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"content": "\u003cp>The woman arrived at the emergency department at Huntington Hospital on New York's Long Island after she was hit by her boyfriend during an argument. Her situation raised concerns among the medical staff, which had recently been trained to be on the lookout for signs of sex trafficking.\u003c/p>\n\u003cp>An undocumented immigrant from El Salvador, she worked at a local cantina frequented by immigrants. Her job was to get patrons drinks and to dance with them, but many workers in those jobs are expected to offer sex, too. Her boyfriend didn't want her to work there, and that led to the fight, one doctor recalled.\u003c/p>\n\u003cp>As part of the intake process, the emergency staff asked the 36-year-old woman a series of questions about whether she'd ever had sex for money, or whether she had to give someone else part of what she earns, among other things. The screening questions were part of a new program at Northwell Health, a 23-hospital system in the New York metro area that includes Huntington Hospital, to train staff and provide them with \u003ca href=\"https://www.northwell.edu/about/news/press-releases/training-staff-identify-help-human-trafficking-victims\" target=\"_blank\" rel=\"noopener\">tools to identify and support victims of human trafficking\u003c/a>.\u003c/p>\n\u003cp>There are few hard figures for how many people are harmed by human trafficking, the term used when individuals are forced to work or have sex for someone else's commercial benefit. Polaris, a Washington, D.C.-based nonprofit that \u003ca href=\"https://humantraffickinghotline.org/type-trafficking/human-trafficking\" target=\"_blank\" rel=\"noopener\">advocates for these people and runs help lines\u003c/a> for them, says calls and texts to its national hotlines have\u003ca href=\"http://polarisproject.org/sites/default/files/2017NHTHStats%20%281%29.pdf\" target=\"_blank\" rel=\"noopener\"> steadily ticked up in recent years\u003c/a>, increasing the number of cases 13 percent to 8,759 between 2016 and 2017.\u003c/p>\n\u003cp>But health care providers frequently fail to recognize these patients' situation. According to a \u003ca href=\"http://www.globalcenturion.org/wp-content/uploads/2014/08/The-Health-Consequences-of-Sex-Trafficking.pdf\" target=\"_blank\" rel=\"noopener\">2014 survey of about 100 survivors of sex trafficking\u003c/a>, 88 percent said that while they were being trafficked they had contact with a health care provider, typically someone in an emergency department.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"When trafficking victims come through the health care system but we don't identify them, it's a big missed opportunity,\" says Dr. Santhosh Paulus, a family physician who is the site director of the Huntington Hospital's family medicine residency program and who started the program at Northwell.\u003c/p>\n\u003cp>Northwell is one of a growing number of hospitals and health care systems that are putting such programs in place. They want to alert staff to be on the lookout for trafficking, much as they watch for signs of child abuse, domestic violence and elder abuse.\u003c/p>\n\u003cp>Since last spring, nearly 300 staff members at Huntington Hospital and a family clinic have received training in how to spot trafficking victims and how to help them.\u003c/p>\n\u003cp>Training is given not only to doctors and nurses but also to registration and reception staff, social workers and security guards. Restore NYC, an organization that assists people caught up in sex trafficking, provided the initial training to key staff, and a hospital task force trains the others. During the next few years, similar efforts will be rolled out at all of Northwell's 23 hospitals, Paulus says.\u003c/p>\n\u003cp>Identifying victims of trafficking is not unlike identifying victims of other forms of violence, says Dr. Wendy Macias-Konstantopoulos, director of the \u003ca href=\"https://www.massgeneral.org/emergencymedicineglobalhealth/initiatives/Human-Trafficking-Initiative.aspx\" target=\"_blank\" rel=\"noopener\">Human Trafficking Initiative\u003c/a> at Massachusetts General Hospital in Boston.\u003c/p>\n\u003cp>One of the big red flags is when people delay coming in for medical care, such as waiting weeks to come in to get an injured ankle or sexually transmitted infection checked out, Macias-Konstantopoulos says. Or it may be a pattern of injuries that don't make sense. Sometimes people are reluctant to explain their injury, or they come in with someone who seems overbearing.\u003c/p>\n\u003cp>\"Having a high index of suspicion is the first step,\" she says. \"If we're not asking about it, we're just not going to see it.\"\u003c/p>\n\u003cp>Starting in October, health care providers can also start \u003ca href=\"https://www.aha.org/system/files/2018-07/icd-10-code-human-trafficking_0.pdf\" target=\"_blank\" rel=\"noopener\">using new diagnosis codes\u003c/a> in their records to differentiate trafficking from other types of abuse. This will help track the number of victims and provide appropriate treatment.\u003c/p>\n\u003cp>Asking may not be enough, however. Depending on what's going on in their lives, these patients may not be willing or ready to acknowledge that they need help, says \u003ca href=\"https://www.traffickinginstitute.org/holly-austin-gibbs-joins-the-human-trafficking-institute/\" target=\"_blank\" rel=\"noopener\">Holly Gibbs\u003c/a>, human trafficking response program director for Dignity Health, a health care system with nearly 40 hospitals in California, Nevada and Arizona.\u003c/p>\n\u003cp>Gibbs knows the issue well. She was forced briefly into prostitution in Atlantic City, N.J., after meeting a man at a shopping mall as a 14-year-old and running away with him. The man persuaded Gibbs to go with him with promises of a new, glamorous life as a musician or model.\u003c/p>\n\u003cp>At the time, Gibbs says, she thought that what happened to her was her own fault, a result of choices she made. No health care or law enforcement professional connected her to social services that could have helped her understand otherwise. She was reunited with her family by law enforcement personnel, who arrested the man, who was later convicted.\u003c/p>\n\u003cp>Dignity Health has implemented a human trafficking response program in the emergency departments and labor and delivery areas of each of its hospitals. Now it's rolling out the program at clinics and physicians' offices as well.\u003c/p>\n\u003cp>A key priority is to help clinicians know how to talk to patients about any violence they may be facing and to connect the patients with outside sources of help.\u003c/p>\n\u003cp>But in the end, if these patients don't want assistance, \"you respect their wishes,\" Gibbs says. \"They may not be ready to accept help now, but you may plant seeds so they'll be able to accept it later on.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"http://khn.org/\" target=\"_blank\" rel=\"noopener\">Kaiser Health News\u003c/a>\u003cem> is a nonprofit news service covering health issues. It is an editorially independent program of the Kaiser Family Foundation that isn't affiliated with Kaiser Permanente. You can follow Michelle Andrews on Twitter: \u003c/em>\u003ca href=\"https://twitter.com/mandrews110\" target=\"_blank\" rel=\"noopener\">@mandrews110\u003c/a>.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 Kaiser Health News. To see more, visit \u003ca href=\"http://www.kaiserhealthnews.org/\" target=\"_blank\" rel=\"noopener\">Kaiser Health News\u003c/a>.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Hospitals+Gear+Up+For+New+Diagnosis%3A+Human+Trafficking+&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The woman arrived at the emergency department at Huntington Hospital on New York's Long Island after she was hit by her boyfriend during an argument. Her situation raised concerns among the medical staff, which had recently been trained to be on the lookout for signs of sex trafficking.\u003c/p>\n\u003cp>An undocumented immigrant from El Salvador, she worked at a local cantina frequented by immigrants. Her job was to get patrons drinks and to dance with them, but many workers in those jobs are expected to offer sex, too. Her boyfriend didn't want her to work there, and that led to the fight, one doctor recalled.\u003c/p>\n\u003cp>As part of the intake process, the emergency staff asked the 36-year-old woman a series of questions about whether she'd ever had sex for money, or whether she had to give someone else part of what she earns, among other things. The screening questions were part of a new program at Northwell Health, a 23-hospital system in the New York metro area that includes Huntington Hospital, to train staff and provide them with \u003ca href=\"https://www.northwell.edu/about/news/press-releases/training-staff-identify-help-human-trafficking-victims\" target=\"_blank\" rel=\"noopener\">tools to identify and support victims of human trafficking\u003c/a>.\u003c/p>\n\u003cp>There are few hard figures for how many people are harmed by human trafficking, the term used when individuals are forced to work or have sex for someone else's commercial benefit. Polaris, a Washington, D.C.-based nonprofit that \u003ca href=\"https://humantraffickinghotline.org/type-trafficking/human-trafficking\" target=\"_blank\" rel=\"noopener\">advocates for these people and runs help lines\u003c/a> for them, says calls and texts to its national hotlines have\u003ca href=\"http://polarisproject.org/sites/default/files/2017NHTHStats%20%281%29.pdf\" target=\"_blank\" rel=\"noopener\"> steadily ticked up in recent years\u003c/a>, increasing the number of cases 13 percent to 8,759 between 2016 and 2017.\u003c/p>\n\u003cp>But health care providers frequently fail to recognize these patients' situation. According to a \u003ca href=\"http://www.globalcenturion.org/wp-content/uploads/2014/08/The-Health-Consequences-of-Sex-Trafficking.pdf\" target=\"_blank\" rel=\"noopener\">2014 survey of about 100 survivors of sex trafficking\u003c/a>, 88 percent said that while they were being trafficked they had contact with a health care provider, typically someone in an emergency department.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"When trafficking victims come through the health care system but we don't identify them, it's a big missed opportunity,\" says Dr. Santhosh Paulus, a family physician who is the site director of the Huntington Hospital's family medicine residency program and who started the program at Northwell.\u003c/p>\n\u003cp>Northwell is one of a growing number of hospitals and health care systems that are putting such programs in place. They want to alert staff to be on the lookout for trafficking, much as they watch for signs of child abuse, domestic violence and elder abuse.\u003c/p>\n\u003cp>Since last spring, nearly 300 staff members at Huntington Hospital and a family clinic have received training in how to spot trafficking victims and how to help them.\u003c/p>\n\u003cp>Training is given not only to doctors and nurses but also to registration and reception staff, social workers and security guards. Restore NYC, an organization that assists people caught up in sex trafficking, provided the initial training to key staff, and a hospital task force trains the others. During the next few years, similar efforts will be rolled out at all of Northwell's 23 hospitals, Paulus says.\u003c/p>\n\u003cp>Identifying victims of trafficking is not unlike identifying victims of other forms of violence, says Dr. Wendy Macias-Konstantopoulos, director of the \u003ca href=\"https://www.massgeneral.org/emergencymedicineglobalhealth/initiatives/Human-Trafficking-Initiative.aspx\" target=\"_blank\" rel=\"noopener\">Human Trafficking Initiative\u003c/a> at Massachusetts General Hospital in Boston.\u003c/p>\n\u003cp>One of the big red flags is when people delay coming in for medical care, such as waiting weeks to come in to get an injured ankle or sexually transmitted infection checked out, Macias-Konstantopoulos says. Or it may be a pattern of injuries that don't make sense. Sometimes people are reluctant to explain their injury, or they come in with someone who seems overbearing.\u003c/p>\n\u003cp>\"Having a high index of suspicion is the first step,\" she says. \"If we're not asking about it, we're just not going to see it.\"\u003c/p>\n\u003cp>Starting in October, health care providers can also start \u003ca href=\"https://www.aha.org/system/files/2018-07/icd-10-code-human-trafficking_0.pdf\" target=\"_blank\" rel=\"noopener\">using new diagnosis codes\u003c/a> in their records to differentiate trafficking from other types of abuse. This will help track the number of victims and provide appropriate treatment.\u003c/p>\n\u003cp>Asking may not be enough, however. Depending on what's going on in their lives, these patients may not be willing or ready to acknowledge that they need help, says \u003ca href=\"https://www.traffickinginstitute.org/holly-austin-gibbs-joins-the-human-trafficking-institute/\" target=\"_blank\" rel=\"noopener\">Holly Gibbs\u003c/a>, human trafficking response program director for Dignity Health, a health care system with nearly 40 hospitals in California, Nevada and Arizona.\u003c/p>\n\u003cp>Gibbs knows the issue well. She was forced briefly into prostitution in Atlantic City, N.J., after meeting a man at a shopping mall as a 14-year-old and running away with him. The man persuaded Gibbs to go with him with promises of a new, glamorous life as a musician or model.\u003c/p>\n\u003cp>At the time, Gibbs says, she thought that what happened to her was her own fault, a result of choices she made. No health care or law enforcement professional connected her to social services that could have helped her understand otherwise. She was reunited with her family by law enforcement personnel, who arrested the man, who was later convicted.\u003c/p>\n\u003cp>Dignity Health has implemented a human trafficking response program in the emergency departments and labor and delivery areas of each of its hospitals. Now it's rolling out the program at clinics and physicians' offices as well.\u003c/p>\n\u003cp>A key priority is to help clinicians know how to talk to patients about any violence they may be facing and to connect the patients with outside sources of help.\u003c/p>\n\u003cp>But in the end, if these patients don't want assistance, \"you respect their wishes,\" Gibbs says. \"They may not be ready to accept help now, but you may plant seeds so they'll be able to accept it later on.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"http://khn.org/\" target=\"_blank\" rel=\"noopener\">Kaiser Health News\u003c/a>\u003cem> is a nonprofit news service covering health issues. It is an editorially independent program of the Kaiser Family Foundation that isn't affiliated with Kaiser Permanente. You can follow Michelle Andrews on Twitter: \u003c/em>\u003ca href=\"https://twitter.com/mandrews110\" target=\"_blank\" rel=\"noopener\">@mandrews110\u003c/a>.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 Kaiser Health News. To see more, visit \u003ca href=\"http://www.kaiserhealthnews.org/\" target=\"_blank\" rel=\"noopener\">Kaiser Health News\u003c/a>.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Hospitals+Gear+Up+For+New+Diagnosis%3A+Human+Trafficking+&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Dr. Elliot Tapper has treated a lot of patients, but this one stood out.\u003c/p>\n\u003cp>\"His whole body was yellow,\" Tapper remembers. \"He could hardly move. It was difficult for him to breathe, and he wasn't eating anything.\"\u003c/p>\n\u003cp>The patient was suffering from chronic liver disease. After years of alcohol use, his liver had stopped filtering his blood. Bilirubin, a yellowish waste compound, was building up in his body and changing his skin color.\u003c/p>\n\u003cp>Disturbing to Tapper, the man was only in his mid-30s – much younger than most liver disease patients.\u003c/p>\n\u003cp>Tapper, a liver specialist and assistant professor of medicine at the University of Michigan Medical School, tried to get the patient to stop drinking.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"We had long, tearful conversations,\" Tapper says, \"but he continued to struggle with alcohol addiction.\" Since then, the young man's condition has continued to deteriorate and Tapper is not optimistic about his chances of survival.\u003c/p>\n\u003cp>It's patient stories like this one that led Tapper to research liver disease in young people. According to a \u003ca href=\"https://www.bmj.com/content/362/bmj.k2817\" target=\"_blank\" rel=\"noopener\">study published Wednesday\u003c/a> in \u003cem>BMJ\u003c/em> by Tapper and a colleague, fatal liver disease has risen, and young people have been hit the hardest.\u003c/p>\n\u003cp>The study examined the number of deaths resulting from cirrhosis, or scarring of the liver, as well as liver cancer. Data came from the Centers for Disease Control and Prevention and covered the period from 1999 to 2016.\u003c/p>\n\u003cp>The analysis revealed that deaths from liver-related illnesses have increased dramatically, and mortality in young people rose the fastest. Although these illnesses can be caused by several things including obesity and hepatitis C infection, the rise among young Americans was caused by alcohol consumption. The number of 25- to 34-year-olds who died annually from alcohol-related liver disease nearly tripled between 1999 and 2016, from 259 in 1999 to 767 in 2016, an average annual increase of around 10 percent.\u003c/p>\n\u003cp>\"What's happening with young people is dismaying to say the least,\" says Tapper.\u003c/p>\n\u003cp>Certain ethnic groups, like whites and Native Americans, also saw large increases in liver-related deaths in all age groups, while Asian-Americans saw decreases.\u003c/p>\n\u003cp>The rise in alcohol-related deaths overlaps with \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/25905846\" target=\"_blank\" rel=\"noopener\">rising rates of binge drinking\u003c/a> from 2002 to 2012 observed across much of the U.S.\u003c/p>\n\u003cp>The authors noted a sharp spike in mortality starting in 2009. The reason for the spike is unclear, but Dr. Neehar Parikh, a liver specialist at the University of Michigan Medical School and Tapper's co-author, has a theory.\u003c/p>\n\u003cp>\"It correlates with the global financial crisis,\" Parikh says. \"We hypothesize that there may be a loss of opportunity, and the psychological burden that comes with that may have driven some of those patients to abusive drinking.\"\u003c/p>\n\u003cp>The increase among younger Americans is particularly troubling, because it kills people in the prime of their life.\u003c/p>\n\u003cp>\"Each young patient that dies is a tragedy,\" says Parikh. \"It's years of life lost.\"\u003c/p>\n\u003cp>The study is the latest to confirm that liver-related illnesses are becoming increasingly prevalent. A report \u003ca href=\"https://www.cdc.gov/nchs/products/databriefs/db314.htm\" target=\"_blank\" rel=\"noopener\">published Tuesday\u003c/a> by the CDC shows that the age-adjusted death rate from liver cancer has increased 43 percent since 2000. And a \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/26255044\" target=\"_blank\" rel=\"noopener\">recent study of veterans\u003c/a> found that cirrhosis cases nearly doubled between 2001 and 2013.\u003c/p>\n\u003cp>But \u003ca href=\"https://www.mayo.edu/research/faculty/shah-vijay-m-d/bio-00083665\" target=\"_blank\" rel=\"noopener\">Dr. Vijay Shah\u003c/a>, who heads the Division of Gastroenterology and Hepatology at the Mayo Clinic and was not involved with this research, says that the study's emphasis on young Americans is new.\u003c/p>\n\u003cp>\"Alcohol-related liver cirrhosis used to be considered a disease that would happen after 30 years of heavy alcohol consumption,\" Shah says. \"But this study is showing that these problems are actually occurring in individuals in their 20s and 30s.\"\u003c/p>\n\u003cp>\"There has been a shift in the kind of patient we're seeing,\" agrees Dr. Sumeet Asrani, a liver specialist practicing in Dallas who did not contribute to the study. \"It fits with what we see in practice. We're seeing younger and younger patients with alcoholic liver disease.\"\u003c/p>\n\u003cp>Despite the recent increase, cirrhosis remains a relatively minor cause of death for young Americans, accounting for only 1.4 percent of total deaths in the 25-34 age range. But it's much more significant for young Native Americans, accounting for 6.3 percent of deaths.\u003c/p>\n\u003cp>Tapper thinks the problem is only going to get worse. Some conditions that cause liver trouble, like hepatitis C, have been falling. But other risk factors, including obesity, are on the rise. Alcohol consumption and obesity could interact to worsen liver disease, Tapper says.\u003c/p>\n\u003cp>Tapper says he thinks that policy could play a role in addressing the problem. For instance, strategic taxation of alcoholic beverages could deter consumption, just as raising the \u003ca href=\"https://www.npr.org/sections/health-shots/2016/11/10/501589893/cigarette-smoking-in-the-u-s-continues-to-fall\" target=\"_blank\" rel=\"noopener\">taxes on cigarettes has been shown to reduce smoking\u003c/a>. He cites the example of Scotland, which recently set minimum prices for units of alcohol to deter binge drinking. He also points to public health interventions, such as counseling, that help people quit drinking.\u003c/p>\n\u003cp>The good news is that liver disease is often reversible. Many patients can recover if they stop drinking soon enough.\u003c/p>\n\u003cp>\"I've had patients who came to me in a wheelchair,\" Tapper says. \"Three months later, they're shoveling snow and their lab tests are normal. It's always because they made that choice to stop drinking.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Paul Chisholm is an intern with NPR's Science desk.\u003c/em>\u003c/p>\n\u003chr>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=A+Spike+In+Liver+Disease+Deaths+Among+Young+Adults+Fueled+By+Alcohol+&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"We had long, tearful conversations,\" Tapper says, \"but he continued to struggle with alcohol addiction.\" Since then, the young man's condition has continued to deteriorate and Tapper is not optimistic about his chances of survival.\u003c/p>\n\u003cp>It's patient stories like this one that led Tapper to research liver disease in young people. According to a \u003ca href=\"https://www.bmj.com/content/362/bmj.k2817\" target=\"_blank\" rel=\"noopener\">study published Wednesday\u003c/a> in \u003cem>BMJ\u003c/em> by Tapper and a colleague, fatal liver disease has risen, and young people have been hit the hardest.\u003c/p>\n\u003cp>The study examined the number of deaths resulting from cirrhosis, or scarring of the liver, as well as liver cancer. Data came from the Centers for Disease Control and Prevention and covered the period from 1999 to 2016.\u003c/p>\n\u003cp>The analysis revealed that deaths from liver-related illnesses have increased dramatically, and mortality in young people rose the fastest. Although these illnesses can be caused by several things including obesity and hepatitis C infection, the rise among young Americans was caused by alcohol consumption. The number of 25- to 34-year-olds who died annually from alcohol-related liver disease nearly tripled between 1999 and 2016, from 259 in 1999 to 767 in 2016, an average annual increase of around 10 percent.\u003c/p>\n\u003cp>\"What's happening with young people is dismaying to say the least,\" says Tapper.\u003c/p>\n\u003cp>Certain ethnic groups, like whites and Native Americans, also saw large increases in liver-related deaths in all age groups, while Asian-Americans saw decreases.\u003c/p>\n\u003cp>The rise in alcohol-related deaths overlaps with \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/25905846\" target=\"_blank\" rel=\"noopener\">rising rates of binge drinking\u003c/a> from 2002 to 2012 observed across much of the U.S.\u003c/p>\n\u003cp>The authors noted a sharp spike in mortality starting in 2009. The reason for the spike is unclear, but Dr. Neehar Parikh, a liver specialist at the University of Michigan Medical School and Tapper's co-author, has a theory.\u003c/p>\n\u003cp>\"It correlates with the global financial crisis,\" Parikh says. \"We hypothesize that there may be a loss of opportunity, and the psychological burden that comes with that may have driven some of those patients to abusive drinking.\"\u003c/p>\n\u003cp>The increase among younger Americans is particularly troubling, because it kills people in the prime of their life.\u003c/p>\n\u003cp>\"Each young patient that dies is a tragedy,\" says Parikh. \"It's years of life lost.\"\u003c/p>\n\u003cp>The study is the latest to confirm that liver-related illnesses are becoming increasingly prevalent. A report \u003ca href=\"https://www.cdc.gov/nchs/products/databriefs/db314.htm\" target=\"_blank\" rel=\"noopener\">published Tuesday\u003c/a> by the CDC shows that the age-adjusted death rate from liver cancer has increased 43 percent since 2000. And a \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/26255044\" target=\"_blank\" rel=\"noopener\">recent study of veterans\u003c/a> found that cirrhosis cases nearly doubled between 2001 and 2013.\u003c/p>\n\u003cp>But \u003ca href=\"https://www.mayo.edu/research/faculty/shah-vijay-m-d/bio-00083665\" target=\"_blank\" rel=\"noopener\">Dr. Vijay Shah\u003c/a>, who heads the Division of Gastroenterology and Hepatology at the Mayo Clinic and was not involved with this research, says that the study's emphasis on young Americans is new.\u003c/p>\n\u003cp>\"Alcohol-related liver cirrhosis used to be considered a disease that would happen after 30 years of heavy alcohol consumption,\" Shah says. \"But this study is showing that these problems are actually occurring in individuals in their 20s and 30s.\"\u003c/p>\n\u003cp>\"There has been a shift in the kind of patient we're seeing,\" agrees Dr. Sumeet Asrani, a liver specialist practicing in Dallas who did not contribute to the study. \"It fits with what we see in practice. We're seeing younger and younger patients with alcoholic liver disease.\"\u003c/p>\n\u003cp>Despite the recent increase, cirrhosis remains a relatively minor cause of death for young Americans, accounting for only 1.4 percent of total deaths in the 25-34 age range. But it's much more significant for young Native Americans, accounting for 6.3 percent of deaths.\u003c/p>\n\u003cp>Tapper thinks the problem is only going to get worse. Some conditions that cause liver trouble, like hepatitis C, have been falling. But other risk factors, including obesity, are on the rise. Alcohol consumption and obesity could interact to worsen liver disease, Tapper says.\u003c/p>\n\u003cp>Tapper says he thinks that policy could play a role in addressing the problem. For instance, strategic taxation of alcoholic beverages could deter consumption, just as raising the \u003ca href=\"https://www.npr.org/sections/health-shots/2016/11/10/501589893/cigarette-smoking-in-the-u-s-continues-to-fall\" target=\"_blank\" rel=\"noopener\">taxes on cigarettes has been shown to reduce smoking\u003c/a>. He cites the example of Scotland, which recently set minimum prices for units of alcohol to deter binge drinking. He also points to public health interventions, such as counseling, that help people quit drinking.\u003c/p>\n\u003cp>The good news is that liver disease is often reversible. Many patients can recover if they stop drinking soon enough.\u003c/p>\n\u003cp>\"I've had patients who came to me in a wheelchair,\" Tapper says. \"Three months later, they're shoveling snow and their lab tests are normal. It's always because they made that choice to stop drinking.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Paul Chisholm is an intern with NPR's Science desk.\u003c/em>\u003c/p>\n\u003chr>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=A+Spike+In+Liver+Disease+Deaths+Among+Young+Adults+Fueled+By+Alcohol+&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Health Insurers Are Vacuuming Up Details About You — And It Could Raise Your Rates",
