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"disqusTitle": "Researchers Hunt for a Link Between Microbiome and Autism",
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"content": "\u003cp>Maude Magali David and Christine Tataru work in a neat and clean office. Sitting on bright pink exercise balls, the research duo analyzes data, occasionally standing to write on a whiteboard.\u003c/p>\n\u003cp>The tidy setting belies the nature of the less-than-sanitary subject of their work.\u003c/p>\n\u003caside class=\"pullquote alignright\">For now, research into a link between the microbiome and autism is 'at a stage where more questions than answers are being generated.'\u003c/aside>\n\u003cp>David and Tataru are interested in poop. Specifically, they’re interested in the microbial life living in the poop of children. If they learn enough about those microbes, they hope, they will find similarities and differences between the gut-life of kids who have autism and those who don’t. And that could change therapeutic approaches to treating autism spectrum disorder.\u003c/p>\n\u003cp>David runs the \u003ca href=\"https://microbiome.stanford.edu/\" target=\"_blank\">Autism Microbiome \u003c/a>project at the Stanford University School of Medicine's \u003ca href=\"http://wall-lab.stanford.edu/\" target=\"_blank\">Wall Lab\u003c/a>, along with the lab's principal investigator, Dennis Wall. In the past several years, interest in the microbiome—bacteria, fungi and \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4500141/\" target=\"_blank\"> other single-celled organisms \u003c/a>living on and within our bodies—has surged. These microbes were once considered either benign or dangerous\u003cstrong>, \u003c/strong>causing illness and disease\u003cstrong>. \u003c/strong>But we now know they also play a huge role in maintaining our health.\u003c/p>\n\u003cp>\u003cstrong>Gut Bugs Are Hot\u003c/strong>\u003c/p>\n\u003cfigure id=\"attachment_256705\" class=\"wp-caption alignright\" style=\"max-width: 450px\">\u003ca href=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/10/kids.jpg\">\u003cimg class=\"size-medium wp-image-256705\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/10/kids-450x600.jpg\" alt=\"Kim and her son Jake, who has autism spectrum disorder, in a family photo. The family is participating in a study searching for links between microbiomes and autism spectrum disorder.\" width=\"450\" height=\"600\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2016/10/kids-450x600.jpg 450w, https://ww2.kqed.org/app/uploads/sites/13/2016/10/kids-400x533.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2016/10/kids-768x1024.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2016/10/kids-885x1180.jpg 885w, https://ww2.kqed.org/app/uploads/sites/13/2016/10/kids.jpg 960w\" sizes=\"(max-width: 450px) 100vw, 450px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Kim and her son Jake, who has autism spectrum disorder, in a family photo. The family is participating in a study searching for links between microbiomes and autism spectrum disorder.\u003c/figcaption>\u003c/figure>\n\u003cp>The shift in perspective has been dramatic. Gut bugs are now \u003ca href=\"http://learn.genetics.utah.edu/content/microbiome/friends/\" target=\"_blank\">credited as being instrumental\u003c/a> in a host of critical processes: extracting food nutrients, developing organ systems, producing vitamins and training the immune system to behave properly. They have even been found to help regulate blood pressure.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>This spring the White House announced a \u003ca href=\"https://www.whitehouse.gov/blog/2016/05/13/announcing-national-microbiome-initiative\" target=\"_blank\">major new initiative \u003c/a>to coordinate the study of these all-important bugs, including \u003ca href=\"https://www.whitehouse.gov/the-press-office/2016/05/12/fact-sheet-announcing-national-microbiome-initiative\" target=\"_blank\">funding \u003c/a>of about a half-billion dollars from the federal government and scores of universities, nonprofits and business.\u003c/p>\n\u003cp>\"The microbiome is the hot thing to study now,\" says Kevin Becker, a researcher at the National Institutes of Health. \"But I think that's exciting; the research is very robust.\"\u003c/p>\n\u003cp>\u003cstrong>Link to Autism\u003c/strong>\u003c/p>\n\u003cp>In 2007, Becker was the first researcher to suggest that the microbiome \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2048743/\" target=\"_blank\">might be connected \u003c/a>to symptoms of autism spectrum disorder. In the decade since, researchers have \u003ca href=\"http://pediatrics.aappublications.org/content/133/5/872.short\" target=\"_blank\">accumulated more evidence\u003c/a> that the gastrointestinal tracts of children with ASD are \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3564498/\" target=\"_blank\">often different\u003c/a>. Depending on the survey, 60 to 90 percent have irritable bowel syndrome or have complained of diarrhea, stomachaches or gluten intolerance, which inflames the gut. For example, a \u003ca href=\"http://journals.lww.com/jrnldbp/Abstract/2006/04002/Frequency_of_Gastrointestinal_Symptoms_in_Children.11.aspx\" target=\"_blank\"> study of 150 children\u003c/a> published in 2006 found that 70 percent of kids with ASD suffered from gastrointestinal woes, compared to 42 percent of developmentally disabled children and 28 percent of children with no developmental disorder.\u003c/p>\n\u003cp>A \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3897394/\" target=\"_blank\">study published in \u003c/a>\u003cem>Cell \u003c/em>in 2013 studied lab mice with ASD-like symptoms, such as avoiding social interaction and compulsive and repetitive behavior\u003cstrong>.\u003c/strong> Remarkably, after subjecting the mice to the human \u003cem>Bacteroides fragilis, \u003c/em>the researchers noted the mice became less anxious and more social. The findings, wrote the authors, \"support a gut-microbiome-brain connection in ASD and identify a potential probiotic therapy for GI and behavioral symptoms of autism.\"\u003c/p>\n\u003cp>\"I read that and thought, 'OK there is something going on here!'\" says David. \"We just need a study with sufficient power to figure out what's going on in humans.\"\u003c/p>\n\u003cp>A few months later she began working with Wall, an autism and bioinformatics expert, on a project that would answer a key question: What is the connection between bacteria in the gut and autism in children?\u003c/p>\n\u003cp>The researchers reached out through social media for families with at least two children under eight who eat the same things but who differ in that at least one is free of ASD. The families—280 have signed up thus far—send in a two- to three-minute video of their kids, saliva and stool samples, and answers to a questionnaire about behavior and diet. In return, the families will receive the results (which the team cautions should not be used for diagnosis).\u003c/p>\n\u003cp>By sampling kids from the same families, the researchers are able to control for some of the factors that contribute to differences in children's gut flora\u003cstrong>, \u003c/strong>such as diet and home environment. Because the study allows for participation by subjects who never have to leave their homes, it has attracted more participants than is typical of such studies.\u003c/p>\n\u003cp>\u003cstrong>At Home With Autism\u003c/strong>\u003c/p>\n\u003cp>One family in the study lives in Pittsburgh. Kim is a busy mother whose days pass in a whirl. She has three five-year-olds: triplets Allie, Hunter and Jake. The kids love playing hide-and-seek. Allie likes dolls and princesses. If anything happens to upset her brothers, she becomes protective. Hunter likes superheroes, and Jake is into cars and trains.\u003c/p>\n\u003cp>\"Jake is the wild man,\" says Kim. \"He just wants to run and see what trouble he can get into.\"\u003c/p>\n\u003cp>Jake is the only one of the siblings with autism. And practically since birth, his mom says, he's had more stomachaches and gastrointestinal problems.\u003c/p>\n\u003cp>Even before participating in the autism study, Kim took steps to improve Jake's diet and gut health, which she believes have helped his symptoms. With fewer intestinal woes, Jake became calmer, less aggressive and more cheerful, she says.\u003c/p>\n\u003cp>When she came across a notice for the \u003ca href=\"https://microbiome.stanford.edu/\" target=\"_blank\">Autism Microbiome \u003c/a>project on Facebook, she was immediately intrigued. She appreciated the change in focus from most of the research on the disorder.\u003c/p>\n\u003cp>\"I think it's really ahead of the times,\" she says. \"A lot of people look at autism and think of it as a psychological disease, and I think of it as more medical. So anything that supports the medical community looking at autism research in a different way, I want to be part of.\"\u003c/p>\n\u003cp>After she signed up, filled out the questionnaire and sent in the requested videos, a sampling kit arrived at her door a few weeks later.\u003c/p>\n\u003cp>\"My hope is that this is going to be a way to help children in the future,\" she says.\u003c/p>\n\u003cp>\u003cstrong>'A Bit More Complex'\u003c/strong>\u003c/p>\n\u003cp>Now that enough samples have been returned from families like Kim's, researchers at the Wall lab have started looking at the early results.\u003c/p>\n\u003cp>In the first phase of their work, David, Tataru, Wall and a fourth member of the team, clinical coordinator Jena Daniels, are analyzing sequences from the stool samples and looking for similarities and differences in what bacteria are present, how abundant they are and what the community of gut bacteria look like.\u003c/p>\n\u003cp>\"We were hoping to find something clear and simple, such as \u003cem>this\u003c/em> bacteria signals autism\" says Tataru. \"Turns out, it's a bit more complex than we were expecting.\"\u003c/p>\n\u003cp>There are no immediately clear distinctions by type or number between the microbiomes of children with autism and those without. The researchers are, however, detecting some subtle differences. Kids within families are the most similar to each other. But kids with ASD in different families have microbiomes that are more alike than the microbiomes of non-autistic children in different families.\u003c/p>\n\u003cp>It's an interesting finding, even if the researchers are not sure what to make of it yet. As a 2014 review of the emerging data on the subject said, “The field is at a stage where more questions than answers are being generated.” And even some leading scientists involved in microbiome research have \u003ca href=\"http://www.nytimes.com/2015/06/28/magazine/can-the-bacteria-in-your-gut-explain-your-mood.html\" target=\"_blank\">cautioned\u003c/a> patients and their families not to get ahead of the research in looking for easy answers.\u003c/p>\n\u003cp>But for scientists like Kevin Becker at the NIH, who is not involved in the project, the turn toward the microbiome in researching ASD is a positive development. \"Genetics has been the focus for a long time and it often dominates the discussion,\" he says. \"Most autistic cases have no known genetic cause. Looking into these other paths is a welcome change.\"\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>The Autism Microbiome project plans to submit its first research paper for publication next month.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Maude Magali David and Christine Tataru work in a neat and clean office. Sitting on bright pink exercise balls, the research duo analyzes data, occasionally standing to write on a whiteboard.\u003c/p>\n\u003cp>The tidy setting belies the nature of the less-than-sanitary subject of their work.\u003c/p>\n\u003caside class=\"pullquote alignright\">For now, research into a link between the microbiome and autism is 'at a stage where more questions than answers are being generated.'\u003c/aside>\n\u003cp>David and Tataru are interested in poop. Specifically, they’re interested in the microbial life living in the poop of children. If they learn enough about those microbes, they hope, they will find similarities and differences between the gut-life of kids who have autism and those who don’t. And that could change therapeutic approaches to treating autism spectrum disorder.\u003c/p>\n\u003cp>David runs the \u003ca href=\"https://microbiome.stanford.edu/\" target=\"_blank\">Autism Microbiome \u003c/a>project at the Stanford University School of Medicine's \u003ca href=\"http://wall-lab.stanford.edu/\" target=\"_blank\">Wall Lab\u003c/a>, along with the lab's principal investigator, Dennis Wall. In the past several years, interest in the microbiome—bacteria, fungi and \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4500141/\" target=\"_blank\"> other single-celled organisms \u003c/a>living on and within our bodies—has surged. These microbes were once considered either benign or dangerous\u003cstrong>, \u003c/strong>causing illness and disease\u003cstrong>. \u003c/strong>But we now know they also play a huge role in maintaining our health.\u003c/p>\n\u003cp>\u003cstrong>Gut Bugs Are Hot\u003c/strong>\u003c/p>\n\u003cfigure id=\"attachment_256705\" class=\"wp-caption alignright\" style=\"max-width: 450px\">\u003ca href=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/10/kids.jpg\">\u003cimg class=\"size-medium wp-image-256705\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/10/kids-450x600.jpg\" alt=\"Kim and her son Jake, who has autism spectrum disorder, in a family photo. The family is participating in a study searching for links between microbiomes and autism spectrum disorder.\" width=\"450\" height=\"600\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2016/10/kids-450x600.jpg 450w, https://ww2.kqed.org/app/uploads/sites/13/2016/10/kids-400x533.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2016/10/kids-768x1024.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2016/10/kids-885x1180.jpg 885w, https://ww2.kqed.org/app/uploads/sites/13/2016/10/kids.jpg 960w\" sizes=\"(max-width: 450px) 100vw, 450px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Kim and her son Jake, who has autism spectrum disorder, in a family photo. The family is participating in a study searching for links between microbiomes and autism spectrum disorder.\u003c/figcaption>\u003c/figure>\n\u003cp>The shift in perspective has been dramatic. Gut bugs are now \u003ca href=\"http://learn.genetics.utah.edu/content/microbiome/friends/\" target=\"_blank\">credited as being instrumental\u003c/a> in a host of critical processes: extracting food nutrients, developing organ systems, producing vitamins and training the immune system to behave properly. They have even been found to help regulate blood pressure.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>This spring the White House announced a \u003ca href=\"https://www.whitehouse.gov/blog/2016/05/13/announcing-national-microbiome-initiative\" target=\"_blank\">major new initiative \u003c/a>to coordinate the study of these all-important bugs, including \u003ca href=\"https://www.whitehouse.gov/the-press-office/2016/05/12/fact-sheet-announcing-national-microbiome-initiative\" target=\"_blank\">funding \u003c/a>of about a half-billion dollars from the federal government and scores of universities, nonprofits and business.\u003c/p>\n\u003cp>\"The microbiome is the hot thing to study now,\" says Kevin Becker, a researcher at the National Institutes of Health. \"But I think that's exciting; the research is very robust.\"\u003c/p>\n\u003cp>\u003cstrong>Link to Autism\u003c/strong>\u003c/p>\n\u003cp>In 2007, Becker was the first researcher to suggest that the microbiome \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2048743/\" target=\"_blank\">might be connected \u003c/a>to symptoms of autism spectrum disorder. In the decade since, researchers have \u003ca href=\"http://pediatrics.aappublications.org/content/133/5/872.short\" target=\"_blank\">accumulated more evidence\u003c/a> that the gastrointestinal tracts of children with ASD are \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3564498/\" target=\"_blank\">often different\u003c/a>. Depending on the survey, 60 to 90 percent have irritable bowel syndrome or have complained of diarrhea, stomachaches or gluten intolerance, which inflames the gut. For example, a \u003ca href=\"http://journals.lww.com/jrnldbp/Abstract/2006/04002/Frequency_of_Gastrointestinal_Symptoms_in_Children.11.aspx\" target=\"_blank\"> study of 150 children\u003c/a> published in 2006 found that 70 percent of kids with ASD suffered from gastrointestinal woes, compared to 42 percent of developmentally disabled children and 28 percent of children with no developmental disorder.\u003c/p>\n\u003cp>A \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3897394/\" target=\"_blank\">study published in \u003c/a>\u003cem>Cell \u003c/em>in 2013 studied lab mice with ASD-like symptoms, such as avoiding social interaction and compulsive and repetitive behavior\u003cstrong>.\u003c/strong> Remarkably, after subjecting the mice to the human \u003cem>Bacteroides fragilis, \u003c/em>the researchers noted the mice became less anxious and more social. The findings, wrote the authors, \"support a gut-microbiome-brain connection in ASD and identify a potential probiotic therapy for GI and behavioral symptoms of autism.\"\u003c/p>\n\u003cp>\"I read that and thought, 'OK there is something going on here!'\" says David. \"We just need a study with sufficient power to figure out what's going on in humans.\"\u003c/p>\n\u003cp>A few months later she began working with Wall, an autism and bioinformatics expert, on a project that would answer a key question: What is the connection between bacteria in the gut and autism in children?\u003c/p>\n\u003cp>The researchers reached out through social media for families with at least two children under eight who eat the same things but who differ in that at least one is free of ASD. The families—280 have signed up thus far—send in a two- to three-minute video of their kids, saliva and stool samples, and answers to a questionnaire about behavior and diet. In return, the families will receive the results (which the team cautions should not be used for diagnosis).\u003c/p>\n\u003cp>By sampling kids from the same families, the researchers are able to control for some of the factors that contribute to differences in children's gut flora\u003cstrong>, \u003c/strong>such as diet and home environment. Because the study allows for participation by subjects who never have to leave their homes, it has attracted more participants than is typical of such studies.\u003c/p>\n\u003cp>\u003cstrong>At Home With Autism\u003c/strong>\u003c/p>\n\u003cp>One family in the study lives in Pittsburgh. Kim is a busy mother whose days pass in a whirl. She has three five-year-olds: triplets Allie, Hunter and Jake. The kids love playing hide-and-seek. Allie likes dolls and princesses. If anything happens to upset her brothers, she becomes protective. Hunter likes superheroes, and Jake is into cars and trains.\u003c/p>\n\u003cp>\"Jake is the wild man,\" says Kim. \"He just wants to run and see what trouble he can get into.\"\u003c/p>\n\u003cp>Jake is the only one of the siblings with autism. And practically since birth, his mom says, he's had more stomachaches and gastrointestinal problems.\u003c/p>\n\u003cp>Even before participating in the autism study, Kim took steps to improve Jake's diet and gut health, which she believes have helped his symptoms. With fewer intestinal woes, Jake became calmer, less aggressive and more cheerful, she says.\u003c/p>\n\u003cp>When she came across a notice for the \u003ca href=\"https://microbiome.stanford.edu/\" target=\"_blank\">Autism Microbiome \u003c/a>project on Facebook, she was immediately intrigued. She appreciated the change in focus from most of the research on the disorder.\u003c/p>\n\u003cp>\"I think it's really ahead of the times,\" she says. \"A lot of people look at autism and think of it as a psychological disease, and I think of it as more medical. So anything that supports the medical community looking at autism research in a different way, I want to be part of.\"\u003c/p>\n\u003cp>After she signed up, filled out the questionnaire and sent in the requested videos, a sampling kit arrived at her door a few weeks later.\u003c/p>\n\u003cp>\"My hope is that this is going to be a way to help children in the future,\" she says.\u003c/p>\n\u003cp>\u003cstrong>'A Bit More Complex'\u003c/strong>\u003c/p>\n\u003cp>Now that enough samples have been returned from families like Kim's, researchers at the Wall lab have started looking at the early results.\u003c/p>\n\u003cp>In the first phase of their work, David, Tataru, Wall and a fourth member of the team, clinical coordinator Jena Daniels, are analyzing sequences from the stool samples and looking for similarities and differences in what bacteria are present, how abundant they are and what the community of gut bacteria look like.\u003c/p>\n\u003cp>\"We were hoping to find something clear and simple, such as \u003cem>this\u003c/em> bacteria signals autism\" says Tataru. \"Turns out, it's a bit more complex than we were expecting.\"\u003c/p>\n\u003cp>There are no immediately clear distinctions by type or number between the microbiomes of children with autism and those without. The researchers are, however, detecting some subtle differences. Kids within families are the most similar to each other. But kids with ASD in different families have microbiomes that are more alike than the microbiomes of non-autistic children in different families.\u003c/p>\n\u003cp>It's an interesting finding, even if the researchers are not sure what to make of it yet. As a 2014 review of the emerging data on the subject said, “The field is at a stage where more questions than answers are being generated.” And even some leading scientists involved in microbiome research have \u003ca href=\"http://www.nytimes.com/2015/06/28/magazine/can-the-bacteria-in-your-gut-explain-your-mood.html\" target=\"_blank\">cautioned\u003c/a> patients and their families not to get ahead of the research in looking for easy answers.\u003c/p>\n\u003cp>But for scientists like Kevin Becker at the NIH, who is not involved in the project, the turn toward the microbiome in researching ASD is a positive development. \"Genetics has been the focus for a long time and it often dominates the discussion,\" he says. \"Most autistic cases have no known genetic cause. Looking into these other paths is a welcome change.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The Autism Microbiome project plans to submit its first research paper for publication next month.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Little Evidence for Effectiveness of 'Brain Training' Programs: Study",
