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"content": "\u003cp>It was not psychiatry’s finest hour. Just over 20 years ago a psychotherapist claimed he had discovered a new mental illness, which he named Internet Abuse Disorder. He saw it all around him: people compulsively reading websites and sending email and feeling anxious if they couldn’t. Psychiatrists and laypeople alike flocked to a listserv to share their experience with this supposed affliction, and the American Psychiatric Association appointed a task force to explore whether there was sufficient evidence to support recognizing internet “abuse” as a mental disorder.\u003c/p>\n\u003caside class=\"pullquote alignright\">An existential dread engulfs some people who are cut off from the online world.\u003c/aside>\n\u003cp>Verdict: There wasn’t then and there isn’t now. Spending hours each day online via either mobile devices or the stationary kind is not a mental illness. In fact, the original proposal, by the late Dr. Ivan Goldberg, was meant as a joke.\u003c/p>\n\u003cp>[contextly_sidebar id=\"v1Vm2rYzINUSkLHhmrEoRc3mBkYRkZme\"]More than any other behavior that people engage in compulsively, the digital version — from checking Facebook to texting — shows that just because you’re compulsive about something doesn’t mean you have a broken brain. To the contrary. As with other compulsions that fall well short of pathology, the allure of being online sheds light on some of the mind’s most salient, and utterly normal, operations, according to the latest research. From our desire to connect to the way we respond to unpredictable rewards, our minds are wired in a way that lets digital technology sink its hooks into us.\u003c/p>\n\u003cp>First, a definition. A compulsive behavior is one that is repeated and chronic, and arises from a feeling of anxiety. Just as someone with obsessive-compulsive disorder (OCD) compulsively and repeatedly washes her hands, for instance, to alleviate the anxiety that comes from believing she is covered with germs, so mentally healthy people who behave compulsively are also driven by anxiety. (Checking one’s phone repeatedly is not considered a disorder, however, because the behavior is grounded in reality, not a delusion, and it usually doesn’t get in the way of living a normal life.)\u003c/p>\n\u003cp>Often, said Moez Limayem, of the University of South Florida, who led a \u003ca href=\"http://onlinelibrary.wiley.com/doi/10.1111/isj.12065/abstract\" target=\"_blank\">2015 study\u003c/a> on mobile use, “The underlying motivation to use a mobile phone is not pleasure,” but is instead “a response to heightened stress and anxiety.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Start with the fact that many of us feel anxious if we’re not making use of every tiny slice of time. The effort required for a single online “transaction” — a click, a view, checking Instagram or Facebook — is minuscule, so much so that not texting or reading your smartphone screen feels like a greater burden than doing so. “The timescale on which you work with online technology is central to making it compelling,” said psychologist Tom Stafford of the University of Sheffield in England. “What else can you do in five seconds that’s interesting? Why not check your phone?” This is a large part of why “using the internet can be compulsive,” he said.\u003c/p>\n\u003cp>One reason we often feel anxious if we’re not using every tiny slice of time is that we find it hard—even unpleasant and anxiety-producing to be alone with our thoughts, as a \u003ca href=\"http://science.sciencemag.org/content/345/6192/75\" target=\"_blank\">2014 study\u003c/a> showed. Researchers led by social psychologist Timothy Wilson of the University of Virginia gave volunteers two options: do “nothing” for 15 minutes or give themselves a small electric shock (which three-quarters had previously told the researchers they’d pay money not to experience). Two-thirds of the men and one-quarter of the women chose the latter, so anxious were they for “something to do.”\u003c/p>\n\u003cp>“The untutored mind does not like to be alone with itself,” Wilson concluded.\u003c/p>\n\u003cp>Especially when the mind encounters payoffs structured like a slot machine’s. Like those one-armed bandits, the digital world offers what are called intermittent/variable rewards: An action — pulling the slot machine’s arm, checking for texts — can bring either a payoff or nothing. Most of what fills your Twitter feed or Facebook updates is digital dross. (“Barbara changed her Facebook picture!”) Payoff: zero. But every so often, you find a gem — a friend offering Bruce Springsteen tickets, an acquaintance posting a link to the morning’s must-read Trump story.\u003c/p>\n\u003cp>“If I give you a treat sometimes, you have to keep checking all the time: You don’t know when it will come,” said Stafford. “No matter how frequently you check, even if you checked only a second ago, a brilliant email might have just come in. You feel anxiety about possibly missing something.” Such low-cost, occasionally high-reward activities are catnip to the brain.\u003c/p>\n\u003cp>If we’re prevented from compulsively checking for texts, the anxiety that the compulsive behavior alleviates comes roaring back. Psychologists have found that people who are separated from their smartphone experience an elevated heart rate and other signs of anxiety.\u003c/p>\n\u003cp>In one \u003ca href=\"http://www.sciencedirect.com/science/article/pii/S0747563215303332\" target=\"_blank\">2016 study\u003c/a>, volunteers who filled out a standard questionnaire about their smartphone use and emotions told researchers that they turn to their phones “to avoid negative experiences or feelings” and “to cope [with] or escape from feelings related to an anxiety-inducing situation.” Psychologist Alejandro Lleras, of the University of Illinois at Urbana-Champaign, who led the study, described it as a security-blanket effect, absorbing our bubbling-over anxiety.\u003c/p>\n\u003cp>That fits with studies finding that people text as a way to escape anxiety; something like 70 percent of study participants say smartphones and texting help them overcome anxiety and other negative moods. It’s become a stereotype that people in awkward (read: anxiety-provoking) situations “turn to their mobile phones as a way to disengage,” the Illinois researchers wrote, especially “during times of more intense distress.”\u003c/p>\n\u003cp>Lleras and a colleague gave volunteers a short writing assignment that, they explained (falsely), would be evaluated by two experts. To ratchet up the stress further, the researchers said the experts would also interview them about their essay. While waiting for that, half the volunteers had access to their mobile phones and half didn’t. Among those who were able to text and surf to their anxiety-ridden-heart’s content, half felt intense anxiety. In comparison, three-quarters of those who were deprived of their phones did, the researchers reported.\u003c/p>\n\u003cp>By giving in to a compulsion to use their phone, many of the study volunteers were able to defuse much of their anxiety. “People seem to be less vulnerable to becoming stressed in anxiety-provoking situations when they have access” to their mobile phone, the researchers wrote.\u003c/p>\n\u003cp>It’s not only being deprived of those variable-interval rewards that makes ditching their smartphone unthinkable for many people. Because it has become our main connection to other people and the world at large, the anxiety that comes from not being able to check it arises, too, from the feeling of missing something, as if everyone else is plugged in, connected, on top of things, and you aren’t.\u003c/p>\n\u003cp>“There are people who feel, if I’m not there, if I’m not on that site, I’m missing something — something about my friends, or my health, or anything else,” said psychiatrist Dr. David Reiss, who practices in San Diego.\u003c/p>\n\u003cp>The internet exploits this FOMO, or fear of missing out. Being disconnected is synonymous with missing out.\u003c/p>\n\u003cp>By making us feel we are always connected to the world, smartphones also alleviate the anxiety that otherwise floods into us from feeling alone and untethered. A character in the 2014 New York City production of Laura Eason’s play “Sex with Strangers,” learning there’s no cellphone service at a bed-and-breakfast, says, “People will think I’m dead.” People don’t like feeling dead.\u003c/p>\n\u003cp>A \u003ca href=\"https://withoutmedia.wordpress.com/\" target=\"_blank\">2010 study\u003c/a> by the International Center for Media and the Public Agenda at the University of Maryland showed how profound an existential dread engulfs people cut off from the online world. The researchers asked 200 students to abstain from using their phones and computers (and all other media) for 24 hours. Describing their experience, the students said they felt disconnected and anxious that they were missing out on something, using terms evoking compulsion: \u003cem>Frantically craving. Very anxious. Extremely antsy. Miserable. Jittery. Crazy.\u003c/em>\u003c/p>\n\u003cp>It’s worth reading some of their comments:“Texting and IM’ing my friends gives me a constant feeling of comfort … the fact that I was not able to communicate with anyone via technology was almost unbearable.”\u003c/p>\n\u003cp>“I feel so disconnected from all the people who I think are calling me, but really they aren’t half the time.”\u003c/p>\n\u003cp>“I couldn’t take it anymore being in my room … alone … with nothing to occupy my mind so I gave up.”\u003c/p>\n\u003cp>And if we do miss out? If we’re not connected? If existence is defined these days by an online presence, then not being online is not to exist. Human history knows no greater motivation for action than the existential one of raging against the dying of the light. When we are not online, when we are not connected, when we miss out, we do not exist, and that causes the most unbearable and existential anxiety there is.That is how we should understand the digital compulsion: not as a pathology, but as the result of the online world’s ability to tap into something deep in the human psyche and make many of us digital casualties.\u003c/p>\n\u003cp>\u003cem>This story was originally published by \u003ca href=\"https://www.statnews.com/2017/02/08/social-media-compulsion-mental-illness/\" target=\"_blank\">STAT\u003c/a>, an online publication of Boston Globe Media that covers health, medicine, and scientific discovery.\u003c/em>\u003c/p>\n\u003cp>\u003cem>It has been adapted from Sharon Begley’s book “\u003ca href=\"https://www.amazon.com/Cant-Just-Stop-Investigation-Compulsions/dp/1476725829\">Can’t. Just. Stop\u003c/a>.: An Investigation of Compulsions,” published by Simon & Schuster on Feb. 7.\u003c/em>\u003c/p>\n\u003cp>\u003cem>Sharon Begley can be reached at \u003ca href=\"mailto:sharon.begley@statnews.com\">sharon.begley@statnews.com\u003c/a>\u003c/em>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>Follow Sharon on Twitter \u003ca href=\"https://twitter.com/sxbegle\" target=\"_blank\">@sxbegle\u003c/a>\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>It was not psychiatry’s finest hour. Just over 20 years ago a psychotherapist claimed he had discovered a new mental illness, which he named Internet Abuse Disorder. He saw it all around him: people compulsively reading websites and sending email and feeling anxious if they couldn’t. Psychiatrists and laypeople alike flocked to a listserv to share their experience with this supposed affliction, and the American Psychiatric Association appointed a task force to explore whether there was sufficient evidence to support recognizing internet “abuse” as a mental disorder.\u003c/p>\n\u003caside class=\"pullquote alignright\">An existential dread engulfs some people who are cut off from the online world.\u003c/aside>\n\u003cp>Verdict: There wasn’t then and there isn’t now. Spending hours each day online via either mobile devices or the stationary kind is not a mental illness. In fact, the original proposal, by the late Dr. Ivan Goldberg, was meant as a joke.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>More than any other behavior that people engage in compulsively, the digital version — from checking Facebook to texting — shows that just because you’re compulsive about something doesn’t mean you have a broken brain. To the contrary. As with other compulsions that fall well short of pathology, the allure of being online sheds light on some of the mind’s most salient, and utterly normal, operations, according to the latest research. From our desire to connect to the way we respond to unpredictable rewards, our minds are wired in a way that lets digital technology sink its hooks into us.\u003c/p>\n\u003cp>First, a definition. A compulsive behavior is one that is repeated and chronic, and arises from a feeling of anxiety. Just as someone with obsessive-compulsive disorder (OCD) compulsively and repeatedly washes her hands, for instance, to alleviate the anxiety that comes from believing she is covered with germs, so mentally healthy people who behave compulsively are also driven by anxiety. (Checking one’s phone repeatedly is not considered a disorder, however, because the behavior is grounded in reality, not a delusion, and it usually doesn’t get in the way of living a normal life.)\u003c/p>\n\u003cp>Often, said Moez Limayem, of the University of South Florida, who led a \u003ca href=\"http://onlinelibrary.wiley.com/doi/10.1111/isj.12065/abstract\" target=\"_blank\">2015 study\u003c/a> on mobile use, “The underlying motivation to use a mobile phone is not pleasure,” but is instead “a response to heightened stress and anxiety.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Start with the fact that many of us feel anxious if we’re not making use of every tiny slice of time. The effort required for a single online “transaction” — a click, a view, checking Instagram or Facebook — is minuscule, so much so that not texting or reading your smartphone screen feels like a greater burden than doing so. “The timescale on which you work with online technology is central to making it compelling,” said psychologist Tom Stafford of the University of Sheffield in England. “What else can you do in five seconds that’s interesting? Why not check your phone?” This is a large part of why “using the internet can be compulsive,” he said.\u003c/p>\n\u003cp>One reason we often feel anxious if we’re not using every tiny slice of time is that we find it hard—even unpleasant and anxiety-producing to be alone with our thoughts, as a \u003ca href=\"http://science.sciencemag.org/content/345/6192/75\" target=\"_blank\">2014 study\u003c/a> showed. Researchers led by social psychologist Timothy Wilson of the University of Virginia gave volunteers two options: do “nothing” for 15 minutes or give themselves a small electric shock (which three-quarters had previously told the researchers they’d pay money not to experience). Two-thirds of the men and one-quarter of the women chose the latter, so anxious were they for “something to do.”\u003c/p>\n\u003cp>“The untutored mind does not like to be alone with itself,” Wilson concluded.\u003c/p>\n\u003cp>Especially when the mind encounters payoffs structured like a slot machine’s. Like those one-armed bandits, the digital world offers what are called intermittent/variable rewards: An action — pulling the slot machine’s arm, checking for texts — can bring either a payoff or nothing. Most of what fills your Twitter feed or Facebook updates is digital dross. (“Barbara changed her Facebook picture!”) Payoff: zero. But every so often, you find a gem — a friend offering Bruce Springsteen tickets, an acquaintance posting a link to the morning’s must-read Trump story.\u003c/p>\n\u003cp>“If I give you a treat sometimes, you have to keep checking all the time: You don’t know when it will come,” said Stafford. “No matter how frequently you check, even if you checked only a second ago, a brilliant email might have just come in. You feel anxiety about possibly missing something.” Such low-cost, occasionally high-reward activities are catnip to the brain.\u003c/p>\n\u003cp>If we’re prevented from compulsively checking for texts, the anxiety that the compulsive behavior alleviates comes roaring back. Psychologists have found that people who are separated from their smartphone experience an elevated heart rate and other signs of anxiety.\u003c/p>\n\u003cp>In one \u003ca href=\"http://www.sciencedirect.com/science/article/pii/S0747563215303332\" target=\"_blank\">2016 study\u003c/a>, volunteers who filled out a standard questionnaire about their smartphone use and emotions told researchers that they turn to their phones “to avoid negative experiences or feelings” and “to cope [with] or escape from feelings related to an anxiety-inducing situation.” Psychologist Alejandro Lleras, of the University of Illinois at Urbana-Champaign, who led the study, described it as a security-blanket effect, absorbing our bubbling-over anxiety.\u003c/p>\n\u003cp>That fits with studies finding that people text as a way to escape anxiety; something like 70 percent of study participants say smartphones and texting help them overcome anxiety and other negative moods. It’s become a stereotype that people in awkward (read: anxiety-provoking) situations “turn to their mobile phones as a way to disengage,” the Illinois researchers wrote, especially “during times of more intense distress.”\u003c/p>\n\u003cp>Lleras and a colleague gave volunteers a short writing assignment that, they explained (falsely), would be evaluated by two experts. To ratchet up the stress further, the researchers said the experts would also interview them about their essay. While waiting for that, half the volunteers had access to their mobile phones and half didn’t. Among those who were able to text and surf to their anxiety-ridden-heart’s content, half felt intense anxiety. In comparison, three-quarters of those who were deprived of their phones did, the researchers reported.\u003c/p>\n\u003cp>By giving in to a compulsion to use their phone, many of the study volunteers were able to defuse much of their anxiety. “People seem to be less vulnerable to becoming stressed in anxiety-provoking situations when they have access” to their mobile phone, the researchers wrote.\u003c/p>\n\u003cp>It’s not only being deprived of those variable-interval rewards that makes ditching their smartphone unthinkable for many people. Because it has become our main connection to other people and the world at large, the anxiety that comes from not being able to check it arises, too, from the feeling of missing something, as if everyone else is plugged in, connected, on top of things, and you aren’t.\u003c/p>\n\u003cp>“There are people who feel, if I’m not there, if I’m not on that site, I’m missing something — something about my friends, or my health, or anything else,” said psychiatrist Dr. David Reiss, who practices in San Diego.\u003c/p>\n\u003cp>The internet exploits this FOMO, or fear of missing out. Being disconnected is synonymous with missing out.\u003c/p>\n\u003cp>By making us feel we are always connected to the world, smartphones also alleviate the anxiety that otherwise floods into us from feeling alone and untethered. A character in the 2014 New York City production of Laura Eason’s play “Sex with Strangers,” learning there’s no cellphone service at a bed-and-breakfast, says, “People will think I’m dead.” People don’t like feeling dead.\u003c/p>\n\u003cp>A \u003ca href=\"https://withoutmedia.wordpress.com/\" target=\"_blank\">2010 study\u003c/a> by the International Center for Media and the Public Agenda at the University of Maryland showed how profound an existential dread engulfs people cut off from the online world. The researchers asked 200 students to abstain from using their phones and computers (and all other media) for 24 hours. Describing their experience, the students said they felt disconnected and anxious that they were missing out on something, using terms evoking compulsion: \u003cem>Frantically craving. Very anxious. Extremely antsy. Miserable. Jittery. Crazy.\u003c/em>\u003c/p>\n\u003cp>It’s worth reading some of their comments:“Texting and IM’ing my friends gives me a constant feeling of comfort … the fact that I was not able to communicate with anyone via technology was almost unbearable.”\u003c/p>\n\u003cp>“I feel so disconnected from all the people who I think are calling me, but really they aren’t half the time.”\u003c/p>\n\u003cp>“I couldn’t take it anymore being in my room … alone … with nothing to occupy my mind so I gave up.”\u003c/p>\n\u003cp>And if we do miss out? If we’re not connected? If existence is defined these days by an online presence, then not being online is not to exist. Human history knows no greater motivation for action than the existential one of raging against the dying of the light. When we are not online, when we are not connected, when we miss out, we do not exist, and that causes the most unbearable and existential anxiety there is.That is how we should understand the digital compulsion: not as a pathology, but as the result of the online world’s ability to tap into something deep in the human psyche and make many of us digital casualties.\u003c/p>\n\u003cp>\u003cem>This story was originally published by \u003ca href=\"https://www.statnews.com/2017/02/08/social-media-compulsion-mental-illness/\" target=\"_blank\">STAT\u003c/a>, an online publication of Boston Globe Media that covers health, medicine, and scientific discovery.\u003c/em>\u003c/p>\n\u003cp>\u003cem>It has been adapted from Sharon Begley’s book “\u003ca href=\"https://www.amazon.com/Cant-Just-Stop-Investigation-Compulsions/dp/1476725829\">Can’t. Just. Stop\u003c/a>.: An Investigation of Compulsions,” published by Simon & Schuster on Feb. 7.\u003c/em>\u003c/p>\n\u003cp>\u003cem>Sharon Begley can be reached at \u003ca href=\"mailto:sharon.begley@statnews.com\">sharon.begley@statnews.com\u003c/a>\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>The U.S. patent office has delivered a potentially lucrative victory to bioengineer \u003ca href=\"https://www.broadinstitute.org/zhang-lab\">Feng Zhang\u003c/a> of the Broad Institute in Massachusetts, regarding patents for an extraordinarily useful gene-editing tool.\u003c/p>\n\u003cp>\u003ca href=\"http://www.npr.org/tags/419142387/crispr\">CRISPR\u003c/a>, a technology that's already worth billions of dollars, is shaping up to play a big role in medicine and medical research because it can edit DNA with unprecedented accuracy. But exactly who has the right to profit from the technology has been up for debate.\u003c/p>\n\u003cp>Wednesday the U.S. Patent and Trademark Office said patents issued to the Broad Institute in 2014, and then challenged by the University of California, Berkeley, are in fact valid.\u003c/p>\n\u003cp>\"It's a pretty monumental decision here,\" said \u003ca href=\"http://www.nyls.edu/faculty/faculty-profiles/faculty_profiles/jacob-s-sherkow/\">Jacob Sherkow\u003c/a>, an associate professor at the New York Law School, who has been tracking the dispute closely.\u003c/p>\n\u003cp>\"It seems to reward the most valuable aspect of CRISPR to the Broad Institute,\" Sherkow told Shots.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The proceedings aren't entirely settled, but as Sherkow sees the situation, the Broad Institute — a joint venture of Harvard University and MIT — will hold the patent for using CRISPR in human beings, other animals, and plants. Sherkow told Shots he believes Cal's patent, which has not yet been issued, could be limited to bacteria.\u003c/p>\n\u003cp>\"Obviously the patents covering the application of this technology in human cells ... are going to be much more financially valuable than using the same technology in bacteria,\" Sherkow says, \"because one can develop drugs and other therapies from them.\"\u003c/p>\n\u003cp>Investors Wednesday seemed to agree with this assessment. The value of companies that were spun off to license the Broad patents rose sharply, while the company based on the Berkeley patent lost value.\u003c/p>\n\u003cp>Potentially, tens of billions of dollars are at stake here, both for the companies and for the universities.\u003c/p>\n\u003cp>Biochemist \u003ca href=\"https://www.hhmi.org/scientists/jennifer-doudna\">Jennifer Doudna\u003c/a>, of U.C. Berkeley and the Howard Hughes Medical Institute, discovered the biology that underlies this technology along with a European colleague, \u003ca href=\"https://www.mpg.de/9343753/infektionsbiologie-charpentier\">Emmanuelle Charpentier\u003c/a>, who is now director of the Institute for Infection Biology at the Max Planck Institute in Berlin.\u003c/p>\n\u003cp>Doudna told Shots she isn't convinced that Berkeley is the big loser here. She said the ruling paves the way for her patent application to move forward.\u003c/p>\n\u003cp>\"We're looking forward to having our patent issued,\" she said. \"And our patent is a very broad patent that covers the composition and the use of this technology in all cell types.\"\u003c/p>\n\u003cp>If the patent office rules the way Doudna hopes it will, people wanting to use CRISPR in higher organisms will have get licenses from both Berkeley and the Broad Institute.\u003c/p>\n\u003cp>\"That's the thing that I think is a bit crazy about the way the decision comes down,\" Doudna said. \"It leaves the field — the situation — where a license would be necessary from both parties. There's not further clarity at this stage.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>There's yet another possibility: Berkeley could appeal Wednesday's ruling, and once again challenge the Broad Institute's patents. Doudna said the university hasn't decided what to do just yet.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Broad+Institute+Wins+Big+Battle+Over+CRISPR+Gene-Editing+Patent&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"excerpt": "CRISPR technology is already worth billions of dollars, investors say. This ruling seems to affirm the biggest piece of the pie goes to the Broad, over patent rival University of California, Berkeley.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The U.S. patent office has delivered a potentially lucrative victory to bioengineer \u003ca href=\"https://www.broadinstitute.org/zhang-lab\">Feng Zhang\u003c/a> of the Broad Institute in Massachusetts, regarding patents for an extraordinarily useful gene-editing tool.\u003c/p>\n\u003cp>\u003ca href=\"http://www.npr.org/tags/419142387/crispr\">CRISPR\u003c/a>, a technology that's already worth billions of dollars, is shaping up to play a big role in medicine and medical research because it can edit DNA with unprecedented accuracy. But exactly who has the right to profit from the technology has been up for debate.\u003c/p>\n\u003cp>Wednesday the U.S. Patent and Trademark Office said patents issued to the Broad Institute in 2014, and then challenged by the University of California, Berkeley, are in fact valid.\u003c/p>\n\u003cp>\"It's a pretty monumental decision here,\" said \u003ca href=\"http://www.nyls.edu/faculty/faculty-profiles/faculty_profiles/jacob-s-sherkow/\">Jacob Sherkow\u003c/a>, an associate professor at the New York Law School, who has been tracking the dispute closely.\u003c/p>\n\u003cp>\"It seems to reward the most valuable aspect of CRISPR to the Broad Institute,\" Sherkow told Shots.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The proceedings aren't entirely settled, but as Sherkow sees the situation, the Broad Institute — a joint venture of Harvard University and MIT — will hold the patent for using CRISPR in human beings, other animals, and plants. Sherkow told Shots he believes Cal's patent, which has not yet been issued, could be limited to bacteria.\u003c/p>\n\u003cp>\"Obviously the patents covering the application of this technology in human cells ... are going to be much more financially valuable than using the same technology in bacteria,\" Sherkow says, \"because one can develop drugs and other therapies from them.\"\u003c/p>\n\u003cp>Investors Wednesday seemed to agree with this assessment. The value of companies that were spun off to license the Broad patents rose sharply, while the company based on the Berkeley patent lost value.\u003c/p>\n\u003cp>Potentially, tens of billions of dollars are at stake here, both for the companies and for the universities.\u003c/p>\n\u003cp>Biochemist \u003ca href=\"https://www.hhmi.org/scientists/jennifer-doudna\">Jennifer Doudna\u003c/a>, of U.C. Berkeley and the Howard Hughes Medical Institute, discovered the biology that underlies this technology along with a European colleague, \u003ca href=\"https://www.mpg.de/9343753/infektionsbiologie-charpentier\">Emmanuelle Charpentier\u003c/a>, who is now director of the Institute for Infection Biology at the Max Planck Institute in Berlin.\u003c/p>\n\u003cp>Doudna told Shots she isn't convinced that Berkeley is the big loser here. She said the ruling paves the way for her patent application to move forward.\u003c/p>\n\u003cp>\"We're looking forward to having our patent issued,\" she said. \"And our patent is a very broad patent that covers the composition and the use of this technology in all cell types.