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Levy (left) and Idit Sagiv-Barfi led the work on a possible cancer treatment that involves injecting immune-stimulating agents directly into tumors in mice.","description":null,"title":"1024x1024 (1)","credit":"Stanford Medicine News Center","status":"inherit","fetchFailed":false,"isLoading":false}},"audioPlayerReducer":{"postId":"stream_live"},"authorsReducer":{"byline_futureofyou_444942":{"type":"authors","id":"byline_futureofyou_444942","meta":{"override":true},"slug":"byline_futureofyou_444942","name":"Sharon Begley\u003cbr />STAT","isLoading":false},"byline_futureofyou_444318":{"type":"authors","id":"byline_futureofyou_444318","meta":{"override":true},"slug":"byline_futureofyou_444318","name":"Joe Palca, NPR","isLoading":false},"byline_futureofyou_441745":{"type":"authors","id":"byline_futureofyou_441745","meta":{"override":true},"slug":"byline_futureofyou_441745","name":"Usha Lee McFarling\u003cbr 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Press","isLoading":false},"aahmed":{"type":"authors","id":"11428","meta":{"index":"authors_1716337520","id":"11428","found":true},"name":"Amel Ahmed","firstName":"Amel","lastName":"Ahmed","slug":"aahmed","email":"aahmed@kqed.org","display_author_email":false,"staff_mastheads":[],"title":"KQED Contributor","bio":"Amel Ahmed is a reporter for KQED. Prior to joining KQED, Amel worked at Al Jazeera America, Al Jazeera English, Democracy Now! and Punched Productions. She also helped produce \u003cem>Changing Face of Harlem\u003c/em>, a documentary that tracked gentrification in Harlem over a period of ten years. She is a 2013 graduate of Brooklyn Law School and is currently researching war on terror prosecutions for an upcoming book.","avatar":"https://secure.gravatar.com/avatar/c8b48ebc98e770640f3013c470d23f3e?s=600&d=blank&r=g","twitter":"amelscript","facebook":null,"instagram":null,"linkedin":null,"sites":[{"site":"futureofyou","roles":[]},{"site":"science","roles":[]}],"headData":{"title":"Amel Ahmed | KQED","description":"KQED Contributor","ogImgSrc":"https://secure.gravatar.com/avatar/c8b48ebc98e770640f3013c470d23f3e?s=600&d=blank&r=g","twImgSrc":"https://secure.gravatar.com/avatar/c8b48ebc98e770640f3013c470d23f3e?s=600&d=blank&r=g"},"isLoading":false,"link":"/author/aahmed"}},"breakingNewsReducer":{},"campaignFinanceReducer":{},"pagesReducer":{},"postsReducer":{"stream_live":{"type":"live","id":"stream_live","audioUrl":"https://streams.kqed.org/kqedradio","title":"Live Stream","excerpt":"Live Stream information currently unavailable.","link":"/radio","featImg":"","label":{"name":"KQED Live","link":"/"}},"stream_kqedNewscast":{"type":"posts","id":"stream_kqedNewscast","audioUrl":"https://www.kqed.org/.stream/anon/radio/RDnews/newscast.mp3?_=1","title":"KQED Newscast","featImg":"","label":{"name":"88.5 FM","link":"/"}},"futureofyou_444942":{"type":"posts","id":"futureofyou_444942","meta":{"index":"posts_1716263798","site":"futureofyou","id":"444942","score":null,"sort":[1539118849000]},"parent":0,"labelTerm":{},"blocks":[],"publishDate":1539118849,"format":"standard","disqusTitle":"CRISPR Cures Inherited Disorder in Mice, Paving Way for Genetic Therapy Before Birth","title":"CRISPR Cures Inherited Disorder in Mice, Paving Way for Genetic Therapy Before Birth","headTitle":"Future of You | KQED Future of You | KQED Science","content":"\u003cp class=\"danger-zone\">Nearly 40 years after surgeons first \u003ca href=\"https://www.ucsf.edu/news/2011/02/9366/ucsf-surgeon-reflects-performing-worlds-first-fetal-surgery-30-years-ago\" target=\"_blank\" rel=\"noopener\">operated on fetuses\u003c/a> to cure devastating abnormalities, researchers have taken the first step toward curing genetic disease before birth via genome editing: scientists reported on Monday that they used the genome editing technique CRISPR to alter the DNA of laboratory mice in the womb, eliminating an often-fatal liver disease before the animals had even been born.[contextly_sidebar id=\"kLt87B75fzdQ6XiJiVHbmy8S3RDMp2KF\"]\u003c/p>\n\u003cp class=\"danger-zone\">The research, by a team at the University of Pennsylvania and the Children’s Hospital of Philadelphia (CHOP), is a very early proof of concept. But while CRISPRing human fetuses is years away, at best, the success in mice bolsters what Dr. William Peranteau, who co-led the study, calls his dream of curing genetic diseases before birth.\u003c/p>\n\u003cp class=\"danger-zone\">“A lot more animal work needs to be done before we can even think about applying this [fetal genome editing] clinically,” said Peranteau, a pediatric and fetal surgeon at CHOP. “But I think fetal genome editing may be where fetal surgery [which is now routine] once was, and that one day we’ll use it to treat diseases that cause significant morbidity and mortality.”\u003c/p>\n\u003cp>Simon Waddington of University College London, a leader in research to develop fetal gene therapy who was not involved in the new study, called the CRISPR approach “an elegant refinement of the brute-force technology” that’s been the focus of \u003ca href=\"https://www.nature.com/articles/s41591-018-0106-7\" target=\"_blank\" rel=\"noopener\">animal studies\u003c/a> of fetal genetic therapy.\u003c/p>\n\u003cp>The success in mouse fetuses raises the possibility that, even before \u003ca href=\"https://www.statnews.com/2018/07/25/can-gene-therapy-halt-diseases-in-babies-before-theyre-even-born/\">traditional gene therapy\u003c/a> is ready to treat inherited disorders in utero, genome editing might emerge as a safer, more effective approach. In traditional gene therapy, an entire healthy gene is ferried, typically by a virus, into cells containing a disease-causing gene. With CRISPR, only the mutated bit of a defective gene is changed. It’s the difference between retyping a whole 5,000 word document and using Word’s “find and replace” to correct a typo.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“We think this represents a safer and more precise way to make changes in the genome,” said Dr. Kiran Musunuru of Penn and a co-leader of the study. “It’s is the better way forward if you want to take CRISPR into the clinic.”[contextly_sidebar id=\"WspKwnRfkmuJ8Ui6Pu5mBgKtCSqZqfJ5\"]\u003c/p>\n\u003cp>The rationale for fetal genetic therapy is simple: it could halt a disease before it causes irreversible and even fatal damage. In people, the inherited liver disease that the scientists targeted in mice, called hereditary tyrosinemia type 1, starts damaging the liver months before birth. Another rationale: because a fetus’s immune system is immature, it is less likely than even a newborn’s to attack the alien CRISPR molecules.\u003c/p>\n\u003cp>For their study, \u003ca href=\"https://www.nature.com/articles/s41591-018-0184-6\" target=\"_blank\" rel=\"noopener\">published in Nature Medicine\u003c/a>, Musunuru and his colleagues gently opened the uterus of a pregnant mouse, removed the fetus from the amniotic sac, and injected CRISPR into the vitelline vein, which is near the surface of the sac and connects to the liver. “We wanted to make sure we got the genome editor into the liver rather than everywhere else,” Musunuru said. The fetus was then replaced in the uterus and was born normally.\u003c/p>\n\u003cp>Instead of using the original form of CRISPR, which cuts DNA where a gene is mutated and inserts a replacement string of A’s, T’s, C’s, and G’s, the scientists used the form of CRISPR called base editing. \u003ca href=\"https://www.statnews.com/2016/04/20/clever-crispr-advance-unveiled/%5D\">Invented\u003c/a> just two years ago, base editing changes an incorrect DNA letter, or base, to the correct one, such as a C to a T or a G to an A. Its advantage is that it doesn’t need to cut DNA to do this, as CRISPR 1.0 does; those cuts can wreak \u003ca href=\"https://www.statnews.com/2018/07/16/crispr-potential-dna-damage-underestimated/\">genetic havoc\u003c/a>, with unknown consequences for CRISPR’d cells.\u003c/p>\n\u003cp>For a dry run, the scientists first made a CRISPR base editor that changes a \u003ca href=\"https://ghr.nlm.nih.gov/gene/PCSK9\" target=\"_blank\" rel=\"noopener\">gene called PCSK9\u003c/a>, which makes a protein that helps regulate the amount of cholesterol in the bloodstream, into a super-cholesterol-lowering form. When injected into mouse fetuses, the base editor changed liver cells as intended and left other organs alone. Crucially, the mouse mother showed no effects of the CRISPR treatment. After birth, the baby mice had ultra-low cholesterol levels, showing that the CRISPR base editor had worked. Only about 15 percent of the liver cells of the baby mice had been edited, but that fraction remained stable through the animals’ adulthood.[contextly_sidebar id=\"7RKromVt2cYnSDdz2L7SJg04iooF89dn\"]\u003c/p>\n\u003cp>The amount of genetic havoc from the base editing was low: about 2 percent, compared to 40 percent for many uses of traditional CRISPR. And none of the likely spots for “off target” effects — DNA sites that resemble the target and so might be inadvertently edited — showed any sign of being altered.\u003c/p>\n\u003cp>The Philadelphia scientists then tried their technique on hereditary tyrosinemia type 1. HT1, which strikes 1 in 100,000 newborns worldwide, is \u003ca href=\"https://rarediseases.info.nih.gov/diseases/2658/tyrosinemia-type-1\" target=\"_blank\" rel=\"noopener\">caused by\u003c/a> any of several mutations in a \u003ca href=\"https://ghr.nlm.nih.gov/gene/FAH\" target=\"_blank\" rel=\"noopener\">gene called FAH\u003c/a>. All the mutations cause the build-up of toxic breakdown products of the amino acid tyrosine, a component of protein, and ultimately destroy the liver. Treatment with the drug nitisinone and a strict tyrosine-free diet is not always effective, with the result that children sometimes develop fatal liver failure or liver cancer.\u003c/p>\n\u003cp>The scientists used their base editor on a gene related to the disease-causing one. If this gene, \u003ca href=\"https://ghr.nlm.nih.gov/gene/HPD\" target=\"_blank\" rel=\"noopener\">called HPD\u003c/a>, is disabled, then no toxic metabolites of tyrosine ever get to where FAH is unable to handle them.\u003c/p>\n\u003cp>Changing a C to a T in the HPD gene disabled it. No toxic molecules built up in the livers of the fetal mice. No other organs showed signs of editing, no off-target effects were detected, and having only 15 percent of their liver cells edited was enough to cure the mice and keep them cured into adulthood. “We weren’t expecting it, but the genome-edited mice did much better” than mice treated with nitisinone, Musunuru said. “They survived longer and gained more weight.”\u003c/p>\n\u003cp>The scientists hope to study fetal base editing for other severe congenital diseases. It remains to be seen whether this technique or conventional gene therapy, which provides an entire replacement gene, will work better.\u003c/p>\n\u003cp>“I’d consider that CRISPR isn’t a replacement” for the latter, Waddington said, “but will be an additional tool” for curing genetic diseases in the womb.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003ci>\u003cspan style=\"font-weight: 400\">This \u003c/span>\u003c/i>\u003ca href=\"https://www.statnews.com/2018/10/08/crispr-cures-inherited-disorder-in-mice-paving-way-for-genetic-therapy-before-birth/\" target=\"_blank\" rel=\"noopener\">\u003ci>\u003cspan style=\"font-weight: 400\">story\u003c/span>\u003c/i>\u003c/a>\u003ci>\u003cspan style=\"font-weight: 400\"> was originally published by STAT, an online publication of Boston Globe Media that covers health, medicine, and scientific discovery.\u003c/span>\u003c/i>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003c/p>\n\n","disqusIdentifier":"444942 https://ww2.kqed.org/futureofyou/?p=444942","disqusUrl":"https://ww2.kqed.org/futureofyou/2018/10/09/crispr-cures-inherited-disorder-in-mice-paving-way-for-genetic-therapy-before-birth/","stats":{"hasVideo":false,"hasChartOrMap":false,"hasAudio":false,"hasPolis":false,"wordCount":1141,"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"iframeSrcs":[],"paragraphCount":16},"modified":1539042769,"excerpt":"In mice with a fatal genetic disease, toxic proteins begin accumulating in the liver before birth. CRISPR performed in utero reversed the condition.","headData":{"twImgId":"","twTitle":"","ogTitle":"","ogImgId":"","twDescription":"","description":"In mice with a fatal genetic disease, toxic proteins begin accumulating in the liver before birth. CRISPR performed in utero reversed the condition.","title":"CRISPR Cures Inherited Disorder in Mice, Paving Way for Genetic Therapy Before Birth | KQED","ogDescription":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"CRISPR Cures Inherited Disorder in Mice, Paving Way for Genetic Therapy Before Birth","datePublished":"2018-10-09T14:00:49-07:00","dateModified":"2018-10-08T16:52:49-07:00","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"guestAuthors":[],"slug":"crispr-cures-inherited-disorder-in-mice-paving-way-for-genetic-therapy-before-birth","status":"publish","nprByline":"Sharon Begley\u003cbr />STAT","source":"Hope/Hype","path":"/futureofyou/444942/crispr-cures-inherited-disorder-in-mice-paving-way-for-genetic-therapy-before-birth","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp class=\"danger-zone\">Nearly 40 years after surgeons first \u003ca href=\"https://www.ucsf.edu/news/2011/02/9366/ucsf-surgeon-reflects-performing-worlds-first-fetal-surgery-30-years-ago\" target=\"_blank\" rel=\"noopener\">operated on fetuses\u003c/a> to cure devastating abnormalities, researchers have taken the first step toward curing genetic disease before birth via genome editing: scientists reported on Monday that they used the genome editing technique CRISPR to alter the DNA of laboratory mice in the womb, eliminating an often-fatal liver disease before the animals had even been born.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp class=\"danger-zone\">The research, by a team at the University of Pennsylvania and the Children’s Hospital of Philadelphia (CHOP), is a very early proof of concept. But while CRISPRing human fetuses is years away, at best, the success in mice bolsters what Dr. William Peranteau, who co-led the study, calls his dream of curing genetic diseases before birth.\u003c/p>\n\u003cp class=\"danger-zone\">“A lot more animal work needs to be done before we can even think about applying this [fetal genome editing] clinically,” said Peranteau, a pediatric and fetal surgeon at CHOP. “But I think fetal genome editing may be where fetal surgery [which is now routine] once was, and that one day we’ll use it to treat diseases that cause significant morbidity and mortality.”\u003c/p>\n\u003cp>Simon Waddington of University College London, a leader in research to develop fetal gene therapy who was not involved in the new study, called the CRISPR approach “an elegant refinement of the brute-force technology” that’s been the focus of \u003ca href=\"https://www.nature.com/articles/s41591-018-0106-7\" target=\"_blank\" rel=\"noopener\">animal studies\u003c/a> of fetal genetic therapy.\u003c/p>\n\u003cp>The success in mouse fetuses raises the possibility that, even before \u003ca href=\"https://www.statnews.com/2018/07/25/can-gene-therapy-halt-diseases-in-babies-before-theyre-even-born/\">traditional gene therapy\u003c/a> is ready to treat inherited disorders in utero, genome editing might emerge as a safer, more effective approach. In traditional gene therapy, an entire healthy gene is ferried, typically by a virus, into cells containing a disease-causing gene. With CRISPR, only the mutated bit of a defective gene is changed. It’s the difference between retyping a whole 5,000 word document and using Word’s “find and replace” to correct a typo.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“We think this represents a safer and more precise way to make changes in the genome,” said Dr. Kiran Musunuru of Penn and a co-leader of the study. “It’s is the better way forward if you want to take CRISPR into the clinic.”\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>The rationale for fetal genetic therapy is simple: it could halt a disease before it causes irreversible and even fatal damage. In people, the inherited liver disease that the scientists targeted in mice, called hereditary tyrosinemia type 1, starts damaging the liver months before birth. Another rationale: because a fetus’s immune system is immature, it is less likely than even a newborn’s to attack the alien CRISPR molecules.\u003c/p>\n\u003cp>For their study, \u003ca href=\"https://www.nature.com/articles/s41591-018-0184-6\" target=\"_blank\" rel=\"noopener\">published in Nature Medicine\u003c/a>, Musunuru and his colleagues gently opened the uterus of a pregnant mouse, removed the fetus from the amniotic sac, and injected CRISPR into the vitelline vein, which is near the surface of the sac and connects to the liver. “We wanted to make sure we got the genome editor into the liver rather than everywhere else,” Musunuru said. The fetus was then replaced in the uterus and was born normally.\u003c/p>\n\u003cp>Instead of using the original form of CRISPR, which cuts DNA where a gene is mutated and inserts a replacement string of A’s, T’s, C’s, and G’s, the scientists used the form of CRISPR called base editing. \u003ca href=\"https://www.statnews.com/2016/04/20/clever-crispr-advance-unveiled/%5D\">Invented\u003c/a> just two years ago, base editing changes an incorrect DNA letter, or base, to the correct one, such as a C to a T or a G to an A. Its advantage is that it doesn’t need to cut DNA to do this, as CRISPR 1.0 does; those cuts can wreak \u003ca href=\"https://www.statnews.com/2018/07/16/crispr-potential-dna-damage-underestimated/\">genetic havoc\u003c/a>, with unknown consequences for CRISPR’d cells.\u003c/p>\n\u003cp>For a dry run, the scientists first made a CRISPR base editor that changes a \u003ca href=\"https://ghr.nlm.nih.gov/gene/PCSK9\" target=\"_blank\" rel=\"noopener\">gene called PCSK9\u003c/a>, which makes a protein that helps regulate the amount of cholesterol in the bloodstream, into a super-cholesterol-lowering form. When injected into mouse fetuses, the base editor changed liver cells as intended and left other organs alone. Crucially, the mouse mother showed no effects of the CRISPR treatment. After birth, the baby mice had ultra-low cholesterol levels, showing that the CRISPR base editor had worked. Only about 15 percent of the liver cells of the baby mice had been edited, but that fraction remained stable through the animals’ adulthood.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>The amount of genetic havoc from the base editing was low: about 2 percent, compared to 40 percent for many uses of traditional CRISPR. And none of the likely spots for “off target” effects — DNA sites that resemble the target and so might be inadvertently edited — showed any sign of being altered.\u003c/p>\n\u003cp>The Philadelphia scientists then tried their technique on hereditary tyrosinemia type 1. HT1, which strikes 1 in 100,000 newborns worldwide, is \u003ca href=\"https://rarediseases.info.nih.gov/diseases/2658/tyrosinemia-type-1\" target=\"_blank\" rel=\"noopener\">caused by\u003c/a> any of several mutations in a \u003ca href=\"https://ghr.nlm.nih.gov/gene/FAH\" target=\"_blank\" rel=\"noopener\">gene called FAH\u003c/a>. All the mutations cause the build-up of toxic breakdown products of the amino acid tyrosine, a component of protein, and ultimately destroy the liver. Treatment with the drug nitisinone and a strict tyrosine-free diet is not always effective, with the result that children sometimes develop fatal liver failure or liver cancer.\u003c/p>\n\u003cp>The scientists used their base editor on a gene related to the disease-causing one. If this gene, \u003ca href=\"https://ghr.nlm.nih.gov/gene/HPD\" target=\"_blank\" rel=\"noopener\">called HPD\u003c/a>, is disabled, then no toxic metabolites of tyrosine ever get to where FAH is unable to handle them.\u003c/p>\n\u003cp>Changing a C to a T in the HPD gene disabled it. No toxic molecules built up in the livers of the fetal mice. No other organs showed signs of editing, no off-target effects were detected, and having only 15 percent of their liver cells edited was enough to cure the mice and keep them cured into adulthood. “We weren’t expecting it, but the genome-edited mice did much better” than mice treated with nitisinone, Musunuru said. “They survived longer and gained more weight.”\u003c/p>\n\u003cp>The scientists hope to study fetal base editing for other severe congenital diseases. It remains to be seen whether this technique or conventional gene therapy, which provides an entire replacement gene, will work better.\u003c/p>\n\u003cp>“I’d consider that CRISPR isn’t a replacement” for the latter, Waddington said, “but will be an additional tool” for curing genetic diseases in the womb.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003ci>\u003cspan style=\"font-weight: 400\">This \u003c/span>\u003c/i>\u003ca href=\"https://www.statnews.com/2018/10/08/crispr-cures-inherited-disorder-in-mice-paving-way-for-genetic-therapy-before-birth/\" target=\"_blank\" rel=\"noopener\">\u003ci>\u003cspan style=\"font-weight: 400\">story\u003c/span>\u003c/i>\u003c/a>\u003ci>\u003cspan style=\"font-weight: 400\"> was originally published by STAT, an online publication of Boston Globe Media that covers health, medicine, and scientific discovery.\u003c/span>\u003c/i>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/444942/crispr-cures-inherited-disorder-in-mice-paving-way-for-genetic-therapy-before-birth","authors":["byline_futureofyou_444942"],"programs":["futureofyou_54"],"categories":["futureofyou_1062","futureofyou_1","futureofyou_73"],"tags":["futureofyou_94","futureofyou_927","futureofyou_324"],"collections":["futureofyou_1097","futureofyou_1094"],"featImg":"futureofyou_1194","label":"source_futureofyou_444942"},"futureofyou_444318":{"type":"posts","id":"futureofyou_444318","meta":{"index":"posts_1716263798","site":"futureofyou","id":"444318","score":null,"sort":[1536267637000]},"parent":0,"labelTerm":{},"blocks":[],"publishDate":1536267637,"format":"standard","disqusTitle":"A Researcher Battling Cancer Explores Alternatives To Opioid Treatments","title":"A Researcher Battling Cancer Explores Alternatives To Opioid Treatments","headTitle":"Future of You | KQED Future of You | KQED Science","content":"\u003cp>The explosion of deaths related to opioid misuse has underscored a pressing need for better ways of treating pain, especially chronic pain.[contextly_sidebar id=\"Lrxhc0PiaxvZNwtQRWNC315GUyNFIRBB\"]\u003c/p>\n\u003cp>Duquesne University pharmacology associate professor Jelena Janjic thinks she's on to one. It involves using a patient's own immune system to deliver non-opioid pain medication to places in the body where there's pain.\u003c/p>\n\u003cp>Janjic's idea, which draws from the field of cancer research, is to insert tiny amounts of over-the-counter pain medications into minute carriers called nanoparticles, and then inject these into pain patients. The medicines would then travel through the body to places where there is inflammation, and relieve the pain.\u003c/p>\n\u003cp>Janjic has a special reason for wanting to develop new medicines for chronic pain: She suffers from it herself.\u003c/p>\n\u003cp>\"As a patient, I want an answer,\" she says. \"I want to figure out this.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>There's no question that the need for better, non-addictive medications is real and urgent. Researchers have come up with\u003ca href=\"https://www.painnewsnetwork.org/stories/2018/6/2/new-treatments-on-the-horizon-for-chronic-pain\"> some ideas\u003c/a>, but so far none has made it to market. Finding new treatments is difficult for any disease and it's proving especially difficult for chronic pain because the underlying causes are poorly understood.