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"content": "\u003cp>Transfusing \u003ca href=\"https://www.statnews.com/2018/03/02/young-blood-anti-aging-study/\" target=\"_blank\" rel=\"noopener\">young blood\u003c/a> and freezing heads may get most of the anti-aging and life-extension buzz, but don’t count out the molecule hunters: After setbacks and stumbles and what critics called \u003ca href=\"http://blogs.sciencemag.org/pipeline/archives/2010/01/12/the_sirtris_compounds_worthless_really\" target=\"_blank\" rel=\"noopener\">debacles\u003c/a>, these scientists are figuring out which biochemicals might potentially, possibly be fountains of youth in pill form.[contextly_sidebar id=\"YaFBEqHshnjDvp4XR5pAEiDxJjAI7Fx4\"]\u003c/p>\n\u003cp>In the latest advance, biologists \u003ca href=\"http://www.cell.com/cell/fulltext/S0092-8674(18)30152-1\" target=\"_blank\" rel=\"noopener\">reported\u003c/a> on Thursday that a molecule already sold by supplement makers (even as scientists scramble to understand it) restored youthfulness to blood vessels in 20-month-old mice, an age comparable to 70 years in people. The research supports the idea that boosting certain genes and molecules that fade with age could keep people functional, resilient, and even spry well into their 80s, even without living longer.\u003c/p>\n\u003cp>“I think it’s quite an important paper,” said Dr. Eric Verdin, of the California-based Buck Institute for Research on Aging, who was not involved in the\u003ca href=\"https://www.kqed.org/futureofyou/439750/superagers-maintain-memory-into-80s-and-90s\" target=\"_blank\" rel=\"noopener\"> new research\u003c/a>. “It’s probably not the magic pill everyone is looking for, but it’s one more brick in our efforts to understand aging and healthspan,” or how long people can stay biologically young(ish) even as their birthday candles proliferate.[contextly_sidebar id=\"Vl0Meh1Zh9UAHnk3RIGR5S5B5rBQ0sSW\"]\u003c/p>\n\u003cp>Others were more skeptical, calling the advance at best “incremental” (and asking to remain anonymous so as not to antagonize colleagues). And science is littered with examples of compounds that worked in mice but not people. “It’s hard to tell how significant any contribution is until it has been replicated and extended” by other labs, said David Harrison of the Jackson Lab, an expert on the molecular \u003ca href=\"https://www.kqed.org/futureofyou/440080/hearts-get-younger-even-at-middle-age-with-exercise\" target=\"_blank\" rel=\"noopener\">mechanisms of aging.\u003c/a>\u003c/p>\n\u003caside>\u003c/aside>\n\u003cp>The new study, in Cell, found that boosting mice’s levels of the naturally occurring molecule NMN, which humans also have, increased levels of another called NAD+. That, in turn, raised levels of a famous anti-aging enzyme called SIRT1, which has been the focus of nearly 30 years of research.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>After two months of NMN, more blood vessels sprouted in the old mice’s muscles. The density of the smallest vessels — capillaries — became comparable to that of young mice. Blood flow increased, and the animals’ endurance, measured by how long they could run on a treadmill before becoming exhausted, was 56 percent to 80 percent greater than that of untreated old mice: 1,400 feet compared to 780 feet.[contextly_sidebar id=\"8Tmsn0Ufo1g8AeUi0b3OJ5Td2G7sq49c\"]\u003c/p>\n\u003cp>The treated mice also benefitted from exercise like mice half their age. In young animals, exercise spurs the creation of new blood vessels and boosts muscle mass, but that effect weakens with age in both people and mice. NMN restored the blood-vessel- and muscle-boosting effects of a good treadmill run, basically “reversing vascular aging in the mice,” said study co-leader David Sinclair of Harvard Medical School.\u003c/p>\n\u003cp>\u003cimg class=\"aligncenter wp-image-440373 size-medium\" title=\"iStock\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/03/iStock-639071970-800x588.jpg\" alt=\"\" width=\"800\" height=\"588\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-639071970-800x588.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-639071970-160x118.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-639071970-768x564.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-639071970-1020x749.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-639071970-1920x1411.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-639071970-1180x867.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-639071970-960x705.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-639071970-240x176.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-639071970-375x275.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-639071970-520x382.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003c/p>\n\u003cp>Opinions differed on how important that is. One expert on the biology of aging said, “So David’s found another molecule that prevents aging?” (Sinclair was a prominent exponent of resveratrol, a compound that slowed aging in mice but proved disappointing in people.) The Jax’s Harrison questioned whether the inbred mice used in the study were representative of humans, who are genetically diverse.\u003c/p>\n\u003cp>New blood vessels could also be a mixed blessing. They support the growth of tumors, which is why anti-angiogenesis molecules have become cancer drugs. The scientists found no excess cancers in the mice given NMR, but “more study is warranted,” they wrote.[contextly_sidebar id=\"EmvIbKqj3sGiXrLYKODcw1UEPJNlCkZr\"]\u003c/p>\n\u003cp>The blood-vessel benefits of NMN didn’t happen if the mice lacked the SIRT1 gene, probably the brightest star in the anti-aging firmament. In the 1990s, it and the six other genes belonging to the family called sirtuins took aging research by storm, as biologists showed that increasing the genes’ activity extended lifespan in yeast, roundworms, and fruit flies by up to 30 percent. When Massachusetts Institute of Technology’s Leonard Guarente, whose lab was sirtuin central, found that the lifespan-extending effect of drastic caloric restriction works by turning up sirtuin genes, it seemed to point the way to slowing aging: Activate sirtuins with a molecule.\u003c/p>\n\u003cp>That proved easier said than done. Some studies, especially in higher animals, contradicted the simple notion that overexpression of sirtuins translated into longer life. The biggest setback involved resveratrol, a compound found in grapes and wine, which activates the SIRT1 gene. After years of hyperbolic headlines and soaring sales, the resveratrol bubble burst. GlaxoSmithKline bought Cambridge, Mass.-based Sirtris Pharmaceuticals, which Sinclair co-founded in 2004 to develop sirtuin-boosting compounds, for $720 million, but within five years essentially shut it down.[contextly_sidebar id=\"FSd7BTxFEMjJhm2kkUJ0cTaJQITZc3CT\"]\u003c/p>\n\u003cp>“Resveratrol is very, very good [at activating SIRT1 and extending lifespan] if you’re a mouse,” said Guarente, who cheerfully acknowledges buying a 10-year supply of micronized resveratrol. Most of it is still in his basement. “But the human trials were all over the place, which was unsettling,” he said.\u003c/p>\n\u003cp>Those failures led scientists to search for other sirtuin-boosting molecules. In 2014, Guarente co-founded Elysium Health, which, for $40 to $60 per month, sells a dietary supplement that boosts NAD+ levels and activates SIRT1. Since levels of NAD+ fall as people age, the hope is that providing the raw material for it will raise those levels, slowing aging. The pills seem to be safe, Guarente and colleagues \u003ca href=\"https://www.nature.com/articles/s41514-017-0016-9\" target=\"_blank\" rel=\"noopener\">reported\u003c/a> last year, and additional human studies are underway to test whether they benefit health.\u003c/p>\n\u003cp>Thanks to \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3188402/\" target=\"_blank\" rel=\"noopener\">negative studies\u003c/a>, the jury is still out on whether anything related to sirtuins will extend lifespan, but the Cell study offers some hope for extending healthspan. If boosting NAD+ promotes blood vessel formation via SIRT1, it might “rescue muscle mass” that otherwise decreases as blood vessels atrophy, Guarente said. That could prevent the bone loss, frailty, and falls that can be fatal in old age.\u003c/p>\n\u003cp>“Anything that contributes to muscle health through vascular health is likely to be quite important,” said the Buck Institute’s Verdin, who takes a daily NAD+ precursor.\u003c/p>\n\u003caside>\u003c/aside>\n\u003cp>Sinclair and his team are now studying whether raising NAD+ might also spur the creation of blood vessels in the brain. There and in other organs, said Sinclair, “the lack of oxygen and buildup of waste products” that results from loss of small blood vessels “sets off a downward spiral of disease and disability.” In the brain, that would include vascular dementia.\u003c/p>\n\u003cp>Sinclair takes NMN to boost NAD+ levels. “In someone my age [49], it’s probably harder to see immediate benefits,” he said, though he said he feels sharper and younger on it. After his 78-year-old father began taking NMN “he started climbing mountains and going whitewater rafting and looking forward to the next five years,” Sinclair said. “It might be psychological, but it isn’t hurting.”\u003c/p>\n\u003cp>Only rigorous human research can determine that. Metro International Biotech, a Michigan-based startup for which Sinclair consults, just finished a clinical trial of the safety of a proprietary version of NMN and hopes to start a trial of the molecule’s efficacy this year, Sinclair said.\u003c/p>\n\u003cp>One concern is that boosting sirtuins could backfire. An excess of the molecules, Verdin said, can promote autoimmunity, which causes diseases such as Crohn’s and rheumatoid arthritis.\u003c/p>\n\u003cp>“That should give us pause about broad claims of what they can do,” he cautioned. “I worry sometimes that [with NAD+-boosting pills already on the market] the field is getting ahead of itself.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This story was originally published by\u003ca href=\"https://www.statnews.com/\" 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",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Transfusing \u003ca href=\"https://www.statnews.com/2018/03/02/young-blood-anti-aging-study/\" target=\"_blank\" rel=\"noopener\">young blood\u003c/a> and freezing heads may get most of the anti-aging and life-extension buzz, but don’t count out the molecule hunters: After setbacks and stumbles and what critics called \u003ca href=\"http://blogs.sciencemag.org/pipeline/archives/2010/01/12/the_sirtris_compounds_worthless_really\" target=\"_blank\" rel=\"noopener\">debacles\u003c/a>, these scientists are figuring out which biochemicals might potentially, possibly be fountains of youth in pill form.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>In the latest advance, biologists \u003ca href=\"http://www.cell.com/cell/fulltext/S0092-8674(18)30152-1\" target=\"_blank\" rel=\"noopener\">reported\u003c/a> on Thursday that a molecule already sold by supplement makers (even as scientists scramble to understand it) restored youthfulness to blood vessels in 20-month-old mice, an age comparable to 70 years in people. The research supports the idea that boosting certain genes and molecules that fade with age could keep people functional, resilient, and even spry well into their 80s, even without living longer.\u003c/p>\n\u003cp>“I think it’s quite an important paper,” said Dr. Eric Verdin, of the California-based Buck Institute for Research on Aging, who was not involved in the\u003ca href=\"https://www.kqed.org/futureofyou/439750/superagers-maintain-memory-into-80s-and-90s\" target=\"_blank\" rel=\"noopener\"> new research\u003c/a>. “It’s probably not the magic pill everyone is looking for, but it’s one more brick in our efforts to understand aging and healthspan,” or how long people can stay biologically young(ish) even as their birthday candles proliferate.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Others were more skeptical, calling the advance at best “incremental” (and asking to remain anonymous so as not to antagonize colleagues). And science is littered with examples of compounds that worked in mice but not people. “It’s hard to tell how significant any contribution is until it has been replicated and extended” by other labs, said David Harrison of the Jackson Lab, an expert on the molecular \u003ca href=\"https://www.kqed.org/futureofyou/440080/hearts-get-younger-even-at-middle-age-with-exercise\" target=\"_blank\" rel=\"noopener\">mechanisms of aging.\u003c/a>\u003c/p>\n\u003caside>\u003c/aside>\n\u003cp>The new study, in Cell, found that boosting mice’s levels of the naturally occurring molecule NMN, which humans also have, increased levels of another called NAD+. That, in turn, raised levels of a famous anti-aging enzyme called SIRT1, which has been the focus of nearly 30 years of research.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>After two months of NMN, more blood vessels sprouted in the old mice’s muscles. The density of the smallest vessels — capillaries — became comparable to that of young mice. Blood flow increased, and the animals’ endurance, measured by how long they could run on a treadmill before becoming exhausted, was 56 percent to 80 percent greater than that of untreated old mice: 1,400 feet compared to 780 feet.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>The treated mice also benefitted from exercise like mice half their age. In young animals, exercise spurs the creation of new blood vessels and boosts muscle mass, but that effect weakens with age in both people and mice. NMN restored the blood-vessel- and muscle-boosting effects of a good treadmill run, basically “reversing vascular aging in the mice,” said study co-leader David Sinclair of Harvard Medical School.\u003c/p>\n\u003cp>\u003cimg class=\"aligncenter wp-image-440373 size-medium\" title=\"iStock\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/03/iStock-639071970-800x588.jpg\" alt=\"\" width=\"800\" height=\"588\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-639071970-800x588.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-639071970-160x118.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-639071970-768x564.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-639071970-1020x749.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-639071970-1920x1411.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-639071970-1180x867.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-639071970-960x705.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-639071970-240x176.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-639071970-375x275.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-639071970-520x382.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003c/p>\n\u003cp>Opinions differed on how important that is. One expert on the biology of aging said, “So David’s found another molecule that prevents aging?” (Sinclair was a prominent exponent of resveratrol, a compound that slowed aging in mice but proved disappointing in people.) The Jax’s Harrison questioned whether the inbred mice used in the study were representative of humans, who are genetically diverse.\u003c/p>\n\u003cp>New blood vessels could also be a mixed blessing. They support the growth of tumors, which is why anti-angiogenesis molecules have become cancer drugs. The scientists found no excess cancers in the mice given NMR, but “more study is warranted,” they wrote.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>The blood-vessel benefits of NMN didn’t happen if the mice lacked the SIRT1 gene, probably the brightest star in the anti-aging firmament. In the 1990s, it and the six other genes belonging to the family called sirtuins took aging research by storm, as biologists showed that increasing the genes’ activity extended lifespan in yeast, roundworms, and fruit flies by up to 30 percent. When Massachusetts Institute of Technology’s Leonard Guarente, whose lab was sirtuin central, found that the lifespan-extending effect of drastic caloric restriction works by turning up sirtuin genes, it seemed to point the way to slowing aging: Activate sirtuins with a molecule.\u003c/p>\n\u003cp>That proved easier said than done. Some studies, especially in higher animals, contradicted the simple notion that overexpression of sirtuins translated into longer life. The biggest setback involved resveratrol, a compound found in grapes and wine, which activates the SIRT1 gene. After years of hyperbolic headlines and soaring sales, the resveratrol bubble burst. GlaxoSmithKline bought Cambridge, Mass.-based Sirtris Pharmaceuticals, which Sinclair co-founded in 2004 to develop sirtuin-boosting compounds, for $720 million, but within five years essentially shut it down.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>“Resveratrol is very, very good [at activating SIRT1 and extending lifespan] if you’re a mouse,” said Guarente, who cheerfully acknowledges buying a 10-year supply of micronized resveratrol. Most of it is still in his basement. “But the human trials were all over the place, which was unsettling,” he said.\u003c/p>\n\u003cp>Those failures led scientists to search for other sirtuin-boosting molecules. In 2014, Guarente co-founded Elysium Health, which, for $40 to $60 per month, sells a dietary supplement that boosts NAD+ levels and activates SIRT1. Since levels of NAD+ fall as people age, the hope is that providing the raw material for it will raise those levels, slowing aging. The pills seem to be safe, Guarente and colleagues \u003ca href=\"https://www.nature.com/articles/s41514-017-0016-9\" target=\"_blank\" rel=\"noopener\">reported\u003c/a> last year, and additional human studies are underway to test whether they benefit health.\u003c/p>\n\u003cp>Thanks to \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3188402/\" target=\"_blank\" rel=\"noopener\">negative studies\u003c/a>, the jury is still out on whether anything related to sirtuins will extend lifespan, but the Cell study offers some hope for extending healthspan. If boosting NAD+ promotes blood vessel formation via SIRT1, it might “rescue muscle mass” that otherwise decreases as blood vessels atrophy, Guarente said. That could prevent the bone loss, frailty, and falls that can be fatal in old age.\u003c/p>\n\u003cp>“Anything that contributes to muscle health through vascular health is likely to be quite important,” said the Buck Institute’s Verdin, who takes a daily NAD+ precursor.\u003c/p>\n\u003caside>\u003c/aside>\n\u003cp>Sinclair and his team are now studying whether raising NAD+ might also spur the creation of blood vessels in the brain. There and in other organs, said Sinclair, “the lack of oxygen and buildup of waste products” that results from loss of small blood vessels “sets off a downward spiral of disease and disability.” In the brain, that would include vascular dementia.\u003c/p>\n\u003cp>Sinclair takes NMN to boost NAD+ levels. “In someone my age [49], it’s probably harder to see immediate benefits,” he said, though he said he feels sharper and younger on it. After his 78-year-old father began taking NMN “he started climbing mountains and going whitewater rafting and looking forward to the next five years,” Sinclair said. “It might be psychological, but it isn’t hurting.”\u003c/p>\n\u003cp>Only rigorous human research can determine that. Metro International Biotech, a Michigan-based startup for which Sinclair consults, just finished a clinical trial of the safety of a proprietary version of NMN and hopes to start a trial of the molecule’s efficacy this year, Sinclair said.\u003c/p>\n\u003cp>One concern is that boosting sirtuins could backfire. An excess of the molecules, Verdin said, can promote autoimmunity, which causes diseases such as Crohn’s and rheumatoid arthritis.\u003c/p>\n\u003cp>“That should give us pause about broad claims of what they can do,” he cautioned. “I worry sometimes that [with NAD+-boosting pills already on the market] the field is getting ahead of itself.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>This story was originally published by\u003ca href=\"https://www.statnews.com/\" 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>",
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"disqusTitle": "Black And Latino Children Are Often Overlooked When It Comes To Autism",
"title": "Black And Latino Children Are Often Overlooked When It Comes To Autism",
"headTitle": "Future of You | KQED Future of You | KQED Science",
"content": "\u003cp>Sherry Alvarez says she knew there was \u003ca href=\"https://www.kqed.org/futureofyou/357617/sesame-street-to-introduce-muppet-with-autism\" target=\"_blank\" rel=\"noopener\">something different\u003c/a> about her son since he was about 9 months old. Back then Sherry says his pediatrician told her there was nothing to worry about, \" 'Boys are a little slower than girls, so let's just wait until his second birthday.' \" We aren't using Sherry's son's name to protect his privacy.\u003c/p>\n\u003cp>By her son's second birthday, Sherry says she was getting desperate. She didn't know why he wasn't talking yet or showing affection like other kids. At 2 1/2, he was referred to Children's Hospital Los Angeles.[contextly_sidebar id=\"HF94QtAhJ0QaonfGcwoc1BDmUjMCZqvd\"]\u003c/p>\n\u003cp>There, after four hours of tests, Sherry says the doctor handed her a 20-page report explaining his autism spectrum disorder diagnosis, among others. She says she was paralyzed by emotion.\u003c/p>\n\u003cp>ASD is a disease that affects people of all races and ethnicities, but \u003ca href=\"http://www.jaacap.com/article/S0890-8567(09)60739-5/abstract\" target=\"_blank\" rel=\"noopener\">research \u003c/a>shows that African-American and Latino children with autism are diagnosed at older ages than white children, giving them less of an opportunity for proper intervention and treatment.\u003c/p>\n\u003cp>This is especially true of minimally verbal kids like Sherry's son and there are many possible reasons for a late diagnosis. Some families face healthcare access issues and prohibitive costs for treatment, and some families just don't know how important it is to \u003ca href=\"https://www.kqed.org/futureofyou/436442/cdc-app-tells-parents-when-to-be-concerned-about-child-development\" target=\"_blank\" rel=\"noopener\">get diagnosed to move on\u003c/a> to the treatment phase. The dialog between doctors and minority families during the diagnosis process is critical.[contextly_sidebar id=\"i6RhCi4DH3w2V0Rp0zM5OR4cXRLu6ZFc\"]\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/29100475\" target=\"_blank\" rel=\"noopener\">A recent study\u003c/a> from Georgia State University found that African-American parents reported fewer concerns about behaviors like delayed speech and repetitive behaviors, even though their children showed a greater severity with these symptoms, overall. But, of course, it isn't all up to parents.\u003c/p>\n\u003cp>\"There are very likely parent aspects of this and very likely clinician aspects of this,\" says Meghan Rose Donohue, a lead researcher on the study. Perhaps families, like Sherry's, don't have the information necessary to really push physicians, but it is also possible that doctors don't take these cases seriously enough from the beginning.\u003c/p>\n\u003cp>\u003cstrong>Misdiagnosis\u003c/strong>\u003cbr>\nFamilies and doctors, alike, can mistake ASD for simple bad behavior, especially in boys, as research has shown over the past couple of decades. \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/11575603\" target=\"_blank\" rel=\"noopener\">A 2001 study\u003c/a> at McGill University in Montreal found that doctors were more hesitant to diagnose ASD in minority families.[contextly_sidebar id=\"z5QvKJ1QNa5Nn1EGXEj633LNkljonhOJ\"]\u003c/p>\n\u003cp>In 2007, \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/17160456\" target=\"_blank\" rel=\"noopener\">a study\u003c/a> by a team at the Center for Autism and Developmental Disabilities Research and Epidemiology, University of Pennsylvania, found that African-American children were 5.1 times more likely to be misdiagnosed with conduct disorders before being diagnosed with ASD.\u003c/p>\n\u003cp>When Sherry was growing up, she had a cousin who the family thought of as \"different,\" she says. \"He was basically hidden. We didn't talk about it as a community.\" He had autism. \"We have to retrain ourselves. It's not OK to hide our kids.\"\u003c/p>\n\u003cp>\u003ca href=\"http://www.dds.ca.gov/RC/\" target=\"_blank\" rel=\"noopener\">Regional Centers\u003c/a> in Los Angeles, which offer services to the developmentally disabled, are now starting to look at the \u003ca href=\"https://www.kqed.org/futureofyou/245794/researchers-hunt-for-the-microbiome-of-autism\" target=\"_blank\" rel=\"noopener\">diagnosis disparity problem\u003c/a>. Westside Regional Center in Culver City just received a grant from the state to look at how autism diagnosis disparities manifest within their intake and treatment programs.[contextly_sidebar id=\"nMqm3DUyCpzzodOPiyxyxYVgb9M171ki\"]\u003c/p>\n\u003cp>\"We've implemented a series of trainings with intake counselors on cultural awareness and sensitivity, and we're starting to have a lot of conversations about biases,\" says Tom Kelly, Westside's chief psychologist.\u003c/p>\n\u003cp>One of the apparent biases among intake counselors at the center stems from the difference in the documentation that arrives with each new child. African-American families tend to arrive at the center with lots of documentation detailing behavior issues from their child's school or social services. With all those official papers sitting in front of them, it's much easier for a counselor to think \"behavior disease\" rather than \"autism,\" says Kelly.\u003c/p>\n\u003cp>\u003cstrong>Economic Disparities\u003c/strong>\u003cbr>\nAnd that disparity exists in dollars spent, as well. As reported in \u003ca href=\"https://issuu.com/publiccounsel/docs/assuring_equitable_funding_of_servi?e=29495352/49041713\" target=\"_blank\" rel=\"noopener\">a 2017 survey\u003c/a>, South Central Regional Center spends $8,000 less per client than the Westside location and the racial disparity \u003ca href=\"http://www.calhealthreport.org/2016/12/12/marked-racial-disparities-in-money-spent-to-help-disabled/\" target=\"_blank\" rel=\"noopener\">persists statewide\u003c/a>.\u003c/p>\n\u003cp>But there are more resources for minority families today than compared to when Sherry's son was young. The Autism Society of Los Angeles runs a hotline to help parents navigate the diagnosis and healthcare landscape and Children's Hospital Los Angeles now employs liaisons to help families connect with the right resources. But, the spending gap persists.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Today, Sherry says her now 15-year-old son is happy. He attends Hamilton High School and communicates almost solely through a typing device. \"This is the time in his life where those early treatments could have made a difference,\" she laments.\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=Black+And+Latino+Children+Are+Often+Overlooked+When+It+Comes+To+Autism&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Sherry Alvarez says she knew there was \u003ca href=\"https://www.kqed.org/futureofyou/357617/sesame-street-to-introduce-muppet-with-autism\" target=\"_blank\" rel=\"noopener\">something different\u003c/a> about her son since he was about 9 months old. Back then Sherry says his pediatrician told her there was nothing to worry about, \" 'Boys are a little slower than girls, so let's just wait until his second birthday.' \" We aren't using Sherry's son's name to protect his privacy.\u003c/p>\n\u003cp>By her son's second birthday, Sherry says she was getting desperate. She didn't know why he wasn't talking yet or showing affection like other kids. At 2 1/2, he was referred to Children's Hospital Los Angeles.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>There, after four hours of tests, Sherry says the doctor handed her a 20-page report explaining his autism spectrum disorder diagnosis, among others. She says she was paralyzed by emotion.