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But for tens of millions of Americans, that kind of stability may sound like an unattainable luxury.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>According to the USDA, 15.8 million households were food insecure in 2015. About 6.3 million of those had to limit the amount of food household members ate. While adults usually bear the burden of disruptions in meals, 274,000 households last year included one or more children who, at some point, had to go without food.\u003c/p>\n\u003cp>Which brings us to the app, called Copia. Komal Ahmad, 26, the company's founder, told KQED Newsroom's Thuy Vu on Friday (see the video above) that the idea came to her a few years ago. Seems she was walking down Telegraph Avenue in Berkeley, California, when she saw a homeless man begging for food. So she bought him lunch -- turned out he was back from his second tour in Iraq and had been waiting weeks for his VA benefits to kick in.\u003c/p>\n\u003cp>\"Right across the street,\" Ahmad, 26, says, \"(UC) Berkeley's dining hall is throwing away thousands of pounds of edible food.\" She calls that ironic proximity the world's \"largest and dumbest problem,\" a matter of distribution, not scarcity. So she created Copia, which allows a company or nonprofit with extra food on its hands to connect with an organization that will distribute it to those in need.\u003c/p>\n\u003cp>\"If you're Google and you have a bunch of food at the end of the day, you would take a picture of the food,\" Ahmad told Vu, describing the donation processs. The company then specifies a time for pickup, with the donation sent to a virtual marketplace to be matched with the nearest food nonprofit. Copia sends a driver to cart the food from donor to donee, and later sends data and analytics to the former; that can help reduce future overpurchasing and disposal costs, Ahmad said.\u003c/p>\n\u003cp>Copia charges businesses $25 per pickup on an on-demand basis . For a recurring pick up, the price is .30-.50 cents per pound, with lower prices charged for more regular donations.\u003c/p>\n\u003cp>Donors are provided with a receipt that can be used for tax reduction. Ahmad said the financial benefit from the deduction is more than the cost of the service, making it \"money you otherwise would have left on the table or worse, in the trash.\"\u003c/p>\n\u003cp>Dana Gunders, a scientist with the Natural Resources Defense Council, \u003ca href=\"https://ww2.kqed.org/news/2015/12/25/big-think-making-food-waste-a-social-taboo/\">told KQED \u003c/a>last year that food waste should, like smoking, become \"a social taboo.\" Her 2012 \u003ca href=\"https://www.nrdc.org/sites/default/files/wasted-food-IP.pdf\" target=\"_blank\">report\u003c/a> on the topic detailed the ways that up to 40 percent of food in America, \"from farm to fork to landfill,\" goes uneaten. The report recommended encouraging \"innovation in online solutions and new technologies\" to help solve the problem.\u003c/p>\n\u003cp>Copia has certainly done that. But as the \u003ca href=\"http://www.sfchronicle.com/business/article/Copia-Food-Runners-recover-leftovers-to-feed-the-6871225.php\" target=\"_blank\">San Francisco Chronicle \u003c/a>noted earlier this year, many local groups, such as one called\u003ca href=\"http://www.foodrunners.org/\" target=\"_blank\"> Food Runners\u003c/a>, will pick up donated food for free.\u003c/p>\n\u003cp>And as Joel Berg, executive director of Hunger Free America, told the Chronicle, a tech solution doesn't get to the root causes of hunger: not enough jobs, low wages and an inadequate safety net.\u003c/p>\n\u003cp>\"There’s a tendency of tech people to think they can fix every possible problem with a snappy new app,\" he said. \"It’s false to think this is as simple as Silicon Valley fixing a taxi-hailing problem.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Meanwhile, Copia's Ahmad says hundreds of businesses and nonprofits have used the company's platform to feed 1 million people across the Bay Area. She said the company has received more than 60,000 requests from around the world to expand its service into areas outside its home turf.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>According to the USDA, 15.8 million households were food insecure in 2015. About 6.3 million of those had to limit the amount of food household members ate. While adults usually bear the burden of disruptions in meals, 274,000 households last year included one or more children who, at some point, had to go without food.\u003c/p>\n\u003cp>Which brings us to the app, called Copia. Komal Ahmad, 26, the company's founder, told KQED Newsroom's Thuy Vu on Friday (see the video above) that the idea came to her a few years ago. Seems she was walking down Telegraph Avenue in Berkeley, California, when she saw a homeless man begging for food. So she bought him lunch -- turned out he was back from his second tour in Iraq and had been waiting weeks for his VA benefits to kick in.\u003c/p>\n\u003cp>\"Right across the street,\" Ahmad, 26, says, \"(UC) Berkeley's dining hall is throwing away thousands of pounds of edible food.\" She calls that ironic proximity the world's \"largest and dumbest problem,\" a matter of distribution, not scarcity. So she created Copia, which allows a company or nonprofit with extra food on its hands to connect with an organization that will distribute it to those in need.\u003c/p>\n\u003cp>\"If you're Google and you have a bunch of food at the end of the day, you would take a picture of the food,\" Ahmad told Vu, describing the donation processs. The company then specifies a time for pickup, with the donation sent to a virtual marketplace to be matched with the nearest food nonprofit. Copia sends a driver to cart the food from donor to donee, and later sends data and analytics to the former; that can help reduce future overpurchasing and disposal costs, Ahmad said.\u003c/p>\n\u003cp>Copia charges businesses $25 per pickup on an on-demand basis . For a recurring pick up, the price is .30-.50 cents per pound, with lower prices charged for more regular donations.\u003c/p>\n\u003cp>Donors are provided with a receipt that can be used for tax reduction. Ahmad said the financial benefit from the deduction is more than the cost of the service, making it \"money you otherwise would have left on the table or worse, in the trash.\"\u003c/p>\n\u003cp>Dana Gunders, a scientist with the Natural Resources Defense Council, \u003ca href=\"https://ww2.kqed.org/news/2015/12/25/big-think-making-food-waste-a-social-taboo/\">told KQED \u003c/a>last year that food waste should, like smoking, become \"a social taboo.\" Her 2012 \u003ca href=\"https://www.nrdc.org/sites/default/files/wasted-food-IP.pdf\" target=\"_blank\">report\u003c/a> on the topic detailed the ways that up to 40 percent of food in America, \"from farm to fork to landfill,\" goes uneaten. The report recommended encouraging \"innovation in online solutions and new technologies\" to help solve the problem.\u003c/p>\n\u003cp>Copia has certainly done that. But as the \u003ca href=\"http://www.sfchronicle.com/business/article/Copia-Food-Runners-recover-leftovers-to-feed-the-6871225.php\" target=\"_blank\">San Francisco Chronicle \u003c/a>noted earlier this year, many local groups, such as one called\u003ca href=\"http://www.foodrunners.org/\" target=\"_blank\"> Food Runners\u003c/a>, will pick up donated food for free.\u003c/p>\n\u003cp>And as Joel Berg, executive director of Hunger Free America, told the Chronicle, a tech solution doesn't get to the root causes of hunger: not enough jobs, low wages and an inadequate safety net.\u003c/p>\n\u003cp>\"There’s a tendency of tech people to think they can fix every possible problem with a snappy new app,\" he said. \"It’s false to think this is as simple as Silicon Valley fixing a taxi-hailing problem.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Meanwhile, Copia's Ahmad says hundreds of businesses and nonprofits have used the company's platform to feed 1 million people across the Bay Area. She said the company has received more than 60,000 requests from around the world to expand its service into areas outside its home turf.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Not to beat a dead unicorn, but this is a pretty interesting story from \u003ca href=\"http://www.wsj.com/articles/theranos-whistleblower-shook-the-companyand-his-family-1479335963\" target=\"_blank\">The Wall Street Journal\u003c/a>, identifying the Theranos employee who squealed to the newspaper and to New York state officials by alleging company manipulation of blood test results. He's Tyler Shultz, 26-year-old grandson of Republican éminence grise George Shultz, the U.S. Secretary of State under Ronald Reagan. The elder Shultz was a Theranos board member from 2011-15, until he was shifted to an advisory position as part of the company's shift from high-profile bigwigs on its board to people with actual medical experience.\u003c/p>\n\u003cp>The Journal reports Tyler Shultz found that the company's test results \"varied widely when tests were rerun with the same blood samples. To reduce that variability, Theranos routinely discarded outlying values from validation reports it compiled, he says.\"\u003c/p>\n\u003cp>Shultz told the Journal he first complained about the practice to CEO Elizabeth Holmes. She referred him to a VP in charge of biostatistics, who told him the ambiguous results were later clarified by subsequent tests. After Shultz filed a complaint with New York State, under an alias, Theranos accused him of leaking trade secrets and violating his non-disclosure agreement. It also sent lawyers to pressure him to identify other employee whistleblowers, and hired private investigators to follow him, he said.\u003c/p>\n\u003cp>Shultz said he and his family have spent more than $400,000 in legal fees. The Journal says he is cooperating with a federal investigation of Theranos.\u003c/p>\n\u003cp>Theranos, a blood testing company that rode to prominence on the claims of its ability to perform dozens of blood tests from a few drops of blood, is now approaching Enron-level status, at least as a brand name. It's been forced to exit the consumer blood-testing business on the heels of severe government penalties for deficiencies and inaccuracies at its lab; it's the subject of a multitude of lawsuits by its former customers, as well as one by former business partner Walgreens; and it's under investigation by several government agencies.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>We reached out to Theranos and to p.r. firm Hill & Knowlton, which is working with the company, but both declined to comment.\u003c/p>\n\u003cp>Read the entire Wall Street Journal article below. Here's our\u003ca href=\"https://ww2.kqed.org/futureofyou/2016/07/14/the-rise-and-fall-of-theranos-a-cartoon-history/\" target=\"_blank\"> cartoon history of Theranos i\u003c/a>f you want some background. And by the way, there's still at least \u003ca href=\"http://www.cnbc.com/2016/11/15/theranos-ceo-elizabeth-holmes-is-a-victim-venture-capitalist-tim-draper-says.html\" target=\"_blank\">one true believer left\u003c/a> in the Theranos camp ...\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>http://www.wsj.com/articles/theranos-whistleblower-shook-the-companyand-his-family-1479335963\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Not to beat a dead unicorn, but this is a pretty interesting story from \u003ca href=\"http://www.wsj.com/articles/theranos-whistleblower-shook-the-companyand-his-family-1479335963\" target=\"_blank\">The Wall Street Journal\u003c/a>, identifying the Theranos employee who squealed to the newspaper and to New York state officials by alleging company manipulation of blood test results. He's Tyler Shultz, 26-year-old grandson of Republican éminence grise George Shultz, the U.S. Secretary of State under Ronald Reagan. The elder Shultz was a Theranos board member from 2011-15, until he was shifted to an advisory position as part of the company's shift from high-profile bigwigs on its board to people with actual medical experience.\u003c/p>\n\u003cp>The Journal reports Tyler Shultz found that the company's test results \"varied widely when tests were rerun with the same blood samples. To reduce that variability, Theranos routinely discarded outlying values from validation reports it compiled, he says.\"\u003c/p>\n\u003cp>Shultz told the Journal he first complained about the practice to CEO Elizabeth Holmes. She referred him to a VP in charge of biostatistics, who told him the ambiguous results were later clarified by subsequent tests. After Shultz filed a complaint with New York State, under an alias, Theranos accused him of leaking trade secrets and violating his non-disclosure agreement. It also sent lawyers to pressure him to identify other employee whistleblowers, and hired private investigators to follow him, he said.\u003c/p>\n\u003cp>Shultz said he and his family have spent more than $400,000 in legal fees. The Journal says he is cooperating with a federal investigation of Theranos.\u003c/p>\n\u003cp>Theranos, a blood testing company that rode to prominence on the claims of its ability to perform dozens of blood tests from a few drops of blood, is now approaching Enron-level status, at least as a brand name. It's been forced to exit the consumer blood-testing business on the heels of severe government penalties for deficiencies and inaccuracies at its lab; it's the subject of a multitude of lawsuits by its former customers, as well as one by former business partner Walgreens; and it's under investigation by several government agencies.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>We reached out to Theranos and to p.r. firm Hill & Knowlton, which is working with the company, but both declined to comment.\u003c/p>\n\u003cp>Read the entire Wall Street Journal article below. Here's our\u003ca href=\"https://ww2.kqed.org/futureofyou/2016/07/14/the-rise-and-fall-of-theranos-a-cartoon-history/\" target=\"_blank\"> cartoon history of Theranos i\u003c/a>f you want some background. And by the way, there's still at least \u003ca href=\"http://www.cnbc.com/2016/11/15/theranos-ceo-elizabeth-holmes-is-a-victim-venture-capitalist-tim-draper-says.html\" target=\"_blank\">one true believer left\u003c/a> in the Theranos camp ...\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>http://www.wsj.com/articles/theranos-whistleblower-shook-the-companyand-his-family-1479335963\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>When the abortion pills arrived in her mailbox this summer, she felt anxious but also in control, knowing she could end her pregnancy entirely in the privacy of her own home.\u003c/p>\n\u003caside class=\"pullquote alignright\">'I was happy that I was going to be able to do it myself and I did not have a nurse there or doctors there staring at me and judging me.'\u003c/aside>\n\u003cp>“I was happy that I was going to be able to do it myself and I did not have a nurse there or doctors there staring at me and judging me,” she said, asking to be identified only by her middle name, Marie, because she did not want people outside her immediate family to know about her abortion.\u003c/p>\n\u003cp>Marie is part of a small but closely watched research effort to determine whether medical abortions — those induced by medicine instead of surgery — can be done safely through an online consultation with a doctor and drugs mailed to a woman’s home.\u003c/p>\n\u003cp>At a time when access to abortion is being restricted on many fronts, advocates say being able to terminate a pregnancy through telemedicine and mail-order drugs would provide a welcome new option for women. Opponents of abortion find the concept dangerous and deeply disturbing.\u003c/p>\n\u003cp>The idea builds on a trend that is helping women obtain birth control more easily. A growing number of smartphone apps and websites now make it possible to get prescription contraceptives without visiting a doctor’s office first. The pills Marie and the other women received through the study are not allowed for sale in pharmacies and are usually available only at hospitals and abortion clinics.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Australia and the Canadian province of British Columbia allow women to get abortion pills by mail after consulting with a physician or other health care provider via phone or the internet. Several international organizations offer mail service in countries where abortion is otherwise unavailable or severely restricted. The oldest group, Women on Web, based in the Netherlands, has provided abortion medications to about 50,000 women in 130 countries since 2006. The service is not available in the United States, and the Food and Drug Administration warns against buying the drugs over the internet.\u003c/p>\n\u003cp>Having the pills delivered to her home in Hawaii meant that Marie could avoid the cost and time of traveling by plane to the nearest abortion clinic, over 100 miles away in Honolulu or Maui. Once she received them, she set the package aside for a week in her bedroom, waiting until she could schedule time off from her job at McDonald’s.\u003c/p>\n\u003cp>\u003cstrong>Over in Three Hours\u003c/strong>\u003c/p>\n\u003cp>The first pill, as expected, had little effect. The next morning, with her mother at her home to watch her toddler, she took the second. Almost immediately, the bleeding and cramping began. Within three hours, her eight-week pregnancy was over. She described the pain as a five on a 10-point scale. That night she cooked dinner for her family, and the next day she went back to work.\u003c/p>\n\u003cp>The study Marie participated in is being conducted in four states — Hawaii, New York, Oregon and Washington. It is being funded and organized by Gynuity Health Projects, a nonprofit research group focused on reproductive health services that seeks to improve women’s access to medical abortions. The FDA has allowed the experiment. Women learn about it when contacting the abortion clinics in the study and other health providers who are aware of the trial and the website telabortion.org.\u003c/p>\n\u003cp>Danco Laboratories, the company that makes the pills, has no plans to seek wider distribution of the medication either through mail-order pharmacies or physical pharmacies, a spokeswoman said. It would have to seek the FDA’s permission to do so; the agency can also ask companies to change how their drugs are distributed.\u003c/p>\n\u003cp>“Abortion is a politically charged issue in this country, and there is an extra degree of caution,” said the spokeswoman, Abby Long, explaining that research would be needed to support changing the drug’s distribution.\u003c/p>\n\u003cp>Of the first 12 women who participated in the study, all in Hawaii, 11 reported they had no complications and one did not take the pills, researchers said. Ten who completed surveys afterward said they were satisfied with the service and would recommend it to a friend, according to the researchers.\u003c/p>\n\u003cp>“It’s absolutely an important step forward to expanding access to abortion that is safe and effective and creating options for women,” said Susan Wood, director of the Jacobs Institute of Women’s Health at George Washington University, in Washington, D.C. She was not involved in the study.\u003c/p>\n\u003cp>\u003cstrong>Outraged\u003c/strong>\u003c/p>\n\u003cp>Anti-abortion groups are outraged by the experiment.\u003c/p>\n\u003cp>“We have grave concerns about handing out dangerous, life-ending drugs without medical supervision because women face great risks for chemical abortions,” said Kristi Hamrick, spokeswoman for Americans United for Life.\u003c/p>\n\u003cp>Carol Tobias, president of the National Right to Life Committee, also raised safety concerns.\u003c/p>\n\u003cp>“If pills are sent through the mail, who are they supposed to call if they have a problem?” she said.\u003c/p>\n\u003cp>“There are serious downsides from the pills,” she said, adding, “and just talking to someone over a computer and sending pills in the mail, to me, that is just reckless.”\u003c/p>\n\u003cp>The process does not allow women to avoid the doctor’s office entirely. Using a video hookup on a home computer, a woman first consults with a doctor (or other clinician such as a nurse practitioner) at one of three participating abortion clinics who evaluates her medical history and explains how to take abortion pills and what to expect afterward. She must then get medical tests including ultrasound and bloodwork.\u003c/p>\n\u003cp>If the tests show she is eligible for the study, the clinic sends her a package with pills and instructions via overnight mail. After taking them, she has some additional tests, such as an ultrasound to verify that the abortion is complete and also a phone consultation to review the results.\u003c/p>\n\u003cp>\u003cstrong>Declining Access\u003c/strong>\u003c/p>\n\u003cp>Access to abortion has been declining steadily in the United States as dozens of clinics have been forced to close under new state restrictions. In Texas, the number of clinics fell to 18 in 2015 from 41 in 2012. Five states have just one clinic that offers abortions.\u003c/p>\n\u003cp>Medical abortions require women to take two drugs that together induce a miscarriage. The first, mifepristone (marketed as Mifeprex), is typically taken in a doctor’s office or clinic while the second, misoprostol, is given to the woman to take at home the next day.\u003c/p>\n\u003cp>In the United States, the FDA has approved medical abortion pills for use only in the first 10 weeks of pregnancy, while surgical abortions can be done later than that.\u003c/p>\n\u003cp>Medical abortions make up a quarter of all abortions in the country. About 2.8 million women in the United States have used mifepristone to terminate a pregnancy since the drug’s approval in 2000, according to Danco Laboratories, its manufacturer.\u003c/p>\n\u003cp>The American abortion study using overnight mail comes nearly a decade after Iowa became the first state to offer medical abortion counseling via telemedicine from a physician. But in Iowa and the three states that followed — Alaska, Maine and Minnesota — women must still go to a clinic that stocks mifepristone to receive the pills.\u003c/p>\n\u003cp>If the study shows the telemedicine and mail approach works, that could encourage the FDA to stop restrictions on mifepristone, Gynuity’s principal investigator, Dr. Elizabeth Raymond, said.\u003c/p>\n\u003cp>“All kinds of dangerous drugs are prescribed and available at pharmacies, including drugs for heart disease and Viagra,” she said. “There is no justification for why this safe drug should not be in pharmacies now.”\u003c/p>\n\u003cp>But even if the FDA were to lift its restriction on where abortion pills are dispensed, 19 states ban the use of telemedicine for abortion and require a physician to be physically present when consulting a woman, according to the Guttmacher Institute, a reproductive rights research group.\u003c/p>\n\u003cp>“While this has the potential for being the future of abortion delivery for a good segment of the population, that vision might not be fulfilled due to the politics around the issue and restrictions in many states,” said Jessica Arons, president and chief executive of the Reproductive Health Technologies Project in Washington, an advocacy group.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This story was produced by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>When the abortion pills arrived in her mailbox this summer, she felt anxious but also in control, knowing she could end her pregnancy entirely in the privacy of her own home.\u003c/p>\n\u003caside class=\"pullquote alignright\">'I was happy that I was going to be able to do it myself and I did not have a nurse there or doctors there staring at me and judging me.'\u003c/aside>\n\u003cp>“I was happy that I was going to be able to do it myself and I did not have a nurse there or doctors there staring at me and judging me,” she said, asking to be identified only by her middle name, Marie, because she did not want people outside her immediate family to know about her abortion.\u003c/p>\n\u003cp>Marie is part of a small but closely watched research effort to determine whether medical abortions — those induced by medicine instead of surgery — can be done safely through an online consultation with a doctor and drugs mailed to a woman’s home.\u003c/p>\n\u003cp>At a time when access to abortion is being restricted on many fronts, advocates say being able to terminate a pregnancy through telemedicine and mail-order drugs would provide a welcome new option for women. Opponents of abortion find the concept dangerous and deeply disturbing.\u003c/p>\n\u003cp>The idea builds on a trend that is helping women obtain birth control more easily. A growing number of smartphone apps and websites now make it possible to get prescription contraceptives without visiting a doctor’s office first. The pills Marie and the other women received through the study are not allowed for sale in pharmacies and are usually available only at hospitals and abortion clinics.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Australia and the Canadian province of British Columbia allow women to get abortion pills by mail after consulting with a physician or other health care provider via phone or the internet. Several international organizations offer mail service in countries where abortion is otherwise unavailable or severely restricted. The oldest group, Women on Web, based in the Netherlands, has provided abortion medications to about 50,000 women in 130 countries since 2006. The service is not available in the United States, and the Food and Drug Administration warns against buying the drugs over the internet.\u003c/p>\n\u003cp>Having the pills delivered to her home in Hawaii meant that Marie could avoid the cost and time of traveling by plane to the nearest abortion clinic, over 100 miles away in Honolulu or Maui. Once she received them, she set the package aside for a week in her bedroom, waiting until she could schedule time off from her job at McDonald’s.