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"content": "\u003cp>\u003cem>Originally published April 10, 2017\u003c/em>\u003c/p>\n\u003cp>A recent trend in anti-aging research sounds straight out of an episode of \"The Twilight Zone\"—or, if you’re younger than 40, the \"Twilight\" series. Scientists are infusing blood from young people into elderly individuals to improve health and delay the afflictions of aging.\u003c/p>\n\u003cp>It may sound creepy, but the potential health benefits of the practice are grounded in more than a decade of research. According to numerous animal studies from Stanford, UC Berkeley and Harvard, young blood can \u003ca href=\"http://science.sciencemag.org/content/344/6184/649\">rejuvenate aging muscles\u003c/a>, \u003ca href=\"http://www.cell.com/cell/abstract/S0092-8674(13)00456-X?_returnURL=http%3A%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS009286741300456X%3Fshowall%3Dtrue\">improve organ function\u003c/a>, help \u003ca href=\"http://www.nature.com/nature/journal/v477/n7362/full/nature10357.html\">generate new brain cells\u003c/a>, and even \u003ca href=\"http://www.nature.com/nm/journal/v20/n6/full/nm.3569.html\">improve cognition\u003c/a>. So far, these benefits have only been seen in mice.\u003c/p>\n\u003caside class=\"pullquote alignright\">'We’re trying to avoid creating expectations of a Eureka moment that we’ll have people who have severe Alzheimer’s disease acting as though they’re adolescents again.' \u003ccite>Joe McCracken, Alkahest\u003c/cite>\u003c/aside>\n\u003cp>Now, two Northern California startups, \u003ca href=\"http://www.alkahest.com/\">Alkahest\u003c/a> and \u003ca href=\"https://www.ambrosiaplasma.com/\">Ambrosia LLC\u003c/a>, are conducting the first studies that attempt to recreate these anti-aging effects in humans. The two companies are running separate clinical trials to infuse plasma from people under the age of 25 into older adults, in an attempt to reverse some of the negative effects of aging and treat age-related diseases.\u003c/p>\n\u003cp>Scientists think certain proteins in the blood either increase or decrease with aging and are behind age-related diseases such as dementia, diabetes and heart disease. Infusions of young blood may replenish helpful proteins that are lost over the years or block the production of damaging ones that typically increase with age.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Although Alkahest and Ambrosia were inspired by the same studies, their goals and approaches to research are very different.\u003c/p>\n\u003cp>\u003cstrong>The Academic\u003c/strong>\u003c/p>\n\u003cp>Stanford professor Tony Wyss-Coray co-founded San Carlos-based Alkahest in 2014, based on his \u003ca href=\"http://www.nature.com/nm/journal/v20/n6/abs/nm.3569.html\">findings\u003c/a> that transfusions of young blood into old mice improve learning and memory and promote the growth of new connections between cells in the hippocampus. That’s a key memory center located in the middle of the brain. Alkahest is now working to translate these benefits to patients with Alzheimer’s disease.\u003c/p>\n\u003cfigure id=\"attachment_368258\" class=\"wp-caption alignright\" style=\"max-width: 800px\">\u003ca href=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/04/Wyss-Coray-2.jpg\">\u003cimg class=\"size-medium wp-image-368258\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/04/Wyss-Coray-2-800x600.jpg\" alt=\"STANFORD. CA., MAY 2, 2014--Dr. Tony Wyss-Coray, Professor of Neurology at Stanford School of Medicine in lab on Friday, May 2, 2014. ( Norbert von der Groeben/Stanford School of Medicine )\" width=\"800\" height=\"600\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/04/Wyss-Coray-2-800x600.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Wyss-Coray-2-160x120.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Wyss-Coray-2-768x576.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Wyss-Coray-2-1020x765.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Wyss-Coray-2-1180x885.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Wyss-Coray-2-960x720.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Wyss-Coray-2-240x180.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Wyss-Coray-2-375x281.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Wyss-Coray-2-520x390.jpg 520w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Wyss-Coray-2.jpg 1200w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Tony Wyss-Coray's clinical trial tested whether infusions of young blood are safe for patients with Alzheimer's disease; future trials may test whether the treatment would be beneficial. \u003ccite>(Norbert von der Groeben/Stanford School of Medicine)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>In 2014, Alkahest sponsored an FDA-approved \u003ca href=\"https://clinicaltrials.gov/ct2/show/NCT02256306\">clinical trial\u003c/a> at Stanford to give Alzheimer’s patients between the ages of 50 and 90 four small, weekly transfusions of plasma. The plasma is obtained from the \u003ca href=\"https://bloodcenter.stanford.edu/research/\">Stanford Blood Center\u003c/a>, which has a dedicated research arm that accepts blood donations specifically for Stanford clinical trials.\u003c/p>\n\u003cp>Joe McCracken, vice president of business development at Alkahest, says that for now, the study is focused on safety and feasibility rather than the efficacy of the treatment.\u003c/p>\n\u003cp>“We’re trying to avoid creating expectations of a Eureka moment that we’ll have people who have severe Alzheimer’s disease acting as though they’re adolescents again,” he says. “The expectation we have is that we will demonstrate that administration of young plasma to elderly patients with Alzheimer’s disease is safe.”\u003c/p>\n\u003cp>The patients are also undergoing memory assessments, brain scans and blood tests to detect any potential changes in disease symptoms. The trial has completed testing on all 18 patients, and McCracken hopes to publish the results by the end of the year. If all goes well, Alkahest plans to conduct a second, larger study to test for efficacy.\u003c/p>\n\u003cp>The company’s long-term goal is to identify the proteins in the blood that change with age, and then synthesize these factors into pharmaceutical drugs.\u003c/p>\n\u003cp>\u003cstrong>The Entrepreneur\u003c/strong>\u003c/p>\n\u003cp>Jesse Karmazin, CEO of Ambrosia, is taking an unconventional—and more controversial—approach to anti-aging research. Ambrosia, which has clinics in Monterey, California and Tampa, Florida, acts as a “pay-to-play” \u003ca href=\"https://clinicaltrials.gov/ct2/show/NCT02803554\">clinical trial\u003c/a>, giving one large plasma transfusion to anyone over the age of 35 for a fee of $8,000. The plasma is purchased from local blood banks, which often have a surplus of the material because hospitals typically only require red blood cells for medical procedures.\u003c/p>\n\u003cp>[contextly_sidebar id=\"Ge8xrkWvdt1iNqxT39StX0C8FxMNPAxq\"]Karmazin, who graduated from Stanford medical school, has gotten some heat for the price his participants are paying. He says his company has no investors, and without the fee the clinic and the study would be impossible. In contrast, Alkahest received a \u003ca href=\"http://www.grifols.com/en/web/international/view-news/-/new/grifols-to-make-a-major-equity-investment-in-alkahest\">$37.5 million investment in 2015 from Grifols\u003c/a>, a Spanish-based company that is the leading producer of blood- and plasma-based products.\u003c/p>\n\u003cp>“You don’t think about it, but you—or your insurance company—ultimately pay for the clinical trial over 20 years after the drug has been approved,” Karmazin says. “Companies patent the drug, they pay up front tens or even hundreds of millions of dollars [for a clinical trial], and then they hope to make a billion dollars over the next 20 years.”\u003c/p>\n\u003cp>Karmazin also justifies the cost of his study by saying that what people choose to do with their money is their decision.\u003c/p>\n\u003cp>“This amount of money for some people is nothing,” he says. “Not for me, I have $200,000 in loans.”\u003c/p>\n\u003cp>Ambrosia is analyzing data from its first 60 participants to look for changes in biomarkers of aging in the blood taken one month after treatment. The company doesn’t have any conclusive results yet.\u003c/p>\n\u003cp>It’s difficult to say whether Ambrosia’s study, as designed, is capable of producing conclusive results. Karmazin is accepting people with a vast range of ages and with different diseases or reasons for wanting the injection. That means the amount of data he gathers on any one condition will likely be limited and may not be useful.\u003c/p>\n\u003cp>\u003cstrong>The Question of Ethics\u003c/strong>\u003c/p>\n\u003cp>Neither company would comment on the work of the other, although Wyss-Coray took some shots in an article in \u003ca href=\"http://www.sciencemag.org/news/2016/08/young-blood-antiaging-trial-raises-questions\">\u003cem>Science\u003c/em>\u003c/a> last year, saying that Karmazin was “basically abusing people’s trust and the public excitement around” the research.\u003c/p>\n\u003cp>Bioethicist Karen Maschke from The Hastings Center, a research institute in New York, says the payment model of the Ambrosia trial “raises a lot of a red flags,” and that the design of the study sounds “very suspect.” She is particularly concerned that participants will think they are paying for a known therapy when in fact they are paying for an experimental and unproven procedure.\u003c/p>\n\u003cp>For his part, Karmazin says that he is \"totally transparent that it is experimental.” Consent documents for the trial do describe the procedure as experimental and do not guarantee any improvements.\u003c/p>\n\u003cp>There have been no serious adverse events from the transfusions reported by either company, and both researchers are optimistic the treatment will provide real benefits to patients.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>Dana Smith is a freelance writer focusing on health and science, with a special interest in the brain. Her work has been featured in The Atlantic, The Guardian, Fast Company, Scientific American, Discover Magazine, and others. In a previous life, she received a Ph.D. in experimental psychology from the University of Cambridge. Find her on Twitter @smithdanag\u003c/em>\u003c/p>\n\n",
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"excerpt": "Remember that study where scientists put blood from young mice into old mice and it reversed aging? Research has begun on humans.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cem>Originally published April 10, 2017\u003c/em>\u003c/p>\n\u003cp>A recent trend in anti-aging research sounds straight out of an episode of \"The Twilight Zone\"—or, if you’re younger than 40, the \"Twilight\" series. Scientists are infusing blood from young people into elderly individuals to improve health and delay the afflictions of aging.\u003c/p>\n\u003cp>It may sound creepy, but the potential health benefits of the practice are grounded in more than a decade of research. According to numerous animal studies from Stanford, UC Berkeley and Harvard, young blood can \u003ca href=\"http://science.sciencemag.org/content/344/6184/649\">rejuvenate aging muscles\u003c/a>, \u003ca href=\"http://www.cell.com/cell/abstract/S0092-8674(13)00456-X?_returnURL=http%3A%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS009286741300456X%3Fshowall%3Dtrue\">improve organ function\u003c/a>, help \u003ca href=\"http://www.nature.com/nature/journal/v477/n7362/full/nature10357.html\">generate new brain cells\u003c/a>, and even \u003ca href=\"http://www.nature.com/nm/journal/v20/n6/full/nm.3569.html\">improve cognition\u003c/a>. So far, these benefits have only been seen in mice.\u003c/p>\n\u003caside class=\"pullquote alignright\">'We’re trying to avoid creating expectations of a Eureka moment that we’ll have people who have severe Alzheimer’s disease acting as though they’re adolescents again.' \u003ccite>Joe McCracken, Alkahest\u003c/cite>\u003c/aside>\n\u003cp>Now, two Northern California startups, \u003ca href=\"http://www.alkahest.com/\">Alkahest\u003c/a> and \u003ca href=\"https://www.ambrosiaplasma.com/\">Ambrosia LLC\u003c/a>, are conducting the first studies that attempt to recreate these anti-aging effects in humans. The two companies are running separate clinical trials to infuse plasma from people under the age of 25 into older adults, in an attempt to reverse some of the negative effects of aging and treat age-related diseases.\u003c/p>\n\u003cp>Scientists think certain proteins in the blood either increase or decrease with aging and are behind age-related diseases such as dementia, diabetes and heart disease. Infusions of young blood may replenish helpful proteins that are lost over the years or block the production of damaging ones that typically increase with age.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Although Alkahest and Ambrosia were inspired by the same studies, their goals and approaches to research are very different.\u003c/p>\n\u003cp>\u003cstrong>The Academic\u003c/strong>\u003c/p>\n\u003cp>Stanford professor Tony Wyss-Coray co-founded San Carlos-based Alkahest in 2014, based on his \u003ca href=\"http://www.nature.com/nm/journal/v20/n6/abs/nm.3569.html\">findings\u003c/a> that transfusions of young blood into old mice improve learning and memory and promote the growth of new connections between cells in the hippocampus. That’s a key memory center located in the middle of the brain. Alkahest is now working to translate these benefits to patients with Alzheimer’s disease.\u003c/p>\n\u003cfigure id=\"attachment_368258\" class=\"wp-caption alignright\" style=\"max-width: 800px\">\u003ca href=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/04/Wyss-Coray-2.jpg\">\u003cimg class=\"size-medium wp-image-368258\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/04/Wyss-Coray-2-800x600.jpg\" alt=\"STANFORD. CA., MAY 2, 2014--Dr. Tony Wyss-Coray, Professor of Neurology at Stanford School of Medicine in lab on Friday, May 2, 2014. ( Norbert von der Groeben/Stanford School of Medicine )\" width=\"800\" height=\"600\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/04/Wyss-Coray-2-800x600.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Wyss-Coray-2-160x120.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Wyss-Coray-2-768x576.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Wyss-Coray-2-1020x765.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Wyss-Coray-2-1180x885.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Wyss-Coray-2-960x720.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Wyss-Coray-2-240x180.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Wyss-Coray-2-375x281.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Wyss-Coray-2-520x390.jpg 520w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Wyss-Coray-2.jpg 1200w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Tony Wyss-Coray's clinical trial tested whether infusions of young blood are safe for patients with Alzheimer's disease; future trials may test whether the treatment would be beneficial. \u003ccite>(Norbert von der Groeben/Stanford School of Medicine)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>In 2014, Alkahest sponsored an FDA-approved \u003ca href=\"https://clinicaltrials.gov/ct2/show/NCT02256306\">clinical trial\u003c/a> at Stanford to give Alzheimer’s patients between the ages of 50 and 90 four small, weekly transfusions of plasma. The plasma is obtained from the \u003ca href=\"https://bloodcenter.stanford.edu/research/\">Stanford Blood Center\u003c/a>, which has a dedicated research arm that accepts blood donations specifically for Stanford clinical trials.\u003c/p>\n\u003cp>Joe McCracken, vice president of business development at Alkahest, says that for now, the study is focused on safety and feasibility rather than the efficacy of the treatment.\u003c/p>\n\u003cp>“We’re trying to avoid creating expectations of a Eureka moment that we’ll have people who have severe Alzheimer’s disease acting as though they’re adolescents again,” he says. “The expectation we have is that we will demonstrate that administration of young plasma to elderly patients with Alzheimer’s disease is safe.”\u003c/p>\n\u003cp>The patients are also undergoing memory assessments, brain scans and blood tests to detect any potential changes in disease symptoms. The trial has completed testing on all 18 patients, and McCracken hopes to publish the results by the end of the year. If all goes well, Alkahest plans to conduct a second, larger study to test for efficacy.\u003c/p>\n\u003cp>The company’s long-term goal is to identify the proteins in the blood that change with age, and then synthesize these factors into pharmaceutical drugs.\u003c/p>\n\u003cp>\u003cstrong>The Entrepreneur\u003c/strong>\u003c/p>\n\u003cp>Jesse Karmazin, CEO of Ambrosia, is taking an unconventional—and more controversial—approach to anti-aging research. Ambrosia, which has clinics in Monterey, California and Tampa, Florida, acts as a “pay-to-play” \u003ca href=\"https://clinicaltrials.gov/ct2/show/NCT02803554\">clinical trial\u003c/a>, giving one large plasma transfusion to anyone over the age of 35 for a fee of $8,000. The plasma is purchased from local blood banks, which often have a surplus of the material because hospitals typically only require red blood cells for medical procedures.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>Karmazin, who graduated from Stanford medical school, has gotten some heat for the price his participants are paying. He says his company has no investors, and without the fee the clinic and the study would be impossible. In contrast, Alkahest received a \u003ca href=\"http://www.grifols.com/en/web/international/view-news/-/new/grifols-to-make-a-major-equity-investment-in-alkahest\">$37.5 million investment in 2015 from Grifols\u003c/a>, a Spanish-based company that is the leading producer of blood- and plasma-based products.\u003c/p>\n\u003cp>“You don’t think about it, but you—or your insurance company—ultimately pay for the clinical trial over 20 years after the drug has been approved,” Karmazin says. “Companies patent the drug, they pay up front tens or even hundreds of millions of dollars [for a clinical trial], and then they hope to make a billion dollars over the next 20 years.”\u003c/p>\n\u003cp>Karmazin also justifies the cost of his study by saying that what people choose to do with their money is their decision.\u003c/p>\n\u003cp>“This amount of money for some people is nothing,” he says. “Not for me, I have $200,000 in loans.”\u003c/p>\n\u003cp>Ambrosia is analyzing data from its first 60 participants to look for changes in biomarkers of aging in the blood taken one month after treatment. The company doesn’t have any conclusive results yet.\u003c/p>\n\u003cp>It’s difficult to say whether Ambrosia’s study, as designed, is capable of producing conclusive results. Karmazin is accepting people with a vast range of ages and with different diseases or reasons for wanting the injection. That means the amount of data he gathers on any one condition will likely be limited and may not be useful.\u003c/p>\n\u003cp>\u003cstrong>The Question of Ethics\u003c/strong>\u003c/p>\n\u003cp>Neither company would comment on the work of the other, although Wyss-Coray took some shots in an article in \u003ca href=\"http://www.sciencemag.org/news/2016/08/young-blood-antiaging-trial-raises-questions\">\u003cem>Science\u003c/em>\u003c/a> last year, saying that Karmazin was “basically abusing people’s trust and the public excitement around” the research.\u003c/p>\n\u003cp>Bioethicist Karen Maschke from The Hastings Center, a research institute in New York, says the payment model of the Ambrosia trial “raises a lot of a red flags,” and that the design of the study sounds “very suspect.” She is particularly concerned that participants will think they are paying for a known therapy when in fact they are paying for an experimental and unproven procedure.\u003c/p>\n\u003cp>For his part, Karmazin says that he is \"totally transparent that it is experimental.” Consent documents for the trial do describe the procedure as experimental and do not guarantee any improvements.\u003c/p>\n\u003cp>There have been no serious adverse events from the transfusions reported by either company, and both researchers are optimistic the treatment will provide real benefits to patients.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>Dana Smith is a freelance writer focusing on health and science, with a special interest in the brain. Her work has been featured in The Atlantic, The Guardian, Fast Company, Scientific American, Discover Magazine, and others. In a previous life, she received a Ph.D. in experimental psychology from the University of Cambridge. Find her on Twitter @smithdanag\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Attendees at the American Diabetes Association’s Scientific Sessions in San Diego this year — many of them young researchers who are active on social media — were surprised to be greeted with the following: “Thanks for joining us at #2017ADA! Photography isn’t allowed during presentations — we’d appreciate it if you’d delete this tweet.”\u003c/p>\n\u003caside class=\"pullquote alignright\">'Excuse the poor focus — taking photos at #2017ADA has turned into a covert activity.'\u003c/aside>\n\u003cp>For many, the essence of gathering at conferences is the sharing of scientific information, a peek at interesting research in progress.\u003c/p>\n\u003cp>The policy, unusual for scientific conferences, is the most public manifestation yet of the tension between the drug and medical device companies that help sponsor the ADA’s flagship programs on one side and researchers and patients on the other.\u003c/p>\n\u003cp>The New England Journal of Medicine doesn’t consider this a problem. Some researchers on Twitter pointed to NEJM guidelines that state “online posting of an audio or video recording of an oral presentation at a medical meeting, with selected slides from the presentation, is not considered prior publication,” according to \u003ca href=\"http://www.medscape.com/viewarticle/881418\">Medscape\u003c/a>.\u003c/p>\n\u003cp>The #2017ADA hashtag — on 10 million people’s feeds, and growing — has been dominated by negative feedback, \u003ca href=\"https://www.symplur.com/healthcare-hashtags/ADA2017/analytics/?hashtag=ADA2017&fdate=\">according to\u003c/a> Symplur, a health care social media analytics platform.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Each year, academic and industry researchers present cutting-edge and sometimes unpublished data at the ADA’s Scientific Sessions. Many of these researchers accept research grants or consulting contracts from insulin makers and other pharmaceutical companies, according to \u003ca href=\"http://www.abstractsonline.com/pp8/#!/4297/presentations/novo/1\">disclosures made\u003c/a> on the conference’s website. The nonprofit’s website shows it accepted corporate sponsorships of up to $135,000\u003ca href=\"https://professional.diabetes.org/content-page/sponsorship-opportunities\"> for the opportunity\u003c/a> to advertise at the conference in a \u003ca href=\"https://indd.adobe.com/view/9bcaa37c-1a78-4c3d-a7fb-b6fea6aa937c\">variety of creative ways\u003c/a>, including promotional handouts at hotel check-ins, ads in the meeting guide and marketing materials in the goody bag distributed to participating physicians. The conference’s \u003ca href=\"https://app.core-apps.com/tristar_ada17\">mobile app\u003c/a> was sponsored by Sanofi, one of the “big three” insulin makers.\u003c/p>\n\u003cp>But the $500-$900 \u003ca href=\"https://professional.diabetes.org/content-page/registration-information\">ticket prices\u003c/a> preclude many physicians, researchers and patients from attending.\u003c/p>\n\u003cp>Conference attendees who live-tweeted photos of presentation slides were quickly rebuked by the ADA. The nonprofit’s social media team tweeted at attendees to delete their photos. The comprehensive policy even applied to sessions about open innovation, an irony not lost on patients and researchers keeping up online with the conference, which concluded Tuesday.\u003c/p>\n\u003cp>The first rule of open invitation: You don't talk about open innovation. \u003ca href=\"https://twitter.com/shivani_go\">@shivani_go\u003c/a> \u003ca href=\"https://twitter.com/hashtag/2017ADA?src=hash\">#2017ADA\u003c/a> \u003ca href=\"https://t.co/YquLkHicfO\">pic.twitter.com/YquLkHicfO\u003c/a>\u003c/p>\n\u003cp>— Matthew Dalby (@MatthewJDalby) \u003ca href=\"https://twitter.com/MatthewJDalby/status/873302836800618496\">June 9, 2017\u003c/a>\u003c/p>\n\u003cp>“I am not familiar enough with the ADA to have an informed opinion on their no photo-taking policy as a general matter. In this particular case, the application of the no-photos policy to a\u003ca href=\"https://youtu.be/SntQ595bUNI\"> talk on patients’ freedom\u003c/a> to — and increasing ability to — design treatments for themselves did seem like a funny juxtaposition,” said the researcher, Eric von Hippel, the T. Wilson Professor in Management at MIT.\u003c/p>\n\u003cp>Still, some rogue attendees tweeted photos anyway, only to find that representatives of the American Diabetes Association were enforcing the policy in person, too.\u003c/p>\n\u003cp>Excuse the poor focus — taking photos at \u003ca href=\"https://twitter.com/hashtag/2017ADA?src=hash\">#2017ADA\u003c/a> has turned into a covert activity. Executive summary: the lockstep slides look damning. \u003ca href=\"https://t.co/kBRJb1RgRp\">pic.twitter.com/kBRJb1RgRp\u003c/a>\u003c/p>\n\u003cp>— Thom Scher (@thomscher) \u003ca href=\"https://twitter.com/thomscher/status/873650155039227904\">June 10, 2017\u003c/a>\u003c/p>\n\u003cp>Defending the unpopular policy, Linda Cann, ADA’s senior vice president of professional services and education, cited legal concerns in a \u003ca href=\"https://twitter.com/health_journo/status/873678574988828672\">statement\u003c/a> to \u003ca href=\"https://twitter.com/health_journo/status/873678770762153986\">pharmaphorum\u003c/a>.\u003c/p>\n\u003cp>“All research slides and posters are the legal property of each of the research authors and their study team, not the Association,” Cann said. “Reversing this policy could unwittingly dismantle the long-standing discourse and engagement of medical and research meetings around the world.\u003c/p>\n\u003cp>“After this year’s meeting, we will re-evaluate the policy and our legal obligations to the researchers who present at Scientific Sessions.”\u003c/p>\n\u003cp>Cann did not explain which legal obligations concerned the ADA. Independent academics are not typically litigious when it comes to intellectual property. Pharmaceutical and medical device companies might worry about breaking Food and Drug Administration rules prohibiting marketing a product before regulatory approval.\u003c/p>\n\u003cp>Some in the diabetic online community have speculated that a snafu at last year’s sessions contributed to this year’s zealous enforcement. In 2016, sensitive data about a new Novo Nordisk drug, Victoza, was shared with conference attendees an hour before its official release to the markets, and the data was immediately shared on Twitter, according to a Bloomberg \u003ca href=\"https://www.bloomberg.com/news/articles/2016-06-14/can-hundreds-of-doctors-keep-an-8b-secret-not-on-twitter\">report\u003c/a>. Novo’s stock dipped by 5.6 percent the following day.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>KHN’s coverage of prescription drug development, costs and pricing is supported in part by the \u003ca href=\"http://www.arnoldfoundation.org/\">Laura and John Arnold Foundation\u003c/a>.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Attendees at the American Diabetes Association’s Scientific Sessions in San Diego this year — many of them young researchers who are active on social media — were surprised to be greeted with the following: “Thanks for joining us at #2017ADA! Photography isn’t allowed during presentations — we’d appreciate it if you’d delete this tweet.”\u003c/p>\n\u003caside class=\"pullquote alignright\">'Excuse the poor focus — taking photos at #2017ADA has turned into a covert activity.'\u003c/aside>\n\u003cp>For many, the essence of gathering at conferences is the sharing of scientific information, a peek at interesting research in progress.\u003c/p>\n\u003cp>The policy, unusual for scientific conferences, is the most public manifestation yet of the tension between the drug and medical device companies that help sponsor the ADA’s flagship programs on one side and researchers and patients on the other.\u003c/p>\n\u003cp>The New England Journal of Medicine doesn’t consider this a problem. Some researchers on Twitter pointed to NEJM guidelines that state “online posting of an audio or video recording of an oral presentation at a medical meeting, with selected slides from the presentation, is not considered prior publication,” according to \u003ca href=\"http://www.medscape.com/viewarticle/881418\">Medscape\u003c/a>.\u003c/p>\n\u003cp>The #2017ADA hashtag — on 10 million people’s feeds, and growing — has been dominated by negative feedback, \u003ca href=\"https://www.symplur.com/healthcare-hashtags/ADA2017/analytics/?hashtag=ADA2017&fdate=\">according to\u003c/a> Symplur, a health care social media analytics platform.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Each year, academic and industry researchers present cutting-edge and sometimes unpublished data at the ADA’s Scientific Sessions. Many of these researchers accept research grants or consulting contracts from insulin makers and other pharmaceutical companies, according to \u003ca href=\"http://www.abstractsonline.com/pp8/#!/4297/presentations/novo/1\">disclosures made\u003c/a> on the conference’s website. The nonprofit’s website shows it accepted corporate sponsorships of up to $135,000\u003ca href=\"https://professional.diabetes.org/content-page/sponsorship-opportunities\"> for the opportunity\u003c/a> to advertise at the conference in a \u003ca href=\"https://indd.adobe.com/view/9bcaa37c-1a78-4c3d-a7fb-b6fea6aa937c\">variety of creative ways\u003c/a>, including promotional handouts at hotel check-ins, ads in the meeting guide and marketing materials in the goody bag distributed to participating physicians. The conference’s \u003ca href=\"https://app.core-apps.com/tristar_ada17\">mobile app\u003c/a> was sponsored by Sanofi, one of the “big three” insulin makers.\u003c/p>\n\u003cp>But the $500-$900 \u003ca href=\"https://professional.diabetes.org/content-page/registration-information\">ticket prices\u003c/a> preclude many physicians, researchers and patients from attending.\u003c/p>\n\u003cp>Conference attendees who live-tweeted photos of presentation slides were quickly rebuked by the ADA. The nonprofit’s social media team tweeted at attendees to delete their photos. The comprehensive policy even applied to sessions about open innovation, an irony not lost on patients and researchers keeping up online with the conference, which concluded Tuesday.\u003c/p>\n\u003cp>The first rule of open invitation: You don't talk about open innovation. \u003ca href=\"https://twitter.com/shivani_go\">@shivani_go\u003c/a> \u003ca href=\"https://twitter.com/hashtag/2017ADA?src=hash\">#2017ADA\u003c/a> \u003ca href=\"https://t.co/YquLkHicfO\">pic.twitter.com/YquLkHicfO\u003c/a>\u003c/p>\n\u003cp>— Matthew Dalby (@MatthewJDalby) \u003ca href=\"https://twitter.com/MatthewJDalby/status/873302836800618496\">June 9, 2017\u003c/a>\u003c/p>\n\u003cp>“I am not familiar enough with the ADA to have an informed opinion on their no photo-taking policy as a general matter. In this particular case, the application of the no-photos policy to a\u003ca href=\"https://youtu.be/SntQ595bUNI\"> talk on patients’ freedom\u003c/a> to — and increasing ability to — design treatments for themselves did seem like a funny juxtaposition,” said the researcher, Eric von Hippel, the T. Wilson Professor in Management at MIT.\u003c/p>\n\u003cp>Still, some rogue attendees tweeted photos anyway, only to find that representatives of the American Diabetes Association were enforcing the policy in person, too.\u003c/p>\n\u003cp>Excuse the poor focus — taking photos at \u003ca href=\"https://twitter.com/hashtag/2017ADA?src=hash\">#2017ADA\u003c/a> has turned into a covert activity. Executive summary: the lockstep slides look damning. \u003ca href=\"https://t.co/kBRJb1RgRp\">pic.twitter.com/kBRJb1RgRp\u003c/a>\u003c/p>\n\u003cp>— Thom Scher (@thomscher) \u003ca href=\"https://twitter.com/thomscher/status/873650155039227904\">June 10, 2017\u003c/a>\u003c/p>\n\u003cp>Defending the unpopular policy, Linda Cann, ADA’s senior vice president of professional services and education, cited legal concerns in a \u003ca href=\"https://twitter.com/health_journo/status/873678574988828672\">statement\u003c/a> to \u003ca href=\"https://twitter.com/health_journo/status/873678770762153986\">pharmaphorum\u003c/a>.\u003c/p>\n\u003cp>“All research slides and posters are the legal property of each of the research authors and their study team, not the Association,” Cann said. “Reversing this policy could unwittingly dismantle the long-standing discourse and engagement of medical and research meetings around the world.\u003c/p>\n\u003cp>“After this year’s meeting, we will re-evaluate the policy and our legal obligations to the researchers who present at Scientific Sessions.”\u003c/p>\n\u003cp>Cann did not explain which legal obligations concerned the ADA. Independent academics are not typically litigious when it comes to intellectual property. Pharmaceutical and medical device companies might worry about breaking Food and Drug Administration rules prohibiting marketing a product before regulatory approval.\u003c/p>\n\u003cp>Some in the diabetic online community have speculated that a snafu at last year’s sessions contributed to this year’s zealous enforcement. In 2016, sensitive data about a new Novo Nordisk drug, Victoza, was shared with conference attendees an hour before its official release to the markets, and the data was immediately shared on Twitter, according to a Bloomberg \u003ca href=\"https://www.bloomberg.com/news/articles/2016-06-14/can-hundreds-of-doctors-keep-an-8b-secret-not-on-twitter\">report\u003c/a>. Novo’s stock dipped by 5.6 percent the following day.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>KHN’s coverage of prescription drug development, costs and pricing is supported in part by the \u003ca href=\"http://www.arnoldfoundation.org/\">Laura and John Arnold Foundation\u003c/a>.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Baby Box Skeptics Say More Testing Needed",
