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"content": "\u003ch3>\u003cem>An alleged killer is now in custody. But critics say the familial DNA testing that helped track him down allows for searches of innocent people who happen to be related to someone suspected of committing a crime or otherwise provided their DNA for inclusion in a database.\u003c/em>\u003c/h3>\n\u003cp>One of the main investigators who helped capture Joseph DeAngelo, the alleged California serial rapist and killer, says his team used a public DNA matching website to track DeAngelo down.\u003c/p>\n\u003cp>The site allows users who have DNA profiles from commercial companies such as Ancestry.com and 23andMe to expand their search for relatives.Lead investigator Paul Holes tells the \u003ca href=\"https://www.mercurynews.com/2018/04/26/ancestry-23andme-deny-assisting-law-enforcement-in-east-area-rapist-case/\" target=\"_blank\" rel=\"noopener\">San Jose Mercury News\u003c/a> that one of his team's biggest tools in catching DeAngelo, who eluded law enforcement for four decades, was GEDMatch, a free, Florida-based site that pools DNA profiles that people upload and share publicly.\u003c/p>\n\u003cp>Major companies, such as 23andMe and Ancestry, do not allow law enforcement to access their genetic data unless they get a court order.\u003c/p>\n\u003cp>Holes says officials did not need a court order to access GEDMatch's large database of genetic blueprints.\u003c/p>\n\u003cp>Privacy concerns have been raised over investigators' use of a genealogical website to find DeAngelo, who was arrested Tuesday. Investigators say they matched crime-scene DNA using genetic material stored by a distant relative on the site.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Authorities say it's an innovative technique that broke open the long-cold case of the Golden State Killer, who slew at least a dozen people and raped 50 women from 1976 to 1986.\u003c/p>\n\u003cp>But Steve Mercer of the Maryland public defender's office says it pinpoints a problem: There aren't strong privacy laws to keep police from trolling such databases.\u003c/p>\n\u003cp>Mercer says right now, people who submit DNA to be tested to find their ancestors can unwittingly become \"genetic informants\" on family members.\u003c/p>\n\u003cp>\"People who submit DNA for ancestors testing are unwittingly becoming genetic informants on their innocent family,\" Mercer said, adding that they \"have fewer privacy protections than convicted offenders whose DNA is contained in regulated databanks.\"\u003c/p>\n\u003cp>The technique that investigators used is known as familial DNA testing, and it has previously raised ethical issues in the forensics community. Typically with the method, investigators search law enforcement databases to identify likely relatives of the person who may have committed the crime.\u003c/p>\n\u003cp>Critics say that familial DNA testing allows for searches of innocent people who happen to be related to someone suspected of committing a crime or otherwise provided their DNA for inclusion in a database. Law enforcement officials have argued the technique can provide investigators with valuable leads.\u003c/p>\n\u003cp>In 2008, California became the first state in the country to authorize the testing. It since has been used in at least eight other states.\u003c/p>\n\u003cp>The method led to the arrest of Lonnie Franklin Jr. in the Los Angeles \"Grim Sleeper\" serial killings from 1985 to 2007. Los Angeles County sheriff's officials also used it last year to solve the decades-old killing of the ex-wife of Righteous Brothers singer Bill Medley.\u003c/p>\n\u003cp>\u003cstrong>DeAngelo Arrest\u003c/strong>\u003c/p>\n\u003cp>Joseph James DeAngelo, 72, was arrested Tuesday. After investigators matched crime-scene \u003ca href=\"https://apnews.com/7621f268d720428e87eaacf73b2f7d3b/A-look-at-DNA-testing-that-ID%27d-a-suspected-serial-killer\">DNA\u003c/a> with a relative, they narrowed it down to the Sacramento-area grandfather using DNA obtained from material he'd discarded, Sacramento County District Attorney Anne Marie Schubert said.\u003c/p>\n\u003cp>DNA potentially may have played an earlier role in the case. It was just coming into use as a criminal investigative tool in 1986 when the predator variously known as the East Area Rapist and the Golden State Killer apparently ended his decade-long wave of attacks.\u003c/p>\n\u003cp>DeAngelo, a former police officer, probably would have known about the new method, experts said.\u003c/p>\n\u003cp>\"He knew police techniques,\" said John Jay College of Criminal Justice professor Louis Schlesinger. \"He was smart.\"\u003c/p>\n\u003cp>No one who knew DeAngelo over the decades connected him with the string of at least a dozen murders, 50 rapes and dozens of burglaries from 1976 to 1986 throughout the state.\u003c/p>\n\u003cp>After he was identified as the suspect, however, prosecutors rushed to charge him with eight killings.\u003c/p>\n\u003cp>In addition, police in the central California farming town of Visalia said Thursday that DeAngelo is a suspect in a 13th killing and about 100 burglaries in the area.\u003c/p>\n\u003cp>In 1975, of community college teacher Claude Snelling was shot while trying to stop a masked intruder from kidnapping his 16-year-old daughter from his home.\u003c/p>\n\u003cp>Investigators lacked DNA evidence so Snelling's death and the burglaries weren't included in the tally of Golden State Killer crimes but fingerprints and shoe tracks will be reviewed for matches to DeAngelo, Visalia Police Chief Jason Salazar said.\u003c/p>\n\u003cp>Investigators searched DeAngelo's home on Thursday, looking for class rings, earrings, dishes and other items that were taken from crime scenes as well as weapons.\u003c/p>\n\u003cp>Meanwhile, DeAngelo's neighbors, relatives and former acquaintances all say they had no inkling that he could be a serial killer. He worked nearly three decades in a Sacramento-area supermarket warehouse as a truck mechanic, retiring last year. As a neighbor, he was known for taking meticulous care of his lawn in suburban Citrus Heights.\u003c/p>\n\u003cp>DeAngelo worked as a police officer in the farming town of Exeter, not far from Visalia, from 1973 to 1976.\u003c/p>\n\u003cp>DeAngelo was a \"black sheep\" who didn't joke around with other officers, said Farrel Ward, 75, who served on the force with DeAngelo.\u003c/p>\n\u003cp>Ward said it's possible that DeAngelo helped with the search for Snelling's killer and the elusive burglar but he doesn't recall DeAngelo directly investigating the killing.\u003c/p>\n\u003cp>\"I've been thinking, but there's no indication whatsoever that anything was wrong,\" Ward said. \"How could you just go out and kill somebody and go back and go to work? I don't understand that.\"\u003c/p>\n\u003cp>Later, DeAngelo joined the Auburn Police Department outside of Sacramento but was fired in 1979 after he was caught shoplifting a hammer and dog repellent.\u003c/p>\n\u003cp>Investigators say they have linked DeAngelo to 11 killings that occurred after he was fired.\u003c/p>\n\u003cp>James Huddle said he always hoped police would catch the killer whose attacks prompted him to buy a pistol.\u003c/p>\n\u003cp>But he was stunned to find out the man arrested was DeAngelo, his former brother-in-law.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>Huddle said it was \"still just going crazy in my mind.\"\u003c/p>\n\n",
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"content": "\u003cp>Killer robots have been a staple of TV and movies for decades, from \u003cem>Westworld\u003c/em> to \u003cem>The Terminator \u003c/em>series. But in the real world, killer robots are officially known as \"autonomous weapons.\"\u003c/p>\n\u003cp>[contextly_sidebar id=\"eJw1zUjAAKCjwH7SulfcR9YdigYQG11O\"]At the Pentagon, Paul Scharre helped create the U.S. policy for such weapons. In his new book, \u003cem>Army of None: Autonomous Weapons and the Future of War, \u003c/em>Scharre discusses the state of these weapons today.\u003c/p>\n\u003cp>\"Killer robots\" might be a bit sensational, he says, but what he's talking about is a weapon that could \"go out on its own and make its own decisions about who to kill on the battlefield.\"\u003c/p>\n\u003cp>At least 30 countries have autonomous weapons that are supervised by humans for defensive purposes, Scharre says.\u003c/p>\n\u003cp>\"[These are] things that would target incoming missiles and shoot them down entirely on their own,\" he says. \"Humans are sitting there at the console that could turn it off if they need to. But in a simple way, those are autonomous weapons.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Scharre says while the current weapons are not like those seen in the movies, the technology is advancing, whether people like it or not.\u003c/p>\n\u003cp>\"Things like more advanced hobby drones, the same technology that will go into self-driving cars, all of those sensors and intelligence will make autonomous weapons also possible,\" he says.\u003c/p>\n\u003cp>[contextly_sidebar id=\"WCz51LeCnbE8x0G4ZrsNGroJshUbo3nK\"]In his book, Scharre looks at the question: \"How hard would it be for someone to build a simple, autonomous weapon in their garage?\"\u003c/p>\n\u003cp>And while that's a scary scenario, he says that it's already happening on some levels as students today are learning programming skills, with free and readily available online resources.\u003c/p>\n\u003cp>\"These tools are available for free download. You can download them online,\" he says. \"[It] took me about three minutes online to find all of the free tools you would need to download this technology and make it happen.\"\u003c/p>\n\u003cp>And while high school students aren't creating these autonomous weapons, the ability to do so is a real possibility. Because of that, Scharre says the debate isn't so much about if this type of technology should be created, but more so what should be done about it.\u003c/p>\n\u003cp>\"What do we do with this? Do we build weaponized versions of them? Do you build them en masse? Do militaries invest in this?\" are all questions being asked as this technology would drastically change warfare.[contextly_sidebar id=\"kEIX8BCTWt9GXcGk8DTx7MsEwX0vyuig\"]\u003c/p>\n\u003cp>\"[It would create] a domain of warfare where humans have less control over what happens on the battlefield — where humans are no longer deciding who lives and who dies, and machines are making those decisions,\" Scharre says.\u003c/p>\n\u003cp>Debates like this are happening in countries all around the world, including those that have repeatedly violated international rules.\u003c/p>\n\u003cp>In Russia, the military is working to create a fleet of \u003ca href=\"http://nationalinterest.org/blog/the-buzz/russia-building-army-robots-24969\" target=\"_blank\" rel=\"noopener\">armed ground robots.\u003c/a>\u003c/p>\n\u003cp>\"They're building large, ground combat vehicles that have anti-tank missiles on them,\" Scharre says. \"Russian generals have talked about a vision in the future of fully robotized units that are independently conducting operations, so other countries are leaning hard into this technology.\"\u003c/p>\n\u003cp>Scharre says that one of the fears of this technology advancing is that \"flash wars\" could occur. Much like a \"flash crash\" in the stock market, a \"flash war\" would occur at such as fast pace that humans would not be involved.\u003c/p>\n\u003cp>[contextly_sidebar id=\"jrjhwoGs48lNnv3YJd09gywhycA0hUD0\"]\"The worry is that you get an equivalent — a flash war, where algorithms interact in some way and the robots start shooting each other and running amuck, and then humans are scrambling to put a lid back on it,\" Scharre says.\u003c/p>\n\u003cp>But, though some scenarios are terrifying, other people argue that autonomous weapons could save lives, by making fewer mistakes than might result from human error.\u003c/p>\n\u003cp>\"Just like self-driving cars could someday make the roads much safer, some people have argued, 'Well, maybe autonomous weapons could be more precise and more humane. By avoiding civilian casualties in war and only killing the enemy,' \" Scharre says.\u003c/p>\n\u003cp>From his own experience in the military serving as a special operations agent, Scharre says he has been in a situation in which an autonomous weapon would have killed a girl that the Taliban was using as a scout, but that soldiers did not target.\u003c/p>\n\u003cp>He says it's situations like that which highlight differences between what is legal in the laws of war and what is morally right — something that autonomous weapons might not distinguish.\u003c/p>\n\u003cp>\"That is one of the concerns that people raise about autonomous weapons is a lack of an ability to feel empathy and to engage in mercy in war,\" Scharre says. \"And that if we built these weapons, they would take away a powerful restraint in warfare that humans have.\"\u003c/p>\n\u003cp>There's still a lot to consider and discuss when it comes to autonomous weapons and the increasing technology, Scharre says. But as for whether humans are doomed, he says there is not a clear answer.\u003c/p>\n\u003cp>\"We do have the opportunity to shape how we use technology. We're not at the mercy of it,\" Schare says. \"The problem at the end of the day isn't the technology. It's getting humans to cooperate together on how we use the technology and make sure that we're using it for good and not for harm.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Noah Caldwell and Emily Kopp produced and edited the audio for this story. Wynne Davis adapted it for Web. \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=Autonomous+Weapons+Would+Take+Warfare+To+A+New+Domain%2C+Without+Humans&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Killer robots have been a staple of TV and movies for decades, from \u003cem>Westworld\u003c/em> to \u003cem>The Terminator \u003c/em>series. But in the real world, killer robots are officially known as \"autonomous weapons.\"\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>At the Pentagon, Paul Scharre helped create the U.S. policy for such weapons. In his new book, \u003cem>Army of None: Autonomous Weapons and the Future of War, \u003c/em>Scharre discusses the state of these weapons today.\u003c/p>\n\u003cp>\"Killer robots\" might be a bit sensational, he says, but what he's talking about is a weapon that could \"go out on its own and make its own decisions about who to kill on the battlefield.\"\u003c/p>\n\u003cp>At least 30 countries have autonomous weapons that are supervised by humans for defensive purposes, Scharre says.\u003c/p>\n\u003cp>\"[These are] things that would target incoming missiles and shoot them down entirely on their own,\" he says. \"Humans are sitting there at the console that could turn it off if they need to. But in a simple way, those are autonomous weapons.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Scharre says while the current weapons are not like those seen in the movies, the technology is advancing, whether people like it or not.\u003c/p>\n\u003cp>\"Things like more advanced hobby drones, the same technology that will go into self-driving cars, all of those sensors and intelligence will make autonomous weapons also possible,\" he says.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>In his book, Scharre looks at the question: \"How hard would it be for someone to build a simple, autonomous weapon in their garage?\"\u003c/p>\n\u003cp>And while that's a scary scenario, he says that it's already happening on some levels as students today are learning programming skills, with free and readily available online resources.\u003c/p>\n\u003cp>\"These tools are available for free download. You can download them online,\" he says. \"[It] took me about three minutes online to find all of the free tools you would need to download this technology and make it happen.\"\u003c/p>\n\u003cp>And while high school students aren't creating these autonomous weapons, the ability to do so is a real possibility. Because of that, Scharre says the debate isn't so much about if this type of technology should be created, but more so what should be done about it.\u003c/p>\n\u003cp>\"What do we do with this? Do we build weaponized versions of them? Do you build them en masse? 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Much like a \"flash crash\" in the stock market, a \"flash war\" would occur at such as fast pace that humans would not be involved.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\"The worry is that you get an equivalent — a flash war, where algorithms interact in some way and the robots start shooting each other and running amuck, and then humans are scrambling to put a lid back on it,\" Scharre says.\u003c/p>\n\u003cp>But, though some scenarios are terrifying, other people argue that autonomous weapons could save lives, by making fewer mistakes than might result from human error.\u003c/p>\n\u003cp>\"Just like self-driving cars could someday make the roads much safer, some people have argued, 'Well, maybe autonomous weapons could be more precise and more humane. By avoiding civilian casualties in war and only killing the enemy,' \" Scharre says.\u003c/p>\n\u003cp>From his own experience in the military serving as a special operations agent, Scharre says he has been in a situation in which an autonomous weapon would have killed a girl that the Taliban was using as a scout, but that soldiers did not target.\u003c/p>\n\u003cp>He says it's situations like that which highlight differences between what is legal in the laws of war and what is morally right — something that autonomous weapons might not distinguish.\u003c/p>\n\u003cp>\"That is one of the concerns that people raise about autonomous weapons is a lack of an ability to feel empathy and to engage in mercy in war,\" Scharre says. \"And that if we built these weapons, they would take away a powerful restraint in warfare that humans have.\"\u003c/p>\n\u003cp>There's still a lot to consider and discuss when it comes to autonomous weapons and the increasing technology, Scharre says. But as for whether humans are doomed, he says there is not a clear answer.\u003c/p>\n\u003cp>\"We do have the opportunity to shape how we use technology. We're not at the mercy of it,\" Schare says. \"The problem at the end of the day isn't the technology. It's getting humans to cooperate together on how we use the technology and make sure that we're using it for good and not for harm.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Noah Caldwell and Emily Kopp produced and edited the audio for this story. Wynne Davis adapted it for Web. \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=Autonomous+Weapons+Would+Take+Warfare+To+A+New+Domain%2C+Without+Humans&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Medicare will require hospitals to post their standard prices online and make electronic medical records more readily available to patients, officials said Tuesday.\u003c/p>\n\u003cp>The program is also starting a comprehensive review of how it will pay for costly new forms of immunotherapy to battle cancer.[contextly_sidebar id=\"HODGqRLEtV1B3RpHUo0k0t9wyrSPA5lr\"]\u003c/p>\n\u003cp>Seema Verma, head of the Centers for Medicare and Medicaid Services, said the new requirement for online prices reflects the Trump administration’s ongoing efforts to encourage patients to become better-educated decision makers in their own care.\u003c/p>\n\u003cp>“We are just beginning on price transparency,” said Verma. “We know that hospitals have this information and we’re asking them to post what they have online.”\u003c/p>\n\u003cp>Hospitals are required to disclose prices publicly, but the latest change would put that information online in machine-readable format that can be easily processed by computers. It may still prove to be confusing to consumers, since standard rates are like list prices and don’t reflect what insurers and government programs pay.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Patients concerned about their potential out-of-pocket costs from a hospitalization would still be advised to consult with their insurer. Most insurance plans nowadays have an annual limit on how much patients must pay in copays and deductibles — although traditional Medicare does not.[contextly_sidebar id=\"2h9g5iEXdqdOugweYZDg5bWHhS2W2vNa\"]\u003c/p>\n\u003cp>Likewise, many health care providers already make computerized records available to patients, but starting in 2021 Medicare would base part of a hospital’s payments on how good a job they do.\u003c/p>\n\u003cp>Using electronic medical records remains a cumbersome task, and the Trump administration has invited technology companies to design secure apps that would let patients access their records from all their providers instead of having to go to different portals.\u003c/p>\n\u003cp>Verma also announced Medicare is starting a comprehensive review of how it will pay for a costly new form of immunotherapy called CAR-T. It’s gene therapy that turbocharges a patient’s own immune system cells to attack cancer.\u003c/p>\n\u003cp>Immune system T cells are filtered from the patient’s own blood and reprogrammed to target and kill cancer cells that had managed to evade them. Hundreds of millions of copies of the revved-up cells are then returned to the patient’s blood to take on the cancer.\u003c/p>\n\u003cp>Though only a couple of such treatments have been approved for blood cancers, the cost can exceed $370,000 per patient.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“It’s a new area for the agency,” said Verma. “We haven’t seen drugs priced at this level and we’re having to think about our strategy.”\u003c/p>\n\n",
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"disqusTitle": "Not All Teaching Hospitals Alike in Training Quality for Doctors",
