores of clinicians. They found that the good ones employed robust strategies to answer these knotty questions, even if they couldn’t always articulate what they were doing and why. The researchers ultimately came to appreciate that the physicians were engaging in a process called “iterative hypothesis testing” to transform the differential diagnosis (or, more accurately, diagnoses, since sick patients often have a variety of abnormalities to be explained) into something actionable. After hearing the initial portion of a case, the doctors began drawing possible scenarios to explain it, modifying their opinions as they went along and more information became available.\u003c/p>\n\u003cp>For example, when a physician confronts a case that begins with, “This 57-year-old man has three days of chest pain, shortness of breath, and lightheadedness,” she responds by thinking, “The worst thing this could be is a heart attack or a pulmonary embolism. I need to ask if the chest pain bores through to the back, which would make me worry about aortic dissection [a rip in the aorta]. I’ll also inquire about typical cardiac symptoms, such as sweating and nausea, and see if the pain is squeezing or radiates to the left arm or jaw. But even if it doesn’t, I’ll certainly get an EKG to rule out a heart attack or pericarditis [inflammation of the sac that surrounds the heart]. If he also reports a fever or a cough, I might begin to suspect pneumonia or pleurisy. The chest X-ray should help sort that out.”\u003c/p>\n\u003cp>Every answer the patient gives, and each positive or negative finding on the physical examination (yes, there is a heart murmur; no, the liver is not enlarged) triggers an automatic, almost intuitive recalibration of the most likely alternatives. When I see a master clinician at work—my favorite is my UCSF colleague Gurpreet Dhaliwal, who was profiled in a 2012\u003ca href=\"http://www.nytimes.com/2012/12/04/health/quest-to-eliminate-diagnostic-lapses.html\" target=\"_blank\"> New York Times article\u003c/a>—I know that these synapses are firing as he asks a patient a series of questions that may seem unrelated to the patient’s presenting complaint but are directed toward “narrowing the differential.” It turns out that there’s an even more impressive piece of cognitive magic going on. The master clinician embraces certain pieces of data (the patient’s trip to rural Thailand last year) while discarding others (an episode of belly pain and bloating three weeks ago). This is the part of diagnostic reasoning that beginners find most vexing, since they lack the foundational knowledge to understand why their teacher focused so intently on one nugget of information and all but ignored others that, to the novice, seemed equally crucial. How do the great diagnosticians make such choices?\u003c/p>\n\u003cp>We now recognize this as a relatively intuitive version of \u003ca href=\"http://www.medicinenet.com/script/main/art.asp?articlekey=10301\" target=\"_blank\">Bayes’ theorem\u003c/a>. Developed by the eighteenth-century British theologian-turned-mathematician Thomas Bayes, this theorem (often ignored by students because it is taught to them with the dryness of a Passover matzo) is the linchpin of clinical reasoning. In essence, Bayes’ theorem says that any medical test must be interpreted from two perspectives. The first: How accurate is the test—that is, how often does it give right or wrong answers? The second: How likely is it that this patient has the disease the test is looking for?\u003c/p>\n\u003cp>These deceptively simple questions explain why, in the early days of the AIDS epidemic (when HIV testing was far less accurate than it is today), it was silly to test heterosexual couples applying for a marriage license, since the vast majority of positive tests in this very low-risk group would be wrong. Similarly, they show why it is foolish to screen healthy 36-year-old executives with a cardiac treadmill test or a heart scan, since positive results will mostly be false positives, serving only to scare the bejesus out of the patients and run up bills for unnecessary follow-up tests. Conversely, in a 68-year-old smoker with diabetes and high cholesterol who develops squeezing chest pain while jogging, there is a 95 percent chance that those pains are from coronary artery disease. In this case, a negative treadmill test only lowers this probability to about 80 percent, so the clinician who reassures the patient that his negative test means that his heart is fine—“take some antacids; it’s OK to keep jogging”—is making a terrible, and potentially fatal, mistake.\u003c/p>\n\u003cp>\u003cstrong>The AI Challenge\u003c/strong>\u003c/p>\n\u003cp>As if this weren’t complicated enough for the poor IBM engineer gearing up to retool Watson from answering questions about “Potent Potables” to diagnosing sick patients, there’s more. While the EHR at least offers a fighting chance for computerized diagnosis (older medical AI programs, built in the pen-and-paper era, required busy physicians to write their notes and then reenter all the key data), parsing an electronic medical record is far from straightforward. Natural language processing is getting much better, but it still has real problems with negation (“the patient has no history of chest pain or cough”) and with family history (“there is a history of arthritis in the patient’s sister, but his mother is well”), to name just a couple of issues. Certain terms have multiple meanings: when written by a psychiatrist, the term depression is likely to refer to a mood disorder, while when it appears in a cardiologist’s note (“there was no evidence of ST-depression”) it probably refers to a dip in the EKG tracing that is often a clue to coronary disease. Ditto abbreviations: Does the patient with “MS” have multiple sclerosis or mitral stenosis, a sticky heart valve? Finally, the computer can’t read a patient’s tone of voice or the anxious look on her face, although engineers are working on this. These clues—like one patient saying, “I have chest pain,” and another, “I HAVE CHEST PAIN!!!”—can make all the difference in the world diagnostically.\u003c/p>\n\u003cp>Perhaps the trickiest problem of all is that—at least today—the very collection of the facts needed to feed an AI system is itself a cognitively complex process. Let’s return to the example of aortic dissection, a rip in the aorta that is often fatal if it is not treated promptly. If the initial history raises the slightest concern about dissection, I’m going to ask questions about whether the pain bores through to the back and check carefully for the quiet murmur of aortic insufficiency as well as for asymmetric blood pressure readings in the two arms, all clues to dissection. If I don’t harbor a suspicion of this scary (and unusual) disease, I’m not going to look for these things—they’re not part of a routine exam.\u003c/p>\n\u003cp>Decades ago, MIT’s Peter Szolovits, an AI expert who worked with Kassirer and his colleagues in the early days, gave up thinking about diagnosis as a simple matter of question answering. This was mostly because he came to appreciate the importance of timing—a nonissue in Jeopardy but a pivotal one in medicine. “A heart attack that happened five years ago has different implications from one that happened five minutes ago,” he explained, and a computer can’t “know” this unless it is programmed to do so. (It turns out that such issues of foundational knowledge are fundamental in AI—computers have no way of “knowing” some of the basic assumptions that allow us to get through our days, things like water is wet, love is good, and death is permanent.)\u003c/p>\n\u003cp>Moreover, much of medical reasoning relies on feedback loops: observing how events unfold and using that information to refine the diagnostic possibilities.We think a patient has bacterial pneumonia, and so we treat the “pneumonia” with antibiotics, but the patient’s fever doesn’t break after three days. So now we consider the possibility of tuberculosis or lupus. This is the cognitive work of the practicing clinician—focused a bit less on “What is the diagnosis?” and more on “How do I best manage this situation?”—and an AI program that doesn’t account for this will be of limited value.\u003c/p>\n\u003cp>\u003cstrong>Early Attempts\u003c/strong>\u003c/p>\n\u003cp>Now that you appreciate the nature of the problem, it’s easy (in retrospect, at least) to see why the choice by early health care computer experts to focus on diagnosis was risky, perhaps even wrongheaded. It’s like tackling Saturday’s crossword puzzle in the New York Times before first mastering the one in USA Today.\u003c/p>\n\u003cp>Larry Fagan, an early Stanford computing pioneer, told me, “We were not naive about the complexity. It’s just that it was the most exciting question.” Diagnosis is not just exciting, it’s at the heart of safe medical care. Diagnostic errors are common, and they can be fatal. A number of autopsy studies conducted over the past 40 years have shown that major diagnoses were overlooked in nearly one in five patients. With the advent of CT scans and MRIs, the number has gone down a bit, but it still hovers around one in ten. Diagnostic errors contribute to 40,000 to 80,000 deaths per year in the United States. And reviews of malpractice cases have demonstrated that diagnostic errors are the most common source of mistakes leading to successful lawsuits.