"title": "Baby Box Skeptics Say More Testing Needed",
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"content": "\u003cp>When Maisha Watson heard about baby boxes, her first reaction was: \"Why would I want to put my baby in a box?\"\u003c/p>\n\u003cp>She was talking with Marcia Virgil — \"Miss Marcia\" to her clients — a family support worker with the \u003ca href=\"http://www.snjpc.org/\">Southern New Jersey Perinatal Cooperative\u003c/a>.\u003c/p>\n\u003caside class=\"pullquote alignright\">'We're very concerned as pediatricians in adopting interventions for babies without thoroughly testing them, because historically we've been burned.'\u003c/aside>\n\u003cp>True, it's a cardboard box, Miss Marcia told her. But it's also a safe place for a baby to sleep: It comes with a firm mattress and a snug sheet, in line with \u003ca href=\"https://www.aap.org/en-us/about-the-aap/aap-press-room/pages/american-academy-of-pediatrics-announces-new-safe-sleep-recommendations-to-protect-against-sids.aspx\">American Academy of Pediatrics recommendations\u003c/a> meant to protect against sleep-related deaths, including sudden infant death syndrome, or SIDS.\u003c/p>\n\u003cp>Watson learned more, and now the mother of 1-month-old Solomon is a big fan. Solomon has slept in a baby box ever since he came home from the hospital.\u003c/p>\n\u003cp>That's because he's living with his mom and dad in a cramped motel room outside Atlantic City, N.J. Watson has lived here for about a year, after a bad car accident made it hard for her to work and stay in school.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>There's no space for a crib or a bassinet. And Watson knows it's dangerous for a baby to sleep on a bed.\u003c/p>\n\u003cp>The box they're using is one of roughly 20,000 that New Jersey has given away since January as part of the first program to provide a box to every newborn in the state. Since then, Ohio, Alabama and Texas have started similar programs, with more on the way.\u003c/p>\n\u003cp>The idea is borrowed from Finland, where for decades, in exchange for a prenatal checkup, the government has given expectant mothers a \u003ca href=\"http://www.kela.fi/web/en/maternitypackage\">maternity package that includes a box that doubles as a crib\u003c/a>. With the new state-sponsored programs in the U.S., anyone who watches a series of online videos focused mainly on safe sleep — and then passes a short quiz — can get a box.\u003c/p>\n\u003cp>Supporters say the free, cheerfully decorated box is just a cool hook, and that the heart of the program is to teach all parents about simple, proven ways to help keep their babies safe while sleeping. Moms like Watson are already finding the boxes useful.\u003c/p>\n\u003cp>But skeptics say there haven't been enough studies or enough testing done on the boxes to prove whether they're safe or effective at preventing infant deaths.\u003c/p>\n\u003cp>The \u003ca href=\"https://www.aap.org/en-us/about-the-aap/Committees-Councils-Sections/Child-Death-Review/Pages/Safe-Sleep.aspx\">American Academy of Pediatrics notes\u003c/a>: \"Currently, there is insufficient data on the role cardboard boxes play in reducing infant mortality.\"\u003c/p>\n\u003cp>Moreover, there are unanswered questions about the boxes' safety, says Dr. Thomas Heygi, medical director of the \u003ca href=\"http://www.rwjms.rutgers.edu/sids/\">SIDS Center of New Jersey\u003c/a>.\u003c/p>\n\u003cp>For instance, he says, will bacterial growth increase if the cardboard gets wet? Or are there glues or emissions that could cause dermatitis or that babies could inhale?\u003c/p>\n\u003cp>Hegyi says enthusiasm for the boxes has outpaced the science. And that worries him, because there are many things that sounded like a good idea for newborns but ended up being dangerous, he says, citing \u003ca href=\"http://www.npr.org/sections/health-shots/2015/11/25/457285189/to-reduce-infant-deaths-doctors-call-for-a-ban-of-crib-bumpers\">crib bumpers as one example\u003c/a>.\u003c/p>\n\u003cp>\"We're very concerned as pediatricians in adopting interventions for babies without thoroughly testing them, because historically we've been burned,\" he says.\u003c/p>\n\u003cp>There is work underway to address safety and testing concerns. A task group of the independent standards organization ASTM International is looking at expanding the standards for bassinets to cover baby boxes.\u003c/p>\n\u003cp>The current ASTM bassinet standard already addresses issues such as sharp edges, small parts, finger entrapment and mattress suffocation hazards. The task group, which next meets later this month, is considering the development of requirements for additional hazards associated with baby boxes. In addition to the questions raised by Hegyi, the task group is considering issues such as the boxes' stability, handle strength and product integrity, among others.\u003c/p>\n\u003cp>But it will likely take at least a year before they're finalized and formally adopted.\u003c/p>\n\u003cp>In the meantime, the California-based Baby Box Company, which produces the boxes and videos used in the program, says it has tested the boxes against relevant bassinet standards and has posted \u003ca href=\"https://www.dropbox.com/sh/yzksxb53j4cdqoi/AABfbt0Vc-LXlJl96bsle3l9a?dl=0\">documentation of its voluntary safety testing\u003c/a> on its website.\u003c/p>\n\u003cp>Dr. Kathie McCans is chair of the New Jersey Child Fatality and Near Fatality Review Board, which is using a $40,000 federal grant to partner with the Baby Box Company for the state program.\u003c/p>\n\u003cp>McCans agrees that standards, regulations and more testing are needed. But she says the benefits of the baby box program's educational component outweigh potential risks.\u003c/p>\n\u003cp>\"How many babies should die while we wait for the Consumer Product Safety Commission to do testing?\" she says. \"The reality is, babies have died in bassinets, babies have died in cribs.\"\u003c/p>\n\u003cp>Proponents point to the long track record of Finland, which started distributing baby boxes in 1938, at a time when \u003ca href=\"http://www.stat.fi/til/ksyyt/2010/ksyyt_2010_2011-12-16_kat_007_en.html\">nearly one out of every 10 children\u003c/a> in the country died before age 1.\u003c/p>\n\u003cp>Finland now has one of the world's lowest infant mortality rates, but many say that's a result of improved medical care and social safety nets, not use of baby boxes. In fact, \u003ca href=\"https://www.nytimes.com/2017/05/24/well/family/put-your-baby-in-a-box-experts-advise-caution.html\">a recent survey\u003c/a> found that the majority of Finnish parents these days don't use the box as a crib.\u003c/p>\n\u003cp>But the Finnish government notes clearly that \u003ca href=\"http://www.kela.fi/web/en/maternity-package-2017/-/blogs/box-can-be-used-as-a-crib-\">the box can be used that way\u003c/a> — and was used that way more frequently in the past, when Finland was a less wealthy country.\u003c/p>\n\u003cp>Ultimately, McCans and other supporters say you can take or leave the baby box — just be sure to take the knowledge.\u003c/p>\n\u003cp>\"My hope is that we will not have people making the errors of putting a baby in a sleep surface that has blankets and pillows and crib bumpers, that everyone will know that every baby needs to be put to sleep on their back each and every time,\" she says.\u003c/p>\n\u003cp>In New Jersey, most sudden unexpected infant deaths are related to sleep — a baby sharing a bed with an adult, or being suffocated by a blanket.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>Parents can do a lot to reduce the risk of SIDS, McCans says, and the goal is to spread that message — using a cute, free baby box as the incentive.\u003c/p>\n\u003chr>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=As+Popularity+Of+Baby+Boxes+Grows%2C+Skeptics+Say+More+Testing+Is+Needed&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>When Maisha Watson heard about baby boxes, her first reaction was: \"Why would I want to put my baby in a box?\"\u003c/p>\n\u003cp>She was talking with Marcia Virgil — \"Miss Marcia\" to her clients — a family support worker with the \u003ca href=\"http://www.snjpc.org/\">Southern New Jersey Perinatal Cooperative\u003c/a>.\u003c/p>\n\u003caside class=\"pullquote alignright\">'We're very concerned as pediatricians in adopting interventions for babies without thoroughly testing them, because historically we've been burned.'\u003c/aside>\n\u003cp>True, it's a cardboard box, Miss Marcia told her. But it's also a safe place for a baby to sleep: It comes with a firm mattress and a snug sheet, in line with \u003ca href=\"https://www.aap.org/en-us/about-the-aap/aap-press-room/pages/american-academy-of-pediatrics-announces-new-safe-sleep-recommendations-to-protect-against-sids.aspx\">American Academy of Pediatrics recommendations\u003c/a> meant to protect against sleep-related deaths, including sudden infant death syndrome, or SIDS.\u003c/p>\n\u003cp>Watson learned more, and now the mother of 1-month-old Solomon is a big fan. Solomon has slept in a baby box ever since he came home from the hospital.\u003c/p>\n\u003cp>That's because he's living with his mom and dad in a cramped motel room outside Atlantic City, N.J. Watson has lived here for about a year, after a bad car accident made it hard for her to work and stay in school.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>There's no space for a crib or a bassinet. And Watson knows it's dangerous for a baby to sleep on a bed.\u003c/p>\n\u003cp>The box they're using is one of roughly 20,000 that New Jersey has given away since January as part of the first program to provide a box to every newborn in the state. Since then, Ohio, Alabama and Texas have started similar programs, with more on the way.\u003c/p>\n\u003cp>The idea is borrowed from Finland, where for decades, in exchange for a prenatal checkup, the government has given expectant mothers a \u003ca href=\"http://www.kela.fi/web/en/maternitypackage\">maternity package that includes a box that doubles as a crib\u003c/a>. With the new state-sponsored programs in the U.S., anyone who watches a series of online videos focused mainly on safe sleep — and then passes a short quiz — can get a box.\u003c/p>\n\u003cp>Supporters say the free, cheerfully decorated box is just a cool hook, and that the heart of the program is to teach all parents about simple, proven ways to help keep their babies safe while sleeping. Moms like Watson are already finding the boxes useful.\u003c/p>\n\u003cp>But skeptics say there haven't been enough studies or enough testing done on the boxes to prove whether they're safe or effective at preventing infant deaths.\u003c/p>\n\u003cp>The \u003ca href=\"https://www.aap.org/en-us/about-the-aap/Committees-Councils-Sections/Child-Death-Review/Pages/Safe-Sleep.aspx\">American Academy of Pediatrics notes\u003c/a>: \"Currently, there is insufficient data on the role cardboard boxes play in reducing infant mortality.\"\u003c/p>\n\u003cp>Moreover, there are unanswered questions about the boxes' safety, says Dr. Thomas Heygi, medical director of the \u003ca href=\"http://www.rwjms.rutgers.edu/sids/\">SIDS Center of New Jersey\u003c/a>.\u003c/p>\n\u003cp>For instance, he says, will bacterial growth increase if the cardboard gets wet? Or are there glues or emissions that could cause dermatitis or that babies could inhale?\u003c/p>\n\u003cp>Hegyi says enthusiasm for the boxes has outpaced the science. And that worries him, because there are many things that sounded like a good idea for newborns but ended up being dangerous, he says, citing \u003ca href=\"http://www.npr.org/sections/health-shots/2015/11/25/457285189/to-reduce-infant-deaths-doctors-call-for-a-ban-of-crib-bumpers\">crib bumpers as one example\u003c/a>.\u003c/p>\n\u003cp>\"We're very concerned as pediatricians in adopting interventions for babies without thoroughly testing them, because historically we've been burned,\" he says.\u003c/p>\n\u003cp>There is work underway to address safety and testing concerns. A task group of the independent standards organization ASTM International is looking at expanding the standards for bassinets to cover baby boxes.\u003c/p>\n\u003cp>The current ASTM bassinet standard already addresses issues such as sharp edges, small parts, finger entrapment and mattress suffocation hazards. The task group, which next meets later this month, is considering the development of requirements for additional hazards associated with baby boxes. In addition to the questions raised by Hegyi, the task group is considering issues such as the boxes' stability, handle strength and product integrity, among others.\u003c/p>\n\u003cp>But it will likely take at least a year before they're finalized and formally adopted.\u003c/p>\n\u003cp>In the meantime, the California-based Baby Box Company, which produces the boxes and videos used in the program, says it has tested the boxes against relevant bassinet standards and has posted \u003ca href=\"https://www.dropbox.com/sh/yzksxb53j4cdqoi/AABfbt0Vc-LXlJl96bsle3l9a?dl=0\">documentation of its voluntary safety testing\u003c/a> on its website.\u003c/p>\n\u003cp>Dr. Kathie McCans is chair of the New Jersey Child Fatality and Near Fatality Review Board, which is using a $40,000 federal grant to partner with the Baby Box Company for the state program.\u003c/p>\n\u003cp>McCans agrees that standards, regulations and more testing are needed. But she says the benefits of the baby box program's educational component outweigh potential risks.\u003c/p>\n\u003cp>\"How many babies should die while we wait for the Consumer Product Safety Commission to do testing?\" she says. \"The reality is, babies have died in bassinets, babies have died in cribs.\"\u003c/p>\n\u003cp>Proponents point to the long track record of Finland, which started distributing baby boxes in 1938, at a time when \u003ca href=\"http://www.stat.fi/til/ksyyt/2010/ksyyt_2010_2011-12-16_kat_007_en.html\">nearly one out of every 10 children\u003c/a> in the country died before age 1.\u003c/p>\n\u003cp>Finland now has one of the world's lowest infant mortality rates, but many say that's a result of improved medical care and social safety nets, not use of baby boxes. In fact, \u003ca href=\"https://www.nytimes.com/2017/05/24/well/family/put-your-baby-in-a-box-experts-advise-caution.html\">a recent survey\u003c/a> found that the majority of Finnish parents these days don't use the box as a crib.\u003c/p>\n\u003cp>But the Finnish government notes clearly that \u003ca href=\"http://www.kela.fi/web/en/maternity-package-2017/-/blogs/box-can-be-used-as-a-crib-\">the box can be used that way\u003c/a> — and was used that way more frequently in the past, when Finland was a less wealthy country.\u003c/p>\n\u003cp>Ultimately, McCans and other supporters say you can take or leave the baby box — just be sure to take the knowledge.\u003c/p>\n\u003cp>\"My hope is that we will not have people making the errors of putting a baby in a sleep surface that has blankets and pillows and crib bumpers, that everyone will know that every baby needs to be put to sleep on their back each and every time,\" she says.\u003c/p>\n\u003cp>In New Jersey, most sudden unexpected infant deaths are related to sleep — a baby sharing a bed with an adult, or being suffocated by a blanket.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Parents can do a lot to reduce the risk of SIDS, McCans says, and the goal is to spread that message — using a cute, free baby box as the incentive.\u003c/p>\n\u003chr>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=As+Popularity+Of+Baby+Boxes+Grows%2C+Skeptics+Say+More+Testing+Is+Needed&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>\u003ciframe src=\"https://embed.ted.com/talks/sharon_terry_science_didn_t_understand_my_kids_rare_disease_until_i_decided_to_study_it\" width=\"640\" height=\"360\" frameborder=\"0\" scrolling=\"no\" webkitallowfullscreen mozallowfullscreen allowfullscreen>\u003c/iframe>\u003c/p>\n\u003cp>\u003cem>Update June 20, 2017:\u003c/em> The video of Sharon Terry's talk at TEDMED has been released.\u003c/p>\n\u003cp>In the mid-1990s, Sharon Terry learned that her two young children had a rare genetic disease called \u003ca href=\"https://ghr.nlm.nih.gov/condition/pseudoxanthoma-elasticum\">pseudoxanthoma elasticum\u003c/a>, also known as Grönblad–Strandberg syndrome and more commonly called PXE.\u003c/p>\n\u003cp>PXE is a slow progressive disease that hardens connective tissue, causing loose, wrinkly skin in the neck, under the arms, around the groin and behind the knees.\u003c/p>\n\u003cp>“There was a moment of just complete devastation that my two beautiful, perfect, wonderful children had a disease that I didn’t understand,” Terry says.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cstrong>Disillusioned by Experts\u003c/strong>\u003c/p>\n\u003cp>The good news was that the Boston family had time. Terry’s five- and seven-year-old might look elderly by the time they were 20, but they had several years before the disease triggered severe aging, obscured their vision or impaired their blood vessels.\u003c/p>\n\u003caside class=\"pullquote alignright\">'We're going to get you to come to us, and play by our rules. And our rule is, ‘You have to share with other scientists.’ \u003ccite>Sharon Terry\u003c/cite>\u003c/aside>\n\u003cp>The bad news was that doctors and researchers knew very little about PXE, and the little they did wasn't being shared across labs. Terry watched, furious, as one group of researchers extracted vials of blood from her children’s arms, only to have a different team of scientists poke and prod her kids for a new set of samples a few days later.\u003c/p>\n\u003cp>“We saw, over and over, intense competition,” says Terry. “We had to figure out how to get these scientists to play with each other.”\u003c/p>\n\u003cp>[audio src=\"hhttp://www.kqed.org/.stream/anon/radio/science/2016/12/WEBGeneticSupermom161219.mp3\" title=\"Listen to the radio story\" program=\"Future of You\" image=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2017/05/SciencePlayer_BG.jpeg\"]\u003c/p>\n\u003cp>\u003cstrong>'Take the Bull By the Horns'\u003c/strong>\u003c/p>\n\u003cp>The family took an unconventional approach to orchestrating their children’s care, especially given that neither parent had a background in science. Terry has a master’s degree in religious studies. She was a college chaplain before she became a full-time mom. Her husband is a construction manager with a concentration in drafting from a trade school.\u003c/p>\n\u003cfigure id=\"attachment_302165\" class=\"wp-caption alignleft\" style=\"max-width: 433px\">\u003cimg class=\"wp-image-302165\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/12/2005-800x540.jpg\" alt=\"Sister and brother Elizabeth and Ian Terry in 2005.\" width=\"433\" height=\"292\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2016/12/2005-800x540.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2016/12/2005-160x108.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2016/12/2005-768x518.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2016/12/2005-240x162.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2016/12/2005-375x253.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2016/12/2005-520x351.jpg 520w, https://ww2.kqed.org/app/uploads/sites/13/2016/12/2005.jpg 900w\" sizes=\"(max-width: 433px) 100vw, 433px\">\u003cfigcaption class=\"wp-caption-text\">Sister and brother Elizabeth and Ian Terry in 2005. \u003ccite>(Sharon Terry)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\"We decided that we had to take the bull by the horns and, first, learn what we could about the disease,\" Terry says. \"We quickly learned there really wasn't anything to learn about the disease.\"\u003c/p>\n\u003cp>Somehow the diligent couple convinced researchers at Harvard to lend them bench space to better understand the genetics driving PXE.\u003c/p>\n\u003cp>Every night the supermom and superdad spent six hours in a lab collecting blood and tissue samples, extracting DNA, and deciphering the code. Generous postdoctoral students tutored the couple until the wee hours of the morning. And, after a couple of years, Terry and her husband discovered the gene behind PXE.\u003c/p>\n\u003caside class=\"pullquote alignright\">'This year we actually have four different treatments that we think are going to be effective.'\u003ccite>Sharon Terry\u003c/cite>\u003c/aside>\n\u003cp>Eventually they built a diagnostic test and posted all of their data on an open online consortium, which Terry now runs, called \u003ca href=\"http://www.geneticalliance.org/advocacy\">Genetic Alliance\u003c/a>.\u003c/p>\n\u003cp>“Cats can be herded if you move their food,” says Terry. “And so we basically said the food is DNA and clinical histories. We're going to put that together, and we're going to get you to come to us, and play by our rules. And our rule is, ‘You have to share with other scientists.'\"\u003c/p>\n\u003cp>\u003cstrong>A Cure on the Horizon\u003c/strong>\u003c/p>\n\u003cp>Genetic Alliance offers a suite of tools to help other families who receive a devastating diagnosis. The advocacy organization offers advice on how to do scientific research, how to talk to kids about genetic disease and how to become an activist on Capitol Hill.\u003c/p>\n\u003cp>Terry’s children, now 27 and 29, are now closer to a cure than at any time since their diagnoses two decades ago.\u003c/p>\n\u003cp>“This year we actually have four different treatments that we think are going to be effective,” Terry says. “They've been effective in our mouse model. We're now looking at moving into human clinical trials for these treatments.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Terry hopes her story will inspire other families to take action when a doctor delivers crushing news. She recently shared her story on stage at the TEDMED health conference in Palm Springs.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003ciframe src=\"https://embed.ted.com/talks/sharon_terry_science_didn_t_understand_my_kids_rare_disease_until_i_decided_to_study_it\" width=\"640\" height=\"360\" frameborder=\"0\" scrolling=\"no\" webkitallowfullscreen mozallowfullscreen allowfullscreen>\u003c/iframe>\u003c/p>\n\u003cp>\u003cem>Update June 20, 2017:\u003c/em> The video of Sharon Terry's talk at TEDMED has been released.\u003c/p>\n\u003cp>In the mid-1990s, Sharon Terry learned that her two young children had a rare genetic disease called \u003ca href=\"https://ghr.nlm.nih.gov/condition/pseudoxanthoma-elasticum\">pseudoxanthoma elasticum\u003c/a>, also known as Grönblad–Strandberg syndrome and more commonly called PXE.\u003c/p>\n\u003cp>PXE is a slow progressive disease that hardens connective tissue, causing loose, wrinkly skin in the neck, under the arms, around the groin and behind the knees.\u003c/p>\n\u003cp>“There was a moment of just complete devastation that my two beautiful, perfect, wonderful children had a disease that I didn’t understand,” Terry says.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cstrong>Disillusioned by Experts\u003c/strong>\u003c/p>\n\u003cp>The good news was that the Boston family had time. Terry’s five- and seven-year-old might look elderly by the time they were 20, but they had several years before the disease triggered severe aging, obscured their vision or impaired their blood vessels.\u003c/p>\n\u003caside class=\"pullquote alignright\">'We're going to get you to come to us, and play by our rules. And our rule is, ‘You have to share with other scientists.’ \u003ccite>Sharon Terry\u003c/cite>\u003c/aside>\n\u003cp>The bad news was that doctors and researchers knew very little about PXE, and the little they did wasn't being shared across labs. Terry watched, furious, as one group of researchers extracted vials of blood from her children’s arms, only to have a different team of scientists poke and prod her kids for a new set of samples a few days later.\u003c/p>\n\u003cp>“We saw, over and over, intense competition,” says Terry. “We had to figure out how to get these scientists to play with each other.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cstrong>'Take the Bull By the Horns'\u003c/strong>\u003c/p>\n\u003cp>The family took an unconventional approach to orchestrating their children’s care, especially given that neither parent had a background in science. Terry has a master’s degree in religious studies. She was a college chaplain before she became a full-time mom. Her husband is a construction manager with a concentration in drafting from a trade school.\u003c/p>\n\u003cfigure id=\"attachment_302165\" class=\"wp-caption alignleft\" style=\"max-width: 433px\">\u003cimg class=\"wp-image-302165\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/12/2005-800x540.jpg\" alt=\"Sister and brother Elizabeth and Ian Terry in 2005.\" width=\"433\" height=\"292\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2016/12/2005-800x540.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2016/12/2005-160x108.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2016/12/2005-768x518.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2016/12/2005-240x162.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2016/12/2005-375x253.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2016/12/2005-520x351.jpg 520w, https://ww2.kqed.org/app/uploads/sites/13/2016/12/2005.jpg 900w\" sizes=\"(max-width: 433px) 100vw, 433px\">\u003cfigcaption class=\"wp-caption-text\">Sister and brother Elizabeth and Ian Terry in 2005. \u003ccite>(Sharon Terry)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\"We decided that we had to take the bull by the horns and, first, learn what we could about the disease,\" Terry says. \"We quickly learned there really wasn't anything to learn about the disease.\"\u003c/p>\n\u003cp>Somehow the diligent couple convinced researchers at Harvard to lend them bench space to better understand the genetics driving PXE.\u003c/p>\n\u003cp>Every night the supermom and superdad spent six hours in a lab collecting blood and tissue samples, extracting DNA, and deciphering the code. Generous postdoctoral students tutored the couple until the wee hours of the morning. And, after a couple of years, Terry and her husband discovered the gene behind PXE.\u003c/p>\n\u003caside class=\"pullquote alignright\">'This year we actually have four different treatments that we think are going to be effective.'\u003ccite>Sharon Terry\u003c/cite>\u003c/aside>\n\u003cp>Eventually they built a diagnostic test and posted all of their data on an open online consortium, which Terry now runs, called \u003ca href=\"http://www.geneticalliance.org/advocacy\">Genetic Alliance\u003c/a>.\u003c/p>\n\u003cp>“Cats can be herded if you move their food,” says Terry. “And so we basically said the food is DNA and clinical histories. We're going to put that together, and we're going to get you to come to us, and play by our rules. And our rule is, ‘You have to share with other scientists.'\"\u003c/p>\n\u003cp>\u003cstrong>A Cure on the Horizon\u003c/strong>\u003c/p>\n\u003cp>Genetic Alliance offers a suite of tools to help other families who receive a devastating diagnosis. The advocacy organization offers advice on how to do scientific research, how to talk to kids about genetic disease and how to become an activist on Capitol Hill.\u003c/p>\n\u003cp>Terry’s children, now 27 and 29, are now closer to a cure than at any time since their diagnoses two decades ago.\u003c/p>\n\u003cp>“This year we actually have four different treatments that we think are going to be effective,” Terry says. “They've been effective in our mouse model. We're now looking at moving into human clinical trials for these treatments.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Terry hopes her story will inspire other families to take action when a doctor delivers crushing news. She recently shared her story on stage at the TEDMED health conference in Palm Springs.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>If there was one misstep that doomed the \u003ca href=\"https://www.statnews.com/2017/04/13/crispr-patent-uc-appeal/\">long and bitter fight\u003c/a> by the University of California to wrest key CRISPR patents from the Broad Institute, it was star UC Berkeley scientist Jennifer Doudna’s habit of being scientifically cautious, realistic, and averse to overpromising.\u003c/p>\n\u003cp>A biochemist who co-led a breakthrough \u003ca href=\"http://science.sciencemag.org/content/337/6096/816\" target=\"_blank\" rel=\"noopener noreferrer\">2012 study\u003c/a> of CRISPR-Cas9, Doudna repeatedly emphasized in interviews the challenges of repurposing the molecular system, which bacteria use to fend off viruses, to edit human genomes. The U.S. patent office, in a February \u003ca href=\"https://www.statnews.com/2017/02/15/crispr-patent-ruling/\">ruling\u003c/a> that let the Broad keep its CRISPR patents (for now), relied heavily on those statements — “We weren’t sure if CRISPR/Cas9 would work in … animal cells,” for example — to conclude that when scientists at the Broad \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3795411/\" target=\"_blank\" rel=\"noopener noreferrer\">CRISPR’d human cells\u003c/a> in 2013, it was a non-obvious advance and therefore deserving of patents.\u003c/p>\n\u003cp class=\"danger-zone\">So it’s striking that the careful, measured Doudna who said CRISPR’ing human cells and thereby curing devastating diseases would be a challenge is hardly in evidence in “A Crack in Creation: Gene Editing and the Unthinkable Power to Control Evolution,” the new book she co-authored with her former student Samuel Sternberg. It went on sale last week.