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"content": "\u003cp>Biomedical research and public health are among the big losers in the Trump administration's proposed budget.\u003c/p>\n\u003cp>The \u003ca href=\"http://www.npr.org/2017/03/16/520379061/read-president-trumps-budget-blueprint\">proposal\u003c/a> promises:\u003c/p>\n\u003cul>\n\u003cli>A \"major reorganization\" in the National Institutes of Health, which supports most of the nation's research on diseases and treatments. That includes a cut of $5.8 billion, about 20 percent of NIH's $30 billion budget.\u003c/li>\n\u003cli>\"Reform\" of funding for the Centers for Disease and Prevention, which works to prevent, monitor and combat disease outbreaks. The budget mentions a $500 million block grant to states.\u003c/li>\n\u003cli>An additional $500 million for the Department of Health and Human Services to \"expand opioid misuse prevention efforts and to increase access to treatment and recovery services to help Americans who are misusing opioids get the help they need.\"\u003c/li>\n\u003cli>Investment in \"mental health activities that are awarded to high-performing entities and focus on high priority areas, such as suicide prevention, serious mental illness, and children's mental health.\" No specifics are provided.\u003c/li>\n\u003c/ul>\n\u003cp>Funding from the National Institutes of Health flows to more than 2,600 institutions around the country and creates more than 313,000 full- and part-time jobs, according to a \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4750411/\">2016 study\u003c/a>. So it's not obvious how slashing billions from the NIH budget, as the Trump administration proposes, will bring more jobs to America.\u003c/p>\n\u003cp>That $5.8 billion cut represents a 20 percent reduction in the NIH budget, which is about $30 billion. The federal government hands out most of this funding rather than spending it on its own employees, but the budget proposal is not clear on how much of the spending cuts target grants to university scientists.\u003c/p>\n\u003cp>Federal research grant money flows primarily to universities, and they in turn spend billions to buy equipment and services from local companies. Economist Bruce Weinberg and colleagues at Ohio State University \u003ca href=\"http://science.sciencemag.org/content/344/6179/41.full\">looked at\u003c/a> what happened to federal research dollars that flowed to nine major Midwestern universities.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>In 2012, these nine institutions received about $7 billion for research, more than half of which came from the NIH, the National Science Foundation and other funding agencies. Of that, the universities spent almost $1 billion on goods and services from U.S. vendors and subcontractors, the study found.\u003c/p>\n\u003cp>Of that, 16 percent went to vendors in the university's home county, over 16 percent was spent elsewhere in the state, and the balance was spread to companies across the United States.\u003c/p>\n\u003cp>University researchers buy chemicals and other ingredients needed for experiments and purchase laboratory equipment. There are entire industries devoted to supporting biomedical research.\u003c/p>\n\u003cp>\"We were surprised by how many were small, niche high-technology companies,\" Weinberg and his colleagues wrote.\u003c/p>\n\u003cp>\"Of course, science funding is not primarily a jobs or economic stimulus program,\" they added. After all, research is a long-term investment in knowledge and the driving force for economic growth.\u003c/p>\n\u003cp>The budget proposal doesn't include a specific funding figure for the Centers for Disease Control and Prevention, which had a budget of $7 billion in 2016. But the proposed budget says it \"reforms\" the CDC through a new $500 million block grant that would \"increase state flexibility and focus on the leading public health challenges to each state.\"\u003c/p>\n\u003cp>No additional details are included, but that could mean diverting those funds from the CDC's core budget to provide block grants to individual states.\u003c/p>\n\u003cp>\"We are encouraged to see that state health agency priorities, such as flexible funding to meet state and territorial public health needs and the public health Emergency Fund, are in the President's Budget,\" said Michael Fraser, executive director of the \u003ca href=\"http://www.astho.org/\">Association of State and Territorial Health Officials\u003c/a>, in an email.\u003c/p>\n\u003cp>\"Those are things we really do want to see,\" Fraser continued. \"However, the fact is that support for those priorities comes at what looks like a very significant cost to existing programs. The proposed reductions to HHS may have serious negative impacts on both federal and state responses to public health needs and that leaves many of us extremely concerned.\"\u003c/p>\n\u003cp>The budget also calls for the creation of a new \"Federal Emergency Response Fund\" that would be designed to \"rapidly respond to public health outbreaks,\" such as Zika. This is an idea that has been gaining support recently, especially in the wake of the Ebola outbreak in West Africa and the emergence of Zika as a threat to pregnant women and their babies.\u003c/p>\n\u003cp>President Obama's emergency funding request to respond to Zika got mired in politics in Congress. The budget doesn't specify how big this new fund would be.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The proposed budget is silent on the National Science Foundation, which provides about $7 billion a year in grants to researchers in many fields.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Trump+Administration+Proposes+Big+Cuts+In+Medical+Research&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Biomedical research and public health are among the big losers in the Trump administration's proposed budget.\u003c/p>\n\u003cp>The \u003ca href=\"http://www.npr.org/2017/03/16/520379061/read-president-trumps-budget-blueprint\">proposal\u003c/a> promises:\u003c/p>\n\u003cul>\n\u003cli>A \"major reorganization\" in the National Institutes of Health, which supports most of the nation's research on diseases and treatments. That includes a cut of $5.8 billion, about 20 percent of NIH's $30 billion budget.\u003c/li>\n\u003cli>\"Reform\" of funding for the Centers for Disease and Prevention, which works to prevent, monitor and combat disease outbreaks. The budget mentions a $500 million block grant to states.\u003c/li>\n\u003cli>An additional $500 million for the Department of Health and Human Services to \"expand opioid misuse prevention efforts and to increase access to treatment and recovery services to help Americans who are misusing opioids get the help they need.\"\u003c/li>\n\u003cli>Investment in \"mental health activities that are awarded to high-performing entities and focus on high priority areas, such as suicide prevention, serious mental illness, and children's mental health.\" No specifics are provided.\u003c/li>\n\u003c/ul>\n\u003cp>Funding from the National Institutes of Health flows to more than 2,600 institutions around the country and creates more than 313,000 full- and part-time jobs, according to a \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4750411/\">2016 study\u003c/a>. So it's not obvious how slashing billions from the NIH budget, as the Trump administration proposes, will bring more jobs to America.\u003c/p>\n\u003cp>That $5.8 billion cut represents a 20 percent reduction in the NIH budget, which is about $30 billion. The federal government hands out most of this funding rather than spending it on its own employees, but the budget proposal is not clear on how much of the spending cuts target grants to university scientists.\u003c/p>\n\u003cp>Federal research grant money flows primarily to universities, and they in turn spend billions to buy equipment and services from local companies. Economist Bruce Weinberg and colleagues at Ohio State University \u003ca href=\"http://science.sciencemag.org/content/344/6179/41.full\">looked at\u003c/a> what happened to federal research dollars that flowed to nine major Midwestern universities.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>In 2012, these nine institutions received about $7 billion for research, more than half of which came from the NIH, the National Science Foundation and other funding agencies. Of that, the universities spent almost $1 billion on goods and services from U.S. vendors and subcontractors, the study found.\u003c/p>\n\u003cp>Of that, 16 percent went to vendors in the university's home county, over 16 percent was spent elsewhere in the state, and the balance was spread to companies across the United States.\u003c/p>\n\u003cp>University researchers buy chemicals and other ingredients needed for experiments and purchase laboratory equipment. There are entire industries devoted to supporting biomedical research.\u003c/p>\n\u003cp>\"We were surprised by how many were small, niche high-technology companies,\" Weinberg and his colleagues wrote.\u003c/p>\n\u003cp>\"Of course, science funding is not primarily a jobs or economic stimulus program,\" they added. After all, research is a long-term investment in knowledge and the driving force for economic growth.\u003c/p>\n\u003cp>The budget proposal doesn't include a specific funding figure for the Centers for Disease Control and Prevention, which had a budget of $7 billion in 2016. But the proposed budget says it \"reforms\" the CDC through a new $500 million block grant that would \"increase state flexibility and focus on the leading public health challenges to each state.\"\u003c/p>\n\u003cp>No additional details are included, but that could mean diverting those funds from the CDC's core budget to provide block grants to individual states.\u003c/p>\n\u003cp>\"We are encouraged to see that state health agency priorities, such as flexible funding to meet state and territorial public health needs and the public health Emergency Fund, are in the President's Budget,\" said Michael Fraser, executive director of the \u003ca href=\"http://www.astho.org/\">Association of State and Territorial Health Officials\u003c/a>, in an email.\u003c/p>\n\u003cp>\"Those are things we really do want to see,\" Fraser continued. \"However, the fact is that support for those priorities comes at what looks like a very significant cost to existing programs. The proposed reductions to HHS may have serious negative impacts on both federal and state responses to public health needs and that leaves many of us extremely concerned.\"\u003c/p>\n\u003cp>The budget also calls for the creation of a new \"Federal Emergency Response Fund\" that would be designed to \"rapidly respond to public health outbreaks,\" such as Zika. This is an idea that has been gaining support recently, especially in the wake of the Ebola outbreak in West Africa and the emergence of Zika as a threat to pregnant women and their babies.\u003c/p>\n\u003cp>President Obama's emergency funding request to respond to Zika got mired in politics in Congress. The budget doesn't specify how big this new fund would be.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The proposed budget is silent on the National Science Foundation, which provides about $7 billion a year in grants to researchers in many fields.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Trump+Administration+Proposes+Big+Cuts+In+Medical+Research&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "A New Diagnosis: ‘Post-Election Stress Disorder’",
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"content": "\u003cp>Wally Pfingsten has always been a news junkie. But since President Donald Trump was elected, he’s been so anxious about the political tumult that even just having the TV news on in the background at home is unbearable.\u003c/p>\n\u003cp>“It’s been crippling,” said the 35-year-old San Mateo resident and political moderate who has supported both Democratic and Republican candidates in the past. “I feel angry, really, really angry, far more angry than I expected to be.”\u003c/p>\n\u003cp>He’s tried hard to quell his anxiety. First, he shut down his Facebook page to limit his exposure to the daily soaking of news from Washington. But not knowing the goings-on made him anxious, too. He found himself sneaking onto the Facebook account he made for his dog. “I felt like I was cheating,” he said.\u003c/p>\n\u003cp>Pfingsten is not alone in his politics-induced anxiety — it’s so common it’s been given an unofficial name: Post-Election Stress Disorder. Mental health professionals around the country, especially those working in Democratic strongholds, report a stream of patients coming in with anxiety and depression related to — or worsened by — the blast of daily news on the new administration.\u003c/p>\n\u003cp>In the past, therapists say it’s been fairly uncommon for patients to bring up politics on the couch. “It is big money to talk about politics with me ― that is not what we do!” said Maria Lymberis, a psychiatrist in Santa Monica.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>But that was before “fake news,” “alternative facts,” “repeal and replace,” contested confirmations, travel bans, protests and suits over travel bans, suspicions about Russian influence and the departures of the acting attorney general and the new national security adviser. Among other things.\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/312550437\" params=\"color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" iframe=\"true\" /]\u003c/p>\n\u003cp>Requests for therapy appointments to Talkspace, an online therapy portal based in New York City, tripled immediately following the election and have remained high through January, according to the company. In particular, Talkspace has seen a steady increase in requests from minorities, including Muslim-Americans, African-Americans, Jews, gays and lesbians.\u003c/p>\n\u003cp>“In my 28 years in practice, I’ve never seen anything like this level of stress,” said Nancy Molitor, a psychologist in the Chicago suburbs. She says the vast majority of her patients — from millennials to those in their 80s — are bringing up politics in their therapy sessions. “What we’re seeing now after the inauguration is a huge uptick in anxiety.”\u003c/p>\n\u003cp>Many of her patients say they are having trouble sleeping and focusing at work or are fighting more with family members, she said.\u003c/p>\n\u003cp>“I have people who’ve told me they’re in mourning, that they’ve lost their libido,” Molitor said. “I have people saying the anxiety is causing them to be so distracted that they’re blowing through stop signs or getting into fender benders.”\u003c/p>\n\u003cp>The anxiety appears to be widespread. Fifty-seven percent of Americans report that the current political climate is a very or somewhat significant source of stress, and 40 percent say the same about the outcome of the election, according to an online survey of 1,019 adults conducted by the American Psychological Association after the inauguration. Between August 2016 and January 2017, the overall average stress level increased significantly for the first time since the Stress in America survey began 10 years ago.\u003c/p>\n\u003cp>And it’s not Democrats: a quarter of Republicans report that the outcome of election is a significant source of stress for them.\u003c/p>\n\u003cp>“I’m seeing lot of anxiety and anger on both sides,” says Elaine DuCharme, a psychologist in Glastonbury, Conn. “People who are Republicans are afraid to tell anyone. They’re afraid that everybody thinks that every Republican thinks exactly as Trump does, and support every single thing he does.”\u003c/p>\n\u003cp>She says some of her patients are particularly concerned about maintaining civil relationships with friends and loved ones who have different political opinions. “People are walking on eggshells,” DuCharme said.\u003c/p>\n\u003cp>Karri King, 56, who lives in Buckeye, Ariz., and voted for Trump, says her experiences on social media have left her feeling sad and hopeless. “There’s so much negative from all these stupid Facebook posts acting like the world is going to end. And it’s false. And I can’t do a thing about it.”\u003c/p>\n\u003cp>King said she’s tried to engage civilly with people online who disagree with her, but “every time [Republicans] turn around, we’re bashed.”\u003c/p>\n\u003cp>When you say “a bunch of idiots” voted Trump in, “you’re talking about half of all Americans! We were hopeful at first, and now we’re angry and tired of being blamed,” said King. “Nobody wants to listen anymore, and that’s where my sadness comes from.”\u003c/p>\n\u003cp>Of course, in some parts of the country, especially those that are overwhelmingly Republican and outside big cities, people seem relieved if not uplifted by the new president’s flurry of executive orders and appointments.\u003c/p>\n\u003cp>Kristin Addison-Brown, a psychologist in rural Jonesboro, Ark., says before the election, some of her patients were voicing concerns about a possible Clinton victory. But since then, “it’s pretty much been crickets for my patients. They got their guy, so they’re not stressed anymore.”\u003c/p>\n\u003cp>Nancy Cottle, a Trump supporter in Mesa, Ariz., has been riding high since the election. “We got to go to the inauguration, and, oh, it was a wonderful experience! We got to go to the Trump hotel and have breakfast and then lunch there, and it was just great. The inauguration itself was very inspiring.”\u003c/p>\n\u003cp>Cottle, 64, has been struggling to understand the public outcry about Trump. “It’s like the sky is falling ― but a lot of that is just drama,” she said. “I feel encouraged, I feel hopeful. I can’t wait to wake up and see what the day’s going to bring and what else is going to happen.”\u003c/p>\n\u003cp>That same daily dose of news ― and the uncertainty of what will happen next ― rattles many Trump opponents. But, like Pfingsten, they can’t seem to quit their news consumption cold turkey.\u003c/p>\n\u003cp>“Part of the brain wants to know what’s going on, and you’re drawn to watching CNN or reading the news. And then the other part of you is saying no, no, this isn’t good for me!” says Molitor, the Chicago psychologist. “It’s unfortunately like driving by a car accident ― they know it’s not good for them [to gawk], but it’s hard to stop.”\u003c/p>\n\u003cp>Molitor recommends patients stay engaged but limit the time they spend on Facebook or watching the news. Focus instead on other things you enjoy, she advises ― calling a friend, taking a walk or reading a book.\u003c/p>\n\u003cp>“I never read the Harry Potter books, so I’m reading Harry Potter,” says Matthew Leal, a 34-year-old San Francisco resident who found himself sinking into a depression after the election. “Someone could see this and say I’m being totally escapist right now, but I feel like it’s kind of what I need.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This story was produced by KQED partner Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.\u003cbr>\n\u003c/em>\u003c/p>\n\n",
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"excerpt": "Trump opponents — and even some supporters — say the election and tumultuous early days of the new administration have left them anxious, angry and afraid of Facebook.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Wally Pfingsten has always been a news junkie. But since President Donald Trump was elected, he’s been so anxious about the political tumult that even just having the TV news on in the background at home is unbearable.\u003c/p>\n\u003cp>“It’s been crippling,” said the 35-year-old San Mateo resident and political moderate who has supported both Democratic and Republican candidates in the past. “I feel angry, really, really angry, far more angry than I expected to be.”\u003c/p>\n\u003cp>He’s tried hard to quell his anxiety. First, he shut down his Facebook page to limit his exposure to the daily soaking of news from Washington. But not knowing the goings-on made him anxious, too. He found himself sneaking onto the Facebook account he made for his dog. “I felt like I was cheating,” he said.\u003c/p>\n\u003cp>Pfingsten is not alone in his politics-induced anxiety — it’s so common it’s been given an unofficial name: Post-Election Stress Disorder. Mental health professionals around the country, especially those working in Democratic strongholds, report a stream of patients coming in with anxiety and depression related to — or worsened by — the blast of daily news on the new administration.\u003c/p>\n\u003cp>In the past, therapists say it’s been fairly uncommon for patients to bring up politics on the couch. “It is big money to talk about politics with me ― that is not what we do!” said Maria Lymberis, a psychiatrist in Santa Monica.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>But that was before “fake news,” “alternative facts,” “repeal and replace,” contested confirmations, travel bans, protests and suits over travel bans, suspicions about Russian influence and the departures of the acting attorney general and the new national security adviser. Among other things.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003cdiv class='utils-parseShortcode-shortcodes-__shortcodes__shortcodeWrapper'>\n \u003ciframe width='100%' height='166'\n scrolling='no' frameborder='no'\n src='https://w.soundcloud.com/player/?url=https://api.soundcloud.com/tracks/312550437&visual=true&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false'\n title='https://api.soundcloud.com/tracks/312550437'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Requests for therapy appointments to Talkspace, an online therapy portal based in New York City, tripled immediately following the election and have remained high through January, according to the company. In particular, Talkspace has seen a steady increase in requests from minorities, including Muslim-Americans, African-Americans, Jews, gays and lesbians.\u003c/p>\n\u003cp>“In my 28 years in practice, I’ve never seen anything like this level of stress,” said Nancy Molitor, a psychologist in the Chicago suburbs. She says the vast majority of her patients — from millennials to those in their 80s — are bringing up politics in their therapy sessions. “What we’re seeing now after the inauguration is a huge uptick in anxiety.”\u003c/p>\n\u003cp>Many of her patients say they are having trouble sleeping and focusing at work or are fighting more with family members, she said.\u003c/p>\n\u003cp>“I have people who’ve told me they’re in mourning, that they’ve lost their libido,” Molitor said. “I have people saying the anxiety is causing them to be so distracted that they’re blowing through stop signs or getting into fender benders.”\u003c/p>\n\u003cp>The anxiety appears to be widespread. Fifty-seven percent of Americans report that the current political climate is a very or somewhat significant source of stress, and 40 percent say the same about the outcome of the election, according to an online survey of 1,019 adults conducted by the American Psychological Association after the inauguration. Between August 2016 and January 2017, the overall average stress level increased significantly for the first time since the Stress in America survey began 10 years ago.\u003c/p>\n\u003cp>And it’s not Democrats: a quarter of Republicans report that the outcome of election is a significant source of stress for them.\u003c/p>\n\u003cp>“I’m seeing lot of anxiety and anger on both sides,” says Elaine DuCharme, a psychologist in Glastonbury, Conn. “People who are Republicans are afraid to tell anyone. They’re afraid that everybody thinks that every Republican thinks exactly as Trump does, and support every single thing he does.”\u003c/p>\n\u003cp>She says some of her patients are particularly concerned about maintaining civil relationships with friends and loved ones who have different political opinions. “People are walking on eggshells,” DuCharme said.\u003c/p>\n\u003cp>Karri King, 56, who lives in Buckeye, Ariz., and voted for Trump, says her experiences on social media have left her feeling sad and hopeless. “There’s so much negative from all these stupid Facebook posts acting like the world is going to end. And it’s false. And I can’t do a thing about it.”\u003c/p>\n\u003cp>King said she’s tried to engage civilly with people online who disagree with her, but “every time [Republicans] turn around, we’re bashed.”\u003c/p>\n\u003cp>When you say “a bunch of idiots” voted Trump in, “you’re talking about half of all Americans! We were hopeful at first, and now we’re angry and tired of being blamed,” said King. “Nobody wants to listen anymore, and that’s where my sadness comes from.”\u003c/p>\n\u003cp>Of course, in some parts of the country, especially those that are overwhelmingly Republican and outside big cities, people seem relieved if not uplifted by the new president’s flurry of executive orders and appointments.\u003c/p>\n\u003cp>Kristin Addison-Brown, a psychologist in rural Jonesboro, Ark., says before the election, some of her patients were voicing concerns about a possible Clinton victory. But since then, “it’s pretty much been crickets for my patients. They got their guy, so they’re not stressed anymore.”\u003c/p>\n\u003cp>Nancy Cottle, a Trump supporter in Mesa, Ariz., has been riding high since the election. “We got to go to the inauguration, and, oh, it was a wonderful experience! We got to go to the Trump hotel and have breakfast and then lunch there, and it was just great. The inauguration itself was very inspiring.”\u003c/p>\n\u003cp>Cottle, 64, has been struggling to understand the public outcry about Trump. “It’s like the sky is falling ― but a lot of that is just drama,” she said. “I feel encouraged, I feel hopeful. I can’t wait to wake up and see what the day’s going to bring and what else is going to happen.”\u003c/p>\n\u003cp>That same daily dose of news ― and the uncertainty of what will happen next ― rattles many Trump opponents. But, like Pfingsten, they can’t seem to quit their news consumption cold turkey.\u003c/p>\n\u003cp>“Part of the brain wants to know what’s going on, and you’re drawn to watching CNN or reading the news. And then the other part of you is saying no, no, this isn’t good for me!” says Molitor, the Chicago psychologist. “It’s unfortunately like driving by a car accident ― they know it’s not good for them [to gawk], but it’s hard to stop.”\u003c/p>\n\u003cp>Molitor recommends patients stay engaged but limit the time they spend on Facebook or watching the news. Focus instead on other things you enjoy, she advises ― calling a friend, taking a walk or reading a book.\u003c/p>\n\u003cp>“I never read the Harry Potter books, so I’m reading Harry Potter,” says Matthew Leal, a 34-year-old San Francisco resident who found himself sinking into a depression after the election. “Someone could see this and say I’m being totally escapist right now, but I feel like it’s kind of what I need.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>Telehealth takes a lot of forms these days\u003cspan style=\"font-weight: 400\">—\u003c/span>consultations with a doctor by video, phone or text; an appointment through the web or a mobile app. The one commonality: You get to interact with a health care provider from anywhere\u003cspan style=\"font-weight: 400\">—\u003c/span>your home, the office, Starbucks. Virtual consultations can mean you don’t have to schlep across town, sit in the waiting room, and leaf through a year-old Time magazine article as prelude to a short visit with your doc.\u003c/p>\n\u003caside class=\"pullquote alignright\">'When you make services that are convenient, it’s an ‘If you build it, they will come' kind of thing.'\u003ccite> Lori Uscher-Pines,\u003cbr>\nRAND Corporation\u003c/cite>\u003c/aside>\n\u003cp>Telehealth appointments are less expensive because the companies offering these services contract with doctors who are paid by the visit, and the companies themselves have little of the overhead necessary in a typical medical office, says Lori Uscher-Pines, a health policy researcher with the RAND Corporation. That means telehealth should theoretically save money for patients, employers and insurance companies -- the entire health care ecosystem. At least this is what telehealth companies claim. But now a \u003ca href=\"http://content.healthaffairs.org/content/36/3/485.abstract\" target=\"_blank\">study\u003c/a> from RAND, published Monday in \u003cem>Health Affairs\u003c/em>, says this isn't the case.\u003c/p>\n\u003cp>The study found that using telehealth for treatment of acute respiratory illnesses increased total annual spending, which the researchers defined as costs to insurers and out-of-pocket payments by patients, by $45 per telehealth user.