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"content": "\u003cp>Though Americans spend \u003ca href=\"https://jamanetwork.com/journals/jama/fullarticle/181453\" target=\"_blank\" rel=\"noopener\">an estimated $80 billion to $100 billion\u003c/a> each year in hopes of easing their aching backs, the \u003ca href=\"http://www.jabfm.org/content/22/1/62.full.pdf+html\" target=\"_blank\" rel=\"noopener\">evidence\u003c/a> is mounting that many pricey standard treatments — including surgery and spinal injections — are often ineffective and can even worsen and prolong the problem.[contextly_sidebar id=\"NnSkz6hWo66qjz82zs3UyfDrUeLrVZMY\"]\u003c/p>\n\u003cp>A \u003ca href=\"http://dx.doi.org/10.1111/1475-6773.12984\">study\u003c/a> published Wednesday in the journal \u003cem>Health Services Research \u003c/em>suggests trying physical therapy first may at least ease the strain on the patient's wallet in the long term — and also curb reliance on opioid painkillers, which carry their own risks.\u003c/p>\n\u003cp>The researchers, from the University of Washington in Seattle and George Washington University in Washington, D.C., analyzed more than 150,000 commercial health insurance claims filed between 2009 and 2013 in six northwestern states. They checked the files of patients who had a new diagnosis of low back pain, comparing the insurance claims of people who had received physical therapy before seeing their family doctor or a specialist to those of people who received PT at a later date, or not at all.\u003c/p>\n\u003cp>The study wasn't designed to look directly at how well physical therapy ameliorates pain. Instead, the researchers wanted to see if physical therapy reduced overall health care costs and patient outlay related to back pain — including the number of opioid prescriptions and the number of advanced imaging tests like MRIs and CT scans, as well as hospitalizations and ER visits.\u003c/p>\n\u003cp>It turned out that patients who saw a physical therapist before trying other treatments had an 89 percent lower probability of eventually needing an opioid prescription, a 28 percent lower probability of having any advanced imaging services, and a 15 percent lower probability of making one or more ER visits.[contextly_sidebar id=\"MTIEjzH2IsBxjNns1qtBA1rsrfEk3FgX\"]\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Overall, patients saw \"significantly lower out-of-pocket costs — on the average, $500 — when they visited a physical therapist first,\" says \u003ca href=\"http://depts.washington.edu/uwchws/staff_pages/bianca.html\" target=\"_blank\" rel=\"noopener\">Bianca Frogner\u003c/a>, a health economist at the University of Washington, and lead author on the study.\u003c/p>\n\u003cp>\"People who get trained in physical therapy have very specialized knowledge about pain management,\" she says, \"especially with the muscular skeletal system. They might actually understand this pain better than the average family physician.\"\u003c/p>\n\u003cp>It's also worth noting, she says, that some patients who could benefit from physical therapy don't get it, because of \u003ca href=\"https://www.npr.org/sections/health-shots/2018/03/13/592983651/lifting-medicare-s-annual-limits-on-physical-therapy-helps-ease-patients-pain\" target=\"_blank\" rel=\"noopener\">health insurance restrictions\u003c/a>, or because they lack insurance, or the co-payments are too high.\u003c/p>\n\u003cp>\u003ca href=\"http://www.gwumc.edu/smhs/facultydirectory/profile.cfm?empName=Kenneth%20Harwood&FacID=2077548168\">Kenneth Harwood\u003c/a>, a coauthor of the study and a physical therapist who directs the program in health care quality at George Washington University, says PT can diminish a patient's pain by physically moving the joints of the back, knee, or hip through a full range of motion, thereby decreasing the stiffness and immobility patients might feel.\u003c/p>\n\u003cp>The therapists can also guide patients through exercise regimens that strengthen muscles and help patients develop control over movements, including posture, he says.[contextly_sidebar id=\"H1m5ta5Q0xHs1pH9Vw3ds2b8I90mjPR4\"]\u003c/p>\n\u003cp>The study did find an unexplained 19 percent higher probability of eventual hospitalization among patients who received physical therapy before other medical care. Researchers didn't have the cause of each hospitalization in their dataset, but Frogner says it may have been, in many cases, the result of other co-morbid conditions associated with low back pain — such as obesity or diabetes.\u003c/p>\n\u003cp>\"It could also be that the physical therapist was able to identify more serious problems on the first visit, and refer patients on to more specialized care,\" she says.\u003c/p>\n\u003cp>Among those whose first treatment was physical therapy the scientists found a dramatic decrease in the likelihood of being prescribed opioids for pain.\u003c/p>\n\u003cp>In an era of pervasive opioid prescriptions, Frogner says, anything that can be done to reduce the number of opioids in circulation is worth considering.\u003c/p>\n\u003cp>\"We need to look for better ways to help patients manage the current pain they have and prevent it from coming back in the future\" says Frogner, adding that physical therapists \"are well positioned to provide ideas on exercises, movement and ways of living to prevent the pain from getting worse — and hopefully from ever coming back, once it's gone.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Pain specialist \u003ca href=\"https://www.hopkinsmedicine.org/profiles/results/directory/profile/10001214/mark-bicket\" target=\"_blank\" rel=\"noopener\">Dr. Mark Bicket\u003c/a>, with Johns Hopkins University School of Medicine, who was not affiliated with the study, says the findings align with the \u003ca href=\"http://annals.org/aim/fullarticle/2603228/noninvasive-treatments-acute-subacute-chronic-low-back-pain-clinical-practice\" target=\"_blank\" rel=\"noopener\">American Pain Society's recommendations\u003c/a> to provide noninvasive treatment — including heat, massage, acupuncture and physical therapy — as the first line of defense against low back pain.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Trying+Physical+Therapy+First+For+Low+Back+Pain+May+Curb+Use+Of+Opioids&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Though Americans spend \u003ca href=\"https://jamanetwork.com/journals/jama/fullarticle/181453\" target=\"_blank\" rel=\"noopener\">an estimated $80 billion to $100 billion\u003c/a> each year in hopes of easing their aching backs, the \u003ca href=\"http://www.jabfm.org/content/22/1/62.full.pdf+html\" target=\"_blank\" rel=\"noopener\">evidence\u003c/a> is mounting that many pricey standard treatments — including surgery and spinal injections — are often ineffective and can even worsen and prolong the problem.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>A \u003ca href=\"http://dx.doi.org/10.1111/1475-6773.12984\">study\u003c/a> published Wednesday in the journal \u003cem>Health Services Research \u003c/em>suggests trying physical therapy first may at least ease the strain on the patient's wallet in the long term — and also curb reliance on opioid painkillers, which carry their own risks.\u003c/p>\n\u003cp>The researchers, from the University of Washington in Seattle and George Washington University in Washington, D.C., analyzed more than 150,000 commercial health insurance claims filed between 2009 and 2013 in six northwestern states. They checked the files of patients who had a new diagnosis of low back pain, comparing the insurance claims of people who had received physical therapy before seeing their family doctor or a specialist to those of people who received PT at a later date, or not at all.\u003c/p>\n\u003cp>The study wasn't designed to look directly at how well physical therapy ameliorates pain. Instead, the researchers wanted to see if physical therapy reduced overall health care costs and patient outlay related to back pain — including the number of opioid prescriptions and the number of advanced imaging tests like MRIs and CT scans, as well as hospitalizations and ER visits.\u003c/p>\n\u003cp>It turned out that patients who saw a physical therapist before trying other treatments had an 89 percent lower probability of eventually needing an opioid prescription, a 28 percent lower probability of having any advanced imaging services, and a 15 percent lower probability of making one or more ER visits.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Overall, patients saw \"significantly lower out-of-pocket costs — on the average, $500 — when they visited a physical therapist first,\" says \u003ca href=\"http://depts.washington.edu/uwchws/staff_pages/bianca.html\" target=\"_blank\" rel=\"noopener\">Bianca Frogner\u003c/a>, a health economist at the University of Washington, and lead author on the study.\u003c/p>\n\u003cp>\"People who get trained in physical therapy have very specialized knowledge about pain management,\" she says, \"especially with the muscular skeletal system. They might actually understand this pain better than the average family physician.\"\u003c/p>\n\u003cp>It's also worth noting, she says, that some patients who could benefit from physical therapy don't get it, because of \u003ca href=\"https://www.npr.org/sections/health-shots/2018/03/13/592983651/lifting-medicare-s-annual-limits-on-physical-therapy-helps-ease-patients-pain\" target=\"_blank\" rel=\"noopener\">health insurance restrictions\u003c/a>, or because they lack insurance, or the co-payments are too high.\u003c/p>\n\u003cp>\u003ca href=\"http://www.gwumc.edu/smhs/facultydirectory/profile.cfm?empName=Kenneth%20Harwood&FacID=2077548168\">Kenneth Harwood\u003c/a>, a coauthor of the study and a physical therapist who directs the program in health care quality at George Washington University, says PT can diminish a patient's pain by physically moving the joints of the back, knee, or hip through a full range of motion, thereby decreasing the stiffness and immobility patients might feel.\u003c/p>\n\u003cp>The therapists can also guide patients through exercise regimens that strengthen muscles and help patients develop control over movements, including posture, he says.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>The study did find an unexplained 19 percent higher probability of eventual hospitalization among patients who received physical therapy before other medical care. Researchers didn't have the cause of each hospitalization in their dataset, but Frogner says it may have been, in many cases, the result of other co-morbid conditions associated with low back pain — such as obesity or diabetes.\u003c/p>\n\u003cp>\"It could also be that the physical therapist was able to identify more serious problems on the first visit, and refer patients on to more specialized care,\" she says.\u003c/p>\n\u003cp>Among those whose first treatment was physical therapy the scientists found a dramatic decrease in the likelihood of being prescribed opioids for pain.\u003c/p>\n\u003cp>In an era of pervasive opioid prescriptions, Frogner says, anything that can be done to reduce the number of opioids in circulation is worth considering.\u003c/p>\n\u003cp>\"We need to look for better ways to help patients manage the current pain they have and prevent it from coming back in the future\" says Frogner, adding that physical therapists \"are well positioned to provide ideas on exercises, movement and ways of living to prevent the pain from getting worse — and hopefully from ever coming back, once it's gone.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Pain specialist \u003ca href=\"https://www.hopkinsmedicine.org/profiles/results/directory/profile/10001214/mark-bicket\" target=\"_blank\" rel=\"noopener\">Dr. Mark Bicket\u003c/a>, with Johns Hopkins University School of Medicine, who was not affiliated with the study, says the findings align with the \u003ca href=\"http://annals.org/aim/fullarticle/2603228/noninvasive-treatments-acute-subacute-chronic-low-back-pain-clinical-practice\" target=\"_blank\" rel=\"noopener\">American Pain Society's recommendations\u003c/a> to provide noninvasive treatment — including heat, massage, acupuncture and physical therapy — as the first line of defense against low back pain.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Trying+Physical+Therapy+First+For+Low+Back+Pain+May+Curb+Use+Of+Opioids&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Every year, \u003ca href=\"http://news.gallup.com/poll/228314/naples-florida-metro-tops-third-time.aspx\" target=\"_blank\" rel=\"noopener\">Gallup ranks\u003c/a> U.S. cities for well-being, based on how residents feel about living in their communities, and their health, finances, social ties and sense of purpose. Perhaps unsurprisingly, places like Naples, Fla., and Boulder, Col., tend to top the list, while Southern and Midwestern towns including Canton, Ohio, and Fort Smith, Ark., often come in last. But what hard data underpin the differences between these communities?[contextly_sidebar id=\"15QRpQod6Gs06FFQ53JgSZCOIKrWS9aL\"]\u003c/p>\n\u003cp>A study published Wednesday takes a step toward teasing out which attributes might contribute to well-being in communities around the country.\u003c/p>\n\u003cp>A Yale-led team of researchers has identified 12 community factors independently related to well-being. The factors included some obvious ones, such as higher levels of education and income, as well as some surprises, including a higher percentage of black residents, a higher percentage of bicycle commuters, and better access to preventive care, such as mammograms. The results appear in \u003ca href=\"http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0196720\" target=\"_blank\" rel=\"noopener\">the journal \u003cem>PLOS ONE\u003c/em>.\u003c/a>\u003c/p>\n\u003cp>Well-being has been associated with \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5150263/\" target=\"_blank\" rel=\"noopener\">longer life expectancy and better health outcomes\u003c/a>. Previous studies \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1448000/\" target=\"_blank\" rel=\"noopener\">have also shown\u003c/a> that where someone lives can improve or diminish well-being.\u003c/p>\n\u003cp>For this study, the researchers compared two types of data: well-being data, gleaned from the \u003ca href=\"https://wellbeingindex.sharecare.com/\" target=\"_blank\" rel=\"noopener\">Gallup-Sharecare Well-Being Index\u003c/a>, based on surveying more than 300,000 Americans; and community attributes that researchers suspected would influence well-being drawn from the Robert Wood Johnson Foundation County Health Rankings, as well as other sources. This data included county-level information on high school graduation rates, percent of children in poverty, and the number of preventable hospital stays, among other things.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Using a statistical model, researchers whittled down more than 75 community attributes to determine which stood out.\u003c/p>\n\u003cp>Many of the potential factors are highly correlated with one another — for example, lower median income is correlated with lower education and less access to healthy food. Researchers wanted to figure out which characteristics measurably affected well-being independent of those other factors.\u003c/p>\n\u003cp>To the researchers' surprise, they discovered that just 12 factors related to demographics, clinical care, social and economic factors, and the physical environment explained over 90 percent of the variation in well-being across the country.[contextly_sidebar id=\"hoO2xlce32NjQsHCOB6fAGcPfegxXuXw\"]\u003c/p>\n\u003cp>\"That's higher than I would have expected,\" says \u003ca href=\"https://medicine.yale.edu/intmed/genmed/people/brita_roy.profile\" target=\"_blank\" rel=\"noopener\">Brita Roy\u003c/a>, assistant professor of medicine at the Yale School of Medicine and lead author of the study.\u003c/p>\n\u003cp>In what Roy called an unexpected but notable result, her team found that communities with higher percentages of black residents reported higher levels of well-being.\u003c/p>\n\u003cp>\"Having something that shows greater diversity is actually better for all of us I think is a really important finding,\" Roy says.\u003c/p>\n\u003cp>\u003ca href=\"https://www.brookings.edu/articles/why-are-black-poor-americans-more-optimistic-than-white-ones/\">Research\u003c/a> by Carol Graham at the Brookings Institution and others has shown high levels of optimism within the black community, which could account for the correlation in the paper.\u003c/p>\n\u003cp>But percentage of black residents is not the same as an overall measure of diversity, says Anita Chandra, director of \u003ca href=\"https://www.rand.org/jie.html\" target=\"_blank\" rel=\"noopener\">RAND Justice, Infrastructure, and Environment\u003c/a>. A better measure of diversity is \u003ca href=\"https://www.rwjf.org/en/cultureofhealth/taking-action/creating-healthier-communities/social-and-economic-environment.html\">diversity exposure\u003c/a>, which calculates how one ethnic or racial group is situated and exposed to all the other groups in a community.\u003c/p>\n\u003cp>Another unexpected finding was the connection between well-being and the percentage of residents commuting by bicycle. People living in places where they could commute to work by bike reported feelings of satisfaction and fulfillment.\u003c/p>\n\u003cp>This could be because places with bike-friendly infrastructure might also support other types of policies that improve living in that area. Or it could be that commuting by bike improves physical health, which in turn improves a sense of well-being; a \u003ca href=\"https://www.bmj.com/content/357/bmj.j1944\">study\u003c/a> in \u003cem>Heart\u003c/em> this week showed walking or cycling to work cut the risk of dying from heart disease or stroke by 30 percent.[contextly_sidebar id=\"d3I8IkqWk8sJqqOWib1G6Ufpur2JF6Nq\"]\u003c/p>\n\u003cp>The researchers hope their findings could lead to future research and even policy applications.\u003c/p>\n\u003cp>\"We are starting to move in the direction of trying to understand at the community level how we can actually work to improve well being for all members of the community,\" says Roy.\u003c/p>\n\u003cp>The study had limitations. It was cross-sectional, meaning researchers used one snapshot in time to see what was linked together, rather than using data over time. \"We can't prove causality at this point,\" Roy says. \"We don't know if we improve these twelve factors, will we actually lead to improved well-being. But it certainly provides us with a first step in understanding what perhaps we should test.\"\u003c/p>\n\u003cp>The study also didn't include psychosocial data, such as levels of trust in community, trust in government and social cohesion. Those data weren't available.\u003c/p>\n\u003cp>Chandra says this study serves as a call for collecting more and better information to help us grasp the full picture of what impacts wellness. \"We collect a lot of data, but we still have these gaps in our understanding of community and individual well-being,\" Chandra says.\u003c/p>\n\u003cp>She says in addition to surveys that measure an individual's sense of well-being, like the Gallup-Sharecare index, researchers need to gather information on larger scale community and civic well-being to bring everything together.\u003c/p>\n\u003cp>\"That's really where policy makers and practitioners can make decisions about resource allocation and where to put time and investment and policies in place,\" she says.\u003c/p>\n\u003cp>Nevertheless, she says this study is another important piece of the puzzle in understanding what drives overall health.\u003c/p>\n\u003cp>\"There are things that communities can do that make it more possible for people to feel more positive about their community,\" she says. \"And some of these things are very much in our control.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Dana Bate is a health and science reporter living in Philadelphia. You can follow her on Twitter: \u003c/em>\u003ca href=\"https://twitter.com/danabate\">\u003cem>@danabate\u003c/em>\u003c/a>\u003cem>.\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Where+You+Live+Affects+Your+Happiness+And+Health%2C+But+How+Exactly%3F+&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Every year, \u003ca href=\"http://news.gallup.com/poll/228314/naples-florida-metro-tops-third-time.aspx\" target=\"_blank\" rel=\"noopener\">Gallup ranks\u003c/a> U.S. cities for well-being, based on how residents feel about living in their communities, and their health, finances, social ties and sense of purpose. Perhaps unsurprisingly, places like Naples, Fla., and Boulder, Col., tend to top the list, while Southern and Midwestern towns including Canton, Ohio, and Fort Smith, Ark., often come in last. But what hard data underpin the differences between these communities?\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>A study published Wednesday takes a step toward teasing out which attributes might contribute to well-being in communities around the country.\u003c/p>\n\u003cp>A Yale-led team of researchers has identified 12 community factors independently related to well-being. The factors included some obvious ones, such as higher levels of education and income, as well as some surprises, including a higher percentage of black residents, a higher percentage of bicycle commuters, and better access to preventive care, such as mammograms. The results appear in \u003ca href=\"http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0196720\" target=\"_blank\" rel=\"noopener\">the journal \u003cem>PLOS ONE\u003c/em>.\u003c/a>\u003c/p>\n\u003cp>Well-being has been associated with \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5150263/\" target=\"_blank\" rel=\"noopener\">longer life expectancy and better health outcomes\u003c/a>. Previous studies \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1448000/\" target=\"_blank\" rel=\"noopener\">have also shown\u003c/a> that where someone lives can improve or diminish well-being.\u003c/p>\n\u003cp>For this study, the researchers compared two types of data: well-being data, gleaned from the \u003ca href=\"https://wellbeingindex.sharecare.com/\" target=\"_blank\" rel=\"noopener\">Gallup-Sharecare Well-Being Index\u003c/a>, based on surveying more than 300,000 Americans; and community attributes that researchers suspected would influence well-being drawn from the Robert Wood Johnson Foundation County Health Rankings, as well as other sources. This data included county-level information on high school graduation rates, percent of children in poverty, and the number of preventable hospital stays, among other things.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Using a statistical model, researchers whittled down more than 75 community attributes to determine which stood out.\u003c/p>\n\u003cp>Many of the potential factors are highly correlated with one another — for example, lower median income is correlated with lower education and less access to healthy food. Researchers wanted to figure out which characteristics measurably affected well-being independent of those other factors.\u003c/p>\n\u003cp>To the researchers' surprise, they discovered that just 12 factors related to demographics, clinical care, social and economic factors, and the physical environment explained over 90 percent of the variation in well-being across the country.