\u003c/p>\n\u003cp>Attempting to modulate inflammation as way to treat pain \"is an active area of research,\" says \u003ca href=\"https://www.ninds.nih.gov/node/8824\" target=\"_blank\" rel=\"noopener\">Michael L. Oshinsky\u003c/a>, Program Director, Pain and Migraine, at the National Institute of Neurological Disorders and Stroke.[contextly_sidebar id=\"wUYL0s18LxOkY4wdczUfG5sVi8cK5dSj\"]\u003c/p>\n\u003cp>Oshinsky says Janjic's idea of targeting the immune system with nanoparticles carrying pain relievers makes sense, although he cautions that the relationship between inflammation and pain is not well understood.\u003c/p>\n\u003cp>Janjic's path to this research began in 2010. She has a doctorate in medicinal chemistry, and she had recently moved to Duquesne University where she had set up a lab focused on using nanomedicine techniques to treat cancer.\u003c/p>\n\u003cp>What seemed like out of nowhere, of the blue, she started to suffer bouts of severe pain.\u003c/p>\n\u003cp>\"The one that hit me real hard was the whole body, from head to toe,\" she says. \"I've had on and off chronic pain since I was a teenager, but this was different.\"\u003c/p>\n\u003cp>In August that year, just before her students arrived back to school, she ended up in the emergency room with pain that was almost intolerable.\u003c/p>\n\u003cp>The doctors' diagnosis was discouraging. They told her she had a chronic pain syndrome. They said there wasn't much they could do about it, and they said it was for life.\u003c/p>\n\u003cp>The medicines they gave her helped with the pain somewhat, but left her feeling like she was living in a fog. She was having trouble remembering things, trouble taking notes.\u003c/p>\n\u003cp>\"Things were weird. So I decided I am going to do research on myself,\" Janjic says.\u003c/p>\n\u003cp>To control her own pain, she turned to mindfulness meditation and other non-medical interventions, including composing music and playing the piano. It's not as if the pain magically went away, she says, but she was able to carry on with her life. Some days were worse than others.\u003c/p>\n\u003cp>But she also wanted to find a medical solution.\u003c/p>\n\u003cp>She made one important treatment decision early on: She didn't want to take opioids for her pain.[contextly_sidebar id=\"QMwX3Yw6AeYbgPKNOtGQ6rPZrGu4Q9y4\"]\u003c/p>\n\u003cp>\"At the time I could have got them very easily,\" Janjic says. \"I said, 'What are you going to give me when I'm 67, or 87, if I take them now?' I knew they don't work long-term very well. So almost the refusal of opioids precipitated everything else that happened.\"\u003c/p>\n\u003cp>Looking for alternatives to opioids, she dove into the scientific literature, to learn all she could about chronic pain.\u003c/p>\n\u003cp>Chronic pain syndromes are not well understood. With acute pain, it's usually possible to identify the cause—an injury of some sort, or inflammation caused by an infection. Chronic pain may be linked to an initial mishap, but may persist long after the initial cause of the pain has disappeared. Sometimes there's no good explanation of the pain at all, a frustrating circumstance for both doctor and patients.\u003c/p>\n\u003cp>In addition to her research, Janjic started paying close attention to her own condition.\u003c/p>\n\u003cp>\"I started to understand that my body was actually inflamed,\" she says.\u003c/p>\n\u003cp>Inflammation occurs when our bodies' immune system tries to deal with some damage, maybe from an invading virus or bacteria, and sends a barrage of immune cells to the affected area. On the one hand this is a good thing, since the cells fight the infection. But on the other, it can stimulate nerve cells in a particular part of the body, causing pain.\u003c/p>\n\u003cp>Janjic also noticed something important about her pain: it varied both in intensity and in location. Sometimes it was in her knees, sometimes in her shoulders.\u003c/p>\n\u003cp>She says none of the medicines available today responded to pain's \"diversity within the body.\"\u003c/p>\n\u003cp>\"I [started] to understand the fluctuation,\" she says.\u003c/p>\n\u003cp>She realized that the fluctuation meant more immune cells were going to the part of the body where the pain was. She figured if she could get pain medicine into immune cells, that medicine would ride with those cells to where it was needed.[contextly_sidebar id=\"YRLyRHWtPrWD1BScVQCmWanq4QjZQPO0\"]\u003c/p>\n\u003cp>Before she got into pain research, Janjic was working on something called \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/29230567\" target=\"_blank\" rel=\"noopener\">cancer nanomedicine\u003c/a>. Cancer nanomedicines work by putting anti-cancer drugs into tiny containers called nanoparticles, and then injecting them into cancer patients, where they enter the patients' immune cells.\u003c/p>\n\u003cp>\"So what did I already know how to do? Mess with the immune system with nanomedicines,\" Janjic says. \"And that's how the idea of pain nanomedicine was born.\"\u003c/p>\n\u003cp>After many years of tinkering, she's started to get positive results. In a \u003ca href=\"https://www.jni-journal.com/article/S0165-5728(18)30012-2/fulltext\">recently published study,\u003c/a> she showed that when researchers put a nonsteroidal, anti-inflammatory drug into a nanoparticle, and then injected that into a rat, it reduced the rat's pain.\u003c/p>\n\u003cp>Janjic says her approach doesn't try to disable the immune cells.\u003c/p>\n\u003cp>\"You still want them to fight infection, you still want them to do what they're supposed to do,\" she says. \"But we almost try to stop them from going into override and causing chronic pain.\"\u003c/p>\n\u003cp>Janjic, who is also the founder and co-director of the \u003ca href=\"https://www.duq.edu/about/centers-and-institutes/chronic-pain-research-consortium\" target=\"_blank\" rel=\"noopener\">Chronic Pain Research Consortium\u003c/a> at Duquesne University, is collaborating with several labs to try pairing different pain medications with different kinds of nano-particles to see what works best. So far progress is slow. And if one of the candidates shows real promise it will be years before anything can be tested in human patients and ultimately approved by the FDA.\u003c/p>\n\u003cp>Janjic credits her own experience with pain for helping her gain a better understanding of pain and how to treat it. She thinks researchers would learn a lot from routinely talking to the people they're trying to help.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\"My take home message is, 'Ask the patient first,' \" Janjic says. \"Ask the kid who's ten. Ask the grandpa with rheumatoid arthritis what that feels like. This is what I really want to see flourish. Maybe this already happening somewhere. If it is, I want to know. If you are inspiring your research this way, then I want to talk to you.\"\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=Inspired+By+Her+Own+Pain%2C+A+Researcher+Explores+Alternatives+To+Opioid+Treatments&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n","disqusIdentifier":"444318 https://ww2.kqed.org/futureofyou/?p=444318","disqusUrl":"https://ww2.kqed.org/futureofyou/2018/09/06/a-researcher-battling-cancer-explores-alternatives-to-opioid-treatments/","stats":{"hasVideo":false,"hasChartOrMap":false,"hasAudio":false,"hasPolis":false,"wordCount":1225,"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"iframeSrcs":[],"paragraphCount":38},"modified":1536179328,"excerpt":"New options for non-addictive pain treatment are sorely needed. One researcher is borrowing from the field of cancer nanomedicine to test an idea that could bring relief to chronic pain sufferers. ","headData":{"twImgId":"","twTitle":"","ogTitle":"","ogImgId":"","twDescription":"","description":"New options for non-addictive pain treatment are sorely needed. One researcher is borrowing from the field of cancer nanomedicine to test an idea that could bring relief to chronic pain sufferers. ","title":"A Researcher Battling Cancer Explores Alternatives To Opioid Treatments | KQED","ogDescription":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"A Researcher Battling Cancer Explores Alternatives To Opioid Treatments","datePublished":"2018-09-06T14:00:37-07:00","dateModified":"2018-09-05T13:28:48-07:00","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"guestAuthors":[],"slug":"a-researcher-battling-cancer-explores-alternatives-to-opioid-treatments","status":"publish","nprApiLink":"http://api.npr.org/query?id=636860122&apiKey=MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004","nprByline":"Joe Palca, NPR","nprStoryDate":"Wed, 05 Sep 2018 15:33:02 -0400","nprLastModifiedDate":"Wed, 05 Sep 2018 15:34:43 -0400","nprHtmlLink":"https://www.npr.org/sections/health-shots/2018/09/05/636860122/inspired-by-her-own-pain-a-researcher-explores-alternatives-to-opioid-treatments?ft=nprml&f=636860122","nprImageAgency":"Jeff Swensen for NPR","source":"DIY Health","nprStoryId":"636860122","nprRetrievedStory":"1","nprPubDate":"Wed, 05 Sep 2018 15:33:00 -0400","path":"/futureofyou/444318/a-researcher-battling-cancer-explores-alternatives-to-opioid-treatments","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>The explosion of deaths related to opioid misuse has underscored a pressing need for better ways of treating pain, especially chronic pain.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Duquesne University pharmacology associate professor Jelena Janjic thinks she's on to one. It involves using a patient's own immune system to deliver non-opioid pain medication to places in the body where there's pain.\u003c/p>\n\u003cp>Janjic's idea, which draws from the field of cancer research, is to insert tiny amounts of over-the-counter pain medications into minute carriers called nanoparticles, and then inject these into pain patients. The medicines would then travel through the body to places where there is inflammation, and relieve the pain.\u003c/p>\n\u003cp>Janjic has a special reason for wanting to develop new medicines for chronic pain: She suffers from it herself.\u003c/p>\n\u003cp>\"As a patient, I want an answer,\" she says. \"I want to figure out this.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>There's no question that the need for better, non-addictive medications is real and urgent. Researchers have come up with\u003ca href=\"https://www.painnewsnetwork.org/stories/2018/6/2/new-treatments-on-the-horizon-for-chronic-pain\"> some ideas\u003c/a>, but so far none has made it to market. Finding new treatments is difficult for any disease and it's proving especially difficult for chronic pain because the underlying causes are poorly understood.\u003c/p>\n\u003cp>Attempting to modulate inflammation as way to treat pain \"is an active area of research,\" says \u003ca href=\"https://www.ninds.nih.gov/node/8824\" target=\"_blank\" rel=\"noopener\">Michael L. Oshinsky\u003c/a>, Program Director, Pain and Migraine, at the National Institute of Neurological Disorders and Stroke.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Oshinsky says Janjic's idea of targeting the immune system with nanoparticles carrying pain relievers makes sense, although he cautions that the relationship between inflammation and pain is not well understood.\u003c/p>\n\u003cp>Janjic's path to this research began in 2010. She has a doctorate in medicinal chemistry, and she had recently moved to Duquesne University where she had set up a lab focused on using nanomedicine techniques to treat cancer.\u003c/p>\n\u003cp>What seemed like out of nowhere, of the blue, she started to suffer bouts of severe pain.\u003c/p>\n\u003cp>\"The one that hit me real hard was the whole body, from head to toe,\" she says. \"I've had on and off chronic pain since I was a teenager, but this was different.\"\u003c/p>\n\u003cp>In August that year, just before her students arrived back to school, she ended up in the emergency room with pain that was almost intolerable.\u003c/p>\n\u003cp>The doctors' diagnosis was discouraging. They told her she had a chronic pain syndrome. They said there wasn't much they could do about it, and they said it was for life.\u003c/p>\n\u003cp>The medicines they gave her helped with the pain somewhat, but left her feeling like she was living in a fog. She was having trouble remembering things, trouble taking notes.\u003c/p>\n\u003cp>\"Things were weird. So I decided I am going to do research on myself,\" Janjic says.\u003c/p>\n\u003cp>To control her own pain, she turned to mindfulness meditation and other non-medical interventions, including composing music and playing the piano. It's not as if the pain magically went away, she says, but she was able to carry on with her life. Some days were worse than others.\u003c/p>\n\u003cp>But she also wanted to find a medical solution.\u003c/p>\n\u003cp>She made one important treatment decision early on: She didn't want to take opioids for her pain.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\"At the time I could have got them very easily,\" Janjic says. \"I said, 'What are you going to give me when I'm 67, or 87, if I take them now?' I knew they don't work long-term very well. So almost the refusal of opioids precipitated everything else that happened.\"\u003c/p>\n\u003cp>Looking for alternatives to opioids, she dove into the scientific literature, to learn all she could about chronic pain.\u003c/p>\n\u003cp>Chronic pain syndromes are not well understood. With acute pain, it's usually possible to identify the cause—an injury of some sort, or inflammation caused by an infection. Chronic pain may be linked to an initial mishap, but may persist long after the initial cause of the pain has disappeared. Sometimes there's no good explanation of the pain at all, a frustrating circumstance for both doctor and patients.\u003c/p>\n\u003cp>In addition to her research, Janjic started paying close attention to her own condition.\u003c/p>\n\u003cp>\"I started to understand that my body was actually inflamed,\" she says.\u003c/p>\n\u003cp>Inflammation occurs when our bodies' immune system tries to deal with some damage, maybe from an invading virus or bacteria, and sends a barrage of immune cells to the affected area. On the one hand this is a good thing, since the cells fight the infection. But on the other, it can stimulate nerve cells in a particular part of the body, causing pain.\u003c/p>\n\u003cp>Janjic also noticed something important about her pain: it varied both in intensity and in location. Sometimes it was in her knees, sometimes in her shoulders.\u003c/p>\n\u003cp>She says none of the medicines available today responded to pain's \"diversity within the body.\"\u003c/p>\n\u003cp>\"I [started] to understand the fluctuation,\" she says.\u003c/p>\n\u003cp>She realized that the fluctuation meant more immune cells were going to the part of the body where the pain was. She figured if she could get pain medicine into immune cells, that medicine would ride with those cells to where it was needed.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Before she got into pain research, Janjic was working on something called \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/29230567\" target=\"_blank\" rel=\"noopener\">cancer nanomedicine\u003c/a>. Cancer nanomedicines work by putting anti-cancer drugs into tiny containers called nanoparticles, and then injecting them into cancer patients, where they enter the patients' immune cells.\u003c/p>\n\u003cp>\"So what did I already know how to do? Mess with the immune system with nanomedicines,\" Janjic says. \"And that's how the idea of pain nanomedicine was born.\"\u003c/p>\n\u003cp>After many years of tinkering, she's started to get positive results. In a \u003ca href=\"https://www.jni-journal.com/article/S0165-5728(18)30012-2/fulltext\">recently published study,\u003c/a> she showed that when researchers put a nonsteroidal, anti-inflammatory drug into a nanoparticle, and then injected that into a rat, it reduced the rat's pain.\u003c/p>\n\u003cp>Janjic says her approach doesn't try to disable the immune cells.\u003c/p>\n\u003cp>\"You still want them to fight infection, you still want them to do what they're supposed to do,\" she says. \"But we almost try to stop them from going into override and causing chronic pain.\"\u003c/p>\n\u003cp>Janjic, who is also the founder and co-director of the \u003ca href=\"https://www.duq.edu/about/centers-and-institutes/chronic-pain-research-consortium\" target=\"_blank\" rel=\"noopener\">Chronic Pain Research Consortium\u003c/a> at Duquesne University, is collaborating with several labs to try pairing different pain medications with different kinds of nano-particles to see what works best. So far progress is slow. And if one of the candidates shows real promise it will be years before anything can be tested in human patients and ultimately approved by the FDA.\u003c/p>\n\u003cp>Janjic credits her own experience with pain for helping her gain a better understanding of pain and how to treat it. She thinks researchers would learn a lot from routinely talking to the people they're trying to help.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"My take home message is, 'Ask the patient first,' \" Janjic says. \"Ask the kid who's ten. Ask the grandpa with rheumatoid arthritis what that feels like. This is what I really want to see flourish. Maybe this already happening somewhere. If it is, I want to know. If you are inspiring your research this way, then I want to talk to you.\"\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=Inspired+By+Her+Own+Pain%2C+A+Researcher+Explores+Alternatives+To+Opioid+Treatments&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/444318/a-researcher-battling-cancer-explores-alternatives-to-opioid-treatments","authors":["byline_futureofyou_444318"],"programs":["futureofyou_54"],"categories":["futureofyou_1060","futureofyou_1","futureofyou_73"],"tags":["futureofyou_828","futureofyou_103","futureofyou_61","futureofyou_938","futureofyou_381","futureofyou_198"],"collections":["futureofyou_1093"],"featImg":"futureofyou_444321","label":"source_futureofyou_444318"},"futureofyou_441745":{"type":"posts","id":"futureofyou_441745","meta":{"index":"posts_1716263798","site":"futureofyou","id":"441745","score":null,"sort":[1526929207000]},"parent":0,"labelTerm":{},"blocks":[],"publishDate":1526929207,"format":"standard","disqusTitle":"New Snail Research Could Shake Up Our Understanding of Memory","title":"New Snail Research Could Shake Up Our Understanding of Memory","headTitle":"Future of You | KQED Future of You | KQED Science","content":"\u003cp>UCLA neuroscientists reported Monday that they have transferred a memory from one animal to another via injections of RNA, a startling result that challenges the widely held view of where and how memories are stored in the brain. [contextly_sidebar id=\"li8sZlyeZueTl33XPD1EtLOaLArCiTWy\"]\u003c/p>\n\u003cp>The finding from the lab of David Glanzman hints at the potential for new RNA-based treatments to one day restore lost memories and, if correct, could shake up the field of memory and learning.\u003c/p>\n\u003cp>“It’s pretty shocking,” said Dr. Todd Sacktor, a neurologist and memory researcher at SUNY Downstate Medical Center in Brooklyn, N.Y. “The big picture is we’re working out the basic alphabet of how memories are stored for the first time.” He was not involved in the research, which was \u003ca href=\"http://www.eneuro.org/content/early/2018/05/14/ENEURO.0038-18.2018\" target=\"_blank\" rel=\"noopener\">published in eNeuro\u003c/a>, the \u003ca href=\"http://www.eneuro.org/\" target=\"_blank\" rel=\"noopener\">online journal\u003c/a> of the Society for Neuroscience.\u003c/p>\n\u003cp>Many scientists are expected to view the research more cautiously. The work is in snails, animals that have proven a powerful model organism for neuroscience but whose simple brains work far differently than those of humans. The experiments will need to be replicated, including in animals with more complex brains. And the results fly in the face of a massive amount of evidence supporting the deeply entrenched idea that memories are stored through changes in the strength of connections, or synapses, between neurons.\u003c/p>\n\u003cp>“If he’s right, this would be absolutely earth-shattering,” said Tomás Ryan, an assistant professor at Trinity College Dublin, whose lab hunts for engrams, or the physical traces of memory. “But I don’t think it’s right.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Glanzman knows his unceremonial demotion of the synapse is not going to go over well in the field. “I expect a lot of astonishment and skepticism,” he said. “I don’t expect people are going to have a parade for me at the next Society for Neuroscience meeting.”\u003c/p>\n\u003cp>Even his own colleagues were dubious. “It took me a long time to convince the people in my lab to do the experiment,” he said. “They thought it was nuts.”\u003c/p>\n\u003cp>Glanzman’s experiments — funded by the National Institutes of Health and the National Science Foundation — involved giving mild electrical shocks to the marine snail Aplysia californica. Shocked snails learn to withdraw their delicate siphons and gills for nearly a minute as a defense when they subsequently receive a weak touch; snails that have not been shocked withdraw only briefly.[contextly_sidebar id=\"hBHp5EEY5u6iaZayEtFqvfhgpnNXWkKq\"]\u003c/p>\n\u003cp>The researchers extracted RNA from the nervous systems of snails that had been shocked and injected the material into unshocked snails. RNA’s primary role is to serve as a messenger inside cells, carrying protein-making instructions from its cousin DNA. But when this RNA was injected, these naive snails withdrew their siphons for extended periods of time after a soft touch. Control snails that received injections of RNA from snails that had not received shocks did not withdraw their siphons for as long.\u003c/p>\n\u003cp>“It’s as if we transferred a memory,” Glanzman said.\u003c/p>\n\u003cp>Glanzman’s group went further, showing that Aplysia sensory neurons in Petri dishes were more excitable, as they tend to be after being shocked, if they were exposed to RNA from shocked snails. Exposure to RNA from snails that had never been shocked did not cause the cells to become more excitable.\u003c/p>\n\u003cdiv>\n\u003cdiv>\n\u003cdiv>\n\u003cp>The results, said Glanzman, suggest that memories may be stored within the nucleus of neurons, where RNA is synthesized and can act on DNA to turn genes on and off. He said he thought memory storage involved these epigenetic changes — changes in the activity of genes and not in the DNA sequences that make up those genes — that are mediated by RNA.\u003c/p>\n\u003c/div>\n\u003c/div>\n\u003c/div>\n\u003cp>This view challenges the widely held notion that memories are stored by enhancing synaptic connections between neurons. Rather, Glanzman sees synaptic changes that occur during memory formation as flowing from the information that the RNA is carrying.\u003c/p>\n\u003cp>“This idea is radical and definitely challenges the field,” said Li-Huei Tsai, a neuroscientist who directs the Picower Institute for Learning and Memory at the Massachusetts Institute of Technology. Tsai, who recently co-authored a \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4874022/\" target=\"_blank\" rel=\"noopener\">major review on memory formation\u003c/a>, called Glanzman’s study “impressive and interesting” and said a number of studies support the notion that epigenetic mechanisms play some role in memory formation, which is likely a complex and multifaceted process. But she said she strongly disagreed with Glanzman’s notion that synaptic connections do not play a key role in memory storage.