\u003c/p>\n\u003cp>ASD is a disease that affects people of all races and ethnicities, but \u003ca href=\"http://www.jaacap.com/article/S0890-8567(09)60739-5/abstract\" target=\"_blank\" rel=\"noopener\">research \u003c/a>shows that African-American and Latino children with autism are diagnosed at older ages than white children, giving them less of an opportunity for proper intervention and treatment.\u003c/p>\n\u003cp>This is especially true of minimally verbal kids like Sherry's son and there are many possible reasons for a late diagnosis. Some families face healthcare access issues and prohibitive costs for treatment, and some families just don't know how important it is to \u003ca href=\"https://www.kqed.org/futureofyou/436442/cdc-app-tells-parents-when-to-be-concerned-about-child-development\" target=\"_blank\" rel=\"noopener\">get diagnosed to move on\u003c/a> to the treatment phase. The dialog between doctors and minority families during the diagnosis process is critical.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/29100475\" target=\"_blank\" rel=\"noopener\">A recent study\u003c/a> from Georgia State University found that African-American parents reported fewer concerns about behaviors like delayed speech and repetitive behaviors, even though their children showed a greater severity with these symptoms, overall. But, of course, it isn't all up to parents.\u003c/p>\n\u003cp>\"There are very likely parent aspects of this and very likely clinician aspects of this,\" says Meghan Rose Donohue, a lead researcher on the study. Perhaps families, like Sherry's, don't have the information necessary to really push physicians, but it is also possible that doctors don't take these cases seriously enough from the beginning.\u003c/p>\n\u003cp>\u003cstrong>Misdiagnosis\u003c/strong>\u003cbr>\nFamilies and doctors, alike, can mistake ASD for simple bad behavior, especially in boys, as research has shown over the past couple of decades. \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/11575603\" target=\"_blank\" rel=\"noopener\">A 2001 study\u003c/a> at McGill University in Montreal found that doctors were more hesitant to diagnose ASD in minority families.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>In 2007, \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/17160456\" target=\"_blank\" rel=\"noopener\">a study\u003c/a> by a team at the Center for Autism and Developmental Disabilities Research and Epidemiology, University of Pennsylvania, found that African-American children were 5.1 times more likely to be misdiagnosed with conduct disorders before being diagnosed with ASD.\u003c/p>\n\u003cp>When Sherry was growing up, she had a cousin who the family thought of as \"different,\" she says. \"He was basically hidden. We didn't talk about it as a community.\" He had autism. \"We have to retrain ourselves. It's not OK to hide our kids.\"\u003c/p>\n\u003cp>\u003ca href=\"http://www.dds.ca.gov/RC/\" target=\"_blank\" rel=\"noopener\">Regional Centers\u003c/a> in Los Angeles, which offer services to the developmentally disabled, are now starting to look at the \u003ca href=\"https://www.kqed.org/futureofyou/245794/researchers-hunt-for-the-microbiome-of-autism\" target=\"_blank\" rel=\"noopener\">diagnosis disparity problem\u003c/a>. Westside Regional Center in Culver City just received a grant from the state to look at how autism diagnosis disparities manifest within their intake and treatment programs.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\"We've implemented a series of trainings with intake counselors on cultural awareness and sensitivity, and we're starting to have a lot of conversations about biases,\" says Tom Kelly, Westside's chief psychologist.\u003c/p>\n\u003cp>One of the apparent biases among intake counselors at the center stems from the difference in the documentation that arrives with each new child. African-American families tend to arrive at the center with lots of documentation detailing behavior issues from their child's school or social services. With all those official papers sitting in front of them, it's much easier for a counselor to think \"behavior disease\" rather than \"autism,\" says Kelly.\u003c/p>\n\u003cp>\u003cstrong>Economic Disparities\u003c/strong>\u003cbr>\nAnd that disparity exists in dollars spent, as well. As reported in \u003ca href=\"https://issuu.com/publiccounsel/docs/assuring_equitable_funding_of_servi?e=29495352/49041713\" target=\"_blank\" rel=\"noopener\">a 2017 survey\u003c/a>, South Central Regional Center spends $8,000 less per client than the Westside location and the racial disparity \u003ca href=\"http://www.calhealthreport.org/2016/12/12/marked-racial-disparities-in-money-spent-to-help-disabled/\" target=\"_blank\" rel=\"noopener\">persists statewide\u003c/a>.\u003c/p>\n\u003cp>But there are more resources for minority families today than compared to when Sherry's son was young. The Autism Society of Los Angeles runs a hotline to help parents navigate the diagnosis and healthcare landscape and Children's Hospital Los Angeles now employs liaisons to help families connect with the right resources. But, the spending gap persists.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Today, Sherry says her now 15-year-old son is happy. He attends Hamilton High School and communicates almost solely through a typing device. \"This is the time in his life where those early treatments could have made a difference,\" she laments.\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=Black+And+Latino+Children+Are+Often+Overlooked+When+It+Comes+To+Autism&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Prospective Parents in Limbo After 2 Accidents Destroy Fertility Clinic Embryos",
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"content": "\u003cp>Two refrigeration failures at fertility clinics in different states, coincidentally occurring on March 4, are raising questions about oversight of the industry and triggered several lawsuits.\u003c/p>\n\u003caside class=\"pullquote alignright\">'We know something has happened but we don't know if our four embryos are alive still.'\u003c/aside>\n\u003cp>In San Francisco, the Pacific Fertility Center says it is still assessing the extent of the damage to the embryos and eggs it stores, said San Francisco Chronicle reporter Catherine Ho on KQED's \u003ca href=\"https://www.kqed.org/forum/2010101864351/woman-sues-fertility-center-after-equipment-failure-destroys-her-eggs\" target=\"_blank\" rel=\"noopener\">Forum program\u003c/a> Friday.\u003c/p>\n\u003cp>One of those clients includes Bill Taroli, who told Forum host Mina Kim he first learned about the malfunction on the evening news. After contacting the center, he and his partner were informed their frozen embryos were in the impacted tank. But it will take at least another week before they learn whether their vials were damaged.\u003c/p>\n\u003cp>\"It's like waiting for any major test. 'Do we have cancer?' We're in this limbo,\" said Taroli, who said he spent $50,000 for the procedure. \"We know something has happened but we don't know if our four embryos are alive still.\"\u003c/p>\n\u003cp>The problem was discovered during a routine check by a senior embryologist who noticed that the liquid nitrogen levels in one tank had dipped to very low levels, affecting thousands of frozen eggs and embryos belonging to about 500 clients.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The tanks rely on liquid nitrogen to keep the frozen vials at the correct storage temperature.\u003c/p>\n\u003cp>The clinic has not yet announced the number of people impacted, said Ho. In a statement, Pacific Fertility Center said, \"The vast majority of the eggs and embryos in the lab were unaffected.\"\u003c/p>\n\u003cp>One of the company's clients includes an unnamed woman who learned on Sunday that her frozen eggs were destroyed. She has since filed a class action lawsuit against the company, seeking $5 million in damages for gross negligence stemming from a failure to properly maintain equipment. That figure is the minimum required to file a class-action suit in federal court.\u003c/p>\n\u003cp>Steven Tindall, the attorney for the woman, told Forum the facility lacked a real-time monitoring system that could have immediately alerted staff of a drop in nitrogen levels.\u003c/p>\n\u003cp>In a statement issued Wednesday, the company said it took immediate action once the malfunction was discovered:\u003c/p>\n\u003cblockquote>\u003cp>On March 4, a single piece of equipment in our cryogenic storage lab lost liquid nitrogen for a brief period of time. We do know that there is viable tissue from this tank. The rest of the tanks were not affected and the equipment was immediately retired. The vast majority of the eggs and embryos in the lab were unaffected and the facility is operating securely. As soon as the issue was discovered, our most senior embryologist took immediate action to transfer those tissues from the affected equipment to a new piece of equipment. And we have brought independent experts and are conducting a full investigation. We are truly sorry this happened and for the anxiety that this will surely cause.\u003c/p>\u003c/blockquote>\n\u003cp>The cost of storing frozen eggs or embryos is $600 a year, according to the center's website. But the entire process can cost anywhere between $10,000 to $100,000, said the Chronicle's Ho. Aside from the financial costs, the process can be emotionally draining for prospective parents.\u003c/p>\n\u003cp>Some of the clinic's clients include former cancer patients who had their eggs taken out in advance of cancer treatments, Tindall said.\u003c/p>\n\u003cp>\"Those people may have lost their opportunity to have biological children.\"\u003c/p>\n\u003cp>\u003cstrong>Ohio Incident\u003c/strong>\u003c/p>\n\u003cp>In a bizarre coincidence, a similar tank malfunction occurred at a Cleveland-based fertility clinic on the same day as the accident in San Francisco. The\u003ca href=\"http://www.cleveland.com/healthfit/index.ssf/2018/03/university_hospitals_notifies.html\" target=\"_blank\" rel=\"noopener\"> Cleveland Plain-Dealer\u003c/a> reported that the University Hospitals Fertility Center lost frozen eggs and embryos from 700 patients. Lawsuits have been filed in this incident as well, according to \u003ca href=\"https://www.washingtonpost.com/news/to-your-health/wp/2018/03/14/class-action-lawsuit-filed-against-pacific-fertility-for-loss-of-up-to-thousands-of-embryos-and-eggs/?utm_term=.705a90a7aa98\" target=\"_blank\" rel=\"noopener\">The Washington Post\u003c/a>.\u003c/p>\n\u003cp>The loss of potentially thousands of eggs and embryos from both clinics mark the biggest such loss on record in the U.S.\u003c/p>\n\u003cp>Regulations for oversight of fertility clinics vary by state. California, for example, requires clinics to be accredited by the Laboratory Field Services division of the California Department of Public Health. Ohio has no such licensing requirement.\u003c/p>\n\u003cp>\"The United States is the Wild West of the fertility industry,” Marcy Darnovsky, executive director of the Center for Genetics and Society told the Pew Charitable Trust's \u003ca href=\"http://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2015/3/18/states-not-eager-to-regulate-fertility-industry\" target=\"_blank\" rel=\"noopener\">Stateline\u003c/a> in 2015.\u003c/p>\n\u003cp>Data shows that 1.5 percent of all infants born in the U.S. are conceived using assisted reproductive technology, according to the \u003ca href=\"https://www.cdc.gov/art/artdata/index.html\" target=\"_blank\" rel=\"noopener\">Centers for Disease Control and Prevention. \u003c/a>More than 60,000 U.S. births in 2015 resulted from such methods.\u003c/p>\n\u003cp>The American Society for Reproductive Medicine does issue guidelines for fertility clinics, but they are not mandatory. The center has been accused of prioritizing the business interests of its members.\u003c/p>\n\u003cp>“It’s a field characterized by strong antiregulatory sentiment because it evolved as a business, not a research enterprise,” Arthur Caplan, director of the division of Medical Ethics at New York University’s School of Medicine, told Pew Charitable Trust.\u003c/p>\n\u003cp>For Taroli, the question of liability doesn't change how the experience has affected him and his partner.\u003c/p>\n\u003cp>\"The reality is ... we've all been affected. Even if it turns out that our embryos are okay,\" he says, \"we're still going through this madness right now of not knowing and we’re worried about whether or not they're still alive.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>The Associated Press contributed to this report.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Two refrigeration failures at fertility clinics in different states, coincidentally occurring on March 4, are raising questions about oversight of the industry and triggered several lawsuits.\u003c/p>\n\u003caside class=\"pullquote alignright\">'We know something has happened but we don't know if our four embryos are alive still.'\u003c/aside>\n\u003cp>In San Francisco, the Pacific Fertility Center says it is still assessing the extent of the damage to the embryos and eggs it stores, said San Francisco Chronicle reporter Catherine Ho on KQED's \u003ca href=\"https://www.kqed.org/forum/2010101864351/woman-sues-fertility-center-after-equipment-failure-destroys-her-eggs\" target=\"_blank\" rel=\"noopener\">Forum program\u003c/a> Friday.\u003c/p>\n\u003cp>One of those clients includes Bill Taroli, who told Forum host Mina Kim he first learned about the malfunction on the evening news. After contacting the center, he and his partner were informed their frozen embryos were in the impacted tank. But it will take at least another week before they learn whether their vials were damaged.\u003c/p>\n\u003cp>\"It's like waiting for any major test. 'Do we have cancer?' We're in this limbo,\" said Taroli, who said he spent $50,000 for the procedure. \"We know something has happened but we don't know if our four embryos are alive still.\"\u003c/p>\n\u003cp>The problem was discovered during a routine check by a senior embryologist who noticed that the liquid nitrogen levels in one tank had dipped to very low levels, affecting thousands of frozen eggs and embryos belonging to about 500 clients.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The tanks rely on liquid nitrogen to keep the frozen vials at the correct storage temperature.\u003c/p>\n\u003cp>The clinic has not yet announced the number of people impacted, said Ho. In a statement, Pacific Fertility Center said, \"The vast majority of the eggs and embryos in the lab were unaffected.\"\u003c/p>\n\u003cp>One of the company's clients includes an unnamed woman who learned on Sunday that her frozen eggs were destroyed. She has since filed a class action lawsuit against the company, seeking $5 million in damages for gross negligence stemming from a failure to properly maintain equipment. That figure is the minimum required to file a class-action suit in federal court.\u003c/p>\n\u003cp>Steven Tindall, the attorney for the woman, told Forum the facility lacked a real-time monitoring system that could have immediately alerted staff of a drop in nitrogen levels.\u003c/p>\n\u003cp>In a statement issued Wednesday, the company said it took immediate action once the malfunction was discovered:\u003c/p>\n\u003cblockquote>\u003cp>On March 4, a single piece of equipment in our cryogenic storage lab lost liquid nitrogen for a brief period of time. We do know that there is viable tissue from this tank. The rest of the tanks were not affected and the equipment was immediately retired. The vast majority of the eggs and embryos in the lab were unaffected and the facility is operating securely. As soon as the issue was discovered, our most senior embryologist took immediate action to transfer those tissues from the affected equipment to a new piece of equipment. And we have brought independent experts and are conducting a full investigation. We are truly sorry this happened and for the anxiety that this will surely cause.\u003c/p>\u003c/blockquote>\n\u003cp>The cost of storing frozen eggs or embryos is $600 a year, according to the center's website. But the entire process can cost anywhere between $10,000 to $100,000, said the Chronicle's Ho. Aside from the financial costs, the process can be emotionally draining for prospective parents.\u003c/p>\n\u003cp>Some of the clinic's clients include former cancer patients who had their eggs taken out in advance of cancer treatments, Tindall said.\u003c/p>\n\u003cp>\"Those people may have lost their opportunity to have biological children.\"\u003c/p>\n\u003cp>\u003cstrong>Ohio Incident\u003c/strong>\u003c/p>\n\u003cp>In a bizarre coincidence, a similar tank malfunction occurred at a Cleveland-based fertility clinic on the same day as the accident in San Francisco. The\u003ca href=\"http://www.cleveland.com/healthfit/index.ssf/2018/03/university_hospitals_notifies.html\" target=\"_blank\" rel=\"noopener\"> Cleveland Plain-Dealer\u003c/a> reported that the University Hospitals Fertility Center lost frozen eggs and embryos from 700 patients. Lawsuits have been filed in this incident as well, according to \u003ca href=\"https://www.washingtonpost.com/news/to-your-health/wp/2018/03/14/class-action-lawsuit-filed-against-pacific-fertility-for-loss-of-up-to-thousands-of-embryos-and-eggs/?utm_term=.705a90a7aa98\" target=\"_blank\" rel=\"noopener\">The Washington Post\u003c/a>.\u003c/p>\n\u003cp>The loss of potentially thousands of eggs and embryos from both clinics mark the biggest such loss on record in the U.S.\u003c/p>\n\u003cp>Regulations for oversight of fertility clinics vary by state. California, for example, requires clinics to be accredited by the Laboratory Field Services division of the California Department of Public Health. Ohio has no such licensing requirement.\u003c/p>\n\u003cp>\"The United States is the Wild West of the fertility industry,” Marcy Darnovsky, executive director of the Center for Genetics and Society told the Pew Charitable Trust's \u003ca href=\"http://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2015/3/18/states-not-eager-to-regulate-fertility-industry\" target=\"_blank\" rel=\"noopener\">Stateline\u003c/a> in 2015.\u003c/p>\n\u003cp>Data shows that 1.5 percent of all infants born in the U.S. are conceived using assisted reproductive technology, according to the \u003ca href=\"https://www.cdc.gov/art/artdata/index.html\" target=\"_blank\" rel=\"noopener\">Centers for Disease Control and Prevention. \u003c/a>More than 60,000 U.S. births in 2015 resulted from such methods.\u003c/p>\n\u003cp>The American Society for Reproductive Medicine does issue guidelines for fertility clinics, but they are not mandatory. The center has been accused of prioritizing the business interests of its members.\u003c/p>\n\u003cp>“It’s a field characterized by strong antiregulatory sentiment because it evolved as a business, not a research enterprise,” Arthur Caplan, director of the division of Medical Ethics at New York University’s School of Medicine, told Pew Charitable Trust.\u003c/p>\n\u003cp>For Taroli, the question of liability doesn't change how the experience has affected him and his partner.\u003c/p>\n\u003cp>\"The reality is ... we've all been affected. Even if it turns out that our embryos are okay,\" he says, \"we're still going through this madness right now of not knowing and we’re worried about whether or not they're still alive.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>The Associated Press contributed to this report.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Genetic mutations are the driving force of evolution, and now scientists have managed to study the effect of mutations in exquisite detail by watching what happens as they pop up in single cells.\u003c/p>\n\u003cp>Only about one percent of mutations were bad enough to kill off the cell, according to a \u003ca href=\"http://science.sciencemag.org/cgi/doi/10.1126/science.aan0797\" target=\"_blank\" rel=\"noopener\">report\u003c/a> published Thursday in \u003cem>Science\u003c/em>. Most of the time, these small changes in its DNA appeared to have no effect at all.[contextly_sidebar id=\"kvnKbnjyKwJnWuLsgRUewEIFcd5eTbqG\"]\u003c/p>\n\u003cp>Mutations have been studied for centuries, says \u003ca href=\"https://www.micalis.fr/micalis_eng/Poles-and-teams/Pole-Biosys/AJ-Aymerich-Jules/SyBER-group-Jules/SyBER-members/Lydia-Robert\" target=\"_blank\" rel=\"noopener\">Lydia Robert\u003c/a>, a researcher at INRA, an agricultural research institute in Paris, France, who notes that they can have medical impacts ranging from antibiotic resistance to cancer.\u003c/p>\n\u003cp>But research on mutations basically has focused on large-scale effects in populations.\u003c/p>\n\u003cp>\"You have a test tube with millions of bacteria, for instance, and you try to measure some property which is an average of all the cells in the population,\" says Robert.[contextly_sidebar id=\"B1EJ5qXFqZz59odJ0F4Nzqz7Z0w5fjPW\"]\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>In contrast, she and her colleagues wanted to study mutations in single cells.\u003c/p>\n\u003cp>So they turned to a so-called \"mother machine\" — a microfluidics device equipped with hundreds of tiny tubes, each no wider than a single E. coli bacterium.\u003c/p>\n\u003cp>\u003cstrong>'Mother Machine'\u003c/strong>\u003cbr>\nThey trapped a single bacterial cell in each tube, and spied on them with a microscope. Every time the bacterial cell divided into two, to reproduce itself, its genetic material got copied. If that copying process went awry and made a mistake, producing a mutation, this error got flagged by a fluorescent tag. The research team tracked about 20,000 mutations over hundreds of generations.\u003c/p>\n\u003cp>The researchers first checked to see if some cells might have an increased mutation rate compared to others.\u003c/p>\n\u003cp>\"We were surprised that in fact it was not the case,\" says Robert, explaining that, under their experimental conditions, all the cells seemed to share the same probability of acquiring mutations, and these genetic changes seemed to occur at a steady rate.\u003c/p>\n\u003cp>\"Many, many of them had no effect at all. This was a bit of a surprise to me,\" Robert says. \"I would have expected a lot of mutations to be slightly bad, and they are not even bad at all.\"\u003c/p>\n\u003cp>Just one percent of the time, a mutation killed the cell outright. And a mutation was very harmful to a cell (but not lethal) about 0.2 percent of the time.\u003c/p>\n\u003cp>\"Most of the time it's really neutral. The cell gets a mutation but it does nothing to the cell,\" says Robert.\u003c/p>\n\u003cp>\u003cstrong>Study Conditions\u003c/strong>\u003cbr>\nIn this study, the bacteria in the little tubes were living under good conditions and weren't exposed to any natural selection or competition—so the researchers could not determine how often mutations produced a beneficial effect that enhanced the bacterial cells' growth and survival.\u003c/p>\n\u003cp>Future studies could start to explore that. \"We're going to change, basically, the environment and see what it changes,\" Robert says. \"What happens if the environment is harsher? Is it going to change the way mutations occur, or are they going to kill more of the cells or less of the cells?\"\u003c/p>\n\u003cp>Already, what the researchers have observed so far confirms a lot of the core thinking that goes into evolutionary biology, says \u003ca href=\"http://myxo.css.msu.edu/\">Richard Lenski\u003c/a>, a biologist at Michigan State University who has spent the last three decades following the evolution of bacteria populations living in flasks in his lab.\u003c/p>\n\u003cp>\"What's exciting about this paper is the technical elegance of it, the rigorous quantification,\" says Lenski, \"This is another nice demonstration that random mutation really has this kind of clock-like dynamic, and that, absent natural selection, populations will, in fact, not only not be able to hold their own, but will tend to decay over time,\" because most mutations are either neutral or deleterious.[contextly_sidebar id=\"KsUxGvhivFMcATApHvyB6fQZaguGW0J5\"]\u003c/p>\n\u003cp>Looking at mutations without any natural selection is very artificial, Lenski says, \"but that allows them to really focus on the underlying process of mutation.\"\u003c/p>\n\u003cp>Some people study evolution in the real world, in all its gory detail, he says. But there's also value in studying genetic changes in this kind of controlled setting that can give a cleaner answers.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"Fitting those two together is always a challenge,\" says Lenski, \"but that's the way science works.\"\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=Biologists+Trace+Genetic+Roots+Of+Evolution%2C+One+Cell+At+A+Time&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"excerpt": "\u003cem>E.coli\u003c/em> bacteria are giving researchers the chance to study single genetic mutations. ",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Genetic mutations are the driving force of evolution, and now scientists have managed to study the effect of mutations in exquisite detail by watching what happens as they pop up in single cells.\u003c/p>\n\u003cp>Only about one percent of mutations were bad enough to kill off the cell, according to a \u003ca href=\"http://science.sciencemag.org/cgi/doi/10.1126/science.aan0797\" target=\"_blank\" rel=\"noopener\">report\u003c/a> published Thursday in \u003cem>Science\u003c/em>. Most of the time, these small changes in its DNA appeared to have no effect at all.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Mutations have been studied for centuries, says \u003ca href=\"https://www.micalis.fr/micalis_eng/Poles-and-teams/Pole-Biosys/AJ-Aymerich-Jules/SyBER-group-Jules/SyBER-members/Lydia-Robert\" target=\"_blank\" rel=\"noopener\">Lydia Robert\u003c/a>, a researcher at INRA, an agricultural research institute in Paris, France, who notes that they can have medical impacts ranging from antibiotic resistance to cancer.\u003c/p>\n\u003cp>But research on mutations basically has focused on large-scale effects in populations.\u003c/p>\n\u003cp>\"You have a test tube with millions of bacteria, for instance, and you try to measure some property which is an average of all the cells in the population,\" says Robert.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>In contrast, she and her colleagues wanted to study mutations in single cells.\u003c/p>\n\u003cp>So they turned to a so-called \"mother machine\" — a microfluidics device equipped with hundreds of tiny tubes, each no wider than a single E. coli bacterium.\u003c/p>\n\u003cp>\u003cstrong>'Mother Machine'\u003c/strong>\u003cbr>\nThey trapped a single bacterial cell in each tube, and spied on them with a microscope. Every time the bacterial cell divided into two, to reproduce itself, its genetic material got copied. If that copying process went awry and made a mistake, producing a mutation, this error got flagged by a fluorescent tag. The research team tracked about 20,000 mutations over hundreds of generations.\u003c/p>\n\u003cp>The researchers first checked to see if some cells might have an increased mutation rate compared to others.\u003c/p>\n\u003cp>\"We were surprised that in fact it was not the case,\" says Robert, explaining that, under their experimental conditions, all the cells seemed to share the same probability of acquiring mutations, and these genetic changes seemed to occur at a steady rate.\u003c/p>\n\u003cp>\"Many, many of them had no effect at all. This was a bit of a surprise to me,\" Robert says. \"I would have expected a lot of mutations to be slightly bad, and they are not even bad at all.\"\u003c/p>\n\u003cp>Just one percent of the time, a mutation killed the cell outright. And a mutation was very harmful to a cell (but not lethal) about 0.2 percent of the time.\u003c/p>\n\u003cp>\"Most of the time it's really neutral. The cell gets a mutation but it does nothing to the cell,\" says Robert.\u003c/p>\n\u003cp>\u003cstrong>Study Conditions\u003c/strong>\u003cbr>\nIn this study, the bacteria in the little tubes were living under good conditions and weren't exposed to any natural selection or competition—so the researchers could not determine how often mutations produced a beneficial effect that enhanced the bacterial cells' growth and survival.\u003c/p>\n\u003cp>Future studies could start to explore that. \"We're going to change, basically, the environment and see what it changes,\" Robert says. \"What happens if the environment is harsher? Is it going to change the way mutations occur, or are they going to kill more of the cells or less of the cells?\"\u003c/p>\n\u003cp>Already, what the researchers have observed so far confirms a lot of the core thinking that goes into evolutionary biology, says \u003ca href=\"http://myxo.css.msu.edu/\">Richard Lenski\u003c/a>, a biologist at Michigan State University who has spent the last three decades following the evolution of bacteria populations living in flasks in his lab.\u003c/p>\n\u003cp>\"What's exciting about this paper is the technical elegance of it, the rigorous quantification,\" says Lenski, \"This is another nice demonstration that random mutation really has this kind of clock-like dynamic, and that, absent natural selection, populations will, in fact, not only not be able to hold their own, but will tend to decay over time,\" because most mutations are either neutral or deleterious.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Looking at mutations without any natural selection is very artificial, Lenski says, \"but that allows them to really focus on the underlying process of mutation.\"\u003c/p>\n\u003cp>Some people study evolution in the real world, in all its gory detail, he says. But there's also value in studying genetic changes in this kind of controlled setting that can give a cleaner answers.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"Fitting those two together is always a challenge,\" says Lenski, \"but that's the way science works.\"\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=Biologists+Trace+Genetic+Roots+Of+Evolution%2C+One+Cell+At+A+Time&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "As Surgery Centers Boom, Patients Are Paying With Their Lives",
