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"content": "\u003cp class=\"danger-zone\">In the lead-up to the 2016 U.S. election, Russian bots and trolls took to Twitter and other social media platforms to try to turn Americans against one another. But in addition to spreading false information and interfering in the election, a new study reports, a significant number of these malevolent actors tried to sow discord over vaccines.[contextly_sidebar id=\"U9m2Xosa038xtsfDSwPz5O7TUvqWe42O\"]\u003c/p>\n\u003cp class=\"danger-zone\">An \u003ca href=\"https://ajph.aphapublications.org/doi/10.2105/AJPH.2018.304567\" target=\"_blank\" rel=\"noopener\">analysis of Twitter accounts\u003c/a> previously identified as having been operated by Russian bots and trolls found they dove into the vaccine debate as early as January 2015, the researchers reported. They did not take one side or the other, but seemed to tweet pro-vaccine and anti-vaccine messages in roughly equal measure.\u003c/p>\n\u003cp class=\"danger-zone\">On a variety of issues, the overall aim of the Russian campaign appeared to be to erode social cohesion and generate confusion by amplifying the number of voices taking part in these debates on social media. But in the case of vaccines, that could have increased the misperception that the science on their safety and effectiveness isn’t settled — as is the case — but rather that it is still subject to debate.\u003c/p>\n\u003cp class=\"\">“We do have a very strong suspicion that these accounts were attempting to generate discord,” said David Broniatowski, assistant professor in George Washington University’s department of engineering management and systems engineering and lead author of the study.\u003c/p>\n\u003cp>In the study, published Thursday in the American Journal of Public Health, Broniatowski and his co-authors focused on Twitter, analyzing tweets from accounts that had been identified as having been operated by Russian trolls, bots, and so-called content polluters whose aim is to disseminate spam and malware. The article is titled “Weaponized Health Communications: Twitter Bots and Russian Trolls Amplify the Vaccine Debate.”[contextly_sidebar id=\"9QtW5fawtVoxY4YEBFmA2GatrjvQlfvd\"]\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The researchers compared tweets from the accounts to a selection of tweets from other users to see if the trolls and bots commented on vaccines more frequently than average Twitter accounts. They did.\u003c/p>\n\u003cp>“We found that, yeah, indeed, this was something that does seem to be part of the lexicon of what some of these bots and trolls use,” Broniatowski told STAT.\u003c/p>\n\u003cp>Even though the division of pro- and anti-vacccine tweets was roughly equal, that still skewed the picture of views on vaccines on Twitter, he noted, pointing to \u003ca href=\"http://www.pewinternet.org/2017/02/02/vast-majority-of-americans-say-benefits-of-childhood-vaccines-outweigh-risks/\" target=\"_blank\" rel=\"noopener\">data from the Pew Trust\u003c/a> that shows the vast majority of Americans support vaccination.\u003c/p>\n\u003cp>“We’ve always been a little puzzled why social media looks like there are so many anti-vaxxers,” said Broniatowski. “So even if somebody’s posting 50-50, compared to the Pew data, there are going to be more anti-vaxxers.”\u003c/p>\n\u003cp>Dr. Amesh Adalja, an infectious diseases physician and senior scholar at the Center for Health Security at Johns Hopkins Bloomberg School of Public Health, said any skepticism about the safety of vaccines risks feeding the concerns of parents who are worried about having their children vaccinated.\u003c/p>\n\u003cp>“The more the vaccine ‘debate’… is amplified it gains an undeserved sense of legitimacy and gives vaccine-hesitant individuals a pretense to forgo vaccination for themselves and their children,” said Adalja, who was harshly critical of the use of vaccinations in efforts to turn people against each other, calling it “overtly nihilistic.”\u003c/p>\n\u003cp>A spokesman for Twitter said that malicious accounts “are likely to target virtually any high profile conversation, since that’s where the views are.”[contextly_sidebar id=\"Q4N5GXoIo4iApYaASdjmnyeqp8POWr3L\"]\u003c/p>\n\u003cp>The spokesman, Ian Plunkett, told STAT that Twitter has aggressively ramped up preventive measures to try to keep such content from general users. In May, he noted, the platform identified and challenged nearly 10 million potentially automated accounts. “We put preemptive measures in place to ensure automated content is filtered from discoverable areas of the services — like trends and search. It’s possible that may users did not see this content before it was suspended,” Plunkett said.\u003c/p>\n\u003cp>Other experts, too, were unsurprised that Russian trolls and bots would delve into vaccines discussions, given the heat the topic can generate.\u003c/p>\n\u003cp>“Vaccination links to deep values around protection, health, harm, and the social contract,” said Julie Leask, an associate professor at the University of Sydney’s Susan Wakil School of Nursing and Midwifery who researches vaccine refusal. “People become highly invested in the discussion, and highly reactive to the notion that people refuse vaccines. The expression of sentiment at the margins — very pro- and very anti-vaccine — generates emotional energy and clicks.”\u003c/p>\n\u003cp>Adam Dunn, an associate professor in the Center for Health Informatics at Australia’s Macquarie University, said responding to this type of activity by internet bots and trolls would be challenging for public health authorities and may rely on the rooting out of the malicious accounts.\u003c/p>\n\u003cp>“The responsibility of managing the health of online conversations may … fall to Twitter itself, and work like this demonstrating the potential for real harm to human health provides a strong impetus for Twitter to act more often and more quickly to identify, isolate, or remove bots and trolls,” Dunn said.\u003c/p>\n\u003cp>Many of the accounts Broniatowski’s group studied have since been shut down, he said. But freeing the Twitter platform of bots and trolls is like playing whack-a-mole, he suggested.\u003c/p>\n\u003cp>For her part, Leask wasn’t certain how Twitter would have an outsized impact on vaccination decisions.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“When parents decide not to vaccinate, the decision isn’t usually taken lightly and a few tweets from bots are unlikely to change this trajectory,” she said. “The decision process is much more complex and centered on beliefs, experience and notions of what it means to be a ‘good parent’ held within that community. What we still need to establish is the relative role of social media independent of the influence of peer networks.”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp class=\"danger-zone\">In the lead-up to the 2016 U.S. election, Russian bots and trolls took to Twitter and other social media platforms to try to turn Americans against one another. But in addition to spreading false information and interfering in the election, a new study reports, a significant number of these malevolent actors tried to sow discord over vaccines.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp class=\"danger-zone\">An \u003ca href=\"https://ajph.aphapublications.org/doi/10.2105/AJPH.2018.304567\" target=\"_blank\" rel=\"noopener\">analysis of Twitter accounts\u003c/a> previously identified as having been operated by Russian bots and trolls found they dove into the vaccine debate as early as January 2015, the researchers reported. They did not take one side or the other, but seemed to tweet pro-vaccine and anti-vaccine messages in roughly equal measure.\u003c/p>\n\u003cp class=\"danger-zone\">On a variety of issues, the overall aim of the Russian campaign appeared to be to erode social cohesion and generate confusion by amplifying the number of voices taking part in these debates on social media. But in the case of vaccines, that could have increased the misperception that the science on their safety and effectiveness isn’t settled — as is the case — but rather that it is still subject to debate.\u003c/p>\n\u003cp class=\"\">“We do have a very strong suspicion that these accounts were attempting to generate discord,” said David Broniatowski, assistant professor in George Washington University’s department of engineering management and systems engineering and lead author of the study.\u003c/p>\n\u003cp>In the study, published Thursday in the American Journal of Public Health, Broniatowski and his co-authors focused on Twitter, analyzing tweets from accounts that had been identified as having been operated by Russian trolls, bots, and so-called content polluters whose aim is to disseminate spam and malware. The article is titled “Weaponized Health Communications: Twitter Bots and Russian Trolls Amplify the Vaccine Debate.”\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>The researchers compared tweets from the accounts to a selection of tweets from other users to see if the trolls and bots commented on vaccines more frequently than average Twitter accounts. They did.\u003c/p>\n\u003cp>“We found that, yeah, indeed, this was something that does seem to be part of the lexicon of what some of these bots and trolls use,” Broniatowski told STAT.\u003c/p>\n\u003cp>Even though the division of pro- and anti-vacccine tweets was roughly equal, that still skewed the picture of views on vaccines on Twitter, he noted, pointing to \u003ca href=\"http://www.pewinternet.org/2017/02/02/vast-majority-of-americans-say-benefits-of-childhood-vaccines-outweigh-risks/\" target=\"_blank\" rel=\"noopener\">data from the Pew Trust\u003c/a> that shows the vast majority of Americans support vaccination.\u003c/p>\n\u003cp>“We’ve always been a little puzzled why social media looks like there are so many anti-vaxxers,” said Broniatowski. “So even if somebody’s posting 50-50, compared to the Pew data, there are going to be more anti-vaxxers.”\u003c/p>\n\u003cp>Dr. Amesh Adalja, an infectious diseases physician and senior scholar at the Center for Health Security at Johns Hopkins Bloomberg School of Public Health, said any skepticism about the safety of vaccines risks feeding the concerns of parents who are worried about having their children vaccinated.\u003c/p>\n\u003cp>“The more the vaccine ‘debate’… is amplified it gains an undeserved sense of legitimacy and gives vaccine-hesitant individuals a pretense to forgo vaccination for themselves and their children,” said Adalja, who was harshly critical of the use of vaccinations in efforts to turn people against each other, calling it “overtly nihilistic.”\u003c/p>\n\u003cp>A spokesman for Twitter said that malicious accounts “are likely to target virtually any high profile conversation, since that’s where the views are.”\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>The spokesman, Ian Plunkett, told STAT that Twitter has aggressively ramped up preventive measures to try to keep such content from general users. In May, he noted, the platform identified and challenged nearly 10 million potentially automated accounts. “We put preemptive measures in place to ensure automated content is filtered from discoverable areas of the services — like trends and search. It’s possible that may users did not see this content before it was suspended,” Plunkett said.\u003c/p>\n\u003cp>Other experts, too, were unsurprised that Russian trolls and bots would delve into vaccines discussions, given the heat the topic can generate.\u003c/p>\n\u003cp>“Vaccination links to deep values around protection, health, harm, and the social contract,” said Julie Leask, an associate professor at the University of Sydney’s Susan Wakil School of Nursing and Midwifery who researches vaccine refusal. “People become highly invested in the discussion, and highly reactive to the notion that people refuse vaccines. The expression of sentiment at the margins — very pro- and very anti-vaccine — generates emotional energy and clicks.”\u003c/p>\n\u003cp>Adam Dunn, an associate professor in the Center for Health Informatics at Australia’s Macquarie University, said responding to this type of activity by internet bots and trolls would be challenging for public health authorities and may rely on the rooting out of the malicious accounts.\u003c/p>\n\u003cp>“The responsibility of managing the health of online conversations may … fall to Twitter itself, and work like this demonstrating the potential for real harm to human health provides a strong impetus for Twitter to act more often and more quickly to identify, isolate, or remove bots and trolls,” Dunn said.\u003c/p>\n\u003cp>Many of the accounts Broniatowski’s group studied have since been shut down, he said. But freeing the Twitter platform of bots and trolls is like playing whack-a-mole, he suggested.\u003c/p>\n\u003cp>For her part, Leask wasn’t certain how Twitter would have an outsized impact on vaccination decisions.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“When parents decide not to vaccinate, the decision isn’t usually taken lightly and a few tweets from bots are unlikely to change this trajectory,” she said. “The decision process is much more complex and centered on beliefs, experience and notions of what it means to be a ‘good parent’ held within that community. What we still need to establish is the relative role of social media independent of the influence of peer networks.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "For Cervical Cancer Screening, Women Over 30 Can Now Choose HPV Test Only",
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"content": "\u003cp>Federal health advisers say women can now consider three options when it's time for their cervical cancer screening tests. The influential group, the U.S. Preventive Services Task Force, has expanded its recommendations for this potentially lifesaving exam.\u003c/p>\n\u003cp>The new recommendations \u003ca href=\"http://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2018.10897\" target=\"_blank\" rel=\"noopener\">are published\u003c/a> in the latest issue of \u003cem>JAMA.\u003c/em>\u003c/p>\n\u003cp>\u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0022605/\" target=\"_blank\" rel=\"noopener\">Pap smears\u003c/a> have saved many lives since they became available decades ago. Inspecting samples of cervical tissue for precancerous changes is effective at catching possible cancer and is still the go-to test for women ages 21 to 29, according to the USPSTF guidelines.\u003c/p>\n\u003cp>But there's another option. \"Most cervical cancer is caused by what's called the human papillomavirus, or HPV,\" says \u003ca href=\"https://profiles.stanford.edu/douglas-owens\" target=\"_blank\" rel=\"noopener\">Dr. Douglas Owens\u003c/a>, a professor of medicine at Stanford University and vice chair of the USPSTF. \"And we now have tests for HPV and that's an important step forward.\"\u003c/p>\n\u003cp>These tests are available alone or in combination with the Pap test. And the USPSTF now says \u003ca href=\"https://www.npr.org/sections/health-shots/2018/07/03/625696664/for-women-over-30-there-may-be-a-better-choice-than-the-pap-smear\" target=\"_blank\" rel=\"noopener\">the evidence\u003c/a> is strong enough that HPV tests can be used by themselves, for women over 30. That third choice expands on the task force's previous recommendation, which was for the Pap test or the combination test.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>And while Pap tests should be repeated every three years, women can wait five years between HPV tests.\u003c/p>\n\u003cp>\"Five years is a good balance between the benefits and harms,\" Owens says. \"It's still highly effective at detecting cancer, and screening more frequently than that may increase some of the potential harms, so we think that's a good interval.\"\u003c/p>\n\u003cp>Potential harms of too frequent screening include unnecessary follow-ups such as biopsies. In a draft recommendation released last year, the task force had considered suggesting just two options, either the Pap smear or the HPV test, but its final recommendation included the hybrid test too.\u003c/p>\n\u003cp>\"The HPV test alone is not available everywhere,\" Owens explains. \"And so we want to be sure that women no matter where they're receiving care have options for cervical cancer screening.\"\u003c/p>\n\u003cp>He says the combination test is widely available, as is the Pap test, \"so all of those are good options and a woman can discuss with her physician what's available at the place where she's receiving care.\"\u003c/p>\n\u003cp>Women may not notice the difference between tests because tissue samples are all collected the same way. But \u003ca href=\"http://pressroom.cancer.org/debbiesaslow\" target=\"_blank\" rel=\"noopener\">Debbie Saslow\u003c/a>, senior director for HPV-related and women's cancers at the American Cancer Society, says if women have a choice, she would recommend the HPV test for women over 30.\u003c/p>\n\u003cp>\"I truly believe that including the HPV test, either along with the Pap or instead of the Pap, is superior than the Pap alone,\" she says. There's some evidence the HPV test is better than the Pap test at detecting a less common form of cervical cancer, adenocarcinoma, she says. \"So wouldn't you rather find the two most common cancers instead of just the one most common type?\"\u003c/p>\n\u003cp>The task force emphasizes that all three tests are highly effective. The overarching recommendation is simply that women should get screened, and to do so regularly until the age of 65. If screening has been adequate up to that point, the task force says women do not need further cervical cancer screening.\u003c/p>\n\u003cp>Health officials also recommend the HPV vaccine, which is given to girls and young women, up to age 26. (Boys and young men are encouraged to get the HPV vaccine as well.) But Owens says a vaccine alone doesn't replace cervical cancer screening.\u003c/p>\n\u003cp>\"Our recommendation applies to everyone whether you've been vaccinated or not,\" he says. \"It's very important that women do not forgo screening because they've been vaccinated.\"\u003c/p>\n\u003cp>An effective vaccine could ultimately render cervical cancer screening unnecessary, but that change will require careful study and could be years away.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>You can reach Richard Harris at \u003c/em>\u003ca href=\"mailto:rharris@npr.org\" target=\"_blank\" rel=\"noopener\">rharris@npr.org\u003c/a>.\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=For+Cervical+Cancer+Screening%2C+Women+Over+30+Can+Now+Choose+The+HPV+Test+Only&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Federal health advisers say women can now consider three options when it's time for their cervical cancer screening tests. The influential group, the U.S. Preventive Services Task Force, has expanded its recommendations for this potentially lifesaving exam.\u003c/p>\n\u003cp>The new recommendations \u003ca href=\"http://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2018.10897\" target=\"_blank\" rel=\"noopener\">are published\u003c/a> in the latest issue of \u003cem>JAMA.\u003c/em>\u003c/p>\n\u003cp>\u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0022605/\" target=\"_blank\" rel=\"noopener\">Pap smears\u003c/a> have saved many lives since they became available decades ago. Inspecting samples of cervical tissue for precancerous changes is effective at catching possible cancer and is still the go-to test for women ages 21 to 29, according to the USPSTF guidelines.\u003c/p>\n\u003cp>But there's another option. \"Most cervical cancer is caused by what's called the human papillomavirus, or HPV,\" says \u003ca href=\"https://profiles.stanford.edu/douglas-owens\" target=\"_blank\" rel=\"noopener\">Dr. Douglas Owens\u003c/a>, a professor of medicine at Stanford University and vice chair of the USPSTF. \"And we now have tests for HPV and that's an important step forward.\"\u003c/p>\n\u003cp>These tests are available alone or in combination with the Pap test. And the USPSTF now says \u003ca href=\"https://www.npr.org/sections/health-shots/2018/07/03/625696664/for-women-over-30-there-may-be-a-better-choice-than-the-pap-smear\" target=\"_blank\" rel=\"noopener\">the evidence\u003c/a> is strong enough that HPV tests can be used by themselves, for women over 30. That third choice expands on the task force's previous recommendation, which was for the Pap test or the combination test.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>And while Pap tests should be repeated every three years, women can wait five years between HPV tests.\u003c/p>\n\u003cp>\"Five years is a good balance between the benefits and harms,\" Owens says. \"It's still highly effective at detecting cancer, and screening more frequently than that may increase some of the potential harms, so we think that's a good interval.\"\u003c/p>\n\u003cp>Potential harms of too frequent screening include unnecessary follow-ups such as biopsies. In a draft recommendation released last year, the task force had considered suggesting just two options, either the Pap smear or the HPV test, but its final recommendation included the hybrid test too.\u003c/p>\n\u003cp>\"The HPV test alone is not available everywhere,\" Owens explains. \"And so we want to be sure that women no matter where they're receiving care have options for cervical cancer screening.\"\u003c/p>\n\u003cp>He says the combination test is widely available, as is the Pap test, \"so all of those are good options and a woman can discuss with her physician what's available at the place where she's receiving care.\"\u003c/p>\n\u003cp>Women may not notice the difference between tests because tissue samples are all collected the same way. But \u003ca href=\"http://pressroom.cancer.org/debbiesaslow\" target=\"_blank\" rel=\"noopener\">Debbie Saslow\u003c/a>, senior director for HPV-related and women's cancers at the American Cancer Society, says if women have a choice, she would recommend the HPV test for women over 30.