\u003c/p>\n\u003cp>That's because 88 percent of the telehealth visits represented people who would not have gone to a doctor otherwise -- what the industry calls new utilization. Just 12 percent of the telehealth sessions, the researchers concluded, amounted to a \u003cem>substitute\u003c/em> for going to see the doc.\u003c/p>\n\u003cp>Uscher-Pines, a co-author of the study, says she's not surprised.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“When you make services that are convenient, it’s an ‘If you build it, they will come' kind of thing.”\u003c/p>\n\u003cp>Uscher-Pines says patients using telehealth for respiratory infections would likely not have gone to a doctor if the service had not been available. Rather, they would self-treat.\u003c/p>\n\u003cp>\"You sit at home, you watch Netflix, you take Tylenol,\" Pines says. \"But now because of these kind of services that are so easy to access, you have a visit that would not have otherwise occurred.”\u003c/p>\n\u003cp>The study is the fourth on telehealth funded by the California Health Care Foundation. Researchers examined claims data from more than 300,000 enrollees in the Blue Shield of California HMO offered by CalPERS, the California Public Employees' Retirement System. In 2012, CalPERS began offering the telehealth appointments to selected members through Teladoc, a Texas-based public company that provides virtual appointments with licensed physicians 24 hours a day, 365 days a year.\u003c/p>\n\u003caside class=\"pullquote alignright\">'You have to use [telehealth] as a more precise tool with particular populations in order to serve their needs. Don’t just go into it blindly.'\u003ccite>Melissa Buckley,\u003cbr>\nCalifornia Health Care Foundation\u003c/cite>\u003c/aside>\n\u003cp>The current study looked at 981 people who used the Teladoc service over 18 months in 2012-13, seeking help for acute respiratory infections like bronchitis, pneumonia or sinusitis. The researchers compared these users with patients who had their acute respiratory infections treated by a doctor in-person. The focus was on this type of illness because it is the most commonly treated by direct-to-consumer telehealth providers, the researchers said.\u003c/p>\n\u003cp>Teladoc, which \u003ca href=\"https://www.teladoc.com/businesses/save-money/\" target=\"_blank\">markets\u003c/a> its service as a cost reduction, says patient information it gathered at the time of care contradicts the findings. Courtney McLeod, the company’s director of public relations, said in an email that just 13 percent of appointments for more than 400,000 acute respiratory infection patients represented new health care utilization.\u003c/p>\n\u003cp>That is pretty much the reverse of the 88 percent new utilization that the RAND researchers found. The RAND study asserts that the discrepancies between its numbers and those of the telehealth companies on new-versus-replacement health care could be due to the companies' use of surveys, as opposed to actual utilization data. The surveyed telehealth patients, the researchers wrote, may have overestimated the likelihood of going to see a doctor as opposed to not acting at all.\u003c/p>\n\u003cp>The researchers did acknowledge that use of telehealth for different conditions might produce better results. One of the study’s limitations was that respiratory infections often resolve on their own. “In contrast, an increase in utilization for patients with diabetes or mental illness might be perceived as a net positive,\" the study reads. \"These are conditions that are often undertreated and for which there is clearer evidence that receiving treatment improves health.\"\u003c/p>\n\u003cp>Uscher-Pines also said there could be economic benefits from telehealth that the study didn’t capture. \"These services can be offering patients reassurance,” she said, which can positively impact employee productivity. Telehealth visits initiated from a patient's work site might also reduce absenteeism,\u003c/p>\n\u003cp>But, she said, “You have to take this with a grain of salt when a company says we’re going to prevent emergency department visits. It’s unclear whether that’s likely to happen given the fact that the literature on innovations in health care delivery frequently tells us that when you increase convenience you increase utilization.\"\u003c/p>\n\u003cp>David Cowling, a co-author of the paper and a research scientist at CalPERS, said the study revealed the tradeoff that telehealth presents.\u003c/p>\n\u003cp>\"We have increased access to our members, which is a good thing. Eighty-eight percent were new utilization, so they wouldn’t have gotten care previously. Our members were seeking care and I’m sure their satisfaction with their health plan was higher.\"\u003c/p>\n\u003cp>But Cowling said the issue could prompt a change in the benefit when CalPERS re-examines its benefit package. He said the organization could potentially limit telehealth access to rural areas, one of the original aims of introducing the service, or tailor it to specific conditions.\u003c/p>\n\u003cp>Melissa Buckley, the director of the California Health Care Foundation’s Innovation Fund, said that sort of strategic thinking may be the best bet when it comes to telehealth.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“If you use it naively you can drive up utilization,\" she said. \"You have to use it as a more precise tool with particular populations in order to serve their needs. Don’t just go into it blindly.”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Telehealth takes a lot of forms these days\u003cspan style=\"font-weight: 400\">—\u003c/span>consultations with a doctor by video, phone or text; an appointment through the web or a mobile app. The one commonality: You get to interact with a health care provider from anywhere\u003cspan style=\"font-weight: 400\">—\u003c/span>your home, the office, Starbucks. Virtual consultations can mean you don’t have to schlep across town, sit in the waiting room, and leaf through a year-old Time magazine article as prelude to a short visit with your doc.\u003c/p>\n\u003caside class=\"pullquote alignright\">'When you make services that are convenient, it’s an ‘If you build it, they will come' kind of thing.'\u003ccite> Lori Uscher-Pines,\u003cbr>\nRAND Corporation\u003c/cite>\u003c/aside>\n\u003cp>Telehealth appointments are less expensive because the companies offering these services contract with doctors who are paid by the visit, and the companies themselves have little of the overhead necessary in a typical medical office, says Lori Uscher-Pines, a health policy researcher with the RAND Corporation. That means telehealth should theoretically save money for patients, employers and insurance companies -- the entire health care ecosystem. At least this is what telehealth companies claim. But now a \u003ca href=\"http://content.healthaffairs.org/content/36/3/485.abstract\" target=\"_blank\">study\u003c/a> from RAND, published Monday in \u003cem>Health Affairs\u003c/em>, says this isn't the case.\u003c/p>\n\u003cp>The study found that using telehealth for treatment of acute respiratory illnesses increased total annual spending, which the researchers defined as costs to insurers and out-of-pocket payments by patients, by $45 per telehealth user.\u003c/p>\n\u003cp>That's because 88 percent of the telehealth visits represented people who would not have gone to a doctor otherwise -- what the industry calls new utilization. Just 12 percent of the telehealth sessions, the researchers concluded, amounted to a \u003cem>substitute\u003c/em> for going to see the doc.\u003c/p>\n\u003cp>Uscher-Pines, a co-author of the study, says she's not surprised.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“When you make services that are convenient, it’s an ‘If you build it, they will come' kind of thing.”\u003c/p>\n\u003cp>Uscher-Pines says patients using telehealth for respiratory infections would likely not have gone to a doctor if the service had not been available. Rather, they would self-treat.\u003c/p>\n\u003cp>\"You sit at home, you watch Netflix, you take Tylenol,\" Pines says. \"But now because of these kind of services that are so easy to access, you have a visit that would not have otherwise occurred.”\u003c/p>\n\u003cp>The study is the fourth on telehealth funded by the California Health Care Foundation. Researchers examined claims data from more than 300,000 enrollees in the Blue Shield of California HMO offered by CalPERS, the California Public Employees' Retirement System. In 2012, CalPERS began offering the telehealth appointments to selected members through Teladoc, a Texas-based public company that provides virtual appointments with licensed physicians 24 hours a day, 365 days a year.\u003c/p>\n\u003caside class=\"pullquote alignright\">'You have to use [telehealth] as a more precise tool with particular populations in order to serve their needs. Don’t just go into it blindly.'\u003ccite>Melissa Buckley,\u003cbr>\nCalifornia Health Care Foundation\u003c/cite>\u003c/aside>\n\u003cp>The current study looked at 981 people who used the Teladoc service over 18 months in 2012-13, seeking help for acute respiratory infections like bronchitis, pneumonia or sinusitis. The researchers compared these users with patients who had their acute respiratory infections treated by a doctor in-person. The focus was on this type of illness because it is the most commonly treated by direct-to-consumer telehealth providers, the researchers said.\u003c/p>\n\u003cp>Teladoc, which \u003ca href=\"https://www.teladoc.com/businesses/save-money/\" target=\"_blank\">markets\u003c/a> its service as a cost reduction, says patient information it gathered at the time of care contradicts the findings. Courtney McLeod, the company’s director of public relations, said in an email that just 13 percent of appointments for more than 400,000 acute respiratory infection patients represented new health care utilization.\u003c/p>\n\u003cp>That is pretty much the reverse of the 88 percent new utilization that the RAND researchers found. The RAND study asserts that the discrepancies between its numbers and those of the telehealth companies on new-versus-replacement health care could be due to the companies' use of surveys, as opposed to actual utilization data. The surveyed telehealth patients, the researchers wrote, may have overestimated the likelihood of going to see a doctor as opposed to not acting at all.\u003c/p>\n\u003cp>The researchers did acknowledge that use of telehealth for different conditions might produce better results. One of the study’s limitations was that respiratory infections often resolve on their own. “In contrast, an increase in utilization for patients with diabetes or mental illness might be perceived as a net positive,\" the study reads. \"These are conditions that are often undertreated and for which there is clearer evidence that receiving treatment improves health.\"\u003c/p>\n\u003cp>Uscher-Pines also said there could be economic benefits from telehealth that the study didn’t capture. \"These services can be offering patients reassurance,” she said, which can positively impact employee productivity. Telehealth visits initiated from a patient's work site might also reduce absenteeism,\u003c/p>\n\u003cp>But, she said, “You have to take this with a grain of salt when a company says we’re going to prevent emergency department visits. It’s unclear whether that’s likely to happen given the fact that the literature on innovations in health care delivery frequently tells us that when you increase convenience you increase utilization.\"\u003c/p>\n\u003cp>David Cowling, a co-author of the paper and a research scientist at CalPERS, said the study revealed the tradeoff that telehealth presents.\u003c/p>\n\u003cp>\"We have increased access to our members, which is a good thing. Eighty-eight percent were new utilization, so they wouldn’t have gotten care previously. Our members were seeking care and I’m sure their satisfaction with their health plan was higher.\"\u003c/p>\n\u003cp>But Cowling said the issue could prompt a change in the benefit when CalPERS re-examines its benefit package. He said the organization could potentially limit telehealth access to rural areas, one of the original aims of introducing the service, or tailor it to specific conditions.\u003c/p>\n\u003cp>Melissa Buckley, the director of the California Health Care Foundation’s Innovation Fund, said that sort of strategic thinking may be the best bet when it comes to telehealth.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>They’re among the nation’s premier medical centers, at the leading edge of scientific research.\u003c/p>\n\u003cp>Yet hospitals affiliated with Yale, Duke, Johns Hopkins, and other top medical research centers also aggressively promote alternative therapies with little or no scientific backing. They offer “energy healing” to help treat multiple sclerosis, acupuncture for infertility, and homeopathic bee venom for fibromyalgia. A public forum hosted by the University of Florida’s hospital even promises to explain how herbal therapy can reverse Alzheimer’s. (It can’t.)\u003c/p>\n\u003cp>This embrace of alternative medicine has been building for years. But a STAT examination of 15 academic research centers across the U.S. underscores just how deeply these therapies have become embedded in prestigious hospitals and medical schools.\u003c/p>\n\u003caside class=\"pullquote alignright\">'We've become witch doctors ... [forfeiting] any claim that we had to be a science-based profession.'\u003ccite>Dr. Steven Novella, Yale School of Medicine \u003c/cite>\u003c/aside>\n\u003cp>Some hospitals have built luxurious, spa-like wellness centers to draw patients for spiritual healing, homeopathy and more. And they’re promoting such treatments for a wide array of conditions, including depression, heart disease, cancer, and chronic pain. Duke even markets a pediatric program that suggests on its website that alternative medicine, including “detoxification programs” and “botanical medicines,” can help children with conditions ranging from autism to asthma to ADHD.\u003c/p>\n\u003cp>“We’ve become witch doctors,” said Dr. Steven Novella, a professor of neurology at the Yale School of Medicine and a longtime critic of alternative medicine.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>STAT’s examination found a booming market for such therapies: The clinic at the University of California, San Francisco, is growing so fast, it’s bursting out of its space.\u003c/p>\n\u003cp>Just in the past year, the teaching hospital connected to the University of Florida began offering cancer patients consultations in homeopathy and traditional Chinese herbal medicine. Thomas Jefferson University in Philadelphia launched an institute whose offerings include \u003ca href=\"https://www.statnews.com/2017/02/23/vitamin-iv-infusion/\" target=\"_blank\">intravenous vitamin and mineral therapies\u003c/a>. And the University of Arizona, a pioneer in the field, received a $1 million gift to boost practitioner training in natural and spiritual healing techniques.\u003c/p>\n\u003cp>Even as they count on these programs to bring in patients and revenue, several hospitals were reluctant to talk to STAT about why they’re lending their distinguished names to unproven therapies.\u003c/p>\n\u003cp>Duke Health declined repeated requests for interviews about its rapidly growing integrative medicine center, which \u003ca href=\"https://www.dukeintegrativemedicine.org/wp-content/uploads/2016/02/primarycare-brochure-web.pdf\" target=\"_blank\">charges patients $1,800 a year\u003c/a> just for a basic membership, with acupuncture and other treatments billed separately.\u003c/p>\n\u003cp>MedStar Georgetown quietly edited its website, citing changes to its clinical offerings, after a reporter asked why it listed the energy healing practice of reiki as a therapy for blood cancer. Cleveland Clinic struggled to find anyone on its staff to defend the hospital’s energy medicine program, ultimately issuing a statement that it’s “responding to the needs of our patients and patient demand.”\u003c/p>\n\u003cp>And the director of an alternative medicine program at another prestigious hospital declined to speak on the record — out of fear, he said, that his remarks would be construed as “fake news” and stir a backlash.\u003c/p>\n\u003cp>The rise of alternative therapies has sparked tension in some hospitals, with doctors openly accusing their peers of peddling snake oil and undermining the credibility of their institutions.\u003c/p>\n\u003cp>By promoting such therapies, Novella said, physicians are forfeiting “any claim that we had to being a science-based profession.”\u003c/p>\n\u003cp>As for patients? They’re “being snookered,” he said.\u003c/p>\n\u003caside class=\"pullquote alignright\">'Yes, as scientists, we want to be rigid. But me, as a physician, I want to find what's best for a patient. Who am I to say that's hogwash?' \u003ccite>Dr. Linda Lee, Johns Hopkins gastroenterologist\u003c/cite>\u003c/aside>\n\u003cp>The counterargument: Modern medicine clearly can’t cure everyone. It fails a great many patients. So why not encourage them to try an ancient Indian remedy or a spiritual healing technique that’s unlikely to cause harm — and may provide some relief, if only from the placebo effect?\u003c/p>\n\u003cp>“Yes, as scientists, we want to be rigid. But me, as a physician, I want to find what’s best for a patient. Who am I to say that’s hogwash?” said Dr. Linda Lee.\u003c/p>\n\u003cp>A gastroenterologist, Lee runs the Johns Hopkins Integrative Medicine and Digestive Center, which offers acupuncture, massage therapy, and reiki — a therapy that the center’s website describes as laying on hands \u003ca href=\"http://www.hopkinsmedicine.org/integrative_medicine_digestive_center/services/reiki.html\" target=\"_blank\">“to transmit Universal Life Energy”\u003c/a> to the patient.\u003c/p>\n\u003cp>Lee and others who promote alternative therapies are careful to say that they can supplement — but can’t replace — conventional treatments. And they make a point of coordinating care with other doctors so that, for instance, patients don’t get prescribed herbal supplements that might interact badly with their chemotherapy.\u003c/p>\n\u003cp>“Here at UF, we do not have alternative medicine. We do not have complementary medicine. We have integrative medicine,” said Dr. Irene Estores, medical director of the integrative medicine program at the University of Florida Shands Hospital in Gainesville, Fla.\u003c/p>\n\u003cp>\u003cstrong>Online Promotions Offer Scant Evidence\u003c/strong>\u003c/p>\n\u003cp>But while those cautions may come through in the clinic, the hospitals also promote alternative medicine online — often, without any nuance.\u003c/p>\n\u003cp>Duke’s Integrative Medicine store, for instance, sells \u003ca href=\"https://shopprovisions.dukestores.duke.edu/index.php?main_page=product_info&cPath=37_1&products_id=196\" target=\"_blank\">“Po Chai Pills”\u003c/a> that are touted on the hospital’s website as a cure for everything from belching to hangovers to headaches. The site explains that taking a pill “harmonizes the stomach, stems counterflow ascent of stomach qi, dispels damp, dispels pathogenic factors, subdues yang, relieves pain.” None of that makes sense in modern biomedical terms.\u003c/p>\n\u003cp>Thomas Jefferson University Hospital’s website touts \u003ca href=\"http://hospitals.jefferson.edu/tests-and-treatments/homeopathic-medicine.html\" target=\"_blank\">homeopathic bee venom\u003c/a> as useful to relieve symptoms for arthritis, nerve pain, and other conditions. The site does tell patients that the biological mechanism for the treatment is “unexplained” but asserts that studies “have been published in medical journals showing homeopathic medicines may provide clinical benefit.”\u003c/p>\n\u003cp>Asked about the therapy, Dr. Daniel Monti, who directs the integrative health center, acknowledged that the data is “largely anecdotal,” and said the hospital offers the treatment only rarely, “when there are few other options.” But those caveats don’t come through on the website.\u003c/p>\n\u003cp>Novella gets alarmed when he sees top-tier hospitals backing therapies with scant evidence behind them. “Patients only want [alternative medicine] because they’re being told they should want it. They see a prestigious hospital is offering it, so they think it’s legitimate,” said Novella.\u003c/p>\n\u003cp>“The perpetuation of these practices is a victory of marketing over truth,” said Steven Salzberg, a biomedical engineer at Johns Hopkins who lectures in the medical school. If a hospital is “offering treatment that’s based on fantasy, it undermines the credibility of the institution.”\u003c/p>\n\u003cp>The debate burst into the public view earlier this year when the medical director of the Cleveland Clinic’s Wellness Institute — which markets a variety of alternative therapies — \u003ca href=\"https://www.statnews.com/2017/01/07/anti-vaccine-claims-cleveland-clinic/\" target=\"_blank\">published an article\u003c/a> raising discredited theories linking vaccines to autism.\u003c/p>\n\u003cp>Cleveland Clinic’s chief executive, Dr. Toby Cosgrove, disavowed the article. And the clinic told STAT last week that it will take down its online wellness store and stop selling homeopathy kits.\u003c/p>\n\u003cp>But Cosgrove has stood up for the general principle of offering alternative treatments.\u003c/p>\n\u003cp>“The old way of combating chronic disease hasn’t worked,” Cosgrove wrote in a column posted on the hospital’s website. “… We have heard from our patients that they want more than conventional medicine can offer.”\u003c/p>\n\u003cfigure id=\"attachment_351821\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/03/bee-venom-800x530.jpg\">\u003cfigcaption class=\"wp-caption-text\">Thomas Jefferson University Hospital’s website touts homeopathic bee venom as useful to relieve symptoms for arthritis, nerve pain, and other conditions. The site tells patients that the biological mechanism for the treatment is “unexplained.” \u003ccite>(erierika/iStock)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>A Booming Market for ‘Natural’ Therapies\u003c/strong>\u003c/p>\n\u003cp>There’s no question that patients want alternative medicine. It’s a $37 billion-a-year business.\u003c/p>\n\u003cp>The typical American adult spent about $800 out of pocket in 2012 on dietary supplements and visits to alternative providers, such as naturopaths and acupuncturists, according to the federal Centers for Disease Control and Prevention.\u003c/p>\n\u003cp>Hospitals have taken note. A national consortium to promote integrative health now counts more than 70 academic centers and health systems as members, up from eight in 1999. Each year, four or five new programs join, said Dr. Leslie Mendoza Temple, the chair of the consortium’s policy working group.\u003c/p>\n\u003cp>In most cases, insurers won’t cover alternative therapies — there’s simply not enough evidence that they actually work — so patients pay out of pocket: $85 for acupuncture, $100 for reiki, $38 for pills made from thyme and oregano oils that promise to “harmonize digestive and respiratory function.”\u003c/p>\n\u003caside class=\"pullquote alignright\">'The people running the hospitals are doctors, but they also have MBAs. They talk of patients as customers. ... Your job is to sell them what they want.' \u003ccite>Arthur Caplan, New York University bioethicist\u003c/cite>\u003c/aside>\n\u003cp>To be sure, not all such integrative medicine clinics are big profit centers. Many are funded by philanthropists, and some hospitals say their programs operate at a loss — but are nonetheless essential to woo patients in a highly competitive marketplace. If they failed to offer “natural” therapies, some hospital executives fear they would lose a chance to attract patients who need more lucrative care, such as orthopedic surgeries or cancer treatments.\u003c/p>\n\u003cp>The integrative medicine center at Thomas Jefferson, for instance, is part of an “enterprise strategy for growth and development,” Monti said.\u003c/p>\n\u003cp>“The people running the hospitals are doctors, but they also have MBAs. They talk of patients as customers. Customers have demands. Your job is to sell them what they want,” said Arthur Caplan, a bioethicist at New York University’s medical school. Too often, he said, the attitude is, “We’re damn well going to do it if the guys down the street are doing it.”\u003c/p>\n\u003cp>While most hospitals declined to give specific revenue figures, STAT found indications of rapid growth.\u003c/p>\n\u003cp>“We’re literally bursting. We have to convert office space to clinic exam rooms,” said Shelley Adler, who runs the Osher Center for Integrative Medicine at the University of California, San Francisco. It offers a wide range of services, including Chinese herbal medicine, massage therapy, and Ayurveda, an ancient healing system from India based on the belief that health results from a balance between the mind, body, and spirit.\u003c/p>\n\u003cp>The center is on pace to get more than 10,300 patient visits this fiscal year, up 37 percent from 2012. It’s expanding its clinical staff by a third.\u003c/p>\n\u003cp>Duke University’s integrative medicine clinic, a stunning space with arching wood ceilings and an indoor garden, has seen strong growth: Total visits jumped 50 percent in 2015, to more than 14,000, Dr. Adam Perlman, the executive director, told IntegrativePractitioner.com. (He declined to talk to STAT.)\u003c/p>\n\u003cp>The center’s membership count also jumped, up 25 percent to 885, Perlman said. If all members paid the list price, that would bring in more than $1 million a year just for primary care.\u003c/p>\n\u003cp>At the University of Pittsburgh’s Center for Integrative Medicine, meanwhile, “our volume pretty much has increased steadily, even when we’ve had recessions and financial downturns,” said Dr. Ronald Glick, the medical director. The center now treats about 8,000 patients a year.\u003c/p>\n\u003cp>Many hospitals have also expanded into more general “wellness” offerings, with classes in healthy cooking, tai chi, meditation, and art therapy. UCSF offers a $375 class on “cultivating emotional balance” (and a free class on “laughter yoga”). Mayo Clinic sells a $2,900 “signature experience,” which includes consultations with a wellness coach.\u003c/p>\n\u003cp>And the Benson-Henry Institute for Mind Body Medicine at Massachusetts General Hospital offers specialized stress management services to help patients deal with conditions including cancer, infertility, and menopause. John Henry, the owner of STAT, has contributed funding to the Benson-Henry Institute.\u003c/p>\n\u003cp>Wellness programs — which are designed to ease stress and encourage healthy behaviors — are seen by many clinicians and hospitals as key to slowing America’s epidemic of chronic disease. They don’t tend to draw sharp criticism, except for their cost.\u003c/p>\n\u003cp>It’s the alternative therapies promoted as a way to treat disease that raise eyebrows.\u003c/p>\n\u003cp>\u003cstrong>‘Energy Healing’ Takes Root\u003c/strong>\u003c/p>\n\u003cp>Despite their deep wells of medical expertise, many top hospitals are offering to help treat serious medical problems with reiki — a practice based on the belief that lightly touching patients can unleash a cosmic energy flow that will heal them naturally.\u003c/p>\n\u003cp>STAT found that it is widely used by academic medical centers, including Johns Hopkins, Yale, the University of Pennsylvania, and Spaulding Rehabilitation Hospital, part of Partners HealthCare in Boston.\u003c/p>\n\u003cp>So, where’s the evidence supporting it?\u003c/p>\n\u003caside class=\"pullquote alignright\">'If it doesn't work, I don't know that you've lost anything. If it does, you do get to a better place.' \u003ccite>Dr. Richard Lang, Cleveland Clinic\u003c/cite>\u003c/aside>\n\u003cp>There is none, according to a division of the National Institutes of Health that funds research into alternative medicines. It says the practice has not been shown to be useful for “any health-related purpose” — and adds that there is no scientific evidence that the “natural healing energy” it’s based on even exists.\u003c/p>\n\u003cp>Asked about the Cleveland Clinic’s promotion of reiki, Dr. Richard Lang, the recently named interim director of the clinic’s Wellness Institute, said he hadn’t had a chance to think about it. “I don’t know that I could give you a plus or minus on that,” he said. Lang served as a vice chair of the Wellness Institute for nearly a decade before taking the top post.