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"content": "\u003cp>\u003cem>This is an edited excerpt from Robert Wachter's \"\u003cem>\u003ca href=\"https://www.amazon.com/Digital-Doctor-Hope-Medicines-Computer/dp/0071849467\" target=\"_blank\" rel=\"noopener\">The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine's Computer Age\u003c/a>\u003c/em>,\" reprinted with permission from McGraw-Hill. Copyright 2015.\u003c/em>\u003c/p>\n\u003cp>\u003cspan style=\"font-size: 4.6875em;float: left;line-height: 0.733em;padding: 0.05em 0.1em 0 0;font-family: times, serif, georgia\">W\u003c/span>hen I was a medical student in the 1980s, the beating heart of the Hospital of the University of Pennsylvania was not the mahogany-lined executive suite, nor the dazzling operating room of L. Henry Edmunds, Jr., HUP's most famed cardiac surgeon. No, it was in the decidedly unglamorous, dimly lit Chest Reading room, where all the X-rays were hung on a moving contraption called an alternator that resembled the one on which the clothes hang at your local dry cleaner. Controlled by a seated radiologist operating a foot pedal, the machine would cycle through panel after panel until it arrived at your films. The radiologist took his foot off the pedal, the machine ground to a halt, and the dark X-ray sheets were brought to life by intense backlighting.\u003c/p>\n\u003cp>At Penn in the 1980s, everybody — and I mean everybody, from the lowliest student to the loftiest transplant surgeon — brought films for deciphering to the late Wallace Miller, Sr., a crusty but endearing professor of radiology and one of the best teachers I've ever known. For students like me, time spent with him was at once exhilarating and terrifying. \"What's this opacity?\" he asked me once, the memory burned into my hippocampus by that cognitive curing process known as overwhelming anxiety. \"A ... a pneumonia?\" I stammered.\u003c/p>\n\u003cp>\"Mooiaaa,\" retorted The Oracle, an unforgettable signature sound uttered as Miller smartly turned his head away in mock disgust. I loved it. We all did.\u003c/p>\n\u003caside class=\"pullquote alignright\">'One day I tried to see if I could go the whole day without speaking to anyone. And that’s what happened—I didn’t speak to a single person.'\u003ccite>A radiologist\u003c/cite>\u003c/aside>\n\u003cp>Today, many of my internal medicine trainees barely know where the radiology department is. Just as your record player and LPs are now long gone, in your local hospital today, the films, the analog X-ray machines, and even those charming film conveyor belts have left the building.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Why? In 2000, only 8 percent of U.S. hospitals had some version of a game-changing computer technology called the Picture Archiving and Communications System, or PACS. By 2008, more than three out of four did.\u003c/p>\n\u003cp>Because radiology was the first medical specialty to computerize, what has happened to it — at once shocking and, in retrospect, entirely predictable — is our canary in the digital coal mine, its experience offering important lessons for patients, clinicians and health care systems.\u003c/p>\n\u003cp>\u003cstrong>The Beauty of PACS\u003c/strong>\u003c/p>\n\u003cp>While the main catalyst for PACS was economic, the quality of the images and the ability to manipulate them were also important. Unlike regular films, CT scans need to be viewed at various contrast levels: One setting is best to look at bones, another to look at lungs, and still another to look at soft tissue like muscle.\u003c/p>\n\u003cp>PACS allowed radiologists to toggle through these views, in the same way that Instagram lets you play with your photos. You can also use a nifty magnifying glass to zoom in on a part of the image. An unexpected benefit was “stacking”: rather than looking at 100 images arrayed in a 10 × 10 grid on a one-dimensional page, the images could be digitally stacked, one on top of another, allowing the radiologist to scroll through them swiftly by rolling a mouse ball. Moreover, computerization let the radiologist look at the images from home, enabling senior experts to weigh in on subtle findings that trainees might flub. And while the images were fuzzy at first, today they’re as crisp as high-definition television.\u003c/p>\n\u003cp>Perhaps most important, PACS obviated the need for maddening searches for prior X-rays. Twenty years ago, when a chest X-ray revealed a lung nodule, the first commandment on the radiologist’s report was to “obtain old films.” The rationale: If the nodule had been unchanged for many years, it could safely be ignored—such stability simply wasn’t consistent with a diagnosis of cancer. But searching for old films was often an exercise in frustration: They were lost, or locked up, or at another institution, or in a filing cabinet in the thoracic surgeon’s garage, behind the golf clubs. When my colleagues and I came up empty-handed, which was more often than not, the patient frequently paid the price in the form of an unnecessary biopsy. But PACS made finding old films a breeze (assuming that they were done at the same hospital or had been scanned into the system); they’re usually just a click away.\u003c/p>\n\u003cp>While PACS was widely anticipated and generally accepted by radiologists, some prescient observers worried that computerization might lead to unbidden effects on the field. In 1999, Stephen Baker, chair of the Department of Radiology at New Jersey Medical School, fretted that PACS might turn radiologists into “disembodied functionaries, more akin to servicing technicians than professional colleagues.” Paul Chang, professor of radiology at the University of Chicago and an early leader in digital radiology, describes the day his father, a retired radiologist, took him to task.\u003c/p>\n\u003cp>“Before PACS, we were the doctor’s doctor,” his father berated him. “Medicine and surgery rounds started in radiology. . . . Every morning the clinicians and the radiologists collaborated.”\u003c/p>\n\u003cp>His father’s less-than-endearing nickname for his famous son: “The Man Who Ruined Radiology.”\u003c/p>\n\u003cp>The advantages of PACS are so vast that few would want to turn back the clock. Yet the effects on those of us who order X-rays and the radiologists who read them have been profound, and they’re not all positive. The fact that we can now review our images without trekking down to radiology means that we rarely do make the trip.\u003c/p>\n\u003cp>https://www.youtube.com/watch?v=fHUzVqoDnts&ab_channel=DoctorKlioze\u003c/p>\n\u003cp>\u003cstrong>An Awkward Trip to Radiology\u003c/strong>\u003c/p>\n\u003cp>A few years ago, when I asked my interns and students to visit the radiology department to review the key films, they looked at me as if I had grown a second head. After my team humored me by accompanying me to the radiology department, I conducted a little sociology experiment. Standing outside my hospital’s chest reading room, I delivered a brief speech:\u003c/p>\n\u003caside class=\"pullquote alignright\">'Did you look at the official report?' he hissed. The unspoken message was clear: Get out of my space; I’m busy.\u003c/aside>\n\u003cp>\"Watch what happens when we enter. Does anybody turn around and welcome us, ask, 'How can I help you?' and seem genuinely enthusiastic? When they go over the X-ray, do they delve a layer deeper than what they said in the formal report? Do they make any teaching points? Does the radiologist suggest courses of action or ask provocative questions?\"\u003c/p>\n\u003cp>I did this because I am deeply concerned that mine is the last generation to have learned the habit of going to the radiology department. Nostalgic for my interactions with Wally Miller and his like, it saddens me that our current trainees will never know how much they can learn from a great radiology teacher, and how much their patients’ care can be improved by actually talking to a real live radiologist. Yet I know that even if I bring my young horses to water, whether they visit the radiology department after I am no longer their wrangler will be determined by the quality of their experience.\u003c/p>\n\u003cp>We entered the chest reading room and were greeted by a wall of radiologists’ backs, their faces trained like lasers on the computer screens in front of them. Not a single head—located atop the shoulders of about eight different radiologists—turned to greet us.\u003c/p>\n\u003cp>After a couple of awkward minutes of crescendo throat-clearing, one of the radiologists grudgingly swiveled around to face my team and me. “Oh, do you need something?” he asked.\u003c/p>\n\u003cp>“Sure; can you help us look at a few films?”\u003c/p>\n\u003cp>He did, kind of, but offered his help in a whisper animated mostly by passive aggressiveness.\u003c/p>\n\u003cp>I thought it couldn’t get any worse, but it did.\u003c/p>\n\u003cp>“What do you think of this area?” I asked him, pointing to a confusing patch of whiteness on one patient’s chest CT scan.\u003c/p>\n\u003cp>“Did you look at the official report?” he hissed. (In other words: \"Perhaps you don’t know how to turn on your computer?\")\u003c/p>\n\u003cp>The unspoken message was clear: Get out of my space; I’m busy.\u003c/p>\n\u003cp>Now, I understand that he might well be busy, and that it has to be annoying having clinicians interrupt you every few minutes to go over images, particularly after you’ve just reviewed them with a different set of specialists and dictated a report. But that is the radiologist’s job. Or at least it used to be.\u003c/p>\n\u003cp>Allison Tillack, a young radiologist and a medical anthropologist whose Ph.D. thesis involved observing the world of radiologists for a year at a prominent academic hospital, has explored how the computerization of radiology has transformed the worlds of radiologists and those who use their services.\u003c/p>\n\u003cp>\"The ability of PACS to alter the accessibility and tempo of medical imaging has resulted in visits to the reading room being viewed now by non-radiology clinicians as a ‘waste of time’ and by radiologists as an ‘interruption,’” she wrote.\u003c/p>\n\u003cp>\u003cstrong>In a Funk\u003c/strong>\u003c/p>\n\u003cp>While I was well aware of the changing perceptions of radiology by nonradiologists, I had not, until I met Tillack, appreciated the degree to which the field of radiology is itself in a PACS-fueled funk.\u003c/p>\n\u003cp>After all, the field remains extremely popular among medical students, as many perceive it as offering the perfect blend of “great lifestyle” (that is, banker’s hours and limited overnight call) and high income, which averaged $340,000 in 2013. In fact, it’s often said that today’s medical students are attracted to the “ROAD specialties”: Radiology, Ophthalmology, Anesthesiology, and Dermatology, all of which are lucrative and none of which involves a lot of contact with those pesky sick people. In her research, Tillack found that the vast majority of radiologists and radiology residents identified the lack of direct patient contact as one of the main attractions of the field.\u003c/p>\n\u003cp>Given all these pluses, many frontline clinicians think of radiologists as having “won the game.” Yet I should have gotten a hint of the field’s handwringing in 2005, when I saw the results of a survey of physicians regarding their satisfaction with their chosen specialty. The happiest doctors were radiation oncologists (the folks who deliver radiation therapy to cancer patients), who do satisfying work, earn a good income, and have predictable hours. The least happy were cardiac surgeons, who train forever and, in recent years, have seen much of their business eroded by stents and other nonsurgical approaches to heart disease.\u003c/p>\n\u003cp>Radiologists show up a bit below the mean on the satisfaction scale—just behind the perennially overwhelmed and undercompensated primary care doctors.\u003c/p>\n\u003cp>In a 2012 paper, Tillack and a colleague described “the loneliness of the long distance radiologist.” One radiologist told them, “Before, I knew the face, name, wife’s name, and kids’ names of all the clinicians, but now I don’t know who you are if you joined the medical staff after we got PACS. . . . Before, when a clinician showed up, I could ask them and find out what’s really going on with the patient.”\u003c/p>\n\u003cp>I hear similar stories from every radiologist I meet. Patrick Luetmer, a Mayo Clinic neuroradiologist, described what happened when his MRI suite was remodeled. The suite was originally configured with two MRI “donuts” (the huge magnets that are responsible for the image) on either side of a central workstation in which Luetmer sat. There, he could monitor the scans as they were being performed, and talk to both the patients and the radiology assistants. Clinicians sometimes wandered down to look at the scans with him.\u003c/p>\n\u003cp>A few years ago, as part of a big efficiency push, Mayo decided that a third MRI machine was a better use of that central area than the radiologist’s air traffic control desk. Luetmer’s workstation was moved to an office a few hundred feet away, where he could follow the scans on his computer monitor and communicate with the techs via a special text messaging system.\u003c/p>\n\u003cp>“One day I tried to see if I could go the whole day without speaking to anyone. And that’s what happened—I didn’t speak to a single person. It was incredibly isolating.”\u003c/p>\n\u003cfigure id=\"attachment_264998\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2019/10/radiology2.jpg\">\u003cimg class=\"size-large wp-image-264998\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2019/10/radiology2-1180x953.jpg\" alt=\"1950s-era radiology at the U.S. Naval Hospital, Charleston, South Carolina.\" width=\"640\" height=\"517\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2019/10/radiology2-1180x953.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2019/10/radiology2-400x323.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2019/10/radiology2-743x600.jpg 743w, https://ww2.kqed.org/app/uploads/sites/13/2019/10/radiology2-768x620.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2019/10/radiology2-1920x1550.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2019/10/radiology2-960x775.jpg 960w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">1950s-era radiology at the U.S. Naval Hospital, Charleston, South Carolina. \u003ccite>(National Library of Medicine)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The radiologists were lonely, sure, but their situation involves something far deeper. Hari Tsoukas, an expert in organizational studies at the University of Cyprus, highlights the distinction between “information” and “knowledge.” Information, he wrote, “consists of objectified, decontextualized, time-less, impersonal, value-free representations,” whereas knowledge is “context-dependent, personalized, time-bound, and infused with values.”\u003c/p>\n\u003cp>Adds Tillack, “Hunches, hypotheses, frustrations with patients or their families, second guessing, judging of colleagues, and similar activities that mark how uncertainty is negotiated on a daily basis in medical practice are rarely reflected in the medical record . . . this knowledge can only circulate in private or semi-private contexts—by its very definition, this knowledge cannot be made a matter of public record.”\u003c/p>\n\u003cp>By purging the informal conversations during which such information was exchanged, the emergence of PACS left radiologists information-rich (Think of all those pixels! And old films just a click away!), but knowledge-poor.\u003c/p>\n\u003cp>\u003cstrong>'Great Case. Next Case.'\u003c/strong>\u003c/p>\n\u003cp>Radiologists’ alienation runs deeper than the lack of collegial exchange and the inability to find out what’s really going on with the patients. It’s also about power, status, and expertise. The fact that the traditional film lived only in the radiology reading room gave radiologists a monopoly over their entire ecosystem. PACS, observes Tillack, created a new normal in which “the ‘right’ to see [the image] is no longer mediated by radiologists, as it was in the reading room,” and has thus “eroded radiologists’ claims for authoritative knowledge over the interpretation of medical images.”\u003c/p>\n\u003cp>Once the radiology department no longer housed the films, the impact was immediate and dramatic. Without any changes in policy or very much forethought, the mid-1990s transition to filmless operations at the Baltimore VA hospital led to an 82 percent decrease in in-person consultation rates for general radiology studies. Today, many clinicians—particularly specialists like neurologists, pulmonologists, and surgeons—look at images themselves and act on their own interpretations; Many don’t even bother to read the radiologist’s formal report (which usually takes several hours, sometimes even a day, to reach the chart) unless they have unanswered questions or judge the study to be particularly challenging.\u003c/p>\n\u003cp>PACS was to increase efficiency, but that virtue has also become a curse, as radiologists increasingly feel like Lucy and Ethel on the assembly line of the chocolate factory. Among teleradiologists (radiologists reading x-rays from a distant site, often covering emergency departments at night while the hospital’s own radiologists are sleeping), there’s a well-known adage that captures the relentless objectification of their modern predicament: “Great case. Next case.\" As with so many other aspects of our modern digital lives, PACS sped up the clock, and did so without mercy.\u003c/p>\n\u003cp>That clock is constantly ticking. “Instead of waiting for films to be acquired, printed, sorted, and hung, radiologists now are always playing catch-up, looking at more ‘stuff’ in less time,” observed Tillack. That miraculous access to old films also creates an obligation for the radiologist to actually review them.\u003c/p>\n\u003cp>And it’s not just the old films that need to be examined; PACS makes vast amounts of information available with every study. In the early days of CT, the output of a scan might have been about 12 “slices,” each one representing a ¼-inch section through the thorax or abdomen, akin to a thick slice of deli-cut salami. But today’s ultra-fast CT scanners can produce images of more than 50 slices per inch of the human body, more like ultra-thin cuts of prosciutto. And PACS, with its massive memory bank and blazingly fast transmission speeds,can easily display every slice, which means that the radiologist has to scroll through hundreds of images in order to read a single CT study. This combination of more information in each scan, more old studies to compare, and more time pressure is unremitting.\u003c/p>\n\u003cp>The clock is ticking for other reasons as well. Since the image is available to the ordering clinician the moment it is created, radiologists feel obliged to perform their review quickly lest their reading seem like old news, like an afternoon newspaper in the Age of Twitter. Piling on, after recognizing the efficiency of PACS, insurance companies and Medicare slashed the reimbursement for each interpretation, pushing radiologists to read more films in less time in order to maintain their incomes. Said one radiologist, “With PACS, work is busier now. We have 70 percent more cases to read than 10 years ago. . . . At the end of the day . . . I’m fried.”\u003c/p>\n\u003cp>On top of this, there are even greater threats to radiologists’ livelihoods and happiness. One of them flows from the growing pressure on health care systems to slash their costs. Currently, virtually every X-ray performed at a U.S. hospital is sent for a formal reading by a radiologist, who is paid a fee by an insurance company. In today’s cost-cutting environment, it’s probably only a matter of time before some health care systems permit their frontline specialists to officially read certain films, reserving radiologist “overreads” for those images that the clinicians have questions about or the ones with super-high malpractice risk if they are misread. Radiologists can be counted on to fight such a move by frantically waving the banner of quality, but they will need to demonstrate that the value of having them review every film is worth the considerable expense.\u003c/p>\n\u003cp>Moreover, a major theme of Obama-era health reform is a shift from our historical fee-for-service, piecework payment model to one that dispenses a single payment to a hospital and doctors to manage all the care for a group of patients (“accountable care organizations,” ACOs for short) or a given episode of disease (“bundled payments”). Under such systems, the risk for the cost of care shifts from the insurer to the providers, and it’s up to the latter to decide how to divvy up the cash. Ron Arenson, chairman of the department of radiology at the University of California, San Francisco, sees this as the greatest threat to his field.\u003c/p>\n\u003cp>“If the world moves to bundled payments, we won’t do well,” he said. “We’re not very high in the pecking order.”\u003c/p>\n\u003cp>Some nonradiologists, particularly ER doctors working nights and weekends, have little sympathy for their colleagues’ new predicament. In fact, they have begun to wonder why radiologists should be compensated for next-day readings when they’ve already looked at the images themselves, acted on their interpretations, and assumed the risk of being sued if anything goes wrong. In a 2011 editorial entitled “The Life Cycle of a Parasitic Specialist,” ER physician William Mallon took off the gloves.\u003c/p>\n\u003cblockquote>\u003cp>[On Monday morning] these parasites will commence to feed on the financial juices of the lowly unfortunate emergency physicians, who had to work the entire weekend without radiologic support or backup. . . . The radiologist arrives well rested, café latte in hand, and promptly installs himself in a dark room to re-read and bill for all the films the emergency physicians read over the weekend. . . . Never has a specialty done so little for so many and been paid so much.\u003c/p>\u003c/blockquote>\n\u003cp>Ouch.\u003c/p>\n\u003cp>Another challenge to radiology made possible by the death of film has come in the form of teleradiology. Once X-rays went digital, it was no longer crucial for radiologists to be in the same building as the patient or the treating clinicians. As a result, many multihospital systems consolidated their reading rooms, particularly on weekends and nights, with centralized radiologists supporting multiple sites. Predictably, once the technical challenges of connectivity were solved, teleradiology companies emerged to fill this need. As is often the case with contented “legacy” providers (in health care and other industries), traditional radiologists were only too happy to have their colleagues read their films during off-hours. Who wouldn’t be?\u003c/p>\n\u003cp>The playing field soon expanded across national borders, as radiologists in Zurich, Israel, and Singapore began to read nighttime X-rays for American hospitals during their own local daytimes. Hundreds of hospitals now use these \"nighthawks,\" and everybody seems happy about it, including the domestic radiologists, who are sleeping soundly while the overnight images are read half a world away.\u003c/p>\n\u003cp>But one wonders whether this is the start of so-called disruptive innovation, the concept made famous by Harvard’s Clay Christensen. Disruption often begins with a fat and happy incumbent content to preserve its existing enviable position in a market. In industries ranging from commercial aviation to steel manufacturing, an upstart comes in and grabs an unattractive part of the market (in this case, nights and weekends). But once a low-cost company has squeezed through a crack to capture a slice of a previously locked franchise, it is rarely content to stay put. With the average U.S. radiologist earning about $350,000 per year and the average Indian radiologist earning less than one-tenth of that, one wonders whether the same World-is-Flat forces that have revolutionized other industries but mostly bypassed health care will be unleashed.\u003c/p>\n\u003cp>This is where radiologists’ loss of trust and collegiality with other clinicians may exact its heaviest toll. “Some people see teleradiology as a big threat, but I don’t,” UCSF’s Arenson told me. “I think that relationships with radiologists are important.” I do too, which is why I believe he may have his head in the sand: If physicians don’t get much out of visiting the radiology department or have even forgotten where it is located, we have little reason to fight to keep it in our buildings. Or, for that matter, our country.\u003c/p>\n\u003cp>Like all legacy providers faced with a technological or global workforce threat, radiologists can be counted on to argue that quality would take a huge hit if we outsourced their work to less expensive providers, domestic or foreign. The degree to which the field has accepted nighttime readings from non-U.S. radiologists will, of course, undermine this argument. It’s hard to make the claim that a Bangalore-based teleradiologist is sufficiently competent to read an image for your hospital at 3 a.m., but not at 3 p.m.\u003c/p>\n\u003cp>\u003cstrong>The Ultimate Threat\u003c/strong>\u003c/p>\n\u003cp>Finally, there is the ultimate threat: replacement by the machine. Of course, this issue is marbled throughout health care as we enter the digital age. To date, most claims that “this technology will replace doctors” (in areas ranging from diagnostic reasoning to robotic surgery) have proven to be hype.\u003c/p>\n\u003cp>However, in fields that are primarily about visual pattern recognition, the promise (or, if you’re a radiologist, the threat) is much more real. Studies have shown that computers can detect significant numbers of breast cancers and pulmonary emboli missed by radiologists, although nobody has yet taken the bold step of having the computers completely supplant the humans, partly because there are armadas of malpractice attorneys waiting to pounce, and partly because, at least for now, the combination of human and machine seems to perform better than either alone.\u003c/p>\n\u003cp>But over the long haul, I wouldn’t bet on the humans here, particularly since one of the hottest areas in artificial intelligence research is “deep learning”—research that has created computers that are reasonably skilled at “reading,” “hearing,” and, yes, “seeing.” The same kind of software that now allows Facebook to guess that a certain collection of pixels is a picture of you, or that alerts the casino’s security guards to keep an eye on that guy, is likely to eventually crack the code in radiology, and in similar areas such as dermatology and pathology.\u003c/p>\n\u003cp>Slowly, radiologists are waking up to their peril. Rather than isolating themselves from clinical care, some are now relocating their reading stations in clinical areas, such as the ER and the ICU, to be in the line of sight of their clinician colleagues. Others are resurrecting interdisciplinary conferences and training their staff in customer service. Technological solutions that allow radiologists and frontline clinicians to communicate through PACS and the electronic health record are springing up (through programs that create a mash-up of a Skype-like communication tool and a John Madden–style telestrator).\u003c/p>\n\u003cp>Said Paul Chang, the University of Chicago radiologist whose advocacy of PACS so upset his father, “We have to go beyond isolating ourselves and concentrating on messages in a bottle, where we just write a report and are done with it, but instead fostering collaboration.”\u003c/p>\n\u003cp>Since radiology represents such a large segment of health care expenditures (and also a source of harm through the risk of radiation), some health care systems are even putting radiologists in the position of being gatekeepers to their own technology. It’s a role they might not have accepted in the past, but, faced with an existential threat, many now welcome it. Said David Levin, a radiologist at Thomas Jefferson University, “We have to act more like consulting physicians . . . to look at the appropriateness of the requests for advanced imaging studies . . . rather than just going ahead and doing the study.”\u003c/p>\n\u003cp>Radiology’s experience over the past 15 years offers a crystal ball for the rest of the health care system. The speed with which computerization unleashed a series of forces that completely transformed an established field would be all too familiar to travel agents, journalists, and others who have been run over by the digital bulldozer, but it has shocked many health care observers, even astute ones.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>Will the computerization of the rest of medicine similarly upend the lives of other kinds of doctors, as well as their patients? The early returns are in, and the answer is yes.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cem>This is an edited excerpt from Robert Wachter's \"\u003cem>\u003ca href=\"https://www.amazon.com/Digital-Doctor-Hope-Medicines-Computer/dp/0071849467\" target=\"_blank\" rel=\"noopener\">The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine's Computer Age\u003c/a>\u003c/em>,\" reprinted with permission from McGraw-Hill. Copyright 2015.\u003c/em>\u003c/p>\n\u003cp>\u003cspan style=\"font-size: 4.6875em;float: left;line-height: 0.733em;padding: 0.05em 0.1em 0 0;font-family: times, serif, georgia\">W\u003c/span>hen I was a medical student in the 1980s, the beating heart of the Hospital of the University of Pennsylvania was not the mahogany-lined executive suite, nor the dazzling operating room of L. Henry Edmunds, Jr., HUP's most famed cardiac surgeon. No, it was in the decidedly unglamorous, dimly lit Chest Reading room, where all the X-rays were hung on a moving contraption called an alternator that resembled the one on which the clothes hang at your local dry cleaner. Controlled by a seated radiologist operating a foot pedal, the machine would cycle through panel after panel until it arrived at your films. The radiologist took his foot off the pedal, the machine ground to a halt, and the dark X-ray sheets were brought to life by intense backlighting.