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"content": "\u003cp>\"I'm not comfortable eating a watch battery.\"\u003c/p>\n\u003cp>That's how researcher \u003ca href=\"http://biomicrosystems.net\">Christopher Bettinger\u003c/a> describes one of the biggest obstacles for sending tiny medical robots into the human body for diagnosing and treating diseases.\u003c/p>\n\u003cp>These devices run on batteries (like those in watches) and they are usually made of toxic materials such as lithium.\u003c/p>\n\u003cp>This month, Bettinger, based at Carnegie Mellon University, presented his group's work on creating \u003ca href=\"https://www.acs.org/content/acs/en/pressroom/newsreleases/2016/august/battery-you-can-swallow-could-enable-future-ingestible-medical-devices.html\">edible, nontoxic batteries\u003c/a> at a national meeting of the American Chemical Society, the world's largest scientific society.\u003c/p>\n\u003cp>https://www.youtube.com/watch?time_continue=14&v=bbUiOrMLpLo&ab_channel=AmericanChemicalSociety\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The Bettinger group's battery is made of melanin, a dark pigment found in human skin, hair, eyes and the brain. Bettinger says the current prototype lasts \"for about 16 hours\" and then \"degrades to benign components.\"\u003c/p>\n\u003cp>\"I have eaten one of my batteries and I'm still fine — I'd be fine eating my battery every single day of my life!\" he says.\u003c/p>\n\u003cp>The battery is made from cuttlefish ink extracts and could be used to power \"pacemakers, \u003ca href=\"https://www.sjm.com/en/patients/chronic-pain/managing-chronic-pain/neurostimulation-therapy\">neurostimulators\u003c/a>, devices to deliver drugs at a specific time, ingestible cameras and glucose monitors,\" Bettinger says.\u003c/p>\n\u003cp>Researchers have experimented with melanin-based electronics since \u003ca href=\"http://smithsonianchips.si.edu/proctor/\">the 1970s\u003c/a>, some even winning the \u003ca href=\"https://www.chemheritage.org/historical-profile/alan-g-macdiarmid-alan-j-heeger-and-hideki-shirakawa\">Nobel Prize\u003c/a> for it. Nevertheless, the discoveries had remained largely forgotten until the \u003ca href=\"http://espace.library.uq.edu.au/view/UQ:246993\">late 2000s\u003c/a>, when a type of melanin was shown to be an electronic conductor, which sparked the renewed interest.\u003c/p>\n\u003cp>Riding this tide, Bettinger tried his hand at creating semiconductor chips with melanin. \"It didn't really work at all, but it turns out that the same property that makes it a terrible transistor makes it a great ingredient for a battery,\" he says.\u003c/p>\n\u003cp>By 2013, Bettinger had his \u003ca href=\"http://www.materials360online.com/newsDetails/43482\">first prototype\u003c/a> of a melanin-based battery, with a lifetime of five hours. Three years of subsequent research tripled the battery life and resulted in \"preliminary [partnership] discussions with a few people — mainly big pharma,\" he says.\u003c/p>\n\u003cp>Making batteries with melanin \"is a very, very interesting and powerful idea,\" says \u003ca href=\"https://bioinspiredmaterials.berkeley.edu/\">Phillip Messersmith\u003c/a>, a professor of material sciences at UC Berkeley. \"Biological inspirations are really powerful in the context of sustainable energy storage and sustainable materials,\" he says.\u003c/p>\n\u003cp>\u003ca href=\"http://www.bioe.umd.edu/faculty/payne\">Gregory Payne\u003c/a>, a professor of bioengineering at the University of Maryland, says \"it's pretty important research.\"\u003c/p>\n\u003cp>Bettinger says the melanin battery research is \"still in the preliminary stage.\" While the team \"anticipates very little toxicity response\" to the melanin battery, he says, no clinical trials have been carried out to prove its safety.\u003c/p>\n\u003cp>The current battery prototype contains a small amount of \u003ca href=\"https://www.chemours.com/Teflon/en_US/\">Teflon\u003c/a>, which \"is expensive and toxic in nature ... dangerous to humans and the environment,\" says \u003ca href=\"http://www.polymtl.ca/recherche/rc/en/professeurs/details.php?NoProf=388\">Clara Santato\u003c/a>, a professor of engineering physics at École Polytechnique de Montréal. According to Santato, research to create a Teflon-free melanin battery is underway.\u003c/p>\n\u003cp>Even then, safety questions linger. \"I don't know that there is consensus on the toxicity of melanin,\" Messersmith says. \"It's an open question ... [although] I do not foresee significant problems in the GI tract applications.\"\u003c/p>\n\u003cp>Payne says, \"What is mystifying to me is that melanin is a relatively abundant material in your body but there's very little understanding of what function it performs.\"\u003c/p>\n\u003cp>Melanin comes in many different forms, and some aren't as good for the purpose of making edible batteries. \"One of the concerns about melanin in the brain is that it doesn't degrade rapidly,\" Payne says.\u003c/p>\n\u003cp>So far, it's unclear if a melanin-based battery is completely safe because nobody really knows what melanin is.\u003c/p>\n\u003cp>\"[Chemists] are still debating it. ... it's not that easy to figure out the structure,\" Payne says.\u003c/p>\n\u003cp>Scientists say there's no guarantee that the lab results can be replicated for mass production since so little is known about melanin.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"It can for sure be improved,\" Santato says. \"It's really now the engineering of the molecules.\"\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=How+An+Edible+Battery+Could+Power+Medical+Robots+You+Swallow+&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"excerpt": "Tiny devices sent into the human body for diagnosing and treating diseases run on batteries that may contain toxic materials. Researchers have come up with a safer battery made of natural pigments.",
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"description": "Tiny devices sent into the human body for diagnosing and treating diseases run on batteries that may contain toxic materials. Researchers have come up with a safer battery made of natural pigments.",
"title": "Wait, an Edible Battery? Not So Hard to Swallow | KQED",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\"I'm not comfortable eating a watch battery.\"\u003c/p>\n\u003cp>That's how researcher \u003ca href=\"http://biomicrosystems.net\">Christopher Bettinger\u003c/a> describes one of the biggest obstacles for sending tiny medical robots into the human body for diagnosing and treating diseases.\u003c/p>\n\u003cp>These devices run on batteries (like those in watches) and they are usually made of toxic materials such as lithium.\u003c/p>\n\u003cp>This month, Bettinger, based at Carnegie Mellon University, presented his group's work on creating \u003ca href=\"https://www.acs.org/content/acs/en/pressroom/newsreleases/2016/august/battery-you-can-swallow-could-enable-future-ingestible-medical-devices.html\">edible, nontoxic batteries\u003c/a> at a national meeting of the American Chemical Society, the world's largest scientific society.\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/bbUiOrMLpLo'\n title='//www.youtube.com/embed/bbUiOrMLpLo'\n allowfullscreen='true'\n style='border:0;'>\u003c/iframe>\n \u003c/span>\n \u003c/span>\u003c/p>\u003cp>\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The Bettinger group's battery is made of melanin, a dark pigment found in human skin, hair, eyes and the brain. Bettinger says the current prototype lasts \"for about 16 hours\" and then \"degrades to benign components.\"\u003c/p>\n\u003cp>\"I have eaten one of my batteries and I'm still fine — I'd be fine eating my battery every single day of my life!\" he says.\u003c/p>\n\u003cp>The battery is made from cuttlefish ink extracts and could be used to power \"pacemakers, \u003ca href=\"https://www.sjm.com/en/patients/chronic-pain/managing-chronic-pain/neurostimulation-therapy\">neurostimulators\u003c/a>, devices to deliver drugs at a specific time, ingestible cameras and glucose monitors,\" Bettinger says.\u003c/p>\n\u003cp>Researchers have experimented with melanin-based electronics since \u003ca href=\"http://smithsonianchips.si.edu/proctor/\">the 1970s\u003c/a>, some even winning the \u003ca href=\"https://www.chemheritage.org/historical-profile/alan-g-macdiarmid-alan-j-heeger-and-hideki-shirakawa\">Nobel Prize\u003c/a> for it. Nevertheless, the discoveries had remained largely forgotten until the \u003ca href=\"http://espace.library.uq.edu.au/view/UQ:246993\">late 2000s\u003c/a>, when a type of melanin was shown to be an electronic conductor, which sparked the renewed interest.\u003c/p>\n\u003cp>Riding this tide, Bettinger tried his hand at creating semiconductor chips with melanin. \"It didn't really work at all, but it turns out that the same property that makes it a terrible transistor makes it a great ingredient for a battery,\" he says.\u003c/p>\n\u003cp>By 2013, Bettinger had his \u003ca href=\"http://www.materials360online.com/newsDetails/43482\">first prototype\u003c/a> of a melanin-based battery, with a lifetime of five hours. Three years of subsequent research tripled the battery life and resulted in \"preliminary [partnership] discussions with a few people — mainly big pharma,\" he says.\u003c/p>\n\u003cp>Making batteries with melanin \"is a very, very interesting and powerful idea,\" says \u003ca href=\"https://bioinspiredmaterials.berkeley.edu/\">Phillip Messersmith\u003c/a>, a professor of material sciences at UC Berkeley. \"Biological inspirations are really powerful in the context of sustainable energy storage and sustainable materials,\" he says.\u003c/p>\n\u003cp>\u003ca href=\"http://www.bioe.umd.edu/faculty/payne\">Gregory Payne\u003c/a>, a professor of bioengineering at the University of Maryland, says \"it's pretty important research.\"\u003c/p>\n\u003cp>Bettinger says the melanin battery research is \"still in the preliminary stage.\" While the team \"anticipates very little toxicity response\" to the melanin battery, he says, no clinical trials have been carried out to prove its safety.\u003c/p>\n\u003cp>The current battery prototype contains a small amount of \u003ca href=\"https://www.chemours.com/Teflon/en_US/\">Teflon\u003c/a>, which \"is expensive and toxic in nature ... dangerous to humans and the environment,\" says \u003ca href=\"http://www.polymtl.ca/recherche/rc/en/professeurs/details.php?NoProf=388\">Clara Santato\u003c/a>, a professor of engineering physics at École Polytechnique de Montréal. According to Santato, research to create a Teflon-free melanin battery is underway.\u003c/p>\n\u003cp>Even then, safety questions linger. \"I don't know that there is consensus on the toxicity of melanin,\" Messersmith says. \"It's an open question ... [although] I do not foresee significant problems in the GI tract applications.\"\u003c/p>\n\u003cp>Payne says, \"What is mystifying to me is that melanin is a relatively abundant material in your body but there's very little understanding of what function it performs.\"\u003c/p>\n\u003cp>Melanin comes in many different forms, and some aren't as good for the purpose of making edible batteries. \"One of the concerns about melanin in the brain is that it doesn't degrade rapidly,\" Payne says.\u003c/p>\n\u003cp>So far, it's unclear if a melanin-based battery is completely safe because nobody really knows what melanin is.\u003c/p>\n\u003cp>\"[Chemists] are still debating it. ... it's not that easy to figure out the structure,\" Payne says.\u003c/p>\n\u003cp>Scientists say there's no guarantee that the lab results can be replicated for mass production since so little is known about melanin.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"It can for sure be improved,\" Santato says. \"It's really now the engineering of the molecules.\"\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=How+An+Edible+Battery+Could+Power+Medical+Robots+You+Swallow+&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Can Monthly Subscriptions to See Doctors Work for Patients?",
"title": "Can Monthly Subscriptions to See Doctors Work for Patients?",
"headTitle": "KQED Future of You | KQED Science",
"content": "\u003cp>Anyone who has ever waited 45 minutes past their official appointment time for their doctor, or gotten tangled in the branches of an insurance company phone tree, has thought something along the lines of:\u003c/p>\n\u003cp>\"There's got to be a better way.\"\u003c/p>\n\u003cp>Well, some primary care doctors say there is. It's called direct primary care, a business model in which doctors drop off the grid of the traditional health care system by refusing to take insurance--\u003cem>any\u003c/em> insurance. Instead, they charge patients a monthly fee for as many visits as needed.\u003c/p>\n\u003caside class=\"pullquote alignright\">Direct primary care is a health care model in which doctors don't take insurance and charge patients a monthly fee. Praise and concerns abound ...\u003c/aside>\n\u003cp>Our \u003ca href=\"https://ww2.kqed.org/futureofyou/2016/08/11/dropout-docs-primary-care-physicians-exit-the-system-to-go-it-alone/\" target=\"_blank\">recent story\u003c/a> on the topic from David Gorn rapidly became one of the most popular we've ever posted, and we received many, many comments from both doctors and patients about this growing trend in primary care.\u003c/p>\n\u003cp>We've decided to pass on some of the more interesting responses (edited for length and clarity), and some new thoughts on the model from a consumer advocate.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>For doctors, the great benefit of direct primary care is freeing their practices of the copious paperwork required by insurance companies; the lack of bureaucratic overhead ostensibly allows physicians to take better care of fewer people. The upside for patients is they get more of their doctor's time, more personalized care and perhaps even house calls.\u003c/p>\n\u003cp>Some patients think this is a nice idea -- for those who can afford it.\u003c/p>\n\u003cblockquote>\u003cp>I don't see this working with low-income populations. Will all the doctors be moving to the rural burbs now to take advantage of those who can afford their services? By abandoning the 'system,' they abandon all those who rely on it for care.\"\u003c/p>\u003c/blockquote>\n\u003cp>And from another reader:\u003c/p>\n\u003cblockquote>\u003cp>The article cited one doctor charging $59 a month for unlimited visits. That's over $700 a year! I don't see this as a cost-effective alternative to insurance. ... What happens when these subscription doctors inform their clients that they can't make a competent diagnosis without a referral to a specialist?\"\u003c/p>\u003c/blockquote>\n\u003cp>Another patient also can't see the financial sense in paying extra:\u003c/p>\n\u003cblockquote>\u003cp>My primary care physician recently did this. Guess what? I still have to pay for insurance. I'm not paying a retainer on top of that just for the right to see one doctor.\u003c/p>\u003c/blockquote>\n\u003cp>Others think insurance companies are requiring so many out-of-pocket costs, the extra price of a \"subscription\" to a primary care doctor makes sense:\u003c/p>\n\u003cblockquote>\u003cp>These insurance companies have such high co-pays and deductibles, more people are going this route! You do need a basic plan for the unexpected hospital stay, surgery, etc., but this makes sense.\u003c/p>\u003c/blockquote>\n\u003cp>Some patients are already experiencing this type of system:\u003c/p>\n\u003cblockquote>\u003cp>Our physician works on a business model very similar to this. We pay a monthly 'member' fee and he accepts whatever Medicare Advantage Plan pays. The real plus here is he is always on time, his waiting room rarely has anyone else in it and your visit is as long as it needs to be. Our annual checkups last two to three hours, include a treadmill stress test, an ultrasound and lots more poking, prodding, asking, talking. Great doctor, too.\u003c/p>\u003c/blockquote>\n\u003cp>Among comments from doctors, there were stories of dissatisfaction and anger at the current system of insurance-based care:\u003c/p>\n\u003cblockquote>\u003cp>If my husband and I and our daughter closed our outpatient internal medicine office and went to a no-insurance model \u003cem>we\u003c/em> would certainly be happier and healthier in the long run. Our average work day is 14 hours, seven days a week, as we do rounds at the hospital on our own patients, and many have our cell numbers so they can call us. Only about 55 percent of what we do every day is billable.\u003c/p>\n\u003cp>It is horrifying to have to call an insurance company to get authorization for a procedure and to have to provide my full name, title and training but not be able to speak with anyone on their end who has one whit of experience, and to know the decision will not be based on medical complexity or necessity but on a check-the-box form.\u003c/p>\u003c/blockquote>\n\u003cp>And many patients were sympathetic to their plight:\u003c/p>\n\u003cblockquote>\u003cp>The doctors and patients are caught in an insurance nightmare, but the doctors do have more power than we do. Two of my longtime doctors went to very part-time. One retired at 58 and another sees 32 patients a day and knows he will leave to teach by 45. Sixty thousand billing codes--it seems insane.\u003c/p>\u003c/blockquote>\n\u003cp>Yet, even some doctors have concerns:\u003c/p>\n\u003cblockquote>\u003cp>Though I have lots of colleagues going this route, I have an ethical dilemma with it. So many of my patients can't afford the $1,500 (sometimes more) annual fee, just for the privilege of being a patient. I'd lose people I've cared for for decades. Often the people who need me the most wouldn't be able to afford it. As bad as the Medicare fee schedule is, I couldn't bear the thought of giving up so many of my patients. Could I make more money? No doubt. Would I be more satisfied? I don't think so.\u003c/p>\u003c/blockquote>\n\u003cp>\u003cstrong>A Consumer Advocate Weighs In\u003c/strong>\u003c/p>\n\u003cp>We wanted to hear what someone who works on consumer health issues thought about the direct primary care trend. Betsy Imholz, director of special projects for Consumers Union, has worked intensively on health reform. And she has a number of concerns.\u003c/p>\n\u003cp>Imholz says that while she understands why both doctors and patients are attracted to direct primary care -- \"the old \u003ca href=\"https://www.youtube.com/watch?v=Y10VEkyKd3w\" target=\"_blank\">Marcus Welby\u003c/a> model,\" as she puts it -- she thinks it's a move in the opposite direction of the current push for an integrated health care system. Ideally, doctors would have access to patients' electronic health records, and \u003ca href=\"http://www.rwjf.org/content/dam/farm/reports/issue_briefs/2014/rwjf409988\" target=\"_blank\">all-payer claims databases\u003c/a>, at least \u003ca href=\"http://www.commondreams.org/newswire/2016/08/03/all-six-states-keep-consumers-dark-cost-medical-procedures\" target=\"_blank\">theoretically\u003c/a>, would allow purchasers of insurance to compare costs.\u003c/p>\n\u003cp>\"It goes against this coordinated care model that the Affordable Care Act and the U.S. is coming to,\" she says, \"having things not fragmented but coordinated [in a way that] enables us to check, make quality assessments.\"\u003c/p>\n\u003cp>Another potential problem, says Imholz: If healthier people are looking at direct primary care as a substitute for insurance rather than an augmentation, it could drain the ACA \u003ca href=\"https://www.washingtonpost.com/news/to-your-health/wp/2016/03/30/theyre-sicker-plus-aca-enrollees-cost-more-in-care-major-insurer-finds/\" target=\"_blank\">risk pool \u003c/a>of the very type of patients \u003ca href=\"http://www.newsweek.com/obamacare-premiums-rise-10-percent-2017-490268\" target=\"_blank\">needed to keep cost increases manageable\u003c/a>.\u003c/p>\n\u003cp>She also agrees with a point health policy professor Janet Coffman made in Gorn's article: Any trend toward this model would reduce the number of primary care doctors available in insurance plans, already a \u003ca href=\"http://www.aafp.org/news/practice-professional-issues/20150303aamcwkforce.html\" target=\"_blank\">growing problem\u003c/a>.\u003c/p>\n\u003cp>\"Primary care is one of the least lucrative areas for doctors to go into,\" Imholz says, \"and therefore sometimes difficult for insurers to get sufficient numbers of.\"\u003c/p>\n\u003cp>Imholz stresses that consumers in California, where Gorn's report takes place, should keep in mind a little-known benefit of the plans offered on the state's health care exchange, called Covered California: Those plans are required to offer three visits outside of the deductible, costing only a co-pay.\u003c/p>\n\u003cp>Ultimately, she says, if patients do want to go the route of direct primary care, they should create their own \u003ca href=\"https://www.healthit.gov/providers-professionals/faqs/what-personal-health-record\" target=\"_blank\">personal health record\u003c/a> for each visit, in case at some point they need to visit a specialist for a serious health problem.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>Here are more curated reader responses to the original post:\u003c/p>\n\u003cblockquote>\u003cp>My doctor started doing this. He hasn't seemed to have lost any patients. His waiting room is always crowded. He has big signs everywhere: WE DO NOT TAKE INSURANCE! I wish every doctor would do this. The insurance companies are the ones stealing from us.\u003c/p>\n\u003chr>\n\u003cp>Please don't ever do this. My husband has sickle cell anemia and after seven years of care his PCP switched to this model and we can't afford to continue to see him anymore. So now we are shopping for a new PCP in a city where very few doctors have even treated sickle cell, much less specialized in it.\u003c/p>\n\u003chr>\n\u003cp>It \u003cem>is\u003c/em> increasingly difficult for doctors to get paid. Patients have no idea how much we do for free. Hours on the phone answering questions; just calling in an Rx for a urinary tract or sinus infection; $200 of mine and my staff's time spent getting prior authorization for a $10 medication because the insurance company wants me to use a $9 one instead. In the private world, I had the option to simply not charge patients I knew had no resources, because it was the right thing to do. But to balance that out I had to limit my practice to no more than 40 percent Medicare. Medicaid I essentially did for free--it cost more to bill and collect for those patients than I actually got paid.\u003c/p>\n\u003chr>\n\u003cp>Ultimately, after 14 years of private practice, I had to close my office and go to work for a hospital-based clinic that happens to be faith-based and has a great policy for providing care to all patients. That has allowed me to continue taking care of all patients without considering their ability to pay. The problem is not with health care, but with insurance. A single-payer system can work, but not until we take out the bureaucracy that managed care has brought into health care.\u003c/p>\n\u003chr>\n\u003cp>The bottom line is a medical practice is a business, and if you can't get paid you can't keep the doors open. Medicine is the only industry that people expect something for nothing. Make a five-minute call to an attorney, you get a bill for 15 minutes minimum and nobody bats an eye. Ask for a $10 co-payment and we get stared at like we have three purple heads.\u003c/p>\n\u003chr>\n\u003cp>Nope, you'll still need insurance coverage for everything else. This is a slick way to cull Medicare patients out of the practice. I just experienced this and it would cost $130 monthly. Time for a new doctor!\u003c/p>\n\u003chr>\n\u003cp>I worry about cherry picking, selecting people who have disposable income and don't need to be seen all that often. I was part of a group that had such a concierge option and it was not for the common folk.\u003c/p>\n\u003chr>\n\u003cp>When my first child was born in 1981, her pediatrician offered a monthly fee plan, and for $15 per month, a monthly well-baby visit and all immunizations included, plus anytime she got sick. For the first visit, the pediatrician came to our home. I wouldn't call it boutique medicine, but it was a big help to our young family.