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"content": "\u003cp>The patient’s breaths had become labored. He struggled to pull air from his mouth to his lungs. It got so bad late one Saturday night that he decided to say something about it the next time his nurse made rounds at Jackson South Community Hospital.\u003c/p>\n\u003cp>The complaint traveled from the nurse to a doctor, who looked at the patient’s records and quickly saw the problem: a feeding tube had been placed into the side of his lung. An anesthesiology trainee had inserted the tube without proper supervision, a federal health inspection later determined, and over the coming weeks, the patient developed pneumonia and sepsis related to the medical error. He was in the hospital two months longer than initially planned.\u003c/p>\n\u003caside class=\"pullquote alignright\">'Sometimes they’ll find minor violations. But the things that are really a threat to patients being alive, it’s hard to discount those.'\u003c/aside>\n\u003cp>Teaching hospitals like Jackson South, located in metro Miami, are where physician trainees get practice treating patients. They prepare the next generation of doctors, and they have a reputation as places of cutting-edge patient care, given their ties to academic institutions.\u003c/p>\n\u003cp>But at some of these hospitals, residents may be learning bad habits. A STAT analysis of federal inspection data finds that there’s a wide gap in the quality of training at teaching hospitals, as shown by how frequently these hospitals are cited for deficiencies by the Centers for Medicare and Medicaid Services. While the majority of the roughly 1,200 teaching hospitals received no citations each year from 2014 to 2017, others racked up dozens of safety violations in that time period — putting patients at risk, and compromising the training that students receive.\u003c/p>\n\u003cp>“In the places where young doctors-in-training practice, what they learn can affect how the person will practice for decades to come,” said Rosemary Gibson, a patient safety advocate and the author of the book “Wall of Silence.” “They’re developing habits … and it’s essential for trainees to learn in clinical settings where patient safety is baked into the system.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>At Jackson South, even before the hospital received a citation from CMS, administrators were analyzing how the feeding tube mistake happened and how to prevent similar errors in the future. They realized that the issue had to do with the initial reading of the X-ray, which is used to make sure doctors don’t misplace feeding tubes. The hospital put in place a pilot program to verify that feeding tubes are properly placed.\u003c/p>\n\u003cp>“We take every deficiency seriously and thoroughly investigate each safety violation,” a Jackson spokesperson said in a statement. “We implement plans to correct them.”\u003c/p>\n\u003cp>Teaching hospitals are making some positive changes, and according to STAT’s analysis, that’s led the average number of violations per teaching hospital to drop to its lowest point in three years, following a major spike in 2015 and 2016. But experts worry that the remaining mishaps mean that America’s future doctors aren’t always being prepared to practice medicine safely.\u003c/p>\n\u003cp>“If residents train in a program where patients aren’t receiving safe care, [they’re] likely at increased risk of burning out or leaving clinical medicine entirely, or providing not as good of care if they stay in clinical medicine,” said Dr. Sumant Ranji, chief of the division of hospital medicine at the Zuckerberg San Francisco General Hospital.\u003c/p>\n\u003cp>Hospitals that participate in Medicaid or Medicare must follow federal safety regulations, and the agency sends inspectors to verify that they are doing so every three to four years, or when a complaint triggers the need for an investigation. Those regulations cover everything from the storage of drugs and supplies to the protection of patient rights.[contextly_sidebar id=\"7lJLROPoNI8V35CnfpV5eDACtFqnGekB\"]\u003c/p>\n\u003cp>Inspections by CMS represent a fraction of all the inspections that hospitals undergo. Independent accreditors and state agencies perform the majority of routine hospital surveys, but rarely make detailed findings public. So STAT’s analysis was based only on the CMS reports.\u003c/p>\n\u003cp>“When [CMS] inspections are done and violations are found, especially the more severe violations, they’re important,” said Dr. Ashish Jha, professor of health policy at the Harvard T.H. Chan School of Public Health. “Sometimes they’ll find minor violations. But the things that are really a threat to patients being alive, it’s hard to discount those.”\u003c/p>\n\u003cp>STAT’s review — aided by the Association of Health Care Journalists’ HospitalInspections.org database — looked at medical facilities that fit the CMS definition of a teaching hospital: those that received Medicare direct graduate medical education or indirect medical education payments from the agency between 2014 and 2017. Collectively, more than 5,500 safety violations occurred at teaching hospitals over that four-year span. In each of those years, more than a quarter of the roughly 1,200 teaching hospitals had at least one safety violation documented.\u003c/p>\n\u003cp>The highest number of citations went to West Valley Medical Center in Idaho (45 violations), Regional Health Rapid City Hospital in South Dakota (44), Howard University Hospital in Washington, D.C. (37), and Jackson Memorial Hospital (36), which is part of the same health care system as Jackson South. Among the others cited were some of the nation’s most prestigious medical centers — including ones affiliated with Columbia, Harvard, and Case Western Reserve universities — as well as rural hospitals that dot the western half of the United States.\u003c/p>\n\u003cp>[contextly_sidebar id=\"THZMAaNUzKC8OTx4ttfJlX7FiRQBtJZy\"]Many teaching hospitals STAT contacted for interviews declined to provide information about their violations. The spokespeople who responded generally said administrators had taken appropriate action to address deficiencies cited by CMS.\u003c/p>\n\u003cp>Some violations, like the Jackson South one, directly concerned medical trainees, while others implicated the leaders responsible for overseeing their education. Jha said CMS inspection reports, known as 2567 forms, provide valuable insight into hospital safety — particularly regarding the quality of training and oversight for medical trainees.\u003c/p>\n\u003cp>In the neonatal intensive care unit of Cooper University Hospital in Camden, N.J., pediatric residents shadow staff physicians as they care for newborns in precarious health. Before entering, staff and visitors are required to wash, rinse, and lather their hands for at least 15 seconds and decontaminate personal items such as cellphones, according to hospital policy.\u003c/p>\n\u003cp>But over a three-hour period last April, an inspector observed nearly a dozen doctors and nurses break those rules. Additionally, the inspector could find no evidence that, after an infant in the ward contracted a superbug, the staff took these precautions to limit the spread of infection.\u003c/p>\n\u003cp>“Unfortunately, these types of infections are not uncommon in NICUs around the country due to the highly fragile nature of this patient population,” Cooper University Health Care spokeswoman Wendy Marano told STAT. “Cooper promptly reported the infections to the New Jersey Department of Health. … We have not experienced any recurrence of MRSA cross-contamination in the NICU.”\u003c/p>\n\u003cp>In the spring of 2017, inspectors cited Montefiore Medical Center in the Bronx after two patients committed suicide in an eight-day period. One of those patients was a 76-year-old man who had collapsed in grief after attending a friend’s funeral. Upon admission to Montefiore, doctors didn’t record a plan for psychiatric treatment, even though hospital policy called for suicide screenings in cases of potential emotional or behavioral disorder. Three days later, the man hanged himself in a shower at the hospital.[contextly_sidebar id=\"LQm8J4f2TTS7MUuL7J4WTevB2RamynKs\"]\u003c/p>\n\u003cp>“Yes, he would have been someone who we would have liked to have seen before he died,” one doctor told an inspector.\u003c/p>\n\u003cp>A spokesperson told STAT that Montefiore is “singularly focused on providing the best education and training for the doctors of tomorrow.”\u003c/p>\n\u003cp>Medical trainees were at the center of some of the violations listed in reports STAT reviewed. A team of NewYork-Presbyterian Hospital residents didn’t notify an attending physician for hours about a patient’s rapid heart rate and drop in blood pressure, and the patient died the following morning. And a resident started a fire in a Nebraska Medicine operating room by accidentally bringing a cautery too close to a flammable liquid medical adhesive. In that case, hospital spokesperson Taylor Wilson told STAT, no patients were harmed. But the incident spurred “new, stronger safety measures” that included training of all surgical staff and trainees, Wilson said.\u003c/p>\n\u003cp>Experts caution that inspection reports don’t tell the whole story. Dr. Tejal Gandhi, chief clinical and safety officer for the Institute for Healthcare Improvement, said each of the leading ways to assess quality and safety “alone won’t give you an overall view” of hospital performance. Matt Austin, a professor of anesthesiology and critical care medicine at Johns Hopkins University’s medical school, said they reflect an “important, but not a complete, picture of patient safety” in hospitals.\u003c/p>\n\u003cp>“If you find the problem on an inspection, it’s worrisome,” Jha said. “If you fail to find problems, it’s not a get-out-of-jail-free card.”\u003c/p>\n\u003cp>For many decades, preventable medical errors in hospitals were chalked up as an inevitable cost of training new doctors, according to Peter Rivard, associate professor of health care administration at Suffolk University in Boston. If something went awry, health administrators reprimanded trainees or their supervisors instead of focusing on the underlying systems that allowed for a mistake to occur in the first place.\u003c/p>\n\u003cp>Then in 1999, the Institute of Medicine released the landmark “To Err Is Human” report, which concluded that as many as 98,000 Americans were killed in the process of receiving medical care. Hospitals scrambled for answers: They began tracking errors more closely, hiring airline pilots as safety consultants, and expanding patient safety as a subject of medical education. But by the mid-2000s, only 54 percent of residents surveyed knew how to report errors at their facilities.\u003c/p>\n\u003cp>Ranji, at San Francisco General, said a “pernicious old-school culture” still pervades much of medical education and espouses minimal oversight of trainees, in addition to the belief that learning happens through making mistakes.\u003c/p>\n\u003cp>In part due to their frequent turnover, medical trainees told STAT that they don’t always feel empowered like permanent staffers to suggest improvements to hospital safety.\u003c/p>\n\u003cp>Trainees who are involved in medical errors can experience “profound psychological consequences,” Ranji said.\u003c/p>\n\u003cp>“The patients I remember best were the adverse ones,” he added. “Those experiences made me more cynical, and sucked the joy out of patient care for me. If something bad happened to patients, [the mindset was to] sweep under the rug, and keep your chin up. But they were profound emotional experiences.”\u003c/p>\n\u003cp>Recognizing that teaching hospitals present specific challenges for patient safety, the leading medical education accreditation group has stepped up its oversight policies.\u003c/p>\n\u003cp>Since 2012, the Accreditation Council for Graduate Medical Education — which accredits more than half of the nation’s teaching hospitals — has sent staff to these hospitals to conduct an evaluation that includes interviewing administrators, observing doctors, and walking the halls with residents.\u003c/p>\n\u003cp>[contextly_sidebar id=\"mRbgvSyd1XTMQNaYv6256AYB0fx6mOsY\"]Dr. Kevin Weiss, senior vice president of institution accreditation for the ACGME, said these mandatory site visits are intended to “increase awareness of residents in formal patient safety activities” like reporting medical errors or participating in debriefs of those errors after the fact, something that makes trainees more mindful of practicing medicine safely.\u003c/p>\n\u003cp>And teaching hospitals are taking matters into their own hands.\u003c/p>\n\u003cp>At the University of Chicago Medical Center, every resident must undergo patient safety training. As part of it, they must spot medical errors in a simulated environment dubbed the “\u003ca href=\"https://news.aamc.org/medical-education/article/patient-safety-residency-training/\" target=\"_blank\" rel=\"noopener\">horror room\u003c/a>.” They’re also strongly encouraged to report adverse patient events or “near misses,” and are expected, in collaboration with superiors, to reverse engineer incidents where patients were harmed under their watch.\u003c/p>\n\u003cp>“We’re really focused on changing behavior,” said Dr. Vineet Arora, director of graduate medical education clinical learning. “It’s important that someone raises their hands, wherever they are on the hierarchy, and can say, ‘I see a problem.’ That’s a mindset change.”\u003c/p>\n\u003cp>Participation in this curriculum, Arora noted, was associated with “three times more event reports by those programs.” University of Chicago Medical Center hasn’t received a safety violation in over two years.\u003c/p>\n\u003cp>Meanwhile, researchers at Boston Children’s Hospital created \u003ca href=\"http://www.childrenshospital.org/news-and-events/2012/april-2012/i-pass-standardizing-patient-handoffs-to-reduce-medical-errors\" target=\"_blank\" rel=\"noopener\">“I-PASS,” a mnemonic device\u003c/a> that’s bundled with training and lectures in order to help \u003ca href=\"https://www.statnews.com/2016/02/01/communication-failures-malpractice-study/\">improve patient handoffs\u003c/a>. A resident whose shift is ending relays information to his or her successor by running through five pieces of information: illness severity, patient summary, action list, situation awareness and contingency planning, and synthesis by receiver.\u003c/p>\n\u003cp>It’s worked so well in pediatric units — one study found its use was associated with a \u003ca href=\"https://www.medpagetoday.com/hospitalbasedmedicine/generalhospitalpractice/48817\" target=\"_blank\" rel=\"noopener\">23 percent drop in medical errors\u003c/a> — that \u003ca href=\"http://app.ihi.org/FacultyDocuments/Events/Event-2613/Presentation-12369/Document-10285/Presentation_C12_FINAL.pdf\" target=\"_blank\" rel=\"noopener\">Massachusetts General Hospital\u003c/a>decided to adopt it throughout the institution. Dr. Elizabeth Mort, senior vice president of quality and safety at Mass. General, said the program led to a “fivefold increase” in safety reporting from trainees.\u003c/p>\n\u003cp>“An understanding of patient safety is something we’re not born with,” said Dr. Anai Kothari, a fourth-year surgery resident at Loyola University. “But it can be learned and applied — and can make a difference when we do it well.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This story was originally published by \u003ca href=\"https://www.statnews.com/2018/04/20/doctors-learn-bad-habits-teaching-hospitals/\" target=\"_blank\" rel=\"noopener\">STAT\u003c/a>, 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>The patient’s breaths had become labored. He struggled to pull air from his mouth to his lungs. It got so bad late one Saturday night that he decided to say something about it the next time his nurse made rounds at Jackson South Community Hospital.\u003c/p>\n\u003cp>The complaint traveled from the nurse to a doctor, who looked at the patient’s records and quickly saw the problem: a feeding tube had been placed into the side of his lung. An anesthesiology trainee had inserted the tube without proper supervision, a federal health inspection later determined, and over the coming weeks, the patient developed pneumonia and sepsis related to the medical error. He was in the hospital two months longer than initially planned.\u003c/p>\n\u003caside class=\"pullquote alignright\">'Sometimes they’ll find minor violations. But the things that are really a threat to patients being alive, it’s hard to discount those.'\u003c/aside>\n\u003cp>Teaching hospitals like Jackson South, located in metro Miami, are where physician trainees get practice treating patients. They prepare the next generation of doctors, and they have a reputation as places of cutting-edge patient care, given their ties to academic institutions.\u003c/p>\n\u003cp>But at some of these hospitals, residents may be learning bad habits. A STAT analysis of federal inspection data finds that there’s a wide gap in the quality of training at teaching hospitals, as shown by how frequently these hospitals are cited for deficiencies by the Centers for Medicare and Medicaid Services. While the majority of the roughly 1,200 teaching hospitals received no citations each year from 2014 to 2017, others racked up dozens of safety violations in that time period — putting patients at risk, and compromising the training that students receive.\u003c/p>\n\u003cp>“In the places where young doctors-in-training practice, what they learn can affect how the person will practice for decades to come,” said Rosemary Gibson, a patient safety advocate and the author of the book “Wall of Silence.” “They’re developing habits … and it’s essential for trainees to learn in clinical settings where patient safety is baked into the system.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>At Jackson South, even before the hospital received a citation from CMS, administrators were analyzing how the feeding tube mistake happened and how to prevent similar errors in the future. They realized that the issue had to do with the initial reading of the X-ray, which is used to make sure doctors don’t misplace feeding tubes. The hospital put in place a pilot program to verify that feeding tubes are properly placed.\u003c/p>\n\u003cp>“We take every deficiency seriously and thoroughly investigate each safety violation,” a Jackson spokesperson said in a statement. “We implement plans to correct them.”\u003c/p>\n\u003cp>Teaching hospitals are making some positive changes, and according to STAT’s analysis, that’s led the average number of violations per teaching hospital to drop to its lowest point in three years, following a major spike in 2015 and 2016. But experts worry that the remaining mishaps mean that America’s future doctors aren’t always being prepared to practice medicine safely.\u003c/p>\n\u003cp>“If residents train in a program where patients aren’t receiving safe care, [they’re] likely at increased risk of burning out or leaving clinical medicine entirely, or providing not as good of care if they stay in clinical medicine,” said Dr. Sumant Ranji, chief of the division of hospital medicine at the Zuckerberg San Francisco General Hospital.\u003c/p>\n\u003cp>Hospitals that participate in Medicaid or Medicare must follow federal safety regulations, and the agency sends inspectors to verify that they are doing so every three to four years, or when a complaint triggers the need for an investigation. Those regulations cover everything from the storage of drugs and supplies to the protection of patient rights.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Inspections by CMS represent a fraction of all the inspections that hospitals undergo. Independent accreditors and state agencies perform the majority of routine hospital surveys, but rarely make detailed findings public. So STAT’s analysis was based only on the CMS reports.\u003c/p>\n\u003cp>“When [CMS] inspections are done and violations are found, especially the more severe violations, they’re important,” said Dr. Ashish Jha, professor of health policy at the Harvard T.H. Chan School of Public Health. “Sometimes they’ll find minor violations. But the things that are really a threat to patients being alive, it’s hard to discount those.”\u003c/p>\n\u003cp>STAT’s review — aided by the Association of Health Care Journalists’ HospitalInspections.org database — looked at medical facilities that fit the CMS definition of a teaching hospital: those that received Medicare direct graduate medical education or indirect medical education payments from the agency between 2014 and 2017. Collectively, more than 5,500 safety violations occurred at teaching hospitals over that four-year span. In each of those years, more than a quarter of the roughly 1,200 teaching hospitals had at least one safety violation documented.\u003c/p>\n\u003cp>The highest number of citations went to West Valley Medical Center in Idaho (45 violations), Regional Health Rapid City Hospital in South Dakota (44), Howard University Hospital in Washington, D.C. (37), and Jackson Memorial Hospital (36), which is part of the same health care system as Jackson South. Among the others cited were some of the nation’s most prestigious medical centers — including ones affiliated with Columbia, Harvard, and Case Western Reserve universities — as well as rural hospitals that dot the western half of the United States.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>Many teaching hospitals STAT contacted for interviews declined to provide information about their violations. The spokespeople who responded generally said administrators had taken appropriate action to address deficiencies cited by CMS.\u003c/p>\n\u003cp>Some violations, like the Jackson South one, directly concerned medical trainees, while others implicated the leaders responsible for overseeing their education. Jha said CMS inspection reports, known as 2567 forms, provide valuable insight into hospital safety — particularly regarding the quality of training and oversight for medical trainees.\u003c/p>\n\u003cp>In the neonatal intensive care unit of Cooper University Hospital in Camden, N.J., pediatric residents shadow staff physicians as they care for newborns in precarious health. Before entering, staff and visitors are required to wash, rinse, and lather their hands for at least 15 seconds and decontaminate personal items such as cellphones, according to hospital policy.\u003c/p>\n\u003cp>But over a three-hour period last April, an inspector observed nearly a dozen doctors and nurses break those rules. Additionally, the inspector could find no evidence that, after an infant in the ward contracted a superbug, the staff took these precautions to limit the spread of infection.\u003c/p>\n\u003cp>“Unfortunately, these types of infections are not uncommon in NICUs around the country due to the highly fragile nature of this patient population,” Cooper University Health Care spokeswoman Wendy Marano told STAT. “Cooper promptly reported the infections to the New Jersey Department of Health. … We have not experienced any recurrence of MRSA cross-contamination in the NICU.”