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\"That's higher than I would have expected,\" says \u003ca href=\"https://medicine.yale.edu/intmed/genmed/people/brita_roy.profile\" target=\"_blank\" rel=\"noopener\">Brita Roy\u003c/a>, assistant professor of medicine at the Yale School of Medicine and lead author of the study.\u003c/p>\n\u003cp>In what Roy called an unexpected but notable result, her team found that communities with higher percentages of black residents reported higher levels of well-being.\u003c/p>\n\u003cp>\"Having something that shows greater diversity is actually better for all of us I think is a really important finding,\" Roy says.\u003c/p>\n\u003cp>\u003ca href=\"https://www.brookings.edu/articles/why-are-black-poor-americans-more-optimistic-than-white-ones/\">Research\u003c/a> by Carol Graham at the Brookings Institution and others has shown high levels of optimism within the black community, which could account for the correlation in the paper.\u003c/p>\n\u003cp>But percentage of black residents is not the same as an overall measure of diversity, says Anita Chandra, director of \u003ca href=\"https://www.rand.org/jie.html\" target=\"_blank\" rel=\"noopener\">RAND Justice, Infrastructure, and Environment\u003c/a>. A better measure of diversity is \u003ca href=\"https://www.rwjf.org/en/cultureofhealth/taking-action/creating-healthier-communities/social-and-economic-environment.html\">diversity exposure\u003c/a>, which calculates how one ethnic or racial group is situated and exposed to all the other groups in a community.\u003c/p>\n\u003cp>Another unexpected finding was the connection between well-being and the percentage of residents commuting by bicycle. People living in places where they could commute to work by bike reported feelings of satisfaction and fulfillment.\u003c/p>\n\u003cp>This could be because places with bike-friendly infrastructure might also support other types of policies that improve living in that area. Or it could be that commuting by bike improves physical health, which in turn improves a sense of well-being; a \u003ca href=\"https://www.bmj.com/content/357/bmj.j1944\">study\u003c/a> in \u003cem>Heart\u003c/em> this week showed walking or cycling to work cut the risk of dying from heart disease or stroke by 30 percent.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>The researchers hope their findings could lead to future research and even policy applications.\u003c/p>\n\u003cp>\"We are starting to move in the direction of trying to understand at the community level how we can actually work to improve well being for all members of the community,\" says Roy.\u003c/p>\n\u003cp>The study had limitations. It was cross-sectional, meaning researchers used one snapshot in time to see what was linked together, rather than using data over time. \"We can't prove causality at this point,\" Roy says. \"We don't know if we improve these twelve factors, will we actually lead to improved well-being. But it certainly provides us with a first step in understanding what perhaps we should test.\"\u003c/p>\n\u003cp>The study also didn't include psychosocial data, such as levels of trust in community, trust in government and social cohesion. Those data weren't available.\u003c/p>\n\u003cp>Chandra says this study serves as a call for collecting more and better information to help us grasp the full picture of what impacts wellness. \"We collect a lot of data, but we still have these gaps in our understanding of community and individual well-being,\" Chandra says.\u003c/p>\n\u003cp>She says in addition to surveys that measure an individual's sense of well-being, like the Gallup-Sharecare index, researchers need to gather information on larger scale community and civic well-being to bring everything together.\u003c/p>\n\u003cp>\"That's really where policy makers and practitioners can make decisions about resource allocation and where to put time and investment and policies in place,\" she says.\u003c/p>\n\u003cp>Nevertheless, she says this study is another important piece of the puzzle in understanding what drives overall health.\u003c/p>\n\u003cp>\"There are things that communities can do that make it more possible for people to feel more positive about their community,\" she says. \"And some of these things are very much in our control.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Dana Bate is a health and science reporter living in Philadelphia. You can follow her on Twitter: \u003c/em>\u003ca href=\"https://twitter.com/danabate\">\u003cem>@danabate\u003c/em>\u003c/a>\u003cem>.\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Where+You+Live+Affects+Your+Happiness+And+Health%2C+But+How+Exactly%3F+&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Why are we checking Facebook, Instagram, Twitter, then Facebook again when we just wanted to check the weather?[contextly_sidebar id=\"KBASAVNdk6q8KVQQyG3VjHzCFQWbG3Xo\"]\u003c/p>\n\u003cp>Turns out, smartphone addiction is by design. Think of the constant stream of notifications, color schemes in apps and all the “likes,” followers and in-game trophies. Our phones and apps are designed to give us short-term, feel-good rewards, so we’ll use them longer — at the expense of reading, enjoying the moment or simply being bored.\u003c/p>\n\u003cp>Some companies are relenting in response to concerns from customers and experts. Google’s next operating system , for instance, will come with a “wind down” mode; the screen will automatically fade to grey at a designated time before bed. Another feature will automatically put your phone in “do not disturb” mode if you flip it face down on a table.\u003c/p>\n\u003cp>But most Android phones won’t get this system, Android P, until late this year or even next year, if at all. And it’s unclear if Apple plans similar features for the iPhone.\u003c/p>\n\u003cp>So, for now, here’s how you can outsmart the smartphone yourself:\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cstrong>LIMIT NOTIFICATIONS\u003c/strong>\u003c/p>\n\u003cp>Notice those red dots on iPhones and Samsung phones showing how many unread messages, news items or app updates you have left to read? Of course, you have.\u003c/p>\n\u003cp>“Red is a trigger color that instantly draws our attention,” notes The Center for Humane Technology , an organization that promotes a healthier, less dependent relationship to technology.\u003c/p>\n\u003cp>Other Android phones running the most recent version, Oreo, have smaller dots. There are no numbers, and colors are more subtle, but the concept is the same: to lure you into opening the app.\u003c/p>\n\u003cp>To foil that on iPhones and most recent Android phones, go to your phone’s settings and turn off the dots, known as badges, for all but the handful of apps you care most about. These might be messaging apps you use with friends, or news services you want breaking-news alerts from. But do you really need a red dot for the 2,346 unread emails you have?\u003c/p>\n\u003cp>You can also turn off push notifications, app by app.\u003c/p>\n\u003cp>With Facebook, you’ll need to go to the app’s own settings to turn off the dozens of notification categories, such as “updates on your friends since you last logged in.” Turning a category off will turn off dots for that category, too.\u003c/p>\n\u003cp>\u003cstrong>DETOX REGULARLY\u003c/strong>\u003c/p>\n\u003cp>It can be as simple as going to the bathroom without your phone or turning it off during meal times or even every Saturday. Leaving your phone behind helps your brain reset.\u003c/p>\n\u003cp>If you need a prompt on just why you should “detox,” try Moment, an app that automatically tracks how much you use your iPhone or iPad each day. It’s not perfect, as the timer runs anytime your screen is unlocked, even if you’ve stepped away. Still, the results will probably surprise you. For Android, there’s an app called QualityTime.\u003c/p>\n\u003cp>\u003cstrong>SET A SCHEDULE\u003c/strong>\u003c/p>\n\u003cp>Nir Eyal, author of “Hooked: How to Build Habit-Forming Products,” compares humans to lab mice in an experiment of random rewards. Mice, it turns out, respond “most voraciously to random rewards,” Eyal wrote in 2012 .\u003c/p>\n\u003cp>Social media apps have perfected the art of random rewards. You don’t know when you’ll get a friend request, or a like, or even when you’ll see a new post from a friend. Cue endless check-ins and scrolling.\u003c/p>\n\u003cp>Set aside a specific time each day to check Facebook — or email, or instant messages. Then resist the urge until the next scheduled time.\u003c/p>\n\u003cp>Along those lines, try deleting the Facebook app from your phone and check only from a computer. This could help reduce the temptation to check all day.\u003c/p>\n\u003cp>\u003cstrong>TURN OFF AUTOPLAY\u003c/strong>\u003c/p>\n\u003cp>Binge-watching might be fun sometimes, but it shouldn’t be standard behavior. Services like YouTube and Netflix often play the next video automatically. Turn that off in the settings. Otherwise, it’s easy to forget where time went in the middle of a “Stranger Things” binge.\u003c/p>\n\u003cp>\u003cstrong>GET AN ALARM CLOCK\u003c/strong>\u003c/p>\n\u003cp>There was a time not too long ago when we were able to wake up without our phones, using a magical device called an alarm clock. Get one.\u003c/p>\n\u003cp>The Center for Humane Technology suggests banishing phones from your bedside, if not the entire bedroom. This should make for better sleep, partly because the blue light emitted from your phone can delay your body’s release of melatonin, which helps your body go to sleep at night. But perking up after a bedtime Facebook “like” or getting anxious after reading a news story can also disrupt your ZZZs.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>So, put your phone a little further and who knows, you might even wake up and say good morning to your partner instead of checking your phone before you’re even out of bed.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cstrong>LIMIT NOTIFICATIONS\u003c/strong>\u003c/p>\n\u003cp>Notice those red dots on iPhones and Samsung phones showing how many unread messages, news items or app updates you have left to read? Of course, you have.\u003c/p>\n\u003cp>“Red is a trigger color that instantly draws our attention,” notes The Center for Humane Technology , an organization that promotes a healthier, less dependent relationship to technology.\u003c/p>\n\u003cp>Other Android phones running the most recent version, Oreo, have smaller dots. There are no numbers, and colors are more subtle, but the concept is the same: to lure you into opening the app.\u003c/p>\n\u003cp>To foil that on iPhones and most recent Android phones, go to your phone’s settings and turn off the dots, known as badges, for all but the handful of apps you care most about. These might be messaging apps you use with friends, or news services you want breaking-news alerts from. But do you really need a red dot for the 2,346 unread emails you have?\u003c/p>\n\u003cp>You can also turn off push notifications, app by app.\u003c/p>\n\u003cp>With Facebook, you’ll need to go to the app’s own settings to turn off the dozens of notification categories, such as “updates on your friends since you last logged in.” Turning a category off will turn off dots for that category, too.\u003c/p>\n\u003cp>\u003cstrong>DETOX REGULARLY\u003c/strong>\u003c/p>\n\u003cp>It can be as simple as going to the bathroom without your phone or turning it off during meal times or even every Saturday. Leaving your phone behind helps your brain reset.\u003c/p>\n\u003cp>If you need a prompt on just why you should “detox,” try Moment, an app that automatically tracks how much you use your iPhone or iPad each day. It’s not perfect, as the timer runs anytime your screen is unlocked, even if you’ve stepped away. Still, the results will probably surprise you. For Android, there’s an app called QualityTime.\u003c/p>\n\u003cp>\u003cstrong>SET A SCHEDULE\u003c/strong>\u003c/p>\n\u003cp>Nir Eyal, author of “Hooked: How to Build Habit-Forming Products,” compares humans to lab mice in an experiment of random rewards. Mice, it turns out, respond “most voraciously to random rewards,” Eyal wrote in 2012 .\u003c/p>\n\u003cp>Social media apps have perfected the art of random rewards. You don’t know when you’ll get a friend request, or a like, or even when you’ll see a new post from a friend. Cue endless check-ins and scrolling.\u003c/p>\n\u003cp>Set aside a specific time each day to check Facebook — or email, or instant messages. Then resist the urge until the next scheduled time.\u003c/p>\n\u003cp>Along those lines, try deleting the Facebook app from your phone and check only from a computer. This could help reduce the temptation to check all day.\u003c/p>\n\u003cp>\u003cstrong>TURN OFF AUTOPLAY\u003c/strong>\u003c/p>\n\u003cp>Binge-watching might be fun sometimes, but it shouldn’t be standard behavior. Services like YouTube and Netflix often play the next video automatically. Turn that off in the settings. Otherwise, it’s easy to forget where time went in the middle of a “Stranger Things” binge.\u003c/p>\n\u003cp>\u003cstrong>GET AN ALARM CLOCK\u003c/strong>\u003c/p>\n\u003cp>There was a time not too long ago when we were able to wake up without our phones, using a magical device called an alarm clock. Get one.\u003c/p>\n\u003cp>The Center for Humane Technology suggests banishing phones from your bedside, if not the entire bedroom. This should make for better sleep, partly because the blue light emitted from your phone can delay your body’s release of melatonin, which helps your body go to sleep at night. But perking up after a bedtime Facebook “like” or getting anxious after reading a news story can also disrupt your ZZZs.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>So, put your phone a little further and who knows, you might even wake up and say good morning to your partner instead of checking your phone before you’re even out of bed.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Federal health officials warned parents Wednesday about the dangers of teething remedies that contain a popular numbing ingredient and asked manufacturers to stop selling their products intended for babies and toddlers.[contextly_sidebar id=\"yOpMR4Y3l8MUiZjv3cWS09VZIo7nESyv\"]\u003c/p>\n\u003cp>The Food and Drug Administration said that various gels and creams containing the drug benzocaine can cause rare but deadly side effects in children, especially those 2 years and younger.\u003c/p>\n\u003cp>The agency has been warning about the products for a decade but said reports of illnesses and deaths have continued. Now, it wants teething products off the market, noting there is little evidence they actually work.\u003c/p>\n\u003cp>“We urge parents, caregivers and retailers who sell them to heed our warnings and not use over-the-counter products containing benzocaine for teething pain,” said FDA Commissioner Scott Gottlieb, in a statement.\u003c/p>\n\u003cp>One major manufacturer, Church and Dwight Co. Inc., said Wednesday it would discontinue its four Orajel teething brands, including Baby Orajel and Orajel Medicated Teething Swabs.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The FDA said it will take legal action against other companies that don’t voluntarily comply as soon as possible.\u003c/p>\n\u003cp>Benzocaine is also used in popular over-the-counter products for toothaches and cold sores in adults, including Orajel and Anbesol and generic drugstore brands. Products for adults can remain on the market but the FDA wants companies to add new warnings. Church and Dwight will continue to sell its other Orajel products, the company said in a statement.[contextly_sidebar id=\"XUJmaqz7WTZ9cneieVB4neXbhhRthxfB\"]\u003c/p>\n\u003cp>Benzocaine can cause a rare blood condition linked to potentially deadly breathing problems. The pain-relieving ingredient can interfere with an oxygen-carrying protein in the blood. Symptoms include shortness of breath, headache and rapid heart rate.\u003c/p>\n\u003cp>The American Academy of Pediatrics does not recommend teething creams because they usually wash out of the baby’s mouth within minutes. Instead, the group recommends giving babies teething rings or simply massaging their gums to relieve pain.\u003c/p>\n\u003cp>The FDA issued warnings about the teething products in 2006, 2011 and 2014, but it did not call for their removal from the market. Officials reviewed 119 cases of the blood disorder linked to benzocaine between 2009 and 2017, including four deaths, according to the FDA.\u003c/p>\n\u003cp>Wednesday’s action comes more than four years after the consumer advocacy group Public Citizen petitioned the FDA to stop sales of teething products. The agency faced a deadline next week after Public Citizen sued the FDA to force a response to the petition.\u003c/p>\n\u003cp>___\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The Associated Press Health & Science Department receives \u003ca href=\"http://bit.ly/2G0n9w6\" target=\"_blank\" rel=\"noopener\">support\u003c/a> from the Howard Hughes Medical Institute’s Department of Science Education. The AP is solely responsible for all content.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Federal health officials warned parents Wednesday about the dangers of teething remedies that contain a popular numbing ingredient and asked manufacturers to stop selling their products intended for babies and toddlers.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>The Food and Drug Administration said that various gels and creams containing the drug benzocaine can cause rare but deadly side effects in children, especially those 2 years and younger.\u003c/p>\n\u003cp>The agency has been warning about the products for a decade but said reports of illnesses and deaths have continued. Now, it wants teething products off the market, noting there is little evidence they actually work.\u003c/p>\n\u003cp>“We urge parents, caregivers and retailers who sell them to heed our warnings and not use over-the-counter products containing benzocaine for teething pain,” said FDA Commissioner Scott Gottlieb, in a statement.\u003c/p>\n\u003cp>One major manufacturer, Church and Dwight Co. Inc., said Wednesday it would discontinue its four Orajel teething brands, including Baby Orajel and Orajel Medicated Teething Swabs.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The FDA said it will take legal action against other companies that don’t voluntarily comply as soon as possible.\u003c/p>\n\u003cp>Benzocaine is also used in popular over-the-counter products for toothaches and cold sores in adults, including Orajel and Anbesol and generic drugstore brands. Products for adults can remain on the market but the FDA wants companies to add new warnings. Church and Dwight will continue to sell its other Orajel products, the company said in a statement.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Benzocaine can cause a rare blood condition linked to potentially deadly breathing problems. The pain-relieving ingredient can interfere with an oxygen-carrying protein in the blood. Symptoms include shortness of breath, headache and rapid heart rate.\u003c/p>\n\u003cp>The American Academy of Pediatrics does not recommend teething creams because they usually wash out of the baby’s mouth within minutes. Instead, the group recommends giving babies teething rings or simply massaging their gums to relieve pain.\u003c/p>\n\u003cp>The FDA issued warnings about the teething products in 2006, 2011 and 2014, but it did not call for their removal from the market. Officials reviewed 119 cases of the blood disorder linked to benzocaine between 2009 and 2017, including four deaths, according to the FDA.\u003c/p>\n\u003cp>Wednesday’s action comes more than four years after the consumer advocacy group Public Citizen petitioned the FDA to stop sales of teething products. The agency faced a deadline next week after Public Citizen sued the FDA to force a response to the petition.\u003c/p>\n\u003cp>___\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The Associated Press Health & Science Department receives \u003ca href=\"http://bit.ly/2G0n9w6\" target=\"_blank\" rel=\"noopener\">support\u003c/a> from the Howard Hughes Medical Institute’s Department of Science Education. The AP is solely responsible for all content.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>If you have a genetic mutation that increases your risk for a treatable medical condition, would you want to know? For many people the answer is yes. But typically such information has not been a part of routine primary care.[contextly_sidebar id=\"VU8CqYIGlxYkDo6XNuxpJzQkcOxIemCe\"]\u003c/p>\n\u003cp>For patients at \u003ca href=\"https://www.geisinger.org/precision-health/our-promise\" target=\"_blank\" rel=\"noopener\">Geisinger Health System\u003c/a>, that could soon change. Starting in the next month or so, the Pennsylvania-based system will offer DNA sequencing to 1,000 patients, with the goal of eventually extending the offer to all 3 million Geisinger patients.\u003c/p>\n\u003cp>The health system's test will look for mutations in at least 77 genes. Many have been associated with medical conditions — dozens of them, ranging from heart disease to cancer. Others have been linked to variability in how people respond to certain medicines based on heredity.\u003c/p>\n\u003cp>\"We're giving more precision to the very important decisions that people need to make,\" says \u003ca href=\"https://www.geisinger.org/about-geisinger/leadership/leadership-team/david-feinberg\" target=\"_blank\" rel=\"noopener\">Dr. David Feinberg\u003c/a>, Geisinger's president and CEO. In the same way that primary care providers currently suggest checking someone's cholesterol, he says, \"we would have that discussion with patients: 'It looks like we haven't done your genome. Why don't we do that?' \"\u003c/p>\n\u003cp>But some physicians and health policy analysts question whether such genetic information is necessary to provide good primary care and whether handling such testing is feasible for many primary care physicians.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The new clinical program builds on a research biobank and genome-sequencing initiative called \u003ca href=\"https://www.geisinger.org/precision-health/mycode\" target=\"_blank\" rel=\"noopener\">MyCode\u003c/a> that Geisinger started in 2007 to collect and analyze its patients' DNA. That effort has enrolled more than 200,000 people.\u003c/p>\n\u003cp>Like MyCode, the new clinical program will be based on \"\u003ca href=\"https://ghr.nlm.nih.gov/primer/testing/sequencing\" target=\"_blank\" rel=\"noopener\">whole exome\u003c/a>\" sequencing, analyzing the roughly 1 percent of the genome that provides instructions for making proteins, where most known disease-causing mutations occur.\u003c/p>\n\u003cp>Using this analysis, clinicians could tell Geisinger patients whether they have a genetic variant associated with \u003ca href=\"https://ghr.nlm.nih.gov/condition/lynch-syndrome\" target=\"_blank\" rel=\"noopener\">Lynch syndrome\u003c/a>, for example, which leads to an \u003ca href=\"https://www.cancer.net/cancer-types/lynch-syndrome\" target=\"_blank\" rel=\"noopener\">increased risk of cancer of the colon\u003c/a> and some other cancers. Or doctors could offer guidance to patients found to have an increased risk for \u003ca href=\"https://medlineplus.gov/ency/article/000392.htm\" target=\"_blank\" rel=\"noopener\">familial hypercholesterolemia\u003c/a>, which can result in high cholesterol levels and heart disease at a young age.