\u003c/p>\n\u003cp>Trinity College’s Ryan, like Glanzman, stands with a minority of neuroscientists — some call them rebels — who \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/28548457\" target=\"_blank\" rel=\"noopener\">question the idea\u003c/a> that memory is stored through synaptic strength. In 2015, Ryan was lead author of a Science paper with MIT Nobelist Susumu Tonegawa that showed \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/26023136\" target=\"_blank\" rel=\"noopener\">memories could be retrieved\u003c/a> even after synapse strengthening was blocked. Ryan said he is pursuing the idea that memories are stored through ensembles of neurons bound together by new synaptic connections, not by strengthening of existing connections.[contextly_sidebar id=\"U81WeRFYsnSgGUp9A3OIFy9mt8TlGFLL\"]\u003c/p>\n\u003cp>Ryan knows Glanzman and trusts his work. He said he believes the data in the new paper. But he doesn’t think the behavior of the snails, or the cells, proves that RNA is transferring memories. He said he doesn’t understand how RNA, which works on a time scale of minutes to hours, could be causing memory recall that is almost instantaneous, or how RNA could connect numerous parts of the brain, like the auditory and visual systems, that are involved in more complex memories.\u003c/p>\n\u003cp>But Glanzman said he is convinced RNA is playing a role that eclipses the synapse. In 2014, his lab showed that \u003ca href=\"https://elifesciences.org/articles/03896\" target=\"_blank\" rel=\"noopener\">memories of shocks that had been lost\u003c/a> in snails due to a series of experimental procedures could be recovered — but the synapse patterns that were lost with the memory reformed in random ways when the memories were recovered, suggesting memories were not stored there. Glanzman’s lab and others have also shown that long-term memory formation can be blocked by preventing epigenetic changes, even when synapse formation or strengthening is not altered.\u003c/p>\n\u003cp>“Synapses can come and go, but the memory can still be there,” he said, saying he sees synapses as merely the “reflection of knowledge held in the nucleus.”\u003c/p>\n\u003cp>Glanzman has studied memory for more than three decades. He did postdoctoral work with none other than Eric Kandel — the neuroscientist who shared the 2000 Nobel prize for research on Aplysia, probing the role of the synapse in memory — and he said he has spent most of his career believing that synaptic change was the key to memory storage.\u003c/p>\n\u003cp>But he said a series of findings from other labs and his own in recent years have led him to start questioning the synaptic dogma. He calls himself “a recovering synaptologist.”\u003c/p>\n\u003cp>The skepticism over Glanzman’s research may be in part because the work harkens back to an unnerving episode in science involving an unconventional psychologist, James V. McConnell, who spent years at the University of Michigan attempting to prove that something outside the brain — a factor he called “memory RNA” — could transfer memories. In the ’50s and ’60s, McConnell trained flatworms and then fed the bodies of trained worms to untrained worms. The untrained worms then appeared to exhibit the behavior of the trained worms they’d cannibalized, suggesting that memories were somehow transferred. He also showed that trained worms that were beheaded could remember their training after they grew new heads.[contextly_sidebar id=\"F5HcwGf5fX0A2ZqbT4U7VYdgDDaJshog\"]\u003c/p>\n\u003cp>Though the work was replicated by some other labs, McConnell’s work was largely ridiculed and is often described as a cautionary tale because so much time and money was spent by other labs trying, often unsuccessfully, to replicate the work. (McConnell died in 1990, five years after he’d been a target of the Unabomber Theodore Kaczynski.)\u003c/p>\n\u003cp>Recently, developmental biologist Michael Levin at Tufts has \u003ca href=\"https://www.theverge.com/2015/3/18/8225321/memory-research-flatworm-cannibalism-james-mcconnell-michael-levin\" target=\"_blank\" rel=\"noopener\">replicated McConnell’s experiments\u003c/a> on headless worms under more controlled settings and thinks McConnell may have indeed been correct.\u003c/p>\n\u003cp>Glanzman said one of McConnell’s students, Al Jacobson, demonstrated the transfer of memories between flatworms via RNA injections, coincidentally while an assistant professor at UCLA. The work was \u003ca href=\"http://www.nature.com/articles/209599a0\" target=\"_blank\" rel=\"noopener\">published in Nature in 1966\u003c/a> but Jacobsen never received tenure, perhaps because of doubts about his findings. The experiment was, however, \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC224185/\" target=\"_blank\" rel=\"noopener\">replicated in rats\u003c/a> shortly afterward.\u003c/p>\n\u003cp>Glanzman learned about McConnell’s work — and his satirical journal “Worm Runner’s Digest” — while he was a psychology undergraduate at Indiana University but never took the results seriously. Now, while he’s still not convinced McConnell was exactly right about being able to transfer memories, he does think both McConnell and Jacobson were onto something.\u003c/p>\n\u003cp>Working in the memory field can be tough for those who challenge the status quo. SUNY’s Sacktor, for example, has \u003ca href=\"https://www.statnews.com/2016/06/23/memory-research-neuroscience/\">spent more than 25 years\u003c/a> — despite the skepticism, rejection, and outright derision of fellow scientists — chasing down a single molecule, PKMzeta, that he believes is critical to the formation of long-term memories and may be connected to the RNA mechanisms that Glanzman has uncovered.\u003c/p>\n\u003cp>The stakes in the field are high because memory is so key to our sense of self and many scientists feel understanding the workings of memory is something that should have been figured out by now. “It’s the last of the great 20th-century questions in biology,” Sacktor said. “Some aspect has made it difficult for neuroscientists to figure out.”\u003c/p>\n\u003cp>The difficulty may be due in part to the overwhelming focus on synaptic strength. Some 12,000 papers have been published on synaptic strength without providing a good explanation for how memories are stored, Ryan noted, adding that he applauds Glanzman for opening up a new path, radical as it is, to explore.\u003c/p>\n\u003cp>“The reality is we know so little about memory,” Ryan said. “I’m excited about any new vistas and avenues.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This \u003ca href=\"https://www.statnews.com/2018/05/14/memory-transfer-between-snails-challenges-standard-theory/\" 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","disqusIdentifier":"441745 https://ww2.kqed.org/futureofyou/?p=441745","disqusUrl":"https://ww2.kqed.org/futureofyou/2018/05/21/new-snail-research-could-shake-up-our-understanding-of-memory/","stats":{"hasVideo":false,"hasChartOrMap":false,"hasAudio":false,"hasPolis":false,"wordCount":1748,"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"iframeSrcs":[],"paragraphCount":32},"modified":1526926150,"excerpt":"The finding could shake up the field of memory and hints at the possibility for new RNA-based treatments to one day restore lost memories.","headData":{"twImgId":"","twTitle":"","ogTitle":"","ogImgId":"","twDescription":"","description":"The finding could shake up the field of memory and hints at the possibility for new RNA-based treatments to one day restore lost memories.","title":"New Snail Research Could Shake Up Our Understanding of Memory | KQED","ogDescription":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"New Snail Research Could Shake Up Our Understanding of Memory","datePublished":"2018-05-21T12:00:07-07:00","dateModified":"2018-05-21T11:09:10-07:00","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"guestAuthors":[],"slug":"new-snail-research-could-shake-up-our-understanding-of-memory","status":"publish","nprByline":"Usha Lee McFarling\u003cbr />STAT","source":"Health","path":"/futureofyou/441745/new-snail-research-could-shake-up-our-understanding-of-memory","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>UCLA neuroscientists reported Monday that they have transferred a memory from one animal to another via injections of RNA, a startling result that challenges the widely held view of where and how memories are stored in the brain. \u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>The finding from the lab of David Glanzman hints at the potential for new RNA-based treatments to one day restore lost memories and, if correct, could shake up the field of memory and learning.\u003c/p>\n\u003cp>“It’s pretty shocking,” said Dr. Todd Sacktor, a neurologist and memory researcher at SUNY Downstate Medical Center in Brooklyn, N.Y. “The big picture is we’re working out the basic alphabet of how memories are stored for the first time.” He was not involved in the research, which was \u003ca href=\"http://www.eneuro.org/content/early/2018/05/14/ENEURO.0038-18.2018\" target=\"_blank\" rel=\"noopener\">published in eNeuro\u003c/a>, the \u003ca href=\"http://www.eneuro.org/\" target=\"_blank\" rel=\"noopener\">online journal\u003c/a> of the Society for Neuroscience.\u003c/p>\n\u003cp>Many scientists are expected to view the research more cautiously. The work is in snails, animals that have proven a powerful model organism for neuroscience but whose simple brains work far differently than those of humans. The experiments will need to be replicated, including in animals with more complex brains. And the results fly in the face of a massive amount of evidence supporting the deeply entrenched idea that memories are stored through changes in the strength of connections, or synapses, between neurons.\u003c/p>\n\u003cp>“If he’s right, this would be absolutely earth-shattering,” said Tomás Ryan, an assistant professor at Trinity College Dublin, whose lab hunts for engrams, or the physical traces of memory. “But I don’t think it’s right.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Glanzman knows his unceremonial demotion of the synapse is not going to go over well in the field. “I expect a lot of astonishment and skepticism,” he said. “I don’t expect people are going to have a parade for me at the next Society for Neuroscience meeting.”\u003c/p>\n\u003cp>Even his own colleagues were dubious. “It took me a long time to convince the people in my lab to do the experiment,” he said. “They thought it was nuts.”\u003c/p>\n\u003cp>Glanzman’s experiments — funded by the National Institutes of Health and the National Science Foundation — involved giving mild electrical shocks to the marine snail Aplysia californica. Shocked snails learn to withdraw their delicate siphons and gills for nearly a minute as a defense when they subsequently receive a weak touch; snails that have not been shocked withdraw only briefly.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>The researchers extracted RNA from the nervous systems of snails that had been shocked and injected the material into unshocked snails. RNA’s primary role is to serve as a messenger inside cells, carrying protein-making instructions from its cousin DNA. But when this RNA was injected, these naive snails withdrew their siphons for extended periods of time after a soft touch. Control snails that received injections of RNA from snails that had not received shocks did not withdraw their siphons for as long.\u003c/p>\n\u003cp>“It’s as if we transferred a memory,” Glanzman said.\u003c/p>\n\u003cp>Glanzman’s group went further, showing that Aplysia sensory neurons in Petri dishes were more excitable, as they tend to be after being shocked, if they were exposed to RNA from shocked snails. Exposure to RNA from snails that had never been shocked did not cause the cells to become more excitable.\u003c/p>\n\u003cdiv>\n\u003cdiv>\n\u003cdiv>\n\u003cp>The results, said Glanzman, suggest that memories may be stored within the nucleus of neurons, where RNA is synthesized and can act on DNA to turn genes on and off. He said he thought memory storage involved these epigenetic changes — changes in the activity of genes and not in the DNA sequences that make up those genes — that are mediated by RNA.\u003c/p>\n\u003c/div>\n\u003c/div>\n\u003c/div>\n\u003cp>This view challenges the widely held notion that memories are stored by enhancing synaptic connections between neurons. Rather, Glanzman sees synaptic changes that occur during memory formation as flowing from the information that the RNA is carrying.\u003c/p>\n\u003cp>“This idea is radical and definitely challenges the field,” said Li-Huei Tsai, a neuroscientist who directs the Picower Institute for Learning and Memory at the Massachusetts Institute of Technology. Tsai, who recently co-authored a \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4874022/\" target=\"_blank\" rel=\"noopener\">major review on memory formation\u003c/a>, called Glanzman’s study “impressive and interesting” and said a number of studies support the notion that epigenetic mechanisms play some role in memory formation, which is likely a complex and multifaceted process. But she said she strongly disagreed with Glanzman’s notion that synaptic connections do not play a key role in memory storage.\u003c/p>\n\u003cp>Trinity College’s Ryan, like Glanzman, stands with a minority of neuroscientists — some call them rebels — who \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/28548457\" target=\"_blank\" rel=\"noopener\">question the idea\u003c/a> that memory is stored through synaptic strength. In 2015, Ryan was lead author of a Science paper with MIT Nobelist Susumu Tonegawa that showed \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/26023136\" target=\"_blank\" rel=\"noopener\">memories could be retrieved\u003c/a> even after synapse strengthening was blocked. Ryan said he is pursuing the idea that memories are stored through ensembles of neurons bound together by new synaptic connections, not by strengthening of existing connections.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Ryan knows Glanzman and trusts his work. He said he believes the data in the new paper. But he doesn’t think the behavior of the snails, or the cells, proves that RNA is transferring memories. He said he doesn’t understand how RNA, which works on a time scale of minutes to hours, could be causing memory recall that is almost instantaneous, or how RNA could connect numerous parts of the brain, like the auditory and visual systems, that are involved in more complex memories.\u003c/p>\n\u003cp>But Glanzman said he is convinced RNA is playing a role that eclipses the synapse. In 2014, his lab showed that \u003ca href=\"https://elifesciences.org/articles/03896\" target=\"_blank\" rel=\"noopener\">memories of shocks that had been lost\u003c/a> in snails due to a series of experimental procedures could be recovered — but the synapse patterns that were lost with the memory reformed in random ways when the memories were recovered, suggesting memories were not stored there. Glanzman’s lab and others have also shown that long-term memory formation can be blocked by preventing epigenetic changes, even when synapse formation or strengthening is not altered.\u003c/p>\n\u003cp>“Synapses can come and go, but the memory can still be there,” he said, saying he sees synapses as merely the “reflection of knowledge held in the nucleus.”\u003c/p>\n\u003cp>Glanzman has studied memory for more than three decades. He did postdoctoral work with none other than Eric Kandel — the neuroscientist who shared the 2000 Nobel prize for research on Aplysia, probing the role of the synapse in memory — and he said he has spent most of his career believing that synaptic change was the key to memory storage.\u003c/p>\n\u003cp>But he said a series of findings from other labs and his own in recent years have led him to start questioning the synaptic dogma. He calls himself “a recovering synaptologist.”\u003c/p>\n\u003cp>The skepticism over Glanzman’s research may be in part because the work harkens back to an unnerving episode in science involving an unconventional psychologist, James V. McConnell, who spent years at the University of Michigan attempting to prove that something outside the brain — a factor he called “memory RNA” — could transfer memories. In the ’50s and ’60s, McConnell trained flatworms and then fed the bodies of trained worms to untrained worms. The untrained worms then appeared to exhibit the behavior of the trained worms they’d cannibalized, suggesting that memories were somehow transferred. He also showed that trained worms that were beheaded could remember their training after they grew new heads.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Though the work was replicated by some other labs, McConnell’s work was largely ridiculed and is often described as a cautionary tale because so much time and money was spent by other labs trying, often unsuccessfully, to replicate the work. (McConnell died in 1990, five years after he’d been a target of the Unabomber Theodore Kaczynski.)\u003c/p>\n\u003cp>Recently, developmental biologist Michael Levin at Tufts has \u003ca href=\"https://www.theverge.com/2015/3/18/8225321/memory-research-flatworm-cannibalism-james-mcconnell-michael-levin\" target=\"_blank\" rel=\"noopener\">replicated McConnell’s experiments\u003c/a> on headless worms under more controlled settings and thinks McConnell may have indeed been correct.\u003c/p>\n\u003cp>Glanzman said one of McConnell’s students, Al Jacobson, demonstrated the transfer of memories between flatworms via RNA injections, coincidentally while an assistant professor at UCLA. The work was \u003ca href=\"http://www.nature.com/articles/209599a0\" target=\"_blank\" rel=\"noopener\">published in Nature in 1966\u003c/a> but Jacobsen never received tenure, perhaps because of doubts about his findings. The experiment was, however, \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC224185/\" target=\"_blank\" rel=\"noopener\">replicated in rats\u003c/a> shortly afterward.\u003c/p>\n\u003cp>Glanzman learned about McConnell’s work — and his satirical journal “Worm Runner’s Digest” — while he was a psychology undergraduate at Indiana University but never took the results seriously. Now, while he’s still not convinced McConnell was exactly right about being able to transfer memories, he does think both McConnell and Jacobson were onto something.\u003c/p>\n\u003cp>Working in the memory field can be tough for those who challenge the status quo. SUNY’s Sacktor, for example, has \u003ca href=\"https://www.statnews.com/2016/06/23/memory-research-neuroscience/\">spent more than 25 years\u003c/a> — despite the skepticism, rejection, and outright derision of fellow scientists — chasing down a single molecule, PKMzeta, that he believes is critical to the formation of long-term memories and may be connected to the RNA mechanisms that Glanzman has uncovered.\u003c/p>\n\u003cp>The stakes in the field are high because memory is so key to our sense of self and many scientists feel understanding the workings of memory is something that should have been figured out by now. “It’s the last of the great 20th-century questions in biology,” Sacktor said. “Some aspect has made it difficult for neuroscientists to figure out.”\u003c/p>\n\u003cp>The difficulty may be due in part to the overwhelming focus on synaptic strength. Some 12,000 papers have been published on synaptic strength without providing a good explanation for how memories are stored, Ryan noted, adding that he applauds Glanzman for opening up a new path, radical as it is, to explore.\u003c/p>\n\u003cp>“The reality is we know so little about memory,” Ryan said. “I’m excited about any new vistas and avenues.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>This \u003ca href=\"https://www.statnews.com/2018/05/14/memory-transfer-between-snails-challenges-standard-theory/\" 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>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/441745/new-snail-research-could-shake-up-our-understanding-of-memory","authors":["byline_futureofyou_441745"],"programs":["futureofyou_54"],"categories":["futureofyou_1","futureofyou_73"],"tags":["futureofyou_56","futureofyou_61","futureofyou_1047","futureofyou_294"],"featImg":"futureofyou_441749","label":"source_futureofyou_441745"},"futureofyou_441274":{"type":"posts","id":"futureofyou_441274","meta":{"index":"posts_1716263798","site":"futureofyou","id":"441274","score":null,"sort":[1525467630000]},"parent":0,"labelTerm":{},"blocks":[],"publishDate":1525467630,"format":"standard","disqusTitle":"DNA Match Sought to Catch Zodiac Killer After Break in Other Case","title":"DNA Match Sought to Catch Zodiac Killer After Break in Other Case","headTitle":"Future of You | KQED Future of You | KQED Science","content":"\u003cp>Northern California detectives still trying to identify the infamous Zodiac Killer who targeted victims in the late 1960s and taunted investigators with letters say they hope to try the same DNA tracing technology recently used to arrest a suspect in another string of cold-case serial slayings — those blamed on the Golden State Killer.[contextly_sidebar id=\"zUhwd65sr96OmXZ5rNGiH0XjWcE7Vddr\"]\u003c/p>\n\u003cp>But first they have to get a better DNA profile.\u003c/p>\n\u003cp>Several months ago, the Vallejo Police Department sent two letters written by the Zodiac Killer to a private lab in hopes of finding his DNA on the back of the stamps or envelope flaps that may have been licked. They are expecting results soon.\u003c/p>\n\u003cp>“They were confident they would be able to get something off it,” Vallejo police Detective Terry Poyser told the Sacramento Bee.\u003c/p>\n\u003cp>Poyser said he hopes a full DNA profile will be found that will enable detectives to try the same DNA sleuthing techniques that were used to arrest Joseph DeAngelo last month. Authorities suspect he committed at least 12 murders and 50 rapes in California between 1976 and 1986.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Investigators uploaded DNA collected at one of the crime scenes to an open-source genealogical website and found a partial match to a distant relative of DeAngelo’s. From there, they painstakingly constructed a family tree dating back several generations before they zeroed in on DeAngelo.\u003c/p>\n\u003cp>Some privacy advocates say they are concerned with the process and worry about future abuses, but detectives investigating the Zodiac Killer say they hope the technique will help solve one of the most vexing cold cases in the country.[contextly_sidebar id=\"g4kjcqBcthT0ZUevaj35GoD7FRXTonPJ\"]\u003c/p>\n\u003cp>“That’s a great idea,” said Gary Harmor, founder and director of the Serological Research Institute, a private DNA lab. “I think we’ll see more investigations use this technique.”\u003c/p>\n\u003cp>Detectives in Southern California are testing DNA collected from a double-murder and rape to see if they can be tied to DeAngelo. Another man, Craig Coley, was recently cleared of those crimes after spending 38 years in prison in the murder of a 24-year-old college student and her 4-year-old son in 1978.\u003c/p>\n\u003cp>The Zodiac Killer fatally stabbed or shot to death five people in Northern California in 1968 and 1969, then sent taunting letters and cryptograms to the police and newspapers. The Vallejo police are the lead investigators because the first two victims were killed there.\u003c/p>\n\u003cp>The suspect was dubbed the Zodiac Killer because some of the cryptograms included astrological symbols and references.