"title": "Health Insurers Are Vacuuming Up Details About You — And It Could Raise Your Rates",
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"content": "\u003cp>To an outsider, the fancy booths at a June health insurance industry gathering in San Diego, Calif., aren't very compelling: a handful of companies pitching \"lifestyle\" data and salespeople touting jargony phrases like \"social determinants of health.\"[contextly_sidebar id=\"79wDHCMXsLwHcrV0uV8lwcSxOMTorwMk\"]\u003c/p>\n\u003cp>But dig deeper and the implications of what they're selling might give many patients pause: a future in which everything you do — the things you buy, the food you eat, the time you spend watching TV — may help determine how much you pay for health insurance.\u003c/p>\n\u003cp>With little public scrutiny, the health insurance industry has joined forces with data brokers to vacuum up personal details about hundreds of millions of Americans, including, odds are, many readers of this story.\u003c/p>\n\u003cp>The companies are tracking your race, education level, TV habits, marital status, net worth. They're collecting what you post on social media, whether you're behind on your bills, what you order online. Then they feed this information into complicated computer algorithms that spit out predictions about how much your health care could cost them.\u003c/p>\n\u003cp>Are you a woman who recently changed your name? You could be newly married and have a pricey pregnancy pending. Or maybe you're stressed and anxious from a recent divorce. That, too, the computer models predict, may run up your medical bills.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Are you a woman who has purchased plus-size clothing? You're considered at risk of depression. Mental health care can be expensive.[contextly_sidebar id=\"bDoTI0AqbPZA0QggUW6RBxclSpZhPjsp\"]\u003c/p>\n\u003cp>Low-income and a minority? That means, the data brokers say, you are more likely to live in a dilapidated and dangerous neighborhood, increasing your health risks.\u003c/p>\n\u003cp>\"We sit on oceans of data,\" said Eric McCulley, director of strategic solutions for \u003ca href=\"https://risk.lexisnexis.com/insurance\" target=\"_blank\" rel=\"noopener\">LexisNexis Risk Solutions\u003c/a>, during a conversation at the data firm's booth. And he isn't apologetic about using it. \"The fact is, our data is in the public domain,\" he said. \"We didn't put it out there.\"\u003c/p>\n\u003cp>Insurers contend that they use the information to spot health issues in their clients — and flag them so they get services they need. And companies like LexisNexis say the data shouldn't be used to set prices. But as a research scientist from one company told me: \"I can't say it hasn't happened.\"\u003c/p>\n\u003cp>At a time when every week brings a new privacy scandal and worries abound about the misuse of personal information, patient advocates and privacy scholars say the insurance industry's data gathering runs counter to its touted, and federally required, allegiance to patients' medical privacy. The \u003ca href=\"https://www.hhs.gov/hipaa/for-individuals/guidance-materials-for-consumers/index.html\" target=\"_blank\" rel=\"noopener\">Health Insurance Portability and Accountability Act\u003c/a>, or HIPAA, only protects medical information.\u003c/p>\n\u003cp>\"We have a health privacy machine that's in crisis,\" said Frank Pasquale, a professor at the University of Maryland Carey School of Law who specializes in issues related to machine learning and algorithms. \"We have a law that only covers one source of health information. They are rapidly developing another source.\"\u003c/p>\n\u003cp>Patient advocates warn that using unverified, error-prone \"lifestyle\" data to make medical assumptions could lead insurers to improperly price plans — for instance, raising rates based on false information — or discriminate against anyone tagged as high cost. And, they say, the use of the data raises thorny questions that should be debated publicly, such as: Should a person's rates be raised because algorithms say they are more likely to run up medical bills? Such questions would be moot in Europe, where a strict law took effect in May that bans trading in personal data.[contextly_sidebar id=\"d5hHSDi3Hs2EqOb5p8wPiO2juNTZPrbB\"]\u003c/p>\n\u003cp>This year, \u003ca href=\"https://www.propublica.org/series/the-health-insurance-hustle\" target=\"_blank\" rel=\"noopener\">ProPublica and NPR are investigating\u003c/a> the various tactics the health insurance industry uses to maximize its profits. Understanding these strategies is important because patients — through taxes, cash payments and insurance premiums — are the ones funding the entire health care system. Yet the industry's bewildering web of strategies and inside deals often has little to do with patients' needs. As the series' \u003ca href=\"https://www.propublica.org/article/why-your-health-insurer-does-not-care-about-your-big-bills\" target=\"_blank\" rel=\"noopener\">first story\u003c/a> showed, contrary to popular belief, lower bills aren't health insurers' top priority.\u003c/p>\n\u003cp>Inside the San Diego Convention Center, there were few qualms about the way insurance companies were mining Americans' lives for information — or what they planned to do with the data.\u003c/p>\n\u003cp>\u003cstrong>Linking Health Costs to Personal Data\u003c/strong>\u003c/p>\n\u003cp>The sprawling convention center was a balmy draw for one of America's Health Insurance Plans' marquee gatherings. Insurance executives and managers wandered through the exhibit hall, sampling chocolate-covered strawberries, champagne and other delectables designed to encourage deal-making.\u003c/p>\n\u003cp>Up front, the prime real estate belonged to the big guns in health data: The booths of Optum, IBM Watson Health and LexisNexis stretched toward the ceiling, with flat-screen monitors and some comfy seating. (NPR collaborates with IBM Watson Health on national polls about consumer health topics.)\u003c/p>\n\u003cp>To understand the scope of what they were offering, consider Optum. The company, owned by the massive UnitedHealth Group, has collected the medical diagnoses, tests, prescriptions, costs and socioeconomic data of 150 million Americans going back to 1993, according to its marketing materials.(UnitedHealth Group provides financial support to NPR.)\u003c/p>\n\u003cp>The company says it uses the information to link patients' medical outcomes and costs to details like their level of education, net worth, family structure and race. An Optum spokesman said the socioeconomic data is de-identified and is not used for pricing health plans.\u003c/p>\n\u003cp>Optum's marketing materials also boast that it now has access to even more. In 2016, the company filed a patent application to gather what people share on platforms like Facebook and Twitter, and to link this material to the person's clinical and payment information. A company spokesman said in an email that the patent application never went anywhere. But the company's current marketing materials say it combines claims and clinical information with social media interactions.\u003c/p>\n\u003cp>I had a lot of questions about this and first reached out to Optum in May, but the company didn't connect me with any of its experts as promised. At the conference, Optum salespeople said they weren't allowed to talk to me about how the company uses this information.\u003c/p>\n\u003cp>It isn't hard to understand the appeal of all this data to insurers. Merging information from data brokers with people's clinical and payment records is a no-brainer if you overlook potential patient concerns. Electronic medical records now make it easy for insurers to analyze massive amounts of information and combine it with the personal details scooped up by data brokers.\u003c/p>\n\u003cp>It also makes sense given the shifts in how providers are getting paid. Doctors and hospitals have typically been paid based on the quantity of care they provide. But the industry is moving toward paying them in lump sums for caring for a patient, or for an event, like a knee surgery. In those cases, the medical providers can profit more when patients stay healthy. More money at stake means more interest in the social factors that might affect a patient's health.\u003c/p>\n\u003cp>Some insurance companies are already using socioeconomic data to help patients get appropriate care, such as programs to help patients with chronic diseases stay healthy. Studies show social and economic aspects of people's lives play an important role in their health. Knowing these personal details can help them identify those who may need help paying for medication or help getting to the doctor.\u003c/p>\n\u003cp>But patient advocates are skeptical that health insurers have altruistic designs on people's personal information.\u003c/p>\n\u003cp>The industry has a history of boosting profits by signing up healthy people and finding ways to avoid sick people — called \"cherry-picking\" and \"lemon-dropping,\" experts say.\u003c/p>\n\u003cp>Among the classic examples: A company was accused of putting its enrollment office on the third floor of a building without an elevator, so only healthy patients could make the trek to sign up. Another tried to appeal to spry seniors by holding square dances.\u003c/p>\n\u003cp>The Affordable Care Act prohibits insurers from denying people coverage based on pre-existing health conditions or charging sick people more for individual or small group plans. But experts said patients' personal information could still be used for marketing, and to assess risks and determine the prices of certain plans. And the Trump administration is promoting short-term health plans, which do allow insurers to deny coverage to sick patients.\u003c/p>\n\u003cp>Robert Greenwald, faculty director of Harvard Law School's Center for Health Law and Policy Innovation, said insurance companies still cherry-pick, but now they're subtler. The center analyzes health insurance plans to see if they discriminate. He said insurers will do things like failing to include enough information about which drugs a plan covers, which pushes sick people who need specific medications elsewhere. Or they may change the things a plan covers, or how much a patient has to pay for a type of care, after a patient has enrolled. Or, Greenwald added, they might exclude or limit certain types of providers from their networks — like those who have skill caring for patients with HIV or hepatitis C.\u003c/p>\n\u003cp>If there were concerns that personal data might be used to cherry-pick or lemon-drop, they weren't raised at the conference.\u003c/p>\n\u003cp>At the IBM Watson Health booth, Kevin Ruane, a senior consulting scientist, told me that the company surveys 80,000 Americans a year to assess lifestyle, attitudes and behaviors that could relate to health care. Participants are asked whether they trust their doctor, have financial problems, go online, or own a Fitbit and similar questions. The responses of hundreds of adjacent households are analyzed together to identify social and economic factors for an area.\u003c/p>\n\u003cp>Ruane said he has used IBM Watson Health's socioeconomic analysis to help insurance companies assess a potential market. The ACA increased the value of such assessments, experts say, because companies often don't know the medical history of people seeking coverage. A region with too many sick people, or with patients who don't take care of themselves, might not be worth the risk.\u003c/p>\n\u003cp>Ruane acknowledged that the information his company gathers may not be accurate for every person. \"We talk to our clients and tell them to be careful about this,\" he said. \"Use it as a data insight. But it's not necessarily a fact.\"\u003c/p>\n\u003cp>In a separate conversation, a salesman from a different company joked about the potential for error. \"God forbid you live on the wrong street these days,\" he said. \"You're going to get lumped in with a lot of bad things.\"\u003c/p>\n\u003cp>The LexisNexis booth was emblazoned with the slogan \"Data. Insight. Action.\" The company said it uses 442 nonmedical personal attributes to predict a person's medical costs. Its cache includes more than 78 billion records from more than 10,000 public and proprietary sources, including people's cellphone numbers, criminal records, bankruptcies, property records, neighborhood safety and more. The information is used to predict patients' health risks and costs in eight areas, including how often they are likely to visit emergency rooms, their total cost, their pharmacy costs, their motivation to stay healthy and their stress levels.\u003c/p>\n\u003cp>People who downsize their homes tend to have higher health care costs, the company says. As do those whose parents didn't finish high school. Patients who own more valuable homes are less likely to land back in the hospital within 30 days of their discharge. The company says it has validated its scores against insurance claims and clinical data. But it won't share its methods and hasn't published the work in peer-reviewed journals.\u003c/p>\n\u003cp>McCulley, LexisNexis' director of strategic solutions, said predictions made by the algorithms about patients are based on the combination of the personal attributes. He gave a hypothetical example: A high school dropout who had a recent income loss and doesn't have a relative nearby might have higher-than-expected health costs.\u003c/p>\n\u003cp>But couldn't that same type of person be healthy?\u003c/p>\n\u003cp>\"Sure,\" McCulley said, with no apparent dismay at the possibility that the predictions could be wrong.\u003c/p>\n\u003cp>McCulley and others at LexisNexis insist the scores are only used to help patients get the care they need and not to determine how much someone would pay for their health insurance. The company cited three different federal laws that restricted them and their clients from using the scores in that way. But privacy experts said none of the laws cited by the company bar the practice. The company backed off the assertions when I pointed that the laws did not seem to apply.\u003c/p>\n\u003cp>LexisNexis officials also said the company's contracts expressly prohibit using the analysis to help price insurance plans. They would not provide a contract. But I knew that in at least one instance a company was already testing whether the scores could be used as a pricing tool.\u003c/p>\n\u003cp>Before the conference, I'd seen a press release announcing that the largest health actuarial firm in the world, Milliman, was now using the LexisNexis scores.\u003c/p>\n\u003cp>I tracked down Marcos Dachary, who works in business development for Milliman. Actuaries calculate health care risks and help set the price of premiums for insurers. I asked Dachary if Milliman was using the LexisNexis scores to price health plans and he said: \"There could be an opportunity.\"\u003c/p>\n\u003cp>The scores could allow an insurance company to assess the risks posed by individual patients and make adjustments to protect themselves from losses, he said. For example, he said, the company could raise premiums or revise contracts with providers.\u003c/p>\n\u003cp>It's too early to tell whether the LexisNexis scores will actually be useful for pricing, he said. But he was excited about the possibilities. \"One thing about social determinants data – it piques your mind,\" he said.\u003c/p>\n\u003cp>Dachary acknowledged the scores could also be used to discriminate. Others, he said, have raised that concern. As much as there could be positive potential, he said, \"there could also be negative potential.\"\u003c/p>\n\u003cp>\u003cstrong>Erroneous Inferences From Group Data\u003c/strong>\u003c/p>\n\u003cp>It's that negative potential that still bothers data analyst Erin Kaufman, who left the health insurance industry in January. The 35-year-old from Atlanta had earned her doctorate in public health because she wanted to help people, but one day at Aetna, her boss told her to work with a new data set.\u003c/p>\n\u003cp>To her surprise, the company had obtained personal information from a data broker on millions of Americans. The data contained each person's habits and hobbies, like whether they owned a gun, and if so, what type, she said. It included whether they had magazine subscriptions, liked to ride bikes or run marathons. It had hundreds of personal details about each person.\u003c/p>\n\u003cp>The Aetna data team merged the data with the information it had on patients it insured. The goal was to see how people's personal interests and hobbies might relate to their health care costs.\u003c/p>\n\u003cp>But Kaufman said it felt wrong: The information about the people who knitted or crocheted made her think of her grandmother. And the details about individuals who liked camping made her think of herself. What business did the insurance company have looking at this information? \"It was a data set that really dug into our clients' lives,\" she said. \"No one gave anyone permission to do this.\"\u003c/p>\n\u003cp>\u003ca href=\"https://www.documentcloud.org/documents/4600083-Aetna-Statement.html\">In a statement\u003c/a>, Aetna said it uses consumer marketing information to supplement its claims and clinical information. The combined data helps predict the risk of repeat emergency room visits or hospital admissions. The information is used to reach out to members and help them and plays no role in pricing plans or underwriting, the statement said.\u003c/p>\n\u003cp>Kaufman said she had concerns about the accuracy of drawing inferences about an individual's health from an analysis of a group of people with similar traits. Health scores generated from arrest records, homeownership and similar material may be wrong, she said.\u003c/p>\n\u003cp>Pam Dixon, executive director of the World Privacy Forum, a nonprofit that advocates for privacy in the digital age, shares Kaufman's concerns. She points to a study by the analytics company SAS, which worked in 2012 with an unnamed major health insurance company to predict a person's health care costs using 1,500 data elements, including the investments and types of cars people owned.\u003c/p>\n\u003cp>The SAS study said higher health care costs could be predicted by looking at things like ethnicity, watching TV and mail-order purchases.\u003c/p>\n\u003cp>\"I find that enormously offensive as a list,\" Dixon said. \"This is not health data. This is inferred data.\"\u003c/p>\n\u003cp>Data scientist Cathy O'Neil said drawing conclusions about health risks on such data could lead to a bias against some poor people. It would be easy to infer they are prone to costly illnesses based on their backgrounds and living conditions, said O'Neil, author of the book \u003cem>Weapons of Math Destruction,\u003c/em> which looked at how algorithms can increase inequality. That could lead to poor people being charged more, making it harder for them to get the care they need, she said. Employers, she said, could even decide not to hire people with data points that could indicate high medical costs in the future.\u003c/p>\n\u003cp>O'Neil said the companies should also measure how the scores might discriminate against the poor, sick or minorities.\u003c/p>\n\u003cp>American policymakers could do more to protect people's information, experts said. In the United States, companies can harvest personal data unless a specific law bans it, although California just passed legislation that could create restrictions, said William McGeveran, a professor at the University of Minnesota Law School. Europe, in contrast, passed a strict law called the \u003ca href=\"https://ec.europa.eu/info/law/law-topic/data-protection/reform/what-does-general-data-protection-regulation-gdpr-govern_en\" target=\"_blank\" rel=\"noopener\">General Data Protection Regulation\u003c/a>, which went into effect in May.\u003c/p>\n\u003cp>\"In Europe, data protection is a constitutional right,\" McGeveran said.\u003c/p>\n\u003cp>Pasquale, the University of Maryland law professor, said health scores should be treated like credit scores. Federal law gives people the right to know their credit scores and how they're calculated. If people are going to be rated by whether they listen to sad songs on Spotify or look up information about AIDS online, they should know, Pasquale said. \"The risk of improper use is extremely high,\" he said. \"And data scores are not properly vetted and validated and available for scrutiny.\"\u003c/p>\n\u003cp>\u003cstrong>A Creepy Walk Down Memory Lane \u003c/strong>\u003c/p>\n\u003cp>As I reported this story I wondered how the data vendors might be using my personal information to score my potential health costs. So, I filled out \u003ca href=\"https://personalreports.lexisnexis.com/access_your_full_file_disclosure.jsp\" target=\"_blank\" rel=\"noopener\">a request on the LexisNexis website\u003c/a> for the company to send me some of the personal information it has on me. A week later, a somewhat creepy, 182-page walk down memory lane arrived in the mail. Federal law only requires the company to provide a subset of the information it collected about me. So that's all I got.\u003c/p>\n\u003cp>LexisNexis had captured details about my life going back 25 years, many that I'd forgotten. It had my phone numbers going back decades and my home addresses going back to my childhood in Golden, Colo. Each location had a field to show whether the address was \"high risk.\" Mine were all blank. The company also collects records of any liens and criminal activity, which, thankfully, I didn't have.\u003c/p>\n\u003cp>My report was boring, which isn't a surprise. I've lived a middle-class life and grown up in good neighborhoods. But it made me wonder: What if I had lived in \"high-risk\" neighborhoods? Could that ever be used by insurers to jack up my rates — or to avoid me altogether?\u003c/p>\n\u003cp>I wanted to see more. If LexisNexis had health risk scores on me, I wanted to see how they were calculated and, more importantly, whether they were accurate. But the company told me that if it had calculated my scores it would have done so on behalf of its client, my insurance company. So, I couldn't have them.\u003c/p>\n\u003chr>\n\u003cp>\u003cem>ProPublica Senior Research Fellow Claire Perlman contributed to this story. \u003c/em>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>ProPublica is a nonprofit newsroom based in New York. Sign up to get ProPublica's \u003c/em>\u003ca href=\"https://go.propublica.org/bigstorynewsletter-20180717\" target=\"_blank\" rel=\"noopener\">Big Story newsletter\u003c/a>\u003cem> to receive stories like this one in your inbox as soon as they are published. \u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 ProPublica. To see more, visit \u003ca>ProPublica\u003c/a>.