\u003c/p>\n\u003chr>\n\u003cp>That small fee for \"members\" will rise just as medical costs rise. We need to fix the paperwork situation to keep good doctors around\u003c/p>\n\u003chr>\n\u003cp>Volume is the name of the game today. New doctors employed by hospital-owned practices also face that same pressure to see as many patients as possible and to order whatever tests, procedures or whatever in order to generate the most income for their parent company. It might be a good business model, but it's not good medicine. Look at how happy both the doctors and patients are with this personal service. It's a win-win for the patient-primary care doctor team.\u003c/p>\n\u003chr>\n\u003cp>A doctor I used to work for has done this, but she charges per visit and per procedure or test. She has contracted with other labs for cheaper tests. By cutting out the insurance she can charge less. She still makes a profit but her patients are able to afford her visit and tests, not including radiology. I think it is fantastic! The retainer or monthly fee doesn't seem like a good route for those unable to afford it, though.\u003c/p>\n\u003chr>\n\u003cp>I work with a great doctor that's doing this for $60 a month, $50 for small business owners. Personally, paying the retainer as well as the annual fine for not carrying insurance stills ends up being more affordable than carrying commercial insurance. Between premiums, deductibles and co-pays, it was ridiculous. In this new system, patients love getting the one-on-one time, and the number of referrals drops dramatically due to the primary having control and being able to make the decisions. Also there's no longer the pressure of seeing patients every 10 minutes -- patients are no longer just a number.\u003c/p>\n\u003chr>\n\u003cp>My pediatrician in the '50s made house calls. My dad had union insurance that seemed to cover everything. I remember going to see my pediatrician on Saturday when I had an emergency. There needs to be room for this kind of medicine. In the long-run people will be healthier and doctors will be more satisfied. I feel so sad for the medical people who take care of me. They look at their watches when they think I'm not looking and still try to do a good job. There has to be a better way.\u003c/p>\n\u003chr>\n\u003cp>My doctor did this, and I couldn't afford it. I still had to pay for hospitalization and prescription medicine insurance. It would have added $140 a month for my husband and I. I miss my old doctor.\u003c/p>\n\u003chr>\n\u003cp>My problem with this is Obamacare \u003cem>requires\u003c/em> me to have health insurance! So.... If I didn't have to pay almost $600 a month for family coverage this would be great! Unfortunately, it's not a feasible option under the current rule of law.\u003c/p>\n\u003chr>\n\u003cp>I love this idea but do not have enough income to pay such a monthly fee. I would love to see some accommodation regarding sliding-fee scale for those of us with little income or social security.\u003c/p>\n\u003chr>\n\u003cp>\"As for the effect on patients, Stanford health professor Laurence Baker says it’s not clear whether or not the longer office and home visits end up providing better care.\"\u003c/p>\n\u003cp>Really? I would love to have my doctor's undivided attention. As it is now, I can request to have a test done or a referral to another doctor a and he'll say OK and then it doesn't happen. I requested to see a pulmonary doctor four months ago and he never followed through. I finally made my own appointment and found out I have emphysema.\u003c/p>\n\u003cp>I don't blame my doctor. He's a good man in a bad situation. He's the herder and I'm sure he worries every day about what he might have missed.\u003c/p>\n\u003chr>\n\u003cp>I love this. It is what has become more and more diminished in patient care over the years: actual interest in the work. The doctors I see now seem like robots, and I feel like a piece of machinery on the assembly line.\u003c/p>\n\u003chr>\n\u003cp>I think this is a great concept, but I wonder how the insurance companies will respond to this. My worry is that, although many can afford to pay for PCP care as they go, they could not afford much in the way of major testing, additional medical procedures or medications for chronic conditions. My guess is that the insurance companies may balk at coverage when referrals come from a non-participating provider.\u003c/p>\n\u003chr>\n\u003cp>This is what my new doctor does. Seventy-five dollars per month is pretty much less than my copay anyway. And I love my doctor!\u003c/p>\n\u003chr>\n\u003cp>Looks like the doctors are going to reform the medical system for us. Can't blame them; they spend more time filling out forms than on patient care.\u003c/p>\u003c/blockquote>\n\n",
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"excerpt": "A consumer advocate and plenty of readers weigh in on doctors who have gone to a subscription model instead of taking insurance.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Anyone who has ever waited 45 minutes past their official appointment time for their doctor, or gotten tangled in the branches of an insurance company phone tree, has thought something along the lines of:\u003c/p>\n\u003cp>\"There's got to be a better way.\"\u003c/p>\n\u003cp>Well, some primary care doctors say there is. It's called direct primary care, a business model in which doctors drop off the grid of the traditional health care system by refusing to take insurance--\u003cem>any\u003c/em> insurance. Instead, they charge patients a monthly fee for as many visits as needed.\u003c/p>\n\u003caside class=\"pullquote alignright\">Direct primary care is a health care model in which doctors don't take insurance and charge patients a monthly fee. Praise and concerns abound ...\u003c/aside>\n\u003cp>Our \u003ca href=\"https://ww2.kqed.org/futureofyou/2016/08/11/dropout-docs-primary-care-physicians-exit-the-system-to-go-it-alone/\" target=\"_blank\">recent story\u003c/a> on the topic from David Gorn rapidly became one of the most popular we've ever posted, and we received many, many comments from both doctors and patients about this growing trend in primary care.\u003c/p>\n\u003cp>We've decided to pass on some of the more interesting responses (edited for length and clarity), and some new thoughts on the model from a consumer advocate.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>For doctors, the great benefit of direct primary care is freeing their practices of the copious paperwork required by insurance companies; the lack of bureaucratic overhead ostensibly allows physicians to take better care of fewer people. The upside for patients is they get more of their doctor's time, more personalized care and perhaps even house calls.\u003c/p>\n\u003cp>Some patients think this is a nice idea -- for those who can afford it.\u003c/p>\n\u003cblockquote>\u003cp>I don't see this working with low-income populations. Will all the doctors be moving to the rural burbs now to take advantage of those who can afford their services? By abandoning the 'system,' they abandon all those who rely on it for care.\"\u003c/p>\u003c/blockquote>\n\u003cp>And from another reader:\u003c/p>\n\u003cblockquote>\u003cp>The article cited one doctor charging $59 a month for unlimited visits. That's over $700 a year! I don't see this as a cost-effective alternative to insurance. ... What happens when these subscription doctors inform their clients that they can't make a competent diagnosis without a referral to a specialist?\"\u003c/p>\u003c/blockquote>\n\u003cp>Another patient also can't see the financial sense in paying extra:\u003c/p>\n\u003cblockquote>\u003cp>My primary care physician recently did this. Guess what? I still have to pay for insurance. I'm not paying a retainer on top of that just for the right to see one doctor.\u003c/p>\u003c/blockquote>\n\u003cp>Others think insurance companies are requiring so many out-of-pocket costs, the extra price of a \"subscription\" to a primary care doctor makes sense:\u003c/p>\n\u003cblockquote>\u003cp>These insurance companies have such high co-pays and deductibles, more people are going this route! You do need a basic plan for the unexpected hospital stay, surgery, etc., but this makes sense.\u003c/p>\u003c/blockquote>\n\u003cp>Some patients are already experiencing this type of system:\u003c/p>\n\u003cblockquote>\u003cp>Our physician works on a business model very similar to this. We pay a monthly 'member' fee and he accepts whatever Medicare Advantage Plan pays. The real plus here is he is always on time, his waiting room rarely has anyone else in it and your visit is as long as it needs to be. Our annual checkups last two to three hours, include a treadmill stress test, an ultrasound and lots more poking, prodding, asking, talking. Great doctor, too.\u003c/p>\u003c/blockquote>\n\u003cp>Among comments from doctors, there were stories of dissatisfaction and anger at the current system of insurance-based care:\u003c/p>\n\u003cblockquote>\u003cp>If my husband and I and our daughter closed our outpatient internal medicine office and went to a no-insurance model \u003cem>we\u003c/em> would certainly be happier and healthier in the long run. Our average work day is 14 hours, seven days a week, as we do rounds at the hospital on our own patients, and many have our cell numbers so they can call us. Only about 55 percent of what we do every day is billable.\u003c/p>\n\u003cp>It is horrifying to have to call an insurance company to get authorization for a procedure and to have to provide my full name, title and training but not be able to speak with anyone on their end who has one whit of experience, and to know the decision will not be based on medical complexity or necessity but on a check-the-box form.\u003c/p>\u003c/blockquote>\n\u003cp>And many patients were sympathetic to their plight:\u003c/p>\n\u003cblockquote>\u003cp>The doctors and patients are caught in an insurance nightmare, but the doctors do have more power than we do. Two of my longtime doctors went to very part-time. One retired at 58 and another sees 32 patients a day and knows he will leave to teach by 45. Sixty thousand billing codes--it seems insane.\u003c/p>\u003c/blockquote>\n\u003cp>Yet, even some doctors have concerns:\u003c/p>\n\u003cblockquote>\u003cp>Though I have lots of colleagues going this route, I have an ethical dilemma with it. So many of my patients can't afford the $1,500 (sometimes more) annual fee, just for the privilege of being a patient. I'd lose people I've cared for for decades. Often the people who need me the most wouldn't be able to afford it. As bad as the Medicare fee schedule is, I couldn't bear the thought of giving up so many of my patients. Could I make more money? No doubt. Would I be more satisfied? I don't think so.\u003c/p>\u003c/blockquote>\n\u003cp>\u003cstrong>A Consumer Advocate Weighs In\u003c/strong>\u003c/p>\n\u003cp>We wanted to hear what someone who works on consumer health issues thought about the direct primary care trend. Betsy Imholz, director of special projects for Consumers Union, has worked intensively on health reform. And she has a number of concerns.\u003c/p>\n\u003cp>Imholz says that while she understands why both doctors and patients are attracted to direct primary care -- \"the old \u003ca href=\"https://www.youtube.com/watch?v=Y10VEkyKd3w\" target=\"_blank\">Marcus Welby\u003c/a> model,\" as she puts it -- she thinks it's a move in the opposite direction of the current push for an integrated health care system. Ideally, doctors would have access to patients' electronic health records, and \u003ca href=\"http://www.rwjf.org/content/dam/farm/reports/issue_briefs/2014/rwjf409988\" target=\"_blank\">all-payer claims databases\u003c/a>, at least \u003ca href=\"http://www.commondreams.org/newswire/2016/08/03/all-six-states-keep-consumers-dark-cost-medical-procedures\" target=\"_blank\">theoretically\u003c/a>, would allow purchasers of insurance to compare costs.\u003c/p>\n\u003cp>\"It goes against this coordinated care model that the Affordable Care Act and the U.S. is coming to,\" she says, \"having things not fragmented but coordinated [in a way that] enables us to check, make quality assessments.\"\u003c/p>\n\u003cp>Another potential problem, says Imholz: If healthier people are looking at direct primary care as a substitute for insurance rather than an augmentation, it could drain the ACA \u003ca href=\"https://www.washingtonpost.com/news/to-your-health/wp/2016/03/30/theyre-sicker-plus-aca-enrollees-cost-more-in-care-major-insurer-finds/\" target=\"_blank\">risk pool \u003c/a>of the very type of patients \u003ca href=\"http://www.newsweek.com/obamacare-premiums-rise-10-percent-2017-490268\" target=\"_blank\">needed to keep cost increases manageable\u003c/a>.\u003c/p>\n\u003cp>She also agrees with a point health policy professor Janet Coffman made in Gorn's article: Any trend toward this model would reduce the number of primary care doctors available in insurance plans, already a \u003ca href=\"http://www.aafp.org/news/practice-professional-issues/20150303aamcwkforce.html\" target=\"_blank\">growing problem\u003c/a>.\u003c/p>\n\u003cp>\"Primary care is one of the least lucrative areas for doctors to go into,\" Imholz says, \"and therefore sometimes difficult for insurers to get sufficient numbers of.\"\u003c/p>\n\u003cp>Imholz stresses that consumers in California, where Gorn's report takes place, should keep in mind a little-known benefit of the plans offered on the state's health care exchange, called Covered California: Those plans are required to offer three visits outside of the deductible, costing only a co-pay.\u003c/p>\n\u003cp>Ultimately, she says, if patients do want to go the route of direct primary care, they should create their own \u003ca href=\"https://www.healthit.gov/providers-professionals/faqs/what-personal-health-record\" target=\"_blank\">personal health record\u003c/a> for each visit, in case at some point they need to visit a specialist for a serious health problem.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Here are more curated reader responses to the original post:\u003c/p>\n\u003cblockquote>\u003cp>My doctor started doing this. He hasn't seemed to have lost any patients. His waiting room is always crowded. He has big signs everywhere: WE DO NOT TAKE INSURANCE! I wish every doctor would do this. The insurance companies are the ones stealing from us.\u003c/p>\n\u003chr>\n\u003cp>Please don't ever do this. My husband has sickle cell anemia and after seven years of care his PCP switched to this model and we can't afford to continue to see him anymore. So now we are shopping for a new PCP in a city where very few doctors have even treated sickle cell, much less specialized in it.\u003c/p>\n\u003chr>\n\u003cp>It \u003cem>is\u003c/em> increasingly difficult for doctors to get paid. Patients have no idea how much we do for free. Hours on the phone answering questions; just calling in an Rx for a urinary tract or sinus infection; $200 of mine and my staff's time spent getting prior authorization for a $10 medication because the insurance company wants me to use a $9 one instead. In the private world, I had the option to simply not charge patients I knew had no resources, because it was the right thing to do. But to balance that out I had to limit my practice to no more than 40 percent Medicare. Medicaid I essentially did for free--it cost more to bill and collect for those patients than I actually got paid.\u003c/p>\n\u003chr>\n\u003cp>Ultimately, after 14 years of private practice, I had to close my office and go to work for a hospital-based clinic that happens to be faith-based and has a great policy for providing care to all patients. That has allowed me to continue taking care of all patients without considering their ability to pay. The problem is not with health care, but with insurance. A single-payer system can work, but not until we take out the bureaucracy that managed care has brought into health care.\u003c/p>\n\u003chr>\n\u003cp>The bottom line is a medical practice is a business, and if you can't get paid you can't keep the doors open. Medicine is the only industry that people expect something for nothing. Make a five-minute call to an attorney, you get a bill for 15 minutes minimum and nobody bats an eye. Ask for a $10 co-payment and we get stared at like we have three purple heads.\u003c/p>\n\u003chr>\n\u003cp>Nope, you'll still need insurance coverage for everything else. This is a slick way to cull Medicare patients out of the practice. I just experienced this and it would cost $130 monthly. Time for a new doctor!\u003c/p>\n\u003chr>\n\u003cp>I worry about cherry picking, selecting people who have disposable income and don't need to be seen all that often. I was part of a group that had such a concierge option and it was not for the common folk.\u003c/p>\n\u003chr>\n\u003cp>When my first child was born in 1981, her pediatrician offered a monthly fee plan, and for $15 per month, a monthly well-baby visit and all immunizations included, plus anytime she got sick. For the first visit, the pediatrician came to our home. I wouldn't call it boutique medicine, but it was a big help to our young family.\u003c/p>\n\u003chr>\n\u003cp>That small fee for \"members\" will rise just as medical costs rise. We need to fix the paperwork situation to keep good doctors around\u003c/p>\n\u003chr>\n\u003cp>Volume is the name of the game today. New doctors employed by hospital-owned practices also face that same pressure to see as many patients as possible and to order whatever tests, procedures or whatever in order to generate the most income for their parent company. It might be a good business model, but it's not good medicine. Look at how happy both the doctors and patients are with this personal service. It's a win-win for the patient-primary care doctor team.\u003c/p>\n\u003chr>\n\u003cp>A doctor I used to work for has done this, but she charges per visit and per procedure or test. She has contracted with other labs for cheaper tests. By cutting out the insurance she can charge less. She still makes a profit but her patients are able to afford her visit and tests, not including radiology. I think it is fantastic! The retainer or monthly fee doesn't seem like a good route for those unable to afford it, though.\u003c/p>\n\u003chr>\n\u003cp>I work with a great doctor that's doing this for $60 a month, $50 for small business owners. Personally, paying the retainer as well as the annual fine for not carrying insurance stills ends up being more affordable than carrying commercial insurance. Between premiums, deductibles and co-pays, it was ridiculous. In this new system, patients love getting the one-on-one time, and the number of referrals drops dramatically due to the primary having control and being able to make the decisions. Also there's no longer the pressure of seeing patients every 10 minutes -- patients are no longer just a number.\u003c/p>\n\u003chr>\n\u003cp>My pediatrician in the '50s made house calls. My dad had union insurance that seemed to cover everything. I remember going to see my pediatrician on Saturday when I had an emergency. There needs to be room for this kind of medicine. In the long-run people will be healthier and doctors will be more satisfied. I feel so sad for the medical people who take care of me. They look at their watches when they think I'm not looking and still try to do a good job. There has to be a better way.\u003c/p>\n\u003chr>\n\u003cp>My doctor did this, and I couldn't afford it. I still had to pay for hospitalization and prescription medicine insurance. It would have added $140 a month for my husband and I. I miss my old doctor.\u003c/p>\n\u003chr>\n\u003cp>My problem with this is Obamacare \u003cem>requires\u003c/em> me to have health insurance! So.... If I didn't have to pay almost $600 a month for family coverage this would be great! Unfortunately, it's not a feasible option under the current rule of law.\u003c/p>\n\u003chr>\n\u003cp>I love this idea but do not have enough income to pay such a monthly fee. I would love to see some accommodation regarding sliding-fee scale for those of us with little income or social security.\u003c/p>\n\u003chr>\n\u003cp>\"As for the effect on patients, Stanford health professor Laurence Baker says it’s not clear whether or not the longer office and home visits end up providing better care.\"\u003c/p>\n\u003cp>Really? I would love to have my doctor's undivided attention. As it is now, I can request to have a test done or a referral to another doctor a and he'll say OK and then it doesn't happen. I requested to see a pulmonary doctor four months ago and he never followed through. I finally made my own appointment and found out I have emphysema.\u003c/p>\n\u003cp>I don't blame my doctor. He's a good man in a bad situation. He's the herder and I'm sure he worries every day about what he might have missed.\u003c/p>\n\u003chr>\n\u003cp>I love this. It is what has become more and more diminished in patient care over the years: actual interest in the work. The doctors I see now seem like robots, and I feel like a piece of machinery on the assembly line.\u003c/p>\n\u003chr>\n\u003cp>I think this is a great concept, but I wonder how the insurance companies will respond to this. My worry is that, although many can afford to pay for PCP care as they go, they could not afford much in the way of major testing, additional medical procedures or medications for chronic conditions. My guess is that the insurance companies may balk at coverage when referrals come from a non-participating provider.\u003c/p>\n\u003chr>\n\u003cp>This is what my new doctor does. Seventy-five dollars per month is pretty much less than my copay anyway. And I love my doctor!\u003c/p>\n\u003chr>\n\u003cp>Looks like the doctors are going to reform the medical system for us. Can't blame them; they spend more time filling out forms than on patient care.\u003c/p>\u003c/blockquote>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Disgusting But Informative: The Path of a Sneeze, in Slow Motion",
"title": "Disgusting But Informative: The Path of a Sneeze, in Slow Motion",
"headTitle": "KQED Future of You | KQED Science",