\"\u003c/p>\n\u003cp>If the patent office rules the way Doudna hopes it will, people wanting to use CRISPR in higher organisms will have get licenses from both Berkeley and the Broad Institute.\u003c/p>\n\u003cp>\"That's the thing that I think is a bit crazy about the way the decision comes down,\" Doudna said. \"It leaves the field — the situation — where a license would be necessary from both parties. There's not further clarity at this stage.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>There's yet another possibility: Berkeley could appeal Wednesday's ruling, and once again challenge the Broad Institute's patents. Doudna said the university hasn't decided what to do just yet.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Broad+Institute+Wins+Big+Battle+Over+CRISPR+Gene-Editing+Patent&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>You’ve heard it many times before from your doctor: If you’re taking antibiotics, don’t stop taking them until the pill vial is empty, even if you feel better.\u003c/p>\n\u003caside class=\"pullquote alignright\">‘An argument can be made for stopping a course of antibiotics immediately after a bacterial infection has been ruled out … or when the signs and symptoms of a mild infection have disappeared.’\u003ccite>From a World Health Organization report\u003c/cite>\u003c/aside>\n\u003cp>The rationale behind this commandment has always been that stopping treatment too soon would fuel the development of antibiotic resistance—the ability of bugs to evade these drugs. Information campaigns aimed at getting the public to take antibiotics properly have been driving home this message for decades.\u003c/p>\n\u003cp>But the warning, a growing number of experts say, is misguided and may actually be exacerbating antibiotic resistance.\u003c/p>\n\u003cp>The reasoning is simple: Exposure to antibiotics is what drives bacteria to develop resistance. Taking drugs when you aren’t sick anymore simply gives the hordes of bacteria in and on your body more incentive to evolve to evade the drugs, so the next time you have an infection, they may not work.\u003c/p>\n\u003cp>The traditional reasoning from doctors “never made any sense. It doesn’t make any sense today,” Dr. Louis Rice, chairman of the department of medicine at the Warren Alpert Medical School at Brown University, told STAT.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Some colleagues credit Rice with being the first person to declare the emperor was wearing no clothes, and it is true that he challenged the dogma in lectures at major meetings of infectious diseases physicians and researchers in 2007 and 2008. A number of researchers now share his skepticism of health guidance that has been previously universally accepted.\u003c/p>\n\u003cp>The question of whether this advice is still appropriate will be raised at a World Health Organization meeting next month in Geneva. A report prepared for that meeting—the agency’s expert committee on the selection and use of essential medicine—already notes that the recommendation isn’t backed by science.\u003c/p>\n\u003cp>In many cases “an argument can be made for stopping a course of antibiotics immediately after a bacterial infection has been ruled out … or when the signs and symptoms of a mild infection have disappeared,” suggests the report, which analyzed information campaigns designed to get the public on board with efforts to fight antibiotic resistance.\u003c/p>\n\u003cp>No one is doubting the lifesaving importance of antibiotics. They kill bacteria. But the more the bugs are exposed to the drugs, the more survival tricks the bacteria acquire. And the more resistant the bacteria become, the harder they are to treat.\u003c/p>\n\u003cp>The concern is that the growing number of bacteria that are resistant to multiple antibiotics will lead to more incurable infections that will threaten medicine’s ability to conduct routine procedures like hip replacements or open heart surgery without endangering lives.\u003c/p>\n\u003cp>So how did this faulty paradigm become entrenched in medical practice? The answer lies back in the 1940s, the dawn of antibiotic use.\u003c/p>\n\u003cp>At the time, resistance wasn’t a concern. After the first antibiotic, penicillin, was discovered, more and more gushed out of the pharmaceutical product pipeline.\u003c/p>\n\u003cp>Doctors were focused only on figuring out how to use the drugs effectively to save lives. An ethos emerged: Treat patients until they get better, and then for a little bit longer to be on the safe side. Around the same time, research on how to cure tuberculosis suggested that under-dosing patients was dangerous—the infection would come back.\u003c/p>\n\u003cp>The idea that stopping antibiotic treatment too quickly after symptoms went away might fuel resistance took hold.\u003c/p>\n\u003cp>“The problem is once it gets baked into culture, it’s really hard to excise it,” said Dr. Brad Spellberg, who is also an advocate for changing this advice. Spellberg is an infectious diseases specialist and chief medical officer at the Los Angeles County-University of Southern California Medical Center in Los Angeles.\u003c/p>\n\u003cp>We think of medicine as a science, guided by mountains of research. But doctors sometimes prescribe antibiotics based more on their experience and intuition than anything else. There are treatment guidelines for different infections, but some provide scant advice on how long to continue treatment, Rice acknowledged. And response to treatment will differ from patient to patient, depending on, among other things, how old they are, how strong their immune systems are, or how well they metabolize drugs.\u003c/p>\n\u003cp>There’s little incentive for pharmaceutical companies to conduct expensive studies aimed at finding the shortest duration of treatment for various conditions. But in the years since Rice first raised his concerns, the National Institutes of Health has been funding such research and almost invariably the ensuing studies have found that many infections can be cured more quickly than had been thought. Treatments that were once two weeks have been cut to one, 10 days have been reduced to seven and so on.\u003c/p>\n\u003cp>There have been occasional exceptions. Just before Christmas, scientists at the University of Pittsburgh reported that 10 days of treatment for otitis media—middle ear infections—was better than five days for children under 2 years of age.\u003c/p>\n\u003cp>It was a surprise, said Spellberg, who noted that studies looking at the same condition in children 2 and older show the shorter treatment works.\u003c/p>\n\u003cp>More of this work is needed, Rice said. “I’m not here saying that every infection can be treated for two days or three days. I’m just saying: Let’s figure it out.”\u003c/p>\n\u003cp>In the meantime, doctors and public health agencies are in a quandary. How do you put the new thinking into practice? And how do you advise the public? Doctors know full well some portion of people unilaterally decide to stop taking their antibiotics because they feel better. But that approach is not safe in all circumstances—for instance tuberculosis or bone infections. And it’s not an approach many physicians feel comfortable endorsing.\u003c/p>\n\u003cp>“This is a very tricky question. It’s not easy to make a blanket statement about this, and there isn’t a simple answer,” Dr. Lauri Hicks, director of the Centers for Disease Control and Prevention’s office of antibiotic stewardship, told STAT in an email.\u003c/p>\n\u003cp>“There are certain diagnoses for which shortening the course of antibiotic therapy is not recommended and/or potentially dangerous. … On the other hand, there are probably many situations for which antibiotic therapy is often prescribed for longer than necessary and the optimal duration is likely ‘until the patient gets better.’”\u003c/p>\n\u003cp>CDC’S Get Smart campaign, on appropriate antibiotic use, urges people never to skip doses or stop the drugs because they’re feeling better. But Hicks noted the CDC recently revised it to add “unless your healthcare professional tells you to do so” to that advice.\u003c/p>\n\u003cp>And that’s one way to deal with the situation, said Dr. James Johnson, a professor of infectious diseases medicine at the University of Minnesota and a specialist at the Minnesota VA Medical Center.\u003c/p>\n\u003cp>“In fact sometimes some of us give that instruction to patients. ‘Here, I’m going to prescribe you a week. My guess is you won’t need it more than, say, three days. If you’re all well in three days, stop then. If you’re not completely well, take it a little longer. But as soon as you feel fine, stop.’ And we can give them permission to do that.”\u003c/p>\n\u003cp>Spellberg is more comfortable with the idea of people checking back with their doctor before stopping their drugs — an approach that requires doctors to be willing to have that conversation. “You should call your doc and say ‘Hey, can I stop?’ … If your doctor won’t get on the phone with you for 20 seconds, you need to find another doctor.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This \u003ca href=\"https://www.statnews.com/2017/02/09/antibiotics-resistance-superbugs/\" target=\"_blank\" rel=\"noopener\">story\u003c/a> was originally published by STAT, an online publication of Boston Globe Media that covers health, medicine, and scientific discovery.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>You’ve heard it many times before from your doctor: If you’re taking antibiotics, don’t stop taking them until the pill vial is empty, even if you feel better.\u003c/p>\n\u003caside class=\"pullquote alignright\">‘An argument can be made for stopping a course of antibiotics immediately after a bacterial infection has been ruled out … or when the signs and symptoms of a mild infection have disappeared.’\u003ccite>From a World Health Organization report\u003c/cite>\u003c/aside>\n\u003cp>The rationale behind this commandment has always been that stopping treatment too soon would fuel the development of antibiotic resistance—the ability of bugs to evade these drugs. Information campaigns aimed at getting the public to take antibiotics properly have been driving home this message for decades.\u003c/p>\n\u003cp>But the warning, a growing number of experts say, is misguided and may actually be exacerbating antibiotic resistance.\u003c/p>\n\u003cp>The reasoning is simple: Exposure to antibiotics is what drives bacteria to develop resistance. Taking drugs when you aren’t sick anymore simply gives the hordes of bacteria in and on your body more incentive to evolve to evade the drugs, so the next time you have an infection, they may not work.\u003c/p>\n\u003cp>The traditional reasoning from doctors “never made any sense. It doesn’t make any sense today,” Dr. Louis Rice, chairman of the department of medicine at the Warren Alpert Medical School at Brown University, told STAT.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Some colleagues credit Rice with being the first person to declare the emperor was wearing no clothes, and it is true that he challenged the dogma in lectures at major meetings of infectious diseases physicians and researchers in 2007 and 2008. A number of researchers now share his skepticism of health guidance that has been previously universally accepted.\u003c/p>\n\u003cp>The question of whether this advice is still appropriate will be raised at a World Health Organization meeting next month in Geneva. A report prepared for that meeting—the agency’s expert committee on the selection and use of essential medicine—already notes that the recommendation isn’t backed by science.\u003c/p>\n\u003cp>In many cases “an argument can be made for stopping a course of antibiotics immediately after a bacterial infection has been ruled out … or when the signs and symptoms of a mild infection have disappeared,” suggests the report, which analyzed information campaigns designed to get the public on board with efforts to fight antibiotic resistance.\u003c/p>\n\u003cp>No one is doubting the lifesaving importance of antibiotics. They kill bacteria. But the more the bugs are exposed to the drugs, the more survival tricks the bacteria acquire. And the more resistant the bacteria become, the harder they are to treat.\u003c/p>\n\u003cp>The concern is that the growing number of bacteria that are resistant to multiple antibiotics will lead to more incurable infections that will threaten medicine’s ability to conduct routine procedures like hip replacements or open heart surgery without endangering lives.\u003c/p>\n\u003cp>So how did this faulty paradigm become entrenched in medical practice? The answer lies back in the 1940s, the dawn of antibiotic use.\u003c/p>\n\u003cp>At the time, resistance wasn’t a concern. After the first antibiotic, penicillin, was discovered, more and more gushed out of the pharmaceutical product pipeline.\u003c/p>\n\u003cp>Doctors were focused only on figuring out how to use the drugs effectively to save lives. An ethos emerged: Treat patients until they get better, and then for a little bit longer to be on the safe side. Around the same time, research on how to cure tuberculosis suggested that under-dosing patients was dangerous—the infection would come back.\u003c/p>\n\u003cp>The idea that stopping antibiotic treatment too quickly after symptoms went away might fuel resistance took hold.\u003c/p>\n\u003cp>“The problem is once it gets baked into culture, it’s really hard to excise it,” said Dr. Brad Spellberg, who is also an advocate for changing this advice. Spellberg is an infectious diseases specialist and chief medical officer at the Los Angeles County-University of Southern California Medical Center in Los Angeles.\u003c/p>\n\u003cp>We think of medicine as a science, guided by mountains of research. But doctors sometimes prescribe antibiotics based more on their experience and intuition than anything else. There are treatment guidelines for different infections, but some provide scant advice on how long to continue treatment, Rice acknowledged. And response to treatment will differ from patient to patient, depending on, among other things, how old they are, how strong their immune systems are, or how well they metabolize drugs.\u003c/p>\n\u003cp>There’s little incentive for pharmaceutical companies to conduct expensive studies aimed at finding the shortest duration of treatment for various conditions. But in the years since Rice first raised his concerns, the National Institutes of Health has been funding such research and almost invariably the ensuing studies have found that many infections can be cured more quickly than had been thought. Treatments that were once two weeks have been cut to one, 10 days have been reduced to seven and so on.\u003c/p>\n\u003cp>There have been occasional exceptions. Just before Christmas, scientists at the University of Pittsburgh reported that 10 days of treatment for otitis media—middle ear infections—was better than five days for children under 2 years of age.\u003c/p>\n\u003cp>It was a surprise, said Spellberg, who noted that studies looking at the same condition in children 2 and older show the shorter treatment works.\u003c/p>\n\u003cp>More of this work is needed, Rice said. “I’m not here saying that every infection can be treated for two days or three days. I’m just saying: Let’s figure it out.”\u003c/p>\n\u003cp>In the meantime, doctors and public health agencies are in a quandary. How do you put the new thinking into practice? And how do you advise the public? Doctors know full well some portion of people unilaterally decide to stop taking their antibiotics because they feel better. But that approach is not safe in all circumstances—for instance tuberculosis or bone infections. And it’s not an approach many physicians feel comfortable endorsing.\u003c/p>\n\u003cp>“This is a very tricky question. It’s not easy to make a blanket statement about this, and there isn’t a simple answer,” Dr. Lauri Hicks, director of the Centers for Disease Control and Prevention’s office of antibiotic stewardship, told STAT in an email.\u003c/p>\n\u003cp>“There are certain diagnoses for which shortening the course of antibiotic therapy is not recommended and/or potentially dangerous. … On the other hand, there are probably many situations for which antibiotic therapy is often prescribed for longer than necessary and the optimal duration is likely ‘until the patient gets better.’”\u003c/p>\n\u003cp>CDC’S Get Smart campaign, on appropriate antibiotic use, urges people never to skip doses or stop the drugs because they’re feeling better. But Hicks noted the CDC recently revised it to add “unless your healthcare professional tells you to do so” to that advice.\u003c/p>\n\u003cp>And that’s one way to deal with the situation, said Dr. James Johnson, a professor of infectious diseases medicine at the University of Minnesota and a specialist at the Minnesota VA Medical Center.\u003c/p>\n\u003cp>“In fact sometimes some of us give that instruction to patients. ‘Here, I’m going to prescribe you a week. My guess is you won’t need it more than, say, three days. If you’re all well in three days, stop then. If you’re not completely well, take it a little longer. But as soon as you feel fine, stop.’ And we can give them permission to do that.”\u003c/p>\n\u003cp>Spellberg is more comfortable with the idea of people checking back with their doctor before stopping their drugs — an approach that requires doctors to be willing to have that conversation. “You should call your doc and say ‘Hey, can I stop?’ … If your doctor won’t get on the phone with you for 20 seconds, you need to find another doctor.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>This \u003ca href=\"https://www.statnews.com/2017/02/09/antibiotics-resistance-superbugs/\" target=\"_blank\" rel=\"noopener\">story\u003c/a> was originally published by STAT, an online publication of Boston Globe Media that covers health, medicine, and scientific discovery.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "What Will Next-Stage Digital Medicine Look Like?",
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"content": "\u003cp>On the health tech beat, you often meet, broadly, two types of people. First, there are lots of very smart people who think we have the know-how to achieve a kind of big-data, perpetual-monitoring, digital-health paradise -- or at least something better than we have now.\u003c/p>\n\u003cp>Then there are some other, equally smart folks who think that particular vision is fueled by too much Silicon Valley dreamin' and too little attention to the basics of health care access and smart policy.\u003c/p>\n\u003cp>Dr. Daniel Kraft is closer to the former category. Dr. Kraft put in an \u003ca href=\"https://ww2.kqed.org/forum/2017/01/24/first-person-daniel-kraft-on-the-next-stage-of-medical-technology/\" target=\"_blank\">appearance\u003c/a> on KQED's Forum radio program recently to discuss cutting edge health tech. Kraft is the chair of medicine at Singularity University, a technology think tank, \u003ca href=\"https://techcrunch.com/2015/09/30/singularity-university-launches-accelerator/\" target=\"_blank\">startup accelerator\u003c/a> and educational organization that looks to \"leverage rapidly accelerating technologies\" to find solutions on a global scale.\u003c/p>\n\u003cp>Kraft and Forum host Michael Krasny talked about the effects of new and prospective technologies, from virtual reality's impact on medical education to the \"Uberization\" of health care. Below are excerpts of Kraft's answers, edited for length and clarity.\u003c/p>\n\u003cp>\u003cstrong>The Uberization of Health Care\u003c/strong>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Everyone is familiar with \u003ca href=\"https://ww2.kqed.org/news/tag/uber/\" target=\"_blank\">Uber as disruptive\u003c/a>. But they couldn’t have existed 10-plus years ago, without smartphones, GPS, online payments--they connected the dots.\u003c/p>\n\u003cp>We all want that ease and transparency of use that we’re used to with Uber. And we’re seeing that kind of mindset come not just to millennials but to \u003ca href=\"https://www.google.com/search?q=senior+citizens+digital+health+care\" target=\"_blank\">older folks\u003c/a> who want access to their clinical data and doctor. There are several companies that have launched apps where you press a button and a doctor will come to you within three hours. Uber itself did a pilot in New York where you press a button and a nurse will come and \u003ca href=\"http://fortune.com/2016/10/25/uber-free-flu-shots/\" target=\"_blank\">give you\u003c/a> a flu shot. This ease-of-access mindset is coming across in many parts of health care, including \u003ca href=\"http://www.cnbc.com/2016/05/16/digital-focused-pharmacy-capsule-opens-in-new-york.html\" target=\"_blank\">delivering your drugs\u003c/a>, whether it's by Uber, Lyft or drone.\u003c/p>\n\u003cp>\u003cstrong>The Potential of Digital Health Data\u003c/strong>\u003c/p>\n\u003cp>We’re in this age of exponential data, but how do you make it useful to you as a consumer, patient and physician? A lot of digital devices get \u003ca href=\"https://ww2.kqed.org/futureofyou/2016/10/10/fitbit-study/\" target=\"_blank\">left in a drawer\u003c/a> after a month or so; the trick is to make them engaging.\u003c/p>\n\u003cp>We practice sick care today, spending most of our time and money on folks who already have disease. But we can really move to more proactive, continuous health care using some of these tools.\u003c/p>\n\u003cp>In the future we’ll have individualized check engine lights. Your information will be synthesized so that a warning light can say, \"Hey, time to come in for a checkup before you blow a gasket.\"\u003c/p>\n\u003cp>\u003cstrong>Digital Mental Health Tools\u003c/strong>\u003c/p>\n\u003cp>With some wearables and other technologies we can now get a pulse on our behaviors. Right now I’m wearing a couple of devices that \u003ca href=\"http://sleepjunkies.com/features/the-ultimate-guide-to-sleep-tracking/\" target=\"_blank\">track my sleep\u003c/a>. I have a ring that can do this; I have a sensor on my mattress. Just getting insight into how you sleep can have a huge impact on health and wellness over the long term.\u003c/p>\n\u003cp>It’s the same thing for depression and anxiety. We’re seeing companies that can be a platform for mental health progression. For example, for bipolar patients, if you’re depressed and not moving much and staying in the house, some of these \u003ca href=\"http://www.nature.com/news/mental-health-there-s-an-app-for-that-1.19694\">new platforms\u003c/a> allow you to access your care team and your family, so you can get a digital hug when you might need one.\u003c/p>\n\u003cp>\u003cstrong>Virtual and Augmented Reality\u003c/strong>\u003c/p>\n\u003cp>Physicians today spend twice as much time typing in their medical records than they do with patients. So one of the best applications is using Google Glass or a similar product so physicians can see their patients and view data but have someone else act as a virtual \u003ca href=\"http://www.healthcare-informatics.com/article/ehr/how-virtual-scribe-enhancing-doctor-patient-relationship\" target=\"_blank\">scribe\u003c/a>.\u003c/p>\n\u003cp>We’re seeing now how Oculus Rift can help medical students \u003ca href=\"http://www.roadtovr.com/vr-human-anatomy-to-give-medical-students-a-hands-on-using-oculus-touch/\" target=\"_blank\">learn anatomy\u003c/a>, allowing them to fly through the heart or the brain. We’re seeing ways to use VR to \u003ca href=\"https://ww2.kqed.org/futureofyou/2015/05/28/how-virtual-reality-worlds-can-help-reduce-pain/\" target=\"_blank\">treat burn patients\u003c/a> who have undergone painful surgeries; they're put into a cold environment where they get to throw snowballs, and it diminishes their pain and their need for opiates. And kids with autism can now \u003ca href=\"https://ww2.kqed.org/futureofyou/2016/04/08/google-glass-flopped-but-kids-with-autism-are-using-it-to-learn-emotions/\" target=\"_blank\">put on Google Glass\u003c/a> and learn to recognize facial emotions.\u003c/p>\n\u003cp>\u003cstrong>Health Screening Tools\u003c/strong>\u003c/p>\n\u003cp>Part of the future will be to use new screening tools: app-based eye-tracking devices, blood-based diagnostics, brain scans that might pick up dementia 10 or 15 years early. There are drugs in development that might stop or reverse plaques when you’re at stage 0, before you have symptoms.\u003c/p>\n\u003cp>Even with your 23andme data, primary care doctors could gain some insights--when to screen you or \u003ca href=\"http://www.npr.org/sections/health-shots/2015/09/01/436584534/are-statins-bad-for-me-personalized-medicine-cant-yet-say\" target=\"_blank\">what statin drugs\u003c/a> may work best for you, based on your \u003ca href=\"https://ghr.nlm.nih.gov/primer/genomicresearch/pharmacogenomics\" target=\"_blank\">pharmacogenomics\u003c/a>. The challenge is a lot of this information doesn’t flow to your physicians; they’re not incentivized to use it, and in some cases they're dis-incentivized.\u003c/p>\n\u003cp>\u003cstrong>Health Care vs. Technology Care\u003c/strong>\u003c/p>\n\u003cp>Folks talk about robot physicians or the app \u003ca href=\"https://ww2.kqed.org/futureofyou/2016/11/07/AI-computers-diagnosis-watson/\" target=\"_blank\">taking over\u003c/a> your medical care. I think it’s going to be more of a blend, not just AI but IA, intelligence augmentation. So in fields like \u003ca href=\"https://ww2.kqed.org/futureofyou/2016/10/25/technology-radiology/\" target=\"_blank\">radiology\u003c/a> or dermatology or pathology, where clinicians are trained to see patterns, now machine learning can arguably do that faster and better, and that can augment a primary care doctor in screening you for melanoma, for example.\u003c/p>\n\u003cp>We’re seeing the ability to do triage with \u003ca href=\"http://www.theverge.com/2016/10/11/13240434/baidu-medical-chatbot-china-melody\" target=\"_blank\">chatbots\u003c/a>, which you might access from your phone and help you do the first steps. I’ve got a few \u003ca href=\"http://tricorder.xprize.org/teams/final-frontier-medical-devices\" target=\"_blank\">medical tricorders\u003c/a>, inspired by \"Star Trek,\" with me. So at home or in your pocket you can literally pull down advanced vital signs that synch up with your phone and connect to your clinicians, and AI agents can help you understand where you are in your baseline and the way things are moving.\u003c/p>\n\u003cp>We don’t need to replace doctors, but maybe every visit \u003ca href=\"https://ww2.kqed.org/futureofyou/2016/02/03/virtual_care_clinic_usc/\" target=\"_blank\">doesn’t need\u003c/a> to require you to take off half a day of work, sit in the waiting room and fill out the same form. You might use your smartphone for a follow-up appointment to look at a wound from surgery, or to check on a suspicious skin lesion. As cost pressures go, we’ll be seeing more and more payment for some of these \u003ca href=\"http://www.huffingtonpost.ca/jacki-andre/health-care-telemedicine_b_14632688.html\" target=\"_blank\">telehealth\u003c/a> platforms.\u003c/p>\n\u003cp>\u003cstrong>Pediatrics and Technology \u003c/strong>\u003c/p>\n\u003cp>There's a lot of new tech coming for pregnant women and children. A connected otoscope can enable you to track kids with ear infections at home, so you don't have to drag them back to the doctor. We’re seeing sensored cribs or infant ankle bracelets, sort of a Fitbit for babies, which can help reassure worried parents or enable a physician to send a child home earlier when they're at risk of SIDS or asthma.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>More on \u003ca href=\"https://su.org/\" target=\"_blank\">Singularity University\u003c/a> and what it calls \u003ca href=\"https://exponential.singularityu.org/medicine/\" target=\"_blank\">exponential medicine here\u003c/a>.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>On the health tech beat, you often meet, broadly, two types of people. First, there are lots of very smart people who think we have the know-how to achieve a kind of big-data, perpetual-monitoring, digital-health paradise -- or at least something better than we have now.\u003c/p>\n\u003cp>Then there are some other, equally smart folks who think that particular vision is fueled by too much Silicon Valley dreamin' and too little attention to the basics of health care access and smart policy.\u003c/p>\n\u003cp>Dr. Daniel Kraft is closer to the former category. Dr. Kraft put in an \u003ca href=\"https://ww2.kqed.org/forum/2017/01/24/first-person-daniel-kraft-on-the-next-stage-of-medical-technology/\" target=\"_blank\">appearance\u003c/a> on KQED's Forum radio program recently to discuss cutting edge health tech. Kraft is the chair of medicine at Singularity University, a technology think tank, \u003ca href=\"https://techcrunch.com/2015/09/30/singularity-university-launches-accelerator/\" target=\"_blank\">startup accelerator\u003c/a> and educational organization that looks to \"leverage rapidly accelerating technologies\" to find solutions on a global scale.\u003c/p>\n\u003cp>Kraft and Forum host Michael Krasny talked about the effects of new and prospective technologies, from virtual reality's impact on medical education to the \"Uberization\" of health care. Below are excerpts of Kraft's answers, edited for length and clarity.