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Health+Insurers+Are+Vacuuming+Up+Details+About+You+%E2%80%94+And+It+Could+Raise+Your+Rates+&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"description": "Without scrutiny, insurers and data brokers are predicting your health costs based on public data about things like race, marital status, your TV consumption and even if you buy plus-size clothing.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>To an outsider, the fancy booths at a June health insurance industry gathering in San Diego, Calif., aren't very compelling: a handful of companies pitching \"lifestyle\" data and salespeople touting jargony phrases like \"social determinants of health.\"\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>But dig deeper and the implications of what they're selling might give many patients pause: a future in which everything you do — the things you buy, the food you eat, the time you spend watching TV — may help determine how much you pay for health insurance.\u003c/p>\n\u003cp>With little public scrutiny, the health insurance industry has joined forces with data brokers to vacuum up personal details about hundreds of millions of Americans, including, odds are, many readers of this story.\u003c/p>\n\u003cp>The companies are tracking your race, education level, TV habits, marital status, net worth. They're collecting what you post on social media, whether you're behind on your bills, what you order online. Then they feed this information into complicated computer algorithms that spit out predictions about how much your health care could cost them.\u003c/p>\n\u003cp>Are you a woman who recently changed your name? You could be newly married and have a pricey pregnancy pending. Or maybe you're stressed and anxious from a recent divorce. That, too, the computer models predict, may run up your medical bills.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Are you a woman who has purchased plus-size clothing? You're considered at risk of depression. Mental health care can be expensive.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Low-income and a minority? That means, the data brokers say, you are more likely to live in a dilapidated and dangerous neighborhood, increasing your health risks.\u003c/p>\n\u003cp>\"We sit on oceans of data,\" said Eric McCulley, director of strategic solutions for \u003ca href=\"https://risk.lexisnexis.com/insurance\" target=\"_blank\" rel=\"noopener\">LexisNexis Risk Solutions\u003c/a>, during a conversation at the data firm's booth. And he isn't apologetic about using it. \"The fact is, our data is in the public domain,\" he said. \"We didn't put it out there.\"\u003c/p>\n\u003cp>Insurers contend that they use the information to spot health issues in their clients — and flag them so they get services they need. And companies like LexisNexis say the data shouldn't be used to set prices. But as a research scientist from one company told me: \"I can't say it hasn't happened.\"\u003c/p>\n\u003cp>At a time when every week brings a new privacy scandal and worries abound about the misuse of personal information, patient advocates and privacy scholars say the insurance industry's data gathering runs counter to its touted, and federally required, allegiance to patients' medical privacy. The \u003ca href=\"https://www.hhs.gov/hipaa/for-individuals/guidance-materials-for-consumers/index.html\" target=\"_blank\" rel=\"noopener\">Health Insurance Portability and Accountability Act\u003c/a>, or HIPAA, only protects medical information.\u003c/p>\n\u003cp>\"We have a health privacy machine that's in crisis,\" said Frank Pasquale, a professor at the University of Maryland Carey School of Law who specializes in issues related to machine learning and algorithms. \"We have a law that only covers one source of health information. They are rapidly developing another source.\"\u003c/p>\n\u003cp>Patient advocates warn that using unverified, error-prone \"lifestyle\" data to make medical assumptions could lead insurers to improperly price plans — for instance, raising rates based on false information — or discriminate against anyone tagged as high cost. And, they say, the use of the data raises thorny questions that should be debated publicly, such as: Should a person's rates be raised because algorithms say they are more likely to run up medical bills? Such questions would be moot in Europe, where a strict law took effect in May that bans trading in personal data.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>This year, \u003ca href=\"https://www.propublica.org/series/the-health-insurance-hustle\" target=\"_blank\" rel=\"noopener\">ProPublica and NPR are investigating\u003c/a> the various tactics the health insurance industry uses to maximize its profits. Understanding these strategies is important because patients — through taxes, cash payments and insurance premiums — are the ones funding the entire health care system. Yet the industry's bewildering web of strategies and inside deals often has little to do with patients' needs. As the series' \u003ca href=\"https://www.propublica.org/article/why-your-health-insurer-does-not-care-about-your-big-bills\" target=\"_blank\" rel=\"noopener\">first story\u003c/a> showed, contrary to popular belief, lower bills aren't health insurers' top priority.\u003c/p>\n\u003cp>Inside the San Diego Convention Center, there were few qualms about the way insurance companies were mining Americans' lives for information — or what they planned to do with the data.\u003c/p>\n\u003cp>\u003cstrong>Linking Health Costs to Personal Data\u003c/strong>\u003c/p>\n\u003cp>The sprawling convention center was a balmy draw for one of America's Health Insurance Plans' marquee gatherings. Insurance executives and managers wandered through the exhibit hall, sampling chocolate-covered strawberries, champagne and other delectables designed to encourage deal-making.\u003c/p>\n\u003cp>Up front, the prime real estate belonged to the big guns in health data: The booths of Optum, IBM Watson Health and LexisNexis stretched toward the ceiling, with flat-screen monitors and some comfy seating. (NPR collaborates with IBM Watson Health on national polls about consumer health topics.)\u003c/p>\n\u003cp>To understand the scope of what they were offering, consider Optum. The company, owned by the massive UnitedHealth Group, has collected the medical diagnoses, tests, prescriptions, costs and socioeconomic data of 150 million Americans going back to 1993, according to its marketing materials.(UnitedHealth Group provides financial support to NPR.)\u003c/p>\n\u003cp>The company says it uses the information to link patients' medical outcomes and costs to details like their level of education, net worth, family structure and race. An Optum spokesman said the socioeconomic data is de-identified and is not used for pricing health plans.\u003c/p>\n\u003cp>Optum's marketing materials also boast that it now has access to even more. In 2016, the company filed a patent application to gather what people share on platforms like Facebook and Twitter, and to link this material to the person's clinical and payment information. A company spokesman said in an email that the patent application never went anywhere. But the company's current marketing materials say it combines claims and clinical information with social media interactions.\u003c/p>\n\u003cp>I had a lot of questions about this and first reached out to Optum in May, but the company didn't connect me with any of its experts as promised. At the conference, Optum salespeople said they weren't allowed to talk to me about how the company uses this information.\u003c/p>\n\u003cp>It isn't hard to understand the appeal of all this data to insurers. Merging information from data brokers with people's clinical and payment records is a no-brainer if you overlook potential patient concerns. Electronic medical records now make it easy for insurers to analyze massive amounts of information and combine it with the personal details scooped up by data brokers.\u003c/p>\n\u003cp>It also makes sense given the shifts in how providers are getting paid. Doctors and hospitals have typically been paid based on the quantity of care they provide. But the industry is moving toward paying them in lump sums for caring for a patient, or for an event, like a knee surgery. In those cases, the medical providers can profit more when patients stay healthy. More money at stake means more interest in the social factors that might affect a patient's health.\u003c/p>\n\u003cp>Some insurance companies are already using socioeconomic data to help patients get appropriate care, such as programs to help patients with chronic diseases stay healthy. Studies show social and economic aspects of people's lives play an important role in their health. Knowing these personal details can help them identify those who may need help paying for medication or help getting to the doctor.\u003c/p>\n\u003cp>But patient advocates are skeptical that health insurers have altruistic designs on people's personal information.\u003c/p>\n\u003cp>The industry has a history of boosting profits by signing up healthy people and finding ways to avoid sick people — called \"cherry-picking\" and \"lemon-dropping,\" experts say.\u003c/p>\n\u003cp>Among the classic examples: A company was accused of putting its enrollment office on the third floor of a building without an elevator, so only healthy patients could make the trek to sign up. Another tried to appeal to spry seniors by holding square dances.\u003c/p>\n\u003cp>The Affordable Care Act prohibits insurers from denying people coverage based on pre-existing health conditions or charging sick people more for individual or small group plans. But experts said patients' personal information could still be used for marketing, and to assess risks and determine the prices of certain plans. And the Trump administration is promoting short-term health plans, which do allow insurers to deny coverage to sick patients.\u003c/p>\n\u003cp>Robert Greenwald, faculty director of Harvard Law School's Center for Health Law and Policy Innovation, said insurance companies still cherry-pick, but now they're subtler. The center analyzes health insurance plans to see if they discriminate. He said insurers will do things like failing to include enough information about which drugs a plan covers, which pushes sick people who need specific medications elsewhere. Or they may change the things a plan covers, or how much a patient has to pay for a type of care, after a patient has enrolled. Or, Greenwald added, they might exclude or limit certain types of providers from their networks — like those who have skill caring for patients with HIV or hepatitis C.\u003c/p>\n\u003cp>If there were concerns that personal data might be used to cherry-pick or lemon-drop, they weren't raised at the conference.\u003c/p>\n\u003cp>At the IBM Watson Health booth, Kevin Ruane, a senior consulting scientist, told me that the company surveys 80,000 Americans a year to assess lifestyle, attitudes and behaviors that could relate to health care. Participants are asked whether they trust their doctor, have financial problems, go online, or own a Fitbit and similar questions. The responses of hundreds of adjacent households are analyzed together to identify social and economic factors for an area.\u003c/p>\n\u003cp>Ruane said he has used IBM Watson Health's socioeconomic analysis to help insurance companies assess a potential market. The ACA increased the value of such assessments, experts say, because companies often don't know the medical history of people seeking coverage. A region with too many sick people, or with patients who don't take care of themselves, might not be worth the risk.\u003c/p>\n\u003cp>Ruane acknowledged that the information his company gathers may not be accurate for every person. \"We talk to our clients and tell them to be careful about this,\" he said. \"Use it as a data insight. But it's not necessarily a fact.\"\u003c/p>\n\u003cp>In a separate conversation, a salesman from a different company joked about the potential for error. \"God forbid you live on the wrong street these days,\" he said. \"You're going to get lumped in with a lot of bad things.\"\u003c/p>\n\u003cp>The LexisNexis booth was emblazoned with the slogan \"Data. Insight. Action.\" The company said it uses 442 nonmedical personal attributes to predict a person's medical costs. Its cache includes more than 78 billion records from more than 10,000 public and proprietary sources, including people's cellphone numbers, criminal records, bankruptcies, property records, neighborhood safety and more. The information is used to predict patients' health risks and costs in eight areas, including how often they are likely to visit emergency rooms, their total cost, their pharmacy costs, their motivation to stay healthy and their stress levels.\u003c/p>\n\u003cp>People who downsize their homes tend to have higher health care costs, the company says. As do those whose parents didn't finish high school. Patients who own more valuable homes are less likely to land back in the hospital within 30 days of their discharge. The company says it has validated its scores against insurance claims and clinical data. But it won't share its methods and hasn't published the work in peer-reviewed journals.\u003c/p>\n\u003cp>McCulley, LexisNexis' director of strategic solutions, said predictions made by the algorithms about patients are based on the combination of the personal attributes. He gave a hypothetical example: A high school dropout who had a recent income loss and doesn't have a relative nearby might have higher-than-expected health costs.\u003c/p>\n\u003cp>But couldn't that same type of person be healthy?\u003c/p>\n\u003cp>\"Sure,\" McCulley said, with no apparent dismay at the possibility that the predictions could be wrong.\u003c/p>\n\u003cp>McCulley and others at LexisNexis insist the scores are only used to help patients get the care they need and not to determine how much someone would pay for their health insurance. The company cited three different federal laws that restricted them and their clients from using the scores in that way. But privacy experts said none of the laws cited by the company bar the practice. The company backed off the assertions when I pointed that the laws did not seem to apply.\u003c/p>\n\u003cp>LexisNexis officials also said the company's contracts expressly prohibit using the analysis to help price insurance plans. They would not provide a contract. But I knew that in at least one instance a company was already testing whether the scores could be used as a pricing tool.\u003c/p>\n\u003cp>Before the conference, I'd seen a press release announcing that the largest health actuarial firm in the world, Milliman, was now using the LexisNexis scores.\u003c/p>\n\u003cp>I tracked down Marcos Dachary, who works in business development for Milliman. Actuaries calculate health care risks and help set the price of premiums for insurers. I asked Dachary if Milliman was using the LexisNexis scores to price health plans and he said: \"There could be an opportunity.\"\u003c/p>\n\u003cp>The scores could allow an insurance company to assess the risks posed by individual patients and make adjustments to protect themselves from losses, he said. For example, he said, the company could raise premiums or revise contracts with providers.\u003c/p>\n\u003cp>It's too early to tell whether the LexisNexis scores will actually be useful for pricing, he said. But he was excited about the possibilities. \"One thing about social determinants data – it piques your mind,\" he said.\u003c/p>\n\u003cp>Dachary acknowledged the scores could also be used to discriminate. Others, he said, have raised that concern. As much as there could be positive potential, he said, \"there could also be negative potential.\"\u003c/p>\n\u003cp>\u003cstrong>Erroneous Inferences From Group Data\u003c/strong>\u003c/p>\n\u003cp>It's that negative potential that still bothers data analyst Erin Kaufman, who left the health insurance industry in January. The 35-year-old from Atlanta had earned her doctorate in public health because she wanted to help people, but one day at Aetna, her boss told her to work with a new data set.\u003c/p>\n\u003cp>To her surprise, the company had obtained personal information from a data broker on millions of Americans. The data contained each person's habits and hobbies, like whether they owned a gun, and if so, what type, she said. It included whether they had magazine subscriptions, liked to ride bikes or run marathons. It had hundreds of personal details about each person.\u003c/p>\n\u003cp>The Aetna data team merged the data with the information it had on patients it insured. The goal was to see how people's personal interests and hobbies might relate to their health care costs.\u003c/p>\n\u003cp>But Kaufman said it felt wrong: The information about the people who knitted or crocheted made her think of her grandmother. And the details about individuals who liked camping made her think of herself. What business did the insurance company have looking at this information? \"It was a data set that really dug into our clients' lives,\" she said. \"No one gave anyone permission to do this.\"\u003c/p>\n\u003cp>\u003ca href=\"https://www.documentcloud.org/documents/4600083-Aetna-Statement.html\">In a statement\u003c/a>, Aetna said it uses consumer marketing information to supplement its claims and clinical information. The combined data helps predict the risk of repeat emergency room visits or hospital admissions. The information is used to reach out to members and help them and plays no role in pricing plans or underwriting, the statement said.\u003c/p>\n\u003cp>Kaufman said she had concerns about the accuracy of drawing inferences about an individual's health from an analysis of a group of people with similar traits. Health scores generated from arrest records, homeownership and similar material may be wrong, she said.\u003c/p>\n\u003cp>Pam Dixon, executive director of the World Privacy Forum, a nonprofit that advocates for privacy in the digital age, shares Kaufman's concerns. She points to a study by the analytics company SAS, which worked in 2012 with an unnamed major health insurance company to predict a person's health care costs using 1,500 data elements, including the investments and types of cars people owned.\u003c/p>\n\u003cp>The SAS study said higher health care costs could be predicted by looking at things like ethnicity, watching TV and mail-order purchases.\u003c/p>\n\u003cp>\"I find that enormously offensive as a list,\" Dixon said. \"This is not health data. This is inferred data.\"\u003c/p>\n\u003cp>Data scientist Cathy O'Neil said drawing conclusions about health risks on such data could lead to a bias against some poor people. It would be easy to infer they are prone to costly illnesses based on their backgrounds and living conditions, said O'Neil, author of the book \u003cem>Weapons of Math Destruction,\u003c/em> which looked at how algorithms can increase inequality. That could lead to poor people being charged more, making it harder for them to get the care they need, she said. Employers, she said, could even decide not to hire people with data points that could indicate high medical costs in the future.\u003c/p>\n\u003cp>O'Neil said the companies should also measure how the scores might discriminate against the poor, sick or minorities.\u003c/p>\n\u003cp>American policymakers could do more to protect people's information, experts said. In the United States, companies can harvest personal data unless a specific law bans it, although California just passed legislation that could create restrictions, said William McGeveran, a professor at the University of Minnesota Law School. Europe, in contrast, passed a strict law called the \u003ca href=\"https://ec.europa.eu/info/law/law-topic/data-protection/reform/what-does-general-data-protection-regulation-gdpr-govern_en\" target=\"_blank\" rel=\"noopener\">General Data Protection Regulation\u003c/a>, which went into effect in May.\u003c/p>\n\u003cp>\"In Europe, data protection is a constitutional right,\" McGeveran said.\u003c/p>\n\u003cp>Pasquale, the University of Maryland law professor, said health scores should be treated like credit scores. Federal law gives people the right to know their credit scores and how they're calculated. If people are going to be rated by whether they listen to sad songs on Spotify or look up information about AIDS online, they should know, Pasquale said. \"The risk of improper use is extremely high,\" he said. \"And data scores are not properly vetted and validated and available for scrutiny.\"\u003c/p>\n\u003cp>\u003cstrong>A Creepy Walk Down Memory Lane \u003c/strong>\u003c/p>\n\u003cp>As I reported this story I wondered how the data vendors might be using my personal information to score my potential health costs. So, I filled out \u003ca href=\"https://personalreports.lexisnexis.com/access_your_full_file_disclosure.jsp\" target=\"_blank\" rel=\"noopener\">a request on the LexisNexis website\u003c/a> for the company to send me some of the personal information it has on me. A week later, a somewhat creepy, 182-page walk down memory lane arrived in the mail. Federal law only requires the company to provide a subset of the information it collected about me. So that's all I got.\u003c/p>\n\u003cp>LexisNexis had captured details about my life going back 25 years, many that I'd forgotten. It had my phone numbers going back decades and my home addresses going back to my childhood in Golden, Colo. Each location had a field to show whether the address was \"high risk.\" Mine were all blank. The company also collects records of any liens and criminal activity, which, thankfully, I didn't have.\u003c/p>\n\u003cp>My report was boring, which isn't a surprise. I've lived a middle-class life and grown up in good neighborhoods. But it made me wonder: What if I had lived in \"high-risk\" neighborhoods? Could that ever be used by insurers to jack up my rates — or to avoid me altogether?\u003c/p>\n\u003cp>I wanted to see more. If LexisNexis had health risk scores on me, I wanted to see how they were calculated and, more importantly, whether they were accurate. But the company told me that if it had calculated my scores it would have done so on behalf of its client, my insurance company. So, I couldn't have them.\u003c/p>\n\u003chr>\n\u003cp>\u003cem>ProPublica Senior Research Fellow Claire Perlman contributed to this story. \u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>ProPublica is a nonprofit newsroom based in New York. Sign up to get ProPublica's \u003c/em>\u003ca href=\"https://go.propublica.org/bigstorynewsletter-20180717\" target=\"_blank\" rel=\"noopener\">Big Story newsletter\u003c/a>\u003cem> to receive stories like this one in your inbox as soon as they are published. \u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 ProPublica. To see more, visit \u003ca>ProPublica\u003c/a>.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Health+Insurers+Are+Vacuuming+Up+Details+About+You+%E2%80%94+And+It+Could+Raise+Your+Rates+&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Physicists Go Small: Let's Put A Particle Accelerator On A Chip",
"title": "Physicists Go Small: Let's Put A Particle Accelerator On A Chip",
