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"content": "\u003cp>For the millions of people infected with HIV, the best way to manage the disease is antiretroviral therapy, which can lower the amount of HIV replicating in the body to undetectable levels.\u003c/p>\n\u003carticle>\n\u003cdiv class=\"body-text\">\n\u003cp>But antiretroviral therapy (ART) can only manage HIV, never eliminate it — leading people to rely on the \u003ca href=\"https://aidsinfo.nih.gov/guidelines/html/1/adult-and-adolescent-arv/459/cost-considerations-and-antiretroviral-therapy\">expensive drugs\u003c/a> for decades. Plus if ART is halted by these patients, HIV bounces back and its levels rise in a matter of weeks. In 2017 the World Health Organization \u003ca href=\"https://www.who.int/gho/hiv/en/\">reported that of\u003c/a> 36.9 million people living with HIV, 21.7 million were taking ART.\u003c/p>\n\u003cp>A new study of mice charts a preliminary path to eliminating this medication dependency, through an injection of gene-editing \u003ca href=\"https://ghr.nlm.nih.gov/primer/genomicresearch/genomeediting\">CRISPR\u003c/a>.\u003c/p>\n\u003cp>Removing HIV from a person’s body is so hard because “once the virus infects cells [the] viral genome integrates into the host genome and then becomes part of our DNA,” said Kamel Khalili, a neurovirologist at Temple University who co-led the study.\u003c/p>\n\u003cp>Once this integration happens, ART can’t reverse it — at least not on its own. But Khalili and his colleagues found combining CRISPR, which can alter DNA, with ART can remove the lingering signs of HIV in a mouse model of the disease. The collaborative effort between researchers at Temple University and the University of Nebraska Medical Center was \u003ca href=\"https://www.nature.com/articles/s41467-019-10366-y\">reported today in Nature Communications\u003c/a>.\u003c/p>\n\u003cp>Results in mouse models do not always translate into effective treatments in humans, but Fyodor Urnov says this study is an “important next step” in addressing a disease like HIV with a technique.\u003c/p>\n\u003cp>“Gene editing is the first-ever technology we have had to address disease at the DNA level,” said Urnov, who works at the Innovative Genomics Institute at the University of California Berkeley and was not involved in the study.\u003c/p>\n\u003cp>CRISPR, which scientists can program to cut DNA at specific sites, has garnered attention as a potential cure for genetic diseases, such as \u003ca href=\"https://cysticfibrosisnewstoday.com/crisprcas9-approach-for-cystic-fibrosis/\">cystic fibrosis\u003c/a> and \u003ca href=\"https://directorsblog.nih.gov/2019/02/26/more-progress-toward-gene-editing-for-kids-with-muscular-dystrophy/\">muscular dystrophy\u003c/a>. Using CRISPR and ART to develop an HIV cure could eventually eliminate the cost and distribution barriers that come with current treatments. To date, \u003ca href=\"https://www.theguardian.com/society/2019/mar/05/london-patient-becomes-second-man-to-be-cleared-of-aids-virus\">only two people have been cured of HIV\u003c/a>after receiving stem cell therapy to treat cancer. This expensive and invasive treatment has failed in every other HIV patient.\u003c/p>\n\u003cp>But CRISPR comes with its own caveats — namely, at the moment it isn’t as precise as many in the general public might think.\u003c/p>\n\u003ch2>What the Study Did\u003c/h2>\n\u003cp>The researchers used “humanized” mice, meaning mice were infused with the type of human immune cells that HIV infects.\u003c/p>\n\u003cp>In three separate trials, HIV-infected mice were given one of three injection therapies: a slow-release version of the common HIV drug ART, the CRISPR protein that finds and cuts genome-incorporated HIV, or a combination of the two.\u003c/p>\n\u003cp>After four weeks of ART treatment, the researchers dispensed CRISPR into the mice by packaging the protein inside of a completely separate virus, called adeno-associated virus, or AAV. AAV doesn’t cause illness, but it acts like a mail carrier, increasing the circulation of CRISPR. CRISPR then becomes more likely to find and cut out all of the HIV DNA, an essential step to prevent the disease from rebounding.\u003c/p>\n\u003cp>The researchers waited eight weeks after all the mice were taken off of ART, then searched for traces of HIV genetic material in blood, spleen, kidneys, gut, lungs, bone marrow and the brain.\u003c/p>\n\u003cp>After eight ART-free weeks, more than 30 percent of the mice that received ART and CRISPR lacked detectable amounts of HIV in any of the tissues the researchers studied.\u003c/p>\n\u003cp>In contrast, HIV was still detectable in all of the other mice, including those that were treated with ART or CRISPR alone.\u003c/p>\n\u003ch2>A Cautious Way Forward\u003c/h2>\n\u003cp>Though the researchers used “humanized mice,” the technology has a long way to go. “Clinical trials…will not start tonight. It will take a few years,” said Urnov. However, Khalili revealed that early data from preliminary trials in monkeys looks promising.\u003c/p>\n\u003cp>Khalili and his colleagues have applied to the U.S. Food and Drug Administration for permission to start human clinical trials as early as next year. Khalili has also launched a for-profit company that is developing CRISPR-based technology to treat disease.\u003c/p>\n\u003cp>That the technology is moving this fast concerns Zandrea Ambrose, a retrovirologist at the University of Pittsburgh, who was not involved in the study. CRISPR comes with a downside, in that it sometimes accidentally cuts the wrong gene.\u003c/p>\n\u003cp>Relative to other gene editors, CRISPR has fewer of these “off-target effects” as they’re called, but even a single error is worrisome. If CRISPR makes a hazardous mutation, it could disrupt any cell’s normal behavior and cause an inadvertent disease.\u003c/p>\n\u003cp>With billions of letters in the genome, it’s going to take a lot of work to avoid all possible off-target effects, Ambrose said. This study is promising, she added, but scientists in the CRISPR field need to get better at detecting these potential accidents.\u003c/p>\n\u003cp>Before clinical trials can begin, she said, researchers need to be sure these accidents won’t occur in humans by first testing them in animals. When researchers scanned the DNA from the “cured” mice, they didn’t find any signs that CRISPR had made cuts outside of the HIV DNA. But they could tell that CRISPR had made cuts within the HIV DNA, meaning the instructions for making new virus were broken.\u003c/p>\n\u003cp>Along with possible off-target effects, Ambrose worries that CRISPR, enclosed in an AAV virus, will remain in the body long after its job is done. If that’s the case, she says “there’s no way to turn” the CRISPR editing off, increasing the chances of an off-target cut.\u003c/p>\n\u003cp>But Khalili is confident that CRISPR is only cutting the DNA where it’s supposed to, based on searches for the “footprints” CRISPR leaves on DNA when it cuts. And CRISPR \u003ca href=\"https://www.pbs.org/newshour/science/jumping-genes-could-help-crispr-replace-disease-causing-dna-study-finds\" target=\"_blank\" rel=\"noopener\">continues to improve everyday\u003c/a>.\u003c/p>\n\u003cp>While a comprehensive, single-shot cure for HIV may be years away, Khalili is encouraged that this milestone “will give those affected hope.”\u003c/p>\n\u003cp>\u003cem>\u003ca href=\"https://www.pbs.org/newshour/science/crispr-gene-editing-eliminates-hiv-in-some-mice-what-does-it-mean-for-humans\">This story\u003c/a> was originally published on PBS Newshour.\u003c/em>\u003c/p>\n\u003c/div>\n\u003c/article>\n\u003cp>[ad fullwidth]\u003c/p>\u003cp>[ad floatright]\u003c/p>\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>For the millions of people infected with HIV, the best way to manage the disease is antiretroviral therapy, which can lower the amount of HIV replicating in the body to undetectable levels.\u003c/p>\n\u003carticle>\n\u003cdiv class=\"body-text\">\n\u003cp>But antiretroviral therapy (ART) can only manage HIV, never eliminate it — leading people to rely on the \u003ca href=\"https://aidsinfo.nih.gov/guidelines/html/1/adult-and-adolescent-arv/459/cost-considerations-and-antiretroviral-therapy\">expensive drugs\u003c/a> for decades. Plus if ART is halted by these patients, HIV bounces back and its levels rise in a matter of weeks. In 2017 the World Health Organization \u003ca href=\"https://www.who.int/gho/hiv/en/\">reported that of\u003c/a> 36.9 million people living with HIV, 21.7 million were taking ART.\u003c/p>\n\u003cp>A new study of mice charts a preliminary path to eliminating this medication dependency, through an injection of gene-editing \u003ca href=\"https://ghr.nlm.nih.gov/primer/genomicresearch/genomeediting\">CRISPR\u003c/a>.\u003c/p>\n\u003cp>Removing HIV from a person’s body is so hard because “once the virus infects cells [the] viral genome integrates into the host genome and then becomes part of our DNA,” said Kamel Khalili, a neurovirologist at Temple University who co-led the study.\u003c/p>\n\u003cp>Once this integration happens, ART can’t reverse it — at least not on its own. But Khalili and his colleagues found combining CRISPR, which can alter DNA, with ART can remove the lingering signs of HIV in a mouse model of the disease. The collaborative effort between researchers at Temple University and the University of Nebraska Medical Center was \u003ca href=\"https://www.nature.com/articles/s41467-019-10366-y\">reported today in Nature Communications\u003c/a>.\u003c/p>\n\u003cp>Results in mouse models do not always translate into effective treatments in humans, but Fyodor Urnov says this study is an “important next step” in addressing a disease like HIV with a technique.\u003c/p>\n\u003cp>“Gene editing is the first-ever technology we have had to address disease at the DNA level,” said Urnov, who works at the Innovative Genomics Institute at the University of California Berkeley and was not involved in the study.\u003c/p>\n\u003cp>CRISPR, which scientists can program to cut DNA at specific sites, has garnered attention as a potential cure for genetic diseases, such as \u003ca href=\"https://cysticfibrosisnewstoday.com/crisprcas9-approach-for-cystic-fibrosis/\">cystic fibrosis\u003c/a> and \u003ca href=\"https://directorsblog.nih.gov/2019/02/26/more-progress-toward-gene-editing-for-kids-with-muscular-dystrophy/\">muscular dystrophy\u003c/a>. Using CRISPR and ART to develop an HIV cure could eventually eliminate the cost and distribution barriers that come with current treatments. To date, \u003ca href=\"https://www.theguardian.com/society/2019/mar/05/london-patient-becomes-second-man-to-be-cleared-of-aids-virus\">only two people have been cured of HIV\u003c/a>after receiving stem cell therapy to treat cancer. This expensive and invasive treatment has failed in every other HIV patient.\u003c/p>\n\u003cp>But CRISPR comes with its own caveats — namely, at the moment it isn’t as precise as many in the general public might think.\u003c/p>\n\u003ch2>What the Study Did\u003c/h2>\n\u003cp>The researchers used “humanized” mice, meaning mice were infused with the type of human immune cells that HIV infects.\u003c/p>\n\u003cp>In three separate trials, HIV-infected mice were given one of three injection therapies: a slow-release version of the common HIV drug ART, the CRISPR protein that finds and cuts genome-incorporated HIV, or a combination of the two.\u003c/p>\n\u003cp>After four weeks of ART treatment, the researchers dispensed CRISPR into the mice by packaging the protein inside of a completely separate virus, called adeno-associated virus, or AAV. AAV doesn’t cause illness, but it acts like a mail carrier, increasing the circulation of CRISPR. CRISPR then becomes more likely to find and cut out all of the HIV DNA, an essential step to prevent the disease from rebounding.\u003c/p>\n\u003cp>The researchers waited eight weeks after all the mice were taken off of ART, then searched for traces of HIV genetic material in blood, spleen, kidneys, gut, lungs, bone marrow and the brain.\u003c/p>\n\u003cp>After eight ART-free weeks, more than 30 percent of the mice that received ART and CRISPR lacked detectable amounts of HIV in any of the tissues the researchers studied.\u003c/p>\n\u003cp>In contrast, HIV was still detectable in all of the other mice, including those that were treated with ART or CRISPR alone.\u003c/p>\n\u003ch2>A Cautious Way Forward\u003c/h2>\n\u003cp>Though the researchers used “humanized mice,” the technology has a long way to go. “Clinical trials…will not start tonight. It will take a few years,” said Urnov. However, Khalili revealed that early data from preliminary trials in monkeys looks promising.\u003c/p>\n\u003cp>Khalili and his colleagues have applied to the U.S. Food and Drug Administration for permission to start human clinical trials as early as next year. Khalili has also launched a for-profit company that is developing CRISPR-based technology to treat disease.\u003c/p>\n\u003cp>That the technology is moving this fast concerns Zandrea Ambrose, a retrovirologist at the University of Pittsburgh, who was not involved in the study. CRISPR comes with a downside, in that it sometimes accidentally cuts the wrong gene.\u003c/p>\n\u003cp>Relative to other gene editors, CRISPR has fewer of these “off-target effects” as they’re called, but even a single error is worrisome. If CRISPR makes a hazardous mutation, it could disrupt any cell’s normal behavior and cause an inadvertent disease.\u003c/p>\n\u003cp>With billions of letters in the genome, it’s going to take a lot of work to avoid all possible off-target effects, Ambrose said. This study is promising, she added, but scientists in the CRISPR field need to get better at detecting these potential accidents.\u003c/p>\n\u003cp>Before clinical trials can begin, she said, researchers need to be sure these accidents won’t occur in humans by first testing them in animals. When researchers scanned the DNA from the “cured” mice, they didn’t find any signs that CRISPR had made cuts outside of the HIV DNA. But they could tell that CRISPR had made cuts within the HIV DNA, meaning the instructions for making new virus were broken.\u003c/p>\n\u003cp>Along with possible off-target effects, Ambrose worries that CRISPR, enclosed in an AAV virus, will remain in the body long after its job is done. If that’s the case, she says “there’s no way to turn” the CRISPR editing off, increasing the chances of an off-target cut.\u003c/p>\n\u003cp>But Khalili is confident that CRISPR is only cutting the DNA where it’s supposed to, based on searches for the “footprints” CRISPR leaves on DNA when it cuts. And CRISPR \u003ca href=\"https://www.pbs.org/newshour/science/jumping-genes-could-help-crispr-replace-disease-causing-dna-study-finds\" target=\"_blank\" rel=\"noopener\">continues to improve everyday\u003c/a>.\u003c/p>\n\u003cp>While a comprehensive, single-shot cure for HIV may be years away, Khalili is encouraged that this milestone “will give those affected hope.”\u003c/p>\n\u003cp>\u003cem>\u003ca href=\"https://www.pbs.org/newshour/science/crispr-gene-editing-eliminates-hiv-in-some-mice-what-does-it-mean-for-humans\">This story\u003c/a> was originally published on PBS Newshour.\u003c/em>\u003c/p>\n\u003c/div>\n\u003c/article>\n\u003cp>\u003c/p>\u003c/div>",
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"title": "Elizabeth Holmes Theranos Trial to Start in July ... of Next Year. The Story So Far",
"headTitle": "Elizabeth Holmes Theranos Trial to Start in July … of Next Year. The Story So Far | KQED",
"content": "\u003cp>Some people are waiting for the final chapter in the Elizabeth Holmes Theranos saga like fans of the “Game of Thrones” books are waiting for George RR Martin to get his butt in gear and finish the thing.\u003c/p>\n\u003cp>Which is to say, the anticipation continues.\u003c/p>\n\u003cp>On Friday\u003cstrong>,\u003c/strong> a federal judge in Northern California set a date of July 28, 2020 for jury selection in the criminal trial of Holmes, the defunct blood-testing company’s founder and CEO; and Ramesh “Sunny” Balwani, its onetime COO and president. The two have been indicted on nine counts of wire fraud and two counts of conspiracy to commit wire fraud.\u003c/p>\n\u003cp>The victims, the government claims, were Theranos investors, as well as the doctors and patients who used the company’s supposedly breakthrough blood tests. Each count carries a maximum penalty of up to 20 years imprisonment and $250,000 in fines, though convictions on multiple counts would typically draw sentences that run concurrently.\u003c/p>\n\u003cp>Those who have perused any of the multiple \u003ca href=\"https://www.kqed.org/futureofyou/203018/the-rise-and-fall-of-theranos-a-cartoon-history\" target=\"_blank\" rel=\"noopener\">narrative accounts\u003c/a> offered up by the still-thriving Theranos Media Industrial Complex know the backstory by now: Elizabeth Holmes, 35, was a Stanford dropout who claimed her company could perform dozens of blood tests from a few finger-sticks of blood for half the price, an advance that would have been massively disruptive to the existing diagnostics industry.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Along the way, with an \u003ca href=\"https://www.youtube.com/watch?v=ho8geEtCYjw&ab_channel=MedCityNews\" target=\"_blank\" rel=\"noopener\">evangelical zeal\u003c/a> that traded on an ethos of patient self-empowerment, she managed to recruit as investors and/or Theranos board members conservative luminaries like Rupert Murdoch, George Shultz and Henry Kissinger, while also \u003ca href=\"https://www.vox.com/2016/3/14/11586966/theranos-ceo-elizabeth-holmes-is-holding-a-hillary-fundraiser-with\" target=\"_blank\" rel=\"noopener\">ingratiating\u003c/a> herself with big-name \u003ca href=\"https://sanfrancisco.cbslocal.com/2015/07/23/vice-president-joe-biden-theranos-elizabeth-holmes-newark-lab-test/\" target=\"_blank\" rel=\"noopener\">Democrats\u003c/a>. Holmes also successfully lobbied the state of Arizona to \u003ca href=\"https://www.phoenixnewtimes.com/news/author-john-carreyrou-how-theranos-scammed-arizona-10477429\" target=\"_blank\" rel=\"noopener\">relax legal contraints\u003c/a> on consumers ordering their own blood tests. And — most crucially — she \u003ca href=\"https://www.wsj.com/articles/craving-growth-walgreens-dismissed-its-doubts-about-theranos-1464207285\" target=\"_blank\" rel=\"noopener\">convinced\u003c/a> the pharmacy chain Walgreen’s to house Theranos “wellness centers” in dozens of its stores in the state. At one point, Forbes \u003ca href=\"https://www.forbes.com/sites/matthewherper/2016/06/01/from-4-5-billion-to-nothing-forbes-revises-estimated-net-worth-of-theranos-founder-elizabeth-holmes/#7eac7ede3633\" target=\"_blank\" rel=\"noopener\">estimated\u003c/a> her net worth at $4.5 billion.\u003c/p>\n\u003cp>But an \u003ca href=\"https://www.wsj.com/articles/theranos-has-struggled-with-blood-tests-1444881901\" target=\"_blank\" rel=\"noopener\">investigation\u003c/a> (and later a book) by Wall Street Journal reporter John Carreyrou exposed Theranos’ claims as bogus, and its testing results as wildly inaccurate. The company was subsequently forced to invalidate hundreds of thousands of blood tests performed on patients, and it eventually exited the consumer blood-testing business after the Centers for Medicare & Medicaid Services found deficiencies at the company’s laboratory that the agency deemed life-threatening.\u003c/p>\n\u003cp>The Securities and Exchange Commission later accused Holmes and Balwani of “\u003ca href=\"https://www.sec.gov/news/press-release/2018-41\" target=\"_blank\" rel=\"noopener\">massive fraud\u003c/a>” for raising more than $700 million from investors based on what the SEC called “exaggerated” or “false statements about the company’s technology, business, and financial performance.” Holmes settled the civil case with the agency by agreeing to pay a $500,000 fine and giving up control of Theranos. Balwani is still \u003ca href=\"https://www.bloomberg.com/news/articles/2019-06-14/ex-theranos-president-wins-bid-to-fight-u-s-sec-at-same-time\" target=\"_blank\" rel=\"noopener\">fighting\u003c/a> the case.\u003c/p>\n\u003cp>Discredited, investigated and serially sued, Theranos then went through multiple rounds of layoffs before \u003ca href=\"https://www.kqed.org/futureofyou/444285/theranos-is-shutting-down\" target=\"_blank\" rel=\"noopener\">closing its doors\u003c/a> for good in September 2018.\u003c/p>\n\u003cp>\u003cstrong>Slam Dunk for the Government? Not So Fast\u003c/strong>\u003c/p>\n\u003cp>While Holmes has become something of a national pariah who appears to be taking \u003ca href=\"https://www.vanityfair.com/news/2019/02/as-theranos-burned-elizabeth-holmes-was-partyingat-burning-man\" target=\"_blank\" rel=\"noopener\">public relations\u003c/a> advice from \u003ca href=\"https://www.prnewsonline.com/what-pr-pros-can-learn-from-elon-musks-weekend-of-deflection/\" target=\"_blank\" rel=\"noopener\">Elon Musk\u003c/a>, her legal fate and that of Balwani could be far from certain.\u003c/p>\n\u003cp>KQED’s Molly Peterson spoke about the case today with Peter Johnson, a lecturer at UCLA who defends federal criminal charges in private practice. While wire fraud is a go-to allegation in most white collar indictments, Johnson said, it’s not just the transmission of a lie or misrepresentation that will secure a conviction. The government also needs to prove intent, a harder lift.\u003c/p>\n\u003cp>“An indictment is not evidence,” Johnson said. “I think sometimes we lose that; the evidence comes out at trial.”\u003c/p>\n\u003cp>Thomas Joo, a UC Davis School of Law professor, told Peterson that the question of whether Balwani and Holmes \u003cem>meant\u003c/em> to lie, mislead or defraud offers them plenty of potential defenses.\u003c/p>\n\u003cp>“She could argue that she never misrepresented any facts, she was just talking about possibilities,” Joo said. While experts may have no differences on the science involved in the case, he said, they may disagree on scientific process and theory.\u003c/p>\n\u003cp>“This is about what \u003cem>could\u003c/em> have happened,” he said.\u003c/p>\n\u003cp>Both experts said discovery and pretrial efforts around expert testimony will shed more light on legal strategy down the line.\u003c/p>\n\u003cp>Here’s a Bloomberg \u003ca href=\"https://www.bloomberg.com/news/articles/2019-06-28/fighting-theranos-charges-holmes-blames-advocacy-journalism\" target=\"_blank\" rel=\"noopener\">analysis\u003c/a> that asserts a motion filed by Holmes’ lawyers last week indicates they will try to make reporter Carreyrou part of their defense, by claiming he influenced government regulators “in a way that appears to have warped the agencies’ focus on the company and possibly biased the agencies’ findings against it,” in the words of the filing.\u003c/p>\n\u003cp>\u003cstrong>And On It Goes\u003c/strong>\u003c/p>\n\u003cp>In the meantime, while Elizabeth Holmes may be out of business, business related to Elizabeth Holmes continues apace.\u003c/p>\n\u003cp>“This case is just so extreme in the extent of pretrial publicity,” Joo said.\u003c/p>\n\u003cp>He wasn’t kidding. In fact, one can just imagine a young Elizabeth Holmes mulling over one of those sweet deals typically offered by genies, demons and the like.\u003c/p>\n\u003cp>“Elizabeth, sign here and one day you’ll be the subject of an HBO\u003ca href=\"https://www.hbo.com/documentaries/the-inventor-out-for-blood-in-silicon-valley\" target=\"_blank\" rel=\"noopener\"> documentary\u003c/a>, an ABC\u003ca href=\"https://abcradio.com/podcasts/the-dropout/\" target=\"_blank\" rel=\"noopener\"> podcast\u003c/a>, a best-selling \u003ca href=\"https://www.kqed.org/futureofyou/442098/book-excerpt-one-execs-tumultuous-last-day-at-theranos\" target=\"_blank\" rel=\"noopener\">book\u003c/a>, a \u003ca href=\"https://www.businessinsider.com/theranos-tv-series-the-dropout-coming-to-hulu-kate-mckinnon-to-star-2019-4\" target=\"_blank\" rel=\"noopener\">TV show\u003c/a> and a \u003ca href=\"https://people.com/movies/elizabeth-holmes-theranos-jennifer-lawrence-movie/\" target=\"_blank\" rel=\"noopener\">movie\u003c/a> with a glamorous Hollywood \u003ca href=\"https://www.vanityfair.com/news/2016/06/jennifer-lawrence-will-star-as-elizabeth-holmes-in-a-movie-about-theranos\" target=\"_blank\" rel=\"noopener\">star\u003c/a> in the role of you.”\u003c/p>\n\u003cp>As in all dealings surrounding Theranos, it’s best to read the fine print.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Molly Peterson contributed to this story.\u003c/em>\u003c/p>\n\n",