\u003c/p>\n\u003cp>In the spring of 2017, inspectors cited Montefiore Medical Center in the Bronx after two patients committed suicide in an eight-day period. One of those patients was a 76-year-old man who had collapsed in grief after attending a friend’s funeral. Upon admission to Montefiore, doctors didn’t record a plan for psychiatric treatment, even though hospital policy called for suicide screenings in cases of potential emotional or behavioral disorder. Three days later, the man hanged himself in a shower at the hospital.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>“Yes, he would have been someone who we would have liked to have seen before he died,” one doctor told an inspector.\u003c/p>\n\u003cp>A spokesperson told STAT that Montefiore is “singularly focused on providing the best education and training for the doctors of tomorrow.”\u003c/p>\n\u003cp>Medical trainees were at the center of some of the violations listed in reports STAT reviewed. A team of NewYork-Presbyterian Hospital residents didn’t notify an attending physician for hours about a patient’s rapid heart rate and drop in blood pressure, and the patient died the following morning. And a resident started a fire in a Nebraska Medicine operating room by accidentally bringing a cautery too close to a flammable liquid medical adhesive. In that case, hospital spokesperson Taylor Wilson told STAT, no patients were harmed. But the incident spurred “new, stronger safety measures” that included training of all surgical staff and trainees, Wilson said.\u003c/p>\n\u003cp>Experts caution that inspection reports don’t tell the whole story. Dr. Tejal Gandhi, chief clinical and safety officer for the Institute for Healthcare Improvement, said each of the leading ways to assess quality and safety “alone won’t give you an overall view” of hospital performance. Matt Austin, a professor of anesthesiology and critical care medicine at Johns Hopkins University’s medical school, said they reflect an “important, but not a complete, picture of patient safety” in hospitals.\u003c/p>\n\u003cp>“If you find the problem on an inspection, it’s worrisome,” Jha said. “If you fail to find problems, it’s not a get-out-of-jail-free card.”\u003c/p>\n\u003cp>For many decades, preventable medical errors in hospitals were chalked up as an inevitable cost of training new doctors, according to Peter Rivard, associate professor of health care administration at Suffolk University in Boston. If something went awry, health administrators reprimanded trainees or their supervisors instead of focusing on the underlying systems that allowed for a mistake to occur in the first place.\u003c/p>\n\u003cp>Then in 1999, the Institute of Medicine released the landmark “To Err Is Human” report, which concluded that as many as 98,000 Americans were killed in the process of receiving medical care. Hospitals scrambled for answers: They began tracking errors more closely, hiring airline pilots as safety consultants, and expanding patient safety as a subject of medical education. But by the mid-2000s, only 54 percent of residents surveyed knew how to report errors at their facilities.\u003c/p>\n\u003cp>Ranji, at San Francisco General, said a “pernicious old-school culture” still pervades much of medical education and espouses minimal oversight of trainees, in addition to the belief that learning happens through making mistakes.\u003c/p>\n\u003cp>In part due to their frequent turnover, medical trainees told STAT that they don’t always feel empowered like permanent staffers to suggest improvements to hospital safety.\u003c/p>\n\u003cp>Trainees who are involved in medical errors can experience “profound psychological consequences,” Ranji said.\u003c/p>\n\u003cp>“The patients I remember best were the adverse ones,” he added. “Those experiences made me more cynical, and sucked the joy out of patient care for me. If something bad happened to patients, [the mindset was to] sweep under the rug, and keep your chin up. But they were profound emotional experiences.”\u003c/p>\n\u003cp>Recognizing that teaching hospitals present specific challenges for patient safety, the leading medical education accreditation group has stepped up its oversight policies.\u003c/p>\n\u003cp>Since 2012, the Accreditation Council for Graduate Medical Education — which accredits more than half of the nation’s teaching hospitals — has sent staff to these hospitals to conduct an evaluation that includes interviewing administrators, observing doctors, and walking the halls with residents.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>Dr. Kevin Weiss, senior vice president of institution accreditation for the ACGME, said these mandatory site visits are intended to “increase awareness of residents in formal patient safety activities” like reporting medical errors or participating in debriefs of those errors after the fact, something that makes trainees more mindful of practicing medicine safely.\u003c/p>\n\u003cp>And teaching hospitals are taking matters into their own hands.\u003c/p>\n\u003cp>At the University of Chicago Medical Center, every resident must undergo patient safety training. As part of it, they must spot medical errors in a simulated environment dubbed the “\u003ca href=\"https://news.aamc.org/medical-education/article/patient-safety-residency-training/\" target=\"_blank\" rel=\"noopener\">horror room\u003c/a>.” They’re also strongly encouraged to report adverse patient events or “near misses,” and are expected, in collaboration with superiors, to reverse engineer incidents where patients were harmed under their watch.\u003c/p>\n\u003cp>“We’re really focused on changing behavior,” said Dr. Vineet Arora, director of graduate medical education clinical learning. “It’s important that someone raises their hands, wherever they are on the hierarchy, and can say, ‘I see a problem.’ That’s a mindset change.”\u003c/p>\n\u003cp>Participation in this curriculum, Arora noted, was associated with “three times more event reports by those programs.” University of Chicago Medical Center hasn’t received a safety violation in over two years.\u003c/p>\n\u003cp>Meanwhile, researchers at Boston Children’s Hospital created \u003ca href=\"http://www.childrenshospital.org/news-and-events/2012/april-2012/i-pass-standardizing-patient-handoffs-to-reduce-medical-errors\" target=\"_blank\" rel=\"noopener\">“I-PASS,” a mnemonic device\u003c/a> that’s bundled with training and lectures in order to help \u003ca href=\"https://www.statnews.com/2016/02/01/communication-failures-malpractice-study/\">improve patient handoffs\u003c/a>. A resident whose shift is ending relays information to his or her successor by running through five pieces of information: illness severity, patient summary, action list, situation awareness and contingency planning, and synthesis by receiver.\u003c/p>\n\u003cp>It’s worked so well in pediatric units — one study found its use was associated with a \u003ca href=\"https://www.medpagetoday.com/hospitalbasedmedicine/generalhospitalpractice/48817\" target=\"_blank\" rel=\"noopener\">23 percent drop in medical errors\u003c/a> — that \u003ca href=\"http://app.ihi.org/FacultyDocuments/Events/Event-2613/Presentation-12369/Document-10285/Presentation_C12_FINAL.pdf\" target=\"_blank\" rel=\"noopener\">Massachusetts General Hospital\u003c/a>decided to adopt it throughout the institution. Dr. Elizabeth Mort, senior vice president of quality and safety at Mass. General, said the program led to a “fivefold increase” in safety reporting from trainees.\u003c/p>\n\u003cp>“An understanding of patient safety is something we’re not born with,” said Dr. Anai Kothari, a fourth-year surgery resident at Loyola University. “But it can be learned and applied — and can make a difference when we do it well.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>This story was originally published by \u003ca href=\"https://www.statnews.com/2018/04/20/doctors-learn-bad-habits-teaching-hospitals/\" target=\"_blank\" rel=\"noopener\">STAT\u003c/a>, an online publication of Boston Globe Media that covers health, medicine, and scientific discovery.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "The Vaccine Dilemma: How Experts Weigh Benefits For Many Against Risks for a Few",
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"content": "\u003cp>You’ve likely seen a version of the image above. Some people observe two faces in profile. Others see a vase.\u003c/p>\n\u003cp>The same phenomenon can occur when scientists look at data, particularly when they try to weigh the benefits and risks of individual vaccines. Vaccines protect huge numbers of people, generally children, from serious diseases, but in rare cases, certain vaccines can tragically cause harm. How do those scientists figure out which to value more?[contextly_sidebar id=\"vM6M1R2zIUt7PSfniSijCNeI1SXmNMTL\"]\u003c/p>\n\u003cp>This dilemma was at the center of last week’s decision by an expert committee advising the World Health Organization to sharply scale back use of a controversial vaccine called Dengvaxia, the first to protect against dengue infection.\u003c/p>\n\u003cp>Two years ago, many of the same experts concluded the vaccine was safe to use in children 9 and older in places where dengue infection is almost unavoidable — even though there were strong theoretical concerns the vaccine might put some vaccinated kids at higher risk of developing a severe form of dengue. Severe dengue can lead to internal bleeding, shock, and even death.\u003c/p>\n\u003cp>Late last year, theory was shown to be reality. After reviewing the data, the WHO’s Strategic Advisory Group of Experts on Immunizations — knows as the SAGE — shifted its stance, recommending last week that the vaccine be given only to children who test positive for a previous dengue infection. A point-of-care blood test doesn’t currently exist, leaving the vaccine’s future in limbo for now.[contextly_sidebar id=\"j6YzLYuARPhSnQ2nKylAVpIU8wdsgIj2\"]\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Benefits trumped theoretical risks. But real risks trumped real benefits — even though the latter outnumbered the former.\u003c/p>\n\u003cp>A variety of factors influence these decisions, according to interviews with public health experts and ethicists who have made or studied them. The severity of disease being prevented and the treatability of the side effects being caused are crucial, as are ethics, public perceptions, and politics. And critically, these days, so is the likelihood that any negative attention generated by one vaccine might stain the reputations of others.\u003c/p>\n\u003cp>Dr. Art Reingold has been involved in countless debates of this type, having served for more than a dozen years on first the SAGE, and later on the corresponding body that advises the Centers for Disease Control and Prevention, the Advisory Committee on Immunization Practices, or ACIP.[contextly_sidebar id=\"xdscPdRSoRoclTtqbEFBgO7cpt3QJHtx\"]\u003c/p>\n\u003cp>“I would say that for many individuals having to vote or being on these committees and weigh in, many of them spend an awful lot of time looking at data and reviewing it and struggling with it when it’s not a slam dunk,” said Reingold, who teaches infectious diseases epidemiology at the University of California, Berkeley’s school of public health.\u003c/p>\n\u003cp>Reingold, whose term on ACIP concluded at the end of last year, noted that while many of that panel’s votes are close to unanimous, some recommendations — or decisions not to recommend a vaccine — are decided by a narrow vote. “And obviously in that instance pretty smart people have come down on different sides of the same question by weighing effectively all the same evidence,’’ he said.\u003c/p>\n\u003cp>\u003cstrong>The Vaccine Calculus\u003cbr>\n\u003c/strong>In some cases, these decisions aren’t that difficult. A flu shot can trigger Guillain-Barre syndrome, though this adverse event is very rare. But influenza infection can also provoke this disorder, a form of progressive paralysis from which most people recover.\u003c/p>\n\u003cp>In other circumstances, the position of the scales — which side is higher, which is lower — tilts over time.\u003c/p>\n\u003cp>Oral polio vaccine has saved untold millions of children from paralysis in the more than half-century it has been in use. But in rare instances the vaccine also paralyzes, a fact that became clear in the first year of its use, back in the early 1960s.\u003c/p>\n\u003cp>Sometimes the paralysis occurs in the child who got the dose of vaccine, or in a close contact of that child, as was reported in 1962. Other times the weakened viruses in the vaccine circulate among unvaccinated children, who ingest them in water or food contaminated with traces of feces. As the viruses travel from gut to gut, they can go rogue — regain the power to paralyze. That phenomenon was first observed in 2000. Yet oral polio vaccine is still used today.\u003c/p>\n\u003cp>[contextly_sidebar id=\"4xoAKYJE6AnYbA5mfYOPli4oSCgYa7Q4\"]As polio eradication efforts have driven down the polio case count to very low levels, the toll of vaccine-related paralysis can surpass the damage caused by the viruses themselves. Last year there were 22 children in the world paralyzed by polioviruses; vaccine viruses crippled 96.\u003c/p>\n\u003cp>The shifting of the risk-benefit ratio for oral polio vaccine led the United States to switch exclusively to injectable polio vaccine in 2000. In 1996, when the decision to phase out oral vaccine was made, eight or nine children a year were being paralyzed by the vaccine, though polio itself hadn’t paralyzed a child in the United States for over a decade.\u003c/p>\n\u003cp>The risk posed by the oral vaccine became intolerable, given there was a safer, albeit more expensive alternative — the injectable polio vaccine does not paralyze. “Obviously thinking on these things can change. The risks and benefits relatively speaking can change,” Reingold said.\u003c/p>\n\u003cp>In 2016, the formulation of the oral vaccines was altered to drop the component that protected against type 2 polioviruses. That part of the vaccine was the most likely to regain the power to paralyze. Type 2 viruses had disappeared in 1999; there was too little benefit and too much risk associated with keeping them in the vaccine.\u003c/p>\n\u003cp>In the case of Dengvaxia, the calculus is not as clear cut. Evidence suggests that in places where about 70 percent of people have been infected at least once with dengue, the vaccine would prevent seven children from getting sick enough to need hospital care for every additional hospitalized case it provoked. In places where 85 percent of people have been infected, there would be 18 hospitalized cases prevented for every one the vaccine created.\u003c/p>\n\u003cp>Some dengue experts have argued those benefits should not be ignored. Others argue those risks cannot ethically be incurred.\u003c/p>\n\u003cp>[contextly_sidebar id=\"YfGTYns6XDY9Onrzu1EUV5DkCwM08fCc\"]The SAGE deliberated over whether it was permissible to use rates of local dengue infection as a substitute for individual testing — in other words, could the vaccine be given, as it had previously recommended, in places where studies show most people have been infected at least once?\u003c/p>\n\u003cp>They concluded both options pose real-world challenges, given the current lack of a rapid, accurate test. But they also noted there is no evidence to date that children who have never been infected with dengue — the ones the vaccine could harm — would ever experience a benefit from Dengvaxia. They worried that wide-scale dengue vaccination programs might be “ethically problematic and have adverse implications for trust and the long-term success of public health programs.”\u003c/p>\n\u003cp>\u003cstrong>Mounting Distrust\u003cbr>\n\u003c/strong>Why have oral polio vaccine risks been tolerated, but Dengvaxia’s deemed serious enough to effectively shelve the vaccine? Here the factors named above plus timing surely play a role.\u003c/p>\n\u003cp>Experts making these types of decisions these days are doing so in a climate of litigiousness and mounting vaccine refusal and hesitancy. Headlines questioning the safety of one vaccine threaten to fuel rejection of others. The government of the Philippines, where Dengvaxia has been given to more than 800,000 children, has threatened legal action against its manufacturer, Sanofi Pasteur.\u003c/p>\n\u003cp>“The public has a whole new understanding of science, data, facts, and fake news,” said Michael Osterholm, director of the University of Minnesota’s Center for Infectious Diseases Research and Policy. “We’ve surely had an anti-science movement well before the current situation, but it’s never been as acute.”[contextly_sidebar id=\"MRQx4tKZn53WSvNmnqGKkUDbBGs0RMX9\"]\u003c/p>\n\u003cp>Then there’s the issue of who gets vaccinated. Most of these products are designed to protect children, who hold a special position in discussions of the ethics of medical treatments.\u003c/p>\n\u003cp>The ethical bar must be placed higher when it comes to kids, because they cannot make an informed decision for themselves, said Art Caplan, a professor of bioethics at New York University’s school of medicine. “So I think the issue is not just: Could we accept huge benefits for small risks? Because I think the answer to that is yes. But I think it’s: Can we accept huge benefits for small risks to very vulnerable children?\u003c/p>\n\u003cp>“When you have that child population put knowingly at risk, it gets really hard from the ethics point of view to ignore that,” he said.\u003c/p>\n\u003cp>And society’s tolerance of risk has changed, Caplan argued, pointing to the so-called Cutter incident to make his case.\u003c/p>\n\u003cp>In 1955, it was discovered that children had been mistakenly injected with polio vaccine that contained live viruses. The process by which the viruses in the vaccine were supposed to be inactivated — killed — hadn’t worked. Fifty-one children in the U.S. were paralyzed and five died.\u003c/p>\n\u003cp>But in the 1950s, polio was an enormous threat. Parents lived in fear their children would end up in an iron lung. Polio vaccination resumed. The company that made the vaccine, Cutter Laboratories, didn’t even go out of business. If a similar incident were to happen today, Caplan said, “it would have shut everything down forever.”[contextly_sidebar id=\"TB4CDGkuuXqcHsBv1pEbtZgMooHhybmV\"]\u003c/p>\n\u003cp>Compare that to the case of RotaShield, the first vaccine licensed to protect against rotavirus infection. These common viruses cause devastating bouts of diarrhea in young children, who can end up in the hospital as a result. Every year some children died of these infections in the U.S., but rotaviruses did more damage in the developing world, where stricken kids didn’t have easy access to hospital care.\u003c/p>\n\u003cp>RotaShield was approved in the U.S. in 1998. A year later, Wyeth Laboratories withdrew it from the market after studies showed babies who got it were at greater risk of developing intussusception, a type of bowel blockage that can kill if it isn’t corrected in time. The CDC estimated that for every 10,000 children vaccinated with RotaShield there would be one or two additional cases of intussusception over what is normally seen.\u003c/p>\n\u003cp>Some experts argued that the vaccine should still be marketed in the developing world, where the number of lives saved would far outstrip the cases of intussusception. The WHO estimated that in 2004, more than half a million children died from rotavirus infections, the lion’s share in South Asia and sub-Saharan Africa.\u003c/p>\n\u003cp>“When you think about the risk-benefit equation in a poor country, almost certainly it would have been far better in terms of illness — preventable deaths averted, cost of care reduced — to continue to use that initial rotavirus vaccine or rather to introduce it and use it in poor countries,” Reingold said.\u003c/p>\n\u003cp>But the vaccine’s fate was sealed.\u003c/p>\n\u003cp>“The fact is that the politics around the thing — this vaccine isn’t good enough for rich white children in the United States but it’s OK for poor black children in poor countries — were a non-starter,” he said. “I mean, it just doesn’t sell. Even if that’s still the wisest thing to do.”\u003c/p>\n\u003cp>It was nearly six years before another, safer rotavirus vaccine made it to market, six years during which more than half a million children a year died from rotavirus infections.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This \u003ca href=\"https://www.statnews.com/2018/04/23/vaccine-dilemma-weigh-benefits-risks/\" 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>You’ve likely seen a version of the image above. Some people observe two faces in profile. Others see a vase.\u003c/p>\n\u003cp>The same phenomenon can occur when scientists look at data, particularly when they try to weigh the benefits and risks of individual vaccines. Vaccines protect huge numbers of people, generally children, from serious diseases, but in rare cases, certain vaccines can tragically cause harm. How do those scientists figure out which to value more?\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>This dilemma was at the center of last week’s decision by an expert committee advising the World Health Organization to sharply scale back use of a controversial vaccine called Dengvaxia, the first to protect against dengue infection.\u003c/p>\n\u003cp>Two years ago, many of the same experts concluded the vaccine was safe to use in children 9 and older in places where dengue infection is almost unavoidable — even though there were strong theoretical concerns the vaccine might put some vaccinated kids at higher risk of developing a severe form of dengue. Severe dengue can lead to internal bleeding, shock, and even death.\u003c/p>\n\u003cp>Late last year, theory was shown to be reality. After reviewing the data, the WHO’s Strategic Advisory Group of Experts on Immunizations — knows as the SAGE — shifted its stance, recommending last week that the vaccine be given only to children who test positive for a previous dengue infection. A point-of-care blood test doesn’t currently exist, leaving the vaccine’s future in limbo for now.\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>Benefits trumped theoretical risks. But real risks trumped real benefits — even though the latter outnumbered the former.\u003c/p>\n\u003cp>A variety of factors influence these decisions, according to interviews with public health experts and ethicists who have made or studied them. The severity of disease being prevented and the treatability of the side effects being caused are crucial, as are ethics, public perceptions, and politics. And critically, these days, so is the likelihood that any negative attention generated by one vaccine might stain the reputations of others.