\u003c/p>\n\u003cp>At Penn in the 1980s, everybody — and I mean everybody, from the lowliest student to the loftiest transplant surgeon — brought films for deciphering to the late Wallace Miller, Sr., a crusty but endearing professor of radiology and one of the best teachers I've ever known. For students like me, time spent with him was at once exhilarating and terrifying. \"What's this opacity?\" he asked me once, the memory burned into my hippocampus by that cognitive curing process known as overwhelming anxiety. \"A ... a pneumonia?\" I stammered.\u003c/p>\n\u003cp>\"Mooiaaa,\" retorted The Oracle, an unforgettable signature sound uttered as Miller smartly turned his head away in mock disgust. I loved it. We all did.\u003c/p>\n\u003caside class=\"pullquote alignright\">'One day I tried to see if I could go the whole day without speaking to anyone. And that’s what happened—I didn’t speak to a single person.'\u003ccite>A radiologist\u003c/cite>\u003c/aside>\n\u003cp>Today, many of my internal medicine trainees barely know where the radiology department is. Just as your record player and LPs are now long gone, in your local hospital today, the films, the analog X-ray machines, and even those charming film conveyor belts have left the building.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Why? In 2000, only 8 percent of U.S. hospitals had some version of a game-changing computer technology called the Picture Archiving and Communications System, or PACS. By 2008, more than three out of four did.\u003c/p>\n\u003cp>Because radiology was the first medical specialty to computerize, what has happened to it — at once shocking and, in retrospect, entirely predictable — is our canary in the digital coal mine, its experience offering important lessons for patients, clinicians and health care systems.\u003c/p>\n\u003cp>\u003cstrong>The Beauty of PACS\u003c/strong>\u003c/p>\n\u003cp>While the main catalyst for PACS was economic, the quality of the images and the ability to manipulate them were also important. Unlike regular films, CT scans need to be viewed at various contrast levels: One setting is best to look at bones, another to look at lungs, and still another to look at soft tissue like muscle.\u003c/p>\n\u003cp>PACS allowed radiologists to toggle through these views, in the same way that Instagram lets you play with your photos. You can also use a nifty magnifying glass to zoom in on a part of the image. An unexpected benefit was “stacking”: rather than looking at 100 images arrayed in a 10 × 10 grid on a one-dimensional page, the images could be digitally stacked, one on top of another, allowing the radiologist to scroll through them swiftly by rolling a mouse ball. Moreover, computerization let the radiologist look at the images from home, enabling senior experts to weigh in on subtle findings that trainees might flub. And while the images were fuzzy at first, today they’re as crisp as high-definition television.\u003c/p>\n\u003cp>Perhaps most important, PACS obviated the need for maddening searches for prior X-rays. Twenty years ago, when a chest X-ray revealed a lung nodule, the first commandment on the radiologist’s report was to “obtain old films.” The rationale: If the nodule had been unchanged for many years, it could safely be ignored—such stability simply wasn’t consistent with a diagnosis of cancer. But searching for old films was often an exercise in frustration: They were lost, or locked up, or at another institution, or in a filing cabinet in the thoracic surgeon’s garage, behind the golf clubs. When my colleagues and I came up empty-handed, which was more often than not, the patient frequently paid the price in the form of an unnecessary biopsy. But PACS made finding old films a breeze (assuming that they were done at the same hospital or had been scanned into the system); they’re usually just a click away.\u003c/p>\n\u003cp>While PACS was widely anticipated and generally accepted by radiologists, some prescient observers worried that computerization might lead to unbidden effects on the field. In 1999, Stephen Baker, chair of the Department of Radiology at New Jersey Medical School, fretted that PACS might turn radiologists into “disembodied functionaries, more akin to servicing technicians than professional colleagues.” Paul Chang, professor of radiology at the University of Chicago and an early leader in digital radiology, describes the day his father, a retired radiologist, took him to task.\u003c/p>\n\u003cp>“Before PACS, we were the doctor’s doctor,” his father berated him. “Medicine and surgery rounds started in radiology. . . . Every morning the clinicians and the radiologists collaborated.”\u003c/p>\n\u003cp>His father’s less-than-endearing nickname for his famous son: “The Man Who Ruined Radiology.”\u003c/p>\n\u003cp>The advantages of PACS are so vast that few would want to turn back the clock. Yet the effects on those of us who order X-rays and the radiologists who read them have been profound, and they’re not all positive. The fact that we can now review our images without trekking down to radiology means that we rarely do make the trip.\u003c/p>\u003c/p>\u003cp>\u003cspan class='utils-parseShortcode-shortcodes-__youtubeShortcode__embedYoutube'>\n \u003cspan class='utils-parseShortcode-shortcodes-__youtubeShortcode__embedYoutubeInside'>\n \u003ciframe\n loading='lazy'\n class='utils-parseShortcode-shortcodes-__youtubeShortcode__youtubePlayer'\n type='text/html'\n src='//www.youtube.com/embed/fHUzVqoDnts'\n title='//www.youtube.com/embed/fHUzVqoDnts'\n allowfullscreen='true'\n style='border:0;'>\u003c/iframe>\n \u003c/span>\n \u003c/span>\u003c/p>\u003cp>\u003cp>\u003cstrong>An Awkward Trip to Radiology\u003c/strong>\u003c/p>\n\u003cp>A few years ago, when I asked my interns and students to visit the radiology department to review the key films, they looked at me as if I had grown a second head. After my team humored me by accompanying me to the radiology department, I conducted a little sociology experiment. Standing outside my hospital’s chest reading room, I delivered a brief speech:\u003c/p>\n\u003caside class=\"pullquote alignright\">'Did you look at the official report?' he hissed. The unspoken message was clear: Get out of my space; I’m busy.\u003c/aside>\n\u003cp>\"Watch what happens when we enter. Does anybody turn around and welcome us, ask, 'How can I help you?' and seem genuinely enthusiastic? When they go over the X-ray, do they delve a layer deeper than what they said in the formal report? Do they make any teaching points? Does the radiologist suggest courses of action or ask provocative questions?\"\u003c/p>\n\u003cp>I did this because I am deeply concerned that mine is the last generation to have learned the habit of going to the radiology department. Nostalgic for my interactions with Wally Miller and his like, it saddens me that our current trainees will never know how much they can learn from a great radiology teacher, and how much their patients’ care can be improved by actually talking to a real live radiologist. Yet I know that even if I bring my young horses to water, whether they visit the radiology department after I am no longer their wrangler will be determined by the quality of their experience.\u003c/p>\n\u003cp>We entered the chest reading room and were greeted by a wall of radiologists’ backs, their faces trained like lasers on the computer screens in front of them. Not a single head—located atop the shoulders of about eight different radiologists—turned to greet us.\u003c/p>\n\u003cp>After a couple of awkward minutes of crescendo throat-clearing, one of the radiologists grudgingly swiveled around to face my team and me. “Oh, do you need something?” he asked.\u003c/p>\n\u003cp>“Sure; can you help us look at a few films?”\u003c/p>\n\u003cp>He did, kind of, but offered his help in a whisper animated mostly by passive aggressiveness.\u003c/p>\n\u003cp>I thought it couldn’t get any worse, but it did.\u003c/p>\n\u003cp>“What do you think of this area?” I asked him, pointing to a confusing patch of whiteness on one patient’s chest CT scan.\u003c/p>\n\u003cp>“Did you look at the official report?” he hissed. (In other words: \"Perhaps you don’t know how to turn on your computer?\")\u003c/p>\n\u003cp>The unspoken message was clear: Get out of my space; I’m busy.\u003c/p>\n\u003cp>Now, I understand that he might well be busy, and that it has to be annoying having clinicians interrupt you every few minutes to go over images, particularly after you’ve just reviewed them with a different set of specialists and dictated a report. But that is the radiologist’s job. Or at least it used to be.\u003c/p>\n\u003cp>Allison Tillack, a young radiologist and a medical anthropologist whose Ph.D. thesis involved observing the world of radiologists for a year at a prominent academic hospital, has explored how the computerization of radiology has transformed the worlds of radiologists and those who use their services.\u003c/p>\n\u003cp>\"The ability of PACS to alter the accessibility and tempo of medical imaging has resulted in visits to the reading room being viewed now by non-radiology clinicians as a ‘waste of time’ and by radiologists as an ‘interruption,’” she wrote.\u003c/p>\n\u003cp>\u003cstrong>In a Funk\u003c/strong>\u003c/p>\n\u003cp>While I was well aware of the changing perceptions of radiology by nonradiologists, I had not, until I met Tillack, appreciated the degree to which the field of radiology is itself in a PACS-fueled funk.\u003c/p>\n\u003cp>After all, the field remains extremely popular among medical students, as many perceive it as offering the perfect blend of “great lifestyle” (that is, banker’s hours and limited overnight call) and high income, which averaged $340,000 in 2013. In fact, it’s often said that today’s medical students are attracted to the “ROAD specialties”: Radiology, Ophthalmology, Anesthesiology, and Dermatology, all of which are lucrative and none of which involves a lot of contact with those pesky sick people. In her research, Tillack found that the vast majority of radiologists and radiology residents identified the lack of direct patient contact as one of the main attractions of the field.\u003c/p>\n\u003cp>Given all these pluses, many frontline clinicians think of radiologists as having “won the game.” Yet I should have gotten a hint of the field’s handwringing in 2005, when I saw the results of a survey of physicians regarding their satisfaction with their chosen specialty. The happiest doctors were radiation oncologists (the folks who deliver radiation therapy to cancer patients), who do satisfying work, earn a good income, and have predictable hours. The least happy were cardiac surgeons, who train forever and, in recent years, have seen much of their business eroded by stents and other nonsurgical approaches to heart disease.\u003c/p>\n\u003cp>Radiologists show up a bit below the mean on the satisfaction scale—just behind the perennially overwhelmed and undercompensated primary care doctors.\u003c/p>\n\u003cp>In a 2012 paper, Tillack and a colleague described “the loneliness of the long distance radiologist.” One radiologist told them, “Before, I knew the face, name, wife’s name, and kids’ names of all the clinicians, but now I don’t know who you are if you joined the medical staff after we got PACS. . . . Before, when a clinician showed up, I could ask them and find out what’s really going on with the patient.”\u003c/p>\n\u003cp>I hear similar stories from every radiologist I meet. Patrick Luetmer, a Mayo Clinic neuroradiologist, described what happened when his MRI suite was remodeled. The suite was originally configured with two MRI “donuts” (the huge magnets that are responsible for the image) on either side of a central workstation in which Luetmer sat. There, he could monitor the scans as they were being performed, and talk to both the patients and the radiology assistants. Clinicians sometimes wandered down to look at the scans with him.\u003c/p>\n\u003cp>A few years ago, as part of a big efficiency push, Mayo decided that a third MRI machine was a better use of that central area than the radiologist’s air traffic control desk. Luetmer’s workstation was moved to an office a few hundred feet away, where he could follow the scans on his computer monitor and communicate with the techs via a special text messaging system.\u003c/p>\n\u003cp>“One day I tried to see if I could go the whole day without speaking to anyone. And that’s what happened—I didn’t speak to a single person. It was incredibly isolating.”\u003c/p>\n\u003cfigure id=\"attachment_264998\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2019/10/radiology2.jpg\">\u003cimg class=\"size-large wp-image-264998\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2019/10/radiology2-1180x953.jpg\" alt=\"1950s-era radiology at the U.S. Naval Hospital, Charleston, South Carolina.\" width=\"640\" height=\"517\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2019/10/radiology2-1180x953.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2019/10/radiology2-400x323.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2019/10/radiology2-743x600.jpg 743w, https://ww2.kqed.org/app/uploads/sites/13/2019/10/radiology2-768x620.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2019/10/radiology2-1920x1550.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2019/10/radiology2-960x775.jpg 960w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">1950s-era radiology at the U.S. Naval Hospital, Charleston, South Carolina. \u003ccite>(National Library of Medicine)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The radiologists were lonely, sure, but their situation involves something far deeper. Hari Tsoukas, an expert in organizational studies at the University of Cyprus, highlights the distinction between “information” and “knowledge.” Information, he wrote, “consists of objectified, decontextualized, time-less, impersonal, value-free representations,” whereas knowledge is “context-dependent, personalized, time-bound, and infused with values.”\u003c/p>\n\u003cp>Adds Tillack, “Hunches, hypotheses, frustrations with patients or their families, second guessing, judging of colleagues, and similar activities that mark how uncertainty is negotiated on a daily basis in medical practice are rarely reflected in the medical record . . . this knowledge can only circulate in private or semi-private contexts—by its very definition, this knowledge cannot be made a matter of public record.”\u003c/p>\n\u003cp>By purging the informal conversations during which such information was exchanged, the emergence of PACS left radiologists information-rich (Think of all those pixels! And old films just a click away!), but knowledge-poor.\u003c/p>\n\u003cp>\u003cstrong>'Great Case. Next Case.'\u003c/strong>\u003c/p>\n\u003cp>Radiologists’ alienation runs deeper than the lack of collegial exchange and the inability to find out what’s really going on with the patients. It’s also about power, status, and expertise. The fact that the traditional film lived only in the radiology reading room gave radiologists a monopoly over their entire ecosystem. PACS, observes Tillack, created a new normal in which “the ‘right’ to see [the image] is no longer mediated by radiologists, as it was in the reading room,” and has thus “eroded radiologists’ claims for authoritative knowledge over the interpretation of medical images.”\u003c/p>\n\u003cp>Once the radiology department no longer housed the films, the impact was immediate and dramatic. Without any changes in policy or very much forethought, the mid-1990s transition to filmless operations at the Baltimore VA hospital led to an 82 percent decrease in in-person consultation rates for general radiology studies. Today, many clinicians—particularly specialists like neurologists, pulmonologists, and surgeons—look at images themselves and act on their own interpretations; Many don’t even bother to read the radiologist’s formal report (which usually takes several hours, sometimes even a day, to reach the chart) unless they have unanswered questions or judge the study to be particularly challenging.\u003c/p>\n\u003cp>PACS was to increase efficiency, but that virtue has also become a curse, as radiologists increasingly feel like Lucy and Ethel on the assembly line of the chocolate factory. Among teleradiologists (radiologists reading x-rays from a distant site, often covering emergency departments at night while the hospital’s own radiologists are sleeping), there’s a well-known adage that captures the relentless objectification of their modern predicament: “Great case. Next case.\" As with so many other aspects of our modern digital lives, PACS sped up the clock, and did so without mercy.\u003c/p>\n\u003cp>That clock is constantly ticking. “Instead of waiting for films to be acquired, printed, sorted, and hung, radiologists now are always playing catch-up, looking at more ‘stuff’ in less time,” observed Tillack. That miraculous access to old films also creates an obligation for the radiologist to actually review them.\u003c/p>\n\u003cp>And it’s not just the old films that need to be examined; PACS makes vast amounts of information available with every study. In the early days of CT, the output of a scan might have been about 12 “slices,” each one representing a ¼-inch section through the thorax or abdomen, akin to a thick slice of deli-cut salami. But today’s ultra-fast CT scanners can produce images of more than 50 slices per inch of the human body, more like ultra-thin cuts of prosciutto. And PACS, with its massive memory bank and blazingly fast transmission speeds,can easily display every slice, which means that the radiologist has to scroll through hundreds of images in order to read a single CT study. This combination of more information in each scan, more old studies to compare, and more time pressure is unremitting.\u003c/p>\n\u003cp>The clock is ticking for other reasons as well. Since the image is available to the ordering clinician the moment it is created, radiologists feel obliged to perform their review quickly lest their reading seem like old news, like an afternoon newspaper in the Age of Twitter. Piling on, after recognizing the efficiency of PACS, insurance companies and Medicare slashed the reimbursement for each interpretation, pushing radiologists to read more films in less time in order to maintain their incomes. Said one radiologist, “With PACS, work is busier now. We have 70 percent more cases to read than 10 years ago. . . . At the end of the day . . . I’m fried.”\u003c/p>\n\u003cp>On top of this, there are even greater threats to radiologists’ livelihoods and happiness. One of them flows from the growing pressure on health care systems to slash their costs. Currently, virtually every X-ray performed at a U.S. hospital is sent for a formal reading by a radiologist, who is paid a fee by an insurance company. In today’s cost-cutting environment, it’s probably only a matter of time before some health care systems permit their frontline specialists to officially read certain films, reserving radiologist “overreads” for those images that the clinicians have questions about or the ones with super-high malpractice risk if they are misread. Radiologists can be counted on to fight such a move by frantically waving the banner of quality, but they will need to demonstrate that the value of having them review every film is worth the considerable expense.\u003c/p>\n\u003cp>Moreover, a major theme of Obama-era health reform is a shift from our historical fee-for-service, piecework payment model to one that dispenses a single payment to a hospital and doctors to manage all the care for a group of patients (“accountable care organizations,” ACOs for short) or a given episode of disease (“bundled payments”). Under such systems, the risk for the cost of care shifts from the insurer to the providers, and it’s up to the latter to decide how to divvy up the cash. Ron Arenson, chairman of the department of radiology at the University of California, San Francisco, sees this as the greatest threat to his field.\u003c/p>\n\u003cp>“If the world moves to bundled payments, we won’t do well,” he said. “We’re not very high in the pecking order.”\u003c/p>\n\u003cp>Some nonradiologists, particularly ER doctors working nights and weekends, have little sympathy for their colleagues’ new predicament. In fact, they have begun to wonder why radiologists should be compensated for next-day readings when they’ve already looked at the images themselves, acted on their interpretations, and assumed the risk of being sued if anything goes wrong. In a 2011 editorial entitled “The Life Cycle of a Parasitic Specialist,” ER physician William Mallon took off the gloves.\u003c/p>\n\u003cblockquote>\u003cp>[On Monday morning] these parasites will commence to feed on the financial juices of the lowly unfortunate emergency physicians, who had to work the entire weekend without radiologic support or backup. . . . The radiologist arrives well rested, café latte in hand, and promptly installs himself in a dark room to re-read and bill for all the films the emergency physicians read over the weekend. . . . Never has a specialty done so little for so many and been paid so much.\u003c/p>\u003c/blockquote>\n\u003cp>Ouch.\u003c/p>\n\u003cp>Another challenge to radiology made possible by the death of film has come in the form of teleradiology. Once X-rays went digital, it was no longer crucial for radiologists to be in the same building as the patient or the treating clinicians. As a result, many multihospital systems consolidated their reading rooms, particularly on weekends and nights, with centralized radiologists supporting multiple sites. Predictably, once the technical challenges of connectivity were solved, teleradiology companies emerged to fill this need. As is often the case with contented “legacy” providers (in health care and other industries), traditional radiologists were only too happy to have their colleagues read their films during off-hours. Who wouldn’t be?\u003c/p>\n\u003cp>The playing field soon expanded across national borders, as radiologists in Zurich, Israel, and Singapore began to read nighttime X-rays for American hospitals during their own local daytimes. Hundreds of hospitals now use these \"nighthawks,\" and everybody seems happy about it, including the domestic radiologists, who are sleeping soundly while the overnight images are read half a world away.\u003c/p>\n\u003cp>But one wonders whether this is the start of so-called disruptive innovation, the concept made famous by Harvard’s Clay Christensen. Disruption often begins with a fat and happy incumbent content to preserve its existing enviable position in a market. In industries ranging from commercial aviation to steel manufacturing, an upstart comes in and grabs an unattractive part of the market (in this case, nights and weekends). But once a low-cost company has squeezed through a crack to capture a slice of a previously locked franchise, it is rarely content to stay put. With the average U.S. radiologist earning about $350,000 per year and the average Indian radiologist earning less than one-tenth of that, one wonders whether the same World-is-Flat forces that have revolutionized other industries but mostly bypassed health care will be unleashed.\u003c/p>\n\u003cp>This is where radiologists’ loss of trust and collegiality with other clinicians may exact its heaviest toll. “Some people see teleradiology as a big threat, but I don’t,” UCSF’s Arenson told me. “I think that relationships with radiologists are important.” I do too, which is why I believe he may have his head in the sand: If physicians don’t get much out of visiting the radiology department or have even forgotten where it is located, we have little reason to fight to keep it in our buildings. Or, for that matter, our country.\u003c/p>\n\u003cp>Like all legacy providers faced with a technological or global workforce threat, radiologists can be counted on to argue that quality would take a huge hit if we outsourced their work to less expensive providers, domestic or foreign. The degree to which the field has accepted nighttime readings from non-U.S. radiologists will, of course, undermine this argument. It’s hard to make the claim that a Bangalore-based teleradiologist is sufficiently competent to read an image for your hospital at 3 a.m., but not at 3 p.m.\u003c/p>\n\u003cp>\u003cstrong>The Ultimate Threat\u003c/strong>\u003c/p>\n\u003cp>Finally, there is the ultimate threat: replacement by the machine. Of course, this issue is marbled throughout health care as we enter the digital age. To date, most claims that “this technology will replace doctors” (in areas ranging from diagnostic reasoning to robotic surgery) have proven to be hype.\u003c/p>\n\u003cp>However, in fields that are primarily about visual pattern recognition, the promise (or, if you’re a radiologist, the threat) is much more real. Studies have shown that computers can detect significant numbers of breast cancers and pulmonary emboli missed by radiologists, although nobody has yet taken the bold step of having the computers completely supplant the humans, partly because there are armadas of malpractice attorneys waiting to pounce, and partly because, at least for now, the combination of human and machine seems to perform better than either alone.\u003c/p>\n\u003cp>But over the long haul, I wouldn’t bet on the humans here, particularly since one of the hottest areas in artificial intelligence research is “deep learning”—research that has created computers that are reasonably skilled at “reading,” “hearing,” and, yes, “seeing.” The same kind of software that now allows Facebook to guess that a certain collection of pixels is a picture of you, or that alerts the casino’s security guards to keep an eye on that guy, is likely to eventually crack the code in radiology, and in similar areas such as dermatology and pathology.\u003c/p>\n\u003cp>Slowly, radiologists are waking up to their peril. Rather than isolating themselves from clinical care, some are now relocating their reading stations in clinical areas, such as the ER and the ICU, to be in the line of sight of their clinician colleagues. Others are resurrecting interdisciplinary conferences and training their staff in customer service. Technological solutions that allow radiologists and frontline clinicians to communicate through PACS and the electronic health record are springing up (through programs that create a mash-up of a Skype-like communication tool and a John Madden–style telestrator).\u003c/p>\n\u003cp>Said Paul Chang, the University of Chicago radiologist whose advocacy of PACS so upset his father, “We have to go beyond isolating ourselves and concentrating on messages in a bottle, where we just write a report and are done with it, but instead fostering collaboration.”\u003c/p>\n\u003cp>Since radiology represents such a large segment of health care expenditures (and also a source of harm through the risk of radiation), some health care systems are even putting radiologists in the position of being gatekeepers to their own technology. It’s a role they might not have accepted in the past, but, faced with an existential threat, many now welcome it. Said David Levin, a radiologist at Thomas Jefferson University, “We have to act more like consulting physicians . . . to look at the appropriateness of the requests for advanced imaging studies . . . rather than just going ahead and doing the study.”\u003c/p>\n\u003cp>Radiology’s experience over the past 15 years offers a crystal ball for the rest of the health care system. The speed with which computerization unleashed a series of forces that completely transformed an established field would be all too familiar to travel agents, journalists, and others who have been run over by the digital bulldozer, but it has shocked many health care observers, even astute ones.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Will the computerization of the rest of medicine similarly upend the lives of other kinds of doctors, as well as their patients? The early returns are in, and the answer is yes.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Synthetic DNA Added to Bacteria Creates New Organism",