"title": "As Surgery Centers Boom, Patients Are Paying With Their Lives",
"headTitle": "Future of You | KQED Future of You | KQED Science",
"content": "\u003cp>The surgery went fine. Her doctors left for the day. Four hours later, Paulina Tam started gasping for air.\u003c/p>\n\u003cp>Internal bleeding was cutting off her windpipe, a well-known complication of the spine surgery she had undergone.\u003c/p>\n\u003cp>But a Medicare inspection report describing the event says that nobody who remained on duty that evening at the Northern California surgery center knew what to do.\u003c/p>\n\u003cp>In desperation, a nurse did something that would not happen in a hospital.\u003c/p>\n\u003cp>She dialed 911.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>By the time an ambulance delivered Tam to the emergency room, the 58-year-old mother of three was lifeless, according to the report.\u003c/p>\n\u003cp>If Tam had been operated on at a hospital, a few simple steps could have saved her life.\u003c/p>\n\u003cp>But like hundreds of thousands of other patients each year, Tam went to one of the nation’s 5,600-plus surgery centers.\u003c/p>\n\u003caside class=\"pullquote alignright\">'Some surgery centers risk patient lives by skimping on training or lifesaving equipment.'\u003c/aside>\n\u003cp>Such centers started nearly 50 years ago as low-cost alternatives for minor surgeries. They now outnumber hospitals as federal regulators have signed off on an ever-widening array of outpatient procedures in an effort to cut federal health care costs.\u003c/p>\n\u003cp>Thousands of times each year, these centers call 911 as patients experience complications ranging from minor to fatal. Yet no one knows how many people die as a result, because no national authority tracks the tragic outcomes. An investigation by Kaiser Health News and the USA TODAY Network has discovered that more than 260 patients have died since 2013 after in-and-out procedures at surgery centers across the country. Dozens — some as young as 2 — have perished after routine operations, such as colonoscopies and tonsillectomies.\u003c/p>\n\u003cp>Reporters examined autopsy records, legal filings and more than 12,000 state and Medicare inspection records, and interviewed dozens of doctors, health policy experts and patients throughout the industry, in the most extensive examination of these records to date.\u003c/p>\n\u003cp>The investigation revealed:\u003c/p>\n\u003cp>Surgery centers have steadily expanded their business by taking on increasingly risky surgeries. At least 14 patients have died after complex spinal surgeries like those that federal regulators at Medicare recently approved for surgery centers. Even as the risks of doing such surgeries off a hospital campus can be great, so is the reward. Doctors who own a share of the center can earn their own fee and a cut of the facility’s fee, a meaningful sum for operations that can cost $100,000 or more.\u003c/p>\n\u003cp>To protect patients, Medicare requires surgery centers to line up a local hospital to take their patients when emergencies arise. In rural areas, centers can be 15 or more miles away. Even when the hospital is close, 20 to 30 minutes can pass between a 911 call and arrival at an ER.\u003c/p>\n\u003caside class=\"pullquote alignright\">'The money overshadows everything.'\u003ccite>Dr. Larry Teuber\u003c/cite>\u003c/aside>\n\u003cp>Some surgery centers are accused of overlooking high-risk health problems and treat patients who experts say should be operated on only in hospitals, if at all. At least 25 people with underlying medical conditions have left surgery centers and died within minutes or days. They include an Ohio woman with out-of-control blood pressure, a 49-year-old West Virginia man awaiting a heart transplant and several children with sleep apnea.\u003c/p>\n\u003cp>Some surgery centers risk patient lives by skimping on training or lifesaving equipment. Others have sent patients home before they were fully recovered. On their drives home, shocked family members in Arkansas, Oklahoma and Georgia discovered their loved ones were not asleep but on the verge of death. Surgery centers have been criticized in cases where staff didn’t have the tools to open a difficult airway or skills to save a patient from bleeding to death.\u003c/p>\n\u003cp>Most operations done in surgery centers go off without a hitch. And surgery carries risk, no matter where it’s done. Some centers have state-of-the-art equipment and highly trained staff that are better prepared to handle emergencies.\u003c/p>\n\u003cp>But Kaiser Health News and the USA TODAY Network found more than a dozen cases where the absence of trained staff or emergency equipment appears to have put patients in peril.\u003c/p>\n\u003cp>\u003cimg class=\"size-medium wp-image-436004 alignleft\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/10/depression-800x533.jpg\" alt=\"\" width=\"800\" height=\"533\">And in cases similar to Tam’s, upper-spine surgery patients have been sent home too soon, with the risk of suffocation looming.\u003c/p>\n\u003cp>In 2008, a 35-year-old Oregon father of three struggled for air, pounding the car roof in frustration while his wife sped him to a hospital. A Dallas man collapsed in his father’s arms waiting for an ambulance in 2011. Another Oregon man began to suffocate in his living room the night of his upper-spine surgery in 2014. A San Diego man gasped “like a fish,” his wife recalled, as they waited for an ambulance on April 28, 2016.\u003c/p>\n\u003cp>None of them survived.\u003c/p>\n\u003cp>Spinal surgery patient McArthur Roberson, 60, lost more than a quart of blood during the operation and struggled to breathe after surgery, his family claimed in a lawsuit. He died on the way home.\u003c/p>\n\u003cp>If he “had been observed in a hospital overnight,” said Dr. Daniel Silcox, an Atlanta spine surgeon and expert for the family in their lawsuit, “his death would not have occurred.”\u003c/p>\n\u003cp>The surgery center denied wrongdoing in the case, which reached a confidential settlement in 2017.\u003c/p>\n\u003cp>Many in the health care field — from doctors to private insurance companies to Medicare — have dismissed the mounting deaths as medical anomalies beyond the control of physicians.[contextly_sidebar id=\"yGkONjf2A21M8TI9B7IbDLgIYlcEIWeB\"]\u003c/p>\n\u003cp>USA TODAY Network and KHN reporters contacted 24 doctors and surgery center administrators about patient deaths and none would answer questions about what went wrong, citing patient privacy laws, or referring reporters to attorneys. Responding to lawsuits around the nation, surgery centers have argued that fatal complications were among the known outcomes of such surgeries. Two centers blamed patients for negligence in their own demise.\u003c/p>\n\u003cp>Bill Prentice, chief executive of the Ambulatory Surgery Center Association, declined to speak about individual cases but said he has seen no data proving surgery centers are less safe than hospitals.\u003c/p>\n\u003cp>“There is nothing distinct or different about the surgery center model that makes the provision of health care any more dangerous than anywhere else,” Prentice said. “The human body is a mysterious thing, and a patient that has met every possible protocol can walk in that day and still have something unimaginable happen to them that has nothing to do with the care that’s being provided.”\u003c/p>\n\u003cp>However, Dr. Kenneth Rothfield, board member of the Physician-Patient Alliance for Health & Safety, said many surgery centers and physicians push the envelope on how much can be done in outpatient centers.[contextly_sidebar id=\"nTpXhL5UY41KmxUslysOyQnfIH1Es3fu\"]\u003c/p>\n\u003cp>“It’s important to realize that surgery centers are not hospitals,” he said. “They have different resources, different equipment.”\u003c/p>\n\u003cp>The explosive growth of surgery centers — which receive $4.1 billion a year from Medicare — has taken place under circumstances some medical experts consider unseemly.\u003c/p>\n\u003cp>Federal law allows surgery center doctors — unlike others — to steer patients to facilities they own, rather than the full-service hospital down the street. In some cases, doing so could increase the risk to a patient, but double a physician’s profits.\u003c/p>\n\u003cp>Prentice said physician ownership of surgery centers is a good thing.\u003c/p>\n\u003cp>“The physicians who practice there are responsible for everything that happens in that surgery center from the moment the patient walks out of their car in the parking lot to the moment they leave,” he said.\u003c/p>\n\u003cp>But several studies have shown that surgery center doctors who are owners perform operations more frequently. And in lawsuits across the country, surgery center doctors have been accused of taking risks with patients.\u003c/p>\n\u003cp>Even some who’ve made their living in the surgery center industry have expressed concerns. Dr. Larry Teuber, a South Dakota neurosurgeon who worked as an executive in the surgery center industry for 22 years, said he has watched surgery center owners take on increasingly complex — and lucrative — orthopedic and spinal surgeries, undercutting a nearby hospital’s profits for their own gain.\u003c/p>\n\u003cp>“When you’re making money doing [complex surgeries] you get on a slippery ethical slope,” Teuber said. “The money overshadows everything.”\u003c/p>\n\u003cp>\u003cstrong>The History\u003c/strong>\u003c/p>\n\u003cp>The first surgery center in the U.S. opened in Phoenix in 1970, a place “squeezed between neighborhood shops and a Baptist church,” where, for $90, a child could receive an incision to relieve pressure on the inner ear, The Arizona Republic reported at the time.\u003c/p>\n\u003cp>The pioneering doctors, John Ford and Wallace Reed, didn’t see why patients needed to be hospitalized for such minor surgeries.\u003c/p>\n\u003cp>Taking the procedures out of hospitals reduced the cost for patients and insurers because surgery centers don’t require the same level of staffing or lifesaving equipment.\u003c/p>\n\u003cp>Medicare helped drive the expansion of surgery centers when it began paying for procedures in 1982.\u003c/p>\n\u003cp>Then in 1993, Congress encouraged doctors to open surgery centers by exempting them from the second Stark Law, which prevents doctors from steering patients to other businesses they own.\u003c/p>\n\u003cfigure id=\"attachment_440038\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-440038\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/03/iStock-638540542-800x534.jpg\" alt=\"\" width=\"800\" height=\"534\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-638540542-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-638540542-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-638540542-768x513.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-638540542-1020x681.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-638540542-1920x1281.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-638540542-1180x788.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-638540542-960x641.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-638540542-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-638540542-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-638540542-520x347.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Surgeons passing scissors to each other \u003ccite>(gpointstudio/IStock)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Doctors-turned-entrepreneurs drove early growth, urging their patients to give the centers a chance. Seeing lucrative elective surgeries moving away, hospitals increasingly bought centers of their own. Last year, insurance giant UnitedHealth Group spent $2.3 billion buying a national surgery center chain.\u003c/p>\n\u003cp>The centers have been popular with patients, who enjoy the convenience and personalized care. Doctors say they like the ease of planning operations without unexpected trauma surgeries upending the schedule. And surgery centers have thrived even as hospitals have battled to contain the spread of infections.\u003c/p>\n\u003cp>Today, there are 5,616 Medicare-certified centers. The expansion has come despite lingering safety concerns. In 2007, Medicare noted that surgery centers “have neither patient safety standards consistent with those in place for hospitals, nor are they required to have the trained staff and equipment needed to provide the breadth of intensity of care. …” Some procedures are “unsafe” to be handled at surgery centers, the report concluded.[contextly_sidebar id=\"Oh8vuiOByjR9KfyFdmF17zW0bJKBCpIa\"]\u003c/p>\n\u003cp>Medicare advised the centers to transfer patients to hospitals when emergencies arise. Only a third of surgery centers participate in a voluntary effort to report how often that happens. They sent at least 7,000 patients to the hospital in the year that ended in September 2017, a KHN analysis of surgery center industry data shows. Not all survive the trip.\u003c/p>\n\u003cp>They include James Long, 56, who had no pulse when an ambulance came to the Colorado surgery center where he’d undergone more than five hours of lower-spine surgery in 2014, according to the center’s medical records provided to the family’s attorney.\u003c/p>\n\u003cp>The state reviewed the case and cited no deficiencies. Jen Kenitzer, the Minimally Invasive Spine Institute administrator, said the center has “extensive procedures in place to respond quickly and appropriately” in emergencies.\u003c/p>\n\u003cp>Yet Long’s loved ones remain troubled by the case.\u003c/p>\n\u003cp>“In the 21st century in the USA, a doctor doing a surgery on a patient has to call 911?” said Robin Long, his ex-wife, who did not sue the center. “Give me a break. … It’s just absolutely ignorant.”\u003c/p>\n\u003cp>\u003cstrong>Preparation Under Par\u003c/strong>\u003c/p>\n\u003cp>Patients enter hospitals with heart attacks, gunshot wounds and traumatic injuries. There, doctors and nurses become skilled at saving lives in emergencies.\u003c/p>\n\u003cp>Doctors in surgery centers may excel at the procedures they perform most often. But the centers aren’t always prepared and sometimes struggle in a crisis, according to a review of Medicare records and more than 70 lawsuits.\u003c/p>\n\u003cp>Health inspectors working on behalf of Medicare have discovered 230 lapses in rescue equipment or training regulations at surgery centers since 2015.\u003c/p>\n\u003cp>A center in California had empty oxygen tanks. One operating on children in Arkansas didn’t have a pediatric tracheotomy set to restore breathing; another lacked pediatric defibrillator pads to shock hearts back into rhythm.[contextly_sidebar id=\"xgSiNPNFJJTyDToF3ZdazMurAQ4SAxDl\"]\u003c/p>\n\u003cp>In an ongoing lawsuit against her and the center, anesthesiologist Dr. Yoori Yim testified that she came up empty-handed on Dec. 23, 2015, when grappling to find the right-sized airway tube to save a patient who had stopped breathing.\u003c/p>\n\u003cp>Rekhaben Shah, 67, had come to Oak Tree Surgery Center in Edison, N.J., for a simple colonoscopy.\u003c/p>\n\u003cp>Yim tried a variety of methods to help Shah breathe, with limited success. From the moment Shah stopped breathing on the operating table, 33 minutes passed before a paramedic effectively inserted a breathing tube, according to medical and EMS records.\u003c/p>\n\u003cp>Paramedics responding to the center’s 911 call had to use a video GlideScope to see inside the patient’s throat, equipment the surgery center didn’t have, court testimony says.\u003c/p>\n\u003cp>By then it was too late. Shah was removed from life support at a nearby hospital on Christmas Day.\u003c/p>\n\u003cp>Neither Yim nor the center returned calls for comment. In court records, an expert for the surgery center said Shah’s airway was obstructed and it was cleared around the time the paramedics arrived. He said the GlideScope is not required in New Jersey, nor would it likely have made a difference. An expert for Yim, however, said her actions were appropriate and if a GlideScope had been at the center, “we would probably not be discussing this case at all.”\u003c/p>\n\u003cp>When emergency crews arrive, surgery centers are not always prepared to receive them.\u003c/p>\n\u003cp>In Yim’s case, paramedics testified that she refused to move away from Shah and allow them to attempt lifesaving measures.\u003c/p>\n\u003cp>In Florida, paramedics who rushed to a surgery center after its usual operating hours hit a locked door while a patient inside gasped for breath. The 55-year-old remains in a vegetative state.\u003c/p>\n\u003cp>In 2016, paramedics arrived at West Lakes Surgery Center in Iowa as staff tried to revive 12-year-old Reuben Van Veldhuizen after he experienced complications during a tonsillectomy, according to a Medicare inspection report.[contextly_sidebar id=\"iy3S1eIYgobood9l19mbUsM4p7gpgSwB\"]\u003c/p>\n\u003cp>One paramedic told state inspectors she had to ask who was in charge of the resuscitation efforts. No one replied, the inspection report says.\u003c/p>\n\u003cp>The boy made it to the hospital 37 minutes after the surgery center staff called 911. There, he was pronounced dead.\u003c/p>\n\u003cp>The family filed suit, alleging that the center and anesthesiologist erred in giving the boy an anesthetic that carries a warning about cardiac arrest risk in young boys.\u003c/p>\n\u003cp>In court records responding to the lawsuit, the surgery center and anesthesiologist said Reuben’s death was a result of “pre-existing conditions, acts of others, or conditions over which (Defendants) had no control or responsibility.”[contextly_sidebar id=\"VI9AZs5TNC51Y7UgdHVDpUXpakSmw0kK\"]\u003c/p>\n\u003cp>Yet lawyers who sue the centers and scrutinize their internal records say they often see deadly delays in care.\u003c/p>\n\u003cp>Pedro Maldonado, 59, went to Ambulatory Care Center in New Jersey to have his upper digestive tract scoped. He was discovered unresponsive 10 minutes after the seven-minute procedure, according to his widow’s lawsuit.\u003c/p>\n\u003cp>It took surgery center staff 25 more minutes to start CPR, according to a lawsuit that Philadelphia attorney Glenn Ellis filed on behalf of Maldonado’s widow. Twenty-seven more minutes passed before Maldonado was wheeled into an ER, the widow’s ongoing suit alleges. Maldonado never regained consciousness.\u003c/p>\n\u003cp>Reached by phone, a center administrator declined to comment. In a legal filing, the center denied claims of wrongdoing.\u003c/p>\n\u003cp>“At a hospital, doctors and nurses … know how they are going to respond,” Ellis said. “These guys at the surgery centers are walking on a tightrope with no safety net.”\u003c/p>\n\u003cp>\u003cstrong>Conveyor Belt Of Care\u003c/strong>\u003c/p>\n\u003cp>While the thrum of a hospital continues through the night, some surgery center doctors keep banker’s hours. That means patients whose surgeries end later in the day are sometimes left in the care of one or two nurses for up to 23-hour stays. Some patients have been sent home to grapple with complications on their own.\u003c/p>\n\u003cp>Sondra Wallace went to the Surgery Center of Oklahoma in early 2017 for a sinus procedure.\u003c/p>\n\u003cp>After the procedure, doctors saw her blood-oxygen level sinking. They realized she had had a reaction to the anesthesia and at 2 p.m. gave her a drug to reverse the effects, an ongoing lawsuit filed by her husband says.[contextly_sidebar id=\"9BEvkmOwOv0XN6LAFVyarPQ0ptuu9CWR\"]\u003c/p>\n\u003cp>Then, an hour later, they sent her home with her husband, Larry, the lawsuit says.\u003c/p>\n\u003cp>It was 3 p.m. on the Friday before Presidents Day weekend.\u003c/p>\n\u003cp>“I just think they wanted to start their three-day weekend,” said daughter Casey Podoll.\u003c/p>\n\u003cp>Larry Wallace alleges in the suit that the center gave him no hint that Sondra had a reaction to the anesthesia.\u003c/p>\n\u003cp>So, Wallace thought nothing of her napping in the back seat as he drove for more than two hours through Oklahoma pastures on his way home. When he arrived, he discovered his wife cold in the back seat. She was pronounced dead at Jackson County Memorial Hospital at 6:30 p.m. that day.\u003c/p>\n\u003cp>“They didn’t give any indication … that there were any red flags whatsoever,” Podoll said.\u003c/p>\n\u003cp>Craig Buchan, attorney for the Surgery Center of Oklahoma, said Wallace met discharge criteria and her cause of death has not been determined. He said the center did not close any earlier “than often occurs after the last patient is discharged.”\u003c/p>\n\u003cp>Cecilia Aldridge said she also felt as if the staff at a surgery center was rushing her out the door, after her 2-year-old daughter’s tonsil surgery in Arkansas in 2015.\u003c/p>\n\u003cp>A lawsuit filed by the parents said the surgery center “discharged Abbygail too early because a snow storm was moving into the area.”\u003c/p>\n\u003cp>Abbygail turned blue in the car on the way home. Her mother said she raced into an emergency room, shouting for help, her toddler in her arms.\u003c/p>\n\u003cp>“She never woke up,” Aldridge said tearfully in an interview.\u003c/p>\n\u003cp>Abbygail’s parents now question whether the surgery center ever should have been willing to treat their daughter.\u003c/p>\n\u003cp>\u003cstrong>Risky Patients\u003c/strong>\u003c/p>\n\u003cp>Because surgery centers have less safety equipment and staffing than hospitals, industry leaders stress the importance of selecting patients healthy enough to fare well. Their predictions, though, are not always correct.\u003c/p>\n\u003cp>Abbygail, who loved her hand-me-down blanket and the film “Frozen,” had sleep apnea, an irregular heartbeat and was very heavy for her age, according to the lawsuit.\u003c/p>\n\u003cp>Sleep apnea increases the risk of serious complications in surgery and the night after, medical research shows. Given her condition, Abbygail “should have been admitted [to a hospital] and monitored post-procedure,” said Dr. Charles Cote, a retired Harvard pediatric anesthesiology professor who was not involved in the family’s lawsuit.[contextly_sidebar id=\"gjUHM4nwVAL7lCCCNoVNHgGksiZfeuxR\"]\u003c/p>\n\u003cp>The lawsuit says Abbygail’s risk factors “were documented and known by the Defendants,” including the doctor. It said the toddler should have been operated on “in an inpatient setting under hospital care and monitored overnight.”\u003c/p>\n\u003cp>Dr. Michael Marsh performed Abbygail’s tonsillectomy at Executive Park Surgery Center in Fort Smith, Ark.\u003c/p>\n\u003cp>The surgery center’s lawyer declined to comment. The doctor’s lawyer did not return email and voice messages. In court documents responding to the lawsuit, Marsh and the center denied wrongdoing.\u003c/p>\n\u003cp>In the court filing, Marsh said the toddler’s injuries were “the natural progression” of her illness. Executive Park Surgery Center said in a court filing that “no action on their part … was a proximate cause of any damages or injury.” The case was settled.\u003c/p>\n\u003cp>In at least 25 cases, surgery centers opened their doors to ailing and fragile patients who died after simple procedures, such as tonsillectomies, retinal repairs or colonoscopies, KHN and USA TODAY Network found.\u003c/p>\n\u003cp>Medicare asks surgery centers to assess each patient’s risk, but inspectors flagged 122 surgery centers in 2015 and 2016 alone for lapses in risk assessments. Some centers failed to gauge risk at all. Others overlooked their own policies.\u003c/p>\n\u003cp>Doctors can use an anesthesia risk assessment to screen out fragile patients — healthy patients get a score of 1, and a score of 5 means a person is nearly dead.\u003c/p>\n\u003cp>A few states, including Pennsylvania and Rhode Island, bar certain surgery centers from operating on patients with an anesthesia risk score of 4. But most states don’t go that far. They leave such decisions up to doctors.\u003c/p>\n\u003cp>And some of those decisions have been cited in tragic outcomes. Sabino Sifuentes, 74, had survived triple-bypass surgery. But on March 23, 2015, nine minutes after the start of anesthesia for an eye procedure, he became unresponsive, never to be revived, according to a Medicare inspection report. A nurse anesthetist who reviewed the case at Eye-Q Vision Care’s surgery center in Fresno, Calif., told state health inspectors that Sifuentes should have been given a risk score of 4 and his care was “completely mismanaged,” the inspection report says.\u003c/p>\n\u003cp>In response to the family’s lawsuit, the surgery center said Sifuentes’ injury was caused by his own negligence and others’.\u003c/p>\n\u003cp>Five other patients with the same risk score died after routine procedures at surgery centers across the U.S.\u003c/p>\n\u003cp>\u003cstrong>A Widening Niche\u003c/strong>\u003c/p>\n\u003cp>Such tragedies rarely find their way into the discussion when Medicare decides whether to approve new procedures at surgery centers.\u003c/p>\n\u003cp>Take spinal surgery.\u003c/p>\n\u003cp>Until 2015, Medicare wouldn’t pay for it at surgery centers. Then, the industry’s trade association urged the agency to make the change, and encouraged a letter-writing campaign from surgery centers across the nation.\u003c/p>\n\u003cp>Letter writers included Dr. Alan Villavicencio, a Colorado surgeon who said he’d been doing such surgeries for 12 years and found that his patients “appreciate the convenience and cost savings.” He did not mention that James Long, 56, had died three weeks earlier at a Lafayette, Colo., surgery center where he is an owner, a review of Colorado health department and medical board records shows.\u003c/p>\n\u003cp>United Surgical Partners International, a surgery center chain, also weighed in urging even more procedures to be approved, not mentioning a patient death hours after a spine surgery at one of its affiliate centers several months before, according to court records and securities filings. The chain said in a statement that it stands behind its comments in support of the proposal.