\u003c/p>\n\u003cp>Dr. Art Reingold has been involved in countless debates of this type, having served for more than a dozen years on first the SAGE, and later on the corresponding body that advises the Centers for Disease Control and Prevention, the Advisory Committee on Immunization Practices, or ACIP.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>“I would say that for many individuals having to vote or being on these committees and weigh in, many of them spend an awful lot of time looking at data and reviewing it and struggling with it when it’s not a slam dunk,” said Reingold, who teaches infectious diseases epidemiology at the University of California, Berkeley’s school of public health.\u003c/p>\n\u003cp>Reingold, whose term on ACIP concluded at the end of last year, noted that while many of that panel’s votes are close to unanimous, some recommendations — or decisions not to recommend a vaccine — are decided by a narrow vote. “And obviously in that instance pretty smart people have come down on different sides of the same question by weighing effectively all the same evidence,’’ he said.\u003c/p>\n\u003cp>\u003cstrong>The Vaccine Calculus\u003cbr>\n\u003c/strong>In some cases, these decisions aren’t that difficult. A flu shot can trigger Guillain-Barre syndrome, though this adverse event is very rare. But influenza infection can also provoke this disorder, a form of progressive paralysis from which most people recover.\u003c/p>\n\u003cp>In other circumstances, the position of the scales — which side is higher, which is lower — tilts over time.\u003c/p>\n\u003cp>Oral polio vaccine has saved untold millions of children from paralysis in the more than half-century it has been in use. But in rare instances the vaccine also paralyzes, a fact that became clear in the first year of its use, back in the early 1960s.\u003c/p>\n\u003cp>Sometimes the paralysis occurs in the child who got the dose of vaccine, or in a close contact of that child, as was reported in 1962. Other times the weakened viruses in the vaccine circulate among unvaccinated children, who ingest them in water or food contaminated with traces of feces. As the viruses travel from gut to gut, they can go rogue — regain the power to paralyze. That phenomenon was first observed in 2000. Yet oral polio vaccine is still used today.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>As polio eradication efforts have driven down the polio case count to very low levels, the toll of vaccine-related paralysis can surpass the damage caused by the viruses themselves. Last year there were 22 children in the world paralyzed by polioviruses; vaccine viruses crippled 96.\u003c/p>\n\u003cp>The shifting of the risk-benefit ratio for oral polio vaccine led the United States to switch exclusively to injectable polio vaccine in 2000. In 1996, when the decision to phase out oral vaccine was made, eight or nine children a year were being paralyzed by the vaccine, though polio itself hadn’t paralyzed a child in the United States for over a decade.\u003c/p>\n\u003cp>The risk posed by the oral vaccine became intolerable, given there was a safer, albeit more expensive alternative — the injectable polio vaccine does not paralyze. “Obviously thinking on these things can change. The risks and benefits relatively speaking can change,” Reingold said.\u003c/p>\n\u003cp>In 2016, the formulation of the oral vaccines was altered to drop the component that protected against type 2 polioviruses. That part of the vaccine was the most likely to regain the power to paralyze. Type 2 viruses had disappeared in 1999; there was too little benefit and too much risk associated with keeping them in the vaccine.\u003c/p>\n\u003cp>In the case of Dengvaxia, the calculus is not as clear cut. Evidence suggests that in places where about 70 percent of people have been infected at least once with dengue, the vaccine would prevent seven children from getting sick enough to need hospital care for every additional hospitalized case it provoked. In places where 85 percent of people have been infected, there would be 18 hospitalized cases prevented for every one the vaccine created.\u003c/p>\n\u003cp>Some dengue experts have argued those benefits should not be ignored. Others argue those risks cannot ethically be incurred.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>The SAGE deliberated over whether it was permissible to use rates of local dengue infection as a substitute for individual testing — in other words, could the vaccine be given, as it had previously recommended, in places where studies show most people have been infected at least once?\u003c/p>\n\u003cp>They concluded both options pose real-world challenges, given the current lack of a rapid, accurate test. But they also noted there is no evidence to date that children who have never been infected with dengue — the ones the vaccine could harm — would ever experience a benefit from Dengvaxia. They worried that wide-scale dengue vaccination programs might be “ethically problematic and have adverse implications for trust and the long-term success of public health programs.”\u003c/p>\n\u003cp>\u003cstrong>Mounting Distrust\u003cbr>\n\u003c/strong>Why have oral polio vaccine risks been tolerated, but Dengvaxia’s deemed serious enough to effectively shelve the vaccine? Here the factors named above plus timing surely play a role.\u003c/p>\n\u003cp>Experts making these types of decisions these days are doing so in a climate of litigiousness and mounting vaccine refusal and hesitancy. Headlines questioning the safety of one vaccine threaten to fuel rejection of others. The government of the Philippines, where Dengvaxia has been given to more than 800,000 children, has threatened legal action against its manufacturer, Sanofi Pasteur.\u003c/p>\n\u003cp>“The public has a whole new understanding of science, data, facts, and fake news,” said Michael Osterholm, director of the University of Minnesota’s Center for Infectious Diseases Research and Policy. “We’ve surely had an anti-science movement well before the current situation, but it’s never been as acute.”\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Then there’s the issue of who gets vaccinated. Most of these products are designed to protect children, who hold a special position in discussions of the ethics of medical treatments.\u003c/p>\n\u003cp>The ethical bar must be placed higher when it comes to kids, because they cannot make an informed decision for themselves, said Art Caplan, a professor of bioethics at New York University’s school of medicine. “So I think the issue is not just: Could we accept huge benefits for small risks? Because I think the answer to that is yes. But I think it’s: Can we accept huge benefits for small risks to very vulnerable children?\u003c/p>\n\u003cp>“When you have that child population put knowingly at risk, it gets really hard from the ethics point of view to ignore that,” he said.\u003c/p>\n\u003cp>And society’s tolerance of risk has changed, Caplan argued, pointing to the so-called Cutter incident to make his case.\u003c/p>\n\u003cp>In 1955, it was discovered that children had been mistakenly injected with polio vaccine that contained live viruses. The process by which the viruses in the vaccine were supposed to be inactivated — killed — hadn’t worked. Fifty-one children in the U.S. were paralyzed and five died.\u003c/p>\n\u003cp>But in the 1950s, polio was an enormous threat. Parents lived in fear their children would end up in an iron lung. Polio vaccination resumed. The company that made the vaccine, Cutter Laboratories, didn’t even go out of business. If a similar incident were to happen today, Caplan said, “it would have shut everything down forever.”\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Compare that to the case of RotaShield, the first vaccine licensed to protect against rotavirus infection. These common viruses cause devastating bouts of diarrhea in young children, who can end up in the hospital as a result. Every year some children died of these infections in the U.S., but rotaviruses did more damage in the developing world, where stricken kids didn’t have easy access to hospital care.\u003c/p>\n\u003cp>RotaShield was approved in the U.S. in 1998. A year later, Wyeth Laboratories withdrew it from the market after studies showed babies who got it were at greater risk of developing intussusception, a type of bowel blockage that can kill if it isn’t corrected in time. The CDC estimated that for every 10,000 children vaccinated with RotaShield there would be one or two additional cases of intussusception over what is normally seen.\u003c/p>\n\u003cp>Some experts argued that the vaccine should still be marketed in the developing world, where the number of lives saved would far outstrip the cases of intussusception. The WHO estimated that in 2004, more than half a million children died from rotavirus infections, the lion’s share in South Asia and sub-Saharan Africa.\u003c/p>\n\u003cp>“When you think about the risk-benefit equation in a poor country, almost certainly it would have been far better in terms of illness — preventable deaths averted, cost of care reduced — to continue to use that initial rotavirus vaccine or rather to introduce it and use it in poor countries,” Reingold said.\u003c/p>\n\u003cp>But the vaccine’s fate was sealed.\u003c/p>\n\u003cp>“The fact is that the politics around the thing — this vaccine isn’t good enough for rich white children in the United States but it’s OK for poor black children in poor countries — were a non-starter,” he said. “I mean, it just doesn’t sell. Even if that’s still the wisest thing to do.”\u003c/p>\n\u003cp>It was nearly six years before another, safer rotavirus vaccine made it to market, six years during which more than half a million children a year died from rotavirus infections.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>U.S. health officials on Friday told consumers to throw away any store-bought romaine lettuce they have in their kitchens and warned restaurants not to serve it amid an E. coli outbreak that has sickened more than 50 people in several states.\u003c/p>\n\u003cp>The U.S. Centers for Disease Control and Prevention expanded its warning about tainted romaine from Arizona, saying information from new illnesses led it to caution against eating any forms of the lettuce that may have come from the city of Yuma. Officials have not found the origin of the contaminated vegetables.[contextly_sidebar id=”2rlLWi81zSsmjwZxnnH20Wd2rPVuQm08″]\u003c/p>\n\u003cp>Previously, CDC officials had only warned against chopped romaine by itself or as part of salads and salad mixes. But they are now extending the risk to heads or hearts of romaine lettuce.\u003c/p>\n\u003cp>People at an Alaska correctional facility recently reported feeling ill after eating from whole heads of romaine lettuce. They were traced to lettuce harvested in the Yuma region, according to the CDC.\u003c/p>\n\u003cp>KQED’s Danielle Venton reports so far there are 31 hospitalizations, and 53 cases, around the country due to this E. coli strain. One case is from California. No deaths have been reported.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Symptoms of E. coli infection include diarrhea, severe stomach cramps and vomiting.\u003c/p>\n\u003cp>The CDC’s updated advisory said consumers nationwide should not buy or eat romaine lettuce from a grocery store or restaurant unless they can get confirmation it did not come from Yuma. People also should toss any romaine they already have at home unless it’s known it didn’t come from the area, the agency said.\u003c/p>\n\u003cp>Restaurants and retailers were warned not to serve or sell romaine lettuce from Yuma.\u003c/p>\n\u003cp>Romaine grown in coastal and central California, Florida and central Mexico is not at risk, according to the Produce Marketing Association.\u003c/p>\n\u003cp>The Yuma region, which is roughly 185 miles southwest of Phoenix and close to the California border, is referred to as the country’s “winter vegetable capital.” It is known for its agriculture and often revels in it with events like a lettuce festival.\u003c/p>\n\u003cp>Steve Alameda, president of the Yuma Fresh Vegetable Association, which represents local growers, said the outbreak has weighed heavily on him and other farmers.\u003c/p>\n\u003cp>“We want to know what happened,” Alameda said. “We can’t afford to lose consumer confidence. It’s heartbreaking to us. We take this very personally.”\u003c/p>\n\u003cp>Growers in Yuma typically plant romaine lettuce between September and January. During the peak of the harvest season, which runs from mid-November until the beginning of April, the Yuma region supplies most of the romaine sold in the U.S., Alameda said. The outbreak came as the harvest of romaine was already near its end.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>While Alameda has not met with anyone from the CDC, he is reviewing his own business. He is going over food safety practices and auditing operations in the farming fields.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>U.S. health officials on Friday told consumers to throw away any store-bought romaine lettuce they have in their kitchens and warned restaurants not to serve it amid an E. coli outbreak that has sickened more than 50 people in several states.\u003c/p>\n\u003cp>The U.S. Centers for Disease Control and Prevention expanded its warning about tainted romaine from Arizona, saying information from new illnesses led it to caution against eating any forms of the lettuce that may have come from the city of Yuma. Officials have not found the origin of the contaminated vegetables.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Previously, CDC officials had only warned against chopped romaine by itself or as part of salads and salad mixes. But they are now extending the risk to heads or hearts of romaine lettuce.\u003c/p>\n\u003cp>People at an Alaska correctional facility recently reported feeling ill after eating from whole heads of romaine lettuce. They were traced to lettuce harvested in the Yuma region, according to the CDC.\u003c/p>\n\u003cp>KQED’s Danielle Venton reports so far there are 31 hospitalizations, and 53 cases, around the country due to this E. coli strain. One case is from California. No deaths have been reported.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Symptoms of E. coli infection include diarrhea, severe stomach cramps and vomiting.\u003c/p>\n\u003cp>The CDC’s updated advisory said consumers nationwide should not buy or eat romaine lettuce from a grocery store or restaurant unless they can get confirmation it did not come from Yuma. People also should toss any romaine they already have at home unless it’s known it didn’t come from the area, the agency said.\u003c/p>\n\u003cp>Restaurants and retailers were warned not to serve or sell romaine lettuce from Yuma.\u003c/p>\n\u003cp>Romaine grown in coastal and central California, Florida and central Mexico is not at risk, according to the Produce Marketing Association.\u003c/p>\n\u003cp>The Yuma region, which is roughly 185 miles southwest of Phoenix and close to the California border, is referred to as the country’s “winter vegetable capital.” It is known for its agriculture and often revels in it with events like a lettuce festival.\u003c/p>\n\u003cp>Steve Alameda, president of the Yuma Fresh Vegetable Association, which represents local growers, said the outbreak has weighed heavily on him and other farmers.\u003c/p>\n\u003cp>“We want to know what happened,” Alameda said. “We can’t afford to lose consumer confidence. It’s heartbreaking to us. We take this very personally.”\u003c/p>\n\u003cp>Growers in Yuma typically plant romaine lettuce between September and January. During the peak of the harvest season, which runs from mid-November until the beginning of April, the Yuma region supplies most of the romaine sold in the U.S., Alameda said. The outbreak came as the harvest of romaine was already near its end.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>While Alameda has not met with anyone from the CDC, he is reviewing his own business. He is going over food safety practices and auditing operations in the farming fields.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>During the stressful teen years, most adolescents experience emotional highs and lows, but for more than \u003ca href=\"https://www.nami.org/learn-more/mental-health-by-the-numbers\" target=\"_blank\" rel=\"noopener\">20 percent\u003c/a> of teenagers, their worries and sad feelings turn into something more serious, like anxiety or depression. \u003ca href=\"https://www.bmj.com/content/349/bmj.g5954\" target=\"_blank\" rel=\"noopener\">Studies\u003c/a> show that 13 percent to 18 percent of distressed teens physically injure themselves via cutting, burning or other forms of self-harm as a way to cope with their pain.[contextly_sidebar id=”DrtrOIrhwdXvJWg13P3oHysKbwZZeMlt”]\u003c/p>\n\u003cp>Recent research and clinical psychologists now suggest that some adolescents are engaging in a newer form of self-aggression — \u003ca href=\"http://www.jahonline.org/article/S1054-139X(17)30313-0/fulltext\" target=\"_blank\" rel=\"noopener\">digital self-harm\u003c/a>. They’re anonymously posting mean and derogatory comments about themselves on social media.\u003c/p>\n\u003cp>Child psychologist \u003ca href=\"http://denverchildtherapy.com/about-us/sheryl-ziegler/\" target=\"_blank\" rel=\"noopener\">Sheryl Gonzalez-Ziegler\u003c/a> of Denver says it’s a growing problem among teens whom she counsels. One recent client, an adolescent girl, told Gonzalez-Ziegler that she anonymously cyberbullied herself because, as a gay teen, she felt vulnerable and exposed.\u003c/p>\n\u003cp>“She set up ghost accounts on Instagram and posted mean comments about herself, saying things like, ‘I think you’re creepy and gay’ and ‘Don’t sit next to me again,’ ” Ziegler says.\u003c/p>\n\u003cp>“She said these things because she feared being mocked by her peers,” the psychologist explains. “She thought their teasing wouldn’t be so bad if she beat them to the punch.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>According to a survey \u003ca href=\"http://www.jahonline.org/article/S1054-139X(17)30313-0/fulltext\" target=\"_blank\" rel=\"noopener\">published\u003c/a> late last year in the \u003cem>Journal of Adolescent Health\u003c/em>, teens are bullying themselves online as a way to manage feelings of sadness and self-hatred and to gain attention from their friends. For the study, 5,593 middle and high school students from across the U.S., ages 12 to 17, completed a series of questionnaires that asked about their experiences with digital self-harm and cyberbullying.\u003c/p>\n\u003cp>[contextly_sidebar id=”HCX9vH8V4cXCVb46T0BO94RkguEqSp86″]”We were alarmed to learn that 6 percent of the youth who participated in our study engaged in some form of digital self-harm,” says \u003ca href=\"http://hinduja.org/\" target=\"_blank\" rel=\"noopener\">Sameer Hinduja\u003c/a>, co-author of the study and a professor of criminology at Florida Atlantic University. He is also the co-director of the \u003ca href=\"https://cyberbullying.org/\" target=\"_blank\" rel=\"noopener\">Cyberbullying Research Center\u003c/a>.\u003c/p>\n\u003cp>Hinduja and a colleague found that more than half the teens who cyberbullied themselves had done so more than once. When asked why they had participated in this behavior, the teens said things like, “I already felt bad about myself, and I wanted to make myself feel worse” and “I wanted to see if someone was really my friend.”\u003c/p>\n\u003cp>Psychologists have seen inklings of this type of self-aggression before. In a smaller, \u003ca href=\"https://webhost.bridgew.edu/marc/DIGITAL%20SELF%20HARM%20report.pdf\" target=\"_blank\" rel=\"noopener\">2012\u003c/a> study of 617 high school freshmen, researchers found that 9 percent of the teens had bullied themselves online. Teens who participated in that study reported harming themselves as a way to encourage others to worry about them, to prove how “tough” they were or to get an adult’s attention.\u003c/p>\n\u003cp>[contextly_sidebar id=”4WLViXQpKTG5m375AY6olZ1s9VjHu8hm”]”Because teens’ online and offline worlds overlap, digital self-harm is a concern for some youth, making online self-harm an emerging area of research,” says, \u003ca href=\"https://cehs.unl.edu/edpsych/faculty/susan-swearer/\" target=\"_blank\" rel=\"noopener\">Susan Swearer\u003c/a>, a professor of psychology at the University of Nebraska, Lincoln who also studies bullying.\u003c/p>\n\u003cp>A \u003ca href=\"https://jamanetwork.com/journals/jama/article-abstract/2664031\" target=\"_blank\" rel=\"noopener\">statistical analysis\u003c/a> by the Centers for Disease Control and Prevention of more than a decade’s worth of emergency room visits in the U.S. suggests that since 2009, the number of girls ages 10 to 14 years who are physically harming themselves has been rising steadily.\u003c/p>\n\u003cp>According to \u003ca href=\"http://www.apa.org/monitor/2015/07-08/who-self-injures.aspx\" target=\"_blank\" rel=\"noopener\">the American Psychological Association\u003c/a>, teens who physically injure themselves often struggle with depression, post-traumatic stress disorder or difficulties with emotional regulation. Not all adolescents who cyberbully themselves have a psychiatric illness, Ziegler notes, but that doesn’t mean their behavior should be taken lightly.\u003c/p>\n\u003cp>“Similar to teens who self-harm by cutting, kids who cyberbully themselves often suffer silently, feeling like they don’t have a friend or adult to confide in,” says Ziegler.\u003c/p>\n\u003cp>If these teens don’t receive mental health treatment, she says, their feelings of loneliness and sadness can cause them to become depressed and, in rare cases, suicidal.\u003c/p>\n\u003cp>Because the advent of social media has changed the way many teens form and experience relationships, normal adolescent feelings of insecurity, anxiety and loneliness can become magnified as they scroll through their peers’ social media reels. Hinduja says some teens cope with that distress by turning their angst on themselves online.\u003c/p>\n\u003cp>While some parents are quick to limit a teen’s social media use in response, that doesn’t adequately address the problem, Hinduja says.