\u003c/p>\n\u003cp>Medical IT experts jumped into the fray in the 1970s, designing a series of computer programs that they believed could help physicians be better diagnosticians, or perhaps even replace them entirely. That decade’s literature was replete with enthusiastic articles about how microprocessors, programmed to think like experts, would soon replace the brains of harried doctors. The attitude was captured by one early computing pioneer in a 1971 paean to his computer: “It is immune from fatigue and carelessness; and it works day and night, weekends and holidays, without coffee breaks, overtime, fringe benefits or human courtesy.”\u003c/p>\n\u003cp>By the mid-1980s, disappointment had set in. The tools that had seemed so promising a decade earlier were, by and large, unable to manage the complexity of clinical medicine, and they garnered few clinician advocates and miniscule commercial adoption. The medical AI movement skidded to a halt, marking the start of a 20-year period that insiders still refer to as the “AI winter.” Ted Shortliffe, one of the field’s longstanding leaders, has said that the early experience with programs like INTERNIST, DXplain, and MYCIN reminded him of this cartoon:\u003c/p>\n\u003cp>\u003ca href=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/11/cartoon.jpg\">\u003cimg class=\"aligncenter size-full wp-image-276235\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/11/cartoon.jpg\" alt=\"cartoon\" width=\"300\" height=\"373\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2016/11/cartoon.jpg 300w, https://ww2.kqed.org/app/uploads/sites/13/2016/11/cartoon-160x199.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2016/11/cartoon-240x298.jpg 240w\" sizes=\"(max-width: 300px) 100vw, 300px\">\u003c/a>\u003c/p>\n\u003cp>\u003cstrong>'Version 0'\u003c/strong>\u003c/p>\n\u003cp>Vinod Khosla is prepared for this. He knows that even today’s generation of medical AI programs will produce some crazy output, akin to when Watson famously mistook Toronto for an American city during its Jeopardy triumph. (It was worse in rehearsal, when Watson referred to civil rights leader Malcolm X as “Malcolm Ten.”) Khosla points out that the enormous cellphones of the late 1980s would seem equally ridiculous when placed alongside our iPhone 6.0s. He calls today’s medical AI programs “Version 0,” and cautions that people should “expect these early systems and tools to be the butt of jokes from many a writer and physician.”\u003c/p>\n\u003cp>These cases illustrate a perennial debate in AI, one that pits two camps against each other: the “neats” and the “scruffies.” The neats seek solutions that are elegant and provable; they try to model the way experts think and work, and then code that into AI tools. The scruffies are the pragmatists, the hackers, the crazy ones; they believe that problems should be attacked through whatever means work, and that modeling the behavior of experts or the scientific truth of a situation isn’t all that important. IBM’s breakthrough was to figure out that a combination of neat and scruffy—programming in some of the core rules of the game, but then folding in the fruits of machine learning and natural language processing—could solve truly complicated problems.\u003c/p>\n\u003cp>When he was asked about the difference between human thinking and Watson’s method, Eric Brown, who runs IBM’s Watson Technologies group, gave a careful answer (note the shout-out to the humans, the bit players who made it all possible):\u003c/p>\n\u003cblockquote>\u003cp>A lot of the way that Watson works is motivated by the way that humans analyze problems and go about trying to find solutions, especially when it comes to dealing with complex problems where there are a number of intermediate steps toget you to the final answer. So it certainly is inspired by that process. . . . But a lot of it is different from the ways humans work; it tends to leverage the powers and advantages of a computer system, and its ability to rapidly analyze huge amounts of data and text that humans just can’t keep track of.\u003c/p>\u003c/blockquote>\n\u003cp>However Watson works, we find ourselves today in a world with new tools, new mental models, and a new sense of optimism that computers can do pretty much anything. But have we finally reached the age when computers can master the art of clinical reasoning?\u003c/p>\n\u003cp>I asked Eric Brown, who worked on the \"Jeopardy\" project and is now helping to lead Watson’s efforts in medicine, what the equivalent event might be in health care, the moment when his team could finally congratulate itself on its successes. I wondered if it would be the creation of some kind of holographic physician—like “\u003ca href=\"http://memory-alpha.wikia.com/wiki/Emergency_Medical_Holographic_program\" target=\"_blank\">The Doctor\u003c/a>” on Star Trek Voyager—with Watson serving as the cognitive engine. His answer, though, reflected the deep respect he and his colleagues have for the magnitude of the challenge:\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“It will be when we have a technology that physicians suddenly can’t live without.”\u003c/p>\n\n",
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"excerpt": "When it comes to the art of medical diagnosis, has Team Human finally triumphed over AI? Or is it only a matter of time before computers supplant the physician's brain? ",
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"description": "When it comes to the art of medical diagnosis, has Team Human finally triumphed over AI? Or is it only a matter of time before computers supplant the physician's brain? ",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cem>This is an edited excerpt from Robert Wachter’s “\u003ca href=\"https://www.amazon.com/Digital-Doctor-Hope-Medicines-Computer/dp/0071849467\" target=\"_blank\">The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine’s Computer Age\u003c/a>,” reprinted with permission from McGraw-Hill. Copyright 2015.\u003c/em>\u003c/p>\n\u003cp>Since 2012, Vinod Khosla, a co-founder of Sun Microsystems, has been predicting that most of what physicians currently do can, will, and should be done by computers. “By 2025,” he has written, “more data-driven, automated health care will displace up to 80 percent of physicians’ diagnostic and prescription work.”\u003c/p>\n\u003caside class=\"pullquote alignright\">A computer can’t read a patient’s tone of voice or anxious look. These clues—like one patient saying, “I have chest pain,” and another, “I HAVE CHEST PAIN!!!”—can make all the difference in diagnosis.\u003c/aside>\n\u003cp>Though Khosla’s comments have irked many a physician, I’m not willing to dismiss him as a kooky provocateur or a utopian techno-evangelist. First of all, his investment track record has made him a Silicon Valley rock star. More important, as recently as a decade ago, some very smart and savvy computer engineers and economists believed that another seemingly intractable problem, building a driverless car, was beyond the reach of modern technology. As of April 2014, the Google car had clocked nearly 700,000 miles and been involved in just two accidents.\u003c/p>\n\u003cp>If the driverless car weren’t enough of a challenge to human superiority, who could have watched IBM’s Watson supercomputer defeat the Jeopardy Hall of Famers in 2011 and not fretted about the future of physicians, or any highly skilled workers, for that matter?\u003c/p>\n\u003cp>\"Just as factory jobs were eliminated in the twentieth century by new assembly-line robots,” wrote all-time (human) Jeopardy champion Ken Jennings soon after the lopsided match ended, “Brad [Rutter, the other defeated champ] and I were the first knowledge-industry workers put out of work by the new generation of ‘thinking’ machines. ‘Quiz show contestant’ may be the first job made redundant by Watson, but I’m sure it won’t be the last.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Soon after the well-publicized trouncing, IBM announced that one of its first “use cases” for Watson would be medicine. Sean Hogan, vice president for IBM Healthcare, told me that “health care jumped out as an area whose complexity and nuances would be\u003ca href=\"https://contextly.com/redirect/?id=K8AsBQdj7f:274449:4068:13:::sidebar:5820be532053f2-30720465\" target=\"_blank\"> receptive to what Watson was representing\u003c/a>.”\u003c/p>\n\u003cp>\u003cstrong>Sticking Up for Team Human\u003c/strong>\u003c/p>\n\u003cp>Andy McAfee, coauthor with Erik Brynjolfsson of the terrific book \"The Second Machine Age,\" agrees with Khosla that computers will ultimately take over much of what physicians do, including diagnosis. “I can’t see how that doesn’t happen,” McAfee, a self-described “technology optimist,” told me when we met for lunch near his MIT office. McAfee and Brynjolfsson argue that the confluence of staggering growth in computing power, zetabytes of fully networked information available on the Web, and the “combinatorial power” of innovation mean that areas that seemed like dead ends, such as artificial intelligence in medicine, are now within reach. They liken the speed with which old digital barriers are falling to Hemingway’s observation about how a person goes broke: “gradually, then suddenly.\"\u003c/p>\n\u003cp>In speaking with both McAfee and Khosla, I felt a strange obligation to stick up for my teams: humans and the subset of humans called doctors. I told McAfee that while I was in awe of the driverless car and IBM’s victories in chess (over world champion Garry Kasparov in 1997) and Jeopardy, he just didn’t understand how hard medicine is. Answering questions posed by Alex Trebek like, “While Maltese borrows many words from Italian, it developed from a dialect of this Semitic language” (the correct response is “What is Arabic?”