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"disqusTitle": "Feds Seize Smallpox Vaccine as FDA Targets 'Deceitful' Stem Cell Clinics",
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"content": "\u003cp>Federal authorities raided a California stem cell clinic and seized a smallpox vaccine that is reserved only for the military and high-risk populations, as the Food and Drug Administration expressed “serious concerns” about how the clinic obtained access to the vaccine at all.\u003c/p>\n\u003cp class=\"danger-zone\">The U.S. Marshals Service seized five vials of the smallpox vaccine, which is not commercially available, the FDA \u003ca href=\"https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm573427.htm\" target=\"_blank\" rel=\"noopener noreferrer\">announced\u003c/a> Monday. Four of the vials — which each hold 100 vaccine doses — were unused, but a portion of the fifth vial had been used.\u003c/p>\n\u003caside class=\"pullquote alignright\">'I especially won’t allow cases such as this one to go unchallenged, where we have good medical reasons to believe these purported treatments can actually harm patients and make their conditions worse.'\u003ccite> FDA Commissioner Scott Gottlieb\u003c/cite>\u003c/aside>\n\u003cp>The treatment mixed some of the vaccine with stem cells taken from a patient to create an injectable — and unproven and unregulated — cancer treatment that was targeted directly at the patient’s tumors, the FDA said. The FDA, which learned of the treatment after inspections, said the injection could have caused inflammation and swelling of the heart.\u003c/p>\n\u003cp>The treatment belonged to San Diego-based company StemImmune Inc., and was given at California Stem Cell Treatment Centers in Rancho Mirage and Beverly Hills. U.S. marshals seized the product on Friday.\u003c/p>\n\u003cp>“The FDA will not allow deceitful actors to take advantage of vulnerable patients by purporting to have treatments or cures for serious diseases without any proof that they actually work,” FDA Commissioner Scott Gottlieb said in a statement. “I especially won’t allow cases such as this one to go unchallenged, where we have good medical reasons to believe these purported treatments can actually harm patients and make their conditions worse.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>A complaint filed in federal court indicates the vials were shipped from outside California but does not provide more detail on the origin. StemImmune also filed \u003ca href=\"http://appft.uspto.gov/netacgi/nph-Parser?Sect1=PTO2&Sect2=HITOFF&u=%2Fnetahtml%2FPTO%2Fsearch-adv.html&r=2&p=1&f=G&l=50&d=PG01&S1=Stemimmune.AANM.&OS=AANM/Stemimmune&RS=AANM/Stemimmune\" target=\"_blank\" rel=\"noopener noreferrer\">a patent application\u003c/a> in February describing “the use of smallpox vaccine to induce an effective anti-tumor immune response.”\u003c/p>\n\u003cp>The type of vaccine that was seized \u003ca href=\"https://www.cdc.gov/smallpox/vaccine-basics/index.html\" target=\"_blank\" rel=\"noopener noreferrer\">is made \u003c/a>from a virus similar to smallpox, but it does not contain smallpox virus and cannot give anyone smallpox, according to the Centers for Disease Control and Prevention.\u003c/p>\n\u003cp>Also Monday, the FDA announced it had sent \u003ca href=\"https://www.fda.gov/ICECI/EnforcementActions/WarningLetters/2017/ucm573187.htm\" target=\"_blank\" rel=\"noopener noreferrer\">a warning letter\u003c/a> to a Florida stem cell clinic where a 2015 procedure led three women to go legally blind, according \u003ca href=\"https://www.statnews.com/2017/03/15/stem-cell-patients-blind-macular-degeneration/\">to a March study\u003c/a> in the New England Journal of Medicine. The letter to U.S. Stem Cell Clinic said that the company was offering unapproved stem cell treatments and that an agency inspection uncovered violations of manufacturing standards, including potential sterility issues. The company also tried to stop FDA inspectors from talking with employees, the letter says.\u003c/p>\n\u003cp>“You should take prompt action to correct these deviations,” says the letter, which was sent Thursday. “Failure to promptly correct these deviations may result in regulatory action without further notice. Such actions include seizure and/or injunction.”\u003c/p>\n\u003cp>StemImmune did not respond immediately to a request for comment. In a statement, U.S. Stem Cell Clinic said it had given the FDA “unrestricted access” since 2014 and that it followed the agency’s rules. But it also suggested that regulations could prevent patients from getting treatments.\u003c/p>\n\u003cp>“The safety and health of our patients are our number one priority and the strict standards that we have in place follow the laws of the [FDA],” it said, adding: “We have helped thousands of patients harness their own healing potential. It would be a mistake to limit these therapies from patients who need them when we are adhering to top industry standards.”\u003c/p>\n\u003cp>The actions announced Monday are the latest salvo in a back-and-forth between regulators and the clinics that claim to be able to treat everything from paralysis to neurodegenerative diseases to erectile dysfunction. The clinics, \u003ca href=\"https://www.statnews.com/2016/06/30/stem-cell-clinics-proliferate/\">which have proliferated\u003c/a> around the country in recent years, have largely evaded regulation enforcement because they typically take a person’s own stem cells and inject them back into the same person, meaning the cells are considered “minimally manipulated.”\u003c/p>\n\u003cp>The \u003ca href=\"https://www.statnews.com/2016/02/08/fda-crackdown-stem-cell-clinics/\">FDA has tried\u003c/a> at various times to regulate clinics offering unproven stem cell treatments more tightly and close down clinics that put patients at risk, but overall, their efforts have not amounted to much.\u003c/p>\n\u003cp>The \u003ca href=\"https://www.statnews.com/2016/09/09/stem-cell-fda-hearing/\">FDA has held meetings\u003c/a> about possibly regulating the therapies more like drugs, a move that has been backed by many academic stem cell experts who say that stem cell therapies, while holding great potential, are not ready to be used widely or outside regulated clinical trials. But clinic owners warn that the FDA could stamp out progress in the field and keep desperate patients from getting treatments.\u003c/p>\n\u003cp>“The government should not regulate our bodies. … I will always stand up for patient rights,” Kristin Comella, U.S. Stem Cell’s chief scientific officer, said at an FDA hearing months ago. (The FDA’s warning letter this month was addressed to Comella.)\u003c/p>\n\u003cp>Some experts have wondered whether the regulation-averse Trump administration would take further action against stem cell clinics. But in a statement Monday, Gottlieb said the FDA would be bolstering its enforcement as a way of “separating the promise from the unscrupulous hype” and that the agency would roll out a new “comprehensive policy framework” this fall to delineate the rules for stem cell treatments.\u003c/p>\n\u003cp>“There are a small number of unscrupulous actors who have seized on the clinical promise of regenerative medicine, while exploiting the uncertainty, in order to make deceptive, and sometimes corrupt, assurances to patients based on unproven and, in some cases, dangerously dubious products,” Gottlieb said. “These dishonest actors exploit the sincere reports of the significant clinical potential of properly developed products as a way of deceiving patients and preying on the optimism of patients facing bad illnesses. This put the entire field at risk.”\u003c/p>\n\u003cp>Experts who study stem cell clinics and the regulatory landscape generally praised the FDA’s moves, but said that it was unclear what the enforcement actions and \u003ca href=\"https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm573443.htm\" target=\"_blank\" rel=\"noopener noreferrer\">Gottlieb’s statement\u003c/a> meant for the field going forward.\u003c/p>\n\u003cp>“The most important thing is that the FDA is now publicly making a commitment to discipline what has become an out-of-control area of fraudulent medicine,” said R. Alta Charo, a bioethicist at the University of Wisconsin Law School.\u003c/p>\n\u003cp>One part of Gottlieb’s statement that stuck out to Charo, she said, was when he signaled some flexibility in terms of the areas that are subject to FDA regulation, with the commissioner writing that “the FDA must advance an efficient and least burdensome framework” and establish “a regulatory structure that does not become a barrier to beneficial new innovation.”\u003c/p>\n\u003cp>“It’s about a tone being set,” Charo said.\u003c/p>\n\u003cp>Leigh Turner, a University of Minnesota bioethicist, said that from one standpoint, the FDA’s enforcement actions targeted the low-hanging fruit of the bad actors in the industry. Presumably any administration would want to seize unauthorized smallpox vaccine supplies, and the Florida clinic was the subject of lawsuits and media coverage in addition to the high-profile academic paper.\u003c/p>\n\u003cp>“The larger question is going to be, what about the stem cell clinics … that are out there marketing therapies and charging people but don’t have a New England Journal of Medicine piece or lawsuits?” Turner asked. “Is it just going to be that after harm occurs that the FDA is going to do something? Or are we going to see a more systemic approach to this marketplace?”\u003c/p>\n\u003cp>The action against the California clinics was solely based on the vaccine, noted Turner, who \u003ca href=\"http://www.cell.com/cell-stem-cell/abstract/S1934-5909(16)30157-6\" target=\"_blank\" rel=\"noopener noreferrer\">has tracked\u003c/a> the growth of clinics around the country. It did not mention all the other diseases and conditions that the clinics have been marketing their unapproved stem cell therapies for.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>\u003cspan style=\"font-weight: 400\">This \u003ca href=\"https://www.statnews.com/2017/08/28/smallpox-stem-cell-clinic/\" target=\"_blank\" rel=\"noopener noreferrer\">story\u003c/a> was originally published by STAT, an online publication of Boston Globe Media that covers health, medicine, and scientific discovery. \u003c/span>\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Federal authorities raided a California stem cell clinic and seized a smallpox vaccine that is reserved only for the military and high-risk populations, as the Food and Drug Administration expressed “serious concerns” about how the clinic obtained access to the vaccine at all.\u003c/p>\n\u003cp class=\"danger-zone\">The U.S. Marshals Service seized five vials of the smallpox vaccine, which is not commercially available, the FDA \u003ca href=\"https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm573427.htm\" target=\"_blank\" rel=\"noopener noreferrer\">announced\u003c/a> Monday. Four of the vials — which each hold 100 vaccine doses — were unused, but a portion of the fifth vial had been used.\u003c/p>\n\u003caside class=\"pullquote alignright\">'I especially won’t allow cases such as this one to go unchallenged, where we have good medical reasons to believe these purported treatments can actually harm patients and make their conditions worse.'\u003ccite> FDA Commissioner Scott Gottlieb\u003c/cite>\u003c/aside>\n\u003cp>The treatment mixed some of the vaccine with stem cells taken from a patient to create an injectable — and unproven and unregulated — cancer treatment that was targeted directly at the patient’s tumors, the FDA said. The FDA, which learned of the treatment after inspections, said the injection could have caused inflammation and swelling of the heart.\u003c/p>\n\u003cp>The treatment belonged to San Diego-based company StemImmune Inc., and was given at California Stem Cell Treatment Centers in Rancho Mirage and Beverly Hills. U.S. marshals seized the product on Friday.\u003c/p>\n\u003cp>“The FDA will not allow deceitful actors to take advantage of vulnerable patients by purporting to have treatments or cures for serious diseases without any proof that they actually work,” FDA Commissioner Scott Gottlieb said in a statement. “I especially won’t allow cases such as this one to go unchallenged, where we have good medical reasons to believe these purported treatments can actually harm patients and make their conditions worse.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>A complaint filed in federal court indicates the vials were shipped from outside California but does not provide more detail on the origin. StemImmune also filed \u003ca href=\"http://appft.uspto.gov/netacgi/nph-Parser?Sect1=PTO2&Sect2=HITOFF&u=%2Fnetahtml%2FPTO%2Fsearch-adv.html&r=2&p=1&f=G&l=50&d=PG01&S1=Stemimmune.AANM.&OS=AANM/Stemimmune&RS=AANM/Stemimmune\" target=\"_blank\" rel=\"noopener noreferrer\">a patent application\u003c/a> in February describing “the use of smallpox vaccine to induce an effective anti-tumor immune response.”\u003c/p>\n\u003cp>The type of vaccine that was seized \u003ca href=\"https://www.cdc.gov/smallpox/vaccine-basics/index.html\" target=\"_blank\" rel=\"noopener noreferrer\">is made \u003c/a>from a virus similar to smallpox, but it does not contain smallpox virus and cannot give anyone smallpox, according to the Centers for Disease Control and Prevention.\u003c/p>\n\u003cp>Also Monday, the FDA announced it had sent \u003ca href=\"https://www.fda.gov/ICECI/EnforcementActions/WarningLetters/2017/ucm573187.htm\" target=\"_blank\" rel=\"noopener noreferrer\">a warning letter\u003c/a> to a Florida stem cell clinic where a 2015 procedure led three women to go legally blind, according \u003ca href=\"https://www.statnews.com/2017/03/15/stem-cell-patients-blind-macular-degeneration/\">to a March study\u003c/a> in the New England Journal of Medicine. The letter to U.S. Stem Cell Clinic said that the company was offering unapproved stem cell treatments and that an agency inspection uncovered violations of manufacturing standards, including potential sterility issues. The company also tried to stop FDA inspectors from talking with employees, the letter says.\u003c/p>\n\u003cp>“You should take prompt action to correct these deviations,” says the letter, which was sent Thursday. “Failure to promptly correct these deviations may result in regulatory action without further notice. Such actions include seizure and/or injunction.”\u003c/p>\n\u003cp>StemImmune did not respond immediately to a request for comment. In a statement, U.S. Stem Cell Clinic said it had given the FDA “unrestricted access” since 2014 and that it followed the agency’s rules. But it also suggested that regulations could prevent patients from getting treatments.\u003c/p>\n\u003cp>“The safety and health of our patients are our number one priority and the strict standards that we have in place follow the laws of the [FDA],” it said, adding: “We have helped thousands of patients harness their own healing potential. It would be a mistake to limit these therapies from patients who need them when we are adhering to top industry standards.”\u003c/p>\n\u003cp>The actions announced Monday are the latest salvo in a back-and-forth between regulators and the clinics that claim to be able to treat everything from paralysis to neurodegenerative diseases to erectile dysfunction. The clinics, \u003ca href=\"https://www.statnews.com/2016/06/30/stem-cell-clinics-proliferate/\">which have proliferated\u003c/a> around the country in recent years, have largely evaded regulation enforcement because they typically take a person’s own stem cells and inject them back into the same person, meaning the cells are considered “minimally manipulated.”\u003c/p>\n\u003cp>The \u003ca href=\"https://www.statnews.com/2016/02/08/fda-crackdown-stem-cell-clinics/\">FDA has tried\u003c/a> at various times to regulate clinics offering unproven stem cell treatments more tightly and close down clinics that put patients at risk, but overall, their efforts have not amounted to much.\u003c/p>\n\u003cp>The \u003ca href=\"https://www.statnews.com/2016/09/09/stem-cell-fda-hearing/\">FDA has held meetings\u003c/a> about possibly regulating the therapies more like drugs, a move that has been backed by many academic stem cell experts who say that stem cell therapies, while holding great potential, are not ready to be used widely or outside regulated clinical trials. But clinic owners warn that the FDA could stamp out progress in the field and keep desperate patients from getting treatments.\u003c/p>\n\u003cp>“The government should not regulate our bodies. … I will always stand up for patient rights,” Kristin Comella, U.S. Stem Cell’s chief scientific officer, said at an FDA hearing months ago. (The FDA’s warning letter this month was addressed to Comella.)\u003c/p>\n\u003cp>Some experts have wondered whether the regulation-averse Trump administration would take further action against stem cell clinics. But in a statement Monday, Gottlieb said the FDA would be bolstering its enforcement as a way of “separating the promise from the unscrupulous hype” and that the agency would roll out a new “comprehensive policy framework” this fall to delineate the rules for stem cell treatments.\u003c/p>\n\u003cp>“There are a small number of unscrupulous actors who have seized on the clinical promise of regenerative medicine, while exploiting the uncertainty, in order to make deceptive, and sometimes corrupt, assurances to patients based on unproven and, in some cases, dangerously dubious products,” Gottlieb said. “These dishonest actors exploit the sincere reports of the significant clinical potential of properly developed products as a way of deceiving patients and preying on the optimism of patients facing bad illnesses. This put the entire field at risk.”\u003c/p>\n\u003cp>Experts who study stem cell clinics and the regulatory landscape generally praised the FDA’s moves, but said that it was unclear what the enforcement actions and \u003ca href=\"https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm573443.htm\" target=\"_blank\" rel=\"noopener noreferrer\">Gottlieb’s statement\u003c/a> meant for the field going forward.\u003c/p>\n\u003cp>“The most important thing is that the FDA is now publicly making a commitment to discipline what has become an out-of-control area of fraudulent medicine,” said R. Alta Charo, a bioethicist at the University of Wisconsin Law School.\u003c/p>\n\u003cp>One part of Gottlieb’s statement that stuck out to Charo, she said, was when he signaled some flexibility in terms of the areas that are subject to FDA regulation, with the commissioner writing that “the FDA must advance an efficient and least burdensome framework” and establish “a regulatory structure that does not become a barrier to beneficial new innovation.”\u003c/p>\n\u003cp>“It’s about a tone being set,” Charo said.\u003c/p>\n\u003cp>Leigh Turner, a University of Minnesota bioethicist, said that from one standpoint, the FDA’s enforcement actions targeted the low-hanging fruit of the bad actors in the industry. Presumably any administration would want to seize unauthorized smallpox vaccine supplies, and the Florida clinic was the subject of lawsuits and media coverage in addition to the high-profile academic paper.\u003c/p>\n\u003cp>“The larger question is going to be, what about the stem cell clinics … that are out there marketing therapies and charging people but don’t have a New England Journal of Medicine piece or lawsuits?” Turner asked. “Is it just going to be that after harm occurs that the FDA is going to do something? Or are we going to see a more systemic approach to this marketplace?”\u003c/p>\n\u003cp>The action against the California clinics was solely based on the vaccine, noted Turner, who \u003ca href=\"http://www.cell.com/cell-stem-cell/abstract/S1934-5909(16)30157-6\" target=\"_blank\" rel=\"noopener noreferrer\">has tracked\u003c/a> the growth of clinics around the country. It did not mention all the other diseases and conditions that the clinics have been marketing their unapproved stem cell therapies for.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>You may check Yelp reviews before deciding where to go to dinner, or which plumber to hire. Now you can use Yelp to decide where to have a baby.\u003c/p>\n\u003cp>The San Francisco-based review site is now adding clinical data on C-sections, episiotomies, and breastfeeding rates to consumer reviews of California hospitals, so women can make more informed decisions about where they deliver.\u003c/p>\n\u003cp>“Just like they’re using that kind of information to buy a car, they should be using it to think about where they’re getting their health care,” says \u003ca href=\"http://www.chcf.org/about/staff/stephanie-teleki\" target=\"_blank\" rel=\"noopener noreferrer\">Stephanie Teleki\u003c/a>, director of evaluation and impact at the California Health Care Foundation.\u003c/p>\n\u003cp>A woman’s chance of having a C-section depends, in part, on where she delivers, Teleki explains. The more C-sections a hospital does, the more likely a woman delivering there will have one.\u003c/p>\n\u003cp>That’s why the Foundation is partnering with Yelp to publish C-section rates for every hospital in the state – nearly 250 total.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>[audio src=\"http://www.kqed.org/.stream/anon/radio/tcr/2017/07/2017-07-27d-tcr.mp3\" Image=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/08/RS19268_IMG_6407-qut-768x576.jpg\" Title=\"Yelp Adds C-Section Rates and Childbirth Data to Reviews of California Hospitals\" program=\"The California Report\"]\u003c/p>\n\u003cp>Shannon Eis, vice president of communications at Yelp, says this would have been helpful information to have when she gave birth to her son in New York. It was her second baby, everything felt normal, when all of a sudden alarms started going off and she was rushed into an emergency C-section.\u003c/p>\n\u003cp>“I had never considered myself a C-section risk,” she says. “I later found out I gave birth at a hospital that has the highest emergency C-section rate in all of New York City.”\u003c/p>\n\u003cp>Eis says putting this data on Yelp will help women choose a hospital that is aligned with their birth plan, so they won’t have to negotiate with doctors and make tough choices while they’re in labor.\u003c/p>\n\u003cp>“All these decisions are washing over you so fast, and so if you haven’t done the research to put yourself in the right environment, where whatever your decisions are can be honored without the tremendous pressure and fear – women are trying to do more planning around that,” she says.\u003c/p>\n\u003cp>The reaction from the state’s hospital industry group was low-key.\u003c/p>\n\u003cp>“We have always supported transparency – this effort simply takes it more directly to consumers,” says Jan Emerson-Shea, from the California Hospital Association. “We’ll have to see how it works.”\u003c/p>\n\u003cp>When the data first went public on government and foundation websites a few years ago, hospitals generally responded by trying to improve care for women, Teleki says. But she’s curious to see how hospitals will respond when those statistics are put right in front of consumers, through the online megaphone of Yelp.\u003c/p>\n\u003cp>“For hospitals that are doing well, that’s a good thing,” she says. “For hospitals that need to improve, I’m sure they will feel some heat and perhaps be discouraged about the release.”\u003c/p>\n\u003cp>California is the first state where Yelp is rolling out this data. With one in eight babies born in the US born here, Eis says it’s the perfect place to test the product before rolling it out to other states.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“If the state of California can do this with the biggest data set in the country, the biggest birthrate in the country, any other state can do it,” she said.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>You may check Yelp reviews before deciding where to go to dinner, or which plumber to hire. Now you can use Yelp to decide where to have a baby.\u003c/p>\n\u003cp>The San Francisco-based review site is now adding clinical data on C-sections, episiotomies, and breastfeeding rates to consumer reviews of California hospitals, so women can make more informed decisions about where they deliver.\u003c/p>\n\u003cp>“Just like they’re using that kind of information to buy a car, they should be using it to think about where they’re getting their health care,” says \u003ca href=\"http://www.chcf.org/about/staff/stephanie-teleki\" target=\"_blank\" rel=\"noopener noreferrer\">Stephanie Teleki\u003c/a>, director of evaluation and impact at the California Health Care Foundation.\u003c/p>\n\u003cp>A woman’s chance of having a C-section depends, in part, on where she delivers, Teleki explains. The more C-sections a hospital does, the more likely a woman delivering there will have one.\u003c/p>\n\u003cp>That’s why the Foundation is partnering with Yelp to publish C-section rates for every hospital in the state – nearly 250 total.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Shannon Eis, vice president of communications at Yelp, says this would have been helpful information to have when she gave birth to her son in New York. It was her second baby, everything felt normal, when all of a sudden alarms started going off and she was rushed into an emergency C-section.\u003c/p>\n\u003cp>“I had never considered myself a C-section risk,” she says. “I later found out I gave birth at a hospital that has the highest emergency C-section rate in all of New York City.”