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“One of the best thing parents can do is to promote open, nonjudgmental lines of communication with their kids,” he says. “Validating a teen’s experience can encourage them to confide in adults about their distressing experiences — offline or online.”\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg decoding=\"async\" src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=When+Teens+Cyberbully+Themselves&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>During the stressful teen years, most adolescents experience emotional highs and lows, but for more than \u003ca href=\"https://www.nami.org/learn-more/mental-health-by-the-numbers\" target=\"_blank\" rel=\"noopener\">20 percent\u003c/a> of teenagers, their worries and sad feelings turn into something more serious, like anxiety or depression. \u003ca href=\"https://www.bmj.com/content/349/bmj.g5954\" target=\"_blank\" rel=\"noopener\">Studies\u003c/a> show that 13 percent to 18 percent of distressed teens physically injure themselves via cutting, burning or other forms of self-harm as a way to cope with their pain.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Recent research and clinical psychologists now suggest that some adolescents are engaging in a newer form of self-aggression — \u003ca href=\"http://www.jahonline.org/article/S1054-139X(17)30313-0/fulltext\" target=\"_blank\" rel=\"noopener\">digital self-harm\u003c/a>. They’re anonymously posting mean and derogatory comments about themselves on social media.\u003c/p>\n\u003cp>Child psychologist \u003ca href=\"http://denverchildtherapy.com/about-us/sheryl-ziegler/\" target=\"_blank\" rel=\"noopener\">Sheryl Gonzalez-Ziegler\u003c/a> of Denver says it’s a growing problem among teens whom she counsels. One recent client, an adolescent girl, told Gonzalez-Ziegler that she anonymously cyberbullied herself because, as a gay teen, she felt vulnerable and exposed.\u003c/p>\n\u003cp>“She set up ghost accounts on Instagram and posted mean comments about herself, saying things like, ‘I think you’re creepy and gay’ and ‘Don’t sit next to me again,’ ” Ziegler says.\u003c/p>\n\u003cp>“She said these things because she feared being mocked by her peers,” the psychologist explains. “She thought their teasing wouldn’t be so bad if she beat them to the punch.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>According to a survey \u003ca href=\"http://www.jahonline.org/article/S1054-139X(17)30313-0/fulltext\" target=\"_blank\" rel=\"noopener\">published\u003c/a> late last year in the \u003cem>Journal of Adolescent Health\u003c/em>, teens are bullying themselves online as a way to manage feelings of sadness and self-hatred and to gain attention from their friends. For the study, 5,593 middle and high school students from across the U.S., ages 12 to 17, completed a series of questionnaires that asked about their experiences with digital self-harm and cyberbullying.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>”We were alarmed to learn that 6 percent of the youth who participated in our study engaged in some form of digital self-harm,” says \u003ca href=\"http://hinduja.org/\" target=\"_blank\" rel=\"noopener\">Sameer Hinduja\u003c/a>, co-author of the study and a professor of criminology at Florida Atlantic University. He is also the co-director of the \u003ca href=\"https://cyberbullying.org/\" target=\"_blank\" rel=\"noopener\">Cyberbullying Research Center\u003c/a>.\u003c/p>\n\u003cp>Hinduja and a colleague found that more than half the teens who cyberbullied themselves had done so more than once. When asked why they had participated in this behavior, the teens said things like, “I already felt bad about myself, and I wanted to make myself feel worse” and “I wanted to see if someone was really my friend.”\u003c/p>\n\u003cp>Psychologists have seen inklings of this type of self-aggression before. In a smaller, \u003ca href=\"https://webhost.bridgew.edu/marc/DIGITAL%20SELF%20HARM%20report.pdf\" target=\"_blank\" rel=\"noopener\">2012\u003c/a> study of 617 high school freshmen, researchers found that 9 percent of the teens had bullied themselves online. Teens who participated in that study reported harming themselves as a way to encourage others to worry about them, to prove how “tough” they were or to get an adult’s attention.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>”Because teens’ online and offline worlds overlap, digital self-harm is a concern for some youth, making online self-harm an emerging area of research,” says, \u003ca href=\"https://cehs.unl.edu/edpsych/faculty/susan-swearer/\" target=\"_blank\" rel=\"noopener\">Susan Swearer\u003c/a>, a professor of psychology at the University of Nebraska, Lincoln who also studies bullying.\u003c/p>\n\u003cp>A \u003ca href=\"https://jamanetwork.com/journals/jama/article-abstract/2664031\" target=\"_blank\" rel=\"noopener\">statistical analysis\u003c/a> by the Centers for Disease Control and Prevention of more than a decade’s worth of emergency room visits in the U.S. suggests that since 2009, the number of girls ages 10 to 14 years who are physically harming themselves has been rising steadily.\u003c/p>\n\u003cp>According to \u003ca href=\"http://www.apa.org/monitor/2015/07-08/who-self-injures.aspx\" target=\"_blank\" rel=\"noopener\">the American Psychological Association\u003c/a>, teens who physically injure themselves often struggle with depression, post-traumatic stress disorder or difficulties with emotional regulation. Not all adolescents who cyberbully themselves have a psychiatric illness, Ziegler notes, but that doesn’t mean their behavior should be taken lightly.\u003c/p>\n\u003cp>“Similar to teens who self-harm by cutting, kids who cyberbully themselves often suffer silently, feeling like they don’t have a friend or adult to confide in,” says Ziegler.\u003c/p>\n\u003cp>If these teens don’t receive mental health treatment, she says, their feelings of loneliness and sadness can cause them to become depressed and, in rare cases, suicidal.\u003c/p>\n\u003cp>Because the advent of social media has changed the way many teens form and experience relationships, normal adolescent feelings of insecurity, anxiety and loneliness can become magnified as they scroll through their peers’ social media reels. Hinduja says some teens cope with that distress by turning their angst on themselves online.\u003c/p>\n\u003cp>While some parents are quick to limit a teen’s social media use in response, that doesn’t adequately address the problem, Hinduja says.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“One of the best thing parents can do is to promote open, nonjudgmental lines of communication with their kids,” he says. “Validating a teen’s experience can encourage them to confide in adults about their distressing experiences — offline or online.”\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg decoding=\"async\" src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=When+Teens+Cyberbully+Themselves&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>So you want to have a baby.\u003c/p>\n\u003cp>Would you like a dark-haired girl with a high risk of someday getting colon cancer, but a good chance of above-average music ability?[contextly_sidebar id=\"hGdwiHda2M4gvFM3sXPeB5lpQehOV9JO\"]\u003c/p>\n\u003cp>Or would you prefer a girl with a good prospect for high SAT scores and a good shot at being athletic, but who also is likely to run an above-average risk of bipolar disorder and lupus as an adult?\u003c/p>\n\u003cp>How about a boy with a good shot at having musical ability and dodging asthma, but who also would be predisposed to cataracts and type 2 diabetes?\u003c/p>\n\u003cp>Confused? You’re just getting started. There are dozens more choices for which of your embryos should be placed in the womb to become your child.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>That’s the future a biomedical ethics expert envisions for 20 to 40 years from now — soon enough that today’s children may face it when they start their own families.\u003c/p>\n\u003cp>“The majority of babies of people who have good health coverage will be conceived this way,” predicts Henry Greely, a Stanford University law professor who works in bioethics.\u003c/p>\n\u003cp>You’ve probably read about concerns over “designer babies,” whose DNA is shaped by gene editing. Greely is focused on a different technology that has gotten much less attention: In a startling bit of biological alchemy, scientists have shown that in mice, they can turn ordinary cells into sperm and eggs.\u003c/p>\n\u003cp class=\"caption\">[contextly_sidebar id=\"eTManZd4WaqVP8G2asFbvl91UNkETnUW\"]A prominent biomedical ethics expert says that in 20 to 40 years, many prospective parents may choose from dozens of embryos to become their babies and would be provided with genetic information about each embryo to help make the choice. (April 18)\u003c/p>\n\u003cp>It’s too soon to know if it could be done in people. But if it can, it could become a powerful infertility treatment, permitting genetic parenthood for people who can’t make their own sperm or eggs.\u003c/p>\n\u003cp>It also would mean that a woman who wants to get pregnant could produce dozens more eggs per attempt than with the current procedure of harvesting some from her ovaries.\u003c/p>\n\u003cp>And that means a lot of choices.\u003c/p>\n\u003cp>\u003cstrong>An Array of Embryos\u003c/strong>\u003cbr>\nHere’s what Greely envisions: A man and woman walk into a fertility clinic. The man drops off some sperm. The woman leaves some skin cells, which are turned into eggs and fertilized with the man’s sperm.\u003c/p>\n\u003cp>Unlike in vitro fertilization today, which typically yields around eight eggs per try, the new method could result in 100 embryos.\u003c/p>\n\u003cp>The embryos’ complete library of DNA would be decoded and analyzed to reveal genetic predispositions, both for disease and personal traits. The man and woman would get dossiers on the embryos that pass minimum tests for suitability.\u003c/p>\n\u003cp>Out of, say, 80 suitable embryos, the couple would then choose one or two to implant.\u003c/p>\n\u003cp>The possibilities don’t stop there. The technology might also help open the door to same-sex couples having children genetically related to both of them, though the additional twist of making eggs from men or sperm from women would be a huge biological challenge.[contextly_sidebar id=\"SrDdSI0zE6VxuvIcDgGVohz7igj80GaU\"]\u003c/p>\n\u003cp>More worrisome is the so-called Brad Pitt scenario: We all shed a bit of sloughed-off DNA every day, like on the lip of a coffee cup. Such discarded material could be secretly snatched up to turn an unwitting celebrity into a genetic parent.\u003c/p>\n\u003cp>It is a long way in the future, but real life is already creeping toward it. Some scientists are trying to make human eggs and sperm in the lab. They are working with “iPS cells,” which are ordinary body cells that have been morphed into a malleable state.\u003c/p>\n\u003cp>Amander Clark of the University of California, Los Angeles, says her goal is to aid basic research into why some people are infertile. She acknowledges the technique might itself be used to treat some infertility, particularly in young people made sterile by cancer treatments.\u003c/p>\n\u003cp>As for decoding the complete DNA library of embryos, Dr. Louanne Hudgins, who studies prenatal genetic screening and diagnosis at Stanford, says some pregnant patients there say they’ve already had fertility clinics do that. They didn’t reveal why, Hudgins said.\u003c/p>\n\u003cp>Hudgins, who’s president of the American College of Medical Genetics and Genomics, said no national medical association has endorsed decoding all the DNA of an embryo, which is called its genome. So she believes no insurance company would pay for that now.\u003c/p>\n\u003cp>\u003cstrong>‘Easy' Prenatal Diagnosis\u003c/strong>\u003cbr>\nGreely, who lays out his ideas in a book called “The End of Sex and the Future of Human Reproduction,” calls his vision “easy PGD,” or prenatal genetic diagnosis.\u003c/p>\n\u003cp>Ordinary PGD has been done for decades. When a couple is known to be at risk for having a child with a specific genetic disorder, such as cystic fibrosis or sickle cell anemia, the woman undergoes a procedure to remove some eggs. After fertilization, some cells are plucked from the embryos and examined to identify those without carry the disease-causing abnormality.\u003c/p>\n\u003cp>That procedure looks for a specific problem in a few embryos, not entire genomes from dozens of them. If a couple wants to select a “super baby,” says Dr. Richard Scott Jr., a founding partner of Reproductive Medicine Associates of New Jersey, “we tell them we can’t do it.”\u003c/p>\n\u003cp>In fact, Scott and others say, even wide-ranging analysis would not provide a precise forecast of how a child will turn out.\u003c/p>\n\u003cp>[contextly_sidebar id=\"izPvBHygWyTNurqnYm1uuauGvc2JdDjo\"]If DNA is the hardware, there’s also the software: chemical modifications that determine when and where particular genes turn on and off. Much of this “epigenome” would develop after an embryo’s genes are sampled, Scott said.\u003c/p>\n\u003cp>“Your child may not turn out to be the three-sport All-American at Stanford,” because “the epigenome didn’t work out,” Scott said.\u003c/p>\n\u003cp>Greely agrees that predictions about behavioral traits like intelligence and athletic ability will be imprecise, because of epigenetics and because of basic uncertainties about what genes are involved and how they interact. And a person’s upbringing and life experiences have a big effect.\u003c/p>\n\u003cp>\u003cstrong>What Would Couples Do?\u003cbr>\n\u003c/strong>Even if the predictions aren’t perfect, would couples want to take steps to control their child’s genetics? Many experts doubt it.\u003c/p>\n\u003cp>Only a “very small minority” seek a perfect baby, says Stanford’s Hudgins. In her practice, she said she often finds women pass up all screening because they figure the baby’s fate is “in God’s hands.”\u003c/p>\n\u003cp>Dr. James Grifo of the New York University Fertility Center also questions how popular the idea would be.\u003c/p>\n\u003cp>“No patient has ever came to me and said, ’I want a designer baby,’” said Grifo, who’s performed in vitro fertilization since 1988.\u003c/p>\n\u003cp>[contextly_sidebar id=\"hN50KvG8BIKoBQkiV9DDiJW3PjvffZIF\"]Greely doubts that influencing brainpower or athleticism would be a major draw for parents. Instead, he thinks they would care most about avoiding awful diseases that strike in infancy or childhood. They’ll probably be less concerned about illnesses that might show up later in life, such as Alzheimer’s or Parkinson’s. For one thing, he says, parents-to-be may see them as becoming treatable by the time a child becomes vulnerable.\u003c/p>\n\u003cp>He thinks easy PGD is coming, and it would be better if properly handled. He says it should be proven safe, subsidized, monitored for long-term effects, and regulated so that parents can choose whether to use it and decide what embryonic traits to focus on. And he’d outlaw stealing somebody’s DNA and unwittingly making them a parent.\u003c/p>\n\u003cp>\u003cstrong>Others See Pitfalls\u003c/strong>\u003cbr>\nOnce the genetic profile is done, could it come back to haunt a child if, say, a life insurer or nursing home demanded to see it to assess disease risk? How would the large number of rejected embryos be handled ethically and politically?\u003c/p>\n\u003cp>Perhaps future regulation could limit the number of embryos created, as well as what traits a couple could select for, said I. Glenn Cohen, a Harvard law professor.\u003c/p>\n\u003cp>Lori B. Andrews, a professor at the Chicago-Kent College of Law, summed up her views in a review of Greely’s book.\u003c/p>\n\u003cp>“The idea of easy PGD,” she wrote, “should make us uneasy indeed.”\u003c/p>\n\u003cp>Still, even some who doubt the idea’s feasibility say Greely is right to raise the issue.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“It’s certainly something we have to take seriously and think through now,” said Marcy Darnovsky, who writes on the politics of human biotechnology as executive director of the Center for Genetics and Society in Berkeley, California. “This is not just a technical or science question.”\u003cbr>\n__\u003cbr>\nThis Associated Press \u003ca href=\"https://apnews.com/tag/GeneticFrontiers\" target=\"_blank\" rel=\"noopener\">series\u003c/a> was produced in \u003ca href=\"https://www.ap.org/press-releases/2018/ap-hhmi-expand-collaboration-to-bolster-health-science-coverage\" target=\"_blank\" rel=\"noopener\">partnership\u003c/a> with 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>So you want to have a baby.\u003c/p>\n\u003cp>Would you like a dark-haired girl with a high risk of someday getting colon cancer, but a good chance of above-average music ability?\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Or would you prefer a girl with a good prospect for high SAT scores and a good shot at being athletic, but who also is likely to run an above-average risk of bipolar disorder and lupus as an adult?\u003c/p>\n\u003cp>How about a boy with a good shot at having musical ability and dodging asthma, but who also would be predisposed to cataracts and type 2 diabetes?\u003c/p>\n\u003cp>Confused? You’re just getting started. There are dozens more choices for which of your embryos should be placed in the womb to become your child.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>That’s the future a biomedical ethics expert envisions for 20 to 40 years from now — soon enough that today’s children may face it when they start their own families.\u003c/p>\n\u003cp>“The majority of babies of people who have good health coverage will be conceived this way,” predicts Henry Greely, a Stanford University law professor who works in bioethics.\u003c/p>\n\u003cp>You’ve probably read about concerns over “designer babies,” whose DNA is shaped by gene editing. Greely is focused on a different technology that has gotten much less attention: In a startling bit of biological alchemy, scientists have shown that in mice, they can turn ordinary cells into sperm and eggs.\u003c/p>\n\u003cp class=\"caption\">\u003c/p>\u003cp>\u003c/p>\u003cp>A prominent biomedical ethics expert says that in 20 to 40 years, many prospective parents may choose from dozens of embryos to become their babies and would be provided with genetic information about each embryo to help make the choice. (April 18)\u003c/p>\n\u003cp>It’s too soon to know if it could be done in people. But if it can, it could become a powerful infertility treatment, permitting genetic parenthood for people who can’t make their own sperm or eggs.\u003c/p>\n\u003cp>It also would mean that a woman who wants to get pregnant could produce dozens more eggs per attempt than with the current procedure of harvesting some from her ovaries.\u003c/p>\n\u003cp>And that means a lot of choices.\u003c/p>\n\u003cp>\u003cstrong>An Array of Embryos\u003c/strong>\u003cbr>\nHere’s what Greely envisions: A man and woman walk into a fertility clinic. The man drops off some sperm. The woman leaves some skin cells, which are turned into eggs and fertilized with the man’s sperm.\u003c/p>\n\u003cp>Unlike in vitro fertilization today, which typically yields around eight eggs per try, the new method could result in 100 embryos.\u003c/p>\n\u003cp>The embryos’ complete library of DNA would be decoded and analyzed to reveal genetic predispositions, both for disease and personal traits. The man and woman would get dossiers on the embryos that pass minimum tests for suitability.\u003c/p>\n\u003cp>Out of, say, 80 suitable embryos, the couple would then choose one or two to implant.\u003c/p>\n\u003cp>The possibilities don’t stop there. The technology might also help open the door to same-sex couples having children genetically related to both of them, though the additional twist of making eggs from men or sperm from women would be a huge biological challenge.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>More worrisome is the so-called Brad Pitt scenario: We all shed a bit of sloughed-off DNA every day, like on the lip of a coffee cup. Such discarded material could be secretly snatched up to turn an unwitting celebrity into a genetic parent.\u003c/p>\n\u003cp>It is a long way in the future, but real life is already creeping toward it. Some scientists are trying to make human eggs and sperm in the lab. They are working with “iPS cells,” which are ordinary body cells that have been morphed into a malleable state.\u003c/p>\n\u003cp>Amander Clark of the University of California, Los Angeles, says her goal is to aid basic research into why some people are infertile. She acknowledges the technique might itself be used to treat some infertility, particularly in young people made sterile by cancer treatments.\u003c/p>\n\u003cp>As for decoding the complete DNA library of embryos, Dr. Louanne Hudgins, who studies prenatal genetic screening and diagnosis at Stanford, says some pregnant patients there say they’ve already had fertility clinics do that. They didn’t reveal why, Hudgins said.\u003c/p>\n\u003cp>Hudgins, who’s president of the American College of Medical Genetics and Genomics, said no national medical association has endorsed decoding all the DNA of an embryo, which is called its genome. So she believes no insurance company would pay for that now.\u003c/p>\n\u003cp>\u003cstrong>‘Easy' Prenatal Diagnosis\u003c/strong>\u003cbr>\nGreely, who lays out his ideas in a book called “The End of Sex and the Future of Human Reproduction,” calls his vision “easy PGD,” or prenatal genetic diagnosis.\u003c/p>\n\u003cp>Ordinary PGD has been done for decades. When a couple is known to be at risk for having a child with a specific genetic disorder, such as cystic fibrosis or sickle cell anemia, the woman undergoes a procedure to remove some eggs. After fertilization, some cells are plucked from the embryos and examined to identify those without carry the disease-causing abnormality.\u003c/p>\n\u003cp>That procedure looks for a specific problem in a few embryos, not entire genomes from dozens of them. If a couple wants to select a “super baby,” says Dr. Richard Scott Jr., a founding partner of Reproductive Medicine Associates of New Jersey, “we tell them we can’t do it.”\u003c/p>\n\u003cp>In fact, Scott and others say, even wide-ranging analysis would not provide a precise forecast of how a child will turn out.