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"content": "\u003cp>Scientists have created a stable organism containing DNA most likely never seen before on Earth\u003cb>.\u003c/b>\u003c/p>\n\u003cp>The intention was to create \"organisms with wholly unnatural attributes and traits not found elsewhere in nature,” as one of the researchers put it. With more advances, these organisms could potentially be used in the creation of medicines and industrial biologicals.\u003c/p>\n\u003cp>The development is described in a \u003ca href=\"http://www.pnas.org/content/early/2017/01/17/1616443114\" target=\"_blank\">new study\u003c/a> published in Proceedings of the National Academy of Sciences.\u003c/p>\n\u003cp>\u003cstrong>Synthetic DNA\u003c/strong>\u003c/p>\n\u003cp>The building blocks of DNA, and thus of all life on Earth, are represented by a four-letter \"alphabet.\" Each letter represents one of the compounds that form DNA. The letters—A, T, C and G—are used in different combinations to encode the instructions that govern the development and traits of living organisms.\u003c/p>\n\u003caside class=\"pullquote alignright\">'We can now get the light of life to stay on. That suggests that all of life's processes can be subject to manipulation.'\u003c/aside>\n\u003cp>Just as scrawled graffiti, a Harlequin romance and a Shakespeare play are written using the same alphabet, so too are a virus, a pig and a human being written with the same set of four bases.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>That started to change \u003ca href=\"https://ww2.kqed.org/science/2014/05/19/dna-adding-two-letters-to-lifes-alphabet/\" target=\"_blank\">back in 2014\u003c/a>, when a group of researchers at The Scripps Research Institute synthesized two new letters, then managed to coax E.coli bacteria into accepting them\u003cstrong>. \u003c/strong>While that was a significant achievement, the bacteria was not ideal and suffered from multiple problems including a tendency not to pass the new letters on to the next generation. Since the artificial bases were not stable in the DNA, they were lost over time.\u003c/p>\n\u003cp>\u003cstrong>Back to the Beginning for CRISPR\u003c/strong>\u003c/p>\n\u003cfigure id=\"attachment_325792\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-325792\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/01/CRISPR800a-800x533.jpg\" alt=\"Back to basics for CRISPR/Cas9.\" width=\"800\" height=\"533\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/01/CRISPR800a.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/CRISPR800a-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/CRISPR800a-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/CRISPR800a-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/CRISPR800a-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/CRISPR800a-520x346.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Back to basics for CRISPR/Cas9. \u003ccite>(Wikipedia)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>One of the ways these researchers managed to get the bacteria to hold on to these new letters was by using one of the biggest things to hit biology in the last few years—the \u003ca href=\"http://genetics.thetech.org/ask-a-geneticist/why-crispr-revolutionary-and-how-it-works\">gene-editing system CRISPR/Cas9\u003c/a>. This tool provides a way to precisely change the DNA of a living thing. It has already revolutionized science in the lab and may one day revolutionize human health as well.\u003c/p>\n\u003cp>CRISPR/Cas9 has a very humble origin—it works as an immune system for bacteria. It essentially looks for a certain set of bases found in an invading virus's DNA and cuts the viral DNA at that spot. This destroys the virus.\u003c/p>\n\u003cp>In creating their new organism, the researchers have taken CRISPR/Cas9 back to its original use. But instead of cutting the DNA of invading viruses, CRISPR/Cas9 now cuts the bacterial DNA, which kills the bacteria. Sounds self-defeating, except that it only does this if the bacteria has lost its new letters.\u003c/p>\n\u003cp>That means the bacteria that pass on the new letters thrive and continue to divide, while the letter-losing bacteria are wiped out. Now, generation after generation, only bacteria with the new bases are produced.\u003c/p>\n\u003cp>Of course this wouldn’t be all that efficient if the majority of bacteria lost the artificial bases and so died--there wouldn't be enough bacteria to do anything with.\u003c/p>\n\u003cfigure id=\"attachment_325790\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003cimg class=\"size-full wp-image-325790\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/01/DNaM-skeletal.png\" alt=\"Say hello to dNaM, one of DNA's first new letters in 3.5 billion years or so. \" width=\"400\" height=\"436\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/01/DNaM-skeletal.png 400w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/DNaM-skeletal-160x174.png 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/DNaM-skeletal-240x262.png 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/DNaM-skeletal-375x409.png 375w\" sizes=\"(max-width: 400px) 100vw, 400px\">\u003cfigcaption class=\"wp-caption-text\">Say hello to dNaM, one of DNA's first new letters in 3.5 billion years or so. \u003ccite>(Wikipedia)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>To make it more likely that the bacteria hold onto their new bases, these researchers also chemically modified one of the bases to something the bacteria liked better. Now the bacteria are more likely to keep these bases, but if they do lose them, they are eliminated from the population. Such an elegant solution!\u003c/p>\n\u003cp>Though the bacteria has successfully incorporated the new letters, it is not actually using them, because the cellular machinery can’t decipher what the letters mean.\u003c/p>\n\u003cp>Scientists hope that won't always be the case. They intend on tweaking the bacteria so they can make sense of the new letters. Then the new organisms could be crafted into something useful. Down the line, researchers could also figure out how to expand the alphabet of more complex organisms.\u003c/p>\n\u003cp>Even if the bacteria the researchers experimented on isn’t yet ready for primetime, it is very cool in that it probably does things that life on Earth has never done before. Which is still a marvel for all science lovers out there.\u003c/p>\n\u003cp>Said one of the scientists, in a statement:\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"We can now get the light of life to stay on. That suggests that all of life's processes can be subject to manipulation.\"\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Scientists have created a stable organism containing DNA most likely never seen before on Earth\u003cb>.\u003c/b>\u003c/p>\n\u003cp>The intention was to create \"organisms with wholly unnatural attributes and traits not found elsewhere in nature,” as one of the researchers put it. With more advances, these organisms could potentially be used in the creation of medicines and industrial biologicals.\u003c/p>\n\u003cp>The development is described in a \u003ca href=\"http://www.pnas.org/content/early/2017/01/17/1616443114\" target=\"_blank\">new study\u003c/a> published in Proceedings of the National Academy of Sciences.\u003c/p>\n\u003cp>\u003cstrong>Synthetic DNA\u003c/strong>\u003c/p>\n\u003cp>The building blocks of DNA, and thus of all life on Earth, are represented by a four-letter \"alphabet.\" Each letter represents one of the compounds that form DNA. The letters—A, T, C and G—are used in different combinations to encode the instructions that govern the development and traits of living organisms.\u003c/p>\n\u003caside class=\"pullquote alignright\">'We can now get the light of life to stay on. That suggests that all of life's processes can be subject to manipulation.'\u003c/aside>\n\u003cp>Just as scrawled graffiti, a Harlequin romance and a Shakespeare play are written using the same alphabet, so too are a virus, a pig and a human being written with the same set of four bases.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>That started to change \u003ca href=\"https://ww2.kqed.org/science/2014/05/19/dna-adding-two-letters-to-lifes-alphabet/\" target=\"_blank\">back in 2014\u003c/a>, when a group of researchers at The Scripps Research Institute synthesized two new letters, then managed to coax E.coli bacteria into accepting them\u003cstrong>. \u003c/strong>While that was a significant achievement, the bacteria was not ideal and suffered from multiple problems including a tendency not to pass the new letters on to the next generation. Since the artificial bases were not stable in the DNA, they were lost over time.\u003c/p>\n\u003cp>\u003cstrong>Back to the Beginning for CRISPR\u003c/strong>\u003c/p>\n\u003cfigure id=\"attachment_325792\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-325792\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/01/CRISPR800a-800x533.jpg\" alt=\"Back to basics for CRISPR/Cas9.\" width=\"800\" height=\"533\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/01/CRISPR800a.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/CRISPR800a-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/CRISPR800a-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/CRISPR800a-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/CRISPR800a-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/CRISPR800a-520x346.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Back to basics for CRISPR/Cas9. \u003ccite>(Wikipedia)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>One of the ways these researchers managed to get the bacteria to hold on to these new letters was by using one of the biggest things to hit biology in the last few years—the \u003ca href=\"http://genetics.thetech.org/ask-a-geneticist/why-crispr-revolutionary-and-how-it-works\">gene-editing system CRISPR/Cas9\u003c/a>. This tool provides a way to precisely change the DNA of a living thing. It has already revolutionized science in the lab and may one day revolutionize human health as well.\u003c/p>\n\u003cp>CRISPR/Cas9 has a very humble origin—it works as an immune system for bacteria. It essentially looks for a certain set of bases found in an invading virus's DNA and cuts the viral DNA at that spot. This destroys the virus.\u003c/p>\n\u003cp>In creating their new organism, the researchers have taken CRISPR/Cas9 back to its original use. But instead of cutting the DNA of invading viruses, CRISPR/Cas9 now cuts the bacterial DNA, which kills the bacteria. Sounds self-defeating, except that it only does this if the bacteria has lost its new letters.\u003c/p>\n\u003cp>That means the bacteria that pass on the new letters thrive and continue to divide, while the letter-losing bacteria are wiped out. Now, generation after generation, only bacteria with the new bases are produced.\u003c/p>\n\u003cp>Of course this wouldn’t be all that efficient if the majority of bacteria lost the artificial bases and so died--there wouldn't be enough bacteria to do anything with.\u003c/p>\n\u003cfigure id=\"attachment_325790\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003cimg class=\"size-full wp-image-325790\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/01/DNaM-skeletal.png\" alt=\"Say hello to dNaM, one of DNA's first new letters in 3.5 billion years or so. \" width=\"400\" height=\"436\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/01/DNaM-skeletal.png 400w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/DNaM-skeletal-160x174.png 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/DNaM-skeletal-240x262.png 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/DNaM-skeletal-375x409.png 375w\" sizes=\"(max-width: 400px) 100vw, 400px\">\u003cfigcaption class=\"wp-caption-text\">Say hello to dNaM, one of DNA's first new letters in 3.5 billion years or so. \u003ccite>(Wikipedia)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>To make it more likely that the bacteria hold onto their new bases, these researchers also chemically modified one of the bases to something the bacteria liked better. Now the bacteria are more likely to keep these bases, but if they do lose them, they are eliminated from the population. Such an elegant solution!\u003c/p>\n\u003cp>Though the bacteria has successfully incorporated the new letters, it is not actually using them, because the cellular machinery can’t decipher what the letters mean.\u003c/p>\n\u003cp>Scientists hope that won't always be the case. They intend on tweaking the bacteria so they can make sense of the new letters. Then the new organisms could be crafted into something useful. Down the line, researchers could also figure out how to expand the alphabet of more complex organisms.\u003c/p>\n\u003cp>Even if the bacteria the researchers experimented on isn’t yet ready for primetime, it is very cool in that it probably does things that life on Earth has never done before. Which is still a marvel for all science lovers out there.\u003c/p>\n\u003cp>Said one of the scientists, in a statement:\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"We can now get the light of life to stay on. That suggests that all of life's processes can be subject to manipulation.\"\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Obamacare Architect Says Silicon Valley Tech Won't Steer Health Care",
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"content": "\u003cp>Ezekiel Emanuel is one of the architects of the Affordable Care Act, aka Obamacare, aka \u003ca href=\"http://www.npr.org/sections/thetwo-way/2017/01/17/510281627/18-million-people-could-lose-insurance-in-first-year-after-partial-obamacare-rep\" target=\"_blank\" rel=\"noopener\">dead-plan-walking\u003c/a>.\u003c/p>\n\u003cp>He's also a \"techno-skeptic,\" as he called himself the other day during an \u003ca href=\"http://audio.californiareport.org/archive/R201701170850/b\" target=\"_blank\" rel=\"noopener\">interview\u003c/a> with KQED health editor Carrie Feibel. When Feibel asked him if there should be any role to play for the \"data gurus of Silicon Valley\" in whatever comes after the ACA, he literally laughed.\u003c/p>\n\u003caside class=\"pullquote alignright\">'I do think there is an important role for tech, but I think the role is probably not what many of the startup companies around here are thinking of.'\u003ccite>Ezekiel Emanuel\u003c/cite>\u003c/aside>\n\u003cp>\"I do think there is an important role for tech, but I think the role is probably not what many of the startup companies around here are thinking of,\" he said, \"around here\" meaning San Francisco and Silicon Valley. Emanuel said tech should play a support role that \"augments\" what health care providers do, providing better data about the patient and where health care funds are spent.\u003c/p>\n\u003cp>\"I am much more skeptical that the computer is going to replace a doctor,\" he said. \"That a computer is going to interface with the patient and take care of them. Not gonna happen.\" (See our posts \"\u003ca href=\"https://ww2.kqed.org/futureofyou/2016/11/07/AI-computers-diagnosis-watson/\" target=\"_blank\" rel=\"noopener\">Will Computers Ever Be as Good as Physicians at Diagnosing Patients\u003c/a>\" and \"\u003ca href=\"https://ww2.kqed.org/futureofyou/2016/02/03/virtual_care_clinic_usc/\" target=\"_blank\" rel=\"noopener\">Would You See a Holographic Doctor?\" \u003c/a>for high hopes surrounding digital docs.)\u003c/p>\n\u003cp>Emanuel said he's also not big on efforts to achieve continuous patient monitoring for health indicators like glucose level and blood pressure. He cited the \u003ca href=\"https://ww2.kqed.org/futureofyou/2016/10/10/fitbit-study/\" target=\"_blank\" rel=\"noopener\">failure of Fitbits and other wearable tech\u003c/a> to improve health outcomes in research studies.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"It’s not that we don’t have information,\" he said. \"The problem is what do you do once you have the information. And there, tech is not going to be the key thing. Medicine fundamentally is about human interaction. That is really the most important challenge, and I don’t think the tech sector has locked onto that part of it.\"\u003c/p>\n\u003cp>This sort of digital contrarianism is not unheard of in the health care biz, even at events and panels where tech-oriented medicine is the focus. Last September, for instance, at the Stanford Medicine X conference, Stephen Downs, the chief technical officer at the Robert Wood Johnson Foundation, said digital health companies\u003ca href=\"https://ww2.kqed.org/futureofyou/2016/09/29/analysis-digital-health-companies-arent-solving-the-right-problems/\" target=\"_blank\" rel=\"noopener\"> weren't focused on solving the right problems\u003c/a>. From a report by KQED's Lesley McClurg:\u003c/p>\n\u003cblockquote>\u003cp>In this age of the Fitbit, Downs said, digital health companies are focused on monitoring the consequences of our \u003ca href=\"http://stateofobesity.org/physical-inactivity/\" target=\"_blank\" rel=\"noopener\">notoriously sedentary lifestyles. \u003c/a>But what is really called for from innovators is to stop treating symptoms and start remedying the roots of the problem.\u003c/p>\n\u003cp>“The system needs to be re-engineered,” said Downs. ... “We don’t need an app that counts steps, because that really just tells you that your day doesn’t naturally incorporate the time and space to walk.”\u003c/p>\u003c/blockquote>\n\u003cp>Instead of a focus on monitoring, he said, engineers and designers need to incorporate solutions --such as enabling urban farming --to core health problems like obesity and heart disease. \u003cstrong>\u003cbr>\n\u003c/strong>\u003c/p>\n\u003cp>\u003cstrong>Policy Versus Scientific Advances\u003c/strong>\u003c/p>\n\u003cp>Several times now at conferences I've witnessed one expert or another--in the midst of a coterie of big data boosters and monitoring mavens, no less--offer up a kind of indirect scolding by cautioning that the best way to improve health is not via smartphones, but smart policy.\u003c/p>\n\u003cp>That dichotomy to some degree echoes a conversation I once had with a longtime health journalist who thought even something as institutionally sanctioned and evidence-based as \u003ca href=\"https://ww2.kqed.org/futureofyou/2017/01/20/time-running-out-california-stem-cell-agency-yet-to-produce-big-results/\" target=\"_blank\" rel=\"noopener\">California's stem cell initiative\u003c/a> was a waste of money, because the funds would have been better directed toward policy prescriptions that address basic health needs.\u003c/p>\n\u003cp>I asked Emanuel to comment on this point, specifically mentioning stem cells.\u003c/p>\n\u003cp>\"Here's a thought experiment,\" he said. \"You know how many lives stem cells have saved? A tiny number compared to the 2.7 million people [in the U.S.] who die each year.\u003c/p>\n\u003cp>\"Now, how many lives have been saved by the ACA?\" he said. \"I don’t know, but it ain’t zero. I intersect with people all the time who happen to recognize me on the street and say I or a family friend got diagnosed with cancer and got therapy or got a heart transplant or something like that.\u003c/p>\n\u003cp>\"In the future, even under a rosy projection, stem cells will not save tons of people,\" he said. \"If you were to cure every single cancer in the U.S.-- no one in America ever dies again of cancer--we add three years to the average life expectancy. It’s a big improvement but it is not anything close to [gains achieved by] doing the basics.\"\u003c/p>\n\u003cp>The two most effective goals for increasing longevity, he said, would be to reduce smoking even further and to control blood pressure.\u003c/p>\n\u003cp>\"We’re not talking high tech,\" he said. \"There is nothing you can do that is going to come close to those two interventions.\"\u003c/p>\n\u003cp>Of course, medical value depends on your perspective, and Emanuel's is a public health view. Someone suffering from any number of horrendous diseases that stem cell research is targeting is not going to be thinking: \"Boy, what a waste to be chasing stem cell cures. I sure wish they'd divert that money to anti-smoking programs.\"\u003c/p>\n\u003cp>And even on the health tech front, some doctors have come around to viewing digital monitoring devices like \u003ca href=\"https://ww2.kqed.org/futureofyou/2016/03/17/mobile-ekg-on-a-watchband-is-useful-for-some-say-docs/\" target=\"_blank\" rel=\"noopener\">mobile EKGs\u003c/a> as useful.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>As for computers versus doctors, physician and author Bob Wachter, has written that radiology may be the \u003ca href=\"https://ww2.kqed.org/futureofyou/2016/10/25/technology-radiology/\" target=\"_blank\" rel=\"noopener\">canary in the coal mine\u003c/a> in terms of algorithms replacing humans.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Ezekiel Emanuel is one of the architects of the Affordable Care Act, aka Obamacare, aka \u003ca href=\"http://www.npr.org/sections/thetwo-way/2017/01/17/510281627/18-million-people-could-lose-insurance-in-first-year-after-partial-obamacare-rep\" target=\"_blank\" rel=\"noopener\">dead-plan-walking\u003c/a>.\u003c/p>\n\u003cp>He's also a \"techno-skeptic,\" as he called himself the other day during an \u003ca href=\"http://audio.californiareport.org/archive/R201701170850/b\" target=\"_blank\" rel=\"noopener\">interview\u003c/a> with KQED health editor Carrie Feibel. When Feibel asked him if there should be any role to play for the \"data gurus of Silicon Valley\" in whatever comes after the ACA, he literally laughed.\u003c/p>\n\u003caside class=\"pullquote alignright\">'I do think there is an important role for tech, but I think the role is probably not what many of the startup companies around here are thinking of.'\u003ccite>Ezekiel Emanuel\u003c/cite>\u003c/aside>\n\u003cp>\"I do think there is an important role for tech, but I think the role is probably not what many of the startup companies around here are thinking of,\" he said, \"around here\" meaning San Francisco and Silicon Valley. Emanuel said tech should play a support role that \"augments\" what health care providers do, providing better data about the patient and where health care funds are spent.\u003c/p>\n\u003cp>\"I am much more skeptical that the computer is going to replace a doctor,\" he said. \"That a computer is going to interface with the patient and take care of them. Not gonna happen.\" (See our posts \"\u003ca href=\"https://ww2.kqed.org/futureofyou/2016/11/07/AI-computers-diagnosis-watson/\" target=\"_blank\" rel=\"noopener\">Will Computers Ever Be as Good as Physicians at Diagnosing Patients\u003c/a>\" and \"\u003ca href=\"https://ww2.kqed.org/futureofyou/2016/02/03/virtual_care_clinic_usc/\" target=\"_blank\" rel=\"noopener\">Would You See a Holographic Doctor?\" \u003c/a>for high hopes surrounding digital docs.)\u003c/p>\n\u003cp>Emanuel said he's also not big on efforts to achieve continuous patient monitoring for health indicators like glucose level and blood pressure. He cited the \u003ca href=\"https://ww2.kqed.org/futureofyou/2016/10/10/fitbit-study/\" target=\"_blank\" rel=\"noopener\">failure of Fitbits and other wearable tech\u003c/a> to improve health outcomes in research studies.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"It’s not that we don’t have information,\" he said. \"The problem is what do you do once you have the information. And there, tech is not going to be the key thing. Medicine fundamentally is about human interaction. That is really the most important challenge, and I don’t think the tech sector has locked onto that part of it.\"\u003c/p>\n\u003cp>This sort of digital contrarianism is not unheard of in the health care biz, even at events and panels where tech-oriented medicine is the focus. Last September, for instance, at the Stanford Medicine X conference, Stephen Downs, the chief technical officer at the Robert Wood Johnson Foundation, said digital health companies\u003ca href=\"https://ww2.kqed.org/futureofyou/2016/09/29/analysis-digital-health-companies-arent-solving-the-right-problems/\" target=\"_blank\" rel=\"noopener\"> weren't focused on solving the right problems\u003c/a>. From a report by KQED's Lesley McClurg:\u003c/p>\n\u003cblockquote>\u003cp>In this age of the Fitbit, Downs said, digital health companies are focused on monitoring the consequences of our \u003ca href=\"http://stateofobesity.org/physical-inactivity/\" target=\"_blank\" rel=\"noopener\">notoriously sedentary lifestyles. \u003c/a>But what is really called for from innovators is to stop treating symptoms and start remedying the roots of the problem.\u003c/p>\n\u003cp>“The system needs to be re-engineered,” said Downs. ... “We don’t need an app that counts steps, because that really just tells you that your day doesn’t naturally incorporate the time and space to walk.”\u003c/p>\u003c/blockquote>\n\u003cp>Instead of a focus on monitoring, he said, engineers and designers need to incorporate solutions --such as enabling urban farming --to core health problems like obesity and heart disease. \u003cstrong>\u003cbr>\n\u003c/strong>\u003c/p>\n\u003cp>\u003cstrong>Policy Versus Scientific Advances\u003c/strong>\u003c/p>\n\u003cp>Several times now at conferences I've witnessed one expert or another--in the midst of a coterie of big data boosters and monitoring mavens, no less--offer up a kind of indirect scolding by cautioning that the best way to improve health is not via smartphones, but smart policy.\u003c/p>\n\u003cp>That dichotomy to some degree echoes a conversation I once had with a longtime health journalist who thought even something as institutionally sanctioned and evidence-based as \u003ca href=\"https://ww2.kqed.org/futureofyou/2017/01/20/time-running-out-california-stem-cell-agency-yet-to-produce-big-results/\" target=\"_blank\" rel=\"noopener\">California's stem cell initiative\u003c/a> was a waste of money, because the funds would have been better directed toward policy prescriptions that address basic health needs.\u003c/p>\n\u003cp>I asked Emanuel to comment on this point, specifically mentioning stem cells.\u003c/p>\n\u003cp>\"Here's a thought experiment,\" he said. \"You know how many lives stem cells have saved? A tiny number compared to the 2.7 million people [in the U.S.] who die each year.\u003c/p>\n\u003cp>\"Now, how many lives have been saved by the ACA?\" he said. \"I don’t know, but it ain’t zero. I intersect with people all the time who happen to recognize me on the street and say I or a family friend got diagnosed with cancer and got therapy or got a heart transplant or something like that.\u003c/p>\n\u003cp>\"In the future, even under a rosy projection, stem cells will not save tons of people,\" he said. \"If you were to cure every single cancer in the U.S.-- no one in America ever dies again of cancer--we add three years to the average life expectancy. It’s a big improvement but it is not anything close to [gains achieved by] doing the basics.\"\u003c/p>\n\u003cp>The two most effective goals for increasing longevity, he said, would be to reduce smoking even further and to control blood pressure.\u003c/p>\n\u003cp>\"We’re not talking high tech,\" he said. \"There is nothing you can do that is going to come close to those two interventions.\"\u003c/p>\n\u003cp>Of course, medical value depends on your perspective, and Emanuel's is a public health view. Someone suffering from any number of horrendous diseases that stem cell research is targeting is not going to be thinking: \"Boy, what a waste to be chasing stem cell cures. I sure wish they'd divert that money to anti-smoking programs.\"\u003c/p>\n\u003cp>And even on the health tech front, some doctors have come around to viewing digital monitoring devices like \u003ca href=\"https://ww2.kqed.org/futureofyou/2016/03/17/mobile-ekg-on-a-watchband-is-useful-for-some-say-docs/\" target=\"_blank\" rel=\"noopener\">mobile EKGs\u003c/a> as useful.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>As for computers versus doctors, physician and author Bob Wachter, has written that radiology may be the \u003ca href=\"https://ww2.kqed.org/futureofyou/2016/10/25/technology-radiology/\" target=\"_blank\" rel=\"noopener\">canary in the coal mine\u003c/a> in terms of algorithms replacing humans.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Several times a month, you can find a doctor in the aisles of Ralph’s market in Huntington Beach, wearing a white coat and helping people learn about food. On one recent day, this doctor was Daniel Nadeau, wandering the cereal aisle with Allison Scott, offering ideas on how to feed kids who studiously avoid anything that tastes healthy.\u003c/p>\n\u003caside class=\"pullquote alignright\">'What people eat can be medicine or poison.'\u003ccite>Dr. Brenda Rea,\u003cbr>\nLoma Linda University School of Medicine\u003c/cite>\u003c/aside>\n\u003cp>“Have you thought about trying smoothies in the morning?” he asks her. “The frozen blueberries and raspberries are a little cheaper, and berries are really good for the brain.”\u003c/p>\n\u003cp>Scott knows about smoothies, actually. She's been cooking a plant-based diet for her family for about nine months, a decision prompted by her husband being diagnosed with systemic inflammation. Scott cooks a couple of hours a day to prepare meals from whole foods. So when she saw a doctor in Ralph's, Scott says, she was delighted to find someone talking about the very thing that has been consuming her life: food as medicine.\u003c/p>\n\u003cp>Nadeau is program director of the nearby \u003ca href=\"https://www.hoag.org/specialties-services/other-programs-services/diabetes-center/\" target=\"_blank\">Mary and Dick Allen Diabetes Center\u003c/a>, part of the \u003ca href=\"http://www.stjosephhoaghealth.org/\" target=\"_blank\">St. Joseph Hoag Health\u003c/a> alliance. The Center's Shop with Your Doc program sends doctors to the grocery store to meet with any patients who sign up for the service, plus any other shoppers who happen by with questions.\u003c/p>\n\u003cp>[contextly_sidebar id=\"0Y40yWL0gmXDr7is5zaqMMREfSYlmCuR\"]“In America, over 50 percent of our food is processed food,” Nadeau says. “And only 5 percent of our food is plant-based food. I think we should try to reverse that.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>It can be hard work, as anyone who's tried to eat more vegetables or quit sugar knows. Part of the work is learning about nutrition and making time to cook, says Scott, who in the beginning ran all her menus past a nutritionist, and sometimes uses a service that delivers her a box of organic food and recipes to prepare it. And for her, another part is getting her two boys, 5 and 8, to make the same changes.\u003c/p>\n\u003cp>\"I always make them try a bite of every single thing I make,\" she says. \"The kids get so mad at me, still, even though they're starting to eat better.\"\u003c/p>\n\u003cp>\u003cstrong>A Small Revolution Brewing\u003c/strong>\u003c/p>\n\u003cp>Scott and Nadeau are part of a small revolution brewing across California. The food-as-medicine movement has been around for decades, but it's making new inroads as physicians and medical institutions make food a formal part of treatment, rather than relying solely on medications. By prescribing nutritional changes or launching programs such as Shop with Your Doc, they're trying to prevent, limit or even reverse disease by changing what patients eat.\u003c/p>\n\u003cp>“There’s no question people can take things a long way toward \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/12323113\" target=\"_blank\">reversing diabetes\u003c/a>, reversing hypertension, even \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/20706936\" target=\"_blank\">preventing cancer\u003c/a> by food choices,” Nadeau says.\u003c/p>\n\u003cfigure id=\"attachment_313608\" class=\"wp-caption alignright\" style=\"max-width: 800px\">\u003ca href=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/01/SF-FoodPantry-63-lowres.jpg\">\u003cimg class=\"size-medium wp-image-313608\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/01/SF-FoodPantry-63-lowres-800x533.jpg\" alt=\"Clients in a pilot program for pregnant women with diabetes choose from an array of fresh fruits and vegetables, at the Community Wellness Program Center at Zuckerberg San Francisco General Hospital.