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"excerpt": "Elizabeth Holmes faces years in prison for her role as the founder and CEO of the blood-testing startup Theranos. Here's a recap of how we got here.",
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"description": "Elizabeth Holmes faces years in prison for her role as the founder and CEO of the blood-testing startup Theranos. Here's a recap of how we got here.",
"title": "Elizabeth Holmes Theranos Trial to Start in July ... of Next Year. The Story So Far | KQED",
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"headline": "Elizabeth Holmes Theranos Trial to Start in July ... of Next Year. The Story So Far",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Some people are waiting for the final chapter in the Elizabeth Holmes Theranos saga like fans of the “Game of Thrones” books are waiting for George RR Martin to get his butt in gear and finish the thing.\u003c/p>\n\u003cp>Which is to say, the anticipation continues.\u003c/p>\n\u003cp>On Friday\u003cstrong>,\u003c/strong> a federal judge in Northern California set a date of July 28, 2020 for jury selection in the criminal trial of Holmes, the defunct blood-testing company’s founder and CEO; and Ramesh “Sunny” Balwani, its onetime COO and president. The two have been indicted on nine counts of wire fraud and two counts of conspiracy to commit wire fraud.\u003c/p>\n\u003cp>The victims, the government claims, were Theranos investors, as well as the doctors and patients who used the company’s supposedly breakthrough blood tests. Each count carries a maximum penalty of up to 20 years imprisonment and $250,000 in fines, though convictions on multiple counts would typically draw sentences that run concurrently.\u003c/p>\n\u003cp>Those who have perused any of the multiple \u003ca href=\"https://www.kqed.org/futureofyou/203018/the-rise-and-fall-of-theranos-a-cartoon-history\" target=\"_blank\" rel=\"noopener\">narrative accounts\u003c/a> offered up by the still-thriving Theranos Media Industrial Complex know the backstory by now: Elizabeth Holmes, 35, was a Stanford dropout who claimed her company could perform dozens of blood tests from a few finger-sticks of blood for half the price, an advance that would have been massively disruptive to the existing diagnostics industry.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Along the way, with an \u003ca href=\"https://www.youtube.com/watch?v=ho8geEtCYjw&ab_channel=MedCityNews\" target=\"_blank\" rel=\"noopener\">evangelical zeal\u003c/a> that traded on an ethos of patient self-empowerment, she managed to recruit as investors and/or Theranos board members conservative luminaries like Rupert Murdoch, George Shultz and Henry Kissinger, while also \u003ca href=\"https://www.vox.com/2016/3/14/11586966/theranos-ceo-elizabeth-holmes-is-holding-a-hillary-fundraiser-with\" target=\"_blank\" rel=\"noopener\">ingratiating\u003c/a> herself with big-name \u003ca href=\"https://sanfrancisco.cbslocal.com/2015/07/23/vice-president-joe-biden-theranos-elizabeth-holmes-newark-lab-test/\" target=\"_blank\" rel=\"noopener\">Democrats\u003c/a>. Holmes also successfully lobbied the state of Arizona to \u003ca href=\"https://www.phoenixnewtimes.com/news/author-john-carreyrou-how-theranos-scammed-arizona-10477429\" target=\"_blank\" rel=\"noopener\">relax legal contraints\u003c/a> on consumers ordering their own blood tests. And — most crucially — she \u003ca href=\"https://www.wsj.com/articles/craving-growth-walgreens-dismissed-its-doubts-about-theranos-1464207285\" target=\"_blank\" rel=\"noopener\">convinced\u003c/a> the pharmacy chain Walgreen’s to house Theranos “wellness centers” in dozens of its stores in the state. At one point, Forbes \u003ca href=\"https://www.forbes.com/sites/matthewherper/2016/06/01/from-4-5-billion-to-nothing-forbes-revises-estimated-net-worth-of-theranos-founder-elizabeth-holmes/#7eac7ede3633\" target=\"_blank\" rel=\"noopener\">estimated\u003c/a> her net worth at $4.5 billion.\u003c/p>\n\u003cp>But an \u003ca href=\"https://www.wsj.com/articles/theranos-has-struggled-with-blood-tests-1444881901\" target=\"_blank\" rel=\"noopener\">investigation\u003c/a> (and later a book) by Wall Street Journal reporter John Carreyrou exposed Theranos’ claims as bogus, and its testing results as wildly inaccurate. The company was subsequently forced to invalidate hundreds of thousands of blood tests performed on patients, and it eventually exited the consumer blood-testing business after the Centers for Medicare & Medicaid Services found deficiencies at the company’s laboratory that the agency deemed life-threatening.\u003c/p>\n\u003cp>The Securities and Exchange Commission later accused Holmes and Balwani of “\u003ca href=\"https://www.sec.gov/news/press-release/2018-41\" target=\"_blank\" rel=\"noopener\">massive fraud\u003c/a>” for raising more than $700 million from investors based on what the SEC called “exaggerated” or “false statements about the company’s technology, business, and financial performance.” Holmes settled the civil case with the agency by agreeing to pay a $500,000 fine and giving up control of Theranos. Balwani is still \u003ca href=\"https://www.bloomberg.com/news/articles/2019-06-14/ex-theranos-president-wins-bid-to-fight-u-s-sec-at-same-time\" target=\"_blank\" rel=\"noopener\">fighting\u003c/a> the case.\u003c/p>\n\u003cp>Discredited, investigated and serially sued, Theranos then went through multiple rounds of layoffs before \u003ca href=\"https://www.kqed.org/futureofyou/444285/theranos-is-shutting-down\" target=\"_blank\" rel=\"noopener\">closing its doors\u003c/a> for good in September 2018.\u003c/p>\n\u003cp>\u003cstrong>Slam Dunk for the Government? Not So Fast\u003c/strong>\u003c/p>\n\u003cp>While Holmes has become something of a national pariah who appears to be taking \u003ca href=\"https://www.vanityfair.com/news/2019/02/as-theranos-burned-elizabeth-holmes-was-partyingat-burning-man\" target=\"_blank\" rel=\"noopener\">public relations\u003c/a> advice from \u003ca href=\"https://www.prnewsonline.com/what-pr-pros-can-learn-from-elon-musks-weekend-of-deflection/\" target=\"_blank\" rel=\"noopener\">Elon Musk\u003c/a>, her legal fate and that of Balwani could be far from certain.\u003c/p>\n\u003cp>KQED’s Molly Peterson spoke about the case today with Peter Johnson, a lecturer at UCLA who defends federal criminal charges in private practice. While wire fraud is a go-to allegation in most white collar indictments, Johnson said, it’s not just the transmission of a lie or misrepresentation that will secure a conviction. The government also needs to prove intent, a harder lift.\u003c/p>\n\u003cp>“An indictment is not evidence,” Johnson said. “I think sometimes we lose that; the evidence comes out at trial.”\u003c/p>\n\u003cp>Thomas Joo, a UC Davis School of Law professor, told Peterson that the question of whether Balwani and Holmes \u003cem>meant\u003c/em> to lie, mislead or defraud offers them plenty of potential defenses.\u003c/p>\n\u003cp>“She could argue that she never misrepresented any facts, she was just talking about possibilities,” Joo said. While experts may have no differences on the science involved in the case, he said, they may disagree on scientific process and theory.\u003c/p>\n\u003cp>“This is about what \u003cem>could\u003c/em> have happened,” he said.\u003c/p>\n\u003cp>Both experts said discovery and pretrial efforts around expert testimony will shed more light on legal strategy down the line.\u003c/p>\n\u003cp>Here’s a Bloomberg \u003ca href=\"https://www.bloomberg.com/news/articles/2019-06-28/fighting-theranos-charges-holmes-blames-advocacy-journalism\" target=\"_blank\" rel=\"noopener\">analysis\u003c/a> that asserts a motion filed by Holmes’ lawyers last week indicates they will try to make reporter Carreyrou part of their defense, by claiming he influenced government regulators “in a way that appears to have warped the agencies’ focus on the company and possibly biased the agencies’ findings against it,” in the words of the filing.\u003c/p>\n\u003cp>\u003cstrong>And On It Goes\u003c/strong>\u003c/p>\n\u003cp>In the meantime, while Elizabeth Holmes may be out of business, business related to Elizabeth Holmes continues apace.\u003c/p>\n\u003cp>“This case is just so extreme in the extent of pretrial publicity,” Joo said.\u003c/p>\n\u003cp>He wasn’t kidding. In fact, one can just imagine a young Elizabeth Holmes mulling over one of those sweet deals typically offered by genies, demons and the like.\u003c/p>\n\u003cp>“Elizabeth, sign here and one day you’ll be the subject of an HBO\u003ca href=\"https://www.hbo.com/documentaries/the-inventor-out-for-blood-in-silicon-valley\" target=\"_blank\" rel=\"noopener\"> documentary\u003c/a>, an ABC\u003ca href=\"https://abcradio.com/podcasts/the-dropout/\" target=\"_blank\" rel=\"noopener\"> podcast\u003c/a>, a best-selling \u003ca href=\"https://www.kqed.org/futureofyou/442098/book-excerpt-one-execs-tumultuous-last-day-at-theranos\" target=\"_blank\" rel=\"noopener\">book\u003c/a>, a \u003ca href=\"https://www.businessinsider.com/theranos-tv-series-the-dropout-coming-to-hulu-kate-mckinnon-to-star-2019-4\" target=\"_blank\" rel=\"noopener\">TV show\u003c/a> and a \u003ca href=\"https://people.com/movies/elizabeth-holmes-theranos-jennifer-lawrence-movie/\" target=\"_blank\" rel=\"noopener\">movie\u003c/a> with a glamorous Hollywood \u003ca href=\"https://www.vanityfair.com/news/2016/06/jennifer-lawrence-will-star-as-elizabeth-holmes-in-a-movie-about-theranos\" target=\"_blank\" rel=\"noopener\">star\u003c/a> in the role of you.”\u003c/p>\n\u003cp>As in all dealings surrounding Theranos, it’s best to read the fine print.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Molly Peterson contributed to this story.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"title": "The Best Health and Science Books to Dip Into This Summer",
"headTitle": "The Best Health and Science Books to Dip Into This Summer | KQED",
"content": "\u003cp>\u003cspan class=\"big-cap-wrap\">\u003cspan class=\"big-cap\">T\u003c/span>\u003c/span>he first day of summer has arrived, and so has STAT’s annual book list of great reads in health, science, and medicine.\u003c/p>\n\u003cp>Read on for recommendations from CRISPR pioneer Jennifer Doudna and CDC Director Robert Redfield. Plus, STAT readers from Boston to Ireland to Australia share their picks, in addition to our staff. Enjoy!\u003c/p>\n\u003cp>\u003cstrong>Notable Figures\u003c/strong>\u003c/p>\n\u003cp>\u003cstrong>\u003ca href=\"https://www.amazon.com/gp/product/0805071806/ref=as_li_tl?ie=UTF8&camp=1789&creative=9325&creativeASIN=0805071806&linkCode=as2&tag=stat03d-20&linkId=7bf123ab6184f5cac33d58beddbb56f6\" target=\"_blank\" rel=\"noopener\">“Scientific Conversations: Interviews on Science from The New York Times”\u003c/a>\u003c/strong>\u003cbr>\n\u003cem>By Claudia Dreifus\u003c/em>\u003cbr>\nThis is an awesome collection of 38 interviews, published originally in the Science Times section of the New York Times, that captures the wonder and excitement of scientific discovery. As an outstanding journalist and a relative outsider to science, Dreifus elicits from her subjects the passion, frustration, inspiration and, ultimately, the joy of doing science. Her writing reminds me of the work of John McPhee: deep and expansive with a sense of fun. A great read!\u003cbr>\n\u003cem>— Jennifer Doudna, professor and HHMI Investigator, UC Berkeley; director, Innovative Genomics Institute of UC Berkeley/UCSF/Gladstone Institutes\u003c/em>\u003c/p>\n\u003cp>\u003cstrong>\u003ca href=\"https://www.amazon.com/gp/product/006122796X/ref=as_li_tl?ie=UTF8&camp=1789&creative=9325&creativeASIN=006122796X&linkCode=as2&tag=stat03d-20&linkId=7cfcc6b0801cc1e4c567331d7f105411\" target=\"_blank\" rel=\"noopener\">“Vaccinated: One Man’s Quest to Defeat the World’s Deadliest Diseases”\u003c/a>\u003c/strong>\u003cbr>\n\u003cem>By Paul A. Offit\u003c/em>\u003cbr>\nPhysicians, parents, and public health professionals seeking credible, timely information about the safety and effectiveness of vaccines will find those answers in Dr. Offit’s “Vaccinated.” He writes a compelling narrative, sharing the underlying science and historical context behind the vaccine regimen recommended today. This fact-based retrospective dispels myths and underscores the importance of immunization for children and adults alike. Readers will have a better understanding of the science-based reasoning to embrace vaccination for themselves, their families, and their communities.\u003cbr>\n\u003cem>— Dr. Robert R. Redfield, director of the Centers for Disease Control and Prevention\u003c/em>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cstrong>\u003ca href=\"https://www.amazon.com/gp/product/0520229134/ref=as_li_tl?ie=UTF8&camp=1789&creative=9325&creativeASIN=0520229134&linkCode=as2&tag=stat03d-20&linkId=f6872536969b6885c29cba642778c5ca\" target=\"_blank\" rel=\"noopener\">“Infections and Inequalities: The Modern Plagues”\u003c/a>\u003c/strong>\u003cbr>\n\u003cem>By Paul Farmer\u003c/em>\u003cbr>\nThis book highlights so well the very inception of the Bill and Melinda Gates Medical Research Institute itself and our mission to develop treatments and preventive agents for diseases burdening the world’s poorest people. Tenderly, Farmer tells the stories of those who suffer, offering their complex circumstances in the face of overwhelming data. The Partners in Health co-founder challenges those determined to care for the most vulnerable to challenge the status quo. Although written 20 years ago, the stories ring truer than ever. Inequities in health have only become magnified and are now manifest in our own backyard. Although sobering, it is also inspiring and may make the reader leap to other resources such as “The Age of Living Machines” by Susan Hockfield, who posits that convergence across scientific disciplines led to the current technological capabilities. Can these not be leveraged with know-how and fortitude to meaningfully address inequities in health?\u003cbr>\n\u003cem>— Dr. Penny Heaton, CEO of the Bill and Melinda Gates Medical Research Institute\u003c/em>\u003c/p>\n\u003cp>\u003cstrong>\u003ca href=\"https://www.amazon.com/gp/product/1845291557/ref=as_li_tl?ie=UTF8&camp=1789&creative=9325&creativeASIN=1845291557&linkCode=as2&tag=stat03d-20&linkId=424b9e11f98c4fb76b3a018ce157005a\" target=\"_blank\" rel=\"noopener\">“A Brief History of Medicine: from Hippocrates to Gene Therapy”\u003c/a>\u003cbr>\n\u003c/strong>\u003cem>By Paul Strathern\u003cbr>\n\u003c/em>Among the many histories of medicine, Paul Strathern’s narrative stands out for its lively prose and colorful portraits of figures who broke with dogma and proved new paradigms. Even the expert reader will find much that is novel and nuanced, not only in stories about prominent characters like Galen and Harvey, but less well known individuals like the Venerable Bede, an English monk who revived Greek and Roman knowledge during the Dark Ages, and Al-Razi, an Islamic scholar who challenged Aristotle’s prevailing notions with experimental data and showed that pediatric disorders need not be viewed as untreatable and hopeless. Each chapter offers a rich tableau depicting advances in medical thinking based on astute observation and rigorous induction. Strathern brilliantly succeeds in both educating and entertaining his reader, a perfect blend for a summer treat.\u003cbr>\n\u003cem>— Dr. Jerome Groopman, New Yorker staff writer and author; Recanati Professor of Medicine, Harvard Medical School\u003c/em>\u003c/p>\n\u003cp>\u003cstrong>\u003ca href=\"https://www.amazon.com/gp/product/0345804570/ref=as_li_tl?ie=UTF8&camp=1789&creative=9325&creativeASIN=0345804570&linkCode=as2&tag=stat03d-20&linkId=137ae7f66e5eee834172c881aa8f1b7a\" target=\"_blank\" rel=\"noopener\">“The Evolution of Beauty: How Darwin’s Forgotten Theory of Mate Choice Shapes the Animal World—and Us”\u003c/a>\u003c/strong>\u003cbr>\n\u003cem>By Richard Prum\u003c/em>\u003cbr>\nWhether you agree with Prum or not, his case for renewed attention to Darwin’s theory of sexual selection — that considerations of beauty, and not just functional adaptation, shape evolution — is eye-opening. The book also reminds us that politics (in this case, 19th-century disapproval of Darwin’s views on female mate choice) can influence what we are taught about science. Even if you are skeptical, Prum will make you think twice about the natural world, and will definitely change how you look at ducks.\u003cbr>\n\u003cem>— Ron Klain, President Obama’s Ebola czar during the West African outbreak\u003c/em>\u003c/p>\n\u003cp>\u003ca href=\"https://www.amazon.com/gp/product/0062338781/ref=as_li_tl?ie=UTF8&camp=1789&creative=9325&creativeASIN=0062338781&linkCode=as2&tag=stat03d-20&linkId=a08377a6dbaebf506ffcb6efb996c457\" target=\"_blank\" rel=\"noopener\">\u003cstrong>“Bottle of Lies: The Inside Story of the Generic Drug Boom”\u003c/strong>\u003c/a>\u003cbr>\n\u003cem>By Katherine Eban\u003cbr>\n\u003c/em>In her fierce and fearless book, “Bottle of Lies,” the investigative journalist Katherine Eban takes us on a journey through the loosely regulated and often corrupt manufacture of generic drugs. Weaving together the story of a terrified but determined whistleblower from India, shady drug producers from China, and a notably timid FDA, Eban’s compelling book should serve as cautionary tale and a wake-up call for consumers, manufacturers, and physicians — “should” being the operative word.\u003cbr>\n\u003cem>— Deborah Blum, author of “The Poison Squad: One Chemist’s Single-Minded Crusade for Food Safety at the Turn of the Twentieth Century” and director of the Knight Science Journalism Program at MIT\u003c/em>\u003c/p>\n\u003cp>\u003cstrong>STAT Readers\u003c/strong>\u003c/p>\n\u003cp>\u003ca href=\"https://www.amazon.com/gp/product/0735224153/ref=as_li_tl?ie=UTF8&camp=1789&creative=9325&creativeASIN=0735224153&linkCode=as2&tag=stat03d-20&linkId=e88ba9aa97ec231e13dcca5e20cbc7bf\" target=\"_blank\" rel=\"noopener\">\u003cstrong>“How to Change Your Mind: What the New Science of Psychedelics Teaches Us About Consciousness, Dying, Addiction, Depression, and Transcendence”\u003c/strong>\u003c/a>\u003cbr>\n\u003cem>By Michael Pollan\u003c/em>\u003cbr>\nWith cannabis medicine now getting the attention it deserves, Michael Pollan has done a tremendous job at digging into the history of psychedelic use, both recreationally and in therapy, together with his own observations as a new psychedelic experimenter at the age of 60. All in all, a comprehensive history of the topic, together with interviews from key psychedelic researchers, and a call for serious researchers to think twice about hasty judgments surrounding this interesting compound.\u003cbr>\n\u003cem>— Jon Calder, Belfast, Northern Ireland\u003c/em>\u003c/p>\n\u003cp>\u003ca href=\"https://www.amazon.com/gp/product/006289627X/ref=as_li_tl?ie=UTF8&camp=1789&creative=9325&creativeASIN=006289627X&linkCode=as2&tag=stat03d-20&linkId=ea6fc765acd3cc5ad1ccd85342cb04ae\" target=\"_blank\" rel=\"noopener\">\u003cstrong>“Bitten: The Secret History of Lyme Disease and Biological Weapons”\u003c/strong>\u003c/a>\u003cbr>\n\u003cem>By Kris Newby\u003c/em>\u003cbr>\n“Bitten” is a riveting narrative that digs into the origins of the Lyme disease epidemic. It connects many dots with compelling evidence and page-turning storytelling that point to the likelihood that a bio-weaponized tick program gone awry could have contributed to the more virulent forms of tick-borne illnesses that have been wreaking havoc on unwitting people for the past five decades. Doctors are not well-trained on tick-borne illness, diagnostics are inadequate, and there are no career tracks in the field other than a few courageous pioneers. Biotech is largely on the sidelines. Yet millions of people are being disabled. Perhaps this book will help stir some action. After all, we all are just one bite away from a nightmare illness.\u003cbr>\n\u003cem>— Nancy Dougherty, Boston\u003c/em>\u003c/p>\n\u003cp>\u003ca href=\"https://www.amazon.com/gp/product/0544114515/ref=as_li_tl?ie=UTF8&camp=1789&creative=9325&creativeASIN=0544114515&linkCode=as2&tag=stat03d-20&linkId=4f6ff933051d07a5d66bb8d7906db1a2\" target=\"_blank\" rel=\"noopener\">\u003cstrong>“How Dogs Love Us: A Neuroscientist and His Adopted Dog Decode the Canine Brain”\u003c/strong>\u003c/a>\u003cbr>\n\u003cem>By Gregory Berns\u003c/em>\u003cbr>\nFabulous book for anyone interested in the realities of research. Getting MRI data on dogs to confirm the similarities in where dogs and human brains respond to stimuli sounds like a good idea. Getting permission to get the dogs into the places where there are MRIs, getting the dogs used to the MRI, selecting real-life animals, and the implications for the experimental conclusions is very different from what usually shows up in methods and results.\u003cbr>\n\u003cem>— Joanna Haas, Boston\u003c/em>\u003c/p>\n\u003cp>\u003ca href=\"https://www.amazon.com/gp/product/0316418080/ref=as_li_tl?ie=UTF8&camp=1789&creative=9325&creativeASIN=0316418080&linkCode=as2&tag=stat03d-20&linkId=ab87c536d62f16a84be8997dbe897c72\" target=\"_blank\" rel=\"noopener\">\u003cstrong>“The Perfect Predator: A Scientist’s Race to Save Her Husband from a Deadly Superbug”\u003c/strong>\u003c/a>\u003cbr>\n\u003cem>By Steffanie Strathdee and Thomas Patterson\u003cbr>\n\u003c/em>Riveting account of a scientist trying to save her husband through a combination of sheer will, determination, and cutting-edge science. It’s an amazing blend of mystery, thriller, and microbiology.\u003cbr>\n\u003cem>— Mallory Johnson, Berkeley, Calif.\u003c/em>\u003c/p>\n\u003cp>\u003ca href=\"https://www.amazon.com/gp/product/0671510576/ref=as_li_tl?ie=UTF8&camp=1789&creative=9325&creativeASIN=0671510576&linkCode=as2&tag=stat03d-20&linkId=cb77504e40e1a9467241ae7547ca194a\" target=\"_blank\" rel=\"noopener\">\u003cstrong>“The Billion Dollar Molecule: One Company’s Quest for the Perfect Drug”\u003c/strong>\u003c/a>\u003cbr>\n\u003cem>By Barry Werth\u003c/em>\u003cbr>\n“Billion Dollar Molecule” is a thrilling story about the development of a now powerful pharmaceutical company, its revolutionary approach in structure-based drug development, and how closely it came to failing along the way. At a time when people doubt the justifications of pricing for pharmaceutical drugs, peeking at the risks involved in development and the arduous journeys of the scientists involved through this story could add nuance to the conversation.