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>If DNA is the hardware, there’s also the software: chemical modifications that determine when and where particular genes turn on and off. Much of this “epigenome” would develop after an embryo’s genes are sampled, Scott said.\u003c/p>\n\u003cp>“Your child may not turn out to be the three-sport All-American at Stanford,” because “the epigenome didn’t work out,” Scott said.\u003c/p>\n\u003cp>Greely agrees that predictions about behavioral traits like intelligence and athletic ability will be imprecise, because of epigenetics and because of basic uncertainties about what genes are involved and how they interact. And a person’s upbringing and life experiences have a big effect.\u003c/p>\n\u003cp>\u003cstrong>What Would Couples Do?\u003cbr>\n\u003c/strong>Even if the predictions aren’t perfect, would couples want to take steps to control their child’s genetics? Many experts doubt it.\u003c/p>\n\u003cp>Only a “very small minority” seek a perfect baby, says Stanford’s Hudgins. In her practice, she said she often finds women pass up all screening because they figure the baby’s fate is “in God’s hands.”\u003c/p>\n\u003cp>Dr. James Grifo of the New York University Fertility Center also questions how popular the idea would be.\u003c/p>\n\u003cp>“No patient has ever came to me and said, ’I want a designer baby,’” said Grifo, who’s performed in vitro fertilization since 1988.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>Greely doubts that influencing brainpower or athleticism would be a major draw for parents. Instead, he thinks they would care most about avoiding awful diseases that strike in infancy or childhood. They’ll probably be less concerned about illnesses that might show up later in life, such as Alzheimer’s or Parkinson’s. For one thing, he says, parents-to-be may see them as becoming treatable by the time a child becomes vulnerable.\u003c/p>\n\u003cp>He thinks easy PGD is coming, and it would be better if properly handled. He says it should be proven safe, subsidized, monitored for long-term effects, and regulated so that parents can choose whether to use it and decide what embryonic traits to focus on. And he’d outlaw stealing somebody’s DNA and unwittingly making them a parent.\u003c/p>\n\u003cp>\u003cstrong>Others See Pitfalls\u003c/strong>\u003cbr>\nOnce the genetic profile is done, could it come back to haunt a child if, say, a life insurer or nursing home demanded to see it to assess disease risk? How would the large number of rejected embryos be handled ethically and politically?\u003c/p>\n\u003cp>Perhaps future regulation could limit the number of embryos created, as well as what traits a couple could select for, said I. Glenn Cohen, a Harvard law professor.\u003c/p>\n\u003cp>Lori B. Andrews, a professor at the Chicago-Kent College of Law, summed up her views in a review of Greely’s book.\u003c/p>\n\u003cp>“The idea of easy PGD,” she wrote, “should make us uneasy indeed.”\u003c/p>\n\u003cp>Still, even some who doubt the idea’s feasibility say Greely is right to raise the issue.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“It’s certainly something we have to take seriously and think through now,” said Marcy Darnovsky, who writes on the politics of human biotechnology as executive director of the Center for Genetics and Society in Berkeley, California. “This is not just a technical or science question.”\u003cbr>\n__\u003cbr>\nThis Associated Press \u003ca href=\"https://apnews.com/tag/GeneticFrontiers\" target=\"_blank\" rel=\"noopener\">series\u003c/a> was produced in \u003ca href=\"https://www.ap.org/press-releases/2018/ap-hhmi-expand-collaboration-to-bolster-health-science-coverage\" target=\"_blank\" rel=\"noopener\">partnership\u003c/a> with 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>The first large-scale, national study of transgender children, including some as young as 3, is poised to expand thanks to a five-year, $1 million grant awarded Thursday by the National Science Foundation to the professor leading the project.\u003c/p>\n\u003cp>University of Washington psychologist Kristina Olson, 36, was named winner of the NSF's annual Alan T. Waterman Award, the government's highest honor for scientists still in the early phases of their careers. The NSF said the choice was unanimous, and noted that pediatricians are already using her findings to raise awareness about gender diversity.\u003c/p>\n\u003cp>While the award citation honors Olson for a broad range of her research on children's perceptions, she has become best known as creator and leader of the TransYouth Project, which is widely considered the most ambitious long-term study of transgender children being conducted in the U.S.\u003c/p>\n\u003cp>Launched in 2013, the project has recruited more than 300 children ages 3-12 from 45 states, with the goal of tracking their development over 20 years. The NSF grant will help Olson maintain the study as many of the children go through adolescence; she hopes to continue it into their adulthood.\u003c/p>\n\u003cp>\"'Transgender children' is a category we have so little scientific knowledge about,\" says Olson. \"I'm interested in their experience of feeling you are in a social category that other people don't think you're a part of.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Some of the study's early findings were reported two years ago in the journal Pediatrics — notably that the 73 children being tracked at that time had rates of depression and anxiety no higher than non-transgender children in control groups. The trans children were supported by their families and allowed to live openly as the gender they identify with — suggesting to Olson that family support was a key to avoiding the mental health problems identified in studies of other transgender youths.\u003c/p>\n\u003cp>\"In a very scientific way, our study shows that this group of kids is doing really, really well,\" she said in a telephone interview.\u003c/p>\n\u003cp>She hopes the NSF grant will enable her to expand the study to encompass youths who are in the process of gender transition but haven't completed it. Some of the funds will be used for Olson's work on other topics, including race and inequality, and also to support research opportunities for undergraduates.\u003c/p>\n\u003cp>The TransYouth Project received positive coverage following the Pediatrics article, but Olson's research also has been the target of criticism. An article last year in The Federalist, a conservative online magazine, asserted that it was \"utterly ridiculous\" to open a study on gender identity to a 3-year-old child \"who is just learning to use the bathroom, spell his name, and the days of the week.\"\u003c/p>\n\u003cp>However, Olson said children of that age, whether transgender or not, show awareness of gender identity in many ways, through their self-descriptions, what they wear, who they prefer to play with.\u003c/p>\n\u003cp>\"People frequently compare early-identifying trans children with those who go through phases of believing they are cats or dinosaurs or who have imaginary friends,\" Olson wrote recently. \"Yet decades of work on gender development suggests these are precisely the ages at which nearly all kids are coming to understand their own and others' gender identities.\"\u003c/p>\n\u003cp>Olson said some critics incorrectly concluded that gender-altering surgery is being performed on the prepubescent children in her study.\u003c/p>\n\u003cp>She also stresses that the parents of the children already had decided to help them make a gender-identity transition — she's not the one advocating for that. Even before she met the children, they were identifying with a gender different from the one they were born with — often adopting a new name, and different clothing, toys, activities and friends.\u003c/p>\n\u003cp>Among those skeptical of the study is Andrew Walker, a parent of two small children who is director of policy studies for the Southern Baptist Convention's Ethics & Religious Liberty Commission.\u003c/p>\n\u003cp>\"I am highly suspect of allowing children to be mature agents in determining this level of self-understanding,\" he said. \"That seems to be highly problematic and borderline reckless... putting drastically catastrophic decisions about a child's life in the child's hands.\"\u003c/p>\n\u003cp>He also questioned the appropriateness of investing federal funds in \"what is ultimately an ideological, contestable issue — the notion of gender fluidity.\"\u003c/p>\n\u003cp>Olson said the vitriol directed at her, via email and social media, became so extreme that she avoided talking to the media for about eight months.\u003c/p>\n\u003cp>\"It doesn't feel good to have people saying negative things about you,\" she said. \"You just have to keep going.\"\u003c/p>\n\u003cp>Cheryl Kaiser, chair of the UW psychology department, described Olson's foray into the project as a \"striking act of bravery.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Olson is the first psychologist to receive the Waterman Award, which was established by Congress in 1975.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The first large-scale, national study of transgender children, including some as young as 3, is poised to expand thanks to a five-year, $1 million grant awarded Thursday by the National Science Foundation to the professor leading the project.\u003c/p>\n\u003cp>University of Washington psychologist Kristina Olson, 36, was named winner of the NSF's annual Alan T. Waterman Award, the government's highest honor for scientists still in the early phases of their careers. The NSF said the choice was unanimous, and noted that pediatricians are already using her findings to raise awareness about gender diversity.\u003c/p>\n\u003cp>While the award citation honors Olson for a broad range of her research on children's perceptions, she has become best known as creator and leader of the TransYouth Project, which is widely considered the most ambitious long-term study of transgender children being conducted in the U.S.\u003c/p>\n\u003cp>Launched in 2013, the project has recruited more than 300 children ages 3-12 from 45 states, with the goal of tracking their development over 20 years. The NSF grant will help Olson maintain the study as many of the children go through adolescence; she hopes to continue it into their adulthood.\u003c/p>\n\u003cp>\"'Transgender children' is a category we have so little scientific knowledge about,\" says Olson. \"I'm interested in their experience of feeling you are in a social category that other people don't think you're a part of.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Some of the study's early findings were reported two years ago in the journal Pediatrics — notably that the 73 children being tracked at that time had rates of depression and anxiety no higher than non-transgender children in control groups. The trans children were supported by their families and allowed to live openly as the gender they identify with — suggesting to Olson that family support was a key to avoiding the mental health problems identified in studies of other transgender youths.\u003c/p>\n\u003cp>\"In a very scientific way, our study shows that this group of kids is doing really, really well,\" she said in a telephone interview.\u003c/p>\n\u003cp>She hopes the NSF grant will enable her to expand the study to encompass youths who are in the process of gender transition but haven't completed it. Some of the funds will be used for Olson's work on other topics, including race and inequality, and also to support research opportunities for undergraduates.\u003c/p>\n\u003cp>The TransYouth Project received positive coverage following the Pediatrics article, but Olson's research also has been the target of criticism. An article last year in The Federalist, a conservative online magazine, asserted that it was \"utterly ridiculous\" to open a study on gender identity to a 3-year-old child \"who is just learning to use the bathroom, spell his name, and the days of the week.\"\u003c/p>\n\u003cp>However, Olson said children of that age, whether transgender or not, show awareness of gender identity in many ways, through their self-descriptions, what they wear, who they prefer to play with.\u003c/p>\n\u003cp>\"People frequently compare early-identifying trans children with those who go through phases of believing they are cats or dinosaurs or who have imaginary friends,\" Olson wrote recently. \"Yet decades of work on gender development suggests these are precisely the ages at which nearly all kids are coming to understand their own and others' gender identities.\"\u003c/p>\n\u003cp>Olson said some critics incorrectly concluded that gender-altering surgery is being performed on the prepubescent children in her study.\u003c/p>\n\u003cp>She also stresses that the parents of the children already had decided to help them make a gender-identity transition — she's not the one advocating for that. Even before she met the children, they were identifying with a gender different from the one they were born with — often adopting a new name, and different clothing, toys, activities and friends.\u003c/p>\n\u003cp>Among those skeptical of the study is Andrew Walker, a parent of two small children who is director of policy studies for the Southern Baptist Convention's Ethics & Religious Liberty Commission.\u003c/p>\n\u003cp>\"I am highly suspect of allowing children to be mature agents in determining this level of self-understanding,\" he said. \"That seems to be highly problematic and borderline reckless... putting drastically catastrophic decisions about a child's life in the child's hands.\"\u003c/p>\n\u003cp>He also questioned the appropriateness of investing federal funds in \"what is ultimately an ideological, contestable issue — the notion of gender fluidity.\"\u003c/p>\n\u003cp>Olson said the vitriol directed at her, via email and social media, became so extreme that she avoided talking to the media for about eight months.\u003c/p>\n\u003cp>\"It doesn't feel good to have people saying negative things about you,\" she said. \"You just have to keep going.\"\u003c/p>\n\u003cp>Cheryl Kaiser, chair of the UW psychology department, described Olson's foray into the project as a \"striking act of bravery.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Olson is the first psychologist to receive the Waterman Award, which was established by Congress in 1975.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Male OB-GYNs Are Rare, But Is That A Problem?",
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"content": "\u003cp>As she leaves a 12-hour-day on the labor and delivery shift, Dr. Katie Merriam turns off her pager.\u003c/p>\n\u003cp>\"I don't know what I'd do without it, you know? It's another limb. I always know where it is,\" she says and laughs.[contextly_sidebar id=\"YNjmmIvrIhdA4E5WvQFE9ShsbCebY22H\"]\u003c/p>\n\u003cp>The third-year resident in obstetrics and gynecology at the Carolinas Medical Center hospital in Charlotte, N.C., works in a medical specialty dominated by women, treating women. Merriam says she feels a special connection to her patients.\"You just, you can feel what they feel and understand why they feel certain ways. I do feel a special bond,\" she says.\u003c/p>\n\u003cp>Nationally, 82 percent of doctors \u003ca href=\"https://m.acog.org/~/media/BB3A7629943642ADA47058D0BDCD1521.pdf\" target=\"_blank\" rel=\"noopener\">matching into OB-GYN residency programs\u003c/a> are women. Many OB-GYN patients say they prefer female doctors. Merriam's residency class is a bit of an anomaly — half of its members are men. Though it's nice to work with so many women, Merriam says, she and some of her female colleagues also like the perspective that men bring to the work environment.\u003c/p>\n\u003cp>\"No one could really pinpoint about what balance they bring, but there's something nice about having them,\" she says.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>[contextly_sidebar id=\"xxd0pnJ8BiRSq6Um262jL74IFF2B4Gk9\"]It's important to have men in the field, she says, if only to continue to give patients options in their choice of providers. But most of her friends and other women she talks to, she says, want female doctors.\u003c/p>\n\u003cp>Blake Butterworth, a fourth-year obstetrics and gynecology resident at the Medical University of South Carolina in Charleston, says he doesn't take it personally when he hears that sort of thing from a patient.\u003c/p>\n\u003cp>\"I don't get discouraged; I don't get offended,\" Butterworth says. \"I gladly hand that patient off.\"\u003c/p>\n\u003cp>He's one of only two male residents in the program of 24 at MUSC and says he finds it rewarding when he can win a new patient's confidence.\u003c/p>\n\u003cp>\"I have patients that clearly express disdain to have to see a guy,\" he says. \"Then I develop rapport with her. And she says, 'I expected you to be x-y-z, and you were better than that.' \"\u003c/p>\n\u003cp>Butterworth says he chose obstetrics and gynecology because it lets him develop long-term relationships with patients — providing routine OB-GYN care and more complicated surgeries if need be.\u003c/p>\n\u003cp>\"Once you really get into it, and get involved in it, I don't think that bias [that the field is best left to women] holds true,\" he says.[contextly_sidebar id=\"JAYbqyJrlg0qXG2TGj01PA9aZ68oHdWG\"]\u003c/p>\n\u003cp>Butterworth believes it is incumbent on male OB-GYNs to talk to male medical students about the benefits of having men in the field. Students need to know it's OK to have an interest in the field, he says, and that they will find work.\u003c/p>\n\u003cp>In fact, says \u003ca href=\"http://academicdepartments.musc.edu/facultydirectory/Savage-Ashlyn\" target=\"_blank\" rel=\"noopener\">Dr. Ashlyn Savage \u003c/a>, an associate professor of obstetrics and gynecology at MUSC, it may be the opposite.\u003c/p>\n\u003cp>\"In an effort to really diversify the applicant pool, we will apply in some cases different screening standards to decide who we are going to interview,\" Savage says. \"For example, we might consider an applicant with a slightly lower board score — just to enhance how many men we are interviewing and considering.\"\u003c/p>\n\u003cp>It has been a challenge to find male OB-GYNs for the program, she says. The gender that at one time dominated the field is now at some schools considered a diversity hire. But Savage questions whether balancing the number of men and women in the specialty is as important as racial or ethnic diversity.\u003c/p>\n\u003cp>\"The interesting thing to me is the primary motivation to [seek a diverse candidate pool] is so that patients have the opportunity to seek out physicians who might ... feel like themselves,\" she says. \"In this particular case ... all of the patients for OB-GYNs are women.\"[contextly_sidebar id=\"SJnnFVMkAgJrTRRKA7yFicLNPD1xw46Z\"]\u003c/p>\n\u003cp>Among practicing OB-GYNs in the U.S., a \u003ca href=\"https://www.acog.org/Clinical-Guidance-and-Publications/The-Ob-Gyn-Workforce/The-Obstetrician-Gynecologist-Workforce-in-the-United-States\" target=\"_blank\" rel=\"noopener\">little less than half are men\u003c/a>, according to the American Congress of Obstetricians and Gynecologists. But ACOG predicts that 10 years from now, two-thirds of the doctors in that specialty will be female.\u003c/p>\n\u003cp>Still, male doctors hold a lot of the key positions in OB-GYN professional organizations.\u003c/p>\n\u003cp>\"Leadership tends to be held by people who are older,\" Savage says. \"And we are still in a scenario where [more of] our older faculty tend to be men.\"\u003c/p>\n\u003cp>A \u003ca href=\"https://journals.lww.com/greenjournal/Abstract/2017/10000/Geographic_Comparison_of_Women_in_Academic.26.aspx\" target=\"_blank\" rel=\"noopener\">study \u003c/a> published last fall found the women are underrepresented in leadership roles in medical school departments of obstetrics and gynecology all around the country. That ratio was most lopsided in men's favor in the South.\u003c/p>\n\u003cp>It's perhaps only a matter of time before that, too, changes. Savage says she just learned that her program's incoming class of OB-GYN residents next year will be all female.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This story is part of NPR's reporting partnership with WFAE and \u003c/em>\u003ca href=\"http://www.kaiserhealthnews.org/\" target=\"_blank\" rel=\"noopener\">\u003cem>Kaiser Health News\u003c/em>\u003c/a>\u003cem>.\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 WFAE. To see more, visit \u003ca href=\"http://www.wfae.org\" target=\"_blank\" rel=\"noopener\">WFAE\u003c/a>.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Male+OB-GYNs+Are+Rare%2C+But+Is+That+A+Problem%3F&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>As she leaves a 12-hour-day on the labor and delivery shift, Dr. Katie Merriam turns off her pager.\u003c/p>\n\u003cp>\"I don't know what I'd do without it, you know? It's another limb. I always know where it is,\" she says and laughs.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>The third-year resident in obstetrics and gynecology at the Carolinas Medical Center hospital in Charlotte, N.C., works in a medical specialty dominated by women, treating women. Merriam says she feels a special connection to her patients.\"You just, you can feel what they feel and understand why they feel certain ways. I do feel a special bond,\" she says.\u003c/p>\n\u003cp>Nationally, 82 percent of doctors \u003ca href=\"https://m.acog.org/~/media/BB3A7629943642ADA47058D0BDCD1521.pdf\" target=\"_blank\" rel=\"noopener\">matching into OB-GYN residency programs\u003c/a> are women. Many OB-GYN patients say they prefer female doctors. Merriam's residency class is a bit of an anomaly — half of its members are men. Though it's nice to work with so many women, Merriam says, she and some of her female colleagues also like the perspective that men bring to the work environment.\u003c/p>\n\u003cp>\"No one could really pinpoint about what balance they bring, but there's something nice about having them,\" she says.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>It's important to have men in the field, she says, if only to continue to give patients options in their choice of providers. But most of her friends and other women she talks to, she says, want female doctors.\u003c/p>\n\u003cp>Blake Butterworth, a fourth-year obstetrics and gynecology resident at the Medical University of South Carolina in Charleston, says he doesn't take it personally when he hears that sort of thing from a patient.\u003c/p>\n\u003cp>\"I don't get discouraged; I don't get offended,\" Butterworth says. \"I gladly hand that patient off.