\u003c/p>\n\u003cp>\u003cstrong>The Uberization of Health Care\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Everyone is familiar with \u003ca href=\"https://ww2.kqed.org/news/tag/uber/\" target=\"_blank\">Uber as disruptive\u003c/a>. But they couldn’t have existed 10-plus years ago, without smartphones, GPS, online payments--they connected the dots.\u003c/p>\n\u003cp>We all want that ease and transparency of use that we’re used to with Uber. And we’re seeing that kind of mindset come not just to millennials but to \u003ca href=\"https://www.google.com/search?q=senior+citizens+digital+health+care\" target=\"_blank\">older folks\u003c/a> who want access to their clinical data and doctor. There are several companies that have launched apps where you press a button and a doctor will come to you within three hours. Uber itself did a pilot in New York where you press a button and a nurse will come and \u003ca href=\"http://fortune.com/2016/10/25/uber-free-flu-shots/\" target=\"_blank\">give you\u003c/a> a flu shot. This ease-of-access mindset is coming across in many parts of health care, including \u003ca href=\"http://www.cnbc.com/2016/05/16/digital-focused-pharmacy-capsule-opens-in-new-york.html\" target=\"_blank\">delivering your drugs\u003c/a>, whether it's by Uber, Lyft or drone.\u003c/p>\n\u003cp>\u003cstrong>The Potential of Digital Health Data\u003c/strong>\u003c/p>\n\u003cp>We’re in this age of exponential data, but how do you make it useful to you as a consumer, patient and physician? A lot of digital devices get \u003ca href=\"https://ww2.kqed.org/futureofyou/2016/10/10/fitbit-study/\" target=\"_blank\">left in a drawer\u003c/a> after a month or so; the trick is to make them engaging.\u003c/p>\n\u003cp>We practice sick care today, spending most of our time and money on folks who already have disease. But we can really move to more proactive, continuous health care using some of these tools.\u003c/p>\n\u003cp>In the future we’ll have individualized check engine lights. Your information will be synthesized so that a warning light can say, \"Hey, time to come in for a checkup before you blow a gasket.\"\u003c/p>\n\u003cp>\u003cstrong>Digital Mental Health Tools\u003c/strong>\u003c/p>\n\u003cp>With some wearables and other technologies we can now get a pulse on our behaviors. Right now I’m wearing a couple of devices that \u003ca href=\"http://sleepjunkies.com/features/the-ultimate-guide-to-sleep-tracking/\" target=\"_blank\">track my sleep\u003c/a>. I have a ring that can do this; I have a sensor on my mattress. Just getting insight into how you sleep can have a huge impact on health and wellness over the long term.\u003c/p>\n\u003cp>It’s the same thing for depression and anxiety. We’re seeing companies that can be a platform for mental health progression. For example, for bipolar patients, if you’re depressed and not moving much and staying in the house, some of these \u003ca href=\"http://www.nature.com/news/mental-health-there-s-an-app-for-that-1.19694\">new platforms\u003c/a> allow you to access your care team and your family, so you can get a digital hug when you might need one.\u003c/p>\n\u003cp>\u003cstrong>Virtual and Augmented Reality\u003c/strong>\u003c/p>\n\u003cp>Physicians today spend twice as much time typing in their medical records than they do with patients. So one of the best applications is using Google Glass or a similar product so physicians can see their patients and view data but have someone else act as a virtual \u003ca href=\"http://www.healthcare-informatics.com/article/ehr/how-virtual-scribe-enhancing-doctor-patient-relationship\" target=\"_blank\">scribe\u003c/a>.\u003c/p>\n\u003cp>We’re seeing now how Oculus Rift can help medical students \u003ca href=\"http://www.roadtovr.com/vr-human-anatomy-to-give-medical-students-a-hands-on-using-oculus-touch/\" target=\"_blank\">learn anatomy\u003c/a>, allowing them to fly through the heart or the brain. We’re seeing ways to use VR to \u003ca href=\"https://ww2.kqed.org/futureofyou/2015/05/28/how-virtual-reality-worlds-can-help-reduce-pain/\" target=\"_blank\">treat burn patients\u003c/a> who have undergone painful surgeries; they're put into a cold environment where they get to throw snowballs, and it diminishes their pain and their need for opiates. And kids with autism can now \u003ca href=\"https://ww2.kqed.org/futureofyou/2016/04/08/google-glass-flopped-but-kids-with-autism-are-using-it-to-learn-emotions/\" target=\"_blank\">put on Google Glass\u003c/a> and learn to recognize facial emotions.\u003c/p>\n\u003cp>\u003cstrong>Health Screening Tools\u003c/strong>\u003c/p>\n\u003cp>Part of the future will be to use new screening tools: app-based eye-tracking devices, blood-based diagnostics, brain scans that might pick up dementia 10 or 15 years early. There are drugs in development that might stop or reverse plaques when you’re at stage 0, before you have symptoms.\u003c/p>\n\u003cp>Even with your 23andme data, primary care doctors could gain some insights--when to screen you or \u003ca href=\"http://www.npr.org/sections/health-shots/2015/09/01/436584534/are-statins-bad-for-me-personalized-medicine-cant-yet-say\" target=\"_blank\">what statin drugs\u003c/a> may work best for you, based on your \u003ca href=\"https://ghr.nlm.nih.gov/primer/genomicresearch/pharmacogenomics\" target=\"_blank\">pharmacogenomics\u003c/a>. The challenge is a lot of this information doesn’t flow to your physicians; they’re not incentivized to use it, and in some cases they're dis-incentivized.\u003c/p>\n\u003cp>\u003cstrong>Health Care vs. Technology Care\u003c/strong>\u003c/p>\n\u003cp>Folks talk about robot physicians or the app \u003ca href=\"https://ww2.kqed.org/futureofyou/2016/11/07/AI-computers-diagnosis-watson/\" target=\"_blank\">taking over\u003c/a> your medical care. I think it’s going to be more of a blend, not just AI but IA, intelligence augmentation. So in fields like \u003ca href=\"https://ww2.kqed.org/futureofyou/2016/10/25/technology-radiology/\" target=\"_blank\">radiology\u003c/a> or dermatology or pathology, where clinicians are trained to see patterns, now machine learning can arguably do that faster and better, and that can augment a primary care doctor in screening you for melanoma, for example.\u003c/p>\n\u003cp>We’re seeing the ability to do triage with \u003ca href=\"http://www.theverge.com/2016/10/11/13240434/baidu-medical-chatbot-china-melody\" target=\"_blank\">chatbots\u003c/a>, which you might access from your phone and help you do the first steps. I’ve got a few \u003ca href=\"http://tricorder.xprize.org/teams/final-frontier-medical-devices\" target=\"_blank\">medical tricorders\u003c/a>, inspired by \"Star Trek,\" with me. So at home or in your pocket you can literally pull down advanced vital signs that synch up with your phone and connect to your clinicians, and AI agents can help you understand where you are in your baseline and the way things are moving.\u003c/p>\n\u003cp>We don’t need to replace doctors, but maybe every visit \u003ca href=\"https://ww2.kqed.org/futureofyou/2016/02/03/virtual_care_clinic_usc/\" target=\"_blank\">doesn’t need\u003c/a> to require you to take off half a day of work, sit in the waiting room and fill out the same form. You might use your smartphone for a follow-up appointment to look at a wound from surgery, or to check on a suspicious skin lesion. As cost pressures go, we’ll be seeing more and more payment for some of these \u003ca href=\"http://www.huffingtonpost.ca/jacki-andre/health-care-telemedicine_b_14632688.html\" target=\"_blank\">telehealth\u003c/a> platforms.\u003c/p>\n\u003cp>\u003cstrong>Pediatrics and Technology \u003c/strong>\u003c/p>\n\u003cp>There's a lot of new tech coming for pregnant women and children. A connected otoscope can enable you to track kids with ear infections at home, so you don't have to drag them back to the doctor. We’re seeing sensored cribs or infant ankle bracelets, sort of a Fitbit for babies, which can help reassure worried parents or enable a physician to send a child home earlier when they're at risk of SIDS or asthma.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>More on \u003ca href=\"https://su.org/\" target=\"_blank\">Singularity University\u003c/a> and what it calls \u003ca href=\"https://exponential.singularityu.org/medicine/\" target=\"_blank\">exponential medicine here\u003c/a>.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Logic might lead you to believe that a mosquito-borne illness like West Nile virus would spread during rainy conditions, as the bugs need water to breed.\u003c/p>\n\u003cp>But a new study demonstrates the opposite is true.\u003c/p>\n\u003cp>Researchers found that the severity of West Nile virus outbreaks spike during dry times. This came as a surprise to researchers at UC Santa Cruz, Stanford University and the New York State Department of Health, who thought other climate variables like precipitation and temperature, including days below freezing, played a more significant role.\u003c/p>\n\u003cp>“But we found that the primary driver of intensity of yearly epidemics of West Nile virus was drought,” says UC Santa Cruz disease ecologist Marm Kilpatrick. ”\u003c/p>\n\u003cp>He recommends health officials amp up mosquito prevention efforts like spraying and traps when the \u003ca href=\"http://droughtmonitor.unl.edu/Home/StateDroughtMonitor.aspx?CA\" target=\"_blank\" rel=\"noopener\">drought index\u003c/a> hits severe.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cstrong>More Research Needed\u003c/strong>\u003c/p>\n\u003cp>Scientists aren’t sure why dry conditions lead to more mosquito carriers.\u003c/p>\n\u003cp>There are two current hypotheses. Some suspect mosquitoes and birds frequent the same watering holes when there are fewer puddles around, leading to more disease carriers in the environment.\u003c/p>\n\u003cp>Others argue that dry conditions lower the immunity of birds because of reduced food supply. Hunger leads to stress, which could make the birds more susceptible to disease.\u003c/p>\n\u003cp>Kilpatrick says more research is needed to determine the exact cause.\u003c/p>\n\u003cp>Researchers found that the other factor in predicting the virus was whether the area had experienced a substantial epidemic in the past. If that was the case, the subsequent epidemics were much smaller, Kilpatrick said. He believes both humans and birds build up immunity over time, so outbreaks are lighter in areas that have already endured the virus.\u003c/p>\n\u003cp>\u003cstrong>History of West Nile virus in the U.S.\u003cbr>\n\u003c/strong>\u003c/p>\n\u003cp>Mosquitoes carry the virus. The insects contract the disease when they feed on infected birds and then transmit it to humans.\u003c/p>\n\u003cp>North America has experienced West Nile virus outbreaks every year since 1999, but the number of cases nationally has greatly fluctuated. In some years only a few hundred people suffered severe symptoms, in other years thousands fell ill. In each of three years (2002, 2003, and 2012) about 3,000 people contracted meningitis or encephalitis, resulting in brain damage and nearly 300 deaths for each outbreak.\u003c/p>\n\u003cp>The unpredictable spikes led scientists at the Centers for Disease Control and Prevention to suggest that predicting the size of future epidemics was difficult or impossible. However, public health experts in California \u003ca href=\"https://ww2.kqed.org/stateofhealth/2014/09/21/drought-may-be-linked-to-increase-in-west-nile/\" target=\"_blank\" rel=\"noopener\">suspected \u003c/a>drought was partly to blame in 2014, when the number of cases doubled. Now the data proves those suspicions correct.\u003c/p>\n\u003cp>\u003cstrong>California Not in the Clear\u003c/strong>\u003c/p>\n\u003cp>Though California was hit with more than 500 cases in both 2014 and 2015, the numbers were not high enough to prevent a future epidemic. “There hasn’t been strong enough evidence that we’ve had enough cases, for our very large population–30 million people–to limit subsequent transmission,” says Kilpatrick. “Our analyses suggest as many as 1000 neuro-invasive disease cases [from West Nile virus] are possible in California under future severe drought conditions.”\u003c/p>\n\u003cfigure id=\"attachment_332812\" class=\"wp-caption aligncenter\" style=\"max-width: 720px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-332812 size-full\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/02/West_Nile_Virus.jpg\" alt=\"Severe West Nile virus in California\" width=\"720\" height=\"432\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/13/2017/02/West_Nile_Virus.jpg 720w, https://cdn.kqed.org/wp-content/uploads/sites/13/2017/02/West_Nile_Virus-160x96.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/13/2017/02/West_Nile_Virus-240x144.jpg 240w, https://cdn.kqed.org/wp-content/uploads/sites/13/2017/02/West_Nile_Virus-375x225.jpg 375w, https://cdn.kqed.org/wp-content/uploads/sites/13/2017/02/West_Nile_Virus-520x312.jpg 520w\" sizes=\"(max-width: 720px) 100vw, 720px\">\u003cfigcaption class=\"wp-caption-text\">\u003cem>WNV = West Nile virus cases in California.\u003c/em> Source: UC Santa Cruz \u003ccite>(UC Santa Cruz)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The majority of people infected with West Nile virus will not show symptoms. Twenty percent will experience flu-like aches and pains, and the virus will \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/07/31/west-nile-virus-making-its-summer-trek-across-california/\" target=\"_blank\" rel=\"noopener\">cause brain damage\u003c/a> in 1 percent of cases. Ten percent of those cases are usually fatal.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Even though the disease is more prevalent during drought years, it’s not because there are more mosquitoes. Rather, a higher percentage of the insects carry the disease. “If there are more infected mosquitoes in the air, you have a higher chance of getting infected,” says Kilpatrick.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Logic might lead you to believe that a mosquito-borne illness like West Nile virus would spread during rainy conditions, as the bugs need water to breed.\u003c/p>\n\u003cp>But a new study demonstrates the opposite is true.\u003c/p>\n\u003cp>Researchers found that the severity of West Nile virus outbreaks spike during dry times. This came as a surprise to researchers at UC Santa Cruz, Stanford University and the New York State Department of Health, who thought other climate variables like precipitation and temperature, including days below freezing, played a more significant role.\u003c/p>\n\u003cp>“But we found that the primary driver of intensity of yearly epidemics of West Nile virus was drought,” says UC Santa Cruz disease ecologist Marm Kilpatrick. ”\u003c/p>\n\u003cp>He recommends health officials amp up mosquito prevention efforts like spraying and traps when the \u003ca href=\"http://droughtmonitor.unl.edu/Home/StateDroughtMonitor.aspx?CA\" target=\"_blank\" rel=\"noopener\">drought index\u003c/a> hits severe.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cstrong>More Research Needed\u003c/strong>\u003c/p>\n\u003cp>Scientists aren’t sure why dry conditions lead to more mosquito carriers.\u003c/p>\n\u003cp>There are two current hypotheses. Some suspect mosquitoes and birds frequent the same watering holes when there are fewer puddles around, leading to more disease carriers in the environment.\u003c/p>\n\u003cp>Others argue that dry conditions lower the immunity of birds because of reduced food supply. Hunger leads to stress, which could make the birds more susceptible to disease.\u003c/p>\n\u003cp>Kilpatrick says more research is needed to determine the exact cause.\u003c/p>\n\u003cp>Researchers found that the other factor in predicting the virus was whether the area had experienced a substantial epidemic in the past. If that was the case, the subsequent epidemics were much smaller, Kilpatrick said. He believes both humans and birds build up immunity over time, so outbreaks are lighter in areas that have already endured the virus.\u003c/p>\n\u003cp>\u003cstrong>History of West Nile virus in the U.S.\u003cbr>\n\u003c/strong>\u003c/p>\n\u003cp>Mosquitoes carry the virus. The insects contract the disease when they feed on infected birds and then transmit it to humans.\u003c/p>\n\u003cp>North America has experienced West Nile virus outbreaks every year since 1999, but the number of cases nationally has greatly fluctuated. In some years only a few hundred people suffered severe symptoms, in other years thousands fell ill. In each of three years (2002, 2003, and 2012) about 3,000 people contracted meningitis or encephalitis, resulting in brain damage and nearly 300 deaths for each outbreak.\u003c/p>\n\u003cp>The unpredictable spikes led scientists at the Centers for Disease Control and Prevention to suggest that predicting the size of future epidemics was difficult or impossible. However, public health experts in California \u003ca href=\"https://ww2.kqed.org/stateofhealth/2014/09/21/drought-may-be-linked-to-increase-in-west-nile/\" target=\"_blank\" rel=\"noopener\">suspected \u003c/a>drought was partly to blame in 2014, when the number of cases doubled. Now the data proves those suspicions correct.\u003c/p>\n\u003cp>\u003cstrong>California Not in the Clear\u003c/strong>\u003c/p>\n\u003cp>Though California was hit with more than 500 cases in both 2014 and 2015, the numbers were not high enough to prevent a future epidemic. “There hasn’t been strong enough evidence that we’ve had enough cases, for our very large population–30 million people–to limit subsequent transmission,” says Kilpatrick. “Our analyses suggest as many as 1000 neuro-invasive disease cases [from West Nile virus] are possible in California under future severe drought conditions.”\u003c/p>\n\u003cfigure id=\"attachment_332812\" class=\"wp-caption aligncenter\" style=\"max-width: 720px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-332812 size-full\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/02/West_Nile_Virus.jpg\" alt=\"Severe West Nile virus in California\" width=\"720\" height=\"432\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/13/2017/02/West_Nile_Virus.jpg 720w, https://cdn.kqed.org/wp-content/uploads/sites/13/2017/02/West_Nile_Virus-160x96.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/13/2017/02/West_Nile_Virus-240x144.jpg 240w, https://cdn.kqed.org/wp-content/uploads/sites/13/2017/02/West_Nile_Virus-375x225.jpg 375w, https://cdn.kqed.org/wp-content/uploads/sites/13/2017/02/West_Nile_Virus-520x312.jpg 520w\" sizes=\"(max-width: 720px) 100vw, 720px\">\u003cfigcaption class=\"wp-caption-text\">\u003cem>WNV = West Nile virus cases in California.\u003c/em> Source: UC Santa Cruz \u003ccite>(UC Santa Cruz)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The majority of people infected with West Nile virus will not show symptoms. Twenty percent will experience flu-like aches and pains, and the virus will \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/07/31/west-nile-virus-making-its-summer-trek-across-california/\" target=\"_blank\" rel=\"noopener\">cause brain damage\u003c/a> in 1 percent of cases. Ten percent of those cases are usually fatal.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Even though the disease is more prevalent during drought years, it’s not because there are more mosquitoes. Rather, a higher percentage of the insects carry the disease. “If there are more infected mosquitoes in the air, you have a higher chance of getting infected,” says Kilpatrick.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>When scientists first read out the human genome 15 years ago, there were high hopes that we'd soon understand how traits like height are inherited. It hasn't been easy. A huge effort to find height-related genes so far only explains a fraction of this trait.\u003c/p>\n\u003cp>Now scientists say they've made some more headway. And the effort is not just useful for understanding how genes determine height, but how they're involved in driving many other human traits.\u003c/p>\n\u003cp>At first, these problems didn't seem to be so complicated. The 19\u003csup>th\u003c/sup>-century monk Gregor Mendel discovered that traits in his garden peas, like smoothness and color, could be passed predictably from one generation to the next.\u003c/p>\n\u003cp>But \u003ca href=\"https://www.broadinstitute.org/bios/joel-hirschhorn\">Joel Hirschhorn\u003c/a>, a geneticist at Boston Children's Hospital and the Broad Institute, says it became evident that most stories of inheritance were not so simple. Height turns out to be a prime example.\u003c/p>\n\u003cp>\"People's height didn't behave like Mendel's peas,\" Hirschhorn says. \"It wasn't like they you had two tall people and they'd either have a tall [child] or a short [child]. Often the child was partway between the parents.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Scientists explained this 100 years ago, when they realized that height was influenced by many genes, and each makes a small contribution.\u003c/p>\n\u003cp>So when the human genome was sequenced, scientists like Hirschhorn thought they could plumb that data to track all the height genes, and finally understand how height — and in fact most other human traits — are shaped by our genes.\u003c/p>\n\u003cp>That effort started slowly. But now, Hirschhorn says, \"For height there are about 700 variants known to affect height, each of them usually with a pretty small effect on height, usually like a millimeter or less.\"\u003c/p>\n\u003cp>That massive global effort has involved studying the genes of more than 700,000 volunteer subjects. Even so, the traits they've found only explain about a quarter of the inherited height factors.\u003c/p>\n\u003cp>And, frustratingly, for most of those variants scientists have no idea what they actually do.\u003c/p>\n\u003cp>Mostly the variants crop up in mysterious bits of DNA between genes on our chromosomes. That makes it hard to figure out their roles.\u003c/p>\n\u003cp>So Hirschhorn and his army of colleagues, who \u003ca href=\"http://nature.com/articles/doi:10.1038/nature21039\">reported\u003c/a> on the effort last week in the journal \u003cem>Nature\u003c/em>, tried a new tack.\u003c/p>\n\u003cp>Their study focused only on variants that are directly in the genes themselves. By knowing that the genes do, they can understand better how variants might influence height. For example, one is in a gene that influences hormones that regulate growth.\u003c/p>\n\u003cp>The variants within genes are uncommon, but some have a remarkably large influence on height.\u003c/p>\n\u003cp>\"We found some that, if you carry them, you might actually be an inch taller or an inch shorter, as opposed to just a millimeter difference that we found with the previous variants,\" Hirschhorn says.\u003c/p>\n\u003cp>Scientists are still very far from identifying all the genes involved with stature, but these new findings do help them better understand the natural biochemistry that influences height.\u003c/p>\n\u003cp>So far most of our understanding of height has come from scientists who study children who have abnormal growth patterns, according to \u003ca href=\"https://www.nichd.nih.gov/about/staff/Pages/bio.aspx?nih_id=0010126245\">Constantine Stratakis\u003c/a>, a pediatrician and scientific director of the National Institute of Child Health and Human Development.\u003c/p>\n\u003cp>\"There are rare experiments of nature that have told us these genes are involved in the regulation of growth,\" he says. In fact, he discovered one of those rare genes, linked to a trait called \u003ca href=\"http://www.nejm.org/doi/full/10.1056/NEJMoa1408028#t=article\">gigantism\u003c/a>.\u003c/p>\n\u003cp>\"It leads to babies that double or triple their length in the first year of life,\" he says.\u003c/p>\n\u003cp>These natural experiments have been most useful for treating height disorders, but Stratakis hopes that eventually the genome-search methods will provide leads for future treatments.\u003c/p>\n\u003cp>The bigger lesson here is figuring out how the biology of a complex trait like height really works.\u003c/p>\n\u003cp>Rare variants can sometimes make a big difference, \"but most of the time it's all about systems that interact that define how an organism behaves, or grows, or has a disease, develops a trait and so on,\" Stratakis says. \"And although it's humbling to see the complexity, at this point it's not unexpected.\"\u003c/p>\n\u003cp>Hirschhorn and his colleagues are expanding their already massive study of 700,000 subjects. That approach has \u003ca href=\"http://www.nejm.org/doi/full/10.1056/NEJMp0806284\">drawn skepticism\u003c/a> from some scientists, who think it's a waste of effort.\u003c/p>\n\u003cp>David Goldstein, a professor of genetics at Columbia University, says an expanded effort could ultimately implicate every gene in existence, and that hardly helps scientists narrow down the biological factors that contribute to height.\u003c/p>\n\u003cp>It's likely scientists will never be able to figure out what these hundreds of common variants do to influence height, \u003ca href=\"http://www.igm.columbia.edu/profile/dbgoldstein\">Goldstein \u003c/a>says. Instead, a much better strategy is what Hirschhorn used in this latest study: looking for rare variants that pack a big punch.\u003c/p>\n\u003cp>Hirschhorn is undeterred.\u003c/p>\n\u003chr>\n\u003cp>\"We probably won't get all of the way to explaining 100 percent of the genetic factors, but in some sense that's not really our goal,\" Hirschhorn says. \"Our goal is to use the genetics to do our best at understanding the biology.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>To that end, Hirschhorn and his colleagues are not just looking at height; they're digging into traits that make people susceptible to diabetes and obesity.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Which+Genes+Make+You+Taller%3F+A+Whole+Bunch+Of+Them%2C+It+Turns+Out&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>When scientists first read out the human genome 15 years ago, there were high hopes that we'd soon understand how traits like height are inherited. It hasn't been easy. A huge effort to find height-related genes so far only explains a fraction of this trait.\u003c/p>\n\u003cp>Now scientists say they've made some more headway. And the effort is not just useful for understanding how genes determine height, but how they're involved in driving many other human traits.\u003c/p>\n\u003cp>At first, these problems didn't seem to be so complicated. The 19\u003csup>th\u003c/sup>-century monk Gregor Mendel discovered that traits in his garden peas, like smoothness and color, could be passed predictably from one generation to the next.\u003c/p>\n\u003cp>But \u003ca href=\"https://www.broadinstitute.org/bios/joel-hirschhorn\">Joel Hirschhorn\u003c/a>, a geneticist at Boston Children's Hospital and the Broad Institute, says it became evident that most stories of inheritance were not so simple. Height turns out to be a prime example.\u003c/p>\n\u003cp>\"People's height didn't behave like Mendel's peas,\" Hirschhorn says. \"It wasn't like they you had two tall people and they'd either have a tall [child] or a short [child]. Often the child was partway between the parents.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Scientists explained this 100 years ago, when they realized that height was influenced by many genes, and each makes a small contribution.\u003c/p>\n\u003cp>So when the human genome was sequenced, scientists like Hirschhorn thought they could plumb that data to track all the height genes, and finally understand how height — and in fact most other human traits — are shaped by our genes.\u003c/p>\n\u003cp>That effort started slowly. But now, Hirschhorn says, \"For height there are about 700 variants known to affect height, each of them usually with a pretty small effect on height, usually like a millimeter or less.\"\u003c/p>\n\u003cp>That massive global effort has involved studying the genes of more than 700,000 volunteer subjects. Even so, the traits they've found only explain about a quarter of the inherited height factors.\u003c/p>\n\u003cp>And, frustratingly, for most of those variants scientists have no idea what they actually do.\u003c/p>\n\u003cp>Mostly the variants crop up in mysterious bits of DNA between genes on our chromosomes. That makes it hard to figure out their roles.\u003c/p>\n\u003cp>So Hirschhorn and his army of colleagues, who \u003ca href=\"http://nature.com/articles/doi:10.1038/nature21039\">reported\u003c/a> on the effort last week in the journal \u003cem>Nature\u003c/em>, tried a new tack.\u003c/p>\n\u003cp>Their study focused only on variants that are directly in the genes themselves. By knowing that the genes do, they can understand better how variants might influence height. For example, one is in a gene that influences hormones that regulate growth.\u003c/p>\n\u003cp>The variants within genes are uncommon, but some have a remarkably large influence on height.\u003c/p>\n\u003cp>\"We found some that, if you carry them, you might actually be an inch taller or an inch shorter, as opposed to just a millimeter difference that we found with the previous variants,\" Hirschhorn says.