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"disqusTitle": "Facebook Blues: How You Use the Site Can Make You Depressed, Say Researchers",
"title": "Facebook Blues: How You Use the Site Can Make You Depressed, Say Researchers",
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"content": "\u003cp>Researchers, at least, love Facebook.\u003c/p>\n\u003cp>A \u003ca href=\"http://00t0holtgrav.iweb.bsu.edu/492/Perspectives%20on%20Psychological%20Science-2012-Wilson-203-20.pdf\">\u003cspan style=\"font-weight: 400\">2012 survey\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> of social science papers related to the social network turned up 412 separate studies. One of the most popular questions: What effect does Facebook have \u003c/span>\u003cspan style=\"font-weight: 400\">on emotional states? \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">As it turns out, it's complicated.\u003c/span>\u003c/p>\n\u003caside class=\"pullquote alignright\">Roughly 22 percent of the world's population use Facebook an average of 50 minutes per day. Is all this interconnectedness creating psychological benefits or global gloom?\u003c/aside>\n\u003cp>\u003cspan style=\"font-weight: 400\">I experienced this myself around Thanksgiving of 2008, when I first joined up. For a week or so, I marveled at Facebook's ability to connect me to people who had long ago faded into the remotest recesses of memory.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">By Christmas, I was in the midst of a full-fledged metaphysical breakdown. \u003c/span>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Those scrolls down memory lane were killing me. Better to have left that kid from third grade, who now liked to post videos of his weightlifting triumphs, a I last remembered him--a skinny punk banging a double off the schoolyard fence.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">It was the collapse of that natural partition between past and present that was upsetting. A few months in, after noting the male-pattern baldness of yet another long-lost pal, I figured out why:\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Facebook had punctured the intransigently juvenile aspect of my personality that refused to recognize the \u003c/span>\u003ci>\u003cspan style=\"font-weight: 400\">passage of time.\u003c/span>\u003c/i>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">And that, of course, provided yet another piece of evidence for the harshest reality of our existence: That we are all going to die.\u003c/span>\u003c/p>\n\u003cp>\u003cstrong>50 Minutes a Day\u003c/strong>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Okay, that was \u003c/span>\u003ci>\u003cspan style=\"font-weight: 400\">my\u003c/span>\u003c/i>\u003cspan style=\"font-weight: 400\"> Facebook freakout—how about yours?\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Start asking around, and lots of folks will volunteer one resentment or another. They don’t like the time they spend on Facebook. Or they don’t like the way people communicate on Facebook. Or they just don’t like \u003c/span>\u003ci>\u003cspan style=\"font-weight: 400\">Facebook\u003c/span>\u003c/i>\u003cspan style=\"font-weight: 400\">. As Laurence Scott wrote in his recent book on digital life, \u003c/span>\u003ca href=\"https://ww2.kqed.org/futureofyou/2016/08/23/the-online-life-as-both-liberation-and-imprisonment/\">\u003cspan style=\"font-weight: 400\">The Four-Dimensional Human\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">, “Everyone knows someone perpetually on the brink of quitting” the site. \u003c/span>\u003c/p>\n\u003caside class=\"pullquote alignright\">'Facebook use may constitute a unique form of social network interaction that predicts impoverished well-being,' says one study.\u003c/aside>\n\u003cp>\u003cspan style=\"font-weight: 400\">Yet, whatever gripes people have, they aren’t hurting business. People use Facebook so much it \u003c/span>\u003ca href=\"http://www.nytimes.com/2016/05/06/business/facebook-bends-the-rules-of-audience-engagement-to-its-advantage.html\">\u003cspan style=\"font-weight: 400\">boggled the mind\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> of The New York Times’ James B. Stewart. After reporting in May on the 50 daily minutes Facebook says users spend on its main site, instant messaging application and Instagram property, he noted that amount beat out all other leisure activities save one. Still the king: Watching TV.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Facebook says it has 1.65 billion active users, which is roughly 22 percent of the world’s population. Given the expanding role it plays in so many lives, it’s not surprising the site has been laden with a surfeit of social and political significance, credited with everything from a \u003c/span>\u003ca href=\"http://wjla.com/news/nation-world/facebook-adultery-trend-rising-as-people-find-long-lost-flings-76049\">\u003cspan style=\"font-weight: 400\">rise in adultery\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> to the \u003c/span>\u003ca href=\"https://www.google.com/search?q=facebook+arab+spring\">\u003cspan style=\"font-weight: 400\">toppling of autocratic regimes\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">.\u003c/span>\u003c/p>\n\u003cp>\u003cstrong>Hazardous to Your Mental Health?\u003c/strong>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Dr. Ethan Kross, the director of the Emotion & Self Control Lab at the University of Michigan who has co-authored several papers on Facebook, says the early research was “all over the place” as to whether using the site boosted or depressed a person’s mental state.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">But it's the research finding a \u003c/span>\u003ca href=\"http://nymag.com/thecut/2016/05/moms-who-post-on-facebook-are-more-depressed.html\">\u003cspan style=\"font-weight: 400\">correlation\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> between Facebook and \u003c/span>\u003ca href=\"https://techcrunch.com/2015/02/03/study-facebook-can-cause-depression/\">\u003cspan style=\"font-weight: 400\">feeling lousy\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> that has drawn the \u003ca href=\"https://www.google.com/search?q=facebook+depression\" target=\"_blank\">attention of the media\u003c/a>. And to be sure, the literature is replete with ominous titles that appear to have been written half by scientists, half by university press offices. Titles like: \u003c/span>\u003cspan style=\"font-weight: 400\">“\u003c/span>\u003ca href=\"https://www.semanticscholar.org/paper/-They-Are-Happier-and-Having-Better-Lives-than-I-Chou-Edge/8ec2a88e39453b50ada493a79371b03be15a5299/pdf\">\u003cspan style=\"font-weight: 400\">They Are Happier and Having Better Lives Than I Am: The Impact of Using Facebook on Perceptions of Others’ Lives.”\u003c/span>\u003c/a>\u003c/p>\n\u003caside class=\"pullquote alignright\">\"I’ve had friends call me and say, ‘Your life looks so amazing.' And I tell them, ‘I’m a marketer. I’m only posting the moments that are amazing.’”\u003ccite>Randi Zuckerberg, sister of Mark, in 2013\u003c/cite>\u003c/aside>\n\u003cp>\u003cspan style=\"font-weight: 400\">This type of research is fueling a growing sense that spending \u003c/span>\u003ca href=\"https://ww2.kqed.org/futureofyou/2016/04/20/screenagers-shows-parents-overwhelmed-by-kids-phone-computer-use/\">\u003cspan style=\"font-weight: 400\">too much time online\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> is emotionally perilous. A \u003c/span>\u003ca href=\"http://www.upmc.com/media/NewsReleases/2016/Pages/lin-primack-sm-depression.aspx\">\u003cspan style=\"font-weight: 400\">study\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> \u003c/span>\u003ca href=\"http://www.cnet.com/news/heavy-facebook-twitter-users-3-times-more-likely-to-be-depressed/\">\u003cspan style=\"font-weight: 400\">making headlines \u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">this spring looked at the relationship between social media use and depression. University of Pittsburgh researchers sampled 1,787 U.S. adults, ages 19 through 32, and found an almost 300 percent greater likelihood of depression in the most active users of sites like Facebook, Twitter and Reddit than in those who used them the least.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">You wonder how Facebook feels about research that basically communicates its product is a mental hazard. A spokesperson for the company pointed me to a \u003c/span>\u003ca href=\"https://research.facebook.com/publications/internet-use-and-psychological-well-being-effects-of-activity-and-audience/\">\u003cspan style=\"font-weight: 400\">meta-analysis\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> it had collaborated on with two researchers, one of whom, Moira Burke, is a computational social psychologist now working on Facebook’s data science team.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The analysis points out that most previous studies about Facebook and psychological well-being were done using cross-sectional surveys, which means they derive data from research participants at a particular point in time. Such studies are viewed as less able to separate cause and effect.\u003c/span>\u003c/p>\n\u003cp>“You really can’t draw any conclusions about what effects online communication in general or Facebook communication in particular has from cross-sectional data,” said Robert Kraut, a co-author of the meta-analysis (he's consulted for Facebook but doesn't work there).\u003c/p>\n\u003cp>The University of Pittsburgh researchers acknowledged as much with this disclaimer: “It may be that people who already are depressed are turning to social media to fill a void.”\u003c/p>\n\u003cp>\u003cstrong>Happiness Deficit\u003c/strong>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">I asked Kraut about \u003c/span>\u003ca href=\"http://www.happinessresearchinstitute.com/download/i/mark_dl/u/4012182887/4624845731/The%20Facebook%20Experiment.pdf\">\u003cspan style=\"font-weight: 400\">one study that \u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> attracted a lot of \u003c/span>\u003ca href=\"https://www.google.com/search?q=%22happiness+research+institute%22+facebook&rlz=1C1CAFB_en___US663&oq=%22happiness+research+institute%22+facebook&aqs=chrome..69i57.447j0j9&sourceid=chrome&ie=UTF-8#q=%22happiness+research+institute%22+facebook&tbm=nws\">\u003cspan style=\"font-weight: 400\">media attention\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> last year—it came from the \u003c/span>\u003ca href=\"http://www.happinessresearchinstitute.com/\">\u003cspan style=\"font-weight: 400\">Happiness Research Institute\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> in Denmark (the \u003c/span>\u003ca href=\"http://www.bbc.com/news/world-europe-35824033\">\u003cspan style=\"font-weight: 400\">happiest\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> place on earth, apparently). The institute conducted an experiment in which it asked half of 1,095 people, most of whom were daily Facebook users, \u003c/span>\u003cspan style=\"font-weight: 400\">to abstain from using it for one week.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“People who had taken a break from Facebook felt happier and were less sad and lonely,\" an online presentation of the study said. Those on the Facebook fast also “reported a significantly higher level of satisfaction” and significantly less stress than those sentenced to remain on the site. \u003c/span>\u003c/p>\n\u003cp>\u003ca href=\"https://www.washingtonpost.com/news/the-intersect/wp/2015/11/12/what-a-viral-study-about-the-harms-of-facebook-gets-wrong/\">\u003cspan style=\"font-weight: 400\">Not everyone\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> was impressed with the study, which has yet to be published in a peer-reviewed journal, but Kraut thought it was a “reasonable” design for discriminating between cause and effect. “We just don’t know how long [the effects] are likely to last, because the behavioral change was only a week long,” he said.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">A small 2013 \u003c/span>\u003ca href=\"http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0069841\">\u003cspan style=\"font-weight: 400\">study\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> also looked at whether Facebook use influences people's assessment of their own well-being over time. Researchers texted online surveys to 82 people every day for two weeks, asking them questions like “How do you feel right now?” Their answers were correlated with their use of Facebook.\u003c/span>\u003c/p>\n\u003cp>“The more people used Facebook the worse they subsequently felt,” the paper reported.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The researchers said \"multiple types of evidence\" showed there was no doubt of what was cause and what was effect in the study. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“Facebook use may constitute a unique form of social network interaction that predicts impoverished well-being,\" they wrote. \u003c/span>\u003c/p>\n\u003cp>\u003cstrong>The Big E\u003c/strong>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Some researchers have divided Facebook use into the categories of \"active\" and \"passive.\" Active use includes those activities that facilitate direct communications, \u003c/span>\u003cspan style=\"font-weight: 400\">like commenting on posts or sending messages; \u003c/span>\u003cspan style=\"font-weight: 400\">passive\u003c/span>\u003cspan style=\"font-weight: 400\"> use refers to the mere \u003c/span>\u003ci>\u003cspan style=\"font-weight: 400\">consumption\u003c/span>\u003c/i>\u003cspan style=\"font-weight: 400\"> of information — like scrolling through your news feed and glimpsing the lawn furniture your cousin just bought.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">A handful of studies from different labs have now established links between passive Facebook use and envy or other negative mental states, said Ethan Kross, the University of Michigan researcher who has co-authored one such \u003c/span>\u003ca href=\"http://selfcontrol.psych.lsa.umich.edu/wp-content/uploads/2015/08/KROSS.pdf\">\u003cspan style=\"font-weight: 400\">paper\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">According to 2013 \u003c/span>\u003ca href=\"http://www.ara.cat/2013/01/28/855594433.pdf?hash=b775840d43f9f93b7a9031449f809c388f342291\">\u003cspan style=\"font-weight: 400\">research \u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">from Germany, \u003c/span>\u003cspan style=\"font-weight: 400\">“upward social comparison and envy can be rampant” on Facebook and other social networks. That’s because the environment promotes “narcissistic behavior, with most users sharing only positive things about themselves.” Among the 357 study participants, the researchers sussed out an “astounding” number of “envy-inducing incidents,” most frequently related to travel and leisure, social interactions, and “happiness.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Furthermore, the researchers wrote, some Facebook users may engage in an “envy-coping plan,” involving “even greater self-promotion and impression management.” And that can trigger a “self-promotion-envy spiral.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">A one-upmanship arms race.\u003c/span>\u003c/p>\n\u003cp>\u003ca href=\"http://selfcontrol.psych.lsa.umich.edu/wp-content/uploads/2015/08/KROSS.pdf\">\u003cspan style=\"font-weight: 400\">Research\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> published in 2015 managed to isolate envy as the culprit in bumming people out, as opposed to other characteristics like number of user friends, usage motivation, and self-esteem.\u003c/span>\u003c/p>\n\u003cp>“Passive Facebook usage predicted envy, and envy predicted declines in affective well-being,” the researchers wrote.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">They concluded with this anecdote from Randi Zuckerberg, the sister of Facebook founder Mark Zuckerberg, which she \u003ca href=\"http://www.nytimes.com/2013/11/03/magazine/randi-zuckerberg-i-really-put-myself-out-there.html\">related to The New York Times\u003c/a> in 2013. “I’ve had friends call me and say, ‘Your life looks so amazing,\" Zuckerberg said. \"\u003c/span>\u003cspan style=\"font-weight: 400\">And I tell them, ‘I’m a marketer. I’m only posting the moments that are amazing.'” \u003c/span>\u003c/p>\n\u003cp>https://www.youtube.com/watch?v=Rkkxc3RpFM8&ab_channel=NewsyTech\u003c/p>\n\u003cp>\u003cstrong>'Do We Have to See That?'\u003c/strong>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">A friend of mine, who doesn’t want to give her name (would you?) has been telling me for years that she gets genuinely depressed on Facebook. Her self-diagnosis of the cause of this condition: envy.\u003c/span>\u003c/p>\n\u003cp>“There’s this woman I know and she is constantly posting, and she does some amazing things,” she told me.“There’s this jealous part of me, that’s like, ‘Do we have to see that?’”\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“Everyone seems like they’re happy on Facebook. … There’s serial posters, where every day there’s a new post, and it’s almost always something nice and wonderful.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Yes. After plodding through these studies, I felt the need to reassess my own Great Facebook Freakout of 2008. It wasn’t hard to see that just beneath the Proustian navel-gazing on time gone by lay a strong component of rivalry: If some of those losers from third grade had not exactly set the world on fire, they’d at least gotten a few sparks going. In my view, I was still gathering kindling. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Not that it made me feel any better, but even if I’d done super-well in this status game, just the \u003c/span>\u003ci>\u003cspan style=\"font-weight: 400\">act of comparison\u003c/span>\u003c/i>\u003cspan style=\"font-weight: 400\"> might have been deflating. Contrary to some studies and consistent with others (naturally), \u003c/span>\u003ca href=\"http://faculty.coe.uh.edu/flopez/docs/Highliight%20Reels%20and%20Comparison.pdf\">\u003cspan style=\"font-weight: 400\">research\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> on Facebook and depression published in 2014 indicated “engaging in frequent social comparison of any kind may be deleterious to one’s mental well-being.”\u003c/span>\u003c/p>\n\u003cp>\u003cstrong>The Happy Studies\u003c/strong>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">There \u003cem>are\u003c/em> studies showing Facebook can enhance a sense of social connectedness. \u003c/span>\u003c/p>\n\u003cp>Kraut and Moira Burke, the Facebook researcher, recently published a \u003ca href=\"http://onlinelibrary.wiley.com/doi/10.1111/jcc4.12162/full\" target=\"_blank\">study\u003c/a> that showed \"people derive benefits from online communication, as long it comes from people they care about and has been tailored for them.\"\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">A 2007 \u003c/span>\u003cspan style=\"font-weight: 400\">\u003ca href=\"http://onlinelibrary.wiley.com/doi/10.1111/j.1083-6101.2007.00367.x/full\">study\u003c/a> \u003c/span>\u003cspan style=\"font-weight: 400\">found that college students who were heavy Facebook users reported higher levels of “social capital,” consisting of resources like emotional support and job opportunities that stem from membership in a social network.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">A 2012 \u003c/span>\u003ca href=\"http://spp.sagepub.com/content/early/2012/12/20/1948550612469233.abstract\">\u003cspan style=\"font-weight: 400\">study\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> found posting status updates decreased loneliness, even when those updates elicited no response. A 2010 \u003c/span>\u003ca href=\"http://primelab.missouri.edu/pdfs/wap10.pdf\">\u003cspan style=\"font-weight: 400\">study\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> measured electrical activity in the body to record moment-by-moment physiological responses when using Facebook. The equipment logged pleasant emotions when users actively sought out information or directly communicated with their Facebook friends, but fewer such positive feelings when passively browsing.\u003c/span>\u003c/p>\n\u003cp>\u003cstrong>It's Up to You\u003c/strong>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Robert Kraut, who has been \u003ca href=\"http://kraut.hciresearch.org/recent-articles-and-chapters\" target=\"_blank\">researching\u003c/a> the emotional effects of using the internet going back to its early days, says his and others' research shows your Facebook experience will be good or bad depending on how you use it.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“In particular, having longer, more substantive communication with people you feel closer to seems to be associated with increases in psychological well-being,” he said. “You don’t get the same effects if the communication is with people who are weaker ties. What seems to be crucial is that these are effortful, targeted communications.”\u003c/span>\u003c/p>\n\u003cp>Dos and don'ts?\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“Don’t treat it as simple entertainment and consume everything that is put in front of you,\" Kraut said. \"Use it more proactively to communicate with people that you care about.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Sounds about right. I myself have made my peace with the site. It's true I sometimes find myself \u003c/span>\u003cspan style=\"font-weight: 400\">scanning that unceasing river of flattering photos, adorable babies and pronouncements of good fortune with a progressive sense of diminishment. Facebook \u003c/span>\u003cspan style=\"font-weight: 400\"> offers a plethora of choices as to how I want to spend my time, and I don't always make the right one.\u003cbr>\n\u003c/span>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>But in that, Facebook is a lot like life.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Researchers, at least, love Facebook.\u003c/p>\n\u003cp>A \u003ca href=\"http://00t0holtgrav.iweb.bsu.edu/492/Perspectives%20on%20Psychological%20Science-2012-Wilson-203-20.pdf\">\u003cspan style=\"font-weight: 400\">2012 survey\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> of social science papers related to the social network turned up 412 separate studies. One of the most popular questions: What effect does Facebook have \u003c/span>\u003cspan style=\"font-weight: 400\">on emotional states? \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">As it turns out, it's complicated.\u003c/span>\u003c/p>\n\u003caside class=\"pullquote alignright\">Roughly 22 percent of the world's population use Facebook an average of 50 minutes per day. Is all this interconnectedness creating psychological benefits or global gloom?\u003c/aside>\n\u003cp>\u003cspan style=\"font-weight: 400\">I experienced this myself around Thanksgiving of 2008, when I first joined up. For a week or so, I marveled at Facebook's ability to connect me to people who had long ago faded into the remotest recesses of memory.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">By Christmas, I was in the midst of a full-fledged metaphysical breakdown. \u003c/span>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Those scrolls down memory lane were killing me. Better to have left that kid from third grade, who now liked to post videos of his weightlifting triumphs, a I last remembered him--a skinny punk banging a double off the schoolyard fence.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">It was the collapse of that natural partition between past and present that was upsetting. A few months in, after noting the male-pattern baldness of yet another long-lost pal, I figured out why:\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Facebook had punctured the intransigently juvenile aspect of my personality that refused to recognize the \u003c/span>\u003ci>\u003cspan style=\"font-weight: 400\">passage of time.\u003c/span>\u003c/i>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">And that, of course, provided yet another piece of evidence for the harshest reality of our existence: That we are all going to die.\u003c/span>\u003c/p>\n\u003cp>\u003cstrong>50 Minutes a Day\u003c/strong>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Okay, that was \u003c/span>\u003ci>\u003cspan style=\"font-weight: 400\">my\u003c/span>\u003c/i>\u003cspan style=\"font-weight: 400\"> Facebook freakout—how about yours?\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Start asking around, and lots of folks will volunteer one resentment or another. They don’t like the time they spend on Facebook. Or they don’t like the way people communicate on Facebook. Or they just don’t like \u003c/span>\u003ci>\u003cspan style=\"font-weight: 400\">Facebook\u003c/span>\u003c/i>\u003cspan style=\"font-weight: 400\">. As Laurence Scott wrote in his recent book on digital life, \u003c/span>\u003ca href=\"https://ww2.kqed.org/futureofyou/2016/08/23/the-online-life-as-both-liberation-and-imprisonment/\">\u003cspan style=\"font-weight: 400\">The Four-Dimensional Human\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">, “Everyone knows someone perpetually on the brink of quitting” the site. \u003c/span>\u003c/p>\n\u003caside class=\"pullquote alignright\">'Facebook use may constitute a unique form of social network interaction that predicts impoverished well-being,' says one study.\u003c/aside>\n\u003cp>\u003cspan style=\"font-weight: 400\">Yet, whatever gripes people have, they aren’t hurting business. People use Facebook so much it \u003c/span>\u003ca href=\"http://www.nytimes.com/2016/05/06/business/facebook-bends-the-rules-of-audience-engagement-to-its-advantage.html\">\u003cspan style=\"font-weight: 400\">boggled the mind\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> of The New York Times’ James B. Stewart. After reporting in May on the 50 daily minutes Facebook says users spend on its main site, instant messaging application and Instagram property, he noted that amount beat out all other leisure activities save one. Still the king: Watching TV.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Facebook says it has 1.65 billion active users, which is roughly 22 percent of the world’s population. Given the expanding role it plays in so many lives, it’s not surprising the site has been laden with a surfeit of social and political significance, credited with everything from a \u003c/span>\u003ca href=\"http://wjla.com/news/nation-world/facebook-adultery-trend-rising-as-people-find-long-lost-flings-76049\">\u003cspan style=\"font-weight: 400\">rise in adultery\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> to the \u003c/span>\u003ca href=\"https://www.google.com/search?q=facebook+arab+spring\">\u003cspan style=\"font-weight: 400\">toppling of autocratic regimes\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">.