—Watson answered it, and 65 of the 74 other questions it rang in for, correctly) is tricky, sure, but, at the end of the day, one is simply culling a series of databases to find a fact—a single right answer.\u003c/p>\n\u003caside class=\"pullquote alignright\">‘Quiz show contestant’ may be the first job made redundant by Watson, but I’m sure it won’t be the last.'\u003ccite>(Human) 'Jeopardy' champ Ken Jennings\u003c/cite>\u003c/aside>\n\u003cp>Medical diagnosis isn’t like that. For one thing, uncertainty is endemic, so that the “correct” answer is often a surprisingly probabilistic notion. For another, many diagnoses reveal themselves over time. The patient may present with, say, a headache, but not a worrisome one, and so the primary treatment is reassurance, Tylenol, and time. If the headache worsens over the next two weeks—particularly if it is now accompanied by additional symptoms such as weakness or nausea—that’s an entirely different story.\u003c/p>\n\u003cp>McAfee listened sympathetically—he’s obviously heard scores of versions of the \"You just don’t understand; my work is different\" argument—and then said, “I imagine there are a bunch of really smart geeks at IBM taking notes as guys like you describe this situation. In their heads, they’re asking, ‘How do I model that?’”\u003c/p>\n\u003cp>Undaunted, I tried another tack on Khosla when we met in his office in Menlo Park. “Vinod,” I said, “in medicine we have something we call the ‘eyeball test.’ That means I can see two patients whose numbers look the same”—things like temperature, heart rate, and blood counts—“and my training allows me to say, ‘That guy is sick [I pointed to an imaginary person across the imposing conference table] and the other is okay.’” And good doctors are usually right, I told him, as we possess a kind of sixth sense that we acquire from our training, our role models, and a thousand cases of trial and error.\u003c/p>\n\u003cp>Before Khosla could dismiss this as the usual whining from a dinosaur on the edge of extinction, I tossed him an example from his own world. “I’ll bet you have CEOs of start-ups constantly coming through this office pitching their companies,” I said. “I can imagine two companies that look the same on paper: both CEOs have Stanford MBAs; the proposals have similar financials. Your skill is to be able to point to one and say, ‘Winner’ and to the other, ‘Loser,’ and I’m guessing you’re right more often than not. You’re using information that isn’t measurable. Right?”\u003c/p>\n\u003cp>Nice try. He didn’t budge. “The question is, ‘Is it not measurable or is it not being measured?’” he responded. “And, when does your instinct work and when does it mislead? I think if you did a rigorous study, you’d find that your ‘eyeball test’ is far less effective than you think.”\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/P18EdAKuC1U'\n title='//www.youtube.com/embed/P18EdAKuC1U'\n allowfullscreen='true'\n style='border:0;'>\u003c/iframe>\n \u003c/span>\n \u003c/span>\u003c/p>\u003cp>\u003cp>\u003cstrong>Secrets of the Great Diagnosticians\u003c/strong>\u003c/p>\n\u003cp>There is a rich 50-year history of efforts to build artificial intelligence (AI) systems in health care, and it’s not a particularly uplifting story. Even technophiles admit that the quest to replace doctors with computers—or even the more modest ambition of providing them with useful guidance at the point of care—has been overhyped and unproductive. But times have changed. The growing prevalence of electronic health records offers grist for the AI and big data mills, grist that wasn’t available when the records were on paper. And in this, the Age of Watson, we have new techniques, like natural language processing and machine learning, at our disposal. Perhaps this is our “gradually, then suddenly” moment.\u003c/p>\n\u003caside class=\"pullquote alignright\">Early attempts to use computers for diagnosis were like tackling Saturday’s crossword puzzle in the New York Times before first mastering the one in USA Today.\u003c/aside>\n\u003cp>The public worships dynamic, innovative surgeons like Michael DeBakey; passionate, insightful researchers like Jonas Salk; and telegenic show horses like Mehmet Oz. But we seldom hear about those doctors whom other physicians tend to hold in the highest esteem: the great medical diagnosticians. These sages, like the legendary Johns Hopkins professors William Osler and A. McGehee Harvey, had the uncanny ability to deduce the truth from what others found to be a jumble of symptoms, signs, and lab results. In fact, Sir Arthur Conan Doyle, a physician by training, modeled Sherlock Holmes on one of his old professors, Joseph Bell, a renowned diagnostician at Edinburgh’s medical school.\u003c/p>\n\u003cp>For most doctors, diagnosis forms the essence of their practice (and of their professional souls), which may help explain why we find it so painful to believe that this particular skill could be replaced by silicon wafers.\u003c/p>\n\u003cp>In the 1970s, a Tufts kidney specialist named Jerome Kassirer (who later became editor of the New England Journal of Medicine) decided to try to unlock the cognitive secrets of the great diagnosticians. If he succeeded, the rewards could be great. The insights, problem-solving strategies, and reasoning patterns of these medical geniuses might be teachable to other physicians, perhaps even programmed into computers.\u003c/p>\n\u003cp>Kassirer focused first on the differential diagnosis, the method that doctors have long used to inventory and sort through their patients’ problems. The differential diagnosis is to a physician what the building of hypotheses is to a basic scientist: the core work of the professional mind. Let’s say a female patient complains of right lower abdominal pain and fever. We automatically begin to generate “a differential,” including appendicitis, pelvic inflammatory disease, kidney infection, and a host of less common disorders—some of them quite serious. Our job is to weigh the facts at hand in an effort to ultimately “rule in” one diagnosis on the list and “rule out” the others. Sometimes, the information we gather from the history and physical examination is sufficient.\u003c/p>\n\u003cp>More often, particularly when patients are truly ill, we require additional laboratory or radiographic studies to push one of the diagnoses over the “rule in” line. There is considerable skill, and no small amount of art, involved in this process. For one thing, we need to figure out whether the patient’s symptoms are part of a single disease or are manifestations of two or more distinct illnesses. The principle known as\u003ca href=\"http://www.medicinenet.com/script/main/art.asp?articlekey=26739\" target=\"_blank\"> Occam’s Razor\u003c/a> bids us to try to find a unifying diagnosis for all of a patient’s symptoms. But as soon as medical students memorize this so-called Law of Clinical Parsimony, we whipsaw them with \u003ca href=\"http://www.emergencymedicalparamedic.com/what-is-hickams-dictum/\" target=\"_blank\">Hickam’s Dictum\u003c/a>, which counters, irreverently, that “patients can have as many diseases as they damn well please.”\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Setting the “rule in” threshold is yet another challenge, since it’s wholly dependent on the context. For diseases with relatively benign treatments and prognoses—let’s say, stomach discomfort with no alarming features—I might make the diagnosis of “nonulcer dyspepsia” if I’m 75 percent certain that this is what’s going on. Why? Dyspepsia is a not-too-serious illness, the other illnesses that might present with the same symptoms aren’t likely to be acutely life-threatening either, and dyspepsia has a safe, inexpensive, and fairly effective treatment. All of this makes a 75 percent threshold high enough for me to try an acid-blocker and see what happens.\u003c/p>\n\u003cp>Now let’s turn to a patient who presents with acute shortness of breath and pleuritic chest pain. In this patient, I’m considering the diagnosis of pulmonary embolism (a blood clot to the lungs), a more serious disorder whose treatment (blood thinners) is riskier. Now, I’d want to be at least 95 percent sure before attaching that diagnostic label. And I won’t rule in a diagnosis of cancer—with its psychological freight, prognostic implications, and toxic treatments—unless I’m close to 100 percent certain, even if it takes a surgical biopsy to achieve this level of confidence.\u003c/p>\n\u003cp>Kassirer and his colleagues observed the diagnostic reasoning of scores of clinicians. They found that the good ones employed robust strategies to answer these knotty questions, even if they couldn’t always articulate what they were doing and why. The researchers ultimately came to appreciate that the physicians were engaging in a process called “iterative hypothesis testing” to transform the differential diagnosis (or, more accurately, diagnoses, since sick patients often have a variety of abnormalities to be explained) into something actionable. After hearing the initial portion of a case, the doctors began drawing possible scenarios to explain it, modifying their opinions as they went along and more information became available.