[contextly_sidebar id=\"CCPlmcc1p0X8Yive8TtLHVBcfOHoTLcq\"]\u003c/p>\n\u003cp>Still other patients who undergo the exome sequencing might learn they have an increased susceptibility to \u003ca href=\"https://ghr.nlm.nih.gov/condition/malignant-hyperthermia\" target=\"_blank\" rel=\"noopener\">malignant hyperthermia\u003c/a>, because of a gene variant that causes a severe reaction to certain medications used during anesthesia; the reaction can be fatal.\u003c/p>\n\u003cp>Geisinger spokesperson Wendy Wilson says that what the company plans is very different from direct-to-consumer services like 23andMe — which tests customers' saliva to determine their genetic risk for several diseases and traits, only some of which are medically actionable, and makes the results available in an online report.\u003c/p>\n\u003cp>\"Geisinger is prescribing DNA sequencing to patients and putting DNA results in electronic health records and actually creating an action plan,\" Wilson says. \"We are preventing disease from happening.\"\u003c/p>\n\u003cp>Geisinger says its program will work like this: Samples of a patient's blood or spit will be used to get a DNA sample. After analysis, the results will be sent to the patient's primary care doctor.\u003c/p>\n\u003cp>The doctor will then take a 30-minute online continuing education tutorial to review genetic testing and get more information on whatever specific susceptibilities have turned up in that patient's results.\u003c/p>\n\u003cp>After that, the patient will be informed and invited to meet with the primary care provider, along with a genetic counselor if desired. At that point the doctor and patient can discuss treatment and prevention options, including any particular lifestyle changes that might reduce the risk of developing the disease or condition.\u003c/p>\n\u003cp>About 3.5 percent of the people who have already been tested through Geisinger's research program had a genetic variant that could result in a medical problem for which clinicians can recommend helpful steps to influence their health, Feinberg says.\u003c/p>\n\u003cp>In the clinical program, only actionable mutations will be communicated to patients. The health care team, for example, won't inform patients if they have a variant of the\u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3726719/\" target=\"_blank\" rel=\"noopener\"> APOE gene \u003c/a>that somewhat increases their risk for getting Alzheimer's disease, because that information wouldn't change anything about their medical treatment. (Geisinger is developing a policy for how to handle these results if \u003ca href=\"https://www.npr.org/sections/health-shots/2012/08/16/158919471/grappling-with-the-uncertainty-of-alzheimers-testing\" target=\"_blank\" rel=\"noopener\">patients ask for them\u003c/a>.)\u003c/p>\n\u003cp>Insurance companies typically don't cover DNA sequencing and do limit a patient's coverage for adult genetic tests for specific mutations, such as those related to the \u003ca href=\"https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/brca-related-cancer-risk-assessment-genetic-counseling-and-genetic-testing\" target=\"_blank\" rel=\"noopener\">breast cancer susceptibility genes BRCA1 or BRCA2\u003c/a>, unless the patient has a family history of the condition or other indications they're at high risk. For each of the patients it tests, Geisinger will absorb the estimated $300 to $500 testing cost.\u003c/p>\n\u003cp>\"Most of the medical spending in America is done after people have gotten sick,\" says Feinberg. \"We think this will decrease spending on a lot of care.\"\u003c/p>\n\u003cp>But some clinicians and academics outside Geisinger aren't so sure. One of them is \u003ca href=\"http://tdi.dartmouth.edu/about/our-people/directory/h-gilbert-welch-md-mph\" target=\"_blank\" rel=\"noopener\">Dr. H. Gilbert Welch\u003c/a>, a professor at the Dartmouth Institute for Health Policy and Clinical Practice who has written books about the hazards of \u003ca href=\"https://www.penguinrandomhouse.com/books/243193/less-medicine-more-health-by-dr-h-gilbert-welch/9780807077580/\" target=\"_blank\" rel=\"noopener\">overdiagnosis and overscreening\u003c/a>, including, \u003cem>Less Medicine, More Health\u003c/em>.\u003c/p>\n\u003cp>He credits Geisinger with carefully targeting the mutations in which it looks for actionable mutations, instead of taking an all-encompassing approach. And he acknowledges that for some conditions, like Lynch syndrome, people with certain genetic mutations would benefit from being followed closely. But he questions the value of DNA sequencing to identify some other susceptibilities, such as some of the genetic variants related to cardiovascular disease.\u003c/p>\n\u003cp>\"What are we really going to do differently for those patients?\" he asks. \"We should all be concerned about heart disease. We should all exercise; we should eat real food.\"\u003c/p>\n\u003cp>Welch says he's also concerned about the cascading effect of expensive and potentially harmful medical treatment when a genetic risk is identified.\u003c/p>\n\u003cp>\"Doctors will feel the pressure to do something — start a medication, order a test, make a referral,\" he warns. \"You have to be careful. Bad things happen.\"\u003c/p>\n\u003cp>Other clinicians question primary care physicians' comfort with and time for incorporating DNA sequencing into their practices.\u003c/p>\n\u003cp>A \u003ca href=\"https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2017.1548?journalCode=hlthaff\" target=\"_blank\" rel=\"noopener\">survey published\u003c/a> this month in the journal \u003cem>Health Affairs\u003c/em> queried nearly 500 primary care providers in the New York City area and found that, in the past year, only a third of them had ordered a genetic test, given patients a genetic test result or referred someone for genetic counseling.\u003c/p>\n\u003cp>Only a quarter of the survey respondents said they felt prepared to work with patients who had genetic testing for common diseases or were at high risk for genetic conditions. Just 14 percent reported they were confident they could interpret genetic test results.\u003c/p>\n\u003cp>\"Even though they had training, they felt unprepared to incorporate genomics into their practice,\" says \u003ca href=\"https://www.sharecare.com/user/dr-carol-horowitz\" target=\"_blank\" rel=\"noopener\">Dr. Carol Horowitz\u003c/a>, an internist and professor at the Icahn School of Medicine at Mount Sinai in New York, who co-authored the study.\u003c/p>\n\u003cp>A busy primary care practitioner herself, Horowitz questions the feasibility of adding genomic medicine to regular office visits.\u003c/p>\n\u003cp>\"Geisinger is a very well-resourced health system and they've made a decision to incorporate that into their practices,\" she says, adding that in Harlem, where she practices, it could be a daunting challenge. \"Our plates are already overflowing, and now you're going to dump a lot more on our plate.\"\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003ca href=\"http://khn.org/\" target=\"_blank\" rel=\"noopener\">\u003cem>Kaiser Health News,\u003c/em>\u003c/a>\u003cem> a nonprofit news service, is an editorially independent program of the Kaiser Family Foundation and not affiliated with Kaiser Permanente.\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 Kaiser Health News. To see more, visit \u003ca href=\"http://www.kaiserhealthnews.org/\">Kaiser Health News\u003c/a>.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Routine+DNA+Screening+Moves+Into+Primary+Care&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>If you have a genetic mutation that increases your risk for a treatable medical condition, would you want to know? For many people the answer is yes. But typically such information has not been a part of routine primary care.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>For patients at \u003ca href=\"https://www.geisinger.org/precision-health/our-promise\" target=\"_blank\" rel=\"noopener\">Geisinger Health System\u003c/a>, that could soon change. Starting in the next month or so, the Pennsylvania-based system will offer DNA sequencing to 1,000 patients, with the goal of eventually extending the offer to all 3 million Geisinger patients.\u003c/p>\n\u003cp>The health system's test will look for mutations in at least 77 genes. Many have been associated with medical conditions — dozens of them, ranging from heart disease to cancer. Others have been linked to variability in how people respond to certain medicines based on heredity.\u003c/p>\n\u003cp>\"We're giving more precision to the very important decisions that people need to make,\" says \u003ca href=\"https://www.geisinger.org/about-geisinger/leadership/leadership-team/david-feinberg\" target=\"_blank\" rel=\"noopener\">Dr. David Feinberg\u003c/a>, Geisinger's president and CEO. In the same way that primary care providers currently suggest checking someone's cholesterol, he says, \"we would have that discussion with patients: 'It looks like we haven't done your genome. Why don't we do that?' \"\u003c/p>\n\u003cp>But some physicians and health policy analysts question whether such genetic information is necessary to provide good primary care and whether handling such testing is feasible for many primary care physicians.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The new clinical program builds on a research biobank and genome-sequencing initiative called \u003ca href=\"https://www.geisinger.org/precision-health/mycode\" target=\"_blank\" rel=\"noopener\">MyCode\u003c/a> that Geisinger started in 2007 to collect and analyze its patients' DNA. That effort has enrolled more than 200,000 people.\u003c/p>\n\u003cp>Like MyCode, the new clinical program will be based on \"\u003ca href=\"https://ghr.nlm.nih.gov/primer/testing/sequencing\" target=\"_blank\" rel=\"noopener\">whole exome\u003c/a>\" sequencing, analyzing the roughly 1 percent of the genome that provides instructions for making proteins, where most known disease-causing mutations occur.\u003c/p>\n\u003cp>Using this analysis, clinicians could tell Geisinger patients whether they have a genetic variant associated with \u003ca href=\"https://ghr.nlm.nih.gov/condition/lynch-syndrome\" target=\"_blank\" rel=\"noopener\">Lynch syndrome\u003c/a>, for example, which leads to an \u003ca href=\"https://www.cancer.net/cancer-types/lynch-syndrome\" target=\"_blank\" rel=\"noopener\">increased risk of cancer of the colon\u003c/a> and some other cancers. Or doctors could offer guidance to patients found to have an increased risk for \u003ca href=\"https://medlineplus.gov/ency/article/000392.htm\" target=\"_blank\" rel=\"noopener\">familial hypercholesterolemia\u003c/a>, which can result in high cholesterol levels and heart disease at a young age.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Still other patients who undergo the exome sequencing might learn they have an increased susceptibility to \u003ca href=\"https://ghr.nlm.nih.gov/condition/malignant-hyperthermia\" target=\"_blank\" rel=\"noopener\">malignant hyperthermia\u003c/a>, because of a gene variant that causes a severe reaction to certain medications used during anesthesia; the reaction can be fatal.\u003c/p>\n\u003cp>Geisinger spokesperson Wendy Wilson says that what the company plans is very different from direct-to-consumer services like 23andMe — which tests customers' saliva to determine their genetic risk for several diseases and traits, only some of which are medically actionable, and makes the results available in an online report.\u003c/p>\n\u003cp>\"Geisinger is prescribing DNA sequencing to patients and putting DNA results in electronic health records and actually creating an action plan,\" Wilson says. \"We are preventing disease from happening.\"\u003c/p>\n\u003cp>Geisinger says its program will work like this: Samples of a patient's blood or spit will be used to get a DNA sample. After analysis, the results will be sent to the patient's primary care doctor.\u003c/p>\n\u003cp>The doctor will then take a 30-minute online continuing education tutorial to review genetic testing and get more information on whatever specific susceptibilities have turned up in that patient's results.\u003c/p>\n\u003cp>After that, the patient will be informed and invited to meet with the primary care provider, along with a genetic counselor if desired. At that point the doctor and patient can discuss treatment and prevention options, including any particular lifestyle changes that might reduce the risk of developing the disease or condition.\u003c/p>\n\u003cp>About 3.5 percent of the people who have already been tested through Geisinger's research program had a genetic variant that could result in a medical problem for which clinicians can recommend helpful steps to influence their health, Feinberg says.\u003c/p>\n\u003cp>In the clinical program, only actionable mutations will be communicated to patients. The health care team, for example, won't inform patients if they have a variant of the\u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3726719/\" target=\"_blank\" rel=\"noopener\"> APOE gene \u003c/a>that somewhat increases their risk for getting Alzheimer's disease, because that information wouldn't change anything about their medical treatment. (Geisinger is developing a policy for how to handle these results if \u003ca href=\"https://www.npr.org/sections/health-shots/2012/08/16/158919471/grappling-with-the-uncertainty-of-alzheimers-testing\" target=\"_blank\" rel=\"noopener\">patients ask for them\u003c/a>.)\u003c/p>\n\u003cp>Insurance companies typically don't cover DNA sequencing and do limit a patient's coverage for adult genetic tests for specific mutations, such as those related to the \u003ca href=\"https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/brca-related-cancer-risk-assessment-genetic-counseling-and-genetic-testing\" target=\"_blank\" rel=\"noopener\">breast cancer susceptibility genes BRCA1 or BRCA2\u003c/a>, unless the patient has a family history of the condition or other indications they're at high risk. For each of the patients it tests, Geisinger will absorb the estimated $300 to $500 testing cost.\u003c/p>\n\u003cp>\"Most of the medical spending in America is done after people have gotten sick,\" says Feinberg. \"We think this will decrease spending on a lot of care.\"\u003c/p>\n\u003cp>But some clinicians and academics outside Geisinger aren't so sure. One of them is \u003ca href=\"http://tdi.dartmouth.edu/about/our-people/directory/h-gilbert-welch-md-mph\" target=\"_blank\" rel=\"noopener\">Dr. H. Gilbert Welch\u003c/a>, a professor at the Dartmouth Institute for Health Policy and Clinical Practice who has written books about the hazards of \u003ca href=\"https://www.penguinrandomhouse.com/books/243193/less-medicine-more-health-by-dr-h-gilbert-welch/9780807077580/\" target=\"_blank\" rel=\"noopener\">overdiagnosis and overscreening\u003c/a>, including, \u003cem>Less Medicine, More Health\u003c/em>.\u003c/p>\n\u003cp>He credits Geisinger with carefully targeting the mutations in which it looks for actionable mutations, instead of taking an all-encompassing approach. And he acknowledges that for some conditions, like Lynch syndrome, people with certain genetic mutations would benefit from being followed closely. But he questions the value of DNA sequencing to identify some other susceptibilities, such as some of the genetic variants related to cardiovascular disease.\u003c/p>\n\u003cp>\"What are we really going to do differently for those patients?\" he asks. \"We should all be concerned about heart disease. We should all exercise; we should eat real food.\"\u003c/p>\n\u003cp>Welch says he's also concerned about the cascading effect of expensive and potentially harmful medical treatment when a genetic risk is identified.\u003c/p>\n\u003cp>\"Doctors will feel the pressure to do something — start a medication, order a test, make a referral,\" he warns. \"You have to be careful. Bad things happen.\"\u003c/p>\n\u003cp>Other clinicians question primary care physicians' comfort with and time for incorporating DNA sequencing into their practices.\u003c/p>\n\u003cp>A \u003ca href=\"https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2017.1548?journalCode=hlthaff\" target=\"_blank\" rel=\"noopener\">survey published\u003c/a> this month in the journal \u003cem>Health Affairs\u003c/em> queried nearly 500 primary care providers in the New York City area and found that, in the past year, only a third of them had ordered a genetic test, given patients a genetic test result or referred someone for genetic counseling.\u003c/p>\n\u003cp>Only a quarter of the survey respondents said they felt prepared to work with patients who had genetic testing for common diseases or were at high risk for genetic conditions. Just 14 percent reported they were confident they could interpret genetic test results.\u003c/p>\n\u003cp>\"Even though they had training, they felt unprepared to incorporate genomics into their practice,\" says \u003ca href=\"https://www.sharecare.com/user/dr-carol-horowitz\" target=\"_blank\" rel=\"noopener\">Dr. Carol Horowitz\u003c/a>, an internist and professor at the Icahn School of Medicine at Mount Sinai in New York, who co-authored the study.\u003c/p>\n\u003cp>A busy primary care practitioner herself, Horowitz questions the feasibility of adding genomic medicine to regular office visits.\u003c/p>\n\u003cp>\"Geisinger is a very well-resourced health system and they've made a decision to incorporate that into their practices,\" she says, adding that in Harlem, where she practices, it could be a daunting challenge. \"Our plates are already overflowing, and now you're going to dump a lot more on our plate.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"http://khn.org/\" target=\"_blank\" rel=\"noopener\">\u003cem>Kaiser Health News,\u003c/em>\u003c/a>\u003cem> a nonprofit news service, is an editorially independent program of the Kaiser Family Foundation and not affiliated with Kaiser Permanente.\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 Kaiser Health News. To see more, visit \u003ca href=\"http://www.kaiserhealthnews.org/\">Kaiser Health News\u003c/a>.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Routine+DNA+Screening+Moves+Into+Primary+Care&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "The Controversial Research on 'Desistance' in Transgender Youth",
"title": "The Controversial Research on 'Desistance' in Transgender Youth",
"headTitle": "KQED Future of You | KQED Science",
"content": "\u003cp>The phenomenon of transgender children \"growing out of\" their transgender identity by the time they are adolescents or adults is called “desistance” by gender researchers.\u003c/p>\n\u003cp>For decades, follow-up studies of transgender kids have shown that a substantial majority -- anywhere from 65 to 94 percent -- eventually ceased to identify as transgender.\u003c/p>\n\u003caside class=\"alignright\">One study found that older children, girls, and those kids who reported more intense gender dysphoria were more likely to stick with their transgender identity as adolescents.\u003c/aside>\n\u003cp>These findings have become part and parcel of the \"How young is too young?\" debate over \"social transitioning,\" the term for allowing kids to publicly live as their identified gender in every way short of medical treatment.\u003c/p>\n\u003cp>If most kids will eventually cease to be transgender, some clinicians have reasoned, isn’t it more prudent to take the least disruptive path in coping with a child's gender dysphoria? That way, if or when kids later stop identifying as transgender, they will have less to “undo.”\u003c/p>\n\u003cp>In recent years, though, a new school of thought has emerged. Many gender specialists now believe that the best course for a transgender child is often “social transition,” where kids as young as three are allowed to change their names, pronouns and style of dress to match the gender they identify with.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cstrong>Looking at the Research\u003c/strong>\u003c/p>\n\u003cp>One reason many researchers believe it’s unnecessary to delay the social transition of a child is that they don’t think the research on desistance is valid. In other words, they think the number of children who \"grow out of\" their transgender identity has been vastly overblown.\u003c/p>\n\u003caside class=\"pullquote alignright\">'The only evidence I have from studies and reports in the literature ... is that not all transgender children will persist in their transgender identity'\u003ccite>Thomas Steensma, VU University Medical Center, Center of Expertise on Gender Dysphoria\u003c/cite>\u003c/aside>\n\u003cp>This school of thought holds that because the criteria for a diagnosis of gender dysphoria (previously called gender identity disorder) was less stringent in the past, the earlier desistance studies included a large cohort of children who today would not be diagnosed with gender dysphoria, gay boys who may have been experimenting with different ways of expressing gender but who were never really transgender in the first place.\u003c/p>\n\u003cp>“The methodology of those studies is very flawed, because they didn't study gender identity,” said Diane Ehrensaft, director of mental health at UCSF’s Child and Adolescent Gender Clinic. “Those desistors were, a good majority of them, simply proto-gay boys whose parents were upset because they were boys wearing dresses. They were brought to the clinics because they weren't fitting gender norms.”\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe src=\"//datawrapper.dwcdn.net/8gbLb/1/\" width=\"100%\" height=\"500\" scrolling=\"yes\" class=\"iframe-class\" frameborder=\"0\">\u003c/iframe>\u003c/p>\n\u003cp>In Amsterdam, clinicians at the Center of Expertise on Gender Dysphoria are much more cautious about recommending social transitions because of the statistics on desistance. Thomas Steensma, a researcher and clinician at the center, acknowledges these studies probably included some kids who would not be diagnosed with gender dysphoria today. Nevertheless, despite the problems with the way they classified children, \"the only evidence I have from studies and reports in the literature ... is that not all transgender children will persist in their transgender identity,\" Steensma said.\u003c/p>\n\u003caside class=\"pullquote alignright\">'Why are we asking a child to conform to something that is not them because society hasn't done its learning yet?'\u003ccite>Diane Ehrensaft, UCSF\u003c/cite>\u003c/aside>\n\u003cp>In 2013, Steensma co-authored an oft-cited \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/23702447\" target=\"_blank\" rel=\"noopener\">study\u003c/a> that examined 127 adolescents, all of whom had displayed various levels of gender dysphoria as children. The researchers found that 80 of the children had desisted by the ages of 15 and 16. That works out to 63 percent of kids who basically stopped being transgender -- a lower rate than in previous studies, but still a majority.\u003c/p>\n\u003cp>Some clinicians criticize this study, however, on methodological grounds, because the researchers defined anyone who did not return to their clinic as desisting. Fifty-two of the children classified as desistors or their parents did send back questionnaires showing the subjects' present lack of gender dysphoria. But 28 neither responded nor could be tracked down.