\" width=\"800\" height=\"533\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/01/SF-FoodPantry-63-lowres-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/SF-FoodPantry-63-lowres-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/SF-FoodPantry-63-lowres-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/SF-FoodPantry-63-lowres-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/SF-FoodPantry-63-lowres-1920x1280.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/SF-FoodPantry-63-lowres-1180x786.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/SF-FoodPantry-63-lowres-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/SF-FoodPantry-63-lowres-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/SF-FoodPantry-63-lowres-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/SF-FoodPantry-63-lowres-520x347.jpg 520w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/SF-FoodPantry-63-lowres.jpg 2000w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">A client in a pilot program for pregnant women with diabetes chooses from an array of fresh fruits and vegetables, with help from a volunteer, at the Community Wellness Program Center at Zuckerberg San Francisco General Hospital. \u003ccite>(UCSF)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>In the big picture, says Dr. Richard Afable, CEO and President of St. Joseph Hoag Health, medical institutions across the state are starting to make a philosophical switch to becoming a health organization, not just a health care organization.\u003c/p>\n\u003cp>That sentiment echoes the tenets of the Therapeutic Food Pantry program at Zuckerberg San Francisco General Hospital, which completed its pilot phase and is about to expand on an ongoing basis to five clinic sites throughout the city. The program will offer patients several bags of food prescribed for their condition, along with intensive training in how to cook it.\u003c/p>\n\u003cp>“We really want to link food and medicine, and not just give away food,\" says Dr. Rita Nguyen, the hospital's medical director of Healthy Food Initiatives. \"We want people to understand what they’re eating, how to prepare it, the role food plays in their lives.”\u003c/p>\n\u003cp>In Southern California, \u003ca href=\"https://medicine.llu.edu/\" target=\"_blank\">Loma Linda University School of Medicine \u003c/a>is offering specialized training for its resident physicians in \u003ca href=\"https://medical-center.lomalindahealth.org/health-professionals/graduate-medical-education/prospective-residents/residency-programs/education-concentrations/lifestyle-medicine\" target=\"_blank\">Lifestyle Medicine\u003c/a>—that's a formal subspecialty in using food to treat disease.\u003c/p>\n\u003cp>Research on the power of food to treat or reverse disease is beginning to accumulate, but that doesn't mean diet alone is always the solution, or that every illness can benefit substantially from dietary changes. Nonetheless, physicians say they look at the cumulative data and a clear picture emerges: that the salt, sugar, fat and processed foods in the American diet contribute to the nation’s high rates of obesity, diabetes and heart disease. According to the World Health Organization, \u003ca href=\"http://www.who.int/chp/chronic_disease_report/full_report.pdf\" target=\"_blank\">80 percent of deaths\u003c/a> from heart disease and stroke are caused by high blood pressure, tobacco use, elevated cholesterol and low consumption of fruits and vegetables.\u003c/p>\n\u003cp>“It’s a different paradigm of how to treat disease,” says Dr. Brenda Rea, who helps run the family and preventive medicine residency program at Loma Linda University School of Medicine.\u003c/p>\n\u003cp>\u003cstrong>Choosing What Foods to Prescribe\u003c/strong>\u003c/p>\n\u003cp>The lifestyle medicine subspecialty is designed to train doctors in how to prevent and treat disease, in part, by changing patients' nutritional habits. The medical center and school at Loma Linda also has a food pantry and kitchen for patients.\u003c/p>\n\u003cfigure id=\"attachment_310967\" class=\"wp-caption alignright\" style=\"max-width: 800px\">\u003ca href=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/12/doc-at-Ralphs.jpg\">\u003cimg class=\"size-medium wp-image-310967\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/12/doc-at-Ralphs-800x600.jpg\" alt=\"St. Joseph Hoag Hospital gives out shopping bags to people who consult the doctor about food choices.\" width=\"800\" height=\"600\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2016/12/doc-at-Ralphs-800x600.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2016/12/doc-at-Ralphs-160x120.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2016/12/doc-at-Ralphs-768x576.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2016/12/doc-at-Ralphs-1020x765.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2016/12/doc-at-Ralphs-1920x1440.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2016/12/doc-at-Ralphs-1180x885.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2016/12/doc-at-Ralphs-960x720.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2016/12/doc-at-Ralphs-240x180.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2016/12/doc-at-Ralphs-375x281.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2016/12/doc-at-Ralphs-520x390.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">St. Joseph Hoag Hospital gives out shopping bags to people who consult the doctor about food choices. \u003ccite>(David Gorn/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Many people don’t know how to cook, Rea says; they only know how to heat things up. That means depending on packaged food with high salt and sugar content. So teaching people about which foods are nutritious and how to prepare them, she says, can actually transform a patient’s life. And beyond that, it might transform the health and lives of that patient’s family.\u003c/p>\n\u003cp>“What people eat can be medicine or poison,” Rea says. “As a physician, nutrition is one of the most powerful things you can change to \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4921549/\" target=\"_blank\">reverse\u003c/a> the effects of \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/12323113\" target=\"_blank\">chronic disease\u003c/a>.”\u003c/p>\n\u003cp>Studies have explored evidence that dietary changes can \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/20674303\" target=\"_blank\">slow inflammation\u003c/a>, for example, or make the body \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/21977033\" target=\"_blank\">inhospitable\u003c/a> to cancer cells.\u003c/p>\n\u003cp>In general, many lifestyle medicine physicians recommend a plant-based diet—particularly for people with diabetes or other inflammatory conditions.\u003c/p>\n\u003cp>“As what happened with tobacco, this will require a cultural shift, but that can happen,\" says Dr. Nguyen. \"In the same way physicians used to smoke, and then stopped smoking and were able to talk to patients about it, I think physicians can have a bigger voice in it.”\u003c/p>\n\u003cp>From her own experience, Allison Scott suggests that anyone making the switch to a plant-based diet have support, because \"it's a complete lifestyle change.\"\u003c/p>\n\u003cp>\"You have to stop buying what's on sale,\" she says. \"You have to go into the store knowing what you want to buy.\"\u003c/p>\n\u003cp>And if you're cooking for a family, she says, plan all your food in advance and have it already on hand.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>One more tip for people who want to quit sugar: read labels. Most salad dressings, soups and breads contain sugar. Even Amy's organic tomato soup. Go figure.\u003c/p>\n\n",
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"excerpt": "What we put in our bodies can be medicine. Literally. Food wisdom now finds its way into hospitals and even medical schools.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Several times a month, you can find a doctor in the aisles of Ralph’s market in Huntington Beach, wearing a white coat and helping people learn about food. On one recent day, this doctor was Daniel Nadeau, wandering the cereal aisle with Allison Scott, offering ideas on how to feed kids who studiously avoid anything that tastes healthy.\u003c/p>\n\u003caside class=\"pullquote alignright\">'What people eat can be medicine or poison.'\u003ccite>Dr. Brenda Rea,\u003cbr>\nLoma Linda University School of Medicine\u003c/cite>\u003c/aside>\n\u003cp>“Have you thought about trying smoothies in the morning?” he asks her. “The frozen blueberries and raspberries are a little cheaper, and berries are really good for the brain.”\u003c/p>\n\u003cp>Scott knows about smoothies, actually. She's been cooking a plant-based diet for her family for about nine months, a decision prompted by her husband being diagnosed with systemic inflammation. Scott cooks a couple of hours a day to prepare meals from whole foods. So when she saw a doctor in Ralph's, Scott says, she was delighted to find someone talking about the very thing that has been consuming her life: food as medicine.\u003c/p>\n\u003cp>Nadeau is program director of the nearby \u003ca href=\"https://www.hoag.org/specialties-services/other-programs-services/diabetes-center/\" target=\"_blank\">Mary and Dick Allen Diabetes Center\u003c/a>, part of the \u003ca href=\"http://www.stjosephhoaghealth.org/\" target=\"_blank\">St. Joseph Hoag Health\u003c/a> alliance. The Center's Shop with Your Doc program sends doctors to the grocery store to meet with any patients who sign up for the service, plus any other shoppers who happen by with questions.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>“In America, over 50 percent of our food is processed food,” Nadeau says. “And only 5 percent of our food is plant-based food. I think we should try to reverse that.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>It can be hard work, as anyone who's tried to eat more vegetables or quit sugar knows. Part of the work is learning about nutrition and making time to cook, says Scott, who in the beginning ran all her menus past a nutritionist, and sometimes uses a service that delivers her a box of organic food and recipes to prepare it. And for her, another part is getting her two boys, 5 and 8, to make the same changes.\u003c/p>\n\u003cp>\"I always make them try a bite of every single thing I make,\" she says. \"The kids get so mad at me, still, even though they're starting to eat better.\"\u003c/p>\n\u003cp>\u003cstrong>A Small Revolution Brewing\u003c/strong>\u003c/p>\n\u003cp>Scott and Nadeau are part of a small revolution brewing across California. The food-as-medicine movement has been around for decades, but it's making new inroads as physicians and medical institutions make food a formal part of treatment, rather than relying solely on medications. By prescribing nutritional changes or launching programs such as Shop with Your Doc, they're trying to prevent, limit or even reverse disease by changing what patients eat.\u003c/p>\n\u003cp>“There’s no question people can take things a long way toward \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/12323113\" target=\"_blank\">reversing diabetes\u003c/a>, reversing hypertension, even \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/20706936\" target=\"_blank\">preventing cancer\u003c/a> by food choices,” Nadeau says.\u003c/p>\n\u003cfigure id=\"attachment_313608\" class=\"wp-caption alignright\" style=\"max-width: 800px\">\u003ca href=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/01/SF-FoodPantry-63-lowres.jpg\">\u003cimg class=\"size-medium wp-image-313608\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/01/SF-FoodPantry-63-lowres-800x533.jpg\" alt=\"Clients in a pilot program for pregnant women with diabetes choose from an array of fresh fruits and vegetables, at the Community Wellness Program Center at Zuckerberg San Francisco General Hospital.\" width=\"800\" height=\"533\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/01/SF-FoodPantry-63-lowres-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/SF-FoodPantry-63-lowres-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/SF-FoodPantry-63-lowres-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/SF-FoodPantry-63-lowres-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/SF-FoodPantry-63-lowres-1920x1280.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/SF-FoodPantry-63-lowres-1180x786.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/SF-FoodPantry-63-lowres-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/SF-FoodPantry-63-lowres-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/SF-FoodPantry-63-lowres-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/SF-FoodPantry-63-lowres-520x347.jpg 520w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/SF-FoodPantry-63-lowres.jpg 2000w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">A client in a pilot program for pregnant women with diabetes chooses from an array of fresh fruits and vegetables, with help from a volunteer, at the Community Wellness Program Center at Zuckerberg San Francisco General Hospital. \u003ccite>(UCSF)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>In the big picture, says Dr. Richard Afable, CEO and President of St. Joseph Hoag Health, medical institutions across the state are starting to make a philosophical switch to becoming a health organization, not just a health care organization.\u003c/p>\n\u003cp>That sentiment echoes the tenets of the Therapeutic Food Pantry program at Zuckerberg San Francisco General Hospital, which completed its pilot phase and is about to expand on an ongoing basis to five clinic sites throughout the city. The program will offer patients several bags of food prescribed for their condition, along with intensive training in how to cook it.\u003c/p>\n\u003cp>“We really want to link food and medicine, and not just give away food,\" says Dr. Rita Nguyen, the hospital's medical director of Healthy Food Initiatives. \"We want people to understand what they’re eating, how to prepare it, the role food plays in their lives.”\u003c/p>\n\u003cp>In Southern California, \u003ca href=\"https://medicine.llu.edu/\" target=\"_blank\">Loma Linda University School of Medicine \u003c/a>is offering specialized training for its resident physicians in \u003ca href=\"https://medical-center.lomalindahealth.org/health-professionals/graduate-medical-education/prospective-residents/residency-programs/education-concentrations/lifestyle-medicine\" target=\"_blank\">Lifestyle Medicine\u003c/a>—that's a formal subspecialty in using food to treat disease.\u003c/p>\n\u003cp>Research on the power of food to treat or reverse disease is beginning to accumulate, but that doesn't mean diet alone is always the solution, or that every illness can benefit substantially from dietary changes. Nonetheless, physicians say they look at the cumulative data and a clear picture emerges: that the salt, sugar, fat and processed foods in the American diet contribute to the nation’s high rates of obesity, diabetes and heart disease. According to the World Health Organization, \u003ca href=\"http://www.who.int/chp/chronic_disease_report/full_report.pdf\" target=\"_blank\">80 percent of deaths\u003c/a> from heart disease and stroke are caused by high blood pressure, tobacco use, elevated cholesterol and low consumption of fruits and vegetables.\u003c/p>\n\u003cp>“It’s a different paradigm of how to treat disease,” says Dr. Brenda Rea, who helps run the family and preventive medicine residency program at Loma Linda University School of Medicine.\u003c/p>\n\u003cp>\u003cstrong>Choosing What Foods to Prescribe\u003c/strong>\u003c/p>\n\u003cp>The lifestyle medicine subspecialty is designed to train doctors in how to prevent and treat disease, in part, by changing patients' nutritional habits. The medical center and school at Loma Linda also has a food pantry and kitchen for patients.\u003c/p>\n\u003cfigure id=\"attachment_310967\" class=\"wp-caption alignright\" style=\"max-width: 800px\">\u003ca href=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/12/doc-at-Ralphs.jpg\">\u003cimg class=\"size-medium wp-image-310967\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/12/doc-at-Ralphs-800x600.jpg\" alt=\"St. Joseph Hoag Hospital gives out shopping bags to people who consult the doctor about food choices.\" width=\"800\" height=\"600\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2016/12/doc-at-Ralphs-800x600.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2016/12/doc-at-Ralphs-160x120.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2016/12/doc-at-Ralphs-768x576.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2016/12/doc-at-Ralphs-1020x765.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2016/12/doc-at-Ralphs-1920x1440.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2016/12/doc-at-Ralphs-1180x885.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2016/12/doc-at-Ralphs-960x720.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2016/12/doc-at-Ralphs-240x180.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2016/12/doc-at-Ralphs-375x281.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2016/12/doc-at-Ralphs-520x390.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">St. Joseph Hoag Hospital gives out shopping bags to people who consult the doctor about food choices. \u003ccite>(David Gorn/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Many people don’t know how to cook, Rea says; they only know how to heat things up. That means depending on packaged food with high salt and sugar content. So teaching people about which foods are nutritious and how to prepare them, she says, can actually transform a patient’s life. And beyond that, it might transform the health and lives of that patient’s family.\u003c/p>\n\u003cp>“What people eat can be medicine or poison,” Rea says. “As a physician, nutrition is one of the most powerful things you can change to \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4921549/\" target=\"_blank\">reverse\u003c/a> the effects of \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/12323113\" target=\"_blank\">chronic disease\u003c/a>.”\u003c/p>\n\u003cp>Studies have explored evidence that dietary changes can \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/20674303\" target=\"_blank\">slow inflammation\u003c/a>, for example, or make the body \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/21977033\" target=\"_blank\">inhospitable\u003c/a> to cancer cells.\u003c/p>\n\u003cp>In general, many lifestyle medicine physicians recommend a plant-based diet—particularly for people with diabetes or other inflammatory conditions.\u003c/p>\n\u003cp>“As what happened with tobacco, this will require a cultural shift, but that can happen,\" says Dr. Nguyen. \"In the same way physicians used to smoke, and then stopped smoking and were able to talk to patients about it, I think physicians can have a bigger voice in it.”\u003c/p>\n\u003cp>From her own experience, Allison Scott suggests that anyone making the switch to a plant-based diet have support, because \"it's a complete lifestyle change.\"\u003c/p>\n\u003cp>\"You have to stop buying what's on sale,\" she says. \"You have to go into the store knowing what you want to buy.\"\u003c/p>\n\u003cp>And if you're cooking for a family, she says, plan all your food in advance and have it already on hand.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>One more tip for people who want to quit sugar: read labels. Most salad dressings, soups and breads contain sugar. Even Amy's organic tomato soup. Go figure.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Last October, Matt Herich was listening to the news while he drove door to door delivering pizzas. A story came on the radio about a technology that sends an electric current through your brain to possibly make you better at some things — moving, remembering, learning. He was fascinated.\u003c/p>\n\u003cp>The neurotechnology is called transcranial direct current stimulation, or tDCS for short. At its simplest, the method involves a device that uses little more than a 9-volt battery and some electrodes to send a low-intensity electrical current to a targeted area of the brain, \u003ca href=\"http://www.jove.com/video/2744/electrode-positioning-montage-transcranial-direct-current\">typically via a headset\u003c/a>.\u003c/p>\n\u003cp>More than a 1,000 studies have been published in peer-reviewed journals over the last decade suggesting benefits of the technique — maybe \u003ca href=\"http://www.sciencedirect.com/science/article/pii/S0014488609001290\">regulating mood\u003c/a>, possibly \u003ca href=\"http://www.sciencedirect.com/science/article/pii/S0166432809006536\">improving language skills\u003c/a> — but its effects, good \u003cem>or\u003c/em> bad, are far from clear.\u003c/p>\n\u003cp>Although researchers see possibilities for tDCS in treating diseases and boosting performance, it's still an exploratory technology, says Mark George, editor-in-chief of \u003cem>Brain Stimulation\u003c/em>, a leading journal on neuromodulation. And leading experts have \u003ca href=\"http://www.tandfonline.com/doi/pdf/10.3109/10601333.2015.980944?needAccess=true\">warned against at-home use\u003c/a> of such devices.\u003c/p>\n\u003cp>\"If we can figure out safe long-term applications, it's so inexpensive we might be able to use it to boost tons of things,\" says George, a professor at the Medical University of South Carolina. \"But I have to underline \u003cem>might \u003c/em>-- we don't know yet.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>When Herich finished his shift delivering pizzas, he raced home and began googling. He found a thriving \u003ca href=\"https://www.reddit.com/r/tDCS/\">community on Reddit\u003c/a> and other online forums dedicated to discussing ways to self-administer tDCS.\u003c/p>\n\u003cp>After reading some scientific studies on neurostimulation, Herich decided to give it a try. He eventually got his hands on a rudimentary tDCS device made by a student at Northern Arizona University.\u003c/p>\n\u003cp>\"I did my research before I put the device on my head,\" Herich says. \"So it was a mix between me being confident it would be safe and me taking a leap of faith.\"\u003c/p>\n\u003cp>In his opinion, the leap of faith paid off. Herich takes online courses on machine learning, and he says that one 20-minute session of tDCS puts him in a state of intense focus that increases his productivity and helps him learn abstract math much faster than before.\u003c/p>\n\u003cp>Herich is not alone — beyond the DIY neurostimulation community, companies are cashing in on the phenomenon, offering brain stimulation kits and ready-to-wear headsets, like \u003ca href=\"http://www.wsj.com/articles/this-gadget-gives-you-a-low-voltage-pick-me-up-1437503825\">Thync\u003c/a> and \u003ca href=\"https://techcrunch.com/2016/11/16/halo-neuroscience/\">Halo\u003c/a>. While the simplest devices can be made with items found in a hardware store, the best-selling versions like \u003ca href=\"http://www.caputron.com/transcutaneous-electrical-stimulation/54-activadose-ii.html?search_query=activadose&results=3\">ActivaDose\u003c/a> or the \u003ca href=\"https://foc.us/\">Foc.us\u003c/a> can cost more than $300.\u003c/p>\n\u003cp>And sales of the devices spike at fairly regular times, says Robin Azzam, CEO of a leading tDCS retailer \u003ca href=\"http://www.caputron.com/content/11-tdcs-device-comaparison\">Caputron\u003c/a>: around college midterms and finals. Caputron also helps point customers to academic studies about tDCS. And Azzam says articles on cognitive enhancement are in particularly high demand during exam times.\u003c/p>\n\u003cp>George says he's also heard students are using tDCS to study for exams, but he doesn't recommend it: There isn't enough data to back up claims that it is effective or safe.\u003c/p>\n\u003cp>He says an updated article will be published soon detailing the experts' concerns about liberal use of tDCS by the DIY community. The main worries include the risks of mistakes in administration by amateurs and the uncertainty of long-term harmful effects of the technique.\u003c/p>\n\u003cp>Besides, George says, at-home users that attempt to study with the device may actually be doing themselves a disservice.\u003c/p>\n\u003cp>\"When we learn something, we're more likely to remember it in the same environment as when we learned it,\" he says. \"So if you study with one of these devices on and then you take your test without the device, you've violated that rule. You may be very good with it on, but unless they allow you to do that in the exam you're actually hurting yourself.\"\u003c/p>\n\u003cp>Plus, the safety of devices can vary — given that most tDCS devices aren't marketed with specific medical claims, they are not reviewed by the Food and Drug Administration.\u003c/p>\n\u003cp>\"A lot of the people that buy these think that they're safe because a company is allowed to sell them,\" says Vince Clark, director of the Psychology Clinical Neuroscience Center at the University of New Mexico. \"What they don't know is that a lot of those devices are never evaluated by the FDA. They go to market without safety studies that everybody expects must have happened. They haven't.\"\u003c/p>\n\u003cp>But like Herich, many users read the literature that supports and condemns tDCS use outside of clinical settings and choose to move forward anyway. And according to \u003ca href=\"http://jme.bmj.com/content/early/2015/08/30/medethics-2015-102704.short\">one academic review of the do-it-yourself brain stimulation community\u003c/a>, most DIYers do draw heavily on existing scientific knowledge, circulate academic journal articles and adopt the standard electrode placement used by scientists.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"I do understand the risks,\" Herich says. \"I know ... the nature of what it is that I'm doing, connecting a 9-volt to the forehead.\" He acknowledges that to many people it may sound crazy. \"I don't know,\" he says, \"I think I just accept that risk.\"\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Students+Zap+Their+Brains+For+a+Boost%2C+For+Better+Or+Worse&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Last October, Matt Herich was listening to the news while he drove door to door delivering pizzas. A story came on the radio about a technology that sends an electric current through your brain to possibly make you better at some things — moving, remembering, learning. He was fascinated.\u003c/p>\n\u003cp>The neurotechnology is called transcranial direct current stimulation, or tDCS for short. At its simplest, the method involves a device that uses little more than a 9-volt battery and some electrodes to send a low-intensity electrical current to a targeted area of the brain, \u003ca href=\"http://www.jove.com/video/2744/electrode-positioning-montage-transcranial-direct-current\">typically via a headset\u003c/a>.\u003c/p>\n\u003cp>More than a 1,000 studies have been published in peer-reviewed journals over the last decade suggesting benefits of the technique — maybe \u003ca href=\"http://www.sciencedirect.com/science/article/pii/S0014488609001290\">regulating mood\u003c/a>, possibly \u003ca href=\"http://www.sciencedirect.com/science/article/pii/S0166432809006536\">improving language skills\u003c/a> — but its effects, good \u003cem>or\u003c/em> bad, are far from clear.\u003c/p>\n\u003cp>Although researchers see possibilities for tDCS in treating diseases and boosting performance, it's still an exploratory technology, says Mark George, editor-in-chief of \u003cem>Brain Stimulation\u003c/em>, a leading journal on neuromodulation. And leading experts have \u003ca href=\"http://www.tandfonline.com/doi/pdf/10.3109/10601333.2015.980944?needAccess=true\">warned against at-home use\u003c/a> of such devices.\u003c/p>\n\u003cp>\"If we can figure out safe long-term applications, it's so inexpensive we might be able to use it to boost tons of things,\" says George, a professor at the Medical University of South Carolina. \"But I have to underline \u003cem>might \u003c/em>-- we don't know yet.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>When Herich finished his shift delivering pizzas, he raced home and began googling. He found a thriving \u003ca href=\"https://www.reddit.com/r/tDCS/\">community on Reddit\u003c/a> and other online forums dedicated to discussing ways to self-administer tDCS.\u003c/p>\n\u003cp>After reading some scientific studies on neurostimulation, Herich decided to give it a try. He eventually got his hands on a rudimentary tDCS device made by a student at Northern Arizona University.\u003c/p>\n\u003cp>\"I did my research before I put the device on my head,\" Herich says. \"So it was a mix between me being confident it would be safe and me taking a leap of faith.\"\u003c/p>\n\u003cp>In his opinion, the leap of faith paid off. Herich takes online courses on machine learning, and he says that one 20-minute session of tDCS puts him in a state of intense focus that increases his productivity and helps him learn abstract math much faster than before.\u003c/p>\n\u003cp>Herich is not alone — beyond the DIY neurostimulation community, companies are cashing in on the phenomenon, offering brain stimulation kits and ready-to-wear headsets, like \u003ca href=\"http://www.wsj.com/articles/this-gadget-gives-you-a-low-voltage-pick-me-up-1437503825\">Thync\u003c/a> and \u003ca href=\"https://techcrunch.com/2016/11/16/halo-neuroscience/\">Halo\u003c/a>. While the simplest devices can be made with items found in a hardware store, the best-selling versions like \u003ca href=\"http://www.caputron.com/transcutaneous-electrical-stimulation/54-activadose-ii.html?search_query=activadose&results=3\">ActivaDose\u003c/a> or the \u003ca href=\"https://foc.us/\">Foc.us\u003c/a> can cost more than $300.\u003c/p>\n\u003cp>And sales of the devices spike at fairly regular times, says Robin Azzam, CEO of a leading tDCS retailer \u003ca href=\"http://www.caputron.com/content/11-tdcs-device-comaparison\">Caputron\u003c/a>: around college midterms and finals. Caputron also helps point customers to academic studies about tDCS. And Azzam says articles on cognitive enhancement are in particularly high demand during exam times.\u003c/p>\n\u003cp>George says he's also heard students are using tDCS to study for exams, but he doesn't recommend it: There isn't enough data to back up claims that it is effective or safe.\u003c/p>\n\u003cp>He says an updated article will be published soon detailing the experts' concerns about liberal use of tDCS by the DIY community. The main worries include the risks of mistakes in administration by amateurs and the uncertainty of long-term harmful effects of the technique.\u003c/p>\n\u003cp>Besides, George says, at-home users that attempt to study with the device may actually be doing themselves a disservice.\u003c/p>\n\u003cp>\"When we learn something, we're more likely to remember it in the same environment as when we learned it,\" he says. \"So if you study with one of these devices on and then you take your test without the device, you've violated that rule. You may be very good with it on, but unless they allow you to do that in the exam you're actually hurting yourself.\"\u003c/p>\n\u003cp>Plus, the safety of devices can vary — given that most tDCS devices aren't marketed with specific medical claims, they are not reviewed by the Food and Drug Administration.\u003c/p>\n\u003cp>\"A lot of the people that buy these think that they're safe because a company is allowed to sell them,\" says Vince Clark, director of the Psychology Clinical Neuroscience Center at the University of New Mexico. \"What they don't know is that a lot of those devices are never evaluated by the FDA. They go to market without safety studies that everybody expects must have happened. They haven't.\"\u003c/p>\n\u003cp>But like Herich, many users read the literature that supports and condemns tDCS use outside of clinical settings and choose to move forward anyway. And according to \u003ca href=\"http://jme.bmj.com/content/early/2015/08/30/medethics-2015-102704.short\">one academic review of the do-it-yourself brain stimulation community\u003c/a>, most DIYers do draw heavily on existing scientific knowledge, circulate academic journal articles and adopt the standard electrode placement used by scientists.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"I do understand the risks,\" Herich says. \"I know ... the nature of what it is that I'm doing, connecting a 9-volt to the forehead.\" He acknowledges that to many people it may sound crazy. \"I don't know,\" he says, \"I think I just accept that risk.\"\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Students+Zap+Their+Brains+For+a+Boost%2C+For+Better+Or+Worse&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Unexpected Risks Found in Procedure for 3-Person Baby",