\u003c/p>\n\u003cp>For example, when a physician confronts a case that begins with, “This 57-year-old man has three days of chest pain, shortness of breath, and lightheadedness,” she responds by thinking, “The worst thing this could be is a heart attack or a pulmonary embolism. I need to ask if the chest pain bores through to the back, which would make me worry about aortic dissection [a rip in the aorta]. I’ll also inquire about typical cardiac symptoms, such as sweating and nausea, and see if the pain is squeezing or radiates to the left arm or jaw. But even if it doesn’t, I’ll certainly get an EKG to rule out a heart attack or pericarditis [inflammation of the sac that surrounds the heart]. If he also reports a fever or a cough, I might begin to suspect pneumonia or pleurisy. The chest X-ray should help sort that out.”\u003c/p>\n\u003cp>Every answer the patient gives, and each positive or negative finding on the physical examination (yes, there is a heart murmur; no, the liver is not enlarged) triggers an automatic, almost intuitive recalibration of the most likely alternatives. When I see a master clinician at work—my favorite is my UCSF colleague Gurpreet Dhaliwal, who was profiled in a 2012\u003ca href=\"http://www.nytimes.com/2012/12/04/health/quest-to-eliminate-diagnostic-lapses.html\" target=\"_blank\"> New York Times article\u003c/a>—I know that these synapses are firing as he asks a patient a series of questions that may seem unrelated to the patient’s presenting complaint but are directed toward “narrowing the differential.” It turns out that there’s an even more impressive piece of cognitive magic going on. The master clinician embraces certain pieces of data (the patient’s trip to rural Thailand last year) while discarding others (an episode of belly pain and bloating three weeks ago). This is the part of diagnostic reasoning that beginners find most vexing, since they lack the foundational knowledge to understand why their teacher focused so intently on one nugget of information and all but ignored others that, to the novice, seemed equally crucial. How do the great diagnosticians make such choices?\u003c/p>\n\u003cp>We now recognize this as a relatively intuitive version of \u003ca href=\"http://www.medicinenet.com/script/main/art.asp?articlekey=10301\" target=\"_blank\">Bayes’ theorem\u003c/a>. Developed by the eighteenth-century British theologian-turned-mathematician Thomas Bayes, this theorem (often ignored by students because it is taught to them with the dryness of a Passover matzo) is the linchpin of clinical reasoning. In essence, Bayes’ theorem says that any medical test must be interpreted from two perspectives. The first: How accurate is the test—that is, how often does it give right or wrong answers? The second: How likely is it that this patient has the disease the test is looking for?\u003c/p>\n\u003cp>These deceptively simple questions explain why, in the early days of the AIDS epidemic (when HIV testing was far less accurate than it is today), it was silly to test heterosexual couples applying for a marriage license, since the vast majority of positive tests in this very low-risk group would be wrong. Similarly, they show why it is foolish to screen healthy 36-year-old executives with a cardiac treadmill test or a heart scan, since positive results will mostly be false positives, serving only to scare the bejesus out of the patients and run up bills for unnecessary follow-up tests. Conversely, in a 68-year-old smoker with diabetes and high cholesterol who develops squeezing chest pain while jogging, there is a 95 percent chance that those pains are from coronary artery disease. In this case, a negative treadmill test only lowers this probability to about 80 percent, so the clinician who reassures the patient that his negative test means that his heart is fine—“take some antacids; it’s OK to keep jogging”—is making a terrible, and potentially fatal, mistake.\u003c/p>\n\u003cp>\u003cstrong>The AI Challenge\u003c/strong>\u003c/p>\n\u003cp>As if this weren’t complicated enough for the poor IBM engineer gearing up to retool Watson from answering questions about “Potent Potables” to diagnosing sick patients, there’s more. While the EHR at least offers a fighting chance for computerized diagnosis (older medical AI programs, built in the pen-and-paper era, required busy physicians to write their notes and then reenter all the key data), parsing an electronic medical record is far from straightforward. Natural language processing is getting much better, but it still has real problems with negation (“the patient has no history of chest pain or cough”) and with family history (“there is a history of arthritis in the patient’s sister, but his mother is well”), to name just a couple of issues. Certain terms have multiple meanings: when written by a psychiatrist, the term depression is likely to refer to a mood disorder, while when it appears in a cardiologist’s note (“there was no evidence of ST-depression”) it probably refers to a dip in the EKG tracing that is often a clue to coronary disease. Ditto abbreviations: Does the patient with “MS” have multiple sclerosis or mitral stenosis, a sticky heart valve? Finally, the computer can’t read a patient’s tone of voice or the anxious look on her face, although engineers are working on this. These clues—like one patient saying, “I have chest pain,” and another, “I HAVE CHEST PAIN!!!”—can make all the difference in the world diagnostically.\u003c/p>\n\u003cp>Perhaps the trickiest problem of all is that—at least today—the very collection of the facts needed to feed an AI system is itself a cognitively complex process. Let’s return to the example of aortic dissection, a rip in the aorta that is often fatal if it is not treated promptly. If the initial history raises the slightest concern about dissection, I’m going to ask questions about whether the pain bores through to the back and check carefully for the quiet murmur of aortic insufficiency as well as for asymmetric blood pressure readings in the two arms, all clues to dissection. If I don’t harbor a suspicion of this scary (and unusual) disease, I’m not going to look for these things—they’re not part of a routine exam.\u003c/p>\n\u003cp>Decades ago, MIT’s Peter Szolovits, an AI expert who worked with Kassirer and his colleagues in the early days, gave up thinking about diagnosis as a simple matter of question answering. This was mostly because he came to appreciate the importance of timing—a nonissue in Jeopardy but a pivotal one in medicine. “A heart attack that happened five years ago has different implications from one that happened five minutes ago,” he explained, and a computer can’t “know” this unless it is programmed to do so. (It turns out that such issues of foundational knowledge are fundamental in AI—computers have no way of “knowing” some of the basic assumptions that allow us to get through our days, things like water is wet, love is good, and death is permanent.)\u003c/p>\n\u003cp>Moreover, much of medical reasoning relies on feedback loops: observing how events unfold and using that information to refine the diagnostic possibilities.We think a patient has bacterial pneumonia, and so we treat the “pneumonia” with antibiotics, but the patient’s fever doesn’t break after three days. So now we consider the possibility of tuberculosis or lupus. This is the cognitive work of the practicing clinician—focused a bit less on “What is the diagnosis?” and more on “How do I best manage this situation?”—and an AI program that doesn’t account for this will be of limited value.\u003c/p>\n\u003cp>\u003cstrong>Early Attempts\u003c/strong>\u003c/p>\n\u003cp>Now that you appreciate the nature of the problem, it’s easy (in retrospect, at least) to see why the choice by early health care computer experts to focus on diagnosis was risky, perhaps even wrongheaded. It’s like tackling Saturday’s crossword puzzle in the New York Times before first mastering the one in USA Today.\u003c/p>\n\u003cp>Larry Fagan, an early Stanford computing pioneer, told me, “We were not naive about the complexity. It’s just that it was the most exciting question.” Diagnosis is not just exciting, it’s at the heart of safe medical care. Diagnostic errors are common, and they can be fatal. A number of autopsy studies conducted over the past 40 years have shown that major diagnoses were overlooked in nearly one in five patients. With the advent of CT scans and MRIs, the number has gone down a bit, but it still hovers around one in ten. Diagnostic errors contribute to 40,000 to 80,000 deaths per year in the United States. And reviews of malpractice cases have demonstrated that diagnostic errors are the most common source of mistakes leading to successful lawsuits.\u003c/p>\n\u003cp>Medical IT experts jumped into the fray in the 1970s, designing a series of computer programs that they believed could help physicians be better diagnosticians, or perhaps even replace them entirely. That decade’s literature was replete with enthusiastic articles about how microprocessors, programmed to think like experts, would soon replace the brains of harried doctors. The attitude was captured by one early computing pioneer in a 1971 paean to his computer: “It is immune from fatigue and carelessness; and it works day and night, weekends and holidays, without coffee breaks, overtime, fringe benefits or human courtesy.”