"content": "\u003cfigure id=\"attachment_230754\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/08/sneeze-slomo.gif\">\u003cimg class=\"size-full wp-image-230754\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/08/sneeze-slomo.gif\" alt=\"A sneeze involves complicated physics, researchers say.\" width=\"640\" height=\"480\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">A sneeze involves complicated physics, researchers say. \u003ccite>(Lydia Bourouiba/ New England Journal of Medicine)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>To a mathematician, it's a violent explosion that shoots out missiles of hot, wet air, slamming a turbulent cloud of moisture into anybody or anything that crosses its path.\u003c/p>\n\u003cp>To the rest of us, it's a sneeze.\u003c/p>\n\u003caside class=\"pullquote alignright\">Working from high-speed photography images, researchers hope to make risk maps for which parts of a room are likely to get contaminated by a sick person.\u003c/aside>\n\u003cp>And \u003ca href=\"https://lbourouiba.mit.edu/people\">Lydia Bourouiba\u003c/a> has made a career out of studying it. Bourouiba, a mathematical physicist, leads a research group at the Massachusetts Institute of Technology that studies fluid dynamics. On Wednesday, her team \u003ca href=\"http://www.nejm.org/doi/full/10.1056/NEJMicm1501197\">published\u003c/a> a slow-motion video of a sneeze in the \u003cem>New England Journal of Medicine\u003c/em>.\u003c/p>\n\u003cp>It's mesmerizing. It's also important.\u003c/p>\n\u003cp>\"Respiratory infectious diseases still remain the leading infectious diseases in the world,\" Bourouiba explains. Many of them hop from person to person in coughs and sneezes, or \"violent emissions,\" as she calls them. If she can understand how a sneeze moves, she says, she can better understand how to prevent microbes from moving from a sick person or contaminated surface to somebody else.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>But as the researchers watched videos of these mini-explosions, they quickly realized that a sneeze involves \u003ca href=\"http://link.springer.com/article/10.1007/s00348-015-2078-4\">complicated physics\u003c/a>.\u003c/p>\n\u003cp>[contextly_sidebar id=\"Zq82BgwlKIM0XIwpYZqTf5RQyrBnObih\"]\"There's a whole range of droplet sizes in this cloud, and the cloud is made of hot and moist air,\" says Bourouiba. \"And it's turbulent, so that means that it has swirls and eddies, and it's moving very fast.\" The conditions in the surrounding room — like airflow, moisture and temperature — can change how all those swirls and zigzags move, she says.\u003c/p>\n\u003cp>A lot of the sanitation measures we're all told to take to stay out of the way of someone else's sneeze are educated guesses at best, says Bourouiba. For example, people have assumed that standing a few feet away from a sick person would be enough to stay out of firing range. But Bourouiba and her colleagues found that the tiny droplets in a sneeze can, under certain conditions, travel across a room in just a few seconds. They can also hover in the air for many minutes.\u003c/p>\n\u003cp>\"It's actually quite amazing that we can produce such a high-speed flow that contains all these ranges of sizes of droplets,\" Bourouiba says.\u003c/p>\n\u003cp>A sneeze is \"quite a fantastic tool for clearance,\" she adds, \"but also a fantastic tool to sustain the overall colonization of other bodies and other people with viruses and pathogens.\"\u003c/p>\n\u003cp>To map the path of a sneeze — and of any infectious particles it might contain — Bourouiba had to become an expert in high-speed photography. So far, her subjects have been healthy sneezers. But now, Bourouiba and her colleagues have started enlisting the help of volunteers who have symptoms of a cold or flu, inviting these sick folks to sneeze in a special room that has controlled moisture, airflow and temperature, as well as camera equipment.\u003c/p>\n\u003cp>The ultimate goal of this study, she says, is to understand in detail how sneezes travel in different conditions.\u003c/p>\n\u003cp>\"So, for example, in a typical hospital room, with a given ambient temperature and moisture and a given airflow, what is the ultimate distribution of the position of these droplets and the pathogens they contain?\" says Bourouiba. \"And if we change the room and ventilation and different environmental conditions, how does that change?\"\u003c/p>\n\u003cp>Armed with that information, the researchers hope to make risk maps for which parts of a room are likely to get contaminated by a sick person, or figure out how far away a visitor needs to stand from a patient to stay out of the line of fire. The information might also improve the design of ventilation systems to help prevent infected droplets from dispersing through a building.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>As for Bourouiba's own technique for squelching the spread of a cold, she recommends sneezing into your elbow. What's the physics there? The elbow reduces the cloud's momentum, she says, limiting how far those virus-filled droplets will travel.\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=Watch%3A+A+Slow-Motion+Sneeze+Looks+A+Lot+Like+Breathing+Fire&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_230754\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/08/sneeze-slomo.gif\">\u003cimg class=\"size-full wp-image-230754\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/08/sneeze-slomo.gif\" alt=\"A sneeze involves complicated physics, researchers say.\" width=\"640\" height=\"480\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">A sneeze involves complicated physics, researchers say. \u003ccite>(Lydia Bourouiba/ New England Journal of Medicine)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>To a mathematician, it's a violent explosion that shoots out missiles of hot, wet air, slamming a turbulent cloud of moisture into anybody or anything that crosses its path.\u003c/p>\n\u003cp>To the rest of us, it's a sneeze.\u003c/p>\n\u003caside class=\"pullquote alignright\">Working from high-speed photography images, researchers hope to make risk maps for which parts of a room are likely to get contaminated by a sick person.\u003c/aside>\n\u003cp>And \u003ca href=\"https://lbourouiba.mit.edu/people\">Lydia Bourouiba\u003c/a> has made a career out of studying it. Bourouiba, a mathematical physicist, leads a research group at the Massachusetts Institute of Technology that studies fluid dynamics. On Wednesday, her team \u003ca href=\"http://www.nejm.org/doi/full/10.1056/NEJMicm1501197\">published\u003c/a> a slow-motion video of a sneeze in the \u003cem>New England Journal of Medicine\u003c/em>.\u003c/p>\n\u003cp>It's mesmerizing. It's also important.\u003c/p>\n\u003cp>\"Respiratory infectious diseases still remain the leading infectious diseases in the world,\" Bourouiba explains. Many of them hop from person to person in coughs and sneezes, or \"violent emissions,\" as she calls them. If she can understand how a sneeze moves, she says, she can better understand how to prevent microbes from moving from a sick person or contaminated surface to somebody else.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>But as the researchers watched videos of these mini-explosions, they quickly realized that a sneeze involves \u003ca href=\"http://link.springer.com/article/10.1007/s00348-015-2078-4\">complicated physics\u003c/a>.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\"There's a whole range of droplet sizes in this cloud, and the cloud is made of hot and moist air,\" says Bourouiba. \"And it's turbulent, so that means that it has swirls and eddies, and it's moving very fast.\" The conditions in the surrounding room — like airflow, moisture and temperature — can change how all those swirls and zigzags move, she says.\u003c/p>\n\u003cp>A lot of the sanitation measures we're all told to take to stay out of the way of someone else's sneeze are educated guesses at best, says Bourouiba. For example, people have assumed that standing a few feet away from a sick person would be enough to stay out of firing range. But Bourouiba and her colleagues found that the tiny droplets in a sneeze can, under certain conditions, travel across a room in just a few seconds. They can also hover in the air for many minutes.\u003c/p>\n\u003cp>\"It's actually quite amazing that we can produce such a high-speed flow that contains all these ranges of sizes of droplets,\" Bourouiba says.\u003c/p>\n\u003cp>A sneeze is \"quite a fantastic tool for clearance,\" she adds, \"but also a fantastic tool to sustain the overall colonization of other bodies and other people with viruses and pathogens.\"\u003c/p>\n\u003cp>To map the path of a sneeze — and of any infectious particles it might contain — Bourouiba had to become an expert in high-speed photography. So far, her subjects have been healthy sneezers. But now, Bourouiba and her colleagues have started enlisting the help of volunteers who have symptoms of a cold or flu, inviting these sick folks to sneeze in a special room that has controlled moisture, airflow and temperature, as well as camera equipment.\u003c/p>\n\u003cp>The ultimate goal of this study, she says, is to understand in detail how sneezes travel in different conditions.\u003c/p>\n\u003cp>\"So, for example, in a typical hospital room, with a given ambient temperature and moisture and a given airflow, what is the ultimate distribution of the position of these droplets and the pathogens they contain?\" says Bourouiba. \"And if we change the room and ventilation and different environmental conditions, how does that change?\"\u003c/p>\n\u003cp>Armed with that information, the researchers hope to make risk maps for which parts of a room are likely to get contaminated by a sick person, or figure out how far away a visitor needs to stand from a patient to stay out of the line of fire. The information might also improve the design of ventilation systems to help prevent infected droplets from dispersing through a building.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>As for Bourouiba's own technique for squelching the spread of a cold, she recommends sneezing into your elbow. What's the physics there? The elbow reduces the cloud's momentum, she says, limiting how far those virus-filled droplets will travel.\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=Watch%3A+A+Slow-Motion+Sneeze+Looks+A+Lot+Like+Breathing+Fire&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "In Search of an Opioid That Reduces Pain, But Without the Euphoria",
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"content": "\u003cp>Once people realized that opioid drugs could cause addiction and deadly overdoses, they tried to use newer forms of opioids to treat the addiction to its parent. Morphine, about 10 times the strength of opium, was used to curb opium cravings in the early 19th century. Codeine, too, was touted as a nonaddictive drug for pain relief, as was heroin.\u003c/p>\n\u003cp>Those attempts were doomed to failure because all opioid drugs interact with the brain in the same way. They dock to a specific neural receptor, the mu-opioid receptor, which controls the effects of pleasure, pain relief and need.\u003c/p>\n\u003cp>Now scientists are trying to create opioid painkillers that give relief from pain without triggering the euphoria, dependence and life-threatening respiratory suppression that causes deadly overdoses.\u003c/p>\n\u003cp>That wasn't thought possible until \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/11130073\">2000\u003c/a>, when a scientist named \u003ca href=\"http://www.scripps.edu/florida/neuro/lbohn.html\">Laura Bohn \u003c/a>found out something about a protein called beta-arrestin, which sticks to the opioid receptor when something like morphine activates it. When she gave morphine to mice that couldn't make beta-arrestin, they were still numb to pain, but a lot of the negative side effects of the drug were missing. They didn't build tolerance to the drug. At certain dosages, they had less withdrawal. Their breathing was more regular, and they weren't as constipated as normal mice on morphine.\u003c/p>\n\u003cp>Before that experiment, scientists thought the mu-opioid receptor was a simple switch that flicked all the effects of opioids on or off together. Now it seems they could be untied. \"The hope is you'd have another molecule that looks like morphine and binds to the same receptor, but the way it turns the receptor on is slightly different,\" says \u003ca href=\"https://med.stanford.edu/profiles/aashish-manglik\">Dr. Aashish Manglik\u003c/a>, a researcher at Stanford University School of Medicine who studies opioid receptors.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>After Bohn's discovery, a number of people, including a team that includes Manglik, started looking for a drug that could connect to the mu-opioid receptor in a way that avoids the negative effects of beta-arrestin.\u003c/p>\n\u003cp>To do that, they mapped the receptor's structure in a computer program and started looking for chemicals that would stick to it. \"We tried to look for molecules that would still bind to this 3-D structure, but are as far away from morphine and codeine as possible,\" Manglik says.\u003c/p>\n\u003cp>The team ran 3 million possibilities through the computer and picked the 23 best candidates to test in a lab. One chemical, PZM21, seems to do what they hoped: Turn the opioid receptor on without using much beta-arrestin. They report their \u003ca href=\"http://nature.com/articles/doi:10.1038/nature19112\">findings\u003c/a> in \u003cem>Nature\u003c/em> on Wednesday.\u003c/p>\n\u003cp>The scientists then tweaked the chemical to make it more potent and gave it to mice. The mice had pain reduction similar to that with morphine. But their breathing was more normal, and they didn't seem to get high.\u003c/p>\n\u003cp>\"If you give a mouse a drug that activates its reward pathways like cocaine, amphetamine or morphine, the mice just run around more. In this compound, we saw very little of that,\" Manglik says. The mice also didn't seem to have a preference between the chemical and salt water.\u003c/p>\n\u003cp>That means it's possible that the compound is less lethal and has less potential for abuse compared to something like morphine, but it still might be as effective of a painkiller. If, of course, it turns out to work in humans. So far it's only been tested in mice.\u003c/p>\n\u003cp>And the role that beta-arrestin plays in opioids is just one hypothesis. It would be eerily convenient if only the negative effects of opiates are tied to this one protein. The mice that didn't have any beta-arrestin actually seemed to have a stronger preference for morphine over saline. So there may be other things going on that science hasn't teased out yet.\u003c/p>\n\u003cp>But the work that Manglik and his collaborators have done is encouraging in the search for the next generation of painkillers — ideally ones that are safer and non-addictive.\u003c/p>\n\u003cp>\"I think this was really a tour de force,\" says \u003ca href=\"https://www.mskcc.org/research-areas/labs/gavril-pasternak\">Gavril Pasternak\u003c/a>, a researcher at the Memorial Sloan Kettering Cancer Center who's also trying to develop new opioids but was not involved in this study. \"They're new entities with totally different pharmacological profiles. These are great promise for opiates over the course of the next five to 10 years.\"\u003c/p>\n\u003cp>Bohn, now a professor at The Scripps Research Institute in Jupiter, Fla., is hopeful that a safer opioid may be coming to the clinic, too.\u003c/p>\n\u003cp>Manglik and some of his collaborators have founded a company that will try to bring these new drugs to market, and the pharmaceutical company \u003ca href=\"http://www.trevena.com/\">Trevena \u003c/a>is running a very similar molecule through clinical trials now.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>But that safe, effective painkiller isn't here yet, Bohn says. \"We have some really gorgeous compounds, and I think opiates are a terrible epidemic. But I would be careful of overselling this as the answer.\"\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=Scientists+Engineer+An+Opioid+That+May+Reduce+Pain+With+Less+Risk&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Once people realized that opioid drugs could cause addiction and deadly overdoses, they tried to use newer forms of opioids to treat the addiction to its parent. Morphine, about 10 times the strength of opium, was used to curb opium cravings in the early 19th century. Codeine, too, was touted as a nonaddictive drug for pain relief, as was heroin.\u003c/p>\n\u003cp>Those attempts were doomed to failure because all opioid drugs interact with the brain in the same way. They dock to a specific neural receptor, the mu-opioid receptor, which controls the effects of pleasure, pain relief and need.\u003c/p>\n\u003cp>Now scientists are trying to create opioid painkillers that give relief from pain without triggering the euphoria, dependence and life-threatening respiratory suppression that causes deadly overdoses.\u003c/p>\n\u003cp>That wasn't thought possible until \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/11130073\">2000\u003c/a>, when a scientist named \u003ca href=\"http://www.scripps.edu/florida/neuro/lbohn.html\">Laura Bohn \u003c/a>found out something about a protein called beta-arrestin, which sticks to the opioid receptor when something like morphine activates it. When she gave morphine to mice that couldn't make beta-arrestin, they were still numb to pain, but a lot of the negative side effects of the drug were missing. They didn't build tolerance to the drug. At certain dosages, they had less withdrawal. Their breathing was more regular, and they weren't as constipated as normal mice on morphine.\u003c/p>\n\u003cp>Before that experiment, scientists thought the mu-opioid receptor was a simple switch that flicked all the effects of opioids on or off together. Now it seems they could be untied. \"The hope is you'd have another molecule that looks like morphine and binds to the same receptor, but the way it turns the receptor on is slightly different,\" says \u003ca href=\"https://med.stanford.edu/profiles/aashish-manglik\">Dr. Aashish Manglik\u003c/a>, a researcher at Stanford University School of Medicine who studies opioid receptors.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>After Bohn's discovery, a number of people, including a team that includes Manglik, started looking for a drug that could connect to the mu-opioid receptor in a way that avoids the negative effects of beta-arrestin.\u003c/p>\n\u003cp>To do that, they mapped the receptor's structure in a computer program and started looking for chemicals that would stick to it. \"We tried to look for molecules that would still bind to this 3-D structure, but are as far away from morphine and codeine as possible,\" Manglik says.\u003c/p>\n\u003cp>The team ran 3 million possibilities through the computer and picked the 23 best candidates to test in a lab. One chemical, PZM21, seems to do what they hoped: Turn the opioid receptor on without using much beta-arrestin. They report their \u003ca href=\"http://nature.com/articles/doi:10.1038/nature19112\">findings\u003c/a> in \u003cem>Nature\u003c/em> on Wednesday.\u003c/p>\n\u003cp>The scientists then tweaked the chemical to make it more potent and gave it to mice. The mice had pain reduction similar to that with morphine. But their breathing was more normal, and they didn't seem to get high.\u003c/p>\n\u003cp>\"If you give a mouse a drug that activates its reward pathways like cocaine, amphetamine or morphine, the mice just run around more. In this compound, we saw very little of that,\" Manglik says. The mice also didn't seem to have a preference between the chemical and salt water.\u003c/p>\n\u003cp>That means it's possible that the compound is less lethal and has less potential for abuse compared to something like morphine, but it still might be as effective of a painkiller. If, of course, it turns out to work in humans. So far it's only been tested in mice.\u003c/p>\n\u003cp>And the role that beta-arrestin plays in opioids is just one hypothesis. It would be eerily convenient if only the negative effects of opiates are tied to this one protein. The mice that didn't have any beta-arrestin actually seemed to have a stronger preference for morphine over saline. So there may be other things going on that science hasn't teased out yet.\u003c/p>\n\u003cp>But the work that Manglik and his collaborators have done is encouraging in the search for the next generation of painkillers — ideally ones that are safer and non-addictive.\u003c/p>\n\u003cp>\"I think this was really a tour de force,\" says \u003ca href=\"https://www.mskcc.org/research-areas/labs/gavril-pasternak\">Gavril Pasternak\u003c/a>, a researcher at the Memorial Sloan Kettering Cancer Center who's also trying to develop new opioids but was not involved in this study. \"They're new entities with totally different pharmacological profiles. These are great promise for opiates over the course of the next five to 10 years.\"\u003c/p>\n\u003cp>Bohn, now a professor at The Scripps Research Institute in Jupiter, Fla., is hopeful that a safer opioid may be coming to the clinic, too.\u003c/p>\n\u003cp>Manglik and some of his collaborators have founded a company that will try to bring these new drugs to market, and the pharmaceutical company \u003ca href=\"http://www.trevena.com/\">Trevena \u003c/a>is running a very similar molecule through clinical trials now.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>But that safe, effective painkiller isn't here yet, Bohn says. \"We have some really gorgeous compounds, and I think opiates are a terrible epidemic. But I would be careful of overselling this as the answer.\"\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=Scientists+Engineer+An+Opioid+That+May+Reduce+Pain+With+Less+Risk&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Precision Medicine: Little Benefit So Far, But Lots of Hope",
"title": "Precision Medicine: Little Benefit So Far, But Lots of Hope",
"headTitle": "KQED Future of You | KQED Science",
"content": "\u003cp>There was one boy, eight years old, who Olena Morozova thinks about still.\u003c/p>\n\u003cp>He was being treated for sarcoma, a rare cancer found in bones or connective tissue. A genetic mutation was found that might partly explain his illness, but there was no therapy to fix it.\u003c/p>\n\u003caside class=\"pullquote alignright\">'I think of all the names and all the faces of kids who have died, and I think, 'There's been too many of them. Let's change this.'\u003c/aside>\n\u003cp>“So the patient was back to square one. Even though he was in the trial, there was nothing that the trial could do,\" says Morozova, the principal researcher in the \u003ca href=\"https://treehouse.soe.ucsc.edu/CKCC\" target=\"_blank\">California Kids Cancer Comparison\u003c/a>. The project attempts to find treatment for children who haven't responded to standard therapy, by analyzing the genetics of their tumors.\u003c/p>\n\u003cp>Morozova's team had developed a tumor map, a graphical representation of how different or similar individual tumors are at a molecular level. Curiously, the boy’s tumor was genetically similar to another type of cancer called neuroblastoma, which is treated with a particular therapy considered to be ill-suited for sarcoma.\u003c/p>\n\u003cp>Out of options, the doctors gave it a try.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"The patient had a partial response,\" says Morozova, \"It wasn't a complete remission, but just the idea that somebody could benefit from this analysis and we could learn something new was very exciting for us as a bioinformatics institution.\"\u003c/p>\n\u003cp>More analysis, another drug, sending the tumor into remission for several months. That gave \u003cspan class=\"\">the boy back something resembling a normal\u003cspan class=\"x_apple-converted-space\"> \u003c/span>\u003c/span>\u003cspan class=\"\">\u003cspan class=\"\">childhood.\u003c/span>\u003cspan class=\"\"> He ran, he played. His appetite returned.\u003c/span>\u003c/span>\u003c/p>\n\u003cp>But the tumor proved resilient.\u003c/p>\n\u003cp>In January, the boy died.\u003c/p>\n\u003cp>Amidst the tragedy, Morozova and her researchers found something to be hopeful about: His temporary recovery showed them their project possessed greater potential to help patients currently fighting disease.\u003c/p>\n\u003cp>It \"started us on this vision,\" she says. \"In the beginning we started out as just a research project. We didn't think that this would be immediately of clinical benefit to patients.\"\u003c/p>\n\u003cp>Now, the California Kids Cancer Comparison gets involved on an individual level, participating in the tumor board at Stanford Hospital, sharing their results with panels of experts from different medical specialties who decide, together, on treatments for patients.\u003c/p>\n\u003cp>\u003cstrong>Results Not There Yet\u003c/strong>\u003c/p>\n\u003cp>Still, the death of group's child patient points to an unhappy reality: What we call \"precision medicine\" -- tailoring treatments according to the genetics, environment and lifestyle of individual patients --still isn’t precise enough. And our growing knowledge of the genetics of cancer has yet to save many lives.\u003c/p>\n\u003cp>The concept of precision medicine grows out of a longstanding frustration in tackling disease: Some patients just do not respond to a treatment that normally works. Not only does this failure necessitate a different remedy, it also puts someone who is ill through a costly and often painful process for no benefit.\u003c/p>\n\u003cfigure id=\"attachment_224189\" class=\"wp-caption alignright\" style=\"max-width: 381px\">\u003ca href=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/08/olena.jpg\">\u003cimg class=\" wp-image-224189\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/08/olena-541x600.jpg\" alt=\"Olena Morozova, principal researcher of the California Kids Cancer Comparison.\" width=\"381\" height=\"423\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2016/08/olena-541x600.jpg 541w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/olena-400x443.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/olena.jpg 692w\" sizes=\"(max-width: 381px) 100vw, 381px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Olena Morozova, principal researcher of the California Kids Cancer Comparison. \u003ccite>(University of California, Santa Cruz)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Being able to choose the right treatment from the start would be an enormous advance. The government is on board. The 2016 federal budget includes $215 million for the \u003ca href=\"https://www.whitehouse.gov/precision-medicine\" target=\"_blank\">Precision Medicine Initiative\u003c/a>. A major part of the project is the creation of a \"national research cohort,\" a group of volunteers willing to share their genomes and daily living habits with researchers from the National Institutes of Health as part of \u003ca href=\"https://www.nih.gov/precision-medicine-initiative-cohort-program\">a 10-year study\u003c/a>.