"title": "Unexpected Risks Found in Procedure for 3-Person Baby",
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"content": "\u003cp>In September, reproductive endocrinologist John Zhang and his team at the New Hope Fertility Center in New York City captured the world's attention when they \u003ca href=\"http://www.npr.org/sections/thetwo-way/2016/09/27/495668299/new-york-fertility-doctor-says-he-created-baby-with-3-genetic-parents\">announced \u003c/a>the birth of a child to a mother carrying a fatal genetic defect.\u003c/p>\n\u003cp>Using a technique called \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4005369/\">mitochondrial replacement therapy\u003c/a>, the researchers combined DNA from two women and one man to bypass the defect and produce a healthy baby boy — one with, quite literally, three genetic parents.\u003c/p>\n\u003cp>It was heralded as a stunning technological leap for in vitro fertilization, albeit one that the team was forced to perform in Mexico, because the technique has not been approved in the United States.\u003c/p>\n\u003cp>The technique is spreading quickly, gaining official \u003ca href=\"https://www.theguardian.com/science/2016/dec/15/three-parent-embryos-regulator-gives-green-light-to-uk-clinics\">approval\u003c/a> this month from the Human Fertilization and Embryology Authority in the U.K. The move will allow clinics to apply for permission there to carry out the treatment, with the first patients expected to be seen as early as next year.\u003c/p>\n\u003cp>But for all the accolades, the method also has scientists concerned that the fatally flawed mitochondria can resurface to threaten a child's health.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Earlier this month, a study published in \u003ca href=\"http://www.nature.com/nature/journal/vaop/ncurrent/pdf/nature20592.pdf\">Nature\u003c/a> by \u003ca href=\"http://www.ohsu.edu/xd/research/centers-institutes/onprc/scientific-discovery/scientists/mitalipov.cfm\">Shoukhrat Mitalipov\u003c/a>, head of the Center for Embryonic Cell and Gene Therapy at the Oregon Health and Science University in Portland, suggested that in roughly 15 percent of cases, the mitochondrial replacement could fail and allow fatal defects to return, or even increase a child's vulnerability to new ailments.\u003c/p>\n\u003cp>The findings confirmed the suspicions of many researchers, and the conclusions drawn by Mitalipov and his team were unequivocal: The potential for conflicts between transplanted and original mitochondrial genomes is real, and more sophisticated matching of donor and recipient eggs — pairing mothers whose mitochondria share genetic similarities, for example — is needed to avoid potential tragedies.\u003c/p>\n\u003cp>\"This study shows the potential as well as the risks of gene therapy in the germline,\" Mitalipov says. This is especially true of mitochondria, because its genomes are so different than the genomes in the nucleus of cells. Slight variations between mitochondrial genomes, he adds, \"turn out to matter a great deal.\"\u003c/p>\n\u003cp>Mitochondria are the energy powerhouses inside our cells, and they carry their own DNA, separate from our nuclear genome.\u003c/p>\n\u003cp>The danger lies in the fact that mitochondria are in some ways like aliens inside our cells. Two billion years ago they were free-floating bacteria basking in the primordial soup. Then one such microbe merged with another free-floating bacterium, and over evolutionary time, the two formed a complete cell. The bacteria eventually evolved into mitochondria, migrating most of their genes to the cell nucleus and keeping just a few dozen, largely to help them produce energy.\u003c/p>\n\u003cp>Today, our nuclear genome contains around \u003ca href=\"https://ghr.nlm.nih.gov/primer/basics/gene\">20,000 genes,\u003c/a> while a \u003ca href=\"https://ghr.nlm.nih.gov/mitochondrial-dna\">scant 37 genes\u003c/a> reside in the mitochondria. And yet the two genomes are intensely symbiotic: 99 percent of mitochondrial proteins are incorporated from the nucleus.\u003c/p>\n\u003cp>Mitochondria also still divide and replicate like the bacteria they once were, and that constant replication means that \u003ca href=\"http://www2.le.ac.uk/departments/emfpu/genetics/explained/mitochondrial\">mutations\u003c/a> arise 10 to 30 times \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/15062813\">more often\u003c/a> in mitochondrial genes than in the nucleus. If too many mitochondria become dysfunctional, the entire cell suffers and serious health problems can result. Faulty mitochondria are implicated in genetic diseases, as well as many \u003ca href=\"http://www.mitoaction.org/mito-faq\">chronic conditions\u003c/a> from \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2922635/\">infertility\u003c/a> to cancer, cardiac disease and neurodegenerative diseases. That's because when mitochondria falter, the energy system of the cell itself is compromised.\u003c/p>\n\u003cp>A three-parent baby could solve the problem by overriding faulty mitochondria, but it also raises the stakes, because the procedure does not completely replace the defective mitochondria with healthy ones.\u003c/p>\n\u003cp>When the mother's nucleus is transferred, it's like a plant dug up out of ground — a bit of the original soil (in this case, the mother's mitochondria) is still clinging to the roots. That creates a situation that never happens in nature: Two different mitochondrial genomes from two different women are forced to live inside the same cell. In most cases, a \u003ca href=\"http://www.sciencemag.org/news/2016/09/unanswered-questions-surround-baby-born-three-parents\">tiny percentage\u003c/a> (usually less than 2 percent) of the diseased mitochondria remain — but that tiny percentage can really matter.\u003c/p>\n\u003cp>In his new study, Mitalipov crafted three-parent embryos from the eggs of three mothers carrying mutant mitochondrial DNA and from the eggs of 11 healthy women. The embryos were then tweaked to become embryonic stem cells that could live forever, so they could be multiplied and studied. In three cases, the original maternal mitochondrial DNA returned.\u003c/p>\n\u003cp>\"That original, maternal mitochondrial DNA took over,\" Mitalipov says, \"and it was pretty drastic. There was less than 1 percent of the original maternal mitochondrial DNA present after replacement with donor DNA and before fertilization, and yet it took over the whole cell later.\"\u003c/p>\n\u003cp>Mitalipov warns that this reversal might not only occur in the embryonic stem cells; it could also occur in the womb at some point during the development of a baby. Complicating things further, Mitalipov found that some mitochondrial DNA stimulates cells to divide more rapidly, which would mean that a cells containing the maternal mitochondrial DNA could eventually dominate as the embryo developed.\u003c/p>\n\u003cp>Some mitochondrial genomes replicate much faster than others, says University of California molecular biologist \u003ca href=\"http://cancer.ucsf.edu/people/profiles/ofarrell_patrick.3574\">Patrick O'Farrell\u003c/a>, who called Mitalipov's research both impressive and in keeping with his own thinking on the matter.\u003c/p>\n\u003cp>A diseased mitochondrial genome could behave like a super-replicating bully, O'Farrell says, re-emerging and having a large impact on the three-parent baby at any time. It could also affect that child's future offspring. \"The diseased genome might stage a sneak comeback to afflict subsequent generations,\" O'Farrell says. On the other hand, he says, the super-replicators could act as \"superheroes,\" if they carry healthy, fit DNA that is able to out-compete a mutant genome.\u003c/p>\n\u003cp>The nuclear genes donated by a father could also influence the behavior of the mitochondria in ways we cannot yet predict, O'Farrell says. For example, the father might introduce new genes that favor the replication rate of a defective bully genome. Or the father might introduce genes that help a \"wimpy\" healthy genome survive and thrive.\u003c/p>\n\u003cp>Mitalipov's proposed solution to the problem is to match the mitochondria of the mother and the donor, since not all mitochondria are alike. Human mitochondria all over the earth are in a sense a billion or more clones of their original mother, passed down in endless biblical begats from mother to child. Yet, even as clones, they have diverged over time into lineages with different characteristics. These are called haplotypes.\u003c/p>\n\u003cp>O'Farrell mentions blood types as a comparison. Just as you would not want to transfuse blood type A into someone with blood type B, you might not want to mix different lineages. And while he says he thinks the idea of matching lineages is brilliant, he suggests going a step further. \"I say let's ... try to get a match with the dominating genome so that the defective genome will ultimately be completely displaced.\"\u003c/p>\n\u003cp>In fact, he adds, the ideal would be to look for one superhero genome, the fastest replicator of all – one that could displace any diseased genome.\u003c/p>\n\u003cp>To find out which branches are super replicators, O'Farrell hopes to collaborate with other laboratories and test the competitive strength of different haplotypes. Earlier this year, O'Farrell's laboratory published \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/27270106\">work\u003c/a> showing that competition between closely related genomes tends to favor the most beneficial, while matchups between distantly related genomes favor super replicators with negative or even lethal consequences. There are, he says, at least 10 major lineages that would be distinct enough to be highly relevant.\u003c/p>\n\u003cp>Mitalipov says that most of the time, matching haplotypes should ensure successful mitochondrial transfers. However, he cautions that even then, tiny differences in the region of the mitochondrial genome that controls replication speed could cause an unexpected surprise. Even in mitochondria from the same haplotype, there could be a single change in a gene that could cause a conflict, he says.\u003c/p>\n\u003cp>In his study, Mitalipov zeroes in on the region that appears responsible for replication speed. In order to find out a mother's haplotype, he says, full sequencing is necessary, and this region from the donor's egg should also be looked at to be sure it matches the mother's. Today, it costs a few hundred dollars to sequence a woman's mitochondrial genome.\u003c/p>\n\u003cp>But battles between mitochondrial genomes are only one part of the emerging story. Some research suggests that nuclear genes evolve to sync well with a mitochondrial haplotype, and that when the pairing is suddenly switched, health might be compromised.\u003c/p>\n\u003cp>Research in fruit flies and in tiny sea creatures called cephalopods shows that when the \"mitonuclear\" partnership diverges too much, infertility and poor health can result. In some cases, however, the divergent pairs are above average and can actually lead to better health.\u003c/p>\n\u003cp>Swapping as little as 0.2 percent of mitochondrial DNA in laboratory animals \"can have profound effects on the function of cells, organs, and even the whole organism, and these effects manifest late in life,\" according to mitochondrial biologist \u003ca href=\"http://www.mrc-mbu.cam.ac.uk/people/patrick-chinnery\">Patrick Chinnery\u003c/a> of the University of Cambridge, \u003ca href=\"http://www.nejm.org/doi/full/10.1056/NEJMcibr1608715\">writing \u003c/a>in November in \u003cem>The New England Journal of Medicine\u003c/em>.\u003c/p>\n\u003cp>Because of all these unknowns, a \u003ca href=\"https://www.nap.edu/read/21871/chapter/1\">U.S. panel recommended last February\u003c/a> that mitochondrial replacement therapy, if approved, implant only male embryos so that the human-altered mitochondrial germline would not be passed down through the generations.\u003c/p>\n\u003cp>Most scientists approve of this advice, but biologist \u003ca href=\"http://www.damiandowlinglab.com/\">Damian Dowling\u003c/a> of Monash University in Melbourne, Australia, has reservations about even this solution.\u003c/p>\n\u003cp>His own research in fruit flies shows that males may actually be more vulnerable than females to impaired health from mitochondrial replacement. Since females pass on mitochondria, natural selection will help daughters sift out any mutations that might be harmful to them, and keep their nuclear and mitochondrial genes well matched. Males aren't so lucky: If mutations don't harm females but do harm males, the males may have to suffer impaired fertility and go to their graves earlier.\u003c/p>\n\u003cp>This is known as the \"\u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/16701262\">mother's curse\u003c/a>\" — a term coined by geneticist \u003ca href=\"http://gemmell-lab.otago.ac.nz/\">Neil Gemmell\u003c/a> of the University of Otago in New Zealand to describe the biological baggage that mothers unwittingly pass down to their male babies.\u003c/p>\n\u003cp>The bottom line, according to biologist \u003ca href=\"http://www.davidrandlab.org/\">David Rand\u003c/a> of Brown University, who studies mitochondrial genomes, is that when you swap mitochondria, the reaction is \"highly unpredictable.\"\u003c/p>\n\u003cp>And that's why many experts are calling for caution even amid all the excitement following the three-parent Mexico trial — though there is reason to believe they aren't being heard.\u003c/p>\n\u003cp>A three-person baby has now been born in China, and two more may soon be born in Ukraine, according to \u003ca href=\"http://www.nature.com/news/reports-of-three-parent-babies-multiply-1.20849\">Nature News\u003c/a>. Zhang, meanwhile, continues to encourage potential patients in Mexico: \"We have received interest both locally and abroad,\" he says, \"and we invite people to learn more about the treatment.\"\u003c/p>\n\u003cp>Doug Wallace, head of the Center for Mitochondrial and Epigenomic Medicine at the Children's Hospital of Philadelphia, is among those calling for a more methodical approach to the technique, though he says he doesn't think there's any way to put the brakes on now. \"I think what's happened is we're going to see more and more trials and some families are going to be exceedingly fortunate — and perhaps some will be an unfortunate part of the learning set.\"\u003c/p>\n\u003cp>Research on mitochondria has to catch up, Wallace says, and while matching haplotypes is a good idea, it isn't so easy to do in practice. \"Finding women to be egg donors is going to be a major limitation,\" he says — especially when you'd first have to survey a large group to find compatible mitochondrial DNA.\u003c/p>\n\u003cp>Still, for women desperate to conceive a healthy child this may seem reasonable. Wallace adds that mitochondrial replacement therapy might find favor even outside those seeking to avoid passing on fatal genetic mutations — such as older women simply facing reduced fertility. \"There's no proof that's the case,\" he says, but if it came to pass, that could mean a therapy that might change the DNA of tens of thousands, maybe hundreds of thousands, of babies conceived by this method.\u003c/p>\n\u003cp>That would have a real impact on the long-term future of society, Wallace adds, and we don't yet fully understand all of the implications.\u003c/p>\n\u003cp>\"I think it's an exciting possibility,\" he says, \"but also a little disconcerting.\"\u003c/p>\n\u003cp>\u003cem>Jill Neimark is an award-winning science journalist and an author of adult and children's books. Her most recent book is \"\u003ca href=\"https://www.amazon.com/Hugging-Tree-Story-About-Resilience/dp/1433819074/ref=sr_1_2?s=books&ie=UTF8&qid=1482511414&sr=1-2\">The Hugging Tree: A Story About Resilience\u003c/a>.\"\u003c/em>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>A version of this article \u003ca href=\"http://undark.org/article/three-parent-babies-battle-mitochondria/\">originally appeared at Undark\u003c/a>, a digital science magazine published by the Knight Science Journalism Fellowship Program at MIT.\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Unexpected+Risks+Found+In+Replacing+DNA+To+Prevent+Inherited+Disorders&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>In September, reproductive endocrinologist John Zhang and his team at the New Hope Fertility Center in New York City captured the world's attention when they \u003ca href=\"http://www.npr.org/sections/thetwo-way/2016/09/27/495668299/new-york-fertility-doctor-says-he-created-baby-with-3-genetic-parents\">announced \u003c/a>the birth of a child to a mother carrying a fatal genetic defect.\u003c/p>\n\u003cp>Using a technique called \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4005369/\">mitochondrial replacement therapy\u003c/a>, the researchers combined DNA from two women and one man to bypass the defect and produce a healthy baby boy — one with, quite literally, three genetic parents.\u003c/p>\n\u003cp>It was heralded as a stunning technological leap for in vitro fertilization, albeit one that the team was forced to perform in Mexico, because the technique has not been approved in the United States.\u003c/p>\n\u003cp>The technique is spreading quickly, gaining official \u003ca href=\"https://www.theguardian.com/science/2016/dec/15/three-parent-embryos-regulator-gives-green-light-to-uk-clinics\">approval\u003c/a> this month from the Human Fertilization and Embryology Authority in the U.K. The move will allow clinics to apply for permission there to carry out the treatment, with the first patients expected to be seen as early as next year.\u003c/p>\n\u003cp>But for all the accolades, the method also has scientists concerned that the fatally flawed mitochondria can resurface to threaten a child's health.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Earlier this month, a study published in \u003ca href=\"http://www.nature.com/nature/journal/vaop/ncurrent/pdf/nature20592.pdf\">Nature\u003c/a> by \u003ca href=\"http://www.ohsu.edu/xd/research/centers-institutes/onprc/scientific-discovery/scientists/mitalipov.cfm\">Shoukhrat Mitalipov\u003c/a>, head of the Center for Embryonic Cell and Gene Therapy at the Oregon Health and Science University in Portland, suggested that in roughly 15 percent of cases, the mitochondrial replacement could fail and allow fatal defects to return, or even increase a child's vulnerability to new ailments.\u003c/p>\n\u003cp>The findings confirmed the suspicions of many researchers, and the conclusions drawn by Mitalipov and his team were unequivocal: The potential for conflicts between transplanted and original mitochondrial genomes is real, and more sophisticated matching of donor and recipient eggs — pairing mothers whose mitochondria share genetic similarities, for example — is needed to avoid potential tragedies.\u003c/p>\n\u003cp>\"This study shows the potential as well as the risks of gene therapy in the germline,\" Mitalipov says. This is especially true of mitochondria, because its genomes are so different than the genomes in the nucleus of cells. Slight variations between mitochondrial genomes, he adds, \"turn out to matter a great deal.\"\u003c/p>\n\u003cp>Mitochondria are the energy powerhouses inside our cells, and they carry their own DNA, separate from our nuclear genome.\u003c/p>\n\u003cp>The danger lies in the fact that mitochondria are in some ways like aliens inside our cells. Two billion years ago they were free-floating bacteria basking in the primordial soup. Then one such microbe merged with another free-floating bacterium, and over evolutionary time, the two formed a complete cell. The bacteria eventually evolved into mitochondria, migrating most of their genes to the cell nucleus and keeping just a few dozen, largely to help them produce energy.\u003c/p>\n\u003cp>Today, our nuclear genome contains around \u003ca href=\"https://ghr.nlm.nih.gov/primer/basics/gene\">20,000 genes,\u003c/a> while a \u003ca href=\"https://ghr.nlm.nih.gov/mitochondrial-dna\">scant 37 genes\u003c/a> reside in the mitochondria. And yet the two genomes are intensely symbiotic: 99 percent of mitochondrial proteins are incorporated from the nucleus.\u003c/p>\n\u003cp>Mitochondria also still divide and replicate like the bacteria they once were, and that constant replication means that \u003ca href=\"http://www2.le.ac.uk/departments/emfpu/genetics/explained/mitochondrial\">mutations\u003c/a> arise 10 to 30 times \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/15062813\">more often\u003c/a> in mitochondrial genes than in the nucleus. If too many mitochondria become dysfunctional, the entire cell suffers and serious health problems can result. Faulty mitochondria are implicated in genetic diseases, as well as many \u003ca href=\"http://www.mitoaction.org/mito-faq\">chronic conditions\u003c/a> from \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2922635/\">infertility\u003c/a> to cancer, cardiac disease and neurodegenerative diseases. That's because when mitochondria falter, the energy system of the cell itself is compromised.\u003c/p>\n\u003cp>A three-parent baby could solve the problem by overriding faulty mitochondria, but it also raises the stakes, because the procedure does not completely replace the defective mitochondria with healthy ones.\u003c/p>\n\u003cp>When the mother's nucleus is transferred, it's like a plant dug up out of ground — a bit of the original soil (in this case, the mother's mitochondria) is still clinging to the roots. That creates a situation that never happens in nature: Two different mitochondrial genomes from two different women are forced to live inside the same cell. In most cases, a \u003ca href=\"http://www.sciencemag.org/news/2016/09/unanswered-questions-surround-baby-born-three-parents\">tiny percentage\u003c/a> (usually less than 2 percent) of the diseased mitochondria remain — but that tiny percentage can really matter.\u003c/p>\n\u003cp>In his new study, Mitalipov crafted three-parent embryos from the eggs of three mothers carrying mutant mitochondrial DNA and from the eggs of 11 healthy women. The embryos were then tweaked to become embryonic stem cells that could live forever, so they could be multiplied and studied. In three cases, the original maternal mitochondrial DNA returned.\u003c/p>\n\u003cp>\"That original, maternal mitochondrial DNA took over,\" Mitalipov says, \"and it was pretty drastic. There was less than 1 percent of the original maternal mitochondrial DNA present after replacement with donor DNA and before fertilization, and yet it took over the whole cell later.\"\u003c/p>\n\u003cp>Mitalipov warns that this reversal might not only occur in the embryonic stem cells; it could also occur in the womb at some point during the development of a baby. Complicating things further, Mitalipov found that some mitochondrial DNA stimulates cells to divide more rapidly, which would mean that a cells containing the maternal mitochondrial DNA could eventually dominate as the embryo developed.\u003c/p>\n\u003cp>Some mitochondrial genomes replicate much faster than others, says University of California molecular biologist \u003ca href=\"http://cancer.ucsf.edu/people/profiles/ofarrell_patrick.3574\">Patrick O'Farrell\u003c/a>, who called Mitalipov's research both impressive and in keeping with his own thinking on the matter.\u003c/p>\n\u003cp>A diseased mitochondrial genome could behave like a super-replicating bully, O'Farrell says, re-emerging and having a large impact on the three-parent baby at any time. It could also affect that child's future offspring. \"The diseased genome might stage a sneak comeback to afflict subsequent generations,\" O'Farrell says. On the other hand, he says, the super-replicators could act as \"superheroes,\" if they carry healthy, fit DNA that is able to out-compete a mutant genome.\u003c/p>\n\u003cp>The nuclear genes donated by a father could also influence the behavior of the mitochondria in ways we cannot yet predict, O'Farrell says. For example, the father might introduce new genes that favor the replication rate of a defective bully genome. Or the father might introduce genes that help a \"wimpy\" healthy genome survive and thrive.\u003c/p>\n\u003cp>Mitalipov's proposed solution to the problem is to match the mitochondria of the mother and the donor, since not all mitochondria are alike. Human mitochondria all over the earth are in a sense a billion or more clones of their original mother, passed down in endless biblical begats from mother to child. Yet, even as clones, they have diverged over time into lineages with different characteristics. These are called haplotypes.\u003c/p>\n\u003cp>O'Farrell mentions blood types as a comparison. Just as you would not want to transfuse blood type A into someone with blood type B, you might not want to mix different lineages. And while he says he thinks the idea of matching lineages is brilliant, he suggests going a step further. \"I say let's ... try to get a match with the dominating genome so that the defective genome will ultimately be completely displaced.\"\u003c/p>\n\u003cp>In fact, he adds, the ideal would be to look for one superhero genome, the fastest replicator of all – one that could displace any diseased genome.\u003c/p>\n\u003cp>To find out which branches are super replicators, O'Farrell hopes to collaborate with other laboratories and test the competitive strength of different haplotypes. Earlier this year, O'Farrell's laboratory published \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/27270106\">work\u003c/a> showing that competition between closely related genomes tends to favor the most beneficial, while matchups between distantly related genomes favor super replicators with negative or even lethal consequences. There are, he says, at least 10 major lineages that would be distinct enough to be highly relevant.\u003c/p>\n\u003cp>Mitalipov says that most of the time, matching haplotypes should ensure successful mitochondrial transfers. However, he cautions that even then, tiny differences in the region of the mitochondrial genome that controls replication speed could cause an unexpected surprise. Even in mitochondria from the same haplotype, there could be a single change in a gene that could cause a conflict, he says.\u003c/p>\n\u003cp>In his study, Mitalipov zeroes in on the region that appears responsible for replication speed. In order to find out a mother's haplotype, he says, full sequencing is necessary, and this region from the donor's egg should also be looked at to be sure it matches the mother's. Today, it costs a few hundred dollars to sequence a woman's mitochondrial genome.\u003c/p>\n\u003cp>But battles between mitochondrial genomes are only one part of the emerging story. Some research suggests that nuclear genes evolve to sync well with a mitochondrial haplotype, and that when the pairing is suddenly switched, health might be compromised.\u003c/p>\n\u003cp>Research in fruit flies and in tiny sea creatures called cephalopods shows that when the \"mitonuclear\" partnership diverges too much, infertility and poor health can result. In some cases, however, the divergent pairs are above average and can actually lead to better health.