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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Mindful of such concerns, the FDA statement took pains to explain the steps taken by the agency to respond to the NDMA problem. These included \u003ca href=\"https://www.fda.gov/Drugs/DrugSafety/ucm613916.htm\" target=\"_blank\" rel=\"noopener\">alerts\u003c/a> issued to patients and health care providers on the agency \u003ca href=\"https://www.fda.gov/Drugs/DrugSafety/ucm613916.htm\" target=\"_blank\" rel=\"noopener\">web site\u003c/a>; analysis by FDA staff at its St. Louis laboratory; communicating with regulators in Canada, Europe, and Japan; and inspecting Zhejiang Huahai facilities in China.\u003c/p>\n\u003cp>At the same time, the FDA reiterated an earlier alert that attempted to put the risk into context.\u003c/p>\n\u003cp>The agency estimated that if 8,000 people took the highest valsartan dose of 320 mg in a pill containing NDMA daily for four years — which is the amount of time the FDA believes the affected pill had been on the U.S. market — there may be one additional case of cancer over their lifetimes beyond the average cancer rate among Americans.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>“This estimate represented the highest possible level of NDMA exposure. It was a measure of the risk under the most extreme circumstances. Most patients who were exposed to the impurity through the use of valsartan received less exposure than this worst-case scenario,” Gottlieb and Woodcock wrote in a bid to reassure the public about the likelihood of the risk of developing cancer.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Meanwhile, they added that they plan to use what they learn from this scare to “inform assessments of product applications being submitted and currently reviewed by the FDA. We will disseminate that information to manufacturers of all drugs and to the scientific community and re-evaluate our existing guidance to manufacturers.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>A new study suggests that ketamine, an increasingly popular treatment for depression, has something in common with drugs like fentanyl and oxycodone.[contextly_sidebar id=\"GKOXapuQ5qMV9rgSB9dSKa6ZDrVupWf3\"]\u003c/p>\n\u003cp>The small study found evidence that ketamine's effectiveness with depression, demonstrated in many small studies over the past decade, comes from its interaction with the brain's opioid system. A Stanford University team \u003ca href=\"http://dx.doi.org/10.1176/appi.ajp.2018.18020138\" target=\"_blank\" rel=\"noopener\">reported \u003c/a>their findings Wednesday in \u003cem>The American Journal of Psychiatry\u003c/em>.\u003c/p>\n\u003cp>\"We think ketamine is acting as an opioid,\" says \u003ca href=\"https://neuroscience.stanford.edu/people/alan-f-schatzberg\" target=\"_blank\" rel=\"noopener\">Alan Schatzberg\u003c/a>, one of the study's authors and a professor of psychiatry and behavioral sciences at Stanford University. \"That's why you're getting these rapid effects.\"\u003c/p>\n\u003cp>Until now, most researchers have attributed ketamine's success to its effect on the brain's glutamate system, which is involved in learning and memory. The opioid system, in contrast, controls pain, reward and addictive behaviors.\u003c/p>\n\u003cp>Ketamine is an anesthetic that is frequently given to children in the emergency room. It is also a popular but illicit party drug that can cause an out-of-body experience at high doses.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>And in the past few years, \u003ca href=\"https://www.npr.org/sections/health-shots/2017/03/20/520169959/ketamine-for-severe-depression-how-do-you-not-offer-this-drug-to-people\" target=\"_blank\" rel=\"noopener\">ketamine has seen increasing use\u003c/a> as an off-label treatment that doctors prescribe for patients with severe depression that doesn't respond to other drugs. Unlike conventional antidepressants like Prozac, which can take weeks to work, an infusion or nasal administration of ketamine typically produces results in hours.[contextly_sidebar id=\"b9ZDNeJgwwqSZavOYEHiljP4WWMQlDiK\"]\u003c/p>\n\u003cp>The new study's findings suggests that taking ketamine for depression could lead to abuse or addiction, says Schatzberg, who has financial ties to several drug companies. Ketamine has a less potent effect on opioid receptors than drugs like fentanyl or oxycodone, he says, \"but that doesn't mean it's safer.\"\u003c/p>\n\u003cp>Other researchers say the study's implications aren't so clear.\u003c/p>\n\u003cp>\"The results are quite intriguing,\" says \u003ca href=\"https://www.nimh.nih.gov/labs-at-nimh/principal-investigators/carlos-zarate.shtml\" target=\"_blank\" rel=\"noopener\">Carlos Zarate Jr.\u003c/a>, an investigator at the National Institute of Mental Health who has been studying ketamine's effects on depression for more than a decade. \"However, this study is preliminary and its results need to be replicated.\"\u003c/p>\n\u003cp>The new study is \"interesting and exciting,\" says \u003ca href=\"https://medicine.yale.edu/psychiatry/people/ronald_duman-1.profile\" target=\"_blank\" rel=\"noopener\">Ronald Duman\u003c/a>, a professor of psychiatry and neurobiology at Yale University who has published research showing how ketamine causes brain cells to form new connections.\u003c/p>\n\u003cp>But Duman isn't convinced that ketamine's effect on the opioid system is the key to its effectiveness in treating depression. He notes that ketamine's effect on the brain's glutamate system is quite powerful, while the drug has \"a relatively low affinity for opiate receptors.\"\u003c/p>\n\u003cp>The Stanford team decided to conduct its study after seeing research that suggested drugs that work on the glutamate system alone aren't very effective antidepressants, Schatzberg says. They researchers also knew that opioid drugs had once been used to treat depression but were largely abandoned because of concern about abuse.[contextly_sidebar id=\"a3FmE4rjr7xcOG9MhJ9mEKI27rlhXnjE\"]\u003c/p>\n\u003cp>So the team designed an experiment that would treat patients with depression in two ways. The first was by giving them an infusion of ketamine alone. The second involved giving each patient the drug naltrexone, which blocks the effects of opioid drugs, before the patient got an infusion of ketamine.\u003c/p>\n\u003cp>An analysis of a dozen patients who got both treatments showed a dramatic difference. Seven of the 12 saw their depression symptoms decrease by at least 50 percent a day after they got ketamine alone. But when they got naltrexone first, there was \"virtually no effect,\" says \u003ca href=\"https://profiles.stanford.edu/carolyn-rodriguez\" target=\"_blank\" rel=\"noopener\">Carolyn Rodriguez\u003c/a>, one of the study's authors and an assistant professor of psychiatry and behavioral sciences at Stanford.\u003c/p>\n\u003cp>Rodriguez, who has pioneered the use of ketamine to treat obsessive-compulsive disorder, says the study doesn't prove that the drug works primarily through the brain's opioid system. Instead, she calls the result \"the beginning of a conversation\" and says it \"highlights that ketamine's mechanism of action is complicated.\"\u003c/p>\n\u003cp>Rodriguez has served as a consultant for several drug companies including Allergan, which is developing a depression drug that acts like ketamine in the brain.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>One possibility is that ketamine's effect on opioid receptors may provide immediate but short-term relief of depression symptoms, Rodriguez says, while the drug's effect on the glutamate system may be what makes that relief last for a week or more.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Ketamine%2C+A+Promising+Depression+Treatment%2C+Seems+To+Act+Like+An+Opioid&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>A new study suggests that ketamine, an increasingly popular treatment for depression, has something in common with drugs like fentanyl and oxycodone.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>The small study found evidence that ketamine's effectiveness with depression, demonstrated in many small studies over the past decade, comes from its interaction with the brain's opioid system. A Stanford University team \u003ca href=\"http://dx.doi.org/10.1176/appi.ajp.2018.18020138\" target=\"_blank\" rel=\"noopener\">reported \u003c/a>their findings Wednesday in \u003cem>The American Journal of Psychiatry\u003c/em>.\u003c/p>\n\u003cp>\"We think ketamine is acting as an opioid,\" says \u003ca href=\"https://neuroscience.stanford.edu/people/alan-f-schatzberg\" target=\"_blank\" rel=\"noopener\">Alan Schatzberg\u003c/a>, one of the study's authors and a professor of psychiatry and behavioral sciences at Stanford University. \"That's why you're getting these rapid effects.\"\u003c/p>\n\u003cp>Until now, most researchers have attributed ketamine's success to its effect on the brain's glutamate system, which is involved in learning and memory. The opioid system, in contrast, controls pain, reward and addictive behaviors.\u003c/p>\n\u003cp>Ketamine is an anesthetic that is frequently given to children in the emergency room. It is also a popular but illicit party drug that can cause an out-of-body experience at high doses.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>And in the past few years, \u003ca href=\"https://www.npr.org/sections/health-shots/2017/03/20/520169959/ketamine-for-severe-depression-how-do-you-not-offer-this-drug-to-people\" target=\"_blank\" rel=\"noopener\">ketamine has seen increasing use\u003c/a> as an off-label treatment that doctors prescribe for patients with severe depression that doesn't respond to other drugs. Unlike conventional antidepressants like Prozac, which can take weeks to work, an infusion or nasal administration of ketamine typically produces results in hours.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>The new study's findings suggests that taking ketamine for depression could lead to abuse or addiction, says Schatzberg, who has financial ties to several drug companies. Ketamine has a less potent effect on opioid receptors than drugs like fentanyl or oxycodone, he says, \"but that doesn't mean it's safer.\"\u003c/p>\n\u003cp>Other researchers say the study's implications aren't so clear.\u003c/p>\n\u003cp>\"The results are quite intriguing,\" says \u003ca href=\"https://www.nimh.nih.gov/labs-at-nimh/principal-investigators/carlos-zarate.shtml\" target=\"_blank\" rel=\"noopener\">Carlos Zarate Jr.\u003c/a>, an investigator at the National Institute of Mental Health who has been studying ketamine's effects on depression for more than a decade. \"However, this study is preliminary and its results need to be replicated.\"\u003c/p>\n\u003cp>The new study is \"interesting and exciting,\" says \u003ca href=\"https://medicine.yale.edu/psychiatry/people/ronald_duman-1.profile\" target=\"_blank\" rel=\"noopener\">Ronald Duman\u003c/a>, a professor of psychiatry and neurobiology at Yale University who has published research showing how ketamine causes brain cells to form new connections.\u003c/p>\n\u003cp>But Duman isn't convinced that ketamine's effect on the opioid system is the key to its effectiveness in treating depression. He notes that ketamine's effect on the brain's glutamate system is quite powerful, while the drug has \"a relatively low affinity for opiate receptors.\"\u003c/p>\n\u003cp>The Stanford team decided to conduct its study after seeing research that suggested drugs that work on the glutamate system alone aren't very effective antidepressants, Schatzberg says. They researchers also knew that opioid drugs had once been used to treat depression but were largely abandoned because of concern about abuse.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>So the team designed an experiment that would treat patients with depression in two ways. The first was by giving them an infusion of ketamine alone. The second involved giving each patient the drug naltrexone, which blocks the effects of opioid drugs, before the patient got an infusion of ketamine.\u003c/p>\n\u003cp>An analysis of a dozen patients who got both treatments showed a dramatic difference. Seven of the 12 saw their depression symptoms decrease by at least 50 percent a day after they got ketamine alone. But when they got naltrexone first, there was \"virtually no effect,\" says \u003ca href=\"https://profiles.stanford.edu/carolyn-rodriguez\" target=\"_blank\" rel=\"noopener\">Carolyn Rodriguez\u003c/a>, one of the study's authors and an assistant professor of psychiatry and behavioral sciences at Stanford.\u003c/p>\n\u003cp>Rodriguez, who has pioneered the use of ketamine to treat obsessive-compulsive disorder, says the study doesn't prove that the drug works primarily through the brain's opioid system. Instead, she calls the result \"the beginning of a conversation\" and says it \"highlights that ketamine's mechanism of action is complicated.\"\u003c/p>\n\u003cp>Rodriguez has served as a consultant for several drug companies including Allergan, which is developing a depression drug that acts like ketamine in the brain.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>One possibility is that ketamine's effect on opioid receptors may provide immediate but short-term relief of depression symptoms, Rodriguez says, while the drug's effect on the glutamate system may be what makes that relief last for a week or more.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Ketamine%2C+A+Promising+Depression+Treatment%2C+Seems+To+Act+Like+An+Opioid&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Experts Warn Era of Killer Robots Not Far as Technological Advances Outpace Regulations",
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"content": "\u003cp>Experts from scores of countries are meeting to discuss ways to define and deal with “killer robots” — futuristic weapons systems that could conduct war without human intervention.[contextly_sidebar id=\"JwnbIGuA2qmrjP4cyRW3G5jeg9YBMKbr\"]\u003c/p>\n\u003cp>The weeklong gathering that opened Monday is the second at U.N. offices in Geneva this year to focus on such lethal autonomous weapons systems and to explore possibilities for regulating them, among other issues.\u003c/p>\n\u003cp>In theory, fully autonomous, computer-controlled weapons don’t exist yet, U.N. officials say. The debate is still in its infancy, and the experts have at times grappled with basic definitions. The United States has argued that it’s premature to establish a definition of such systems, much less regulate them.\u003c/p>\n\u003cdiv id=\"div-gpt-ad-1470255291270-0\" class=\"ad-placeholder\">\n\u003carticle id=\"contentArea\" class=\" \">\n\u003cdiv class=\"articleBody\">\n\u003cp>Some top advocacy groups say governments and militaries should be prevented from developing such systems, which have sparked fears and led some critics to envisage harrowing scenarios about their use.\u003c/p>\n\u003cp>As the meeting got underway, Amnesty International urged countries to work toward a ban.[contextly_sidebar id=\"0OgluTdEZx9UFQGbj03uYz6oMpORelQX\"]\u003c/p>\n\u003cp>Killer robots are “no longer the stuff of science fiction,” Rasha Abdul Rahim, an artificial intelligence researcher for the human rights organization, said. Rahim warned that technological advances are outpacing international law.\u003c/p>\n\u003cp>Part of the trouble for activists, however, is that the U.N.-backed conference that convened the meeting works by consensus. A single participating country — like a big military power — therefore could scuttle efforts to reach an international ban.\u003c/p>\n\u003cp>Amandeep Gill, who is chairing the meeting and a former Indian ambassador to the U.N.-backed Conference on Disarmament, said progress is being made. He summarized three general camps of countries: One seeks a formal, legal ban on such weapons; another wants a political, but non-binding agreement; and a third wants no changes at all.\u003c/p>\n\u003cp>“We are coming closer to an agreement on what should be the guiding principles — guiding the behavior of states and guiding the development and deployment of such systems around the world,” Gill told reporters Monday. “And this is not an insignificant outcome.”[contextly_sidebar id=\"7CVR44SpGjuPwzybFHNCXk25HyuLfGfX\"]\u003c/p>\n\u003cp>At a news conference hosted by the Campaign to Stop Killer Robots, Nobel Peace Prize laureate Jody Williams said the group wanted “meaningful human control” when it comes to the use of military weapons and negotiations toward a ban on computer-controlled weapons systems.\u003c/p>\n\u003cp>“There is a lot of movement within the governments: We’re up to 26 now that have called for a ban,” said Williams, who won the 1997 Nobel for her work against land mines. “Logic would dictate — at least in my thinking — that there would be a mandate toward negotiating a binding instrument, and that’s what we’re pushing for here this week.”\u003c/p>\n\u003c/div>\n\u003c/article>\n\u003cdiv id=\"taboolaContainer\" class=\"taboolaContainer\">\n\u003cdiv id=\"taboola-below-article-text-links\">\u003c/div>\n\u003cdiv id=\"taboola-below-article-thumbnails-2nd\" class=\" trc_related_container trc_spotlight_widget\">\u003c/div>\n\u003cdiv id=\"taboola-below-article-thumbnails\" class=\" trc_related_container trc_spotlight_widget render-late-effect tbl-feed-container tbl-feed-full-width\">\n\u003cdiv class=\"tbl-feed-header\">\u003c/div>\n\u003c/div>\n\u003c/div>\n\u003c/div>\n\u003cp>[ad fullwidth]\u003c/p>\u003cp>\u003c/p>\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Experts from scores of countries are meeting to discuss ways to define and deal with “killer robots” — futuristic weapons systems that could conduct war without human intervention.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>The weeklong gathering that opened Monday is the second at U.N. offices in Geneva this year to focus on such lethal autonomous weapons systems and to explore possibilities for regulating them, among other issues.\u003c/p>\n\u003cp>In theory, fully autonomous, computer-controlled weapons don’t exist yet, U.N. officials say. The debate is still in its infancy, and the experts have at times grappled with basic definitions. The United States has argued that it’s premature to establish a definition of such systems, much less regulate them.\u003c/p>\n\u003cdiv id=\"div-gpt-ad-1470255291270-0\" class=\"ad-placeholder\">\n\u003carticle id=\"contentArea\" class=\" \">\n\u003cdiv class=\"articleBody\">\n\u003cp>Some top advocacy groups say governments and militaries should be prevented from developing such systems, which have sparked fears and led some critics to envisage harrowing scenarios about their use.\u003c/p>\n\u003cp>As the meeting got underway, Amnesty International urged countries to work toward a ban.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Killer robots are “no longer the stuff of science fiction,” Rasha Abdul Rahim, an artificial intelligence researcher for the human rights organization, said. Rahim warned that technological advances are outpacing international law.\u003c/p>\n\u003cp>Part of the trouble for activists, however, is that the U.N.-backed conference that convened the meeting works by consensus. A single participating country — like a big military power — therefore could scuttle efforts to reach an international ban.\u003c/p>\n\u003cp>Amandeep Gill, who is chairing the meeting and a former Indian ambassador to the U.N.-backed Conference on Disarmament, said progress is being made. He summarized three general camps of countries: One seeks a formal, legal ban on such weapons; another wants a political, but non-binding agreement; and a third wants no changes at all.\u003c/p>\n\u003cp>“We are coming closer to an agreement on what should be the guiding principles — guiding the behavior of states and guiding the development and deployment of such systems around the world,” Gill told reporters Monday. “And this is not an insignificant outcome.”\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>At a news conference hosted by the Campaign to Stop Killer Robots, Nobel Peace Prize laureate Jody Williams said the group wanted “meaningful human control” when it comes to the use of military weapons and negotiations toward a ban on computer-controlled weapons systems.\u003c/p>\n\u003cp>“There is a lot of movement within the governments: We’re up to 26 now that have called for a ban,” said Williams, who won the 1997 Nobel for her work against land mines. “Logic would dictate — at least in my thinking — that there would be a mandate toward negotiating a binding instrument, and that’s what we’re pushing for here this week.”\u003c/p>\n\u003c/div>\n\u003c/article>\n\u003cdiv id=\"taboolaContainer\" class=\"taboolaContainer\">\n\u003cdiv id=\"taboola-below-article-text-links\">\u003c/div>\n\u003cdiv id=\"taboola-below-article-thumbnails-2nd\" class=\" trc_related_container trc_spotlight_widget\">\u003c/div>\n\u003cdiv id=\"taboola-below-article-thumbnails\" class=\" trc_related_container trc_spotlight_widget render-late-effect tbl-feed-container tbl-feed-full-width\">\n\u003cdiv class=\"tbl-feed-header\">\u003c/div>\n\u003c/div>\n\u003c/div>\n\u003c/div>\n\u003cp>\u003c/p>\u003c/div>",
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"disqusTitle": "Why is a Consumer Group Fighting to Stop a Nationwide Study Of Sepsis?",
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"content": "\u003cp>A consumer advocacy organization is asking federal health officials Tuesday to halt a large medical study being conducted at major universities nationwide.\u003c/p>\n\u003cp>Public Citizen says that the study, involving treatment for \u003ca href=\"https://www.cdc.gov/sepsis/\" target=\"_blank\" rel=\"noopener\">sepsis,\u003c/a> puts patients at risk and will at best produce confusing results.\u003c/p>\n\u003cp>The \u003ca href=\"https://clinicaltrials.gov/ct2/show/NCT03434028?term=NCT03434028&rank=1\" target=\"_blank\" rel=\"noopener\">CLOVERS study\u003c/a> seeks to answer a key question about sepsis, which is a common and life-threatening response to infection. Sepsis kills more than 250,000 Americans a year, often by triggering the failure of multiple organs. As patients' blood vessels get leaky as a result of sepsis, it becomes difficult to maintain safe fluid balance and blood pressure.\u003c/p>\n\u003cp>Doctors use a combination of IV fluids and blood-pressure medicines called vasopressors, such as epinephrine and norepinephrine, to manage this life-threatening complication. But there is no consensus about the best strategy. Some doctors prefer to give lots of fluids and use drugs sparingly; others take the opposite approach.\u003c/p>\n\u003cp>\"So, trying to find the sweet spot — or the 'Goldilocks place' — is important,\" says \u003ca href=\"http://www.surgery.emory.edu/about-us/faculty_directory/faculty_profile_craig_coopersmith.html\" target=\"_blank\" rel=\"noopener\">Dr. Craig Coopersmith\u003c/a>, director of the surgical transplant intensive care unit at Emory University Hospital and an expert on sepsis.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The CLOVERS trial is an attempt to find that sweet spot. Patients who volunteer for the study are put into one of two groups: One gets plentiful fluids; the other gets limited fluids and more medication. Unlike most research, this study lacks a control group — people who receive the typically given amounts of IV fluids and drugs — as a comparison.\u003c/p>\n\u003cp>\"The problem is, both of those experimental ways for treating sepsis may do worse,\" says \u003ca href=\"https://www.citizen.org/about/michael-carome-md\" target=\"_blank\" rel=\"noopener\">Dr. Michael Carome,\u003c/a> head of the Public Citizen Health Research Group, which has lodged a complaint with federal health officials.\u003c/p>\n\u003cp>\"There may be higher mortality rates for both groups compared to usual care,\" Carome says, and without a comparison group there's no way to tell.\u003c/p>\n\u003cp>And if people on one of these experimental treatments do better than those on the other, that doesn't mean it would be better than usual care, he says. This study can't answer that question.\u003c/p>\n\u003cp>Carome is also alarmed that, in certain unusual circumstances, the protocol calls for holding off on treating dangerously low blood pressure for several hours.\u003c/p>\n\u003cp>\"No one caring for a sepsis patient would normally do that as part of usual care,\" he says.\u003c/p>\n\u003cp>The study, designed at Harvard and funded by the National Institutes of Health, went through multiple reviews by people who concluded that it didn't pose an undue risk to patients.\u003c/p>\n\u003cp>\"But the fact that it got through these layers of review with these serious design flaws signals that our system for protecting human subjects is broken,\" Carome says.\u003c/p>\n\u003cp>Coopersmith, who is not involved with the CLOVERS study, reviewed Public Citizen's complaint at NPR's request. He doesn't share Carome's sense of alarm.\u003c/p>\n\u003cp>Coopersmith agrees that including a comparison group that received the standard of care would be a better study design.\u003c/p>\n\u003cp>But, \"there's no clear standard of care for the first 24 hours,\" he says. Standard protocols for sepsis treatment dictate what doctors should do during the first six hours of treatment only, whereas the CLOVERS study is guiding treatment over a longer time period.\u003c/p>\n\u003cp>He says he agrees with Carome that the study won't clearly show that one of these experimental treatments is better than a more middle-of-the road approach to fluids and blood pressure medication; so sepsis doctors won't get clear guidance from the results. But the findings might help nudge doctors in one direction or another, he says, if it helps resolve the question of what's better — limited fluids or a lot?\u003c/p>\n\u003cp>As for the concerns about how to deal with a patient with very low blood pressure, Coopersmith says, \"in a very narrow patient population for a narrow period of time, there is a theoretical chance that someone could have what I would consider to be too low a blood pressure.\"\u003c/p>\n\u003cp>If he were a doctor involved in this trial and encountered that, he says, he would deviate from the protocol and treat that patient with standard care. He expects his colleagues would do that as well.\u003c/p>\n\u003cp>The study isn't designed the way he would have done it, Coopersmith says, but, he \"would be comfortable enrolling patients in this trial.\"\u003c/p>\n\u003cp>\u003ca href=\"http://cvbr.hms.harvard.edu/researchers/shapiro.html\" target=\"_blank\" rel=\"noopener\">Dr. Nathan Shapiro\u003c/a>, a professor of Emergency Medicine at Harvard's Beth Israel Deaconess Medical Center and one of the principal investigators for the CLOVERS study, stands by it. He declined a request for an interview, but sent a written response to NPR.\u003c/p>\n\u003cp>\"The study protocol was designed by expert clinicians in emergency and critical care medicine representing nearly 50 hospitals in the United States and follows a well-accepted design,\" he writes.\u003c/p>\n\u003cp>A spokesperson for the federal \u003ca href=\"https://www.hhs.gov/ohrp/\" target=\"_blank\" rel=\"noopener\">Office for Human Research Protections\u003c/a> says the office has not yet seen the Public Citizen complaint, but will review the allegations.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Richard Harris can be reached at \u003c/em>\u003ca href=\"mailto:rharris@npr.org\" target=\"_blank\" rel=\"noopener\">\u003cem>rharris@npr.org\u003c/em>\u003c/a>\u003cem>.