\u003cbr>\n\u003cem>— Eric Kishel, Buffalo, N.Y.\u003c/em>\u003c/p>\n\u003cp>\u003ca href=\"https://www.amazon.com/gp/product/0190916834/ref=as_li_tl?ie=UTF8&camp=1789&creative=9325&creativeASIN=0190916834&linkCode=as2&tag=stat03d-20&linkId=4c465b27e88b48c0879f78555b17f6ef\" target=\"_blank\" rel=\"noopener\">\u003cstrong>“Well: What We Need to Talk About When We Talk About Health”\u003c/strong>\u003c/a>\u003cbr>\n\u003cem>By Sandro Galea\u003c/em>\u003cbr>\n“Well” moves beyond talk of health disparities as simply numbers and statistics, dissecting the factors that influence health and well-being. This is an excellent read for health professionals or anyone interested in better understanding all the variables that impact our decisions and behaviors, like power, politics, and luck.\u003cbr>\n\u003cem>— Jamie Klufts, Boston\u003c/em>\u003c/p>\n\u003cp>\u003ca href=\"https://www.amazon.com/gp/product/0312430000/ref=as_li_tl?ie=UTF8&camp=1789&creative=9325&creativeASIN=0312430000&linkCode=as2&tag=stat03d-20&linkId=35421e550159f565498198501246b2c1\" target=\"_blank\" rel=\"noopener\">\u003cstrong>“The Checklist Manifesto: How to Get Things Right”\u003c/strong>\u003c/a>\u003cbr>\n\u003cem>By Atul Gawande\u003c/em>\u003cbr>\nYears after reading it, the message and themes of this book still resonate with me. One for everyone involved in health.\u003cbr>\n\u003cem>— Eliza Metcalfe, Melbourne, Australia \u003c/em>\u003c/p>\n\u003cp>\u003ca href=\"https://www.amazon.com/gp/product/154164414X/ref=as_li_tl?ie=UTF8&camp=1789&creative=9325&creativeASIN=154164414X&linkCode=as2&tag=stat03d-20&linkId=9df8ac5f5bb7af175e206e2ce490fcfb\" target=\"_blank\" rel=\"noopener\">\u003cstrong>“Rigor Mortis: How Sloppy Science Creates Worthless Cures, Crushes Hope, and Wastes Billions”\u003c/strong>\u003c/a>\u003cbr>\n\u003cem>By Richard Harris\u003c/em>\u003cbr>\n“Rigor Mortis” delves into data reproducibility and scientific rigor in biomedical research. Using deft anecdotes and commentary, Harris explores how sociocultural forces and perverse incentives in funding mechanisms can conspire to create a dirge of confidence in the research process. Anyone interested in learning about how flawed science undermines medicine should pick up this book for a relatively quick and incisive read.\u003cbr>\n\u003cem>— Kyle Penrod, Providence, R.I.\u003c/em>\u003c/p>\n\u003cp>\u003ca href=\"https://www.amazon.com/gp/product/0316051632/ref=as_li_tl?ie=UTF8&camp=1789&creative=9325&creativeASIN=0316051632&linkCode=as2&tag=stat03d-20&linkId=102a5090c27ba3b32e74ee3014fa30fc\" target=\"_blank\" rel=\"noopener\">\u003cstrong>“The Disappearing Spoon: And Other True Tales of Madness, Love, and the History of the World from the Periodic Table of the Elements”\u003c/strong>\u003c/a>\u003cbr>\n\u003cem>By Sam Kean\u003c/em>\u003cbr>\nThis book is an entertaining and amazing look at the history of the periodic table and the discovery of the elements. Kean writes in a narrative fashion that gripped me from the very first page. This book is a must for lovers of science, history, and science history.\u003cbr>\n\u003cem>— Katie Reeves, Augusta, Ga.\u003c/em>\u003c/p>\n\u003cp>\u003cstrong>STAT Reporters\u003c/strong>\u003c/p>\n\u003cp>\u003ca href=\"https://www.amazon.com/gp/product/1608192075/ref=as_li_tl?ie=UTF8&camp=1789&creative=9325&creativeASIN=1608192075&linkCode=as2&tag=stat03d-20&linkId=7aa079684701270fecebca869fe0c79e\" target=\"_blank\" rel=\"noopener\">\u003cstrong>“Methland: The Death and Life of an American Small Town”\u003c/strong>\u003c/a>\u003cbr>\n\u003cem>By Nick Reding\u003c/em>\u003cbr>\nThe 2016 election sparked a national obsession with reporting from “flyover country” — a hasty attempt from the national media to remember the forgotten swathes of land between the coasts. But some of the resulting coverage was so full of caricatures it seemed like just another version of flying over. Stumbling across “Methland” in the public library provided a strong antidote to those datelines without depth. Nick Reding’s portraits of small-town Iowans who are cooking, using, or working against meth are so deeply reported that you feel as if you’ve met these people in the flesh. The details are striking — kids mixing “crank” in soda bottles as they tootle around on their bikes, a dealer investing in car selling and horse racing as fronts for her drug empire — but the book also has an impressive sweep: It chronicles rural economies overtaken by agricultural behemoths, towns left behind by everyone with the means to leave, and public health and existential crises ensnaring the people who remain.\u003cbr>\n\u003cem>— Eric Boodman, reporter\u003c/em>\u003c/p>\n\u003cp>\u003ca href=\"https://www.amazon.com/gp/product/1568585810/ref=as_li_tl?ie=UTF8&camp=1789&creative=9325&creativeASIN=1568585810&linkCode=as2&tag=stat03d-20&linkId=c7392af7e5427afc8fbd10e2f028fc99\" target=\"_blank\" rel=\"noopener\">\u003cstrong>“Ask Me About My Uterus: A Quest to Make Doctors Believe in Women’s Pain”\u003c/strong>\u003c/a>\u003cbr>\n\u003cem>By Abby Norman\u003c/em>\u003cbr>\nAny woman whose pain has been dismissed as being “part of what it means to be a woman” will highly relate to this book. “Ask Me About My Uterus” is the story of Abby Norman, whose long and frustrating journey of finding out what was causing her excruciating pain, unexplainable weight loss, and a host of other symptoms meant she had to drop out of college her freshman year. Norman describes how relationships and hobbies all fell by the wayside as the constant pain kept her at home. Only after she got a job at a hospital and spent hours educating herself did Norman finally get a diagnosis of endometriosis. The book weaves together Norman’s own story as well as research and evidence to indicate how medicine continues to ignore women’s pain. I learned a lot of things, but how to be more assertive when I visit with a physician is at the top of the list!\u003cbr>\n\u003cem>— Shraddha Chakradhar, reporter and Morning Rounds writer\u003c/em>\u003c/p>\n\u003cp>\u003ca href=\"https://www.amazon.com/gp/product/B07DP6MSJG/ref=as_li_tl?ie=UTF8&camp=1789&creative=9325&creativeASIN=B07DP6MSJG&linkCode=as2&tag=stat03d-20&linkId=169853d1a860b739e89a5805d07eee17\" target=\"_blank\" rel=\"noopener\">\u003cstrong>“Good to Go: What the Athlete in All of us Can Learn From the Strange Science of Recovery”\u003c/strong>\u003c/a>\u003cbr>\n\u003cem>By Christie Aschwanden\u003c/em>\u003cbr>\nLike many who live life with a daily dose of sweat, I’m always on the lookout for the best ways to recover from exercise and get myself back out the door. In her new book, science journalist and athlete Christie Aschwanden deftly unravels the complex web of science, pseudoscience, and downright bogus claims in the world of exercise recovery. She takes the reader into infrared saunas, ice baths, and float spas and tests techniques I’d never heard of (meditation headbands are a thing?) meant to help athletes bounce back from their hard efforts.\u003cbr>\n\u003cem>— Brittany Flaherty, news intern\u003c/em>\u003c/p>\n\u003cp>\u003ca href=\"https://www.amazon.com/gp/product/0812997417/ref=as_li_tl?ie=UTF8&camp=1789&creative=9325&creativeASIN=0812997417&linkCode=as2&tag=stat03d-20&linkId=3df4e39b8793e8725667e7c8b16161f3\" target=\"_blank\" rel=\"noopener\">\u003cstrong>“Lake Success”\u003c/strong>\u003c/a>\u003cbr>\n\u003cem>By Gary Shteyngart\u003c/em>\u003cbr>\n“Lake Success” is the story of Barry Cohen, a superlatively successful hedge fund manager whose enviable Manhattan life comes hideously unglued after he makes an ill-advised bet on what is clearly a stand-in for Valeant Pharmaceuticals. What ensues is a never sanguine, always empathetic, reliably funny portrait of a fabulously wealthy person who seems to have forgotten the concept of failure. It’s also a fascinating character study for those of us biotech schnooks who looked at alleged insider traders like Mathew Martoma and wondered how on earth they thought they’d get away with it all. Plus there’s fancy watches, generational angst, and a meditation on the creeping financialization of everything that promises to bring about a new Gilded Age. You know, beach stuff.\u003cbr>\n\u003cem>— Damian Garde, national biotech reporter\u003c/em>\u003c/p>\n\u003cp>\u003ca href=\"https://www.amazon.com/gp/product/1524732710/ref=as_li_tl?ie=UTF8&camp=1789&creative=9325&creativeASIN=1524732710&linkCode=as2&tag=stat03d-20&linkId=f0f49695f97eea1f87af0be2c561a5fe\" target=\"_blank\" rel=\"noopener\">\u003cstrong>“Inheritance: A Memoir of Genealogy, Paternity, and Love”\u003c/strong>\u003c/a>\u003cbr>\n\u003cem>By Dani Shapiro\u003c/em>\u003cbr>\nWherever she speaks during her book tour for “Inheritance,” memoirist Dani Shapiro is approached by people who, like her, discovered through a DNA spit test that their biological father is not who they thought he was, and that their family history is a lot more twisted than they realized. Indeed, when I heard her in Boston, a man stood up during the Q&A and announced he’d learned he was the product of a sperm donor who turned out to be a fertility doctor who’d fathered dozens of children. Shapiro’s book is a very personal story, but clearly one that resonates broadly in our DNA-obsessed age.\u003cbr>\n\u003cem>— Gideon Gil, managing editor\u003c/em>\u003c/p>\n\u003cp>\u003ca href=\"https://www.amazon.com/gp/product/1501168681/ref=as_li_tl?ie=UTF8&camp=1789&creative=9325&creativeASIN=1501168681&linkCode=as2&tag=stat03d-20&linkId=22c75b403593e8a3a77e635029a3d63f\" target=\"_blank\" rel=\"noopener\">\u003cstrong>“The Pioneers: The Heroic Story of the Settlers Who Brought The American Ideal West”\u003c/strong>\u003c/a>\u003cbr>\n\u003cem>By David McCullough\u003c/em>\u003cbr>\nA great way to gain perspective on the impact of modern medicine is to consider life before it arrived. McCullough’s account of the pioneers who settled America’s Northwest Territory — an area that includes the states of Ohio, Indiana, Illinois, Michigan, and Wisconsin — offers a window into the ruggedness required of both doctors and patients who stared down deadly illnesses in the unbroken wilderness with few defenses. Episodic disease outbreaks swept across the frontier like wildfire, often decimating settlements and taking the lives of multiple children in the same family. As a father living in present-day Ohio, it is hard to imagine the panic this must have instilled, and the resolve required to push forward despite the heart-wrenching costs. But this book has given me fresh insight and a few reasons to reconsider my own grievances in the relative utopia we’ve carved out of the Wild West.\u003cbr>\n\u003cem>— Casey Ross, national technology correspondent\u003c/em>\u003c/p>\n\u003cp>\u003ca href=\"https://www.amazon.com/gp/product/0812982525/ref=as_li_tl?ie=UTF8&camp=1789&creative=9325&creativeASIN=0812982525&linkCode=as2&tag=stat03d-20&linkId=ca6e6c07db5238906a40e5ea31a25d71\" target=\"_blank\" rel=\"noopener\">\u003cstrong>“Patient H.M.: A Story of Memory, Madness, and Family Secrets”\u003c/strong>\u003c/a>\u003cbr>\n\u003cem>By Luke Dittrich\u003c/em>\u003cbr>\nThe book weaves the neuroscience legend of Henry Molaison with author Luke Dittrich’s own family dramas. After Dittrich’s grandfather operated on Molaison’s brain in an effort to treat his debilitating epilepsy, he wasn’t able to form any short-term memories. For decades after the surgery, researchers worked with Molaison to better understand how human memory works. Patient H.M.’s story is interesting enough. But when the story is mentioned, the surgeon is usually a minor player. This time, Dittrich brings his grandfather to life — and uses his family’s own history to explore some of the darker chapters in neuroscience history.\u003cbr>\n\u003cem>— Kate Sheridan, reporter\u003c/em>\u003c/p>\n\u003cp>\u003ca href=\"https://www.amazon.com/gp/product/0525552960/ref=as_li_tl?ie=UTF8&camp=1789&creative=9325&creativeASIN=0525552960&linkCode=as2&tag=stat03d-20&linkId=0abcda54b107dd77066adae0db4d637f\" target=\"_blank\" rel=\"noopener\">\u003cstrong>“Darius The Great is Not Okay”\u003c/strong>\u003c/a>\u003cbr>\n\u003cem>By Adib Khorram\u003c/em>\u003cbr>\nAdib Khorram’s debut novel is about many things: identity, immigration, family, friendship. It’s also about living with clinical depression as a teen, and being a teen with a parent who has depression. Khorram is able to give readers a window into living with mental illness without making it the sole focus of the characters or their stories. And while it’s technically a young adult book, I’d recommend it to adults of all ages.\u003cbr>\n\u003cem>— Megan Thielking, reporter\u003c/em>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This \u003ca href=\"https://www.statnews.com/2019/05/01/from-protegee-to-whistleblower-a-former-theranos-scientist-says-elizabeth-holmes-should-come-forward-and-apologize/\">story\u003c/a> was originally published by \u003ca href=\"https://www.statnews.com/\">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>\u003cspan class=\"big-cap-wrap\">\u003cspan class=\"big-cap\">T\u003c/span>\u003c/span>he first day of summer has arrived, and so has STAT’s annual book list of great reads in health, science, and medicine.\u003c/p>\n\u003cp>Read on for recommendations from CRISPR pioneer Jennifer Doudna and CDC Director Robert Redfield. Plus, STAT readers from Boston to Ireland to Australia share their picks, in addition to our staff. Enjoy!\u003c/p>\n\u003cp>\u003cstrong>Notable Figures\u003c/strong>\u003c/p>\n\u003cp>\u003cstrong>\u003ca href=\"https://www.amazon.com/gp/product/0805071806/ref=as_li_tl?ie=UTF8&camp=1789&creative=9325&creativeASIN=0805071806&linkCode=as2&tag=stat03d-20&linkId=7bf123ab6184f5cac33d58beddbb56f6\" target=\"_blank\" rel=\"noopener\">“Scientific Conversations: Interviews on Science from The New York Times”\u003c/a>\u003c/strong>\u003cbr>\n\u003cem>By Claudia Dreifus\u003c/em>\u003cbr>\nThis is an awesome collection of 38 interviews, published originally in the Science Times section of the New York Times, that captures the wonder and excitement of scientific discovery. As an outstanding journalist and a relative outsider to science, Dreifus elicits from her subjects the passion, frustration, inspiration and, ultimately, the joy of doing science. Her writing reminds me of the work of John McPhee: deep and expansive with a sense of fun. A great read!\u003cbr>\n\u003cem>— Jennifer Doudna, professor and HHMI Investigator, UC Berkeley; director, Innovative Genomics Institute of UC Berkeley/UCSF/Gladstone Institutes\u003c/em>\u003c/p>\n\u003cp>\u003cstrong>\u003ca href=\"https://www.amazon.com/gp/product/006122796X/ref=as_li_tl?ie=UTF8&camp=1789&creative=9325&creativeASIN=006122796X&linkCode=as2&tag=stat03d-20&linkId=7cfcc6b0801cc1e4c567331d7f105411\" target=\"_blank\" rel=\"noopener\">“Vaccinated: One Man’s Quest to Defeat the World’s Deadliest Diseases”\u003c/a>\u003c/strong>\u003cbr>\n\u003cem>By Paul A. Offit\u003c/em>\u003cbr>\nPhysicians, parents, and public health professionals seeking credible, timely information about the safety and effectiveness of vaccines will find those answers in Dr. Offit’s “Vaccinated.” He writes a compelling narrative, sharing the underlying science and historical context behind the vaccine regimen recommended today. This fact-based retrospective dispels myths and underscores the importance of immunization for children and adults alike. Readers will have a better understanding of the science-based reasoning to embrace vaccination for themselves, their families, and their communities.\u003cbr>\n\u003cem>— Dr. Robert R. Redfield, director of the Centers for Disease Control and Prevention\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cstrong>\u003ca href=\"https://www.amazon.com/gp/product/0520229134/ref=as_li_tl?ie=UTF8&camp=1789&creative=9325&creativeASIN=0520229134&linkCode=as2&tag=stat03d-20&linkId=f6872536969b6885c29cba642778c5ca\" target=\"_blank\" rel=\"noopener\">“Infections and Inequalities: The Modern Plagues”\u003c/a>\u003c/strong>\u003cbr>\n\u003cem>By Paul Farmer\u003c/em>\u003cbr>\nThis book highlights so well the very inception of the Bill and Melinda Gates Medical Research Institute itself and our mission to develop treatments and preventive agents for diseases burdening the world’s poorest people. Tenderly, Farmer tells the stories of those who suffer, offering their complex circumstances in the face of overwhelming data. The Partners in Health co-founder challenges those determined to care for the most vulnerable to challenge the status quo. Although written 20 years ago, the stories ring truer than ever. Inequities in health have only become magnified and are now manifest in our own backyard. Although sobering, it is also inspiring and may make the reader leap to other resources such as “The Age of Living Machines” by Susan Hockfield, who posits that convergence across scientific disciplines led to the current technological capabilities. Can these not be leveraged with know-how and fortitude to meaningfully address inequities in health?\u003cbr>\n\u003cem>— Dr. Penny Heaton, CEO of the Bill and Melinda Gates Medical Research Institute\u003c/em>\u003c/p>\n\u003cp>\u003cstrong>\u003ca href=\"https://www.amazon.com/gp/product/1845291557/ref=as_li_tl?ie=UTF8&camp=1789&creative=9325&creativeASIN=1845291557&linkCode=as2&tag=stat03d-20&linkId=424b9e11f98c4fb76b3a018ce157005a\" target=\"_blank\" rel=\"noopener\">“A Brief History of Medicine: from Hippocrates to Gene Therapy”\u003c/a>\u003cbr>\n\u003c/strong>\u003cem>By Paul Strathern\u003cbr>\n\u003c/em>Among the many histories of medicine, Paul Strathern’s narrative stands out for its lively prose and colorful portraits of figures who broke with dogma and proved new paradigms. Even the expert reader will find much that is novel and nuanced, not only in stories about prominent characters like Galen and Harvey, but less well known individuals like the Venerable Bede, an English monk who revived Greek and Roman knowledge during the Dark Ages, and Al-Razi, an Islamic scholar who challenged Aristotle’s prevailing notions with experimental data and showed that pediatric disorders need not be viewed as untreatable and hopeless. Each chapter offers a rich tableau depicting advances in medical thinking based on astute observation and rigorous induction. Strathern brilliantly succeeds in both educating and entertaining his reader, a perfect blend for a summer treat.\u003cbr>\n\u003cem>— Dr. Jerome Groopman, New Yorker staff writer and author; Recanati Professor of Medicine, Harvard Medical School\u003c/em>\u003c/p>\n\u003cp>\u003cstrong>\u003ca href=\"https://www.amazon.com/gp/product/0345804570/ref=as_li_tl?ie=UTF8&camp=1789&creative=9325&creativeASIN=0345804570&linkCode=as2&tag=stat03d-20&linkId=137ae7f66e5eee834172c881aa8f1b7a\" target=\"_blank\" rel=\"noopener\">“The Evolution of Beauty: How Darwin’s Forgotten Theory of Mate Choice Shapes the Animal World—and Us”\u003c/a>\u003c/strong>\u003cbr>\n\u003cem>By Richard Prum\u003c/em>\u003cbr>\nWhether you agree with Prum or not, his case for renewed attention to Darwin’s theory of sexual selection — that considerations of beauty, and not just functional adaptation, shape evolution — is eye-opening. The book also reminds us that politics (in this case, 19th-century disapproval of Darwin’s views on female mate choice) can influence what we are taught about science. Even if you are skeptical, Prum will make you think twice about the natural world, and will definitely change how you look at ducks.\u003cbr>\n\u003cem>— Ron Klain, President Obama’s Ebola czar during the West African outbreak\u003c/em>\u003c/p>\n\u003cp>\u003ca href=\"https://www.amazon.com/gp/product/0062338781/ref=as_li_tl?ie=UTF8&camp=1789&creative=9325&creativeASIN=0062338781&linkCode=as2&tag=stat03d-20&linkId=a08377a6dbaebf506ffcb6efb996c457\" target=\"_blank\" rel=\"noopener\">\u003cstrong>“Bottle of Lies: The Inside Story of the Generic Drug Boom”\u003c/strong>\u003c/a>\u003cbr>\n\u003cem>By Katherine Eban\u003cbr>\n\u003c/em>In her fierce and fearless book, “Bottle of Lies,” the investigative journalist Katherine Eban takes us on a journey through the loosely regulated and often corrupt manufacture of generic drugs. Weaving together the story of a terrified but determined whistleblower from India, shady drug producers from China, and a notably timid FDA, Eban’s compelling book should serve as cautionary tale and a wake-up call for consumers, manufacturers, and physicians — “should” being the operative word.\u003cbr>\n\u003cem>— Deborah Blum, author of “The Poison Squad: One Chemist’s Single-Minded Crusade for Food Safety at the Turn of the Twentieth Century” and director of the Knight Science Journalism Program at MIT\u003c/em>\u003c/p>\n\u003cp>\u003cstrong>STAT Readers\u003c/strong>\u003c/p>\n\u003cp>\u003ca href=\"https://www.amazon.com/gp/product/0735224153/ref=as_li_tl?ie=UTF8&camp=1789&creative=9325&creativeASIN=0735224153&linkCode=as2&tag=stat03d-20&linkId=e88ba9aa97ec231e13dcca5e20cbc7bf\" target=\"_blank\" rel=\"noopener\">\u003cstrong>“How to Change Your Mind: What the New Science of Psychedelics Teaches Us About Consciousness, Dying, Addiction, Depression, and Transcendence”\u003c/strong>\u003c/a>\u003cbr>\n\u003cem>By Michael Pollan\u003c/em>\u003cbr>\nWith cannabis medicine now getting the attention it deserves, Michael Pollan has done a tremendous job at digging into the history of psychedelic use, both recreationally and in therapy, together with his own observations as a new psychedelic experimenter at the age of 60. All in all, a comprehensive history of the topic, together with interviews from key psychedelic researchers, and a call for serious researchers to think twice about hasty judgments surrounding this interesting compound.\u003cbr>\n\u003cem>— Jon Calder, Belfast, Northern Ireland\u003c/em>\u003c/p>\n\u003cp>\u003ca href=\"https://www.amazon.com/gp/product/006289627X/ref=as_li_tl?ie=UTF8&camp=1789&creative=9325&creativeASIN=006289627X&linkCode=as2&tag=stat03d-20&linkId=ea6fc765acd3cc5ad1ccd85342cb04ae\" target=\"_blank\" rel=\"noopener\">\u003cstrong>“Bitten: The Secret History of Lyme Disease and Biological Weapons”\u003c/strong>\u003c/a>\u003cbr>\n\u003cem>By Kris Newby\u003c/em>\u003cbr>\n“Bitten” is a riveting narrative that digs into the origins of the Lyme disease epidemic. It connects many dots with compelling evidence and page-turning storytelling that point to the likelihood that a bio-weaponized tick program gone awry could have contributed to the more virulent forms of tick-borne illnesses that have been wreaking havoc on unwitting people for the past five decades. Doctors are not well-trained on tick-borne illness, diagnostics are inadequate, and there are no career tracks in the field other than a few courageous pioneers. Biotech is largely on the sidelines. Yet millions of people are being disabled. Perhaps this book will help stir some action. After all, we all are just one bite away from a nightmare illness.