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"content": "\u003cp>When people think of particle accelerators, they tend to think of giant structures: tunnels many miles long that electrons and protons race through at tremendous speeds, packing enormous energy.\u003c/p>\n\u003cp>But scientists in California think small is beautiful. They want to build an accelerator on semiconductor chips. An accelerator built that way won't achieve the energy of its much larger cousins, but it could accelerate material research and revolutionize medical therapy.\u003c/p>\n\u003cp>First of all, what is an accelerator?\u003c/p>\n\u003cp>\"An accelerator is a way to add energy to particles,\" says \u003ca href=\"https://web.stanford.edu/~rlbyer/\" target=\"_blank\" rel=\"noopener\">Robert Byer\u003c/a>, a physicist at Stanford University. Once you have those energetic particles, you can do things with them, like irradiate tumors or generate X-rays that scientists use to investigate new materials. An accelerator built this way would bring an accelerator's usefulness within the reach of more researchers.\u003c/p>\n\u003cp>Byer has been trying to shrink the size of particle accelerators for more than 40 years. His idea is to use lasers to add energy to electrons as they zip through a tiny channel in a semiconductor chip. Byer says this is a miniaturized version of what goes on in larger accelerators, but there are big challenges to doing this on such a small scale.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"We need to focus the electrons,\" Byer says. \"We need to bunch them so they surf the wavelength of light right at the crest, so they get the maximum acceleration.\"\u003c/p>\n\u003cp>Byer and his colleagues are working on those challenges in a laboratory in the basement of the Spilker Engineering and Applied Sciences building on the Stanford campus. Byer took me on a tour there.\u003c/p>\n\u003cp>We put on glasses to protect our eyes from the powerful laser light used in the pint-sized accelerator.\u003c/p>\n\u003cp>A big red emergency shut-off button attached to a shelf suggests this is not equipment to trifle with.\u003c/p>\n\u003cp>\u003ca href=\"https://www.laserphysics.nat.fau.eu/person/peter-hommelhoff/\" target=\"_blank\" rel=\"noopener\">Peter Hommelhoff\u003c/a> of the Friedrich-Alexander-Universität Erlangen-Nürnberg in Germany says one of the big challenges is to keep the electrons in the accelerator traveling where you want them to.\u003c/p>\n\u003cp>\"The acceleration channel is very narrow, so you have to generate a very, very narrow electron beam that you can send through the channel,\" Hommelhoff says.\u003c/p>\n\u003cp>\"It's a little like threading an invisible needle,\" says Dylan Black, a Stanford graduate student in physics.\u003c/p>\n\u003cp>Testing their accelerator requires lasers and lenses and pumps scattered around benches in the lab, it takes up a fair amount of space. But this is just a prototype.\u003c/p>\n\u003cp>Black points to a bright circle of light on a monitor's screen.\u003c/p>\n\u003cp>\"That there is a picture of what the electron beam would look like if you put your eye right in front of the beam,\" Black says.\u003c/p>\n\u003cp>\"Which I would not recommend,\" interjects Ken Leedle, a research engineer working on the accelerator-on-a-chip project.\u003c/p>\n\u003cp>I asked \u003ca href=\"https://portal.slac.stanford.edu/sites/ard_public/people/joen/Pages/default.aspx\" target=\"_blank\" rel=\"noopener\">R. Joel England\u003c/a>, a physicist at the SLAC National Accelerator Laboratory who has been working on the accelerator-on-a-chip project, how long it will be before the prototype turns into a working instrument.\u003c/p>\n\u003cp>\"Depending on how much progress gets made, I would say five to 10 years,\" England says. England is enthusiastic about the promise of these small-scale accelerators.\u003c/p>\n\u003cp>\"One of the applications could be to take one of the fairly bulky, 10,000-pound accelerator devices that's used in hospitals for radiation therapy and make that into something that's chip-sized,\" he says.\u003c/p>\n\u003cp>In addition to saving huge costs and space, it might eventually be possible to insert a chip-sized accelerator into a patient's body, where it could directly irradiate a tumor.\u003c/p>\n\u003cp>Even though it may take a decade or more, Robert Byer is convinced smaller accelerators will become a reality. His isn't the only lab working on the idea. And besides, he points out, new technologies often start out bulky. Take the first laser to come on the scene.\u003c/p>\n\u003cp>\"Early on, lasers were big — and they were inefficient and they took all the power and water in your building to operate them,\" Byer says. \"They got more and more efficient because we converted to semiconductor lasers and solid state lasers — and all of a sudden, lasers then became everywhere.\"\u003c/p>\n\u003cp>Even new mobile phones have lasers in them, Byer says.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The day of the accelerator on a chip, he believes, is coming.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Physicists+Go+Small%3A+Let%27s+Put+A+Particle+Accelerator+On+A+Chip&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>When people think of particle accelerators, they tend to think of giant structures: tunnels many miles long that electrons and protons race through at tremendous speeds, packing enormous energy.\u003c/p>\n\u003cp>But scientists in California think small is beautiful. They want to build an accelerator on semiconductor chips. An accelerator built that way won't achieve the energy of its much larger cousins, but it could accelerate material research and revolutionize medical therapy.\u003c/p>\n\u003cp>First of all, what is an accelerator?\u003c/p>\n\u003cp>\"An accelerator is a way to add energy to particles,\" says \u003ca href=\"https://web.stanford.edu/~rlbyer/\" target=\"_blank\" rel=\"noopener\">Robert Byer\u003c/a>, a physicist at Stanford University. Once you have those energetic particles, you can do things with them, like irradiate tumors or generate X-rays that scientists use to investigate new materials. An accelerator built this way would bring an accelerator's usefulness within the reach of more researchers.\u003c/p>\n\u003cp>Byer has been trying to shrink the size of particle accelerators for more than 40 years. His idea is to use lasers to add energy to electrons as they zip through a tiny channel in a semiconductor chip. Byer says this is a miniaturized version of what goes on in larger accelerators, but there are big challenges to doing this on such a small scale.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"We need to focus the electrons,\" Byer says. \"We need to bunch them so they surf the wavelength of light right at the crest, so they get the maximum acceleration.\"\u003c/p>\n\u003cp>Byer and his colleagues are working on those challenges in a laboratory in the basement of the Spilker Engineering and Applied Sciences building on the Stanford campus. Byer took me on a tour there.\u003c/p>\n\u003cp>We put on glasses to protect our eyes from the powerful laser light used in the pint-sized accelerator.\u003c/p>\n\u003cp>A big red emergency shut-off button attached to a shelf suggests this is not equipment to trifle with.\u003c/p>\n\u003cp>\u003ca href=\"https://www.laserphysics.nat.fau.eu/person/peter-hommelhoff/\" target=\"_blank\" rel=\"noopener\">Peter Hommelhoff\u003c/a> of the Friedrich-Alexander-Universität Erlangen-Nürnberg in Germany says one of the big challenges is to keep the electrons in the accelerator traveling where you want them to.\u003c/p>\n\u003cp>\"The acceleration channel is very narrow, so you have to generate a very, very narrow electron beam that you can send through the channel,\" Hommelhoff says.\u003c/p>\n\u003cp>\"It's a little like threading an invisible needle,\" says Dylan Black, a Stanford graduate student in physics.\u003c/p>\n\u003cp>Testing their accelerator requires lasers and lenses and pumps scattered around benches in the lab, it takes up a fair amount of space. But this is just a prototype.\u003c/p>\n\u003cp>Black points to a bright circle of light on a monitor's screen.\u003c/p>\n\u003cp>\"That there is a picture of what the electron beam would look like if you put your eye right in front of the beam,\" Black says.\u003c/p>\n\u003cp>\"Which I would not recommend,\" interjects Ken Leedle, a research engineer working on the accelerator-on-a-chip project.\u003c/p>\n\u003cp>I asked \u003ca href=\"https://portal.slac.stanford.edu/sites/ard_public/people/joen/Pages/default.aspx\" target=\"_blank\" rel=\"noopener\">R. Joel England\u003c/a>, a physicist at the SLAC National Accelerator Laboratory who has been working on the accelerator-on-a-chip project, how long it will be before the prototype turns into a working instrument.\u003c/p>\n\u003cp>\"Depending on how much progress gets made, I would say five to 10 years,\" England says. England is enthusiastic about the promise of these small-scale accelerators.\u003c/p>\n\u003cp>\"One of the applications could be to take one of the fairly bulky, 10,000-pound accelerator devices that's used in hospitals for radiation therapy and make that into something that's chip-sized,\" he says.\u003c/p>\n\u003cp>In addition to saving huge costs and space, it might eventually be possible to insert a chip-sized accelerator into a patient's body, where it could directly irradiate a tumor.\u003c/p>\n\u003cp>Even though it may take a decade or more, Robert Byer is convinced smaller accelerators will become a reality. His isn't the only lab working on the idea. And besides, he points out, new technologies often start out bulky. Take the first laser to come on the scene.\u003c/p>\n\u003cp>\"Early on, lasers were big — and they were inefficient and they took all the power and water in your building to operate them,\" Byer says. \"They got more and more efficient because we converted to semiconductor lasers and solid state lasers — and all of a sudden, lasers then became everywhere.\"\u003c/p>\n\u003cp>Even new mobile phones have lasers in them, Byer says.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The day of the accelerator on a chip, he believes, is coming.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Physicists+Go+Small%3A+Let%27s+Put+A+Particle+Accelerator+On+A+Chip&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>CTE has been part of the national lexicon in the U.S. since the 2015 movie \u003cem>\u003ca href=\"http://www.sonypictures.com/movies/concussion/\" target=\"_blank\" rel=\"noopener\">Concussion\u003c/a> \u003c/em>dramatized the discovery of this degenerative brain disease among football players.[contextly_sidebar id=”ehLMKdjS8P8l8PM67KnXRoh4cZnjRNoD”]\u003c/p>\n\u003cp>\u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2945234/\" target=\"_blank\" rel=\"noopener\">Chronic traumatic encephalopathy\u003c/a> is found among people who’ve had head injuries. Though not everyone with head trauma develops CTE, the group that’s come to be most associated with it is football players, whose brains can be routinely jarred by hard hits. The disease has been linked to depression, dementia and even suicide among those who play the game.\u003c/p>\n\u003cp>But the \u003cem>Journal of Alzheimer’s Disease\u003c/em> published a study Tuesday that helps broaden the understanding of who is potentially affected by CTE to include \u003ca href=\"https://www.npr.org/sections/health-shots/2017/04/05/522613294/do-u-s-troops-risk-brain-injury-when-they-fire-heavy-weapons\" target=\"_blank\" rel=\"noopener\">military personnel\u003c/a>. And, perhaps more significantly, the study represents a step forward in developing a test for the disease in the living.\u003c/p>\n\u003cp>Right now, accurately diagnosing CTE requires the close study of brain tissue during autopsy, to identify the telltale abnormal proteins that kill brain cells. And this is a key reason why knowledge about CTE — who gets it, how widespread it is and the development of treatments — has lagged.\u003c/p>\n\u003cp>“You’ve really got to have a living diagnosis scan in order to make much headway on understanding the disease,” says \u003ca href=\"http://www.protectthebrain.org/Our-Team.aspx\" target=\"_blank\" rel=\"noopener\">Dr. Julian Bailes\u003c/a>, a neurosurgeon at the Chicago area’s NorthShore University HealthSystem, and one of the study’s authors.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>That diagnostic scan is what researchers have gotten close to in this case.\u003c/p>\n\u003cp>\u003cstrong>A Comparison of Brains\u003c/strong>\u003c/p>\n\u003cp>The small study involved seven military personnel — five veterans and two active duty — who’d had brain injuries and experienced CTE-type symptoms, such as memory loss and mood swings. They were injected with what’s called a molecular tracer — in this case the shorthand name is FDDNP. The FDDNP tracer, which is radioactive, binds with the abnormal proteins in the brain and then appears in neural PET scans.[contextly_sidebar id=”Ndl9rWapqUS4IcPfG65Xr4EsLQn8p0vR”]\u003c/p>\n\u003cp>“The PET scanner functions a bit like a Geiger counter, which measures radioactivity,” says the study’s lead researcher, \u003ca href=\"http://www.bri.ucla.edu/people/gary-w-small-md\" target=\"_blank\" rel=\"noopener\">Dr. Gary Small\u003c/a>, a professor of geriatric psychiatry and biobehavioral sciences at UCLA’s David Geffen School of Medicine. (Small is a co-inventor of the FDDNP marker; he and some other researchers in the project have disclosed a financial interest in Taumark LLC, a company licensed by UCLA to develop the tracer.)\u003c/p>\n\u003cp>Small’s team compared the scans with those of a number of other people: Fifteen retired football players who had suffered brain injuries and exhibited CTE symptoms; two dozen people who had Alzheimer’s dementia and 28 healthy “control” subjects who were cognitively intact.\u003c/p>\n\u003cp>The results: The scans of the military personel showed patterns similar to the retired football players and different from the Alzheimer’s patients and control subjects.\u003c/p>\n\u003cp>And, it should be noted, the former players — all of them professionals who’d played in the NFL — had brain scans consistent with those of people who had died and had autopsies that \u003cem>confirmed\u003c/em> CTE.\u003c/p>\n\u003cp>\u003cstrong>Not Just a Problem for Athletes, Soldiers\u003c/strong>\u003c/p>\n\u003cp>Small says the study paves the way for deeper investigation of CTE’s brain changes.\u003c/p>\n\u003cp>“It could help us not just with people who’ve had head trauma from sports,” he says, “but also from other forms of injury, such as blast injury in the military.” \u003ca href=\"https://www.npr.org/sections/health-shots/2018/05/30/613779769/domestic-violence-s-untold-damage-concussion-and-brain-injury\" target=\"_blank\" rel=\"noopener\">Survivors of domestic violence\u003c/a> are another group believed to be vulnerable to CTE.[contextly_sidebar id=”1oVFhsMiBXNwtZ6trkQG3xEAzXq6oKRy”]\u003c/p>\n\u003cp>Small is quick to caution that the study isn’t definitive.\u003c/p>\n\u003cp>“There are several limitations,” he says. “One is [the small] sample size. Another is that we don’t have a control group of individuals who’ve been subjected to the same degree of head trauma, but are asymptomatic. … And what does that tell us? There may be something else we’re completely unaware of that’s driving the disease.”\u003c/p>\n\u003cp>A reliable test for CTE in living people is still at least a few years away, he estimates. But there already are plans for more research.\u003c/p>\n\u003cp>“We’re still within the scientific process of trying to figure out where this test lands on the scale of being definitive,” Bailes says. The researchers still need to determine “how it correlates with the changes actually seen in the brain when people die,” he explains. “It’s not definitive yet but this paper in a military setting is another piece of the puzzle, we think.”\u003c/p>\n\u003cp>A potentially pivotal piece of the puzzle.\u003c/p>\n\u003cp>“If you can’t diagnose a disease when someone’s alive,” says Bailes, “you really can’t help them. And you really don’t know, in a new and emerging and not completely understood situation like CTE. You don’t know the prevalence of it. You don’t know exactly who gets it and why. You don’t know how it evolves or changes over time and if there’s ever a potential for treatment.”\u003c/p>\n\u003cp>As another football season approaches, CTE will again be a lingering issue. And in some instances, it will be portrayed by some as it has in the past few years — as an “epidemic,” threatening the game’s future.\u003c/p>\n\u003cp>Which Bailes says is wrong.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“I don’t think it’s an epidemic,” he says, “but whatever the number is, is important. And you have to have living diagnosis in order to be able to tell that.”\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg decoding=\"async\" src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Scientists+Hunt+For+A+Test+To+Diagnose+Chronic+Brain+Injury+In+Living+People&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>CTE has been part of the national lexicon in the U.S. since the 2015 movie \u003cem>\u003ca href=\"http://www.sonypictures.com/movies/concussion/\" target=\"_blank\" rel=\"noopener\">Concussion\u003c/a> \u003c/em>dramatized the discovery of this degenerative brain disease among football players.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2945234/\" target=\"_blank\" rel=\"noopener\">Chronic traumatic encephalopathy\u003c/a> is found among people who’ve had head injuries. Though not everyone with head trauma develops CTE, the group that’s come to be most associated with it is football players, whose brains can be routinely jarred by hard hits. The disease has been linked to depression, dementia and even suicide among those who play the game.\u003c/p>\n\u003cp>But the \u003cem>Journal of Alzheimer’s Disease\u003c/em> published a study Tuesday that helps broaden the understanding of who is potentially affected by CTE to include \u003ca href=\"https://www.npr.org/sections/health-shots/2017/04/05/522613294/do-u-s-troops-risk-brain-injury-when-they-fire-heavy-weapons\" target=\"_blank\" rel=\"noopener\">military personnel\u003c/a>. And, perhaps more significantly, the study represents a step forward in developing a test for the disease in the living.\u003c/p>\n\u003cp>Right now, accurately diagnosing CTE requires the close study of brain tissue during autopsy, to identify the telltale abnormal proteins that kill brain cells. And this is a key reason why knowledge about CTE — who gets it, how widespread it is and the development of treatments — has lagged.\u003c/p>\n\u003cp>“You’ve really got to have a living diagnosis scan in order to make much headway on understanding the disease,” says \u003ca href=\"http://www.protectthebrain.org/Our-Team.aspx\" target=\"_blank\" rel=\"noopener\">Dr. Julian Bailes\u003c/a>, a neurosurgeon at the Chicago area’s NorthShore University HealthSystem, and one of the study’s authors.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>That diagnostic scan is what researchers have gotten close to in this case.\u003c/p>\n\u003cp>\u003cstrong>A Comparison of Brains\u003c/strong>\u003c/p>\n\u003cp>The small study involved seven military personnel — five veterans and two active duty — who’d had brain injuries and experienced CTE-type symptoms, such as memory loss and mood swings. They were injected with what’s called a molecular tracer — in this case the shorthand name is FDDNP. The FDDNP tracer, which is radioactive, binds with the abnormal proteins in the brain and then appears in neural PET scans.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>“The PET scanner functions a bit like a Geiger counter, which measures radioactivity,” says the study’s lead researcher, \u003ca href=\"http://www.bri.ucla.edu/people/gary-w-small-md\" target=\"_blank\" rel=\"noopener\">Dr. Gary Small\u003c/a>, a professor of geriatric psychiatry and biobehavioral sciences at UCLA’s David Geffen School of Medicine. (Small is a co-inventor of the FDDNP marker; he and some other researchers in the project have disclosed a financial interest in Taumark LLC, a company licensed by UCLA to develop the tracer.)\u003c/p>\n\u003cp>Small’s team compared the scans with those of a number of other people: Fifteen retired football players who had suffered brain injuries and exhibited CTE symptoms; two dozen people who had Alzheimer’s dementia and 28 healthy “control” subjects who were cognitively intact.\u003c/p>\n\u003cp>The results: The scans of the military personel showed patterns similar to the retired football players and different from the Alzheimer’s patients and control subjects.\u003c/p>\n\u003cp>And, it should be noted, the former players — all of them professionals who’d played in the NFL — had brain scans consistent with those of people who had died and had autopsies that \u003cem>confirmed\u003c/em> CTE.\u003c/p>\n\u003cp>\u003cstrong>Not Just a Problem for Athletes, Soldiers\u003c/strong>\u003c/p>\n\u003cp>Small says the study paves the way for deeper investigation of CTE’s brain changes.\u003c/p>\n\u003cp>“It could help us not just with people who’ve had head trauma from sports,” he says, “but also from other forms of injury, such as blast injury in the military.” \u003ca href=\"https://www.npr.org/sections/health-shots/2018/05/30/613779769/domestic-violence-s-untold-damage-concussion-and-brain-injury\" target=\"_blank\" rel=\"noopener\">Survivors of domestic violence\u003c/a> are another group believed to be vulnerable to CTE.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Small is quick to caution that the study isn’t definitive.\u003c/p>\n\u003cp>“There are several limitations,” he says. “One is [the small] sample size. Another is that we don’t have a control group of individuals who’ve been subjected to the same degree of head trauma, but are asymptomatic. … And what does that tell us? There may be something else we’re completely unaware of that’s driving the disease.”\u003c/p>\n\u003cp>A reliable test for CTE in living people is still at least a few years away, he estimates. But there already are plans for more research.\u003c/p>\n\u003cp>“We’re still within the scientific process of trying to figure out where this test lands on the scale of being definitive,” Bailes says. The researchers still need to determine “how it correlates with the changes actually seen in the brain when people die,” he explains. “It’s not definitive yet but this paper in a military setting is another piece of the puzzle, we think.”\u003c/p>\n\u003cp>A potentially pivotal piece of the puzzle.\u003c/p>\n\u003cp>“If you can’t diagnose a disease when someone’s alive,” says Bailes, “you really can’t help them. And you really don’t know, in a new and emerging and not completely understood situation like CTE. You don’t know the prevalence of it. You don’t know exactly who gets it and why. You don’t know how it evolves or changes over time and if there’s ever a potential for treatment.”\u003c/p>\n\u003cp>As another football season approaches, CTE will again be a lingering issue. And in some instances, it will be portrayed by some as it has in the past few years — as an “epidemic,” threatening the game’s future.\u003c/p>\n\u003cp>Which Bailes says is wrong.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“I don’t think it’s an epidemic,” he says, “but whatever the number is, is important. And you have to have living diagnosis in order to be able to tell that.”\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg decoding=\"async\" src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Scientists+Hunt+For+A+Test+To+Diagnose+Chronic+Brain+Injury+In+Living+People&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Insurers And Government Are Slow To Cover Expensive CAR-T Cancer Therapy",