\u003c/p>\n\u003cp>Various pieces of evidence, including a rope used to tie a victim as well as the letters, have been tested unsuccessfully for the killer’s DNA profile. Poyser said recent advances in DNA testing prompted investigators to seek a match on two of the killer’s letters.\u003c/p>\n\u003cp>Vallejo Mayor Bob Sampayan said the samples were sent to the lab as a matter of routine. Sampayan, a former homicide detective, said police submit samples every couple of years in hopes that advances in DNA testing will finally yield a profile detectives can use.[contextly_sidebar id=\"ij6OwtCH46Lhi3AkKIvypYUgun9XpRrV\"]\u003c/p>\n\u003cp>“It was coincidental,” Sampayan said of the new DNA test occurring at the same time as the breakthrough in the Golden State Killer case.\u003c/p>\n\u003cp>“There will come a time when we get a match,” he said.\u003c/p>\n\u003cp>The 2007 movie “Zodiac,” starring Jake Gyllenhaal and Robert Downey Jr., renewed widespread interest in a case that has always had a cult following of amateur detectives and cryptographers who sought to crack the killer’s code.\u003c/p>\n\u003cp>One of those amateur sleuths, Tom Voigt, said the key to solving the Zodiac killings is mimicking the Golden State Killer investigation, which included forming a full-time task force dedicated to the case and exploiting publicly accessible DNA databases.\u003c/p>\n\u003cp>Voigt said the Zodiac case was being investigated part time by a Police Department in a city that filed for municipal bankruptcy.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“There’s a formula to follow,” Voigt said. “And it’s to simply copy what happened to the Golden State Killer.”\u003c/p>\n\n","disqusIdentifier":"441274 https://ww2.kqed.org/futureofyou/?p=441274","disqusUrl":"https://ww2.kqed.org/futureofyou/2018/05/04/dna-match-sought-to-catch-zodiac-killer-after-break-in-other-case/","stats":{"hasVideo":false,"hasChartOrMap":false,"hasAudio":false,"hasPolis":false,"wordCount":694,"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"iframeSrcs":[],"paragraphCount":21},"modified":1525459662,"excerpt":"Some privacy advocates express concern about potential abuses, but detectives say they hope the technique will help solve one of the most vexing cold cases in the country.","headData":{"twImgId":"","twTitle":"","ogTitle":"","ogImgId":"","twDescription":"","description":"Some privacy advocates express concern about potential abuses, but detectives say they hope the technique will help solve one of the most vexing cold cases in the country.","title":"DNA Match Sought to Catch Zodiac Killer After Break in Other Case | KQED","ogDescription":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"DNA Match Sought to Catch Zodiac Killer After Break in Other Case","datePublished":"2018-05-04T14:00:30-07:00","dateModified":"2018-05-04T11:47:42-07:00","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"guestAuthors":[],"slug":"dna-match-sought-to-catch-zodiac-killer-after-break-in-other-case","status":"publish","nprByline":"The Associated Press","source":"Your Genes","path":"/futureofyou/441274/dna-match-sought-to-catch-zodiac-killer-after-break-in-other-case","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Northern California detectives still trying to identify the infamous Zodiac Killer who targeted victims in the late 1960s and taunted investigators with letters say they hope to try the same DNA tracing technology recently used to arrest a suspect in another string of cold-case serial slayings — those blamed on the Golden State Killer.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>But first they have to get a better DNA profile.\u003c/p>\n\u003cp>Several months ago, the Vallejo Police Department sent two letters written by the Zodiac Killer to a private lab in hopes of finding his DNA on the back of the stamps or envelope flaps that may have been licked. They are expecting results soon.\u003c/p>\n\u003cp>“They were confident they would be able to get something off it,” Vallejo police Detective Terry Poyser told the Sacramento Bee.\u003c/p>\n\u003cp>Poyser said he hopes a full DNA profile will be found that will enable detectives to try the same DNA sleuthing techniques that were used to arrest Joseph DeAngelo last month. Authorities suspect he committed at least 12 murders and 50 rapes in California between 1976 and 1986.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Investigators uploaded DNA collected at one of the crime scenes to an open-source genealogical website and found a partial match to a distant relative of DeAngelo’s. From there, they painstakingly constructed a family tree dating back several generations before they zeroed in on DeAngelo.\u003c/p>\n\u003cp>Some privacy advocates say they are concerned with the process and worry about future abuses, but detectives investigating the Zodiac Killer say they hope the technique will help solve one of the most vexing cold cases in the country.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>“That’s a great idea,” said Gary Harmor, founder and director of the Serological Research Institute, a private DNA lab. “I think we’ll see more investigations use this technique.”\u003c/p>\n\u003cp>Detectives in Southern California are testing DNA collected from a double-murder and rape to see if they can be tied to DeAngelo. Another man, Craig Coley, was recently cleared of those crimes after spending 38 years in prison in the murder of a 24-year-old college student and her 4-year-old son in 1978.\u003c/p>\n\u003cp>The Zodiac Killer fatally stabbed or shot to death five people in Northern California in 1968 and 1969, then sent taunting letters and cryptograms to the police and newspapers. The Vallejo police are the lead investigators because the first two victims were killed there.\u003c/p>\n\u003cp>The suspect was dubbed the Zodiac Killer because some of the cryptograms included astrological symbols and references.\u003c/p>\n\u003cp>Various pieces of evidence, including a rope used to tie a victim as well as the letters, have been tested unsuccessfully for the killer’s DNA profile. Poyser said recent advances in DNA testing prompted investigators to seek a match on two of the killer’s letters.\u003c/p>\n\u003cp>Vallejo Mayor Bob Sampayan said the samples were sent to the lab as a matter of routine. Sampayan, a former homicide detective, said police submit samples every couple of years in hopes that advances in DNA testing will finally yield a profile detectives can use.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>“It was coincidental,” Sampayan said of the new DNA test occurring at the same time as the breakthrough in the Golden State Killer case.\u003c/p>\n\u003cp>“There will come a time when we get a match,” he said.\u003c/p>\n\u003cp>The 2007 movie “Zodiac,” starring Jake Gyllenhaal and Robert Downey Jr., renewed widespread interest in a case that has always had a cult following of amateur detectives and cryptographers who sought to crack the killer’s code.\u003c/p>\n\u003cp>One of those amateur sleuths, Tom Voigt, said the key to solving the Zodiac killings is mimicking the Golden State Killer investigation, which included forming a full-time task force dedicated to the case and exploiting publicly accessible DNA databases.\u003c/p>\n\u003cp>Voigt said the Zodiac case was being investigated part time by a Police Department in a city that filed for municipal bankruptcy.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“There’s a formula to follow,” Voigt said. “And it’s to simply copy what happened to the Golden State Killer.”\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/441274/dna-match-sought-to-catch-zodiac-killer-after-break-in-other-case","authors":["byline_futureofyou_441274"],"programs":["futureofyou_54"],"categories":["futureofyou_1","futureofyou_73","futureofyou_1064"],"tags":["futureofyou_17","futureofyou_324","futureofyou_271","futureofyou_35"],"featImg":"futureofyou_441281","label":"source_futureofyou_441274"},"futureofyou_441130":{"type":"posts","id":"futureofyou_441130","meta":{"index":"posts_1716263798","site":"futureofyou","id":"441130","score":null,"sort":[1525122037000]},"parent":0,"labelTerm":{},"blocks":[],"publishDate":1525122037,"format":"standard","disqusTitle":"Viral Video Highlights America's Emergency Psychiatric Crisis","title":"Viral Video Highlights America's Emergency Psychiatric Crisis","headTitle":"Future of You | KQED Future of You | KQED Science","content":"\u003cp>A viral video from Baltimore is drawing attention to a crisis that's unfolding in emergency rooms across the country: Surging numbers of patients with psychiatric conditions aren't receiving the care they need.\u003c/p>\n\u003cp>On a cold night in January, a man walking by a downtown Baltimore hospital saw something that shocked him. He started recording the incident on his phone.[contextly_sidebar id=\"szGKbRaruZx5ZzbLuwCWnThGfKj4M6NW\"]\u003c/p>\n\u003cp>Imamu Baraka's video, which has been viewed more than 3 million times, shows security guards walking away from a bus stop next to the emergency room of University of Maryland Medical Center Midtown Campus.\u003c/p>\n\u003cp>One is pushing an empty wheelchair. The woman they left there is wearing a thin yellow hospital gown and socks.\u003c/p>\n\u003cp>\"Wait, so you're just going to leave this lady out here with no clothes on?\" Baraka asks the guards. They continue walking away.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The woman, later identified as a 22-year-old named Rebecca, staggers near the bus stop. She appears distressed and confused. She moans and shouts.\u003c/p>\n\u003cp>\"Are you OK, ma'am? Do you need me to call the police?\" Baraka asks.\u003c/p>\n\u003cp>Nationwide, hospitals are struggling to provide services to people with psychiatric emergencies. Between 2006 and 2013, ER visits increased by more than 50 percent for psychoses and bipolar disorders and depression, anxiety and stress reactions \u003ca href=\"https://www.hcup-us.ahrq.gov/reports/statbriefs/sb216-Mental-Substance-Use-Disorder-ED-Visit-Trends.pdf\" target=\"_blank\" rel=\"noopener\">according to the Healthcare Cost and Utilization Project\u003c/a>, which compiles health care data. Between those years the number of visits climbed from 3,448 visits to 5,330 per 100,000 U.S. patients ages 15 and older.[contextly_sidebar id=\"OwR2yLry7rt36cQxbBEeKvzvQmLWRIHK\"]\u003c/p>\n\u003cp>\"We're just failing patients with mental illness and it's just getting worse as time goes on,\" says \u003ca href=\"https://www.acep.org/Membership/Leadership/John-J--Rogers,-MD,-CPE,-FACEP,-President-Elect/#sm.00001sg4kgdr2xd0gwjdhu1dohu7f\" target=\"_blank\" rel=\"noopener\">Dr. John Rogers\u003c/a>, president-elect of the American College of Emergency Physicians.\u003c/p>\n\u003cp>In the viral video, Rebecca has a visible wound on her forehead, and her breath forms white clouds in the cold. Baraka calls for an ambulance, which brings her back to the hospital that just discharged her.\u003c/p>\n\u003cp>Rebecca's mother, Cheryl Chandler, says she happened to click on the video, not knowing it showed her daughter. \"Once he focused on her face I realized it was her. And I think I went into shock initially,\" Chandler says.\u003c/p>\n\u003cp>That realization set off a desperate search. The hospital wouldn't tell her where she was. Chandler called the police. They found out that the hospital didn't readmit Rebecca, even though according to \u003ca href=\"https://www.documentcloud.org/documents/4417187-UMMC-Investigation-2.html\" target=\"_blank\" rel=\"noopener\">a federal regulator's report\u003c/a>, Rebecca told workers in the ambulance, \"I do not feel normal, and do not know what normal is.\"\u003c/p>\n\u003cp>Hospital staff put her into a cab that took her to a nearby homeless shelter, where family members found her the next day. She's been hospitalized on and off since the incident.\u003c/p>\n\u003cp>\"She could have got hypothermia. She could have died. She could have been raped, she could have been killed,\" Chandler says. \"All she wanted was treatment and they had two opportunities to do it and denied it both times.\"[contextly_sidebar id=\"qVILeFSoPW1ICG0oW2MIVApcccHW7EoZ\"]\u003c/p>\n\u003cp>Rebecca was clearly asking for medical care, her mother says, which ERs are legally required to provide.\u003c/p>\n\u003cp>\"That, what I saw in the video, was my worst nightmare for Rebecca,\" Chandler says. Several years ago, Rebecca was diagnosed with bipolar and schizoaffective disorders. Her mom adds that she's a shy and lovable introvert who loves animals and making art.\u003c/p>\n\u003cp>Rebecca has insurance and had been in a residential home when she went missing, Chandler says.\u003c/p>\n\u003cp>The hospital has apologized and says it has already put in place measures to correct the issues.\u003c/p>\n\u003cp>Chandler says she hopes that means it won't happen to other patients. But she adds that Rebecca will continue to suffer from the hospital's decisions: \"No part of Rebecca, because of this, is going to heal. No part. We can't make the scars go away.\"\u003c/p>\n\u003cp>James E. Farmer, a lawyer for Rebecca's family, says they're investigating now and considering filing lawsuits. \"It's going to be difficult to determine the exact extent of harm to Rebecca,\" he says. \"I could not imagine the psychological damage and harm that was done as a result of this.\"\u003c/p>\n\u003cp>The Centers for Medicare & Medicaid Services says the hospital failed to discharge the patient safely, among other breaches.\u003c/p>\n\u003cp>According to the federal regulator's report, Rebecca was \"resistant to discharge and refused to get dressed into street clothes when requested by nursing.\" The hospital stated there was a \"communication failure\" which led to her discharge into the cold weather, though the report says it is not clear whether nursing or security staff made that decision.\u003c/p>\n\u003cp>Chandler says she's heard from other families with similar stories: \"The only difference is it wasn't caught on video.\u003cem>\"\u003c/em>\u003c/p>\n\u003cp>\u003cstrong>\"They told me to leave\"\u003c/strong>\u003c/p>\n\u003cp>Here's another story from Baltimore, about Laura Pogliano and her son Zaccaria. Zac, who had schizophrenia, died in 2015 of heart failure when he was 23.\u003c/p>\n\u003cp>Zac was sensitive and empathetic, and loved playing the piano, his mother says. He started to show symptoms of the disease when he was 16. He became paranoid, and started doing things like hiding kitchen implements out of fear that someone was trying to kill his family.\u003c/p>\n\u003cp>\"His personality just drastically changed,\" Pogliano says. \"He had a thousand rituals around things so that he wasn't harmed.\"\u003c/p>\n\u003cp>Then, as part of his illness, Zac started to think that he actually did have dramatic injuries. Like a gunshot wound or a pulverized ankle. He'd call 911.\u003c/p>\n\u003cp>\"He got to the point where he would pick up the phone at the drop of a hat and say, can someone come and help me, I'm having a heart attack,\" Pogliano says.\u003c/p>\n\u003cp>This happened about 20 times in the two years before his death, she says. Often, ambulances took Zac to Good Samaritan Hospital, where Pogliano says the doctors would typically call her to let her know he arrived and would provide appropriate care for him. Later, hospital staff would call her to pick him up.\u003c/p>\n\u003cp>But one night after Zac went to the ER, Pogliano woke up hours later and got worried that she hadn't received a call.\u003c/p>\n\u003cp>\"I just got in the car and drove over there, and he was sitting outside. It was early spring but it was still wintery, probably 40 degrees out, 45 degrees out,\" she says.[contextly_sidebar id=\"rDd0VJsZFkI99YckcnBP9H20wW3og3pM\"]\u003c/p>\n\u003cp>\"All he had on was what he wore to the hospital, which was a pair of white linen shorts. I know he didn't have shoes on. ... And a hospital gown and no shirt. I said to him, 'Oh my gosh, what are you doing here?' He said, 'They told me to leave.' \"\u003c/p>\n\u003cp>A hospital spokeswoman acknowledged that Pogliano was a patient there but says she found no indication that he was ever inappropriately evaluated or mistreated. She says she couldn't comment further because of federal privacy laws.\u003c/p>\n\u003cp>Emergency room doctors are frustrated at the growing gap in care for patients with psychiatric disabilities.\u003c/p>\n\u003cp>\"We're kind of tired of waiting for legislators and regulators to act and to meet their responsibility to these patients in the form of providing funding for resources,\" says Rogers, the president-elect of the American College of Emergency Physicians.\u003c/p>\n\u003cp>Even as there is increasing demand, there are fewer resources to care for psychiatric patients. It can be difficult for doctors to find an inpatient bed — the numbers are have decreased dramatically over the decades. Rogers says there have been significant cuts to community and outpatient resources — so the emergency department is often the only place for psychiatric patients to go.\u003c/p>\n\u003cp>\"Every emergency physician in the country knows this problem well and wants to do something about it,\" Rogers says.\u003c/p>\n\u003cp>Often the ER is not properly equipped with staff that can offer treatment to psychiatric patients. The emergency room's mission is to assess and stabilize, but the actual care they can provide psychiatric patients is fairly limited. \u003ca href=\"https://www.acep.org/uploadedFiles/ACEP/newsroom/NewsMediaResources/StatisticsData/Psychiatric%20Boarding%20Summary.pdf\">A 2008 survey of ER doctors\u003c/a> found that 62 percent of them said there were no psychiatric services provided while the patients were in the ER.[contextly_sidebar id=\"lGkbbkYcbyqeAi9PmdSR23pZZwe16xA2\"]\u003c/p>\n\u003cp>\"And the disparity between our ability to care for a patient with a medical problem and a patient with a psychiatric problem is growing, that gap is increasing,\" Rogers says.\u003c/p>\n\u003cp>He says Rebecca's case is an outlier. More common, he says, is that ERs will hold patients for too long before they can transfer them somewhere that can treat them. In \u003ca href=\"http://newsroom.acep.org/2015-02-24-psychiatric-emergencies\" target=\"_blank\" rel=\"noopener\">a recent poll of emergency physicians\u003c/a>, 84 percent said that psychiatric patients are \"boarded\" in their departments for hours or days. Rogers says he's heard of patients being held for weeks.\u003c/p>\n\u003cp>And the options for where to transfer them are often limited. \"And that's where it starts breaking down,\" he says. \"The time that it takes to get someone transferred for something like that is just unacceptable....They wait, and wait, and wait.\"\u003c/p>\n\u003cp>It's a bad situation for everyone – for patients with psychiatric disabilities, and for other patients who have lengthy wait times because ERs are overwhelmed.\u003c/p>\n\u003cp>\"They're being asked to do way too much with way too few resources,\" says Susan Stefan, a lawyer focusing on rights of people with psychiatric disabilities. ERs \"have a specific mission, which is to provide emergency medical care, and they're being turned into essentially 24-7 social service agencies.\"[contextly_sidebar id=\"Ei91X4TinBmgcEKaNWK697YV179b4rWn\"]\u003c/p>\n\u003cp>Stefan, who wrote a \u003ca href=\"https://www.amazon.com/Emergency-Department-Treatment-Psychiatric-Patient/dp/0195189299\" target=\"_blank\" rel=\"noopener\">book about treating psychiatric patients in ERs\u003c/a>, says it's common for them to transfer people to homeless shelters because they are not equipped to find people stable housing.\u003c/p>\n\u003cp>And there's another crucial point here: The ER is simply a bad place to treat severe mental illness, even as it is becoming increasingly central for those patients.\u003c/p>\n\u003cp>\"The emergency department is probably the worst place for somebody in psychiatric crisis,\" Stefan says. \"It's loud, it's chaotic and people don't take a lot of time because they don't have a lot of time.\"\u003c/p>\n\u003cp>And it's not straightforward to transform an ER into a place that \u003cem>is\u003c/em> appropriate to provide treatment to people who are in the middle of psychiatric crises — although there are hospitals that are experimenting with new models to better serve these patients.\u003c/p>\n\u003cp>The Alameda Health System in Alameda County, Calif., is a model that both Stefan and Rogers point to. There, a doctor named Scott Zeller has set up a dedicated psychiatric emergency service — a department separate from the standard emergency room that can provide specialized evaluation and treatment for these patients.\u003c/p>\n\u003cp>The Alameda model reduced boarding times by 80 percent, according to a \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3935777/\" target=\"_blank\" rel=\"noopener\">study published \u003c/a>in the \u003cem>Western Journal of Emergency Medicine\u003c/em>, and the fast, stabilizing treatment made it far less likely that the patient would need to be transferred to an inpatient bed.\u003c/p>\n\u003cp>If there were adequate services in place, most of the people coming to ERs for psychiatric crises wouldn't need to come there at all, says Jennifer Mathis, the director of policy and legal advocacy at the Bazelon Center for Mental Health Law.\u003c/p>\n\u003cp>\"And much as everybody loves to talk about the need for mental health services, that doesn't translate into state policy and funding for community mental health services,\" she says.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>The problem here, Mathis says, is political will. There's a big gap between politicians talking about mental health and actually making sure people are getting the services they need.\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=%27Failing+Patients%27%3A+Baltimore+Video+Highlights+Crisis+Of+Emergency+Psychiatric+Care&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n","disqusIdentifier":"441130 https://ww2.kqed.org/futureofyou/?p=441130","disqusUrl":"https://ww2.kqed.org/futureofyou/2018/04/30/baltimore-video-highlights-americas-emergency-psychiatric-crisis/","stats":{"hasVideo":false,"hasChartOrMap":false,"hasAudio":false,"hasPolis":false,"wordCount":1934,"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"iframeSrcs":[],"paragraphCount":55},"modified":1525460489,"excerpt":"A viral video is drawing attention to a problem in hospital emergency rooms across the country. More and more patients with urgent psychiatric conditions aren't receiving the care they need.","headData":{"twImgId":"","twTitle":"","ogTitle":"","ogImgId":"","twDescription":"","description":"A viral video is drawing attention to a problem in hospital emergency rooms across the country. More and more patients with urgent psychiatric conditions aren't receiving the care they need.","title":"Viral Video Highlights America's Emergency Psychiatric Crisis | KQED","ogDescription":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Viral Video Highlights America's Emergency Psychiatric Crisis","datePublished":"2018-04-30T14:00:37-07:00","dateModified":"2018-05-04T12:01:29-07:00","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"guestAuthors":[],"slug":"baltimore-video-highlights-americas-emergency-psychiatric-crisis","status":"publish","nprApiLink":"http://api.npr.org/query?id=599892160&apiKey=MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004","nprByline":"Merrit Kennedy, NPR","nprStoryDate":"Sun, 29 Apr 2018 08:10:51 -0400","nprLastModifiedDate":"Sun, 29 Apr 2018 10:46:17 -0400","nprHtmlLink":"https://www.npr.org/sections/health-shots/2018/04/29/599892160/failing-patients-baltimore-video-highlights-crisis-of-emergency-psychiatric-care?ft=nprml&f=599892160","nprAudio":"https://ondemand.npr.org/anon.npr-mp3/npr/wesun/2018/04/20180429_wesun_failing_patients_baltimore_video_highlights_crisis_of_emergency_psychiatric_care.mp3?orgId=1&topicId=1128&d=484&p=10&story=599892160&ft=nprml&f=599892160","nprImageAgency":"Jared Soares for NPR","source":"Health","nprAudioM3u":"http://api.npr.org/m3u/1606859358-3e7f6f.m3u?orgId=1&topicId=1128&d=484&p=10&story=599892160&ft=nprml&f=599892160","nprStoryId":"599892160","nprRetrievedStory":"1","nprPubDate":"Sun, 29 Apr 2018 10:46:00 -0400","path":"/futureofyou/441130/baltimore-video-highlights-americas-emergency-psychiatric-crisis","audioUrl":"https://ondemand.npr.org/anon.npr-mp3/npr/wesun/2018/04/20180429_wesun_failing_patients_baltimore_video_highlights_crisis_of_emergency_psychiatric_care.mp3?orgId=1&topicId=1128&d=484&p=10&story=599892160&ft=nprml&f=599892160","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>A viral video from Baltimore is drawing attention to a crisis that's unfolding in emergency rooms across the country: Surging numbers of patients with psychiatric conditions aren't receiving the care they need.