\u003c/p>\n\u003cp>Scientists are still very far from identifying all the genes involved with stature, but these new findings do help them better understand the natural biochemistry that influences height.\u003c/p>\n\u003cp>So far most of our understanding of height has come from scientists who study children who have abnormal growth patterns, according to \u003ca href=\"https://www.nichd.nih.gov/about/staff/Pages/bio.aspx?nih_id=0010126245\">Constantine Stratakis\u003c/a>, a pediatrician and scientific director of the National Institute of Child Health and Human Development.\u003c/p>\n\u003cp>\"There are rare experiments of nature that have told us these genes are involved in the regulation of growth,\" he says. In fact, he discovered one of those rare genes, linked to a trait called \u003ca href=\"http://www.nejm.org/doi/full/10.1056/NEJMoa1408028#t=article\">gigantism\u003c/a>.\u003c/p>\n\u003cp>\"It leads to babies that double or triple their length in the first year of life,\" he says.\u003c/p>\n\u003cp>These natural experiments have been most useful for treating height disorders, but Stratakis hopes that eventually the genome-search methods will provide leads for future treatments.\u003c/p>\n\u003cp>The bigger lesson here is figuring out how the biology of a complex trait like height really works.\u003c/p>\n\u003cp>Rare variants can sometimes make a big difference, \"but most of the time it's all about systems that interact that define how an organism behaves, or grows, or has a disease, develops a trait and so on,\" Stratakis says. \"And although it's humbling to see the complexity, at this point it's not unexpected.\"\u003c/p>\n\u003cp>Hirschhorn and his colleagues are expanding their already massive study of 700,000 subjects. That approach has \u003ca href=\"http://www.nejm.org/doi/full/10.1056/NEJMp0806284\">drawn skepticism\u003c/a> from some scientists, who think it's a waste of effort.\u003c/p>\n\u003cp>David Goldstein, a professor of genetics at Columbia University, says an expanded effort could ultimately implicate every gene in existence, and that hardly helps scientists narrow down the biological factors that contribute to height.\u003c/p>\n\u003cp>It's likely scientists will never be able to figure out what these hundreds of common variants do to influence height, \u003ca href=\"http://www.igm.columbia.edu/profile/dbgoldstein\">Goldstein \u003c/a>says. Instead, a much better strategy is what Hirschhorn used in this latest study: looking for rare variants that pack a big punch.\u003c/p>\n\u003cp>Hirschhorn is undeterred.\u003c/p>\n\u003chr>\n\u003cp>\"We probably won't get all of the way to explaining 100 percent of the genetic factors, but in some sense that's not really our goal,\" Hirschhorn says. \"Our goal is to use the genetics to do our best at understanding the biology.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>To that end, Hirschhorn and his colleagues are not just looking at height; they're digging into traits that make people susceptible to diabetes and obesity.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Which+Genes+Make+You+Taller%3F+A+Whole+Bunch+Of+Them%2C+It+Turns+Out&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Humans have had to face death and mortality since since the beginning of time, but our experience of the dying process has changed dramatically in recent history.\u003c/p>\n\u003cp>Haider Warraich, a fellow in cardiology at Duke University Medical Center, tells \u003cem>Fresh Air \u003c/em>that death used to be sudden, unexpected and relatively swift — the result of a violent cause, or perhaps an infection. But, he says, modern medicines and medical technologies have lead to a \"dramatic extension\" of life — and a more prolonged dying processes.\u003c/p>\n\u003cp>\"We've now ... introduced a phase of our life, which can be considered as 'dying,' in which patients have terminal diseases in which they are in and out of the hospital, they are dependent in nursing homes,\" Warraich says. \"That is something that is a very, very recent development in our history as a species.\"\u003c/p>\n\u003cp>Prolonging life might sound like a good thing, but Warraich notes that medical technologies often force patients, their loved ones and their doctors to make difficult, painful decisions. In his new book, \u003cem>Modern Death,\u003c/em> he writes about a patient with end-stage dementia who screamed \"kill me\" as a feeding tube was inserted into his nose.\u003c/p>\n\u003cp>\"This is probably one of the encounters that I had in residency that I have been unable to shake from my memory,\" Warraich says. \"I think if you ask any physician, any nurse, any paramedic, they'll have many such stories to tell you.\"\u003c/p>\n\u003chr>\n\u003ch3>\u003cstrong>Interview Highlights\u003c/strong>\u003c/h3>\n\u003cp>\u003cstrong>On the importance of having a health care proxy, living will and advanced directive \u003c/strong>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>One of the biggest problems that we face in not only modern society, but in societies of olden times as well, is that people have always been very afraid to talk about death. In many cultures it is considered bad luck to talk about death and it is thought to be a bad omen. I think to some extent that extends to this very day. But ... I think having a living will, having an advanced directive, or perhaps most importantly, having a designated healthcare proxy, someone who can help transmit your decisions to the team when you're not able to do so, is perhaps the most important thing that we can do for ourselves as patients and as human beings.\u003c/p>\n\u003cp>\u003cstrong>On giving CPR and knowing when to stop giving CPR\u003c/strong>\u003c/p>\n\u003cp>One of the things about CPR, Terry, is that almost everyone in medicine knows how to start CPR, when to start CPR, really what to do in CPR under even complex situations, but the one thing that almost no one really teaches us, and there are no guidelines for, is when to stop CPR. I think in some ways that is one of the biggest challenges that we in medicine face all the time. ...\u003c/p>\n\u003cp>I was actually working in the hospital last night and it was about three in the morning and I was called by one of my other colleagues who was another cardiology fellow, he asked me, \"Haider, I need your help. I have a patient that we are doing CPR on,\" and he wanted some help from me. So I walked over to the intensive care unit, and the patient was in her 60s. ... There was an entire team in the room doing chest compressions on this woman, and they had been doing it for an hour and a half at that point, much, much, much longer than most CPRs last. ...\u003c/p>\n\u003cp>At the same time while this CPR was ongoing, the patient's family member, her daughter, was outside the room, and she was crying. ... Even though we could give her all the information ... that wasn't perhaps what she was looking for, because what we were asking her to think about or to do was one of the hardest things anyone has to ever bear, which was, \"Do you want us to stop CPR?\" And that's the type of thing that I don't think any of us can ever prepare for, especially when it's our parent that's involved.\u003c/p>\n\u003cp>\u003cstrong>On why he wrote a book about dying\u003c/strong>\u003c/p>\n\u003cp>I really wanted to find answers to some very, very basic questions, like what are the implications of the sort of life extension that we have achieved? What is the role of religion, not only a patient's religion but a physician's religion when it comes to dealing with the end of life? How is social media affecting how people experience the end of life? ...\u003c/p>\n\u003cp>So many times I've found myself in the room where there are people who were so much more experienced in life than I was, yet knew so little about death and dying. And so I wanted to write a book so that people could go into those really, really difficult places and feel like they're armed with information, that this isn't a completely foreign territory for them and that in some way could help them navigate and deal with the sort of difficult situations that lay ahead for them.\u003c/p>\n\u003cp>\u003cstrong>On the possible repeal of the \u003ca href=\"http://www.npr.org/tags/131849999/affordable-care-act\">Affordable Care Act\u003c/a>\u003c/strong>\u003c/p>\n\u003cp>It is very unfortunate that health is so politicized in this country, because it doesn't have to be. Health and wellness aren't red or blue, and they shouldn't be, but unfortunately that is where we are. I hope that when policies are being enacted in DC, patient's voices, those who have benefited from the ACA, those who have gained insurance, those voices are not lost in the midst of all of this political activity.\u003c/p>\n\u003cp>\u003cstrong>On immigrating to the U.S. from Pakistan\u003c/strong>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>I came to the United States in 2010 and [until now] have only lived in an America in which Barack Obama was the president. I think in some ways Trump's victory has really shaken me, because of how invested I was in the idea that America is a special place, it's a truly multicultural society. And I'm still trying to understand, I think like so many others, just exactly what happened. Especially as a writer and as a physician I've tried to separate myself from my identity as a Muslim. I'd rather be known as a physician/scientist/writer who happens to be Pakistani, rather than a young Pakistani Muslim immigrant who happens to be a doctor and a writer, but I don't know. Given how things are changing, I'm not even sure if I'll be able to set that narrative for myself. That's a scary thought — to live an identity that is so politicized even when you wish for it to not be.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 Fresh Air. To see more, visit \u003ca href=\"http://www.npr.org/programs/fresh-air/\">Fresh Air\u003c/a>.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Doctor+Considers+The+Pitfalls+Of+Extending+Life+And+Prolonging+Death&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Humans have had to face death and mortality since since the beginning of time, but our experience of the dying process has changed dramatically in recent history.\u003c/p>\n\u003cp>Haider Warraich, a fellow in cardiology at Duke University Medical Center, tells \u003cem>Fresh Air \u003c/em>that death used to be sudden, unexpected and relatively swift — the result of a violent cause, or perhaps an infection. But, he says, modern medicines and medical technologies have lead to a \"dramatic extension\" of life — and a more prolonged dying processes.\u003c/p>\n\u003cp>\"We've now ... introduced a phase of our life, which can be considered as 'dying,' in which patients have terminal diseases in which they are in and out of the hospital, they are dependent in nursing homes,\" Warraich says. \"That is something that is a very, very recent development in our history as a species.\"\u003c/p>\n\u003cp>Prolonging life might sound like a good thing, but Warraich notes that medical technologies often force patients, their loved ones and their doctors to make difficult, painful decisions. In his new book, \u003cem>Modern Death,\u003c/em> he writes about a patient with end-stage dementia who screamed \"kill me\" as a feeding tube was inserted into his nose.\u003c/p>\n\u003cp>\"This is probably one of the encounters that I had in residency that I have been unable to shake from my memory,\" Warraich says. \"I think if you ask any physician, any nurse, any paramedic, they'll have many such stories to tell you.\"\u003c/p>\n\u003chr>\n\u003ch3>\u003cstrong>Interview Highlights\u003c/strong>\u003c/h3>\n\u003cp>\u003cstrong>On the importance of having a health care proxy, living will and advanced directive \u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>One of the biggest problems that we face in not only modern society, but in societies of olden times as well, is that people have always been very afraid to talk about death. In many cultures it is considered bad luck to talk about death and it is thought to be a bad omen. I think to some extent that extends to this very day. But ... I think having a living will, having an advanced directive, or perhaps most importantly, having a designated healthcare proxy, someone who can help transmit your decisions to the team when you're not able to do so, is perhaps the most important thing that we can do for ourselves as patients and as human beings.\u003c/p>\n\u003cp>\u003cstrong>On giving CPR and knowing when to stop giving CPR\u003c/strong>\u003c/p>\n\u003cp>One of the things about CPR, Terry, is that almost everyone in medicine knows how to start CPR, when to start CPR, really what to do in CPR under even complex situations, but the one thing that almost no one really teaches us, and there are no guidelines for, is when to stop CPR. I think in some ways that is one of the biggest challenges that we in medicine face all the time. ...\u003c/p>\n\u003cp>I was actually working in the hospital last night and it was about three in the morning and I was called by one of my other colleagues who was another cardiology fellow, he asked me, \"Haider, I need your help. I have a patient that we are doing CPR on,\" and he wanted some help from me. So I walked over to the intensive care unit, and the patient was in her 60s. ... There was an entire team in the room doing chest compressions on this woman, and they had been doing it for an hour and a half at that point, much, much, much longer than most CPRs last. ...\u003c/p>\n\u003cp>At the same time while this CPR was ongoing, the patient's family member, her daughter, was outside the room, and she was crying. ... Even though we could give her all the information ... that wasn't perhaps what she was looking for, because what we were asking her to think about or to do was one of the hardest things anyone has to ever bear, which was, \"Do you want us to stop CPR?\" And that's the type of thing that I don't think any of us can ever prepare for, especially when it's our parent that's involved.\u003c/p>\n\u003cp>\u003cstrong>On why he wrote a book about dying\u003c/strong>\u003c/p>\n\u003cp>I really wanted to find answers to some very, very basic questions, like what are the implications of the sort of life extension that we have achieved? What is the role of religion, not only a patient's religion but a physician's religion when it comes to dealing with the end of life? How is social media affecting how people experience the end of life? ...\u003c/p>\n\u003cp>So many times I've found myself in the room where there are people who were so much more experienced in life than I was, yet knew so little about death and dying. And so I wanted to write a book so that people could go into those really, really difficult places and feel like they're armed with information, that this isn't a completely foreign territory for them and that in some way could help them navigate and deal with the sort of difficult situations that lay ahead for them.\u003c/p>\n\u003cp>\u003cstrong>On the possible repeal of the \u003ca href=\"http://www.npr.org/tags/131849999/affordable-care-act\">Affordable Care Act\u003c/a>\u003c/strong>\u003c/p>\n\u003cp>It is very unfortunate that health is so politicized in this country, because it doesn't have to be. Health and wellness aren't red or blue, and they shouldn't be, but unfortunately that is where we are. I hope that when policies are being enacted in DC, patient's voices, those who have benefited from the ACA, those who have gained insurance, those voices are not lost in the midst of all of this political activity.\u003c/p>\n\u003cp>\u003cstrong>On immigrating to the U.S. from Pakistan\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>I came to the United States in 2010 and [until now] have only lived in an America in which Barack Obama was the president. I think in some ways Trump's victory has really shaken me, because of how invested I was in the idea that America is a special place, it's a truly multicultural society. And I'm still trying to understand, I think like so many others, just exactly what happened. Especially as a writer and as a physician I've tried to separate myself from my identity as a Muslim. I'd rather be known as a physician/scientist/writer who happens to be Pakistani, rather than a young Pakistani Muslim immigrant who happens to be a doctor and a writer, but I don't know. Given how things are changing, I'm not even sure if I'll be able to set that narrative for myself. That's a scary thought — to live an identity that is so politicized even when you wish for it to not be.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 Fresh Air. To see more, visit \u003ca href=\"http://www.npr.org/programs/fresh-air/\">Fresh Air\u003c/a>.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Doctor+Considers+The+Pitfalls+Of+Extending+Life+And+Prolonging+Death&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Despite a 99 percent failure rate and another major setback last month, Alzheimer’s researchers are plowing ahead with hundreds of experiments — and a boost in federal money — to try to a crack a deadly disease that has flummoxed them for decades.\u003c/p>\n\u003cp>A \u003ca href=\"http://www.npr.org/sections/health-shots/2016/12/02/504139105/winners-and-losers-if-21st-century-cures-bill-becomes-law\" target=\"_blank\">law\u003c/a> passed by Congress in December and signed by President Obama sets aside $3 billion over 10 years to fund research of brain diseases and precision medicine, a shot in the arm for Alzheimer’s research. The law, called the 21st Century Cures Act, also includes prize money to encourage Alzheimer’s experiments.\u003c/p>\n\u003cp>But billions of dollars have so far made little progress in decoding the memory-robbing disease, which affects 5 million Americans. Alzheimer’s is currently the nation’s sixth leading cause of death. Decades of research have not produced a single drug that alters the disease’s course.\u003c/p>\n\u003cp>December began with another major setback: Eli Lilly shared disappointing results of a late-stage clinical trial of its experimental drug solanezumab, which failed to significantly slow Alzheimer’s progression.\u003c/p>\n\u003cp>But scientists aren’t giving up on the main hypothesis behind Eli Lilly’s trial: that Alzheimer’s can be defeated by using drugs to attack amyloid “plaques” that build up in the brain of Alzheimer’s patients. Some scientists believe these cause the disease.\u003c/p>\n\u003cfigure class=\"related\">\u003c/figure>\n\u003cp>Many observers still hold out hope for another promising anti-amyloid drug, Biogen’s aducanumab, which in an early trial \u003ca href=\"http://www.nature.com/nature/journal/v537/n7618/full/nature19323.html\" target=\"_blank\">improved cognitive decline\u003c/a> in a small number of patients.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Other potentially groundbreaking research aims to intervene before patients even feel any symptoms. Using PET scans, scientists can now identify amyloid plaques building up in a patient’s brain years before they develop Alzheimer’s. The \u003ca href=\"http://a4study.org/about/\" target=\"_blank\">A4 study\u003c/a>, for instance, is testing solanezumab in adults who are accumulating amyloid plaques, but showing no outward signs of Alzheimer’s, such as memory loss or cognitive decline.\u003c/p>\n\u003cp>Other scientists are targeting what they believe is the true culprit, the protein tau, which creates “tangles” in the brain, the disease’s other primary marker.\u003c/p>\n\u003cp>The experiments continue against a bleak backdrop: No new Alzheimer’s therapies have won federal approval since 2003, and Alzheimer’s clinical trials have had a \u003ca href=\"http://alzres.biomedcentral.com/articles/10.1186/alzrt269#B13\" target=\"_blank\">99 percent failure rate\u003c/a>. Patients can access only four Food and Drug Administration-approved Alzheimer’s drugs that alleviate symptoms but do not prevent, slow or reverse brain damage.\u003c/p>\n\u003cp>“The history of clinical trials results has been a history of disappointment,” said Keith Fargo, director of scientific programs and outreach at the Alzheimer’s Association.\u003c/p>\n\u003cp>Still, 77 Alzheimer’s drugs are currently being investigated or developed, according to the trade group PhRMA. And other experiments seek to repurpose FDA-approved drugs for other conditions, such as diabetes or cancer, to see if they can help Alzheimer’s patients — and cut several years from the drug development process.\u003c/p>\n\u003caside class=\"pullquote alignright\">Despite failures, 'there's still more optimism in Alzheimer's research right now than there has been for 10 years.'\u003ccite>Keith Fargo, director of scientific programs and outreach at the Alzheimer’s Association\u003c/cite>\u003c/aside>\n\u003cp>Non-pharmaceutical solutions are also being explored. Observational studies have shown that people who exercise more and have healthier diets seem to get the disease later in life. Researchers are now conducting trials to more closely measure the effects of exercise and diet. One randomized trial underway at Wake Forest University, \u003ca href=\"https://clinicaltrials.gov/ct2/show/NCT02814526\" target=\"_blank\">dubbed EXERT\u003c/a>, is testing the effects of high-intensity aerobic exercise on adults with mild cognitive impairment by enrolling them in exercise programs at a YMCA.\u003c/p>\n\u003cp>Even before last month’s passage of the 21st Century Cures Act, public funding for Alzheimer’s research has been rising. The National Institutes of Health allocated almost $1 billion to Alzheimer’s research in fiscal 2016 — a $350 million increase over the previous year, according to Laurie Ryan, chief of NIH’s Dementias of Aging Branch. There are 468 open clinical trials related to Alzheimer’s, and over a hundred more in progress, \u003ca href=\"https://clinicaltrials.gov/ct2/results?term=alzheimer%27s&Search=Search\" target=\"_blank\">listed on the\u003c/a> government database ClinicalTrials.gov.\u003c/p>\n\u003cp>Meanwhile, Alzheimer’s advocates still grapple with a basic question: Is the rate of Alzheimer’s actually going down? A \u003ca href=\"http://khn.org/news/dementia-rates-decline-sharply-among-senior-citizens/\">study\u003c/a> in JAMA in November found that even as scientists have made no progress in changing Alzheimer’s course, overall dementia rates, which include Alzheimer’s and other dementias, appear to be dramatically declining. The paper cast doubt over a major talking point of the Alzheimer’s lobby: That as baby boomers age, the number of Americans living with Alzheimer’s will explode from the current 5 million \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/23390181\" target=\"_blank\">to 14 million\u003c/a> in 2050. The study also suggested that lifestyle changes may make a difference.\u003c/p>\n\u003cp>While some heralded that as good news, others downplayed the finding.\u003c/p>\n\u003cp>Even if dementia rates drop, Alzheimer’s remains a major killer, and the number of afflicted people will likely still rise, because the US population is aging so rapidly, predicted Fargo. He also questioned the study’s methods, which relied largely on telephone interviews.\u003c/p>\n\u003cp>“It’s not time to let our foot up off the gas,” Fargo said.\u003c/p>\n\u003cp>Eli Lilly’s closely watched trial, dubbed Expedition 3, was the latest potential breakthrough to fall flat. In 2,100 people with mild dementia, solanezumab failed to show significant results compared to a placebo.\u003c/p>\n\u003cp>Some critics said the failure casts doubt on the hotly disputed hypothesis that Alzheimer’s is triggered by the buildup of amyloid plaques.\u003c/p>\n\u003cp>But Eli Lilly spokeswoman Nicole Hebert said more work is needed to test the hypothesis, because the trial explored just one method of removing amyloid, on one subgroup of people. She said the company is pursuing seven other lines of attack.\u003c/p>\n\u003cp>“Rumors of the death of the amyloid hypothesis have been around for many years, and they’re probably premature,” Fargo agreed.\u003c/p>\n\u003cp>Fargo noted that brain imaging has shown that amyloid plaques start to build up 15 to 20 years before signs of dementia appear. So to really test the amyloid hypothesis, he said, scientists may have to intervene earlier than they did in Expedition 3.\u003c/p>\n\u003cp>Despite the latest failure, Fargo said, “there’s still more optimism in Alzheimer’s research right now than there has been for 10 years.”\u003c/p>\n\u003cp>The answer to Alzheimer’s, Ryan said, is not going to be one “magic bullet,” but an array of solutions tailored to different patients.\u003c/p>\n\u003cp>Will scientists ever find a cure?\u003c/p>\n\u003cp>Dr. Ron Petersen, director of the Alzheimer’s Disease Research Center at the Mayo Clinic, isn’t betting on it. But there’s still “a lot going on to be hopeful about,” he said.\u003c/p>\n\u003cp>“I think slowing the progression and/or delaying the onset, are realistic goals.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>KHN’s coverage of end-of-life and serious illness issues is supported by \u003ca href=\"https://www.moore.org/\" target=\"_blank\">The Gordon and Betty Moore Foundation\u003c/a>.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Despite a 99 percent failure rate and another major setback last month, Alzheimer’s researchers are plowing ahead with hundreds of experiments — and a boost in federal money — to try to a crack a deadly disease that has flummoxed them for decades.\u003c/p>\n\u003cp>A \u003ca href=\"http://www.npr.org/sections/health-shots/2016/12/02/504139105/winners-and-losers-if-21st-century-cures-bill-becomes-law\" target=\"_blank\">law\u003c/a> passed by Congress in December and signed by President Obama sets aside $3 billion over 10 years to fund research of brain diseases and precision medicine, a shot in the arm for Alzheimer’s research. The law, called the 21st Century Cures Act, also includes prize money to encourage Alzheimer’s experiments.\u003c/p>\n\u003cp>But billions of dollars have so far made little progress in decoding the memory-robbing disease, which affects 5 million Americans. Alzheimer’s is currently the nation’s sixth leading cause of death. Decades of research have not produced a single drug that alters the disease’s course.\u003c/p>\n\u003cp>December began with another major setback: Eli Lilly shared disappointing results of a late-stage clinical trial of its experimental drug solanezumab, which failed to significantly slow Alzheimer’s progression.\u003c/p>\n\u003cp>But scientists aren’t giving up on the main hypothesis behind Eli Lilly’s trial: that Alzheimer’s can be defeated by using drugs to attack amyloid “plaques” that build up in the brain of Alzheimer’s patients. Some scientists believe these cause the disease.\u003c/p>\n\u003cfigure class=\"related\">\u003c/figure>\n\u003cp>Many observers still hold out hope for another promising anti-amyloid drug, Biogen’s aducanumab, which in an early trial \u003ca href=\"http://www.nature.com/nature/journal/v537/n7618/full/nature19323.html\" target=\"_blank\">improved cognitive decline\u003c/a> in a small number of patients.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Other potentially groundbreaking research aims to intervene before patients even feel any symptoms. Using PET scans, scientists can now identify amyloid plaques building up in a patient’s brain years before they develop Alzheimer’s. The \u003ca href=\"http://a4study.org/about/\" target=\"_blank\">A4 study\u003c/a>, for instance, is testing solanezumab in adults who are accumulating amyloid plaques, but showing no outward signs of Alzheimer’s, such as memory loss or cognitive decline.\u003c/p>\n\u003cp>Other scientists are targeting what they believe is the true culprit, the protein tau, which creates “tangles” in the brain, the disease’s other primary marker.\u003c/p>\n\u003cp>The experiments continue against a bleak backdrop: No new Alzheimer’s therapies have won federal approval since 2003, and Alzheimer’s clinical trials have had a \u003ca href=\"http://alzres.biomedcentral.com/articles/10.1186/alzrt269#B13\" target=\"_blank\">99 percent failure rate\u003c/a>. Patients can access only four Food and Drug Administration-approved Alzheimer’s drugs that alleviate symptoms but do not prevent, slow or reverse brain damage.\u003c/p>\n\u003cp>“The history of clinical trials results has been a history of disappointment,” said Keith Fargo, director of scientific programs and outreach at the Alzheimer’s Association.\u003c/p>\n\u003cp>Still, 77 Alzheimer’s drugs are currently being investigated or developed, according to the trade group PhRMA. And other experiments seek to repurpose FDA-approved drugs for other conditions, such as diabetes or cancer, to see if they can help Alzheimer’s patients — and cut several years from the drug development process.\u003c/p>\n\u003caside class=\"pullquote alignright\">Despite failures, 'there's still more optimism in Alzheimer's research right now than there has been for 10 years.'