[contextly_sidebar id=\"VpVDiD85oVGnFVcTHpIcD2xozEou9ew9\"]\u003c/p>\n\u003cp>Such letters carry weight with Medicare, which approves procedures to be done in surgery centers based on the invasiveness and complexity of the surgery and on input from stakeholders.\u003c/p>\n\u003cp>Robert Beatty-Walters, a Portland, Ore., attorney who has represented the families of three people who died after surgery center spine procedures, said Medicare’s decision-making process is not even-handed.\u003c/p>\n\u003cp>“The stakeholders — they call them — during these regulatory proceedings are the profit-makers, not the people who are being provided the service,” he said. “The spine centers just want to have more people come. They make more money. I hate to be that cynical about it, but that’s just what I’ve seen.”\u003c/p>\n\u003cp>Medicare approved 10 spine-surgery codes to be billed at surgery centers starting in 2015 and added more spinal procedures for 2017. A Medicare spokesman denied a request for a telephone interview. In an email, a spokeswoman said Medicare opened the spine proposal to the public and received no comments suggesting the procedures would pose a threat to Medicare patients. She said the final decision about where a patient will have surgery is up to a doctor and patient.\u003c/p>\n\u003cp>By 2017, at least 14 patients had died soon after spine operations at surgery centers, according to the KHN/USA TODAY Network investigation.\u003c/p>\n\u003cp>The 14 spine-surgery deaths have gleaned little recognition in the industry or beyond. Only one made headlines in local newspapers. The rest are documented in places like the Macon, Ga., courthouse or in obscure regulatory reports. And there may be far more because some states, including New York, Illinois and Florida, disclose no details about surgery center deaths.\u003c/p>\n\u003cp>Paulina Tam’s death at Fremont Surgery Center was a tragic example. At 58, the mother of three had finished careers as a nurse and an educator. Next, she planned to travel the world with her husband of 32 years.\u003c/p>\n\u003cp>“She was the driving force of the family, the spirit I guess,” said her son, Eric Tam, a doctor in New York City, said. “We didn’t expect the worst to happen.”\u003c/p>\n\u003cp>The care she received at the center is documented in court records, EMS reports and a Medicare inspection report that concluded that the center “failed to provide a safe environment for surgery.”\u003c/p>\n\u003cp>Tam’s doctor scheduled her for a procedure to replace two discs in her upper spine on April 7, 2014. Pain from a car crash had bothered her for years. Any such surgery — entering the front of the neck to address pain in the spine — comes with a risk of suffocation, according to the Medicare inspection report.\u003c/p>\n\u003cp>Yet, with her surgeon and anesthesiologist already gone, the only doctor on-site was a digestive health specialist, the inspection report shows. About four hours after her procedure, Tam told a nurse that her surgical collar felt too tight. Then, that she couldn’t breathe.\u003c/p>\n\u003cp>The nurse called a “code blue” just after 6:30 p.m., records say.\u003c/p>\n\u003cp>Medical experts say the first step in helping such patients is removing the surgical staples so the pooled blood can disperse, allowing the patient to breathe.\u003c/p>\n\u003cp>In Tam’s case, staff repeatedly tried and failed to insert a breathing tube through her mouth and into her airway, the inspection report shows. A last-ditch remedy would have been to punch a hole through the front of her throat to restore breathing, but the gastroenterologist later told an inspector that he was “not prepared” to do so.\u003c/p>\n\u003cp>The inability to perform the suffocation-rescue maneuver, the inspection report says, amounted to the center’s “failure to ensure patient safety.”\u003c/p>\n\u003cp>From the time a nurse called 911, it took 24 minutes to get Tam to the nearest hospital, EMS records show. She arrived without a pulse and remained on life support overnight, as her children raced to her bedside to say goodbye.[contextly_sidebar id=\"bLBYWBIiszrFf7LXQxCNRj9SYTbpB4ln\"]\u003c/p>\n\u003cp>The center did not return calls and denied wrongdoing in the court case. Tam’s surgeon declined to discuss the case but filed pleadings in court saying Tam’s “carelessness and negligence” caused her death. It’s unclear what the defense meant by negligence. The case reached a confidential settlement.\u003c/p>\n\u003cp>After Tam’s death, the center told Medicare inspectors that a qualified doctor would stay on-site after all upper-spine cases.\u003c/p>\n\u003cp>Dr. Nancy Epstein, chief of neurosurgical and spine care at New York University Winthrop Hospital, said surgery centers doing delicate work near the spinal cord, windpipe and esophagus in a same-day procedure is “pretty revolting.” But she said the centers are making so much money — “reeling it in hand over fist” that the potential dangers are being ignored.\u003c/p>\n\u003cp>“Medically, it should not be tolerated,” she said, “but it is.”\u003c/p>\n\u003cp>\u003cem>Lindy Washburn of The (Bergen County, N.J.) Record and NorthJersey.com contributed to this report.\u003c/em>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This story was originally published by \u003ca href=\"http://khn.org/\" target=\"_blank\" rel=\"noopener\">Kaiser Health News\u003c/a>.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The surgery went fine. Her doctors left for the day. Four hours later, Paulina Tam started gasping for air.\u003c/p>\n\u003cp>Internal bleeding was cutting off her windpipe, a well-known complication of the spine surgery she had undergone.\u003c/p>\n\u003cp>But a Medicare inspection report describing the event says that nobody who remained on duty that evening at the Northern California surgery center knew what to do.\u003c/p>\n\u003cp>In desperation, a nurse did something that would not happen in a hospital.\u003c/p>\n\u003cp>She dialed 911.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>By the time an ambulance delivered Tam to the emergency room, the 58-year-old mother of three was lifeless, according to the report.\u003c/p>\n\u003cp>If Tam had been operated on at a hospital, a few simple steps could have saved her life.\u003c/p>\n\u003cp>But like hundreds of thousands of other patients each year, Tam went to one of the nation’s 5,600-plus surgery centers.\u003c/p>\n\u003caside class=\"pullquote alignright\">'Some surgery centers risk patient lives by skimping on training or lifesaving equipment.'\u003c/aside>\n\u003cp>Such centers started nearly 50 years ago as low-cost alternatives for minor surgeries. They now outnumber hospitals as federal regulators have signed off on an ever-widening array of outpatient procedures in an effort to cut federal health care costs.\u003c/p>\n\u003cp>Thousands of times each year, these centers call 911 as patients experience complications ranging from minor to fatal. Yet no one knows how many people die as a result, because no national authority tracks the tragic outcomes. An investigation by Kaiser Health News and the USA TODAY Network has discovered that more than 260 patients have died since 2013 after in-and-out procedures at surgery centers across the country. Dozens — some as young as 2 — have perished after routine operations, such as colonoscopies and tonsillectomies.\u003c/p>\n\u003cp>Reporters examined autopsy records, legal filings and more than 12,000 state and Medicare inspection records, and interviewed dozens of doctors, health policy experts and patients throughout the industry, in the most extensive examination of these records to date.\u003c/p>\n\u003cp>The investigation revealed:\u003c/p>\n\u003cp>Surgery centers have steadily expanded their business by taking on increasingly risky surgeries. At least 14 patients have died after complex spinal surgeries like those that federal regulators at Medicare recently approved for surgery centers. Even as the risks of doing such surgeries off a hospital campus can be great, so is the reward. Doctors who own a share of the center can earn their own fee and a cut of the facility’s fee, a meaningful sum for operations that can cost $100,000 or more.\u003c/p>\n\u003cp>To protect patients, Medicare requires surgery centers to line up a local hospital to take their patients when emergencies arise. In rural areas, centers can be 15 or more miles away. Even when the hospital is close, 20 to 30 minutes can pass between a 911 call and arrival at an ER.\u003c/p>\n\u003caside class=\"pullquote alignright\">'The money overshadows everything.'\u003ccite>Dr. Larry Teuber\u003c/cite>\u003c/aside>\n\u003cp>Some surgery centers are accused of overlooking high-risk health problems and treat patients who experts say should be operated on only in hospitals, if at all. At least 25 people with underlying medical conditions have left surgery centers and died within minutes or days. They include an Ohio woman with out-of-control blood pressure, a 49-year-old West Virginia man awaiting a heart transplant and several children with sleep apnea.\u003c/p>\n\u003cp>Some surgery centers risk patient lives by skimping on training or lifesaving equipment. Others have sent patients home before they were fully recovered. On their drives home, shocked family members in Arkansas, Oklahoma and Georgia discovered their loved ones were not asleep but on the verge of death. Surgery centers have been criticized in cases where staff didn’t have the tools to open a difficult airway or skills to save a patient from bleeding to death.\u003c/p>\n\u003cp>Most operations done in surgery centers go off without a hitch. And surgery carries risk, no matter where it’s done. Some centers have state-of-the-art equipment and highly trained staff that are better prepared to handle emergencies.\u003c/p>\n\u003cp>But Kaiser Health News and the USA TODAY Network found more than a dozen cases where the absence of trained staff or emergency equipment appears to have put patients in peril.\u003c/p>\n\u003cp>\u003cimg class=\"size-medium wp-image-436004 alignleft\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/10/depression-800x533.jpg\" alt=\"\" width=\"800\" height=\"533\">And in cases similar to Tam’s, upper-spine surgery patients have been sent home too soon, with the risk of suffocation looming.\u003c/p>\n\u003cp>In 2008, a 35-year-old Oregon father of three struggled for air, pounding the car roof in frustration while his wife sped him to a hospital. A Dallas man collapsed in his father’s arms waiting for an ambulance in 2011. Another Oregon man began to suffocate in his living room the night of his upper-spine surgery in 2014. A San Diego man gasped “like a fish,” his wife recalled, as they waited for an ambulance on April 28, 2016.\u003c/p>\n\u003cp>None of them survived.\u003c/p>\n\u003cp>Spinal surgery patient McArthur Roberson, 60, lost more than a quart of blood during the operation and struggled to breathe after surgery, his family claimed in a lawsuit. He died on the way home.\u003c/p>\n\u003cp>If he “had been observed in a hospital overnight,” said Dr. Daniel Silcox, an Atlanta spine surgeon and expert for the family in their lawsuit, “his death would not have occurred.”\u003c/p>\n\u003cp>The surgery center denied wrongdoing in the case, which reached a confidential settlement in 2017.\u003c/p>\n\u003cp>Many in the health care field — from doctors to private insurance companies to Medicare — have dismissed the mounting deaths as medical anomalies beyond the control of physicians.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>USA TODAY Network and KHN reporters contacted 24 doctors and surgery center administrators about patient deaths and none would answer questions about what went wrong, citing patient privacy laws, or referring reporters to attorneys. Responding to lawsuits around the nation, surgery centers have argued that fatal complications were among the known outcomes of such surgeries. Two centers blamed patients for negligence in their own demise.\u003c/p>\n\u003cp>Bill Prentice, chief executive of the Ambulatory Surgery Center Association, declined to speak about individual cases but said he has seen no data proving surgery centers are less safe than hospitals.\u003c/p>\n\u003cp>“There is nothing distinct or different about the surgery center model that makes the provision of health care any more dangerous than anywhere else,” Prentice said. “The human body is a mysterious thing, and a patient that has met every possible protocol can walk in that day and still have something unimaginable happen to them that has nothing to do with the care that’s being provided.”\u003c/p>\n\u003cp>However, Dr. Kenneth Rothfield, board member of the Physician-Patient Alliance for Health & Safety, said many surgery centers and physicians push the envelope on how much can be done in outpatient centers.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>“It’s important to realize that surgery centers are not hospitals,” he said. “They have different resources, different equipment.”\u003c/p>\n\u003cp>The explosive growth of surgery centers — which receive $4.1 billion a year from Medicare — has taken place under circumstances some medical experts consider unseemly.\u003c/p>\n\u003cp>Federal law allows surgery center doctors — unlike others — to steer patients to facilities they own, rather than the full-service hospital down the street. In some cases, doing so could increase the risk to a patient, but double a physician’s profits.\u003c/p>\n\u003cp>Prentice said physician ownership of surgery centers is a good thing.\u003c/p>\n\u003cp>“The physicians who practice there are responsible for everything that happens in that surgery center from the moment the patient walks out of their car in the parking lot to the moment they leave,” he said.\u003c/p>\n\u003cp>But several studies have shown that surgery center doctors who are owners perform operations more frequently. And in lawsuits across the country, surgery center doctors have been accused of taking risks with patients.\u003c/p>\n\u003cp>Even some who’ve made their living in the surgery center industry have expressed concerns. Dr. Larry Teuber, a South Dakota neurosurgeon who worked as an executive in the surgery center industry for 22 years, said he has watched surgery center owners take on increasingly complex — and lucrative — orthopedic and spinal surgeries, undercutting a nearby hospital’s profits for their own gain.\u003c/p>\n\u003cp>“When you’re making money doing [complex surgeries] you get on a slippery ethical slope,” Teuber said. “The money overshadows everything.”\u003c/p>\n\u003cp>\u003cstrong>The History\u003c/strong>\u003c/p>\n\u003cp>The first surgery center in the U.S. opened in Phoenix in 1970, a place “squeezed between neighborhood shops and a Baptist church,” where, for $90, a child could receive an incision to relieve pressure on the inner ear, The Arizona Republic reported at the time.\u003c/p>\n\u003cp>The pioneering doctors, John Ford and Wallace Reed, didn’t see why patients needed to be hospitalized for such minor surgeries.\u003c/p>\n\u003cp>Taking the procedures out of hospitals reduced the cost for patients and insurers because surgery centers don’t require the same level of staffing or lifesaving equipment.\u003c/p>\n\u003cp>Medicare helped drive the expansion of surgery centers when it began paying for procedures in 1982.\u003c/p>\n\u003cp>Then in 1993, Congress encouraged doctors to open surgery centers by exempting them from the second Stark Law, which prevents doctors from steering patients to other businesses they own.\u003c/p>\n\u003cfigure id=\"attachment_440038\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-440038\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/03/iStock-638540542-800x534.jpg\" alt=\"\" width=\"800\" height=\"534\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-638540542-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-638540542-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-638540542-768x513.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-638540542-1020x681.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-638540542-1920x1281.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-638540542-1180x788.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-638540542-960x641.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-638540542-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-638540542-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-638540542-520x347.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Surgeons passing scissors to each other \u003ccite>(gpointstudio/IStock)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Doctors-turned-entrepreneurs drove early growth, urging their patients to give the centers a chance. Seeing lucrative elective surgeries moving away, hospitals increasingly bought centers of their own. Last year, insurance giant UnitedHealth Group spent $2.3 billion buying a national surgery center chain.\u003c/p>\n\u003cp>The centers have been popular with patients, who enjoy the convenience and personalized care. Doctors say they like the ease of planning operations without unexpected trauma surgeries upending the schedule. And surgery centers have thrived even as hospitals have battled to contain the spread of infections.\u003c/p>\n\u003cp>Today, there are 5,616 Medicare-certified centers. The expansion has come despite lingering safety concerns. In 2007, Medicare noted that surgery centers “have neither patient safety standards consistent with those in place for hospitals, nor are they required to have the trained staff and equipment needed to provide the breadth of intensity of care. …” Some procedures are “unsafe” to be handled at surgery centers, the report concluded.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Medicare advised the centers to transfer patients to hospitals when emergencies arise. Only a third of surgery centers participate in a voluntary effort to report how often that happens. They sent at least 7,000 patients to the hospital in the year that ended in September 2017, a KHN analysis of surgery center industry data shows. Not all survive the trip.\u003c/p>\n\u003cp>They include James Long, 56, who had no pulse when an ambulance came to the Colorado surgery center where he’d undergone more than five hours of lower-spine surgery in 2014, according to the center’s medical records provided to the family’s attorney.\u003c/p>\n\u003cp>The state reviewed the case and cited no deficiencies. Jen Kenitzer, the Minimally Invasive Spine Institute administrator, said the center has “extensive procedures in place to respond quickly and appropriately” in emergencies.\u003c/p>\n\u003cp>Yet Long’s loved ones remain troubled by the case.\u003c/p>\n\u003cp>“In the 21st century in the USA, a doctor doing a surgery on a patient has to call 911?” said Robin Long, his ex-wife, who did not sue the center. “Give me a break. … It’s just absolutely ignorant.”\u003c/p>\n\u003cp>\u003cstrong>Preparation Under Par\u003c/strong>\u003c/p>\n\u003cp>Patients enter hospitals with heart attacks, gunshot wounds and traumatic injuries. There, doctors and nurses become skilled at saving lives in emergencies.\u003c/p>\n\u003cp>Doctors in surgery centers may excel at the procedures they perform most often. But the centers aren’t always prepared and sometimes struggle in a crisis, according to a review of Medicare records and more than 70 lawsuits.\u003c/p>\n\u003cp>Health inspectors working on behalf of Medicare have discovered 230 lapses in rescue equipment or training regulations at surgery centers since 2015.\u003c/p>\n\u003cp>A center in California had empty oxygen tanks. One operating on children in Arkansas didn’t have a pediatric tracheotomy set to restore breathing; another lacked pediatric defibrillator pads to shock hearts back into rhythm.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>In an ongoing lawsuit against her and the center, anesthesiologist Dr. Yoori Yim testified that she came up empty-handed on Dec. 23, 2015, when grappling to find the right-sized airway tube to save a patient who had stopped breathing.\u003c/p>\n\u003cp>Rekhaben Shah, 67, had come to Oak Tree Surgery Center in Edison, N.J., for a simple colonoscopy.\u003c/p>\n\u003cp>Yim tried a variety of methods to help Shah breathe, with limited success. From the moment Shah stopped breathing on the operating table, 33 minutes passed before a paramedic effectively inserted a breathing tube, according to medical and EMS records.\u003c/p>\n\u003cp>Paramedics responding to the center’s 911 call had to use a video GlideScope to see inside the patient’s throat, equipment the surgery center didn’t have, court testimony says.\u003c/p>\n\u003cp>By then it was too late. Shah was removed from life support at a nearby hospital on Christmas Day.\u003c/p>\n\u003cp>Neither Yim nor the center returned calls for comment. In court records, an expert for the surgery center said Shah’s airway was obstructed and it was cleared around the time the paramedics arrived. He said the GlideScope is not required in New Jersey, nor would it likely have made a difference. An expert for Yim, however, said her actions were appropriate and if a GlideScope had been at the center, “we would probably not be discussing this case at all.”\u003c/p>\n\u003cp>When emergency crews arrive, surgery centers are not always prepared to receive them.\u003c/p>\n\u003cp>In Yim’s case, paramedics testified that she refused to move away from Shah and allow them to attempt lifesaving measures.\u003c/p>\n\u003cp>In Florida, paramedics who rushed to a surgery center after its usual operating hours hit a locked door while a patient inside gasped for breath. The 55-year-old remains in a vegetative state.\u003c/p>\n\u003cp>In 2016, paramedics arrived at West Lakes Surgery Center in Iowa as staff tried to revive 12-year-old Reuben Van Veldhuizen after he experienced complications during a tonsillectomy, according to a Medicare inspection report.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>One paramedic told state inspectors she had to ask who was in charge of the resuscitation efforts. No one replied, the inspection report says.\u003c/p>\n\u003cp>The boy made it to the hospital 37 minutes after the surgery center staff called 911. There, he was pronounced dead.\u003c/p>\n\u003cp>The family filed suit, alleging that the center and anesthesiologist erred in giving the boy an anesthetic that carries a warning about cardiac arrest risk in young boys.\u003c/p>\n\u003cp>In court records responding to the lawsuit, the surgery center and anesthesiologist said Reuben’s death was a result of “pre-existing conditions, acts of others, or conditions over which (Defendants) had no control or responsibility.”\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Yet lawyers who sue the centers and scrutinize their internal records say they often see deadly delays in care.\u003c/p>\n\u003cp>Pedro Maldonado, 59, went to Ambulatory Care Center in New Jersey to have his upper digestive tract scoped. He was discovered unresponsive 10 minutes after the seven-minute procedure, according to his widow’s lawsuit.\u003c/p>\n\u003cp>It took surgery center staff 25 more minutes to start CPR, according to a lawsuit that Philadelphia attorney Glenn Ellis filed on behalf of Maldonado’s widow. Twenty-seven more minutes passed before Maldonado was wheeled into an ER, the widow’s ongoing suit alleges. Maldonado never regained consciousness.\u003c/p>\n\u003cp>Reached by phone, a center administrator declined to comment. In a legal filing, the center denied claims of wrongdoing.\u003c/p>\n\u003cp>“At a hospital, doctors and nurses … know how they are going to respond,” Ellis said. “These guys at the surgery centers are walking on a tightrope with no safety net.”\u003c/p>\n\u003cp>\u003cstrong>Conveyor Belt Of Care\u003c/strong>\u003c/p>\n\u003cp>While the thrum of a hospital continues through the night, some surgery center doctors keep banker’s hours. That means patients whose surgeries end later in the day are sometimes left in the care of one or two nurses for up to 23-hour stays. Some patients have been sent home to grapple with complications on their own.\u003c/p>\n\u003cp>Sondra Wallace went to the Surgery Center of Oklahoma in early 2017 for a sinus procedure.\u003c/p>\n\u003cp>After the procedure, doctors saw her blood-oxygen level sinking. They realized she had had a reaction to the anesthesia and at 2 p.m. gave her a drug to reverse the effects, an ongoing lawsuit filed by her husband says.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Then, an hour later, they sent her home with her husband, Larry, the lawsuit says.\u003c/p>\n\u003cp>It was 3 p.m. on the Friday before Presidents Day weekend.\u003c/p>\n\u003cp>“I just think they wanted to start their three-day weekend,” said daughter Casey Podoll.\u003c/p>\n\u003cp>Larry Wallace alleges in the suit that the center gave him no hint that Sondra had a reaction to the anesthesia.\u003c/p>\n\u003cp>So, Wallace thought nothing of her napping in the back seat as he drove for more than two hours through Oklahoma pastures on his way home. When he arrived, he discovered his wife cold in the back seat. She was pronounced dead at Jackson County Memorial Hospital at 6:30 p.m. that day.\u003c/p>\n\u003cp>“They didn’t give any indication … that there were any red flags whatsoever,” Podoll said.\u003c/p>\n\u003cp>Craig Buchan, attorney for the Surgery Center of Oklahoma, said Wallace met discharge criteria and her cause of death has not been determined. He said the center did not close any earlier “than often occurs after the last patient is discharged.”\u003c/p>\n\u003cp>Cecilia Aldridge said she also felt as if the staff at a surgery center was rushing her out the door, after her 2-year-old daughter’s tonsil surgery in Arkansas in 2015.\u003c/p>\n\u003cp>A lawsuit filed by the parents said the surgery center “discharged Abbygail too early because a snow storm was moving into the area.”\u003c/p>\n\u003cp>Abbygail turned blue in the car on the way home. Her mother said she raced into an emergency room, shouting for help, her toddler in her arms.\u003c/p>\n\u003cp>“She never woke up,” Aldridge said tearfully in an interview.\u003c/p>\n\u003cp>Abbygail’s parents now question whether the surgery center ever should have been willing to treat their daughter.\u003c/p>\n\u003cp>\u003cstrong>Risky Patients\u003c/strong>\u003c/p>\n\u003cp>Because surgery centers have less safety equipment and staffing than hospitals, industry leaders stress the importance of selecting patients healthy enough to fare well. Their predictions, though, are not always correct.\u003c/p>\n\u003cp>Abbygail, who loved her hand-me-down blanket and the film “Frozen,” had sleep apnea, an irregular heartbeat and was very heavy for her age, according to the lawsuit.\u003c/p>\n\u003cp>Sleep apnea increases the risk of serious complications in surgery and the night after, medical research shows. Given her condition, Abbygail “should have been admitted [to a hospital] and monitored post-procedure,” said Dr. Charles Cote, a retired Harvard pediatric anesthesiology professor who was not involved in the family’s lawsuit.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>The lawsuit says Abbygail’s risk factors “were documented and known by the Defendants,” including the doctor. It said the toddler should have been operated on “in an inpatient setting under hospital care and monitored overnight.”\u003c/p>\n\u003cp>Dr. Michael Marsh performed Abbygail’s tonsillectomy at Executive Park Surgery Center in Fort Smith, Ark.\u003c/p>\n\u003cp>The surgery center’s lawyer declined to comment. The doctor’s lawyer did not return email and voice messages. In court documents responding to the lawsuit, Marsh and the center denied wrongdoing.\u003c/p>\n\u003cp>In the court filing, Marsh said the toddler’s injuries were “the natural progression” of her illness. Executive Park Surgery Center said in a court filing that “no action on their part … was a proximate cause of any damages or injury.” The case was settled.\u003c/p>\n\u003cp>In at least 25 cases, surgery centers opened their doors to ailing and fragile patients who died after simple procedures, such as tonsillectomies, retinal repairs or colonoscopies, KHN and USA TODAY Network found.