\u003c/p>\n\u003cp>Eis says putting this data on Yelp will help women choose a hospital that is aligned with their birth plan, so they won’t have to negotiate with doctors and make tough choices while they’re in labor.\u003c/p>\n\u003cp>“All these decisions are washing over you so fast, and so if you haven’t done the research to put yourself in the right environment, where whatever your decisions are can be honored without the tremendous pressure and fear – women are trying to do more planning around that,” she says.\u003c/p>\n\u003cp>The reaction from the state’s hospital industry group was low-key.\u003c/p>\n\u003cp>“We have always supported transparency – this effort simply takes it more directly to consumers,” says Jan Emerson-Shea, from the California Hospital Association. “We’ll have to see how it works.”\u003c/p>\n\u003cp>When the data first went public on government and foundation websites a few years ago, hospitals generally responded by trying to improve care for women, Teleki says. But she’s curious to see how hospitals will respond when those statistics are put right in front of consumers, through the online megaphone of Yelp.\u003c/p>\n\u003cp>“For hospitals that are doing well, that’s a good thing,” she says. “For hospitals that need to improve, I’m sure they will feel some heat and perhaps be discouraged about the release.”\u003c/p>\n\u003cp>California is the first state where Yelp is rolling out this data. With one in eight babies born in the US born here, Eis says it’s the perfect place to test the product before rolling it out to other states.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“If the state of California can do this with the biggest data set in the country, the biggest birthrate in the country, any other state can do it,” she said.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>The familiar phrase, “The doctor will see you now,” is not what it used to be.\u003c/p>\n\u003cp>That's because during most exams, physicians are spending a good chunk of time not looking at the patient, but at the patient's electronic health record on a computer screen.\u003c/p>\n\u003caside class=\"pullquote alignright\">'We have invested a lot of time to train physicians, so why not have them use their expertise in the most efficient way possible?'\u003c/aside>\n\u003cp>A 2016 \u003ca href=\"http://annals.org/aim/article/2546704/allocation-physician-time-ambulatory-practice-time-motion-study-4-specialties\" target=\"_blank\" rel=\"noopener noreferrer\"> study\u003c/a> in the \u003cem>Annals of Internal Medicine\u003c/em> found that physicians spent 37 percent of their time on\u003cstrong> \u003c/strong>a computer during exams.\u003c/p>\n\u003cp>The situation can be frustrating for patients, who don't think they are getting the doctor's full attention.\u003c/p>\n\u003cp>\"That most fundamental aspect of human communication, which is eye contact, now is being robbed from the medical encounter because of the electronic health record,\" says Dr. Lloyd Minor, dean of Stanford's medical school.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>While acknowledging the benefits of EHRs, which are meant to improve patient care by providing an easily accessible health history, physicians have also railed against the heavy amount of data entry they require. Physicians spend an estimated one to two hours after work completing EHRs and other \"desktop medicine\" requirements, according to the study in \u003cem>Annals of Internal Medicine.\u003c/em>\u003c/p>\n\u003cp>But now Dr. Albert Chan, the chief of digital patient experience for the Sutter Health Network, thinks he has a solution for the burden of EHRs. Chan uses \u003ca href=\"https://www.x.company/glass/\" target=\"_blank\" rel=\"noopener noreferrer\">Google Glass\u003c/a>, with its tiny camera mounted on a device worn like eyeglasses, to stream audio and video of the patient to an offsite medical scribe. The scribe sees and hears what the doctor does, writing the notes that go into the electronic health record. This frees up the physician to give the patient her full attention. Doctors can communicate with their note-takers through a headset, asking them to retrieve test results and other data. The scribe responds via text message, which the physician sees in the Glass lens.\u003c/p>\n\u003caside class=\"pullquote alignright\">'You’re just adding more layers of cost and people to assist in the exam room.'\u003c/aside>\n\u003cp>“For patients, it’s better care because the doctors focus on them, and the doctors spend more time with them,\" Chan says. He says that because the doctor’s attention is not divided between the computer and the patient, records of the visit are more accurate.\u003c/p>\n\u003cp>The system is provided by a company called Augmedix, of which Sutter Health is an investor.\u003c/p>\n\u003cp>Currently about 100 Sutter doctors are using the system. After first deploying it among physicians in internal medicine, Sutter is now expanding it for use by specialists like dermatologists, podiatrists and orthopedists across its Northern California network.\u003c/p>\n\u003cp>“I mean, we have invested a lot of time to train physicians, so why not have them use their expertise in the most efficient way possible?” says Chan.\u003c/p>\n\u003cp>\u003cstrong>Encounter at Dolores Park\u003c/strong>\u003c/p>\n\u003cp>Augmedix was founded in 2012, by Ian Shakil and Pelu Tran. Shakil, who is the CEO, says he got the idea after a chance encounter at San Francisco's Dolores Park with some Google employees who were working on Glass. \"They had Glass in their backpacks. And they let us try it on,\" he says.\u003c/p>\n\u003cp>[contextly_sidebar id=\"TXibesbDeLMGc9JYIC8IybWNpNcdvmaW\"]After the Google crew explained the product was intended for consumers, \"I got into a big argument with the group that this was really meant for doctors.\" (Glass was a notorious bust with the public, but is \u003ca href=\"https://www.wired.com/story/google-glass-2-is-here/\" target=\"_blank\" rel=\"noopener noreferrer\">now hitting its stride as a workplace tool.\u003c/a>)\u003c/p>\n\u003cp>Shakil, who knew from media reports and his own encounters with physicians that they were beleaguered with documentation requirements, says he became obsessed with the idea of using Glass as a solution. \"I couldn't sleep; I couldn't stop talking about it. I literally quit my job.\"\u003c/p>\n\u003cp>He then reeled in his friend Tran, who dropped out of his fourth year at medical school, and the two formed the company. Shakil says more than 1,000 doctors are currently using Augmedix across the U.S. , with the largest deployment by Sutter.\u003c/p>\n\u003cp>Besides Sutter, investors include health services company McKesson and Dignity Health network.\u003c/p>\n\u003cp>Sutter's Dr. Chan says the scribes provide a number of benefits, including reminding physicians to address issues they might otherwise miss.\u003c/p>\n\u003cp>“If you have shoulder pain and chest pain, for instance, well, if I forget to address the shoulder pain during the exam, I can get a subtle hint from the transcriptionist -- ‘Hey, you may want to address the shoulder pain, too.’ ”\u003c/p>\n\u003cp>Because doctors use shorthand when entering information in an EHR, Chan says, they often have to go back hours later and fill in the gaps; that isn't necessary when a third party is taking the notes in real-time.\u003c/p>\n\u003cp>\u003cstrong>'Oh, I Can See My Kid's Soccer Game'\u003c/strong>\u003c/p>\n\u003cp>About two-thirds of Augmedix's note-takers are located overseas, in India, the Dominican Republic and Sri Lanka, says CEO Shakil. But Adeeba Hasan, a full-time scribe for the company, works out of headquarters in San Francisco. Hasan says she's able to take 80 percent of the EHR workload off a doctor's hands. \"My doctors are able to leave and get home about two or three hours early,\" Hasan says. \"They definitely thank for me for little things like, 'Oh, I can see my kids' soccer game.' \"\u003c/p>\n\u003cp>She has scribed for 20 doctors, whose predominant perspective, she says, is that while EHRs are important, they don't require a medical degree to complete. She herself is applying to medical school and finds the experience valuable. \"I'm learning all about different medications and illnesses and how you talk to patients,\" she says.\u003c/p>\n\u003cp>\u003cstrong>A Doubter\u003c/strong>\u003c/p>\n\u003cp>So is this the future of medicine as we know it?\u003c/p>\n\u003cp>“Oh my God, I hope not,” says David Lansky, executive director of the Pacific Business Group on Health, a nonprofit consortium of private companies and public agencies working toward greater health care affordability and quality.\u003c/p>\n\u003cp>The Augmedix service generally ranges from $1,500 to $3,500 per physician, per month, according to Shakil. Lansky says fixing the dysfunctional health care system requires putting the brakes on runaway costs, and using expensive scribes does just the opposite.\u003c/p>\n\u003cp>“You’re just adding more layers of cost and people to assist in the exam room,” Lansky says.\u003c/p>\n\u003cp>He thinks the solution to the burden of EHRs is to lessen reporting requirements, from quality measures to insurance coding to language intended to fend off lawsuits\u003cb>.\u003c/b>\u003c/p>\n\u003cp>“The real problem is that administrative requirements are uncoordinated and useless,\" Lansky says. \"I mean, no one’s even looking at the quality measures physicians are required to key in.\"\u003c/p>\n\u003cp>“The two paths we want to pursue are to reduce reporting and improve EHR function. If everything’s in front of you, you can use your face time [with the patient] to really \u003cem>do\u003c/em> face time.”\u003c/p>\n\u003cp>\u003cstrong>What About the Creepiness Factor?\u003c/strong>\u003c/p>\n\u003cp>Might some patients, especially women, not take too kindly to having something as intimate as a medical exam observed by someone they don't know and can't see?\u003c/p>\n\u003cp>\"To be honest\u003cstrong>, \u003c/strong>\u003cspan class=\"s1\">when we first founded the business, we had no idea if this issue was going to be a show-stopper or not a big deal,\" says Shakil. \"We’ve since grown and we’ve learned that it’ s not actually a big deal.\" \u003c/span>\u003c/p>\n\u003cp>He says only 2 percent of patients have opted out so far, a rate that remains steady across all demographics, including sex.\u003c/p>\n\u003cp>Shakil says the audio-video stream is encrypted, so hacking is not an issue. \"We've penetration-tested it, and it's Fort Knox, basically.\" The scribes sit in what he calls an \"ultra-secure environment,\" with nothing in their pockets, video monitoring, and computers that can only run the company's application.\u003c/p>\n\u003cp>The doctor can also temporarily switch off the Glass feed by swiping or verbal command if there's something occurring the patient doesn't want transmitted. The light on the device changes color to indicate its no longer active, which the patient can see.\u003c/p>\n\u003cp>Interestingly enough, there is one small sub-group of patients who are opting out at a slightly greater rate.\u003c/p>\n\u003cp>\"It's a little bit higher around the Google campus than anywhere in the country,\" Shakil says.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>Make of that what you will.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The familiar phrase, “The doctor will see you now,” is not what it used to be.\u003c/p>\n\u003cp>That's because during most exams, physicians are spending a good chunk of time not looking at the patient, but at the patient's electronic health record on a computer screen.\u003c/p>\n\u003caside class=\"pullquote alignright\">'We have invested a lot of time to train physicians, so why not have them use their expertise in the most efficient way possible?'\u003c/aside>\n\u003cp>A 2016 \u003ca href=\"http://annals.org/aim/article/2546704/allocation-physician-time-ambulatory-practice-time-motion-study-4-specialties\" target=\"_blank\" rel=\"noopener noreferrer\"> study\u003c/a> in the \u003cem>Annals of Internal Medicine\u003c/em> found that physicians spent 37 percent of their time on\u003cstrong> \u003c/strong>a computer during exams.\u003c/p>\n\u003cp>The situation can be frustrating for patients, who don't think they are getting the doctor's full attention.\u003c/p>\n\u003cp>\"That most fundamental aspect of human communication, which is eye contact, now is being robbed from the medical encounter because of the electronic health record,\" says Dr. Lloyd Minor, dean of Stanford's medical school.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>While acknowledging the benefits of EHRs, which are meant to improve patient care by providing an easily accessible health history, physicians have also railed against the heavy amount of data entry they require. Physicians spend an estimated one to two hours after work completing EHRs and other \"desktop medicine\" requirements, according to the study in \u003cem>Annals of Internal Medicine.\u003c/em>\u003c/p>\n\u003cp>But now Dr. Albert Chan, the chief of digital patient experience for the Sutter Health Network, thinks he has a solution for the burden of EHRs. Chan uses \u003ca href=\"https://www.x.company/glass/\" target=\"_blank\" rel=\"noopener noreferrer\">Google Glass\u003c/a>, with its tiny camera mounted on a device worn like eyeglasses, to stream audio and video of the patient to an offsite medical scribe. The scribe sees and hears what the doctor does, writing the notes that go into the electronic health record. This frees up the physician to give the patient her full attention. Doctors can communicate with their note-takers through a headset, asking them to retrieve test results and other data. The scribe responds via text message, which the physician sees in the Glass lens.\u003c/p>\n\u003caside class=\"pullquote alignright\">'You’re just adding more layers of cost and people to assist in the exam room.'\u003c/aside>\n\u003cp>“For patients, it’s better care because the doctors focus on them, and the doctors spend more time with them,\" Chan says. He says that because the doctor’s attention is not divided between the computer and the patient, records of the visit are more accurate.\u003c/p>\n\u003cp>The system is provided by a company called Augmedix, of which Sutter Health is an investor.\u003c/p>\n\u003cp>Currently about 100 Sutter doctors are using the system. After first deploying it among physicians in internal medicine, Sutter is now expanding it for use by specialists like dermatologists, podiatrists and orthopedists across its Northern California network.\u003c/p>\n\u003cp>“I mean, we have invested a lot of time to train physicians, so why not have them use their expertise in the most efficient way possible?” says Chan.\u003c/p>\n\u003cp>\u003cstrong>Encounter at Dolores Park\u003c/strong>\u003c/p>\n\u003cp>Augmedix was founded in 2012, by Ian Shakil and Pelu Tran. Shakil, who is the CEO, says he got the idea after a chance encounter at San Francisco's Dolores Park with some Google employees who were working on Glass. \"They had Glass in their backpacks. And they let us try it on,\" he says.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>After the Google crew explained the product was intended for consumers, \"I got into a big argument with the group that this was really meant for doctors.\" (Glass was a notorious bust with the public, but is \u003ca href=\"https://www.wired.com/story/google-glass-2-is-here/\" target=\"_blank\" rel=\"noopener noreferrer\">now hitting its stride as a workplace tool.\u003c/a>)\u003c/p>\n\u003cp>Shakil, who knew from media reports and his own encounters with physicians that they were beleaguered with documentation requirements, says he became obsessed with the idea of using Glass as a solution. \"I couldn't sleep; I couldn't stop talking about it. I literally quit my job.\"\u003c/p>\n\u003cp>He then reeled in his friend Tran, who dropped out of his fourth year at medical school, and the two formed the company. Shakil says more than 1,000 doctors are currently using Augmedix across the U.S. , with the largest deployment by Sutter.\u003c/p>\n\u003cp>Besides Sutter, investors include health services company McKesson and Dignity Health network.\u003c/p>\n\u003cp>Sutter's Dr. Chan says the scribes provide a number of benefits, including reminding physicians to address issues they might otherwise miss.\u003c/p>\n\u003cp>“If you have shoulder pain and chest pain, for instance, well, if I forget to address the shoulder pain during the exam, I can get a subtle hint from the transcriptionist -- ‘Hey, you may want to address the shoulder pain, too.’ ”\u003c/p>\n\u003cp>Because doctors use shorthand when entering information in an EHR, Chan says, they often have to go back hours later and fill in the gaps; that isn't necessary when a third party is taking the notes in real-time.\u003c/p>\n\u003cp>\u003cstrong>'Oh, I Can See My Kid's Soccer Game'\u003c/strong>\u003c/p>\n\u003cp>About two-thirds of Augmedix's note-takers are located overseas, in India, the Dominican Republic and Sri Lanka, says CEO Shakil. But Adeeba Hasan, a full-time scribe for the company, works out of headquarters in San Francisco. Hasan says she's able to take 80 percent of the EHR workload off a doctor's hands. \"My doctors are able to leave and get home about two or three hours early,\" Hasan says. \"They definitely thank for me for little things like, 'Oh, I can see my kids' soccer game.' \"\u003c/p>\n\u003cp>She has scribed for 20 doctors, whose predominant perspective, she says, is that while EHRs are important, they don't require a medical degree to complete. She herself is applying to medical school and finds the experience valuable. \"I'm learning all about different medications and illnesses and how you talk to patients,\" she says.\u003c/p>\n\u003cp>\u003cstrong>A Doubter\u003c/strong>\u003c/p>\n\u003cp>So is this the future of medicine as we know it?\u003c/p>\n\u003cp>“Oh my God, I hope not,” says David Lansky, executive director of the Pacific Business Group on Health, a nonprofit consortium of private companies and public agencies working toward greater health care affordability and quality.\u003c/p>\n\u003cp>The Augmedix service generally ranges from $1,500 to $3,500 per physician, per month, according to Shakil. Lansky says fixing the dysfunctional health care system requires putting the brakes on runaway costs, and using expensive scribes does just the opposite.\u003c/p>\n\u003cp>“You’re just adding more layers of cost and people to assist in the exam room,” Lansky says.\u003c/p>\n\u003cp>He thinks the solution to the burden of EHRs is to lessen reporting requirements, from quality measures to insurance coding to language intended to fend off lawsuits\u003cb>.\u003c/b>\u003c/p>\n\u003cp>“The real problem is that administrative requirements are uncoordinated and useless,\" Lansky says. \"I mean, no one’s even looking at the quality measures physicians are required to key in.\"\u003c/p>\n\u003cp>“The two paths we want to pursue are to reduce reporting and improve EHR function. If everything’s in front of you, you can use your face time [with the patient] to really \u003cem>do\u003c/em> face time.”\u003c/p>\n\u003cp>\u003cstrong>What About the Creepiness Factor?\u003c/strong>\u003c/p>\n\u003cp>Might some patients, especially women, not take too kindly to having something as intimate as a medical exam observed by someone they don't know and can't see?\u003c/p>\n\u003cp>\"To be honest\u003cstrong>, \u003c/strong>\u003cspan class=\"s1\">when we first founded the business, we had no idea if this issue was going to be a show-stopper or not a big deal,\" says Shakil. \"We’ve since grown and we’ve learned that it’ s not actually a big deal.\" \u003c/span>\u003c/p>\n\u003cp>He says only 2 percent of patients have opted out so far, a rate that remains steady across all demographics, including sex.\u003c/p>\n\u003cp>Shakil says the audio-video stream is encrypted, so hacking is not an issue. \"We've penetration-tested it, and it's Fort Knox, basically.\" The scribes sit in what he calls an \"ultra-secure environment,\" with nothing in their pockets, video monitoring, and computers that can only run the company's application.\u003c/p>\n\u003cp>The doctor can also temporarily switch off the Glass feed by swiping or verbal command if there's something occurring the patient doesn't want transmitted. The light on the device changes color to indicate its no longer active, which the patient can see.\u003c/p>\n\u003cp>Interestingly enough, there is one small sub-group of patients who are opting out at a slightly greater rate.\u003c/p>\n\u003cp>\"It's a little bit higher around the Google campus than anywhere in the country,\" Shakil says.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>https://www.youtube.com/watch?v=IS5Yankf1GY&feature=youtu.be\u003c/p>\n\u003cp>The idea was a simple one: Create a summer camp where \u003ca href=\"https://ww2.kqed.org/stateofhealth/2016/06/09/day-camp-for-transgender-youth-allows-kids-to-be-themselves/\" target=\"_blank\" rel=\"noopener noreferrer\">transgender kids can go to feel safe\u003c/a>, welcome and empowered.\u003c/p>\n\u003cp>The \u003ca href=\"http://rainbowdaycamp.org\" target=\"_blank\" rel=\"noopener noreferrer\">Bay Area Rainbow Day Camp\u003c/a> has now wrapped up its third summer. The camp was the brainchild of Sandra Collins, who got the idea after her daughter, Scarlett, had a run-in at her previous camp. Scarlett's friend, in anger, had revealed to other kids that Scarlett had been born a biological boy.\u003c/p>\n\u003cp>Now, Rainbow Camp, run out of a school in El Cerrito, is a place \"where gender-diverse youth can come together, have fun, and feel a sense of gender-identity pride and resilience, and feel safe and belonging in a community,\" Collins says.\u003c/p>\n\u003cp>“To be in this space where there are lots and lots of [transgender] kids is actually really unique,” says Sara Kaplan, whose son, James, attended the camp this summer. \"Because most of the time they’re in experiences where they’re the only child who is transgender.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>James says being surrounded by other transgender kids has definitely been a positive.\u003c/p>\n\u003cp>“It’s very amazing to be with people that are also transgender,” James says. “The camp has helped me in life experience and being less shy about who I am.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Watch the video, above.\u003c/p>\n\n",