\u003c/p>\n\u003cp>In the nation’s most populous state, Gov. Jerry Brown has supported the launch of the \u003ca href=\"http://www.ciapm.org/\" target=\"_blank\">California Initiative to Advance Precision Medicine\u003c/a>. But so far, public and private funders have dedicated just $3 million to the project. Still, the researchers at the California Kids Cancer Comparison, a pilot project of CIAPM, aren’t complaining.\u003c/p>\n\u003cp>\"Pediatric cancer research is very poorly funded,\" says Isabel Bjork, director of the Cancer Comparison. \"It's a demonstration project -- that was important for us, because we had some theories that we had seen work a few times, but we need bigger comparisons to really test them.\"\u003c/p>\n\u003cp>Many hospitals are conducting their own precision medicine trials, sequencing genetic information from their patients and their patients’ tumors in the hopes of finding an \"actionable mutation\" that might respond to a treatment.\u003c/p>\n\u003cp>The results to date have been underwhelming. \"In the majority of the clinical trials, the benefit has been very small, measured as two months of longer survival,\" Antonio Fojo, an oncologist at Columbia University \u003ca href=\"https://www.aacc.org/publications/cln/articles/2016/july/the-perils-and-promise-of-precision-medicine\" target=\"_blank\">reported at the American Association for Clinical Chemistry\u003c/a> in July.\u003c/p>\n\u003cp>\u003cb>'Let's Change This'\u003c/b>\u003c/p>\n\u003cp>When President Obama said in his 2015 State of the Union Address that the national initiative would \"bring us closer to curing diseases like cancer and diabetes,\" \u003ca href=\"http://www.nytimes.com/2015/01/29/opinion/moonshot-medicine-will-let-us-down.html?_r=0\" target=\"_blank\">some experts were skeptical. \u003c/a>The interplay of genetics and daily life habits are too complicated to figure out, they argued.\u003c/p>\n\u003cp>But for those who work with pediatric cancer patients, any medical advance, even the most incremental, is cause for hope.\u003c/p>\n\u003cp>Mariela Medina works at Jacob's Heart, an organization in Watsonville, California that helps kids with cancer, and their families, cope with the disease. Many of the children cared for by the organization are also part of the California Kids Cancer Comparison.\u003c/p>\n\u003cp>Medina specializes in working with teens, and she knows first-hand what they're going through. More than a decade ago, just before she turned 14, she was diagnosed with Hodgkin Lymphoma, stage IV. She's been cancer-free for 10 years now, but not before a trio of relapses.\u003c/p>\n\u003cp>Her memory of her cancer years is foggy, something she attributes to chemotherapy, but from what she recalls, the treatment was rough, with bad nausea. \"I couldn't keep anything down, I was on so many medicines,\" she says.\u003c/p>\n\u003cp>Lori Butterworth, founder and director of Jacob's Heart, says her hope is that researchers like Olena Morozova will put her out of business.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"I think of all the names and all the faces of kids who have died,\" she says, \"and I think, 'There's been too many of them. Let's change this.' \"\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>There was one boy, eight years old, who Olena Morozova thinks about still.\u003c/p>\n\u003cp>He was being treated for sarcoma, a rare cancer found in bones or connective tissue. A genetic mutation was found that might partly explain his illness, but there was no therapy to fix it.\u003c/p>\n\u003caside class=\"pullquote alignright\">'I think of all the names and all the faces of kids who have died, and I think, 'There's been too many of them. Let's change this.'\u003c/aside>\n\u003cp>“So the patient was back to square one. Even though he was in the trial, there was nothing that the trial could do,\" says Morozova, the principal researcher in the \u003ca href=\"https://treehouse.soe.ucsc.edu/CKCC\" target=\"_blank\">California Kids Cancer Comparison\u003c/a>. The project attempts to find treatment for children who haven't responded to standard therapy, by analyzing the genetics of their tumors.\u003c/p>\n\u003cp>Morozova's team had developed a tumor map, a graphical representation of how different or similar individual tumors are at a molecular level. Curiously, the boy’s tumor was genetically similar to another type of cancer called neuroblastoma, which is treated with a particular therapy considered to be ill-suited for sarcoma.\u003c/p>\n\u003cp>Out of options, the doctors gave it a try.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"The patient had a partial response,\" says Morozova, \"It wasn't a complete remission, but just the idea that somebody could benefit from this analysis and we could learn something new was very exciting for us as a bioinformatics institution.\"\u003c/p>\n\u003cp>More analysis, another drug, sending the tumor into remission for several months. That gave \u003cspan class=\"\">the boy back something resembling a normal\u003cspan class=\"x_apple-converted-space\"> \u003c/span>\u003c/span>\u003cspan class=\"\">\u003cspan class=\"\">childhood.\u003c/span>\u003cspan class=\"\"> He ran, he played. His appetite returned.\u003c/span>\u003c/span>\u003c/p>\n\u003cp>But the tumor proved resilient.\u003c/p>\n\u003cp>In January, the boy died.\u003c/p>\n\u003cp>Amidst the tragedy, Morozova and her researchers found something to be hopeful about: His temporary recovery showed them their project possessed greater potential to help patients currently fighting disease.\u003c/p>\n\u003cp>It \"started us on this vision,\" she says. \"In the beginning we started out as just a research project. We didn't think that this would be immediately of clinical benefit to patients.\"\u003c/p>\n\u003cp>Now, the California Kids Cancer Comparison gets involved on an individual level, participating in the tumor board at Stanford Hospital, sharing their results with panels of experts from different medical specialties who decide, together, on treatments for patients.\u003c/p>\n\u003cp>\u003cstrong>Results Not There Yet\u003c/strong>\u003c/p>\n\u003cp>Still, the death of group's child patient points to an unhappy reality: What we call \"precision medicine\" -- tailoring treatments according to the genetics, environment and lifestyle of individual patients --still isn’t precise enough. And our growing knowledge of the genetics of cancer has yet to save many lives.\u003c/p>\n\u003cp>The concept of precision medicine grows out of a longstanding frustration in tackling disease: Some patients just do not respond to a treatment that normally works. Not only does this failure necessitate a different remedy, it also puts someone who is ill through a costly and often painful process for no benefit.\u003c/p>\n\u003cfigure id=\"attachment_224189\" class=\"wp-caption alignright\" style=\"max-width: 381px\">\u003ca href=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/08/olena.jpg\">\u003cimg class=\" wp-image-224189\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/08/olena-541x600.jpg\" alt=\"Olena Morozova, principal researcher of the California Kids Cancer Comparison.\" width=\"381\" height=\"423\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2016/08/olena-541x600.jpg 541w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/olena-400x443.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/olena.jpg 692w\" sizes=\"(max-width: 381px) 100vw, 381px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Olena Morozova, principal researcher of the California Kids Cancer Comparison. \u003ccite>(University of California, Santa Cruz)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Being able to choose the right treatment from the start would be an enormous advance. The government is on board. The 2016 federal budget includes $215 million for the \u003ca href=\"https://www.whitehouse.gov/precision-medicine\" target=\"_blank\">Precision Medicine Initiative\u003c/a>. A major part of the project is the creation of a \"national research cohort,\" a group of volunteers willing to share their genomes and daily living habits with researchers from the National Institutes of Health as part of \u003ca href=\"https://www.nih.gov/precision-medicine-initiative-cohort-program\">a 10-year study\u003c/a>.\u003c/p>\n\u003cp>In the nation’s most populous state, Gov. Jerry Brown has supported the launch of the \u003ca href=\"http://www.ciapm.org/\" target=\"_blank\">California Initiative to Advance Precision Medicine\u003c/a>. But so far, public and private funders have dedicated just $3 million to the project. Still, the researchers at the California Kids Cancer Comparison, a pilot project of CIAPM, aren’t complaining.\u003c/p>\n\u003cp>\"Pediatric cancer research is very poorly funded,\" says Isabel Bjork, director of the Cancer Comparison. \"It's a demonstration project -- that was important for us, because we had some theories that we had seen work a few times, but we need bigger comparisons to really test them.\"\u003c/p>\n\u003cp>Many hospitals are conducting their own precision medicine trials, sequencing genetic information from their patients and their patients’ tumors in the hopes of finding an \"actionable mutation\" that might respond to a treatment.\u003c/p>\n\u003cp>The results to date have been underwhelming. \"In the majority of the clinical trials, the benefit has been very small, measured as two months of longer survival,\" Antonio Fojo, an oncologist at Columbia University \u003ca href=\"https://www.aacc.org/publications/cln/articles/2016/july/the-perils-and-promise-of-precision-medicine\" target=\"_blank\">reported at the American Association for Clinical Chemistry\u003c/a> in July.\u003c/p>\n\u003cp>\u003cb>'Let's Change This'\u003c/b>\u003c/p>\n\u003cp>When President Obama said in his 2015 State of the Union Address that the national initiative would \"bring us closer to curing diseases like cancer and diabetes,\" \u003ca href=\"http://www.nytimes.com/2015/01/29/opinion/moonshot-medicine-will-let-us-down.html?_r=0\" target=\"_blank\">some experts were skeptical. \u003c/a>The interplay of genetics and daily life habits are too complicated to figure out, they argued.\u003c/p>\n\u003cp>But for those who work with pediatric cancer patients, any medical advance, even the most incremental, is cause for hope.\u003c/p>\n\u003cp>Mariela Medina works at Jacob's Heart, an organization in Watsonville, California that helps kids with cancer, and their families, cope with the disease. Many of the children cared for by the organization are also part of the California Kids Cancer Comparison.\u003c/p>\n\u003cp>Medina specializes in working with teens, and she knows first-hand what they're going through. More than a decade ago, just before she turned 14, she was diagnosed with Hodgkin Lymphoma, stage IV. She's been cancer-free for 10 years now, but not before a trio of relapses.\u003c/p>\n\u003cp>Her memory of her cancer years is foggy, something she attributes to chemotherapy, but from what she recalls, the treatment was rough, with bad nausea. \"I couldn't keep anything down, I was on so many medicines,\" she says.\u003c/p>\n\u003cp>Lori Butterworth, founder and director of Jacob's Heart, says her hope is that researchers like Olena Morozova will put her out of business.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"I think of all the names and all the faces of kids who have died,\" she says, \"and I think, 'There's been too many of them. Let's change this.' \"\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "2 Proteins in Zika Virus May Be Cause of Birth Defects",
"title": "2 Proteins in Zika Virus May Be Cause of Birth Defects",
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"content": "\u003cp>Scientists at the University of Southern California discovered a key weapon used by the Zika virus to ravage the brains of infected fetuses: proteins.\u003c/p>\n\u003cp>In an article published Thursday in the journal Cell Stem Cell, researchers identified two proteins in Zika potentially responsible for causing microcephaly.\u003c/p>\n\u003cp>Microcephaly is a birth defect in which a child’s head is smaller than the average size. A variety of factors can trigger the condition, according to the Centers for Disease Control and Prevention, including malnutrition, environmental agents and other viruses. Although it is associated with brain damage, some children born with the disease never develop cognitive issues.\u003c/p>\n\u003cfigure id=\"attachment_221942\" class=\"wp-caption alignright\" style=\"max-width: 355px\">\u003ca href=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/08/Zika-drawing-e1471040488174.jpg\">\u003cimg class=\"wp-image-221942\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/08/Zika-drawing-607x600.jpg\" alt=\"A representation of the surface of the Zika virus is shown.\" width=\"355\" height=\"351\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">A representation of the surface of the Zika virus is shown. \u003ccite>(Purdue University image/courtesy of Kuhn and Rossmann research groups)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The proteins — called NS4A and NS4B — affect the brain by targeting a critical signaling pathway that controls cell growth and breaks down damaged cells and their elements. Initially, Zika slows cell development and reduces the variety of cells in the brain. Over time, this “rigged” system enables the virus to thrive and spread while healthy cells die.\u003c/p>\n\u003cp>The finding is the first step toward developing future drugs that could prevent Zika’s damaging effects, said Jae Jung, the study’s co-author and director of the USC Institute of Emerging Pathogens and Immune Diseases. ”Those two viral proteins are ultimately the target for therapy development,” he said.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Working with discarded tissue, the researchers infected fetal neural stem cells — a building block of the nervous system — with three different strains of the Zika virus. Stem cells infected with the ZIKV strain, which is responsible for causing the current outbreak, died at rates more than four times higher than an uninfected brain.\u003c/p>\n\u003cp>The specific proteins in question kill neural cells by hijacking a signaling mechanism called AKT-Mtor pathway. The pathway handles the process of breaking down damaged cells, also known as autophagy. As Zika spreads in the developing fetus, the virus actually uses the disposal process to continue proliferating. Cells began dying as early as two weeks after infection occurred.\u003c/p>\n\u003cp>The Zika virus rose to prominence in 2015 after cases of an unknown disease were reported in Brazil. Since then, the outbreak has affected more than 40 countries, including the United States.\u003c/p>\n\u003cp>The virus is spread by certain mosquitoes and can cause flu-like symptoms such as fever, muscle aches and joint pain in adults. Pregnant women are considered especially vulnerable because of the risk of microcephaly.\u003c/p>\n\u003cp>Dr. Kjersti Aagaard, a maternal-fetal medicine specialist at Texas Children’s Hospital Pavilion for Women and the Baylor College of Medicine, said microcephaly triggered by Zika is an urgent concern because of its association with brain malformation. With the virus, Aagaard said, a smaller head likely encases a smaller brain ravaged by disease.\u003c/p>\n\u003cp>“Microcephaly is the endpoint of the damage,” she said.\u003c/p>\n\u003cp>Aagaard also noted that the virus can affect pregnant women in other serious ways, too. The illness can lead to miscarriage, stillbirths and low amniotic fluid. In some cases, the illness causes both mother and child to develop ulcers in the eye.\u003c/p>\n\u003cp>But, some pregnant women who become infected never pass the virus to the fetus at all, Aagaard stressed. Early screening is key in identifying if and when a fetus is affected by the infected mother.\u003c/p>\n\u003cp>“An infected mom does not equal an infected fetus,” she said. “And an infected fetus does not equal an affected fetus.”\u003c/p>\n\u003cp>Findings from the latest study have already prompted further research to develop various Zika drugs and vaccines. Scientists are already working on a live, attenuated vaccine that will use a strain of the virus without the microcephaly-causing proteins, Jung said.\u003c/p>\n\u003cp>But questions remain, such as how these proteins interrupt the cell’s ability to regulate brain development. And while the scientists made this discovery in six months, Jung anticipates the next phase may take several years.\u003c/p>\n\u003cp>“We know where we are going but we need to find the detailed map,” he said.\u003c/p>\n\u003cp>Funding is also an issue. Congress left for recess in July without allocating monies for the Zika effort, which means labs that depend on government grants will be strapped for cash in the coming months.\u003c/p>\n\u003cp>But Dr. Gary Clark, chief of pediatric neurology and developmental neuroscience at Texas Children’s Hospital, said research should not be the medical community’s main priority. Instead, authorities should refocus on educating pregnant women and travelers entering the country from affected areas to prevent the virus’ spread and protect future children from a lifetime of disability.\u003c/p>\n\u003cp>“I think that bottom line is that this virus causes brain damage,” he said. “And this is permanent.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This story was produced by\u003ca href=\"http://khn.org/\">Kaiser Health News\u003c/a>, which publishes California Healthline, a service of the California Health Care Foundation.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Scientists at the University of Southern California discovered a key weapon used by the Zika virus to ravage the brains of infected fetuses: proteins.\u003c/p>\n\u003cp>In an article published Thursday in the journal Cell Stem Cell, researchers identified two proteins in Zika potentially responsible for causing microcephaly.\u003c/p>\n\u003cp>Microcephaly is a birth defect in which a child’s head is smaller than the average size. A variety of factors can trigger the condition, according to the Centers for Disease Control and Prevention, including malnutrition, environmental agents and other viruses. Although it is associated with brain damage, some children born with the disease never develop cognitive issues.\u003c/p>\n\u003cfigure id=\"attachment_221942\" class=\"wp-caption alignright\" style=\"max-width: 355px\">\u003ca href=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/08/Zika-drawing-e1471040488174.jpg\">\u003cimg class=\"wp-image-221942\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/08/Zika-drawing-607x600.jpg\" alt=\"A representation of the surface of the Zika virus is shown.\" width=\"355\" height=\"351\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">A representation of the surface of the Zika virus is shown. \u003ccite>(Purdue University image/courtesy of Kuhn and Rossmann research groups)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The proteins — called NS4A and NS4B — affect the brain by targeting a critical signaling pathway that controls cell growth and breaks down damaged cells and their elements. Initially, Zika slows cell development and reduces the variety of cells in the brain. Over time, this “rigged” system enables the virus to thrive and spread while healthy cells die.\u003c/p>\n\u003cp>The finding is the first step toward developing future drugs that could prevent Zika’s damaging effects, said Jae Jung, the study’s co-author and director of the USC Institute of Emerging Pathogens and Immune Diseases. ”Those two viral proteins are ultimately the target for therapy development,” he said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Working with discarded tissue, the researchers infected fetal neural stem cells — a building block of the nervous system — with three different strains of the Zika virus. Stem cells infected with the ZIKV strain, which is responsible for causing the current outbreak, died at rates more than four times higher than an uninfected brain.\u003c/p>\n\u003cp>The specific proteins in question kill neural cells by hijacking a signaling mechanism called AKT-Mtor pathway. The pathway handles the process of breaking down damaged cells, also known as autophagy. As Zika spreads in the developing fetus, the virus actually uses the disposal process to continue proliferating. Cells began dying as early as two weeks after infection occurred.\u003c/p>\n\u003cp>The Zika virus rose to prominence in 2015 after cases of an unknown disease were reported in Brazil. Since then, the outbreak has affected more than 40 countries, including the United States.\u003c/p>\n\u003cp>The virus is spread by certain mosquitoes and can cause flu-like symptoms such as fever, muscle aches and joint pain in adults. Pregnant women are considered especially vulnerable because of the risk of microcephaly.\u003c/p>\n\u003cp>Dr. Kjersti Aagaard, a maternal-fetal medicine specialist at Texas Children’s Hospital Pavilion for Women and the Baylor College of Medicine, said microcephaly triggered by Zika is an urgent concern because of its association with brain malformation. With the virus, Aagaard said, a smaller head likely encases a smaller brain ravaged by disease.\u003c/p>\n\u003cp>“Microcephaly is the endpoint of the damage,” she said.\u003c/p>\n\u003cp>Aagaard also noted that the virus can affect pregnant women in other serious ways, too. The illness can lead to miscarriage, stillbirths and low amniotic fluid. In some cases, the illness causes both mother and child to develop ulcers in the eye.\u003c/p>\n\u003cp>But, some pregnant women who become infected never pass the virus to the fetus at all, Aagaard stressed. Early screening is key in identifying if and when a fetus is affected by the infected mother.\u003c/p>\n\u003cp>“An infected mom does not equal an infected fetus,” she said. “And an infected fetus does not equal an affected fetus.”\u003c/p>\n\u003cp>Findings from the latest study have already prompted further research to develop various Zika drugs and vaccines. Scientists are already working on a live, attenuated vaccine that will use a strain of the virus without the microcephaly-causing proteins, Jung said.\u003c/p>\n\u003cp>But questions remain, such as how these proteins interrupt the cell’s ability to regulate brain development. And while the scientists made this discovery in six months, Jung anticipates the next phase may take several years.\u003c/p>\n\u003cp>“We know where we are going but we need to find the detailed map,” he said.\u003c/p>\n\u003cp>Funding is also an issue. Congress left for recess in July without allocating monies for the Zika effort, which means labs that depend on government grants will be strapped for cash in the coming months.\u003c/p>\n\u003cp>But Dr. Gary Clark, chief of pediatric neurology and developmental neuroscience at Texas Children’s Hospital, said research should not be the medical community’s main priority. Instead, authorities should refocus on educating pregnant women and travelers entering the country from affected areas to prevent the virus’ spread and protect future children from a lifetime of disability.\u003c/p>\n\u003cp>“I think that bottom line is that this virus causes brain damage,” he said. “And this is permanent.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This story was produced by\u003ca href=\"http://khn.org/\">Kaiser Health News\u003c/a>, which publishes California Healthline, a service of the California Health Care Foundation.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>The federal government announced plans Thursday to lift a moratorium on funding of certain controversial experiments that use human stem cells to create animal embryos that are partly human.\u003c/p>\n\u003cp>The National Institutes of Health is \u003ca href=\"http://www.npr.org/sections/health-shots/2016/08/04/488387729/nih-plans-to-lift-ban-on-research-funds-for-part-human-part-animal-embryos\">proposing\u003c/a> a new policy to permit scientists to get federal money to make embryos, known as chimeras, under certain carefully monitored conditions.