\u003c/span>\u003c/p>\n\u003cp>\u003cstrong>Hazardous to Your Mental Health?\u003c/strong>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Dr. Ethan Kross, the director of the Emotion & Self Control Lab at the University of Michigan who has co-authored several papers on Facebook, says the early research was “all over the place” as to whether using the site boosted or depressed a person’s mental state.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">But it's the research finding a \u003c/span>\u003ca href=\"http://nymag.com/thecut/2016/05/moms-who-post-on-facebook-are-more-depressed.html\">\u003cspan style=\"font-weight: 400\">correlation\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> between Facebook and \u003c/span>\u003ca href=\"https://techcrunch.com/2015/02/03/study-facebook-can-cause-depression/\">\u003cspan style=\"font-weight: 400\">feeling lousy\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> that has drawn the \u003ca href=\"https://www.google.com/search?q=facebook+depression\" target=\"_blank\">attention of the media\u003c/a>. And to be sure, the literature is replete with ominous titles that appear to have been written half by scientists, half by university press offices. Titles like: \u003c/span>\u003cspan style=\"font-weight: 400\">“\u003c/span>\u003ca href=\"https://www.semanticscholar.org/paper/-They-Are-Happier-and-Having-Better-Lives-than-I-Chou-Edge/8ec2a88e39453b50ada493a79371b03be15a5299/pdf\">\u003cspan style=\"font-weight: 400\">They Are Happier and Having Better Lives Than I Am: The Impact of Using Facebook on Perceptions of Others’ Lives.”\u003c/span>\u003c/a>\u003c/p>\n\u003caside class=\"pullquote alignright\">\"I’ve had friends call me and say, ‘Your life looks so amazing.' And I tell them, ‘I’m a marketer. I’m only posting the moments that are amazing.’”\u003ccite>Randi Zuckerberg, sister of Mark, in 2013\u003c/cite>\u003c/aside>\n\u003cp>\u003cspan style=\"font-weight: 400\">This type of research is fueling a growing sense that spending \u003c/span>\u003ca href=\"https://ww2.kqed.org/futureofyou/2016/04/20/screenagers-shows-parents-overwhelmed-by-kids-phone-computer-use/\">\u003cspan style=\"font-weight: 400\">too much time online\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> is emotionally perilous. A \u003c/span>\u003ca href=\"http://www.upmc.com/media/NewsReleases/2016/Pages/lin-primack-sm-depression.aspx\">\u003cspan style=\"font-weight: 400\">study\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> \u003c/span>\u003ca href=\"http://www.cnet.com/news/heavy-facebook-twitter-users-3-times-more-likely-to-be-depressed/\">\u003cspan style=\"font-weight: 400\">making headlines \u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">this spring looked at the relationship between social media use and depression. University of Pittsburgh researchers sampled 1,787 U.S. adults, ages 19 through 32, and found an almost 300 percent greater likelihood of depression in the most active users of sites like Facebook, Twitter and Reddit than in those who used them the least.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">You wonder how Facebook feels about research that basically communicates its product is a mental hazard. A spokesperson for the company pointed me to a \u003c/span>\u003ca href=\"https://research.facebook.com/publications/internet-use-and-psychological-well-being-effects-of-activity-and-audience/\">\u003cspan style=\"font-weight: 400\">meta-analysis\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> it had collaborated on with two researchers, one of whom, Moira Burke, is a computational social psychologist now working on Facebook’s data science team.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The analysis points out that most previous studies about Facebook and psychological well-being were done using cross-sectional surveys, which means they derive data from research participants at a particular point in time. Such studies are viewed as less able to separate cause and effect.\u003c/span>\u003c/p>\n\u003cp>“You really can’t draw any conclusions about what effects online communication in general or Facebook communication in particular has from cross-sectional data,” said Robert Kraut, a co-author of the meta-analysis (he's consulted for Facebook but doesn't work there).\u003c/p>\n\u003cp>The University of Pittsburgh researchers acknowledged as much with this disclaimer: “It may be that people who already are depressed are turning to social media to fill a void.”\u003c/p>\n\u003cp>\u003cstrong>Happiness Deficit\u003c/strong>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">I asked Kraut about \u003c/span>\u003ca href=\"http://www.happinessresearchinstitute.com/download/i/mark_dl/u/4012182887/4624845731/The%20Facebook%20Experiment.pdf\">\u003cspan style=\"font-weight: 400\">one study that \u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> attracted a lot of \u003c/span>\u003ca href=\"https://www.google.com/search?q=%22happiness+research+institute%22+facebook&rlz=1C1CAFB_en___US663&oq=%22happiness+research+institute%22+facebook&aqs=chrome..69i57.447j0j9&sourceid=chrome&ie=UTF-8#q=%22happiness+research+institute%22+facebook&tbm=nws\">\u003cspan style=\"font-weight: 400\">media attention\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> last year—it came from the \u003c/span>\u003ca href=\"http://www.happinessresearchinstitute.com/\">\u003cspan style=\"font-weight: 400\">Happiness Research Institute\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> in Denmark (the \u003c/span>\u003ca href=\"http://www.bbc.com/news/world-europe-35824033\">\u003cspan style=\"font-weight: 400\">happiest\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> place on earth, apparently). The institute conducted an experiment in which it asked half of 1,095 people, most of whom were daily Facebook users, \u003c/span>\u003cspan style=\"font-weight: 400\">to abstain from using it for one week.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“People who had taken a break from Facebook felt happier and were less sad and lonely,\" an online presentation of the study said. Those on the Facebook fast also “reported a significantly higher level of satisfaction” and significantly less stress than those sentenced to remain on the site. \u003c/span>\u003c/p>\n\u003cp>\u003ca href=\"https://www.washingtonpost.com/news/the-intersect/wp/2015/11/12/what-a-viral-study-about-the-harms-of-facebook-gets-wrong/\">\u003cspan style=\"font-weight: 400\">Not everyone\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> was impressed with the study, which has yet to be published in a peer-reviewed journal, but Kraut thought it was a “reasonable” design for discriminating between cause and effect. “We just don’t know how long [the effects] are likely to last, because the behavioral change was only a week long,” he said.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">A small 2013 \u003c/span>\u003ca href=\"http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0069841\">\u003cspan style=\"font-weight: 400\">study\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> also looked at whether Facebook use influences people's assessment of their own well-being over time. Researchers texted online surveys to 82 people every day for two weeks, asking them questions like “How do you feel right now?” Their answers were correlated with their use of Facebook.\u003c/span>\u003c/p>\n\u003cp>“The more people used Facebook the worse they subsequently felt,” the paper reported.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The researchers said \"multiple types of evidence\" showed there was no doubt of what was cause and what was effect in the study. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“Facebook use may constitute a unique form of social network interaction that predicts impoverished well-being,\" they wrote. \u003c/span>\u003c/p>\n\u003cp>\u003cstrong>The Big E\u003c/strong>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Some researchers have divided Facebook use into the categories of \"active\" and \"passive.\" Active use includes those activities that facilitate direct communications, \u003c/span>\u003cspan style=\"font-weight: 400\">like commenting on posts or sending messages; \u003c/span>\u003cspan style=\"font-weight: 400\">passive\u003c/span>\u003cspan style=\"font-weight: 400\"> use refers to the mere \u003c/span>\u003ci>\u003cspan style=\"font-weight: 400\">consumption\u003c/span>\u003c/i>\u003cspan style=\"font-weight: 400\"> of information — like scrolling through your news feed and glimpsing the lawn furniture your cousin just bought.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">A handful of studies from different labs have now established links between passive Facebook use and envy or other negative mental states, said Ethan Kross, the University of Michigan researcher who has co-authored one such \u003c/span>\u003ca href=\"http://selfcontrol.psych.lsa.umich.edu/wp-content/uploads/2015/08/KROSS.pdf\">\u003cspan style=\"font-weight: 400\">paper\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">According to 2013 \u003c/span>\u003ca href=\"http://www.ara.cat/2013/01/28/855594433.pdf?hash=b775840d43f9f93b7a9031449f809c388f342291\">\u003cspan style=\"font-weight: 400\">research \u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">from Germany, \u003c/span>\u003cspan style=\"font-weight: 400\">“upward social comparison and envy can be rampant” on Facebook and other social networks. That’s because the environment promotes “narcissistic behavior, with most users sharing only positive things about themselves.” Among the 357 study participants, the researchers sussed out an “astounding” number of “envy-inducing incidents,” most frequently related to travel and leisure, social interactions, and “happiness.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Furthermore, the researchers wrote, some Facebook users may engage in an “envy-coping plan,” involving “even greater self-promotion and impression management.” And that can trigger a “self-promotion-envy spiral.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">A one-upmanship arms race.\u003c/span>\u003c/p>\n\u003cp>\u003ca href=\"http://selfcontrol.psych.lsa.umich.edu/wp-content/uploads/2015/08/KROSS.pdf\">\u003cspan style=\"font-weight: 400\">Research\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> published in 2015 managed to isolate envy as the culprit in bumming people out, as opposed to other characteristics like number of user friends, usage motivation, and self-esteem.\u003c/span>\u003c/p>\n\u003cp>“Passive Facebook usage predicted envy, and envy predicted declines in affective well-being,” the researchers wrote.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">They concluded with this anecdote from Randi Zuckerberg, the sister of Facebook founder Mark Zuckerberg, which she \u003ca href=\"http://www.nytimes.com/2013/11/03/magazine/randi-zuckerberg-i-really-put-myself-out-there.html\">related to The New York Times\u003c/a> in 2013. “I’ve had friends call me and say, ‘Your life looks so amazing,\" Zuckerberg said. \"\u003c/span>\u003cspan style=\"font-weight: 400\">And I tell them, ‘I’m a marketer. I’m only posting the moments that are amazing.'” \u003c/span>\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/Rkkxc3RpFM8'\n title='//www.youtube.com/embed/Rkkxc3RpFM8'\n allowfullscreen='true'\n style='border:0;'>\u003c/iframe>\n \u003c/span>\n \u003c/span>\u003c/p>\u003cp>\u003cp>\u003cstrong>'Do We Have to See That?'\u003c/strong>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">A friend of mine, who doesn’t want to give her name (would you?) has been telling me for years that she gets genuinely depressed on Facebook. Her self-diagnosis of the cause of this condition: envy.\u003c/span>\u003c/p>\n\u003cp>“There’s this woman I know and she is constantly posting, and she does some amazing things,” she told me.“There’s this jealous part of me, that’s like, ‘Do we have to see that?’”\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“Everyone seems like they’re happy on Facebook. … There’s serial posters, where every day there’s a new post, and it’s almost always something nice and wonderful.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Yes. After plodding through these studies, I felt the need to reassess my own Great Facebook Freakout of 2008. It wasn’t hard to see that just beneath the Proustian navel-gazing on time gone by lay a strong component of rivalry: If some of those losers from third grade had not exactly set the world on fire, they’d at least gotten a few sparks going. In my view, I was still gathering kindling. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Not that it made me feel any better, but even if I’d done super-well in this status game, just the \u003c/span>\u003ci>\u003cspan style=\"font-weight: 400\">act of comparison\u003c/span>\u003c/i>\u003cspan style=\"font-weight: 400\"> might have been deflating. Contrary to some studies and consistent with others (naturally), \u003c/span>\u003ca href=\"http://faculty.coe.uh.edu/flopez/docs/Highliight%20Reels%20and%20Comparison.pdf\">\u003cspan style=\"font-weight: 400\">research\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> on Facebook and depression published in 2014 indicated “engaging in frequent social comparison of any kind may be deleterious to one’s mental well-being.”\u003c/span>\u003c/p>\n\u003cp>\u003cstrong>The Happy Studies\u003c/strong>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">There \u003cem>are\u003c/em> studies showing Facebook can enhance a sense of social connectedness. \u003c/span>\u003c/p>\n\u003cp>Kraut and Moira Burke, the Facebook researcher, recently published a \u003ca href=\"http://onlinelibrary.wiley.com/doi/10.1111/jcc4.12162/full\" target=\"_blank\">study\u003c/a> that showed \"people derive benefits from online communication, as long it comes from people they care about and has been tailored for them.\"\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">A 2007 \u003c/span>\u003cspan style=\"font-weight: 400\">\u003ca href=\"http://onlinelibrary.wiley.com/doi/10.1111/j.1083-6101.2007.00367.x/full\">study\u003c/a> \u003c/span>\u003cspan style=\"font-weight: 400\">found that college students who were heavy Facebook users reported higher levels of “social capital,” consisting of resources like emotional support and job opportunities that stem from membership in a social network.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">A 2012 \u003c/span>\u003ca href=\"http://spp.sagepub.com/content/early/2012/12/20/1948550612469233.abstract\">\u003cspan style=\"font-weight: 400\">study\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> found posting status updates decreased loneliness, even when those updates elicited no response. A 2010 \u003c/span>\u003ca href=\"http://primelab.missouri.edu/pdfs/wap10.pdf\">\u003cspan style=\"font-weight: 400\">study\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> measured electrical activity in the body to record moment-by-moment physiological responses when using Facebook. The equipment logged pleasant emotions when users actively sought out information or directly communicated with their Facebook friends, but fewer such positive feelings when passively browsing.\u003c/span>\u003c/p>\n\u003cp>\u003cstrong>It's Up to You\u003c/strong>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Robert Kraut, who has been \u003ca href=\"http://kraut.hciresearch.org/recent-articles-and-chapters\" target=\"_blank\">researching\u003c/a> the emotional effects of using the internet going back to its early days, says his and others' research shows your Facebook experience will be good or bad depending on how you use it.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“In particular, having longer, more substantive communication with people you feel closer to seems to be associated with increases in psychological well-being,” he said. “You don’t get the same effects if the communication is with people who are weaker ties. What seems to be crucial is that these are effortful, targeted communications.”\u003c/span>\u003c/p>\n\u003cp>Dos and don'ts?\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“Don’t treat it as simple entertainment and consume everything that is put in front of you,\" Kraut said. \"Use it more proactively to communicate with people that you care about.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Sounds about right. I myself have made my peace with the site. It's true I sometimes find myself \u003c/span>\u003cspan style=\"font-weight: 400\">scanning that unceasing river of flattering photos, adorable babies and pronouncements of good fortune with a progressive sense of diminishment. Facebook \u003c/span>\u003cspan style=\"font-weight: 400\"> offers a plethora of choices as to how I want to spend my time, and I don't always make the right one.\u003cbr>\n\u003c/span>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>https://www.youtube.com/watch?v=g1JhyU_IB70&ab_channel=AbeAboraya\u003c/p>\n\u003cp>For engineer Matt Bellina, of Cocoa Beach, Fla., riding the perfect wave was a group mission.\u003c/p>\n\u003caside class=\"pullquote alignright\">'I feel like I'm home.'\u003ccite>Matt Bellina, back in his wheelchair, after surfing again for first time since being paralyzed.\u003c/cite>\u003c/aside>\n\u003cp>More than 15 friends gathered on Florida's Cocoa Beach on a Saturday morning this summer. Their task? Get 40-year-old Bellina back into the water surfing.\u003c/p>\n\u003cp>It wasn't easy. On Memorial Day, 2014, Bellina broke his neck, as he slid head-first down a water slide and into an inflatable wall. Bellina broke his C4 vertebra and damaged his high-cervical nerve. He's one of an estimated 17,000 Americans each year who suffer a spinal cord injury and live. Bellina can't walk, and has limited arm movement.\u003c/p>\n\u003cp>But, despite the odds, he wanted to surf again, and his friends wanted to help. They hoisted Bellina from a beach wheelchair to a sailboard that had been modified with a kayak seat. With four people on each side, they paddled Bellina out into the Atlantic.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Longtime friends, coworkers and family positioned themselves strategically in the water to rescue Bellina if he lost his balance and fell off the board. Though he wore a life jacket, there was an element of danger: Because of his injury, Bellina can't hold his breath for long. If he slipped, they'd have to get his head above water fast.\u003c/p>\n\u003cp>And that's exactly what happened on the first wave. As Bellina took off, sitting up in the kayak chair, he lost his balance and tumbled to one side — basically falling into the arms of a friend, but still getting dunked underwater.\u003c/p>\n\u003cp>The team quickly righted Bellina, and hoisted him up for another try. This time, the surfer tried lying flat on his back, and having his friends push him into a wave.\u003c/p>\n\u003cp>They let go — and it worked! Bellina was surfing again. He cruised through the water, grinning from ear to ear, as his crowd of friends cheered. He caught two more rides before taking a break.\u003c/p>\n\u003cp>Back on the sand, Bellina was hoisted back in the wheel chair and took a sip of fresh water. How did he feel?\u003c/p>\n\u003cp>\"So good, \u003cem>so good\u003c/em>,\" he said, with a smile. \"That was killer.\"\u003c/p>\n\u003cp>Bellina lives in a condo on the beach, but being \u003cem>in\u003c/em> the water is something else.\u003c/p>\n\u003cp>\"I feel like I'm home,\" he said. \"I've grown up here, but I've lived in several different places. And being in the ocean has always felt like returning to home. That's what it feels like. It feels like I finally get to be myself, even if for a few seconds.\"\u003c/p>\n\u003cp>Research evidence shows that physical activity comes with a host of benefits for those with spinal cord injuries, said \u003ca href=\"http://www.spineuniverse.com/author/1505/thomas\">Dr. Santhosh Thomas\u003c/a> at the Cleveland Clinic Center for Spine Health. And as Bellina's experience demonstrates, the benefits go beyond any physical gains.\u003c/p>\n\u003cp>\"It's always good to get ... people back to near-normal activities that they enjoy, Thomas said, adding that \"with quadriplegia you need a pretty good support system to get to that level.\"\u003c/p>\n\u003cp>Physical pain from the injury can be treated, Thomas said. But emotional wounds can be harder to handle.\u003c/p>\n\u003cp>\"A lot of young adults who are the victims of these spinal cord injuries are devastated,\" Thomas said. \"And getting them back into activities they enjoyed before the injury almost certainly has positive effects.\"\u003c/p>\n\u003cp>It can build friendships, he said, and help with cardiac conditioning, prevent bone loss, boost energy and help with self-image. Regaining some physical mastery can help with the anxiety and depression that are common after spinal cord injuries.\u003c/p>\n\u003cp>\u003ca href=\"https://www.woundedwarriorproject.org/mission/executive-staff/tracy-farrell\">Tracy Farrell\u003c/a>, executive vice president for physical health and wellness at the \u003ca href=\"https://www.woundedwarriorproject.org/\">Wounded Warrior project\u003c/a>, said the joy that Bellina experienced in getting back on the water is the sort of thing she sees all the time among injured veterans who engage in \u003ca href=\"http://www.va.gov/adaptivesports/\">adaptive sports\u003c/a>.\u003c/p>\n\u003cp>\"You can look at studies that say physical health and physical wellness impacts depression, impacts PTSD, impacts cognitive abilities,\" she said. \"So any way we can get individuals moving again after an injury, the better their overall emotional health.\"\u003c/p>\n\u003cp>Being able to return to a much-loved activity can be motivating — and transforming — in other ways, too, she said.\u003c/p>\n\u003cp>\"When people get struck into the mindset of 'this is what the rest of my life will look like,' if you can challenge them to attain some sort of physical mobility again, many will strive and reach that challenge,\" Farrell said. \"And the water is a happy place for many.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Science reporters at NPR have been exploring all sorts of waves this summer — from gravitational to seismic and more. You can f\u003c/em>\u003cem>ind all \u003ca href=\"http://www.npr.org/2016/08/15/488285360/www.npr.org/series/488377743/summer-waves?live=1\">our favorites here\u003c/a>.\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 WMFE-FM. To see more, visit \u003ca href=\"http://www.wmfe.org\">WMFE-FM\u003c/a>.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=A+Paralyzed+Florida+Surfer+Finds+His+Own+%27Perfect+Wave%27&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\u003cp>\u003cspan class='utils-parseShortcode-shortcodes-__youtubeShortcode__embedYoutube'>\n \u003cspan class='utils-parseShortcode-shortcodes-__youtubeShortcode__embedYoutubeInside'>\n \u003ciframe\n loading='lazy'\n class='utils-parseShortcode-shortcodes-__youtubeShortcode__youtubePlayer'\n type='text/html'\n src='//www.youtube.com/embed/g1JhyU_IB70'\n title='//www.youtube.com/embed/g1JhyU_IB70'\n allowfullscreen='true'\n style='border:0;'>\u003c/iframe>\n \u003c/span>\n \u003c/span>\u003c/p>\u003cp>\u003cp>For engineer Matt Bellina, of Cocoa Beach, Fla., riding the perfect wave was a group mission.\u003c/p>\n\u003caside class=\"pullquote alignright\">'I feel like I'm home.'\u003ccite>Matt Bellina, back in his wheelchair, after surfing again for first time since being paralyzed.\u003c/cite>\u003c/aside>\n\u003cp>More than 15 friends gathered on Florida's Cocoa Beach on a Saturday morning this summer. Their task? Get 40-year-old Bellina back into the water surfing.\u003c/p>\n\u003cp>It wasn't easy. On Memorial Day, 2014, Bellina broke his neck, as he slid head-first down a water slide and into an inflatable wall. Bellina broke his C4 vertebra and damaged his high-cervical nerve. He's one of an estimated 17,000 Americans each year who suffer a spinal cord injury and live. Bellina can't walk, and has limited arm movement.\u003c/p>\n\u003cp>But, despite the odds, he wanted to surf again, and his friends wanted to help. They hoisted Bellina from a beach wheelchair to a sailboard that had been modified with a kayak seat. With four people on each side, they paddled Bellina out into the Atlantic.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Longtime friends, coworkers and family positioned themselves strategically in the water to rescue Bellina if he lost his balance and fell off the board. Though he wore a life jacket, there was an element of danger: Because of his injury, Bellina can't hold his breath for long. If he slipped, they'd have to get his head above water fast.\u003c/p>\n\u003cp>And that's exactly what happened on the first wave. As Bellina took off, sitting up in the kayak chair, he lost his balance and tumbled to one side — basically falling into the arms of a friend, but still getting dunked underwater.\u003c/p>\n\u003cp>The team quickly righted Bellina, and hoisted him up for another try. This time, the surfer tried lying flat on his back, and having his friends push him into a wave.\u003c/p>\n\u003cp>They let go — and it worked! Bellina was surfing again. He cruised through the water, grinning from ear to ear, as his crowd of friends cheered. He caught two more rides before taking a break.\u003c/p>\n\u003cp>Back on the sand, Bellina was hoisted back in the wheel chair and took a sip of fresh water. How did he feel?\u003c/p>\n\u003cp>\"So good, \u003cem>so good\u003c/em>,\" he said, with a smile. \"That was killer.\"\u003c/p>\n\u003cp>Bellina lives in a condo on the beach, but being \u003cem>in\u003c/em> the water is something else.\u003c/p>\n\u003cp>\"I feel like I'm home,\" he said. \"I've grown up here, but I've lived in several different places. And being in the ocean has always felt like returning to home. That's what it feels like. It feels like I finally get to be myself, even if for a few seconds.\"\u003c/p>\n\u003cp>Research evidence shows that physical activity comes with a host of benefits for those with spinal cord injuries, said \u003ca href=\"http://www.spineuniverse.com/author/1505/thomas\">Dr. Santhosh Thomas\u003c/a> at the Cleveland Clinic Center for Spine Health. And as Bellina's experience demonstrates, the benefits go beyond any physical gains.\u003c/p>\n\u003cp>\"It's always good to get ... people back to near-normal activities that they enjoy, Thomas said, adding that \"with quadriplegia you need a pretty good support system to get to that level.\"\u003c/p>\n\u003cp>Physical pain from the injury can be treated, Thomas said. But emotional wounds can be harder to handle.\u003c/p>\n\u003cp>\"A lot of young adults who are the victims of these spinal cord injuries are devastated,\" Thomas said. \"And getting them back into activities they enjoyed before the injury almost certainly has positive effects.\"\u003c/p>\n\u003cp>It can build friendships, he said, and help with cardiac conditioning, prevent bone loss, boost energy and help with self-image. Regaining some physical mastery can help with the anxiety and depression that are common after spinal cord injuries.\u003c/p>\n\u003cp>\u003ca href=\"https://www.woundedwarriorproject.org/mission/executive-staff/tracy-farrell\">Tracy Farrell\u003c/a>, executive vice president for physical health and wellness at the \u003ca href=\"https://www.woundedwarriorproject.org/\">Wounded Warrior project\u003c/a>, said the joy that Bellina experienced in getting back on the water is the sort of thing she sees all the time among injured veterans who engage in \u003ca href=\"http://www.va.gov/adaptivesports/\">adaptive sports\u003c/a>.\u003c/p>\n\u003cp>\"You can look at studies that say physical health and physical wellness impacts depression, impacts PTSD, impacts cognitive abilities,\" she said. \"So any way we can get individuals moving again after an injury, the better their overall emotional health.\"\u003c/p>\n\u003cp>Being able to return to a much-loved activity can be motivating — and transforming — in other ways, too, she said.\u003c/p>\n\u003cp>\"When people get struck into the mindset of 'this is what the rest of my life will look like,' if you can challenge them to attain some sort of physical mobility again, many will strive and reach that challenge,\" Farrell said. \"And the water is a happy place for many.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Science reporters at NPR have been exploring all sorts of waves this summer — from gravitational to seismic and more. You can f\u003c/em>\u003cem>ind all \u003ca href=\"http://www.npr.org/2016/08/15/488285360/www.npr.org/series/488377743/summer-waves?live=1\">our favorites here\u003c/a>.\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 WMFE-FM. To see more, visit \u003ca href=\"http://www.wmfe.org\">WMFE-FM\u003c/a>.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=A+Paralyzed+Florida+Surfer+Finds+His+Own+%27Perfect+Wave%27&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Theranos to Appeal Severe Government Sanctions",