\u003c/p>\n\u003cp>On a cold night in January, a man walking by a downtown Baltimore hospital saw something that shocked him. He started recording the incident on his phone.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Imamu Baraka's video, which has been viewed more than 3 million times, shows security guards walking away from a bus stop next to the emergency room of University of Maryland Medical Center Midtown Campus.\u003c/p>\n\u003cp>One is pushing an empty wheelchair. The woman they left there is wearing a thin yellow hospital gown and socks.\u003c/p>\n\u003cp>\"Wait, so you're just going to leave this lady out here with no clothes on?\" Baraka asks the guards. They continue walking away.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The woman, later identified as a 22-year-old named Rebecca, staggers near the bus stop. She appears distressed and confused. She moans and shouts.\u003c/p>\n\u003cp>\"Are you OK, ma'am? Do you need me to call the police?\" Baraka asks.\u003c/p>\n\u003cp>Nationwide, hospitals are struggling to provide services to people with psychiatric emergencies. Between 2006 and 2013, ER visits increased by more than 50 percent for psychoses and bipolar disorders and depression, anxiety and stress reactions \u003ca href=\"https://www.hcup-us.ahrq.gov/reports/statbriefs/sb216-Mental-Substance-Use-Disorder-ED-Visit-Trends.pdf\" target=\"_blank\" rel=\"noopener\">according to the Healthcare Cost and Utilization Project\u003c/a>, which compiles health care data. Between those years the number of visits climbed from 3,448 visits to 5,330 per 100,000 U.S. patients ages 15 and older.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\"We're just failing patients with mental illness and it's just getting worse as time goes on,\" says \u003ca href=\"https://www.acep.org/Membership/Leadership/John-J--Rogers,-MD,-CPE,-FACEP,-President-Elect/#sm.00001sg4kgdr2xd0gwjdhu1dohu7f\" target=\"_blank\" rel=\"noopener\">Dr. John Rogers\u003c/a>, president-elect of the American College of Emergency Physicians.\u003c/p>\n\u003cp>In the viral video, Rebecca has a visible wound on her forehead, and her breath forms white clouds in the cold. Baraka calls for an ambulance, which brings her back to the hospital that just discharged her.\u003c/p>\n\u003cp>Rebecca's mother, Cheryl Chandler, says she happened to click on the video, not knowing it showed her daughter. \"Once he focused on her face I realized it was her. And I think I went into shock initially,\" Chandler says.\u003c/p>\n\u003cp>That realization set off a desperate search. The hospital wouldn't tell her where she was. Chandler called the police. They found out that the hospital didn't readmit Rebecca, even though according to \u003ca href=\"https://www.documentcloud.org/documents/4417187-UMMC-Investigation-2.html\" target=\"_blank\" rel=\"noopener\">a federal regulator's report\u003c/a>, Rebecca told workers in the ambulance, \"I do not feel normal, and do not know what normal is.\"\u003c/p>\n\u003cp>Hospital staff put her into a cab that took her to a nearby homeless shelter, where family members found her the next day. She's been hospitalized on and off since the incident.\u003c/p>\n\u003cp>\"She could have got hypothermia. She could have died. She could have been raped, she could have been killed,\" Chandler says. \"All she wanted was treatment and they had two opportunities to do it and denied it both times.\"\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Rebecca was clearly asking for medical care, her mother says, which ERs are legally required to provide.\u003c/p>\n\u003cp>\"That, what I saw in the video, was my worst nightmare for Rebecca,\" Chandler says. Several years ago, Rebecca was diagnosed with bipolar and schizoaffective disorders. Her mom adds that she's a shy and lovable introvert who loves animals and making art.\u003c/p>\n\u003cp>Rebecca has insurance and had been in a residential home when she went missing, Chandler says.\u003c/p>\n\u003cp>The hospital has apologized and says it has already put in place measures to correct the issues.\u003c/p>\n\u003cp>Chandler says she hopes that means it won't happen to other patients. But she adds that Rebecca will continue to suffer from the hospital's decisions: \"No part of Rebecca, because of this, is going to heal. No part. We can't make the scars go away.\"\u003c/p>\n\u003cp>James E. Farmer, a lawyer for Rebecca's family, says they're investigating now and considering filing lawsuits. \"It's going to be difficult to determine the exact extent of harm to Rebecca,\" he says. \"I could not imagine the psychological damage and harm that was done as a result of this.\"\u003c/p>\n\u003cp>The Centers for Medicare & Medicaid Services says the hospital failed to discharge the patient safely, among other breaches.\u003c/p>\n\u003cp>According to the federal regulator's report, Rebecca was \"resistant to discharge and refused to get dressed into street clothes when requested by nursing.\" The hospital stated there was a \"communication failure\" which led to her discharge into the cold weather, though the report says it is not clear whether nursing or security staff made that decision.\u003c/p>\n\u003cp>Chandler says she's heard from other families with similar stories: \"The only difference is it wasn't caught on video.\u003cem>\"\u003c/em>\u003c/p>\n\u003cp>\u003cstrong>\"They told me to leave\"\u003c/strong>\u003c/p>\n\u003cp>Here's another story from Baltimore, about Laura Pogliano and her son Zaccaria. Zac, who had schizophrenia, died in 2015 of heart failure when he was 23.\u003c/p>\n\u003cp>Zac was sensitive and empathetic, and loved playing the piano, his mother says. He started to show symptoms of the disease when he was 16. He became paranoid, and started doing things like hiding kitchen implements out of fear that someone was trying to kill his family.\u003c/p>\n\u003cp>\"His personality just drastically changed,\" Pogliano says. \"He had a thousand rituals around things so that he wasn't harmed.\"\u003c/p>\n\u003cp>Then, as part of his illness, Zac started to think that he actually did have dramatic injuries. Like a gunshot wound or a pulverized ankle. He'd call 911.\u003c/p>\n\u003cp>\"He got to the point where he would pick up the phone at the drop of a hat and say, can someone come and help me, I'm having a heart attack,\" Pogliano says.\u003c/p>\n\u003cp>This happened about 20 times in the two years before his death, she says. Often, ambulances took Zac to Good Samaritan Hospital, where Pogliano says the doctors would typically call her to let her know he arrived and would provide appropriate care for him. Later, hospital staff would call her to pick him up.\u003c/p>\n\u003cp>But one night after Zac went to the ER, Pogliano woke up hours later and got worried that she hadn't received a call.\u003c/p>\n\u003cp>\"I just got in the car and drove over there, and he was sitting outside. It was early spring but it was still wintery, probably 40 degrees out, 45 degrees out,\" she says.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\"All he had on was what he wore to the hospital, which was a pair of white linen shorts. I know he didn't have shoes on. ... And a hospital gown and no shirt. I said to him, 'Oh my gosh, what are you doing here?' He said, 'They told me to leave.' \"\u003c/p>\n\u003cp>A hospital spokeswoman acknowledged that Pogliano was a patient there but says she found no indication that he was ever inappropriately evaluated or mistreated. She says she couldn't comment further because of federal privacy laws.\u003c/p>\n\u003cp>Emergency room doctors are frustrated at the growing gap in care for patients with psychiatric disabilities.\u003c/p>\n\u003cp>\"We're kind of tired of waiting for legislators and regulators to act and to meet their responsibility to these patients in the form of providing funding for resources,\" says Rogers, the president-elect of the American College of Emergency Physicians.\u003c/p>\n\u003cp>Even as there is increasing demand, there are fewer resources to care for psychiatric patients. It can be difficult for doctors to find an inpatient bed — the numbers are have decreased dramatically over the decades. Rogers says there have been significant cuts to community and outpatient resources — so the emergency department is often the only place for psychiatric patients to go.\u003c/p>\n\u003cp>\"Every emergency physician in the country knows this problem well and wants to do something about it,\" Rogers says.\u003c/p>\n\u003cp>Often the ER is not properly equipped with staff that can offer treatment to psychiatric patients. The emergency room's mission is to assess and stabilize, but the actual care they can provide psychiatric patients is fairly limited. \u003ca href=\"https://www.acep.org/uploadedFiles/ACEP/newsroom/NewsMediaResources/StatisticsData/Psychiatric%20Boarding%20Summary.pdf\">A 2008 survey of ER doctors\u003c/a> found that 62 percent of them said there were no psychiatric services provided while the patients were in the ER.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\"And the disparity between our ability to care for a patient with a medical problem and a patient with a psychiatric problem is growing, that gap is increasing,\" Rogers says.\u003c/p>\n\u003cp>He says Rebecca's case is an outlier. More common, he says, is that ERs will hold patients for too long before they can transfer them somewhere that can treat them. In \u003ca href=\"http://newsroom.acep.org/2015-02-24-psychiatric-emergencies\" target=\"_blank\" rel=\"noopener\">a recent poll of emergency physicians\u003c/a>, 84 percent said that psychiatric patients are \"boarded\" in their departments for hours or days. Rogers says he's heard of patients being held for weeks.\u003c/p>\n\u003cp>And the options for where to transfer them are often limited. \"And that's where it starts breaking down,\" he says. \"The time that it takes to get someone transferred for something like that is just unacceptable....They wait, and wait, and wait.\"\u003c/p>\n\u003cp>It's a bad situation for everyone – for patients with psychiatric disabilities, and for other patients who have lengthy wait times because ERs are overwhelmed.\u003c/p>\n\u003cp>\"They're being asked to do way too much with way too few resources,\" says Susan Stefan, a lawyer focusing on rights of people with psychiatric disabilities. ERs \"have a specific mission, which is to provide emergency medical care, and they're being turned into essentially 24-7 social service agencies.\"\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Stefan, who wrote a \u003ca href=\"https://www.amazon.com/Emergency-Department-Treatment-Psychiatric-Patient/dp/0195189299\" target=\"_blank\" rel=\"noopener\">book about treating psychiatric patients in ERs\u003c/a>, says it's common for them to transfer people to homeless shelters because they are not equipped to find people stable housing.\u003c/p>\n\u003cp>And there's another crucial point here: The ER is simply a bad place to treat severe mental illness, even as it is becoming increasingly central for those patients.\u003c/p>\n\u003cp>\"The emergency department is probably the worst place for somebody in psychiatric crisis,\" Stefan says. \"It's loud, it's chaotic and people don't take a lot of time because they don't have a lot of time.\"\u003c/p>\n\u003cp>And it's not straightforward to transform an ER into a place that \u003cem>is\u003c/em> appropriate to provide treatment to people who are in the middle of psychiatric crises — although there are hospitals that are experimenting with new models to better serve these patients.\u003c/p>\n\u003cp>The Alameda Health System in Alameda County, Calif., is a model that both Stefan and Rogers point to. There, a doctor named Scott Zeller has set up a dedicated psychiatric emergency service — a department separate from the standard emergency room that can provide specialized evaluation and treatment for these patients.\u003c/p>\n\u003cp>The Alameda model reduced boarding times by 80 percent, according to a \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3935777/\" target=\"_blank\" rel=\"noopener\">study published \u003c/a>in the \u003cem>Western Journal of Emergency Medicine\u003c/em>, and the fast, stabilizing treatment made it far less likely that the patient would need to be transferred to an inpatient bed.\u003c/p>\n\u003cp>If there were adequate services in place, most of the people coming to ERs for psychiatric crises wouldn't need to come there at all, says Jennifer Mathis, the director of policy and legal advocacy at the Bazelon Center for Mental Health Law.\u003c/p>\n\u003cp>\"And much as everybody loves to talk about the need for mental health services, that doesn't translate into state policy and funding for community mental health services,\" she says.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The problem here, Mathis says, is political will. There's a big gap between politicians talking about mental health and actually making sure people are getting the services they need.\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=%27Failing+Patients%27%3A+Baltimore+Video+Highlights+Crisis+Of+Emergency+Psychiatric+Care&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/441130/baltimore-video-highlights-americas-emergency-psychiatric-crisis","authors":["byline_futureofyou_441130"],"programs":["futureofyou_54"],"categories":["futureofyou_1","futureofyou_73"],"tags":["futureofyou_61","futureofyou_177","futureofyou_204","futureofyou_1430"],"featImg":"futureofyou_441153","label":"source_futureofyou_441130"},"futureofyou_441008":{"type":"posts","id":"futureofyou_441008","meta":{"index":"posts_1716263798","site":"futureofyou","id":"441008","score":null,"sort":[1524776453000]},"parent":0,"labelTerm":{},"blocks":[],"publishDate":1524776453,"format":"standard","disqusTitle":"Autonomous Weapons May One Day Trigger Robot Warfare","title":"Autonomous Weapons May One Day Trigger Robot Warfare","headTitle":"Future of You | KQED Future of You | KQED Science","content":"\u003cp>Killer robots have been a staple of TV and movies for decades, from \u003cem>Westworld\u003c/em> to \u003cem>The Terminator \u003c/em>series. But in the real world, killer robots are officially known as \"autonomous weapons.\"\u003c/p>\n\u003cp>[contextly_sidebar id=\"eJw1zUjAAKCjwH7SulfcR9YdigYQG11O\"]At the Pentagon, Paul Scharre helped create the U.S. policy for such weapons. In his new book, \u003cem>Army of None: Autonomous Weapons and the Future of War, \u003c/em>Scharre discusses the state of these weapons today.\u003c/p>\n\u003cp>\"Killer robots\" might be a bit sensational, he says, but what he's talking about is a weapon that could \"go out on its own and make its own decisions about who to kill on the battlefield.\"\u003c/p>\n\u003cp>At least 30 countries have autonomous weapons that are supervised by humans for defensive purposes, Scharre says.\u003c/p>\n\u003cp>\"[These are] things that would target incoming missiles and shoot them down entirely on their own,\" he says. \"Humans are sitting there at the console that could turn it off if they need to. But in a simple way, those are autonomous weapons.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Scharre says while the current weapons are not like those seen in the movies, the technology is advancing, whether people like it or not.\u003c/p>\n\u003cp>\"Things like more advanced hobby drones, the same technology that will go into self-driving cars, all of those sensors and intelligence will make autonomous weapons also possible,\" he says.\u003c/p>\n\u003cp>[contextly_sidebar id=\"WCz51LeCnbE8x0G4ZrsNGroJshUbo3nK\"]In his book, Scharre looks at the question: \"How hard would it be for someone to build a simple, autonomous weapon in their garage?\"\u003c/p>\n\u003cp>And while that's a scary scenario, he says that it's already happening on some levels as students today are learning programming skills, with free and readily available online resources.\u003c/p>\n\u003cp>\"These tools are available for free download. You can download them online,\" he says. \"[It] took me about three minutes online to find all of the free tools you would need to download this technology and make it happen.\"\u003c/p>\n\u003cp>And while high school students aren't creating these autonomous weapons, the ability to do so is a real possibility. Because of that, Scharre says the debate isn't so much about if this type of technology should be created, but more so what should be done about it.\u003c/p>\n\u003cp>\"What do we do with this? Do we build weaponized versions of them? Do you build them en masse? Do militaries invest in this?\" are all questions being asked as this technology would drastically change warfare.[contextly_sidebar id=\"kEIX8BCTWt9GXcGk8DTx7MsEwX0vyuig\"]\u003c/p>\n\u003cp>\"[It would create] a domain of warfare where humans have less control over what happens on the battlefield — where humans are no longer deciding who lives and who dies, and machines are making those decisions,\" Scharre says.\u003c/p>\n\u003cp>Debates like this are happening in countries all around the world, including those that have repeatedly violated international rules.\u003c/p>\n\u003cp>In Russia, the military is working to create a fleet of \u003ca href=\"http://nationalinterest.org/blog/the-buzz/russia-building-army-robots-24969\" target=\"_blank\" rel=\"noopener\">armed ground robots.\u003c/a>\u003c/p>\n\u003cp>\"They're building large, ground combat vehicles that have anti-tank missiles on them,\" Scharre says. \"Russian generals have talked about a vision in the future of fully robotized units that are independently conducting operations, so other countries are leaning hard into this technology.\"\u003c/p>\n\u003cp>Scharre says that one of the fears of this technology advancing is that \"flash wars\" could occur. Much like a \"flash crash\" in the stock market, a \"flash war\" would occur at such as fast pace that humans would not be involved.\u003c/p>\n\u003cp>[contextly_sidebar id=\"jrjhwoGs48lNnv3YJd09gywhycA0hUD0\"]\"The worry is that you get an equivalent — a flash war, where algorithms interact in some way and the robots start shooting each other and running amuck, and then humans are scrambling to put a lid back on it,\" Scharre says.\u003c/p>\n\u003cp>But, though some scenarios are terrifying, other people argue that autonomous weapons could save lives, by making fewer mistakes than might result from human error.\u003c/p>\n\u003cp>\"Just like self-driving cars could someday make the roads much safer, some people have argued, 'Well, maybe autonomous weapons could be more precise and more humane. By avoiding civilian casualties in war and only killing the enemy,' \" Scharre says.\u003c/p>\n\u003cp>From his own experience in the military serving as a special operations agent, Scharre says he has been in a situation in which an autonomous weapon would have killed a girl that the Taliban was using as a scout, but that soldiers did not target.\u003c/p>\n\u003cp>He says it's situations like that which highlight differences between what is legal in the laws of war and what is morally right — something that autonomous weapons might not distinguish.\u003c/p>\n\u003cp>\"That is one of the concerns that people raise about autonomous weapons is a lack of an ability to feel empathy and to engage in mercy in war,\" Scharre says. \"And that if we built these weapons, they would take away a powerful restraint in warfare that humans have.\"\u003c/p>\n\u003cp>There's still a lot to consider and discuss when it comes to autonomous weapons and the increasing technology, Scharre says. But as for whether humans are doomed, he says there is not a clear answer.\u003c/p>\n\u003cp>\"We do have the opportunity to shape how we use technology. We're not at the mercy of it,\" Schare says. \"The problem at the end of the day isn't the technology. It's getting humans to cooperate together on how we use the technology and make sure that we're using it for good and not for harm.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Noah Caldwell and Emily Kopp produced and edited the audio for this story. Wynne Davis adapted it for Web. \u003c/em>\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=Autonomous+Weapons+Would+Take+Warfare+To+A+New+Domain%2C+Without+Humans&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n","disqusIdentifier":"441008 https://ww2.kqed.org/futureofyou/?p=441008","disqusUrl":"https://ww2.kqed.org/futureofyou/2018/04/26/autonomous-weapons-may-one-day-trigger-robot-warfare/","stats":{"hasVideo":false,"hasChartOrMap":false,"hasAudio":false,"hasPolis":false,"wordCount":927,"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"iframeSrcs":[],"paragraphCount":28},"modified":1524765041,"excerpt":"Former special operations agent Paul Scharre helped create U.S. military guidelines on autonomous weapons. His new book \u003cem>Army of None,\u003c/em> looks at the advances in technology, and the questions they raise.","headData":{"twImgId":"","twTitle":"","ogTitle":"","ogImgId":"","twDescription":"","description":"Former special operations agent Paul Scharre helped create U.S. military guidelines on autonomous weapons. His new book Army of None, looks at the advances in technology, and the questions they raise.","title":"Autonomous Weapons May One Day Trigger Robot Warfare | KQED","ogDescription":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Autonomous Weapons May One Day Trigger Robot Warfare","datePublished":"2018-04-26T14:00:53-07:00","dateModified":"2018-04-26T10:50:41-07:00","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"guestAuthors":[],"slug":"autonomous-weapons-may-one-day-trigger-robot-warfare","status":"publish","nprApiLink":"http://api.npr.org/query?id=604438311&apiKey=MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004","nprByline":"Ari Shapiro\u003cbr />NPR","nprStoryDate":"Mon, 23 Apr 2018 20:07:00 -0400","nprLastModifiedDate":"Mon, 23 Apr 2018 20:50:36 -0400","nprHtmlLink":"https://www.npr.org/sections/alltechconsidered/2018/04/23/604438311/autonomous-weapons-would-take-warfare-to-a-new-domain-without-humans?ft=nprml&f=604438311","nprAudio":"https://ondemand.npr.org/anon.npr-mp3/npr/atc/2018/04/20180423_atc_book_-_army_of_none.mp3?orgId=1&topicId=1019&d=460&p=2&story=604438311&ft=nprml&f=604438311","nprImageAgency":"U.S. Army","source":"Environment","nprAudioM3u":"http://api.npr.org/m3u/1605045051-171f95.m3u?orgId=1&topicId=1019&d=460&p=2&story=604438311&ft=nprml&f=604438311","nprStoryId":"604438311","nprRetrievedStory":"1","nprPubDate":"Mon, 23 Apr 2018 21:28:00 -0400","path":"/futureofyou/441008/autonomous-weapons-may-one-day-trigger-robot-warfare","audioUrl":"https://ondemand.npr.org/anon.npr-mp3/npr/atc/2018/04/20180423_atc_book_-_army_of_none.mp3?orgId=1&topicId=1019&d=460&p=2&story=604438311&ft=nprml&f=604438311","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Killer robots have been a staple of TV and movies for decades, from \u003cem>Westworld\u003c/em> to \u003cem>The Terminator \u003c/em>series. But in the real world, killer robots are officially known as \"autonomous weapons.