\u003c/p>\n\u003cp>\"I truly believe that including the HPV test, either along with the Pap or instead of the Pap, is superior than the Pap alone,\" she says. There's some evidence the HPV test is better than the Pap test at detecting a less common form of cervical cancer, adenocarcinoma, she says. \"So wouldn't you rather find the two most common cancers instead of just the one most common type?\"\u003c/p>\n\u003cp>The task force emphasizes that all three tests are highly effective. The overarching recommendation is simply that women should get screened, and to do so regularly until the age of 65. If screening has been adequate up to that point, the task force says women do not need further cervical cancer screening.\u003c/p>\n\u003cp>Health officials also recommend the HPV vaccine, which is given to girls and young women, up to age 26. (Boys and young men are encouraged to get the HPV vaccine as well.) But Owens says a vaccine alone doesn't replace cervical cancer screening.\u003c/p>\n\u003cp>\"Our recommendation applies to everyone whether you've been vaccinated or not,\" he says. \"It's very important that women do not forgo screening because they've been vaccinated.\"\u003c/p>\n\u003cp>An effective vaccine could ultimately render cervical cancer screening unnecessary, but that change will require careful study and could be years away.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>You can reach Richard Harris at \u003c/em>\u003ca href=\"mailto:rharris@npr.org\" target=\"_blank\" rel=\"noopener\">rharris@npr.org\u003c/a>.\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=For+Cervical+Cancer+Screening%2C+Women+Over+30+Can+Now+Choose+The+HPV+Test+Only&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>In the end, it wasn’t easy for Aaron McQ to decide when to die.\u003c/p>\n\u003cp>The 50-year-old Seattle man — a former world traveler, triathlete and cyclist — learned he had leukemia five years ago, followed by an even grimmer diagnosis in 2016: a rare form of amyotrophic lateral sclerosis, or ALS.\u003c/p>\n\u003cp>An interior and urban designer who legally changed his given name, McQ had been in pain and physical decline for years. Then the disease threatened to shut down his ability to swallow and breathe.\u003c/p>\n\u003cp>“It’s like waking up every morning in quicksand,” McQ said. “It’s terrifying.”\u003c/p>\n\u003cp>Last fall, McQ decided to use Washington state’s 2009 Death With Dignity law to end his suffering. The practice, approved in seven states and the District of Columbia, allows people with a projected six months or less to live to obtain lethal drugs to end their lives.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Although the option was legal, actually carrying it out was difficult for McQ, who agreed to discuss his deliberations with Kaiser Health News. He said he hoped to shed light on an often secretive and misunderstood practice.\u003c/p>\n\u003cp>“How does anyone get their head around dying?” he said, sitting in a wheelchair in his Seattle apartment in late January.\u003c/p>\n\u003cfigure id=\"attachment_443968\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003cimg class=\"size-large wp-image-443968\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/08/01-aaron-mcq-als_1350-1020x680.jpg\" alt=\"\" width=\"640\" height=\"427\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2018/08/01-aaron-mcq-als_1350-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/01-aaron-mcq-als_1350-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/01-aaron-mcq-als_1350-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/01-aaron-mcq-als_1350-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/01-aaron-mcq-als_1350-1200x800.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/01-aaron-mcq-als_1350-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/01-aaron-mcq-als_1350-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/01-aaron-mcq-als_1350-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/01-aaron-mcq-als_1350-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/01-aaron-mcq-als_1350-520x347.jpg 520w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/01-aaron-mcq-als_1350.jpg 1270w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003cfigcaption class=\"wp-caption-text\">Aaron McQ speaks during an interview in his Seattle apartment in January. “No one is ever really ready to die,” McQ said. “There will always be a reason not to.” \u003ccite>(Dan Delong/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>More than 3,000 people in the U.S. have chosen such deaths since Oregon’s law was enacted in 1997, according to state reports. Even as similar statutes have expanded to more venues — including, this year, \u003ca href=\"https://www.reuters.com/article/us-hawaii-dying/hawaii-lawmakers-approve-medical-aid-in-dying-for-terminally-ill-idUSKBN1H606J\" target=\"_blank\" rel=\"noopener\">Hawaii\u003c/a> — it has remained controversial.\u003c/p>\n\u003cp>California’s End of Life Option Act, which took effect in 2016, was suspended for three weeks this spring after a court challenge, leaving hundreds of dying patients \u003ca href=\"https://khn.org/news/suspension-of-californias-aid-in-dying-law-leaves-sick-patients-in-limbo/\" target=\"_blank\" rel=\"noopener\">briefly in limbo\u003c/a>.\u003c/p>\n\u003cp>Supporters say the practice gives patients control over their own fate in the face of a terminal illness. Detractors — including religious groups, disability rights advocates and \u003ca href=\"https://khn.org/news/as-doctors-drop-opposition-aid-in-dying-advocates-target-next-battleground-states/\" target=\"_blank\" rel=\"noopener\">some doctors\u003c/a> — argue that such laws could put pressure on vulnerable people and that proper palliative care can ease end-of-life suffering.\u003c/p>\n\u003cp>Thin and wan, with silver hair and piercing blue eyes, McQ still could have passed for the photographer’s model he once was. But McQ’s legs shook involuntarily beneath his dark jeans and his voice was hoarse with pain during a three-hour effort to tell his story.\u003c/p>\n\u003cp>Last November, doctors told McQ he had six months or less to live. The choice, he said, became not death over a healthy life, but a “certain outcome” now over a prolonged, painful — and “unknowable” — end.\u003c/p>\n\u003cp>“I’m not wanting to die,” he said. “I’m very much alive, yet I’m suffering. And I would rather have it not be a surprise.”\u003c/p>\n\u003cp>In late December, a friend picked up a prescription for 100 tablets of the powerful sedative secobarbital. For weeks, the bottle holding the lethal dose sat on a shelf in his kitchen.\u003c/p>\n\u003cp>“I was not relaxed or confident until I had it in my cupboard,” McQ said.\u003c/p>\n\u003cp>At the time, he intended to take the drug in late February. Or maybe mid-March. He had wanted to get past Christmas, so he didn’t ruin anyone’s holiday. Then his sister and her family came for a visit. Then there was a friend’s birthday and another friend’s wedding.\u003c/p>\n\u003cp>“No one is ever really ready to die,” McQ said. “There will always be a reason not to.”\u003c/p>\n\u003cdiv id=\"attachment_862690\" class=\"wp-caption alignnone\">\n\u003cfigure id=\"attachment_862690\" class=\"wp-caption alignnone\" style=\"max-width: 1024px\">\u003cimg class=\"wp-image-862690 size-full\" src=\"https://kaiserhealthnews.files.wordpress.com/2018/07/09-aaron-mcq-als_1350.jpg?w=1024&h=683\" alt=\"\" width=\"1024\" height=\"683\">\u003cfigcaption class=\"wp-caption-text\">In late December, a friend picked up Aaron McQ’s prescription for 100 tablets of the powerful sedative secobarbital. For weeks, the bottle holding the lethal dose sat on a shelf in his kitchen.(DAN DELONG FOR KHN)\u003c/figcaption>\u003c/figure>\n\u003c/div>\n\u003cp>Many people who opt for medical aid-in-dying are so sick that they take the drugs as soon as they can, impatiently enduring state-mandated waiting periods to obtain the prescriptions\u003c/p>\n\u003cp>Data from Oregon show that the median time from first request to death is 48 days, or about seven weeks. But it has ranged from two weeks to more than 2.7 years, records show.\u003c/p>\n\u003cp>Neurodegenerative diseases like ALS are particularly difficult, said Dr. Lonny Shavelson, a Berkeley, Calif., physician who has supervised nearly 90 aid-in-dying deaths in that state and advised more than 600 patients since 2016.\u003c/p>\n\u003cp>“It’s a very complicated decision week to week,” he said. “How do you decide? When do you decide? We don’t let them make that decision alone.”\u003c/p>\n\u003cp>Philosophically, McQ had been a supporter of aid-in-dying for years. He was the final caregiver for his grandmother, Milly, who he said begged for death to end pain at the end of her life.\u003c/p>\n\u003cp>By late spring, McQ’s own struggle was worse, said Karen Robinson, McQ’s health care proxy and friend of two decades. He was admitted to home hospice care, but continued to decline. When a nurse recommended that McQ transfer to a hospice facility to control his growing pain, he decided he’d rather die at home.\u003c/p>\n\u003cp>“There was part of him that was hoping there were some other alternative,” Robinson said.\u003c/p>\n\u003cp>McQ considered several dates — and then changed his mind, partly because of the pressure that such a choice imposed.\u003c/p>\n\u003cp>“I don’t want to talk about it because I don’t want to feel like, now you gotta,” he said.\u003c/p>\n\u003cp>Along with the pain, the risk of losing the physical ability to administer the medication himself, a legal requirement, was growing.\u003c/p>\n\u003cp>“I talked with him about losing his window of opportunity,” said Gretchen DeRoche, a volunteer with the group End of Life Washington, who said she has supervised hundreds of aid-in-dying deaths.\u003c/p>\n\u003cp>Finally, McQ chose the day: April 10. Robinson came over early in the afternoon, as she had often done, to drink coffee and talk — but not about his impending death.\u003c/p>\n\u003cp>“There was a part of him that didn’t want it to be like \u003cem>this is the day\u003c/em>,” she said.\u003c/p>\n\u003cp>DeRoche arrived exactly at 5:30 p.m., per McQ’s instructions. At 6 p.m., McQ took anti-nausea medication. Because the lethal drugs are so bitter, there is some chance patients won’t keep them down.\u003c/p>\n\u003cp>Four close friends gathered, along with Robinson. They sorted through McQ’s CDs, trying to find appropriate music.\u003c/p>\n\u003cp>“He put on Marianne Faithfull. She’s amazing, but, it was too much,” Robinson said. “Then he put on James Taylor for, like, 15 seconds. It was ‘You’ve Got a Friend.’ I vetoed that. I said, ‘Aaron, you cannot do that if you want us to hold it together.’”\u003c/p>\n\u003cp>DeRoche went into a bedroom to open the 100 capsules of 100-milligram secobarbital, one at a time, a tedious process. Then she mixed the drug with coconut water and some vodka.\u003c/p>\n\u003cp>Just then, McQ started to cry, DeRoche said. “I think he was just kind of mourning the loss of the life he had expected to live.”\u003c/p>\n\u003cp>After that, he said he was ready. McQ asked everyone but DeRoche to leave the room. She told him he could still change his mind.\u003c/p>\n\u003cp>“I said, as I do to everyone: ‘If you take this medication, you’re going to go to sleep and you are not going to wake up,’” she recalled.\u003c/p>\n\u003cp>McQ drank half the drug mixture, paused and drank water. Then he swallowed the rest.\u003c/p>\n\u003cp>His friends returned, but remained silent.\u003c/p>\n\u003cp>“They just all gathered around him, each one touching him,” DeRoche said.\u003c/p>\n\u003cp>Very quickly, just before 7:30 p.m., it was over.\u003c/p>\n\u003cp>“It was just like one fluid motion,” DeRoche said. “He drank the medication, he went to sleep and he died in six minutes. I think we were all a little surprised he was gone that fast.”\u003c/p>\n\u003cp>The friends stayed until a funeral home worker arrived.\u003c/p>\n\u003cp>“Once we got him into the vehicle, she asked, ‘What kind of music does he like?’” Robinson recalled. “It was just such a sweet, human thing for her to say. He was driving away, listening to jazz.”\u003c/p>\n\u003cp>McQ’s friends gathered June 30 in Seattle for a “happy memories celebration” of his life, Robinson said. She and a few others kayaked out into Lake Washington and left McQ’s ashes in the water, along with rose petals.\u003c/p>\n\u003cp>In the months since her friend’s death, Robinson has reflected on McQ’s decision to die. It was probably what he expected, she said, but not anything that he desired.\u003c/p>\n\u003cp>“It’s really tough to be alive and then not be alive because of your choice,” she said.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“If he had his wish, he would have died in his sleep.”\u003cem> \u003c/em>\u003c/p>\n\n",
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"excerpt": "Supporters say the practice gives patients control over their own fate while detractors argue that such laws could put pressure on vulnerable people and that proper palliative care can ease end-of-life suffering.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>In the end, it wasn’t easy for Aaron McQ to decide when to die.\u003c/p>\n\u003cp>The 50-year-old Seattle man — a former world traveler, triathlete and cyclist — learned he had leukemia five years ago, followed by an even grimmer diagnosis in 2016: a rare form of amyotrophic lateral sclerosis, or ALS.\u003c/p>\n\u003cp>An interior and urban designer who legally changed his given name, McQ had been in pain and physical decline for years. Then the disease threatened to shut down his ability to swallow and breathe.\u003c/p>\n\u003cp>“It’s like waking up every morning in quicksand,” McQ said. “It’s terrifying.”\u003c/p>\n\u003cp>Last fall, McQ decided to use Washington state’s 2009 Death With Dignity law to end his suffering. The practice, approved in seven states and the District of Columbia, allows people with a projected six months or less to live to obtain lethal drugs to end their lives.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Although the option was legal, actually carrying it out was difficult for McQ, who agreed to discuss his deliberations with Kaiser Health News. He said he hoped to shed light on an often secretive and misunderstood practice.\u003c/p>\n\u003cp>“How does anyone get their head around dying?” he said, sitting in a wheelchair in his Seattle apartment in late January.\u003c/p>\n\u003cfigure id=\"attachment_443968\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003cimg class=\"size-large wp-image-443968\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/08/01-aaron-mcq-als_1350-1020x680.jpg\" alt=\"\" width=\"640\" height=\"427\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2018/08/01-aaron-mcq-als_1350-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/01-aaron-mcq-als_1350-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/01-aaron-mcq-als_1350-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/01-aaron-mcq-als_1350-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/01-aaron-mcq-als_1350-1200x800.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/01-aaron-mcq-als_1350-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/01-aaron-mcq-als_1350-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/01-aaron-mcq-als_1350-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/01-aaron-mcq-als_1350-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/01-aaron-mcq-als_1350-520x347.jpg 520w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/01-aaron-mcq-als_1350.jpg 1270w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003cfigcaption class=\"wp-caption-text\">Aaron McQ speaks during an interview in his Seattle apartment in January. “No one is ever really ready to die,” McQ said. “There will always be a reason not to.” \u003ccite>(Dan Delong/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>More than 3,000 people in the U.S. have chosen such deaths since Oregon’s law was enacted in 1997, according to state reports. Even as similar statutes have expanded to more venues — including, this year, \u003ca href=\"https://www.reuters.com/article/us-hawaii-dying/hawaii-lawmakers-approve-medical-aid-in-dying-for-terminally-ill-idUSKBN1H606J\" target=\"_blank\" rel=\"noopener\">Hawaii\u003c/a> — it has remained controversial.\u003c/p>\n\u003cp>California’s End of Life Option Act, which took effect in 2016, was suspended for three weeks this spring after a court challenge, leaving hundreds of dying patients \u003ca href=\"https://khn.org/news/suspension-of-californias-aid-in-dying-law-leaves-sick-patients-in-limbo/\" target=\"_blank\" rel=\"noopener\">briefly in limbo\u003c/a>.\u003c/p>\n\u003cp>Supporters say the practice gives patients control over their own fate in the face of a terminal illness. Detractors — including religious groups, disability rights advocates and \u003ca href=\"https://khn.org/news/as-doctors-drop-opposition-aid-in-dying-advocates-target-next-battleground-states/\" target=\"_blank\" rel=\"noopener\">some doctors\u003c/a> — argue that such laws could put pressure on vulnerable people and that proper palliative care can ease end-of-life suffering.\u003c/p>\n\u003cp>Thin and wan, with silver hair and piercing blue eyes, McQ still could have passed for the photographer’s model he once was. But McQ’s legs shook involuntarily beneath his dark jeans and his voice was hoarse with pain during a three-hour effort to tell his story.\u003c/p>\n\u003cp>Last November, doctors told McQ he had six months or less to live. The choice, he said, became not death over a healthy life, but a “certain outcome” now over a prolonged, painful — and “unknowable” — end.\u003c/p>\n\u003cp>“I’m not wanting to die,” he said. “I’m very much alive, yet I’m suffering. And I would rather have it not be a surprise.”\u003c/p>\n\u003cp>In late December, a friend picked up a prescription for 100 tablets of the powerful sedative secobarbital. For weeks, the bottle holding the lethal dose sat on a shelf in his kitchen.\u003c/p>\n\u003cp>“I was not relaxed or confident until I had it in my cupboard,” McQ said.\u003c/p>\n\u003cp>At the time, he intended to take the drug in late February. Or maybe mid-March. He had wanted to get past Christmas, so he didn’t ruin anyone’s holiday. Then his sister and her family came for a visit. Then there was a friend’s birthday and another friend’s wedding.\u003c/p>\n\u003cp>“No one is ever really ready to die,” McQ said. “There will always be a reason not to.”\u003c/p>\n\u003cdiv id=\"attachment_862690\" class=\"wp-caption alignnone\">\n\u003cfigure id=\"attachment_862690\" class=\"wp-caption alignnone\" style=\"max-width: 1024px\">\u003cimg class=\"wp-image-862690 size-full\" src=\"https://kaiserhealthnews.files.wordpress.com/2018/07/09-aaron-mcq-als_1350.jpg?w=1024&h=683\" alt=\"\" width=\"1024\" height=\"683\">\u003cfigcaption class=\"wp-caption-text\">In late December, a friend picked up Aaron McQ’s prescription for 100 tablets of the powerful sedative secobarbital. For weeks, the bottle holding the lethal dose sat on a shelf in his kitchen.(DAN DELONG FOR KHN)\u003c/figcaption>\u003c/figure>\n\u003c/div>\n\u003cp>Many people who opt for medical aid-in-dying are so sick that they take the drugs as soon as they can, impatiently enduring state-mandated waiting periods to obtain the prescriptions\u003c/p>\n\u003cp>Data from Oregon show that the median time from first request to death is 48 days, or about seven weeks. But it has ranged from two weeks to more than 2.7 years, records show.\u003c/p>\n\u003cp>Neurodegenerative diseases like ALS are particularly difficult, said Dr. Lonny Shavelson, a Berkeley, Calif., physician who has supervised nearly 90 aid-in-dying deaths in that state and advised more than 600 patients since 2016.\u003c/p>\n\u003cp>“It’s a very complicated decision week to week,” he said. “How do you decide? When do you decide? We don’t let them make that decision alone.”\u003c/p>\n\u003cp>Philosophically, McQ had been a supporter of aid-in-dying for years. He was the final caregiver for his grandmother, Milly, who he said begged for death to end pain at the end of her life.\u003c/p>\n\u003cp>By late spring, McQ’s own struggle was worse, said Karen Robinson, McQ’s health care proxy and friend of two decades. He was admitted to home hospice care, but continued to decline. When a nurse recommended that McQ transfer to a hospice facility to control his growing pain, he decided he’d rather die at home.\u003c/p>\n\u003cp>“There was part of him that was hoping there were some other alternative,” Robinson said.\u003c/p>\n\u003cp>McQ considered several dates — and then changed his mind, partly because of the pressure that such a choice imposed.\u003c/p>\n\u003cp>“I don’t want to talk about it because I don’t want to feel like, now you gotta,” he said.\u003c/p>\n\u003cp>Along with the pain, the risk of losing the physical ability to administer the medication himself, a legal requirement, was growing.\u003c/p>\n\u003cp>“I talked with him about losing his window of opportunity,” said Gretchen DeRoche, a volunteer with the group End of Life Washington, who said she has supervised hundreds of aid-in-dying deaths.\u003c/p>\n\u003cp>Finally, McQ chose the day: April 10. Robinson came over early in the afternoon, as she had often done, to drink coffee and talk — but not about his impending death.\u003c/p>\n\u003cp>“There was a part of him that didn’t want it to be like \u003cem>this is the day\u003c/em>,” she said.\u003c/p>\n\u003cp>DeRoche arrived exactly at 5:30 p.m., per McQ’s instructions. At 6 p.m., McQ took anti-nausea medication. Because the lethal drugs are so bitter, there is some chance patients won’t keep them down.\u003c/p>\n\u003cp>Four close friends gathered, along with Robinson. They sorted through McQ’s CDs, trying to find appropriate music.\u003c/p>\n\u003cp>“He put on Marianne Faithfull. She’s amazing, but, it was too much,” Robinson said. “Then he put on James Taylor for, like, 15 seconds. It was ‘You’ve Got a Friend.’ I vetoed that. I said, ‘Aaron, you cannot do that if you want us to hold it together.’”\u003c/p>\n\u003cp>DeRoche went into a bedroom to open the 100 capsules of 100-milligram secobarbital, one at a time, a tedious process. Then she mixed the drug with coconut water and some vodka.\u003c/p>\n\u003cp>Just then, McQ started to cry, DeRoche said. “I think he was just kind of mourning the loss of the life he had expected to live.”\u003c/p>\n\u003cp>After that, he said he was ready. McQ asked everyone but DeRoche to leave the room. She told him he could still change his mind.\u003c/p>\n\u003cp>“I said, as I do to everyone: ‘If you take this medication, you’re going to go to sleep and you are not going to wake up,’” she recalled.\u003c/p>\n\u003cp>McQ drank half the drug mixture, paused and drank water. Then he swallowed the rest.\u003c/p>\n\u003cp>His friends returned, but remained silent.\u003c/p>\n\u003cp>“They just all gathered around him, each one touching him,” DeRoche said.\u003c/p>\n\u003cp>Very quickly, just before 7:30 p.m., it was over.\u003c/p>\n\u003cp>“It was just like one fluid motion,” DeRoche said. “He drank the medication, he went to sleep and he died in six minutes. I think we were all a little surprised he was gone that fast.”\u003c/p>\n\u003cp>The friends stayed until a funeral home worker arrived.\u003c/p>\n\u003cp>“Once we got him into the vehicle, she asked, ‘What kind of music does he like?’” Robinson recalled. “It was just such a sweet, human thing for her to say. He was driving away, listening to jazz.”\u003c/p>\n\u003cp>McQ’s friends gathered June 30 in Seattle for a “happy memories celebration” of his life, Robinson said. She and a few others kayaked out into Lake Washington and left McQ’s ashes in the water, along with rose petals.\u003c/p>\n\u003cp>In the months since her friend’s death, Robinson has reflected on McQ’s decision to die. It was probably what he expected, she said, but not anything that he desired.\u003c/p>\n\u003cp>“It’s really tough to be alive and then not be alive because of your choice,” she said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“If he had his wish, he would have died in his sleep.”\u003cem> \u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Medical Students Skip Class in Droves, Making Lectures Increasingly Obsolete",