\u003c/p>\n\u003cp>Pressed for a more substantive answer, the clinic sent a statement saying it offers energy medicine as a complementary therapy, not as a replacement solution. But its website only briefly alludes to a patient’s broader “care team” in describing a “full range of emotional and physical issues” that can be treated with energy therapies, including autoimmune diseases, migraines, hormonal imbalances, and “cancer treatment support and recovery.”\u003c/p>\n\u003cp>Academic medical centers often boast that they’re more rigorous in evaluating alternative therapies — and weeding out scams — than a for-profit wellness center might be.\u003c/p>\n\u003cp>“The important thing about practicing in an academic center is that we must hold ourselves to certain standards,” said Estores, the medical director at the University of Florida’s integrative medicine clinic.\u003c/p>\n\u003cp>At the University of Pittsburgh, Glick echoed that sentiment: “We’re an academic institution … [so] we’re offering services that have greater evidence basis [and] scientific explanation.”\u003c/p>\n\u003cp>But that evidence isn’t always rigorous.\u003c/p>\n\u003cp>The University of Florida, for instance, is using Facebook to advertise an herbal medicine workshop for providers and the public that promises to answer questions including, “How can we stabilize or reverse Alzheimer’s disease?”\u003c/p>\n\u003cp>Asked about the evidence for that statement, Susan Marynowski, the herbalist presenting the workshop, cited several papers and a book chapter that she said showed herbs, in conjunction with lifestyle adjustments, could reverse Alzheimer’s-associated memory loss. However, at least two of those papers were small collections of case studies published in a journal with a reputation for less-than-rigorous review. (Marynowski said she knew the studies’ size and design limited the strength of their conclusions, but that she was not aware of the journal’s reputation.)\u003c/p>\n\u003cp>At Pittsburgh, the integrative medical center does take care to note on its website that alternative therapies “generally have not been subjected to the same level of research as standard medical approaches.”\u003c/p>\n\u003cp>But the site then goes on to promote dozens of treatments for everything from ADHD to whiplash, saying they have “appeared to be beneficial in this and other complementary medicine clinics.” (Glick noted that the body of research had grown since he wrote the caveat on the website in 2003.)\u003c/p>\n\u003cp>\u003cstrong>‘It’s not Black and White’\u003c/strong>\u003c/p>\n\u003cp>Perhaps the most prevalent alternative treatment STAT found on offer is acupuncture. It’s promoted for more than a dozen conditions, including high blood pressure, sinus problems, infertility, migraines, and digestive irregularities.\u003c/p>\n\u003cp>A 3,000-year-old Chinese therapy, acupuncture is based on the belief that by stimulating certain points on the body, most often with needles, practitioners can unlock a natural healing energy that flows through the body’s “meridians.” Research suggests it helps with certain pain conditions and might help prevent migraine headaches — but it also suggests that the placebo effect may play an important role.\u003c/p>\n\u003cp>Its value in treating other conditions is uncertain, according to the NIH’s center on integrative medicine.\u003c/p>\n\u003cp>Several major insurers, including Aetna, Anthem, and regional Blue Cross Blue Shield affiliates, cover acupuncture as a treatment for chronic pain and nausea. But the Centers for Medicare and Medicaid Services won’t pay for acupuncture, dismissing the scientific evidence as insufficient.\u003c/p>\n\u003cp>Still, it’s important for physicians to keep an open mind, said Lang, the interim director of the Cleveland Clinic Wellness Institute.\u003c/p>\n\u003cp>He said, for example, that he used to avoid referring patients for acupuncture, until he saw the benefit it provided to some of them. “I have seen it work in some chronic pain situations,” said Lang. “It can be very helpful. If it doesn’t work, I don’t know that you’ve lost anything. If it does, you do get to a better place.”\u003c/p>\n\u003cp>And while the evidence of its efficacy is not ironclad, neither is the evidence for various pharmaceutical therapies that are routinely provided by hospitals and covered by insurance. Some of those solutions, such as opioids to treat pain, have resulted in addiction and harm to patients.\u003c/p>\n\u003cp>Advocates of alternative medicine say it’s difficult to test some alternative therapies through rigorous clinical trials, primarily because treatment techniques vary from patient to patient. (The federal government does, however, spend roughly $120 million a year to fund research through the NIH National Center for Complementary and Integrative Health.)\u003c/p>\n\u003cp>They note, too, that traditional doctors sometimes stray from proven treatments, for instance when they prescribe medicines off-label for conditions the drugs have not been approved to treat.\u003c/p>\n\u003cp>“We do use things that aren’t necessarily 100 percent evidence-based, but I would argue that’s also true within all of medicine,” said Dr. Jill Schneiderhan, co-director of the University of Michigan’s integrative family medicine program. “I feel like it’s not black and white.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>\u003cspan style=\"font-weight: 400\">This \u003ca href=\"https://www.statnews.com/2017/03/07/alternative-medicine-hospitals-promote/\" target=\"_blank\">story\u003c/a> was originally published by STAT, an online publication of Boston Globe Media that covers health, medicine, and scientific discovery. \u003c/span>\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>They’re among the nation’s premier medical centers, at the leading edge of scientific research.\u003c/p>\n\u003cp>Yet hospitals affiliated with Yale, Duke, Johns Hopkins, and other top medical research centers also aggressively promote alternative therapies with little or no scientific backing. They offer “energy healing” to help treat multiple sclerosis, acupuncture for infertility, and homeopathic bee venom for fibromyalgia. A public forum hosted by the University of Florida’s hospital even promises to explain how herbal therapy can reverse Alzheimer’s. (It can’t.)\u003c/p>\n\u003cp>This embrace of alternative medicine has been building for years. But a STAT examination of 15 academic research centers across the U.S. underscores just how deeply these therapies have become embedded in prestigious hospitals and medical schools.\u003c/p>\n\u003caside class=\"pullquote alignright\">'We've become witch doctors ... [forfeiting] any claim that we had to be a science-based profession.'\u003ccite>Dr. Steven Novella, Yale School of Medicine \u003c/cite>\u003c/aside>\n\u003cp>Some hospitals have built luxurious, spa-like wellness centers to draw patients for spiritual healing, homeopathy and more. And they’re promoting such treatments for a wide array of conditions, including depression, heart disease, cancer, and chronic pain. Duke even markets a pediatric program that suggests on its website that alternative medicine, including “detoxification programs” and “botanical medicines,” can help children with conditions ranging from autism to asthma to ADHD.\u003c/p>\n\u003cp>“We’ve become witch doctors,” said Dr. Steven Novella, a professor of neurology at the Yale School of Medicine and a longtime critic of alternative medicine.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>STAT’s examination found a booming market for such therapies: The clinic at the University of California, San Francisco, is growing so fast, it’s bursting out of its space.\u003c/p>\n\u003cp>Just in the past year, the teaching hospital connected to the University of Florida began offering cancer patients consultations in homeopathy and traditional Chinese herbal medicine. Thomas Jefferson University in Philadelphia launched an institute whose offerings include \u003ca href=\"https://www.statnews.com/2017/02/23/vitamin-iv-infusion/\" target=\"_blank\">intravenous vitamin and mineral therapies\u003c/a>. And the University of Arizona, a pioneer in the field, received a $1 million gift to boost practitioner training in natural and spiritual healing techniques.\u003c/p>\n\u003cp>Even as they count on these programs to bring in patients and revenue, several hospitals were reluctant to talk to STAT about why they’re lending their distinguished names to unproven therapies.\u003c/p>\n\u003cp>Duke Health declined repeated requests for interviews about its rapidly growing integrative medicine center, which \u003ca href=\"https://www.dukeintegrativemedicine.org/wp-content/uploads/2016/02/primarycare-brochure-web.pdf\" target=\"_blank\">charges patients $1,800 a year\u003c/a> just for a basic membership, with acupuncture and other treatments billed separately.\u003c/p>\n\u003cp>MedStar Georgetown quietly edited its website, citing changes to its clinical offerings, after a reporter asked why it listed the energy healing practice of reiki as a therapy for blood cancer. Cleveland Clinic struggled to find anyone on its staff to defend the hospital’s energy medicine program, ultimately issuing a statement that it’s “responding to the needs of our patients and patient demand.”\u003c/p>\n\u003cp>And the director of an alternative medicine program at another prestigious hospital declined to speak on the record — out of fear, he said, that his remarks would be construed as “fake news” and stir a backlash.\u003c/p>\n\u003cp>The rise of alternative therapies has sparked tension in some hospitals, with doctors openly accusing their peers of peddling snake oil and undermining the credibility of their institutions.\u003c/p>\n\u003cp>By promoting such therapies, Novella said, physicians are forfeiting “any claim that we had to being a science-based profession.”\u003c/p>\n\u003cp>As for patients? They’re “being snookered,” he said.\u003c/p>\n\u003caside class=\"pullquote alignright\">'Yes, as scientists, we want to be rigid. But me, as a physician, I want to find what's best for a patient. Who am I to say that's hogwash?' \u003ccite>Dr. Linda Lee, Johns Hopkins gastroenterologist\u003c/cite>\u003c/aside>\n\u003cp>The counterargument: Modern medicine clearly can’t cure everyone. It fails a great many patients. So why not encourage them to try an ancient Indian remedy or a spiritual healing technique that’s unlikely to cause harm — and may provide some relief, if only from the placebo effect?\u003c/p>\n\u003cp>“Yes, as scientists, we want to be rigid. But me, as a physician, I want to find what’s best for a patient. Who am I to say that’s hogwash?” said Dr. Linda Lee.\u003c/p>\n\u003cp>A gastroenterologist, Lee runs the Johns Hopkins Integrative Medicine and Digestive Center, which offers acupuncture, massage therapy, and reiki — a therapy that the center’s website describes as laying on hands \u003ca href=\"http://www.hopkinsmedicine.org/integrative_medicine_digestive_center/services/reiki.html\" target=\"_blank\">“to transmit Universal Life Energy”\u003c/a> to the patient.\u003c/p>\n\u003cp>Lee and others who promote alternative therapies are careful to say that they can supplement — but can’t replace — conventional treatments. And they make a point of coordinating care with other doctors so that, for instance, patients don’t get prescribed herbal supplements that might interact badly with their chemotherapy.\u003c/p>\n\u003cp>“Here at UF, we do not have alternative medicine. We do not have complementary medicine. We have integrative medicine,” said Dr. Irene Estores, medical director of the integrative medicine program at the University of Florida Shands Hospital in Gainesville, Fla.\u003c/p>\n\u003cp>\u003cstrong>Online Promotions Offer Scant Evidence\u003c/strong>\u003c/p>\n\u003cp>But while those cautions may come through in the clinic, the hospitals also promote alternative medicine online — often, without any nuance.\u003c/p>\n\u003cp>Duke’s Integrative Medicine store, for instance, sells \u003ca href=\"https://shopprovisions.dukestores.duke.edu/index.php?main_page=product_info&cPath=37_1&products_id=196\" target=\"_blank\">“Po Chai Pills”\u003c/a> that are touted on the hospital’s website as a cure for everything from belching to hangovers to headaches. The site explains that taking a pill “harmonizes the stomach, stems counterflow ascent of stomach qi, dispels damp, dispels pathogenic factors, subdues yang, relieves pain.” None of that makes sense in modern biomedical terms.\u003c/p>\n\u003cp>Thomas Jefferson University Hospital’s website touts \u003ca href=\"http://hospitals.jefferson.edu/tests-and-treatments/homeopathic-medicine.html\" target=\"_blank\">homeopathic bee venom\u003c/a> as useful to relieve symptoms for arthritis, nerve pain, and other conditions. The site does tell patients that the biological mechanism for the treatment is “unexplained” but asserts that studies “have been published in medical journals showing homeopathic medicines may provide clinical benefit.”\u003c/p>\n\u003cp>Asked about the therapy, Dr. Daniel Monti, who directs the integrative health center, acknowledged that the data is “largely anecdotal,” and said the hospital offers the treatment only rarely, “when there are few other options.” But those caveats don’t come through on the website.\u003c/p>\n\u003cp>Novella gets alarmed when he sees top-tier hospitals backing therapies with scant evidence behind them. “Patients only want [alternative medicine] because they’re being told they should want it. They see a prestigious hospital is offering it, so they think it’s legitimate,” said Novella.\u003c/p>\n\u003cp>“The perpetuation of these practices is a victory of marketing over truth,” said Steven Salzberg, a biomedical engineer at Johns Hopkins who lectures in the medical school. If a hospital is “offering treatment that’s based on fantasy, it undermines the credibility of the institution.”\u003c/p>\n\u003cp>The debate burst into the public view earlier this year when the medical director of the Cleveland Clinic’s Wellness Institute — which markets a variety of alternative therapies — \u003ca href=\"https://www.statnews.com/2017/01/07/anti-vaccine-claims-cleveland-clinic/\" target=\"_blank\">published an article\u003c/a> raising discredited theories linking vaccines to autism.\u003c/p>\n\u003cp>Cleveland Clinic’s chief executive, Dr. Toby Cosgrove, disavowed the article. And the clinic told STAT last week that it will take down its online wellness store and stop selling homeopathy kits.\u003c/p>\n\u003cp>But Cosgrove has stood up for the general principle of offering alternative treatments.\u003c/p>\n\u003cp>“The old way of combating chronic disease hasn’t worked,” Cosgrove wrote in a column posted on the hospital’s website. “… We have heard from our patients that they want more than conventional medicine can offer.”\u003c/p>\n\u003cfigure id=\"attachment_351821\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/03/bee-venom-800x530.jpg\">\u003cfigcaption class=\"wp-caption-text\">Thomas Jefferson University Hospital’s website touts homeopathic bee venom as useful to relieve symptoms for arthritis, nerve pain, and other conditions. The site tells patients that the biological mechanism for the treatment is “unexplained.” \u003ccite>(erierika/iStock)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>A Booming Market for ‘Natural’ Therapies\u003c/strong>\u003c/p>\n\u003cp>There’s no question that patients want alternative medicine. It’s a $37 billion-a-year business.\u003c/p>\n\u003cp>The typical American adult spent about $800 out of pocket in 2012 on dietary supplements and visits to alternative providers, such as naturopaths and acupuncturists, according to the federal Centers for Disease Control and Prevention.\u003c/p>\n\u003cp>Hospitals have taken note. A national consortium to promote integrative health now counts more than 70 academic centers and health systems as members, up from eight in 1999. Each year, four or five new programs join, said Dr. Leslie Mendoza Temple, the chair of the consortium’s policy working group.\u003c/p>\n\u003cp>In most cases, insurers won’t cover alternative therapies — there’s simply not enough evidence that they actually work — so patients pay out of pocket: $85 for acupuncture, $100 for reiki, $38 for pills made from thyme and oregano oils that promise to “harmonize digestive and respiratory function.”\u003c/p>\n\u003caside class=\"pullquote alignright\">'The people running the hospitals are doctors, but they also have MBAs. They talk of patients as customers. ... Your job is to sell them what they want.' \u003ccite>Arthur Caplan, New York University bioethicist\u003c/cite>\u003c/aside>\n\u003cp>To be sure, not all such integrative medicine clinics are big profit centers. Many are funded by philanthropists, and some hospitals say their programs operate at a loss — but are nonetheless essential to woo patients in a highly competitive marketplace. If they failed to offer “natural” therapies, some hospital executives fear they would lose a chance to attract patients who need more lucrative care, such as orthopedic surgeries or cancer treatments.\u003c/p>\n\u003cp>The integrative medicine center at Thomas Jefferson, for instance, is part of an “enterprise strategy for growth and development,” Monti said.\u003c/p>\n\u003cp>“The people running the hospitals are doctors, but they also have MBAs. They talk of patients as customers. Customers have demands. Your job is to sell them what they want,” said Arthur Caplan, a bioethicist at New York University’s medical school. Too often, he said, the attitude is, “We’re damn well going to do it if the guys down the street are doing it.”\u003c/p>\n\u003cp>While most hospitals declined to give specific revenue figures, STAT found indications of rapid growth.\u003c/p>\n\u003cp>“We’re literally bursting. We have to convert office space to clinic exam rooms,” said Shelley Adler, who runs the Osher Center for Integrative Medicine at the University of California, San Francisco. It offers a wide range of services, including Chinese herbal medicine, massage therapy, and Ayurveda, an ancient healing system from India based on the belief that health results from a balance between the mind, body, and spirit.\u003c/p>\n\u003cp>The center is on pace to get more than 10,300 patient visits this fiscal year, up 37 percent from 2012. It’s expanding its clinical staff by a third.\u003c/p>\n\u003cp>Duke University’s integrative medicine clinic, a stunning space with arching wood ceilings and an indoor garden, has seen strong growth: Total visits jumped 50 percent in 2015, to more than 14,000, Dr. Adam Perlman, the executive director, told IntegrativePractitioner.com. (He declined to talk to STAT.)\u003c/p>\n\u003cp>The center’s membership count also jumped, up 25 percent to 885, Perlman said. If all members paid the list price, that would bring in more than $1 million a year just for primary care.\u003c/p>\n\u003cp>At the University of Pittsburgh’s Center for Integrative Medicine, meanwhile, “our volume pretty much has increased steadily, even when we’ve had recessions and financial downturns,” said Dr. Ronald Glick, the medical director. The center now treats about 8,000 patients a year.\u003c/p>\n\u003cp>Many hospitals have also expanded into more general “wellness” offerings, with classes in healthy cooking, tai chi, meditation, and art therapy. UCSF offers a $375 class on “cultivating emotional balance” (and a free class on “laughter yoga”). Mayo Clinic sells a $2,900 “signature experience,” which includes consultations with a wellness coach.\u003c/p>\n\u003cp>And the Benson-Henry Institute for Mind Body Medicine at Massachusetts General Hospital offers specialized stress management services to help patients deal with conditions including cancer, infertility, and menopause. John Henry, the owner of STAT, has contributed funding to the Benson-Henry Institute.\u003c/p>\n\u003cp>Wellness programs — which are designed to ease stress and encourage healthy behaviors — are seen by many clinicians and hospitals as key to slowing America’s epidemic of chronic disease. They don’t tend to draw sharp criticism, except for their cost.\u003c/p>\n\u003cp>It’s the alternative therapies promoted as a way to treat disease that raise eyebrows.\u003c/p>\n\u003cp>\u003cstrong>‘Energy Healing’ Takes Root\u003c/strong>\u003c/p>\n\u003cp>Despite their deep wells of medical expertise, many top hospitals are offering to help treat serious medical problems with reiki — a practice based on the belief that lightly touching patients can unleash a cosmic energy flow that will heal them naturally.\u003c/p>\n\u003cp>STAT found that it is widely used by academic medical centers, including Johns Hopkins, Yale, the University of Pennsylvania, and Spaulding Rehabilitation Hospital, part of Partners HealthCare in Boston.\u003c/p>\n\u003cp>So, where’s the evidence supporting it?\u003c/p>\n\u003caside class=\"pullquote alignright\">'If it doesn't work, I don't know that you've lost anything. If it does, you do get to a better place.' \u003ccite>Dr. Richard Lang, Cleveland Clinic\u003c/cite>\u003c/aside>\n\u003cp>There is none, according to a division of the National Institutes of Health that funds research into alternative medicines. It says the practice has not been shown to be useful for “any health-related purpose” — and adds that there is no scientific evidence that the “natural healing energy” it’s based on even exists.\u003c/p>\n\u003cp>Asked about the Cleveland Clinic’s promotion of reiki, Dr. Richard Lang, the recently named interim director of the clinic’s Wellness Institute, said he hadn’t had a chance to think about it. “I don’t know that I could give you a plus or minus on that,” he said. Lang served as a vice chair of the Wellness Institute for nearly a decade before taking the top post.\u003c/p>\n\u003cp>Pressed for a more substantive answer, the clinic sent a statement saying it offers energy medicine as a complementary therapy, not as a replacement solution. But its website only briefly alludes to a patient’s broader “care team” in describing a “full range of emotional and physical issues” that can be treated with energy therapies, including autoimmune diseases, migraines, hormonal imbalances, and “cancer treatment support and recovery.”\u003c/p>\n\u003cp>Academic medical centers often boast that they’re more rigorous in evaluating alternative therapies — and weeding out scams — than a for-profit wellness center might be.\u003c/p>\n\u003cp>“The important thing about practicing in an academic center is that we must hold ourselves to certain standards,” said Estores, the medical director at the University of Florida’s integrative medicine clinic.\u003c/p>\n\u003cp>At the University of Pittsburgh, Glick echoed that sentiment: “We’re an academic institution … [so] we’re offering services that have greater evidence basis [and] scientific explanation.”\u003c/p>\n\u003cp>But that evidence isn’t always rigorous.\u003c/p>\n\u003cp>The University of Florida, for instance, is using Facebook to advertise an herbal medicine workshop for providers and the public that promises to answer questions including, “How can we stabilize or reverse Alzheimer’s disease?”\u003c/p>\n\u003cp>Asked about the evidence for that statement, Susan Marynowski, the herbalist presenting the workshop, cited several papers and a book chapter that she said showed herbs, in conjunction with lifestyle adjustments, could reverse Alzheimer’s-associated memory loss. However, at least two of those papers were small collections of case studies published in a journal with a reputation for less-than-rigorous review. (Marynowski said she knew the studies’ size and design limited the strength of their conclusions, but that she was not aware of the journal’s reputation.)\u003c/p>\n\u003cp>At Pittsburgh, the integrative medical center does take care to note on its website that alternative therapies “generally have not been subjected to the same level of research as standard medical approaches.”\u003c/p>\n\u003cp>But the site then goes on to promote dozens of treatments for everything from ADHD to whiplash, saying they have “appeared to be beneficial in this and other complementary medicine clinics.” (Glick noted that the body of research had grown since he wrote the caveat on the website in 2003.)\u003c/p>\n\u003cp>\u003cstrong>‘It’s not Black and White’\u003c/strong>\u003c/p>\n\u003cp>Perhaps the most prevalent alternative treatment STAT found on offer is acupuncture. It’s promoted for more than a dozen conditions, including high blood pressure, sinus problems, infertility, migraines, and digestive irregularities.\u003c/p>\n\u003cp>A 3,000-year-old Chinese therapy, acupuncture is based on the belief that by stimulating certain points on the body, most often with needles, practitioners can unlock a natural healing energy that flows through the body’s “meridians.” Research suggests it helps with certain pain conditions and might help prevent migraine headaches — but it also suggests that the placebo effect may play an important role.\u003c/p>\n\u003cp>Its value in treating other conditions is uncertain, according to the NIH’s center on integrative medicine.\u003c/p>\n\u003cp>Several major insurers, including Aetna, Anthem, and regional Blue Cross Blue Shield affiliates, cover acupuncture as a treatment for chronic pain and nausea. But the Centers for Medicare and Medicaid Services won’t pay for acupuncture, dismissing the scientific evidence as insufficient.\u003c/p>\n\u003cp>Still, it’s important for physicians to keep an open mind, said Lang, the interim director of the Cleveland Clinic Wellness Institute.\u003c/p>\n\u003cp>He said, for example, that he used to avoid referring patients for acupuncture, until he saw the benefit it provided to some of them. “I have seen it work in some chronic pain situations,” said Lang. “It can be very helpful. If it doesn’t work, I don’t know that you’ve lost anything. If it does, you do get to a better place.”\u003c/p>\n\u003cp>And while the evidence of its efficacy is not ironclad, neither is the evidence for various pharmaceutical therapies that are routinely provided by hospitals and covered by insurance. Some of those solutions, such as opioids to treat pain, have resulted in addiction and harm to patients.\u003c/p>\n\u003cp>Advocates of alternative medicine say it’s difficult to test some alternative therapies through rigorous clinical trials, primarily because treatment techniques vary from patient to patient. (The federal government does, however, spend roughly $120 million a year to fund research through the NIH National Center for Complementary and Integrative Health.)\u003c/p>\n\u003cp>They note, too, that traditional doctors sometimes stray from proven treatments, for instance when they prescribe medicines off-label for conditions the drugs have not been approved to treat.\u003c/p>\n\u003cp>“We do use things that aren’t necessarily 100 percent evidence-based, but I would argue that’s also true within all of medicine,” said Dr. Jill Schneiderhan, co-director of the University of Michigan’s integrative family medicine program. “I feel like it’s not black and white.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>\u003cspan style=\"font-weight: 400\">This \u003ca href=\"https://www.statnews.com/2017/03/07/alternative-medicine-hospitals-promote/\" target=\"_blank\">story\u003c/a> was originally published by STAT, an online publication of Boston Globe Media that covers health, medicine, and scientific discovery. \u003c/span>\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Don't Get EKG-Happy, Say Docs, as Heart Screening For Teens Questioned",
"title": "Don't Get EKG-Happy, Say Docs, as Heart Screening For Teens Questioned",