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"content": "\u003cp>Patients whose blood cancers have failed to respond to repeated rounds of chemotherapy may be candidates for a new type of gene therapy that could send their cancers into remission for years. But the two approved therapies, with price tags of hundreds of thousands of dollars, have roiled the insurance approval process, leading to delays and, in some cases, denials of coverage, clinicians and analysts say.[contextly_sidebar id=\"ReV9Gv0J6j7ADmv2dqbEuegAVdiLN5dE\"]\u003c/p>\n\u003cp>The therapy involves collecting patients' own T cells, a type of white blood cell, genetically modifying them, and then infusing them back into patients, where they hunt down and kill cancer cells. Known as \u003ca href=\"https://www.cancer.gov/about-cancer/treatment/research/car-t-cells\" target=\"_blank\" rel=\"noopener\">CAR-T cell therapy\u003c/a>, it's been characterized as a \"living drug\" by some researchers.\u003c/p>\n\u003cp>Two different CAR-T drugs — \u003ca href=\"https://www.us.kymriah.com/diffuse-large-b-cell-lymphoma-adults/?site=KYDDAY0DTCBR0040&source=01030&gclid=CNDIg4PMpNwCFRj1swod-MwKyw&gclsrc=ds\" target=\"_blank\" rel=\"noopener\">Kymriah\u003c/a> and \u003ca href=\"https://www.yescarta.com/therapy#how-yescarta-is-different\" target=\"_blank\" rel=\"noopener\">Yescarta\u003c/a> — were approved by the FDA last year to treat patients whose blood cancers haven't responded to at least two other rounds of treatment.\u003c/p>\n\u003cp>Kymriah is \u003ca href=\"https://www.fda.gov/Drugs/InformationOnDrugs/ApprovedDrugs/ucm574154.htm\">approved\u003c/a> for people up to age 25 with a form of acute lymphoblastic leukemia, the most common cancer in children. Kymriah and Yescarta are \u003ca href=\"https://www.fda.gov/Drugs/InformationOnDrugs/ApprovedDrugs/ucm606540.htm\" target=\"_blank\" rel=\"noopener\">both\u003c/a> \u003ca href=\"https://www.fda.gov/Drugs/InformationOnDrugs/ApprovedDrugs/ucm581296.htm\" target=\"_blank\" rel=\"noopener\">approved\u003c/a> for adults with advanced lymphomas.\u003c/p>\n\u003cp>Researchers report that some critically ill patients who received the therapy have remained cancer-free for as long as five years.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"This is what patients need,\" says \u003ca href=\"https://www.mayo.edu/research/faculty/lin-yi-m-d-ph-d/bio-00092684\" target=\"_blank\" rel=\"noopener\">Dr. Yi Lin\u003c/a>, a hematologist who oversees the CAR-T cell practice and research for the Mayo Clinic. \"With the likelihood of getting patients into durable survival, we don't want to deny them the therapy.\" She says she receives no personal financial support from the drugs' makers.[contextly_sidebar id=\"nsB5Luqi8Mrdsb9vLceD3T77zYYY4sKK\"]\u003c/p>\n\u003cp>But the treatment comes at a cost — the drug treatments are hugely expensive. Kymriah and Yescarta cost $373,000 for a one-time infusion to treat adults with advanced lymphomas, while Kymriah costs $475,000 to treat acute lymphoblastic leukemia in children and young adults. That's the cost of the drug itself; in addition, many patients experience serious side effects that can land them in a hospital intensive care unit for weeks, \u003ca href=\"https://khn.org/news/cascade-of-costs-could-push-new-gene-therapy-above-1-million-per-patient/\" target=\"_blank\" rel=\"noopener\">pushing treatment costs to more than $1 million\u003c/a>.\u003c/p>\n\u003cp>All of this gives government and private insurers pause.\u003c/p>\n\u003cp>Most commercial insurers are covering CAR-T cell therapies now, but they do so on an individual basis, writing single-patient agreements each time, say cancer specialists. Large insurers that are already familiar with complicated therapies like stem-cell transplants are getting speedier at handling requests for CAR-T cell treatment, they say. But that's not always the case at smaller or regional plans, where delays can add weeks to the approval process.\u003c/p>\n\u003cp>\"A request for CAR-T may end up with somebody on the payer authorization team who doesn't understand the technology or the urgency of the request, when somebody has only weeks or months to live,\" says \u003ca href=\"https://www.asbmt.org/about/contact-us\" target=\"_blank\" rel=\"noopener\">Stephanie Farnia\u003c/a>, director of health policy and strategic relations at the American Society for Blood and Marrow Transplantation.\u003c/p>\n\u003cp>Farnia is in contact with many of the more than 50 medical centers that are authorized to provide treatment. The process of getting to a treatment center and evaluated for therapy is involved, she says. \"To then be substantially delayed due to paperwork is incredibly frustrating\" for patients.[contextly_sidebar id=\"mCjXSziNW7nkG4M52QmA48lgOAVmv3eg\"]\u003c/p>\n\u003cp>Medicare and Medicaid often pose greater coverage challenges than do private insurers, according to insurance experts.\u003c/p>\n\u003cp>Some Medicaid programs don't cover the treatment, says \u003ca href=\"AndrewsCAR-TandInsuranceDFedit.docx\" target=\"_blank\" rel=\"noopener\">Dr. Michael Bishop\u003c/a>, director of the cellular therapy program in the hematology/oncology section at the University of Chicago. Medicaid, the state-federal health program, covers children in low-income households and some adults.\u003c/p>\n\u003cp>\"Medicaid has been very tough,\" he says. \"Certain states just deny coverage — even states with balanced budgets.\"\u003c/p>\n\u003cp>States \u003ca href=\"https://icer-review.org/wp-content/uploads/2017/07/ICER_CAR_T_Final_Evidence_Report_032318.pdf\" target=\"_blank\" rel=\"noopener\">have to evaluate the cost as well as the drugs' effectiveness\u003c/a>, says \u003ca href=\"http://medicaiddirectors.org/about/staff/\" target=\"_blank\" rel=\"noopener\">Matt Salo\u003c/a>, executive director of the National Association of Medicaid Directors.\u003c/p>\n\u003cp>\"Medicaid is a finite pot of money, and it's stretched threadbare even on a good day,\" he says.\u003c/p>\n\u003cp>People who are on Medicare, the health insurance program for people age 65 and older and some people with disabilities, typically haven't faced coverage denials to date, clinicians say. But the government's reimbursement rates are raising concerns for providers.\u003c/p>\n\u003cp>Last spring, Medicare announced payment rates for providers who administer Yescarta and Kymriah on an outpatient basis. The payments would more than cover the costs of the drugs. Medicare beneficiaries' out-of-pocket costs would be capped at $1,340 plus the beneficiaries' Part B deductible (if that hasn't already been met), the agency says.[contextly_sidebar id=\"zRKGtFwAO4CBGEIycv3lNE5oWVwoZuVf\"]\u003c/p>\n\u003cp>The problem with this plan? Facilities typically provide treatment on an inpatient basis, not outpatient, because of the potential for severe, systemic side effects.\u003c/p>\n\u003cp>\"There's a lot of toxicity and questions about whether it can even be provided in an outpatient setting,\" says Gary Goldstein, the business manager at the blood and marrow transplant program at Stanford Health Care in Stanford, Calif.\u003c/p>\n\u003cp>For inpatient care, \"CAR-T cell therapy ... would be paid at a much lower amount compared to outpatient hospital use,\" according to officials at the Centers for Medicare & Medicaid Services.\u003c/p>\n\u003cp>The agency is considering how to handle payment for inpatient CAR-T care for the fiscal year that starts in October. For now, some medical centers are absorbing whatever Medicare doesn't pay.\u003c/p>\n\u003cp>\"How can you tell a patient who's 66, 'If only you'd gotten lymphoma when you were 64'?\" Goldstein asks.\u003c/p>\n\u003cp>But the current approach can't continue indefinitely, he says.\u003c/p>\n\u003cp>\"Even if there aren't any centers that are making that decision today, if coverage doesn't change for Medicare, it absolutely is going to be a problem tomorrow,\" says Goldstein.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"http://khn.org/\" target=\"_blank\" rel=\"noopener\">\u003cem>Kaiser Health News\u003c/em>\u003c/a>\u003cem>, a nonprofit news service, is an editorially independent program of the Kaiser Family Foundation, and is not affiliated with Kaiser Permanente. Michelle Andrews is on Twitter \u003c/em>\u003ca href=\"https://twitter.com/mandrews110\" target=\"_blank\" rel=\"noopener\">\u003cem>@mandrews110\u003c/em>\u003c/a>\u003cem>.\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 Kaiser Health News. To see more, visit \u003ca href=\"http://www.kaiserhealthnews.org/\" target=\"_blank\" rel=\"noopener\">Kaiser Health News\u003c/a>.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Insurers+And+Government+Are+Slow+To+Cover+Expensive+CAR-T+Cancer+Therapy&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"excerpt": "Treatment costs for the immunotherapy can run to more than $1 million. Some state Medicaid programs aren't paying for the treatment, and Medicare's complicated payment rates have hospitals worried.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Patients whose blood cancers have failed to respond to repeated rounds of chemotherapy may be candidates for a new type of gene therapy that could send their cancers into remission for years. But the two approved therapies, with price tags of hundreds of thousands of dollars, have roiled the insurance approval process, leading to delays and, in some cases, denials of coverage, clinicians and analysts say.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>The therapy involves collecting patients' own T cells, a type of white blood cell, genetically modifying them, and then infusing them back into patients, where they hunt down and kill cancer cells. Known as \u003ca href=\"https://www.cancer.gov/about-cancer/treatment/research/car-t-cells\" target=\"_blank\" rel=\"noopener\">CAR-T cell therapy\u003c/a>, it's been characterized as a \"living drug\" by some researchers.\u003c/p>\n\u003cp>Two different CAR-T drugs — \u003ca href=\"https://www.us.kymriah.com/diffuse-large-b-cell-lymphoma-adults/?site=KYDDAY0DTCBR0040&source=01030&gclid=CNDIg4PMpNwCFRj1swod-MwKyw&gclsrc=ds\" target=\"_blank\" rel=\"noopener\">Kymriah\u003c/a> and \u003ca href=\"https://www.yescarta.com/therapy#how-yescarta-is-different\" target=\"_blank\" rel=\"noopener\">Yescarta\u003c/a> — were approved by the FDA last year to treat patients whose blood cancers haven't responded to at least two other rounds of treatment.\u003c/p>\n\u003cp>Kymriah is \u003ca href=\"https://www.fda.gov/Drugs/InformationOnDrugs/ApprovedDrugs/ucm574154.htm\">approved\u003c/a> for people up to age 25 with a form of acute lymphoblastic leukemia, the most common cancer in children. Kymriah and Yescarta are \u003ca href=\"https://www.fda.gov/Drugs/InformationOnDrugs/ApprovedDrugs/ucm606540.htm\" target=\"_blank\" rel=\"noopener\">both\u003c/a> \u003ca href=\"https://www.fda.gov/Drugs/InformationOnDrugs/ApprovedDrugs/ucm581296.htm\" target=\"_blank\" rel=\"noopener\">approved\u003c/a> for adults with advanced lymphomas.\u003c/p>\n\u003cp>Researchers report that some critically ill patients who received the therapy have remained cancer-free for as long as five years.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"This is what patients need,\" says \u003ca href=\"https://www.mayo.edu/research/faculty/lin-yi-m-d-ph-d/bio-00092684\" target=\"_blank\" rel=\"noopener\">Dr. Yi Lin\u003c/a>, a hematologist who oversees the CAR-T cell practice and research for the Mayo Clinic. \"With the likelihood of getting patients into durable survival, we don't want to deny them the therapy.\" She says she receives no personal financial support from the drugs' makers.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>But the treatment comes at a cost — the drug treatments are hugely expensive. Kymriah and Yescarta cost $373,000 for a one-time infusion to treat adults with advanced lymphomas, while Kymriah costs $475,000 to treat acute lymphoblastic leukemia in children and young adults. That's the cost of the drug itself; in addition, many patients experience serious side effects that can land them in a hospital intensive care unit for weeks, \u003ca href=\"https://khn.org/news/cascade-of-costs-could-push-new-gene-therapy-above-1-million-per-patient/\" target=\"_blank\" rel=\"noopener\">pushing treatment costs to more than $1 million\u003c/a>.\u003c/p>\n\u003cp>All of this gives government and private insurers pause.\u003c/p>\n\u003cp>Most commercial insurers are covering CAR-T cell therapies now, but they do so on an individual basis, writing single-patient agreements each time, say cancer specialists. Large insurers that are already familiar with complicated therapies like stem-cell transplants are getting speedier at handling requests for CAR-T cell treatment, they say. But that's not always the case at smaller or regional plans, where delays can add weeks to the approval process.\u003c/p>\n\u003cp>\"A request for CAR-T may end up with somebody on the payer authorization team who doesn't understand the technology or the urgency of the request, when somebody has only weeks or months to live,\" says \u003ca href=\"https://www.asbmt.org/about/contact-us\" target=\"_blank\" rel=\"noopener\">Stephanie Farnia\u003c/a>, director of health policy and strategic relations at the American Society for Blood and Marrow Transplantation.\u003c/p>\n\u003cp>Farnia is in contact with many of the more than 50 medical centers that are authorized to provide treatment. The process of getting to a treatment center and evaluated for therapy is involved, she says. \"To then be substantially delayed due to paperwork is incredibly frustrating\" for patients.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Medicare and Medicaid often pose greater coverage challenges than do private insurers, according to insurance experts.\u003c/p>\n\u003cp>Some Medicaid programs don't cover the treatment, says \u003ca href=\"AndrewsCAR-TandInsuranceDFedit.docx\" target=\"_blank\" rel=\"noopener\">Dr. Michael Bishop\u003c/a>, director of the cellular therapy program in the hematology/oncology section at the University of Chicago. Medicaid, the state-federal health program, covers children in low-income households and some adults.\u003c/p>\n\u003cp>\"Medicaid has been very tough,\" he says. \"Certain states just deny coverage — even states with balanced budgets.\"\u003c/p>\n\u003cp>States \u003ca href=\"https://icer-review.org/wp-content/uploads/2017/07/ICER_CAR_T_Final_Evidence_Report_032318.pdf\" target=\"_blank\" rel=\"noopener\">have to evaluate the cost as well as the drugs' effectiveness\u003c/a>, says \u003ca href=\"http://medicaiddirectors.org/about/staff/\" target=\"_blank\" rel=\"noopener\">Matt Salo\u003c/a>, executive director of the National Association of Medicaid Directors.\u003c/p>\n\u003cp>\"Medicaid is a finite pot of money, and it's stretched threadbare even on a good day,\" he says.\u003c/p>\n\u003cp>People who are on Medicare, the health insurance program for people age 65 and older and some people with disabilities, typically haven't faced coverage denials to date, clinicians say. But the government's reimbursement rates are raising concerns for providers.\u003c/p>\n\u003cp>Last spring, Medicare announced payment rates for providers who administer Yescarta and Kymriah on an outpatient basis. The payments would more than cover the costs of the drugs. Medicare beneficiaries' out-of-pocket costs would be capped at $1,340 plus the beneficiaries' Part B deductible (if that hasn't already been met), the agency says.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>The problem with this plan? Facilities typically provide treatment on an inpatient basis, not outpatient, because of the potential for severe, systemic side effects.\u003c/p>\n\u003cp>\"There's a lot of toxicity and questions about whether it can even be provided in an outpatient setting,\" says Gary Goldstein, the business manager at the blood and marrow transplant program at Stanford Health Care in Stanford, Calif.\u003c/p>\n\u003cp>For inpatient care, \"CAR-T cell therapy ... would be paid at a much lower amount compared to outpatient hospital use,\" according to officials at the Centers for Medicare & Medicaid Services.\u003c/p>\n\u003cp>The agency is considering how to handle payment for inpatient CAR-T care for the fiscal year that starts in October. For now, some medical centers are absorbing whatever Medicare doesn't pay.\u003c/p>\n\u003cp>\"How can you tell a patient who's 66, 'If only you'd gotten lymphoma when you were 64'?\" Goldstein asks.\u003c/p>\n\u003cp>But the current approach can't continue indefinitely, he says.\u003c/p>\n\u003cp>\"Even if there aren't any centers that are making that decision today, if coverage doesn't change for Medicare, it absolutely is going to be a problem tomorrow,\" says Goldstein.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"http://khn.org/\" target=\"_blank\" rel=\"noopener\">\u003cem>Kaiser Health News\u003c/em>\u003c/a>\u003cem>, a nonprofit news service, is an editorially independent program of the Kaiser Family Foundation, and is not affiliated with Kaiser Permanente. Michelle Andrews is on Twitter \u003c/em>\u003ca href=\"https://twitter.com/mandrews110\" target=\"_blank\" rel=\"noopener\">\u003cem>@mandrews110\u003c/em>\u003c/a>\u003cem>.\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 Kaiser Health News. To see more, visit \u003ca href=\"http://www.kaiserhealthnews.org/\" target=\"_blank\" rel=\"noopener\">Kaiser Health News\u003c/a>.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Insurers+And+Government+Are+Slow+To+Cover+Expensive+CAR-T+Cancer+Therapy&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Potential DNA Damage From CRISPR ‘Seriously Underestimated,’ Study Finds",
"title": "Potential DNA Damage From CRISPR ‘Seriously Underestimated,’ Study Finds",
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"content": "\u003cp>From the earliest days of the CRISPR-Cas9 era, scientists have known that the first step in how it \u003ca href=\"https://www.statnews.com/2018/04/04/how-crispr-works-visualized/\">edits genomes\u003c/a> — snipping DNA — creates an unholy mess: Cellular repairmen frantically try to fix the cuts by throwing random chunks of DNA into the breach and deleting other random bits. \u003ca href=\"https://www.nature.com/articles/Nbt.4192\" target=\"_blank\" rel=\"noopener\">Research\u003c/a> published on Monday suggests that’s only the tip of a Titanic-sized iceberg: CRISPR-Cas9 can cause significantly greater genetic havoc than experts thought, the study concludes, perhaps enough to threaten the health of patients who would one day receive \u003ca href=\"https://www.statnews.com/2018/02/21/crispr-sickle-cell-clinical-trials/\">CRISPR-based therapy\u003c/a>.[contextly_sidebar id=\"y9TqAZzR84fJHw52DmhRAZZb04jkzjxD\"]\u003c/p>\n\u003cp>The results come hard on the heels of two \u003ca href=\"https://www.statnews.com/2018/06/11/crispr-hurdle-edited-cells-might-cause-cancer/\">studies\u003c/a> that identified a related issue: Some CRISPR’d cells might be missing a key anti-cancer mechanism and therefore be able to initiate tumors.\u003c/p>\n\u003cp>The DNA damage found in the new study included deletions of thousands of DNA bases, including at spots far from the edit. Some of the deletions can silence genes that should be active and activate genes that should be silent, including cancer-causing genes.\u003c/p>\n\u003cp>The DNA chaos that CRISPR unleashes has been “seriously underestimated,” said geneticist Allan Bradley of England’s Wellcome Sanger Institute, who led the study. “This should be a wake-up call.”\u003c/p>\n\u003cp>Leading CRISPR companies scrambled to play down the latest threat to what they hope will be a multibillion-dollar business \u003cstrong>— \u003c/strong>and to their stock prices, but investors reacted with alarm. Within the first 20 minutes of when the study was released, the three publicly traded CRISPR companies lost more than $300 million in value, and it was downhill from there: CRISPR Therapeutics ended down 8.6 percent, Editas Medicine fell 7 percent, and Intellia Therapeutics lost nearly 10 percent.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The companies questioned whether the CRISPR-caused DNA damage reported in the new study applied to the kind of cells they’re planning to CRISPR. They emphasized that if genomic scrambling is at all common then it should also be seen in earlier forms of genome-editing such as \u003ca href=\"https://www.statnews.com/2017/11/30/crispr-talens-gene-editing/\">zinc fingers and TALENs\u003c/a> (but apparently isn’t). And they insisted they’re on the case.\u003c/p>\n\u003cp>“We’re not Pollyannaish about this,” said geneticist Tom Barnes, chief innovation officer at Intellia. For its mouse experiments, Intellia analyzes edited genomes for collateral damage both near the editing target and tens of thousands of DNA letters away, he said, but “we have not seen any [cancer-causing] transformation of these cells, even with all the edits we’ve introduced.”[contextly_sidebar id=\"X3REPdHlQY5Hjsf4rQxCF5iuUbyNXJ8K\"]\u003c/p>\n\u003cp>In a statement, Editas spokeswoman Cristi Barnett said the possibility of genetic chaos from CRISPR is “an interesting topic” that the company “actively examine[s].” The reported DNA havoc, she said, is not “specifically problematic in our work to make CRISPR-based medicines.” CRISPR Therapeutics did not respond to requests for comment.\u003c/p>\n\u003cp>Academic scientists were less dismissive of the new study, in Nature Biotechnology. One leading CRISPR developer called it “well-done and credible,” “a cautionary note to the [genome-editing] community,” and consistent with other research showing that the DNA cuts that CRISPR makes, called double-stranded breaks, “can induce the types of genomic DNA rearrangements and deletions they report.” He asked not to be identified so as not to jeopardize business relationships with genome-editing companies.\u003c/p>\n\u003cp>But just as critics of last month’s studies asked why, if CRISPR’d cells can initiate cancer, no CRISPR’d mice had turned up with tumors, so scientists raised similar questions about the new genomic havoc finding: Why don’t scientists see it when they analyze the DNA of CRISPR’d cells?\u003c/p>\n\u003cp>“You find what you look for,” said Bradley. “No one is looking at the impact [of these DNA changes] on downstream genes.”\u003c/p>\n\u003cp>And few studies conduct full-out genome sequencing of CRISPR’d cells. Moreover, scientists typically search for one form of the collateral damage the Sanger study found — deletions of thousands of DNA bases (the double helix’s famous A’s, T’s, C’s, and G’s) — using a standard technique called PCR, which makes millions of DNA copies. But to work, PCR must attach to a “binding site” on DNA; CRISPR sometimes deletes that binding site, said Bradley, whose team used a different technique to analyze the double helix for collateral damage from CRISPR.\u003c/p>\n\u003cp>The Sanger scientists didn’t set out to find collateral DNA damage from CRISPR. As they investigated how CRISPR might change gene expression, a “weird thing” showed up, Bradley said: The target DNA was accurately changed, but that set off a chain reaction that engulfed genes far from the target. The scientists therefore changed course.[contextly_sidebar id=\"dkt97iGOrAQULIvrxP1t89Dkl2rYRsky\"]\u003c/p>\n\u003cp>When they aimed CRISPR at different targets in mouse embryonic stem cells, mouse blood-making cells, and human retinal cells, “extensive on-target genomic damage [was] a common outcome,” they wrote in their paper. In one case, genomes in about two-thirds of the CRISPR’d cells showed the expected small-scale inadvertent havoc, but 21 percent had DNA deletions of more than 250 bases and up to 6,000 bases long.\u003c/p>\n\u003cp>Since therapeutic uses of CRISPR would edit the genomes of billions of cells in, say, a patient’s liver, even rare DNA damage “makes it likely that one or more edited cells … would be endowed with an important [disease-causing] lesion,” the scientists wrote.\u003c/p>\n\u003cp>Nature Biotechnology took a year to publish the paper, after asking Bradley numerous variations of “are you sure?” and “did you consider this?” and asking him to run additional experiments, Bradley said. The results all held up.\u003c/p>\n\u003cp>The one U.S. \u003ca href=\"https://clinicaltrials.gov/ct2/show/NCT03399448\" target=\"_blank\" rel=\"noopener\">clinical trial\u003c/a> using CRISPR’d cells began recruiting patients this year. It will use CRISPR to make immune cells, removed from patients with any of four types of cancer, attack telltale molecules on the tumor cells’ surface. Asked what genome analysis he plans to do, lead investigator Dr. Edward Stadtmauer of the University of Pennsylvania said, “We are doing extensive testing of the final cellular product as well as the cells within the patient.”\u003c/p>\n\u003cp>The possibility of adverse consequences from CRISPR’d cells has caused some company officials to argue that if, say, their therapy cures a child of a devastating disease, but increases her risk of cancer, that might be an acceptable trade-off.\u003c/p>\n\u003cp>That argument may well prevail. In 2003, however, when a boy in a gene therapy trial in France \u003ca href=\"https://www.nejm.org/doi/full/10.1056/NEJM200301163480314\" target=\"_blank\" rel=\"noopener\">developed leukemia\u003c/a> because the repair gene landed in the wrong place in his genome and activated a cancer-causing gene, it shut down gene therapy development on both sides of the Atlantic for years.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This\u003ca href=\"https://www.statnews.com/2018/07/16/crispr-potential-dna-damage-underestimated/\" target=\"_blank\" rel=\"noopener\"> story\u003c/a> was originally published by STAT, an online publication of Boston Globe Media that covers health, medicine, and scientific discovery.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>From the earliest days of the CRISPR-Cas9 era, scientists have known that the first step in how it \u003ca href=\"https://www.statnews.com/2018/04/04/how-crispr-works-visualized/\">edits genomes\u003c/a> — snipping DNA — creates an unholy mess: Cellular repairmen frantically try to fix the cuts by throwing random chunks of DNA into the breach and deleting other random bits. \u003ca href=\"https://www.nature.com/articles/Nbt.4192\" target=\"_blank\" rel=\"noopener\">Research\u003c/a> published on Monday suggests that’s only the tip of a Titanic-sized iceberg: CRISPR-Cas9 can cause significantly greater genetic havoc than experts thought, the study concludes, perhaps enough to threaten the health of patients who would one day receive \u003ca href=\"https://www.statnews.com/2018/02/21/crispr-sickle-cell-clinical-trials/\">CRISPR-based therapy\u003c/a>.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>The results come hard on the heels of two \u003ca href=\"https://www.statnews.com/2018/06/11/crispr-hurdle-edited-cells-might-cause-cancer/\">studies\u003c/a> that identified a related issue: Some CRISPR’d cells might be missing a key anti-cancer mechanism and therefore be able to initiate tumors.\u003c/p>\n\u003cp>The DNA damage found in the new study included deletions of thousands of DNA bases, including at spots far from the edit. Some of the deletions can silence genes that should be active and activate genes that should be silent, including cancer-causing genes.\u003c/p>\n\u003cp>The DNA chaos that CRISPR unleashes has been “seriously underestimated,” said geneticist Allan Bradley of England’s Wellcome Sanger Institute, who led the study. “This should be a wake-up call.”\u003c/p>\n\u003cp>Leading CRISPR companies scrambled to play down the latest threat to what they hope will be a multibillion-dollar business \u003cstrong>— \u003c/strong>and to their stock prices, but investors reacted with alarm. Within the first 20 minutes of when the study was released, the three publicly traded CRISPR companies lost more than $300 million in value, and it was downhill from there: CRISPR Therapeutics ended down 8.6 percent, Editas Medicine fell 7 percent, and Intellia Therapeutics lost nearly 10 percent.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The companies questioned whether the CRISPR-caused DNA damage reported in the new study applied to the kind of cells they’re planning to CRISPR. They emphasized that if genomic scrambling is at all common then it should also be seen in earlier forms of genome-editing such as \u003ca href=\"https://www.statnews.com/2017/11/30/crispr-talens-gene-editing/\">zinc fingers and TALENs\u003c/a> (but apparently isn’t). And they insisted they’re on the case.