\u003cbr>\n\u003cem>— Nancy Dougherty, Boston\u003c/em>\u003c/p>\n\u003cp>\u003ca href=\"https://www.amazon.com/gp/product/0544114515/ref=as_li_tl?ie=UTF8&camp=1789&creative=9325&creativeASIN=0544114515&linkCode=as2&tag=stat03d-20&linkId=4f6ff933051d07a5d66bb8d7906db1a2\" target=\"_blank\" rel=\"noopener\">\u003cstrong>“How Dogs Love Us: A Neuroscientist and His Adopted Dog Decode the Canine Brain”\u003c/strong>\u003c/a>\u003cbr>\n\u003cem>By Gregory Berns\u003c/em>\u003cbr>\nFabulous book for anyone interested in the realities of research. Getting MRI data on dogs to confirm the similarities in where dogs and human brains respond to stimuli sounds like a good idea. Getting permission to get the dogs into the places where there are MRIs, getting the dogs used to the MRI, selecting real-life animals, and the implications for the experimental conclusions is very different from what usually shows up in methods and results.\u003cbr>\n\u003cem>— Joanna Haas, Boston\u003c/em>\u003c/p>\n\u003cp>\u003ca href=\"https://www.amazon.com/gp/product/0316418080/ref=as_li_tl?ie=UTF8&camp=1789&creative=9325&creativeASIN=0316418080&linkCode=as2&tag=stat03d-20&linkId=ab87c536d62f16a84be8997dbe897c72\" target=\"_blank\" rel=\"noopener\">\u003cstrong>“The Perfect Predator: A Scientist’s Race to Save Her Husband from a Deadly Superbug”\u003c/strong>\u003c/a>\u003cbr>\n\u003cem>By Steffanie Strathdee and Thomas Patterson\u003cbr>\n\u003c/em>Riveting account of a scientist trying to save her husband through a combination of sheer will, determination, and cutting-edge science. It’s an amazing blend of mystery, thriller, and microbiology.\u003cbr>\n\u003cem>— Mallory Johnson, Berkeley, Calif.\u003c/em>\u003c/p>\n\u003cp>\u003ca href=\"https://www.amazon.com/gp/product/0671510576/ref=as_li_tl?ie=UTF8&camp=1789&creative=9325&creativeASIN=0671510576&linkCode=as2&tag=stat03d-20&linkId=cb77504e40e1a9467241ae7547ca194a\" target=\"_blank\" rel=\"noopener\">\u003cstrong>“The Billion Dollar Molecule: One Company’s Quest for the Perfect Drug”\u003c/strong>\u003c/a>\u003cbr>\n\u003cem>By Barry Werth\u003c/em>\u003cbr>\n“Billion Dollar Molecule” is a thrilling story about the development of a now powerful pharmaceutical company, its revolutionary approach in structure-based drug development, and how closely it came to failing along the way. At a time when people doubt the justifications of pricing for pharmaceutical drugs, peeking at the risks involved in development and the arduous journeys of the scientists involved through this story could add nuance to the conversation.\u003cbr>\n\u003cem>— Eric Kishel, Buffalo, N.Y.\u003c/em>\u003c/p>\n\u003cp>\u003ca href=\"https://www.amazon.com/gp/product/0190916834/ref=as_li_tl?ie=UTF8&camp=1789&creative=9325&creativeASIN=0190916834&linkCode=as2&tag=stat03d-20&linkId=4c465b27e88b48c0879f78555b17f6ef\" target=\"_blank\" rel=\"noopener\">\u003cstrong>“Well: What We Need to Talk About When We Talk About Health”\u003c/strong>\u003c/a>\u003cbr>\n\u003cem>By Sandro Galea\u003c/em>\u003cbr>\n“Well” moves beyond talk of health disparities as simply numbers and statistics, dissecting the factors that influence health and well-being. This is an excellent read for health professionals or anyone interested in better understanding all the variables that impact our decisions and behaviors, like power, politics, and luck.\u003cbr>\n\u003cem>— Jamie Klufts, Boston\u003c/em>\u003c/p>\n\u003cp>\u003ca href=\"https://www.amazon.com/gp/product/0312430000/ref=as_li_tl?ie=UTF8&camp=1789&creative=9325&creativeASIN=0312430000&linkCode=as2&tag=stat03d-20&linkId=35421e550159f565498198501246b2c1\" target=\"_blank\" rel=\"noopener\">\u003cstrong>“The Checklist Manifesto: How to Get Things Right”\u003c/strong>\u003c/a>\u003cbr>\n\u003cem>By Atul Gawande\u003c/em>\u003cbr>\nYears after reading it, the message and themes of this book still resonate with me. One for everyone involved in health.\u003cbr>\n\u003cem>— Eliza Metcalfe, Melbourne, Australia \u003c/em>\u003c/p>\n\u003cp>\u003ca href=\"https://www.amazon.com/gp/product/154164414X/ref=as_li_tl?ie=UTF8&camp=1789&creative=9325&creativeASIN=154164414X&linkCode=as2&tag=stat03d-20&linkId=9df8ac5f5bb7af175e206e2ce490fcfb\" target=\"_blank\" rel=\"noopener\">\u003cstrong>“Rigor Mortis: How Sloppy Science Creates Worthless Cures, Crushes Hope, and Wastes Billions”\u003c/strong>\u003c/a>\u003cbr>\n\u003cem>By Richard Harris\u003c/em>\u003cbr>\n“Rigor Mortis” delves into data reproducibility and scientific rigor in biomedical research. Using deft anecdotes and commentary, Harris explores how sociocultural forces and perverse incentives in funding mechanisms can conspire to create a dirge of confidence in the research process. Anyone interested in learning about how flawed science undermines medicine should pick up this book for a relatively quick and incisive read.\u003cbr>\n\u003cem>— Kyle Penrod, Providence, R.I.\u003c/em>\u003c/p>\n\u003cp>\u003ca href=\"https://www.amazon.com/gp/product/0316051632/ref=as_li_tl?ie=UTF8&camp=1789&creative=9325&creativeASIN=0316051632&linkCode=as2&tag=stat03d-20&linkId=102a5090c27ba3b32e74ee3014fa30fc\" target=\"_blank\" rel=\"noopener\">\u003cstrong>“The Disappearing Spoon: And Other True Tales of Madness, Love, and the History of the World from the Periodic Table of the Elements”\u003c/strong>\u003c/a>\u003cbr>\n\u003cem>By Sam Kean\u003c/em>\u003cbr>\nThis book is an entertaining and amazing look at the history of the periodic table and the discovery of the elements. Kean writes in a narrative fashion that gripped me from the very first page. This book is a must for lovers of science, history, and science history.\u003cbr>\n\u003cem>— Katie Reeves, Augusta, Ga.\u003c/em>\u003c/p>\n\u003cp>\u003cstrong>STAT Reporters\u003c/strong>\u003c/p>\n\u003cp>\u003ca href=\"https://www.amazon.com/gp/product/1608192075/ref=as_li_tl?ie=UTF8&camp=1789&creative=9325&creativeASIN=1608192075&linkCode=as2&tag=stat03d-20&linkId=7aa079684701270fecebca869fe0c79e\" target=\"_blank\" rel=\"noopener\">\u003cstrong>“Methland: The Death and Life of an American Small Town”\u003c/strong>\u003c/a>\u003cbr>\n\u003cem>By Nick Reding\u003c/em>\u003cbr>\nThe 2016 election sparked a national obsession with reporting from “flyover country” — a hasty attempt from the national media to remember the forgotten swathes of land between the coasts. But some of the resulting coverage was so full of caricatures it seemed like just another version of flying over. Stumbling across “Methland” in the public library provided a strong antidote to those datelines without depth. Nick Reding’s portraits of small-town Iowans who are cooking, using, or working against meth are so deeply reported that you feel as if you’ve met these people in the flesh. The details are striking — kids mixing “crank” in soda bottles as they tootle around on their bikes, a dealer investing in car selling and horse racing as fronts for her drug empire — but the book also has an impressive sweep: It chronicles rural economies overtaken by agricultural behemoths, towns left behind by everyone with the means to leave, and public health and existential crises ensnaring the people who remain.\u003cbr>\n\u003cem>— Eric Boodman, reporter\u003c/em>\u003c/p>\n\u003cp>\u003ca href=\"https://www.amazon.com/gp/product/1568585810/ref=as_li_tl?ie=UTF8&camp=1789&creative=9325&creativeASIN=1568585810&linkCode=as2&tag=stat03d-20&linkId=c7392af7e5427afc8fbd10e2f028fc99\" target=\"_blank\" rel=\"noopener\">\u003cstrong>“Ask Me About My Uterus: A Quest to Make Doctors Believe in Women’s Pain”\u003c/strong>\u003c/a>\u003cbr>\n\u003cem>By Abby Norman\u003c/em>\u003cbr>\nAny woman whose pain has been dismissed as being “part of what it means to be a woman” will highly relate to this book. “Ask Me About My Uterus” is the story of Abby Norman, whose long and frustrating journey of finding out what was causing her excruciating pain, unexplainable weight loss, and a host of other symptoms meant she had to drop out of college her freshman year. Norman describes how relationships and hobbies all fell by the wayside as the constant pain kept her at home. Only after she got a job at a hospital and spent hours educating herself did Norman finally get a diagnosis of endometriosis. The book weaves together Norman’s own story as well as research and evidence to indicate how medicine continues to ignore women’s pain. I learned a lot of things, but how to be more assertive when I visit with a physician is at the top of the list!\u003cbr>\n\u003cem>— Shraddha Chakradhar, reporter and Morning Rounds writer\u003c/em>\u003c/p>\n\u003cp>\u003ca href=\"https://www.amazon.com/gp/product/B07DP6MSJG/ref=as_li_tl?ie=UTF8&camp=1789&creative=9325&creativeASIN=B07DP6MSJG&linkCode=as2&tag=stat03d-20&linkId=169853d1a860b739e89a5805d07eee17\" target=\"_blank\" rel=\"noopener\">\u003cstrong>“Good to Go: What the Athlete in All of us Can Learn From the Strange Science of Recovery”\u003c/strong>\u003c/a>\u003cbr>\n\u003cem>By Christie Aschwanden\u003c/em>\u003cbr>\nLike many who live life with a daily dose of sweat, I’m always on the lookout for the best ways to recover from exercise and get myself back out the door. In her new book, science journalist and athlete Christie Aschwanden deftly unravels the complex web of science, pseudoscience, and downright bogus claims in the world of exercise recovery. She takes the reader into infrared saunas, ice baths, and float spas and tests techniques I’d never heard of (meditation headbands are a thing?) meant to help athletes bounce back from their hard efforts.\u003cbr>\n\u003cem>— Brittany Flaherty, news intern\u003c/em>\u003c/p>\n\u003cp>\u003ca href=\"https://www.amazon.com/gp/product/0812997417/ref=as_li_tl?ie=UTF8&camp=1789&creative=9325&creativeASIN=0812997417&linkCode=as2&tag=stat03d-20&linkId=3df4e39b8793e8725667e7c8b16161f3\" target=\"_blank\" rel=\"noopener\">\u003cstrong>“Lake Success”\u003c/strong>\u003c/a>\u003cbr>\n\u003cem>By Gary Shteyngart\u003c/em>\u003cbr>\n“Lake Success” is the story of Barry Cohen, a superlatively successful hedge fund manager whose enviable Manhattan life comes hideously unglued after he makes an ill-advised bet on what is clearly a stand-in for Valeant Pharmaceuticals. What ensues is a never sanguine, always empathetic, reliably funny portrait of a fabulously wealthy person who seems to have forgotten the concept of failure. It’s also a fascinating character study for those of us biotech schnooks who looked at alleged insider traders like Mathew Martoma and wondered how on earth they thought they’d get away with it all. Plus there’s fancy watches, generational angst, and a meditation on the creeping financialization of everything that promises to bring about a new Gilded Age. You know, beach stuff.\u003cbr>\n\u003cem>— Damian Garde, national biotech reporter\u003c/em>\u003c/p>\n\u003cp>\u003ca href=\"https://www.amazon.com/gp/product/1524732710/ref=as_li_tl?ie=UTF8&camp=1789&creative=9325&creativeASIN=1524732710&linkCode=as2&tag=stat03d-20&linkId=f0f49695f97eea1f87af0be2c561a5fe\" target=\"_blank\" rel=\"noopener\">\u003cstrong>“Inheritance: A Memoir of Genealogy, Paternity, and Love”\u003c/strong>\u003c/a>\u003cbr>\n\u003cem>By Dani Shapiro\u003c/em>\u003cbr>\nWherever she speaks during her book tour for “Inheritance,” memoirist Dani Shapiro is approached by people who, like her, discovered through a DNA spit test that their biological father is not who they thought he was, and that their family history is a lot more twisted than they realized. Indeed, when I heard her in Boston, a man stood up during the Q&A and announced he’d learned he was the product of a sperm donor who turned out to be a fertility doctor who’d fathered dozens of children. Shapiro’s book is a very personal story, but clearly one that resonates broadly in our DNA-obsessed age.\u003cbr>\n\u003cem>— Gideon Gil, managing editor\u003c/em>\u003c/p>\n\u003cp>\u003ca href=\"https://www.amazon.com/gp/product/1501168681/ref=as_li_tl?ie=UTF8&camp=1789&creative=9325&creativeASIN=1501168681&linkCode=as2&tag=stat03d-20&linkId=22c75b403593e8a3a77e635029a3d63f\" target=\"_blank\" rel=\"noopener\">\u003cstrong>“The Pioneers: The Heroic Story of the Settlers Who Brought The American Ideal West”\u003c/strong>\u003c/a>\u003cbr>\n\u003cem>By David McCullough\u003c/em>\u003cbr>\nA great way to gain perspective on the impact of modern medicine is to consider life before it arrived. McCullough’s account of the pioneers who settled America’s Northwest Territory — an area that includes the states of Ohio, Indiana, Illinois, Michigan, and Wisconsin — offers a window into the ruggedness required of both doctors and patients who stared down deadly illnesses in the unbroken wilderness with few defenses. Episodic disease outbreaks swept across the frontier like wildfire, often decimating settlements and taking the lives of multiple children in the same family. As a father living in present-day Ohio, it is hard to imagine the panic this must have instilled, and the resolve required to push forward despite the heart-wrenching costs. But this book has given me fresh insight and a few reasons to reconsider my own grievances in the relative utopia we’ve carved out of the Wild West.\u003cbr>\n\u003cem>— Casey Ross, national technology correspondent\u003c/em>\u003c/p>\n\u003cp>\u003ca href=\"https://www.amazon.com/gp/product/0812982525/ref=as_li_tl?ie=UTF8&camp=1789&creative=9325&creativeASIN=0812982525&linkCode=as2&tag=stat03d-20&linkId=ca6e6c07db5238906a40e5ea31a25d71\" target=\"_blank\" rel=\"noopener\">\u003cstrong>“Patient H.M.: A Story of Memory, Madness, and Family Secrets”\u003c/strong>\u003c/a>\u003cbr>\n\u003cem>By Luke Dittrich\u003c/em>\u003cbr>\nThe book weaves the neuroscience legend of Henry Molaison with author Luke Dittrich’s own family dramas. After Dittrich’s grandfather operated on Molaison’s brain in an effort to treat his debilitating epilepsy, he wasn’t able to form any short-term memories. For decades after the surgery, researchers worked with Molaison to better understand how human memory works. Patient H.M.’s story is interesting enough. But when the story is mentioned, the surgeon is usually a minor player. This time, Dittrich brings his grandfather to life — and uses his family’s own history to explore some of the darker chapters in neuroscience history.\u003cbr>\n\u003cem>— Kate Sheridan, reporter\u003c/em>\u003c/p>\n\u003cp>\u003ca href=\"https://www.amazon.com/gp/product/0525552960/ref=as_li_tl?ie=UTF8&camp=1789&creative=9325&creativeASIN=0525552960&linkCode=as2&tag=stat03d-20&linkId=0abcda54b107dd77066adae0db4d637f\" target=\"_blank\" rel=\"noopener\">\u003cstrong>“Darius The Great is Not Okay”\u003c/strong>\u003c/a>\u003cbr>\n\u003cem>By Adib Khorram\u003c/em>\u003cbr>\nAdib Khorram’s debut novel is about many things: identity, immigration, family, friendship. It’s also about living with clinical depression as a teen, and being a teen with a parent who has depression. Khorram is able to give readers a window into living with mental illness without making it the sole focus of the characters or their stories. And while it’s technically a young adult book, I’d recommend it to adults of all ages.\u003cbr>\n\u003cem>— Megan Thielking, reporter\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 \u003ca href=\"https://www.statnews.com/2019/05/01/from-protegee-to-whistleblower-a-former-theranos-scientist-says-elizabeth-holmes-should-come-forward-and-apologize/\">story\u003c/a> was originally published by \u003ca href=\"https://www.statnews.com/\">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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"title": "No, Smartphones Aren’t Making Millennials Grow Horns. Here’s How to Spot a Bad Study",
"headTitle": "No, Smartphones Aren’t Making Millennials Grow Horns. Here’s How to Spot a Bad Study | KQED",
"content": "\u003cp>It’s the kind of story that could sound true, but seems off.\u003c/p>\n\u003cp>That was the feeling I got last week, when a \u003ca href=\"https://www.washingtonpost.com/nation/2019/06/20/horns-are-growing-young-peoples-skulls-phone-use-is-blame-research-suggests/?utm_term=.e5a4ce48be7d\" target=\"_blank\" rel=\"noopener\">Washington Post article\u003c/a> — “Horns are growing on young people’s skulls. Phone use is to blame, research suggests” — appeared in my email inbox.\u003c/p>\n\u003cp>The report covers a 2018 study \u003ca href=\"https://www.nature.com/articles/s41598-018-21625-1\">published in Scientific Reports\u003c/a>, which used head X-rays of 1,200 chiropractic patients to claim that young adults aged 18 to 30 are growing bone masses on the backs of their skulls, a supposed phenomenon that The Washington Post described as “horns” (which are technically bone spurs called enlarged external occipital protuberances — EEOPs or EOPs).\u003c/p>\n\u003cp>A week before The Washington Post article, BBC Future published a feature story on “\u003ca href=\"http://www.bbc.com/future/story/20190610-how-modern-life-is-transforming-the-human-skeleton\">How modern life is transforming the human skeleton\u003c/a>,” which featured the same study from Scientific Reports.\u003c/p>\n\u003cp>The original study and both news stories — which have gone viral, picked up by dozens more outlets in recent days — link these alleged bone deformities to the use of mobile technology, specifically because users are bending “their heads forward to make sense of what’s happening on the miniature screens,” as the Post wrote.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>There’s one problem.\u003c/p>\n\u003cp>The researchers “haven’t provided the data to back up their claim,” said John Hawks, a paleoanthropologist at the University of Wisconsin, who studies human evolution and was not involved in the study.\u003c/p>\n\u003cp>On a basic level, the study has flaws, namely that it makes written claims that are not supported by the numbers, images and other data reported in the study itself. This isn’t a situation where a research group made a controversial discovery, and other scientists simply disagree.\u003c/p>\n\u003cp>\u003ca href=\"https://www.nature.com/articles/s41598-018-21625-1\">Scientific Reports\u003c/a> is published by Nature Research, one of the most well-regarded science publishers in the world. Typically, all Nature Research papers are peer reviewed by two reviewers on average, according to a statement from the publisher. That can help safeguard against the publication of unsound research but it isn’t a guarantee. Those reviewers are typically experts in their fields of study, but it is against Nature Research’s editorial policy to reveal their names.\u003c/p>\n\u003cp>“We are looking into issues regarding this \u003ca href=\"https://www.nature.com/articles/s41598-018-21625-1\">paper\u003c/a> and we will take action where appropriate,” a spokesperson for Scientific Reports told the PBS NewsHour on Friday.\u003c/p>\n\u003cp>“When any concerns are raised with Scientific Reports about papers we have published, we investigate them carefully following established procedures, but we cannot comment on the specific editorial history of a particular paper published in the journal,” the Scientific Reports spokesperson stated.\u003c/p>\n\u003cp>I \u003ca href=\"https://twitter.com/MoNscience/status/1141758379406307328\">asked people on Twitter if they could spot the issues with the study\u003c/a>. (Some were more apparent than others). You can \u003ca href=\"https://www.nature.com/articles/s41598-018-21625-1\">read the paper yourself\u003c/a>, given it is open-access. I even offered clues.\u003c/p>\n\u003cp>https://twitter.com/MoNscience/status/1141758712870330368\u003c/p>\n\u003cp>This isn’t the first time thin research has gone viral, but this episode involves more than just a study with a few flaws.\u003c/p>\n\u003cp>This story became popular in part due to the nature of the modern media landscape, specifically how news organizations re-report stories, and how quickly \u003ca href=\"https://www.vice.com/en_us/article/evy8kw/phones-cause-teens-to-grow-horns-is-dumb-tech-moral-panic\">stories steeped in moral panic are shared on social media.\u003c/a> And \u003ca href=\"https://www.nytimes.com/2016/11/06/upshot/fact-checking-can-change-views-we-rate-that-as-mostly-true.html\">recent research\u003c/a> tells us that it is difficult, if not impossible, to correct a viral story once it has invaded the zeitgeist.\u003c/p>\n\u003cp>So what can you do?\u003c/p>\n\u003cp>Here’s a list of the reasons you should be skeptical of this study, ranked from obvious to expert, and some questions to ask before you share a story that seems suspicious.\u003c/p>\n\u003cp>\u003cstrong>1. The Study Doesn’t Actually Measure Cellphone Usage\u003c/strong>\u003c/p>\n\u003cp>This is the most basic flaw. The study does not measure the cellphone usage of its 1,200 patients.\u003c/p>\n\u003cp>There are now smartphone apps that can record a person’s screen time, but the researchers did not employ them. I asked one of the co-authors — David Shahar, a chiropractor who specializes in biomechanics at the University of the Sunshine Coast in Australia — about why the team didn’t directly measure smartphone usage.\u003c/p>\n\u003cp>“Other studies have reported on that issue,” Shahar, who co-authored the paper with sports biomechanicist Mark Sayers, told the PBS NewsHour via email. “This study was not about the use of mobile devices, but it is about the prevalence of EEOP across the age groups.”\u003c/p>\n\u003cp>Still, the study starts by hypothesizing a possible link between how bad postures “associated with the emergence and extensive use of hand-held contemporary technologies, such as smartphones and tablets.”\u003c/p>\n\u003cp>“They’re arguing that young people are spending a lot of time hunched over their laptops and their phones,” said Jeff Goldsmith, a biostatistician at Columbia University. “But they don’t actually have any data about screen time, their [subjects’] typical posture or about any of the things that might give you a way to evaluate that hypothesis.”\u003c/p>\n\u003cp>The study assumes that the people age 18 to 30 in this study used their phones more than older subjects, based purely on \u003ca href=\"https://www.pewresearch.org/fact-tank/2018/05/02/millennials-stand-out-for-their-technology-use-but-older-generations-also-embrace-digital-life/\">the general habits of society.\u003c/a> But Shahar and Sayers did not provide data on their subjects to support that assumption.\u003c/p>\n\u003cp>“The overall tone of the paper is at odds with the data that they actually have to make any of these particular claims,” Goldsmith added.\u003c/p>\n\u003cp>\u003cstrong>2. The Findings Mean Nothing for the General Population\u003c/strong>\u003c/p>\n\u003cp>Shahar and Sayers write that the study “demonstrated the prevalence of [EOP] to be 33% of the total population” and that “our findings raise a concern about the future musculoskeletal health of the young adult population.”\u003c/p>\n\u003cp>But a study must have a random, demographically representative sample in order to be applicable to the public at-large. And these subjects did not represent a general population, or close to it.\u003c/p>\n\u003cp>“If you notice, they worked from a database that was based on people who went to the chiropractor for help, so first of all, the study is not a random, representative sample,” said Regina Nuzzo, senior advisor for statistics communication and media innovation at the American Statistical Association.\u003c/p>\n\u003cp>Furthermore, the team may have also skewed their pool of patients by only including people from that database who reported mild symptoms. Anyone who went to a chiropractor with severe symptoms was automatically excluded from the analysis.