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"content": "\u003cp>Dozens of not-for-profit organizations have formed in the past decade to promote free or low-cost heart screenings for teens. The groups often claim such tests save lives by finding abnormalities that might pose a risk of sudden cardiac death.\u003c/p>\n\u003cp>But the efforts are raising concerns. There's no evidence that screening adolescents with \u003ca href=\"http://www.heart.org/HEARTORG/Conditions/HeartAttack/DiagnosingaHeartAttack/Electrocardiogram-ECG-or-EKG_UCM_309050_Article.jsp#.WKc4HTsrKUk\" target=\"_blank\">electrocardiograms\u003c/a> prevents deaths. Sudden cardiac death is rare in young people, and some physicians worry screening kids with no symptoms or family history of disease could do more harm than good. The tests can set off false alarms that can lead to follow-up tests and risky interventions or force some kids to quit sports unnecessarily.\u003c/p>\n\u003cp>\"There are harms that I don't think a lot of people realize,\" said Dr. Kristin Burns, who oversees a two-year-old \u003ca href=\"https://www.nhlbi.nih.gov/news/spotlight/fact-sheet/frequently-asked-questions-about-sudden-death-young-case-registry\">registry\u003c/a> at the National Institute of Health of sudden deaths in people under 20. It's one of several efforts aimed at gathering better data about cardiac abnormalities in kids.\u003c/p>\n\u003cp>Studies using limited data have found between \u003ca href=\"http://heartsmartekg.org/sites/ekgyourteen/files/SCD%20in%20the%20Young%20article.pdf\" target=\"_blank\">one and four sudden cardiac deaths\u003c/a> occur annually per 100,000 kids between ages 1 and 18. By comparison, 22 in 100,000 U.S. teens are killed each year in accidents, including those involving motor vehicles; 9 in 100,000 commit suicide, according to the Centers for Disease Control and Prevention.\u003c/p>\n\u003cp>Some screening advocates believe sudden cardiac deaths are underreported and that not enough is being done to spare families from the fate of losing a child. \"We have to acknowledge that every kid who drops dead, they've been failed by the current system,\" said Darren Sudman, who founded \u003ca href=\"http://www.simonsfund.org/\" target=\"_blank\">Simon's Fund\u003c/a>, a screening effort in greater Philadelphia in memory of his infant son, who died of an arrhythmia.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Screening programs say they're educating parents about the risks. \"What we want to emphasize is, make sure your kid is heart-safe,\" said Dr. Jonathan Drezner, a sports and family medicine specialist at \u003ca href=\"http://www.uwmedicine.org/bios/jonathan-drezner\">UW Medicine\u003c/a> and medical director of the Seattle-area \u003ca href=\"http://nickoftimefoundation.org/\">Nick of Time Foundation\u003c/a>.\u003c/p>\n\u003cp>Enthusiasm for EKGs, which measure the electrical activity in the heart to detect abnormalities, grew after a 2006 \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/17018804\">study\u003c/a> showed they lowered death rates among athletes in Italy. But research in other countries hasn't yielded similar results, and the Italian researchers recently \u003ca href=\"http://www.bmj.com/content/353/bmj.i2208\" target=\"_blank\">were accused of\u003c/a> refusing to share their data so it could be evaluated independently.\u003c/p>\n\u003cp>Some 60,000 to 70,000 U.S. teens were screened with EKGs in 2016, most by foundations created by families who lost a child to sudden cardiac death, said Sudman, who runs the online directory \u003ca href=\"http://www.screenacrossamerica.org/\" target=\"_blank\">Screen Across America\u003c/a>. It's unclear whether high school athletes face higher risk than nonathletes, so screening programs usually invite everybody.\u003c/p>\n\u003cp>Screenings typically are held in high schools and overseen by volunteer cardiologists, with funding from individuals and businesses including hospitals. A handful of hospitals and for-profit companies also run screenings.\u003c/p>\n\u003cp>It may be presumptuous to claim EKGs save lives, but parents often believe they do, said Sudman. \"If I find a heart condition, I promise you there are parents who are thanking me for savings their kid's life,\" he said.\u003c/p>\n\u003cp>That perception is stoked by tragic stories in the media of children who died suddenly after never reporting a symptom.\u003c/p>\n\u003cp>Meanwhile, the drawbacks of EKGs are seldom depicted. As many as 1 in 10 EKGs detects a potential abnormality, and the emotional and financial toll of such a finding can be significant — especially when they turn out to be wrong.\u003c/p>\n\u003cp>Following a screening EKG and echocardiogram last fall, Daniel Garza, 16, a talented sophomore basketball player in San Antonio, was told he had \u003ca href=\"https://medlineplus.gov/ency/article/000192.htm\">hypertrophic cardiomyopathy\u003c/a>, a thickening of the heart muscle and the most common cause of sudden cardiac death in young people. He was advised to quit all exercise, at least temporarily.\u003c/p>\n\u003cp>\"We were shocked, just shocked,\" said his mother, Denise. She said her son became depressed when he couldn't play the sport he enjoyed and excelled at. \"He came home and cried himself to sleep. He said, 'Mom, why did God give me this gift to take it away?' \"\u003c/p>\n\u003cp>The Garzas traveled to the Mayo Clinic in Rochester, Minn., where further tests indicated his enlarged heart was a benign condition known as athletic heart, a result of intense training. His mother estimates that correcting the misdiagnosis cost more than $20,000, including medical costs, travel and lost work.\u003c/p>\n\u003cp>Daniel has returned to the basketball court. Still, Denise Garza said the emotional toll was rough: \"It was one of the hardest things my family has ever endured.\"\u003c/p>\n\u003cp>Several cardiologists said they often see cases like this — or worse. Even after follow-up testing, it can be unclear which cases are life-threatening, so kids with low risk could be restricted from exercise or given life-altering interventions such as implantable defibrillators, surgery or anti-arrhythmic medications.\u003c/p>\n\u003cp>Medical groups have wrestled with the issue. The American Heart Association and the American College of Cardiology \u003ca href=\"http://circ.ahajournals.org/content/130/15/1303\" target=\"_blank\">recommended\u003c/a> in 2014 against mass ECG screening, noting that sudden cardiac death is rare in teens and false positives generate \"excessive and costly second-tier testing.\" ECGs also miss at least 1 in 10 cases of hypertrophic cardiomyopathy and more than 9 in 10 cases of congenital anomalies, the second-most-common cause.\u003c/p>\n\u003cp>But the medical panel accepted voluntary screening \"in relatively small cohorts,\" if there's physician involvement, quality control and a recognition of unreliable results and ancillary costs.\u003c/p>\n\u003cp>Efforts are underway to improve the accuracy of the screening programs. Some are adding \u003ca href=\"http://www.heart.org/HEARTORG/Conditions/HeartAttack/DiagnosingaHeartAttack/Echocardiogram%E2%80%94-Echo_UCM_451485_Article.jsp#.WKc5rjsrKUk\" target=\"_blank\">echocardiograms\u003c/a>, which use ultrasound to produce images of the heart, to assess potential abnormalities. Advocates say false positives have dropped as a result of better interpretation guidelines, known as the \u003ca href=\"https://www.amssm.org/BMJ_ECGModules.php\" target=\"_blank\">Seattle Criteria\u003c/a>, which are expected to soon be endorsed by cardiology societies in revised form.\u003c/p>\n\u003cp>But the criteria aren't perfect, and there's a \"giant gap\" in training cardiologists to use them, said Drezner, one of the developers. He's also a medical adviser for \u003ca href=\"https://parentheartwatch.org/\" target=\"_blank\">Parent Heart Watch\u003c/a>, a consortium of foundations. \"If I was a parent, I'd want to know about the experience of the (cardiologists) and what they're going to do to help my kid if they have a positive screen.\"\u003c/p>\n\u003cp>One problem with EKGs is a lack of good data.\u003c/p>\n\u003cp>\"There's no evidence we have that [EKG] screening saves lives,\" said Dr. Jonathan Kaltman of the National Heart, Lung, and Blood Institute. \"There's never been a controlled clinical trial, which is the only way to answer that question.\"\u003c/p>\n\u003cp>At the urging of screening advocates, the NIH partnered with the Centers for Disease Control and Prevention to rigorously track cardiac deaths as part of a Sudden Death in the Young Case Registry. So far a handful of states and counties have joined the effort, which helps local health departments collect better data. The goal is to standardize death investigations and get a firm handle on how often kids die from heart abnormalities as well as the role of factors such as genetics. Initial findings are expected to be available in about two years. The NIH is also funding three university-based research groups to answer key questions about sudden cardiac death in the young.\u003c/p>\n\u003cp>Some screening organizations are getting behind a nascent initiative with the \u003ca href=\"http://cardiac-safety.org/\" target=\"_blank\">Cardiac Safety Research Consortium\u003c/a> to harness their own screening data for research. It would require standardizing their practices and tracking outcomes, which organizations aren't now equipped to do.\u003c/p>\n\u003cp>\"Screening is happening. We can't avoid that,\" said Dr. Salim Idriss, director of pediatric electrophysiology at Duke University and co-chair of the initiative. \"We have a really good opportunity to get the data we need to make it better.\"\u003c/p>\n\u003cp>Separately, the UT Southwestern Medical Center in Dallas recently began a \u003ca href=\"http://www.utsouthwestern.edu/newsroom/news-releases/year-2016/september/ecg-athletes-levine.html\" target=\"_blank\">four-year pilot study \u003c/a>involving athletes and band members at eight high schools to determine the feasibility of a full-scale randomized controlled trial.\u003c/p>\n\u003cp>A valid finding on the overarching question of whether EKG screening saves lives could require at least 800,000 participants and a cost of $15 million, said Dr. Benjamin Levine, a cardiologist and the lead researcher.\u003c/p>\n\u003cp>The pilot is partly a response to legislation that would mandate EKGs for student athletes in Texas. A similar bill was also introduced in South Carolina. Both bills failed, but it's expected there will be more attempts to mandate EKGs, leaving state legislators looking for better guidance.\u003c/p>\n\u003cp>\"We're not going to solve this by having more debates, but by having more data,\" Levine said.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>Kaiser Health News is an editorially independent news service that is part of the nonpartisan Henry J. Kaiser Family Foundation.\u003c/em> \u003cem>Mary Chris Jaklevic is a freelance health and environment writer based in Chicago. She's on Twitter: \u003c/em>\u003ca href=\"https://twitter.com/mcjaklevic\">@mcjaklevic\u003c/a>.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 Kaiser Health News. To see more, visit \u003ca href=\"http://www.kaiserhealthnews.org/\">Kaiser Health News\u003c/a>.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Heart+Screening+For+Teens+May+Cause+More+Problems+Than+It+Solves&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Dozens of not-for-profit organizations have formed in the past decade to promote free or low-cost heart screenings for teens. The groups often claim such tests save lives by finding abnormalities that might pose a risk of sudden cardiac death.\u003c/p>\n\u003cp>But the efforts are raising concerns. There's no evidence that screening adolescents with \u003ca href=\"http://www.heart.org/HEARTORG/Conditions/HeartAttack/DiagnosingaHeartAttack/Electrocardiogram-ECG-or-EKG_UCM_309050_Article.jsp#.WKc4HTsrKUk\" target=\"_blank\">electrocardiograms\u003c/a> prevents deaths. Sudden cardiac death is rare in young people, and some physicians worry screening kids with no symptoms or family history of disease could do more harm than good. The tests can set off false alarms that can lead to follow-up tests and risky interventions or force some kids to quit sports unnecessarily.\u003c/p>\n\u003cp>\"There are harms that I don't think a lot of people realize,\" said Dr. Kristin Burns, who oversees a two-year-old \u003ca href=\"https://www.nhlbi.nih.gov/news/spotlight/fact-sheet/frequently-asked-questions-about-sudden-death-young-case-registry\">registry\u003c/a> at the National Institute of Health of sudden deaths in people under 20. It's one of several efforts aimed at gathering better data about cardiac abnormalities in kids.\u003c/p>\n\u003cp>Studies using limited data have found between \u003ca href=\"http://heartsmartekg.org/sites/ekgyourteen/files/SCD%20in%20the%20Young%20article.pdf\" target=\"_blank\">one and four sudden cardiac deaths\u003c/a> occur annually per 100,000 kids between ages 1 and 18. By comparison, 22 in 100,000 U.S. teens are killed each year in accidents, including those involving motor vehicles; 9 in 100,000 commit suicide, according to the Centers for Disease Control and Prevention.\u003c/p>\n\u003cp>Some screening advocates believe sudden cardiac deaths are underreported and that not enough is being done to spare families from the fate of losing a child. \"We have to acknowledge that every kid who drops dead, they've been failed by the current system,\" said Darren Sudman, who founded \u003ca href=\"http://www.simonsfund.org/\" target=\"_blank\">Simon's Fund\u003c/a>, a screening effort in greater Philadelphia in memory of his infant son, who died of an arrhythmia.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Screening programs say they're educating parents about the risks. \"What we want to emphasize is, make sure your kid is heart-safe,\" said Dr. Jonathan Drezner, a sports and family medicine specialist at \u003ca href=\"http://www.uwmedicine.org/bios/jonathan-drezner\">UW Medicine\u003c/a> and medical director of the Seattle-area \u003ca href=\"http://nickoftimefoundation.org/\">Nick of Time Foundation\u003c/a>.\u003c/p>\n\u003cp>Enthusiasm for EKGs, which measure the electrical activity in the heart to detect abnormalities, grew after a 2006 \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/17018804\">study\u003c/a> showed they lowered death rates among athletes in Italy. But research in other countries hasn't yielded similar results, and the Italian researchers recently \u003ca href=\"http://www.bmj.com/content/353/bmj.i2208\" target=\"_blank\">were accused of\u003c/a> refusing to share their data so it could be evaluated independently.\u003c/p>\n\u003cp>Some 60,000 to 70,000 U.S. teens were screened with EKGs in 2016, most by foundations created by families who lost a child to sudden cardiac death, said Sudman, who runs the online directory \u003ca href=\"http://www.screenacrossamerica.org/\" target=\"_blank\">Screen Across America\u003c/a>. It's unclear whether high school athletes face higher risk than nonathletes, so screening programs usually invite everybody.\u003c/p>\n\u003cp>Screenings typically are held in high schools and overseen by volunteer cardiologists, with funding from individuals and businesses including hospitals. A handful of hospitals and for-profit companies also run screenings.\u003c/p>\n\u003cp>It may be presumptuous to claim EKGs save lives, but parents often believe they do, said Sudman. \"If I find a heart condition, I promise you there are parents who are thanking me for savings their kid's life,\" he said.\u003c/p>\n\u003cp>That perception is stoked by tragic stories in the media of children who died suddenly after never reporting a symptom.\u003c/p>\n\u003cp>Meanwhile, the drawbacks of EKGs are seldom depicted. As many as 1 in 10 EKGs detects a potential abnormality, and the emotional and financial toll of such a finding can be significant — especially when they turn out to be wrong.\u003c/p>\n\u003cp>Following a screening EKG and echocardiogram last fall, Daniel Garza, 16, a talented sophomore basketball player in San Antonio, was told he had \u003ca href=\"https://medlineplus.gov/ency/article/000192.htm\">hypertrophic cardiomyopathy\u003c/a>, a thickening of the heart muscle and the most common cause of sudden cardiac death in young people. He was advised to quit all exercise, at least temporarily.\u003c/p>\n\u003cp>\"We were shocked, just shocked,\" said his mother, Denise. She said her son became depressed when he couldn't play the sport he enjoyed and excelled at. \"He came home and cried himself to sleep. He said, 'Mom, why did God give me this gift to take it away?' \"\u003c/p>\n\u003cp>The Garzas traveled to the Mayo Clinic in Rochester, Minn., where further tests indicated his enlarged heart was a benign condition known as athletic heart, a result of intense training. His mother estimates that correcting the misdiagnosis cost more than $20,000, including medical costs, travel and lost work.\u003c/p>\n\u003cp>Daniel has returned to the basketball court. Still, Denise Garza said the emotional toll was rough: \"It was one of the hardest things my family has ever endured.\"\u003c/p>\n\u003cp>Several cardiologists said they often see cases like this — or worse. Even after follow-up testing, it can be unclear which cases are life-threatening, so kids with low risk could be restricted from exercise or given life-altering interventions such as implantable defibrillators, surgery or anti-arrhythmic medications.\u003c/p>\n\u003cp>Medical groups have wrestled with the issue. The American Heart Association and the American College of Cardiology \u003ca href=\"http://circ.ahajournals.org/content/130/15/1303\" target=\"_blank\">recommended\u003c/a> in 2014 against mass ECG screening, noting that sudden cardiac death is rare in teens and false positives generate \"excessive and costly second-tier testing.\" ECGs also miss at least 1 in 10 cases of hypertrophic cardiomyopathy and more than 9 in 10 cases of congenital anomalies, the second-most-common cause.\u003c/p>\n\u003cp>But the medical panel accepted voluntary screening \"in relatively small cohorts,\" if there's physician involvement, quality control and a recognition of unreliable results and ancillary costs.\u003c/p>\n\u003cp>Efforts are underway to improve the accuracy of the screening programs. Some are adding \u003ca href=\"http://www.heart.org/HEARTORG/Conditions/HeartAttack/DiagnosingaHeartAttack/Echocardiogram%E2%80%94-Echo_UCM_451485_Article.jsp#.WKc5rjsrKUk\" target=\"_blank\">echocardiograms\u003c/a>, which use ultrasound to produce images of the heart, to assess potential abnormalities. Advocates say false positives have dropped as a result of better interpretation guidelines, known as the \u003ca href=\"https://www.amssm.org/BMJ_ECGModules.php\" target=\"_blank\">Seattle Criteria\u003c/a>, which are expected to soon be endorsed by cardiology societies in revised form.\u003c/p>\n\u003cp>But the criteria aren't perfect, and there's a \"giant gap\" in training cardiologists to use them, said Drezner, one of the developers. He's also a medical adviser for \u003ca href=\"https://parentheartwatch.org/\" target=\"_blank\">Parent Heart Watch\u003c/a>, a consortium of foundations. \"If I was a parent, I'd want to know about the experience of the (cardiologists) and what they're going to do to help my kid if they have a positive screen.\"\u003c/p>\n\u003cp>One problem with EKGs is a lack of good data.\u003c/p>\n\u003cp>\"There's no evidence we have that [EKG] screening saves lives,\" said Dr. Jonathan Kaltman of the National Heart, Lung, and Blood Institute. \"There's never been a controlled clinical trial, which is the only way to answer that question.\"\u003c/p>\n\u003cp>At the urging of screening advocates, the NIH partnered with the Centers for Disease Control and Prevention to rigorously track cardiac deaths as part of a Sudden Death in the Young Case Registry. So far a handful of states and counties have joined the effort, which helps local health departments collect better data. The goal is to standardize death investigations and get a firm handle on how often kids die from heart abnormalities as well as the role of factors such as genetics. Initial findings are expected to be available in about two years. The NIH is also funding three university-based research groups to answer key questions about sudden cardiac death in the young.\u003c/p>\n\u003cp>Some screening organizations are getting behind a nascent initiative with the \u003ca href=\"http://cardiac-safety.org/\" target=\"_blank\">Cardiac Safety Research Consortium\u003c/a> to harness their own screening data for research. It would require standardizing their practices and tracking outcomes, which organizations aren't now equipped to do.\u003c/p>\n\u003cp>\"Screening is happening. We can't avoid that,\" said Dr. Salim Idriss, director of pediatric electrophysiology at Duke University and co-chair of the initiative. \"We have a really good opportunity to get the data we need to make it better.\"\u003c/p>\n\u003cp>Separately, the UT Southwestern Medical Center in Dallas recently began a \u003ca href=\"http://www.utsouthwestern.edu/newsroom/news-releases/year-2016/september/ecg-athletes-levine.html\" target=\"_blank\">four-year pilot study \u003c/a>involving athletes and band members at eight high schools to determine the feasibility of a full-scale randomized controlled trial.\u003c/p>\n\u003cp>A valid finding on the overarching question of whether EKG screening saves lives could require at least 800,000 participants and a cost of $15 million, said Dr. Benjamin Levine, a cardiologist and the lead researcher.\u003c/p>\n\u003cp>The pilot is partly a response to legislation that would mandate EKGs for student athletes in Texas. A similar bill was also introduced in South Carolina. Both bills failed, but it's expected there will be more attempts to mandate EKGs, leaving state legislators looking for better guidance.\u003c/p>\n\u003cp>\"We're not going to solve this by having more debates, but by having more data,\" Levine said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>Kaiser Health News is an editorially independent news service that is part of the nonpartisan Henry J. Kaiser Family Foundation.\u003c/em> \u003cem>Mary Chris Jaklevic is a freelance health and environment writer based in Chicago. She's on Twitter: \u003c/em>\u003ca href=\"https://twitter.com/mcjaklevic\">@mcjaklevic\u003c/a>.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 Kaiser Health News. To see more, visit \u003ca href=\"http://www.kaiserhealthnews.org/\">Kaiser Health News\u003c/a>.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Heart+Screening+For+Teens+May+Cause+More+Problems+Than+It+Solves&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>https://www.youtube.com/watch?v=i6GHhqPMVZ4\u003c/p>\n\u003cp>Can your social status make you sick?\u003c/p>\n\u003cp>And can what you \u003cem>think\u003c/em> is your social status make you sick?\u003c/p>\n\u003cp>Researchers have long known that your social class, or where you are on the social ladder in terms of income, education and employment, is one of the most powerful predictors of health, more powerful, even, than genetics and smoking.\u003c/p>\n\u003cp>But research has shown there is another important social factor that affects health, though it doesn't get as much attention: your \u003ci>perception \u003c/i>of your social status, regardless of what it actually is.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>This 2016 \u003ca href=\"http://journals.sagepub.com/doi/abs/10.1177/0044118X16646028\" target=\"_blank\">study,\u003c/a> for example, looked at the health of adolescents in relation to both their parents' social class and the teens' \u003cem>subjective\u003c/em> social class. The researchers discovered that the actual social class of the parents did not predict certain health outcomes among their children as much as the teens' \u003cem>perceived\u003c/em> social class compared to classmates.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>For more on social status and its relation to health, watch the video above, from \"\u003ca href=\"https://www.youtube.com/abovethenoise\" target=\"_blank\">Above the Noise\u003c/a>,\" KQED's new YouTube series for teens.\u003c/p>\n\n",
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"excerpt": "Researchers have long known that social class is a powerful predictor of health. But there is another important factor that doesn’t get as much attention: your \u003ci>perception\u003c/i> of your social status, regardless of what it actually is. ",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\u003cp>\u003cspan class='utils-parseShortcode-shortcodes-__youtubeShortcode__embedYoutube'>\n \u003cspan class='utils-parseShortcode-shortcodes-__youtubeShortcode__embedYoutubeInside'>\n \u003ciframe\n loading='lazy'\n class='utils-parseShortcode-shortcodes-__youtubeShortcode__youtubePlayer'\n type='text/html'\n src='//www.youtube.com/embed/i6GHhqPMVZ4'\n title='//www.youtube.com/embed/i6GHhqPMVZ4'\n allowfullscreen='true'\n style='border:0;'>\u003c/iframe>\n \u003c/span>\n \u003c/span>\u003c/p>\u003cp>\u003cp>Can your social status make you sick?\u003c/p>\n\u003cp>And can what you \u003cem>think\u003c/em> is your social status make you sick?\u003c/p>\n\u003cp>Researchers have long known that your social class, or where you are on the social ladder in terms of income, education and employment, is one of the most powerful predictors of health, more powerful, even, than genetics and smoking.\u003c/p>\n\u003cp>But research has shown there is another important social factor that affects health, though it doesn't get as much attention: your \u003ci>perception \u003c/i>of your social status, regardless of what it actually is.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>This 2016 \u003ca href=\"http://journals.sagepub.com/doi/abs/10.1177/0044118X16646028\" target=\"_blank\">study,\u003c/a> for example, looked at the health of adolescents in relation to both their parents' social class and the teens' \u003cem>subjective\u003c/em> social class. The researchers discovered that the actual social class of the parents did not predict certain health outcomes among their children as much as the teens' \u003cem>perceived\u003c/em> social class compared to classmates.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>For more on social status and its relation to health, watch the video above, from \"\u003ca href=\"https://www.youtube.com/abovethenoise\" target=\"_blank\">Above the Noise\u003c/a>,\" KQED's new YouTube series for teens.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Significantly Longer Life Expectancy Coming. For Americans, Not So Much: Study",
"title": "Significantly Longer Life Expectancy Coming. For Americans, Not So Much: Study",
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"content": "\u003cp>People born in 2030 will have longer lives than scientists once thought possible, but American babies born in 2030 will continue to have one of the lowest life expectancies of any developed country, according to a \u003ca href=\"http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)32381-9/abstract\" target=\"_blank\">new study\u003c/a>.\u003c/p>\n\u003caside class=\"pullquote alignright\">'I can imagine that there is a limit, but we are still very far from it.'\u003c/aside>\n\u003cp>Scientists once thought an average life expectancy beyond 90 was impossible but medical advances combined with improved social programs are continuing to break barriers, including in countries where many people already live well into old age, according to the study's lead researcher, Majid Ezzati of Imperial College London.\u003c/p>\n\u003cp>\"I can imagine that there is a limit,\" he said, \"but we are still very far from it.\"\u003c/p>\n\u003cp>Ezzati estimated that someday people could survive on average to at least 110 or 120 years.\u003c/p>\n\u003cp>The study shows South Korean girls born in 2030 are likely to have the greatest lifespan. They'll have a more than 50 percent chance of living past 90 --that's roughly 7 years longer than South Korean girls born in 2010. The longevity of South Korean women estimated in 2030 is due largely to investments in universal health care, he said. South Korea also led the list for men.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"It's basically the opposite of what we're doing in the West, where there's a lot of austerity and inequality,\" he said.\u003c/p>\n\u003cp>Ezzati and his co-authors used death and longevity trends to estimate life expectancy in 35 developed countries for a baby born in 2030. The study was published online Tuesday in \u003ca href=\"http://www.thelancet.com/journals/lancet/issue/current\" target=\"_blank\">The Lancet\u003c/a>.\u003c/p>\n\u003cp>Women were ahead of men in all countries. Behind South Korea, women in France, Japan, Spain and Switzerland were projected to live until 88. For South Korea men, life expectancy is expected to reach 84. Next were Australia, Switzerland, Canada and the Netherlands at nearly 84.\u003c/p>\n\u003cp>At the bottom of the list: Macedonia for women at nearly 78, and Serbia for men at about 73.\u003c/p>\n\u003cp>While some genetic factors might explain the longevity in certain countries, Ezzati said, social and environmental factors were probably more important.\u003c/p>\n\u003cp>The study estimated that the U.S., which already lags behind other developed countries, will fall even further behind by 2030, when men and women are projected to live to 80 and 83. American women will fall to 27th out of 35 countries, from their current ranking of 25, and men will fall from 23rd to 26th.\u003c/p>\n\u003cp>The researchers note that, among rich countries, the U.S. has the highest maternal and child death rates, homicide rate and body-mass index. It's the only country in the Organisation for Economic Co-operation and Development (OECD) without universal health care. \"The poor recent and projected U.S. performance is at least partly due to high and inequitable mortality from chronic diseases and violence, and insufficient and inequitable health care,\" the study notes.\u003c/p>\n\u003cp>In an accompanying commentary, Ailiana Santosa of Umea University in Sweden wrote that the projections raise \"crucial issues\" about which strategies are needed to tackle worsening inequality problems.\u003c/p>\n\u003cp>\"Achieving universal health coverage is worthy, plausible and needs to be continued,\" she said.\u003c/p>\n\u003cp>The study was paid for by the U.K. Medical Research Council and the U.S. Environmental Protection Agency.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Editor's Note: This article has been edited for clarity.\u003c/em>\u003c/p>\n\n",