\u003c/p>\n\u003cp>\u003cstrong>Over in Three Hours\u003c/strong>\u003c/p>\n\u003cp>The first pill, as expected, had little effect. The next morning, with her mother at her home to watch her toddler, she took the second. Almost immediately, the bleeding and cramping began. Within three hours, her eight-week pregnancy was over. She described the pain as a five on a 10-point scale. That night she cooked dinner for her family, and the next day she went back to work.\u003c/p>\n\u003cp>The study Marie participated in is being conducted in four states — Hawaii, New York, Oregon and Washington. It is being funded and organized by Gynuity Health Projects, a nonprofit research group focused on reproductive health services that seeks to improve women’s access to medical abortions. The FDA has allowed the experiment. Women learn about it when contacting the abortion clinics in the study and other health providers who are aware of the trial and the website telabortion.org.\u003c/p>\n\u003cp>Danco Laboratories, the company that makes the pills, has no plans to seek wider distribution of the medication either through mail-order pharmacies or physical pharmacies, a spokeswoman said. It would have to seek the FDA’s permission to do so; the agency can also ask companies to change how their drugs are distributed.\u003c/p>\n\u003cp>“Abortion is a politically charged issue in this country, and there is an extra degree of caution,” said the spokeswoman, Abby Long, explaining that research would be needed to support changing the drug’s distribution.\u003c/p>\n\u003cp>Of the first 12 women who participated in the study, all in Hawaii, 11 reported they had no complications and one did not take the pills, researchers said. Ten who completed surveys afterward said they were satisfied with the service and would recommend it to a friend, according to the researchers.\u003c/p>\n\u003cp>“It’s absolutely an important step forward to expanding access to abortion that is safe and effective and creating options for women,” said Susan Wood, director of the Jacobs Institute of Women’s Health at George Washington University, in Washington, D.C. She was not involved in the study.\u003c/p>\n\u003cp>\u003cstrong>Outraged\u003c/strong>\u003c/p>\n\u003cp>Anti-abortion groups are outraged by the experiment.\u003c/p>\n\u003cp>“We have grave concerns about handing out dangerous, life-ending drugs without medical supervision because women face great risks for chemical abortions,” said Kristi Hamrick, spokeswoman for Americans United for Life.\u003c/p>\n\u003cp>Carol Tobias, president of the National Right to Life Committee, also raised safety concerns.\u003c/p>\n\u003cp>“If pills are sent through the mail, who are they supposed to call if they have a problem?” she said.\u003c/p>\n\u003cp>“There are serious downsides from the pills,” she said, adding, “and just talking to someone over a computer and sending pills in the mail, to me, that is just reckless.”\u003c/p>\n\u003cp>The process does not allow women to avoid the doctor’s office entirely. Using a video hookup on a home computer, a woman first consults with a doctor (or other clinician such as a nurse practitioner) at one of three participating abortion clinics who evaluates her medical history and explains how to take abortion pills and what to expect afterward. She must then get medical tests including ultrasound and bloodwork.\u003c/p>\n\u003cp>If the tests show she is eligible for the study, the clinic sends her a package with pills and instructions via overnight mail. After taking them, she has some additional tests, such as an ultrasound to verify that the abortion is complete and also a phone consultation to review the results.\u003c/p>\n\u003cp>\u003cstrong>Declining Access\u003c/strong>\u003c/p>\n\u003cp>Access to abortion has been declining steadily in the United States as dozens of clinics have been forced to close under new state restrictions. In Texas, the number of clinics fell to 18 in 2015 from 41 in 2012. Five states have just one clinic that offers abortions.\u003c/p>\n\u003cp>Medical abortions require women to take two drugs that together induce a miscarriage. The first, mifepristone (marketed as Mifeprex), is typically taken in a doctor’s office or clinic while the second, misoprostol, is given to the woman to take at home the next day.\u003c/p>\n\u003cp>In the United States, the FDA has approved medical abortion pills for use only in the first 10 weeks of pregnancy, while surgical abortions can be done later than that.\u003c/p>\n\u003cp>Medical abortions make up a quarter of all abortions in the country. About 2.8 million women in the United States have used mifepristone to terminate a pregnancy since the drug’s approval in 2000, according to Danco Laboratories, its manufacturer.\u003c/p>\n\u003cp>The American abortion study using overnight mail comes nearly a decade after Iowa became the first state to offer medical abortion counseling via telemedicine from a physician. But in Iowa and the three states that followed — Alaska, Maine and Minnesota — women must still go to a clinic that stocks mifepristone to receive the pills.\u003c/p>\n\u003cp>If the study shows the telemedicine and mail approach works, that could encourage the FDA to stop restrictions on mifepristone, Gynuity’s principal investigator, Dr. Elizabeth Raymond, said.\u003c/p>\n\u003cp>“All kinds of dangerous drugs are prescribed and available at pharmacies, including drugs for heart disease and Viagra,” she said. “There is no justification for why this safe drug should not be in pharmacies now.”\u003c/p>\n\u003cp>But even if the FDA were to lift its restriction on where abortion pills are dispensed, 19 states ban the use of telemedicine for abortion and require a physician to be physically present when consulting a woman, according to the Guttmacher Institute, a reproductive rights research group.\u003c/p>\n\u003cp>“While this has the potential for being the future of abortion delivery for a good segment of the population, that vision might not be fulfilled due to the politics around the issue and restrictions in many states,” said Jessica Arons, president and chief executive of the Reproductive Health Technologies Project in Washington, an advocacy group.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>This story was produced by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>It's a truism that we distrust what we don't understand. Let me confide something.\u003c/p>\n\u003cp>I grew a lot of yeast and bacteria in my college lab. Between raising and killing these living organisms, I explored and shaped them, tinkering with their DNA to make them glow, resist an antibiotic or digest a new nutrient.\u003c/p>\n\u003cp>Yet when the \u003ca href=\"http://blogs.sciencemag.org/pipeline/archives/2010/10/07/more_on_garage_biotech\" target=\"_blank\">DIY bio\u003c/a> phenomenon \u003ca href=\"https://www.wired.com/2011/08/mf_diylab/\" target=\"_blank\">burst\u003c/a> into the \u003ca href=\"http://www.nature.com/news/2010/101006/full/467650a.html\" target=\"_blank\">popular \u003c/a>science \u003ca href=\"http://www.nytimes.com/2012/01/17/science/for-bio-hackers-lab-work-often-begins-at-home.html\" target=\"_blank\">press\u003c/a> a couple of years ago, my first thought was: Should they be \u003cem>allowed \u003c/em>to do this? What if they create a dangerous pathogen and launch a deadly epidemic? Pretty much what all the media started imagining. In 2009 the Wall Street Journal ran the hair-raising headline \"\u003ca href=\"http://www.wsj.com/news/articles/SB124207326903607931\" target=\"_blank\">In Attics and Closets, 'Biohackers' Discover Their Inner Frankenstein\u003c/a>.\"\u003c/p>\n\u003cp>Offerings from just this year include:\u003c/p>\n\u003cul>\n\u003cli>\u003ca href=\"http://fusion.net/story/285454/diy-crispr-biohackers-garage-labs/\" target=\"_blank\">Inside the Garage Labs of DIY Gene Hackers, Whose Hobby May Terrify You\u003c/a> (Fusion)\u003c/li>\n\u003cli>\u003ca href=\"https://motherboard.vice.com/read/accessible-synthetic-biology-raises-new-concerns-for-diy-biological-warfare\" target=\"_blank\">Accessible Synthetic Biology Raises New Concerns for DIY Biological Warfare\u003c/a> (Motherboard)\u003c/li>\n\u003c/ul>\n\u003cp>\"People seem to think that we're not concerned about safety,\" says \u003ca href=\"https://www.linkedin.com/in/eharness\" target=\"_blank\">Eric Harness\u003c/a>, director of lab operations and safety at \u003ca href=\"http://biocurious.org/about/\" target=\"_blank\">BioCurious\u003c/a>, a community lab in Sunnyvale.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>I'd found Harness at a conference in Oakland billed as \u003ca href=\"http://biohacktheplanet.com/\" target=\"_blank\">BioHACK THE PLANET\u003c/a>, and told him my editor and I were particularly intrigued by a portion of Sunday's \u003ca href=\"http://biohacktheplanet.com/schedule/\" target=\"_blank\">program\u003c/a> titled \"Bad things happen - are you prepared?\"\u003c/p>\n\u003cp>Harness was unsurprised. That's what every member of the press wants to talk about, he said.\u003c/p>\n\u003cp>As it turns out, the subject is far less juicy than you might expect.\u003c/p>\n\u003cp>According to a 2013 survey titled \"\u003ca href=\"http://www.synbioproject.org/publications/6676/\" target=\"_blank\">Seven Myths and Realities about Do-It-Yourself Biology\u003c/a>\" by the \u003ca href=\"http://www.synbioproject.org/events/archive/6673/\" target=\"_blank\">Woodrow Wilson International Center for Scholars\u003c/a> in Washington, D. C., the vast majority of DIYers work with non-toxic, non-harmful organisms approved for biosafety level 1 research. Just like a high school lab.\u003c/p>\n\u003cp>Rather than working anonymously and solitarily, the report finds, DIYers overwhelmingly use group lab space. Many are still learning the basics of biology and don't have knowledge or tools of an advanced virologist. More importantly, lab directors keep an eye on all materials purchased, brought in, and removed from the lab, providing an obstacle to anyone trying to do secret nefarious \"\u003cspan class=\"s1\">Frankensteinian\" \u003c/span>work.\u003c/p>\n\u003cp>Granted, it would be naive to suggest something \u003cem>couldn't\u003c/em> go wrong. A workshop in August held by the \u003ca href=\"https://cgsr.llnl.gov/\" target=\"_blank\">Center for Global Security Research\u003c/a> concluded that self regulation of community labs is working well so far, while also acknowledging that probability of an \"unfortunate incident\" increases as the DIY bio community continues to grow. (\u003ca href=\"https://cgsr.llnl.gov/content/assets/docs/Independent_Biotechnology_Workshop_SummaryNOV2016.pdf\" target=\"_blank\">Read the workshop report.\u003c/a>)\u003c/p>\n\u003cp>One idea under consideration is the creation of a \"soft\" safety licensing program for unaffiliated researchers, similar to amateur radio FCC licensing. Another recommendation from the workshop is that DIY labs create a code of conduct and establish relationships with local fire departments, public health officials and law enforcement.\u003c/p>\n\u003cp>Independent experimenters, working in their garages and kitchens, seem to trigger the greatest fears. And while these DIY-ers may fly under the radar (no one can control what you do in you garage after all), the report suggests we're probably more fearful that we need to be.\u003c/p>\n\u003cp>\"Early narratives created by some writers and opinion-makers presented the notion of a lone 'biohacker' in a garage laboratory surreptitiously working with—or creating—dangerous pathogens,\" says the CGSR report. This is likely a \"greatly exaggerated threat\" the authors conclude, as it generally assumes amateurs in home labs can do what cannot yet be done by professional biologists in institutional settings.\u003c/p>\n\u003cp>\u003cstrong>Creativity, Unleashed \u003c/strong>\u003c/p>\n\u003cp>Patrik D'haeseleer, self-described \"cat herder\" at \u003ca href=\"https://counterculturelabs.org/\" target=\"_blank\">Counter Culture Labs\u003c/a>, works a day job as a computational scientist at Lawrence Livermore National Laboratory.\u003c/p>\n\u003cp>\"I've worked my whole career side by side with experimental biologists and I've always regretted not having the chance to build up that side of the skills as well,\" he told me. \"So when I first heard about DIY bio I jumped on that. It's liberating. It's really energized my own career, because it opens up a field of creativity where I can just play around with things and try things out in the lab.\"\u003c/p>\n\u003cp>If he gets a cool idea on Saturday he might be working on it come Monday. In his professional career, he says by contrast, \"at a very minimum it would be at least a year before we can actually work on it.\"\u003c/p>\n\u003cp>DIY biologists are currently working on such cool ideas as \u003ca href=\"https://wiki.realvegancheese.org/index.php/Real_Vegan_Cheese\" target=\"_blank\">'real vegan cheese'\u003c/a> by coaxing baker's yeast into expressing milk protein. Someone is at work on an \u003ca href=\"https://techcrunch.com/2016/09/21/pharma-hackers-create-a-diy-epipen-the-epipencil/\" target=\"_blank\">EpiPencil\u003c/a>, which would cost $30, instead of the hundreds charged for an EpiPen. Others are working to develop more affordable generic medical treatments, such as \u003ca href=\"https://experiment.com/projects/open-insulin\" target=\"_blank\">insulin\u003c/a> for diabetics, or \u003ca href=\"http://maggic.ooo/Open-Source-Estrogen-2015\" target=\"_blank\">estrogen\u003c/a> for trans women. (Before reaching the market, these products would require normal regulatory approval.)\u003c/p>\n\u003cp>Eri Gentry, co-founder and president of \u003ca href=\"http://biocurious.org/about/\" target=\"_blank\">BioCurious\u003c/a> (she works a day job at \u003ca href=\"http://www.iftf.org/erigentry/\" target=\"_blank\">Institute for the Future\u003c/a> too), says she sees a current lack of investment in basic research and development. Her hope is \u003cspan class=\"s1\">to make biological research accessible to more people, broaden the playing field and spur more innovation.\u003c/span>\u003c/p>\n\u003cp>\"I'm hoping that we'll see more solutions for mankind,\" Gentry says.\u003c/p>\n\u003cp>[youtube https://www.youtube.com/watch?v=eh6I7IXiEVM]\u003c/p>\n\u003cp>Biotech will be the technology of this century D'haeseleer says. \"It's going to affect our lives just as much or more as computers have.\"\u003c/p>\n\u003cp>D'haeseleer points to \u003ca href=\"http://ww2.kqed.org/futureofyou/2016/04/29/how-a-new-crisprcas9-technique-may-get-us-closer-to-curing-genetic-diseases/\">CRISPR, a gene-editing technique\u003c/a> which has raised both widespread hope and alarms.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"To me, it's just a better screwdriver,\" D'haeseleer says. \"There's lots of [good or bad] stuff you could do with a better screwdriver and it's probably those things you should be worried about and not the screwdriver.\"\u003c/p>\n\n",
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"excerpt": "Frightening headlines about biohacking have become the norm, but those who have investigated the do-it-yourself biology movement have found a much less dangerous culture of experimentation than some have imagined.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>It's a truism that we distrust what we don't understand. Let me confide something.\u003c/p>\n\u003cp>I grew a lot of yeast and bacteria in my college lab. Between raising and killing these living organisms, I explored and shaped them, tinkering with their DNA to make them glow, resist an antibiotic or digest a new nutrient.\u003c/p>\n\u003cp>Yet when the \u003ca href=\"http://blogs.sciencemag.org/pipeline/archives/2010/10/07/more_on_garage_biotech\" target=\"_blank\">DIY bio\u003c/a> phenomenon \u003ca href=\"https://www.wired.com/2011/08/mf_diylab/\" target=\"_blank\">burst\u003c/a> into the \u003ca href=\"http://www.nature.com/news/2010/101006/full/467650a.html\" target=\"_blank\">popular \u003c/a>science \u003ca href=\"http://www.nytimes.com/2012/01/17/science/for-bio-hackers-lab-work-often-begins-at-home.html\" target=\"_blank\">press\u003c/a> a couple of years ago, my first thought was: Should they be \u003cem>allowed \u003c/em>to do this? What if they create a dangerous pathogen and launch a deadly epidemic? Pretty much what all the media started imagining. In 2009 the Wall Street Journal ran the hair-raising headline \"\u003ca href=\"http://www.wsj.com/news/articles/SB124207326903607931\" target=\"_blank\">In Attics and Closets, 'Biohackers' Discover Their Inner Frankenstein\u003c/a>.\"\u003c/p>\n\u003cp>Offerings from just this year include:\u003c/p>\n\u003cul>\n\u003cli>\u003ca href=\"http://fusion.net/story/285454/diy-crispr-biohackers-garage-labs/\" target=\"_blank\">Inside the Garage Labs of DIY Gene Hackers, Whose Hobby May Terrify You\u003c/a> (Fusion)\u003c/li>\n\u003cli>\u003ca href=\"https://motherboard.vice.com/read/accessible-synthetic-biology-raises-new-concerns-for-diy-biological-warfare\" target=\"_blank\">Accessible Synthetic Biology Raises New Concerns for DIY Biological Warfare\u003c/a> (Motherboard)\u003c/li>\n\u003c/ul>\n\u003cp>\"People seem to think that we're not concerned about safety,\" says \u003ca href=\"https://www.linkedin.com/in/eharness\" target=\"_blank\">Eric Harness\u003c/a>, director of lab operations and safety at \u003ca href=\"http://biocurious.org/about/\" target=\"_blank\">BioCurious\u003c/a>, a community lab in Sunnyvale.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>I'd found Harness at a conference in Oakland billed as \u003ca href=\"http://biohacktheplanet.com/\" target=\"_blank\">BioHACK THE PLANET\u003c/a>, and told him my editor and I were particularly intrigued by a portion of Sunday's \u003ca href=\"http://biohacktheplanet.com/schedule/\" target=\"_blank\">program\u003c/a> titled \"Bad things happen - are you prepared?\"\u003c/p>\n\u003cp>Harness was unsurprised. That's what every member of the press wants to talk about, he said.\u003c/p>\n\u003cp>As it turns out, the subject is far less juicy than you might expect.\u003c/p>\n\u003cp>According to a 2013 survey titled \"\u003ca href=\"http://www.synbioproject.org/publications/6676/\" target=\"_blank\">Seven Myths and Realities about Do-It-Yourself Biology\u003c/a>\" by the \u003ca href=\"http://www.synbioproject.org/events/archive/6673/\" target=\"_blank\">Woodrow Wilson International Center for Scholars\u003c/a> in Washington, D. C., the vast majority of DIYers work with non-toxic, non-harmful organisms approved for biosafety level 1 research. Just like a high school lab.\u003c/p>\n\u003cp>Rather than working anonymously and solitarily, the report finds, DIYers overwhelmingly use group lab space. Many are still learning the basics of biology and don't have knowledge or tools of an advanced virologist. More importantly, lab directors keep an eye on all materials purchased, brought in, and removed from the lab, providing an obstacle to anyone trying to do secret nefarious \"\u003cspan class=\"s1\">Frankensteinian\" \u003c/span>work.\u003c/p>\n\u003cp>Granted, it would be naive to suggest something \u003cem>couldn't\u003c/em> go wrong. A workshop in August held by the \u003ca href=\"https://cgsr.llnl.gov/\" target=\"_blank\">Center for Global Security Research\u003c/a> concluded that self regulation of community labs is working well so far, while also acknowledging that probability of an \"unfortunate incident\" increases as the DIY bio community continues to grow. (\u003ca href=\"https://cgsr.llnl.gov/content/assets/docs/Independent_Biotechnology_Workshop_SummaryNOV2016.pdf\" target=\"_blank\">Read the workshop report.\u003c/a>)\u003c/p>\n\u003cp>One idea under consideration is the creation of a \"soft\" safety licensing program for unaffiliated researchers, similar to amateur radio FCC licensing. Another recommendation from the workshop is that DIY labs create a code of conduct and establish relationships with local fire departments, public health officials and law enforcement.\u003c/p>\n\u003cp>Independent experimenters, working in their garages and kitchens, seem to trigger the greatest fears. And while these DIY-ers may fly under the radar (no one can control what you do in you garage after all), the report suggests we're probably more fearful that we need to be.\u003c/p>\n\u003cp>\"Early narratives created by some writers and opinion-makers presented the notion of a lone 'biohacker' in a garage laboratory surreptitiously working with—or creating—dangerous pathogens,\" says the CGSR report. This is likely a \"greatly exaggerated threat\" the authors conclude, as it generally assumes amateurs in home labs can do what cannot yet be done by professional biologists in institutional settings.\u003c/p>\n\u003cp>\u003cstrong>Creativity, Unleashed \u003c/strong>\u003c/p>\n\u003cp>Patrik D'haeseleer, self-described \"cat herder\" at \u003ca href=\"https://counterculturelabs.org/\" target=\"_blank\">Counter Culture Labs\u003c/a>, works a day job as a computational scientist at Lawrence Livermore National Laboratory.\u003c/p>\n\u003cp>\"I've worked my whole career side by side with experimental biologists and I've always regretted not having the chance to build up that side of the skills as well,\" he told me. \"So when I first heard about DIY bio I jumped on that. It's liberating. It's really energized my own career, because it opens up a field of creativity where I can just play around with things and try things out in the lab.\"\u003c/p>\n\u003cp>If he gets a cool idea on Saturday he might be working on it come Monday. In his professional career, he says by contrast, \"at a very minimum it would be at least a year before we can actually work on it.\"\u003c/p>\n\u003cp>DIY biologists are currently working on such cool ideas as \u003ca href=\"https://wiki.realvegancheese.org/index.php/Real_Vegan_Cheese\" target=\"_blank\">'real vegan cheese'\u003c/a> by coaxing baker's yeast into expressing milk protein. Someone is at work on an \u003ca href=\"https://techcrunch.com/2016/09/21/pharma-hackers-create-a-diy-epipen-the-epipencil/\" target=\"_blank\">EpiPencil\u003c/a>, which would cost $30, instead of the hundreds charged for an EpiPen. Others are working to develop more affordable generic medical treatments, such as \u003ca href=\"https://experiment.com/projects/open-insulin\" target=\"_blank\">insulin\u003c/a> for diabetics, or \u003ca href=\"http://maggic.ooo/Open-Source-Estrogen-2015\" target=\"_blank\">estrogen\u003c/a> for trans women. (Before reaching the market, these products would require normal regulatory approval.)\u003c/p>\n\u003cp>Eri Gentry, co-founder and president of \u003ca href=\"http://biocurious.org/about/\" target=\"_blank\">BioCurious\u003c/a> (she works a day job at \u003ca href=\"http://www.iftf.org/erigentry/\" target=\"_blank\">Institute for the Future\u003c/a> too), says she sees a current lack of investment in basic research and development. Her hope is \u003cspan class=\"s1\">to make biological research accessible to more people, broaden the playing field and spur more innovation.\u003c/span>\u003c/p>\n\u003cp>\"I'm hoping that we'll see more solutions for mankind,\" Gentry says.\u003c/p>\n\u003cp>\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/eh6I7IXiEVM'\n title='//www.youtube.com/embed/eh6I7IXiEVM'\n allowfullscreen='true'\n style='border:0;'>\u003c/iframe>\n \u003c/span>\n \u003c/span>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Biotech will be the technology of this century D'haeseleer says. \"It's going to affect our lives just as much or more as computers have.\"\u003c/p>\n\u003cp>D'haeseleer points to \u003ca href=\"http://ww2.kqed.org/futureofyou/2016/04/29/how-a-new-crisprcas9-technique-may-get-us-closer-to-curing-genetic-diseases/\">CRISPR, a gene-editing technique\u003c/a> which has raised both widespread hope and alarms.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"To me, it's just a better screwdriver,\" D'haeseleer says. \"There's lots of [good or bad] stuff you could do with a better screwdriver and it's probably those things you should be worried about and not the screwdriver.\"\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Erik Vance didn't go to a doctor until he was 18; he grew up in California in a family that practiced Christian Science. \"For the first half of my life, I never questioned the power of God to heal me,\" Vance writes in his new book, \u003ca href=\"http://suggestibleyou.com/\">Suggestible You\u003c/a>\u003cem>: Placebos, False Memories, Hypnosis, and the Power of Your Astonishing Brain\u003c/em>.\u003c/p>\n\u003cp>As a young man, Vance left the faith behind, but as he became a science journalist he didn't stop thinking about how people's beliefs and expectations affect their health, whether it's with placebo pills, mystical practices or treatments like acupuncture. The answer, he found, is in our brains.\u003c/p>\n\u003cp>Erik and I chatted about the book while attending a recent meeting of the National Association of Science Writers. Here are highlights of our conversation, edited for length and clarity.\u003c/p>\n\u003chr>\n\u003ch3>\u003cstrong>Interview Highlights\u003c/strong>\u003c/h3>\n\u003cp>\u003cstrong>You point out that even though most of us didn't grow up Christian Scientist, we often use belief to manage our health. \u003c/strong>\u003c/p>\n\u003cp>I've learned from writing this book that there are a lot of people around the world who really rely on expectation and placebos. And I grew up in the most extreme possible group, but it's not that different from seeing a homeopath. You're using faith to manage your body; what a psychologist would call expectation. Having had that experience really prepared me to ask some of these questions.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cstrong>How would your mom take care of you when you were sick?\u003c/strong>\u003c/p>\n\u003cp>As a kid we might have 7UP with orange juice; we might go that far because it made you feel better. But the treatment was to call a practitioner, to call a healer. Mine was named Lameice; she had the most amazing comforting voice ever. You'd call her up and this voice would say, \"How you doing honey, how you feeling?\" And everything would feel OK. You'd talk about the Bible and you'd talk about the writings of Mary Baker Eddy. The key in all this is the belief that you're actually healthy, and once you're able to see that, it will be manifest. And that in psychological terms is actually more powerful — hoping or asking doesn't have as much power in your brain as thinking it's already happened. It's certainty. And that has a big effect on brain chemicals and how your body responds to those chemicals.