\u003c/p>\n\u003cp>Those excluded might have primarily been older people, given the elderly suffer from more bone issues, including these bone spurs. Indeed, Figure 3 from the paper shows their subjects older than 60 were more likely to have a posture condition — called forward head protraction — which seems to parallel an increase in EOPs, shown in Figure 4.\u003c/p>\n\u003cfigure id=\"attachment_1943904\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-1943904 size-medium\" src=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2019/06/Figure-3_new-1024x776-800x606.png\" alt=\"\" width=\"800\" height=\"606\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2019/06/Figure-3_new-1024x776-800x606.png 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2019/06/Figure-3_new-1024x776-160x121.png 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2019/06/Figure-3_new-1024x776-768x582.png 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2019/06/Figure-3_new-1024x776-1020x773.png 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2019/06/Figure-3_new-1024x776.png 1024w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Forward head protraction values across the age groups and sexes as reported in Figure 3 in Shahar D. and Sayers M., Scientific Reports, 2019/CC BY 4.0\u003c/figcaption>\u003c/figure>\n\u003cfigure id=\"attachment_1943905\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-1943905 size-medium\" src=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2019/06/Figure-4_new-1024x763-800x596.png\" alt=\"\" width=\"800\" height=\"596\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2019/06/Figure-4_new-1024x763-800x596.png 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2019/06/Figure-4_new-1024x763-160x119.png 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2019/06/Figure-4_new-1024x763-768x572.png 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2019/06/Figure-4_new-1024x763-1020x760.png 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2019/06/Figure-4_new-1024x763.png 1024w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">The prevalence of EEOPs in both sexes across the age groups as reported in Figure 4 of Shahar D. and Sayers M., Scientific Reports, 2019/CC BY 4.0\u003c/figcaption>\u003c/figure>\n\u003cp> \u003c/p>\n\u003cp>“The generalizations you can make from this study are very, very limited,” Nuzzo said.\u003c/p>\n\u003cp>Despite those limitations, Shahar and Sayers argue that their “findings raise a concern about the future musculoskeletal health of the young adult population and reinforce the need for prevention intervention through posture improvement education.” On Saturday, \u003ca href=\"https://qz.com/1649011/researcher-behind-smartphone-horns-study-sells-posture-pillows/\">Quartz reported\u003c/a> that Shahar runs an online store that sells posture pillows.\u003c/p>\n\u003cp>\u003cstrong>3. The Study Isn’t Studying Horns\u003c/strong>\u003c/p>\n\u003cp>Let’s settle this horn business. The study did not look at horns. A bone spur is not a horn, as Hawks detailed \u003ca href=\"https://medium.com/@johnhawks/are-millennials-really-growing-horns-from-using-their-phones-2b7bd6162938\">in a Medium post\u003c/a> on Thursday.\u003c/p>\n\u003cp>A horn is made of keratin, the same material you find in animal hooves, claws and hair. Shahar told the NewsHour that he used “horn” in his interview with The Washington Post and that “it is not unusual to use descriptive terms in anatomy.”\u003c/p>\n\u003cp>But using “horn” to describe a bone spur is like saying your elbow is a fingernail. EOPs and horns are just not created in the same way.\u003c/p>\n\u003cp>“Even if you did have a large bone outgrowth in that area, it would not look or feel like a horn,” said Sara Becker, a bioarchaeologist at the University of California Riverside. That’s because “in living people, that area would be wrapped in muscle. Even bone spurs in other regions are hard to feel or see in most people and they may not be permanent.”\u003c/p>\n\u003cp>Becker’s point appears to contradict what The Washington Post story said: “Those who have the hornlike feature can probably feel it.”\u003c/p>\n\u003cp>\u003cstrong>4. If These Bone Spurs are Happening, Where Are the X-rays?\u003c/strong>\u003c/p>\n\u003cp>Hawks, a paleoanthropologist who specializes in bone evolution, said the study did not provide the X-rays needed to confirm that the researchers were even measuring bone spurs.\u003c/p>\n\u003cp>Providing X-rays is important because an EOP is a trait that can develop in normal people with normal posture, Hawks said.\u003c/p>\n\u003cp>These bones masses, which can form in \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/17350676\">various spots on a person’s skeleton\u003c/a>, tend to appear later in life and be associated with bone diseases. One study of \u003ca href=\"http://www.ismni.org/jmni/pdf/11/12VOUDOURIS.pdf\">3,670 rheumatology patients found 16 percent\u003c/a> had spurs somewhere in the body. However, young, healthy people can grow these spurs too. One study of 234 healthy schoolchildren \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/12784411/\">revealed these spurs 29 percent of the time.\u003c/a>\u003c/p>\n\u003cp>“A good example are the bones of elite tennis players, where you can see not just [these] changes but thickening to the cortical bone in the playing arm,” said Nivien Speith, a biological anthropologist and bioarchaeologist at the University of Derby. Spieth also said these bone spur can disappear over the course of a person’s life.\u003c/p>\n\u003cp>The back of the skull doesn’t only feature bone. It’s a mishmash of ligaments, connective tissues and your neck muscles, which rank among the strongest in your body. The X-rays included in the study look to be taken with different exposure conditions, Hawks said. You can see a lot of soft tissue in some, for instance, but not in others, he said. “When radiographs are being taken under different conditions like that, it is really difficult to score them consistently and to know what you’re looking at.”\u003c/p>\n\u003cfigure id=\"attachment_1943906\" class=\"wp-caption alignnone\" style=\"max-width: 678px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-1943906 size-full\" src=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2019/06/horns_x-rays-678x1024.jpg\" alt=\"\" width=\"678\" height=\"1024\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2019/06/horns_x-rays-678x1024.jpg 678w, https://cdn.kqed.org/wp-content/uploads/sites/35/2019/06/horns_x-rays-678x1024-160x242.jpg 160w\" sizes=\"(max-width: 678px) 100vw, 678px\">\u003cfigcaption class=\"wp-caption-text\">Example radiographs of two male participants (28-years-old and 58-years-old) presenting with large EOPs, according to the study. Image Shahar D. and Sayers M., Scientific Reports, 2019/CC BY 4.0\u003c/figcaption>\u003c/figure>\n\u003cp>A bone spur like those the study suggests occur due to the “nuchal ligament,” which originates at the neck’s base and runs up the middle until it connects to the head.\u003c/p>\n\u003cp>“The nuchal ligament helps to stabilize your head when you run,” Hawks said. Many primates have a nuchal ligament, but only humans experience bone spurs on their necks because of the way we run: upright. The strain created by upright physical activity can cause muscles and the nuchal ligament to pull on connective tissue, which in turn can stress the bone into forming a spur.\u003c/p>\n\u003cfigure id=\"attachment_1943907\" class=\"wp-caption alignnone\" style=\"max-width: 539px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-1943907\" src=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2019/06/Nuchal_ligament.png\" alt=\"\" width=\"539\" height=\"520\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2019/06/Nuchal_ligament.png 539w, https://cdn.kqed.org/wp-content/uploads/sites/35/2019/06/Nuchal_ligament-160x154.png 160w\" sizes=\"(max-width: 539px) 100vw, 539px\">\u003cfigcaption class=\"wp-caption-text\">Nuchal ligament is highlighted in bright red. \u003ccite>(Medical gallery of Mikael Häggström 2014)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Hawks said when comparing ancient skeletons to those of people today, you can see humans have been gradually losing their EOPs. This is largely because as nations become more Westernized people are less physically active.\u003c/p>\n\u003cp>“If you really wanted to understand the back of the neck and if it’s changing,” Hawks said, “you’re going to put devices that measure muscle activity on the back of the neck to see what’s going on with their heads.” In other words, if the research team didn’t have access to a smartphone tracking app, Hawks said they could have simply examined the subjects’ neck muscles to look for signs of this strain.\u003c/p>\n\u003cp>\u003cstrong>5. The Study Claims males Have More of These Bone Spurs, but Doesn’t Back It Up\u003c/strong>\u003c/p>\n\u003cp>The study claims these bone spurs on the back of the skull predominately occurred in males. It even goes as far as to quantify the difference, stating that “sex was the primary predictor with males being 5.48 times more likely to have [EOP] than females.”\u003c/p>\n\u003cp>This finding would actually agree with what’s known in the anthropological record. “A bigger EOP is more common in human male skeletons than female skeletons,” Becker said\u003c/p>\n\u003cp>But the study, once again, does not show evidence for its assertion if you look at Figure 4:\u003c/p>\n\u003cp>\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-1943905 size-medium\" src=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2019/06/Figure-4_new-1024x763-800x596.png\" alt=\"\" width=\"800\" height=\"596\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2019/06/Figure-4_new-1024x763-800x596.png 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2019/06/Figure-4_new-1024x763-160x119.png 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2019/06/Figure-4_new-1024x763-768x572.png 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2019/06/Figure-4_new-1024x763-1020x760.png 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2019/06/Figure-4_new-1024x763.png 1024w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003c/p>\n\u003cp>Notice that in the youngest group — 18-29 year olds — there are more females with EOPs than males. The pattern switches for those in their 40s, but otherwise there are no sex differences.\u003c/p>\n\u003cp>When I asked Shahar about this discrepancy between his study states and what his study shows, he replied, “While I have no doubt that the 5.48 figure is correct, I must admit that I see your point about the graph.”\u003c/p>\n\u003cp>Shahar said he would check into the data behind these figures and respond at a later time.\u003c/p>\n\u003cp>\u003cstrong>6. The Study Also Fails To Make a Clear Connection To Millennials\u003c/strong>\u003c/p>\n\u003cp>Both Goldsmith and Nuzzo said the study did not include data behind its statistical models, which are necessary to confirm the connection between millennials and the EOPs.\u003c/p>\n\u003cp>In Figure 4, the authors group the subjects by age and compare those groups with a statistical test called a Chi-squared. That’s problematic in this case because the way the team used the test — to arbitrarily group and contrast subjects by age — made it lose the ability to make comparisons.\u003c/p>\n\u003cp>“That’s like a broad brush stroke. You lose all kinds of information,” Nuzzo said. You lose the ability to tell how people are changing as they age, she added. Without a more robust test, the study cannot allege a correlation between young age and EOPs.\u003c/p>\n\u003cp>Nuzzo said instead the study should have used other statistical tests that can pull out trends in multiple variables as they change over time (like linear regressions, ANOVA or ANCOVA). “Then you’d be able to say, ‘Yes, for every year or every decade, we’re able to see a 0.1 millimeter increase in bone growth,’” she said.\u003c/p>\n\u003cp>Shahar and Sayers have used these statistical alternatives, both in this study and others on the same subject. One \u003ca href=\"https://onlinelibrary.wiley.com/doi/full/10.1111/joa.12466\">in 2016\u003c/a> concluded young adults have an abundance of EOPs, but it didn’t look at older adults. The \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/29448082\">other in 2018\u003c/a> tried to make the same conclusions in healthy teenagers but only involved 4 male patients.\u003c/p>\n\u003cp>In the latest study published in Scientific Reports, Shahar and Sayers’ linear regression test seems to stop short. Rather than use it to individually measure the influence of age, sex and forward head protraction, all of those factors are lumped together to make a connection to EOP. If the factors are grouped, you can’t point to a single one — like age — and say it is the reason for the bone spurs.\u003c/p>\n\u003cp>They needed to do the opposite analysis — make a linear regression model that could peel apart those factors and look at how each one influences those bone spurs. Nuzzo said such an analysis is nowhere to be found in the study.\u003c/p>\n\u003cp>“They didn’t present their results very well,” Nuzzo said. When I pointed out these statistical blips to Shahar, he responded: “Statistical analysis questions should be referred to a different person who is unavailable at this late hour.”\u003c/p>\n\u003cp>\u003cstrong>How Did This Happen and Why Does it Matter?\u003c/strong>\u003c/p>\n\u003cp>The second part of this equation is how studies like these are covered by the media.\u003c/p>\n\u003cp>An outsider perspective — from a source not involved with the research — can be invaluable when trying to put a piece of science into its appropriate context or even when deciding to pass on a story.\u003c/p>\n\u003cp>When The Washington Post published its story early in the morning on June 20, the original version did not include an interview from a researcher who was not involved in the study. The BBC story also lacks outside commentary on Shahar and Sayers’s study.\u003c/p>\n\u003cp>The Washington Post updated its story with additional context, more than eight hours after publication, \u003ca href=\"https://web.archive.org/web/*/https://www.washingtonpost.com/nation/2019/06/20/horns-are-growing-young-peoples-skulls-phone-use-is-blame-research-suggests/\">according to the Wayback Machine\u003c/a>. By then the story had received massive news coverage, many of which cited The Washington Post and BBC as a source.\u003c/p>\n\u003cp>Molly Gannon, a communications manager for The Washington Post, shared this statement in response to our questions:\u003c/p>\n\u003cp>\u003cem>Our story reports on the findings of studies that ran in multiple peer-reviewed journals and includes interviews with the scientists who conducted the research. It also includes an interview with an outside expert, which reflects our standard practice, and which was moved higher in the story to make it more prominent. The word ‘horns’ was used by one of the scientists.\u003c/em>\u003c/p>\n\u003cp>On Tuesday, The Washington Post also updated its story to include Shahar’s possible conflict of interest regarding his posture pillows company.\u003c/p>\n\u003cp>A BBC spokesperson said “This is \u003ca href=\"http://www.bbc.com/future/story/20190610-how-modern-life-is-transforming-the-human-skeleton\">an article\u003c/a> about osteobiography, of which Dr Sahar’s study was one example of many.”\u003c/p>\n\u003cp>The weaknesses in the “horns” study are opaque to most readers. But things you can look for when you’re trying to suss out whether a science story holds up:\u003c/p>\n\u003cul>\n\u003cli>outside commentary on the study at-hand\u003c/li>\n\u003cli>clues about whether the research was peer-reviewed and by whom,\u003c/li>\n\u003cli>what data the study uses as a source\u003c/li>\n\u003cli>and finally: Does the study claim more than it proves?\u003c/li>\n\u003c/ul>\n\u003cp>This last point and this episode offer a reminder about the modern news cycle.\u003c/p>\n\u003cp>History shows us — such as with \u003ca href=\"https://www.pbs.org/newshour/science/how-bad-is-the-measles-comeback-heres-70-years-of-data\">Andrew Wakefield’s retracted study on measles and autism\u003c/a> — that the stakes are high when reporting on science and health. Such misinformation \u003ca href=\"https://www.pbs.org/newshour/science/real-consequences-fake-news-stories-brain-cant-ignore\">erodes the public’s ability\u003c/a> to comprehend what is empirically right and backed by facts versus what is fiction.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>Even if this EOP study is retracted and every news story is corrected with additional context, people who saw the first story may not notice or see the update. Research conducted over the last decade or so shows that once an idea gains traction in people’s minds, it \u003ca href=\"https://www.researchgate.net/publication/323650280_The_science_of_fake_news\">can repel fact-checking\u003c/a>. Indeed, \u003ca href=\"https://www.sciencedirect.com/science/article/pii/S2211368116301838\">a correction can at times\u003c/a> reinforce the misinformation.\u003c/p>\n\u003cdiv id=\"attachment_307011\" class=\"wp-caption aligncenter\">\n\u003cp> \u003c/p>\n\u003c/div>\n\n",
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"excerpt": "A viral science paper and news story alleged that children were growing ‘horns’ and linked the phenomena to cell phone usage. But outside researchers say the study is flawed.",
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"description": "A viral science paper and news story alleged that children were growing ‘horns’ and linked the phenomena to cell phone usage. But outside researchers say the study is flawed.",
"title": "No, Smartphones Aren’t Making Millennials Grow Horns. Here’s How to Spot a Bad Study | KQED",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>It’s the kind of story that could sound true, but seems off.\u003c/p>\n\u003cp>That was the feeling I got last week, when a \u003ca href=\"https://www.washingtonpost.com/nation/2019/06/20/horns-are-growing-young-peoples-skulls-phone-use-is-blame-research-suggests/?utm_term=.e5a4ce48be7d\" target=\"_blank\" rel=\"noopener\">Washington Post article\u003c/a> — “Horns are growing on young people’s skulls. Phone use is to blame, research suggests” — appeared in my email inbox.\u003c/p>\n\u003cp>The report covers a 2018 study \u003ca href=\"https://www.nature.com/articles/s41598-018-21625-1\">published in Scientific Reports\u003c/a>, which used head X-rays of 1,200 chiropractic patients to claim that young adults aged 18 to 30 are growing bone masses on the backs of their skulls, a supposed phenomenon that The Washington Post described as “horns” (which are technically bone spurs called enlarged external occipital protuberances — EEOPs or EOPs).\u003c/p>\n\u003cp>A week before The Washington Post article, BBC Future published a feature story on “\u003ca href=\"http://www.bbc.com/future/story/20190610-how-modern-life-is-transforming-the-human-skeleton\">How modern life is transforming the human skeleton\u003c/a>,” which featured the same study from Scientific Reports.\u003c/p>\n\u003cp>The original study and both news stories — which have gone viral, picked up by dozens more outlets in recent days — link these alleged bone deformities to the use of mobile technology, specifically because users are bending “their heads forward to make sense of what’s happening on the miniature screens,” as the Post wrote.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>There’s one problem.\u003c/p>\n\u003cp>The researchers “haven’t provided the data to back up their claim,” said John Hawks, a paleoanthropologist at the University of Wisconsin, who studies human evolution and was not involved in the study.\u003c/p>\n\u003cp>On a basic level, the study has flaws, namely that it makes written claims that are not supported by the numbers, images and other data reported in the study itself. This isn’t a situation where a research group made a controversial discovery, and other scientists simply disagree.\u003c/p>\n\u003cp>\u003ca href=\"https://www.nature.com/articles/s41598-018-21625-1\">Scientific Reports\u003c/a> is published by Nature Research, one of the most well-regarded science publishers in the world. Typically, all Nature Research papers are peer reviewed by two reviewers on average, according to a statement from the publisher. That can help safeguard against the publication of unsound research but it isn’t a guarantee. Those reviewers are typically experts in their fields of study, but it is against Nature Research’s editorial policy to reveal their names.\u003c/p>\n\u003cp>“We are looking into issues regarding this \u003ca href=\"https://www.nature.com/articles/s41598-018-21625-1\">paper\u003c/a> and we will take action where appropriate,” a spokesperson for Scientific Reports told the PBS NewsHour on Friday.\u003c/p>\n\u003cp>“When any concerns are raised with Scientific Reports about papers we have published, we investigate them carefully following established procedures, but we cannot comment on the specific editorial history of a particular paper published in the journal,” the Scientific Reports spokesperson stated.\u003c/p>\n\u003cp>I \u003ca href=\"https://twitter.com/MoNscience/status/1141758379406307328\">asked people on Twitter if they could spot the issues with the study\u003c/a>. (Some were more apparent than others). You can \u003ca href=\"https://www.nature.com/articles/s41598-018-21625-1\">read the paper yourself\u003c/a>, given it is open-access. I even offered clues.\u003c/p>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\n\u003cp>This isn’t the first time thin research has gone viral, but this episode involves more than just a study with a few flaws.\u003c/p>\n\u003cp>This story became popular in part due to the nature of the modern media landscape, specifically how news organizations re-report stories, and how quickly \u003ca href=\"https://www.vice.com/en_us/article/evy8kw/phones-cause-teens-to-grow-horns-is-dumb-tech-moral-panic\">stories steeped in moral panic are shared on social media.\u003c/a> And \u003ca href=\"https://www.nytimes.com/2016/11/06/upshot/fact-checking-can-change-views-we-rate-that-as-mostly-true.html\">recent research\u003c/a> tells us that it is difficult, if not impossible, to correct a viral story once it has invaded the zeitgeist.\u003c/p>\n\u003cp>So what can you do?\u003c/p>\n\u003cp>Here’s a list of the reasons you should be skeptical of this study, ranked from obvious to expert, and some questions to ask before you share a story that seems suspicious.\u003c/p>\n\u003cp>\u003cstrong>1. The Study Doesn’t Actually Measure Cellphone Usage\u003c/strong>\u003c/p>\n\u003cp>This is the most basic flaw. The study does not measure the cellphone usage of its 1,200 patients.\u003c/p>\n\u003cp>There are now smartphone apps that can record a person’s screen time, but the researchers did not employ them. I asked one of the co-authors — David Shahar, a chiropractor who specializes in biomechanics at the University of the Sunshine Coast in Australia — about why the team didn’t directly measure smartphone usage.\u003c/p>\n\u003cp>“Other studies have reported on that issue,” Shahar, who co-authored the paper with sports biomechanicist Mark Sayers, told the PBS NewsHour via email. “This study was not about the use of mobile devices, but it is about the prevalence of EEOP across the age groups.”\u003c/p>\n\u003cp>Still, the study starts by hypothesizing a possible link between how bad postures “associated with the emergence and extensive use of hand-held contemporary technologies, such as smartphones and tablets.”