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"content": "\u003cp>Want to be smarter? More focused? Free of memory problems as you age?\u003c/p>\n\u003cp>If so, don't count on brain games to help you.\u003c/p>\n\u003cp>That's the conclusion of an exhaustive evaluation of the scientific literature on brain training games and programs. It was \u003ca href=\"http://psi.sagepub.com/content/current\">published\u003c/a> Monday in the journal \u003cem>Psychological Science in the Public Interest.\u003c/em>\u003c/p>\n\u003cp>\"It's disappointing that the evidence isn't stronger,\" says \u003ca href=\"http://www.psychology.illinois.edu/people/dsimons\">Daniel Simons\u003c/a>, an author of the article and a psychology professor at the University of Illinois at Urbana-Champaign.\u003c/p>\n\u003cp>\"It would be really nice if you could play some games and have it radically change your cognitive abilities,\" Simons says. \"But the studies don't show that on objectively measured real-world outcomes.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The evaluation, done by a team of seven scientists, is a response to a very public disagreement about the effectiveness of brain games, Simons says.\u003c/p>\n\u003cp>In October 2014, more than 70 scientists published an \u003ca href=\"http://longevity3.stanford.edu/blog/2014/10/15/the-consensus-on-the-brain-training-industry-from-the-scientific-community-2/\">open letter\u003c/a> objecting to marketing claims made by brain training companies. Pretty soon, another group, with more than 100 scientists, published a \u003ca href=\"http://www.cognitivetrainingdata.org/the-controversy-does-brain-training-work/response-letter/\">rebuttal\u003c/a> saying brain training has a solid scientific base.\u003c/p>\n\u003cp>\"So you had two consensus statements, each signed by many, many people, that came to essentially opposite conclusions,\" Simons says.\u003c/p>\n\u003cp>In an effort to clarify the issue, Simons and six other scientists reviewed more than 130 studies of brain games and other forms of cognitive training. The evaluation included studies of products from industry giant \u003ca href=\"https://www.lumosity.com/\">Lumosity\u003c/a>, which has been a prominent sponsor of NPR and other public radio programming.\u003c/p>\n\u003cp>\"We went through each paper and tried to look at the kind of evidence it provided,\" Simons says.\u003c/p>\n\u003cp>That meant asking questions like: How big was the study? Did it have an appropriate control group? Do the results support the marketing claims made by companies?\u003c/p>\n\u003cp>The scientists found that \"many of the studies did not really adhere to what we think of as the best practices,\" Simons says.\u003c/p>\n\u003cp>Some of the studies included only a few participants. Others lacked adequate control groups or failed to account for the placebo effect, which causes people to improve on a test simply because they are trying harder or are more confident.\u003c/p>\n\u003cp>There were some good studies, Simons says. And they showed that brain games do help people get better at a specific task.\u003c/p>\n\u003cp>\"You can practice, for example, scanning baggage at an airport and looking for a knife,\" he says. \"And you get really, really good at spotting that knife.\"\u003c/p>\n\u003cp>But there was less evidence that people got better at related tasks, like spotting other suspicious items, Simons says. And there was no strong evidence that practicing a narrow skill led to overall improvements in memory or thinking.\u003c/p>\n\u003cp>That's disappointing, Simons says, because \"what you want to do is be better able to function at work or at school.\"\u003c/p>\n\u003cp>The evaluation got a warm reception from at least some of the scientists who had signed the 2014 letter defending the science behind brain training.\u003c/p>\n\u003cp>\"The evaluation was very even-handed and raised many excellent points,\" says \u003ca href=\"http://www.hopkinsmedicine.org/profiles/results/directory/profile/9783561/george-rebok\">George Rebok\u003c/a>, a psychologist at Johns Hopkins University who has been involved in brain training research for the past 20 years. \"It really helped raise the bar in terms of the level of science that we must aspire to.\"\u003c/p>\n\u003cp>Rebok, who says he has no ties to brain training companies, remains optimistic that the right program of brain exercises can improve mental functioning and delay the effects of aging.\u003c/p>\n\u003cp>One reason brain games haven't shown a clear benefit so far, he says, may be that they don't work the brain hard enough or over a long enough time period.\u003c/p>\n\u003cp>\"It takes mental effort and practice to be able to see results,\" Rebok says. \"If we can implement that long range, I think that there will be a big dividend eventually.\"\u003c/p>\n\u003cp>In the meantime, the brain training industry is facing scrutiny from the Federal Trade Commission.\u003c/p>\n\u003cp>In January, the company behind Lumosity agreed to \u003ca href=\"https://www.ftc.gov/news-events/press-releases/2016/01/lumosity-pay-2-million-settle-ftc-deceptive-advertising-charges\">pay a $2 million fine\u003c/a> to settle \u003ca href=\"https://www.ftc.gov/system/files/documents/cases/160105lumoslabsstip.pdf\">FTC charges\u003c/a> that it made unfounded claims about its brain training program.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>And in May, a smaller brain training company called LearningRx agreed to pay a $200,000 fine to settle \u003ca href=\"https://www.ftc.gov/news-events/press-releases/2016/05/marketers-one-one-brain-training-programs-settle-ftc-charges\">similar charges\u003c/a>. Even so, the \u003ca href=\"http://www.learningrx.com/\">Learning Rx website\u003c/a> still promises \"A better brain at any age.\"\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Brain+Game+Claims+Fail+A+Big+Scientific+Test&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Want to be smarter? More focused? Free of memory problems as you age?\u003c/p>\n\u003cp>If so, don't count on brain games to help you.\u003c/p>\n\u003cp>That's the conclusion of an exhaustive evaluation of the scientific literature on brain training games and programs. It was \u003ca href=\"http://psi.sagepub.com/content/current\">published\u003c/a> Monday in the journal \u003cem>Psychological Science in the Public Interest.\u003c/em>\u003c/p>\n\u003cp>\"It's disappointing that the evidence isn't stronger,\" says \u003ca href=\"http://www.psychology.illinois.edu/people/dsimons\">Daniel Simons\u003c/a>, an author of the article and a psychology professor at the University of Illinois at Urbana-Champaign.\u003c/p>\n\u003cp>\"It would be really nice if you could play some games and have it radically change your cognitive abilities,\" Simons says. \"But the studies don't show that on objectively measured real-world outcomes.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The evaluation, done by a team of seven scientists, is a response to a very public disagreement about the effectiveness of brain games, Simons says.\u003c/p>\n\u003cp>In October 2014, more than 70 scientists published an \u003ca href=\"http://longevity3.stanford.edu/blog/2014/10/15/the-consensus-on-the-brain-training-industry-from-the-scientific-community-2/\">open letter\u003c/a> objecting to marketing claims made by brain training companies. Pretty soon, another group, with more than 100 scientists, published a \u003ca href=\"http://www.cognitivetrainingdata.org/the-controversy-does-brain-training-work/response-letter/\">rebuttal\u003c/a> saying brain training has a solid scientific base.\u003c/p>\n\u003cp>\"So you had two consensus statements, each signed by many, many people, that came to essentially opposite conclusions,\" Simons says.\u003c/p>\n\u003cp>In an effort to clarify the issue, Simons and six other scientists reviewed more than 130 studies of brain games and other forms of cognitive training. The evaluation included studies of products from industry giant \u003ca href=\"https://www.lumosity.com/\">Lumosity\u003c/a>, which has been a prominent sponsor of NPR and other public radio programming.\u003c/p>\n\u003cp>\"We went through each paper and tried to look at the kind of evidence it provided,\" Simons says.\u003c/p>\n\u003cp>That meant asking questions like: How big was the study? Did it have an appropriate control group? Do the results support the marketing claims made by companies?\u003c/p>\n\u003cp>The scientists found that \"many of the studies did not really adhere to what we think of as the best practices,\" Simons says.\u003c/p>\n\u003cp>Some of the studies included only a few participants. Others lacked adequate control groups or failed to account for the placebo effect, which causes people to improve on a test simply because they are trying harder or are more confident.\u003c/p>\n\u003cp>There were some good studies, Simons says. And they showed that brain games do help people get better at a specific task.\u003c/p>\n\u003cp>\"You can practice, for example, scanning baggage at an airport and looking for a knife,\" he says. \"And you get really, really good at spotting that knife.\"\u003c/p>\n\u003cp>But there was less evidence that people got better at related tasks, like spotting other suspicious items, Simons says. And there was no strong evidence that practicing a narrow skill led to overall improvements in memory or thinking.\u003c/p>\n\u003cp>That's disappointing, Simons says, because \"what you want to do is be better able to function at work or at school.\"\u003c/p>\n\u003cp>The evaluation got a warm reception from at least some of the scientists who had signed the 2014 letter defending the science behind brain training.\u003c/p>\n\u003cp>\"The evaluation was very even-handed and raised many excellent points,\" says \u003ca href=\"http://www.hopkinsmedicine.org/profiles/results/directory/profile/9783561/george-rebok\">George Rebok\u003c/a>, a psychologist at Johns Hopkins University who has been involved in brain training research for the past 20 years. \"It really helped raise the bar in terms of the level of science that we must aspire to.\"\u003c/p>\n\u003cp>Rebok, who says he has no ties to brain training companies, remains optimistic that the right program of brain exercises can improve mental functioning and delay the effects of aging.\u003c/p>\n\u003cp>One reason brain games haven't shown a clear benefit so far, he says, may be that they don't work the brain hard enough or over a long enough time period.\u003c/p>\n\u003cp>\"It takes mental effort and practice to be able to see results,\" Rebok says. \"If we can implement that long range, I think that there will be a big dividend eventually.\"\u003c/p>\n\u003cp>In the meantime, the brain training industry is facing scrutiny from the Federal Trade Commission.\u003c/p>\n\u003cp>In January, the company behind Lumosity agreed to \u003ca href=\"https://www.ftc.gov/news-events/press-releases/2016/01/lumosity-pay-2-million-settle-ftc-deceptive-advertising-charges\">pay a $2 million fine\u003c/a> to settle \u003ca href=\"https://www.ftc.gov/system/files/documents/cases/160105lumoslabsstip.pdf\">FTC charges\u003c/a> that it made unfounded claims about its brain training program.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>And in May, a smaller brain training company called LearningRx agreed to pay a $200,000 fine to settle \u003ca href=\"https://www.ftc.gov/news-events/press-releases/2016/05/marketers-one-one-brain-training-programs-settle-ftc-charges\">similar charges\u003c/a>. Even so, the \u003ca href=\"http://www.learningrx.com/\">Learning Rx website\u003c/a> still promises \"A better brain at any age.\"\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Brain+Game+Claims+Fail+A+Big+Scientific+Test&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>The Food and Drug Administration's approval of a new insulin delivery system for people with Type 1 diabetes is a big deal.\u003c/p>\n\u003cp>With Type 1 diabetes, the pancreas makes little or no insulin so people have to replace it with either multiple daily injections or a pump. In either case, that process involves constant error-prone adjustments, particularly around food and exercise. Over the long term, high blood sugar levels can lead to organ damage, but over-correcting by giving more insulin can cause dangerous low blood sugars that can lead to unconsciousness.\u003c/p>\n\u003cp>The device, Medtronic's MiniMed 670G hybrid closed loop system, is made up of an insulin pump and continuous glucose monitor (CGM), both of which are already on the market separately. The new part involves the communication between the two devices.\u003c/p>\n\u003cp>Medtronic's \u003ca href=\"http://www.npr.org/sections/health-shots/2015/01/30/382172052/diabetes-technology-inches-closer-to-an-artificial-pancreas\">previous system \u003c/a>already had a feature that would shut down the insulin pump if the wearer's blood sugar dropped too low. But the 670G predicts when a person's blood sugar is dropping and prevents the low in the first place, and also corrects high blood sugars.\u003c/p>\n\u003cp>This is the first such machine in the world with that level of automation, and thus it is informally being called the first \"artificial pancreas\" system.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>However, it's called a hybrid rather than a fully closed-loop system because users will still need to signal that they're about to eat and estimate the carbohydrate count of the food so the device can calculate the additional amount of insulin needed. That means there's still the possibility of mistakes. But now if that count is off, the 670G will correct the error automatically.\u003c/p>\n\u003cp>For people with Type 1 diabetes, the new capabilities mean they can both sleep through the night without worrying about their blood sugars dropping too low and can go through their day without having to think about their diabetes all the time, according to Aaron Kowalski, chief mission officer for the JDRF, the organization that funds much of the \"artificial pancreas\" research.\u003c/p>\n\u003cp>\"You get almost normalized overnight blood glucose. For people with Type 1 diabetes, that's massively important,\" he said, adding that the overall 24/7 burden reduction means better quality of life. \"The diabetes isn't gone, but [wearers] can think about it less ...This is a historic milestone.\"\u003c/p>\n\u003cp>And more systems like this are coming.\u003c/p>\n\u003cp>Medtronic, via the Minimed division that it acquired in 2001, was the first to market because it's still the only company that manufactures both the insulin pump and CGM technology. But at least five other partnerships between other manufacturers are now developing closed-loop systems, some using already-available pumps and CGMs, others creating new devices. The systems will likely differ from one another in form, user interface, and in the algorithmic approaches embedded in the communication software, \"so people with diabetes will have more choices,\" Kowalski says, noting that JDRF is \"celebrating Medtronic because it's the first commercial system, but we're supporting the entire field.\"\u003c/p>\n\u003cp>Of course, the field still faces challenges. One of the major technological problems is that insulin deposited just under the skin takes too long to begin working; that's why people still need to signal ahead that they're about to eat. The JDRF is currently funding several initiatives working on making faster-acting insulins.\u003c/p>\n\u003cp>\"The faster the insulin works, the more closed the loop will be,\" Kowalski notes. \"It's not easy, but there's a lot of work going on.\"\u003c/p>\n\u003cp>Wearability is another issue. Some people simply don't want to be strapped to devices, even if it means better diabetes control. So, the JDRF has recently announced new funding for miniaturization of the devices.\u003c/p>\n\u003cp>And of course, there's the problem of access. While insurance coverage for insulin pumps is widely established, this is not the case for the CGM component. Medicare doesn't cover CGM technology, meaning that people now must give up those devices or pay out of pocket when they reach age 65. The JDRF is one of several organizations lobbying to change that, as well as to make sure that all payers recognize both the health and economic advantages of new diabetes technologies.\u003c/p>\n\u003cp>\"This is a priority for us,\" Kowalski says. \"We need to make sure people have access. Not just rich people, but anybody who will benefit.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>For now, the 670G, which the FDA gave the nod on Wednesday, is only \u003ca href=\"http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/UCM522974.htm\">approved\u003c/a> for people aged 14 years and older. But Medtronic is studying it in children ages 7-13 with the aim of making it available for them, too.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=FDA+Approves+The+First+Automated+Insulin+System+For+Type+1+Diabetes&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The Food and Drug Administration's approval of a new insulin delivery system for people with Type 1 diabetes is a big deal.\u003c/p>\n\u003cp>With Type 1 diabetes, the pancreas makes little or no insulin so people have to replace it with either multiple daily injections or a pump. In either case, that process involves constant error-prone adjustments, particularly around food and exercise. Over the long term, high blood sugar levels can lead to organ damage, but over-correcting by giving more insulin can cause dangerous low blood sugars that can lead to unconsciousness.\u003c/p>\n\u003cp>The device, Medtronic's MiniMed 670G hybrid closed loop system, is made up of an insulin pump and continuous glucose monitor (CGM), both of which are already on the market separately. The new part involves the communication between the two devices.\u003c/p>\n\u003cp>Medtronic's \u003ca href=\"http://www.npr.org/sections/health-shots/2015/01/30/382172052/diabetes-technology-inches-closer-to-an-artificial-pancreas\">previous system \u003c/a>already had a feature that would shut down the insulin pump if the wearer's blood sugar dropped too low. But the 670G predicts when a person's blood sugar is dropping and prevents the low in the first place, and also corrects high blood sugars.\u003c/p>\n\u003cp>This is the first such machine in the world with that level of automation, and thus it is informally being called the first \"artificial pancreas\" system.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>However, it's called a hybrid rather than a fully closed-loop system because users will still need to signal that they're about to eat and estimate the carbohydrate count of the food so the device can calculate the additional amount of insulin needed. That means there's still the possibility of mistakes. But now if that count is off, the 670G will correct the error automatically.\u003c/p>\n\u003cp>For people with Type 1 diabetes, the new capabilities mean they can both sleep through the night without worrying about their blood sugars dropping too low and can go through their day without having to think about their diabetes all the time, according to Aaron Kowalski, chief mission officer for the JDRF, the organization that funds much of the \"artificial pancreas\" research.\u003c/p>\n\u003cp>\"You get almost normalized overnight blood glucose. For people with Type 1 diabetes, that's massively important,\" he said, adding that the overall 24/7 burden reduction means better quality of life. \"The diabetes isn't gone, but [wearers] can think about it less ...This is a historic milestone.\"\u003c/p>\n\u003cp>And more systems like this are coming.\u003c/p>\n\u003cp>Medtronic, via the Minimed division that it acquired in 2001, was the first to market because it's still the only company that manufactures both the insulin pump and CGM technology. But at least five other partnerships between other manufacturers are now developing closed-loop systems, some using already-available pumps and CGMs, others creating new devices. The systems will likely differ from one another in form, user interface, and in the algorithmic approaches embedded in the communication software, \"so people with diabetes will have more choices,\" Kowalski says, noting that JDRF is \"celebrating Medtronic because it's the first commercial system, but we're supporting the entire field.\"\u003c/p>\n\u003cp>Of course, the field still faces challenges. One of the major technological problems is that insulin deposited just under the skin takes too long to begin working; that's why people still need to signal ahead that they're about to eat. The JDRF is currently funding several initiatives working on making faster-acting insulins.\u003c/p>\n\u003cp>\"The faster the insulin works, the more closed the loop will be,\" Kowalski notes. \"It's not easy, but there's a lot of work going on.\"\u003c/p>\n\u003cp>Wearability is another issue. Some people simply don't want to be strapped to devices, even if it means better diabetes control. So, the JDRF has recently announced new funding for miniaturization of the devices.\u003c/p>\n\u003cp>And of course, there's the problem of access. While insurance coverage for insulin pumps is widely established, this is not the case for the CGM component. Medicare doesn't cover CGM technology, meaning that people now must give up those devices or pay out of pocket when they reach age 65. The JDRF is one of several organizations lobbying to change that, as well as to make sure that all payers recognize both the health and economic advantages of new diabetes technologies.\u003c/p>\n\u003cp>\"This is a priority for us,\" Kowalski says. \"We need to make sure people have access. Not just rich people, but anybody who will benefit.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>For now, the 670G, which the FDA gave the nod on Wednesday, is only \u003ca href=\"http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/UCM522974.htm\">approved\u003c/a> for people aged 14 years and older. But Medtronic is studying it in children ages 7-13 with the aim of making it available for them, too.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=FDA+Approves+The+First+Automated+Insulin+System+For+Type+1+Diabetes&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "A Doctor's Quest to Determine if Simple Medication Can Prevent Heart Attacks",