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"content": "\u003cp>The future doctors of America cut class. Not to gossip in the bathroom or flirt behind the bleachers. They skip to learn — at twice the speed.\u003c/p>\n\u003cp class=\"danger-zone\">Some medical students follow along with class remotely, watching sped-up recordings of their professors at home, in their pajamas. Others rarely tune in. At one school, attendance is so bad that a Nobel laureate recently lectured to mostly empty seats.\u003c/p>\n\u003cp class=\"danger-zone\">Nationally, nearly one-quarter of second-year medical students \u003ca href=\"https://www.aamc.org/download/488336/data/y2q2017report.pdf\" target=\"_blank\" rel=\"noopener\">reported\u003c/a> last year that they “almost never” attended class during their first two, preclinical years, a 5 percent increase from 2015.\u003c/p>\n\u003cp>The AWOL students highlight increasing dissatisfaction and anxiety that there’s a mismatch between what they’re taught in class during those years and what they’re expected to know — or how they’re tested — on national licensing exams. Despite paying nearly \u003ca href=\"https://www.aamc.org/data/tuitionandstudentfees/\" target=\"_blank\" rel=\"noopener\">$60,000 a year\u003c/a> in tuition, medical students are turning to unsanctioned online resources to prepare for Step 1, the make-or-break test typically taken at the end of the preclinical years.\u003c/p>\n\u003cp>These self-guided med students are akin to a group of American tourists wandering through Tokyo without a map. Like a tour guide hired on the street, the online learning tools — including memory aids, videos, and online quizzes — can enhance the educational journey, or send the students down a dead end.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Lawrence Wang, a third-year M.D.-Ph.D. student at the University of California, San Diego, and the National Institutes of Health, said he relied heavily on these resources during his first two years of medical school.\u003c/p>\n\u003cp>“There were times that I didn’t go to a single class, and then I’d get to the actual exam and it would be my first time seeing the professor,” he said. “Especially, when Step was coming up, I pretty much completely focused on studying outside materials.”\u003c/p>\n\u003cp>Wang isn’t alone. According to 2017 data from the Association for American Medical Colleges, 1 in 4 preclinical students watches educational videos — like those on YouTube — on a daily basis. And according to two video developers, tens of thousands of medical students subscribe to their products — one of which costs $250 for two years, the other $370 for one year.\u003c/p>\n\u003cp>Leaders in medical education have begun to scramble. Some medical schools, like Harvard, have done away with lectures for the most part. Instead of spending hours in an auditorium, Harvard students learn the course content at home and then apply the knowledge in mandatory small group sessions.\u003c/p>\n\u003cp>Other institutions, like Johns Hopkins, are moving in the same direction, but have yet to make a full switch. Hopkins cut down on lectures and boosted sessions that require active student participation. Preclinical lecture attendance hovers around 30 to 40 percent, according to Dr. Nancy Hueppchen, associate dean for curriculum.\u003c/p>\n\u003cp>For many students, she said, licensing exam prep begins on day one of medical school: “They have this parallel curriculum going along with what we’re teaching them.”\u003c/p>\n\u003cp>Step 1, an eight-hour multiple choice test, is a big deal. Performance on the exam, though it’s taken before most students even begin training in a hospital, heavily influences which medical specialties they can eventually pursue after school and at what hospitals they can pursue them.\u003c/p>\n\u003cp>With medical schools grading pass-fail, the Step 1 score is an increasingly significant piece of information that’s used to sort through residency applications, Hueppchen said. When she took the exam, it was only used as a pass-fail test. Today, residency programs rely on the score more heavily; students and faculty suspect that it’s used as a cutoff for making admissions decisions.\u003c/p>\n\u003cp>Ryan Carlson, a third-year M.D.-Ph.D. student at the University of Washington, said that his school focused on teaching “what they thought was important for a physician to know.” But medical students have to know more than what is relevant to a practicing clinician to succeed on Step. The exam focuses on rare diseases and other minutiae, said Carlson, who now tutors for the test.\u003c/p>\n\u003cp>Hueppchen acknowledged that students at Hopkins and elsewhere “express some distrust that they’re getting everything they need — or that we’re being meticulous in pointing out what they need — to study for and excel on the Step 1 exam.”\u003c/p>\n\u003cp>\u003cstrong>Medical Tour Guides\u003c/strong>\u003c/p>\n\u003cp>That distrust has spawned a cottage industry of online study aids. Most are a far cry from your high school SAT prep course.\u003c/p>\n\u003cp>\u003ca href=\"https://www.sketchymedical.com/#!/home\" target=\"_blank\" rel=\"noopener\">SketchyMedical\u003c/a> is one of the most popular guides. The company, built in 2013 by three then-medical students at the University of California, Irvine, produces visual memory aids with elaborate illustrations to help students learn and retain the voluminous material they’re expected to know.\u003c/p>\n\u003cp>Dr. Andrew Berg and his co-founders, Drs. Saud Siddiqui and Bryan Lemieux, started sketching pictures and pairing them with stories while taking microbiology in their second year of medical school.\u003c/p>\n\u003cp>“We were just bombarded with different names of bacteria, viruses, and fungi, and we were having a tough time keeping them all straight,” he said.'\u003c/p>\n\u003cp>The sketches helped them, and now other students are using them, too.\u003c/p>\n\u003cp>Imagine it’s test day and a med student is asked which drug she would use to treat a patient’s postoperative gastrointestinal blockage. The student closes her eyes and mentally enters the world of “Acetyl-Cola,” a bustling port town that’s depicted in one of SketchyMedical’s cartoons. Outside a storefront, the student finds construction workers, motorcyclists wearing brain-shaped helmets, piles of dripping-wet fish, and a man sporting an adrenal gland-shaped beanie.\u003c/p>\n\u003cp>A colon-shaped mixing truck pouring out cement is an unfortunate, but effective, symbol for defecation, and a worker wearing a name tag reading “Beth” and drinking a cola reminds the student of the drug bethanechol, given to treat intestinal obstructions.\u003c/p>\n\u003cp>The illustrations are turned into narrated videos, which teach drug names and their mechanisms and side effects. SketchyMedical has also produced videos on microbiology and pathology.\u003c/p>\n\u003cp>\u003ca href=\"https://www.youtube.com/watch?v=8Dv3zZbDvig\" target=\"_blank\" rel=\"noopener\">Berg compares\u003c/a> the work of Sketchy to hieroglyphics in ancient Egypt. But for many, Sketchy evokes a different technique used a thousand years later in ancient Greece: method of loci, also called a memory palace or journey.\u003c/p>\n\u003cp>Memory palaces are typically imagined spaces in which a person can store information like a string of numbers or a series of words. Each piece of information is placed somewhere inside the palace. When the palace builder wants to recall an item, she can take a mental stroll through the space to retrieve it. This technique famously enabled Cicero, the Roman statesman and philosopher, to commit his speeches to memory.\u003c/p>\n\u003cp>“We accidentally stumbled upon these visual learning techniques, but now looking back we see there’s a lot of evidence supporting visual learning,” Berg said.\u003c/p>\n\u003cp>SketchyMedical is not the only extracurricular resource students rely on. An entire industry cropped up in the last few years, marketing videos and self-quizzing features to preclinical students. Dr. Jason Ryan, the creator of Boards and Beyond, is a name (and voice) familiar to medical students across the country.\u003c/p>\n\u003cp>Ryan, a faculty member at University of Connecticut School of Medicine, creates explanatory videos that track along with the content in First Aid, a Step preparatory book that Ryan said is more like “an encyclopedia of terms” than a real study aid. Ask any medical student if they use First Aid, and they’ll point you to their heavily annotated, tattered copy.\u003c/p>\n\u003cp>While both Ryan and Berg consider their products supplements to regular medical education, many students view them as necessary investments for success. Choosing which ones to use can be a challenge, however.\u003c/p>\n\u003cp>“That was the biggest learning curve of med school — it wasn’t so much how do I do well in it, it was, how do I use all these crazy resources that are being marketed to me to best meet my goal of passing Step,” Carlson said.\u003c/p>\n\u003cp>\u003cstrong>Old Players React\u003c/strong>\u003c/p>\n\u003cp>This expanding corner of the medical education industry is both a product of a new attitude among students — born from anxiety surrounding exam prep — and a disrupter of the traditional classroom education. Med schools now have to think more creatively about how they train their future doctors, Berg said.\u003c/p>\n\u003cp>In 2015, Harvard Medical School revamped its curriculum for the first two years to enable clinical exposure and boost class attendance with a flipped-classroom model: Students learn the content at home, and then apply it during in-class exercises. Dr. Richard Schwartzstein, director of education scholarship, said the program now emphasizes problem-solving and critical thinking — skills seen as essential to practicing medicine — instead of factual recall.\u003c/p>\n\u003cp>But while medical schools are de-emphasizing pure memorization, the national licensing exams have yet to reconsider, he acknowledged. Still, Schwartzstein is not a huge fan of external resources, citing their focus on memorization and pattern recognition as major weaknesses.\u003c/p>\n\u003cp>“You don’t have to actually teach pattern recognition,” he said. “We all are born with the capability of recognizing pattern.” He advises students to stick to Harvard-developed videos and their recommended readings. Like many medical schools, Harvard gives students a dedicated study period — six to eight weeks without coursework — to “prepare in whatever way they deem most appropriate to take the boards,” he said.\u003c/p>\n\u003cp>Hueppchen said that the outside resources “may have value in day-to-day studying, they may have value in studying for Step 1,” but Hopkins has not vetted them so it doesn’t recommend them to students either.\u003c/p>\n\u003cp>The National Board of Medical Examiners, which works with state medical boards to set the minimum standards for medical licensing and administers the Step exam, also doesn’t endorse these products — or their use as hard lines for residency admissions, said Dr. Michael Barone, vice president of licensure programs. The group “is aware of some secondary uses of scores,” he said, but the test’s primary purpose is to report licensure alone.\u003c/p>\n\u003cp>So long as Step still requires intensive rote memorization, companies like SketchyMedical and Boards and Beyond will likely remain in business.\u003c/p>\n\u003cp>Both Berg and Ryan agree that physicians no longer need to memorize as much as they did in the past. Ryan’s grandmother was one of the first female physicians to graduate from her medical school in the 1940s. Back then, he said, she had to remember everything. “If she had to go to a book every time she saw a patient, she’d never be able to work through the day.”\u003c/p>\n\u003cp>Today, there’s much more to know, and medicine is evolving so rapidly — with new drugs, guidelines, and practices — that physicians can’t possibly remember it all. Instead, they look information up on their cellphones, using a variety of apps on the clinic floors. But preclinical students still need to commit board-tested material to memory, a task often compared to drinking from a firehose.\u003c/p>\n\u003cp>Needing to memorize for boards and learn in parallel for their institutions is the breeding ground for anxiety that Hueppchen said “has truly detracted from the joy of learning.” It has even detracted from the joy of teaching, she added.\u003c/p>\n\u003cp>Berg said he tries to bring joy to memorization: “I think that what I hope to contribute the most is making studying more fun.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This\u003ca href=\"https://www.statnews.com/2018/08/14/medical-students-skipping-class/\" 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>The future doctors of America cut class. Not to gossip in the bathroom or flirt behind the bleachers. They skip to learn — at twice the speed.\u003c/p>\n\u003cp class=\"danger-zone\">Some medical students follow along with class remotely, watching sped-up recordings of their professors at home, in their pajamas. Others rarely tune in. At one school, attendance is so bad that a Nobel laureate recently lectured to mostly empty seats.\u003c/p>\n\u003cp class=\"danger-zone\">Nationally, nearly one-quarter of second-year medical students \u003ca href=\"https://www.aamc.org/download/488336/data/y2q2017report.pdf\" target=\"_blank\" rel=\"noopener\">reported\u003c/a> last year that they “almost never” attended class during their first two, preclinical years, a 5 percent increase from 2015.\u003c/p>\n\u003cp>The AWOL students highlight increasing dissatisfaction and anxiety that there’s a mismatch between what they’re taught in class during those years and what they’re expected to know — or how they’re tested — on national licensing exams. Despite paying nearly \u003ca href=\"https://www.aamc.org/data/tuitionandstudentfees/\" target=\"_blank\" rel=\"noopener\">$60,000 a year\u003c/a> in tuition, medical students are turning to unsanctioned online resources to prepare for Step 1, the make-or-break test typically taken at the end of the preclinical years.\u003c/p>\n\u003cp>These self-guided med students are akin to a group of American tourists wandering through Tokyo without a map. Like a tour guide hired on the street, the online learning tools — including memory aids, videos, and online quizzes — can enhance the educational journey, or send the students down a dead end.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Lawrence Wang, a third-year M.D.-Ph.D. student at the University of California, San Diego, and the National Institutes of Health, said he relied heavily on these resources during his first two years of medical school.\u003c/p>\n\u003cp>“There were times that I didn’t go to a single class, and then I’d get to the actual exam and it would be my first time seeing the professor,” he said. “Especially, when Step was coming up, I pretty much completely focused on studying outside materials.”\u003c/p>\n\u003cp>Wang isn’t alone. According to 2017 data from the Association for American Medical Colleges, 1 in 4 preclinical students watches educational videos — like those on YouTube — on a daily basis. And according to two video developers, tens of thousands of medical students subscribe to their products — one of which costs $250 for two years, the other $370 for one year.\u003c/p>\n\u003cp>Leaders in medical education have begun to scramble. Some medical schools, like Harvard, have done away with lectures for the most part. Instead of spending hours in an auditorium, Harvard students learn the course content at home and then apply the knowledge in mandatory small group sessions.\u003c/p>\n\u003cp>Other institutions, like Johns Hopkins, are moving in the same direction, but have yet to make a full switch. Hopkins cut down on lectures and boosted sessions that require active student participation. Preclinical lecture attendance hovers around 30 to 40 percent, according to Dr. Nancy Hueppchen, associate dean for curriculum.\u003c/p>\n\u003cp>For many students, she said, licensing exam prep begins on day one of medical school: “They have this parallel curriculum going along with what we’re teaching them.”\u003c/p>\n\u003cp>Step 1, an eight-hour multiple choice test, is a big deal. Performance on the exam, though it’s taken before most students even begin training in a hospital, heavily influences which medical specialties they can eventually pursue after school and at what hospitals they can pursue them.\u003c/p>\n\u003cp>With medical schools grading pass-fail, the Step 1 score is an increasingly significant piece of information that’s used to sort through residency applications, Hueppchen said. When she took the exam, it was only used as a pass-fail test. Today, residency programs rely on the score more heavily; students and faculty suspect that it’s used as a cutoff for making admissions decisions.\u003c/p>\n\u003cp>Ryan Carlson, a third-year M.D.-Ph.D. student at the University of Washington, said that his school focused on teaching “what they thought was important for a physician to know.” But medical students have to know more than what is relevant to a practicing clinician to succeed on Step. The exam focuses on rare diseases and other minutiae, said Carlson, who now tutors for the test.\u003c/p>\n\u003cp>Hueppchen acknowledged that students at Hopkins and elsewhere “express some distrust that they’re getting everything they need — or that we’re being meticulous in pointing out what they need — to study for and excel on the Step 1 exam.”\u003c/p>\n\u003cp>\u003cstrong>Medical Tour Guides\u003c/strong>\u003c/p>\n\u003cp>That distrust has spawned a cottage industry of online study aids. Most are a far cry from your high school SAT prep course.\u003c/p>\n\u003cp>\u003ca href=\"https://www.sketchymedical.com/#!/home\" target=\"_blank\" rel=\"noopener\">SketchyMedical\u003c/a> is one of the most popular guides. The company, built in 2013 by three then-medical students at the University of California, Irvine, produces visual memory aids with elaborate illustrations to help students learn and retain the voluminous material they’re expected to know.\u003c/p>\n\u003cp>Dr. Andrew Berg and his co-founders, Drs. Saud Siddiqui and Bryan Lemieux, started sketching pictures and pairing them with stories while taking microbiology in their second year of medical school.\u003c/p>\n\u003cp>“We were just bombarded with different names of bacteria, viruses, and fungi, and we were having a tough time keeping them all straight,” he said.'\u003c/p>\n\u003cp>The sketches helped them, and now other students are using them, too.\u003c/p>\n\u003cp>Imagine it’s test day and a med student is asked which drug she would use to treat a patient’s postoperative gastrointestinal blockage. The student closes her eyes and mentally enters the world of “Acetyl-Cola,” a bustling port town that’s depicted in one of SketchyMedical’s cartoons. Outside a storefront, the student finds construction workers, motorcyclists wearing brain-shaped helmets, piles of dripping-wet fish, and a man sporting an adrenal gland-shaped beanie.\u003c/p>\n\u003cp>A colon-shaped mixing truck pouring out cement is an unfortunate, but effective, symbol for defecation, and a worker wearing a name tag reading “Beth” and drinking a cola reminds the student of the drug bethanechol, given to treat intestinal obstructions.\u003c/p>\n\u003cp>The illustrations are turned into narrated videos, which teach drug names and their mechanisms and side effects. SketchyMedical has also produced videos on microbiology and pathology.\u003c/p>\n\u003cp>\u003ca href=\"https://www.youtube.com/watch?v=8Dv3zZbDvig\" target=\"_blank\" rel=\"noopener\">Berg compares\u003c/a> the work of Sketchy to hieroglyphics in ancient Egypt. But for many, Sketchy evokes a different technique used a thousand years later in ancient Greece: method of loci, also called a memory palace or journey.\u003c/p>\n\u003cp>Memory palaces are typically imagined spaces in which a person can store information like a string of numbers or a series of words. Each piece of information is placed somewhere inside the palace. When the palace builder wants to recall an item, she can take a mental stroll through the space to retrieve it. This technique famously enabled Cicero, the Roman statesman and philosopher, to commit his speeches to memory.