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"content": "\u003cp>In a \u003ca href=\"https://news.theranos.com/2016/08/25/theranos-to-appeal-cms-sanctions/\" target=\"_blank\">statement\u003c/a> issued Thursday, the blood-testing company Theranos, which has stretched the adjective \"beleaguered\" to its very limits, said it would appeal the harsh \u003ca href=\"https://ww2.kqed.org/futureofyou/2016/07/08/theranos-lab-license-yanked-elizabeth-holmes-suspended/\" target=\"_blank\">penalties\u003c/a> the Centers for Medicare & Medicaid Services levied on it last month in response to what the agency called life-threatening deficiencies at the company's California lab.\u003c/p>\n\u003cp>Theranos said it has filed an intent to appeal the sanctions with CMS.\u003c/p>\n\u003cp>\"Theranos is not conducting patient testing at its Newark facility,\" the statement said. \"In addition, since CMS originally announced the imposition of sanctions, Theranos has made substantial progress toward correcting the deficiencies CMS identified, including appointing new laboratory leadership; enhancing Theranos’ clinical policies and procedures; and revamping training programs.\u003c/p>\n\u003cp>\"While the appeal is pending, Theranos intends to continue communicating with CMS regarding the possibility of reaching a mutually agreeable resolution to this matter.\"\u003c/p>\n\u003cp>CMS had previously said Theranos could “begin negotiations” with the agency. Any agreement would be based on the ability of Theranos to “remove immediate jeopardy” to patients, the agency said, as well as other factors, such as the severity of the lab's deficiencies and “the overall compliance history of the laboratory.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The \u003ca href=\"https://www.scribd.com/document/317817195/CMS-Notification-of-Imposition-of-Sanctions-for-Theranos\" target=\"_blank\">penalties\u003c/a> CMS imposed on Theranos include revoking the blood-testing company’s license to operate the Newark, California lab and barring founder and CEO Elizabeth Holmes from owning, operating or directing a lab for at least two years. CMS also canceled the Newark lab’s approval to receive payments from Medicare and Medicaid.\u003c/p>\n\u003cp>When the penalties were announced in July, laboratory medicine experts called them unusually harsh.\u003c/p>\n\u003cp>Dr. Norman Paradis, a professor of medicine at Dartmouth, who has consulted for both diagnostic startups and biomed investors, said the magnitude of the penalties could be one-of-a-kind.\u003c/p>\n\u003cp>“I’ve never heard of a penalty this severe,” he said. “I’m surprised that they could not have avoided this in light of the new involvement of experienced people and renowned attorneys.”\u003c/p>\n\u003cp>In April, Theranos hired a number of experts for its medical advisory board. High-powered lawyer David Boies represents the company and \u003ca href=\"http://www.nytimes.com/2016/02/03/business/dealbook/david-boiess-dual-roles-at-theranos-set-up-conflict.html\" target=\"_blank\">also serves\u003c/a> on its board.\u003c/p>\n\u003cp>Earlier this month, Holmes attempted a fresh start by giving a much-anticipated presentation at the annual meeting of the American Association for Clinical Chemistry. That was a gathering of the very sort of experts who had expressed skepticism about the company's central claim -- that it could perform dozens of tests by collecting just a few drops of the patient's blood from a finger prick. The FDA has approved only one of those assays, for the herpes simplex virus.\u003c/p>\n\u003cp>But rather than using the presentation to produce data verifying its technology, Holmes unveiled a new portable testing device called a miniLab, which was \u003ca href=\"https://ww2.kqed.org/futureofyou/2016/07/29/theranos-elizabeth-holmes-will-face-1000-scientists-monday-can-she-say-anything-to-gain-their-trust/\" target=\"_blank\">underwhelming\u003c/a> to those present.\u003c/p>\n\u003cp>The Wall Street Journal has reported the company is facing at least eight lawsuits related to that original, controversial and mysterious technology, called \"Edison,\" which Theranos\u003cstrong> \u003c/strong>says is now obsolete. In May, the company \u003ca href=\"https://ww2.kqed.org/futureofyou/2016/05/19/theranos-corrects-tens-of-thousands-of-blood-tests/\" target=\"_blank\">voided or corrected\u003c/a> tens of thousands of blood tests from 2014-15.\u003c/p>\n\u003cp>Per \u003ca href=\"https://www.law.cornell.edu/cfr/text/42/493.1844\" target=\"_blank\">federal regulations\u003c/a>, if Theranos loses its appeal, which will go to an administrative law judge, it can file a request for review by an appeals board. If it loses that one, it will have 60 days to request judicial review with the U.S. Court of Appeals.\u003c/p>\n\u003cp>Experts who have commented on the case have said if no settlement can be reached, companies almost never win these things.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>In the meantime, Theranos is still operating its remaining lab, in Arizona. But how brisk can business be? Walgreens withdrew from its partnership with the company, shutting down dozens of Theranos blood-draw centers in the pharmacy chain's Arizona stores. That leaves just a handful of collection sites for customers to patronize.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>In a \u003ca href=\"https://news.theranos.com/2016/08/25/theranos-to-appeal-cms-sanctions/\" target=\"_blank\">statement\u003c/a> issued Thursday, the blood-testing company Theranos, which has stretched the adjective \"beleaguered\" to its very limits, said it would appeal the harsh \u003ca href=\"https://ww2.kqed.org/futureofyou/2016/07/08/theranos-lab-license-yanked-elizabeth-holmes-suspended/\" target=\"_blank\">penalties\u003c/a> the Centers for Medicare & Medicaid Services levied on it last month in response to what the agency called life-threatening deficiencies at the company's California lab.\u003c/p>\n\u003cp>Theranos said it has filed an intent to appeal the sanctions with CMS.\u003c/p>\n\u003cp>\"Theranos is not conducting patient testing at its Newark facility,\" the statement said. \"In addition, since CMS originally announced the imposition of sanctions, Theranos has made substantial progress toward correcting the deficiencies CMS identified, including appointing new laboratory leadership; enhancing Theranos’ clinical policies and procedures; and revamping training programs.\u003c/p>\n\u003cp>\"While the appeal is pending, Theranos intends to continue communicating with CMS regarding the possibility of reaching a mutually agreeable resolution to this matter.\"\u003c/p>\n\u003cp>CMS had previously said Theranos could “begin negotiations” with the agency. Any agreement would be based on the ability of Theranos to “remove immediate jeopardy” to patients, the agency said, as well as other factors, such as the severity of the lab's deficiencies and “the overall compliance history of the laboratory.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The \u003ca href=\"https://www.scribd.com/document/317817195/CMS-Notification-of-Imposition-of-Sanctions-for-Theranos\" target=\"_blank\">penalties\u003c/a> CMS imposed on Theranos include revoking the blood-testing company’s license to operate the Newark, California lab and barring founder and CEO Elizabeth Holmes from owning, operating or directing a lab for at least two years. CMS also canceled the Newark lab’s approval to receive payments from Medicare and Medicaid.\u003c/p>\n\u003cp>When the penalties were announced in July, laboratory medicine experts called them unusually harsh.\u003c/p>\n\u003cp>Dr. Norman Paradis, a professor of medicine at Dartmouth, who has consulted for both diagnostic startups and biomed investors, said the magnitude of the penalties could be one-of-a-kind.\u003c/p>\n\u003cp>“I’ve never heard of a penalty this severe,” he said. “I’m surprised that they could not have avoided this in light of the new involvement of experienced people and renowned attorneys.”\u003c/p>\n\u003cp>In April, Theranos hired a number of experts for its medical advisory board. High-powered lawyer David Boies represents the company and \u003ca href=\"http://www.nytimes.com/2016/02/03/business/dealbook/david-boiess-dual-roles-at-theranos-set-up-conflict.html\" target=\"_blank\">also serves\u003c/a> on its board.\u003c/p>\n\u003cp>Earlier this month, Holmes attempted a fresh start by giving a much-anticipated presentation at the annual meeting of the American Association for Clinical Chemistry. That was a gathering of the very sort of experts who had expressed skepticism about the company's central claim -- that it could perform dozens of tests by collecting just a few drops of the patient's blood from a finger prick. The FDA has approved only one of those assays, for the herpes simplex virus.\u003c/p>\n\u003cp>But rather than using the presentation to produce data verifying its technology, Holmes unveiled a new portable testing device called a miniLab, which was \u003ca href=\"https://ww2.kqed.org/futureofyou/2016/07/29/theranos-elizabeth-holmes-will-face-1000-scientists-monday-can-she-say-anything-to-gain-their-trust/\" target=\"_blank\">underwhelming\u003c/a> to those present.\u003c/p>\n\u003cp>The Wall Street Journal has reported the company is facing at least eight lawsuits related to that original, controversial and mysterious technology, called \"Edison,\" which Theranos\u003cstrong> \u003c/strong>says is now obsolete. In May, the company \u003ca href=\"https://ww2.kqed.org/futureofyou/2016/05/19/theranos-corrects-tens-of-thousands-of-blood-tests/\" target=\"_blank\">voided or corrected\u003c/a> tens of thousands of blood tests from 2014-15.\u003c/p>\n\u003cp>Per \u003ca href=\"https://www.law.cornell.edu/cfr/text/42/493.1844\" target=\"_blank\">federal regulations\u003c/a>, if Theranos loses its appeal, which will go to an administrative law judge, it can file a request for review by an appeals board. If it loses that one, it will have 60 days to request judicial review with the U.S. Court of Appeals.\u003c/p>\n\u003cp>Experts who have commented on the case have said if no settlement can be reached, companies almost never win these things.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>In the meantime, Theranos is still operating its remaining lab, in Arizona. But how brisk can business be? Walgreens withdrew from its partnership with the company, shutting down dozens of Theranos blood-draw centers in the pharmacy chain's Arizona stores. That leaves just a handful of collection sites for customers to patronize.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "With Gene Test, Some Breast Cancer Patients Can Skip Chemo: Study",
"title": "With Gene Test, Some Breast Cancer Patients Can Skip Chemo: Study",
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"content": "\u003cp>Some early-stage, post-operative breast cancer patients meeting a certain genetic profile can avoid potentially dangerous and expensive chemotherapy with only a slightly lower survival rate, and without the cancer spreading, a \u003ca href=\"http://www.nejm.org/doi/full/10.1056/NEJMoa1602253\">major study\u003c/a> published in The New England Journal of Medicine Wednesday has found.\u003c/p>\n\u003cp>The study said that 46 percent of subjects who were classified as high-risk by traditional clinical criteria but low-risk according to their genetics could skip chemo and expose themselves to just a slightly greater risk – 1.5 percent -- of the cancer \u003ca href=\"http://www.cancer.gov/publications/dictionaries/cancer-terms?cdrid=46283\" target=\"_blank\">metastasizing\u003c/a> after five years.\u003c/p>\n\u003cp>Those who received chemo had a 95.9 percent rate of success after five years, compared to 94.4 percent of those who did not get the treatment.\u003c/p>\n\u003cfigure id=\"attachment_230055\" class=\"wp-caption aligncenter\" style=\"max-width: 460px\">\u003cimg class=\"size-medium wp-image-230055\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/08/iStock_000067189851_Large-1920x2502-460x600.jpg\" alt=\"A mammogram image.\" width=\"460\" height=\"600\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2016/08/iStock_000067189851_Large-1920x2502-460x600.jpg 460w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/iStock_000067189851_Large-1920x2502-400x521.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/iStock_000067189851_Large-1920x2502-768x1001.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/iStock_000067189851_Large-1920x2502-906x1180.jpg 906w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/iStock_000067189851_Large-1920x2502.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/iStock_000067189851_Large-1920x2502-1180x1538.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/iStock_000067189851_Large-1920x2502-960x1251.jpg 960w\" sizes=\"(max-width: 460px) 100vw, 460px\">\u003cfigcaption class=\"wp-caption-text\">A mammogram image. \u003ccite>(Getty Images)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>In other words, the difference between opting for chemo or not is so small that \"You would have to treat 100 of those [patients] with chemotherapy for the benefit of one,\" said Dr. Laura van't Veer, one of the leaders of the breast oncology program at the University of California, San Francisco, who helped develop the test that the researchers used to determine the genetic risk level of recurrence for each patient.\u003c/p>\n\u003cp>That still may be enough of a difference for some patients and their doctors to choose chemo. In an \u003ca href=\"http://www.nejm.org/doi/full/10.1056/NEJMe1607947?query=featured_genetics\" target=\"_blank\">editorial\u003c/a> that accompanied the study in the NEJM, Dr. Clifford A. Hudis, chief executive officer of the American Society of Clinical Oncology, and Dr. Maura Dickler, a researcher who also treats breast cancer patients at Memorial Sloan Kettering Cancer Center in New York City, said the decision whether to undergo chemo or not won't be a slam dunk, even with the new information provided by the test.\u003c/p>\n\u003caside class=\"pullquote alignright\">'It's such a low benefit that many breast cancer patients will decide not to take chemotherapy.'\u003ccite>Prof. Laura van't Veer, UCSF\u003c/cite>\u003c/aside>\n\u003cp>\"(A) difference of 1.5 percentage points, if real, might mean more to one patient than to another,\" they wrote. \"Thus, the stated difference does not precisely exclude a benefit that clinicians and patients might find meaningful.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Dr. van't Veer said, nevertheless, many whose risk is low according to the test would opt out: \"It doesn't mean you should not acknowledge [the risk], but it's such a low benefit that many breast cancer patients will decide not to take chemotherapy.\"\u003c/p>\n\u003cp>Dr. Fatima Cardoso, the study's lead author and a breast cancer specialist at the Champalimaud Clinical Center in Lisbon, Portugal, said that women at her clinic shown to be at low genetic risk through MammaPrint usually choose to forego chemo.\u003c/p>\n\u003cp>\"But there always [are] some patients for whom 1 percent benefit is enough — and you need to respect the wishes of each individual patient.\"\u003c/p>\n\u003cp>Side effects from chemotherapy can include hair loss, mouth sores, diarrhea, early menopause, dental issues and in rare cases leukemia and other diseases.\u003c/p>\n\u003cp>MammaPrint is priced at $4,200 and is covered by some insurance in the U.S.\u003c/p>\n\u003cp>\u003cstrong>European Study\u003c/strong>\u003c/p>\n\u003cp>The phase 3 study, called MINDACT, enrolled 6,693 breast cancer patients, recruited from 2007 to 2011 from 112 hospitals in nine European countries. Patients were between 18 and 70.\u003c/p>\n\u003cp>The point of the study was to compare a 70-gene risk-assessment test called \u003ca href=\"http://www.agendia.com/healthcare-professionals/breast-cancer/mammaprint/\" target=\"_blank\">MammaPrint\u003c/a> to a risk classification system that ignores genetics but takes into account clinical characteristics like a patient's age, tumor diameter, and whether the cancer has spread to the lymph nodes. The researchers wanted to know whether patients who were classified as high-risk according to the clinical criteria but low-risk according to MammaPrint had better or worse outcomes if they did not receive chemo.\u003c/p>\n\u003cp>Dr. van’t Veer and other researchers in the study are part of a company, \u003ca href=\"http://www.agendia.com/about/executive-management/\">Agendia\u003c/a>, that has sold MammaPrint commercially in the U.S. since 2008.\u003c/p>\n\u003cp>A total of 1,550 patients fell under a group with either high clinical and low genetic risk profiles or low clinical and high genetic risk profiles. Those patients were then randomized into either receiving chemo or not. After five years, those who had not received the treatment were 1.5 percent more likely to avoid seeing the cancer spread into distant areas than those who had received the treatment. [contextly_sidebar id=\"ZGXIiKTBs6PgwGIe3Te78GFDOl9QSCmS\"]\u003c/p>\n\u003cp>The study focused on women with stage 1, stage 2 and operable stage 3 breast cancer, with up to three affected lymph nodes.\u003c/p>\n\u003cp>About 246,660 patients will receive an invasive breast cancer diagnosis in 2016, according to the \u003ca href=\"http://www.cancer.org/cancer/breastcancer/detailedguide/breast-cancer-key-statistics\" target=\"_blank\">American Cancer Society\u003c/a>. Of that group, van't Veer estimated that MammaPrint could flag 35,000 to 40,000 breast cancer patients as being in a position not to pursue chemotherapy and still experience a statistically small chance of recurrence.\u003c/p>\n\u003cp>Karuna Jaggar, the executive director of Breast Cancer Action, a breast cancer advocacy organization, thought the study was significant, and a win for what's known as precision medicine -- tailoring treatments according to the individual characteristics of patients.\u003c/p>\n\u003cp>\"We know that there are harms that come with any treatment, whether it's surgery, radiation or chemotherapy. And it's very important for patients to be able to weigh the risks and benefits when making their own treatment decisions.\"\u003c/p>\n\u003cp>Jaggar said the financial fallout from receiving chemotherapy can be significant. Besides the cost of treatment, which she said can reach well over $100,000, \"There's a lot of data that shows even several years after treatment, women who have undergone chemotherapy are more likely to be un- and underemployed.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>\u003ca href=\"http://www.npr.org/sections/health-shots/2016/08/24/491213713/study-of-breast-cancer-treatment-reveals-paradox-of-precision-medicine\" target=\"_blank\">NPR\u003c/a> contributed to this report.\u003c/em>\u003c/p>\n\n",
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"excerpt": "Up to 46 percent of breast cancer patients who receive chemotherapy may find it no more effective than if they had skipped it altogether, and a genetic test can spare them the unnecessary treatment, a new study says.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Some early-stage, post-operative breast cancer patients meeting a certain genetic profile can avoid potentially dangerous and expensive chemotherapy with only a slightly lower survival rate, and without the cancer spreading, a \u003ca href=\"http://www.nejm.org/doi/full/10.1056/NEJMoa1602253\">major study\u003c/a> published in The New England Journal of Medicine Wednesday has found.\u003c/p>\n\u003cp>The study said that 46 percent of subjects who were classified as high-risk by traditional clinical criteria but low-risk according to their genetics could skip chemo and expose themselves to just a slightly greater risk – 1.5 percent -- of the cancer \u003ca href=\"http://www.cancer.gov/publications/dictionaries/cancer-terms?cdrid=46283\" target=\"_blank\">metastasizing\u003c/a> after five years.\u003c/p>\n\u003cp>Those who received chemo had a 95.9 percent rate of success after five years, compared to 94.4 percent of those who did not get the treatment.\u003c/p>\n\u003cfigure id=\"attachment_230055\" class=\"wp-caption aligncenter\" style=\"max-width: 460px\">\u003cimg class=\"size-medium wp-image-230055\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/08/iStock_000067189851_Large-1920x2502-460x600.jpg\" alt=\"A mammogram image.\" width=\"460\" height=\"600\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2016/08/iStock_000067189851_Large-1920x2502-460x600.jpg 460w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/iStock_000067189851_Large-1920x2502-400x521.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/iStock_000067189851_Large-1920x2502-768x1001.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/iStock_000067189851_Large-1920x2502-906x1180.jpg 906w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/iStock_000067189851_Large-1920x2502.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/iStock_000067189851_Large-1920x2502-1180x1538.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/iStock_000067189851_Large-1920x2502-960x1251.jpg 960w\" sizes=\"(max-width: 460px) 100vw, 460px\">\u003cfigcaption class=\"wp-caption-text\">A mammogram image. \u003ccite>(Getty Images)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>In other words, the difference between opting for chemo or not is so small that \"You would have to treat 100 of those [patients] with chemotherapy for the benefit of one,\" said Dr. Laura van't Veer, one of the leaders of the breast oncology program at the University of California, San Francisco, who helped develop the test that the researchers used to determine the genetic risk level of recurrence for each patient.\u003c/p>\n\u003cp>That still may be enough of a difference for some patients and their doctors to choose chemo. In an \u003ca href=\"http://www.nejm.org/doi/full/10.1056/NEJMe1607947?query=featured_genetics\" target=\"_blank\">editorial\u003c/a> that accompanied the study in the NEJM, Dr. Clifford A. Hudis, chief executive officer of the American Society of Clinical Oncology, and Dr. Maura Dickler, a researcher who also treats breast cancer patients at Memorial Sloan Kettering Cancer Center in New York City, said the decision whether to undergo chemo or not won't be a slam dunk, even with the new information provided by the test.\u003c/p>\n\u003caside class=\"pullquote alignright\">'It's such a low benefit that many breast cancer patients will decide not to take chemotherapy.'\u003ccite>Prof. Laura van't Veer, UCSF\u003c/cite>\u003c/aside>\n\u003cp>\"(A) difference of 1.5 percentage points, if real, might mean more to one patient than to another,\" they wrote. \"Thus, the stated difference does not precisely exclude a benefit that clinicians and patients might find meaningful.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Dr. van't Veer said, nevertheless, many whose risk is low according to the test would opt out: \"It doesn't mean you should not acknowledge [the risk], but it's such a low benefit that many breast cancer patients will decide not to take chemotherapy.\"\u003c/p>\n\u003cp>Dr. Fatima Cardoso, the study's lead author and a breast cancer specialist at the Champalimaud Clinical Center in Lisbon, Portugal, said that women at her clinic shown to be at low genetic risk through MammaPrint usually choose to forego chemo.\u003c/p>\n\u003cp>\"But there always [are] some patients for whom 1 percent benefit is enough — and you need to respect the wishes of each individual patient.\"\u003c/p>\n\u003cp>Side effects from chemotherapy can include hair loss, mouth sores, diarrhea, early menopause, dental issues and in rare cases leukemia and other diseases.\u003c/p>\n\u003cp>MammaPrint is priced at $4,200 and is covered by some insurance in the U.S.\u003c/p>\n\u003cp>\u003cstrong>European Study\u003c/strong>\u003c/p>\n\u003cp>The phase 3 study, called MINDACT, enrolled 6,693 breast cancer patients, recruited from 2007 to 2011 from 112 hospitals in nine European countries. Patients were between 18 and 70.