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"content": "\u003cp>When Harry Selker was working as a cardiologist in the 1970s, clot-busting drugs were showing great promise against heart attacks. But their lifesaving properties were very time sensitive. \"If you give it within the first hour it has a 47 percent reduction of mortality; if you wait another hour, it has a 28 percent reduction; another hour, 23 percent. And people were taking about 90 minutes to make that decision,\" he recalls. \"So they were losing the opportunity to save patients' lives.\"\u003c/p>\n\u003cp>Selker envisioned a predictive tool, a kind of calculator that would help make the decision faster. He knew the data to create such a tool were already out there, from research on drugs that dissolve blood clots. \"We made mathematical models and they kind of represented that comparison from those data, and that helped us make these predictive instruments. We built them into electrocardiograms,\" Selker says. That helped physicians make better decisions.\u003c/p>\n\u003cp>The EKG-based \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/12118963\">predictive instruments\u003c/a> have helped doctors prescribe clotbusters within the hour, increasing the use of the therapy within one hour, and getting more people treated with either clotbusting drugs or angioplasty.\u003c/p>\n\u003cp>Building on this success, \u003ca href=\"https://www.tuftsmedicalcenter.org/PhysicianDirectory/Harry-Selker.aspx\">Selker \u003c/a>and colleagues at the Institute for Clinical Research and Health Policy Studies at Tufts Medical Center in Boston, where he is executive director, have gone on to develop other predictive tools, in areas from knee replacement therapy to opioid addiction treatment.\u003c/p>\n\u003cp>Selker grew up in a household in the Seattle area where he was encouraged to tinker. In his office, he proudly shows off the first automobile shock absorber, invented by his grandfather.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>And while Selker's own list of patents will attest to his passion for innovation, he's equally passionate about working to ensure those innovations will have an impact.\u003c/p>\n\u003cp>One medical treatment Selker is pursuing right now has never delivered on its early promise for saving lives. It's a cocktail of glucose, insulin and potassium, known by its chemical initials GIK. In studies with baboons and rabbits more than 50 years ago, GIK seemed to actually prevent heart attacks. \"They would clamp off these coronary arteries simulating coronary thrombosis, but keep infusing them with glucose and insulin, then potassium,\" Selker says.\u003c/p>\n\u003cp>When the researchers unclamped the arteries, they found no signs of cardiac arrest, as would be expected. The simple concoction had protected heart muscles against damage. Selker says: \"So it was very encouraging. It was extraordinary, really.\"\u003c/p>\n\u003cp>But there was a problem in translation: In human studies, GIK didn't seem to do much of anything to prevent heart attacks or damage. The research sat on the shelf. But when Selker learned about the research from a colleague and they started to discuss it, he became convinced there were fatal flaws in the human studies, including administering the GIK too late to have an effect. Selker and his colleagues designed a study to test GIK in humans.\u003c/p>\n\u003cp>Paramedics in 13 cities gave people who appeared to be having a heart attack either GIK or a placebo. The GIK didn't keep people from having heart attacks, but those given it were less likely to suffer cardiac arrest or death in the hospital. It also reduced the amount of heart damage by 80 percent. The \u003ca href=\"http://jama.jamanetwork.com/article.aspx?articleid=1151528\">results\u003c/a> were published in \u003cem>JAMA \u003c/em>in 2012.\u003c/p>\n\u003cp>Selker says that if additional research supports these findings, many lives could be saved with a simple therapy that costs less than a hundred bucks. But he soon discovered that knowing what needed to be done wasn't enough.\u003c/p>\n\u003cp>\"I thought, pretty much, my work was done and people call me up and say you know, 'when would we get this GIK stuff?' And I realized nobody's making it, nobody's selling it. And so I started talking to the pharmaceutical companies saying, 'You know, would you make this stuff?' And they basically weren't interested.\"\u003c/p>\n\u003cp>GIK is a cocktail of existing off-the-shelf ingredients. A company could invest in the additional research and work to get it out to patients, but there'd be no big payoff. But Selker refuses to be deterred.\u003c/p>\n\u003cp>He is now in dialogue with the Food and Drug Administration about the details of a definitive clinical trial to determine the effectiveness of GIK in acute coronary emergencies. And like so many times before, he's continuing to reach across professional boundaries, working with policy experts, statistical modelers, anyone who can push the process forward.\u003c/p>\n\u003cp>\"If you're going to try to improve things, you have to work on all angles, you have to work in all disciplines,\" Selker says. \"You can't just work in biology; that would never get you anywhere.\"\u003c/p>\n\u003cp>His happiest moments in research, he says, have been sitting down with people who have ideas he never could have imagined, where he gets to push and prod, challenging them to figure out how to put those ideas to use.\u003c/p>\n\u003cp>\"So working across disciplines and personalities and in different perspectives; that's the good stuff for me. Now really that makes a great day.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Selker is hopeful that the next clinical trial for GIK will take place by early next year, moving one step closer to a tested treatment that could save lives.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=This+Doctor+Is+Trying+To+Stop+Heart+Attacks+In+Their+Tracks&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"excerpt": "Harry Selker has spent his life trying to come up with better ways to keep people from dying of heart attacks. Now he's intent on figuring out if a simple, cheap medication could be a game changer.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>When Harry Selker was working as a cardiologist in the 1970s, clot-busting drugs were showing great promise against heart attacks. But their lifesaving properties were very time sensitive. \"If you give it within the first hour it has a 47 percent reduction of mortality; if you wait another hour, it has a 28 percent reduction; another hour, 23 percent. And people were taking about 90 minutes to make that decision,\" he recalls. \"So they were losing the opportunity to save patients' lives.\"\u003c/p>\n\u003cp>Selker envisioned a predictive tool, a kind of calculator that would help make the decision faster. He knew the data to create such a tool were already out there, from research on drugs that dissolve blood clots. \"We made mathematical models and they kind of represented that comparison from those data, and that helped us make these predictive instruments. We built them into electrocardiograms,\" Selker says. That helped physicians make better decisions.\u003c/p>\n\u003cp>The EKG-based \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/12118963\">predictive instruments\u003c/a> have helped doctors prescribe clotbusters within the hour, increasing the use of the therapy within one hour, and getting more people treated with either clotbusting drugs or angioplasty.\u003c/p>\n\u003cp>Building on this success, \u003ca href=\"https://www.tuftsmedicalcenter.org/PhysicianDirectory/Harry-Selker.aspx\">Selker \u003c/a>and colleagues at the Institute for Clinical Research and Health Policy Studies at Tufts Medical Center in Boston, where he is executive director, have gone on to develop other predictive tools, in areas from knee replacement therapy to opioid addiction treatment.\u003c/p>\n\u003cp>Selker grew up in a household in the Seattle area where he was encouraged to tinker. In his office, he proudly shows off the first automobile shock absorber, invented by his grandfather.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>And while Selker's own list of patents will attest to his passion for innovation, he's equally passionate about working to ensure those innovations will have an impact.\u003c/p>\n\u003cp>One medical treatment Selker is pursuing right now has never delivered on its early promise for saving lives. It's a cocktail of glucose, insulin and potassium, known by its chemical initials GIK. In studies with baboons and rabbits more than 50 years ago, GIK seemed to actually prevent heart attacks. \"They would clamp off these coronary arteries simulating coronary thrombosis, but keep infusing them with glucose and insulin, then potassium,\" Selker says.\u003c/p>\n\u003cp>When the researchers unclamped the arteries, they found no signs of cardiac arrest, as would be expected. The simple concoction had protected heart muscles against damage. Selker says: \"So it was very encouraging. It was extraordinary, really.\"\u003c/p>\n\u003cp>But there was a problem in translation: In human studies, GIK didn't seem to do much of anything to prevent heart attacks or damage. The research sat on the shelf. But when Selker learned about the research from a colleague and they started to discuss it, he became convinced there were fatal flaws in the human studies, including administering the GIK too late to have an effect. Selker and his colleagues designed a study to test GIK in humans.\u003c/p>\n\u003cp>Paramedics in 13 cities gave people who appeared to be having a heart attack either GIK or a placebo. The GIK didn't keep people from having heart attacks, but those given it were less likely to suffer cardiac arrest or death in the hospital. It also reduced the amount of heart damage by 80 percent. The \u003ca href=\"http://jama.jamanetwork.com/article.aspx?articleid=1151528\">results\u003c/a> were published in \u003cem>JAMA \u003c/em>in 2012.\u003c/p>\n\u003cp>Selker says that if additional research supports these findings, many lives could be saved with a simple therapy that costs less than a hundred bucks. But he soon discovered that knowing what needed to be done wasn't enough.\u003c/p>\n\u003cp>\"I thought, pretty much, my work was done and people call me up and say you know, 'when would we get this GIK stuff?' And I realized nobody's making it, nobody's selling it. And so I started talking to the pharmaceutical companies saying, 'You know, would you make this stuff?' And they basically weren't interested.\"\u003c/p>\n\u003cp>GIK is a cocktail of existing off-the-shelf ingredients. A company could invest in the additional research and work to get it out to patients, but there'd be no big payoff. But Selker refuses to be deterred.\u003c/p>\n\u003cp>He is now in dialogue with the Food and Drug Administration about the details of a definitive clinical trial to determine the effectiveness of GIK in acute coronary emergencies. And like so many times before, he's continuing to reach across professional boundaries, working with policy experts, statistical modelers, anyone who can push the process forward.\u003c/p>\n\u003cp>\"If you're going to try to improve things, you have to work on all angles, you have to work in all disciplines,\" Selker says. \"You can't just work in biology; that would never get you anywhere.\"\u003c/p>\n\u003cp>His happiest moments in research, he says, have been sitting down with people who have ideas he never could have imagined, where he gets to push and prod, challenging them to figure out how to put those ideas to use.\u003c/p>\n\u003cp>\"So working across disciplines and personalities and in different perspectives; that's the good stuff for me. Now really that makes a great day.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Selker is hopeful that the next clinical trial for GIK will take place by early next year, moving one step closer to a tested treatment that could save lives.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=This+Doctor+Is+Trying+To+Stop+Heart+Attacks+In+Their+Tracks&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Priscilla Chan and Mark Zuckerberg are smiling, standing in front of a backdrop emblazoned with the question: \"Can we cure all diseases in our children's lifetime?\" They're announcing a $3 billion initiative to achieve that goal, and they're calling it Chan Zuckerberg Science.\u003c/p>\n\u003cp>No sickness in the whole world by the time today's babies, like the couple's 9-month-old daughter Max Zuckerberg, are old folks?\u003c/p>\n\u003cp>Seems like unbelievable hype from the Facebook founder and his pediatrician spouse. Zuckerberg himself walked the expectations back during the Sept. 21 launch. \"Now, that doesn't mean no one will ever get sick,\" he said.\u003c/p>\n\u003cp>But what \u003cem>does\u003c/em> it mean? The initiative will bring together teams of scientists and engineers from Stanford University, University of California, Berkeley and University of California, San Francisco. The first project is a new research center — the Biohub — in the Bay Area, funded at $600 million over 10 years. The idea is to accelerate basic science research to cure, prevent or manage all diseases by 2100.\u003c/p>\n\u003cp>A lot can happen \"in our children's lifetime.\" That's about 80 years, give or take a decade or so. \"Eighty years is a long time,\" says \u003ca href=\"http://www.rockefeller.edu/research/faculty/labheads/CoriBargmann/#content\">Dr. Cori Bargmann\u003c/a>, a neuroscientist at the Rockefeller University and newly named president of science for the Chan Zuckerberg initiative. \"When I was a kid, there were no statins, there was no bypass surgery, no stents. Your friend's father would have a heart attack, and he would die.\" Today, roughly 40-plus years after Bargmann's childhood, a million people a year have either surgery to bypass clogged arteries or the implantation of stents to unblock dangerously clogged arteries — extending millions of lives.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Imagine what might happen in twice that time with an extra infusion of $3 billion to speed up research into the four major causes of early death: infectious disease, heart disease, cancer and neurological disorders like Alzheimer's and \u003ca href=\"http://www.nhs.uk/news/2016/03March/Pages/People-with-autism-are-dying-younger-warns-study.aspx\">autism\u003c/a>.\u003c/p>\n\u003cp>So a backdrop slogan that sounds like hyperbole actually may be a realistic goal, says \u003ca href=\"https://www.nih.gov/about-nih/who-we-are/nih-director\">Dr. Francis Collins\u003c/a>, director of the National Institutes of Health, who is not part of the initiative. \"I don't think they're naïve at all. I admire audacious goals,\" says Collins, a physician-geneticist and former leader of the Human Genome Project. \"I think it's great that they're putting something out that sounds almost unreachable to make people think about what it would take to actually accomplish it. And when you think how far we've come in the last 80 years, it might just be possible.\"\u003c/p>\n\u003cp>\u003ca href=\"https://www.bbe.caltech.edu/content/david-baltimore\">Dr. David Baltimore\u003c/a> agrees. He is president \u003cem>emeritus\u003c/em> of Caltech and a 1975 Nobel Prize winner for his discovery of the \u003ca href=\"https://www.britannica.com/science/reverse-transcriptase\">reverse transcriptase enzyme \u003c/a>that transfers genetic information both ways from DNA to RNA. \"It's a reasonable goal that over the next century we're going to see the elimination of a lot of disease. They can make a significant contribution with the resources they're willing to put on the table,\" he says. \"It is very important that they're going to fund the basic research that in the long run is going to make a difference.\"\u003c/p>\n\u003cp>But even billionaires can't solve the world's ills single-handedly. They can only help fill the gaps in research that other organizations, mainly the National Institutes of Health, can't cover. The NIH is the U.S. federal agency that is the world's biggest funder of medical research, to the tune of more than $32 billion a year. The Chan Zuckerberg Initiative is, comparatively, a pittance. And yet... \"Three billion dollars is a lot of money,\" says Collins, \"and I welcome their contribution.\"\u003c/p>\n\u003cp>People like Zuckerberg and Bill Gates — through the Bill & Melinda Gates Foundation — can help fund basic research or, more commonly, target specific diseases, like AIDS or malaria, says Collins. He says such contributions are important but shouldn't be used to argue that the government can afford to spend less on medical research. \"Believe me, I worry about that,\" Collins says. \"Despite the wonderful contributions by philanthropists, they have not made up for what the NIH has lost in the past 16 years.\" Between 2003 and 2015, the NIH lost 22 percent of its capacity to fund research due to inflation and budget cuts, according to the Federation of American Societies for Experimental Biology.\u003c/p>\n\u003cp>Philanthropy can complement, never replace the NIH, says Bargmann. But federal dollars are spent cautiously, while philanthropists, like Chan and Zuckerberg, \"are looking for opportunities to fund big, less proven, ideas,\" Baltimore says.\u003c/p>\n\u003cp>And the relatively smaller size of the Chan Zuckerberg initiative means it can be more nimble. \"Small organizations have more tolerance for risk and failure. You can try different models and take more risks,\" says Bargmann. \"Some will fail, some will work. When they work, other people can copy them.\" And let's face it. Billionaires like Zuckerberg got where they are in part because of their tolerance for taking risks, says Baltimore.\u003c/p>\n\u003cp>The new initiative aims to develop new technology that can drive science forward. Technology has often come first, followed by medical breakthroughs—like the invention of the microscope preceding the development of the germ theory of disease; or the mapping of the human genome preceding genetic breakthroughs.\u003c/p>\n\u003cp>One project the initiative will work on is the creation of an atlas of all the cells of the human body, where they are and their molecular components. \"That's information that can be used to understand every single disease,\" Bargmann says.\u003c/p>\n\u003cp>One specific disease in her field of neuroscience is an extreme form of narcolepsy, in which people cannot stay awake. \"There are 86 billion nerve cells in the brain,\" says Bargmann, \"and 20,000 of them make orexin.\" Orexin regulates arousal and wakefulness, and when those 20,000 cells don't function, people suddenly drop into sleep. \"The other 86 billion neurons cannot keep you awake. That's why knowing where the cells are is important.\"\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>And why not let a billionaire or two help pay for the science to get humans closer to a disease-free life. \"There's an enormous amount of money flowing into the hands of a very small number of people in the U.S.,\" says Baltimore, also not part of the initiative. \"These people who have resources measured in billions can make a difference. With the right mindset, two people can make an enormous dent in how we're going to move forward.\"\u003c/p>\n\u003chr>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=What%27s+The+Prognosis+For+%243+Billion+Zuckerberg+Health+Plan%3F&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Imagine what might happen in twice that time with an extra infusion of $3 billion to speed up research into the four major causes of early death: infectious disease, heart disease, cancer and neurological disorders like Alzheimer's and \u003ca href=\"http://www.nhs.uk/news/2016/03March/Pages/People-with-autism-are-dying-younger-warns-study.aspx\">autism\u003c/a>.\u003c/p>\n\u003cp>So a backdrop slogan that sounds like hyperbole actually may be a realistic goal, says \u003ca href=\"https://www.nih.gov/about-nih/who-we-are/nih-director\">Dr. Francis Collins\u003c/a>, director of the National Institutes of Health, who is not part of the initiative. \"I don't think they're naïve at all. I admire audacious goals,\" says Collins, a physician-geneticist and former leader of the Human Genome Project. \"I think it's great that they're putting something out that sounds almost unreachable to make people think about what it would take to actually accomplish it. And when you think how far we've come in the last 80 years, it might just be possible.\"\u003c/p>\n\u003cp>\u003ca href=\"https://www.bbe.caltech.edu/content/david-baltimore\">Dr. David Baltimore\u003c/a> agrees. He is president \u003cem>emeritus\u003c/em> of Caltech and a 1975 Nobel Prize winner for his discovery of the \u003ca href=\"https://www.britannica.com/science/reverse-transcriptase\">reverse transcriptase enzyme \u003c/a>that transfers genetic information both ways from DNA to RNA. \"It's a reasonable goal that over the next century we're going to see the elimination of a lot of disease. They can make a significant contribution with the resources they're willing to put on the table,\" he says. \"It is very important that they're going to fund the basic research that in the long run is going to make a difference.\"\u003c/p>\n\u003cp>But even billionaires can't solve the world's ills single-handedly. They can only help fill the gaps in research that other organizations, mainly the National Institutes of Health, can't cover. The NIH is the U.S. federal agency that is the world's biggest funder of medical research, to the tune of more than $32 billion a year. The Chan Zuckerberg Initiative is, comparatively, a pittance. And yet... \"Three billion dollars is a lot of money,\" says Collins, \"and I welcome their contribution.\"\u003c/p>\n\u003cp>People like Zuckerberg and Bill Gates — through the Bill & Melinda Gates Foundation — can help fund basic research or, more commonly, target specific diseases, like AIDS or malaria, says Collins. He says such contributions are important but shouldn't be used to argue that the government can afford to spend less on medical research. \"Believe me, I worry about that,\" Collins says. \"Despite the wonderful contributions by philanthropists, they have not made up for what the NIH has lost in the past 16 years.\" Between 2003 and 2015, the NIH lost 22 percent of its capacity to fund research due to inflation and budget cuts, according to the Federation of American Societies for Experimental Biology.\u003c/p>\n\u003cp>Philanthropy can complement, never replace the NIH, says Bargmann. But federal dollars are spent cautiously, while philanthropists, like Chan and Zuckerberg, \"are looking for opportunities to fund big, less proven, ideas,\" Baltimore says.\u003c/p>\n\u003cp>And the relatively smaller size of the Chan Zuckerberg initiative means it can be more nimble. \"Small organizations have more tolerance for risk and failure. You can try different models and take more risks,\" says Bargmann. \"Some will fail, some will work. When they work, other people can copy them.\" And let's face it. Billionaires like Zuckerberg got where they are in part because of their tolerance for taking risks, says Baltimore.\u003c/p>\n\u003cp>The new initiative aims to develop new technology that can drive science forward. Technology has often come first, followed by medical breakthroughs—like the invention of the microscope preceding the development of the germ theory of disease; or the mapping of the human genome preceding genetic breakthroughs.\u003c/p>\n\u003cp>One project the initiative will work on is the creation of an atlas of all the cells of the human body, where they are and their molecular components. \"That's information that can be used to understand every single disease,\" Bargmann says.\u003c/p>\n\u003cp>One specific disease in her field of neuroscience is an extreme form of narcolepsy, in which people cannot stay awake. \"There are 86 billion nerve cells in the brain,\" says Bargmann, \"and 20,000 of them make orexin.\" Orexin regulates arousal and wakefulness, and when those 20,000 cells don't function, people suddenly drop into sleep. \"The other 86 billion neurons cannot keep you awake. That's why knowing where the cells are is important.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"disqusTitle": "The FDA's Controversial Approval of Muscular Dystrophy Drug",