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"content": "\u003cp>Dr. Lloyd Minor is frustrated. As dean of Stanford University Medical School, he says he can handle the constant cascade of large-scale challenges that come with his job. But what flummoxes him — drives him crazy, in fact — is something that occurs on a much smaller scale every time he examines someone in his clinical practice.\u003c/p>\n\u003cp>Minor cannot get the electronic health record, which provides a medical history of each patient, to work the way he wants. So he spends too much time wrestling with the computer and not enough directly communicating with his patient.\u003c/p>\n\u003caside class=\"pullquote alignright\">'There is nothing more frustrating to a patient than talking to their doctor, wanting advice, and that provider is typing away and looking at a computer screen instead of the patient.' \u003ccite>Stanford medical school Dean Lloyd Minor\u003c/cite>\u003c/aside>\n\u003cp>“There is nothing more frustrating to a patient than talking to their doctor, wanting advice, and that provider is typing away and looking at a computer screen instead of the patient,\" Minor says. \"That most fundamental aspect of human communication, which is eye contact, now is being robbed from the medical encounter because of the electronic health record.”\u003c/p>\n\u003cp>He says EHRs now function primarily as documentation for billing and quality reporting rather than as an aid to doctors. Given their cumbersome nature, the EHR, long touted as a way to dramatically improve patient care, often does just the opposite, Minor believes.\u003c/p>\n\u003cp>“As a provider, you’re thinking about what do I need to document, or how do I navigate the EHR system, not how do I assimilate this information to provide the best care advice to the patient,\" he says. \"You’re thinking about the mechanics of the documentation, rather than the implications of the symptoms and findings.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cstrong>Data Entry or Medicine?\u003c/strong>\u003c/p>\n\u003cp>Many physicians are fed up with the amount of documentation required in EHRs. Many feel they spend more time as data-entry clerks than as doctors.\u003c/p>\n\u003cp>[contextly_sidebar id=\"iCL76xAqQztIVtwiKb3Jdka9M3FawwGC\"]Studies bear that out. Only 27 percent of a doctor’s time is spent with patients — and nearly half is spent on EHR and desk work, according to a \u003ca href=\"http://annals.org/aim/article/2546704/allocation-physician-time-ambulatory-practice-time-motion-study-4-specialties\">2016 study\u003c/a> published in \u003cem>Annals of Internal Medicine\u003c/em>. The study looked at physicians in family practice, internal medicine, cardiology and orthopedics. A smaller\u003ca href=\"http://content.healthaffairs.org/content/36/4/655.abstract\" target=\"_blank\" rel=\"noopener noreferrer\"> study\u003c/a> published in April by \u003cem>Health Affairs, \u003c/em>focusing on primary care physicians, also found about a 50-50 split in direct patient care time versus desktop medicine.\u003c/p>\n\u003cp>When doctors do spend time in the exam room with patients, they spent 37 percent of that time looking at the computer, the 2016 study estimated.\u003c/p>\n\u003cp>It's not just recording the patient's medical information that takes up time, according to Dr. Albert Chan, a family practice physician and the chief of digital patient experience for the Sutter Health Network. Doctors now need to report a series of quality measurements, provide proper insurance coding, and introduce more legalistic wording into the EHR to prevent lawsuits, he says.\u003c/p>\n\u003cp>There’s so much required paperwork and documentation now that primary care physicians spend an estimated one to two hours every night after work finishing up their data entry on EHRs, the study in \u003cem>Annals of Internal Medicine\u003c/em> found.\u003c/p>\n\u003cp>In the business, that’s called \"pajama time.\" In the real world, it's called one reason for burnout. Fifty-four \u003ca href=\"http://www.mayoclinicproceedings.org/article/S0025-6196(15)00716-8/abstract\">percent of physicians\u003c/a> reported at least one symptom of burnout, according to a recent Mayo Clinic study. A separate Mayo study found that a higher risk of burnout was \u003ca href=\"http://www.mayoclinicproceedings.org/article/S0025-6196(16)30215-4/abstract\">linked\u003c/a> to frustrations with the data-entry workload of EHRs.\u003c/p>\n\u003cp>\u003cstrong>A Powerful Tool\u003c/strong>\u003c/p>\n\u003cp>When the Affordable Care Act and the 2009 \u003ca href=\"https://www.hhs.gov/hipaa/for-professionals/special-topics/HITECH-act-enforcement-interim-final-rule/index.html\">HITECH Act\u003c/a> required electronic health records to be incorporated into medical practices, Dr. Chan says, many medical groups and physicians rushed to install EHR systems. That means the search function may not work well, or the system may require multiple keystrokes and screens to accomplish common tasks.\u003c/p>\n\u003cp>(Eric Helsher, vice president of client success at Epic, one of the leading EHR providers, responded that customer feedback \"drives our continuous development, with the aim of making the software a joy to use, helping them get value from their data, and facilitating collaboration across the Epic community.\")\u003c/p>\n\u003caside class=\"pullquote alignright\">'I remember back in the old days of paper medical records … not being able to find a patient’s chart was just maddening. We don’t have that anymore.'\u003ccite>Dr. Albert Chan\u003c/cite>\u003c/aside>\n\u003cp>But, Chan says, as flawed as the EHR is, it would be wise not to throw the baby out with the bathwater.\u003c/p>\n\u003cp>“It’s important to note that the EHR is an incredibly powerful tool,” he says. “There are tremendous things you can do with the EHR. You can automatically alert patients about their conditions, for example; you can personalize their care. The lesson I’ve learned is that the EHR requires work to make it work.”\u003c/p>\n\u003cp>Chan says he would never want to go back to the paper-only era.\u003c/p>\n\u003cp>“I remember back in the old days of paper medical records ... not being able to find a patient’s chart was just maddening. We don’t have that anymore.\"\u003c/p>\n\u003cp>\u003cstrong>The Interoperability Problem\u003c/strong>\u003c/p>\n\u003cp>Current design problems can be corrected over time by EHR system vendors, Chan says, and he expects the furor over EHRs to dissipate as annoying and time-consuming glitches are altered.\u003c/p>\n\u003cp>One of the big complaints doctors have had is the lack of interoperability between EHR systems, so that hospitals, medical groups, insurers and physicians can't easily share patient data with each other. In the San Francisco Bay Area, some sharing is now starting to occur among institutions like Sutter Health, Kaiser, UCSF and Stanford that all that use the EHR system Epic.\u003c/p>\n\u003cp>“We’re starting to see fruits of our labor to connect data,” Chan says.\u003c/p>\n\u003cp>But that may be a glass-half-full view, according to Will Ross, a project manager at Redwood MedNet, a nonprofit health information exchange based in Ukiah. Ross has been working on trying to improve the interoperability of EHRs for two decades, and says the progress has been plodding, to say the least.\u003c/p>\n\u003cp>Ross says EHRs took a turn for the worse after Congress tried to get physicians to prove they were meaningfully using them in the HITECH Act of 2009. Those rules, which he calls arbitrary, made the whole process much more complex and time-consuming.\u003c/p>\n\u003cp>\u003cspan style=\"color: #2b2b2b\">“That transformed all of this into busy work and nonsense,” Ross says. \u003c/span>\u003c/p>\n\u003cp>The obvious solution is for vendors to improve their products, he says. But that’s easier proposed than accomplished.\u003c/p>\n\u003cp>“A lot of the EHRs are cash cows to their owners,” Ross says. “They make their money on installing them, not changing them.”\u003c/p>\n\u003cp>Even if the complex problems of interoperability and ease of use were magically solved today, physicians would still be overloaded by reporting requirements, Ross says.\u003c/p>\n\u003cp>“Documentation is still there, so blaming the computer for what insurers and the government are requiring you to do is misplacing the blame.\"\u003c/p>\n\u003cp>Large organizations such as Kaiser and Sutter Health have tackled some of the ease-of-use problems of the EHR, according to David Lansky, executive director of the Pacific Business Group on Health, a nonprofit consortium of private businesses and public agencies. That’s not so easy for smaller practices to do.\u003c/p>\n\u003cp>“In big medical groups, the burden on the individual doctor using EHR is lower already, it’s easier,” Lansky says. “But small-group practices and individuals have the same administrative burden as the large-group practices.\"\u003c/p>\n\u003cp>Lansky’s organization is encouraging smaller groups to join provider contracting networks — niche companies that will help them track patients, install reminder systems, streamline quality reporting and connect with health information exchanges — so smaller practices are not trying to solve the problem themselves.\u003c/p>\n\u003cp class=\"p1\">He says the idea is to get doctors to use their skills and training properly. “We have this cult of the physician, and we pay a lot of money to train them,” Lansky says, “yet they’re being asked to do work others can do very well.”\u003c/p>\n\u003cp>That rings true for Stanford medical school's Dean Minor. He’s sick of scrolling down page by page; sick of checking off a million little boxes. All the time spent on medical documentation cuts down on physician efficiency, he says.\u003c/p>\n\u003cp>If doctors are working so many extra hours entering data, they’re likely to cut down on their patient load to make up for it. That means they make less money, and the quality of patient visits continues to decline.\u003c/p>\n\u003cp>“It negatively impacts patient care, that’s the main thing,” he says.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This post had been edited.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Dr. Lloyd Minor is frustrated. As dean of Stanford University Medical School, he says he can handle the constant cascade of large-scale challenges that come with his job. But what flummoxes him — drives him crazy, in fact — is something that occurs on a much smaller scale every time he examines someone in his clinical practice.\u003c/p>\n\u003cp>Minor cannot get the electronic health record, which provides a medical history of each patient, to work the way he wants. So he spends too much time wrestling with the computer and not enough directly communicating with his patient.\u003c/p>\n\u003caside class=\"pullquote alignright\">'There is nothing more frustrating to a patient than talking to their doctor, wanting advice, and that provider is typing away and looking at a computer screen instead of the patient.' \u003ccite>Stanford medical school Dean Lloyd Minor\u003c/cite>\u003c/aside>\n\u003cp>“There is nothing more frustrating to a patient than talking to their doctor, wanting advice, and that provider is typing away and looking at a computer screen instead of the patient,\" Minor says. \"That most fundamental aspect of human communication, which is eye contact, now is being robbed from the medical encounter because of the electronic health record.”\u003c/p>\n\u003cp>He says EHRs now function primarily as documentation for billing and quality reporting rather than as an aid to doctors. Given their cumbersome nature, the EHR, long touted as a way to dramatically improve patient care, often does just the opposite, Minor believes.\u003c/p>\n\u003cp>“As a provider, you’re thinking about what do I need to document, or how do I navigate the EHR system, not how do I assimilate this information to provide the best care advice to the patient,\" he says. \"You’re thinking about the mechanics of the documentation, rather than the implications of the symptoms and findings.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cstrong>Data Entry or Medicine?\u003c/strong>\u003c/p>\n\u003cp>Many physicians are fed up with the amount of documentation required in EHRs. Many feel they spend more time as data-entry clerks than as doctors.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>Studies bear that out. Only 27 percent of a doctor’s time is spent with patients — and nearly half is spent on EHR and desk work, according to a \u003ca href=\"http://annals.org/aim/article/2546704/allocation-physician-time-ambulatory-practice-time-motion-study-4-specialties\">2016 study\u003c/a> published in \u003cem>Annals of Internal Medicine\u003c/em>. The study looked at physicians in family practice, internal medicine, cardiology and orthopedics. A smaller\u003ca href=\"http://content.healthaffairs.org/content/36/4/655.abstract\" target=\"_blank\" rel=\"noopener noreferrer\"> study\u003c/a> published in April by \u003cem>Health Affairs, \u003c/em>focusing on primary care physicians, also found about a 50-50 split in direct patient care time versus desktop medicine.\u003c/p>\n\u003cp>When doctors do spend time in the exam room with patients, they spent 37 percent of that time looking at the computer, the 2016 study estimated.\u003c/p>\n\u003cp>It's not just recording the patient's medical information that takes up time, according to Dr. Albert Chan, a family practice physician and the chief of digital patient experience for the Sutter Health Network. Doctors now need to report a series of quality measurements, provide proper insurance coding, and introduce more legalistic wording into the EHR to prevent lawsuits, he says.\u003c/p>\n\u003cp>There’s so much required paperwork and documentation now that primary care physicians spend an estimated one to two hours every night after work finishing up their data entry on EHRs, the study in \u003cem>Annals of Internal Medicine\u003c/em> found.\u003c/p>\n\u003cp>In the business, that’s called \"pajama time.\" In the real world, it's called one reason for burnout. Fifty-four \u003ca href=\"http://www.mayoclinicproceedings.org/article/S0025-6196(15)00716-8/abstract\">percent of physicians\u003c/a> reported at least one symptom of burnout, according to a recent Mayo Clinic study. A separate Mayo study found that a higher risk of burnout was \u003ca href=\"http://www.mayoclinicproceedings.org/article/S0025-6196(16)30215-4/abstract\">linked\u003c/a> to frustrations with the data-entry workload of EHRs.\u003c/p>\n\u003cp>\u003cstrong>A Powerful Tool\u003c/strong>\u003c/p>\n\u003cp>When the Affordable Care Act and the 2009 \u003ca href=\"https://www.hhs.gov/hipaa/for-professionals/special-topics/HITECH-act-enforcement-interim-final-rule/index.html\">HITECH Act\u003c/a> required electronic health records to be incorporated into medical practices, Dr. Chan says, many medical groups and physicians rushed to install EHR systems. That means the search function may not work well, or the system may require multiple keystrokes and screens to accomplish common tasks.\u003c/p>\n\u003cp>(Eric Helsher, vice president of client success at Epic, one of the leading EHR providers, responded that customer feedback \"drives our continuous development, with the aim of making the software a joy to use, helping them get value from their data, and facilitating collaboration across the Epic community.\")\u003c/p>\n\u003caside class=\"pullquote alignright\">'I remember back in the old days of paper medical records … not being able to find a patient’s chart was just maddening. We don’t have that anymore.'\u003ccite>Dr. Albert Chan\u003c/cite>\u003c/aside>\n\u003cp>But, Chan says, as flawed as the EHR is, it would be wise not to throw the baby out with the bathwater.\u003c/p>\n\u003cp>“It’s important to note that the EHR is an incredibly powerful tool,” he says. “There are tremendous things you can do with the EHR. You can automatically alert patients about their conditions, for example; you can personalize their care. The lesson I’ve learned is that the EHR requires work to make it work.”\u003c/p>\n\u003cp>Chan says he would never want to go back to the paper-only era.\u003c/p>\n\u003cp>“I remember back in the old days of paper medical records ... not being able to find a patient’s chart was just maddening. We don’t have that anymore.\"\u003c/p>\n\u003cp>\u003cstrong>The Interoperability Problem\u003c/strong>\u003c/p>\n\u003cp>Current design problems can be corrected over time by EHR system vendors, Chan says, and he expects the furor over EHRs to dissipate as annoying and time-consuming glitches are altered.\u003c/p>\n\u003cp>One of the big complaints doctors have had is the lack of interoperability between EHR systems, so that hospitals, medical groups, insurers and physicians can't easily share patient data with each other. In the San Francisco Bay Area, some sharing is now starting to occur among institutions like Sutter Health, Kaiser, UCSF and Stanford that all that use the EHR system Epic.\u003c/p>\n\u003cp>“We’re starting to see fruits of our labor to connect data,” Chan says.\u003c/p>\n\u003cp>But that may be a glass-half-full view, according to Will Ross, a project manager at Redwood MedNet, a nonprofit health information exchange based in Ukiah. Ross has been working on trying to improve the interoperability of EHRs for two decades, and says the progress has been plodding, to say the least.\u003c/p>\n\u003cp>Ross says EHRs took a turn for the worse after Congress tried to get physicians to prove they were meaningfully using them in the HITECH Act of 2009. Those rules, which he calls arbitrary, made the whole process much more complex and time-consuming.\u003c/p>\n\u003cp>\u003cspan style=\"color: #2b2b2b\">“That transformed all of this into busy work and nonsense,” Ross says. \u003c/span>\u003c/p>\n\u003cp>The obvious solution is for vendors to improve their products, he says. But that’s easier proposed than accomplished.\u003c/p>\n\u003cp>“A lot of the EHRs are cash cows to their owners,” Ross says. “They make their money on installing them, not changing them.”\u003c/p>\n\u003cp>Even if the complex problems of interoperability and ease of use were magically solved today, physicians would still be overloaded by reporting requirements, Ross says.\u003c/p>\n\u003cp>“Documentation is still there, so blaming the computer for what insurers and the government are requiring you to do is misplacing the blame.\"\u003c/p>\n\u003cp>Large organizations such as Kaiser and Sutter Health have tackled some of the ease-of-use problems of the EHR, according to David Lansky, executive director of the Pacific Business Group on Health, a nonprofit consortium of private businesses and public agencies. That’s not so easy for smaller practices to do.\u003c/p>\n\u003cp>“In big medical groups, the burden on the individual doctor using EHR is lower already, it’s easier,” Lansky says. “But small-group practices and individuals have the same administrative burden as the large-group practices.\"\u003c/p>\n\u003cp>Lansky’s organization is encouraging smaller groups to join provider contracting networks — niche companies that will help them track patients, install reminder systems, streamline quality reporting and connect with health information exchanges — so smaller practices are not trying to solve the problem themselves.\u003c/p>\n\u003cp class=\"p1\">He says the idea is to get doctors to use their skills and training properly. “We have this cult of the physician, and we pay a lot of money to train them,” Lansky says, “yet they’re being asked to do work others can do very well.”\u003c/p>\n\u003cp>That rings true for Stanford medical school's Dean Minor. He’s sick of scrolling down page by page; sick of checking off a million little boxes. All the time spent on medical documentation cuts down on physician efficiency, he says.\u003c/p>\n\u003cp>If doctors are working so many extra hours entering data, they’re likely to cut down on their patient load to make up for it. That means they make less money, and the quality of patient visits continues to decline.\u003c/p>\n\u003cp>“It negatively impacts patient care, that’s the main thing,” he says.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>Harsh life experiences appear to leave African-Americans vulnerable to Alzheimer's and other forms of dementia, researchers \u003ca href=\"https://www.alz.org/aaic/2017_news_releases.asp\">reported\u003c/a> Sunday at the Alzheimer's Association International Conference in London.\u003c/p>\n\u003cp>Several teams presented evidence that poverty, disadvantage and stressful life events are strongly associated with cognitive problems in middle age and dementia later in life among African-Americans.\u003c/p>\n\u003cp>The findings could help explain why African-Americans are twice as likely as white Americans to develop dementia. And the research suggests genetic factors are not a major contributor.\u003c/p>\n\u003cp>\"The increased risk seems to be a matter of experience rather than ancestry,\" says \u003ca href=\"http://obgyn.wisc.edu/directory/detail.aspx?id=321\">Megan Zuelsdorff\u003c/a>, a postdoctoral fellow in the Health Disparities Research Scholars Program at the University of Wisconsin-Madison.\u003c/p>\n\u003cp>Scientists have struggled to understand why African-Americans are so likely to develop dementia. They are more likely to have conditions like high blood pressure and diabetes, which can affect the brain. And \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4084964/\">previous research\u003c/a> has found some evidence that African-Americans are more likely to carry genes that raise the risk.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>But more recent studies suggest those explanations are incomplete, says \u003ca href=\"https://divisionofresearch.kaiserpermanente.org/researchers/whitmer-rachel\">Rachel Whitmer\u003c/a>, an epidemiologist with Kaiser Permanente's Division of Research in Northern California.\u003c/p>\n\u003cp>Whitmer has been involved in several studies that accounted for genetic and disease risks when comparing dementia in white and black Americans. \"And we still saw these [racial] differences,\" she says. \"So there is still something there that we are trying to get at.\"\u003c/p>\n\u003cp>The research presented at the Alzheimer's conference suggests the missing factors involve adverse life experiences beginning in childhood. These experiences have already been \u003ca href=\"http://www.ajpmonline.org/article/S0749-3797(98)00017-8/abstract\">linked\u003c/a> to a range of diseases, including heart disease and cancer.\u003c/p>\n\u003cp>\"We're starting to understand how early life stress and early life deprivation can increase your risk of a number of health outcomes in late life,\" Whitmer says. \"And the latest thing is understanding how and why that might affect the brain.\"\u003c/p>\n\u003cp>Whitmer was part of a team that presented results of a study of more than 6,000 Kaiser Permanente health plan members, most born in the 1920s.\u003c/p>\n\u003cp>The team wanted to know whether people who grew up in harsher conditions were more likely to develop dementia. So they looked at people who'd been born in states with high infant mortality rates — an indicator of social problems like poverty and limited access to medical care.\u003c/p>\n\u003cp>White people's risk of dementia wasn't affected by their place of birth. But black people were 40 percent more likely to develop dementia if they'd been born in a state with high infant mortality.\u003c/p>\n\u003cp>\"These people left the state and subsequently moved to northern California, yet there was still this very robust association between being born in a state with high infant mortality and increased risk of dementia,\" Whitmer says.\u003c/p>\n\u003cp>Scientists from the University of Wisconsin presented results of a study of the link between stressful life events and mental function in middle age. They studied more than 1,300 people in their 50s and 60s, including 82 African-Americans.\u003c/p>\n\u003cp>Stressful experiences included having a parent with a drinking problem, financial insecurity, legal issues, divorce, being fired from a job, and the death of a child.\u003c/p>\n\u003cp>African-Americans reported 60 percent more of these stressful events than white Americans. But that was only part of the difference, Zuelsdorff says.\u003c/p>\n\u003cp>\"The impact of these stressful events was stronger in African-Americans than it was in non-Hispanic white participants,\" she says.\u003c/p>\n\u003cp>The researchers discovered this by administering tests that reveal the brain's speed and flexibility in doing certain tasks. These abilities normally decline with age. So the team looked for evidence that stressful events were accelerating this decline.\u003c/p>\n\u003cp>And they found that in white participants, each stressful event added about a year and a half to normal brain aging. But in African-Americans, each event aged the brain an extra four years.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The next challenge for researchers is to figure out precisely how adverse life experiences are changing the brain, Zuelsdorff says. That will mean looking at the effects of stress hormones and seeing whether stress leads to inflammation in the brain, something that has been associated with Alzheimer's.\u003c/p>\n\u003chr>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Stress+And+Poverty+May+Explain+High+Rates+Of+Dementia+In+African-Americans&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Harsh life experiences appear to leave African-Americans vulnerable to Alzheimer's and other forms of dementia, researchers \u003ca href=\"https://www.alz.org/aaic/2017_news_releases.asp\">reported\u003c/a> Sunday at the Alzheimer's Association International Conference in London.\u003c/p>\n\u003cp>Several teams presented evidence that poverty, disadvantage and stressful life events are strongly associated with cognitive problems in middle age and dementia later in life among African-Americans.\u003c/p>\n\u003cp>The findings could help explain why African-Americans are twice as likely as white Americans to develop dementia. And the research suggests genetic factors are not a major contributor.\u003c/p>\n\u003cp>\"The increased risk seems to be a matter of experience rather than ancestry,\" says \u003ca href=\"http://obgyn.wisc.edu/directory/detail.aspx?id=321\">Megan Zuelsdorff\u003c/a>, a postdoctoral fellow in the Health Disparities Research Scholars Program at the University of Wisconsin-Madison.\u003c/p>\n\u003cp>Scientists have struggled to understand why African-Americans are so likely to develop dementia. They are more likely to have conditions like high blood pressure and diabetes, which can affect the brain. And \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4084964/\">previous research\u003c/a> has found some evidence that African-Americans are more likely to carry genes that raise the risk.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>But more recent studies suggest those explanations are incomplete, says \u003ca href=\"https://divisionofresearch.kaiserpermanente.org/researchers/whitmer-rachel\">Rachel Whitmer\u003c/a>, an epidemiologist with Kaiser Permanente's Division of Research in Northern California.\u003c/p>\n\u003cp>Whitmer has been involved in several studies that accounted for genetic and disease risks when comparing dementia in white and black Americans. \"And we still saw these [racial] differences,\" she says. \"So there is still something there that we are trying to get at.\"\u003c/p>\n\u003cp>The research presented at the Alzheimer's conference suggests the missing factors involve adverse life experiences beginning in childhood. These experiences have already been \u003ca href=\"http://www.ajpmonline.org/article/S0749-3797(98)00017-8/abstract\">linked\u003c/a> to a range of diseases, including heart disease and cancer.\u003c/p>\n\u003cp>\"We're starting to understand how early life stress and early life deprivation can increase your risk of a number of health outcomes in late life,\" Whitmer says. \"And the latest thing is understanding how and why that might affect the brain.\"\u003c/p>\n\u003cp>Whitmer was part of a team that presented results of a study of more than 6,000 Kaiser Permanente health plan members, most born in the 1920s.\u003c/p>\n\u003cp>The team wanted to know whether people who grew up in harsher conditions were more likely to develop dementia. So they looked at people who'd been born in states with high infant mortality rates — an indicator of social problems like poverty and limited access to medical care.\u003c/p>\n\u003cp>White people's risk of dementia wasn't affected by their place of birth. But black people were 40 percent more likely to develop dementia if they'd been born in a state with high infant mortality.