\u003ccite>Keith Fargo, director of scientific programs and outreach at the Alzheimer’s Association\u003c/cite>\u003c/aside>\n\u003cp>Non-pharmaceutical solutions are also being explored. Observational studies have shown that people who exercise more and have healthier diets seem to get the disease later in life. Researchers are now conducting trials to more closely measure the effects of exercise and diet. One randomized trial underway at Wake Forest University, \u003ca href=\"https://clinicaltrials.gov/ct2/show/NCT02814526\" target=\"_blank\">dubbed EXERT\u003c/a>, is testing the effects of high-intensity aerobic exercise on adults with mild cognitive impairment by enrolling them in exercise programs at a YMCA.\u003c/p>\n\u003cp>Even before last month’s passage of the 21st Century Cures Act, public funding for Alzheimer’s research has been rising. The National Institutes of Health allocated almost $1 billion to Alzheimer’s research in fiscal 2016 — a $350 million increase over the previous year, according to Laurie Ryan, chief of NIH’s Dementias of Aging Branch. There are 468 open clinical trials related to Alzheimer’s, and over a hundred more in progress, \u003ca href=\"https://clinicaltrials.gov/ct2/results?term=alzheimer%27s&Search=Search\" target=\"_blank\">listed on the\u003c/a> government database ClinicalTrials.gov.\u003c/p>\n\u003cp>Meanwhile, Alzheimer’s advocates still grapple with a basic question: Is the rate of Alzheimer’s actually going down? A \u003ca href=\"http://khn.org/news/dementia-rates-decline-sharply-among-senior-citizens/\">study\u003c/a> in JAMA in November found that even as scientists have made no progress in changing Alzheimer’s course, overall dementia rates, which include Alzheimer’s and other dementias, appear to be dramatically declining. The paper cast doubt over a major talking point of the Alzheimer’s lobby: That as baby boomers age, the number of Americans living with Alzheimer’s will explode from the current 5 million \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/23390181\" target=\"_blank\">to 14 million\u003c/a> in 2050. The study also suggested that lifestyle changes may make a difference.\u003c/p>\n\u003cp>While some heralded that as good news, others downplayed the finding.\u003c/p>\n\u003cp>Even if dementia rates drop, Alzheimer’s remains a major killer, and the number of afflicted people will likely still rise, because the US population is aging so rapidly, predicted Fargo. He also questioned the study’s methods, which relied largely on telephone interviews.\u003c/p>\n\u003cp>“It’s not time to let our foot up off the gas,” Fargo said.\u003c/p>\n\u003cp>Eli Lilly’s closely watched trial, dubbed Expedition 3, was the latest potential breakthrough to fall flat. In 2,100 people with mild dementia, solanezumab failed to show significant results compared to a placebo.\u003c/p>\n\u003cp>Some critics said the failure casts doubt on the hotly disputed hypothesis that Alzheimer’s is triggered by the buildup of amyloid plaques.\u003c/p>\n\u003cp>But Eli Lilly spokeswoman Nicole Hebert said more work is needed to test the hypothesis, because the trial explored just one method of removing amyloid, on one subgroup of people. She said the company is pursuing seven other lines of attack.\u003c/p>\n\u003cp>“Rumors of the death of the amyloid hypothesis have been around for many years, and they’re probably premature,” Fargo agreed.\u003c/p>\n\u003cp>Fargo noted that brain imaging has shown that amyloid plaques start to build up 15 to 20 years before signs of dementia appear. So to really test the amyloid hypothesis, he said, scientists may have to intervene earlier than they did in Expedition 3.\u003c/p>\n\u003cp>Despite the latest failure, Fargo said, “there’s still more optimism in Alzheimer’s research right now than there has been for 10 years.”\u003c/p>\n\u003cp>The answer to Alzheimer’s, Ryan said, is not going to be one “magic bullet,” but an array of solutions tailored to different patients.\u003c/p>\n\u003cp>Will scientists ever find a cure?\u003c/p>\n\u003cp>Dr. Ron Petersen, director of the Alzheimer’s Disease Research Center at the Mayo Clinic, isn’t betting on it. But there’s still “a lot going on to be hopeful about,” he said.\u003c/p>\n\u003cp>“I think slowing the progression and/or delaying the onset, are realistic goals.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>KHN’s coverage of end-of-life and serious illness issues is supported by \u003ca href=\"https://www.moore.org/\" target=\"_blank\">The Gordon and Betty Moore Foundation\u003c/a>.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Much has been written about the \u003ca href=\"https://aspe.hhs.gov/sites/default/files/pdf/187551/ACA2010-2016.pdf\">20 million people\u003c/a> who gained health insurance under the Affordable Care Act, and \u003ca href=\"http://www.npr.org/sections/health-shots/2017/01/24/511413971/arizona-children-could-lose-health-coverage-under-obamacare-repeal\">what could happen\u003c/a> to these patients if the ACA is repealed without a replacement. But some people don’t realize that hospitals nationwide could take a big financial hit on several fronts, too.\u003c/p>\n\u003cp>First, it’s likely that fewer patients would be able to pay their hospital bills, health policy analysts say, so the institutions would be stuck with that bad debt, as they were before Obamacare.\u003c/p>\n\u003cp>“If the Medicaid expansion goes away wholesale, and things go back to the way they were before this expansion was in place, a lot of those hospitals would see an increase in their uncompensated care costs,” says \u003ca href=\"http://kff.org/person/rachel-garfield/\">Rachel Garfield\u003c/a>, an analyst with the Kaiser Family Foundation. The American Hospital Association estimates that hospitals across the U.S. could \u003ca href=\"http://www.aha.org/content/16/impact-repeal-aca-exec-summary.pdf\">lose\u003c/a> more than $160 billion from the reduction in Medicaid revenue and the increase in unpaid medical bills.\u003c/p>\n\u003cp>Then there’s this: The ACA has used financial incentives to encourage hospitals to experiment with ways to improve their care of patients, while reducing health care’s cost. That sort of experimentation has included a sizable upfront investment by many hospitals.\u003c/p>\n\u003cp>Massachusetts General Hospital in Boston, for example, signed \u003ca href=\"http://www.partners.org/For-Patients/ACO/\">agreements\u003c/a> with physicians and insurers to create \u003ca href=\"http://www.npr.org/2011/04/01/132937232/accountable-care-organizations-explained\">accountable care organizations\u003c/a>, in hopes of saving money in the long run. With an ACO, insurers pay doctors for making sure the patient is getting the best and most appropriate care, instead of paying for every test and procedure a doctor does.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“We have now more than 20 different programs,” says \u003ca href=\"http://www.massgeneral.org/children/doctors/doctor.aspx?id=16933\">Dr. Timothy Ferris\u003c/a>, an internist and medical director of the Mass General Physicians Organization. “Video visits, electronic consultation with specialists, home hospitalization, [and] programs for patients with diabetes and heart disease. I would be worried that a repeal of the ACA would undermine our ability to invest in services for our patients.”\u003c/p>\n\u003cp>Ferris acknowledges that most of those experiments \u003ca href=\"http://www.npr.org/sections/health-shots/2015/09/14/440240225/medicare-fails-to-save-money-so-far-on-cooperative-care-experiment\">haven’t yet\u003c/a> saved money. But they need more time to work out the kinks safely, he says.\u003c/p>\n\u003cp>“One of the things that it’s difficult for people outside of health care to appreciate — particularly politicians — is how long it takes to make significant improvements in the delivery of care,” Ferris says. “You have to be very careful when you make changes.”\u003c/p>\n\u003cp>Ferris says the threatened repeal of the ACA makes him worry “that the progress we’ve made over the past five years would be threatened.”\u003c/p>\n\u003cp>Many other \u003ca href=\"http://healthaffairs.org/blog/2016/04/21/accountable-care-organizations-in-2016-private-and-public-sector-growth-and-dispersion/\">hospitals across the country\u003c/a> have invested in accountable care organizations — often overhauling their medical records systems, hiring staff and creating new services. \u003ca href=\"http://www.carenewengland.org/about/board-of-directors/dennis-keefe.cfm\">Dennis Keefe\u003c/a>, head of a large hospital chain called \u003ca href=\"http://www.carenewengland.org/\">Care New England\u003c/a> in Rhode Island, says he, too, worries about the future of his ACO, \u003ca href=\"http://www.integracare.org/\">Integra\u003c/a>.\u003c/p>\n\u003cp>“I think, if there’s a real change in direction away from these alternative payment models, we will be assuming risk to care for a population,” Keefe says.”We have invested enormously to be successful in this area.”\u003c/p>\n\u003cp>But these seismic changes in the way hospitals do business were predicated, he adds, on long-term support from the federal government — support that might disappear if the ACA is repealed.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This story is part of NPR’s reporting partnership with NPR, Rhode Island Public Radio and Kaiser Health News. The Kaiser Family Foundation supports Kaiser Health News, an editorially independent program that produces news reports heard on NPR and published on \u003c/em>\u003ca href=\"http://NPR.org\">NPR.org\u003c/a>.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 Rhode Island Public Radio. To see more, visit \u003ca href=\"http://www.ripr.org/\">Rhode Island Public Radio\u003c/a>.\u003cimg decoding=\"async\" src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Hospitals+Worry+Repeal+Of+Obamacare+Would+Jeopardize+Innovations+In+Care&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Much has been written about the \u003ca href=\"https://aspe.hhs.gov/sites/default/files/pdf/187551/ACA2010-2016.pdf\">20 million people\u003c/a> who gained health insurance under the Affordable Care Act, and \u003ca href=\"http://www.npr.org/sections/health-shots/2017/01/24/511413971/arizona-children-could-lose-health-coverage-under-obamacare-repeal\">what could happen\u003c/a> to these patients if the ACA is repealed without a replacement. But some people don’t realize that hospitals nationwide could take a big financial hit on several fronts, too.\u003c/p>\n\u003cp>First, it’s likely that fewer patients would be able to pay their hospital bills, health policy analysts say, so the institutions would be stuck with that bad debt, as they were before Obamacare.\u003c/p>\n\u003cp>“If the Medicaid expansion goes away wholesale, and things go back to the way they were before this expansion was in place, a lot of those hospitals would see an increase in their uncompensated care costs,” says \u003ca href=\"http://kff.org/person/rachel-garfield/\">Rachel Garfield\u003c/a>, an analyst with the Kaiser Family Foundation. The American Hospital Association estimates that hospitals across the U.S. could \u003ca href=\"http://www.aha.org/content/16/impact-repeal-aca-exec-summary.pdf\">lose\u003c/a> more than $160 billion from the reduction in Medicaid revenue and the increase in unpaid medical bills.\u003c/p>\n\u003cp>Then there’s this: The ACA has used financial incentives to encourage hospitals to experiment with ways to improve their care of patients, while reducing health care’s cost. That sort of experimentation has included a sizable upfront investment by many hospitals.\u003c/p>\n\u003cp>Massachusetts General Hospital in Boston, for example, signed \u003ca href=\"http://www.partners.org/For-Patients/ACO/\">agreements\u003c/a> with physicians and insurers to create \u003ca href=\"http://www.npr.org/2011/04/01/132937232/accountable-care-organizations-explained\">accountable care organizations\u003c/a>, in hopes of saving money in the long run. With an ACO, insurers pay doctors for making sure the patient is getting the best and most appropriate care, instead of paying for every test and procedure a doctor does.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“We have now more than 20 different programs,” says \u003ca href=\"http://www.massgeneral.org/children/doctors/doctor.aspx?id=16933\">Dr. Timothy Ferris\u003c/a>, an internist and medical director of the Mass General Physicians Organization. “Video visits, electronic consultation with specialists, home hospitalization, [and] programs for patients with diabetes and heart disease. I would be worried that a repeal of the ACA would undermine our ability to invest in services for our patients.”\u003c/p>\n\u003cp>Ferris acknowledges that most of those experiments \u003ca href=\"http://www.npr.org/sections/health-shots/2015/09/14/440240225/medicare-fails-to-save-money-so-far-on-cooperative-care-experiment\">haven’t yet\u003c/a> saved money. But they need more time to work out the kinks safely, he says.\u003c/p>\n\u003cp>“One of the things that it’s difficult for people outside of health care to appreciate — particularly politicians — is how long it takes to make significant improvements in the delivery of care,” Ferris says. “You have to be very careful when you make changes.”\u003c/p>\n\u003cp>Ferris says the threatened repeal of the ACA makes him worry “that the progress we’ve made over the past five years would be threatened.”\u003c/p>\n\u003cp>Many other \u003ca href=\"http://healthaffairs.org/blog/2016/04/21/accountable-care-organizations-in-2016-private-and-public-sector-growth-and-dispersion/\">hospitals across the country\u003c/a> have invested in accountable care organizations — often overhauling their medical records systems, hiring staff and creating new services. \u003ca href=\"http://www.carenewengland.org/about/board-of-directors/dennis-keefe.cfm\">Dennis Keefe\u003c/a>, head of a large hospital chain called \u003ca href=\"http://www.carenewengland.org/\">Care New England\u003c/a> in Rhode Island, says he, too, worries about the future of his ACO, \u003ca href=\"http://www.integracare.org/\">Integra\u003c/a>.\u003c/p>\n\u003cp>“I think, if there’s a real change in direction away from these alternative payment models, we will be assuming risk to care for a population,” Keefe says.”We have invested enormously to be successful in this area.”\u003c/p>\n\u003cp>But these seismic changes in the way hospitals do business were predicated, he adds, on long-term support from the federal government — support that might disappear if the ACA is repealed.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This story is part of NPR’s reporting partnership with NPR, Rhode Island Public Radio and Kaiser Health News. The Kaiser Family Foundation supports Kaiser Health News, an editorially independent program that produces news reports heard on NPR and published on \u003c/em>\u003ca href=\"http://NPR.org\">NPR.org\u003c/a>.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 Rhode Island Public Radio. To see more, visit \u003ca href=\"http://www.ripr.org/\">Rhode Island Public Radio\u003c/a>.\u003cimg decoding=\"async\" src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Hospitals+Worry+Repeal+Of+Obamacare+Would+Jeopardize+Innovations+In+Care&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Has Technology Ruined the Radiology Profession?",
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"content": "\u003cp>\u003cem>This is an edited excerpt from Robert Wachter's \"\u003cem>\u003ca href=\"https://www.amazon.com/Digital-Doctor-Hope-Medicines-Computer/dp/0071849467\" target=\"_blank\" rel=\"noopener\">The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine's Computer Age\u003c/a>\u003c/em>,\" reprinted with permission from McGraw-Hill. Copyright 2015.\u003c/em>\u003c/p>\n\u003cp>\u003cspan style=\"font-size: 4.6875em;float: left;line-height: 0.733em;padding: 0.05em 0.1em 0 0;font-family: times, serif, georgia\">W\u003c/span>hen I was a medical student in the 1980s, the beating heart of the Hospital of the University of Pennsylvania was not the mahogany-lined executive suite, nor the dazzling operating room of L. Henry Edmunds, Jr., HUP's most famed cardiac surgeon. No, it was in the decidedly unglamorous, dimly lit Chest Reading room, where all the X-rays were hung on a moving contraption called an alternator that resembled the one on which the clothes hang at your local dry cleaner. Controlled by a seated radiologist operating a foot pedal, the machine would cycle through panel after panel until it arrived at your films. The radiologist took his foot off the pedal, the machine ground to a halt, and the dark X-ray sheets were brought to life by intense backlighting.\u003c/p>\n\u003cp>At Penn in the 1980s, everybody — and I mean everybody, from the lowliest student to the loftiest transplant surgeon — brought films for deciphering to the late Wallace Miller, Sr., a crusty but endearing professor of radiology and one of the best teachers I've ever known. For students like me, time spent with him was at once exhilarating and terrifying. \"What's this opacity?\" he asked me once, the memory burned into my hippocampus by that cognitive curing process known as overwhelming anxiety. \"A ... a pneumonia?\" I stammered.\u003c/p>\n\u003cp>\"Mooiaaa,\" retorted The Oracle, an unforgettable signature sound uttered as Miller smartly turned his head away in mock disgust. I loved it. We all did.\u003c/p>\n\u003caside class=\"pullquote alignright\">'One day I tried to see if I could go the whole day without speaking to anyone. And that’s what happened—I didn’t speak to a single person.'\u003ccite>A radiologist\u003c/cite>\u003c/aside>\n\u003cp>Today, many of my internal medicine trainees barely know where the radiology department is. Just as your record player and LPs are now long gone, in your local hospital today, the films, the analog X-ray machines, and even those charming film conveyor belts have left the building.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Why? In 2000, only 8 percent of U.S. hospitals had some version of a game-changing computer technology called the Picture Archiving and Communications System, or PACS. By 2008, more than three out of four did.\u003c/p>\n\u003cp>Because radiology was the first medical specialty to computerize, what has happened to it — at once shocking and, in retrospect, entirely predictable — is our canary in the digital coal mine, its experience offering important lessons for patients, clinicians and health care systems.\u003c/p>\n\u003cp>\u003cstrong>The Beauty of PACS\u003c/strong>\u003c/p>\n\u003cp>While the main catalyst for PACS was economic, the quality of the images and the ability to manipulate them were also important. Unlike regular films, CT scans need to be viewed at various contrast levels: One setting is best to look at bones, another to look at lungs, and still another to look at soft tissue like muscle.\u003c/p>\n\u003cp>PACS allowed radiologists to toggle through these views, in the same way that Instagram lets you play with your photos. You can also use a nifty magnifying glass to zoom in on a part of the image. An unexpected benefit was “stacking”: rather than looking at 100 images arrayed in a 10 × 10 grid on a one-dimensional page, the images could be digitally stacked, one on top of another, allowing the radiologist to scroll through them swiftly by rolling a mouse ball. Moreover, computerization let the radiologist look at the images from home, enabling senior experts to weigh in on subtle findings that trainees might flub. And while the images were fuzzy at first, today they’re as crisp as high-definition television.\u003c/p>\n\u003cp>Perhaps most important, PACS obviated the need for maddening searches for prior X-rays. Twenty years ago, when a chest X-ray revealed a lung nodule, the first commandment on the radiologist’s report was to “obtain old films.” The rationale: If the nodule had been unchanged for many years, it could safely be ignored—such stability simply wasn’t consistent with a diagnosis of cancer. But searching for old films was often an exercise in frustration: They were lost, or locked up, or at another institution, or in a filing cabinet in the thoracic surgeon’s garage, behind the golf clubs. When my colleagues and I came up empty-handed, which was more often than not, the patient frequently paid the price in the form of an unnecessary biopsy. But PACS made finding old films a breeze (assuming that they were done at the same hospital or had been scanned into the system); they’re usually just a click away.\u003c/p>\n\u003cp>While PACS was widely anticipated and generally accepted by radiologists, some prescient observers worried that computerization might lead to unbidden effects on the field. In 1999, Stephen Baker, chair of the Department of Radiology at New Jersey Medical School, fretted that PACS might turn radiologists into “disembodied functionaries, more akin to servicing technicians than professional colleagues.” Paul Chang, professor of radiology at the University of Chicago and an early leader in digital radiology, describes the day his father, a retired radiologist, took him to task.\u003c/p>\n\u003cp>“Before PACS, we were the doctor’s doctor,” his father berated him. “Medicine and surgery rounds started in radiology. . . . Every morning the clinicians and the radiologists collaborated.”\u003c/p>\n\u003cp>His father’s less-than-endearing nickname for his famous son: “The Man Who Ruined Radiology.”\u003c/p>\n\u003cp>The advantages of PACS are so vast that few would want to turn back the clock. Yet the effects on those of us who order X-rays and the radiologists who read them have been profound, and they’re not all positive. The fact that we can now review our images without trekking down to radiology means that we rarely do make the trip.\u003c/p>\n\u003cp>https://www.youtube.com/watch?v=fHUzVqoDnts&ab_channel=DoctorKlioze\u003c/p>\n\u003cp>\u003cstrong>An Awkward Trip to Radiology\u003c/strong>\u003c/p>\n\u003cp>A few years ago, when I asked my interns and students to visit the radiology department to review the key films, they looked at me as if I had grown a second head. After my team humored me by accompanying me to the radiology department, I conducted a little sociology experiment. Standing outside my hospital’s chest reading room, I delivered a brief speech:\u003c/p>\n\u003caside class=\"pullquote alignright\">'Did you look at the official report?' he hissed. The unspoken message was clear: Get out of my space; I’m busy.\u003c/aside>\n\u003cp>\"Watch what happens when we enter. Does anybody turn around and welcome us, ask, 'How can I help you?' and seem genuinely enthusiastic? When they go over the X-ray, do they delve a layer deeper than what they said in the formal report? Do they make any teaching points? Does the radiologist suggest courses of action or ask provocative questions?\"\u003c/p>\n\u003cp>I did this because I am deeply concerned that mine is the last generation to have learned the habit of going to the radiology department. Nostalgic for my interactions with Wally Miller and his like, it saddens me that our current trainees will never know how much they can learn from a great radiology teacher, and how much their patients’ care can be improved by actually talking to a real live radiologist. Yet I know that even if I bring my young horses to water, whether they visit the radiology department after I am no longer their wrangler will be determined by the quality of their experience.\u003c/p>\n\u003cp>We entered the chest reading room and were greeted by a wall of radiologists’ backs, their faces trained like lasers on the computer screens in front of them. Not a single head—located atop the shoulders of about eight different radiologists—turned to greet us.\u003c/p>\n\u003cp>After a couple of awkward minutes of crescendo throat-clearing, one of the radiologists grudgingly swiveled around to face my team and me. “Oh, do you need something?” he asked.\u003c/p>\n\u003cp>“Sure; can you help us look at a few films?”\u003c/p>\n\u003cp>He did, kind of, but offered his help in a whisper animated mostly by passive aggressiveness.\u003c/p>\n\u003cp>I thought it couldn’t get any worse, but it did.\u003c/p>\n\u003cp>“What do you think of this area?” I asked him, pointing to a confusing patch of whiteness on one patient’s chest CT scan.\u003c/p>\n\u003cp>“Did you look at the official report?” he hissed. (In other words: \"Perhaps you don’t know how to turn on your computer?\")\u003c/p>\n\u003cp>The unspoken message was clear: Get out of my space; I’m busy.\u003c/p>\n\u003cp>Now, I understand that he might well be busy, and that it has to be annoying having clinicians interrupt you every few minutes to go over images, particularly after you’ve just reviewed them with a different set of specialists and dictated a report. But that is the radiologist’s job. Or at least it used to be.\u003c/p>\n\u003cp>Allison Tillack, a young radiologist and a medical anthropologist whose Ph.D. thesis involved observing the world of radiologists for a year at a prominent academic hospital, has explored how the computerization of radiology has transformed the worlds of radiologists and those who use their services.\u003c/p>\n\u003cp>\"The ability of PACS to alter the accessibility and tempo of medical imaging has resulted in visits to the reading room being viewed now by non-radiology clinicians as a ‘waste of time’ and by radiologists as an ‘interruption,’” she wrote.\u003c/p>\n\u003cp>\u003cstrong>In a Funk\u003c/strong>\u003c/p>\n\u003cp>While I was well aware of the changing perceptions of radiology by nonradiologists, I had not, until I met Tillack, appreciated the degree to which the field of radiology is itself in a PACS-fueled funk.\u003c/p>\n\u003cp>After all, the field remains extremely popular among medical students, as many perceive it as offering the perfect blend of “great lifestyle” (that is, banker’s hours and limited overnight call) and high income, which averaged $340,000 in 2013. In fact, it’s often said that today’s medical students are attracted to the “ROAD specialties”: Radiology, Ophthalmology, Anesthesiology, and Dermatology, all of which are lucrative and none of which involves a lot of contact with those pesky sick people. In her research, Tillack found that the vast majority of radiologists and radiology residents identified the lack of direct patient contact as one of the main attractions of the field.\u003c/p>\n\u003cp>Given all these pluses, many frontline clinicians think of radiologists as having “won the game.” Yet I should have gotten a hint of the field’s handwringing in 2005, when I saw the results of a survey of physicians regarding their satisfaction with their chosen specialty. The happiest doctors were radiation oncologists (the folks who deliver radiation therapy to cancer patients), who do satisfying work, earn a good income, and have predictable hours. The least happy were cardiac surgeons, who train forever and, in recent years, have seen much of their business eroded by stents and other nonsurgical approaches to heart disease.\u003c/p>\n\u003cp>Radiologists show up a bit below the mean on the satisfaction scale—just behind the perennially overwhelmed and undercompensated primary care doctors.\u003c/p>\n\u003cp>In a 2012 paper, Tillack and a colleague described “the loneliness of the long distance radiologist.” One radiologist told them, “Before, I knew the face, name, wife’s name, and kids’ names of all the clinicians, but now I don’t know who you are if you joined the medical staff after we got PACS. . . . Before, when a clinician showed up, I could ask them and find out what’s really going on with the patient.”\u003c/p>\n\u003cp>I hear similar stories from every radiologist I meet. Patrick Luetmer, a Mayo Clinic neuroradiologist, described what happened when his MRI suite was remodeled. The suite was originally configured with two MRI “donuts” (the huge magnets that are responsible for the image) on either side of a central workstation in which Luetmer sat. There, he could monitor the scans as they were being performed, and talk to both the patients and the radiology assistants. Clinicians sometimes wandered down to look at the scans with him.\u003c/p>\n\u003cp>A few years ago, as part of a big efficiency push, Mayo decided that a third MRI machine was a better use of that central area than the radiologist’s air traffic control desk. Luetmer’s workstation was moved to an office a few hundred feet away, where he could follow the scans on his computer monitor and communicate with the techs via a special text messaging system.\u003c/p>\n\u003cp>“One day I tried to see if I could go the whole day without speaking to anyone. And that’s what happened—I didn’t speak to a single person. It was incredibly isolating.”\u003c/p>\n\u003cfigure id=\"attachment_264998\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2019/10/radiology2.jpg\">\u003cimg class=\"size-large wp-image-264998\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2019/10/radiology2-1180x953.jpg\" alt=\"1950s-era radiology at the U.S. Naval Hospital, Charleston, South Carolina.\" width=\"640\" height=\"517\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2019/10/radiology2-1180x953.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2019/10/radiology2-400x323.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2019/10/radiology2-743x600.jpg 743w, https://ww2.kqed.org/app/uploads/sites/13/2019/10/radiology2-768x620.