\"\u003c/p>\n\u003cp>He's one of only two male residents in the program of 24 at MUSC and says he finds it rewarding when he can win a new patient's confidence.\u003c/p>\n\u003cp>\"I have patients that clearly express disdain to have to see a guy,\" he says. \"Then I develop rapport with her. And she says, 'I expected you to be x-y-z, and you were better than that.' \"\u003c/p>\n\u003cp>Butterworth says he chose obstetrics and gynecology because it lets him develop long-term relationships with patients — providing routine OB-GYN care and more complicated surgeries if need be.\u003c/p>\n\u003cp>\"Once you really get into it, and get involved in it, I don't think that bias [that the field is best left to women] holds true,\" he says.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Butterworth believes it is incumbent on male OB-GYNs to talk to male medical students about the benefits of having men in the field. Students need to know it's OK to have an interest in the field, he says, and that they will find work.\u003c/p>\n\u003cp>In fact, says \u003ca href=\"http://academicdepartments.musc.edu/facultydirectory/Savage-Ashlyn\" target=\"_blank\" rel=\"noopener\">Dr. Ashlyn Savage \u003c/a>, an associate professor of obstetrics and gynecology at MUSC, it may be the opposite.\u003c/p>\n\u003cp>\"In an effort to really diversify the applicant pool, we will apply in some cases different screening standards to decide who we are going to interview,\" Savage says. \"For example, we might consider an applicant with a slightly lower board score — just to enhance how many men we are interviewing and considering.\"\u003c/p>\n\u003cp>It has been a challenge to find male OB-GYNs for the program, she says. The gender that at one time dominated the field is now at some schools considered a diversity hire. But Savage questions whether balancing the number of men and women in the specialty is as important as racial or ethnic diversity.\u003c/p>\n\u003cp>\"The interesting thing to me is the primary motivation to [seek a diverse candidate pool] is so that patients have the opportunity to seek out physicians who might ... feel like themselves,\" she says. \"In this particular case ... all of the patients for OB-GYNs are women.\"\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Among practicing OB-GYNs in the U.S., a \u003ca href=\"https://www.acog.org/Clinical-Guidance-and-Publications/The-Ob-Gyn-Workforce/The-Obstetrician-Gynecologist-Workforce-in-the-United-States\" target=\"_blank\" rel=\"noopener\">little less than half are men\u003c/a>, according to the American Congress of Obstetricians and Gynecologists. But ACOG predicts that 10 years from now, two-thirds of the doctors in that specialty will be female.\u003c/p>\n\u003cp>Still, male doctors hold a lot of the key positions in OB-GYN professional organizations.\u003c/p>\n\u003cp>\"Leadership tends to be held by people who are older,\" Savage says. \"And we are still in a scenario where [more of] our older faculty tend to be men.\"\u003c/p>\n\u003cp>A \u003ca href=\"https://journals.lww.com/greenjournal/Abstract/2017/10000/Geographic_Comparison_of_Women_in_Academic.26.aspx\" target=\"_blank\" rel=\"noopener\">study \u003c/a> published last fall found the women are underrepresented in leadership roles in medical school departments of obstetrics and gynecology all around the country. That ratio was most lopsided in men's favor in the South.\u003c/p>\n\u003cp>It's perhaps only a matter of time before that, too, changes. Savage says she just learned that her program's incoming class of OB-GYN residents next year will be all female.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This story is part of NPR's reporting partnership with WFAE and \u003c/em>\u003ca href=\"http://www.kaiserhealthnews.org/\" target=\"_blank\" rel=\"noopener\">\u003cem>Kaiser Health News\u003c/em>\u003c/a>\u003cem>.\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 WFAE. To see more, visit \u003ca href=\"http://www.wfae.org\" target=\"_blank\" rel=\"noopener\">WFAE\u003c/a>.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Male+OB-GYNs+Are+Rare%2C+But+Is+That+A+Problem%3F&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp class=\"danger-zone\">Theranos this week \u003ca href=\"https://www.wsj.com/articles/theranos-lays-off-most-of-its-remaining-workforce-1523382373\" target=\"_blank\" rel=\"noopener\">laid off\u003c/a> all but about two dozen of its remaining employees — the latest indignity for the once fabulously rich blood-testing company that’s become a parable for Silicon Valley hubris.\u003c/p>\n\u003cp class=\"danger-zone\">As with much of the flood of bad news for Theranos, word of the layoffs came from John Carreyrou, the investigative reporter at the Wall Street Journal who was the first to \u003ca href=\"https://www.wsj.com/articles/theranos-has-struggled-with-blood-tests-1444881901\" target=\"_blank\" rel=\"noopener\">break the story\u003c/a> of the company’s troubles in October 2015 and who later landed a string of Theranos-related scoops.\u003c/p>\n\u003cp class=\"danger-zone\">Carreyrou also happens to be the author of a new book on the company, “\u003ca href=\"https://www.penguinrandomhouse.com/books/549478/bad-blood-by-john-carreyrou/9781524731656/\" target=\"_blank\" rel=\"noopener\">Bad Blood: Secrets and Lies in a Silicon Valley Startup\u003c/a>,” which is being released on May 21. The first print, from the publishing house Alfred A. Knopf, will be 100,000 copies.\u003c/p>\n\u003cp class=\"danger-zone\">STAT obtained an advance copy of the roughly 300-page book. Through countless details and episodes reported for the first time, Carreyrou paints a damning portrait of the culture of dysfunction and deception overseen by CEO Elizabeth Holmes.\u003c/p>\n\u003cp>Below are the eight most remarkable things we learned from reading “Bad Blood.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The company, we should add, didn’t return STAT’s request for comment.\u003c/p>\n\u003ch2>\u003cb>1. Theranos was lying as early as 2006\u003c/b>\u003c/h2>\n\u003cp>Much of the attention on Theranos’ misdeeds has been focused on what happened (and what failed to happen) \u003ci>after\u003c/i> the company launched its blood-testing services to the public in Walgreens drugstores in September 2013.\u003c/p>\n\u003cp>But Carreyrou says there was deception going on far earlier.\u003c/p>\n\u003cp>In an episode reported for the first time in the book, Carreyrou describes a surreal scene from 2006, in which the company’s first chief financial officer learned that Theranos had deceived Novartis executives in demonstrating its technology at a pitch meeting in Switzerland. The trick: Because the blood-testing system was inconsistent in generating results, Theranos staffers had recorded a result from one of the times it worked to display in the demonstration.\u003c/p>\n\u003cp>And when the CFO raised concern about that with Holmes? He was fired on the spot.\u003c/p>\n\u003ch2>\u003cb>2. Theranos’s technology was more amateurish than previously known\u003c/b>\u003c/h2>\n\u003cp>Theranos has largely taken heat for lying. But Carreyrou also found absurdity and amateurism at the heart of the company’s technology.\u003c/p>\n\u003cp>In one revealing incident, Holmes and an associate spent two hours pricking their fingers in a hotel before a big meeting with Novartis in a futile effort to get the buggy technology to work. In another, an executive bragged that he could write the code for the technology’s software faster using Flash — before a “Learn Flash” book turned up on his desk.\u003c/p>\n\u003ch2>\u003cb>3. It didn’t take much to get fired or fall out of favor at Theranos\u003c/b>\u003c/h2>\n\u003cp>It’s not unusual for a fast-growing startup to see some employee turnover. But Carreyrou’s book describes Theranos’s corporate culture as far more toxic and chaotic than previously known.\u003c/p>\n\u003cp>\u003ca href=\"https://www.statnews.com/2018/03/19/theranos-ramesh-balwani/\">Sunny Balwani\u003c/a>, Theranos’s shadowy former No. 2 executive, fired employees without explanation to the rest of the staff so frequently that surviving employees referred to dismissed colleagues with a memorable turn of phrase. “‘Sunny disappeared him,’ they would say, conjuring up the image of a Mafia hit in 1970s Brooklyn,” Carreyrou writes.\u003c/p>\n\u003cp>Even when Theranos employees didn’t get sacked, even the smallest incidents could cause them to offend Holmes and Balwani and lose their status within the company hierarchy. In one surreal incident Carreyrou describes, an employee was castigated for a weekend project in which he invented a new type of bike light — seen by Holmes and Balwani as a major conflict of interest.\u003c/p>\n\u003ch2>\u003cb>4. Holmes’s younger brother led a pack of ‘Therabros’\u003c/b>\u003c/h2>\n\u003cp>Among the hires at Theranos: Holmes’s younger brother.\u003c/p>\n\u003cp>Carreyrou’s book details for the first time the strange role that Christian Holmes played at the company. Despite no relevant qualifications, Christian Holmes joined Theranos’ product management team just a few years after graduating from Duke University. He cut a very different figure than his sister, coming off as more interested in having fun than in changing the world, Carreyrou reports.\u003c/p>\n\u003cp>Christian Holmes recruited several of his fraternity brothers from Duke to join Theranos, forming a clique with an outsized status in the corporate hierarchy that other employees called “the Frat Pack.” In one of the most memorable lines of Carreyrou’s book, one staffer at an ad agency that worked with Theranos referred to Christian Holmes’s clique as the “Therabros.”\u003c/p>\n\u003cp>It’s unclear if Christian Holmes still works at Theranos, though his \u003ca href=\"https://www.linkedin.com/in/christian-holmes-20233414/\" target=\"_blank\" rel=\"noopener\">LinkedIn page \u003c/a>still lists him as the company’s senior director of business development.\u003c/p>\n\u003ch2>\u003cb>5. Super-lawyer David Boies comes off looking bad\u003c/b>\u003c/h2>\n\u003cp>David Boies, the legendary lawyer who represented Al Gore in Florida and took on Bill Gates in a massive antitrust case, has had a bad few months: He took a reputation hit for his role in silencing the women who’ve accused Harvey Weinstein of sexual harrassment and assault. The New York Times fired him. So did a\u003ca href=\"https://abovethelaw.com/2017/11/david-boies-loses-more-work-over-weinstein-debacle/\" target=\"_blank\" rel=\"noopener\"> Florida city\u003c/a>, on a pro bono case.\u003c/p>\n\u003cp>Carreyrou’s new book might not help Boies’ ailing image.\u003c/p>\n\u003cp>“Bad Blood” paints a vivid portrait of the central role that Boies played in unsuccessfully trying to pressure the Wall Street Journal to kill Carreyrou’s original story — and in trying to intimidate Tyler Schultz, the young Stanford graduate who briefly worked at Theranos and blew the whistle on the company’s misdeeds.\u003c/p>\n\u003ch2>\u003cb>6. Holmes wasn’t manipulated — but her deep voice may be\u003c/b>\u003c/h2>\n\u003cp>The public fascination with the Theranos scandal has been driven in no small part by the cult of personality around Holmes, the charismatic, turtleneck-clad young woman who dropped out of Stanford at age 19 to revolutionize blood testing.\u003c/p>\n\u003cp>As Theranos’s misdeeds have come to light, her mystique has centered around a key question: Was she the key figure behind the deception — or simply a pawn of Balwani, who happened to also be her boyfriend for a time? (More on that in a second.)\u003c/p>\n\u003cp>Carreyrou’s account gives every reason to believe Holmes was the decision-maker. Scene after scene in the book shows her convincing people to do her bidding, often in the face of overwhelming reason to do otherwise.\u003c/p>\n\u003cp>Holmes also comes off as supremely in control of her own image. In one memorable incident, she slipped out of her trademark baritone into a voice many octaves higher, leading one former employee to suspect that the deep voice may be affected to fit in in a corporate world dominated by men.\u003c/p>\n\u003ch2>\u003cb>7. Balwani is even more central to the Theranos saga than you thought\u003c/b>\u003c/h2>\n\u003cp>Balwani was in the public spotlight last month when he was charged with fraud by the Securities and Exchange Commission. While Holmes and her company settled analogous charges, Balwani is going to court to fight the SEC.\u003c/p>\n\u003cp>Carreyrou’s book paints the most detailed portrait to date of Balwani. The book describes him as a man who drove statement sports cars, wore way too much cologne to the office, and mercilessly bullied employees even though he understood little about blood testing.\u003c/p>\n\u003cp>The book also provides new details about the timeline of the romantic relationship between Holmes and Balwani, who is nearly 20 years Holmes’s senior. According to Carreyrou, they became romantically involved not long after she dropped out of Stanford at age 19. And they broke up in the spring of 2016, when Holmes pushed him out of the company as Theranos’ problems were growing.\u003c/p>\n\u003ch2>\u003cb>8. Carreyrou has a reporter’s notebook for the ages\u003c/b>\u003c/h2>\n\u003cp>The first-person account of how a journalist got a big story, known in the news business as a reporter’s notebook, has become a familiar genre. In the book, Carreyrou for the first time pens his own account of how he landed one of the biggest business stories of the decade.\u003c/p>\n\u003cp>Carreyrou writes vividly about getting the tip that sparked the story (it came by phone, from a pathology blogger), taking a breakthrough call while watching his sons play at a Brooklyn park, and getting information that led him to conclude that he or Schultz was being surveilled by Theranos.\u003c/p>\n\u003cp>Carreyrou’s own story, like the rest of the book, does not disappoint.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>\u003cspan style=\"font-weight: 400\">This \u003ca href=\"https://www.statnews.com/2018/04/12/theranos-bad-blood-carreyrou/\" 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/span>\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp class=\"danger-zone\">Theranos this week \u003ca href=\"https://www.wsj.com/articles/theranos-lays-off-most-of-its-remaining-workforce-1523382373\" target=\"_blank\" rel=\"noopener\">laid off\u003c/a> all but about two dozen of its remaining employees — the latest indignity for the once fabulously rich blood-testing company that’s become a parable for Silicon Valley hubris.\u003c/p>\n\u003cp class=\"danger-zone\">As with much of the flood of bad news for Theranos, word of the layoffs came from John Carreyrou, the investigative reporter at the Wall Street Journal who was the first to \u003ca href=\"https://www.wsj.com/articles/theranos-has-struggled-with-blood-tests-1444881901\" target=\"_blank\" rel=\"noopener\">break the story\u003c/a> of the company’s troubles in October 2015 and who later landed a string of Theranos-related scoops.\u003c/p>\n\u003cp class=\"danger-zone\">Carreyrou also happens to be the author of a new book on the company, “\u003ca href=\"https://www.penguinrandomhouse.com/books/549478/bad-blood-by-john-carreyrou/9781524731656/\" target=\"_blank\" rel=\"noopener\">Bad Blood: Secrets and Lies in a Silicon Valley Startup\u003c/a>,” which is being released on May 21. The first print, from the publishing house Alfred A. Knopf, will be 100,000 copies.\u003c/p>\n\u003cp class=\"danger-zone\">STAT obtained an advance copy of the roughly 300-page book. Through countless details and episodes reported for the first time, Carreyrou paints a damning portrait of the culture of dysfunction and deception overseen by CEO Elizabeth Holmes.\u003c/p>\n\u003cp>Below are the eight most remarkable things we learned from reading “Bad Blood.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The company, we should add, didn’t return STAT’s request for comment.\u003c/p>\n\u003ch2>\u003cb>1. Theranos was lying as early as 2006\u003c/b>\u003c/h2>\n\u003cp>Much of the attention on Theranos’ misdeeds has been focused on what happened (and what failed to happen) \u003ci>after\u003c/i> the company launched its blood-testing services to the public in Walgreens drugstores in September 2013.\u003c/p>\n\u003cp>But Carreyrou says there was deception going on far earlier.\u003c/p>\n\u003cp>In an episode reported for the first time in the book, Carreyrou describes a surreal scene from 2006, in which the company’s first chief financial officer learned that Theranos had deceived Novartis executives in demonstrating its technology at a pitch meeting in Switzerland. The trick: Because the blood-testing system was inconsistent in generating results, Theranos staffers had recorded a result from one of the times it worked to display in the demonstration.\u003c/p>\n\u003cp>And when the CFO raised concern about that with Holmes? He was fired on the spot.\u003c/p>\n\u003ch2>\u003cb>2. Theranos’s technology was more amateurish than previously known\u003c/b>\u003c/h2>\n\u003cp>Theranos has largely taken heat for lying. But Carreyrou also found absurdity and amateurism at the heart of the company’s technology.\u003c/p>\n\u003cp>In one revealing incident, Holmes and an associate spent two hours pricking their fingers in a hotel before a big meeting with Novartis in a futile effort to get the buggy technology to work. In another, an executive bragged that he could write the code for the technology’s software faster using Flash — before a “Learn Flash” book turned up on his desk.\u003c/p>\n\u003ch2>\u003cb>3. It didn’t take much to get fired or fall out of favor at Theranos\u003c/b>\u003c/h2>\n\u003cp>It’s not unusual for a fast-growing startup to see some employee turnover. But Carreyrou’s book describes Theranos’s corporate culture as far more toxic and chaotic than previously known.\u003c/p>\n\u003cp>\u003ca href=\"https://www.statnews.com/2018/03/19/theranos-ramesh-balwani/\">Sunny Balwani\u003c/a>, Theranos’s shadowy former No. 2 executive, fired employees without explanation to the rest of the staff so frequently that surviving employees referred to dismissed colleagues with a memorable turn of phrase. “‘Sunny disappeared him,’ they would say, conjuring up the image of a Mafia hit in 1970s Brooklyn,” Carreyrou writes.\u003c/p>\n\u003cp>Even when Theranos employees didn’t get sacked, even the smallest incidents could cause them to offend Holmes and Balwani and lose their status within the company hierarchy. In one surreal incident Carreyrou describes, an employee was castigated for a weekend project in which he invented a new type of bike light — seen by Holmes and Balwani as a major conflict of interest.\u003c/p>\n\u003ch2>\u003cb>4. Holmes’s younger brother led a pack of ‘Therabros’\u003c/b>\u003c/h2>\n\u003cp>Among the hires at Theranos: Holmes’s younger brother.\u003c/p>\n\u003cp>Carreyrou’s book details for the first time the strange role that Christian Holmes played at the company. Despite no relevant qualifications, Christian Holmes joined Theranos’ product management team just a few years after graduating from Duke University. He cut a very different figure than his sister, coming off as more interested in having fun than in changing the world, Carreyrou reports.\u003c/p>\n\u003cp>Christian Holmes recruited several of his fraternity brothers from Duke to join Theranos, forming a clique with an outsized status in the corporate hierarchy that other employees called “the Frat Pack.” In one of the most memorable lines of Carreyrou’s book, one staffer at an ad agency that worked with Theranos referred to Christian Holmes’s clique as the “Therabros.”\u003c/p>\n\u003cp>It’s unclear if Christian Holmes still works at Theranos, though his \u003ca href=\"https://www.linkedin.com/in/christian-holmes-20233414/\" target=\"_blank\" rel=\"noopener\">LinkedIn page \u003c/a>still lists him as the company’s senior director of business development.\u003c/p>\n\u003ch2>\u003cb>5. Super-lawyer David Boies comes off looking bad\u003c/b>\u003c/h2>\n\u003cp>David Boies, the legendary lawyer who represented Al Gore in Florida and took on Bill Gates in a massive antitrust case, has had a bad few months: He took a reputation hit for his role in silencing the women who’ve accused Harvey Weinstein of sexual harrassment and assault. The New York Times fired him. So did a\u003ca href=\"https://abovethelaw.com/2017/11/david-boies-loses-more-work-over-weinstein-debacle/\" target=\"_blank\" rel=\"noopener\"> Florida city\u003c/a>, on a pro bono case.\u003c/p>\n\u003cp>Carreyrou’s new book might not help Boies’ ailing image.\u003c/p>\n\u003cp>“Bad Blood” paints a vivid portrait of the central role that Boies played in unsuccessfully trying to pressure the Wall Street Journal to kill Carreyrou’s original story — and in trying to intimidate Tyler Schultz, the young Stanford graduate who briefly worked at Theranos and blew the whistle on the company’s misdeeds.\u003c/p>\n\u003ch2>\u003cb>6. Holmes wasn’t manipulated — but her deep voice may be\u003c/b>\u003c/h2>\n\u003cp>The public fascination with the Theranos scandal has been driven in no small part by the cult of personality around Holmes, the charismatic, turtleneck-clad young woman who dropped out of Stanford at age 19 to revolutionize blood testing.\u003c/p>\n\u003cp>As Theranos’s misdeeds have come to light, her mystique has centered around a key question: Was she the key figure behind the deception — or simply a pawn of Balwani, who happened to also be her boyfriend for a time? (More on that in a second.)\u003c/p>\n\u003cp>Carreyrou’s account gives every reason to believe Holmes was the decision-maker. Scene after scene in the book shows her convincing people to do her bidding, often in the face of overwhelming reason to do otherwise.\u003c/p>\n\u003cp>Holmes also comes off as supremely in control of her own image. In one memorable incident, she slipped out of her trademark baritone into a voice many octaves higher, leading one former employee to suspect that the deep voice may be affected to fit in in a corporate world dominated by men.\u003c/p>\n\u003ch2>\u003cb>7. Balwani is even more central to the Theranos saga than you thought\u003c/b>\u003c/h2>\n\u003cp>Balwani was in the public spotlight last month when he was charged with fraud by the Securities and Exchange Commission. While Holmes and her company settled analogous charges, Balwani is going to court to fight the SEC.\u003c/p>\n\u003cp>Carreyrou’s book paints the most detailed portrait to date of Balwani. The book describes him as a man who drove statement sports cars, wore way too much cologne to the office, and mercilessly bullied employees even though he understood little about blood testing.\u003c/p>\n\u003cp>The book also provides new details about the timeline of the romantic relationship between Holmes and Balwani, who is nearly 20 years Holmes’s senior. According to Carreyrou, they became romantically involved not long after she dropped out of Stanford at age 19. And they broke up in the spring of 2016, when Holmes pushed him out of the company as Theranos’ problems were growing.\u003c/p>\n\u003ch2>\u003cb>8. Carreyrou has a reporter’s notebook for the ages\u003c/b>\u003c/h2>\n\u003cp>The first-person account of how a journalist got a big story, known in the news business as a reporter’s notebook, has become a familiar genre. In the book, Carreyrou for the first time pens his own account of how he landed one of the biggest business stories of the decade.\u003c/p>\n\u003cp>Carreyrou writes vividly about getting the tip that sparked the story (it came by phone, from a pathology blogger), taking a breakthrough call while watching his sons play at a Brooklyn park, and getting information that led him to conclude that he or Schultz was being surveilled by Theranos.\u003c/p>\n\u003cp>Carreyrou’s own story, like the rest of the book, does not disappoint.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>\u003cspan style=\"font-weight: 400\">This \u003ca href=\"https://www.statnews.com/2018/04/12/theranos-bad-blood-carreyrou/\" 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/span>\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "For Chronic Pain, A Change In Habits Can Beat Opioids For Relief",