\u003c/p>\n\u003cp>“We’re not Pollyannaish about this,” said geneticist Tom Barnes, chief innovation officer at Intellia. For its mouse experiments, Intellia analyzes edited genomes for collateral damage both near the editing target and tens of thousands of DNA letters away, he said, but “we have not seen any [cancer-causing] transformation of these cells, even with all the edits we’ve introduced.”\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>In a statement, Editas spokeswoman Cristi Barnett said the possibility of genetic chaos from CRISPR is “an interesting topic” that the company “actively examine[s].” The reported DNA havoc, she said, is not “specifically problematic in our work to make CRISPR-based medicines.” CRISPR Therapeutics did not respond to requests for comment.\u003c/p>\n\u003cp>Academic scientists were less dismissive of the new study, in Nature Biotechnology. One leading CRISPR developer called it “well-done and credible,” “a cautionary note to the [genome-editing] community,” and consistent with other research showing that the DNA cuts that CRISPR makes, called double-stranded breaks, “can induce the types of genomic DNA rearrangements and deletions they report.” He asked not to be identified so as not to jeopardize business relationships with genome-editing companies.\u003c/p>\n\u003cp>But just as critics of last month’s studies asked why, if CRISPR’d cells can initiate cancer, no CRISPR’d mice had turned up with tumors, so scientists raised similar questions about the new genomic havoc finding: Why don’t scientists see it when they analyze the DNA of CRISPR’d cells?\u003c/p>\n\u003cp>“You find what you look for,” said Bradley. “No one is looking at the impact [of these DNA changes] on downstream genes.”\u003c/p>\n\u003cp>And few studies conduct full-out genome sequencing of CRISPR’d cells. Moreover, scientists typically search for one form of the collateral damage the Sanger study found — deletions of thousands of DNA bases (the double helix’s famous A’s, T’s, C’s, and G’s) — using a standard technique called PCR, which makes millions of DNA copies. But to work, PCR must attach to a “binding site” on DNA; CRISPR sometimes deletes that binding site, said Bradley, whose team used a different technique to analyze the double helix for collateral damage from CRISPR.\u003c/p>\n\u003cp>The Sanger scientists didn’t set out to find collateral DNA damage from CRISPR. As they investigated how CRISPR might change gene expression, a “weird thing” showed up, Bradley said: The target DNA was accurately changed, but that set off a chain reaction that engulfed genes far from the target. The scientists therefore changed course.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>When they aimed CRISPR at different targets in mouse embryonic stem cells, mouse blood-making cells, and human retinal cells, “extensive on-target genomic damage [was] a common outcome,” they wrote in their paper. In one case, genomes in about two-thirds of the CRISPR’d cells showed the expected small-scale inadvertent havoc, but 21 percent had DNA deletions of more than 250 bases and up to 6,000 bases long.\u003c/p>\n\u003cp>Since therapeutic uses of CRISPR would edit the genomes of billions of cells in, say, a patient’s liver, even rare DNA damage “makes it likely that one or more edited cells … would be endowed with an important [disease-causing] lesion,” the scientists wrote.\u003c/p>\n\u003cp>Nature Biotechnology took a year to publish the paper, after asking Bradley numerous variations of “are you sure?” and “did you consider this?” and asking him to run additional experiments, Bradley said. The results all held up.\u003c/p>\n\u003cp>The one U.S. \u003ca href=\"https://clinicaltrials.gov/ct2/show/NCT03399448\" target=\"_blank\" rel=\"noopener\">clinical trial\u003c/a> using CRISPR’d cells began recruiting patients this year. It will use CRISPR to make immune cells, removed from patients with any of four types of cancer, attack telltale molecules on the tumor cells’ surface. Asked what genome analysis he plans to do, lead investigator Dr. Edward Stadtmauer of the University of Pennsylvania said, “We are doing extensive testing of the final cellular product as well as the cells within the patient.”\u003c/p>\n\u003cp>The possibility of adverse consequences from CRISPR’d cells has caused some company officials to argue that if, say, their therapy cures a child of a devastating disease, but increases her risk of cancer, that might be an acceptable trade-off.\u003c/p>\n\u003cp>That argument may well prevail. In 2003, however, when a boy in a gene therapy trial in France \u003ca href=\"https://www.nejm.org/doi/full/10.1056/NEJM200301163480314\" target=\"_blank\" rel=\"noopener\">developed leukemia\u003c/a> because the repair gene landed in the wrong place in his genome and activated a cancer-causing gene, it shut down gene therapy development on both sides of the Atlantic for years.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"disqusTitle": "Worried About Dementia? You Might Want to Check Your Blood Pressure",
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"content": "\u003cp>Every day, \u003ca href=\"https://www.ninds.nih.gov/About-NINDS/Who-We-Are/Directors-Corner\" target=\"_blank\" rel=\"noopener\">Dr. Walter Koroshetz\u003c/a>, 65, takes a pill as part of his effort to help keep his brain healthy and sharp.[contextly_sidebar id=\"4qBhSsrstKRvTKQK6tvUcmCtY4bzQNtv\"]\u003c/p>\n\u003cp>The pill is his blood pressure medication. And Koroshetz, who directs the National Institute of Neurological Disorders and Stroke, says controlling high blood pressure helps him reduce his risk of dementia.\u003c/p>\n\u003cp>He also keeps his blood pressure down by exercising and paying attention to his weight and diet. \"I'm a believer,\" he says.\u003c/p>\n\u003cp>Koroshetz is urging other people with high blood pressure to follow his lead.\u003c/p>\n\u003cp>He is responsible for the institute's public health campaign called \u003ca href=\"https://mindyourrisks.nih.gov/\" target=\"_blank\" rel=\"noopener\">Mind Your Risks\u003c/a>. Its goal is to let people know that there is a link between high blood pressure, stroke and dementia.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>When blood pressure rises, it strains the tiny blood vessels that keep brain cells alive, Koroshetz says.\u003c/p>\n\u003cp>\"With every pulse of your heart, you are pushing blood into these very small blood vessels in the brain,\" he says. And when the heart pushes too hard, as it does when blood pressure is elevated, it can cause damage that can lead to a stroke.[contextly_sidebar id=\"8eq71K4GS69glebb5gMvhBNDaKzdVXhl\"]\u003c/p>\n\u003cp>At least two large studies have revealed an alarming trend among stroke patients, Koroshetz says.\u003c/p>\n\u003cp>\"If you had a stroke, even a small stroke, your risk of dementia within the next two years was greatly magnified,\" he says. \"So there's something about having a stroke that drives a lot of the processes that give rise to dementia.\"\u003c/p>\n\u003cp>The evidence is clearest for a type of dementia called \u003ca href=\"https://www.alz.org/alzheimers-dementia/what-is-dementia/types-of-dementia/vascular-dementia\" target=\"_blank\" rel=\"noopener\">vascular dementia\u003c/a>. It occurs when something blocks or reduces the flow of blood to brain cells.\u003c/p>\n\u003cp>But high blood pressure also appears to increase a person's risk of developing Alzheimer's disease, which is associated with the accumulation of plaques and tangles in the brain.\u003c/p>\n\u003cp>If people knew about the link between dementia and high blood pressure, they might be more inclined to do something about it, Koroshetz says.\u003c/p>\n\u003cp>\"Only about 50 percent of people who have hypertension are actually treated,\" he says. \"So I think there's a lot to be said for trying to get high blood pressure under control.\"\u003c/p>\n\u003cp>Koroshetz's campaign is getting some help from the \u003ca href=\"https://www.alz.org/alzheimers-dementia/what-is-dementia/types-of-dementia/vascular-dementia\" target=\"_blank\" rel=\"noopener\">Alzheimer's Association\u003c/a>.\u003c/p>\n\u003cp>The group will present new research on blood pressure and Alzheimer's at its annual scientific \u003ca href=\"https://www.alz.org/aaic/about/chicago.asp\" target=\"_blank\" rel=\"noopener\">meeting\u003c/a> in Chicago, which starts July 22. And the group is encouraging people to control high blood pressure.\u003c/p>\n\u003cp>\"The good news is that we can control blood pressure now,\" says Maria Carrillo, the group's chief science officer. \"We can do that with exercise, with lifestyle, with healthy eating and also with medications.\"\u003c/p>\n\u003cp>Koroshetz is using all of these approaches. And he says other people with high blood pressure should follow his lead.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"When you get to be my age, you're going to be very grateful that you controlled your blood pressure and exercised,\" he says.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Worried+About+Dementia%3F+You+Might+Want+to+Check+Your+Blood+Pressure&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Every day, \u003ca href=\"https://www.ninds.nih.gov/About-NINDS/Who-We-Are/Directors-Corner\" target=\"_blank\" rel=\"noopener\">Dr. Walter Koroshetz\u003c/a>, 65, takes a pill as part of his effort to help keep his brain healthy and sharp.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>The pill is his blood pressure medication. And Koroshetz, who directs the National Institute of Neurological Disorders and Stroke, says controlling high blood pressure helps him reduce his risk of dementia.\u003c/p>\n\u003cp>He also keeps his blood pressure down by exercising and paying attention to his weight and diet. \"I'm a believer,\" he says.\u003c/p>\n\u003cp>Koroshetz is urging other people with high blood pressure to follow his lead.\u003c/p>\n\u003cp>He is responsible for the institute's public health campaign called \u003ca href=\"https://mindyourrisks.nih.gov/\" target=\"_blank\" rel=\"noopener\">Mind Your Risks\u003c/a>. Its goal is to let people know that there is a link between high blood pressure, stroke and dementia.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>When blood pressure rises, it strains the tiny blood vessels that keep brain cells alive, Koroshetz says.\u003c/p>\n\u003cp>\"With every pulse of your heart, you are pushing blood into these very small blood vessels in the brain,\" he says. And when the heart pushes too hard, as it does when blood pressure is elevated, it can cause damage that can lead to a stroke.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>At least two large studies have revealed an alarming trend among stroke patients, Koroshetz says.\u003c/p>\n\u003cp>\"If you had a stroke, even a small stroke, your risk of dementia within the next two years was greatly magnified,\" he says. \"So there's something about having a stroke that drives a lot of the processes that give rise to dementia.\"\u003c/p>\n\u003cp>The evidence is clearest for a type of dementia called \u003ca href=\"https://www.alz.org/alzheimers-dementia/what-is-dementia/types-of-dementia/vascular-dementia\" target=\"_blank\" rel=\"noopener\">vascular dementia\u003c/a>. It occurs when something blocks or reduces the flow of blood to brain cells.\u003c/p>\n\u003cp>But high blood pressure also appears to increase a person's risk of developing Alzheimer's disease, which is associated with the accumulation of plaques and tangles in the brain.\u003c/p>\n\u003cp>If people knew about the link between dementia and high blood pressure, they might be more inclined to do something about it, Koroshetz says.\u003c/p>\n\u003cp>\"Only about 50 percent of people who have hypertension are actually treated,\" he says. \"So I think there's a lot to be said for trying to get high blood pressure under control.\"\u003c/p>\n\u003cp>Koroshetz's campaign is getting some help from the \u003ca href=\"https://www.alz.org/alzheimers-dementia/what-is-dementia/types-of-dementia/vascular-dementia\" target=\"_blank\" rel=\"noopener\">Alzheimer's Association\u003c/a>.\u003c/p>\n\u003cp>The group will present new research on blood pressure and Alzheimer's at its annual scientific \u003ca href=\"https://www.alz.org/aaic/about/chicago.asp\" target=\"_blank\" rel=\"noopener\">meeting\u003c/a> in Chicago, which starts July 22. And the group is encouraging people to control high blood pressure.\u003c/p>\n\u003cp>\"The good news is that we can control blood pressure now,\" says Maria Carrillo, the group's chief science officer. \"We can do that with exercise, with lifestyle, with healthy eating and also with medications.\"\u003c/p>\n\u003cp>Koroshetz is using all of these approaches. And he says other people with high blood pressure should follow his lead.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"When you get to be my age, you're going to be very grateful that you controlled your blood pressure and exercised,\" he says.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Worried+About+Dementia%3F+You+Might+Want+to+Check+Your+Blood+Pressure&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Can't cool off this summer? Heat waves can slow us down in ways we may not realize.[contextly_sidebar id=\"vfD9z3obGh2C18mIRbWsth99DmsY1OtQ\"]\u003c/p>\n\u003cp>New research suggests heat stress can muddle our thinking, making simple math a little harder to do.\u003c/p>\n\u003cp>\"There's evidence that our brains are susceptible to temperature abnormalities,\" says \u003ca href=\"https://www.hsph.harvard.edu/joseph-allen/\" target=\"_blank\" rel=\"noopener\">Joe Allen\u003c/a>, co-director of the \u003ca href=\"https://www.hsph.harvard.edu/c-change/\" target=\"_blank\" rel=\"noopener\">Center for Climate, Health and the Global Environment\u003c/a> at Harvard University. And as the climate changes, temperatures spike and \u003ca href=\"https://science2017.globalchange.gov/chapter/6/\" target=\"_blank\" rel=\"noopener\">heat waves are more frequent\u003c/a>.\u003c/p>\n\u003cp>To learn more about how the heat influences young, healthy adults, Allen and his colleagues studied college students living in dorms during a summer heat wave in Boston.\u003c/p>\n\u003cp>Half of the students lived in buildings with central AC, where the indoor air temperature averaged 71 degrees. The other half lived in dorms with no AC, where air temperatures averaged almost 80 degrees.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"In the morning, when they woke up, we pushed tests out to their cellphones,\" explains Allen. The students took two tests a day for 12 consecutive days.\u003c/p>\n\u003cp>One test, which included basic addition and subtraction, measured cognitive speed and memory. A second test assessed attention and processing speed.\u003c/p>\n\u003cp>\"We found that the students who were in the non-air-conditioned buildings actually had slower reaction times: 13 percent lower performance on basic arithmetic tests, and nearly a 10 percent reduction in the number of correct responses per minute,\" Allen explains.\u003c/p>\n\u003cp>The results, \u003ca href=\"http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002605\" target=\"_blank\" rel=\"noopener\">published in PLOS Medicine\u003c/a>, may come as a surprise. \"I think it's a little bit akin to the frog in the boiling water,\" Allen says. There's a \"slow, steady — largely imperceptible — rise in temperature, and you don't realize it's having an impact on you.\"\u003c/p>\n\u003cp>The findings add to a growing body of evidence that documents the effect of heat on mental performance, both in schools and workplaces.\u003c/p>\n\u003cp>For instance, a 2006 study from researchers at the Lawrence Berkeley National Lab found that when office temperatures rise above the mid-70s, \u003ca href=\"https://indoor.lbl.gov/publications/effect-temperature-task-performance\" target=\"_blank\" rel=\"noopener\">workers' performance begins to drop off\u003c/a>. Researchers reviewed multiple studies that evaluated performance on common office tasks\u003cem>.\u003c/em> The study found that worker productivity is highest at about 72 degrees. When temperatures exceeded the mid-80s, worker productivity decreased by about 9 percent.\u003c/p>\n\u003cp>Another, \u003ca href=\"https://www.sciencedirect.com/science/article/pii/S0360132316304723\" target=\"_blank\" rel=\"noopener\">more recent study\u003c/a> compared worker performance in green-certified buildings and typical office buildings. They found a dip in cognitive function linked to conditions in the indoor environment, including higher indoor temperatures and poor lighting.\u003c/p>\n\u003cp>And, when it comes to performance in the classroom, a study funded by the Harvard Environmental Economics Program finds that taking a standardized test on a very hot day is\u003ca href=\"https://scholar.harvard.edu/files/jisungpark/files/paper_nyc_aejep.pdf\" target=\"_blank\" rel=\"noopener\"> linked to poorer performance\u003c/a>. The study includes an analysis of test scores from students in New York City who take a series of high-school exams called the Regents Exams.\u003c/p>\n\u003cp>The author, R. Jisung Park, assistant professor at the University of California, Los Angeles, writes that compared with a 72-degree day, \"taking an exam on a 90◦F day leads to a 10.9 percent lower likelihood of passing a particular subject (e.g. Algebra), which in turn affects probability of graduation.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>There's still a lot to learn about how our brains and bodies respond to heat. \"We all tend to think we can compensate, we can do just fine\" during heat waves says Allen. But he says the \"evidence shows that the indoor temperature can have a dramatic impact on our ability to be productive and learn.\"\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Heat+Making+You+Lethargic%3F+Research+Shows+It+Can+Slow+Your+Brain%2C+Too&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Can't cool off this summer? Heat waves can slow us down in ways we may not realize.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>New research suggests heat stress can muddle our thinking, making simple math a little harder to do.\u003c/p>\n\u003cp>\"There's evidence that our brains are susceptible to temperature abnormalities,\" says \u003ca href=\"https://www.hsph.harvard.edu/joseph-allen/\" target=\"_blank\" rel=\"noopener\">Joe Allen\u003c/a>, co-director of the \u003ca href=\"https://www.hsph.harvard.edu/c-change/\" target=\"_blank\" rel=\"noopener\">Center for Climate, Health and the Global Environment\u003c/a> at Harvard University. And as the climate changes, temperatures spike and \u003ca href=\"https://science2017.globalchange.gov/chapter/6/\" target=\"_blank\" rel=\"noopener\">heat waves are more frequent\u003c/a>.\u003c/p>\n\u003cp>To learn more about how the heat influences young, healthy adults, Allen and his colleagues studied college students living in dorms during a summer heat wave in Boston.\u003c/p>\n\u003cp>Half of the students lived in buildings with central AC, where the indoor air temperature averaged 71 degrees. The other half lived in dorms with no AC, where air temperatures averaged almost 80 degrees.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"In the morning, when they woke up, we pushed tests out to their cellphones,\" explains Allen. The students took two tests a day for 12 consecutive days.\u003c/p>\n\u003cp>One test, which included basic addition and subtraction, measured cognitive speed and memory. A second test assessed attention and processing speed.\u003c/p>\n\u003cp>\"We found that the students who were in the non-air-conditioned buildings actually had slower reaction times: 13 percent lower performance on basic arithmetic tests, and nearly a 10 percent reduction in the number of correct responses per minute,\" Allen explains.\u003c/p>\n\u003cp>The results, \u003ca href=\"http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002605\" target=\"_blank\" rel=\"noopener\">published in PLOS Medicine\u003c/a>, may come as a surprise. \"I think it's a little bit akin to the frog in the boiling water,\" Allen says. There's a \"slow, steady — largely imperceptible — rise in temperature, and you don't realize it's having an impact on you.\"\u003c/p>\n\u003cp>The findings add to a growing body of evidence that documents the effect of heat on mental performance, both in schools and workplaces.\u003c/p>\n\u003cp>For instance, a 2006 study from researchers at the Lawrence Berkeley National Lab found that when office temperatures rise above the mid-70s, \u003ca href=\"https://indoor.lbl.gov/publications/effect-temperature-task-performance\" target=\"_blank\" rel=\"noopener\">workers' performance begins to drop off\u003c/a>. Researchers reviewed multiple studies that evaluated performance on common office tasks\u003cem>.\u003c/em> The study found that worker productivity is highest at about 72 degrees. When temperatures exceeded the mid-80s, worker productivity decreased by about 9 percent.\u003c/p>\n\u003cp>Another, \u003ca href=\"https://www.sciencedirect.com/science/article/pii/S0360132316304723\" target=\"_blank\" rel=\"noopener\">more recent study\u003c/a> compared worker performance in green-certified buildings and typical office buildings. They found a dip in cognitive function linked to conditions in the indoor environment, including higher indoor temperatures and poor lighting.\u003c/p>\n\u003cp>And, when it comes to performance in the classroom, a study funded by the Harvard Environmental Economics Program finds that taking a standardized test on a very hot day is\u003ca href=\"https://scholar.harvard.edu/files/jisungpark/files/paper_nyc_aejep.pdf\" target=\"_blank\" rel=\"noopener\"> linked to poorer performance\u003c/a>. The study includes an analysis of test scores from students in New York City who take a series of high-school exams called the Regents Exams.\u003c/p>\n\u003cp>The author, R. Jisung Park, assistant professor at the University of California, Los Angeles, writes that compared with a 72-degree day, \"taking an exam on a 90◦F day leads to a 10.9 percent lower likelihood of passing a particular subject (e.g. Algebra), which in turn affects probability of graduation.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>There's still a lot to learn about how our brains and bodies respond to heat. \"We all tend to think we can compensate, we can do just fine\" during heat waves says Allen. But he says the \"evidence shows that the indoor temperature can have a dramatic impact on our ability to be productive and learn.\"\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Heat+Making+You+Lethargic%3F+Research+Shows+It+Can+Slow+Your+Brain%2C+Too&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Could the tick that just bit you carry a pathogen that causes Lyme disease or another ailment? If you’re worried, you could ship the offending bug to a \u003ca href=\"https://www.tickreport.com/\" target=\"_blank\" rel=\"noopener\">private testing service\u003c/a> to find out. But between August 2016 and January 2017, you could have gotten a free analysis by sending it to \u003ca href=\"https://www.nietolab.com/\" target=\"_blank\" rel=\"noopener\">Nathan Nieto\u003c/a>‘s lab at Northern Arizona University. You’d get back info on the critter that bit you and, if applicable, a pathology report.[contextly_sidebar id=”vQtnCzXhkQcs89CEeEPJrr32XWz2BjaR”]\u003c/p>\n\u003cp>Nieto’s project wasn’t just a goodwill gesture: It was an unprecedented attempt to include the public in tick research. Nieto, a microbiologist at Northern Arizona University, and his team published \u003ca href=\"http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0199644\" target=\"_blank\" rel=\"noopener\">the results\u003c/a> of their brief tick-collecting experiment Thursday in \u003cem>PLOS One\u003c/em>. They say it shows the potential of citizen science to fill in gaps in research—and that data gathered this way could ultimately help form a more proactive public health response when it comes to identifying and preventing tick-borne disease.\u003c/p>\n\u003cp>Public health officials track the number of reported cases of tick-borne diseases, and researchers can study ticks in their local habitats. But when it comes to assessing the risk of potential infection from tick-born pathogens, figuring out which ticks commonly bite humans, what pathogens they carry, and how many people actually get sick from bites, the picture’s always been blurry.\u003c/p>\n\u003cp>Until now. Usually, Nieto says, scientists collect around 100 ticks at a time for local research using surprisingly low-tech methods (such as dragging a long swath of fabric behind a truck, then counting the number of ticks it catches). In this case, researchers received thousands of ticks. Most had been removed from humans or dogs—and there were many more than they originally planned for.\u003c/p>\n\u003cp>“We budgeted for 2,400,” says Nieto. “Then all of a sudden it was over 16,000.” The massive response shows how hungry the public is for information on the ticks that bite them, he says. In the meantime, it fed scientists an unexpectedly large dataset, and information on ticks from 49 states and Puerto Rico.[contextly_sidebar id=”ohPookGuQNsrQ7oV2MNauvfZDjgmSRp5″]\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Once ticks made their way into the lab, the team identified them and tested them for four tick-born pathogens, including \u003cem>Borrelia burgdorferi\u003c/em>, the bacterium that causes Lyme disease. They sent information on the pathogen back to the people who submitted ticks and mapped their geographic distribution.