\u003c/p>\n\u003cp>“You can't do that in scientific studies,” Ehrensaft said. “You have to have your subjects in front of you and know who they are. You can't just assume somebody is in a category because you don't see them anymore.”\u003c/p>\n\u003cp>In addition, 38 of the 127 kids were originally designated “subthreshold” for gender identity disorder, meaning they did not fulfill all the criteria for meeting the official diagnosis.\u003c/p>\n\u003cp>This, according to Erica Anderson, a gender clinician at UCSF, makes the desistance findings even more suspect.\" [It] begs the question of whether these kids were actually divergent [in their gender identity] before the study selected them,” she said.\u003c/p>\n\u003cp>Steensma stands by the study’s methodology. But interestingly, he added that citing these findings as a measure of desistance is wrongheaded, because the study was never designed with that goal in mind.\u003c/p>\n\u003cp>“Providing these [desistance] numbers will only lead to wrong conclusions,” he said.\u003c/p>\n\u003cfigure id=\"attachment_441933\" class=\"wp-caption alignright\" style=\"max-width: 385px\">\u003ca href=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/05/Ehrensaft.jpg\">\u003cimg class=\" wp-image-441933\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/05/Ehrensaft-1020x1528.jpg\" alt=\"\" width=\"385\" height=\"577\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2018/05/Ehrensaft-1020x1528.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2018/05/Ehrensaft-160x240.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2018/05/Ehrensaft-800x1198.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2018/05/Ehrensaft-768x1150.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2018/05/Ehrensaft-801x1200.jpg 801w, https://ww2.kqed.org/app/uploads/sites/13/2018/05/Ehrensaft.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2018/05/Ehrensaft-1180x1768.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2018/05/Ehrensaft-960x1438.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2018/05/Ehrensaft-240x360.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2018/05/Ehrensaft-375x562.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2018/05/Ehrensaft-520x779.jpg 520w\" sizes=\"(max-width: 385px) 100vw, 385px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Diane Ehrensaft, director of mental health at UCSF's gender clinic. \u003ccite>(Lauren Hanussak/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Rather, he says, the researchers wanted to see if they could find predictors of persistence. Which they did: The study found that transgender children who were older, born female, and reported more intense gender dysphoria were more likely to stick with their transgender identity than younger children, natal boys and those with less pronounced gender dysphoric traits.\u003c/p>\n\u003cp>Steensma and colleagues also culled one very specific indicator of future persistence: When asked when they were children, “Are you a boy or a girl?” those who answered the opposite of their birth sex were found more likely to have retained their gender identity in adolescence. The desistors, on the other hand, tended to merely \u003cem>wish\u003c/em> they were the opposite sex.\u003c/p>\n\u003cp>“(E)xplicitly asking children with GD (gender dysphoria) with which sex they identify seems to be of great value in predicting a future outcome for both boys and girls with GD,” the study says.\u003c/p>\n\u003cp>Today, Steensma cautions that this question is not a litmus test for which children will persist in their transgender identity. He believes that gender identity in kids is still developing, and that it’s responsive to what occurs at different life stages. He also says it’s possible that a social transition could lead to persistence where it otherwise might not have occurred.\u003c/p>\n\u003cp>“That's not something we can answer,” he said. “It's something we have to study and find out.”\u003c/p>\n\u003cp>\u003cstrong>‘It’s Time to Teach Society’\u003c/strong>\u003c/p>\n\u003cp>Another contentious topic in the transgender community is what the literature calls “detransitioning,” or reverting back to one's natal gender.\u003c/p>\n\u003cp>The current Standards of Care written by the World Professional Association for Transgender Health cautions that “a change back to the original gender role can be highly distressing” The guidelines use that assertion as a reason to be cautious about early social transitioning.\u003c/p>\n\u003cp>But the cautionary language, Ehrensaft points out, is based on one qualitative study, coauthored by Steensma, which looked at the dilemma of just two Dutch girls who’d transitioned when they were in elementary school and wanted to switch back. She doesn’t think it’s particularly relevant.\u003c/p>\n\u003cp>“The stress [of detransitioning] comes from microaggressions and lack of acceptance in the environment,” she said. “If we offer social support and opportunities for children over time, we don’t have any evidence that [detransitioning] will be damaging for them.”\u003c/p>\n\u003cp>Ehrensaft believes the conventional treatment of transgender children has been based, for the most part, on traditionally negative views of gender nonconformity. So, she believes, the burden is now on the culture to see transgender children as they really are.\u003c/p>\n\u003cp>“Why are we asking a child to conform to something that is not them because society hasn't done its learning yet?”she says. “It's time to teach society.”\u003c/p>\n\u003cp>\u003cstrong>Toward the Nonbinary\u003c/strong>\u003c/p>\n\u003cp>One of the more interesting takes I heard on persistence and desistance came from UCSF gender clinician Erica Anderson, who is transgender herself. She views the very notion of measuring persistence/desistance as something of a fool’s errand, because such definitions are mediated by changing cultural norms, the self-perceptions of children and the ways that researchers interpret them.\u003c/p>\n\u003cp>“We’ve got kids of varying sophistication levels of language trying to explain to other people who have no experience [being transgender],\" Anderson said, \"and it’s being driven by shifting professional understanding or consensus and culture. You’ve got moving parts. In that context we’ve got a dynamic situation where kids who might say ‘I’m a girl’ might have said five years ago ‘maybe I’m a girl.’ ”\u003c/p>\n\u003cp>Ehrensaft herself doesn’t even like to use the terms persistence and desistance. Those words imply something fixed — a binary state of yes or no. But younger generations of transgender people — and even \u003ca href=\"https://fusiondotnet.files.wordpress.com/2015/02/fusion-poll-gender-spectrum.pdf\" target=\"_blank\" rel=\"noopener\">younger generations\u003c/a> in the general population — see gender as more protean, even customizable. Of nearly 28,000 respondents to the \u003ca href=\"http://www.ustranssurvey.org/\" target=\"_blank\" rel=\"noopener\">2015 U.S. Transgender Survey\u003c/a>, more than one-third said they were some form of \u003ca href=\"https://www.kqed.org/futureofyou/335790/boy-girl-both-neither-a-new-generation-overthrows-gender\" target=\"_blank\" rel=\"noopener\">nonbinary\u003c/a>. That means they may identify as both male and female, neither male nor female, or \u003cem>sometimes\u003c/em> male, \u003cem>sometimes\u003c/em> female.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>This, in theory, could solve a lot of problems. After all, if the gender fluidity trend continues, perhaps many people will have no unitary gender to \"persist\" or \"desist\" from.\u003c/p>\n\n",
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"excerpt": "For decades, follow-up studies of transgender kids have shown that a substantial majority eventually ceased to identify as transgender. But some gender researchers say that research is faulty.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The phenomenon of transgender children \"growing out of\" their transgender identity by the time they are adolescents or adults is called “desistance” by gender researchers.\u003c/p>\n\u003cp>For decades, follow-up studies of transgender kids have shown that a substantial majority -- anywhere from 65 to 94 percent -- eventually ceased to identify as transgender.\u003c/p>\n\u003caside class=\"alignright\">One study found that older children, girls, and those kids who reported more intense gender dysphoria were more likely to stick with their transgender identity as adolescents.\u003c/aside>\n\u003cp>These findings have become part and parcel of the \"How young is too young?\" debate over \"social transitioning,\" the term for allowing kids to publicly live as their identified gender in every way short of medical treatment.\u003c/p>\n\u003cp>If most kids will eventually cease to be transgender, some clinicians have reasoned, isn’t it more prudent to take the least disruptive path in coping with a child's gender dysphoria? That way, if or when kids later stop identifying as transgender, they will have less to “undo.”\u003c/p>\n\u003cp>In recent years, though, a new school of thought has emerged. Many gender specialists now believe that the best course for a transgender child is often “social transition,” where kids as young as three are allowed to change their names, pronouns and style of dress to match the gender they identify with.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cstrong>Looking at the Research\u003c/strong>\u003c/p>\n\u003cp>One reason many researchers believe it’s unnecessary to delay the social transition of a child is that they don’t think the research on desistance is valid. In other words, they think the number of children who \"grow out of\" their transgender identity has been vastly overblown.\u003c/p>\n\u003caside class=\"pullquote alignright\">'The only evidence I have from studies and reports in the literature ... is that not all transgender children will persist in their transgender identity'\u003ccite>Thomas Steensma, VU University Medical Center, Center of Expertise on Gender Dysphoria\u003c/cite>\u003c/aside>\n\u003cp>This school of thought holds that because the criteria for a diagnosis of gender dysphoria (previously called gender identity disorder) was less stringent in the past, the earlier desistance studies included a large cohort of children who today would not be diagnosed with gender dysphoria, gay boys who may have been experimenting with different ways of expressing gender but who were never really transgender in the first place.\u003c/p>\n\u003cp>“The methodology of those studies is very flawed, because they didn't study gender identity,” said Diane Ehrensaft, director of mental health at UCSF’s Child and Adolescent Gender Clinic. “Those desistors were, a good majority of them, simply proto-gay boys whose parents were upset because they were boys wearing dresses. They were brought to the clinics because they weren't fitting gender norms.”\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe src=\"//datawrapper.dwcdn.net/8gbLb/1/\" width=\"100%\" height=\"500\" scrolling=\"yes\" class=\"iframe-class\" frameborder=\"0\">\u003c/iframe>\u003c/p>\n\u003cp>In Amsterdam, clinicians at the Center of Expertise on Gender Dysphoria are much more cautious about recommending social transitions because of the statistics on desistance. Thomas Steensma, a researcher and clinician at the center, acknowledges these studies probably included some kids who would not be diagnosed with gender dysphoria today. Nevertheless, despite the problems with the way they classified children, \"the only evidence I have from studies and reports in the literature ... is that not all transgender children will persist in their transgender identity,\" Steensma said.\u003c/p>\n\u003caside class=\"pullquote alignright\">'Why are we asking a child to conform to something that is not them because society hasn't done its learning yet?'\u003ccite>Diane Ehrensaft, UCSF\u003c/cite>\u003c/aside>\n\u003cp>In 2013, Steensma co-authored an oft-cited \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/23702447\" target=\"_blank\" rel=\"noopener\">study\u003c/a> that examined 127 adolescents, all of whom had displayed various levels of gender dysphoria as children. The researchers found that 80 of the children had desisted by the ages of 15 and 16. That works out to 63 percent of kids who basically stopped being transgender -- a lower rate than in previous studies, but still a majority.\u003c/p>\n\u003cp>Some clinicians criticize this study, however, on methodological grounds, because the researchers defined anyone who did not return to their clinic as desisting. Fifty-two of the children classified as desistors or their parents did send back questionnaires showing the subjects' present lack of gender dysphoria. But 28 neither responded nor could be tracked down.\u003c/p>\n\u003cp>“You can't do that in scientific studies,” Ehrensaft said. “You have to have your subjects in front of you and know who they are. You can't just assume somebody is in a category because you don't see them anymore.”\u003c/p>\n\u003cp>In addition, 38 of the 127 kids were originally designated “subthreshold” for gender identity disorder, meaning they did not fulfill all the criteria for meeting the official diagnosis.\u003c/p>\n\u003cp>This, according to Erica Anderson, a gender clinician at UCSF, makes the desistance findings even more suspect.\" [It] begs the question of whether these kids were actually divergent [in their gender identity] before the study selected them,” she said.\u003c/p>\n\u003cp>Steensma stands by the study’s methodology. But interestingly, he added that citing these findings as a measure of desistance is wrongheaded, because the study was never designed with that goal in mind.\u003c/p>\n\u003cp>“Providing these [desistance] numbers will only lead to wrong conclusions,” he said.\u003c/p>\n\u003cfigure id=\"attachment_441933\" class=\"wp-caption alignright\" style=\"max-width: 385px\">\u003ca href=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/05/Ehrensaft.jpg\">\u003cimg class=\" wp-image-441933\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/05/Ehrensaft-1020x1528.jpg\" alt=\"\" width=\"385\" height=\"577\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2018/05/Ehrensaft-1020x1528.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2018/05/Ehrensaft-160x240.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2018/05/Ehrensaft-800x1198.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2018/05/Ehrensaft-768x1150.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2018/05/Ehrensaft-801x1200.jpg 801w, https://ww2.kqed.org/app/uploads/sites/13/2018/05/Ehrensaft.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2018/05/Ehrensaft-1180x1768.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2018/05/Ehrensaft-960x1438.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2018/05/Ehrensaft-240x360.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2018/05/Ehrensaft-375x562.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2018/05/Ehrensaft-520x779.jpg 520w\" sizes=\"(max-width: 385px) 100vw, 385px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Diane Ehrensaft, director of mental health at UCSF's gender clinic. \u003ccite>(Lauren Hanussak/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Rather, he says, the researchers wanted to see if they could find predictors of persistence. Which they did: The study found that transgender children who were older, born female, and reported more intense gender dysphoria were more likely to stick with their transgender identity than younger children, natal boys and those with less pronounced gender dysphoric traits.\u003c/p>\n\u003cp>Steensma and colleagues also culled one very specific indicator of future persistence: When asked when they were children, “Are you a boy or a girl?” those who answered the opposite of their birth sex were found more likely to have retained their gender identity in adolescence. The desistors, on the other hand, tended to merely \u003cem>wish\u003c/em> they were the opposite sex.\u003c/p>\n\u003cp>“(E)xplicitly asking children with GD (gender dysphoria) with which sex they identify seems to be of great value in predicting a future outcome for both boys and girls with GD,” the study says.\u003c/p>\n\u003cp>Today, Steensma cautions that this question is not a litmus test for which children will persist in their transgender identity. He believes that gender identity in kids is still developing, and that it’s responsive to what occurs at different life stages. He also says it’s possible that a social transition could lead to persistence where it otherwise might not have occurred.\u003c/p>\n\u003cp>“That's not something we can answer,” he said. “It's something we have to study and find out.”\u003c/p>\n\u003cp>\u003cstrong>‘It’s Time to Teach Society’\u003c/strong>\u003c/p>\n\u003cp>Another contentious topic in the transgender community is what the literature calls “detransitioning,” or reverting back to one's natal gender.\u003c/p>\n\u003cp>The current Standards of Care written by the World Professional Association for Transgender Health cautions that “a change back to the original gender role can be highly distressing” The guidelines use that assertion as a reason to be cautious about early social transitioning.\u003c/p>\n\u003cp>But the cautionary language, Ehrensaft points out, is based on one qualitative study, coauthored by Steensma, which looked at the dilemma of just two Dutch girls who’d transitioned when they were in elementary school and wanted to switch back. She doesn’t think it’s particularly relevant.\u003c/p>\n\u003cp>“The stress [of detransitioning] comes from microaggressions and lack of acceptance in the environment,” she said. “If we offer social support and opportunities for children over time, we don’t have any evidence that [detransitioning] will be damaging for them.”\u003c/p>\n\u003cp>Ehrensaft believes the conventional treatment of transgender children has been based, for the most part, on traditionally negative views of gender nonconformity. So, she believes, the burden is now on the culture to see transgender children as they really are.\u003c/p>\n\u003cp>“Why are we asking a child to conform to something that is not them because society hasn't done its learning yet?”she says. “It's time to teach society.”\u003c/p>\n\u003cp>\u003cstrong>Toward the Nonbinary\u003c/strong>\u003c/p>\n\u003cp>One of the more interesting takes I heard on persistence and desistance came from UCSF gender clinician Erica Anderson, who is transgender herself. She views the very notion of measuring persistence/desistance as something of a fool’s errand, because such definitions are mediated by changing cultural norms, the self-perceptions of children and the ways that researchers interpret them.\u003c/p>\n\u003cp>“We’ve got kids of varying sophistication levels of language trying to explain to other people who have no experience [being transgender],\" Anderson said, \"and it’s being driven by shifting professional understanding or consensus and culture. You’ve got moving parts. In that context we’ve got a dynamic situation where kids who might say ‘I’m a girl’ might have said five years ago ‘maybe I’m a girl.’ ”\u003c/p>\n\u003cp>Ehrensaft herself doesn’t even like to use the terms persistence and desistance. Those words imply something fixed — a binary state of yes or no. But younger generations of transgender people — and even \u003ca href=\"https://fusiondotnet.files.wordpress.com/2015/02/fusion-poll-gender-spectrum.pdf\" target=\"_blank\" rel=\"noopener\">younger generations\u003c/a> in the general population — see gender as more protean, even customizable. Of nearly 28,000 respondents to the \u003ca href=\"http://www.ustranssurvey.org/\" target=\"_blank\" rel=\"noopener\">2015 U.S. Transgender Survey\u003c/a>, more than one-third said they were some form of \u003ca href=\"https://www.kqed.org/futureofyou/335790/boy-girl-both-neither-a-new-generation-overthrows-gender\" target=\"_blank\" rel=\"noopener\">nonbinary\u003c/a>. That means they may identify as both male and female, neither male nor female, or \u003cem>sometimes\u003c/em> male, \u003cem>sometimes\u003c/em> female.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>This, in theory, could solve a lot of problems. After all, if the gender fluidity trend continues, perhaps many people will have no unitary gender to \"persist\" or \"desist\" from.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>UCLA neuroscientists reported Monday that they have transferred a memory from one animal to another via injections of RNA, a startling result that challenges the widely held view of where and how memories are stored in the brain. [contextly_sidebar id=\"li8sZlyeZueTl33XPD1EtLOaLArCiTWy\"]\u003c/p>\n\u003cp>The finding from the lab of David Glanzman hints at the potential for new RNA-based treatments to one day restore lost memories and, if correct, could shake up the field of memory and learning.\u003c/p>\n\u003cp>“It’s pretty shocking,” said Dr. Todd Sacktor, a neurologist and memory researcher at SUNY Downstate Medical Center in Brooklyn, N.Y. “The big picture is we’re working out the basic alphabet of how memories are stored for the first time.” He was not involved in the research, which was \u003ca href=\"http://www.eneuro.org/content/early/2018/05/14/ENEURO.0038-18.2018\" target=\"_blank\" rel=\"noopener\">published in eNeuro\u003c/a>, the \u003ca href=\"http://www.eneuro.org/\" target=\"_blank\" rel=\"noopener\">online journal\u003c/a> of the Society for Neuroscience.\u003c/p>\n\u003cp>Many scientists are expected to view the research more cautiously. The work is in snails, animals that have proven a powerful model organism for neuroscience but whose simple brains work far differently than those of humans. The experiments will need to be replicated, including in animals with more complex brains. And the results fly in the face of a massive amount of evidence supporting the deeply entrenched idea that memories are stored through changes in the strength of connections, or synapses, between neurons.\u003c/p>\n\u003cp>“If he’s right, this would be absolutely earth-shattering,” said Tomás Ryan, an assistant professor at Trinity College Dublin, whose lab hunts for engrams, or the physical traces of memory. “But I don’t think it’s right.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Glanzman knows his unceremonial demotion of the synapse is not going to go over well in the field. “I expect a lot of astonishment and skepticism,” he said. “I don’t expect people are going to have a parade for me at the next Society for Neuroscience meeting.”\u003c/p>\n\u003cp>Even his own colleagues were dubious. “It took me a long time to convince the people in my lab to do the experiment,” he said. “They thought it was nuts.”\u003c/p>\n\u003cp>Glanzman’s experiments — funded by the National Institutes of Health and the National Science Foundation — involved giving mild electrical shocks to the marine snail Aplysia californica. Shocked snails learn to withdraw their delicate siphons and gills for nearly a minute as a defense when they subsequently receive a weak touch; snails that have not been shocked withdraw only briefly.[contextly_sidebar id=\"hBHp5EEY5u6iaZayEtFqvfhgpnNXWkKq\"]\u003c/p>\n\u003cp>The researchers extracted RNA from the nervous systems of snails that had been shocked and injected the material into unshocked snails. RNA’s primary role is to serve as a messenger inside cells, carrying protein-making instructions from its cousin DNA. But when this RNA was injected, these naive snails withdrew their siphons for extended periods of time after a soft touch. Control snails that received injections of RNA from snails that had not received shocks did not withdraw their siphons for as long.