\u003c/p>\n\u003cp>“We accidentally stumbled upon these visual learning techniques, but now looking back we see there’s a lot of evidence supporting visual learning,” Berg said.\u003c/p>\n\u003cp>SketchyMedical is not the only extracurricular resource students rely on. An entire industry cropped up in the last few years, marketing videos and self-quizzing features to preclinical students. Dr. Jason Ryan, the creator of Boards and Beyond, is a name (and voice) familiar to medical students across the country.\u003c/p>\n\u003cp>Ryan, a faculty member at University of Connecticut School of Medicine, creates explanatory videos that track along with the content in First Aid, a Step preparatory book that Ryan said is more like “an encyclopedia of terms” than a real study aid. Ask any medical student if they use First Aid, and they’ll point you to their heavily annotated, tattered copy.\u003c/p>\n\u003cp>While both Ryan and Berg consider their products supplements to regular medical education, many students view them as necessary investments for success. Choosing which ones to use can be a challenge, however.\u003c/p>\n\u003cp>“That was the biggest learning curve of med school — it wasn’t so much how do I do well in it, it was, how do I use all these crazy resources that are being marketed to me to best meet my goal of passing Step,” Carlson said.\u003c/p>\n\u003cp>\u003cstrong>Old Players React\u003c/strong>\u003c/p>\n\u003cp>This expanding corner of the medical education industry is both a product of a new attitude among students — born from anxiety surrounding exam prep — and a disrupter of the traditional classroom education. Med schools now have to think more creatively about how they train their future doctors, Berg said.\u003c/p>\n\u003cp>In 2015, Harvard Medical School revamped its curriculum for the first two years to enable clinical exposure and boost class attendance with a flipped-classroom model: Students learn the content at home, and then apply it during in-class exercises. Dr. Richard Schwartzstein, director of education scholarship, said the program now emphasizes problem-solving and critical thinking — skills seen as essential to practicing medicine — instead of factual recall.\u003c/p>\n\u003cp>But while medical schools are de-emphasizing pure memorization, the national licensing exams have yet to reconsider, he acknowledged. Still, Schwartzstein is not a huge fan of external resources, citing their focus on memorization and pattern recognition as major weaknesses.\u003c/p>\n\u003cp>“You don’t have to actually teach pattern recognition,” he said. “We all are born with the capability of recognizing pattern.” He advises students to stick to Harvard-developed videos and their recommended readings. Like many medical schools, Harvard gives students a dedicated study period — six to eight weeks without coursework — to “prepare in whatever way they deem most appropriate to take the boards,” he said.\u003c/p>\n\u003cp>Hueppchen said that the outside resources “may have value in day-to-day studying, they may have value in studying for Step 1,” but Hopkins has not vetted them so it doesn’t recommend them to students either.\u003c/p>\n\u003cp>The National Board of Medical Examiners, which works with state medical boards to set the minimum standards for medical licensing and administers the Step exam, also doesn’t endorse these products — or their use as hard lines for residency admissions, said Dr. Michael Barone, vice president of licensure programs. The group “is aware of some secondary uses of scores,” he said, but the test’s primary purpose is to report licensure alone.\u003c/p>\n\u003cp>So long as Step still requires intensive rote memorization, companies like SketchyMedical and Boards and Beyond will likely remain in business.\u003c/p>\n\u003cp>Both Berg and Ryan agree that physicians no longer need to memorize as much as they did in the past. Ryan’s grandmother was one of the first female physicians to graduate from her medical school in the 1940s. Back then, he said, she had to remember everything. “If she had to go to a book every time she saw a patient, she’d never be able to work through the day.”\u003c/p>\n\u003cp>Today, there’s much more to know, and medicine is evolving so rapidly — with new drugs, guidelines, and practices — that physicians can’t possibly remember it all. Instead, they look information up on their cellphones, using a variety of apps on the clinic floors. But preclinical students still need to commit board-tested material to memory, a task often compared to drinking from a firehose.\u003c/p>\n\u003cp>Needing to memorize for boards and learn in parallel for their institutions is the breeding ground for anxiety that Hueppchen said “has truly detracted from the joy of learning.” It has even detracted from the joy of teaching, she added.\u003c/p>\n\u003cp>Berg said he tries to bring joy to memorization: “I think that what I hope to contribute the most is making studying more fun.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>You know your cholesterol, your blood pressure ... your heart gene score? Researchers say a new way of analyzing genetic test data may one day help identify people at high risk of a youthful heart attack in time to help.\u003c/p>\n\u003cp>Today, gene testing mostly focuses on rare mutations in one or a few genes, like those that cause cystic fibrosis or sickle cell disease, or the BRCA gene responsible for a small fraction of breast cancer. It is less useful for some of the most common diseases, such as heart disease or diabetes, because they are influenced by vast numbers of genes-gone-wrong working together in complicated ways.\u003c/p>\n\u003cp>Monday, researchers reported a new way to measure millions of small genetic variations that add up to cause harm, letting them calculate someone’s inherited risk for the most common form of heart disease and four other serious disorders. The potential cardiac impact: They estimated that up to 25 million Americans may have triple the average person’s risk for coronary artery disease even if they haven’t yet developed warning signs like high cholesterol.\u003c/p>\n\u003cp>“What I foresee is in five years, each person will know this risk number, this ‘polygenic risk score,’ similar to the way each person knows his or her cholesterol,” said Dr. Sekar Kathiresan who led the research team from the Broad Institute, Massachusetts General Hospital and Harvard Medical School.\u003c/p>\n\u003cp>If the approach pans out and doctors adopt it, a bad score wouldn’t mean you’d get a disease, just that your genetic makeup increases the chance — one more piece of information in deciding care. For example, when the researchers tested the system using a DNA database from Britain, less than 1 percent of people with the lowest risk scores were diagnosed with coronary artery disease, compared to 11 percent of people with the highest risk score.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“There are things you can do to lower the risk,” Kathiresan said — the usual advice about diet, exercise, cholesterol medication and not smoking helps.\u003c/p>\n\u003cp>On the flip side, a low-risk score “doesn’t give you a free pass,” he added. An unhealthy lifestyle could overwhelm the protection of good genes.\u003c/p>\n\u003cp>The scoring system also can predict an increased risk of Type 2 diabetes, inflammatory bowel disease, breast cancer and an irregular heartbeat called atrial fibrillation, the team reported in the journal Nature Genetics — noting that next steps include learning what might likewise lower those risks.\u003c/p>\n\u003cp>It doesn’t require the most sophisticated type of genetic testing. Instead, Kathiresan can calculate risk scores for those five diseases — eventually maybe more — simply by reanalyzing the kind of raw data people receive after sending a cheek swab to companies like 23andMe.\u003c/p>\n\u003cp>A geneticist who specializes in cardiovascular disease, he hopes to open a website where people can send in such data to learn their heart risk, as part of continuing research. Kathiresan and co-author Dr. Amit Khera, a Mass General cardiologist, are co-inventors on a patent application for the system.\u003c/p>\n\u003cp>Other scientists and companies have long sought ways to measure risk from multiple, additive gene effects — the “poly” in polygenic — and Myriad Genetics has begun selling a type of polygenic test for breast cancer risk.\u003c/p>\n\u003cp>But specialists in heart disease and genetics who weren’t involved with the research called the new findings exciting because of their scope.\u003c/p>\n\u003cp>“The results should be eye-opening for cardiologists,” said Dr. Charles C. Hong, director of cardiovascular research at the University of Maryland School of Medicine. “The only disappointment is that this score applies only to those with European ancestry, so I wonder if similar scores are in the works for the large majority of the world population that is not white.”\u003c/p>\n\u003cp>Hong pointed to a friend who recently died of a massive heart attack despite being a super-fit marathon runner who’d never smoked, the kind of puzzling death that doctors have long hoped that a better understanding of genetics could help to prevent.\u003c/p>\n\u003cp>“Most of the variation in disease risk comes from an enormous number of very tiny effects” in genes, agreed Stanford University genetics professor Jonathan Pritchard. “This is the first time polygenic scores have really been shown to reach the level of precision where they can have an impact” on patient health.\u003c/p>\n\u003cp>First, the Boston-based team combed previous studies that mapped the DNA of large numbers of people, looking for links to the five diseases — not outright mutations but minor misspellings in the genetic code.\u003c/p>\n\u003cp>Each variation alone would have only a tiny effect on health. They developed a computerized system that analyzed how those effects add up, and tested it using DNA and medical records from 400,000 people stored in Britain’s UK Biobank. Scores more than three times the average person’s risk were deemed high.\u003c/p>\n\u003cp>___\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The Associated Press Health & Science Department receives \u003ca href=\"http://bit.ly/2G0n9w6\">support\u003c/a> from the Howard Hughes Medical Institute’s Department of Science Education. The AP is solely responsible for all content.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>You know your cholesterol, your blood pressure ... your heart gene score? Researchers say a new way of analyzing genetic test data may one day help identify people at high risk of a youthful heart attack in time to help.\u003c/p>\n\u003cp>Today, gene testing mostly focuses on rare mutations in one or a few genes, like those that cause cystic fibrosis or sickle cell disease, or the BRCA gene responsible for a small fraction of breast cancer. It is less useful for some of the most common diseases, such as heart disease or diabetes, because they are influenced by vast numbers of genes-gone-wrong working together in complicated ways.\u003c/p>\n\u003cp>Monday, researchers reported a new way to measure millions of small genetic variations that add up to cause harm, letting them calculate someone’s inherited risk for the most common form of heart disease and four other serious disorders. The potential cardiac impact: They estimated that up to 25 million Americans may have triple the average person’s risk for coronary artery disease even if they haven’t yet developed warning signs like high cholesterol.\u003c/p>\n\u003cp>“What I foresee is in five years, each person will know this risk number, this ‘polygenic risk score,’ similar to the way each person knows his or her cholesterol,” said Dr. Sekar Kathiresan who led the research team from the Broad Institute, Massachusetts General Hospital and Harvard Medical School.\u003c/p>\n\u003cp>If the approach pans out and doctors adopt it, a bad score wouldn’t mean you’d get a disease, just that your genetic makeup increases the chance — one more piece of information in deciding care. For example, when the researchers tested the system using a DNA database from Britain, less than 1 percent of people with the lowest risk scores were diagnosed with coronary artery disease, compared to 11 percent of people with the highest risk score.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“There are things you can do to lower the risk,” Kathiresan said — the usual advice about diet, exercise, cholesterol medication and not smoking helps.\u003c/p>\n\u003cp>On the flip side, a low-risk score “doesn’t give you a free pass,” he added. An unhealthy lifestyle could overwhelm the protection of good genes.\u003c/p>\n\u003cp>The scoring system also can predict an increased risk of Type 2 diabetes, inflammatory bowel disease, breast cancer and an irregular heartbeat called atrial fibrillation, the team reported in the journal Nature Genetics — noting that next steps include learning what might likewise lower those risks.\u003c/p>\n\u003cp>It doesn’t require the most sophisticated type of genetic testing. Instead, Kathiresan can calculate risk scores for those five diseases — eventually maybe more — simply by reanalyzing the kind of raw data people receive after sending a cheek swab to companies like 23andMe.\u003c/p>\n\u003cp>A geneticist who specializes in cardiovascular disease, he hopes to open a website where people can send in such data to learn their heart risk, as part of continuing research. Kathiresan and co-author Dr. Amit Khera, a Mass General cardiologist, are co-inventors on a patent application for the system.\u003c/p>\n\u003cp>Other scientists and companies have long sought ways to measure risk from multiple, additive gene effects — the “poly” in polygenic — and Myriad Genetics has begun selling a type of polygenic test for breast cancer risk.\u003c/p>\n\u003cp>But specialists in heart disease and genetics who weren’t involved with the research called the new findings exciting because of their scope.\u003c/p>\n\u003cp>“The results should be eye-opening for cardiologists,” said Dr. Charles C. Hong, director of cardiovascular research at the University of Maryland School of Medicine. “The only disappointment is that this score applies only to those with European ancestry, so I wonder if similar scores are in the works for the large majority of the world population that is not white.”\u003c/p>\n\u003cp>Hong pointed to a friend who recently died of a massive heart attack despite being a super-fit marathon runner who’d never smoked, the kind of puzzling death that doctors have long hoped that a better understanding of genetics could help to prevent.\u003c/p>\n\u003cp>“Most of the variation in disease risk comes from an enormous number of very tiny effects” in genes, agreed Stanford University genetics professor Jonathan Pritchard. “This is the first time polygenic scores have really been shown to reach the level of precision where they can have an impact” on patient health.\u003c/p>\n\u003cp>First, the Boston-based team combed previous studies that mapped the DNA of large numbers of people, looking for links to the five diseases — not outright mutations but minor misspellings in the genetic code.\u003c/p>\n\u003cp>Each variation alone would have only a tiny effect on health. They developed a computerized system that analyzed how those effects add up, and tested it using DNA and medical records from 400,000 people stored in Britain’s UK Biobank. Scores more than three times the average person’s risk were deemed high.\u003c/p>\n\u003cp>___\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The Associated Press Health & Science Department receives \u003ca href=\"http://bit.ly/2G0n9w6\">support\u003c/a> from the Howard Hughes Medical Institute’s Department of Science Education. The AP is solely responsible for all content.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Teens are no more sexually promiscuous in states that have passed legislation promoting the HPV vaccine than those living in states that have not, according to a newly published study.\u003c/p>\n\u003cp>\u003cspan style=\"color: #000000\">The study, released in the journal Pediatrics, compared the District of Columbia and 23 U.S. states that passed legislation to promote the vaccine for human papillomavirus (HPV) with states with no such policies. Researchers then analyzed the results of a \u003ca style=\"color: #000000\" href=\"https://www.cdc.gov/healthyyouth/data/yrbs/pdf/2017/ss6708.pdf\" target=\"_blank\" rel=\"noopener\">multi-year survey\u003c/a> conducted by the Centers for Disease Control and Prevention to determine whether teens living in states with pro-HPV vaccine policies had more sex. They didn’t, the study concluded.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"color: #000000\">“Concern that legislation will increase risky adolescent sexual behaviors should not be used when deciding to pass HPV legislation,” the study said.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"color: #000000\">In states that promoted vaccines, these policies ranged from in-school awareness programs to incentivizing insurance companies to cover the vaccine’s cost, said Erin Cook, the study’s primary author who led this research as part of her doctoral dissertation in epidemiology at the Harvard T.H. Chan School of Public Health.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"color: #000000\">“The big takeaway is that passage of legislation regarding HPV didn’t seem to be associated with any changes in adolescent sexual behaviors in the sample of states we were able to look at,” Cook said.\u003c/span>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cspan style=\"color: #000000\">The study did not examine how well these policies were implemented but simply used the mere presence or absence of such legislation as an indicator of a state’s political will to act on HPV vaccine, cancer prevention and public health, she cautioned.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"color: #000000\">According to the CDC, some 79 million Americans have HPV; it’s the most common sexually transmitted infection in the U.S., this latest study says. Another 14 million people are infected with HPV each year, the CDC says, many of them in their teens and early 20s. Cervical cancer cases \u003ca style=\"color: #000000\" href=\"https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)31206-5/fulltext\" target=\"_blank\" rel=\"noopener\">almost always link\u003c/a> back to the human papillomavirus, according to the Lancet.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"color: #000000\">The U.S. approved use of the three-dose HPV vaccine for girls in 2006 and for boys in 2011. By 2014, just a third of U.S. girls — 37 percent — and 13 percent of American boys had completed the vaccination course. By 2016, nearly half of U.S. girls were vaccinated.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"color: #000000\">Still, half of U.S. states have not implemented policies to promote the vaccine, which scientific research shows can effectively \u003ca style=\"color: #000000\" href=\"https://www.cdc.gov/vaccines/parents/diseases/teen/hpv.html\" target=\"_blank\" rel=\"noopener\">prevent cancers caused by HPV infection\u003c/a>, according to the CDC.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"color: #000000\">These findings are not new, despite persistent attitudes that the HPV vaccine could encourage sexual promiscuity. In 2015, JAMA published a Harvard Medical School study that showed \u003ca style=\"color: #000000\" href=\"https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2109856\" target=\"_blank\" rel=\"noopener\">no link between the vaccine\u003c/a>and a change in teen sexual behavior.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"color: #000000\">In 2007, Gary Freed, a pediatrician and professor at the University of Michigan, chaired the National Vaccine Advisory Council, and told \u003ca style=\"color: #000000\" href=\"http://www.pbs.org/now/shows/308/hpv-vaccine.html\" target=\"_blank\" rel=\"noopener\">Now on PBS\u003c/a>: “If we have the ability to prevent any cancer deaths, much less a significant number of cancer deaths that affect a segment of our population that historically have not been necessarily as well served as they could have been, then I think it’s incumbent upon society to make sure that we’re able to prevent these cancers.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"color: #000000\">Freed said this latest study reinforces the idea that teens are not deciding whether to have sex based on the threat of receiving an HPV infection. This is partly because so few people have heard of HPV, and because “adolescents think in the here and now, not 40 years from now.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"color: #000000\">“We as a society need to decide how much we want to prevent cervical cancer for the children of today,” Freed said. “That’s really what this is all about. We can make pap smears a thing of the past.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"color: #000000\">The U.S. is not alone in its sluggish implementation of a vaccine that can prevent illness and death as a result of cervical cancer. In 2016, \u003ca style=\"color: #000000\" href=\"https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(16)30099-7/fulltext?code=lancet-site\" target=\"_blank\" rel=\"noopener\">a study published in the Lancet\u003c/a> reported that out of 64 nations and 12 territories, only 47 million women finished the three-dose HPV vaccine course. Most of those women lived in high-income or upper middle income countries, the study said.\u003c/span>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cspan style=\"color: #000000\">“Access to HPV vaccination in low-income and lower-middle-income countries is almost non-existent, despite these countries carrying most of the burden of cervical cancer cases worldwide,” the report said.\u003c/span>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Teens are no more sexually promiscuous in states that have passed legislation promoting the HPV vaccine than those living in states that have not, according to a newly published study.