\u003c/p>\n\u003cp>The NIH imposed a \u003ca href=\"http://www.npr.org/sections/health-shots/2015/11/06/454693391/should-human-stem-cells-be-used-to-make-partly-human-chimeras\">moratorium\u003c/a> on funding these experiments in September because they could raise ethical \u003ca href=\"http://www.npr.org/sections/health-shots/2016/05/18/478212837/in-search-for-cures-scientists-create-embryos-that-are-both-animal-and-human\">concerns\u003c/a>.\u003c/p>\n\u003cp>One issue is that scientists might inadvertently create animals that have partly human brains, endowing them with some semblance of human consciousness or human thinking abilities. Another is that they could develop into animals with human sperm and eggs and breed, producing human embryos or fetuses inside animals or hybrid creatures.\u003c/p>\n\u003cp>But scientists have argued that they could take steps to prevent those outcomes and that the embryos provide invaluable tools for medical research.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>For example, scientists hope to use the embryos to create animal models of human diseases, which could lead to new ways to prevent and treat illnesses. Researchers also hope to produce sheep, pigs and cows with human hearts, kidneys, livers, pancreases and possibly other organs that could be used for transplants.\u003c/p>\n\u003cp>To address the ethical concerns, the NIH's new policy imposes several restrictions.\u003c/p>\n\u003cp>The policy proposes prohibiting the introduction of certain types of human cells into embryos of nonhuman primates, such as monkeys and chimps, at even earlier stages of development than what was currently prohibited.\u003c/p>\n\u003cp>The extra protections are being added because these animals are so closely related to humans.\u003c/p>\n\u003cp>But the policy would lift the moratorium on funding experiments involving other species. Because of the ethical concerns, though, at least some of the experiments would go through an extra layer of review by a new, special committee of government officials.\u003c/p>\n\u003cp>That committee would, for example, consider experiments designed to create animals with human brain cells or human brain tissue. Scientists might want to create them to study neurological conditions such as Alzheimer's and Parkinson's diseases. But the experiments would undergo intensive scrutiny if there's any chance there might be a \"substantial contribution\" or \"substantial functional modification\" to an animal's brain.\u003c/p>\n\u003cp>In addition, the NIH would even consider experiments that could create animals with human sperm and human eggs since they may be useful for studying human development and infertility. But in that case steps would have to be taken to prevent the animals from breeding.\u003c/p>\n\u003cp>\"I am confident that these proposed changes will enable the NIH research community to move this promising area of science forward in a responsible manner,\" \u003ca href=\"http://osp.od.nih.gov/under-the-poliscope/wolinetz-bio\">Carrie Wolinetz\u003c/a>, the NIH's associate director for science policy, wrote in a \u003ca href=\"http://osp.od.nih.gov/under-the-poliscope/2016/08/next-steps-research-using-animal-embryos-containing-human-cells\">blog post\u003c/a>.\u003c/p>\n\u003cp>\"At the end of the day, we want to make sure this research progresses because its very important to our understanding of disease. It's important to our mission to improve human health,\" she said in an interview with NPR. \"But we also want to make sure there's an extra set of eyes on these projects because they do have this ethical set of concerns associated with them.\"\u003c/p>\n\u003cp>Several scientists said they are thrilled by the new policy. \"It's very, very welcome news that NIH will consider funding this type of research,\" says \u003ca href=\"http://animalscience.ucdavis.edu/faculty/ross/\">Pablo Ross\u003c/a>, a developmental biologist at the University of California, Davis, trying to grow human organs in farm animals. \"We need funding to be able to answer some very important questions.\"\u003c/p>\n\u003cp>But critics denounced the decision. \"Science fiction writers might have imagined worlds like this — like \u003cem>The\u003c/em> \u003cem>Island of Dr. Moreau,\u003c/em> \u003cem>Brave New World,\u003c/em> \u003cem>Frankenstein,\u003c/em>\" says \u003ca href=\"https://www.nymc.edu/faculty/directory/by-name/newman-stuart/\">Stuart Newman\u003c/a>, a biologist at New York Medical College. \"There have been speculations. But now they're becoming more real. And I think that we just can't say that since it's possible then let's do it.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The public has 30 days to comment on the proposed new policy. NIH could start funding projects as early as the start of 2017.\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=NIH+Plans+To+Lift+Ban+On+Research+Funds+For+Part-Human%2C+Part-Animal+Embryos&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The federal government announced plans Thursday to lift a moratorium on funding of certain controversial experiments that use human stem cells to create animal embryos that are partly human.\u003c/p>\n\u003cp>The National Institutes of Health is \u003ca href=\"http://www.npr.org/sections/health-shots/2016/08/04/488387729/nih-plans-to-lift-ban-on-research-funds-for-part-human-part-animal-embryos\">proposing\u003c/a> a new policy to permit scientists to get federal money to make embryos, known as chimeras, under certain carefully monitored conditions.\u003c/p>\n\u003cp>The NIH imposed a \u003ca href=\"http://www.npr.org/sections/health-shots/2015/11/06/454693391/should-human-stem-cells-be-used-to-make-partly-human-chimeras\">moratorium\u003c/a> on funding these experiments in September because they could raise ethical \u003ca href=\"http://www.npr.org/sections/health-shots/2016/05/18/478212837/in-search-for-cures-scientists-create-embryos-that-are-both-animal-and-human\">concerns\u003c/a>.\u003c/p>\n\u003cp>One issue is that scientists might inadvertently create animals that have partly human brains, endowing them with some semblance of human consciousness or human thinking abilities. Another is that they could develop into animals with human sperm and eggs and breed, producing human embryos or fetuses inside animals or hybrid creatures.\u003c/p>\n\u003cp>But scientists have argued that they could take steps to prevent those outcomes and that the embryos provide invaluable tools for medical research.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>For example, scientists hope to use the embryos to create animal models of human diseases, which could lead to new ways to prevent and treat illnesses. Researchers also hope to produce sheep, pigs and cows with human hearts, kidneys, livers, pancreases and possibly other organs that could be used for transplants.\u003c/p>\n\u003cp>To address the ethical concerns, the NIH's new policy imposes several restrictions.\u003c/p>\n\u003cp>The policy proposes prohibiting the introduction of certain types of human cells into embryos of nonhuman primates, such as monkeys and chimps, at even earlier stages of development than what was currently prohibited.\u003c/p>\n\u003cp>The extra protections are being added because these animals are so closely related to humans.\u003c/p>\n\u003cp>But the policy would lift the moratorium on funding experiments involving other species. Because of the ethical concerns, though, at least some of the experiments would go through an extra layer of review by a new, special committee of government officials.\u003c/p>\n\u003cp>That committee would, for example, consider experiments designed to create animals with human brain cells or human brain tissue. Scientists might want to create them to study neurological conditions such as Alzheimer's and Parkinson's diseases. But the experiments would undergo intensive scrutiny if there's any chance there might be a \"substantial contribution\" or \"substantial functional modification\" to an animal's brain.\u003c/p>\n\u003cp>In addition, the NIH would even consider experiments that could create animals with human sperm and human eggs since they may be useful for studying human development and infertility. But in that case steps would have to be taken to prevent the animals from breeding.\u003c/p>\n\u003cp>\"I am confident that these proposed changes will enable the NIH research community to move this promising area of science forward in a responsible manner,\" \u003ca href=\"http://osp.od.nih.gov/under-the-poliscope/wolinetz-bio\">Carrie Wolinetz\u003c/a>, the NIH's associate director for science policy, wrote in a \u003ca href=\"http://osp.od.nih.gov/under-the-poliscope/2016/08/next-steps-research-using-animal-embryos-containing-human-cells\">blog post\u003c/a>.\u003c/p>\n\u003cp>\"At the end of the day, we want to make sure this research progresses because its very important to our understanding of disease. It's important to our mission to improve human health,\" she said in an interview with NPR. \"But we also want to make sure there's an extra set of eyes on these projects because they do have this ethical set of concerns associated with them.\"\u003c/p>\n\u003cp>Several scientists said they are thrilled by the new policy. \"It's very, very welcome news that NIH will consider funding this type of research,\" says \u003ca href=\"http://animalscience.ucdavis.edu/faculty/ross/\">Pablo Ross\u003c/a>, a developmental biologist at the University of California, Davis, trying to grow human organs in farm animals. \"We need funding to be able to answer some very important questions.\"\u003c/p>\n\u003cp>But critics denounced the decision. \"Science fiction writers might have imagined worlds like this — like \u003cem>The\u003c/em> \u003cem>Island of Dr. Moreau,\u003c/em> \u003cem>Brave New World,\u003c/em> \u003cem>Frankenstein,\u003c/em>\" says \u003ca href=\"https://www.nymc.edu/faculty/directory/by-name/newman-stuart/\">Stuart Newman\u003c/a>, a biologist at New York Medical College. \"There have been speculations. But now they're becoming more real. And I think that we just can't say that since it's possible then let's do it.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The public has 30 days to comment on the proposed new policy. NIH could start funding projects as early as the start of 2017.\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=NIH+Plans+To+Lift+Ban+On+Research+Funds+For+Part-Human%2C+Part-Animal+Embryos&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Could 'Brain Training' Games Actually Work? New Study Surprises Scientists",
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"content": "\u003cp>We've seen -- and \u003ca href=\"http://ww2.kqed.org/futureofyou/2016/01/21/lumosity-ceo-admits-brain-training-games-may-produce-no-direct-benefits/\" target=\"_blank\">done\u003c/a> -- some negative coverage of the so-called brain training industry, in which companies provide computerized games that ostensibly improve memory, attention, and other mental capabilities while -- so some of the ads suggested -- warding off cognitive decline. In January, one of the leading brands in this space, Lumosity made a \u003ca href=\"https://www.ftc.gov/system/files/documents/cases/160105lumoslabsstip.pdf\" target=\"_blank\">deal\u003c/a> with the Federal Trade Commission to cough up $2 million for partial refunds as compensation for deceptive advertising.\u003c/p>\n\u003caside class=\"pullquote alignright\">'That’s a spectacular finding. We didn’t have any evidence that computerized training had any preventive effects on dementia.'\u003ccite>Susanne Jaeggi, director, Working Memory and Plasticity Laboratory, University of California, Irvine\u003c/cite>\u003c/aside>\n\u003cp>And yet, even the doubters haven't entirely ruled out the possibility that some form of cognitive training may be beneficial. A 2014 \u003ca href=\"http://longevity3.stanford.edu/blog/2014/10/15/the-consensus-on-the-brain-training-industry-from-the-scientific-community-2/\" target=\"_blank\">statement\u003c/a> from dozens of cognitive scientists taking the industry to task for making claims without evidence also acknowledged \"some intriguing isolated reports do inspire additional research.”\u003c/p>\n\u003cp>Now, there may be some solid evidence that the training works. On July 24, at the \u003ca href=\"https://www.alz.org/aaic/about/overview.asp\" target=\"_blank\">Alzheimer’s Assn.’s International Conference\u003c/a> in Toronto, researchers of a long-range study announced that a relatively small amount of cognitive training resulted in a significant reduction in the risk of developing cognitive decline or dementia over 10 years.\u003c/p>\n\u003cp>The results are still preliminary, as the study is currently under review for publication in a peer-reviewed journal.\u003c/p>\n\u003cp>\u003cstrong>The ACTIVE Study\u003cbr>\n\u003c/strong>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>[contextly_sidebar id=\"7jQIX9d22jIjItiEyF6aCA80u9fPGDYj\"]The Advanced Cognitive Training for Independent and Vital Elderly, or ACTIVE, study divided 2,785 participants with an average age of almost 74 into three intervention groups and one control group. The intervention groups received, respectively, classroom-based memory strategies, classroom-based reasoning strategies and computerized speed-of-processing training in the form of a \u003ca href=\"http://www.newyorker.com/tech/elements/could-brain-training-prevent-dementia\" target=\"_blank\">game by Posit Science\u003c/a>, a for-profit company that offers subscriptions to its \"brain training exercises\" for a monthly fee.\u003c/p>\n\u003cp>Ten years later, the people in the speed-of-processing training experienced reduced cognitive decline; the other two interventions showed a statistically insignificant impact and a control group that received no training received no benefit.\u003c/p>\n\u003caside class=\"pullquote alignright\">'I remain optimistic but do not consider it to be definitive.'\u003ccite> Dr. Murali Doraiswamy, Duke Institute for Brain Sciences\u003c/cite>\u003c/aside>\n\u003cp>A \u003ca href=\"http://www.multivu.com/players/English/7865351-aaic-2016-cognitive-training/docs/press-release-1311562930.pdf\" target=\"_blank\">release\u003c/a> from the Alzheimer's Association described the game/training that the study participants received:\u003c/p>\n\u003cblockquote>\u003cp>The user identifies an object (i.e., a truck) at the center of his/her gaze while at the same time identifying a target in the periphery (i.e., a car). As the user gets the answers correct, the speed of presentation becomes progressively briefer, while the targets become more similar. In the more difficult training tasks, the target in the periphery is obscured by distracting objects\u003cstrong>\u003cbr>\n\u003c/strong>\u003c/p>\u003c/blockquote>\n\u003cp>Participants only played the Posit game for an hour, in 10 sessions over five weeks. Yet 10 years later, just 73 out of 698 people who received the training developed dementia or exhibited cognitive decline, compared with 97 out of 695 in the control group.\u003c/p>\n\u003cp>That's a 33 percent reduction in risk for the intervention group. Furthermore, subjects who received an additional four sessions one year after the original training and four more sessions about three years after showed a whopping 48 percent reduction in risk for the same conditions.\u003c/p>\n\u003cp>The ACTIVE study, which is being run by scientists from multiple institutions, had previously found people who took the Posit training reported the same or greater ability to perform the so-called \u003ca href=\"http://www.healthcare.uiowa.edu/igec/tools/function/lawtonbrody.pdf\" target=\"_blank\">instrumental activities of daily living\u003c/a>, like doing laundry and managing medication, compared to a control group.\u003c/p>\n\u003cp>The ACTIVE experiments have been ongoing and are well-respected. Dr. Murali Doraiswamy, of the Duke Institute for Brain Sciences, calls it \"the best trial in the field.\" \u003ca href=\"http://www.newyorker.com/tech/elements/could-brain-training-prevent-dementia\" target=\"_blank\">The New Yorker\u003c/a> reports that more than 50 peer-reviewed scientific papers have come out of it, and the study is funded in part by the National Institute on Aging.\u003c/p>\n\u003cp>\u003cstrong>'Sufficiently Strong Evidence'\u003c/strong>\u003c/p>\n\u003cp>The chief science officer for the Alzheimer’s Association, Maria C. Carrillo, cautiously backed the results, saying the organization \"believes there is sufficiently strong evidence to conclude that lifelong learning and certain types of cognitive training may reduce the risk of cognitive decline. These new 10-year finds are evidence that it may hold true for dementia as well as cognitive decline.\"\u003c/p>\n\u003cp>Some cognitive scientists were impressed with the results.\u003c/p>\n\u003cp>“That’s a spectacular finding,” Susanne Jaeggi, the director of the Working Memory and Plasticity Laboratory at the University of California, Irvine, and a signatory of the 2014 statement slamming brain training companies, told The New Yorker. \"We didn’t have any evidence that computerized training had any preventive effects on dementia. You could argue that this study provides evidence that it is possible.\"\u003c/p>\n\u003cp>Dr. Ronald Petersen, director of the Mayo Clinic Alzheimer's Disease Research Center told Reuters, \"At first blush, that's kind of a big deal. This may even be clinically relevant.\"\u003c/p>\n\u003cp>Dr. Doraiswamy, from Duke, said that until the results are replicated, no conclusion can be reached. \"I remain optimistic but do not consider it to be definitive. I also want to see an independent body like the FDA vet it since they will have access to all the data whereas we are just seeing what is being presented.\"\u003c/p>\n\u003cp>\u003cstrong>So Little Yields So Much?\u003c/strong>\u003c/p>\n\u003cp>Other researchers expressed a sense of wonder that just 10 hours of cognitive training could result in such a big benefit.\u003c/p>\n\u003cp>\"It’s hard to understand how such a brief intervention could have a long-lasting impact,” Dr. Howard Fillit, executive director of the Alzheimer’s Drug Discovery Foundation, which supports pharmaceutical research on the disease, told \u003ca href=\"https://www.statnews.com/2016/07/24/brain-training-cuts-dementia-risk/\" target=\"_blank\">STAT\u003c/a>. \"But you have to respect the data.”\u003c/p>\n\u003cp>Jaeggi, the expert interviewed by The New Yorker, said: “If you stop doing it after 10 or even 14 sessions, how on earth can you continue to have these effects 10 years later?”\u003c/p>\n\u003cp>A potential answer, from STAT:\u003c/p>\n\u003cblockquote>\u003cp>One possibility is a bootstrapping effect. Maybe people who received speed-of-processing training “did something different over the years,” said Laurie Ryan, who oversees Alzheimer’s research at the National Institute on Aging. “Maybe they changed their lifestyle in some way,” with the training giving them a little cognitive boost that they parlayed into more reading, more travel, more social engagement, and more of other activities that boost “cognitive reserve,” the brain’s cushion against dementia.\u003c/p>\n\u003cp>In fact, some ACTIVE participants told scientists that the cognitive boost they felt from the training inspired them to enroll in classes at a local college or keep driving, said Rebok, both of which can keep people socially and intellectually engaged.\u003c/p>\u003c/blockquote>\n\u003cp>In any event, Dr. Michael Merzenich, a co-founder and chief scientific officer of Posit Science, did not think there was any mystery to it. \"We’re not a bit surprised that this simple thing was protective,\" he told me over the phone. He said speed-of-processing functioned as a sort of \"master switch\" for the brain.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\"It’s a very straightforward result,\" he said. \"It’s hard to deny the truth of it.\"\u003c/p>\n\n",
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"excerpt": "The 'brain-training' industry has been sharply criticized for making unsupported claims. But a new study shows playing a computerized game may have greatly reduced the risk of dementia.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>We've seen -- and \u003ca href=\"http://ww2.kqed.org/futureofyou/2016/01/21/lumosity-ceo-admits-brain-training-games-may-produce-no-direct-benefits/\" target=\"_blank\">done\u003c/a> -- some negative coverage of the so-called brain training industry, in which companies provide computerized games that ostensibly improve memory, attention, and other mental capabilities while -- so some of the ads suggested -- warding off cognitive decline. In January, one of the leading brands in this space, Lumosity made a \u003ca href=\"https://www.ftc.gov/system/files/documents/cases/160105lumoslabsstip.pdf\" target=\"_blank\">deal\u003c/a> with the Federal Trade Commission to cough up $2 million for partial refunds as compensation for deceptive advertising.\u003c/p>\n\u003caside class=\"pullquote alignright\">'That’s a spectacular finding. We didn’t have any evidence that computerized training had any preventive effects on dementia.'\u003ccite>Susanne Jaeggi, director, Working Memory and Plasticity Laboratory, University of California, Irvine\u003c/cite>\u003c/aside>\n\u003cp>And yet, even the doubters haven't entirely ruled out the possibility that some form of cognitive training may be beneficial. A 2014 \u003ca href=\"http://longevity3.stanford.edu/blog/2014/10/15/the-consensus-on-the-brain-training-industry-from-the-scientific-community-2/\" target=\"_blank\">statement\u003c/a> from dozens of cognitive scientists taking the industry to task for making claims without evidence also acknowledged \"some intriguing isolated reports do inspire additional research.”\u003c/p>\n\u003cp>Now, there may be some solid evidence that the training works. On July 24, at the \u003ca href=\"https://www.alz.org/aaic/about/overview.asp\" target=\"_blank\">Alzheimer’s Assn.’s International Conference\u003c/a> in Toronto, researchers of a long-range study announced that a relatively small amount of cognitive training resulted in a significant reduction in the risk of developing cognitive decline or dementia over 10 years.\u003c/p>\n\u003cp>The results are still preliminary, as the study is currently under review for publication in a peer-reviewed journal.\u003c/p>\n\u003cp>\u003cstrong>The ACTIVE Study\u003cbr>\n\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>The Advanced Cognitive Training for Independent and Vital Elderly, or ACTIVE, study divided 2,785 participants with an average age of almost 74 into three intervention groups and one control group. The intervention groups received, respectively, classroom-based memory strategies, classroom-based reasoning strategies and computerized speed-of-processing training in the form of a \u003ca href=\"http://www.newyorker.com/tech/elements/could-brain-training-prevent-dementia\" target=\"_blank\">game by Posit Science\u003c/a>, a for-profit company that offers subscriptions to its \"brain training exercises\" for a monthly fee.\u003c/p>\n\u003cp>Ten years later, the people in the speed-of-processing training experienced reduced cognitive decline; the other two interventions showed a statistically insignificant impact and a control group that received no training received no benefit.\u003c/p>\n\u003caside class=\"pullquote alignright\">'I remain optimistic but do not consider it to be definitive.'\u003ccite> Dr. Murali Doraiswamy, Duke Institute for Brain Sciences\u003c/cite>\u003c/aside>\n\u003cp>A \u003ca href=\"http://www.multivu.com/players/English/7865351-aaic-2016-cognitive-training/docs/press-release-1311562930.pdf\" target=\"_blank\">release\u003c/a> from the Alzheimer's Association described the game/training that the study participants received:\u003c/p>\n\u003cblockquote>\u003cp>The user identifies an object (i.e., a truck) at the center of his/her gaze while at the same time identifying a target in the periphery (i.e., a car). As the user gets the answers correct, the speed of presentation becomes progressively briefer, while the targets become more similar. In the more difficult training tasks, the target in the periphery is obscured by distracting objects\u003cstrong>\u003cbr>\n\u003c/strong>\u003c/p>\u003c/blockquote>\n\u003cp>Participants only played the Posit game for an hour, in 10 sessions over five weeks. Yet 10 years later, just 73 out of 698 people who received the training developed dementia or exhibited cognitive decline, compared with 97 out of 695 in the control group.