"title": "The FDA's Controversial Approval of Muscular Dystrophy Drug",
"headTitle": "KQED Future of You | KQED Science",
"content": "\u003cp>When 15-year-old Billy Ellsworth stepped up to the microphone at a Food and Drug Administration public meeting in April, he had no way to know he was part of a historic shift in how the government considers the desires of patients and their advocates in evaluating new drugs.\u003c/p>\n\u003cp>Ellsworth has Duchenne muscular dystrophy, a muscle-wasting disease, that mainly affects boys. And he was taking an experimental drug that the FDA was trying to decide whether to approve.\u003c/p>\n\u003cp>\"I'm going to beat this bloody disease but I need your help,\" Billy told the scientists weighing the evidence about the drug. \"So please help me and my friends and do the right thing. FDA, please don't let me die early.\"\u003c/p>\n\u003cp>Applause swelled from the overflow crowd.\u003c/p>\n\u003cp>His testimony and other pleas like it during the 10-hour hearing clearly affected some of the scientists sitting in judgment of the experimental drug called eteplirsen. But when the scientists turned their attention to the slim evidence before them, they ultimately voted that drugmaker \u003ca href=\"https://www.sarepta.com/\">Sarepta\u003c/a> had not shown that the experimental drug was effective.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Just 12 boys had been involved in the key study, and just about everybody agreed that the research was deeply flawed. But parents of some of those boys were convinced that the drug was in fact helping delay the progression of a disease that ultimately proves fatal.\u003c/p>\n\u003cp>\"We came away really heartbroken in many ways,\" said Pat Furlong, a longtime advocate who founded \u003ca href=\"http://www.parentprojectmd.org/\">Parent Project Muscular Dystrophy\u003c/a> and who had lost two sons to the disease.\u003c/p>\n\u003cp>One similar drug had previously been rejected by the FDA, and two others were turned away before they could even get through the door. There was no approved drug to stop the progression of this disease.\u003c/p>\n\u003cp>But that wasn't the end of the story.\u003c/p>\n\u003cp>Times are changing at the FDA and other federal agencies. In recent years, legislation and regulation has pushed for a greater patient voice in decisions. The FDA's job wasn't simply to look at the science, as it has done for many years. They have \"to look to what is meaningful benefit on the part of the patients,\" Furlong said. \"What do the patients value?\"\u003c/p>\n\u003cp>In this case, the parents saw real promise in this drug, despite the results from the flawed study. They also noted that the drug appears to be safe, so there wasn't much risk. And the research did show that boys on the drug were producing a small amount of a potentially helpful protein called dystrophin, which could be a sign that the drug provides some benefit.\u003c/p>\n\u003cp>That was all part of the FDA's thinking when on Monday \u003ca href=\"http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm521263.htm\">it approved\u003c/a> eteplirsen, brand name Exondys 51, on a provisional basis. A \u003ca href=\"http://www.accessdata.fda.gov/drugsatfda_docs/nda/2016/206488_summary%20review_Redacted.pdf\">letter\u003c/a> written by FDA Commissioner Robert Califf laid out in remarkably frank terms the heated internal debate at the agency, which \u003ca href=\"https://www.statnews.com/pharmalot/2016/09/14/fda-sarepta-farkas-duchenne/\">may have led to the departure\u003c/a> of one key scientist who was opposed to approving the drug.\u003c/p>\n\u003cp>\"It is inevitable that in some of these situations, highly qualified experts will disagree,\" Califf wrote, and he praised Dr. Janet Woodcock, the head of the FDA division that reviews new drugs, who made the call \"in the face of profound changes in science and social interactions related to drugs.\"\u003c/p>\n\u003cp>Califf said Woodcock ultimately made a scientific judgment call, anchored on the observation that the drug does prompt patients to produce at least a small amount of dystrophin.\u003c/p>\n\u003cp>Yet the role of advocacy here was inescapable. It is, after all, the patients who face the risks and the benefits.\u003c/p>\n\u003cp>\"You can look at this as being a potentially damaging precedent, and on the other hand you can look of this as being an innovative precedent, that could bring good things and earlier access to medicines,\" Eric Hoffman told NPR.\u003c/p>\n\u003cp>Hoffman and Louis Kunkel \u003ca href=\"http://www.cell.com/cell/abstract/0092-8674(87)90579-4?_returnURL=http%3A%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2F0092867487905794%3Fshowall%3Dtrue\">discovered the dystrophin gene in 1987\u003c/a>. Hoffman is now CEO of ReveraGen, a company working on a drug for the disease, as well as associate dean of research at the University of Binghamton's pharmacy school in New York.\u003c/p>\n\u003cp>The FDA decision approves the drug on an accelerated basis, but that approval is contingent on follow-up studies and it can be withdrawn. In other diseases, provisional approvals have been reversed after follow-up studies failed to show the drugs were effective. (Avastin for advanced breast cancer is \u003ca href=\"http://www.npr.org/sections/health-shots/2011/11/18/142503630/fda-pulls-approval-of-avastin-for-advanced-breast-cancer\">a notable example\u003c/a>, despite pleas from patient groups to keep the approval intact).\u003c/p>\n\u003cp>The Sarepta drug addresses just one genetic mutation in muscular dystrophy, and that particular flaw only affects about 1,500 boys in the entire United States. Drugmaker Sarepta plans to use the same approach now to target other mutations related to the disease, and to use those study results to comply with the FDA's requirement for more and better studies.\u003c/p>\n\u003cp>In the meantime, Sarepta can start charging $300,000 per patient per year for treatment with eteplirsen.\u003c/p>\n\u003cp>\"Yes, there was a lot of pressure,\" Dr. Edward Kaye, CEO of Sarepta said, \"but I think the FDA demonstrated the flexibility they are allowed under the law. It took a lot of courage for them to do this. It's always easy to take the safe path and say, just give us more data.\"\u003c/p>\n\u003cp>Advocate Pat Furlong agreed. \"I think the important aspect of this is maybe a new social contract,\" she said. Since the drug is apparently safe and possibly useful, parents wanted to make the drug available while the questions about usefulness and value are fully answered. \"And at the end of five years we can reevaluate whether this really hits its mark in terms of the healthcare cost and the benefit to patients,\" she said.\u003c/p>\n\u003cp>More than a dozen potential drugs for this disease are in the pipeline now, and at the very least they now have a standard against which they can be judged.\u003c/p>\n\u003cp>The decision about eteplirsen would have been considerably easier, for patients and scientists alike, if the company had conducted its trials carefully and rigorously.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\"Considering that a substantially flawed development program contributed to the difficulty of coming to resolution in this case, we must redouble our efforts to ... use methods that will produce high-quality evidence from the outset,\" Califf wrote.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Controversy+Continues+Over+Muscular+Dystrophy+Drug%2C+Despite+FDA+Approval&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"excerpt": "The Food and Drug Administration approved a muscular dystrophy drug despite deeply flawed evidence. Was the decision a dangerous precedent or flexible pragmatism reflecting patients' values?",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>When 15-year-old Billy Ellsworth stepped up to the microphone at a Food and Drug Administration public meeting in April, he had no way to know he was part of a historic shift in how the government considers the desires of patients and their advocates in evaluating new drugs.\u003c/p>\n\u003cp>Ellsworth has Duchenne muscular dystrophy, a muscle-wasting disease, that mainly affects boys. And he was taking an experimental drug that the FDA was trying to decide whether to approve.\u003c/p>\n\u003cp>\"I'm going to beat this bloody disease but I need your help,\" Billy told the scientists weighing the evidence about the drug. \"So please help me and my friends and do the right thing. FDA, please don't let me die early.\"\u003c/p>\n\u003cp>Applause swelled from the overflow crowd.\u003c/p>\n\u003cp>His testimony and other pleas like it during the 10-hour hearing clearly affected some of the scientists sitting in judgment of the experimental drug called eteplirsen. But when the scientists turned their attention to the slim evidence before them, they ultimately voted that drugmaker \u003ca href=\"https://www.sarepta.com/\">Sarepta\u003c/a> had not shown that the experimental drug was effective.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Just 12 boys had been involved in the key study, and just about everybody agreed that the research was deeply flawed. But parents of some of those boys were convinced that the drug was in fact helping delay the progression of a disease that ultimately proves fatal.\u003c/p>\n\u003cp>\"We came away really heartbroken in many ways,\" said Pat Furlong, a longtime advocate who founded \u003ca href=\"http://www.parentprojectmd.org/\">Parent Project Muscular Dystrophy\u003c/a> and who had lost two sons to the disease.\u003c/p>\n\u003cp>One similar drug had previously been rejected by the FDA, and two others were turned away before they could even get through the door. There was no approved drug to stop the progression of this disease.\u003c/p>\n\u003cp>But that wasn't the end of the story.\u003c/p>\n\u003cp>Times are changing at the FDA and other federal agencies. In recent years, legislation and regulation has pushed for a greater patient voice in decisions. The FDA's job wasn't simply to look at the science, as it has done for many years. They have \"to look to what is meaningful benefit on the part of the patients,\" Furlong said. \"What do the patients value?\"\u003c/p>\n\u003cp>In this case, the parents saw real promise in this drug, despite the results from the flawed study. They also noted that the drug appears to be safe, so there wasn't much risk. And the research did show that boys on the drug were producing a small amount of a potentially helpful protein called dystrophin, which could be a sign that the drug provides some benefit.\u003c/p>\n\u003cp>That was all part of the FDA's thinking when on Monday \u003ca href=\"http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm521263.htm\">it approved\u003c/a> eteplirsen, brand name Exondys 51, on a provisional basis. A \u003ca href=\"http://www.accessdata.fda.gov/drugsatfda_docs/nda/2016/206488_summary%20review_Redacted.pdf\">letter\u003c/a> written by FDA Commissioner Robert Califf laid out in remarkably frank terms the heated internal debate at the agency, which \u003ca href=\"https://www.statnews.com/pharmalot/2016/09/14/fda-sarepta-farkas-duchenne/\">may have led to the departure\u003c/a> of one key scientist who was opposed to approving the drug.\u003c/p>\n\u003cp>\"It is inevitable that in some of these situations, highly qualified experts will disagree,\" Califf wrote, and he praised Dr. Janet Woodcock, the head of the FDA division that reviews new drugs, who made the call \"in the face of profound changes in science and social interactions related to drugs.\"\u003c/p>\n\u003cp>Califf said Woodcock ultimately made a scientific judgment call, anchored on the observation that the drug does prompt patients to produce at least a small amount of dystrophin.\u003c/p>\n\u003cp>Yet the role of advocacy here was inescapable. It is, after all, the patients who face the risks and the benefits.\u003c/p>\n\u003cp>\"You can look at this as being a potentially damaging precedent, and on the other hand you can look of this as being an innovative precedent, that could bring good things and earlier access to medicines,\" Eric Hoffman told NPR.\u003c/p>\n\u003cp>Hoffman and Louis Kunkel \u003ca href=\"http://www.cell.com/cell/abstract/0092-8674(87)90579-4?_returnURL=http%3A%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2F0092867487905794%3Fshowall%3Dtrue\">discovered the dystrophin gene in 1987\u003c/a>. Hoffman is now CEO of ReveraGen, a company working on a drug for the disease, as well as associate dean of research at the University of Binghamton's pharmacy school in New York.\u003c/p>\n\u003cp>The FDA decision approves the drug on an accelerated basis, but that approval is contingent on follow-up studies and it can be withdrawn. In other diseases, provisional approvals have been reversed after follow-up studies failed to show the drugs were effective. (Avastin for advanced breast cancer is \u003ca href=\"http://www.npr.org/sections/health-shots/2011/11/18/142503630/fda-pulls-approval-of-avastin-for-advanced-breast-cancer\">a notable example\u003c/a>, despite pleas from patient groups to keep the approval intact).\u003c/p>\n\u003cp>The Sarepta drug addresses just one genetic mutation in muscular dystrophy, and that particular flaw only affects about 1,500 boys in the entire United States. Drugmaker Sarepta plans to use the same approach now to target other mutations related to the disease, and to use those study results to comply with the FDA's requirement for more and better studies.\u003c/p>\n\u003cp>In the meantime, Sarepta can start charging $300,000 per patient per year for treatment with eteplirsen.\u003c/p>\n\u003cp>\"Yes, there was a lot of pressure,\" Dr. Edward Kaye, CEO of Sarepta said, \"but I think the FDA demonstrated the flexibility they are allowed under the law. It took a lot of courage for them to do this. It's always easy to take the safe path and say, just give us more data.\"\u003c/p>\n\u003cp>Advocate Pat Furlong agreed. \"I think the important aspect of this is maybe a new social contract,\" she said. Since the drug is apparently safe and possibly useful, parents wanted to make the drug available while the questions about usefulness and value are fully answered. \"And at the end of five years we can reevaluate whether this really hits its mark in terms of the healthcare cost and the benefit to patients,\" she said.\u003c/p>\n\u003cp>More than a dozen potential drugs for this disease are in the pipeline now, and at the very least they now have a standard against which they can be judged.\u003c/p>\n\u003cp>The decision about eteplirsen would have been considerably easier, for patients and scientists alike, if the company had conducted its trials carefully and rigorously.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"Considering that a substantially flawed development program contributed to the difficulty of coming to resolution in this case, we must redouble our efforts to ... use methods that will produce high-quality evidence from the outset,\" Califf wrote.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Controversy+Continues+Over+Muscular+Dystrophy+Drug%2C+Despite+FDA+Approval&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Eternal Sunshine of the Spotless Mice: Researchers Study Wiping Out Memories",
"title": "Eternal Sunshine of the Spotless Mice: Researchers Study Wiping Out Memories",
"headTitle": "KQED Future of You | KQED Science",
"content": "\u003cp>Perhaps you know the word “engram” from its \u003ca href=\"https://en.wikipedia.org/wiki/Engram_(Dianetics)\">prominent place\u003c/a> in L. Ron Hubbard’s masterpiece of pseudo-science, “Dianetics.”\u003c/p>\n\u003cp>The term, however, has real meaning within the field of cognitive science. The quest for the engram extends back to the 1920s, when pioneer neuroscientist Karl Lashley removed parts of a rat’s cortex to see how it affected the animal's ability to remember its way through a maze. He was looking for the engram, a term first coined in 1921 by evolutionary biologist Richard Semon and loosely defined as the physical representation of memory.\u003c/p>\n\u003cp>Despite three decades of research, Lashley couldn't find the engram. Yet he correctly surmised that storing and retrieving memory involved a network in the brain.\u003c/p>\n\u003cp>Today’s scientists have made great strides in finding where memory lives, even if a precise definition remains elusive. “The engram is a catch-all phrase for that bit in the brain that stores a memory,” says neuroscientist Sheena Josselyn, whom \u003ca href=\"https://www.quantamagazine.org/20160623-the-maestro-of-memory-manipulation/\">Quanta Magazine\u003c/a> recently called “the maestro of memory manipulation.”\u003c/p>\n\u003caside class=\"pullquote alignright\">'By just manipulating cells that we think are important, we got the animal to act is if it never had cocaine before.’\u003ccite>Sheena Josselyn, University of Toronto\u003c/cite>\u003c/aside>\n\u003cp>“We think it’s a collection of cells active during an event, which form an assembly that can be reactivated, allowing you to recall a memory.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>In her lab at the University of Toronto, Josselyn and colleagues probe the architecture of memories by looking into the amygdalas of mice. This region of the brain plays an important role in processing the experience of fear. Frightening events spark a cascade of rapid-fire electrical and chemical communications in neurons -- nerve cells -- in the amygdala and other regions of the brain. It is those responses that help to make up the fabled engram.\u003c/p>\n\u003cp>\u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/19286560\">In a 2009 study\u003c/a>, Josselyn’s team showed that specific groups of neurons formed the basis of memories, which, incredibly, could be erased. Once researchers extinguished these cells (with a diphtheria toxin no less), the mice no longer froze up at the sound of a tone that they had come to associate with an electric shock, \u003ca href=\"http://www.simplypsychology.org/pavlov.html\" target=\"_blank\">Pavlov style\u003c/a>. The experiment brings to mind sci-fi scenarios like the one in “Eternal Sunshine of the Spotless Mind,” a film about a romantic couple who have undergone a process to erase each other from memory. This, naturally, goes awry. \u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003c/p>\n\u003cp>https://www.youtube.com/watch?v=1GiLxkDK8sI\u003c/p>\n\u003cp>But the concept of memory eradication also suggests the tantalizing possibility of cures for mental conditions like PTSD and drug addiction. In 2014, for instance, Josselyn’s team \u003ca href=\"http://www.jneurosci.org/content/34/42/14115.long\">extinguished memories\u003c/a> of cocaine highs in mice.\u003c/p>\n\u003cp>“Sometimes people who have had problems with drug abuse do fine in rehab, where they are removed from a lot of the cues associated with drug taking,” she told Quanta. “But when they get back in the environment where they previously took drugs, they can relapse, because they expect and crave the drugs that have become associated with these places. We tried to get at the heart of that by saying: Can we do something to weaken this cocaine memory? By just manipulating cells that we think are important, we got the animal to act is if it never had cocaine before.”\u003c/p>\n\u003cp>In study results \u003ca href=\"http://science.sciencemag.org/content/353/6297/383\">published this summer\u003c/a>, Josselyn’s lab again used Pavlovian conditioning to determine if memories of fearful events could become linked.\u003c/p>\n\u003cp>Mice that received an electric shock between 1.5 hours and six hours apart showed a greater degree of fear by freezing when they heard the same specific sound than other groups of mice that went 18 or 24 hours between receiving the shocks. Researchers found that the storage of fear memories in the same sets of neurons occurred only when the two events happened relatively close in time\u003cb>. \u003c/b>[contextly_sidebar id=\"ULvMylz6xHnKRYLHvjAryuC8UKJ13zkW\"]\u003c/p>\n\u003cp>The researchers also affirmed that a small percentage of neurons containing a molecule called CREB are the ones involved in forming a fearful memory. Decades ago, Nobel laureate \u003ca href=\"http://erickandel.blogspot.com/2007/09/1-kandels-big-discovery.html\">Eric Kandel\u003c/a> found that sea slugs could remember being shocked, due to CREB, which helps form long-term memories. A former colleague of Josselyn’s at UCLA, \u003ca href=\"http://www.annualreviews.org/doi/abs/10.1146/annurev.neuro.21.1.127\">Alcino Silva\u003c/a>, has found similar results in rats and mice.\u003c/p>\n\u003cp>Asim Rashid, lead researcher on the \u003ca href=\"http://www.the-scientist.com/?articles.view/articleNo/46611/title/Neurons-Compete-to-Form-Memories/\">recent study of linked memories\u003c/a>, explains why fear-inducing events that happen closer in time had a profound effect on the mice’s fear response. Because the first shock increased CREB activity in certain neurons, these same highly active neurons were then “recruited” into the second one, thus forming memories that linked the two experiences. “When we experience these two fearful events close in time, the second event becomes enhanced or exaggerated compared to what could happen on its own,” says Rashid.\u003c/p>\n\u003cp>In the next part of the study, the Toronto scientists used a technique called optogenetics developed by Stanford researcher \u003ca href=\"http://www.nature.com/news/neuroscience-method-man-1.13077\">Karl Deisseroth\u003c/a>. Researchers artificially forced the same neurons to store memories of different fearful events taking place 24 hours apart, by shining a blue light in the animals’ lateral amygdalas that activated the neurons.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Where brain research once relied on broad-brush techniques such as electrodes and tissue removal, today’s scientists use precision tools to observe and alter the inner workings of the brain. Of course, there are ethical issues involved. If we really could indeed erase memories, there is the potential for collateral damage to other linked memories. Ultimately, memory loss could affect our personalities. Targeting neurons in ailing humans may still be a ways off, but doing so would be “revolutionary,” said Josselyn. “For drug treatments, one day we won’t need to drug the entire brain, the entire body; we can have a more targeted approach to handling disorders like PTSD.”