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"excerpt": "People born in 2030 will have longer lives than once thought possible. American babies, however, will continue to have one of the lowest life expectancies of any developed country, according to a new study.",
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"title": "Significantly Longer Life Expectancy Coming. For Americans, Not So Much: Study | KQED",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>People born in 2030 will have longer lives than scientists once thought possible, but American babies born in 2030 will continue to have one of the lowest life expectancies of any developed country, according to a \u003ca href=\"http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)32381-9/abstract\" target=\"_blank\">new study\u003c/a>.\u003c/p>\n\u003caside class=\"pullquote alignright\">'I can imagine that there is a limit, but we are still very far from it.'\u003c/aside>\n\u003cp>Scientists once thought an average life expectancy beyond 90 was impossible but medical advances combined with improved social programs are continuing to break barriers, including in countries where many people already live well into old age, according to the study's lead researcher, Majid Ezzati of Imperial College London.\u003c/p>\n\u003cp>\"I can imagine that there is a limit,\" he said, \"but we are still very far from it.\"\u003c/p>\n\u003cp>Ezzati estimated that someday people could survive on average to at least 110 or 120 years.\u003c/p>\n\u003cp>The study shows South Korean girls born in 2030 are likely to have the greatest lifespan. They'll have a more than 50 percent chance of living past 90 --that's roughly 7 years longer than South Korean girls born in 2010. The longevity of South Korean women estimated in 2030 is due largely to investments in universal health care, he said. South Korea also led the list for men.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"It's basically the opposite of what we're doing in the West, where there's a lot of austerity and inequality,\" he said.\u003c/p>\n\u003cp>Ezzati and his co-authors used death and longevity trends to estimate life expectancy in 35 developed countries for a baby born in 2030. The study was published online Tuesday in \u003ca href=\"http://www.thelancet.com/journals/lancet/issue/current\" target=\"_blank\">The Lancet\u003c/a>.\u003c/p>\n\u003cp>Women were ahead of men in all countries. Behind South Korea, women in France, Japan, Spain and Switzerland were projected to live until 88. For South Korea men, life expectancy is expected to reach 84. Next were Australia, Switzerland, Canada and the Netherlands at nearly 84.\u003c/p>\n\u003cp>At the bottom of the list: Macedonia for women at nearly 78, and Serbia for men at about 73.\u003c/p>\n\u003cp>While some genetic factors might explain the longevity in certain countries, Ezzati said, social and environmental factors were probably more important.\u003c/p>\n\u003cp>The study estimated that the U.S., which already lags behind other developed countries, will fall even further behind by 2030, when men and women are projected to live to 80 and 83. American women will fall to 27th out of 35 countries, from their current ranking of 25, and men will fall from 23rd to 26th.\u003c/p>\n\u003cp>The researchers note that, among rich countries, the U.S. has the highest maternal and child death rates, homicide rate and body-mass index. It's the only country in the Organisation for Economic Co-operation and Development (OECD) without universal health care. \"The poor recent and projected U.S. performance is at least partly due to high and inequitable mortality from chronic diseases and violence, and insufficient and inequitable health care,\" the study notes.\u003c/p>\n\u003cp>In an accompanying commentary, Ailiana Santosa of Umea University in Sweden wrote that the projections raise \"crucial issues\" about which strategies are needed to tackle worsening inequality problems.\u003c/p>\n\u003cp>\"Achieving universal health coverage is worthy, plausible and needs to be continued,\" she said.\u003c/p>\n\u003cp>The study was paid for by the U.K. Medical Research Council and the U.S. Environmental Protection Agency.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Editor's Note: This article has been edited for clarity.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "20 Years After Dolly: Cloning Past, Present and Future",
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"content": "\u003cp>It’s been 20 years since scientists in Scotland told the world about \u003ca href=\"http://dolly.roslin.ed.ac.uk/facts/the-life-of-dolly/\">Dolly the sheep\u003c/a>, the first mammal successfully \u003ca href=\"http://dx.doi.org/10.1038/385810a0\">cloned from an adult body cell\u003c/a>. What was special about Dolly is that her “parents” were actually a single cell originating from mammary tissue of an adult ewe. Dolly was an exact genetic copy of that sheep – a clone.\u003c/p>\n\u003cp>Dolly captured people’s imaginations, but those of us in the field had seen her coming through \u003ca href=\"http://doi.org/10.1038/380064a0\">previous research\u003c/a>. I’ve been working with \u003ca href=\"http://doi.org/10.1002/jez.1402280217\">mammalian embryos for over 40 years\u003c/a>, with some work in my lab specifically focusing on various methods of cloning cattle and other livestock species. In fact, one of the coauthors of the paper announcing Dolly worked in our laboratory for three years prior to going to Scotland to help create the famous clone.\u003c/p>\n\u003caside class=\"pullquote alignright\">The endgame was never meant to be armies of genetically identical livestock.\u003c/aside>\n\u003cp>Dolly was an important milestone, inspiring scientists to continue improving cloning technology as well as to pursue new concepts in stem cell research. The endgame was never meant to be armies of genetically identical livestock: Rather, researchers continue to refine the techniques and combine them with other methods to turbocharge traditional animal breeding methods as well as gain insights into aging and disease.\u003c/p>\n\u003cp>\u003cstrong>Not the Usual Sperm + Egg\u003c/strong>\u003c/p>\n\u003cp>Dolly was a perfectly normal sheep who became the mother of numerous normal lambs. She lived to six and a half years, when she \u003ca href=\"http://www.nature.com/news/1998/030217/full/news030217-6.html\">was eventually put down\u003c/a> after a contagious disease spread through her flock, infecting cloned and normally reproduced sheep alike. Her life wasn’t unusual; it’s her origin that made her unique.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Before the decades of experiments that led to Dolly, it was thought that normal animals could be produced only by fertilization of an egg by a sperm. That’s how things naturally work. These germ cells are the only ones in the body that have their genetic material all jumbled up and in half the quantity of every other kind of cell. That way when these so-called haploid cells come together at fertilization, they produce one cell with the full complement of DNA. Joined together, the cell is termed diploid, for twice, or double. Two halves make a whole.\u003c/p>\n\u003cp>From that moment forward, nearly all cells in that body have the same genetic makeup. When the one-cell embryo duplicates its genetic material, both cells of the now two-cell embryo are genetically identical. When they in turn duplicate their genetic material, each cell at the four-cell stage is genetically identical. This pattern goes on so that each of the trillions of cells in an adult is genetically exactly the same – whether it’s in a lung or a bone or the blood.\u003c/p>\n\u003cfigure id=\"attachment_345327\" class=\"wp-caption aligncenter\" style=\"max-width: 760px\">\u003cimg class=\"wp-image-345327 size-full\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/02/scnt.gif\" alt=\"Somatic cell nuclear transfer\" width=\"760\" height=\"420\">\u003cfigcaption class=\"wp-caption-text\">Somatic cell nuclear transfer uses genetic material from a body cell. \u003ccite>(Australian Department of Industry)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>In contrast, Dolly was produced by what’s called \u003ca href=\"http://doi.org/10.1146/annurev-animal-031412-103709\">somatic cell nuclear transfer\u003c/a>. In this process, researchers remove the genetic material from an egg and replace it with the nucleus of some other body cell. The resulting egg becomes a factory to produce an embryo that develops into an offspring. No sperm is in the picture; instead of half the genetic material coming from a sperm and half from an egg, it all comes from a single cell. It’s diploid from the start.\u003c/p>\n\u003cp>\u003cstrong>Long Research Path Led to Dolly\u003c/strong>\u003c/p>\n\u003cp>Dolly was the culmination of hundreds of cloning experiments that, for example, showed diploid embryonic and fetal cells could be parents of offspring. But there was no way to easily know all the characteristics of the animal that would result from a cloned embryo or fetus. Researchers could freeze a few of the cells of a 16-cell embryo, while going on to produce clones from the other cells; if a desirable animal was produced, they could thaw the frozen cells and make more copies. But this was impractical because of low success rates.\u003c/p>\n\u003cp>Dolly demonstrated that adult somatic cells also could be used as parents. Thus, one could know the characteristics of the animal being cloned.\u003c/p>\n\u003cp>By my calculations, Dolly was the single success from 277 tries at somatic cell nuclear transfer. Sometimes the process of cloning by somatic cell nuclear transfer still produces abnormal embryos, most of which die. But the process has greatly improved so success rates \u003ca href=\"http://www.fda.gov/AnimalVeterinary/SafetyHealth/AnimalCloning/ucm124840.htm\">now are more like 10 percent\u003c/a>; it’s highly variable, though, depending on the cell type used and the species.\u003c/p>\n\u003cp>More than 10 different cell types have been used successfully as “parents” for cloning. These days most cloning is done using cells obtained by \u003ca href=\"http://assets.redangus.org/media/Documents/ARA_Magazine/Archived_Issues/2006/11-November/An_Update_On_The_Science_And_Commercialization_Of_Cloning_Cattle.pdf\">biopsying skin\u003c/a>.\u003c/p>\n\u003cp>\u003cstrong>More Than Genes Can Affect a Clone\u003c/strong>\u003c/p>\n\u003cp>Genetics is only part of the story. Even while clones are genetically identical, their phenotypes – the characteristics they express – will be different. It’s like naturally occurring identical twins: They share all their genes \u003ca href=\"http://doi.org/10.1016/b978-012174597-4.50012-0\">but they’re not really exactly alike\u003c/a>, especially if reared in different settings.\u003c/p>\n\u003cp>Environment plays a huge role for some characteristics. Food availability can influence weight. Diseases can stunt growth. These kinds of lifestyle, nutrition or disease effects can influence which genes are turned on or off in an individual; these are called \u003ca href=\"http://learn.genetics.utah.edu/content/epigenetics/\">epigenetic effects\u003c/a>. Even though all the genetic material may be the same in two identical clones, they might not be expressing all the same genes.\u003c/p>\n\u003caside class=\"pullquote alignright\">In racehorses, good genes don't guarantee a winner.\u003c/aside>\n\u003cp>Consider the \u003ca href=\"http://doi.org/10.1530/REP-07-0069\">practice of cloning winning racehorses\u003c/a>. Clones of winners sometimes also will be winners – but most of the time they’re not. This is because winners are outliers; they need to have the right genetics, but also the right epigenetics and the right environment to reach that winning potential. For example, one can never exactly duplicate the uterine conditions a winning racehorse experienced when it was a developing fetus. Thus, cloning champions usually leads to disappointment. On the other hand, \u003ca href=\"http://www.wiley.com/WileyCDA/WileyTitle/productCd-0813819717.html\">cloning a stallion\u003c/a> that sires a high proportion of race-winning horses will result very reliably in a clone that similarly sires winners. This is a genetic rather than a phenotypic situation.\u003c/p>\n\u003cfigure id=\"attachment_345354\" class=\"wp-caption alignleft\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-345354\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/02/horses-430439_960_720-800x626.jpg\" alt=\"Racehorses\" width=\"800\" height=\"626\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/02/horses-430439_960_720-800x626.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2017/02/horses-430439_960_720-160x125.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/02/horses-430439_960_720-768x601.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2017/02/horses-430439_960_720-240x188.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/02/horses-430439_960_720-375x293.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/02/horses-430439_960_720-520x407.jpg 520w, https://ww2.kqed.org/app/uploads/sites/13/2017/02/horses-430439_960_720.jpg 920w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Cloning a winning racehorse is usually leads to disappointment. There is much more than genetics at work. \u003ccite>(Pixabay user Bhakti2)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Even though the genetics are reliable, there are aspects of the cloning procedure that mean the epigenetics and environment are suboptimal. For example, sperm have \u003ca href=\"http://doi.org/10.1016/j.rbmo.2010.02.015\">elegant ways of activating the eggs they fertilize\u003c/a>, which will die unless activated properly; with cloning, activation usually is accomplished by a strong electric shock. Many of the steps of cloning and subsequent embryonic development are done in test tubes in incubators. These conditions are not perfect substitutes for the female reproductive tract where fertilization and early embryonic development normally occur.\u003c/p>\n\u003cp>\u003ca href=\"http://doi.org/10.1038/nbt0102-13\">Sometimes abnormal fetuses develop to term\u003c/a>, resulting in \u003ca href=\"http://doi.org/10.1530/REP-07-0069\">abnormalities at birth\u003c/a>. The most striking abnormal phenotype of some clones is termed “\u003ca href=\"http://doi.org/10.1530/ror.0.0030155\">large offspring syndrome\u003c/a>,” in which calves or lambs are 30 or 40 percent larger than normal, resulting in difficult birth. The problems stem from \u003ca href=\"http://dx.doi.org/10.1016/j.theriogenology.2016.05.017\">an abnormal placenta\u003c/a>. At birth, these clones are genetically normal, but are overly large, and tend to be hyperinsulinemic and hypoglycemic. (The conditions normalize over time once the offspring is no longer influenced by the abnormal placenta.)\u003c/p>\n\u003cp>Recent improvements in cloning procedures have greatly reduced these abnormalities, which also occur with natural reproduction, but at a much lower incidence.\u003c/p>\n\u003cp>\u003cstrong>Continuing Onward With Cloning\u003c/strong>\u003c/p>\n\u003cp>Many thousands of cloned mammals have been produced in nearly two dozen species. Very few of these concern practical applications, such as cloning a famous Angus bull named Final Answer (who recently died at an old age) in order to produce more high-quality cattle via his clone’s sperm.\u003c/p>\n\u003cp>But the cloning research landscape is changing fast. The driving force for producing Dolly was not to \u003ca href=\"http://doi.org/10.1126/science.280.5368.1400\">produce genetically identical animals\u003c/a>. Rather researchers want to combine cloning techniques with other methods in order to efficiently change animals genetically – much quicker than traditional animal breeding methods that take decades to make changes in populations of species such as cattle.\u003c/p>\n\u003cp>One recent example is \u003ca href=\"http://doi.org/10.1038/nbt.3560\">introducing the polled (no horns) gene into dairy cattle\u003c/a>, thus eliminating the need for the painful process of dehorning. An even more striking application has been to produce a strain of pigs that is \u003ca href=\"http://doi.org/10.1038/nbt.3434\">incapable of being infected\u003c/a> by the very contagious and debilitating PRRS virus. Researchers have even made cattle that \u003ca href=\"http://doi.org/10.1038/nbt1271\">cannot develop Mad Cow Disease\u003c/a>. For each of these procedures, somatic cell nuclear transplantation is an essential part of the process.\u003c/p>\n\u003cp>To date, the most valuable contribution of these somatic cell nuclear transplantation experiments has been the scientific information and insights gained. They’ve enhanced our understanding of normal and abnormal embryonic development, including aspects of aging, and more. \u003ca href=\"http://doi.org/10.17226/24623\">This information is already helping\u003c/a> reduce birth defects, improve methods of circumventing infertility, develop tools to fight certain cancers and even decrease some of the negative consequences of aging – in livestock and even in people. Two decades since Dolly, important applications are still evolving.\u003cimg src=\"https://counter.theconversation.edu.au/content/72655/count.gif?distributor=republish-lightbox-basic\" alt=\"The Conversation\" width=\"1\" height=\"1\">\u003c/p>\n\u003cp>\u003cem>\u003ca href=\"https://theconversation.com/profiles/george-seidel-336737\">George Seidel\u003c/a> is a professor of biomedical science at \u003ca href=\"http://theconversation.com/institutions/colorado-state-university-1267\">Colorado State University\u003c/a>.\u003c/em>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This article was originally published on \u003ca href=\"http://theconversation.com\">The Conversation\u003c/a>. Read the \u003ca href=\"https://theconversation.com/20-years-after-dolly-everything-you-always-wanted-to-know-about-the-cloned-sheep-and-what-came-next-72655\">original article\u003c/a>.\u003c/em>\u003c/p>\n\n",
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"excerpt": "In 1997, Scottish scientists captured the world's attention by announcing the first successful cloning of a mammal, Dolly the sheep. Here, a look back at the insights Dolly gave researchers.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>It’s been 20 years since scientists in Scotland told the world about \u003ca href=\"http://dolly.roslin.ed.ac.uk/facts/the-life-of-dolly/\">Dolly the sheep\u003c/a>, the first mammal successfully \u003ca href=\"http://dx.doi.org/10.1038/385810a0\">cloned from an adult body cell\u003c/a>. What was special about Dolly is that her “parents” were actually a single cell originating from mammary tissue of an adult ewe. Dolly was an exact genetic copy of that sheep – a clone.\u003c/p>\n\u003cp>Dolly captured people’s imaginations, but those of us in the field had seen her coming through \u003ca href=\"http://doi.org/10.1038/380064a0\">previous research\u003c/a>. I’ve been working with \u003ca href=\"http://doi.org/10.1002/jez.1402280217\">mammalian embryos for over 40 years\u003c/a>, with some work in my lab specifically focusing on various methods of cloning cattle and other livestock species. In fact, one of the coauthors of the paper announcing Dolly worked in our laboratory for three years prior to going to Scotland to help create the famous clone.\u003c/p>\n\u003caside class=\"pullquote alignright\">The endgame was never meant to be armies of genetically identical livestock.\u003c/aside>\n\u003cp>Dolly was an important milestone, inspiring scientists to continue improving cloning technology as well as to pursue new concepts in stem cell research. The endgame was never meant to be armies of genetically identical livestock: Rather, researchers continue to refine the techniques and combine them with other methods to turbocharge traditional animal breeding methods as well as gain insights into aging and disease.\u003c/p>\n\u003cp>\u003cstrong>Not the Usual Sperm + Egg\u003c/strong>\u003c/p>\n\u003cp>Dolly was a perfectly normal sheep who became the mother of numerous normal lambs. She lived to six and a half years, when she \u003ca href=\"http://www.nature.com/news/1998/030217/full/news030217-6.html\">was eventually put down\u003c/a> after a contagious disease spread through her flock, infecting cloned and normally reproduced sheep alike. Her life wasn’t unusual; it’s her origin that made her unique.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Before the decades of experiments that led to Dolly, it was thought that normal animals could be produced only by fertilization of an egg by a sperm. That’s how things naturally work. These germ cells are the only ones in the body that have their genetic material all jumbled up and in half the quantity of every other kind of cell. That way when these so-called haploid cells come together at fertilization, they produce one cell with the full complement of DNA. Joined together, the cell is termed diploid, for twice, or double. Two halves make a whole.\u003c/p>\n\u003cp>From that moment forward, nearly all cells in that body have the same genetic makeup. When the one-cell embryo duplicates its genetic material, both cells of the now two-cell embryo are genetically identical. When they in turn duplicate their genetic material, each cell at the four-cell stage is genetically identical. This pattern goes on so that each of the trillions of cells in an adult is genetically exactly the same – whether it’s in a lung or a bone or the blood.\u003c/p>\n\u003cfigure id=\"attachment_345327\" class=\"wp-caption aligncenter\" style=\"max-width: 760px\">\u003cimg class=\"wp-image-345327 size-full\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/02/scnt.gif\" alt=\"Somatic cell nuclear transfer\" width=\"760\" height=\"420\">\u003cfigcaption class=\"wp-caption-text\">Somatic cell nuclear transfer uses genetic material from a body cell. \u003ccite>(Australian Department of Industry)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>In contrast, Dolly was produced by what’s called \u003ca href=\"http://doi.org/10.1146/annurev-animal-031412-103709\">somatic cell nuclear transfer\u003c/a>. In this process, researchers remove the genetic material from an egg and replace it with the nucleus of some other body cell. The resulting egg becomes a factory to produce an embryo that develops into an offspring. No sperm is in the picture; instead of half the genetic material coming from a sperm and half from an egg, it all comes from a single cell. It’s diploid from the start.\u003c/p>\n\u003cp>\u003cstrong>Long Research Path Led to Dolly\u003c/strong>\u003c/p>\n\u003cp>Dolly was the culmination of hundreds of cloning experiments that, for example, showed diploid embryonic and fetal cells could be parents of offspring. But there was no way to easily know all the characteristics of the animal that would result from a cloned embryo or fetus. Researchers could freeze a few of the cells of a 16-cell embryo, while going on to produce clones from the other cells; if a desirable animal was produced, they could thaw the frozen cells and make more copies. But this was impractical because of low success rates.\u003c/p>\n\u003cp>Dolly demonstrated that adult somatic cells also could be used as parents. Thus, one could know the characteristics of the animal being cloned.\u003c/p>\n\u003cp>By my calculations, Dolly was the single success from 277 tries at somatic cell nuclear transfer. Sometimes the process of cloning by somatic cell nuclear transfer still produces abnormal embryos, most of which die. But the process has greatly improved so success rates \u003ca href=\"http://www.fda.gov/AnimalVeterinary/SafetyHealth/AnimalCloning/ucm124840.htm\">now are more like 10 percent\u003c/a>; it’s highly variable, though, depending on the cell type used and the species.\u003c/p>\n\u003cp>More than 10 different cell types have been used successfully as “parents” for cloning. These days most cloning is done using cells obtained by \u003ca href=\"http://assets.redangus.org/media/Documents/ARA_Magazine/Archived_Issues/2006/11-November/An_Update_On_The_Science_And_Commercialization_Of_Cloning_Cattle.pdf\">biopsying skin\u003c/a>.\u003c/p>\n\u003cp>\u003cstrong>More Than Genes Can Affect a Clone\u003c/strong>\u003c/p>\n\u003cp>Genetics is only part of the story. Even while clones are genetically identical, their phenotypes – the characteristics they express – will be different. It’s like naturally occurring identical twins: They share all their genes \u003ca href=\"http://doi.org/10.1016/b978-012174597-4.50012-0\">but they’re not really exactly alike\u003c/a>, especially if reared in different settings.\u003c/p>\n\u003cp>Environment plays a huge role for some characteristics. Food availability can influence weight. Diseases can stunt growth. These kinds of lifestyle, nutrition or disease effects can influence which genes are turned on or off in an individual; these are called \u003ca href=\"http://learn.genetics.utah.edu/content/epigenetics/\">epigenetic effects\u003c/a>. Even though all the genetic material may be the same in two identical clones, they might not be expressing all the same genes.\u003c/p>\n\u003caside class=\"pullquote alignright\">In racehorses, good genes don't guarantee a winner.\u003c/aside>\n\u003cp>Consider the \u003ca href=\"http://doi.org/10.1530/REP-07-0069\">practice of cloning winning racehorses\u003c/a>. Clones of winners sometimes also will be winners – but most of the time they’re not. This is because winners are outliers; they need to have the right genetics, but also the right epigenetics and the right environment to reach that winning potential. For example, one can never exactly duplicate the uterine conditions a winning racehorse experienced when it was a developing fetus. Thus, cloning champions usually leads to disappointment. On the other hand, \u003ca href=\"http://www.wiley.com/WileyCDA/WileyTitle/productCd-0813819717.html\">cloning a stallion\u003c/a> that sires a high proportion of race-winning horses will result very reliably in a clone that similarly sires winners. This is a genetic rather than a phenotypic situation.\u003c/p>\n\u003cfigure id=\"attachment_345354\" class=\"wp-caption alignleft\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-345354\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/02/horses-430439_960_720-800x626.jpg\" alt=\"Racehorses\" width=\"800\" height=\"626\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/02/horses-430439_960_720-800x626.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2017/02/horses-430439_960_720-160x125.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/02/horses-430439_960_720-768x601.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2017/02/horses-430439_960_720-240x188.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/02/horses-430439_960_720-375x293.