\u003c/p>\n\u003cp>By the mid-1980s, disappointment had set in. The tools that had seemed so promising a decade earlier were, by and large, unable to manage the complexity of clinical medicine, and they garnered few clinician advocates and miniscule commercial adoption. The medical AI movement skidded to a halt, marking the start of a 20-year period that insiders still refer to as the “AI winter.” Ted Shortliffe, one of the field’s longstanding leaders, has said that the early experience with programs like INTERNIST, DXplain, and MYCIN reminded him of this cartoon:\u003c/p>\n\u003cp>\u003ca href=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/11/cartoon.jpg\">\u003cimg class=\"aligncenter size-full wp-image-276235\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/11/cartoon.jpg\" alt=\"cartoon\" width=\"300\" height=\"373\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2016/11/cartoon.jpg 300w, https://ww2.kqed.org/app/uploads/sites/13/2016/11/cartoon-160x199.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2016/11/cartoon-240x298.jpg 240w\" sizes=\"(max-width: 300px) 100vw, 300px\">\u003c/a>\u003c/p>\n\u003cp>\u003cstrong>'Version 0'\u003c/strong>\u003c/p>\n\u003cp>Vinod Khosla is prepared for this. He knows that even today’s generation of medical AI programs will produce some crazy output, akin to when Watson famously mistook Toronto for an American city during its Jeopardy triumph. (It was worse in rehearsal, when Watson referred to civil rights leader Malcolm X as “Malcolm Ten.”) Khosla points out that the enormous cellphones of the late 1980s would seem equally ridiculous when placed alongside our iPhone 6.0s. He calls today’s medical AI programs “Version 0,” and cautions that people should “expect these early systems and tools to be the butt of jokes from many a writer and physician.”\u003c/p>\n\u003cp>These cases illustrate a perennial debate in AI, one that pits two camps against each other: the “neats” and the “scruffies.” The neats seek solutions that are elegant and provable; they try to model the way experts think and work, and then code that into AI tools. The scruffies are the pragmatists, the hackers, the crazy ones; they believe that problems should be attacked through whatever means work, and that modeling the behavior of experts or the scientific truth of a situation isn’t all that important. IBM’s breakthrough was to figure out that a combination of neat and scruffy—programming in some of the core rules of the game, but then folding in the fruits of machine learning and natural language processing—could solve truly complicated problems.\u003c/p>\n\u003cp>When he was asked about the difference between human thinking and Watson’s method, Eric Brown, who runs IBM’s Watson Technologies group, gave a careful answer (note the shout-out to the humans, the bit players who made it all possible):\u003c/p>\n\u003cblockquote>\u003cp>A lot of the way that Watson works is motivated by the way that humans analyze problems and go about trying to find solutions, especially when it comes to dealing with complex problems where there are a number of intermediate steps toget you to the final answer. So it certainly is inspired by that process. . . . But a lot of it is different from the ways humans work; it tends to leverage the powers and advantages of a computer system, and its ability to rapidly analyze huge amounts of data and text that humans just can’t keep track of.\u003c/p>\u003c/blockquote>\n\u003cp>However Watson works, we find ourselves today in a world with new tools, new mental models, and a new sense of optimism that computers can do pretty much anything. But have we finally reached the age when computers can master the art of clinical reasoning?\u003c/p>\n\u003cp>I asked Eric Brown, who worked on the \"Jeopardy\" project and is now helping to lead Watson’s efforts in medicine, what the equivalent event might be in health care, the moment when his team could finally congratulate itself on its successes. I wondered if it would be the creation of some kind of holographic physician—like “\u003ca href=\"http://memory-alpha.wikia.com/wiki/Emergency_Medical_Holographic_program\" target=\"_blank\">The Doctor\u003c/a>” on Star Trek Voyager—with Watson serving as the cognitive engine. His answer, though, reflected the deep respect he and his colleagues have for the magnitude of the challenge:\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>Every day in the United States, millions of expectant mothers take a prenatal vitamin on the advice of their doctor.\u003c/p>\n\u003cp>The counsel typically comes with physical health in mind: folic acid to help avoid fetal spinal cord problems; iodine to spur healthy brain development; calcium to be bound like molecular Legos into diminutive baby bones.\u003c/p>\n\u003cp>But what about a child's future mental health? Questions about whether ADHD might arise a few years down the road or whether schizophrenia could crop up in young adulthood tend to be overshadowed by more immediate parental anxieties. As a friend with a newborn daughter recently fretted over lunch, \"I'm just trying not to drop her!\"\u003c/p>\n\u003cp>Yet much as pediatricians administer childhood vaccines to guard against future infections, some psychiatrists now are thinking about how to shift their treatment-centric discipline toward one that also deals in early prevention.\u003c/p>\n\u003cp>In 2013, University of Colorado psychiatrist \u003ca href=\"http://www.ucdenver.edu/academics/colleges/medicalschool/departments/psychiatry/Faculty/Pages/Freedman,%20Robert.aspx\">Robert Freedman\u003c/a> and colleagues recruited 100 healthy, pregnant women from greater Denver to study whether giving the \u003ca href=\"//www.ncbi.nlm.nih.gov/books/NBK114308/\">B vitamin choline\u003c/a> during pregnancy would enhance brain growth in the developing fetus.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The moms-to-be were randomly given either a placebo or a form of choline called phosphatidylcholine. Choline itself is broken down by bacteria in the gut; by giving it in this related form the supplement can more effectively be absorbed into the bloodstream.\u003c/p>\n\u003cp>Those in the treatment group received 3,600 milligrams of phosphatidylcholine in the morning and 2,700 milligrams at night. Since phosphatidylcholine is roughly 13-15 percent choline, the amount the women received was about 900 milligrams of choline a day, twice that recommended by the Health and Medicine Division of the National Academies (and about the same amount contained in three large eggs).\u003c/p>\n\u003cp>After birth, infants were given either 100 milligrams of liquid phosphatidylcholine or placebo once a day for approximately three months. Given that both groups were also getting choline from regular feeding, the dose ensured that those supplemented received well over the Institute of Medicine's guideline that infants receive at least 125 milligrams a day.\u003c/p>\n\u003cp>At 5 weeks old, the children were exposed to a series of clicking sounds in the lab while their brain activity was monitored by \u003ca href=\"https://medlineplus.gov/ency/article/003931.htm\">electroencephalogram\u003c/a>, or EEG, a method for recording electrical brain activity via electrodes placed on the scalp. Normally, when exposed to the same sound successively, both infant and adult brains will exhibit \"inhibition,\" or a far weaker pulse of activity in response to the second sound. We realize that the now familiar tone is insignificant; our brains are unmoved.\u003c/p>\n\u003cp>However, in some kids this inhibition doesn't occur — a finding linked with an increased risk for attention problems, social withdrawal and, later in life, schizophrenia.\u003c/p>\n\u003cp>The \u003ca href=\"http://ajp.psychiatryonline.org/doi/abs/10.1176/appi.ajp.2012.12070940\">results published in 2013\u003c/a> in the \u003cem>American Journal of Psychiatry\u003c/em> by Freedman's group show that 76 percent of newborns whose mothers received choline supplements had normal inhibition to the sound stimuli. The proportion fell to 43 percent in those born to mothers who didn't get them. It appeared that choline might steer the infant brain away from a developmental course that predicted mental health problems.\u003c/p>\n\u003cp>A follow-up study at 40 months found that the children who had received choline supplements \u003cem>in utero\u003c/em> and after birth had fewer attention problems and less social withdrawal.\u003c/p>\n\u003cp>Excessive choline consumption — or that over 7,500 milligrams a day — has been associated with drops in blood pressure, sweating, gastrointestinal side effects and a \"fishy\" body odor. But most diets contain adequate choline, and supplementation to optimal levels poses no known side effects or risk to fetal development, Freedman says.\u003c/p>\n\u003cp>\u003cstrong>A genetic theory \u003c/strong>\u003c/p>\n\u003cp>One of the first genes to be linked to schizophrenia goes by the catchy name \"\u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/26376812\">CHRNA7\u003c/a>.\" Normally it encodes for a receptor on neurons in the brain that respond to the neurotransmitter acetylcholine as well as nicotine, a transmission essential to normal brain function and cognition. Genetic mutations in the CHRNA7 gene cause decreased levels of the neuronal receptor to be produced in people with schizophrenia.\u003c/p>\n\u003cp>A light bulb glowed for Freedman.\u003c/p>\n\u003cp>And the idea, he admits, is rather simple when you think about it: Choline is known to be essential to brain development and function and is also frequently deficient in pregnant women.\u003c/p>\n\u003cp>Couple these facts with animal and human research by Freedman and his colleagues showing that choline in the amniotic fluid also activates the CHRNA7 receptor in the developing fetal brain.