\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Critics+Trying+To+Stop+A+Big+Study+Of+Sepsis+Say+The+Research+Puts+Patients+At+Risk&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>A consumer advocacy organization is asking federal health officials Tuesday to halt a large medical study being conducted at major universities nationwide.\u003c/p>\n\u003cp>Public Citizen says that the study, involving treatment for \u003ca href=\"https://www.cdc.gov/sepsis/\" target=\"_blank\" rel=\"noopener\">sepsis,\u003c/a> puts patients at risk and will at best produce confusing results.\u003c/p>\n\u003cp>The \u003ca href=\"https://clinicaltrials.gov/ct2/show/NCT03434028?term=NCT03434028&rank=1\" target=\"_blank\" rel=\"noopener\">CLOVERS study\u003c/a> seeks to answer a key question about sepsis, which is a common and life-threatening response to infection. Sepsis kills more than 250,000 Americans a year, often by triggering the failure of multiple organs. As patients' blood vessels get leaky as a result of sepsis, it becomes difficult to maintain safe fluid balance and blood pressure.\u003c/p>\n\u003cp>Doctors use a combination of IV fluids and blood-pressure medicines called vasopressors, such as epinephrine and norepinephrine, to manage this life-threatening complication. But there is no consensus about the best strategy. Some doctors prefer to give lots of fluids and use drugs sparingly; others take the opposite approach.\u003c/p>\n\u003cp>\"So, trying to find the sweet spot — or the 'Goldilocks place' — is important,\" says \u003ca href=\"http://www.surgery.emory.edu/about-us/faculty_directory/faculty_profile_craig_coopersmith.html\" target=\"_blank\" rel=\"noopener\">Dr. Craig Coopersmith\u003c/a>, director of the surgical transplant intensive care unit at Emory University Hospital and an expert on sepsis.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The CLOVERS trial is an attempt to find that sweet spot. Patients who volunteer for the study are put into one of two groups: One gets plentiful fluids; the other gets limited fluids and more medication. Unlike most research, this study lacks a control group — people who receive the typically given amounts of IV fluids and drugs — as a comparison.\u003c/p>\n\u003cp>\"The problem is, both of those experimental ways for treating sepsis may do worse,\" says \u003ca href=\"https://www.citizen.org/about/michael-carome-md\" target=\"_blank\" rel=\"noopener\">Dr. Michael Carome,\u003c/a> head of the Public Citizen Health Research Group, which has lodged a complaint with federal health officials.\u003c/p>\n\u003cp>\"There may be higher mortality rates for both groups compared to usual care,\" Carome says, and without a comparison group there's no way to tell.\u003c/p>\n\u003cp>And if people on one of these experimental treatments do better than those on the other, that doesn't mean it would be better than usual care, he says. This study can't answer that question.\u003c/p>\n\u003cp>Carome is also alarmed that, in certain unusual circumstances, the protocol calls for holding off on treating dangerously low blood pressure for several hours.\u003c/p>\n\u003cp>\"No one caring for a sepsis patient would normally do that as part of usual care,\" he says.\u003c/p>\n\u003cp>The study, designed at Harvard and funded by the National Institutes of Health, went through multiple reviews by people who concluded that it didn't pose an undue risk to patients.\u003c/p>\n\u003cp>\"But the fact that it got through these layers of review with these serious design flaws signals that our system for protecting human subjects is broken,\" Carome says.\u003c/p>\n\u003cp>Coopersmith, who is not involved with the CLOVERS study, reviewed Public Citizen's complaint at NPR's request. He doesn't share Carome's sense of alarm.\u003c/p>\n\u003cp>Coopersmith agrees that including a comparison group that received the standard of care would be a better study design.\u003c/p>\n\u003cp>But, \"there's no clear standard of care for the first 24 hours,\" he says. Standard protocols for sepsis treatment dictate what doctors should do during the first six hours of treatment only, whereas the CLOVERS study is guiding treatment over a longer time period.\u003c/p>\n\u003cp>He says he agrees with Carome that the study won't clearly show that one of these experimental treatments is better than a more middle-of-the road approach to fluids and blood pressure medication; so sepsis doctors won't get clear guidance from the results. But the findings might help nudge doctors in one direction or another, he says, if it helps resolve the question of what's better — limited fluids or a lot?\u003c/p>\n\u003cp>As for the concerns about how to deal with a patient with very low blood pressure, Coopersmith says, \"in a very narrow patient population for a narrow period of time, there is a theoretical chance that someone could have what I would consider to be too low a blood pressure.\"\u003c/p>\n\u003cp>If he were a doctor involved in this trial and encountered that, he says, he would deviate from the protocol and treat that patient with standard care. He expects his colleagues would do that as well.\u003c/p>\n\u003cp>The study isn't designed the way he would have done it, Coopersmith says, but, he \"would be comfortable enrolling patients in this trial.\"\u003c/p>\n\u003cp>\u003ca href=\"http://cvbr.hms.harvard.edu/researchers/shapiro.html\" target=\"_blank\" rel=\"noopener\">Dr. Nathan Shapiro\u003c/a>, a professor of Emergency Medicine at Harvard's Beth Israel Deaconess Medical Center and one of the principal investigators for the CLOVERS study, stands by it. He declined a request for an interview, but sent a written response to NPR.\u003c/p>\n\u003cp>\"The study protocol was designed by expert clinicians in emergency and critical care medicine representing nearly 50 hospitals in the United States and follows a well-accepted design,\" he writes.\u003c/p>\n\u003cp>A spokesperson for the federal \u003ca href=\"https://www.hhs.gov/ohrp/\" target=\"_blank\" rel=\"noopener\">Office for Human Research Protections\u003c/a> says the office has not yet seen the Public Citizen complaint, but will review the allegations.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Richard Harris can be reached at \u003c/em>\u003ca href=\"mailto:rharris@npr.org\" target=\"_blank\" rel=\"noopener\">\u003cem>rharris@npr.org\u003c/em>\u003c/a>\u003cem>.\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Critics+Trying+To+Stop+A+Big+Study+Of+Sepsis+Say+The+Research+Puts+Patients+At+Risk&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Scientists Discover Neuron That is Unique to the Human Brain",
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"content": "\u003cp>Scientists have taken another step toward understanding what makes the human brain unique.\u003c/p>\n\u003cp>An international team has identified a kind of brain cell that exists in people but not mice, the team \u003ca href=\"https://www.nature.com/articles/s41593-018-0205-2\" target=\"_blank\" rel=\"noopener\">reported\u003c/a> Monday in the journal \u003cem>Nature Neuroscience.\u003c/em>\u003c/p>\n\u003cp>\"This particular type of cell had properties that had never actually been described in another species,\" says \u003ca href=\"https://www.alleninstitute.org/what-we-do/brain-science/about/team/staff-profiles/ed-lein/\" target=\"_blank\" rel=\"noopener\">Ed Lein\u003c/a>, one of the study's authors and an investigator at the \u003cem>Allen Institute for Brain Science \u003c/em>in Seattle.\u003c/p>\n\u003cp>The finding could help explain why many experimental treatments for brain disorders have worked in mice, but failed in people. It could also provide new clues to scientists who study human brain disorders ranging from autism to Alzheimer's disease to schizophrenia.\u003c/p>\n\u003cp>\"It may be that in order to fully understand psychiatric disorders, we need to get access to these special types of neurons that exist only in humans,\" says \u003ca href=\"National%20Institute%20of%20Mental%20Health,%20which%20helped%20fund%20the%20research.\" target=\"_blank\" rel=\"noopener\">Joshua Gordon\u003c/a>, director of the National Institute of Mental Health, which helped fund the research.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Researchers have suggested several other brain cells that might be unique to humans. But these cells have either been \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/17441195\" target=\"_blank\" rel=\"noopener\">found in other species\u003c/a>, or the evidence for them has been less convincing.\u003c/p>\n\u003cp>It is still possible that these newly identified neurons will also be found the brains of primates like monkeys or chimps, Lein says.\u003c/p>\n\u003cp>The brain cells have been named \"rose hip neurons\" by a team at the University of Szeged in Hungary, which played a key role in the discovery.\u003c/p>\n\u003cp>A scientist named \u003ca href=\"http://tamaslab.org/\" target=\"_blank\" rel=\"noopener\">Gábor Tamás\u003c/a> and members of his lab were studying brain cells called inhibitory neurons, which act like the brakes in a car. They tell other brain cells when to slow down.\u003c/p>\n\u003cp>Tamas was recording electrical signals from inhibitory neurons taken from the cortex of two men who had died.\u003c/p>\n\u003cp>\"In the course of doing these recordings, he started to notice a very distinctive type of cell that, to him, had the shape of a rose after the petals have fallen off,\" Lein says. \"So he called them the rose hip cell.\"\u003c/p>\n\u003cp>By chance, scientists at the Allen Institute had also identified these cells using an entirely different approach, a new technique that allowed them to detect the genes that are switched on in human brain cells.\u003c/p>\n\u003cp>So the researchers combined what they had learned and confirmed that rose hip cells were a distinct subtype of inhibitory neurons.\u003c/p>\n\u003cp>The finding challenges earlier evidence that the human brain is merely bigger and more sophisticated than a mouse brain. At some point, humans acquired at least one kind of brain cell that a mouse doesn't have.\u003c/p>\n\u003cp>Scientists aren't sure exactly what rose hip cells do, though they appear to be involved in the controlling the flow of information in specific areas of the brain.\u003c/p>\n\u003cp>But regardless of their precise function, the discovery of rose hip neurons has implications for brain research. For one thing, \"it throws some doubt on the ability to use the mouse to study certain elements of human function and disease,\" Lein says. And because rose hip neurons are a type of inhibitory neuron, they could play a role in mental illness, he says.\u003c/p>\n\u003cp>\"These types of cells [inhibitory neurons] are extremely important,\" he says. And when there's dysfunction in them, he says, that can \"directly be linked to different types of neuropsychiatric disease, like schizophrenia.\"\u003c/p>\n\u003cp>The identification of rose hip neurons is part of a much larger \u003ca href=\"https://www.nih.gov/news-events/news-releases/nih-brain-initiative-launches-cell-census\" target=\"_blank\" rel=\"noopener\">effort\u003c/a> by the National Institutes of Health to identify every type of cell found in the brains of mice, monkeys and people. It is also part of the federal \u003ca href=\"https://obamawhitehouse.archives.gov/the-press-office/2013/04/02/fact-sheet-brain-initiative\" target=\"_blank\" rel=\"noopener\">BRAIN Initiative\u003c/a> announced by President Barack Obama in 2013.\u003c/p>\n\u003cp>These initiatives are taking advantage of new technologies that are likely to reveal other brain cells that exist in people but not animals, Gordon says.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"I think it's very, very likely that this is the tip of the iceberg,\" he says.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=What+Makes+A+Human+Brain+Unique%3F+A+Newly+Discovered+Neuron+May+Be+A+Clue&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Scientists have taken another step toward understanding what makes the human brain unique.\u003c/p>\n\u003cp>An international team has identified a kind of brain cell that exists in people but not mice, the team \u003ca href=\"https://www.nature.com/articles/s41593-018-0205-2\" target=\"_blank\" rel=\"noopener\">reported\u003c/a> Monday in the journal \u003cem>Nature Neuroscience.\u003c/em>\u003c/p>\n\u003cp>\"This particular type of cell had properties that had never actually been described in another species,\" says \u003ca href=\"https://www.alleninstitute.org/what-we-do/brain-science/about/team/staff-profiles/ed-lein/\" target=\"_blank\" rel=\"noopener\">Ed Lein\u003c/a>, one of the study's authors and an investigator at the \u003cem>Allen Institute for Brain Science \u003c/em>in Seattle.\u003c/p>\n\u003cp>The finding could help explain why many experimental treatments for brain disorders have worked in mice, but failed in people. It could also provide new clues to scientists who study human brain disorders ranging from autism to Alzheimer's disease to schizophrenia.\u003c/p>\n\u003cp>\"It may be that in order to fully understand psychiatric disorders, we need to get access to these special types of neurons that exist only in humans,\" says \u003ca href=\"National%20Institute%20of%20Mental%20Health,%20which%20helped%20fund%20the%20research.\" target=\"_blank\" rel=\"noopener\">Joshua Gordon\u003c/a>, director of the National Institute of Mental Health, which helped fund the research.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Researchers have suggested several other brain cells that might be unique to humans. But these cells have either been \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/17441195\" target=\"_blank\" rel=\"noopener\">found in other species\u003c/a>, or the evidence for them has been less convincing.\u003c/p>\n\u003cp>It is still possible that these newly identified neurons will also be found the brains of primates like monkeys or chimps, Lein says.\u003c/p>\n\u003cp>The brain cells have been named \"rose hip neurons\" by a team at the University of Szeged in Hungary, which played a key role in the discovery.\u003c/p>\n\u003cp>A scientist named \u003ca href=\"http://tamaslab.org/\" target=\"_blank\" rel=\"noopener\">Gábor Tamás\u003c/a> and members of his lab were studying brain cells called inhibitory neurons, which act like the brakes in a car. They tell other brain cells when to slow down.\u003c/p>\n\u003cp>Tamas was recording electrical signals from inhibitory neurons taken from the cortex of two men who had died.\u003c/p>\n\u003cp>\"In the course of doing these recordings, he started to notice a very distinctive type of cell that, to him, had the shape of a rose after the petals have fallen off,\" Lein says. \"So he called them the rose hip cell.\"\u003c/p>\n\u003cp>By chance, scientists at the Allen Institute had also identified these cells using an entirely different approach, a new technique that allowed them to detect the genes that are switched on in human brain cells.\u003c/p>\n\u003cp>So the researchers combined what they had learned and confirmed that rose hip cells were a distinct subtype of inhibitory neurons.\u003c/p>\n\u003cp>The finding challenges earlier evidence that the human brain is merely bigger and more sophisticated than a mouse brain. At some point, humans acquired at least one kind of brain cell that a mouse doesn't have.\u003c/p>\n\u003cp>Scientists aren't sure exactly what rose hip cells do, though they appear to be involved in the controlling the flow of information in specific areas of the brain.\u003c/p>\n\u003cp>But regardless of their precise function, the discovery of rose hip neurons has implications for brain research. For one thing, \"it throws some doubt on the ability to use the mouse to study certain elements of human function and disease,\" Lein says. And because rose hip neurons are a type of inhibitory neuron, they could play a role in mental illness, he says.\u003c/p>\n\u003cp>\"These types of cells [inhibitory neurons] are extremely important,\" he says. And when there's dysfunction in them, he says, that can \"directly be linked to different types of neuropsychiatric disease, like schizophrenia.\"\u003c/p>\n\u003cp>The identification of rose hip neurons is part of a much larger \u003ca href=\"https://www.nih.gov/news-events/news-releases/nih-brain-initiative-launches-cell-census\" target=\"_blank\" rel=\"noopener\">effort\u003c/a> by the National Institutes of Health to identify every type of cell found in the brains of mice, monkeys and people. It is also part of the federal \u003ca href=\"https://obamawhitehouse.archives.gov/the-press-office/2013/04/02/fact-sheet-brain-initiative\" target=\"_blank\" rel=\"noopener\">BRAIN Initiative\u003c/a> announced by President Barack Obama in 2013.\u003c/p>\n\u003cp>These initiatives are taking advantage of new technologies that are likely to reveal other brain cells that exist in people but not animals, Gordon says.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"I think it's very, very likely that this is the tip of the iceberg,\" he says.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=What+Makes+A+Human+Brain+Unique%3F+A+Newly+Discovered+Neuron+May+Be+A+Clue&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Is Three Too Young for Children to Know They're a Different Gender? Transgender Researchers Disagree",
"title": "Is Three Too Young for Children to Know They're a Different Gender? Transgender Researchers Disagree",
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"content": "\u003caside>\n\u003cul>\n\u003cli>Many gender clinicians now recommend parents 'socially transition' kids who persistently express a transgender identity.\u003c/li>\n\u003cli>But research has shown most children will give up their transgender identity by the time they are adolescents.\u003c/li>\n\u003cli>Not all researchers agree, though, that this research is valid.\u003c/li>\n\u003c/ul>\n\u003c/aside>\n\u003cp>Gracie is the youngest transgender person I've ever met. She's so young, she still likes to tack on \"and-a-half\" when giving her age, which is six. One day last summer, bouncing all over the grounds at day camp, she looked as delighted as you'd expect any kid would on \"Water Day.”\u003c/p>\n\u003caside class=\"alignright\">\u003ca href=\"https://www.kqed.org/futureofyou/441784/the-controversial-research-on-desistance-in-transgender-youth\">The Controversial Research on 'Desistance' in Transgender Youth\u003c/a>\u003c/aside>\n\u003cp>This is Rainbow Day Camp, in the East Bay town of El Cerrito. It was created specifically to be a safe place for transgender kids, and in fact, being transgender is so unremarkable here, when I asked Gracie what makes it “special,\" she shrugged and said:\u003c/p>\n\u003cp>“You get to do fun stuff.”\u003c/p>\n\u003cp>Her mother, Molly, tried to coax a reporter-friendly answer out of her.\u003c/p>\n\u003cp>“What is special about you, and the same as everybody else in the camp?” she prompted.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“I don’t know,” Gracie said.\u003c/p>\n\u003caside class=\"pullquote alignright\">'What if we let our son walk into the world in a dress with fairy wings, and crowns, and high heels, and even just in regular girl clothes … and then he changes his mind?'\u003ccite>Molly, whose 6-year-old daughter, Gracie, socially transitioned at age four\u003c/cite>\u003c/aside>\n\u003cp>“You’re transgender and there’s other kids that are transgender, too...”\u003c/p>\n\u003cp>“I’m transgender and there’s other kids that are transgender, too.”\u003c/p>\n\u003cp>Ah, kids. ... But when I asked Gracie how she \u003cem>used\u003c/em> to feel, when other people thought she was a boy, she got straight to the point.\u003c/p>\n\u003cp>“It was not right to me, and I didn’t want people to say that, but they said it,” she said. “It hurted my feelings a lot.\"\u003c/p>\n\u003cp>Did it make her angry?\u003c/p>\n\u003cp>“No, it just made me sad.”\u003c/p>\n\u003caside class=\"alignright\">\u003ca href=\"mailto:jbrooks@kqed.org\">Email the reporter\u003c/a>\u003c/aside>\n\u003cp>How about now?\u003c/p>\n\u003cp>“It feels happy to me.”\u003c/p>\n\u003cp>And that, in a child’s nutshell, sums up one side of a contentious debate about the right age for transgender children to begin what gender clinicians call “social transitioning.”\u003c/p>\n\u003cp>https://www.youtube.com/watch?v=IS5Yankf1GY\u003c/p>\n\u003cp>\u003cstrong>Even Three-Year-Olds\u003c/strong>\u003c/p>\n\u003cp>When I met Gracie, she was a few months out of kindergarten — pretty young for a transgender kid, I thought. Gracie lives with her parents and younger brother in a small city in the East Bay. She is already two years into her transition, having started her public life as a girl at four. The family began by discarding her boy name and referring to Gracie as “she” and “her.” She was also allowed to wear girl clothes outside the home, and her parents changed the gender on her birth certificate to avoid confusion at school.\u003c/p>\n\u003caside class=\"alignright noborder\">\u003cstrong>How young is too young?\u003c/strong>\u003cbr>\nUCSF’s Diane Ehrensaft, one of the leading proponents of socially transitioning transgender children, believes there is no minimum age, really, to pursue such a change.'For all of these interventions, our model is stages not ages,” she said. 'When a child is at the place in their life that they can get themselves in focus, help us see them, and are clear, consistent, and stable in both their representation of themselves, and also can express their desires of how they want to live their gender, that's the age.'We have seen some kids as young as two whose parents are bringing them in because they're beginning to say, ‘Me not boy. Me girl.’ Social transition can happen as soon as a child has language or the ability to communicate to us who they are.'\u003c/aside>\n\u003cp>Steps like these make up the “social” aspects of social, not medical, transitioning. The distinction is important: According to Endocrine Society \u003ca href=\"https://academic.oup.com/jcem/article/102/11/3869/4157558\" target=\"_blank\" rel=\"noopener\">guidelines\u003c/a>, patients who want to begin medical treatment like puberty blockers, hormones or surgery should be old enough to give “informed consent,” which the organization says is usually attained by 16.\u003c/p>\n\u003cp>Therapists at \u003ca href=\"https://www.ucsfbenioffchildrens.org/clinics/child_and_adolescent_gender_center/\" target=\"_blank\" rel=\"noopener\">UCSF’s Child and Adolescent Gender Center Clinic\u003c/a> in San Francisco told me they’ve socially transitioned kids as young as three.\u003c/p>\n\u003cp>Diane Ehrensaft, the San Francisco Center’s mental health director and a leading proponent of early social transitioning, acknowledges this approach has been controversial.\u003c/p>\n\u003cp>“There are some people that think folks like myself, and the people at our clinic, have fallen off the deep end,” she told me. She wasn’t just talking about the religious right, either. She was referring to other mental health professionals.\u003c/p>\n\u003cp>I myself experienced a fair bit of surprise when Ehrensaft told me how young these kids are. My first, reflexive comment was a simple, \"Wow.\" This was not an uncommon reaction when I discussed this story with people in my own life, even in the progressive Bay Area.\u003c/p>\n\u003cp>Yet, when I spoke with Gracie’s mom, Molly (the family didn't want their last name used for reasons of privacy), nothing about the decision to allow her then-son to publicly make the switch to a girl, at an age when many kids are still sucking their thumbs, sounded in the slightest bit rash.\u003c/p>\n\u003cp>We spoke at Rainbow Day Camp, in a classroom set aside for interviews. The children’s art adorning the walls, the shrimpy seats — it felt like a place to talk about kickball, not the gender identity of first graders.\u003c/p>\n\u003cp>Yet here we were.\u003c/p>\n\u003caside class=\"alignright\">\u003cstrong>The Biological Roots of Gender Identity\u003c/strong>\u003cbr>\nMolly is the mother of two children, a 3-year-old boy and a 7-year-old transgender girl. The younger child is the “stereotype of what I thought having a son would be like,” she said. “He loves trucks, cars, construction, superheroes and destroying the house.”Her first child, also born male, just did not develop in the same way. Rather, from the time he acquired language on, he protested that he was really a girl. (\u003ca href=\"https://www.kqed.org/futureofyou/the-biological-roots-of-gender-identity\" target=\"_blank\" rel=\"noopener\">Continue reading)\u003c/a>\u003c/aside>\n\u003cp>“What if we do this?” Molly recalled asking a gender therapist, back when they were debating the pros and cons of letting Gracie transition. “What if we let our son walk into the world in a dress with fairy wings, and crowns, and high heels, and even just in regular girl clothes … and then he changes his mind?”\u003c/p>\n\u003cp>\"That's not the question,” the therapist told Molly. “The question is, what if you don't do it?”\u003c/p>\n\u003cp>It was only semi-rhetorical. Some gender therapists say there are serious potential dangers if adults suppress a child’s desired transition. On surveys, American transgender adults have reported attempting suicide at the startling \u003ca href=\"https://williamsinstitute.law.ucla.edu/wp-content/uploads/AFSP-Williams-Suicide-Report-Final.pdf\" target=\"_blank\" rel=\"noopener\">rate\u003c/a> of around 40 percent.\u003c/p>\n\u003cp>The stakes couldn’t have been higher, Molly knew.\u003c/p>\n\u003cp>At Rainbow Day Camp, recalling that time, she started to cry.\u003c/p>\n\u003cp>“As soon as I knew there was even a chance that my kid could feel ashamed of who they are, there was no way … ” Her voice cracked into a higher register. “I had to support, I had to listen, and I had to let her steer, a little bit, the ship. Period. No matter what.”\u003c/p>\n\u003cfigure id=\"attachment_441862\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2020/04/gracie-sliding-water-1.jpg\">\u003cimg class=\"wp-image-441862 size-large\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2020/04/gracie-sliding-water-1-1020x527.jpg\" alt=\"\" width=\"640\" height=\"331\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2020/04/gracie-sliding-water-1-1020x527.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2020/04/gracie-sliding-water-1-160x83.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2020/04/gracie-sliding-water-1-800x414.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2020/04/gracie-sliding-water-1-768x397.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2020/04/gracie-sliding-water-1-1200x620.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/13/2020/04/gracie-sliding-water-1-1180x610.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2020/04/gracie-sliding-water-1-960x496.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2020/04/gracie-sliding-water-1-240x124.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2020/04/gracie-sliding-water-1-375x194.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2020/04/gracie-sliding-water-1-520x269.jpg 520w, https://ww2.kqed.org/app/uploads/sites/13/2020/04/gracie-sliding-water-1.jpg 1209w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Gracie, six, on Water Day at Rainbow Day Camp, which was created as a safe space for transgender kids. \u003ccite>(KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>‘I’m a Girl’\u003c/strong>\u003c/p>\n\u003cp>Ehrensaft calls children like Gracie “persistent, consistent, and insistent” in their declarations of cross-gender identity. For Gracie, this manifested through words, wishes, and, well, practically everything.\u003c/p>\n\u003caside class=\"pullquote alignright\">'Why would we deny for the vast majority of kids something that is basically suicide prevention?'