\u003c/p>\n\u003cp>\"These people left the state and subsequently moved to northern California, yet there was still this very robust association between being born in a state with high infant mortality and increased risk of dementia,\" Whitmer says.\u003c/p>\n\u003cp>Scientists from the University of Wisconsin presented results of a study of the link between stressful life events and mental function in middle age. They studied more than 1,300 people in their 50s and 60s, including 82 African-Americans.\u003c/p>\n\u003cp>Stressful experiences included having a parent with a drinking problem, financial insecurity, legal issues, divorce, being fired from a job, and the death of a child.\u003c/p>\n\u003cp>African-Americans reported 60 percent more of these stressful events than white Americans. But that was only part of the difference, Zuelsdorff says.\u003c/p>\n\u003cp>\"The impact of these stressful events was stronger in African-Americans than it was in non-Hispanic white participants,\" she says.\u003c/p>\n\u003cp>The researchers discovered this by administering tests that reveal the brain's speed and flexibility in doing certain tasks. These abilities normally decline with age. So the team looked for evidence that stressful events were accelerating this decline.\u003c/p>\n\u003cp>And they found that in white participants, each stressful event added about a year and a half to normal brain aging. But in African-Americans, each event aged the brain an extra four years.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The next challenge for researchers is to figure out precisely how adverse life experiences are changing the brain, Zuelsdorff says. That will mean looking at the effects of stress hormones and seeing whether stress leads to inflammation in the brain, something that has been associated with Alzheimer's.\u003c/p>\n\u003chr>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Stress+And+Poverty+May+Explain+High+Rates+Of+Dementia+In+African-Americans&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>The first thing I do is put on Google Glass, its tiny camera situated over my right eye.\u003c/p>\n\u003cp>A MiFi — a personal wireless hotspot — goes into my pocket. I pop in earbuds connected to a smartphone. Then I close my eyes. I am trying to simulate, for this demonstration, what it's like to navigate without being able to see.\u003c/p>\n\u003caside class=\"alignright\">Finding a cafe, describing a museum exhibit, or helping someone fold origami -- a new service guides blind people by connecting them with live agents who view their surroundings through smartglasses like Google Glass.\u003c/aside>\n\u003cp>All geared up, I am now ready for my test run. \u003ca href=\"https://aira.io/#service\" target=\"_blank\" rel=\"noopener noreferrer\">Aira\u003c/a>, based in San Diego, is a paid service that offers \"visual interpretation\" for the blind and visually impaired. With a smartphone app, Aira users connect with a remote agent who sees through any one of four types of smartglasses and describes the client's environment to her. Employees say the service, which became available in March, is like \u003ca href=\"https://www.theatlantic.com/business/archive/2016/04/onstar/480471/\" target=\"_blank\" rel=\"noopener noreferrer\">\u003cspan style=\"color: #24890d\">OnStar\u003c/span>\u003c/a>\u003cspan class=\"m-6819587429447741435apple-converted-space\"> \u003c/span>for the blind — or maybe like having your own personal “\u003ca href=\"http://24.wikia.com/wiki/Chloe_O%27Brian\" target=\"_blank\" rel=\"noopener noreferrer\">\u003cspan style=\"color: #24890d\">Chloe\u003c/span>\u003c/a>,” the intelligence analyst on the TV show \"24\" who often remotely assists hero Jack Bauer.\u003c/p>\n\u003cp>I summon \u003cem>my\u003c/em> Chloe using the Aira interface, which consists of a giant blue button. All I have to do is tap anywhere on the phone's display.\u003c/p>\n\u003cp>“Thank you for calling Aira,” a friendly voice says. “How can I help you?”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>This is Andy Del Valle, my agent, and, for as long as I need him, my long-distance eyes. Del Valle — sitting in front of his laptop — can now see through my Google Glass feed. As I scan my surroundings, he sees Amy Bernal, the company’s vice president of customer experience, who has helped get me outfitted; then I lower my head so he can see the path before my feet.\u003c/p>\n\u003cp>Thanks to my GPS connection, Del Valle is also able to locate me using Google Maps. We’re on the campus of San Francisco State University, for me unfamiliar turf. I ask him to direct me to the nearest cafe.\u003c/p>\n\u003cp>Within seconds, he's produced a route.\u003c/p>\n\u003cp>Granted, we’re approximating the Aira experience; I’m a sighted person with no orientation and mobility training, and I'm not using a dog or cane, as regular users do. I am, to put it gently, perhaps not the most graceful mover Del Valle has ever assisted. But he is cheerful as he offers me directions, like to turn left toward 11 o’clock. As I walk, he offers environmental cues, telling me to turn when I feel the slope of the sidewalk level out, or when I can feel the sun as I emerge from a nearby building’s shadow.\u003c/p>\n\u003cp>I quickly grow to trust his voice in my ear.\u003c/p>\n\u003cp>After a short walk, I hear music and a cash register — we’ve arrived at our destination. I want to order an iced coffee; Del Valle asks me to turn so he can scan a posted menu.\u003c/p>\n\u003cfigure id=\"attachment_424306\" class=\"wp-caption alignleft\" style=\"max-width: 292px\">\u003ca href=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/07/AiraPhoto1-e1499819013990.jpg\">\u003cimg class=\"wp-image-424306\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/07/AiraPhoto1-1020x1360.jpg\" alt=\"\" width=\"292\" height=\"390\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Orientation and mobility specialist using Aira at the International Mobility Conference in 2016. (Courtesy Aira)\u003c/figcaption>\u003c/figure>\n\u003cp>“Taking picture,” an automated voice intones as Del Valle grabs a shot from the camera feed and zooms in. He also pulls up a more detailed menu online and gives me a rundown of options — espresso? Blended java drink? — and a headcount of how many people are in line.\u003c/p>\n\u003cp>Del Valle is among the 33 agents working that day, covering customers across the United States. The service runs from 4 a.m. to 10 p.m., Pacific time or 7 a.m.to 1 a.m. Eastern, and clients subscribe to a monthly plan or a package of minutes. (The monthly plans go from $89 to $329, depending on \u003ca href=\"https://aira.io/plans\" target=\"_blank\" rel=\"noopener noreferrer\">level of service\u003c/a>.\u003cstrong>) \u003c/strong>Each user gets a personal profile that lists details like allergies, so an agent can warn someone allergic to shellfish, for example, that there’s shrimp salad on the potluck table. The company says it has \"hundreds\" of clients.\u003c/p>\n\u003cp>Bernal, the customer experience VP, is also an agent, and she's set up shop for the afternoon in the campus’ special education department. The calls she fields run from the mundane (a man looking for a trash can while cleaning up after his guide dog) to the complicated (a lost woman with bad directions from a passerby can't find her bus stop.) “You'll never know until you pick up the call,” Bernal says.\u003c/p>\n\u003caside class=\"pullquote alignright\">'There are hundreds of thousands of very clever and efficient solutions that don’t involve sight.'\u003ccite>Bryan Bashin, LightHouse for the Blind and Visually Impaired\u003c/cite>\u003c/aside>\n\u003cp>Sometimes they get a strange one — Bernal recalls an agent being asked to help a user do origami, having to hastily grab some paper and fold along. But most are the stuff of ordinary life: setting up the cable box, checking the expiration date on the milk, matching a shirt and tie.\u003c/p>\n\u003cp>Tiffany Manosh, president of the River City Chapter of the National Federation of the Blind, in Sacramento, has been using Aira for about a year. She likes it for tasks that involve browsing, like shopping. Sure, she could ask a clerk for help, but “they go directly to whatever item we’ve asked for,” she says. “Well, what if I want to see maybe what’s on sale?”\u003c/p>\n\u003cp>At a natural history museum, she once had an agent describe the exhibits. A docent could have done that — if she’d booked one a month in advance. “Sighted people don’t have to do that, so why should we?” she asks. “Aira gives us the freedom to be able to really integrate and do things at our own time — when we want to, and where we want to go.” An agent even helped her find her father’s gravesite at Arlington National Cemetery. “It was a very emotional and just phenomenal feeling to be able to do it on my own time,” says Manosh.\u003c/p>\n\u003cp>Aira, based in San Diego, test-launched three years ago with 200 beta users. Among them was Victorville resident Michael Hingson, who has been blind since birth and recently became the company’s director of strategic sales. “Aira is not helping a blind person see,” Hingson says. “Aira is giving me information that the sighted world has not learned to provide to us.”\u003c/p>\n\u003cp>For example, on emails or websites, those who are visually impaired might use a screen reader that speaks the text aloud. For printed materials, they might try a phone app like the \u003ca href=\"http://www.knfbreader.com/\" target=\"_blank\" rel=\"noopener noreferrer\">KNFB Reader\u003c/a>, which translates text using optical character recognition. But those don’t cover everything. Hingson recalls trying to assemble a laundry cart and discovering the instructions were in pictures, which his reader couldn’t decipher. So he called Aira. The agent zoomed in on the cart’s bar code and found assembly instructions on the internet. In a half-hour, Hingson said, “I had a working laundry cart.”\u003c/p>\n\u003cp>Aira agents are trained to give factual information without offering advice, deferring to the user’s orientation and mobility training. “What I don’t want is an agent telling me it’s safe to cross the street — because the agent doesn't \u003cem>know\u003c/em> it’s safe to cross the street,” says Hingson. “That should be my choice.”\u003c/p>\n\u003cp>Learning to give the right information is a balancing act, says Bernal. “When agents first start, they feel like they have to say every little thing that is in any remote path of a user,” she says. But a person’s dog or cane will help them avoid obstacles. Instead, it might be more useful to offer social information, like where the empty seat in the room is, or whether the driver greeting you at the airport is smiling and waving you over.\u003c/p>\n\u003cp>https://www.youtube.com/watch?v=Jxkq-Ta0tv4&ab_channel=KansasCityStarVideo\u003c/p>\n\u003cp>\u003cstrong>Free Services\u003c/strong>\u003c/p>\n\u003cp>Bryan Bashin, CEO of the training and advocacy group \u003ca href=\"http://lighthouse-sf.org/\">LightHouse for the Blind and Visually Impaired\u003c/a>, in San Francisco, has tried Aira, and points out that while it’s the first such for-profit service, it’s not the first visual interpretation app.\u003c/p>\n\u003cp>Once the iPhone debuted, he says, “a lot of people had the same idea at the same time.” He sometimes uses \u003ca href=\"http://bemyeyes.com/\" target=\"_blank\" rel=\"noopener noreferrer\">Be My Eyes\u003c/a>, a free worldwide service powered by volunteers who assist by cellphone video chat. The free app \u003ca href=\"http://taptapseeapp.com/\" target=\"_blank\" rel=\"noopener noreferrer\">TapTapSee\u003c/a> identifies the content of still photos and speaks it aloud. And people can also improvise by simply Facetiming with friends or relatives. Bashin says these solutions are more accessible to low-income people than Aira’s paid service, although they lack some of the features — smartglasses, GPS mapping, agents trained to work with the blind. But what they all have in common, Bashin says, “is the world is still not 100 percent accessible for blind people.”\u003c/p>\n\u003cp>Bashin says that dialing a sighted person can be especially helpful when optical character readers fail, noting they are often thwarted by glare (think thermostat screens) or fancy script (think wine bottle labels or handwritten mail). But Bashin cautions against over-reliance on visual interpreters.\u003c/p>\n\u003cp>“When somebody first becomes blind, they think that the answers to the obstacles of blindness are to have someone see for you,” he says. Yet a person can skillfully use other senses, like touch and hearing, and low-tech solutions, like Braille. “There are hundreds of thousands of very clever and efficient solutions that don’t involve sight,” Bashin continues. “That’s what we teach at the LightHouse, and that’s what will get us through the day with a little bit of grace, so that we can reserve these technologies for when they really count. I'm a little bit afraid that new students will avoid learning what they need to learn to be competent blind people.”\u003c/p>\n\u003cp>While some Aira users prefer a paid agent — often for fear of imposing on others’ time — Bashin doesn't mind asking a stranger to steer him toward the check-in desk or describe what’s on the buffet, because that’s a social activity. “Yes, I’ll learn where the strawberries are, but I’ll also learn about \u003cem>them\u003c/em>. Now I’ve made a bridge to another person instead of isolating myself talking into a headset and some goggles,” he says.\u003c/p>\n\u003cp>But Manosh, from the Sacramento National Federation of the Blind chapter, disagrees that the service will encourage isolation or over-reliance. She calls Aira “a tool in my toolbox” that also includes her cane and her mobility training. “You don’t have to rely \u003cem>just\u003c/em> on it, and that’s the beauty of it,” she says.\u003c/p>\n\u003cfigure id=\"attachment_418103\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/06/Aira5.jpg\">\u003cimg class=\"wp-image-418103 size-large\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/06/Aira5-1020x680.jpg\" alt=\"\" width=\"640\" height=\"427\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/06/Aira5-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2017/06/Aira5-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/06/Aira5-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2017/06/Aira5-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2017/06/Aira5-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2017/06/Aira5-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2017/06/Aira5-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/06/Aira5-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/06/Aira5-520x347.jpg 520w, https://ww2.kqed.org/app/uploads/sites/13/2017/06/Aira5.jpg 1600w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Amy Bernal, Aira's vice president of customer experience, demonstrates what agents connected to the company's clients see on their screen -- a Google Map of the user's location with an inset of the video stream coming from their glasses or phone. (Kara Platoni/KQED)\u003c/figcaption>\u003c/figure>\n\u003caside class=\"pullquote alignright\">'I’ve had this experience where I’ve actually gone to an airport and thought ‘How do I know this airport? I’ve never been here before. You realize that you’ve been an agent for a user in an airport. You are like, ‘Oh, I’ve been in this terminal, but I haven’t \u003cem>been in this terminal\u003c/em>.’ It’s very déjà vu.'\u003ccite>Amy Bernal, Aira’s vice president of customer experience\u003c/cite>\u003c/aside>\n\u003cp>The next phase of Aira’s development will be to turn some tasks over to a machine. At first, Bernal says, the AI will likely assist the agent. Later, it might guide people through routine tasks, like daily commutes. Or it might replace agents in sensitive situations, while users are in restrooms or dealing with finances, for instance. (Currently, users can go into “privacy mode” with no video or audio, or hang up and call back.)\u003c/p>\n\u003cp>Hingson imagines sending a shopping list to Aira, and having the AI map his path through the store and check barcodes to confirm that he's grabbed the right items. He’d also like Aira integration with Facebook, so the system could use facial recognition to let him know if his friends are nearby.\u003c/p>\n\u003cp>For now, employees like Bernal are happy to assist with just about everything, although she notes that there’s one oddly sci-fi effect of seeing the world through someone else’s lenses.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“I’ve had this experience where I’ve actually gone to an airport and thought ‘How do I know this airport? I’ve never been here before,’ ” she says. “But you realize that you’ve been an agent for a user in an airport. You are like, ‘Oh, I’ve been in this terminal, but I haven’t \u003cem>been in this terminal\u003c/em>.’ It’s very déjà vu.”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The first thing I do is put on Google Glass, its tiny camera situated over my right eye.\u003c/p>\n\u003cp>A MiFi — a personal wireless hotspot — goes into my pocket. I pop in earbuds connected to a smartphone. Then I close my eyes. I am trying to simulate, for this demonstration, what it's like to navigate without being able to see.\u003c/p>\n\u003caside class=\"alignright\">Finding a cafe, describing a museum exhibit, or helping someone fold origami -- a new service guides blind people by connecting them with live agents who view their surroundings through smartglasses like Google Glass.\u003c/aside>\n\u003cp>All geared up, I am now ready for my test run. \u003ca href=\"https://aira.io/#service\" target=\"_blank\" rel=\"noopener noreferrer\">Aira\u003c/a>, based in San Diego, is a paid service that offers \"visual interpretation\" for the blind and visually impaired. With a smartphone app, Aira users connect with a remote agent who sees through any one of four types of smartglasses and describes the client's environment to her. Employees say the service, which became available in March, is like \u003ca href=\"https://www.theatlantic.com/business/archive/2016/04/onstar/480471/\" target=\"_blank\" rel=\"noopener noreferrer\">\u003cspan style=\"color: #24890d\">OnStar\u003c/span>\u003c/a>\u003cspan class=\"m-6819587429447741435apple-converted-space\"> \u003c/span>for the blind — or maybe like having your own personal “\u003ca href=\"http://24.wikia.com/wiki/Chloe_O%27Brian\" target=\"_blank\" rel=\"noopener noreferrer\">\u003cspan style=\"color: #24890d\">Chloe\u003c/span>\u003c/a>,” the intelligence analyst on the TV show \"24\" who often remotely assists hero Jack Bauer.\u003c/p>\n\u003cp>I summon \u003cem>my\u003c/em> Chloe using the Aira interface, which consists of a giant blue button. All I have to do is tap anywhere on the phone's display.\u003c/p>\n\u003cp>“Thank you for calling Aira,” a friendly voice says. “How can I help you?”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>This is Andy Del Valle, my agent, and, for as long as I need him, my long-distance eyes. Del Valle — sitting in front of his laptop — can now see through my Google Glass feed. As I scan my surroundings, he sees Amy Bernal, the company’s vice president of customer experience, who has helped get me outfitted; then I lower my head so he can see the path before my feet.\u003c/p>\n\u003cp>Thanks to my GPS connection, Del Valle is also able to locate me using Google Maps. We’re on the campus of San Francisco State University, for me unfamiliar turf. I ask him to direct me to the nearest cafe.\u003c/p>\n\u003cp>Within seconds, he's produced a route.\u003c/p>\n\u003cp>Granted, we’re approximating the Aira experience; I’m a sighted person with no orientation and mobility training, and I'm not using a dog or cane, as regular users do. I am, to put it gently, perhaps not the most graceful mover Del Valle has ever assisted. But he is cheerful as he offers me directions, like to turn left toward 11 o’clock. As I walk, he offers environmental cues, telling me to turn when I feel the slope of the sidewalk level out, or when I can feel the sun as I emerge from a nearby building’s shadow.\u003c/p>\n\u003cp>I quickly grow to trust his voice in my ear.\u003c/p>\n\u003cp>After a short walk, I hear music and a cash register — we’ve arrived at our destination. I want to order an iced coffee; Del Valle asks me to turn so he can scan a posted menu.\u003c/p>\n\u003cfigure id=\"attachment_424306\" class=\"wp-caption alignleft\" style=\"max-width: 292px\">\u003ca href=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/07/AiraPhoto1-e1499819013990.jpg\">\u003cimg class=\"wp-image-424306\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/07/AiraPhoto1-1020x1360.jpg\" alt=\"\" width=\"292\" height=\"390\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Orientation and mobility specialist using Aira at the International Mobility Conference in 2016. (Courtesy Aira)\u003c/figcaption>\u003c/figure>\n\u003cp>“Taking picture,” an automated voice intones as Del Valle grabs a shot from the camera feed and zooms in. He also pulls up a more detailed menu online and gives me a rundown of options — espresso? Blended java drink? — and a headcount of how many people are in line.\u003c/p>\n\u003cp>Del Valle is among the 33 agents working that day, covering customers across the United States. The service runs from 4 a.m. to 10 p.m., Pacific time or 7 a.m.to 1 a.m. Eastern, and clients subscribe to a monthly plan or a package of minutes. (The monthly plans go from $89 to $329, depending on \u003ca href=\"https://aira.io/plans\" target=\"_blank\" rel=\"noopener noreferrer\">level of service\u003c/a>.\u003cstrong>) \u003c/strong>Each user gets a personal profile that lists details like allergies, so an agent can warn someone allergic to shellfish, for example, that there’s shrimp salad on the potluck table. The company says it has \"hundreds\" of clients.\u003c/p>\n\u003cp>Bernal, the customer experience VP, is also an agent, and she's set up shop for the afternoon in the campus’ special education department. The calls she fields run from the mundane (a man looking for a trash can while cleaning up after his guide dog) to the complicated (a lost woman with bad directions from a passerby can't find her bus stop.) “You'll never know until you pick up the call,” Bernal says.\u003c/p>\n\u003caside class=\"pullquote alignright\">'There are hundreds of thousands of very clever and efficient solutions that don’t involve sight.'\u003ccite>Bryan Bashin, LightHouse for the Blind and Visually Impaired\u003c/cite>\u003c/aside>\n\u003cp>Sometimes they get a strange one — Bernal recalls an agent being asked to help a user do origami, having to hastily grab some paper and fold along. But most are the stuff of ordinary life: setting up the cable box, checking the expiration date on the milk, matching a shirt and tie.\u003c/p>\n\u003cp>Tiffany Manosh, president of the River City Chapter of the National Federation of the Blind, in Sacramento, has been using Aira for about a year. She likes it for tasks that involve browsing, like shopping. Sure, she could ask a clerk for help, but “they go directly to whatever item we’ve asked for,” she says. “Well, what if I want to see maybe what’s on sale?”\u003c/p>\n\u003cp>At a natural history museum, she once had an agent describe the exhibits. A docent could have done that — if she’d booked one a month in advance. “Sighted people don’t have to do that, so why should we?” she asks. “Aira gives us the freedom to be able to really integrate and do things at our own time — when we want to, and where we want to go.” An agent even helped her find her father’s gravesite at Arlington National Cemetery. “It was a very emotional and just phenomenal feeling to be able to do it on my own time,” says Manosh.\u003c/p>\n\u003cp>Aira, based in San Diego, test-launched three years ago with 200 beta users. Among them was Victorville resident Michael Hingson, who has been blind since birth and recently became the company’s director of strategic sales. “Aira is not helping a blind person see,” Hingson says. “Aira is giving me information that the sighted world has not learned to provide to us.”\u003c/p>\n\u003cp>For example, on emails or websites, those who are visually impaired might use a screen reader that speaks the text aloud. For printed materials, they might try a phone app like the \u003ca href=\"http://www.knfbreader.com/\" target=\"_blank\" rel=\"noopener noreferrer\">KNFB Reader\u003c/a>, which translates text using optical character recognition. But those don’t cover everything. Hingson recalls trying to assemble a laundry cart and discovering the instructions were in pictures, which his reader couldn’t decipher. So he called Aira. The agent zoomed in on the cart’s bar code and found assembly instructions on the internet. In a half-hour, Hingson said, “I had a working laundry cart.”\u003c/p>\n\u003cp>Aira agents are trained to give factual information without offering advice, deferring to the user’s orientation and mobility training. “What I don’t want is an agent telling me it’s safe to cross the street — because the agent doesn't \u003cem>know\u003c/em> it’s safe to cross the street,” says Hingson. “That should be my choice.”\u003c/p>\n\u003cp>Learning to give the right information is a balancing act, says Bernal. “When agents first start, they feel like they have to say every little thing that is in any remote path of a user,” she says. But a person’s dog or cane will help them avoid obstacles. Instead, it might be more useful to offer social information, like where the empty seat in the room is, or whether the driver greeting you at the airport is smiling and waving you over.