\u003c/p>\n\u003cp>\u003cspan style=\"color: #000000\">The study, released in the journal Pediatrics, compared the District of Columbia and 23 U.S. states that passed legislation to promote the vaccine for human papillomavirus (HPV) with states with no such policies. Researchers then analyzed the results of a \u003ca style=\"color: #000000\" href=\"https://www.cdc.gov/healthyyouth/data/yrbs/pdf/2017/ss6708.pdf\" target=\"_blank\" rel=\"noopener\">multi-year survey\u003c/a> conducted by the Centers for Disease Control and Prevention to determine whether teens living in states with pro-HPV vaccine policies had more sex. They didn’t, the study concluded.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"color: #000000\">“Concern that legislation will increase risky adolescent sexual behaviors should not be used when deciding to pass HPV legislation,” the study said.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"color: #000000\">In states that promoted vaccines, these policies ranged from in-school awareness programs to incentivizing insurance companies to cover the vaccine’s cost, said Erin Cook, the study’s primary author who led this research as part of her doctoral dissertation in epidemiology at the Harvard T.H. Chan School of Public Health.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"color: #000000\">“The big takeaway is that passage of legislation regarding HPV didn’t seem to be associated with any changes in adolescent sexual behaviors in the sample of states we were able to look at,” Cook said.\u003c/span>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cspan style=\"color: #000000\">The study did not examine how well these policies were implemented but simply used the mere presence or absence of such legislation as an indicator of a state’s political will to act on HPV vaccine, cancer prevention and public health, she cautioned.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"color: #000000\">According to the CDC, some 79 million Americans have HPV; it’s the most common sexually transmitted infection in the U.S., this latest study says. Another 14 million people are infected with HPV each year, the CDC says, many of them in their teens and early 20s. Cervical cancer cases \u003ca style=\"color: #000000\" href=\"https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)31206-5/fulltext\" target=\"_blank\" rel=\"noopener\">almost always link\u003c/a> back to the human papillomavirus, according to the Lancet.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"color: #000000\">The U.S. approved use of the three-dose HPV vaccine for girls in 2006 and for boys in 2011. By 2014, just a third of U.S. girls — 37 percent — and 13 percent of American boys had completed the vaccination course. By 2016, nearly half of U.S. girls were vaccinated.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"color: #000000\">Still, half of U.S. states have not implemented policies to promote the vaccine, which scientific research shows can effectively \u003ca style=\"color: #000000\" href=\"https://www.cdc.gov/vaccines/parents/diseases/teen/hpv.html\" target=\"_blank\" rel=\"noopener\">prevent cancers caused by HPV infection\u003c/a>, according to the CDC.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"color: #000000\">These findings are not new, despite persistent attitudes that the HPV vaccine could encourage sexual promiscuity. In 2015, JAMA published a Harvard Medical School study that showed \u003ca style=\"color: #000000\" href=\"https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2109856\" target=\"_blank\" rel=\"noopener\">no link between the vaccine\u003c/a>and a change in teen sexual behavior.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"color: #000000\">In 2007, Gary Freed, a pediatrician and professor at the University of Michigan, chaired the National Vaccine Advisory Council, and told \u003ca style=\"color: #000000\" href=\"http://www.pbs.org/now/shows/308/hpv-vaccine.html\" target=\"_blank\" rel=\"noopener\">Now on PBS\u003c/a>: “If we have the ability to prevent any cancer deaths, much less a significant number of cancer deaths that affect a segment of our population that historically have not been necessarily as well served as they could have been, then I think it’s incumbent upon society to make sure that we’re able to prevent these cancers.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"color: #000000\">Freed said this latest study reinforces the idea that teens are not deciding whether to have sex based on the threat of receiving an HPV infection. This is partly because so few people have heard of HPV, and because “adolescents think in the here and now, not 40 years from now.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"color: #000000\">“We as a society need to decide how much we want to prevent cervical cancer for the children of today,” Freed said. “That’s really what this is all about. We can make pap smears a thing of the past.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"color: #000000\">The U.S. is not alone in its sluggish implementation of a vaccine that can prevent illness and death as a result of cervical cancer. In 2016, \u003ca style=\"color: #000000\" href=\"https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(16)30099-7/fulltext?code=lancet-site\" target=\"_blank\" rel=\"noopener\">a study published in the Lancet\u003c/a> reported that out of 64 nations and 12 territories, only 47 million women finished the three-dose HPV vaccine course. Most of those women lived in high-income or upper middle income countries, the study said.\u003c/span>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cspan style=\"color: #000000\">“Access to HPV vaccination in low-income and lower-middle-income countries is almost non-existent, despite these countries carrying most of the burden of cervical cancer cases worldwide,” the report said.\u003c/span>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Can an App Warning to Avoid Risky Friends Prevent Opioid Relapses?",
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"content": "\u003cp>You’re in recovery from opioid addiction, and your walk to work takes you down the same streets where you used to buy heroin. The drug’s calling to you, still. Just then, your phone buzzes, with a message that reads like a text from an old friend:\u003c/p>\n\u003cp>“Hey, I know you’re near a risky area. You can do this.”\u003c/p>\n\u003cp>It’s from Hey,Charlie, an app — conceived at a 2016 Massachusetts Institute of Technology health hackathon — that aims to help people avoid environmental triggers that might threaten their recovery from an opioid addiction. The app, now being piloted by several treatment centers in Boston and Framingham, Mass., monitors a user’s contacts and location, and sends pop-up notifications to caution them about risky acquaintances or neighborhoods.[contextly_sidebar id=\"B6m1pmj1KurktxXVtJVATPZuSNjGkhGD\"]\u003c/p>\n\u003cp>“People and places can remind you of using drugs and stress you out,” leading people to relapse, said Emily Lindemer, co-founder of Hey,Charlie.\u003c/p>\n\u003cp>The app chimes in with a different reminder: recovery. “It helps them keep their sobriety at the front of their mind,” she said.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>There are a sea of addiction apps, many connecting people to treatment or augmenting their outpatient therapy, by counting the number of days in recovery, for example, or recording fluctuations in mood or cravings. Some simply encourage users with inspirational quotes or hypnosis guides. Social apps are increasingly a focus, as well.\u003c/p>\n\u003cp>“Social outlets are critically important,” said Wilson Washington Jr., a senior public health adviser at the federal Substance Abuse and Mental Health Services Administration (SAMHSA). “You need family support, you need community support, you need system support.”\u003c/p>\n\u003cp>One such app, \u003ca href=\"http://www.sobertool.com/about/\" target=\"_blank\" rel=\"noopener\">SoberTool\u003c/a>, offers an anonymous forum for discussion. \u003ca href=\"https://www.sobergrid.com/\" target=\"_blank\" rel=\"noopener\">Sober Grid \u003c/a>is a social network — purported to be the largest for people with a chemical dependency — with a news feed reminiscent of Instagram.\u003c/p>\n\u003cp>But when Lindemer attended the MIT hackathon, she saw a gaping hole among the existing apps — not only could an app foster positive social connections, but it could also help people sever the negative ones.\u003c/p>\n\u003cp>Michael Kidorf, a psychiatrist and associate director of addiction treatment services at Johns Hopkins School of Medicine, told STAT that the social networks of urban drug users tend to include a mix of people who use substances and people who are drug-free.[contextly_sidebar id=\"cwsZEwnwKgEBeLVOmPCSFLGkj8YqHqD4\"]\u003c/p>\n\u003cp>“As you would expect, people who have more network members who use illicit drugs use more drugs [themselves] and engage in more risky behaviors,” he said by email.\u003c/p>\n\u003cp>Opioid users also rely heavily on their contacts to secure heroin and other drugs, Kidorf added. Studies consistently show that regular interaction with other users predicts poorer treatment outcomes.\u003c/p>\n\u003cp>The hard part, he said, is getting people to dismantle and rebuild their social network. “It is relatively easy to tell substance users to ‘change people, places, and things.’ It is much harder to provide a strategy to help them achieve this important goal.”\u003c/p>\n\u003cp>Hey,Charlie is piloting one such strategy.\u003c/p>\n\u003cp>Having watched someone close to her — the namesake for Hey,Charlie — struggle with opioid addiction, Lindemer noticed the obstacles people in recovery face. Even for those who receive \u003ca href=\"https://www.statnews.com/2018/08/06/fda-expands-medication-assisted-treatment/\">medication-assisted treatment\u003c/a>, “you go live your life and in the day-to-day 24/7 doing normal things, you still are in recovery and you still have to battle these constant environmental triggers,” she said.\u003c/p>\n\u003cp>As a then-Ph.D. student in the joint Harvard-MIT Health Sciences and Technology program, Lindemer thought an app could help mediate those urges.\u003c/p>\n\u003cp>Following the hackathon, Lindemer with her co-founder, Vincent Valant, and head developer, Benjamin Pyser, created a company that initially was funded through MIT grants. Now that she has graduated — she has a day job as a scientist at Watson Health in Cambridge, Mass. – the startup is running mostly on funding from the Robert Wood Johnson Foundation and the National Institute on Drug Abuse.\u003c/p>\n\u003cp>Hey,Charlie’s business model is their “Achilles’ heel,” Lindemer said.\u003c/p>\n\u003cp>She wants to ensure that Hey,Charlie is accessible to everybody. “Our goal is that, if we are charging for it, we are not charging the patient. We want it to fit into a treatment program,” which is why the company hopes to eventually demonstrate the app’s clinical efficacy in controlled trials.[contextly_sidebar id=\"dahwcW9QuGAKTVxO8aXeHP8Uk5bpWbni\"]\u003c/p>\n\u003cp>The app is still being refined, but the basics are in place. When sending a text to a “risky” contact, or receiving one, a message from Hey,Charlie will pop up: “Wait a minute, are you sure you want to speak to John Smith right now?” If the user decides against communicating, Hey,Charlie can send an automatic response. The app also shares a handful of affirmative messages with the user throughout the day.\u003c/p>\n\u003cp>For now, Hey,Charlie’s location services simply create a pause (you’re near a risky area). “The idea is that if you are aware of a potentially triggering situation before it arises, you are more mentally primed to handle it effectively,” said Lindemer.\u003c/p>\n\u003cp>But in the future, Lindemer hopes the app can go one step further. She envisions it not only warning people that they’re approaching a risky location, but suggesting an entirely different path as well. Lindemer wants to partner with local businesses so that Hey,Charlie can say, “Hey, there’s a coffee shop with a discount a couple of blocks away if you’re willing to switch up your route!”\u003c/p>\n\u003cp>The app relies on a combination of data actively input by users — a one-time occurrence — and data passively collected as they continue to use their cellphones. The onboarding process asks users a series of questions about their contacts, ranked by frequency of communication, and then calculates the risk each contact poses.\u003c/p>\n\u003cp>Lindemer said that she and her team don’t expect users to be completely upfront and that, especially at the beginning of recovery, relationships can be confusing as they rapidly evolve. Hey,Charlie continues to check in periodically, asking, “Is there anything you want to tell me about this person?”[contextly_sidebar id=\"m4GxEhhH8zjyZ8polANWuf0odOZy5mLJ\"]\u003c/p>\n\u003cp>While the initial version of the app focused on sheltering users from risky contacts, Lindemer and her team are now working to incorporate positive support features as well — letting supportive contacts know when their friend or family member is in a risky place.\u003c/p>\n\u003cp>“One of the things we know really well is that many people in recovery do have somebody — like a really close family member or friend — who wants to help them, and they often just don’t have the tools, and they don’t know when is the right time to reach out, so we’re trying to address that,” Lindemer said.\u003c/p>\n\u003cp>Kidorf stressed the importance of supportive, drug-free contacts. His research focuses on how treatment providers can mobilize drug-free individuals to be active participants in their loved one’s recovery.\u003c/p>\n\u003cp>Hey,Charlie is being piloted at local clinics in and around Boston. Dr. Christopher Shanahan, an internist and professor at Boston University School of Medicine, is leading the effort.\u003c/p>\n\u003cp>Shanahan, who has been studying substance use for nearly 20 years, loved the idea that Hey,Charlie could be there for his patients when he can’t. He said Lindemer pitched it to him and his colleagues during their journal club hour — when researchers typically discuss new papers published in their field.\u003c/p>\n\u003cp>“We have, what, 15 to 20 minutes with a patient in a clinic?” Shanahan said. “We give them some advice, a little bit of coaching, and send them out with some buprenorphine — and then it’s a crapshoot.”\u003c/p>\n\u003cp>The app, he said, is “a very innovative way of addressing the other 23 hours and 15 minutes of the day where doctors aren’t seeing patients.”\u003c/p>\n\u003cp>But he won’t hang his hat on it. An app can help patients cope with triggers and temptations, but it’s far from the perfect solution, he said.\u003c/p>\n\u003cp>Kidorf expressed a similar level-headed optimism, noting that apps can bring users closer to people and organizations that can support their recovery. “Overall, I think it is fair to say that these apps can be helpful for people motivated to use them.”\u003c/p>\n\u003cp>But still, he added, “We have to do better at thinking of opioid use disorder as a severe and often chronic disorder. The best apps in the world will have a hard time competing with it.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This \u003ca href=\"https://www.statnews.com/2018/08/07/can-phone-app-prevent-opioid-addiction-relapses/\" target=\"_blank\" rel=\"noopener\">story\u003c/a> was originally published by STAT, an online publication of Boston Globe Media that covers health, medicine, and scientific discovery.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>You’re in recovery from opioid addiction, and your walk to work takes you down the same streets where you used to buy heroin. The drug’s calling to you, still. Just then, your phone buzzes, with a message that reads like a text from an old friend:\u003c/p>\n\u003cp>“Hey, I know you’re near a risky area. You can do this.”\u003c/p>\n\u003cp>It’s from Hey,Charlie, an app — conceived at a 2016 Massachusetts Institute of Technology health hackathon — that aims to help people avoid environmental triggers that might threaten their recovery from an opioid addiction. The app, now being piloted by several treatment centers in Boston and Framingham, Mass., monitors a user’s contacts and location, and sends pop-up notifications to caution them about risky acquaintances or neighborhoods.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>“People and places can remind you of using drugs and stress you out,” leading people to relapse, said Emily Lindemer, co-founder of Hey,Charlie.\u003c/p>\n\u003cp>The app chimes in with a different reminder: recovery. “It helps them keep their sobriety at the front of their mind,” she said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>There are a sea of addiction apps, many connecting people to treatment or augmenting their outpatient therapy, by counting the number of days in recovery, for example, or recording fluctuations in mood or cravings. Some simply encourage users with inspirational quotes or hypnosis guides. Social apps are increasingly a focus, as well.\u003c/p>\n\u003cp>“Social outlets are critically important,” said Wilson Washington Jr., a senior public health adviser at the federal Substance Abuse and Mental Health Services Administration (SAMHSA). “You need family support, you need community support, you need system support.”\u003c/p>\n\u003cp>One such app, \u003ca href=\"http://www.sobertool.com/about/\" target=\"_blank\" rel=\"noopener\">SoberTool\u003c/a>, offers an anonymous forum for discussion. \u003ca href=\"https://www.sobergrid.com/\" target=\"_blank\" rel=\"noopener\">Sober Grid \u003c/a>is a social network — purported to be the largest for people with a chemical dependency — with a news feed reminiscent of Instagram.\u003c/p>\n\u003cp>But when Lindemer attended the MIT hackathon, she saw a gaping hole among the existing apps — not only could an app foster positive social connections, but it could also help people sever the negative ones.\u003c/p>\n\u003cp>Michael Kidorf, a psychiatrist and associate director of addiction treatment services at Johns Hopkins School of Medicine, told STAT that the social networks of urban drug users tend to include a mix of people who use substances and people who are drug-free.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>“As you would expect, people who have more network members who use illicit drugs use more drugs [themselves] and engage in more risky behaviors,” he said by email.\u003c/p>\n\u003cp>Opioid users also rely heavily on their contacts to secure heroin and other drugs, Kidorf added. Studies consistently show that regular interaction with other users predicts poorer treatment outcomes.\u003c/p>\n\u003cp>The hard part, he said, is getting people to dismantle and rebuild their social network. “It is relatively easy to tell substance users to ‘change people, places, and things.’ It is much harder to provide a strategy to help them achieve this important goal.”\u003c/p>\n\u003cp>Hey,Charlie is piloting one such strategy.\u003c/p>\n\u003cp>Having watched someone close to her — the namesake for Hey,Charlie — struggle with opioid addiction, Lindemer noticed the obstacles people in recovery face. Even for those who receive \u003ca href=\"https://www.statnews.com/2018/08/06/fda-expands-medication-assisted-treatment/\">medication-assisted treatment\u003c/a>, “you go live your life and in the day-to-day 24/7 doing normal things, you still are in recovery and you still have to battle these constant environmental triggers,” she said.\u003c/p>\n\u003cp>As a then-Ph.D. student in the joint Harvard-MIT Health Sciences and Technology program, Lindemer thought an app could help mediate those urges.\u003c/p>\n\u003cp>Following the hackathon, Lindemer with her co-founder, Vincent Valant, and head developer, Benjamin Pyser, created a company that initially was funded through MIT grants. Now that she has graduated — she has a day job as a scientist at Watson Health in Cambridge, Mass. – the startup is running mostly on funding from the Robert Wood Johnson Foundation and the National Institute on Drug Abuse.\u003c/p>\n\u003cp>Hey,Charlie’s business model is their “Achilles’ heel,” Lindemer said.\u003c/p>\n\u003cp>She wants to ensure that Hey,Charlie is accessible to everybody. “Our goal is that, if we are charging for it, we are not charging the patient. We want it to fit into a treatment program,” which is why the company hopes to eventually demonstrate the app’s clinical efficacy in controlled trials.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>The app is still being refined, but the basics are in place. When sending a text to a “risky” contact, or receiving one, a message from Hey,Charlie will pop up: “Wait a minute, are you sure you want to speak to John Smith right now?” If the user decides against communicating, Hey,Charlie can send an automatic response. The app also shares a handful of affirmative messages with the user throughout the day.\u003c/p>\n\u003cp>For now, Hey,Charlie’s location services simply create a pause (you’re near a risky area). “The idea is that if you are aware of a potentially triggering situation before it arises, you are more mentally primed to handle it effectively,” said Lindemer.\u003c/p>\n\u003cp>But in the future, Lindemer hopes the app can go one step further. She envisions it not only warning people that they’re approaching a risky location, but suggesting an entirely different path as well. Lindemer wants to partner with local businesses so that Hey,Charlie can say, “Hey, there’s a coffee shop with a discount a couple of blocks away if you’re willing to switch up your route!”\u003c/p>\n\u003cp>The app relies on a combination of data actively input by users — a one-time occurrence — and data passively collected as they continue to use their cellphones. The onboarding process asks users a series of questions about their contacts, ranked by frequency of communication, and then calculates the risk each contact poses.\u003c/p>\n\u003cp>Lindemer said that she and her team don’t expect users to be completely upfront and that, especially at the beginning of recovery, relationships can be confusing as they rapidly evolve. Hey,Charlie continues to check in periodically, asking, “Is there anything you want to tell me about this person?”\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>While the initial version of the app focused on sheltering users from risky contacts, Lindemer and her team are now working to incorporate positive support features as well — letting supportive contacts know when their friend or family member is in a risky place.\u003c/p>\n\u003cp>“One of the things we know really well is that many people in recovery do have somebody — like a really close family member or friend — who wants to help them, and they often just don’t have the tools, and they don’t know when is the right time to reach out, so we’re trying to address that,” Lindemer said.\u003c/p>\n\u003cp>Kidorf stressed the importance of supportive, drug-free contacts. His research focuses on how treatment providers can mobilize drug-free individuals to be active participants in their loved one’s recovery.\u003c/p>\n\u003cp>Hey,Charlie is being piloted at local clinics in and around Boston. Dr. Christopher Shanahan, an internist and professor at Boston University School of Medicine, is leading the effort.\u003c/p>\n\u003cp>Shanahan, who has been studying substance use for nearly 20 years, loved the idea that Hey,Charlie could be there for his patients when he can’t. He said Lindemer pitched it to him and his colleagues during their journal club hour — when researchers typically discuss new papers published in their field.\u003c/p>\n\u003cp>“We have, what, 15 to 20 minutes with a patient in a clinic?” Shanahan said. “We give them some advice, a little bit of coaching, and send them out with some buprenorphine — and then it’s a crapshoot.”\u003c/p>\n\u003cp>The app, he said, is “a very innovative way of addressing the other 23 hours and 15 minutes of the day where doctors aren’t seeing patients.”\u003c/p>\n\u003cp>But he won’t hang his hat on it. An app can help patients cope with triggers and temptations, but it’s far from the perfect solution, he said.\u003c/p>\n\u003cp>Kidorf expressed a similar level-headed optimism, noting that apps can bring users closer to people and organizations that can support their recovery. “Overall, I think it is fair to say that these apps can be helpful for people motivated to use them.”\u003c/p>\n\u003cp>But still, he added, “We have to do better at thinking of opioid use disorder as a severe and often chronic disorder. The best apps in the world will have a hard time competing with it.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>This \u003ca href=\"https://www.statnews.com/2018/08/07/can-phone-app-prevent-opioid-addiction-relapses/\" target=\"_blank\" rel=\"noopener\">story\u003c/a> was originally published by STAT, an online publication of Boston Globe Media that covers health, medicine, and scientific discovery.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Women Survive Heart Attack More Often When Doctor is Female, Study Finds",