\u003ccite>Diane Ehrensaft, UCSF\u003c/cite>\u003c/aside>\n\u003cp>Gracie was her parents' first child. From toddlerhood on, Molly said, their son had displayed a “constant obsession and fixation on all things girl. As soon as she could tell us, it was, ‘I'm a girl. I'm a sister. I'm a daughter. I'm that girl on that show. I'm that girl in that book.’”\u003c/p>\n\u003cp>Gracie's parents weren’t on board at first.\u003c/p>\n\u003cp>“We filled her world with trucks, and dinosaurs, and superheroes, and we refused girl things,” Molly said. “Like, ‘No, you can't be Elsa for Halloween. You have to be Superman. No, you can't have the dolls for Christmas. We're going to get you a pirate ship.’”\u003c/p>\n\u003cp>They also made a rule: No girl clothing outside the house.\u003c/p>\n\u003cp>Molly tells me: “That’s the part I’m ashamed of now.”\u003c/p>\n\u003cp>\u003cstrong>'These Kids Do Come Forward'\u003c/strong>\u003c/p>\n\u003cp>Molly and her husband finally relented — they just could not deny how much happier their child felt when recognized as a girl.\u003c/p>\n\u003cfigure id=\"attachment_441832\" class=\"wp-caption alignright\" style=\"max-width: 640px\">\u003ca href=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2020/04/Phoenix5-e1527011026777.jpg\">\u003cimg class=\"size-large wp-image-441832\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2020/04/Phoenix5-1020x1530.jpg\" alt=\"\" width=\"640\" height=\"960\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Phoenix, a transgender girl who began wearing dresses to school at age 5. She began made a complete social transition at the start of second grade. \u003ccite>(Courtesy of family)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>I asked: Has Gracie ever looked back?\u003c/p>\n\u003cp>Molly chuckled.\u003c/p>\n\u003cp>“If you think of gender as a spectrum, she is like a full, all-the-way girl.”\u003c/p>\n\u003cp>It’s not rocket science, Ehrensaft explained, if you really listen to the children. “A child will say: ‘Stop calling me Jane. Let me wear my dresses. Please call me she.’ That's a child making a clear statement.”\u003c/p>\n\u003cp>Kristina Olson, a University of Washington gender researcher, said parents do not always listen to what their kids are telling them.\u003c/p>\n\u003cp>“The ones that are most likely to transition are kids who for many years are very consistently saying this is who they are,” she said. ”We often see this happen for years before parents socially transition their kids.”\u003c/p>\n\u003cp>UCSF gender specialist Erica Anderson recently treated a five-year-old who had reached a point of desperation.\u003c/p>\n\u003cp>“In the bathtub, he would compare himself to his younger sister, and really start getting upset. At one point he went in the bathroom with a pair of shears — he was going to cut his penis off.”\u003c/p>\n\u003cp>“This child has been so clear for a couple of years,” Anderson said. “These kids do come forward.”\u003c/p>\n\u003cp>\u003cstrong>Changing Approaches\u003c/strong>\u003c/p>\n\u003cp>Gender clinicians who recommend social transition at such an early age call their model “gender affirmative,” and they believe their approach is now ascendant. Historically, clinicians more commonly treated transgender kids by discouraging cross-gender identity. The method was most famously practiced by longtime gender researcher Ken Zucker.\u003c/p>\n\u003cp>Zucker is now an extraordinarily controversial figure in the transgender community. He believed that an outcome in which a child becomes transgender should be avoided, if possible. You can get a glimpse of his methods in this \u003ca href=\"https://www.npr.org/2008/05/07/90247842/two-families-grapple-with-sons-gender-preferences\" target=\"_blank\" rel=\"noopener\">NPR story\u003c/a> from 2008. Zucker is counseling the family of a young boy he’d diagnosed with gender identity disorder, the term used for gender dysphoria before 2013.\u003c/p>\n\u003cblockquote>\u003cp>Zucker explained to Carol that she and her husband would have to radically change their parenting. Bradley would no longer be allowed to spend time with girls. He would no longer be allowed to play with girlish toys or pretend that he was a female character. Zucker said that all of these activities were dangerous to a kid with gender identity disorder. He explained that unless Carol and her husband helped the child to change his behavior, as Bradley grew older, he likely would be rejected by both peer groups.\u003c/p>\u003c/blockquote>\n\u003cp>Other researchers and transgender activists have criticized this approach as too close to the “conversion therapy” inflicted on gay and lesbian youth, a practice that is now illegal in a number of states, including \u003ca href=\"https://www.sfgate.com/news/article/State-bans-gay-repair-therapy-for-minors-3906032.php\" target=\"_blank\" rel=\"noopener\">California\u003c/a>.\u003c/p>\n\u003cp>[emailsignup newslettername='science' align='right']The World Professional Association for Transgender Health's guidelines for clinicians, called the \u003ca href=\"https://www.wpath.org/publications/soc\" target=\"_blank\" rel=\"noopener\">Standards of Care\u003c/a>, states that “treatment aimed at trying to change a person’s gender identity and expression to become more congruent with sex assigned at birth” is “no longer considered ethical.”\u003c/p>\n\u003cp>Zucker was the psychologist-in-chief and head of the gender identity clinic at a Toronto mental health hospital before administrators shut down the clinic in 2015, after a review of his practices. That was also \u003ca href=\"https://www.theglobeandmail.com/life/health-and-fitness/health/alleged-exchange-with-gender-identity-doctor-didnt-happen-camh-says/article28471923/\" target=\"_blank\" rel=\"noopener\">controversial\u003c/a>, and Zucker is suing his former employer for defamation. (Zucker declined to comment for this article. For a defense of his work, you can read Jesse Singal’s \u003ca href=\"https://www.thecut.com/2016/02/fight-over-trans-kids-got-a-researcher-fired.html\" target=\"_blank\" rel=\"noopener\">reporting\u003c/a> from 2016.)\u003c/p>\n\u003cp>\u003cstrong>Watchful Waiting\u003c/strong>\u003c/p>\n\u003cp>Zucker’s approach aside, there is another alternative to gender affirmative therapy. It’s the approach taken by the \u003ca href=\"https://www.vumc.com/branch/gender-dysphoria/\" target=\"_blank\" rel=\"noopener\">Center of Expertise on Gender Dysphoria\u003c/a> in Amsterdam, and gender specialists commonly refer to it as the “Dutch Model.”\u003c/p>\n\u003cp>This treatment sometimes involves the social transition of young children, according to Thomas Steensma, a researcher and clinician at the center. But for the most part, its counseling incorporates the idea that the vast majority of gender dysphoric children will eventually stop identifying as transgender.\u003c/p>\n\u003cp>The research literature calls these individuals “desistant.” The kids who retain their transgender identity as they grow up are dubbed “persistent.”\u003c/p>\n\u003cp>\u003cstrong>The Desistance Controversy\u003c/strong>\u003c/p>\n\u003cp>Nothing roils the world of transgender research like the topic of \u003ca href=\"https://www.kqed.org/futureofyou/441784/the-controversial-research-on-desistance-in-transgender-youth\" target=\"_blank\" rel=\"noopener\">desistance\u003c/a>. Brynn Tannehill, a transgender activist who follows the research closely, said the concept is often used by anti-LGBT groups to make the case that rejecting children’s transgender identity is in their best interests.\u003c/p>\n\u003caside class=\"pullquote alignright\">'[Desistance research] is used primarily as an attack on the validity of transgender identities, which usually quickly disintegrates into a debate on whether we should exist.' \u003ccite>Brynn Tannehill, transgender activist\u003c/cite>.\u003c/aside>\n\u003cp>“It is used primarily as an attack on the validity of transgender identities, which usually quickly disintegrates into a debate on whether we should exist,” Tannehill said.\u003c/p>\n\u003cp>And yet, the fact is that just about every published study on the topic to date has found that a majority of children who once reported various degrees of gender dysphoria ended up eventually giving up their transgender identity.\u003c/p>\n\u003cp>To grasp the implications of this, remember Molly’s anxious questioning of the gender therapist: What if we go through all this, and it turns out to be just a phase? Shouldn’t we wait?\u003c/p>\n\u003cp>The gender affirmative camp says no. That’s because it doesn’t believe that the body of research on desistance, some of it conducted by Zucker and his associates, is valid.\u003c/p>\n\u003cp>Many gender researchers maintain that the current criteria for diagnosing gender dysphoria are much more stringent than in the past. Therefore, many of the studies that found so many kids had \"grown out\" of their transgender identity were actually measuring children who were \u003cem>never really transgender\u003c/em> in the first place.\u003c/p>\n\u003cp>“Some of those studies are decades old,” said gender researcher Kristina Olson. “So if you had a son in the early 1980s who liked playing with dolls and wanted to occasionally wear a dress, even today maybe you would think to bring that child to talk to a doctor about it. But that child wouldn't necessarily be transgender, because that kid doesn't necessarily think of himself as a girl.\"\u003c/p>\n\u003cp>Ehrensaft said that her San Francisco clinic sees “a tiny, tiny proportion” of clients who stop identifying as transgender after transitioning.\u003c/p>\n\u003cp>Even the Amsterdam clinic’s Thomas Steensma, who firmly believes most gender dysphoric kids will \u003cem>not\u003c/em> grow up to be transgender, acknowledged the earlier studies probably included “milder cases” that are “hard to compare with the clinical samples we see now in our clinics.”\u003c/p>\n\u003cfigure id=\"attachment_441834\" class=\"wp-caption alignright\" style=\"max-width: 720px\">\u003ca href=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2020/04/James.jpeg\">\u003cimg class=\"size-full wp-image-441834\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2020/04/James.jpeg\" alt=\"\" width=\"720\" height=\"960\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2020/04/James.jpeg 720w, https://ww2.kqed.org/app/uploads/sites/13/2020/04/James-160x213.jpeg 160w, https://ww2.kqed.org/app/uploads/sites/13/2020/04/James-240x320.jpeg 240w, https://ww2.kqed.org/app/uploads/sites/13/2020/04/James-375x500.jpeg 375w, https://ww2.kqed.org/app/uploads/sites/13/2020/04/James-520x693.jpeg 520w\" sizes=\"(max-width: 720px) 100vw, 720px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Olivia, a transgender girl who socially transitioned when she was four, and her brother, James, who transitioned when he was eight. \u003ccite>(Courtesy of family)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Nevertheless, he said, “The only evidence I have from studies and reports in the literature ... is that children who struggle with gender incongruence … will not all persist into adolescence.\"\u003c/p>\n\u003cp>Talking to Steensma over Skype, he seemed bemused by the fact that the “Dutch model” is now considered conservative compared to what has taken hold in America. After all, his Amsterdam clinic had been a pioneer in the medical treatment of transgender youth, especially in the use of puberty blockers, which delay the onset of secondary sex characteristics.\u003c/p>\n\u003cp>But what about the \u003cem>social transitioning\u003c/em> of young kids?\u003c/p>\n\u003cp>\"It's not a 'yes' or a 'no' in our opinion, but a 'maybe,' Steensma told me.\u003c/p>\n\u003cp>I wondered if there was any real argument between him and Ehrensaft, after all. So I described to him the case of persistent, insistent, consistent Gracie.\u003c/p>\n\u003cp>A slam dunk for social transition?\u003c/p>\n\u003cp>Steensma said no.\u003c/p>\n\u003cp>“We would counsel them ... that it's okay to express your feelings, your interests, to show your behaviors. But with certain steps like a name change, or a pronoun change, with a result that maybe others will only perceive you as a girl — that's somewhere where we say, ‘Okay, maybe you should explore things without taking steps that are hard to reverse.’”\u003c/p>\n\u003cp>There are mental health professionals in the U.S. who agree. Dr. Jack Drescher is a clinical professor of psychiatry at Columbia University; he served on the American Psychiatric Association's committee that revised the diagnosis of gender identity disorder in 2013. He said gender affirmative therapists have never proven they can successfully identify those kids who will stick with transgender identity.\u003c/p>\n\u003caside class=\"pullquote alignright\">'There are some people that think folks like myself, and the people at our clinic, have fallen off the deep end.”\u003ccite>Diane Ehrensaft, UCSF\u003c/cite>\u003c/aside>\n\u003cp>He also says there’s no evidence to back a corollary belief, that kids who might later need to “detransition” back to their original gender will not suffer any long-lasting psychological effects.\u003c/p>\n\u003cp>“This is what they believe, but it's not based on research,” he said of gender affirmative clinicians. “This is a meme, not really a piece of scientific finding.”\u003c/p>\n\u003cp>Steensma concurred: “If a child transitions, it is not just, ‘Oh, we do the transition and we go on with our life.’ It has a huge impact on the child, on the family and their environment.’”\u003c/p>\n\u003cp>The current Standards of Care, issued by the World Professional Association of Transgender Health in 2011, are more or less in accordance with this view, as even Ehrensaft acknowledges. The guidelines describe “relatively low persistence rates” as “relevant” to helping parents weigh the decision to socially transition. The standards also state that “a change back to the original gender role can be highly distressing.”\u003c/p>\n\u003cp>The one thing everyone in the field agrees on is more research is needed. Almost every gender specialist I spoke with cited Kristina Olson’s longitudinal study at the University of Washington as critical to answering some of these hotly debated unknowns. Olson recently received a $1 million grant from the National Science Foundation, which she's using to expand the study.\u003c/p>\n\u003cp>Preliminary research coming out of the project has already provided good news for the families of transgender kids. In a pair of studies published over the last several years, Olson and her colleagues found that socially transitioned children and adolescents between the ages of 3 and 14 did \u003ca href=\"https://www.kqed.org/stateofhealth/153172/transgender-children-living-openly-are-doing-well-study-shows\" target=\"_blank\" rel=\"noopener\">not experience\u003c/a> any more depression than separate control groups of peers and siblings, as well as the general population.\u003c/p>\n\u003cp>The transgender health association is now gearing up to revise the Standards of Care. Both Steensma, known for “watchful waiting,” and Ehrensaft, of the gender affirmative school, are on the committee in charge of the section about children. The jockeying to influence the direction of the committee has already begun, as evidenced by the critical \u003ca href=\"https://www.tandfonline.com/doi/full/10.1080/15532739.2018.1456390\" target=\"_blank\" rel=\"noopener\">commentaries\u003c/a> now appearing in academic \u003ca href=\"https://www.tandfonline.com/doi/abs/10.1080/15532739.2017.1414649\" target=\"_blank\" rel=\"noopener\">journals\u003c/a>.\u003c/p>\n\u003cp>“My prediction is that there will be more endorsement of social transitions at earlier ages, without the cautionary tales,” Ehrensaft said of the upcoming revision.\u003c/p>\n\u003cp>\u003cb>Not Just Numbers\u003c/b>\u003c/p>\n\u003cp>When it comes down to it, when we talk about the controversy over socially transitioning young kids, we are talking about risk analysis. Which is more disruptive and potentially harmful: to deny children their genuinely felt gender identity in the present moment, until the adults are \u003cem>absolutely sure\u003c/em> it will stick? Or to validate a child’s persistent, consistent and insistent protestations that ‘\u003cem>Hey, someone has made a terrible mistake here,\u003c/em>’ even if they eventually decide they no longer feel that way?\u003c/p>\n\u003cp>Ehrensaft, at least, is clear on the answer:\u003c/p>\n\u003cp>“Why would we deny for the vast majority of kids something that is basically suicide prevention?”\u003c/p>\n\u003cp>As a parent, I wonder: If my daughter became incandescently happy when allowed to change her name and take on other aspects of being transgender — as happy as Molly describes Gracie becoming when recognized as a girl — what would I do? If some statistics indicated my child might one day switch back, but my deepest parental instincts told me to trust her joyfulness, could I ignore the latter?\u003c/p>\n\u003cp>At Rainbow Day Camp, I spoke to James, a 9-year-old transgender boy who’d transitioned during second grade. He told me matter-of-factly that he’d been bullied by older kids, who’d called him an “It.”\u003c/p>\n\u003cp>After he transitioned, his mother said, “There was just this comfort that came about him, and comfort's something that you can't really fake. He’s [just] a happier kid.”\u003c/p>\n\u003cp>Similarly, before Gracie’s transition, family life was “lackluster,” Molly recalled. The constant tension drained the joy out of childhood for everybody.\u003c/p>\n\u003cp>“You never got to see that sort of sparkle, or that sort of magic of, like, a Christmas morning, or a Halloween, or just regular day-to-day happiness,” Molly said.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“Now she gets to really live.”\u003c/p>\n\n",
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"excerpt": "Many gender clinicians now recommend transgender kids as young as three be allowed to live publicly as the gender they identity with, even though studies have shown most kids won't stay transgender as they grow older. ",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003caside>\n\u003cul>\n\u003cli>Many gender clinicians now recommend parents 'socially transition' kids who persistently express a transgender identity.\u003c/li>\n\u003cli>But research has shown most children will give up their transgender identity by the time they are adolescents.\u003c/li>\n\u003cli>Not all researchers agree, though, that this research is valid.\u003c/li>\n\u003c/ul>\n\u003c/aside>\n\u003cp>Gracie is the youngest transgender person I've ever met. She's so young, she still likes to tack on \"and-a-half\" when giving her age, which is six. One day last summer, bouncing all over the grounds at day camp, she looked as delighted as you'd expect any kid would on \"Water Day.”\u003c/p>\n\u003caside class=\"alignright\">\u003ca href=\"https://www.kqed.org/futureofyou/441784/the-controversial-research-on-desistance-in-transgender-youth\">The Controversial Research on 'Desistance' in Transgender Youth\u003c/a>\u003c/aside>\n\u003cp>This is Rainbow Day Camp, in the East Bay town of El Cerrito. It was created specifically to be a safe place for transgender kids, and in fact, being transgender is so unremarkable here, when I asked Gracie what makes it “special,\" she shrugged and said:\u003c/p>\n\u003cp>“You get to do fun stuff.”\u003c/p>\n\u003cp>Her mother, Molly, tried to coax a reporter-friendly answer out of her.\u003c/p>\n\u003cp>“What is special about you, and the same as everybody else in the camp?” she prompted.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“I don’t know,” Gracie said.\u003c/p>\n\u003caside class=\"pullquote alignright\">'What if we let our son walk into the world in a dress with fairy wings, and crowns, and high heels, and even just in regular girl clothes … and then he changes his mind?'\u003ccite>Molly, whose 6-year-old daughter, Gracie, socially transitioned at age four\u003c/cite>\u003c/aside>\n\u003cp>“You’re transgender and there’s other kids that are transgender, too...”\u003c/p>\n\u003cp>“I’m transgender and there’s other kids that are transgender, too.”\u003c/p>\n\u003cp>Ah, kids. ... But when I asked Gracie how she \u003cem>used\u003c/em> to feel, when other people thought she was a boy, she got straight to the point.\u003c/p>\n\u003cp>“It was not right to me, and I didn’t want people to say that, but they said it,” she said. “It hurted my feelings a lot.\"\u003c/p>\n\u003cp>Did it make her angry?\u003c/p>\n\u003cp>“No, it just made me sad.”\u003c/p>\n\u003caside class=\"alignright\">\u003ca href=\"mailto:jbrooks@kqed.org\">Email the reporter\u003c/a>\u003c/aside>\n\u003cp>How about now?\u003c/p>\n\u003cp>“It feels happy to me.”\u003c/p>\n\u003cp>And that, in a child’s nutshell, sums up one side of a contentious debate about the right age for transgender children to begin what gender clinicians call “social transitioning.”\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/IS5Yankf1GY'\n title='//www.youtube.com/embed/IS5Yankf1GY'\n allowfullscreen='true'\n style='border:0;'>\u003c/iframe>\n \u003c/span>\n \u003c/span>\u003c/p>\u003cp>\u003cp>\u003cstrong>Even Three-Year-Olds\u003c/strong>\u003c/p>\n\u003cp>When I met Gracie, she was a few months out of kindergarten — pretty young for a transgender kid, I thought. Gracie lives with her parents and younger brother in a small city in the East Bay. She is already two years into her transition, having started her public life as a girl at four. The family began by discarding her boy name and referring to Gracie as “she” and “her.” She was also allowed to wear girl clothes outside the home, and her parents changed the gender on her birth certificate to avoid confusion at school.\u003c/p>\n\u003caside class=\"alignright noborder\">\u003cstrong>How young is too young?\u003c/strong>\u003cbr>\nUCSF’s Diane Ehrensaft, one of the leading proponents of socially transitioning transgender children, believes there is no minimum age, really, to pursue such a change.'For all of these interventions, our model is stages not ages,” she said. 'When a child is at the place in their life that they can get themselves in focus, help us see them, and are clear, consistent, and stable in both their representation of themselves, and also can express their desires of how they want to live their gender, that's the age.'We have seen some kids as young as two whose parents are bringing them in because they're beginning to say, ‘Me not boy. Me girl.’ Social transition can happen as soon as a child has language or the ability to communicate to us who they are.'\u003c/aside>\n\u003cp>Steps like these make up the “social” aspects of social, not medical, transitioning. The distinction is important: According to Endocrine Society \u003ca href=\"https://academic.oup.com/jcem/article/102/11/3869/4157558\" target=\"_blank\" rel=\"noopener\">guidelines\u003c/a>, patients who want to begin medical treatment like puberty blockers, hormones or surgery should be old enough to give “informed consent,” which the organization says is usually attained by 16.\u003c/p>\n\u003cp>Therapists at \u003ca href=\"https://www.ucsfbenioffchildrens.org/clinics/child_and_adolescent_gender_center/\" target=\"_blank\" rel=\"noopener\">UCSF’s Child and Adolescent Gender Center Clinic\u003c/a> in San Francisco told me they’ve socially transitioned kids as young as three.\u003c/p>\n\u003cp>Diane Ehrensaft, the San Francisco Center’s mental health director and a leading proponent of early social transitioning, acknowledges this approach has been controversial.\u003c/p>\n\u003cp>“There are some people that think folks like myself, and the people at our clinic, have fallen off the deep end,” she told me. She wasn’t just talking about the religious right, either. She was referring to other mental health professionals.\u003c/p>\n\u003cp>I myself experienced a fair bit of surprise when Ehrensaft told me how young these kids are. My first, reflexive comment was a simple, \"Wow.\" This was not an uncommon reaction when I discussed this story with people in my own life, even in the progressive Bay Area.\u003c/p>\n\u003cp>Yet, when I spoke with Gracie’s mom, Molly (the family didn't want their last name used for reasons of privacy), nothing about the decision to allow her then-son to publicly make the switch to a girl, at an age when many kids are still sucking their thumbs, sounded in the slightest bit rash.\u003c/p>\n\u003cp>We spoke at Rainbow Day Camp, in a classroom set aside for interviews. The children’s art adorning the walls, the shrimpy seats — it felt like a place to talk about kickball, not the gender identity of first graders.\u003c/p>\n\u003cp>Yet here we were.\u003c/p>\n\u003caside class=\"alignright\">\u003cstrong>The Biological Roots of Gender Identity\u003c/strong>\u003cbr>\nMolly is the mother of two children, a 3-year-old boy and a 7-year-old transgender girl. The younger child is the “stereotype of what I thought having a son would be like,” she said. “He loves trucks, cars, construction, superheroes and destroying the house.”Her first child, also born male, just did not develop in the same way. Rather, from the time he acquired language on, he protested that he was really a girl. (\u003ca href=\"https://www.kqed.org/futureofyou/the-biological-roots-of-gender-identity\" target=\"_blank\" rel=\"noopener\">Continue reading)\u003c/a>\u003c/aside>\n\u003cp>“What if we do this?” Molly recalled asking a gender therapist, back when they were debating the pros and cons of letting Gracie transition. “What if we let our son walk into the world in a dress with fairy wings, and crowns, and high heels, and even just in regular girl clothes … and then he changes his mind?”\u003c/p>\n\u003cp>\"That's not the question,” the therapist told Molly. “The question is, what if you don't do it?”\u003c/p>\n\u003cp>It was only semi-rhetorical. Some gender therapists say there are serious potential dangers if adults suppress a child’s desired transition. On surveys, American transgender adults have reported attempting suicide at the startling \u003ca href=\"https://williamsinstitute.law.ucla.edu/wp-content/uploads/AFSP-Williams-Suicide-Report-Final.pdf\" target=\"_blank\" rel=\"noopener\">rate\u003c/a> of around 40 percent.\u003c/p>\n\u003cp>The stakes couldn’t have been higher, Molly knew.\u003c/p>\n\u003cp>At Rainbow Day Camp, recalling that time, she started to cry.\u003c/p>\n\u003cp>“As soon as I knew there was even a chance that my kid could feel ashamed of who they are, there was no way … ” Her voice cracked into a higher register. “I had to support, I had to listen, and I had to let her steer, a little bit, the ship. Period. No matter what.”\u003c/p>\n\u003cfigure id=\"attachment_441862\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2020/04/gracie-sliding-water-1.jpg\">\u003cimg class=\"wp-image-441862 size-large\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2020/04/gracie-sliding-water-1-1020x527.jpg\" alt=\"\" width=\"640\" height=\"331\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2020/04/gracie-sliding-water-1-1020x527.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2020/04/gracie-sliding-water-1-160x83.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2020/04/gracie-sliding-water-1-800x414.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2020/04/gracie-sliding-water-1-768x397.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2020/04/gracie-sliding-water-1-1200x620.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/13/2020/04/gracie-sliding-water-1-1180x610.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2020/04/gracie-sliding-water-1-960x496.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2020/04/gracie-sliding-water-1-240x124.