\"\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>At the Pentagon, Paul Scharre helped create the U.S. policy for such weapons. In his new book, \u003cem>Army of None: Autonomous Weapons and the Future of War, \u003c/em>Scharre discusses the state of these weapons today.\u003c/p>\n\u003cp>\"Killer robots\" might be a bit sensational, he says, but what he's talking about is a weapon that could \"go out on its own and make its own decisions about who to kill on the battlefield.\"\u003c/p>\n\u003cp>At least 30 countries have autonomous weapons that are supervised by humans for defensive purposes, Scharre says.\u003c/p>\n\u003cp>\"[These are] things that would target incoming missiles and shoot them down entirely on their own,\" he says. \"Humans are sitting there at the console that could turn it off if they need to. But in a simple way, those are autonomous weapons.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Scharre says while the current weapons are not like those seen in the movies, the technology is advancing, whether people like it or not.\u003c/p>\n\u003cp>\"Things like more advanced hobby drones, the same technology that will go into self-driving cars, all of those sensors and intelligence will make autonomous weapons also possible,\" he says.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>In his book, Scharre looks at the question: \"How hard would it be for someone to build a simple, autonomous weapon in their garage?\"\u003c/p>\n\u003cp>And while that's a scary scenario, he says that it's already happening on some levels as students today are learning programming skills, with free and readily available online resources.\u003c/p>\n\u003cp>\"These tools are available for free download. You can download them online,\" he says. \"[It] took me about three minutes online to find all of the free tools you would need to download this technology and make it happen.\"\u003c/p>\n\u003cp>And while high school students aren't creating these autonomous weapons, the ability to do so is a real possibility. Because of that, Scharre says the debate isn't so much about if this type of technology should be created, but more so what should be done about it.\u003c/p>\n\u003cp>\"What do we do with this? Do we build weaponized versions of them? Do you build them en masse? Do militaries invest in this?\" are all questions being asked as this technology would drastically change warfare.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\"[It would create] a domain of warfare where humans have less control over what happens on the battlefield — where humans are no longer deciding who lives and who dies, and machines are making those decisions,\" Scharre says.\u003c/p>\n\u003cp>Debates like this are happening in countries all around the world, including those that have repeatedly violated international rules.\u003c/p>\n\u003cp>In Russia, the military is working to create a fleet of \u003ca href=\"http://nationalinterest.org/blog/the-buzz/russia-building-army-robots-24969\" target=\"_blank\" rel=\"noopener\">armed ground robots.\u003c/a>\u003c/p>\n\u003cp>\"They're building large, ground combat vehicles that have anti-tank missiles on them,\" Scharre says. \"Russian generals have talked about a vision in the future of fully robotized units that are independently conducting operations, so other countries are leaning hard into this technology.\"\u003c/p>\n\u003cp>Scharre says that one of the fears of this technology advancing is that \"flash wars\" could occur. Much like a \"flash crash\" in the stock market, a \"flash war\" would occur at such as fast pace that humans would not be involved.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\"The worry is that you get an equivalent — a flash war, where algorithms interact in some way and the robots start shooting each other and running amuck, and then humans are scrambling to put a lid back on it,\" Scharre says.\u003c/p>\n\u003cp>But, though some scenarios are terrifying, other people argue that autonomous weapons could save lives, by making fewer mistakes than might result from human error.\u003c/p>\n\u003cp>\"Just like self-driving cars could someday make the roads much safer, some people have argued, 'Well, maybe autonomous weapons could be more precise and more humane. By avoiding civilian casualties in war and only killing the enemy,' \" Scharre says.\u003c/p>\n\u003cp>From his own experience in the military serving as a special operations agent, Scharre says he has been in a situation in which an autonomous weapon would have killed a girl that the Taliban was using as a scout, but that soldiers did not target.\u003c/p>\n\u003cp>He says it's situations like that which highlight differences between what is legal in the laws of war and what is morally right — something that autonomous weapons might not distinguish.\u003c/p>\n\u003cp>\"That is one of the concerns that people raise about autonomous weapons is a lack of an ability to feel empathy and to engage in mercy in war,\" Scharre says. \"And that if we built these weapons, they would take away a powerful restraint in warfare that humans have.\"\u003c/p>\n\u003cp>There's still a lot to consider and discuss when it comes to autonomous weapons and the increasing technology, Scharre says. But as for whether humans are doomed, he says there is not a clear answer.\u003c/p>\n\u003cp>\"We do have the opportunity to shape how we use technology. We're not at the mercy of it,\" Schare says. \"The problem at the end of the day isn't the technology. It's getting humans to cooperate together on how we use the technology and make sure that we're using it for good and not for harm.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Noah Caldwell and Emily Kopp produced and edited the audio for this story. Wynne Davis adapted it for Web. \u003c/em>\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=Autonomous+Weapons+Would+Take+Warfare+To+A+New+Domain%2C+Without+Humans&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/441008/autonomous-weapons-may-one-day-trigger-robot-warfare","authors":["byline_futureofyou_441008"],"programs":["futureofyou_54"],"categories":["futureofyou_1","futureofyou_73"],"tags":["futureofyou_849","futureofyou_1491","futureofyou_365","futureofyou_35","futureofyou_1490"],"featImg":"futureofyou_441009","label":"source_futureofyou_441008"},"futureofyou_440967":{"type":"posts","id":"futureofyou_440967","meta":{"index":"posts_1716263798","site":"futureofyou","id":"440967","score":null,"sort":[1524596434000]},"parent":0,"labelTerm":{},"blocks":[],"publishDate":1524596434,"format":"standard","disqusTitle":"Not All Teaching Hospitals Alike in Training Quality for Doctors","title":"Not All Teaching Hospitals Alike in Training Quality for Doctors","headTitle":"Future of You | KQED Future of You | KQED Science","content":"\u003cp>The patient’s breaths had become labored. He struggled to pull air from his mouth to his lungs. It got so bad late one Saturday night that he decided to say something about it the next time his nurse made rounds at Jackson South Community Hospital.\u003c/p>\n\u003cp>The complaint traveled from the nurse to a doctor, who looked at the patient’s records and quickly saw the problem: a feeding tube had been placed into the side of his lung. An anesthesiology trainee had inserted the tube without proper supervision, a federal health inspection later determined, and over the coming weeks, the patient developed pneumonia and sepsis related to the medical error. He was in the hospital two months longer than initially planned.\u003c/p>\n\u003caside class=\"pullquote alignright\">'Sometimes they’ll find minor violations. But the things that are really a threat to patients being alive, it’s hard to discount those.'\u003c/aside>\n\u003cp>Teaching hospitals like Jackson South, located in metro Miami, are where physician trainees get practice treating patients. They prepare the next generation of doctors, and they have a reputation as places of cutting-edge patient care, given their ties to academic institutions.\u003c/p>\n\u003cp>But at some of these hospitals, residents may be learning bad habits. A STAT analysis of federal inspection data finds that there’s a wide gap in the quality of training at teaching hospitals, as shown by how frequently these hospitals are cited for deficiencies by the Centers for Medicare and Medicaid Services. While the majority of the roughly 1,200 teaching hospitals received no citations each year from 2014 to 2017, others racked up dozens of safety violations in that time period — putting patients at risk, and compromising the training that students receive.\u003c/p>\n\u003cp>“In the places where young doctors-in-training practice, what they learn can affect how the person will practice for decades to come,” said Rosemary Gibson, a patient safety advocate and the author of the book “Wall of Silence.” “They’re developing habits … and it’s essential for trainees to learn in clinical settings where patient safety is baked into the system.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>At Jackson South, even before the hospital received a citation from CMS, administrators were analyzing how the feeding tube mistake happened and how to prevent similar errors in the future. They realized that the issue had to do with the initial reading of the X-ray, which is used to make sure doctors don’t misplace feeding tubes. The hospital put in place a pilot program to verify that feeding tubes are properly placed.\u003c/p>\n\u003cp>“We take every deficiency seriously and thoroughly investigate each safety violation,” a Jackson spokesperson said in a statement. “We implement plans to correct them.”\u003c/p>\n\u003cp>Teaching hospitals are making some positive changes, and according to STAT’s analysis, that’s led the average number of violations per teaching hospital to drop to its lowest point in three years, following a major spike in 2015 and 2016. But experts worry that the remaining mishaps mean that America’s future doctors aren’t always being prepared to practice medicine safely.\u003c/p>\n\u003cp>“If residents train in a program where patients aren’t receiving safe care, [they’re] likely at increased risk of burning out or leaving clinical medicine entirely, or providing not as good of care if they stay in clinical medicine,” said Dr. Sumant Ranji, chief of the division of hospital medicine at the Zuckerberg San Francisco General Hospital.\u003c/p>\n\u003cp>Hospitals that participate in Medicaid or Medicare must follow federal safety regulations, and the agency sends inspectors to verify that they are doing so every three to four years, or when a complaint triggers the need for an investigation. Those regulations cover everything from the storage of drugs and supplies to the protection of patient rights.[contextly_sidebar id=\"7lJLROPoNI8V35CnfpV5eDACtFqnGekB\"]\u003c/p>\n\u003cp>Inspections by CMS represent a fraction of all the inspections that hospitals undergo. Independent accreditors and state agencies perform the majority of routine hospital surveys, but rarely make detailed findings public. So STAT’s analysis was based only on the CMS reports.\u003c/p>\n\u003cp>“When [CMS] inspections are done and violations are found, especially the more severe violations, they’re important,” said Dr. Ashish Jha, professor of health policy at the Harvard T.H. Chan School of Public Health. “Sometimes they’ll find minor violations. But the things that are really a threat to patients being alive, it’s hard to discount those.”\u003c/p>\n\u003cp>STAT’s review — aided by the Association of Health Care Journalists’ HospitalInspections.org database — looked at medical facilities that fit the CMS definition of a teaching hospital: those that received Medicare direct graduate medical education or indirect medical education payments from the agency between 2014 and 2017. Collectively, more than 5,500 safety violations occurred at teaching hospitals over that four-year span. In each of those years, more than a quarter of the roughly 1,200 teaching hospitals had at least one safety violation documented.\u003c/p>\n\u003cp>The highest number of citations went to West Valley Medical Center in Idaho (45 violations), Regional Health Rapid City Hospital in South Dakota (44), Howard University Hospital in Washington, D.C. (37), and Jackson Memorial Hospital (36), which is part of the same health care system as Jackson South. Among the others cited were some of the nation’s most prestigious medical centers — including ones affiliated with Columbia, Harvard, and Case Western Reserve universities — as well as rural hospitals that dot the western half of the United States.\u003c/p>\n\u003cp>[contextly_sidebar id=\"THZMAaNUzKC8OTx4ttfJlX7FiRQBtJZy\"]Many teaching hospitals STAT contacted for interviews declined to provide information about their violations. The spokespeople who responded generally said administrators had taken appropriate action to address deficiencies cited by CMS.\u003c/p>\n\u003cp>Some violations, like the Jackson South one, directly concerned medical trainees, while others implicated the leaders responsible for overseeing their education. Jha said CMS inspection reports, known as 2567 forms, provide valuable insight into hospital safety — particularly regarding the quality of training and oversight for medical trainees.\u003c/p>\n\u003cp>In the neonatal intensive care unit of Cooper University Hospital in Camden, N.J., pediatric residents shadow staff physicians as they care for newborns in precarious health. Before entering, staff and visitors are required to wash, rinse, and lather their hands for at least 15 seconds and decontaminate personal items such as cellphones, according to hospital policy.\u003c/p>\n\u003cp>But over a three-hour period last April, an inspector observed nearly a dozen doctors and nurses break those rules. Additionally, the inspector could find no evidence that, after an infant in the ward contracted a superbug, the staff took these precautions to limit the spread of infection.\u003c/p>\n\u003cp>“Unfortunately, these types of infections are not uncommon in NICUs around the country due to the highly fragile nature of this patient population,” Cooper University Health Care spokeswoman Wendy Marano told STAT. “Cooper promptly reported the infections to the New Jersey Department of Health. … We have not experienced any recurrence of MRSA cross-contamination in the NICU.”\u003c/p>\n\u003cp>In the spring of 2017, inspectors cited Montefiore Medical Center in the Bronx after two patients committed suicide in an eight-day period. One of those patients was a 76-year-old man who had collapsed in grief after attending a friend’s funeral. Upon admission to Montefiore, doctors didn’t record a plan for psychiatric treatment, even though hospital policy called for suicide screenings in cases of potential emotional or behavioral disorder. Three days later, the man hanged himself in a shower at the hospital.[contextly_sidebar id=\"LQm8J4f2TTS7MUuL7J4WTevB2RamynKs\"]\u003c/p>\n\u003cp>“Yes, he would have been someone who we would have liked to have seen before he died,” one doctor told an inspector.\u003c/p>\n\u003cp>A spokesperson told STAT that Montefiore is “singularly focused on providing the best education and training for the doctors of tomorrow.”\u003c/p>\n\u003cp>Medical trainees were at the center of some of the violations listed in reports STAT reviewed. A team of NewYork-Presbyterian Hospital residents didn’t notify an attending physician for hours about a patient’s rapid heart rate and drop in blood pressure, and the patient died the following morning. And a resident started a fire in a Nebraska Medicine operating room by accidentally bringing a cautery too close to a flammable liquid medical adhesive. In that case, hospital spokesperson Taylor Wilson told STAT, no patients were harmed. But the incident spurred “new, stronger safety measures” that included training of all surgical staff and trainees, Wilson said.\u003c/p>\n\u003cp>Experts caution that inspection reports don’t tell the whole story. Dr. Tejal Gandhi, chief clinical and safety officer for the Institute for Healthcare Improvement, said each of the leading ways to assess quality and safety “alone won’t give you an overall view” of hospital performance. Matt Austin, a professor of anesthesiology and critical care medicine at Johns Hopkins University’s medical school, said they reflect an “important, but not a complete, picture of patient safety” in hospitals.\u003c/p>\n\u003cp>“If you find the problem on an inspection, it’s worrisome,” Jha said. “If you fail to find problems, it’s not a get-out-of-jail-free card.”\u003c/p>\n\u003cp>For many decades, preventable medical errors in hospitals were chalked up as an inevitable cost of training new doctors, according to Peter Rivard, associate professor of health care administration at Suffolk University in Boston. If something went awry, health administrators reprimanded trainees or their supervisors instead of focusing on the underlying systems that allowed for a mistake to occur in the first place.\u003c/p>\n\u003cp>Then in 1999, the Institute of Medicine released the landmark “To Err Is Human” report, which concluded that as many as 98,000 Americans were killed in the process of receiving medical care. Hospitals scrambled for answers: They began tracking errors more closely, hiring airline pilots as safety consultants, and expanding patient safety as a subject of medical education. But by the mid-2000s, only 54 percent of residents surveyed knew how to report errors at their facilities.\u003c/p>\n\u003cp>Ranji, at San Francisco General, said a “pernicious old-school culture” still pervades much of medical education and espouses minimal oversight of trainees, in addition to the belief that learning happens through making mistakes.\u003c/p>\n\u003cp>In part due to their frequent turnover, medical trainees told STAT that they don’t always feel empowered like permanent staffers to suggest improvements to hospital safety.\u003c/p>\n\u003cp>Trainees who are involved in medical errors can experience “profound psychological consequences,” Ranji said.\u003c/p>\n\u003cp>“The patients I remember best were the adverse ones,” he added. “Those experiences made me more cynical, and sucked the joy out of patient care for me. If something bad happened to patients, [the mindset was to] sweep under the rug, and keep your chin up. But they were profound emotional experiences.”\u003c/p>\n\u003cp>Recognizing that teaching hospitals present specific challenges for patient safety, the leading medical education accreditation group has stepped up its oversight policies.\u003c/p>\n\u003cp>Since 2012, the Accreditation Council for Graduate Medical Education — which accredits more than half of the nation’s teaching hospitals — has sent staff to these hospitals to conduct an evaluation that includes interviewing administrators, observing doctors, and walking the halls with residents.\u003c/p>\n\u003cp>[contextly_sidebar id=\"mRbgvSyd1XTMQNaYv6256AYB0fx6mOsY\"]Dr. Kevin Weiss, senior vice president of institution accreditation for the ACGME, said these mandatory site visits are intended to “increase awareness of residents in formal patient safety activities” like reporting medical errors or participating in debriefs of those errors after the fact, something that makes trainees more mindful of practicing medicine safely.\u003c/p>\n\u003cp>And teaching hospitals are taking matters into their own hands.\u003c/p>\n\u003cp>At the University of Chicago Medical Center, every resident must undergo patient safety training. As part of it, they must spot medical errors in a simulated environment dubbed the “\u003ca href=\"https://news.aamc.org/medical-education/article/patient-safety-residency-training/\" target=\"_blank\" rel=\"noopener\">horror room\u003c/a>.” They’re also strongly encouraged to report adverse patient events or “near misses,” and are expected, in collaboration with superiors, to reverse engineer incidents where patients were harmed under their watch.\u003c/p>\n\u003cp>“We’re really focused on changing behavior,” said Dr. Vineet Arora, director of graduate medical education clinical learning. “It’s important that someone raises their hands, wherever they are on the hierarchy, and can say, ‘I see a problem.’ That’s a mindset change.”\u003c/p>\n\u003cp>Participation in this curriculum, Arora noted, was associated with “three times more event reports by those programs.” University of Chicago Medical Center hasn’t received a safety violation in over two years.\u003c/p>\n\u003cp>Meanwhile, researchers at Boston Children’s Hospital created \u003ca href=\"http://www.childrenshospital.org/news-and-events/2012/april-2012/i-pass-standardizing-patient-handoffs-to-reduce-medical-errors\" target=\"_blank\" rel=\"noopener\">“I-PASS,” a mnemonic device\u003c/a> that’s bundled with training and lectures in order to help \u003ca href=\"https://www.statnews.com/2016/02/01/communication-failures-malpractice-study/\">improve patient handoffs\u003c/a>. A resident whose shift is ending relays information to his or her successor by running through five pieces of information: illness severity, patient summary, action list, situation awareness and contingency planning, and synthesis by receiver.\u003c/p>\n\u003cp>It’s worked so well in pediatric units — one study found its use was associated with a \u003ca href=\"https://www.medpagetoday.com/hospitalbasedmedicine/generalhospitalpractice/48817\" target=\"_blank\" rel=\"noopener\">23 percent drop in medical errors\u003c/a> — that \u003ca href=\"http://app.ihi.org/FacultyDocuments/Events/Event-2613/Presentation-12369/Document-10285/Presentation_C12_FINAL.pdf\" target=\"_blank\" rel=\"noopener\">Massachusetts General Hospital\u003c/a>decided to adopt it throughout the institution. Dr. Elizabeth Mort, senior vice president of quality and safety at Mass. General, said the program led to a “fivefold increase” in safety reporting from trainees.\u003c/p>\n\u003cp>“An understanding of patient safety is something we’re not born with,” said Dr. Anai Kothari, a fourth-year surgery resident at Loyola University. “But it can be learned and applied — and can make a difference when we do it well.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This story was originally published by \u003ca href=\"https://www.statnews.com/2018/04/20/doctors-learn-bad-habits-teaching-hospitals/\" target=\"_blank\" rel=\"noopener\">STAT\u003c/a>, an online publication of Boston Globe Media that covers health, medicine, and scientific discovery.