\u003c/p>\n\u003cp class=\"danger-zone\">This Doudna doesn’t hold back. We are “on the cusp of a new age in genetic engineering and biological mastery,” she and Sternberg write, dangling the prospect of “life-changing treatments” and “lifesaving cures.” She says she is “not kidding” that CRISPR could bring about “woolly mammoths, winged lizards, and unicorns. … It won’t be long before CRISPR allows us to bend nature to our will.”\u003c/p>\n\u003cp class=\"danger-zone\">The hyperbole contrasts with CRISPR’s stumbles, including altering parts of genomes (in lab studies, not patients yet) it wasn’t supposed to. “I don’t think we’ll have a version of CRISPR that’s 100 percent perfect, so it comes down to a risk-benefit analysis,” Sternberg, a biochemist at \u003ca href=\"https://www.statnews.com/2016/06/22/rachel-haurwitz-crispr-caribou/\">Caribou Biosciences\u003c/a> (which Doudna co-founded), said in an interview. “There has been phenomenal progress in understanding off-target effects; I think it’s a solvable problem. … We have every reason to be optimistic but I hope we avoided overhyping and didn’t give the impression that there would be windfall of cures in the next couple of years.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>This is not a tell-all. The farthest Doudna goes in addressing the patent fight — a “disheartening twist” — is to say that because of such rivalries she experienced “the gamut of human relationships, from deep friendships to disturbing betrayals.” She doesn’t name the betrayers.\u003c/p>\n\u003cp>An early \u003ca href=\"https://www.nature.com/nature/journal/v546/n7656/full/546030a.html\" target=\"_blank\" rel=\"noopener noreferrer\">review\u003c/a> chastised Doudna for presenting herself as “so flawless” the book “seems more concealing than revealing,” not “insightful [and] candid.”\u003c/p>\n\u003cp>So what she does choose to reveal is fascinating, especially about her collaboration with Emmanuelle Charpentier. The two are so closely linked that all the prizes they’ve won for CRISPR, they’ve won together; among CRISPR watchers “Doudna and Charpentier” is virtually a macro.\u003c/p>\n\u003cp>But the book’s account of their breakthrough experiment showing that CRISPR could be programmed to edit a precise spot in a genome leaves a different impression. We read that “Martin [Jinek, Doudna’s postdoctoral fellow] showed” and “Martin labored tirelessly,” “Martin and I brainstormed” and “designed an experiment,” and when “Martin walked me through the data,” Doudna knew “we’d done it.”\u003c/p>\n\u003cp>That work was described in the 2012 paper, which is widely recognized — by prize committees, the European Patent Office, and many scientists — as the Bastille moment for the CRISPR revolution. It identified the three crucial molecules in the CRISPR system — one to cut, one to guide the cutting enzyme to its target DNA, one to activate the cutting enzyme — that produced a programmable DNA-cutting machine. “We had built the means to rewrite the code of life,” Doudna and Sternberg write. “Nothing after that would ever be the same.”\u003c/p>\n\u003cp>Although Doudna and her collaborators didn’t actually change genomes in cells — their CRISPR molecules altered cell-free DNA in test tubes — that was an obvious next step. How difficult a next step was the core dispute in the patent fight and one that she repeatedly cautioned was no slam dunk. But “Crack in Creation” says that doing so “was immediately clear to us,” and “there were good reasons to expect success.”\u003c/p>\n\u003cp>That contrasts with her cautious statements, cited by the patent office, at the time. When \u003ca href=\"https://www.statnews.com/2015/11/06/hollywood-inspired-scientist-rewrite-code-life/\">Feng Zhang\u003c/a> of the Broad Institute and \u003ca href=\"https://www.statnews.com/2017/06/08/george-church-narcolepsy/\">George Church\u003c/a> of Harvard used CRISPR to edit genes, it was “just as we had proposed in 2012,” according to the book. She was elated that her 2012 work “inspired others to pursue a line of experimentation similar to our own.”\u003c/p>\n\u003cp>Doudna became a public scientist — she’s given a \u003ca href=\"https://www.ted.com/talks/jennifer_doudna_we_can_now_edit_our_dna_but_let_s_do_it_wisely\" target=\"_blank\" rel=\"noopener noreferrer\">TED talk\u003c/a> and will appear on “Sunday Night with Megyn Kelly” — because of her research, but also because she was instrumental in getting the scientific community to focus on ethical issues it raises, especially about editing embryos in a way that would be inherited by future generations (“germline” editing). She writes that she had nightmares that a man asking her about this was Hitler and that she “began to feel a bit like Dr. Frankenstein.”\u003c/p>\n\u003cp>Her own moral journey is intriguing. She feels germline editing can be safe, and the “it’s unnatural!” argument “doesn’t carry much weight with me anymore,” she writes. “It seems to me that we’d be justified in using” CRISPR to eliminate genes that cause untold suffering, such as those for Huntington’s disease. “When I think about the pain that genetic diseases cause families, the stakes are simply too high to exclude the possibility of eventually using germline editing,” as an expert panel also \u003ca href=\"https://www.statnews.com/2017/02/14/national-academy-crispr-report/\">concluded\u003c/a>.\u003c/p>\n\u003cp>Doudna acknowledges, however, that “it’s difficult to see how we’d do it equitably,” especially when the line between therapy and enhancement is paper thin: Some families might purchase a genetic legacy that gives them less need for sleep, greater endurance, extra-strong bones, leaner or larger muscles, lower risk of diabetes and Alzheimer’s, even less armpit odor — while other families muddle through with the genes nature gave them.\u003c/p>\n\u003cp>That threatens to “transcribe our societies’ financial inequality into our genetic code,” Doudna writes.\u003c/p>\n\u003cp>Her solution? “Redoubl[ing] our commitment to building a society in which all humans are respected and treated equally, regardless of their genetic makeup.”\u003c/p>\n\u003cp>\u003cem>Update, June 14: Doudna, whose office cancelled an interview with STAT before this story ran, said in an email that “positioning Martin Jinek’s role to your readers as above the work of Emmanuelle Charpentier is incorrect and unfair. Our work was conducted closely with Emmanuelle, whose contributions and insights including the role of tracrRNA in the DNA targeting complex were a key aspect of the development of CRISPR-Cas as a gene editing technology.”\u003c/em>\u003c/p>\n\u003cp>\u003cem>\u003cspan style=\"font-weight: 400\">This \u003ca href=\"https://www.statnews.com/2017/06/11/crispr-jennifer-doudna-book/\" target=\"_blank\" rel=\"noopener noreferrer\">story \u003c/a>was originally published by STAT, an online publication of Boston Globe Media that covers health, medicine, and scientific discovery. \u003c/span>\u003c/em>\u003c/p>\n\u003cp> \u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp> \u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>If there was one misstep that doomed the \u003ca href=\"https://www.statnews.com/2017/04/13/crispr-patent-uc-appeal/\">long and bitter fight\u003c/a> by the University of California to wrest key CRISPR patents from the Broad Institute, it was star UC Berkeley scientist Jennifer Doudna’s habit of being scientifically cautious, realistic, and averse to overpromising.\u003c/p>\n\u003cp>A biochemist who co-led a breakthrough \u003ca href=\"http://science.sciencemag.org/content/337/6096/816\" target=\"_blank\" rel=\"noopener noreferrer\">2012 study\u003c/a> of CRISPR-Cas9, Doudna repeatedly emphasized in interviews the challenges of repurposing the molecular system, which bacteria use to fend off viruses, to edit human genomes. The U.S. patent office, in a February \u003ca href=\"https://www.statnews.com/2017/02/15/crispr-patent-ruling/\">ruling\u003c/a> that let the Broad keep its CRISPR patents (for now), relied heavily on those statements — “We weren’t sure if CRISPR/Cas9 would work in … animal cells,” for example — to conclude that when scientists at the Broad \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3795411/\" target=\"_blank\" rel=\"noopener noreferrer\">CRISPR’d human cells\u003c/a> in 2013, it was a non-obvious advance and therefore deserving of patents.\u003c/p>\n\u003cp class=\"danger-zone\">So it’s striking that the careful, measured Doudna who said CRISPR’ing human cells and thereby curing devastating diseases would be a challenge is hardly in evidence in “A Crack in Creation: Gene Editing and the Unthinkable Power to Control Evolution,” the new book she co-authored with her former student Samuel Sternberg. It went on sale last week.\u003c/p>\n\u003cp class=\"danger-zone\">This Doudna doesn’t hold back. We are “on the cusp of a new age in genetic engineering and biological mastery,” she and Sternberg write, dangling the prospect of “life-changing treatments” and “lifesaving cures.” She says she is “not kidding” that CRISPR could bring about “woolly mammoths, winged lizards, and unicorns. … It won’t be long before CRISPR allows us to bend nature to our will.”\u003c/p>\n\u003cp class=\"danger-zone\">The hyperbole contrasts with CRISPR’s stumbles, including altering parts of genomes (in lab studies, not patients yet) it wasn’t supposed to. “I don’t think we’ll have a version of CRISPR that’s 100 percent perfect, so it comes down to a risk-benefit analysis,” Sternberg, a biochemist at \u003ca href=\"https://www.statnews.com/2016/06/22/rachel-haurwitz-crispr-caribou/\">Caribou Biosciences\u003c/a> (which Doudna co-founded), said in an interview. “There has been phenomenal progress in understanding off-target effects; I think it’s a solvable problem. … We have every reason to be optimistic but I hope we avoided overhyping and didn’t give the impression that there would be windfall of cures in the next couple of years.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>This is not a tell-all. The farthest Doudna goes in addressing the patent fight — a “disheartening twist” — is to say that because of such rivalries she experienced “the gamut of human relationships, from deep friendships to disturbing betrayals.” She doesn’t name the betrayers.\u003c/p>\n\u003cp>An early \u003ca href=\"https://www.nature.com/nature/journal/v546/n7656/full/546030a.html\" target=\"_blank\" rel=\"noopener noreferrer\">review\u003c/a> chastised Doudna for presenting herself as “so flawless” the book “seems more concealing than revealing,” not “insightful [and] candid.”\u003c/p>\n\u003cp>So what she does choose to reveal is fascinating, especially about her collaboration with Emmanuelle Charpentier. The two are so closely linked that all the prizes they’ve won for CRISPR, they’ve won together; among CRISPR watchers “Doudna and Charpentier” is virtually a macro.\u003c/p>\n\u003cp>But the book’s account of their breakthrough experiment showing that CRISPR could be programmed to edit a precise spot in a genome leaves a different impression. We read that “Martin [Jinek, Doudna’s postdoctoral fellow] showed” and “Martin labored tirelessly,” “Martin and I brainstormed” and “designed an experiment,” and when “Martin walked me through the data,” Doudna knew “we’d done it.”\u003c/p>\n\u003cp>That work was described in the 2012 paper, which is widely recognized — by prize committees, the European Patent Office, and many scientists — as the Bastille moment for the CRISPR revolution. It identified the three crucial molecules in the CRISPR system — one to cut, one to guide the cutting enzyme to its target DNA, one to activate the cutting enzyme — that produced a programmable DNA-cutting machine. “We had built the means to rewrite the code of life,” Doudna and Sternberg write. “Nothing after that would ever be the same.”\u003c/p>\n\u003cp>Although Doudna and her collaborators didn’t actually change genomes in cells — their CRISPR molecules altered cell-free DNA in test tubes — that was an obvious next step. How difficult a next step was the core dispute in the patent fight and one that she repeatedly cautioned was no slam dunk. But “Crack in Creation” says that doing so “was immediately clear to us,” and “there were good reasons to expect success.”\u003c/p>\n\u003cp>That contrasts with her cautious statements, cited by the patent office, at the time. When \u003ca href=\"https://www.statnews.com/2015/11/06/hollywood-inspired-scientist-rewrite-code-life/\">Feng Zhang\u003c/a> of the Broad Institute and \u003ca href=\"https://www.statnews.com/2017/06/08/george-church-narcolepsy/\">George Church\u003c/a> of Harvard used CRISPR to edit genes, it was “just as we had proposed in 2012,” according to the book. She was elated that her 2012 work “inspired others to pursue a line of experimentation similar to our own.”\u003c/p>\n\u003cp>Doudna became a public scientist — she’s given a \u003ca href=\"https://www.ted.com/talks/jennifer_doudna_we_can_now_edit_our_dna_but_let_s_do_it_wisely\" target=\"_blank\" rel=\"noopener noreferrer\">TED talk\u003c/a> and will appear on “Sunday Night with Megyn Kelly” — because of her research, but also because she was instrumental in getting the scientific community to focus on ethical issues it raises, especially about editing embryos in a way that would be inherited by future generations (“germline” editing). She writes that she had nightmares that a man asking her about this was Hitler and that she “began to feel a bit like Dr. Frankenstein.”\u003c/p>\n\u003cp>Her own moral journey is intriguing. She feels germline editing can be safe, and the “it’s unnatural!” argument “doesn’t carry much weight with me anymore,” she writes. “It seems to me that we’d be justified in using” CRISPR to eliminate genes that cause untold suffering, such as those for Huntington’s disease. “When I think about the pain that genetic diseases cause families, the stakes are simply too high to exclude the possibility of eventually using germline editing,” as an expert panel also \u003ca href=\"https://www.statnews.com/2017/02/14/national-academy-crispr-report/\">concluded\u003c/a>.\u003c/p>\n\u003cp>Doudna acknowledges, however, that “it’s difficult to see how we’d do it equitably,” especially when the line between therapy and enhancement is paper thin: Some families might purchase a genetic legacy that gives them less need for sleep, greater endurance, extra-strong bones, leaner or larger muscles, lower risk of diabetes and Alzheimer’s, even less armpit odor — while other families muddle through with the genes nature gave them.\u003c/p>\n\u003cp>That threatens to “transcribe our societies’ financial inequality into our genetic code,” Doudna writes.\u003c/p>\n\u003cp>Her solution? “Redoubl[ing] our commitment to building a society in which all humans are respected and treated equally, regardless of their genetic makeup.”\u003c/p>\n\u003cp>\u003cem>Update, June 14: Doudna, whose office cancelled an interview with STAT before this story ran, said in an email that “positioning Martin Jinek’s role to your readers as above the work of Emmanuelle Charpentier is incorrect and unfair. Our work was conducted closely with Emmanuelle, whose contributions and insights including the role of tracrRNA in the DNA targeting complex were a key aspect of the development of CRISPR-Cas as a gene editing technology.”\u003c/em>\u003c/p>\n\u003cp>\u003cem>\u003cspan style=\"font-weight: 400\">This \u003ca href=\"https://www.statnews.com/2017/06/11/crispr-jennifer-doudna-book/\" target=\"_blank\" rel=\"noopener noreferrer\">story \u003c/a>was originally published by STAT, an online publication of Boston Globe Media that covers health, medicine, and scientific discovery. \u003c/span>\u003c/em>\u003c/p>\n\u003cp> \u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>\u003cspan style=\"font-weight: 400\">Sunnyvale’s San Miguel neighborhood, with its leafy trees and modest houses, is home to hundreds of families and four schools for young children. Underneath these quiet streets lies a shadow of Silicon Valley’s past: groundwater contaminated with a solvent once used to make computer chips, and known to cause cancer and birth defects. \u003c/span>\u003c/p>\n\u003cp>That chemical, known as \u003ca href=\"https://www.epa.gov/assessing-and-managing-chemicals-under-tsca/trichloroethylene-tce\">trichloroethylene or TCE\u003c/a>, was as crucial to chipmakers in the 1960s and 1970s as yeast is to a bakery. TCE is a powerful solvent used to clean silicon wafers before the chip design is etched onto them. And it’s responsible for nearly half the federal Superfund sites in \u003ca href=\"https://en.wikipedia.org/wiki/List_of_Superfund_sites_in_California#Santa_Clara_County\">Santa Clara County\u003c/a>. These are areas the U.S. Environmental Protection Agency designates as the nation’s most toxic.\u003c/p>\n\u003cp>Santa Clara has 24 Superfund sites, according to former EPA regional director Jared Blumenfeld. The neighborhood of San Miguel is located within one of them.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">When TCE is present in groundwater, it can turn to vapor, seeping through cracks in building frames and into homes and classrooms. Short-term exposure can cause slowed breathing, light-headedness and headaches; over the longer term, TCE exposure causes cancer, particularly kidney cancer and \u003c/span>\u003cspan style=\"font-weight: 400\">non-Hodgkin lymphoma\u003c/span>\u003cspan style=\"font-weight: 400\">. And in 2011, a \u003c/span>\u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3339451/\">\u003cspan style=\"font-weight: 400\">study appeared to show \u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">that fetuses exposed to TCE in the first trimester have a higher risk of heart defects at birth. Socioeconomic differences could have influenced the results, though researchers tried to account for that.\u003c/span>\u003c/p>\n\u003cfigure id=\"attachment_388759\" class=\"wp-caption alignleft\" style=\"max-width: 378px\">\u003cimg class=\"wp-image-388759\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/05/10-Triple-Site-Map-page-0-800x1445.jpg\" alt=\"\" width=\"378\" height=\"683\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/05/10-Triple-Site-Map-page-0-800x1445.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2017/05/10-Triple-Site-Map-page-0-160x289.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/05/10-Triple-Site-Map-page-0-768x1387.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2017/05/10-Triple-Site-Map-page-0-1020x1842.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2017/05/10-Triple-Site-Map-page-0-960x1734.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2017/05/10-Triple-Site-Map-page-0-240x433.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/05/10-Triple-Site-Map-page-0-375x677.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/05/10-Triple-Site-Map-page-0-520x939.jpg 520w, https://ww2.kqed.org/app/uploads/sites/13/2017/05/10-Triple-Site-Map-page-0.jpg 1113w\" sizes=\"(max-width: 378px) 100vw, 378px\">\u003cfigcaption class=\"wp-caption-text\">Map of the Triple Site area in Sunnyvale, Calif. \u003ccite>(U.S. Environmental Protection Agency)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cb>Years of Contamination\u003c/b>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">A half-mile south of the San Miguel neighborhood is Lowe’s Home Improvement, built on the site where \u003c/span>\u003ca href=\"https://en.wikipedia.org/wiki/Signetics\">\u003cspan style=\"font-weight: 400\">Signetics Inc.\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">—which became \u003c/span>\u003ca href=\"http://www.usa.philips.com/\">\u003cspan style=\"font-weight: 400\">Philips Semiconductors\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> in 1975—left massive amounts of trichloroethylene in the soil and groundwater from nearly 30 years of chip manufacturing. Next to Lowe’s is a large, vacant dome of soil carpeted with dry grass.\u003c/span>\u003c/p>\n\u003cp>“Here’s where we have the highest concentrations of TCE,” says EPA site manager Melanie Morash, gesturing at the mound. This is essentially Ground Zero for what the EPA calls the Triple Site.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The Triple Site gets its name from the three chipmakers responsible for the contamination: Philips, \u003c/span>\u003ca href=\"http://www.amd.com/en/home\">\u003cspan style=\"font-weight: 400\">Advanced Micro Devices\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> and \u003c/span>\u003ca href=\"https://yosemite.epa.gov/r9/sfund/r9sfdocw.nsf/vwsoalphabetic/TRW+Microwave,+Inc.+(Building+825)\">\u003cspan style=\"font-weight: 400\">TRW Microwave\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">. In the 1960s and ‘70s, these companies stored TCE in underground tanks for later use. But the tanks and pipelines sometimes ruptured, leaking TCE into the soil and groundwater. It wasn’t until the 1980s, when the EPA launched its \u003c/span>\u003ca href=\"https://en.wikipedia.org/wiki/Superfund\">\u003cspan style=\"font-weight: 400\">Superfund program\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> to clean up the nation’s most toxic sites, that these properties began to get attention. By then, the TCE had spread through groundwater a mile to the north, underneath hundreds of homes and apartments and all four schools.\u003c/span>\u003c/p>\n\u003cp>\u003cb>Cleanup Begins\u003c/b>\u003c/p>\n\u003cp>In the early 1980s, the EPA worked with the manufacturers to clean up the toxic plume by excavating soil and treating the water. One method decontaminates the water by exposing it to ultraviolet light; the other oxygenates the water, releasing the TCE into the air, where it disperses. Although it isn’t ideal to make TCE airborne, it reduces concentrations enough that it isn’t a health risk to people, Blumenfeld said.\u003c/p>\n\u003cfigure id=\"attachment_410384\" class=\"wp-caption alignright\" style=\"max-width: 800px\">\u003ca href=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/06/6-melanie-dome.jpg\">\u003cimg class=\"size-medium wp-image-410384\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/06/6-melanie-dome-800x1067.jpg\" alt=\"EPA Triple Site site manager Melanie Morash at the dome of earth near the former Philips Semiconductor property, where TCE contamination is concentrated. \" width=\"800\" height=\"1067\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/06/6-melanie-dome-800x1067.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2017/06/6-melanie-dome-160x213.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/06/6-melanie-dome-768x1024.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2017/06/6-melanie-dome-1020x1360.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2017/06/6-melanie-dome-1920x2560.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2017/06/6-melanie-dome-1180x1573.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2017/06/6-melanie-dome-960x1280.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2017/06/6-melanie-dome-240x320.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/06/6-melanie-dome-375x500.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/06/6-melanie-dome-520x693.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">EPA Triple Site site manager Melanie Morash at the dome of earth near the former Philips Semiconductor property, where TCE contamination is concentrated. \u003ccite>(Beth Winegarner/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Across the street from Ground Zero, in the parking lot of Planet Granite, gym-goers breeze past a fenced-off cluster of machinery. The systems hum as they pump groundwater from beneath the soil, aerate the water to disperse toxic chemicals, and return the water to the aquifer. This is one of the Phillips treatment plants.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">In the early 2000s, AMD and TRW switched to \u003c/span>\u003ca href=\"http://news.stanford.edu/news/1997/april23/tce.html\">\u003cspan style=\"font-weight: 400\">a method pioneered at Stanford University\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> in which natural bacteria break down the TCE. The bacteria are fed molasses, lactose or vegetable oil to boost their population, creating enough microbes to transform TCE into harmless components, according to Michael Calhoun, a geologist with Haley & Aldrich Inc. and a consultant for AMD.\u003c/span>\u003c/p>\n\u003cp>Bioremediation has been successful for TRW and AMD. Philips—which is now responsible for the remaining cleanup at the Triple Site—held off, sticking to traditional methods. It wasn’t until 2016 that Philips began testing bioremediation.\u003c/p>\n\u003cp>Spokeswoman Silvie Casanova declined to comment on why Philips waited so long to try the method. It’s unclear whether it will work as well now.\u003c/p>\n\u003cp>“If you have a contaminant released into the ground and it sits there for a while, it can diffuse into the soil, and then it’s more difficult to get back out,” Calhoun said. “Even if you clean up the groundwater, it will continue to diffuse from the soil back into the water.”\u003c/p>\n\u003cfigure id=\"attachment_388757\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-388757\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/05/9-image-tester-in-classroom-800x600.jpg\" alt=\"\" width=\"800\" height=\"600\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/05/9-image-tester-in-classroom-800x600.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2017/05/9-image-tester-in-classroom-160x120.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/05/9-image-tester-in-classroom-768x576.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2017/05/9-image-tester-in-classroom-1020x766.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2017/05/9-image-tester-in-classroom-1180x886.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2017/05/9-image-tester-in-classroom-960x721.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2017/05/9-image-tester-in-classroom-240x180.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/05/9-image-tester-in-classroom-375x281.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/05/9-image-tester-in-classroom-520x390.jpg 520w, https://ww2.kqed.org/app/uploads/sites/13/2017/05/9-image-tester-in-classroom.jpg 1279w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Two air monitors inside a classroom at San Miguel Elementary School in Sunnyvale. The devices monitor inside buildings for signs of TCE vapor. They must be in place for at least 24 hours to get accurate results. \u003ccite>(Beth Winegarner/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cb>Fighting to Protect Public Health\u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">After the 2011 study revealed \u003c/span>\u003ca href=\"https://www.atsdr.cdc.gov/phs/phs.asp?id=171&tid=30\">\u003cspan style=\"font-weight: 400\">the risk for birth defects from TCE\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">, the EPA worked to update its process of notifying people about contamination. Previously, the agency tested buildings in Superfund zones quarterly, and then notified occupants of the results four to five months later, said former regional director Blumenfeld. But the risk to fetuses is highest in the first trimester, meaning pregnant women needed the information much sooner.\u003c/span>\u003c/p>\n\u003cp>[contextly_sidebar id=\"QIiBrV7DZWww9hv35669NPpPlzzmI7hs\"]Getting the agency to change was an uphill battle. Chipmakers hired lawyers to fight back. EPA headquarters in Washington D.C. told Blumenfeld to hold off because it was working on new national guidelines, but they never materialized, he said.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Blumenfeld eventually won. Under the \u003c/span>\u003ca href=\"https://yosemite.epa.gov/r9/sfund/r9sfdocw.nsf/3dc283e6c5d6056f88257426007417a2/6a24ed351efe25b888257d16007659e8/%24FILE/R9%20TCE%20Action%20Levels%20and%20Recs%20Memo%207_14.pdf\">\u003cspan style=\"font-weight: 400\">new notification requirements\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> adopted in 2014, the EPA is required to test air quality inside buildings vulnerable to TCE vapor, install mitigation measures “quickly” and retest to make sure they’re working. When exposures reach a certain level, those mitigations must happen immediately, and residents aren’t allowed back in until it’s safe.\u003c/span>\u003c/p>\n\u003cp>\u003cb>Knocking on Doors\u003c/b>\u003c/p>\n\u003cp>Doing all that testing, though, meant getting permission from property owners. The schools within the Triple Site complied quickly, but residents were another story. EPA workers, led by Morash and Alejandro Diaz, the EPA’s community involvement coordinator for the site, began going door-to-door to ask if they could test the air inside.\u003c/p>\n\u003cp>The San Miguel neighborhood includes mostly small, single-family homes with grassy front yards. Sprinkled among them are several modest-sized apartment buildings. During the day, the streets are quiet; almost nobody remains outside. The neighborhood is also extremely diverse, with large concentrations of Latino, Asian and South Asian residents. Diaz said the EPA did outreach in several languages, including Vietnamese, Tagalog, Punjabi and Urdu.\u003c/p>\n\u003cfigure id=\"attachment_410388\" class=\"wp-caption alignright\" style=\"max-width: 800px\">\u003ca href=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/06/3-Riser-pipe-and-fan-inside-the-box.jpg\">\u003cimg class=\"size-medium wp-image-410388\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/06/3-Riser-pipe-and-fan-inside-the-box-800x1067.jpg\" alt=\"This riser pipe and fan are part of a system that diverts TCE vapor from underneath a building to its roof, where it’s released into the air rather than going inside the building. \" width=\"800\" height=\"1067\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/06/3-Riser-pipe-and-fan-inside-the-box-800x1067.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2017/06/3-Riser-pipe-and-fan-inside-the-box-160x213.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/06/3-Riser-pipe-and-fan-inside-the-box-768x1024.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2017/06/3-Riser-pipe-and-fan-inside-the-box-1020x1360.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2017/06/3-Riser-pipe-and-fan-inside-the-box-1920x2560.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2017/06/3-Riser-pipe-and-fan-inside-the-box-1180x1573.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2017/06/3-Riser-pipe-and-fan-inside-the-box-960x1280.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2017/06/3-Riser-pipe-and-fan-inside-the-box-240x320.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/06/3-Riser-pipe-and-fan-inside-the-box-375x500.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/06/3-Riser-pipe-and-fan-inside-the-box-520x693.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">This riser pipe and fan are part of a\u003cbr>system that diverts TCE vapor from underneath a building to its roof, where it’s released into the air rather than going inside the building. \u003ccite>(EPA)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“The idea is to remove any barriers and make it the least scary possible,” he said.\u003c/p>\n\u003cp>Since early 2015, the team has knocked on more than 500 doors—every property in the Triple Site zone—and tested every school building. About 225 households have allowed testing. The team has detected concerning levels of TCE vapor in 55 households and 37 school buildings, Morash said. Buildings at Rainbow Montessori, San Miguel Elementary and King’s Academy all tested positive for TCE vapor; mitigation systems are in place in the schools now, and their air is monitored regularly.\u003c/p>\n\u003cp>About 30 properties, which include some 100 households, have refused air testing, Huitric said; those who said no haven’t told the team why. The EPA keeps in touch with the property owners, ready to act if they change their minds.\u003c/p>\n\u003cp>Shashi Jaggia, who has owned a 12-unit apartment building on Duane Avenue within the Triple Site zone since 1999, cooperated with the EPA when they came calling. Jaggia had no idea her tenants were being exposed to TCE until the EPA contacted her a couple of years ago. But she wasn’t surprised.\u003c/p>\n\u003cp>“I’m in the real estate business,” she said. “I know there’s lots of contamination in the groundwater in the area.”\u003c/p>\n\u003cp>During the first year after installing the systems, the EPA tests the air frequently to make sure levels remain safe. If they do, the tests are less frequent in following years. That’s the protocol for all properties in the Triple Site, Huitric said.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">For now, cleanup, testing and mitigation at the Triple Site is expected to continue indefinitely, until the TCE levels in both groundwater and indoor air are safe. President Donald Trump’s \u003c/span>\u003ca href=\"https://www.theatlantic.com/science/archive/2017/05/trump-epa-budget-noaa-climate-change/527814/\">\u003cspan style=\"font-weight: 400\">proposed budget\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> includes a 31.4 percent cut to the EPA, including $330 million in cuts to the Superfund program. Philips is bankrolling cleanup costs at the Triple Site, but other elements of the process could be in trouble, Blumenfeld said, including enforcement.\u003c/span>\u003c/p>\n\u003cp>“We’re not planning for anything until we know for a fact what’s happening,” said Caleb Shaffer, section chief for Superfund’s California Cleanup Section. “We can’t predict the future.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>UCSF's Maria Glymour contributed to this post.\u003c/em>\u003c/p>\n\n",