"title": "Women Survive Heart Attack More Often When Doctor is Female, Study Finds",
"headTitle": "Women’s Health | KQED Future of You | KQED Science",
"content": "\u003cp>Much like shoes or skinny jeans, heart attacks can fit women a little differently than men. Their symptoms don’t always look the same, and for a meshwork of reasons, physicians all too often fail to diagnose heart attacks in women with enough time to intervene.\u003c/p>\n\u003cp>The consequence: Women are more likely to die from heart attacks than men are. But, according to a new study, not if they’re treated by female doctors.\u003c/p>\n\u003cp>The \u003ca href=\"http://www.pnas.org/cgi/doi/10.1073/pnas.1800097115\" target=\"_blank\" rel=\"noopener\">research\u003c/a>, published Monday in Proceedings of the National Academy of Sciences, found that female patients are two to three times more likely to survive a heart attack when the doctor overseeing their care is also a woman. But the difference diminished when male doctors worked in emergency rooms with a higher percentage of female physicians.\u003c/p>\n\u003cp>In fact, both men and women suffering heart attacks fared better when treated by female doctors or when treated by men working alongside more female clinicians, the authors reported.\u003c/p>\n\u003cp>These findings raise an unavoidable question: Are women better doctors? And, does rubbing elbows with women physicians help men become better clinicians? The answers are more convoluted than the questions.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Previous research has found better outcomes among hospitalized Medicare patients treated by women, but the underlying reasons remain murky at best.\u003c/p>\n\u003cp>“It’s important to not get caught up in the idea that women are better doctors,” said Dr. Klea Bertakis, a physician and researcher at the University of California, Davis, who studies gender dynamics in health care. “It’s not a men-against-women kind of thing, it’s what are the best practice styles and how can we teach them.”\u003c/p>\n\u003cp>Bertakis pointed to specific practice behaviors – female physicians tend to share more information with patients and to focus more on partnership and patient participation. Male physicians, on the other hand, tend to stick to “the facts,” emphasizing the patient history and physical exam, she said.\u003c/p>\n\u003cp>Dr. Sharonne Hayes, a cardiologist at the Mayo Women’s Heart Clinic, broke down one common explanation for the differences in outcomes for male and female heart attack patients — the symptoms.\u003c/p>\n\u003cp>During a heart attack, women are less likely to experience chest pain, and are more likely to present with nausea and vomiting. But Hayes pointed out that there are more similarities than differences: 30 percent of both men and women won’t experience chest pain, and men can have nausea, too. The symptom hypothesis doesn’t fully explain the different rates of diagnosis and survival.\u003c/p>\n\u003cp>Hayes suggested that part of the problem is that physicians and people in general are “still stuck with some confirmation bias about who gets a heart attack.”\u003c/p>\n\u003cp>The new study, conducted by three business school professors at the University of Minnesota, Washington University in St. Louis, and Harvard, started by looking at whether gender concordance between patients and the attending physicians in the emergency department influenced survival.\u003c/p>\n\u003cp>“There’s relatively deep streams of literature in economics, political science, and sociology that suggest when advocates differ from the people they advocate for, there are often penalties,” said lead author Brad Greenwood of Minnesota’s Carlson School of Management.\u003c/p>\n\u003cp>“Penalties” are business-speak that, when applied in an emergency room, refer to mortality. And “advocacy,” in this case, translates to physician care.\u003c/p>\n\u003cp>Using a census of heart attack patients admitted to Florida hospitals between 1991 and 2010, Greenwood and his colleagues found that when the gender of the patient matched the gender of the physician, both male and female patients were more likely to survive.\u003c/p>\n\u003cp>Looking more closely at the data revealed that female patients treated by male physicians were the least likely to survive a heart attack.\u003c/p>\n\u003cp>The magnitude of the difference impressed Greenwood, but he was not surprised by its existence.\u003c/p>\n\u003cp>Greenwood and his co-authors took their research one step further, studying not only the physicians’ gender, but their environment. They found that patients were more likely to survive heart attacks when treated in emergency departments with higher percentages of female physicians.\u003c/p>\n\u003cp>Greenwood and co-author Seth Carnahan, of Washington University, were both hesitant to speculate about the reasons underlying their observations. Carnahan — who compared the patient-physician relationship to an employee-customer one — acknowledged that, as business professors, he and his colleagues lack the perspective of clinicians.\u003c/p>\n\u003cp>“We have expertise in analyzing data like this and thinking about organizational problems, but we don’t have the firsthand experience and knowledge that doctors have,” he said.\u003c/p>\n\u003cp>Hayes said their statistical analysis went beyond what most doctors could even “conceptualize,” but she and Bertakis expressed some concern over the study’s methods and conclusions. The data, now eight years old, might miss the impact of recent efforts to educate physicians and the public about gender differences in cardiovascular disease.\u003c/p>\n\u003cp>Both physicians also noted that the attending doctor used in the data analysis was likely the physician that discharged the patient — or signed their death certificate — which might not be the same doctor who treated the patient in the emergency room.\u003c/p>\n\u003cp>Bertakis took issue with the the study’s recommendation that one way to improve outcomes would be to increase the number of female physicians in the emergency department.\u003c/p>\n\u003cp>“These approaches are not likely to be feasible,” she said. Instead, she would focus on continuing to improve the curriculum in medical schools and in residency programs to teach physicians about gender differences — both at the patient and physician level — in cardiovascular care.\u003c/p>\n\u003cp>Hayes would like future research to focus on understanding why male physicians who work among more female doctors have better patient survival rates. “Where’s the education coming from? Is it in the hallways and at the watercooler?” she asked. “Or are there policy changes and practice changes?”\u003c/p>\n\u003cp>The new study is a launchpad to address these questions, she said: “Understanding differences in how we need to care for men and women — particularly with heart disease, but for many other conditions — is something we should all be teaching our medical students, and learning, and incorporating in our daily practice.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This\u003ca href=\"https://www.statnews.com/2018/08/06/heart-attacks-women-female-doctors/\" 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>Much like shoes or skinny jeans, heart attacks can fit women a little differently than men. Their symptoms don’t always look the same, and for a meshwork of reasons, physicians all too often fail to diagnose heart attacks in women with enough time to intervene.\u003c/p>\n\u003cp>The consequence: Women are more likely to die from heart attacks than men are. But, according to a new study, not if they’re treated by female doctors.\u003c/p>\n\u003cp>The \u003ca href=\"http://www.pnas.org/cgi/doi/10.1073/pnas.1800097115\" target=\"_blank\" rel=\"noopener\">research\u003c/a>, published Monday in Proceedings of the National Academy of Sciences, found that female patients are two to three times more likely to survive a heart attack when the doctor overseeing their care is also a woman. But the difference diminished when male doctors worked in emergency rooms with a higher percentage of female physicians.\u003c/p>\n\u003cp>In fact, both men and women suffering heart attacks fared better when treated by female doctors or when treated by men working alongside more female clinicians, the authors reported.\u003c/p>\n\u003cp>These findings raise an unavoidable question: Are women better doctors? And, does rubbing elbows with women physicians help men become better clinicians? The answers are more convoluted than the questions.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Previous research has found better outcomes among hospitalized Medicare patients treated by women, but the underlying reasons remain murky at best.\u003c/p>\n\u003cp>“It’s important to not get caught up in the idea that women are better doctors,” said Dr. Klea Bertakis, a physician and researcher at the University of California, Davis, who studies gender dynamics in health care. “It’s not a men-against-women kind of thing, it’s what are the best practice styles and how can we teach them.”\u003c/p>\n\u003cp>Bertakis pointed to specific practice behaviors – female physicians tend to share more information with patients and to focus more on partnership and patient participation. Male physicians, on the other hand, tend to stick to “the facts,” emphasizing the patient history and physical exam, she said.\u003c/p>\n\u003cp>Dr. Sharonne Hayes, a cardiologist at the Mayo Women’s Heart Clinic, broke down one common explanation for the differences in outcomes for male and female heart attack patients — the symptoms.\u003c/p>\n\u003cp>During a heart attack, women are less likely to experience chest pain, and are more likely to present with nausea and vomiting. But Hayes pointed out that there are more similarities than differences: 30 percent of both men and women won’t experience chest pain, and men can have nausea, too. The symptom hypothesis doesn’t fully explain the different rates of diagnosis and survival.\u003c/p>\n\u003cp>Hayes suggested that part of the problem is that physicians and people in general are “still stuck with some confirmation bias about who gets a heart attack.”\u003c/p>\n\u003cp>The new study, conducted by three business school professors at the University of Minnesota, Washington University in St. Louis, and Harvard, started by looking at whether gender concordance between patients and the attending physicians in the emergency department influenced survival.\u003c/p>\n\u003cp>“There’s relatively deep streams of literature in economics, political science, and sociology that suggest when advocates differ from the people they advocate for, there are often penalties,” said lead author Brad Greenwood of Minnesota’s Carlson School of Management.\u003c/p>\n\u003cp>“Penalties” are business-speak that, when applied in an emergency room, refer to mortality. And “advocacy,” in this case, translates to physician care.\u003c/p>\n\u003cp>Using a census of heart attack patients admitted to Florida hospitals between 1991 and 2010, Greenwood and his colleagues found that when the gender of the patient matched the gender of the physician, both male and female patients were more likely to survive.\u003c/p>\n\u003cp>Looking more closely at the data revealed that female patients treated by male physicians were the least likely to survive a heart attack.\u003c/p>\n\u003cp>The magnitude of the difference impressed Greenwood, but he was not surprised by its existence.\u003c/p>\n\u003cp>Greenwood and his co-authors took their research one step further, studying not only the physicians’ gender, but their environment. They found that patients were more likely to survive heart attacks when treated in emergency departments with higher percentages of female physicians.\u003c/p>\n\u003cp>Greenwood and co-author Seth Carnahan, of Washington University, were both hesitant to speculate about the reasons underlying their observations. Carnahan — who compared the patient-physician relationship to an employee-customer one — acknowledged that, as business professors, he and his colleagues lack the perspective of clinicians.\u003c/p>\n\u003cp>“We have expertise in analyzing data like this and thinking about organizational problems, but we don’t have the firsthand experience and knowledge that doctors have,” he said.\u003c/p>\n\u003cp>Hayes said their statistical analysis went beyond what most doctors could even “conceptualize,” but she and Bertakis expressed some concern over the study’s methods and conclusions. The data, now eight years old, might miss the impact of recent efforts to educate physicians and the public about gender differences in cardiovascular disease.\u003c/p>\n\u003cp>Both physicians also noted that the attending doctor used in the data analysis was likely the physician that discharged the patient — or signed their death certificate — which might not be the same doctor who treated the patient in the emergency room.\u003c/p>\n\u003cp>Bertakis took issue with the the study’s recommendation that one way to improve outcomes would be to increase the number of female physicians in the emergency department.\u003c/p>\n\u003cp>“These approaches are not likely to be feasible,” she said. Instead, she would focus on continuing to improve the curriculum in medical schools and in residency programs to teach physicians about gender differences — both at the patient and physician level — in cardiovascular care.\u003c/p>\n\u003cp>Hayes would like future research to focus on understanding why male physicians who work among more female doctors have better patient survival rates. “Where’s the education coming from? Is it in the hallways and at the watercooler?” she asked. “Or are there policy changes and practice changes?”\u003c/p>\n\u003cp>The new study is a launchpad to address these questions, she said: “Understanding differences in how we need to care for men and women — particularly with heart disease, but for many other conditions — is something we should all be teaching our medical students, and learning, and incorporating in our daily practice.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>Federal authorities have issued a public health alert about more than two dozen beef, pork and poultry salad and wrap products as a precaution due to possible parasite contamination.\u003c/p>\n\u003cp>The Agriculture Department’s Food Safety and Inspection Service says the products, distributed by Indianapolis-based Caito Foods may be contaminated with cyclospora. The parasite causes intestinal illness.\u003c/p>\n\u003cp>The USDA says Caito Foods was notified from their lettuce supplier, Fresh Express, that the chopped romaine used in some of the salads was being recalled.\u003c/p>\n\u003cp>The products were sold by grocery stores including Trader Joe’s, Walgreens and Kroger. They have the establishment number “EST. 39985 or P-39985.” The USDA has posted a complete list \u003ca href=\"https://www.fsis.usda.gov/wps/wcm/connect/1827c9ab-6a03-4020-a74e-e8b2d5e7e8dc/List-USDA-Product-PHA-Cyclospora.pdf?MOD=AJPERES\" target=\"_blank\" rel=\"noopener\">online\u003c/a> . Consumers are urged to throw them away.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\u003cp>\u003c/p>\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Federal authorities have issued a public health alert about more than two dozen beef, pork and poultry salad and wrap products as a precaution due to possible parasite contamination.\u003c/p>\n\u003cp>The Agriculture Department’s Food Safety and Inspection Service says the products, distributed by Indianapolis-based Caito Foods may be contaminated with cyclospora. The parasite causes intestinal illness.\u003c/p>\n\u003cp>The USDA says Caito Foods was notified from their lettuce supplier, Fresh Express, that the chopped romaine used in some of the salads was being recalled.\u003c/p>\n\u003cp>The products were sold by grocery stores including Trader Joe’s, Walgreens and Kroger. They have the establishment number “EST. 39985 or P-39985.” The USDA has posted a complete list \u003ca href=\"https://www.fsis.usda.gov/wps/wcm/connect/1827c9ab-6a03-4020-a74e-e8b2d5e7e8dc/List-USDA-Product-PHA-Cyclospora.pdf?MOD=AJPERES\" target=\"_blank\" rel=\"noopener\">online\u003c/a> . Consumers are urged to throw them away.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>Was it hard to concentrate during that long meeting? Does the crossword seem a little tougher? You could be mildly dehydrated.\u003c/p>\n\u003cp>A growing body of evidence finds that being just a little dehydrated is tied to a range of subtle effects — from mood changes to muddled thinking.\u003c/p>\n\u003cp>\"We find that when people are mildly dehydrated they really don't do as well on tasks that require complex processing or on tasks that require a lot of their attention,\" says \u003ca href=\"http://biosci.gatech.edu/people/mindy-millard-stafford\" target=\"_blank\" rel=\"noopener\">Mindy Millard-Stafford\u003c/a>, director of the Exercise Physiology Laboratory at Georgia Institute of Technology. She \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/?term=dehydration+impairs+cognition+Millard-Stafford\" target=\"_blank\" rel=\"noopener\">published\u003c/a> an analysis of the evidence this month, based on 33 studies.\u003c/p>\n\u003cp>How long does it take to become mildly dehydrated in the summer heat? Not long at all, studies show, especially when you exercise outdoors.\u003c/p>\n\u003cp>\"If I were hiking at moderate intensity for one hour, I could reach about 1.5 percent to 2 percent dehydration,\" says \u003ca href=\"https://ksi.uconn.edu/about/staff/\" target=\"_blank\" rel=\"noopener\">Doug Casa\u003c/a>, a professor of kinesiology at the University of Connecticut, and CEO of the Korey Stringer Institute.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>For an average-size person, 2 percent dehydration equates to sweating out about a liter of water.\u003c/p>\n\u003cp>\"Most people don't realize how high their sweat rate is in the heat,\" Casa says. If you're going hard during a run, you can reach that level of dehydration in about 30 minutes.\u003c/p>\n\u003cp>And at this level of dehydration, the feeling of thirst, for many of us, is only just beginning to kick in. \"Most people can't perceive that they're 1.5 percent dehydrated,\" Casa says.\u003c/p>\n\u003cp>But already there are subtle — maybe even imperceptible — effects on our bodies and our mental performance.\u003c/p>\n\u003cp>Take, for example, the findings from a \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/?term=Water+Intake+Reverses+Dehydration+Executive+Function\" target=\"_blank\" rel=\"noopener\">recent study\u003c/a> of young, healthy and active women who agreed to take a bunch of cognitive tests and also agreed to restrict their fluid intake to no more than 6 ounces for one day.\u003c/p>\n\u003cp>\"We did manage to dehydrate them by [about] 1 percent just by telling them not to drink for the day,\" says \u003ca href=\"http://jbpierce.org/faculty/nina-stachenfeld-phd/\" target=\"_blank\" rel=\"noopener\">Nina Stachenfeld\u003c/a>, of the Yale School of Medicine and the John B. Pierce Laboratory, who led the research.