\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/Jxkq-Ta0tv4'\n title='//www.youtube.com/embed/Jxkq-Ta0tv4'\n allowfullscreen='true'\n style='border:0;'>\u003c/iframe>\n \u003c/span>\n \u003c/span>\u003c/p>\u003cp>\u003cp>\u003cstrong>Free Services\u003c/strong>\u003c/p>\n\u003cp>Bryan Bashin, CEO of the training and advocacy group \u003ca href=\"http://lighthouse-sf.org/\">LightHouse for the Blind and Visually Impaired\u003c/a>, in San Francisco, has tried Aira, and points out that while it’s the first such for-profit service, it’s not the first visual interpretation app.\u003c/p>\n\u003cp>Once the iPhone debuted, he says, “a lot of people had the same idea at the same time.” He sometimes uses \u003ca href=\"http://bemyeyes.com/\" target=\"_blank\" rel=\"noopener noreferrer\">Be My Eyes\u003c/a>, a free worldwide service powered by volunteers who assist by cellphone video chat. The free app \u003ca href=\"http://taptapseeapp.com/\" target=\"_blank\" rel=\"noopener noreferrer\">TapTapSee\u003c/a> identifies the content of still photos and speaks it aloud. And people can also improvise by simply Facetiming with friends or relatives. Bashin says these solutions are more accessible to low-income people than Aira’s paid service, although they lack some of the features — smartglasses, GPS mapping, agents trained to work with the blind. But what they all have in common, Bashin says, “is the world is still not 100 percent accessible for blind people.”\u003c/p>\n\u003cp>Bashin says that dialing a sighted person can be especially helpful when optical character readers fail, noting they are often thwarted by glare (think thermostat screens) or fancy script (think wine bottle labels or handwritten mail). But Bashin cautions against over-reliance on visual interpreters.\u003c/p>\n\u003cp>“When somebody first becomes blind, they think that the answers to the obstacles of blindness are to have someone see for you,” he says. Yet a person can skillfully use other senses, like touch and hearing, and low-tech solutions, like Braille. “There are hundreds of thousands of very clever and efficient solutions that don’t involve sight,” Bashin continues. “That’s what we teach at the LightHouse, and that’s what will get us through the day with a little bit of grace, so that we can reserve these technologies for when they really count. I'm a little bit afraid that new students will avoid learning what they need to learn to be competent blind people.”\u003c/p>\n\u003cp>While some Aira users prefer a paid agent — often for fear of imposing on others’ time — Bashin doesn't mind asking a stranger to steer him toward the check-in desk or describe what’s on the buffet, because that’s a social activity. “Yes, I’ll learn where the strawberries are, but I’ll also learn about \u003cem>them\u003c/em>. Now I’ve made a bridge to another person instead of isolating myself talking into a headset and some goggles,” he says.\u003c/p>\n\u003cp>But Manosh, from the Sacramento National Federation of the Blind chapter, disagrees that the service will encourage isolation or over-reliance. She calls Aira “a tool in my toolbox” that also includes her cane and her mobility training. “You don’t have to rely \u003cem>just\u003c/em> on it, and that’s the beauty of it,” she says.\u003c/p>\n\u003cfigure id=\"attachment_418103\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/06/Aira5.jpg\">\u003cimg class=\"wp-image-418103 size-large\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/06/Aira5-1020x680.jpg\" alt=\"\" width=\"640\" height=\"427\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/06/Aira5-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2017/06/Aira5-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/06/Aira5-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2017/06/Aira5-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2017/06/Aira5-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2017/06/Aira5-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2017/06/Aira5-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/06/Aira5-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/06/Aira5-520x347.jpg 520w, https://ww2.kqed.org/app/uploads/sites/13/2017/06/Aira5.jpg 1600w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Amy Bernal, Aira's vice president of customer experience, demonstrates what agents connected to the company's clients see on their screen -- a Google Map of the user's location with an inset of the video stream coming from their glasses or phone. (Kara Platoni/KQED)\u003c/figcaption>\u003c/figure>\n\u003caside class=\"pullquote alignright\">'I’ve had this experience where I’ve actually gone to an airport and thought ‘How do I know this airport? I’ve never been here before. You realize that you’ve been an agent for a user in an airport. You are like, ‘Oh, I’ve been in this terminal, but I haven’t \u003cem>been in this terminal\u003c/em>.’ It’s very déjà vu.'\u003ccite>Amy Bernal, Aira’s vice president of customer experience\u003c/cite>\u003c/aside>\n\u003cp>The next phase of Aira’s development will be to turn some tasks over to a machine. At first, Bernal says, the AI will likely assist the agent. Later, it might guide people through routine tasks, like daily commutes. Or it might replace agents in sensitive situations, while users are in restrooms or dealing with finances, for instance. (Currently, users can go into “privacy mode” with no video or audio, or hang up and call back.)\u003c/p>\n\u003cp>Hingson imagines sending a shopping list to Aira, and having the AI map his path through the store and check barcodes to confirm that he's grabbed the right items. He’d also like Aira integration with Facebook, so the system could use facial recognition to let him know if his friends are nearby.\u003c/p>\n\u003cp>For now, employees like Bernal are happy to assist with just about everything, although she notes that there’s one oddly sci-fi effect of seeing the world through someone else’s lenses.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>\u003cem>Originally published April 10, 2017\u003c/em>\u003c/p>\n\u003cp>A recent trend in anti-aging research sounds straight out of an episode of \"The Twilight Zone\"—or, if you’re younger than 40, the \"Twilight\" series. Scientists are infusing blood from young people into elderly individuals to improve health and delay the afflictions of aging.\u003c/p>\n\u003cp>It may sound creepy, but the potential health benefits of the practice are grounded in more than a decade of research. According to numerous animal studies from Stanford, UC Berkeley and Harvard, young blood can \u003ca href=\"http://science.sciencemag.org/content/344/6184/649\">rejuvenate aging muscles\u003c/a>, \u003ca href=\"http://www.cell.com/cell/abstract/S0092-8674(13)00456-X?_returnURL=http%3A%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS009286741300456X%3Fshowall%3Dtrue\">improve organ function\u003c/a>, help \u003ca href=\"http://www.nature.com/nature/journal/v477/n7362/full/nature10357.html\">generate new brain cells\u003c/a>, and even \u003ca href=\"http://www.nature.com/nm/journal/v20/n6/full/nm.3569.html\">improve cognition\u003c/a>. So far, these benefits have only been seen in mice.\u003c/p>\n\u003caside class=\"pullquote alignright\">'We’re trying to avoid creating expectations of a Eureka moment that we’ll have people who have severe Alzheimer’s disease acting as though they’re adolescents again.' \u003ccite>Joe McCracken, Alkahest\u003c/cite>\u003c/aside>\n\u003cp>Now, two Northern California startups, \u003ca href=\"http://www.alkahest.com/\">Alkahest\u003c/a> and \u003ca href=\"https://www.ambrosiaplasma.com/\">Ambrosia LLC\u003c/a>, are conducting the first studies that attempt to recreate these anti-aging effects in humans. The two companies are running separate clinical trials to infuse plasma from people under the age of 25 into older adults, in an attempt to reverse some of the negative effects of aging and treat age-related diseases.\u003c/p>\n\u003cp>Scientists think certain proteins in the blood either increase or decrease with aging and are behind age-related diseases such as dementia, diabetes and heart disease. Infusions of young blood may replenish helpful proteins that are lost over the years or block the production of damaging ones that typically increase with age.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Although Alkahest and Ambrosia were inspired by the same studies, their goals and approaches to research are very different.\u003c/p>\n\u003cp>\u003cstrong>The Academic\u003c/strong>\u003c/p>\n\u003cp>Stanford professor Tony Wyss-Coray co-founded San Carlos-based Alkahest in 2014, based on his \u003ca href=\"http://www.nature.com/nm/journal/v20/n6/abs/nm.3569.html\">findings\u003c/a> that transfusions of young blood into old mice improve learning and memory and promote the growth of new connections between cells in the hippocampus. That’s a key memory center located in the middle of the brain. Alkahest is now working to translate these benefits to patients with Alzheimer’s disease.\u003c/p>\n\u003cfigure id=\"attachment_368258\" class=\"wp-caption alignright\" style=\"max-width: 800px\">\u003ca href=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/04/Wyss-Coray-2.jpg\">\u003cimg class=\"size-medium wp-image-368258\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/04/Wyss-Coray-2-800x600.jpg\" alt=\"STANFORD. CA., MAY 2, 2014--Dr. Tony Wyss-Coray, Professor of Neurology at Stanford School of Medicine in lab on Friday, May 2, 2014. ( Norbert von der Groeben/Stanford School of Medicine )\" width=\"800\" height=\"600\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/04/Wyss-Coray-2-800x600.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Wyss-Coray-2-160x120.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Wyss-Coray-2-768x576.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Wyss-Coray-2-1020x765.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Wyss-Coray-2-1180x885.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Wyss-Coray-2-960x720.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Wyss-Coray-2-240x180.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Wyss-Coray-2-375x281.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Wyss-Coray-2-520x390.jpg 520w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Wyss-Coray-2.jpg 1200w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Tony Wyss-Coray's clinical trial tested whether infusions of young blood are safe for patients with Alzheimer's disease; future trials may test whether the treatment would be beneficial. \u003ccite>(Norbert von der Groeben/Stanford School of Medicine)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>In 2014, Alkahest sponsored an FDA-approved \u003ca href=\"https://clinicaltrials.gov/ct2/show/NCT02256306\">clinical trial\u003c/a> at Stanford to give Alzheimer’s patients between the ages of 50 and 90 four small, weekly transfusions of plasma. The plasma is obtained from the \u003ca href=\"https://bloodcenter.stanford.edu/research/\">Stanford Blood Center\u003c/a>, which has a dedicated research arm that accepts blood donations specifically for Stanford clinical trials.\u003c/p>\n\u003cp>Joe McCracken, vice president of business development at Alkahest, says that for now, the study is focused on safety and feasibility rather than the efficacy of the treatment.\u003c/p>\n\u003cp>“We’re trying to avoid creating expectations of a Eureka moment that we’ll have people who have severe Alzheimer’s disease acting as though they’re adolescents again,” he says. “The expectation we have is that we will demonstrate that administration of young plasma to elderly patients with Alzheimer’s disease is safe.”\u003c/p>\n\u003cp>The patients are also undergoing memory assessments, brain scans and blood tests to detect any potential changes in disease symptoms. The trial has completed testing on all 18 patients, and McCracken hopes to publish the results by the end of the year. If all goes well, Alkahest plans to conduct a second, larger study to test for efficacy.\u003c/p>\n\u003cp>The company’s long-term goal is to identify the proteins in the blood that change with age, and then synthesize these factors into pharmaceutical drugs.\u003c/p>\n\u003cp>\u003cstrong>The Entrepreneur\u003c/strong>\u003c/p>\n\u003cp>Jesse Karmazin, CEO of Ambrosia, is taking an unconventional—and more controversial—approach to anti-aging research. Ambrosia, which has clinics in Monterey, California and Tampa, Florida, acts as a “pay-to-play” \u003ca href=\"https://clinicaltrials.gov/ct2/show/NCT02803554\">clinical trial\u003c/a>, giving one large plasma transfusion to anyone over the age of 35 for a fee of $8,000. The plasma is purchased from local blood banks, which often have a surplus of the material because hospitals typically only require red blood cells for medical procedures.\u003c/p>\n\u003cp>[contextly_sidebar id=\"Ge8xrkWvdt1iNqxT39StX0C8FxMNPAxq\"]Karmazin, who graduated from Stanford medical school, has gotten some heat for the price his participants are paying. He says his company has no investors, and without the fee the clinic and the study would be impossible. In contrast, Alkahest received a \u003ca href=\"http://www.grifols.com/en/web/international/view-news/-/new/grifols-to-make-a-major-equity-investment-in-alkahest\">$37.5 million investment in 2015 from Grifols\u003c/a>, a Spanish-based company that is the leading producer of blood- and plasma-based products.\u003c/p>\n\u003cp>“You don’t think about it, but you—or your insurance company—ultimately pay for the clinical trial over 20 years after the drug has been approved,” Karmazin says. “Companies patent the drug, they pay up front tens or even hundreds of millions of dollars [for a clinical trial], and then they hope to make a billion dollars over the next 20 years.”\u003c/p>\n\u003cp>Karmazin also justifies the cost of his study by saying that what people choose to do with their money is their decision.\u003c/p>\n\u003cp>“This amount of money for some people is nothing,” he says. “Not for me, I have $200,000 in loans.”\u003c/p>\n\u003cp>Ambrosia is analyzing data from its first 60 participants to look for changes in biomarkers of aging in the blood taken one month after treatment. The company doesn’t have any conclusive results yet.\u003c/p>\n\u003cp>It’s difficult to say whether Ambrosia’s study, as designed, is capable of producing conclusive results. Karmazin is accepting people with a vast range of ages and with different diseases or reasons for wanting the injection. That means the amount of data he gathers on any one condition will likely be limited and may not be useful.\u003c/p>\n\u003cp>\u003cstrong>The Question of Ethics\u003c/strong>\u003c/p>\n\u003cp>Neither company would comment on the work of the other, although Wyss-Coray took some shots in an article in \u003ca href=\"http://www.sciencemag.org/news/2016/08/young-blood-antiaging-trial-raises-questions\">\u003cem>Science\u003c/em>\u003c/a> last year, saying that Karmazin was “basically abusing people’s trust and the public excitement around” the research.\u003c/p>\n\u003cp>Bioethicist Karen Maschke from The Hastings Center, a research institute in New York, says the payment model of the Ambrosia trial “raises a lot of a red flags,” and that the design of the study sounds “very suspect.” She is particularly concerned that participants will think they are paying for a known therapy when in fact they are paying for an experimental and unproven procedure.\u003c/p>\n\u003cp>For his part, Karmazin says that he is \"totally transparent that it is experimental.” Consent documents for the trial do describe the procedure as experimental and do not guarantee any improvements.\u003c/p>\n\u003cp>There have been no serious adverse events from the transfusions reported by either company, and both researchers are optimistic the treatment will provide real benefits to patients.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>Dana Smith is a freelance writer focusing on health and science, with a special interest in the brain. Her work has been featured in The Atlantic, The Guardian, Fast Company, Scientific American, Discover Magazine, and others. In a previous life, she received a Ph.D. in experimental psychology from the University of Cambridge. Find her on Twitter @smithdanag\u003c/em>\u003c/p>\n\n",
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"excerpt": "Remember that study where scientists put blood from young mice into old mice and it reversed aging? Research has begun on humans.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cem>Originally published April 10, 2017\u003c/em>\u003c/p>\n\u003cp>A recent trend in anti-aging research sounds straight out of an episode of \"The Twilight Zone\"—or, if you’re younger than 40, the \"Twilight\" series. Scientists are infusing blood from young people into elderly individuals to improve health and delay the afflictions of aging.\u003c/p>\n\u003cp>It may sound creepy, but the potential health benefits of the practice are grounded in more than a decade of research. According to numerous animal studies from Stanford, UC Berkeley and Harvard, young blood can \u003ca href=\"http://science.sciencemag.org/content/344/6184/649\">rejuvenate aging muscles\u003c/a>, \u003ca href=\"http://www.cell.com/cell/abstract/S0092-8674(13)00456-X?_returnURL=http%3A%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS009286741300456X%3Fshowall%3Dtrue\">improve organ function\u003c/a>, help \u003ca href=\"http://www.nature.com/nature/journal/v477/n7362/full/nature10357.html\">generate new brain cells\u003c/a>, and even \u003ca href=\"http://www.nature.com/nm/journal/v20/n6/full/nm.3569.html\">improve cognition\u003c/a>. So far, these benefits have only been seen in mice.\u003c/p>\n\u003caside class=\"pullquote alignright\">'We’re trying to avoid creating expectations of a Eureka moment that we’ll have people who have severe Alzheimer’s disease acting as though they’re adolescents again.' \u003ccite>Joe McCracken, Alkahest\u003c/cite>\u003c/aside>\n\u003cp>Now, two Northern California startups, \u003ca href=\"http://www.alkahest.com/\">Alkahest\u003c/a> and \u003ca href=\"https://www.ambrosiaplasma.com/\">Ambrosia LLC\u003c/a>, are conducting the first studies that attempt to recreate these anti-aging effects in humans. The two companies are running separate clinical trials to infuse plasma from people under the age of 25 into older adults, in an attempt to reverse some of the negative effects of aging and treat age-related diseases.\u003c/p>\n\u003cp>Scientists think certain proteins in the blood either increase or decrease with aging and are behind age-related diseases such as dementia, diabetes and heart disease. Infusions of young blood may replenish helpful proteins that are lost over the years or block the production of damaging ones that typically increase with age.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Although Alkahest and Ambrosia were inspired by the same studies, their goals and approaches to research are very different.\u003c/p>\n\u003cp>\u003cstrong>The Academic\u003c/strong>\u003c/p>\n\u003cp>Stanford professor Tony Wyss-Coray co-founded San Carlos-based Alkahest in 2014, based on his \u003ca href=\"http://www.nature.com/nm/journal/v20/n6/abs/nm.3569.html\">findings\u003c/a> that transfusions of young blood into old mice improve learning and memory and promote the growth of new connections between cells in the hippocampus. That’s a key memory center located in the middle of the brain. Alkahest is now working to translate these benefits to patients with Alzheimer’s disease.\u003c/p>\n\u003cfigure id=\"attachment_368258\" class=\"wp-caption alignright\" style=\"max-width: 800px\">\u003ca href=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/04/Wyss-Coray-2.jpg\">\u003cimg class=\"size-medium wp-image-368258\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/04/Wyss-Coray-2-800x600.jpg\" alt=\"STANFORD. CA., MAY 2, 2014--Dr. Tony Wyss-Coray, Professor of Neurology at Stanford School of Medicine in lab on Friday, May 2, 2014. ( Norbert von der Groeben/Stanford School of Medicine )\" width=\"800\" height=\"600\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/04/Wyss-Coray-2-800x600.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Wyss-Coray-2-160x120.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Wyss-Coray-2-768x576.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Wyss-Coray-2-1020x765.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Wyss-Coray-2-1180x885.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Wyss-Coray-2-960x720.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Wyss-Coray-2-240x180.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Wyss-Coray-2-375x281.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Wyss-Coray-2-520x390.jpg 520w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Wyss-Coray-2.jpg 1200w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Tony Wyss-Coray's clinical trial tested whether infusions of young blood are safe for patients with Alzheimer's disease; future trials may test whether the treatment would be beneficial. \u003ccite>(Norbert von der Groeben/Stanford School of Medicine)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>In 2014, Alkahest sponsored an FDA-approved \u003ca href=\"https://clinicaltrials.gov/ct2/show/NCT02256306\">clinical trial\u003c/a> at Stanford to give Alzheimer’s patients between the ages of 50 and 90 four small, weekly transfusions of plasma. The plasma is obtained from the \u003ca href=\"https://bloodcenter.stanford.edu/research/\">Stanford Blood Center\u003c/a>, which has a dedicated research arm that accepts blood donations specifically for Stanford clinical trials.\u003c/p>\n\u003cp>Joe McCracken, vice president of business development at Alkahest, says that for now, the study is focused on safety and feasibility rather than the efficacy of the treatment.\u003c/p>\n\u003cp>“We’re trying to avoid creating expectations of a Eureka moment that we’ll have people who have severe Alzheimer’s disease acting as though they’re adolescents again,” he says. “The expectation we have is that we will demonstrate that administration of young plasma to elderly patients with Alzheimer’s disease is safe.”\u003c/p>\n\u003cp>The patients are also undergoing memory assessments, brain scans and blood tests to detect any potential changes in disease symptoms. The trial has completed testing on all 18 patients, and McCracken hopes to publish the results by the end of the year. If all goes well, Alkahest plans to conduct a second, larger study to test for efficacy.\u003c/p>\n\u003cp>The company’s long-term goal is to identify the proteins in the blood that change with age, and then synthesize these factors into pharmaceutical drugs.\u003c/p>\n\u003cp>\u003cstrong>The Entrepreneur\u003c/strong>\u003c/p>\n\u003cp>Jesse Karmazin, CEO of Ambrosia, is taking an unconventional—and more controversial—approach to anti-aging research. Ambrosia, which has clinics in Monterey, California and Tampa, Florida, acts as a “pay-to-play” \u003ca href=\"https://clinicaltrials.gov/ct2/show/NCT02803554\">clinical trial\u003c/a>, giving one large plasma transfusion to anyone over the age of 35 for a fee of $8,000. The plasma is purchased from local blood banks, which often have a surplus of the material because hospitals typically only require red blood cells for medical procedures.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>Karmazin, who graduated from Stanford medical school, has gotten some heat for the price his participants are paying. He says his company has no investors, and without the fee the clinic and the study would be impossible. In contrast, Alkahest received a \u003ca href=\"http://www.grifols.com/en/web/international/view-news/-/new/grifols-to-make-a-major-equity-investment-in-alkahest\">$37.5 million investment in 2015 from Grifols\u003c/a>, a Spanish-based company that is the leading producer of blood- and plasma-based products.\u003c/p>\n\u003cp>“You don’t think about it, but you—or your insurance company—ultimately pay for the clinical trial over 20 years after the drug has been approved,” Karmazin says. “Companies patent the drug, they pay up front tens or even hundreds of millions of dollars [for a clinical trial], and then they hope to make a billion dollars over the next 20 years.”\u003c/p>\n\u003cp>Karmazin also justifies the cost of his study by saying that what people choose to do with their money is their decision.\u003c/p>\n\u003cp>“This amount of money for some people is nothing,” he says. “Not for me, I have $200,000 in loans.”\u003c/p>\n\u003cp>Ambrosia is analyzing data from its first 60 participants to look for changes in biomarkers of aging in the blood taken one month after treatment. The company doesn’t have any conclusive results yet.\u003c/p>\n\u003cp>It’s difficult to say whether Ambrosia’s study, as designed, is capable of producing conclusive results. Karmazin is accepting people with a vast range of ages and with different diseases or reasons for wanting the injection. That means the amount of data he gathers on any one condition will likely be limited and may not be useful.\u003c/p>\n\u003cp>\u003cstrong>The Question of Ethics\u003c/strong>\u003c/p>\n\u003cp>Neither company would comment on the work of the other, although Wyss-Coray took some shots in an article in \u003ca href=\"http://www.sciencemag.org/news/2016/08/young-blood-antiaging-trial-raises-questions\">\u003cem>Science\u003c/em>\u003c/a> last year, saying that Karmazin was “basically abusing people’s trust and the public excitement around” the research.