\u003c/p>\n\u003cp>The point of the study was to compare a 70-gene risk-assessment test called \u003ca href=\"http://www.agendia.com/healthcare-professionals/breast-cancer/mammaprint/\" target=\"_blank\">MammaPrint\u003c/a> to a risk classification system that ignores genetics but takes into account clinical characteristics like a patient's age, tumor diameter, and whether the cancer has spread to the lymph nodes. The researchers wanted to know whether patients who were classified as high-risk according to the clinical criteria but low-risk according to MammaPrint had better or worse outcomes if they did not receive chemo.\u003c/p>\n\u003cp>Dr. van’t Veer and other researchers in the study are part of a company, \u003ca href=\"http://www.agendia.com/about/executive-management/\">Agendia\u003c/a>, that has sold MammaPrint commercially in the U.S. since 2008.\u003c/p>\n\u003cp>A total of 1,550 patients fell under a group with either high clinical and low genetic risk profiles or low clinical and high genetic risk profiles. Those patients were then randomized into either receiving chemo or not. After five years, those who had not received the treatment were 1.5 percent more likely to avoid seeing the cancer spread into distant areas than those who had received the treatment. \u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>The study focused on women with stage 1, stage 2 and operable stage 3 breast cancer, with up to three affected lymph nodes.\u003c/p>\n\u003cp>About 246,660 patients will receive an invasive breast cancer diagnosis in 2016, according to the \u003ca href=\"http://www.cancer.org/cancer/breastcancer/detailedguide/breast-cancer-key-statistics\" target=\"_blank\">American Cancer Society\u003c/a>. Of that group, van't Veer estimated that MammaPrint could flag 35,000 to 40,000 breast cancer patients as being in a position not to pursue chemotherapy and still experience a statistically small chance of recurrence.\u003c/p>\n\u003cp>Karuna Jaggar, the executive director of Breast Cancer Action, a breast cancer advocacy organization, thought the study was significant, and a win for what's known as precision medicine -- tailoring treatments according to the individual characteristics of patients.\u003c/p>\n\u003cp>\"We know that there are harms that come with any treatment, whether it's surgery, radiation or chemotherapy. And it's very important for patients to be able to weigh the risks and benefits when making their own treatment decisions.\"\u003c/p>\n\u003cp>Jaggar said the financial fallout from receiving chemotherapy can be significant. Besides the cost of treatment, which she said can reach well over $100,000, \"There's a lot of data that shows even several years after treatment, women who have undergone chemotherapy are more likely to be un- and underemployed.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>\u003ca href=\"http://www.npr.org/sections/health-shots/2016/08/24/491213713/study-of-breast-cancer-treatment-reveals-paradox-of-precision-medicine\" target=\"_blank\">NPR\u003c/a> contributed to this report.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>When Scott Gatz and his husband decided to become fathers several years ago, pursuing parenthood meant finding both an egg donor and a surrogate to help them conceive a baby. Their first round of in vitro fertilization produced seven healthy embryos. One of those embryos was successfully transferred to their surrogate's womb, resulting in their son Matthew, who is now 6-years-old.\u003c/p>\n\u003caside class=\"pullquote alignright\">\"Every time we read the 'destroy' option on the form, my stomach does a somersault. It feels as if our future children are showing up once a year to confront us.\"\u003c/aside>\n\u003cp>While the San Francisco couple feels their family is now complete, they are still in a quandary over what to do with their six remaining embryos — what they call their \"maybe babies.\"\u003c/p>\n\u003cp>Every year they're forced to weigh their options again, Gatz tells Shots, when a letter arrives from the fertility clinic. It asks whether they want to destroy the embryos, donate them for medical research, give them to another infertile couple or continue paying $800 annually to keep the embryos frozen.\u003c/p>\n\u003cp>\"Every time we read the 'destroy' option on the form, my stomach does a somersault,\" Gatz says. \"It feels as if our future children are showing up once a year to confront us.\"\u003c/p>\n\u003cp>The men are not alone in their ambivalence. It's estimated that, in the United States, there are almost \u003ca href=\"http://www.hhs.gov/opa/about-opa-and-initiatives/embryo-adoption/\">one million\u003c/a> frozen embryos now in storage, a number that includes embryos reserved for research, as well as those reserved to expand families.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cstrong>Indecision Reigns\u003c/strong>\u003c/p>\n\u003cp>In a 2005 \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/16084886\">study\u003c/a> that interviewed 58 couples who conceived through IVF and had at least one frozen embryo in storage, more than 70 percent had not yet decided — even several years after the procedure — how they would dispose of a surplus embryo. Some said they considered the embryos to be biologic tissue or a genetic or psychological \"insurance policy.\" Others told the researchers they thought of the embryos as living entities — \"virtual children\" that have interests that needed to be considered and protected.\u003c/p>\n\u003cp>\"With the astonishing advancements in reproductive science, IVF now produces far more embryos than it did in the past,\" says Dr. Anna Glezer, a psychiatrist at the University of California, San Francisco. The choices that abundance poses are very difficult for some couples, she says, \"which raises the need for psychological resources, such as peer support groups for these families.'\u003c/p>\n\u003cp>After conceiving their daughter via IVF, Megan and Jay Khmelev had eight remaining embryos. For two years, says Megan, she was overcome by guilt, anxiety, and sadness as she struggled with what to do with them. At the beginning of her fertility journey, she had imagined one day donating the embryos to science or to another infertile couple.\u003c/p>\n\u003cp>But after her daughter arrived, she says, she couldn't imagine parting with the surplus embryos in this way. The Khmelevs didn't want eight more children, but discarding the embryos didn't feel like the right choice, either.\u003c/p>\n\u003cp>\"I wish someone had told me that I'd be haunted by the grief of my infertility struggle all over again as I wrestled with my decision,\" Megan says.\u003c/p>\n\u003cp>\u003ca href=\"http://eggwhisperer.com/\">Dr. Aimee Eyvazzadeh\u003c/a>, a reproductive endocrinologist in the San Francisco Bay area, says many families she counsels struggle with these choices.\u003c/p>\n\u003cp>\"It's a complicated process,\" Eyvazzadeh says. \"At the beginning of IVF, patients hope for many embryos, because they long to have a baby. They don't realize how their feelings might change once their children are born.\"\u003c/p>\n\u003cp>In the 1980s, when fertility clinics began freezing embryos, there wasn't any available research about how patients would feel regarding their frozen embryos after they became parents. More than 30 years later, though the number of IVF babies has \u003ca href=\"http://www.npr.org/sections/health-shots/2014/02/18/279035110/ivf-baby-boom-births-from-fertility-procedure-hit-new-high\">steadily climbed\u003c/a>, many fertility doctors are still unsure how to handle some patients' ambivalence.\u003c/p>\n\u003cp>\"Our clinic told us that we could freeze our embryos and explained the cost associated with yearly storage fees,\" Gatz says, \"but they didn't mention the feelings that might arise as we faced these choices.\"\u003c/p>\n\u003cp>A study \u003ca href=\"http://www.fertstert.org/article/S0015-0282(15)02109-3/abstract\">published\u003c/a> in the March issue of the journal \u003cem>Fertility and Sterility\u003c/em> found that that after successful IVF treatment, most of the 131 couples responding to a survey were dissatisfied with the education they obtained from their health care providers about disposal decisions. And less than 50 percent were satisfied with the emotional guidance they got.\u003c/p>\n\u003cp>Yet other research suggests that \u003ca href=\"http://www.sciencedirect.com/science/article/pii/S0015028215022232\">peer support\u003c/a> \u003cem>can \u003c/em>help people make these complicated choices, by giving them a place to disclose their struggles in the company of others who have been through the process.\u003c/p>\n\u003cp>\u003ca href=\"http://latalktherapy.com/dr-lederer/\">Francine Lederer,\u003c/a> a clinical psychologist in private practice in Los Angeles, offers a \"disposition support group,\" specifically aimed at couples and individuals who are deciding what to do with their embryos.\u003c/p>\n\u003cp>\"After successful IVF treatments, many couples come to view their embryos as human life, which makes it even harder for them to find closure,\" Lederer says. Some even have funeral ceremonies for the embryos.\u003c/p>\n\u003cp>For other couples, making these decisions ignites emotional conflict between the spouses, or even beyond — to include the extended family, Lederer finds, because religious beliefs and personal preferences play a role in how each person views the stored embryos. One couple she counseled who had decided to destroy the embryos mentioned that to their parents and discovered the in-laws were aghast.\u003c/p>\n\u003cp>\"Too often, these families have never shared their stories aloud,\" says Lederer. \"Support groups can make a difference by allowing them to talk about their personal experiences with others who understand, which can help them to feel less isolated.\"\u003c/p>\n\u003cp>Megan and Jay Khmelev finally decided to do additional rounds of IVF, and use the remaining embryos themselves, but none resulted in a viable pregnancy.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"I'm glad I did the transfers anyway,\" Megan says. \"It gave me and my husband closure, knowing that we had given them a chance to become life.\"\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=After+IVF%2C+Some+Struggle+With+What+To+Do+With+Leftover+Embryos&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>When Scott Gatz and his husband decided to become fathers several years ago, pursuing parenthood meant finding both an egg donor and a surrogate to help them conceive a baby. Their first round of in vitro fertilization produced seven healthy embryos. One of those embryos was successfully transferred to their surrogate's womb, resulting in their son Matthew, who is now 6-years-old.\u003c/p>\n\u003caside class=\"pullquote alignright\">\"Every time we read the 'destroy' option on the form, my stomach does a somersault. It feels as if our future children are showing up once a year to confront us.\"\u003c/aside>\n\u003cp>While the San Francisco couple feels their family is now complete, they are still in a quandary over what to do with their six remaining embryos — what they call their \"maybe babies.\"\u003c/p>\n\u003cp>Every year they're forced to weigh their options again, Gatz tells Shots, when a letter arrives from the fertility clinic. It asks whether they want to destroy the embryos, donate them for medical research, give them to another infertile couple or continue paying $800 annually to keep the embryos frozen.\u003c/p>\n\u003cp>\"Every time we read the 'destroy' option on the form, my stomach does a somersault,\" Gatz says. \"It feels as if our future children are showing up once a year to confront us.\"\u003c/p>\n\u003cp>The men are not alone in their ambivalence. It's estimated that, in the United States, there are almost \u003ca href=\"http://www.hhs.gov/opa/about-opa-and-initiatives/embryo-adoption/\">one million\u003c/a> frozen embryos now in storage, a number that includes embryos reserved for research, as well as those reserved to expand families.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cstrong>Indecision Reigns\u003c/strong>\u003c/p>\n\u003cp>In a 2005 \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/16084886\">study\u003c/a> that interviewed 58 couples who conceived through IVF and had at least one frozen embryo in storage, more than 70 percent had not yet decided — even several years after the procedure — how they would dispose of a surplus embryo. Some said they considered the embryos to be biologic tissue or a genetic or psychological \"insurance policy.\" Others told the researchers they thought of the embryos as living entities — \"virtual children\" that have interests that needed to be considered and protected.\u003c/p>\n\u003cp>\"With the astonishing advancements in reproductive science, IVF now produces far more embryos than it did in the past,\" says Dr. Anna Glezer, a psychiatrist at the University of California, San Francisco. The choices that abundance poses are very difficult for some couples, she says, \"which raises the need for psychological resources, such as peer support groups for these families.'\u003c/p>\n\u003cp>After conceiving their daughter via IVF, Megan and Jay Khmelev had eight remaining embryos. For two years, says Megan, she was overcome by guilt, anxiety, and sadness as she struggled with what to do with them. At the beginning of her fertility journey, she had imagined one day donating the embryos to science or to another infertile couple.\u003c/p>\n\u003cp>But after her daughter arrived, she says, she couldn't imagine parting with the surplus embryos in this way. The Khmelevs didn't want eight more children, but discarding the embryos didn't feel like the right choice, either.\u003c/p>\n\u003cp>\"I wish someone had told me that I'd be haunted by the grief of my infertility struggle all over again as I wrestled with my decision,\" Megan says.\u003c/p>\n\u003cp>\u003ca href=\"http://eggwhisperer.com/\">Dr. Aimee Eyvazzadeh\u003c/a>, a reproductive endocrinologist in the San Francisco Bay area, says many families she counsels struggle with these choices.\u003c/p>\n\u003cp>\"It's a complicated process,\" Eyvazzadeh says. \"At the beginning of IVF, patients hope for many embryos, because they long to have a baby. They don't realize how their feelings might change once their children are born.\"\u003c/p>\n\u003cp>In the 1980s, when fertility clinics began freezing embryos, there wasn't any available research about how patients would feel regarding their frozen embryos after they became parents. More than 30 years later, though the number of IVF babies has \u003ca href=\"http://www.npr.org/sections/health-shots/2014/02/18/279035110/ivf-baby-boom-births-from-fertility-procedure-hit-new-high\">steadily climbed\u003c/a>, many fertility doctors are still unsure how to handle some patients' ambivalence.\u003c/p>\n\u003cp>\"Our clinic told us that we could freeze our embryos and explained the cost associated with yearly storage fees,\" Gatz says, \"but they didn't mention the feelings that might arise as we faced these choices.\"\u003c/p>\n\u003cp>A study \u003ca href=\"http://www.fertstert.org/article/S0015-0282(15)02109-3/abstract\">published\u003c/a> in the March issue of the journal \u003cem>Fertility and Sterility\u003c/em> found that that after successful IVF treatment, most of the 131 couples responding to a survey were dissatisfied with the education they obtained from their health care providers about disposal decisions. And less than 50 percent were satisfied with the emotional guidance they got.\u003c/p>\n\u003cp>Yet other research suggests that \u003ca href=\"http://www.sciencedirect.com/science/article/pii/S0015028215022232\">peer support\u003c/a> \u003cem>can \u003c/em>help people make these complicated choices, by giving them a place to disclose their struggles in the company of others who have been through the process.\u003c/p>\n\u003cp>\u003ca href=\"http://latalktherapy.com/dr-lederer/\">Francine Lederer,\u003c/a> a clinical psychologist in private practice in Los Angeles, offers a \"disposition support group,\" specifically aimed at couples and individuals who are deciding what to do with their embryos.\u003c/p>\n\u003cp>\"After successful IVF treatments, many couples come to view their embryos as human life, which makes it even harder for them to find closure,\" Lederer says. Some even have funeral ceremonies for the embryos.\u003c/p>\n\u003cp>For other couples, making these decisions ignites emotional conflict between the spouses, or even beyond — to include the extended family, Lederer finds, because religious beliefs and personal preferences play a role in how each person views the stored embryos. One couple she counseled who had decided to destroy the embryos mentioned that to their parents and discovered the in-laws were aghast.\u003c/p>\n\u003cp>\"Too often, these families have never shared their stories aloud,\" says Lederer. \"Support groups can make a difference by allowing them to talk about their personal experiences with others who understand, which can help them to feel less isolated.\"\u003c/p>\n\u003cp>Megan and Jay Khmelev finally decided to do additional rounds of IVF, and use the remaining embryos themselves, but none resulted in a viable pregnancy.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"I'm glad I did the transfers anyway,\" Megan says. \"It gave me and my husband closure, knowing that we had given them a chance to become life.\"\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=After+IVF%2C+Some+Struggle+With+What+To+Do+With+Leftover+Embryos&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Puberty is no picnic, even in the best of circumstances. Once the sex hormones estrogen or testosterone kick in, there’s no turning back: Here come breasts and periods, Adam’s apples and acne. It’s a tough passage for many kids, but for some — transgender youth whose bodies don’t match their gender identity — puberty can be unbearable.\u003c/p>\n\u003caside class=\"pullquote alignright\">Full-blown puberty is irreversible, but for transgender children, it’s no longer inevitable.\u003c/aside>\n\u003cp>For one Oakland family, their daughter’s path was clear from the time she was three. Her birth certificate said “male,” but the child would always say she wanted to be a girl, and that soon became, “I AM a girl,” said the mother, who asked that her family’s name not be used to protect her daughter’s privacy. She recalled a day when the girl wept in frustration trying to fashion a skirt out of some t-shirts.\u003c/p>\n\u003cp>“Finally I just said, ‘Honey, do you want a dress?’’ and they went to a store and bought one. “I literally thought she was going to faint or hyperventilate,” said the mother. “She couldn’t sit still, she was so excited and so happy. It was a moment of pure joy for her, and also a turning point,” she said.\u003c/p>\n\u003cp>She was happy growing up and attended a progressive school in the San Francisco Bay Area as a girl. But when she was approaching puberty, she became very nervous, “worried about getting facial hair or watching her shoulders get broader. It was all very painful for her,” her mother said.\u003c/p>\n\u003cp>The child was experiencing what’s known as \u003ca href=\"http://www.dsm5.org/documents/gender%20dysphoria%20fact%20sheet.pdf\" target=\"_blank\">gender dysphoria\u003c/a>, a DSM-5 diagnosis of significant ongoing distress, with the feeling of being assigned the wrong gender at birth. Researchers at Harvard \u003ca href=\"http://www.jahonline.org/article/S1054-139X%2814%2900693-4/abstract\" target=\"_blank\">recently found\u003c/a> that transgender youth are at a much higher risk for mental disorders, including depression, anxiety, suicidal thoughts and self-harm. They are more than twice as likely as non-trans youth to be diagnosed with depression (50.6 percent vs. 20.6 percent) or suffer from anxiety (26.7 percent vs. 10 percent).\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“These kids are saying to the world, ‘I was born in the wrong body, and there’s something just not right about living this way,’” said Scott Leibowitz, head child and adolescent psychiatrist at the Ann & Robert H. Lurie Children’s Hospital of Chicago.\u003c/p>\n\u003cp>\u003cstrong>Blockers ‘Safe and Effective’\u003c/strong>\u003c/p>\n\u003cp>Full-blown puberty is irreversible, but for transgender children, it’s no longer inevitable. By taking a gonadotropin-releasing hormone (GnRH) agonist, secretion of the sex hormones can be stopped and the onset of puberty suppressed, so that the body does not develop secondary sex characteristics. This has been done safely for decades to suppress sex hormones in children who develop too early, a condition known as precocious puberty. Suppressors have also been used to treat endometriosis, uterine fibroids and prostate cancer.\u003c/p>\n\u003cp>It was only in 2008 that \u003ca href=\"https://endocrine.org/\" target=\"_blank\">the Endocrine Society\u003c/a> approved puberty suppressors as a treatment for transgender adolescents as young as 12 years old. The Society, with members in more than 100 countries, has \u003ca href=\"https://www.endocrine.org/news-room/press-release-archives/2013/medical-intervention-in-transgender-adolescents-appears-to-be-safe-and-effective\" target=\"_blank\">since declared\u003c/a> that the intervention appears to be safe and effective. In 2011 the \u003ca href=\"http://www.wpath.org/site_page.cfm?pk_association_webpage_menu=1347&pk_association_webpage=4233\" target=\"_blank\">World Professional Association for Transgender Health\u003c/a> (WPATH), also issued Standards of Care for the treatment of patients with gender dysphoria, which include puberty suppression.\u003c/p>\n\u003caside class=\"pullquote alignright\">'As soon as he got breast buds, it was like the panic button was hit. He was quickly and very intensely uncomfortable and afraid.'\u003c/aside>\n\u003cp>There are few reported side effects to this off-label use of sex hormone suppressors. Despite early concerns that blocking sex hormones might harm bone development, a \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/25427144\" target=\"_blank\">recent study\u003c/a> from the Netherlands found no evidence of long-term effects on bone mineral density. If the suppressors are halted, puberty resumes as if there had been no treatment.\u003c/p>\n\u003cp>Data on the use of puberty blockers is scarce, but in the past decade or so, it’s believed thousands of transgender youth and their families have chosen to suppress puberty to give adolescents a time-out while they figure out the next step in their development.\u003c/p>\n\u003cp>A St. Louis, Mo., child was classified as female at birth, one of a set of twin girls. But the parents had been discussing puberty blockers with him since he was seven years old, after he had begun dressing as a boy and showing more masculine traits.\u003c/p>\n\u003cp>“I remember watching a documentary where he learned what blockers were and we talked about it and he was sure that’s what he wanted when the time came,” said his mother, who also asked that the family’s names not be used to protect her child’s privacy.\u003c/p>\n\u003cp>“As soon as he got breast buds, it was like the panic button was hit,” the mother said. “He was quickly and very intensely uncomfortable and afraid. He would cry, knowing that this was the beginning of something that he didn’t want, that he knew wasn’t right for him,” she said.\u003c/p>\n\u003cp>In March, after the boy turned 11, a pediatric endocrinologist prescribed the sex hormone suppressor Eligard, an injection that he receives every four months. According to his mother, because they intervened early, the unwanted breast buds receded quickly, along with her son’s depression and anxiety. “I don’t know what we would have done if we were not able to stop puberty so he doesn’t have to feel in constant conflict with his own body,” she said.\u003c/p>\n\u003cp>So far, according to the mother, the biggest problem their family has faced has been trying to get insurance coverage for her son’s treatment. She said they have been lucky to obtain the injections at cost — $500 per shot — rather than the $1,500 to $2,000 per shot that the therapy typically costs. Her husband’s employer, which self-funds its medical insurance plan, chose a clause that excludes transgender care.\u003c/p>\n\u003cp>That kind of exclusion could change, especially since the Obama Administration recently issued \u003ca href=\"https://s3.amazonaws.com/public-inspection.federalregister.gov/2016-11458.pdf\" target=\"_blank\">final regulations on Section 1557 of the Affordable Care Act\u003c/a> that ban the denial of health care on the basis of gender identity in programs that receive federal funding. The rule could help people who feel they have been discriminated against to bring complaints or lawsuits, according to the \u003ca href=\"http://transgenderlawcenter.org/archives/12908\" target=\"_blank\">Transgender Law Center\u003c/a> in Oakland, Calif.\u003c/p>\n\u003cp>In 2014, Oregon became the first state to provide Medicaid coverage for adolescents receiving puberty blockers. Medicaid programs in other states, including New York and California, have also expanded transgender healthcare coverage, although that does not mean that puberty blockers always are covered.\u003c/p>\n\u003cp>\u003cstrong>How Early is Too Early?\u003c/strong>\u003c/p>\n\u003cp>Treatment with puberty blockers gives transgender children a breather so they can continue to mature and decide whether they will pursue treatment with cross-sex hormones or gender reassignment surgery. For many families, the question is not whether to intervene with blockers, but how early to start.\u003c/p>\n\u003cp>Because the onset of puberty varies so widely — as early as age 9 for some — suppression can begin at different ages. And that’s prompted some disagreement within the field — the “age versus stage” debate — about when to begin, according to Leibowitz. Most often blockers are initiated at the first visible signs of development as measured by the \u003ca href=\"http://www.childgrowthfoundation.org/CMS/FILES/Puberty_and_the_Tanner_Stages.pdf\" target=\"_blank\">Tanner Stages\u003c/a>, a scale of sexual maturation developed by pediatrician James Tanner. The trigger for suppression is usually Tanner stage 2, when pubic hair and breast buds appear.\u003c/p>\n\u003cp>“If you are able to suspend puberty as soon as it happens you’re optimizing the benefits that it can bring physically,” said Leibowitz. Starting early may alleviate the need for surgical breast removal or voice modification therapy later on. It also makes it far easier for transgender teens to fit in. “That ability to blend in and be perceived as the gender that they identify with is associated with long-term psychological benefits,” said Leibowitz.\u003c/p>\n\u003cp>But does that mean that 9- or 10-year-old transgender kids should be started on puberty blockers? Even though the treatment is reversible and is considered safe, Leibowitz said some clinicians argue the age issue is important because less is known about very early interventions. How long can puberty be safely suppressed? And if the next step is transitioning with cross-sex hormones, at what age should that begin?