\u003c/p>\n\u003cp>Though researchers weren’t on the hunt for new tick-borne pathogens, they did uncover some surprises. Unexpected ticks turned up in unexpected locations, like Lone Star ticks you’d expect to find in the Southeast as far north as Maine and as far west as California. And ticks capable of carrying Lyme disease were reported in 83 counties where they hadn’t been recorded before. A few rare ticks turned up, too, though none of them carried pathogens.\u003c/p>\n\u003cp>For Nieto, the real point was to show how citizens might help fill in a gray area between incidence and risk, documenting human and animal exposure to ticks.\u003c/p>\n\u003cp>“We can use this data to show when risk is actually happening in the system,” says Nieto. “It ends up being predictive.” The data could be lined up to reports of tick-borne disease in a certain geographic area, for example, to show how long it takes for people to report illness or to help public health officials brace for next year’s tick season.\u003c/p>\n\u003cp>The researchers note that gathering data at this scale wouldn’t be possible without citizen scientists — and future studies of this type could help improve understanding of tick-borne disease.[contextly_sidebar id=”clkhy1Xj8UN6TWA04SmgdSJIeSSTp8ZO”]\u003c/p>\n\u003cp>“It’s a great example of using citizen science to ask questions about the ecology of infectious disease,” says \u003ca href=\"https://profiles.stanford.edu/katharine-walter\" target=\"_blank\" rel=\"noopener\">Katharine Walter\u003c/a>, an epidemiologist at Stanford University who has studied the prevalence and spread of tick-borne diseases. Walter, who did not participate in the research, says that a longer-term project could yield real insights not just into disease, but climate change and human impacts on their environment.\u003c/p>\n\u003cp>“That’s the power of science,” says Walter. “I really believe that scientific research shouldn’t be just for scientists.”\u003c/p>\n\u003cp>The study’s authors admit there are some real limitations to their work. They didn’t find out if and where people had traveled before they found the ticks. Since ticks can hang out on the body for days, they could have traveled along with people or animals on the move and resulted in misreporting. Nieto says his team didn’t ask for the data out of privacy concerns and a desire to encourage participation.\u003c/p>\n\u003cp>Another limitation is that people who never hear about a citizen science initiative can’t participate, and the study wasn’t advertised beyond an initial PR campaign conducted by the \u003ca href=\"https://www.bayarealyme.org/\" target=\"_blank\" rel=\"noopener\">Bay Area Lyme Foundation\u003c/a>, which funded the project. Socioeconomic barriers to the internet may also have limited participants, and there’s no way to verify how many participants misreported information about the ticks that bit them.\u003c/p>\n\u003cp>What’s next for the tick collectors? First, says Nieto, they’ll dig deeper into the ticks’ DNA, and hopefully open up another wave of free tick analysis in an attempt to broaden the data even more. From there, says Nieto, it’s up to others to use the dataset for good.\u003c/p>\n\u003cp>“We have this information,” he says. “Now we need some technology or changes in behavior that are going to help us actually prevent infection.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Erin Blakemore is a science writer based in Boulder, Colo. \u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg decoding=\"async\" src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Researchers+Study+Thousands+Of+Ticks+Collected+By+The+People+They+Bit&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Could the tick that just bit you carry a pathogen that causes Lyme disease or another ailment? If you’re worried, you could ship the offending bug to a \u003ca href=\"https://www.tickreport.com/\" target=\"_blank\" rel=\"noopener\">private testing service\u003c/a> to find out. But between August 2016 and January 2017, you could have gotten a free analysis by sending it to \u003ca href=\"https://www.nietolab.com/\" target=\"_blank\" rel=\"noopener\">Nathan Nieto\u003c/a>‘s lab at Northern Arizona University. You’d get back info on the critter that bit you and, if applicable, a pathology report.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Nieto’s project wasn’t just a goodwill gesture: It was an unprecedented attempt to include the public in tick research. Nieto, a microbiologist at Northern Arizona University, and his team published \u003ca href=\"http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0199644\" target=\"_blank\" rel=\"noopener\">the results\u003c/a> of their brief tick-collecting experiment Thursday in \u003cem>PLOS One\u003c/em>. They say it shows the potential of citizen science to fill in gaps in research—and that data gathered this way could ultimately help form a more proactive public health response when it comes to identifying and preventing tick-borne disease.\u003c/p>\n\u003cp>Public health officials track the number of reported cases of tick-borne diseases, and researchers can study ticks in their local habitats. But when it comes to assessing the risk of potential infection from tick-born pathogens, figuring out which ticks commonly bite humans, what pathogens they carry, and how many people actually get sick from bites, the picture’s always been blurry.\u003c/p>\n\u003cp>Until now. Usually, Nieto says, scientists collect around 100 ticks at a time for local research using surprisingly low-tech methods (such as dragging a long swath of fabric behind a truck, then counting the number of ticks it catches). In this case, researchers received thousands of ticks. Most had been removed from humans or dogs—and there were many more than they originally planned for.\u003c/p>\n\u003cp>“We budgeted for 2,400,” says Nieto. “Then all of a sudden it was over 16,000.” The massive response shows how hungry the public is for information on the ticks that bite them, he says. In the meantime, it fed scientists an unexpectedly large dataset, and information on ticks from 49 states and Puerto Rico.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Once ticks made their way into the lab, the team identified them and tested them for four tick-born pathogens, including \u003cem>Borrelia burgdorferi\u003c/em>, the bacterium that causes Lyme disease. They sent information on the pathogen back to the people who submitted ticks and mapped their geographic distribution.\u003c/p>\n\u003cp>Though researchers weren’t on the hunt for new tick-borne pathogens, they did uncover some surprises. Unexpected ticks turned up in unexpected locations, like Lone Star ticks you’d expect to find in the Southeast as far north as Maine and as far west as California. And ticks capable of carrying Lyme disease were reported in 83 counties where they hadn’t been recorded before. A few rare ticks turned up, too, though none of them carried pathogens.\u003c/p>\n\u003cp>For Nieto, the real point was to show how citizens might help fill in a gray area between incidence and risk, documenting human and animal exposure to ticks.\u003c/p>\n\u003cp>“We can use this data to show when risk is actually happening in the system,” says Nieto. “It ends up being predictive.” The data could be lined up to reports of tick-borne disease in a certain geographic area, for example, to show how long it takes for people to report illness or to help public health officials brace for next year’s tick season.\u003c/p>\n\u003cp>The researchers note that gathering data at this scale wouldn’t be possible without citizen scientists — and future studies of this type could help improve understanding of tick-borne disease.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>“It’s a great example of using citizen science to ask questions about the ecology of infectious disease,” says \u003ca href=\"https://profiles.stanford.edu/katharine-walter\" target=\"_blank\" rel=\"noopener\">Katharine Walter\u003c/a>, an epidemiologist at Stanford University who has studied the prevalence and spread of tick-borne diseases. Walter, who did not participate in the research, says that a longer-term project could yield real insights not just into disease, but climate change and human impacts on their environment.\u003c/p>\n\u003cp>“That’s the power of science,” says Walter. “I really believe that scientific research shouldn’t be just for scientists.”\u003c/p>\n\u003cp>The study’s authors admit there are some real limitations to their work. They didn’t find out if and where people had traveled before they found the ticks. Since ticks can hang out on the body for days, they could have traveled along with people or animals on the move and resulted in misreporting. Nieto says his team didn’t ask for the data out of privacy concerns and a desire to encourage participation.\u003c/p>\n\u003cp>Another limitation is that people who never hear about a citizen science initiative can’t participate, and the study wasn’t advertised beyond an initial PR campaign conducted by the \u003ca href=\"https://www.bayarealyme.org/\" target=\"_blank\" rel=\"noopener\">Bay Area Lyme Foundation\u003c/a>, which funded the project. Socioeconomic barriers to the internet may also have limited participants, and there’s no way to verify how many participants misreported information about the ticks that bit them.\u003c/p>\n\u003cp>What’s next for the tick collectors? First, says Nieto, they’ll dig deeper into the ticks’ DNA, and hopefully open up another wave of free tick analysis in an attempt to broaden the data even more. From there, says Nieto, it’s up to others to use the dataset for good.\u003c/p>\n\u003cp>“We have this information,” he says. “Now we need some technology or changes in behavior that are going to help us actually prevent infection.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Erin Blakemore is a science writer based in Boulder, Colo. \u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg decoding=\"async\" src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Researchers+Study+Thousands+Of+Ticks+Collected+By+The+People+They+Bit&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Could light one day be used to restore hearing loss?\u003c/p>\n\u003cp>To try to answer that question, a team of German bioengineers surgically installed coiled strips of optical fibers in the ears of deaf gerbils.\u003c/p>\n\u003cp>While they still had their hearing, the gerbils had learned to hurdle a small barrier upon hearing an alarm. Now researchers sent a pulse of blue laser light deep into the animals’ ears. They jumped.\u003c/p>\n\u003cp>The experiment was part of a \u003ca href=\"http://stm.sciencemag.org/content/10/449/eaaq1564\" target=\"_blank\" rel=\"noopener\">study\u003c/a> published Wednesday seeking to improve upon cochlear implants — electronic devices that stimulate auditory neurons to partially restore hearing. Instead of using electrical currents, scientists are trying to determine whether optogenetics, a new field that uses light to control living cells, could one day help improve someone’s sense of hearing.\u003c/p>\n\u003cp>Although it could take decades to use optogenetics-based technologies in humans, researchers are beginning to demonstrate that light, not electricity, may be the best way to convey the rich information contained in sound.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“Through my experience with patients, I’ve recognized the huge potential of cochlear implants,” said Tobias Moser, director of the Institute for Auditory Neuroscience at the University Medical Center Göttingen and lead author of the new study. “At the same time I’ve also witnessed the shortcomings.”\u003c/p>\n\u003cp>Patients with cochlear implants often describe the sound quality through the devices as harsh and tinny. Listening to music or picking out one voice from several others is often impossible. The goal of the new research, said Moser, is to improve the technology and create “a more natural hearing so that patients can recognize the melody in music and speech.”\u003c/p>\n\u003cp>At the most basic level, the act of hearing is transforming sound into electrochemical signals, the language of neurons, that the brain can then interpret.\u003c/p>\n\u003cp>Much of this process occurs in the cochlea, a snail-shaped organ within the inner ear lined with specialized sensory cells called hair cells. When hair cells detect vibration through thin protrusions on their surface, they generate electrical current in neighboring nerve cells that travel to the brain.\u003c/p>\n\u003cp>In people who have dysfunctional or dead hair cells, cochlear implants work by electrically stimulating auditory nerve cells directly.\u003c/p>\n\u003cp>According to Dan Polley, an associate professor at Harvard Medical School and director of the Lauer Tinnitus Research Center who was not involved in the study, the successes and limitations of the cochlear implant are determined by the anatomy of the inner ear.\u003c/p>\n\u003cp>Within the cochlea, hair cells rest on an organic platform known as the basilar membrane that is floppy and wide on one end and narrow and taut on the other. This biomechanical organization causes hair cells to wiggle in response to specific sound frequencies or pitches that are mapped out smoothly from low to high, like keys on a piano.\u003c/p>\n\u003cp>When implanting cochlear implants, Polley explained, surgeons thread electrodes into specific locations along the basilar membrane to target nerves that are sensitive to particular frequencies.\u003c/p>\n\u003cp>With cochlear implants, however, electrical current spreads itself over a large area and activates not only the targeted nerves but also neighboring cells as well. This impercision distorts and muffles sound.\u003c/p>\n\u003cp>Moser and other scientists believe that using light, which can be more finely targeted, will improve the performance of implants.\u003c/p>\n\u003cp>“Using electricity to control neurons is like playing the piano with your elbow,” said Polley. “Whereas light is better. It is more like playing the piano while wearing mittens.”\u003c/p>\n\u003cp>Auditory neurons normally don’t respond to light. However, the rapidly growing field of optogenetics has made this possible. The key is to genetically engineer neurons so that they contain light-sensitive proteins that are found elsewhere in nature including bacteria, algae, and the human eye.\u003c/p>\n\u003cp>Moser and his team of scientists performed this technique in adult Mongolian gerbils instead of mice or rats, which were used in previous studies. Gerbils, in contrast to other rodents, are a better proxy for humans because they hear low frequencies used by the human ear and have relatively large cochleas that are only two-and-a-half times smaller than those of humans.\u003c/p>\n\u003cp>The researchers also used a new version of light-sensitive proteins, called CatCh, to increase how quickly nerve cells could respond to light stimulation. Previous versions of the protein worked sluggishly to move ions in and out of neurons — a critical step in generating electrical signals to the brain conveying the rapidly changing characteristics of sound like loudness and pitch.\u003c/p>\n\u003cp>This really hampers our ability to “capture the dynamics of speech,” said Polley. “If you have to deliver pulses [of light] more slowly, you can’t keep up.”\u003c/p>\n\u003cp>To test how quickly neurons equipped with CatCh could process information, researchers exposed neurons to rapid bursts of laser light, up to 300 flashes per second. They observed that individual neurons and groups of neurons were able to keep pace with the flashes by releasing their own corresponding surges of electrical energy.\u003c/p>\n\u003cp>“This is a big improvement over our previous work, “ said Moser. The response “is quick and approaches physiological performance of normal neurons.”\u003c/p>\n\u003cp>Aside from faster processing, the neurons also showed a graded response to different intensities of light. This suggests that the gerbils could experience an accurate representation of loudness that is proportional to how strongly neurons are activated by light.\u003c/p>\n\u003cp>But how could researchers be sure that all this promising electrical activity was actually creating a sense of hearing in gerbils?\u003c/p>\n\u003cp>Scientists first surgically implanted a loop of optical fibers — a primitive prototype of high-tech cochlear implants that could one day be used in humans — into the gerbils’ inner ear. They then trained the animals to jump over a fence-like obstacle dividing two halves of a box. Once the gerbils learned this behavior, scientists deafened the animals, causing them to become unresponsive to the loudspeaker. However, when researchers pulsed blue laser light through the optic fiber, the gerbils leapt into the air again.\u003c/p>\n\u003cp>“It’s not hearing until you measure behavior,” said Polley. “Because hearing is a psychological property. [This experiment] shows that the animals generalize light stimulation to sound, they treat it as if it were sound.”\u003c/p>\n\u003cp>Despite these dramatic results, Moser is quick to point out that light-based cochlear implants are not ready for human use.\u003c/p>\n\u003cp>The most obvious hurdle is that installing light-sensitive proteins into cells requires genetic engineering. In the case of gerbils, scientists accomplished the feat by injecting viruses carrying specially designed DNA into the animals’ ears. While gene therapy is being used to treat certain diseases in clinical trials — and has been approved for a \u003ca href=\"https://www.statnews.com/2018/03/21/gene-therapy-luxturna-launch/\">rare form of blindness\u003c/a> — it remains a long way from reality for most conditions.\u003c/p>\n\u003cp>“Right now,” said Polley, “ I doubt anyone would suggest that you get this gene therapy instead of cochlear implants.”\u003c/p>\n\u003cp>Even if gene therapy was a proven technology, light-based implants have other restrictions. In humans, bioengineers imagine using tiny light-emitting diodes (LEDs) to stimulate genetically engineered auditory neurons. However these machines consume a lot of power and dissipate heat, making it unclear how patients would wear or operate such a device.\u003c/p>\n\u003cp>“Optogenetics is the most sophisticated way we have to stimulate nerves in the cochlea,” said Adrien Eshraghi, a professor at the Miller School of Medicine and director of the Hearing Research Laboratory at the University of Miami who was not involved with the study. “It is still [in] the early basics of science research, but I think optogenetics has a good future.”\u003c/p>\n\u003cp>Another source of optimism is the power of the brain to adapt to new signaling inputs.\u003c/p>\n\u003cp>In the case of cochlear implants, patients initially experience the human voice as high-pitched and scratchy (think Mickey Mouse) but adapt over time. Although researchers don’t know what light will sound like, they expect a similar adjustment process.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“At the end of the day for engineers,” said Polley, “the brain is the hero … it is one of the best players on their team because they don’t have to perfect the signal, they just have to make it reasonably good, and then the brain can take it the rest of the way.”\u003c/p>\n\u003cdiv> \u003cem>This\u003ca href=\"https://www.statnews.com/2018/07/11/optogenetics-hearing-gerbils-cochlear-implants/\" target=\"_blank\" rel=\"noopener\"> story\u003c/a> was originally published by STAT, an online publication of Boston Globe Media that covers health, medicine, and scientific discovery.\u003c/em>\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“Through my experience with patients, I’ve recognized the huge potential of cochlear implants,” said Tobias Moser, director of the Institute for Auditory Neuroscience at the University Medical Center Göttingen and lead author of the new study. “At the same time I’ve also witnessed the shortcomings.”\u003c/p>\n\u003cp>Patients with cochlear implants often describe the sound quality through the devices as harsh and tinny. Listening to music or picking out one voice from several others is often impossible. The goal of the new research, said Moser, is to improve the technology and create “a more natural hearing so that patients can recognize the melody in music and speech.”\u003c/p>\n\u003cp>At the most basic level, the act of hearing is transforming sound into electrochemical signals, the language of neurons, that the brain can then interpret.\u003c/p>\n\u003cp>Much of this process occurs in the cochlea, a snail-shaped organ within the inner ear lined with specialized sensory cells called hair cells. When hair cells detect vibration through thin protrusions on their surface, they generate electrical current in neighboring nerve cells that travel to the brain.\u003c/p>\n\u003cp>In people who have dysfunctional or dead hair cells, cochlear implants work by electrically stimulating auditory nerve cells directly.\u003c/p>\n\u003cp>According to Dan Polley, an associate professor at Harvard Medical School and director of the Lauer Tinnitus Research Center who was not involved in the study, the successes and limitations of the cochlear implant are determined by the anatomy of the inner ear.\u003c/p>\n\u003cp>Within the cochlea, hair cells rest on an organic platform known as the basilar membrane that is floppy and wide on one end and narrow and taut on the other. This biomechanical organization causes hair cells to wiggle in response to specific sound frequencies or pitches that are mapped out smoothly from low to high, like keys on a piano.\u003c/p>\n\u003cp>When implanting cochlear implants, Polley explained, surgeons thread electrodes into specific locations along the basilar membrane to target nerves that are sensitive to particular frequencies.\u003c/p>\n\u003cp>With cochlear implants, however, electrical current spreads itself over a large area and activates not only the targeted nerves but also neighboring cells as well. This impercision distorts and muffles sound.\u003c/p>\n\u003cp>Moser and other scientists believe that using light, which can be more finely targeted, will improve the performance of implants.\u003c/p>\n\u003cp>“Using electricity to control neurons is like playing the piano with your elbow,” said Polley. “Whereas light is better. It is more like playing the piano while wearing mittens.”\u003c/p>\n\u003cp>Auditory neurons normally don’t respond to light. However, the rapidly growing field of optogenetics has made this possible. The key is to genetically engineer neurons so that they contain light-sensitive proteins that are found elsewhere in nature including bacteria, algae, and the human eye.\u003c/p>\n\u003cp>Moser and his team of scientists performed this technique in adult Mongolian gerbils instead of mice or rats, which were used in previous studies. Gerbils, in contrast to other rodents, are a better proxy for humans because they hear low frequencies used by the human ear and have relatively large cochleas that are only two-and-a-half times smaller than those of humans.\u003c/p>\n\u003cp>The researchers also used a new version of light-sensitive proteins, called CatCh, to increase how quickly nerve cells could respond to light stimulation. Previous versions of the protein worked sluggishly to move ions in and out of neurons — a critical step in generating electrical signals to the brain conveying the rapidly changing characteristics of sound like loudness and pitch.\u003c/p>\n\u003cp>This really hampers our ability to “capture the dynamics of speech,” said Polley. “If you have to deliver pulses [of light] more slowly, you can’t keep up.”\u003c/p>\n\u003cp>To test how quickly neurons equipped with CatCh could process information, researchers exposed neurons to rapid bursts of laser light, up to 300 flashes per second. They observed that individual neurons and groups of neurons were able to keep pace with the flashes by releasing their own corresponding surges of electrical energy.\u003c/p>\n\u003cp>“This is a big improvement over our previous work, “ said Moser. The response “is quick and approaches physiological performance of normal neurons.”\u003c/p>\n\u003cp>Aside from faster processing, the neurons also showed a graded response to different intensities of light. This suggests that the gerbils could experience an accurate representation of loudness that is proportional to how strongly neurons are activated by light.\u003c/p>\n\u003cp>But how could researchers be sure that all this promising electrical activity was actually creating a sense of hearing in gerbils?\u003c/p>\n\u003cp>Scientists first surgically implanted a loop of optical fibers — a primitive prototype of high-tech cochlear implants that could one day be used in humans — into the gerbils’ inner ear. They then trained the animals to jump over a fence-like obstacle dividing two halves of a box. Once the gerbils learned this behavior, scientists deafened the animals, causing them to become unresponsive to the loudspeaker. However, when researchers pulsed blue laser light through the optic fiber, the gerbils leapt into the air again.\u003c/p>\n\u003cp>“It’s not hearing until you measure behavior,” said Polley. “Because hearing is a psychological property. [This experiment] shows that the animals generalize light stimulation to sound, they treat it as if it were sound.”