\u003c/p>\n\u003cp>That's a 33 percent reduction in risk for the intervention group. Furthermore, subjects who received an additional four sessions one year after the original training and four more sessions about three years after showed a whopping 48 percent reduction in risk for the same conditions.\u003c/p>\n\u003cp>The ACTIVE study, which is being run by scientists from multiple institutions, had previously found people who took the Posit training reported the same or greater ability to perform the so-called \u003ca href=\"http://www.healthcare.uiowa.edu/igec/tools/function/lawtonbrody.pdf\" target=\"_blank\">instrumental activities of daily living\u003c/a>, like doing laundry and managing medication, compared to a control group.\u003c/p>\n\u003cp>The ACTIVE experiments have been ongoing and are well-respected. Dr. Murali Doraiswamy, of the Duke Institute for Brain Sciences, calls it \"the best trial in the field.\" \u003ca href=\"http://www.newyorker.com/tech/elements/could-brain-training-prevent-dementia\" target=\"_blank\">The New Yorker\u003c/a> reports that more than 50 peer-reviewed scientific papers have come out of it, and the study is funded in part by the National Institute on Aging.\u003c/p>\n\u003cp>\u003cstrong>'Sufficiently Strong Evidence'\u003c/strong>\u003c/p>\n\u003cp>The chief science officer for the Alzheimer’s Association, Maria C. Carrillo, cautiously backed the results, saying the organization \"believes there is sufficiently strong evidence to conclude that lifelong learning and certain types of cognitive training may reduce the risk of cognitive decline. These new 10-year finds are evidence that it may hold true for dementia as well as cognitive decline.\"\u003c/p>\n\u003cp>Some cognitive scientists were impressed with the results.\u003c/p>\n\u003cp>“That’s a spectacular finding,” Susanne Jaeggi, the director of the Working Memory and Plasticity Laboratory at the University of California, Irvine, and a signatory of the 2014 statement slamming brain training companies, told The New Yorker. \"We didn’t have any evidence that computerized training had any preventive effects on dementia. You could argue that this study provides evidence that it is possible.\"\u003c/p>\n\u003cp>Dr. Ronald Petersen, director of the Mayo Clinic Alzheimer's Disease Research Center told Reuters, \"At first blush, that's kind of a big deal. This may even be clinically relevant.\"\u003c/p>\n\u003cp>Dr. Doraiswamy, from Duke, said that until the results are replicated, no conclusion can be reached. \"I remain optimistic but do not consider it to be definitive. I also want to see an independent body like the FDA vet it since they will have access to all the data whereas we are just seeing what is being presented.\"\u003c/p>\n\u003cp>\u003cstrong>So Little Yields So Much?\u003c/strong>\u003c/p>\n\u003cp>Other researchers expressed a sense of wonder that just 10 hours of cognitive training could result in such a big benefit.\u003c/p>\n\u003cp>\"It’s hard to understand how such a brief intervention could have a long-lasting impact,” Dr. Howard Fillit, executive director of the Alzheimer’s Drug Discovery Foundation, which supports pharmaceutical research on the disease, told \u003ca href=\"https://www.statnews.com/2016/07/24/brain-training-cuts-dementia-risk/\" target=\"_blank\">STAT\u003c/a>. \"But you have to respect the data.”\u003c/p>\n\u003cp>Jaeggi, the expert interviewed by The New Yorker, said: “If you stop doing it after 10 or even 14 sessions, how on earth can you continue to have these effects 10 years later?”\u003c/p>\n\u003cp>A potential answer, from STAT:\u003c/p>\n\u003cblockquote>\u003cp>One possibility is a bootstrapping effect. Maybe people who received speed-of-processing training “did something different over the years,” said Laurie Ryan, who oversees Alzheimer’s research at the National Institute on Aging. “Maybe they changed their lifestyle in some way,” with the training giving them a little cognitive boost that they parlayed into more reading, more travel, more social engagement, and more of other activities that boost “cognitive reserve,” the brain’s cushion against dementia.\u003c/p>\n\u003cp>In fact, some ACTIVE participants told scientists that the cognitive boost they felt from the training inspired them to enroll in classes at a local college or keep driving, said Rebok, both of which can keep people socially and intellectually engaged.\u003c/p>\u003c/blockquote>\n\u003cp>In any event, Dr. Michael Merzenich, a co-founder and chief scientific officer of Posit Science, did not think there was any mystery to it. \"We’re not a bit surprised that this simple thing was protective,\" he told me over the phone. He said speed-of-processing functioned as a sort of \"master switch\" for the brain.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"It’s a very straightforward result,\" he said. \"It’s hard to deny the truth of it.\"\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Implantable Opioid Abuse Treatment Requires New Training for Docs",
"title": "Implantable Opioid Abuse Treatment Requires New Training for Docs",
"headTitle": "KQED Future of You | KQED Science",
"content": "\u003cp>In a big hotel conference room near New York's Times Square, six doctors huddle around a greasy piece of raw pork. They watch as addiction medicine specialist Michael Frost delicately marks the meat, incises it and implants four match-sized rods.\u003c/p>\n\u003caside class=\"pullquote alignright\">'If you can do it well on the pork, you can easily do it on the person.'\u003c/aside>\n\u003cp>\"If you can do it well on the pork, you can easily do it on the person,\" Frost tells his audience.\u003c/p>\n\u003cp>Frost consults for Braeburn Pharmaceuticals, the company behind the \u003ca href=\"http://www.npr.org/sections/health-shots/2016/05/27/479755813/long-acting-opioid-treatment-could-be-available-in-a-month\">newly FDA-approved treatment\u003c/a> Probuphine, and is teaching doctors how to use it. They are learning to implant it in pork so they can later implant it in patients' arms.\u003c/p>\n\u003cp>Although addiction specialists welcome \u003ca href=\"http://www.titanpharm.com/pipeline/probuphine\">Probuphine\u003c/a>, which delivers a constant dose of the drug buprenorphine over six months, at this early stage it's complicated for physicians to add it to their repertoire. Because physicians who treat addiction don't necessarily have experience with surgery or access to sterile spaces, some are having to learn a new skill and develop new systems.\u003c/p>\n\u003cp>Probuphine is unlike any other addiction treatment on the market. It promises to be life-changing for people already stable in recovery using medication-assisted treatment, who would otherwise need a daily dose of a similar drug to stay free of cravings and withdrawal pains.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Patients using Probuphine were 14 percent more likely to stay opioid-free compared to those using a daily sublingual version of buprenophine, according to a \u003ca href=\"http://jama.jamanetwork.com/article.aspx?articleid=2533504#Discussion\">study\u003c/a> published this month in \u003cem>JAMA, t\u003c/em>he Journal of the American Medical Association. Patients in this study had been stable on buprenorphine for an average of three-and-a-half years beforehand. The authors do caution against generalizing these findings. Most participants, they note, were white, employed, had at least a high school education and were previously addicted to prescription opioids rather than heroin.\u003c/p>\n\u003cp>\"They don't have to be dependent on taking something every day. It takes the choice out of that,\" says Ella Leers, a doctor who treats substance abuse at the Carnegie Hill Institute in Manhattan.\u003c/p>\n\u003cp>The FDA approved Probuphine under the condition that physicians are trained and tested before implanting or even prescribing the treatment. There are three kinds of certification: implanter, prescriber or both. If doctors can't perform the implanting themselves, they need to coordinate with another doctor who can.\u003c/p>\n\u003cp>To date, over 1,800 healthcare practitioners have been certified — 27 have implanted dozens of patients, according to a representative for Braeburn Pharmaceuticals, Probuphine's maker.\u003c/p>\n\u003cp>\u003ca href=\"https://www.urmc.rochester.edu/people/22342058-gloria-j-baciewicz\">Gloria Baciewicz\u003c/a>, chief of addiction psychiatry at the University of Rochester Medical Center, says using the new treatment will take some adjustments. But, she adds, there need to be as many effective treatments as possible for opioid use disorder.\u003c/p>\n\u003cp>\"Now with Probuphine, we have to take it up to a whole different level because we have to have either agreements with implanters or a room where we can implant. We have to get the equipment. There will be a lot more to do,\" she says. Her team was already planning on moving to another space, which will have the facilities they need to conduct minor surgery.\u003c/p>\n\u003cp>Prescribing Probuphine may also call for a new approach to the counseling and behavioral therapy that is typically recommended for those on medication-assisted treatment.\u003c/p>\n\u003cp>\"If you're implanting something that can be there for six months, you want to make sure that the patients are still coming in to get the other types of support that they can use because of their addiction issues,\" says Leers.\u003c/p>\n\u003cp>There are also questions about insurance coverage. Billing codes are still being established. For now, doctors need to buy the Probuphine kits that run almost $5,000 themselves, and then bill patients or insurance companies.\u003c/p>\n\u003cp>Braeburn has offered to help physicians verify if an insurance plan would reimburse any of the cost. According to the company, Blue Cross Blue Shield and United Healthcare approved reimbursement for a few patients who have implants. Medicare, Medicaid and the VA have Probuphine in their formulary and are required to cover it if deemed medically necessary.\u003c/p>\n\u003cp>Despite having to get certified and the other hurdles, many doctors welcome the treatment option. Opioid drug overdoses have reached epidemic levels — roughly 78 Americans die every day from \u003ca href=\"https://www.cdc.gov/drugoverdose/epidemic/\">opioid overdose\u003c/a>, according to the Center for Disease Control and Prevention.\u003c/p>\n\u003cp>So it's good to have a another way to deliver medication-assisted treatment, says \u003ca href=\"http://www.mountsinai.org/profiles/richard-n-rosenthal\">Richard Rosenthal\u003c/a>, medical director of addiction psychiatry for the Mount Sinai Health System. Rosenthal was one of two principal investigators on a Probuphine clinical trial.\u003c/p>\n\u003cp>\"Everybody is waking up to the fact that we're in the midst of an opioid epidemic,\" says Rosenthal. \"There are actually very few medications for addiction of any kind. Given the addiction treatment system in the United States, most of the treatment that's given is psychosocial. There's very little use of FDA-approved medications.\"\u003c/p>\n\u003cp>Probuphine made a difference, says Scott Jernigan of Jacksonville, Fla. He was in recovery for almost a year, taking another medication, when he signed up for a Probuphine clinical trial. He said Probuphine freed him from weekly doctor visits and pharmacy runs, and from fears of how sick he'd feel if he missed a dose or forgot to take his medication.\u003c/p>\n\u003cp>\"[It] meant that I could become more of what my normal is going to be,\" Jernigan says.\u003c/p>\n\u003cp>Some specialists recommend patients stay on \u003ca href=\"http://www.samhsa.gov/medication-assisted-treatment/treatment\">medication-assisted treatment\u003c/a> for years, or even indefinitely. For now, Probuphine can only be prescribed for two runs of six-month use and is meant for people already stable on 8 mg or less of a medication like buprenorphine.\u003c/p>\n\u003cp>Authors of the \u003cem>JAMA\u003c/em> study suggest further investigation of Probuphine to gauge issues often associated with buprenorphine, such as diversion or pediatric exposure.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This story is part of a reporting partnership with NPR,\u003c/em> \u003cem>\u003ca href=\"http://sideeffectspublicmedia.org/\">Side Effects Public Media\u003c/a>\u003c/em> \u003cem>and\u003c/em> \u003ca href=\"http://www.kaiserhealthnews.org\">\u003cem>Kaiser Health News\u003c/em>\u003c/a>\u003cem>.\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 Side Effects Public Media. To see more, visit \u003ca>Side Effects Public Media\u003c/a>.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Doctors+Need+A+New+Skill+Set+For+This+Opioid+Abuse+Treatment+&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"excerpt": "Practicing surgery on a piece of pork — that's how some doctors are learning to implant a new drug that curbs opioid cravings. It's not a skill set typically used in addiction medicine.",
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"description": "Practicing surgery on a piece of pork — that's how some doctors are learning to implant a new drug that curbs opioid cravings. It's not a skill set typically used in addiction medicine.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>In a big hotel conference room near New York's Times Square, six doctors huddle around a greasy piece of raw pork. They watch as addiction medicine specialist Michael Frost delicately marks the meat, incises it and implants four match-sized rods.\u003c/p>\n\u003caside class=\"pullquote alignright\">'If you can do it well on the pork, you can easily do it on the person.'\u003c/aside>\n\u003cp>\"If you can do it well on the pork, you can easily do it on the person,\" Frost tells his audience.\u003c/p>\n\u003cp>Frost consults for Braeburn Pharmaceuticals, the company behind the \u003ca href=\"http://www.npr.org/sections/health-shots/2016/05/27/479755813/long-acting-opioid-treatment-could-be-available-in-a-month\">newly FDA-approved treatment\u003c/a> Probuphine, and is teaching doctors how to use it. They are learning to implant it in pork so they can later implant it in patients' arms.\u003c/p>\n\u003cp>Although addiction specialists welcome \u003ca href=\"http://www.titanpharm.com/pipeline/probuphine\">Probuphine\u003c/a>, which delivers a constant dose of the drug buprenorphine over six months, at this early stage it's complicated for physicians to add it to their repertoire. Because physicians who treat addiction don't necessarily have experience with surgery or access to sterile spaces, some are having to learn a new skill and develop new systems.\u003c/p>\n\u003cp>Probuphine is unlike any other addiction treatment on the market. It promises to be life-changing for people already stable in recovery using medication-assisted treatment, who would otherwise need a daily dose of a similar drug to stay free of cravings and withdrawal pains.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Patients using Probuphine were 14 percent more likely to stay opioid-free compared to those using a daily sublingual version of buprenophine, according to a \u003ca href=\"http://jama.jamanetwork.com/article.aspx?articleid=2533504#Discussion\">study\u003c/a> published this month in \u003cem>JAMA, t\u003c/em>he Journal of the American Medical Association. Patients in this study had been stable on buprenorphine for an average of three-and-a-half years beforehand. The authors do caution against generalizing these findings. Most participants, they note, were white, employed, had at least a high school education and were previously addicted to prescription opioids rather than heroin.\u003c/p>\n\u003cp>\"They don't have to be dependent on taking something every day. It takes the choice out of that,\" says Ella Leers, a doctor who treats substance abuse at the Carnegie Hill Institute in Manhattan.\u003c/p>\n\u003cp>The FDA approved Probuphine under the condition that physicians are trained and tested before implanting or even prescribing the treatment. There are three kinds of certification: implanter, prescriber or both. If doctors can't perform the implanting themselves, they need to coordinate with another doctor who can.\u003c/p>\n\u003cp>To date, over 1,800 healthcare practitioners have been certified — 27 have implanted dozens of patients, according to a representative for Braeburn Pharmaceuticals, Probuphine's maker.\u003c/p>\n\u003cp>\u003ca href=\"https://www.urmc.rochester.edu/people/22342058-gloria-j-baciewicz\">Gloria Baciewicz\u003c/a>, chief of addiction psychiatry at the University of Rochester Medical Center, says using the new treatment will take some adjustments. But, she adds, there need to be as many effective treatments as possible for opioid use disorder.\u003c/p>\n\u003cp>\"Now with Probuphine, we have to take it up to a whole different level because we have to have either agreements with implanters or a room where we can implant. We have to get the equipment. There will be a lot more to do,\" she says. Her team was already planning on moving to another space, which will have the facilities they need to conduct minor surgery.\u003c/p>\n\u003cp>Prescribing Probuphine may also call for a new approach to the counseling and behavioral therapy that is typically recommended for those on medication-assisted treatment.\u003c/p>\n\u003cp>\"If you're implanting something that can be there for six months, you want to make sure that the patients are still coming in to get the other types of support that they can use because of their addiction issues,\" says Leers.\u003c/p>\n\u003cp>There are also questions about insurance coverage. Billing codes are still being established. For now, doctors need to buy the Probuphine kits that run almost $5,000 themselves, and then bill patients or insurance companies.\u003c/p>\n\u003cp>Braeburn has offered to help physicians verify if an insurance plan would reimburse any of the cost. According to the company, Blue Cross Blue Shield and United Healthcare approved reimbursement for a few patients who have implants. Medicare, Medicaid and the VA have Probuphine in their formulary and are required to cover it if deemed medically necessary.\u003c/p>\n\u003cp>Despite having to get certified and the other hurdles, many doctors welcome the treatment option. Opioid drug overdoses have reached epidemic levels — roughly 78 Americans die every day from \u003ca href=\"https://www.cdc.gov/drugoverdose/epidemic/\">opioid overdose\u003c/a>, according to the Center for Disease Control and Prevention.\u003c/p>\n\u003cp>So it's good to have a another way to deliver medication-assisted treatment, says \u003ca href=\"http://www.mountsinai.org/profiles/richard-n-rosenthal\">Richard Rosenthal\u003c/a>, medical director of addiction psychiatry for the Mount Sinai Health System. Rosenthal was one of two principal investigators on a Probuphine clinical trial.\u003c/p>\n\u003cp>\"Everybody is waking up to the fact that we're in the midst of an opioid epidemic,\" says Rosenthal. \"There are actually very few medications for addiction of any kind. Given the addiction treatment system in the United States, most of the treatment that's given is psychosocial. There's very little use of FDA-approved medications.\"\u003c/p>\n\u003cp>Probuphine made a difference, says Scott Jernigan of Jacksonville, Fla. He was in recovery for almost a year, taking another medication, when he signed up for a Probuphine clinical trial. He said Probuphine freed him from weekly doctor visits and pharmacy runs, and from fears of how sick he'd feel if he missed a dose or forgot to take his medication.\u003c/p>\n\u003cp>\"[It] meant that I could become more of what my normal is going to be,\" Jernigan says.\u003c/p>\n\u003cp>Some specialists recommend patients stay on \u003ca href=\"http://www.samhsa.gov/medication-assisted-treatment/treatment\">medication-assisted treatment\u003c/a> for years, or even indefinitely. For now, Probuphine can only be prescribed for two runs of six-month use and is meant for people already stable on 8 mg or less of a medication like buprenorphine.\u003c/p>\n\u003cp>Authors of the \u003cem>JAMA\u003c/em> study suggest further investigation of Probuphine to gauge issues often associated with buprenorphine, such as diversion or pediatric exposure.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This story is part of a reporting partnership with NPR,\u003c/em> \u003cem>\u003ca href=\"http://sideeffectspublicmedia.org/\">Side Effects Public Media\u003c/a>\u003c/em> \u003cem>and\u003c/em> \u003ca href=\"http://www.kaiserhealthnews.org\">\u003cem>Kaiser Health News\u003c/em>\u003c/a>\u003cem>.\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 Side Effects Public Media. To see more, visit \u003ca>Side Effects Public Media\u003c/a>.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Doctors+Need+A+New+Skill+Set+For+This+Opioid+Abuse+Treatment+&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "$14,000 to Get Into a Clinical Trial? Pay-to-Play Listings Creep Into Government's Website",
"title": "$14,000 to Get Into a Clinical Trial? Pay-to-Play Listings Creep Into Government's Website",
"headTitle": "KQED Future of You | KQED Science",