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"excerpt": "A toxic chemical, known as trichloroethylene, or TCE, was as crucial to chipmakers in the 1960s and 1970s as yeast is to a bakery. ",
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"description": "A toxic chemical, known as trichloroethylene, or TCE, was as crucial to chipmakers in the 1960s and 1970s as yeast is to a bakery. ",
"title": "Silicon Valley's Toxic Past Haunts Sunnyvale Neighborhood | KQED",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cspan style=\"font-weight: 400\">Sunnyvale’s San Miguel neighborhood, with its leafy trees and modest houses, is home to hundreds of families and four schools for young children. Underneath these quiet streets lies a shadow of Silicon Valley’s past: groundwater contaminated with a solvent once used to make computer chips, and known to cause cancer and birth defects. \u003c/span>\u003c/p>\n\u003cp>That chemical, known as \u003ca href=\"https://www.epa.gov/assessing-and-managing-chemicals-under-tsca/trichloroethylene-tce\">trichloroethylene or TCE\u003c/a>, was as crucial to chipmakers in the 1960s and 1970s as yeast is to a bakery. TCE is a powerful solvent used to clean silicon wafers before the chip design is etched onto them. And it’s responsible for nearly half the federal Superfund sites in \u003ca href=\"https://en.wikipedia.org/wiki/List_of_Superfund_sites_in_California#Santa_Clara_County\">Santa Clara County\u003c/a>. These are areas the U.S. Environmental Protection Agency designates as the nation’s most toxic.\u003c/p>\n\u003cp>Santa Clara has 24 Superfund sites, according to former EPA regional director Jared Blumenfeld. The neighborhood of San Miguel is located within one of them.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">When TCE is present in groundwater, it can turn to vapor, seeping through cracks in building frames and into homes and classrooms. Short-term exposure can cause slowed breathing, light-headedness and headaches; over the longer term, TCE exposure causes cancer, particularly kidney cancer and \u003c/span>\u003cspan style=\"font-weight: 400\">non-Hodgkin lymphoma\u003c/span>\u003cspan style=\"font-weight: 400\">. And in 2011, a \u003c/span>\u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3339451/\">\u003cspan style=\"font-weight: 400\">study appeared to show \u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">that fetuses exposed to TCE in the first trimester have a higher risk of heart defects at birth. Socioeconomic differences could have influenced the results, though researchers tried to account for that.\u003c/span>\u003c/p>\n\u003cfigure id=\"attachment_388759\" class=\"wp-caption alignleft\" style=\"max-width: 378px\">\u003cimg class=\"wp-image-388759\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/05/10-Triple-Site-Map-page-0-800x1445.jpg\" alt=\"\" width=\"378\" height=\"683\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/05/10-Triple-Site-Map-page-0-800x1445.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2017/05/10-Triple-Site-Map-page-0-160x289.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/05/10-Triple-Site-Map-page-0-768x1387.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2017/05/10-Triple-Site-Map-page-0-1020x1842.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2017/05/10-Triple-Site-Map-page-0-960x1734.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2017/05/10-Triple-Site-Map-page-0-240x433.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/05/10-Triple-Site-Map-page-0-375x677.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/05/10-Triple-Site-Map-page-0-520x939.jpg 520w, https://ww2.kqed.org/app/uploads/sites/13/2017/05/10-Triple-Site-Map-page-0.jpg 1113w\" sizes=\"(max-width: 378px) 100vw, 378px\">\u003cfigcaption class=\"wp-caption-text\">Map of the Triple Site area in Sunnyvale, Calif. \u003ccite>(U.S. Environmental Protection Agency)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cb>Years of Contamination\u003c/b>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">A half-mile south of the San Miguel neighborhood is Lowe’s Home Improvement, built on the site where \u003c/span>\u003ca href=\"https://en.wikipedia.org/wiki/Signetics\">\u003cspan style=\"font-weight: 400\">Signetics Inc.\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">—which became \u003c/span>\u003ca href=\"http://www.usa.philips.com/\">\u003cspan style=\"font-weight: 400\">Philips Semiconductors\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> in 1975—left massive amounts of trichloroethylene in the soil and groundwater from nearly 30 years of chip manufacturing. Next to Lowe’s is a large, vacant dome of soil carpeted with dry grass.\u003c/span>\u003c/p>\n\u003cp>“Here’s where we have the highest concentrations of TCE,” says EPA site manager Melanie Morash, gesturing at the mound. This is essentially Ground Zero for what the EPA calls the Triple Site.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The Triple Site gets its name from the three chipmakers responsible for the contamination: Philips, \u003c/span>\u003ca href=\"http://www.amd.com/en/home\">\u003cspan style=\"font-weight: 400\">Advanced Micro Devices\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> and \u003c/span>\u003ca href=\"https://yosemite.epa.gov/r9/sfund/r9sfdocw.nsf/vwsoalphabetic/TRW+Microwave,+Inc.+(Building+825)\">\u003cspan style=\"font-weight: 400\">TRW Microwave\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">. In the 1960s and ‘70s, these companies stored TCE in underground tanks for later use. But the tanks and pipelines sometimes ruptured, leaking TCE into the soil and groundwater. It wasn’t until the 1980s, when the EPA launched its \u003c/span>\u003ca href=\"https://en.wikipedia.org/wiki/Superfund\">\u003cspan style=\"font-weight: 400\">Superfund program\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> to clean up the nation’s most toxic sites, that these properties began to get attention. By then, the TCE had spread through groundwater a mile to the north, underneath hundreds of homes and apartments and all four schools.\u003c/span>\u003c/p>\n\u003cp>\u003cb>Cleanup Begins\u003c/b>\u003c/p>\n\u003cp>In the early 1980s, the EPA worked with the manufacturers to clean up the toxic plume by excavating soil and treating the water. One method decontaminates the water by exposing it to ultraviolet light; the other oxygenates the water, releasing the TCE into the air, where it disperses. Although it isn’t ideal to make TCE airborne, it reduces concentrations enough that it isn’t a health risk to people, Blumenfeld said.\u003c/p>\n\u003cfigure id=\"attachment_410384\" class=\"wp-caption alignright\" style=\"max-width: 800px\">\u003ca href=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/06/6-melanie-dome.jpg\">\u003cimg class=\"size-medium wp-image-410384\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/06/6-melanie-dome-800x1067.jpg\" alt=\"EPA Triple Site site manager Melanie Morash at the dome of earth near the former Philips Semiconductor property, where TCE contamination is concentrated. \" width=\"800\" height=\"1067\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/06/6-melanie-dome-800x1067.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2017/06/6-melanie-dome-160x213.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/06/6-melanie-dome-768x1024.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2017/06/6-melanie-dome-1020x1360.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2017/06/6-melanie-dome-1920x2560.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2017/06/6-melanie-dome-1180x1573.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2017/06/6-melanie-dome-960x1280.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2017/06/6-melanie-dome-240x320.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/06/6-melanie-dome-375x500.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/06/6-melanie-dome-520x693.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">EPA Triple Site site manager Melanie Morash at the dome of earth near the former Philips Semiconductor property, where TCE contamination is concentrated. \u003ccite>(Beth Winegarner/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Across the street from Ground Zero, in the parking lot of Planet Granite, gym-goers breeze past a fenced-off cluster of machinery. The systems hum as they pump groundwater from beneath the soil, aerate the water to disperse toxic chemicals, and return the water to the aquifer. This is one of the Phillips treatment plants.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">In the early 2000s, AMD and TRW switched to \u003c/span>\u003ca href=\"http://news.stanford.edu/news/1997/april23/tce.html\">\u003cspan style=\"font-weight: 400\">a method pioneered at Stanford University\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> in which natural bacteria break down the TCE. The bacteria are fed molasses, lactose or vegetable oil to boost their population, creating enough microbes to transform TCE into harmless components, according to Michael Calhoun, a geologist with Haley & Aldrich Inc. and a consultant for AMD.\u003c/span>\u003c/p>\n\u003cp>Bioremediation has been successful for TRW and AMD. Philips—which is now responsible for the remaining cleanup at the Triple Site—held off, sticking to traditional methods. It wasn’t until 2016 that Philips began testing bioremediation.\u003c/p>\n\u003cp>Spokeswoman Silvie Casanova declined to comment on why Philips waited so long to try the method. It’s unclear whether it will work as well now.\u003c/p>\n\u003cp>“If you have a contaminant released into the ground and it sits there for a while, it can diffuse into the soil, and then it’s more difficult to get back out,” Calhoun said. “Even if you clean up the groundwater, it will continue to diffuse from the soil back into the water.”\u003c/p>\n\u003cfigure id=\"attachment_388757\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-388757\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/05/9-image-tester-in-classroom-800x600.jpg\" alt=\"\" width=\"800\" height=\"600\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/05/9-image-tester-in-classroom-800x600.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2017/05/9-image-tester-in-classroom-160x120.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/05/9-image-tester-in-classroom-768x576.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2017/05/9-image-tester-in-classroom-1020x766.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2017/05/9-image-tester-in-classroom-1180x886.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2017/05/9-image-tester-in-classroom-960x721.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2017/05/9-image-tester-in-classroom-240x180.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/05/9-image-tester-in-classroom-375x281.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/05/9-image-tester-in-classroom-520x390.jpg 520w, https://ww2.kqed.org/app/uploads/sites/13/2017/05/9-image-tester-in-classroom.jpg 1279w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Two air monitors inside a classroom at San Miguel Elementary School in Sunnyvale. The devices monitor inside buildings for signs of TCE vapor. They must be in place for at least 24 hours to get accurate results. \u003ccite>(Beth Winegarner/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cb>Fighting to Protect Public Health\u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">After the 2011 study revealed \u003c/span>\u003ca href=\"https://www.atsdr.cdc.gov/phs/phs.asp?id=171&tid=30\">\u003cspan style=\"font-weight: 400\">the risk for birth defects from TCE\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">, the EPA worked to update its process of notifying people about contamination. Previously, the agency tested buildings in Superfund zones quarterly, and then notified occupants of the results four to five months later, said former regional director Blumenfeld. But the risk to fetuses is highest in the first trimester, meaning pregnant women needed the information much sooner.\u003c/span>\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>Getting the agency to change was an uphill battle. Chipmakers hired lawyers to fight back. EPA headquarters in Washington D.C. told Blumenfeld to hold off because it was working on new national guidelines, but they never materialized, he said.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Blumenfeld eventually won. Under the \u003c/span>\u003ca href=\"https://yosemite.epa.gov/r9/sfund/r9sfdocw.nsf/3dc283e6c5d6056f88257426007417a2/6a24ed351efe25b888257d16007659e8/%24FILE/R9%20TCE%20Action%20Levels%20and%20Recs%20Memo%207_14.pdf\">\u003cspan style=\"font-weight: 400\">new notification requirements\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> adopted in 2014, the EPA is required to test air quality inside buildings vulnerable to TCE vapor, install mitigation measures “quickly” and retest to make sure they’re working. When exposures reach a certain level, those mitigations must happen immediately, and residents aren’t allowed back in until it’s safe.\u003c/span>\u003c/p>\n\u003cp>\u003cb>Knocking on Doors\u003c/b>\u003c/p>\n\u003cp>Doing all that testing, though, meant getting permission from property owners. The schools within the Triple Site complied quickly, but residents were another story. EPA workers, led by Morash and Alejandro Diaz, the EPA’s community involvement coordinator for the site, began going door-to-door to ask if they could test the air inside.\u003c/p>\n\u003cp>The San Miguel neighborhood includes mostly small, single-family homes with grassy front yards. Sprinkled among them are several modest-sized apartment buildings. During the day, the streets are quiet; almost nobody remains outside. The neighborhood is also extremely diverse, with large concentrations of Latino, Asian and South Asian residents. Diaz said the EPA did outreach in several languages, including Vietnamese, Tagalog, Punjabi and Urdu.\u003c/p>\n\u003cfigure id=\"attachment_410388\" class=\"wp-caption alignright\" style=\"max-width: 800px\">\u003ca href=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/06/3-Riser-pipe-and-fan-inside-the-box.jpg\">\u003cimg class=\"size-medium wp-image-410388\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/06/3-Riser-pipe-and-fan-inside-the-box-800x1067.jpg\" alt=\"This riser pipe and fan are part of a system that diverts TCE vapor from underneath a building to its roof, where it’s released into the air rather than going inside the building. \" width=\"800\" height=\"1067\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/06/3-Riser-pipe-and-fan-inside-the-box-800x1067.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2017/06/3-Riser-pipe-and-fan-inside-the-box-160x213.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/06/3-Riser-pipe-and-fan-inside-the-box-768x1024.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2017/06/3-Riser-pipe-and-fan-inside-the-box-1020x1360.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2017/06/3-Riser-pipe-and-fan-inside-the-box-1920x2560.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2017/06/3-Riser-pipe-and-fan-inside-the-box-1180x1573.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2017/06/3-Riser-pipe-and-fan-inside-the-box-960x1280.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2017/06/3-Riser-pipe-and-fan-inside-the-box-240x320.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/06/3-Riser-pipe-and-fan-inside-the-box-375x500.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/06/3-Riser-pipe-and-fan-inside-the-box-520x693.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">This riser pipe and fan are part of a\u003cbr>system that diverts TCE vapor from underneath a building to its roof, where it’s released into the air rather than going inside the building. \u003ccite>(EPA)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“The idea is to remove any barriers and make it the least scary possible,” he said.\u003c/p>\n\u003cp>Since early 2015, the team has knocked on more than 500 doors—every property in the Triple Site zone—and tested every school building. About 225 households have allowed testing. The team has detected concerning levels of TCE vapor in 55 households and 37 school buildings, Morash said. Buildings at Rainbow Montessori, San Miguel Elementary and King’s Academy all tested positive for TCE vapor; mitigation systems are in place in the schools now, and their air is monitored regularly.\u003c/p>\n\u003cp>About 30 properties, which include some 100 households, have refused air testing, Huitric said; those who said no haven’t told the team why. The EPA keeps in touch with the property owners, ready to act if they change their minds.\u003c/p>\n\u003cp>Shashi Jaggia, who has owned a 12-unit apartment building on Duane Avenue within the Triple Site zone since 1999, cooperated with the EPA when they came calling. Jaggia had no idea her tenants were being exposed to TCE until the EPA contacted her a couple of years ago. But she wasn’t surprised.\u003c/p>\n\u003cp>“I’m in the real estate business,” she said. “I know there’s lots of contamination in the groundwater in the area.”\u003c/p>\n\u003cp>During the first year after installing the systems, the EPA tests the air frequently to make sure levels remain safe. If they do, the tests are less frequent in following years. That’s the protocol for all properties in the Triple Site, Huitric said.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">For now, cleanup, testing and mitigation at the Triple Site is expected to continue indefinitely, until the TCE levels in both groundwater and indoor air are safe. President Donald Trump’s \u003c/span>\u003ca href=\"https://www.theatlantic.com/science/archive/2017/05/trump-epa-budget-noaa-climate-change/527814/\">\u003cspan style=\"font-weight: 400\">proposed budget\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> includes a 31.4 percent cut to the EPA, including $330 million in cuts to the Superfund program. Philips is bankrolling cleanup costs at the Triple Site, but other elements of the process could be in trouble, Blumenfeld said, including enforcement.\u003c/span>\u003c/p>\n\u003cp>“We’re not planning for anything until we know for a fact what’s happening,” said Caleb Shaffer, section chief for Superfund’s California Cleanup Section. “We can’t predict the future.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"disqusTitle": "Inhalers Plus Smartphones Meant Fewer Trips to ER, Hospital",
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"content": "\u003cp>Asthma attacks come with little warning and are often triggered by invisible particles in the air. Now, thanks to advances in Bluetooth technology, smartphones have become the newest weapon in the fight against asthma.\u003c/p>\n\u003caside class=\"pullquote alignright\">In one study, asthma-related hospitalizations dropped from 1.9 to 0 among 330 patients using the sensor. These patients also had 60 percent fewer asthma-related ER visits.\u003c/aside>\n\u003cp>Propeller Health, a Wisconsin-based company, \u003ca href=\"http://propellerhealth.com/\" target=\"_blank\" rel=\"noopener noreferrer\">wants to help\u003c/a> those with respiratory problems by supplementing medicine with technology. The firm has wired an inhaler with a Bluetooth transmitter to communicate with an asthma patient’s smartphone. This sensor activates when the inhaler is pressed, setting into motion a process that records the exact time and location of a patient’s asthma attack on a smartphone app. Doctors can view this data and see, not only how frequently the patient suffers attacks, but also tease apart the environmental factors that caused the distress.\u003c/p>\n\u003cp>“We see firsthand the value of collecting data, and so we see this as being the clear future of health care,” said Chris Hogg, the COO of Propeller Health. “[This technology] helps health care providers prioritize patients. With all the information coming off of the connected devices, [doctors] can really see who should be focused on.”\u003c/p>\n\u003cp>https://www.youtube.com/watch?v=KoQZS36CJzc\u003c/p>\n\u003cp>Smart inhalers are part of an emerging trend in medical technology known as “connected health.” Major tech firms have introduced ventures like Apple Health, a part of the iOS operating system that groups together biometric data recorded by apps and accessories. Meanwhile, medical equipment firms are installing internet connections on their devices, such as Continuous Positive Airway Pressure sleep machines, glucose meters and blood pressure monitors.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The Propeller sensor also sets out to manage medication schedules. On average, less than 50 percent of asthma patients take their medicine correctly, said Linda Neuhauser, a professor at University of California, Berkeley who researches asthma treatments.\u003c/p>\n\u003cp>[contextly_sidebar id=\"2J9aoXruEvErjns0VhyDOoSveLi92vLi\"]\"The inhaler tells you, and your health care provider, maybe your parent, if you’ve taken your medication today correctly,” Neuhauser continued. “We know that if you take it correctly, you can avoid an attack, going to the emergency department, or being hospitalized.”\u003c/p>\n\u003cp>A study conducted by Propeller and Dignity Health, a California hospital system, found that asthma-related hospitalizations dropped from 1.9 to 0 among 330 patients who had attached the sensor to their inhaler during an 11-month period. These participants also experienced 60 percent fewer asthma-related ER visits.\u003c/p>\n\u003cp>“There’s a community aspect to collecting data like this. When we have a lot of users in the same town, or same region, we can do a lot to help them,” Hogg said. “We start to see hot spots and trends over time.”\u003c/p>\n\u003cp>One of Propeller’s biggest tests of their system was in Louisville, Kentucky, where they gave 140 asthmatic individuals sensors for their inhaler, and they recorded 5,600 uses over two years. The study found that proximity to railroads and utilities were the two major causes of asthma attacks, but they also found that public common areas, such as schools and places of worship were also full of asthma triggers. After the test, Propeller gave the data to the city,\u003c/p>\n\u003cp>“They’re now making policy changes to improve emissions standards and clean the air, Hogg said.\u003c/p>\n\u003cp>It’s not cheap though. A standard albuterol inhaler costs $5 to $60, while the Propeller sensor has a unit cost of approximately $300. And while most connected health devices can be easily purchased online, the Propeller sensor is only available through a handful of health plans and sponsors. It is typically prescribed by a doctor.\u003c/p>\n\u003cp>Air quality monitors are another technological tool in the fight against asthma. One brand, Speck, has been used to research the causes of asthma attacks in the home.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“The Speck monitor measures indoor air quality, and this is the first time that parents, and older children, have had an opportunity to get feedback about the air quality inside their homes,” Neuhauser said. “Otherwise you just do what you think is good, and you just hope you’re reducing the allergens and irritants that might trigger asthma.”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The Propeller sensor also sets out to manage medication schedules. On average, less than 50 percent of asthma patients take their medicine correctly, said Linda Neuhauser, a professor at University of California, Berkeley who researches asthma treatments.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\"The inhaler tells you, and your health care provider, maybe your parent, if you’ve taken your medication today correctly,” Neuhauser continued. “We know that if you take it correctly, you can avoid an attack, going to the emergency department, or being hospitalized.”\u003c/p>\n\u003cp>A study conducted by Propeller and Dignity Health, a California hospital system, found that asthma-related hospitalizations dropped from 1.9 to 0 among 330 patients who had attached the sensor to their inhaler during an 11-month period. These participants also experienced 60 percent fewer asthma-related ER visits.\u003c/p>\n\u003cp>“There’s a community aspect to collecting data like this. When we have a lot of users in the same town, or same region, we can do a lot to help them,” Hogg said. “We start to see hot spots and trends over time.”\u003c/p>\n\u003cp>One of Propeller’s biggest tests of their system was in Louisville, Kentucky, where they gave 140 asthmatic individuals sensors for their inhaler, and they recorded 5,600 uses over two years. The study found that proximity to railroads and utilities were the two major causes of asthma attacks, but they also found that public common areas, such as schools and places of worship were also full of asthma triggers. After the test, Propeller gave the data to the city,\u003c/p>\n\u003cp>“They’re now making policy changes to improve emissions standards and clean the air, Hogg said.\u003c/p>\n\u003cp>It’s not cheap though. A standard albuterol inhaler costs $5 to $60, while the Propeller sensor has a unit cost of approximately $300. And while most connected health devices can be easily purchased online, the Propeller sensor is only available through a handful of health plans and sponsors. It is typically prescribed by a doctor.\u003c/p>\n\u003cp>Air quality monitors are another technological tool in the fight against asthma. One brand, Speck, has been used to research the causes of asthma attacks in the home.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“The Speck monitor measures indoor air quality, and this is the first time that parents, and older children, have had an opportunity to get feedback about the air quality inside their homes,” Neuhauser said. “Otherwise you just do what you think is good, and you just hope you’re reducing the allergens and irritants that might trigger asthma.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>The idea that big tech companies like Facebook, Google and Apple are \u003ca href=\"https://ww2.kqed.org/futureofyou/2017/05/25/tristan-harris-brain-hacking/\" target=\"_blank\" rel=\"noopener noreferrer\">addicting us to their products\u003c/a> has gained a fair amount of traction. That's thanks in large part to Tristan Harris, a former design ethicist at Google who has turned whistleblower of sorts by revealing the techniques tech companies use to instill all that compulsive clicking and scrolling into your brain. Harris appeared on \"\u003ca href=\"http://www.cbsnews.com/news/brain-hacking-tech-insiders-60-minutes/\" target=\"_blank\" rel=\"noopener noreferrer\">60 Minutes\u003c/a>\" a couple of months ago, and last week he discussed the issue on \u003ca href=\"https://www.youtube.com/watch?v=Ewj4ql6pu9w&ab_channel=TimeWellSpent\" target=\"_blank\" rel=\"noopener noreferrer\">Bill Maher's HBO show\u003c/a>.\u003c/p>\n\u003caside class=\"pullquote alignright\">'It’s driving teenagers crazy.'\u003ccite>Tech design expert Tristan Harris on Snapchat's Snapstreaks feature.\u003c/cite>\u003c/aside>\n\u003cp>Many of the design elements these companies employ to ensnare users are derived from behavioral research and neuroscience, Harris and other experts claim. Here are seven such tricks of the trade used on popular tech platforms, as identified by these experts in interviews with KQED, other media outlets, and on \u003ca href=\"http://www.tristanharris.com/essays/\" target=\"_blank\" rel=\"noopener noreferrer\">Harris' blog\u003c/a>.\u003c/p>\n\u003cp>\u003cstrong>1. Snapstreaks (Snapchat)\u003c/strong>\u003c/p>\n\u003cp>This feature of the messaging app Snapchat tells users how many days in a row they’ve communicated with each other. Bloomberg \u003ca href=\"https://www.bloomberg.com/news/features/2017-01-30/inside-the-mind-of-a-snapchat-streaker\" target=\"_blank\" rel=\"noopener noreferrer\">reported\u003c/a> in January that some obsessed teenagers have been logging on just to keep their streaks alive.\u003c/p>\n\u003cp>“For those that have streaks, they provide a validation for the relationship,” Emily Weinstein, a Harvard University doctoral candidate studying adolescents and social media, told Bloomberg. “Attention to your streaks each day is a way of saying ‘We’re OK.' ”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>[contextly_sidebar id=\"7FumuTrhbkfbAZZFTQAs4skZNLMfGs2D\"]Spurring even more use: The company's use of hourglass emojis, notifying users when their streak is in jeopardy,\u003c/p>\n\u003cp>“The makers built into the app a system so you have to check constantly or risk missing out,” Nancy Colier, a psychotherapist and author of The Power of Off,” told Bloomberg. “It taps into the primal fear of exclusion, of being out of the tribe and not able to survive.”\u003c/p>\n\u003cp>Tristan Harris told KQED’s Lesley McClurg that \u003ca href=\"https://support.snapchat.com/en-US/a/Snaps-snapstreak\" target=\"_blank\" rel=\"noopener noreferrer\">Snapstreaks\u003c/a> “might sound like it's innocuous and kind of gamey, but if you have a number that's, say, over 100, you don't want to lose your streak. It's really persuasive. They just gave you something to lose.\"\u003c/p>\n\u003cp>Harris said teens who were unable to log on during vacations were giving their passwords to friends to keep their streaks going.\u003c/p>\n\u003cp>“It’s driving teenagers crazy,” he said.\u003c/p>\n\u003cp>\u003cstrong>2. Video Auto-Play (Netflix, Facebook, YouTube)\u003c/strong>\u003c/p>\n\u003cp>These companies are using the same principle to keep people viewing their content as the one demonstrated in a \u003ca href=\"http://foodpsychology.cornell.edu/discoveries/bottomless-bowls\" target=\"_blank\" rel=\"noopener noreferrer\">study \u003c/a>involving trick bowls of soup, Harris wrote in his blog. As the subjects ate from them, the bowls were imperceptibly refilled.\u003c/p>\n\u003cp>The study reported that the eaters who got the refills consumed 73 percent more soup than those who ate from normal bowls. The reason: They did not receive the visual cue of an empty bowl that would prompt them to stop eating. More food, more consumption.