\u003c/p>\n\u003cp>\"It occurred to us that just as folic acid can help overcome defects in brain and spinal cord development, perhaps supplementing mothers with choline could help prevent mental illness,\" Freedman recalls. \"And now that the children in our study are over 4 years old, we can see that those given the supplement appear to be on a different developmental track, one with fewer mental problems.\"\u003c/p>\n\u003cp>Moreover, though experimental psychosis treatments targeting the CHRNA7 gene and the receptor it codes for are being explored by other researchers, Freedman explains that levels of the receptor peak in the fetal brain and diminish after birth. \"We realized the optimal time to try this intervention is during pregnancy,\" he says.\u003c/p>\n\u003cp>Though choline is available in a number of foods — eggs, seafood and liver are particularly rich in the nutrient — Freedman's work suggests that for many women, dietary sources may be inadequate during pregnancy. Also, prenatal supplements tend not to include it.\u003c/p>\n\u003cp>Two past observational studies — conducted with diet questionnaires rather than the more rigorous placebo-controlled supplementation Freedman's group tried — also found beneficial effects associated with higher maternal choline intake during pregnancy. At 7 years of age, children of moms consuming over 400 milligrams of choline a day performed better on memory and intelligence tests. At 18 months, infants whose mothers had higher blood levels of choline had significantly higher cognitive test scores.\u003c/p>\n\u003cp>Dr. Steve Zeisel of the University of North Carolina was one of the first doctors to strongly advocate for choline supplementation in pregnancy. In 2012, Zeisel \u003ca href=\"http://ajcn.nutrition.org/content/96/6/1465.long\">published the only other\u003c/a> placebo-controlled trial of the vitamin in pregnant moms. While he did not assess for future mental health risks, the findings suggested that choline supplementation did not enhance infant cognitive function at 1 year of age. However, Freedman point outs that all of the women included in the trial were highly educated and were found to have blood metabolites reflecting diets high in healthful, choline-containing foods.\u003c/p>\n\u003cp>The prospects of choline supplementation in pregnancy have piqued medical interest, but also notes of caution. \"I think the choline research is really intriguing, and we're starting to investigate maternal choline levels as well,\" says \u003ca href=\"http://profiles.columbiapsychiatry.org/profile/cmonk\">Catherine Monk\u003c/a>, an associate professor in psychiatry and obstetrics and gynecology at Columbia University Medical Center. \"Some prenatal vitamins do contain it and foods rich in choline are readily available. But we have a lot more research to do before we start recommending it widely.\"\u003c/p>\n\u003cp>In general, evidence-based interventions during pregnancy and early childhood to prevent mental illness are scant. Yet there are some modifiable risk factors that might make a difference, many of which focus on improving maternal wellbeing.\u003c/p>\n\u003cp>Monk's own research explores on the impact of an expecting mother's emotional state on the developing fetus. She and others have shown that stress, depression and anxiety during pregnancy increase a child's risk for ADHD, conduct disorders and depression later in life. At Columbia, Monk and her colleagues employ a program Practical Resources for Effective Postpartum Parenting, or PREPP, in which pregnant women who are distressed and at high-risk for postpartum depression are counseled and taught coping skills to make pregnancy and parenting more manageable emotionally.\u003c/p>\n\u003cp>Optimal nutrition, including choline and adequate amounts of zinc and omega-3 fatty acids, may also have developmental and mental health benefits as might avoiding smoking.\u003c/p>\n\u003cp>\u003cstrong>The future of funding\u003c/strong>\u003c/p>\n\u003cp>Despite incomplete data on choline supplementation, Freedman's research colleague \u003ca href=\"http://www.ucdenver.edu/academics/colleges/medicalschool/programs/winnlab/AboutUs/Pages/CamilleHoffman.aspx\">Dr. Camille Hoffman-Shuler\u003c/a>, an obstetrician, sees it as a promising intervention that should continue to be explored.\u003c/p>\n\u003cp>\"Obstetricians and midwives are not widely aware of choline supplementation,\" she says. \"But I do recommend it to pregnant women, especially if they have other mental health vulnerabilities. And I'd personally want it with a future pregnancy based on existing data.\"\u003c/p>\n\u003cp>Both Freedman and Hoffman-Shuler hope to continue choline research, yet decry the obstacles to securing the money to do it.\u003c/p>\n\u003cp>\"The NIH is currently funding no trials of any intervention in humans during pregnancy to prevent mental illness,\" says Freedman, \"yet ideally we'd follow these children for another 20 to 25 years to see if they develop mental illness. This is beyond the scope of most imaginable — and fundable — experiments.\"\u003c/p>\n\u003cp>Hoffman-Shuler is prepared to do what it takes. \"The hardest part is getting this across to the funding agencies and the public,\" she says. But this is a serious public health issue in which prevention during pregnancy is far more preferable to the loss of health and consequences that come with mental illness!\"\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>Bret Stetka is a writer based in New York and an editorial director at\u003c/em> \u003ca href=\"http://www.medscape.com/public/bios/bio-bretstetka\" target=\"_blank\">Medscape\u003c/a>. \u003cem>His work has appeared in\u003c/em> Wired\u003cem>,\u003c/em> Scientific American \u003cem>and on The Atlantic.com. He graduated from University of Virginia School of Medicine in 2005. You can follow him on Twitter: \u003c/em>\u003ca href=\"https://twitter.com/BretStetka\" target=\"_blank\">@BretStetka\u003c/a>.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Can+Mental+Illness+Be+Prevented+In+The+Womb%3F&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Every day in the United States, millions of expectant mothers take a prenatal vitamin on the advice of their doctor.\u003c/p>\n\u003cp>The counsel typically comes with physical health in mind: folic acid to help avoid fetal spinal cord problems; iodine to spur healthy brain development; calcium to be bound like molecular Legos into diminutive baby bones.\u003c/p>\n\u003cp>But what about a child's future mental health? Questions about whether ADHD might arise a few years down the road or whether schizophrenia could crop up in young adulthood tend to be overshadowed by more immediate parental anxieties. As a friend with a newborn daughter recently fretted over lunch, \"I'm just trying not to drop her!\"\u003c/p>\n\u003cp>Yet much as pediatricians administer childhood vaccines to guard against future infections, some psychiatrists now are thinking about how to shift their treatment-centric discipline toward one that also deals in early prevention.\u003c/p>\n\u003cp>In 2013, University of Colorado psychiatrist \u003ca href=\"http://www.ucdenver.edu/academics/colleges/medicalschool/departments/psychiatry/Faculty/Pages/Freedman,%20Robert.aspx\">Robert Freedman\u003c/a> and colleagues recruited 100 healthy, pregnant women from greater Denver to study whether giving the \u003ca href=\"//www.ncbi.nlm.nih.gov/books/NBK114308/\">B vitamin choline\u003c/a> during pregnancy would enhance brain growth in the developing fetus.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The moms-to-be were randomly given either a placebo or a form of choline called phosphatidylcholine. Choline itself is broken down by bacteria in the gut; by giving it in this related form the supplement can more effectively be absorbed into the bloodstream.\u003c/p>\n\u003cp>Those in the treatment group received 3,600 milligrams of phosphatidylcholine in the morning and 2,700 milligrams at night. Since phosphatidylcholine is roughly 13-15 percent choline, the amount the women received was about 900 milligrams of choline a day, twice that recommended by the Health and Medicine Division of the National Academies (and about the same amount contained in three large eggs).\u003c/p>\n\u003cp>After birth, infants were given either 100 milligrams of liquid phosphatidylcholine or placebo once a day for approximately three months. Given that both groups were also getting choline from regular feeding, the dose ensured that those supplemented received well over the Institute of Medicine's guideline that infants receive at least 125 milligrams a day.\u003c/p>\n\u003cp>At 5 weeks old, the children were exposed to a series of clicking sounds in the lab while their brain activity was monitored by \u003ca href=\"https://medlineplus.gov/ency/article/003931.htm\">electroencephalogram\u003c/a>, or EEG, a method for recording electrical brain activity via electrodes placed on the scalp. Normally, when exposed to the same sound successively, both infant and adult brains will exhibit \"inhibition,\" or a far weaker pulse of activity in response to the second sound. We realize that the now familiar tone is insignificant; our brains are unmoved.\u003c/p>\n\u003cp>However, in some kids this inhibition doesn't occur — a finding linked with an increased risk for attention problems, social withdrawal and, later in life, schizophrenia.