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2020/04/gracie-sliding-water-1-375x194.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2020/04/gracie-sliding-water-1-520x269.jpg 520w, https://ww2.kqed.org/app/uploads/sites/13/2020/04/gracie-sliding-water-1.jpg 1209w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Gracie, six, on Water Day at Rainbow Day Camp, which was created as a safe space for transgender kids. \u003ccite>(KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>‘I’m a Girl’\u003c/strong>\u003c/p>\n\u003cp>Ehrensaft calls children like Gracie “persistent, consistent, and insistent” in their declarations of cross-gender identity. For Gracie, this manifested through words, wishes, and, well, practically everything.\u003c/p>\n\u003caside class=\"pullquote alignright\">'Why would we deny for the vast majority of kids something that is basically suicide prevention?'\u003ccite>Diane Ehrensaft, UCSF\u003c/cite>\u003c/aside>\n\u003cp>Gracie was her parents' first child. From toddlerhood on, Molly said, their son had displayed a “constant obsession and fixation on all things girl. As soon as she could tell us, it was, ‘I'm a girl. I'm a sister. I'm a daughter. I'm that girl on that show. I'm that girl in that book.’”\u003c/p>\n\u003cp>Gracie's parents weren’t on board at first.\u003c/p>\n\u003cp>“We filled her world with trucks, and dinosaurs, and superheroes, and we refused girl things,” Molly said. “Like, ‘No, you can't be Elsa for Halloween. You have to be Superman. No, you can't have the dolls for Christmas. We're going to get you a pirate ship.’”\u003c/p>\n\u003cp>They also made a rule: No girl clothing outside the house.\u003c/p>\n\u003cp>Molly tells me: “That’s the part I’m ashamed of now.”\u003c/p>\n\u003cp>\u003cstrong>'These Kids Do Come Forward'\u003c/strong>\u003c/p>\n\u003cp>Molly and her husband finally relented — they just could not deny how much happier their child felt when recognized as a girl.\u003c/p>\n\u003cfigure id=\"attachment_441832\" class=\"wp-caption alignright\" style=\"max-width: 640px\">\u003ca href=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2020/04/Phoenix5-e1527011026777.jpg\">\u003cimg class=\"size-large wp-image-441832\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2020/04/Phoenix5-1020x1530.jpg\" alt=\"\" width=\"640\" height=\"960\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Phoenix, a transgender girl who began wearing dresses to school at age 5. She began made a complete social transition at the start of second grade. \u003ccite>(Courtesy of family)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>I asked: Has Gracie ever looked back?\u003c/p>\n\u003cp>Molly chuckled.\u003c/p>\n\u003cp>“If you think of gender as a spectrum, she is like a full, all-the-way girl.”\u003c/p>\n\u003cp>It’s not rocket science, Ehrensaft explained, if you really listen to the children. “A child will say: ‘Stop calling me Jane. Let me wear my dresses. Please call me she.’ That's a child making a clear statement.”\u003c/p>\n\u003cp>Kristina Olson, a University of Washington gender researcher, said parents do not always listen to what their kids are telling them.\u003c/p>\n\u003cp>“The ones that are most likely to transition are kids who for many years are very consistently saying this is who they are,” she said. ”We often see this happen for years before parents socially transition their kids.”\u003c/p>\n\u003cp>UCSF gender specialist Erica Anderson recently treated a five-year-old who had reached a point of desperation.\u003c/p>\n\u003cp>“In the bathtub, he would compare himself to his younger sister, and really start getting upset. At one point he went in the bathroom with a pair of shears — he was going to cut his penis off.”\u003c/p>\n\u003cp>“This child has been so clear for a couple of years,” Anderson said. “These kids do come forward.”\u003c/p>\n\u003cp>\u003cstrong>Changing Approaches\u003c/strong>\u003c/p>\n\u003cp>Gender clinicians who recommend social transition at such an early age call their model “gender affirmative,” and they believe their approach is now ascendant. Historically, clinicians more commonly treated transgender kids by discouraging cross-gender identity. The method was most famously practiced by longtime gender researcher Ken Zucker.\u003c/p>\n\u003cp>Zucker is now an extraordinarily controversial figure in the transgender community. He believed that an outcome in which a child becomes transgender should be avoided, if possible. You can get a glimpse of his methods in this \u003ca href=\"https://www.npr.org/2008/05/07/90247842/two-families-grapple-with-sons-gender-preferences\" target=\"_blank\" rel=\"noopener\">NPR story\u003c/a> from 2008. Zucker is counseling the family of a young boy he’d diagnosed with gender identity disorder, the term used for gender dysphoria before 2013.\u003c/p>\n\u003cblockquote>\u003cp>Zucker explained to Carol that she and her husband would have to radically change their parenting. Bradley would no longer be allowed to spend time with girls. He would no longer be allowed to play with girlish toys or pretend that he was a female character. Zucker said that all of these activities were dangerous to a kid with gender identity disorder. He explained that unless Carol and her husband helped the child to change his behavior, as Bradley grew older, he likely would be rejected by both peer groups.\u003c/p>\u003c/blockquote>\n\u003cp>Other researchers and transgender activists have criticized this approach as too close to the “conversion therapy” inflicted on gay and lesbian youth, a practice that is now illegal in a number of states, including \u003ca href=\"https://www.sfgate.com/news/article/State-bans-gay-repair-therapy-for-minors-3906032.php\" target=\"_blank\" rel=\"noopener\">California\u003c/a>.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>The World Professional Association for Transgender Health's guidelines for clinicians, called the \u003ca href=\"https://www.wpath.org/publications/soc\" target=\"_blank\" rel=\"noopener\">Standards of Care\u003c/a>, states that “treatment aimed at trying to change a person’s gender identity and expression to become more congruent with sex assigned at birth” is “no longer considered ethical.”\u003c/p>\n\u003cp>Zucker was the psychologist-in-chief and head of the gender identity clinic at a Toronto mental health hospital before administrators shut down the clinic in 2015, after a review of his practices. That was also \u003ca href=\"https://www.theglobeandmail.com/life/health-and-fitness/health/alleged-exchange-with-gender-identity-doctor-didnt-happen-camh-says/article28471923/\" target=\"_blank\" rel=\"noopener\">controversial\u003c/a>, and Zucker is suing his former employer for defamation. (Zucker declined to comment for this article. For a defense of his work, you can read Jesse Singal’s \u003ca href=\"https://www.thecut.com/2016/02/fight-over-trans-kids-got-a-researcher-fired.html\" target=\"_blank\" rel=\"noopener\">reporting\u003c/a> from 2016.)\u003c/p>\n\u003cp>\u003cstrong>Watchful Waiting\u003c/strong>\u003c/p>\n\u003cp>Zucker’s approach aside, there is another alternative to gender affirmative therapy. It’s the approach taken by the \u003ca href=\"https://www.vumc.com/branch/gender-dysphoria/\" target=\"_blank\" rel=\"noopener\">Center of Expertise on Gender Dysphoria\u003c/a> in Amsterdam, and gender specialists commonly refer to it as the “Dutch Model.”\u003c/p>\n\u003cp>This treatment sometimes involves the social transition of young children, according to Thomas Steensma, a researcher and clinician at the center. But for the most part, its counseling incorporates the idea that the vast majority of gender dysphoric children will eventually stop identifying as transgender.\u003c/p>\n\u003cp>The research literature calls these individuals “desistant.” The kids who retain their transgender identity as they grow up are dubbed “persistent.”\u003c/p>\n\u003cp>\u003cstrong>The Desistance Controversy\u003c/strong>\u003c/p>\n\u003cp>Nothing roils the world of transgender research like the topic of \u003ca href=\"https://www.kqed.org/futureofyou/441784/the-controversial-research-on-desistance-in-transgender-youth\" target=\"_blank\" rel=\"noopener\">desistance\u003c/a>. Brynn Tannehill, a transgender activist who follows the research closely, said the concept is often used by anti-LGBT groups to make the case that rejecting children’s transgender identity is in their best interests.\u003c/p>\n\u003caside class=\"pullquote alignright\">'[Desistance research] is used primarily as an attack on the validity of transgender identities, which usually quickly disintegrates into a debate on whether we should exist.' \u003ccite>Brynn Tannehill, transgender activist\u003c/cite>.\u003c/aside>\n\u003cp>“It is used primarily as an attack on the validity of transgender identities, which usually quickly disintegrates into a debate on whether we should exist,” Tannehill said.\u003c/p>\n\u003cp>And yet, the fact is that just about every published study on the topic to date has found that a majority of children who once reported various degrees of gender dysphoria ended up eventually giving up their transgender identity.\u003c/p>\n\u003cp>To grasp the implications of this, remember Molly’s anxious questioning of the gender therapist: What if we go through all this, and it turns out to be just a phase? Shouldn’t we wait?\u003c/p>\n\u003cp>The gender affirmative camp says no. That’s because it doesn’t believe that the body of research on desistance, some of it conducted by Zucker and his associates, is valid.\u003c/p>\n\u003cp>Many gender researchers maintain that the current criteria for diagnosing gender dysphoria are much more stringent than in the past. Therefore, many of the studies that found so many kids had \"grown out\" of their transgender identity were actually measuring children who were \u003cem>never really transgender\u003c/em> in the first place.\u003c/p>\n\u003cp>“Some of those studies are decades old,” said gender researcher Kristina Olson. “So if you had a son in the early 1980s who liked playing with dolls and wanted to occasionally wear a dress, even today maybe you would think to bring that child to talk to a doctor about it. But that child wouldn't necessarily be transgender, because that kid doesn't necessarily think of himself as a girl.\"\u003c/p>\n\u003cp>Ehrensaft said that her San Francisco clinic sees “a tiny, tiny proportion” of clients who stop identifying as transgender after transitioning.\u003c/p>\n\u003cp>Even the Amsterdam clinic’s Thomas Steensma, who firmly believes most gender dysphoric kids will \u003cem>not\u003c/em> grow up to be transgender, acknowledged the earlier studies probably included “milder cases” that are “hard to compare with the clinical samples we see now in our clinics.”\u003c/p>\n\u003cfigure id=\"attachment_441834\" class=\"wp-caption alignright\" style=\"max-width: 720px\">\u003ca href=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2020/04/James.jpeg\">\u003cimg class=\"size-full wp-image-441834\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2020/04/James.jpeg\" alt=\"\" width=\"720\" height=\"960\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2020/04/James.jpeg 720w, https://ww2.kqed.org/app/uploads/sites/13/2020/04/James-160x213.jpeg 160w, https://ww2.kqed.org/app/uploads/sites/13/2020/04/James-240x320.jpeg 240w, https://ww2.kqed.org/app/uploads/sites/13/2020/04/James-375x500.jpeg 375w, https://ww2.kqed.org/app/uploads/sites/13/2020/04/James-520x693.jpeg 520w\" sizes=\"(max-width: 720px) 100vw, 720px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Olivia, a transgender girl who socially transitioned when she was four, and her brother, James, who transitioned when he was eight. \u003ccite>(Courtesy of family)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Nevertheless, he said, “The only evidence I have from studies and reports in the literature ... is that children who struggle with gender incongruence … will not all persist into adolescence.\"\u003c/p>\n\u003cp>Talking to Steensma over Skype, he seemed bemused by the fact that the “Dutch model” is now considered conservative compared to what has taken hold in America. After all, his Amsterdam clinic had been a pioneer in the medical treatment of transgender youth, especially in the use of puberty blockers, which delay the onset of secondary sex characteristics.\u003c/p>\n\u003cp>But what about the \u003cem>social transitioning\u003c/em> of young kids?\u003c/p>\n\u003cp>\"It's not a 'yes' or a 'no' in our opinion, but a 'maybe,' Steensma told me.\u003c/p>\n\u003cp>I wondered if there was any real argument between him and Ehrensaft, after all. So I described to him the case of persistent, insistent, consistent Gracie.\u003c/p>\n\u003cp>A slam dunk for social transition?\u003c/p>\n\u003cp>Steensma said no.\u003c/p>\n\u003cp>“We would counsel them ... that it's okay to express your feelings, your interests, to show your behaviors. But with certain steps like a name change, or a pronoun change, with a result that maybe others will only perceive you as a girl — that's somewhere where we say, ‘Okay, maybe you should explore things without taking steps that are hard to reverse.’”\u003c/p>\n\u003cp>There are mental health professionals in the U.S. who agree. Dr. Jack Drescher is a clinical professor of psychiatry at Columbia University; he served on the American Psychiatric Association's committee that revised the diagnosis of gender identity disorder in 2013. He said gender affirmative therapists have never proven they can successfully identify those kids who will stick with transgender identity.\u003c/p>\n\u003caside class=\"pullquote alignright\">'There are some people that think folks like myself, and the people at our clinic, have fallen off the deep end.”\u003ccite>Diane Ehrensaft, UCSF\u003c/cite>\u003c/aside>\n\u003cp>He also says there’s no evidence to back a corollary belief, that kids who might later need to “detransition” back to their original gender will not suffer any long-lasting psychological effects.\u003c/p>\n\u003cp>“This is what they believe, but it's not based on research,” he said of gender affirmative clinicians. “This is a meme, not really a piece of scientific finding.”\u003c/p>\n\u003cp>Steensma concurred: “If a child transitions, it is not just, ‘Oh, we do the transition and we go on with our life.’ It has a huge impact on the child, on the family and their environment.’”\u003c/p>\n\u003cp>The current Standards of Care, issued by the World Professional Association of Transgender Health in 2011, are more or less in accordance with this view, as even Ehrensaft acknowledges. The guidelines describe “relatively low persistence rates” as “relevant” to helping parents weigh the decision to socially transition. The standards also state that “a change back to the original gender role can be highly distressing.”\u003c/p>\n\u003cp>The one thing everyone in the field agrees on is more research is needed. Almost every gender specialist I spoke with cited Kristina Olson’s longitudinal study at the University of Washington as critical to answering some of these hotly debated unknowns. Olson recently received a $1 million grant from the National Science Foundation, which she's using to expand the study.\u003c/p>\n\u003cp>Preliminary research coming out of the project has already provided good news for the families of transgender kids. In a pair of studies published over the last several years, Olson and her colleagues found that socially transitioned children and adolescents between the ages of 3 and 14 did \u003ca href=\"https://www.kqed.org/stateofhealth/153172/transgender-children-living-openly-are-doing-well-study-shows\" target=\"_blank\" rel=\"noopener\">not experience\u003c/a> any more depression than separate control groups of peers and siblings, as well as the general population.\u003c/p>\n\u003cp>The transgender health association is now gearing up to revise the Standards of Care. Both Steensma, known for “watchful waiting,” and Ehrensaft, of the gender affirmative school, are on the committee in charge of the section about children. The jockeying to influence the direction of the committee has already begun, as evidenced by the critical \u003ca href=\"https://www.tandfonline.com/doi/full/10.1080/15532739.2018.1456390\" target=\"_blank\" rel=\"noopener\">commentaries\u003c/a> now appearing in academic \u003ca href=\"https://www.tandfonline.com/doi/abs/10.1080/15532739.2017.1414649\" target=\"_blank\" rel=\"noopener\">journals\u003c/a>.\u003c/p>\n\u003cp>“My prediction is that there will be more endorsement of social transitions at earlier ages, without the cautionary tales,” Ehrensaft said of the upcoming revision.\u003c/p>\n\u003cp>\u003cb>Not Just Numbers\u003c/b>\u003c/p>\n\u003cp>When it comes down to it, when we talk about the controversy over socially transitioning young kids, we are talking about risk analysis. Which is more disruptive and potentially harmful: to deny children their genuinely felt gender identity in the present moment, until the adults are \u003cem>absolutely sure\u003c/em> it will stick? Or to validate a child’s persistent, consistent and insistent protestations that ‘\u003cem>Hey, someone has made a terrible mistake here,\u003c/em>’ even if they eventually decide they no longer feel that way?\u003c/p>\n\u003cp>Ehrensaft, at least, is clear on the answer:\u003c/p>\n\u003cp>“Why would we deny for the vast majority of kids something that is basically suicide prevention?”\u003c/p>\n\u003cp>As a parent, I wonder: If my daughter became incandescently happy when allowed to change her name and take on other aspects of being transgender — as happy as Molly describes Gracie becoming when recognized as a girl — what would I do? If some statistics indicated my child might one day switch back, but my deepest parental instincts told me to trust her joyfulness, could I ignore the latter?\u003c/p>\n\u003cp>At Rainbow Day Camp, I spoke to James, a 9-year-old transgender boy who’d transitioned during second grade. He told me matter-of-factly that he’d been bullied by older kids, who’d called him an “It.”\u003c/p>\n\u003cp>After he transitioned, his mother said, “There was just this comfort that came about him, and comfort's something that you can't really fake. He’s [just] a happier kid.”\u003c/p>\n\u003cp>Similarly, before Gracie’s transition, family life was “lackluster,” Molly recalled. The constant tension drained the joy out of childhood for everybody.\u003c/p>\n\u003cp>“You never got to see that sort of sparkle, or that sort of magic of, like, a Christmas morning, or a Halloween, or just regular day-to-day happiness,” Molly said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“Now she gets to really live.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "NYU's Move To Make Medical School Free For All Gets Mixed Reviews",
"title": "NYU's Move To Make Medical School Free For All Gets Mixed Reviews",
"headTitle": "KQED Future of You | KQED Science",
"content": "\u003cp>New York University's School of Medicine is learning that no good deed goes unpunished.[contextly_sidebar id=\"NsiSrL9RDjMOi9nyPvNgRoT4Pxfwz6iJ\"]\u003c/p>\n\u003cp>The highly ranked medical school announced with much fanfare this month that it is raising $600 million from private donors to \u003ca href=\"https://www.npr.org/2018/08/17/639467023/nyu-medical-school-says-it-will-offer-free-tuition-to-all-students\" target=\"_blank\" rel=\"noopener\">eliminate tuition\u003c/a> for all its students — even providing refunds to those currently enrolled. Before the announcement, annual tuition at the school was $55,018.\u003c/p>\n\u003cp>NYU leaders hope the move will help address the increasing problem of student debt among young doctors, which many educators argue pushes students to enter higher-paying specialties instead of primary care, and deters some from becoming doctors in the first place.\u003c/p>\n\u003cp>\"A population as diverse as ours is best served by doctors from all walks of life, we believe, and aspiring physicians and surgeons should not be prevented from pursuing a career in medicine because of the prospect of overwhelming financial debt,\" \u003ca href=\"https://nyulangone.org/our-story/our-leadership/executive-leadership/robert-i-grossman-md\" target=\"_blank\" rel=\"noopener\">Dr. Robert Grossman\u003c/a>, the dean of the medical school and CEO of NYU Langone Health, said in a \u003ca href=\"https://nyulangone.org/press-releases/nyu-school-of-medicine-offers-full-tuition-scholarships-to-all-new-current-medical-students\">statement\u003c/a> released by the university. NYU declined a request to elaborate further on its plans.\u003c/p>\n\u003cp>The announcement generated headlines and cheers from students. But not everyone thinks waiving tuition for all med students, including those who can afford to pay, is the best way to approach the complicated issue of student debt.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"As I start rank-ordering the various charities I want to give to, the people who can pay for medical school in cash aren't at the top of my list,\" says Craig Garthwaite, a health economist at Northwestern University's Kellogg School of Management.\u003c/p>\n\u003cp>\"If you had to find some cause to put tons of money behind, this strikes me as an odd one,\" says \u003ca href=\"https://theincidentaleconomist.com/wordpress/about/about-aaron/\" target=\"_blank\" rel=\"noopener\">Dr. Aaron Carroll\u003c/a>, a pediatrician and researcher at Indiana University.[contextly_sidebar id=\"yL41mObfPR0lBjTvBa84Y4Ui3t2xzWmm\"]\u003c/p>\n\u003cp>Still, medical education debt is a big issue in health care. According to the Association of American Medical Colleges, which represents U.S. medical schools and academic health centers, 75 percent of graduating physicians in 2017 had \u003ca href=\"https://members.aamc.org/iweb/upload/2017%20Debt%20Fact%20Card.pdf\" target=\"_blank\" rel=\"noopener\">student loan debt\u003c/a> as they launched their careers, with a median tally of $192,000. Nearly half owed more than $200,000.\u003c/p>\n\u003cp>But it is less clear how much of an impact that debt has on students' choice of medical specialty. The AAMC's data suggest debt does not play as big a role in specialty selection as \u003ca href=\"https://journalofethics.ama-assn.org/article/educational-debt-and-specialty-choice/2013-07\" target=\"_blank\" rel=\"noopener\">some analysts claim\u003c/a>.\u003c/p>\n\u003cp>If debt were a huge factor, one would expect that doctors who owed the most would choose the highest-paying specialties. However, that's not the case.\u003c/p>\n\u003cp>\"Debt doesn't vary much across the specialties,\" says \u003ca href=\"https://www.aamc.org/cim/435632/contactus.html\" target=\"_blank\" rel=\"noopener\">Julie Fresne\u003c/a>, AAMC's director of student financial services and debt management.\u003c/p>\n\u003cp>Garthwaite agrees. He says surveys in which young doctors claim debt as a reason for choosing a more lucrative specialty should be viewed with suspicion.\u003c/p>\n\u003cp>\"No one [who chooses a higher-paying job] says they did it because they want two Teslas,\" he says. \"They say they have all this debt.\"\u003c/p>\n\u003cp>Carroll questions how much difference even $200,000 in student debt makes to people who, at the lowest end of the medical spectrum, still stand to make six figures a year. \"Doctors in general do just fine,\" he says. \"The idea we should pity physicians or worry about them strikes me as odd.\"\u003c/p>\n\u003cp>Choice of specialty is also influenced by more than money. Some specialties may bring less demanding lifestyles than primary care, or more prestige. Carroll says when he opted for pediatrics, his surgeon father was not impressed, calling it a \"garbageman\" specialty.\u003c/p>\n\u003cp>There is also an array of government programs that help students afford medical school or that forgive student loans, although usually such programs require the new doctors to serve several years either in the military or in a medically underserved location. The federal \u003ca href=\"https://bhw.hrsa.gov/loansscholarships/nhsc\">National Health Service Corps\u003c/a>, for example, provides scholarships and loan repayments to medical professionals who agree to work in mostly rural or inner-city areas that have a shortage of health care providers. And the Department of Education oversees the \u003ca href=\"https://studentaid.ed.gov/sa/repay-loans/forgiveness-cancellation/public-service\" target=\"_blank\" rel=\"noopener\">Public Service Loan Forgiveness\u003c/a> program, which cancels outstanding loan balances after 10 years for those who work for nonprofit employers.\u003c/p>\n\u003cp>Medical schools themselves are addressing the student debt problem. Many — \u003ca href=\"https://med.nyu.edu/education/md-degree/accelerated-three-year-md\" target=\"_blank\" rel=\"noopener\">including NYU\u003c/a> — have created programs that let students finish medical school in three years rather than four — reducing the cost by 25 percent. And the \u003ca href=\"http://portals.clevelandclinic.org/cclcm/About-the-College\" target=\"_blank\" rel=\"noopener\">Cleveland Clinic\u003c/a>, together with Case Western Reserve University, has a tuition-free medical school program aimed at training future medical researchers. It takes five years, but grants graduates with both a doctor of medicine title and a special research credential or master's degree.\u003c/p>\n\u003cp>This latest move by NYU, however, is part of a continuing race among top-tier medical schools to attract the best students — and possibly improve a school's national rankings.[contextly_sidebar id=\"i4jKckSF3mAh5YMO9p60jhWlOpsZAUJQ\"]\u003c/p>\n\u003cp>In 2014, \u003ca href=\"http://medschool.ucla.edu/body.cfm?id=1158&action=detail&ref=35\">UCLA\u003c/a> announced it would provide merit-based scholarships covering the entire cost of medical education (including not just tuition, but also living expenses) to 20 percent of its students. \u003ca href=\"http://newsroom.cumc.columbia.edu/blog/2018/04/11/vagelos-college-of-physicians-and-surgeons-launches-scholarship-program-to-eliminate-medical-school-loans-for-students-with-financial-need/\" target=\"_blank\" rel=\"noopener\">Columbia University\u003c/a> announced a similar plan earlier this year, although unlike NYU and UCLA, Columbia's program is based on a student's financial need.\u003c/p>\n\u003cp>These programs are funded, in whole or in part, by large donors whose names brand each medical school — entertainment mogul David Geffen at UCLA, former Merck CEO P. Roy Vagelos at Columbia, and Home Depot's co-founder, Kenneth Langone, at NYU.\u003c/p>\n\u003cp>Economist Garthwaite says it is all well and good if top medical schools want to compete for top students by offering discounts. But if their goal is to encourage more students to enter primary care or to steer more people from lower-income families into medicine, waiving everyone's tuition \"is not the most target-efficient way to reach that goal.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"http://khn.org/\" target=\"_blank\" rel=\"noopener\">\u003cem>Kaiser Health News\u003c/em>\u003c/a>\u003cem>,\u003c/em>\u003cem> a nonprofit news service, is an editorially independent program of the Kaiser Family Foundation, and is not affiliated with Kaiser Permanente.\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 Kaiser Health News. To see more, visit \u003ca href=\"http://www.kaiserhealthnews.org/\" target=\"_blank\" rel=\"noopener\">Kaiser Health News\u003c/a>.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=NYU%27s+Move+To+Make+Medical+School+Free+For+All+Gets+Mixed+Reviews&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>New York University's School of Medicine is learning that no good deed goes unpunished.