\u003c/p>\n\u003cp>Of course, there is no treatment at all unless the parents of transgender children agree. “For most of my clients [who are minors], the issue revolves around whether they can start hormones or puberty blockers without parental consent, and the short answer is ‘No,”’ said Danielle Castro, a psychotherapist and project director at the Center of Excellence for Transgender Health at the University of California, San Francisco.\u003c/p>\n\u003cp>Castro said families of some transgender youth refuse the intervention because they believe their children are “just going through a phase.” A \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/18981931\" target=\"_blank\">study\u003c/a> in 2008 found that 43 percent of very young children who experienced gender dysphoria no longer felt that way after adolescence. The 27 percent who remained dysphoric were the ones who had felt that way most strongly when they were young.\u003c/p>\n\u003cp>Young children may indeed change their minds, but gender identity seems to be fixed by the time kids have reached puberty. The Endocrine Society finds that transgender adolescents grow up to be transgender adults “100 percent of the time.” Dr. Stephen Rosenthal, director of the Child and Adolescent Gender Center at UCSF, \u003ca href=\"http://press.endocrine.org/doi/pdf/10.1210/jc.2014-1919\" target=\"_blank\">agrees\u003c/a>: “Children who meet the mental health criteria for gender dysphoria in adolescence are likely to be transgender for life.”\u003c/p>\n\u003cp>In a \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/20646177\" target=\"_blank\">recent study\u003c/a> of 70 participants all the adolescents who had been given puberty blockers went through with sex reassignment.\u003c/p>\n\u003cp>\u003cstrong>The Standard of Care\u003c/strong>\u003c/p>\n\u003cp>Even though the Oakland family had agreed in advance that their daughter would start on blockers at the right time, “we had to reassure her constantly that we wouldn’t let it go too far,” she said.\u003c/p>\n\u003cp>When she turned 13, the girl started receiving monthly injections of Lupron, a widely prescribed sex hormone suppressor. “As soon as she started, you could just see the relief in her,” said the mother. “You could see it in her demeanor, in her mood; it was just a huge weight off her shoulders,” she said.\u003c/p>\n\u003cp>The family’s insurer, Kaiser Permanente, covered the treatment. Puberty blockers are considered “standard of care in the appropriate clinical circumstances,” said Erica Metz, medical director for Transgender Health at Kaiser Permanente Northern California. According to Metz, the treatment “gives patients and their families time to work with their mental health and medical providers to determine if it is appropriate to start transitioning.”\u003c/p>\n\u003cp>When the girl was 14, she started taking estrogen — the next step in her male-to-female transition. Instead of growing facial hair and a male physique, she developed breasts and some curves. Her voice didn’t deepen, and she doesn’t have an Adam’s apple.\u003c/p>\n\u003cp>The mother described her daughter as a social, outgoing and well-adjusted teenager. She knows the \u003ca href=\"http://williamsinstitute.law.ucla.edu/research/suicide-attempts-among-transgender-and-gender-non-conforming-adults/\" target=\"_blank\">grim mental health statistics\u003c/a> for transgender people — 41 percent have attempted suicide, nearly nine times the national average — and she doesn’t want to imagine a world where her daughter would be without puberty blockers, a medical intervention that she called a “lifesaver.”\u003c/p>\n\u003cp>“The thought of her having had to go through male puberty, I think it would have destroyed her mental health and well-being,” the mother said.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This story was produced by Kaiser Health News, which publishes California Healthline, a service of the California Health Care Foundation.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Puberty is no picnic, even in the best of circumstances. Once the sex hormones estrogen or testosterone kick in, there’s no turning back: Here come breasts and periods, Adam’s apples and acne. It’s a tough passage for many kids, but for some — transgender youth whose bodies don’t match their gender identity — puberty can be unbearable.\u003c/p>\n\u003caside class=\"pullquote alignright\">Full-blown puberty is irreversible, but for transgender children, it’s no longer inevitable.\u003c/aside>\n\u003cp>For one Oakland family, their daughter’s path was clear from the time she was three. Her birth certificate said “male,” but the child would always say she wanted to be a girl, and that soon became, “I AM a girl,” said the mother, who asked that her family’s name not be used to protect her daughter’s privacy. She recalled a day when the girl wept in frustration trying to fashion a skirt out of some t-shirts.\u003c/p>\n\u003cp>“Finally I just said, ‘Honey, do you want a dress?’’ and they went to a store and bought one. “I literally thought she was going to faint or hyperventilate,” said the mother. “She couldn’t sit still, she was so excited and so happy. It was a moment of pure joy for her, and also a turning point,” she said.\u003c/p>\n\u003cp>She was happy growing up and attended a progressive school in the San Francisco Bay Area as a girl. But when she was approaching puberty, she became very nervous, “worried about getting facial hair or watching her shoulders get broader. It was all very painful for her,” her mother said.\u003c/p>\n\u003cp>The child was experiencing what’s known as \u003ca href=\"http://www.dsm5.org/documents/gender%20dysphoria%20fact%20sheet.pdf\" target=\"_blank\">gender dysphoria\u003c/a>, a DSM-5 diagnosis of significant ongoing distress, with the feeling of being assigned the wrong gender at birth. Researchers at Harvard \u003ca href=\"http://www.jahonline.org/article/S1054-139X%2814%2900693-4/abstract\" target=\"_blank\">recently found\u003c/a> that transgender youth are at a much higher risk for mental disorders, including depression, anxiety, suicidal thoughts and self-harm. They are more than twice as likely as non-trans youth to be diagnosed with depression (50.6 percent vs. 20.6 percent) or suffer from anxiety (26.7 percent vs. 10 percent).\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“These kids are saying to the world, ‘I was born in the wrong body, and there’s something just not right about living this way,’” said Scott Leibowitz, head child and adolescent psychiatrist at the Ann & Robert H. Lurie Children’s Hospital of Chicago.\u003c/p>\n\u003cp>\u003cstrong>Blockers ‘Safe and Effective’\u003c/strong>\u003c/p>\n\u003cp>Full-blown puberty is irreversible, but for transgender children, it’s no longer inevitable. By taking a gonadotropin-releasing hormone (GnRH) agonist, secretion of the sex hormones can be stopped and the onset of puberty suppressed, so that the body does not develop secondary sex characteristics. This has been done safely for decades to suppress sex hormones in children who develop too early, a condition known as precocious puberty. Suppressors have also been used to treat endometriosis, uterine fibroids and prostate cancer.\u003c/p>\n\u003cp>It was only in 2008 that \u003ca href=\"https://endocrine.org/\" target=\"_blank\">the Endocrine Society\u003c/a> approved puberty suppressors as a treatment for transgender adolescents as young as 12 years old. The Society, with members in more than 100 countries, has \u003ca href=\"https://www.endocrine.org/news-room/press-release-archives/2013/medical-intervention-in-transgender-adolescents-appears-to-be-safe-and-effective\" target=\"_blank\">since declared\u003c/a> that the intervention appears to be safe and effective. In 2011 the \u003ca href=\"http://www.wpath.org/site_page.cfm?pk_association_webpage_menu=1347&pk_association_webpage=4233\" target=\"_blank\">World Professional Association for Transgender Health\u003c/a> (WPATH), also issued Standards of Care for the treatment of patients with gender dysphoria, which include puberty suppression.\u003c/p>\n\u003caside class=\"pullquote alignright\">'As soon as he got breast buds, it was like the panic button was hit. He was quickly and very intensely uncomfortable and afraid.'\u003c/aside>\n\u003cp>There are few reported side effects to this off-label use of sex hormone suppressors. Despite early concerns that blocking sex hormones might harm bone development, a \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/25427144\" target=\"_blank\">recent study\u003c/a> from the Netherlands found no evidence of long-term effects on bone mineral density. If the suppressors are halted, puberty resumes as if there had been no treatment.\u003c/p>\n\u003cp>Data on the use of puberty blockers is scarce, but in the past decade or so, it’s believed thousands of transgender youth and their families have chosen to suppress puberty to give adolescents a time-out while they figure out the next step in their development.\u003c/p>\n\u003cp>A St. Louis, Mo., child was classified as female at birth, one of a set of twin girls. But the parents had been discussing puberty blockers with him since he was seven years old, after he had begun dressing as a boy and showing more masculine traits.\u003c/p>\n\u003cp>“I remember watching a documentary where he learned what blockers were and we talked about it and he was sure that’s what he wanted when the time came,” said his mother, who also asked that the family’s names not be used to protect her child’s privacy.\u003c/p>\n\u003cp>“As soon as he got breast buds, it was like the panic button was hit,” the mother said. “He was quickly and very intensely uncomfortable and afraid. He would cry, knowing that this was the beginning of something that he didn’t want, that he knew wasn’t right for him,” she said.\u003c/p>\n\u003cp>In March, after the boy turned 11, a pediatric endocrinologist prescribed the sex hormone suppressor Eligard, an injection that he receives every four months. According to his mother, because they intervened early, the unwanted breast buds receded quickly, along with her son’s depression and anxiety. “I don’t know what we would have done if we were not able to stop puberty so he doesn’t have to feel in constant conflict with his own body,” she said.\u003c/p>\n\u003cp>So far, according to the mother, the biggest problem their family has faced has been trying to get insurance coverage for her son’s treatment. She said they have been lucky to obtain the injections at cost — $500 per shot — rather than the $1,500 to $2,000 per shot that the therapy typically costs. Her husband’s employer, which self-funds its medical insurance plan, chose a clause that excludes transgender care.\u003c/p>\n\u003cp>That kind of exclusion could change, especially since the Obama Administration recently issued \u003ca href=\"https://s3.amazonaws.com/public-inspection.federalregister.gov/2016-11458.pdf\" target=\"_blank\">final regulations on Section 1557 of the Affordable Care Act\u003c/a> that ban the denial of health care on the basis of gender identity in programs that receive federal funding. The rule could help people who feel they have been discriminated against to bring complaints or lawsuits, according to the \u003ca href=\"http://transgenderlawcenter.org/archives/12908\" target=\"_blank\">Transgender Law Center\u003c/a> in Oakland, Calif.\u003c/p>\n\u003cp>In 2014, Oregon became the first state to provide Medicaid coverage for adolescents receiving puberty blockers. Medicaid programs in other states, including New York and California, have also expanded transgender healthcare coverage, although that does not mean that puberty blockers always are covered.\u003c/p>\n\u003cp>\u003cstrong>How Early is Too Early?\u003c/strong>\u003c/p>\n\u003cp>Treatment with puberty blockers gives transgender children a breather so they can continue to mature and decide whether they will pursue treatment with cross-sex hormones or gender reassignment surgery. For many families, the question is not whether to intervene with blockers, but how early to start.\u003c/p>\n\u003cp>Because the onset of puberty varies so widely — as early as age 9 for some — suppression can begin at different ages. And that’s prompted some disagreement within the field — the “age versus stage” debate — about when to begin, according to Leibowitz. Most often blockers are initiated at the first visible signs of development as measured by the \u003ca href=\"http://www.childgrowthfoundation.org/CMS/FILES/Puberty_and_the_Tanner_Stages.pdf\" target=\"_blank\">Tanner Stages\u003c/a>, a scale of sexual maturation developed by pediatrician James Tanner. The trigger for suppression is usually Tanner stage 2, when pubic hair and breast buds appear.\u003c/p>\n\u003cp>“If you are able to suspend puberty as soon as it happens you’re optimizing the benefits that it can bring physically,” said Leibowitz. Starting early may alleviate the need for surgical breast removal or voice modification therapy later on. It also makes it far easier for transgender teens to fit in. “That ability to blend in and be perceived as the gender that they identify with is associated with long-term psychological benefits,” said Leibowitz.\u003c/p>\n\u003cp>But does that mean that 9- or 10-year-old transgender kids should be started on puberty blockers? Even though the treatment is reversible and is considered safe, Leibowitz said some clinicians argue the age issue is important because less is known about very early interventions. How long can puberty be safely suppressed? And if the next step is transitioning with cross-sex hormones, at what age should that begin?\u003c/p>\n\u003cp>Of course, there is no treatment at all unless the parents of transgender children agree. “For most of my clients [who are minors], the issue revolves around whether they can start hormones or puberty blockers without parental consent, and the short answer is ‘No,”’ said Danielle Castro, a psychotherapist and project director at the Center of Excellence for Transgender Health at the University of California, San Francisco.\u003c/p>\n\u003cp>Castro said families of some transgender youth refuse the intervention because they believe their children are “just going through a phase.” A \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/18981931\" target=\"_blank\">study\u003c/a> in 2008 found that 43 percent of very young children who experienced gender dysphoria no longer felt that way after adolescence. The 27 percent who remained dysphoric were the ones who had felt that way most strongly when they were young.\u003c/p>\n\u003cp>Young children may indeed change their minds, but gender identity seems to be fixed by the time kids have reached puberty. The Endocrine Society finds that transgender adolescents grow up to be transgender adults “100 percent of the time.” Dr. Stephen Rosenthal, director of the Child and Adolescent Gender Center at UCSF, \u003ca href=\"http://press.endocrine.org/doi/pdf/10.1210/jc.2014-1919\" target=\"_blank\">agrees\u003c/a>: “Children who meet the mental health criteria for gender dysphoria in adolescence are likely to be transgender for life.”\u003c/p>\n\u003cp>In a \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/20646177\" target=\"_blank\">recent study\u003c/a> of 70 participants all the adolescents who had been given puberty blockers went through with sex reassignment.\u003c/p>\n\u003cp>\u003cstrong>The Standard of Care\u003c/strong>\u003c/p>\n\u003cp>Even though the Oakland family had agreed in advance that their daughter would start on blockers at the right time, “we had to reassure her constantly that we wouldn’t let it go too far,” she said.\u003c/p>\n\u003cp>When she turned 13, the girl started receiving monthly injections of Lupron, a widely prescribed sex hormone suppressor. “As soon as she started, you could just see the relief in her,” said the mother. “You could see it in her demeanor, in her mood; it was just a huge weight off her shoulders,” she said.\u003c/p>\n\u003cp>The family’s insurer, Kaiser Permanente, covered the treatment. Puberty blockers are considered “standard of care in the appropriate clinical circumstances,” said Erica Metz, medical director for Transgender Health at Kaiser Permanente Northern California. According to Metz, the treatment “gives patients and their families time to work with their mental health and medical providers to determine if it is appropriate to start transitioning.”\u003c/p>\n\u003cp>When the girl was 14, she started taking estrogen — the next step in her male-to-female transition. Instead of growing facial hair and a male physique, she developed breasts and some curves. Her voice didn’t deepen, and she doesn’t have an Adam’s apple.\u003c/p>\n\u003cp>The mother described her daughter as a social, outgoing and well-adjusted teenager. She knows the \u003ca href=\"http://williamsinstitute.law.ucla.edu/research/suicide-attempts-among-transgender-and-gender-non-conforming-adults/\" target=\"_blank\">grim mental health statistics\u003c/a> for transgender people — 41 percent have attempted suicide, nearly nine times the national average — and she doesn’t want to imagine a world where her daughter would be without puberty blockers, a medical intervention that she called a “lifesaver.”\u003c/p>\n\u003cp>“The thought of her having had to go through male puberty, I think it would have destroyed her mental health and well-being,” the mother said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>This story was produced by Kaiser Health News, which publishes California Healthline, a service of the California Health Care Foundation.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>A computer may soon be able to offer highly personalized treatment suggestions for cancer patients based on the specifics of their cases and the full sweep of the most relevant scientific research.\u003c/p>\n\u003caside class=\"pullquote alignright\">Time is of the essence in formulating precision treatment plans for cancer patients. 'By the time we got through with this patient, the patient died.'\u003c/aside>\n\u003cp>IBM and the New York Genome Center, a consortium of medical research institutions in New York City, are collaborating on a \u003ca href=\"https://clinicaltrials.gov/ct2/show/NCT02725684\">project\u003c/a> to speed up cancer diagnoses and treatment.\u003c/p>\n\u003cp>The work, which got underway in 2013, is exploring the use of computers to help analyze a wide range of genetic information and the scientific literature with the goal of quickly formulating precise treatment plans for cancer patients.\u003c/p>\n\u003cp>The line of research is being orchestrated by \u003ca href=\"http://www.nygenome.org/authorbio/robert-b-darnell/\">Robert Darnell\u003c/a>, the founding director of the New York Genome Center and a neuro-oncologist at Rockefeller University. A project on brain tumors aims to bring cancer experts in New York City to bear on treatment plans that take advantage of the very latest scientific evidence.\u003c/p>\n\u003cp>An essential assistant on Darnell's team is supercomputer \u003ca href=\"https://www.ibm.com/watson/\">IBM Watson\u003c/a>, which helps by comparing the genetic differences between healthy cells and tumor cells in patients, as well as fetching the newest treatment ideas from medical journals.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Watson wasn't always part of Darnell's lineup. When he started the project, he relied on the collective brainpower of a bunch of medical researchers in New York City. Fifteen of them, including Darnell, spent three weeks evaluating the case of the first patient of the project. But, he says, \"by the time we got through with this patient, the patient died.\"\u003c/p>\n\u003cp>Speed matters, given how fast cancer can spread. Information overload is a particular challenge.\u003c/p>\n\u003cp>\"Cancer is not giving you the luxury of time,\" says \u003ca href=\"http://researcher.watson.ibm.com/\">Ajay Royyuru\u003c/a>, the director of IBM's Healthcare and Life Sciences Research. And, he adds, there are \"more papers published in each year than cancer researchers can read and remember.\"\u003c/p>\n\u003cp>In contrast, IBM's supercomputer Watson, famous for defeating former champions in \u003cem>Jeopardy!\u003c/em> \u003ca href=\"https://www.youtube.com/watch?v=WFR3lOm_xhE\">in 2011\u003c/a>, is able to read \"800 million pages per second ... from medical literature to patient records to doctors' notes,\" according to Christine Douglass at IBM Watson Health.\u003c/p>\n\u003cp>Upon learning about Watson's abilities, Darnell approached IBM. By 2014, a human-computer coalition to fight cancer \u003ca href=\"https://www.washingtonpost.com/business/on-it/ibms-watson-new-york-genome-center-partner-on-brain-cancer-treatment/2014/03/18/35019894-aba7-11e3-af5f-4c56b834c4bf_story.html\">was born\u003c/a>.\u003c/p>\n\u003cp>\"Compare what the genetics in the healthy cell looks like to what the genetics in the cancer cell looks like, you get the list of differences,\" says \u003ca href=\"http://stevejamesharvey.com/\">Steve Harvey\u003c/a>, vice president of Watson Health at IBM. \"Watson will first try to figure out what are the differences that could be causing cancer. For each of those potential genetic issues, it will go through databases and literature to find\" known treatment options, he says.\u003c/p>\n\u003cp>With the help of Watson, Darnell's group studied 30 patients with glioblastoma, an aggressive form of brain cancer, and developed personalized treatment options for each patient \"based on genetic mutations present in the tumor,\" according to Darnell. Darnell declined to comment on the specifics of the findings before they're published. But, he says, \"there are patients who will benefit\" from this study. A preliminary report on the findings has been submitted to \u003cem>The Journal of Clinical Oncology\u003c/em>.\u003c/p>\n\u003cp>Both IBM and the New York Genome Center are moving on to find out whether Watson can apply what he learned from Darnell's research to a larger group of glioblastoma patients.\u003c/p>\n\u003cp>\"We'll be \u003ca href=\"https://www.whitehouse.gov/the-press-office/2016/06/28/fact-sheet-cancer-moonshot-summit-vice-president-biden-announces-new\">working with\u003c/a> the Veterans Health Administration,\" says Harvey. According to Harvey, \"The VHA overseas the largest population of cancer patients — 3.5 percent of all cancer patients in the US are from the VHA.\"\u003c/p>\n\u003cp>According to Darnell, the paper his group submitted will \"lay the groundwork for the larger, more comprehensive paper on the same study.\" Darnell says the current research project is not yet a clinical trial, and he hopes to execute a large-scale clinical trial in the future, recruiting \"any cancer patient who is sick, not necessarily from glioblastoma.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"It's not going to be doable without the machines,\" says Darnell.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Why+Doctors+Want+A+Computerized+Assistant+For+Cancer+Care&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>A computer may soon be able to offer highly personalized treatment suggestions for cancer patients based on the specifics of their cases and the full sweep of the most relevant scientific research.\u003c/p>\n\u003caside class=\"pullquote alignright\">Time is of the essence in formulating precision treatment plans for cancer patients. 'By the time we got through with this patient, the patient died.'\u003c/aside>\n\u003cp>IBM and the New York Genome Center, a consortium of medical research institutions in New York City, are collaborating on a \u003ca href=\"https://clinicaltrials.gov/ct2/show/NCT02725684\">project\u003c/a> to speed up cancer diagnoses and treatment.\u003c/p>\n\u003cp>The work, which got underway in 2013, is exploring the use of computers to help analyze a wide range of genetic information and the scientific literature with the goal of quickly formulating precise treatment plans for cancer patients.\u003c/p>\n\u003cp>The line of research is being orchestrated by \u003ca href=\"http://www.nygenome.org/authorbio/robert-b-darnell/\">Robert Darnell\u003c/a>, the founding director of the New York Genome Center and a neuro-oncologist at Rockefeller University. A project on brain tumors aims to bring cancer experts in New York City to bear on treatment plans that take advantage of the very latest scientific evidence.\u003c/p>\n\u003cp>An essential assistant on Darnell's team is supercomputer \u003ca href=\"https://www.ibm.com/watson/\">IBM Watson\u003c/a>, which helps by comparing the genetic differences between healthy cells and tumor cells in patients, as well as fetching the newest treatment ideas from medical journals.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Watson wasn't always part of Darnell's lineup. When he started the project, he relied on the collective brainpower of a bunch of medical researchers in New York City. Fifteen of them, including Darnell, spent three weeks evaluating the case of the first patient of the project. But, he says, \"by the time we got through with this patient, the patient died.\"\u003c/p>\n\u003cp>Speed matters, given how fast cancer can spread. Information overload is a particular challenge.\u003c/p>\n\u003cp>\"Cancer is not giving you the luxury of time,\" says \u003ca href=\"http://researcher.watson.ibm.com/\">Ajay Royyuru\u003c/a>, the director of IBM's Healthcare and Life Sciences Research. And, he adds, there are \"more papers published in each year than cancer researchers can read and remember.\"\u003c/p>\n\u003cp>In contrast, IBM's supercomputer Watson, famous for defeating former champions in \u003cem>Jeopardy!\u003c/em> \u003ca href=\"https://www.youtube.com/watch?v=WFR3lOm_xhE\">in 2011\u003c/a>, is able to read \"800 million pages per second ... from medical literature to patient records to doctors' notes,\" according to Christine Douglass at IBM Watson Health.\u003c/p>\n\u003cp>Upon learning about Watson's abilities, Darnell approached IBM. By 2014, a human-computer coalition to fight cancer \u003ca href=\"https://www.washingtonpost.com/business/on-it/ibms-watson-new-york-genome-center-partner-on-brain-cancer-treatment/2014/03/18/35019894-aba7-11e3-af5f-4c56b834c4bf_story.html\">was born\u003c/a>.\u003c/p>\n\u003cp>\"Compare what the genetics in the healthy cell looks like to what the genetics in the cancer cell looks like, you get the list of differences,\" says \u003ca href=\"http://stevejamesharvey.com/\">Steve Harvey\u003c/a>, vice president of Watson Health at IBM. \"Watson will first try to figure out what are the differences that could be causing cancer. For each of those potential genetic issues, it will go through databases and literature to find\" known treatment options, he says.\u003c/p>\n\u003cp>With the help of Watson, Darnell's group studied 30 patients with glioblastoma, an aggressive form of brain cancer, and developed personalized treatment options for each patient \"based on genetic mutations present in the tumor,\" according to Darnell. Darnell declined to comment on the specifics of the findings before they're published. But, he says, \"there are patients who will benefit\" from this study. A preliminary report on the findings has been submitted to \u003cem>The Journal of Clinical Oncology\u003c/em>.\u003c/p>\n\u003cp>Both IBM and the New York Genome Center are moving on to find out whether Watson can apply what he learned from Darnell's research to a larger group of glioblastoma patients.\u003c/p>\n\u003cp>\"We'll be \u003ca href=\"https://www.whitehouse.gov/the-press-office/2016/06/28/fact-sheet-cancer-moonshot-summit-vice-president-biden-announces-new\">working with\u003c/a> the Veterans Health Administration,\" says Harvey. According to Harvey, \"The VHA overseas the largest population of cancer patients — 3.5 percent of all cancer patients in the US are from the VHA.\"\u003c/p>\n\u003cp>According to Darnell, the paper his group submitted will \"lay the groundwork for the larger, more comprehensive paper on the same study.\" Darnell says the current research project is not yet a clinical trial, and he hopes to execute a large-scale clinical trial in the future, recruiting \"any cancer patient who is sick, not necessarily from glioblastoma.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"It's not going to be doable without the machines,\" says Darnell.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Why+Doctors+Want+A+Computerized+Assistant+For+Cancer+Care&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Hospitals Create Separate Units to Accommodate Elderly",