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2019/10/radiology2-1920x1550.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2019/10/radiology2-960x775.jpg 960w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">1950s-era radiology at the U.S. Naval Hospital, Charleston, South Carolina. \u003ccite>(National Library of Medicine)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The radiologists were lonely, sure, but their situation involves something far deeper. Hari Tsoukas, an expert in organizational studies at the University of Cyprus, highlights the distinction between “information” and “knowledge.” Information, he wrote, “consists of objectified, decontextualized, time-less, impersonal, value-free representations,” whereas knowledge is “context-dependent, personalized, time-bound, and infused with values.”\u003c/p>\n\u003cp>Adds Tillack, “Hunches, hypotheses, frustrations with patients or their families, second guessing, judging of colleagues, and similar activities that mark how uncertainty is negotiated on a daily basis in medical practice are rarely reflected in the medical record . . . this knowledge can only circulate in private or semi-private contexts—by its very definition, this knowledge cannot be made a matter of public record.”\u003c/p>\n\u003cp>By purging the informal conversations during which such information was exchanged, the emergence of PACS left radiologists information-rich (Think of all those pixels! And old films just a click away!), but knowledge-poor.\u003c/p>\n\u003cp>\u003cstrong>'Great Case. Next Case.'\u003c/strong>\u003c/p>\n\u003cp>Radiologists’ alienation runs deeper than the lack of collegial exchange and the inability to find out what’s really going on with the patients. It’s also about power, status, and expertise. The fact that the traditional film lived only in the radiology reading room gave radiologists a monopoly over their entire ecosystem. PACS, observes Tillack, created a new normal in which “the ‘right’ to see [the image] is no longer mediated by radiologists, as it was in the reading room,” and has thus “eroded radiologists’ claims for authoritative knowledge over the interpretation of medical images.”\u003c/p>\n\u003cp>Once the radiology department no longer housed the films, the impact was immediate and dramatic. Without any changes in policy or very much forethought, the mid-1990s transition to filmless operations at the Baltimore VA hospital led to an 82 percent decrease in in-person consultation rates for general radiology studies. Today, many clinicians—particularly specialists like neurologists, pulmonologists, and surgeons—look at images themselves and act on their own interpretations; Many don’t even bother to read the radiologist’s formal report (which usually takes several hours, sometimes even a day, to reach the chart) unless they have unanswered questions or judge the study to be particularly challenging.\u003c/p>\n\u003cp>PACS was to increase efficiency, but that virtue has also become a curse, as radiologists increasingly feel like Lucy and Ethel on the assembly line of the chocolate factory. Among teleradiologists (radiologists reading x-rays from a distant site, often covering emergency departments at night while the hospital’s own radiologists are sleeping), there’s a well-known adage that captures the relentless objectification of their modern predicament: “Great case. Next case.\" As with so many other aspects of our modern digital lives, PACS sped up the clock, and did so without mercy.\u003c/p>\n\u003cp>That clock is constantly ticking. “Instead of waiting for films to be acquired, printed, sorted, and hung, radiologists now are always playing catch-up, looking at more ‘stuff’ in less time,” observed Tillack. That miraculous access to old films also creates an obligation for the radiologist to actually review them.\u003c/p>\n\u003cp>And it’s not just the old films that need to be examined; PACS makes vast amounts of information available with every study. In the early days of CT, the output of a scan might have been about 12 “slices,” each one representing a ¼-inch section through the thorax or abdomen, akin to a thick slice of deli-cut salami. But today’s ultra-fast CT scanners can produce images of more than 50 slices per inch of the human body, more like ultra-thin cuts of prosciutto. And PACS, with its massive memory bank and blazingly fast transmission speeds,can easily display every slice, which means that the radiologist has to scroll through hundreds of images in order to read a single CT study. This combination of more information in each scan, more old studies to compare, and more time pressure is unremitting.\u003c/p>\n\u003cp>The clock is ticking for other reasons as well. Since the image is available to the ordering clinician the moment it is created, radiologists feel obliged to perform their review quickly lest their reading seem like old news, like an afternoon newspaper in the Age of Twitter. Piling on, after recognizing the efficiency of PACS, insurance companies and Medicare slashed the reimbursement for each interpretation, pushing radiologists to read more films in less time in order to maintain their incomes. Said one radiologist, “With PACS, work is busier now. We have 70 percent more cases to read than 10 years ago. . . . At the end of the day . . . I’m fried.”\u003c/p>\n\u003cp>On top of this, there are even greater threats to radiologists’ livelihoods and happiness. One of them flows from the growing pressure on health care systems to slash their costs. Currently, virtually every X-ray performed at a U.S. hospital is sent for a formal reading by a radiologist, who is paid a fee by an insurance company. In today’s cost-cutting environment, it’s probably only a matter of time before some health care systems permit their frontline specialists to officially read certain films, reserving radiologist “overreads” for those images that the clinicians have questions about or the ones with super-high malpractice risk if they are misread. Radiologists can be counted on to fight such a move by frantically waving the banner of quality, but they will need to demonstrate that the value of having them review every film is worth the considerable expense.\u003c/p>\n\u003cp>Moreover, a major theme of Obama-era health reform is a shift from our historical fee-for-service, piecework payment model to one that dispenses a single payment to a hospital and doctors to manage all the care for a group of patients (“accountable care organizations,” ACOs for short) or a given episode of disease (“bundled payments”). Under such systems, the risk for the cost of care shifts from the insurer to the providers, and it’s up to the latter to decide how to divvy up the cash. Ron Arenson, chairman of the department of radiology at the University of California, San Francisco, sees this as the greatest threat to his field.\u003c/p>\n\u003cp>“If the world moves to bundled payments, we won’t do well,” he said. “We’re not very high in the pecking order.”\u003c/p>\n\u003cp>Some nonradiologists, particularly ER doctors working nights and weekends, have little sympathy for their colleagues’ new predicament. In fact, they have begun to wonder why radiologists should be compensated for next-day readings when they’ve already looked at the images themselves, acted on their interpretations, and assumed the risk of being sued if anything goes wrong. In a 2011 editorial entitled “The Life Cycle of a Parasitic Specialist,” ER physician William Mallon took off the gloves.\u003c/p>\n\u003cblockquote>\u003cp>[On Monday morning] these parasites will commence to feed on the financial juices of the lowly unfortunate emergency physicians, who had to work the entire weekend without radiologic support or backup. . . . The radiologist arrives well rested, café latte in hand, and promptly installs himself in a dark room to re-read and bill for all the films the emergency physicians read over the weekend. . . . Never has a specialty done so little for so many and been paid so much.\u003c/p>\u003c/blockquote>\n\u003cp>Ouch.\u003c/p>\n\u003cp>Another challenge to radiology made possible by the death of film has come in the form of teleradiology. Once X-rays went digital, it was no longer crucial for radiologists to be in the same building as the patient or the treating clinicians. As a result, many multihospital systems consolidated their reading rooms, particularly on weekends and nights, with centralized radiologists supporting multiple sites. Predictably, once the technical challenges of connectivity were solved, teleradiology companies emerged to fill this need. As is often the case with contented “legacy” providers (in health care and other industries), traditional radiologists were only too happy to have their colleagues read their films during off-hours. Who wouldn’t be?\u003c/p>\n\u003cp>The playing field soon expanded across national borders, as radiologists in Zurich, Israel, and Singapore began to read nighttime X-rays for American hospitals during their own local daytimes. Hundreds of hospitals now use these \"nighthawks,\" and everybody seems happy about it, including the domestic radiologists, who are sleeping soundly while the overnight images are read half a world away.\u003c/p>\n\u003cp>But one wonders whether this is the start of so-called disruptive innovation, the concept made famous by Harvard’s Clay Christensen. Disruption often begins with a fat and happy incumbent content to preserve its existing enviable position in a market. In industries ranging from commercial aviation to steel manufacturing, an upstart comes in and grabs an unattractive part of the market (in this case, nights and weekends). But once a low-cost company has squeezed through a crack to capture a slice of a previously locked franchise, it is rarely content to stay put. With the average U.S. radiologist earning about $350,000 per year and the average Indian radiologist earning less than one-tenth of that, one wonders whether the same World-is-Flat forces that have revolutionized other industries but mostly bypassed health care will be unleashed.\u003c/p>\n\u003cp>This is where radiologists’ loss of trust and collegiality with other clinicians may exact its heaviest toll. “Some people see teleradiology as a big threat, but I don’t,” UCSF’s Arenson told me. “I think that relationships with radiologists are important.” I do too, which is why I believe he may have his head in the sand: If physicians don’t get much out of visiting the radiology department or have even forgotten where it is located, we have little reason to fight to keep it in our buildings. Or, for that matter, our country.\u003c/p>\n\u003cp>Like all legacy providers faced with a technological or global workforce threat, radiologists can be counted on to argue that quality would take a huge hit if we outsourced their work to less expensive providers, domestic or foreign. The degree to which the field has accepted nighttime readings from non-U.S. radiologists will, of course, undermine this argument. It’s hard to make the claim that a Bangalore-based teleradiologist is sufficiently competent to read an image for your hospital at 3 a.m., but not at 3 p.m.\u003c/p>\n\u003cp>\u003cstrong>The Ultimate Threat\u003c/strong>\u003c/p>\n\u003cp>Finally, there is the ultimate threat: replacement by the machine. Of course, this issue is marbled throughout health care as we enter the digital age. To date, most claims that “this technology will replace doctors” (in areas ranging from diagnostic reasoning to robotic surgery) have proven to be hype.\u003c/p>\n\u003cp>However, in fields that are primarily about visual pattern recognition, the promise (or, if you’re a radiologist, the threat) is much more real. Studies have shown that computers can detect significant numbers of breast cancers and pulmonary emboli missed by radiologists, although nobody has yet taken the bold step of having the computers completely supplant the humans, partly because there are armadas of malpractice attorneys waiting to pounce, and partly because, at least for now, the combination of human and machine seems to perform better than either alone.\u003c/p>\n\u003cp>But over the long haul, I wouldn’t bet on the humans here, particularly since one of the hottest areas in artificial intelligence research is “deep learning”—research that has created computers that are reasonably skilled at “reading,” “hearing,” and, yes, “seeing.” The same kind of software that now allows Facebook to guess that a certain collection of pixels is a picture of you, or that alerts the casino’s security guards to keep an eye on that guy, is likely to eventually crack the code in radiology, and in similar areas such as dermatology and pathology.\u003c/p>\n\u003cp>Slowly, radiologists are waking up to their peril. Rather than isolating themselves from clinical care, some are now relocating their reading stations in clinical areas, such as the ER and the ICU, to be in the line of sight of their clinician colleagues. Others are resurrecting interdisciplinary conferences and training their staff in customer service. Technological solutions that allow radiologists and frontline clinicians to communicate through PACS and the electronic health record are springing up (through programs that create a mash-up of a Skype-like communication tool and a John Madden–style telestrator).\u003c/p>\n\u003cp>Said Paul Chang, the University of Chicago radiologist whose advocacy of PACS so upset his father, “We have to go beyond isolating ourselves and concentrating on messages in a bottle, where we just write a report and are done with it, but instead fostering collaboration.”\u003c/p>\n\u003cp>Since radiology represents such a large segment of health care expenditures (and also a source of harm through the risk of radiation), some health care systems are even putting radiologists in the position of being gatekeepers to their own technology. It’s a role they might not have accepted in the past, but, faced with an existential threat, many now welcome it. Said David Levin, a radiologist at Thomas Jefferson University, “We have to act more like consulting physicians . . . to look at the appropriateness of the requests for advanced imaging studies . . . rather than just going ahead and doing the study.”\u003c/p>\n\u003cp>Radiology’s experience over the past 15 years offers a crystal ball for the rest of the health care system. The speed with which computerization unleashed a series of forces that completely transformed an established field would be all too familiar to travel agents, journalists, and others who have been run over by the digital bulldozer, but it has shocked many health care observers, even astute ones.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>Will the computerization of the rest of medicine similarly upend the lives of other kinds of doctors, as well as their patients? The early returns are in, and the answer is yes.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cem>This is an edited excerpt from Robert Wachter's \"\u003cem>\u003ca href=\"https://www.amazon.com/Digital-Doctor-Hope-Medicines-Computer/dp/0071849467\" target=\"_blank\" rel=\"noopener\">The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine's Computer Age\u003c/a>\u003c/em>,\" reprinted with permission from McGraw-Hill. Copyright 2015.\u003c/em>\u003c/p>\n\u003cp>\u003cspan style=\"font-size: 4.6875em;float: left;line-height: 0.733em;padding: 0.05em 0.1em 0 0;font-family: times, serif, georgia\">W\u003c/span>hen I was a medical student in the 1980s, the beating heart of the Hospital of the University of Pennsylvania was not the mahogany-lined executive suite, nor the dazzling operating room of L. Henry Edmunds, Jr., HUP's most famed cardiac surgeon. No, it was in the decidedly unglamorous, dimly lit Chest Reading room, where all the X-rays were hung on a moving contraption called an alternator that resembled the one on which the clothes hang at your local dry cleaner. Controlled by a seated radiologist operating a foot pedal, the machine would cycle through panel after panel until it arrived at your films. The radiologist took his foot off the pedal, the machine ground to a halt, and the dark X-ray sheets were brought to life by intense backlighting.\u003c/p>\n\u003cp>At Penn in the 1980s, everybody — and I mean everybody, from the lowliest student to the loftiest transplant surgeon — brought films for deciphering to the late Wallace Miller, Sr., a crusty but endearing professor of radiology and one of the best teachers I've ever known. For students like me, time spent with him was at once exhilarating and terrifying. \"What's this opacity?\" he asked me once, the memory burned into my hippocampus by that cognitive curing process known as overwhelming anxiety. \"A ... a pneumonia?\" I stammered.\u003c/p>\n\u003cp>\"Mooiaaa,\" retorted The Oracle, an unforgettable signature sound uttered as Miller smartly turned his head away in mock disgust. I loved it. We all did.\u003c/p>\n\u003caside class=\"pullquote alignright\">'One day I tried to see if I could go the whole day without speaking to anyone. And that’s what happened—I didn’t speak to a single person.'\u003ccite>A radiologist\u003c/cite>\u003c/aside>\n\u003cp>Today, many of my internal medicine trainees barely know where the radiology department is. Just as your record player and LPs are now long gone, in your local hospital today, the films, the analog X-ray machines, and even those charming film conveyor belts have left the building.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Why? In 2000, only 8 percent of U.S. hospitals had some version of a game-changing computer technology called the Picture Archiving and Communications System, or PACS. By 2008, more than three out of four did.\u003c/p>\n\u003cp>Because radiology was the first medical specialty to computerize, what has happened to it — at once shocking and, in retrospect, entirely predictable — is our canary in the digital coal mine, its experience offering important lessons for patients, clinicians and health care systems.\u003c/p>\n\u003cp>\u003cstrong>The Beauty of PACS\u003c/strong>\u003c/p>\n\u003cp>While the main catalyst for PACS was economic, the quality of the images and the ability to manipulate them were also important. Unlike regular films, CT scans need to be viewed at various contrast levels: One setting is best to look at bones, another to look at lungs, and still another to look at soft tissue like muscle.\u003c/p>\n\u003cp>PACS allowed radiologists to toggle through these views, in the same way that Instagram lets you play with your photos. You can also use a nifty magnifying glass to zoom in on a part of the image. An unexpected benefit was “stacking”: rather than looking at 100 images arrayed in a 10 × 10 grid on a one-dimensional page, the images could be digitally stacked, one on top of another, allowing the radiologist to scroll through them swiftly by rolling a mouse ball. Moreover, computerization let the radiologist look at the images from home, enabling senior experts to weigh in on subtle findings that trainees might flub. And while the images were fuzzy at first, today they’re as crisp as high-definition television.\u003c/p>\n\u003cp>Perhaps most important, PACS obviated the need for maddening searches for prior X-rays. Twenty years ago, when a chest X-ray revealed a lung nodule, the first commandment on the radiologist’s report was to “obtain old films.” The rationale: If the nodule had been unchanged for many years, it could safely be ignored—such stability simply wasn’t consistent with a diagnosis of cancer. But searching for old films was often an exercise in frustration: They were lost, or locked up, or at another institution, or in a filing cabinet in the thoracic surgeon’s garage, behind the golf clubs. When my colleagues and I came up empty-handed, which was more often than not, the patient frequently paid the price in the form of an unnecessary biopsy. But PACS made finding old films a breeze (assuming that they were done at the same hospital or had been scanned into the system); they’re usually just a click away.\u003c/p>\n\u003cp>While PACS was widely anticipated and generally accepted by radiologists, some prescient observers worried that computerization might lead to unbidden effects on the field. In 1999, Stephen Baker, chair of the Department of Radiology at New Jersey Medical School, fretted that PACS might turn radiologists into “disembodied functionaries, more akin to servicing technicians than professional colleagues.” Paul Chang, professor of radiology at the University of Chicago and an early leader in digital radiology, describes the day his father, a retired radiologist, took him to task.\u003c/p>\n\u003cp>“Before PACS, we were the doctor’s doctor,” his father berated him. “Medicine and surgery rounds started in radiology. . . . Every morning the clinicians and the radiologists collaborated.”\u003c/p>\n\u003cp>His father’s less-than-endearing nickname for his famous son: “The Man Who Ruined Radiology.”\u003c/p>\n\u003cp>The advantages of PACS are so vast that few would want to turn back the clock. Yet the effects on those of us who order X-rays and the radiologists who read them have been profound, and they’re not all positive. The fact that we can now review our images without trekking down to radiology means that we rarely do make the trip.\u003c/p>\u003c/p>\u003cp>\u003cspan class='utils-parseShortcode-shortcodes-__youtubeShortcode__embedYoutube'>\n \u003cspan class='utils-parseShortcode-shortcodes-__youtubeShortcode__embedYoutubeInside'>\n \u003ciframe\n loading='lazy'\n class='utils-parseShortcode-shortcodes-__youtubeShortcode__youtubePlayer'\n type='text/html'\n src='//www.youtube.com/embed/fHUzVqoDnts'\n title='//www.youtube.com/embed/fHUzVqoDnts'\n allowfullscreen='true'\n style='border:0;'>\u003c/iframe>\n \u003c/span>\n \u003c/span>\u003c/p>\u003cp>\u003cp>\u003cstrong>An Awkward Trip to Radiology\u003c/strong>\u003c/p>\n\u003cp>A few years ago, when I asked my interns and students to visit the radiology department to review the key films, they looked at me as if I had grown a second head. After my team humored me by accompanying me to the radiology department, I conducted a little sociology experiment. Standing outside my hospital’s chest reading room, I delivered a brief speech:\u003c/p>\n\u003caside class=\"pullquote alignright\">'Did you look at the official report?' he hissed. The unspoken message was clear: Get out of my space; I’m busy.\u003c/aside>\n\u003cp>\"Watch what happens when we enter. Does anybody turn around and welcome us, ask, 'How can I help you?' and seem genuinely enthusiastic? When they go over the X-ray, do they delve a layer deeper than what they said in the formal report? Do they make any teaching points? Does the radiologist suggest courses of action or ask provocative questions?\"\u003c/p>\n\u003cp>I did this because I am deeply concerned that mine is the last generation to have learned the habit of going to the radiology department. Nostalgic for my interactions with Wally Miller and his like, it saddens me that our current trainees will never know how much they can learn from a great radiology teacher, and how much their patients’ care can be improved by actually talking to a real live radiologist. Yet I know that even if I bring my young horses to water, whether they visit the radiology department after I am no longer their wrangler will be determined by the quality of their experience.\u003c/p>\n\u003cp>We entered the chest reading room and were greeted by a wall of radiologists’ backs, their faces trained like lasers on the computer screens in front of them. Not a single head—located atop the shoulders of about eight different radiologists—turned to greet us.\u003c/p>\n\u003cp>After a couple of awkward minutes of crescendo throat-clearing, one of the radiologists grudgingly swiveled around to face my team and me. “Oh, do you need something?” he asked.\u003c/p>\n\u003cp>“Sure; can you help us look at a few films?”\u003c/p>\n\u003cp>He did, kind of, but offered his help in a whisper animated mostly by passive aggressiveness.\u003c/p>\n\u003cp>I thought it couldn’t get any worse, but it did.\u003c/p>\n\u003cp>“What do you think of this area?” I asked him, pointing to a confusing patch of whiteness on one patient’s chest CT scan.\u003c/p>\n\u003cp>“Did you look at the official report?” he hissed. (In other words: \"Perhaps you don’t know how to turn on your computer?\")\u003c/p>\n\u003cp>The unspoken message was clear: Get out of my space; I’m busy.\u003c/p>\n\u003cp>Now, I understand that he might well be busy, and that it has to be annoying having clinicians interrupt you every few minutes to go over images, particularly after you’ve just reviewed them with a different set of specialists and dictated a report. But that is the radiologist’s job. Or at least it used to be.\u003c/p>\n\u003cp>Allison Tillack, a young radiologist and a medical anthropologist whose Ph.D. thesis involved observing the world of radiologists for a year at a prominent academic hospital, has explored how the computerization of radiology has transformed the worlds of radiologists and those who use their services.\u003c/p>\n\u003cp>\"The ability of PACS to alter the accessibility and tempo of medical imaging has resulted in visits to the reading room being viewed now by non-radiology clinicians as a ‘waste of time’ and by radiologists as an ‘interruption,’” she wrote.\u003c/p>\n\u003cp>\u003cstrong>In a Funk\u003c/strong>\u003c/p>\n\u003cp>While I was well aware of the changing perceptions of radiology by nonradiologists, I had not, until I met Tillack, appreciated the degree to which the field of radiology is itself in a PACS-fueled funk.\u003c/p>\n\u003cp>After all, the field remains extremely popular among medical students, as many perceive it as offering the perfect blend of “great lifestyle” (that is, banker’s hours and limited overnight call) and high income, which averaged $340,000 in 2013. In fact, it’s often said that today’s medical students are attracted to the “ROAD specialties”: Radiology, Ophthalmology, Anesthesiology, and Dermatology, all of which are lucrative and none of which involves a lot of contact with those pesky sick people. In her research, Tillack found that the vast majority of radiologists and radiology residents identified the lack of direct patient contact as one of the main attractions of the field.\u003c/p>\n\u003cp>Given all these pluses, many frontline clinicians think of radiologists as having “won the game.” Yet I should have gotten a hint of the field’s handwringing in 2005, when I saw the results of a survey of physicians regarding their satisfaction with their chosen specialty. The happiest doctors were radiation oncologists (the folks who deliver radiation therapy to cancer patients), who do satisfying work, earn a good income, and have predictable hours. The least happy were cardiac surgeons, who train forever and, in recent years, have seen much of their business eroded by stents and other nonsurgical approaches to heart disease.\u003c/p>\n\u003cp>Radiologists show up a bit below the mean on the satisfaction scale—just behind the perennially overwhelmed and undercompensated primary care doctors.\u003c/p>\n\u003cp>In a 2012 paper, Tillack and a colleague described “the loneliness of the long distance radiologist.” One radiologist told them, “Before, I knew the face, name, wife’s name, and kids’ names of all the clinicians, but now I don’t know who you are if you joined the medical staff after we got PACS. . . . Before, when a clinician showed up, I could ask them and find out what’s really going on with the patient.”\u003c/p>\n\u003cp>I hear similar stories from every radiologist I meet. Patrick Luetmer, a Mayo Clinic neuroradiologist, described what happened when his MRI suite was remodeled. The suite was originally configured with two MRI “donuts” (the huge magnets that are responsible for the image) on either side of a central workstation in which Luetmer sat. There, he could monitor the scans as they were being performed, and talk to both the patients and the radiology assistants. Clinicians sometimes wandered down to look at the scans with him.\u003c/p>\n\u003cp>A few years ago, as part of a big efficiency push, Mayo decided that a third MRI machine was a better use of that central area than the radiologist’s air traffic control desk. Luetmer’s workstation was moved to an office a few hundred feet away, where he could follow the scans on his computer monitor and communicate with the techs via a special text messaging system.\u003c/p>\n\u003cp>“One day I tried to see if I could go the whole day without speaking to anyone. And that’s what happened—I didn’t speak to a single person. It was incredibly isolating.”\u003c/p>\n\u003cfigure id=\"attachment_264998\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2019/10/radiology2.jpg\">\u003cimg class=\"size-large wp-image-264998\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2019/10/radiology2-1180x953.jpg\" alt=\"1950s-era radiology at the U.S. Naval Hospital, Charleston, South Carolina.\" width=\"640\" height=\"517\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2019/10/radiology2-1180x953.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2019/10/radiology2-400x323.