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"content": "\u003cp>It took several months and a team of half a dozen doctors, nurses and therapists to help Kim Brown taper off the opioid painkillers she'd been on for two years.\u003c/p>\n\u003cp>Brown, 57, had been taking the pills since a back injury in 2010. It wasn't until she met Dr. Dennis McManus, a neurologist who specializes in managing pain without drugs, that she learned she had some control over her pain.\u003c/p>\n\u003cp>\"That's when life changed,\" she said.\u003c/p>\n\u003cp>During a 12-week series of appointments at McManus' clinic in Peoria, Ill., Brown learned new ways to prevent and cope with pain, as she gradually reduced her opioid doses.\u003c/p>\n\u003caside class=\"pullquote alignright\">'In a single year, health care providers write enough opioid prescriptions for every adult in the U.S. to have a bottle of pills.’\u003c/aside>\n\u003cp>Roughly \u003ca href=\"http://www.nationalacademies.org/hmd/Reports/2011/Relieving-Pain-in-America-A-Blueprint-for-Transforming-Prevention-Care-Education-Research/Report-Brief.aspx\" target=\"_blank\" rel=\"noopener\">a third of Americans live with chronic pain\u003c/a>, and many of them become dependent on opioids prescribed to treat it. But there's a growing consensus among pain specialists that a low-tech approach focused on lifestyle changes can be more effective.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>This kind of treatment can be more expensive — and less convenient — than a bottle of pills. But pain experts say it can save money over the long term by helping patients get off addictive medications and improving their quality of life.\u003c/p>\n\u003cp>\"It's important to remember that the main treatments that are recommended for these pain conditions are not medication treatments,\" said Dr. Erin Krebs, a primary care physician and researcher at the Minneapolis VA Health Care System.[contextly_sidebar id=\"V0C48krhDpEf36aihsYishHMpftd4maj\"]\u003c/p>\n\u003cp>Recently, Krebs published the first \u003ca href=\"https://jamanetwork.com/journals/jama/article-abstract/2673971?redirect=true\" target=\"_blank\" rel=\"noopener\">long-term randomized trial of opioids\u003c/a> for treating chronic back pain and arthritis, and found that opioids are no better than nonopioid medications. She said drugs of any kind are the lesser choice for the vast majority of patients.\u003c/p>\n\u003cp>The gold standard for treatment, she said, is a combination of things like exercise, rehabilitation therapies, yoga and cognitive behavioral therapies.\u003c/p>\n\u003cp>This approach is consistent with the most recent guidelines \u003ca href=\"https://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm\" target=\"_blank\" rel=\"noopener\">from the Centers for Disease Control and Prevention\u003c/a> for prescribing opioids for chronic pain. But it's still uncommon.\u003c/p>\n\u003cp>Brown's painkiller use started after she blew out a disk in her back.\u003c/p>\n\u003cp>\"It was the simplest thing,\" Brown said. \"I picked up a bag of garbage with my right hand, and I immediately knew something was wrong.\"[contextly_sidebar id=\"KxtsC3dvl0zmNmyhnx0NVfydGpZ8NYsa\"]\u003c/p>\n\u003cp>She was put on opioids, like so many others who see the doctor about pain. In a single year, health care providers write enough opioid prescriptions for \u003ca href=\"https://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm\" target=\"_blank\" rel=\"noopener\">every adult in the U.S.\u003c/a> to have a bottle of pills.\u003c/p>\n\u003cp>Each time Brown came back, still in pain, another opioid was added to the list. She was eventually taking four different drugs — Percocet, Vicodin, morphine and Dilaudid — popping pills every two hours.\u003c/p>\n\u003cp>\"I was just drugged constantly,\" Brown said. \"And even with that, it didn't take care of the pain.\"\u003c/p>\n\u003cp>Not only did the drugs not help with the pain, the side effects made it worse. Brown had such severe abdominal pain from constipation she could hardly walk.\u003c/p>\n\u003cp>\"It kills your life. It totally robs you of every aspect,\" she said. \"I couldn't do anything because of the pain. But I couldn't do anything because of the pain meds. And I couldn't talk to anyone about it, because it was so embarrassing.\"[contextly_sidebar id=\"vuwfumTsjRlj4bRQzDECQ4gkdOYjrq9B\"]\u003c/p>\n\u003cp>Brown tried to quit on her own. But after nine days of nausea and fainting from withdrawal, she was back on the medications.\u003c/p>\n\u003cp>\"I finally went to my family doctor and said, 'I need help, I've got to get off this stuff. I can't live like this anymore,' \" she said.\u003c/p>\n\u003cp>That's when she was referred to McManus, director of the OSF Central Illinois Pain Center in Peoria. He specializes in helping chronic pain sufferers like Brown get off opioids.\u003c/p>\n\u003cp>\"From my perspective, if you stabilize the dose and slowly taper off, these patients do remarkably well,\" he said.\u003c/p>\n\u003cp>At the center, a team of providers works together to help patients make lifestyle changes that reduce pain during everyday activities.\u003c/p>\n\u003cp>The approach includes a combination of physical and occupational therapy, massage and nutrition counseling. Patients also participate in cognitive behavioral therapy to address the psychological issues that often accompany pain — such as overcoming fears of letting go of medications they've become dependent on. A nurse coordinator oversees all the moving parts and does follow-up assessments after the program is completed.\u003c/p>\n\u003cp>[contextly_sidebar id=\"prJEo6QPBRmwbqUUojWuQEFBS0fOvffp\"]At the clinic, Brown met occupational therapist Gabe Stickling, who taught her things like how to properly lift heavy objects and how to safely keep exercising even when she feels a twinge of pain.\u003c/p>\n\u003cp>Stickling said people with chronic pain often avoid physical activity \"because they're afraid they're going to injure themselves or damage their bodies.\" But inactivity can make the pain worse.\u003c/p>\n\u003cp>McManus said some of his chronic pain patients can taper off opioids with a less intensive treatment. But for some of his patients, the multidisciplinary program is most effective — if they're willing to commit to making change.\u003c/p>\n\u003cp>\"Most people just really want to have the magic wand that will get them all better,\" he said. \"And I'm just trying to say, I don't have a magic wand but I might have a way out of this jungle that you're in.\"[contextly_sidebar id=\"ljkiJf2Vl2dDfHJZPYML2MxBJQo2QVzo\"]\u003c/p>\n\u003cp>And because pain treatments that don't rely on drugs are hands-on and time-intensive, it can be hard to find a clinic that offers them — and to get insurance to cover them.\u003c/p>\n\u003cp>This wasn't always the case. Until the 1980s, the multidisciplinary approach was the go-to treatment for chronic pain, according to a \u003ca href=\"https://www.sciencedirect.com/science/article/pii/S0376871617300030#!\" target=\"_blank\" rel=\"noopener\">2016 review\u003c/a> on the history of chronic pain management. Its popularity declined as reimbursement rates went down and hospitals began to emphasize more lucrative procedures. Gradually, opioid treatment became the predominant strategy for pain treatment strategy.\u003c/p>\n\u003cp>Today, McManus said his practice spends a lot of time fighting to get the treatments covered. \"The pain program is not considered to be worthy of the price,\" McManus said.\u003c/p>\n\u003cp>Costs vary but run to several thousand dollars for a program like the one Kim Brown went through.\u003c/p>\n\u003cp>\"If you compare a fairly intensive multidisciplinary program to surgery and to drugs, the cost is not high,\" said Steven Kamper, a public health researcher at the University of Sydney in Australia. He's co-author of a \u003ca href=\"http://www.cochrane.org/CD000963/BACK_multidisciplinary-treatment-for-back-pain\" target=\"_blank\" rel=\"noopener\">2014 meta-analysis\u003c/a> that found modest benefits for multidisciplinary treatment programs for chronic low back pain.[contextly_sidebar id=\"t5KGSGdfaVMwNHpSdqorpggRmDpacuwm\"]\u003c/p>\n\u003cp>Kamper said, the costs are reasonable especially if you consider the long-term effects of living in pain. Many chronic pain sufferers are unable to work and become eligible for disability insurance.\u003c/p>\n\u003cp>\"The big costs of chronic pain are in productivity losses,\" Kamper said.\u003c/p>\n\u003cp>Krebs is hopeful non-drug therapies will regain popularity, as communities recognize the hidden costs of opioids.\u003c/p>\n\u003cp>\"It's not just the price of the pills,\" she said. \"It's also the price of the consequences when you over-rely on something.\"\u003c/p>\n\u003cp>Krebs and Kamper agree more research into pain treatment is needed. But when choosing between an addictive medication with no evidence of benefit, and low-tech therapies with some evidence of benefits, McManus said the choice is clear.\u003c/p>\n\u003cp>\"I did take an oath: First do no harm,\" McManus said. \"As a pain physician, I have a responsibility to use evidence-based medicine to manage my patients that have chronic pain.\"\u003c/p>\n\u003cp>Brown is thankful that the multidisciplinary approach helped her taper off opioids and get her life back, even though it's a different life than before her injury.\u003c/p>\n\u003cp>\"There's no such thing as a pain-free day for me,\" Brown said. \"It never, never fully goes away.\"\u003c/p>\n\u003cp>She has just learned how to manage life with it.\u003c/p>\n\u003chr>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This story was produced by \u003c/em>\u003ca href=\"http://sideeffectspublicmedia.org/\" target=\"_blank\" rel=\"noopener\">Side Effects Public Media\u003c/a>, \u003cem>a news collaborative covering public health. You can follow Christine Herman on Twitter: \u003c/em>\u003ca href=\"https://twitter.com/CTHerman\" target=\"_blank\" rel=\"noopener\">@CTHerman\u003c/a>.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 Side Effects Public Media. To see more, visit \u003ca>Side Effects Public Media\u003c/a>.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=For+Chronic+Pain%2C+A+Change+In+Habits+Can+Beat+Opioids+For+Relief&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>It took several months and a team of half a dozen doctors, nurses and therapists to help Kim Brown taper off the opioid painkillers she'd been on for two years.\u003c/p>\n\u003cp>Brown, 57, had been taking the pills since a back injury in 2010. It wasn't until she met Dr. Dennis McManus, a neurologist who specializes in managing pain without drugs, that she learned she had some control over her pain.\u003c/p>\n\u003cp>\"That's when life changed,\" she said.\u003c/p>\n\u003cp>During a 12-week series of appointments at McManus' clinic in Peoria, Ill., Brown learned new ways to prevent and cope with pain, as she gradually reduced her opioid doses.\u003c/p>\n\u003caside class=\"pullquote alignright\">'In a single year, health care providers write enough opioid prescriptions for every adult in the U.S. to have a bottle of pills.’\u003c/aside>\n\u003cp>Roughly \u003ca href=\"http://www.nationalacademies.org/hmd/Reports/2011/Relieving-Pain-in-America-A-Blueprint-for-Transforming-Prevention-Care-Education-Research/Report-Brief.aspx\" target=\"_blank\" rel=\"noopener\">a third of Americans live with chronic pain\u003c/a>, and many of them become dependent on opioids prescribed to treat it. But there's a growing consensus among pain specialists that a low-tech approach focused on lifestyle changes can be more effective.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>This kind of treatment can be more expensive — and less convenient — than a bottle of pills. But pain experts say it can save money over the long term by helping patients get off addictive medications and improving their quality of life.\u003c/p>\n\u003cp>\"It's important to remember that the main treatments that are recommended for these pain conditions are not medication treatments,\" said Dr. Erin Krebs, a primary care physician and researcher at the Minneapolis VA Health Care System.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Recently, Krebs published the first \u003ca href=\"https://jamanetwork.com/journals/jama/article-abstract/2673971?redirect=true\" target=\"_blank\" rel=\"noopener\">long-term randomized trial of opioids\u003c/a> for treating chronic back pain and arthritis, and found that opioids are no better than nonopioid medications. She said drugs of any kind are the lesser choice for the vast majority of patients.\u003c/p>\n\u003cp>The gold standard for treatment, she said, is a combination of things like exercise, rehabilitation therapies, yoga and cognitive behavioral therapies.\u003c/p>\n\u003cp>This approach is consistent with the most recent guidelines \u003ca href=\"https://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm\" target=\"_blank\" rel=\"noopener\">from the Centers for Disease Control and Prevention\u003c/a> for prescribing opioids for chronic pain. But it's still uncommon.\u003c/p>\n\u003cp>Brown's painkiller use started after she blew out a disk in her back.\u003c/p>\n\u003cp>\"It was the simplest thing,\" Brown said. \"I picked up a bag of garbage with my right hand, and I immediately knew something was wrong.\"\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>She was put on opioids, like so many others who see the doctor about pain. In a single year, health care providers write enough opioid prescriptions for \u003ca href=\"https://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm\" target=\"_blank\" rel=\"noopener\">every adult in the U.S.\u003c/a> to have a bottle of pills.\u003c/p>\n\u003cp>Each time Brown came back, still in pain, another opioid was added to the list. She was eventually taking four different drugs — Percocet, Vicodin, morphine and Dilaudid — popping pills every two hours.\u003c/p>\n\u003cp>\"I was just drugged constantly,\" Brown said. \"And even with that, it didn't take care of the pain.\"\u003c/p>\n\u003cp>Not only did the drugs not help with the pain, the side effects made it worse. Brown had such severe abdominal pain from constipation she could hardly walk.\u003c/p>\n\u003cp>\"It kills your life. It totally robs you of every aspect,\" she said. \"I couldn't do anything because of the pain. But I couldn't do anything because of the pain meds. And I couldn't talk to anyone about it, because it was so embarrassing.\"\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Brown tried to quit on her own. But after nine days of nausea and fainting from withdrawal, she was back on the medications.\u003c/p>\n\u003cp>\"I finally went to my family doctor and said, 'I need help, I've got to get off this stuff. I can't live like this anymore,' \" she said.\u003c/p>\n\u003cp>That's when she was referred to McManus, director of the OSF Central Illinois Pain Center in Peoria. He specializes in helping chronic pain sufferers like Brown get off opioids.\u003c/p>\n\u003cp>\"From my perspective, if you stabilize the dose and slowly taper off, these patients do remarkably well,\" he said.\u003c/p>\n\u003cp>At the center, a team of providers works together to help patients make lifestyle changes that reduce pain during everyday activities.\u003c/p>\n\u003cp>The approach includes a combination of physical and occupational therapy, massage and nutrition counseling. Patients also participate in cognitive behavioral therapy to address the psychological issues that often accompany pain — such as overcoming fears of letting go of medications they've become dependent on. A nurse coordinator oversees all the moving parts and does follow-up assessments after the program is completed.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>At the clinic, Brown met occupational therapist Gabe Stickling, who taught her things like how to properly lift heavy objects and how to safely keep exercising even when she feels a twinge of pain.\u003c/p>\n\u003cp>Stickling said people with chronic pain often avoid physical activity \"because they're afraid they're going to injure themselves or damage their bodies.\" But inactivity can make the pain worse.\u003c/p>\n\u003cp>McManus said some of his chronic pain patients can taper off opioids with a less intensive treatment. But for some of his patients, the multidisciplinary program is most effective — if they're willing to commit to making change.\u003c/p>\n\u003cp>\"Most people just really want to have the magic wand that will get them all better,\" he said. \"And I'm just trying to say, I don't have a magic wand but I might have a way out of this jungle that you're in.\"\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>And because pain treatments that don't rely on drugs are hands-on and time-intensive, it can be hard to find a clinic that offers them — and to get insurance to cover them.\u003c/p>\n\u003cp>This wasn't always the case. Until the 1980s, the multidisciplinary approach was the go-to treatment for chronic pain, according to a \u003ca href=\"https://www.sciencedirect.com/science/article/pii/S0376871617300030#!\" target=\"_blank\" rel=\"noopener\">2016 review\u003c/a> on the history of chronic pain management. Its popularity declined as reimbursement rates went down and hospitals began to emphasize more lucrative procedures. Gradually, opioid treatment became the predominant strategy for pain treatment strategy.\u003c/p>\n\u003cp>Today, McManus said his practice spends a lot of time fighting to get the treatments covered. \"The pain program is not considered to be worthy of the price,\" McManus said.\u003c/p>\n\u003cp>Costs vary but run to several thousand dollars for a program like the one Kim Brown went through.\u003c/p>\n\u003cp>\"If you compare a fairly intensive multidisciplinary program to surgery and to drugs, the cost is not high,\" said Steven Kamper, a public health researcher at the University of Sydney in Australia. He's co-author of a \u003ca href=\"http://www.cochrane.org/CD000963/BACK_multidisciplinary-treatment-for-back-pain\" target=\"_blank\" rel=\"noopener\">2014 meta-analysis\u003c/a> that found modest benefits for multidisciplinary treatment programs for chronic low back pain.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Kamper said, the costs are reasonable especially if you consider the long-term effects of living in pain. Many chronic pain sufferers are unable to work and become eligible for disability insurance.\u003c/p>\n\u003cp>\"The big costs of chronic pain are in productivity losses,\" Kamper said.\u003c/p>\n\u003cp>Krebs is hopeful non-drug therapies will regain popularity, as communities recognize the hidden costs of opioids.\u003c/p>\n\u003cp>\"It's not just the price of the pills,\" she said. \"It's also the price of the consequences when you over-rely on something.\"\u003c/p>\n\u003cp>Krebs and Kamper agree more research into pain treatment is needed. But when choosing between an addictive medication with no evidence of benefit, and low-tech therapies with some evidence of benefits, McManus said the choice is clear.\u003c/p>\n\u003cp>\"I did take an oath: First do no harm,\" McManus said. \"As a pain physician, I have a responsibility to use evidence-based medicine to manage my patients that have chronic pain.\"\u003c/p>\n\u003cp>Brown is thankful that the multidisciplinary approach helped her taper off opioids and get her life back, even though it's a different life than before her injury.\u003c/p>\n\u003cp>\"There's no such thing as a pain-free day for me,\" Brown said. \"It never, never fully goes away.\"\u003c/p>\n\u003cp>She has just learned how to manage life with it.\u003c/p>\n\u003chr>\n\u003cp>\u003c/p>\u003c/div>",
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"info": "Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. Together in Possible, Hoffman and Finger lead enlightening discussions about building a brighter collective future. The show features interviews with visionary guests like Trevor Noah, Sam Altman and Janette Sadik-Khan. Possible paints an optimistic portrait of the world we can create through science, policy, business, art and our shared humanity. It asks: What if everything goes right for once? How can we get there? Each episode also includes a short fiction story generated by advanced AI GPT-4, serving as a thought-provoking springboard to speculate how humanity could leverage technology for good.",
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"tagline": "Art is where you find it",
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"soldout": {
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"info": "The TED Radio Hour is a journey through fascinating ideas, astonishing inventions, fresh approaches to old problems, and new ways to think and create.",
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