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Perhaps you know the word “engram” from its \u003ca href=\"https://en.wikipedia.org/wiki/Engram_(Dianetics)\">prominent place\u003c/a> in L. Ron Hubbard’s masterpiece of pseudo-science, “Dianetics.”\u003c/p>\n\u003cp>The term, however, has real meaning within the field of cognitive science. The quest for the engram extends back to the 1920s, when pioneer neuroscientist Karl Lashley removed parts of a rat’s cortex to see how it affected the animal's ability to remember its way through a maze. He was looking for the engram, a term first coined in 1921 by evolutionary biologist Richard Semon and loosely defined as the physical representation of memory.\u003c/p>\n\u003cp>Despite three decades of research, Lashley couldn't find the engram. Yet he correctly surmised that storing and retrieving memory involved a network in the brain.\u003c/p>\n\u003cp>Today’s scientists have made great strides in finding where memory lives, even if a precise definition remains elusive. “The engram is a catch-all phrase for that bit in the brain that stores a memory,” says neuroscientist Sheena Josselyn, whom \u003ca href=\"https://www.quantamagazine.org/20160623-the-maestro-of-memory-manipulation/\">Quanta Magazine\u003c/a> recently called “the maestro of memory manipulation.”\u003c/p>\n\u003caside class=\"pullquote alignright\">'By just manipulating cells that we think are important, we got the animal to act is if it never had cocaine before.’\u003ccite>Sheena Josselyn, University of Toronto\u003c/cite>\u003c/aside>\n\u003cp>“We think it’s a collection of cells active during an event, which form an assembly that can be reactivated, allowing you to recall a memory.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>In her lab at the University of Toronto, Josselyn and colleagues probe the architecture of memories by looking into the amygdalas of mice. This region of the brain plays an important role in processing the experience of fear. Frightening events spark a cascade of rapid-fire electrical and chemical communications in neurons -- nerve cells -- in the amygdala and other regions of the brain. It is those responses that help to make up the fabled engram.\u003c/p>\n\u003cp>\u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/19286560\">In a 2009 study\u003c/a>, Josselyn’s team showed that specific groups of neurons formed the basis of memories, which, incredibly, could be erased. Once researchers extinguished these cells (with a diphtheria toxin no less), the mice no longer froze up at the sound of a tone that they had come to associate with an electric shock, \u003ca href=\"http://www.simplypsychology.org/pavlov.html\" target=\"_blank\">Pavlov style\u003c/a>. The experiment brings to mind sci-fi scenarios like the one in “Eternal Sunshine of the Spotless Mind,” a film about a romantic couple who have undergone a process to erase each other from memory. This, naturally, goes awry. \u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003c/p>\u003c/p>\u003cp>\u003cspan class='utils-parseShortcode-shortcodes-__youtubeShortcode__embedYoutube'>\n \u003cspan class='utils-parseShortcode-shortcodes-__youtubeShortcode__embedYoutubeInside'>\n \u003ciframe\n loading='lazy'\n class='utils-parseShortcode-shortcodes-__youtubeShortcode__youtubePlayer'\n type='text/html'\n src='//www.youtube.com/embed/1GiLxkDK8sI'\n title='//www.youtube.com/embed/1GiLxkDK8sI'\n allowfullscreen='true'\n style='border:0;'>\u003c/iframe>\n \u003c/span>\n \u003c/span>\u003c/p>\u003cp>\u003cp>But the concept of memory eradication also suggests the tantalizing possibility of cures for mental conditions like PTSD and drug addiction. In 2014, for instance, Josselyn’s team \u003ca href=\"http://www.jneurosci.org/content/34/42/14115.long\">extinguished memories\u003c/a> of cocaine highs in mice.\u003c/p>\n\u003cp>“Sometimes people who have had problems with drug abuse do fine in rehab, where they are removed from a lot of the cues associated with drug taking,” she told Quanta. “But when they get back in the environment where they previously took drugs, they can relapse, because they expect and crave the drugs that have become associated with these places. We tried to get at the heart of that by saying: Can we do something to weaken this cocaine memory? By just manipulating cells that we think are important, we got the animal to act is if it never had cocaine before.”\u003c/p>\n\u003cp>In study results \u003ca href=\"http://science.sciencemag.org/content/353/6297/383\">published this summer\u003c/a>, Josselyn’s lab again used Pavlovian conditioning to determine if memories of fearful events could become linked.\u003c/p>\n\u003cp>Mice that received an electric shock between 1.5 hours and six hours apart showed a greater degree of fear by freezing when they heard the same specific sound than other groups of mice that went 18 or 24 hours between receiving the shocks. Researchers found that the storage of fear memories in the same sets of neurons occurred only when the two events happened relatively close in time\u003cb>. \u003c/b>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>The researchers also affirmed that a small percentage of neurons containing a molecule called CREB are the ones involved in forming a fearful memory. Decades ago, Nobel laureate \u003ca href=\"http://erickandel.blogspot.com/2007/09/1-kandels-big-discovery.html\">Eric Kandel\u003c/a> found that sea slugs could remember being shocked, due to CREB, which helps form long-term memories. A former colleague of Josselyn’s at UCLA, \u003ca href=\"http://www.annualreviews.org/doi/abs/10.1146/annurev.neuro.21.1.127\">Alcino Silva\u003c/a>, has found similar results in rats and mice.\u003c/p>\n\u003cp>Asim Rashid, lead researcher on the \u003ca href=\"http://www.the-scientist.com/?articles.view/articleNo/46611/title/Neurons-Compete-to-Form-Memories/\">recent study of linked memories\u003c/a>, explains why fear-inducing events that happen closer in time had a profound effect on the mice’s fear response. Because the first shock increased CREB activity in certain neurons, these same highly active neurons were then “recruited” into the second one, thus forming memories that linked the two experiences. “When we experience these two fearful events close in time, the second event becomes enhanced or exaggerated compared to what could happen on its own,” says Rashid.\u003c/p>\n\u003cp>In the next part of the study, the Toronto scientists used a technique called optogenetics developed by Stanford researcher \u003ca href=\"http://www.nature.com/news/neuroscience-method-man-1.13077\">Karl Deisseroth\u003c/a>. Researchers artificially forced the same neurons to store memories of different fearful events taking place 24 hours apart, by shining a blue light in the animals’ lateral amygdalas that activated the neurons.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Where brain research once relied on broad-brush techniques such as electrodes and tissue removal, today’s scientists use precision tools to observe and alter the inner workings of the brain. Of course, there are ethical issues involved. If we really could indeed erase memories, there is the potential for collateral damage to other linked memories. Ultimately, memory loss could affect our personalities. Targeting neurons in ailing humans may still be a ways off, but doing so would be “revolutionary,” said Josselyn. “For drug treatments, one day we won’t need to drug the entire brain, the entire body; we can have a more targeted approach to handling disorders like PTSD.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Paralyzed Patients in Stem Cell Study Regain Some Movement, Company Says",
"title": "Paralyzed Patients in Stem Cell Study Regain Some Movement, Company Says",
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"content": "\u003cp>\u003cstrong>Update Sept. 23:\u003c/strong> You can read our original post about the remarkable case of Kris Boesen after this update. But some \u003ca href=\"http://asteriasbiotherapeutics.com/wp-content/uploads/2016/09/Wirth-ISCoS-14SEP2016-talk-FINAL.pdf\" target=\"_blank\">data\u003c/a> on the trial that Boesen is participating in was released last week by Asterias Biotherapeutics, the company that developed the stem cells injected into Boesen and other patients with cervical spinal cord injuries.\u003c/p>\n\u003cp>Asterias \u003ca href=\"http://asteriasbiotherapeutics.com/asterias-biotherapeutics-announces-positive-efficacy-data-in-patients-with-complete-cervical-spinal-cord-injuries-treated-with-ast-opc1/\" target=\"_blank\">says\u003c/a> the trial results to date are encouraging. The sample is still extremely small and nothing is really proven at this point, but the data are certainly positive for other patients besides Boesen.\u003c/p>\n\u003cp>There are two groups of patients: three who received a dose of 2 million stem cells and five who received a larger dose of 10 million.\u003c/p>\n\u003cp>To measure improvement, researchers use the \u003ca href=\"http://www.nature.com/sc/journal/v45/n3/fig_tab/3102008t1.html\" target=\"_blank\">Upper Extremity Motor Scale\u003c/a>, or UEMS. The scale runs from zero, which indicates total paralysis, to five, which means a patient has active movement.\u003c/p>\n\u003cp>The results:\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>First cohort, 2 million stem cells injected: On the six-point UEMS scale, one of three patients improved one motor level on one side of the body, while the other two patients improved one level on both sides.\u003c/p>\n\u003cp>Second cohort, 10 million stem cells: One of four patients improved two levels on both sides. Two other patients showed two levels of improvement on one side. And the fourth patient improved one level on one side. (One of the five patients in this group has not yet reached the 90-day point at which results are measured, so no report on that patient yet.)\u003c/p>\n\u003cp>The other significant finding, Asterias said, is that no one showed any measurable negative effects of the therapy -- researchers started with the smaller dose to make sure patients weren't harmed by the experimental trial, then went to the higher 10-million-cell dose.\u003c/p>\n\u003cp>Researchers have said the optimal dosage target is 20 million cells, but that point has not been reached yet in the trial.\u003c/p>\n\u003cp>The next milestone for getting a clearer picture of the results will be at the six-month mark for the second cohort, in January 2017.\u003c/p>\n\u003cp>All patients in the trial, being conducted at six sites around the country, have either \"lost all movement below their injury site and experience severe paralysis of the upper and lower limbs,\" or \"lost all motor function but may retain some minimal sensory function below their injury site,\" according to Asterias.\u003c/p>\n\u003cp>You can see more info on the study, which is called \u003ca href=\"http://www.scistar-study.com/\" target=\"_blank\">SCIStar\u003c/a>, at\u003ca href=\"https://clinicaltrials.gov/ct2/show/study/NCT02302157?term=NCT02302157&rank=1\" target=\"_blank\"> ClinicalTrials.gov.\u003c/a>\u003c/p>\n\u003cp>\u003cstrong>Original post\u003c/strong>\u003c/p>\n\u003cp class=\"p2\">\u003cspan class=\"s1\">Rod Boesen says his son, Kris, was so bad off he couldn't move a muscle from the neck down, and needed a ventilator to keep him drawing breath.\u003c/span>\u003c/p>\n\u003cp class=\"p2\">In March, Kris, then 20, was driving on a wet road when he crashed his car into a tree and a telephone poll, crushing three of his vertebrae. The accident left him with almost no feeling south of his neck, and doctors foresaw that he would lead the life of a paraplegic.\u003c/p>\n\u003cp class=\"p2\">\u003cspan class=\"s1\">\"They thought he was going to be totally, from the head on down, paralyzed,\" says Rod\u003c/span>\u003c/p>\n\u003cp class=\"p2\">But that has not been the case; Kris has regained the use of his hands and arms.\u003c/p>\n\u003caside class=\"pullquote alignright\">'They thought he was going to be totally, from the head on down, paralyzed.'\u003c/aside>\n\u003cp class=\"p2\">\u003cspan class=\"s1\">In April, as part of a research trial, a surgical team from USC's Keck Medical Center injected millions of embryonic stem cells into Boesen's spine. Two weeks later, Boesen began to show some improvement. After six weeks, he was discharged and returned home to Bakersfield, California to continue his rehabilitation.\u003cbr>\n\u003c/span>\u003c/p>\n\u003cp class=\"p2\">Now, five months after the stem cell injection, Boesen is remarkably self-sufficient, considering the initial prognosis. From feeding himself to talking on the phone to being able to twist the cap off a soda bottle, life is a degree more normal than anyone thought possible.\u003c/p>\n\u003cp class=\"p2\">\"We used to lift weights, that's something we used to do together,\" his dad says. \"Now we're doing that again. Only it's a lot less weight.\"\u003c/p>\n\u003cp class=\"p2\">The goal of the experimental stem cell treatment is to regrow the protective myelin sheath around each nerve, giving them a chance to heal. Whether this has occurred in Boesen yet is unknown--doctors would need to administer a spinal tap to find out, and that is dangerous for patients in this condition.\u003c/p>\n\u003cp class=\"p2\">So researchers don't know yet whether Boesen's recovery is due to the injection of stem cells. All they can say is that his progress has been remarkable, if not unprecedented for this type of spine injury.\u003c/p>\n\u003cfigure id=\"attachment_243385\" class=\"wp-caption alignright\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/09/Neurosurgery-Stem-Cell-spine-patient-Kris-Boesen_04.jpg\">\u003cimg class=\"wp-image-243385 size-large\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/09/Neurosurgery-Stem-Cell-spine-patient-Kris-Boesen_04-1180x775.jpg\" alt=\"Lifting weights is part of Kris Boesen’s regular program of physical therapy. \" width=\"640\" height=\"420\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Lifting weights is part of Kris Boesen’s regular program of physical therapy. \u003ccite>(Greg Iger/Keck Medicine of USC))\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp class=\"p2\">\u003cspan class=\"s1\">The clinical mid-stage trial is very small; if it's successful, FDA approval would still be many years away. But the results in Boesen and four other patients have thus far been very encouraging.\u003c/span>\u003c/p>\n\u003cp class=\"p2\">\u003cspan class=\"s1\">With most spinal injuries, doctors and physical therapists usually look to see what's still intact, then try to make incremental improvements. As a matter of course, people don't recover much of the movement or function they've lost.\u003c/span>\u003c/p>\n\u003cp class=\"p2\">\u003cspan class=\"s1\">Charles Liu, a neurosurgeon and director of the USC Neurorestoration Center that's leading the research, \u003c/span>\u003cspan class=\"s1\">says the goal is not to attempt to repair the entire vertebral column, but to target the \u003ca href=\"http://www.spine-health.com/video/cervical-spine-anatomy-video\" target=\"_blank\">cervical spine\u003c/a> and restore neurological function.\u003c/span>\u003c/p>\n\u003cp class=\"p2\">\u003cspan class=\"s1\">The other four patients in the cohort have shown some progress, but not as much as Boesen, according to Liu. Each person received one shot of stem cells, and the other patients got lower doses than the 10 million stem cells injected into Boesen's cervical spinal cord. \u003c/span>\u003c/p>\n\u003cp class=\"p2\">\u003cspan class=\"s1\">Boesen's recovery may have been helped by his young age, and by the fact that he received the stem-cell injection so soon – just five weeks after his car crash, Liu said. \u003c/span>\u003c/p>\n\u003cp class=\"p2\">\u003cspan class=\"s1\">\"This is unique, yes,\" Liu said of the clinical trial. \"No one has taken this approach before.\" \u003c/span>\u003c/p>\n\u003cp class=\"p2\">\u003cspan class=\"s1\">Or achieved these kind of results. Liu cautioned that not all spinal injury victims will benefit from this type of treatment, but he said it does offer hope that there may be a remedy for some spinal injuries.\u003c/span>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp class=\"p2\">Data from patients in the study is set to be released on Wednesday.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cstrong>Update Sept. 23:\u003c/strong> You can read our original post about the remarkable case of Kris Boesen after this update. But some \u003ca href=\"http://asteriasbiotherapeutics.com/wp-content/uploads/2016/09/Wirth-ISCoS-14SEP2016-talk-FINAL.pdf\" target=\"_blank\">data\u003c/a> on the trial that Boesen is participating in was released last week by Asterias Biotherapeutics, the company that developed the stem cells injected into Boesen and other patients with cervical spinal cord injuries.\u003c/p>\n\u003cp>Asterias \u003ca href=\"http://asteriasbiotherapeutics.com/asterias-biotherapeutics-announces-positive-efficacy-data-in-patients-with-complete-cervical-spinal-cord-injuries-treated-with-ast-opc1/\" target=\"_blank\">says\u003c/a> the trial results to date are encouraging. The sample is still extremely small and nothing is really proven at this point, but the data are certainly positive for other patients besides Boesen.\u003c/p>\n\u003cp>There are two groups of patients: three who received a dose of 2 million stem cells and five who received a larger dose of 10 million.\u003c/p>\n\u003cp>To measure improvement, researchers use the \u003ca href=\"http://www.nature.com/sc/journal/v45/n3/fig_tab/3102008t1.html\" target=\"_blank\">Upper Extremity Motor Scale\u003c/a>, or UEMS. The scale runs from zero, which indicates total paralysis, to five, which means a patient has active movement.\u003c/p>\n\u003cp>The results:\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>First cohort, 2 million stem cells injected: On the six-point UEMS scale, one of three patients improved one motor level on one side of the body, while the other two patients improved one level on both sides.\u003c/p>\n\u003cp>Second cohort, 10 million stem cells: One of four patients improved two levels on both sides. Two other patients showed two levels of improvement on one side. And the fourth patient improved one level on one side. (One of the five patients in this group has not yet reached the 90-day point at which results are measured, so no report on that patient yet.)\u003c/p>\n\u003cp>The other significant finding, Asterias said, is that no one showed any measurable negative effects of the therapy -- researchers started with the smaller dose to make sure patients weren't harmed by the experimental trial, then went to the higher 10-million-cell dose.\u003c/p>\n\u003cp>Researchers have said the optimal dosage target is 20 million cells, but that point has not been reached yet in the trial.\u003c/p>\n\u003cp>The next milestone for getting a clearer picture of the results will be at the six-month mark for the second cohort, in January 2017.\u003c/p>\n\u003cp>All patients in the trial, being conducted at six sites around the country, have either \"lost all movement below their injury site and experience severe paralysis of the upper and lower limbs,\" or \"lost all motor function but may retain some minimal sensory function below their injury site,\" according to Asterias.\u003c/p>\n\u003cp>You can see more info on the study, which is called \u003ca href=\"http://www.scistar-study.com/\" target=\"_blank\">SCIStar\u003c/a>, at\u003ca href=\"https://clinicaltrials.gov/ct2/show/study/NCT02302157?term=NCT02302157&rank=1\" target=\"_blank\"> ClinicalTrials.gov.\u003c/a>\u003c/p>\n\u003cp>\u003cstrong>Original post\u003c/strong>\u003c/p>\n\u003cp class=\"p2\">\u003cspan class=\"s1\">Rod Boesen says his son, Kris, was so bad off he couldn't move a muscle from the neck down, and needed a ventilator to keep him drawing breath.\u003c/span>\u003c/p>\n\u003cp class=\"p2\">In March, Kris, then 20, was driving on a wet road when he crashed his car into a tree and a telephone poll, crushing three of his vertebrae. The accident left him with almost no feeling south of his neck, and doctors foresaw that he would lead the life of a paraplegic.\u003c/p>\n\u003cp class=\"p2\">\u003cspan class=\"s1\">\"They thought he was going to be totally, from the head on down, paralyzed,\" says Rod\u003c/span>\u003c/p>\n\u003cp class=\"p2\">But that has not been the case; Kris has regained the use of his hands and arms.\u003c/p>\n\u003caside class=\"pullquote alignright\">'They thought he was going to be totally, from the head on down, paralyzed.'\u003c/aside>\n\u003cp class=\"p2\">\u003cspan class=\"s1\">In April, as part of a research trial, a surgical team from USC's Keck Medical Center injected millions of embryonic stem cells into Boesen's spine. Two weeks later, Boesen began to show some improvement. After six weeks, he was discharged and returned home to Bakersfield, California to continue his rehabilitation.\u003cbr>\n\u003c/span>\u003c/p>\n\u003cp class=\"p2\">Now, five months after the stem cell injection, Boesen is remarkably self-sufficient, considering the initial prognosis. From feeding himself to talking on the phone to being able to twist the cap off a soda bottle, life is a degree more normal than anyone thought possible.\u003c/p>\n\u003cp class=\"p2\">\"We used to lift weights, that's something we used to do together,\" his dad says. \"Now we're doing that again. Only it's a lot less weight.\"\u003c/p>\n\u003cp class=\"p2\">The goal of the experimental stem cell treatment is to regrow the protective myelin sheath around each nerve, giving them a chance to heal. Whether this has occurred in Boesen yet is unknown--doctors would need to administer a spinal tap to find out, and that is dangerous for patients in this condition.\u003c/p>\n\u003cp class=\"p2\">So researchers don't know yet whether Boesen's recovery is due to the injection of stem cells. All they can say is that his progress has been remarkable, if not unprecedented for this type of spine injury.\u003c/p>\n\u003cfigure id=\"attachment_243385\" class=\"wp-caption alignright\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/09/Neurosurgery-Stem-Cell-spine-patient-Kris-Boesen_04.jpg\">\u003cimg class=\"wp-image-243385 size-large\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/09/Neurosurgery-Stem-Cell-spine-patient-Kris-Boesen_04-1180x775.jpg\" alt=\"Lifting weights is part of Kris Boesen’s regular program of physical therapy. \" width=\"640\" height=\"420\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Lifting weights is part of Kris Boesen’s regular program of physical therapy. \u003ccite>(Greg Iger/Keck Medicine of USC))\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp class=\"p2\">\u003cspan class=\"s1\">The clinical mid-stage trial is very small; if it's successful, FDA approval would still be many years away. But the results in Boesen and four other patients have thus far been very encouraging.\u003c/span>\u003c/p>\n\u003cp class=\"p2\">\u003cspan class=\"s1\">With most spinal injuries, doctors and physical therapists usually look to see what's still intact, then try to make incremental improvements. As a matter of course, people don't recover much of the movement or function they've lost.\u003c/span>\u003c/p>\n\u003cp class=\"p2\">\u003cspan class=\"s1\">Charles Liu, a neurosurgeon and director of the USC Neurorestoration Center that's leading the research, \u003c/span>\u003cspan class=\"s1\">says the goal is not to attempt to repair the entire vertebral column, but to target the \u003ca href=\"http://www.spine-health.com/video/cervical-spine-anatomy-video\" target=\"_blank\">cervical spine\u003c/a> and restore neurological function.\u003c/span>\u003c/p>\n\u003cp class=\"p2\">\u003cspan class=\"s1\">The other four patients in the cohort have shown some progress, but not as much as Boesen, according to Liu. Each person received one shot of stem cells, and the other patients got lower doses than the 10 million stem cells injected into Boesen's cervical spinal cord. \u003c/span>\u003c/p>\n\u003cp class=\"p2\">\u003cspan class=\"s1\">Boesen's recovery may have been helped by his young age, and by the fact that he received the stem-cell injection so soon – just five weeks after his car crash, Liu said. \u003c/span>\u003c/p>\n\u003cp class=\"p2\">\u003cspan class=\"s1\">\"This is unique, yes,\" Liu said of the clinical trial. \"No one has taken this approach before.\" \u003c/span>\u003c/p>\n\u003cp class=\"p2\">\u003cspan class=\"s1\">Or achieved these kind of results. Liu cautioned that not all spinal injury victims will benefit from this type of treatment, but he said it does offer hope that there may be a remedy for some spinal injuries.\u003c/span>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp class=\"p2\">Data from patients in the study is set to be released on Wednesday.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "California Could Soon Legalize Marijuana But Pot’s Brain Effects Remain a Mystery",