\u003c/p>\n\u003cp>Medicare asks surgery centers to assess each patient’s risk, but inspectors flagged 122 surgery centers in 2015 and 2016 alone for lapses in risk assessments. Some centers failed to gauge risk at all. Others overlooked their own policies.\u003c/p>\n\u003cp>Doctors can use an anesthesia risk assessment to screen out fragile patients — healthy patients get a score of 1, and a score of 5 means a person is nearly dead.\u003c/p>\n\u003cp>A few states, including Pennsylvania and Rhode Island, bar certain surgery centers from operating on patients with an anesthesia risk score of 4. But most states don’t go that far. They leave such decisions up to doctors.\u003c/p>\n\u003cp>And some of those decisions have been cited in tragic outcomes. Sabino Sifuentes, 74, had survived triple-bypass surgery. But on March 23, 2015, nine minutes after the start of anesthesia for an eye procedure, he became unresponsive, never to be revived, according to a Medicare inspection report. A nurse anesthetist who reviewed the case at Eye-Q Vision Care’s surgery center in Fresno, Calif., told state health inspectors that Sifuentes should have been given a risk score of 4 and his care was “completely mismanaged,” the inspection report says.\u003c/p>\n\u003cp>In response to the family’s lawsuit, the surgery center said Sifuentes’ injury was caused by his own negligence and others’.\u003c/p>\n\u003cp>Five other patients with the same risk score died after routine procedures at surgery centers across the U.S.\u003c/p>\n\u003cp>\u003cstrong>A Widening Niche\u003c/strong>\u003c/p>\n\u003cp>Such tragedies rarely find their way into the discussion when Medicare decides whether to approve new procedures at surgery centers.\u003c/p>\n\u003cp>Take spinal surgery.\u003c/p>\n\u003cp>Until 2015, Medicare wouldn’t pay for it at surgery centers. Then, the industry’s trade association urged the agency to make the change, and encouraged a letter-writing campaign from surgery centers across the nation.\u003c/p>\n\u003cp>Letter writers included Dr. Alan Villavicencio, a Colorado surgeon who said he’d been doing such surgeries for 12 years and found that his patients “appreciate the convenience and cost savings.” He did not mention that James Long, 56, had died three weeks earlier at a Lafayette, Colo., surgery center where he is an owner, a review of Colorado health department and medical board records shows.\u003c/p>\n\u003cp>United Surgical Partners International, a surgery center chain, also weighed in urging even more procedures to be approved, not mentioning a patient death hours after a spine surgery at one of its affiliate centers several months before, according to court records and securities filings. The chain said in a statement that it stands behind its comments in support of the proposal.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Such letters carry weight with Medicare, which approves procedures to be done in surgery centers based on the invasiveness and complexity of the surgery and on input from stakeholders.\u003c/p>\n\u003cp>Robert Beatty-Walters, a Portland, Ore., attorney who has represented the families of three people who died after surgery center spine procedures, said Medicare’s decision-making process is not even-handed.\u003c/p>\n\u003cp>“The stakeholders — they call them — during these regulatory proceedings are the profit-makers, not the people who are being provided the service,” he said. “The spine centers just want to have more people come. They make more money. I hate to be that cynical about it, but that’s just what I’ve seen.”\u003c/p>\n\u003cp>Medicare approved 10 spine-surgery codes to be billed at surgery centers starting in 2015 and added more spinal procedures for 2017. A Medicare spokesman denied a request for a telephone interview. In an email, a spokeswoman said Medicare opened the spine proposal to the public and received no comments suggesting the procedures would pose a threat to Medicare patients. She said the final decision about where a patient will have surgery is up to a doctor and patient.\u003c/p>\n\u003cp>By 2017, at least 14 patients had died soon after spine operations at surgery centers, according to the KHN/USA TODAY Network investigation.\u003c/p>\n\u003cp>The 14 spine-surgery deaths have gleaned little recognition in the industry or beyond. Only one made headlines in local newspapers. The rest are documented in places like the Macon, Ga., courthouse or in obscure regulatory reports. And there may be far more because some states, including New York, Illinois and Florida, disclose no details about surgery center deaths.\u003c/p>\n\u003cp>Paulina Tam’s death at Fremont Surgery Center was a tragic example. At 58, the mother of three had finished careers as a nurse and an educator. Next, she planned to travel the world with her husband of 32 years.\u003c/p>\n\u003cp>“She was the driving force of the family, the spirit I guess,” said her son, Eric Tam, a doctor in New York City, said. “We didn’t expect the worst to happen.”\u003c/p>\n\u003cp>The care she received at the center is documented in court records, EMS reports and a Medicare inspection report that concluded that the center “failed to provide a safe environment for surgery.”\u003c/p>\n\u003cp>Tam’s doctor scheduled her for a procedure to replace two discs in her upper spine on April 7, 2014. Pain from a car crash had bothered her for years. Any such surgery — entering the front of the neck to address pain in the spine — comes with a risk of suffocation, according to the Medicare inspection report.\u003c/p>\n\u003cp>Yet, with her surgeon and anesthesiologist already gone, the only doctor on-site was a digestive health specialist, the inspection report shows. About four hours after her procedure, Tam told a nurse that her surgical collar felt too tight. Then, that she couldn’t breathe.\u003c/p>\n\u003cp>The nurse called a “code blue” just after 6:30 p.m., records say.\u003c/p>\n\u003cp>Medical experts say the first step in helping such patients is removing the surgical staples so the pooled blood can disperse, allowing the patient to breathe.\u003c/p>\n\u003cp>In Tam’s case, staff repeatedly tried and failed to insert a breathing tube through her mouth and into her airway, the inspection report shows. A last-ditch remedy would have been to punch a hole through the front of her throat to restore breathing, but the gastroenterologist later told an inspector that he was “not prepared” to do so.\u003c/p>\n\u003cp>The inability to perform the suffocation-rescue maneuver, the inspection report says, amounted to the center’s “failure to ensure patient safety.”\u003c/p>\n\u003cp>From the time a nurse called 911, it took 24 minutes to get Tam to the nearest hospital, EMS records show. She arrived without a pulse and remained on life support overnight, as her children raced to her bedside to say goodbye.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>The center did not return calls and denied wrongdoing in the court case. Tam’s surgeon declined to discuss the case but filed pleadings in court saying Tam’s “carelessness and negligence” caused her death. It’s unclear what the defense meant by negligence. The case reached a confidential settlement.\u003c/p>\n\u003cp>After Tam’s death, the center told Medicare inspectors that a qualified doctor would stay on-site after all upper-spine cases.\u003c/p>\n\u003cp>Dr. Nancy Epstein, chief of neurosurgical and spine care at New York University Winthrop Hospital, said surgery centers doing delicate work near the spinal cord, windpipe and esophagus in a same-day procedure is “pretty revolting.” But she said the centers are making so much money — “reeling it in hand over fist” that the potential dangers are being ignored.\u003c/p>\n\u003cp>“Medically, it should not be tolerated,” she said, “but it is.”\u003c/p>\n\u003cp>\u003cem>Lindy Washburn of The (Bergen County, N.J.) Record and NorthJersey.com contributed to this report.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>This story was originally published by \u003ca href=\"http://khn.org/\" target=\"_blank\" rel=\"noopener\">Kaiser Health News\u003c/a>.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "FDA Approves First Direct-to-Consumer Test for Breast Cancer Risk",
"title": "FDA Approves First Direct-to-Consumer Test for Breast Cancer Risk",
"headTitle": "Future of You | KQED Future of You | KQED Science",
"content": "\u003cp>Federal regulators approved the first direct-to-consumer test for the BRCA genes, which increase the risk of breast and ovarian cancer, the agency announced on Tuesday.\u003c/p>\n\u003cp>The test for the BRCA1 and BRCA2 genes, from \u003ca href=\"https://www.statnews.com/2017/04/07/genetic-analysis-need-to-know/\" target=\"_blank\" rel=\"noopener\">23andMe\u003c/a>, uses a saliva sample. But it assesses only three of the more than 1,000 known BRCA1/2 mutations, raising concerns that women who are told they do not have any of those variants will be lulled into believing that, as a result, they do not have an elevated risk for breast and ovarian cancer.\u003c/p>\n\u003cp>The three specific BRCA1/BRCA2 breast cancer \u003ca href=\"https://www.kqed.org/futureofyou/439059/why-even-siblings-can-get-different-ancestry-results-from-dna-tests\" target=\"_blank\" rel=\"noopener\">gene mutations \u003c/a>are most common in people with Ashkenazi (Eastern European) Jewish ancestry, accounting for more than 90 percent of their risk of heritable breast and ovarian cancer. But even in this population only 2 percent of women carry any of these three so-called “founder” mutations, the FDA said. Women with one of the mutations have a 45 percent to 85 percent chance of developing breast cancer by age 70, 23andMe said.\u003c/p>\n\u003cp>[contextly_sidebar id=\"n8fyxUwdBRcgBMG96UbMv2Lu8p4ZNItq\"]But these three variants are not the most common BRCA1/BRCA2 mutations in the general population: No more than 0.1 percent of women with non-Ashkenazi ancestry carry the mutations. “A negative result does not rule out the possibility that an individual carries other BRCA mutations that increase cancer risk,” the FDA warned.\u003c/p>\n\u003cp>\u003cstrong>Test Limitations\u003c/strong>\u003cbr>\nThe 23andMe test “is a step forward in the availability of DTC genetic tests,” Donald St. Pierre, acting director of the FDA’s Office of In Vitro Diagnostics and Radiological Health, said in a statement. “But it has a lot of caveats.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The agency therefore warned that individuals and their physicians should not use the test results to make decisions about treatments, including prophylactic removal of the breasts or ovaries. That should be based on more extensive testing. Myriad Genetics, which developed the first BRCA1/2 tests, assesses DNA for thousands of variants; it has long \u003ca href=\"http://investor.myriad.com/releasedetail.cfm?releaseid=1021443\" target=\"_blank\" rel=\"noopener\">warned\u003c/a> that other tests, which came on the market after the Supreme Court threw out Myriad’s key BRCA patents, could mislead women.\u003c/p>\n\u003cp>In addition, most cases of breast cancer are not hereditary, from BRCA or other mutations, but “sporadic,” meaning they arise at random or from smoking, obesity, exposure to toxic chemicals, hormone use, and other environmental factors.[contextly_sidebar id=\"ixqQWxrYKmKKTNT32BcHv1EguBJm96pF\"]\u003c/p>\n\u003cp>“At a minimum, 23andMe should be clear with people about what their test is and isn’t and present the information in a fair and balanced way that the average person can understand,” said Myriad spokesman Ron Rogers, who added that some customers might be uncomfortable about 23andMe’s \u003ca href=\"https://gizmodo.com/what-dna-testing-companies-terrifying-privacy-policies-1819158337\" target=\"_blank\" rel=\"noopener\">selling\u003c/a> of genetic information to third parties.\u003c/p>\n\u003cp>For women with Ashkenazi ancestry, the test “is not too bad as a screen,” said Robert Cook-Deegan of Arizona State University, a longtime scholar in the field of genomics ethics and law. “But for other groups with different founder mutations, and there are many, it won’t help much. There’s a big need for users to understand that nuance, which is not widely understood.”\u003c/p>\n\u003cp>\u003cstrong>Direct-to-Consumer Tests\u003c/strong>\u003cbr>\nThe FDA’s decision was based on data from 23andMe showing that its test can accurately identify the three genetic variants in saliva samples. The privately held company also submitted studies showing that consumers understood the report it will send to customers on what the results might mean, how to interpret them, and where to find additional information.\u003c/p>\n\u003cp>“Being the first and only direct-to-consumer genetics company to receive FDA authorization to test for cancer risk without a prescription is a major milestone for 23andMe and for the consumer,” Anne Wojcicki, 23andMe CEO and co-founder, said in a statement. “We believe it’s important for consumers to have direct and affordable access to this potentially life-saving information. … This authorization is incredibly valuable for those who might not be aware of their Ashkenazi Jewish descent.”\u003c/p>\n\u003cp>She, too, emphasized that “our test does not account for all genetic variants that can cause a higher risk of cancer, and people should continue with their recommended cancer screenings.” Myriad, for instance, has identified some 20,000 BRCA1/2 variants.\u003c/p>\n\u003cp>The decision follows one last year in which the FDA gave 23andMe the go-ahead to sell DNA tests assessing customers’ risk of 10 diseases, including Parkinson’s and late-onset Alzheimer’s. Those were the first FDA-approved direct-to-consumer tests for genetic risk of any disease or condition, which the agency said could help people make lifestyle decisions. At the time, the FDA also warned that genetic risk for complex diseases is not a sure thing: People whose 23andMe test does not find genetic variants that increase the risk of a disease can still develop it, and people whose DNA test shows no disease-causing variants might not.\u003c/p>\n\u003cp>The BRCA test will be part of 23andme’s $199 Health + Ancestry test. Existing customers can opt to receive BRCA information for no additional cost, and as with the other disease-risk tests they as well as new customers must specifically choose to receive the information.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“My libertarian streak says this, properly understood, is a good thing that increases access,” said Cook-Deegan, “although I do worry about proliferation of commercial purveyors as the sources of information and keeping the data.”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Federal regulators approved the first direct-to-consumer test for the BRCA genes, which increase the risk of breast and ovarian cancer, the agency announced on Tuesday.\u003c/p>\n\u003cp>The test for the BRCA1 and BRCA2 genes, from \u003ca href=\"https://www.statnews.com/2017/04/07/genetic-analysis-need-to-know/\" target=\"_blank\" rel=\"noopener\">23andMe\u003c/a>, uses a saliva sample. But it assesses only three of the more than 1,000 known BRCA1/2 mutations, raising concerns that women who are told they do not have any of those variants will be lulled into believing that, as a result, they do not have an elevated risk for breast and ovarian cancer.\u003c/p>\n\u003cp>The three specific BRCA1/BRCA2 breast cancer \u003ca href=\"https://www.kqed.org/futureofyou/439059/why-even-siblings-can-get-different-ancestry-results-from-dna-tests\" target=\"_blank\" rel=\"noopener\">gene mutations \u003c/a>are most common in people with Ashkenazi (Eastern European) Jewish ancestry, accounting for more than 90 percent of their risk of heritable breast and ovarian cancer. But even in this population only 2 percent of women carry any of these three so-called “founder” mutations, the FDA said. Women with one of the mutations have a 45 percent to 85 percent chance of developing breast cancer by age 70, 23andMe said.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>But these three variants are not the most common BRCA1/BRCA2 mutations in the general population: No more than 0.1 percent of women with non-Ashkenazi ancestry carry the mutations. “A negative result does not rule out the possibility that an individual carries other BRCA mutations that increase cancer risk,” the FDA warned.\u003c/p>\n\u003cp>\u003cstrong>Test Limitations\u003c/strong>\u003cbr>\nThe 23andMe test “is a step forward in the availability of DTC genetic tests,” Donald St. Pierre, acting director of the FDA’s Office of In Vitro Diagnostics and Radiological Health, said in a statement. “But it has a lot of caveats.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The agency therefore warned that individuals and their physicians should not use the test results to make decisions about treatments, including prophylactic removal of the breasts or ovaries. That should be based on more extensive testing. Myriad Genetics, which developed the first BRCA1/2 tests, assesses DNA for thousands of variants; it has long \u003ca href=\"http://investor.myriad.com/releasedetail.cfm?releaseid=1021443\" target=\"_blank\" rel=\"noopener\">warned\u003c/a> that other tests, which came on the market after the Supreme Court threw out Myriad’s key BRCA patents, could mislead women.\u003c/p>\n\u003cp>In addition, most cases of breast cancer are not hereditary, from BRCA or other mutations, but “sporadic,” meaning they arise at random or from smoking, obesity, exposure to toxic chemicals, hormone use, and other environmental factors.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>“At a minimum, 23andMe should be clear with people about what their test is and isn’t and present the information in a fair and balanced way that the average person can understand,” said Myriad spokesman Ron Rogers, who added that some customers might be uncomfortable about 23andMe’s \u003ca href=\"https://gizmodo.com/what-dna-testing-companies-terrifying-privacy-policies-1819158337\" target=\"_blank\" rel=\"noopener\">selling\u003c/a> of genetic information to third parties.\u003c/p>\n\u003cp>For women with Ashkenazi ancestry, the test “is not too bad as a screen,” said Robert Cook-Deegan of Arizona State University, a longtime scholar in the field of genomics ethics and law. “But for other groups with different founder mutations, and there are many, it won’t help much. There’s a big need for users to understand that nuance, which is not widely understood.”\u003c/p>\n\u003cp>\u003cstrong>Direct-to-Consumer Tests\u003c/strong>\u003cbr>\nThe FDA’s decision was based on data from 23andMe showing that its test can accurately identify the three genetic variants in saliva samples. The privately held company also submitted studies showing that consumers understood the report it will send to customers on what the results might mean, how to interpret them, and where to find additional information.\u003c/p>\n\u003cp>“Being the first and only direct-to-consumer genetics company to receive FDA authorization to test for cancer risk without a prescription is a major milestone for 23andMe and for the consumer,” Anne Wojcicki, 23andMe CEO and co-founder, said in a statement. “We believe it’s important for consumers to have direct and affordable access to this potentially life-saving information. … This authorization is incredibly valuable for those who might not be aware of their Ashkenazi Jewish descent.”\u003c/p>\n\u003cp>She, too, emphasized that “our test does not account for all genetic variants that can cause a higher risk of cancer, and people should continue with their recommended cancer screenings.” Myriad, for instance, has identified some 20,000 BRCA1/2 variants.\u003c/p>\n\u003cp>The decision follows one last year in which the FDA gave 23andMe the go-ahead to sell DNA tests assessing customers’ risk of 10 diseases, including Parkinson’s and late-onset Alzheimer’s. Those were the first FDA-approved direct-to-consumer tests for genetic risk of any disease or condition, which the agency said could help people make lifestyle decisions. At the time, the FDA also warned that genetic risk for complex diseases is not a sure thing: People whose 23andMe test does not find genetic variants that increase the risk of a disease can still develop it, and people whose DNA test shows no disease-causing variants might not.\u003c/p>\n\u003cp>The BRCA test will be part of 23andme’s $199 Health + Ancestry test. Existing customers can opt to receive BRCA information for no additional cost, and as with the other disease-risk tests they as well as new customers must specifically choose to receive the information.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“My libertarian streak says this, properly understood, is a good thing that increases access,” said Cook-Deegan, “although I do worry about proliferation of commercial purveyors as the sources of information and keeping the data.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>When patients arrive in the emergency room, nearly all but those with the most minor complaints get an IV.\u003c/p>\n\u003cp>To draw blood, give medications or administer fluids, the IV is the way doctors and nurses gain access to the body. Putting one in is quick and simple, and it's no more painful than a mild bee sting.\u003c/p>\n\u003cp>Yet for some patients, this routine procedure becomes excruciating. On my shifts as an emergency physician, I began to notice a strange pattern. These hypersensitive patients often had a history of using opioids.\u003c/p>\n\u003cp>Shouldn't these patients be less susceptible to pain, instead of more so?\u003c/p>\n\u003cp>As I looked into it, I found that I was far from the first to notice the paradox of heightened pain sensitivity with opioid use. An English physician in 1870 \u003ca href=\"http://publikationen.ub.uni-frankfurt.de/frontdoor/index/index/year/2013/docId/9551\" target=\"_blank\" rel=\"noopener\">reported\u003c/a> on morphine's tendency to \"encourage the very pain it pretends to relieve.\" In 1880, a German doctor named Rossbach \u003ca href=\"https://academic.oup.com/painmedicine/article/16/suppl_1/S32/2472483\" target=\"_blank\" rel=\"noopener\">described\u003c/a> a similar hypersensitivity to pain with opioid dependence.[contextly_sidebar id=\"JdvyNC50xeYkStqD74JGNEYfNupPuvtu\"]\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>A century passed before the phenomenon received serious scientific attention. That is when American scientists \u003ca href=\"http://jpet.aspetjournals.org/content/177/3/509.long\" target=\"_blank\" rel=\"noopener\">showed\u003c/a> that rats exhibited increased sensitivity to pain after exposure to morphine, a phenomenon that became known as opioid-induced hyperalgesia.\u003c/p>\n\u003cp>By the 1990s, the \u003ca href=\"http://anesthesiology.pubs.asahq.org/article.aspx?articleid=1923441\" target=\"_blank\" rel=\"noopener\">evidence\u003c/a> of this unusual reaction in animals was strong, but whether it occurred in humans wasn't clear.\u003c/p>\n\u003cp>A hint came in 1994, when researchers \u003ca href=\"http://www.jpsmjournal.com/article/0885-3924(94)90203-8/pdf\" target=\"_blank\" rel=\"noopener\">found\u003c/a> that active heroin users were more sensitive to pain than expected. Other investigators took note, and by decade's end, a half-dozen studies had demonstrated similar results among heroin users as well as among recovering users on methadone.\u003c/p>\n\u003cp>But had these people used heroin because they had always been more sensitive to pain, perhaps from birth? The studies couldn't say.\u003c/p>\n\u003cp>In 2006, a group of Stanford researchers \u003ca href=\"http://www.jpain.org/article/S1526-5900(05)00826-6/fulltext\" target=\"_blank\" rel=\"noopener\">attempted\u003c/a> to tease apart this question. The scientists measured pain thresholds in patients with back pain before and after four months of oral morphine. The researchers found that the patients had become significantly more sensitive to pain by the study's end.\u003c/p>\n\u003cp>Another way that scientists have tried to approach the problem is by studying opioids used during surgery. Several \u003ca href=\"http://www.jcvaonline.com/article/S1053-0770(15)00049-X/fulltext\" target=\"_blank\" rel=\"noopener\">studies\u003c/a> have shown that patients randomized to receive higher doses of opioids during operations have worse pain afterward than patients who received smaller doses or a placebo. Similarly, giving short-acting opioids to healthy volunteers has been found to \u003ca href=\"https://insights.ovid.com/pubmed?pmid=14581110\" target=\"_blank\" rel=\"noopener\">heighten\u003c/a> their sensitivity to pain.\u003c/p>\n\u003cp>Taken together, these findings do seem to suggest that exposure to opioids can paradoxically increase pain, but Martin Angst, a Stanford anesthesiologist, points out a problem common to all of these studies: Were these patients just becoming tolerant to the painkillers?\u003c/p>\n\u003cp>\"Is this hyperalgesia? Is this tolerance?\" he told me. \"Nobody can say.\"\u003c/p>\n\u003cp>The questions have plagued much of the research. In pharmacology, tolerance refers to decreasing efficacy of a drug with repeated use. Not all medications are subject to this effect, but opioids certainly are. Over time, they simply don't work as well, and the original pain returns.\u003c/p>\n\u003cp>Doctors often increase the dose to counteract this effect, which works until the patient becomes tolerant to the increased amount of medicine. The result can be an upward spiral, with no clear end in sight.[contextly_sidebar id=\"tYIZr9XqaiXC4XWGHMvv6XDQ7lK72GDt\"]\u003c/p>\n\u003cp>But there is a drawback to this approach. If worsening pain is due to opioid-induced hyperalgesia rather than tolerance, then \"increasing the dose will only make the pain worse,\" explains Caroline Arout, a scientist at the New York State Psychiatric Institute. While tolerance is characterized by desensitization of neural pain pathways, which can be overcome by higher doses, opioid-induced hyperalgesia is the result of hypersensitization of those pathways, she says.\u003c/p>\n\u003cp>\"This could be a major factor in the opioid crisis,\" Arout says. \"People have worsening pain, and so their dose is often increased because they are thought to be tolerant.\" But the result is that some patients may find themselves taking dangerously high doses while their pain continues to intensify.\u003c/p>\n\u003cp>So how common is opioid-induced hyperalgesia? \"This is the million-dollar question,\" Stanford's Angst answers. \"We just don't know.\"\u003c/p>\n\u003cp>Although the current research isn't definitive, Angst says opioid-induced hyperalgesia strikes him as a serious problem. Addressing it may require adopting a new perspective on pain.\u003c/p>\n\u003cp>Pain is a critical adaptation for survival, even in the era of modern medicine. \"Think of pain in a different way, as a very useful thing to the body,\" he says. Pain in the abdomen can sometimes herald appendicitis, or some other dangerous infection. And chest pain is a cardinal symptom of heart attacks.\u003c/p>\n\u003cp>\"When we overwhelm the system with large doses of opioids — does the system fight back?\" Angst asks.\u003c/p>\n\u003cp>\"We have to accept that there are limitations to any biological system, and if you exceed them, then bad things will happen,\" he says. \"And one of those things may be opioid-induced hyperalgesia.\"\u003c/p>\n\u003chr>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Clayton Dalton is a resident physician at Massachusetts General Hospital in Boston.\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit \u003ca href=\"http://www.npr.org/\" target=\"_blank\" rel=\"noopener\">http://www.npr.org/\u003c/a>.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=When+Opioids+Make+Pain+Worse+&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>When patients arrive in the emergency room, nearly all but those with the most minor complaints get an IV.\u003c/p>\n\u003cp>To draw blood, give medications or administer fluids, the IV is the way doctors and nurses gain access to the body. Putting one in is quick and simple, and it's no more painful than a mild bee sting.