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/02/horses-430439_960_720-520x407.jpg 520w, https://ww2.kqed.org/app/uploads/sites/13/2017/02/horses-430439_960_720.jpg 920w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Cloning a winning racehorse is usually leads to disappointment. There is much more than genetics at work. \u003ccite>(Pixabay user Bhakti2)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Even though the genetics are reliable, there are aspects of the cloning procedure that mean the epigenetics and environment are suboptimal. For example, sperm have \u003ca href=\"http://doi.org/10.1016/j.rbmo.2010.02.015\">elegant ways of activating the eggs they fertilize\u003c/a>, which will die unless activated properly; with cloning, activation usually is accomplished by a strong electric shock. Many of the steps of cloning and subsequent embryonic development are done in test tubes in incubators. These conditions are not perfect substitutes for the female reproductive tract where fertilization and early embryonic development normally occur.\u003c/p>\n\u003cp>\u003ca href=\"http://doi.org/10.1038/nbt0102-13\">Sometimes abnormal fetuses develop to term\u003c/a>, resulting in \u003ca href=\"http://doi.org/10.1530/REP-07-0069\">abnormalities at birth\u003c/a>. The most striking abnormal phenotype of some clones is termed “\u003ca href=\"http://doi.org/10.1530/ror.0.0030155\">large offspring syndrome\u003c/a>,” in which calves or lambs are 30 or 40 percent larger than normal, resulting in difficult birth. The problems stem from \u003ca href=\"http://dx.doi.org/10.1016/j.theriogenology.2016.05.017\">an abnormal placenta\u003c/a>. At birth, these clones are genetically normal, but are overly large, and tend to be hyperinsulinemic and hypoglycemic. (The conditions normalize over time once the offspring is no longer influenced by the abnormal placenta.)\u003c/p>\n\u003cp>Recent improvements in cloning procedures have greatly reduced these abnormalities, which also occur with natural reproduction, but at a much lower incidence.\u003c/p>\n\u003cp>\u003cstrong>Continuing Onward With Cloning\u003c/strong>\u003c/p>\n\u003cp>Many thousands of cloned mammals have been produced in nearly two dozen species. Very few of these concern practical applications, such as cloning a famous Angus bull named Final Answer (who recently died at an old age) in order to produce more high-quality cattle via his clone’s sperm.\u003c/p>\n\u003cp>But the cloning research landscape is changing fast. The driving force for producing Dolly was not to \u003ca href=\"http://doi.org/10.1126/science.280.5368.1400\">produce genetically identical animals\u003c/a>. Rather researchers want to combine cloning techniques with other methods in order to efficiently change animals genetically – much quicker than traditional animal breeding methods that take decades to make changes in populations of species such as cattle.\u003c/p>\n\u003cp>One recent example is \u003ca href=\"http://doi.org/10.1038/nbt.3560\">introducing the polled (no horns) gene into dairy cattle\u003c/a>, thus eliminating the need for the painful process of dehorning. An even more striking application has been to produce a strain of pigs that is \u003ca href=\"http://doi.org/10.1038/nbt.3434\">incapable of being infected\u003c/a> by the very contagious and debilitating PRRS virus. Researchers have even made cattle that \u003ca href=\"http://doi.org/10.1038/nbt1271\">cannot develop Mad Cow Disease\u003c/a>. For each of these procedures, somatic cell nuclear transplantation is an essential part of the process.\u003c/p>\n\u003cp>To date, the most valuable contribution of these somatic cell nuclear transplantation experiments has been the scientific information and insights gained. They’ve enhanced our understanding of normal and abnormal embryonic development, including aspects of aging, and more. \u003ca href=\"http://doi.org/10.17226/24623\">This information is already helping\u003c/a> reduce birth defects, improve methods of circumventing infertility, develop tools to fight certain cancers and even decrease some of the negative consequences of aging – in livestock and even in people. Two decades since Dolly, important applications are still evolving.\u003cimg src=\"https://counter.theconversation.edu.au/content/72655/count.gif?distributor=republish-lightbox-basic\" alt=\"The Conversation\" width=\"1\" height=\"1\">\u003c/p>\n\u003cp>\u003cem>\u003ca href=\"https://theconversation.com/profiles/george-seidel-336737\">George Seidel\u003c/a> is a professor of biomedical science at \u003ca href=\"http://theconversation.com/institutions/colorado-state-university-1267\">Colorado State University\u003c/a>.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>This article was originally published on \u003ca href=\"http://theconversation.com\">The Conversation\u003c/a>. Read the \u003ca href=\"https://theconversation.com/20-years-after-dolly-everything-you-always-wanted-to-know-about-the-cloned-sheep-and-what-came-next-72655\">original article\u003c/a>.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Which doctor a person happens to see at a local emergency room can have long-term consequences when it comes to opioid use.\u003c/p>\n\u003cp>Within the same hospital, some doctors are three times more likely to prescribe an opioid than other doctors, and patients treated by high-prescribing doctors are more likely to become long-term opioid users, according to a study published recently in the \u003cem>New England Journal of Medicine\u003c/em>.\u003c/p>\n\u003cp>“Physicians are just doing things all over the map,” says Dr. Michael Barnett, an assistant professor at the Harvard T. H. Chan School of Public Health and one of the study’s authors. “This is a call to arms for people to start paying a lot more attention to having a unified approach.”\u003c/p>\n\u003cp>The study looked at how many opioid prescriptions emergency physicians gave to about 377,000 Medicare beneficiaries from 2008 through 2011. The lowest-prescribing quartile of doctors prescribed opioids to just 7 percent of patients, while the highest prescribed opioids to 24 percent — more than three times as often.\u003c/p>\n\u003cp>Patients who saw a high-intensity prescriber were about 30 percent more likely to end up with a long-term opioid prescription of at least six months within the year following their hospital visit. They were also more likely to return to the hospital in the next 12 months with an opioid-related fall or fracture, a risk factor for seniors who take the powerful painkillers.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Overall, about one in every 48 Medicare patients prescribed an opioid in the study were likely to become a long-term opioid user.\u003c/p>\n\u003cp>There is a growing consensus among doctors that opioids have long been overprescribed. In 2010, there were enough prescriptions written to supply every American adult with hydrocodone for a month, according to the \u003ca href=\"https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6043a4.htm\" target=\"_blank\">Centers for Disease Control and Prevention\u003c/a>.\u003c/p>\n\u003cp>Part of the problem, Barnett believes, is that there isn’t enough guidance for doctors on when it’s appropriate to prescribe an opioid. Much of the evidence for when they are appropriate comes from small studies sponsored by drug companies.\u003c/p>\n\u003cp>“It’s kind of a grey area and there’s not very clear evidence around what you should do, so we use our own judgement. And there’s a huge gulf between what one doctor thinks and another,” Barnett explains.\u003c/p>\n\u003cp>Take, for example, a patient who comes to the emergency room complaining of back pain. There’s evidence that opioids are not necessary in that situation, but many doctors prescribe them anyway, said Barnett. “The world of pain treatment outside of opioids is limited and can take time to figure out. Opioids are an easy fix.”\u003c/p>\n\u003cp>The problem, he said, is that “even one prescription for opioids carries risks with it, that from my own experience as a provider, we tend to underestimate and under-explain to patients.”\u003c/p>\n\u003cp>“It is very, very plausible that well-intentioned but perhaps overly aggressive prescribing of opioids makes it likely that a patient will continue a medication long-term even if they don’t truly need it,” said Dr. \u003ca href=\"http://ihpme.utoronto.ca/faculty/david-juurlink/\" target=\"_blank\">David Juurlink\u003c/a>, a professor of medicine at the University of Toronto. He was not involved in the study. “The doctors in the lowest quartile are the ones whose prescribing we should seek to be emulating.”\u003c/p>\n\u003cp>The study did not look at whether the opioids were correctly prescribed in each incidence. Dr. \u003ca href=\"http://californiahealthline.org/news/prescribing-opioids-to-seniors-its-a-balancing-act/\">Carla Perissinotto\u003c/a>, a geriatrician at the University of California San Francisco, worries that some of the doctors in the lowest quartile might be under-prescribing. “We have to be careful to not make assumptions too quickly and assume they’re bad prescribers, because it could be the opposite,” said Perissinotto, who also was not involved in the study.\u003c/p>\n\u003cp>Usually, a patient is prescribed just a handful of pills by a doctor at the emergency department to tide them over until the patient can visit his or her primary care physician.\u003c/p>\n\u003cp>But many primary care doctors simply refill the opioid prescription for another 30 days or longer, a phenomenon Barnett calls clinical inertia. “There’s this cognitive bias to keep going with the flow especially if the patient still feels they’re in pain.”\u003c/p>\n\u003cp>That can have long-term implications: One-third of people who have taken prescription opioids for at least two months say they became addicted to or physically dependent on them, a recent \u003ca href=\"https://www.washingtonpost.com/page/2010-2019/WashingtonPost/2016/12/09/National-Politics/Polling/release_455.xml\" target=\"_blank\">Washington Post-Kaiser Family Foundation survey found.\u003c/a>\u003c/p>\n\u003cp>“We know there is a population of people who will potentially get addicted if they’re exposed to an opioid,” said Dr. \u003ca href=\"http://njms.rutgers.edu/departments/emergency_medicine/\">Lewis Nelson\u003c/a>, chair of the department of emergency medicine at Rutgers New Jersey Medical School, who was not involved with the study. “It’s a numbers game. The more people you expose, the more people you are likely to hit in that population likely to get addicted.”\u003c/p>\n\u003cp>Some hospitals are starting to help doctors prescribe opioids more judiciously. Many of those efforts have taken place after 2011, and therefore any changes would not be seen in the New England Journal of Medicine study.\u003c/p>\n\u003cp>For the past year, St. Joseph’s Regional Medical Center in New Jersey has been instructing doctors to prescribe opioids only as a last resort, said Dr. \u003ca href=\"https://www.acep.org/About-Us/Mark-S--Rosenberg,-DO,-MBA,-FACEP/\" target=\"_blank\">Mark Rosenberg\u003c/a>, who runs the hospital’s emergency department and is on the board of the American College of Emergency Physicians. Rosenberg helped institute protocols that have doctors try other methods of pain relief first, such as a Novocain injection. In just over a year, the hospital has managed to reduce the number of opioid prescriptions written in the emergency room by 50 percent.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>New York City and Washington state have also tried to introduce opioid prescribing guidelines into hospitals, and the ACEP expects to release new nationwide guidelines for emergency physicians in 2018.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Which doctor a person happens to see at a local emergency room can have long-term consequences when it comes to opioid use.\u003c/p>\n\u003cp>Within the same hospital, some doctors are three times more likely to prescribe an opioid than other doctors, and patients treated by high-prescribing doctors are more likely to become long-term opioid users, according to a study published recently in the \u003cem>New England Journal of Medicine\u003c/em>.\u003c/p>\n\u003cp>“Physicians are just doing things all over the map,” says Dr. Michael Barnett, an assistant professor at the Harvard T. H. Chan School of Public Health and one of the study’s authors. “This is a call to arms for people to start paying a lot more attention to having a unified approach.”\u003c/p>\n\u003cp>The study looked at how many opioid prescriptions emergency physicians gave to about 377,000 Medicare beneficiaries from 2008 through 2011. The lowest-prescribing quartile of doctors prescribed opioids to just 7 percent of patients, while the highest prescribed opioids to 24 percent — more than three times as often.\u003c/p>\n\u003cp>Patients who saw a high-intensity prescriber were about 30 percent more likely to end up with a long-term opioid prescription of at least six months within the year following their hospital visit. They were also more likely to return to the hospital in the next 12 months with an opioid-related fall or fracture, a risk factor for seniors who take the powerful painkillers.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Overall, about one in every 48 Medicare patients prescribed an opioid in the study were likely to become a long-term opioid user.\u003c/p>\n\u003cp>There is a growing consensus among doctors that opioids have long been overprescribed. In 2010, there were enough prescriptions written to supply every American adult with hydrocodone for a month, according to the \u003ca href=\"https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6043a4.htm\" target=\"_blank\">Centers for Disease Control and Prevention\u003c/a>.\u003c/p>\n\u003cp>Part of the problem, Barnett believes, is that there isn’t enough guidance for doctors on when it’s appropriate to prescribe an opioid. Much of the evidence for when they are appropriate comes from small studies sponsored by drug companies.\u003c/p>\n\u003cp>“It’s kind of a grey area and there’s not very clear evidence around what you should do, so we use our own judgement. And there’s a huge gulf between what one doctor thinks and another,” Barnett explains.\u003c/p>\n\u003cp>Take, for example, a patient who comes to the emergency room complaining of back pain. There’s evidence that opioids are not necessary in that situation, but many doctors prescribe them anyway, said Barnett. “The world of pain treatment outside of opioids is limited and can take time to figure out. Opioids are an easy fix.”\u003c/p>\n\u003cp>The problem, he said, is that “even one prescription for opioids carries risks with it, that from my own experience as a provider, we tend to underestimate and under-explain to patients.”\u003c/p>\n\u003cp>“It is very, very plausible that well-intentioned but perhaps overly aggressive prescribing of opioids makes it likely that a patient will continue a medication long-term even if they don’t truly need it,” said Dr. \u003ca href=\"http://ihpme.utoronto.ca/faculty/david-juurlink/\" target=\"_blank\">David Juurlink\u003c/a>, a professor of medicine at the University of Toronto. He was not involved in the study. “The doctors in the lowest quartile are the ones whose prescribing we should seek to be emulating.”\u003c/p>\n\u003cp>The study did not look at whether the opioids were correctly prescribed in each incidence. Dr. \u003ca href=\"http://californiahealthline.org/news/prescribing-opioids-to-seniors-its-a-balancing-act/\">Carla Perissinotto\u003c/a>, a geriatrician at the University of California San Francisco, worries that some of the doctors in the lowest quartile might be under-prescribing. “We have to be careful to not make assumptions too quickly and assume they’re bad prescribers, because it could be the opposite,” said Perissinotto, who also was not involved in the study.\u003c/p>\n\u003cp>Usually, a patient is prescribed just a handful of pills by a doctor at the emergency department to tide them over until the patient can visit his or her primary care physician.\u003c/p>\n\u003cp>But many primary care doctors simply refill the opioid prescription for another 30 days or longer, a phenomenon Barnett calls clinical inertia. “There’s this cognitive bias to keep going with the flow especially if the patient still feels they’re in pain.”\u003c/p>\n\u003cp>That can have long-term implications: One-third of people who have taken prescription opioids for at least two months say they became addicted to or physically dependent on them, a recent \u003ca href=\"https://www.washingtonpost.com/page/2010-2019/WashingtonPost/2016/12/09/National-Politics/Polling/release_455.xml\" target=\"_blank\">Washington Post-Kaiser Family Foundation survey found.\u003c/a>\u003c/p>\n\u003cp>“We know there is a population of people who will potentially get addicted if they’re exposed to an opioid,” said Dr. \u003ca href=\"http://njms.rutgers.edu/departments/emergency_medicine/\">Lewis Nelson\u003c/a>, chair of the department of emergency medicine at Rutgers New Jersey Medical School, who was not involved with the study. “It’s a numbers game. The more people you expose, the more people you are likely to hit in that population likely to get addicted.”\u003c/p>\n\u003cp>Some hospitals are starting to help doctors prescribe opioids more judiciously. Many of those efforts have taken place after 2011, and therefore any changes would not be seen in the New England Journal of Medicine study.\u003c/p>\n\u003cp>For the past year, St. Joseph’s Regional Medical Center in New Jersey has been instructing doctors to prescribe opioids only as a last resort, said Dr. \u003ca href=\"https://www.acep.org/About-Us/Mark-S--Rosenberg,-DO,-MBA,-FACEP/\" target=\"_blank\">Mark Rosenberg\u003c/a>, who runs the hospital’s emergency department and is on the board of the American College of Emergency Physicians. Rosenberg helped institute protocols that have doctors try other methods of pain relief first, such as a Novocain injection. In just over a year, the hospital has managed to reduce the number of opioid prescriptions written in the emergency room by 50 percent.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>New York City and Washington state have also tried to introduce opioid prescribing guidelines into hospitals, and the ACEP expects to release new nationwide guidelines for emergency physicians in 2018.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Hundreds of Babies Reported Harmed by Homeopathic Product",
"title": "Hundreds of Babies Reported Harmed by Homeopathic Product",
"headTitle": "KQED Future of You | KQED Science",
"content": "\u003cp>Case 7682299: Aug. 1, 2010. A mother gives her toddler three homeopathic pills to relieve her teething pain. Within minutes, the baby stops breathing.\u003c/p>\n\u003cp>“My daughter had a seizure, lost consciousness, and stopped breathing about 30 minutes after I gave her three Hyland’s Teething Tablets,” the mother later told the Food and Drug Administration. “She had to receive mouth-to-mouth CPR to resume breathing and was brought to the hospital.”\u003c/p>\n\u003cp>The company, \u003ca href=\"https://www.hylands.com/\" target=\"_blank\">Hyland’s\u003c/a>, promotes “safe, effective, and natural health solutions” that appeal to parents seeking alternative treatments. But the agency would soon hear much more about Hyland’s teething products. Staff at the FDA would come to consider Case 7682299 one of the luckier outcomes.\u003c/p>\n\u003cfigure id=\"attachment_341968\" class=\"wp-caption alignright\" style=\"max-width: 800px\">\u003cimg class=\"wp-image-341968 size-medium\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/02/homeopathic-800x800.jpg\" alt=\"A review of FDA records shows that some babies who were given Hyland’s teething products had repeated seizures, became delirious or turned blue and died. \" width=\"800\" height=\"800\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/02/homeopathic-800x800.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2017/02/homeopathic-160x160.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/02/homeopathic-768x768.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2017/02/homeopathic-1020x1020.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2017/02/homeopathic-1180x1180.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2017/02/homeopathic-960x960.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2017/02/homeopathic-240x240.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/02/homeopathic-375x375.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/02/homeopathic-520x520.jpg 520w, https://ww2.kqed.org/app/uploads/sites/13/2017/02/homeopathic-32x32.jpg 32w, https://ww2.kqed.org/app/uploads/sites/13/2017/02/homeopathic-50x50.jpg 50w, https://ww2.kqed.org/app/uploads/sites/13/2017/02/homeopathic-64x64.jpg 64w, https://ww2.kqed.org/app/uploads/sites/13/2017/02/homeopathic-96x96.jpg 96w, https://ww2.kqed.org/app/uploads/sites/13/2017/02/homeopathic-128x128.jpg 128w, https://ww2.kqed.org/app/uploads/sites/13/2017/02/homeopathic-150x150.jpg 150w, https://ww2.kqed.org/app/uploads/sites/13/2017/02/homeopathic.jpg 1600w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">A review of FDA records shows that some babies who were given Hyland’s teething products had repeated seizures, became delirious or turned blue and died. \u003ccite>(Photo from FDA)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>A review of FDA records obtained by STAT under the Freedom of Information Act paints a far grimmer picture: Babies who were given Hyland’s teething products turned blue and died. Babies had repeated seizures. Babies became delirious. Babies were airlifted to the hospital, where emergency room staff tried to figure out what had caused their legs and arms to start twitching.\u003cstrong> \u003c/strong>\u003c/p>\n\u003cp>Over a 10-year period, from 2006 to 2016, the FDA collected reports of “adverse events” in more than 370 children who had used Hyland’s homeopathic teething tablets or gel, a similar product that is applied directly to a baby’s gums. Agency records show eight cases in which babies were reported to have died after taking Hyland’s products, though the FDA says the question of whether those products caused the deaths is still under review.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>(The agency is also investigating two other deaths tied to teething remedies but declined to confirm the manufacturer of the products or provide the case reports.)\u003c/p>\n\u003cp>Following an \u003ca href=\"http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm523468.htm\" target=\"_blank\">FDA warning in September\u003c/a>, Hyland’s said that it \u003ca href=\"https://www.hylands.com/hylands-discontinues-teething-tablets-and-gels\" target=\"_blank\">would no longer manufacture\u003c/a> the teething products. But they remained on some store shelves for months, and are still available on the internet. They likely continue to be used in homes nationwide.\u003c/p>\n\u003cp>Hyland’s, a 114-year-old private company based in Los Angeles, is the nation’s largest homeopathic business. It insists its products are safe and says the FDA has failed to show there is a scientific link between them and infant seizures or other complications.\u003c/p>\n\u003cp>“That doesn’t mean that children don’t have a sensitivity to a product. There is a lot of sensitivity on kids’ parts and we have to watch carefully,” said a spokeswoman, Mary Borneman. “It’s not something that condemns the entire product line.”\u003c/p>\n\u003cp>Behind each of the FDA case numbers are angry and, in some cases, heartbroken parents. But a STAT examination — and the first detailed look at the case reports — also raises questions over the response of regulators.\u003c/p>\n\u003cp>It took four years until the FDA pushed Hyland’s to reformulate its remedies, in 2010. In the seven years since then, there has been a steady stream of reports of adverse events tied to Hyland’s homeopathic teething products.\u003c/p>\n\u003cp>“The FDA could bring the hammer down on them,” said Sarah Sorscher, an attorney for the nonprofit Public Citizen Health Research Group. “But it doesn’t. At the point where you have infants being hospitalized and deaths reported, it’s simply not acceptable for the agency to delay in taking action.”\u003c/p>\n\u003cp>An FDA spokeswoman defended the agency’s handling of the matter.\u003c/p>\n\u003cp>“It is important to note that while adverse event reports give us some information about a product and serious injuries or deaths related to use of a particular product, they often indicate situations that require additional analysis and do not constitute conclusive evidence of a problem with the product,” the spokeswoman, Lyndsay Meyer, said in a statement.\u003c/p>\n\u003cp>Despite the FDA’s difficulty in proving Hyland’s products harmed children, some doctors had no doubt.\u003c/p>\n\u003cp>In case 462749, dated Sept. 15, 2011, a physician sent Hyland’s a handwritten note, stating his patient, a 5-month-old girl, was unresponsive for 45 minutes after taking its teething tablets.\u003c/p>\n\u003cp>“I am sure this was not an allergic reaction,” he wrote. “I would like you to report it, find a contact at the FDA, so we can start an investigation and pull this dangerous, unregulated product from the shelves.”\u003c/p>\n\u003cp>One mother wrote the company to say her son’s pupils dilated “like marbles with big black eyes.” Another described seizures her daughter continued to have after taking the tablets and told the company, “I hate hate hate u for this.”\u003c/p>\n\u003cfigure id=\"attachment_342003\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"wp-image-342003 size-medium\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/02/homeophathadverse-800x450.jpg\" alt=\"homeophathadverse\" width=\"800\" height=\"450\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/02/homeophathadverse-800x450.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2017/02/homeophathadverse-160x90.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/02/homeophathadverse-768x432.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2017/02/homeophathadverse-1020x574.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2017/02/homeophathadverse.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2017/02/homeophathadverse-1180x664.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2017/02/homeophathadverse-960x540.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2017/02/homeophathadverse-240x135.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/02/homeophathadverse-375x211.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/02/homeophathadverse-520x293.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Adverse event report on Hyland' teething tablets, sent to FDA. \u003ccite>(Photo by STAT)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>An Industry Giant in a Giant Industry\u003c/strong>\u003c/p>\n\u003cp>Hyland’s and its parent company, Standard Homeopathy Co., are considered major players in the homeopathic market. CEO \u003ca href=\"https://www.hylands.com/meet-the-team/jay-borneman\" target=\"_blank\">John P. Borneman\u003c/a> comes from a family that has been in the business for generations, and is president of the industry group that publishes the Homeopathic Pharmacopeia, a compendium that serves as the bible of the industry.\u003c/p>\n\u003cp>The company sells dozens of products for pain relief, stress, sleep problems, allergies, flu, and other maladies.\u003c/p>\n\u003cp>As with all homeopathic treatments, Hyland’s products are based on a theory that patients can benefit from highly diluted natural substances that, in their original form, might make people sick.\u003c/p>\n\u003cp>Despite a lack of scientific evidence that homeopathic remedies work, they are ubiquitous.\u003c/p>\n\u003cp>Homeopathy has become a multibillion-dollar industry. Its products are big sellers around the world, and popular with adherents from Cher to Prince Charles. The industry also has political clout: It has been able to exempt itself from many rules proposed by Congress and the FDA over the years.\u003c/p>\n\u003cp>Unlike pharmaceutical company-produced drugs, homeopathic products don’t have to prove that they are effective at treating anything in particular before going on the market. It is left to the FDA’s drug division to determine whether they are unsafe after they are on the market — a difficult task since the adverse event reports are generally considered to represent only a fraction of the actual incidents and may lack sufficient information to allow for thorough investigations.\u003c/p>\n\u003cp>“If I’m working in the emergency room and I have a family that comes in with a seizing infant, I may not have the wherewithal to get the history of homeopathic use,” said Dr. Edward W. Boyer, a toxicologist in Harvard Medical School’s emergency medicine department.