\u003c/p>\n\u003cp>Bioethicist Karen Maschke from The Hastings Center, a research institute in New York, says the payment model of the Ambrosia trial “raises a lot of a red flags,” and that the design of the study sounds “very suspect.” She is particularly concerned that participants will think they are paying for a known therapy when in fact they are paying for an experimental and unproven procedure.\u003c/p>\n\u003cp>For his part, Karmazin says that he is \"totally transparent that it is experimental.” Consent documents for the trial do describe the procedure as experimental and do not guarantee any improvements.\u003c/p>\n\u003cp>There have been no serious adverse events from the transfusions reported by either company, and both researchers are optimistic the treatment will provide real benefits to patients.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>Dana Smith is a freelance writer focusing on health and science, with a special interest in the brain. Her work has been featured in The Atlantic, The Guardian, Fast Company, Scientific American, Discover Magazine, and others. In a previous life, she received a Ph.D. in experimental psychology from the University of Cambridge. Find her on Twitter @smithdanag\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Attendees at the American Diabetes Association’s Scientific Sessions in San Diego this year — many of them young researchers who are active on social media — were surprised to be greeted with the following: “Thanks for joining us at #2017ADA! Photography isn’t allowed during presentations — we’d appreciate it if you’d delete this tweet.”\u003c/p>\n\u003caside class=\"pullquote alignright\">'Excuse the poor focus — taking photos at #2017ADA has turned into a covert activity.'\u003c/aside>\n\u003cp>For many, the essence of gathering at conferences is the sharing of scientific information, a peek at interesting research in progress.\u003c/p>\n\u003cp>The policy, unusual for scientific conferences, is the most public manifestation yet of the tension between the drug and medical device companies that help sponsor the ADA’s flagship programs on one side and researchers and patients on the other.\u003c/p>\n\u003cp>The New England Journal of Medicine doesn’t consider this a problem. Some researchers on Twitter pointed to NEJM guidelines that state “online posting of an audio or video recording of an oral presentation at a medical meeting, with selected slides from the presentation, is not considered prior publication,” according to \u003ca href=\"http://www.medscape.com/viewarticle/881418\">Medscape\u003c/a>.\u003c/p>\n\u003cp>The #2017ADA hashtag — on 10 million people’s feeds, and growing — has been dominated by negative feedback, \u003ca href=\"https://www.symplur.com/healthcare-hashtags/ADA2017/analytics/?hashtag=ADA2017&fdate=\">according to\u003c/a> Symplur, a health care social media analytics platform.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Each year, academic and industry researchers present cutting-edge and sometimes unpublished data at the ADA’s Scientific Sessions. Many of these researchers accept research grants or consulting contracts from insulin makers and other pharmaceutical companies, according to \u003ca href=\"http://www.abstractsonline.com/pp8/#!/4297/presentations/novo/1\">disclosures made\u003c/a> on the conference’s website. The nonprofit’s website shows it accepted corporate sponsorships of up to $135,000\u003ca href=\"https://professional.diabetes.org/content-page/sponsorship-opportunities\"> for the opportunity\u003c/a> to advertise at the conference in a \u003ca href=\"https://indd.adobe.com/view/9bcaa37c-1a78-4c3d-a7fb-b6fea6aa937c\">variety of creative ways\u003c/a>, including promotional handouts at hotel check-ins, ads in the meeting guide and marketing materials in the goody bag distributed to participating physicians. The conference’s \u003ca href=\"https://app.core-apps.com/tristar_ada17\">mobile app\u003c/a> was sponsored by Sanofi, one of the “big three” insulin makers.\u003c/p>\n\u003cp>But the $500-$900 \u003ca href=\"https://professional.diabetes.org/content-page/registration-information\">ticket prices\u003c/a> preclude many physicians, researchers and patients from attending.\u003c/p>\n\u003cp>Conference attendees who live-tweeted photos of presentation slides were quickly rebuked by the ADA. The nonprofit’s social media team tweeted at attendees to delete their photos. The comprehensive policy even applied to sessions about open innovation, an irony not lost on patients and researchers keeping up online with the conference, which concluded Tuesday.\u003c/p>\n\u003cp>The first rule of open invitation: You don't talk about open innovation. \u003ca href=\"https://twitter.com/shivani_go\">@shivani_go\u003c/a> \u003ca href=\"https://twitter.com/hashtag/2017ADA?src=hash\">#2017ADA\u003c/a> \u003ca href=\"https://t.co/YquLkHicfO\">pic.twitter.com/YquLkHicfO\u003c/a>\u003c/p>\n\u003cp>— Matthew Dalby (@MatthewJDalby) \u003ca href=\"https://twitter.com/MatthewJDalby/status/873302836800618496\">June 9, 2017\u003c/a>\u003c/p>\n\u003cp>“I am not familiar enough with the ADA to have an informed opinion on their no photo-taking policy as a general matter. In this particular case, the application of the no-photos policy to a\u003ca href=\"https://youtu.be/SntQ595bUNI\"> talk on patients’ freedom\u003c/a> to — and increasing ability to — design treatments for themselves did seem like a funny juxtaposition,” said the researcher, Eric von Hippel, the T. Wilson Professor in Management at MIT.\u003c/p>\n\u003cp>Still, some rogue attendees tweeted photos anyway, only to find that representatives of the American Diabetes Association were enforcing the policy in person, too.\u003c/p>\n\u003cp>Excuse the poor focus — taking photos at \u003ca href=\"https://twitter.com/hashtag/2017ADA?src=hash\">#2017ADA\u003c/a> has turned into a covert activity. Executive summary: the lockstep slides look damning. \u003ca href=\"https://t.co/kBRJb1RgRp\">pic.twitter.com/kBRJb1RgRp\u003c/a>\u003c/p>\n\u003cp>— Thom Scher (@thomscher) \u003ca href=\"https://twitter.com/thomscher/status/873650155039227904\">June 10, 2017\u003c/a>\u003c/p>\n\u003cp>Defending the unpopular policy, Linda Cann, ADA’s senior vice president of professional services and education, cited legal concerns in a \u003ca href=\"https://twitter.com/health_journo/status/873678574988828672\">statement\u003c/a> to \u003ca href=\"https://twitter.com/health_journo/status/873678770762153986\">pharmaphorum\u003c/a>.\u003c/p>\n\u003cp>“All research slides and posters are the legal property of each of the research authors and their study team, not the Association,” Cann said. “Reversing this policy could unwittingly dismantle the long-standing discourse and engagement of medical and research meetings around the world.\u003c/p>\n\u003cp>“After this year’s meeting, we will re-evaluate the policy and our legal obligations to the researchers who present at Scientific Sessions.”\u003c/p>\n\u003cp>Cann did not explain which legal obligations concerned the ADA. Independent academics are not typically litigious when it comes to intellectual property. Pharmaceutical and medical device companies might worry about breaking Food and Drug Administration rules prohibiting marketing a product before regulatory approval.\u003c/p>\n\u003cp>Some in the diabetic online community have speculated that a snafu at last year’s sessions contributed to this year’s zealous enforcement. In 2016, sensitive data about a new Novo Nordisk drug, Victoza, was shared with conference attendees an hour before its official release to the markets, and the data was immediately shared on Twitter, according to a Bloomberg \u003ca href=\"https://www.bloomberg.com/news/articles/2016-06-14/can-hundreds-of-doctors-keep-an-8b-secret-not-on-twitter\">report\u003c/a>. Novo’s stock dipped by 5.6 percent the following day.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>KHN’s coverage of prescription drug development, costs and pricing is supported in part by the \u003ca href=\"http://www.arnoldfoundation.org/\">Laura and John Arnold Foundation\u003c/a>.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Attendees at the American Diabetes Association’s Scientific Sessions in San Diego this year — many of them young researchers who are active on social media — were surprised to be greeted with the following: “Thanks for joining us at #2017ADA! Photography isn’t allowed during presentations — we’d appreciate it if you’d delete this tweet.”\u003c/p>\n\u003caside class=\"pullquote alignright\">'Excuse the poor focus — taking photos at #2017ADA has turned into a covert activity.'\u003c/aside>\n\u003cp>For many, the essence of gathering at conferences is the sharing of scientific information, a peek at interesting research in progress.\u003c/p>\n\u003cp>The policy, unusual for scientific conferences, is the most public manifestation yet of the tension between the drug and medical device companies that help sponsor the ADA’s flagship programs on one side and researchers and patients on the other.\u003c/p>\n\u003cp>The New England Journal of Medicine doesn’t consider this a problem. Some researchers on Twitter pointed to NEJM guidelines that state “online posting of an audio or video recording of an oral presentation at a medical meeting, with selected slides from the presentation, is not considered prior publication,” according to \u003ca href=\"http://www.medscape.com/viewarticle/881418\">Medscape\u003c/a>.\u003c/p>\n\u003cp>The #2017ADA hashtag — on 10 million people’s feeds, and growing — has been dominated by negative feedback, \u003ca href=\"https://www.symplur.com/healthcare-hashtags/ADA2017/analytics/?hashtag=ADA2017&fdate=\">according to\u003c/a> Symplur, a health care social media analytics platform.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Each year, academic and industry researchers present cutting-edge and sometimes unpublished data at the ADA’s Scientific Sessions. Many of these researchers accept research grants or consulting contracts from insulin makers and other pharmaceutical companies, according to \u003ca href=\"http://www.abstractsonline.com/pp8/#!/4297/presentations/novo/1\">disclosures made\u003c/a> on the conference’s website. The nonprofit’s website shows it accepted corporate sponsorships of up to $135,000\u003ca href=\"https://professional.diabetes.org/content-page/sponsorship-opportunities\"> for the opportunity\u003c/a> to advertise at the conference in a \u003ca href=\"https://indd.adobe.com/view/9bcaa37c-1a78-4c3d-a7fb-b6fea6aa937c\">variety of creative ways\u003c/a>, including promotional handouts at hotel check-ins, ads in the meeting guide and marketing materials in the goody bag distributed to participating physicians. The conference’s \u003ca href=\"https://app.core-apps.com/tristar_ada17\">mobile app\u003c/a> was sponsored by Sanofi, one of the “big three” insulin makers.\u003c/p>\n\u003cp>But the $500-$900 \u003ca href=\"https://professional.diabetes.org/content-page/registration-information\">ticket prices\u003c/a> preclude many physicians, researchers and patients from attending.\u003c/p>\n\u003cp>Conference attendees who live-tweeted photos of presentation slides were quickly rebuked by the ADA. The nonprofit’s social media team tweeted at attendees to delete their photos. The comprehensive policy even applied to sessions about open innovation, an irony not lost on patients and researchers keeping up online with the conference, which concluded Tuesday.\u003c/p>\n\u003cp>The first rule of open invitation: You don't talk about open innovation. \u003ca href=\"https://twitter.com/shivani_go\">@shivani_go\u003c/a> \u003ca href=\"https://twitter.com/hashtag/2017ADA?src=hash\">#2017ADA\u003c/a> \u003ca href=\"https://t.co/YquLkHicfO\">pic.twitter.com/YquLkHicfO\u003c/a>\u003c/p>\n\u003cp>— Matthew Dalby (@MatthewJDalby) \u003ca href=\"https://twitter.com/MatthewJDalby/status/873302836800618496\">June 9, 2017\u003c/a>\u003c/p>\n\u003cp>“I am not familiar enough with the ADA to have an informed opinion on their no photo-taking policy as a general matter. In this particular case, the application of the no-photos policy to a\u003ca href=\"https://youtu.be/SntQ595bUNI\"> talk on patients’ freedom\u003c/a> to — and increasing ability to — design treatments for themselves did seem like a funny juxtaposition,” said the researcher, Eric von Hippel, the T. Wilson Professor in Management at MIT.\u003c/p>\n\u003cp>Still, some rogue attendees tweeted photos anyway, only to find that representatives of the American Diabetes Association were enforcing the policy in person, too.\u003c/p>\n\u003cp>Excuse the poor focus — taking photos at \u003ca href=\"https://twitter.com/hashtag/2017ADA?src=hash\">#2017ADA\u003c/a> has turned into a covert activity. Executive summary: the lockstep slides look damning. \u003ca href=\"https://t.co/kBRJb1RgRp\">pic.twitter.com/kBRJb1RgRp\u003c/a>\u003c/p>\n\u003cp>— Thom Scher (@thomscher) \u003ca href=\"https://twitter.com/thomscher/status/873650155039227904\">June 10, 2017\u003c/a>\u003c/p>\n\u003cp>Defending the unpopular policy, Linda Cann, ADA’s senior vice president of professional services and education, cited legal concerns in a \u003ca href=\"https://twitter.com/health_journo/status/873678574988828672\">statement\u003c/a> to \u003ca href=\"https://twitter.com/health_journo/status/873678770762153986\">pharmaphorum\u003c/a>.\u003c/p>\n\u003cp>“All research slides and posters are the legal property of each of the research authors and their study team, not the Association,” Cann said. “Reversing this policy could unwittingly dismantle the long-standing discourse and engagement of medical and research meetings around the world.\u003c/p>\n\u003cp>“After this year’s meeting, we will re-evaluate the policy and our legal obligations to the researchers who present at Scientific Sessions.”\u003c/p>\n\u003cp>Cann did not explain which legal obligations concerned the ADA. Independent academics are not typically litigious when it comes to intellectual property. Pharmaceutical and medical device companies might worry about breaking Food and Drug Administration rules prohibiting marketing a product before regulatory approval.\u003c/p>\n\u003cp>Some in the diabetic online community have speculated that a snafu at last year’s sessions contributed to this year’s zealous enforcement. In 2016, sensitive data about a new Novo Nordisk drug, Victoza, was shared with conference attendees an hour before its official release to the markets, and the data was immediately shared on Twitter, according to a Bloomberg \u003ca href=\"https://www.bloomberg.com/news/articles/2016-06-14/can-hundreds-of-doctors-keep-an-8b-secret-not-on-twitter\">report\u003c/a>. Novo’s stock dipped by 5.6 percent the following day.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>KHN’s coverage of prescription drug development, costs and pricing is supported in part by the \u003ca href=\"http://www.arnoldfoundation.org/\">Laura and John Arnold Foundation\u003c/a>.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>If there was one misstep that doomed the \u003ca href=\"https://www.statnews.com/2017/04/13/crispr-patent-uc-appeal/\">long and bitter fight\u003c/a> by the University of California to wrest key CRISPR patents from the Broad Institute, it was star UC Berkeley scientist Jennifer Doudna’s habit of being scientifically cautious, realistic, and averse to overpromising.\u003c/p>\n\u003cp>A biochemist who co-led a breakthrough \u003ca href=\"http://science.sciencemag.org/content/337/6096/816\" target=\"_blank\" rel=\"noopener noreferrer\">2012 study\u003c/a> of CRISPR-Cas9, Doudna repeatedly emphasized in interviews the challenges of repurposing the molecular system, which bacteria use to fend off viruses, to edit human genomes. The U.S. patent office, in a February \u003ca href=\"https://www.statnews.com/2017/02/15/crispr-patent-ruling/\">ruling\u003c/a> that let the Broad keep its CRISPR patents (for now), relied heavily on those statements — “We weren’t sure if CRISPR/Cas9 would work in … animal cells,” for example — to conclude that when scientists at the Broad \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3795411/\" target=\"_blank\" rel=\"noopener noreferrer\">CRISPR’d human cells\u003c/a> in 2013, it was a non-obvious advance and therefore deserving of patents.\u003c/p>\n\u003cp class=\"danger-zone\">So it’s striking that the careful, measured Doudna who said CRISPR’ing human cells and thereby curing devastating diseases would be a challenge is hardly in evidence in “A Crack in Creation: Gene Editing and the Unthinkable Power to Control Evolution,” the new book she co-authored with her former student Samuel Sternberg. It went on sale last week.\u003c/p>\n\u003cp class=\"danger-zone\">This Doudna doesn’t hold back. We are “on the cusp of a new age in genetic engineering and biological mastery,” she and Sternberg write, dangling the prospect of “life-changing treatments” and “lifesaving cures.” She says she is “not kidding” that CRISPR could bring about “woolly mammoths, winged lizards, and unicorns. … It won’t be long before CRISPR allows us to bend nature to our will.”\u003c/p>\n\u003cp class=\"danger-zone\">The hyperbole contrasts with CRISPR’s stumbles, including altering parts of genomes (in lab studies, not patients yet) it wasn’t supposed to. “I don’t think we’ll have a version of CRISPR that’s 100 percent perfect, so it comes down to a risk-benefit analysis,” Sternberg, a biochemist at \u003ca href=\"https://www.statnews.com/2016/06/22/rachel-haurwitz-crispr-caribou/\">Caribou Biosciences\u003c/a> (which Doudna co-founded), said in an interview. “There has been phenomenal progress in understanding off-target effects; I think it’s a solvable problem. … We have every reason to be optimistic but I hope we avoided overhyping and didn’t give the impression that there would be windfall of cures in the next couple of years.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>This is not a tell-all. The farthest Doudna goes in addressing the patent fight — a “disheartening twist” — is to say that because of such rivalries she experienced “the gamut of human relationships, from deep friendships to disturbing betrayals.” She doesn’t name the betrayers.\u003c/p>\n\u003cp>An early \u003ca href=\"https://www.nature.com/nature/journal/v546/n7656/full/546030a.html\" target=\"_blank\" rel=\"noopener noreferrer\">review\u003c/a> chastised Doudna for presenting herself as “so flawless” the book “seems more concealing than revealing,” not “insightful [and] candid.”\u003c/p>\n\u003cp>So what she does choose to reveal is fascinating, especially about her collaboration with Emmanuelle Charpentier. The two are so closely linked that all the prizes they’ve won for CRISPR, they’ve won together; among CRISPR watchers “Doudna and Charpentier” is virtually a macro.\u003c/p>\n\u003cp>But the book’s account of their breakthrough experiment showing that CRISPR could be programmed to edit a precise spot in a genome leaves a different impression. We read that “Martin [Jinek, Doudna’s postdoctoral fellow] showed” and “Martin labored tirelessly,” “Martin and I brainstormed” and “designed an experiment,” and when “Martin walked me through the data,” Doudna knew “we’d done it.”\u003c/p>\n\u003cp>That work was described in the 2012 paper, which is widely recognized — by prize committees, the European Patent Office, and many scientists — as the Bastille moment for the CRISPR revolution. It identified the three crucial molecules in the CRISPR system — one to cut, one to guide the cutting enzyme to its target DNA, one to activate the cutting enzyme — that produced a programmable DNA-cutting machine. “We had built the means to rewrite the code of life,” Doudna and Sternberg write. “Nothing after that would ever be the same.”\u003c/p>\n\u003cp>Although Doudna and her collaborators didn’t actually change genomes in cells — their CRISPR molecules altered cell-free DNA in test tubes — that was an obvious next step. How difficult a next step was the core dispute in the patent fight and one that she repeatedly cautioned was no slam dunk. But “Crack in Creation” says that doing so “was immediately clear to us,” and “there were good reasons to expect success.”\u003c/p>\n\u003cp>That contrasts with her cautious statements, cited by the patent office, at the time. When \u003ca href=\"https://www.statnews.com/2015/11/06/hollywood-inspired-scientist-rewrite-code-life/\">Feng Zhang\u003c/a> of the Broad Institute and \u003ca href=\"https://www.statnews.com/2017/06/08/george-church-narcolepsy/\">George Church\u003c/a> of Harvard used CRISPR to edit genes, it was “just as we had proposed in 2012,” according to the book. She was elated that her 2012 work “inspired others to pursue a line of experimentation similar to our own.”\u003c/p>\n\u003cp>Doudna became a public scientist — she’s given a \u003ca href=\"https://www.ted.com/talks/jennifer_doudna_we_can_now_edit_our_dna_but_let_s_do_it_wisely\" target=\"_blank\" rel=\"noopener noreferrer\">TED talk\u003c/a> and will appear on “Sunday Night with Megyn Kelly” — because of her research, but also because she was instrumental in getting the scientific community to focus on ethical issues it raises, especially about editing embryos in a way that would be inherited by future generations (“germline” editing). She writes that she had nightmares that a man asking her about this was Hitler and that she “began to feel a bit like Dr. Frankenstein.”\u003c/p>\n\u003cp>Her own moral journey is intriguing. She feels germline editing can be safe, and the “it’s unnatural!” argument “doesn’t carry much weight with me anymore,” she writes. “It seems to me that we’d be justified in using” CRISPR to eliminate genes that cause untold suffering, such as those for Huntington’s disease. “When I think about the pain that genetic diseases cause families, the stakes are simply too high to exclude the possibility of eventually using germline editing,” as an expert panel also \u003ca href=\"https://www.statnews.com/2017/02/14/national-academy-crispr-report/\">concluded\u003c/a>.\u003c/p>\n\u003cp>Doudna acknowledges, however, that “it’s difficult to see how we’d do it equitably,” especially when the line between therapy and enhancement is paper thin: Some families might purchase a genetic legacy that gives them less need for sleep, greater endurance, extra-strong bones, leaner or larger muscles, lower risk of diabetes and Alzheimer’s, even less armpit odor — while other families muddle through with the genes nature gave them.\u003c/p>\n\u003cp>That threatens to “transcribe our societies’ financial inequality into our genetic code,” Doudna writes.\u003c/p>\n\u003cp>Her solution? “Redoubl[ing] our commitment to building a society in which all humans are respected and treated equally, regardless of their genetic makeup.”\u003c/p>\n\u003cp>\u003cem>Update, June 14: Doudna, whose office cancelled an interview with STAT before this story ran, said in an email that “positioning Martin Jinek’s role to your readers as above the work of Emmanuelle Charpentier is incorrect and unfair. Our work was conducted closely with Emmanuelle, whose contributions and insights including the role of tracrRNA in the DNA targeting complex were a key aspect of the development of CRISPR-Cas as a gene editing technology.”\u003c/em>\u003c/p>\n\u003cp>\u003cem>\u003cspan style=\"font-weight: 400\">This \u003ca href=\"https://www.statnews.com/2017/06/11/crispr-jennifer-doudna-book/\" target=\"_blank\" rel=\"noopener noreferrer\">story \u003c/a>was originally published by STAT, an online publication of Boston Globe Media that covers health, medicine, and scientific discovery. \u003c/span>\u003c/em>\u003c/p>\n\u003cp> \u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp> \u003c/p>\n\n",