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"content": "\u003cdiv id=\"storytext\" class=\"storytext storylocation linkLocation\">\n\u003cp>Five states are voting this fall on whether marijuana should be legal, like alcohol, for recreational use. That has sparked questions about what we know — and don't know — about marijuana's effect on the brain.\u003c/p>\n\u003cp>Research is scarce. The U.S. Drug Enforcement Agency classifies marijuana as a \u003ca href=\"https://www.dea.gov/druginfo/ds.shtml\">Schedule I drug\u003c/a>. That classification puts up barriers to conducting research on it, including a cumbersome \u003ca href=\"http://www.deadiversion.usdoj.gov/21cfr/cfr/1301/1301_18.htm\">DEA approval\u003c/a> application and a requirement that scientists \u003ca href=\"http://grants.nih.gov/grants/guide/notice-files/not99-091.html\">procure\u003c/a> very specific marijuana plants.\u003c/p>\n\u003cp>One long-term study in New Zealand compared the IQs of people at age 13 and then through adolescence and adulthood to age 38. Those who used pot heavily from adolescence onward showed an average 8 percent drop in IQ. People who never smoked, by contrast, showed slightly increased IQ.\u003c/p>\n\u003cp>Critics pounced on \u003ca href=\"http://www.pnas.org/content/109/40/E2657.full.pdf\">the study\u003c/a>, which was published in 2012, because it didn't adjust for many other things that affect IQ such as home life or family income. And there's no proof the IQ differences are due to pot.\u003c/p>\n\u003cp>One of those critics, \u003ca href=\"http://domstat.med.ucla.edu/pages/nicholas-jackson\">Nicholas Jackson\u003c/a>, now a senior statistician at the University of California, Los Angeles, wondered what would happen if he could rule out some of those elements by comparing twins.\u003c/p>\n\u003cp>\"Individuals that share the same genes, grew up in the same household, where the difference between them was that one of the twins was using marijuana and one was not,\" Jackson says.\u003c/p>\n\u003cp>Jackson and \u003ca href=\"https://www.researchgate.net/profile/Joshua_Isen\">Joshua Isen\u003c/a>, now an assistant professor of psychology at the University of South Alabama, conducted \u003ca href=\"http://www.pnas.org/content/113/5/E500.abstract\">a study\u003c/a> comparing IQ tests of twins age 9 to 12, before either had smoked marijuana, and then seven to 10 years later, after one had started.\u003c/p>\n\u003cp>\"If marijuana was causing IQ decline, what we would expect to see is that the twin who goes on and uses marijuana should have IQ deficits,\" Jackson says. \"We don't find that.\"\u003c/p>\n\u003cp>IQ scores for both twins varied slightly over time. And for twins who smoked marijuana, there was no significant difference in effect between daily and occasional use. So was the New Zealand finding wrong? The authors did not comment for this story, but have said that the twins study of teenagers does not address the effects of decades of heavy marijuana use.\u003c/p>\n\u003cp>Marijuana seems to affect a particular kind of intelligence, like short term retention of vocabulary words and other information that you might learn in school, says \u003ca href=\"http://www.albany.edu/psychology/20874.php\">Mitch Earleywine\u003c/a>, a professor of psychology at the University of Albany.\u003c/p>\n\u003cp>\"They haven't learned a whole lot of vocabulary words or they never learned the capital of Maine because they were high at school that day,\" he says. \"But when it comes to things that are more liquid intelligence, more fluid intelligence, they're usually pretty good at those because it requires just intelligence in the moment, so to speak.\"\u003c/p>\n\u003cp>It's not clear how marijuana use may keep Augusta from being filed next to \"capital of Maine\" in the brain. Some studies that \u003ca href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3930618/\">compare brain scans\u003c/a> of teenagers who use marijuana to those who don't show thinner, less dense connections between lobes. \u003ca href=\"https://www.drugabuse.gov/about-nida/directors-page/biography-dr-nora-volkow\">Nora Volkow\u003c/a>, director of the National Institute on Drug Abuse, says brains with less connectivity don't work as well as they should.\u003c/p>\n\u003cp>\"You could expect that that will decrease your capacity to memorize things and to learn them which is necessary to you to actually further develop your cognitive abilities,\" she says.\u003c/p>\n\u003cp>Volkow says there's little proof that marijuana causes poor brain connections. Studies so far have not compared brains before and after pot. Maybe kids who are already having trouble in school are more likely to try marijuana. Still, she is convinced that marijuana is bad for the brains of adults who began smoking in their youth.\u003c/p>\n\u003cp>People who regularly smoked marijuana as teens, \"are achieving much less both in their education as well as their profession as well as their economic earnings,\" Volkow says. \"They also tend to be much more dissatisfied with life. Many studies have shown that.\"\u003c/p>\n\u003cp>NIDA is one of several agencies behind a major study that will map the effects of marijuana and other substances on brain development. The Adolescent Brain and Cognitive Development Study (ABCD) will follow 10,000 9- to 10- year-olds through early adulthood, using neuroimaging to map changes in the brain.\u003c/p>\n\u003cp>But as of now, the research suggests if you don't start young and don't use marijuana often, there's not much evidence of permanent harm to the brain. That's led some experts in marijuana brain science to say it might be OK to make pot legal, with strong oversight. That includes \u003ca href=\"http://drkevinhill.com/three-big-reasons-marijuana-is-misunderstood/\">Kevin Hill,\u003c/a> an assistant professor of psychiatry at Harvard Medical School.\u003c/p>\n\u003cp>\"I'm not sure how I would vote [on the Massachusetts ballot question] at this point. I want to see sensible marijuana policy that works, that gives people what they want while limiting risk,\" says Hill, who wrote \u003ca href=\"https://www.amazon.com/Marijuana-Unbiased-Truth-World%C2%92s-Popular/dp/1616495596\">Marijuana: The Unbiased Truth about the World's Most Popular Weed\u003c/a>.\u003c/p>\n\u003cp>Massachusetts is one of five states, including Arizona, California, Maine and Nevada, that will vote in November on legalizing recreational marijuana.\u003c/p>\n\u003cp>Hill would like to see stronger regulation of marijuana if it becomes legal, with limits on advertising and of edible products that attract children, as well as a higher rate of taxation than the proposed 12 percent. If Massachusetts approves marijuana for recreational use, it would not be legal for anyone under age 21, when most, but not all, brain development occurs.\u003c/p>\n\u003cp>\u003cem>This story is part of a reporting partnership with NPR, WBUR and \u003c/em>\u003ca href=\"http://www.kaiserhealthnews.org/\">Kaiser Health News\u003c/a>.\u003c/p>\n\u003c/div>\n\u003cdiv class=\"tags\">\u003c/div>\n\u003cp>[ad fullwidth]\u003c/p>\u003cp>\u003c/p>\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cdiv id=\"storytext\" class=\"storytext storylocation linkLocation\">\n\u003cp>Five states are voting this fall on whether marijuana should be legal, like alcohol, for recreational use. That has sparked questions about what we know — and don't know — about marijuana's effect on the brain.\u003c/p>\n\u003cp>Research is scarce. The U.S. Drug Enforcement Agency classifies marijuana as a \u003ca href=\"https://www.dea.gov/druginfo/ds.shtml\">Schedule I drug\u003c/a>. That classification puts up barriers to conducting research on it, including a cumbersome \u003ca href=\"http://www.deadiversion.usdoj.gov/21cfr/cfr/1301/1301_18.htm\">DEA approval\u003c/a> application and a requirement that scientists \u003ca href=\"http://grants.nih.gov/grants/guide/notice-files/not99-091.html\">procure\u003c/a> very specific marijuana plants.\u003c/p>\n\u003cp>One long-term study in New Zealand compared the IQs of people at age 13 and then through adolescence and adulthood to age 38. Those who used pot heavily from adolescence onward showed an average 8 percent drop in IQ. People who never smoked, by contrast, showed slightly increased IQ.\u003c/p>\n\u003cp>Critics pounced on \u003ca href=\"http://www.pnas.org/content/109/40/E2657.full.pdf\">the study\u003c/a>, which was published in 2012, because it didn't adjust for many other things that affect IQ such as home life or family income. And there's no proof the IQ differences are due to pot.\u003c/p>\n\u003cp>One of those critics, \u003ca href=\"http://domstat.med.ucla.edu/pages/nicholas-jackson\">Nicholas Jackson\u003c/a>, now a senior statistician at the University of California, Los Angeles, wondered what would happen if he could rule out some of those elements by comparing twins.\u003c/p>\n\u003cp>\"Individuals that share the same genes, grew up in the same household, where the difference between them was that one of the twins was using marijuana and one was not,\" Jackson says.\u003c/p>\n\u003cp>Jackson and \u003ca href=\"https://www.researchgate.net/profile/Joshua_Isen\">Joshua Isen\u003c/a>, now an assistant professor of psychology at the University of South Alabama, conducted \u003ca href=\"http://www.pnas.org/content/113/5/E500.abstract\">a study\u003c/a> comparing IQ tests of twins age 9 to 12, before either had smoked marijuana, and then seven to 10 years later, after one had started.\u003c/p>\n\u003cp>\"If marijuana was causing IQ decline, what we would expect to see is that the twin who goes on and uses marijuana should have IQ deficits,\" Jackson says. \"We don't find that.\"\u003c/p>\n\u003cp>IQ scores for both twins varied slightly over time. And for twins who smoked marijuana, there was no significant difference in effect between daily and occasional use. So was the New Zealand finding wrong? The authors did not comment for this story, but have said that the twins study of teenagers does not address the effects of decades of heavy marijuana use.\u003c/p>\n\u003cp>Marijuana seems to affect a particular kind of intelligence, like short term retention of vocabulary words and other information that you might learn in school, says \u003ca href=\"http://www.albany.edu/psychology/20874.php\">Mitch Earleywine\u003c/a>, a professor of psychology at the University of Albany.\u003c/p>\n\u003cp>\"They haven't learned a whole lot of vocabulary words or they never learned the capital of Maine because they were high at school that day,\" he says. \"But when it comes to things that are more liquid intelligence, more fluid intelligence, they're usually pretty good at those because it requires just intelligence in the moment, so to speak.\"\u003c/p>\n\u003cp>It's not clear how marijuana use may keep Augusta from being filed next to \"capital of Maine\" in the brain. Some studies that \u003ca href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3930618/\">compare brain scans\u003c/a> of teenagers who use marijuana to those who don't show thinner, less dense connections between lobes. \u003ca href=\"https://www.drugabuse.gov/about-nida/directors-page/biography-dr-nora-volkow\">Nora Volkow\u003c/a>, director of the National Institute on Drug Abuse, says brains with less connectivity don't work as well as they should.\u003c/p>\n\u003cp>\"You could expect that that will decrease your capacity to memorize things and to learn them which is necessary to you to actually further develop your cognitive abilities,\" she says.\u003c/p>\n\u003cp>Volkow says there's little proof that marijuana causes poor brain connections. Studies so far have not compared brains before and after pot. Maybe kids who are already having trouble in school are more likely to try marijuana. Still, she is convinced that marijuana is bad for the brains of adults who began smoking in their youth.\u003c/p>\n\u003cp>People who regularly smoked marijuana as teens, \"are achieving much less both in their education as well as their profession as well as their economic earnings,\" Volkow says. \"They also tend to be much more dissatisfied with life. Many studies have shown that.\"\u003c/p>\n\u003cp>NIDA is one of several agencies behind a major study that will map the effects of marijuana and other substances on brain development. The Adolescent Brain and Cognitive Development Study (ABCD) will follow 10,000 9- to 10- year-olds through early adulthood, using neuroimaging to map changes in the brain.\u003c/p>\n\u003cp>But as of now, the research suggests if you don't start young and don't use marijuana often, there's not much evidence of permanent harm to the brain. That's led some experts in marijuana brain science to say it might be OK to make pot legal, with strong oversight. That includes \u003ca href=\"http://drkevinhill.com/three-big-reasons-marijuana-is-misunderstood/\">Kevin Hill,\u003c/a> an assistant professor of psychiatry at Harvard Medical School.\u003c/p>\n\u003cp>\"I'm not sure how I would vote [on the Massachusetts ballot question] at this point. I want to see sensible marijuana policy that works, that gives people what they want while limiting risk,\" says Hill, who wrote \u003ca href=\"https://www.amazon.com/Marijuana-Unbiased-Truth-World%C2%92s-Popular/dp/1616495596\">Marijuana: The Unbiased Truth about the World's Most Popular Weed\u003c/a>.\u003c/p>\n\u003cp>Massachusetts is one of five states, including Arizona, California, Maine and Nevada, that will vote in November on legalizing recreational marijuana.\u003c/p>\n\u003cp>Hill would like to see stronger regulation of marijuana if it becomes legal, with limits on advertising and of edible products that attract children, as well as a higher rate of taxation than the proposed 12 percent. If Massachusetts approves marijuana for recreational use, it would not be legal for anyone under age 21, when most, but not all, brain development occurs.\u003c/p>\n\u003cp>\u003cem>This story is part of a reporting partnership with NPR, WBUR and \u003c/em>\u003ca href=\"http://www.kaiserhealthnews.org/\">Kaiser Health News\u003c/a>.\u003c/p>\n\u003c/div>\n\u003cdiv class=\"tags\">\u003c/div>\n\u003cp>\u003c/p>\u003c/div>",
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"disqusTitle": "Some Insurers Require Genetic Counseling Before Breast Cancer Tests",
"title": "Some Insurers Require Genetic Counseling Before Breast Cancer Tests",
"headTitle": "KQED Future of You | KQED Science",
"content": "\u003cp>Health care providers and insurers agree that it’s in everyone’s best interest to refer women for genetic testing if their family history of breast or ovarian cancer puts them at higher risk. What they don’t agree on is what should happen before testing, specifically whether women need to be advised by a certified genetic counselor or someone with similar training before the test is ordered.\u003c/p>\n\u003caside class=\"pullquote alignright\">'Too often the wrong tests were being ordered.'\u003c/aside>\n\u003cp>On the one hand, obstetrician-gynecologists say that counseling patients about hereditary cancers of the breast, ovaries, uterus and other reproductive organs is part of their normal routine, as is counseling pregnant patients about prenatal genetic testing. As licensed physicians, they are considered competent to provide this type of care.\u003c/p>\n\u003cp>“This is what we do,” said Dr. Mark DeFrancesco, the immediate past president of the American Congress of Obstetricians and Gynecologists, noting that most physicians have been taking family histories since medical school. “There are simple-to-understand criteria for who should be considered for genetic testing, and it usually has to do with whether you or someone in your family has had cancer.”\u003c/p>\n\u003cp>DeFrancesco recalled a patient whose mother, grandmother and maternal aunt all had breast cancer, but the insurer required she see a genetic counselor before testing would be approved. In such cases, “it will take a few extra weeks to get tested, and she might decide not to bother,” he said.\u003c/p>\n\u003cp>DeFrancesco said genetic counselors have an important role to play after testing has been done to help patients who test positive for a genetic mutation understand the results.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>In a statement released last December, the physicians group said it opposed such a restriction and warned that it limits patients’ access to care.\u003c/p>\n\u003cp>\u003cstrong>Insurers' View\u003c/strong>\u003c/p>\n\u003cp>Insurers sometimes take a different view, although their rules vary. Two national insurers, UnitedHealthcare and Cigna, require women to receive counseling by a certified genetic counselor or other professional trained in cancer genetics before they will approve coverage for tests that look for mutations in two genes, BRCA1 and BRCA2, that increase the risk for breast, ovarian and other cancers.\u003c/p>\n\u003cp>UnitedHealthcare began requiring genetic counseling for BRCA tests in January. The insurer allows physicians to do the counseling themselves if they attest they’re qualified to do so, said Dr. Lee Newcomer, senior vice president for oncology and genetics.\u003c/p>\n\u003cp>Cigna made counseling a requirement in 2013 for BRCA and colorectal hereditary cancers and a heart condition called Long-QT. In July, the company expanded the list to include all hereditary cancers. Cigna generally requires physicians to get additional training in cancer genetics in order to meet its counseling requirement, said Dr. Jeffrey Hankoff, Cigna’s medical officer for clinical performance and quality.\u003c/p>\n\u003cp>BRCA mutations increase a woman’s risk of developing breast cancer by age 70 by between 45 and 65 percent. They account for 5 to 10 percent of all breast cancers. BRCA mutations raise women’s risk of ovarian and other cancers as well. There are other known genetic mutations that also increase a woman’s risk for breast and ovarian cancers, but they are less commonly tested for.\u003c/p>\n\u003cp>The U.S. Preventive Services Task Force, an independent panel of medical experts, recommends that women with a family history of breast, ovarian, fallopian tube or peritoneal cancer be screened to determine if they’re at increased risk for BRCA mutations and referred for genetic counseling and testing, if indicated.\u003c/p>\n\u003cp>Under the health law, women with insurance aren’t responsible for paying anything out of pocket for the testing and counseling recommended by the task force if it’s performed by in-network providers.\u003c/p>\n\u003cp>The health law coverage requirement didn’t drive Cigna’s BRCA genetic counseling decision, said Hankoff.\u003c/p>\n\u003cp>“We had concerns that people were having testing ordered that didn’t appear to need it and probably didn’t understand it,” Hankoff said. In addition, “Too often the wrong tests were being ordered.”\u003c/p>\n\u003cp>For example, a woman whose sister has been diagnosed with breast cancer and tested positive for a specific mutation doesn’t need a genetic test that looks for all hereditary breast cancer mutations, Hankoff said. She only needs to be tested for the specific mutation that her sister has.\u003c/p>\n\u003cp>Genetic counselors, meanwhile, try to walk a middle line in the debate. To become certified, people complete a master’s degree program that encompasses both classroom study and clinical training in genetics, ethics and the psychosocial aspects of helping families through diagnosis and the decision-making process, among other things. Certification by the American Board of Genetic Counseling is typically required in order to practice.\u003c/p>\n\u003cp>“There are a lot of complexities with genetic testing,” said Mary Freivogel, president-elect of the National Society of Genetic Counselors, who practices in the Denver area. “A lot of [OB-GYNs] don’t have the time or interest to do this well.”\u003c/p>\n\u003cp>With the number of genetic tests growing by leaps and bounds, meeting the demand for counseling can be a challenge, experts agree.\u003c/p>\n\u003cp>Physicians don’t necessarily get it right. For one thing, they often aren’t great at taking family histories, neglecting to gather information about the men in a family, for example, or factoring in close relatives who died at a young age, said Robert Smith, a cancer epidemiologist who is vice president for cancer screening at the American Cancer Society.\u003c/p>\n\u003cp>“Not everybody has a set of family members that allow for the elevated risk to be obvious,” Smith said. “There’s a lot to be said for having a specialist do it.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Please visit khn.org/columnists to send comments or ideas for future topics for the Insuring Your Health column.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Health care providers and insurers agree that it’s in everyone’s best interest to refer women for genetic testing if their family history of breast or ovarian cancer puts them at higher risk. What they don’t agree on is what should happen before testing, specifically whether women need to be advised by a certified genetic counselor or someone with similar training before the test is ordered.