\u003c/p>\n\u003cp>In some cases, parents assume that products described as natural remedies, as is the case with Hyland’s tablets and gels, could not possibly result in complications, and never mention their use to a doctor. Without sufficient evidence of a problem, the FDA lacks what it needs to use the enforcement tools it does have.\u003c/p>\n\u003cp>For Karinna Talbott, a 26-year-old mother in Colorado Springs, the fact that Hyland’s teething products were labeled “natural” made her lower her guard.\u003c/p>\n\u003cp>“When our fourth kiddo comes around and starts teething at three months, we were like, ‘OK, what can we do to give him some relief?’” Talbott said. “Someone told us about the teething tablets and we thought, ‘give them a try.' ’’\u003c/p>\n\u003cp>Shortly after her son began taking the tablets, she said, his hands began twitching.\u003c/p>\n\u003cp>“We didn’t correlate it to the teething tablets,” Talbott said. “And his symptoms got worse, went to his arms and his feet. Sometimes they all happened together.”\u003c/p>\n\u003cp>Talbott said her doctor was at first uncertain as to the cause. But when they stopped giving him the tablets, the seizures also stopped.\u003c/p>\n\u003cp>“The neurologist said, maybe he was a little sensitive to the products in the teething tablet.”\u003c/p>\n\u003cp>\u003cstrong>‘Deadly nightshade’\u003c/strong>\u003c/p>\n\u003cp>In investigating Hyland’s teething products, the FDA focused on an ingredient known as atropa belladonna, an herb known colloquially as “deadly nightshade.”\u003c/p>\n\u003cp>In diluted form, the substance is not expected to pose any health risk. In 2010, however, FDA inspectors who examined Hyland’s facilities criticized the company for substandard manufacturing practices and found inconsistent levels of atropa belladonna in its products.\u003c/p>\n\u003cp>The agency issued a public warning, noting “reports of serious adverse events in children taking this product that are consistent with belladonna toxicity.”\u003c/p>\n\u003cp>It also noted that “infants are very susceptible to the neurotoxicity of drugs” because of how the body distributes and responds to drugs, and noted that “absorption of belladonna from the skin and mouth was fairly rapid.”\u003c/p>\n\u003cp>The company voluntarily took the products off shelves and agreed to reformulate them, although it insisted they were safe.\u003c/p>\n\u003cp>“We felt it was the right thing to do so that parents didn’t have to be concerned about the product,” said Borneman, the spokeswoman.\u003c/p>\n\u003cp>But the number of serious adverse events tied by the FDA to the products kept climbing. Some pediatricians and neurologists concluded the tablets and gels were the cause. Many parents wrote to the FDA, accusingly, asking why the pills were still on the market.\u003c/p>\n\u003cp>“My son had 3 of Hyland’s Teething Tablets,” a mother told FDA on Feb. 13, 2012, noting that the product appeared to have caused several seizures. “I am shocked at the popularity of this product, which is growing, and the lack of knowledge among parents, as well as the lack of warnings on the labels. Parents desperately need to be warned about this product if it is going to stay on the shelves!!!! Please do something!”\u003c/p>\n\u003cp>In September 2016, the \u003ca href=\"http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm523468.htm\" target=\"_blank\">FDA announced\u003c/a> that it was investigating more adverse events reports and recommended that consumers stop using Hyland’s and other homeopathic teething products and dispose of any in their possession. Some stores, including Target and CVS, which sold Hyland’s and other homeopathic teething products, pulled them in response.\u003c/p>\n\u003cp>The FDA also asked Hyland’s to recall its products again. But this time Hyland’s stood its ground, and the agency has no authority to enforce a recall of homeopathic products.\u003c/p>\n\u003cp>Borneman said the company’s “pharmacovigilance program,” a product safety review system launched after 2010, offers proof that the treatments are safe.\u003c/p>\n\u003cp>“Homeopathic medicine has a very large margin of safety,” she said. “Our testing ensures there’s not too much belladonna in any bottle” of tablets.\u003c/p>\n\u003cp>At the same time, the company decided to stop manufacturing the teething tablets. In an \u003ca href=\"https://www.hylands.com/hylands-discontinues-teething-tablets-and-gels\" target=\"_blank\">open letter to customers\u003c/a>, Hyland’s said the FDA warning had “created confusion among parents.”\u003c/p>\n\u003cp>“Putting you in a position of having to choose who to trust in the face of contradictory information is burdensome and undermines the FDA,” the company said, while insisting Hyland’s products, “including those you already have, are safe for use.”\u003c/p>\n\u003cp>Several weeks ago, on Jan. 27, the FDA \u003ca href=\"http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm538684.htm\" target=\"_blank\">issued another warning\u003c/a>, saying that laboratory analysis of Hyland’s teething tablets found levels of belladonna “sometimes far exceeding the amount claimed on the label.” The agency warned consumers not to use the products and to seek medical care immediately if their child has seizures, difficulty breathing, lethargy, muscle weakness, or other problems after using homeopathic teething products.\u003c/p>\n\u003cp>The FDA also said there was no evidence that they actually worked.\u003c/p>\n\u003cfigure id=\"attachment_342006\" class=\"wp-caption aligncenter\" style=\"max-width: 768px\">\u003cimg class=\"wp-image-342006 size-full\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/02/homeopathicevent.jpg\" alt=\"homeopathicevent\" width=\"768\" height=\"432\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/02/homeopathicevent.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2017/02/homeopathicevent-160x90.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/02/homeopathicevent-240x135.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/02/homeopathicevent-375x211.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/02/homeopathicevent-520x293.jpg 520w\" sizes=\"(max-width: 768px) 100vw, 768px\">\u003cfigcaption class=\"wp-caption-text\">Report sent to FDA by a physician. \u003ccite>(Photo by STAT)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>Cracks in the FDA’s Authority\u003c/strong>\u003c/p>\n\u003cp>With concerns about toxic levels of belladonna, and the sheer number of cases of adverse events, some critics — and parents — say the FDA should have moved faster in the case of Hyland’s.\u003c/p>\n\u003cp>But they also acknowledge that the episode underlines the cracks in the agency’s regulatory power when it comes to homeopathic products. There is no set mathematical formula or official standard that spells out how many sick or deceased children must be reported before the FDA seizes a company’s inventory or levies fines or shuts it down.\u003c/p>\n\u003cp>Critics say the fact that homeopathic products are generally highly diluted has kept them on the FDA’s back burner.\u003c/p>\n\u003cp>“It’s low on their priority list,” said Dr. Aaron S. Kesselheim, who \u003ca href=\"http://www.nejm.org/doi/full/10.1056/NEJMp1513393#t=article\" target=\"_blank\">coauthored a paper\u003c/a> in the New England Journal of Medicine last year on the subject. “FDA for a long time just kind of deferred on homeopathic products because they are mostly inert and so diluted. The harm comes from people wasting their money, or diverting them from things that do work.”\u003c/p>\n\u003cp>In the case of some of Hyland’s products, however, Kesselheim believes that the toxic levels of belladonna show a substantial safety problem, putting a responsibility on FDA to respond.\u003c/p>\n\u003cp>One problem the FDA has in doing so is a matter of staffing: The agency has a medical officer review each report from manufacturers, but it doesn’t have someone who can routinely follow up with the patient, the patient’s family, or physician for missing records necessary to take a serious enforcement action.\u003c/p>\n\u003cp>“Is it fair to criticize FDA for the time lag between 2010 and now?” says Patricia Zettler, a former FDA counsel and associate law professor at Georgia State University. “I think the agency is in a tough position, with these kinds of products and with adverse event reports in general. They are not necessarily a perfect indication of something happening with a drug.”\u003c/p>\n\u003cp>“That said,” Zettler added, “it does sound like this is a product the agency was concerned about. It’s tough to parse out whether two reports of seizures should have been enough, or three or 10. There’s a balance the agency has to strike between acting quickly on safety information and not overreacting to something that may not actually be caused by the product.”\u003c/p>\n\u003cp>Public Citizen’s Sorscher said criminal cases take years to pursue, so the FDA would much prefer voluntary compliance.\u003c/p>\n\u003cp>“They don’t have a mechanism to say, ‘this ingredient is unsafe, nobody should sell it,’” she said. “It might be time for Congress to give FDA a standard and say, you can issue a regulation saying no one can make it anymore.”\u003c/p>\n\u003cp>Outraged by the standoff between FDA and Hyland’s, Connecticut Democratic Representative Rosa DeLauro \u003ca href=\"https://delauro.house.gov/media-center/press-releases/delauro-introduces-bill-give-fda-mandatory-recall-authority-over-drugs\" target=\"_blank\">introduced a bill last week\u003c/a> called the Recall Unsafe Drugs Act. The proposal would give the FDA mandatory recall authority over homeopathic products and drugs.\u003c/p>\n\u003cp>“Hyland’s refusal to recall its teething tablets, despite numerous health and safety warnings from the FDA, is downright shameful,” DeLauro said, adding that the company “is choosing instead to prioritize the company’s profits and reputation before the safety of our children.”\u003c/p>\n\u003cp>“As it stands the FDA would have to go through an arduous legal process to take action against manufacturers such as Hyland’s. This is unacceptable and threatens the health and safety of American families.’’\u003c/p>\n\u003cp>For the parents of Case 10723317, any action would come too late. A mother reported that on July 9, 2014, her 9-month-old daughter died after being given two teething tablets, crushed, for the first time. She gave her infant the tablets, then a bottle, and then left her to sleep. When she checked on her 45 minutes later, she was dead in her crib, beside a puddle of vomit.\u003c/p>\n\u003cp>Five months later, after reading online reports suggesting babies may experience seizures after taking belladonna, she contacted Hyland’s.\u003c/p>\n\u003cp>“Customer did not request a refund or replacement,” noted the Hyland’s staffer who filed the report with the FDA. Hyland’s also noted that it was not able to test the bottle, because the customer threw it away.\u003c/p>\n\u003cp>“Due to the limited information provided by the reporter no further investigation is possible at this time of this incident,” the company concluded.\u003c/p>\n\u003cp>\u003cem>Ike Swetlitz contributed reporting.\u003c/em>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This \u003ca href=\"https://www.statnews.com/2017/02/21/hylands-homeopathic-teething-fda/\" target=\"_blank\">story\u003c/a> was originally published by STAT, an online publication of Boston Globe Media that covers health, medicine, and scientific discovery.\u003c/em>\u003c/p>\n\n",
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"excerpt": "The FDA has collected reports of 'adverse events' in over 370 children who used Hyland’s homeopathic teething products, and the agency is investigating whether the products caused the deaths of eight babies. ",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Case 7682299: Aug. 1, 2010. A mother gives her toddler three homeopathic pills to relieve her teething pain. Within minutes, the baby stops breathing.\u003c/p>\n\u003cp>“My daughter had a seizure, lost consciousness, and stopped breathing about 30 minutes after I gave her three Hyland’s Teething Tablets,” the mother later told the Food and Drug Administration. “She had to receive mouth-to-mouth CPR to resume breathing and was brought to the hospital.”\u003c/p>\n\u003cp>The company, \u003ca href=\"https://www.hylands.com/\" target=\"_blank\">Hyland’s\u003c/a>, promotes “safe, effective, and natural health solutions” that appeal to parents seeking alternative treatments. But the agency would soon hear much more about Hyland’s teething products. Staff at the FDA would come to consider Case 7682299 one of the luckier outcomes.\u003c/p>\n\u003cfigure id=\"attachment_341968\" class=\"wp-caption alignright\" style=\"max-width: 800px\">\u003cimg class=\"wp-image-341968 size-medium\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/02/homeopathic-800x800.jpg\" alt=\"A review of FDA records shows that some babies who were given Hyland’s teething products had repeated seizures, became delirious or turned blue and died. \" width=\"800\" height=\"800\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/02/homeopathic-800x800.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2017/02/homeopathic-160x160.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/02/homeopathic-768x768.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2017/02/homeopathic-1020x1020.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2017/02/homeopathic-1180x1180.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2017/02/homeopathic-960x960.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2017/02/homeopathic-240x240.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/02/homeopathic-375x375.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/02/homeopathic-520x520.jpg 520w, https://ww2.kqed.org/app/uploads/sites/13/2017/02/homeopathic-32x32.jpg 32w, https://ww2.kqed.org/app/uploads/sites/13/2017/02/homeopathic-50x50.jpg 50w, https://ww2.kqed.org/app/uploads/sites/13/2017/02/homeopathic-64x64.jpg 64w, https://ww2.kqed.org/app/uploads/sites/13/2017/02/homeopathic-96x96.jpg 96w, https://ww2.kqed.org/app/uploads/sites/13/2017/02/homeopathic-128x128.jpg 128w, https://ww2.kqed.org/app/uploads/sites/13/2017/02/homeopathic-150x150.jpg 150w, https://ww2.kqed.org/app/uploads/sites/13/2017/02/homeopathic.jpg 1600w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">A review of FDA records shows that some babies who were given Hyland’s teething products had repeated seizures, became delirious or turned blue and died. \u003ccite>(Photo from FDA)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>A review of FDA records obtained by STAT under the Freedom of Information Act paints a far grimmer picture: Babies who were given Hyland’s teething products turned blue and died. Babies had repeated seizures. Babies became delirious. Babies were airlifted to the hospital, where emergency room staff tried to figure out what had caused their legs and arms to start twitching.\u003cstrong> \u003c/strong>\u003c/p>\n\u003cp>Over a 10-year period, from 2006 to 2016, the FDA collected reports of “adverse events” in more than 370 children who had used Hyland’s homeopathic teething tablets or gel, a similar product that is applied directly to a baby’s gums. Agency records show eight cases in which babies were reported to have died after taking Hyland’s products, though the FDA says the question of whether those products caused the deaths is still under review.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>(The agency is also investigating two other deaths tied to teething remedies but declined to confirm the manufacturer of the products or provide the case reports.)\u003c/p>\n\u003cp>Following an \u003ca href=\"http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm523468.htm\" target=\"_blank\">FDA warning in September\u003c/a>, Hyland’s said that it \u003ca href=\"https://www.hylands.com/hylands-discontinues-teething-tablets-and-gels\" target=\"_blank\">would no longer manufacture\u003c/a> the teething products. But they remained on some store shelves for months, and are still available on the internet. They likely continue to be used in homes nationwide.\u003c/p>\n\u003cp>Hyland’s, a 114-year-old private company based in Los Angeles, is the nation’s largest homeopathic business. It insists its products are safe and says the FDA has failed to show there is a scientific link between them and infant seizures or other complications.\u003c/p>\n\u003cp>“That doesn’t mean that children don’t have a sensitivity to a product. There is a lot of sensitivity on kids’ parts and we have to watch carefully,” said a spokeswoman, Mary Borneman. “It’s not something that condemns the entire product line.”\u003c/p>\n\u003cp>Behind each of the FDA case numbers are angry and, in some cases, heartbroken parents. But a STAT examination — and the first detailed look at the case reports — also raises questions over the response of regulators.\u003c/p>\n\u003cp>It took four years until the FDA pushed Hyland’s to reformulate its remedies, in 2010. In the seven years since then, there has been a steady stream of reports of adverse events tied to Hyland’s homeopathic teething products.\u003c/p>\n\u003cp>“The FDA could bring the hammer down on them,” said Sarah Sorscher, an attorney for the nonprofit Public Citizen Health Research Group. “But it doesn’t. At the point where you have infants being hospitalized and deaths reported, it’s simply not acceptable for the agency to delay in taking action.”\u003c/p>\n\u003cp>An FDA spokeswoman defended the agency’s handling of the matter.\u003c/p>\n\u003cp>“It is important to note that while adverse event reports give us some information about a product and serious injuries or deaths related to use of a particular product, they often indicate situations that require additional analysis and do not constitute conclusive evidence of a problem with the product,” the spokeswoman, Lyndsay Meyer, said in a statement.\u003c/p>\n\u003cp>Despite the FDA’s difficulty in proving Hyland’s products harmed children, some doctors had no doubt.\u003c/p>\n\u003cp>In case 462749, dated Sept. 15, 2011, a physician sent Hyland’s a handwritten note, stating his patient, a 5-month-old girl, was unresponsive for 45 minutes after taking its teething tablets.\u003c/p>\n\u003cp>“I am sure this was not an allergic reaction,” he wrote. “I would like you to report it, find a contact at the FDA, so we can start an investigation and pull this dangerous, unregulated product from the shelves.”\u003c/p>\n\u003cp>One mother wrote the company to say her son’s pupils dilated “like marbles with big black eyes.” Another described seizures her daughter continued to have after taking the tablets and told the company, “I hate hate hate u for this.”\u003c/p>\n\u003cfigure id=\"attachment_342003\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"wp-image-342003 size-medium\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/02/homeophathadverse-800x450.jpg\" alt=\"homeophathadverse\" width=\"800\" height=\"450\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/02/homeophathadverse-800x450.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2017/02/homeophathadverse-160x90.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/02/homeophathadverse-768x432.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2017/02/homeophathadverse-1020x574.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2017/02/homeophathadverse.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2017/02/homeophathadverse-1180x664.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2017/02/homeophathadverse-960x540.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2017/02/homeophathadverse-240x135.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/02/homeophathadverse-375x211.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/02/homeophathadverse-520x293.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Adverse event report on Hyland' teething tablets, sent to FDA. \u003ccite>(Photo by STAT)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>An Industry Giant in a Giant Industry\u003c/strong>\u003c/p>\n\u003cp>Hyland’s and its parent company, Standard Homeopathy Co., are considered major players in the homeopathic market. CEO \u003ca href=\"https://www.hylands.com/meet-the-team/jay-borneman\" target=\"_blank\">John P. Borneman\u003c/a> comes from a family that has been in the business for generations, and is president of the industry group that publishes the Homeopathic Pharmacopeia, a compendium that serves as the bible of the industry.\u003c/p>\n\u003cp>The company sells dozens of products for pain relief, stress, sleep problems, allergies, flu, and other maladies.\u003c/p>\n\u003cp>As with all homeopathic treatments, Hyland’s products are based on a theory that patients can benefit from highly diluted natural substances that, in their original form, might make people sick.\u003c/p>\n\u003cp>Despite a lack of scientific evidence that homeopathic remedies work, they are ubiquitous.\u003c/p>\n\u003cp>Homeopathy has become a multibillion-dollar industry. Its products are big sellers around the world, and popular with adherents from Cher to Prince Charles. The industry also has political clout: It has been able to exempt itself from many rules proposed by Congress and the FDA over the years.\u003c/p>\n\u003cp>Unlike pharmaceutical company-produced drugs, homeopathic products don’t have to prove that they are effective at treating anything in particular before going on the market. It is left to the FDA’s drug division to determine whether they are unsafe after they are on the market — a difficult task since the adverse event reports are generally considered to represent only a fraction of the actual incidents and may lack sufficient information to allow for thorough investigations.\u003c/p>\n\u003cp>“If I’m working in the emergency room and I have a family that comes in with a seizing infant, I may not have the wherewithal to get the history of homeopathic use,” said Dr. Edward W. Boyer, a toxicologist in Harvard Medical School’s emergency medicine department.\u003c/p>\n\u003cp>In some cases, parents assume that products described as natural remedies, as is the case with Hyland’s tablets and gels, could not possibly result in complications, and never mention their use to a doctor. Without sufficient evidence of a problem, the FDA lacks what it needs to use the enforcement tools it does have.\u003c/p>\n\u003cp>For Karinna Talbott, a 26-year-old mother in Colorado Springs, the fact that Hyland’s teething products were labeled “natural” made her lower her guard.\u003c/p>\n\u003cp>“When our fourth kiddo comes around and starts teething at three months, we were like, ‘OK, what can we do to give him some relief?’” Talbott said. “Someone told us about the teething tablets and we thought, ‘give them a try.' ’’\u003c/p>\n\u003cp>Shortly after her son began taking the tablets, she said, his hands began twitching.\u003c/p>\n\u003cp>“We didn’t correlate it to the teething tablets,” Talbott said. “And his symptoms got worse, went to his arms and his feet. Sometimes they all happened together.”\u003c/p>\n\u003cp>Talbott said her doctor was at first uncertain as to the cause. But when they stopped giving him the tablets, the seizures also stopped.\u003c/p>\n\u003cp>“The neurologist said, maybe he was a little sensitive to the products in the teething tablet.”\u003c/p>\n\u003cp>\u003cstrong>‘Deadly nightshade’\u003c/strong>\u003c/p>\n\u003cp>In investigating Hyland’s teething products, the FDA focused on an ingredient known as atropa belladonna, an herb known colloquially as “deadly nightshade.”\u003c/p>\n\u003cp>In diluted form, the substance is not expected to pose any health risk. In 2010, however, FDA inspectors who examined Hyland’s facilities criticized the company for substandard manufacturing practices and found inconsistent levels of atropa belladonna in its products.\u003c/p>\n\u003cp>The agency issued a public warning, noting “reports of serious adverse events in children taking this product that are consistent with belladonna toxicity.”\u003c/p>\n\u003cp>It also noted that “infants are very susceptible to the neurotoxicity of drugs” because of how the body distributes and responds to drugs, and noted that “absorption of belladonna from the skin and mouth was fairly rapid.”\u003c/p>\n\u003cp>The company voluntarily took the products off shelves and agreed to reformulate them, although it insisted they were safe.\u003c/p>\n\u003cp>“We felt it was the right thing to do so that parents didn’t have to be concerned about the product,” said Borneman, the spokeswoman.\u003c/p>\n\u003cp>But the number of serious adverse events tied by the FDA to the products kept climbing. Some pediatricians and neurologists concluded the tablets and gels were the cause. Many parents wrote to the FDA, accusingly, asking why the pills were still on the market.\u003c/p>\n\u003cp>“My son had 3 of Hyland’s Teething Tablets,” a mother told FDA on Feb. 13, 2012, noting that the product appeared to have caused several seizures. “I am shocked at the popularity of this product, which is growing, and the lack of knowledge among parents, as well as the lack of warnings on the labels. Parents desperately need to be warned about this product if it is going to stay on the shelves!!!! Please do something!”\u003c/p>\n\u003cp>In September 2016, the \u003ca href=\"http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm523468.htm\" target=\"_blank\">FDA announced\u003c/a> that it was investigating more adverse events reports and recommended that consumers stop using Hyland’s and other homeopathic teething products and dispose of any in their possession. Some stores, including Target and CVS, which sold Hyland’s and other homeopathic teething products, pulled them in response.\u003c/p>\n\u003cp>The FDA also asked Hyland’s to recall its products again. But this time Hyland’s stood its ground, and the agency has no authority to enforce a recall of homeopathic products.\u003c/p>\n\u003cp>Borneman said the company’s “pharmacovigilance program,” a product safety review system launched after 2010, offers proof that the treatments are safe.\u003c/p>\n\u003cp>“Homeopathic medicine has a very large margin of safety,” she said. “Our testing ensures there’s not too much belladonna in any bottle” of tablets.\u003c/p>\n\u003cp>At the same time, the company decided to stop manufacturing the teething tablets. In an \u003ca href=\"https://www.hylands.com/hylands-discontinues-teething-tablets-and-gels\" target=\"_blank\">open letter to customers\u003c/a>, Hyland’s said the FDA warning had “created confusion among parents.”\u003c/p>\n\u003cp>“Putting you in a position of having to choose who to trust in the face of contradictory information is burdensome and undermines the FDA,” the company said, while insisting Hyland’s products, “including those you already have, are safe for use.”\u003c/p>\n\u003cp>Several weeks ago, on Jan. 27, the FDA \u003ca href=\"http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm538684.htm\" target=\"_blank\">issued another warning\u003c/a>, saying that laboratory analysis of Hyland’s teething tablets found levels of belladonna “sometimes far exceeding the amount claimed on the label.” The agency warned consumers not to use the products and to seek medical care immediately if their child has seizures, difficulty breathing, lethargy, muscle weakness, or other problems after using homeopathic teething products.\u003c/p>\n\u003cp>The FDA also said there was no evidence that they actually worked.\u003c/p>\n\u003cfigure id=\"attachment_342006\" class=\"wp-caption aligncenter\" style=\"max-width: 768px\">\u003cimg class=\"wp-image-342006 size-full\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/02/homeopathicevent.jpg\" alt=\"homeopathicevent\" width=\"768\" height=\"432\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/02/homeopathicevent.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2017/02/homeopathicevent-160x90.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/02/homeopathicevent-240x135.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/02/homeopathicevent-375x211.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/02/homeopathicevent-520x293.jpg 520w\" sizes=\"(max-width: 768px) 100vw, 768px\">\u003cfigcaption class=\"wp-caption-text\">Report sent to FDA by a physician. \u003ccite>(Photo by STAT)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>Cracks in the FDA’s Authority\u003c/strong>\u003c/p>\n\u003cp>With concerns about toxic levels of belladonna, and the sheer number of cases of adverse events, some critics — and parents — say the FDA should have moved faster in the case of Hyland’s.