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>The highly ranked medical school announced with much fanfare this month that it is raising $600 million from private donors to \u003ca href=\"https://www.npr.org/2018/08/17/639467023/nyu-medical-school-says-it-will-offer-free-tuition-to-all-students\" target=\"_blank\" rel=\"noopener\">eliminate tuition\u003c/a> for all its students — even providing refunds to those currently enrolled. Before the announcement, annual tuition at the school was $55,018.\u003c/p>\n\u003cp>NYU leaders hope the move will help address the increasing problem of student debt among young doctors, which many educators argue pushes students to enter higher-paying specialties instead of primary care, and deters some from becoming doctors in the first place.\u003c/p>\n\u003cp>\"A population as diverse as ours is best served by doctors from all walks of life, we believe, and aspiring physicians and surgeons should not be prevented from pursuing a career in medicine because of the prospect of overwhelming financial debt,\" \u003ca href=\"https://nyulangone.org/our-story/our-leadership/executive-leadership/robert-i-grossman-md\" target=\"_blank\" rel=\"noopener\">Dr. Robert Grossman\u003c/a>, the dean of the medical school and CEO of NYU Langone Health, said in a \u003ca href=\"https://nyulangone.org/press-releases/nyu-school-of-medicine-offers-full-tuition-scholarships-to-all-new-current-medical-students\">statement\u003c/a> released by the university. NYU declined a request to elaborate further on its plans.\u003c/p>\n\u003cp>The announcement generated headlines and cheers from students. But not everyone thinks waiving tuition for all med students, including those who can afford to pay, is the best way to approach the complicated issue of student debt.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"As I start rank-ordering the various charities I want to give to, the people who can pay for medical school in cash aren't at the top of my list,\" says Craig Garthwaite, a health economist at Northwestern University's Kellogg School of Management.\u003c/p>\n\u003cp>\"If you had to find some cause to put tons of money behind, this strikes me as an odd one,\" says \u003ca href=\"https://theincidentaleconomist.com/wordpress/about/about-aaron/\" target=\"_blank\" rel=\"noopener\">Dr. Aaron Carroll\u003c/a>, a pediatrician and researcher at Indiana University.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Still, medical education debt is a big issue in health care. According to the Association of American Medical Colleges, which represents U.S. medical schools and academic health centers, 75 percent of graduating physicians in 2017 had \u003ca href=\"https://members.aamc.org/iweb/upload/2017%20Debt%20Fact%20Card.pdf\" target=\"_blank\" rel=\"noopener\">student loan debt\u003c/a> as they launched their careers, with a median tally of $192,000. Nearly half owed more than $200,000.\u003c/p>\n\u003cp>But it is less clear how much of an impact that debt has on students' choice of medical specialty. The AAMC's data suggest debt does not play as big a role in specialty selection as \u003ca href=\"https://journalofethics.ama-assn.org/article/educational-debt-and-specialty-choice/2013-07\" target=\"_blank\" rel=\"noopener\">some analysts claim\u003c/a>.\u003c/p>\n\u003cp>If debt were a huge factor, one would expect that doctors who owed the most would choose the highest-paying specialties. However, that's not the case.\u003c/p>\n\u003cp>\"Debt doesn't vary much across the specialties,\" says \u003ca href=\"https://www.aamc.org/cim/435632/contactus.html\" target=\"_blank\" rel=\"noopener\">Julie Fresne\u003c/a>, AAMC's director of student financial services and debt management.\u003c/p>\n\u003cp>Garthwaite agrees. He says surveys in which young doctors claim debt as a reason for choosing a more lucrative specialty should be viewed with suspicion.\u003c/p>\n\u003cp>\"No one [who chooses a higher-paying job] says they did it because they want two Teslas,\" he says. \"They say they have all this debt.\"\u003c/p>\n\u003cp>Carroll questions how much difference even $200,000 in student debt makes to people who, at the lowest end of the medical spectrum, still stand to make six figures a year. \"Doctors in general do just fine,\" he says. \"The idea we should pity physicians or worry about them strikes me as odd.\"\u003c/p>\n\u003cp>Choice of specialty is also influenced by more than money. Some specialties may bring less demanding lifestyles than primary care, or more prestige. Carroll says when he opted for pediatrics, his surgeon father was not impressed, calling it a \"garbageman\" specialty.\u003c/p>\n\u003cp>There is also an array of government programs that help students afford medical school or that forgive student loans, although usually such programs require the new doctors to serve several years either in the military or in a medically underserved location. The federal \u003ca href=\"https://bhw.hrsa.gov/loansscholarships/nhsc\">National Health Service Corps\u003c/a>, for example, provides scholarships and loan repayments to medical professionals who agree to work in mostly rural or inner-city areas that have a shortage of health care providers. And the Department of Education oversees the \u003ca href=\"https://studentaid.ed.gov/sa/repay-loans/forgiveness-cancellation/public-service\" target=\"_blank\" rel=\"noopener\">Public Service Loan Forgiveness\u003c/a> program, which cancels outstanding loan balances after 10 years for those who work for nonprofit employers.\u003c/p>\n\u003cp>Medical schools themselves are addressing the student debt problem. Many — \u003ca href=\"https://med.nyu.edu/education/md-degree/accelerated-three-year-md\" target=\"_blank\" rel=\"noopener\">including NYU\u003c/a> — have created programs that let students finish medical school in three years rather than four — reducing the cost by 25 percent. And the \u003ca href=\"http://portals.clevelandclinic.org/cclcm/About-the-College\" target=\"_blank\" rel=\"noopener\">Cleveland Clinic\u003c/a>, together with Case Western Reserve University, has a tuition-free medical school program aimed at training future medical researchers. It takes five years, but grants graduates with both a doctor of medicine title and a special research credential or master's degree.\u003c/p>\n\u003cp>This latest move by NYU, however, is part of a continuing race among top-tier medical schools to attract the best students — and possibly improve a school's national rankings.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>In 2014, \u003ca href=\"http://medschool.ucla.edu/body.cfm?id=1158&action=detail&ref=35\">UCLA\u003c/a> announced it would provide merit-based scholarships covering the entire cost of medical education (including not just tuition, but also living expenses) to 20 percent of its students. \u003ca href=\"http://newsroom.cumc.columbia.edu/blog/2018/04/11/vagelos-college-of-physicians-and-surgeons-launches-scholarship-program-to-eliminate-medical-school-loans-for-students-with-financial-need/\" target=\"_blank\" rel=\"noopener\">Columbia University\u003c/a> announced a similar plan earlier this year, although unlike NYU and UCLA, Columbia's program is based on a student's financial need.\u003c/p>\n\u003cp>These programs are funded, in whole or in part, by large donors whose names brand each medical school — entertainment mogul David Geffen at UCLA, former Merck CEO P. Roy Vagelos at Columbia, and Home Depot's co-founder, Kenneth Langone, at NYU.\u003c/p>\n\u003cp>Economist Garthwaite says it is all well and good if top medical schools want to compete for top students by offering discounts. But if their goal is to encourage more students to enter primary care or to steer more people from lower-income families into medicine, waiving everyone's tuition \"is not the most target-efficient way to reach that goal.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"http://khn.org/\" target=\"_blank\" rel=\"noopener\">\u003cem>Kaiser Health News\u003c/em>\u003c/a>\u003cem>,\u003c/em>\u003cem> a nonprofit news service, is an editorially independent program of the Kaiser Family Foundation, and is not affiliated with Kaiser Permanente.\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 Kaiser Health News. To see more, visit \u003ca href=\"http://www.kaiserhealthnews.org/\" target=\"_blank\" rel=\"noopener\">Kaiser Health News\u003c/a>.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=NYU%27s+Move+To+Make+Medical+School+Free+For+All+Gets+Mixed+Reviews&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Science is Finding Some Truth in ‘Microdosing’ Claims Touted by ’Shroomers and Reddit Users",
"title": "Science is Finding Some Truth in ‘Microdosing’ Claims Touted by ’Shroomers and Reddit Users",
"headTitle": "KQED Future of You | KQED Science",
"content": "\u003cp>Dennis van der Meijden isn’t aiming to see the face of God, feel one with the cosmos, grasp the hidden reality of time and space, or embark on a \u003ca href=\"https://www.amazon.com/Psychedelic-Explorers-Guide-Therapeutic-Journeys/dp/1594774021\" target=\"_blank\" rel=\"noopener\">sacred journey\u003c/a>. What the Dutch graphic designer, producer, and rapper (under the professional name Terilekst) wants — and gets — from his twice-weekly “microdoses” of psilocybin is more modest.[contextly_sidebar id=\"2u046KLqIpjlWqt95jSvMRrGksdXK55L\"]\u003c/p>\n\u003cp>“It sharpens all the senses, as if the frequencies of all of your atoms and energy field are raised a little bit and are being slightly more conscious,” said van der Meijden, 39, who told STAT he first microdosed psilocybin — the active ingredient in “magic mushrooms” — three years ago. It makes him energetic enough to skip coffee, “as if I’m kicked in some sort of orbit for that day.” If he becomes distracted, “I’m very much aware of that, as if seeing myself from a bird’s eye view, so I can correct myself very fast.” But van der Meijden says he’s careful not to exceed about 0.4 grams, because 0.5 made him “a bit too joyful and a bit too philosophical,” which wasn’t always appropriate.\u003c/p>\n\u003cp>Microdosing involves taking roughly one-tenth the “trip” dose of a psychedelic drug, an amount too little to trigger hallucinations but enough, its proponents say, to sharpen the mind. Psilocybin microdosers (including hundreds on Reddit) report that the mushrooms can increase creativity, calm anxiety, decrease the need for caffeine, and reduce depression. There is enough evidence that trip doses might have the latter effect that, on Wednesday, London-based Compass Pathways received Food and Drug Administration \u003ca href=\"https://markets.businessinsider.com/news/stocks/compass-pathways-receives-fda-approval-for-psilocybin-therapy-clinical-trial-for-treatment-resistant-depression-1027477289\" target=\"_blank\" rel=\"noopener\">approval\u003c/a> for a Phase 2B clinical trial of psilocybin (in larger-than-microdoses) for treatment-resistant depression. But research into microdosing is minimal.\u003c/p>\n\u003cp>In the nearly 10 years since psychologist and psychedelics researcher James Fadiman introduced the notion of microdosing and devised a widely followed \u003ca href=\"https://sites.google.com/view/microdosingpsychedelics/home\" target=\"_blank\" rel=\"noopener\">protocol\u003c/a> for it, and three years after microdosing psychedelics became the latest Silicon Valley “\u003ca href=\"https://www.forbes.com/sites/robertglatter/2015/11/27/lsd-microdosing-the-new-job-enhancer-in-silicon-valley-and-beyond/#8ece3fe188a8\" target=\"_blank\" rel=\"noopener\">productivity hack\u003c/a>,” all the evidence about its effects has been anecdotal. Psilocybin is illegal almost everywhere, so it’s been nearly impossible to study scientifically. That is changing, however, as the Netherlands and other countries effectively decriminalize it and scientists in places where it remains illegal obtain government permission to study it.[contextly_sidebar id=\"uhfAqZqMFWRdicHoQZb7cSTv52omgvqK\"]\u003c/p>\n\u003cp>The scientific interest is driven, in part, by numerous reports over the years that psilocybin might have antidepressant or anti-anxiety effects that might guide the development of better psychiatric drugs. But it also reflects an itch to see whether there is any basis for the anecdotal accounts. Now, in the first \u003ca href=\"https://www.biorxiv.org/content/early/2018/08/11/384412\" target=\"_blank\" rel=\"noopener\">study\u003c/a> of its kind, scientists in the Netherlands found that psilocybin microdoses have no noticeable effect on the problem-solving, rational-thinking, and abstract-reasoning ability called fluid intelligence. But they do seem to improve two forms of thinking that underlie creativity.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“Performance was significantly higher” on tests of convergent and divergent thinking, said psychologist Bernhard Hommel of Leiden University in the Netherlands, who led the study. Convergent thinking is the ability to focus on abstract concepts to identify a single solution to a well-defined problem. Divergent thinking requires meandering mental forays and mental flexibility. Psychologists consider both to be ingredients of creativity.\u003c/p>\n\u003cp>Whatever the dose, psilocybin (O-phosphoryl-4-hydroxy-N, N-dimethyltryptamine) binds to receptors for the neurotransmitter serotonin. The cortex is packed with these 5-HT2A receptors, especially in areas that control reflection, imagination, and introspection, but “whether there is a minimum dose [of psilocybin that’s required to activate them] is an empirical question that we try to tackle,” Hommel said.\u003c/p>\n\u003cp>To do so, he and his colleagues zeroed in on the effects that many users report: creativity, problem-solving, and the “cognitive flexibility” deemed crucial to both. Leiden’s Luisa Prochazkova took the lead in inviting members of the Psychedelic Society of the Netherlands to participate in the study; she got 38 takers.\u003c/p>\n\u003cp>Before their microdose, the volunteers took three standard psychological tests, two related to creative problem-solving and one an assessment of fluid intelligence. The scientists ran chemical analyses of the mushroom samples to determine how much psilocybin they contained. Since a trip dose is about 3 grams of dried ’shrooms, a microdose is around 0.33 grams. Participants averaged 0.37 grams of the dried preparation, which can be taken with food or packed into gelcaps for easy swallowing.\u003c/p>\n\u003cp>About 90 minutes after the microdose, the participants took the three tests again.\u003c/p>\n\u003cp>In the Picture Concept Task, they saw three rows of three pictures, and had to choose three — one from each row — that were related. That requires converging on the correct solution, like noticing that a bathtub, a sink, and a hose all have something to do with water. The brain must focus, weigh alternatives, and reject wrong ones.\u003c/p>\n\u003cp>In the Alternate Uses Task, the microdosers had five minutes to think of ways to use a pen (tracheotomy? finger splint?) or towel. That measures divergent thinking, to move thoughts away from writing, for example, in the case of the pen.\u003c/p>\n\u003cp>The microdosers also took a “progressive matrices” test: In blocks of two-by-two or three-by-three patterns, with the bottom right one missing, they had to choose which of six possibilities belonged in the blank square — a task that requires fluid intelligence.\u003c/p>\n\u003cp>The scientists found no post-microdose difference on the fluid intelligence test. But after microdosing, performance on the picture concept test was significantly higher (an average score of 7.6) than before (6.6). That suggested an improvement in the convergent thinking element of creativity.\u003c/p>\n\u003cp>The microdosers also came up with significantly more uses for pens and towels, 16.7 vs. 14.7. That suggests a microdose of psilocybin “allowed participants to create more out-of-the-box alternative solutions for a problem,” the scientists wrote. Taken together, the three findings suggest a specific effect of psilocybin microdoses on creativity but not on fluid intelligence.\u003c/p>\n\u003cp>For van der Meijden, a microdose of psilocybin makes his musical brainstorm sessions yield “more concepts, ideas, and solutions,” he said, partly because it lets him “better understand and visualize other people’s concepts.” In his design and illustration work, it produces a “more natural flow of line drawing” and lets him “see more possibilities in how things can be or look.” In his music, it lets him “analyze all the different instruments better” and know, for instance, whether to turn up or down the reverberation effect.\u003c/p>\n\u003cp>The Dutch study, which was published on a preprint site and has not undergone peer review at a journal, has several caveats. For one thing, having seen a test before might make people better at it. More problematic, the study didn’t have a control group of people who took something other than psilocybin. That leaves open the possibility that it wasn’t the compound that improved some forms of thinking, but the expectation that it would do so. Maybe people who microdose believe in its benefits enough to make those expectations reality.\u003c/p>\n\u003cp>On the other hand, the results fit with another new \u003ca href=\"https://www.biorxiv.org/content/early/2018/07/25/376491\" target=\"_blank\" rel=\"noopener\">study\u003c/a> of psilocybin. In this one, scientists led by computational neuroscientist Joana Cabral of the University of Oxford used fMRI scans to study the brain activity of nine people who volunteered to be injected with 2 milligram (trip-inducing) doses. The chemical changed the functional connectivity of various brain regions, so that activity in one became synced with that in another. In particular, the rational, logical, well-behaved frontoparietal regions became “strongly destabilized,” the scientists reported, melding with activity in emotional and other regions to produce “unconstrained consciousness,” “mind wandering,” and a sense that everything is connected to everything else. Seeing connections that elude other people is almost the definition of creativity.\u003c/p>\n\u003cp>The findings in the microdosing study also fit with many anecdotal reports. One college student who is a member of the Portland, Ore., microdosing community said that although he doesn’t microdose psilocybin with the express purpose of boosting creativity or focus, he has found that “things seem to have quieted down, in terms of racing thoughts.” He can still be distracted, said Alex, 38, who asked not to be further identified because the drug is illegal in the U.S. But “if I want to go about doing something, then I have an easier time with it because I’m not being bogged down by my thoughts,” he added.\u003c/p>\n\u003cp>Jakobien van der Weijden takes one psilocybin microdose every three days, with bimonthly breaks, “to work more focused, more efficiently and be more creative” at his marketing job in the Netherlands, he said. “On the downside, I would often feel that the inspiration was still there at night and I would keep working on projects until late. So it was somewhat more difficult to maintain a healthy biorhythm.”\u003c/p>\n\u003cp>As legal strictures loosen, there will likely be more rigorous studies of microdosing psilocybin. “Scientific studies could legitimize the claimed benefits,” said Will Burns, CEO of Wenham, Mass.-based \u003ca href=\"http://www.ideasicle.com/\" target=\"_blank\" rel=\"noopener\">Ideasicle\u003c/a>, which develops branding and marketing ideas. He does not microdose, Burns said, but has \u003ca href=\"https://www.forbes.com/sites/willburns/2015/11/29/lsd-microdosing-deserves-more-serious-research/#6824b00d656d\" target=\"_blank\" rel=\"noopener\">called for\u003c/a> research into its purported effects, including improving productivity and creativity. “Right now, we’re swimming in a world of anecdotes and almost no one has taken this seriously,” he said. “We need scientific studies.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This \u003ca href=\"https://www.statnews.com/2018/08/23/science-testing-claimed-benefits-of-psilocybin-microdosing/\" target=\"_blank\" rel=\"noopener\">story\u003c/a> was originally published by STAT, an online publication of Boston Globe Media that covers health, medicine, and scientific discovery.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Dennis van der Meijden isn’t aiming to see the face of God, feel one with the cosmos, grasp the hidden reality of time and space, or embark on a \u003ca href=\"https://www.amazon.com/Psychedelic-Explorers-Guide-Therapeutic-Journeys/dp/1594774021\" target=\"_blank\" rel=\"noopener\">sacred journey\u003c/a>. What the Dutch graphic designer, producer, and rapper (under the professional name Terilekst) wants — and gets — from his twice-weekly “microdoses” of psilocybin is more modest.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>“It sharpens all the senses, as if the frequencies of all of your atoms and energy field are raised a little bit and are being slightly more conscious,” said van der Meijden, 39, who told STAT he first microdosed psilocybin — the active ingredient in “magic mushrooms” — three years ago. It makes him energetic enough to skip coffee, “as if I’m kicked in some sort of orbit for that day.” If he becomes distracted, “I’m very much aware of that, as if seeing myself from a bird’s eye view, so I can correct myself very fast.” But van der Meijden says he’s careful not to exceed about 0.4 grams, because 0.5 made him “a bit too joyful and a bit too philosophical,” which wasn’t always appropriate.\u003c/p>\n\u003cp>Microdosing involves taking roughly one-tenth the “trip” dose of a psychedelic drug, an amount too little to trigger hallucinations but enough, its proponents say, to sharpen the mind. Psilocybin microdosers (including hundreds on Reddit) report that the mushrooms can increase creativity, calm anxiety, decrease the need for caffeine, and reduce depression. There is enough evidence that trip doses might have the latter effect that, on Wednesday, London-based Compass Pathways received Food and Drug Administration \u003ca href=\"https://markets.businessinsider.com/news/stocks/compass-pathways-receives-fda-approval-for-psilocybin-therapy-clinical-trial-for-treatment-resistant-depression-1027477289\" target=\"_blank\" rel=\"noopener\">approval\u003c/a> for a Phase 2B clinical trial of psilocybin (in larger-than-microdoses) for treatment-resistant depression. But research into microdosing is minimal.\u003c/p>\n\u003cp>In the nearly 10 years since psychologist and psychedelics researcher James Fadiman introduced the notion of microdosing and devised a widely followed \u003ca href=\"https://sites.google.com/view/microdosingpsychedelics/home\" target=\"_blank\" rel=\"noopener\">protocol\u003c/a> for it, and three years after microdosing psychedelics became the latest Silicon Valley “\u003ca href=\"https://www.forbes.com/sites/robertglatter/2015/11/27/lsd-microdosing-the-new-job-enhancer-in-silicon-valley-and-beyond/#8ece3fe188a8\" target=\"_blank\" rel=\"noopener\">productivity hack\u003c/a>,” all the evidence about its effects has been anecdotal. Psilocybin is illegal almost everywhere, so it’s been nearly impossible to study scientifically. That is changing, however, as the Netherlands and other countries effectively decriminalize it and scientists in places where it remains illegal obtain government permission to study it.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>The scientific interest is driven, in part, by numerous reports over the years that psilocybin might have antidepressant or anti-anxiety effects that might guide the development of better psychiatric drugs. But it also reflects an itch to see whether there is any basis for the anecdotal accounts. Now, in the first \u003ca href=\"https://www.biorxiv.org/content/early/2018/08/11/384412\" target=\"_blank\" rel=\"noopener\">study\u003c/a> of its kind, scientists in the Netherlands found that psilocybin microdoses have no noticeable effect on the problem-solving, rational-thinking, and abstract-reasoning ability called fluid intelligence. But they do seem to improve two forms of thinking that underlie creativity.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“Performance was significantly higher” on tests of convergent and divergent thinking, said psychologist Bernhard Hommel of Leiden University in the Netherlands, who led the study. Convergent thinking is the ability to focus on abstract concepts to identify a single solution to a well-defined problem. Divergent thinking requires meandering mental forays and mental flexibility. Psychologists consider both to be ingredients of creativity.\u003c/p>\n\u003cp>Whatever the dose, psilocybin (O-phosphoryl-4-hydroxy-N, N-dimethyltryptamine) binds to receptors for the neurotransmitter serotonin. The cortex is packed with these 5-HT2A receptors, especially in areas that control reflection, imagination, and introspection, but “whether there is a minimum dose [of psilocybin that’s required to activate them] is an empirical question that we try to tackle,” Hommel said.\u003c/p>\n\u003cp>To do so, he and his colleagues zeroed in on the effects that many users report: creativity, problem-solving, and the “cognitive flexibility” deemed crucial to both. Leiden’s Luisa Prochazkova took the lead in inviting members of the Psychedelic Society of the Netherlands to participate in the study; she got 38 takers.\u003c/p>\n\u003cp>Before their microdose, the volunteers took three standard psychological tests, two related to creative problem-solving and one an assessment of fluid intelligence. The scientists ran chemical analyses of the mushroom samples to determine how much psilocybin they contained. Since a trip dose is about 3 grams of dried ’shrooms, a microdose is around 0.33 grams. Participants averaged 0.37 grams of the dried preparation, which can be taken with food or packed into gelcaps for easy swallowing.\u003c/p>\n\u003cp>About 90 minutes after the microdose, the participants took the three tests again.\u003c/p>\n\u003cp>In the Picture Concept Task, they saw three rows of three pictures, and had to choose three — one from each row — that were related. That requires converging on the correct solution, like noticing that a bathtub, a sink, and a hose all have something to do with water. The brain must focus, weigh alternatives, and reject wrong ones.\u003c/p>\n\u003cp>In the Alternate Uses Task, the microdosers had five minutes to think of ways to use a pen (tracheotomy? finger splint?) or towel. That measures divergent thinking, to move thoughts away from writing, for example, in the case of the pen.\u003c/p>\n\u003cp>The microdosers also took a “progressive matrices” test: In blocks of two-by-two or three-by-three patterns, with the bottom right one missing, they had to choose which of six possibilities belonged in the blank square — a task that requires fluid intelligence.\u003c/p>\n\u003cp>The scientists found no post-microdose difference on the fluid intelligence test. But after microdosing, performance on the picture concept test was significantly higher (an average score of 7.6) than before (6.6). That suggested an improvement in the convergent thinking element of creativity.\u003c/p>\n\u003cp>The microdosers also came up with significantly more uses for pens and towels, 16.7 vs. 14.7. That suggests a microdose of psilocybin “allowed participants to create more out-of-the-box alternative solutions for a problem,” the scientists wrote. Taken together, the three findings suggest a specific effect of psilocybin microdoses on creativity but not on fluid intelligence.