"content": "\u003cp>Last summer, Linda Smith learned she was losing significant cartilage in her knees, a consequence of her lifelong love of skiing, running and ultimate frisbee.\u003c/p>\n\u003caside class=\"pullquote alignright\">\"It’s unethical that these companies are saying, ‘Sure, come take part in our study and by the way, we’re going to charge you for the privilege.’ ”\u003c/aside>\n\u003cp>Diagnosed with osteoarthritis, she wanted to avoid surgery and was eager to consider alternatives.\u003c/p>\n\u003cp>So the 56-year-old Morgan Hill, Calif., resident embarked on a search for clinical trials, which test potential treatments on human subjects. She scoured the government-run website ClinicalTrials.gov, focusing on a form of stem cell therapy — a promising but unproven approach for her condition.\u003c/p>\n\u003cp>She thought she’d scored with StemGenex, a clinic in La Jolla, and called to inquire. The screener asked a long list of questions, then dropped a bomb: If Smith wanted in, she’d have to pay “associated” costs.\u003c/p>\n\u003cp>Total charge: $14,000.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“I was outraged,” Smith said. Her anger only grew when the screener suggested she could raise the money, as other callers had, through family and friends in an online GoFundMe campaign, she said.\u003c/p>\n\u003cp>Smith, a retired hospital administrator, knew enough about clinical studies to understand that the $14,000 price tag was unusual. Most trials are free and some even pay people to participate, in recognition of the possible risks and inconvenience involved.\u003c/p>\n\u003cp>The ClinicialTrials.gov website, run by the National Institutes of Health (NIH) through its National Library of Medicine, is the most comprehensive such database available to the public in the United States, with listings for more than 210,000 clinical studies both here and abroad. But Smith’s experience exposes one of its little-known limitations: It does not require trial sponsors to disclose charges to patients — and does not even independently vet the listings.\u003c/p>\n\u003cp>“I went back to the website and looked at the study again. It doesn’t say that patients are the funding source,” said Smith, who refused the $14,000 proposal. “I was disappointed in the NIH. I thought, ‘Why are you letting this occur?'”\u003c/p>\n\u003cp>\u003cstrong>Misleading Consumers\u003c/strong>\u003c/p>\n\u003cp>StemGenex denies that it charges for participation in its clinical study. It says it only charges for the treatment that is being studied and that participation in the study is separate and voluntary.\u003c/p>\n\u003cp>Some ethicists and other experts who shared Smith’s concern said that’s a false distinction. If trial sponsors require participants to pay, they said, the government website ought to let people know.\u003c/p>\n\u003cp>They argued that ClinicalTrials.gov’s failure to disclose charges by trial sponsors misleads consumers and allows the site to become a marketing tool for pay-to-play research.\u003c/p>\n\u003cfigure id=\"attachment_212124\" class=\"wp-caption aligncenter\" style=\"max-width: 770px\">\u003ca href=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/07/linda-smith-4.jpg\">\u003cimg class=\"wp-image-212124 size-full\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/07/linda-smith-4.jpg\" alt=\"Linda Smith lost significant cartilage in both of her knees due to years of skiing, running and ultimate frisbee. The 56-year-old Morgan Hill, Calif., resident researched stem cell therapy for osteoarthritis to avoid surgery. \" width=\"770\" height=\"513\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2016/07/linda-smith-4.jpg 770w, https://ww2.kqed.org/app/uploads/sites/13/2016/07/linda-smith-4-400x266.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2016/07/linda-smith-4-768x512.jpg 768w\" sizes=\"(max-width: 770px) 100vw, 770px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Linda Smith lost significant cartilage in both of her knees due to years of skiing, running and ultimate frisbee. The 56-year-old Morgan Hill, Calif., resident researched stem cell therapy for osteoarthritis to avoid surgery. \u003ccite>(Heidi de Marco/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“It’s unethical that these companies are saying, ‘Sure, come take part in our study and by the way, we’re going to charge you for the privilege’,” said Alison Bateman-House, a postdoctoral fellow in medical ethics at the New York University School of Medicine. “If you’re going to be charging patients for the opportunity to be involved in the study, they should not be allowed to be listed on ClinicalTrials.gov, or at least the cost should be listed on the site.”\u003c/p>\n\u003cp>She and others worry that many patients seeking to participate in clinical trials might be desperately sick or in pain, and vulnerable to requests for money they don’t have. These patients see the website’s “.gov” domain and the NIH imprimatur as stamps of approval that mean the research is legitimate, these critics say.\u003c/p>\n\u003cp>“The average patient and even people in health care … kind of let their guard down when they’re in that database. It’s like, ‘If a trial is listed here, it must be OK’,” said Paul Knoepfler, an associate professor at the University of California, Davis, School of Medicine who writes a blog about stem cell research. “Most people don’t realize that creeping into that database are some trials whose main goal is to generate profit.”\u003c/p>\n\u003cp>Leigh Turner, an associate professor at the University of Minnesota Center for Bioethics, said it’s not clear if this phenomenon is only occurring with stem cell studies, but the surge in stem cell research — and in clinics offering high-priced, unproven treatments — has intensified the problem.\u003c/p>\n\u003cp>“It’s not just a handful of patients who are encountering these kind of so-called studies on ClinicalTrials.gov and not just a handful of studies,” he said. “It is a bigger problem than that.”\u003c/p>\n\u003cp>Asked whether costs should be disclosed on ClinicalTrials.gov, Dr. Rebecca Williams, assistant director of the website, said “that’s a valid question.”\u003c/p>\n\u003cp>As a practical matter, she said, “that has been information we don’t collect in a systematic way and nor is it available. We have no way to know whether they’re for-profit or not, and don’t have a policy that would exclude them.”\u003c/p>\n\u003cp>\u003cstrong>Not an Endorsement\u003c/strong>\u003c/p>\n\u003cp>Williams pointed to the website’s disclaimer that the government is not liable for and does not “make any warranties” about information in the database. She also noted that the site suggests questions for consumers to ask, including, “Who will pay for my participation?”\u003c/p>\n\u003cp>Williams stressed that the website is intended primarily as a “clearinghouse” of listings, and that just because a study is there “does not necessarily mean an endorsement by the federal government.”\u003c/p>\n\u003cp>It means that the study sponsors have attested that the information they’re submitting is complete and that their research complies with “all of the applicable regulations that may apply,” she said.\u003c/p>\n\u003cp>The website is not legally required to independently verify the information provided by study sponsors. ClinicalTrials.gov relies heavily on the honor system, Williams said.\u003c/p>\n\u003cp>Study sponsors who wish to list their studies on the website register online and must provide a variety of details, including, in most cases, information about the committees that oversee the welfare and treatment of human subjects.\u003c/p>\n\u003cp>Thanks to a 2007 law, changes will be made to the website’s listings and requirements, possibly by the end of this year. But Williams said it’s “unlikely” they will include disclosures of costs to patients.\u003c/p>\n\u003cp>Generally speaking, the U.S. Food and Drug Administration regulates clinical trials of medications and medical devices, and sets guidelines that determine when patients can be charged. But stem cell research, which often uses a patients’ own cells for treatment, can fall into a gray area, and what requires FDA approval is sometimes unclear or in dispute.\u003c/p>\n\u003cp>\u003cstrong>Pay to Play\u003c/strong>\u003c/p>\n\u003cp>StemGenex says it does not charge anyone for the osteoporosis study listed in ClinicalTrials.gov.\u003c/p>\n\u003cp>“StemGenex’s study is intended to be an observational study comparing two sets of data — before and after stem cell treatment,” Candace Henderson, the clinic’s vice president of operations, said in a prepared statement.\u003c/p>\n\u003cp>The way she explained it, patients who first pay for the company’s stem cell treatment can then “volunteer” to participate in the long-term observational study of how well the treatment works.\u003c/p>\n\u003cp>“The actual treatment is not part of the study protocol,” Henderson said. She declined to share a copy of the protocol, saying it “is proprietary to StemGenex.”\u003c/p>\n\u003cp>But the reality is that patients who want to participate in research like this must first shell out thousands for the stem cell treatment, University of Minnesota’s Turner said. In effect, he said, they pay to play.\u003c/p>\n\u003cp>StemGenex says it invests revenue from its clinical trials “in innovation and research to further the development and advancement” of therapies. It has four other studies listed on the NIH website: for Parkinson’s disease, multiple sclerosis, rheumatoid arthritis and chronic obstructive pulmonary disease. In those cases, too, participants “are recruited from among patients who are having stem cell treatment,” Henderson said in the company statement.\u003c/p>\n\u003cp>\u003ca href=\"https://stemgenex.com/frequently-asked-questions/#tab-14\" target=\"_blank\">On its website\u003c/a>, the company explains that it harvests dormant stem cells from a patient’s fat through “a mini-liposuction” and isolates the cells from the fat. The cells are then “activated with the patient’s growth factors,” and infused back into the patient. The stem cells then “follow inflammatory signals from damaged tissues and have multiple ways of repairing these damaged areas.”\u003c/p>\n\u003cp>The company, which describes itself as “\u003ca href=\"https://stemgenex.com/about-us/\" target=\"_blank\">the premiere leader in the United States for regenerative medicine\u003c/a>,” says it offers a “\u003ca href=\"https://stemgenex.com/treatment-center/traveling-stemgenex/make-getting-easy/\" target=\"_blank\">a concierge approach to treatment\u003c/a>,” which includes covering the cost of its patients’ hotel accommodations and a car service that “\u003ca href=\"https://stemgenex.com/frequently-asked-questions/\" target=\"_blank\">will be waiting for you at the airport baggage claim when you arrive\u003c/a>.”\u003c/p>\n\u003cp>\u003ca href=\"https://stemgenex.com/frequently-asked-questions/#tab-14\" target=\"_blank\">The company acknowledges\u003c/a> that its procedures — like most stem cell treatments — are not FDA-approved. \u003ca href=\"https://stemgenex.com/press/stemgenex-new-clinical-study-aims-provide-relief-osteoarthritis-patients-latest-stem-cell-therapy/\" target=\"_blank\">On its website\u003c/a>, however, StemGenex underscores that its studies are “registered through The National Institutes of Health which can be found at\u003ca href=\"http://www.clinicaltrials.gov.xn--ivg/\" rel=\"nofollow\">http://www.clinicaltrials.gov.”\u003c/a>\u003c/p>\n\u003cp>“By providing patients access to stem cell studies registered through The National Institutes of Health, patients now have the ability to choose treatment for osteoarthritis that focuses on both safety and efficacy,” it says.\u003c/p>\n\u003cp>\u003ca href=\"https://stemgenex.com/frequently-asked-questions/#tab-14\" target=\"_blank\">Also on its website\u003c/a>, the clinic says that having studies registered on ClinicalTrials.gov gives it a “significant advantage compared with treatment centers offering unregistered studies.”\u003c/p>\n\u003cp>Turner called the messages misleading, because they suggest the NIH has vetted the clinic’s osteoarthritis and other studies. “In fact, nobody at the NIH or in our government has necessarily, or even likely, looked at this study,” he said.\u003c/p>\n\u003cp>He pointed to other stem cell clinics posting on ClinicalTrials.gov that ask patients to pay, including one in Rancho Mirage that is conducting a study on stem cell treatment for conditions such as emphysema, osteoarthritis and erectile dysfunction.\u003c/p>\n\u003cp>Knoepfler said he used to direct patients to ClinicalTrials.gov, but then, “I started realizing, ‘wait a minute … there are listings on that website that are not what I thought would be on ClinicalTrials.gov.'”\u003c/p>\n\u003cp>He and other critics would like to see ClinicalTrials.gov reevaluate its position on allowing for-profit trials to post on the website.\u003c/p>\n\u003cp>“It’s one of the best sources we have, but there’s still room for misleading and incomplete information, and I would imagine in some cases, there are people preying on desperate patients, even on the ClinicalTrials.gov registry,” said \u003ca href=\"http://csdd.tufts.edu/about/staff_profile/ken_getz\" target=\"_blank\">Ken Getz\u003c/a>, an associate professor at Tufts University School of Medicine, and founder of the Center for Information and Study on Clinical Research Participation.\u003c/p>\n\u003cp>\u003cem>This story was produced by \u003ca href=\"http://khn.org/\" target=\"_blank\">Kaiser Health News\u003c/a>, which publishes \u003ca href=\"http://www.californiahealthline.org/\" target=\"_blank\">California Healthline\u003c/a>, a service of the \u003ca href=\"http://www.chcf.org/\" target=\"_blank\">California Health Care Foundation\u003c/a>.\u003c/em>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp> \u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Last summer, Linda Smith learned she was losing significant cartilage in her knees, a consequence of her lifelong love of skiing, running and ultimate frisbee.\u003c/p>\n\u003caside class=\"pullquote alignright\">\"It’s unethical that these companies are saying, ‘Sure, come take part in our study and by the way, we’re going to charge you for the privilege.’ ”\u003c/aside>\n\u003cp>Diagnosed with osteoarthritis, she wanted to avoid surgery and was eager to consider alternatives.\u003c/p>\n\u003cp>So the 56-year-old Morgan Hill, Calif., resident embarked on a search for clinical trials, which test potential treatments on human subjects. She scoured the government-run website ClinicalTrials.gov, focusing on a form of stem cell therapy — a promising but unproven approach for her condition.\u003c/p>\n\u003cp>She thought she’d scored with StemGenex, a clinic in La Jolla, and called to inquire. The screener asked a long list of questions, then dropped a bomb: If Smith wanted in, she’d have to pay “associated” costs.\u003c/p>\n\u003cp>Total charge: $14,000.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“I was outraged,” Smith said. Her anger only grew when the screener suggested she could raise the money, as other callers had, through family and friends in an online GoFundMe campaign, she said.\u003c/p>\n\u003cp>Smith, a retired hospital administrator, knew enough about clinical studies to understand that the $14,000 price tag was unusual. Most trials are free and some even pay people to participate, in recognition of the possible risks and inconvenience involved.\u003c/p>\n\u003cp>The ClinicialTrials.gov website, run by the National Institutes of Health (NIH) through its National Library of Medicine, is the most comprehensive such database available to the public in the United States, with listings for more than 210,000 clinical studies both here and abroad. But Smith’s experience exposes one of its little-known limitations: It does not require trial sponsors to disclose charges to patients — and does not even independently vet the listings.\u003c/p>\n\u003cp>“I went back to the website and looked at the study again. It doesn’t say that patients are the funding source,” said Smith, who refused the $14,000 proposal. “I was disappointed in the NIH. I thought, ‘Why are you letting this occur?'”\u003c/p>\n\u003cp>\u003cstrong>Misleading Consumers\u003c/strong>\u003c/p>\n\u003cp>StemGenex denies that it charges for participation in its clinical study. It says it only charges for the treatment that is being studied and that participation in the study is separate and voluntary.\u003c/p>\n\u003cp>Some ethicists and other experts who shared Smith’s concern said that’s a false distinction. If trial sponsors require participants to pay, they said, the government website ought to let people know.\u003c/p>\n\u003cp>They argued that ClinicalTrials.gov’s failure to disclose charges by trial sponsors misleads consumers and allows the site to become a marketing tool for pay-to-play research.\u003c/p>\n\u003cfigure id=\"attachment_212124\" class=\"wp-caption aligncenter\" style=\"max-width: 770px\">\u003ca href=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/07/linda-smith-4.jpg\">\u003cimg class=\"wp-image-212124 size-full\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/07/linda-smith-4.jpg\" alt=\"Linda Smith lost significant cartilage in both of her knees due to years of skiing, running and ultimate frisbee. The 56-year-old Morgan Hill, Calif., resident researched stem cell therapy for osteoarthritis to avoid surgery. \" width=\"770\" height=\"513\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2016/07/linda-smith-4.jpg 770w, https://ww2.kqed.org/app/uploads/sites/13/2016/07/linda-smith-4-400x266.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2016/07/linda-smith-4-768x512.jpg 768w\" sizes=\"(max-width: 770px) 100vw, 770px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Linda Smith lost significant cartilage in both of her knees due to years of skiing, running and ultimate frisbee. The 56-year-old Morgan Hill, Calif., resident researched stem cell therapy for osteoarthritis to avoid surgery. \u003ccite>(Heidi de Marco/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“It’s unethical that these companies are saying, ‘Sure, come take part in our study and by the way, we’re going to charge you for the privilege’,” said Alison Bateman-House, a postdoctoral fellow in medical ethics at the New York University School of Medicine. “If you’re going to be charging patients for the opportunity to be involved in the study, they should not be allowed to be listed on ClinicalTrials.gov, or at least the cost should be listed on the site.”\u003c/p>\n\u003cp>She and others worry that many patients seeking to participate in clinical trials might be desperately sick or in pain, and vulnerable to requests for money they don’t have. These patients see the website’s “.gov” domain and the NIH imprimatur as stamps of approval that mean the research is legitimate, these critics say.\u003c/p>\n\u003cp>“The average patient and even people in health care … kind of let their guard down when they’re in that database. It’s like, ‘If a trial is listed here, it must be OK’,” said Paul Knoepfler, an associate professor at the University of California, Davis, School of Medicine who writes a blog about stem cell research. “Most people don’t realize that creeping into that database are some trials whose main goal is to generate profit.”\u003c/p>\n\u003cp>Leigh Turner, an associate professor at the University of Minnesota Center for Bioethics, said it’s not clear if this phenomenon is only occurring with stem cell studies, but the surge in stem cell research — and in clinics offering high-priced, unproven treatments — has intensified the problem.\u003c/p>\n\u003cp>“It’s not just a handful of patients who are encountering these kind of so-called studies on ClinicalTrials.gov and not just a handful of studies,” he said. “It is a bigger problem than that.”\u003c/p>\n\u003cp>Asked whether costs should be disclosed on ClinicalTrials.gov, Dr. Rebecca Williams, assistant director of the website, said “that’s a valid question.”\u003c/p>\n\u003cp>As a practical matter, she said, “that has been information we don’t collect in a systematic way and nor is it available. We have no way to know whether they’re for-profit or not, and don’t have a policy that would exclude them.”\u003c/p>\n\u003cp>\u003cstrong>Not an Endorsement\u003c/strong>\u003c/p>\n\u003cp>Williams pointed to the website’s disclaimer that the government is not liable for and does not “make any warranties” about information in the database. She also noted that the site suggests questions for consumers to ask, including, “Who will pay for my participation?”\u003c/p>\n\u003cp>Williams stressed that the website is intended primarily as a “clearinghouse” of listings, and that just because a study is there “does not necessarily mean an endorsement by the federal government.”\u003c/p>\n\u003cp>It means that the study sponsors have attested that the information they’re submitting is complete and that their research complies with “all of the applicable regulations that may apply,” she said.\u003c/p>\n\u003cp>The website is not legally required to independently verify the information provided by study sponsors. ClinicalTrials.gov relies heavily on the honor system, Williams said.\u003c/p>\n\u003cp>Study sponsors who wish to list their studies on the website register online and must provide a variety of details, including, in most cases, information about the committees that oversee the welfare and treatment of human subjects.\u003c/p>\n\u003cp>Thanks to a 2007 law, changes will be made to the website’s listings and requirements, possibly by the end of this year. But Williams said it’s “unlikely” they will include disclosures of costs to patients.\u003c/p>\n\u003cp>Generally speaking, the U.S. Food and Drug Administration regulates clinical trials of medications and medical devices, and sets guidelines that determine when patients can be charged. But stem cell research, which often uses a patients’ own cells for treatment, can fall into a gray area, and what requires FDA approval is sometimes unclear or in dispute.\u003c/p>\n\u003cp>\u003cstrong>Pay to Play\u003c/strong>\u003c/p>\n\u003cp>StemGenex says it does not charge anyone for the osteoporosis study listed in ClinicalTrials.gov.\u003c/p>\n\u003cp>“StemGenex’s study is intended to be an observational study comparing two sets of data — before and after stem cell treatment,” Candace Henderson, the clinic’s vice president of operations, said in a prepared statement.\u003c/p>\n\u003cp>The way she explained it, patients who first pay for the company’s stem cell treatment can then “volunteer” to participate in the long-term observational study of how well the treatment works.\u003c/p>\n\u003cp>“The actual treatment is not part of the study protocol,” Henderson said. She declined to share a copy of the protocol, saying it “is proprietary to StemGenex.”\u003c/p>\n\u003cp>But the reality is that patients who want to participate in research like this must first shell out thousands for the stem cell treatment, University of Minnesota’s Turner said. In effect, he said, they pay to play.\u003c/p>\n\u003cp>StemGenex says it invests revenue from its clinical trials “in innovation and research to further the development and advancement” of therapies. It has four other studies listed on the NIH website: for Parkinson’s disease, multiple sclerosis, rheumatoid arthritis and chronic obstructive pulmonary disease. In those cases, too, participants “are recruited from among patients who are having stem cell treatment,” Henderson said in the company statement.\u003c/p>\n\u003cp>\u003ca href=\"https://stemgenex.com/frequently-asked-questions/#tab-14\" target=\"_blank\">On its website\u003c/a>, the company explains that it harvests dormant stem cells from a patient’s fat through “a mini-liposuction” and isolates the cells from the fat. The cells are then “activated with the patient’s growth factors,” and infused back into the patient. The stem cells then “follow inflammatory signals from damaged tissues and have multiple ways of repairing these damaged areas.”\u003c/p>\n\u003cp>The company, which describes itself as “\u003ca href=\"https://stemgenex.com/about-us/\" target=\"_blank\">the premiere leader in the United States for regenerative medicine\u003c/a>,” says it offers a “\u003ca href=\"https://stemgenex.com/treatment-center/traveling-stemgenex/make-getting-easy/\" target=\"_blank\">a concierge approach to treatment\u003c/a>,” which includes covering the cost of its patients’ hotel accommodations and a car service that “\u003ca href=\"https://stemgenex.com/frequently-asked-questions/\" target=\"_blank\">will be waiting for you at the airport baggage claim when you arrive\u003c/a>.”\u003c/p>\n\u003cp>\u003ca href=\"https://stemgenex.com/frequently-asked-questions/#tab-14\" target=\"_blank\">The company acknowledges\u003c/a> that its procedures — like most stem cell treatments — are not FDA-approved. \u003ca href=\"https://stemgenex.com/press/stemgenex-new-clinical-study-aims-provide-relief-osteoarthritis-patients-latest-stem-cell-therapy/\" target=\"_blank\">On its website\u003c/a>, however, StemGenex underscores that its studies are “registered through The National Institutes of Health which can be found at\u003ca href=\"http://www.clinicaltrials.gov.xn--ivg/\" rel=\"nofollow\">http://www.clinicaltrials.gov.”\u003c/a>\u003c/p>\n\u003cp>“By providing patients access to stem cell studies registered through The National Institutes of Health, patients now have the ability to choose treatment for osteoarthritis that focuses on both safety and efficacy,” it says.\u003c/p>\n\u003cp>\u003ca href=\"https://stemgenex.com/frequently-asked-questions/#tab-14\" target=\"_blank\">Also on its website\u003c/a>, the clinic says that having studies registered on ClinicalTrials.gov gives it a “significant advantage compared with treatment centers offering unregistered studies.”\u003c/p>\n\u003cp>Turner called the messages misleading, because they suggest the NIH has vetted the clinic’s osteoarthritis and other studies. “In fact, nobody at the NIH or in our government has necessarily, or even likely, looked at this study,” he said.\u003c/p>\n\u003cp>He pointed to other stem cell clinics posting on ClinicalTrials.gov that ask patients to pay, including one in Rancho Mirage that is conducting a study on stem cell treatment for conditions such as emphysema, osteoarthritis and erectile dysfunction.\u003c/p>\n\u003cp>Knoepfler said he used to direct patients to ClinicalTrials.gov, but then, “I started realizing, ‘wait a minute … there are listings on that website that are not what I thought would be on ClinicalTrials.gov.'”\u003c/p>\n\u003cp>He and other critics would like to see ClinicalTrials.gov reevaluate its position on allowing for-profit trials to post on the website.\u003c/p>\n\u003cp>“It’s one of the best sources we have, but there’s still room for misleading and incomplete information, and I would imagine in some cases, there are people preying on desperate patients, even on the ClinicalTrials.gov registry,” said \u003ca href=\"http://csdd.tufts.edu/about/staff_profile/ken_getz\" target=\"_blank\">Ken Getz\u003c/a>, an associate professor at Tufts University School of Medicine, and founder of the Center for Information and Study on Clinical Research Participation.\u003c/p>\n\u003cp>\u003cem>This story was produced by \u003ca href=\"http://khn.org/\" target=\"_blank\">Kaiser Health News\u003c/a>, which publishes \u003ca href=\"http://www.californiahealthline.org/\" target=\"_blank\">California Healthline\u003c/a>, a service of the \u003ca href=\"http://www.chcf.org/\" target=\"_blank\">California Health Care Foundation\u003c/a>.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"disqusTitle": "Odor Test May Identify Alzheimer's",