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"excerpt": "In 'A Crack in Creation: Gene Editing and the Unthinkable Power to Control Evolution,' UC Berkeley's Jennifer Doudna says CRISPR could result in life-saving cures, woolly mammoths and unicorns.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>If there was one misstep that doomed the \u003ca href=\"https://www.statnews.com/2017/04/13/crispr-patent-uc-appeal/\">long and bitter fight\u003c/a> by the University of California to wrest key CRISPR patents from the Broad Institute, it was star UC Berkeley scientist Jennifer Doudna’s habit of being scientifically cautious, realistic, and averse to overpromising.\u003c/p>\n\u003cp>A biochemist who co-led a breakthrough \u003ca href=\"http://science.sciencemag.org/content/337/6096/816\" target=\"_blank\" rel=\"noopener noreferrer\">2012 study\u003c/a> of CRISPR-Cas9, Doudna repeatedly emphasized in interviews the challenges of repurposing the molecular system, which bacteria use to fend off viruses, to edit human genomes. The U.S. patent office, in a February \u003ca href=\"https://www.statnews.com/2017/02/15/crispr-patent-ruling/\">ruling\u003c/a> that let the Broad keep its CRISPR patents (for now), relied heavily on those statements — “We weren’t sure if CRISPR/Cas9 would work in … animal cells,” for example — to conclude that when scientists at the Broad \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3795411/\" target=\"_blank\" rel=\"noopener noreferrer\">CRISPR’d human cells\u003c/a> in 2013, it was a non-obvious advance and therefore deserving of patents.\u003c/p>\n\u003cp class=\"danger-zone\">So it’s striking that the careful, measured Doudna who said CRISPR’ing human cells and thereby curing devastating diseases would be a challenge is hardly in evidence in “A Crack in Creation: Gene Editing and the Unthinkable Power to Control Evolution,” the new book she co-authored with her former student Samuel Sternberg. It went on sale last week.\u003c/p>\n\u003cp class=\"danger-zone\">This Doudna doesn’t hold back. We are “on the cusp of a new age in genetic engineering and biological mastery,” she and Sternberg write, dangling the prospect of “life-changing treatments” and “lifesaving cures.” She says she is “not kidding” that CRISPR could bring about “woolly mammoths, winged lizards, and unicorns. … It won’t be long before CRISPR allows us to bend nature to our will.”\u003c/p>\n\u003cp class=\"danger-zone\">The hyperbole contrasts with CRISPR’s stumbles, including altering parts of genomes (in lab studies, not patients yet) it wasn’t supposed to. “I don’t think we’ll have a version of CRISPR that’s 100 percent perfect, so it comes down to a risk-benefit analysis,” Sternberg, a biochemist at \u003ca href=\"https://www.statnews.com/2016/06/22/rachel-haurwitz-crispr-caribou/\">Caribou Biosciences\u003c/a> (which Doudna co-founded), said in an interview. “There has been phenomenal progress in understanding off-target effects; I think it’s a solvable problem. … We have every reason to be optimistic but I hope we avoided overhyping and didn’t give the impression that there would be windfall of cures in the next couple of years.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>This is not a tell-all. The farthest Doudna goes in addressing the patent fight — a “disheartening twist” — is to say that because of such rivalries she experienced “the gamut of human relationships, from deep friendships to disturbing betrayals.” She doesn’t name the betrayers.\u003c/p>\n\u003cp>An early \u003ca href=\"https://www.nature.com/nature/journal/v546/n7656/full/546030a.html\" target=\"_blank\" rel=\"noopener noreferrer\">review\u003c/a> chastised Doudna for presenting herself as “so flawless” the book “seems more concealing than revealing,” not “insightful [and] candid.”\u003c/p>\n\u003cp>So what she does choose to reveal is fascinating, especially about her collaboration with Emmanuelle Charpentier. The two are so closely linked that all the prizes they’ve won for CRISPR, they’ve won together; among CRISPR watchers “Doudna and Charpentier” is virtually a macro.\u003c/p>\n\u003cp>But the book’s account of their breakthrough experiment showing that CRISPR could be programmed to edit a precise spot in a genome leaves a different impression. We read that “Martin [Jinek, Doudna’s postdoctoral fellow] showed” and “Martin labored tirelessly,” “Martin and I brainstormed” and “designed an experiment,” and when “Martin walked me through the data,” Doudna knew “we’d done it.”\u003c/p>\n\u003cp>That work was described in the 2012 paper, which is widely recognized — by prize committees, the European Patent Office, and many scientists — as the Bastille moment for the CRISPR revolution. It identified the three crucial molecules in the CRISPR system — one to cut, one to guide the cutting enzyme to its target DNA, one to activate the cutting enzyme — that produced a programmable DNA-cutting machine. “We had built the means to rewrite the code of life,” Doudna and Sternberg write. “Nothing after that would ever be the same.”\u003c/p>\n\u003cp>Although Doudna and her collaborators didn’t actually change genomes in cells — their CRISPR molecules altered cell-free DNA in test tubes — that was an obvious next step. How difficult a next step was the core dispute in the patent fight and one that she repeatedly cautioned was no slam dunk. But “Crack in Creation” says that doing so “was immediately clear to us,” and “there were good reasons to expect success.”\u003c/p>\n\u003cp>That contrasts with her cautious statements, cited by the patent office, at the time. When \u003ca href=\"https://www.statnews.com/2015/11/06/hollywood-inspired-scientist-rewrite-code-life/\">Feng Zhang\u003c/a> of the Broad Institute and \u003ca href=\"https://www.statnews.com/2017/06/08/george-church-narcolepsy/\">George Church\u003c/a> of Harvard used CRISPR to edit genes, it was “just as we had proposed in 2012,” according to the book. She was elated that her 2012 work “inspired others to pursue a line of experimentation similar to our own.”\u003c/p>\n\u003cp>Doudna became a public scientist — she’s given a \u003ca href=\"https://www.ted.com/talks/jennifer_doudna_we_can_now_edit_our_dna_but_let_s_do_it_wisely\" target=\"_blank\" rel=\"noopener noreferrer\">TED talk\u003c/a> and will appear on “Sunday Night with Megyn Kelly” — because of her research, but also because she was instrumental in getting the scientific community to focus on ethical issues it raises, especially about editing embryos in a way that would be inherited by future generations (“germline” editing). She writes that she had nightmares that a man asking her about this was Hitler and that she “began to feel a bit like Dr. Frankenstein.”\u003c/p>\n\u003cp>Her own moral journey is intriguing. She feels germline editing can be safe, and the “it’s unnatural!” argument “doesn’t carry much weight with me anymore,” she writes. “It seems to me that we’d be justified in using” CRISPR to eliminate genes that cause untold suffering, such as those for Huntington’s disease. “When I think about the pain that genetic diseases cause families, the stakes are simply too high to exclude the possibility of eventually using germline editing,” as an expert panel also \u003ca href=\"https://www.statnews.com/2017/02/14/national-academy-crispr-report/\">concluded\u003c/a>.\u003c/p>\n\u003cp>Doudna acknowledges, however, that “it’s difficult to see how we’d do it equitably,” especially when the line between therapy and enhancement is paper thin: Some families might purchase a genetic legacy that gives them less need for sleep, greater endurance, extra-strong bones, leaner or larger muscles, lower risk of diabetes and Alzheimer’s, even less armpit odor — while other families muddle through with the genes nature gave them.\u003c/p>\n\u003cp>That threatens to “transcribe our societies’ financial inequality into our genetic code,” Doudna writes.\u003c/p>\n\u003cp>Her solution? “Redoubl[ing] our commitment to building a society in which all humans are respected and treated equally, regardless of their genetic makeup.”\u003c/p>\n\u003cp>\u003cem>Update, June 14: Doudna, whose office cancelled an interview with STAT before this story ran, said in an email that “positioning Martin Jinek’s role to your readers as above the work of Emmanuelle Charpentier is incorrect and unfair. Our work was conducted closely with Emmanuelle, whose contributions and insights including the role of tracrRNA in the DNA targeting complex were a key aspect of the development of CRISPR-Cas as a gene editing technology.”\u003c/em>\u003c/p>\n\u003cp>\u003cem>\u003cspan style=\"font-weight: 400\">This \u003ca href=\"https://www.statnews.com/2017/06/11/crispr-jennifer-doudna-book/\" target=\"_blank\" rel=\"noopener noreferrer\">story \u003c/a>was originally published by STAT, an online publication of Boston Globe Media that covers health, medicine, and scientific discovery. \u003c/span>\u003c/em>\u003c/p>\n\u003cp> \u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"disqusTitle": "Silicon Valley's Toxic Past Haunts Sunnyvale Neighborhood",
"title": "Silicon Valley's Toxic Past Haunts Sunnyvale Neighborhood",
"headTitle": "KQED Future of You | KQED Science",
"content": "\u003cp>\u003cspan style=\"font-weight: 400\">Sunnyvale’s San Miguel neighborhood, with its leafy trees and modest houses, is home to hundreds of families and four schools for young children. Underneath these quiet streets lies a shadow of Silicon Valley’s past: groundwater contaminated with a solvent once used to make computer chips, and known to cause cancer and birth defects. \u003c/span>\u003c/p>\n\u003cp>That chemical, known as \u003ca href=\"https://www.epa.gov/assessing-and-managing-chemicals-under-tsca/trichloroethylene-tce\">trichloroethylene or TCE\u003c/a>, was as crucial to chipmakers in the 1960s and 1970s as yeast is to a bakery. TCE is a powerful solvent used to clean silicon wafers before the chip design is etched onto them. And it’s responsible for nearly half the federal Superfund sites in \u003ca href=\"https://en.wikipedia.org/wiki/List_of_Superfund_sites_in_California#Santa_Clara_County\">Santa Clara County\u003c/a>. These are areas the U.S. Environmental Protection Agency designates as the nation’s most toxic.\u003c/p>\n\u003cp>Santa Clara has 24 Superfund sites, according to former EPA regional director Jared Blumenfeld. The neighborhood of San Miguel is located within one of them.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">When TCE is present in groundwater, it can turn to vapor, seeping through cracks in building frames and into homes and classrooms. Short-term exposure can cause slowed breathing, light-headedness and headaches; over the longer term, TCE exposure causes cancer, particularly kidney cancer and \u003c/span>\u003cspan style=\"font-weight: 400\">non-Hodgkin lymphoma\u003c/span>\u003cspan style=\"font-weight: 400\">. And in 2011, a \u003c/span>\u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3339451/\">\u003cspan style=\"font-weight: 400\">study appeared to show \u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">that fetuses exposed to TCE in the first trimester have a higher risk of heart defects at birth. Socioeconomic differences could have influenced the results, though researchers tried to account for that.\u003c/span>\u003c/p>\n\u003cfigure id=\"attachment_388759\" class=\"wp-caption alignleft\" style=\"max-width: 378px\">\u003cimg class=\"wp-image-388759\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/05/10-Triple-Site-Map-page-0-800x1445.jpg\" alt=\"\" width=\"378\" height=\"683\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/05/10-Triple-Site-Map-page-0-800x1445.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2017/05/10-Triple-Site-Map-page-0-160x289.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/05/10-Triple-Site-Map-page-0-768x1387.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2017/05/10-Triple-Site-Map-page-0-1020x1842.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2017/05/10-Triple-Site-Map-page-0-960x1734.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2017/05/10-Triple-Site-Map-page-0-240x433.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/05/10-Triple-Site-Map-page-0-375x677.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/05/10-Triple-Site-Map-page-0-520x939.jpg 520w, https://ww2.kqed.org/app/uploads/sites/13/2017/05/10-Triple-Site-Map-page-0.jpg 1113w\" sizes=\"(max-width: 378px) 100vw, 378px\">\u003cfigcaption class=\"wp-caption-text\">Map of the Triple Site area in Sunnyvale, Calif. \u003ccite>(U.S. Environmental Protection Agency)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cb>Years of Contamination\u003c/b>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">A half-mile south of the San Miguel neighborhood is Lowe’s Home Improvement, built on the site where \u003c/span>\u003ca href=\"https://en.wikipedia.org/wiki/Signetics\">\u003cspan style=\"font-weight: 400\">Signetics Inc.\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">—which became \u003c/span>\u003ca href=\"http://www.usa.philips.com/\">\u003cspan style=\"font-weight: 400\">Philips Semiconductors\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> in 1975—left massive amounts of trichloroethylene in the soil and groundwater from nearly 30 years of chip manufacturing. Next to Lowe’s is a large, vacant dome of soil carpeted with dry grass.\u003c/span>\u003c/p>\n\u003cp>“Here’s where we have the highest concentrations of TCE,” says EPA site manager Melanie Morash, gesturing at the mound. This is essentially Ground Zero for what the EPA calls the Triple Site.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The Triple Site gets its name from the three chipmakers responsible for the contamination: Philips, \u003c/span>\u003ca href=\"http://www.amd.com/en/home\">\u003cspan style=\"font-weight: 400\">Advanced Micro Devices\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> and \u003c/span>\u003ca href=\"https://yosemite.epa.gov/r9/sfund/r9sfdocw.nsf/vwsoalphabetic/TRW+Microwave,+Inc.+(Building+825)\">\u003cspan style=\"font-weight: 400\">TRW Microwave\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">. In the 1960s and ‘70s, these companies stored TCE in underground tanks for later use. But the tanks and pipelines sometimes ruptured, leaking TCE into the soil and groundwater. It wasn’t until the 1980s, when the EPA launched its \u003c/span>\u003ca href=\"https://en.wikipedia.org/wiki/Superfund\">\u003cspan style=\"font-weight: 400\">Superfund program\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> to clean up the nation’s most toxic sites, that these properties began to get attention. By then, the TCE had spread through groundwater a mile to the north, underneath hundreds of homes and apartments and all four schools.\u003c/span>\u003c/p>\n\u003cp>\u003cb>Cleanup Begins\u003c/b>\u003c/p>\n\u003cp>In the early 1980s, the EPA worked with the manufacturers to clean up the toxic plume by excavating soil and treating the water. One method decontaminates the water by exposing it to ultraviolet light; the other oxygenates the water, releasing the TCE into the air, where it disperses. Although it isn’t ideal to make TCE airborne, it reduces concentrations enough that it isn’t a health risk to people, Blumenfeld said.\u003c/p>\n\u003cfigure id=\"attachment_410384\" class=\"wp-caption alignright\" style=\"max-width: 800px\">\u003ca href=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/06/6-melanie-dome.jpg\">\u003cimg class=\"size-medium wp-image-410384\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/06/6-melanie-dome-800x1067.jpg\" alt=\"EPA Triple Site site manager Melanie Morash at the dome of earth near the former Philips Semiconductor property, where TCE contamination is concentrated. \" width=\"800\" height=\"1067\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/06/6-melanie-dome-800x1067.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2017/06/6-melanie-dome-160x213.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/06/6-melanie-dome-768x1024.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2017/06/6-melanie-dome-1020x1360.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2017/06/6-melanie-dome-1920x2560.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2017/06/6-melanie-dome-1180x1573.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2017/06/6-melanie-dome-960x1280.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2017/06/6-melanie-dome-240x320.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/06/6-melanie-dome-375x500.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/06/6-melanie-dome-520x693.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">EPA Triple Site site manager Melanie Morash at the dome of earth near the former Philips Semiconductor property, where TCE contamination is concentrated. \u003ccite>(Beth Winegarner/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Across the street from Ground Zero, in the parking lot of Planet Granite, gym-goers breeze past a fenced-off cluster of machinery. The systems hum as they pump groundwater from beneath the soil, aerate the water to disperse toxic chemicals, and return the water to the aquifer. This is one of the Phillips treatment plants.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">In the early 2000s, AMD and TRW switched to \u003c/span>\u003ca href=\"http://news.stanford.edu/news/1997/april23/tce.html\">\u003cspan style=\"font-weight: 400\">a method pioneered at Stanford University\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> in which natural bacteria break down the TCE. The bacteria are fed molasses, lactose or vegetable oil to boost their population, creating enough microbes to transform TCE into harmless components, according to Michael Calhoun, a geologist with Haley & Aldrich Inc. and a consultant for AMD.\u003c/span>\u003c/p>\n\u003cp>Bioremediation has been successful for TRW and AMD. Philips—which is now responsible for the remaining cleanup at the Triple Site—held off, sticking to traditional methods. It wasn’t until 2016 that Philips began testing bioremediation.\u003c/p>\n\u003cp>Spokeswoman Silvie Casanova declined to comment on why Philips waited so long to try the method. It’s unclear whether it will work as well now.\u003c/p>\n\u003cp>“If you have a contaminant released into the ground and it sits there for a while, it can diffuse into the soil, and then it’s more difficult to get back out,” Calhoun said. “Even if you clean up the groundwater, it will continue to diffuse from the soil back into the water.”\u003c/p>\n\u003cfigure id=\"attachment_388757\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-388757\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/05/9-image-tester-in-classroom-800x600.jpg\" alt=\"\" width=\"800\" height=\"600\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/05/9-image-tester-in-classroom-800x600.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2017/05/9-image-tester-in-classroom-160x120.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/05/9-image-tester-in-classroom-768x576.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2017/05/9-image-tester-in-classroom-1020x766.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2017/05/9-image-tester-in-classroom-1180x886.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2017/05/9-image-tester-in-classroom-960x721.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2017/05/9-image-tester-in-classroom-240x180.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/05/9-image-tester-in-classroom-375x281.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/05/9-image-tester-in-classroom-520x390.jpg 520w, https://ww2.kqed.org/app/uploads/sites/13/2017/05/9-image-tester-in-classroom.jpg 1279w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Two air monitors inside a classroom at San Miguel Elementary School in Sunnyvale. The devices monitor inside buildings for signs of TCE vapor. They must be in place for at least 24 hours to get accurate results. \u003ccite>(Beth Winegarner/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cb>Fighting to Protect Public Health\u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">After the 2011 study revealed \u003c/span>\u003ca href=\"https://www.atsdr.cdc.gov/phs/phs.asp?id=171&tid=30\">\u003cspan style=\"font-weight: 400\">the risk for birth defects from TCE\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">, the EPA worked to update its process of notifying people about contamination. Previously, the agency tested buildings in Superfund zones quarterly, and then notified occupants of the results four to five months later, said former regional director Blumenfeld. But the risk to fetuses is highest in the first trimester, meaning pregnant women needed the information much sooner.\u003c/span>\u003c/p>\n\u003cp>[contextly_sidebar id=\"QIiBrV7DZWww9hv35669NPpPlzzmI7hs\"]Getting the agency to change was an uphill battle. Chipmakers hired lawyers to fight back. EPA headquarters in Washington D.C. told Blumenfeld to hold off because it was working on new national guidelines, but they never materialized, he said.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Blumenfeld eventually won. Under the \u003c/span>\u003ca href=\"https://yosemite.epa.gov/r9/sfund/r9sfdocw.nsf/3dc283e6c5d6056f88257426007417a2/6a24ed351efe25b888257d16007659e8/%24FILE/R9%20TCE%20Action%20Levels%20and%20Recs%20Memo%207_14.pdf\">\u003cspan style=\"font-weight: 400\">new notification requirements\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> adopted in 2014, the EPA is required to test air quality inside buildings vulnerable to TCE vapor, install mitigation measures “quickly” and retest to make sure they’re working. When exposures reach a certain level, those mitigations must happen immediately, and residents aren’t allowed back in until it’s safe.\u003c/span>\u003c/p>\n\u003cp>\u003cb>Knocking on Doors\u003c/b>\u003c/p>\n\u003cp>Doing all that testing, though, meant getting permission from property owners. The schools within the Triple Site complied quickly, but residents were another story. EPA workers, led by Morash and Alejandro Diaz, the EPA’s community involvement coordinator for the site, began going door-to-door to ask if they could test the air inside.\u003c/p>\n\u003cp>The San Miguel neighborhood includes mostly small, single-family homes with grassy front yards. Sprinkled among them are several modest-sized apartment buildings. During the day, the streets are quiet; almost nobody remains outside. The neighborhood is also extremely diverse, with large concentrations of Latino, Asian and South Asian residents. Diaz said the EPA did outreach in several languages, including Vietnamese, Tagalog, Punjabi and Urdu.\u003c/p>\n\u003cfigure id=\"attachment_410388\" class=\"wp-caption alignright\" style=\"max-width: 800px\">\u003ca href=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/06/3-Riser-pipe-and-fan-inside-the-box.jpg\">\u003cimg class=\"size-medium wp-image-410388\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/06/3-Riser-pipe-and-fan-inside-the-box-800x1067.jpg\" alt=\"This riser pipe and fan are part of a system that diverts TCE vapor from underneath a building to its roof, where it’s released into the air rather than going inside the building. \" width=\"800\" height=\"1067\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/06/3-Riser-pipe-and-fan-inside-the-box-800x1067.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2017/06/3-Riser-pipe-and-fan-inside-the-box-160x213.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/06/3-Riser-pipe-and-fan-inside-the-box-768x1024.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2017/06/3-Riser-pipe-and-fan-inside-the-box-1020x1360.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2017/06/3-Riser-pipe-and-fan-inside-the-box-1920x2560.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2017/06/3-Riser-pipe-and-fan-inside-the-box-1180x1573.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2017/06/3-Riser-pipe-and-fan-inside-the-box-960x1280.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2017/06/3-Riser-pipe-and-fan-inside-the-box-240x320.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/06/3-Riser-pipe-and-fan-inside-the-box-375x500.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/06/3-Riser-pipe-and-fan-inside-the-box-520x693.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">This riser pipe and fan are part of a\u003cbr>system that diverts TCE vapor from underneath a building to its roof, where it’s released into the air rather than going inside the building. \u003ccite>(EPA)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“The idea is to remove any barriers and make it the least scary possible,” he said.\u003c/p>\n\u003cp>Since early 2015, the team has knocked on more than 500 doors—every property in the Triple Site zone—and tested every school building. About 225 households have allowed testing. The team has detected concerning levels of TCE vapor in 55 households and 37 school buildings, Morash said. Buildings at Rainbow Montessori, San Miguel Elementary and King’s Academy all tested positive for TCE vapor; mitigation systems are in place in the schools now, and their air is monitored regularly.\u003c/p>\n\u003cp>About 30 properties, which include some 100 households, have refused air testing, Huitric said; those who said no haven’t told the team why. The EPA keeps in touch with the property owners, ready to act if they change their minds.\u003c/p>\n\u003cp>Shashi Jaggia, who has owned a 12-unit apartment building on Duane Avenue within the Triple Site zone since 1999, cooperated with the EPA when they came calling. Jaggia had no idea her tenants were being exposed to TCE until the EPA contacted her a couple of years ago. But she wasn’t surprised.\u003c/p>\n\u003cp>“I’m in the real estate business,” she said. “I know there’s lots of contamination in the groundwater in the area.”\u003c/p>\n\u003cp>During the first year after installing the systems, the EPA tests the air frequently to make sure levels remain safe. If they do, the tests are less frequent in following years. That’s the protocol for all properties in the Triple Site, Huitric said.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">For now, cleanup, testing and mitigation at the Triple Site is expected to continue indefinitely, until the TCE levels in both groundwater and indoor air are safe. President Donald Trump’s \u003c/span>\u003ca href=\"https://www.theatlantic.com/science/archive/2017/05/trump-epa-budget-noaa-climate-change/527814/\">\u003cspan style=\"font-weight: 400\">proposed budget\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> includes a 31.4 percent cut to the EPA, including $330 million in cuts to the Superfund program. Philips is bankrolling cleanup costs at the Triple Site, but other elements of the process could be in trouble, Blumenfeld said, including enforcement.\u003c/span>\u003c/p>\n\u003cp>“We’re not planning for anything until we know for a fact what’s happening,” said Caleb Shaffer, section chief for Superfund’s California Cleanup Section. “We can’t predict the future.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>UCSF's Maria Glymour contributed to this post.\u003c/em>\u003c/p>\n\n",
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"excerpt": "A toxic chemical, known as trichloroethylene, or TCE, was as crucial to chipmakers in the 1960s and 1970s as yeast is to a bakery. ",
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"description": "A toxic chemical, known as trichloroethylene, or TCE, was as crucial to chipmakers in the 1960s and 1970s as yeast is to a bakery. ",