\u003c/p>\n\u003cp>Yet for some patients, this routine procedure becomes excruciating. On my shifts as an emergency physician, I began to notice a strange pattern. These hypersensitive patients often had a history of using opioids.\u003c/p>\n\u003cp>Shouldn't these patients be less susceptible to pain, instead of more so?\u003c/p>\n\u003cp>As I looked into it, I found that I was far from the first to notice the paradox of heightened pain sensitivity with opioid use. An English physician in 1870 \u003ca href=\"http://publikationen.ub.uni-frankfurt.de/frontdoor/index/index/year/2013/docId/9551\" target=\"_blank\" rel=\"noopener\">reported\u003c/a> on morphine's tendency to \"encourage the very pain it pretends to relieve.\" In 1880, a German doctor named Rossbach \u003ca href=\"https://academic.oup.com/painmedicine/article/16/suppl_1/S32/2472483\" target=\"_blank\" rel=\"noopener\">described\u003c/a> a similar hypersensitivity to pain with opioid dependence.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>A century passed before the phenomenon received serious scientific attention. That is when American scientists \u003ca href=\"http://jpet.aspetjournals.org/content/177/3/509.long\" target=\"_blank\" rel=\"noopener\">showed\u003c/a> that rats exhibited increased sensitivity to pain after exposure to morphine, a phenomenon that became known as opioid-induced hyperalgesia.\u003c/p>\n\u003cp>By the 1990s, the \u003ca href=\"http://anesthesiology.pubs.asahq.org/article.aspx?articleid=1923441\" target=\"_blank\" rel=\"noopener\">evidence\u003c/a> of this unusual reaction in animals was strong, but whether it occurred in humans wasn't clear.\u003c/p>\n\u003cp>A hint came in 1994, when researchers \u003ca href=\"http://www.jpsmjournal.com/article/0885-3924(94)90203-8/pdf\" target=\"_blank\" rel=\"noopener\">found\u003c/a> that active heroin users were more sensitive to pain than expected. Other investigators took note, and by decade's end, a half-dozen studies had demonstrated similar results among heroin users as well as among recovering users on methadone.\u003c/p>\n\u003cp>But had these people used heroin because they had always been more sensitive to pain, perhaps from birth? The studies couldn't say.\u003c/p>\n\u003cp>In 2006, a group of Stanford researchers \u003ca href=\"http://www.jpain.org/article/S1526-5900(05)00826-6/fulltext\" target=\"_blank\" rel=\"noopener\">attempted\u003c/a> to tease apart this question. The scientists measured pain thresholds in patients with back pain before and after four months of oral morphine. The researchers found that the patients had become significantly more sensitive to pain by the study's end.\u003c/p>\n\u003cp>Another way that scientists have tried to approach the problem is by studying opioids used during surgery. Several \u003ca href=\"http://www.jcvaonline.com/article/S1053-0770(15)00049-X/fulltext\" target=\"_blank\" rel=\"noopener\">studies\u003c/a> have shown that patients randomized to receive higher doses of opioids during operations have worse pain afterward than patients who received smaller doses or a placebo. Similarly, giving short-acting opioids to healthy volunteers has been found to \u003ca href=\"https://insights.ovid.com/pubmed?pmid=14581110\" target=\"_blank\" rel=\"noopener\">heighten\u003c/a> their sensitivity to pain.\u003c/p>\n\u003cp>Taken together, these findings do seem to suggest that exposure to opioids can paradoxically increase pain, but Martin Angst, a Stanford anesthesiologist, points out a problem common to all of these studies: Were these patients just becoming tolerant to the painkillers?\u003c/p>\n\u003cp>\"Is this hyperalgesia? Is this tolerance?\" he told me. \"Nobody can say.\"\u003c/p>\n\u003cp>The questions have plagued much of the research. In pharmacology, tolerance refers to decreasing efficacy of a drug with repeated use. Not all medications are subject to this effect, but opioids certainly are. Over time, they simply don't work as well, and the original pain returns.\u003c/p>\n\u003cp>Doctors often increase the dose to counteract this effect, which works until the patient becomes tolerant to the increased amount of medicine. The result can be an upward spiral, with no clear end in sight.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>But there is a drawback to this approach. If worsening pain is due to opioid-induced hyperalgesia rather than tolerance, then \"increasing the dose will only make the pain worse,\" explains Caroline Arout, a scientist at the New York State Psychiatric Institute. While tolerance is characterized by desensitization of neural pain pathways, which can be overcome by higher doses, opioid-induced hyperalgesia is the result of hypersensitization of those pathways, she says.\u003c/p>\n\u003cp>\"This could be a major factor in the opioid crisis,\" Arout says. \"People have worsening pain, and so their dose is often increased because they are thought to be tolerant.\" But the result is that some patients may find themselves taking dangerously high doses while their pain continues to intensify.\u003c/p>\n\u003cp>So how common is opioid-induced hyperalgesia? \"This is the million-dollar question,\" Stanford's Angst answers. \"We just don't know.\"\u003c/p>\n\u003cp>Although the current research isn't definitive, Angst says opioid-induced hyperalgesia strikes him as a serious problem. Addressing it may require adopting a new perspective on pain.\u003c/p>\n\u003cp>Pain is a critical adaptation for survival, even in the era of modern medicine. \"Think of pain in a different way, as a very useful thing to the body,\" he says. Pain in the abdomen can sometimes herald appendicitis, or some other dangerous infection. And chest pain is a cardinal symptom of heart attacks.\u003c/p>\n\u003cp>\"When we overwhelm the system with large doses of opioids — does the system fight back?\" Angst asks.\u003c/p>\n\u003cp>\"We have to accept that there are limitations to any biological system, and if you exceed them, then bad things will happen,\" he says. \"And one of those things may be opioid-induced hyperalgesia.\"\u003c/p>\n\u003chr>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Clayton Dalton is a resident physician at Massachusetts General Hospital in Boston.\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit \u003ca href=\"http://www.npr.org/\" target=\"_blank\" rel=\"noopener\">http://www.npr.org/\u003c/a>.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=When+Opioids+Make+Pain+Worse+&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>When she started collecting brains, neuroscientist Yasmin Hurd’s peers wondered what she could possibly be thinking.\u003c/p>\n\u003cp>Studying animals made way more sense as a way to trace how chronic drug use changes the brain, they thought — after all, how was Hurd going to parse the long-term effects from the trauma of the overdoses that killed the brain donors?\u003c/p>\n\u003cp>She waved her colleagues off. She wanted to know what was happening in human brains, not in mice.[contextly_sidebar id=\"xjgcW8qRPdqM7MN9tkvvBeggkwrVyhgv\"]\u003c/p>\n\u003cp>So she began filling up freezers with slices of brain tissue from hundreds of overdose victims, most of them killed by too much cocaine.\u003c/p>\n\u003cp>“We had a lot of freezers, sadly,” said Hurd, who now runs the Addiction Institute at the Mount Sinai School of Medicine. And then, early in the 2000s, she noticed a tidal shift: Suddenly, the overdoses were dominated by heroin.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>She saw the opioid crisis coming. Ever since, she’s been trying to figure out how to intervene — could she modify or reverse the way addiction changed the brains being studied in her lab?\u003c/p>\n\u003cp>Hurd has honed in on cannabidiol, one of the two main compounds plucked from the marijuana plant. She thinks it might hold the potential to curb cravings for heroin and other opioids.\u003c/p>\n\u003cp>She’s running against the wind. Cannabidiol is classified as a Schedule I drug, meaning the U.S. government thinks it carries severe safety concerns, no medicinal benefits, and a high risk of abuse. Even as a growing number of states legalize marijuana, the hard-line federal stance has made it difficult to do clinical research involving cannabis in this country.\u003c/p>\n\u003caside class=\"pullquote alignright\">'You have to treat every epidemic the same, whether it’s a drug epidemic or a viral epidemic.'\u003ccite>Dr. Yasmin Hurd\u003c/cite>\u003c/aside>\n\u003cp>But Hurd is throwing all of her weight into studying whether it can combat addiction. And she’s trying to rally other scientists to do the same, by creating a consortium to conduct cannabidiol clinical trials across the globe.\u003c/p>\n\u003cp>“If this is something that could be potentially beneficial, and there’s an indication that it could be beneficial,” Hurd said in an interview, “why not put all hands on deck?”\u003c/p>\n\u003cp>Hurd has the reputation and academic standing to pull this off — last fall, she was named to the prestigious National Academy of Medicine, along with dozens of other top-tier researchers.\u003c/p>\n\u003cp>More than that, she has determination: On the front of her computer screen, she’s stuck up a yellow Post-it note that says, “GAIN CONTROL.” Only she’s crossed out “GAIN,” and replaced it with “TAKE.”\u003c/p>\n\u003cp>\u003cstrong>Unraveling The Biology of Addiction\u003cbr>\n\u003c/strong>Hurd has always had what she calls a “pure fascination” with the brain. Her own bounces quickly from one thought to the next, sometimes leaving threads unfinished for the sake of starting a new one. One idea may spin off into a dozen new ones. During a recent interview, she jumped from why she finds outliers in science so intriguing to why she loves murder mysteries (Alfred Hitchcock is a personal favorite).\u003c/p>\n\u003cp>That mental multitasking is mirrored in her lab, where her team is working on a slew of projects, from how chronic drug use restructures the brain to how the brain’s circuits play a role in psychiatric disease.\u003c/p>\n\u003cp>“My research, unfortunately, reflects me,” she said.\u003c/p>\n\u003cp>Her mind is constantly hunting for new ideas in unlikely, often difficult places — like on the list of Schedule I drugs.\u003c/p>\n\u003cp>Past studies have shown that cannabidiol works on a number of brain circuits involved in addiction and drug-seeking behavior. That’s made it an exciting pharmacological target — but the data, by and large, have just been preliminary and unpersuasive. Hurd started looking for more concrete evidence on cannabidiol.\u003c/p>\n\u003caside class=\"pullquote alignright\">'The hard-line federal stance has made it difficult to do clinical research involving cannabis in this country.'\u003c/aside>\n\u003cp>The compound is one of the two main cannabinoids found in the marijuana plant, the other being tetrahydrocannabinol, or THC. But unlike THC, cannabidiol doesn’t get people high. Scientists are studying whether the compound can treat conditions such as epilepsy and anxiety. Hurd is testing whether cannabidiol can cut down on cravings in patients who are addicted to opioids — and in turn, can prevent relapse.\u003c/p>\n\u003cp>In her research on animals, the compound has decreased cravings and anxiety without producing any psychoactive effects. But she’s not sure why, exactly, it’s working. So at the same time, she’s orchestrating studies to delve into the biology that underlies addiction.\u003c/p>\n\u003cp>Some quick background: The neurons in the brain talk to each other through neurotransmitters such as dopamine, serotonin, and endocannabinoids. Those chemical messengers ferry information between brain cells through a synapse, which is the intersection between two neurons. Drugs like heroin are like a car crash — they damage those synapses to the point that other cars can’t get through.[contextly_sidebar id=\"lXwRcOY5jUafks0cGN2BzjpnPSmw1csG\"]\u003c/p>\n\u003cp>Hurd’s lab is studying the wreckage through research like the experiment that one of her postdoctoral researchers, Noel Warren, is working on. Warren hits rat neurons with a compound that mimics chronic heroin use to see how synaptic plasticity — the way the brain changes the connections among neurons, forming new ones while pruning others — is different in the brain after drug use.\u003c/p>\n\u003cp>Based on her findings, Hurd has launched trials to test cannabidiol in humans — but that’s no easy task.\u003c/p>\n\u003cp>\u003cstrong>‘The Hurdles Are Enormous’\u003cbr>\n\u003c/strong>Studying cannabidiol is daunting, and not just because the brain is so complex. To use cannabidiol or any part of the cannabis plant for research, a scientist has to get a special license from the Drug Enforcement Administration, which can take years. Then, scientists have to get approval from the Food and Drug Administration to administer it to patients.\u003c/p>\n\u003cp>“The hurdles are enormous,” said Margaret Haney, a neurobiologist at Columbia University who studies cannabis use disorder and the therapeutic potential of cannabinoids in humans. Haney has to keep the cannabis used in her trials in a gun safe that’s stashed inside a freezer that’s sitting in a special room in her lab that can only be accessed with her fingerprint. That’s routine for cannabis research.\u003c/p>\n\u003cp>\u003cimg class=\" wp-image-128930 alignleft\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/03/medmar-800x533.jpg\" alt=\"\" width=\"423\" height=\"282\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2016/03/medmar-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2016/03/medmar-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2016/03/medmar-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2016/03/medmar-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2016/03/medmar.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2016/03/medmar-960x640.jpg 960w\" sizes=\"(max-width: 423px) 100vw, 423px\">And patients who are enrolled in clinical trials involving cannabis have to come to the lab of the researcher who holds a DEA license to get the drug, which isn’t always doable for individuals with serious medical conditions.\u003c/p>\n\u003cp>“Our hands are tied even though cannabidiol is not addictive,” Hurd said. But because it derives from the cannabis plant, the government classifies it as a Schedule I drug — like heroin, LSD, ecstasy, and peyote — which are considered to be harmful and have no medicinal value.\u003c/p>\n\u003cp>That means there are relatively few scientists doing research involving cannabis, and even fewer studying its potential to treat addiction or testing cannabidiol in humans. Hurd isn’t in a crowded field.\u003c/p>\n\u003cp>“There’s really not that many people that do that,” said Dr. Sachin Patel, of Vanderbilt University, who has done research with cannabis to understand how marijuana exposure early in life raises the risk of psychiatric disorders.\u003c/p>\n\u003cp>And then, there’s the issue of supply.\u003c/p>\n\u003caside class=\"pullquote alignright\">'Our hands are tied even though cannabidiol is not addictive.'\u003ccite>Dr. Yasmin Hurd\u003c/cite>\u003c/aside>\n\u003cp>For decades, the only sanctioned source of marijuana available for U.S. research was the University of Mississippi, which held an exclusive contract with the federal government.\u003c/p>\n\u003cp>“If you’re trying to do a clinical trial and you need cannabidiol, it’s actually quite difficult to get the types of cannabis needed to do the research,” said Patel.\u003c/p>\n\u003cp>Hurd said the restricted supply has made it all but impossible for her to study the specific formulations of cannabidiol she suspects would be the most therapeutic.\u003c/p>\n\u003cp>She is currently running Phase 2 clinical trials in New York to test cannabidiol’s ability to reduce cravings in people addicted to heroin. And she’s initiating similar studies to test cannabidiol soon in Canada and Jamaica.\u003c/p>\n\u003caside class=\"pullquote alignright\">'[T]he process has felt painstakingly slow when people are dying so quickly.'\u003c/aside>\n\u003cp>But for Hurd, the process has felt painstakingly slow when people are dying so quickly. An estimated 63,600 people died of drug overdoses in 2016. Two-thirds of those deaths were caused by opioids.\u003c/p>\n\u003cp>Hurd is frustrated by how both the government is grappling with the crisis. It’s paled in comparison to the response to the Zika virus and other public health concerns in recent years, she said.\u003c/p>\n\u003cp>“People swarmed to do something. That did not happen with the opioid epidemic,” Hurd said.\u003c/p>\n\u003cp>\u003cimg class=\"alignnone wp-image-435640 \" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/09/iStock-594036552-800x668.jpg\" alt=\"\" width=\"384\" height=\"321\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/09/iStock-594036552-800x668.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2017/09/iStock-594036552-160x134.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/09/iStock-594036552-768x641.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2017/09/iStock-594036552-1020x852.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2017/09/iStock-594036552-1180x985.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2017/09/iStock-594036552-960x801.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2017/09/iStock-594036552-240x200.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/09/iStock-594036552-375x313.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/09/iStock-594036552-520x434.jpg 520w, https://ww2.kqed.org/app/uploads/sites/13/2017/09/iStock-594036552.jpg 1895w\" sizes=\"(max-width: 384px) 100vw, 384px\">\u003c/p>\n\u003cp>Why not? Hurd blames it, in large part, on discrimination against people who are addicted to drugs. But if there were more federal funding for research, Hurd said, scientists could accelerate the search for solutions.\u003c/p>\n\u003cp>“You have to treat every epidemic the same,” she said, “whether it’s a drug epidemic or a viral epidemic.”\u003c/p>\n\u003cp>She’s quick to note that she’s not arguing that cannabidiol is a cure-all for the crisis. Hurd just wants to have enough researchers working on the problem that they can quickly say whether something works — or whether it doesn’t — and then move on.\u003c/p>\n\u003cp>Haney, the Columbia neurobiologist, echoed that frustration. The DEA said it has not rescheduled cannabis because there aren’t enough studies to show it has medical potential. But until it’s rescheduled, Haney said, those kind of large, randomized studies won’t really be feasible.\u003c/p>\n\u003cp>“We’re in a vicious cycle,” she said.\u003c/p>\n\u003cp>And dispensaries and cannabis companies in the 29 states that have already legalized medical marijuana don’t have any incentive to fund or conduct clinical trials on the medical benefits, experts say, because they’re already able to sell their products to patients without government approval.\u003c/p>\n\u003cp>“The money-making is all happening outside of any data,” Haney said.\u003c/p>\n\u003cp>So Hurd is trying to spur her fellow scientists to do as much research as possible on the potential of cannabidiol to treat opioid addiction, in a bid to build a cannabinoid consortium. She’s connected with clinicians, pharmacologists, and neuroscientists to talk about how to spur new research. And she’s working to rope in companies interested in cannabidiol, too. Without National Institutes of Health funding for such a project, she’s hopeful they’ll help fund the consortium.\u003c/p>\n\u003cp>Her goal: build an infrastructure that’s far broader than her own.\u003c/p>\n\u003cp>“I don’t need to be the only person in the room studying cannabidiol for opioid addiction,” she said. “It can’t be done with just one little Yasmin Hurd lab.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This article is reproduced with permission from \u003ca href=\"https://www.statnews.com/\" target=\"_blank\" rel=\"noopener\">STAT\u003c/a>. It was first published on Feb. 28, 2018. Find the original story \u003ca href=\"https://www.statnews.com/2018/02/28/marijuana-cannabidiol-opioids-addiction/\" target=\"_blank\" rel=\"noopener\">here\u003c/a>.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>When she started collecting brains, neuroscientist Yasmin Hurd’s peers wondered what she could possibly be thinking.\u003c/p>\n\u003cp>Studying animals made way more sense as a way to trace how chronic drug use changes the brain, they thought — after all, how was Hurd going to parse the long-term effects from the trauma of the overdoses that killed the brain donors?\u003c/p>\n\u003cp>She waved her colleagues off. She wanted to know what was happening in human brains, not in mice.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>So she began filling up freezers with slices of brain tissue from hundreds of overdose victims, most of them killed by too much cocaine.\u003c/p>\n\u003cp>“We had a lot of freezers, sadly,” said Hurd, who now runs the Addiction Institute at the Mount Sinai School of Medicine. And then, early in the 2000s, she noticed a tidal shift: Suddenly, the overdoses were dominated by heroin.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>She saw the opioid crisis coming. Ever since, she’s been trying to figure out how to intervene — could she modify or reverse the way addiction changed the brains being studied in her lab?\u003c/p>\n\u003cp>Hurd has honed in on cannabidiol, one of the two main compounds plucked from the marijuana plant. She thinks it might hold the potential to curb cravings for heroin and other opioids.\u003c/p>\n\u003cp>She’s running against the wind. Cannabidiol is classified as a Schedule I drug, meaning the U.S. government thinks it carries severe safety concerns, no medicinal benefits, and a high risk of abuse. Even as a growing number of states legalize marijuana, the hard-line federal stance has made it difficult to do clinical research involving cannabis in this country.\u003c/p>\n\u003caside class=\"pullquote alignright\">'You have to treat every epidemic the same, whether it’s a drug epidemic or a viral epidemic.'\u003ccite>Dr. Yasmin Hurd\u003c/cite>\u003c/aside>\n\u003cp>But Hurd is throwing all of her weight into studying whether it can combat addiction. And she’s trying to rally other scientists to do the same, by creating a consortium to conduct cannabidiol clinical trials across the globe.\u003c/p>\n\u003cp>“If this is something that could be potentially beneficial, and there’s an indication that it could be beneficial,” Hurd said in an interview, “why not put all hands on deck?”\u003c/p>\n\u003cp>Hurd has the reputation and academic standing to pull this off — last fall, she was named to the prestigious National Academy of Medicine, along with dozens of other top-tier researchers.\u003c/p>\n\u003cp>More than that, she has determination: On the front of her computer screen, she’s stuck up a yellow Post-it note that says, “GAIN CONTROL.” Only she’s crossed out “GAIN,” and replaced it with “TAKE.”\u003c/p>\n\u003cp>\u003cstrong>Unraveling The Biology of Addiction\u003cbr>\n\u003c/strong>Hurd has always had what she calls a “pure fascination” with the brain. Her own bounces quickly from one thought to the next, sometimes leaving threads unfinished for the sake of starting a new one. One idea may spin off into a dozen new ones. During a recent interview, she jumped from why she finds outliers in science so intriguing to why she loves murder mysteries (Alfred Hitchcock is a personal favorite).\u003c/p>\n\u003cp>That mental multitasking is mirrored in her lab, where her team is working on a slew of projects, from how chronic drug use restructures the brain to how the brain’s circuits play a role in psychiatric disease.\u003c/p>\n\u003cp>“My research, unfortunately, reflects me,” she said.\u003c/p>\n\u003cp>Her mind is constantly hunting for new ideas in unlikely, often difficult places — like on the list of Schedule I drugs.\u003c/p>\n\u003cp>Past studies have shown that cannabidiol works on a number of brain circuits involved in addiction and drug-seeking behavior. That’s made it an exciting pharmacological target — but the data, by and large, have just been preliminary and unpersuasive. Hurd started looking for more concrete evidence on cannabidiol.\u003c/p>\n\u003caside class=\"pullquote alignright\">'The hard-line federal stance has made it difficult to do clinical research involving cannabis in this country.'\u003c/aside>\n\u003cp>The compound is one of the two main cannabinoids found in the marijuana plant, the other being tetrahydrocannabinol, or THC. But unlike THC, cannabidiol doesn’t get people high. Scientists are studying whether the compound can treat conditions such as epilepsy and anxiety. Hurd is testing whether cannabidiol can cut down on cravings in patients who are addicted to opioids — and in turn, can prevent relapse.\u003c/p>\n\u003cp>In her research on animals, the compound has decreased cravings and anxiety without producing any psychoactive effects. But she’s not sure why, exactly, it’s working. So at the same time, she’s orchestrating studies to delve into the biology that underlies addiction.\u003c/p>\n\u003cp>Some quick background: The neurons in the brain talk to each other through neurotransmitters such as dopamine, serotonin, and endocannabinoids. Those chemical messengers ferry information between brain cells through a synapse, which is the intersection between two neurons. Drugs like heroin are like a car crash — they damage those synapses to the point that other cars can’t get through.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Hurd’s lab is studying the wreckage through research like the experiment that one of her postdoctoral researchers, Noel Warren, is working on. Warren hits rat neurons with a compound that mimics chronic heroin use to see how synaptic plasticity — the way the brain changes the connections among neurons, forming new ones while pruning others — is different in the brain after drug use.\u003c/p>\n\u003cp>Based on her findings, Hurd has launched trials to test cannabidiol in humans — but that’s no easy task.\u003c/p>\n\u003cp>\u003cstrong>‘The Hurdles Are Enormous’\u003cbr>\n\u003c/strong>Studying cannabidiol is daunting, and not just because the brain is so complex. To use cannabidiol or any part of the cannabis plant for research, a scientist has to get a special license from the Drug Enforcement Administration, which can take years. Then, scientists have to get approval from the Food and Drug Administration to administer it to patients.\u003c/p>\n\u003cp>“The hurdles are enormous,” said Margaret Haney, a neurobiologist at Columbia University who studies cannabis use disorder and the therapeutic potential of cannabinoids in humans. Haney has to keep the cannabis used in her trials in a gun safe that’s stashed inside a freezer that’s sitting in a special room in her lab that can only be accessed with her fingerprint. That’s routine for cannabis research.\u003c/p>\n\u003cp>\u003cimg class=\" wp-image-128930 alignleft\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/03/medmar-800x533.jpg\" alt=\"\" width=\"423\" height=\"282\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2016/03/medmar-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2016/03/medmar-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2016/03/medmar-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2016/03/medmar-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2016/03/medmar.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2016/03/medmar-960x640.jpg 960w\" sizes=\"(max-width: 423px) 100vw, 423px\">And patients who are enrolled in clinical trials involving cannabis have to come to the lab of the researcher who holds a DEA license to get the drug, which isn’t always doable for individuals with serious medical conditions.\u003c/p>\n\u003cp>“Our hands are tied even though cannabidiol is not addictive,” Hurd said. But because it derives from the cannabis plant, the government classifies it as a Schedule I drug — like heroin, LSD, ecstasy, and peyote — which are considered to be harmful and have no medicinal value.\u003c/p>\n\u003cp>That means there are relatively few scientists doing research involving cannabis, and even fewer studying its potential to treat addiction or testing cannabidiol in humans. Hurd isn’t in a crowded field.