"title": "Odor Test May Identify Alzheimer's",
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"content": "\u003cp>Two \u003ca href=\"http://www.multivu.com/players/English/7865353-aaic-2016-smell-eye-tests/\">studies\u003c/a> released at an international Alzheimer's meeting Tuesday suggest doctors may eventually be able to screen people for this form of dementia by testing the ability to identify familiar odors, like smoke, coffee and raspberry.\u003c/p>\n\u003caside class=\"pullquote alignright\">One study found that people who had trouble identifying odors were three times more likely to have memory problems.\u003c/aside>\n\u003cp>In both studies, people who were in their 60s and older took a standard odor detection test. And in both cases, those who did poorly on the test were more likely to already have — or go on to develop — problems with memory and thinking.\u003c/p>\n\u003cp>\"The whole idea is to create tests that a general clinician can use in an office setting,\" says \u003ca href=\"http://www.columbiadoctors.org/prof/wckreisl\">Dr. William Kreisl\u003c/a>, a neurologist at Columbia University, where both studies were done. The research was presented at the Alzheimer's Association International Conference in Toronto.\u003c/p>\n\u003cp>Currently, any tests that are able to spot people in the earliest stages of Alzheimer's are costly and difficult. They include PET scans, which can detect sticky plaques in the brain, and spinal taps that measure the levels of certain proteins in spinal fluid.\u003c/p>\n\u003cp>The idea of an odor detection test arose, in part, from something doctors have observed for many years in patients with Alzheimer's, Kreisl says.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"Patients will tell us that food does not taste as good,\" he says. The reason is often that these patients have lost the ability to smell what they eat.\u003c/p>\n\u003cp>That's not surprising, Kreisl says, given that odor signals from the nose have to be processed in areas of the brain that are among the first to be affected by Alzheimer's disease.\u003c/p>\n\u003cp>But it's been tricky to develop a reliable screening test using odor detection.\u003c/p>\n\u003cp>So Kreisl and a team of researchers studied 84 people in their 60s and 70s, including 58 with the sort of memory problems that suggest early Alzheimer's.\u003c/p>\n\u003cp>The participants took something called the University of Pennsylvania Smell Identification Test, or UPSIT.\u003c/p>\n\u003cp>\"It's basically a set of cards,\" Kreisl says. \"And each card has a little scratch and sniff test on it.\" The cards feature familiar odors like coffee, chocolate, cinnamon and licorice.\u003c/p>\n\u003cp>The study found that people who had trouble identifying odors were three times more likely than other people to have memory problems. Moreover, the odor test \"was able to predict memory decline in older adults about as well as the PET scan or spinal tap,\" Kreisl says.\u003c/p>\n\u003cp>A second study by another team from Columbia followed, for more than four years, 397 people whose average age was 80 at the start. Their scores on the odor test were a good predictor of which people were most likely to go on to develop dementia, the researchers found.\u003c/p>\n\u003cp>The odor tests aren't perfect. For one thing, other degenerative brain diseases, including Parkinson's, can also affect odor detection. Also, the ability to smell can be diminished by smoking, certain head injuries and even normal aging.\u003c/p>\n\u003cp>So researchers are looking at other \"biomarkers\" of Alzheimer's, including some changes that affect the eye.\u003c/p>\n\u003cp>\"The eye has nerves that are very closely linked to the brain,\" says \u003ca href=\"http://www.alz.org/research/funding/advisory_council_alzheimers_association.asp\">Maria Carrillo\u003c/a>, chief science officer of the Alzheimer's Association. So changes in those nerves can help reveal early Alzheimer's.\u003c/p>\n\u003cp>But all the screening tests for Alzheimer's are of limited value, Carrillo cautions, because there is still no drug that can slow or halt the disease.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"What we really need,\" she says, \"is to be able to use these screening tools at the same time that we have a therapeutic.\"\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=A+Sniff+Test+For+Alzheimer%27s+Checks+For+The+Ability+To+Identify+Odors&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"headline": "Odor Test May Identify Alzheimer's",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Two \u003ca href=\"http://www.multivu.com/players/English/7865353-aaic-2016-smell-eye-tests/\">studies\u003c/a> released at an international Alzheimer's meeting Tuesday suggest doctors may eventually be able to screen people for this form of dementia by testing the ability to identify familiar odors, like smoke, coffee and raspberry.\u003c/p>\n\u003caside class=\"pullquote alignright\">One study found that people who had trouble identifying odors were three times more likely to have memory problems.\u003c/aside>\n\u003cp>In both studies, people who were in their 60s and older took a standard odor detection test. And in both cases, those who did poorly on the test were more likely to already have — or go on to develop — problems with memory and thinking.\u003c/p>\n\u003cp>\"The whole idea is to create tests that a general clinician can use in an office setting,\" says \u003ca href=\"http://www.columbiadoctors.org/prof/wckreisl\">Dr. William Kreisl\u003c/a>, a neurologist at Columbia University, where both studies were done. The research was presented at the Alzheimer's Association International Conference in Toronto.\u003c/p>\n\u003cp>Currently, any tests that are able to spot people in the earliest stages of Alzheimer's are costly and difficult. They include PET scans, which can detect sticky plaques in the brain, and spinal taps that measure the levels of certain proteins in spinal fluid.\u003c/p>\n\u003cp>The idea of an odor detection test arose, in part, from something doctors have observed for many years in patients with Alzheimer's, Kreisl says.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"Patients will tell us that food does not taste as good,\" he says. The reason is often that these patients have lost the ability to smell what they eat.\u003c/p>\n\u003cp>That's not surprising, Kreisl says, given that odor signals from the nose have to be processed in areas of the brain that are among the first to be affected by Alzheimer's disease.\u003c/p>\n\u003cp>But it's been tricky to develop a reliable screening test using odor detection.\u003c/p>\n\u003cp>So Kreisl and a team of researchers studied 84 people in their 60s and 70s, including 58 with the sort of memory problems that suggest early Alzheimer's.\u003c/p>\n\u003cp>The participants took something called the University of Pennsylvania Smell Identification Test, or UPSIT.\u003c/p>\n\u003cp>\"It's basically a set of cards,\" Kreisl says. \"And each card has a little scratch and sniff test on it.\" The cards feature familiar odors like coffee, chocolate, cinnamon and licorice.\u003c/p>\n\u003cp>The study found that people who had trouble identifying odors were three times more likely than other people to have memory problems. Moreover, the odor test \"was able to predict memory decline in older adults about as well as the PET scan or spinal tap,\" Kreisl says.\u003c/p>\n\u003cp>A second study by another team from Columbia followed, for more than four years, 397 people whose average age was 80 at the start. Their scores on the odor test were a good predictor of which people were most likely to go on to develop dementia, the researchers found.\u003c/p>\n\u003cp>The odor tests aren't perfect. For one thing, other degenerative brain diseases, including Parkinson's, can also affect odor detection. Also, the ability to smell can be diminished by smoking, certain head injuries and even normal aging.\u003c/p>\n\u003cp>So researchers are looking at other \"biomarkers\" of Alzheimer's, including some changes that affect the eye.\u003c/p>\n\u003cp>\"The eye has nerves that are very closely linked to the brain,\" says \u003ca href=\"http://www.alz.org/research/funding/advisory_council_alzheimers_association.asp\">Maria Carrillo\u003c/a>, chief science officer of the Alzheimer's Association. So changes in those nerves can help reveal early Alzheimer's.\u003c/p>\n\u003cp>But all the screening tests for Alzheimer's are of limited value, Carrillo cautions, because there is still no drug that can slow or halt the disease.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"What we really need,\" she says, \"is to be able to use these screening tools at the same time that we have a therapeutic.\"\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=A+Sniff+Test+For+Alzheimer%27s+Checks+For+The+Ability+To+Identify+Odors&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Treatment for Tinnitus is Loud and Clear: Cognitive Behavioral Therapy",
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"content": "\u003cp>About three years ago, a high-pitched \"eeeeeeeee\" sound started ringing in Linda Gray's ears. Sometimes, the ring would suddenly turn into a roar, sending Gray into panic mode. Her heart would speed up. She'd try to find a quiet room. \"You're trying to escape it. It's like, 'Turn this off!' \" she says.\u003c/p>\n\u003caside class=\"pullquote alignright\">'Cognitive behavioral therapy is widely accepted and promoted by our national professional society, but very few people know about it.'\u003ccite>Ear surgeon Harrison Lin\u003c/cite>\u003c/aside>\n\u003cp>A lot of people experience ringing, roaring or buzzing, also known as \u003ca href=\"http://www.npr.org/2011/07/18/138163304/tinnitus-why-wont-my-ears-stop-ringing\">tinnitus.\u003c/a> It can be maddening.\u003c/p>\n\u003cp>\"It consumed me, it really did,\" says Gray, a childbirth educator living in Ohio. \"I avoided talking on the phone, I avoided any social situation because it was so bothersome.\" She stopped working for months.\u003c/p>\n\u003cp>Doctors writing Thursday in the journal \u003cem>JAMA Otolaryngology-Head & Neck Surgery\u003c/em> \u003ca href=\"http://archotol.jamanetwork.com/article.aspx?doi=10.1001/jamaoto.2016.1700\">found that\u003c/a> about 1 in 10 U.S. adults reported experiencing tinnitus within the last year. And, surprisingly, very few of them talked with their doctors about one of the few methods known to help with it.\u003c/p>\n\u003cp>\"Tinnitus is intimately tied to hearing loss,\" says \u003ca href=\"http://www.ucirvinehealth.org/find-a-doctor/l/harrison-lin/\">Harrison Lin\u003c/a>, an ear surgeon at the University of California, Irvine Medical Center and an author on the report. When a person loses the ability to hear a certain range of sound, their brain might chime in with its own iteration, like a soldier who can still feel pain in a limb they've lost.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"You hear a sound — a buzzing, a hissing or a tone — and no one else hears it. It's generated by something in your brain,\" says Lin.\u003c/p>\n\u003cp>Looking at a national survey of more than 75,000 people, Lin and his colleagues found that about a quarter said they'd experienced symptoms for more than 15 years. Over a third said their symptoms were nearly constant. According to the U.S. Department of Veteran Affairs, over a million veterans get \u003ca href=\"http://benefits.va.gov/REPORTS/abr/ABR-Compensation-FY15-05092016.pdf\">disability payments\u003c/a> for tinnitus.\u003c/p>\n\u003cp>For a lot of people, tinnitus is minor enough that they don't consider it a problem. But in cases where the sensation is intolerable, it's connected with anxiety, depression and lower quality of life.\u003c/p>\n\u003cp>Lin says one way to counteract it is to get hearing aids, so that the brain stops trying to compensate for the silence. The other thing known to help with tinnitus sounds a little odd coming out of a surgeon's mouth — psychotherapy.\u003c/p>\n\u003cp>\"Cognitive behavioral therapy is \u003ca href=\"http://oto.sagepub.com/content/151/2_suppl/S1.full.pdf+html\">widely accepted\u003c/a> and promoted by our national professional society, but very few people know about it,\" says Lin. \"It's about converting the way in which you think about tinnitus from negative emotions and trains of thought to more positive trains of thought.\"\u003c/p>\n\u003cp>For example, Lin says, a patient might be limiting their activities because of negative thoughts around their tinnitus. The therapy would help them take the bad thought, like \"My tinnitus is very bad today, and I won't enjoy going out to dinner with my spouse, so I won't go,\" and turn it into a good one, like \"I have tinnitus, and it may be distracting at times, but I will likely enjoy spending time with my spouse, delight in the meal and have an otherwise great evening.\"\u003c/p>\n\u003cp>Participants also learn relaxation techniques, how to manage sleep better, and ways to reduce their fear about encountering unpleasant sounds.\u003c/p>\n\u003cp>Despite \u003ca href=\"http://www.cochrane.org/CD005233/ENT_cognitive-behavioural-therapy-for-tinnitus\">studies showing\u003c/a> the effectiveness of behavioral therapy, doctors rarely bring it up with patients. According to the survey Lin studied, about 0.2 percent of respondents with tinnitus had talked about it with their doctors.\u003c/p>\n\u003cp>Jennifer Gans, a psychologist with a \u003ca href=\"http://www.drjennifergans.com/\">private practice\u003c/a> in San Francisco, is pushing for another form of therapy for tinnitus patients: mindfulness. The evidence for its effectiveness is a lot harder to come by than for cognitive behavioral therapy, but it operates on the same assumption — that changing a person's attitude about their affliction can minimize its impact on their life.\u003c/p>\n\u003cp>After learning about how mindfulness could help people with chronic pain, Gans decided to apply the method to tinnitus. She now has an online course in stress reduction to help people cope with the infuriating sounds.\u003c/p>\n\u003cp>\"There's this great quote that 'Pain in life is inevitable, but suffering is optional,' and it really stands true,\" she says.\u003c/p>\n\u003cp>Gans asks participants to meditate for half an hour every day, learning to live with the tinnitus rather than harping on it as a burden. In the first lesson, she asks participants to pick up a raisin and focus on each detail — the texture, the sound of it rolling between two fingers, the look, taste, smell. She even asks people to notice the feeling of being \"one raisin heavier\" after eating it.\u003c/p>\n\u003cp>The idea is to help people learn to control their focus and their stress so that when something out of their control happens, like a loud ringing in their head, they can keep calm and get on with their daily life.\u003c/p>\n\u003cp>She says some people initially say, \"No way, I'm not into that mumbo-jumbo stuff.\" But when all else fails, they tend to come around.\u003c/p>\n\u003cp>Linda Gray, who eventually took Gans' course, was initially among the skeptical.\u003c/p>\n\u003cp>\"I'd done hearing aids, acupuncture, massage, tinnitus retraining therapy, and there was nothing else left,\" she says. She doubted that an online course involving a yoga mat would do much to help. But, she says, \"I had to get on with my life. I couldn't just sit in my bedroom listening to white noise for days or weeks at a time.\u003c/p>\n\u003cp>\"I'd still prefer it to be gone. As we're talking now, I can hear it,\" she says. But, she says, \"I have some tools now to cope with it, rather than panic.\"\u003c/p>\n\u003cp>Though few studies have shown the effectiveness of mindfulness for tinnitus patients, a few \u003ca href=\"http://onlinelibrary.wiley.com/doi/10.1002/cpp.756/abstract;jsessionid=25839FD8358A6D325FECC02E2528208B.f03t02\">studies\u003c/a> have \u003ca href=\"http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=1657092&fileId=S0022215107007438\">shown\u003c/a> that combining mindfulness with cognitive behavioral therapy can reduce the negative psychological impact of chronic tinnitus.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>Lin and his colleagues at UC Irvine have created their own 8-week online course in cognitive behavioral therapy. They're now enrolling people with tinnitus in a trial to understand how much it helps improve their quality of life.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Psychotherapy+Helps+People+Turn+Down+The+Din+Of+Tinnitus&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>About three years ago, a high-pitched \"eeeeeeeee\" sound started ringing in Linda Gray's ears. Sometimes, the ring would suddenly turn into a roar, sending Gray into panic mode. Her heart would speed up. She'd try to find a quiet room. \"You're trying to escape it. It's like, 'Turn this off!' \" she says.\u003c/p>\n\u003caside class=\"pullquote alignright\">'Cognitive behavioral therapy is widely accepted and promoted by our national professional society, but very few people know about it.'\u003ccite>Ear surgeon Harrison Lin\u003c/cite>\u003c/aside>\n\u003cp>A lot of people experience ringing, roaring or buzzing, also known as \u003ca href=\"http://www.npr.org/2011/07/18/138163304/tinnitus-why-wont-my-ears-stop-ringing\">tinnitus.\u003c/a> It can be maddening.\u003c/p>\n\u003cp>\"It consumed me, it really did,\" says Gray, a childbirth educator living in Ohio. \"I avoided talking on the phone, I avoided any social situation because it was so bothersome.\" She stopped working for months.\u003c/p>\n\u003cp>Doctors writing Thursday in the journal \u003cem>JAMA Otolaryngology-Head & Neck Surgery\u003c/em> \u003ca href=\"http://archotol.jamanetwork.com/article.aspx?doi=10.1001/jamaoto.2016.1700\">found that\u003c/a> about 1 in 10 U.S. adults reported experiencing tinnitus within the last year. And, surprisingly, very few of them talked with their doctors about one of the few methods known to help with it.\u003c/p>\n\u003cp>\"Tinnitus is intimately tied to hearing loss,\" says \u003ca href=\"http://www.ucirvinehealth.org/find-a-doctor/l/harrison-lin/\">Harrison Lin\u003c/a>, an ear surgeon at the University of California, Irvine Medical Center and an author on the report. When a person loses the ability to hear a certain range of sound, their brain might chime in with its own iteration, like a soldier who can still feel pain in a limb they've lost.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"You hear a sound — a buzzing, a hissing or a tone — and no one else hears it. It's generated by something in your brain,\" says Lin.\u003c/p>\n\u003cp>Looking at a national survey of more than 75,000 people, Lin and his colleagues found that about a quarter said they'd experienced symptoms for more than 15 years. Over a third said their symptoms were nearly constant. According to the U.S. Department of Veteran Affairs, over a million veterans get \u003ca href=\"http://benefits.va.gov/REPORTS/abr/ABR-Compensation-FY15-05092016.pdf\">disability payments\u003c/a> for tinnitus.\u003c/p>\n\u003cp>For a lot of people, tinnitus is minor enough that they don't consider it a problem. But in cases where the sensation is intolerable, it's connected with anxiety, depression and lower quality of life.\u003c/p>\n\u003cp>Lin says one way to counteract it is to get hearing aids, so that the brain stops trying to compensate for the silence. The other thing known to help with tinnitus sounds a little odd coming out of a surgeon's mouth — psychotherapy.\u003c/p>\n\u003cp>\"Cognitive behavioral therapy is \u003ca href=\"http://oto.sagepub.com/content/151/2_suppl/S1.full.pdf+html\">widely accepted\u003c/a> and promoted by our national professional society, but very few people know about it,\" says Lin. \"It's about converting the way in which you think about tinnitus from negative emotions and trains of thought to more positive trains of thought.\"\u003c/p>\n\u003cp>For example, Lin says, a patient might be limiting their activities because of negative thoughts around their tinnitus. The therapy would help them take the bad thought, like \"My tinnitus is very bad today, and I won't enjoy going out to dinner with my spouse, so I won't go,\" and turn it into a good one, like \"I have tinnitus, and it may be distracting at times, but I will likely enjoy spending time with my spouse, delight in the meal and have an otherwise great evening.\"\u003c/p>\n\u003cp>Participants also learn relaxation techniques, how to manage sleep better, and ways to reduce their fear about encountering unpleasant sounds.\u003c/p>\n\u003cp>Despite \u003ca href=\"http://www.cochrane.org/CD005233/ENT_cognitive-behavioural-therapy-for-tinnitus\">studies showing\u003c/a> the effectiveness of behavioral therapy, doctors rarely bring it up with patients. According to the survey Lin studied, about 0.2 percent of respondents with tinnitus had talked about it with their doctors.\u003c/p>\n\u003cp>Jennifer Gans, a psychologist with a \u003ca href=\"http://www.drjennifergans.com/\">private practice\u003c/a> in San Francisco, is pushing for another form of therapy for tinnitus patients: mindfulness. The evidence for its effectiveness is a lot harder to come by than for cognitive behavioral therapy, but it operates on the same assumption — that changing a person's attitude about their affliction can minimize its impact on their life.\u003c/p>\n\u003cp>After learning about how mindfulness could help people with chronic pain, Gans decided to apply the method to tinnitus. She now has an online course in stress reduction to help people cope with the infuriating sounds.\u003c/p>\n\u003cp>\"There's this great quote that 'Pain in life is inevitable, but suffering is optional,' and it really stands true,\" she says.\u003c/p>\n\u003cp>Gans asks participants to meditate for half an hour every day, learning to live with the tinnitus rather than harping on it as a burden. In the first lesson, she asks participants to pick up a raisin and focus on each detail — the texture, the sound of it rolling between two fingers, the look, taste, smell. She even asks people to notice the feeling of being \"one raisin heavier\" after eating it.\u003c/p>\n\u003cp>The idea is to help people learn to control their focus and their stress so that when something out of their control happens, like a loud ringing in their head, they can keep calm and get on with their daily life.\u003c/p>\n\u003cp>She says some people initially say, \"No way, I'm not into that mumbo-jumbo stuff.\" But when all else fails, they tend to come around.\u003c/p>\n\u003cp>Linda Gray, who eventually took Gans' course, was initially among the skeptical.\u003c/p>\n\u003cp>\"I'd done hearing aids, acupuncture, massage, tinnitus retraining therapy, and there was nothing else left,\" she says. She doubted that an online course involving a yoga mat would do much to help. But, she says, \"I had to get on with my life. I couldn't just sit in my bedroom listening to white noise for days or weeks at a time.\u003c/p>\n\u003cp>\"I'd still prefer it to be gone. As we're talking now, I can hear it,\" she says. But, she says, \"I have some tools now to cope with it, rather than panic.\"\u003c/p>\n\u003cp>Though few studies have shown the effectiveness of mindfulness for tinnitus patients, a few \u003ca href=\"http://onlinelibrary.wiley.com/doi/10.1002/cpp.756/abstract;jsessionid=25839FD8358A6D325FECC02E2528208B.f03t02\">studies\u003c/a> have \u003ca href=\"http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=1657092&fileId=S0022215107007438\">shown\u003c/a> that combining mindfulness with cognitive behavioral therapy can reduce the negative psychological impact of chronic tinnitus.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"info": "Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. Together in Possible, Hoffman and Finger lead enlightening discussions about building a brighter collective future. The show features interviews with visionary guests like Trevor Noah, Sam Altman and Janette Sadik-Khan. Possible paints an optimistic portrait of the world we can create through science, policy, business, art and our shared humanity. It asks: What if everything goes right for once? How can we get there? Each episode also includes a short fiction story generated by advanced AI GPT-4, serving as a thought-provoking springboard to speculate how humanity could leverage technology for good.",
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