\u003c/p>\n\u003cp>But they also acknowledge that the episode underlines the cracks in the agency’s regulatory power when it comes to homeopathic products. There is no set mathematical formula or official standard that spells out how many sick or deceased children must be reported before the FDA seizes a company’s inventory or levies fines or shuts it down.\u003c/p>\n\u003cp>Critics say the fact that homeopathic products are generally highly diluted has kept them on the FDA’s back burner.\u003c/p>\n\u003cp>“It’s low on their priority list,” said Dr. Aaron S. Kesselheim, who \u003ca href=\"http://www.nejm.org/doi/full/10.1056/NEJMp1513393#t=article\" target=\"_blank\">coauthored a paper\u003c/a> in the New England Journal of Medicine last year on the subject. “FDA for a long time just kind of deferred on homeopathic products because they are mostly inert and so diluted. The harm comes from people wasting their money, or diverting them from things that do work.”\u003c/p>\n\u003cp>In the case of some of Hyland’s products, however, Kesselheim believes that the toxic levels of belladonna show a substantial safety problem, putting a responsibility on FDA to respond.\u003c/p>\n\u003cp>One problem the FDA has in doing so is a matter of staffing: The agency has a medical officer review each report from manufacturers, but it doesn’t have someone who can routinely follow up with the patient, the patient’s family, or physician for missing records necessary to take a serious enforcement action.\u003c/p>\n\u003cp>“Is it fair to criticize FDA for the time lag between 2010 and now?” says Patricia Zettler, a former FDA counsel and associate law professor at Georgia State University. “I think the agency is in a tough position, with these kinds of products and with adverse event reports in general. They are not necessarily a perfect indication of something happening with a drug.”\u003c/p>\n\u003cp>“That said,” Zettler added, “it does sound like this is a product the agency was concerned about. It’s tough to parse out whether two reports of seizures should have been enough, or three or 10. There’s a balance the agency has to strike between acting quickly on safety information and not overreacting to something that may not actually be caused by the product.”\u003c/p>\n\u003cp>Public Citizen’s Sorscher said criminal cases take years to pursue, so the FDA would much prefer voluntary compliance.\u003c/p>\n\u003cp>“They don’t have a mechanism to say, ‘this ingredient is unsafe, nobody should sell it,’” she said. “It might be time for Congress to give FDA a standard and say, you can issue a regulation saying no one can make it anymore.”\u003c/p>\n\u003cp>Outraged by the standoff between FDA and Hyland’s, Connecticut Democratic Representative Rosa DeLauro \u003ca href=\"https://delauro.house.gov/media-center/press-releases/delauro-introduces-bill-give-fda-mandatory-recall-authority-over-drugs\" target=\"_blank\">introduced a bill last week\u003c/a> called the Recall Unsafe Drugs Act. The proposal would give the FDA mandatory recall authority over homeopathic products and drugs.\u003c/p>\n\u003cp>“Hyland’s refusal to recall its teething tablets, despite numerous health and safety warnings from the FDA, is downright shameful,” DeLauro said, adding that the company “is choosing instead to prioritize the company’s profits and reputation before the safety of our children.”\u003c/p>\n\u003cp>“As it stands the FDA would have to go through an arduous legal process to take action against manufacturers such as Hyland’s. This is unacceptable and threatens the health and safety of American families.’’\u003c/p>\n\u003cp>For the parents of Case 10723317, any action would come too late. A mother reported that on July 9, 2014, her 9-month-old daughter died after being given two teething tablets, crushed, for the first time. She gave her infant the tablets, then a bottle, and then left her to sleep. When she checked on her 45 minutes later, she was dead in her crib, beside a puddle of vomit.\u003c/p>\n\u003cp>Five months later, after reading online reports suggesting babies may experience seizures after taking belladonna, she contacted Hyland’s.\u003c/p>\n\u003cp>“Customer did not request a refund or replacement,” noted the Hyland’s staffer who filed the report with the FDA. Hyland’s also noted that it was not able to test the bottle, because the customer threw it away.\u003c/p>\n\u003cp>“Due to the limited information provided by the reporter no further investigation is possible at this time of this incident,” the company concluded.\u003c/p>\n\u003cp>\u003cem>Ike Swetlitz contributed reporting.\u003c/em>\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/2017/02/21/hylands-homeopathic-teething-fda/\" target=\"_blank\">story\u003c/a> was originally published by STAT, an online publication of Boston Globe Media that covers health, medicine, and scientific discovery.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "CRISPR Patent Ruling: 3 Different Takes",
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"content": "\u003cp>\u003ca href=\"https://ww2.kqed.org/futureofyou/2017/02/16/broad-institute-wins-decision-over-uc-berkeley-in-crispr-patent-battle/\" target=\"_blank\">Last week\u003c/a> the feds may have dashed \u003ca href=\"http://www.berkeley.edu/\" target=\"_blank\">UC Berkeley's\u003c/a> billion-dollar dreams when it decided not to give the university patent rights over CRISPR-Cas9, a revolutionary gene-editing technology.\u003c/p>\n\u003cp>The Feb. 15 ruling from the U.S. Patent and Trademark Office let Berkeley's rival--the \u003ca href=\"https://www.broadinstitute.org/\" target=\"_blank\">Broad Institute\u003c/a> jointly owned by Harvard and MIT--keep its existing patents issued in 2014. UC Berkeley has yet to say whether or not it will appeal.\u003c/p>\n\u003cp>[contextly_sidebar id=\"6PeUNVfkMeIqGUVoQhOEw9qi7r38vVhJ\"] Berkeley was seeking to have some of those patents repealed because the university says they conflict with its pending patent application for CRISPR.\u003c/p>\n\u003cp>The judges reasoned that Berkeley's patent request doesn't affect Broad's existing patents because the two are based on different gene editing techniques.\u003c/p>\n\u003cp>Berkeley's patent request is for editing genes in bacteria, whereas Broad's existing patents are for editing genes in eukaryotic cells, i.e. cells found in plants and animals, including humans.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>But Berkeley argues that its research tool can easily be extended to use in non-bacterial cells.\u003c/p>\n\u003cp>That distinction is key since potentially lucrative applications of gene editing in medicine and health will involve eukaryotic cells found in humans.\u003c/p>\n\u003cp>UC Berkeley biologist Jennifer Doudna, who is credited with co-inventing CRISPR-Cas9 now has two options:\u003c/p>\n\u003cp>1) Appeal to the \u003ca href=\"http://www.cafc.uscourts.gov/\" target=\"_blank\">U.S. Court of Appeals for the Federal Circuit\u003c/a>\u003cbr>\n2) Go back to the \u003ca href=\"https://www.uspto.gov/\" target=\"_blank\">U.S. Patent and Trademark Office\u003c/a>\u003c/p>\n\u003cp>If Berkeley appeals, the court could overrule the patent office decision in favor of Berkeley.\u003c/p>\n\u003cp>If Berkeley loses, it could go back to the patent office, where it could be required to narrow its claims, i.e., specifying that its technique is only intended to be used in bacteria.\u003c/p>\n\u003cp>Or it could get a broad patent that still doesn't specify how to use CRISPR in eukaryotic cells. But according to \u003ca href=\"http://www.nyls.edu/faculty/faculty-profiles/faculty_profiles/jacob-s-sherkow/\" target=\"_blank\">Jacob Sherkow\u003c/a>, a law professor at \u003ca href=\"http://www.nyls.edu/\" target=\"_blank\">New York Law School\u003c/a>, that could lead to future legal challenges.\u003c/p>\n\u003cp>\"It’s not going to be that strong because anyone who wants to challenge it later can say, 'that patent doesn't disclose how to use the tool in eukaryotic cells,'\" says Sherkow.\u003c/p>\n\u003cp>And the money is in altering those specific cells.\u003c/p>\n\u003cp>So what's next? Only Berkeley knows; the university has said it will \"\u003ca href=\"http://news.berkeley.edu/2017/02/15/berkeley-statement-regarding-patent-boards-decision-on-crispr-cas9-gene-editing-technology/\" target=\"_blank\">carefully consider all options\u003c/a>.\"\u003c/p>\n\u003cp>Science journalists are abuzz about what this means for biotech. Here's a sampling of what they're saying:\u003c/p>\n\u003cp>\u003cstrong>1. \u003c/strong>\u003cstrong>Berkeley + Broad = Virtual Monopoly on CRISPR-Cas9\u003c/strong> (\u003ca href=\"http://gizmodo.com/should-anyone-really-control-who-gets-to-use-crispr-1792659635\" target=\"_blank\">Gizmodo\u003c/a>)\u003c/p>\n\u003cblockquote>\u003cp>Why does this matter? While academic researchers can still use CRISPR for free, companies hoping to harness the gene editing tool to fight disease, solve agricultural problems, or for myriad other potential applications, may have to pay not one, but both institutions, a hefty fee. It’s a decision that has caused some to wonder whether the rights to such revolutionary technology don’t really belong to a third party: the people.\u003c/p>\u003c/blockquote>\n\u003cp>\u003cstrong>2. Could the Case Encourage Scientists to Be Less Honest?\u003c/strong> (\u003ca href=\"https://www.statnews.com/2017/02/16/crispr-patent-decision-six-takeaways/\" target=\"_blank\">STAT\u003c/a>)\u003c/p>\n\u003cblockquote>\u003cp>The patent judges concluded that “the inventors themselves were uncertain” about making CRISPR work in human cells.\u003c/p>\n\u003cp>That could send a terrible message to scientists, said \u003ca href=\"https://isearch.asu.edu/profile/2783639\" target=\"_blank\">Dr. Robert Cook-Deegan\u003c/a> of \u003ca href=\"https://www.asu.edu/\" target=\"_blank\">Arizona State University\u003c/a>, an expert on legal and ethical issues surrounding biotechnology. “I hope this does not become the poster child that patent offices use to coach scientists not to be honest about uncertainties about their discoveries,” he said. “The fact that Doudna’s quotes were used by the judges mainly tells me Doudna was being honest. I hope scientists will continue to be honest and not succumb to being told they can’t say things that might undermine a broad patenting strategy.”\u003c/p>\u003c/blockquote>\n\u003cp>\u003cstrong>3. Fogettaboutit, Companies Can Sidestep Berkeley and Broad\u003c/strong> (\u003ca href=\"http://www.nature.com/news/why-the-crispr-patent-verdict-isn-t-the-end-of-the-story-1.21510\" target=\"_blank\">Nature\u003c/a>)\u003c/p>\n\u003cblockquote>\u003cp>Researchers in academia and industry have been pushing CRISPR gene editing beyond the scope of the Broad and Berkeley patents.\u003c/p>\n\u003cp>Both patent families cover the use of CRISPR–Cas9, which relies on the Cas9 enzyme to cut DNA. But there are alternatives to Cas9 that provide other functions, and a way to sidestep the Berkeley–Broad patent fight.\u003c/p>\n\u003cp>One attractive alternative is Cpf1, an enzyme that \u003ca href=\"http://www.nature.com/news/alternative-crispr-system-could-improve-genome-editing-1.18432\" target=\"_blank\">may be simpler to use\u003c/a> and more accurate than Cas9 in some cases. The Broad has already filed patents on applications of Cpf1 in gene editing, and has licensed them to biotech company Editas Medicine in Cambridge, Massachusetts.\u003c/p>\u003c/blockquote>\n\u003cp>\u003c/p>\n\u003cp>Remember, my friends, if UC Berkeley appeals, this whole process could last through 2020. Or longer.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003ca href=\"https://ww2.kqed.org/futureofyou/2017/02/16/broad-institute-wins-decision-over-uc-berkeley-in-crispr-patent-battle/\" target=\"_blank\">Last week\u003c/a> the feds may have dashed \u003ca href=\"http://www.berkeley.edu/\" target=\"_blank\">UC Berkeley's\u003c/a> billion-dollar dreams when it decided not to give the university patent rights over CRISPR-Cas9, a revolutionary gene-editing technology.\u003c/p>\n\u003cp>The Feb. 15 ruling from the U.S. Patent and Trademark Office let Berkeley's rival--the \u003ca href=\"https://www.broadinstitute.org/\" target=\"_blank\">Broad Institute\u003c/a> jointly owned by Harvard and MIT--keep its existing patents issued in 2014. UC Berkeley has yet to say whether or not it will appeal.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp> Berkeley was seeking to have some of those patents repealed because the university says they conflict with its pending patent application for CRISPR.\u003c/p>\n\u003cp>The judges reasoned that Berkeley's patent request doesn't affect Broad's existing patents because the two are based on different gene editing techniques.\u003c/p>\n\u003cp>Berkeley's patent request is for editing genes in bacteria, whereas Broad's existing patents are for editing genes in eukaryotic cells, i.e. cells found in plants and animals, including humans.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>But Berkeley argues that its research tool can easily be extended to use in non-bacterial cells.\u003c/p>\n\u003cp>That distinction is key since potentially lucrative applications of gene editing in medicine and health will involve eukaryotic cells found in humans.\u003c/p>\n\u003cp>UC Berkeley biologist Jennifer Doudna, who is credited with co-inventing CRISPR-Cas9 now has two options:\u003c/p>\n\u003cp>1) Appeal to the \u003ca href=\"http://www.cafc.uscourts.gov/\" target=\"_blank\">U.S. Court of Appeals for the Federal Circuit\u003c/a>\u003cbr>\n2) Go back to the \u003ca href=\"https://www.uspto.gov/\" target=\"_blank\">U.S. Patent and Trademark Office\u003c/a>\u003c/p>\n\u003cp>If Berkeley appeals, the court could overrule the patent office decision in favor of Berkeley.\u003c/p>\n\u003cp>If Berkeley loses, it could go back to the patent office, where it could be required to narrow its claims, i.e., specifying that its technique is only intended to be used in bacteria.\u003c/p>\n\u003cp>Or it could get a broad patent that still doesn't specify how to use CRISPR in eukaryotic cells. But according to \u003ca href=\"http://www.nyls.edu/faculty/faculty-profiles/faculty_profiles/jacob-s-sherkow/\" target=\"_blank\">Jacob Sherkow\u003c/a>, a law professor at \u003ca href=\"http://www.nyls.edu/\" target=\"_blank\">New York Law School\u003c/a>, that could lead to future legal challenges.\u003c/p>\n\u003cp>\"It’s not going to be that strong because anyone who wants to challenge it later can say, 'that patent doesn't disclose how to use the tool in eukaryotic cells,'\" says Sherkow.\u003c/p>\n\u003cp>And the money is in altering those specific cells.\u003c/p>\n\u003cp>So what's next? Only Berkeley knows; the university has said it will \"\u003ca href=\"http://news.berkeley.edu/2017/02/15/berkeley-statement-regarding-patent-boards-decision-on-crispr-cas9-gene-editing-technology/\" target=\"_blank\">carefully consider all options\u003c/a>.\"\u003c/p>\n\u003cp>Science journalists are abuzz about what this means for biotech. Here's a sampling of what they're saying:\u003c/p>\n\u003cp>\u003cstrong>1. \u003c/strong>\u003cstrong>Berkeley + Broad = Virtual Monopoly on CRISPR-Cas9\u003c/strong> (\u003ca href=\"http://gizmodo.com/should-anyone-really-control-who-gets-to-use-crispr-1792659635\" target=\"_blank\">Gizmodo\u003c/a>)\u003c/p>\n\u003cblockquote>\u003cp>Why does this matter? While academic researchers can still use CRISPR for free, companies hoping to harness the gene editing tool to fight disease, solve agricultural problems, or for myriad other potential applications, may have to pay not one, but both institutions, a hefty fee. It’s a decision that has caused some to wonder whether the rights to such revolutionary technology don’t really belong to a third party: the people.\u003c/p>\u003c/blockquote>\n\u003cp>\u003cstrong>2. Could the Case Encourage Scientists to Be Less Honest?\u003c/strong> (\u003ca href=\"https://www.statnews.com/2017/02/16/crispr-patent-decision-six-takeaways/\" target=\"_blank\">STAT\u003c/a>)\u003c/p>\n\u003cblockquote>\u003cp>The patent judges concluded that “the inventors themselves were uncertain” about making CRISPR work in human cells.\u003c/p>\n\u003cp>That could send a terrible message to scientists, said \u003ca href=\"https://isearch.asu.edu/profile/2783639\" target=\"_blank\">Dr. Robert Cook-Deegan\u003c/a> of \u003ca href=\"https://www.asu.edu/\" target=\"_blank\">Arizona State University\u003c/a>, an expert on legal and ethical issues surrounding biotechnology. “I hope this does not become the poster child that patent offices use to coach scientists not to be honest about uncertainties about their discoveries,” he said. “The fact that Doudna’s quotes were used by the judges mainly tells me Doudna was being honest. I hope scientists will continue to be honest and not succumb to being told they can’t say things that might undermine a broad patenting strategy.”\u003c/p>\u003c/blockquote>\n\u003cp>\u003cstrong>3. Fogettaboutit, Companies Can Sidestep Berkeley and Broad\u003c/strong> (\u003ca href=\"http://www.nature.com/news/why-the-crispr-patent-verdict-isn-t-the-end-of-the-story-1.21510\" target=\"_blank\">Nature\u003c/a>)\u003c/p>\n\u003cblockquote>\u003cp>Researchers in academia and industry have been pushing CRISPR gene editing beyond the scope of the Broad and Berkeley patents.\u003c/p>\n\u003cp>Both patent families cover the use of CRISPR–Cas9, which relies on the Cas9 enzyme to cut DNA. But there are alternatives to Cas9 that provide other functions, and a way to sidestep the Berkeley–Broad patent fight.\u003c/p>\n\u003cp>One attractive alternative is Cpf1, an enzyme that \u003ca href=\"http://www.nature.com/news/alternative-crispr-system-could-improve-genome-editing-1.18432\" target=\"_blank\">may be simpler to use\u003c/a> and more accurate than Cas9 in some cases. The Broad has already filed patents on applications of Cpf1 in gene editing, and has licensed them to biotech company Editas Medicine in Cambridge, Massachusetts.\u003c/p>\u003c/blockquote>\n\u003cp>\u003c/p>\n\u003cp>Remember, my friends, if UC Berkeley appeals, this whole process could last through 2020. Or longer.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Testosterone Anti-Aging Studies: Some Benefits, But None to Mental Function",
"title": "Testosterone Anti-Aging Studies: Some Benefits, But None to Mental Function",
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"content": "\u003cp>Testosterone treatment did not improve older men's memory or mental function in the latest results from landmark government research that challenges the anti-aging claims of popular supplements.\u003c/p>\n\u003caside class=\"pullquote alignright\">\"I don't think anybody would interpret these results as saying, 'Wow, this is a fountain of youth, this is a magical anti-aging potion.'\"\u003c/aside>\n\u003cp>While testosterone use for one year appeared to strengthen bones and reduce anemia, it also showed signs of worsening artery disease. Questions also remain about other potential risks. The researchers said more studies are needed to determine long-term effects — the kind of research the U.S. Food and Drug Administration has already asked supplement makers to conduct.\u003c/p>\n\u003cp>\"I don't think anybody would interpret these results as saying, 'Wow, this is a fountain of youth, this is a magical anti-aging potion,'\" said study co-author Susan Ellenberg, a University of Pennsylvania researcher.\u003c/p>\n\u003cp>[contextly_sidebar id=\"vGIx3CEh4RE10Omd9HBu0aZMjktQ5IJ6\"]The results are from the final four studies in a seven-part project mostly funded by the National Institute on Aging, involving nearly 800 U.S. men aged 65 and older with low testosterone levels. The goal was to see if rubbing testosterone gel on the skin daily for a year could treat problems linked with low levels of the male hormone, which declines with age. Half the men in each group used the real thing and half used fake gel.\u003c/p>\n\u003cp>Results published a year ago from the same research linked testosterone with mostly modest improvement in sexual performance, walking strength and mood.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The key new findings:\u003c/p>\n\u003cul>\n\u003cli>Testosterone had no effect on memory or mental function, based on tests given before, halfway and at the end of treatment to nearly 500 men with age-related memory decline.\u003c/li>\n\u003cli>Among almost 140 men who underwent heart artery imaging tests to see if the hormone slowed progression of plaque, those who used testosterone had more plaque buildup and narrower arteries after a year than the fake gel group. Those changes could signal increased chances for heart attacks although none occurred in the study. Men in this sub-study were already more vulnerable for heart problems because of conditions including artery disease, obesity and high blood pressure.\u003c/li>\n\u003cli>Among about 200 men given bone imaging tests before and at the end of treatment, those on testosterone showed increases in bone density and strength, especially in the spine, while minimal changes were found in the group that used fake gel. The improvement was similar to bone changes seen with treatment for osteoporosis, although most men studied did not have that bone-thinning condition, which can lead to fractures.\u003c/li>\n\u003cli>Among 126 men with anemia — a fatigue-linked condition involving inadequate red blood cells — those on testosterone showed substantial improvement. By the study's end, anemia had vanished in almost 60 percent of men on testosterone compared with 22 percent of the fake gel group. The hormone group also reported having more energy.\u003c/li>\n\u003c/ul>\n\u003cp>\"The overall health benefits, however, remain to be determined,\" the researchers said.\u003c/p>\n\u003cp>The studies were published Tuesday in the Journal of the American Medical Association and JAMA Internal Medicine. AbbVie Pharmaceuticals provided its gel for the study and helped pay for the research but had no other role in the study.\u003c/p>\n\u003cp>The research was not designed to look at risks and does not apply to younger men or those with normal levels of testosterone, said study leader Dr. Peter Snyder, a University of Pennsylvania hormone specialist. It's also not known if other forms of testosterone supplements would have similar effects in older men with low levels.\u003c/p>\n\u003cp>Prescription testosterone products, including gel, are approved only for men with low levels of the hormones caused by various medical conditions. Benefits and risks are unknown in men whose levels are low due only to aging, the FDA says. The agency requires testosterone labels to include possible risks for heart attacks and strokes, based on some previous studies.\u003c/p>\n\u003cp>A separate study published Tuesday in JAMA Internal Medicine found that men using prescription testosterone gel, patches or injections had fewer heart attacks and strokes than non-users during about three years of follow-up. But this was only observational data in men aged 40 and up, not rigorous research testing the hormone against a placebo.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Clarifying testosterone's effects on heart problems, fractures and age-related disability will require larger, longer studies, said Dr. Evan Hadley of the National Institute on Aging. He said decisions about whether to use testosterone should take into account men's individual risks for conditions the hormone could affect.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Testosterone treatment did not improve older men's memory or mental function in the latest results from landmark government research that challenges the anti-aging claims of popular supplements.\u003c/p>\n\u003caside class=\"pullquote alignright\">\"I don't think anybody would interpret these results as saying, 'Wow, this is a fountain of youth, this is a magical anti-aging potion.'\"\u003c/aside>\n\u003cp>While testosterone use for one year appeared to strengthen bones and reduce anemia, it also showed signs of worsening artery disease. Questions also remain about other potential risks. The researchers said more studies are needed to determine long-term effects — the kind of research the U.S. Food and Drug Administration has already asked supplement makers to conduct.\u003c/p>\n\u003cp>\"I don't think anybody would interpret these results as saying, 'Wow, this is a fountain of youth, this is a magical anti-aging potion,'\" said study co-author Susan Ellenberg, a University of Pennsylvania researcher.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>The results are from the final four studies in a seven-part project mostly funded by the National Institute on Aging, involving nearly 800 U.S. men aged 65 and older with low testosterone levels. The goal was to see if rubbing testosterone gel on the skin daily for a year could treat problems linked with low levels of the male hormone, which declines with age. Half the men in each group used the real thing and half used fake gel.\u003c/p>\n\u003cp>Results published a year ago from the same research linked testosterone with mostly modest improvement in sexual performance, walking strength and mood.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The key new findings:\u003c/p>\n\u003cul>\n\u003cli>Testosterone had no effect on memory or mental function, based on tests given before, halfway and at the end of treatment to nearly 500 men with age-related memory decline.\u003c/li>\n\u003cli>Among almost 140 men who underwent heart artery imaging tests to see if the hormone slowed progression of plaque, those who used testosterone had more plaque buildup and narrower arteries after a year than the fake gel group. Those changes could signal increased chances for heart attacks although none occurred in the study. Men in this sub-study were already more vulnerable for heart problems because of conditions including artery disease, obesity and high blood pressure.\u003c/li>\n\u003cli>Among about 200 men given bone imaging tests before and at the end of treatment, those on testosterone showed increases in bone density and strength, especially in the spine, while minimal changes were found in the group that used fake gel. The improvement was similar to bone changes seen with treatment for osteoporosis, although most men studied did not have that bone-thinning condition, which can lead to fractures.\u003c/li>\n\u003cli>Among 126 men with anemia — a fatigue-linked condition involving inadequate red blood cells — those on testosterone showed substantial improvement. By the study's end, anemia had vanished in almost 60 percent of men on testosterone compared with 22 percent of the fake gel group. The hormone group also reported having more energy.\u003c/li>\n\u003c/ul>\n\u003cp>\"The overall health benefits, however, remain to be determined,\" the researchers said.\u003c/p>\n\u003cp>The studies were published Tuesday in the Journal of the American Medical Association and JAMA Internal Medicine. AbbVie Pharmaceuticals provided its gel for the study and helped pay for the research but had no other role in the study.\u003c/p>\n\u003cp>The research was not designed to look at risks and does not apply to younger men or those with normal levels of testosterone, said study leader Dr. Peter Snyder, a University of Pennsylvania hormone specialist. It's also not known if other forms of testosterone supplements would have similar effects in older men with low levels.\u003c/p>\n\u003cp>Prescription testosterone products, including gel, are approved only for men with low levels of the hormones caused by various medical conditions. Benefits and risks are unknown in men whose levels are low due only to aging, the FDA says. The agency requires testosterone labels to include possible risks for heart attacks and strokes, based on some previous studies.\u003c/p>\n\u003cp>A separate study published Tuesday in JAMA Internal Medicine found that men using prescription testosterone gel, patches or injections had fewer heart attacks and strokes than non-users during about three years of follow-up. But this was only observational data in men aged 40 and up, not rigorous research testing the hormone against a placebo.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Clarifying testosterone's effects on heart problems, fractures and age-related disability will require larger, longer studies, said Dr. Evan Hadley of the National Institute on Aging. He said decisions about whether to use testosterone should take into account men's individual risks for conditions the hormone could affect.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"soldout": {
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