\u003c/p>\n\u003cp>For van der Meijden, a microdose of psilocybin makes his musical brainstorm sessions yield “more concepts, ideas, and solutions,” he said, partly because it lets him “better understand and visualize other people’s concepts.” In his design and illustration work, it produces a “more natural flow of line drawing” and lets him “see more possibilities in how things can be or look.” In his music, it lets him “analyze all the different instruments better” and know, for instance, whether to turn up or down the reverberation effect.\u003c/p>\n\u003cp>The Dutch study, which was published on a preprint site and has not undergone peer review at a journal, has several caveats. For one thing, having seen a test before might make people better at it. More problematic, the study didn’t have a control group of people who took something other than psilocybin. That leaves open the possibility that it wasn’t the compound that improved some forms of thinking, but the expectation that it would do so. Maybe people who microdose believe in its benefits enough to make those expectations reality.\u003c/p>\n\u003cp>On the other hand, the results fit with another new \u003ca href=\"https://www.biorxiv.org/content/early/2018/07/25/376491\" target=\"_blank\" rel=\"noopener\">study\u003c/a> of psilocybin. In this one, scientists led by computational neuroscientist Joana Cabral of the University of Oxford used fMRI scans to study the brain activity of nine people who volunteered to be injected with 2 milligram (trip-inducing) doses. The chemical changed the functional connectivity of various brain regions, so that activity in one became synced with that in another. In particular, the rational, logical, well-behaved frontoparietal regions became “strongly destabilized,” the scientists reported, melding with activity in emotional and other regions to produce “unconstrained consciousness,” “mind wandering,” and a sense that everything is connected to everything else. Seeing connections that elude other people is almost the definition of creativity.\u003c/p>\n\u003cp>The findings in the microdosing study also fit with many anecdotal reports. One college student who is a member of the Portland, Ore., microdosing community said that although he doesn’t microdose psilocybin with the express purpose of boosting creativity or focus, he has found that “things seem to have quieted down, in terms of racing thoughts.” He can still be distracted, said Alex, 38, who asked not to be further identified because the drug is illegal in the U.S. But “if I want to go about doing something, then I have an easier time with it because I’m not being bogged down by my thoughts,” he added.\u003c/p>\n\u003cp>Jakobien van der Weijden takes one psilocybin microdose every three days, with bimonthly breaks, “to work more focused, more efficiently and be more creative” at his marketing job in the Netherlands, he said. “On the downside, I would often feel that the inspiration was still there at night and I would keep working on projects until late. So it was somewhat more difficult to maintain a healthy biorhythm.”\u003c/p>\n\u003cp>As legal strictures loosen, there will likely be more rigorous studies of microdosing psilocybin. “Scientific studies could legitimize the claimed benefits,” said Will Burns, CEO of Wenham, Mass.-based \u003ca href=\"http://www.ideasicle.com/\" target=\"_blank\" rel=\"noopener\">Ideasicle\u003c/a>, which develops branding and marketing ideas. He does not microdose, Burns said, but has \u003ca href=\"https://www.forbes.com/sites/willburns/2015/11/29/lsd-microdosing-deserves-more-serious-research/#6824b00d656d\" target=\"_blank\" rel=\"noopener\">called for\u003c/a> research into its purported effects, including improving productivity and creativity. “Right now, we’re swimming in a world of anecdotes and almost no one has taken this seriously,” he said. “We need scientific studies.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>This \u003ca href=\"https://www.statnews.com/2018/08/23/science-testing-claimed-benefits-of-psilocybin-microdosing/\" target=\"_blank\" rel=\"noopener\">story\u003c/a> was originally published by STAT, an online publication of Boston Globe Media that covers health, medicine, and scientific discovery.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "America's Vaccine Wars Stoked By Russian Bots and Troll Armies",
"title": "America's Vaccine Wars Stoked By Russian Bots and Troll Armies",
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"content": "\u003cp class=\"danger-zone\">In the lead-up to the 2016 U.S. election, Russian bots and trolls took to Twitter and other social media platforms to try to turn Americans against one another. But in addition to spreading false information and interfering in the election, a new study reports, a significant number of these malevolent actors tried to sow discord over vaccines.[contextly_sidebar id=\"U9m2Xosa038xtsfDSwPz5O7TUvqWe42O\"]\u003c/p>\n\u003cp class=\"danger-zone\">An \u003ca href=\"https://ajph.aphapublications.org/doi/10.2105/AJPH.2018.304567\" target=\"_blank\" rel=\"noopener\">analysis of Twitter accounts\u003c/a> previously identified as having been operated by Russian bots and trolls found they dove into the vaccine debate as early as January 2015, the researchers reported. They did not take one side or the other, but seemed to tweet pro-vaccine and anti-vaccine messages in roughly equal measure.\u003c/p>\n\u003cp class=\"danger-zone\">On a variety of issues, the overall aim of the Russian campaign appeared to be to erode social cohesion and generate confusion by amplifying the number of voices taking part in these debates on social media. But in the case of vaccines, that could have increased the misperception that the science on their safety and effectiveness isn’t settled — as is the case — but rather that it is still subject to debate.\u003c/p>\n\u003cp class=\"\">“We do have a very strong suspicion that these accounts were attempting to generate discord,” said David Broniatowski, assistant professor in George Washington University’s department of engineering management and systems engineering and lead author of the study.\u003c/p>\n\u003cp>In the study, published Thursday in the American Journal of Public Health, Broniatowski and his co-authors focused on Twitter, analyzing tweets from accounts that had been identified as having been operated by Russian trolls, bots, and so-called content polluters whose aim is to disseminate spam and malware. The article is titled “Weaponized Health Communications: Twitter Bots and Russian Trolls Amplify the Vaccine Debate.”[contextly_sidebar id=\"9QtW5fawtVoxY4YEBFmA2GatrjvQlfvd\"]\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The researchers compared tweets from the accounts to a selection of tweets from other users to see if the trolls and bots commented on vaccines more frequently than average Twitter accounts. They did.\u003c/p>\n\u003cp>“We found that, yeah, indeed, this was something that does seem to be part of the lexicon of what some of these bots and trolls use,” Broniatowski told STAT.\u003c/p>\n\u003cp>Even though the division of pro- and anti-vacccine tweets was roughly equal, that still skewed the picture of views on vaccines on Twitter, he noted, pointing to \u003ca href=\"http://www.pewinternet.org/2017/02/02/vast-majority-of-americans-say-benefits-of-childhood-vaccines-outweigh-risks/\" target=\"_blank\" rel=\"noopener\">data from the Pew Trust\u003c/a> that shows the vast majority of Americans support vaccination.\u003c/p>\n\u003cp>“We’ve always been a little puzzled why social media looks like there are so many anti-vaxxers,” said Broniatowski. “So even if somebody’s posting 50-50, compared to the Pew data, there are going to be more anti-vaxxers.”\u003c/p>\n\u003cp>Dr. Amesh Adalja, an infectious diseases physician and senior scholar at the Center for Health Security at Johns Hopkins Bloomberg School of Public Health, said any skepticism about the safety of vaccines risks feeding the concerns of parents who are worried about having their children vaccinated.\u003c/p>\n\u003cp>“The more the vaccine ‘debate’… is amplified it gains an undeserved sense of legitimacy and gives vaccine-hesitant individuals a pretense to forgo vaccination for themselves and their children,” said Adalja, who was harshly critical of the use of vaccinations in efforts to turn people against each other, calling it “overtly nihilistic.”\u003c/p>\n\u003cp>A spokesman for Twitter said that malicious accounts “are likely to target virtually any high profile conversation, since that’s where the views are.”[contextly_sidebar id=\"Q4N5GXoIo4iApYaASdjmnyeqp8POWr3L\"]\u003c/p>\n\u003cp>The spokesman, Ian Plunkett, told STAT that Twitter has aggressively ramped up preventive measures to try to keep such content from general users. In May, he noted, the platform identified and challenged nearly 10 million potentially automated accounts. “We put preemptive measures in place to ensure automated content is filtered from discoverable areas of the services — like trends and search. It’s possible that may users did not see this content before it was suspended,” Plunkett said.\u003c/p>\n\u003cp>Other experts, too, were unsurprised that Russian trolls and bots would delve into vaccines discussions, given the heat the topic can generate.\u003c/p>\n\u003cp>“Vaccination links to deep values around protection, health, harm, and the social contract,” said Julie Leask, an associate professor at the University of Sydney’s Susan Wakil School of Nursing and Midwifery who researches vaccine refusal. “People become highly invested in the discussion, and highly reactive to the notion that people refuse vaccines. The expression of sentiment at the margins — very pro- and very anti-vaccine — generates emotional energy and clicks.”\u003c/p>\n\u003cp>Adam Dunn, an associate professor in the Center for Health Informatics at Australia’s Macquarie University, said responding to this type of activity by internet bots and trolls would be challenging for public health authorities and may rely on the rooting out of the malicious accounts.\u003c/p>\n\u003cp>“The responsibility of managing the health of online conversations may … fall to Twitter itself, and work like this demonstrating the potential for real harm to human health provides a strong impetus for Twitter to act more often and more quickly to identify, isolate, or remove bots and trolls,” Dunn said.\u003c/p>\n\u003cp>Many of the accounts Broniatowski’s group studied have since been shut down, he said. But freeing the Twitter platform of bots and trolls is like playing whack-a-mole, he suggested.\u003c/p>\n\u003cp>For her part, Leask wasn’t certain how Twitter would have an outsized impact on vaccination decisions.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“When parents decide not to vaccinate, the decision isn’t usually taken lightly and a few tweets from bots are unlikely to change this trajectory,” she said. “The decision process is much more complex and centered on beliefs, experience and notions of what it means to be a ‘good parent’ held within that community. What we still need to establish is the relative role of social media independent of the influence of peer networks.”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp class=\"danger-zone\">In the lead-up to the 2016 U.S. election, Russian bots and trolls took to Twitter and other social media platforms to try to turn Americans against one another. But in addition to spreading false information and interfering in the election, a new study reports, a significant number of these malevolent actors tried to sow discord over vaccines.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp class=\"danger-zone\">An \u003ca href=\"https://ajph.aphapublications.org/doi/10.2105/AJPH.2018.304567\" target=\"_blank\" rel=\"noopener\">analysis of Twitter accounts\u003c/a> previously identified as having been operated by Russian bots and trolls found they dove into the vaccine debate as early as January 2015, the researchers reported. They did not take one side or the other, but seemed to tweet pro-vaccine and anti-vaccine messages in roughly equal measure.\u003c/p>\n\u003cp class=\"danger-zone\">On a variety of issues, the overall aim of the Russian campaign appeared to be to erode social cohesion and generate confusion by amplifying the number of voices taking part in these debates on social media. But in the case of vaccines, that could have increased the misperception that the science on their safety and effectiveness isn’t settled — as is the case — but rather that it is still subject to debate.\u003c/p>\n\u003cp class=\"\">“We do have a very strong suspicion that these accounts were attempting to generate discord,” said David Broniatowski, assistant professor in George Washington University’s department of engineering management and systems engineering and lead author of the study.\u003c/p>\n\u003cp>In the study, published Thursday in the American Journal of Public Health, Broniatowski and his co-authors focused on Twitter, analyzing tweets from accounts that had been identified as having been operated by Russian trolls, bots, and so-called content polluters whose aim is to disseminate spam and malware. The article is titled “Weaponized Health Communications: Twitter Bots and Russian Trolls Amplify the Vaccine Debate.”\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The researchers compared tweets from the accounts to a selection of tweets from other users to see if the trolls and bots commented on vaccines more frequently than average Twitter accounts. They did.\u003c/p>\n\u003cp>“We found that, yeah, indeed, this was something that does seem to be part of the lexicon of what some of these bots and trolls use,” Broniatowski told STAT.\u003c/p>\n\u003cp>Even though the division of pro- and anti-vacccine tweets was roughly equal, that still skewed the picture of views on vaccines on Twitter, he noted, pointing to \u003ca href=\"http://www.pewinternet.org/2017/02/02/vast-majority-of-americans-say-benefits-of-childhood-vaccines-outweigh-risks/\" target=\"_blank\" rel=\"noopener\">data from the Pew Trust\u003c/a> that shows the vast majority of Americans support vaccination.\u003c/p>\n\u003cp>“We’ve always been a little puzzled why social media looks like there are so many anti-vaxxers,” said Broniatowski. “So even if somebody’s posting 50-50, compared to the Pew data, there are going to be more anti-vaxxers.”\u003c/p>\n\u003cp>Dr. Amesh Adalja, an infectious diseases physician and senior scholar at the Center for Health Security at Johns Hopkins Bloomberg School of Public Health, said any skepticism about the safety of vaccines risks feeding the concerns of parents who are worried about having their children vaccinated.\u003c/p>\n\u003cp>“The more the vaccine ‘debate’… is amplified it gains an undeserved sense of legitimacy and gives vaccine-hesitant individuals a pretense to forgo vaccination for themselves and their children,” said Adalja, who was harshly critical of the use of vaccinations in efforts to turn people against each other, calling it “overtly nihilistic.”\u003c/p>\n\u003cp>A spokesman for Twitter said that malicious accounts “are likely to target virtually any high profile conversation, since that’s where the views are.”\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>The spokesman, Ian Plunkett, told STAT that Twitter has aggressively ramped up preventive measures to try to keep such content from general users. In May, he noted, the platform identified and challenged nearly 10 million potentially automated accounts. “We put preemptive measures in place to ensure automated content is filtered from discoverable areas of the services — like trends and search. It’s possible that may users did not see this content before it was suspended,” Plunkett said.\u003c/p>\n\u003cp>Other experts, too, were unsurprised that Russian trolls and bots would delve into vaccines discussions, given the heat the topic can generate.\u003c/p>\n\u003cp>“Vaccination links to deep values around protection, health, harm, and the social contract,” said Julie Leask, an associate professor at the University of Sydney’s Susan Wakil School of Nursing and Midwifery who researches vaccine refusal. “People become highly invested in the discussion, and highly reactive to the notion that people refuse vaccines. The expression of sentiment at the margins — very pro- and very anti-vaccine — generates emotional energy and clicks.”\u003c/p>\n\u003cp>Adam Dunn, an associate professor in the Center for Health Informatics at Australia’s Macquarie University, said responding to this type of activity by internet bots and trolls would be challenging for public health authorities and may rely on the rooting out of the malicious accounts.\u003c/p>\n\u003cp>“The responsibility of managing the health of online conversations may … fall to Twitter itself, and work like this demonstrating the potential for real harm to human health provides a strong impetus for Twitter to act more often and more quickly to identify, isolate, or remove bots and trolls,” Dunn said.\u003c/p>\n\u003cp>Many of the accounts Broniatowski’s group studied have since been shut down, he said. But freeing the Twitter platform of bots and trolls is like playing whack-a-mole, he suggested.\u003c/p>\n\u003cp>For her part, Leask wasn’t certain how Twitter would have an outsized impact on vaccination decisions.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“When parents decide not to vaccinate, the decision isn’t usually taken lightly and a few tweets from bots are unlikely to change this trajectory,” she said. “The decision process is much more complex and centered on beliefs, experience and notions of what it means to be a ‘good parent’ held within that community. What we still need to establish is the relative role of social media independent of the influence of peer networks.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "For Cervical Cancer Screening, Women Over 30 Can Now Choose HPV Test Only",
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"content": "\u003cp>Federal health advisers say women can now consider three options when it's time for their cervical cancer screening tests. The influential group, the U.S. Preventive Services Task Force, has expanded its recommendations for this potentially lifesaving exam.\u003c/p>\n\u003cp>The new recommendations \u003ca href=\"http://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2018.10897\" target=\"_blank\" rel=\"noopener\">are published\u003c/a> in the latest issue of \u003cem>JAMA.\u003c/em>\u003c/p>\n\u003cp>\u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0022605/\" target=\"_blank\" rel=\"noopener\">Pap smears\u003c/a> have saved many lives since they became available decades ago. Inspecting samples of cervical tissue for precancerous changes is effective at catching possible cancer and is still the go-to test for women ages 21 to 29, according to the USPSTF guidelines.\u003c/p>\n\u003cp>But there's another option. \"Most cervical cancer is caused by what's called the human papillomavirus, or HPV,\" says \u003ca href=\"https://profiles.stanford.edu/douglas-owens\" target=\"_blank\" rel=\"noopener\">Dr. Douglas Owens\u003c/a>, a professor of medicine at Stanford University and vice chair of the USPSTF. \"And we now have tests for HPV and that's an important step forward.\"\u003c/p>\n\u003cp>These tests are available alone or in combination with the Pap test. And the USPSTF now says \u003ca href=\"https://www.npr.org/sections/health-shots/2018/07/03/625696664/for-women-over-30-there-may-be-a-better-choice-than-the-pap-smear\" target=\"_blank\" rel=\"noopener\">the evidence\u003c/a> is strong enough that HPV tests can be used by themselves, for women over 30. That third choice expands on the task force's previous recommendation, which was for the Pap test or the combination test.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>And while Pap tests should be repeated every three years, women can wait five years between HPV tests.\u003c/p>\n\u003cp>\"Five years is a good balance between the benefits and harms,\" Owens says. \"It's still highly effective at detecting cancer, and screening more frequently than that may increase some of the potential harms, so we think that's a good interval.\"\u003c/p>\n\u003cp>Potential harms of too frequent screening include unnecessary follow-ups such as biopsies. In a draft recommendation released last year, the task force had considered suggesting just two options, either the Pap smear or the HPV test, but its final recommendation included the hybrid test too.\u003c/p>\n\u003cp>\"The HPV test alone is not available everywhere,\" Owens explains. \"And so we want to be sure that women no matter where they're receiving care have options for cervical cancer screening.\"\u003c/p>\n\u003cp>He says the combination test is widely available, as is the Pap test, \"so all of those are good options and a woman can discuss with her physician what's available at the place where she's receiving care.\"\u003c/p>\n\u003cp>Women may not notice the difference between tests because tissue samples are all collected the same way. But \u003ca href=\"http://pressroom.cancer.org/debbiesaslow\" target=\"_blank\" rel=\"noopener\">Debbie Saslow\u003c/a>, senior director for HPV-related and women's cancers at the American Cancer Society, says if women have a choice, she would recommend the HPV test for women over 30.\u003c/p>\n\u003cp>\"I truly believe that including the HPV test, either along with the Pap or instead of the Pap, is superior than the Pap alone,\" she says. There's some evidence the HPV test is better than the Pap test at detecting a less common form of cervical cancer, adenocarcinoma, she says. \"So wouldn't you rather find the two most common cancers instead of just the one most common type?\"\u003c/p>\n\u003cp>The task force emphasizes that all three tests are highly effective. The overarching recommendation is simply that women should get screened, and to do so regularly until the age of 65. If screening has been adequate up to that point, the task force says women do not need further cervical cancer screening.\u003c/p>\n\u003cp>Health officials also recommend the HPV vaccine, which is given to girls and young women, up to age 26. (Boys and young men are encouraged to get the HPV vaccine as well.) But Owens says a vaccine alone doesn't replace cervical cancer screening.\u003c/p>\n\u003cp>\"Our recommendation applies to everyone whether you've been vaccinated or not,\" he says. \"It's very important that women do not forgo screening because they've been vaccinated.\"\u003c/p>\n\u003cp>An effective vaccine could ultimately render cervical cancer screening unnecessary, but that change will require careful study and could be years away.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>You can reach Richard Harris at \u003c/em>\u003ca href=\"mailto:rharris@npr.org\" target=\"_blank\" rel=\"noopener\">rharris@npr.org\u003c/a>.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=For+Cervical+Cancer+Screening%2C+Women+Over+30+Can+Now+Choose+The+HPV+Test+Only&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Federal health advisers say women can now consider three options when it's time for their cervical cancer screening tests. The influential group, the U.S. Preventive Services Task Force, has expanded its recommendations for this potentially lifesaving exam.\u003c/p>\n\u003cp>The new recommendations \u003ca href=\"http://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2018.10897\" target=\"_blank\" rel=\"noopener\">are published\u003c/a> in the latest issue of \u003cem>JAMA.\u003c/em>\u003c/p>\n\u003cp>\u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0022605/\" target=\"_blank\" rel=\"noopener\">Pap smears\u003c/a> have saved many lives since they became available decades ago. Inspecting samples of cervical tissue for precancerous changes is effective at catching possible cancer and is still the go-to test for women ages 21 to 29, according to the USPSTF guidelines.\u003c/p>\n\u003cp>But there's another option. \"Most cervical cancer is caused by what's called the human papillomavirus, or HPV,\" says \u003ca href=\"https://profiles.stanford.edu/douglas-owens\" target=\"_blank\" rel=\"noopener\">Dr. Douglas Owens\u003c/a>, a professor of medicine at Stanford University and vice chair of the USPSTF. \"And we now have tests for HPV and that's an important step forward.\"\u003c/p>\n\u003cp>These tests are available alone or in combination with the Pap test. And the USPSTF now says \u003ca href=\"https://www.npr.org/sections/health-shots/2018/07/03/625696664/for-women-over-30-there-may-be-a-better-choice-than-the-pap-smear\" target=\"_blank\" rel=\"noopener\">the evidence\u003c/a> is strong enough that HPV tests can be used by themselves, for women over 30. That third choice expands on the task force's previous recommendation, which was for the Pap test or the combination test.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>And while Pap tests should be repeated every three years, women can wait five years between HPV tests.\u003c/p>\n\u003cp>\"Five years is a good balance between the benefits and harms,\" Owens says. \"It's still highly effective at detecting cancer, and screening more frequently than that may increase some of the potential harms, so we think that's a good interval.\"\u003c/p>\n\u003cp>Potential harms of too frequent screening include unnecessary follow-ups such as biopsies. In a draft recommendation released last year, the task force had considered suggesting just two options, either the Pap smear or the HPV test, but its final recommendation included the hybrid test too.\u003c/p>\n\u003cp>\"The HPV test alone is not available everywhere,\" Owens explains. \"And so we want to be sure that women no matter where they're receiving care have options for cervical cancer screening.\"\u003c/p>\n\u003cp>He says the combination test is widely available, as is the Pap test, \"so all of those are good options and a woman can discuss with her physician what's available at the place where she's receiving care.\"\u003c/p>\n\u003cp>Women may not notice the difference between tests because tissue samples are all collected the same way. But \u003ca href=\"http://pressroom.cancer.org/debbiesaslow\" target=\"_blank\" rel=\"noopener\">Debbie Saslow\u003c/a>, senior director for HPV-related and women's cancers at the American Cancer Society, says if women have a choice, she would recommend the HPV test for women over 30.\u003c/p>\n\u003cp>\"I truly believe that including the HPV test, either along with the Pap or instead of the Pap, is superior than the Pap alone,\" she says. There's some evidence the HPV test is better than the Pap test at detecting a less common form of cervical cancer, adenocarcinoma, she says. \"So wouldn't you rather find the two most common cancers instead of just the one most common type?\"\u003c/p>\n\u003cp>The task force emphasizes that all three tests are highly effective. The overarching recommendation is simply that women should get screened, and to do so regularly until the age of 65. If screening has been adequate up to that point, the task force says women do not need further cervical cancer screening.\u003c/p>\n\u003cp>Health officials also recommend the HPV vaccine, which is given to girls and young women, up to age 26. (Boys and young men are encouraged to get the HPV vaccine as well.) But Owens says a vaccine alone doesn't replace cervical cancer screening.\u003c/p>\n\u003cp>\"Our recommendation applies to everyone whether you've been vaccinated or not,\" he says. \"It's very important that women do not forgo screening because they've been vaccinated.\"\u003c/p>\n\u003cp>An effective vaccine could ultimately render cervical cancer screening unnecessary, but that change will require careful study and could be years away.