\u003c/p>\n\u003cp>\u003cstrong>The idea that the mind affects the body isn't new. How has the science changed to help us understand what's going on? \u003c/strong>\u003c/p>\n\u003cp>Saying that going to church will lower your blood pressure or lengthen your life a little bit; that's been known. But my question is, what's the mechanism? I actually didn't clue into this until I was at a conference for brain mapping and I saw a name on the speakers list talking about placebos and I recognized him as a Christian Scientist. I thought, wow, what's a Christian Scientist doing talking at a brain conference? Talking about placebos, which I think of as a very medical thing.\u003c/p>\n\u003cp>Placebo is a connection between the mind and body that can be measured, that can be seen in a brain scan; for the first time we have a tool that we can actually see working.\u003c/p>\n\u003cp>\u003cstrong>We just covered a \u003ca href=\"http://www.npr.org/sections/health-shots/2016/10/27/499475288/is-it-still-a-placebo-when-it-works-and-you-know-its-a-placebo\">study \u003c/a>by Ted Kaptchuk, a professor of medicine at Harvard, that found that even if people know that a placebo was a fake pill, their back pain got better. Is that what you're talking about?\u003c/strong>\u003c/p>\n\u003cp>Yeah, it's called open label. With an earlier, famous study by Kaptchuk, I kind of assumed that they just gave them a form that said placebo somewhere. But then I talked to Ted, and it turns out that the subjects had to tell the researchers they knew it was a placebo. They weren't subtle about it; they were very explicit.\u003c/p>\n\u003cp>But we're also learning now that people can have a placebo response even if they're unaware of any suggestion that they'll get better or worse; it's part of the unconscious brain. It may be a totally different pathway, but it's a very important part of the whole mix.\u003c/p>\n\u003cp>People say, \"I'm not gullible, I don't fall for these things, but echinacea really works.\" The first thing is not true; we're all gullible. And the second thing is, that person probably experienced an unconscious placebo. They think they're way too smart to be fooled. We should just all accept that this is what we do and embrace it. It gives us an honorable way to say, \"This is how it works.\"\u003c/p>\n\u003cp>\u003cstrong>But placebos don't work for everything. When do they help? \u003c/strong>\u003c/p>\n\u003cp>Cancer is one good example. Pain, nausea and the symptoms of chemotherapy respond really well to placebo. Tumors do not respond to placebos, as far as we know. So you can endanger your life very easily by taking a placebo when you have a serious disease and don't seek an active treatment.\u003c/p>\n\u003cp>The actual rules are according to the brain chemical involved, like dopamine, or endogenous opioids. These are internal endorphins that act like morphine, or serotonin, or a bunch of other ones that I don't want to bore you with. Parkinson's disease involves dopamine, so Parkinson's symptoms respond very well to placebos.\u003c/p>\n\u003cp>A lot of these chemicals do double duty; dopamine has like 50 different roles in the body, and some of these chemicals respond to each other, they interact with each other, and they respond differently to drugs. That's one reason why it's been so hard to pin down these effects for so long.\u003c/p>\n\u003cp>\u003cstrong>How do the stories we tell factor into healing? \u003c/strong>\u003c/p>\n\u003cp>Your brain on a very basic level doesn't want to be wrong. It will shift the chemicals involved so it will be right. And we're not scientific creatures; we believe what we believe. The narratives shift to fit the story we want. I think that makes expectation more powerful. When you remember the time you did the acupuncture and immediately everything got better — that can prime your expectation for the next time you go get acupuncture.\u003c/p>\n\u003cp>\u003cstrong>How did you shift your narrative?\u003c/strong>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>Part of it was probably just juvenile rebellion: I'm a rebel — I'm going to have an Advil. I've literally said that. Then fell in love with biology. And that leads you down the path where you have to get into these medical questions. Rather than being mysterious and scary, I found it to be really fascinating, almost as exciting as God's loving hand cradling you from disease. It didn't feel like a really big shift. It's not like I'm rebelling against anything anymore; it's just that the other thing is pretty cool, and the idea of proving things with logic, it just sort of works. I like my new narrative. And my new narrative is in line with evidence.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=How+The+Brain+Powers+Placebos%2C+False+Memories+And+Healing&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cstrong>How would your mom take care of you when you were sick?\u003c/strong>\u003c/p>\n\u003cp>As a kid we might have 7UP with orange juice; we might go that far because it made you feel better. But the treatment was to call a practitioner, to call a healer. Mine was named Lameice; she had the most amazing comforting voice ever. You'd call her up and this voice would say, \"How you doing honey, how you feeling?\" And everything would feel OK. You'd talk about the Bible and you'd talk about the writings of Mary Baker Eddy. The key in all this is the belief that you're actually healthy, and once you're able to see that, it will be manifest. And that in psychological terms is actually more powerful — hoping or asking doesn't have as much power in your brain as thinking it's already happened. It's certainty. 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"disqusTitle": "Will Computers Ever Be as Good as Physicians at Diagnosing Patients?",
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"content": "\u003cp>\u003cem>This is an edited excerpt from Robert Wachter’s “\u003ca href=\"https://www.amazon.com/Digital-Doctor-Hope-Medicines-Computer/dp/0071849467\" target=\"_blank\">The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine’s Computer Age\u003c/a>,” reprinted with permission from McGraw-Hill. Copyright 2015.\u003c/em>\u003c/p>\n\u003cp>Since 2012, Vinod Khosla, a co-founder of Sun Microsystems, has been predicting that most of what physicians currently do can, will, and should be done by computers. “By 2025,” he has written, “more data-driven, automated health care will displace up to 80 percent of physicians’ diagnostic and prescription work.”\u003c/p>\n\u003caside class=\"pullquote alignright\">A computer can’t read a patient’s tone of voice or anxious look. These clues—like one patient saying, “I have chest pain,” and another, “I HAVE CHEST PAIN!!!”—can make all the difference in diagnosis.\u003c/aside>\n\u003cp>Though Khosla’s comments have irked many a physician, I’m not willing to dismiss him as a kooky provocateur or a utopian techno-evangelist. First of all, his investment track record has made him a Silicon Valley rock star. More important, as recently as a decade ago, some very smart and savvy computer engineers and economists believed that another seemingly intractable problem, building a driverless car, was beyond the reach of modern technology. As of April 2014, the Google car had clocked nearly 700,000 miles and been involved in just two accidents.\u003c/p>\n\u003cp>If the driverless car weren’t enough of a challenge to human superiority, who could have watched IBM’s Watson supercomputer defeat the Jeopardy Hall of Famers in 2011 and not fretted about the future of physicians, or any highly skilled workers, for that matter?\u003c/p>\n\u003cp>\"Just as factory jobs were eliminated in the twentieth century by new assembly-line robots,” wrote all-time (human) Jeopardy champion Ken Jennings soon after the lopsided match ended, “Brad [Rutter, the other defeated champ] and I were the first knowledge-industry workers put out of work by the new generation of ‘thinking’ machines. ‘Quiz show contestant’ may be the first job made redundant by Watson, but I’m sure it won’t be the last.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Soon after the well-publicized trouncing, IBM announced that one of its first “use cases” for Watson would be medicine. Sean Hogan, vice president for IBM Healthcare, told me that “health care jumped out as an area whose complexity and nuances would be\u003ca href=\"https://contextly.com/redirect/?id=K8AsBQdj7f:274449:4068:13:::sidebar:5820be532053f2-30720465\" target=\"_blank\"> receptive to what Watson was representing\u003c/a>.”\u003c/p>\n\u003cp>\u003cstrong>Sticking Up for Team Human\u003c/strong>\u003c/p>\n\u003cp>Andy McAfee, coauthor with Erik Brynjolfsson of the terrific book \"The Second Machine Age,\" agrees with Khosla that computers will ultimately take over much of what physicians do, including diagnosis. “I can’t see how that doesn’t happen,” McAfee, a self-described “technology optimist,” told me when we met for lunch near his MIT office. McAfee and Brynjolfsson argue that the confluence of staggering growth in computing power, zetabytes of fully networked information available on the Web, and the “combinatorial power” of innovation mean that areas that seemed like dead ends, such as artificial intelligence in medicine, are now within reach. They liken the speed with which old digital barriers are falling to Hemingway’s observation about how a person goes broke: “gradually, then suddenly.\"\u003c/p>\n\u003cp>In speaking with both McAfee and Khosla, I felt a strange obligation to stick up for my teams: humans and the subset of humans called doctors. I told McAfee that while I was in awe of the driverless car and IBM’s victories in chess (over world champion Garry Kasparov in 1997) and Jeopardy, he just didn’t understand how hard medicine is. Answering questions posed by Alex Trebek like, “While Maltese borrows many words from Italian, it developed from a dialect of this Semitic language” (the correct response is “What is Arabic?”—Watson answered it, and 65 of the 74 other questions it rang in for, correctly) is tricky, sure, but, at the end of the day, one is simply culling a series of databases to find a fact—a single right answer.\u003c/p>\n\u003caside class=\"pullquote alignright\">‘Quiz show contestant’ may be the first job made redundant by Watson, but I’m sure it won’t be the last.'\u003ccite>(Human) 'Jeopardy' champ Ken Jennings\u003c/cite>\u003c/aside>\n\u003cp>Medical diagnosis isn’t like that. For one thing, uncertainty is endemic, so that the “correct” answer is often a surprisingly probabilistic notion. For another, many diagnoses reveal themselves over time. The patient may present with, say, a headache, but not a worrisome one, and so the primary treatment is reassurance, Tylenol, and time. If the headache worsens over the next two weeks—particularly if it is now accompanied by additional symptoms such as weakness or nausea—that’s an entirely different story.\u003c/p>\n\u003cp>McAfee listened sympathetically—he’s obviously heard scores of versions of the \"You just don’t understand; my work is different\" argument—and then said, “I imagine there are a bunch of really smart geeks at IBM taking notes as guys like you describe this situation. In their heads, they’re asking, ‘How do I model that?’”\u003c/p>\n\u003cp>Undaunted, I tried another tack on Khosla when we met in his office in Menlo Park. “Vinod,” I said, “in medicine we have something we call the ‘eyeball test.’ That means I can see two patients whose numbers look the same”—things like temperature, heart rate, and blood counts—“and my training allows me to say, ‘That guy is sick [I pointed to an imaginary person across the imposing conference table] and the other is okay.’” And good doctors are usually right, I told him, as we possess a kind of sixth sense that we acquire from our training, our role models, and a thousand cases of trial and error.\u003c/p>\n\u003cp>Before Khosla could dismiss this as the usual whining from a dinosaur on the edge of extinction, I tossed him an example from his own world. “I’ll bet you have CEOs of start-ups constantly coming through this office pitching their companies,” I said. “I can imagine two companies that look the same on paper: both CEOs have Stanford MBAs; the proposals have similar financials. Your skill is to be able to point to one and say, ‘Winner’ and to the other, ‘Loser,’ and I’m guessing you’re right more often than not. You’re using information that isn’t measurable. Right?”\u003c/p>\n\u003cp>Nice try. He didn’t budge. “The question is, ‘Is it not measurable or is it not being measured?’” he responded. “And, when does your instinct work and when does it mislead? I think if you did a rigorous study, you’d find that your ‘eyeball test’ is far less effective than you think.”\u003c/p>\n\u003cp>https://www.youtube.com/watch?v=P18EdAKuC1U\u003c/p>\n\u003cp>\u003cstrong>Secrets of the Great Diagnosticians\u003c/strong>\u003c/p>\n\u003cp>There is a rich 50-year history of efforts to build artificial intelligence (AI) systems in health care, and it’s not a particularly uplifting story. Even technophiles admit that the quest to replace doctors with computers—or even the more modest ambition of providing them with useful guidance at the point of care—has been overhyped and unproductive. But times have changed. The growing prevalence of electronic health records offers grist for the AI and big data mills, grist that wasn’t available when the records were on paper. And in this, the Age of Watson, we have new techniques, like natural language processing and machine learning, at our disposal. Perhaps this is our “gradually, then suddenly” moment.\u003c/p>\n\u003caside class=\"pullquote alignright\">Early attempts to use computers for diagnosis were like tackling Saturday’s crossword puzzle in the New York Times before first mastering the one in USA Today.\u003c/aside>\n\u003cp>The public worships dynamic, innovative surgeons like Michael DeBakey; passionate, insightful researchers like Jonas Salk; and telegenic show horses like Mehmet Oz. But we seldom hear about those doctors whom other physicians tend to hold in the highest esteem: the great medical diagnosticians. These sages, like the legendary Johns Hopkins professors William Osler and A. McGehee Harvey, had the uncanny ability to deduce the truth from what others found to be a jumble of symptoms, signs, and lab results. In fact, Sir Arthur Conan Doyle, a physician by training, modeled Sherlock Holmes on one of his old professors, Joseph Bell, a renowned diagnostician at Edinburgh’s medical school.\u003c/p>\n\u003cp>For most doctors, diagnosis forms the essence of their practice (and of their professional souls), which may help explain why we find it so painful to believe that this particular skill could be replaced by silicon wafers.\u003c/p>\n\u003cp>In the 1970s, a Tufts kidney specialist named Jerome Kassirer (who later became editor of the New England Journal of Medicine) decided to try to unlock the cognitive secrets of the great diagnosticians. If he succeeded, the rewards could be great. The insights, problem-solving strategies, and reasoning patterns of these medical geniuses might be teachable to other physicians, perhaps even programmed into computers.\u003c/p>\n\u003cp>Kassirer focused first on the differential diagnosis, the method that doctors have long used to inventory and sort through their patients’ problems. The differential diagnosis is to a physician what the building of hypotheses is to a basic scientist: the core work of the professional mind. Let’s say a female patient complains of right lower abdominal pain and fever. We automatically begin to generate “a differential,” including appendicitis, pelvic inflammatory disease, kidney infection, and a host of less common disorders—some of them quite serious. Our job is to weigh the facts at hand in an effort to ultimately “rule in” one diagnosis on the list and “rule out” the others. Sometimes, the information we gather from the history and physical examination is sufficient.\u003c/p>\n\u003cp>More often, particularly when patients are truly ill, we require additional laboratory or radiographic studies to push one of the diagnoses over the “rule in” line. There is considerable skill, and no small amount of art, involved in this process. For one thing, we need to figure out whether the patient’s symptoms are part of a single disease or are manifestations of two or more distinct illnesses. The principle known as\u003ca href=\"http://www.medicinenet.com/script/main/art.asp?articlekey=26739\" target=\"_blank\"> Occam’s Razor\u003c/a> bids us to try to find a unifying diagnosis for all of a patient’s symptoms. But as soon as medical students memorize this so-called Law of Clinical Parsimony, we whipsaw them with \u003ca href=\"http://www.emergencymedicalparamedic.com/what-is-hickams-dictum/\" target=\"_blank\">Hickam’s Dictum\u003c/a>, which counters, irreverently, that “patients can have as many diseases as they damn well please.”\u003c/p>\n\u003cp>[contextly_sidebar id=\"fXsrKyRyGekfunOt3dsmZPdJAbzwHrbd\"]\u003c/p>\n\u003cp>Setting the “rule in” threshold is yet another challenge, since it’s wholly dependent on the context. For diseases with relatively benign treatments and prognoses—let’s say, stomach discomfort with no alarming features—I might make the diagnosis of “nonulcer dyspepsia” if I’m 75 percent certain that this is what’s going on. Why? Dyspepsia is a not-too-serious illness, the other illnesses that might present with the same symptoms aren’t likely to be acutely life-threatening either, and dyspepsia has a safe, inexpensive, and fairly effective treatment. All of this makes a 75 percent threshold high enough for me to try an acid-blocker and see what happens.\u003c/p>\n\u003cp>Now let’s turn to a patient who presents with acute shortness of breath and pleuritic chest pain. In this patient, I’m considering the diagnosis of pulmonary embolism (a blood clot to the lungs), a more serious disorder whose treatment (blood thinners) is riskier. Now, I’d want to be at least 95 percent sure before attaching that diagnostic label. And I won’t rule in a diagnosis of cancer—with its psychological freight, prognostic implications, and toxic treatments—unless I’m close to 100 percent certain, even if it takes a surgical biopsy to achieve this level of confidence.\u003c/p>\n\u003cp>Kassirer and his colleagues observed the diagnostic reasoning of scores of clinicians. They found that the good ones employed robust strategies to answer these knotty questions, even if they couldn’t always articulate what they were doing and why. The researchers ultimately came to appreciate that the physicians were engaging in a process called “iterative hypothesis testing” to transform the differential diagnosis (or, more accurately, diagnoses, since sick patients often have a variety of abnormalities to be explained) into something actionable. After hearing the initial portion of a case, the doctors began drawing possible scenarios to explain it, modifying their opinions as they went along and more information became available.\u003c/p>\n\u003cp>For example, when a physician confronts a case that begins with, “This 57-year-old man has three days of chest pain, shortness of breath, and lightheadedness,” she responds by thinking, “The worst thing this could be is a heart attack or a pulmonary embolism. I need to ask if the chest pain bores through to the back, which would make me worry about aortic dissection [a rip in the aorta]. I’ll also inquire about typical cardiac symptoms, such as sweating and nausea, and see if the pain is squeezing or radiates to the left arm or jaw. But even if it doesn’t, I’ll certainly get an EKG to rule out a heart attack or pericarditis [inflammation of the sac that surrounds the heart]. If he also reports a fever or a cough, I might begin to suspect pneumonia or pleurisy. The chest X-ray should help sort that out.”\u003c/p>\n\u003cp>Every answer the patient gives, and each positive or negative finding on the physical examination (yes, there is a heart murmur; no, the liver is not enlarged) triggers an automatic, almost intuitive recalibration of the most likely alternatives. When I see a master clinician at work—my favorite is my UCSF colleague Gurpreet Dhaliwal, who was profiled in a 2012\u003ca href=\"http://www.nytimes.com/2012/12/04/health/quest-to-eliminate-diagnostic-lapses.html\" target=\"_blank\"> New York Times article\u003c/a>—I know that these synapses are firing as he asks a patient a series of questions that may seem unrelated to the patient’s presenting complaint but are directed toward “narrowing the differential.” It turns out that there’s an even more impressive piece of cognitive magic going on. The master clinician embraces certain pieces of data (the patient’s trip to rural Thailand last year) while discarding others (an episode of belly pain and bloating three weeks ago). This is the part of diagnostic reasoning that beginners find most vexing, since they lack the foundational knowledge to understand why their teacher focused so intently on one nugget of information and all but ignored others that, to the novice, seemed equally crucial. How do the great diagnosticians make such choices?\u003c/p>\n\u003cp>We now recognize this as a relatively intuitive version of \u003ca href=\"http://www.medicinenet.com/script/main/art.asp?articlekey=10301\" target=\"_blank\">Bayes’ theorem\u003c/a>. Developed by the eighteenth-century British theologian-turned-mathematician Thomas Bayes, this theorem (often ignored by students because it is taught to them with the dryness of a Passover matzo) is the linchpin of clinical reasoning. In essence, Bayes’ theorem says that any medical test must be interpreted from two perspectives. The first: How accurate is the test—that is, how often does it give right or wrong answers? The second: How likely is it that this patient has the disease the test is looking for?\u003c/p>\n\u003cp>These deceptively simple questions explain why, in the early days of the AIDS epidemic (when HIV testing was far less accurate than it is today), it was silly to test heterosexual couples applying for a marriage license, since the vast majority of positive tests in this very low-risk group would be wrong. Similarly, they show why it is foolish to screen healthy 36-year-old executives with a cardiac treadmill test or a heart scan, since positive results will mostly be false positives, serving only to scare the bejesus out of the patients and run up bills for unnecessary follow-up tests. Conversely, in a 68-year-old smoker with diabetes and high cholesterol who develops squeezing chest pain while jogging, there is a 95 percent chance that those pains are from coronary artery disease. In this case, a negative treadmill test only lowers this probability to about 80 percent, so the clinician who reassures the patient that his negative test means that his heart is fine—“take some antacids; it’s OK to keep jogging”—is making a terrible, and potentially fatal, mistake.\u003c/p>\n\u003cp>\u003cstrong>The AI Challenge\u003c/strong>\u003c/p>\n\u003cp>As if this weren’t complicated enough for the poor IBM engineer gearing up to retool Watson from answering questions about “Potent Potables” to diagnosing sick patients, there’s more. While the EHR at least offers a fighting chance for computerized diagnosis (older medical AI programs, built in the pen-and-paper era, required busy physicians to write their notes and then reenter all the key data), parsing an electronic medical record is far from straightforward. Natural language processing is getting much better, but it still has real problems with negation (“the patient has no history of chest pain or cough”) and with family history (“there is a history of arthritis in the patient’s sister, but his mother is well”), to name just a couple of issues. Certain terms have multiple meanings: when written by a psychiatrist, the term depression is likely to refer to a mood disorder, while when it appears in a cardiologist’s note (“there was no evidence of ST-depression”) it probably refers to a dip in the EKG tracing that is often a clue to coronary disease. Ditto abbreviations: Does the patient with “MS” have multiple sclerosis or mitral stenosis, a sticky heart valve? Finally, the computer can’t read a patient’s tone of voice or the anxious look on her face, although engineers are working on this. These clues—like one patient saying, “I have chest pain,” and another, “I HAVE CHEST PAIN!!!”—can make all the difference in the world diagnostically.\u003c/p>\n\u003cp>Perhaps the trickiest problem of all is that—at least today—the very collection of the facts needed to feed an AI system is itself a cognitively complex process. Let’s return to the example of aortic dissection, a rip in the aorta that is often fatal if it is not treated promptly. If the initial history raises the slightest concern about dissection, I’m going to ask questions about whether the pain bores through to the back and check carefully for the quiet murmur of aortic insufficiency as well as for asymmetric blood pressure readings in the two arms, all clues to dissection. If I don’t harbor a suspicion of this scary (and unusual) disease, I’m not going to look for these things—they’re not part of a routine exam.\u003c/p>\n\u003cp>Decades ago, MIT’s Peter Szolovits, an AI expert who worked with Kassirer and his colleagues in the early days, gave up thinking about diagnosis as a simple matter of question answering. This was mostly because he came to appreciate the importance of timing—a nonissue in Jeopardy but a pivotal one in medicine. “A heart attack that happened five years ago has different implications from one that happened five minutes ago,” he explained, and a computer can’t “know” this unless it is programmed to do so. (It turns out that such issues of foundational knowledge are fundamental in AI—computers have no way of “knowing” some of the basic assumptions that allow us to get through our days, things like water is wet, love is good, and death is permanent.)