"title": "Hospitals Create Separate Units to Accommodate Elderly",
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"content": "\u003cp>Janet Prochazka was active and outspoken, living by herself and working as a special education tutor. Then, in March, a bad fall landed her in the hospital.\u003c/p>\n\u003caside class=\"pullquote alignright\">'The older you are, the worse the hospital is for you.'\u003c/aside>\n\u003cp>Doctors cared for her wounds and treated her pneumonia. But Prochazka, 75, didn’t sleep or eat well at Zuckerberg San Francisco General Hospital and Trauma Center. She became confused and agitated and ultimately contracted a serious stomach infection. After more than three weeks in the hospital and three more in a rehabilitation facility, she emerged far weaker than before, shaky and unable to think clearly.\u003c/p>\n\u003cp>She had to stop working and wasn’t able to drive for months. And now, she’s considering a move to Maine to be closer to relatives for support.\u003c/p>\n\u003cp>“It’s a big, big change,” said her stepdaughter, Kitty Gilbert, soon after Prochazka returned home. “I am hopeful that she will regain a lot of what she lost, but I am not sure.”\u003c/p>\n\u003cp>Many elderly patients like Prochazka deteriorate mentally or physically in the hospital, even if they recover from the original illness or injury that brought them there. About one-third of patients over 70 years old and more than half of patients over 85 leave the hospital more disabled than when they arrived, research shows.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>As a result, many seniors are unable to care for themselves after discharge and need assistance with daily activities such as bathing, dressing or even walking.\u003c/p>\n\u003cp>“The older you are, the worse the hospital is for you,” said Ken Covinsky, a physician and researcher at the University of California, San Francisco division of geriatrics. “A lot of the stuff we do in medicine does more harm than good. And sometimes with the care of older people, less is more.”\u003c/p>\n\u003cp>Hospital staff often fail to feed older patients properly, get them out of bed enough or control their pain adequately. Providers frequently restrict their movements by tethering them to beds with oxygen tanks and IV poles. Doctors subject them to unnecessary procedures and prescribe redundant or potentially harmful medications. And caregivers deprive them of sleep by placing them in noisy wards or checking vital signs at all hours of the night.\u003c/p>\n\u003cp>Interrupted sleep, unappetizing food and days in bed may be merely annoying for younger patients, but they can cause lasting damage to older ones. Elderly patients are far different than their younger counterparts — so much so that some hospitals are treating some of them in separate medical units.\u003c/p>\n\u003cp>San Francisco General is one of them. Its Acute Care for Elders (ACE) ward, which opened in 2007, has special accommodations and a team of providers to address the unique needs of older patients. They focus less on the original diagnosis and more on how to get patients back home, living as independently as possible.\u003c/p>\n\u003cp>Early on, the staff tests patients’ memories and assesses how well they can walk and care for themselves at home. Then they give patients practice doing things for themselves as much as possible throughout their stay. They remove catheters and IVs, and encourage patients to get out of bed and eat in a communal dining area.\u003c/p>\n\u003cp>“Bed rest is really, really bad,” said the medical director of the ACE unit, Edgar Pierluissi. “It sets off an explosive chain of events that are very detrimental to people’s health.”\u003c/p>\n\u003cp>Such units are still rare — there are only about 200 around the country. And even where they exist, not every senior is admitted, in part because space is limited.\u003c/p>\n\u003cp>Prochazka went to the emergency room first, then intensive care. She was transferred to ACE about a week later. The staff weaned her off some of her medications and got her up and walking. They also limited the disorienting nighttime checks. Prochazka said she got “the first good night of sleep I have had.”\u003c/p>\n\u003cp>But for her, the move might have been too late.\u003c/p>\n\u003cp>“She will not leave here where she started,” Pierluissi said several days before Prochazka was discharged. “She is going to be weaker and unable to do the things you really need to do to live independently.”\u003c/p>\n\u003cp>\u003cstrong>Not a Priority\u003c/strong>\u003c/p>\n\u003cp>How hospitals handle the old — and very old — is a pressing problem. Elderly patients are a growing clientele for hospitals, a trend that will only accelerate as baby boomers age. Patients over 65 already make up more than one-third of all discharges, according to the federal government, and nearly 13 million seniors are hospitalized each year. And they stay longer than younger patients.\u003c/p>\n\u003cp>Many seniors are already suspended precariously between independent living and reliance on others. They are weakened by multiple chronic diseases and medications.\u003c/p>\n\u003cp>One bad hospitalization can tip them over the edge, and they may never recover, said Melissa Mattison, chief of the hospital medicine unit at Massachusetts General Hospital.\u003c/p>\n\u003cp>“It is like putting Humpty Dumpty back together again,” said Mattison, who wrote a 2013 report detailing the risks elderly patients face in the hospital.\u003c/p>\n\u003cp>Yet the unique needs of older patients are not a priority for most hospitals, Covinsky said. Doctors and other hospital staff focus so intensely on treating injuries or acute illnesses — like pneumonia or an exacerbation of heart disease — that they can overlook nearly all other aspects of caring for the patients, he noted.\u003c/p>\n\u003cp>In addition, hospitals face few consequences if elderly patients become more impaired or less functional during their stays. The federal government penalizes hospitals when patients fall, get preventable infections or return to the hospital within 30 days of their discharge. But hospitals aren’t held accountable if patients lose their memories or their ability to walk. As a result, most don’t measure those things.\u003c/p>\n\u003cp>“If you don’t measure it, you can’t fix it,” Covinsky said.\u003c/p>\n\u003cp>Improving care for older patients requires an investment that hospital administrators are not always willing to make, experts said. Some argue, however, that the investment pays off — not just for older people but for hospitals themselves as well as for a country intent on controlling health care spending.\u003c/p>\n\u003cp>Though research on the financial impact of problematic hospital care for the elderly has been limited, a 2010 report by the Department of Health and Human Services’ Office of Inspector General found that more than a quarter of hospitalized Medicare beneficiaries had suffered an “adverse event,” or harm as a result of medical care.\u003c/p>\n\u003cp>Those events, such as bed sores or oxygen deficiency, cost Medicare about $4.4 billion annually, according to the report. Physicians who reviewed the incidents determined that 44 percent could have been prevented.\u003c/p>\n\u003cp>In addition to outright mistakes, poor or inadequate treatment in hospitals leads to needless medical spending on extended hospital visits, readmissions, in-home caregivers and nursing home care. Nursing home stays cost about $85,000 a year. And the average hospital stay for an elderly person is $12,000, according to the Agency for Healthcare Research and Quality.\u003c/p>\n\u003cp>“If you don’t feed a patient, if you don’t mobilize a patient, you have just made it far more likely they will go to a skilled nursing [facility], and that’s expensive,” said Robert Palmer, director of the geriatrics and gerontology center at Eastern Virginia Medical School and one of the brains behind the idea of ACE units.\u003c/p>\n\u003cp>ACE units have been shown to reduce hospital-inflicted disabilities in older patients, decrease lengths of stay and reduce the number of patients discharged to nursing homes. In one 2012 Health Affairs study, Palmer and other researchers found that hospital units for the elderly saved about $1,000 per patient visit.\u003c/p>\n\u003cp>\u003cstrong>A Different Life\u003c/strong>\u003c/p>\n\u003cp>After coming home, Prochazka said she felt weak. It took weeks of walking her labradoodle, Gino, to regain strength.\u003c/p>\n\u003cp>Her stepdaughter, Gilbert, said Prochazka has started to improve. “We knew she was getting better when she was getting ornery,” she said.\u003c/p>\n\u003cp>But Prochazka, who is highly educated, still has some short-term memory loss, Gilbert said.\u003c/p>\n\u003cp>Prochazka knows that her life after hospitalization is different than before — she will have to depend more on others. It’s not an easy adjustment, she said.\u003c/p>\n\u003cp>“I have been somebody who has always been both mentally and physically active,” she said. “Before I fell … I was respected for what I have and what I did and all of a sudden, I’m not.”\u003c/p>\n\u003cp>She said her time at San Francisco General was frustrating. Getting the infection just as she was starting to recover was especially hard, she said. “I felt like I had been dealt a blow I really didn’t need.”\u003c/p>\n\u003cp>For other patients, being admitted proactively to the special geriatric unit can stave off such precipitous declines.\u003c/p>\n\u003cp>Rosenda Esquivel, 80, spent 18 days at San Francisco General, much of it in the unit, this spring. She suffered no noticeable setbacks, physical or mental, during her time in the hospital, according to Annelie Nilsson, a clinical nurse specialist in the unit.\u003c/p>\n\u003cp>Esquivel, an animated woman who used to work as a home caregiver, was admitted with intense arthritic pain and, while hospitalized, underwent a procedure to address an abnormal heartbeat.\u003c/p>\n\u003cp>Soon after her arrival, Pierluissi, the ACE unit medical director, speaking to Esquivel in her native Spanish, sought to determine how independent she was at home. He learned that a friend helped take care of her but that she took pride in cooking and cleaning for herself.\u003c/p>\n\u003cp>The doctor noticed that Esquivel needed help to get up from a chair but that she could get around with a walker. Her memory, though, wasn’t too strong. A few minutes after hearing three words — “honesty,” “baseball” and “flower” — she could only recall one of them.\u003c/p>\n\u003cp>Pierluissi came up with a plan for her time in the hospital: Get Esquivel’s pain under control. Make sure she walks three or four times a day. Arrange for her to have a caregiver at home to remind her to take her diabetes and blood pressure medications.\u003c/p>\n\u003cp>Then, release her as fast as possible.\u003c/p>\n\u003cp>“The less time she spends here, the better,” Pierluissi said.\u003c/p>\n\u003cp>This story was reported while its author, Anna Gorman, participated in a fellowship supported by New America Media, the Gerontological Society of America and The Commonwealth Fund.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>KHN’s coverage of aging and long-term care issues is supported by a grant from The SCAN Foundation, and its coverage of late life and geriatric care is supported by The John A. Hartford Foundation.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Janet Prochazka was active and outspoken, living by herself and working as a special education tutor. Then, in March, a bad fall landed her in the hospital.\u003c/p>\n\u003caside class=\"pullquote alignright\">'The older you are, the worse the hospital is for you.'\u003c/aside>\n\u003cp>Doctors cared for her wounds and treated her pneumonia. But Prochazka, 75, didn’t sleep or eat well at Zuckerberg San Francisco General Hospital and Trauma Center. She became confused and agitated and ultimately contracted a serious stomach infection. After more than three weeks in the hospital and three more in a rehabilitation facility, she emerged far weaker than before, shaky and unable to think clearly.\u003c/p>\n\u003cp>She had to stop working and wasn’t able to drive for months. And now, she’s considering a move to Maine to be closer to relatives for support.\u003c/p>\n\u003cp>“It’s a big, big change,” said her stepdaughter, Kitty Gilbert, soon after Prochazka returned home. “I am hopeful that she will regain a lot of what she lost, but I am not sure.”\u003c/p>\n\u003cp>Many elderly patients like Prochazka deteriorate mentally or physically in the hospital, even if they recover from the original illness or injury that brought them there. About one-third of patients over 70 years old and more than half of patients over 85 leave the hospital more disabled than when they arrived, research shows.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>As a result, many seniors are unable to care for themselves after discharge and need assistance with daily activities such as bathing, dressing or even walking.\u003c/p>\n\u003cp>“The older you are, the worse the hospital is for you,” said Ken Covinsky, a physician and researcher at the University of California, San Francisco division of geriatrics. “A lot of the stuff we do in medicine does more harm than good. And sometimes with the care of older people, less is more.”\u003c/p>\n\u003cp>Hospital staff often fail to feed older patients properly, get them out of bed enough or control their pain adequately. Providers frequently restrict their movements by tethering them to beds with oxygen tanks and IV poles. Doctors subject them to unnecessary procedures and prescribe redundant or potentially harmful medications. And caregivers deprive them of sleep by placing them in noisy wards or checking vital signs at all hours of the night.\u003c/p>\n\u003cp>Interrupted sleep, unappetizing food and days in bed may be merely annoying for younger patients, but they can cause lasting damage to older ones. Elderly patients are far different than their younger counterparts — so much so that some hospitals are treating some of them in separate medical units.\u003c/p>\n\u003cp>San Francisco General is one of them. Its Acute Care for Elders (ACE) ward, which opened in 2007, has special accommodations and a team of providers to address the unique needs of older patients. They focus less on the original diagnosis and more on how to get patients back home, living as independently as possible.\u003c/p>\n\u003cp>Early on, the staff tests patients’ memories and assesses how well they can walk and care for themselves at home. Then they give patients practice doing things for themselves as much as possible throughout their stay. They remove catheters and IVs, and encourage patients to get out of bed and eat in a communal dining area.\u003c/p>\n\u003cp>“Bed rest is really, really bad,” said the medical director of the ACE unit, Edgar Pierluissi. “It sets off an explosive chain of events that are very detrimental to people’s health.”\u003c/p>\n\u003cp>Such units are still rare — there are only about 200 around the country. And even where they exist, not every senior is admitted, in part because space is limited.\u003c/p>\n\u003cp>Prochazka went to the emergency room first, then intensive care. She was transferred to ACE about a week later. The staff weaned her off some of her medications and got her up and walking. They also limited the disorienting nighttime checks. Prochazka said she got “the first good night of sleep I have had.”\u003c/p>\n\u003cp>But for her, the move might have been too late.\u003c/p>\n\u003cp>“She will not leave here where she started,” Pierluissi said several days before Prochazka was discharged. “She is going to be weaker and unable to do the things you really need to do to live independently.”\u003c/p>\n\u003cp>\u003cstrong>Not a Priority\u003c/strong>\u003c/p>\n\u003cp>How hospitals handle the old — and very old — is a pressing problem. Elderly patients are a growing clientele for hospitals, a trend that will only accelerate as baby boomers age. Patients over 65 already make up more than one-third of all discharges, according to the federal government, and nearly 13 million seniors are hospitalized each year. And they stay longer than younger patients.\u003c/p>\n\u003cp>Many seniors are already suspended precariously between independent living and reliance on others. They are weakened by multiple chronic diseases and medications.\u003c/p>\n\u003cp>One bad hospitalization can tip them over the edge, and they may never recover, said Melissa Mattison, chief of the hospital medicine unit at Massachusetts General Hospital.\u003c/p>\n\u003cp>“It is like putting Humpty Dumpty back together again,” said Mattison, who wrote a 2013 report detailing the risks elderly patients face in the hospital.\u003c/p>\n\u003cp>Yet the unique needs of older patients are not a priority for most hospitals, Covinsky said. Doctors and other hospital staff focus so intensely on treating injuries or acute illnesses — like pneumonia or an exacerbation of heart disease — that they can overlook nearly all other aspects of caring for the patients, he noted.\u003c/p>\n\u003cp>In addition, hospitals face few consequences if elderly patients become more impaired or less functional during their stays. The federal government penalizes hospitals when patients fall, get preventable infections or return to the hospital within 30 days of their discharge. But hospitals aren’t held accountable if patients lose their memories or their ability to walk. As a result, most don’t measure those things.\u003c/p>\n\u003cp>“If you don’t measure it, you can’t fix it,” Covinsky said.\u003c/p>\n\u003cp>Improving care for older patients requires an investment that hospital administrators are not always willing to make, experts said. Some argue, however, that the investment pays off — not just for older people but for hospitals themselves as well as for a country intent on controlling health care spending.\u003c/p>\n\u003cp>Though research on the financial impact of problematic hospital care for the elderly has been limited, a 2010 report by the Department of Health and Human Services’ Office of Inspector General found that more than a quarter of hospitalized Medicare beneficiaries had suffered an “adverse event,” or harm as a result of medical care.\u003c/p>\n\u003cp>Those events, such as bed sores or oxygen deficiency, cost Medicare about $4.4 billion annually, according to the report. Physicians who reviewed the incidents determined that 44 percent could have been prevented.\u003c/p>\n\u003cp>In addition to outright mistakes, poor or inadequate treatment in hospitals leads to needless medical spending on extended hospital visits, readmissions, in-home caregivers and nursing home care. Nursing home stays cost about $85,000 a year. And the average hospital stay for an elderly person is $12,000, according to the Agency for Healthcare Research and Quality.\u003c/p>\n\u003cp>“If you don’t feed a patient, if you don’t mobilize a patient, you have just made it far more likely they will go to a skilled nursing [facility], and that’s expensive,” said Robert Palmer, director of the geriatrics and gerontology center at Eastern Virginia Medical School and one of the brains behind the idea of ACE units.\u003c/p>\n\u003cp>ACE units have been shown to reduce hospital-inflicted disabilities in older patients, decrease lengths of stay and reduce the number of patients discharged to nursing homes. In one 2012 Health Affairs study, Palmer and other researchers found that hospital units for the elderly saved about $1,000 per patient visit.\u003c/p>\n\u003cp>\u003cstrong>A Different Life\u003c/strong>\u003c/p>\n\u003cp>After coming home, Prochazka said she felt weak. It took weeks of walking her labradoodle, Gino, to regain strength.\u003c/p>\n\u003cp>Her stepdaughter, Gilbert, said Prochazka has started to improve. “We knew she was getting better when she was getting ornery,” she said.\u003c/p>\n\u003cp>But Prochazka, who is highly educated, still has some short-term memory loss, Gilbert said.\u003c/p>\n\u003cp>Prochazka knows that her life after hospitalization is different than before — she will have to depend more on others. It’s not an easy adjustment, she said.\u003c/p>\n\u003cp>“I have been somebody who has always been both mentally and physically active,” she said. “Before I fell … I was respected for what I have and what I did and all of a sudden, I’m not.”\u003c/p>\n\u003cp>She said her time at San Francisco General was frustrating. Getting the infection just as she was starting to recover was especially hard, she said. “I felt like I had been dealt a blow I really didn’t need.”\u003c/p>\n\u003cp>For other patients, being admitted proactively to the special geriatric unit can stave off such precipitous declines.\u003c/p>\n\u003cp>Rosenda Esquivel, 80, spent 18 days at San Francisco General, much of it in the unit, this spring. She suffered no noticeable setbacks, physical or mental, during her time in the hospital, according to Annelie Nilsson, a clinical nurse specialist in the unit.\u003c/p>\n\u003cp>Esquivel, an animated woman who used to work as a home caregiver, was admitted with intense arthritic pain and, while hospitalized, underwent a procedure to address an abnormal heartbeat.\u003c/p>\n\u003cp>Soon after her arrival, Pierluissi, the ACE unit medical director, speaking to Esquivel in her native Spanish, sought to determine how independent she was at home. He learned that a friend helped take care of her but that she took pride in cooking and cleaning for herself.\u003c/p>\n\u003cp>The doctor noticed that Esquivel needed help to get up from a chair but that she could get around with a walker. Her memory, though, wasn’t too strong. A few minutes after hearing three words — “honesty,” “baseball” and “flower” — she could only recall one of them.\u003c/p>\n\u003cp>Pierluissi came up with a plan for her time in the hospital: Get Esquivel’s pain under control. Make sure she walks three or four times a day. 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"disqusTitle": "In Florida Zika Fight, U.S. Approves Release of Genetically Modified Mosquitoes",
"title": "In Florida Zika Fight, U.S. Approves Release of Genetically Modified Mosquitoes",
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"content": "\u003cp>Federal authorities gave final approval Friday to a plan to release genetically modified mosquitoes in Florida, but none of the insects will be immediately dispatched in the state's fight against the spread of Zika.\u003c/p>\n\u003cp>After considering thousands of public comments, the U.S. Food and Drug Administration's Center for Veterinary Medicine concluded the proposal from biotech firm Oxitec to release its mosquitoes in an island neighborhood just north of Key West would not significantly affect the environment, according a statement from the agency.\u003c/p>\n\u003cp>The Centers for Disease Control and Prevention and the Environmental Protection Agency also contributed to the FDA's review. Local officials will hold a nonbinding vote on the proposal for Florida Keys residents in November.\u003c/p>\n\u003cp>The FDA approval came hours before Florida's Department of Health confirmed a new Zika infection within a 1-square-mile zone encompassing Miami's Wynwood neighborhood. That brings the state's tally of non-travel-related Zika cases to 16, in addition to 351 travel-related infections.\u003c/p>\n\u003cp>In the Keys, Oxitec would release nonbiting male Aedes aegypti mosquitoes modified with synthetic DNA to produce offspring that die outside a lab.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The Florida Keys Mosquito Control District approached Oxitec after a dengue outbreak in Key West ended in 2010. The district wants new ways to eradicate Aedes aegypti mosquitoes, which it considers a significant and expensive threat in the tourism-dependent island chain.\u003c/p>\n\u003cp>Brazil and the Cayman Islands are releasing Oxitec's insects as part of other mosquito control operations. The company, a subsidiary of Maryland-based Intrexon, also has tested the mosquitoes in Panama.\u003c/p>\n\u003cp>In separate projects overseen by the U.S. Department of Agriculture, Oxitec has tested genetically modified pink bollworms and diamondback moths to fight agricultural pests in the U.S.\u003c/p>\n\u003cp>Anti-GMO activists have criticized Oxitec for allowing the release of some modified female mosquitoes, which do bite humans. The company has said only a very small number of females are released, and no humans have reported any health problems from their bites.\u003c/p>\n\u003cp>Oxitec CEO Hadyn Perry said the FDA's approval of the field trial should lead to discussions about fast-tracking releases elsewhere during a public health crisis.\u003c/p>\n\u003cp>\"The pathways that enable emergency use should be looked at because the crisis is here and now, and it would be an awful shame if we looked back in two or three years and say, 'Why didn't we do this?'\" Parry remarked in a conference call with reporters.\u003c/p>\n\u003cp>Oxitec promotes its technology as a chemical-free way to control mosquitoes and reduce the risks of Zika, dengue fever or chikungunya. In Miami this week, the head of the CDC credited aerial pesticide spraying with killing a significant number of mosquitoes in an arts district where Zika was apparently transmitted by insects on the U.S. mainland for the first time.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Zika is mainly spread by mosquitoes, as well as sex. Except for the 16 confirmed cases in the Miami area, the other 1,825 infections reported in the U.S. have been linked to travel to countries in Latin America or the Caribbean with Zika outbreaks.\u003c/p>\n\n",