\u003c/em>\u003c/p>\n\n","disqusIdentifier":"440967 https://ww2.kqed.org/futureofyou/?p=440967","disqusUrl":"https://ww2.kqed.org/futureofyou/2018/04/24/the-next-generation-of-doctors-may-be-learning-bad-habits-at-teaching-hospitals-with-many-safety-violations/","stats":{"hasVideo":false,"hasChartOrMap":false,"hasAudio":false,"hasPolis":false,"wordCount":2337,"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"iframeSrcs":[],"paragraphCount":44},"modified":1524693356,"excerpt":"Special report finds that by the mid-2000s, only 54 percent of residents surveyed knew how to report errors.","headData":{"twImgId":"","twTitle":"","ogTitle":"","ogImgId":"","twDescription":"","description":"Special report finds that by the mid-2000s, only 54 percent of residents surveyed knew how to report errors.","title":"Not All Teaching Hospitals Alike in Training Quality for Doctors | KQED","ogDescription":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Not All Teaching Hospitals Alike in Training Quality for Doctors","datePublished":"2018-04-24T12:00:34-07:00","dateModified":"2018-04-25T14:55:56-07:00","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"guestAuthors":[],"slug":"the-next-generation-of-doctors-may-be-learning-bad-habits-at-teaching-hospitals-with-many-safety-violations","status":"publish","nprByline":"Max Blau\u003cbr />STAT News","source":"Health","path":"/futureofyou/440967/the-next-generation-of-doctors-may-be-learning-bad-habits-at-teaching-hospitals-with-many-safety-violations","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>The patient’s breaths had become labored. He struggled to pull air from his mouth to his lungs. It got so bad late one Saturday night that he decided to say something about it the next time his nurse made rounds at Jackson South Community Hospital.\u003c/p>\n\u003cp>The complaint traveled from the nurse to a doctor, who looked at the patient’s records and quickly saw the problem: a feeding tube had been placed into the side of his lung. An anesthesiology trainee had inserted the tube without proper supervision, a federal health inspection later determined, and over the coming weeks, the patient developed pneumonia and sepsis related to the medical error. He was in the hospital two months longer than initially planned.\u003c/p>\n\u003caside class=\"pullquote alignright\">'Sometimes they’ll find minor violations. But the things that are really a threat to patients being alive, it’s hard to discount those.'\u003c/aside>\n\u003cp>Teaching hospitals like Jackson South, located in metro Miami, are where physician trainees get practice treating patients. They prepare the next generation of doctors, and they have a reputation as places of cutting-edge patient care, given their ties to academic institutions.\u003c/p>\n\u003cp>But at some of these hospitals, residents may be learning bad habits. A STAT analysis of federal inspection data finds that there’s a wide gap in the quality of training at teaching hospitals, as shown by how frequently these hospitals are cited for deficiencies by the Centers for Medicare and Medicaid Services. While the majority of the roughly 1,200 teaching hospitals received no citations each year from 2014 to 2017, others racked up dozens of safety violations in that time period — putting patients at risk, and compromising the training that students receive.\u003c/p>\n\u003cp>“In the places where young doctors-in-training practice, what they learn can affect how the person will practice for decades to come,” said Rosemary Gibson, a patient safety advocate and the author of the book “Wall of Silence.” “They’re developing habits … and it’s essential for trainees to learn in clinical settings where patient safety is baked into the system.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>At Jackson South, even before the hospital received a citation from CMS, administrators were analyzing how the feeding tube mistake happened and how to prevent similar errors in the future. They realized that the issue had to do with the initial reading of the X-ray, which is used to make sure doctors don’t misplace feeding tubes. The hospital put in place a pilot program to verify that feeding tubes are properly placed.\u003c/p>\n\u003cp>“We take every deficiency seriously and thoroughly investigate each safety violation,” a Jackson spokesperson said in a statement. “We implement plans to correct them.”\u003c/p>\n\u003cp>Teaching hospitals are making some positive changes, and according to STAT’s analysis, that’s led the average number of violations per teaching hospital to drop to its lowest point in three years, following a major spike in 2015 and 2016. But experts worry that the remaining mishaps mean that America’s future doctors aren’t always being prepared to practice medicine safely.\u003c/p>\n\u003cp>“If residents train in a program where patients aren’t receiving safe care, [they’re] likely at increased risk of burning out or leaving clinical medicine entirely, or providing not as good of care if they stay in clinical medicine,” said Dr. Sumant Ranji, chief of the division of hospital medicine at the Zuckerberg San Francisco General Hospital.\u003c/p>\n\u003cp>Hospitals that participate in Medicaid or Medicare must follow federal safety regulations, and the agency sends inspectors to verify that they are doing so every three to four years, or when a complaint triggers the need for an investigation. Those regulations cover everything from the storage of drugs and supplies to the protection of patient rights.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Inspections by CMS represent a fraction of all the inspections that hospitals undergo. Independent accreditors and state agencies perform the majority of routine hospital surveys, but rarely make detailed findings public. So STAT’s analysis was based only on the CMS reports.\u003c/p>\n\u003cp>“When [CMS] inspections are done and violations are found, especially the more severe violations, they’re important,” said Dr. Ashish Jha, professor of health policy at the Harvard T.H. Chan School of Public Health. “Sometimes they’ll find minor violations. But the things that are really a threat to patients being alive, it’s hard to discount those.”\u003c/p>\n\u003cp>STAT’s review — aided by the Association of Health Care Journalists’ HospitalInspections.org database — looked at medical facilities that fit the CMS definition of a teaching hospital: those that received Medicare direct graduate medical education or indirect medical education payments from the agency between 2014 and 2017. Collectively, more than 5,500 safety violations occurred at teaching hospitals over that four-year span. In each of those years, more than a quarter of the roughly 1,200 teaching hospitals had at least one safety violation documented.\u003c/p>\n\u003cp>The highest number of citations went to West Valley Medical Center in Idaho (45 violations), Regional Health Rapid City Hospital in South Dakota (44), Howard University Hospital in Washington, D.C. (37), and Jackson Memorial Hospital (36), which is part of the same health care system as Jackson South. Among the others cited were some of the nation’s most prestigious medical centers — including ones affiliated with Columbia, Harvard, and Case Western Reserve universities — as well as rural hospitals that dot the western half of the United States.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>Many teaching hospitals STAT contacted for interviews declined to provide information about their violations. The spokespeople who responded generally said administrators had taken appropriate action to address deficiencies cited by CMS.\u003c/p>\n\u003cp>Some violations, like the Jackson South one, directly concerned medical trainees, while others implicated the leaders responsible for overseeing their education. Jha said CMS inspection reports, known as 2567 forms, provide valuable insight into hospital safety — particularly regarding the quality of training and oversight for medical trainees.\u003c/p>\n\u003cp>In the neonatal intensive care unit of Cooper University Hospital in Camden, N.J., pediatric residents shadow staff physicians as they care for newborns in precarious health. Before entering, staff and visitors are required to wash, rinse, and lather their hands for at least 15 seconds and decontaminate personal items such as cellphones, according to hospital policy.\u003c/p>\n\u003cp>But over a three-hour period last April, an inspector observed nearly a dozen doctors and nurses break those rules. Additionally, the inspector could find no evidence that, after an infant in the ward contracted a superbug, the staff took these precautions to limit the spread of infection.\u003c/p>\n\u003cp>“Unfortunately, these types of infections are not uncommon in NICUs around the country due to the highly fragile nature of this patient population,” Cooper University Health Care spokeswoman Wendy Marano told STAT. “Cooper promptly reported the infections to the New Jersey Department of Health. … We have not experienced any recurrence of MRSA cross-contamination in the NICU.”\u003c/p>\n\u003cp>In the spring of 2017, inspectors cited Montefiore Medical Center in the Bronx after two patients committed suicide in an eight-day period. One of those patients was a 76-year-old man who had collapsed in grief after attending a friend’s funeral. Upon admission to Montefiore, doctors didn’t record a plan for psychiatric treatment, even though hospital policy called for suicide screenings in cases of potential emotional or behavioral disorder. Three days later, the man hanged himself in a shower at the hospital.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>“Yes, he would have been someone who we would have liked to have seen before he died,” one doctor told an inspector.\u003c/p>\n\u003cp>A spokesperson told STAT that Montefiore is “singularly focused on providing the best education and training for the doctors of tomorrow.”\u003c/p>\n\u003cp>Medical trainees were at the center of some of the violations listed in reports STAT reviewed. A team of NewYork-Presbyterian Hospital residents didn’t notify an attending physician for hours about a patient’s rapid heart rate and drop in blood pressure, and the patient died the following morning. And a resident started a fire in a Nebraska Medicine operating room by accidentally bringing a cautery too close to a flammable liquid medical adhesive. In that case, hospital spokesperson Taylor Wilson told STAT, no patients were harmed. But the incident spurred “new, stronger safety measures” that included training of all surgical staff and trainees, Wilson said.\u003c/p>\n\u003cp>Experts caution that inspection reports don’t tell the whole story. Dr. Tejal Gandhi, chief clinical and safety officer for the Institute for Healthcare Improvement, said each of the leading ways to assess quality and safety “alone won’t give you an overall view” of hospital performance. Matt Austin, a professor of anesthesiology and critical care medicine at Johns Hopkins University’s medical school, said they reflect an “important, but not a complete, picture of patient safety” in hospitals.\u003c/p>\n\u003cp>“If you find the problem on an inspection, it’s worrisome,” Jha said. “If you fail to find problems, it’s not a get-out-of-jail-free card.”\u003c/p>\n\u003cp>For many decades, preventable medical errors in hospitals were chalked up as an inevitable cost of training new doctors, according to Peter Rivard, associate professor of health care administration at Suffolk University in Boston. If something went awry, health administrators reprimanded trainees or their supervisors instead of focusing on the underlying systems that allowed for a mistake to occur in the first place.\u003c/p>\n\u003cp>Then in 1999, the Institute of Medicine released the landmark “To Err Is Human” report, which concluded that as many as 98,000 Americans were killed in the process of receiving medical care. Hospitals scrambled for answers: They began tracking errors more closely, hiring airline pilots as safety consultants, and expanding patient safety as a subject of medical education. But by the mid-2000s, only 54 percent of residents surveyed knew how to report errors at their facilities.\u003c/p>\n\u003cp>Ranji, at San Francisco General, said a “pernicious old-school culture” still pervades much of medical education and espouses minimal oversight of trainees, in addition to the belief that learning happens through making mistakes.\u003c/p>\n\u003cp>In part due to their frequent turnover, medical trainees told STAT that they don’t always feel empowered like permanent staffers to suggest improvements to hospital safety.\u003c/p>\n\u003cp>Trainees who are involved in medical errors can experience “profound psychological consequences,” Ranji said.\u003c/p>\n\u003cp>“The patients I remember best were the adverse ones,” he added. “Those experiences made me more cynical, and sucked the joy out of patient care for me. If something bad happened to patients, [the mindset was to] sweep under the rug, and keep your chin up. But they were profound emotional experiences.”\u003c/p>\n\u003cp>Recognizing that teaching hospitals present specific challenges for patient safety, the leading medical education accreditation group has stepped up its oversight policies.\u003c/p>\n\u003cp>Since 2012, the Accreditation Council for Graduate Medical Education — which accredits more than half of the nation’s teaching hospitals — has sent staff to these hospitals to conduct an evaluation that includes interviewing administrators, observing doctors, and walking the halls with residents.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>Dr. Kevin Weiss, senior vice president of institution accreditation for the ACGME, said these mandatory site visits are intended to “increase awareness of residents in formal patient safety activities” like reporting medical errors or participating in debriefs of those errors after the fact, something that makes trainees more mindful of practicing medicine safely.\u003c/p>\n\u003cp>And teaching hospitals are taking matters into their own hands.\u003c/p>\n\u003cp>At the University of Chicago Medical Center, every resident must undergo patient safety training. As part of it, they must spot medical errors in a simulated environment dubbed the “\u003ca href=\"https://news.aamc.org/medical-education/article/patient-safety-residency-training/\" target=\"_blank\" rel=\"noopener\">horror room\u003c/a>.” They’re also strongly encouraged to report adverse patient events or “near misses,” and are expected, in collaboration with superiors, to reverse engineer incidents where patients were harmed under their watch.\u003c/p>\n\u003cp>“We’re really focused on changing behavior,” said Dr. Vineet Arora, director of graduate medical education clinical learning. “It’s important that someone raises their hands, wherever they are on the hierarchy, and can say, ‘I see a problem.’ That’s a mindset change.”\u003c/p>\n\u003cp>Participation in this curriculum, Arora noted, was associated with “three times more event reports by those programs.” University of Chicago Medical Center hasn’t received a safety violation in over two years.\u003c/p>\n\u003cp>Meanwhile, researchers at Boston Children’s Hospital created \u003ca href=\"http://www.childrenshospital.org/news-and-events/2012/april-2012/i-pass-standardizing-patient-handoffs-to-reduce-medical-errors\" target=\"_blank\" rel=\"noopener\">“I-PASS,” a mnemonic device\u003c/a> that’s bundled with training and lectures in order to help \u003ca href=\"https://www.statnews.com/2016/02/01/communication-failures-malpractice-study/\">improve patient handoffs\u003c/a>. A resident whose shift is ending relays information to his or her successor by running through five pieces of information: illness severity, patient summary, action list, situation awareness and contingency planning, and synthesis by receiver.\u003c/p>\n\u003cp>It’s worked so well in pediatric units — one study found its use was associated with a \u003ca href=\"https://www.medpagetoday.com/hospitalbasedmedicine/generalhospitalpractice/48817\" target=\"_blank\" rel=\"noopener\">23 percent drop in medical errors\u003c/a> — that \u003ca href=\"http://app.ihi.org/FacultyDocuments/Events/Event-2613/Presentation-12369/Document-10285/Presentation_C12_FINAL.pdf\" target=\"_blank\" rel=\"noopener\">Massachusetts General Hospital\u003c/a>decided to adopt it throughout the institution. Dr. Elizabeth Mort, senior vice president of quality and safety at Mass. General, said the program led to a “fivefold increase” in safety reporting from trainees.\u003c/p>\n\u003cp>“An understanding of patient safety is something we’re not born with,” said Dr. Anai Kothari, a fourth-year surgery resident at Loyola University. “But it can be learned and applied — and can make a difference when we do it well.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>This story was originally published by \u003ca href=\"https://www.statnews.com/2018/04/20/doctors-learn-bad-habits-teaching-hospitals/\" target=\"_blank\" rel=\"noopener\">STAT\u003c/a>, an online publication of Boston Globe Media that covers health, medicine, and scientific discovery.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/440967/the-next-generation-of-doctors-may-be-learning-bad-habits-at-teaching-hospitals-with-many-safety-violations","authors":["byline_futureofyou_440967"],"programs":["futureofyou_54"],"categories":["futureofyou_1","futureofyou_73"],"tags":["futureofyou_190","futureofyou_61","futureofyou_177","futureofyou_80","futureofyou_1256"],"featImg":"futureofyou_440969","label":"source_futureofyou_440967"},"futureofyou_440861":{"type":"posts","id":"futureofyou_440861","meta":{"index":"posts_1716263798","site":"futureofyou","id":"440861","score":null,"sort":[1524244072000]},"parent":0,"labelTerm":{},"blocks":[],"publishDate":1524244072,"format":"standard","disqusTitle":"Parenting of the Future: Converting Ordinary Cells Into Sperm and Eggs","title":"Parenting of the Future: Converting Ordinary Cells Into Sperm and Eggs","headTitle":"Future of You | KQED Future of You | KQED Science","content":"\u003cp>So you want to have a baby.\u003c/p>\n\u003cp>Would you like a dark-haired girl with a high risk of someday getting colon cancer, but a good chance of above-average music ability?[contextly_sidebar id=\"hGdwiHda2M4gvFM3sXPeB5lpQehOV9JO\"]\u003c/p>\n\u003cp>Or would you prefer a girl with a good prospect for high SAT scores and a good shot at being athletic, but who also is likely to run an above-average risk of bipolar disorder and lupus as an adult?\u003c/p>\n\u003cp>How about a boy with a good shot at having musical ability and dodging asthma, but who also would be predisposed to cataracts and type 2 diabetes?\u003c/p>\n\u003cp>Confused? You’re just getting started. There are dozens more choices for which of your embryos should be placed in the womb to become your child.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>That’s the future a biomedical ethics expert envisions for 20 to 40 years from now — soon enough that today’s children may face it when they start their own families.\u003c/p>\n\u003cp>“The majority of babies of people who have good health coverage will be conceived this way,” predicts Henry Greely, a Stanford University law professor who works in bioethics.\u003c/p>\n\u003cp>You’ve probably read about concerns over “designer babies,” whose DNA is shaped by gene editing. Greely is focused on a different technology that has gotten much less attention: In a startling bit of biological alchemy, scientists have shown that in mice, they can turn ordinary cells into sperm and eggs.\u003c/p>\n\u003cp class=\"caption\">[contextly_sidebar id=\"eTManZd4WaqVP8G2asFbvl91UNkETnUW\"]A prominent biomedical ethics expert says that in 20 to 40 years, many prospective parents may choose from dozens of embryos to become their babies and would be provided with genetic information about each embryo to help make the choice. (April 18)\u003c/p>\n\u003cp>It’s too soon to know if it could be done in people. But if it can, it could become a powerful infertility treatment, permitting genetic parenthood for people who can’t make their own sperm or eggs.\u003c/p>\n\u003cp>It also would mean that a woman who wants to get pregnant could produce dozens more eggs per attempt than with the current procedure of harvesting some from her ovaries.\u003c/p>\n\u003cp>And that means a lot of choices.\u003c/p>\n\u003cp>\u003cstrong>An Array of Embryos\u003c/strong>\u003cbr>\nHere’s what Greely envisions: A man and woman walk into a fertility clinic. The man drops off some sperm. The woman leaves some skin cells, which are turned into eggs and fertilized with the man’s sperm.\u003c/p>\n\u003cp>Unlike in vitro fertilization today, which typically yields around eight eggs per try, the new method could result in 100 embryos.\u003c/p>\n\u003cp>The embryos’ complete library of DNA would be decoded and analyzed to reveal genetic predispositions, both for disease and personal traits. The man and woman would get dossiers on the embryos that pass minimum tests for suitability.\u003c/p>\n\u003cp>Out of, say, 80 suitable embryos, the couple would then choose one or two to implant.\u003c/p>\n\u003cp>The possibilities don’t stop there. The technology might also help open the door to same-sex couples having children genetically related to both of them, though the additional twist of making eggs from men or sperm from women would be a huge biological challenge.[contextly_sidebar id=\"SrDdSI0zE6VxuvIcDgGVohz7igj80GaU\"]\u003c/p>\n\u003cp>More worrisome is the so-called Brad Pitt scenario: We all shed a bit of sloughed-off DNA every day, like on the lip of a coffee cup. Such discarded material could be secretly snatched up to turn an unwitting celebrity into a genetic parent.\u003c/p>\n\u003cp>It is a long way in the future, but real life is already creeping toward it. Some scientists are trying to make human eggs and sperm in the lab. They are working with “iPS cells,” which are ordinary body cells that have been morphed into a malleable state.\u003c/p>\n\u003cp>Amander Clark of the University of California, Los Angeles, says her goal is to aid basic research into why some people are infertile. She acknowledges the technique might itself be used to treat some infertility, particularly in young people made sterile by cancer treatments.\u003c/p>\n\u003cp>As for decoding the complete DNA library of embryos, Dr. Louanne Hudgins, who studies prenatal genetic screening and diagnosis at Stanford, says some pregnant patients there say they’ve already had fertility clinics do that. They didn’t reveal why, Hudgins said.\u003c/p>\n\u003cp>Hudgins, who’s president of the American College of Medical Genetics and Genomics, said no national medical association has endorsed decoding all the DNA of an embryo, which is called its genome. So she believes no insurance company would pay for that now.\u003c/p>\n\u003cp>\u003cstrong>‘Easy' Prenatal Diagnosis\u003c/strong>\u003cbr>\nGreely, who lays out his ideas in a book called “The End of Sex and the Future of Human Reproduction,” calls his vision “easy PGD,” or prenatal genetic diagnosis.\u003c/p>\n\u003cp>Ordinary PGD has been done for decades. When a couple is known to be at risk for having a child with a specific genetic disorder, such as cystic fibrosis or sickle cell anemia, the woman undergoes a procedure to remove some eggs. After fertilization, some cells are plucked from the embryos and examined to identify those without carry the disease-causing abnormality.\u003c/p>\n\u003cp>That procedure looks for a specific problem in a few embryos, not entire genomes from dozens of them. If a couple wants to select a “super baby,” says Dr. Richard Scott Jr., a founding partner of Reproductive Medicine Associates of New Jersey, “we tell them we can’t do it.”\u003c/p>\n\u003cp>In fact, Scott and others say, even wide-ranging analysis would not provide a precise forecast of how a child will turn out.\u003c/p>\n\u003cp>[contextly_sidebar id=\"izPvBHygWyTNurqnYm1uuauGvc2JdDjo\"]If DNA is the hardware, there’s also the software: chemical modifications that determine when and where particular genes turn on and off. Much of this “epigenome” would develop after an embryo’s genes are sampled, Scott said.\u003c/p>\n\u003cp>“Your child may not turn out to be the three-sport All-American at Stanford,” because “the epigenome didn’t work out,” Scott said.