\u003c/p>\n\u003cp>Moreover, much of medical reasoning relies on feedback loops: observing how events unfold and using that information to refine the diagnostic possibilities.We think a patient has bacterial pneumonia, and so we treat the “pneumonia” with antibiotics, but the patient’s fever doesn’t break after three days. So now we consider the possibility of tuberculosis or lupus. This is the cognitive work of the practicing clinician—focused a bit less on “What is the diagnosis?” and more on “How do I best manage this situation?”—and an AI program that doesn’t account for this will be of limited value.\u003c/p>\n\u003cp>\u003cstrong>Early Attempts\u003c/strong>\u003c/p>\n\u003cp>Now that you appreciate the nature of the problem, it’s easy (in retrospect, at least) to see why the choice by early health care computer experts to focus on diagnosis was risky, perhaps even wrongheaded. It’s like tackling Saturday’s crossword puzzle in the New York Times before first mastering the one in USA Today.\u003c/p>\n\u003cp>Larry Fagan, an early Stanford computing pioneer, told me, “We were not naive about the complexity. It’s just that it was the most exciting question.” Diagnosis is not just exciting, it’s at the heart of safe medical care. Diagnostic errors are common, and they can be fatal. A number of autopsy studies conducted over the past 40 years have shown that major diagnoses were overlooked in nearly one in five patients. With the advent of CT scans and MRIs, the number has gone down a bit, but it still hovers around one in ten. Diagnostic errors contribute to 40,000 to 80,000 deaths per year in the United States. And reviews of malpractice cases have demonstrated that diagnostic errors are the most common source of mistakes leading to successful lawsuits.\u003c/p>\n\u003cp>Medical IT experts jumped into the fray in the 1970s, designing a series of computer programs that they believed could help physicians be better diagnosticians, or perhaps even replace them entirely. That decade’s literature was replete with enthusiastic articles about how microprocessors, programmed to think like experts, would soon replace the brains of harried doctors. The attitude was captured by one early computing pioneer in a 1971 paean to his computer: “It is immune from fatigue and carelessness; and it works day and night, weekends and holidays, without coffee breaks, overtime, fringe benefits or human courtesy.”\u003c/p>\n\u003cp>By the mid-1980s, disappointment had set in. The tools that had seemed so promising a decade earlier were, by and large, unable to manage the complexity of clinical medicine, and they garnered few clinician advocates and miniscule commercial adoption. The medical AI movement skidded to a halt, marking the start of a 20-year period that insiders still refer to as the “AI winter.” Ted Shortliffe, one of the field’s longstanding leaders, has said that the early experience with programs like INTERNIST, DXplain, and MYCIN reminded him of this cartoon:\u003c/p>\n\u003cp>\u003ca href=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/11/cartoon.jpg\">\u003cimg class=\"aligncenter size-full wp-image-276235\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/11/cartoon.jpg\" alt=\"cartoon\" width=\"300\" height=\"373\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2016/11/cartoon.jpg 300w, https://ww2.kqed.org/app/uploads/sites/13/2016/11/cartoon-160x199.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2016/11/cartoon-240x298.jpg 240w\" sizes=\"(max-width: 300px) 100vw, 300px\">\u003c/a>\u003c/p>\n\u003cp>\u003cstrong>'Version 0'\u003c/strong>\u003c/p>\n\u003cp>Vinod Khosla is prepared for this. He knows that even today’s generation of medical AI programs will produce some crazy output, akin to when Watson famously mistook Toronto for an American city during its Jeopardy triumph. (It was worse in rehearsal, when Watson referred to civil rights leader Malcolm X as “Malcolm Ten.”) Khosla points out that the enormous cellphones of the late 1980s would seem equally ridiculous when placed alongside our iPhone 6.0s. He calls today’s medical AI programs “Version 0,” and cautions that people should “expect these early systems and tools to be the butt of jokes from many a writer and physician.”\u003c/p>\n\u003cp>These cases illustrate a perennial debate in AI, one that pits two camps against each other: the “neats” and the “scruffies.” The neats seek solutions that are elegant and provable; they try to model the way experts think and work, and then code that into AI tools. The scruffies are the pragmatists, the hackers, the crazy ones; they believe that problems should be attacked through whatever means work, and that modeling the behavior of experts or the scientific truth of a situation isn’t all that important. IBM’s breakthrough was to figure out that a combination of neat and scruffy—programming in some of the core rules of the game, but then folding in the fruits of machine learning and natural language processing—could solve truly complicated problems.\u003c/p>\n\u003cp>When he was asked about the difference between human thinking and Watson’s method, Eric Brown, who runs IBM’s Watson Technologies group, gave a careful answer (note the shout-out to the humans, the bit players who made it all possible):\u003c/p>\n\u003cblockquote>\u003cp>A lot of the way that Watson works is motivated by the way that humans analyze problems and go about trying to find solutions, especially when it comes to dealing with complex problems where there are a number of intermediate steps toget you to the final answer. So it certainly is inspired by that process. . . . But a lot of it is different from the ways humans work; it tends to leverage the powers and advantages of a computer system, and its ability to rapidly analyze huge amounts of data and text that humans just can’t keep track of.\u003c/p>\u003c/blockquote>\n\u003cp>However Watson works, we find ourselves today in a world with new tools, new mental models, and a new sense of optimism that computers can do pretty much anything. But have we finally reached the age when computers can master the art of clinical reasoning?\u003c/p>\n\u003cp>I asked Eric Brown, who worked on the \"Jeopardy\" project and is now helping to lead Watson’s efforts in medicine, what the equivalent event might be in health care, the moment when his team could finally congratulate itself on its successes. I wondered if it would be the creation of some kind of holographic physician—like “\u003ca href=\"http://memory-alpha.wikia.com/wiki/Emergency_Medical_Holographic_program\" target=\"_blank\">The Doctor\u003c/a>” on Star Trek Voyager—with Watson serving as the cognitive engine. His answer, though, reflected the deep respect he and his colleagues have for the magnitude of the challenge:\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“It will be when we have a technology that physicians suddenly can’t live without.”\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 “\u003ca href=\"https://www.amazon.com/Digital-Doctor-Hope-Medicines-Computer/dp/0071849467\" target=\"_blank\">The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine’s Computer Age\u003c/a>,” reprinted with permission from McGraw-Hill. Copyright 2015.\u003c/em>\u003c/p>\n\u003cp>Since 2012, Vinod Khosla, a co-founder of Sun Microsystems, has been predicting that most of what physicians currently do can, will, and should be done by computers. “By 2025,” he has written, “more data-driven, automated health care will displace up to 80 percent of physicians’ diagnostic and prescription work.”\u003c/p>\n\u003caside class=\"pullquote alignright\">A computer can’t read a patient’s tone of voice or anxious look. These clues—like one patient saying, “I have chest pain,” and another, “I HAVE CHEST PAIN!!!”—can make all the difference in diagnosis.\u003c/aside>\n\u003cp>Though Khosla’s comments have irked many a physician, I’m not willing to dismiss him as a kooky provocateur or a utopian techno-evangelist. First of all, his investment track record has made him a Silicon Valley rock star. More important, as recently as a decade ago, some very smart and savvy computer engineers and economists believed that another seemingly intractable problem, building a driverless car, was beyond the reach of modern technology. As of April 2014, the Google car had clocked nearly 700,000 miles and been involved in just two accidents.\u003c/p>\n\u003cp>If the driverless car weren’t enough of a challenge to human superiority, who could have watched IBM’s Watson supercomputer defeat the Jeopardy Hall of Famers in 2011 and not fretted about the future of physicians, or any highly skilled workers, for that matter?\u003c/p>\n\u003cp>\"Just as factory jobs were eliminated in the twentieth century by new assembly-line robots,” wrote all-time (human) Jeopardy champion Ken Jennings soon after the lopsided match ended, “Brad [Rutter, the other defeated champ] and I were the first knowledge-industry workers put out of work by the new generation of ‘thinking’ machines. ‘Quiz show contestant’ may be the first job made redundant by Watson, but I’m sure it won’t be the last.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Soon after the well-publicized trouncing, IBM announced that one of its first “use cases” for Watson would be medicine. Sean Hogan, vice president for IBM Healthcare, told me that “health care jumped out as an area whose complexity and nuances would be\u003ca href=\"https://contextly.com/redirect/?id=K8AsBQdj7f:274449:4068:13:::sidebar:5820be532053f2-30720465\" target=\"_blank\"> receptive to what Watson was representing\u003c/a>.”\u003c/p>\n\u003cp>\u003cstrong>Sticking Up for Team Human\u003c/strong>\u003c/p>\n\u003cp>Andy McAfee, coauthor with Erik Brynjolfsson of the terrific book \"The Second Machine Age,\" agrees with Khosla that computers will ultimately take over much of what physicians do, including diagnosis. “I can’t see how that doesn’t happen,” McAfee, a self-described “technology optimist,” told me when we met for lunch near his MIT office. McAfee and Brynjolfsson argue that the confluence of staggering growth in computing power, zetabytes of fully networked information available on the Web, and the “combinatorial power” of innovation mean that areas that seemed like dead ends, such as artificial intelligence in medicine, are now within reach. They liken the speed with which old digital barriers are falling to Hemingway’s observation about how a person goes broke: “gradually, then suddenly.\"\u003c/p>\n\u003cp>In speaking with both McAfee and Khosla, I felt a strange obligation to stick up for my teams: humans and the subset of humans called doctors. I told McAfee that while I was in awe of the driverless car and IBM’s victories in chess (over world champion Garry Kasparov in 1997) and Jeopardy, he just didn’t understand how hard medicine is. Answering questions posed by Alex Trebek like, “While Maltese borrows many words from Italian, it developed from a dialect of this Semitic language” (the correct response is “What is Arabic?”—Watson answered it, and 65 of the 74 other questions it rang in for, correctly) is tricky, sure, but, at the end of the day, one is simply culling a series of databases to find a fact—a single right answer.\u003c/p>\n\u003caside class=\"pullquote alignright\">‘Quiz show contestant’ may be the first job made redundant by Watson, but I’m sure it won’t be the last.'\u003ccite>(Human) 'Jeopardy' champ Ken Jennings\u003c/cite>\u003c/aside>\n\u003cp>Medical diagnosis isn’t like that. For one thing, uncertainty is endemic, so that the “correct” answer is often a surprisingly probabilistic notion. For another, many diagnoses reveal themselves over time. The patient may present with, say, a headache, but not a worrisome one, and so the primary treatment is reassurance, Tylenol, and time. If the headache worsens over the next two weeks—particularly if it is now accompanied by additional symptoms such as weakness or nausea—that’s an entirely different story.\u003c/p>\n\u003cp>McAfee listened sympathetically—he’s obviously heard scores of versions of the \"You just don’t understand; my work is different\" argument—and then said, “I imagine there are a bunch of really smart geeks at IBM taking notes as guys like you describe this situation. In their heads, they’re asking, ‘How do I model that?’”\u003c/p>\n\u003cp>Undaunted, I tried another tack on Khosla when we met in his office in Menlo Park. “Vinod,” I said, “in medicine we have something we call the ‘eyeball test.’ That means I can see two patients whose numbers look the same”—things like temperature, heart rate, and blood counts—“and my training allows me to say, ‘That guy is sick [I pointed to an imaginary person across the imposing conference table] and the other is okay.’” And good doctors are usually right, I told him, as we possess a kind of sixth sense that we acquire from our training, our role models, and a thousand cases of trial and error.\u003c/p>\n\u003cp>Before Khosla could dismiss this as the usual whining from a dinosaur on the edge of extinction, I tossed him an example from his own world. “I’ll bet you have CEOs of start-ups constantly coming through this office pitching their companies,” I said. “I can imagine two companies that look the same on paper: both CEOs have Stanford MBAs; the proposals have similar financials. Your skill is to be able to point to one and say, ‘Winner’ and to the other, ‘Loser,’ and I’m guessing you’re right more often than not. You’re using information that isn’t measurable. Right?”\u003c/p>\n\u003cp>Nice try. He didn’t budge. “The question is, ‘Is it not measurable or is it not being measured?’” he responded. “And, when does your instinct work and when does it mislead? I think if you did a rigorous study, you’d find that your ‘eyeball test’ is far less effective than you think.”\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/P18EdAKuC1U'\n title='//www.youtube.com/embed/P18EdAKuC1U'\n allowfullscreen='true'\n style='border:0;'>\u003c/iframe>\n \u003c/span>\n \u003c/span>\u003c/p>\u003cp>\u003cp>\u003cstrong>Secrets of the Great Diagnosticians\u003c/strong>\u003c/p>\n\u003cp>There is a rich 50-year history of efforts to build artificial intelligence (AI) systems in health care, and it’s not a particularly uplifting story. Even technophiles admit that the quest to replace doctors with computers—or even the more modest ambition of providing them with useful guidance at the point of care—has been overhyped and unproductive. But times have changed. The growing prevalence of electronic health records offers grist for the AI and big data mills, grist that wasn’t available when the records were on paper. And in this, the Age of Watson, we have new techniques, like natural language processing and machine learning, at our disposal. Perhaps this is our “gradually, then suddenly” moment.\u003c/p>\n\u003caside class=\"pullquote alignright\">Early attempts to use computers for diagnosis were like tackling Saturday’s crossword puzzle in the New York Times before first mastering the one in USA Today.\u003c/aside>\n\u003cp>The public worships dynamic, innovative surgeons like Michael DeBakey; passionate, insightful researchers like Jonas Salk; and telegenic show horses like Mehmet Oz. But we seldom hear about those doctors whom other physicians tend to hold in the highest esteem: the great medical diagnosticians. These sages, like the legendary Johns Hopkins professors William Osler and A. McGehee Harvey, had the uncanny ability to deduce the truth from what others found to be a jumble of symptoms, signs, and lab results. In fact, Sir Arthur Conan Doyle, a physician by training, modeled Sherlock Holmes on one of his old professors, Joseph Bell, a renowned diagnostician at Edinburgh’s medical school.\u003c/p>\n\u003cp>For most doctors, diagnosis forms the essence of their practice (and of their professional souls), which may help explain why we find it so painful to believe that this particular skill could be replaced by silicon wafers.\u003c/p>\n\u003cp>In the 1970s, a Tufts kidney specialist named Jerome Kassirer (who later became editor of the New England Journal of Medicine) decided to try to unlock the cognitive secrets of the great diagnosticians. If he succeeded, the rewards could be great. The insights, problem-solving strategies, and reasoning patterns of these medical geniuses might be teachable to other physicians, perhaps even programmed into computers.\u003c/p>\n\u003cp>Kassirer focused first on the differential diagnosis, the method that doctors have long used to inventory and sort through their patients’ problems. The differential diagnosis is to a physician what the building of hypotheses is to a basic scientist: the core work of the professional mind. Let’s say a female patient complains of right lower abdominal pain and fever. We automatically begin to generate “a differential,” including appendicitis, pelvic inflammatory disease, kidney infection, and a host of less common disorders—some of them quite serious. Our job is to weigh the facts at hand in an effort to ultimately “rule in” one diagnosis on the list and “rule out” the others. Sometimes, the information we gather from the history and physical examination is sufficient.\u003c/p>\n\u003cp>More often, particularly when patients are truly ill, we require additional laboratory or radiographic studies to push one of the diagnoses over the “rule in” line. There is considerable skill, and no small amount of art, involved in this process. For one thing, we need to figure out whether the patient’s symptoms are part of a single disease or are manifestations of two or more distinct illnesses. The principle known as\u003ca href=\"http://www.medicinenet.com/script/main/art.asp?articlekey=26739\" target=\"_blank\"> Occam’s Razor\u003c/a> bids us to try to find a unifying diagnosis for all of a patient’s symptoms. But as soon as medical students memorize this so-called Law of Clinical Parsimony, we whipsaw them with \u003ca href=\"http://www.emergencymedicalparamedic.com/what-is-hickams-dictum/\" target=\"_blank\">Hickam’s Dictum\u003c/a>, which counters, irreverently, that “patients can have as many diseases as they damn well please.”\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Setting the “rule in” threshold is yet another challenge, since it’s wholly dependent on the context. For diseases with relatively benign treatments and prognoses—let’s say, stomach discomfort with no alarming features—I might make the diagnosis of “nonulcer dyspepsia” if I’m 75 percent certain that this is what’s going on. Why? Dyspepsia is a not-too-serious illness, the other illnesses that might present with the same symptoms aren’t likely to be acutely life-threatening either, and dyspepsia has a safe, inexpensive, and fairly effective treatment. All of this makes a 75 percent threshold high enough for me to try an acid-blocker and see what happens.\u003c/p>\n\u003cp>Now let’s turn to a patient who presents with acute shortness of breath and pleuritic chest pain. In this patient, I’m considering the diagnosis of pulmonary embolism (a blood clot to the lungs), a more serious disorder whose treatment (blood thinners) is riskier. Now, I’d want to be at least 95 percent sure before attaching that diagnostic label. And I won’t rule in a diagnosis of cancer—with its psychological freight, prognostic implications, and toxic treatments—unless I’m close to 100 percent certain, even if it takes a surgical biopsy to achieve this level of confidence.\u003c/p>\n\u003cp>Kassirer and his colleagues observed the diagnostic reasoning of scores of clinicians. They found that the good ones employed robust strategies to answer these knotty questions, even if they couldn’t always articulate what they were doing and why. The researchers ultimately came to appreciate that the physicians were engaging in a process called “iterative hypothesis testing” to transform the differential diagnosis (or, more accurately, diagnoses, since sick patients often have a variety of abnormalities to be explained) into something actionable. After hearing the initial portion of a case, the doctors began drawing possible scenarios to explain it, modifying their opinions as they went along and more information became available.\u003c/p>\n\u003cp>For example, when a physician confronts a case that begins with, “This 57-year-old man has three days of chest pain, shortness of breath, and lightheadedness,” she responds by thinking, “The worst thing this could be is a heart attack or a pulmonary embolism. I need to ask if the chest pain bores through to the back, which would make me worry about aortic dissection [a rip in the aorta]. I’ll also inquire about typical cardiac symptoms, such as sweating and nausea, and see if the pain is squeezing or radiates to the left arm or jaw. But even if it doesn’t, I’ll certainly get an EKG to rule out a heart attack or pericarditis [inflammation of the sac that surrounds the heart]. If he also reports a fever or a cough, I might begin to suspect pneumonia or pleurisy. The chest X-ray should help sort that out.”\u003c/p>\n\u003cp>Every answer the patient gives, and each positive or negative finding on the physical examination (yes, there is a heart murmur; no, the liver is not enlarged) triggers an automatic, almost intuitive recalibration of the most likely alternatives. When I see a master clinician at work—my favorite is my UCSF colleague Gurpreet Dhaliwal, who was profiled in a 2012\u003ca href=\"http://www.nytimes.com/2012/12/04/health/quest-to-eliminate-diagnostic-lapses.html\" target=\"_blank\"> New York Times article\u003c/a>—I know that these synapses are firing as he asks a patient a series of questions that may seem unrelated to the patient’s presenting complaint but are directed toward “narrowing the differential.” It turns out that there’s an even more impressive piece of cognitive magic going on. The master clinician embraces certain pieces of data (the patient’s trip to rural Thailand last year) while discarding others (an episode of belly pain and bloating three weeks ago). This is the part of diagnostic reasoning that beginners find most vexing, since they lack the foundational knowledge to understand why their teacher focused so intently on one nugget of information and all but ignored others that, to the novice, seemed equally crucial. How do the great diagnosticians make such choices?\u003c/p>\n\u003cp>We now recognize this as a relatively intuitive version of \u003ca href=\"http://www.medicinenet.com/script/main/art.asp?articlekey=10301\" target=\"_blank\">Bayes’ theorem\u003c/a>. Developed by the eighteenth-century British theologian-turned-mathematician Thomas Bayes, this theorem (often ignored by students because it is taught to them with the dryness of a Passover matzo) is the linchpin of clinical reasoning. In essence, Bayes’ theorem says that any medical test must be interpreted from two perspectives. The first: How accurate is the test—that is, how often does it give right or wrong answers? The second: How likely is it that this patient has the disease the test is looking for?\u003c/p>\n\u003cp>These deceptively simple questions explain why, in the early days of the AIDS epidemic (when HIV testing was far less accurate than it is today), it was silly to test heterosexual couples applying for a marriage license, since the vast majority of positive tests in this very low-risk group would be wrong. Similarly, they show why it is foolish to screen healthy 36-year-old executives with a cardiac treadmill test or a heart scan, since positive results will mostly be false positives, serving only to scare the bejesus out of the patients and run up bills for unnecessary follow-up tests. Conversely, in a 68-year-old smoker with diabetes and high cholesterol who develops squeezing chest pain while jogging, there is a 95 percent chance that those pains are from coronary artery disease. In this case, a negative treadmill test only lowers this probability to about 80 percent, so the clinician who reassures the patient that his negative test means that his heart is fine—“take some antacids; it’s OK to keep jogging”—is making a terrible, and potentially fatal, mistake.\u003c/p>\n\u003cp>\u003cstrong>The AI Challenge\u003c/strong>\u003c/p>\n\u003cp>As if this weren’t complicated enough for the poor IBM engineer gearing up to retool Watson from answering questions about “Potent Potables” to diagnosing sick patients, there’s more. While the EHR at least offers a fighting chance for computerized diagnosis (older medical AI programs, built in the pen-and-paper era, required busy physicians to write their notes and then reenter all the key data), parsing an electronic medical record is far from straightforward. Natural language processing is getting much better, but it still has real problems with negation (“the patient has no history of chest pain or cough”) and with family history (“there is a history of arthritis in the patient’s sister, but his mother is well”), to name just a couple of issues. Certain terms have multiple meanings: when written by a psychiatrist, the term depression is likely to refer to a mood disorder, while when it appears in a cardiologist’s note (“there was no evidence of ST-depression”) it probably refers to a dip in the EKG tracing that is often a clue to coronary disease. Ditto abbreviations: Does the patient with “MS” have multiple sclerosis or mitral stenosis, a sticky heart valve? Finally, the computer can’t read a patient’s tone of voice or the anxious look on her face, although engineers are working on this. These clues—like one patient saying, “I have chest pain,” and another, “I HAVE CHEST PAIN!!!”—can make all the difference in the world diagnostically.\u003c/p>\n\u003cp>Perhaps the trickiest problem of all is that—at least today—the very collection of the facts needed to feed an AI system is itself a cognitively complex process. Let’s return to the example of aortic dissection, a rip in the aorta that is often fatal if it is not treated promptly. If the initial history raises the slightest concern about dissection, I’m going to ask questions about whether the pain bores through to the back and check carefully for the quiet murmur of aortic insufficiency as well as for asymmetric blood pressure readings in the two arms, all clues to dissection. If I don’t harbor a suspicion of this scary (and unusual) disease, I’m not going to look for these things—they’re not part of a routine exam.