\u003c/p>\n\u003cp>The \u003ca href=\"http://ajp.psychiatryonline.org/doi/abs/10.1176/appi.ajp.2012.12070940\">results published in 2013\u003c/a> in the \u003cem>American Journal of Psychiatry\u003c/em> by Freedman's group show that 76 percent of newborns whose mothers received choline supplements had normal inhibition to the sound stimuli. The proportion fell to 43 percent in those born to mothers who didn't get them. It appeared that choline might steer the infant brain away from a developmental course that predicted mental health problems.\u003c/p>\n\u003cp>A follow-up study at 40 months found that the children who had received choline supplements \u003cem>in utero\u003c/em> and after birth had fewer attention problems and less social withdrawal.\u003c/p>\n\u003cp>Excessive choline consumption — or that over 7,500 milligrams a day — has been associated with drops in blood pressure, sweating, gastrointestinal side effects and a \"fishy\" body odor. But most diets contain adequate choline, and supplementation to optimal levels poses no known side effects or risk to fetal development, Freedman says.\u003c/p>\n\u003cp>\u003cstrong>A genetic theory \u003c/strong>\u003c/p>\n\u003cp>One of the first genes to be linked to schizophrenia goes by the catchy name \"\u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/26376812\">CHRNA7\u003c/a>.\" Normally it encodes for a receptor on neurons in the brain that respond to the neurotransmitter acetylcholine as well as nicotine, a transmission essential to normal brain function and cognition. Genetic mutations in the CHRNA7 gene cause decreased levels of the neuronal receptor to be produced in people with schizophrenia.\u003c/p>\n\u003cp>A light bulb glowed for Freedman.\u003c/p>\n\u003cp>And the idea, he admits, is rather simple when you think about it: Choline is known to be essential to brain development and function and is also frequently deficient in pregnant women.\u003c/p>\n\u003cp>Couple these facts with animal and human research by Freedman and his colleagues showing that choline in the amniotic fluid also activates the CHRNA7 receptor in the developing fetal brain.\u003c/p>\n\u003cp>\"It occurred to us that just as folic acid can help overcome defects in brain and spinal cord development, perhaps supplementing mothers with choline could help prevent mental illness,\" Freedman recalls. \"And now that the children in our study are over 4 years old, we can see that those given the supplement appear to be on a different developmental track, one with fewer mental problems.\"\u003c/p>\n\u003cp>Moreover, though experimental psychosis treatments targeting the CHRNA7 gene and the receptor it codes for are being explored by other researchers, Freedman explains that levels of the receptor peak in the fetal brain and diminish after birth. \"We realized the optimal time to try this intervention is during pregnancy,\" he says.\u003c/p>\n\u003cp>Though choline is available in a number of foods — eggs, seafood and liver are particularly rich in the nutrient — Freedman's work suggests that for many women, dietary sources may be inadequate during pregnancy. Also, prenatal supplements tend not to include it.\u003c/p>\n\u003cp>Two past observational studies — conducted with diet questionnaires rather than the more rigorous placebo-controlled supplementation Freedman's group tried — also found beneficial effects associated with higher maternal choline intake during pregnancy. At 7 years of age, children of moms consuming over 400 milligrams of choline a day performed better on memory and intelligence tests. At 18 months, infants whose mothers had higher blood levels of choline had significantly higher cognitive test scores.\u003c/p>\n\u003cp>Dr. Steve Zeisel of the University of North Carolina was one of the first doctors to strongly advocate for choline supplementation in pregnancy. In 2012, Zeisel \u003ca href=\"http://ajcn.nutrition.org/content/96/6/1465.long\">published the only other\u003c/a> placebo-controlled trial of the vitamin in pregnant moms. While he did not assess for future mental health risks, the findings suggested that choline supplementation did not enhance infant cognitive function at 1 year of age. However, Freedman point outs that all of the women included in the trial were highly educated and were found to have blood metabolites reflecting diets high in healthful, choline-containing foods.\u003c/p>\n\u003cp>The prospects of choline supplementation in pregnancy have piqued medical interest, but also notes of caution. \"I think the choline research is really intriguing, and we're starting to investigate maternal choline levels as well,\" says \u003ca href=\"http://profiles.columbiapsychiatry.org/profile/cmonk\">Catherine Monk\u003c/a>, an associate professor in psychiatry and obstetrics and gynecology at Columbia University Medical Center. \"Some prenatal vitamins do contain it and foods rich in choline are readily available. But we have a lot more research to do before we start recommending it widely.\"\u003c/p>\n\u003cp>In general, evidence-based interventions during pregnancy and early childhood to prevent mental illness are scant. Yet there are some modifiable risk factors that might make a difference, many of which focus on improving maternal wellbeing.\u003c/p>\n\u003cp>Monk's own research explores on the impact of an expecting mother's emotional state on the developing fetus. She and others have shown that stress, depression and anxiety during pregnancy increase a child's risk for ADHD, conduct disorders and depression later in life. At Columbia, Monk and her colleagues employ a program Practical Resources for Effective Postpartum Parenting, or PREPP, in which pregnant women who are distressed and at high-risk for postpartum depression are counseled and taught coping skills to make pregnancy and parenting more manageable emotionally.\u003c/p>\n\u003cp>Optimal nutrition, including choline and adequate amounts of zinc and omega-3 fatty acids, may also have developmental and mental health benefits as might avoiding smoking.\u003c/p>\n\u003cp>\u003cstrong>The future of funding\u003c/strong>\u003c/p>\n\u003cp>Despite incomplete data on choline supplementation, Freedman's research colleague \u003ca href=\"http://www.ucdenver.edu/academics/colleges/medicalschool/programs/winnlab/AboutUs/Pages/CamilleHoffman.aspx\">Dr. Camille Hoffman-Shuler\u003c/a>, an obstetrician, sees it as a promising intervention that should continue to be explored.\u003c/p>\n\u003cp>\"Obstetricians and midwives are not widely aware of choline supplementation,\" she says. \"But I do recommend it to pregnant women, especially if they have other mental health vulnerabilities. And I'd personally want it with a future pregnancy based on existing data.\"\u003c/p>\n\u003cp>Both Freedman and Hoffman-Shuler hope to continue choline research, yet decry the obstacles to securing the money to do it.\u003c/p>\n\u003cp>\"The NIH is currently funding no trials of any intervention in humans during pregnancy to prevent mental illness,\" says Freedman, \"yet ideally we'd follow these children for another 20 to 25 years to see if they develop mental illness. This is beyond the scope of most imaginable — and fundable — experiments.\"\u003c/p>\n\u003cp>Hoffman-Shuler is prepared to do what it takes. \"The hardest part is getting this across to the funding agencies and the public,\" she says. But this is a serious public health issue in which prevention during pregnancy is far more preferable to the loss of health and consequences that come with mental illness!\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>Bret Stetka is a writer based in New York and an editorial director at\u003c/em> \u003ca href=\"http://www.medscape.com/public/bios/bio-bretstetka\" target=\"_blank\">Medscape\u003c/a>. \u003cem>His work has appeared in\u003c/em> Wired\u003cem>,\u003c/em> Scientific American \u003cem>and on The Atlantic.com. He graduated from University of Virginia School of Medicine in 2005. You can follow him on Twitter: \u003c/em>\u003ca href=\"https://twitter.com/BretStetka\" target=\"_blank\">@BretStetka\u003c/a>.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Can+Mental+Illness+Be+Prevented+In+The+Womb%3F&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Whether it's an IUD, a shot, an implant, or a daily pill, birth control is a regular part of many adult women's lives. It has left a lot of women asking: Why not men?\u003c/p>\n\u003cp>For years, people have tried to create birth control for men. The World Health Organization commissioned what sounded like a promising trial, a two-hormone injection designed to lower sperm count. Initial results looked like it would be 96 percent effective in preventing pregnancy in the participants' partners. But the Stage II trial was stopped after an independent review panel found that the drug had too many side effects. The \u003ca href=\"http://press.endocrine.org/doi/10.1210/jc.2016-2141\">results\u003c/a> were published last week in \u003cem>The Journal of Clinical Endocrinology and Metabolism\u003c/em>.\u003c/p>\n\u003cp>\u003cem>All Things Considered\u003c/em>'s Audie Cornish sat down with NPR science correspondent Rob Stein to discuss the trial and the reason it was canceled. Here are excerpts of their conversation, edited for length and clarity.\u003c/p>\n\u003chr>\n\u003cp>\u003cstrong>How did this latest study work?\u003c/strong>\u003c/p>\n\u003cp>It was a pretty big study; they gave shots to 320 men every eight weeks, in different countries around the world. The shot contained two hormones, and it worked pretty well. It knocked down their sperm counts significantly, and there were only a handful of pregnancies among partners of men in the trial.