\u003c/p>\n\u003cp>“It’s as if we transferred a memory,” Glanzman said.\u003c/p>\n\u003cp>Glanzman’s group went further, showing that Aplysia sensory neurons in Petri dishes were more excitable, as they tend to be after being shocked, if they were exposed to RNA from shocked snails. Exposure to RNA from snails that had never been shocked did not cause the cells to become more excitable.\u003c/p>\n\u003cdiv>\n\u003cdiv>\n\u003cdiv>\n\u003cp>The results, said Glanzman, suggest that memories may be stored within the nucleus of neurons, where RNA is synthesized and can act on DNA to turn genes on and off. He said he thought memory storage involved these epigenetic changes — changes in the activity of genes and not in the DNA sequences that make up those genes — that are mediated by RNA.\u003c/p>\n\u003c/div>\n\u003c/div>\n\u003c/div>\n\u003cp>This view challenges the widely held notion that memories are stored by enhancing synaptic connections between neurons. Rather, Glanzman sees synaptic changes that occur during memory formation as flowing from the information that the RNA is carrying.\u003c/p>\n\u003cp>“This idea is radical and definitely challenges the field,” said Li-Huei Tsai, a neuroscientist who directs the Picower Institute for Learning and Memory at the Massachusetts Institute of Technology. Tsai, who recently co-authored a \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4874022/\" target=\"_blank\" rel=\"noopener\">major review on memory formation\u003c/a>, called Glanzman’s study “impressive and interesting” and said a number of studies support the notion that epigenetic mechanisms play some role in memory formation, which is likely a complex and multifaceted process. But she said she strongly disagreed with Glanzman’s notion that synaptic connections do not play a key role in memory storage.\u003c/p>\n\u003cp>Trinity College’s Ryan, like Glanzman, stands with a minority of neuroscientists — some call them rebels — who \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/28548457\" target=\"_blank\" rel=\"noopener\">question the idea\u003c/a> that memory is stored through synaptic strength. In 2015, Ryan was lead author of a Science paper with MIT Nobelist Susumu Tonegawa that showed \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/26023136\" target=\"_blank\" rel=\"noopener\">memories could be retrieved\u003c/a> even after synapse strengthening was blocked. Ryan said he is pursuing the idea that memories are stored through ensembles of neurons bound together by new synaptic connections, not by strengthening of existing connections.[contextly_sidebar id=\"U81WeRFYsnSgGUp9A3OIFy9mt8TlGFLL\"]\u003c/p>\n\u003cp>Ryan knows Glanzman and trusts his work. He said he believes the data in the new paper. But he doesn’t think the behavior of the snails, or the cells, proves that RNA is transferring memories. He said he doesn’t understand how RNA, which works on a time scale of minutes to hours, could be causing memory recall that is almost instantaneous, or how RNA could connect numerous parts of the brain, like the auditory and visual systems, that are involved in more complex memories.\u003c/p>\n\u003cp>But Glanzman said he is convinced RNA is playing a role that eclipses the synapse. In 2014, his lab showed that \u003ca href=\"https://elifesciences.org/articles/03896\" target=\"_blank\" rel=\"noopener\">memories of shocks that had been lost\u003c/a> in snails due to a series of experimental procedures could be recovered — but the synapse patterns that were lost with the memory reformed in random ways when the memories were recovered, suggesting memories were not stored there. Glanzman’s lab and others have also shown that long-term memory formation can be blocked by preventing epigenetic changes, even when synapse formation or strengthening is not altered.\u003c/p>\n\u003cp>“Synapses can come and go, but the memory can still be there,” he said, saying he sees synapses as merely the “reflection of knowledge held in the nucleus.”\u003c/p>\n\u003cp>Glanzman has studied memory for more than three decades. He did postdoctoral work with none other than Eric Kandel — the neuroscientist who shared the 2000 Nobel prize for research on Aplysia, probing the role of the synapse in memory — and he said he has spent most of his career believing that synaptic change was the key to memory storage.\u003c/p>\n\u003cp>But he said a series of findings from other labs and his own in recent years have led him to start questioning the synaptic dogma. He calls himself “a recovering synaptologist.”\u003c/p>\n\u003cp>The skepticism over Glanzman’s research may be in part because the work harkens back to an unnerving episode in science involving an unconventional psychologist, James V. McConnell, who spent years at the University of Michigan attempting to prove that something outside the brain — a factor he called “memory RNA” — could transfer memories. In the ’50s and ’60s, McConnell trained flatworms and then fed the bodies of trained worms to untrained worms. The untrained worms then appeared to exhibit the behavior of the trained worms they’d cannibalized, suggesting that memories were somehow transferred. He also showed that trained worms that were beheaded could remember their training after they grew new heads.[contextly_sidebar id=\"F5HcwGf5fX0A2ZqbT4U7VYdgDDaJshog\"]\u003c/p>\n\u003cp>Though the work was replicated by some other labs, McConnell’s work was largely ridiculed and is often described as a cautionary tale because so much time and money was spent by other labs trying, often unsuccessfully, to replicate the work. (McConnell died in 1990, five years after he’d been a target of the Unabomber Theodore Kaczynski.)\u003c/p>\n\u003cp>Recently, developmental biologist Michael Levin at Tufts has \u003ca href=\"https://www.theverge.com/2015/3/18/8225321/memory-research-flatworm-cannibalism-james-mcconnell-michael-levin\" target=\"_blank\" rel=\"noopener\">replicated McConnell’s experiments\u003c/a> on headless worms under more controlled settings and thinks McConnell may have indeed been correct.\u003c/p>\n\u003cp>Glanzman said one of McConnell’s students, Al Jacobson, demonstrated the transfer of memories between flatworms via RNA injections, coincidentally while an assistant professor at UCLA. The work was \u003ca href=\"http://www.nature.com/articles/209599a0\" target=\"_blank\" rel=\"noopener\">published in Nature in 1966\u003c/a> but Jacobsen never received tenure, perhaps because of doubts about his findings. The experiment was, however, \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC224185/\" target=\"_blank\" rel=\"noopener\">replicated in rats\u003c/a> shortly afterward.\u003c/p>\n\u003cp>Glanzman learned about McConnell’s work — and his satirical journal “Worm Runner’s Digest” — while he was a psychology undergraduate at Indiana University but never took the results seriously. Now, while he’s still not convinced McConnell was exactly right about being able to transfer memories, he does think both McConnell and Jacobson were onto something.\u003c/p>\n\u003cp>Working in the memory field can be tough for those who challenge the status quo. SUNY’s Sacktor, for example, has \u003ca href=\"https://www.statnews.com/2016/06/23/memory-research-neuroscience/\">spent more than 25 years\u003c/a> — despite the skepticism, rejection, and outright derision of fellow scientists — chasing down a single molecule, PKMzeta, that he believes is critical to the formation of long-term memories and may be connected to the RNA mechanisms that Glanzman has uncovered.\u003c/p>\n\u003cp>The stakes in the field are high because memory is so key to our sense of self and many scientists feel understanding the workings of memory is something that should have been figured out by now. “It’s the last of the great 20th-century questions in biology,” Sacktor said. “Some aspect has made it difficult for neuroscientists to figure out.”\u003c/p>\n\u003cp>The difficulty may be due in part to the overwhelming focus on synaptic strength. Some 12,000 papers have been published on synaptic strength without providing a good explanation for how memories are stored, Ryan noted, adding that he applauds Glanzman for opening up a new path, radical as it is, to explore.\u003c/p>\n\u003cp>“The reality is we know so little about memory,” Ryan said. “I’m excited about any new vistas and avenues.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This \u003ca href=\"https://www.statnews.com/2018/05/14/memory-transfer-between-snails-challenges-standard-theory/\" target=\"_blank\" rel=\"noopener\">story\u003c/a> was originally published by STAT, an online publication of Boston Globe Media that covers health, medicine, and scientific discovery.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>UCLA neuroscientists reported Monday that they have transferred a memory from one animal to another via injections of RNA, a startling result that challenges the widely held view of where and how memories are stored in the brain. \u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>The finding from the lab of David Glanzman hints at the potential for new RNA-based treatments to one day restore lost memories and, if correct, could shake up the field of memory and learning.\u003c/p>\n\u003cp>“It’s pretty shocking,” said Dr. Todd Sacktor, a neurologist and memory researcher at SUNY Downstate Medical Center in Brooklyn, N.Y. “The big picture is we’re working out the basic alphabet of how memories are stored for the first time.” He was not involved in the research, which was \u003ca href=\"http://www.eneuro.org/content/early/2018/05/14/ENEURO.0038-18.2018\" target=\"_blank\" rel=\"noopener\">published in eNeuro\u003c/a>, the \u003ca href=\"http://www.eneuro.org/\" target=\"_blank\" rel=\"noopener\">online journal\u003c/a> of the Society for Neuroscience.\u003c/p>\n\u003cp>Many scientists are expected to view the research more cautiously. The work is in snails, animals that have proven a powerful model organism for neuroscience but whose simple brains work far differently than those of humans. The experiments will need to be replicated, including in animals with more complex brains. And the results fly in the face of a massive amount of evidence supporting the deeply entrenched idea that memories are stored through changes in the strength of connections, or synapses, between neurons.\u003c/p>\n\u003cp>“If he’s right, this would be absolutely earth-shattering,” said Tomás Ryan, an assistant professor at Trinity College Dublin, whose lab hunts for engrams, or the physical traces of memory. “But I don’t think it’s right.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Glanzman knows his unceremonial demotion of the synapse is not going to go over well in the field. “I expect a lot of astonishment and skepticism,” he said. “I don’t expect people are going to have a parade for me at the next Society for Neuroscience meeting.”\u003c/p>\n\u003cp>Even his own colleagues were dubious. “It took me a long time to convince the people in my lab to do the experiment,” he said. “They thought it was nuts.”\u003c/p>\n\u003cp>Glanzman’s experiments — funded by the National Institutes of Health and the National Science Foundation — involved giving mild electrical shocks to the marine snail Aplysia californica. Shocked snails learn to withdraw their delicate siphons and gills for nearly a minute as a defense when they subsequently receive a weak touch; snails that have not been shocked withdraw only briefly.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>The researchers extracted RNA from the nervous systems of snails that had been shocked and injected the material into unshocked snails. RNA’s primary role is to serve as a messenger inside cells, carrying protein-making instructions from its cousin DNA. But when this RNA was injected, these naive snails withdrew their siphons for extended periods of time after a soft touch. Control snails that received injections of RNA from snails that had not received shocks did not withdraw their siphons for as long.\u003c/p>\n\u003cp>“It’s as if we transferred a memory,” Glanzman said.\u003c/p>\n\u003cp>Glanzman’s group went further, showing that Aplysia sensory neurons in Petri dishes were more excitable, as they tend to be after being shocked, if they were exposed to RNA from shocked snails. Exposure to RNA from snails that had never been shocked did not cause the cells to become more excitable.\u003c/p>\n\u003cdiv>\n\u003cdiv>\n\u003cdiv>\n\u003cp>The results, said Glanzman, suggest that memories may be stored within the nucleus of neurons, where RNA is synthesized and can act on DNA to turn genes on and off. He said he thought memory storage involved these epigenetic changes — changes in the activity of genes and not in the DNA sequences that make up those genes — that are mediated by RNA.\u003c/p>\n\u003c/div>\n\u003c/div>\n\u003c/div>\n\u003cp>This view challenges the widely held notion that memories are stored by enhancing synaptic connections between neurons. Rather, Glanzman sees synaptic changes that occur during memory formation as flowing from the information that the RNA is carrying.\u003c/p>\n\u003cp>“This idea is radical and definitely challenges the field,” said Li-Huei Tsai, a neuroscientist who directs the Picower Institute for Learning and Memory at the Massachusetts Institute of Technology. Tsai, who recently co-authored a \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4874022/\" target=\"_blank\" rel=\"noopener\">major review on memory formation\u003c/a>, called Glanzman’s study “impressive and interesting” and said a number of studies support the notion that epigenetic mechanisms play some role in memory formation, which is likely a complex and multifaceted process. But she said she strongly disagreed with Glanzman’s notion that synaptic connections do not play a key role in memory storage.\u003c/p>\n\u003cp>Trinity College’s Ryan, like Glanzman, stands with a minority of neuroscientists — some call them rebels — who \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/28548457\" target=\"_blank\" rel=\"noopener\">question the idea\u003c/a> that memory is stored through synaptic strength. In 2015, Ryan was lead author of a Science paper with MIT Nobelist Susumu Tonegawa that showed \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/26023136\" target=\"_blank\" rel=\"noopener\">memories could be retrieved\u003c/a> even after synapse strengthening was blocked. Ryan said he is pursuing the idea that memories are stored through ensembles of neurons bound together by new synaptic connections, not by strengthening of existing connections.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Ryan knows Glanzman and trusts his work. He said he believes the data in the new paper. But he doesn’t think the behavior of the snails, or the cells, proves that RNA is transferring memories. He said he doesn’t understand how RNA, which works on a time scale of minutes to hours, could be causing memory recall that is almost instantaneous, or how RNA could connect numerous parts of the brain, like the auditory and visual systems, that are involved in more complex memories.\u003c/p>\n\u003cp>But Glanzman said he is convinced RNA is playing a role that eclipses the synapse. In 2014, his lab showed that \u003ca href=\"https://elifesciences.org/articles/03896\" target=\"_blank\" rel=\"noopener\">memories of shocks that had been lost\u003c/a> in snails due to a series of experimental procedures could be recovered — but the synapse patterns that were lost with the memory reformed in random ways when the memories were recovered, suggesting memories were not stored there. Glanzman’s lab and others have also shown that long-term memory formation can be blocked by preventing epigenetic changes, even when synapse formation or strengthening is not altered.\u003c/p>\n\u003cp>“Synapses can come and go, but the memory can still be there,” he said, saying he sees synapses as merely the “reflection of knowledge held in the nucleus.”\u003c/p>\n\u003cp>Glanzman has studied memory for more than three decades. He did postdoctoral work with none other than Eric Kandel — the neuroscientist who shared the 2000 Nobel prize for research on Aplysia, probing the role of the synapse in memory — and he said he has spent most of his career believing that synaptic change was the key to memory storage.\u003c/p>\n\u003cp>But he said a series of findings from other labs and his own in recent years have led him to start questioning the synaptic dogma. He calls himself “a recovering synaptologist.”\u003c/p>\n\u003cp>The skepticism over Glanzman’s research may be in part because the work harkens back to an unnerving episode in science involving an unconventional psychologist, James V. McConnell, who spent years at the University of Michigan attempting to prove that something outside the brain — a factor he called “memory RNA” — could transfer memories. In the ’50s and ’60s, McConnell trained flatworms and then fed the bodies of trained worms to untrained worms. The untrained worms then appeared to exhibit the behavior of the trained worms they’d cannibalized, suggesting that memories were somehow transferred. He also showed that trained worms that were beheaded could remember their training after they grew new heads.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Though the work was replicated by some other labs, McConnell’s work was largely ridiculed and is often described as a cautionary tale because so much time and money was spent by other labs trying, often unsuccessfully, to replicate the work. (McConnell died in 1990, five years after he’d been a target of the Unabomber Theodore Kaczynski.)\u003c/p>\n\u003cp>Recently, developmental biologist Michael Levin at Tufts has \u003ca href=\"https://www.theverge.com/2015/3/18/8225321/memory-research-flatworm-cannibalism-james-mcconnell-michael-levin\" target=\"_blank\" rel=\"noopener\">replicated McConnell’s experiments\u003c/a> on headless worms under more controlled settings and thinks McConnell may have indeed been correct.\u003c/p>\n\u003cp>Glanzman said one of McConnell’s students, Al Jacobson, demonstrated the transfer of memories between flatworms via RNA injections, coincidentally while an assistant professor at UCLA. The work was \u003ca href=\"http://www.nature.com/articles/209599a0\" target=\"_blank\" rel=\"noopener\">published in Nature in 1966\u003c/a> but Jacobsen never received tenure, perhaps because of doubts about his findings. The experiment was, however, \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC224185/\" target=\"_blank\" rel=\"noopener\">replicated in rats\u003c/a> shortly afterward.\u003c/p>\n\u003cp>Glanzman learned about McConnell’s work — and his satirical journal “Worm Runner’s Digest” — while he was a psychology undergraduate at Indiana University but never took the results seriously. Now, while he’s still not convinced McConnell was exactly right about being able to transfer memories, he does think both McConnell and Jacobson were onto something.\u003c/p>\n\u003cp>Working in the memory field can be tough for those who challenge the status quo. SUNY’s Sacktor, for example, has \u003ca href=\"https://www.statnews.com/2016/06/23/memory-research-neuroscience/\">spent more than 25 years\u003c/a> — despite the skepticism, rejection, and outright derision of fellow scientists — chasing down a single molecule, PKMzeta, that he believes is critical to the formation of long-term memories and may be connected to the RNA mechanisms that Glanzman has uncovered.\u003c/p>\n\u003cp>The stakes in the field are high because memory is so key to our sense of self and many scientists feel understanding the workings of memory is something that should have been figured out by now. “It’s the last of the great 20th-century questions in biology,” Sacktor said. “Some aspect has made it difficult for neuroscientists to figure out.”\u003c/p>\n\u003cp>The difficulty may be due in part to the overwhelming focus on synaptic strength. Some 12,000 papers have been published on synaptic strength without providing a good explanation for how memories are stored, Ryan noted, adding that he applauds Glanzman for opening up a new path, radical as it is, to explore.\u003c/p>\n\u003cp>“The reality is we know so little about memory,” Ryan said. “I’m excited about any new vistas and avenues.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>The Food and Drug Administration has approved a first-of-its-kind drug that reduces the number of migraines among people prone to these sometimes crippling headaches.[contextly_sidebar id=\"eVSpdADwfHP9wNaEEpapPJOooMFjlmTD\"]\u003c/p>\n\u003cp>That's welcome news to some of the millions of Americans who suffer from these \u003ca href=\"https://www.ninds.nih.gov/Disorders/All-Disorders/Migraine-Information-Page\" target=\"_blank\" rel=\"noopener\">potentially debilitating headaches\u003c/a>. Much more common in women than men, these throbbing headaches can also come with nausea, visual disturbances and sensitivity to light. People who suffer them frequently sometimes find themselves anxious, depressed and even disabled.\u003c/p>\n\u003cp>Most of the drugs on the market today are used to control the symptoms of migraine.\u003c/p>\n\u003cp>The new drug, Aimovig was \u003ca href=\"https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm608120.htm\" target=\"_blank\" rel=\"noopener\">approved by the FDA on Thursday\u003c/a>. It's the first medicine in a new class that's designed to reduce the number of migraines among people who suffer them frequently. The medicine, known generically as erenumab-aooe, is being sold by Amgen in the U.S.\u003c/p>\n\u003cp>Aimovig and several other migraine drugs in development are based on research begun in the 1980s. Scientists found people having migraine attacks have high levels of something called \"calcitonin gene–related peptide,\" or CGRP, in their blood, as Lauren Gravitz \u003ca href=\"https://www.npr.org/sections/health-shots/2018/02/03/581092093/gone-with-a-shot-hopeful-new-signs-of-relief-for-migraine-sufferers\" target=\"_blank\" rel=\"noopener\">reported for Shots in February\u003c/a>.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>When the peptide was injected in people prone to migraines, it triggered headaches. People not prone to migraines were unaffected by the peptide injections.\u003c/p>\n\u003cp>With this insight in hand, drugmakers worked to make antibodies to block the peptide's activity inside the body as a way to prevent migraines.\u003c/p>\n\u003cp>In \u003ca href=\"https://www.nejm.org/doi/full/10.1056/NEJMoa1705848\" target=\"_blank\" rel=\"noopener\">one of the large studies\u003c/a> that set the stage for FDA approval of Aimovig, the number of migraines per month dropped from eight to fewer than five, on average. Patients taking dummy \"placebo\" shots also had fewer migraines.\u003c/p>\n\u003cp>Patients in Aimovig studies reported generally mild side effects, though any long-term or rarer risks from Aimovig could come to light only over time.[contextly_sidebar id=\"qA38kZhQPznYkiyYxVV7PlTRdiD9ko0z\"]\u003c/p>\n\u003cp>People inject the drug themselves using a pen-like device, like those used for insulin.\u003c/p>\n\u003cp>Aimovig is an expensive type of medication called a monoclonal antibody. Antibodies are produced in living cells rather than in a chemical laboratory.