\u003c/p>\n\u003cp>Swapping as little as 0.2 percent of mitochondrial DNA in laboratory animals \"can have profound effects on the function of cells, organs, and even the whole organism, and these effects manifest late in life,\" according to mitochondrial biologist \u003ca href=\"http://www.mrc-mbu.cam.ac.uk/people/patrick-chinnery\">Patrick Chinnery\u003c/a> of the University of Cambridge, \u003ca href=\"http://www.nejm.org/doi/full/10.1056/NEJMcibr1608715\">writing \u003c/a>in November in \u003cem>The New England Journal of Medicine\u003c/em>.\u003c/p>\n\u003cp>Because of all these unknowns, a \u003ca href=\"https://www.nap.edu/read/21871/chapter/1\">U.S. panel recommended last February\u003c/a> that mitochondrial replacement therapy, if approved, implant only male embryos so that the human-altered mitochondrial germline would not be passed down through the generations.\u003c/p>\n\u003cp>Most scientists approve of this advice, but biologist \u003ca href=\"http://www.damiandowlinglab.com/\">Damian Dowling\u003c/a> of Monash University in Melbourne, Australia, has reservations about even this solution.\u003c/p>\n\u003cp>His own research in fruit flies shows that males may actually be more vulnerable than females to impaired health from mitochondrial replacement. Since females pass on mitochondria, natural selection will help daughters sift out any mutations that might be harmful to them, and keep their nuclear and mitochondrial genes well matched. Males aren't so lucky: If mutations don't harm females but do harm males, the males may have to suffer impaired fertility and go to their graves earlier.\u003c/p>\n\u003cp>This is known as the \"\u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/16701262\">mother's curse\u003c/a>\" — a term coined by geneticist \u003ca href=\"http://gemmell-lab.otago.ac.nz/\">Neil Gemmell\u003c/a> of the University of Otago in New Zealand to describe the biological baggage that mothers unwittingly pass down to their male babies.\u003c/p>\n\u003cp>The bottom line, according to biologist \u003ca href=\"http://www.davidrandlab.org/\">David Rand\u003c/a> of Brown University, who studies mitochondrial genomes, is that when you swap mitochondria, the reaction is \"highly unpredictable.\"\u003c/p>\n\u003cp>And that's why many experts are calling for caution even amid all the excitement following the three-parent Mexico trial — though there is reason to believe they aren't being heard.\u003c/p>\n\u003cp>A three-person baby has now been born in China, and two more may soon be born in Ukraine, according to \u003ca href=\"http://www.nature.com/news/reports-of-three-parent-babies-multiply-1.20849\">Nature News\u003c/a>. Zhang, meanwhile, continues to encourage potential patients in Mexico: \"We have received interest both locally and abroad,\" he says, \"and we invite people to learn more about the treatment.\"\u003c/p>\n\u003cp>Doug Wallace, head of the Center for Mitochondrial and Epigenomic Medicine at the Children's Hospital of Philadelphia, is among those calling for a more methodical approach to the technique, though he says he doesn't think there's any way to put the brakes on now. \"I think what's happened is we're going to see more and more trials and some families are going to be exceedingly fortunate — and perhaps some will be an unfortunate part of the learning set.\"\u003c/p>\n\u003cp>Research on mitochondria has to catch up, Wallace says, and while matching haplotypes is a good idea, it isn't so easy to do in practice. \"Finding women to be egg donors is going to be a major limitation,\" he says — especially when you'd first have to survey a large group to find compatible mitochondrial DNA.\u003c/p>\n\u003cp>Still, for women desperate to conceive a healthy child this may seem reasonable. Wallace adds that mitochondrial replacement therapy might find favor even outside those seeking to avoid passing on fatal genetic mutations — such as older women simply facing reduced fertility. \"There's no proof that's the case,\" he says, but if it came to pass, that could mean a therapy that might change the DNA of tens of thousands, maybe hundreds of thousands, of babies conceived by this method.\u003c/p>\n\u003cp>That would have a real impact on the long-term future of society, Wallace adds, and we don't yet fully understand all of the implications.\u003c/p>\n\u003cp>\"I think it's an exciting possibility,\" he says, \"but also a little disconcerting.\"\u003c/p>\n\u003cp>\u003cem>Jill Neimark is an award-winning science journalist and an author of adult and children's books. Her most recent book is \"\u003ca href=\"https://www.amazon.com/Hugging-Tree-Story-About-Resilience/dp/1433819074/ref=sr_1_2?s=books&ie=UTF8&qid=1482511414&sr=1-2\">The Hugging Tree: A Story About Resilience\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>A version of this article \u003ca href=\"http://undark.org/article/three-parent-babies-battle-mitochondria/\">originally appeared at Undark\u003c/a>, a digital science magazine published by the Knight Science Journalism Fellowship Program at MIT.\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Unexpected+Risks+Found+In+Replacing+DNA+To+Prevent+Inherited+Disorders&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Many famous composers may have fended off madness through music. Robert Schumann, Pyotr Ilyich Tchaikovsky and Ludwig van Beethoven all suffered from psychiatric illness, but they were also some of the most talented legends of all time. There is a long history of mental illness in poets, performers and artists.\u003c/p>\n\u003caside class=\"pullquote alignright\">'I’m convinced that a modern day psychiatrist examining [Gershwin] would give him a diagnosis of conduct disorder and might diagnose him with ADHD.'\u003ccite>Dr. Richard Kogan, clinical psychiatrist\u003c/cite>\u003c/aside>\n\u003cp>Dr. Richard Kogan, a clinical psychiatrist at Weill Cornell Medical Center and a renowned concert pianist, has studied the biographies of many musicians to better understand how mental instability ignited creative genius, and how their passion healed internal chaos.\u003c/p>\n\u003cp>Kogan recently spoke at the \u003ca href=\"http://tedmed.com/\" target=\"_blank\">TEDMED\u003c/a> conference in Palm Springs. He opened his talk with the story of George Gershwin as an anxious young boy.\u003c/p>\n\u003cp>\u003cstrong>Lessons From 'Rhapsody in Blue'\u003c/strong>\u003c/p>\n\u003cp>“George Gershwin exhibited enormous behavioral problems,” explains Kogan. “He was involved in fistfights and he set fires. He had trouble in school. He was inattentive. He couldn't sit still in the classroom. I'm convinced that a modern day psychiatrist examining him would give him a diagnosis of conduct disorder and might diagnose him with ADHD (attention deficit hyperactivity disorder), and might have started him on one of the psycho-stimulant medications like Adderall or Ritalin.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>But Gershwin was not medicated, because ADHD drugs didn't exist in the early years of the 20th century. Instead, according to Kogan, it was music that eventually taught him how to focus.\u003c/p>\n\u003cp>When Gershwin heard the sounds of a violin at the age of 10, his wild mind was utterly transfixed. On the spot, the young boy decided to devote his life to the study of music.\u003c/p>\n\u003cp>“Music provided a sense of order for Gershwin,” says Kogan. “Even though he retained the hyperactivity for the rest of his life, he no longer had impulse control problems or attention deficit problems.\"\u003c/p>\n\u003cp>Gershwin listened to the world differently from most people. Many of his masterpieces were inspired by simple chaotic sounds. On a train ride from New York to Boston, the click-clack of the train along the tracks inspired the construction of \"Rhapsody in Blue.\" The sounds of Parisian taxi horns were foundational to the rhythm of \"American in Paris.\"\u003c/p>\n\u003cp>“I think his exposure to music unlocked something that none of his early school teachers or anybody in his family saw, which was that he had extraordinary creative potential,” says Kogan. “And music was the way it was expressed.”\u003c/p>\n\u003cp>\u003cstrong>The Roots of Music and Medicine\u003c/strong>\u003c/p>\n\u003cp>\u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/22169917\" target=\"_blank\">Research\u003c/a> highlights how music used to play a much more integral role in healing. Kogan points back to the Greek god Apollo, who was recognized as both the deity of music and medicine. In primitive cultures, shamans served as both musician\u003cem> and\u003c/em> physician. During the Middle Ages, convents within the Catholic Church offered healing through music. The \u003ca href=\"http://www.washingtontimes.com/news/2008/jun/25/chant-a-healing-art/\" target=\"_blank\">health benefits\u003c/a> of chanting in many cultures have been studied. But over time, the scientific approach to medicine has helped dissolve the relationship between music and healing. Kogan hopes that changes.\u003c/p>\n\u003cp>\"There are researchers who are doing impressive work now in demonstrating scientifically exactly what music does,\" Kogan says about groundbreaking work in neuroscience. \"And I think when the results are in I predict there's going to be an explosion in the use of music as a modality of healing.\"\u003c/p>\n\u003cp>\u003cstrong>Why Mania Ignites Inspiration \u003c/strong>\u003c/p>\n\u003cp>There are features of elevated moods associated with mental illness that are conducive to creativity. For example, when individuals with bipolar disorder are in a hypomanic state, they experience increased energy, playful imagination and a decreased need for sleep.\u003c/p>\n\u003cp>Kogan explains how music helped Beethoven fend off suicidal tendencies in the video below.\u003c/p>\n\u003cp>\u003ciframe width=\"640\" height=\"360\" src=\"https://www.youtube.com/embed/PDNhzfcNJqQ?feature=oembed\" frameborder=\"0\" allow=\"autoplay; encrypted-media\" allowfullscreen>\u003c/iframe>\u003c/p>\n\u003cp>\u003cspan class=\"st\">Frédéric François Chopin, the Polish composer and virtuoso pianist, suffered from temporal lobe epilepsy, which caused dark hallucinations of phantoms and corpses. These images likely contributed to his famed funeral march, Piano Sonata No. 2. \u003c/span>Kogan shares Chopin's story in the video below.\u003c/p>\n\u003cp>\u003ciframe width=\"640\" height=\"360\" src=\"https://www.youtube.com/embed/3XmmXKqx-Sc?feature=oembed\" frameborder=\"0\" allow=\"autoplay; encrypted-media\" allowfullscreen>\u003c/iframe>\u003c/p>\n\u003cp>However, Kogan cautions against the tendency to over-romanticize psychiatric illness.\u003c/p>\n\u003cp>“Individuals may be reluctant to comply with treatment recommendations because they don't want to give up the creative highs associated with their mania,” says Kogan. “Unfortunately, that mind state tends to be unstable and often rather destructive. Plus, most people who are depressed are too paralyzed to write a symphony. Most people who are psychotic are too disorganized to put together anything coherent. So I think the best clinicians appreciate the potential advantages of mental illness and try to work with it to ultimately enhance creativity.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>That's what many musical legends did without the use of pharmacology. For George Gershwin the creative realm not only provided relief, it made him better than well.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Many famous composers may have fended off madness through music. Robert Schumann, Pyotr Ilyich Tchaikovsky and Ludwig van Beethoven all suffered from psychiatric illness, but they were also some of the most talented legends of all time. There is a long history of mental illness in poets, performers and artists.\u003c/p>\n\u003caside class=\"pullquote alignright\">'I’m convinced that a modern day psychiatrist examining [Gershwin] would give him a diagnosis of conduct disorder and might diagnose him with ADHD.'\u003ccite>Dr. Richard Kogan, clinical psychiatrist\u003c/cite>\u003c/aside>\n\u003cp>Dr. Richard Kogan, a clinical psychiatrist at Weill Cornell Medical Center and a renowned concert pianist, has studied the biographies of many musicians to better understand how mental instability ignited creative genius, and how their passion healed internal chaos.\u003c/p>\n\u003cp>Kogan recently spoke at the \u003ca href=\"http://tedmed.com/\" target=\"_blank\">TEDMED\u003c/a> conference in Palm Springs. He opened his talk with the story of George Gershwin as an anxious young boy.\u003c/p>\n\u003cp>\u003cstrong>Lessons From 'Rhapsody in Blue'\u003c/strong>\u003c/p>\n\u003cp>“George Gershwin exhibited enormous behavioral problems,” explains Kogan. “He was involved in fistfights and he set fires. He had trouble in school. He was inattentive. He couldn't sit still in the classroom. I'm convinced that a modern day psychiatrist examining him would give him a diagnosis of conduct disorder and might diagnose him with ADHD (attention deficit hyperactivity disorder), and might have started him on one of the psycho-stimulant medications like Adderall or Ritalin.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>But Gershwin was not medicated, because ADHD drugs didn't exist in the early years of the 20th century. Instead, according to Kogan, it was music that eventually taught him how to focus.\u003c/p>\n\u003cp>When Gershwin heard the sounds of a violin at the age of 10, his wild mind was utterly transfixed. On the spot, the young boy decided to devote his life to the study of music.\u003c/p>\n\u003cp>“Music provided a sense of order for Gershwin,” says Kogan. “Even though he retained the hyperactivity for the rest of his life, he no longer had impulse control problems or attention deficit problems.\"\u003c/p>\n\u003cp>Gershwin listened to the world differently from most people. Many of his masterpieces were inspired by simple chaotic sounds. On a train ride from New York to Boston, the click-clack of the train along the tracks inspired the construction of \"Rhapsody in Blue.\" The sounds of Parisian taxi horns were foundational to the rhythm of \"American in Paris.\"\u003c/p>\n\u003cp>“I think his exposure to music unlocked something that none of his early school teachers or anybody in his family saw, which was that he had extraordinary creative potential,” says Kogan. “And music was the way it was expressed.”\u003c/p>\n\u003cp>\u003cstrong>The Roots of Music and Medicine\u003c/strong>\u003c/p>\n\u003cp>\u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/22169917\" target=\"_blank\">Research\u003c/a> highlights how music used to play a much more integral role in healing. Kogan points back to the Greek god Apollo, who was recognized as both the deity of music and medicine. In primitive cultures, shamans served as both musician\u003cem> and\u003c/em> physician. During the Middle Ages, convents within the Catholic Church offered healing through music. The \u003ca href=\"http://www.washingtontimes.com/news/2008/jun/25/chant-a-healing-art/\" target=\"_blank\">health benefits\u003c/a> of chanting in many cultures have been studied. But over time, the scientific approach to medicine has helped dissolve the relationship between music and healing. Kogan hopes that changes.\u003c/p>\n\u003cp>\"There are researchers who are doing impressive work now in demonstrating scientifically exactly what music does,\" Kogan says about groundbreaking work in neuroscience. \"And I think when the results are in I predict there's going to be an explosion in the use of music as a modality of healing.\"\u003c/p>\n\u003cp>\u003cstrong>Why Mania Ignites Inspiration \u003c/strong>\u003c/p>\n\u003cp>There are features of elevated moods associated with mental illness that are conducive to creativity. For example, when individuals with bipolar disorder are in a hypomanic state, they experience increased energy, playful imagination and a decreased need for sleep.\u003c/p>\n\u003cp>Kogan explains how music helped Beethoven fend off suicidal tendencies in the video below.\u003c/p>\n\u003cp>\u003ciframe width=\"640\" height=\"360\" src=\"https://www.youtube.com/embed/PDNhzfcNJqQ?feature=oembed\" frameborder=\"0\" allow=\"autoplay; encrypted-media\" allowfullscreen>\u003c/iframe>\u003c/p>\n\u003cp>\u003cspan class=\"st\">Frédéric François Chopin, the Polish composer and virtuoso pianist, suffered from temporal lobe epilepsy, which caused dark hallucinations of phantoms and corpses. These images likely contributed to his famed funeral march, Piano Sonata No. 2. \u003c/span>Kogan shares Chopin's story in the video below.\u003c/p>\n\u003cp>\u003ciframe width=\"640\" height=\"360\" src=\"https://www.youtube.com/embed/3XmmXKqx-Sc?feature=oembed\" frameborder=\"0\" allow=\"autoplay; encrypted-media\" allowfullscreen>\u003c/iframe>\u003c/p>\n\u003cp>However, Kogan cautions against the tendency to over-romanticize psychiatric illness.\u003c/p>\n\u003cp>“Individuals may be reluctant to comply with treatment recommendations because they don't want to give up the creative highs associated with their mania,” says Kogan. “Unfortunately, that mind state tends to be unstable and often rather destructive. Plus, most people who are depressed are too paralyzed to write a symphony. Most people who are psychotic are too disorganized to put together anything coherent. So I think the best clinicians appreciate the potential advantages of mental illness and try to work with it to ultimately enhance creativity.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>That's what many musical legends did without the use of pharmacology. For George Gershwin the creative realm not only provided relief, it made him better than well.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Wearable Sensors Help Diagnose Lyme Disease in Stanford Study",
"title": "Wearable Sensors Help Diagnose Lyme Disease in Stanford Study",
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"content": "\u003cp>A next step for smart watches and fitness trackers? Wearable gadgets gave a Stanford University professor an early warning that he was getting sick before he ever felt any symptoms of Lyme disease.\u003c/p>\n\u003cp>Geneticist Michael Snyder never had Lyme's characteristic bulls-eye rash. But a smart watch and other sensors charted changes in Snyder's heart rate and oxygen levels during a family vacation. Eventually a fever struck that led to his diagnosis.\u003c/p>\n\u003cp>Say \"wearables,\" and step-counting fitness trackers spring to mind. It's not clear if they really make a difference in users' health. Now Snyder's team at Stanford is starting to find out, tracking the everyday lives of several dozen volunteers wearing devices that monitor more than mere activity.\u003c/p>\n\u003cp>He envisions one day having wearables that act as a sort of \"check engine\" light indicating it's time to see the doctor.\u003c/p>\n\u003cp>\"One way to look at this is, these are the equivalent of oral thermometers but you're measuring yourself all the time,\" said Snyder, senior author of a report released Thursday on the project.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Among the earliest hints: Changes in people's day-to-day physiology may flag when certain ailments are brewing, from colds to Lyme to Type 2 diabetes, researchers reported in the journal PLOS Biology.\u003c/p>\n\u003cp>Interest in wearable sensors is growing along with efforts to personalize medicine, as scientists learn how to tailor treatments and preventive care to people's genes, environment and lifestyle. The sensors are expected to be a part of the National Institutes of Health's huge \"precision medicine\" study, planned to begin later this year.\u003c/p>\n\u003cp>But a first step is learning what's normal for different people under different conditions.\u003c/p>\n\u003cp>The Stanford team is collecting reams of data — as many as 250,000 daily measurements — from volunteers who wear up to eight activity monitors or other sensors of varying sizes that measure heart rate, blood oxygen, skin temperature, sleep, calories expended, exercise and even exposure to radiation. That's paired with occasional laboratory tests to measure blood chemistry and some genetic information.\u003c/p>\n\u003cp>An initial finding: Blood oxygen levels decrease with rising altitudes during plane flights, in turn triggering fatigue. But toward the end of long flights, oxygen begins rising again, possibly as bodies adapt, the researchers reported.\u003c/p>\n\u003cp>It was that phenomenon that alerted Snyder, the longest-tested participant, \"that something wasn't quite right\" on one of his frequent long flights.\u003c/p>\n\u003cp>Landing in Norway for a family vacation, Snyder noticed his oxygen levels didn't return to normal like they always had before. Plus his heart rate was much higher than normal, which sometimes signals infection.\u003c/p>\n\u003cp>Sure enough, soon a low-grade fever left him dragging. He feared Lyme because two weeks before going abroad, Snyder had helped his brother build a fence in a tick-infested rural area in Massachusetts. He persuaded a Norwegian doctor to prescribe the appropriate antibiotic, and post-vacation testing back home confirmed the diagnosis.\u003c/p>\n\u003cp>Also during the study's first two years, Snyder and several other volunteers had minor cold-like illnesses that began with higher-than-normal readings for heart rate and skin temperature — and correlated with blood tests showing inflammation was on the rise before any sniffling.\u003c/p>\n\u003cp>In addition, the Stanford team detected variations in heart rate patterns that could tell the difference between study participants with what's called insulin resistance — a risk factor for Type 2 diabetes — and healthy people.\u003c/p>\n\u003cp>No, don't try to self-diagnose with your fitness tracker any time soon. The findings in Thursday's report are intriguing but the study is highly experimental, cautioned medical technology specialist Dr. Atul Butte of the University of California, San Francisco, who wasn't involved with the research.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"This kind of approach is going to help science more than the general public\" until there's better data about what's normal or not, Butte said. \"Remember, the baseline is always in motion. We're always getting older. We're always exposed to things. Just because there's a deviation doesn't mean it's abnormal.\"\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>A next step for smart watches and fitness trackers? Wearable gadgets gave a Stanford University professor an early warning that he was getting sick before he ever felt any symptoms of Lyme disease.\u003c/p>\n\u003cp>Geneticist Michael Snyder never had Lyme's characteristic bulls-eye rash. But a smart watch and other sensors charted changes in Snyder's heart rate and oxygen levels during a family vacation. Eventually a fever struck that led to his diagnosis.\u003c/p>\n\u003cp>Say \"wearables,\" and step-counting fitness trackers spring to mind. It's not clear if they really make a difference in users' health. Now Snyder's team at Stanford is starting to find out, tracking the everyday lives of several dozen volunteers wearing devices that monitor more than mere activity.\u003c/p>\n\u003cp>He envisions one day having wearables that act as a sort of \"check engine\" light indicating it's time to see the doctor.\u003c/p>\n\u003cp>\"One way to look at this is, these are the equivalent of oral thermometers but you're measuring yourself all the time,\" said Snyder, senior author of a report released Thursday on the project.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Among the earliest hints: Changes in people's day-to-day physiology may flag when certain ailments are brewing, from colds to Lyme to Type 2 diabetes, researchers reported in the journal PLOS Biology.\u003c/p>\n\u003cp>Interest in wearable sensors is growing along with efforts to personalize medicine, as scientists learn how to tailor treatments and preventive care to people's genes, environment and lifestyle. The sensors are expected to be a part of the National Institutes of Health's huge \"precision medicine\" study, planned to begin later this year.\u003c/p>\n\u003cp>But a first step is learning what's normal for different people under different conditions.\u003c/p>\n\u003cp>The Stanford team is collecting reams of data — as many as 250,000 daily measurements — from volunteers who wear up to eight activity monitors or other sensors of varying sizes that measure heart rate, blood oxygen, skin temperature, sleep, calories expended, exercise and even exposure to radiation. That's paired with occasional laboratory tests to measure blood chemistry and some genetic information.\u003c/p>\n\u003cp>An initial finding: Blood oxygen levels decrease with rising altitudes during plane flights, in turn triggering fatigue. But toward the end of long flights, oxygen begins rising again, possibly as bodies adapt, the researchers reported.\u003c/p>\n\u003cp>It was that phenomenon that alerted Snyder, the longest-tested participant, \"that something wasn't quite right\" on one of his frequent long flights.\u003c/p>\n\u003cp>Landing in Norway for a family vacation, Snyder noticed his oxygen levels didn't return to normal like they always had before. Plus his heart rate was much higher than normal, which sometimes signals infection.\u003c/p>\n\u003cp>Sure enough, soon a low-grade fever left him dragging. He feared Lyme because two weeks before going abroad, Snyder had helped his brother build a fence in a tick-infested rural area in Massachusetts. He persuaded a Norwegian doctor to prescribe the appropriate antibiotic, and post-vacation testing back home confirmed the diagnosis.\u003c/p>\n\u003cp>Also during the study's first two years, Snyder and several other volunteers had minor cold-like illnesses that began with higher-than-normal readings for heart rate and skin temperature — and correlated with blood tests showing inflammation was on the rise before any sniffling.\u003c/p>\n\u003cp>In addition, the Stanford team detected variations in heart rate patterns that could tell the difference between study participants with what's called insulin resistance — a risk factor for Type 2 diabetes — and healthy people.\u003c/p>\n\u003cp>No, don't try to self-diagnose with your fitness tracker any time soon. The findings in Thursday's report are intriguing but the study is highly experimental, cautioned medical technology specialist Dr. Atul Butte of the University of California, San Francisco, who wasn't involved with the research.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"This kind of approach is going to help science more than the general public\" until there's better data about what's normal or not, Butte said. \"Remember, the baseline is always in motion. We're always getting older. We're always exposed to things. Just because there's a deviation doesn't mean it's abnormal.\"\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>One of the largest educational gifts in U.S. history — $500 million — went to a California university today.\u003c/p>\n\u003cp>When \u003ca href=\"https://www.ucsf.edu/\" target=\"_blank\" rel=\"noopener\">UCSF\u003c/a> chancellor Sam Hawgood heard about the donation, he was grateful, of course — and shocked.\u003c/p>\n\u003cp>“I have to pinch myself every time I think about it,” says Hawgood.\u003c/p>\n\u003caside class=\"pullquote alignright\">The money could help fund some of the university’s current biomedical work including \u003ca href=\"https://ww2.kqed.org/futureofyou/2015/11/30/a-cure-for-aids-scientists-say-its-on-the-horizon/\" target=\"_blank\" rel=\"noopener\">finding a cure for AIDS\u003c/a>.\u003c/aside>\n\u003cp>As large donations to American universities go, the UCSF gift is matched only by \u003ca href=\"https://www.philanthropy.com/factfile/gifts_detail?GiftDonorJoin_a_DonorID=PGDON1706\" target=\"_blank\" rel=\"noopener\">$500 million gifts\u003c/a> to two Oregon universities from Nike co-founder Phil Knight.\u003c/p>\n\u003cp>The UCSF windfall comes from the \u003ca href=\"http://dillerteenfellows.org/en/about/helen-diller-family-foundation\" target=\"_blank\" rel=\"noopener\">Helen Diller Foundation\u003c/a>. Diller, who died in 2015, was a San Francisco native and public education advocate. Her foundation had already given $150 million to UCSF before Wednesday’s announcement.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Diller, whose family fortune rose from real estate development, knew about the planned donation before her death. Her daughter Jackie Safier, who’s president of the foundation, says her mother, “r\u003cspan style=\"font-weight: 400\">eally believed [UCSF] could have an incredible impact on healthcare worldwide if they had the necessary resources.”\u003c/span>\u003c/p>\n\u003cp>UCSF is known for its health care schools, including Medicine, Nursing, Pharmacy and Dentistry and its medical centers, the newest of which, at \u003ca href=\"https://www.ucsfhealth.org/\" target=\"_blank\" rel=\"noopener\">Mission Bay\u003c/a> in San Francisco, opened in 2015.\u003c/p>\n\u003cp>Its \u003ca href=\"https://www.ucsf.edu/about/achievements\" target=\"_blank\" rel=\"noopener\">scientific breakthroughs\u003c/a> include: discovering vitamin E, isolating the gene for insulin, co-discovering the AIDS virus and being the first to link obesity to Type 2 diabetes.\u003c/p>\n\u003cp>What’s unusual about the Diller donation is that it’s “relatively unrestricted.” That means the funds don’t have to be used for a narrow purpose. Those types of university contributions, though desperately sought, are uncommon, according to Hawgood.\u003c/p>\n\u003cp>Last year, less than one percent of UCSF’s financial gifts were “discretionary,” the term used for unrestricted funds.\u003c/p>\n\u003cp>“\u003cspan style=\"font-weight: 400\">So it’s extraordinarily remarkable, rare and frankly, exciting,” says Hawgood.\u003c/span>\u003c/p>\n\u003cp>He says the money will go toward attracting “the best of the best” faculty and will support students who couldn’t otherwise afford higher education.\u003c/p>\n\u003cp>“We are really committed to a very diverse student body,” says Hawgood. “This kind of funding for students allows us to put that on steroids.”\u003c/p>\n\u003cp>Four hundred million will go toward UCSF’s endowment and $100 million will support an innovation fund.