\u003c/p>\n\u003cp>Decades ago, MIT’s Peter Szolovits, an AI expert who worked with Kassirer and his colleagues in the early days, gave up thinking about diagnosis as a simple matter of question answering. This was mostly because he came to appreciate the importance of timing—a nonissue in Jeopardy but a pivotal one in medicine. “A heart attack that happened five years ago has different implications from one that happened five minutes ago,” he explained, and a computer can’t “know” this unless it is programmed to do so. (It turns out that such issues of foundational knowledge are fundamental in AI—computers have no way of “knowing” some of the basic assumptions that allow us to get through our days, things like water is wet, love is good, and death is permanent.)\u003c/p>\n\u003cp>Moreover, much of medical reasoning relies on feedback loops: observing how events unfold and using that information to refine the diagnostic possibilities.We think a patient has bacterial pneumonia, and so we treat the “pneumonia” with antibiotics, but the patient’s fever doesn’t break after three days. So now we consider the possibility of tuberculosis or lupus. This is the cognitive work of the practicing clinician—focused a bit less on “What is the diagnosis?” and more on “How do I best manage this situation?”—and an AI program that doesn’t account for this will be of limited value.\u003c/p>\n\u003cp>\u003cstrong>Early Attempts\u003c/strong>\u003c/p>\n\u003cp>Now that you appreciate the nature of the problem, it’s easy (in retrospect, at least) to see why the choice by early health care computer experts to focus on diagnosis was risky, perhaps even wrongheaded. It’s like tackling Saturday’s crossword puzzle in the New York Times before first mastering the one in USA Today.\u003c/p>\n\u003cp>Larry Fagan, an early Stanford computing pioneer, told me, “We were not naive about the complexity. It’s just that it was the most exciting question.” Diagnosis is not just exciting, it’s at the heart of safe medical care. Diagnostic errors are common, and they can be fatal. A number of autopsy studies conducted over the past 40 years have shown that major diagnoses were overlooked in nearly one in five patients. With the advent of CT scans and MRIs, the number has gone down a bit, but it still hovers around one in ten. Diagnostic errors contribute to 40,000 to 80,000 deaths per year in the United States. And reviews of malpractice cases have demonstrated that diagnostic errors are the most common source of mistakes leading to successful lawsuits.\u003c/p>\n\u003cp>Medical IT experts jumped into the fray in the 1970s, designing a series of computer programs that they believed could help physicians be better diagnosticians, or perhaps even replace them entirely. That decade’s literature was replete with enthusiastic articles about how microprocessors, programmed to think like experts, would soon replace the brains of harried doctors. The attitude was captured by one early computing pioneer in a 1971 paean to his computer: “It is immune from fatigue and carelessness; and it works day and night, weekends and holidays, without coffee breaks, overtime, fringe benefits or human courtesy.”\u003c/p>\n\u003cp>By the mid-1980s, disappointment had set in. The tools that had seemed so promising a decade earlier were, by and large, unable to manage the complexity of clinical medicine, and they garnered few clinician advocates and miniscule commercial adoption. The medical AI movement skidded to a halt, marking the start of a 20-year period that insiders still refer to as the “AI winter.” Ted Shortliffe, one of the field’s longstanding leaders, has said that the early experience with programs like INTERNIST, DXplain, and MYCIN reminded him of this cartoon:\u003c/p>\n\u003cp>\u003ca href=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/11/cartoon.jpg\">\u003cimg class=\"aligncenter size-full wp-image-276235\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/11/cartoon.jpg\" alt=\"cartoon\" width=\"300\" height=\"373\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2016/11/cartoon.jpg 300w, https://ww2.kqed.org/app/uploads/sites/13/2016/11/cartoon-160x199.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2016/11/cartoon-240x298.jpg 240w\" sizes=\"(max-width: 300px) 100vw, 300px\">\u003c/a>\u003c/p>\n\u003cp>\u003cstrong>'Version 0'\u003c/strong>\u003c/p>\n\u003cp>Vinod Khosla is prepared for this. He knows that even today’s generation of medical AI programs will produce some crazy output, akin to when Watson famously mistook Toronto for an American city during its Jeopardy triumph. (It was worse in rehearsal, when Watson referred to civil rights leader Malcolm X as “Malcolm Ten.”) Khosla points out that the enormous cellphones of the late 1980s would seem equally ridiculous when placed alongside our iPhone 6.0s. He calls today’s medical AI programs “Version 0,” and cautions that people should “expect these early systems and tools to be the butt of jokes from many a writer and physician.”\u003c/p>\n\u003cp>These cases illustrate a perennial debate in AI, one that pits two camps against each other: the “neats” and the “scruffies.” The neats seek solutions that are elegant and provable; they try to model the way experts think and work, and then code that into AI tools. The scruffies are the pragmatists, the hackers, the crazy ones; they believe that problems should be attacked through whatever means work, and that modeling the behavior of experts or the scientific truth of a situation isn’t all that important. IBM’s breakthrough was to figure out that a combination of neat and scruffy—programming in some of the core rules of the game, but then folding in the fruits of machine learning and natural language processing—could solve truly complicated problems.\u003c/p>\n\u003cp>When he was asked about the difference between human thinking and Watson’s method, Eric Brown, who runs IBM’s Watson Technologies group, gave a careful answer (note the shout-out to the humans, the bit players who made it all possible):\u003c/p>\n\u003cblockquote>\u003cp>A lot of the way that Watson works is motivated by the way that humans analyze problems and go about trying to find solutions, especially when it comes to dealing with complex problems where there are a number of intermediate steps toget you to the final answer. So it certainly is inspired by that process. . . . But a lot of it is different from the ways humans work; it tends to leverage the powers and advantages of a computer system, and its ability to rapidly analyze huge amounts of data and text that humans just can’t keep track of.\u003c/p>\u003c/blockquote>\n\u003cp>However Watson works, we find ourselves today in a world with new tools, new mental models, and a new sense of optimism that computers can do pretty much anything. But have we finally reached the age when computers can master the art of clinical reasoning?\u003c/p>\n\u003cp>I asked Eric Brown, who worked on the \"Jeopardy\" project and is now helping to lead Watson’s efforts in medicine, what the equivalent event might be in health care, the moment when his team could finally congratulate itself on its successes. I wondered if it would be the creation of some kind of holographic physician—like “\u003ca href=\"http://memory-alpha.wikia.com/wiki/Emergency_Medical_Holographic_program\" target=\"_blank\">The Doctor\u003c/a>” on Star Trek Voyager—with Watson serving as the cognitive engine. His answer, though, reflected the deep respect he and his colleagues have for the magnitude of the challenge:\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“It will be when we have a technology that physicians suddenly can’t live without.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Can Mental Illness Be Prevented In The Womb?",
"title": "Can Mental Illness Be Prevented In The Womb?",
"headTitle": "KQED Future of You | KQED Science",
"content": "\u003cp>Every day in the United States, millions of expectant mothers take a prenatal vitamin on the advice of their doctor.\u003c/p>\n\u003cp>The counsel typically comes with physical health in mind: folic acid to help avoid fetal spinal cord problems; iodine to spur healthy brain development; calcium to be bound like molecular Legos into diminutive baby bones.\u003c/p>\n\u003cp>But what about a child's future mental health? Questions about whether ADHD might arise a few years down the road or whether schizophrenia could crop up in young adulthood tend to be overshadowed by more immediate parental anxieties. As a friend with a newborn daughter recently fretted over lunch, \"I'm just trying not to drop her!\"\u003c/p>\n\u003cp>Yet much as pediatricians administer childhood vaccines to guard against future infections, some psychiatrists now are thinking about how to shift their treatment-centric discipline toward one that also deals in early prevention.\u003c/p>\n\u003cp>In 2013, University of Colorado psychiatrist \u003ca href=\"http://www.ucdenver.edu/academics/colleges/medicalschool/departments/psychiatry/Faculty/Pages/Freedman,%20Robert.aspx\">Robert Freedman\u003c/a> and colleagues recruited 100 healthy, pregnant women from greater Denver to study whether giving the \u003ca href=\"//www.ncbi.nlm.nih.gov/books/NBK114308/\">B vitamin choline\u003c/a> during pregnancy would enhance brain growth in the developing fetus.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The moms-to-be were randomly given either a placebo or a form of choline called phosphatidylcholine. Choline itself is broken down by bacteria in the gut; by giving it in this related form the supplement can more effectively be absorbed into the bloodstream.\u003c/p>\n\u003cp>Those in the treatment group received 3,600 milligrams of phosphatidylcholine in the morning and 2,700 milligrams at night. Since phosphatidylcholine is roughly 13-15 percent choline, the amount the women received was about 900 milligrams of choline a day, twice that recommended by the Health and Medicine Division of the National Academies (and about the same amount contained in three large eggs).\u003c/p>\n\u003cp>After birth, infants were given either 100 milligrams of liquid phosphatidylcholine or placebo once a day for approximately three months. Given that both groups were also getting choline from regular feeding, the dose ensured that those supplemented received well over the Institute of Medicine's guideline that infants receive at least 125 milligrams a day.\u003c/p>\n\u003cp>At 5 weeks old, the children were exposed to a series of clicking sounds in the lab while their brain activity was monitored by \u003ca href=\"https://medlineplus.gov/ency/article/003931.htm\">electroencephalogram\u003c/a>, or EEG, a method for recording electrical brain activity via electrodes placed on the scalp. Normally, when exposed to the same sound successively, both infant and adult brains will exhibit \"inhibition,\" or a far weaker pulse of activity in response to the second sound. We realize that the now familiar tone is insignificant; our brains are unmoved.\u003c/p>\n\u003cp>However, in some kids this inhibition doesn't occur — a finding linked with an increased risk for attention problems, social withdrawal and, later in life, schizophrenia.\u003c/p>\n\u003cp>The \u003ca href=\"http://ajp.psychiatryonline.org/doi/abs/10.1176/appi.ajp.2012.12070940\">results published in 2013\u003c/a> in the \u003cem>American Journal of Psychiatry\u003c/em> by Freedman's group show that 76 percent of newborns whose mothers received choline supplements had normal inhibition to the sound stimuli. The proportion fell to 43 percent in those born to mothers who didn't get them. It appeared that choline might steer the infant brain away from a developmental course that predicted mental health problems.\u003c/p>\n\u003cp>A follow-up study at 40 months found that the children who had received choline supplements \u003cem>in utero\u003c/em> and after birth had fewer attention problems and less social withdrawal.\u003c/p>\n\u003cp>Excessive choline consumption — or that over 7,500 milligrams a day — has been associated with drops in blood pressure, sweating, gastrointestinal side effects and a \"fishy\" body odor. But most diets contain adequate choline, and supplementation to optimal levels poses no known side effects or risk to fetal development, Freedman says.\u003c/p>\n\u003cp>\u003cstrong>A genetic theory \u003c/strong>\u003c/p>\n\u003cp>One of the first genes to be linked to schizophrenia goes by the catchy name \"\u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/26376812\">CHRNA7\u003c/a>.\" Normally it encodes for a receptor on neurons in the brain that respond to the neurotransmitter acetylcholine as well as nicotine, a transmission essential to normal brain function and cognition. Genetic mutations in the CHRNA7 gene cause decreased levels of the neuronal receptor to be produced in people with schizophrenia.\u003c/p>\n\u003cp>A light bulb glowed for Freedman.\u003c/p>\n\u003cp>And the idea, he admits, is rather simple when you think about it: Choline is known to be essential to brain development and function and is also frequently deficient in pregnant women.\u003c/p>\n\u003cp>Couple these facts with animal and human research by Freedman and his colleagues showing that choline in the amniotic fluid also activates the CHRNA7 receptor in the developing fetal brain.\u003c/p>\n\u003cp>\"It occurred to us that just as folic acid can help overcome defects in brain and spinal cord development, perhaps supplementing mothers with choline could help prevent mental illness,\" Freedman recalls. \"And now that the children in our study are over 4 years old, we can see that those given the supplement appear to be on a different developmental track, one with fewer mental problems.\"\u003c/p>\n\u003cp>Moreover, though experimental psychosis treatments targeting the CHRNA7 gene and the receptor it codes for are being explored by other researchers, Freedman explains that levels of the receptor peak in the fetal brain and diminish after birth. \"We realized the optimal time to try this intervention is during pregnancy,\" he says.\u003c/p>\n\u003cp>Though choline is available in a number of foods — eggs, seafood and liver are particularly rich in the nutrient — Freedman's work suggests that for many women, dietary sources may be inadequate during pregnancy. Also, prenatal supplements tend not to include it.\u003c/p>\n\u003cp>Two past observational studies — conducted with diet questionnaires rather than the more rigorous placebo-controlled supplementation Freedman's group tried — also found beneficial effects associated with higher maternal choline intake during pregnancy. At 7 years of age, children of moms consuming over 400 milligrams of choline a day performed better on memory and intelligence tests. At 18 months, infants whose mothers had higher blood levels of choline had significantly higher cognitive test scores.\u003c/p>\n\u003cp>Dr. Steve Zeisel of the University of North Carolina was one of the first doctors to strongly advocate for choline supplementation in pregnancy. In 2012, Zeisel \u003ca href=\"http://ajcn.nutrition.org/content/96/6/1465.long\">published the only other\u003c/a> placebo-controlled trial of the vitamin in pregnant moms. While he did not assess for future mental health risks, the findings suggested that choline supplementation did not enhance infant cognitive function at 1 year of age. However, Freedman point outs that all of the women included in the trial were highly educated and were found to have blood metabolites reflecting diets high in healthful, choline-containing foods.\u003c/p>\n\u003cp>The prospects of choline supplementation in pregnancy have piqued medical interest, but also notes of caution. \"I think the choline research is really intriguing, and we're starting to investigate maternal choline levels as well,\" says \u003ca href=\"http://profiles.columbiapsychiatry.org/profile/cmonk\">Catherine Monk\u003c/a>, an associate professor in psychiatry and obstetrics and gynecology at Columbia University Medical Center. \"Some prenatal vitamins do contain it and foods rich in choline are readily available. But we have a lot more research to do before we start recommending it widely.\"\u003c/p>\n\u003cp>In general, evidence-based interventions during pregnancy and early childhood to prevent mental illness are scant. Yet there are some modifiable risk factors that might make a difference, many of which focus on improving maternal wellbeing.\u003c/p>\n\u003cp>Monk's own research explores on the impact of an expecting mother's emotional state on the developing fetus. She and others have shown that stress, depression and anxiety during pregnancy increase a child's risk for ADHD, conduct disorders and depression later in life. At Columbia, Monk and her colleagues employ a program Practical Resources for Effective Postpartum Parenting, or PREPP, in which pregnant women who are distressed and at high-risk for postpartum depression are counseled and taught coping skills to make pregnancy and parenting more manageable emotionally.\u003c/p>\n\u003cp>Optimal nutrition, including choline and adequate amounts of zinc and omega-3 fatty acids, may also have developmental and mental health benefits as might avoiding smoking.\u003c/p>\n\u003cp>\u003cstrong>The future of funding\u003c/strong>\u003c/p>\n\u003cp>Despite incomplete data on choline supplementation, Freedman's research colleague \u003ca href=\"http://www.ucdenver.edu/academics/colleges/medicalschool/programs/winnlab/AboutUs/Pages/CamilleHoffman.aspx\">Dr. Camille Hoffman-Shuler\u003c/a>, an obstetrician, sees it as a promising intervention that should continue to be explored.\u003c/p>\n\u003cp>\"Obstetricians and midwives are not widely aware of choline supplementation,\" she says. \"But I do recommend it to pregnant women, especially if they have other mental health vulnerabilities. And I'd personally want it with a future pregnancy based on existing data.\"\u003c/p>\n\u003cp>Both Freedman and Hoffman-Shuler hope to continue choline research, yet decry the obstacles to securing the money to do it.\u003c/p>\n\u003cp>\"The NIH is currently funding no trials of any intervention in humans during pregnancy to prevent mental illness,\" says Freedman, \"yet ideally we'd follow these children for another 20 to 25 years to see if they develop mental illness. This is beyond the scope of most imaginable — and fundable — experiments.\"\u003c/p>\n\u003cp>Hoffman-Shuler is prepared to do what it takes. \"The hardest part is getting this across to the funding agencies and the public,\" she says. But this is a serious public health issue in which prevention during pregnancy is far more preferable to the loss of health and consequences that come with mental illness!\"\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>Bret Stetka is a writer based in New York and an editorial director at\u003c/em> \u003ca href=\"http://www.medscape.com/public/bios/bio-bretstetka\" target=\"_blank\">Medscape\u003c/a>. \u003cem>His work has appeared in\u003c/em> Wired\u003cem>,\u003c/em> Scientific American \u003cem>and on The Atlantic.com. He graduated from University of Virginia School of Medicine in 2005. You can follow him on Twitter: \u003c/em>\u003ca href=\"https://twitter.com/BretStetka\" target=\"_blank\">@BretStetka\u003c/a>.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Can+Mental+Illness+Be+Prevented+In+The+Womb%3F&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Every day in the United States, millions of expectant mothers take a prenatal vitamin on the advice of their doctor.\u003c/p>\n\u003cp>The counsel typically comes with physical health in mind: folic acid to help avoid fetal spinal cord problems; iodine to spur healthy brain development; calcium to be bound like molecular Legos into diminutive baby bones.\u003c/p>\n\u003cp>But what about a child's future mental health? Questions about whether ADHD might arise a few years down the road or whether schizophrenia could crop up in young adulthood tend to be overshadowed by more immediate parental anxieties. As a friend with a newborn daughter recently fretted over lunch, \"I'm just trying not to drop her!\"\u003c/p>\n\u003cp>Yet much as pediatricians administer childhood vaccines to guard against future infections, some psychiatrists now are thinking about how to shift their treatment-centric discipline toward one that also deals in early prevention.\u003c/p>\n\u003cp>In 2013, University of Colorado psychiatrist \u003ca href=\"http://www.ucdenver.edu/academics/colleges/medicalschool/departments/psychiatry/Faculty/Pages/Freedman,%20Robert.aspx\">Robert Freedman\u003c/a> and colleagues recruited 100 healthy, pregnant women from greater Denver to study whether giving the \u003ca href=\"//www.ncbi.nlm.nih.gov/books/NBK114308/\">B vitamin choline\u003c/a> during pregnancy would enhance brain growth in the developing fetus.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The moms-to-be were randomly given either a placebo or a form of choline called phosphatidylcholine. Choline itself is broken down by bacteria in the gut; by giving it in this related form the supplement can more effectively be absorbed into the bloodstream.\u003c/p>\n\u003cp>Those in the treatment group received 3,600 milligrams of phosphatidylcholine in the morning and 2,700 milligrams at night. Since phosphatidylcholine is roughly 13-15 percent choline, the amount the women received was about 900 milligrams of choline a day, twice that recommended by the Health and Medicine Division of the National Academies (and about the same amount contained in three large eggs).\u003c/p>\n\u003cp>After birth, infants were given either 100 milligrams of liquid phosphatidylcholine or placebo once a day for approximately three months. Given that both groups were also getting choline from regular feeding, the dose ensured that those supplemented received well over the Institute of Medicine's guideline that infants receive at least 125 milligrams a day.\u003c/p>\n\u003cp>At 5 weeks old, the children were exposed to a series of clicking sounds in the lab while their brain activity was monitored by \u003ca href=\"https://medlineplus.gov/ency/article/003931.htm\">electroencephalogram\u003c/a>, or EEG, a method for recording electrical brain activity via electrodes placed on the scalp. Normally, when exposed to the same sound successively, both infant and adult brains will exhibit \"inhibition,\" or a far weaker pulse of activity in response to the second sound. We realize that the now familiar tone is insignificant; our brains are unmoved.\u003c/p>\n\u003cp>However, in some kids this inhibition doesn't occur — a finding linked with an increased risk for attention problems, social withdrawal and, later in life, schizophrenia.\u003c/p>\n\u003cp>The \u003ca href=\"http://ajp.psychiatryonline.org/doi/abs/10.1176/appi.ajp.2012.12070940\">results published in 2013\u003c/a> in the \u003cem>American Journal of Psychiatry\u003c/em> by Freedman's group show that 76 percent of newborns whose mothers received choline supplements had normal inhibition to the sound stimuli. The proportion fell to 43 percent in those born to mothers who didn't get them. It appeared that choline might steer the infant brain away from a developmental course that predicted mental health problems.\u003c/p>\n\u003cp>A follow-up study at 40 months found that the children who had received choline supplements \u003cem>in utero\u003c/em> and after birth had fewer attention problems and less social withdrawal.\u003c/p>\n\u003cp>Excessive choline consumption — or that over 7,500 milligrams a day — has been associated with drops in blood pressure, sweating, gastrointestinal side effects and a \"fishy\" body odor. But most diets contain adequate choline, and supplementation to optimal levels poses no known side effects or risk to fetal development, Freedman says.\u003c/p>\n\u003cp>\u003cstrong>A genetic theory \u003c/strong>\u003c/p>\n\u003cp>One of the first genes to be linked to schizophrenia goes by the catchy name \"\u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/26376812\">CHRNA7\u003c/a>.\" Normally it encodes for a receptor on neurons in the brain that respond to the neurotransmitter acetylcholine as well as nicotine, a transmission essential to normal brain function and cognition. Genetic mutations in the CHRNA7 gene cause decreased levels of the neuronal receptor to be produced in people with schizophrenia.\u003c/p>\n\u003cp>A light bulb glowed for Freedman.\u003c/p>\n\u003cp>And the idea, he admits, is rather simple when you think about it: Choline is known to be essential to brain development and function and is also frequently deficient in pregnant women.\u003c/p>\n\u003cp>Couple these facts with animal and human research by Freedman and his colleagues showing that choline in the amniotic fluid also activates the CHRNA7 receptor in the developing fetal brain.\u003c/p>\n\u003cp>\"It occurred to us that just as folic acid can help overcome defects in brain and spinal cord development, perhaps supplementing mothers with choline could help prevent mental illness,\" Freedman recalls. \"And now that the children in our study are over 4 years old, we can see that those given the supplement appear to be on a different developmental track, one with fewer mental problems.\"\u003c/p>\n\u003cp>Moreover, though experimental psychosis treatments targeting the CHRNA7 gene and the receptor it codes for are being explored by other researchers, Freedman explains that levels of the receptor peak in the fetal brain and diminish after birth. \"We realized the optimal time to try this intervention is during pregnancy,\" he says.\u003c/p>\n\u003cp>Though choline is available in a number of foods — eggs, seafood and liver are particularly rich in the nutrient — Freedman's work suggests that for many women, dietary sources may be inadequate during pregnancy. Also, prenatal supplements tend not to include it.\u003c/p>\n\u003cp>Two past observational studies — conducted with diet questionnaires rather than the more rigorous placebo-controlled supplementation Freedman's group tried — also found beneficial effects associated with higher maternal choline intake during pregnancy. At 7 years of age, children of moms consuming over 400 milligrams of choline a day performed better on memory and intelligence tests. At 18 months, infants whose mothers had higher blood levels of choline had significantly higher cognitive test scores.