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"description": "Federal authorities gave final approval Friday to a plan to release genetically modified mosquitoes in Florida, but it will be awhile before any are dispatched.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Federal authorities gave final approval Friday to a plan to release genetically modified mosquitoes in Florida, but none of the insects will be immediately dispatched in the state's fight against the spread of Zika.\u003c/p>\n\u003cp>After considering thousands of public comments, the U.S. Food and Drug Administration's Center for Veterinary Medicine concluded the proposal from biotech firm Oxitec to release its mosquitoes in an island neighborhood just north of Key West would not significantly affect the environment, according a statement from the agency.\u003c/p>\n\u003cp>The Centers for Disease Control and Prevention and the Environmental Protection Agency also contributed to the FDA's review. Local officials will hold a nonbinding vote on the proposal for Florida Keys residents in November.\u003c/p>\n\u003cp>The FDA approval came hours before Florida's Department of Health confirmed a new Zika infection within a 1-square-mile zone encompassing Miami's Wynwood neighborhood. That brings the state's tally of non-travel-related Zika cases to 16, in addition to 351 travel-related infections.\u003c/p>\n\u003cp>In the Keys, Oxitec would release nonbiting male Aedes aegypti mosquitoes modified with synthetic DNA to produce offspring that die outside a lab.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The Florida Keys Mosquito Control District approached Oxitec after a dengue outbreak in Key West ended in 2010. The district wants new ways to eradicate Aedes aegypti mosquitoes, which it considers a significant and expensive threat in the tourism-dependent island chain.\u003c/p>\n\u003cp>Brazil and the Cayman Islands are releasing Oxitec's insects as part of other mosquito control operations. The company, a subsidiary of Maryland-based Intrexon, also has tested the mosquitoes in Panama.\u003c/p>\n\u003cp>In separate projects overseen by the U.S. Department of Agriculture, Oxitec has tested genetically modified pink bollworms and diamondback moths to fight agricultural pests in the U.S.\u003c/p>\n\u003cp>Anti-GMO activists have criticized Oxitec for allowing the release of some modified female mosquitoes, which do bite humans. The company has said only a very small number of females are released, and no humans have reported any health problems from their bites.\u003c/p>\n\u003cp>Oxitec CEO Hadyn Perry said the FDA's approval of the field trial should lead to discussions about fast-tracking releases elsewhere during a public health crisis.\u003c/p>\n\u003cp>\"The pathways that enable emergency use should be looked at because the crisis is here and now, and it would be an awful shame if we looked back in two or three years and say, 'Why didn't we do this?'\" Parry remarked in a conference call with reporters.\u003c/p>\n\u003cp>Oxitec promotes its technology as a chemical-free way to control mosquitoes and reduce the risks of Zika, dengue fever or chikungunya. In Miami this week, the head of the CDC credited aerial pesticide spraying with killing a significant number of mosquitoes in an arts district where Zika was apparently transmitted by insects on the U.S. mainland for the first time.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Zika is mainly spread by mosquitoes, as well as sex. Except for the 16 confirmed cases in the Miami area, the other 1,825 infections reported in the U.S. have been linked to travel to countries in Latin America or the Caribbean with Zika outbreaks.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Beautiful But Deadly: Images of Cancer, Close Up",
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"content": "\u003cp>Sometimes, nature is an abstract expressionist.\u003c/p>\n\u003cp>Below are selected images from the National Cancer Institute's \"\u003ca href=\"https://visualsonline.cancer.gov/collection.cfm?groupid=4\" target=\"_blank\">Cancer Close Up 2016\u003c/a>\" collection, posted last month.\u003c/p>\n\u003cp>The NCI in February put out a call to researchers for \"spectacular microscopy photographs of cancer-related cells, tissues, and molecules that colorfully illustrate significant research conducted by NCI-designated cancer centers.\"\u003c/p>\n\u003cp>The NCI said it was particularly interested in images related to precision medicine, for which the agency receives funding as part of the federal government's \u003ca href=\"https://www.whitehouse.gov/the-press-office/2015/01/30/fact-sheet-president-obama-s-precision-medicine-initiative%22%20target=%22_blank\" target=\"_blank\">Precision Medicine Initiative.\u003c/a>\u003c/p>\n\u003cp>Most of the images were created using fluorescence microscope, an NCI spokesperson said. Some used an electron microscope. The images will adorn its exhibit booth at annual cancer research meetings and will be featured in public image galleries (not to mention \u003ca href=\"https://www.instagram.com/ncivisualsonline/\" target=\"_blank\">Instagram\u003c/a>).\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>You can \u003ca href=\"https://visualsonline.cancer.gov/collection.cfm?groupid=4\" target=\"_blank\">see the full collection here\u003c/a>, but we liked these the best. The descriptions are from the NCI and have been lightly edited.\u003c/p>\n\u003cfigure id=\"attachment_217174\" class=\"wp-caption aligncenter\" style=\"max-width: 720px\">\u003ca href=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/08/ncilipid.jpg\">\u003cimg class=\"wp-image-217174 size-full\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/08/ncilipid.jpg\" alt=\"ncilipid\" width=\"720\" height=\"720\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2016/08/ncilipid.jpg 720w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/ncilipid-400x400.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/ncilipid-600x600.jpg 600w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/ncilipid-32x32.jpg 32w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/ncilipid-50x50.jpg 50w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/ncilipid-64x64.jpg 64w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/ncilipid-96x96.jpg 96w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/ncilipid-128x128.jpg 128w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/ncilipid-150x150.jpg 150w\" sizes=\"(max-width: 720px) 100vw, 720px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Altered lipid metabolism may be a key signature of cancer. This image reveals the storage of cholesterol ester in lipid droplets (bright dots) in aggressive human prostate cancer. This finding may lead to new cancer drugs that work by blocking the activity of cholesterol esterification. \u003ci>(Ji-Xin Cheng/NCI)\u003c/i>\u003c/figcaption>\u003c/figure>\n\u003cp> \u003c/p>\n\u003cfigure id=\"attachment_217176\" class=\"wp-caption aligncenter\" style=\"max-width: 672px\">\u003ca href=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/08/ncioncoprotein.jpg\">\u003cimg class=\"wp-image-217176 size-full\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/08/ncioncoprotein.jpg\" alt=\"ncioncoprotein\" width=\"672\" height=\"511\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2016/08/ncioncoprotein.jpg 672w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/ncioncoprotein-400x304.jpg 400w\" sizes=\"(max-width: 672px) 100vw, 672px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Infection with certain types of human papillomavirus (HPV) is associated with various cancers. Researchers are working to understand the processes by which HPV can transform a healthy cell into a cancerous one. This image shows actin (stained in green), a protein involved in cell motion, in HPV-16 E6 and E7-expressing human foreskin keratinocytes. (\u003ci>Ewa Krawczyk/NCI)\u003c/i>\u003c/figcaption>\u003c/figure>\n\u003cp> \u003c/p>\n\u003cfigure id=\"attachment_217203\" class=\"wp-caption aligncenter\" style=\"max-width: 720px\">\u003ca href=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/08/ncibreasttumor.jpg\">\u003cimg class=\"wp-image-217203 size-full\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/08/ncibreasttumor.jpg\" alt=\"ncibreasttumor\" width=\"720\" height=\"720\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2016/08/ncibreasttumor.jpg 720w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/ncibreasttumor-400x400.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/ncibreasttumor-600x600.jpg 600w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/ncibreasttumor-32x32.jpg 32w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/ncibreasttumor-50x50.jpg 50w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/ncibreasttumor-64x64.jpg 64w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/ncibreasttumor-96x96.jpg 96w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/ncibreasttumor-128x128.jpg 128w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/ncibreasttumor-150x150.jpg 150w\" sizes=\"(max-width: 720px) 100vw, 720px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">This image of a breast cancer tumor and its microenvironment was obtained from a live mouse model. The image was obtained without any fluorophores, stains, or dyes, using only the metabolic co-factors of NADH and FAD, which are already inside of cells, along with second harmonic generation to see collagen. This technique has important clinical potential for patients who require label-free imaging, and may lead to more effective diagnoses and treatments. Tumor cells display in cyan, macrophages in red, collagen fibers in green. (\u003ci>Joseph Szulczewski, David Inman, Kevin Eliceiri and Patricia Keely/NCI)\u003c/i>\u003c/figcaption>\u003c/figure>\n\u003cp> \u003c/p>\n\u003cfigure id=\"attachment_217205\" class=\"wp-caption aligncenter\" style=\"max-width: 965px\">\u003ca href=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/08/nciimmunotherapy.jpg\">\u003cimg class=\"wp-image-217205 size-full\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/08/nciimmunotherapy.jpg\" alt=\"nciimmunotherapy\" width=\"965\" height=\"803\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2016/08/nciimmunotherapy.jpg 965w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/nciimmunotherapy-400x333.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/nciimmunotherapy-721x600.jpg 721w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/nciimmunotherapy-768x639.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/nciimmunotherapy-960x799.jpg 960w\" sizes=\"(max-width: 965px) 100vw, 965px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Shown here is a pseudo-colored scanning electron micrograph of an oral squamous cancer cell (white) being attacked by two cytotoxic T cells (red), part of a natural immune response. Nanomedicine researchers are creating personalized cancer vaccines by loading neoantigens identified from the patient's tumor into nanoparticles. When presented with immune stimulants, this activates the patient's own immune system, leading to expansion of tumor-specific cytotoxic T cells. (\u003ci>Rita Elena Serda/NCI)\u003c/i>\u003c/figcaption>\u003c/figure>\n\u003cp> \u003c/p>\n\u003cfigure id=\"attachment_217207\" class=\"wp-caption aligncenter\" style=\"max-width: 864px\">\u003ca href=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/08/nciDrosophilia.jpg\">\u003cimg class=\"wp-image-217207 size-full\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/08/nciDrosophilia.jpg\" alt=\"nciDrosophilia\" width=\"864\" height=\"864\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2016/08/nciDrosophilia.jpg 864w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/nciDrosophilia-400x400.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/nciDrosophilia-600x600.jpg 600w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/nciDrosophilia-768x768.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/nciDrosophilia-32x32.jpg 32w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/nciDrosophilia-50x50.jpg 50w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/nciDrosophilia-64x64.jpg 64w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/nciDrosophilia-96x96.jpg 96w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/nciDrosophilia-128x128.jpg 128w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/nciDrosophilia-150x150.jpg 150w\" sizes=\"(max-width: 864px) 100vw, 864px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">The human CBFA2T3-GLIS2 fusion protein is a key driver of pediatric acute megakaryoblastic leukemia (AMKL), and confers a poor prognosis. Researchers found a way to express CBFA2T3-GLIS2 (red) in larval fruit fly wing disc cells. This confirms a major role for a pathway that may provide a target for new therapies. Nuclei (green) and actin filaments (purple) are also shown. (\u003ci>Suresh Marada/NCI)\u003c/i>\u003c/figcaption>\u003c/figure>\n\u003cp> \u003c/p>\n\u003cfigure id=\"attachment_217209\" class=\"wp-caption aligncenter\" style=\"max-width: 768px\">\u003ca href=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/08/nci-nanoparticles.jpg\">\u003cimg class=\"wp-image-217209 size-full\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/08/nci-nanoparticles.jpg\" alt=\"nci nanoparticles\" width=\"768\" height=\"768\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2016/08/nci-nanoparticles.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/nci-nanoparticles-400x400.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/nci-nanoparticles-600x600.jpg 600w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/nci-nanoparticles-32x32.jpg 32w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/nci-nanoparticles-50x50.jpg 50w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/nci-nanoparticles-64x64.jpg 64w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/nci-nanoparticles-96x96.jpg 96w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/nci-nanoparticles-128x128.jpg 128w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/nci-nanoparticles-150x150.jpg 150w\" sizes=\"(max-width: 768px) 100vw, 768px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Treating cancer in the brain is particularly difficult because most drug molecules are not small enough to penetrate the blood-brain barrier. Researchers wonder whether nanoparticles can serve as a drug-delivery mechanism. This image shows nanoparticles (red) being taken up in the brain of a live rat model with glioblastoma (in green). Nuclear DNA is in blue; tumor-associated macrophages in white.\u003ci> (Eric Hoyeon Song, Alice Gaudin, W. Mark Saltzman/NCI)\u003c/i>\u003c/figcaption>\u003c/figure>\n\u003cp>More detail on how the images were created from \u003ca href=\"https://www.washingtonpost.com/national/health-science/deadly-and-beautiful-the-mesmerizing-images-of-cancer-research/2016/07/11/307edb24-43a3-11e6-8856-f26de2537a9d_story.html\" target=\"_blank\">The Washington Post\u003c/a>:\u003c/p>\n\u003cblockquote>\u003cp>Most of the photos ... are made with fluorescent optical microscopes with attached digital cameras. Scientists use various fluorescent stains to highlight specific cellular structures ... and these stains and dyes “light up” when exposed to specific wavelengths of light. (Often) the final multicolored images obtained are composites — overlays — of separate images taken using different wavelengths.\u003c/p>\u003c/blockquote>\n\u003cp>\u003c/p>\n\u003cp>And from \u003ca href=\"https://www.statnews.com/2016/07/15/cancer-cells-slideshow/\" target=\"_blank\">STAT\u003c/a>:\u003c/p>\n\u003cblockquote>\u003cp>The photographic techniques that produced them are allowing scientists to understand how the interactions between cellular proteins and the cell nucleus allow cancer cells to invade far-flung tissue, for instance, and how certain molecules allow tumor cells to withstand chemotherapy.\u003c/p>\u003c/blockquote>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Sometimes, nature is an abstract expressionist.\u003c/p>\n\u003cp>Below are selected images from the National Cancer Institute's \"\u003ca href=\"https://visualsonline.cancer.gov/collection.cfm?groupid=4\" target=\"_blank\">Cancer Close Up 2016\u003c/a>\" collection, posted last month.\u003c/p>\n\u003cp>The NCI in February put out a call to researchers for \"spectacular microscopy photographs of cancer-related cells, tissues, and molecules that colorfully illustrate significant research conducted by NCI-designated cancer centers.\"\u003c/p>\n\u003cp>The NCI said it was particularly interested in images related to precision medicine, for which the agency receives funding as part of the federal government's \u003ca href=\"https://www.whitehouse.gov/the-press-office/2015/01/30/fact-sheet-president-obama-s-precision-medicine-initiative%22%20target=%22_blank\" target=\"_blank\">Precision Medicine Initiative.\u003c/a>\u003c/p>\n\u003cp>Most of the images were created using fluorescence microscope, an NCI spokesperson said. Some used an electron microscope. The images will adorn its exhibit booth at annual cancer research meetings and will be featured in public image galleries (not to mention \u003ca href=\"https://www.instagram.com/ncivisualsonline/\" target=\"_blank\">Instagram\u003c/a>).\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>You can \u003ca href=\"https://visualsonline.cancer.gov/collection.cfm?groupid=4\" target=\"_blank\">see the full collection here\u003c/a>, but we liked these the best. The descriptions are from the NCI and have been lightly edited.\u003c/p>\n\u003cfigure id=\"attachment_217174\" class=\"wp-caption aligncenter\" style=\"max-width: 720px\">\u003ca href=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/08/ncilipid.jpg\">\u003cimg class=\"wp-image-217174 size-full\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/08/ncilipid.jpg\" alt=\"ncilipid\" width=\"720\" height=\"720\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2016/08/ncilipid.jpg 720w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/ncilipid-400x400.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/ncilipid-600x600.jpg 600w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/ncilipid-32x32.jpg 32w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/ncilipid-50x50.jpg 50w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/ncilipid-64x64.jpg 64w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/ncilipid-96x96.jpg 96w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/ncilipid-128x128.jpg 128w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/ncilipid-150x150.jpg 150w\" sizes=\"(max-width: 720px) 100vw, 720px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Altered lipid metabolism may be a key signature of cancer. This image reveals the storage of cholesterol ester in lipid droplets (bright dots) in aggressive human prostate cancer. This finding may lead to new cancer drugs that work by blocking the activity of cholesterol esterification. \u003ci>(Ji-Xin Cheng/NCI)\u003c/i>\u003c/figcaption>\u003c/figure>\n\u003cp> \u003c/p>\n\u003cfigure id=\"attachment_217176\" class=\"wp-caption aligncenter\" style=\"max-width: 672px\">\u003ca href=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/08/ncioncoprotein.jpg\">\u003cimg class=\"wp-image-217176 size-full\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/08/ncioncoprotein.jpg\" alt=\"ncioncoprotein\" width=\"672\" height=\"511\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2016/08/ncioncoprotein.jpg 672w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/ncioncoprotein-400x304.jpg 400w\" sizes=\"(max-width: 672px) 100vw, 672px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Infection with certain types of human papillomavirus (HPV) is associated with various cancers. Researchers are working to understand the processes by which HPV can transform a healthy cell into a cancerous one. This image shows actin (stained in green), a protein involved in cell motion, in HPV-16 E6 and E7-expressing human foreskin keratinocytes. (\u003ci>Ewa Krawczyk/NCI)\u003c/i>\u003c/figcaption>\u003c/figure>\n\u003cp> \u003c/p>\n\u003cfigure id=\"attachment_217203\" class=\"wp-caption aligncenter\" style=\"max-width: 720px\">\u003ca href=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/08/ncibreasttumor.jpg\">\u003cimg class=\"wp-image-217203 size-full\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/08/ncibreasttumor.jpg\" alt=\"ncibreasttumor\" width=\"720\" height=\"720\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2016/08/ncibreasttumor.jpg 720w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/ncibreasttumor-400x400.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/ncibreasttumor-600x600.jpg 600w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/ncibreasttumor-32x32.jpg 32w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/ncibreasttumor-50x50.jpg 50w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/ncibreasttumor-64x64.jpg 64w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/ncibreasttumor-96x96.jpg 96w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/ncibreasttumor-128x128.jpg 128w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/ncibreasttumor-150x150.jpg 150w\" sizes=\"(max-width: 720px) 100vw, 720px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">This image of a breast cancer tumor and its microenvironment was obtained from a live mouse model. The image was obtained without any fluorophores, stains, or dyes, using only the metabolic co-factors of NADH and FAD, which are already inside of cells, along with second harmonic generation to see collagen. This technique has important clinical potential for patients who require label-free imaging, and may lead to more effective diagnoses and treatments. Tumor cells display in cyan, macrophages in red, collagen fibers in green. (\u003ci>Joseph Szulczewski, David Inman, Kevin Eliceiri and Patricia Keely/NCI)\u003c/i>\u003c/figcaption>\u003c/figure>\n\u003cp> \u003c/p>\n\u003cfigure id=\"attachment_217205\" class=\"wp-caption aligncenter\" style=\"max-width: 965px\">\u003ca href=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/08/nciimmunotherapy.jpg\">\u003cimg class=\"wp-image-217205 size-full\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/08/nciimmunotherapy.jpg\" alt=\"nciimmunotherapy\" width=\"965\" height=\"803\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2016/08/nciimmunotherapy.jpg 965w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/nciimmunotherapy-400x333.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/nciimmunotherapy-721x600.jpg 721w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/nciimmunotherapy-768x639.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/nciimmunotherapy-960x799.jpg 960w\" sizes=\"(max-width: 965px) 100vw, 965px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Shown here is a pseudo-colored scanning electron micrograph of an oral squamous cancer cell (white) being attacked by two cytotoxic T cells (red), part of a natural immune response. Nanomedicine researchers are creating personalized cancer vaccines by loading neoantigens identified from the patient's tumor into nanoparticles. When presented with immune stimulants, this activates the patient's own immune system, leading to expansion of tumor-specific cytotoxic T cells. (\u003ci>Rita Elena Serda/NCI)\u003c/i>\u003c/figcaption>\u003c/figure>\n\u003cp> \u003c/p>\n\u003cfigure id=\"attachment_217207\" class=\"wp-caption aligncenter\" style=\"max-width: 864px\">\u003ca href=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/08/nciDrosophilia.jpg\">\u003cimg class=\"wp-image-217207 size-full\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/08/nciDrosophilia.jpg\" alt=\"nciDrosophilia\" width=\"864\" height=\"864\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2016/08/nciDrosophilia.jpg 864w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/nciDrosophilia-400x400.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/nciDrosophilia-600x600.jpg 600w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/nciDrosophilia-768x768.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/nciDrosophilia-32x32.jpg 32w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/nciDrosophilia-50x50.jpg 50w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/nciDrosophilia-64x64.jpg 64w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/nciDrosophilia-96x96.jpg 96w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/nciDrosophilia-128x128.jpg 128w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/nciDrosophilia-150x150.jpg 150w\" sizes=\"(max-width: 864px) 100vw, 864px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">The human CBFA2T3-GLIS2 fusion protein is a key driver of pediatric acute megakaryoblastic leukemia (AMKL), and confers a poor prognosis. Researchers found a way to express CBFA2T3-GLIS2 (red) in larval fruit fly wing disc cells. This confirms a major role for a pathway that may provide a target for new therapies. Nuclei (green) and actin filaments (purple) are also shown. (\u003ci>Suresh Marada/NCI)\u003c/i>\u003c/figcaption>\u003c/figure>\n\u003cp> \u003c/p>\n\u003cfigure id=\"attachment_217209\" class=\"wp-caption aligncenter\" style=\"max-width: 768px\">\u003ca href=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/08/nci-nanoparticles.jpg\">\u003cimg class=\"wp-image-217209 size-full\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/08/nci-nanoparticles.jpg\" alt=\"nci nanoparticles\" width=\"768\" height=\"768\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2016/08/nci-nanoparticles.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/nci-nanoparticles-400x400.