\u003c/p>\n\u003cp>Despite these dramatic results, Moser is quick to point out that light-based cochlear implants are not ready for human use.\u003c/p>\n\u003cp>The most obvious hurdle is that installing light-sensitive proteins into cells requires genetic engineering. In the case of gerbils, scientists accomplished the feat by injecting viruses carrying specially designed DNA into the animals’ ears. While gene therapy is being used to treat certain diseases in clinical trials — and has been approved for a \u003ca href=\"https://www.statnews.com/2018/03/21/gene-therapy-luxturna-launch/\">rare form of blindness\u003c/a> — it remains a long way from reality for most conditions.\u003c/p>\n\u003cp>“Right now,” said Polley, “ I doubt anyone would suggest that you get this gene therapy instead of cochlear implants.”\u003c/p>\n\u003cp>Even if gene therapy was a proven technology, light-based implants have other restrictions. In humans, bioengineers imagine using tiny light-emitting diodes (LEDs) to stimulate genetically engineered auditory neurons. However these machines consume a lot of power and dissipate heat, making it unclear how patients would wear or operate such a device.\u003c/p>\n\u003cp>“Optogenetics is the most sophisticated way we have to stimulate nerves in the cochlea,” said Adrien Eshraghi, a professor at the Miller School of Medicine and director of the Hearing Research Laboratory at the University of Miami who was not involved with the study. “It is still [in] the early basics of science research, but I think optogenetics has a good future.”\u003c/p>\n\u003cp>Another source of optimism is the power of the brain to adapt to new signaling inputs.\u003c/p>\n\u003cp>In the case of cochlear implants, patients initially experience the human voice as high-pitched and scratchy (think Mickey Mouse) but adapt over time. Although researchers don’t know what light will sound like, they expect a similar adjustment process.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“At the end of the day for engineers,” said Polley, “the brain is the hero … it is one of the best players on their team because they don’t have to perfect the signal, they just have to make it reasonably good, and then the brain can take it the rest of the way.”\u003c/p>\n\u003cdiv> \u003cem>This\u003ca href=\"https://www.statnews.com/2018/07/11/optogenetics-hearing-gerbils-cochlear-implants/\" target=\"_blank\" rel=\"noopener\"> story\u003c/a> was originally published by STAT, an online publication of Boston Globe Media that covers health, medicine, and scientific discovery.\u003c/em>\u003c/div>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Breastfeeding remains the gold standard for infant nutrition across the world. And while the United States lags behind many developed nations, most U.S. states have significantly improved breastfeeding rates over the past decade.\u003c/p>\n\u003cp>\u003cstrong>Why Are We Talking About This?\u003c/strong>\u003c/p>\n\u003cp>On July 8, The New York Times reported the \u003ca href=\"https://www.nytimes.com/2018/07/08/health/world-health-breastfeeding-ecuador-trump.html\">Trump administration opposed a breastfeeding policy\u003c/a> Ecuador planned to introduce during the World Health Assembly. Under pressure from the infant formula industry, U.S. officials threatened retaliatory trade and military measures if Ecuador moved forward, according to the Times. Ultimately, Russia introduced the policy, which the United Nations-affiliated body then passed largely intact.\u003c/p>\n\u003cp>In a \u003ca href=\"https://twitter.com/realDonaldTrump/status/1016367395294908421\">tweet\u003c/a> Monday, President Donald Trump criticized the Times’ coverage of the story. He suggested the reporting was false, but then said: “The U.S. strongly supports breastfeeding but we don’t believe women should be denied access to formula. Many women need this option because of malnutrition and poverty.”\u003c/p>\n\u003cp>These reports shocked physicians and public health advocates in the United States and around the world and stood in stark contrast to decades of infant and maternal research and guidelines. In war zones and during humanitarian crises, infant formula makes sense, said Gayle Tzemach Lemmon, an author and senior fellow at the Council on Foreign Relations, \u003ca href=\"https://www.cnn.com/2017/08/12/opinions/global-breastfeeding-policies-opinion-lemmon/index.html?\">in this piece\u003c/a>. In those extreme cases, access to formula should be provided.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>But research has long shown that breastfeeding is the best way to \u003ca href=\"https://medlineplus.gov/ency/patientinstructions/000803.htm\">nourish an infant\u003c/a>, boost their \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/9892025\">immune system\u003c/a>, prevent them from being sick or becoming \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/19693959\">overweight or obese\u003c/a> and forge \u003ca href=\"https://www.ncbi.nlm.nih.gov/books/NBK52687/\">bonding between mother and child\u003c/a>. It can also help maternal health. And, experts said after the president’s remarks, low-income and impoverished areas are where breastfeeding can make the biggest improvements.\u003c/p>\n\u003cp>\u003cstrong>Where Does the U.S. Stand?\u003c/strong>\u003c/p>\n\u003cp>Despite having one of the \u003ca href=\"http://www.oecd.org/els/family/database.htm\">lowest breastfeeding initiation rates among industrialized countries\u003c/a> — it ranked 26th, according to the latest available data from the Organisation for Economic Co-operation and Development — breastfeeding rates in the U.S. improved nationwide and in nearly every state between 2007 and 2016, according to the latest available CDC data.\u003c/p>\n\u003cp>In 2007, nearly 74 percent of U.S. women said they had ever breastfed, according to results from the CDC’s National Immunization Survey. A decade later, that number rose to 81 percent of American women. And the rate of women who said they continued breastfeeding at six months, consistent with recommendations from the WHO, rose from 42 percent to 52 percent by 2016.\u003c/p>\n\u003cp>Most states revealed increases of 10-percentage points or more among women who said they had ever breastfed during the same time period. Utah reported the highest breastfeeding rate — 94 percent — while just over half of Mississippi mothers said they had tried to breastfeed their children. Three states — Vermont, Washington and Tennessee — slipped slightly.\u003c/p>\n\u003cp>\u003cstrong>Why it Matters?\u003c/strong>\u003c/p>\n\u003cp>“Breastfeeding is one of the most cost-effective interventions for improving maternal and child health,” said Georges Benjamin, executive director for the American Public Health Association, in a released statement.\u003c/p>\n\u003cp>But in the U.S., \u003ca href=\"https://www.cdc.gov/mmwr/volumes/66/wr/mm6627a3.htm\">disparities in race, income and geography\u003c/a> underscore the work that’s left to do to support U.S. mothers who want to give their infants breastmilk.\u003c/p>\n\u003cp>In 2014, the World Health Organization challenged the global community to raise by 2025 the number of babies who were \u003ca href=\"http://apps.who.int/iris/bitstream/handle/10665/149022/WHO_NMH_NHD_14.7_eng.pdf;jsessionid=46F03474C750F2F4847BA40C1F94BD52?sequence=1\">exclusively breastfed during their first six months\u003c/a> by 50 percent. The Centers for Disease Control and Prevention also recognizes breast milk “as the \u003ca href=\"https://www.cdc.gov/breastfeeding/resources/us-breastfeeding-rates.html\">best source of nutrition for most infants\u003c/a>.”\u003c/p>\n\u003cp>Some places in the U.S. have spearheaded their own efforts to improve breastfeeding rates. The Make The Breast Pump Not Suck Hackathon at the Massachusetts Institute for Technology is an annual event that gives grants to projects that would improve access to breast feeding, from designing better breast pumps to improving social policies. In 2016, San Francisco took steps to ensure \u003ca href=\"http://www.populationsciences.berkeley.edu/sites/default/files/SF%20Paid%20Parental%20Leave%20-%20UC%20Berkeley%20issue%20brief%201.pdf\">paid parental leave\u003c/a>, something advocates suggest could further improve breastfeeding rates. The United States remains the \u003ca href=\"https://www.oecd.org/els/soc/PF2_1_Parental_leave_systems.pdf\">only developed nation without mandated paid maternity leave\u003c/a>, according to the OECD.\u003c/p>\n\u003cp>Catherine D’Ignazio, who founded the hackathon event in 2014, said the reality is that many people still “don’t have access to making that choice” to breastfeed.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cimg class=\"extendsBeyondTextColumn aligncenter\" src=\"https://d3i6fh83elv35t.cloudfront.net/static/2018/07/breastfeed-graphic.jpg\" alt=\"\" width=\"1031\" height=\"4685\">\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Breastfeeding remains the gold standard for infant nutrition across the world. And while the United States lags behind many developed nations, most U.S. states have significantly improved breastfeeding rates over the past decade.\u003c/p>\n\u003cp>\u003cstrong>Why Are We Talking About This?\u003c/strong>\u003c/p>\n\u003cp>On July 8, The New York Times reported the \u003ca href=\"https://www.nytimes.com/2018/07/08/health/world-health-breastfeeding-ecuador-trump.html\">Trump administration opposed a breastfeeding policy\u003c/a> Ecuador planned to introduce during the World Health Assembly. Under pressure from the infant formula industry, U.S. officials threatened retaliatory trade and military measures if Ecuador moved forward, according to the Times. Ultimately, Russia introduced the policy, which the United Nations-affiliated body then passed largely intact.\u003c/p>\n\u003cp>In a \u003ca href=\"https://twitter.com/realDonaldTrump/status/1016367395294908421\">tweet\u003c/a> Monday, President Donald Trump criticized the Times’ coverage of the story. He suggested the reporting was false, but then said: “The U.S. strongly supports breastfeeding but we don’t believe women should be denied access to formula. Many women need this option because of malnutrition and poverty.”\u003c/p>\n\u003cp>These reports shocked physicians and public health advocates in the United States and around the world and stood in stark contrast to decades of infant and maternal research and guidelines. In war zones and during humanitarian crises, infant formula makes sense, said Gayle Tzemach Lemmon, an author and senior fellow at the Council on Foreign Relations, \u003ca href=\"https://www.cnn.com/2017/08/12/opinions/global-breastfeeding-policies-opinion-lemmon/index.html?\">in this piece\u003c/a>. In those extreme cases, access to formula should be provided.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>But research has long shown that breastfeeding is the best way to \u003ca href=\"https://medlineplus.gov/ency/patientinstructions/000803.htm\">nourish an infant\u003c/a>, boost their \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/9892025\">immune system\u003c/a>, prevent them from being sick or becoming \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/19693959\">overweight or obese\u003c/a> and forge \u003ca href=\"https://www.ncbi.nlm.nih.gov/books/NBK52687/\">bonding between mother and child\u003c/a>. It can also help maternal health. And, experts said after the president’s remarks, low-income and impoverished areas are where breastfeeding can make the biggest improvements.\u003c/p>\n\u003cp>\u003cstrong>Where Does the U.S. Stand?\u003c/strong>\u003c/p>\n\u003cp>Despite having one of the \u003ca href=\"http://www.oecd.org/els/family/database.htm\">lowest breastfeeding initiation rates among industrialized countries\u003c/a> — it ranked 26th, according to the latest available data from the Organisation for Economic Co-operation and Development — breastfeeding rates in the U.S. improved nationwide and in nearly every state between 2007 and 2016, according to the latest available CDC data.\u003c/p>\n\u003cp>In 2007, nearly 74 percent of U.S. women said they had ever breastfed, according to results from the CDC’s National Immunization Survey. A decade later, that number rose to 81 percent of American women. And the rate of women who said they continued breastfeeding at six months, consistent with recommendations from the WHO, rose from 42 percent to 52 percent by 2016.\u003c/p>\n\u003cp>Most states revealed increases of 10-percentage points or more among women who said they had ever breastfed during the same time period. Utah reported the highest breastfeeding rate — 94 percent — while just over half of Mississippi mothers said they had tried to breastfeed their children. Three states — Vermont, Washington and Tennessee — slipped slightly.\u003c/p>\n\u003cp>\u003cstrong>Why it Matters?\u003c/strong>\u003c/p>\n\u003cp>“Breastfeeding is one of the most cost-effective interventions for improving maternal and child health,” said Georges Benjamin, executive director for the American Public Health Association, in a released statement.\u003c/p>\n\u003cp>But in the U.S., \u003ca href=\"https://www.cdc.gov/mmwr/volumes/66/wr/mm6627a3.htm\">disparities in race, income and geography\u003c/a> underscore the work that’s left to do to support U.S. mothers who want to give their infants breastmilk.\u003c/p>\n\u003cp>In 2014, the World Health Organization challenged the global community to raise by 2025 the number of babies who were \u003ca href=\"http://apps.who.int/iris/bitstream/handle/10665/149022/WHO_NMH_NHD_14.7_eng.pdf;jsessionid=46F03474C750F2F4847BA40C1F94BD52?sequence=1\">exclusively breastfed during their first six months\u003c/a> by 50 percent. The Centers for Disease Control and Prevention also recognizes breast milk “as the \u003ca href=\"https://www.cdc.gov/breastfeeding/resources/us-breastfeeding-rates.html\">best source of nutrition for most infants\u003c/a>.”\u003c/p>\n\u003cp>Some places in the U.S. have spearheaded their own efforts to improve breastfeeding rates. The Make The Breast Pump Not Suck Hackathon at the Massachusetts Institute for Technology is an annual event that gives grants to projects that would improve access to breast feeding, from designing better breast pumps to improving social policies. In 2016, San Francisco took steps to ensure \u003ca href=\"http://www.populationsciences.berkeley.edu/sites/default/files/SF%20Paid%20Parental%20Leave%20-%20UC%20Berkeley%20issue%20brief%201.pdf\">paid parental leave\u003c/a>, something advocates suggest could further improve breastfeeding rates. The United States remains the \u003ca href=\"https://www.oecd.org/els/soc/PF2_1_Parental_leave_systems.pdf\">only developed nation without mandated paid maternity leave\u003c/a>, according to the OECD.\u003c/p>\n\u003cp>Catherine D’Ignazio, who founded the hackathon event in 2014, said the reality is that many people still “don’t have access to making that choice” to breastfeed.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cimg class=\"extendsBeyondTextColumn aligncenter\" src=\"https://d3i6fh83elv35t.cloudfront.net/static/2018/07/breastfeed-graphic.jpg\" alt=\"\" width=\"1031\" height=\"4685\">\u003c/p>\n\n\u003c/div>\u003c/p>",
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"order": 3
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},
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"info": "The day's top stories from BBC News compiled twice daily in the week, once at weekends.",
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"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/BBC-World-Service-Podcast-Tile-360x360-1.jpg",
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},
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"rss": "https://podcasts.files.bbci.co.uk/p02nq0gn.rss"
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},
"californiareport": {
"id": "californiareport",
"title": "The California Report",
"tagline": "California, day by day",
"info": "KQED’s statewide radio news program providing daily coverage of issues, trends and public policy decisions.",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/The-California-Report-Podcast-Tile-703x703-1.jpg",
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"officialWebsiteLink": "/californiareport",
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"source": "kqed",
"order": 8
},
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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.",
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"order": 10
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM3NjkwNjk1OTAz",
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"info": "A one-hour radio program to hear celebrated writers, artists and thinkers address contemporary ideas and values, often discussing the creative process. Please note: tapes or transcripts are not available",
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"airtime": "SUN 1pm-2pm, TUE 10pm, WED 1am",
"meta": {
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"source": "City Arts & Lectures"
},
"link": "https://www.cityarts.net",
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},
"closealltabs": {
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"order": 1
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"info": "\u003cem>Code Switch\u003c/em>, which listeners will hear in the first part of the hour, has fearless and much-needed conversations about race. Hosted by journalists of color, the show tackles the subject of race head-on, exploring how it impacts every part of society — from politics and pop culture to history, sports and more.\u003cbr />\u003cbr />\u003cem>Life Kit\u003c/em>, which will be in the second part of the hour, guides you through spaces and feelings no one prepares you for — from finances to mental health, from workplace microaggressions to imposter syndrome, from relationships to parenting. The show features experts with real world experience and shares their knowledge. Because everyone needs a little help being human.\u003cbr />\u003cbr />\u003ca href=\"https://www.npr.org/podcasts/510312/codeswitch\">\u003cem>Code Switch\u003c/em> offical site and podcast\u003c/a>\u003cbr />\u003ca href=\"https://www.npr.org/lifekit\">\u003cem>Life Kit\u003c/em> offical site and podcast\u003c/a>\u003cbr />",
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"id": "commonwealth-club",
"title": "Commonwealth Club of California Podcast",
"info": "The Commonwealth Club of California is the nation's oldest and largest public affairs forum. As a non-partisan forum, The Club brings to the public airwaves diverse viewpoints on important topics. The Club's weekly radio broadcast - the oldest in the U.S., dating back to 1924 - is carried across the nation on public radio stations and is now podcasting. Our website archive features audio of our recent programs, as well as selected speeches from our long and distinguished history. This podcast feed is usually updated twice a week and is always un-edited.",
"airtime": "THU 10pm, FRI 1am",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Commonwealth-Club-Podcast-Tile-360x360-1.jpg",
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"source": "Commonwealth Club of California"
},
"link": "/radio/program/commonwealth-club",
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"google": "https://podcasts.google.com/feed/aHR0cDovL3d3dy5jb21tb253ZWFsdGhjbHViLm9yZy9hdWRpby9wb2RjYXN0L3dlZWtseS54bWw",
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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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"source": "kqed",
"order": 9
},
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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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},
"fresh-air": {
"id": "fresh-air",
"title": "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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"here-and-now": {
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"info": "A live production of NPR and WBUR Boston, in collaboration with stations across the country, Here & Now reflects the fluid world of news as it's happening in the middle of the day, with timely, in-depth news, interviews and conversation. Hosted by Robin Young, Jeremy Hobson and Tonya Mosley.",
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"hidden-brain": {
"id": "hidden-brain",
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"info": "Shankar Vedantam uses science and storytelling to reveal the unconscious patterns that drive human behavior, shape our choices and direct our relationships.",
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"airtime": "SUN 7pm-8pm",
"meta": {
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"source": "NPR"
},
"link": "/radio/program/hidden-brain",
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},
"how-i-built-this": {
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"title": "How I Built This with Guy Raz",
"info": "Guy Raz dives into the stories behind some of the world's best known companies. How I Built This weaves a narrative journey about innovators, entrepreneurs and idealists—and the movements they built.",
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"airtime": "SUN 7:30pm-8pm",
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"link": "/radio/program/how-i-built-this",
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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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"order": 15
},
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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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"order": 18
},
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},
"latino-usa": {
"id": "latino-usa",
"title": "Latino USA",
"airtime": "MON 1am-2am, SUN 6pm-7pm",
"info": "Latino USA, the radio journal of news and culture, is the only national, English-language radio program produced from a Latino perspective.",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/latinoUsa.jpg",
"officialWebsiteLink": "http://latinousa.org/",
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},
"link": "/radio/program/latino-usa",
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"apple": "https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=79681317&at=11l79Y&ct=nprdirectory",
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"rss": "https://feeds.npr.org/510016/podcast.xml"
}
},
"marketplace": {
"id": "marketplace",
"title": "Marketplace",
"info": "Our flagship program, helmed by Kai Ryssdal, examines what the day in money delivered, through stories, conversations, newsworthy numbers and more. Updated Monday through Friday at about 3:30 p.m. PT.",
"airtime": "MON-FRI 4pm-4:30pm, MON-WED 6:30pm-7pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Marketplace-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.marketplace.org/",
"meta": {
"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"
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},
"masters-of-scale": {
"id": "masters-of-scale",
"title": "Masters of Scale",
"info": "Masters of Scale is an original podcast in which LinkedIn co-founder and Greylock Partner Reid Hoffman sets out to describe and prove theories that explain how great entrepreneurs take their companies from zero to a gazillion in ingenious fashion.",
"airtime": "Every other Wednesday June 12 through October 16 at 8pm (repeats Thursdays at 2am)",
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"officialWebsiteLink": "https://mastersofscale.com/",
"meta": {
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"source": "WaitWhat"
},
"link": "/radio/program/masters-of-scale",
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"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",
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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",
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}
},
"morning-edition": {
"id": "morning-edition",
"title": "Morning Edition",
"info": "\u003cem>Morning Edition\u003c/em> takes listeners around the country and the world with multi-faceted stories and commentaries every weekday. Hosts Steve Inskeep, David Greene and Rachel Martin bring you the latest breaking news and features to prepare you for the day.",
"airtime": "MON-FRI 3am-9am",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Morning-Edition-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.npr.org/programs/morning-edition/",
"meta": {
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},
"link": "/radio/program/morning-edition"
},
"onourwatch": {
"id": "onourwatch",
"title": "On Our Watch",
"tagline": "Deeply-reported investigative journalism",
"info": "For decades, the process for how police police themselves has been inconsistent – if not opaque. In some states, like California, these proceedings were completely hidden. After a new police transparency law unsealed scores of internal affairs files, our reporters set out to examine these cases and the shadow world of police discipline. On Our Watch brings listeners into the rooms where officers are questioned and witnesses are interrogated to find out who this system is really protecting. Is it the officers, or the public they've sworn to serve?",
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