\u003c/p>\n\u003caside class=\"pullquote alignright\">'Too often the wrong tests were being ordered.'\u003c/aside>\n\u003cp>On the one hand, obstetrician-gynecologists say that counseling patients about hereditary cancers of the breast, ovaries, uterus and other reproductive organs is part of their normal routine, as is counseling pregnant patients about prenatal genetic testing. As licensed physicians, they are considered competent to provide this type of care.\u003c/p>\n\u003cp>“This is what we do,” said Dr. Mark DeFrancesco, the immediate past president of the American Congress of Obstetricians and Gynecologists, noting that most physicians have been taking family histories since medical school. “There are simple-to-understand criteria for who should be considered for genetic testing, and it usually has to do with whether you or someone in your family has had cancer.”\u003c/p>\n\u003cp>DeFrancesco recalled a patient whose mother, grandmother and maternal aunt all had breast cancer, but the insurer required she see a genetic counselor before testing would be approved. In such cases, “it will take a few extra weeks to get tested, and she might decide not to bother,” he said.\u003c/p>\n\u003cp>DeFrancesco said genetic counselors have an important role to play after testing has been done to help patients who test positive for a genetic mutation understand the results.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>In a statement released last December, the physicians group said it opposed such a restriction and warned that it limits patients’ access to care.\u003c/p>\n\u003cp>\u003cstrong>Insurers' View\u003c/strong>\u003c/p>\n\u003cp>Insurers sometimes take a different view, although their rules vary. Two national insurers, UnitedHealthcare and Cigna, require women to receive counseling by a certified genetic counselor or other professional trained in cancer genetics before they will approve coverage for tests that look for mutations in two genes, BRCA1 and BRCA2, that increase the risk for breast, ovarian and other cancers.\u003c/p>\n\u003cp>UnitedHealthcare began requiring genetic counseling for BRCA tests in January. The insurer allows physicians to do the counseling themselves if they attest they’re qualified to do so, said Dr. Lee Newcomer, senior vice president for oncology and genetics.\u003c/p>\n\u003cp>Cigna made counseling a requirement in 2013 for BRCA and colorectal hereditary cancers and a heart condition called Long-QT. In July, the company expanded the list to include all hereditary cancers. Cigna generally requires physicians to get additional training in cancer genetics in order to meet its counseling requirement, said Dr. Jeffrey Hankoff, Cigna’s medical officer for clinical performance and quality.\u003c/p>\n\u003cp>BRCA mutations increase a woman’s risk of developing breast cancer by age 70 by between 45 and 65 percent. They account for 5 to 10 percent of all breast cancers. BRCA mutations raise women’s risk of ovarian and other cancers as well. There are other known genetic mutations that also increase a woman’s risk for breast and ovarian cancers, but they are less commonly tested for.\u003c/p>\n\u003cp>The U.S. Preventive Services Task Force, an independent panel of medical experts, recommends that women with a family history of breast, ovarian, fallopian tube or peritoneal cancer be screened to determine if they’re at increased risk for BRCA mutations and referred for genetic counseling and testing, if indicated.\u003c/p>\n\u003cp>Under the health law, women with insurance aren’t responsible for paying anything out of pocket for the testing and counseling recommended by the task force if it’s performed by in-network providers.\u003c/p>\n\u003cp>The health law coverage requirement didn’t drive Cigna’s BRCA genetic counseling decision, said Hankoff.\u003c/p>\n\u003cp>“We had concerns that people were having testing ordered that didn’t appear to need it and probably didn’t understand it,” Hankoff said. In addition, “Too often the wrong tests were being ordered.”\u003c/p>\n\u003cp>For example, a woman whose sister has been diagnosed with breast cancer and tested positive for a specific mutation doesn’t need a genetic test that looks for all hereditary breast cancer mutations, Hankoff said. She only needs to be tested for the specific mutation that her sister has.\u003c/p>\n\u003cp>Genetic counselors, meanwhile, try to walk a middle line in the debate. To become certified, people complete a master’s degree program that encompasses both classroom study and clinical training in genetics, ethics and the psychosocial aspects of helping families through diagnosis and the decision-making process, among other things. Certification by the American Board of Genetic Counseling is typically required in order to practice.\u003c/p>\n\u003cp>“There are a lot of complexities with genetic testing,” said Mary Freivogel, president-elect of the National Society of Genetic Counselors, who practices in the Denver area. “A lot of [OB-GYNs] don’t have the time or interest to do this well.”\u003c/p>\n\u003cp>With the number of genetic tests growing by leaps and bounds, meeting the demand for counseling can be a challenge, experts agree.\u003c/p>\n\u003cp>Physicians don’t necessarily get it right. For one thing, they often aren’t great at taking family histories, neglecting to gather information about the men in a family, for example, or factoring in close relatives who died at a young age, said Robert Smith, a cancer epidemiologist who is vice president for cancer screening at the American Cancer Society.\u003c/p>\n\u003cp>“Not everybody has a set of family members that allow for the elevated risk to be obvious,” Smith said. “There’s a lot to be said for having a specialist do it.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Please visit khn.org/columnists to send comments or ideas for future topics for the Insuring Your Health column.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>A recent study making \u003ca href=\"https://ww2.kqed.org/futureofyou/2016/08/24/with-gene-test-some-breast-cancer-patients-can-skip-chemo-study/\" target=\"_blank\">headlines\u003c/a> around the world found that some early-stage breast cancer patients could avoid chemotherapy with only a slightly higher risk of the cancer recurring and spreading than those who underwent the treatment.\u003c/p>\n\u003caside class=\"pullquote alignright\">There is often potential variation in study numbers that make the headlines.\u003c/aside>\n\u003cp>The study found that after five years, women with a particular genetic profile--uncovered in a genetic test--fared hardly any better after chemo than woman who skipped the treatment.\u003c/p>\n\u003cp>The cancer failed to spread in 95.9 percent of the women who received chemotherapy, compared to 94.5 percent of those who went without it.\u003c/p>\n\u003cp>This appears to mean that if you have the right genetic profile, you would be taking on only a 1.5 percent greater risk by avoiding a costly treatment known for side effects such as hair loss, mouth sores, diarrhea and, in rare cases, leukemia or other diseases.\u003c/p>\n\u003cp>[contextly_sidebar id=\"umpVHsLRM86oNnIerZgYm9lySd4eYGjp\"]Deanna Attai, assistant clinical professor of surgery at the David Geffen School of Medicine at the University of California, Los Angeles, told Health News Review that one of her takeaways from the study was that it is \"very clear that not all patients benefit from chemotherapy. Our old habit of recommending chemotherapy 'just to be sure' is not appropriate.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>While that may be true for some clinicians and patients, a close look at the study results shows there is more potential variation in the risk rates than the headline number of 1.5 percent suggests.\u003c/p>\n\u003cp>That's because the narrow, 1.5 percent difference between the two groups could be just \u003ca href=\"http://www.wisegeek.com/what-is-statistical-noise.htm\" target=\"_blank\">statistical noise\u003c/a>--a random variation that would not be duplicated if the experiment were run again. If and when someone replicates this study, it could turn out that women who get chemo might do a bit worse or might do a bit better. And the same is true for women who don't get chemo.\u003c/p>\n\u003cp>How would you know that?\u003c/p>\n\u003cp>You'd have to look for two numbers that are sometimes deep in the data. These numbers are really different sides of the same coin and are related to each other. These two measures can often give you some idea about how significant a result really is.\u003c/p>\n\u003cp>\u003cstrong>Are the Results Significant?\u003c/strong>\u003c/p>\n\u003cp>One way to tell if a result is significant--meaning not due to chance-- is by looking for the number that tells you how likely it is the result is random. That number is called the p-value.\u003c/p>\n\u003cfigure id=\"attachment_234680\" class=\"wp-caption alignright\" style=\"max-width: 800px\">\u003ca href=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/08/ChemoNCI.jpg\">\u003cimg class=\"wp-image-234680 size-medium\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/08/ChemoNCI-800x475.jpg\" alt=\"Woman receiving chemotherapy.\" width=\"800\" height=\"475\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Woman receiving chemotherapy.\u003c/figcaption>\u003c/figure>\n\u003cp>A p-value of 0.1 means there is a 10 percent chance the result happened randomly. A 0.2 translates into a 20 percent chance the result is random, and so on. Scientists have decided that in most experiments, a result is significant if the p-value is less than 0.05. (Though this threshold of validity is not without \u003ca href=\"http://amstat.tandfonline.com/doi/abs/10.1080/00031305.2016.1154108\" target=\"_blank\">controversy\u003c/a>.)\u003c/p>\n\u003cp>So when trying to determine the significance of a particular result, you should look for the p-value that's associated with it. Ideally you want this number to be lower than 0.05. Anything much higher could be a red flag.\u003c/p>\n\u003cp>In the breast cancer study, it turns out that the p-value for the 1.5 percent lower risk offered by chemotherapy is 0.27. That is very high for a scientific study. It means there is a 27 percent chance the result was random.\u003c/p>\n\u003cp>\"That is pretty highly insignificant,\" Susan Wei, an assistant professor in the Division of Biostatistics at the University of Minnesota, told \u003ca href=\"http://www.healthnewsreview.org/2016/08/much-significance-health-news-give-statistically-nonsignificant-results-case-study-stories-skipping-breast-cancer-chemo/\" target=\"_blank\">Health News Review\u003c/a>.\u003c/p>\n\u003cp>In other words, the study can’t say with certainty that a woman who chooses not to have chemo actually takes on only a 1.5 percent higher risk. The risk could be somewhat higher or lower, and this may or may not make a difference in someone's treatment decisions.\u003c/p>\n\u003cp>\u003cstrong>How Confident Can You Be in the Results?\u003c/strong>\u003c/p>\n\u003cp>Another way to evaluate a result involves looking at how confident researchers are that they would get the same result if they repeated the experiment. This is another way of asking whether or not the study is relevant for a broader population.\u003c/p>\n\u003cp>This measure is called the \"95 percent confidence interval,\" or CI.\u003c/p>\n\u003cp>The CI tells you that 95 percent of the time, when the experiment is repeated, the result will fall between a specific range of numbers. Ideally, you want this range to be small. The wider the range of possible results, the less confidence the researcher can have in the particular result they got.\u003c/p>\n\u003cp>It's something like the margin of error in a poll: If it's too great, it will put the outcome in doubt.\u003c/p>\n\u003cp>Let's take a made-up poll that shows Hillary Clinton beating Donald Trump 40-33. That sounds very good for Clinton supporters. But if the margin of error were 10 percent, that would mean the poll results could actually be 50-23 in favor of Clinton or 30-43 in favor of Trump. When the margin of error is so large it can swing the outcome in the opposite direction, that means the poll results are statistically in question.\u003c/p>\n\u003cp>If the margin of error were only, say, three percent, the narrowest lead Clinton could have would be 37 to 36; there is no potential change in the outcome -- she still wins.\u003c/p>\n\u003cp>Now let's look at the breast cancer study.\u003c/p>\n\u003cp>Of the women who received chemo, 95.9 percent of them made it to the 5-year mark with no breast cancer spreading.\u003c/p>\n\u003cp>But a more complete reporting of the results shows the CI for that group of women is a range between 94 and 97.2 percent. That means if someone repeats the experiment, the number of women who receive chemo and make it five years with no cancer spreading could be anywhere between 94 and 97.2 percent. So the benefit of getting chemo could be higher or lower than the study suggests.\u003c/p>\n\u003cp>For the women who didn't get chemo, the CI is between 92.3 and 95.9 percent.\u003c/p>\n\u003cp>Chemo: 94 to 97.2 percent\u003c/p>\n\u003cp>No Chemo: 92.3 to 95.9 percent\u003c/p>\n\u003cp>It means the study isn't able to say that if you have a particular genetic profile, you can avoid chemotherapy and do just as well after five years as women who get chemo. You can't know the answer to that because the possible results have such a wide range and overlap that they can even swing the outcome in the opposite direction:\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe id=\"datawrapper-chart-eJ9aC\" src=\"//datawrapper.dwcdn.net/eJ9aC/3/\" frameborder=\"0\" allowtransparency=\"true\" allowfullscreen=\"allowfullscreen\" webkitallowfullscreen=\"webkitallowfullscreen\" mozallowfullscreen=\"mozallowfullscreen\" oallowfullscreen=\"oallowfullscreen\" msallowfullscreen=\"msallowfullscreen\" width=\"100%\" height=\"230\" scrolling=\"yes\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003cp>Bottom line, the CI tells you the study can't say whether or not women with this particular genetic profile can safely avoid chemo and do almost as well five years later as those who got chemo. Researchers would need to repeat the experiment, maybe several times, maybe with a larger group or by making other changes, to get a more confident answer.\u003c/p>\n\u003cp>That doesn't make this a bad study; it still showed that a lot of women with a certain genetic profile did not have their cancer spread despite foregoing chemo. However, the results still need to be more firmly proved.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>Attai, the UCLA surgery professor, told Health News Review: \"Studies like these often raise more questions and prompt discussion. It is important to note that we do not yet have the 'crystal ball' that will tell an individual patient with absolute certainty that their cancer will recur or not. We are closer than we’ve ever been, but we do not have a test that will predict the outcome with 100 percent certainty.\"\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>A recent study making \u003ca href=\"https://ww2.kqed.org/futureofyou/2016/08/24/with-gene-test-some-breast-cancer-patients-can-skip-chemo-study/\" target=\"_blank\">headlines\u003c/a> around the world found that some early-stage breast cancer patients could avoid chemotherapy with only a slightly higher risk of the cancer recurring and spreading than those who underwent the treatment.\u003c/p>\n\u003caside class=\"pullquote alignright\">There is often potential variation in study numbers that make the headlines.\u003c/aside>\n\u003cp>The study found that after five years, women with a particular genetic profile--uncovered in a genetic test--fared hardly any better after chemo than woman who skipped the treatment.\u003c/p>\n\u003cp>The cancer failed to spread in 95.9 percent of the women who received chemotherapy, compared to 94.5 percent of those who went without it.\u003c/p>\n\u003cp>This appears to mean that if you have the right genetic profile, you would be taking on only a 1.5 percent greater risk by avoiding a costly treatment known for side effects such as hair loss, mouth sores, diarrhea and, in rare cases, leukemia or other diseases.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>Deanna Attai, assistant clinical professor of surgery at the David Geffen School of Medicine at the University of California, Los Angeles, told Health News Review that one of her takeaways from the study was that it is \"very clear that not all patients benefit from chemotherapy. Our old habit of recommending chemotherapy 'just to be sure' is not appropriate.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>While that may be true for some clinicians and patients, a close look at the study results shows there is more potential variation in the risk rates than the headline number of 1.5 percent suggests.\u003c/p>\n\u003cp>That's because the narrow, 1.5 percent difference between the two groups could be just \u003ca href=\"http://www.wisegeek.com/what-is-statistical-noise.htm\" target=\"_blank\">statistical noise\u003c/a>--a random variation that would not be duplicated if the experiment were run again. If and when someone replicates this study, it could turn out that women who get chemo might do a bit worse or might do a bit better. And the same is true for women who don't get chemo.\u003c/p>\n\u003cp>How would you know that?\u003c/p>\n\u003cp>You'd have to look for two numbers that are sometimes deep in the data. These numbers are really different sides of the same coin and are related to each other. These two measures can often give you some idea about how significant a result really is.\u003c/p>\n\u003cp>\u003cstrong>Are the Results Significant?\u003c/strong>\u003c/p>\n\u003cp>One way to tell if a result is significant--meaning not due to chance-- is by looking for the number that tells you how likely it is the result is random. That number is called the p-value.\u003c/p>\n\u003cfigure id=\"attachment_234680\" class=\"wp-caption alignright\" style=\"max-width: 800px\">\u003ca href=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/08/ChemoNCI.jpg\">\u003cimg class=\"wp-image-234680 size-medium\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/08/ChemoNCI-800x475.jpg\" alt=\"Woman receiving chemotherapy.\" width=\"800\" height=\"475\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Woman receiving chemotherapy.\u003c/figcaption>\u003c/figure>\n\u003cp>A p-value of 0.1 means there is a 10 percent chance the result happened randomly. A 0.2 translates into a 20 percent chance the result is random, and so on. Scientists have decided that in most experiments, a result is significant if the p-value is less than 0.05. (Though this threshold of validity is not without \u003ca href=\"http://amstat.tandfonline.com/doi/abs/10.1080/00031305.2016.1154108\" target=\"_blank\">controversy\u003c/a>.)\u003c/p>\n\u003cp>So when trying to determine the significance of a particular result, you should look for the p-value that's associated with it. Ideally you want this number to be lower than 0.05. Anything much higher could be a red flag.\u003c/p>\n\u003cp>In the breast cancer study, it turns out that the p-value for the 1.5 percent lower risk offered by chemotherapy is 0.27. That is very high for a scientific study. It means there is a 27 percent chance the result was random.\u003c/p>\n\u003cp>\"That is pretty highly insignificant,\" Susan Wei, an assistant professor in the Division of Biostatistics at the University of Minnesota, told \u003ca href=\"http://www.healthnewsreview.org/2016/08/much-significance-health-news-give-statistically-nonsignificant-results-case-study-stories-skipping-breast-cancer-chemo/\" target=\"_blank\">Health News Review\u003c/a>.\u003c/p>\n\u003cp>In other words, the study can’t say with certainty that a woman who chooses not to have chemo actually takes on only a 1.5 percent higher risk. The risk could be somewhat higher or lower, and this may or may not make a difference in someone's treatment decisions.\u003c/p>\n\u003cp>\u003cstrong>How Confident Can You Be in the Results?\u003c/strong>\u003c/p>\n\u003cp>Another way to evaluate a result involves looking at how confident researchers are that they would get the same result if they repeated the experiment. This is another way of asking whether or not the study is relevant for a broader population.\u003c/p>\n\u003cp>This measure is called the \"95 percent confidence interval,\" or CI.\u003c/p>\n\u003cp>The CI tells you that 95 percent of the time, when the experiment is repeated, the result will fall between a specific range of numbers. Ideally, you want this range to be small. The wider the range of possible results, the less confidence the researcher can have in the particular result they got.\u003c/p>\n\u003cp>It's something like the margin of error in a poll: If it's too great, it will put the outcome in doubt.\u003c/p>\n\u003cp>Let's take a made-up poll that shows Hillary Clinton beating Donald Trump 40-33. That sounds very good for Clinton supporters. But if the margin of error were 10 percent, that would mean the poll results could actually be 50-23 in favor of Clinton or 30-43 in favor of Trump. When the margin of error is so large it can swing the outcome in the opposite direction, that means the poll results are statistically in question.\u003c/p>\n\u003cp>If the margin of error were only, say, three percent, the narrowest lead Clinton could have would be 37 to 36; there is no potential change in the outcome -- she still wins.\u003c/p>\n\u003cp>Now let's look at the breast cancer study.\u003c/p>\n\u003cp>Of the women who received chemo, 95.9 percent of them made it to the 5-year mark with no breast cancer spreading.\u003c/p>\n\u003cp>But a more complete reporting of the results shows the CI for that group of women is a range between 94 and 97.2 percent. That means if someone repeats the experiment, the number of women who receive chemo and make it five years with no cancer spreading could be anywhere between 94 and 97.2 percent. So the benefit of getting chemo could be higher or lower than the study suggests.\u003c/p>\n\u003cp>For the women who didn't get chemo, the CI is between 92.3 and 95.9 percent.\u003c/p>\n\u003cp>Chemo: 94 to 97.2 percent\u003c/p>\n\u003cp>No Chemo: 92.3 to 95.9 percent\u003c/p>\n\u003cp>It means the study isn't able to say that if you have a particular genetic profile, you can avoid chemotherapy and do just as well after five years as women who get chemo. You can't know the answer to that because the possible results have such a wide range and overlap that they can even swing the outcome in the opposite direction:\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe id=\"datawrapper-chart-eJ9aC\" src=\"//datawrapper.dwcdn.net/eJ9aC/3/\" frameborder=\"0\" allowtransparency=\"true\" allowfullscreen=\"allowfullscreen\" webkitallowfullscreen=\"webkitallowfullscreen\" mozallowfullscreen=\"mozallowfullscreen\" oallowfullscreen=\"oallowfullscreen\" msallowfullscreen=\"msallowfullscreen\" width=\"100%\" height=\"230\" scrolling=\"yes\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003cp>Bottom line, the CI tells you the study can't say whether or not women with this particular genetic profile can safely avoid chemo and do almost as well five years later as those who got chemo. Researchers would need to repeat the experiment, maybe several times, maybe with a larger group or by making other changes, to get a more confident answer.