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>But two committees were paying close attention to the study, and they realized that a lot of guys were dropping out because they were experiencing side effects. The most common side effect was acne, and sometimes that acne was pretty severe. Some men also developed mood swings and in some cases those mood swings got pretty bad. One man developed severe depression, and another tried to commit suicide. Because of that, they cut the study short.\u003c/p>\n\u003cp>But when they spoke with guys in the study who didn't drop out, most said that if this product was available, they would use it.\u003c/p>\n\u003cp>\u003cstrong>There's been a lot of eye rolling on the Internet about these side effects, because women have been experiencing things like mood swings and weight gain for decades with hormonal birth control.\u003c/strong>\u003c/p>\n\u003cp>No birth control is perfect. Almost everything has some sort of side effect. And the side effects they saw in this study were not that different from those you see with other kinds of birth control — except for the severe emotional problems. That was definitely more than we see with the birth control pill.\u003c/p>\n\u003cp>But there's a little bit of a different risk-benefit analysis when it comes to men using a contraceptive. When women use a contraceptive, they're balancing the risks of the drug against the risks of getting pregnant. And pregnancy itself carries risks. But these are healthy men — they're not going to suffer any risks if they get somebody else pregnant.\u003c/p>\n\u003cp>\u003cstrong>Why is it harder to develop birth control for men than women?\u003c/strong>\u003c/p>\n\u003cp>That's the a big question. There are a couple of reasons. One is that it's harder from a biological point of view. If you think about it, it's a numbers game: Women produce one egg a month, while men are producing millions of sperm constantly. With women, you can take advantage of their normal monthly cycle with the birth control pill. There's nothing equivalent to that in men.\u003c/p>\n\u003cp>\u003cstrong>What does this mean for male birth control in general? Is this particular study a big setback, or is it no big deal?\u003c/strong>\u003c/p>\n\u003cp>It's a setback and it's definitely a disappointment. People had a lot of optimism about this study. But I've talked to a bunch of scientists about this, and they say they're not giving up yet. They're going to tinker with the doses of the hormones to see if they can come up with safer levels. They're also going to try different kinds of hormones and maybe administer them differently, like in a gel or an implant. They could also target how a sperm works by making it not swim as well, making it worse at fertilizing the egg.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>There's a lot of research still going on, but most of it is at a fairly early level. Scientists are saying, \"We're gonna keep trying,\" but they're still a decade away from coming up with something for men.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Male+Birth+Control+Study+Killed+After+Men+Complain+About+Side+Effects&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"info": "What kind of no sabo word is Hyphenación? For us, it’s about living within a hyphenation. Like being a third-gen Mexican-American from the Texas border now living that Bay Area Chicano life. Like Xorje! Each week we bring together a couple of hyphenated Latinos to talk all about personal life choices: family, careers, relationships, belonging … everything is on the table. ",
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"marketplace": {
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"info": "Our flagship program, helmed by Kai Ryssdal, examines what the day in money delivered, through stories, conversations, newsworthy numbers and more. Updated Monday through Friday at about 3:30 p.m. PT.",
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"masters-of-scale": {
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"mindshift": {
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"info": "The MindShift podcast explores the innovations in education that are shaping how kids learn. Hosts Ki Sung and Katrina Schwartz introduce listeners to educators, researchers, parents and students who are developing effective ways to improve how kids learn. We cover topics like how fed-up administrators are developing surprising tactics to deal with classroom disruptions; how listening to podcasts are helping kids develop reading skills; the consequences of overparenting; and why interdisciplinary learning can engage students on all ends of the traditional achievement spectrum. This podcast is part of the MindShift education site, a division of KQED News. KQED is an NPR/PBS member station based in San Francisco. You can also visit the MindShift website for episodes and supplemental blog posts or tweet us \u003ca href=\"https://twitter.com/MindShiftKQED\">@MindShiftKQED\u003c/a> or visit us at \u003ca href=\"/mindshift\">MindShift.KQED.org\u003c/a>",
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"order": 12
},
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM1NzY0NjAwNDI5",
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"morning-edition": {
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"tagline": "Deeply-reported investigative journalism",
"info": "For decades, the process for how police police themselves has been inconsistent – if not opaque. In some states, like California, these proceedings were completely hidden. After a new police transparency law unsealed scores of internal affairs files, our reporters set out to examine these cases and the shadow world of police discipline. On Our Watch brings listeners into the rooms where officers are questioned and witnesses are interrogated to find out who this system is really protecting. Is it the officers, or the public they've sworn to serve?",
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"info": "Our weekly podcast explores how the media 'sausage' is made, casts an incisive eye on fluctuations in the marketplace of ideas, and examines threats to the freedom of information and expression in America and abroad. For one hour a week, the show tries to lift the veil from the process of \"making media,\" especially news media, because it's through that lens that we see the world and the world sees us",
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},
"pbs-newshour": {
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},
"perspectives": {
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"order": 14
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"info": "The economy explained. Imagine you could call up a friend and say, Meet me at the bar and tell me what's going on with the economy. Now imagine that's actually a fun evening.",
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"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/planetmoney.jpg",
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"link": "/radio/program/planet-money",
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"politicalbreakdown": {
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"title": "Political Breakdown",
"tagline": "Politics from a personal perspective",
"info": "Political Breakdown is a new series that explores the political intersection of California and the nation. Each week hosts Scott Shafer and Marisa Lagos are joined with a new special guest to unpack politics -- with personality — and offer an insider’s glimpse at how politics happens.",
"airtime": "THU 6:30pm-7pm",
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"order": 5
},
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"possible": {
"id": "possible",
"title": "Possible",
"info": "Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. Together in Possible, Hoffman and Finger lead enlightening discussions about building a brighter collective future. The show features interviews with visionary guests like Trevor Noah, Sam Altman and Janette Sadik-Khan. Possible paints an optimistic portrait of the world we can create through science, policy, business, art and our shared humanity. It asks: What if everything goes right for once? How can we get there? Each episode also includes a short fiction story generated by advanced AI GPT-4, serving as a thought-provoking springboard to speculate how humanity could leverage technology for good.",
"airtime": "SUN 2pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Possible-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.possible.fm/",
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"source": "Possible"
},
"link": "/radio/program/possible",
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"spotify": "https://open.spotify.com/show/730YpdUSNlMyPQwNnyjp4k"
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},
"pri-the-world": {
"id": "pri-the-world",
"title": "PRI's The World: Latest Edition",
"info": "Each weekday, host Marco Werman and his team of producers bring you the world's most interesting stories in an hour of radio that reminds us just how small our planet really is.",
"airtime": "MON-FRI 2pm-3pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/The-World-Podcast-Tile-360x360-1.jpg",
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},
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},
"radiolab": {
"id": "radiolab",
"title": "Radiolab",
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