\u003c/p>\n\u003cp>“There’s really not that many people that do that,” said Dr. Sachin Patel, of Vanderbilt University, who has done research with cannabis to understand how marijuana exposure early in life raises the risk of psychiatric disorders.\u003c/p>\n\u003cp>And then, there’s the issue of supply.\u003c/p>\n\u003caside class=\"pullquote alignright\">'Our hands are tied even though cannabidiol is not addictive.'\u003ccite>Dr. Yasmin Hurd\u003c/cite>\u003c/aside>\n\u003cp>For decades, the only sanctioned source of marijuana available for U.S. research was the University of Mississippi, which held an exclusive contract with the federal government.\u003c/p>\n\u003cp>“If you’re trying to do a clinical trial and you need cannabidiol, it’s actually quite difficult to get the types of cannabis needed to do the research,” said Patel.\u003c/p>\n\u003cp>Hurd said the restricted supply has made it all but impossible for her to study the specific formulations of cannabidiol she suspects would be the most therapeutic.\u003c/p>\n\u003cp>She is currently running Phase 2 clinical trials in New York to test cannabidiol’s ability to reduce cravings in people addicted to heroin. And she’s initiating similar studies to test cannabidiol soon in Canada and Jamaica.\u003c/p>\n\u003caside class=\"pullquote alignright\">'[T]he process has felt painstakingly slow when people are dying so quickly.'\u003c/aside>\n\u003cp>But for Hurd, the process has felt painstakingly slow when people are dying so quickly. An estimated 63,600 people died of drug overdoses in 2016. Two-thirds of those deaths were caused by opioids.\u003c/p>\n\u003cp>Hurd is frustrated by how both the government is grappling with the crisis. It’s paled in comparison to the response to the Zika virus and other public health concerns in recent years, she said.\u003c/p>\n\u003cp>“People swarmed to do something. That did not happen with the opioid epidemic,” Hurd said.\u003c/p>\n\u003cp>\u003cimg class=\"alignnone wp-image-435640 \" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/09/iStock-594036552-800x668.jpg\" alt=\"\" width=\"384\" height=\"321\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/09/iStock-594036552-800x668.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2017/09/iStock-594036552-160x134.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/09/iStock-594036552-768x641.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2017/09/iStock-594036552-1020x852.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2017/09/iStock-594036552-1180x985.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2017/09/iStock-594036552-960x801.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2017/09/iStock-594036552-240x200.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/09/iStock-594036552-375x313.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/09/iStock-594036552-520x434.jpg 520w, https://ww2.kqed.org/app/uploads/sites/13/2017/09/iStock-594036552.jpg 1895w\" sizes=\"(max-width: 384px) 100vw, 384px\">\u003c/p>\n\u003cp>Why not? Hurd blames it, in large part, on discrimination against people who are addicted to drugs. But if there were more federal funding for research, Hurd said, scientists could accelerate the search for solutions.\u003c/p>\n\u003cp>“You have to treat every epidemic the same,” she said, “whether it’s a drug epidemic or a viral epidemic.”\u003c/p>\n\u003cp>She’s quick to note that she’s not arguing that cannabidiol is a cure-all for the crisis. Hurd just wants to have enough researchers working on the problem that they can quickly say whether something works — or whether it doesn’t — and then move on.\u003c/p>\n\u003cp>Haney, the Columbia neurobiologist, echoed that frustration. The DEA said it has not rescheduled cannabis because there aren’t enough studies to show it has medical potential. But until it’s rescheduled, Haney said, those kind of large, randomized studies won’t really be feasible.\u003c/p>\n\u003cp>“We’re in a vicious cycle,” she said.\u003c/p>\n\u003cp>And dispensaries and cannabis companies in the 29 states that have already legalized medical marijuana don’t have any incentive to fund or conduct clinical trials on the medical benefits, experts say, because they’re already able to sell their products to patients without government approval.\u003c/p>\n\u003cp>“The money-making is all happening outside of any data,” Haney said.\u003c/p>\n\u003cp>So Hurd is trying to spur her fellow scientists to do as much research as possible on the potential of cannabidiol to treat opioid addiction, in a bid to build a cannabinoid consortium. She’s connected with clinicians, pharmacologists, and neuroscientists to talk about how to spur new research. And she’s working to rope in companies interested in cannabidiol, too. Without National Institutes of Health funding for such a project, she’s hopeful they’ll help fund the consortium.\u003c/p>\n\u003cp>Her goal: build an infrastructure that’s far broader than her own.\u003c/p>\n\u003cp>“I don’t need to be the only person in the room studying cannabidiol for opioid addiction,” she said. “It can’t be done with just one little Yasmin Hurd lab.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>This article is reproduced with permission from \u003ca href=\"https://www.statnews.com/\" target=\"_blank\" rel=\"noopener\">STAT\u003c/a>. It was first published on Feb. 28, 2018. Find the original story \u003ca href=\"https://www.statnews.com/2018/02/28/marijuana-cannabidiol-opioids-addiction/\" target=\"_blank\" rel=\"noopener\">here\u003c/a>.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Tests that measure a woman’s “ovarian reserve” to estimate how many more years of fertility she has have grown increasingly popular. But a new study finds that levels of the hormones commonly tested aren’t tied to lower chances of getting pregnant.\u003c/p>\n\u003cp class=\"danger-zone\">The new research, published in the \u003cem>Journal of the American Medical Association\u003c/em>, looked at three markers: anti-Müllerian hormone (AMH), follicle-stimulating hormone (FSH), and inhibin B.\u003c/p>\n\u003caside class=\"pullquote alignright\">'Women with low values are going to have unnecessary anxiety, and women with high values may be incorrectly reassured.'\u003ccite>Dr. Anne Steiner, University of North Carolina\u003c/cite>\u003c/aside>\n\u003cp>That’s led to a boom in ovarian reserve testing, both in the clinic and with direct-to-consumer tests from companies. One startup, Modern Fertility, is pre-selling a new $149 fertility test that measures FSH, AMH, and other fertility hormones. The company says physicians will tally all those measures up and calculate a “fertility score.” Previous research has correlated levels of the three hormones with the number of eggs a woman has in her ovaries — a measure known as “ovarian reserve.” Studies have suggested that information could be used to predict how well a woman will respond to in vitro fertilization. But in recent years, as more women are delaying pregnancy until later ages, ovarian reserve tests have begun to be used as a way to test for future fertility.\u003c/p>\n\u003cp>“Women are already using these as fertility tests. Over the years, they’ve worked their way into being in the mainstream without evidence,” said Dr. Anne Steiner, a reproductive endocrinologist at the University of North Carolina and one of the study’s authors.\u003c/p>\n\u003cp>“As we get older, fertility becomes a giant egg-shaped question mark,” the company said in an August blog post announcing the test.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>But the new study finds that looking at levels FSH, AMH, and inhibin B isn’t an answer to the question of fertility.\u003c/p>\n\u003cp>Steiner and her colleagues analyzed data from 750 women between ages 30 and 44 who didn’t have any known fertility problems, had been trying to get pregnant for three months or less, and lived with a male partner. Women who had lower levels of the biomarkers — indicating “diminished ovarian reserve” — weren’t any less likely to get pregnant in the first year than women who had higher levels of the biomarkers.\u003c/p>\n\u003cp>In other words, ovarian reserve tests run the risk of giving women an inaccurate impression of their future chances of having children.\u003c/p>\n\u003cp>“Women with low values are going to have unnecessary anxiety, and women with high values may be incorrectly reassured,” Steiner said. She added that women shouldn’t use the tests to decide whether to freeze their eggs.\u003c/p>\n\u003cp>The caveats: The outcome studied was getting pregnant, not carrying a healthy pregnancy fully to term. It also only followed women for the first year they were trying to get pregnant. And the researchers didn’t run any fertility tests on the partners of the women involved in the study — though Steiner pointed out that direct-to-consumer fertility tests only test women’s levels as well.\u003c/p>\n\u003cp>Dr. Stephen Collins of the Yale Fertility Center, who wasn’t affiliated with the study, said that with this evidence in hand, doctors and the makers of direct-to-consumer tests should be upfront about the evidence for FSH, AMH, and inhibin B tests to predict fertility in the short term.\u003c/p>\n\u003cp>“As practitioners, we need to recognize the limitations of the tests that we’re offering,” he said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>\u003cspan style=\"font-weight: 400\">This \u003ca href=\"https://www.statnews.com/2017/10/10/ovarian-reserve-tests-fertility/\" 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/span>\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Tests that measure a woman’s “ovarian reserve” to estimate how many more years of fertility she has have grown increasingly popular. But a new study finds that levels of the hormones commonly tested aren’t tied to lower chances of getting pregnant.\u003c/p>\n\u003cp class=\"danger-zone\">The new research, published in the \u003cem>Journal of the American Medical Association\u003c/em>, looked at three markers: anti-Müllerian hormone (AMH), follicle-stimulating hormone (FSH), and inhibin B.\u003c/p>\n\u003caside class=\"pullquote alignright\">'Women with low values are going to have unnecessary anxiety, and women with high values may be incorrectly reassured.'\u003ccite>Dr. Anne Steiner, University of North Carolina\u003c/cite>\u003c/aside>\n\u003cp>That’s led to a boom in ovarian reserve testing, both in the clinic and with direct-to-consumer tests from companies. One startup, Modern Fertility, is pre-selling a new $149 fertility test that measures FSH, AMH, and other fertility hormones. The company says physicians will tally all those measures up and calculate a “fertility score.” Previous research has correlated levels of the three hormones with the number of eggs a woman has in her ovaries — a measure known as “ovarian reserve.” Studies have suggested that information could be used to predict how well a woman will respond to in vitro fertilization. But in recent years, as more women are delaying pregnancy until later ages, ovarian reserve tests have begun to be used as a way to test for future fertility.\u003c/p>\n\u003cp>“Women are already using these as fertility tests. Over the years, they’ve worked their way into being in the mainstream without evidence,” said Dr. Anne Steiner, a reproductive endocrinologist at the University of North Carolina and one of the study’s authors.\u003c/p>\n\u003cp>“As we get older, fertility becomes a giant egg-shaped question mark,” the company said in an August blog post announcing the test.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>But the new study finds that looking at levels FSH, AMH, and inhibin B isn’t an answer to the question of fertility.\u003c/p>\n\u003cp>Steiner and her colleagues analyzed data from 750 women between ages 30 and 44 who didn’t have any known fertility problems, had been trying to get pregnant for three months or less, and lived with a male partner. Women who had lower levels of the biomarkers — indicating “diminished ovarian reserve” — weren’t any less likely to get pregnant in the first year than women who had higher levels of the biomarkers.\u003c/p>\n\u003cp>In other words, ovarian reserve tests run the risk of giving women an inaccurate impression of their future chances of having children.\u003c/p>\n\u003cp>“Women with low values are going to have unnecessary anxiety, and women with high values may be incorrectly reassured,” Steiner said. She added that women shouldn’t use the tests to decide whether to freeze their eggs.\u003c/p>\n\u003cp>The caveats: The outcome studied was getting pregnant, not carrying a healthy pregnancy fully to term. It also only followed women for the first year they were trying to get pregnant. And the researchers didn’t run any fertility tests on the partners of the women involved in the study — though Steiner pointed out that direct-to-consumer fertility tests only test women’s levels as well.\u003c/p>\n\u003cp>Dr. Stephen Collins of the Yale Fertility Center, who wasn’t affiliated with the study, said that with this evidence in hand, doctors and the makers of direct-to-consumer tests should be upfront about the evidence for FSH, AMH, and inhibin B tests to predict fertility in the short term.\u003c/p>\n\u003cp>“As practitioners, we need to recognize the limitations of the tests that we’re offering,” he said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>\u003cspan style=\"font-weight: 400\">This \u003ca href=\"https://www.statnews.com/2017/10/10/ovarian-reserve-tests-fertility/\" 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/span>\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Farmworkers Want Pesticide Banned in California After EPA Refuses",
"title": "Farmworkers Want Pesticide Banned in California After EPA Refuses",
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"content": "\u003cp>Environmentalists and farmworkers are pushing California regulators to ban the \u003ca href=\"https://www.epa.gov/sites/production/files/2016-05/documents/session-2-chlorpyrifos-human-health-risk-assessment-approach.pdf\" target=\"_blank\" rel=\"noopener\">most commonly\u003c/a> used conventional insecticide in the country. The Environmental Protection Agency under President Obama proposed \u003ca href=\"https://www.gpo.gov/fdsys/pkg/FR-2015-11-06/pdf/2015-28083.pdf\" target=\"_blank\" rel=\"noopener\">banning\u003c/a> chlorpyrifos in 2015 because studies suggest it threatens human health, but the Trump administration \u003ca href=\"https://www.epa.gov/newsreleases/epa-administrator-pruitt-denies-petition-ban-widely-used-pesticide-0\" target=\"_blank\" rel=\"noopener\">reversed\u003c/a> that decision this spring. Now activists are pushing for a statewide ban.\u003c/p>\n\u003cp>\u003cstrong>Clorpyrifos: What Is it? \u003c/strong>\u003c/p>\n\u003cp>Dow Chemical registered chlorpyrifos in 1965. Around 6 million pounds are used nationally every year, and about a million pounds are used annually in California. Farmers use it to kill pests like ants, moths, larvae and worms on about 60 crops, including oranges, alfalfa and almonds.\u003c/p>\n\u003cp>Chlorpyrifos is part of a class of chemicals called organophosphates, which can poison the nervous systems of insects and mammals. \u003ca href=\"https://www.osha.gov/SLTC/emergencypreparedness/guides/nerve.html\" target=\"_blank\" rel=\"noopener\">Sarin gas, \u003c/a>the nerve agent used in chemical warfare, is also an organophosphate, though chlorpyrifos is much less toxic.\u003c/p>\n\u003caside class=\"pullquote alignright\">'They know it impacts children's brains — the question is about what levels.'\u003ccite>Paul Towers, Pesticide Action Network\u003c/cite>\u003c/aside>\n\u003cp>At high doses, nerve agents like chlorpyrifos cause symptoms like headaches, nausea, dizziness and disorientation. If larger doses are ingested, it can lead to vomiting, stomachaches, diarrhea and even death.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The EPA banned chlorpyrifos for the majority of home and garden uses in 2000 due to toxic effects on the nervous system. The agency has also restricted its use on a few commercial crops like apples and tomatoes. A few years ago the U.K. banned the chemical on nearly all crops.\u003c/p>\n\u003cp>\u003cstrong>Trump EPA Revokes Ban\u003cbr>\n\u003c/strong>\u003c/p>\n\u003cp>In March, the new chief of the EPA, Scott Pruitt, rejected the proposed ban, which had been recommended by EPA scientists. In a \u003ca href=\"https://www.epa.gov/newsreleases/epa-administrator-pruitt-denies-petition-ban-widely-used-pesticide-0\">press release\u003c/a> Pruitt said, \"By reversing the previous administration’s steps to ban one of the most widely used pesticides in the world, we are returning to using sound science in decision-making — rather than predetermined results.\" He said the EPA would not make any final decisions on chlorpyrifos until 2022, pending the agency's further scientific review.\u003c/p>\n\u003cp>Pruitt's actions outraged environmentalists and many scientists who have studied the chemical for decades. Activists were further angered this spring when the widely used pesticide Vulcan (whose active ingredient is chlorpyrifos) drifted from a field in Kern County over to a group of farmworkers picking cabbage. Five of them sought medical treatment.\u003c/p>\n\u003cfigure id=\"attachment_435787\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003cimg class=\"wp-image-435787 size-large\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/10/chlorpyrifos-pics-1020x680.jpg\" alt=\"\" width=\"640\" height=\"427\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/10/chlorpyrifos-pics-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2017/10/chlorpyrifos-pics-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/10/chlorpyrifos-pics-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2017/10/chlorpyrifos-pics-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2017/10/chlorpyrifos-pics-1180x786.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2017/10/chlorpyrifos-pics-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2017/10/chlorpyrifos-pics-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/10/chlorpyrifos-pics-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/10/chlorpyrifos-pics-520x347.jpg 520w, https://ww2.kqed.org/app/uploads/sites/13/2017/10/chlorpyrifos-pics.jpg 1280w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003cfigcaption class=\"wp-caption-text\">Protesters near the state Capitol in Sacramento calling for a ban on chlorpyrifos in September 2017. \u003ccite>(Joan Cusick)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>California Tightens Restrictions, But No Ban\u003c/strong>\u003c/p>\n\u003cp>The California Department of Pesticide Regulation is in the midst of reviewing the science on chlorpyrifos to analyze whether a statewide ban is justified. California already had stricter rules related to its application than most states. For example, farmers must have a permit to apply the chemical; they must post a warning after they spray a field; and the state requires buffer zones between sprayed fields and human dwellings.\u003c/p>\n\u003cp>Last week CDPR implemented even stricter rules while it completes its lengthy scientific review. The interim guidelines require greater distances between fields sprayed with chlorpyrifos and \"sensitive areas\" like homes. The distances are now up to 500 feet, about three times longer than previous requirements.\u003c/p>\n\u003cp>“Our scientists have figured out a way that we can use this pesticide with protections and restrictions in place safely in California,\" said CDPR spokeswoman Charlotte Fadipe. \"And we are saying we want more scientific eyes on this to see if those restrictions are robust enough or whether we need to do more.”\u003c/p>\n\u003cp>But the enhanced mitigation does not satisfy activists.\u003c/p>\n\u003cp>\"We are calling on DPR to hit the pause button on continued use of this chemical based on what they know, \" said Paul Towers of Pesticide Action Network. \"They know it impacts children's brains -- the question is about what levels. So while we determine that through two different lengthy scientific bodies we should suspend the use of chlorpyrifos in California.\"\u003c/p>\n\u003cp>When EPA scientists proposed banning chlorpyrifos in November 2015, their recommendation was based on the \u003ca href=\"http://unesdoc.unesco.org/images/0013/001395/139578e.pdf\">precautionary \u003c/a>principle: better to err on the side of caution rather than putting anyone at risk. Towers is calling on state regulators to take the same stance to protect agricultural communities.\u003c/p>\n\u003cfigure id=\"attachment_435850\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"wp-image-435850 size-medium\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/10/JCP_2026-X2-800x533.jpg\" alt=\"\" width=\"800\" height=\"533\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/10/JCP_2026-X2-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2017/10/JCP_2026-X2-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/10/JCP_2026-X2-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2017/10/JCP_2026-X2-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2017/10/JCP_2026-X2-1180x786.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2017/10/JCP_2026-X2-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2017/10/JCP_2026-X2-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/10/JCP_2026-X2-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/10/JCP_2026-X2-520x347.jpg 520w, https://ww2.kqed.org/app/uploads/sites/13/2017/10/JCP_2026-X2.jpg 1280w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">California farmworker protests use of chlorpyrifos at the state capitol in July 2017. \u003ccite>(Joan Cusick)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>Does the Science Justify a Ban?\u003cbr>\n\u003c/strong>\u003c/p>\n\u003cp>The majority of research available has looked at how exposure to chlorpyrifos influences the developing fetus rather than workers in the field. Research shows that prenatal exposure can lead to preterm births, abnormal reflexes in newborns, pervasive attention problems, motor control deficiencies and lower IQ. Scientists have also noted that some young children who have been exposed to the chemical have conditions related to compromised lung function, like asthma.\u003c/p>\n\u003cp>Brenda Eskenazi is an epidemiologist and neuropsychologist at UC Berkeley who has studied organophosphates for many years. She says the EPA under the Obama administration made a sound scientific decision when the agency recommended a ban. “A weight of evidence strongly suggests that chlorpyrifos has sufficient evidence in animals — limited evidence in humans — to restrict or even ban it’s use.”\u003c/p>\n\u003cp>Eskenazi also says chlorpyrifos is not the worst organophosphate used in agriculture; there are other chemicals that may be more toxic to human health. But environmentalists are targeting chlorpyrifos because it is one of the most widely studied chemicals in the world, even though there is still little research on whether residue in produce could impact consumer health.\u003c/p>\n\u003cp>Dow Agrosciences says it remains confident that authorized uses of its product offer wide margins of protection for human health and safety. In a statement the company said, \"Overall, more than 4,000 studies and reports have examined chlorpyrifos in terms of health, safety and the environment. No pest-control product has been or continues to be more thoroughly evaluated.\"\u003c/p>\n\u003cp>Towers draws a different conclusion from the abundance of research.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"If we can't act on this pesticide,\" he say, \"what pesticide can we act on?\"\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Environmentalists and farmworkers are pushing California regulators to ban the \u003ca href=\"https://www.epa.gov/sites/production/files/2016-05/documents/session-2-chlorpyrifos-human-health-risk-assessment-approach.pdf\" target=\"_blank\" rel=\"noopener\">most commonly\u003c/a> used conventional insecticide in the country. The Environmental Protection Agency under President Obama proposed \u003ca href=\"https://www.gpo.gov/fdsys/pkg/FR-2015-11-06/pdf/2015-28083.pdf\" target=\"_blank\" rel=\"noopener\">banning\u003c/a> chlorpyrifos in 2015 because studies suggest it threatens human health, but the Trump administration \u003ca href=\"https://www.epa.gov/newsreleases/epa-administrator-pruitt-denies-petition-ban-widely-used-pesticide-0\" target=\"_blank\" rel=\"noopener\">reversed\u003c/a> that decision this spring. Now activists are pushing for a statewide ban.\u003c/p>\n\u003cp>\u003cstrong>Clorpyrifos: What Is it? \u003c/strong>\u003c/p>\n\u003cp>Dow Chemical registered chlorpyrifos in 1965. Around 6 million pounds are used nationally every year, and about a million pounds are used annually in California. Farmers use it to kill pests like ants, moths, larvae and worms on about 60 crops, including oranges, alfalfa and almonds.\u003c/p>\n\u003cp>Chlorpyrifos is part of a class of chemicals called organophosphates, which can poison the nervous systems of insects and mammals. \u003ca href=\"https://www.osha.gov/SLTC/emergencypreparedness/guides/nerve.html\" target=\"_blank\" rel=\"noopener\">Sarin gas, \u003c/a>the nerve agent used in chemical warfare, is also an organophosphate, though chlorpyrifos is much less toxic.\u003c/p>\n\u003caside class=\"pullquote alignright\">'They know it impacts children's brains — the question is about what levels.'\u003ccite>Paul Towers, Pesticide Action Network\u003c/cite>\u003c/aside>\n\u003cp>At high doses, nerve agents like chlorpyrifos cause symptoms like headaches, nausea, dizziness and disorientation. If larger doses are ingested, it can lead to vomiting, stomachaches, diarrhea and even death.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The EPA banned chlorpyrifos for the majority of home and garden uses in 2000 due to toxic effects on the nervous system. The agency has also restricted its use on a few commercial crops like apples and tomatoes. A few years ago the U.K. banned the chemical on nearly all crops.\u003c/p>\n\u003cp>\u003cstrong>Trump EPA Revokes Ban\u003cbr>\n\u003c/strong>\u003c/p>\n\u003cp>In March, the new chief of the EPA, Scott Pruitt, rejected the proposed ban, which had been recommended by EPA scientists. In a \u003ca href=\"https://www.epa.gov/newsreleases/epa-administrator-pruitt-denies-petition-ban-widely-used-pesticide-0\">press release\u003c/a> Pruitt said, \"By reversing the previous administration’s steps to ban one of the most widely used pesticides in the world, we are returning to using sound science in decision-making — rather than predetermined results.\" He said the EPA would not make any final decisions on chlorpyrifos until 2022, pending the agency's further scientific review.\u003c/p>\n\u003cp>Pruitt's actions outraged environmentalists and many scientists who have studied the chemical for decades. Activists were further angered this spring when the widely used pesticide Vulcan (whose active ingredient is chlorpyrifos) drifted from a field in Kern County over to a group of farmworkers picking cabbage. Five of them sought medical treatment.\u003c/p>\n\u003cfigure id=\"attachment_435787\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003cimg class=\"wp-image-435787 size-large\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/10/chlorpyrifos-pics-1020x680.jpg\" alt=\"\" width=\"640\" height=\"427\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/10/chlorpyrifos-pics-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2017/10/chlorpyrifos-pics-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/10/chlorpyrifos-pics-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2017/10/chlorpyrifos-pics-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2017/10/chlorpyrifos-pics-1180x786.