\u003c/p>\n\u003cp>And that, says Harris, is why Netflix, Facebook and YouTube auto-play the next video after the one you are watching is finished, “instead of waiting for you to make a conscious choice. A huge portion of traffic on these websites is driven by auto-playing the next thing.”\u003c/p>\n\u003cp>\u003cstrong>3. Continuous Scroll (Facebook, Twitter)\u003c/strong>\u003c/p>\n\u003cp>Similar to auto-play, perpetual replenishment of written material will keep you hunting for something you want to engage with.\u003c/p>\n\u003caside class=\"pullquote alignright\">'What's different today is that machines are being created to use these techniques.'\u003ccite>BJ Fogg, Stanford Persuasive Tech Lab\u003c/cite>\u003c/aside>\n\u003cp>“News feeds are purposely designed to auto-refill with reasons to keep you scrolling, and purposely eliminate any reason for you to pause, reconsider or leave,” Harris writes.\u003c/p>\n\u003cp>“Continuous scroll is a proven way to keep you searching longer,\" said Ramsay Brown, the co-founder of a company that uses artificial intelligence and neuroscience to help app writers attract and retain users. \"You spend half your time on Facebook just scrolling to find one good piece worth looking at.”\u003c/p>\n\u003cp>\u003cstrong>4. Invitations to Connect (LinkedIn)\u003c/strong>\u003c/p>\n\u003cp>When LinkedIn sends you emails prompting you to connect with someone, says Harris, the implication is that “this person made this conscious choice to invite me to connect and they're actually waiting there when I get that e-mail.”\u003c/p>\n\u003cp>He says at play is a principle called social reciprocity.\u003c/p>\n\u003cp>\"You imagine that person making a conscious choice to invite you, when in reality, they likely unconsciously responded to LinkedIn’s list of suggested contacts. In other words, LinkedIn turns your unconscious impulses (to “add” a person) into new social obligations that millions of people feel obligated to repay,\" he writes on his blog.\u003c/p>\n\u003cp>In addition, If you accept an endorsement from someone through the site, LinkedIn \"takes advantage of your bias to reciprocate by offering four additional people for you to endorse in return.\"\u003c/p>\n\u003cp>\"And so we can sit there drowning in social obligations,\" Harris told KQED.\u003c/p>\n\u003cp>\u003cstrong>5. Notifications (Facebook, Instagram)\u003c/strong>\u003c/p>\n\u003cp>Harris and Brown believe that social media companies use a concept known as variable rewards, which is a technique slot machines employ to hook gamblers, and which will similarly keep users compulsively checking their phones due to the possibility some bit of social approval may be waiting there.\u003c/p>\n\u003cp>“The brain isn’t particularly craving any one little feel-good signal as much as it does a really good rhythm and pattern,” Brown told me. He says Facebook and Instagram tailor the timing of the “notifications” they deliver — on Facebook, indicated by that number in red at the top right of the screen — in order to deliver, literally, hits of dopamine to users at algorithmically determined times.\u003c/p>\n\u003cp>Sometimes the companies will stockpile these notifications before delivering them all in a batch to maximize the emotional impact a user experiences, he says.\u003c/p>\n\u003cp>\"Like, hey, here’s the 30 likes we didn’t mention from a little while ago, “he told \"60 Minutes.\"\u003c/p>\n\u003cp>\u003cstrong>6. Swiping Left or Right (Tinder)\u003c/strong>\u003c/p>\n\u003cp>“Fear of missing out” drives much of social media’s hold on people, writes Harris. “If I convince you that I’m a channel for important information, messages, friendships, or potential sexual opportunities — it will be hard for you to turn me off, unsubscribe, or remove your account — because (aha, I win) you might miss something important.\"\u003c/p>\n\u003cp>This is what will keep us swiping faces on a dating app like Tinder, \"even when we haven’t met up with anyone in a while. .. But if we zoom into that fear, we’ll discover that it’s unbounded: we’ll always miss something important at any point when we stop using something.”\u003c/p>\n\u003cp>\u003cstrong>7. Photo Tagging: (Facebook, Instagram, Snapchat)\u003c/strong>\u003c/p>\n\u003cp>Getting tagged in photos plays right into our need for social approval, Harris says. He contends that because Facebook actually prompts users to identify people in photos, it is artificially creating social approval for people.\u003c/p>\n\u003cp>This craving for validation also comes into play when we change our profile photo . \"Facebook knows that’s a moment when we’re vulnerable to social approval,\" he writes. \"What do my friends think of my new pic?”\u003c/p>\n\u003cp>Facebook can rank this \"event,\" such as it is, higher in the news feed, \"so it sticks around for longer and more friends will like or comment on it. Each time they like or comment on it, I’ll get pulled right back.”\u003c/p>\n\u003cfigure id=\"attachment_397048\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/05/screenaddiction.jpg\">\u003cimg class=\"wp-image-397048 size-large\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/05/screenaddiction-1020x751.jpg\" alt=\"\" width=\"640\" height=\"471\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/05/screenaddiction-1020x751.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2017/05/screenaddiction-160x118.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/05/screenaddiction-800x589.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2017/05/screenaddiction-768x565.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2017/05/screenaddiction-1180x868.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2017/05/screenaddiction-960x707.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2017/05/screenaddiction-240x177.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/05/screenaddiction-375x276.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/05/screenaddiction-520x383.jpg 520w, https://ww2.kqed.org/app/uploads/sites/13/2017/05/screenaddiction.jpg 1250w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Image by IvanNikulin/iStock \u003ccite>(Image by IvanNikulin/iStock)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>So, some may ask: What's a successful social media app to do? Start kicking people off?\u003c/p>\n\u003cp>“Asking technology companies, asking content creators to be less good at what they do feels like a ridiculous ask,” tech consultant Gabe Zichermann told “60 Minutes.” “It feels impossible. And also it’s very anti-capitalistic. This isn’t the system that we live in.”\u003c/p>\n\u003cp>It should also be noted that Harris himself doesn’t necessarily think all of these strategies have been formulated intentionally by the companies \"Apple and Google’s designers didn’t want phones to work like slot machines,\" he wrote. “It emerged by accident.\"\u003c/p>\n\u003cp>BJ Fogg, who runs the \u003ca href=\"http://captology.stanford.edu/\">Stanford Persuasive Tech Lab\u003c/a>, where many young entrepreneurs have learned methods like the ones mentioned above, told me a lot of these strategies have been employed by non-digital companies for a very long time.\u003c/p>\n\u003cp>“What ‘s different today is that machines are being created to use these techniques,” he said.\u003c/p>\n\u003cp>Indeed. Ramsay Brown put it this way:\u003c/p>\n\u003cp>“We have now developed a rigorous technology of the human mind, and that is both exciting and terrifying. We have the ability to twiddle some nobs in a machine learning dashboard we build, and around the world hundreds of thousands of people are going to quietly change their behavior in ways that, unbeknownst to them, feel second-nature but are really by design.\u003c/p>\n\u003cp>“Which means that there’s a deep ethical imperative for us to use it for good.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>Facebook, Snapchat and Google did not respond to our requests for comment. LinkedIn declined to comment.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The idea that big tech companies like Facebook, Google and Apple are \u003ca href=\"https://ww2.kqed.org/futureofyou/2017/05/25/tristan-harris-brain-hacking/\" target=\"_blank\" rel=\"noopener noreferrer\">addicting us to their products\u003c/a> has gained a fair amount of traction. That's thanks in large part to Tristan Harris, a former design ethicist at Google who has turned whistleblower of sorts by revealing the techniques tech companies use to instill all that compulsive clicking and scrolling into your brain. Harris appeared on \"\u003ca href=\"http://www.cbsnews.com/news/brain-hacking-tech-insiders-60-minutes/\" target=\"_blank\" rel=\"noopener noreferrer\">60 Minutes\u003c/a>\" a couple of months ago, and last week he discussed the issue on \u003ca href=\"https://www.youtube.com/watch?v=Ewj4ql6pu9w&ab_channel=TimeWellSpent\" target=\"_blank\" rel=\"noopener noreferrer\">Bill Maher's HBO show\u003c/a>.\u003c/p>\n\u003caside class=\"pullquote alignright\">'It’s driving teenagers crazy.'\u003ccite>Tech design expert Tristan Harris on Snapchat's Snapstreaks feature.\u003c/cite>\u003c/aside>\n\u003cp>Many of the design elements these companies employ to ensnare users are derived from behavioral research and neuroscience, Harris and other experts claim. Here are seven such tricks of the trade used on popular tech platforms, as identified by these experts in interviews with KQED, other media outlets, and on \u003ca href=\"http://www.tristanharris.com/essays/\" target=\"_blank\" rel=\"noopener noreferrer\">Harris' blog\u003c/a>.\u003c/p>\n\u003cp>\u003cstrong>1. Snapstreaks (Snapchat)\u003c/strong>\u003c/p>\n\u003cp>This feature of the messaging app Snapchat tells users how many days in a row they’ve communicated with each other. Bloomberg \u003ca href=\"https://www.bloomberg.com/news/features/2017-01-30/inside-the-mind-of-a-snapchat-streaker\" target=\"_blank\" rel=\"noopener noreferrer\">reported\u003c/a> in January that some obsessed teenagers have been logging on just to keep their streaks alive.\u003c/p>\n\u003cp>“For those that have streaks, they provide a validation for the relationship,” Emily Weinstein, a Harvard University doctoral candidate studying adolescents and social media, told Bloomberg. “Attention to your streaks each day is a way of saying ‘We’re OK.' ”\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>Spurring even more use: The company's use of hourglass emojis, notifying users when their streak is in jeopardy,\u003c/p>\n\u003cp>“The makers built into the app a system so you have to check constantly or risk missing out,” Nancy Colier, a psychotherapist and author of The Power of Off,” told Bloomberg. “It taps into the primal fear of exclusion, of being out of the tribe and not able to survive.”\u003c/p>\n\u003cp>Tristan Harris told KQED’s Lesley McClurg that \u003ca href=\"https://support.snapchat.com/en-US/a/Snaps-snapstreak\" target=\"_blank\" rel=\"noopener noreferrer\">Snapstreaks\u003c/a> “might sound like it's innocuous and kind of gamey, but if you have a number that's, say, over 100, you don't want to lose your streak. It's really persuasive. They just gave you something to lose.\"\u003c/p>\n\u003cp>Harris said teens who were unable to log on during vacations were giving their passwords to friends to keep their streaks going.\u003c/p>\n\u003cp>“It’s driving teenagers crazy,” he said.\u003c/p>\n\u003cp>\u003cstrong>2. Video Auto-Play (Netflix, Facebook, YouTube)\u003c/strong>\u003c/p>\n\u003cp>These companies are using the same principle to keep people viewing their content as the one demonstrated in a \u003ca href=\"http://foodpsychology.cornell.edu/discoveries/bottomless-bowls\" target=\"_blank\" rel=\"noopener noreferrer\">study \u003c/a>involving trick bowls of soup, Harris wrote in his blog. As the subjects ate from them, the bowls were imperceptibly refilled.\u003c/p>\n\u003cp>The study reported that the eaters who got the refills consumed 73 percent more soup than those who ate from normal bowls. The reason: They did not receive the visual cue of an empty bowl that would prompt them to stop eating. More food, more consumption.\u003c/p>\n\u003cp>And that, says Harris, is why Netflix, Facebook and YouTube auto-play the next video after the one you are watching is finished, “instead of waiting for you to make a conscious choice. A huge portion of traffic on these websites is driven by auto-playing the next thing.”\u003c/p>\n\u003cp>\u003cstrong>3. Continuous Scroll (Facebook, Twitter)\u003c/strong>\u003c/p>\n\u003cp>Similar to auto-play, perpetual replenishment of written material will keep you hunting for something you want to engage with.\u003c/p>\n\u003caside class=\"pullquote alignright\">'What's different today is that machines are being created to use these techniques.'\u003ccite>BJ Fogg, Stanford Persuasive Tech Lab\u003c/cite>\u003c/aside>\n\u003cp>“News feeds are purposely designed to auto-refill with reasons to keep you scrolling, and purposely eliminate any reason for you to pause, reconsider or leave,” Harris writes.\u003c/p>\n\u003cp>“Continuous scroll is a proven way to keep you searching longer,\" said Ramsay Brown, the co-founder of a company that uses artificial intelligence and neuroscience to help app writers attract and retain users. \"You spend half your time on Facebook just scrolling to find one good piece worth looking at.”\u003c/p>\n\u003cp>\u003cstrong>4. Invitations to Connect (LinkedIn)\u003c/strong>\u003c/p>\n\u003cp>When LinkedIn sends you emails prompting you to connect with someone, says Harris, the implication is that “this person made this conscious choice to invite me to connect and they're actually waiting there when I get that e-mail.”\u003c/p>\n\u003cp>He says at play is a principle called social reciprocity.\u003c/p>\n\u003cp>\"You imagine that person making a conscious choice to invite you, when in reality, they likely unconsciously responded to LinkedIn’s list of suggested contacts. In other words, LinkedIn turns your unconscious impulses (to “add” a person) into new social obligations that millions of people feel obligated to repay,\" he writes on his blog.\u003c/p>\n\u003cp>In addition, If you accept an endorsement from someone through the site, LinkedIn \"takes advantage of your bias to reciprocate by offering four additional people for you to endorse in return.\"\u003c/p>\n\u003cp>\"And so we can sit there drowning in social obligations,\" Harris told KQED.\u003c/p>\n\u003cp>\u003cstrong>5. Notifications (Facebook, Instagram)\u003c/strong>\u003c/p>\n\u003cp>Harris and Brown believe that social media companies use a concept known as variable rewards, which is a technique slot machines employ to hook gamblers, and which will similarly keep users compulsively checking their phones due to the possibility some bit of social approval may be waiting there.\u003c/p>\n\u003cp>“The brain isn’t particularly craving any one little feel-good signal as much as it does a really good rhythm and pattern,” Brown told me. He says Facebook and Instagram tailor the timing of the “notifications” they deliver — on Facebook, indicated by that number in red at the top right of the screen — in order to deliver, literally, hits of dopamine to users at algorithmically determined times.\u003c/p>\n\u003cp>Sometimes the companies will stockpile these notifications before delivering them all in a batch to maximize the emotional impact a user experiences, he says.\u003c/p>\n\u003cp>\"Like, hey, here’s the 30 likes we didn’t mention from a little while ago, “he told \"60 Minutes.\"\u003c/p>\n\u003cp>\u003cstrong>6. Swiping Left or Right (Tinder)\u003c/strong>\u003c/p>\n\u003cp>“Fear of missing out” drives much of social media’s hold on people, writes Harris. “If I convince you that I’m a channel for important information, messages, friendships, or potential sexual opportunities — it will be hard for you to turn me off, unsubscribe, or remove your account — because (aha, I win) you might miss something important.\"\u003c/p>\n\u003cp>This is what will keep us swiping faces on a dating app like Tinder, \"even when we haven’t met up with anyone in a while. .. But if we zoom into that fear, we’ll discover that it’s unbounded: we’ll always miss something important at any point when we stop using something.”\u003c/p>\n\u003cp>\u003cstrong>7. Photo Tagging: (Facebook, Instagram, Snapchat)\u003c/strong>\u003c/p>\n\u003cp>Getting tagged in photos plays right into our need for social approval, Harris says. He contends that because Facebook actually prompts users to identify people in photos, it is artificially creating social approval for people.\u003c/p>\n\u003cp>This craving for validation also comes into play when we change our profile photo . \"Facebook knows that’s a moment when we’re vulnerable to social approval,\" he writes. \"What do my friends think of my new pic?”\u003c/p>\n\u003cp>Facebook can rank this \"event,\" such as it is, higher in the news feed, \"so it sticks around for longer and more friends will like or comment on it. Each time they like or comment on it, I’ll get pulled right back.”\u003c/p>\n\u003cfigure id=\"attachment_397048\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/05/screenaddiction.jpg\">\u003cimg class=\"wp-image-397048 size-large\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/05/screenaddiction-1020x751.jpg\" alt=\"\" width=\"640\" height=\"471\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/05/screenaddiction-1020x751.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2017/05/screenaddiction-160x118.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/05/screenaddiction-800x589.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2017/05/screenaddiction-768x565.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2017/05/screenaddiction-1180x868.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2017/05/screenaddiction-960x707.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2017/05/screenaddiction-240x177.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/05/screenaddiction-375x276.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/05/screenaddiction-520x383.jpg 520w, https://ww2.kqed.org/app/uploads/sites/13/2017/05/screenaddiction.jpg 1250w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Image by IvanNikulin/iStock \u003ccite>(Image by IvanNikulin/iStock)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>So, some may ask: What's a successful social media app to do? Start kicking people off?\u003c/p>\n\u003cp>“Asking technology companies, asking content creators to be less good at what they do feels like a ridiculous ask,” tech consultant Gabe Zichermann told “60 Minutes.” “It feels impossible. And also it’s very anti-capitalistic. This isn’t the system that we live in.”\u003c/p>\n\u003cp>It should also be noted that Harris himself doesn’t necessarily think all of these strategies have been formulated intentionally by the companies \"Apple and Google’s designers didn’t want phones to work like slot machines,\" he wrote. “It emerged by accident.\"\u003c/p>\n\u003cp>BJ Fogg, who runs the \u003ca href=\"http://captology.stanford.edu/\">Stanford Persuasive Tech Lab\u003c/a>, where many young entrepreneurs have learned methods like the ones mentioned above, told me a lot of these strategies have been employed by non-digital companies for a very long time.\u003c/p>\n\u003cp>“What ‘s different today is that machines are being created to use these techniques,” he said.\u003c/p>\n\u003cp>Indeed. Ramsay Brown put it this way:\u003c/p>\n\u003cp>“We have now developed a rigorous technology of the human mind, and that is both exciting and terrifying. We have the ability to twiddle some nobs in a machine learning dashboard we build, and around the world hundreds of thousands of people are going to quietly change their behavior in ways that, unbeknownst to them, feel second-nature but are really by design.\u003c/p>\n\u003cp>“Which means that there’s a deep ethical imperative for us to use it for good.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>Facebook, Snapchat and Google did not respond to our requests for comment. LinkedIn declined to comment.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Horrific Ghost Ship Fire Tests Oakland Firefighters' Culture of Not Seeking Help",
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"content": "\u003cp>The day was dawning clear and sunny as Dan Robertson picked his way through the remnants of the inferno. The veteran firefighter was with a few of the other guys, making a final sweep to check that all the flames were out, when morbid curiosity got the better of them. He was cold and wet from water and sweat, and his knees told him it was time to go home. But he wondered, what does a warehouse look like, all burnt up from the inside out?\u003c/p>\n\u003cp>They walked over charcoal debris; some stuff they could recognize, like rugs and alarm clocks. Other stuff had melted into dark indecipherable shapes. The winter air smelled like that moment when you pour water on a big log-filled campfire, but with scents of burning plastic and chemicals mixed in.\u003c/p>\n\u003cp>What Robertson noticed most were the pianos. There were singed pianos everywhere, at least four or five in the front, near the doorway. He remembered being inside six hours earlier, at the height of the blaze, a piano blocking his path as he tried to carry a hose through the crackling flames.\u003c/p>\n\u003cp>[contextly_sidebar id=\"FWeW0K2AmQ9JTRMadzqx4CF7Jv6E82U1\"]By the time they had finished exploring the Ghost Ship warehouse that morning of Dec. 3, 2016, nine people had been confirmed dead; 27 more victims would be found by the end of that week in the building, which had been converted into an artists collective.\u003c/p>\n\u003cp>It wasn’t until Robertson was back at the firehouse, showering and changing into fresh clothes, that his experiences that night finally caught up to him. He drove his Toyota Tundra home and found his wife, Cheri, awake. She had just heard about the fire, and asked whether he was OK. He tried to speak, but nothing came out. He just started sobbing.\u003c/p>\n\u003caside class=\"pullquote alignright\">Many Oakland firefighters told STAT they are still struggling with the emotional fallout from that night six months ago.\u003c/aside>\n\u003cp>Many Oakland firefighters told STAT they are still struggling with the emotional fallout from that night six months ago. But few have sought mental health treatment, because of stigma within the department, combined with a limit on free counseling sessions provided by the city.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Now the Ghost Ship fire has become a catalyst for change in the Oakland Fire Department, where Robertson, a 54-year-old lieutenant and the president of the Oakland firefighters union, and other firefighters are pushing to create a peer counseling program. Firefighters in general are at high risk of developing post-traumatic stress disorder, which can lead to anxiety, substance abuse and even suicide, and that has spurred firefighters in numerous cities to demand that their mental health be treated as urgently as any other injury sustained on the job.\u003c/p>\n\u003cp>Oakland fire officials insist that existing mental health services are sufficient but underused. Deputy Chief Mark Hoffmann pointed to the city’s “incredibly robust workers comp system,” and noted that firefighters who were at the Ghost Ship fire have been offered extra employee assistance program sessions, though few have claimed them.\u003c/p>\n\u003cp>Robertson disagrees. The fact that few firefighters use the current services, he said, is proof that they aren’t working. “Is it underutilized because it’s not needed, or is it underutilized because people have no faith in it?” Robertson asked.\u003c/p>\n\u003cfigure id=\"attachment_403984\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-403984\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/06/RS23048_GettyImages-627450192-qut-800x534-800x534.jpg\" alt=\"\" width=\"800\" height=\"534\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/06/RS23048_GettyImages-627450192-qut-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2017/06/RS23048_GettyImages-627450192-qut-800x534-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/06/RS23048_GettyImages-627450192-qut-800x534-768x513.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2017/06/RS23048_GettyImages-627450192-qut-800x534-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/06/RS23048_GettyImages-627450192-qut-800x534-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/06/RS23048_GettyImages-627450192-qut-800x534-520x347.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Firefighters clear debris from the entrance to the Ghost Ship warehouse in Oakland, where a fire killed 36 people on Dec. 2, 2016. \u003ccite>((Elijah Nouvelage/Getty Images))\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>‘That Was Going to Sit With Me’\u003c/strong>\u003c/p>\n\u003cp>After the fire came the search for bodies. Eight men and women who participated in the recovery efforts said it was the most difficult aspect of the whole week. One fire captain, who has been with the department for more than 20 years, said thinking about it still makes him feel like he is teetering on the edge of a breakdown. He could see 10 bodies in the ash and rubble when he arrived, and he knew from the way the building collapsed that there would be more.\u003c/p>\n\u003cp>The victims died of smoke inhalation, not fire, so all their features were recognizable. The firefighters could see every detail: The cellphones in their pockets flooded with missed calls. Their tattoos. Their eyelashes. “There was no question,” said another firefighter, “that was going to sit with me for a while.”\u003c/p>\n\u003cp>All of them spoke about that day on condition of anonymity because they weren’t authorized to speak to the news media.\u003c/p>\n\u003cp>The firefighters were quick to emphasize that the Ghost Ship fire was just one in a long series of traumatic events over the course of their careers. In a big city like Oakland, they respond to everything from stubbed toes to heart attacks, from shootings to wildfires to structure fires. When asked to think back on a call that stuck with them, all the firefighters were able to conjure up several memories in perfect detail.\u003c/p>\n\u003cp>There was the firefighter-paramedic who still remembers the faces of two teenage girls shot in the head execution-style on a street. Another firefighter, in the department for less than five years, described a day when they drove an alcoholic to the hospital to get detoxed; as the man left the hospital that evening to go home, he was shot in a botched robbery, and the same team was called back to the scene to pronounce him dead.\u003c/p>\n\u003cp>Firefighters have a metaphor for their emotional baggage: the backpack. After every traumatic event, more junk is thrown into their symbolic backpacks for them to carry around each day. Eventually it will get too heavy; it will drag them down. “My backpack’s full,” said a firefighter still in his 18-month probation period. “It’s super full.”\u003c/p>\n\u003cp>PTSD and other post-trauma mental health issues can be tricky to identify in first responders, said psychologist Mark Kemena, a lead clinician for the West Coast Post-trauma Retreat, because it often builds up over time. It is like having a car alarm that is triggered when even the slightest wind passes by, said Michael Palmertree, a psychologist who has worked extensively with the Oakland Police Department.\u003c/p>\n\u003cp>There have been many studies about rates of PTSD in veterans and police, but reliable statistics for mental trauma in firefighters are hard to find. Suzy Gulliver, director of the Warriors Research Institute, is one of the few clinicians who has done studies on firefighter mental health. Over the course of a lifetime, she said, 20 to 22 percent of firefighters in the United States will experience PTSD — the same rate as returning combat veterans.\u003c/p>\n\u003cp>The consequences can be tragic. According to estimates from the National Fallen Firefighters Foundation, firefighters are three times more likely to die of suicide than in the line of duty. And many PTSD sufferers self-medicate with drugs or alcohol. Robertson said excessive drinking and substance use, including marijuana, have always been common in the fire department, particularly in young members. He himself had to go to drug rehab early in his career.\u003c/p>\n\u003caside class=\"pullquote alignright\">'When you do this for a little while, you’re scarred mentally for sure'\u003ccite>Chris Foley, Veteran fire captain\u003c/cite>\u003c/aside>\n\u003cp>“When you do this for a little while,” said Chris Foley, a veteran fire captain helping Robertson start the peer counseling program, “you’re scarred mentally for sure.”\u003c/p>\n\u003cp>\u003cstrong>Firefighters Wary of \u003c/strong>\u003cstrong>Treatment\u003c/strong>\u003c/p>\n\u003cp>Firefighters like to say that the fire service is 150 years of tradition, unimpeded by progress. When Robertson was a new recruit in the early 1990s, mental health wasn’t talked about in the firehouse. Back then, veterans from World War II, Korea, and Vietnam were on the crew, men who had already experienced their fair share of trauma.\u003c/p>\n\u003cp>“You can’t handle it?” Robertson recalled them saying if they saw a new crew member getting emotional after a run. “Then you need to go somewhere else.”\u003c/p>\n\u003cp>The culture has started changing, Robertson said, but many firefighters still won’t admit that a call affected them, fearing it would be seen as weakness and make their coworkers trust them a little less. In a recent survey conducted by the NBC Bay Area investigative news team, almost 50 percent of the 700 firefighters that responded said that concerns about colleagues not trusting their judgment contributed to the stigma of seeking mental health treatment.\u003c/p>\n\u003cp>Only one of the eight firefighters STAT interviewed who were at the scene that night has sought regular mental health treatment. For the few who do try to seek help, options are limited and, they say, often confusing.\u003c/p>\n\u003cp>Firefighters in Oakland are offered the same counseling program that every Oakland city employee gets: three free therapy sessions every six months through their employee assistance program (EAP). Tom Farris, president of Claremont EAP, which runs the city’s program, said it is designed to be a bridge to longer-term care, though firefighters have to pay for additional sessions through insurance copayments or out of pocket.\u003c/p>\n\u003cp>Complex mental health problems like PTSD are “absolutely not” resolved within three sessions, said Farris, who is a licensed psychologist. But “that’s not really what EAPs are scoped out to handle,” he said. Farris noted that in many cities, first responders are offered six to 10 EAP sessions, not three. More benefits for public safety employees “is a good idea,” he said.\u003c/p>\n\u003cp>Another resource in the fire department is a Critical Incident Stress Management team that is dispatched to fire stations after big events such as the Ghost Ship fire. The team members can vary from priests to other firefighters to experienced psychologists to brand-new therapists trying to boost their resume, and firefighters are required to sit together and debrief the incident.\u003c/p>\n\u003cp>Reactions to CISM are mixed. While psychologists say it can be very helpful, some firefighters say the team members often can’t relate to their experiences. Robertson said many of the CISM therapists wouldn’t be able to hold their own in a burning building. “Why the hell would I open up to you?” he said.\u003c/p>\n\u003cp>Hoffmann, the deputy chief who has been in the fire department 37 years, acknowledged that CISM has been “poorly applied at times” and said team members hadn’t received training “in about two years,” but he believes that it is an effective behavioral health tool.