\u003c/p>\n\u003cp>“They’re arguing that young people are spending a lot of time hunched over their laptops and their phones,” said Jeff Goldsmith, a biostatistician at Columbia University. “But they don’t actually have any data about screen time, their [subjects’] typical posture or about any of the things that might give you a way to evaluate that hypothesis.”\u003c/p>\n\u003cp>The study assumes that the people age 18 to 30 in this study used their phones more than older subjects, based purely on \u003ca href=\"https://www.pewresearch.org/fact-tank/2018/05/02/millennials-stand-out-for-their-technology-use-but-older-generations-also-embrace-digital-life/\">the general habits of society.\u003c/a> But Shahar and Sayers did not provide data on their subjects to support that assumption.\u003c/p>\n\u003cp>“The overall tone of the paper is at odds with the data that they actually have to make any of these particular claims,” Goldsmith added.\u003c/p>\n\u003cp>\u003cstrong>2. The Findings Mean Nothing for the General Population\u003c/strong>\u003c/p>\n\u003cp>Shahar and Sayers write that the study “demonstrated the prevalence of [EOP] to be 33% of the total population” and that “our findings raise a concern about the future musculoskeletal health of the young adult population.”\u003c/p>\n\u003cp>But a study must have a random, demographically representative sample in order to be applicable to the public at-large. And these subjects did not represent a general population, or close to it.\u003c/p>\n\u003cp>“If you notice, they worked from a database that was based on people who went to the chiropractor for help, so first of all, the study is not a random, representative sample,” said Regina Nuzzo, senior advisor for statistics communication and media innovation at the American Statistical Association.\u003c/p>\n\u003cp>Furthermore, the team may have also skewed their pool of patients by only including people from that database who reported mild symptoms. Anyone who went to a chiropractor with severe symptoms was automatically excluded from the analysis.\u003c/p>\n\u003cp>Those excluded might have primarily been older people, given the elderly suffer from more bone issues, including these bone spurs. Indeed, Figure 3 from the paper shows their subjects older than 60 were more likely to have a posture condition — called forward head protraction — which seems to parallel an increase in EOPs, shown in Figure 4.\u003c/p>\n\u003cfigure id=\"attachment_1943904\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-1943904 size-medium\" src=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2019/06/Figure-3_new-1024x776-800x606.png\" alt=\"\" width=\"800\" height=\"606\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2019/06/Figure-3_new-1024x776-800x606.png 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2019/06/Figure-3_new-1024x776-160x121.png 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2019/06/Figure-3_new-1024x776-768x582.png 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2019/06/Figure-3_new-1024x776-1020x773.png 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2019/06/Figure-3_new-1024x776.png 1024w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Forward head protraction values across the age groups and sexes as reported in Figure 3 in Shahar D. and Sayers M., Scientific Reports, 2019/CC BY 4.0\u003c/figcaption>\u003c/figure>\n\u003cfigure id=\"attachment_1943905\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-1943905 size-medium\" src=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2019/06/Figure-4_new-1024x763-800x596.png\" alt=\"\" width=\"800\" height=\"596\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2019/06/Figure-4_new-1024x763-800x596.png 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2019/06/Figure-4_new-1024x763-160x119.png 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2019/06/Figure-4_new-1024x763-768x572.png 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2019/06/Figure-4_new-1024x763-1020x760.png 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2019/06/Figure-4_new-1024x763.png 1024w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">The prevalence of EEOPs in both sexes across the age groups as reported in Figure 4 of Shahar D. and Sayers M., Scientific Reports, 2019/CC BY 4.0\u003c/figcaption>\u003c/figure>\n\u003cp> \u003c/p>\n\u003cp>“The generalizations you can make from this study are very, very limited,” Nuzzo said.\u003c/p>\n\u003cp>Despite those limitations, Shahar and Sayers argue that their “findings raise a concern about the future musculoskeletal health of the young adult population and reinforce the need for prevention intervention through posture improvement education.” On Saturday, \u003ca href=\"https://qz.com/1649011/researcher-behind-smartphone-horns-study-sells-posture-pillows/\">Quartz reported\u003c/a> that Shahar runs an online store that sells posture pillows.\u003c/p>\n\u003cp>\u003cstrong>3. The Study Isn’t Studying Horns\u003c/strong>\u003c/p>\n\u003cp>Let’s settle this horn business. The study did not look at horns. A bone spur is not a horn, as Hawks detailed \u003ca href=\"https://medium.com/@johnhawks/are-millennials-really-growing-horns-from-using-their-phones-2b7bd6162938\">in a Medium post\u003c/a> on Thursday.\u003c/p>\n\u003cp>A horn is made of keratin, the same material you find in animal hooves, claws and hair. Shahar told the NewsHour that he used “horn” in his interview with The Washington Post and that “it is not unusual to use descriptive terms in anatomy.”\u003c/p>\n\u003cp>But using “horn” to describe a bone spur is like saying your elbow is a fingernail. EOPs and horns are just not created in the same way.\u003c/p>\n\u003cp>“Even if you did have a large bone outgrowth in that area, it would not look or feel like a horn,” said Sara Becker, a bioarchaeologist at the University of California Riverside. That’s because “in living people, that area would be wrapped in muscle. Even bone spurs in other regions are hard to feel or see in most people and they may not be permanent.”\u003c/p>\n\u003cp>Becker’s point appears to contradict what The Washington Post story said: “Those who have the hornlike feature can probably feel it.”\u003c/p>\n\u003cp>\u003cstrong>4. If These Bone Spurs are Happening, Where Are the X-rays?\u003c/strong>\u003c/p>\n\u003cp>Hawks, a paleoanthropologist who specializes in bone evolution, said the study did not provide the X-rays needed to confirm that the researchers were even measuring bone spurs.\u003c/p>\n\u003cp>Providing X-rays is important because an EOP is a trait that can develop in normal people with normal posture, Hawks said.\u003c/p>\n\u003cp>These bones masses, which can form in \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/17350676\">various spots on a person’s skeleton\u003c/a>, tend to appear later in life and be associated with bone diseases. One study of \u003ca href=\"http://www.ismni.org/jmni/pdf/11/12VOUDOURIS.pdf\">3,670 rheumatology patients found 16 percent\u003c/a> had spurs somewhere in the body. However, young, healthy people can grow these spurs too. One study of 234 healthy schoolchildren \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/12784411/\">revealed these spurs 29 percent of the time.\u003c/a>\u003c/p>\n\u003cp>“A good example are the bones of elite tennis players, where you can see not just [these] changes but thickening to the cortical bone in the playing arm,” said Nivien Speith, a biological anthropologist and bioarchaeologist at the University of Derby. Spieth also said these bone spur can disappear over the course of a person’s life.\u003c/p>\n\u003cp>The back of the skull doesn’t only feature bone. It’s a mishmash of ligaments, connective tissues and your neck muscles, which rank among the strongest in your body. The X-rays included in the study look to be taken with different exposure conditions, Hawks said. You can see a lot of soft tissue in some, for instance, but not in others, he said. “When radiographs are being taken under different conditions like that, it is really difficult to score them consistently and to know what you’re looking at.”\u003c/p>\n\u003cfigure id=\"attachment_1943906\" class=\"wp-caption alignnone\" style=\"max-width: 678px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-1943906 size-full\" src=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2019/06/horns_x-rays-678x1024.jpg\" alt=\"\" width=\"678\" height=\"1024\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2019/06/horns_x-rays-678x1024.jpg 678w, https://cdn.kqed.org/wp-content/uploads/sites/35/2019/06/horns_x-rays-678x1024-160x242.jpg 160w\" sizes=\"(max-width: 678px) 100vw, 678px\">\u003cfigcaption class=\"wp-caption-text\">Example radiographs of two male participants (28-years-old and 58-years-old) presenting with large EOPs, according to the study. Image Shahar D. and Sayers M., Scientific Reports, 2019/CC BY 4.0\u003c/figcaption>\u003c/figure>\n\u003cp>A bone spur like those the study suggests occur due to the “nuchal ligament,” which originates at the neck’s base and runs up the middle until it connects to the head.\u003c/p>\n\u003cp>“The nuchal ligament helps to stabilize your head when you run,” Hawks said. Many primates have a nuchal ligament, but only humans experience bone spurs on their necks because of the way we run: upright. The strain created by upright physical activity can cause muscles and the nuchal ligament to pull on connective tissue, which in turn can stress the bone into forming a spur.\u003c/p>\n\u003cfigure id=\"attachment_1943907\" class=\"wp-caption alignnone\" style=\"max-width: 539px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-1943907\" src=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2019/06/Nuchal_ligament.png\" alt=\"\" width=\"539\" height=\"520\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2019/06/Nuchal_ligament.png 539w, https://cdn.kqed.org/wp-content/uploads/sites/35/2019/06/Nuchal_ligament-160x154.png 160w\" sizes=\"(max-width: 539px) 100vw, 539px\">\u003cfigcaption class=\"wp-caption-text\">Nuchal ligament is highlighted in bright red. \u003ccite>(Medical gallery of Mikael Häggström 2014)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Hawks said when comparing ancient skeletons to those of people today, you can see humans have been gradually losing their EOPs. This is largely because as nations become more Westernized people are less physically active.\u003c/p>\n\u003cp>“If you really wanted to understand the back of the neck and if it’s changing,” Hawks said, “you’re going to put devices that measure muscle activity on the back of the neck to see what’s going on with their heads.” In other words, if the research team didn’t have access to a smartphone tracking app, Hawks said they could have simply examined the subjects’ neck muscles to look for signs of this strain.\u003c/p>\n\u003cp>\u003cstrong>5. The Study Claims males Have More of These Bone Spurs, but Doesn’t Back It Up\u003c/strong>\u003c/p>\n\u003cp>The study claims these bone spurs on the back of the skull predominately occurred in males. It even goes as far as to quantify the difference, stating that “sex was the primary predictor with males being 5.48 times more likely to have [EOP] than females.”\u003c/p>\n\u003cp>This finding would actually agree with what’s known in the anthropological record. “A bigger EOP is more common in human male skeletons than female skeletons,” Becker said\u003c/p>\n\u003cp>But the study, once again, does not show evidence for its assertion if you look at Figure 4:\u003c/p>\n\u003cp>\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-1943905 size-medium\" src=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2019/06/Figure-4_new-1024x763-800x596.png\" alt=\"\" width=\"800\" height=\"596\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2019/06/Figure-4_new-1024x763-800x596.png 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2019/06/Figure-4_new-1024x763-160x119.png 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2019/06/Figure-4_new-1024x763-768x572.png 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2019/06/Figure-4_new-1024x763-1020x760.png 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2019/06/Figure-4_new-1024x763.png 1024w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003c/p>\n\u003cp>Notice that in the youngest group — 18-29 year olds — there are more females with EOPs than males. The pattern switches for those in their 40s, but otherwise there are no sex differences.\u003c/p>\n\u003cp>When I asked Shahar about this discrepancy between his study states and what his study shows, he replied, “While I have no doubt that the 5.48 figure is correct, I must admit that I see your point about the graph.”\u003c/p>\n\u003cp>Shahar said he would check into the data behind these figures and respond at a later time.\u003c/p>\n\u003cp>\u003cstrong>6. The Study Also Fails To Make a Clear Connection To Millennials\u003c/strong>\u003c/p>\n\u003cp>Both Goldsmith and Nuzzo said the study did not include data behind its statistical models, which are necessary to confirm the connection between millennials and the EOPs.\u003c/p>\n\u003cp>In Figure 4, the authors group the subjects by age and compare those groups with a statistical test called a Chi-squared. That’s problematic in this case because the way the team used the test — to arbitrarily group and contrast subjects by age — made it lose the ability to make comparisons.\u003c/p>\n\u003cp>“That’s like a broad brush stroke. You lose all kinds of information,” Nuzzo said. You lose the ability to tell how people are changing as they age, she added. Without a more robust test, the study cannot allege a correlation between young age and EOPs.\u003c/p>\n\u003cp>Nuzzo said instead the study should have used other statistical tests that can pull out trends in multiple variables as they change over time (like linear regressions, ANOVA or ANCOVA). “Then you’d be able to say, ‘Yes, for every year or every decade, we’re able to see a 0.1 millimeter increase in bone growth,’” she said.\u003c/p>\n\u003cp>Shahar and Sayers have used these statistical alternatives, both in this study and others on the same subject. One \u003ca href=\"https://onlinelibrary.wiley.com/doi/full/10.1111/joa.12466\">in 2016\u003c/a> concluded young adults have an abundance of EOPs, but it didn’t look at older adults. The \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/29448082\">other in 2018\u003c/a> tried to make the same conclusions in healthy teenagers but only involved 4 male patients.\u003c/p>\n\u003cp>In the latest study published in Scientific Reports, Shahar and Sayers’ linear regression test seems to stop short. Rather than use it to individually measure the influence of age, sex and forward head protraction, all of those factors are lumped together to make a connection to EOP. If the factors are grouped, you can’t point to a single one — like age — and say it is the reason for the bone spurs.\u003c/p>\n\u003cp>They needed to do the opposite analysis — make a linear regression model that could peel apart those factors and look at how each one influences those bone spurs. Nuzzo said such an analysis is nowhere to be found in the study.\u003c/p>\n\u003cp>“They didn’t present their results very well,” Nuzzo said. When I pointed out these statistical blips to Shahar, he responded: “Statistical analysis questions should be referred to a different person who is unavailable at this late hour.”\u003c/p>\n\u003cp>\u003cstrong>How Did This Happen and Why Does it Matter?\u003c/strong>\u003c/p>\n\u003cp>The second part of this equation is how studies like these are covered by the media.\u003c/p>\n\u003cp>An outsider perspective — from a source not involved with the research — can be invaluable when trying to put a piece of science into its appropriate context or even when deciding to pass on a story.\u003c/p>\n\u003cp>When The Washington Post published its story early in the morning on June 20, the original version did not include an interview from a researcher who was not involved in the study. The BBC story also lacks outside commentary on Shahar and Sayers’s study.\u003c/p>\n\u003cp>The Washington Post updated its story with additional context, more than eight hours after publication, \u003ca href=\"https://web.archive.org/web/*/https://www.washingtonpost.com/nation/2019/06/20/horns-are-growing-young-peoples-skulls-phone-use-is-blame-research-suggests/\">according to the Wayback Machine\u003c/a>. By then the story had received massive news coverage, many of which cited The Washington Post and BBC as a source.\u003c/p>\n\u003cp>Molly Gannon, a communications manager for The Washington Post, shared this statement in response to our questions:\u003c/p>\n\u003cp>\u003cem>Our story reports on the findings of studies that ran in multiple peer-reviewed journals and includes interviews with the scientists who conducted the research. It also includes an interview with an outside expert, which reflects our standard practice, and which was moved higher in the story to make it more prominent. The word ‘horns’ was used by one of the scientists.\u003c/em>\u003c/p>\n\u003cp>On Tuesday, The Washington Post also updated its story to include Shahar’s possible conflict of interest regarding his posture pillows company.\u003c/p>\n\u003cp>A BBC spokesperson said “This is \u003ca href=\"http://www.bbc.com/future/story/20190610-how-modern-life-is-transforming-the-human-skeleton\">an article\u003c/a> about osteobiography, of which Dr Sahar’s study was one example of many.”\u003c/p>\n\u003cp>The weaknesses in the “horns” study are opaque to most readers. But things you can look for when you’re trying to suss out whether a science story holds up:\u003c/p>\n\u003cul>\n\u003cli>outside commentary on the study at-hand\u003c/li>\n\u003cli>clues about whether the research was peer-reviewed and by whom,\u003c/li>\n\u003cli>what data the study uses as a source\u003c/li>\n\u003cli>and finally: Does the study claim more than it proves?\u003c/li>\n\u003c/ul>\n\u003cp>This last point and this episode offer a reminder about the modern news cycle.\u003c/p>\n\u003cp>History shows us — such as with \u003ca href=\"https://www.pbs.org/newshour/science/how-bad-is-the-measles-comeback-heres-70-years-of-data\">Andrew Wakefield’s retracted study on measles and autism\u003c/a> — that the stakes are high when reporting on science and health. Such misinformation \u003ca href=\"https://www.pbs.org/newshour/science/real-consequences-fake-news-stories-brain-cant-ignore\">erodes the public’s ability\u003c/a> to comprehend what is empirically right and backed by facts versus what is fiction.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Even if this EOP study is retracted and every news story is corrected with additional context, people who saw the first story may not notice or see the update. Research conducted over the last decade or so shows that once an idea gains traction in people’s minds, it \u003ca href=\"https://www.researchgate.net/publication/323650280_The_science_of_fake_news\">can repel fact-checking\u003c/a>. Indeed, \u003ca href=\"https://www.sciencedirect.com/science/article/pii/S2211368116301838\">a correction can at times\u003c/a> reinforce the misinformation.\u003c/p>\n\u003cdiv id=\"attachment_307011\" class=\"wp-caption aligncenter\">\n\u003cp> \u003c/p>\n\u003c/div>\n\n\u003c/div>\u003c/p>",
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"title": "New Forensic Tool Uses Single Hair to Identify Perpetrators",
"headTitle": "New Forensic Tool Uses Single Hair to Identify Perpetrators | KQED",
"content": "\u003cp>A new forensic technique could help identify perpetrators of sexual assault using a kind of evidence typically deemed unreliable by the scientific community: hair.\u003c/p>\n\u003cp>Historically, analysis of hair samples has been fraught with far more \u003ca href=\"https://www.washingtonpost.com/local/crime/fbi-overstated-forensic-hair-matches-in-nearly-all-criminal-trials-for-decades/2015/04/18/39c8d8c6-e515-11e4-b510-962fcfabc310_story.html?utm_term=.2ea44eba6676\">controversy\u003c/a> than crime shows might lead someone to believe. In 2013, the FBI, responding to the exoneration of three men whose hair-based convictions did not align with DNA evidence, announced what was lauded as a “historic” and “unprecedented” partnership with the U.S. Department of Justice, the Innocence Project, and the National Association of Criminal Defense Lawyers. The collaboration reopened an investigation into prior criminal convictions that had been decided, at least in part, by forensic analysis of hair.\u003c/p>\n\u003cp>Two years later, it admitted to significant errors. Of the cases it examined, the \u003ca href=\"https://www.fbi.gov/news/pressrel/press-releases/fbi-testimony-on-microscopic-hair-analysis-contained-errors-in-at-least-90-percent-of-cases-in-ongoing-review\">FBI estimated\u003c/a> that its own agents and analysts had submitted erroneous statements or testimony based on faulty science in at least 90% of trial transcripts. In its press release, the agency quoted a director of The Innocence Project, who called the over-reliance on hair analysis in court no less than “an epic miscarriage of justice.”\u003c/p>\n\u003cp>Analyzing hair is a frustrating task for forensic scientists. First, hair lacks the DNA found in the nucleus of a cell, the gold standard for human identification. The DNA present in the cell’s mitochondria, which are found in hair, only passes down from mother to child and cannot necessarily serve as conclusive identification. DNA also degrades quickly, so forensic analysts often simply cannot use strands of hair left out in the sun or cold, or hairs that have aged.\u003c/p>\n\u003cp>In the past, scientists often examined hair appearance instead, comparing two samples under a microscope. Many analysts and agents testified in court that the samples came from a particular suspect based on qualities such as color, coarseness and straightness; without a method of definitively measuring the difference between one hair and another, courts were forced to trust the scientist’s testimony, rather than the reliability of the evidence itself.\u003c/p>\n\u003cfigure id=\"attachment_1943741\" class=\"wp-caption alignleft\" style=\"max-width: 450px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-1943741 size-full\" src=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2019/06/forensicsciencecenter450px.jpg\" alt=\"\" width=\"450\" height=\"302\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2019/06/forensicsciencecenter450px.jpg 450w, https://cdn.kqed.org/wp-content/uploads/sites/35/2019/06/forensicsciencecenter450px-160x107.jpg 160w\" sizes=\"(max-width: 450px) 100vw, 450px\">\u003cfigcaption class=\"wp-caption-text\">Brad Hart, Glendon Parker and Deon Anex analyze hair samples using mass spectrometry. \u003ccite>(Julie Russell/LLNL)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>New Tool for Sexual Assault Cases?\u003c/strong>\u003c/p>\n\u003cp>A recent breakthrough from Lawrence Livermore National Laboratory could provide the forensic community with a new quantitative method to identify perpetrators based on a single human hair from anywhere on the body. \u003ca href=\"https://www.llnl.gov/news/llnl-led-study-finds-any-single-hair-human-body-can-be-used-identification\">The findings\u003c/a>, published last month in \u003cem>Scientific Reports\u003c/em>, build on \u003ca href=\"https://www.llnl.gov/news/llnl-led-team-develops-forensic-method-identify-people-using-human-hair-proteins\">previous research\u003c/a> that allowed LLNL scientists to identify a person from a human hair based on the information contained in its proteins, which are more durable than DNA and can tell a scientist about mutations in the DNA itself.\u003c/p>\n\u003cp>“The drive is to get away from subjective kinds of analyses,” said Deon Anex, group leader at the Forensics Science Center at LLNL (Anex credited chemist Fanny Chu, a Livermore Graduate Scholar, with the majority of the study’s findings.) What the group’s new technique would offer, he said, is a way of analyzing hair samples that would not rely on any scientist’s opinion, how many years of experience they have, or their persuasiveness in court.\u003c/p>\n\u003cp>Perhaps most importantly, Anex said, the method could provide law enforcement agencies with a new tool to use in the analysis of sexual assault cases. Tying a perpetrator to a rape using traditional forensic techniques is often challenging, since fluid samples taken from a victim frequently contain multiple contributors, complicating DNA analysis. LLNL’s technique can most likely be used on single hairs from anywhere on the human body, a critical development for investigations in which scientists cannot identify hair origins by sight.\u003c/p>\n\u003cp>Pubic hairs contain especially high protein content, so any conclusions from protein-based analysis would likely be more reliable than for other kinds of hair. The accuracy of the technique hinges on how many protein markers are examined, and is measured by the probability that any two people might have the same match; the LLNL team aims for 1 in 10 billion.\u003c/p>\n\u003cfigure id=\"attachment_1943726\" class=\"wp-caption alignright\" style=\"max-width: 680px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-1943726 size-full\" src=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2019/06/ch_fanny_hair_800.jpg\" alt=\"\" width=\"680\" height=\"425\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2019/06/ch_fanny_hair_800.jpg 680w, https://cdn.kqed.org/wp-content/uploads/sites/35/2019/06/ch_fanny_hair_800-160x100.jpg 160w\" sizes=\"(max-width: 680px) 100vw, 680px\">\u003cfigcaption class=\"wp-caption-text\">Graduate student Fanny Chu examines a vial containing hair samples that will be used for protein-based analysis. \u003ccite>(Julie Russell/LLNL)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>LLNL’s protein-based identification method is not currently in use in any forensic labs, but Anex envisions creating a kit that would allow law enforcement agencies to perform the analysis in their own facilities.\u003c/p>\n\u003cp>That development, however, might still be several years away. Hair typically represents a small percentage of samples submitted for analysis in sexual assault cases, according to Tracey Dawson Cruz, professor of Forensic Science and chair of the Department of Forensic Science at Virginia Commonwealth University.\u003c/p>\n\u003cp>“Currently forensic labs are not equipped or trained for [protein-based] work, so this would be a significant shift for a lab and would likely not be pursued for such a minor sample type,” Dawson Cruz wrote in an email. “This, however, could change in the future as more and more work on protein identification is lending itself to forensic applications.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003c/p>\n",