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2017/10/chlorpyrifos-pics-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2017/10/chlorpyrifos-pics-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/10/chlorpyrifos-pics-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/10/chlorpyrifos-pics-520x347.jpg 520w, https://ww2.kqed.org/app/uploads/sites/13/2017/10/chlorpyrifos-pics.jpg 1280w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003cfigcaption class=\"wp-caption-text\">Protesters near the state Capitol in Sacramento calling for a ban on chlorpyrifos in September 2017. \u003ccite>(Joan Cusick)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>California Tightens Restrictions, But No Ban\u003c/strong>\u003c/p>\n\u003cp>The California Department of Pesticide Regulation is in the midst of reviewing the science on chlorpyrifos to analyze whether a statewide ban is justified. California already had stricter rules related to its application than most states. For example, farmers must have a permit to apply the chemical; they must post a warning after they spray a field; and the state requires buffer zones between sprayed fields and human dwellings.\u003c/p>\n\u003cp>Last week CDPR implemented even stricter rules while it completes its lengthy scientific review. The interim guidelines require greater distances between fields sprayed with chlorpyrifos and \"sensitive areas\" like homes. The distances are now up to 500 feet, about three times longer than previous requirements.\u003c/p>\n\u003cp>“Our scientists have figured out a way that we can use this pesticide with protections and restrictions in place safely in California,\" said CDPR spokeswoman Charlotte Fadipe. \"And we are saying we want more scientific eyes on this to see if those restrictions are robust enough or whether we need to do more.”\u003c/p>\n\u003cp>But the enhanced mitigation does not satisfy activists.\u003c/p>\n\u003cp>\"We are calling on DPR to hit the pause button on continued use of this chemical based on what they know, \" said Paul Towers of Pesticide Action Network. \"They know it impacts children's brains -- the question is about what levels. So while we determine that through two different lengthy scientific bodies we should suspend the use of chlorpyrifos in California.\"\u003c/p>\n\u003cp>When EPA scientists proposed banning chlorpyrifos in November 2015, their recommendation was based on the \u003ca href=\"http://unesdoc.unesco.org/images/0013/001395/139578e.pdf\">precautionary \u003c/a>principle: better to err on the side of caution rather than putting anyone at risk. Towers is calling on state regulators to take the same stance to protect agricultural communities.\u003c/p>\n\u003cfigure id=\"attachment_435850\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"wp-image-435850 size-medium\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/10/JCP_2026-X2-800x533.jpg\" alt=\"\" width=\"800\" height=\"533\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/10/JCP_2026-X2-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2017/10/JCP_2026-X2-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/10/JCP_2026-X2-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2017/10/JCP_2026-X2-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2017/10/JCP_2026-X2-1180x786.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2017/10/JCP_2026-X2-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2017/10/JCP_2026-X2-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/10/JCP_2026-X2-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/10/JCP_2026-X2-520x347.jpg 520w, https://ww2.kqed.org/app/uploads/sites/13/2017/10/JCP_2026-X2.jpg 1280w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">California farmworker protests use of chlorpyrifos at the state capitol in July 2017. \u003ccite>(Joan Cusick)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>Does the Science Justify a Ban?\u003cbr>\n\u003c/strong>\u003c/p>\n\u003cp>The majority of research available has looked at how exposure to chlorpyrifos influences the developing fetus rather than workers in the field. Research shows that prenatal exposure can lead to preterm births, abnormal reflexes in newborns, pervasive attention problems, motor control deficiencies and lower IQ. Scientists have also noted that some young children who have been exposed to the chemical have conditions related to compromised lung function, like asthma.\u003c/p>\n\u003cp>Brenda Eskenazi is an epidemiologist and neuropsychologist at UC Berkeley who has studied organophosphates for many years. She says the EPA under the Obama administration made a sound scientific decision when the agency recommended a ban. “A weight of evidence strongly suggests that chlorpyrifos has sufficient evidence in animals — limited evidence in humans — to restrict or even ban it’s use.”\u003c/p>\n\u003cp>Eskenazi also says chlorpyrifos is not the worst organophosphate used in agriculture; there are other chemicals that may be more toxic to human health. But environmentalists are targeting chlorpyrifos because it is one of the most widely studied chemicals in the world, even though there is still little research on whether residue in produce could impact consumer health.\u003c/p>\n\u003cp>Dow Agrosciences says it remains confident that authorized uses of its product offer wide margins of protection for human health and safety. In a statement the company said, \"Overall, more than 4,000 studies and reports have examined chlorpyrifos in terms of health, safety and the environment. No pest-control product has been or continues to be more thoroughly evaluated.\"\u003c/p>\n\u003cp>Towers draws a different conclusion from the abundance of research.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"If we can't act on this pesticide,\" he say, \"what pesticide can we act on?\"\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Robotic Exoskeletons Help Kids With Cerebral Palsy Walk (Video)",
"title": "Robotic Exoskeletons Help Kids With Cerebral Palsy Walk (Video)",
"headTitle": "Future of You | KQED Future of You | KQED Science",
"content": "\u003cp>In the first clip, the boy appears to drag his feet as he walks, while his knees — particularly the left one — stay bent throughout his steps.\u003c/p>\n\u003cp>In the second clip, his knees remain bowed inward. But his legs -- now clad in a robotic exoskeleton — swing more as they move, and his feet lift off the ground and his knees bend and flex in time with his step.\u003c/p>\n\u003cp>The boy is one of seven children with cerebral palsy who were outfitted with \u003ca href=\"https://www.statnews.com/2016/08/11/paraplegics-exoskeleton-brain-training/\">exoskeletons\u003c/a> in hopes that the robotic devices could improve their crouched posture, making it easier for them to take simple steps. Those steps will otherwise become more difficult over time; 50 percent of people with cerebral palsy stop walking when they reach adulthood.\u003c/p>\n\u003cp>In \u003ca href=\"http://stm.sciencemag.org/lookup/doi/10.1126/scitranslmed.aam9145\">a study\u003c/a> published Wednesday in the journal Science Translational Medicine, researchers reported that the exoskeletons helped most participants straighten their legs as they walked, alleviating the permanent knee bend that causes the crouching disorder known as “crouch gait.” The researchers also found that while the exoskeletons provided support when it was needed, participants were still in control of their own steps.\u003c/p>\n\u003cp>https://www.youtube.com/watch?v=PPULKI2FRXA\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The study was an initial attempt to show that exoskeleton technology should be explored further as a tool to help children with cerebral palsy maintain mobility, said Thomas Bulea, a biomedical engineer at the National Institutes of Health and one of the paper’s authors. Now, researchers want to determine whether long-term use of the exoskeleton, including outside of a research setting, could ease crouch gait even when the exoskeleton isn’t being worn. The hope is that such extensive training could enable people with cerebral palsy to walk on their own for much longer.“We want to transfer the walking patterns we see with the exoskeleton to walking without the exoskeleton,” Bulea said. “If we can correct or treat this crouch gait at a young age, then throughout their life, we may be able to increase their mobility.”\u003c/p>\n\u003cp>Cerebral palsy is a neurological condition that leads to problems with movement and coordination. With crouch gait, children can often walk on their own, adapting to taking steps in a crouched position. It’s often treated with therapy, surgery, or injections that relax the knee flexors. But still, as people get older and get bigger, it becomes harder to walk.\u003c/p>\n\u003cp>The new research is a long way from showing that exoskeletons would be an effective clinical solution, and many outstanding questions remain.\u003c/p>\n\u003cp>For the study, researchers only recruited children who were still able to walk well independently. They want to investigate whether an exoskeleton could help children who have already lost more mobility, as well as with children with other conditions that lead to mobility problems, such as spina bifida or muscular dystrophy.\u003c/p>\n\u003cp>“It may be useful for some of those kids, but more severe kids may not benefit,” said Dr. Bruce Dobkin, the director of the UCLA Neurological Rehabilitation and Research Program, who was not involved with the study.\u003c/p>\n\u003cp>Moreover, there is the concern that exoskeletons may not help preserve mobility as children age. That has also been the case with some surgeries and medications, Dobkin said. In those cases, the interventions may not be worth the effort or cost, in part because children have an “amazing ability to compensate” and walk with gait problems while they are still ambulatory, he said.\u003c/p>\n\u003caside class=\"pullquote alignright\">'If we can correct or treat this crouch gait at a young age, then throughout their life, we may be able to increase their mobility.'\u003ccite>Thomas Bulea, NIH\u003c/cite>\u003c/aside>\n\u003cp>Still, those are concerns that a longer and larger study could help answer. In this study, six of the seven participants saw improvements in their crouch gait and knee extension, gaining an average of about 13 degrees in knee angle as they stepped. The children also saw improvements over the course of their training sessions, which Bulea said suggests that further gains may be possible with additional exoskeleton use.\u003c/p>\n\u003cp>The researchers hope that they can refine the exoskeletons so they can be worn outside the lab. That could provide the amount of training necessary to extend benefits even when the device isn’t being worn.\u003c/p>\n\u003cp>The study is one of the first attempts to bring exoskeleton technology to children and adolescents. So far, exoskeleton trials have largely been aimed at restoring movement in adults who were paralyzed after a stroke or spinal injury, including the exoskeleton-wearing man who kicked a soccer ball at the start of the 2014 World Cup.\u003c/p>\n\u003cp>In those cases, patients needed the exoskeleton to restore lost movement. But in the new study, the exoskeletons were being used in an attempt to assist children who remain ambulatory and who could still control their own steps. Importantly, the researchers found that the participants maintained their muscle activity while wearing the device.\u003c/p>\n\u003cp>“That shows us that these participants were working with the exoskeleton rather than offloading the knee extension to the robot,” Bulea said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>\u003cspan style=\"font-weight: 400\">This \u003ca href=\"https://www.statnews.com/2017/08/23/cerebral-palsy-exoskeletons/\" target=\"_blank\" rel=\"noopener noreferrer\">story\u003c/a> was originally published by STAT, an online publication of Boston Globe Media that covers health, medicine, and scientific discovery. \u003c/span>\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>In the first clip, the boy appears to drag his feet as he walks, while his knees — particularly the left one — stay bent throughout his steps.\u003c/p>\n\u003cp>In the second clip, his knees remain bowed inward. But his legs -- now clad in a robotic exoskeleton — swing more as they move, and his feet lift off the ground and his knees bend and flex in time with his step.\u003c/p>\n\u003cp>The boy is one of seven children with cerebral palsy who were outfitted with \u003ca href=\"https://www.statnews.com/2016/08/11/paraplegics-exoskeleton-brain-training/\">exoskeletons\u003c/a> in hopes that the robotic devices could improve their crouched posture, making it easier for them to take simple steps. Those steps will otherwise become more difficult over time; 50 percent of people with cerebral palsy stop walking when they reach adulthood.\u003c/p>\n\u003cp>In \u003ca href=\"http://stm.sciencemag.org/lookup/doi/10.1126/scitranslmed.aam9145\">a study\u003c/a> published Wednesday in the journal Science Translational Medicine, researchers reported that the exoskeletons helped most participants straighten their legs as they walked, alleviating the permanent knee bend that causes the crouching disorder known as “crouch gait.” The researchers also found that while the exoskeletons provided support when it was needed, participants were still in control of their own steps.\u003c/p>\u003c/p>\u003cp>\u003cspan class='utils-parseShortcode-shortcodes-__youtubeShortcode__embedYoutube'>\n \u003cspan class='utils-parseShortcode-shortcodes-__youtubeShortcode__embedYoutubeInside'>\n \u003ciframe\n loading='lazy'\n class='utils-parseShortcode-shortcodes-__youtubeShortcode__youtubePlayer'\n type='text/html'\n src='//www.youtube.com/embed/PPULKI2FRXA'\n title='//www.youtube.com/embed/PPULKI2FRXA'\n allowfullscreen='true'\n style='border:0;'>\u003c/iframe>\n \u003c/span>\n \u003c/span>\u003c/p>\u003cp>\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The study was an initial attempt to show that exoskeleton technology should be explored further as a tool to help children with cerebral palsy maintain mobility, said Thomas Bulea, a biomedical engineer at the National Institutes of Health and one of the paper’s authors. Now, researchers want to determine whether long-term use of the exoskeleton, including outside of a research setting, could ease crouch gait even when the exoskeleton isn’t being worn. The hope is that such extensive training could enable people with cerebral palsy to walk on their own for much longer.“We want to transfer the walking patterns we see with the exoskeleton to walking without the exoskeleton,” Bulea said. “If we can correct or treat this crouch gait at a young age, then throughout their life, we may be able to increase their mobility.”\u003c/p>\n\u003cp>Cerebral palsy is a neurological condition that leads to problems with movement and coordination. With crouch gait, children can often walk on their own, adapting to taking steps in a crouched position. It’s often treated with therapy, surgery, or injections that relax the knee flexors. But still, as people get older and get bigger, it becomes harder to walk.\u003c/p>\n\u003cp>The new research is a long way from showing that exoskeletons would be an effective clinical solution, and many outstanding questions remain.\u003c/p>\n\u003cp>For the study, researchers only recruited children who were still able to walk well independently. They want to investigate whether an exoskeleton could help children who have already lost more mobility, as well as with children with other conditions that lead to mobility problems, such as spina bifida or muscular dystrophy.\u003c/p>\n\u003cp>“It may be useful for some of those kids, but more severe kids may not benefit,” said Dr. Bruce Dobkin, the director of the UCLA Neurological Rehabilitation and Research Program, who was not involved with the study.\u003c/p>\n\u003cp>Moreover, there is the concern that exoskeletons may not help preserve mobility as children age. That has also been the case with some surgeries and medications, Dobkin said. In those cases, the interventions may not be worth the effort or cost, in part because children have an “amazing ability to compensate” and walk with gait problems while they are still ambulatory, he said.\u003c/p>\n\u003caside class=\"pullquote alignright\">'If we can correct or treat this crouch gait at a young age, then throughout their life, we may be able to increase their mobility.'\u003ccite>Thomas Bulea, NIH\u003c/cite>\u003c/aside>\n\u003cp>Still, those are concerns that a longer and larger study could help answer. In this study, six of the seven participants saw improvements in their crouch gait and knee extension, gaining an average of about 13 degrees in knee angle as they stepped. The children also saw improvements over the course of their training sessions, which Bulea said suggests that further gains may be possible with additional exoskeleton use.\u003c/p>\n\u003cp>The researchers hope that they can refine the exoskeletons so they can be worn outside the lab. That could provide the amount of training necessary to extend benefits even when the device isn’t being worn.\u003c/p>\n\u003cp>The study is one of the first attempts to bring exoskeleton technology to children and adolescents. So far, exoskeleton trials have largely been aimed at restoring movement in adults who were paralyzed after a stroke or spinal injury, including the exoskeleton-wearing man who kicked a soccer ball at the start of the 2014 World Cup.\u003c/p>\n\u003cp>In those cases, patients needed the exoskeleton to restore lost movement. But in the new study, the exoskeletons were being used in an attempt to assist children who remain ambulatory and who could still control their own steps. Importantly, the researchers found that the participants maintained their muscle activity while wearing the device.\u003c/p>\n\u003cp>“That shows us that these participants were working with the exoskeleton rather than offloading the knee extension to the robot,” Bulea said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>\u003cspan style=\"font-weight: 400\">This \u003ca href=\"https://www.statnews.com/2017/08/23/cerebral-palsy-exoskeletons/\" target=\"_blank\" rel=\"noopener noreferrer\">story\u003c/a> was originally published by STAT, an online publication of Boston Globe Media that covers health, medicine, and scientific discovery. \u003c/span>\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Harsh life experiences appear to leave African-Americans vulnerable to Alzheimer's and other forms of dementia, researchers \u003ca href=\"https://www.alz.org/aaic/2017_news_releases.asp\">reported\u003c/a> Sunday at the Alzheimer's Association International Conference in London.\u003c/p>\n\u003cp>Several teams presented evidence that poverty, disadvantage and stressful life events are strongly associated with cognitive problems in middle age and dementia later in life among African-Americans.\u003c/p>\n\u003cp>The findings could help explain why African-Americans are twice as likely as white Americans to develop dementia. And the research suggests genetic factors are not a major contributor.\u003c/p>\n\u003cp>\"The increased risk seems to be a matter of experience rather than ancestry,\" says \u003ca href=\"http://obgyn.wisc.edu/directory/detail.aspx?id=321\">Megan Zuelsdorff\u003c/a>, a postdoctoral fellow in the Health Disparities Research Scholars Program at the University of Wisconsin-Madison.\u003c/p>\n\u003cp>Scientists have struggled to understand why African-Americans are so likely to develop dementia. They are more likely to have conditions like high blood pressure and diabetes, which can affect the brain. And \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4084964/\">previous research\u003c/a> has found some evidence that African-Americans are more likely to carry genes that raise the risk.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>But more recent studies suggest those explanations are incomplete, says \u003ca href=\"https://divisionofresearch.kaiserpermanente.org/researchers/whitmer-rachel\">Rachel Whitmer\u003c/a>, an epidemiologist with Kaiser Permanente's Division of Research in Northern California.\u003c/p>\n\u003cp>Whitmer has been involved in several studies that accounted for genetic and disease risks when comparing dementia in white and black Americans. \"And we still saw these [racial] differences,\" she says. \"So there is still something there that we are trying to get at.\"\u003c/p>\n\u003cp>The research presented at the Alzheimer's conference suggests the missing factors involve adverse life experiences beginning in childhood. These experiences have already been \u003ca href=\"http://www.ajpmonline.org/article/S0749-3797(98)00017-8/abstract\">linked\u003c/a> to a range of diseases, including heart disease and cancer.\u003c/p>\n\u003cp>\"We're starting to understand how early life stress and early life deprivation can increase your risk of a number of health outcomes in late life,\" Whitmer says. \"And the latest thing is understanding how and why that might affect the brain.\"\u003c/p>\n\u003cp>Whitmer was part of a team that presented results of a study of more than 6,000 Kaiser Permanente health plan members, most born in the 1920s.\u003c/p>\n\u003cp>The team wanted to know whether people who grew up in harsher conditions were more likely to develop dementia. So they looked at people who'd been born in states with high infant mortality rates — an indicator of social problems like poverty and limited access to medical care.\u003c/p>\n\u003cp>White people's risk of dementia wasn't affected by their place of birth. But black people were 40 percent more likely to develop dementia if they'd been born in a state with high infant mortality.\u003c/p>\n\u003cp>\"These people left the state and subsequently moved to northern California, yet there was still this very robust association between being born in a state with high infant mortality and increased risk of dementia,\" Whitmer says.\u003c/p>\n\u003cp>Scientists from the University of Wisconsin presented results of a study of the link between stressful life events and mental function in middle age. They studied more than 1,300 people in their 50s and 60s, including 82 African-Americans.\u003c/p>\n\u003cp>Stressful experiences included having a parent with a drinking problem, financial insecurity, legal issues, divorce, being fired from a job, and the death of a child.\u003c/p>\n\u003cp>African-Americans reported 60 percent more of these stressful events than white Americans. But that was only part of the difference, Zuelsdorff says.\u003c/p>\n\u003cp>\"The impact of these stressful events was stronger in African-Americans than it was in non-Hispanic white participants,\" she says.\u003c/p>\n\u003cp>The researchers discovered this by administering tests that reveal the brain's speed and flexibility in doing certain tasks. These abilities normally decline with age. So the team looked for evidence that stressful events were accelerating this decline.\u003c/p>\n\u003cp>And they found that in white participants, each stressful event added about a year and a half to normal brain aging. But in African-Americans, each event aged the brain an extra four years.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The next challenge for researchers is to figure out precisely how adverse life experiences are changing the brain, Zuelsdorff says. That will mean looking at the effects of stress hormones and seeing whether stress leads to inflammation in the brain, something that has been associated with Alzheimer's.\u003c/p>\n\u003chr>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Stress+And+Poverty+May+Explain+High+Rates+Of+Dementia+In+African-Americans&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>But more recent studies suggest those explanations are incomplete, says \u003ca href=\"https://divisionofresearch.kaiserpermanente.org/researchers/whitmer-rachel\">Rachel Whitmer\u003c/a>, an epidemiologist with Kaiser Permanente's Division of Research in Northern California.\u003c/p>\n\u003cp>Whitmer has been involved in several studies that accounted for genetic and disease risks when comparing dementia in white and black Americans. \"And we still saw these [racial] differences,\" she says. \"So there is still something there that we are trying to get at.\"\u003c/p>\n\u003cp>The research presented at the Alzheimer's conference suggests the missing factors involve adverse life experiences beginning in childhood. These experiences have already been \u003ca href=\"http://www.ajpmonline.org/article/S0749-3797(98)00017-8/abstract\">linked\u003c/a> to a range of diseases, including heart disease and cancer.\u003c/p>\n\u003cp>\"We're starting to understand how early life stress and early life deprivation can increase your risk of a number of health outcomes in late life,\" Whitmer says. \"And the latest thing is understanding how and why that might affect the brain.\"\u003c/p>\n\u003cp>Whitmer was part of a team that presented results of a study of more than 6,000 Kaiser Permanente health plan members, most born in the 1920s.\u003c/p>\n\u003cp>The team wanted to know whether people who grew up in harsher conditions were more likely to develop dementia. So they looked at people who'd been born in states with high infant mortality rates — an indicator of social problems like poverty and limited access to medical care.\u003c/p>\n\u003cp>White people's risk of dementia wasn't affected by their place of birth. But black people were 40 percent more likely to develop dementia if they'd been born in a state with high infant mortality.\u003c/p>\n\u003cp>\"These people left the state and subsequently moved to northern California, yet there was still this very robust association between being born in a state with high infant mortality and increased risk of dementia,\" Whitmer says.\u003c/p>\n\u003cp>Scientists from the University of Wisconsin presented results of a study of the link between stressful life events and mental function in middle age. They studied more than 1,300 people in their 50s and 60s, including 82 African-Americans.\u003c/p>\n\u003cp>Stressful experiences included having a parent with a drinking problem, financial insecurity, legal issues, divorce, being fired from a job, and the death of a child.\u003c/p>\n\u003cp>African-Americans reported 60 percent more of these stressful events than white Americans. But that was only part of the difference, Zuelsdorff says.\u003c/p>\n\u003cp>\"The impact of these stressful events was stronger in African-Americans than it was in non-Hispanic white participants,\" she says.\u003c/p>\n\u003cp>The researchers discovered this by administering tests that reveal the brain's speed and flexibility in doing certain tasks. These abilities normally decline with age. So the team looked for evidence that stressful events were accelerating this decline.\u003c/p>\n\u003cp>And they found that in white participants, each stressful event added about a year and a half to normal brain aging. But in African-Americans, each event aged the brain an extra four years.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The next challenge for researchers is to figure out precisely how adverse life experiences are changing the brain, Zuelsdorff says. That will mean looking at the effects of stress hormones and seeing whether stress leads to inflammation in the brain, something that has been associated with Alzheimer's.\u003c/p>\n\u003chr>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Stress+And+Poverty+May+Explain+High+Rates+Of+Dementia+In+African-Americans&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"info": "Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. Together in Possible, Hoffman and Finger lead enlightening discussions about building a brighter collective future. The show features interviews with visionary guests like Trevor Noah, Sam Altman and Janette Sadik-Khan. Possible paints an optimistic portrait of the world we can create through science, policy, business, art and our shared humanity. It asks: What if everything goes right for once? How can we get there? Each episode also includes a short fiction story generated by advanced AI GPT-4, serving as a thought-provoking springboard to speculate how humanity could leverage technology for good.",
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"soldout": {
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