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2019/10/radiology2-743x600.jpg 743w, https://ww2.kqed.org/app/uploads/sites/13/2019/10/radiology2-768x620.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2019/10/radiology2-1920x1550.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2019/10/radiology2-960x775.jpg 960w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">1950s-era radiology at the U.S. Naval Hospital, Charleston, South Carolina. \u003ccite>(National Library of Medicine)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The radiologists were lonely, sure, but their situation involves something far deeper. Hari Tsoukas, an expert in organizational studies at the University of Cyprus, highlights the distinction between “information” and “knowledge.” Information, he wrote, “consists of objectified, decontextualized, time-less, impersonal, value-free representations,” whereas knowledge is “context-dependent, personalized, time-bound, and infused with values.”\u003c/p>\n\u003cp>Adds Tillack, “Hunches, hypotheses, frustrations with patients or their families, second guessing, judging of colleagues, and similar activities that mark how uncertainty is negotiated on a daily basis in medical practice are rarely reflected in the medical record . . . this knowledge can only circulate in private or semi-private contexts—by its very definition, this knowledge cannot be made a matter of public record.”\u003c/p>\n\u003cp>By purging the informal conversations during which such information was exchanged, the emergence of PACS left radiologists information-rich (Think of all those pixels! And old films just a click away!), but knowledge-poor.\u003c/p>\n\u003cp>\u003cstrong>'Great Case. Next Case.'\u003c/strong>\u003c/p>\n\u003cp>Radiologists’ alienation runs deeper than the lack of collegial exchange and the inability to find out what’s really going on with the patients. It’s also about power, status, and expertise. The fact that the traditional film lived only in the radiology reading room gave radiologists a monopoly over their entire ecosystem. PACS, observes Tillack, created a new normal in which “the ‘right’ to see [the image] is no longer mediated by radiologists, as it was in the reading room,” and has thus “eroded radiologists’ claims for authoritative knowledge over the interpretation of medical images.”\u003c/p>\n\u003cp>Once the radiology department no longer housed the films, the impact was immediate and dramatic. Without any changes in policy or very much forethought, the mid-1990s transition to filmless operations at the Baltimore VA hospital led to an 82 percent decrease in in-person consultation rates for general radiology studies. Today, many clinicians—particularly specialists like neurologists, pulmonologists, and surgeons—look at images themselves and act on their own interpretations; Many don’t even bother to read the radiologist’s formal report (which usually takes several hours, sometimes even a day, to reach the chart) unless they have unanswered questions or judge the study to be particularly challenging.\u003c/p>\n\u003cp>PACS was to increase efficiency, but that virtue has also become a curse, as radiologists increasingly feel like Lucy and Ethel on the assembly line of the chocolate factory. Among teleradiologists (radiologists reading x-rays from a distant site, often covering emergency departments at night while the hospital’s own radiologists are sleeping), there’s a well-known adage that captures the relentless objectification of their modern predicament: “Great case. Next case.\" As with so many other aspects of our modern digital lives, PACS sped up the clock, and did so without mercy.\u003c/p>\n\u003cp>That clock is constantly ticking. “Instead of waiting for films to be acquired, printed, sorted, and hung, radiologists now are always playing catch-up, looking at more ‘stuff’ in less time,” observed Tillack. That miraculous access to old films also creates an obligation for the radiologist to actually review them.\u003c/p>\n\u003cp>And it’s not just the old films that need to be examined; PACS makes vast amounts of information available with every study. In the early days of CT, the output of a scan might have been about 12 “slices,” each one representing a ¼-inch section through the thorax or abdomen, akin to a thick slice of deli-cut salami. But today’s ultra-fast CT scanners can produce images of more than 50 slices per inch of the human body, more like ultra-thin cuts of prosciutto. And PACS, with its massive memory bank and blazingly fast transmission speeds,can easily display every slice, which means that the radiologist has to scroll through hundreds of images in order to read a single CT study. This combination of more information in each scan, more old studies to compare, and more time pressure is unremitting.\u003c/p>\n\u003cp>The clock is ticking for other reasons as well. Since the image is available to the ordering clinician the moment it is created, radiologists feel obliged to perform their review quickly lest their reading seem like old news, like an afternoon newspaper in the Age of Twitter. Piling on, after recognizing the efficiency of PACS, insurance companies and Medicare slashed the reimbursement for each interpretation, pushing radiologists to read more films in less time in order to maintain their incomes. Said one radiologist, “With PACS, work is busier now. We have 70 percent more cases to read than 10 years ago. . . . At the end of the day . . . I’m fried.”\u003c/p>\n\u003cp>On top of this, there are even greater threats to radiologists’ livelihoods and happiness. One of them flows from the growing pressure on health care systems to slash their costs. Currently, virtually every X-ray performed at a U.S. hospital is sent for a formal reading by a radiologist, who is paid a fee by an insurance company. In today’s cost-cutting environment, it’s probably only a matter of time before some health care systems permit their frontline specialists to officially read certain films, reserving radiologist “overreads” for those images that the clinicians have questions about or the ones with super-high malpractice risk if they are misread. Radiologists can be counted on to fight such a move by frantically waving the banner of quality, but they will need to demonstrate that the value of having them review every film is worth the considerable expense.\u003c/p>\n\u003cp>Moreover, a major theme of Obama-era health reform is a shift from our historical fee-for-service, piecework payment model to one that dispenses a single payment to a hospital and doctors to manage all the care for a group of patients (“accountable care organizations,” ACOs for short) or a given episode of disease (“bundled payments”). Under such systems, the risk for the cost of care shifts from the insurer to the providers, and it’s up to the latter to decide how to divvy up the cash. Ron Arenson, chairman of the department of radiology at the University of California, San Francisco, sees this as the greatest threat to his field.\u003c/p>\n\u003cp>“If the world moves to bundled payments, we won’t do well,” he said. “We’re not very high in the pecking order.”\u003c/p>\n\u003cp>Some nonradiologists, particularly ER doctors working nights and weekends, have little sympathy for their colleagues’ new predicament. In fact, they have begun to wonder why radiologists should be compensated for next-day readings when they’ve already looked at the images themselves, acted on their interpretations, and assumed the risk of being sued if anything goes wrong. In a 2011 editorial entitled “The Life Cycle of a Parasitic Specialist,” ER physician William Mallon took off the gloves.\u003c/p>\n\u003cblockquote>\u003cp>[On Monday morning] these parasites will commence to feed on the financial juices of the lowly unfortunate emergency physicians, who had to work the entire weekend without radiologic support or backup. . . . The radiologist arrives well rested, café latte in hand, and promptly installs himself in a dark room to re-read and bill for all the films the emergency physicians read over the weekend. . . . Never has a specialty done so little for so many and been paid so much.\u003c/p>\u003c/blockquote>\n\u003cp>Ouch.\u003c/p>\n\u003cp>Another challenge to radiology made possible by the death of film has come in the form of teleradiology. Once X-rays went digital, it was no longer crucial for radiologists to be in the same building as the patient or the treating clinicians. As a result, many multihospital systems consolidated their reading rooms, particularly on weekends and nights, with centralized radiologists supporting multiple sites. Predictably, once the technical challenges of connectivity were solved, teleradiology companies emerged to fill this need. As is often the case with contented “legacy” providers (in health care and other industries), traditional radiologists were only too happy to have their colleagues read their films during off-hours. Who wouldn’t be?\u003c/p>\n\u003cp>The playing field soon expanded across national borders, as radiologists in Zurich, Israel, and Singapore began to read nighttime X-rays for American hospitals during their own local daytimes. Hundreds of hospitals now use these \"nighthawks,\" and everybody seems happy about it, including the domestic radiologists, who are sleeping soundly while the overnight images are read half a world away.\u003c/p>\n\u003cp>But one wonders whether this is the start of so-called disruptive innovation, the concept made famous by Harvard’s Clay Christensen. Disruption often begins with a fat and happy incumbent content to preserve its existing enviable position in a market. In industries ranging from commercial aviation to steel manufacturing, an upstart comes in and grabs an unattractive part of the market (in this case, nights and weekends). But once a low-cost company has squeezed through a crack to capture a slice of a previously locked franchise, it is rarely content to stay put. With the average U.S. radiologist earning about $350,000 per year and the average Indian radiologist earning less than one-tenth of that, one wonders whether the same World-is-Flat forces that have revolutionized other industries but mostly bypassed health care will be unleashed.\u003c/p>\n\u003cp>This is where radiologists’ loss of trust and collegiality with other clinicians may exact its heaviest toll. “Some people see teleradiology as a big threat, but I don’t,” UCSF’s Arenson told me. “I think that relationships with radiologists are important.” I do too, which is why I believe he may have his head in the sand: If physicians don’t get much out of visiting the radiology department or have even forgotten where it is located, we have little reason to fight to keep it in our buildings. Or, for that matter, our country.\u003c/p>\n\u003cp>Like all legacy providers faced with a technological or global workforce threat, radiologists can be counted on to argue that quality would take a huge hit if we outsourced their work to less expensive providers, domestic or foreign. The degree to which the field has accepted nighttime readings from non-U.S. radiologists will, of course, undermine this argument. It’s hard to make the claim that a Bangalore-based teleradiologist is sufficiently competent to read an image for your hospital at 3 a.m., but not at 3 p.m.\u003c/p>\n\u003cp>\u003cstrong>The Ultimate Threat\u003c/strong>\u003c/p>\n\u003cp>Finally, there is the ultimate threat: replacement by the machine. Of course, this issue is marbled throughout health care as we enter the digital age. To date, most claims that “this technology will replace doctors” (in areas ranging from diagnostic reasoning to robotic surgery) have proven to be hype.\u003c/p>\n\u003cp>However, in fields that are primarily about visual pattern recognition, the promise (or, if you’re a radiologist, the threat) is much more real. Studies have shown that computers can detect significant numbers of breast cancers and pulmonary emboli missed by radiologists, although nobody has yet taken the bold step of having the computers completely supplant the humans, partly because there are armadas of malpractice attorneys waiting to pounce, and partly because, at least for now, the combination of human and machine seems to perform better than either alone.\u003c/p>\n\u003cp>But over the long haul, I wouldn’t bet on the humans here, particularly since one of the hottest areas in artificial intelligence research is “deep learning”—research that has created computers that are reasonably skilled at “reading,” “hearing,” and, yes, “seeing.” The same kind of software that now allows Facebook to guess that a certain collection of pixels is a picture of you, or that alerts the casino’s security guards to keep an eye on that guy, is likely to eventually crack the code in radiology, and in similar areas such as dermatology and pathology.\u003c/p>\n\u003cp>Slowly, radiologists are waking up to their peril. Rather than isolating themselves from clinical care, some are now relocating their reading stations in clinical areas, such as the ER and the ICU, to be in the line of sight of their clinician colleagues. Others are resurrecting interdisciplinary conferences and training their staff in customer service. Technological solutions that allow radiologists and frontline clinicians to communicate through PACS and the electronic health record are springing up (through programs that create a mash-up of a Skype-like communication tool and a John Madden–style telestrator).\u003c/p>\n\u003cp>Said Paul Chang, the University of Chicago radiologist whose advocacy of PACS so upset his father, “We have to go beyond isolating ourselves and concentrating on messages in a bottle, where we just write a report and are done with it, but instead fostering collaboration.”\u003c/p>\n\u003cp>Since radiology represents such a large segment of health care expenditures (and also a source of harm through the risk of radiation), some health care systems are even putting radiologists in the position of being gatekeepers to their own technology. It’s a role they might not have accepted in the past, but, faced with an existential threat, many now welcome it. Said David Levin, a radiologist at Thomas Jefferson University, “We have to act more like consulting physicians . . . to look at the appropriateness of the requests for advanced imaging studies . . . rather than just going ahead and doing the study.”\u003c/p>\n\u003cp>Radiology’s experience over the past 15 years offers a crystal ball for the rest of the health care system. The speed with which computerization unleashed a series of forces that completely transformed an established field would be all too familiar to travel agents, journalists, and others who have been run over by the digital bulldozer, but it has shocked many health care observers, even astute ones.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Will the computerization of the rest of medicine similarly upend the lives of other kinds of doctors, as well as their patients? The early returns are in, and the answer is yes.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Obamacare Architect Says Silicon Valley Tech Won't Steer Health Care",
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"content": "\u003cp>Ezekiel Emanuel is one of the architects of the Affordable Care Act, aka Obamacare, aka \u003ca href=\"http://www.npr.org/sections/thetwo-way/2017/01/17/510281627/18-million-people-could-lose-insurance-in-first-year-after-partial-obamacare-rep\" target=\"_blank\" rel=\"noopener\">dead-plan-walking\u003c/a>.\u003c/p>\n\u003cp>He's also a \"techno-skeptic,\" as he called himself the other day during an \u003ca href=\"http://audio.californiareport.org/archive/R201701170850/b\" target=\"_blank\" rel=\"noopener\">interview\u003c/a> with KQED health editor Carrie Feibel. When Feibel asked him if there should be any role to play for the \"data gurus of Silicon Valley\" in whatever comes after the ACA, he literally laughed.\u003c/p>\n\u003caside class=\"pullquote alignright\">'I do think there is an important role for tech, but I think the role is probably not what many of the startup companies around here are thinking of.'\u003ccite>Ezekiel Emanuel\u003c/cite>\u003c/aside>\n\u003cp>\"I do think there is an important role for tech, but I think the role is probably not what many of the startup companies around here are thinking of,\" he said, \"around here\" meaning San Francisco and Silicon Valley. Emanuel said tech should play a support role that \"augments\" what health care providers do, providing better data about the patient and where health care funds are spent.\u003c/p>\n\u003cp>\"I am much more skeptical that the computer is going to replace a doctor,\" he said. \"That a computer is going to interface with the patient and take care of them. Not gonna happen.\" (See our posts \"\u003ca href=\"https://ww2.kqed.org/futureofyou/2016/11/07/AI-computers-diagnosis-watson/\" target=\"_blank\" rel=\"noopener\">Will Computers Ever Be as Good as Physicians at Diagnosing Patients\u003c/a>\" and \"\u003ca href=\"https://ww2.kqed.org/futureofyou/2016/02/03/virtual_care_clinic_usc/\" target=\"_blank\" rel=\"noopener\">Would You See a Holographic Doctor?\" \u003c/a>for high hopes surrounding digital docs.)\u003c/p>\n\u003cp>Emanuel said he's also not big on efforts to achieve continuous patient monitoring for health indicators like glucose level and blood pressure. He cited the \u003ca href=\"https://ww2.kqed.org/futureofyou/2016/10/10/fitbit-study/\" target=\"_blank\" rel=\"noopener\">failure of Fitbits and other wearable tech\u003c/a> to improve health outcomes in research studies.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"It’s not that we don’t have information,\" he said. \"The problem is what do you do once you have the information. And there, tech is not going to be the key thing. Medicine fundamentally is about human interaction. That is really the most important challenge, and I don’t think the tech sector has locked onto that part of it.\"\u003c/p>\n\u003cp>This sort of digital contrarianism is not unheard of in the health care biz, even at events and panels where tech-oriented medicine is the focus. Last September, for instance, at the Stanford Medicine X conference, Stephen Downs, the chief technical officer at the Robert Wood Johnson Foundation, said digital health companies\u003ca href=\"https://ww2.kqed.org/futureofyou/2016/09/29/analysis-digital-health-companies-arent-solving-the-right-problems/\" target=\"_blank\" rel=\"noopener\"> weren't focused on solving the right problems\u003c/a>. From a report by KQED's Lesley McClurg:\u003c/p>\n\u003cblockquote>\u003cp>In this age of the Fitbit, Downs said, digital health companies are focused on monitoring the consequences of our \u003ca href=\"http://stateofobesity.org/physical-inactivity/\" target=\"_blank\" rel=\"noopener\">notoriously sedentary lifestyles. \u003c/a>But what is really called for from innovators is to stop treating symptoms and start remedying the roots of the problem.\u003c/p>\n\u003cp>“The system needs to be re-engineered,” said Downs. ... “We don’t need an app that counts steps, because that really just tells you that your day doesn’t naturally incorporate the time and space to walk.”\u003c/p>\u003c/blockquote>\n\u003cp>Instead of a focus on monitoring, he said, engineers and designers need to incorporate solutions --such as enabling urban farming --to core health problems like obesity and heart disease. \u003cstrong>\u003cbr>\n\u003c/strong>\u003c/p>\n\u003cp>\u003cstrong>Policy Versus Scientific Advances\u003c/strong>\u003c/p>\n\u003cp>Several times now at conferences I've witnessed one expert or another--in the midst of a coterie of big data boosters and monitoring mavens, no less--offer up a kind of indirect scolding by cautioning that the best way to improve health is not via smartphones, but smart policy.\u003c/p>\n\u003cp>That dichotomy to some degree echoes a conversation I once had with a longtime health journalist who thought even something as institutionally sanctioned and evidence-based as \u003ca href=\"https://ww2.kqed.org/futureofyou/2017/01/20/time-running-out-california-stem-cell-agency-yet-to-produce-big-results/\" target=\"_blank\" rel=\"noopener\">California's stem cell initiative\u003c/a> was a waste of money, because the funds would have been better directed toward policy prescriptions that address basic health needs.\u003c/p>\n\u003cp>I asked Emanuel to comment on this point, specifically mentioning stem cells.\u003c/p>\n\u003cp>\"Here's a thought experiment,\" he said. \"You know how many lives stem cells have saved? A tiny number compared to the 2.7 million people [in the U.S.] who die each year.\u003c/p>\n\u003cp>\"Now, how many lives have been saved by the ACA?\" he said. \"I don’t know, but it ain’t zero. I intersect with people all the time who happen to recognize me on the street and say I or a family friend got diagnosed with cancer and got therapy or got a heart transplant or something like that.\u003c/p>\n\u003cp>\"In the future, even under a rosy projection, stem cells will not save tons of people,\" he said. \"If you were to cure every single cancer in the U.S.-- no one in America ever dies again of cancer--we add three years to the average life expectancy. It’s a big improvement but it is not anything close to [gains achieved by] doing the basics.\"\u003c/p>\n\u003cp>The two most effective goals for increasing longevity, he said, would be to reduce smoking even further and to control blood pressure.\u003c/p>\n\u003cp>\"We’re not talking high tech,\" he said. \"There is nothing you can do that is going to come close to those two interventions.\"\u003c/p>\n\u003cp>Of course, medical value depends on your perspective, and Emanuel's is a public health view. Someone suffering from any number of horrendous diseases that stem cell research is targeting is not going to be thinking: \"Boy, what a waste to be chasing stem cell cures. I sure wish they'd divert that money to anti-smoking programs.\"\u003c/p>\n\u003cp>And even on the health tech front, some doctors have come around to viewing digital monitoring devices like \u003ca href=\"https://ww2.kqed.org/futureofyou/2016/03/17/mobile-ekg-on-a-watchband-is-useful-for-some-say-docs/\" target=\"_blank\" rel=\"noopener\">mobile EKGs\u003c/a> as useful.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>As for computers versus doctors, physician and author Bob Wachter, has written that radiology may be the \u003ca href=\"https://ww2.kqed.org/futureofyou/2016/10/25/technology-radiology/\" target=\"_blank\" rel=\"noopener\">canary in the coal mine\u003c/a> in terms of algorithms replacing humans.\u003c/p>\n\n",
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"excerpt": "In interviews, Ezekiel Emanuel, a former adviser on health care to President Obama, disses digital health monitoring and even stem cell research. ",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Ezekiel Emanuel is one of the architects of the Affordable Care Act, aka Obamacare, aka \u003ca href=\"http://www.npr.org/sections/thetwo-way/2017/01/17/510281627/18-million-people-could-lose-insurance-in-first-year-after-partial-obamacare-rep\" target=\"_blank\" rel=\"noopener\">dead-plan-walking\u003c/a>.\u003c/p>\n\u003cp>He's also a \"techno-skeptic,\" as he called himself the other day during an \u003ca href=\"http://audio.californiareport.org/archive/R201701170850/b\" target=\"_blank\" rel=\"noopener\">interview\u003c/a> with KQED health editor Carrie Feibel. When Feibel asked him if there should be any role to play for the \"data gurus of Silicon Valley\" in whatever comes after the ACA, he literally laughed.\u003c/p>\n\u003caside class=\"pullquote alignright\">'I do think there is an important role for tech, but I think the role is probably not what many of the startup companies around here are thinking of.'\u003ccite>Ezekiel Emanuel\u003c/cite>\u003c/aside>\n\u003cp>\"I do think there is an important role for tech, but I think the role is probably not what many of the startup companies around here are thinking of,\" he said, \"around here\" meaning San Francisco and Silicon Valley. Emanuel said tech should play a support role that \"augments\" what health care providers do, providing better data about the patient and where health care funds are spent.\u003c/p>\n\u003cp>\"I am much more skeptical that the computer is going to replace a doctor,\" he said. \"That a computer is going to interface with the patient and take care of them. Not gonna happen.\" (See our posts \"\u003ca href=\"https://ww2.kqed.org/futureofyou/2016/11/07/AI-computers-diagnosis-watson/\" target=\"_blank\" rel=\"noopener\">Will Computers Ever Be as Good as Physicians at Diagnosing Patients\u003c/a>\" and \"\u003ca href=\"https://ww2.kqed.org/futureofyou/2016/02/03/virtual_care_clinic_usc/\" target=\"_blank\" rel=\"noopener\">Would You See a Holographic Doctor?\" \u003c/a>for high hopes surrounding digital docs.)\u003c/p>\n\u003cp>Emanuel said he's also not big on efforts to achieve continuous patient monitoring for health indicators like glucose level and blood pressure. He cited the \u003ca href=\"https://ww2.kqed.org/futureofyou/2016/10/10/fitbit-study/\" target=\"_blank\" rel=\"noopener\">failure of Fitbits and other wearable tech\u003c/a> to improve health outcomes in research studies.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"It’s not that we don’t have information,\" he said. \"The problem is what do you do once you have the information. And there, tech is not going to be the key thing. Medicine fundamentally is about human interaction. That is really the most important challenge, and I don’t think the tech sector has locked onto that part of it.\"\u003c/p>\n\u003cp>This sort of digital contrarianism is not unheard of in the health care biz, even at events and panels where tech-oriented medicine is the focus. Last September, for instance, at the Stanford Medicine X conference, Stephen Downs, the chief technical officer at the Robert Wood Johnson Foundation, said digital health companies\u003ca href=\"https://ww2.kqed.org/futureofyou/2016/09/29/analysis-digital-health-companies-arent-solving-the-right-problems/\" target=\"_blank\" rel=\"noopener\"> weren't focused on solving the right problems\u003c/a>. From a report by KQED's Lesley McClurg:\u003c/p>\n\u003cblockquote>\u003cp>In this age of the Fitbit, Downs said, digital health companies are focused on monitoring the consequences of our \u003ca href=\"http://stateofobesity.org/physical-inactivity/\" target=\"_blank\" rel=\"noopener\">notoriously sedentary lifestyles. \u003c/a>But what is really called for from innovators is to stop treating symptoms and start remedying the roots of the problem.\u003c/p>\n\u003cp>“The system needs to be re-engineered,” said Downs. ... “We don’t need an app that counts steps, because that really just tells you that your day doesn’t naturally incorporate the time and space to walk.”\u003c/p>\u003c/blockquote>\n\u003cp>Instead of a focus on monitoring, he said, engineers and designers need to incorporate solutions --such as enabling urban farming --to core health problems like obesity and heart disease. \u003cstrong>\u003cbr>\n\u003c/strong>\u003c/p>\n\u003cp>\u003cstrong>Policy Versus Scientific Advances\u003c/strong>\u003c/p>\n\u003cp>Several times now at conferences I've witnessed one expert or another--in the midst of a coterie of big data boosters and monitoring mavens, no less--offer up a kind of indirect scolding by cautioning that the best way to improve health is not via smartphones, but smart policy.\u003c/p>\n\u003cp>That dichotomy to some degree echoes a conversation I once had with a longtime health journalist who thought even something as institutionally sanctioned and evidence-based as \u003ca href=\"https://ww2.kqed.org/futureofyou/2017/01/20/time-running-out-california-stem-cell-agency-yet-to-produce-big-results/\" target=\"_blank\" rel=\"noopener\">California's stem cell initiative\u003c/a> was a waste of money, because the funds would have been better directed toward policy prescriptions that address basic health needs.\u003c/p>\n\u003cp>I asked Emanuel to comment on this point, specifically mentioning stem cells.\u003c/p>\n\u003cp>\"Here's a thought experiment,\" he said. \"You know how many lives stem cells have saved? A tiny number compared to the 2.7 million people [in the U.S.] who die each year.\u003c/p>\n\u003cp>\"Now, how many lives have been saved by the ACA?\" he said. \"I don’t know, but it ain’t zero. I intersect with people all the time who happen to recognize me on the street and say I or a family friend got diagnosed with cancer and got therapy or got a heart transplant or something like that.\u003c/p>\n\u003cp>\"In the future, even under a rosy projection, stem cells will not save tons of people,\" he said. \"If you were to cure every single cancer in the U.S.-- no one in America ever dies again of cancer--we add three years to the average life expectancy. It’s a big improvement but it is not anything close to [gains achieved by] doing the basics.\"\u003c/p>\n\u003cp>The two most effective goals for increasing longevity, he said, would be to reduce smoking even further and to control blood pressure.\u003c/p>\n\u003cp>\"We’re not talking high tech,\" he said. \"There is nothing you can do that is going to come close to those two interventions.\"\u003c/p>\n\u003cp>Of course, medical value depends on your perspective, and Emanuel's is a public health view. Someone suffering from any number of horrendous diseases that stem cell research is targeting is not going to be thinking: \"Boy, what a waste to be chasing stem cell cures. I sure wish they'd divert that money to anti-smoking programs.\"\u003c/p>\n\u003cp>And even on the health tech front, some doctors have come around to viewing digital monitoring devices like \u003ca href=\"https://ww2.kqed.org/futureofyou/2016/03/17/mobile-ekg-on-a-watchband-is-useful-for-some-say-docs/\" target=\"_blank\" rel=\"noopener\">mobile EKGs\u003c/a> as useful.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>As for computers versus doctors, physician and author Bob Wachter, has written that radiology may be the \u003ca href=\"https://ww2.kqed.org/futureofyou/2016/10/25/technology-radiology/\" target=\"_blank\" rel=\"noopener\">canary in the coal mine\u003c/a> in terms of algorithms replacing humans.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Food as Medicine is No Longer a Fringe Idea",