\u003c/p>\n\u003cp>Dr. Steve Zeisel of the University of North Carolina was one of the first doctors to strongly advocate for choline supplementation in pregnancy. In 2012, Zeisel \u003ca href=\"http://ajcn.nutrition.org/content/96/6/1465.long\">published the only other\u003c/a> placebo-controlled trial of the vitamin in pregnant moms. While he did not assess for future mental health risks, the findings suggested that choline supplementation did not enhance infant cognitive function at 1 year of age. However, Freedman point outs that all of the women included in the trial were highly educated and were found to have blood metabolites reflecting diets high in healthful, choline-containing foods.\u003c/p>\n\u003cp>The prospects of choline supplementation in pregnancy have piqued medical interest, but also notes of caution. \"I think the choline research is really intriguing, and we're starting to investigate maternal choline levels as well,\" says \u003ca href=\"http://profiles.columbiapsychiatry.org/profile/cmonk\">Catherine Monk\u003c/a>, an associate professor in psychiatry and obstetrics and gynecology at Columbia University Medical Center. \"Some prenatal vitamins do contain it and foods rich in choline are readily available. But we have a lot more research to do before we start recommending it widely.\"\u003c/p>\n\u003cp>In general, evidence-based interventions during pregnancy and early childhood to prevent mental illness are scant. Yet there are some modifiable risk factors that might make a difference, many of which focus on improving maternal wellbeing.\u003c/p>\n\u003cp>Monk's own research explores on the impact of an expecting mother's emotional state on the developing fetus. She and others have shown that stress, depression and anxiety during pregnancy increase a child's risk for ADHD, conduct disorders and depression later in life. At Columbia, Monk and her colleagues employ a program Practical Resources for Effective Postpartum Parenting, or PREPP, in which pregnant women who are distressed and at high-risk for postpartum depression are counseled and taught coping skills to make pregnancy and parenting more manageable emotionally.\u003c/p>\n\u003cp>Optimal nutrition, including choline and adequate amounts of zinc and omega-3 fatty acids, may also have developmental and mental health benefits as might avoiding smoking.\u003c/p>\n\u003cp>\u003cstrong>The future of funding\u003c/strong>\u003c/p>\n\u003cp>Despite incomplete data on choline supplementation, Freedman's research colleague \u003ca href=\"http://www.ucdenver.edu/academics/colleges/medicalschool/programs/winnlab/AboutUs/Pages/CamilleHoffman.aspx\">Dr. Camille Hoffman-Shuler\u003c/a>, an obstetrician, sees it as a promising intervention that should continue to be explored.\u003c/p>\n\u003cp>\"Obstetricians and midwives are not widely aware of choline supplementation,\" she says. \"But I do recommend it to pregnant women, especially if they have other mental health vulnerabilities. And I'd personally want it with a future pregnancy based on existing data.\"\u003c/p>\n\u003cp>Both Freedman and Hoffman-Shuler hope to continue choline research, yet decry the obstacles to securing the money to do it.\u003c/p>\n\u003cp>\"The NIH is currently funding no trials of any intervention in humans during pregnancy to prevent mental illness,\" says Freedman, \"yet ideally we'd follow these children for another 20 to 25 years to see if they develop mental illness. This is beyond the scope of most imaginable — and fundable — experiments.\"\u003c/p>\n\u003cp>Hoffman-Shuler is prepared to do what it takes. \"The hardest part is getting this across to the funding agencies and the public,\" she says. But this is a serious public health issue in which prevention during pregnancy is far more preferable to the loss of health and consequences that come with mental illness!\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>Bret Stetka is a writer based in New York and an editorial director at\u003c/em> \u003ca href=\"http://www.medscape.com/public/bios/bio-bretstetka\" target=\"_blank\">Medscape\u003c/a>. \u003cem>His work has appeared in\u003c/em> Wired\u003cem>,\u003c/em> Scientific American \u003cem>and on The Atlantic.com. He graduated from University of Virginia School of Medicine in 2005. You can follow him on Twitter: \u003c/em>\u003ca href=\"https://twitter.com/BretStetka\" target=\"_blank\">@BretStetka\u003c/a>.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Can+Mental+Illness+Be+Prevented+In+The+Womb%3F&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Whether it's an IUD, a shot, an implant, or a daily pill, birth control is a regular part of many adult women's lives. It has left a lot of women asking: Why not men?\u003c/p>\n\u003cp>For years, people have tried to create birth control for men. The World Health Organization commissioned what sounded like a promising trial, a two-hormone injection designed to lower sperm count. Initial results looked like it would be 96 percent effective in preventing pregnancy in the participants' partners. But the Stage II trial was stopped after an independent review panel found that the drug had too many side effects. The \u003ca href=\"http://press.endocrine.org/doi/10.1210/jc.2016-2141\">results\u003c/a> were published last week in \u003cem>The Journal of Clinical Endocrinology and Metabolism\u003c/em>.\u003c/p>\n\u003cp>\u003cem>All Things Considered\u003c/em>'s Audie Cornish sat down with NPR science correspondent Rob Stein to discuss the trial and the reason it was canceled. Here are excerpts of their conversation, edited for length and clarity.\u003c/p>\n\u003chr>\n\u003cp>\u003cstrong>How did this latest study work?\u003c/strong>\u003c/p>\n\u003cp>It was a pretty big study; they gave shots to 320 men every eight weeks, in different countries around the world. The shot contained two hormones, and it worked pretty well. It knocked down their sperm counts significantly, and there were only a handful of pregnancies among partners of men in the trial.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>But two committees were paying close attention to the study, and they realized that a lot of guys were dropping out because they were experiencing side effects. The most common side effect was acne, and sometimes that acne was pretty severe. Some men also developed mood swings and in some cases those mood swings got pretty bad. One man developed severe depression, and another tried to commit suicide. Because of that, they cut the study short.\u003c/p>\n\u003cp>But when they spoke with guys in the study who didn't drop out, most said that if this product was available, they would use it.\u003c/p>\n\u003cp>\u003cstrong>There's been a lot of eye rolling on the Internet about these side effects, because women have been experiencing things like mood swings and weight gain for decades with hormonal birth control.\u003c/strong>\u003c/p>\n\u003cp>No birth control is perfect. Almost everything has some sort of side effect. And the side effects they saw in this study were not that different from those you see with other kinds of birth control — except for the severe emotional problems. That was definitely more than we see with the birth control pill.\u003c/p>\n\u003cp>But there's a little bit of a different risk-benefit analysis when it comes to men using a contraceptive. When women use a contraceptive, they're balancing the risks of the drug against the risks of getting pregnant. And pregnancy itself carries risks. But these are healthy men — they're not going to suffer any risks if they get somebody else pregnant.\u003c/p>\n\u003cp>\u003cstrong>Why is it harder to develop birth control for men than women?\u003c/strong>\u003c/p>\n\u003cp>That's the a big question. There are a couple of reasons. One is that it's harder from a biological point of view. If you think about it, it's a numbers game: Women produce one egg a month, while men are producing millions of sperm constantly. With women, you can take advantage of their normal monthly cycle with the birth control pill. There's nothing equivalent to that in men.\u003c/p>\n\u003cp>\u003cstrong>What does this mean for male birth control in general? Is this particular study a big setback, or is it no big deal?\u003c/strong>\u003c/p>\n\u003cp>It's a setback and it's definitely a disappointment. People had a lot of optimism about this study. But I've talked to a bunch of scientists about this, and they say they're not giving up yet. They're going to tinker with the doses of the hormones to see if they can come up with safer levels. They're also going to try different kinds of hormones and maybe administer them differently, like in a gel or an implant. They could also target how a sperm works by making it not swim as well, making it worse at fertilizing the egg.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>There's a lot of research still going on, but most of it is at a fairly early level. Scientists are saying, \"We're gonna keep trying,\" but they're still a decade away from coming up with something for men.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Male+Birth+Control+Study+Killed+After+Men+Complain+About+Side+Effects&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Whether it's an IUD, a shot, an implant, or a daily pill, birth control is a regular part of many adult women's lives. It has left a lot of women asking: Why not men?\u003c/p>\n\u003cp>For years, people have tried to create birth control for men. The World Health Organization commissioned what sounded like a promising trial, a two-hormone injection designed to lower sperm count. Initial results looked like it would be 96 percent effective in preventing pregnancy in the participants' partners. But the Stage II trial was stopped after an independent review panel found that the drug had too many side effects. The \u003ca href=\"http://press.endocrine.org/doi/10.1210/jc.2016-2141\">results\u003c/a> were published last week in \u003cem>The Journal of Clinical Endocrinology and Metabolism\u003c/em>.\u003c/p>\n\u003cp>\u003cem>All Things Considered\u003c/em>'s Audie Cornish sat down with NPR science correspondent Rob Stein to discuss the trial and the reason it was canceled. Here are excerpts of their conversation, edited for length and clarity.\u003c/p>\n\u003chr>\n\u003cp>\u003cstrong>How did this latest study work?\u003c/strong>\u003c/p>\n\u003cp>It was a pretty big study; they gave shots to 320 men every eight weeks, in different countries around the world. The shot contained two hormones, and it worked pretty well. It knocked down their sperm counts significantly, and there were only a handful of pregnancies among partners of men in the trial.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>But two committees were paying close attention to the study, and they realized that a lot of guys were dropping out because they were experiencing side effects. The most common side effect was acne, and sometimes that acne was pretty severe. Some men also developed mood swings and in some cases those mood swings got pretty bad. One man developed severe depression, and another tried to commit suicide. Because of that, they cut the study short.\u003c/p>\n\u003cp>But when they spoke with guys in the study who didn't drop out, most said that if this product was available, they would use it.\u003c/p>\n\u003cp>\u003cstrong>There's been a lot of eye rolling on the Internet about these side effects, because women have been experiencing things like mood swings and weight gain for decades with hormonal birth control.\u003c/strong>\u003c/p>\n\u003cp>No birth control is perfect. Almost everything has some sort of side effect. And the side effects they saw in this study were not that different from those you see with other kinds of birth control — except for the severe emotional problems. That was definitely more than we see with the birth control pill.\u003c/p>\n\u003cp>But there's a little bit of a different risk-benefit analysis when it comes to men using a contraceptive. When women use a contraceptive, they're balancing the risks of the drug against the risks of getting pregnant. And pregnancy itself carries risks. But these are healthy men — they're not going to suffer any risks if they get somebody else pregnant.\u003c/p>\n\u003cp>\u003cstrong>Why is it harder to develop birth control for men than women?\u003c/strong>\u003c/p>\n\u003cp>That's the a big question. There are a couple of reasons. One is that it's harder from a biological point of view. If you think about it, it's a numbers game: Women produce one egg a month, while men are producing millions of sperm constantly. With women, you can take advantage of their normal monthly cycle with the birth control pill. There's nothing equivalent to that in men.\u003c/p>\n\u003cp>\u003cstrong>What does this mean for male birth control in general? Is this particular study a big setback, or is it no big deal?\u003c/strong>\u003c/p>\n\u003cp>It's a setback and it's definitely a disappointment. People had a lot of optimism about this study. But I've talked to a bunch of scientists about this, and they say they're not giving up yet. They're going to tinker with the doses of the hormones to see if they can come up with safer levels. They're also going to try different kinds of hormones and maybe administer them differently, like in a gel or an implant. They could also target how a sperm works by making it not swim as well, making it worse at fertilizing the egg.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>There's a lot of research still going on, but most of it is at a fairly early level. Scientists are saying, \"We're gonna keep trying,\" but they're still a decade away from coming up with something for men.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Male+Birth+Control+Study+Killed+After+Men+Complain+About+Side+Effects&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Evidence Piles Up: The Poor Are High Risk for Mental Illness",
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"content": "\u003cp>After a mother killed her four young children and then herself last month in rural China, onlookers quickly pointed to life circumstances.\u003c/p>\n\u003cp>The family lived in extreme poverty, and bloggers speculated that her inability to escape adversity pushed her over the edge.\u003c/p>\n\u003cp>Can poverty really cause mental illness?\u003c/p>\n\u003caside class=\"pullquote alignright\">Studies show that all over the globe, there is a connection between poverty and mental illness.\u003c/aside>\n\u003cp>It's a complex question that is fairly new to science. Despite high rates of both poverty and mental disorders around the world, researchers only started probing the possible links about 25 years ago.\u003c/p>\n\u003cp>Since then, evidence has piled up to make the case that, at the very least, there is a connection. People who live in poverty appear to be at higher risk for mental illnesses. They also report lower levels of happiness.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>That seems to be true all over the globe. In a \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/20621748\">2010 review\u003c/a> of 115 studies that spanned 33 countries across the developed and developing worlds, nearly 80 percent of the studies showed that poverty comes with higher rates of mental illness. Among people living in poverty, those studies also found, mental illnesses were more severe, lasted longer and had worse outcomes.\u003c/p>\n\u003cp>And there's growing \u003ca href=\"https://www.brookings.edu/research/subjective-well%e2%80%90being-and-income-is-there-any-evidence-of-satiation/;%20https://www.dartmouth.edu/~neudc2012/docs/paper_195.pdf\">evidence\u003c/a> that levels of depression are higher in poorer countries than in wealthier ones. Those kinds of findings challenge a long-held myth of the \"poor but happy African sitting under a palm tree,\" says \u003ca href=\"http://www.princeton.edu/haushofer/\">Johannes Haushofer\u003c/a>, an economist and neurobiologist who studies interactions between poverty and mental health at Princeton University.\u003c/p>\n\u003cp>As data builds to connect tough economic circumstances with mental struggles, scientists are still trying to answer a trickier question: Which causes which?\u003c/p>\n\u003cp>There is no easy answer, says psychologist \u003ca href=\"http://www.health.uct.ac.za/fhs/departments/psychiatry/staff/crick-lund\">Crick Lund \u003c/a>of the University of Capetown, who studies mental health policy. Mental illness is never caused by just one thing. Poverty can be one factor that interacts with genetics, adverse life events or substance abuse.\u003c/p>\n\u003cp>But so far, the strongest evidence suggests that poverty can lead to mental illness, especially in cases of disorders like depression.\u003c/p>\n\u003cp>Because scientists can't experimentally plunge people into poverty to see what happens to their mental health, natural experiments offer one kind of clue. When disasters or tough spells (like losing a job or enduring periods of drought for farmers) destroy financial circumstances, numerous studies show a rise in rates of depression, Haushofer says.\u003c/p>\n\u003cp>On the flip side, people often get happier after economic windfalls. In a \u003ca href=\"http://www.princeton.edu/haushofer/publications/Haushofer_Shapiro_UCT_2016.04.25.pdf\">new study\u003c/a>, Haushofer and a colleague found that when families in Kenya were given cash grants averaging $700 (nearly twice the amount typically spent per person per year), they reported higher levels of life satisfaction and lower levels of depression than they did before they got the money, which they could spend on anything. The larger the cash transfer, the bigger the mental boost. It didn't matter if the money came in monthly installments or all at once.\u003c/p>\n\u003cp>Despite the long-held belief that winning the lottery destroys lives as people make bad decisions about \u003ca href=\"http://qje.oxfordjournals.org/content/early/2016/02/17/qje.qjw001.full.pdf\">how to use the money\u003c/a>, Haushofer adds, newer evidence suggests the opposite. In study published this year, researchers in Sweden, reported that lottery winners used fewer anti-anxiety medications and sleeping pills after collecting their payout, suggesting that they became happier.\u003c/p>\n\u003cp>So how does poverty \"get under the skin\" or into the brain, Lund asks? Stress is a leading contender. \u003ca href=\"https://www.dartmouth.edu/~neudc2012/docs/paper_195.pdf\">Some studies\u003c/a> have found higher levels of the stress hormone cortisol in people living in poverty. In Mexican households that received cash grants, found a \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2768580/\">2009 study\u003c/a>, young children had lower cortisol levels compared to kids from families that didn't get extra money. Other studies, however, have failed to find any changes in cortisol.\u003c/p>\n\u003cp>Rates of violence are also higher among people who face economic tension. Living amid violence can exacerbate depression, Lund adds. And studies have found connections between mental illness and poverty-associated conditions, such as not having enough to eat, not making enough money to live on and having a greater chance of developing risks for physical illnesses.\u003c/p>\n\u003cp>Mental illness may, in some cases, lead people down a road to poverty, Lund says, because of disability, stigma or the need to spend extra money on health care. may play a role, with some evidence suggesting that poverty more often leads to depression while disorders like schizophrenia more often lead to poverty.\u003c/p>\n\u003cp>Still unclear is how best to break the cycle. Although cash-transfer programs have shown promising improvements to mental health, studies have yet to determine whether those improvements persist in the long-term.\u003c/p>\n\u003cp>\"I think the jury is still out on the extent to which poverty alleviation interventions actually lead to mental health improvements,\" Lund says. \"It hasn't been evaluated rigorously enough.\"\u003c/p>\n\u003cp>Data is also lacking on whether mental-health interventions can make a true dent in poverty rates or why some people remain resilient even in extremely challenging circumstances.\u003c/p>\n\u003cp>\"We don't know whether intervening in depression is also a good poverty intervention,\" Haushofer says. Because depression keeps people out of work, treating it should help, but evidence is still lacking.\u003c/p>\n\u003cp>Better data may be coming. Lund is in charge of an effort called \u003ca href=\"http://www.prime.uct.ac.za/background/about-prime\">PRIME\u003c/a>, a multinational consortium that aims to implement treatment programs for mental disorders in low-resource settings. One project involves tracking efforts to improve access to mental health services in five countries, including Ethiopia, South Africa and Uganda, with preliminary results expected within the next year.\u003c/p>\n\u003cp>\u003ca href=\"http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)61139-3/fulltext\">In 2013\u003c/a>, the World Health Organization committed to a mental health action plan, with a goal of increasing access to services for severe mental health disorders by 20 percent and reducing the suicide rate by 10 percent in 135 member countries by 2020.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>As for why the mother in China took the lives of her children, no one can say for sure. Similar tragedies happen in wealthy countries, too.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Can+Poverty+Lead+To+Mental+Illness%3F&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>That seems to be true all over the globe. In a \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/20621748\">2010 review\u003c/a> of 115 studies that spanned 33 countries across the developed and developing worlds, nearly 80 percent of the studies showed that poverty comes with higher rates of mental illness. Among people living in poverty, those studies also found, mental illnesses were more severe, lasted longer and had worse outcomes.\u003c/p>\n\u003cp>And there's growing \u003ca href=\"https://www.brookings.edu/research/subjective-well%e2%80%90being-and-income-is-there-any-evidence-of-satiation/;%20https://www.dartmouth.edu/~neudc2012/docs/paper_195.pdf\">evidence\u003c/a> that levels of depression are higher in poorer countries than in wealthier ones. Those kinds of findings challenge a long-held myth of the \"poor but happy African sitting under a palm tree,\" says \u003ca href=\"http://www.princeton.edu/haushofer/\">Johannes Haushofer\u003c/a>, an economist and neurobiologist who studies interactions between poverty and mental health at Princeton University.\u003c/p>\n\u003cp>As data builds to connect tough economic circumstances with mental struggles, scientists are still trying to answer a trickier question: Which causes which?\u003c/p>\n\u003cp>There is no easy answer, says psychologist \u003ca href=\"http://www.health.uct.ac.za/fhs/departments/psychiatry/staff/crick-lund\">Crick Lund \u003c/a>of the University of Capetown, who studies mental health policy. Mental illness is never caused by just one thing. Poverty can be one factor that interacts with genetics, adverse life events or substance abuse.\u003c/p>\n\u003cp>But so far, the strongest evidence suggests that poverty can lead to mental illness, especially in cases of disorders like depression.\u003c/p>\n\u003cp>Because scientists can't experimentally plunge people into poverty to see what happens to their mental health, natural experiments offer one kind of clue. When disasters or tough spells (like losing a job or enduring periods of drought for farmers) destroy financial circumstances, numerous studies show a rise in rates of depression, Haushofer says.\u003c/p>\n\u003cp>On the flip side, people often get happier after economic windfalls. In a \u003ca href=\"http://www.princeton.edu/haushofer/publications/Haushofer_Shapiro_UCT_2016.04.25.pdf\">new study\u003c/a>, Haushofer and a colleague found that when families in Kenya were given cash grants averaging $700 (nearly twice the amount typically spent per person per year), they reported higher levels of life satisfaction and lower levels of depression than they did before they got the money, which they could spend on anything. The larger the cash transfer, the bigger the mental boost. It didn't matter if the money came in monthly installments or all at once.\u003c/p>\n\u003cp>Despite the long-held belief that winning the lottery destroys lives as people make bad decisions about \u003ca href=\"http://qje.oxfordjournals.org/content/early/2016/02/17/qje.qjw001.full.pdf\">how to use the money\u003c/a>, Haushofer adds, newer evidence suggests the opposite. In study published this year, researchers in Sweden, reported that lottery winners used fewer anti-anxiety medications and sleeping pills after collecting their payout, suggesting that they became happier.\u003c/p>\n\u003cp>So how does poverty \"get under the skin\" or into the brain, Lund asks? Stress is a leading contender. \u003ca href=\"https://www.dartmouth.edu/~neudc2012/docs/paper_195.pdf\">Some studies\u003c/a> have found higher levels of the stress hormone cortisol in people living in poverty. In Mexican households that received cash grants, found a \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2768580/\">2009 study\u003c/a>, young children had lower cortisol levels compared to kids from families that didn't get extra money. Other studies, however, have failed to find any changes in cortisol.\u003c/p>\n\u003cp>Rates of violence are also higher among people who face economic tension. Living amid violence can exacerbate depression, Lund adds. And studies have found connections between mental illness and poverty-associated conditions, such as not having enough to eat, not making enough money to live on and having a greater chance of developing risks for physical illnesses.\u003c/p>\n\u003cp>Mental illness may, in some cases, lead people down a road to poverty, Lund says, because of disability, stigma or the need to spend extra money on health care. may play a role, with some evidence suggesting that poverty more often leads to depression while disorders like schizophrenia more often lead to poverty.\u003c/p>\n\u003cp>Still unclear is how best to break the cycle. Although cash-transfer programs have shown promising improvements to mental health, studies have yet to determine whether those improvements persist in the long-term.\u003c/p>\n\u003cp>\"I think the jury is still out on the extent to which poverty alleviation interventions actually lead to mental health improvements,\" Lund says. \"It hasn't been evaluated rigorously enough.\"\u003c/p>\n\u003cp>Data is also lacking on whether mental-health interventions can make a true dent in poverty rates or why some people remain resilient even in extremely challenging circumstances.\u003c/p>\n\u003cp>\"We don't know whether intervening in depression is also a good poverty intervention,\" Haushofer says. Because depression keeps people out of work, treating it should help, but evidence is still lacking.\u003c/p>\n\u003cp>Better data may be coming. Lund is in charge of an effort called \u003ca href=\"http://www.prime.uct.ac.za/background/about-prime\">PRIME\u003c/a>, a multinational consortium that aims to implement treatment programs for mental disorders in low-resource settings. One project involves tracking efforts to improve access to mental health services in five countries, including Ethiopia, South Africa and Uganda, with preliminary results expected within the next year.\u003c/p>\n\u003cp>\u003ca href=\"http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)61139-3/fulltext\">In 2013\u003c/a>, the World Health Organization committed to a mental health action plan, with a goal of increasing access to services for severe mental health disorders by 20 percent and reducing the suicide rate by 10 percent in 135 member countries by 2020.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>As for why the mother in China took the lives of her children, no one can say for sure. Similar tragedies happen in wealthy countries, too.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Can+Poverty+Lead+To+Mental+Illness%3F&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "All That Multitasking is Harming, Not Helping Your Productivity. Here's Why",