\u003c/p>\n\u003cp>Drugmaker \u003ca href=\"https://www.amgen.com/media/news-releases/2018/05/fda-approves-aimovig-erenumabaooe-a-novel-treatment-developed-specifically-for-migraine-prevention/\" target=\"_blank\" rel=\"noopener\">Amgen says is has set the list price\u003c/a> at $6,900 a year.\u003c/p>\n\u003cp>Some analysts had expected the initial price of this drug to be set substantially higher – at $10,000 a year or more. But high prices have recently been generating political backlash, and \u003ca href=\"https://www.statnews.com/2016/10/28/cholesterol-drug-failure/\" target=\"_blank\" rel=\"noopener\">some expensive drugs have fizzled\u003c/a> after insurance companies sharply limited which patients they would cover.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>With the new migraine drug, those questions will come to the fore quickly, as Amgen says it's ready to put the drug on the market within a week, and has programs in place to help ease the cost to some patients.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=New+Type+Of+Drug+To+Prevent+Migraines+Heads+To+Market&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The Food and Drug Administration has approved a first-of-its-kind drug that reduces the number of migraines among people prone to these sometimes crippling headaches.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>That's welcome news to some of the millions of Americans who suffer from these \u003ca href=\"https://www.ninds.nih.gov/Disorders/All-Disorders/Migraine-Information-Page\" target=\"_blank\" rel=\"noopener\">potentially debilitating headaches\u003c/a>. Much more common in women than men, these throbbing headaches can also come with nausea, visual disturbances and sensitivity to light. People who suffer them frequently sometimes find themselves anxious, depressed and even disabled.\u003c/p>\n\u003cp>Most of the drugs on the market today are used to control the symptoms of migraine.\u003c/p>\n\u003cp>The new drug, Aimovig was \u003ca href=\"https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm608120.htm\" target=\"_blank\" rel=\"noopener\">approved by the FDA on Thursday\u003c/a>. It's the first medicine in a new class that's designed to reduce the number of migraines among people who suffer them frequently. The medicine, known generically as erenumab-aooe, is being sold by Amgen in the U.S.\u003c/p>\n\u003cp>Aimovig and several other migraine drugs in development are based on research begun in the 1980s. Scientists found people having migraine attacks have high levels of something called \"calcitonin gene–related peptide,\" or CGRP, in their blood, as Lauren Gravitz \u003ca href=\"https://www.npr.org/sections/health-shots/2018/02/03/581092093/gone-with-a-shot-hopeful-new-signs-of-relief-for-migraine-sufferers\" target=\"_blank\" rel=\"noopener\">reported for Shots in February\u003c/a>.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>When the peptide was injected in people prone to migraines, it triggered headaches. People not prone to migraines were unaffected by the peptide injections.\u003c/p>\n\u003cp>With this insight in hand, drugmakers worked to make antibodies to block the peptide's activity inside the body as a way to prevent migraines.\u003c/p>\n\u003cp>In \u003ca href=\"https://www.nejm.org/doi/full/10.1056/NEJMoa1705848\" target=\"_blank\" rel=\"noopener\">one of the large studies\u003c/a> that set the stage for FDA approval of Aimovig, the number of migraines per month dropped from eight to fewer than five, on average. Patients taking dummy \"placebo\" shots also had fewer migraines.\u003c/p>\n\u003cp>Patients in Aimovig studies reported generally mild side effects, though any long-term or rarer risks from Aimovig could come to light only over time.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>People inject the drug themselves using a pen-like device, like those used for insulin.\u003c/p>\n\u003cp>Aimovig is an expensive type of medication called a monoclonal antibody. Antibodies are produced in living cells rather than in a chemical laboratory.\u003c/p>\n\u003cp>Drugmaker \u003ca href=\"https://www.amgen.com/media/news-releases/2018/05/fda-approves-aimovig-erenumabaooe-a-novel-treatment-developed-specifically-for-migraine-prevention/\" target=\"_blank\" rel=\"noopener\">Amgen says is has set the list price\u003c/a> at $6,900 a year.\u003c/p>\n\u003cp>Some analysts had expected the initial price of this drug to be set substantially higher – at $10,000 a year or more. But high prices have recently been generating political backlash, and \u003ca href=\"https://www.statnews.com/2016/10/28/cholesterol-drug-failure/\" target=\"_blank\" rel=\"noopener\">some expensive drugs have fizzled\u003c/a> after insurance companies sharply limited which patients they would cover.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>With the new migraine drug, those questions will come to the fore quickly, as Amgen says it's ready to put the drug on the market within a week, and has programs in place to help ease the cost to some patients.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=New+Type+Of+Drug+To+Prevent+Migraines+Heads+To+Market&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Mounting Evidence Shows Diet Soda May Be Hurting Your Diet — Here's How",
"title": "Mounting Evidence Shows Diet Soda May Be Hurting Your Diet — Here's How",
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"content": "\u003cp>Artificial sweeteners are everywhere, but the jury is still out on whether these chemicals are harmless. Also called non-nutritive sweeteners, these can be synthetic – such as saccharin and aspartame – or naturally derived, such as steviol, which comes from the Stevia plant. To date, the U.S. Food and Drug Administration has approved \u003ca href=\"https://www.fda.gov/Food/IngredientsPackagingLabeling/FoodAdditivesIngredients/ucm397725.htm\" target=\"_blank\" rel=\"noopener\">six types of artificial and two types of natural non-nutritive sweeteners\u003c/a> for use in food.[contextly_sidebar id=\"9cHOWFJBVWEQQfvraluyBJ45Elnnkn5i\"]\u003c/p>\n\u003cp>That’s been great news for those working hard to curb their sugar consumption. \u003ca href=\"https://doi.org/10.3945/ajcn.111.030833\" target=\"_blank\" rel=\"noopener\">Aspartame\u003c/a>, for example, is found in more than 6,000 foods worldwide, and about 5,000-5,500 tons are consumed every year in the United States alone.\u003c/p>\n\u003cp>The American Diabetes Association – the most well-respected professional group focusing on diabetes – \u003ca href=\"http://www.diabetes.org/food-and-fitness/food/what-can-i-eat/making-healthy-food-choices/what-can-i-drink.html\" target=\"_blank\" rel=\"noopener\">officially recommends diet soda as an alternative\u003c/a> to sugar-sweetened beverages. To date, seven U.S. municipalities have imposed a sugary beverage tax to discourage consumption.\u003c/p>\n\u003cp>However, recent medical studies suggest that policymakers eager to implement a soda tax may also want to include diet drinks because these sweeteners may be contributing to chronic diabetes and cardiovascular diseases as well.\u003c/p>\n\u003cp>\u003cstrong>Why Are These Sweeteners Calorie-Free?\u003c/strong>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The key to these virtually calorie-free sweeteners is that they are not broken down during digestion into natural sugars like glucose, fructose and galactose, which are then either used for energy or converted into fat.\u003c/p>\n\u003cp>Non-nutritive sweeteners have different byproducts that are not converted into calories. Aspartame, for example, undergoes a different metabolic process that doesn’t yield simple sugars. Others such as saccharin and sucralose are not broken down at all, but instead are absorbed directly into the bloodstream and excreted in the urine.\u003c/p>\n\u003cp>Theoretically, these sweeteners should be a “better” choice than sugar for diabetics. Glucose stimulates release of insulin, a hormone that regulates blood sugar levels. Type 2 diabetes occurs when the body no longer responds as well to insulin as it should, leading to higher levels of glucose in the blood that damages the nerves, kidneys, blood vessels and heart. Since non-nutritive sweeteners aren’t actually sugar, they should sidestep this problem.\u003c/p>\n\u003cp>\u003cstrong>Artificial Sweeteners, Your Brain and Your Microbiome\u003c/strong>\u003c/p>\n\u003cp>However, there is growing evidence over the last decade that these sweeteners can alter healthy metabolic processes in other ways, specifically in the gut.\u003c/p>\n\u003cp>Long-term use of these sweeteners has \u003ca href=\"https://doi.org/10.2337/dc08-1799\" target=\"_blank\" rel=\"noopener\">been associated with a higher risk of Type 2 diabetes\u003c/a>. Sweeteners, such as saccharin, have been shown to \u003ca href=\"http://doi.org/10.1038/nature13793\" target=\"_blank\" rel=\"noopener\">change the type and function of the gut microbiome\u003c/a>, the community of microorganisms that live in the intestine. Aspartame \u003ca href=\"https://doi.org/10.1139/apnm-2016-0346\" target=\"_blank\" rel=\"noopener\">decreases the activity of a gut enzyme\u003c/a> that is normally protective against Type 2 diabetes. Furthermore, this response may be exacerbated by the “mismatch” between the body perceiving something as tasting sweet and the expected associated calories. The greater the discrepancy between the sweetness and actual caloric content, the \u003ca href=\"http://doi.org/10.1016/j.cub.2017.07.018\" target=\"_blank\" rel=\"noopener\">greater the metabolic dysregulation\u003c/a>.[contextly_sidebar id=\"1WiRRvjeXSgRFmENuLBZhCvtglNEvId8\"]\u003c/p>\n\u003cp>Sweeteners have also been shown to change brain activity associated with eating sweet foods. A functional MRI exam, which studies brain activity by measuring blood flow, has shown that sucralose, compared to regular sugar, \u003ca href=\"https://doi.org/10.1016/j.appet.2011.12.001\">decreases activity in the amygdala\u003c/a>, a part of the brain involved with taste perception and the experience of eating.\u003c/p>\n\u003cp>Another study revealed that longer-term and higher diet soda consumption are linked to \u003ca href=\"https://doi.org/10.1016/j.physbeh.2012.05.006\">lower activity in the brain’s “caudate head,”\u003c/a> a region that mediates the reward pathway and is necessary for generating a feeling of satisfaction. Researchers have hypothesized that this decreased activity could lead a diet soda drinker to compensate for the lack of pleasure they now derive from the food by increasing their consumption of all foods, not just soda.\u003c/p>\n\u003cp>Together these cellular and brain studies may explain why people who consume sweeteners still have a \u003ca href=\"https://doi.org/10.1371/journal.pone.0167241\">higher risk of obesity\u003c/a> than individuals who don’t consume these products.\u003c/p>\n\u003cp>\u003ca href=\"https://doi.org/10.1503/cmaj.161390\">As this debate on the pros and cons of these sugar substitutes rages on\u003c/a>, we must view these behavioral studies with a grain of salt (or sugar) because many diet soda drinkers – or any health-conscious individual who consumes zero-calorie sweeteners – already has the risk factors for obesity, diabetes, hypertension or heart disease. Those who are already overweight or obese may turn toward low-calorie drinks, making it look as though the diet sodas are causing their weight gain.\u003c/p>\n\u003cp>This same group may also be less likely to moderate their consumption. For example, those people may think that having a diet soda multiple times a week is much healthier than drinking one case of soda with sugar.[contextly_sidebar id=\"nPADPRMuF9gHM8AprlV1Wgo1Jciefs8f\"]\u003c/p>\n\u003cp>These findings signal that consumers and health practitioners all need to check our assumptions about the health benefits of these products. Sweeteners are everywhere, from beverages to salad dressing, from cookies to yogurt, and we must recognize that there is no guarantee that these chemicals won’t increase the burden of metabolic diseases in the future.\u003c/p>\n\u003cp>As a physician of internal medicine specializing in general prevention and public health, I would like to be able to tell my patients what the true risks and benefits are if they drink diet soda instead of water.\u003c/p>\n\u003cp>Legislators considering soda taxes to encourage better dietary habits perhaps should think about including foods with non-nutritive sweeteners. Of course, there is an argument to be made for being realistic and pursuing the lesser of two evils. But even if the negative consequences of sugar substitutes doesn’t sway our tax policy – for now – at least the medical community should be honest with the public about what they stand to lose or gain, consuming these foods.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>\u003cspan class=\"fn author-name\">Eunice Zhang is a c\u003c/span>linical fellow of preventive medicine at the University of Michigan. This article was originally published on \u003ca href=\"https://theconversation.com/diet-soda-may-be-hurting-your-diet-96181\" target=\"_blank\" rel=\"noopener\">The Conversation\u003c/a>.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Artificial sweeteners are everywhere, but the jury is still out on whether these chemicals are harmless. Also called non-nutritive sweeteners, these can be synthetic – such as saccharin and aspartame – or naturally derived, such as steviol, which comes from the Stevia plant. To date, the U.S. Food and Drug Administration has approved \u003ca href=\"https://www.fda.gov/Food/IngredientsPackagingLabeling/FoodAdditivesIngredients/ucm397725.htm\" target=\"_blank\" rel=\"noopener\">six types of artificial and two types of natural non-nutritive sweeteners\u003c/a> for use in food.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>That’s been great news for those working hard to curb their sugar consumption. \u003ca href=\"https://doi.org/10.3945/ajcn.111.030833\" target=\"_blank\" rel=\"noopener\">Aspartame\u003c/a>, for example, is found in more than 6,000 foods worldwide, and about 5,000-5,500 tons are consumed every year in the United States alone.\u003c/p>\n\u003cp>The American Diabetes Association – the most well-respected professional group focusing on diabetes – \u003ca href=\"http://www.diabetes.org/food-and-fitness/food/what-can-i-eat/making-healthy-food-choices/what-can-i-drink.html\" target=\"_blank\" rel=\"noopener\">officially recommends diet soda as an alternative\u003c/a> to sugar-sweetened beverages. To date, seven U.S. municipalities have imposed a sugary beverage tax to discourage consumption.\u003c/p>\n\u003cp>However, recent medical studies suggest that policymakers eager to implement a soda tax may also want to include diet drinks because these sweeteners may be contributing to chronic diabetes and cardiovascular diseases as well.\u003c/p>\n\u003cp>\u003cstrong>Why Are These Sweeteners Calorie-Free?\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The key to these virtually calorie-free sweeteners is that they are not broken down during digestion into natural sugars like glucose, fructose and galactose, which are then either used for energy or converted into fat.\u003c/p>\n\u003cp>Non-nutritive sweeteners have different byproducts that are not converted into calories. Aspartame, for example, undergoes a different metabolic process that doesn’t yield simple sugars. Others such as saccharin and sucralose are not broken down at all, but instead are absorbed directly into the bloodstream and excreted in the urine.\u003c/p>\n\u003cp>Theoretically, these sweeteners should be a “better” choice than sugar for diabetics. Glucose stimulates release of insulin, a hormone that regulates blood sugar levels. Type 2 diabetes occurs when the body no longer responds as well to insulin as it should, leading to higher levels of glucose in the blood that damages the nerves, kidneys, blood vessels and heart. Since non-nutritive sweeteners aren’t actually sugar, they should sidestep this problem.\u003c/p>\n\u003cp>\u003cstrong>Artificial Sweeteners, Your Brain and Your Microbiome\u003c/strong>\u003c/p>\n\u003cp>However, there is growing evidence over the last decade that these sweeteners can alter healthy metabolic processes in other ways, specifically in the gut.\u003c/p>\n\u003cp>Long-term use of these sweeteners has \u003ca href=\"https://doi.org/10.2337/dc08-1799\" target=\"_blank\" rel=\"noopener\">been associated with a higher risk of Type 2 diabetes\u003c/a>. Sweeteners, such as saccharin, have been shown to \u003ca href=\"http://doi.org/10.1038/nature13793\" target=\"_blank\" rel=\"noopener\">change the type and function of the gut microbiome\u003c/a>, the community of microorganisms that live in the intestine. Aspartame \u003ca href=\"https://doi.org/10.1139/apnm-2016-0346\" target=\"_blank\" rel=\"noopener\">decreases the activity of a gut enzyme\u003c/a> that is normally protective against Type 2 diabetes. Furthermore, this response may be exacerbated by the “mismatch” between the body perceiving something as tasting sweet and the expected associated calories. The greater the discrepancy between the sweetness and actual caloric content, the \u003ca href=\"http://doi.org/10.1016/j.cub.2017.07.018\" target=\"_blank\" rel=\"noopener\">greater the metabolic dysregulation\u003c/a>.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Sweeteners have also been shown to change brain activity associated with eating sweet foods. A functional MRI exam, which studies brain activity by measuring blood flow, has shown that sucralose, compared to regular sugar, \u003ca href=\"https://doi.org/10.1016/j.appet.2011.12.001\">decreases activity in the amygdala\u003c/a>, a part of the brain involved with taste perception and the experience of eating.\u003c/p>\n\u003cp>Another study revealed that longer-term and higher diet soda consumption are linked to \u003ca href=\"https://doi.org/10.1016/j.physbeh.2012.05.006\">lower activity in the brain’s “caudate head,”\u003c/a> a region that mediates the reward pathway and is necessary for generating a feeling of satisfaction. Researchers have hypothesized that this decreased activity could lead a diet soda drinker to compensate for the lack of pleasure they now derive from the food by increasing their consumption of all foods, not just soda.\u003c/p>\n\u003cp>Together these cellular and brain studies may explain why people who consume sweeteners still have a \u003ca href=\"https://doi.org/10.1371/journal.pone.0167241\">higher risk of obesity\u003c/a> than individuals who don’t consume these products.\u003c/p>\n\u003cp>\u003ca href=\"https://doi.org/10.1503/cmaj.161390\">As this debate on the pros and cons of these sugar substitutes rages on\u003c/a>, we must view these behavioral studies with a grain of salt (or sugar) because many diet soda drinkers – or any health-conscious individual who consumes zero-calorie sweeteners – already has the risk factors for obesity, diabetes, hypertension or heart disease. Those who are already overweight or obese may turn toward low-calorie drinks, making it look as though the diet sodas are causing their weight gain.\u003c/p>\n\u003cp>This same group may also be less likely to moderate their consumption. For example, those people may think that having a diet soda multiple times a week is much healthier than drinking one case of soda with sugar.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>These findings signal that consumers and health practitioners all need to check our assumptions about the health benefits of these products. Sweeteners are everywhere, from beverages to salad dressing, from cookies to yogurt, and we must recognize that there is no guarantee that these chemicals won’t increase the burden of metabolic diseases in the future.\u003c/p>\n\u003cp>As a physician of internal medicine specializing in general prevention and public health, I would like to be able to tell my patients what the true risks and benefits are if they drink diet soda instead of water.\u003c/p>\n\u003cp>Legislators considering soda taxes to encourage better dietary habits perhaps should think about including foods with non-nutritive sweeteners. Of course, there is an argument to be made for being realistic and pursuing the lesser of two evils. But even if the negative consequences of sugar substitutes doesn’t sway our tax policy – for now – at least the medical community should be honest with the public about what they stand to lose or gain, consuming these foods.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>\u003cspan class=\"fn author-name\">Eunice Zhang is a c\u003c/span>linical fellow of preventive medicine at the University of Michigan. This article was originally published on \u003ca href=\"https://theconversation.com/diet-soda-may-be-hurting-your-diet-96181\" target=\"_blank\" rel=\"noopener\">The Conversation\u003c/a>.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Congo’s Ebola outbreak has spread to a crossroads city of more than 1 million people in a troubling turn that marks the first time the vast, impoverished country has encountered the lethal virus in an urban area.\u003c/p>\n\u003cp>“This is a major, major game-changer in the outbreak,” Dr. Peter Salama, the World Health Organization’s deputy director-general of emergency preparedness and response, warned on Thursday.\u003c/p>\n\u003cp>A single case of Ebola was confirmed in Mbandaka, a densely populated provincial capital on the Congo River, Congo’s Health Minister Oly Ilunga said late Wednesday. The city is about 93 miles from Bikoro, the rural area where the outbreak was announced last week.\u003c/p>\n\u003cp>Medical teams rushed to track down anyone thought to have had contact with infected people, while WHO continued shipping thousands of doses of an experimental vaccine.\u003c/p>\n\u003cp>A total of 44 cases of Ebola have been reported in Congo in this outbreak: three confirmed, 20 probable and 21 suspected, according to WHO. Twenty-three of those people have died.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Until now, the outbreak was confined to remote rural areas, where Ebola, which is spread by bodily fluids, travels more slowly.\u003c/p>\n\u003cp>“We’re certainly not trying to cause any panic in the national or international community,” Salama said. But “urban Ebola can result in an exponential increase in cases in a way that rural Ebola struggles to do.”\u003c/p>\n\u003cp>Mbandaka, a city of almost 1.2 million, is in a busy travel corridor in Congo’s northwest Equateur province and is upstream from the capital, Kinshasa, a city of about 10 million. It is an hour’s plane ride from Kinshasa or a four- to seven-day trip by river barge.\u003c/p>\n\u003cp>Salama also noted Mbandaka’s proximity to neighboring countries, including Central African Republic and Republic of Congo.\u003c/p>\n\u003cp>“The scenario has changed, and it has become most serious and worrying, since the disease is now affecting an urban area,” said Henry Gray, emergency coordinator in Mbandaka for Doctors Without Borders.\u003c/p>\n\u003cp>\u003cstrong>Ebola Vaccinations\u003c/strong>\u003cbr>\nThe aid organization said 514 people believed to have been in contact with infected people are being monitored. WHO said it is deploying about 30 more experts to the city.\u003c/p>\n\u003cp>Those exposed will for the first time in Congo receive Ebola vaccinations, the health minister said. WHO has sent 4,000 doses to Congo and said it will dispatch thousands more in the coming days as needed.