\u003c/p>\n\u003cp>Unsatisfied with the current treatment options, Robertson, along with Foley, has made it his mission in his last two years before retirement to launch a peer counseling program. They want to follow in the steps of other departments, including Phoenix and New York City, that have been using this model for years. Several other Bay Area cities have these programs, including neighboring Berkeley.\u003c/p>\n\u003cp>The International Association of Fire Fighters (IAFF) started offering peer counseling training courses last year and so far has offered 24 courses across North America. Elaine Viccora, a behavioral specialist at IAFF, said it plans to offer three to four trainings each month.\u003c/p>\n\u003cp>Robertson hopes to model the Oakland peer counseling program after the one in Phoenix. Brian French, a Phoenix firefighter, helped develop it in 2010 after four members of the department committed suicide within seven months.\u003c/p>\n\u003cp>Their model, French said, is “listen, refer, support.” Peer counselors are trained to reach out to individual station members after a critical incident and encourage them to get professional counseling if they think it is needed. French also oversees the day-to-day operations of a website called Firestrong, an online portal where fire departments around the country can list area-specific mental health resources for their members.\u003c/p>\n\u003cp>Robertson faces two main barriers as he tries to get the peer-counseling program off the ground: persuading the firefighters to admit when they need help, and convincing Hoffmann and other city administrators to pay for it.\u003c/p>\n\u003cp>It costs more than $250 for one firefighter to be trained as a peer counselor through the IAFF program, and membership to the Firestrong website is an additional $1,500 per year. So far, the union has paid for the training, and Robertson plans to push for city money in union negotiations this August.\u003c/p>\n\u003cp>But Hoffmann said he is worried that the peer counseling program won’t be inclusive and that the people chosen as counselors could just be winners of a popularity contest within the union. “The way they’re describing doing their program,” Hoffman said, “I can’t spend city money on that.”\u003c/p>\n\u003cp>\u003cstrong>‘Just Doing Our Job’\u003c/strong>\u003c/p>\n\u003cp>In early April, Robertson attended an IAFF conference in Phoenix and was surprised to receive a plaque commending the Oakland firefighters on their actions the night of the Ghost Ship fire. The honor made him distinctly uncomfortable. It was weird, he said, to get a plaque “for us just doing our job.” Especially, he added, on a night when 36 people lost their lives.\u003c/p>\n\u003cp>Robertson frowns at any mention of leaving a legacy in the department. That’s not why he’s creating the peer counseling program, he said, though it’s hard for him to come up with the words to describe why firefighter PTSD is such an important issue for him personally.\u003c/p>\n\u003cp>“It’s probably because I’m all fucked up myself by it,” he said.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This story was \u003ca href=\"https://www.statnews.com/2017/06/02/ghost-ship-firefighters/\" target=\"_blank\" rel=\"noopener noreferrer\">originally published by 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 day was dawning clear and sunny as Dan Robertson picked his way through the remnants of the inferno. The veteran firefighter was with a few of the other guys, making a final sweep to check that all the flames were out, when morbid curiosity got the better of them. He was cold and wet from water and sweat, and his knees told him it was time to go home. But he wondered, what does a warehouse look like, all burnt up from the inside out?\u003c/p>\n\u003cp>They walked over charcoal debris; some stuff they could recognize, like rugs and alarm clocks. Other stuff had melted into dark indecipherable shapes. The winter air smelled like that moment when you pour water on a big log-filled campfire, but with scents of burning plastic and chemicals mixed in.\u003c/p>\n\u003cp>What Robertson noticed most were the pianos. There were singed pianos everywhere, at least four or five in the front, near the doorway. He remembered being inside six hours earlier, at the height of the blaze, a piano blocking his path as he tried to carry a hose through the crackling flames.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>By the time they had finished exploring the Ghost Ship warehouse that morning of Dec. 3, 2016, nine people had been confirmed dead; 27 more victims would be found by the end of that week in the building, which had been converted into an artists collective.\u003c/p>\n\u003cp>It wasn’t until Robertson was back at the firehouse, showering and changing into fresh clothes, that his experiences that night finally caught up to him. He drove his Toyota Tundra home and found his wife, Cheri, awake. She had just heard about the fire, and asked whether he was OK. He tried to speak, but nothing came out. He just started sobbing.\u003c/p>\n\u003caside class=\"pullquote alignright\">Many Oakland firefighters told STAT they are still struggling with the emotional fallout from that night six months ago.\u003c/aside>\n\u003cp>Many Oakland firefighters told STAT they are still struggling with the emotional fallout from that night six months ago. But few have sought mental health treatment, because of stigma within the department, combined with a limit on free counseling sessions provided by the city.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Now the Ghost Ship fire has become a catalyst for change in the Oakland Fire Department, where Robertson, a 54-year-old lieutenant and the president of the Oakland firefighters union, and other firefighters are pushing to create a peer counseling program. Firefighters in general are at high risk of developing post-traumatic stress disorder, which can lead to anxiety, substance abuse and even suicide, and that has spurred firefighters in numerous cities to demand that their mental health be treated as urgently as any other injury sustained on the job.\u003c/p>\n\u003cp>Oakland fire officials insist that existing mental health services are sufficient but underused. Deputy Chief Mark Hoffmann pointed to the city’s “incredibly robust workers comp system,” and noted that firefighters who were at the Ghost Ship fire have been offered extra employee assistance program sessions, though few have claimed them.\u003c/p>\n\u003cp>Robertson disagrees. The fact that few firefighters use the current services, he said, is proof that they aren’t working. “Is it underutilized because it’s not needed, or is it underutilized because people have no faith in it?” Robertson asked.\u003c/p>\n\u003cfigure id=\"attachment_403984\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-403984\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/06/RS23048_GettyImages-627450192-qut-800x534-800x534.jpg\" alt=\"\" width=\"800\" height=\"534\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/06/RS23048_GettyImages-627450192-qut-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2017/06/RS23048_GettyImages-627450192-qut-800x534-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/06/RS23048_GettyImages-627450192-qut-800x534-768x513.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2017/06/RS23048_GettyImages-627450192-qut-800x534-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/06/RS23048_GettyImages-627450192-qut-800x534-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/06/RS23048_GettyImages-627450192-qut-800x534-520x347.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Firefighters clear debris from the entrance to the Ghost Ship warehouse in Oakland, where a fire killed 36 people on Dec. 2, 2016. \u003ccite>((Elijah Nouvelage/Getty Images))\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>‘That Was Going to Sit With Me’\u003c/strong>\u003c/p>\n\u003cp>After the fire came the search for bodies. Eight men and women who participated in the recovery efforts said it was the most difficult aspect of the whole week. One fire captain, who has been with the department for more than 20 years, said thinking about it still makes him feel like he is teetering on the edge of a breakdown. He could see 10 bodies in the ash and rubble when he arrived, and he knew from the way the building collapsed that there would be more.\u003c/p>\n\u003cp>The victims died of smoke inhalation, not fire, so all their features were recognizable. The firefighters could see every detail: The cellphones in their pockets flooded with missed calls. Their tattoos. Their eyelashes. “There was no question,” said another firefighter, “that was going to sit with me for a while.”\u003c/p>\n\u003cp>All of them spoke about that day on condition of anonymity because they weren’t authorized to speak to the news media.\u003c/p>\n\u003cp>The firefighters were quick to emphasize that the Ghost Ship fire was just one in a long series of traumatic events over the course of their careers. In a big city like Oakland, they respond to everything from stubbed toes to heart attacks, from shootings to wildfires to structure fires. When asked to think back on a call that stuck with them, all the firefighters were able to conjure up several memories in perfect detail.\u003c/p>\n\u003cp>There was the firefighter-paramedic who still remembers the faces of two teenage girls shot in the head execution-style on a street. Another firefighter, in the department for less than five years, described a day when they drove an alcoholic to the hospital to get detoxed; as the man left the hospital that evening to go home, he was shot in a botched robbery, and the same team was called back to the scene to pronounce him dead.\u003c/p>\n\u003cp>Firefighters have a metaphor for their emotional baggage: the backpack. After every traumatic event, more junk is thrown into their symbolic backpacks for them to carry around each day. Eventually it will get too heavy; it will drag them down. “My backpack’s full,” said a firefighter still in his 18-month probation period. “It’s super full.”\u003c/p>\n\u003cp>PTSD and other post-trauma mental health issues can be tricky to identify in first responders, said psychologist Mark Kemena, a lead clinician for the West Coast Post-trauma Retreat, because it often builds up over time. It is like having a car alarm that is triggered when even the slightest wind passes by, said Michael Palmertree, a psychologist who has worked extensively with the Oakland Police Department.\u003c/p>\n\u003cp>There have been many studies about rates of PTSD in veterans and police, but reliable statistics for mental trauma in firefighters are hard to find. Suzy Gulliver, director of the Warriors Research Institute, is one of the few clinicians who has done studies on firefighter mental health. Over the course of a lifetime, she said, 20 to 22 percent of firefighters in the United States will experience PTSD — the same rate as returning combat veterans.\u003c/p>\n\u003cp>The consequences can be tragic. According to estimates from the National Fallen Firefighters Foundation, firefighters are three times more likely to die of suicide than in the line of duty. And many PTSD sufferers self-medicate with drugs or alcohol. Robertson said excessive drinking and substance use, including marijuana, have always been common in the fire department, particularly in young members. He himself had to go to drug rehab early in his career.\u003c/p>\n\u003caside class=\"pullquote alignright\">'When you do this for a little while, you’re scarred mentally for sure'\u003ccite>Chris Foley, Veteran fire captain\u003c/cite>\u003c/aside>\n\u003cp>“When you do this for a little while,” said Chris Foley, a veteran fire captain helping Robertson start the peer counseling program, “you’re scarred mentally for sure.”\u003c/p>\n\u003cp>\u003cstrong>Firefighters Wary of \u003c/strong>\u003cstrong>Treatment\u003c/strong>\u003c/p>\n\u003cp>Firefighters like to say that the fire service is 150 years of tradition, unimpeded by progress. When Robertson was a new recruit in the early 1990s, mental health wasn’t talked about in the firehouse. Back then, veterans from World War II, Korea, and Vietnam were on the crew, men who had already experienced their fair share of trauma.\u003c/p>\n\u003cp>“You can’t handle it?” Robertson recalled them saying if they saw a new crew member getting emotional after a run. “Then you need to go somewhere else.”\u003c/p>\n\u003cp>The culture has started changing, Robertson said, but many firefighters still won’t admit that a call affected them, fearing it would be seen as weakness and make their coworkers trust them a little less. In a recent survey conducted by the NBC Bay Area investigative news team, almost 50 percent of the 700 firefighters that responded said that concerns about colleagues not trusting their judgment contributed to the stigma of seeking mental health treatment.\u003c/p>\n\u003cp>Only one of the eight firefighters STAT interviewed who were at the scene that night has sought regular mental health treatment. For the few who do try to seek help, options are limited and, they say, often confusing.\u003c/p>\n\u003cp>Firefighters in Oakland are offered the same counseling program that every Oakland city employee gets: three free therapy sessions every six months through their employee assistance program (EAP). Tom Farris, president of Claremont EAP, which runs the city’s program, said it is designed to be a bridge to longer-term care, though firefighters have to pay for additional sessions through insurance copayments or out of pocket.\u003c/p>\n\u003cp>Complex mental health problems like PTSD are “absolutely not” resolved within three sessions, said Farris, who is a licensed psychologist. But “that’s not really what EAPs are scoped out to handle,” he said. Farris noted that in many cities, first responders are offered six to 10 EAP sessions, not three. More benefits for public safety employees “is a good idea,” he said.\u003c/p>\n\u003cp>Another resource in the fire department is a Critical Incident Stress Management team that is dispatched to fire stations after big events such as the Ghost Ship fire. The team members can vary from priests to other firefighters to experienced psychologists to brand-new therapists trying to boost their resume, and firefighters are required to sit together and debrief the incident.\u003c/p>\n\u003cp>Reactions to CISM are mixed. While psychologists say it can be very helpful, some firefighters say the team members often can’t relate to their experiences. Robertson said many of the CISM therapists wouldn’t be able to hold their own in a burning building. “Why the hell would I open up to you?” he said.\u003c/p>\n\u003cp>Hoffmann, the deputy chief who has been in the fire department 37 years, acknowledged that CISM has been “poorly applied at times” and said team members hadn’t received training “in about two years,” but he believes that it is an effective behavioral health tool.\u003c/p>\n\u003cp>Unsatisfied with the current treatment options, Robertson, along with Foley, has made it his mission in his last two years before retirement to launch a peer counseling program. They want to follow in the steps of other departments, including Phoenix and New York City, that have been using this model for years. Several other Bay Area cities have these programs, including neighboring Berkeley.\u003c/p>\n\u003cp>The International Association of Fire Fighters (IAFF) started offering peer counseling training courses last year and so far has offered 24 courses across North America. Elaine Viccora, a behavioral specialist at IAFF, said it plans to offer three to four trainings each month.\u003c/p>\n\u003cp>Robertson hopes to model the Oakland peer counseling program after the one in Phoenix. Brian French, a Phoenix firefighter, helped develop it in 2010 after four members of the department committed suicide within seven months.\u003c/p>\n\u003cp>Their model, French said, is “listen, refer, support.” Peer counselors are trained to reach out to individual station members after a critical incident and encourage them to get professional counseling if they think it is needed. French also oversees the day-to-day operations of a website called Firestrong, an online portal where fire departments around the country can list area-specific mental health resources for their members.\u003c/p>\n\u003cp>Robertson faces two main barriers as he tries to get the peer-counseling program off the ground: persuading the firefighters to admit when they need help, and convincing Hoffmann and other city administrators to pay for it.\u003c/p>\n\u003cp>It costs more than $250 for one firefighter to be trained as a peer counselor through the IAFF program, and membership to the Firestrong website is an additional $1,500 per year. So far, the union has paid for the training, and Robertson plans to push for city money in union negotiations this August.\u003c/p>\n\u003cp>But Hoffmann said he is worried that the peer counseling program won’t be inclusive and that the people chosen as counselors could just be winners of a popularity contest within the union. “The way they’re describing doing their program,” Hoffman said, “I can’t spend city money on that.”\u003c/p>\n\u003cp>\u003cstrong>‘Just Doing Our Job’\u003c/strong>\u003c/p>\n\u003cp>In early April, Robertson attended an IAFF conference in Phoenix and was surprised to receive a plaque commending the Oakland firefighters on their actions the night of the Ghost Ship fire. The honor made him distinctly uncomfortable. It was weird, he said, to get a plaque “for us just doing our job.” Especially, he added, on a night when 36 people lost their lives.\u003c/p>\n\u003cp>Robertson frowns at any mention of leaving a legacy in the department. That’s not why he’s creating the peer counseling program, he said, though it’s hard for him to come up with the words to describe why firefighter PTSD is such an important issue for him personally.\u003c/p>\n\u003cp>“It’s probably because I’m all fucked up myself by it,” he said.\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 \u003ca href=\"https://www.statnews.com/2017/06/02/ghost-ship-firefighters/\" target=\"_blank\" rel=\"noopener noreferrer\">originally published by 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": "Was the EpiPen Hack Ethical?",
"title": "Was the EpiPen Hack Ethical?",
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"content": "\u003cp>\u003cstrong>Update June 5, 2017 \u003c/strong>\u003c/p>\n\u003cp>From The New York Times Sunday: Charles Duhigg \u003ca href=\"https://www.nytimes.com/2017/06/04/business/angry-about-epipen-prices-executive-dont-care-much.html\" target=\"_blank\" rel=\"noopener noreferrer\">writes\u003c/a> that last year's outrage over Mylan ratcheting up the price of the EpiPen, so that patients\u003ca href=\"http://www.reuters.com/article/us-health-epipen-costs-idUSKBN16Y24O\" target=\"_blank\" rel=\"noopener noreferrer\"> out-of-pocket costs\u003c/a> increased by over 500 percent in a few years, has not resulted in the company lowering the price of the product. Duhigg writes:\u003c/p>\n\u003cblockquote>\u003cp>Mylan has been called out again and again over the years — by the company’s own employees, regulators, patients, politicians and the press — and hasn’t changed, even as revenue has skyrocketed, hitting $11 billion last year. The firm is a case study in the limits of what consumer and employee activism, as well as government oversight, can achieve.\u003c/p>\u003c/blockquote>\n\u003cp>Meanwhile last week, Iowa Republican Sen. Charles Grassley\u003ca href=\"https://www.grassley.senate.gov/news/news-releases/grassley-latest-estimate-taxpayers-overpaid-127-billion-epipen\" target=\"_blank\" rel=\"noopener noreferrer\"> announced\u003c/a> that the government has estimated Mylan may have overcharged Medicaid by as much as $1.27 billion for the EpiPen under the agency's drug rebate program.\u003c/p>\n\u003cp>\u003cstrong>Original post from Jan. 23, 2017\u003c/strong>\u003c/p>\n\u003cp>Should we be free, as individuals, to make and take our own medicine at home? Who’s responsible if we get hurt or die? Do we have to right to do what we wish with our bodies in the interests of survival, healing and self-care? For years, such questions have been at the heart of public health debates over euthanasia – the right to die – and even drug addiction.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>They also lie at the center of the infamous Mylan EpiPen pricing scandal. Last fall, Mylan CEO Heather Bresch appeared before the House Oversight Committee to explain the company’s 548 percent price hike for a simple device that injects a lifesaving anti-allergy hormone, FDA-approved epinephrine.\u003c/p>\n\u003cp>The cost drove desperate allergy patients to seek alternatives, including \u003ca href=\"http://www.thedailybeast.com/articles/2016/09/22/please-do-not-hack-your-own-epipen.html\">the dangerous practice\u003c/a> of shooting epinephrine straight from a vial into a muscle.\u003c/p>\n\u003cp>Enter a new challenger: the pharmaceutical hacking collective \u003ca href=\"https://fourthievesvinegar.org/\">Four Thieves Vinegar.\u003c/a> The group is led by Michael Laufer, a math professor by day at Menlo College in Atherton, California, who shot to internet fame overnight last August when he uploaded a DIY instructional video that went viral, showcasing his homemade version of a copycat EpiPen he called the EpiPencil. \u003ca href=\"https://www.the-parallax.com/2016/09/19/epipencil-hack-costs-fraction-epipen-exclusive/\">His device costs around $35 to construct\u003c/a>– a fraction of Mylan’s $600 brand name dual-pack EpiPen. Anyone can make it at home for personal use, he claims.\u003c/p>\n\u003cp>Laufer isn’t a medical doctor and doesn’t pretend to be. But he’s a numbers guy, well versed in computer science, and has dipped into biology and chemistry. It took him two weeks to research and assemble the plastic components of the EpiPen, an auto injector created by a NASA researcher and marketed in 1980 for $20. Mylan later picked up the patent and has benefited from a monopoly.\u003c/p>\n\u003cfigure id=\"attachment_323237\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-323237\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/01/Epi-Pencil-packaging-sent-by-Laufer-800x1013.jpg\" alt=\"Close-up of packaging used in the Epi-Pencil. \" width=\"800\" height=\"1013\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/01/Epi-Pencil-packaging-sent-by-Laufer-800x1013.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/Epi-Pencil-packaging-sent-by-Laufer-160x203.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/Epi-Pencil-packaging-sent-by-Laufer-768x973.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/Epi-Pencil-packaging-sent-by-Laufer-1020x1292.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/Epi-Pencil-packaging-sent-by-Laufer-1920x2432.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/Epi-Pencil-packaging-sent-by-Laufer-1180x1495.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/Epi-Pencil-packaging-sent-by-Laufer-960x1216.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/Epi-Pencil-packaging-sent-by-Laufer-240x304.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/Epi-Pencil-packaging-sent-by-Laufer-375x475.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/Epi-Pencil-packaging-sent-by-Laufer-520x659.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Close-up of packaging used in the EpiPencil. \u003ccite>(Four Thieves Vinegar Collective)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Four Thieves Vinegar is named after a folk remedy made from vinegar and spices to ward off bubonic plague. The collective is part of the fast-growing DIY Biology movement, a subculture in which tech meets pharma--a Maker Faire for bio-geeks. In the video, Laufer carefully demonstrates how anyone can do what he did: combine a cheap off-the-shelf needle injector made for diabetics that is easy to buy on the internet, and combine it with a syringe that can be preloaded with a $1 dose of epinephrine.\u003c/p>\n\u003cp>Under fire, Mylan soon released\u003ca href=\"http://newsroom.mylan.com/2016-12-16-Mylan-Launches-the-First-Generic-for-EpiPen-epinephrine-injection-USP-Auto-Injector-as-an-Authorized-Generic\"> a $300 generic of its EpiPen\u003c/a>, but that did little to quiet critics. Georgia Congressman Buddy Carter accused the company of failing to disclose the truth about its profiteering. “There is no transparency, that's the problem here,\" he declared.\u003c/p>\n\u003cp>Leaders also criticized the FDA for its slow-paced approval of generic rivals. Teva Pharmaceutical Industries failed to get approval \u003ca href=\"https://consumerist.com/2016/09/12/teva-will-try-again-to-get-fda-approval-on-epipen-competitor-by-2018/\">for its generic EpiPen\u003c/a> in late 2016, but expects approval by 2018. Meanwhile, CVS Pharmacy has just released a $109.99 generic \u003ca href=\"http://www.pharmacytimes.com/sap-news/cvs-offers-2pack-adrenaclick-for-fraction-of-epipen-price\">two-pack EpiPen called Adrenaclick\u003c/a>. At $55 a pen, it’s close to Laufer’s DIY price -- and provides consumers with a safe, FDA-approved product.\u003c/p>\n\u003cp>That’s exactly what Laufer hoped might happen. As he sees it, his EpiPencil hack was a classic example of The Emperor Has No Clothes: It revealed the actual cost of the plastic auto injector – and showed others how they could make such a device cheaply.\u003c/p>\n\u003cp>It’s a mixed victory, though. The media spotlight gained supporters for Laufer's collective, but also opened him up to criticism. “I get a lot more fan mail then hate mail,” he says, including from parents. But others sharply condemn his actions, and his hacking group’s broader mission: making medicine at home.\u003c/p>\n\u003cp>\u003cstrong>Home Pharma Hacks Raise Safety Questions\u003c/strong>\u003c/p>\n\u003cp>Shortly after Laufer’s hack, the FDA issued a strongly worded warning against its use: “Using unapproved prescription drugs for personal use is a potentially dangerous practice,” an FDA spokesperson \u003ca href=\"http://www.in-pharmatechnologist.com/Regulatory-Safety/US-FDA-warns-against-30-alternative-to-Mylan-s-EpiPen\">told\u003c/a> the website in-PharmaTechnologist. “Unapproved drugs may be contaminated, sub-potent, super-potent or counterfeit.”\u003c/p>\n\u003cp>Critics agree. Yvette d’Entremont, known as SciBabe, is a former chemist-cum-blogger who quickly labeled the EpiPen hack a potential major fail if misused. “It seems like such a bad idea,” she told the Daily Beast. “It’s all fun and games until your product gets contaminated and you get a giant abscess in your muscle.”\u003c/p>\n\u003caside class=\"pullquote alignright\">'I believe in empowering people, in sharing information. We need to talk about alternatives to expensive medication regimens.’\u003ccite>Michael Laufer\u003c/cite>\u003c/aside>\n\u003cp>Contamination and improper dosing can happen with approved drugs too. Epinephrine is a serious drug, used to shock the heart. Laufer defends his device as safe. “In most ways it is equivalent” to Mylan’s EpiPen, he argues, pointing out that it features a safety cap like approved EpiPens, and only carries a single dose.\u003c/p>\n\u003cp>But it’s still untested. And as the father of toxicology himself, Paracelsus, famously warned: all medicine is poison at a certain dose.\u003c/p>\n\u003cp>Oncologist Ezekiel Emanuel, a bioethicist and senior fellow at the Center for American Progress, adds to the chorus of concern, cautioning strongly against using the device.\u003c/p>\n\u003cp>“We have the FDA for a reason. We want to protect the American public from dangerous drugs, which they have no ability to evaluate independently,” he says. “So now we’re going to have some guy who’s going to make a drug and a drug delivery device, put it out there -- no testing, no evaluation of whether it’s safe or effective -- and who the hell knows how many people are going to be hurt -- or not.”\u003c/p>\n\u003cfigure id=\"attachment_323239\" class=\"wp-caption aligncenter\" style=\"max-width: 678px\">\u003cimg class=\"size-full wp-image-323239\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/01/RESEND-capture-of-screenshot-of-Daraprim-chemical-breakdown.jpg\" alt=\"Michael Laufer demonstrates how to lead the Epi-Pencil in a DIY video posted to YouTube.\" width=\"678\" height=\"487\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/01/RESEND-capture-of-screenshot-of-Daraprim-chemical-breakdown.jpg 678w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/RESEND-capture-of-screenshot-of-Daraprim-chemical-breakdown-160x115.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/RESEND-capture-of-screenshot-of-Daraprim-chemical-breakdown-240x172.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/RESEND-capture-of-screenshot-of-Daraprim-chemical-breakdown-375x269.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/RESEND-capture-of-screenshot-of-Daraprim-chemical-breakdown-520x374.jpg 520w\" sizes=\"(max-width: 678px) 100vw, 678px\">\u003cfigcaption class=\"wp-caption-text\">Michael Laufer demonstrates the EpiPencil in a DIY video posted to YouTube. \u003ccite>(Anne-christine d'Adesky/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Adds Emanuel: “In this case he may turn out to be lucky and no one’s hurt. But we don’t want that regime.”\u003c/p>\n\u003cp>He said the solution to high pharmaceutical prices was \"not this cockamamie 'let people throw drugs out there untested,'\" but to reduce the market power that drug companies rely on to set prices.\u003c/p>\n\u003cp>\"We give drug companies monopolies through the patent law, and marketing exclusivity,\" he said. \"No other country gives a monopoly and then expects good behavior on pricing.\u003c/p>\n\u003cp>\"So what we’ve done is say, 'Oh we’re giving drug companies monopoly pricing power and then we’re like shocked, shocked they're raising prices.\"\u003c/p>\n\u003cp>Margaret McLean, director of bioethics at the\u003ca href=\"https://www.scu.edu/ethics/focus-areas/bioethics/\"> Markkula Center for Applied Ethics\u003c/a> in Santa Clara, also agrees using Laufer's device could be dangerous. She herself, carries an EpiPen. It carries a higher copay than her other medicines, so she sympathizes with parents who can’t afford even generic versions. But the safety risks remain serious.\u003c/p>\n\u003cp>“There is always user error,” says McLean, citing incorrect dosing as a concern. “That is true with FDA-approved drugs too. But the error is less if I don’t have to draw up the right amount of epinephrine myself. I’m grateful for the standardization and check on the injector itself, and that the dose in there is appropriate for me.” She doesn’t want to worry about bubbles in the syringe, which are very dangerous. “There are a lot of steps here,” she says of Laufer’s DIY epinephrine device, “where sitting at home in your kitchen, never having done this before, it puts you in a higher risk category then buying it from the pharmacy.”\u003c/p>\n\u003cp>Still, she understands the urgent unmet need for affordable EpiPens. “The FDA is not able to move things through in an expeditious way, so people rightly get antsy.”\u003c/p>\n\u003cp>Perhaps surprisingly, Laufer agrees about the warnings on safety. “Chemistry is science. So, yes, it’s a concern. You have to think immediately, ‘What if it’s misused?’ But that’s a first-order reaction,” he says. “Ideologically, I believe that more access to more information is inherently better for everyone.” He supports FDA safety reviews and clinical trial tests for new drugs and devices that are marketed to consumers. But he stresses, he’s not marketing anything.\u003c/p>\n\u003caside class=\"pullquote alignright\">'We have the FDA for a reason. We want to protect the American public from dangerous drugs which they have no ability to evaluate independently.'