\u003c/p>\n\u003cp>Greely agrees that predictions about behavioral traits like intelligence and athletic ability will be imprecise, because of epigenetics and because of basic uncertainties about what genes are involved and how they interact. And a person’s upbringing and life experiences have a big effect.\u003c/p>\n\u003cp>\u003cstrong>What Would Couples Do?\u003cbr>\n\u003c/strong>Even if the predictions aren’t perfect, would couples want to take steps to control their child’s genetics? Many experts doubt it.\u003c/p>\n\u003cp>Only a “very small minority” seek a perfect baby, says Stanford’s Hudgins. In her practice, she said she often finds women pass up all screening because they figure the baby’s fate is “in God’s hands.”\u003c/p>\n\u003cp>Dr. James Grifo of the New York University Fertility Center also questions how popular the idea would be.\u003c/p>\n\u003cp>“No patient has ever came to me and said, ’I want a designer baby,’” said Grifo, who’s performed in vitro fertilization since 1988.\u003c/p>\n\u003cp>[contextly_sidebar id=\"hN50KvG8BIKoBQkiV9DDiJW3PjvffZIF\"]Greely doubts that influencing brainpower or athleticism would be a major draw for parents. Instead, he thinks they would care most about avoiding awful diseases that strike in infancy or childhood. They’ll probably be less concerned about illnesses that might show up later in life, such as Alzheimer’s or Parkinson’s. For one thing, he says, parents-to-be may see them as becoming treatable by the time a child becomes vulnerable.\u003c/p>\n\u003cp>He thinks easy PGD is coming, and it would be better if properly handled. He says it should be proven safe, subsidized, monitored for long-term effects, and regulated so that parents can choose whether to use it and decide what embryonic traits to focus on. And he’d outlaw stealing somebody’s DNA and unwittingly making them a parent.\u003c/p>\n\u003cp>\u003cstrong>Others See Pitfalls\u003c/strong>\u003cbr>\nOnce the genetic profile is done, could it come back to haunt a child if, say, a life insurer or nursing home demanded to see it to assess disease risk? How would the large number of rejected embryos be handled ethically and politically?\u003c/p>\n\u003cp>Perhaps future regulation could limit the number of embryos created, as well as what traits a couple could select for, said I. Glenn Cohen, a Harvard law professor.\u003c/p>\n\u003cp>Lori B. Andrews, a professor at the Chicago-Kent College of Law, summed up her views in a review of Greely’s book.\u003c/p>\n\u003cp>“The idea of easy PGD,” she wrote, “should make us uneasy indeed.”\u003c/p>\n\u003cp>Still, even some who doubt the idea’s feasibility say Greely is right to raise the issue.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“It’s certainly something we have to take seriously and think through now,” said Marcy Darnovsky, who writes on the politics of human biotechnology as executive director of the Center for Genetics and Society in Berkeley, California. “This is not just a technical or science question.”\u003cbr>\n__\u003cbr>\nThis Associated Press \u003ca href=\"https://apnews.com/tag/GeneticFrontiers\" target=\"_blank\" rel=\"noopener\">series\u003c/a> was produced in \u003ca href=\"https://www.ap.org/press-releases/2018/ap-hhmi-expand-collaboration-to-bolster-health-science-coverage\" target=\"_blank\" rel=\"noopener\">partnership\u003c/a> with the Howard Hughes Medical Institute’s Department of Science Education. The AP is solely responsible for all content.\u003c/p>\n\n","disqusIdentifier":"440861 https://ww2.kqed.org/futureofyou/?p=440861","disqusUrl":"https://ww2.kqed.org/futureofyou/2018/04/20/parenting-of-the-future-converting-ordinary-cells-into-sperm-and-eggs/","stats":{"hasVideo":false,"hasChartOrMap":false,"hasAudio":false,"hasPolis":false,"wordCount":1539,"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"iframeSrcs":[],"paragraphCount":42},"modified":1524244072,"excerpt":"The tool may one day permit \"genetic parenthood\" for people who can’t make their own sperm or eggs.","headData":{"twImgId":"","twTitle":"","ogTitle":"","ogImgId":"","twDescription":"","description":"The tool may one day permit "genetic parenthood" for people who can’t make their own sperm or eggs.","title":"Parenting of the Future: Converting Ordinary Cells Into Sperm and Eggs | KQED","ogDescription":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Parenting of the Future: Converting Ordinary Cells Into Sperm and Eggs","datePublished":"2018-04-20T10:07:52-07:00","dateModified":"2018-04-20T10:07:52-07:00","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"guestAuthors":[],"slug":"parenting-of-the-future-converting-ordinary-cells-into-sperm-and-eggs","status":"publish","nprByline":"Malcolm Ritter\u003cbr />The Associated Press","source":"DIY Health","path":"/futureofyou/440861/parenting-of-the-future-converting-ordinary-cells-into-sperm-and-eggs","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>So you want to have a baby.\u003c/p>\n\u003cp>Would you like a dark-haired girl with a high risk of someday getting colon cancer, but a good chance of above-average music ability?\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Or would you prefer a girl with a good prospect for high SAT scores and a good shot at being athletic, but who also is likely to run an above-average risk of bipolar disorder and lupus as an adult?\u003c/p>\n\u003cp>How about a boy with a good shot at having musical ability and dodging asthma, but who also would be predisposed to cataracts and type 2 diabetes?\u003c/p>\n\u003cp>Confused? You’re just getting started. There are dozens more choices for which of your embryos should be placed in the womb to become your child.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>That’s the future a biomedical ethics expert envisions for 20 to 40 years from now — soon enough that today’s children may face it when they start their own families.\u003c/p>\n\u003cp>“The majority of babies of people who have good health coverage will be conceived this way,” predicts Henry Greely, a Stanford University law professor who works in bioethics.\u003c/p>\n\u003cp>You’ve probably read about concerns over “designer babies,” whose DNA is shaped by gene editing. Greely is focused on a different technology that has gotten much less attention: In a startling bit of biological alchemy, scientists have shown that in mice, they can turn ordinary cells into sperm and eggs.\u003c/p>\n\u003cp class=\"caption\">\u003c/p>\u003cp>\u003c/p>\u003cp>A prominent biomedical ethics expert says that in 20 to 40 years, many prospective parents may choose from dozens of embryos to become their babies and would be provided with genetic information about each embryo to help make the choice. (April 18)\u003c/p>\n\u003cp>It’s too soon to know if it could be done in people. But if it can, it could become a powerful infertility treatment, permitting genetic parenthood for people who can’t make their own sperm or eggs.\u003c/p>\n\u003cp>It also would mean that a woman who wants to get pregnant could produce dozens more eggs per attempt than with the current procedure of harvesting some from her ovaries.\u003c/p>\n\u003cp>And that means a lot of choices.\u003c/p>\n\u003cp>\u003cstrong>An Array of Embryos\u003c/strong>\u003cbr>\nHere’s what Greely envisions: A man and woman walk into a fertility clinic. The man drops off some sperm. The woman leaves some skin cells, which are turned into eggs and fertilized with the man’s sperm.\u003c/p>\n\u003cp>Unlike in vitro fertilization today, which typically yields around eight eggs per try, the new method could result in 100 embryos.\u003c/p>\n\u003cp>The embryos’ complete library of DNA would be decoded and analyzed to reveal genetic predispositions, both for disease and personal traits. The man and woman would get dossiers on the embryos that pass minimum tests for suitability.\u003c/p>\n\u003cp>Out of, say, 80 suitable embryos, the couple would then choose one or two to implant.\u003c/p>\n\u003cp>The possibilities don’t stop there. The technology might also help open the door to same-sex couples having children genetically related to both of them, though the additional twist of making eggs from men or sperm from women would be a huge biological challenge.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>More worrisome is the so-called Brad Pitt scenario: We all shed a bit of sloughed-off DNA every day, like on the lip of a coffee cup. Such discarded material could be secretly snatched up to turn an unwitting celebrity into a genetic parent.\u003c/p>\n\u003cp>It is a long way in the future, but real life is already creeping toward it. Some scientists are trying to make human eggs and sperm in the lab. They are working with “iPS cells,” which are ordinary body cells that have been morphed into a malleable state.\u003c/p>\n\u003cp>Amander Clark of the University of California, Los Angeles, says her goal is to aid basic research into why some people are infertile. She acknowledges the technique might itself be used to treat some infertility, particularly in young people made sterile by cancer treatments.\u003c/p>\n\u003cp>As for decoding the complete DNA library of embryos, Dr. Louanne Hudgins, who studies prenatal genetic screening and diagnosis at Stanford, says some pregnant patients there say they’ve already had fertility clinics do that. They didn’t reveal why, Hudgins said.\u003c/p>\n\u003cp>Hudgins, who’s president of the American College of Medical Genetics and Genomics, said no national medical association has endorsed decoding all the DNA of an embryo, which is called its genome. So she believes no insurance company would pay for that now.\u003c/p>\n\u003cp>\u003cstrong>‘Easy' Prenatal Diagnosis\u003c/strong>\u003cbr>\nGreely, who lays out his ideas in a book called “The End of Sex and the Future of Human Reproduction,” calls his vision “easy PGD,” or prenatal genetic diagnosis.\u003c/p>\n\u003cp>Ordinary PGD has been done for decades. When a couple is known to be at risk for having a child with a specific genetic disorder, such as cystic fibrosis or sickle cell anemia, the woman undergoes a procedure to remove some eggs. After fertilization, some cells are plucked from the embryos and examined to identify those without carry the disease-causing abnormality.\u003c/p>\n\u003cp>That procedure looks for a specific problem in a few embryos, not entire genomes from dozens of them. If a couple wants to select a “super baby,” says Dr. Richard Scott Jr., a founding partner of Reproductive Medicine Associates of New Jersey, “we tell them we can’t do it.”\u003c/p>\n\u003cp>In fact, Scott and others say, even wide-ranging analysis would not provide a precise forecast of how a child will turn out.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>If DNA is the hardware, there’s also the software: chemical modifications that determine when and where particular genes turn on and off. Much of this “epigenome” would develop after an embryo’s genes are sampled, Scott said.\u003c/p>\n\u003cp>“Your child may not turn out to be the three-sport All-American at Stanford,” because “the epigenome didn’t work out,” Scott said.\u003c/p>\n\u003cp>Greely agrees that predictions about behavioral traits like intelligence and athletic ability will be imprecise, because of epigenetics and because of basic uncertainties about what genes are involved and how they interact. And a person’s upbringing and life experiences have a big effect.\u003c/p>\n\u003cp>\u003cstrong>What Would Couples Do?\u003cbr>\n\u003c/strong>Even if the predictions aren’t perfect, would couples want to take steps to control their child’s genetics? Many experts doubt it.\u003c/p>\n\u003cp>Only a “very small minority” seek a perfect baby, says Stanford’s Hudgins. In her practice, she said she often finds women pass up all screening because they figure the baby’s fate is “in God’s hands.”\u003c/p>\n\u003cp>Dr. James Grifo of the New York University Fertility Center also questions how popular the idea would be.\u003c/p>\n\u003cp>“No patient has ever came to me and said, ’I want a designer baby,’” said Grifo, who’s performed in vitro fertilization since 1988.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>Greely doubts that influencing brainpower or athleticism would be a major draw for parents. Instead, he thinks they would care most about avoiding awful diseases that strike in infancy or childhood. They’ll probably be less concerned about illnesses that might show up later in life, such as Alzheimer’s or Parkinson’s. For one thing, he says, parents-to-be may see them as becoming treatable by the time a child becomes vulnerable.\u003c/p>\n\u003cp>He thinks easy PGD is coming, and it would be better if properly handled. He says it should be proven safe, subsidized, monitored for long-term effects, and regulated so that parents can choose whether to use it and decide what embryonic traits to focus on. And he’d outlaw stealing somebody’s DNA and unwittingly making them a parent.\u003c/p>\n\u003cp>\u003cstrong>Others See Pitfalls\u003c/strong>\u003cbr>\nOnce the genetic profile is done, could it come back to haunt a child if, say, a life insurer or nursing home demanded to see it to assess disease risk? How would the large number of rejected embryos be handled ethically and politically?\u003c/p>\n\u003cp>Perhaps future regulation could limit the number of embryos created, as well as what traits a couple could select for, said I. Glenn Cohen, a Harvard law professor.\u003c/p>\n\u003cp>Lori B. Andrews, a professor at the Chicago-Kent College of Law, summed up her views in a review of Greely’s book.\u003c/p>\n\u003cp>“The idea of easy PGD,” she wrote, “should make us uneasy indeed.”\u003c/p>\n\u003cp>Still, even some who doubt the idea’s feasibility say Greely is right to raise the issue.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“It’s certainly something we have to take seriously and think through now,” said Marcy Darnovsky, who writes on the politics of human biotechnology as executive director of the Center for Genetics and Society in Berkeley, California. “This is not just a technical or science question.”\u003cbr>\n__\u003cbr>\nThis Associated Press \u003ca href=\"https://apnews.com/tag/GeneticFrontiers\" target=\"_blank\" rel=\"noopener\">series\u003c/a> was produced in \u003ca href=\"https://www.ap.org/press-releases/2018/ap-hhmi-expand-collaboration-to-bolster-health-science-coverage\" target=\"_blank\" rel=\"noopener\">partnership\u003c/a> with 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>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/440861/parenting-of-the-future-converting-ordinary-cells-into-sperm-and-eggs","authors":["byline_futureofyou_440861"],"programs":["futureofyou_54"],"categories":["futureofyou_1060","futureofyou_1062","futureofyou_1","futureofyou_73","futureofyou_1064"],"tags":["futureofyou_221","futureofyou_927","futureofyou_466","futureofyou_61","futureofyou_347"],"collections":["futureofyou_1093","futureofyou_1094"],"featImg":"futureofyou_440862","label":"source_futureofyou_440861"},"futureofyou_440520":{"type":"posts","id":"futureofyou_440520","meta":{"index":"posts_1716263798","site":"futureofyou","id":"440520","score":null,"sort":[1522357217000]},"parent":0,"labelTerm":{},"blocks":[],"publishDate":1522357217,"format":"standard","disqusTitle":"New Immune Treatment Eliminated Tumors in 97 Percent of Mice","title":"New Immune Treatment Eliminated Tumors in 97 Percent of Mice","headTitle":"Future of You | KQED Future of You | KQED Science","content":"\u003cp class=\"p1\">A cutting-edge immune system treatment cured certain cancers in 97 percent of mice, and it didn’t require chemotherapy. The treatment is now headed for a human trial at the \u003ca href=\"http://med.stanford.edu/\" target=\"_blank\" rel=\"noopener\">Stanford University School of Medicine.\u003c/a>\u003c/p>\n\u003cp>[contextly_sidebar id=\"kQL3J5XDxpDn2B9MPaqB9jKa15YAzuFt\"]Stanford researchers looked at four types of tumors— breast cancer, colon cancer, lymphoma, and melanoma. The clinical trial will, however, be limited to individuals with low-grade lymphoma.\u003c/p>\n\u003cp>The \u003ca href=\"http://stm.sciencemag.org/content/10/426/eaan4488\" target=\"_blank\" rel=\"noopener\">study\u003c/a>, published in journal \u003ca href=\"http://stm.sciencemag.org/\" target=\"_blank\" rel=\"noopener\">Science Translational Medicine, \u003c/a>is part of a new wave of innovative cancer research focusing on the body's immune system. Recent developments in the field mark a watershed moment in cancer research, says Ronald Levy, a Stanford oncology professor and the study's senior author.\u003c/p>\n\u003cp>[contextly_sidebar id=\"bc7NJIwxkt2B4Cp42gfRjdCM1aSALuS5\"]The \u003ca href=\"http://med.stanford.edu/news/all-news/2018/01/cancer-vaccine-eliminates-tumors-in-mice.html\" target=\"_blank\" rel=\"noopener\">treatment\u003c/a> injects two immune stimulants directly into a tumor. The combination of stimulants activates the immune system's T-cells, the white blood cells responsible for fighting signs of infection in the body. In the successfully treated mice, the activated cells eliminated the entire tumor from the bodies of the mice.\u003c/p>\n\u003cp>\"It's really a very exciting time,\" says Levy. \"These successful therapies have come after decades of work in trying to make the immune system fight the cancer. And now that we know that it's possible, it has brought an enormous amount of interest and investment into the field.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The side affects of the treatment are typically what you would expect from any injection — possible fever and soreness at the injection site.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>While the clinical trial has not yet started, Stanford Medical School researchers are currently accepting applications for volunteers and \u003ca href=\"http://med.stanford.edu/cancer/trials/vaccine.html\" target=\"_blank\" rel=\"noopener\">providing information\u003c/a> about the study.\u003c/p>\n\n","disqusIdentifier":"440520 https://ww2.kqed.org/futureofyou/?p=440520","disqusUrl":"https://ww2.kqed.org/futureofyou/2018/03/29/new-immune-treatment-eliminated-tumors-in-97-percent-of-mice/","stats":{"hasVideo":false,"hasChartOrMap":false,"hasAudio":false,"hasPolis":false,"wordCount":281,"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"iframeSrcs":[],"paragraphCount":8},"modified":1522351892,"excerpt":"Stanford prepares to launch a human trial with a promising new cancer treatment. ","headData":{"twImgId":"","twTitle":"","ogTitle":"","ogImgId":"","twDescription":"","description":"Stanford prepares to launch a human trial with a promising new cancer treatment. ","title":"New Immune Treatment Eliminated Tumors in 97 Percent of Mice | KQED","ogDescription":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"New Immune Treatment Eliminated Tumors in 97 Percent of Mice","datePublished":"2018-03-29T14:00:17-07:00","dateModified":"2018-03-29T12:31:32-07:00","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"guestAuthors":[],"slug":"new-immune-treatment-eliminated-tumors-in-97-percent-of-mice","status":"publish","source":"Hope/Hype","path":"/futureofyou/440520/new-immune-treatment-eliminated-tumors-in-97-percent-of-mice","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp class=\"p1\">A cutting-edge immune system treatment cured certain cancers in 97 percent of mice, and it didn’t require chemotherapy. The treatment is now headed for a human trial at the \u003ca href=\"http://med.stanford.edu/\" target=\"_blank\" rel=\"noopener\">Stanford University School of Medicine.\u003c/a>\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>Stanford researchers looked at four types of tumors— breast cancer, colon cancer, lymphoma, and melanoma. The clinical trial will, however, be limited to individuals with low-grade lymphoma.\u003c/p>\n\u003cp>The \u003ca href=\"http://stm.sciencemag.org/content/10/426/eaan4488\" target=\"_blank\" rel=\"noopener\">study\u003c/a>, published in journal \u003ca href=\"http://stm.sciencemag.org/\" target=\"_blank\" rel=\"noopener\">Science Translational Medicine, \u003c/a>is part of a new wave of innovative cancer research focusing on the body's immune system. Recent developments in the field mark a watershed moment in cancer research, says Ronald Levy, a Stanford oncology professor and the study's senior author.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>The \u003ca href=\"http://med.stanford.edu/news/all-news/2018/01/cancer-vaccine-eliminates-tumors-in-mice.html\" target=\"_blank\" rel=\"noopener\">treatment\u003c/a> injects two immune stimulants directly into a tumor. The combination of stimulants activates the immune system's T-cells, the white blood cells responsible for fighting signs of infection in the body. In the successfully treated mice, the activated cells eliminated the entire tumor from the bodies of the mice.\u003c/p>\n\u003cp>\"It's really a very exciting time,\" says Levy. \"These successful therapies have come after decades of work in trying to make the immune system fight the cancer. And now that we know that it's possible, it has brought an enormous amount of interest and investment into the field.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The side affects of the treatment are typically what you would expect from any injection — possible fever and soreness at the injection site.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>While the clinical trial has not yet started, Stanford Medical School researchers are currently accepting applications for volunteers and \u003ca href=\"http://med.stanford.edu/cancer/trials/vaccine.html\" target=\"_blank\" rel=\"noopener\">providing information\u003c/a> about the study.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/440520/new-immune-treatment-eliminated-tumors-in-97-percent-of-mice","authors":["11428"],"programs":["futureofyou_54"],"categories":["futureofyou_452","futureofyou_1062","futureofyou_1","futureofyou_73"],"tags":["futureofyou_103","futureofyou_1403","futureofyou_1189","futureofyou_141","futureofyou_61","futureofyou_327"],"collections":["futureofyou_1097"],"featImg":"futureofyou_440531","label":"source_futureofyou_440520"}},"programsReducer":{"possible":{"id":"possible","title":"Possible","info":"Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. 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Hosted by journalists of color, the show tackles the subject of race head-on, exploring how it impacts every part of society — from politics and pop culture to history, sports and more.\u003cbr />\u003cbr />\u003cem>Life Kit\u003c/em>, which will be in the second part of the hour, guides you through spaces and feelings no one prepares you for — from finances to mental health, from workplace microaggressions to imposter syndrome, from relationships to parenting. The show features experts with real world experience and shares their knowledge. Because everyone needs a little help being human.\u003cbr />\u003cbr />\u003ca href=\"https://www.npr.org/podcasts/510312/codeswitch\">\u003cem>Code Switch\u003c/em> offical site and podcast\u003c/a>\u003cbr />\u003ca href=\"https://www.npr.org/lifekit\">\u003cem>Life Kit\u003c/em> offical site and podcast\u003c/a>\u003cbr />","airtime":"SUN 9pm-10pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Code-Switch-Life-Kit-Podcast-Tile-360x360-1.jpg","meta":{"site":"radio","source":"npr"},"link":"/radio/program/code-switch-life-kit","subscribe":{"apple":"https://podcasts.apple.com/podcast/1112190608?mt=2&at=11l79Y&ct=nprdirectory","google":"https://podcasts.google.com/feed/aHR0cHM6Ly93d3cubnByLm9yZy9yc3MvcG9kY2FzdC5waHA_aWQ9NTEwMzEy","spotify":"https://open.spotify.com/show/3bExJ9JQpkwNhoHvaIIuyV","rss":"https://feeds.npr.org/510312/podcast.xml"}},"commonwealth-club":{"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. 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