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"title": "New Forensic Tool Uses Single Hair to Identify Perpetrators | KQED",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>A new forensic technique could help identify perpetrators of sexual assault using a kind of evidence typically deemed unreliable by the scientific community: hair.\u003c/p>\n\u003cp>Historically, analysis of hair samples has been fraught with far more \u003ca href=\"https://www.washingtonpost.com/local/crime/fbi-overstated-forensic-hair-matches-in-nearly-all-criminal-trials-for-decades/2015/04/18/39c8d8c6-e515-11e4-b510-962fcfabc310_story.html?utm_term=.2ea44eba6676\">controversy\u003c/a> than crime shows might lead someone to believe. In 2013, the FBI, responding to the exoneration of three men whose hair-based convictions did not align with DNA evidence, announced what was lauded as a “historic” and “unprecedented” partnership with the U.S. Department of Justice, the Innocence Project, and the National Association of Criminal Defense Lawyers. The collaboration reopened an investigation into prior criminal convictions that had been decided, at least in part, by forensic analysis of hair.\u003c/p>\n\u003cp>Two years later, it admitted to significant errors. Of the cases it examined, the \u003ca href=\"https://www.fbi.gov/news/pressrel/press-releases/fbi-testimony-on-microscopic-hair-analysis-contained-errors-in-at-least-90-percent-of-cases-in-ongoing-review\">FBI estimated\u003c/a> that its own agents and analysts had submitted erroneous statements or testimony based on faulty science in at least 90% of trial transcripts. In its press release, the agency quoted a director of The Innocence Project, who called the over-reliance on hair analysis in court no less than “an epic miscarriage of justice.”\u003c/p>\n\u003cp>Analyzing hair is a frustrating task for forensic scientists. First, hair lacks the DNA found in the nucleus of a cell, the gold standard for human identification. The DNA present in the cell’s mitochondria, which are found in hair, only passes down from mother to child and cannot necessarily serve as conclusive identification. DNA also degrades quickly, so forensic analysts often simply cannot use strands of hair left out in the sun or cold, or hairs that have aged.\u003c/p>\n\u003cp>In the past, scientists often examined hair appearance instead, comparing two samples under a microscope. Many analysts and agents testified in court that the samples came from a particular suspect based on qualities such as color, coarseness and straightness; without a method of definitively measuring the difference between one hair and another, courts were forced to trust the scientist’s testimony, rather than the reliability of the evidence itself.\u003c/p>\n\u003cfigure id=\"attachment_1943741\" class=\"wp-caption alignleft\" style=\"max-width: 450px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-1943741 size-full\" src=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2019/06/forensicsciencecenter450px.jpg\" alt=\"\" width=\"450\" height=\"302\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2019/06/forensicsciencecenter450px.jpg 450w, https://cdn.kqed.org/wp-content/uploads/sites/35/2019/06/forensicsciencecenter450px-160x107.jpg 160w\" sizes=\"(max-width: 450px) 100vw, 450px\">\u003cfigcaption class=\"wp-caption-text\">Brad Hart, Glendon Parker and Deon Anex analyze hair samples using mass spectrometry. \u003ccite>(Julie Russell/LLNL)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>New Tool for Sexual Assault Cases?\u003c/strong>\u003c/p>\n\u003cp>A recent breakthrough from Lawrence Livermore National Laboratory could provide the forensic community with a new quantitative method to identify perpetrators based on a single human hair from anywhere on the body. \u003ca href=\"https://www.llnl.gov/news/llnl-led-study-finds-any-single-hair-human-body-can-be-used-identification\">The findings\u003c/a>, published last month in \u003cem>Scientific Reports\u003c/em>, build on \u003ca href=\"https://www.llnl.gov/news/llnl-led-team-develops-forensic-method-identify-people-using-human-hair-proteins\">previous research\u003c/a> that allowed LLNL scientists to identify a person from a human hair based on the information contained in its proteins, which are more durable than DNA and can tell a scientist about mutations in the DNA itself.\u003c/p>\n\u003cp>“The drive is to get away from subjective kinds of analyses,” said Deon Anex, group leader at the Forensics Science Center at LLNL (Anex credited chemist Fanny Chu, a Livermore Graduate Scholar, with the majority of the study’s findings.) What the group’s new technique would offer, he said, is a way of analyzing hair samples that would not rely on any scientist’s opinion, how many years of experience they have, or their persuasiveness in court.\u003c/p>\n\u003cp>Perhaps most importantly, Anex said, the method could provide law enforcement agencies with a new tool to use in the analysis of sexual assault cases. Tying a perpetrator to a rape using traditional forensic techniques is often challenging, since fluid samples taken from a victim frequently contain multiple contributors, complicating DNA analysis. LLNL’s technique can most likely be used on single hairs from anywhere on the human body, a critical development for investigations in which scientists cannot identify hair origins by sight.\u003c/p>\n\u003cp>Pubic hairs contain especially high protein content, so any conclusions from protein-based analysis would likely be more reliable than for other kinds of hair. The accuracy of the technique hinges on how many protein markers are examined, and is measured by the probability that any two people might have the same match; the LLNL team aims for 1 in 10 billion.\u003c/p>\n\u003cfigure id=\"attachment_1943726\" class=\"wp-caption alignright\" style=\"max-width: 680px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-1943726 size-full\" src=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2019/06/ch_fanny_hair_800.jpg\" alt=\"\" width=\"680\" height=\"425\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2019/06/ch_fanny_hair_800.jpg 680w, https://cdn.kqed.org/wp-content/uploads/sites/35/2019/06/ch_fanny_hair_800-160x100.jpg 160w\" sizes=\"(max-width: 680px) 100vw, 680px\">\u003cfigcaption class=\"wp-caption-text\">Graduate student Fanny Chu examines a vial containing hair samples that will be used for protein-based analysis. \u003ccite>(Julie Russell/LLNL)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>LLNL’s protein-based identification method is not currently in use in any forensic labs, but Anex envisions creating a kit that would allow law enforcement agencies to perform the analysis in their own facilities.\u003c/p>\n\u003cp>That development, however, might still be several years away. Hair typically represents a small percentage of samples submitted for analysis in sexual assault cases, according to Tracey Dawson Cruz, professor of Forensic Science and chair of the Department of Forensic Science at Virginia Commonwealth University.\u003c/p>\n\u003cp>“Currently forensic labs are not equipped or trained for [protein-based] work, so this would be a significant shift for a lab and would likely not be pursued for such a minor sample type,” Dawson Cruz wrote in an email. “This, however, could change in the future as more and more work on protein identification is lending itself to forensic applications.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"title": "Surgeons Are Still Prescribing Opioids at Alarming Rates",
"headTitle": "Surgeons Are Still Prescribing Opioids at Alarming Rates | KQED",
"content": "\u003cp>As opioid addiction and deadly overdoses escalated into an epidemic across the U.S., thousands of surgeons continued to hand out far more pills than needed for postoperative pain relief, according to a \u003ca href=\"https://khn.org/news/opioid-prescribing/\">Kaiser Health News-Johns Hopkins analysis\u003c/a> of Medicare data.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">[pullquote align='right' citation='Dr. Marty Makary, Johns Hopkins']“I think there’s an ‘aha’ moment that many of us in medicine have had or need to have.”[/pullquote]\u003c/span>\u003c/p>\n\u003cp>Many doctors wrote prescriptions for dozens of opioid tablets after surgeries — even for operations that cause most patients relatively little pain, according to the analysis, done in collaboration with researchers at Johns Hopkins Bloomberg School of Public Health. It examined almost 350,000 prescriptions written for patients operated on by nearly 20,000 surgeons from 2011 to 2016 — the latest year for which data are available.\u003c/p>\n\u003cp>Some surgeons wrote prescriptions for more than 100 opioid pills in the week following the surgery. The total amounts often exceeded current guidelines from several academic medical centers, which call for zero to 10 pills for many of the procedures in the analysis, and up to 30 for coronary bypass surgery.\u003c/p>\n\u003cp>While hundreds of state and local lawsuits have been filed against opioid manufacturers, claiming they engaged in aggressive and misleading marketing of these addictive drugs, the role of physicians in contributing to a national tragedy has received less scrutiny. Research shows that a significant portion of people who become addicted to opioids started with a prescription after surgery.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>In sheer numbers, opioid prescribing in the U.S. \u003ca href=\"https://www.cdc.gov/mmwr/volumes/66/wr/mm6626a4.htm\" target=\"_blank\" rel=\"noopener\">peaked in 2010\u003c/a>, but it remains \u003ca href=\"https://theconversation.com/what-the-us-can-learn-from-other-countries-in-dealing-with-pain-and-the-opioid-crisis-97491\" target=\"_blank\" rel=\"noopener\">among the highest in the world\u003c/a>, according to studies and other data.\u003c/p>\n\u003cp>In 2016, opioids of all kinds were linked to 42,249 deaths, up from the 33,091 reported in 2015. The opioid-related death rate jumped nearly 28% from the year before, \u003ca href=\"https://www.cdc.gov/mmwr/volumes/67/wr/mm6712a1.htm\" target=\"_blank\" rel=\"noopener\">according to the CDC\u003c/a>.\u003c/p>\n\u003cp>Yet long-ingrained and freewheeling prescribing patterns changed little over the six years analyzed. KHN and Johns Hopkins examined the prescribing habits of all U.S. surgeons who frequently perform seven common surgical procedures and found that in the first week after surgery:\u003c/p>\n\u003cp>Coronary artery bypass patients operated on by the highest-prescribing 1% of surgeons filled prescriptions in 2016 exceeding an average of 105 opioid pills.\u003c/p>\n\u003cp>Patients undergoing a far less painful procedure — a lumpectomy to remove a breast tumor — were given an average of 26 pills in 2016 the week after surgery. The highest-prescribing 5% of surgeons prescribed 40 to 70 pills on average.\u003c/p>\n\u003cp>Some knee surgery patients took home more than 100 pills in the week following their surgery.\u003c/p>\n\u003cp>Those amounts — each “pill” in the analysis was the equivalent of 5 milligrams of oxycodone — are many times what is currently recommended by some physician groups to relieve acute pain, which occurs as a result of surgery, accident or injury. The analysis included only patients not prescribed opioids in the year before their operation.\u003c/p>\n\u003cp>“Prescribers should have known better” based on studies and other information available at the time, said Andrew Kolodny, co-director of opioid policy research at Brandeis University and director of the advocacy group Physicians for Responsible Opioid Prescribing.\u003c/p>\n\u003cp>While the dataset included only prescriptions written for patients on Medicare, the findings may well understate the depth of the problem, since doctors are more hesitant to give older patients the powerful painkillers because of their sedating side effects.\u003c/p>\n\u003cp>Surgeons’ prescribing habits are significant because \u003ca href=\"https://jamanetwork.com/journals/jamasurgery/fullarticle/2618383\" target=\"_blank\" rel=\"noopener\">studies show\u003c/a> that 6% of patients who are prescribed opioids after surgery will still be taking them three to six months later, having become dependent. The likelihood of persistent use rises with the number of pills and the length of time opioids are taken during recuperation.\u003c/p>\n\u003cp>Also, unused pills in medicine cabinets can make their way onto the street.\u003c/p>\n\u003cp>Dr. Marty Makary, a surgical oncologist at Johns Hopkins, admits that he too once handed out opioids liberally. Now he is marshaling a campaign to get surgeons to use these powerful painkillers more consciously and sparingly. “I think there’s an ‘aha’ moment that many of us in medicine have had or need to have,” he said.\u003c/p>\n\u003cp>But old habits are hard to kick.\u003c/p>\n\u003cp>KHN contacted dozens of the surgeons who topped the ranks of opioid prescribers in the 2016 database. They hailed from small, community hospitals as well as major academic medical centers. The majority declined to comment, some bristling when questioned.\u003c/p>\n\u003cp>You can search the KHN database by doctor and hospital \u003ca href=\"https://khn.org/news/opioid-prescribing/\" target=\"_blank\" rel=\"noopener\">here.\u003c/a>\u003c/p>\n\u003cp>Some of those surgeons were critical of the analysis, saying it didn’t take into account certain essential factors. For example, it was not possible to determine whether patients had complications or needed higher amounts of pain medication for another reason. And some surgeons had only a handful of patients who filled prescriptions, making for a small sample size.\u003c/p>\n\u003cp>But surgeons also indicated that the way they prescribe pain pills was less than intentional. It was sometimes an outgrowth of computer programs that default to preset amounts following procedures, or practice habits developed before the opioid crisis. Additionally, they blame efforts in the late 1990s and early 2000s that encouraged doctors and hospitals to consider pain as “the fifth vital sign.” A major hospital accrediting group required providers to ask patients how well their pain was treated. Pharmaceutical companies used the fifth vital sign campaign as a way to promote their opioid treatments.\u003c/p>\n\u003cp>Makary, who oversaw the analysis of the Medicare dataset, said that, while opioid prescribing is slowly dropping, to date many surgeons have not paid enough attention to the problem or responded with sufficient urgency.\u003c/p>\n\u003cp>Dr. Audrey Garrett, an oncologic surgeon in Oregon, said she was “surprised” to hear that she was among the top tier of prescribers. She said she planned to re-evaluate her clinic’s automated prescribing program, which is set to order specific amounts of opioids.\u003c/p>\n\u003cp>KHN will analyze data for 2017 and subsequent years when it becomes available to follow how prescribing is changing.\u003c/p>\n\u003cp>\u003cstrong>Prescribing Patterns Highlight What’s At Stake\u003c/strong>\u003c/p>\n\u003cp>The analysis examined prescribing habits after seven common procedures: coronary artery bypass, minimally invasive gallbladder removal, lumpectomy, meniscectomy (which removes part of a torn meniscus in the knee), minimally invasive hysterectomy, open colectomy and prostatectomy.\u003c/p>\n\u003cp>Across the board, the analysis showed that physicians gave a large number of narcotics when fewer pills or alternative medications, including over-the-counter pain relief tablets, could be equally effective, according to recent guidelines from Makary and other academic researchers.\u003c/p>\n\u003cp>On average, from 2011 to 2016, Medicare patients in the analysis took home 48 pills in the week following coronary artery bypass; 31 following laparoscopic gallbladder removal; 28 after a lumpectomy; 41 after meniscectomy; 34 after minimally invasive hysterectomy; 34 after open colon surgery; and 33 after prostatectomy.\u003c/p>\n\u003cp>\u003cimg loading=\"lazy\" decoding=\"async\" class=\"alignnone size-medium wp-image-1943831\" src=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2019/06/opioid-prescribing-chart2-800x533.png\" alt=\"\" width=\"800\" height=\"533\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2019/06/opioid-prescribing-chart2-800x533.png 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2019/06/opioid-prescribing-chart2-160x107.png 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2019/06/opioid-prescribing-chart2-768x512.png 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2019/06/opioid-prescribing-chart2-1020x679.png 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2019/06/opioid-prescribing-chart2-1200x799.png 1200w, https://cdn.kqed.org/wp-content/uploads/sites/35/2019/06/opioid-prescribing-chart2.png 1270w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003c/p>\n\u003cp>According to \u003ca href=\"https://www.solvethecrisis.org/best-practices\">post-surgical guidelines\u003c/a> spearheaded by Makary for his hospital last year, those surgeries should require at most 30 pills for bypass; 10 pills for minimally invasive gallbladder removal, lumpectomy, minimally invasive hysterectomy and prostatectomy; and eight pills for knee surgery. It has not yet published a guideline for open colon surgery.\u003c/p>\n\u003cp>The Johns Hopkins’ doctors developed their own standards because of a dearth of national guidelines for post-surgical opioids. They arrived at those figures after \u003ca href=\"https://khn.org/news/doling-out-pain-pills-post-surgery-an-ingrown-toenail-not-the-same-as-a-bypass/\">reaching a consensus\u003c/a> among surgeons, nurses, patients and other medical staff on how many pills were needed after particular surgeries.\u003c/p>\n\u003cp>Hoping to reduce overprescribing, Makary is preparing to send letters next month to surgeons around the country who are among the highest opioid prescribers under a grant he received from the Arnold Foundation, a nonprofit group whose focus includes drug price issues. (Kaiser Health News also received funding from the Arnold Foundation.)\u003c/p>\n\u003cp>Even if the prescription numbers have fallen since 2016, the amounts given today are likely still excessive.\u003c/p>\n\u003cp>“When prescribing may have been five to 20 times too high, even a reduction that is quite meaningful still likely reflects overprescribing,” said Dr. Chad Brummett, an anesthesiologist and associate professor at the University of Michigan.\u003c/p>\n\u003cp>Brummett is also co-director of the Michigan Opioid Prescribing Engagement Network, a collaboration of physicians that makes \u003ca href=\"https://www.opioidprescribing.info/\">surgery-specific recommendations\u003c/a>, many of them in the 10- to 20-pill range.\u003c/p>\n\u003cp>“Reducing unnecessary exposure is key to reducing the risk of new addiction,” said former Food and Drug Administration commissioner Scott Gottlieb. In August 2018, when Gottlieb was at the agency’s helm, it commissioned a report from the National Academy of Sciences on how best to set opioid prescribing guidelines for acute pain from specific conditions or surgical procedures. Its findings are expected later this year.\u003c/p>\n\u003cp>“There are still too many 30-tablet prescriptions being written,” said Gottlieb.\u003c/p>\n\u003cp>\u003cstrong>Healers Sowing Disease?\u003c/strong>\u003c/p>\n\u003cp>Naturally, surgeons rankle at the idea that they played a role in the opioid epidemic. But studies raise serious concerns.\u003c/p>\n\u003cp>Transplant surgeon Dr. Michael Engelsbe, director of the Michigan Surgical Quality Collaborative, points to the study showing 6% of post-op patients who get opioids for pain develop long-term dependence. That means a surgeon who does 300 operations a year paves the way for 18 newly dependent people, he said.\u003c/p>\n\u003cp>Many patients do not need the amounts prescribed.