\u003c/p>\n\u003cp>That doesn't make this a bad study; it still showed that a lot of women with a certain genetic profile did not have their cancer spread despite foregoing chemo. However, the results still need to be more firmly proved.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Attai, the UCLA surgery professor, told Health News Review: \"Studies like these often raise more questions and prompt discussion. It is important to note that we do not yet have the 'crystal ball' that will tell an individual patient with absolute certainty that their cancer will recur or not. We are closer than we’ve ever been, but we do not have a test that will predict the outcome with 100 percent certainty.\"\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Hundreds of clinics around the country are offering to treat a long list of health problems with stem cells.\u003c/p>\n\u003cp>The clinics claim that stem cells found in fat tissue, blood, bone marrow and even placentas can help people suffering from arthritic joints and torn tendons to more serious medical problems, including spinal cord injuries, Parkinson's disease and strokes. Some even \u003ca href=\"http://www.stemcell.life/autism.html\">claim\u003c/a> the cells can help children with autism.\u003c/p>\n\u003cp>But leading stem cell researchers say there's not enough evidence to support the clinics' claims.\u003c/p>\n\u003cp>Doctors have long used \u003ca href=\"http://stemcells.nih.gov/info/basics/Pages/Default.aspx\">stem cells\u003c/a> from bone marrow and blood to treat some \u003ca href=\"http://www.cancer.gov/about-cancer/treatment/types/stem-cell-transplant/stem-cell-fact-sheet\">types of cancer,\u003c/a> such as leukemia and lymphoma. And stem cells are being widely studied as potential treatments for other health problems. Researchers hope stem cells may someday make it possible to repair or replace damaged cells, tissues and even entire organs — but there are very few treatments currently available that have been proven safe and effective.\u003c/p>\n\u003cp>\"There's a lot of sketchy stuff going on,\" says \u003ca href=\"https://daley.med.harvard.edu/\">George Daley\u003c/a>, a Harvard stem cell researcher.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"You've got clinics springing up, taking a patient's own cells and then injecting these cells into arthritic joints, into spinal cords, into the brain. And there's really no evidence this is going to work,\" says Daley. \"In fact, there are major concerns about safety.\"\u003c/p>\n\u003cp>The treatments could cause life-threatening infections, create tumors or trigger dangerous reactions by a patient's immune system, says Daley and other stem cell researchers.\u003c/p>\n\u003cp>So far the \u003ca href=\"http://www.fda.gov/default.htm\">Food and Drug Administration\u003c/a> has not aggressively regulated stem cell clinics. The reason is the stem cells being used typically come from the patient's own body — \u003ca href=\"https://www.mskcc.org/cancer-care/treatments/cancer-treatments/blood-stem-cell-transplantation/approach/autologous-transplantation\">an autologous transplant\u003c/a>. And the clinics don't process the cells much before injecting them.\u003c/p>\n\u003cp>But now that the treatments are being offered so much more widely, the FDA is considering more aggressive regulation. As part of that process, the agency will hold a workshop this Thursday, followed by a two-day hearing next week.\u003c/p>\n\u003cp>Another issue is cost. Patients are paying thousands of dollars for these treatments, which are not covered by insurance.\u003c/p>\n\u003cp>\"We're talking about really big bucks here,\" says \u003ca href=\"http://www.ucdmc.ucdavis.edu/cellbio/faculty/knoepfler/\">Paul Knoepfler\u003c/a>, a stem cell scientist at the University of California, Davis, who monitors health and safety issues with stem cell clinics in his \u003ca href=\"http://www.ipscell.com/\">blog\u003c/a>.\u003c/p>\n\u003cp>The treatments can cost from $5,000 to as much as $100,000, Knoepfler reports in an \u003ca href=\"http://www.cell.com/cell-stem-cell/abstract/S1934-5909%2816%2930157-6\">article\u003c/a> recently published in the journal \u003cem>Cell Stem Cell.\u003c/em> He estimates that there are more than 500 stem cell clinics treating as many as 100,000 patients a year in the United States.\u003c/p>\n\u003cp>Knoepfler hopes the FDA will crack down on the clinics.\u003c/p>\n\u003cp>\"The FDA needs to step up its game on this, because otherwise this could continue to grow as an industry, and it's just going to put more and more people at risk,\" he says.\u003c/p>\n\u003cp>The clinics defend what they're doing.\u003c/p>\n\u003cp>\"Patients should have access to their own body tissue,\" says \u003ca href=\"http://us-stemcell.com/en/about-us/\">Kristin Comella\u003c/a>, chief scientific officer at the \u003ca href=\"http://usstemcellclinic.com/en/home/\">U.S. Stem Cell\u003c/a> clinic, which is based in Sunrise, Fla. Comella also serves as president of the \u003ca href=\"http://www.regenerativeacademy.com/\">Academy of Regenerative Practices\u003c/a>, which represents the clinics.\u003c/p>\n\u003cp>If patients \"are able to provide and give informed consent to move forward with these treatments, that is their right,\" Comella says. \"In particular for diseases where they have not had much success with traditional medicine.\"\u003c/p>\n\u003cp>Comella acknowledges that two of her clinic's patients suffered detached retinas after getting stem cells injected into their eyes. As a result, the clinic has stopped treating eye conditions. But otherwise, Comella says, the clinic has had no serious problems. It offers stem cell treatments for a host of conditions including diabetes, spinal cord injuries and congestive heart failure.\u003c/p>\n\u003cp>\"There are always risks no matter what you're doing. That being said, our group has treated more than 6,000 cases and we've had very few safety events associated with these treatments,\" she says.\u003c/p>\n\u003cp>The clinics point out that the cells they are using are not \u003ca href=\"http://stemcells.nih.gov/info/basics/pages/basics3.aspx\">human embryonic stem cells\u003c/a>, which are controversial because embryos are destroyed to get them. And they're not \u003ca href=\"http://stemcells.nih.gov/info/basics/pages/basics10.aspx\">induced pluripotent stem cells,\u003c/a> which scientists create in the lab.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The FDA has no timetable for when it expects to make any decisions on regulation. In the meantime, the \u003ca href=\"http://stemcells.nih.gov/info/pages/health.aspx\">FDA website\u003c/a> suggests patients carefully research \u003ca href=\"http://www.closerlookatstemcells.org/stem-cells-and-medicine/nine-things-to-know-about-stem-cell-treatments\">any stem cell treatment\u003c/a> before going ahead with it.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Researchers+Question+Safety%2C+Value+Of+Untested+Stem+Cell+Treatments&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Hundreds of clinics around the country are offering to treat a long list of health problems with stem cells.\u003c/p>\n\u003cp>The clinics claim that stem cells found in fat tissue, blood, bone marrow and even placentas can help people suffering from arthritic joints and torn tendons to more serious medical problems, including spinal cord injuries, Parkinson's disease and strokes. Some even \u003ca href=\"http://www.stemcell.life/autism.html\">claim\u003c/a> the cells can help children with autism.\u003c/p>\n\u003cp>But leading stem cell researchers say there's not enough evidence to support the clinics' claims.\u003c/p>\n\u003cp>Doctors have long used \u003ca href=\"http://stemcells.nih.gov/info/basics/Pages/Default.aspx\">stem cells\u003c/a> from bone marrow and blood to treat some \u003ca href=\"http://www.cancer.gov/about-cancer/treatment/types/stem-cell-transplant/stem-cell-fact-sheet\">types of cancer,\u003c/a> such as leukemia and lymphoma. And stem cells are being widely studied as potential treatments for other health problems. Researchers hope stem cells may someday make it possible to repair or replace damaged cells, tissues and even entire organs — but there are very few treatments currently available that have been proven safe and effective.\u003c/p>\n\u003cp>\"There's a lot of sketchy stuff going on,\" says \u003ca href=\"https://daley.med.harvard.edu/\">George Daley\u003c/a>, a Harvard stem cell researcher.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"You've got clinics springing up, taking a patient's own cells and then injecting these cells into arthritic joints, into spinal cords, into the brain. And there's really no evidence this is going to work,\" says Daley. \"In fact, there are major concerns about safety.\"\u003c/p>\n\u003cp>The treatments could cause life-threatening infections, create tumors or trigger dangerous reactions by a patient's immune system, says Daley and other stem cell researchers.\u003c/p>\n\u003cp>So far the \u003ca href=\"http://www.fda.gov/default.htm\">Food and Drug Administration\u003c/a> has not aggressively regulated stem cell clinics. The reason is the stem cells being used typically come from the patient's own body — \u003ca href=\"https://www.mskcc.org/cancer-care/treatments/cancer-treatments/blood-stem-cell-transplantation/approach/autologous-transplantation\">an autologous transplant\u003c/a>. And the clinics don't process the cells much before injecting them.\u003c/p>\n\u003cp>But now that the treatments are being offered so much more widely, the FDA is considering more aggressive regulation. As part of that process, the agency will hold a workshop this Thursday, followed by a two-day hearing next week.\u003c/p>\n\u003cp>Another issue is cost. Patients are paying thousands of dollars for these treatments, which are not covered by insurance.\u003c/p>\n\u003cp>\"We're talking about really big bucks here,\" says \u003ca href=\"http://www.ucdmc.ucdavis.edu/cellbio/faculty/knoepfler/\">Paul Knoepfler\u003c/a>, a stem cell scientist at the University of California, Davis, who monitors health and safety issues with stem cell clinics in his \u003ca href=\"http://www.ipscell.com/\">blog\u003c/a>.\u003c/p>\n\u003cp>The treatments can cost from $5,000 to as much as $100,000, Knoepfler reports in an \u003ca href=\"http://www.cell.com/cell-stem-cell/abstract/S1934-5909%2816%2930157-6\">article\u003c/a> recently published in the journal \u003cem>Cell Stem Cell.\u003c/em> He estimates that there are more than 500 stem cell clinics treating as many as 100,000 patients a year in the United States.\u003c/p>\n\u003cp>Knoepfler hopes the FDA will crack down on the clinics.\u003c/p>\n\u003cp>\"The FDA needs to step up its game on this, because otherwise this could continue to grow as an industry, and it's just going to put more and more people at risk,\" he says.\u003c/p>\n\u003cp>The clinics defend what they're doing.\u003c/p>\n\u003cp>\"Patients should have access to their own body tissue,\" says \u003ca href=\"http://us-stemcell.com/en/about-us/\">Kristin Comella\u003c/a>, chief scientific officer at the \u003ca href=\"http://usstemcellclinic.com/en/home/\">U.S. Stem Cell\u003c/a> clinic, which is based in Sunrise, Fla. Comella also serves as president of the \u003ca href=\"http://www.regenerativeacademy.com/\">Academy of Regenerative Practices\u003c/a>, which represents the clinics.\u003c/p>\n\u003cp>If patients \"are able to provide and give informed consent to move forward with these treatments, that is their right,\" Comella says. \"In particular for diseases where they have not had much success with traditional medicine.\"\u003c/p>\n\u003cp>Comella acknowledges that two of her clinic's patients suffered detached retinas after getting stem cells injected into their eyes. As a result, the clinic has stopped treating eye conditions. But otherwise, Comella says, the clinic has had no serious problems. It offers stem cell treatments for a host of conditions including diabetes, spinal cord injuries and congestive heart failure.\u003c/p>\n\u003cp>\"There are always risks no matter what you're doing. That being said, our group has treated more than 6,000 cases and we've had very few safety events associated with these treatments,\" she says.\u003c/p>\n\u003cp>The clinics point out that the cells they are using are not \u003ca href=\"http://stemcells.nih.gov/info/basics/pages/basics3.aspx\">human embryonic stem cells\u003c/a>, which are controversial because embryos are destroyed to get them. And they're not \u003ca href=\"http://stemcells.nih.gov/info/basics/pages/basics10.aspx\">induced pluripotent stem cells,\u003c/a> which scientists create in the lab.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The FDA has no timetable for when it expects to make any decisions on regulation. In the meantime, the \u003ca href=\"http://stemcells.nih.gov/info/pages/health.aspx\">FDA website\u003c/a> suggests patients carefully research \u003ca href=\"http://www.closerlookatstemcells.org/stem-cells-and-medicine/nine-things-to-know-about-stem-cell-treatments\">any stem cell treatment\u003c/a> before going ahead with it.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Researchers+Question+Safety%2C+Value+Of+Untested+Stem+Cell+Treatments&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"tagline": "The flip side of gentrification, told through one town",
"info": "Gentrification is changing cities across America, forcing people from neighborhoods they have long called home. Call them the displaced. Now those priced out of the Bay Area are looking for a better life in an unlikely place. American Suburb follows this migration to one California town along the Delta, 45 miles from San Francisco. But is this once sleepy suburb ready for them?",
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},
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"tagline": "Exploring the Bay Area, one question at a time",
"info": "KQED’s new podcast, Bay Curious, gets to the bottom of the mysteries — both profound and peculiar — that give the Bay Area its unique identity. And we’ll do it with your help! You ask the questions. You decide what Bay Curious investigates. And you join us on the journey to find the answers.",
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},
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"info": "KQED’s statewide radio news program providing daily coverage of issues, trends and public policy decisions.",
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"order": 8
},
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},
"link": "https://www.cityarts.net",
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"order": 1
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"info": "\u003cem>Code Switch\u003c/em>, which listeners will hear in the first part of the hour, has fearless and much-needed conversations about race. Hosted by journalists of color, the show tackles the subject of race head-on, exploring how it impacts every part of society — from politics and pop culture to history, sports and more.\u003cbr />\u003cbr />\u003cem>Life Kit\u003c/em>, which will be in the second part of the hour, guides you through spaces and feelings no one prepares you for — from finances to mental health, from workplace microaggressions to imposter syndrome, from relationships to parenting. The show features experts with real world experience and shares their knowledge. Because everyone needs a little help being human.\u003cbr />\u003cbr />\u003ca href=\"https://www.npr.org/podcasts/510312/codeswitch\">\u003cem>Code Switch\u003c/em> offical site and podcast\u003c/a>\u003cbr />\u003ca href=\"https://www.npr.org/lifekit\">\u003cem>Life Kit\u003c/em> offical site and podcast\u003c/a>\u003cbr />",
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"id": "commonwealth-club",
"title": "Commonwealth Club of California Podcast",
"info": "The Commonwealth Club of California is the nation's oldest and largest public affairs forum. As a non-partisan forum, The Club brings to the public airwaves diverse viewpoints on important topics. The Club's weekly radio broadcast - the oldest in the U.S., dating back to 1924 - is carried across the nation on public radio stations and is now podcasting. Our website archive features audio of our recent programs, as well as selected speeches from our long and distinguished history. This podcast feed is usually updated twice a week and is always un-edited.",
"airtime": "THU 10pm, FRI 1am",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Commonwealth-Club-Podcast-Tile-360x360-1.jpg",
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"source": "Commonwealth Club of California"
},
"link": "/radio/program/commonwealth-club",
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}
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"tagline": "The conversation starts here",
"info": "KQED’s live call-in program discussing local, state, national and international issues, as well as in-depth interviews.",
"airtime": "MON-FRI 9am-11am, 10pm-11pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Forum-Podcast-Tile-703x703-1.jpg",
"imageAlt": "KQED Forum with Mina Kim and Alexis Madrigal",
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"source": "kqed",
"order": 9
},
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"id": "fresh-air",
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"hidden-brain": {
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"info": "Shankar Vedantam uses science and storytelling to reveal the unconscious patterns that drive human behavior, shape our choices and direct our relationships.",
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"airtime": "SUN 7pm-8pm",
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"source": "NPR"
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"info": "Guy Raz dives into the stories behind some of the world's best known companies. How I Built This weaves a narrative journey about innovators, entrepreneurs and idealists—and the movements they built.",
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"airtime": "SUN 7:30pm-8pm",
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"tagline": "Where conversation and cultura meet",
"info": "What kind of no sabo word is Hyphenación? For us, it’s about living within a hyphenation. Like being a third-gen Mexican-American from the Texas border now living that Bay Area Chicano life. Like Xorje! Each week we bring together a couple of hyphenated Latinos to talk all about personal life choices: family, careers, relationships, belonging … everything is on the table. ",
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"jerrybrown": {
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"title": "The Political Mind of Jerry Brown",
"tagline": "Lessons from a lifetime in politics",
"info": "The Political Mind of Jerry Brown brings listeners the wisdom of the former Governor, Mayor, and presidential candidate. Scott Shafer interviewed Brown for more than 40 hours, covering the former governor's life and half-century in the political game – and Brown has some lessons he'd like to share. ",
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"order": 18
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},
"latino-usa": {
"id": "latino-usa",
"title": "Latino USA",
"airtime": "MON 1am-2am, SUN 6pm-7pm",
"info": "Latino USA, the radio journal of news and culture, is the only national, English-language radio program produced from a Latino perspective.",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/latinoUsa.jpg",
"officialWebsiteLink": "http://latinousa.org/",
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},
"link": "/radio/program/latino-usa",
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"rss": "https://feeds.npr.org/510016/podcast.xml"
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},
"marketplace": {
"id": "marketplace",
"title": "Marketplace",
"info": "Our flagship program, helmed by Kai Ryssdal, examines what the day in money delivered, through stories, conversations, newsworthy numbers and more. Updated Monday through Friday at about 3:30 p.m. PT.",
"airtime": "MON-FRI 4pm-4:30pm, MON-WED 6:30pm-7pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Marketplace-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.marketplace.org/",
"meta": {
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"source": "American Public Media"
},
"link": "/radio/program/marketplace",
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"rss": "https://feeds.publicradio.org/public_feeds/marketplace-pm/rss/rss"
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},
"masters-of-scale": {
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"title": "Masters of Scale",
"info": "Masters of Scale is an original podcast in which LinkedIn co-founder and Greylock Partner Reid Hoffman sets out to describe and prove theories that explain how great entrepreneurs take their companies from zero to a gazillion in ingenious fashion.",
"airtime": "Every other Wednesday June 12 through October 16 at 8pm (repeats Thursdays at 2am)",
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"officialWebsiteLink": "https://mastersofscale.com/",
"meta": {
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"source": "WaitWhat"
},
"link": "/radio/program/masters-of-scale",
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"rss": "https://rss.art19.com/masters-of-scale"
}
},
"mindshift": {
"id": "mindshift",
"title": "MindShift",
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"info": "The MindShift podcast explores the innovations in education that are shaping how kids learn. Hosts Ki Sung and Katrina Schwartz introduce listeners to educators, researchers, parents and students who are developing effective ways to improve how kids learn. We cover topics like how fed-up administrators are developing surprising tactics to deal with classroom disruptions; how listening to podcasts are helping kids develop reading skills; the consequences of overparenting; and why interdisciplinary learning can engage students on all ends of the traditional achievement spectrum. This podcast is part of the MindShift education site, a division of KQED News. KQED is an NPR/PBS member station based in San Francisco. You can also visit the MindShift website for episodes and supplemental blog posts or tweet us \u003ca href=\"https://twitter.com/MindShiftKQED\">@MindShiftKQED\u003c/a> or visit us at \u003ca href=\"/mindshift\">MindShift.KQED.org\u003c/a>",
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