\u003c/p>\n\u003cp>Of the $400 million, half will go toward supporting current faculty and attracting new talent. The other $200 million will support students at UCSF’s four professional schools, some of it, in the form of scholarships.\u003c/p>\n\u003cp>That financial aid is definitely needed, says Hawgood. The majority of UCSF’s professional students receive financial aid but less than 10 percent get enough to cover all their costs.\u003c/p>\n\u003cp>The final $100 million is part of an innovation fund to be used at the chancellor’s discretion.\u003c/p>\n\u003cp>It could help fund some of the university’s current biomedical work including \u003ca href=\"https://www.ucsf.edu/news/2016/11/404936/science-focus-how-do-white-blood-cells-move-so-fast\" target=\"_blank\" rel=\"noopener\">advanced microscopy techniques\u003c/a>, \u003ca href=\"http://www.genengnews.com/gen-news-highlights/perturb-seq-combines-crispr-and-single-cell-rna-seq/81253575\" target=\"_blank\" rel=\"noopener\">cell engineering\u003c/a> using gene-splicing tools such as \u003ca href=\"https://ww2.kqed.org/futureofyou/2016/04/29/how-a-new-crisprcas9-technique-may-get-us-closer-to-curing-genetic-diseases/\" target=\"_blank\" rel=\"noopener\">CRISPR,\u003c/a> and \u003ca href=\"https://ww2.kqed.org/futureofyou/2015/11/30/a-cure-for-aids-scientists-say-its-on-the-horizon/\" target=\"_blank\" rel=\"noopener\">finding a cure for AIDS\u003c/a>.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>UCSF hasn’t disclosed when the funding will become available. When it does, students will be able to discover scholarship opportunities on the university’s \u003ca href=\"https://www.ucsf.edu/education/admissions\" target=\"_blank\" rel=\"noopener\">admissions website\u003c/a>.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>One of the largest educational gifts in U.S. history — $500 million — went to a California university today.\u003c/p>\n\u003cp>When \u003ca href=\"https://www.ucsf.edu/\" target=\"_blank\" rel=\"noopener\">UCSF\u003c/a> chancellor Sam Hawgood heard about the donation, he was grateful, of course — and shocked.\u003c/p>\n\u003cp>“I have to pinch myself every time I think about it,” says Hawgood.\u003c/p>\n\u003caside class=\"pullquote alignright\">The money could help fund some of the university’s current biomedical work including \u003ca href=\"https://ww2.kqed.org/futureofyou/2015/11/30/a-cure-for-aids-scientists-say-its-on-the-horizon/\" target=\"_blank\" rel=\"noopener\">finding a cure for AIDS\u003c/a>.\u003c/aside>\n\u003cp>As large donations to American universities go, the UCSF gift is matched only by \u003ca href=\"https://www.philanthropy.com/factfile/gifts_detail?GiftDonorJoin_a_DonorID=PGDON1706\" target=\"_blank\" rel=\"noopener\">$500 million gifts\u003c/a> to two Oregon universities from Nike co-founder Phil Knight.\u003c/p>\n\u003cp>The UCSF windfall comes from the \u003ca href=\"http://dillerteenfellows.org/en/about/helen-diller-family-foundation\" target=\"_blank\" rel=\"noopener\">Helen Diller Foundation\u003c/a>. Diller, who died in 2015, was a San Francisco native and public education advocate. Her foundation had already given $150 million to UCSF before Wednesday’s announcement.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Diller, whose family fortune rose from real estate development, knew about the planned donation before her death. Her daughter Jackie Safier, who’s president of the foundation, says her mother, “r\u003cspan style=\"font-weight: 400\">eally believed [UCSF] could have an incredible impact on healthcare worldwide if they had the necessary resources.”\u003c/span>\u003c/p>\n\u003cp>UCSF is known for its health care schools, including Medicine, Nursing, Pharmacy and Dentistry and its medical centers, the newest of which, at \u003ca href=\"https://www.ucsfhealth.org/\" target=\"_blank\" rel=\"noopener\">Mission Bay\u003c/a> in San Francisco, opened in 2015.\u003c/p>\n\u003cp>Its \u003ca href=\"https://www.ucsf.edu/about/achievements\" target=\"_blank\" rel=\"noopener\">scientific breakthroughs\u003c/a> include: discovering vitamin E, isolating the gene for insulin, co-discovering the AIDS virus and being the first to link obesity to Type 2 diabetes.\u003c/p>\n\u003cp>What’s unusual about the Diller donation is that it’s “relatively unrestricted.” That means the funds don’t have to be used for a narrow purpose. Those types of university contributions, though desperately sought, are uncommon, according to Hawgood.\u003c/p>\n\u003cp>Last year, less than one percent of UCSF’s financial gifts were “discretionary,” the term used for unrestricted funds.\u003c/p>\n\u003cp>“\u003cspan style=\"font-weight: 400\">So it’s extraordinarily remarkable, rare and frankly, exciting,” says Hawgood.\u003c/span>\u003c/p>\n\u003cp>He says the money will go toward attracting “the best of the best” faculty and will support students who couldn’t otherwise afford higher education.\u003c/p>\n\u003cp>“We are really committed to a very diverse student body,” says Hawgood. “This kind of funding for students allows us to put that on steroids.”\u003c/p>\n\u003cp>Four hundred million will go toward UCSF’s endowment and $100 million will support an innovation fund.\u003c/p>\n\u003cp>Of the $400 million, half will go toward supporting current faculty and attracting new talent. The other $200 million will support students at UCSF’s four professional schools, some of it, in the form of scholarships.\u003c/p>\n\u003cp>That financial aid is definitely needed, says Hawgood. The majority of UCSF’s professional students receive financial aid but less than 10 percent get enough to cover all their costs.\u003c/p>\n\u003cp>The final $100 million is part of an innovation fund to be used at the chancellor’s discretion.\u003c/p>\n\u003cp>It could help fund some of the university’s current biomedical work including \u003ca href=\"https://www.ucsf.edu/news/2016/11/404936/science-focus-how-do-white-blood-cells-move-so-fast\" target=\"_blank\" rel=\"noopener\">advanced microscopy techniques\u003c/a>, \u003ca href=\"http://www.genengnews.com/gen-news-highlights/perturb-seq-combines-crispr-and-single-cell-rna-seq/81253575\" target=\"_blank\" rel=\"noopener\">cell engineering\u003c/a> using gene-splicing tools such as \u003ca href=\"https://ww2.kqed.org/futureofyou/2016/04/29/how-a-new-crisprcas9-technique-may-get-us-closer-to-curing-genetic-diseases/\" target=\"_blank\" rel=\"noopener\">CRISPR,\u003c/a> and \u003ca href=\"https://ww2.kqed.org/futureofyou/2015/11/30/a-cure-for-aids-scientists-say-its-on-the-horizon/\" target=\"_blank\" rel=\"noopener\">finding a cure for AIDS\u003c/a>.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>UCSF hasn’t disclosed when the funding will become available. When it does, students will be able to discover scholarship opportunities on the university’s \u003ca href=\"https://www.ucsf.edu/education/admissions\" target=\"_blank\" rel=\"noopener\">admissions website\u003c/a>.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>In a disappointment to Alzheimer's patients and researchers, drugmaker Eli Lilly said last November that a clinical trial of solanezumab, an experimental medication to treat the degenerative neurological condition, had failed.\u003c/p>\n\u003cp>[contextly_sidebar id=\"bkxEquaMuhkiSOe9yahNlZeRXqAVY7vi\"]The company has pressed on with tests of solanezumab, despite \u003ca href=\"http://www.npr.org/sections/health-shots/2012/08/24/159997459/failure-of-lilly-drug-is-latest-alzheimers-setback\">mixed results\u003c/a> in earlier studies. The latest test, involving more than 2,000 patients, found the drug didn't significantly slow cognitive decline in patients with mild dementia from Alzheimer's.\u003c/p>\n\u003cp>The sad refrain is a familiar one, unfortunately.\u003c/p>\n\u003cp>Solanezumab is just the latest casualty in a decades-long \u003ca href=\"http://alzres.biomedcentral.com/articles/10.1186/alzrt269#B13\">parade\u003c/a> of disappointing dementia drug trials. But the frustration brought by this particular failure could signal a shift in Alzheimer's research — a shift away from targeting accumulations of so-called amyloid protein in the brain, long considered by many in the field to be the crux of Alzheimer's pathology.\u003c/p>\n\u003cp>Ever since Dr. George G. Glenner's 1984 \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/6375662\">discovery\u003c/a> that amyloid is the main component of the plaques that riddle the Alzheimer's-afflicted brain, it has been assumed that the protein somehow contributes to the disorder — that it jams up cellular machinery, rendering neurons unable to effectively communicate, to form new memories, to remember where the keys are.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Like many other failed medications for symptomatic Alzheimer's, solanezumab works by attacking amyloid in the brain.\u003c/p>\n\u003cp>So in light of the new findings, is it finally time to let the amyloid theory go? The answer isn't clear.\u003c/p>\n\u003cp>\"The low magnitude of effects would lend support to the idea that it might be time to move on from amyloid,\" says Weill Cornell Medical College neurologist Dr. Richard Isaacson, who wasn't involved in the solanezumab study. \"Yet though the study failed overall, there were improvements in cognition and function in treated patients.\"\u003c/p>\n\u003cp>He points out that perhaps the tested dose wasn't high enough or that the patients' disease was too advanced to respond. By the time symptoms of Alzheimer's arise, the brain is already speckled with amyloid. Two other ongoing trials should confirm whether solanezumab is more effective in patients at risk for Alzheimer's, but who have not yet developed symptoms, he says.\u003c/p>\n\u003cp>Solanezumab, an antibody, works by attacking amyloid floating in cerebrospinal fluid. A different type of investigational medication, so-called BACE inhibitors, prevent amyloid formation in the first place, by neutralizing an enzyme that cuts away amyloid from a larger protein. Biogen's aducanumab, another experimental drug that's \u003ca href=\"http://www.npr.org/sections/health-shots/2016/08/31/491941518/test-of-experimental-alzheimers-drug-finds-progress-against-brain-plaques\">far along in clinical testing\u003c/a>, binds to and clears amyloid that is already ensnared in plaques.\u003c/p>\n\u003cp>Earlier this year the FDA granted aducanumab \u003ca href=\"http://media.biogen.com/press-release/neurodegenerative-diseases/biogens-investigational-alzheimers-disease-treatment-aduc-0\">fast-track status\u003c/a> after results from a small, early-stage study suggested that it reduces amyloid plaques and slows cognitive decline in people with very early stage disease. Those people did have amyloid deposits visible with positron emission tomography imaging. At the Clinical Trials on Alzheimer's Disease and Dementia meeting in San Diego in early December, follow-up data were \u003ca href=\"http://www.businesswire.com/news/home/20161208006320/en/Biogen-Presents-Data-Phase-1b-Study-Investigational\">presented\u003c/a> that confirmed cognitive improvement out to two years of treatment.\u003c/p>\n\u003cp>\"The good news is that there are a number of trials in progress with different anti-amyloid drugs in asymptomatic subjects; and that one failed drug doesn't mean that another won't have an effect,\" says Dr. James Burke, professor of medicine and psychiatry at Duke University's Alzheimer's Disease Research Center. \"These trials also suggest that the best chance for a significant effect on cognition is likely to be treating asymptomatic people with amyloid deposits on imaging.\"\u003c/p>\n\u003cp>Yet, Burke adds, if these trials don't show a significant clinical benefit, the focus on amyloid will likely end.\u003c/p>\n\u003cp>In any event, Weill's Isaacson feels that researchers should be looking to other options. \"I've never been a firm believer in the amyloid hypothesis being the be-all and end-all as to the cause of Alzheimer's,\" says Isaacson. \"I think it's much more complicated and there are probably many roads leading to the disease.\"\u003c/p>\n\u003cp>One such road might be to target the tau protein, which also accumulates in tangles inside the Alzheimer's-hindered brain. Another involves treating the inflammation that occurs with dementia, as the immune system attempts to clear clustered amyloid. Even simpler are dietary interventions. Mediterranean-like diets high in omega-3 fatty acids show particular promise in slowing cognitive decline.\u003c/p>\n\u003cp>As in so many other disorders, fully understanding Alzheimer's disease might ultimately entail figuring out how our bodies interact with the trillions of microbes living in our guts, or our \"microbiota.\" Research in animals and humans suggest that certain combinations of these organisms may rev up the immune system in ways that contribute to dementia. A \u003ca href=\"http://www.nature.com/articles/srep30028\">study published\u003c/a> in July in \u003cem>Scientific Reports\u003c/em> found that a long course of antibiotic treatment to alter gut flora in dementia-prone mice reduced the number and size of amyloid plaques in the brain.\u003c/p>\n\u003cp>Whether it's antibiotics, probiotics or vaccines, the list of potential Alzheimer's treatments being considered goes on.\u003c/p>\n\u003cp>\"The bottom line is we need to take more shots on goal,\" says Isaacson. \"The next frontier is recognizing that there probably isn't a one-size-fits-all approach, and that using targeted therapies based on a person's own biology and genetics will bring the most benefit. The future of Alzheimer's therapeutics is in precision medicine.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Bret Stetka is a writer based in New York and an editorial director at\u003c/em> \u003ca href=\"http://www.medscape.com/public/bios/bio-bretstetka\" target=\"_blank\">Medscape\u003c/a>. \u003cem>His work has appeared in\u003c/em> Wired\u003cem>,\u003c/em> Scientific American \u003cem>and on The Atlantic.com. He graduated from University of Virginia School of Medicine in 2005. He's also on Twitter: \u003c/em>\u003ca href=\"https://twitter.com/BretStetka\" target=\"_blank\">@BretStetka\u003c/a>.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Where+Does+Alzheimer%27s+Treatment+Go+From+Here%3F&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"excerpt": "The failure of an experimental drug that targets clumps of protein inside the brains of Alzheimer's patients called into question one of the leading theories about the cause of the dementia.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>In a disappointment to Alzheimer's patients and researchers, drugmaker Eli Lilly said last November that a clinical trial of solanezumab, an experimental medication to treat the degenerative neurological condition, had failed.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>The company has pressed on with tests of solanezumab, despite \u003ca href=\"http://www.npr.org/sections/health-shots/2012/08/24/159997459/failure-of-lilly-drug-is-latest-alzheimers-setback\">mixed results\u003c/a> in earlier studies. The latest test, involving more than 2,000 patients, found the drug didn't significantly slow cognitive decline in patients with mild dementia from Alzheimer's.\u003c/p>\n\u003cp>The sad refrain is a familiar one, unfortunately.\u003c/p>\n\u003cp>Solanezumab is just the latest casualty in a decades-long \u003ca href=\"http://alzres.biomedcentral.com/articles/10.1186/alzrt269#B13\">parade\u003c/a> of disappointing dementia drug trials. But the frustration brought by this particular failure could signal a shift in Alzheimer's research — a shift away from targeting accumulations of so-called amyloid protein in the brain, long considered by many in the field to be the crux of Alzheimer's pathology.\u003c/p>\n\u003cp>Ever since Dr. George G. Glenner's 1984 \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/6375662\">discovery\u003c/a> that amyloid is the main component of the plaques that riddle the Alzheimer's-afflicted brain, it has been assumed that the protein somehow contributes to the disorder — that it jams up cellular machinery, rendering neurons unable to effectively communicate, to form new memories, to remember where the keys are.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Like many other failed medications for symptomatic Alzheimer's, solanezumab works by attacking amyloid in the brain.\u003c/p>\n\u003cp>So in light of the new findings, is it finally time to let the amyloid theory go? The answer isn't clear.\u003c/p>\n\u003cp>\"The low magnitude of effects would lend support to the idea that it might be time to move on from amyloid,\" says Weill Cornell Medical College neurologist Dr. Richard Isaacson, who wasn't involved in the solanezumab study. \"Yet though the study failed overall, there were improvements in cognition and function in treated patients.\"\u003c/p>\n\u003cp>He points out that perhaps the tested dose wasn't high enough or that the patients' disease was too advanced to respond. By the time symptoms of Alzheimer's arise, the brain is already speckled with amyloid. Two other ongoing trials should confirm whether solanezumab is more effective in patients at risk for Alzheimer's, but who have not yet developed symptoms, he says.\u003c/p>\n\u003cp>Solanezumab, an antibody, works by attacking amyloid floating in cerebrospinal fluid. A different type of investigational medication, so-called BACE inhibitors, prevent amyloid formation in the first place, by neutralizing an enzyme that cuts away amyloid from a larger protein. Biogen's aducanumab, another experimental drug that's \u003ca href=\"http://www.npr.org/sections/health-shots/2016/08/31/491941518/test-of-experimental-alzheimers-drug-finds-progress-against-brain-plaques\">far along in clinical testing\u003c/a>, binds to and clears amyloid that is already ensnared in plaques.\u003c/p>\n\u003cp>Earlier this year the FDA granted aducanumab \u003ca href=\"http://media.biogen.com/press-release/neurodegenerative-diseases/biogens-investigational-alzheimers-disease-treatment-aduc-0\">fast-track status\u003c/a> after results from a small, early-stage study suggested that it reduces amyloid plaques and slows cognitive decline in people with very early stage disease. Those people did have amyloid deposits visible with positron emission tomography imaging. At the Clinical Trials on Alzheimer's Disease and Dementia meeting in San Diego in early December, follow-up data were \u003ca href=\"http://www.businesswire.com/news/home/20161208006320/en/Biogen-Presents-Data-Phase-1b-Study-Investigational\">presented\u003c/a> that confirmed cognitive improvement out to two years of treatment.\u003c/p>\n\u003cp>\"The good news is that there are a number of trials in progress with different anti-amyloid drugs in asymptomatic subjects; and that one failed drug doesn't mean that another won't have an effect,\" says Dr. James Burke, professor of medicine and psychiatry at Duke University's Alzheimer's Disease Research Center. \"These trials also suggest that the best chance for a significant effect on cognition is likely to be treating asymptomatic people with amyloid deposits on imaging.\"\u003c/p>\n\u003cp>Yet, Burke adds, if these trials don't show a significant clinical benefit, the focus on amyloid will likely end.\u003c/p>\n\u003cp>In any event, Weill's Isaacson feels that researchers should be looking to other options. \"I've never been a firm believer in the amyloid hypothesis being the be-all and end-all as to the cause of Alzheimer's,\" says Isaacson. \"I think it's much more complicated and there are probably many roads leading to the disease.\"\u003c/p>\n\u003cp>One such road might be to target the tau protein, which also accumulates in tangles inside the Alzheimer's-hindered brain. Another involves treating the inflammation that occurs with dementia, as the immune system attempts to clear clustered amyloid. Even simpler are dietary interventions. Mediterranean-like diets high in omega-3 fatty acids show particular promise in slowing cognitive decline.\u003c/p>\n\u003cp>As in so many other disorders, fully understanding Alzheimer's disease might ultimately entail figuring out how our bodies interact with the trillions of microbes living in our guts, or our \"microbiota.\" Research in animals and humans suggest that certain combinations of these organisms may rev up the immune system in ways that contribute to dementia. A \u003ca href=\"http://www.nature.com/articles/srep30028\">study published\u003c/a> in July in \u003cem>Scientific Reports\u003c/em> found that a long course of antibiotic treatment to alter gut flora in dementia-prone mice reduced the number and size of amyloid plaques in the brain.\u003c/p>\n\u003cp>Whether it's antibiotics, probiotics or vaccines, the list of potential Alzheimer's treatments being considered goes on.\u003c/p>\n\u003cp>\"The bottom line is we need to take more shots on goal,\" says Isaacson. \"The next frontier is recognizing that there probably isn't a one-size-fits-all approach, and that using targeted therapies based on a person's own biology and genetics will bring the most benefit. The future of Alzheimer's therapeutics is in precision medicine.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Bret Stetka is a writer based in New York and an editorial director at\u003c/em> \u003ca href=\"http://www.medscape.com/public/bios/bio-bretstetka\" target=\"_blank\">Medscape\u003c/a>. \u003cem>His work has appeared in\u003c/em> Wired\u003cem>,\u003c/em> Scientific American \u003cem>and on The Atlantic.com. He graduated from University of Virginia School of Medicine in 2005. He's also on Twitter: \u003c/em>\u003ca href=\"https://twitter.com/BretStetka\" target=\"_blank\">@BretStetka\u003c/a>.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Where+Does+Alzheimer%27s+Treatment+Go+From+Here%3F&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Most Important Genetics Stories 2016",
"title": "Most Important Genetics Stories 2016",
"headTitle": "KQED Future of You | KQED Science",
"content": "\u003cp class=\"p1\">\u003cspan class=\"s1\">Two thousand and sixteen was a big year for genetics, and there was no bigger story than everyone’s favorite gene-editing tool, \u003ca href=\"http://genetics.thetech.org/ask-a-geneticist/why-crispr-revolutionary-and-how-it-works\">CRISPR-Cas9\u003c/a>. But that wasn’t the only story: A “three-parent baby” was born in Mexico, the minimum number of genes needed for bacterial life was determined, gene drives were tentatively approved for dealing with the Zika virus, and four species of giraffes were identified based on DNA alone. And there were many more.\u003c/span>\u003c/p>\n\u003cp class=\"p1\">\u003cspan class=\"s1\">Here's the rundown of our top stories.\u003c/span>\u003c/p>\n\u003cp class=\"p1\">\u003cspan class=\"s1\">\u003cb>The Many Tales of CRISPR-Cas9\u003c/b>\u003c/span>\u003c/p>\n\u003cp class=\"p1\">For the last couple of years, there's been a lot of news about tweaking genes using the CRISPR-Cas9 system. In 2016, scientists began to use this cutting-edge gene-editing tool in earnest.\u003c/p>\n\u003cp class=\"p1\">\u003cspan class=\"s1\">Last year was the first time that CRISPR-Cas9 was \u003ca href=\"http://www.nature.com/news/crispr-gene-editing-tested-in-a-person-for-the-first-time-1.20988\">\u003cspan class=\"s2\">directly used to treat a disease\u003c/span>\u003c/a> in a patient. In late October, Dr. Lu You of Sichuan University in Chengdu, China used CRISPR-Cas9 to change the DNA in a patient’s immune cells so that these cells would attack the patient’s cancer. This approach is called immunotherapy--a \u003ca href=\"http://www.cnn.com/2016/10/26/health/immunotherapy-cancer-treatments/\">\u003cspan class=\"s2\">big story all on its own\u003c/span>\u003c/a>.\u003c/span>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp class=\"p1\">What these researchers did was to remove immune cells from the patient and knock out their PD-1 gene, which can incorrectly determine that cancer cells are not a threat. Removing the gene should theoretically help the immune cells recognize and destroy cancer cells. The researchers grew the modified cells in the lab and then injected them back into the patient. While it is too soon to know if the treatment is effective, we do know that -- so far at least-- the patient hasn't experienced any negative effects.\u003c/p>\n\u003cp class=\"p1\">\u003cspan class=\"s1\">Last year, for only the second time, \u003ca href=\"http://www.nature.com/news/second-chinese-team-reports-gene-editing-in-human-embryos-1.19718\">\u003cspan class=\"s2\">researchers “successfully” changed DNA in human embryos\u003c/span>\u003c/a> using CRISPR-Cas9. (The first time was way back in 2015.) The researchers purposely used nonviable embryos, which were not transferred into a womb.\u003c/span>\u003c/p>\n\u003cp class=\"p1\">\u003cspan class=\"s1\">The reason I included the quotation marks is that gene editing human embryos is still very much a work in progress. Only four of the 26 embryos were successfully edited. And the results were not identical even in these four; some had additional mutations in the targeted gene. \u003c/span>\u003cspan class=\"s1\">These mixed results emphasize how much more work needs to be done before editing human embryos can become routine.\u003c/span>\u003c/p>\n\u003cp class=\"p1\">\u003cspan class=\"s1\">And of course, the \u003ca href=\"https://ww2.kqed.org/futureofyou/2016/01/15/crispr-patent-war-billions-at-stake-for-uc-berkeley/\">\u003cspan class=\"s2\">CRISPR-Cas9 patent war\u003c/span>\u003c/a> between UC Berkeley and the Broad Institute of Harvard and MIT continued to rage on. Whoever wins stands to make a whole lot of money, which makes this a very nasty, ongoing battle unlikely to end soon. \u003c/span>\u003c/p>\n\u003cp>CRISPR-Cas9 even became a player in the GMO field. The \u003ca href=\"https://www.washingtonpost.com/news/speaking-of-science/wp/2016/04/18/why-this-genetically-modified-mushroom-is-bypassing-usda-regulation/?utm_term=.1af905912360\">\u003cspan class=\"s2\">FDA ruled\u003c/span>\u003c/a> that a mushroom with a gene that had been modified with CRISPR-Cas9 didn’t need to jump through the usual regulatory hoops that a genetically modified organism has to.\u003c/p>\n\u003cp class=\"p1\">\u003cspan class=\"s1\">Another big story last year, gene drives, owes its existence to CRISPR-Cas9:\u003c/span>\u003c/p>\n\u003cp class=\"p1\">\u003cspan class=\"s1\">\u003cb>Gene Drives, Mosquitoes and Zika\u003c/b>\u003c/span>\u003c/p>\n\u003cp class=\"p1\">\u003cspan class=\"s1\">Last year, the Zika virus spread like wildfire across South and Central America, leaving over 1,000 babies with the birth defect microcephaly.\u003c/span>\u003c/p>\n\u003cp class=\"p1\">\u003cspan class=\"s1\">Scientists are working on a number of ways to prevent Zika infections. The most controversial is to wipe out the mosquito that carries the virus using \u003ca href=\"http://genetics.thetech.org/driving-genes-wild\">gene drives\u003c/a>. \u003c/span>\u003c/p>\n\u003cp class=\"p1\">\u003cspan class=\"s1\">Gene drives use CRISPR-Cas9 to quickly and easily spread a harmful gene through a population. In this case the idea would be to destroy the population of mosquitoes that carry the Zika virus. \u003c/span>\u003c/p>\n\u003cp class=\"p1\">This method was given \u003ca href=\"http://www.forbes.com/sites/robertglatter/2016/03/14/fda-grants-tentative-approval-for-gmo-mosquito-trial-in-florida-keys/\">\u003cspan class=\"s2\">tentative approval by the FDA\u003c/span>\u003c/a> back in March 2016, but it has not yet been used, as\u003ca href=\"http://blogs.plos.org/scicomm/2016/11/09/as-florida-voters-are-asked-to-weigh-in-on-a-gm-mosquito-field-trial-where-is-and-isnt-the-science-of-zika-virus-control/\"> many Florida residents strongly oppose it\u003c/a>.\u003c/p>\n\u003cp class=\"p1\">Gene drives were mostly theoretical until CRISPR-Cas9 came along to make them a relatively simple thing to make. In fact, so simple that a group of undergraduate students \u003ca href=\"http://gizmodo.com/college-students-show-how-easy-it-is-to-use-terrifying-1790526457\">\u003cspan class=\"s2\">nearly pulled it off\u003c/span>\u003c/a> at the end of 2016.\u003c/p>\n\u003cp class=\"p1\">\u003cb>Child With Three Parents\u003c/b>\u003c/p>\n\u003cp class=\"p1\">\u003cspan class=\"s1\">In 2015, a big controversy swirled around whether to \u003ca href=\"http://genetics.thetech.org/ask/ask70\">\u003cspan class=\"s2\">restart\u003c/span>\u003c/a> a genetic technique that allows some women who carry mitochondrial diseases to have children without passing them on to their kids. In 2016 \u003ca href=\"https://www.newscientist.com/article/2107219-exclusive-worlds-first-baby-born-with-new-3-parent-technique/\">\u003cspan class=\"s2\">a healthy baby boy was born\u003c/span>\u003c/a> in Mexico using this technique.\u003c/span>\u003c/p>\n\u003cp>The technique is controversial for a couple of reasons. First, any girls born will pass their genetically engineered DNA down to their children. This has always been an ethics no-fly zone, as the feeling is that whatever genetic modification we make in a person should stay in that person. Because the woman in Mexico had a son, the issue was sidestepped.\u003c/p>\n\u003cp class=\"p1\">\u003cspan class=\"s1\">The other controversy is that this boy has DNA from three people instead of the usual two. \u003c/span>\u003c/p>\n\u003cfigure id=\"attachment_316963\" class=\"wp-caption aligncenter\" style=\"max-width: 500px\">\u003cimg class=\"wp-image-316963 size-full\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/01/3parent.jpg\" alt=\"This egg is now fertilized with dad's sperm.\" width=\"500\" height=\"335\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/01/3parent.jpg 500w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/3parent-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/3parent-240x161.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/3parent-375x251.jpg 375w\" sizes=\"(max-width: 500px) 100vw, 500px\">\u003cfigcaption class=\"wp-caption-text\">This egg is now fertilized with dad's sperm. (Image by Barry Starr)\u003c/figcaption>\u003c/figure>\n\u003cp class=\"p1\">The child has mitochondria, and thus mitochondrial DNA, from the donor, along with DNA from his mom and dad. (Mitochondria are the organelles that supply our cells with energy; they have a bit of DNA all their own.) Although this is referred to as having three parents, that might be a bit of an overstatement. After all, s\u003cspan class=\"s1\">omething like 1/300,000\u003c/span>\u003cspan class=\"s3\">\u003csup>th\u003c/sup>\u003c/span>\u003cspan class=\"s1\"> of the child's DNA comes from the donor, with the rest coming from the mother and father. 