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>You can reach Richard Harris at \u003c/em>\u003ca href=\"mailto:rharris@npr.org\" target=\"_blank\" rel=\"noopener\">rharris@npr.org\u003c/a>.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=For+Cervical+Cancer+Screening%2C+Women+Over+30+Can+Now+Choose+The+HPV+Test+Only&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Did you know that there are more women living with HIV in the world than men? Or that young women and girls make up 60 percent of youth cases? If you didn’t, Loren Jones won’t be surprised. Many people in the U.S. still view HIV as a disease that impacts men – especially gay and bisexual men – far more than women.\u003c/p>\n\u003caside class=\"pullquote alignright\">'You know what? We need more women to be getting treatment and more women in clinical trials.'\u003ccite>Loren Jones\u003c/cite>\u003c/aside>\n\u003cp>“People don’t see women,” says Jones, who’s 65 and has had HIV for more than 30 years. “Even women often don’t see women. All of the attention has focused for so long on gay men.” She shrugs. “That really hasn’t changed that much.”\u003c/p>\n\u003cp>Jones is a friendly, outspoken woman who also fits the broad profile of women and girls most at risk for acquiring HIV in the U.S.: she’s heterosexual, African-American, has been homeless, and had boyfriends who did drugs. She’s also been a mother living in poverty.\u003c/p>\n\u003cp>“If you’d have told me when I was younger that I’d be here, doing what I do, I’d a told you no way,” says Jones. “But you know what? We need more women to be getting treatment and more women in clinical trials.”\u003c/p>\n\u003cp>Jones is a volunteer member of the \u003ca href=\"http://www.amfar.org/cure-research-institute/\" target=\"_blank\" rel=\"noopener\">amfAR Institute for HIV Cure Research\u003c/a>’s watchdog community advisory board, or CAB. Her role is to inform others about new cure studies, such as the UC San Francisco remission study starting this fall. Clinical trials, she knows from personal experience, are a great way to access HIV care.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“I was actually positive for 20 years before I took meds,” she says, “I got into treatment by joining a study.”\u003c/p>\n\u003cp>[contextly_sidebar id=\"OxLwEk6hcW75D0coV2Sp2m7d1a2cx02b\"]Jones was the second person in California to join the ongoing WIHS, or \u003ca href=\"https://statepi.jhsph.edu/wihs/wordpress/\" target=\"_blank\" rel=\"noopener\">Women’s Interagency HIV Study\u003c/a>, a pioneering observational study of HIV in US women. Back then, she’d lost weight and her immune T-cell count was way down – signs of HIV’s advance.\u003c/p>\n\u003cp>“I joined to help myself,” she says. “I had no money or insurance, and I got excellent care. Plus, I met others who helped educate me. It’s helped me survive.”\u003c/p>\n\u003cp>The care in a clinical trial is free, and participants were given a small stipend. Since then, Jones has remained on standard HIV therapy and is in good health, with an undetectable viral load.\u003c/p>\n\u003cp>In the trials, she also learned how few women participate in HIV drug studies and how African-Americans and Latinos are \u003ca href=\"https://www.researchgate.net/publication/7374843_Disparities_and_gaps_in_HIV_research_and_care\">historically underrepresented\u003c/a> in HIV trials. In 1994, 9 percent of HIV drug trial participants were women; a decade later, that number had doubled, but by 2011, it was still only 22 percent, according to \u003ca href=\"http://www.catie.ca/en/catienews/2015-10-05/women-found-under-represented-hiv-clinical-trials\">one Canadian study\u003c/a>. It also showed African-Americans and Latinos with HIV received suboptimal care compared with whites – another continuing trend -- and that clinical trials could help close the gap by providing top-level care.\u003c/p>\n\u003caside class=\"pullquote alignright\">'I can take what the scientists say and bring that back to the ghetto because, let me tell you, the scientists don’t know how to talk to people in my community.'\u003ccite>Loren Jones>\u003c/cite>\u003c/aside>\n\u003cp>WIHS studies have shed important light on how women may process HIV drugs differently than men. They’ve also shown how domestic violence, poverty, sexual abuse and racial inequity are major factors that put HIV in a woman’s path.\u003c/p>\n\u003cp>All three are elements of Jones’ HIV story, itself a testament to her grit and ability to survive.\u003c/p>\n\u003cp>Jones, who is gregarious and likes to laugh, was born in Philadelphia. She describes a very lonely childhood growing up in the care of strict Pentecostalist relatives, apart from her parents and five siblings. She loved books and liked school, until she was bussed to a mostly white school. “I took the ghetto bus to a middle-class neighborhood,” she says. “It was absolutely miserable.” Her isolation continued at Penn State, where she studied nursing, struggling to make ends meet.\u003c/p>\n\u003cp>[contextly_sidebar id=\"QxseLeDIn6vIF3w27GoVucGtwJOLzADj\"]That’s when her destiny shifted. While at Penn State, she was invited to dance in a strip bar. “I was a skinny little string bean; she jokes, “there was nothing to see. But the money was good.” After that, she grabbed her freedom. “I was 17, 18,” she recalls, “and California was a big mystery to me. People talked about diversity and freedom. I wanted that.” She hitchhiked to Oakland in seven days -- with seven dollars in her pocket. “I found Berkeley – there were people walking around blowing bubbles in clown suits on stilts.” She never looked back.\u003c/p>\n\u003cp>She didn’t see HIV coming either. Jones was still a church-going good girl, wide-eyed about the world. One day a handsome guy drove by on a motorcycle and she hopped on. “He was a wild child,” Jones recalls, laughing. They had a child but, too soon, her boyfriend took off. Jones relied on temp jobs, but with a toddler, it was too difficult. She fell into homelessness, lived in her car, then joined a tougher crowd. “This was the 80s; they were outlaws, not a violent gang, but tough enough,” she says of her circle. “We were drinking and drugging in the Oakland hills.”\u003c/p>\n\u003cp>One day she visited a health clinic where they offered the HIV test. She wasn’t prepared, but wasn’t totally surprised, to get a positive result. She told no one for two years. “It was very lonely,” she says. “Back then, if you tested positive, you were definitely gonna die; that was the message.”\u003c/p>\n\u003cp>Jones found her new community by accident in the early 1990s at a temp job when she picked up a newsletter from the Oakland-based \u003ca href=\"http://www.womenhiv.org/\" target=\"_blank\" rel=\"noopener\">Women Organized to Respond to Life Threatening Diseases\u003c/a>, or WORLD. It remains a leading platform for HIV-positive women in the Bay Area.\u003c/p>\n\u003cp>“I want women to know about what’s going on with cure research,” says Jones, explaining her newest focus. “We need our communities in here. We can’t just leave it up to the scientists. They need us.”\u003c/p>\n\u003cp>Jones says her role on the Community Advisory Board isn’t to recruit, but to let women know the studies that are available. But she’s very aware of hurdles standing in the way for women to participate – including poverty, health literacy and distrust of the medical profession.\u003c/p>\n\u003cp>“I overcome the obstacles by talking about my experience,” she says of her approach. “I may be college educated, but I ride the bus too.”\u003c/p>\n\u003cp>“I talk to women who are mostly my home girls; they are like me,” she adds. “They are black women with low income, who live in residential hotels, single income, who live with their mama – women who are really down to earth. We can relate.”\u003c/p>\n\u003cp>Jones says she’s learned in her journey that she doesn’t have to be a scientist to help others.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“I can take what the scientists say and bring that back to the ghetto, because, let me tell you, the scientists don’t know how to talk to people in my community. I’m comfortable in both worlds -- the scientific and the street. My message is: ‘We gotta find more ways to invite the community to be involved in this cure research.’ They need to get on board.”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Did you know that there are more women living with HIV in the world than men? Or that young women and girls make up 60 percent of youth cases? If you didn’t, Loren Jones won’t be surprised. Many people in the U.S. still view HIV as a disease that impacts men – especially gay and bisexual men – far more than women.\u003c/p>\n\u003caside class=\"pullquote alignright\">'You know what? We need more women to be getting treatment and more women in clinical trials.'\u003ccite>Loren Jones\u003c/cite>\u003c/aside>\n\u003cp>“People don’t see women,” says Jones, who’s 65 and has had HIV for more than 30 years. “Even women often don’t see women. All of the attention has focused for so long on gay men.” She shrugs. “That really hasn’t changed that much.”\u003c/p>\n\u003cp>Jones is a friendly, outspoken woman who also fits the broad profile of women and girls most at risk for acquiring HIV in the U.S.: she’s heterosexual, African-American, has been homeless, and had boyfriends who did drugs. She’s also been a mother living in poverty.\u003c/p>\n\u003cp>“If you’d have told me when I was younger that I’d be here, doing what I do, I’d a told you no way,” says Jones. “But you know what? We need more women to be getting treatment and more women in clinical trials.”\u003c/p>\n\u003cp>Jones is a volunteer member of the \u003ca href=\"http://www.amfar.org/cure-research-institute/\" target=\"_blank\" rel=\"noopener\">amfAR Institute for HIV Cure Research\u003c/a>’s watchdog community advisory board, or CAB. Her role is to inform others about new cure studies, such as the UC San Francisco remission study starting this fall. Clinical trials, she knows from personal experience, are a great way to access HIV care.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“I was actually positive for 20 years before I took meds,” she says, “I got into treatment by joining a study.”\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>Jones was the second person in California to join the ongoing WIHS, or \u003ca href=\"https://statepi.jhsph.edu/wihs/wordpress/\" target=\"_blank\" rel=\"noopener\">Women’s Interagency HIV Study\u003c/a>, a pioneering observational study of HIV in US women. Back then, she’d lost weight and her immune T-cell count was way down – signs of HIV’s advance.\u003c/p>\n\u003cp>“I joined to help myself,” she says. “I had no money or insurance, and I got excellent care. Plus, I met others who helped educate me. It’s helped me survive.”\u003c/p>\n\u003cp>The care in a clinical trial is free, and participants were given a small stipend. Since then, Jones has remained on standard HIV therapy and is in good health, with an undetectable viral load.\u003c/p>\n\u003cp>In the trials, she also learned how few women participate in HIV drug studies and how African-Americans and Latinos are \u003ca href=\"https://www.researchgate.net/publication/7374843_Disparities_and_gaps_in_HIV_research_and_care\">historically underrepresented\u003c/a> in HIV trials. In 1994, 9 percent of HIV drug trial participants were women; a decade later, that number had doubled, but by 2011, it was still only 22 percent, according to \u003ca href=\"http://www.catie.ca/en/catienews/2015-10-05/women-found-under-represented-hiv-clinical-trials\">one Canadian study\u003c/a>. It also showed African-Americans and Latinos with HIV received suboptimal care compared with whites – another continuing trend -- and that clinical trials could help close the gap by providing top-level care.\u003c/p>\n\u003caside class=\"pullquote alignright\">'I can take what the scientists say and bring that back to the ghetto because, let me tell you, the scientists don’t know how to talk to people in my community.'\u003ccite>Loren Jones>\u003c/cite>\u003c/aside>\n\u003cp>WIHS studies have shed important light on how women may process HIV drugs differently than men. They’ve also shown how domestic violence, poverty, sexual abuse and racial inequity are major factors that put HIV in a woman’s path.\u003c/p>\n\u003cp>All three are elements of Jones’ HIV story, itself a testament to her grit and ability to survive.\u003c/p>\n\u003cp>Jones, who is gregarious and likes to laugh, was born in Philadelphia. She describes a very lonely childhood growing up in the care of strict Pentecostalist relatives, apart from her parents and five siblings. She loved books and liked school, until she was bussed to a mostly white school. “I took the ghetto bus to a middle-class neighborhood,” she says. “It was absolutely miserable.” Her isolation continued at Penn State, where she studied nursing, struggling to make ends meet.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>That’s when her destiny shifted. While at Penn State, she was invited to dance in a strip bar. “I was a skinny little string bean; she jokes, “there was nothing to see. But the money was good.” After that, she grabbed her freedom. “I was 17, 18,” she recalls, “and California was a big mystery to me. People talked about diversity and freedom. I wanted that.” She hitchhiked to Oakland in seven days -- with seven dollars in her pocket. “I found Berkeley – there were people walking around blowing bubbles in clown suits on stilts.” She never looked back.\u003c/p>\n\u003cp>She didn’t see HIV coming either. Jones was still a church-going good girl, wide-eyed about the world. One day a handsome guy drove by on a motorcycle and she hopped on. “He was a wild child,” Jones recalls, laughing. They had a child but, too soon, her boyfriend took off. Jones relied on temp jobs, but with a toddler, it was too difficult. She fell into homelessness, lived in her car, then joined a tougher crowd. “This was the 80s; they were outlaws, not a violent gang, but tough enough,” she says of her circle. “We were drinking and drugging in the Oakland hills.”\u003c/p>\n\u003cp>One day she visited a health clinic where they offered the HIV test. She wasn’t prepared, but wasn’t totally surprised, to get a positive result. She told no one for two years. “It was very lonely,” she says. “Back then, if you tested positive, you were definitely gonna die; that was the message.”\u003c/p>\n\u003cp>Jones found her new community by accident in the early 1990s at a temp job when she picked up a newsletter from the Oakland-based \u003ca href=\"http://www.womenhiv.org/\" target=\"_blank\" rel=\"noopener\">Women Organized to Respond to Life Threatening Diseases\u003c/a>, or WORLD. It remains a leading platform for HIV-positive women in the Bay Area.\u003c/p>\n\u003cp>“I want women to know about what’s going on with cure research,” says Jones, explaining her newest focus. “We need our communities in here. We can’t just leave it up to the scientists. They need us.”\u003c/p>\n\u003cp>Jones says her role on the Community Advisory Board isn’t to recruit, but to let women know the studies that are available. But she’s very aware of hurdles standing in the way for women to participate – including poverty, health literacy and distrust of the medical profession.\u003c/p>\n\u003cp>“I overcome the obstacles by talking about my experience,” she says of her approach. “I may be college educated, but I ride the bus too.”\u003c/p>\n\u003cp>“I talk to women who are mostly my home girls; they are like me,” she adds. “They are black women with low income, who live in residential hotels, single income, who live with their mama – women who are really down to earth. We can relate.”\u003c/p>\n\u003cp>Jones says she’s learned in her journey that she doesn’t have to be a scientist to help others.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"disqusTitle": "‘No One Is Ever Really Ready’: Aid-In-Dying Patient Chooses His Last Day",
"title": "‘No One Is Ever Really Ready’: Aid-In-Dying Patient Chooses His Last Day",
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"content": "\u003cp>In the end, it wasn’t easy for Aaron McQ to decide when to die.\u003c/p>\n\u003cp>The 50-year-old Seattle man — a former world traveler, triathlete and cyclist — learned he had leukemia five years ago, followed by an even grimmer diagnosis in 2016: a rare form of amyotrophic lateral sclerosis, or ALS.\u003c/p>\n\u003cp>An interior and urban designer who legally changed his given name, McQ had been in pain and physical decline for years. Then the disease threatened to shut down his ability to swallow and breathe.\u003c/p>\n\u003cp>“It’s like waking up every morning in quicksand,” McQ said. “It’s terrifying.”\u003c/p>\n\u003cp>Last fall, McQ decided to use Washington state’s 2009 Death With Dignity law to end his suffering. The practice, approved in seven states and the District of Columbia, allows people with a projected six months or less to live to obtain lethal drugs to end their lives.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Although the option was legal, actually carrying it out was difficult for McQ, who agreed to discuss his deliberations with Kaiser Health News. He said he hoped to shed light on an often secretive and misunderstood practice.\u003c/p>\n\u003cp>“How does anyone get their head around dying?” he said, sitting in a wheelchair in his Seattle apartment in late January.\u003c/p>\n\u003cfigure id=\"attachment_443968\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003cimg class=\"size-large wp-image-443968\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/08/01-aaron-mcq-als_1350-1020x680.jpg\" alt=\"\" width=\"640\" height=\"427\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2018/08/01-aaron-mcq-als_1350-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/01-aaron-mcq-als_1350-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/01-aaron-mcq-als_1350-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/01-aaron-mcq-als_1350-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/01-aaron-mcq-als_1350-1200x800.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/01-aaron-mcq-als_1350-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/01-aaron-mcq-als_1350-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/01-aaron-mcq-als_1350-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/01-aaron-mcq-als_1350-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/01-aaron-mcq-als_1350-520x347.jpg 520w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/01-aaron-mcq-als_1350.jpg 1270w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003cfigcaption class=\"wp-caption-text\">Aaron McQ speaks during an interview in his Seattle apartment in January. “No one is ever really ready to die,” McQ said. “There will always be a reason not to.” \u003ccite>(Dan Delong/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>More than 3,000 people in the U.S. have chosen such deaths since Oregon’s law was enacted in 1997, according to state reports. Even as similar statutes have expanded to more venues — including, this year, \u003ca href=\"https://www.reuters.com/article/us-hawaii-dying/hawaii-lawmakers-approve-medical-aid-in-dying-for-terminally-ill-idUSKBN1H606J\" target=\"_blank\" rel=\"noopener\">Hawaii\u003c/a> — it has remained controversial.\u003c/p>\n\u003cp>California’s End of Life Option Act, which took effect in 2016, was suspended for three weeks this spring after a court challenge, leaving hundreds of dying patients \u003ca href=\"https://khn.org/news/suspension-of-californias-aid-in-dying-law-leaves-sick-patients-in-limbo/\" target=\"_blank\" rel=\"noopener\">briefly in limbo\u003c/a>.\u003c/p>\n\u003cp>Supporters say the practice gives patients control over their own fate in the face of a terminal illness. Detractors — including religious groups, disability rights advocates and \u003ca href=\"https://khn.org/news/as-doctors-drop-opposition-aid-in-dying-advocates-target-next-battleground-states/\" target=\"_blank\" rel=\"noopener\">some doctors\u003c/a> — argue that such laws could put pressure on vulnerable people and that proper palliative care can ease end-of-life suffering.\u003c/p>\n\u003cp>Thin and wan, with silver hair and piercing blue eyes, McQ still could have passed for the photographer’s model he once was. But McQ’s legs shook involuntarily beneath his dark jeans and his voice was hoarse with pain during a three-hour effort to tell his story.\u003c/p>\n\u003cp>Last November, doctors told McQ he had six months or less to live. The choice, he said, became not death over a healthy life, but a “certain outcome” now over a prolonged, painful — and “unknowable” — end.\u003c/p>\n\u003cp>“I’m not wanting to die,” he said. “I’m very much alive, yet I’m suffering. And I would rather have it not be a surprise.”\u003c/p>\n\u003cp>In late December, a friend picked up a prescription for 100 tablets of the powerful sedative secobarbital. For weeks, the bottle holding the lethal dose sat on a shelf in his kitchen.\u003c/p>\n\u003cp>“I was not relaxed or confident until I had it in my cupboard,” McQ said.\u003c/p>\n\u003cp>At the time, he intended to take the drug in late February. Or maybe mid-March. He had wanted to get past Christmas, so he didn’t ruin anyone’s holiday. Then his sister and her family came for a visit. Then there was a friend’s birthday and another friend’s wedding.\u003c/p>\n\u003cp>“No one is ever really ready to die,” McQ said. “There will always be a reason not to.”\u003c/p>\n\u003cdiv id=\"attachment_862690\" class=\"wp-caption alignnone\">\n\u003cfigure id=\"attachment_862690\" class=\"wp-caption alignnone\" style=\"max-width: 1024px\">\u003cimg class=\"wp-image-862690 size-full\" src=\"https://kaiserhealthnews.files.wordpress.com/2018/07/09-aaron-mcq-als_1350.jpg?w=1024&h=683\" alt=\"\" width=\"1024\" height=\"683\">\u003cfigcaption class=\"wp-caption-text\">In late December, a friend picked up Aaron McQ’s prescription for 100 tablets of the powerful sedative secobarbital. For weeks, the bottle holding the lethal dose sat on a shelf in his kitchen.(DAN DELONG FOR KHN)\u003c/figcaption>\u003c/figure>\n\u003c/div>\n\u003cp>Many people who opt for medical aid-in-dying are so sick that they take the drugs as soon as they can, impatiently enduring state-mandated waiting periods to obtain the prescriptions\u003c/p>\n\u003cp>Data from Oregon show that the median time from first request to death is 48 days, or about seven weeks. But it has ranged from two weeks to more than 2.7 years, records show.\u003c/p>\n\u003cp>Neurodegenerative diseases like ALS are particularly difficult, said Dr. Lonny Shavelson, a Berkeley, Calif., physician who has supervised nearly 90 aid-in-dying deaths in that state and advised more than 600 patients since 2016.\u003c/p>\n\u003cp>“It’s a very complicated decision week to week,” he said. “How do you decide? When do you decide? We don’t let them make that decision alone.”\u003c/p>\n\u003cp>Philosophically, McQ had been a supporter of aid-in-dying for years. He was the final caregiver for his grandmother, Milly, who he said begged for death to end pain at the end of her life.\u003c/p>\n\u003cp>By late spring, McQ’s own struggle was worse, said Karen Robinson, McQ’s health care proxy and friend of two decades. He was admitted to home hospice care, but continued to decline. When a nurse recommended that McQ transfer to a hospice facility to control his growing pain, he decided he’d rather die at home.\u003c/p>\n\u003cp>“There was part of him that was hoping there were some other alternative,” Robinson said.\u003c/p>\n\u003cp>McQ considered several dates — and then changed his mind, partly because of the pressure that such a choice imposed.\u003c/p>\n\u003cp>“I don’t want to talk about it because I don’t want to feel like, now you gotta,” he said.\u003c/p>\n\u003cp>Along with the pain, the risk of losing the physical ability to administer the medication himself, a legal requirement, was growing.\u003c/p>\n\u003cp>“I talked with him about losing his window of opportunity,” said Gretchen DeRoche, a volunteer with the group End of Life Washington, who said she has supervised hundreds of aid-in-dying deaths.\u003c/p>\n\u003cp>Finally, McQ chose the day: April 10. Robinson came over early in the afternoon, as she had often done, to drink coffee and talk — but not about his impending death.\u003c/p>\n\u003cp>“There was a part of him that didn’t want it to be like \u003cem>this is the day\u003c/em>,” she said.\u003c/p>\n\u003cp>DeRoche arrived exactly at 5:30 p.m., per McQ’s instructions. At 6 p.m., McQ took anti-nausea medication. Because the lethal drugs are so bitter, there is some chance patients won’t keep them down.\u003c/p>\n\u003cp>Four close friends gathered, along with Robinson. They sorted through McQ’s CDs, trying to find appropriate music.\u003c/p>\n\u003cp>“He put on Marianne Faithfull. She’s amazing, but, it was too much,” Robinson said. “Then he put on James Taylor for, like, 15 seconds. It was ‘You’ve Got a Friend.’ I vetoed that. I said, ‘Aaron, you cannot do that if you want us to hold it together.’”\u003c/p>\n\u003cp>DeRoche went into a bedroom to open the 100 capsules of 100-milligram secobarbital, one at a time, a tedious process. Then she mixed the drug with coconut water and some vodka.\u003c/p>\n\u003cp>Just then, McQ started to cry, DeRoche said. “I think he was just kind of mourning the loss of the life he had expected to live.”\u003c/p>\n\u003cp>After that, he said he was ready. McQ asked everyone but DeRoche to leave the room. She told him he could still change his mind.\u003c/p>\n\u003cp>“I said, as I do to everyone: ‘If you take this medication, you’re going to go to sleep and you are not going to wake up,’” she recalled.\u003c/p>\n\u003cp>McQ drank half the drug mixture, paused and drank water. Then he swallowed the rest.\u003c/p>\n\u003cp>His friends returned, but remained silent.\u003c/p>\n\u003cp>“They just all gathered around him, each one touching him,” DeRoche said.\u003c/p>\n\u003cp>Very quickly, just before 7:30 p.m., it was over.\u003c/p>\n\u003cp>“It was just like one fluid motion,” DeRoche said. “He drank the medication, he went to sleep and he died in six minutes. I think we were all a little surprised he was gone that fast.”\u003c/p>\n\u003cp>The friends stayed until a funeral home worker arrived.\u003c/p>\n\u003cp>“Once we got him into the vehicle, she asked, ‘What kind of music does he like?’” Robinson recalled. “It was just such a sweet, human thing for her to say. He was driving away, listening to jazz.”\u003c/p>\n\u003cp>McQ’s friends gathered June 30 in Seattle for a “happy memories celebration” of his life, Robinson said. She and a few others kayaked out into Lake Washington and left McQ’s ashes in the water, along with rose petals.\u003c/p>\n\u003cp>In the months since her friend’s death, Robinson has reflected on McQ’s decision to die. It was probably what he expected, she said, but not anything that he desired.\u003c/p>\n\u003cp>“It’s really tough to be alive and then not be alive because of your choice,” she said.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“If he had his wish, he would have died in his sleep.”\u003cem> \u003c/em>\u003c/p>\n\n",
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"excerpt": "Supporters say the practice gives patients control over their own fate while detractors argue that such laws could put pressure on vulnerable people and that proper palliative care can ease end-of-life suffering.",