\u003c/p>\n\u003cp>The women took one test designed to measure cognitive flexibility. It's a card game that requires a lot of attention, since the rules keep changing throughout the game.\u003c/p>\n\u003cp>\"When the women were dehydrated they had about 12 percent more total errors\" in the game, says Stachenfeld.\u003c/p>\n\u003cp>She repeated the tests after the women drank sufficient water, and their performance improved. \"We were able to improve executive function back to normal — in other words, back to the baseline day — when they rehydrated,\" the scientist says.\u003c/p>\n\u003cp>Dehydration didn't hamper performance on all the tests; the women's reaction time, for example, was not impeded. The decline was seen during the complicated tasks.\u003c/p>\n\u003cp>Though the study was small, and funded by PepsiCo, which sells bottled water, Stachenfeld designed the methods and completed the analysis independently. And other scientists say her findings fit with a growing body of independent evidence that points to similar conclusions.\u003c/p>\n\u003cp>\"I absolutely think there could be big implications of having a mild cognitive deficiency with small amounts of dehydration,\" Casa says.\u003c/p>\n\u003cp>If you're a student, for example, a 12 percent increase in errors on a test might matter. And whether you're a pilot, a soldier, a surgeon or a scholar, many daily tasks depend on the ability to be precise and pay attention.\u003c/p>\n\u003cp>For anyone trying to do their best work, the findings raise a number of questions:\u003c/p>\n\u003cp>\u003cstrong>How Much Water Do We Need?\u003c/strong>\u003c/p>\n\u003cp>There are no exact daily requirements, but there are general recommendations.\u003c/p>\n\u003cp>A panel of scholars convened several years ago by the National Academies of Sciences, Engineering and Medicine \u003ca href=\"http://www.nationalacademies.org/hmd/Reports/2004/Dietary-Reference-Intakes-Water-Potassium-Sodium-Chloride-and-Sulfate.aspx\" target=\"_blank\" rel=\"noopener\">concluded\u003c/a> that women should consume, on average, about 91 ounces of total water per day. For men, the suggested level is even higher (125 ounces).\u003c/p>\n\u003cp>Note that this total includes water from all sources, including food and other beverages, such as coffee and tea. Typically, people get about 20 percent of the water they need daily from fruits, vegetables and other food.\u003c/p>\n\u003cp>Also, water needs vary from person to person. For example, body weight and muscle mass matter. Also, physical activity and heat exposure can increase the amount of fluid a person needs.\u003c/p>\n\u003cp>\u003cstrong>How Can You Tell If You're Dehydrated?\u003c/strong>\u003c/p>\n\u003cp>One easy test: The color of your urine is a good guide. As a general rule of thumb, the darker the color, the more likely you are to be dehydrated. Aim for shades that have been described as \"pale lemonade\" or \"straw.\" A \u003ca href=\"http://www.hydrationcheck.com/about.php\" target=\"_blank\" rel=\"noopener\">color chart\u003c/a> developed by physiologist and University of Connecticut professor \u003ca href=\"https://kins.uconn.edu/lawrence-e-armstrong-ph-d/\" target=\"_blank\" rel=\"noopener\">Lawrence Armstrong\u003c/a> can be a helpful guide, researchers say.\u003c/p>\n\u003cp>\u003cstrong>Are Older People More Vulnerable to Dehydration?\u003c/strong>\u003c/p>\n\u003cp>As we age, we're not as good at recognizing thirst. And there's \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/?term=suhr+cognition+and+dehydration\" target=\"_blank\" rel=\"noopener\">evidence\u003c/a> that older adults are prone to the same dips in mental sharpness as anyone else when mildly dehydrated.\u003c/p>\n\u003cp>Don't wait until you're thirsty. A good rule of thumb is to sip fluids throughout the day. No need to chug huge amounts at one time; there are some \u003ca href=\"https://www.merckmanuals.com/home/hormonal-and-metabolic-disorders/water-balance/overhydration\" target=\"_blank\" rel=\"noopener\">risks to overhydrating\u003c/a>, too.\u003c/p>\n\u003cp>\u003cstrong>Can Coffee, Tea and Other Caffeinated Drinks Dehydrate?\u003c/strong>\u003c/p>\n\u003cp>The most recent evidence finds that coffee provides similar hydrating qualities to water. In other words, yes, your morning cup of joe — or whatever caffeinated beverage you fancy, can help to keep you hydrated.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>As we \u003ca href=\"https://www.npr.org/sections/thesalt/2014/01/13/262175623/coffee-myth-busting-cup-of-joe-may-help-hydration-and-memory\" target=\"_blank\" rel=\"noopener\">reported\u003c/a> in 2014, people who routinely drink coffee or tea develop a tolerance to the potential diuretic effects of caffeine.\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=Off+Your+Mental+Game%3F+You+Could+Be+Mildly+Dehydrated&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Was it hard to concentrate during that long meeting? Does the crossword seem a little tougher? You could be mildly dehydrated.\u003c/p>\n\u003cp>A growing body of evidence finds that being just a little dehydrated is tied to a range of subtle effects — from mood changes to muddled thinking.\u003c/p>\n\u003cp>\"We find that when people are mildly dehydrated they really don't do as well on tasks that require complex processing or on tasks that require a lot of their attention,\" says \u003ca href=\"http://biosci.gatech.edu/people/mindy-millard-stafford\" target=\"_blank\" rel=\"noopener\">Mindy Millard-Stafford\u003c/a>, director of the Exercise Physiology Laboratory at Georgia Institute of Technology. She \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/?term=dehydration+impairs+cognition+Millard-Stafford\" target=\"_blank\" rel=\"noopener\">published\u003c/a> an analysis of the evidence this month, based on 33 studies.\u003c/p>\n\u003cp>How long does it take to become mildly dehydrated in the summer heat? Not long at all, studies show, especially when you exercise outdoors.\u003c/p>\n\u003cp>\"If I were hiking at moderate intensity for one hour, I could reach about 1.5 percent to 2 percent dehydration,\" says \u003ca href=\"https://ksi.uconn.edu/about/staff/\" target=\"_blank\" rel=\"noopener\">Doug Casa\u003c/a>, a professor of kinesiology at the University of Connecticut, and CEO of the Korey Stringer Institute.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>For an average-size person, 2 percent dehydration equates to sweating out about a liter of water.\u003c/p>\n\u003cp>\"Most people don't realize how high their sweat rate is in the heat,\" Casa says. If you're going hard during a run, you can reach that level of dehydration in about 30 minutes.\u003c/p>\n\u003cp>And at this level of dehydration, the feeling of thirst, for many of us, is only just beginning to kick in. \"Most people can't perceive that they're 1.5 percent dehydrated,\" Casa says.\u003c/p>\n\u003cp>But already there are subtle — maybe even imperceptible — effects on our bodies and our mental performance.\u003c/p>\n\u003cp>Take, for example, the findings from a \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/?term=Water+Intake+Reverses+Dehydration+Executive+Function\" target=\"_blank\" rel=\"noopener\">recent study\u003c/a> of young, healthy and active women who agreed to take a bunch of cognitive tests and also agreed to restrict their fluid intake to no more than 6 ounces for one day.\u003c/p>\n\u003cp>\"We did manage to dehydrate them by [about] 1 percent just by telling them not to drink for the day,\" says \u003ca href=\"http://jbpierce.org/faculty/nina-stachenfeld-phd/\" target=\"_blank\" rel=\"noopener\">Nina Stachenfeld\u003c/a>, of the Yale School of Medicine and the John B. Pierce Laboratory, who led the research.\u003c/p>\n\u003cp>The women took one test designed to measure cognitive flexibility. It's a card game that requires a lot of attention, since the rules keep changing throughout the game.\u003c/p>\n\u003cp>\"When the women were dehydrated they had about 12 percent more total errors\" in the game, says Stachenfeld.\u003c/p>\n\u003cp>She repeated the tests after the women drank sufficient water, and their performance improved. \"We were able to improve executive function back to normal — in other words, back to the baseline day — when they rehydrated,\" the scientist says.\u003c/p>\n\u003cp>Dehydration didn't hamper performance on all the tests; the women's reaction time, for example, was not impeded. The decline was seen during the complicated tasks.\u003c/p>\n\u003cp>Though the study was small, and funded by PepsiCo, which sells bottled water, Stachenfeld designed the methods and completed the analysis independently. And other scientists say her findings fit with a growing body of independent evidence that points to similar conclusions.\u003c/p>\n\u003cp>\"I absolutely think there could be big implications of having a mild cognitive deficiency with small amounts of dehydration,\" Casa says.\u003c/p>\n\u003cp>If you're a student, for example, a 12 percent increase in errors on a test might matter. And whether you're a pilot, a soldier, a surgeon or a scholar, many daily tasks depend on the ability to be precise and pay attention.\u003c/p>\n\u003cp>For anyone trying to do their best work, the findings raise a number of questions:\u003c/p>\n\u003cp>\u003cstrong>How Much Water Do We Need?\u003c/strong>\u003c/p>\n\u003cp>There are no exact daily requirements, but there are general recommendations.\u003c/p>\n\u003cp>A panel of scholars convened several years ago by the National Academies of Sciences, Engineering and Medicine \u003ca href=\"http://www.nationalacademies.org/hmd/Reports/2004/Dietary-Reference-Intakes-Water-Potassium-Sodium-Chloride-and-Sulfate.aspx\" target=\"_blank\" rel=\"noopener\">concluded\u003c/a> that women should consume, on average, about 91 ounces of total water per day. For men, the suggested level is even higher (125 ounces).\u003c/p>\n\u003cp>Note that this total includes water from all sources, including food and other beverages, such as coffee and tea. Typically, people get about 20 percent of the water they need daily from fruits, vegetables and other food.\u003c/p>\n\u003cp>Also, water needs vary from person to person. For example, body weight and muscle mass matter. Also, physical activity and heat exposure can increase the amount of fluid a person needs.\u003c/p>\n\u003cp>\u003cstrong>How Can You Tell If You're Dehydrated?\u003c/strong>\u003c/p>\n\u003cp>One easy test: The color of your urine is a good guide. As a general rule of thumb, the darker the color, the more likely you are to be dehydrated. Aim for shades that have been described as \"pale lemonade\" or \"straw.\" A \u003ca href=\"http://www.hydrationcheck.com/about.php\" target=\"_blank\" rel=\"noopener\">color chart\u003c/a> developed by physiologist and University of Connecticut professor \u003ca href=\"https://kins.uconn.edu/lawrence-e-armstrong-ph-d/\" target=\"_blank\" rel=\"noopener\">Lawrence Armstrong\u003c/a> can be a helpful guide, researchers say.\u003c/p>\n\u003cp>\u003cstrong>Are Older People More Vulnerable to Dehydration?\u003c/strong>\u003c/p>\n\u003cp>As we age, we're not as good at recognizing thirst. And there's \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/?term=suhr+cognition+and+dehydration\" target=\"_blank\" rel=\"noopener\">evidence\u003c/a> that older adults are prone to the same dips in mental sharpness as anyone else when mildly dehydrated.\u003c/p>\n\u003cp>Don't wait until you're thirsty. A good rule of thumb is to sip fluids throughout the day. No need to chug huge amounts at one time; there are some \u003ca href=\"https://www.merckmanuals.com/home/hormonal-and-metabolic-disorders/water-balance/overhydration\" target=\"_blank\" rel=\"noopener\">risks to overhydrating\u003c/a>, too.\u003c/p>\n\u003cp>\u003cstrong>Can Coffee, Tea and Other Caffeinated Drinks Dehydrate?\u003c/strong>\u003c/p>\n\u003cp>The most recent evidence finds that coffee provides similar hydrating qualities to water. In other words, yes, your morning cup of joe — or whatever caffeinated beverage you fancy, can help to keep you hydrated.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>As we \u003ca href=\"https://www.npr.org/sections/thesalt/2014/01/13/262175623/coffee-myth-busting-cup-of-joe-may-help-hydration-and-memory\" target=\"_blank\" rel=\"noopener\">reported\u003c/a> in 2014, people who routinely drink coffee or tea develop a tolerance to the potential diuretic effects of caffeine.\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=Off+Your+Mental+Game%3F+You+Could+Be+Mildly+Dehydrated&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Most People Think Pot's Totally Safe. But We Don't Actually Know",
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"content": "\u003cp>When it comes to pot, many Americans seem to think it is a magic cure-all despite the lack of scientific data to corroborate that view.[contextly_sidebar id=\"qbIMJ6HAj7B7PdjXyzZ3WGlgtNv4dD58\"]\u003c/p>\n\u003cp>Those are the findings of a new survey, published this week in the journal \u003ca href=\"http://annals.org/aim/article/doi/10.7326/M18-0810\">\u003cem>Annals of Internal Medicine\u003c/em>. \u003c/a>The online survey, conducted by researchers at UC San Francisco, found that many Americans believe marijuana has significant health benefits, despite a lack of scientific data to support that view.\u003c/p>\n\u003cp>That data lack is largely due to marijuana's restricted legal status in the U.S., which makes it difficult for scientists to study the drug's impact on human health, according to Timothy Fong, a professor of addiction psychiatry at UC Los Angeles.\u003c/p>\n\u003cp>[contextly_sidebar id=\"1hOtotjglJ20ftdvAgNx5fpFHerDNbOZ\"]Without actual data to go on, people fall back on personal or anecdotal evidence.\u003c/p>\n\u003cp>\"We want to do more studies, but we can’t do a darn thing if the federal government handcuffs us,” Fong told \u003ca href=\"https://www.reuters.com/article/us-health-marijuana/americans-view-of-marijuana-is-rosy-and-unscientific-idUSKBN1KD2IR\" target=\"_blank\" rel=\"noopener\">Reuters.\u003c/a> “This is the kind of study that I think elevates the discussion. And it shows we have a long way to go.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Researchers surveyed 16,280 people in the U.S. and found that 81 percent of respondents believe that smoking marijuana has at least one health benefit, with pain management being the most commonly cited one.\u003c/p>\n\u003cp>Yet a separate study \u003ca href=\"https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(18)30110-5/fulltext?code=lancet-site\" target=\"_blank\" rel=\"noopener\">spanning four years\u003c/a> found no evidence that marijuana use improves the symptoms of chronic pain.\u003c/p>\n\u003cp>The survey also found that 91 percent of respondents believe that marijuana has at least one risk, but the most commonly cited risk — legal trouble — wasn't health related, a finding researchers found troubling because it indicates that many people are downplaying potential harm, according to \u003ca href=\"http://chime.ucsf.edu/people/salomeh-keyhani-md\" target=\"_blank\" rel=\"noopener\">Dr. Salomeh Keyhani,\u003c/a> a professor of medicine at UC San Francisco.\u003c/p>\n\u003cp>“The American public has a much more favorable point of view than is warranted by the evidence,” Dr. Keyhani told \u003ca href=\"https://www.reuters.com/article/us-health-marijuana/americans-view-of-marijuana-is-rosy-and-unscientific-idUSKBN1KD2IR\" target=\"_blank\" rel=\"noopener\">Reuters.\u003c/a> “Perhaps most concerning is that they think that it prevents health problems.”\u003c/p>\n\u003cp>The survey found that 18 percent of respondents believe that smoking marijuana is somewhat or completely safe for adults.\u003c/p>\n\u003cp>In addition, nearly half of those surveyed believe that marijuana can alleviate insomnia, anxiety and depression, none of which are scientifically established, says Dr. Keyhani.[contextly_sidebar id=\"llwIT8YXMfGYSqJGFFEv4ackgmMz0K5Q\"]\u003c/p>\n\u003cp>\"The bottom line is that there's no evidence for the vast majority of this,\" Dr. Keyhani told \u003ca href=\"https://www.livescience.com/63141-marijuana-assumed-beneficial.html\" target=\"_blank\" rel=\"noopener\">Livescience\u003c/a>. \"There's limited data on harm, and people think that means it's OK.\"\u003c/p>\n\u003cp>Researchers created the survey to examine the impact of marketing on the public's perception of marijuana. From \u003ca href=\"https://www.theguardian.com/society/2018/jul/23/cannabis-health-benefits-american-attitudes-study\" target=\"_blank\" rel=\"noopener\">the Guardian\u003c/a>:\u003c/p>\n\u003cblockquote>\u003cp>Mixed signals regarding marijuana’s potential dangers and benefits have enabled the commercial marijuana industry to promote a maximalist view of marijuana’s possible benefits. Since direct unproven claims of marijuana’s medical benefits, and assertions such as that a product cures cancer, can lead to unwanted attention from the FDA regulators, cannabis companies have learned to be much more subtle.\u003c/p>\u003c/blockquote>\n\u003cp>Despite the federal ban on marijuana, the Food and Drug Administration \u003ca href=\"https://www.kqed.org/futureofyou/443383/meet-sam-the-berkeley-kid-who-inspired-first-marijuana-based-drug\" target=\"_blank\" rel=\"noopener\">recently approved Epidiolex, an epilepsy drug\u003c/a> derived from marijuana. Medical marijuana is also legal in 31 states, a fact that only contributes to its rosy reputation.\u003c/p>\n\u003cp>Still, Keyhani says more research needs to be done. Until that happens, most of the health claims touted by the industry remain unproven.\u003c/p>\n\u003cp>“We need better data,” Keyhani told the Guardian. “We need any data.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp> \u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>When it comes to pot, many Americans seem to think it is a magic cure-all despite the lack of scientific data to corroborate that view.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Those are the findings of a new survey, published this week in the journal \u003ca href=\"http://annals.org/aim/article/doi/10.7326/M18-0810\">\u003cem>Annals of Internal Medicine\u003c/em>. \u003c/a>The online survey, conducted by researchers at UC San Francisco, found that many Americans believe marijuana has significant health benefits, despite a lack of scientific data to support that view.\u003c/p>\n\u003cp>That data lack is largely due to marijuana's restricted legal status in the U.S., which makes it difficult for scientists to study the drug's impact on human health, according to Timothy Fong, a professor of addiction psychiatry at UC Los Angeles.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>Without actual data to go on, people fall back on personal or anecdotal evidence.\u003c/p>\n\u003cp>\"We want to do more studies, but we can’t do a darn thing if the federal government handcuffs us,” Fong told \u003ca href=\"https://www.reuters.com/article/us-health-marijuana/americans-view-of-marijuana-is-rosy-and-unscientific-idUSKBN1KD2IR\" target=\"_blank\" rel=\"noopener\">Reuters.\u003c/a> “This is the kind of study that I think elevates the discussion. And it shows we have a long way to go.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Researchers surveyed 16,280 people in the U.S. and found that 81 percent of respondents believe that smoking marijuana has at least one health benefit, with pain management being the most commonly cited one.\u003c/p>\n\u003cp>Yet a separate study \u003ca href=\"https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(18)30110-5/fulltext?code=lancet-site\" target=\"_blank\" rel=\"noopener\">spanning four years\u003c/a> found no evidence that marijuana use improves the symptoms of chronic pain.\u003c/p>\n\u003cp>The survey also found that 91 percent of respondents believe that marijuana has at least one risk, but the most commonly cited risk — legal trouble — wasn't health related, a finding researchers found troubling because it indicates that many people are downplaying potential harm, according to \u003ca href=\"http://chime.ucsf.edu/people/salomeh-keyhani-md\" target=\"_blank\" rel=\"noopener\">Dr. Salomeh Keyhani,\u003c/a> a professor of medicine at UC San Francisco.\u003c/p>\n\u003cp>“The American public has a much more favorable point of view than is warranted by the evidence,” Dr. Keyhani told \u003ca href=\"https://www.reuters.com/article/us-health-marijuana/americans-view-of-marijuana-is-rosy-and-unscientific-idUSKBN1KD2IR\" target=\"_blank\" rel=\"noopener\">Reuters.\u003c/a> “Perhaps most concerning is that they think that it prevents health problems.”\u003c/p>\n\u003cp>The survey found that 18 percent of respondents believe that smoking marijuana is somewhat or completely safe for adults.\u003c/p>\n\u003cp>In addition, nearly half of those surveyed believe that marijuana can alleviate insomnia, anxiety and depression, none of which are scientifically established, says Dr. Keyhani.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\"The bottom line is that there's no evidence for the vast majority of this,\" Dr. Keyhani told \u003ca href=\"https://www.livescience.com/63141-marijuana-assumed-beneficial.html\" target=\"_blank\" rel=\"noopener\">Livescience\u003c/a>. \"There's limited data on harm, and people think that means it's OK.\"\u003c/p>\n\u003cp>Researchers created the survey to examine the impact of marketing on the public's perception of marijuana. From \u003ca href=\"https://www.theguardian.com/society/2018/jul/23/cannabis-health-benefits-american-attitudes-study\" target=\"_blank\" rel=\"noopener\">the Guardian\u003c/a>:\u003c/p>\n\u003cblockquote>\u003cp>Mixed signals regarding marijuana’s potential dangers and benefits have enabled the commercial marijuana industry to promote a maximalist view of marijuana’s possible benefits. Since direct unproven claims of marijuana’s medical benefits, and assertions such as that a product cures cancer, can lead to unwanted attention from the FDA regulators, cannabis companies have learned to be much more subtle.