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"content": "\u003cp>I'll admit it. I even take my phone with me to fire off a few texts when I go to the restroom. Or I'll scroll through my email when I leave the office for lunch. My eyes are often glued to my phone from the moment I wake up, but I often reach the end of my days wondering what I've accomplished.\u003c/p>\n\u003caside class=\"alignright\">\n\u003ch2>Tips for Productivity at Work\u003c/h2>\n\u003cul>\n\u003cli>Start by clearing off your work space. Remove mobile devices and any extraneous papers.\u003c/li>\n\u003cli>Use one computer screen. Shut down all unnecessary programs and apps. Open one browser and use only one tab.\u003c/li>\n\u003cli>Turn off email.\u003c/li>\n\u003cli>Set expectations. Tell your boss you’re going offline for a while. Or, set an auto response for both your texts and emails explaining that you’ll be offline for a set period of time.\u003c/li>\n\u003cli>Work in a quiet environment devoid of people. If you must work in a coffee shop use noise-cancelling headphones.\u003c/li>\n\u003cli>Display a “no interruption zone” at your desk or on your office door.\u003c/li>\n\u003cli>Check out helpful apps like SelfControl, Freedom, or FocusMe\u003c/li>\n\u003c/ul>\n\u003c/aside>\n\u003cp>My productivity mystery was solved after reading “The Distracted Mind: Ancient Brains in a High Tech World,\" by University of California, San Francisco neuroscientist Dr. \u003ca href=\"http://gazzaleylab.ucsf.edu/people-profiles/adam-gazzaley/\">Adam Gazzaley \u003c/a>and California State University, Dominguez Hills professor emeritus Larry Rosen. The book explains why the brain can't multitask, and why my near-obsessive efforts to keep up on emails is likely lowering my productive output.\u003c/p>\n\u003cp>\u003cstrong>How the Digital Age Zaps Productivity\u003c/strong>\u003c/p>\n\u003cp>I visited Gazzaley in his UCSF laboratory, Neuroscape, to learn more about the science of distraction. Gazzaley pulled up, on a TV screen, a 3-D image of a brain, created from an MRI Scan. He pointed to different sections to explain what's going on when our attention flits between tasks.\u003c/p>\n\u003cp>[contextly_sidebar id=\"mQNeLsl599Zl2MgROKE009FDdid0LEJr\"]\"The prefrontal cortex is the area most challenged,\" Gazzely says. \"And then visual areas, auditory areas, and the hippocampus — these networks are really what's challenged when we are constantly switching between multiple tasks that our technological world might throw at us.\"\u003c/p>\n\u003caside class=\"pullquote alignright\">If you're working on a project and you stop to answer an email, research shows, it will take you nearly a half-hour to get back on task.\u003c/aside>\n\u003cp>When you engage in one task at a time, the prefrontal cortex works in harmony with other parts of the brain, but when you toss in another task it forces the left and right sides of the brain to work independently. The process of splitting our attention usually leads to mistakes.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>In other words, each time our eyes glance away from our computer monitor to sneak a peak at a text message, the brain takes in new information, which reduces our primary focus. We \u003cem>think\u003c/em> the mind can juggle two or three activities successfully at once, but Gazzaley says we woefully overestimate our ability to multitask.\u003c/p>\n\u003cp>\"An example is when you attempt to check your email while on a conference call,\" says Gazzaley. \"The act of doing that makes it so incredibly obvious how you can't really parallel process two attention-demanding tasks. You either have to catch up and ask what happened in the conversation, or you have to read over the email before you send it — if you're wise!\"\u003c/p>\n\u003cp>\u003cstrong>Answering an Email Takes A Lot Longer Than You Think\u003cbr>\n\u003c/strong>\u003c/p>\n\u003cp>Gazzaley stresses that our tendency to respond immediately to emails and texts hinders high-level thinking. If you're working on a project and you stop to answer an email, the \u003ca href=\"http://research.microsoft.com/en-us/um/people/horvitz/CHI_2007_Iqbal_Horvitz.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">research\u003c/a> shows, it will take you nearly a half-hour to get back on task.\u003c/p>\n\u003caside class=\"pullquote alignright\">Research has found that high-tech jugglers struggle to pay attention, recall information, or complete one task at a time.\u003c/aside>\n\u003cp>\"When a focused stream of thought is interrupted it needs to be reset,\" explains Gazzaley. \"You can't just press a button and switch back to it. You have to re-engage those thought processes, and recreate all the elements of what you were engaged in. That takes time, and frequently one interruption leads to another.\"\u003c/p>\n\u003cp>In other words, repetitively switching tasks lowers performance and productivity because your brain can only fully and efficiently focus on one thing at a time.\u003c/p>\n\u003cfigure id=\"attachment_262693\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-262693\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/10/Gazzeley-800x600.jpg\" alt=\"When UCSF neuroscientist Adam Gazzeley needs to focus on a high level project he clears his desk, works on one screen and turns off all distracting digital devices.\" width=\"800\" height=\"600\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2016/10/Gazzeley-800x600.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2016/10/Gazzeley-400x300.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2016/10/Gazzeley-768x576.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2016/10/Gazzeley-1180x885.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2016/10/Gazzeley-1920x1440.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2016/10/Gazzeley-960x720.jpg 960w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">When UCSF neuroscientist Adam Gazzeley needs to focus on a high level project he clears his desk, works on one screen and turns off all distracting digital devices. \u003ccite>(Sierra Niblett )\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Plus, \u003ca href=\"http://journalistsresource.org/studies/society/social-media/multitasking-social-media-distraction-what-does-research-say\" target=\"_blank\" rel=\"noopener noreferrer\">mounting evidence\u003c/a> shows that multitasking could impair the brain's cognitive abilities. \u003ca href=\"http://news.stanford.edu/2009/08/24/multitask-research-study-082409/\" target=\"_blank\" rel=\"noopener noreferrer\">Stanford researchers\u003c/a> studied the minds of people who regularly engage in several digital communication streams at once. They found that high-tech jugglers struggle to pay attention, recall information, or complete one task at a time.\u003c/p>\n\u003cp>“When they’re in situations where there are multiple sources of information coming from the external world or emerging out of memory, they’re not able to filter out what’s not relevant to their current goal,” says Stanford neuroscientist\u003ca href=\"https://psychology.stanford.edu/awagner\" target=\"_blank\" rel=\"noopener noreferrer\"> Anthony Wagner\u003c/a>. “That failure to filter means they’re slowed down by that irrelevant information.”\u003c/p>\n\u003cp>The researchers are still studying what's causing multitaskers to perform poorly on cognitive tests. It could be that they are born with an inability to concentrate, or digital distractions are taking a toll. In any case, the researchers believe the minds of multitaskers are not performing optimally.\u003c/p>\n\u003cp>And the habit of multitasking could lower your score on an IQ test, according to researchers at the \u003ca href=\"http://discovery.ucl.ac.uk/1465496/\" target=\"_blank\" rel=\"noopener noreferrer\">University of London\u003c/a>.\u003c/p>\n\u003cp>\u003cstrong>Creating Digital Boundaries\u003c/strong>\u003c/p>\n\u003cp>But don't worry. Gazzaley says. It’s not about opting out of technology. In fact, there's a time and place for multitasking. If you’re in the midst of a mundane task that just has to get done, it’s probably not detrimental to have your phone nearby or a bunch of tabs open. The distractions may reduce boredom and help you stay engaged. But if you’re finishing a business plan, or a high-level writing project, then it’s a good idea to set yourself up to stay focused.\u003c/p>\n\u003cp>Check out Gazzaley's tips for turning off distractions in the sidebar above.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>Now, get back to work!\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>I'll admit it. I even take my phone with me to fire off a few texts when I go to the restroom. Or I'll scroll through my email when I leave the office for lunch. My eyes are often glued to my phone from the moment I wake up, but I often reach the end of my days wondering what I've accomplished.\u003c/p>\n\u003caside class=\"alignright\">\n\u003ch2>Tips for Productivity at Work\u003c/h2>\n\u003cul>\n\u003cli>Start by clearing off your work space. Remove mobile devices and any extraneous papers.\u003c/li>\n\u003cli>Use one computer screen. Shut down all unnecessary programs and apps. Open one browser and use only one tab.\u003c/li>\n\u003cli>Turn off email.\u003c/li>\n\u003cli>Set expectations. Tell your boss you’re going offline for a while. Or, set an auto response for both your texts and emails explaining that you’ll be offline for a set period of time.\u003c/li>\n\u003cli>Work in a quiet environment devoid of people. If you must work in a coffee shop use noise-cancelling headphones.\u003c/li>\n\u003cli>Display a “no interruption zone” at your desk or on your office door.\u003c/li>\n\u003cli>Check out helpful apps like SelfControl, Freedom, or FocusMe\u003c/li>\n\u003c/ul>\n\u003c/aside>\n\u003cp>My productivity mystery was solved after reading “The Distracted Mind: Ancient Brains in a High Tech World,\" by University of California, San Francisco neuroscientist Dr. \u003ca href=\"http://gazzaleylab.ucsf.edu/people-profiles/adam-gazzaley/\">Adam Gazzaley \u003c/a>and California State University, Dominguez Hills professor emeritus Larry Rosen. The book explains why the brain can't multitask, and why my near-obsessive efforts to keep up on emails is likely lowering my productive output.\u003c/p>\n\u003cp>\u003cstrong>How the Digital Age Zaps Productivity\u003c/strong>\u003c/p>\n\u003cp>I visited Gazzaley in his UCSF laboratory, Neuroscape, to learn more about the science of distraction. Gazzaley pulled up, on a TV screen, a 3-D image of a brain, created from an MRI Scan. He pointed to different sections to explain what's going on when our attention flits between tasks.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\"The prefrontal cortex is the area most challenged,\" Gazzely says. \"And then visual areas, auditory areas, and the hippocampus — these networks are really what's challenged when we are constantly switching between multiple tasks that our technological world might throw at us.\"\u003c/p>\n\u003caside class=\"pullquote alignright\">If you're working on a project and you stop to answer an email, research shows, it will take you nearly a half-hour to get back on task.\u003c/aside>\n\u003cp>When you engage in one task at a time, the prefrontal cortex works in harmony with other parts of the brain, but when you toss in another task it forces the left and right sides of the brain to work independently. The process of splitting our attention usually leads to mistakes.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>In other words, each time our eyes glance away from our computer monitor to sneak a peak at a text message, the brain takes in new information, which reduces our primary focus. We \u003cem>think\u003c/em> the mind can juggle two or three activities successfully at once, but Gazzaley says we woefully overestimate our ability to multitask.\u003c/p>\n\u003cp>\"An example is when you attempt to check your email while on a conference call,\" says Gazzaley. \"The act of doing that makes it so incredibly obvious how you can't really parallel process two attention-demanding tasks. You either have to catch up and ask what happened in the conversation, or you have to read over the email before you send it — if you're wise!\"\u003c/p>\n\u003cp>\u003cstrong>Answering an Email Takes A Lot Longer Than You Think\u003cbr>\n\u003c/strong>\u003c/p>\n\u003cp>Gazzaley stresses that our tendency to respond immediately to emails and texts hinders high-level thinking. If you're working on a project and you stop to answer an email, the \u003ca href=\"http://research.microsoft.com/en-us/um/people/horvitz/CHI_2007_Iqbal_Horvitz.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">research\u003c/a> shows, it will take you nearly a half-hour to get back on task.\u003c/p>\n\u003caside class=\"pullquote alignright\">Research has found that high-tech jugglers struggle to pay attention, recall information, or complete one task at a time.\u003c/aside>\n\u003cp>\"When a focused stream of thought is interrupted it needs to be reset,\" explains Gazzaley. \"You can't just press a button and switch back to it. You have to re-engage those thought processes, and recreate all the elements of what you were engaged in. That takes time, and frequently one interruption leads to another.\"\u003c/p>\n\u003cp>In other words, repetitively switching tasks lowers performance and productivity because your brain can only fully and efficiently focus on one thing at a time.\u003c/p>\n\u003cfigure id=\"attachment_262693\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-262693\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/10/Gazzeley-800x600.jpg\" alt=\"When UCSF neuroscientist Adam Gazzeley needs to focus on a high level project he clears his desk, works on one screen and turns off all distracting digital devices.\" width=\"800\" height=\"600\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2016/10/Gazzeley-800x600.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2016/10/Gazzeley-400x300.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2016/10/Gazzeley-768x576.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2016/10/Gazzeley-1180x885.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2016/10/Gazzeley-1920x1440.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2016/10/Gazzeley-960x720.jpg 960w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">When UCSF neuroscientist Adam Gazzeley needs to focus on a high level project he clears his desk, works on one screen and turns off all distracting digital devices. \u003ccite>(Sierra Niblett )\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Plus, \u003ca href=\"http://journalistsresource.org/studies/society/social-media/multitasking-social-media-distraction-what-does-research-say\" target=\"_blank\" rel=\"noopener noreferrer\">mounting evidence\u003c/a> shows that multitasking could impair the brain's cognitive abilities. \u003ca href=\"http://news.stanford.edu/2009/08/24/multitask-research-study-082409/\" target=\"_blank\" rel=\"noopener noreferrer\">Stanford researchers\u003c/a> studied the minds of people who regularly engage in several digital communication streams at once. They found that high-tech jugglers struggle to pay attention, recall information, or complete one task at a time.\u003c/p>\n\u003cp>“When they’re in situations where there are multiple sources of information coming from the external world or emerging out of memory, they’re not able to filter out what’s not relevant to their current goal,” says Stanford neuroscientist\u003ca href=\"https://psychology.stanford.edu/awagner\" target=\"_blank\" rel=\"noopener noreferrer\"> Anthony Wagner\u003c/a>. “That failure to filter means they’re slowed down by that irrelevant information.”\u003c/p>\n\u003cp>The researchers are still studying what's causing multitaskers to perform poorly on cognitive tests. It could be that they are born with an inability to concentrate, or digital distractions are taking a toll. In any case, the researchers believe the minds of multitaskers are not performing optimally.\u003c/p>\n\u003cp>And the habit of multitasking could lower your score on an IQ test, according to researchers at the \u003ca href=\"http://discovery.ucl.ac.uk/1465496/\" target=\"_blank\" rel=\"noopener noreferrer\">University of London\u003c/a>.\u003c/p>\n\u003cp>\u003cstrong>Creating Digital Boundaries\u003c/strong>\u003c/p>\n\u003cp>But don't worry. Gazzaley says. It’s not about opting out of technology. In fact, there's a time and place for multitasking. If you’re in the midst of a mundane task that just has to get done, it’s probably not detrimental to have your phone nearby or a bunch of tabs open. The distractions may reduce boredom and help you stay engaged. But if you’re finishing a business plan, or a high-level writing project, then it’s a good idea to set yourself up to stay focused.\u003c/p>\n\u003cp>Check out Gazzaley's tips for turning off distractions in the sidebar above.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>Just about every day, genetic counselor Shawn Fayer heads to the maternity ward at Brigham and Women’s Hospital in Boston and tries to convince new parents to give him a blood sample.\u003c/p>\n\u003caside class=\"pullquote alignright\">Ninety-four percent of parents approached by researchers are declining to have their newborns’ genes sequenced.\u003c/aside>\n\u003cp>Fayer is offering gene sequencing for newborns. It gives parents a tantalizing look at their baby’s genetic information.\u003c/p>\n\u003cp>New parents Lauren and Ian Patrick, from Marion, Mass., were excited when they were first approached earlier this month.\u003c/p>\n\u003cp>“My initial reaction — why wouldn’t someone do this? Why wouldn’t they want the information?” Ian Patrick says as he cradles his newborn son, Finn. “For me, more information is better, even if it’s not always good.”\u003c/p>\n\u003cp>If his parents sign him up, Finn would join the \u003ca href=\"http://www.genomes2people.org/babyseqproject/\">BabySeq\u003c/a> project, an NIH-funded study led by \u003ca href=\"http://www.brighamandwomens.org/Research/depts/Medicine/genetics/pis/Default.aspx\">Dr. Robert Green\u003c/a>, a medical geneticist at Brigham and Women’s Hospital, and Alan Beggs at Boston Children’s Hospital. With genetic testing getting cheaper and cheaper, Green wants to figure out what happens when parents know their child’s genetic blueprint from day one.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Half of the babies who join the study will have their protein-coding genes sequenced and screened for variants that are associated with diseases of childhood, with a method called whole-exome sequencing. The other half will get the regular heel-prick blood test offered to all newborns, which screens for major genetic disorders like cystic fibrosis.\u003c/p>\n\u003cp>[contextly_sidebar id=”0oB4UbBMca7FkmnzM9TuzpFpRg2XPk3h”]\u003cbr>\nResearchers will follow both sets of babies to figure out how genetic sequencing impacts them. They want to find out if knowing a child’s genetic makeup could actually make them healthier, or if it could increase their health care costs, or even change their relationship with their parents.\u003c/p>\n\u003cp>“We are looking for all sorts of unanticipated variations in DNA,” Green says, “and we say right up front we don’t know what they all mean. We don’t know what they’re all going to mean for your baby.”\u003c/p>\n\u003cp>Green is particularly interested in a list of 1,514 genes where there are good reasons to reveal a mutation because a disease might be treated or prevented. But there are so many changes in everyone’s DNA, he says, he’s finding something to report in every baby he sequences.\u003c/p>\n\u003cp>Right now, that’s a pretty small number of babies. Green has sequenced the genes of 51 newborns so far, and he’s found five who have genetic mutations families wouldn’t have known about otherwise. Two babies have \u003ca href=\"https://www.nigms.nih.gov/News/Meetings/Pages/DrugResponses.aspx\">pharmacogenetic variants\u003c/a> — mutations that mean certain drugs might not work as well on them. Three have mutations associated with heart conditions they inherited from a parent. Both the babies and their parents appears to be totally healthy.\u003c/p>\n\u003cp>One of those babies is Kai Gracia. His parents, Alyssa and Jason Gracia, agreed to the test when Kai was just a few days old. They didn’t expect to find much. Alyssa was genotyped a few years before, and the information she got was mostly trivial — she learned she metabolized caffeine particularly quickly and she discovered she didn’t have the photic sneeze reflex, meaning she wasn’t likely to sneeze when suddenly exposed to bright light. So when the results on her baby came back, she was shocked. Right there in Kai’s genetic report was this: \u003ca href=\"https://ghr.nlm.nih.gov/condition/supravalvular-aortic-stenosis\">supravalvular aortic stenosis.\u003c/a>\u003c/p>\n\u003cp>It turns out Kai has a mutation in a gene that codes for a protein called elastin. Elastin helps heart muscles bend and stretch. Not producing enough of it can cause the aorta to narrow. People can die from this, or need multiple surgeries as they grow.\u003c/p>\n\u003cp>Now that she knew her baby might get sick, Alyssa Gracia had lots of questions. Would Kai be able to play sports when he got older? Did he need surgery? Could crying too much be dangerous?\u003c/p>\n\u003cp>She made appointments with pediatric cardiologists and brought in Kai’s genetic report. One doctor said he looked fine, and only needed to be monitored every few years. Another said his parents should bring him back after just a few months. Usually, a condition like Kai’s isn’t diagnosed until a child is showing symptoms. That means doctors still aren’t quite sure how to treat Kai.\u003c/p>\n\u003cp>This is the kind of story that both thrills and terrifies the observers of this new technology, according to Green.\u003c/p>\n\u003cp>“There’s no consensus on how to manage these findings,” he says. And it’s unclear if the follow-up is worth it, or if it might actually do harm.\u003c/p>\n\u003cp>Gene sequencing reveals medical information about not just one person, but potentially a whole family. So all that follow-up is being done not just on Kai, but on his dad and his grandmother — all people who might be carrying this gene and might be at risk themselves.\u003c/p>\n\u003cp>So what can families do with all this information? Dr. Green says that for one family, this genetic report was potentially lifesaving.\u003c/p>\n\u003cp>It showed an inherited mutation in the baby’s \u003ca href=\"https://www.cancer.gov/about-cancer/causes-prevention/genetics/brca-fact-sheet\">BRCA2\u003c/a> gene, which increases the risk of breast, ovarian, prostate and pancreatic cancers. This means not only is the baby at risk, but the child’s mother or father could be, too.\u003c/p>\n\u003cp>Before they told the family, the researchers had to deal with “a really pernicious ethical problem,” says Green. He and his colleagues had agreed they would only tell parents about genetic variants that could impact babies in childhood, since the children weren’t able to decide for themselves whether they wanted to know their genetic risks. BRCA2 causes cancer in adults, not children.\u003c/p>\n\u003cp>But this information was so important, Green decided to break protocol.\u003c/p>\n\u003cp>“You know what the first four words were out of the mother’s mouth when she was told?” Green asks. ” ‘Oh, that explains it.’ ”\u003c/p>\n\u003cp>It turns out the mother knew distant relatives who had died from cancer, but she hadn’t thought it meant anything for her. Without her baby’s test, she might never have learned about her own risk.\u003c/p>\n\u003cp>Not every mutation is actionable like this. Green is also finding a lot of single recessive mutations for conditions like \u003ca href=\"http://www.nhlbi.nih.gov/health/health-topics/topics/cf/\">cystic fibrosis\u003c/a>, \u003ca href=\"http://www.ninds.nih.gov/disorders/taysachs/taysachs.htm\">Tay-Sachs\u003c/a> and \u003ca href=\"http://www.nhlbi.nih.gov/health/health-topics/topics/sca/\">sickle cell\u003c/a>. Since it takes two mutations, one each from mother and father, to cause the disease, it becomes an issue only when these babies grow up and decide to have children themselves.