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"content": "\u003cp>Several times a month, you can find a doctor in the aisles of Ralph’s market in Huntington Beach, wearing a white coat and helping people learn about food. On one recent day, this doctor was Daniel Nadeau, wandering the cereal aisle with Allison Scott, offering ideas on how to feed kids who studiously avoid anything that tastes healthy.\u003c/p>\n\u003caside class=\"pullquote alignright\">'What people eat can be medicine or poison.'\u003ccite>Dr. Brenda Rea,\u003cbr>\nLoma Linda University School of Medicine\u003c/cite>\u003c/aside>\n\u003cp>“Have you thought about trying smoothies in the morning?” he asks her. “The frozen blueberries and raspberries are a little cheaper, and berries are really good for the brain.”\u003c/p>\n\u003cp>Scott knows about smoothies, actually. She's been cooking a plant-based diet for her family for about nine months, a decision prompted by her husband being diagnosed with systemic inflammation. Scott cooks a couple of hours a day to prepare meals from whole foods. So when she saw a doctor in Ralph's, Scott says, she was delighted to find someone talking about the very thing that has been consuming her life: food as medicine.\u003c/p>\n\u003cp>Nadeau is program director of the nearby \u003ca href=\"https://www.hoag.org/specialties-services/other-programs-services/diabetes-center/\" target=\"_blank\">Mary and Dick Allen Diabetes Center\u003c/a>, part of the \u003ca href=\"http://www.stjosephhoaghealth.org/\" target=\"_blank\">St. Joseph Hoag Health\u003c/a> alliance. The Center's Shop with Your Doc program sends doctors to the grocery store to meet with any patients who sign up for the service, plus any other shoppers who happen by with questions.\u003c/p>\n\u003cp>[contextly_sidebar id=\"0Y40yWL0gmXDr7is5zaqMMREfSYlmCuR\"]“In America, over 50 percent of our food is processed food,” Nadeau says. “And only 5 percent of our food is plant-based food. I think we should try to reverse that.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>It can be hard work, as anyone who's tried to eat more vegetables or quit sugar knows. Part of the work is learning about nutrition and making time to cook, says Scott, who in the beginning ran all her menus past a nutritionist, and sometimes uses a service that delivers her a box of organic food and recipes to prepare it. And for her, another part is getting her two boys, 5 and 8, to make the same changes.\u003c/p>\n\u003cp>\"I always make them try a bite of every single thing I make,\" she says. \"The kids get so mad at me, still, even though they're starting to eat better.\"\u003c/p>\n\u003cp>\u003cstrong>A Small Revolution Brewing\u003c/strong>\u003c/p>\n\u003cp>Scott and Nadeau are part of a small revolution brewing across California. The food-as-medicine movement has been around for decades, but it's making new inroads as physicians and medical institutions make food a formal part of treatment, rather than relying solely on medications. By prescribing nutritional changes or launching programs such as Shop with Your Doc, they're trying to prevent, limit or even reverse disease by changing what patients eat.\u003c/p>\n\u003cp>“There’s no question people can take things a long way toward \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/12323113\" target=\"_blank\">reversing diabetes\u003c/a>, reversing hypertension, even \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/20706936\" target=\"_blank\">preventing cancer\u003c/a> by food choices,” Nadeau says.\u003c/p>\n\u003cfigure id=\"attachment_313608\" class=\"wp-caption alignright\" style=\"max-width: 800px\">\u003ca href=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/01/SF-FoodPantry-63-lowres.jpg\">\u003cimg class=\"size-medium wp-image-313608\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/01/SF-FoodPantry-63-lowres-800x533.jpg\" alt=\"Clients in a pilot program for pregnant women with diabetes choose from an array of fresh fruits and vegetables, at the Community Wellness Program Center at Zuckerberg San Francisco General Hospital.\" width=\"800\" height=\"533\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/01/SF-FoodPantry-63-lowres-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/SF-FoodPantry-63-lowres-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/SF-FoodPantry-63-lowres-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/SF-FoodPantry-63-lowres-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/SF-FoodPantry-63-lowres-1920x1280.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/SF-FoodPantry-63-lowres-1180x786.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/SF-FoodPantry-63-lowres-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/SF-FoodPantry-63-lowres-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/SF-FoodPantry-63-lowres-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/SF-FoodPantry-63-lowres-520x347.jpg 520w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/SF-FoodPantry-63-lowres.jpg 2000w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">A client in a pilot program for pregnant women with diabetes chooses from an array of fresh fruits and vegetables, with help from a volunteer, at the Community Wellness Program Center at Zuckerberg San Francisco General Hospital. \u003ccite>(UCSF)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>In the big picture, says Dr. Richard Afable, CEO and President of St. Joseph Hoag Health, medical institutions across the state are starting to make a philosophical switch to becoming a health organization, not just a health care organization.\u003c/p>\n\u003cp>That sentiment echoes the tenets of the Therapeutic Food Pantry program at Zuckerberg San Francisco General Hospital, which completed its pilot phase and is about to expand on an ongoing basis to five clinic sites throughout the city. The program will offer patients several bags of food prescribed for their condition, along with intensive training in how to cook it.\u003c/p>\n\u003cp>“We really want to link food and medicine, and not just give away food,\" says Dr. Rita Nguyen, the hospital's medical director of Healthy Food Initiatives. \"We want people to understand what they’re eating, how to prepare it, the role food plays in their lives.”\u003c/p>\n\u003cp>In Southern California, \u003ca href=\"https://medicine.llu.edu/\" target=\"_blank\">Loma Linda University School of Medicine \u003c/a>is offering specialized training for its resident physicians in \u003ca href=\"https://medical-center.lomalindahealth.org/health-professionals/graduate-medical-education/prospective-residents/residency-programs/education-concentrations/lifestyle-medicine\" target=\"_blank\">Lifestyle Medicine\u003c/a>—that's a formal subspecialty in using food to treat disease.\u003c/p>\n\u003cp>Research on the power of food to treat or reverse disease is beginning to accumulate, but that doesn't mean diet alone is always the solution, or that every illness can benefit substantially from dietary changes. Nonetheless, physicians say they look at the cumulative data and a clear picture emerges: that the salt, sugar, fat and processed foods in the American diet contribute to the nation’s high rates of obesity, diabetes and heart disease. According to the World Health Organization, \u003ca href=\"http://www.who.int/chp/chronic_disease_report/full_report.pdf\" target=\"_blank\">80 percent of deaths\u003c/a> from heart disease and stroke are caused by high blood pressure, tobacco use, elevated cholesterol and low consumption of fruits and vegetables.\u003c/p>\n\u003cp>“It’s a different paradigm of how to treat disease,” says Dr. Brenda Rea, who helps run the family and preventive medicine residency program at Loma Linda University School of Medicine.\u003c/p>\n\u003cp>\u003cstrong>Choosing What Foods to Prescribe\u003c/strong>\u003c/p>\n\u003cp>The lifestyle medicine subspecialty is designed to train doctors in how to prevent and treat disease, in part, by changing patients' nutritional habits. The medical center and school at Loma Linda also has a food pantry and kitchen for patients.\u003c/p>\n\u003cfigure id=\"attachment_310967\" class=\"wp-caption alignright\" style=\"max-width: 800px\">\u003ca href=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/12/doc-at-Ralphs.jpg\">\u003cimg class=\"size-medium wp-image-310967\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/12/doc-at-Ralphs-800x600.jpg\" alt=\"St. Joseph Hoag Hospital gives out shopping bags to people who consult the doctor about food choices.\" width=\"800\" height=\"600\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2016/12/doc-at-Ralphs-800x600.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2016/12/doc-at-Ralphs-160x120.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2016/12/doc-at-Ralphs-768x576.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2016/12/doc-at-Ralphs-1020x765.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2016/12/doc-at-Ralphs-1920x1440.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2016/12/doc-at-Ralphs-1180x885.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2016/12/doc-at-Ralphs-960x720.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2016/12/doc-at-Ralphs-240x180.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2016/12/doc-at-Ralphs-375x281.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2016/12/doc-at-Ralphs-520x390.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">St. Joseph Hoag Hospital gives out shopping bags to people who consult the doctor about food choices. \u003ccite>(David Gorn/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Many people don’t know how to cook, Rea says; they only know how to heat things up. That means depending on packaged food with high salt and sugar content. So teaching people about which foods are nutritious and how to prepare them, she says, can actually transform a patient’s life. And beyond that, it might transform the health and lives of that patient’s family.\u003c/p>\n\u003cp>“What people eat can be medicine or poison,” Rea says. “As a physician, nutrition is one of the most powerful things you can change to \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4921549/\" target=\"_blank\">reverse\u003c/a> the effects of \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/12323113\" target=\"_blank\">chronic disease\u003c/a>.”\u003c/p>\n\u003cp>Studies have explored evidence that dietary changes can \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/20674303\" target=\"_blank\">slow inflammation\u003c/a>, for example, or make the body \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/21977033\" target=\"_blank\">inhospitable\u003c/a> to cancer cells.\u003c/p>\n\u003cp>In general, many lifestyle medicine physicians recommend a plant-based diet—particularly for people with diabetes or other inflammatory conditions.\u003c/p>\n\u003cp>“As what happened with tobacco, this will require a cultural shift, but that can happen,\" says Dr. Nguyen. \"In the same way physicians used to smoke, and then stopped smoking and were able to talk to patients about it, I think physicians can have a bigger voice in it.”\u003c/p>\n\u003cp>From her own experience, Allison Scott suggests that anyone making the switch to a plant-based diet have support, because \"it's a complete lifestyle change.\"\u003c/p>\n\u003cp>\"You have to stop buying what's on sale,\" she says. \"You have to go into the store knowing what you want to buy.\"\u003c/p>\n\u003cp>And if you're cooking for a family, she says, plan all your food in advance and have it already on hand.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>One more tip for people who want to quit sugar: read labels. Most salad dressings, soups and breads contain sugar. Even Amy's organic tomato soup. Go figure.\u003c/p>\n\n",
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"excerpt": "What we put in our bodies can be medicine. Literally. Food wisdom now finds its way into hospitals and even medical schools.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Several times a month, you can find a doctor in the aisles of Ralph’s market in Huntington Beach, wearing a white coat and helping people learn about food. On one recent day, this doctor was Daniel Nadeau, wandering the cereal aisle with Allison Scott, offering ideas on how to feed kids who studiously avoid anything that tastes healthy.\u003c/p>\n\u003caside class=\"pullquote alignright\">'What people eat can be medicine or poison.'\u003ccite>Dr. Brenda Rea,\u003cbr>\nLoma Linda University School of Medicine\u003c/cite>\u003c/aside>\n\u003cp>“Have you thought about trying smoothies in the morning?” he asks her. “The frozen blueberries and raspberries are a little cheaper, and berries are really good for the brain.”\u003c/p>\n\u003cp>Scott knows about smoothies, actually. She's been cooking a plant-based diet for her family for about nine months, a decision prompted by her husband being diagnosed with systemic inflammation. Scott cooks a couple of hours a day to prepare meals from whole foods. So when she saw a doctor in Ralph's, Scott says, she was delighted to find someone talking about the very thing that has been consuming her life: food as medicine.\u003c/p>\n\u003cp>Nadeau is program director of the nearby \u003ca href=\"https://www.hoag.org/specialties-services/other-programs-services/diabetes-center/\" target=\"_blank\">Mary and Dick Allen Diabetes Center\u003c/a>, part of the \u003ca href=\"http://www.stjosephhoaghealth.org/\" target=\"_blank\">St. Joseph Hoag Health\u003c/a> alliance. The Center's Shop with Your Doc program sends doctors to the grocery store to meet with any patients who sign up for the service, plus any other shoppers who happen by with questions.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>“In America, over 50 percent of our food is processed food,” Nadeau says. “And only 5 percent of our food is plant-based food. I think we should try to reverse that.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>It can be hard work, as anyone who's tried to eat more vegetables or quit sugar knows. Part of the work is learning about nutrition and making time to cook, says Scott, who in the beginning ran all her menus past a nutritionist, and sometimes uses a service that delivers her a box of organic food and recipes to prepare it. And for her, another part is getting her two boys, 5 and 8, to make the same changes.\u003c/p>\n\u003cp>\"I always make them try a bite of every single thing I make,\" she says. \"The kids get so mad at me, still, even though they're starting to eat better.\"\u003c/p>\n\u003cp>\u003cstrong>A Small Revolution Brewing\u003c/strong>\u003c/p>\n\u003cp>Scott and Nadeau are part of a small revolution brewing across California. The food-as-medicine movement has been around for decades, but it's making new inroads as physicians and medical institutions make food a formal part of treatment, rather than relying solely on medications. By prescribing nutritional changes or launching programs such as Shop with Your Doc, they're trying to prevent, limit or even reverse disease by changing what patients eat.\u003c/p>\n\u003cp>“There’s no question people can take things a long way toward \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/12323113\" target=\"_blank\">reversing diabetes\u003c/a>, reversing hypertension, even \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/20706936\" target=\"_blank\">preventing cancer\u003c/a> by food choices,” Nadeau says.\u003c/p>\n\u003cfigure id=\"attachment_313608\" class=\"wp-caption alignright\" style=\"max-width: 800px\">\u003ca href=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/01/SF-FoodPantry-63-lowres.jpg\">\u003cimg class=\"size-medium wp-image-313608\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/01/SF-FoodPantry-63-lowres-800x533.jpg\" alt=\"Clients in a pilot program for pregnant women with diabetes choose from an array of fresh fruits and vegetables, at the Community Wellness Program Center at Zuckerberg San Francisco General Hospital.\" width=\"800\" height=\"533\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/01/SF-FoodPantry-63-lowres-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/SF-FoodPantry-63-lowres-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/SF-FoodPantry-63-lowres-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/SF-FoodPantry-63-lowres-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/SF-FoodPantry-63-lowres-1920x1280.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/SF-FoodPantry-63-lowres-1180x786.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/SF-FoodPantry-63-lowres-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/SF-FoodPantry-63-lowres-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/SF-FoodPantry-63-lowres-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/SF-FoodPantry-63-lowres-520x347.jpg 520w, https://ww2.kqed.org/app/uploads/sites/13/2017/01/SF-FoodPantry-63-lowres.jpg 2000w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">A client in a pilot program for pregnant women with diabetes chooses from an array of fresh fruits and vegetables, with help from a volunteer, at the Community Wellness Program Center at Zuckerberg San Francisco General Hospital. \u003ccite>(UCSF)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>In the big picture, says Dr. Richard Afable, CEO and President of St. Joseph Hoag Health, medical institutions across the state are starting to make a philosophical switch to becoming a health organization, not just a health care organization.\u003c/p>\n\u003cp>That sentiment echoes the tenets of the Therapeutic Food Pantry program at Zuckerberg San Francisco General Hospital, which completed its pilot phase and is about to expand on an ongoing basis to five clinic sites throughout the city. The program will offer patients several bags of food prescribed for their condition, along with intensive training in how to cook it.\u003c/p>\n\u003cp>“We really want to link food and medicine, and not just give away food,\" says Dr. Rita Nguyen, the hospital's medical director of Healthy Food Initiatives. \"We want people to understand what they’re eating, how to prepare it, the role food plays in their lives.”\u003c/p>\n\u003cp>In Southern California, \u003ca href=\"https://medicine.llu.edu/\" target=\"_blank\">Loma Linda University School of Medicine \u003c/a>is offering specialized training for its resident physicians in \u003ca href=\"https://medical-center.lomalindahealth.org/health-professionals/graduate-medical-education/prospective-residents/residency-programs/education-concentrations/lifestyle-medicine\" target=\"_blank\">Lifestyle Medicine\u003c/a>—that's a formal subspecialty in using food to treat disease.\u003c/p>\n\u003cp>Research on the power of food to treat or reverse disease is beginning to accumulate, but that doesn't mean diet alone is always the solution, or that every illness can benefit substantially from dietary changes. Nonetheless, physicians say they look at the cumulative data and a clear picture emerges: that the salt, sugar, fat and processed foods in the American diet contribute to the nation’s high rates of obesity, diabetes and heart disease. According to the World Health Organization, \u003ca href=\"http://www.who.int/chp/chronic_disease_report/full_report.pdf\" target=\"_blank\">80 percent of deaths\u003c/a> from heart disease and stroke are caused by high blood pressure, tobacco use, elevated cholesterol and low consumption of fruits and vegetables.\u003c/p>\n\u003cp>“It’s a different paradigm of how to treat disease,” says Dr. Brenda Rea, who helps run the family and preventive medicine residency program at Loma Linda University School of Medicine.\u003c/p>\n\u003cp>\u003cstrong>Choosing What Foods to Prescribe\u003c/strong>\u003c/p>\n\u003cp>The lifestyle medicine subspecialty is designed to train doctors in how to prevent and treat disease, in part, by changing patients' nutritional habits. The medical center and school at Loma Linda also has a food pantry and kitchen for patients.\u003c/p>\n\u003cfigure id=\"attachment_310967\" class=\"wp-caption alignright\" style=\"max-width: 800px\">\u003ca href=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/12/doc-at-Ralphs.jpg\">\u003cimg class=\"size-medium wp-image-310967\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/12/doc-at-Ralphs-800x600.jpg\" alt=\"St. Joseph Hoag Hospital gives out shopping bags to people who consult the doctor about food choices.\" width=\"800\" height=\"600\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2016/12/doc-at-Ralphs-800x600.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2016/12/doc-at-Ralphs-160x120.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2016/12/doc-at-Ralphs-768x576.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2016/12/doc-at-Ralphs-1020x765.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2016/12/doc-at-Ralphs-1920x1440.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2016/12/doc-at-Ralphs-1180x885.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2016/12/doc-at-Ralphs-960x720.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2016/12/doc-at-Ralphs-240x180.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2016/12/doc-at-Ralphs-375x281.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2016/12/doc-at-Ralphs-520x390.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">St. Joseph Hoag Hospital gives out shopping bags to people who consult the doctor about food choices. \u003ccite>(David Gorn/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Many people don’t know how to cook, Rea says; they only know how to heat things up. That means depending on packaged food with high salt and sugar content. So teaching people about which foods are nutritious and how to prepare them, she says, can actually transform a patient’s life. And beyond that, it might transform the health and lives of that patient’s family.\u003c/p>\n\u003cp>“What people eat can be medicine or poison,” Rea says. “As a physician, nutrition is one of the most powerful things you can change to \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4921549/\" target=\"_blank\">reverse\u003c/a> the effects of \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/12323113\" target=\"_blank\">chronic disease\u003c/a>.”\u003c/p>\n\u003cp>Studies have explored evidence that dietary changes can \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/20674303\" target=\"_blank\">slow inflammation\u003c/a>, for example, or make the body \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/21977033\" target=\"_blank\">inhospitable\u003c/a> to cancer cells.\u003c/p>\n\u003cp>In general, many lifestyle medicine physicians recommend a plant-based diet—particularly for people with diabetes or other inflammatory conditions.\u003c/p>\n\u003cp>“As what happened with tobacco, this will require a cultural shift, but that can happen,\" says Dr. Nguyen. \"In the same way physicians used to smoke, and then stopped smoking and were able to talk to patients about it, I think physicians can have a bigger voice in it.”\u003c/p>\n\u003cp>From her own experience, Allison Scott suggests that anyone making the switch to a plant-based diet have support, because \"it's a complete lifestyle change.\"\u003c/p>\n\u003cp>\"You have to stop buying what's on sale,\" she says. \"You have to go into the store knowing what you want to buy.\"\u003c/p>\n\u003cp>And if you're cooking for a family, she says, plan all your food in advance and have it already on hand.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>One more tip for people who want to quit sugar: read labels. Most salad dressings, soups and breads contain sugar. Even Amy's organic tomato soup. Go figure.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"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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"info": "The Political Mind of Jerry Brown brings listeners the wisdom of the former Governor, Mayor, and presidential candidate. Scott Shafer interviewed Brown for more than 40 hours, covering the former governor's life and half-century in the political game – and Brown has some lessons he'd like to share. ",
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"marketplace": {
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"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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"mindshift": {
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"info": "The MindShift podcast explores the innovations in education that are shaping how kids learn. Hosts Ki Sung and Katrina Schwartz introduce listeners to educators, researchers, parents and students who are developing effective ways to improve how kids learn. We cover topics like how fed-up administrators are developing surprising tactics to deal with classroom disruptions; how listening to podcasts are helping kids develop reading skills; the consequences of overparenting; and why interdisciplinary learning can engage students on all ends of the traditional achievement spectrum. This podcast is part of the MindShift education site, a division of KQED News. KQED is an NPR/PBS member station based in San Francisco. You can also visit the MindShift website for episodes and supplemental blog posts or tweet us \u003ca href=\"https://twitter.com/MindShiftKQED\">@MindShiftKQED\u003c/a> or visit us at \u003ca href=\"/mindshift\">MindShift.KQED.org\u003c/a>",
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"order": 12
},
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM1NzY0NjAwNDI5",
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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": {
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"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?",
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"perspectives": {
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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.",
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"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",
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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",
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},
"pri-the-world": {
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"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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},
"radiolab": {
"id": "radiolab",
"title": "Radiolab",
"info": "A two-time Peabody Award-winner, Radiolab is an investigation told through sounds and stories, and centered around one big idea. In the Radiolab world, information sounds like music and science and culture collide. Hosted by Jad Abumrad and Robert Krulwich, the show is designed for listeners who demand skepticism, but appreciate wonder. WNYC Studios is the producer of other leading podcasts including Freakonomics Radio, Death, Sex & Money, On the Media and many more.",
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},
"reveal": {
"id": "reveal",
"title": "Reveal",
"info": "Created by The Center for Investigative Reporting and PRX, Reveal is public radios first one-hour weekly radio show and podcast dedicated to investigative reporting. Credible, fact based and without a partisan agenda, Reveal combines the power and artistry of driveway moment storytelling with data-rich reporting on critically important issues. The result is stories that inform and inspire, arming our listeners with information to right injustices, hold the powerful accountable and improve lives.Reveal is hosted by Al Letson and showcases the award-winning work of CIR and newsrooms large and small across the nation. In a radio and podcast market crowded with choices, Reveal focuses on important and often surprising stories that illuminate the world for our listeners.",
"airtime": "SAT 4pm-5pm",
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"officialWebsiteLink": "https://www.revealnews.org/episodes/",
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},
"link": "/radio/program/reveal",
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"rss": "http://feeds.revealradio.org/revealpodcast"
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