\u003c/p>\u003c/blockquote>\n\u003cp>Despite the federal ban on marijuana, the Food and Drug Administration \u003ca href=\"https://www.kqed.org/futureofyou/443383/meet-sam-the-berkeley-kid-who-inspired-first-marijuana-based-drug\" target=\"_blank\" rel=\"noopener\">recently approved Epidiolex, an epilepsy drug\u003c/a> derived from marijuana. Medical marijuana is also legal in 31 states, a fact that only contributes to its rosy reputation.\u003c/p>\n\u003cp>Still, Keyhani says more research needs to be done. Until that happens, most of the health claims touted by the industry remain unproven.\u003c/p>\n\u003cp>“We need better data,” Keyhani told the Guardian. “We need any data.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp> \u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>If you're in the hospital or a doctor's office with a painful problem, you'll likely be asked to rate your pain on a \u003ca href=\"https://paindoctor.com/pain-scales/\" target=\"_blank\" rel=\"noopener\">scale\u003c/a> of 0 to 10 – with 0 meaning no pain at all and 10 indicating the worst pain you can imagine. But many doctors and nurses say this rating system isn't working and they're trying a new approach.[contextly_sidebar id=\"PzT9DEOa22PlTyV4kUDRN8kM4A2CX5Tx\"]\u003c/p>\n\u003cp>The numeric pain scale may just be too simplistic, says \u003ca href=\"https://www.urmc.rochester.edu/people/21192807-john-d-markman\" target=\"_blank\" rel=\"noopener\">Dr. John Markman\u003c/a>, director of the Translational Pain Research Program at the University of Rochester School of Medicine and Dentistry. It can lead doctors to \"treat by numbers,\" he says and as a result, patients may not be getting the most effective treatment for their pain.\u003c/p>\n\u003cp>Take the case of 33-year-old Adam Rosette, who was recently hospitalized for \u003ca href=\"https://orthoinfo.aaos.org/en/diseases--conditions/fibrous-dysplasia/\" target=\"_blank\" rel=\"noopener\">fibrous dysplasia\u003c/a>, a bone disorder that made it nearly impossible for him to chew or even speak. After brain surgery to remove benign tumors related to the disorder, he was definitely in pain. But he was reluctant to label the pain too high.\u003c/p>\n\u003cp>\"I don't think I ever answered higher than a '7' because an '8' would be, in my mind, like I'm missing half of my body or a limb,\" he recalls.\u003c/p>\n\u003cp>On the pain scale a rating of 4 to 7 is considered moderate. Mild pain is rated 1 to 3. Over 7 is considered severe.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Today, Rosette has recovered and is pain-free, but he wonders if \"low balling\" his pain level while in the hospital, meant he wasn't given adequate pain medication.[contextly_sidebar id=\"gNyBEO7kaaOOQQPLiTFHH1VcWAsQe2Bq\"]\u003c/p>\n\u003cp>\"You realize you got less medicine and it's been eight hours and they're not allowed to give you more for a while,\" Rosette says.\u003c/p>\n\u003cp>If your doctor gets the wrong idea about your pain, it's not just going to affect your comfort — it can affect your treatment. Markman says that especially after an injury, there's therapeutic value to keeping the pain tamped down, so that you can keep up with physical therapy.\u003c/p>\n\u003cp>For chronic pain, being clear can help clinicians choose the right mix of therapies or medications to allow you to stay as active as possible. And staying active can help manage chronic pain, says \u003ca href=\"https://anesthesiology.duke.edu/?page_id=834374\" target=\"_blank\" rel=\"noopener\">Dr. William Maixner\u003c/a>, with Duke University School of Medicine and current president of the American Pain Society.\u003c/p>\n\u003cp>Exercise, he says, \"causes the release of a number of anti-inflammatory substances from the muscle that can help diminish pain and pain processing and make the individual more resilient.\"\u003c/p>\n\u003cp>To find out more about how the numerical pain scale was affecting treatment, Markman and colleagues at the University of Rochester did a study, which they will present at the World Congress on Pain in Boston in September. The research analyzed data from other studies, which asked chronic pain patients to rate their pain using both numbers and words.\u003c/p>\n\u003cp>Patients were asked to rate their pain on a scale of 0 to 10, and they were also asked the question, \"Is your pain tolerable?\"\u003c/p>\n\u003cp>Surprisingly, three quarters of the patients who rated their pain between 4 and 7 on the numerical scale, a range that typically calls for higher doses of medications, also described their pain as \"tolerable\" — a description that normally means no more pain treatment is needed.[contextly_sidebar id=\"ClUbqCuoEqdLIyjzgS1I1irhMb4fhntn\"]\u003c/p>\n\u003cp>This showed the danger of relying only on a number, Markman says. \"If you were just treating by the numbers you might say, 'Well, someone has a pain that is 6 [out of]10. I feel obligated to do something about that ... to fix that number just like you might fix their blood pressure or their blood glucose,' \" he says.\u003c/p>\n\u003cp>If clinicians just look at a number, Markman says, they may be more likely to over-treat or prescribe more medication, which can be worrisome during an era of concern about opioid abuse and addiction.\u003c/p>\n\u003cp>So if today's pain scale isn't working well for patients and doctors, what's the alternative?\u003c/p>\n\u003cp>Many health care providers are trying to come up with a system that involves words, not numbers.\u003c/p>\n\u003cp>\"I never look at just the pain scale,\" says \u003ca href=\"https://www.uclahealth.org/chrystina-jeter\" target=\"_blank\" rel=\"noopener\">Dr. Chrystina Jeter\u003c/a>, an anesthesiologist and pain management specialist with UCLA Health, who was Rosette's doctor.\u003c/p>\n\u003cp>Using words to describe pain brings greater specificity to the measurement of pain, says Maixner.[contextly_sidebar id=\"jBdk15Gcdb1FQXh8PlzSvMvHZmeTdBu9\"]\u003c/p>\n\u003cp>If patients can describe their pain precisely, he says, their appointment with a health care provider will be much more focused, allowing the physician to \"come to a decision about treatment in a much more rapid and logical way.\"\u003c/p>\n\u003cp>Here's advice for the next time you need to talk to your doctor about your pain.\u003c/p>\n\u003cp>\u003cstrong>Get Descriptive\u003c/strong>\u003c/p>\n\u003cp>You can help doctors understand just how debilitating your pain is by being more descriptive.\u003c/p>\n\u003cp>\"It's perfectly OK to be a little more flowery in the description of pain,\" says Jeter. \"My pain is aching, burning. What does it feel like to you? Where is it? Does it move?\"\u003c/p>\n\u003cp>Jeter typically asks patients to compare their current pain to the worst pain they ever had, such as childbirth or kidney stones. This helps put their pain in context, she says, and may help them realize their pain may not be that bad after all.\u003c/p>\n\u003cp>\u003cstrong>Describe Your Day\u003c/strong>\u003c/p>\n\u003cp>It can be helpful to talk about how your pain waxes and wanes throughout the day, says Jeter. For example, is it mostly when you eat, walk, or do certain activities?\u003c/p>\n\u003cp>\"I look for trends over time and I look at their function,\" she says.\u003c/p>\n\u003cp>\u003cstrong>Talk About Function, Not Feeling\u003c/strong>\u003c/p>\n\u003cp>Be clear about how your pain interferes with daily activities, such as getting out of bed early, getting dressed, feeling fatigued, or no longer enjoying getting out with friends, suggests Maixner.\u003c/p>\n\u003cp>Thinking about function is key, agrees Markman. He says the most accurate measurement of pain may be what it prevents patients from doing. For example, if a patient cannot chew or talk, walk, or exercise that might be more disturbing to them than the pain. Sometimes it's more useful to seek ways to \"work around the pain\" rather than \"making it go away,\" Markman says.\u003c/p>\n\u003cp>\u003cstrong>Share Treatment History\u003c/strong>\u003c/p>\n\u003cp>Describe the history of the pain, the location, how long it's been hurting and what factors seem to aggravate it, or help it get better, suggests Maixner.\u003c/p>\n\u003cp>Share other treatments you've sought, such as acupuncture, massage and certain medications, he says. \"Let the doctor know what you've done and whether it was effective.\"\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>Family history is also important, he says, especially when you consider much of an individual's pain sensitivity is inherited. If your parents were highly sensitive to pain, chances are you will be, too, 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=Words+Matter+When+Talking+About+Pain+With+Your+Doctor&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>If you're in the hospital or a doctor's office with a painful problem, you'll likely be asked to rate your pain on a \u003ca href=\"https://paindoctor.com/pain-scales/\" target=\"_blank\" rel=\"noopener\">scale\u003c/a> of 0 to 10 – with 0 meaning no pain at all and 10 indicating the worst pain you can imagine. But many doctors and nurses say this rating system isn't working and they're trying a new approach.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>The numeric pain scale may just be too simplistic, says \u003ca href=\"https://www.urmc.rochester.edu/people/21192807-john-d-markman\" target=\"_blank\" rel=\"noopener\">Dr. John Markman\u003c/a>, director of the Translational Pain Research Program at the University of Rochester School of Medicine and Dentistry. It can lead doctors to \"treat by numbers,\" he says and as a result, patients may not be getting the most effective treatment for their pain.\u003c/p>\n\u003cp>Take the case of 33-year-old Adam Rosette, who was recently hospitalized for \u003ca href=\"https://orthoinfo.aaos.org/en/diseases--conditions/fibrous-dysplasia/\" target=\"_blank\" rel=\"noopener\">fibrous dysplasia\u003c/a>, a bone disorder that made it nearly impossible for him to chew or even speak. After brain surgery to remove benign tumors related to the disorder, he was definitely in pain. But he was reluctant to label the pain too high.\u003c/p>\n\u003cp>\"I don't think I ever answered higher than a '7' because an '8' would be, in my mind, like I'm missing half of my body or a limb,\" he recalls.\u003c/p>\n\u003cp>On the pain scale a rating of 4 to 7 is considered moderate. Mild pain is rated 1 to 3. Over 7 is considered severe.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Today, Rosette has recovered and is pain-free, but he wonders if \"low balling\" his pain level while in the hospital, meant he wasn't given adequate pain medication.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\"You realize you got less medicine and it's been eight hours and they're not allowed to give you more for a while,\" Rosette says.\u003c/p>\n\u003cp>If your doctor gets the wrong idea about your pain, it's not just going to affect your comfort — it can affect your treatment. Markman says that especially after an injury, there's therapeutic value to keeping the pain tamped down, so that you can keep up with physical therapy.\u003c/p>\n\u003cp>For chronic pain, being clear can help clinicians choose the right mix of therapies or medications to allow you to stay as active as possible. And staying active can help manage chronic pain, says \u003ca href=\"https://anesthesiology.duke.edu/?page_id=834374\" target=\"_blank\" rel=\"noopener\">Dr. William Maixner\u003c/a>, with Duke University School of Medicine and current president of the American Pain Society.\u003c/p>\n\u003cp>Exercise, he says, \"causes the release of a number of anti-inflammatory substances from the muscle that can help diminish pain and pain processing and make the individual more resilient.\"\u003c/p>\n\u003cp>To find out more about how the numerical pain scale was affecting treatment, Markman and colleagues at the University of Rochester did a study, which they will present at the World Congress on Pain in Boston in September. The research analyzed data from other studies, which asked chronic pain patients to rate their pain using both numbers and words.\u003c/p>\n\u003cp>Patients were asked to rate their pain on a scale of 0 to 10, and they were also asked the question, \"Is your pain tolerable?\"\u003c/p>\n\u003cp>Surprisingly, three quarters of the patients who rated their pain between 4 and 7 on the numerical scale, a range that typically calls for higher doses of medications, also described their pain as \"tolerable\" — a description that normally means no more pain treatment is needed.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>This showed the danger of relying only on a number, Markman says. \"If you were just treating by the numbers you might say, 'Well, someone has a pain that is 6 [out of]10. I feel obligated to do something about that ... to fix that number just like you might fix their blood pressure or their blood glucose,' \" he says.\u003c/p>\n\u003cp>If clinicians just look at a number, Markman says, they may be more likely to over-treat or prescribe more medication, which can be worrisome during an era of concern about opioid abuse and addiction.\u003c/p>\n\u003cp>So if today's pain scale isn't working well for patients and doctors, what's the alternative?\u003c/p>\n\u003cp>Many health care providers are trying to come up with a system that involves words, not numbers.\u003c/p>\n\u003cp>\"I never look at just the pain scale,\" says \u003ca href=\"https://www.uclahealth.org/chrystina-jeter\" target=\"_blank\" rel=\"noopener\">Dr. Chrystina Jeter\u003c/a>, an anesthesiologist and pain management specialist with UCLA Health, who was Rosette's doctor.\u003c/p>\n\u003cp>Using words to describe pain brings greater specificity to the measurement of pain, says Maixner.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>If patients can describe their pain precisely, he says, their appointment with a health care provider will be much more focused, allowing the physician to \"come to a decision about treatment in a much more rapid and logical way.\"\u003c/p>\n\u003cp>Here's advice for the next time you need to talk to your doctor about your pain.\u003c/p>\n\u003cp>\u003cstrong>Get Descriptive\u003c/strong>\u003c/p>\n\u003cp>You can help doctors understand just how debilitating your pain is by being more descriptive.\u003c/p>\n\u003cp>\"It's perfectly OK to be a little more flowery in the description of pain,\" says Jeter. \"My pain is aching, burning. What does it feel like to you? Where is it? Does it move?\"\u003c/p>\n\u003cp>Jeter typically asks patients to compare their current pain to the worst pain they ever had, such as childbirth or kidney stones. This helps put their pain in context, she says, and may help them realize their pain may not be that bad after all.\u003c/p>\n\u003cp>\u003cstrong>Describe Your Day\u003c/strong>\u003c/p>\n\u003cp>It can be helpful to talk about how your pain waxes and wanes throughout the day, says Jeter. For example, is it mostly when you eat, walk, or do certain activities?\u003c/p>\n\u003cp>\"I look for trends over time and I look at their function,\" she says.\u003c/p>\n\u003cp>\u003cstrong>Talk About Function, Not Feeling\u003c/strong>\u003c/p>\n\u003cp>Be clear about how your pain interferes with daily activities, such as getting out of bed early, getting dressed, feeling fatigued, or no longer enjoying getting out with friends, suggests Maixner.\u003c/p>\n\u003cp>Thinking about function is key, agrees Markman. He says the most accurate measurement of pain may be what it prevents patients from doing. For example, if a patient cannot chew or talk, walk, or exercise that might be more disturbing to them than the pain. 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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Family history is also important, he says, especially when you consider much of an individual's pain sensitivity is inherited. If your parents were highly sensitive to pain, chances are you will be, too, 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=Words+Matter+When+Talking+About+Pain+With+Your+Doctor&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"tagline": "The flip side of gentrification, told through one town",
"info": "Gentrification is changing cities across America, forcing people from neighborhoods they have long called home. Call them the displaced. Now those priced out of the Bay Area are looking for a better life in an unlikely place. American Suburb follows this migration to one California town along the Delta, 45 miles from San Francisco. But is this once sleepy suburb ready for them?",
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"tagline": "Exploring the Bay Area, one question at a time",
"info": "KQED’s new podcast, Bay Curious, gets to the bottom of the mysteries — both profound and peculiar — that give the Bay Area its unique identity. And we’ll do it with your help! You ask the questions. You decide what Bay Curious investigates. And you join us on the journey to find the answers.",
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"info": "KQED’s statewide radio news program providing daily coverage of issues, trends and public policy decisions.",
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"order": 8
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},
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"id": "commonwealth-club",
"title": "Commonwealth Club of California Podcast",
"info": "The Commonwealth Club of California is the nation's oldest and largest public affairs forum. As a non-partisan forum, The Club brings to the public airwaves diverse viewpoints on important topics. The Club's weekly radio broadcast - the oldest in the U.S., dating back to 1924 - is carried across the nation on public radio stations and is now podcasting. Our website archive features audio of our recent programs, as well as selected speeches from our long and distinguished history. This podcast feed is usually updated twice a week and is always un-edited.",
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"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"
},
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"info": "KQED’s live call-in program discussing local, state, national and international issues, as well as in-depth interviews.",
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"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Forum-Podcast-Tile-703x703-1.jpg",
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"order": 9
},
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"hidden-brain": {
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"airtime": "SUN 7:30pm-8pm",
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"tagline": "Where conversation and cultura meet",
"info": "What kind of no sabo word is Hyphenación? For us, it’s about living within a hyphenation. Like being a third-gen Mexican-American from the Texas border now living that Bay Area Chicano life. Like Xorje! Each week we bring together a couple of hyphenated Latinos to talk all about personal life choices: family, careers, relationships, belonging … everything is on the table. ",
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"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. ",
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"order": 18
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"id": "latino-usa",
"title": "Latino USA",
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"info": "Latino USA, the radio journal of news and culture, is the only national, English-language radio program produced from a Latino perspective.",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/latinoUsa.jpg",
"officialWebsiteLink": "http://latinousa.org/",
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},
"marketplace": {
"id": "marketplace",
"title": "Marketplace",
"info": "Our flagship program, helmed by Kai Ryssdal, examines what the day in money delivered, through stories, conversations, newsworthy numbers and more. Updated Monday through Friday at about 3:30 p.m. PT.",
"airtime": "MON-FRI 4pm-4:30pm, MON-WED 6:30pm-7pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Marketplace-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.marketplace.org/",
"meta": {
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"source": "American Public Media"
},
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"rss": "https://feeds.publicradio.org/public_feeds/marketplace-pm/rss/rss"
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},
"masters-of-scale": {
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"title": "Masters of Scale",
"info": "Masters of Scale is an original podcast in which LinkedIn co-founder and Greylock Partner Reid Hoffman sets out to describe and prove theories that explain how great entrepreneurs take their companies from zero to a gazillion in ingenious fashion.",
"airtime": "Every other Wednesday June 12 through October 16 at 8pm (repeats Thursdays at 2am)",
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"officialWebsiteLink": "https://mastersofscale.com/",
"meta": {
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"source": "WaitWhat"
},
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"rss": "https://rss.art19.com/masters-of-scale"
}
},
"mindshift": {
"id": "mindshift",
"title": "MindShift",
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"info": "The MindShift podcast explores the innovations in education that are shaping how kids learn. Hosts Ki Sung and Katrina Schwartz introduce listeners to educators, researchers, parents and students who are developing effective ways to improve how kids learn. We cover topics like how fed-up administrators are developing surprising tactics to deal with classroom disruptions; how listening to podcasts are helping kids develop reading skills; the consequences of overparenting; and why interdisciplinary learning can engage students on all ends of the traditional achievement spectrum. This podcast is part of the MindShift education site, a division of KQED News. KQED is an NPR/PBS member station based in San Francisco. You can also visit the MindShift website for episodes and supplemental blog posts or tweet us \u003ca href=\"https://twitter.com/MindShiftKQED\">@MindShiftKQED\u003c/a> or visit us at \u003ca href=\"/mindshift\">MindShift.KQED.org\u003c/a>",
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