"title": "Silicon Valley's Toxic Past Haunts Sunnyvale Neighborhood | KQED",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cspan style=\"font-weight: 400\">Sunnyvale’s San Miguel neighborhood, with its leafy trees and modest houses, is home to hundreds of families and four schools for young children. Underneath these quiet streets lies a shadow of Silicon Valley’s past: groundwater contaminated with a solvent once used to make computer chips, and known to cause cancer and birth defects. \u003c/span>\u003c/p>\n\u003cp>That chemical, known as \u003ca href=\"https://www.epa.gov/assessing-and-managing-chemicals-under-tsca/trichloroethylene-tce\">trichloroethylene or TCE\u003c/a>, was as crucial to chipmakers in the 1960s and 1970s as yeast is to a bakery. TCE is a powerful solvent used to clean silicon wafers before the chip design is etched onto them. And it’s responsible for nearly half the federal Superfund sites in \u003ca href=\"https://en.wikipedia.org/wiki/List_of_Superfund_sites_in_California#Santa_Clara_County\">Santa Clara County\u003c/a>. These are areas the U.S. Environmental Protection Agency designates as the nation’s most toxic.\u003c/p>\n\u003cp>Santa Clara has 24 Superfund sites, according to former EPA regional director Jared Blumenfeld. The neighborhood of San Miguel is located within one of them.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">When TCE is present in groundwater, it can turn to vapor, seeping through cracks in building frames and into homes and classrooms. Short-term exposure can cause slowed breathing, light-headedness and headaches; over the longer term, TCE exposure causes cancer, particularly kidney cancer and \u003c/span>\u003cspan style=\"font-weight: 400\">non-Hodgkin lymphoma\u003c/span>\u003cspan style=\"font-weight: 400\">. And in 2011, a \u003c/span>\u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3339451/\">\u003cspan style=\"font-weight: 400\">study appeared to show \u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">that fetuses exposed to TCE in the first trimester have a higher risk of heart defects at birth. Socioeconomic differences could have influenced the results, though researchers tried to account for that.\u003c/span>\u003c/p>\n\u003cfigure id=\"attachment_388759\" class=\"wp-caption alignleft\" style=\"max-width: 378px\">\u003cimg class=\"wp-image-388759\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/05/10-Triple-Site-Map-page-0-800x1445.jpg\" alt=\"\" width=\"378\" height=\"683\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/05/10-Triple-Site-Map-page-0-800x1445.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2017/05/10-Triple-Site-Map-page-0-160x289.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/05/10-Triple-Site-Map-page-0-768x1387.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2017/05/10-Triple-Site-Map-page-0-1020x1842.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2017/05/10-Triple-Site-Map-page-0-960x1734.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2017/05/10-Triple-Site-Map-page-0-240x433.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/05/10-Triple-Site-Map-page-0-375x677.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/05/10-Triple-Site-Map-page-0-520x939.jpg 520w, https://ww2.kqed.org/app/uploads/sites/13/2017/05/10-Triple-Site-Map-page-0.jpg 1113w\" sizes=\"(max-width: 378px) 100vw, 378px\">\u003cfigcaption class=\"wp-caption-text\">Map of the Triple Site area in Sunnyvale, Calif. \u003ccite>(U.S. Environmental Protection Agency)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cb>Years of Contamination\u003c/b>\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\">A half-mile south of the San Miguel neighborhood is Lowe’s Home Improvement, built on the site where \u003c/span>\u003ca href=\"https://en.wikipedia.org/wiki/Signetics\">\u003cspan style=\"font-weight: 400\">Signetics Inc.\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">—which became \u003c/span>\u003ca href=\"http://www.usa.philips.com/\">\u003cspan style=\"font-weight: 400\">Philips Semiconductors\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> in 1975—left massive amounts of trichloroethylene in the soil and groundwater from nearly 30 years of chip manufacturing. Next to Lowe’s is a large, vacant dome of soil carpeted with dry grass.\u003c/span>\u003c/p>\n\u003cp>“Here’s where we have the highest concentrations of TCE,” says EPA site manager Melanie Morash, gesturing at the mound. This is essentially Ground Zero for what the EPA calls the Triple Site.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The Triple Site gets its name from the three chipmakers responsible for the contamination: Philips, \u003c/span>\u003ca href=\"http://www.amd.com/en/home\">\u003cspan style=\"font-weight: 400\">Advanced Micro Devices\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> and \u003c/span>\u003ca href=\"https://yosemite.epa.gov/r9/sfund/r9sfdocw.nsf/vwsoalphabetic/TRW+Microwave,+Inc.+(Building+825)\">\u003cspan style=\"font-weight: 400\">TRW Microwave\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">. In the 1960s and ‘70s, these companies stored TCE in underground tanks for later use. But the tanks and pipelines sometimes ruptured, leaking TCE into the soil and groundwater. It wasn’t until the 1980s, when the EPA launched its \u003c/span>\u003ca href=\"https://en.wikipedia.org/wiki/Superfund\">\u003cspan style=\"font-weight: 400\">Superfund program\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> to clean up the nation’s most toxic sites, that these properties began to get attention. By then, the TCE had spread through groundwater a mile to the north, underneath hundreds of homes and apartments and all four schools.\u003c/span>\u003c/p>\n\u003cp>\u003cb>Cleanup Begins\u003c/b>\u003c/p>\n\u003cp>In the early 1980s, the EPA worked with the manufacturers to clean up the toxic plume by excavating soil and treating the water. One method decontaminates the water by exposing it to ultraviolet light; the other oxygenates the water, releasing the TCE into the air, where it disperses. Although it isn’t ideal to make TCE airborne, it reduces concentrations enough that it isn’t a health risk to people, Blumenfeld said.\u003c/p>\n\u003cfigure id=\"attachment_410384\" class=\"wp-caption alignright\" style=\"max-width: 800px\">\u003ca href=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/06/6-melanie-dome.jpg\">\u003cimg class=\"size-medium wp-image-410384\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/06/6-melanie-dome-800x1067.jpg\" alt=\"EPA Triple Site site manager Melanie Morash at the dome of earth near the former Philips Semiconductor property, where TCE contamination is concentrated. \" width=\"800\" height=\"1067\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/06/6-melanie-dome-800x1067.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2017/06/6-melanie-dome-160x213.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/06/6-melanie-dome-768x1024.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2017/06/6-melanie-dome-1020x1360.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2017/06/6-melanie-dome-1920x2560.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2017/06/6-melanie-dome-1180x1573.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2017/06/6-melanie-dome-960x1280.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2017/06/6-melanie-dome-240x320.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/06/6-melanie-dome-375x500.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/06/6-melanie-dome-520x693.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">EPA Triple Site site manager Melanie Morash at the dome of earth near the former Philips Semiconductor property, where TCE contamination is concentrated. \u003ccite>(Beth Winegarner/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Across the street from Ground Zero, in the parking lot of Planet Granite, gym-goers breeze past a fenced-off cluster of machinery. The systems hum as they pump groundwater from beneath the soil, aerate the water to disperse toxic chemicals, and return the water to the aquifer. This is one of the Phillips treatment plants.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">In the early 2000s, AMD and TRW switched to \u003c/span>\u003ca href=\"http://news.stanford.edu/news/1997/april23/tce.html\">\u003cspan style=\"font-weight: 400\">a method pioneered at Stanford University\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> in which natural bacteria break down the TCE. The bacteria are fed molasses, lactose or vegetable oil to boost their population, creating enough microbes to transform TCE into harmless components, according to Michael Calhoun, a geologist with Haley & Aldrich Inc. and a consultant for AMD.\u003c/span>\u003c/p>\n\u003cp>Bioremediation has been successful for TRW and AMD. Philips—which is now responsible for the remaining cleanup at the Triple Site—held off, sticking to traditional methods. It wasn’t until 2016 that Philips began testing bioremediation.\u003c/p>\n\u003cp>Spokeswoman Silvie Casanova declined to comment on why Philips waited so long to try the method. It’s unclear whether it will work as well now.\u003c/p>\n\u003cp>“If you have a contaminant released into the ground and it sits there for a while, it can diffuse into the soil, and then it’s more difficult to get back out,” Calhoun said. “Even if you clean up the groundwater, it will continue to diffuse from the soil back into the water.”\u003c/p>\n\u003cfigure id=\"attachment_388757\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-388757\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/05/9-image-tester-in-classroom-800x600.jpg\" alt=\"\" width=\"800\" height=\"600\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/05/9-image-tester-in-classroom-800x600.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2017/05/9-image-tester-in-classroom-160x120.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/05/9-image-tester-in-classroom-768x576.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2017/05/9-image-tester-in-classroom-1020x766.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2017/05/9-image-tester-in-classroom-1180x886.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2017/05/9-image-tester-in-classroom-960x721.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2017/05/9-image-tester-in-classroom-240x180.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/05/9-image-tester-in-classroom-375x281.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/05/9-image-tester-in-classroom-520x390.jpg 520w, https://ww2.kqed.org/app/uploads/sites/13/2017/05/9-image-tester-in-classroom.jpg 1279w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Two air monitors inside a classroom at San Miguel Elementary School in Sunnyvale. The devices monitor inside buildings for signs of TCE vapor. They must be in place for at least 24 hours to get accurate results. \u003ccite>(Beth Winegarner/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cb>Fighting to Protect Public Health\u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">After the 2011 study revealed \u003c/span>\u003ca href=\"https://www.atsdr.cdc.gov/phs/phs.asp?id=171&tid=30\">\u003cspan style=\"font-weight: 400\">the risk for birth defects from TCE\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">, the EPA worked to update its process of notifying people about contamination. Previously, the agency tested buildings in Superfund zones quarterly, and then notified occupants of the results four to five months later, said former regional director Blumenfeld. But the risk to fetuses is highest in the first trimester, meaning pregnant women needed the information much sooner.\u003c/span>\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>Getting the agency to change was an uphill battle. Chipmakers hired lawyers to fight back. EPA headquarters in Washington D.C. told Blumenfeld to hold off because it was working on new national guidelines, but they never materialized, he said.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Blumenfeld eventually won. Under the \u003c/span>\u003ca href=\"https://yosemite.epa.gov/r9/sfund/r9sfdocw.nsf/3dc283e6c5d6056f88257426007417a2/6a24ed351efe25b888257d16007659e8/%24FILE/R9%20TCE%20Action%20Levels%20and%20Recs%20Memo%207_14.pdf\">\u003cspan style=\"font-weight: 400\">new notification requirements\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> adopted in 2014, the EPA is required to test air quality inside buildings vulnerable to TCE vapor, install mitigation measures “quickly” and retest to make sure they’re working. When exposures reach a certain level, those mitigations must happen immediately, and residents aren’t allowed back in until it’s safe.\u003c/span>\u003c/p>\n\u003cp>\u003cb>Knocking on Doors\u003c/b>\u003c/p>\n\u003cp>Doing all that testing, though, meant getting permission from property owners. The schools within the Triple Site complied quickly, but residents were another story. EPA workers, led by Morash and Alejandro Diaz, the EPA’s community involvement coordinator for the site, began going door-to-door to ask if they could test the air inside.\u003c/p>\n\u003cp>The San Miguel neighborhood includes mostly small, single-family homes with grassy front yards. Sprinkled among them are several modest-sized apartment buildings. During the day, the streets are quiet; almost nobody remains outside. The neighborhood is also extremely diverse, with large concentrations of Latino, Asian and South Asian residents. Diaz said the EPA did outreach in several languages, including Vietnamese, Tagalog, Punjabi and Urdu.\u003c/p>\n\u003cfigure id=\"attachment_410388\" class=\"wp-caption alignright\" style=\"max-width: 800px\">\u003ca href=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/06/3-Riser-pipe-and-fan-inside-the-box.jpg\">\u003cimg class=\"size-medium wp-image-410388\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/06/3-Riser-pipe-and-fan-inside-the-box-800x1067.jpg\" alt=\"This riser pipe and fan are part of a system that diverts TCE vapor from underneath a building to its roof, where it’s released into the air rather than going inside the building. \" width=\"800\" height=\"1067\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/06/3-Riser-pipe-and-fan-inside-the-box-800x1067.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2017/06/3-Riser-pipe-and-fan-inside-the-box-160x213.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/06/3-Riser-pipe-and-fan-inside-the-box-768x1024.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2017/06/3-Riser-pipe-and-fan-inside-the-box-1020x1360.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2017/06/3-Riser-pipe-and-fan-inside-the-box-1920x2560.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2017/06/3-Riser-pipe-and-fan-inside-the-box-1180x1573.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2017/06/3-Riser-pipe-and-fan-inside-the-box-960x1280.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2017/06/3-Riser-pipe-and-fan-inside-the-box-240x320.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/06/3-Riser-pipe-and-fan-inside-the-box-375x500.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/06/3-Riser-pipe-and-fan-inside-the-box-520x693.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">This riser pipe and fan are part of a\u003cbr>system that diverts TCE vapor from underneath a building to its roof, where it’s released into the air rather than going inside the building. \u003ccite>(EPA)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“The idea is to remove any barriers and make it the least scary possible,” he said.\u003c/p>\n\u003cp>Since early 2015, the team has knocked on more than 500 doors—every property in the Triple Site zone—and tested every school building. About 225 households have allowed testing. The team has detected concerning levels of TCE vapor in 55 households and 37 school buildings, Morash said. Buildings at Rainbow Montessori, San Miguel Elementary and King’s Academy all tested positive for TCE vapor; mitigation systems are in place in the schools now, and their air is monitored regularly.\u003c/p>\n\u003cp>About 30 properties, which include some 100 households, have refused air testing, Huitric said; those who said no haven’t told the team why. The EPA keeps in touch with the property owners, ready to act if they change their minds.\u003c/p>\n\u003cp>Shashi Jaggia, who has owned a 12-unit apartment building on Duane Avenue within the Triple Site zone since 1999, cooperated with the EPA when they came calling. Jaggia had no idea her tenants were being exposed to TCE until the EPA contacted her a couple of years ago. But she wasn’t surprised.\u003c/p>\n\u003cp>“I’m in the real estate business,” she said. “I know there’s lots of contamination in the groundwater in the area.”\u003c/p>\n\u003cp>During the first year after installing the systems, the EPA tests the air frequently to make sure levels remain safe. If they do, the tests are less frequent in following years. That’s the protocol for all properties in the Triple Site, Huitric said.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">For now, cleanup, testing and mitigation at the Triple Site is expected to continue indefinitely, until the TCE levels in both groundwater and indoor air are safe. President Donald Trump’s \u003c/span>\u003ca href=\"https://www.theatlantic.com/science/archive/2017/05/trump-epa-budget-noaa-climate-change/527814/\">\u003cspan style=\"font-weight: 400\">proposed budget\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> includes a 31.4 percent cut to the EPA, including $330 million in cuts to the Superfund program. Philips is bankrolling cleanup costs at the Triple Site, but other elements of the process could be in trouble, Blumenfeld said, including enforcement.\u003c/span>\u003c/p>\n\u003cp>“We’re not planning for anything until we know for a fact what’s happening,” said Caleb Shaffer, section chief for Superfund’s California Cleanup Section. “We can’t predict the future.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"disqusTitle": "Inhalers Plus Smartphones Meant Fewer Trips to ER, Hospital",
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"content": "\u003cp>Asthma attacks come with little warning and are often triggered by invisible particles in the air. Now, thanks to advances in Bluetooth technology, smartphones have become the newest weapon in the fight against asthma.\u003c/p>\n\u003caside class=\"pullquote alignright\">In one study, asthma-related hospitalizations dropped from 1.9 to 0 among 330 patients using the sensor. These patients also had 60 percent fewer asthma-related ER visits.\u003c/aside>\n\u003cp>Propeller Health, a Wisconsin-based company, \u003ca href=\"http://propellerhealth.com/\" target=\"_blank\" rel=\"noopener noreferrer\">wants to help\u003c/a> those with respiratory problems by supplementing medicine with technology. The firm has wired an inhaler with a Bluetooth transmitter to communicate with an asthma patient’s smartphone. This sensor activates when the inhaler is pressed, setting into motion a process that records the exact time and location of a patient’s asthma attack on a smartphone app. Doctors can view this data and see, not only how frequently the patient suffers attacks, but also tease apart the environmental factors that caused the distress.\u003c/p>\n\u003cp>“We see firsthand the value of collecting data, and so we see this as being the clear future of health care,” said Chris Hogg, the COO of Propeller Health. “[This technology] helps health care providers prioritize patients. With all the information coming off of the connected devices, [doctors] can really see who should be focused on.”\u003c/p>\n\u003cp>https://www.youtube.com/watch?v=KoQZS36CJzc\u003c/p>\n\u003cp>Smart inhalers are part of an emerging trend in medical technology known as “connected health.” Major tech firms have introduced ventures like Apple Health, a part of the iOS operating system that groups together biometric data recorded by apps and accessories. Meanwhile, medical equipment firms are installing internet connections on their devices, such as Continuous Positive Airway Pressure sleep machines, glucose meters and blood pressure monitors.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The Propeller sensor also sets out to manage medication schedules. On average, less than 50 percent of asthma patients take their medicine correctly, said Linda Neuhauser, a professor at University of California, Berkeley who researches asthma treatments.\u003c/p>\n\u003cp>[contextly_sidebar id=\"2J9aoXruEvErjns0VhyDOoSveLi92vLi\"]\"The inhaler tells you, and your health care provider, maybe your parent, if you’ve taken your medication today correctly,” Neuhauser continued. “We know that if you take it correctly, you can avoid an attack, going to the emergency department, or being hospitalized.”\u003c/p>\n\u003cp>A study conducted by Propeller and Dignity Health, a California hospital system, found that asthma-related hospitalizations dropped from 1.9 to 0 among 330 patients who had attached the sensor to their inhaler during an 11-month period. These participants also experienced 60 percent fewer asthma-related ER visits.\u003c/p>\n\u003cp>“There’s a community aspect to collecting data like this. When we have a lot of users in the same town, or same region, we can do a lot to help them,” Hogg said. “We start to see hot spots and trends over time.”\u003c/p>\n\u003cp>One of Propeller’s biggest tests of their system was in Louisville, Kentucky, where they gave 140 asthmatic individuals sensors for their inhaler, and they recorded 5,600 uses over two years. The study found that proximity to railroads and utilities were the two major causes of asthma attacks, but they also found that public common areas, such as schools and places of worship were also full of asthma triggers. After the test, Propeller gave the data to the city,\u003c/p>\n\u003cp>“They’re now making policy changes to improve emissions standards and clean the air, Hogg said.\u003c/p>\n\u003cp>It’s not cheap though. A standard albuterol inhaler costs $5 to $60, while the Propeller sensor has a unit cost of approximately $300. And while most connected health devices can be easily purchased online, the Propeller sensor is only available through a handful of health plans and sponsors. It is typically prescribed by a doctor.\u003c/p>\n\u003cp>Air quality monitors are another technological tool in the fight against asthma. One brand, Speck, has been used to research the causes of asthma attacks in the home.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“The Speck monitor measures indoor air quality, and this is the first time that parents, and older children, have had an opportunity to get feedback about the air quality inside their homes,” Neuhauser said. “Otherwise you just do what you think is good, and you just hope you’re reducing the allergens and irritants that might trigger asthma.”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The Propeller sensor also sets out to manage medication schedules. On average, less than 50 percent of asthma patients take their medicine correctly, said Linda Neuhauser, a professor at University of California, Berkeley who researches asthma treatments.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\"The inhaler tells you, and your health care provider, maybe your parent, if you’ve taken your medication today correctly,” Neuhauser continued. “We know that if you take it correctly, you can avoid an attack, going to the emergency department, or being hospitalized.”\u003c/p>\n\u003cp>A study conducted by Propeller and Dignity Health, a California hospital system, found that asthma-related hospitalizations dropped from 1.9 to 0 among 330 patients who had attached the sensor to their inhaler during an 11-month period. These participants also experienced 60 percent fewer asthma-related ER visits.\u003c/p>\n\u003cp>“There’s a community aspect to collecting data like this. When we have a lot of users in the same town, or same region, we can do a lot to help them,” Hogg said. “We start to see hot spots and trends over time.”\u003c/p>\n\u003cp>One of Propeller’s biggest tests of their system was in Louisville, Kentucky, where they gave 140 asthmatic individuals sensors for their inhaler, and they recorded 5,600 uses over two years. The study found that proximity to railroads and utilities were the two major causes of asthma attacks, but they also found that public common areas, such as schools and places of worship were also full of asthma triggers. After the test, Propeller gave the data to the city,\u003c/p>\n\u003cp>“They’re now making policy changes to improve emissions standards and clean the air, Hogg said.\u003c/p>\n\u003cp>It’s not cheap though. A standard albuterol inhaler costs $5 to $60, while the Propeller sensor has a unit cost of approximately $300. And while most connected health devices can be easily purchased online, the Propeller sensor is only available through a handful of health plans and sponsors. It is typically prescribed by a doctor.\u003c/p>\n\u003cp>Air quality monitors are another technological tool in the fight against asthma. One brand, Speck, has been used to research the causes of asthma attacks in the home.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“The Speck monitor measures indoor air quality, and this is the first time that parents, and older children, have had an opportunity to get feedback about the air quality inside their homes,” Neuhauser said. “Otherwise you just do what you think is good, and you just hope you’re reducing the allergens and irritants that might trigger asthma.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"soldout": {
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