\u003c/p>\n\u003cp>“This is a concerning development, but we now have better tools than ever before to combat Ebola,” Tedros Adhanom Ghebreyesus, WHO director-general, said of the new urban case.\u003c/p>\n\u003cp>The vaccine has been shown to be highly effective against Ebola. It was tested in Guinea during the outbreak that killed more than 11,300 people in West Africa from 2014 to 2016.\u003c/p>\n\u003cp>WHO has said it will use the “ring vaccination” method. It involves vaccinating contacts of those feared infected, contacts of those contacts, and health care and other front-line workers.\u003c/p>\n\u003cp>This is the ninth Ebola outbreak in Congo since 1976, when the disease was first identified. The virus is initially transmitted to people from wild animals, including bats and monkeys.\u003c/p>\n\u003cp>There is no specific treatment for Ebola. Symptoms include fever, vomiting, diarrhea, muscle pain and at times internal and external bleeding. The virus can be fatal in up to 90 percent of cases, depending on the strain.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp> \u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Congo’s Ebola outbreak has spread to a crossroads city of more than 1 million people in a troubling turn that marks the first time the vast, impoverished country has encountered the lethal virus in an urban area.\u003c/p>\n\u003cp>“This is a major, major game-changer in the outbreak,” Dr. Peter Salama, the World Health Organization’s deputy director-general of emergency preparedness and response, warned on Thursday.\u003c/p>\n\u003cp>A single case of Ebola was confirmed in Mbandaka, a densely populated provincial capital on the Congo River, Congo’s Health Minister Oly Ilunga said late Wednesday. The city is about 93 miles from Bikoro, the rural area where the outbreak was announced last week.\u003c/p>\n\u003cp>Medical teams rushed to track down anyone thought to have had contact with infected people, while WHO continued shipping thousands of doses of an experimental vaccine.\u003c/p>\n\u003cp>A total of 44 cases of Ebola have been reported in Congo in this outbreak: three confirmed, 20 probable and 21 suspected, according to WHO. Twenty-three of those people have died.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Until now, the outbreak was confined to remote rural areas, where Ebola, which is spread by bodily fluids, travels more slowly.\u003c/p>\n\u003cp>“We’re certainly not trying to cause any panic in the national or international community,” Salama said. But “urban Ebola can result in an exponential increase in cases in a way that rural Ebola struggles to do.”\u003c/p>\n\u003cp>Mbandaka, a city of almost 1.2 million, is in a busy travel corridor in Congo’s northwest Equateur province and is upstream from the capital, Kinshasa, a city of about 10 million. It is an hour’s plane ride from Kinshasa or a four- to seven-day trip by river barge.\u003c/p>\n\u003cp>Salama also noted Mbandaka’s proximity to neighboring countries, including Central African Republic and Republic of Congo.\u003c/p>\n\u003cp>“The scenario has changed, and it has become most serious and worrying, since the disease is now affecting an urban area,” said Henry Gray, emergency coordinator in Mbandaka for Doctors Without Borders.\u003c/p>\n\u003cp>\u003cstrong>Ebola Vaccinations\u003c/strong>\u003cbr>\nThe aid organization said 514 people believed to have been in contact with infected people are being monitored. WHO said it is deploying about 30 more experts to the city.\u003c/p>\n\u003cp>Those exposed will for the first time in Congo receive Ebola vaccinations, the health minister said. WHO has sent 4,000 doses to Congo and said it will dispatch thousands more in the coming days as needed.\u003c/p>\n\u003cp>“This is a concerning development, but we now have better tools than ever before to combat Ebola,” Tedros Adhanom Ghebreyesus, WHO director-general, said of the new urban case.\u003c/p>\n\u003cp>The vaccine has been shown to be highly effective against Ebola. It was tested in Guinea during the outbreak that killed more than 11,300 people in West Africa from 2014 to 2016.\u003c/p>\n\u003cp>WHO has said it will use the “ring vaccination” method. It involves vaccinating contacts of those feared infected, contacts of those contacts, and health care and other front-line workers.\u003c/p>\n\u003cp>This is the ninth Ebola outbreak in Congo since 1976, when the disease was first identified. The virus is initially transmitted to people from wild animals, including bats and monkeys.\u003c/p>\n\u003cp>There is no specific treatment for Ebola. Symptoms include fever, vomiting, diarrhea, muscle pain and at times internal and external bleeding. The virus can be fatal in up to 90 percent of cases, depending on the strain.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp> \u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>When I heard about home testing for sexually transmitted diseases, I was intrigued. Who doesn't despise that particularly awkward conversation with their doctor? And who doesn't want to skip the waiting room and long line at the lab?\u003c/p>\n\u003caside class=\"pullquote alignright\">A 15-minute procedure in the privacy of your own home. But the kits can get pricey.\u003c/aside>\n\u003cp>The kit I used is available online for $189 from a company called myLAB Box. Many other companies offer similar tests -- EverlyWell and LetsGetChecked, to name two. The kits cost anywhere from $100 to $400, depending on the number of diseases you're tested for.\u003c/p>\n\u003cp>\u003cstrong>Simple Steps\u003c/strong>\u003c/p>\n\u003cp>After opening my kit, I saw everything I needed packed neatly into a box about the size of my palm. Following the steps outlined in pictures on the instruction sheet, the entire procedure took less than 15 minutes. First I used a giant Q-tip as a vaginal swab. I doused my ring finger with alcohol and pricked it with a plastic lancet, carefully letting droplets of blood land in circles on a white collection card. After sealing both samples in separate biohazard bags, I shipped the specimens off in a prepaid envelope.\u003c/p>\n\u003cfigure id=\"attachment_440848\" class=\"wp-caption alignright\" style=\"max-width: 411px\">\u003ca href=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/04/RS30399_ATHOMETEST_035-e1524194755230.jpg\">\u003cimg class=\" wp-image-440848\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/04/RS30399_ATHOMETEST_035-1020x1528.jpg\" alt=\"\" width=\"411\" height=\"616\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Lesley McClurg uses a lancet to get a blood sample for a home STD test. \u003ccite>(Lauren Hanussak/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>I had ordered tests for chlamydia, gonorrhea, HIV and trichomoniasis -- the basic package. A few days later I received an email confirming that my results were negative. (Unlike \u003ca href=\"https://www.youtube.com/watch?v=bv26dLnbi9g\" target=\"_blank\" rel=\"noopener\">George Costanza\u003c/a>, of \"Seinfeld\" fame, I knew that \"negative\" is good in this context.)\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>If any of the tests had come back positive, myLAB Box would have connected me with a physician for a free telemedicine consultation.\u003c/p>\n\u003cp>\u003cstrong>Accelerating STD Rates\u003c/strong>\u003c/p>\n\u003cp>Health officials think home testing of STDs has the potential to curb accelerating transmission rates. The Centers for Disease Control and Prevention \u003ca href=\"https://www.cdc.gov/std/stats16/default.htm\" target=\"_blank\" rel=\"noopener\">reported\u003c/a> all-time highs for STDs in 2016, and an estimated \u003ca href=\"https://www.cdc.gov/nchhstp/newsroom/docs/factsheets/std-trends-508.pdf\" target=\"_blank\" rel=\"noopener\">20 million Americans\u003c/a> contract an infection through sexual contact every year. Meanwhile, in California, numerous public testing clinics have closed over the past decade, according to the state's Department of Health.\u003c/p>\n\u003caside class=\"pullquote alignright\">'Patient surveys have demonstrated that individuals don't always feel comfortable talking to their regular medical provider about their risk for STD or interest in STD testing.'\u003ccite>California Department of Public Health\u003c/cite>\u003c/aside>\n\u003cp>\"Many people still face significant challenges getting high-quality sexual health services, including STD testing,\" a spokesperson said in an email. \"This is particularly true of youth, males, and sexual minorities. Patient surveys have demonstrated that individuals don't always feel comfortable talking to their regular medical provider about their risk for STD or interest in STD testing.\"\u003c/p>\n\u003cp>Dr. Jennifer Conti, a gynecologist and clinical assistant professor at Stanford University, agrees that home testing increases access. \"I think anyone can prick their finger or pee on a stick,\" she said.\u003c/p>\n\u003cp>Conti recommends testing every six months if you're sexually active with multiple partners. This can get pricey if you're paying out of pocket. Though insurance companies are required to pay for preventative STD screening under the Affordable Care Act, most providers will not reimburse patients for home tests.\u003c/p>\n\u003cp>\u003cstrong>No FDA Approval\u003c/strong>\u003c/p>\n\u003cp>If you do decide to purchase a home test, you should know the Food and Drug Administration has only approved \u003ca href=\"https://www.cdc.gov/hiv/testing/hometests.html\" target=\"_blank\" rel=\"noopener\">two HIV tests\u003c/a> for the home market. Anything beyond that, the quality of different products may vary.\u003c/p>\n\u003cp>“The people who draw your blood in a hospital or in clinic are all trained, and they obtain specimens that have no inconsistency,\" said Dr. Norman Paradis, an emergency room physician who teaches at the Geisel School of Medicine at Dartmouth College. \"But some of the new devices for doing this on yourself at home haven't been validated to the same extent.”\u003c/p>\n\u003cp>The CEO of myLab Box, Lora Ivanova, said results are tested in a lab meeting the standards of the \u003ca href=\"https://www.cms.gov/Regulations-and-Guidance/Legislation/CLIA/index.html?redirect=/CLIA/\" target=\"_blank\" rel=\"noopener\">Clinical Laboratory Improvement Amendments, \u003c/a>used by the federal government to certify labs.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Paradis says the benefits of home testing far outweigh the risks, as long as patients see a doctor when a test comes back positive and when experiencing abnormal symptoms.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>When I heard about home testing for sexually transmitted diseases, I was intrigued. Who doesn't despise that particularly awkward conversation with their doctor? And who doesn't want to skip the waiting room and long line at the lab?\u003c/p>\n\u003caside class=\"pullquote alignright\">A 15-minute procedure in the privacy of your own home. But the kits can get pricey.\u003c/aside>\n\u003cp>The kit I used is available online for $189 from a company called myLAB Box. Many other companies offer similar tests -- EverlyWell and LetsGetChecked, to name two. The kits cost anywhere from $100 to $400, depending on the number of diseases you're tested for.\u003c/p>\n\u003cp>\u003cstrong>Simple Steps\u003c/strong>\u003c/p>\n\u003cp>After opening my kit, I saw everything I needed packed neatly into a box about the size of my palm. Following the steps outlined in pictures on the instruction sheet, the entire procedure took less than 15 minutes. First I used a giant Q-tip as a vaginal swab. I doused my ring finger with alcohol and pricked it with a plastic lancet, carefully letting droplets of blood land in circles on a white collection card. After sealing both samples in separate biohazard bags, I shipped the specimens off in a prepaid envelope.\u003c/p>\n\u003cfigure id=\"attachment_440848\" class=\"wp-caption alignright\" style=\"max-width: 411px\">\u003ca href=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/04/RS30399_ATHOMETEST_035-e1524194755230.jpg\">\u003cimg class=\" wp-image-440848\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/04/RS30399_ATHOMETEST_035-1020x1528.jpg\" alt=\"\" width=\"411\" height=\"616\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Lesley McClurg uses a lancet to get a blood sample for a home STD test. \u003ccite>(Lauren Hanussak/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>I had ordered tests for chlamydia, gonorrhea, HIV and trichomoniasis -- the basic package. A few days later I received an email confirming that my results were negative. (Unlike \u003ca href=\"https://www.youtube.com/watch?v=bv26dLnbi9g\" target=\"_blank\" rel=\"noopener\">George Costanza\u003c/a>, of \"Seinfeld\" fame, I knew that \"negative\" is good in this context.)\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>If any of the tests had come back positive, myLAB Box would have connected me with a physician for a free telemedicine consultation.\u003c/p>\n\u003cp>\u003cstrong>Accelerating STD Rates\u003c/strong>\u003c/p>\n\u003cp>Health officials think home testing of STDs has the potential to curb accelerating transmission rates. The Centers for Disease Control and Prevention \u003ca href=\"https://www.cdc.gov/std/stats16/default.htm\" target=\"_blank\" rel=\"noopener\">reported\u003c/a> all-time highs for STDs in 2016, and an estimated \u003ca href=\"https://www.cdc.gov/nchhstp/newsroom/docs/factsheets/std-trends-508.pdf\" target=\"_blank\" rel=\"noopener\">20 million Americans\u003c/a> contract an infection through sexual contact every year. Meanwhile, in California, numerous public testing clinics have closed over the past decade, according to the state's Department of Health.\u003c/p>\n\u003caside class=\"pullquote alignright\">'Patient surveys have demonstrated that individuals don't always feel comfortable talking to their regular medical provider about their risk for STD or interest in STD testing.'\u003ccite>California Department of Public Health\u003c/cite>\u003c/aside>\n\u003cp>\"Many people still face significant challenges getting high-quality sexual health services, including STD testing,\" a spokesperson said in an email. \"This is particularly true of youth, males, and sexual minorities. Patient surveys have demonstrated that individuals don't always feel comfortable talking to their regular medical provider about their risk for STD or interest in STD testing.\"\u003c/p>\n\u003cp>Dr. Jennifer Conti, a gynecologist and clinical assistant professor at Stanford University, agrees that home testing increases access. \"I think anyone can prick their finger or pee on a stick,\" she said.\u003c/p>\n\u003cp>Conti recommends testing every six months if you're sexually active with multiple partners. This can get pricey if you're paying out of pocket. Though insurance companies are required to pay for preventative STD screening under the Affordable Care Act, most providers will not reimburse patients for home tests.\u003c/p>\n\u003cp>\u003cstrong>No FDA Approval\u003c/strong>\u003c/p>\n\u003cp>If you do decide to purchase a home test, you should know the Food and Drug Administration has only approved \u003ca href=\"https://www.cdc.gov/hiv/testing/hometests.html\" target=\"_blank\" rel=\"noopener\">two HIV tests\u003c/a> for the home market. Anything beyond that, the quality of different products may vary.\u003c/p>\n\u003cp>“The people who draw your blood in a hospital or in clinic are all trained, and they obtain specimens that have no inconsistency,\" said Dr. Norman Paradis, an emergency room physician who teaches at the Geisel School of Medicine at Dartmouth College. \"But some of the new devices for doing this on yourself at home haven't been validated to the same extent.”\u003c/p>\n\u003cp>The CEO of myLab Box, Lora Ivanova, said results are tested in a lab meeting the standards of the \u003ca href=\"https://www.cms.gov/Regulations-and-Guidance/Legislation/CLIA/index.html?redirect=/CLIA/\" target=\"_blank\" rel=\"noopener\">Clinical Laboratory Improvement Amendments, \u003c/a>used by the federal government to certify labs.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Paradis says the benefits of home testing far outweigh the risks, as long as patients see a doctor when a test comes back positive and when experiencing abnormal symptoms.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "FDA Injunctions Send Clear Message: Stem Cell Clinics Beware",
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"content": "\u003cp>The Food and Drug Administration is getting serious about reining in stem cell clinics. On Wednesday, the agency \u003ca href=\"https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm607257.htm\" target=\"_blank\" rel=\"noopener\">announced\u003c/a> it wants to bar two of the largest clinic networks in the country from marketing their treatments, which would effectively halt their operations.\u003c/p>\n\u003caside class=\"pullquote alignright\">'The clinic customers are really the guinea pigs here. And they’re paying [up to] $20,000 for that right to be a guinea pig.'\u003ccite>Paul Knoepfler, UC Davis\u003c/cite>\u003c/aside>\n\u003cp>At the FDA’s request, the Department of Justice will seek permanent injunctions to halt the core stem cell therapy used by U.S. Stem Cell Clinic of Sunshine, Florida, as well as the California Stem Cell Treatment Center and its affiliated Cell Surgical Network Corporation, located in Southern California. The two businesses\u003cb> \u003c/b>have affiliations with dozens of other stem cell clinics across the country, and the FDA said their method of stem cell therapy is unapproved, untested, and potentially dangerous for patients.\u003c/p>\n\u003cp>The request for the Florida injunction was prompted by four cases of blindness that occurred after patients received stem cell injections. In the filing against the California stem cell clinics, the FDA pointed to the use of smallpox vaccine to help create and use an unproven cancer therapy.\u003c/p>\n\u003cp>The agency’s action reflects its growing concern over the increase in stem cell clinics — an estimated 700 of them have popped up across the nation, with operations in almost every state.\u003c/p>\n\u003cp>Paul Knoepfler, a cell biology professor at UC Davis, is a stem cell researcher and one of the early critics of what he calls rogue stem cell clinics. These businesses leverage the power and hope resonant in the words “stem cell therapy,” while offering treatments that carry a big price tag and lack regulatory approval, he said.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“The clinic customers are really the guinea pigs here,” Knoepfler said. “And they’re paying [up to] $20,000 for that right to be a guinea pig. These stem cells can do unexpected things, like grow tumors, or grow things where they’re not supposed to – like scar tissue inside someone’s eyeball.”\u003c/p>\n\u003cp>Many stem cell clinics promise cutting‐edge treatment for just about every malady imaginable, from impotence to autism to lymphoma to multiple sclerosis. To get stem cells for the treatment, many clinics suction off a patient’s belly fat, which contains stem cells, then create an extract of those cells to inject into other parts of the body. The theory is some of these cells might promote healing.\u003c/p>\n\u003cp>More traditional stem cell research has produced some impressive cures. But that process involves many levels of clinical trials and proof of efficacy before a treatment goes on the market, something stem cell clinics do not provide.\u003c/p>\n\u003cp>Knoepfler has compiled \u003ca href=\"http://www.cell.com/cms/attachment/2062931415/2065421495/mmc2.xlsx\">a list\u003c/a> of the roughly 700 clinics nationwide. “California is a hotspot state,” he said. “It’s the number one state. It has more than 100 clinics here.”\u003c/p>\n\u003cp>And the epicenter of that stem cell clinic activity is Southern California, and Beverly Hills in particular, which has 18 clinics, Knoepfler said.\u003c/p>\n\u003cp>The FDA began increasing oversight of stem cell clinics in August of last year, when it sent a warning letter to the U.S. Stem Cell Clinic in Florida, and at the same time asked U.S. marshals to conduct a raid on a company called StemImmune in San Diego, seizing vials of smallpox vaccine that were planned for use at two California Stem Cell Treatment Centers in Beverly Hills and Rancho Mirage.\u003c/p>\n\u003cp>And in November last year, the FDA \u003ca href=\"https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm585345.htm\">released tightened rules\u003c/a> for stem cell clinics, making clear that fat-derived stem cell therapies would be classified as a drug and should be subject to FDA approval.\u003c/p>\n\u003cp>The stem cell clinic owners at the two targeted sites said they’ll vigorously fight the requested injunctions. Their argument is that people’s own cells cannot be classified as a drug or drug therapy, and that people should be allowed to use them in any way they want.\u003c/p>\n\u003cp>In a company statement, the Florida-based U.S. Stem Cell said it “believes that the patient and physician have the right to decide whether or not to use a patient’s own cells for a therapeutic purpose without federal government interference.”\u003c/p>\n\u003cp>Knoepfler said the issue should not prompt a philosophical debate; it’s simply about patient safety.\u003c/p>\n\u003cp>“In theory the FDA can invoke criminal consequences, though we haven’t really seen that happen yet,” he said. “But with involvement of the Department of Justice in these particular cases with the injunctions, that to me seems a pretty serious indicator that this is something for stem cell clinics to take seriously.”\u003c/p>\n\u003cp>\u003cstrong>A Bigger Stick?\u003c/strong>\u003c/p>\n\u003cp>There is one more stick, yet to be wielded, that might be used to limit what therapies stem cell clinics can offer, and what claims they can make. The national Federation of State Medical Boards on May 8 released new\u003ca href=\"http://www.fsmb.org/globalassets/advocacy/policies/fsmb-stem-cell-workgroup-report.pdf\"> best-practices guidelines\u003c/a> for stem cell clinics. That’s significant because medical boards hold and can withdraw one of the things physicians value most: their medical license.\u003c/p>\n\u003cp>The recommendations are far-reaching: Medical boards can review and potentially withdraw licenses if stem cell clinics they are affiliated with make unsubstantiated claims, promote therapies not supported by science or use nondisclosure agreements to settle complaints.\u003c/p>\n\u003cp>Fines levied and court action taken by the FDA certainly can get people's attention, Knoepfler said, but the medical board federation's stance could be the real game-changer.\u003c/p>\n\u003cp>If doctors at stem cell clinics lose their medical license, it would cripple their credibility, impact their livelihood and potentially start an exodus of medical professionals out of the industry, he said.\u003c/p>\n\u003cp>“Somehow with the medical board license, for physicians it’s more of a tangible thing to take seriously,” Knoepfler said.\u003c/p>\n\u003cp> \u003c/p>\n\u003cp>\u003c/p>\n\u003cp> \u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The Food and Drug Administration is getting serious about reining in stem cell clinics. On Wednesday, the agency \u003ca href=\"https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm607257.htm\" target=\"_blank\" rel=\"noopener\">announced\u003c/a> it wants to bar two of the largest clinic networks in the country from marketing their treatments, which would effectively halt their operations.