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"description": "Supporters say the practice gives patients control over their own fate while detractors argue that such laws could put pressure on vulnerable people and that proper palliative care can ease end-of-life suffering.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>In the end, it wasn’t easy for Aaron McQ to decide when to die.\u003c/p>\n\u003cp>The 50-year-old Seattle man — a former world traveler, triathlete and cyclist — learned he had leukemia five years ago, followed by an even grimmer diagnosis in 2016: a rare form of amyotrophic lateral sclerosis, or ALS.\u003c/p>\n\u003cp>An interior and urban designer who legally changed his given name, McQ had been in pain and physical decline for years. Then the disease threatened to shut down his ability to swallow and breathe.\u003c/p>\n\u003cp>“It’s like waking up every morning in quicksand,” McQ said. “It’s terrifying.”\u003c/p>\n\u003cp>Last fall, McQ decided to use Washington state’s 2009 Death With Dignity law to end his suffering. The practice, approved in seven states and the District of Columbia, allows people with a projected six months or less to live to obtain lethal drugs to end their lives.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Although the option was legal, actually carrying it out was difficult for McQ, who agreed to discuss his deliberations with Kaiser Health News. He said he hoped to shed light on an often secretive and misunderstood practice.\u003c/p>\n\u003cp>“How does anyone get their head around dying?” he said, sitting in a wheelchair in his Seattle apartment in late January.\u003c/p>\n\u003cfigure id=\"attachment_443968\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003cimg class=\"size-large wp-image-443968\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/08/01-aaron-mcq-als_1350-1020x680.jpg\" alt=\"\" width=\"640\" height=\"427\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2018/08/01-aaron-mcq-als_1350-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/01-aaron-mcq-als_1350-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/01-aaron-mcq-als_1350-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/01-aaron-mcq-als_1350-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/01-aaron-mcq-als_1350-1200x800.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/01-aaron-mcq-als_1350-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/01-aaron-mcq-als_1350-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/01-aaron-mcq-als_1350-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/01-aaron-mcq-als_1350-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/01-aaron-mcq-als_1350-520x347.jpg 520w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/01-aaron-mcq-als_1350.jpg 1270w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003cfigcaption class=\"wp-caption-text\">Aaron McQ speaks during an interview in his Seattle apartment in January. “No one is ever really ready to die,” McQ said. “There will always be a reason not to.” \u003ccite>(Dan Delong/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>More than 3,000 people in the U.S. have chosen such deaths since Oregon’s law was enacted in 1997, according to state reports. Even as similar statutes have expanded to more venues — including, this year, \u003ca href=\"https://www.reuters.com/article/us-hawaii-dying/hawaii-lawmakers-approve-medical-aid-in-dying-for-terminally-ill-idUSKBN1H606J\" target=\"_blank\" rel=\"noopener\">Hawaii\u003c/a> — it has remained controversial.\u003c/p>\n\u003cp>California’s End of Life Option Act, which took effect in 2016, was suspended for three weeks this spring after a court challenge, leaving hundreds of dying patients \u003ca href=\"https://khn.org/news/suspension-of-californias-aid-in-dying-law-leaves-sick-patients-in-limbo/\" target=\"_blank\" rel=\"noopener\">briefly in limbo\u003c/a>.\u003c/p>\n\u003cp>Supporters say the practice gives patients control over their own fate in the face of a terminal illness. Detractors — including religious groups, disability rights advocates and \u003ca href=\"https://khn.org/news/as-doctors-drop-opposition-aid-in-dying-advocates-target-next-battleground-states/\" target=\"_blank\" rel=\"noopener\">some doctors\u003c/a> — argue that such laws could put pressure on vulnerable people and that proper palliative care can ease end-of-life suffering.\u003c/p>\n\u003cp>Thin and wan, with silver hair and piercing blue eyes, McQ still could have passed for the photographer’s model he once was. But McQ’s legs shook involuntarily beneath his dark jeans and his voice was hoarse with pain during a three-hour effort to tell his story.\u003c/p>\n\u003cp>Last November, doctors told McQ he had six months or less to live. The choice, he said, became not death over a healthy life, but a “certain outcome” now over a prolonged, painful — and “unknowable” — end.\u003c/p>\n\u003cp>“I’m not wanting to die,” he said. “I’m very much alive, yet I’m suffering. And I would rather have it not be a surprise.”\u003c/p>\n\u003cp>In late December, a friend picked up a prescription for 100 tablets of the powerful sedative secobarbital. For weeks, the bottle holding the lethal dose sat on a shelf in his kitchen.\u003c/p>\n\u003cp>“I was not relaxed or confident until I had it in my cupboard,” McQ said.\u003c/p>\n\u003cp>At the time, he intended to take the drug in late February. Or maybe mid-March. He had wanted to get past Christmas, so he didn’t ruin anyone’s holiday. Then his sister and her family came for a visit. Then there was a friend’s birthday and another friend’s wedding.\u003c/p>\n\u003cp>“No one is ever really ready to die,” McQ said. “There will always be a reason not to.”\u003c/p>\n\u003cdiv id=\"attachment_862690\" class=\"wp-caption alignnone\">\n\u003cfigure id=\"attachment_862690\" class=\"wp-caption alignnone\" style=\"max-width: 1024px\">\u003cimg class=\"wp-image-862690 size-full\" src=\"https://kaiserhealthnews.files.wordpress.com/2018/07/09-aaron-mcq-als_1350.jpg?w=1024&h=683\" alt=\"\" width=\"1024\" height=\"683\">\u003cfigcaption class=\"wp-caption-text\">In late December, a friend picked up Aaron McQ’s prescription for 100 tablets of the powerful sedative secobarbital. For weeks, the bottle holding the lethal dose sat on a shelf in his kitchen.(DAN DELONG FOR KHN)\u003c/figcaption>\u003c/figure>\n\u003c/div>\n\u003cp>Many people who opt for medical aid-in-dying are so sick that they take the drugs as soon as they can, impatiently enduring state-mandated waiting periods to obtain the prescriptions\u003c/p>\n\u003cp>Data from Oregon show that the median time from first request to death is 48 days, or about seven weeks. But it has ranged from two weeks to more than 2.7 years, records show.\u003c/p>\n\u003cp>Neurodegenerative diseases like ALS are particularly difficult, said Dr. Lonny Shavelson, a Berkeley, Calif., physician who has supervised nearly 90 aid-in-dying deaths in that state and advised more than 600 patients since 2016.\u003c/p>\n\u003cp>“It’s a very complicated decision week to week,” he said. “How do you decide? When do you decide? We don’t let them make that decision alone.”\u003c/p>\n\u003cp>Philosophically, McQ had been a supporter of aid-in-dying for years. He was the final caregiver for his grandmother, Milly, who he said begged for death to end pain at the end of her life.\u003c/p>\n\u003cp>By late spring, McQ’s own struggle was worse, said Karen Robinson, McQ’s health care proxy and friend of two decades. He was admitted to home hospice care, but continued to decline. When a nurse recommended that McQ transfer to a hospice facility to control his growing pain, he decided he’d rather die at home.\u003c/p>\n\u003cp>“There was part of him that was hoping there were some other alternative,” Robinson said.\u003c/p>\n\u003cp>McQ considered several dates — and then changed his mind, partly because of the pressure that such a choice imposed.\u003c/p>\n\u003cp>“I don’t want to talk about it because I don’t want to feel like, now you gotta,” he said.\u003c/p>\n\u003cp>Along with the pain, the risk of losing the physical ability to administer the medication himself, a legal requirement, was growing.\u003c/p>\n\u003cp>“I talked with him about losing his window of opportunity,” said Gretchen DeRoche, a volunteer with the group End of Life Washington, who said she has supervised hundreds of aid-in-dying deaths.\u003c/p>\n\u003cp>Finally, McQ chose the day: April 10. Robinson came over early in the afternoon, as she had often done, to drink coffee and talk — but not about his impending death.\u003c/p>\n\u003cp>“There was a part of him that didn’t want it to be like \u003cem>this is the day\u003c/em>,” she said.\u003c/p>\n\u003cp>DeRoche arrived exactly at 5:30 p.m., per McQ’s instructions. At 6 p.m., McQ took anti-nausea medication. Because the lethal drugs are so bitter, there is some chance patients won’t keep them down.\u003c/p>\n\u003cp>Four close friends gathered, along with Robinson. They sorted through McQ’s CDs, trying to find appropriate music.\u003c/p>\n\u003cp>“He put on Marianne Faithfull. She’s amazing, but, it was too much,” Robinson said. “Then he put on James Taylor for, like, 15 seconds. It was ‘You’ve Got a Friend.’ I vetoed that. I said, ‘Aaron, you cannot do that if you want us to hold it together.’”\u003c/p>\n\u003cp>DeRoche went into a bedroom to open the 100 capsules of 100-milligram secobarbital, one at a time, a tedious process. Then she mixed the drug with coconut water and some vodka.\u003c/p>\n\u003cp>Just then, McQ started to cry, DeRoche said. “I think he was just kind of mourning the loss of the life he had expected to live.”\u003c/p>\n\u003cp>After that, he said he was ready. McQ asked everyone but DeRoche to leave the room. She told him he could still change his mind.\u003c/p>\n\u003cp>“I said, as I do to everyone: ‘If you take this medication, you’re going to go to sleep and you are not going to wake up,’” she recalled.\u003c/p>\n\u003cp>McQ drank half the drug mixture, paused and drank water. Then he swallowed the rest.\u003c/p>\n\u003cp>His friends returned, but remained silent.\u003c/p>\n\u003cp>“They just all gathered around him, each one touching him,” DeRoche said.\u003c/p>\n\u003cp>Very quickly, just before 7:30 p.m., it was over.\u003c/p>\n\u003cp>“It was just like one fluid motion,” DeRoche said. “He drank the medication, he went to sleep and he died in six minutes. I think we were all a little surprised he was gone that fast.”\u003c/p>\n\u003cp>The friends stayed until a funeral home worker arrived.\u003c/p>\n\u003cp>“Once we got him into the vehicle, she asked, ‘What kind of music does he like?’” Robinson recalled. “It was just such a sweet, human thing for her to say. He was driving away, listening to jazz.”\u003c/p>\n\u003cp>McQ’s friends gathered June 30 in Seattle for a “happy memories celebration” of his life, Robinson said. She and a few others kayaked out into Lake Washington and left McQ’s ashes in the water, along with rose petals.\u003c/p>\n\u003cp>In the months since her friend’s death, Robinson has reflected on McQ’s decision to die. It was probably what he expected, she said, but not anything that he desired.\u003c/p>\n\u003cp>“It’s really tough to be alive and then not be alive because of your choice,” she said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"rss": "https://podcasts.files.bbci.co.uk/p02nq0gn.rss"
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},
"californiareport": {
"id": "californiareport",
"title": "The California Report",
"tagline": "California, day by day",
"info": "KQED’s statewide radio news program providing daily coverage of issues, trends and public policy decisions.",
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"officialWebsiteLink": "/californiareport",
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"order": 8
},
"link": "/californiareport",
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}
},
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"id": "californiareportmagazine",
"title": "The California Report Magazine",
"tagline": "Your state, your stories",
"info": "Every week, The California Report Magazine takes you on a road trip for the ears: to visit the places and meet the people who make California unique. The in-depth storytelling podcast from the California Report.",
"airtime": "FRI 4:30pm-5pm, 6:30pm-7pm, 11pm-11:30pm",
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"officialWebsiteLink": "/californiareportmagazine",
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"order": 10
},
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM3NjkwNjk1OTAz",
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},
"city-arts": {
"id": "city-arts",
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"info": "A one-hour radio program to hear celebrated writers, artists and thinkers address contemporary ideas and values, often discussing the creative process. Please note: tapes or transcripts are not available",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/05/cityartsandlecture-300x300.jpg",
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"airtime": "SUN 1pm-2pm, TUE 10pm, WED 1am",
"meta": {
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"source": "City Arts & Lectures"
},
"link": "https://www.cityarts.net",
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"rss": "https://www.cityarts.net/feed/"
}
},
"closealltabs": {
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"order": 1
},
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"title": "Code Switch / Life Kit",
"info": "\u003cem>Code Switch\u003c/em>, which listeners will hear in the first part of the hour, has fearless and much-needed conversations about race. Hosted by journalists of color, the show tackles the subject of race head-on, exploring how it impacts every part of society — from politics and pop culture to history, sports and more.\u003cbr />\u003cbr />\u003cem>Life Kit\u003c/em>, which will be in the second part of the hour, guides you through spaces and feelings no one prepares you for — from finances to mental health, from workplace microaggressions to imposter syndrome, from relationships to parenting. The show features experts with real world experience and shares their knowledge. Because everyone needs a little help being human.\u003cbr />\u003cbr />\u003ca href=\"https://www.npr.org/podcasts/510312/codeswitch\">\u003cem>Code Switch\u003c/em> offical site and podcast\u003c/a>\u003cbr />\u003ca href=\"https://www.npr.org/lifekit\">\u003cem>Life Kit\u003c/em> offical site and podcast\u003c/a>\u003cbr />",
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"id": "commonwealth-club",
"title": "Commonwealth Club of California Podcast",
"info": "The Commonwealth Club of California is the nation's oldest and largest public affairs forum. As a non-partisan forum, The Club brings to the public airwaves diverse viewpoints on important topics. The Club's weekly radio broadcast - the oldest in the U.S., dating back to 1924 - is carried across the nation on public radio stations and is now podcasting. Our website archive features audio of our recent programs, as well as selected speeches from our long and distinguished history. This podcast feed is usually updated twice a week and is always un-edited.",
"airtime": "THU 10pm, FRI 1am",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Commonwealth-Club-Podcast-Tile-360x360-1.jpg",
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"meta": {
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"source": "Commonwealth Club of California"
},
"link": "/radio/program/commonwealth-club",
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"google": "https://podcasts.google.com/feed/aHR0cDovL3d3dy5jb21tb253ZWFsdGhjbHViLm9yZy9hdWRpby9wb2RjYXN0L3dlZWtseS54bWw",
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},
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"id": "forum",
"title": "Forum",
"tagline": "The conversation starts here",
"info": "KQED’s live call-in program discussing local, state, national and international issues, as well as in-depth interviews.",
"airtime": "MON-FRI 9am-11am, 10pm-11pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Forum-Podcast-Tile-703x703-1.jpg",
"imageAlt": "KQED Forum with Mina Kim and Alexis Madrigal",
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"source": "kqed",
"order": 9
},
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM5NTU3MzgxNjMz",
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"imageSrc": "https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/05/freakonomicsRadio.png",
"officialWebsiteLink": "http://freakonomics.com/",
"airtime": "SUN 1am-2am, SAT 3pm-4pm",
"meta": {
"site": "radio",
"source": "WNYC"
},
"link": "/radio/program/freakonomics-radio",
"subscribe": {
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"apple": "https://itunes.apple.com/us/podcast/freakonomics-radio/id354668519",
"tuneIn": "https://tunein.com/podcasts/WNYC-Podcasts/Freakonomics-Radio-p272293/",
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},
"fresh-air": {
"id": "fresh-air",
"title": "Fresh Air",
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"apple": "https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=214089682&at=11l79Y&ct=nprdirectory",
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"here-and-now": {
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"info": "A live production of NPR and WBUR Boston, in collaboration with stations across the country, Here & Now reflects the fluid world of news as it's happening in the middle of the day, with timely, in-depth news, interviews and conversation. Hosted by Robin Young, Jeremy Hobson and Tonya Mosley.",
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"rss": "https://feeds.npr.org/510051/podcast.xml"
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},
"hidden-brain": {
"id": "hidden-brain",
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"info": "Shankar Vedantam uses science and storytelling to reveal the unconscious patterns that drive human behavior, shape our choices and direct our relationships.",
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"airtime": "SUN 7pm-8pm",
"meta": {
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"source": "NPR"
},
"link": "/radio/program/hidden-brain",
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},
"how-i-built-this": {
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"title": "How I Built This with Guy Raz",
"info": "Guy Raz dives into the stories behind some of the world's best known companies. How I Built This weaves a narrative journey about innovators, entrepreneurs and idealists—and the movements they built.",
"imageSrc": "https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/05/howIBuiltThis.png",
"officialWebsiteLink": "https://www.npr.org/podcasts/510313/how-i-built-this",
"airtime": "SUN 7:30pm-8pm",
"meta": {
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"source": "npr"
},
"link": "/radio/program/how-i-built-this",
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"npr": "https://rpb3r.app.goo.gl/3zxy",
"apple": "https://itunes.apple.com/us/podcast/how-i-built-this-with-guy-raz/id1150510297?mt=2",
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},
"hyphenacion": {
"id": "hyphenacion",
"title": "Hyphenación",
"tagline": "Where conversation and cultura meet",
"info": "What kind of no sabo word is Hyphenación? For us, it’s about living within a hyphenation. Like being a third-gen Mexican-American from the Texas border now living that Bay Area Chicano life. Like Xorje! Each week we bring together a couple of hyphenated Latinos to talk all about personal life choices: family, careers, relationships, belonging … everything is on the table. ",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2025/03/Hyphenacion_FinalAssets_PodcastTile.png",
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"officialWebsiteLink": "/podcasts/hyphenacion",
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"order": 15
},
"link": "/podcasts/hyphenacion",
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},
"jerrybrown": {
"id": "jerrybrown",
"title": "The Political Mind of Jerry Brown",
"tagline": "Lessons from a lifetime in politics",
"info": "The Political Mind of Jerry Brown brings listeners the wisdom of the former Governor, Mayor, and presidential candidate. Scott Shafer interviewed Brown for more than 40 hours, covering the former governor's life and half-century in the political game – and Brown has some lessons he'd like to share. ",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/The-Political-Mind-of-Jerry-Brown-Podcast-Tile-703x703-1.jpg",
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"officialWebsiteLink": "/podcasts/jerrybrown",
"meta": {
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"order": 18
},
"link": "/podcasts/jerrybrown",
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"apple": "https://itunes.apple.com/us/podcast/id1492194549",
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}
},
"latino-usa": {
"id": "latino-usa",
"title": "Latino USA",
"airtime": "MON 1am-2am, SUN 6pm-7pm",
"info": "Latino USA, the radio journal of news and culture, is the only national, English-language radio program produced from a Latino perspective.",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/latinoUsa.jpg",
"officialWebsiteLink": "http://latinousa.org/",
"meta": {
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},
"link": "/radio/program/latino-usa",
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"apple": "https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=79681317&at=11l79Y&ct=nprdirectory",
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"rss": "https://feeds.npr.org/510016/podcast.xml"
}
},
"marketplace": {
"id": "marketplace",
"title": "Marketplace",
"info": "Our flagship program, helmed by Kai Ryssdal, examines what the day in money delivered, through stories, conversations, newsworthy numbers and more. Updated Monday through Friday at about 3:30 p.m. PT.",
"airtime": "MON-FRI 4pm-4:30pm, MON-WED 6:30pm-7pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Marketplace-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.marketplace.org/",
"meta": {
"site": "news",
"source": "American Public Media"
},
"link": "/radio/program/marketplace",
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"rss": "https://feeds.publicradio.org/public_feeds/marketplace-pm/rss/rss"
}
},
"masters-of-scale": {
"id": "masters-of-scale",
"title": "Masters of Scale",
"info": "Masters of Scale is an original podcast in which LinkedIn co-founder and Greylock Partner Reid Hoffman sets out to describe and prove theories that explain how great entrepreneurs take their companies from zero to a gazillion in ingenious fashion.",
"airtime": "Every other Wednesday June 12 through October 16 at 8pm (repeats Thursdays at 2am)",
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"officialWebsiteLink": "https://mastersofscale.com/",
"meta": {
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"source": "WaitWhat"
},
"link": "/radio/program/masters-of-scale",
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"rss": "https://rss.art19.com/masters-of-scale"
}
},
"mindshift": {
"id": "mindshift",
"title": "MindShift",
"tagline": "A podcast about the future of learning and how we raise our kids",
"info": "The MindShift podcast explores the innovations in education that are shaping how kids learn. Hosts Ki Sung and Katrina Schwartz introduce listeners to educators, researchers, parents and students who are developing effective ways to improve how kids learn. We cover topics like how fed-up administrators are developing surprising tactics to deal with classroom disruptions; how listening to podcasts are helping kids develop reading skills; the consequences of overparenting; and why interdisciplinary learning can engage students on all ends of the traditional achievement spectrum. This podcast is part of the MindShift education site, a division of KQED News. KQED is an NPR/PBS member station based in San Francisco. You can also visit the MindShift website for episodes and supplemental blog posts or tweet us \u003ca href=\"https://twitter.com/MindShiftKQED\">@MindShiftKQED\u003c/a> or visit us at \u003ca href=\"/mindshift\">MindShift.KQED.org\u003c/a>",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Mindshift-Podcast-Tile-703x703-1.jpg",
"imageAlt": "KQED MindShift: How We Will Learn",
"officialWebsiteLink": "/mindshift/",
"meta": {
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"source": "kqed",
"order": 12
},
"link": "/podcasts/mindshift",
"subscribe": {
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM1NzY0NjAwNDI5",
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"stitcher": "https://www.stitcher.com/podcast/kqed/stories-teachers-share",
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}
},
"morning-edition": {
"id": "morning-edition",
"title": "Morning Edition",
"info": "\u003cem>Morning Edition\u003c/em> takes listeners around the country and the world with multi-faceted stories and commentaries every weekday. Hosts Steve Inskeep, David Greene and Rachel Martin bring you the latest breaking news and features to prepare you for the day.",
"airtime": "MON-FRI 3am-9am",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Morning-Edition-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.npr.org/programs/morning-edition/",
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"link": "/radio/program/morning-edition"
},
"onourwatch": {
"id": "onourwatch",
"title": "On Our Watch",
"tagline": "Deeply-reported investigative journalism",
"info": "For decades, the process for how police police themselves has been inconsistent – if not opaque. In some states, like California, these proceedings were completely hidden. After a new police transparency law unsealed scores of internal affairs files, our reporters set out to examine these cases and the shadow world of police discipline. On Our Watch brings listeners into the rooms where officers are questioned and witnesses are interrogated to find out who this system is really protecting. Is it the officers, or the public they've sworn to serve?",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/On-Our-Watch-Podcast-Tile-703x703-1.jpg",
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"officialWebsiteLink": "/podcasts/onourwatch",
"meta": {
"site": "news",
"source": "kqed",
"order": 11
},
"link": "/podcasts/onourwatch",
"subscribe": {
"apple": "https://podcasts.apple.com/podcast/id1567098962",
"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5ucHIub3JnLzUxMDM2MC9wb2RjYXN0LnhtbD9zYz1nb29nbGVwb2RjYXN0cw",
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"stitcher": "https://www.stitcher.com/show/on-our-watch",
"rss": "https://feeds.npr.org/510360/podcast.xml"
}
},
"on-the-media": {
"id": "on-the-media",
"title": "On The Media",
"info": "Our weekly podcast explores how the media 'sausage' is made, casts an incisive eye on fluctuations in the marketplace of ideas, and examines threats to the freedom of information and expression in America and abroad. For one hour a week, the show tries to lift the veil from the process of \"making media,\" especially news media, because it's through that lens that we see the world and the world sees us",
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"info": "One of public radio's most dynamic voices, Sam Sanders helped launch The NPR Politics Podcast and hosted NPR's hit show It's Been A Minute. Now, the award-winning host returns with something brand new, The Sam Sanders Show. Every week, Sam Sanders and friends dig into the culture that shapes our lives: what's driving the biggest trends, how artists really think, and even the memes you can't stop scrolling past. Sam is beloved for his way of unpacking the world and bringing you up close to fresh currents and engaging conversations. The Sam Sanders Show is smart, funny and always a good time.",
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