\u003ccite>Ezekiel Emanuel, Center for American Progress\u003c/cite>\u003c/aside>\n\u003cp>Where Laufer draws a hard line – and marks his battleground -- is the domain of the private individual. “What I’m saying is, here is something you can think about... If you decide you’d like to adopt it, then that’s the whole ethic: Here is an idea, play with it, if you like -- no strings attached.”\u003c/p>\n\u003cp>\u003cstrong>More Drug Hacks On the Horizon\u003c/strong>\u003c/p>\n\u003cp>In his cramped faculty office, Laufer greets visitors with a warm smile, eager to share his mission and rebut critics who, he feels, have misperceptions about the true goals and the impact of his hacking action. Online, he looks like a steampunk rebel hero in a metal-studded leather jacket, rimless glasses shoved high on his forehead. Offline, he’s natty in a dark suit, purple tie and tie pin, and fancy abacus-shaped cuff links befitting a math geek.\u003c/p>\n\u003cp>“I believe in empowering people, in sharing information,” Laufer says, citing his hacker creed. “We need to talk about alternatives to expensive medication regimens.” He compares the need for a cheap drug delivery device like his EpiPencil to IKEA furniture: something that should be easy to make, with simple instructions for the average consumer.\u003c/p>\n\u003cp>What people do with that information is not his business, he declares. “I don’t know if anyone has built it besides me,” he says of the EpiPencil. “I don’t want to know. I believe in giving people information they can use to make important decisions about their self-care. That’s what I can offer.”[contextly_sidebar id=\"ucdOGkeG5JNKwxC6hhmw4jS3XUbH2VRU\"]\u003c/p>\n\u003cp>Anyone who copies a patented device risks running afoul of patent law. It's a form of civil disobedience with life-or-death stakes. That make it easy to justify, according to Laufer's group, whose \u003ca href=\"https://fourthievesvinegar.org/faq\">website asks\u003c/a>, \"If the choices presented to you are to die, because you cannot afford medication, or violate a copyright, which would you choose?\"\u003c/p>\n\u003cp>Four Thieves Vinegar is presently focused on “small batch” chemistry--medicines that are easy to make with at-home equipment. Laufer’s first successful hack was pyrimethamine (brand name Daraprim), a decades-old drug used to treat toxoplasmosis in AIDS, cancer and malaria patients. Turing Pharmaceuticals purchased the patent in August 2015 and, a month later, \u003ca href=\"http://www.cbsnews.com/news/generic-drug-price-increases-5000-percent-overnight/\">hiked the price for a single Daraprim pill overnight\u003c/a> by 5,000 percent, from $13.50 to $750. Turing CEO Martin Shkreli became a Big Pharma pariah. In response, Laufer made a batch of DIY Daraprim for $2 a pill. So did a group of \u003ca href=\"https://qz.com/851416/why-martin-shkreli-and-turings-daraprim-still-costs-750-in-the-us-when-australian-schoolkids-can-make-it-for-2/\">Australian high school students\u003c/a>.\u003c/p>\n\u003cp>Laufer has now set his sights on several drugs he feels urgently merit greater public access, including the\u003ca href=\"http://www.rawstory.com/2016/05/american-women-increasingly-turn-to-diy-abortion-drugs-after-gop-laws-shut-down-health-clinics/\"> abortion drugs RU-486 (Mifepristone) and Misoprostol\u003c/a>; Solvadi, a hepatitis C drug; and Glaxo’s HIV prevention pill, GSK-744. He’s keenly aware his choices remain controversial and politically charged.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>Looking ahead, Laufer foresees a future of medicine more like Socrates, less like Big Pharma: “Maybe in not too long, the idea of doing chemistry on a personal and individual level and applying it to medicine will be more commonplace. I like dreaming about that.”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cstrong>Update June 5, 2017 \u003c/strong>\u003c/p>\n\u003cp>From The New York Times Sunday: Charles Duhigg \u003ca href=\"https://www.nytimes.com/2017/06/04/business/angry-about-epipen-prices-executive-dont-care-much.html\" target=\"_blank\" rel=\"noopener noreferrer\">writes\u003c/a> that last year's outrage over Mylan ratcheting up the price of the EpiPen, so that patients\u003ca href=\"http://www.reuters.com/article/us-health-epipen-costs-idUSKBN16Y24O\" target=\"_blank\" rel=\"noopener noreferrer\"> out-of-pocket costs\u003c/a> increased by over 500 percent in a few years, has not resulted in the company lowering the price of the product. Duhigg writes:\u003c/p>\n\u003cblockquote>\u003cp>Mylan has been called out again and again over the years — by the company’s own employees, regulators, patients, politicians and the press — and hasn’t changed, even as revenue has skyrocketed, hitting $11 billion last year. The firm is a case study in the limits of what consumer and employee activism, as well as government oversight, can achieve.\u003c/p>\u003c/blockquote>\n\u003cp>Meanwhile last week, Iowa Republican Sen. Charles Grassley\u003ca href=\"https://www.grassley.senate.gov/news/news-releases/grassley-latest-estimate-taxpayers-overpaid-127-billion-epipen\" target=\"_blank\" rel=\"noopener noreferrer\"> announced\u003c/a> that the government has estimated Mylan may have overcharged Medicaid by as much as $1.27 billion for the EpiPen under the agency's drug rebate program.\u003c/p>\n\u003cp>\u003cstrong>Original post from Jan. 23, 2017\u003c/strong>\u003c/p>\n\u003cp>Should we be free, as individuals, to make and take our own medicine at home? Who’s responsible if we get hurt or die? Do we have to right to do what we wish with our bodies in the interests of survival, healing and self-care? For years, such questions have been at the heart of public health debates over euthanasia – the right to die – and even drug addiction.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>They also lie at the center of the infamous Mylan EpiPen pricing scandal. Last fall, Mylan CEO Heather Bresch appeared before the House Oversight Committee to explain the company’s 548 percent price hike for a simple device that injects a lifesaving anti-allergy hormone, FDA-approved epinephrine.\u003c/p>\n\u003cp>The cost drove desperate allergy patients to seek alternatives, including \u003ca href=\"http://www.thedailybeast.com/articles/2016/09/22/please-do-not-hack-your-own-epipen.html\">the dangerous practice\u003c/a> of shooting epinephrine straight from a vial into a muscle.\u003c/p>\n\u003cp>Enter a new challenger: the pharmaceutical hacking collective \u003ca href=\"https://fourthievesvinegar.org/\">Four Thieves Vinegar.\u003c/a> The group is led by Michael Laufer, a math professor by day at Menlo College in Atherton, California, who shot to internet fame overnight last August when he uploaded a DIY instructional video that went viral, showcasing his homemade version of a copycat EpiPen he called the EpiPencil. \u003ca href=\"https://www.the-parallax.com/2016/09/19/epipencil-hack-costs-fraction-epipen-exclusive/\">His device costs around $35 to construct\u003c/a>– a fraction of Mylan’s $600 brand name dual-pack EpiPen. Anyone can make it at home for personal use, he claims.\u003c/p>\n\u003cp>Laufer isn’t a medical doctor and doesn’t pretend to be. But he’s a numbers guy, well versed in computer science, and has dipped into biology and chemistry. It took him two weeks to research and assemble the plastic components of the EpiPen, an auto injector created by a NASA researcher and marketed in 1980 for $20. Mylan later picked up the patent and has benefited from a monopoly.\u003c/p>\n\u003cfigure id=\"attachment_323237\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-323237\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/01/Epi-Pencil-packaging-sent-by-Laufer-800x1013.jpg\" alt=\"Close-up of packaging used in the Epi-Pencil. \" width=\"800\" height=\"1013\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/01/Epi-Pencil-packaging-sent-by-Laufer-800x1013.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/Epi-Pencil-packaging-sent-by-Laufer-160x203.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/Epi-Pencil-packaging-sent-by-Laufer-768x973.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/Epi-Pencil-packaging-sent-by-Laufer-1020x1292.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/Epi-Pencil-packaging-sent-by-Laufer-1920x2432.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/Epi-Pencil-packaging-sent-by-Laufer-1180x1495.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/Epi-Pencil-packaging-sent-by-Laufer-960x1216.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/Epi-Pencil-packaging-sent-by-Laufer-240x304.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/Epi-Pencil-packaging-sent-by-Laufer-375x475.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/Epi-Pencil-packaging-sent-by-Laufer-520x659.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Close-up of packaging used in the EpiPencil. \u003ccite>(Four Thieves Vinegar Collective)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Four Thieves Vinegar is named after a folk remedy made from vinegar and spices to ward off bubonic plague. The collective is part of the fast-growing DIY Biology movement, a subculture in which tech meets pharma--a Maker Faire for bio-geeks. In the video, Laufer carefully demonstrates how anyone can do what he did: combine a cheap off-the-shelf needle injector made for diabetics that is easy to buy on the internet, and combine it with a syringe that can be preloaded with a $1 dose of epinephrine.\u003c/p>\n\u003cp>Under fire, Mylan soon released\u003ca href=\"http://newsroom.mylan.com/2016-12-16-Mylan-Launches-the-First-Generic-for-EpiPen-epinephrine-injection-USP-Auto-Injector-as-an-Authorized-Generic\"> a $300 generic of its EpiPen\u003c/a>, but that did little to quiet critics. Georgia Congressman Buddy Carter accused the company of failing to disclose the truth about its profiteering. “There is no transparency, that's the problem here,\" he declared.\u003c/p>\n\u003cp>Leaders also criticized the FDA for its slow-paced approval of generic rivals. Teva Pharmaceutical Industries failed to get approval \u003ca href=\"https://consumerist.com/2016/09/12/teva-will-try-again-to-get-fda-approval-on-epipen-competitor-by-2018/\">for its generic EpiPen\u003c/a> in late 2016, but expects approval by 2018. Meanwhile, CVS Pharmacy has just released a $109.99 generic \u003ca href=\"http://www.pharmacytimes.com/sap-news/cvs-offers-2pack-adrenaclick-for-fraction-of-epipen-price\">two-pack EpiPen called Adrenaclick\u003c/a>. At $55 a pen, it’s close to Laufer’s DIY price -- and provides consumers with a safe, FDA-approved product.\u003c/p>\n\u003cp>That’s exactly what Laufer hoped might happen. As he sees it, his EpiPencil hack was a classic example of The Emperor Has No Clothes: It revealed the actual cost of the plastic auto injector – and showed others how they could make such a device cheaply.\u003c/p>\n\u003cp>It’s a mixed victory, though. The media spotlight gained supporters for Laufer's collective, but also opened him up to criticism. “I get a lot more fan mail then hate mail,” he says, including from parents. But others sharply condemn his actions, and his hacking group’s broader mission: making medicine at home.\u003c/p>\n\u003cp>\u003cstrong>Home Pharma Hacks Raise Safety Questions\u003c/strong>\u003c/p>\n\u003cp>Shortly after Laufer’s hack, the FDA issued a strongly worded warning against its use: “Using unapproved prescription drugs for personal use is a potentially dangerous practice,” an FDA spokesperson \u003ca href=\"http://www.in-pharmatechnologist.com/Regulatory-Safety/US-FDA-warns-against-30-alternative-to-Mylan-s-EpiPen\">told\u003c/a> the website in-PharmaTechnologist. “Unapproved drugs may be contaminated, sub-potent, super-potent or counterfeit.”\u003c/p>\n\u003cp>Critics agree. Yvette d’Entremont, known as SciBabe, is a former chemist-cum-blogger who quickly labeled the EpiPen hack a potential major fail if misused. “It seems like such a bad idea,” she told the Daily Beast. “It’s all fun and games until your product gets contaminated and you get a giant abscess in your muscle.”\u003c/p>\n\u003caside class=\"pullquote alignright\">'I believe in empowering people, in sharing information. We need to talk about alternatives to expensive medication regimens.’\u003ccite>Michael Laufer\u003c/cite>\u003c/aside>\n\u003cp>Contamination and improper dosing can happen with approved drugs too. Epinephrine is a serious drug, used to shock the heart. Laufer defends his device as safe. “In most ways it is equivalent” to Mylan’s EpiPen, he argues, pointing out that it features a safety cap like approved EpiPens, and only carries a single dose.\u003c/p>\n\u003cp>But it’s still untested. And as the father of toxicology himself, Paracelsus, famously warned: all medicine is poison at a certain dose.\u003c/p>\n\u003cp>Oncologist Ezekiel Emanuel, a bioethicist and senior fellow at the Center for American Progress, adds to the chorus of concern, cautioning strongly against using the device.\u003c/p>\n\u003cp>“We have the FDA for a reason. We want to protect the American public from dangerous drugs, which they have no ability to evaluate independently,” he says. “So now we’re going to have some guy who’s going to make a drug and a drug delivery device, put it out there -- no testing, no evaluation of whether it’s safe or effective -- and who the hell knows how many people are going to be hurt -- or not.”\u003c/p>\n\u003cfigure id=\"attachment_323239\" class=\"wp-caption aligncenter\" style=\"max-width: 678px\">\u003cimg class=\"size-full wp-image-323239\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/01/RESEND-capture-of-screenshot-of-Daraprim-chemical-breakdown.jpg\" alt=\"Michael Laufer demonstrates how to lead the Epi-Pencil in a DIY video posted to YouTube.\" width=\"678\" height=\"487\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/01/RESEND-capture-of-screenshot-of-Daraprim-chemical-breakdown.jpg 678w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/RESEND-capture-of-screenshot-of-Daraprim-chemical-breakdown-160x115.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/RESEND-capture-of-screenshot-of-Daraprim-chemical-breakdown-240x172.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/RESEND-capture-of-screenshot-of-Daraprim-chemical-breakdown-375x269.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/RESEND-capture-of-screenshot-of-Daraprim-chemical-breakdown-520x374.jpg 520w\" sizes=\"(max-width: 678px) 100vw, 678px\">\u003cfigcaption class=\"wp-caption-text\">Michael Laufer demonstrates the EpiPencil in a DIY video posted to YouTube. \u003ccite>(Anne-christine d'Adesky/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Adds Emanuel: “In this case he may turn out to be lucky and no one’s hurt. But we don’t want that regime.”\u003c/p>\n\u003cp>He said the solution to high pharmaceutical prices was \"not this cockamamie 'let people throw drugs out there untested,'\" but to reduce the market power that drug companies rely on to set prices.\u003c/p>\n\u003cp>\"We give drug companies monopolies through the patent law, and marketing exclusivity,\" he said. \"No other country gives a monopoly and then expects good behavior on pricing.\u003c/p>\n\u003cp>\"So what we’ve done is say, 'Oh we’re giving drug companies monopoly pricing power and then we’re like shocked, shocked they're raising prices.\"\u003c/p>\n\u003cp>Margaret McLean, director of bioethics at the\u003ca href=\"https://www.scu.edu/ethics/focus-areas/bioethics/\"> Markkula Center for Applied Ethics\u003c/a> in Santa Clara, also agrees using Laufer's device could be dangerous. She herself, carries an EpiPen. It carries a higher copay than her other medicines, so she sympathizes with parents who can’t afford even generic versions. But the safety risks remain serious.\u003c/p>\n\u003cp>“There is always user error,” says McLean, citing incorrect dosing as a concern. “That is true with FDA-approved drugs too. But the error is less if I don’t have to draw up the right amount of epinephrine myself. I’m grateful for the standardization and check on the injector itself, and that the dose in there is appropriate for me.” She doesn’t want to worry about bubbles in the syringe, which are very dangerous. “There are a lot of steps here,” she says of Laufer’s DIY epinephrine device, “where sitting at home in your kitchen, never having done this before, it puts you in a higher risk category then buying it from the pharmacy.”\u003c/p>\n\u003cp>Still, she understands the urgent unmet need for affordable EpiPens. “The FDA is not able to move things through in an expeditious way, so people rightly get antsy.”\u003c/p>\n\u003cp>Perhaps surprisingly, Laufer agrees about the warnings on safety. “Chemistry is science. So, yes, it’s a concern. You have to think immediately, ‘What if it’s misused?’ But that’s a first-order reaction,” he says. “Ideologically, I believe that more access to more information is inherently better for everyone.” He supports FDA safety reviews and clinical trial tests for new drugs and devices that are marketed to consumers. But he stresses, he’s not marketing anything.\u003c/p>\n\u003caside class=\"pullquote alignright\">'We have the FDA for a reason. We want to protect the American public from dangerous drugs which they have no ability to evaluate independently.'\u003ccite>Ezekiel Emanuel, Center for American Progress\u003c/cite>\u003c/aside>\n\u003cp>Where Laufer draws a hard line – and marks his battleground -- is the domain of the private individual. “What I’m saying is, here is something you can think about... If you decide you’d like to adopt it, then that’s the whole ethic: Here is an idea, play with it, if you like -- no strings attached.”\u003c/p>\n\u003cp>\u003cstrong>More Drug Hacks On the Horizon\u003c/strong>\u003c/p>\n\u003cp>In his cramped faculty office, Laufer greets visitors with a warm smile, eager to share his mission and rebut critics who, he feels, have misperceptions about the true goals and the impact of his hacking action. Online, he looks like a steampunk rebel hero in a metal-studded leather jacket, rimless glasses shoved high on his forehead. Offline, he’s natty in a dark suit, purple tie and tie pin, and fancy abacus-shaped cuff links befitting a math geek.\u003c/p>\n\u003cp>“I believe in empowering people, in sharing information,” Laufer says, citing his hacker creed. “We need to talk about alternatives to expensive medication regimens.” He compares the need for a cheap drug delivery device like his EpiPencil to IKEA furniture: something that should be easy to make, with simple instructions for the average consumer.\u003c/p>\n\u003cp>What people do with that information is not his business, he declares. “I don’t know if anyone has built it besides me,” he says of the EpiPencil. “I don’t want to know. I believe in giving people information they can use to make important decisions about their self-care. That’s what I can offer.”\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Anyone who copies a patented device risks running afoul of patent law. It's a form of civil disobedience with life-or-death stakes. That make it easy to justify, according to Laufer's group, whose \u003ca href=\"https://fourthievesvinegar.org/faq\">website asks\u003c/a>, \"If the choices presented to you are to die, because you cannot afford medication, or violate a copyright, which would you choose?\"\u003c/p>\n\u003cp>Four Thieves Vinegar is presently focused on “small batch” chemistry--medicines that are easy to make with at-home equipment. Laufer’s first successful hack was pyrimethamine (brand name Daraprim), a decades-old drug used to treat toxoplasmosis in AIDS, cancer and malaria patients. Turing Pharmaceuticals purchased the patent in August 2015 and, a month later, \u003ca href=\"http://www.cbsnews.com/news/generic-drug-price-increases-5000-percent-overnight/\">hiked the price for a single Daraprim pill overnight\u003c/a> by 5,000 percent, from $13.50 to $750. Turing CEO Martin Shkreli became a Big Pharma pariah. In response, Laufer made a batch of DIY Daraprim for $2 a pill. So did a group of \u003ca href=\"https://qz.com/851416/why-martin-shkreli-and-turings-daraprim-still-costs-750-in-the-us-when-australian-schoolkids-can-make-it-for-2/\">Australian high school students\u003c/a>.\u003c/p>\n\u003cp>Laufer has now set his sights on several drugs he feels urgently merit greater public access, including the\u003ca href=\"http://www.rawstory.com/2016/05/american-women-increasingly-turn-to-diy-abortion-drugs-after-gop-laws-shut-down-health-clinics/\"> abortion drugs RU-486 (Mifepristone) and Misoprostol\u003c/a>; Solvadi, a hepatitis C drug; and Glaxo’s HIV prevention pill, GSK-744. He’s keenly aware his choices remain controversial and politically charged.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Looking ahead, Laufer foresees a future of medicine more like Socrates, less like Big Pharma: “Maybe in not too long, the idea of doing chemistry on a personal and individual level and applying it to medicine will be more commonplace. I like dreaming about that.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>For the majority of us, it's not a question of whether we'll someday experience back pain; it's a question of when.\u003c/p>\n\u003caside class=\"pullquote alignright\">'Study after study after study has shown that long-term visits to chiropractors don't help patients. They don't prevent back pain; they don't solve back pain.'\u003c/aside>\n\u003cp>But searching for solutions can lead sufferers into an expensive and sometimes dangerous maze of ineffectual treatments, procedures and pills, as journalist and investigative reporter Cathryn Jakobson Ramin found. For years, she searched for ways to alleviate her own intractable back pain. Then she began to investigate the entire back pain ecosystem: doctors, chiropractors, surgery centers, pharmaceutical companies, \"posture mavens,\" collusion between personal injury attorneys and doctors ... you name it. [contextly_sidebar id=\"JG48iB524FEZTdlnUCsiXnLPWkVrjosK\"]\u003c/p>\n\u003cp>Her new book, \"\u003ca href=\"http://www.cathrynjakobsonramin.com/books/\" target=\"_blank\" rel=\"noopener noreferrer\">Crooked: Outwitting the Back Pain Industry and Getting On the Road to Recovery,\u003c/a>\" explores what she found, while also telling the story of how she overcame her chronic suffering. When it comes to people making money on -- literally -- the backs of other people, \"A lot of things didn't add up,\" she says. \"That generally means something is wrong.\"\u003c/p>\n\u003cp>Ramin recently spoke about her investigation with Eric Westervelt on \u003ca href=\"https://ww2.kqed.org/forum/2017/05/19/cathryn-jakobson-ramin-on-the-crooked-back-pain-industry/\" target=\"_blank\" rel=\"noopener noreferrer\">KQED's Forum\u003c/a> program. Here is some of what she said.\u003c/p>\n\u003cp>\u003cstrong>Beware the One Surgeon Who Says Yes\u003c/strong>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Ramin, who had ineffective minor surgery for her back pain, said the post-surgical woes of Tiger Woods and Golden State Warriors' coach Steve Kerr serve as prime examples of what can go wrong with back surgery.\u003c/p>\n\u003caside class=\"pullquote alignright\">'Minimally invasive surgery' is a marketing term. 'The damage beneath the skin will be exactly the same as it would be in traditional spine surgery.'\u003c/aside>\n\u003cp>She said some athletes do have successful surgery for back pain, but that it's unlikely their example would apply to the rest of us. \"Those athletes are highly, highly trained and in excellent condition,\" she says.\u003c/p>\n\u003cp>Ramin says the fee-for-service payment system in the U.S. incentivizes unnecessary and potentially damaging spine surgery, where in other countries, spine surgery is rare.\u003c/p>\n\u003cp>And beware the surgeon who agrees to operate on you after other reputable doctors have turned you down. She gave the example of author, physician and marathon runner Jerome Groopman, who, after five surgeons had told him there was nothing they could do for his back injury, found a sixth who claimed he could operate and get him up and running in six weeks.\u003c/p>\n\u003cp>\"He spent the next 19 years in extraordinary pain,\" Ramin says.\u003c/p>\n\u003cp>Ramin also warns against taking the description \"minimally invasive spine surgery\" literally, calling it a marketing term.\u003c/p>\n\u003cp>\"These are sexy buzzwords,\" she says. \"Perhaps the incision is small -- and it isn't always. If in fact you do have a small incision, good for you, you might look better in a bathing suit. The damage beneath the skin will be exactly the same as it would be in regular, traditional, conventional spine surgery.\"\u003c/p>\n\u003cp>These procedures are often done in outpatient surgery centers , she says. \"If anything goes wrong afterward, you're not in a hospital environment.\"\u003c/p>\n\u003cp>\u003cstrong>Chiropractors: A Very Mixed Bag\u003c/strong>\u003c/p>\n\u003cp>Ramin says some chiropractors are completely ineffectual while some are treating patients the right way. Of the latter, \"They have stopped seeking vertebral subluxations [partial dislocations] which don't actually exist on any X-ray or any type of scan, and have moved onto the very excellent practice of rehabilitation. They may ultimately be a back patient's best hope because they have studied exercise science and they have worked hard on it.\"\u003c/p>\n\u003caside class=\"pullquote alignright\">On yoga: 'One of the risk factors is finding yourself in a very competitive Northern California yoga class where you are pushed to do what you really cannot do.'\u003c/aside>\n\u003cp>However, \"If you see a chiropractor more than one or two sessions, you are wasting your time if you are being cracked, adjusted or walked over. Study after study after study has shown that long-term visits to chiropractors don't help patients. They don't prevent back pain; they don't solve back pain.\"\u003c/p>\n\u003cp>She said the World Health Organization has come up with a long list of all the diagnoses for which chiropractic is contra-indicated.( See page 20 \u003ca href=\"http://apps.who.int/medicinedocs/documents/s14076e/s14076e.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">here\u003c/a>.) \"And it's probably anything that would take you to a chiropractor.\"\u003c/p>\n\u003cp>Neck adjustments, she said, \"are to be avoided at all costs. There is no reason to let a chiropractor anywhere near your neck.\"\u003c/p>\n\u003cp>\u003cstrong>Pharmaceutical Companies: Painkilling Pill Pushers\u003c/strong>\u003c/p>\n\u003cp>In the 1990s, Ramin says, pharmaecutical companies embarked on a well-funded campaign to get primary care doctors to ask all their patients if they were experiencing any pain.\u003c/p>\n\u003caside class=\"pullquote alignright\">'There is no reason to let a chiropractor anywhere near your neck.'\u003c/aside>\n\u003cp>Oftentimes they were experiencing some back pain, \"because it is a human condition,\" she says. \"The answer to that from the primary care doctor's perspective, because of the active marketing from pharmaceutical companies, was to say 'Well, we can take care of that pain.' \"\u003c/p>\n\u003cp>Doctors often started out with short-acting pain killers, such as Vicodin, a potent and addictive narcotic. This was often followed by longer-acting, extended-release painkillers, such as the opioid-based Oxycodone -- which has led thousands into heroin addiction.\u003c/p>\n\u003cp>But, Ramin says, opioid painkillers don't work well for people with back pain.\u003c/p>\n\u003cp>\"They cause those patients to become very unmotivated and very sleepy,\" she says.\u003c/p>\n\u003cp>Plus, a condition called \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/21412369\" target=\"_blank\" rel=\"noopener noreferrer\">opioid-induced hyperalgesia\u003c/a> can arise, in which the brain generates pain independent of the original injury.\u003c/p>\n\u003cp>\u003cstrong>Expensive Chairs and Standing Desks\u003c/strong>\u003c/p>\n\u003cp>Ergonomic \"experts\" rely on what Ramin calls \"smoke and mirrors.\"\u003c/p>\n\u003cp>For instance, many back sufferers will try new office chairs.\u003c/p>\n\u003cp>\"I had a stable of office chairs,\" she says. \"One after another, expensive office chairs parading through my office, and I found most of them to be not very good.\"\u003c/p>\n\u003cp>These chairs are \"often built for 250-pound men,\" she says.\u003c/p>\n\u003cp>\"I realized you could have a chair from Costco for $25 that could keep you in the right position.\"\u003c/p>\n\u003cp>The standard, erect typing position, she says, is actually a relic from when you had to press hard on typewriter keys to get them to work.\u003c/p>\n\u003cp>Regarding the use of standing desks, Ramin says those come with their own problems. \"It's a nice variation from sitting. But remember, if you are standing, you are putting tremendous pressure on possibly a different set of ligaments,\" she says. \"But still you're asking your ligaments to hold you up for a really extended period of time. We're seeing all kinds of problems related to standing desks, now. They tend to be knee and hip problems, but those will lead to back problems.\"\u003c/p>\n\u003cp>If you have a standing desk, you still need to move around every so often, she counsels.\u003c/p>\n\u003cp>\u003cstrong>The Yoga Trap\u003c/strong>\u003c/p>\n\u003cp>Some tremendous benefits can be gained from doing yoga, Ramin says, but there is potential harm, as well.\u003c/p>\n\u003cp>\"One of the risk factors is finding yourself in a very competitive Northern California yoga class where you are pushed to do what you really cannot do. Most of us who are even remotely competitive will experience that.\"\u003c/p>\n\u003cp>She says if you have back pain, there are limitations to what you should do in class, and you need an instructor who can give you variations on postures to suit your condition.\u003c/p>\n\u003cp>\"Be very careful about finding yourself in a flow yoga class where things are moving very fast and there's no way the teacher can keep a close eye on you.\"\u003c/p>\n\u003cp>Two type of yoga she recommends for back sufferers: Iyengar yoga and Viniyoga.\u003c/p>\n\u003cp>\"Both of them have a very powerful orthopedic focus,\" Ramin says.\u003c/p>\n\u003cp>\u003cb>So What Does Work? \u003c/b>\u003c/p>\n\u003cp>Two things: Exercise and changing the way you think about back pain.\u003c/p>\n\u003cp>\"Understanding that hurt does not mean harm,\" Ramin says. \"You can continue to live an active life. The most dangerous thing you can do for yourself is take to the couch or take to your bed or take to pain management. But of course that is what most people do.“\u003c/p>\n\u003cp>Ramin recommends finding a \"back whisperer\"--someone who understands the musculoskeletal system and is able to help people build strength, balance their gaits and move effectively.\u003c/p>\n\u003cp>Moving is the key. Our bodies are not built to sit or stand in one place for hours at a time, she says. \"The best posture is your next posture.\"\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>For more info: Ramin's website features an extensive \u003ca href=\"http://www.cathrynjakobsonramin.com/resource-search\" target=\"_blank\" rel=\"noopener noreferrer\">resources section\u003c/a> directing people to information, videos and medical professionals who may be able to help alleviate back pain.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>For the majority of us, it's not a question of whether we'll someday experience back pain; it's a question of when.\u003c/p>\n\u003caside class=\"pullquote alignright\">'Study after study after study has shown that long-term visits to chiropractors don't help patients. They don't prevent back pain; they don't solve back pain.'