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This is the bare bones machinery needed to keep a bacterium going.\u003c/span>\u003c/p>\n\u003cp class=\"p1\">\u003cspan class=\"s1\">What is cool is that we would not have been able to predict that these were the 473 a bacterium would need. We don’t even know what 143 of them do... .\u003c/span>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp class=\"p1\">Genetics is bound to be a hot topic in 2017 as well. Stay tuned.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp class=\"p1\">\u003cspan class=\"s1\">Two thousand and sixteen was a big year for genetics, and there was no bigger story than everyone’s favorite gene-editing tool, \u003ca href=\"http://genetics.thetech.org/ask-a-geneticist/why-crispr-revolutionary-and-how-it-works\">CRISPR-Cas9\u003c/a>. But that wasn’t the only story: A “three-parent baby” was born in Mexico, the minimum number of genes needed for bacterial life was determined, gene drives were tentatively approved for dealing with the Zika virus, and four species of giraffes were identified based on DNA alone. And there were many more.\u003c/span>\u003c/p>\n\u003cp class=\"p1\">\u003cspan class=\"s1\">Here's the rundown of our top stories.\u003c/span>\u003c/p>\n\u003cp class=\"p1\">\u003cspan class=\"s1\">\u003cb>The Many Tales of CRISPR-Cas9\u003c/b>\u003c/span>\u003c/p>\n\u003cp class=\"p1\">For the last couple of years, there's been a lot of news about tweaking genes using the CRISPR-Cas9 system. In 2016, scientists began to use this cutting-edge gene-editing tool in earnest.\u003c/p>\n\u003cp class=\"p1\">\u003cspan class=\"s1\">Last year was the first time that CRISPR-Cas9 was \u003ca href=\"http://www.nature.com/news/crispr-gene-editing-tested-in-a-person-for-the-first-time-1.20988\">\u003cspan class=\"s2\">directly used to treat a disease\u003c/span>\u003c/a> in a patient. In late October, Dr. Lu You of Sichuan University in Chengdu, China used CRISPR-Cas9 to change the DNA in a patient’s immune cells so that these cells would attack the patient’s cancer. This approach is called immunotherapy--a \u003ca href=\"http://www.cnn.com/2016/10/26/health/immunotherapy-cancer-treatments/\">\u003cspan class=\"s2\">big story all on its own\u003c/span>\u003c/a>.\u003c/span>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp class=\"p1\">What these researchers did was to remove immune cells from the patient and knock out their PD-1 gene, which can incorrectly determine that cancer cells are not a threat. Removing the gene should theoretically help the immune cells recognize and destroy cancer cells. The researchers grew the modified cells in the lab and then injected them back into the patient. While it is too soon to know if the treatment is effective, we do know that -- so far at least-- the patient hasn't experienced any negative effects.\u003c/p>\n\u003cp class=\"p1\">\u003cspan class=\"s1\">Last year, for only the second time, \u003ca href=\"http://www.nature.com/news/second-chinese-team-reports-gene-editing-in-human-embryos-1.19718\">\u003cspan class=\"s2\">researchers “successfully” changed DNA in human embryos\u003c/span>\u003c/a> using CRISPR-Cas9. (The first time was way back in 2015.) The researchers purposely used nonviable embryos, which were not transferred into a womb.\u003c/span>\u003c/p>\n\u003cp class=\"p1\">\u003cspan class=\"s1\">The reason I included the quotation marks is that gene editing human embryos is still very much a work in progress. Only four of the 26 embryos were successfully edited. And the results were not identical even in these four; some had additional mutations in the targeted gene. \u003c/span>\u003cspan class=\"s1\">These mixed results emphasize how much more work needs to be done before editing human embryos can become routine.\u003c/span>\u003c/p>\n\u003cp class=\"p1\">\u003cspan class=\"s1\">And of course, the \u003ca href=\"https://ww2.kqed.org/futureofyou/2016/01/15/crispr-patent-war-billions-at-stake-for-uc-berkeley/\">\u003cspan class=\"s2\">CRISPR-Cas9 patent war\u003c/span>\u003c/a> between UC Berkeley and the Broad Institute of Harvard and MIT continued to rage on. Whoever wins stands to make a whole lot of money, which makes this a very nasty, ongoing battle unlikely to end soon. \u003c/span>\u003c/p>\n\u003cp>CRISPR-Cas9 even became a player in the GMO field. The \u003ca href=\"https://www.washingtonpost.com/news/speaking-of-science/wp/2016/04/18/why-this-genetically-modified-mushroom-is-bypassing-usda-regulation/?utm_term=.1af905912360\">\u003cspan class=\"s2\">FDA ruled\u003c/span>\u003c/a> that a mushroom with a gene that had been modified with CRISPR-Cas9 didn’t need to jump through the usual regulatory hoops that a genetically modified organism has to.\u003c/p>\n\u003cp class=\"p1\">\u003cspan class=\"s1\">Another big story last year, gene drives, owes its existence to CRISPR-Cas9:\u003c/span>\u003c/p>\n\u003cp class=\"p1\">\u003cspan class=\"s1\">\u003cb>Gene Drives, Mosquitoes and Zika\u003c/b>\u003c/span>\u003c/p>\n\u003cp class=\"p1\">\u003cspan class=\"s1\">Last year, the Zika virus spread like wildfire across South and Central America, leaving over 1,000 babies with the birth defect microcephaly.\u003c/span>\u003c/p>\n\u003cp class=\"p1\">\u003cspan class=\"s1\">Scientists are working on a number of ways to prevent Zika infections. The most controversial is to wipe out the mosquito that carries the virus using \u003ca href=\"http://genetics.thetech.org/driving-genes-wild\">gene drives\u003c/a>. \u003c/span>\u003c/p>\n\u003cp class=\"p1\">\u003cspan class=\"s1\">Gene drives use CRISPR-Cas9 to quickly and easily spread a harmful gene through a population. In this case the idea would be to destroy the population of mosquitoes that carry the Zika virus. \u003c/span>\u003c/p>\n\u003cp class=\"p1\">This method was given \u003ca href=\"http://www.forbes.com/sites/robertglatter/2016/03/14/fda-grants-tentative-approval-for-gmo-mosquito-trial-in-florida-keys/\">\u003cspan class=\"s2\">tentative approval by the FDA\u003c/span>\u003c/a> back in March 2016, but it has not yet been used, as\u003ca href=\"http://blogs.plos.org/scicomm/2016/11/09/as-florida-voters-are-asked-to-weigh-in-on-a-gm-mosquito-field-trial-where-is-and-isnt-the-science-of-zika-virus-control/\"> many Florida residents strongly oppose it\u003c/a>.\u003c/p>\n\u003cp class=\"p1\">Gene drives were mostly theoretical until CRISPR-Cas9 came along to make them a relatively simple thing to make. In fact, so simple that a group of undergraduate students \u003ca href=\"http://gizmodo.com/college-students-show-how-easy-it-is-to-use-terrifying-1790526457\">\u003cspan class=\"s2\">nearly pulled it off\u003c/span>\u003c/a> at the end of 2016.\u003c/p>\n\u003cp class=\"p1\">\u003cb>Child With Three Parents\u003c/b>\u003c/p>\n\u003cp class=\"p1\">\u003cspan class=\"s1\">In 2015, a big controversy swirled around whether to \u003ca href=\"http://genetics.thetech.org/ask/ask70\">\u003cspan class=\"s2\">restart\u003c/span>\u003c/a> a genetic technique that allows some women who carry mitochondrial diseases to have children without passing them on to their kids. In 2016 \u003ca href=\"https://www.newscientist.com/article/2107219-exclusive-worlds-first-baby-born-with-new-3-parent-technique/\">\u003cspan class=\"s2\">a healthy baby boy was born\u003c/span>\u003c/a> in Mexico using this technique.\u003c/span>\u003c/p>\n\u003cp>The technique is controversial for a couple of reasons. First, any girls born will pass their genetically engineered DNA down to their children. This has always been an ethics no-fly zone, as the feeling is that whatever genetic modification we make in a person should stay in that person. Because the woman in Mexico had a son, the issue was sidestepped.\u003c/p>\n\u003cp class=\"p1\">\u003cspan class=\"s1\">The other controversy is that this boy has DNA from three people instead of the usual two. \u003c/span>\u003c/p>\n\u003cfigure id=\"attachment_316963\" class=\"wp-caption aligncenter\" style=\"max-width: 500px\">\u003cimg class=\"wp-image-316963 size-full\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/01/3parent.jpg\" alt=\"This egg is now fertilized with dad's sperm.\" width=\"500\" height=\"335\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/01/3parent.jpg 500w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/3parent-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/3parent-240x161.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/3parent-375x251.jpg 375w\" sizes=\"(max-width: 500px) 100vw, 500px\">\u003cfigcaption class=\"wp-caption-text\">This egg is now fertilized with dad's sperm. (Image by Barry Starr)\u003c/figcaption>\u003c/figure>\n\u003cp class=\"p1\">The child has mitochondria, and thus mitochondrial DNA, from the donor, along with DNA from his mom and dad. (Mitochondria are the organelles that supply our cells with energy; they have a bit of DNA all their own.) Although this is referred to as having three parents, that might be a bit of an overstatement. After all, s\u003cspan class=\"s1\">omething like 1/300,000\u003c/span>\u003cspan class=\"s3\">\u003csup>th\u003c/sup>\u003c/span>\u003cspan class=\"s1\"> of the child's DNA comes from the donor, with the rest coming from the mother and father. If the donor is a parent, she is a very minor one indeed.\u003c/span>\u003c/p>\n\u003cp class=\"p1\">\u003cb>The Edge of Life\u003c/b>\u003c/p>\n\u003cp class=\"p1\">\u003cspan class=\"s1\">With the exception of viruses, most life has evolved with a thousand or more genes.Humans have somewhere around 22,000 genes; the humble yeast that gives beer and wine its alcohol has around 6,000; and the bacterium with the fewest known number of genes has 901.\u003c/span>\u003c/p>\n\u003cp class=\"p1\">\u003cspan class=\"s1\">In 2016 a group of researchers was able to show that this last bacterium could get by \u003ca href=\"https://www.sciencenews.org/article/scientists-build-minimum-genome-bacterium\">\u003cspan class=\"s2\">with only 473 genes\u003c/span>\u003c/a>. This is the bare bones machinery needed to keep a bacterium going.\u003c/span>\u003c/p>\n\u003cp class=\"p1\">\u003cspan class=\"s1\">What is cool is that we would not have been able to predict that these were the 473 a bacterium would need. We don’t even know what 143 of them do... .\u003c/span>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp class=\"p1\">Genetics is bound to be a hot topic in 2017 as well. Stay tuned.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Vice President Joe Biden is outlining how he intends to pursue his \"cancer moonshot\" agenda after he leaves office next week.\u003c/p>\n\u003cp>[contextly_sidebar id=\"fXg9Yi3NNbgCtbEglpi4NJfWUuSjRQHo\"]The vice president, speaking at the J.P. Morgan Healthcare Conference in San Francisco, Monday, said cancer is a bipartisan issue, and he offered to help the next administration carry on his mission to end the deadly disease. But he said he will also create an organization called the Biden Cancer Initiative; the primary focus will be collaboration between scientists so that research will be widely shared across specialties.\u003c/p>\n\u003cp>“Virologists, geneticists, chemical and biological engineers -- they weren’t all working in unison, but today we’ve reached an inflection point ... and the promise is enormous,\" Biden said.\u003c/p>\n\u003cp>Biden said the initiative will also concentrate on improving data standards to help researchers, work with community care organizations to improve access, and push pharmaceutical companies, insurance providers and biotech companies to make sure patients can afford treatments.\u003c/p>\n\u003cp>The subject hits home for the vice president, whose son, former Delaware Attorney General Beau Biden, died of brain cancer in May 2015.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\u003cp>\u003c/p>\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Vice President Joe Biden is outlining how he intends to pursue his \"cancer moonshot\" agenda after he leaves office next week.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>The vice president, speaking at the J.P. Morgan Healthcare Conference in San Francisco, Monday, said cancer is a bipartisan issue, and he offered to help the next administration carry on his mission to end the deadly disease. But he said he will also create an organization called the Biden Cancer Initiative; the primary focus will be collaboration between scientists so that research will be widely shared across specialties.\u003c/p>\n\u003cp>“Virologists, geneticists, chemical and biological engineers -- they weren’t all working in unison, but today we’ve reached an inflection point ... and the promise is enormous,\" Biden said.\u003c/p>\n\u003cp>Biden said the initiative will also concentrate on improving data standards to help researchers, work with community care organizations to improve access, and push pharmaceutical companies, insurance providers and biotech companies to make sure patients can afford treatments.\u003c/p>\n\u003cp>The subject hits home for the vice president, whose son, former Delaware Attorney General Beau Biden, died of brain cancer in May 2015.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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}
},
"baycurious": {
"id": "baycurious",
"title": "Bay Curious",
"tagline": "Exploring the Bay Area, one question at a time",
"info": "KQED’s new podcast, Bay Curious, gets to the bottom of the mysteries — both profound and peculiar — that give the Bay Area its unique identity. And we’ll do it with your help! You ask the questions. You decide what Bay Curious investigates. And you join us on the journey to find the answers.",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Bay-Curious-Podcast-Tile-703x703-1.jpg",
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"officialWebsiteLink": "/news/series/baycurious",
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"source": "kqed",
"order": 3
},
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"npr": "https://www.npr.org/podcasts/500557090/bay-curious",
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}
},
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"id": "bbc-world-service",
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"info": "The day's top stories from BBC News compiled twice daily in the week, once at weekends.",
"airtime": "MON-FRI 9pm-10pm, TUE-FRI 1am-2am",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/BBC-World-Service-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.bbc.co.uk/sounds/play/live:bbc_world_service",
"meta": {
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"source": "BBC World Service"
},
"link": "/radio/program/bbc-world-service",
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"apple": "https://itunes.apple.com/us/podcast/global-news-podcast/id135067274?mt=2",
"tuneIn": "https://tunein.com/radio/BBC-World-Service-p455581/",
"rss": "https://podcasts.files.bbci.co.uk/p02nq0gn.rss"
}
},
"californiareport": {
"id": "californiareport",
"title": "The California Report",
"tagline": "California, day by day",
"info": "KQED’s statewide radio news program providing daily coverage of issues, trends and public policy decisions.",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/The-California-Report-Podcast-Tile-703x703-1.jpg",
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"officialWebsiteLink": "/californiareport",
"meta": {
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"source": "kqed",
"order": 8
},
"link": "/californiareport",
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"amazon": "https://music.amazon.com/podcasts/26099305-72af-4542-9dde-ac1807fe36d5/kqed-s-the-california-report",
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}
},
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"title": "The California Report Magazine",
"tagline": "Your state, your stories",
"info": "Every week, The California Report Magazine takes you on a road trip for the ears: to visit the places and meet the people who make California unique. The in-depth storytelling podcast from the California Report.",
"airtime": "FRI 4:30pm-5pm, 6:30pm-7pm, 11pm-11:30pm",
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"officialWebsiteLink": "/californiareportmagazine",
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"order": 10
},
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM3NjkwNjk1OTAz",
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},
"city-arts": {
"id": "city-arts",
"title": "City Arts & Lectures",
"info": "A one-hour radio program to hear celebrated writers, artists and thinkers address contemporary ideas and values, often discussing the creative process. Please note: tapes or transcripts are not available",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/05/cityartsandlecture-300x300.jpg",
"officialWebsiteLink": "https://www.cityarts.net/",
"airtime": "SUN 1pm-2pm, TUE 10pm, WED 1am",
"meta": {
"site": "news",
"source": "City Arts & Lectures"
},
"link": "https://www.cityarts.net",
"subscribe": {
"tuneIn": "https://tunein.com/radio/City-Arts-and-Lectures-p692/",
"rss": "https://www.cityarts.net/feed/"
}
},
"closealltabs": {
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"officialWebsiteLink": "/podcasts/closealltabs",
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"source": "kqed",
"order": 1
},
"link": "/podcasts/closealltabs",
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"title": "Code Switch / Life Kit",
"info": "\u003cem>Code Switch\u003c/em>, which listeners will hear in the first part of the hour, has fearless and much-needed conversations about race. Hosted by journalists of color, the show tackles the subject of race head-on, exploring how it impacts every part of society — from politics and pop culture to history, sports and more.\u003cbr />\u003cbr />\u003cem>Life Kit\u003c/em>, which will be in the second part of the hour, guides you through spaces and feelings no one prepares you for — from finances to mental health, from workplace microaggressions to imposter syndrome, from relationships to parenting. The show features experts with real world experience and shares their knowledge. Because everyone needs a little help being human.\u003cbr />\u003cbr />\u003ca href=\"https://www.npr.org/podcasts/510312/codeswitch\">\u003cem>Code Switch\u003c/em> offical site and podcast\u003c/a>\u003cbr />\u003ca href=\"https://www.npr.org/lifekit\">\u003cem>Life Kit\u003c/em> offical site and podcast\u003c/a>\u003cbr />",
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"meta": {
"site": "radio",
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},
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"id": "commonwealth-club",
"title": "Commonwealth Club of California Podcast",
"info": "The Commonwealth Club of California is the nation's oldest and largest public affairs forum. As a non-partisan forum, The Club brings to the public airwaves diverse viewpoints on important topics. The Club's weekly radio broadcast - the oldest in the U.S., dating back to 1924 - is carried across the nation on public radio stations and is now podcasting. Our website archive features audio of our recent programs, as well as selected speeches from our long and distinguished history. This podcast feed is usually updated twice a week and is always un-edited.",
"airtime": "THU 10pm, FRI 1am",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Commonwealth-Club-Podcast-Tile-360x360-1.jpg",
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"meta": {
"site": "news",
"source": "Commonwealth Club of California"
},
"link": "/radio/program/commonwealth-club",
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"apple": "https://itunes.apple.com/us/podcast/commonwealth-club-of-california-podcast/id976334034?mt=2",
"google": "https://podcasts.google.com/feed/aHR0cDovL3d3dy5jb21tb253ZWFsdGhjbHViLm9yZy9hdWRpby9wb2RjYXN0L3dlZWtseS54bWw",
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}
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"id": "forum",
"title": "Forum",
"tagline": "The conversation starts here",
"info": "KQED’s live call-in program discussing local, state, national and international issues, as well as in-depth interviews.",
"airtime": "MON-FRI 9am-11am, 10pm-11pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Forum-Podcast-Tile-703x703-1.jpg",
"imageAlt": "KQED Forum with Mina Kim and Alexis Madrigal",
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"meta": {
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"source": "kqed",
"order": 9
},
"link": "/forum",
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM5NTU3MzgxNjMz",
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"freakonomics-radio": {
"id": "freakonomics-radio",
"title": "Freakonomics Radio",
"info": "Freakonomics Radio is a one-hour award-winning podcast and public-radio project hosted by Stephen Dubner, with co-author Steve Levitt as a regular guest. It is produced in partnership with WNYC.",
"imageSrc": "https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/05/freakonomicsRadio.png",
"officialWebsiteLink": "http://freakonomics.com/",
"airtime": "SUN 1am-2am, SAT 3pm-4pm",
"meta": {
"site": "radio",
"source": "WNYC"
},
"link": "/radio/program/freakonomics-radio",
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"apple": "https://itunes.apple.com/us/podcast/freakonomics-radio/id354668519",
"tuneIn": "https://tunein.com/podcasts/WNYC-Podcasts/Freakonomics-Radio-p272293/",
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},
"fresh-air": {
"id": "fresh-air",
"title": "Fresh Air",
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"link": "/radio/program/fresh-air",
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"apple": "https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=214089682&at=11l79Y&ct=nprdirectory",
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"rss": "https://feeds.npr.org/381444908/podcast.xml"
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"info": "A live production of NPR and WBUR Boston, in collaboration with stations across the country, Here & Now reflects the fluid world of news as it's happening in the middle of the day, with timely, in-depth news, interviews and conversation. Hosted by Robin Young, Jeremy Hobson and Tonya Mosley.",
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"rss": "https://feeds.npr.org/510051/podcast.xml"
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},
"hidden-brain": {
"id": "hidden-brain",
"title": "Hidden Brain",
"info": "Shankar Vedantam uses science and storytelling to reveal the unconscious patterns that drive human behavior, shape our choices and direct our relationships.",
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"officialWebsiteLink": "https://www.npr.org/series/423302056/hidden-brain",
"airtime": "SUN 7pm-8pm",
"meta": {
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"source": "NPR"
},
"link": "/radio/program/hidden-brain",
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},
"how-i-built-this": {
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"title": "How I Built This with Guy Raz",
"info": "Guy Raz dives into the stories behind some of the world's best known companies. How I Built This weaves a narrative journey about innovators, entrepreneurs and idealists—and the movements they built.",
"imageSrc": "https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/05/howIBuiltThis.png",
"officialWebsiteLink": "https://www.npr.org/podcasts/510313/how-i-built-this",
"airtime": "SUN 7:30pm-8pm",
"meta": {
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"source": "npr"
},
"link": "/radio/program/how-i-built-this",
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"apple": "https://itunes.apple.com/us/podcast/how-i-built-this-with-guy-raz/id1150510297?mt=2",
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},
"hyphenacion": {
"id": "hyphenacion",
"title": "Hyphenación",
"tagline": "Where conversation and cultura meet",
"info": "What kind of no sabo word is Hyphenación? For us, it’s about living within a hyphenation. Like being a third-gen Mexican-American from the Texas border now living that Bay Area Chicano life. Like Xorje! Each week we bring together a couple of hyphenated Latinos to talk all about personal life choices: family, careers, relationships, belonging … everything is on the table. ",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2025/03/Hyphenacion_FinalAssets_PodcastTile.png",
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"officialWebsiteLink": "/podcasts/hyphenacion",
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"order": 15
},
"link": "/podcasts/hyphenacion",
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},
"jerrybrown": {
"id": "jerrybrown",
"title": "The Political Mind of Jerry Brown",
"tagline": "Lessons from a lifetime in politics",
"info": "The Political Mind of Jerry Brown brings listeners the wisdom of the former Governor, Mayor, and presidential candidate. Scott Shafer interviewed Brown for more than 40 hours, covering the former governor's life and half-century in the political game – and Brown has some lessons he'd like to share. ",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/The-Political-Mind-of-Jerry-Brown-Podcast-Tile-703x703-1.jpg",
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"officialWebsiteLink": "/podcasts/jerrybrown",
"meta": {
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"source": "kqed",
"order": 18
},
"link": "/podcasts/jerrybrown",
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"apple": "https://itunes.apple.com/us/podcast/id1492194549",
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}
},
"latino-usa": {
"id": "latino-usa",
"title": "Latino USA",
"airtime": "MON 1am-2am, SUN 6pm-7pm",
"info": "Latino USA, the radio journal of news and culture, is the only national, English-language radio program produced from a Latino perspective.",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/latinoUsa.jpg",
"officialWebsiteLink": "http://latinousa.org/",
"meta": {
"site": "news",
"source": "npr"
},
"link": "/radio/program/latino-usa",
"subscribe": {
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"apple": "https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=79681317&at=11l79Y&ct=nprdirectory",
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"rss": "https://feeds.npr.org/510016/podcast.xml"
}
},
"marketplace": {
"id": "marketplace",
"title": "Marketplace",
"info": "Our flagship program, helmed by Kai Ryssdal, examines what the day in money delivered, through stories, conversations, newsworthy numbers and more. Updated Monday through Friday at about 3:30 p.m. PT.",
"airtime": "MON-FRI 4pm-4:30pm, MON-WED 6:30pm-7pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Marketplace-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.marketplace.org/",
"meta": {
"site": "news",
"source": "American Public Media"
},
"link": "/radio/program/marketplace",
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"rss": "https://feeds.publicradio.org/public_feeds/marketplace-pm/rss/rss"
}
},
"masters-of-scale": {
"id": "masters-of-scale",
"title": "Masters of Scale",
"info": "Masters of Scale is an original podcast in which LinkedIn co-founder and Greylock Partner Reid Hoffman sets out to describe and prove theories that explain how great entrepreneurs take their companies from zero to a gazillion in ingenious fashion.",
"airtime": "Every other Wednesday June 12 through October 16 at 8pm (repeats Thursdays at 2am)",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Masters-of-Scale-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://mastersofscale.com/",
"meta": {
"site": "radio",
"source": "WaitWhat"
},
"link": "/radio/program/masters-of-scale",
"subscribe": {
"apple": "http://mastersofscale.app.link/",
"rss": "https://rss.art19.com/masters-of-scale"
}
},
"mindshift": {
"id": "mindshift",
"title": "MindShift",
"tagline": "A podcast about the future of learning and how we raise our kids",
"info": "The MindShift podcast explores the innovations in education that are shaping how kids learn. Hosts Ki Sung and Katrina Schwartz introduce listeners to educators, researchers, parents and students who are developing effective ways to improve how kids learn. We cover topics like how fed-up administrators are developing surprising tactics to deal with classroom disruptions; how listening to podcasts are helping kids develop reading skills; the consequences of overparenting; and why interdisciplinary learning can engage students on all ends of the traditional achievement spectrum. This podcast is part of the MindShift education site, a division of KQED News. KQED is an NPR/PBS member station based in San Francisco. You can also visit the MindShift website for episodes and supplemental blog posts or tweet us \u003ca href=\"https://twitter.com/MindShiftKQED\">@MindShiftKQED\u003c/a> or visit us at \u003ca href=\"/mindshift\">MindShift.KQED.org\u003c/a>",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Mindshift-Podcast-Tile-703x703-1.jpg",
"imageAlt": "KQED MindShift: How We Will Learn",
"officialWebsiteLink": "/mindshift/",
"meta": {
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"source": "kqed",
"order": 12
},
"link": "/podcasts/mindshift",
"subscribe": {
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM1NzY0NjAwNDI5",
"npr": "https://www.npr.org/podcasts/464615685/mind-shift-podcast",
"stitcher": "https://www.stitcher.com/podcast/kqed/stories-teachers-share",
"spotify": "https://open.spotify.com/show/0MxSpNYZKNprFLCl7eEtyx"
}
},
"morning-edition": {
"id": "morning-edition",
"title": "Morning Edition",
"info": "\u003cem>Morning Edition\u003c/em> takes listeners around the country and the world with multi-faceted stories and commentaries every weekday. Hosts Steve Inskeep, David Greene and Rachel Martin bring you the latest breaking news and features to prepare you for the day.",
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