\u003c/p>\n\u003caside class=\"pullquote alignright\">'The clinic customers are really the guinea pigs here. And they’re paying [up to] $20,000 for that right to be a guinea pig.'\u003ccite>Paul Knoepfler, UC Davis\u003c/cite>\u003c/aside>\n\u003cp>At the FDA’s request, the Department of Justice will seek permanent injunctions to halt the core stem cell therapy used by U.S. Stem Cell Clinic of Sunshine, Florida, as well as the California Stem Cell Treatment Center and its affiliated Cell Surgical Network Corporation, located in Southern California. The two businesses\u003cb> \u003c/b>have affiliations with dozens of other stem cell clinics across the country, and the FDA said their method of stem cell therapy is unapproved, untested, and potentially dangerous for patients.\u003c/p>\n\u003cp>The request for the Florida injunction was prompted by four cases of blindness that occurred after patients received stem cell injections. In the filing against the California stem cell clinics, the FDA pointed to the use of smallpox vaccine to help create and use an unproven cancer therapy.\u003c/p>\n\u003cp>The agency’s action reflects its growing concern over the increase in stem cell clinics — an estimated 700 of them have popped up across the nation, with operations in almost every state.\u003c/p>\n\u003cp>Paul Knoepfler, a cell biology professor at UC Davis, is a stem cell researcher and one of the early critics of what he calls rogue stem cell clinics. These businesses leverage the power and hope resonant in the words “stem cell therapy,” while offering treatments that carry a big price tag and lack regulatory approval, he said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“The clinic customers are really the guinea pigs here,” Knoepfler said. “And they’re paying [up to] $20,000 for that right to be a guinea pig. These stem cells can do unexpected things, like grow tumors, or grow things where they’re not supposed to – like scar tissue inside someone’s eyeball.”\u003c/p>\n\u003cp>Many stem cell clinics promise cutting‐edge treatment for just about every malady imaginable, from impotence to autism to lymphoma to multiple sclerosis. To get stem cells for the treatment, many clinics suction off a patient’s belly fat, which contains stem cells, then create an extract of those cells to inject into other parts of the body. The theory is some of these cells might promote healing.\u003c/p>\n\u003cp>More traditional stem cell research has produced some impressive cures. But that process involves many levels of clinical trials and proof of efficacy before a treatment goes on the market, something stem cell clinics do not provide.\u003c/p>\n\u003cp>Knoepfler has compiled \u003ca href=\"http://www.cell.com/cms/attachment/2062931415/2065421495/mmc2.xlsx\">a list\u003c/a> of the roughly 700 clinics nationwide. “California is a hotspot state,” he said. “It’s the number one state. It has more than 100 clinics here.”\u003c/p>\n\u003cp>And the epicenter of that stem cell clinic activity is Southern California, and Beverly Hills in particular, which has 18 clinics, Knoepfler said.\u003c/p>\n\u003cp>The FDA began increasing oversight of stem cell clinics in August of last year, when it sent a warning letter to the U.S. Stem Cell Clinic in Florida, and at the same time asked U.S. marshals to conduct a raid on a company called StemImmune in San Diego, seizing vials of smallpox vaccine that were planned for use at two California Stem Cell Treatment Centers in Beverly Hills and Rancho Mirage.\u003c/p>\n\u003cp>And in November last year, the FDA \u003ca href=\"https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm585345.htm\">released tightened rules\u003c/a> for stem cell clinics, making clear that fat-derived stem cell therapies would be classified as a drug and should be subject to FDA approval.\u003c/p>\n\u003cp>The stem cell clinic owners at the two targeted sites said they’ll vigorously fight the requested injunctions. Their argument is that people’s own cells cannot be classified as a drug or drug therapy, and that people should be allowed to use them in any way they want.\u003c/p>\n\u003cp>In a company statement, the Florida-based U.S. Stem Cell said it “believes that the patient and physician have the right to decide whether or not to use a patient’s own cells for a therapeutic purpose without federal government interference.”\u003c/p>\n\u003cp>Knoepfler said the issue should not prompt a philosophical debate; it’s simply about patient safety.\u003c/p>\n\u003cp>“In theory the FDA can invoke criminal consequences, though we haven’t really seen that happen yet,” he said. “But with involvement of the Department of Justice in these particular cases with the injunctions, that to me seems a pretty serious indicator that this is something for stem cell clinics to take seriously.”\u003c/p>\n\u003cp>\u003cstrong>A Bigger Stick?\u003c/strong>\u003c/p>\n\u003cp>There is one more stick, yet to be wielded, that might be used to limit what therapies stem cell clinics can offer, and what claims they can make. The national Federation of State Medical Boards on May 8 released new\u003ca href=\"http://www.fsmb.org/globalassets/advocacy/policies/fsmb-stem-cell-workgroup-report.pdf\"> best-practices guidelines\u003c/a> for stem cell clinics. That’s significant because medical boards hold and can withdraw one of the things physicians value most: their medical license.\u003c/p>\n\u003cp>The recommendations are far-reaching: Medical boards can review and potentially withdraw licenses if stem cell clinics they are affiliated with make unsubstantiated claims, promote therapies not supported by science or use nondisclosure agreements to settle complaints.\u003c/p>\n\u003cp>Fines levied and court action taken by the FDA certainly can get people's attention, Knoepfler said, but the medical board federation's stance could be the real game-changer.\u003c/p>\n\u003cp>If doctors at stem cell clinics lose their medical license, it would cripple their credibility, impact their livelihood and potentially start an exodus of medical professionals out of the industry, he said.\u003c/p>\n\u003cp>“Somehow with the medical board license, for physicians it’s more of a tangible thing to take seriously,” Knoepfler said.\u003c/p>\n\u003cp> \u003c/p>\n\u003cp>\u003c/p>\n\u003cp> \u003c/p>\n\n\u003c/div>\u003c/p>",
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"rss": "https://podcasts.files.bbci.co.uk/p02nq0gn.rss"
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},
"californiareport": {
"id": "californiareport",
"title": "The California Report",
"tagline": "California, day by day",
"info": "KQED’s statewide radio news program providing daily coverage of issues, trends and public policy decisions.",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/The-California-Report-Podcast-Tile-703x703-1.jpg",
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"officialWebsiteLink": "/californiareport",
"meta": {
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"source": "kqed",
"order": 8
},
"link": "/californiareport",
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"amazon": "https://music.amazon.com/podcasts/26099305-72af-4542-9dde-ac1807fe36d5/kqed-s-the-california-report",
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}
},
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"id": "californiareportmagazine",
"title": "The California Report Magazine",
"tagline": "Your state, your stories",
"info": "Every week, The California Report Magazine takes you on a road trip for the ears: to visit the places and meet the people who make California unique. The in-depth storytelling podcast from the California Report.",
"airtime": "FRI 4:30pm-5pm, 6:30pm-7pm, 11pm-11:30pm",
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"officialWebsiteLink": "/californiareportmagazine",
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"order": 10
},
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM3NjkwNjk1OTAz",
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},
"city-arts": {
"id": "city-arts",
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"info": "A one-hour radio program to hear celebrated writers, artists and thinkers address contemporary ideas and values, often discussing the creative process. Please note: tapes or transcripts are not available",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/05/cityartsandlecture-300x300.jpg",
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"airtime": "SUN 1pm-2pm, TUE 10pm, WED 1am",
"meta": {
"site": "news",
"source": "City Arts & Lectures"
},
"link": "https://www.cityarts.net",
"subscribe": {
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"rss": "https://www.cityarts.net/feed/"
}
},
"closealltabs": {
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"order": 1
},
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"title": "Code Switch / Life Kit",
"info": "\u003cem>Code Switch\u003c/em>, which listeners will hear in the first part of the hour, has fearless and much-needed conversations about race. Hosted by journalists of color, the show tackles the subject of race head-on, exploring how it impacts every part of society — from politics and pop culture to history, sports and more.\u003cbr />\u003cbr />\u003cem>Life Kit\u003c/em>, which will be in the second part of the hour, guides you through spaces and feelings no one prepares you for — from finances to mental health, from workplace microaggressions to imposter syndrome, from relationships to parenting. The show features experts with real world experience and shares their knowledge. Because everyone needs a little help being human.\u003cbr />\u003cbr />\u003ca href=\"https://www.npr.org/podcasts/510312/codeswitch\">\u003cem>Code Switch\u003c/em> offical site and podcast\u003c/a>\u003cbr />\u003ca href=\"https://www.npr.org/lifekit\">\u003cem>Life Kit\u003c/em> offical site and podcast\u003c/a>\u003cbr />",
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"id": "commonwealth-club",
"title": "Commonwealth Club of California Podcast",
"info": "The Commonwealth Club of California is the nation's oldest and largest public affairs forum. As a non-partisan forum, The Club brings to the public airwaves diverse viewpoints on important topics. The Club's weekly radio broadcast - the oldest in the U.S., dating back to 1924 - is carried across the nation on public radio stations and is now podcasting. Our website archive features audio of our recent programs, as well as selected speeches from our long and distinguished history. This podcast feed is usually updated twice a week and is always un-edited.",
"airtime": "THU 10pm, FRI 1am",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Commonwealth-Club-Podcast-Tile-360x360-1.jpg",
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"meta": {
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"source": "Commonwealth Club of California"
},
"link": "/radio/program/commonwealth-club",
"subscribe": {
"apple": "https://itunes.apple.com/us/podcast/commonwealth-club-of-california-podcast/id976334034?mt=2",
"google": "https://podcasts.google.com/feed/aHR0cDovL3d3dy5jb21tb253ZWFsdGhjbHViLm9yZy9hdWRpby9wb2RjYXN0L3dlZWtseS54bWw",
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}
},
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"id": "forum",
"title": "Forum",
"tagline": "The conversation starts here",
"info": "KQED’s live call-in program discussing local, state, national and international issues, as well as in-depth interviews.",
"airtime": "MON-FRI 9am-11am, 10pm-11pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Forum-Podcast-Tile-703x703-1.jpg",
"imageAlt": "KQED Forum with Mina Kim and Alexis Madrigal",
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"meta": {
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"source": "kqed",
"order": 9
},
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM5NTU3MzgxNjMz",
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"id": "freakonomics-radio",
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"imageSrc": "https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/05/freakonomicsRadio.png",
"officialWebsiteLink": "http://freakonomics.com/",
"airtime": "SUN 1am-2am, SAT 3pm-4pm",
"meta": {
"site": "radio",
"source": "WNYC"
},
"link": "/radio/program/freakonomics-radio",
"subscribe": {
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"apple": "https://itunes.apple.com/us/podcast/freakonomics-radio/id354668519",
"tuneIn": "https://tunein.com/podcasts/WNYC-Podcasts/Freakonomics-Radio-p272293/",
"rss": "https://feeds.feedburner.com/freakonomicsradio"
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},
"fresh-air": {
"id": "fresh-air",
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"apple": "https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=214089682&at=11l79Y&ct=nprdirectory",
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"info": "A live production of NPR and WBUR Boston, in collaboration with stations across the country, Here & Now reflects the fluid world of news as it's happening in the middle of the day, with timely, in-depth news, interviews and conversation. Hosted by Robin Young, Jeremy Hobson and Tonya Mosley.",
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},
"hidden-brain": {
"id": "hidden-brain",
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"info": "Shankar Vedantam uses science and storytelling to reveal the unconscious patterns that drive human behavior, shape our choices and direct our relationships.",
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"airtime": "SUN 7pm-8pm",
"meta": {
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"source": "NPR"
},
"link": "/radio/program/hidden-brain",
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},
"how-i-built-this": {
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"title": "How I Built This with Guy Raz",
"info": "Guy Raz dives into the stories behind some of the world's best known companies. How I Built This weaves a narrative journey about innovators, entrepreneurs and idealists—and the movements they built.",
"imageSrc": "https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/05/howIBuiltThis.png",
"officialWebsiteLink": "https://www.npr.org/podcasts/510313/how-i-built-this",
"airtime": "SUN 7:30pm-8pm",
"meta": {
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"source": "npr"
},
"link": "/radio/program/how-i-built-this",
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"npr": "https://rpb3r.app.goo.gl/3zxy",
"apple": "https://itunes.apple.com/us/podcast/how-i-built-this-with-guy-raz/id1150510297?mt=2",
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},
"hyphenacion": {
"id": "hyphenacion",
"title": "Hyphenación",
"tagline": "Where conversation and cultura meet",
"info": "What kind of no sabo word is Hyphenación? For us, it’s about living within a hyphenation. Like being a third-gen Mexican-American from the Texas border now living that Bay Area Chicano life. Like Xorje! Each week we bring together a couple of hyphenated Latinos to talk all about personal life choices: family, careers, relationships, belonging … everything is on the table. ",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2025/03/Hyphenacion_FinalAssets_PodcastTile.png",
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"officialWebsiteLink": "/podcasts/hyphenacion",
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"order": 15
},
"link": "/podcasts/hyphenacion",
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},
"jerrybrown": {
"id": "jerrybrown",
"title": "The Political Mind of Jerry Brown",
"tagline": "Lessons from a lifetime in politics",
"info": "The Political Mind of Jerry Brown brings listeners the wisdom of the former Governor, Mayor, and presidential candidate. Scott Shafer interviewed Brown for more than 40 hours, covering the former governor's life and half-century in the political game – and Brown has some lessons he'd like to share. ",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/The-Political-Mind-of-Jerry-Brown-Podcast-Tile-703x703-1.jpg",
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"officialWebsiteLink": "/podcasts/jerrybrown",
"meta": {
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"order": 18
},
"link": "/podcasts/jerrybrown",
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"apple": "https://itunes.apple.com/us/podcast/id1492194549",
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}
},
"latino-usa": {
"id": "latino-usa",
"title": "Latino USA",
"airtime": "MON 1am-2am, SUN 6pm-7pm",
"info": "Latino USA, the radio journal of news and culture, is the only national, English-language radio program produced from a Latino perspective.",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/latinoUsa.jpg",
"officialWebsiteLink": "http://latinousa.org/",
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},
"link": "/radio/program/latino-usa",
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"apple": "https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=79681317&at=11l79Y&ct=nprdirectory",
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"rss": "https://feeds.npr.org/510016/podcast.xml"
}
},
"marketplace": {
"id": "marketplace",
"title": "Marketplace",
"info": "Our flagship program, helmed by Kai Ryssdal, examines what the day in money delivered, through stories, conversations, newsworthy numbers and more. Updated Monday through Friday at about 3:30 p.m. PT.",
"airtime": "MON-FRI 4pm-4:30pm, MON-WED 6:30pm-7pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Marketplace-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.marketplace.org/",
"meta": {
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"source": "American Public Media"
},
"link": "/radio/program/marketplace",
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"rss": "https://feeds.publicradio.org/public_feeds/marketplace-pm/rss/rss"
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},
"masters-of-scale": {
"id": "masters-of-scale",
"title": "Masters of Scale",
"info": "Masters of Scale is an original podcast in which LinkedIn co-founder and Greylock Partner Reid Hoffman sets out to describe and prove theories that explain how great entrepreneurs take their companies from zero to a gazillion in ingenious fashion.",
"airtime": "Every other Wednesday June 12 through October 16 at 8pm (repeats Thursdays at 2am)",
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"officialWebsiteLink": "https://mastersofscale.com/",
"meta": {
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"source": "WaitWhat"
},
"link": "/radio/program/masters-of-scale",
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"rss": "https://rss.art19.com/masters-of-scale"
}
},
"mindshift": {
"id": "mindshift",
"title": "MindShift",
"tagline": "A podcast about the future of learning and how we raise our kids",
"info": "The MindShift podcast explores the innovations in education that are shaping how kids learn. Hosts Ki Sung and Katrina Schwartz introduce listeners to educators, researchers, parents and students who are developing effective ways to improve how kids learn. We cover topics like how fed-up administrators are developing surprising tactics to deal with classroom disruptions; how listening to podcasts are helping kids develop reading skills; the consequences of overparenting; and why interdisciplinary learning can engage students on all ends of the traditional achievement spectrum. This podcast is part of the MindShift education site, a division of KQED News. KQED is an NPR/PBS member station based in San Francisco. You can also visit the MindShift website for episodes and supplemental blog posts or tweet us \u003ca href=\"https://twitter.com/MindShiftKQED\">@MindShiftKQED\u003c/a> or visit us at \u003ca href=\"/mindshift\">MindShift.KQED.org\u003c/a>",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Mindshift-Podcast-Tile-703x703-1.jpg",
"imageAlt": "KQED MindShift: How We Will Learn",
"officialWebsiteLink": "/mindshift/",
"meta": {
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"source": "kqed",
"order": 12
},
"link": "/podcasts/mindshift",
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM1NzY0NjAwNDI5",
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}
},
"morning-edition": {
"id": "morning-edition",
"title": "Morning Edition",
"info": "\u003cem>Morning Edition\u003c/em> takes listeners around the country and the world with multi-faceted stories and commentaries every weekday. Hosts Steve Inskeep, David Greene and Rachel Martin bring you the latest breaking news and features to prepare you for the day.",
"airtime": "MON-FRI 3am-9am",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Morning-Edition-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.npr.org/programs/morning-edition/",
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"link": "/radio/program/morning-edition"
},
"onourwatch": {
"id": "onourwatch",
"title": "On Our Watch",
"tagline": "Deeply-reported investigative journalism",
"info": "For decades, the process for how police police themselves has been inconsistent – if not opaque. In some states, like California, these proceedings were completely hidden. After a new police transparency law unsealed scores of internal affairs files, our reporters set out to examine these cases and the shadow world of police discipline. On Our Watch brings listeners into the rooms where officers are questioned and witnesses are interrogated to find out who this system is really protecting. Is it the officers, or the public they've sworn to serve?",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/On-Our-Watch-Podcast-Tile-703x703-1.jpg",
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"officialWebsiteLink": "/podcasts/onourwatch",
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"source": "kqed",
"order": 11
},
"link": "/podcasts/onourwatch",
"subscribe": {
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5ucHIub3JnLzUxMDM2MC9wb2RjYXN0LnhtbD9zYz1nb29nbGVwb2RjYXN0cw",
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"rss": "https://feeds.npr.org/510360/podcast.xml"
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},
"on-the-media": {
"id": "on-the-media",
"title": "On The Media",
"info": "Our weekly podcast explores how the media 'sausage' is made, casts an incisive eye on fluctuations in the marketplace of ideas, and examines threats to the freedom of information and expression in America and abroad. For one hour a week, the show tries to lift the veil from the process of \"making media,\" especially news media, because it's through that lens that we see the world and the world sees us",
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"info": "One of public radio's most dynamic voices, Sam Sanders helped launch The NPR Politics Podcast and hosted NPR's hit show It's Been A Minute. Now, the award-winning host returns with something brand new, The Sam Sanders Show. Every week, Sam Sanders and friends dig into the culture that shapes our lives: what's driving the biggest trends, how artists really think, and even the memes you can't stop scrolling past. Sam is beloved for his way of unpacking the world and bringing you up close to fresh currents and engaging conversations. The Sam Sanders Show is smart, funny and always a good time.",
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