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/nci-nanoparticles-600x600.jpg 600w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/nci-nanoparticles-32x32.jpg 32w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/nci-nanoparticles-50x50.jpg 50w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/nci-nanoparticles-64x64.jpg 64w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/nci-nanoparticles-96x96.jpg 96w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/nci-nanoparticles-128x128.jpg 128w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/nci-nanoparticles-150x150.jpg 150w\" sizes=\"(max-width: 768px) 100vw, 768px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Treating cancer in the brain is particularly difficult because most drug molecules are not small enough to penetrate the blood-brain barrier. Researchers wonder whether nanoparticles can serve as a drug-delivery mechanism. This image shows nanoparticles (red) being taken up in the brain of a live rat model with glioblastoma (in green). Nuclear DNA is in blue; tumor-associated macrophages in white.\u003ci> (Eric Hoyeon Song, Alice Gaudin, W. Mark Saltzman/NCI)\u003c/i>\u003c/figcaption>\u003c/figure>\n\u003cp>More detail on how the images were created from \u003ca href=\"https://www.washingtonpost.com/national/health-science/deadly-and-beautiful-the-mesmerizing-images-of-cancer-research/2016/07/11/307edb24-43a3-11e6-8856-f26de2537a9d_story.html\" target=\"_blank\">The Washington Post\u003c/a>:\u003c/p>\n\u003cblockquote>\u003cp>Most of the photos ... are made with fluorescent optical microscopes with attached digital cameras. Scientists use various fluorescent stains to highlight specific cellular structures ... and these stains and dyes “light up” when exposed to specific wavelengths of light. (Often) the final multicolored images obtained are composites — overlays — of separate images taken using different wavelengths.\u003c/p>\u003c/blockquote>\n\u003cp>\u003c/p>\n\u003cp>And from \u003ca href=\"https://www.statnews.com/2016/07/15/cancer-cells-slideshow/\" target=\"_blank\">STAT\u003c/a>:\u003c/p>\n\u003cblockquote>\u003cp>The photographic techniques that produced them are allowing scientists to understand how the interactions between cellular proteins and the cell nucleus allow cancer cells to invade far-flung tissue, for instance, and how certain molecules allow tumor cells to withstand chemotherapy.\u003c/p>\u003c/blockquote>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>There are apps that can help people with diabetes keep track of their blood sugar and apps that can attach to a blood pressure cuff and store blood pressure information. I use an app called ZocDoc to schedule and manage doctor's appointments. Every time I see a therapist or a primary care doctor or dentist, the data get stored in my personal account.\u003c/p>\n\u003cp>But we leave behind other trails of health data, too, from apps and activities that are sometimes only tangentially health related. When I walk down the street, an app on my phone logs steps as it bounces against my thigh. When I swipe a loyalty card at the pharmacy, the over-the-counter medications that I buy become bits of data attached to my name. Medical information can be gleaned from all this and more, says \u003ca href=\"http://www.law.smu.edu/professor-profiles/cortez\">Nathan Cortez\u003c/a>, a professor of law at the Southern Methodist University Dedman School of Law.\u003c/p>\n\u003cp>Those data aren't always protected. A recent \u003ca href=\"https://www.healthit.gov/sites/default/files/non-covered_entities_report_june_17_2016.pdf\">report\u003c/a> from the Department of Health and Human Services showed that the vast majority of mobile health apps on the marketplace aren't covered by the Health Information Portability and Accountability Act. \"HIPAA is pretty narrow as far as these things go. It applies only to traditional entities [like hospitals, doctors and health insurance providers], and it's not surprising. HIPAA was written by Congress in 1996 before we had health apps,\" Cortez says.\u003c/p>\n\u003cp>Apps or devices used in conjunction with a doctor's office or a hospital can't share or sell your information. But there's no definitive federal law governing what happens to the data that an app developer, tech company or private individual collects. Cortez and I spoke about what that means and what people can do with individuals' data. This interview has been shortened for length and clarity.\u003c/p>\n\u003cp>\u003cstrong>So if you share your data with a physician or a hospital, then it's covered under HIPAA. If you share it with someone like Apple, then it's not?\u003c/strong>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Yeah, that's right. If your physician tells you to use an app and tells you to share that data with her, then for most purposes that data-sharing would be covered by HIPAA. And physicians have professional obligations to maintain confidentiality. So if you're sitting and show them data on your app but don't send it to their computer, they would have professional obligations under state law to keep that information confidential.\u003c/p>\n\u003cp>Now let's say there's an app made by a third-party developer. It's not covered under HIPAA. Then you take that data and send it to your physician, who puts it into your medical record. The data in your medical record would be covered by HIPAA. The data that the third-party app developer has would not.\u003c/p>\n\u003cp>\u003cstrong>It's literally that identical bits of data in different computers have different protections. The data the app developer has are not protected, while the very same bits of information in the doctor's computer are?\u003c/strong>\u003c/p>\n\u003cp>Yup. But the Federal Trade Commission has taken a few enforcement actions where mobile app developers made privacy promises but haven't kept those promises. If you're an app company you might not be governed by HIPAA, but you have to be careful to do what you're saying you're doing with that information. If you're engaging in any unfair or deceptive practices with regards to user data, the FTC could swoop in and take action.\u003c/p>\n\u003cp>\u003cstrong>What are the kinds of data that mobile app developers and tech companies have that people might be concerned about?\u003c/strong>\u003c/p>\n\u003cp>There's quite a few thoughtful researchers in this space who basically say that any data can be health data. Your online search terms, location, all of these are combined into a kind of profile of each of us. There's the famous case of \u003ca href=\"http://www.nytimes.com/2012/02/19/magazine/shopping-habits.html?pagewanted=1&_r=2&hp\">Target\u003c/a> sending mailers to a house because they accurately predicted the high-school-age daughter was pregnant. That was all predictive analytics based on shopping patterns and the like.\u003c/p>\n\u003cp>If you start shopping for certain goods and analytics online, it's not that hard for companies to figure out what medical conditions you might be dealing with.\u003c/p>\n\u003cp>\u003cstrong>Amazon has these shopping lists or wish lists that are public. I realized that somebody with my email address could probably learn a lot about me just based on what I have on that shopping list.\u003c/strong> \u003cstrong>Or if you're sending more texts than usual that could that mean you aren't feeling so great that day — that kind of thing?\u003c/strong>\u003c/p>\n\u003cp>Yeah, or what words are you using? Do you check into certain restaurants? Your gym patterns? Your travel patterns? There's a huge industry that's emerging around this data-gathering where you can predict a lot and ascertain a lot about people from data where on its face doesn't seem like health data. You can learn a lot about someone's health, even really intensely personal information, by analyzing this information.\u003c/p>\n\u003cp>\u003cstrong>Do you think an employer purchasing those data could use the information to figure out whether you have a certain medical condition that might give the company second thoughts about hiring you?\u003c/strong>\u003c/p>\n\u003cp>The discrimination question is really interesting and really scary, potentially. We have laws that inhibit medical insurance companies from discriminating based on your past medical history. But you can take a lot of data points and make inferences that get you to the same spot.\u003c/p>\n\u003cp>Legal scholars are wondering — is this a backdoor way to discriminate against insured populations based on their medical history? There's a company called Oscar based out of New York that has [become] really popular. They market themselves as a next-generation health insurance company where we're smart and we're data driven, we use modern technologies, we're not an old stodgy health insurance company. They give you an \u003ca href=\"http://blog.hioscar.com/post/119375641948/building-better-rewards-step-by-step\">incentive\u003c/a> to use [wearables] and use apps [to track exercise and give an opportunity to earn rewards].\u003c/p>\n\u003cp>But if you're using a Fitbit and you have a desk job and you sit around, will you be charged premiums for that or denied coverage in the future? Can we measure people's health risks in advance based on data points that individually seem innocuous but put together paint pretty detailed pictures?\u003c/p>\n\u003cp>\u003cstrong>Of course, some people would be happy to share those data, right? We do it all the time to get better traffic information. We could potentially be getting much better health care and health apps by freely sharing our information.\u003c/strong>\u003c/p>\n\u003cp>Of course! Not all consumers want their data to be locked up and in silos and kept confidential. I went to a conference at Stanford last month, and a bunch of patients there wanted their data to be open and free. One good thing about health going online is you have patient communities with chronic or difficult diseases where patients can find and help each other.\u003c/p>\n\u003cp>But there are certain egregious practices [from data brokers] that are predatory and abusive. It's very tricky to come up with a legal system that will work for everybody.\u003c/p>\n\u003cp>\u003cstrong>So, say I'm a consumer who wants to use these apps. How do I check and make sure that my data are protected to my satisfaction? \u003c/strong>\u003c/p>\n\u003cp>It depends on your level of concern. If it's very sensitive and you're very concerned, I wouldn't use an app unless it's from a traditional provider. If you're going to a hospital and they have an app that allows you to access records, which should be protected by definition.\u003c/p>\n\u003cp>If you're downloading ... fitness tracking, health, lifestyle apps or even apps for chronic disease that aren't being offered by traditional providers, there's a good chance it's not covered by HIPAA. If you are concerned, read the privacy policy. Unfortunately, they're written by lawyers and aren't always clear. That's a lot of work for a consumer. It's a very buyer-beware market.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This story is part of the bonus material for NPR's podcast and show \u003c/em>\u003ca href=\"http://www.npr.org/podcasts/510307/invisibilia\">Invisibilia\u003c/a>,\u003cem> which this week tells the tale of a woman who used a blood-glucose monitoring app to track the health of her twin sister from afar.\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=How+Your+Health+Data+Lead+A+Not-So-Secret+Life+Online&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>There are apps that can help people with diabetes keep track of their blood sugar and apps that can attach to a blood pressure cuff and store blood pressure information. I use an app called ZocDoc to schedule and manage doctor's appointments. Every time I see a therapist or a primary care doctor or dentist, the data get stored in my personal account.\u003c/p>\n\u003cp>But we leave behind other trails of health data, too, from apps and activities that are sometimes only tangentially health related. When I walk down the street, an app on my phone logs steps as it bounces against my thigh. When I swipe a loyalty card at the pharmacy, the over-the-counter medications that I buy become bits of data attached to my name. Medical information can be gleaned from all this and more, says \u003ca href=\"http://www.law.smu.edu/professor-profiles/cortez\">Nathan Cortez\u003c/a>, a professor of law at the Southern Methodist University Dedman School of Law.\u003c/p>\n\u003cp>Those data aren't always protected. A recent \u003ca href=\"https://www.healthit.gov/sites/default/files/non-covered_entities_report_june_17_2016.pdf\">report\u003c/a> from the Department of Health and Human Services showed that the vast majority of mobile health apps on the marketplace aren't covered by the Health Information Portability and Accountability Act. \"HIPAA is pretty narrow as far as these things go. It applies only to traditional entities [like hospitals, doctors and health insurance providers], and it's not surprising. HIPAA was written by Congress in 1996 before we had health apps,\" Cortez says.\u003c/p>\n\u003cp>Apps or devices used in conjunction with a doctor's office or a hospital can't share or sell your information. But there's no definitive federal law governing what happens to the data that an app developer, tech company or private individual collects. Cortez and I spoke about what that means and what people can do with individuals' data. This interview has been shortened for length and clarity.\u003c/p>\n\u003cp>\u003cstrong>So if you share your data with a physician or a hospital, then it's covered under HIPAA. If you share it with someone like Apple, then it's not?\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Yeah, that's right. If your physician tells you to use an app and tells you to share that data with her, then for most purposes that data-sharing would be covered by HIPAA. And physicians have professional obligations to maintain confidentiality. So if you're sitting and show them data on your app but don't send it to their computer, they would have professional obligations under state law to keep that information confidential.\u003c/p>\n\u003cp>Now let's say there's an app made by a third-party developer. It's not covered under HIPAA. Then you take that data and send it to your physician, who puts it into your medical record. The data in your medical record would be covered by HIPAA. The data that the third-party app developer has would not.\u003c/p>\n\u003cp>\u003cstrong>It's literally that identical bits of data in different computers have different protections. The data the app developer has are not protected, while the very same bits of information in the doctor's computer are?\u003c/strong>\u003c/p>\n\u003cp>Yup. But the Federal Trade Commission has taken a few enforcement actions where mobile app developers made privacy promises but haven't kept those promises. If you're an app company you might not be governed by HIPAA, but you have to be careful to do what you're saying you're doing with that information. If you're engaging in any unfair or deceptive practices with regards to user data, the FTC could swoop in and take action.\u003c/p>\n\u003cp>\u003cstrong>What are the kinds of data that mobile app developers and tech companies have that people might be concerned about?\u003c/strong>\u003c/p>\n\u003cp>There's quite a few thoughtful researchers in this space who basically say that any data can be health data. Your online search terms, location, all of these are combined into a kind of profile of each of us. There's the famous case of \u003ca href=\"http://www.nytimes.com/2012/02/19/magazine/shopping-habits.html?pagewanted=1&_r=2&hp\">Target\u003c/a> sending mailers to a house because they accurately predicted the high-school-age daughter was pregnant. That was all predictive analytics based on shopping patterns and the like.\u003c/p>\n\u003cp>If you start shopping for certain goods and analytics online, it's not that hard for companies to figure out what medical conditions you might be dealing with.\u003c/p>\n\u003cp>\u003cstrong>Amazon has these shopping lists or wish lists that are public. I realized that somebody with my email address could probably learn a lot about me just based on what I have on that shopping list.\u003c/strong> \u003cstrong>Or if you're sending more texts than usual that could that mean you aren't feeling so great that day — that kind of thing?\u003c/strong>\u003c/p>\n\u003cp>Yeah, or what words are you using? Do you check into certain restaurants? Your gym patterns? Your travel patterns? There's a huge industry that's emerging around this data-gathering where you can predict a lot and ascertain a lot about people from data where on its face doesn't seem like health data. You can learn a lot about someone's health, even really intensely personal information, by analyzing this information.\u003c/p>\n\u003cp>\u003cstrong>Do you think an employer purchasing those data could use the information to figure out whether you have a certain medical condition that might give the company second thoughts about hiring you?\u003c/strong>\u003c/p>\n\u003cp>The discrimination question is really interesting and really scary, potentially. We have laws that inhibit medical insurance companies from discriminating based on your past medical history. But you can take a lot of data points and make inferences that get you to the same spot.\u003c/p>\n\u003cp>Legal scholars are wondering — is this a backdoor way to discriminate against insured populations based on their medical history? There's a company called Oscar based out of New York that has [become] really popular. They market themselves as a next-generation health insurance company where we're smart and we're data driven, we use modern technologies, we're not an old stodgy health insurance company. They give you an \u003ca href=\"http://blog.hioscar.com/post/119375641948/building-better-rewards-step-by-step\">incentive\u003c/a> to use [wearables] and use apps [to track exercise and give an opportunity to earn rewards].\u003c/p>\n\u003cp>But if you're using a Fitbit and you have a desk job and you sit around, will you be charged premiums for that or denied coverage in the future? Can we measure people's health risks in advance based on data points that individually seem innocuous but put together paint pretty detailed pictures?\u003c/p>\n\u003cp>\u003cstrong>Of course, some people would be happy to share those data, right? We do it all the time to get better traffic information. We could potentially be getting much better health care and health apps by freely sharing our information.\u003c/strong>\u003c/p>\n\u003cp>Of course! Not all consumers want their data to be locked up and in silos and kept confidential. I went to a conference at Stanford last month, and a bunch of patients there wanted their data to be open and free. One good thing about health going online is you have patient communities with chronic or difficult diseases where patients can find and help each other.\u003c/p>\n\u003cp>But there are certain egregious practices [from data brokers] that are predatory and abusive. It's very tricky to come up with a legal system that will work for everybody.\u003c/p>\n\u003cp>\u003cstrong>So, say I'm a consumer who wants to use these apps. How do I check and make sure that my data are protected to my satisfaction? \u003c/strong>\u003c/p>\n\u003cp>It depends on your level of concern. If it's very sensitive and you're very concerned, I wouldn't use an app unless it's from a traditional provider. If you're going to a hospital and they have an app that allows you to access records, which should be protected by definition.\u003c/p>\n\u003cp>If you're downloading ... fitness tracking, health, lifestyle apps or even apps for chronic disease that aren't being offered by traditional providers, there's a good chance it's not covered by HIPAA. If you are concerned, read the privacy policy. Unfortunately, they're written by lawyers and aren't always clear. That's a lot of work for a consumer. It's a very buyer-beware market.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>https://www.youtube.com/watch?v=n6JRG733ReQ&ab_channel=AACC\u003c/p>\n\u003cp>Speaking Monday before an estimated 2,650 people -- most of them laboratory scientists -- at the annual meeting of the American Association for Clinical Chemistry, Theranos CEO Elizabeth Holmes \u003ca href=\"http://ww2.kqed.org/futureofyou/2016/07/29/theranos-elizabeth-holmes-will-face-1000-scientists-monday-can-she-say-anything-to-gain-their-trust/\" target=\"_blank\">introduced a new device\u003c/a> that can fit on a desktop. Holmes said the machine, called a miniLab, integrates several blood-testing methodologies and, using robots and its proprietary “nanotainer” collection tube, will be able to process small volumes of blood remotely and send data back to a centralized location.\u003c/p>\n\u003cp>Holmes did not present data concerning the problematic consumer blood tests the company ran over the past few years -- tests that have led to a suspension of Holmes by the Centers for Medicare & Medicaid Services as well as severe penalties for Theranos, multiple lawsuits, and the loss of the company's key parternship with Walgreens.\u003c/p>\n\u003cp>You can watch Holmes' entire presentation, plus the question and answer period, above.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\u003cp>\u003c/p>\n",
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"info": "What kind of no sabo word is Hyphenación? For us, it’s about living within a hyphenation. Like being a third-gen Mexican-American from the Texas border now living that Bay Area Chicano life. Like Xorje! Each week we bring together a couple of hyphenated Latinos to talk all about personal life choices: family, careers, relationships, belonging … everything is on the table. ",
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"info": "Our flagship program, helmed by Kai Ryssdal, examines what the day in money delivered, through stories, conversations, newsworthy numbers and more. Updated Monday through Friday at about 3:30 p.m. PT.",
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"mindshift": {
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"info": "The MindShift podcast explores the innovations in education that are shaping how kids learn. Hosts Ki Sung and Katrina Schwartz introduce listeners to educators, researchers, parents and students who are developing effective ways to improve how kids learn. We cover topics like how fed-up administrators are developing surprising tactics to deal with classroom disruptions; how listening to podcasts are helping kids develop reading skills; the consequences of overparenting; and why interdisciplinary learning can engage students on all ends of the traditional achievement spectrum. This podcast is part of the MindShift education site, a division of KQED News. KQED is an NPR/PBS member station based in San Francisco. You can also visit the MindShift website for episodes and supplemental blog posts or tweet us \u003ca href=\"https://twitter.com/MindShiftKQED\">@MindShiftKQED\u003c/a> or visit us at \u003ca href=\"/mindshift\">MindShift.KQED.org\u003c/a>",
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"order": 12
},
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM1NzY0NjAwNDI5",
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"info": "For decades, the process for how police police themselves has been inconsistent – if not opaque. In some states, like California, these proceedings were completely hidden. After a new police transparency law unsealed scores of internal affairs files, our reporters set out to examine these cases and the shadow world of police discipline. On Our Watch brings listeners into the rooms where officers are questioned and witnesses are interrogated to find out who this system is really protecting. Is it the officers, or the public they've sworn to serve?",
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"info": "Our weekly podcast explores how the media 'sausage' is made, casts an incisive eye on fluctuations in the marketplace of ideas, and examines threats to the freedom of information and expression in America and abroad. For one hour a week, the show tries to lift the veil from the process of \"making media,\" especially news media, because it's through that lens that we see the world and the world sees us",
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},
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},
"perspectives": {
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"order": 14
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"info": "The economy explained. Imagine you could call up a friend and say, Meet me at the bar and tell me what's going on with the economy. Now imagine that's actually a fun evening.",
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"politicalbreakdown": {
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"title": "Political Breakdown",
"tagline": "Politics from a personal perspective",
"info": "Political Breakdown is a new series that explores the political intersection of California and the nation. Each week hosts Scott Shafer and Marisa Lagos are joined with a new special guest to unpack politics -- with personality — and offer an insider’s glimpse at how politics happens.",
"airtime": "THU 6:30pm-7pm",
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"possible": {
"id": "possible",
"title": "Possible",
"info": "Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. Together in Possible, Hoffman and Finger lead enlightening discussions about building a brighter collective future. The show features interviews with visionary guests like Trevor Noah, Sam Altman and Janette Sadik-Khan. Possible paints an optimistic portrait of the world we can create through science, policy, business, art and our shared humanity. It asks: What if everything goes right for once? How can we get there? Each episode also includes a short fiction story generated by advanced AI GPT-4, serving as a thought-provoking springboard to speculate how humanity could leverage technology for good.",
"airtime": "SUN 2pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Possible-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.possible.fm/",
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"source": "Possible"
},
"link": "/radio/program/possible",
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"spotify": "https://open.spotify.com/show/730YpdUSNlMyPQwNnyjp4k"
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},
"pri-the-world": {
"id": "pri-the-world",
"title": "PRI's The World: Latest Edition",
"info": "Each weekday, host Marco Werman and his team of producers bring you the world's most interesting stories in an hour of radio that reminds us just how small our planet really is.",
"airtime": "MON-FRI 2pm-3pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/The-World-Podcast-Tile-360x360-1.jpg",
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},
"radiolab": {
"id": "radiolab",
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