\u003c/p>\n\u003cp>One thing Green hadn’t anticipated is how hard it has been to convince new parents to do this screening in the first place. Early research showed the majority of parents were interested in the medical information. But 94 percent of parents Green and his team are approaching are saying no.\u003c/p>\n\u003cp>Lauren and Ian Patrick, the parents of baby Finn, are a good case study.\u003c/p>\n\u003cp>Initially, they were convinced they wanted the screening. But after an hour talking to a genetic counselor about all the ways this sequencing could go wrong, they decided against it.\u003c/p>\n\u003cp>They learned that any genetic sequencing would go in their son’s medical record, and it wouldn’t be able to be removed. And while federal law prohibits genetic discrimination by health care providers and in the workplace, life insurers can still use genetic information to pick and choose whom they’ll sell policies to. By the time the meeting was over, the Patricks’ excitement had been replaced with concern.\u003c/p>\n\u003cp>“It really gave me pause that this would be part of the medical record that private companies would have access to,” Lauren Patrick says. “That was my full stop in the end.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>After all, for the first time she’s making a decision for someone who has no say, she says. “That’s the biggest thing on my mind, this new dynamic.”\u003c/p>\n\u003chr>\n\u003cdiv class=\"fullattribution\">Copyright 2016 WNYC Radio. To see more, visit \u003ca href=\"http://www.wnyc.org/\">WNYC Radio\u003c/a>.\u003cimg decoding=\"async\" src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Would+You+Want+To+Know+The+Secrets+Hidden+In+Your+Baby%27s+Genes%3F&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Just about every day, genetic counselor Shawn Fayer heads to the maternity ward at Brigham and Women’s Hospital in Boston and tries to convince new parents to give him a blood sample.\u003c/p>\n\u003caside class=\"pullquote alignright\">Ninety-four percent of parents approached by researchers are declining to have their newborns’ genes sequenced.\u003c/aside>\n\u003cp>Fayer is offering gene sequencing for newborns. It gives parents a tantalizing look at their baby’s genetic information.\u003c/p>\n\u003cp>New parents Lauren and Ian Patrick, from Marion, Mass., were excited when they were first approached earlier this month.\u003c/p>\n\u003cp>“My initial reaction — why wouldn’t someone do this? Why wouldn’t they want the information?” Ian Patrick says as he cradles his newborn son, Finn. “For me, more information is better, even if it’s not always good.”\u003c/p>\n\u003cp>If his parents sign him up, Finn would join the \u003ca href=\"http://www.genomes2people.org/babyseqproject/\">BabySeq\u003c/a> project, an NIH-funded study led by \u003ca href=\"http://www.brighamandwomens.org/Research/depts/Medicine/genetics/pis/Default.aspx\">Dr. Robert Green\u003c/a>, a medical geneticist at Brigham and Women’s Hospital, and Alan Beggs at Boston Children’s Hospital. With genetic testing getting cheaper and cheaper, Green wants to figure out what happens when parents know their child’s genetic blueprint from day one.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Half of the babies who join the study will have their protein-coding genes sequenced and screened for variants that are associated with diseases of childhood, with a method called whole-exome sequencing. The other half will get the regular heel-prick blood test offered to all newborns, which screens for major genetic disorders like cystic fibrosis.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003cbr>\nResearchers will follow both sets of babies to figure out how genetic sequencing impacts them. They want to find out if knowing a child’s genetic makeup could actually make them healthier, or if it could increase their health care costs, or even change their relationship with their parents.\u003c/p>\n\u003cp>“We are looking for all sorts of unanticipated variations in DNA,” Green says, “and we say right up front we don’t know what they all mean. We don’t know what they’re all going to mean for your baby.”\u003c/p>\n\u003cp>Green is particularly interested in a list of 1,514 genes where there are good reasons to reveal a mutation because a disease might be treated or prevented. But there are so many changes in everyone’s DNA, he says, he’s finding something to report in every baby he sequences.\u003c/p>\n\u003cp>Right now, that’s a pretty small number of babies. Green has sequenced the genes of 51 newborns so far, and he’s found five who have genetic mutations families wouldn’t have known about otherwise. Two babies have \u003ca href=\"https://www.nigms.nih.gov/News/Meetings/Pages/DrugResponses.aspx\">pharmacogenetic variants\u003c/a> — mutations that mean certain drugs might not work as well on them. Three have mutations associated with heart conditions they inherited from a parent. Both the babies and their parents appears to be totally healthy.\u003c/p>\n\u003cp>One of those babies is Kai Gracia. His parents, Alyssa and Jason Gracia, agreed to the test when Kai was just a few days old. They didn’t expect to find much. Alyssa was genotyped a few years before, and the information she got was mostly trivial — she learned she metabolized caffeine particularly quickly and she discovered she didn’t have the photic sneeze reflex, meaning she wasn’t likely to sneeze when suddenly exposed to bright light. So when the results on her baby came back, she was shocked. Right there in Kai’s genetic report was this: \u003ca href=\"https://ghr.nlm.nih.gov/condition/supravalvular-aortic-stenosis\">supravalvular aortic stenosis.\u003c/a>\u003c/p>\n\u003cp>It turns out Kai has a mutation in a gene that codes for a protein called elastin. Elastin helps heart muscles bend and stretch. Not producing enough of it can cause the aorta to narrow. People can die from this, or need multiple surgeries as they grow.\u003c/p>\n\u003cp>Now that she knew her baby might get sick, Alyssa Gracia had lots of questions. Would Kai be able to play sports when he got older? Did he need surgery? Could crying too much be dangerous?\u003c/p>\n\u003cp>She made appointments with pediatric cardiologists and brought in Kai’s genetic report. One doctor said he looked fine, and only needed to be monitored every few years. Another said his parents should bring him back after just a few months. Usually, a condition like Kai’s isn’t diagnosed until a child is showing symptoms. That means doctors still aren’t quite sure how to treat Kai.\u003c/p>\n\u003cp>This is the kind of story that both thrills and terrifies the observers of this new technology, according to Green.\u003c/p>\n\u003cp>“There’s no consensus on how to manage these findings,” he says. And it’s unclear if the follow-up is worth it, or if it might actually do harm.\u003c/p>\n\u003cp>Gene sequencing reveals medical information about not just one person, but potentially a whole family. So all that follow-up is being done not just on Kai, but on his dad and his grandmother — all people who might be carrying this gene and might be at risk themselves.\u003c/p>\n\u003cp>So what can families do with all this information? Dr. Green says that for one family, this genetic report was potentially lifesaving.\u003c/p>\n\u003cp>It showed an inherited mutation in the baby’s \u003ca href=\"https://www.cancer.gov/about-cancer/causes-prevention/genetics/brca-fact-sheet\">BRCA2\u003c/a> gene, which increases the risk of breast, ovarian, prostate and pancreatic cancers. This means not only is the baby at risk, but the child’s mother or father could be, too.\u003c/p>\n\u003cp>Before they told the family, the researchers had to deal with “a really pernicious ethical problem,” says Green. He and his colleagues had agreed they would only tell parents about genetic variants that could impact babies in childhood, since the children weren’t able to decide for themselves whether they wanted to know their genetic risks. BRCA2 causes cancer in adults, not children.\u003c/p>\n\u003cp>But this information was so important, Green decided to break protocol.\u003c/p>\n\u003cp>“You know what the first four words were out of the mother’s mouth when she was told?” Green asks. ” ‘Oh, that explains it.’ ”\u003c/p>\n\u003cp>It turns out the mother knew distant relatives who had died from cancer, but she hadn’t thought it meant anything for her. Without her baby’s test, she might never have learned about her own risk.\u003c/p>\n\u003cp>Not every mutation is actionable like this. Green is also finding a lot of single recessive mutations for conditions like \u003ca href=\"http://www.nhlbi.nih.gov/health/health-topics/topics/cf/\">cystic fibrosis\u003c/a>, \u003ca href=\"http://www.ninds.nih.gov/disorders/taysachs/taysachs.htm\">Tay-Sachs\u003c/a> and \u003ca href=\"http://www.nhlbi.nih.gov/health/health-topics/topics/sca/\">sickle cell\u003c/a>. Since it takes two mutations, one each from mother and father, to cause the disease, it becomes an issue only when these babies grow up and decide to have children themselves.\u003c/p>\n\u003cp>One thing Green hadn’t anticipated is how hard it has been to convince new parents to do this screening in the first place. Early research showed the majority of parents were interested in the medical information. But 94 percent of parents Green and his team are approaching are saying no.\u003c/p>\n\u003cp>Lauren and Ian Patrick, the parents of baby Finn, are a good case study.\u003c/p>\n\u003cp>Initially, they were convinced they wanted the screening. But after an hour talking to a genetic counselor about all the ways this sequencing could go wrong, they decided against it.\u003c/p>\n\u003cp>They learned that any genetic sequencing would go in their son’s medical record, and it wouldn’t be able to be removed. And while federal law prohibits genetic discrimination by health care providers and in the workplace, life insurers can still use genetic information to pick and choose whom they’ll sell policies to. 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"info": "KQED’s new podcast, Bay Curious, gets to the bottom of the mysteries — both profound and peculiar — that give the Bay Area its unique identity. And we’ll do it with your help! You ask the questions. You decide what Bay Curious investigates. And you join us on the journey to find the answers.",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Bay-Curious-Podcast-Tile-703x703-1.jpg",
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"officialWebsiteLink": "/news/series/baycurious",
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"source": "kqed",
"order": 3
},
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}
},
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"id": "bbc-world-service",
"title": "BBC World Service",
"info": "The day's top stories from BBC News compiled twice daily in the week, once at weekends.",
"airtime": "MON-FRI 9pm-10pm, TUE-FRI 1am-2am",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/BBC-World-Service-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.bbc.co.uk/sounds/play/live:bbc_world_service",
"meta": {
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"source": "BBC World Service"
},
"link": "/radio/program/bbc-world-service",
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"rss": "https://podcasts.files.bbci.co.uk/p02nq0gn.rss"
}
},
"californiareport": {
"id": "californiareport",
"title": "The California Report",
"tagline": "California, day by day",
"info": "KQED’s statewide radio news program providing daily coverage of issues, trends and public policy decisions.",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/The-California-Report-Podcast-Tile-703x703-1.jpg",
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"officialWebsiteLink": "/californiareport",
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"source": "kqed",
"order": 8
},
"link": "/californiareport",
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}
},
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"title": "The California Report Magazine",
"tagline": "Your state, your stories",
"info": "Every week, The California Report Magazine takes you on a road trip for the ears: to visit the places and meet the people who make California unique. The in-depth storytelling podcast from the California Report.",
"airtime": "FRI 4:30pm-5pm, 6:30pm-7pm, 11pm-11:30pm",
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"officialWebsiteLink": "/californiareportmagazine",
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"order": 10
},
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM3NjkwNjk1OTAz",
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},
"city-arts": {
"id": "city-arts",
"title": "City Arts & Lectures",
"info": "A one-hour radio program to hear celebrated writers, artists and thinkers address contemporary ideas and values, often discussing the creative process. Please note: tapes or transcripts are not available",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/05/cityartsandlecture-300x300.jpg",
"officialWebsiteLink": "https://www.cityarts.net/",
"airtime": "SUN 1pm-2pm, TUE 10pm, WED 1am",
"meta": {
"site": "news",
"source": "City Arts & Lectures"
},
"link": "https://www.cityarts.net",
"subscribe": {
"tuneIn": "https://tunein.com/radio/City-Arts-and-Lectures-p692/",
"rss": "https://www.cityarts.net/feed/"
}
},
"closealltabs": {
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"info": "Close All Tabs breaks down how digital culture shapes our world through thoughtful insights and irreverent humor.",
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"officialWebsiteLink": "/podcasts/closealltabs",
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"source": "kqed",
"order": 1
},
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"id": "code-switch-life-kit",
"title": "Code Switch / Life Kit",
"info": "\u003cem>Code Switch\u003c/em>, which listeners will hear in the first part of the hour, has fearless and much-needed conversations about race. Hosted by journalists of color, the show tackles the subject of race head-on, exploring how it impacts every part of society — from politics and pop culture to history, sports and more.\u003cbr />\u003cbr />\u003cem>Life Kit\u003c/em>, which will be in the second part of the hour, guides you through spaces and feelings no one prepares you for — from finances to mental health, from workplace microaggressions to imposter syndrome, from relationships to parenting. The show features experts with real world experience and shares their knowledge. Because everyone needs a little help being human.\u003cbr />\u003cbr />\u003ca href=\"https://www.npr.org/podcasts/510312/codeswitch\">\u003cem>Code Switch\u003c/em> offical site and podcast\u003c/a>\u003cbr />\u003ca href=\"https://www.npr.org/lifekit\">\u003cem>Life Kit\u003c/em> offical site and podcast\u003c/a>\u003cbr />",
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"meta": {
"site": "radio",
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},
"link": "/radio/program/code-switch-life-kit",
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},
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"id": "commonwealth-club",
"title": "Commonwealth Club of California Podcast",
"info": "The Commonwealth Club of California is the nation's oldest and largest public affairs forum. As a non-partisan forum, The Club brings to the public airwaves diverse viewpoints on important topics. The Club's weekly radio broadcast - the oldest in the U.S., dating back to 1924 - is carried across the nation on public radio stations and is now podcasting. Our website archive features audio of our recent programs, as well as selected speeches from our long and distinguished history. This podcast feed is usually updated twice a week and is always un-edited.",
"airtime": "THU 10pm, FRI 1am",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Commonwealth-Club-Podcast-Tile-360x360-1.jpg",
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"meta": {
"site": "news",
"source": "Commonwealth Club of California"
},
"link": "/radio/program/commonwealth-club",
"subscribe": {
"apple": "https://itunes.apple.com/us/podcast/commonwealth-club-of-california-podcast/id976334034?mt=2",
"google": "https://podcasts.google.com/feed/aHR0cDovL3d3dy5jb21tb253ZWFsdGhjbHViLm9yZy9hdWRpby9wb2RjYXN0L3dlZWtseS54bWw",
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},
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"id": "forum",
"title": "Forum",
"tagline": "The conversation starts here",
"info": "KQED’s live call-in program discussing local, state, national and international issues, as well as in-depth interviews.",
"airtime": "MON-FRI 9am-11am, 10pm-11pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Forum-Podcast-Tile-703x703-1.jpg",
"imageAlt": "KQED Forum with Mina Kim and Alexis Madrigal",
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"meta": {
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"source": "kqed",
"order": 9
},
"link": "/forum",
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM5NTU3MzgxNjMz",
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"freakonomics-radio": {
"id": "freakonomics-radio",
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"imageSrc": "https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/05/freakonomicsRadio.png",
"officialWebsiteLink": "http://freakonomics.com/",
"airtime": "SUN 1am-2am, SAT 3pm-4pm",
"meta": {
"site": "radio",
"source": "WNYC"
},
"link": "/radio/program/freakonomics-radio",
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"apple": "https://itunes.apple.com/us/podcast/freakonomics-radio/id354668519",
"tuneIn": "https://tunein.com/podcasts/WNYC-Podcasts/Freakonomics-Radio-p272293/",
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},
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"id": "fresh-air",
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"link": "/radio/program/fresh-air",
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"apple": "https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=214089682&at=11l79Y&ct=nprdirectory",
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"info": "A live production of NPR and WBUR Boston, in collaboration with stations across the country, Here & Now reflects the fluid world of news as it's happening in the middle of the day, with timely, in-depth news, interviews and conversation. Hosted by Robin Young, Jeremy Hobson and Tonya Mosley.",
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},
"hidden-brain": {
"id": "hidden-brain",
"title": "Hidden Brain",
"info": "Shankar Vedantam uses science and storytelling to reveal the unconscious patterns that drive human behavior, shape our choices and direct our relationships.",
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"airtime": "SUN 7pm-8pm",
"meta": {
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"source": "NPR"
},
"link": "/radio/program/hidden-brain",
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},
"how-i-built-this": {
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"title": "How I Built This with Guy Raz",
"info": "Guy Raz dives into the stories behind some of the world's best known companies. How I Built This weaves a narrative journey about innovators, entrepreneurs and idealists—and the movements they built.",
"imageSrc": "https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/05/howIBuiltThis.png",
"officialWebsiteLink": "https://www.npr.org/podcasts/510313/how-i-built-this",
"airtime": "SUN 7:30pm-8pm",
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"source": "npr"
},
"link": "/radio/program/how-i-built-this",
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"apple": "https://itunes.apple.com/us/podcast/how-i-built-this-with-guy-raz/id1150510297?mt=2",
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},
"hyphenacion": {
"id": "hyphenacion",
"title": "Hyphenación",
"tagline": "Where conversation and cultura meet",
"info": "What kind of no sabo word is Hyphenación? For us, it’s about living within a hyphenation. Like being a third-gen Mexican-American from the Texas border now living that Bay Area Chicano life. Like Xorje! Each week we bring together a couple of hyphenated Latinos to talk all about personal life choices: family, careers, relationships, belonging … everything is on the table. ",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2025/03/Hyphenacion_FinalAssets_PodcastTile.png",
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"officialWebsiteLink": "/podcasts/hyphenacion",
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"order": 15
},
"link": "/podcasts/hyphenacion",
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},
"jerrybrown": {
"id": "jerrybrown",
"title": "The Political Mind of Jerry Brown",
"tagline": "Lessons from a lifetime in politics",
"info": "The Political Mind of Jerry Brown brings listeners the wisdom of the former Governor, Mayor, and presidential candidate. Scott Shafer interviewed Brown for more than 40 hours, covering the former governor's life and half-century in the political game – and Brown has some lessons he'd like to share. ",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/The-Political-Mind-of-Jerry-Brown-Podcast-Tile-703x703-1.jpg",
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"officialWebsiteLink": "/podcasts/jerrybrown",
"meta": {
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"source": "kqed",
"order": 18
},
"link": "/podcasts/jerrybrown",
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}
},
"latino-usa": {
"id": "latino-usa",
"title": "Latino USA",
"airtime": "MON 1am-2am, SUN 6pm-7pm",
"info": "Latino USA, the radio journal of news and culture, is the only national, English-language radio program produced from a Latino perspective.",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/latinoUsa.jpg",
"officialWebsiteLink": "http://latinousa.org/",
"meta": {
"site": "news",
"source": "npr"
},
"link": "/radio/program/latino-usa",
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"apple": "https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=79681317&at=11l79Y&ct=nprdirectory",
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"rss": "https://feeds.npr.org/510016/podcast.xml"
}
},
"marketplace": {
"id": "marketplace",
"title": "Marketplace",
"info": "Our flagship program, helmed by Kai Ryssdal, examines what the day in money delivered, through stories, conversations, newsworthy numbers and more. Updated Monday through Friday at about 3:30 p.m. PT.",
"airtime": "MON-FRI 4pm-4:30pm, MON-WED 6:30pm-7pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Marketplace-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.marketplace.org/",
"meta": {
"site": "news",
"source": "American Public Media"
},
"link": "/radio/program/marketplace",
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"rss": "https://feeds.publicradio.org/public_feeds/marketplace-pm/rss/rss"
}
},
"masters-of-scale": {
"id": "masters-of-scale",
"title": "Masters of Scale",
"info": "Masters of Scale is an original podcast in which LinkedIn co-founder and Greylock Partner Reid Hoffman sets out to describe and prove theories that explain how great entrepreneurs take their companies from zero to a gazillion in ingenious fashion.",
"airtime": "Every other Wednesday June 12 through October 16 at 8pm (repeats Thursdays at 2am)",
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"officialWebsiteLink": "https://mastersofscale.com/",
"meta": {
"site": "radio",
"source": "WaitWhat"
},
"link": "/radio/program/masters-of-scale",
"subscribe": {
"apple": "http://mastersofscale.app.link/",
"rss": "https://rss.art19.com/masters-of-scale"
}
},
"mindshift": {
"id": "mindshift",
"title": "MindShift",
"tagline": "A podcast about the future of learning and how we raise our kids",
"info": "The MindShift podcast explores the innovations in education that are shaping how kids learn. Hosts Ki Sung and Katrina Schwartz introduce listeners to educators, researchers, parents and students who are developing effective ways to improve how kids learn. We cover topics like how fed-up administrators are developing surprising tactics to deal with classroom disruptions; how listening to podcasts are helping kids develop reading skills; the consequences of overparenting; and why interdisciplinary learning can engage students on all ends of the traditional achievement spectrum. This podcast is part of the MindShift education site, a division of KQED News. KQED is an NPR/PBS member station based in San Francisco. You can also visit the MindShift website for episodes and supplemental blog posts or tweet us \u003ca href=\"https://twitter.com/MindShiftKQED\">@MindShiftKQED\u003c/a> or visit us at \u003ca href=\"/mindshift\">MindShift.KQED.org\u003c/a>",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Mindshift-Podcast-Tile-703x703-1.jpg",
"imageAlt": "KQED MindShift: How We Will Learn",
"officialWebsiteLink": "/mindshift/",
"meta": {
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"source": "kqed",
"order": 12
},
"link": "/podcasts/mindshift",
"subscribe": {
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM1NzY0NjAwNDI5",
"npr": "https://www.npr.org/podcasts/464615685/mind-shift-podcast",
"stitcher": "https://www.stitcher.com/podcast/kqed/stories-teachers-share",
"spotify": "https://open.spotify.com/show/0MxSpNYZKNprFLCl7eEtyx"
}
},
"morning-edition": {
"id": "morning-edition",
"title": "Morning Edition",
"info": "\u003cem>Morning Edition\u003c/em> takes listeners around the country and the world with multi-faceted stories and commentaries every weekday. Hosts Steve Inskeep, David Greene and Rachel Martin bring you the latest breaking news and features to prepare you for the day.",
"airtime": "MON-FRI 3am-9am",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Morning-Edition-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.npr.org/programs/morning-edition/",
"meta": {
"site": "news",
"source": "npr"
},
"link": "/radio/program/morning-edition"
},
"onourwatch": {
"id": "onourwatch",
"title": "On Our Watch",
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