\u003c/aside>\n\u003cp>But searching for solutions can lead sufferers into an expensive and sometimes dangerous maze of ineffectual treatments, procedures and pills, as journalist and investigative reporter Cathryn Jakobson Ramin found. For years, she searched for ways to alleviate her own intractable back pain. Then she began to investigate the entire back pain ecosystem: doctors, chiropractors, surgery centers, pharmaceutical companies, \"posture mavens,\" collusion between personal injury attorneys and doctors ... you name it. \u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Her new book, \"\u003ca href=\"http://www.cathrynjakobsonramin.com/books/\" target=\"_blank\" rel=\"noopener noreferrer\">Crooked: Outwitting the Back Pain Industry and Getting On the Road to Recovery,\u003c/a>\" explores what she found, while also telling the story of how she overcame her chronic suffering. When it comes to people making money on -- literally -- the backs of other people, \"A lot of things didn't add up,\" she says. \"That generally means something is wrong.\"\u003c/p>\n\u003cp>Ramin recently spoke about her investigation with Eric Westervelt on \u003ca href=\"https://ww2.kqed.org/forum/2017/05/19/cathryn-jakobson-ramin-on-the-crooked-back-pain-industry/\" target=\"_blank\" rel=\"noopener noreferrer\">KQED's Forum\u003c/a> program. Here is some of what she said.\u003c/p>\n\u003cp>\u003cstrong>Beware the One Surgeon Who Says Yes\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Ramin, who had ineffective minor surgery for her back pain, said the post-surgical woes of Tiger Woods and Golden State Warriors' coach Steve Kerr serve as prime examples of what can go wrong with back surgery.\u003c/p>\n\u003caside class=\"pullquote alignright\">'Minimally invasive surgery' is a marketing term. 'The damage beneath the skin will be exactly the same as it would be in traditional spine surgery.'\u003c/aside>\n\u003cp>She said some athletes do have successful surgery for back pain, but that it's unlikely their example would apply to the rest of us. \"Those athletes are highly, highly trained and in excellent condition,\" she says.\u003c/p>\n\u003cp>Ramin says the fee-for-service payment system in the U.S. incentivizes unnecessary and potentially damaging spine surgery, where in other countries, spine surgery is rare.\u003c/p>\n\u003cp>And beware the surgeon who agrees to operate on you after other reputable doctors have turned you down. She gave the example of author, physician and marathon runner Jerome Groopman, who, after five surgeons had told him there was nothing they could do for his back injury, found a sixth who claimed he could operate and get him up and running in six weeks.\u003c/p>\n\u003cp>\"He spent the next 19 years in extraordinary pain,\" Ramin says.\u003c/p>\n\u003cp>Ramin also warns against taking the description \"minimally invasive spine surgery\" literally, calling it a marketing term.\u003c/p>\n\u003cp>\"These are sexy buzzwords,\" she says. \"Perhaps the incision is small -- and it isn't always. If in fact you do have a small incision, good for you, you might look better in a bathing suit. The damage beneath the skin will be exactly the same as it would be in regular, traditional, conventional spine surgery.\"\u003c/p>\n\u003cp>These procedures are often done in outpatient surgery centers , she says. \"If anything goes wrong afterward, you're not in a hospital environment.\"\u003c/p>\n\u003cp>\u003cstrong>Chiropractors: A Very Mixed Bag\u003c/strong>\u003c/p>\n\u003cp>Ramin says some chiropractors are completely ineffectual while some are treating patients the right way. Of the latter, \"They have stopped seeking vertebral subluxations [partial dislocations] which don't actually exist on any X-ray or any type of scan, and have moved onto the very excellent practice of rehabilitation. They may ultimately be a back patient's best hope because they have studied exercise science and they have worked hard on it.\"\u003c/p>\n\u003caside class=\"pullquote alignright\">On yoga: 'One of the risk factors is finding yourself in a very competitive Northern California yoga class where you are pushed to do what you really cannot do.'\u003c/aside>\n\u003cp>However, \"If you see a chiropractor more than one or two sessions, you are wasting your time if you are being cracked, adjusted or walked over. Study after study after study has shown that long-term visits to chiropractors don't help patients. They don't prevent back pain; they don't solve back pain.\"\u003c/p>\n\u003cp>She said the World Health Organization has come up with a long list of all the diagnoses for which chiropractic is contra-indicated.( See page 20 \u003ca href=\"http://apps.who.int/medicinedocs/documents/s14076e/s14076e.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">here\u003c/a>.) \"And it's probably anything that would take you to a chiropractor.\"\u003c/p>\n\u003cp>Neck adjustments, she said, \"are to be avoided at all costs. There is no reason to let a chiropractor anywhere near your neck.\"\u003c/p>\n\u003cp>\u003cstrong>Pharmaceutical Companies: Painkilling Pill Pushers\u003c/strong>\u003c/p>\n\u003cp>In the 1990s, Ramin says, pharmaecutical companies embarked on a well-funded campaign to get primary care doctors to ask all their patients if they were experiencing any pain.\u003c/p>\n\u003caside class=\"pullquote alignright\">'There is no reason to let a chiropractor anywhere near your neck.'\u003c/aside>\n\u003cp>Oftentimes they were experiencing some back pain, \"because it is a human condition,\" she says. \"The answer to that from the primary care doctor's perspective, because of the active marketing from pharmaceutical companies, was to say 'Well, we can take care of that pain.' \"\u003c/p>\n\u003cp>Doctors often started out with short-acting pain killers, such as Vicodin, a potent and addictive narcotic. This was often followed by longer-acting, extended-release painkillers, such as the opioid-based Oxycodone -- which has led thousands into heroin addiction.\u003c/p>\n\u003cp>But, Ramin says, opioid painkillers don't work well for people with back pain.\u003c/p>\n\u003cp>\"They cause those patients to become very unmotivated and very sleepy,\" she says.\u003c/p>\n\u003cp>Plus, a condition called \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/21412369\" target=\"_blank\" rel=\"noopener noreferrer\">opioid-induced hyperalgesia\u003c/a> can arise, in which the brain generates pain independent of the original injury.\u003c/p>\n\u003cp>\u003cstrong>Expensive Chairs and Standing Desks\u003c/strong>\u003c/p>\n\u003cp>Ergonomic \"experts\" rely on what Ramin calls \"smoke and mirrors.\"\u003c/p>\n\u003cp>For instance, many back sufferers will try new office chairs.\u003c/p>\n\u003cp>\"I had a stable of office chairs,\" she says. \"One after another, expensive office chairs parading through my office, and I found most of them to be not very good.\"\u003c/p>\n\u003cp>These chairs are \"often built for 250-pound men,\" she says.\u003c/p>\n\u003cp>\"I realized you could have a chair from Costco for $25 that could keep you in the right position.\"\u003c/p>\n\u003cp>The standard, erect typing position, she says, is actually a relic from when you had to press hard on typewriter keys to get them to work.\u003c/p>\n\u003cp>Regarding the use of standing desks, Ramin says those come with their own problems. \"It's a nice variation from sitting. But remember, if you are standing, you are putting tremendous pressure on possibly a different set of ligaments,\" she says. \"But still you're asking your ligaments to hold you up for a really extended period of time. We're seeing all kinds of problems related to standing desks, now. They tend to be knee and hip problems, but those will lead to back problems.\"\u003c/p>\n\u003cp>If you have a standing desk, you still need to move around every so often, she counsels.\u003c/p>\n\u003cp>\u003cstrong>The Yoga Trap\u003c/strong>\u003c/p>\n\u003cp>Some tremendous benefits can be gained from doing yoga, Ramin says, but there is potential harm, as well.\u003c/p>\n\u003cp>\"One of the risk factors is finding yourself in a very competitive Northern California yoga class where you are pushed to do what you really cannot do. Most of us who are even remotely competitive will experience that.\"\u003c/p>\n\u003cp>She says if you have back pain, there are limitations to what you should do in class, and you need an instructor who can give you variations on postures to suit your condition.\u003c/p>\n\u003cp>\"Be very careful about finding yourself in a flow yoga class where things are moving very fast and there's no way the teacher can keep a close eye on you.\"\u003c/p>\n\u003cp>Two type of yoga she recommends for back sufferers: Iyengar yoga and Viniyoga.\u003c/p>\n\u003cp>\"Both of them have a very powerful orthopedic focus,\" Ramin says.\u003c/p>\n\u003cp>\u003cb>So What Does Work? \u003c/b>\u003c/p>\n\u003cp>Two things: Exercise and changing the way you think about back pain.\u003c/p>\n\u003cp>\"Understanding that hurt does not mean harm,\" Ramin says. \"You can continue to live an active life. The most dangerous thing you can do for yourself is take to the couch or take to your bed or take to pain management. But of course that is what most people do.“\u003c/p>\n\u003cp>Ramin recommends finding a \"back whisperer\"--someone who understands the musculoskeletal system and is able to help people build strength, balance their gaits and move effectively.\u003c/p>\n\u003cp>Moving is the key. Our bodies are not built to sit or stand in one place for hours at a time, she says. \"The best posture is your next posture.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>For more info: Ramin's website features an extensive \u003ca href=\"http://www.cathrynjakobsonramin.com/resource-search\" target=\"_blank\" rel=\"noopener noreferrer\">resources section\u003c/a> directing people to information, videos and medical professionals who may be able to help alleviate back pain.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Leaving Segregated Areas Lowered African-Americans' Blood Pressure",
"title": "Leaving Segregated Areas Lowered African-Americans' Blood Pressure",
"headTitle": "KQED Future of You | KQED Science",
"content": "\u003cp>African-Americans experience a significant drop in their blood pressure after they move out of highly segregated neighborhoods and into more integrated neighborhoods, researchers reported recently.\u003c/p>\n\u003cp>A \u003ca href=\"http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/10.1001/jamainternmed.2017.1226\">study\u003c/a> involving more than 2,000 African-Americans found that those who moved from the most-segregated neighborhoods to less-segregated neighborhoods later experienced lower systolic blood pressure, a factor in heart attacks and strokes.\u003c/p>\n\u003caside class=\"pullquote alignright\">The researchers found the difference in blood pressure persisted after accounting for other factors that could have played a role, such as changes in income and education.\u003c/aside>\n\u003cp>\"The big message here is that this study shines a light on one of the root causes of heart disease and stroke in our country,\" says \u003ca href=\"http://www.cardiovascularbusiness.com/topics/practice-management/nhlbi-names-david-goff-director-division-cardiovascular-sciences\">David Goff\u003c/a>, director of the division of cardiovascular diseases at the National Heart, Lung, and Blood Institute, which funded the study. It was published in \u003cem>JAMA Internal Medicine\u003c/em>.\u003c/p>\n\u003cp>Doctors have known for a long time that African-Americans are prone to \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0024199/\">high blood pressure\u003c/a>. And previous research had found that people living in segregated places tended to have higher blood pressure.\u003c/p>\n\u003cp>The new study is the first to follow people over time to see how leaving segregated communities could affect the risk of heart disease. This kind of before-and-after study strengthens the observations made in the earlier studies.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Kiarri Kershaw, an assistant professor of preventive medicine at Northwestern University, and her colleagues followed 2,280 African-Americans participating in the \u003ca href=\"https://www.nhlbi.nih.gov/research/resources/obesity/population/cardia.htm\">Coronary Artery Risk Development in Young Adults\u003c/a> study.\u003c/p>\n\u003cp>The subjects were living in highly segregated neighborhoods in Chicago, Minneapolis, Birmingham, Ala., and Oakland, Calif., when the study began in 1985. They were between the ages of 18 and 30 when the study started.\u003c/p>\n\u003cp>The researchers followed the study subjects for 25 years, when they reached the ages of 43 to 55. Those who moved away from highly segregated neighborhoods to less-segregated neighborhoods and stayed there during that period had significantly lower blood pressure.\u003c/p>\n\u003cp>Their systolic blood pressure, the first of the two numbers used to measure blood pressure, was one to five points lower, the researchers reported.\u003c/p>\n\u003cp>While the differences in blood pressure may seem small, that difference among a large number of people could translate into thousands fewer heart attacks and strokes over time. Systolic blood pressure is thought to be the more important number when it comes to developing cardiovascular disease.\u003c/p>\n\u003cp>\"I think it's pretty powerful in the sense that the reasons for their moves were not necessarily for their health, but it has these other added benefits,\" Kershaw says.\u003c/p>\n\u003cp>The study did not examine how moving to less-segregated neighborhoods could affect blood pressure. But Kershaw thinks it's probably because of a combination of factors, including experiencing less stress from being exposed to less violence.\u003c/p>\n\u003cp>\"There's a decent-size body of evidence relating stress to blood pressure and that's one pathway that we hypothesize that segregation influences health — through exposure to violence, things like that — that could increase your stress level and then potentially influence blood pressure,\" Kershaw says.\u003c/p>\n\u003cp>Less-segregated neighborhoods may also provide more economic opportunities for people and their children and access to better schools, which could also reduce stress, she says.\u003c/p>\n\u003cp>In addition, those neighborhoods may also make it easier to live healthier lifestyles by having more access to parks, sidewalks, gyms, grocery stores with more fresh produce and pharmacies to get medication.\u003c/p>\n\u003cp>The researchers found the difference in blood pressure persisted after accounting for other factors that could have played a role, such as changes in income and education.\u003c/p>\n\u003cp>Kershaw acknowledges, however, that moving to less segregated neighborhoods could increase stress in at least one way — by potentially exposing African-Americans to more racism.\u003c/p>\n\u003cp>\"It's certainly possible that those who move to less segregated neighborhoods experience more exposure to racism, which could be one reason why some African-Americans choose to stay in more segregated neighborhoods,\" she wrote in an email. She noted that African-Americans living in more segregated neighborhoods tend to have better mental health.\u003c/p>\n\u003cp>But Kershaw says her study found there was an overall beneficial ffect on blood pressure of leaving a segregated neighborhood.\u003c/p>\n\u003cp>\"The take-home message is that policies that can allow people who are living in segregated neighborhoods to move and live in more integrated neighborhoods have some spillover effects that influences health like blood pressures,\" Kershaw says.\u003c/p>\n\u003cp>Others agree. \"This study is really important,\" says \u003ca href=\"https://www.hsph.harvard.edu/ashish-jha/\">Ashish Jha\u003c/a>, who studies health policy at the Harvard T.H. Chan School of Public Health and was not involved in the study.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"It helps us really feel much more confident that there's something about segregation itself that's leading to worse health outcomes,\" Jha says. \"And this study says that we really do have to tackle segregation if we're going to really improve the health of minorities in America.\"\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Leaving+Segregated+Neighborhoods+Lowers+Blacks%27+Blood+Pressure&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>African-Americans experience a significant drop in their blood pressure after they move out of highly segregated neighborhoods and into more integrated neighborhoods, researchers reported recently.\u003c/p>\n\u003cp>A \u003ca href=\"http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/10.1001/jamainternmed.2017.1226\">study\u003c/a> involving more than 2,000 African-Americans found that those who moved from the most-segregated neighborhoods to less-segregated neighborhoods later experienced lower systolic blood pressure, a factor in heart attacks and strokes.\u003c/p>\n\u003caside class=\"pullquote alignright\">The researchers found the difference in blood pressure persisted after accounting for other factors that could have played a role, such as changes in income and education.\u003c/aside>\n\u003cp>\"The big message here is that this study shines a light on one of the root causes of heart disease and stroke in our country,\" says \u003ca href=\"http://www.cardiovascularbusiness.com/topics/practice-management/nhlbi-names-david-goff-director-division-cardiovascular-sciences\">David Goff\u003c/a>, director of the division of cardiovascular diseases at the National Heart, Lung, and Blood Institute, which funded the study. It was published in \u003cem>JAMA Internal Medicine\u003c/em>.\u003c/p>\n\u003cp>Doctors have known for a long time that African-Americans are prone to \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0024199/\">high blood pressure\u003c/a>. And previous research had found that people living in segregated places tended to have higher blood pressure.\u003c/p>\n\u003cp>The new study is the first to follow people over time to see how leaving segregated communities could affect the risk of heart disease. This kind of before-and-after study strengthens the observations made in the earlier studies.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Kiarri Kershaw, an assistant professor of preventive medicine at Northwestern University, and her colleagues followed 2,280 African-Americans participating in the \u003ca href=\"https://www.nhlbi.nih.gov/research/resources/obesity/population/cardia.htm\">Coronary Artery Risk Development in Young Adults\u003c/a> study.\u003c/p>\n\u003cp>The subjects were living in highly segregated neighborhoods in Chicago, Minneapolis, Birmingham, Ala., and Oakland, Calif., when the study began in 1985. They were between the ages of 18 and 30 when the study started.\u003c/p>\n\u003cp>The researchers followed the study subjects for 25 years, when they reached the ages of 43 to 55. Those who moved away from highly segregated neighborhoods to less-segregated neighborhoods and stayed there during that period had significantly lower blood pressure.\u003c/p>\n\u003cp>Their systolic blood pressure, the first of the two numbers used to measure blood pressure, was one to five points lower, the researchers reported.\u003c/p>\n\u003cp>While the differences in blood pressure may seem small, that difference among a large number of people could translate into thousands fewer heart attacks and strokes over time. Systolic blood pressure is thought to be the more important number when it comes to developing cardiovascular disease.\u003c/p>\n\u003cp>\"I think it's pretty powerful in the sense that the reasons for their moves were not necessarily for their health, but it has these other added benefits,\" Kershaw says.\u003c/p>\n\u003cp>The study did not examine how moving to less-segregated neighborhoods could affect blood pressure. But Kershaw thinks it's probably because of a combination of factors, including experiencing less stress from being exposed to less violence.\u003c/p>\n\u003cp>\"There's a decent-size body of evidence relating stress to blood pressure and that's one pathway that we hypothesize that segregation influences health — through exposure to violence, things like that — that could increase your stress level and then potentially influence blood pressure,\" Kershaw says.\u003c/p>\n\u003cp>Less-segregated neighborhoods may also provide more economic opportunities for people and their children and access to better schools, which could also reduce stress, she says.\u003c/p>\n\u003cp>In addition, those neighborhoods may also make it easier to live healthier lifestyles by having more access to parks, sidewalks, gyms, grocery stores with more fresh produce and pharmacies to get medication.\u003c/p>\n\u003cp>The researchers found the difference in blood pressure persisted after accounting for other factors that could have played a role, such as changes in income and education.\u003c/p>\n\u003cp>Kershaw acknowledges, however, that moving to less segregated neighborhoods could increase stress in at least one way — by potentially exposing African-Americans to more racism.\u003c/p>\n\u003cp>\"It's certainly possible that those who move to less segregated neighborhoods experience more exposure to racism, which could be one reason why some African-Americans choose to stay in more segregated neighborhoods,\" she wrote in an email. She noted that African-Americans living in more segregated neighborhoods tend to have better mental health.\u003c/p>\n\u003cp>But Kershaw says her study found there was an overall beneficial ffect on blood pressure of leaving a segregated neighborhood.\u003c/p>\n\u003cp>\"The take-home message is that policies that can allow people who are living in segregated neighborhoods to move and live in more integrated neighborhoods have some spillover effects that influences health like blood pressures,\" Kershaw says.\u003c/p>\n\u003cp>Others agree. \"This study is really important,\" says \u003ca href=\"https://www.hsph.harvard.edu/ashish-jha/\">Ashish Jha\u003c/a>, who studies health policy at the Harvard T.H. Chan School of Public Health and was not involved in the study.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"It helps us really feel much more confident that there's something about segregation itself that's leading to worse health outcomes,\" Jha says. \"And this study says that we really do have to tackle segregation if we're going to really improve the health of minorities in America.\"\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Leaving+Segregated+Neighborhoods+Lowers+Blacks%27+Blood+Pressure&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"info": "The Commonwealth Club of California is the nation's oldest and largest public affairs forum. As a non-partisan forum, The Club brings to the public airwaves diverse viewpoints on important topics. The Club's weekly radio broadcast - the oldest in the U.S., dating back to 1924 - is carried across the nation on public radio stations and is now podcasting. Our website archive features audio of our recent programs, as well as selected speeches from our long and distinguished history. This podcast feed is usually updated twice a week and is always un-edited.",
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"order": 9
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"id": "fresh-air",
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"airtime": "SUN 7:30pm-8pm",
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"tagline": "Where conversation and cultura meet",
"info": "What kind of no sabo word is Hyphenación? For us, it’s about living within a hyphenation. Like being a third-gen Mexican-American from the Texas border now living that Bay Area Chicano life. Like Xorje! Each week we bring together a couple of hyphenated Latinos to talk all about personal life choices: family, careers, relationships, belonging … everything is on the table. ",
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"order": 15
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"title": "The Political Mind of Jerry Brown",
"tagline": "Lessons from a lifetime in politics",
"info": "The Political Mind of Jerry Brown brings listeners the wisdom of the former Governor, Mayor, and presidential candidate. Scott Shafer interviewed Brown for more than 40 hours, covering the former governor's life and half-century in the political game – and Brown has some lessons he'd like to share. ",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/The-Political-Mind-of-Jerry-Brown-Podcast-Tile-703x703-1.jpg",
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"order": 18
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"info": "Latino USA, the radio journal of news and culture, is the only national, English-language radio program produced from a Latino perspective.",
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"marketplace": {
"id": "marketplace",
"title": "Marketplace",
"info": "Our flagship program, helmed by Kai Ryssdal, examines what the day in money delivered, through stories, conversations, newsworthy numbers and more. Updated Monday through Friday at about 3:30 p.m. PT.",
"airtime": "MON-FRI 4pm-4:30pm, MON-WED 6:30pm-7pm",
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"source": "American Public Media"
},
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"masters-of-scale": {
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"title": "Masters of Scale",
"info": "Masters of Scale is an original podcast in which LinkedIn co-founder and Greylock Partner Reid Hoffman sets out to describe and prove theories that explain how great entrepreneurs take their companies from zero to a gazillion in ingenious fashion.",
"airtime": "Every other Wednesday June 12 through October 16 at 8pm (repeats Thursdays at 2am)",
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},
"mindshift": {
"id": "mindshift",
"title": "MindShift",
"tagline": "A podcast about the future of learning and how we raise our kids",
"info": "The MindShift podcast explores the innovations in education that are shaping how kids learn. Hosts Ki Sung and Katrina Schwartz introduce listeners to educators, researchers, parents and students who are developing effective ways to improve how kids learn. We cover topics like how fed-up administrators are developing surprising tactics to deal with classroom disruptions; how listening to podcasts are helping kids develop reading skills; the consequences of overparenting; and why interdisciplinary learning can engage students on all ends of the traditional achievement spectrum. This podcast is part of the MindShift education site, a division of KQED News. KQED is an NPR/PBS member station based in San Francisco. You can also visit the MindShift website for episodes and supplemental blog posts or tweet us \u003ca href=\"https://twitter.com/MindShiftKQED\">@MindShiftKQED\u003c/a> or visit us at \u003ca href=\"/mindshift\">MindShift.KQED.org\u003c/a>",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Mindshift-Podcast-Tile-703x703-1.jpg",
"imageAlt": "KQED MindShift: How We Will Learn",
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"meta": {
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"order": 12
},
"link": "/podcasts/mindshift",
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM1NzY0NjAwNDI5",
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"morning-edition": {
"id": "morning-edition",
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"info": "\u003cem>Morning Edition\u003c/em> takes listeners around the country and the world with multi-faceted stories and commentaries every weekday. Hosts Steve Inskeep, David Greene and Rachel Martin bring you the latest breaking news and features to prepare you for the day.",
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"onourwatch": {
"id": "onourwatch",
"title": "On Our Watch",
"tagline": "Deeply-reported investigative journalism",
"info": "For decades, the process for how police police themselves has been inconsistent – if not opaque. In some states, like California, these proceedings were completely hidden. After a new police transparency law unsealed scores of internal affairs files, our reporters set out to examine these cases and the shadow world of police discipline. On Our Watch brings listeners into the rooms where officers are questioned and witnesses are interrogated to find out who this system is really protecting. Is it the officers, or the public they've sworn to serve?",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/On-Our-Watch-Podcast-Tile-703x703-1.jpg",
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"order": 11
},
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"on-the-media": {
"id": "on-the-media",
"title": "On The Media",
"info": "Our weekly podcast explores how the media 'sausage' is made, casts an incisive eye on fluctuations in the marketplace of ideas, and examines threats to the freedom of information and expression in America and abroad. For one hour a week, the show tries to lift the veil from the process of \"making media,\" especially news media, because it's through that lens that we see the world and the world sees us",
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},
"link": "/radio/program/on-the-media",
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},
"pbs-newshour": {
"id": "pbs-newshour",
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"info": "Analysis, background reports and updates from the PBS NewsHour putting today's news in context.",
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"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/PBS-News-Hour-Podcast-Tile-360x360-1.jpg",
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"apple": "https://itunes.apple.com/us/podcast/pbs-newshour-full-show/id394432287?mt=2",
"tuneIn": "https://tunein.com/radio/PBS-NewsHour---Full-Show-p425698/",
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},
"perspectives": {
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"order": 14
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"planet-money": {
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"info": "The economy explained. Imagine you could call up a friend and say, Meet me at the bar and tell me what's going on with the economy. Now imagine that's actually a fun evening.",
"airtime": "SUN 3pm-4pm",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/planetmoney.jpg",
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},
"link": "/radio/program/planet-money",
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"apple": "https://itunes.apple.com/us/podcast/planet-money/id290783428?mt=2",
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},
"politicalbreakdown": {
"id": "politicalbreakdown",
"title": "Political Breakdown",
"tagline": "Politics from a personal perspective",
"info": "Political Breakdown is a new series that explores the political intersection of California and the nation. Each week hosts Scott Shafer and Marisa Lagos are joined with a new special guest to unpack politics -- with personality — and offer an insider’s glimpse at how politics happens.",
"airtime": "THU 6:30pm-7pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Political-Breakdown-2024-Podcast-Tile-703x703-1.jpg",
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"order": 5
},
"link": "/podcasts/politicalbreakdown",
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"possible": {
"id": "possible",
"title": "Possible",
"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.",
"airtime": "SUN 2pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Possible-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.possible.fm/",
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"source": "Possible"
},
"link": "/radio/program/possible",
"subscribe": {
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"spotify": "https://open.spotify.com/show/730YpdUSNlMyPQwNnyjp4k"
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},
"pri-the-world": {
"id": "pri-the-world",
"title": "PRI's The World: Latest Edition",
"info": "Each weekday, host Marco Werman and his team of producers bring you the world's most interesting stories in an hour of radio that reminds us just how small our planet really is.",
"airtime": "MON-FRI 2pm-3pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/The-World-Podcast-Tile-360x360-1.jpg",
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},
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