\u003c/p>\n\u003cp>Intermountain Healthcare, a not-for-profit system of hospitals, clinics, and doctors in Utah, began surveying patients two years ago to find out how much of their prescribed supply of opioids they actually took following surgery.\u003c/p>\n\u003cp>“Globally, we were overprescribing by 50%,” said Dr. David Hasleton, senior medical director.\u003c/p>\n\u003cp>But Intermountain approached individual doctors carefully. “If you go to a prescriber to say, ‘You are overprescribing,’ it never goes well. A common reaction is, ‘Your data is wrong’ or ‘My patients are different than his,’” said Hasleton.\u003c/p>\n\u003cp>For the analysis, KHN attempted to contact more than 50 surgeons whose 2016 numbers ranked them among the top prescribers in each surgical category.\u003c/p>\n\u003cp>One who did agree to speak was Dr. Daniel J. Waters, who 13 years ago had his chest cut open to remove a tumor, an operation technically similar to what he does for a living: coronary artery bypass.\u003c/p>\n\u003cp>“So I have both the doctor perspective and the patient perspective,” said Waters, who practices in Mason City, Iowa.\u003c/p>\n\u003cp>In 2016, Waters’ Medicare bypass patients who filled their prescriptions took home an average of nearly 157 pills each, according to the KHN-Johns Hopkins analysis.\u003c/p>\n\u003cp>“When I went home from the hospital, 30 would not have been enough,” said Waters of the number recommended by the Hopkins team for that surgery.\u003c/p>\n\u003cp>But he said he has recently curbed his prescribing to 84 pills.\u003c/p>\n\u003cp>Nationally, the average prescription filled for a coronary artery bypass was 49 pills in 2016 and had changed little since 2011, the analysis shows.\u003c/p>\n\u003cp>Others who spoke with KHN said they had developed the habit of prescribing copiously — sometimes giving out multiple opioid prescriptions — because they didn’t want patients to get stuck far from the office or over a weekend with pain or because they were trying to avoid calls from dissatisfied, hurting patients.\u003c/p>\n\u003cp>In the KHN-Johns Hopkins data, the seven patients of Dr. Antonio Santillan-Gomez who filled opioid prescriptions after minimally invasive hysterectomies in 2016 received an average of 77 pills each.\u003c/p>\n\u003cp>A gynecologic oncologist, Santillan-Gomez said: “I’m in San Antonio, and some of my patients come from Laredo or Corpus Christi, so they would have to drive two to three hours for a prescription.”\u003c/p>\n\u003cp>Still, he said, since e-prescribing of opioids became more widespread in the past few years, he and other surgeons in his group have limited prescriptions to 20 to 30 pills and encouraged patients to take Tylenol or other over-the-counter medications if they run out. E-prescribing can not only help track patients getting opioids but also reduce the problem of patients having to drive back to the office to get a written prescription.\u003c/p>\n\u003cp>Dr. Janet Grange, a breast surgeon in Omaha, Neb., said that in her experience, opioid dependence had not been a problem.\u003c/p>\n\u003cp>“I can absolutely tell you I don’t have even 1% who become long-term opioid users,” said Grange.\u003c/p>\n\u003cp>The analysis showed that Grange had 12 opioid-naïve Medicare patients who had a lumpectomy in 2016. Eight of them filled prescriptions for an average of 47 pills per patient.\u003c/p>\n\u003cp>She called Johns Hopkins’ zero-to-10-pill pain-control recommendation following that procedure “miserly.”\u003c/p>\n\u003cp>\u003cstrong>The Pendulum Swings\u003c/strong>\u003c/p>\n\u003cp>Some of the higher-prescribing surgeons in the KHN-Johns Hopkins analysis reflected on their potential contribution to a national catastrophe and are changing their practice.\u003c/p>\n\u003cp>“That is a shocking number,” said oncologist Garrett, speaking of the finding that 6% of patients who go home with opioids will become dependent. “If it’s true, it’s something we need to educate physicians on much earlier in their medical careers.”\u003c/p>\n\u003cp>Garrett, in Eugene, Ore., said she has cut back on the number of pills she gives patients since 2016. The KHN-Johns Hopkins analysis showed that seven of her 13 opioid-naïve Medicare patients undergoing minimally invasive hysterectomies filled a prescription for opioids in 2016. Those patients took home an average of 76 pills each.\u003c/p>\n\u003cp>Johns Hopkins guidelines call for no more than 10 opioid pills following this procedure, while Brummett’s Michigan network recommends no more than 15.\u003c/p>\n\u003cp>Surgeon and researcher Dr. Richard Barth, once a heavy prescriber himself, said that his own experience convinced him that physicians’ preconceptions about how much pain relief is needed are often way off.\u003c/p>\n\u003cp>The analysis showed his lumpectomy patients in 2013 filled an average of 33 pills in the week after surgery. By 2016, that average had dropped to seven pills. Many patients, he said, can do just fine after lumpectomy with over-the-counter medications — and often no opioids at all.\u003c/p>\n\u003cp>The key, he said, is to set patients’ expectations upfront.\u003c/p>\n\u003cp>“I tell them it’s OK to have a little discomfort, that we’re not trying to get to zero pain,” said Barth, who is chief of general surgery at Dartmouth-Hitchcock Medical Center and has published extensively on opioid prescribing.\u003c/p>\n\u003cp>After lumpectomy, “what I recommend is Tylenol and ibuprofen for at least a few days and to use the opioids only if the discomfort isn’t relieved by those.”\u003c/p>\n\u003cp>Indeed, the data analysis showed that a significant number of patients given prescriptions for opioids never filled them because they don’t need that level of pain relief.\u003c/p>\n\u003cp>Between 2011 and 2016, for example, only 62% of lumpectomy patients in the analysis filled prescriptions, similar to hysterectomy patients.\u003c/p>\n\u003cp>In 2016, patients of Dr. Kimberli Cox, a surgeon in Peoria, Ariz., were prescribed about 59 pills in the week following lumpectomy, well above the recommendations from both Johns Hopkins and others.\u003c/p>\n\u003cp>But the KHN-Johns Hopkins analysis of that year’s data shows that half of her patients never filled a painkiller prescription — a fact she acknowledges has changed her thinking.\u003c/p>\n\u003cp>“I am now starting to prescribe less because many patients say, ‘You gave me too many’ or ‘I didn’t fill it,” she said.\u003c/p>\n\u003cp>\u003cem>This story was produced by \u003ca href=\"http://khn.org/\" target=\"_blank\" rel=\"noopener\">Kaiser Health News\u003c/a>, an editorially independent program of the \u003ca href=\"https://www.kff.org/\" target=\"_blank\" rel=\"noopener\">Kaiser Family Foundation\u003c/a>.\u003c/em>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>\u003ca href=\"http://www.kaiserhealthnews.org/\" target=\"_blank\" rel=\"noopener\">Kaiser Health News\u003c/a> (KHN) is a national health policy news service. It is an editorially independent program of the \u003ca href=\"http://www.kff.org/\" target=\"_blank\" rel=\"noopener\">Henry J. Kaiser Family Foundation\u003c/a> which is not affiliated with Kaiser Permanente.\u003c/em>\u003c/p>\n\n",
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"excerpt": "A new data analysis by Kaiser Health News and Johns Hopkins researchers shows that even as the CDC issued warnings, surgeons handed out many times the number of opioid pills needed for post-op pain.",
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"description": "A new data analysis by Kaiser Health News and Johns Hopkins researchers shows that even as the CDC issued warnings, surgeons handed out many times the number of opioid pills needed for post-op pain.",
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"nprByline": "Julie Appleby and Elizabeth Lucas \u003cbr/> Kaiser Health News \u003cbr>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>As opioid addiction and deadly overdoses escalated into an epidemic across the U.S., thousands of surgeons continued to hand out far more pills than needed for postoperative pain relief, according to a \u003ca href=\"https://khn.org/news/opioid-prescribing/\">Kaiser Health News-Johns Hopkins analysis\u003c/a> of Medicare data.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003c/p>\u003c/div>",
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"content": "“I think there’s an ‘aha’ moment that many of us in medicine have had or need to have.”",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/span>\u003c/p>\n\u003cp>Many doctors wrote prescriptions for dozens of opioid tablets after surgeries — even for operations that cause most patients relatively little pain, according to the analysis, done in collaboration with researchers at Johns Hopkins Bloomberg School of Public Health. It examined almost 350,000 prescriptions written for patients operated on by nearly 20,000 surgeons from 2011 to 2016 — the latest year for which data are available.\u003c/p>\n\u003cp>Some surgeons wrote prescriptions for more than 100 opioid pills in the week following the surgery. The total amounts often exceeded current guidelines from several academic medical centers, which call for zero to 10 pills for many of the procedures in the analysis, and up to 30 for coronary bypass surgery.\u003c/p>\n\u003cp>While hundreds of state and local lawsuits have been filed against opioid manufacturers, claiming they engaged in aggressive and misleading marketing of these addictive drugs, the role of physicians in contributing to a national tragedy has received less scrutiny. Research shows that a significant portion of people who become addicted to opioids started with a prescription after surgery.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>In sheer numbers, opioid prescribing in the U.S. \u003ca href=\"https://www.cdc.gov/mmwr/volumes/66/wr/mm6626a4.htm\" target=\"_blank\" rel=\"noopener\">peaked in 2010\u003c/a>, but it remains \u003ca href=\"https://theconversation.com/what-the-us-can-learn-from-other-countries-in-dealing-with-pain-and-the-opioid-crisis-97491\" target=\"_blank\" rel=\"noopener\">among the highest in the world\u003c/a>, according to studies and other data.\u003c/p>\n\u003cp>In 2016, opioids of all kinds were linked to 42,249 deaths, up from the 33,091 reported in 2015. The opioid-related death rate jumped nearly 28% from the year before, \u003ca href=\"https://www.cdc.gov/mmwr/volumes/67/wr/mm6712a1.htm\" target=\"_blank\" rel=\"noopener\">according to the CDC\u003c/a>.\u003c/p>\n\u003cp>Yet long-ingrained and freewheeling prescribing patterns changed little over the six years analyzed. KHN and Johns Hopkins examined the prescribing habits of all U.S. surgeons who frequently perform seven common surgical procedures and found that in the first week after surgery:\u003c/p>\n\u003cp>Coronary artery bypass patients operated on by the highest-prescribing 1% of surgeons filled prescriptions in 2016 exceeding an average of 105 opioid pills.\u003c/p>\n\u003cp>Patients undergoing a far less painful procedure — a lumpectomy to remove a breast tumor — were given an average of 26 pills in 2016 the week after surgery. The highest-prescribing 5% of surgeons prescribed 40 to 70 pills on average.\u003c/p>\n\u003cp>Some knee surgery patients took home more than 100 pills in the week following their surgery.\u003c/p>\n\u003cp>Those amounts — each “pill” in the analysis was the equivalent of 5 milligrams of oxycodone — are many times what is currently recommended by some physician groups to relieve acute pain, which occurs as a result of surgery, accident or injury. The analysis included only patients not prescribed opioids in the year before their operation.\u003c/p>\n\u003cp>“Prescribers should have known better” based on studies and other information available at the time, said Andrew Kolodny, co-director of opioid policy research at Brandeis University and director of the advocacy group Physicians for Responsible Opioid Prescribing.\u003c/p>\n\u003cp>While the dataset included only prescriptions written for patients on Medicare, the findings may well understate the depth of the problem, since doctors are more hesitant to give older patients the powerful painkillers because of their sedating side effects.\u003c/p>\n\u003cp>Surgeons’ prescribing habits are significant because \u003ca href=\"https://jamanetwork.com/journals/jamasurgery/fullarticle/2618383\" target=\"_blank\" rel=\"noopener\">studies show\u003c/a> that 6% of patients who are prescribed opioids after surgery will still be taking them three to six months later, having become dependent. The likelihood of persistent use rises with the number of pills and the length of time opioids are taken during recuperation.\u003c/p>\n\u003cp>Also, unused pills in medicine cabinets can make their way onto the street.\u003c/p>\n\u003cp>Dr. Marty Makary, a surgical oncologist at Johns Hopkins, admits that he too once handed out opioids liberally. Now he is marshaling a campaign to get surgeons to use these powerful painkillers more consciously and sparingly. “I think there’s an ‘aha’ moment that many of us in medicine have had or need to have,” he said.\u003c/p>\n\u003cp>But old habits are hard to kick.\u003c/p>\n\u003cp>KHN contacted dozens of the surgeons who topped the ranks of opioid prescribers in the 2016 database. They hailed from small, community hospitals as well as major academic medical centers. The majority declined to comment, some bristling when questioned.\u003c/p>\n\u003cp>You can search the KHN database by doctor and hospital \u003ca href=\"https://khn.org/news/opioid-prescribing/\" target=\"_blank\" rel=\"noopener\">here.\u003c/a>\u003c/p>\n\u003cp>Some of those surgeons were critical of the analysis, saying it didn’t take into account certain essential factors. For example, it was not possible to determine whether patients had complications or needed higher amounts of pain medication for another reason. And some surgeons had only a handful of patients who filled prescriptions, making for a small sample size.\u003c/p>\n\u003cp>But surgeons also indicated that the way they prescribe pain pills was less than intentional. It was sometimes an outgrowth of computer programs that default to preset amounts following procedures, or practice habits developed before the opioid crisis. Additionally, they blame efforts in the late 1990s and early 2000s that encouraged doctors and hospitals to consider pain as “the fifth vital sign.” A major hospital accrediting group required providers to ask patients how well their pain was treated. Pharmaceutical companies used the fifth vital sign campaign as a way to promote their opioid treatments.\u003c/p>\n\u003cp>Makary, who oversaw the analysis of the Medicare dataset, said that, while opioid prescribing is slowly dropping, to date many surgeons have not paid enough attention to the problem or responded with sufficient urgency.\u003c/p>\n\u003cp>Dr. Audrey Garrett, an oncologic surgeon in Oregon, said she was “surprised” to hear that she was among the top tier of prescribers. She said she planned to re-evaluate her clinic’s automated prescribing program, which is set to order specific amounts of opioids.\u003c/p>\n\u003cp>KHN will analyze data for 2017 and subsequent years when it becomes available to follow how prescribing is changing.\u003c/p>\n\u003cp>\u003cstrong>Prescribing Patterns Highlight What’s At Stake\u003c/strong>\u003c/p>\n\u003cp>The analysis examined prescribing habits after seven common procedures: coronary artery bypass, minimally invasive gallbladder removal, lumpectomy, meniscectomy (which removes part of a torn meniscus in the knee), minimally invasive hysterectomy, open colectomy and prostatectomy.\u003c/p>\n\u003cp>Across the board, the analysis showed that physicians gave a large number of narcotics when fewer pills or alternative medications, including over-the-counter pain relief tablets, could be equally effective, according to recent guidelines from Makary and other academic researchers.\u003c/p>\n\u003cp>On average, from 2011 to 2016, Medicare patients in the analysis took home 48 pills in the week following coronary artery bypass; 31 following laparoscopic gallbladder removal; 28 after a lumpectomy; 41 after meniscectomy; 34 after minimally invasive hysterectomy; 34 after open colon surgery; and 33 after prostatectomy.\u003c/p>\n\u003cp>\u003cimg loading=\"lazy\" decoding=\"async\" class=\"alignnone size-medium wp-image-1943831\" src=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2019/06/opioid-prescribing-chart2-800x533.png\" alt=\"\" width=\"800\" height=\"533\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2019/06/opioid-prescribing-chart2-800x533.png 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2019/06/opioid-prescribing-chart2-160x107.png 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2019/06/opioid-prescribing-chart2-768x512.png 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2019/06/opioid-prescribing-chart2-1020x679.png 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2019/06/opioid-prescribing-chart2-1200x799.png 1200w, https://cdn.kqed.org/wp-content/uploads/sites/35/2019/06/opioid-prescribing-chart2.png 1270w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003c/p>\n\u003cp>According to \u003ca href=\"https://www.solvethecrisis.org/best-practices\">post-surgical guidelines\u003c/a> spearheaded by Makary for his hospital last year, those surgeries should require at most 30 pills for bypass; 10 pills for minimally invasive gallbladder removal, lumpectomy, minimally invasive hysterectomy and prostatectomy; and eight pills for knee surgery. It has not yet published a guideline for open colon surgery.\u003c/p>\n\u003cp>The Johns Hopkins’ doctors developed their own standards because of a dearth of national guidelines for post-surgical opioids. They arrived at those figures after \u003ca href=\"https://khn.org/news/doling-out-pain-pills-post-surgery-an-ingrown-toenail-not-the-same-as-a-bypass/\">reaching a consensus\u003c/a> among surgeons, nurses, patients and other medical staff on how many pills were needed after particular surgeries.\u003c/p>\n\u003cp>Hoping to reduce overprescribing, Makary is preparing to send letters next month to surgeons around the country who are among the highest opioid prescribers under a grant he received from the Arnold Foundation, a nonprofit group whose focus includes drug price issues. (Kaiser Health News also received funding from the Arnold Foundation.)\u003c/p>\n\u003cp>Even if the prescription numbers have fallen since 2016, the amounts given today are likely still excessive.\u003c/p>\n\u003cp>“When prescribing may have been five to 20 times too high, even a reduction that is quite meaningful still likely reflects overprescribing,” said Dr. Chad Brummett, an anesthesiologist and associate professor at the University of Michigan.\u003c/p>\n\u003cp>Brummett is also co-director of the Michigan Opioid Prescribing Engagement Network, a collaboration of physicians that makes \u003ca href=\"https://www.opioidprescribing.info/\">surgery-specific recommendations\u003c/a>, many of them in the 10- to 20-pill range.\u003c/p>\n\u003cp>“Reducing unnecessary exposure is key to reducing the risk of new addiction,” said former Food and Drug Administration commissioner Scott Gottlieb. In August 2018, when Gottlieb was at the agency’s helm, it commissioned a report from the National Academy of Sciences on how best to set opioid prescribing guidelines for acute pain from specific conditions or surgical procedures. Its findings are expected later this year.\u003c/p>\n\u003cp>“There are still too many 30-tablet prescriptions being written,” said Gottlieb.\u003c/p>\n\u003cp>\u003cstrong>Healers Sowing Disease?\u003c/strong>\u003c/p>\n\u003cp>Naturally, surgeons rankle at the idea that they played a role in the opioid epidemic. But studies raise serious concerns.\u003c/p>\n\u003cp>Transplant surgeon Dr. Michael Engelsbe, director of the Michigan Surgical Quality Collaborative, points to the study showing 6% of post-op patients who get opioids for pain develop long-term dependence. That means a surgeon who does 300 operations a year paves the way for 18 newly dependent people, he said.\u003c/p>\n\u003cp>Many patients do not need the amounts prescribed.\u003c/p>\n\u003cp>Intermountain Healthcare, a not-for-profit system of hospitals, clinics, and doctors in Utah, began surveying patients two years ago to find out how much of their prescribed supply of opioids they actually took following surgery.\u003c/p>\n\u003cp>“Globally, we were overprescribing by 50%,” said Dr. David Hasleton, senior medical director.\u003c/p>\n\u003cp>But Intermountain approached individual doctors carefully. “If you go to a prescriber to say, ‘You are overprescribing,’ it never goes well. A common reaction is, ‘Your data is wrong’ or ‘My patients are different than his,’” said Hasleton.\u003c/p>\n\u003cp>For the analysis, KHN attempted to contact more than 50 surgeons whose 2016 numbers ranked them among the top prescribers in each surgical category.\u003c/p>\n\u003cp>One who did agree to speak was Dr. Daniel J. Waters, who 13 years ago had his chest cut open to remove a tumor, an operation technically similar to what he does for a living: coronary artery bypass.\u003c/p>\n\u003cp>“So I have both the doctor perspective and the patient perspective,” said Waters, who practices in Mason City, Iowa.\u003c/p>\n\u003cp>In 2016, Waters’ Medicare bypass patients who filled their prescriptions took home an average of nearly 157 pills each, according to the KHN-Johns Hopkins analysis.\u003c/p>\n\u003cp>“When I went home from the hospital, 30 would not have been enough,” said Waters of the number recommended by the Hopkins team for that surgery.\u003c/p>\n\u003cp>But he said he has recently curbed his prescribing to 84 pills.\u003c/p>\n\u003cp>Nationally, the average prescription filled for a coronary artery bypass was 49 pills in 2016 and had changed little since 2011, the analysis shows.\u003c/p>\n\u003cp>Others who spoke with KHN said they had developed the habit of prescribing copiously — sometimes giving out multiple opioid prescriptions — because they didn’t want patients to get stuck far from the office or over a weekend with pain or because they were trying to avoid calls from dissatisfied, hurting patients.\u003c/p>\n\u003cp>In the KHN-Johns Hopkins data, the seven patients of Dr. Antonio Santillan-Gomez who filled opioid prescriptions after minimally invasive hysterectomies in 2016 received an average of 77 pills each.\u003c/p>\n\u003cp>A gynecologic oncologist, Santillan-Gomez said: “I’m in San Antonio, and some of my patients come from Laredo or Corpus Christi, so they would have to drive two to three hours for a prescription.”\u003c/p>\n\u003cp>Still, he said, since e-prescribing of opioids became more widespread in the past few years, he and other surgeons in his group have limited prescriptions to 20 to 30 pills and encouraged patients to take Tylenol or other over-the-counter medications if they run out. E-prescribing can not only help track patients getting opioids but also reduce the problem of patients having to drive back to the office to get a written prescription.\u003c/p>\n\u003cp>Dr. Janet Grange, a breast surgeon in Omaha, Neb., said that in her experience, opioid dependence had not been a problem.\u003c/p>\n\u003cp>“I can absolutely tell you I don’t have even 1% who become long-term opioid users,” said Grange.\u003c/p>\n\u003cp>The analysis showed that Grange had 12 opioid-naïve Medicare patients who had a lumpectomy in 2016. Eight of them filled prescriptions for an average of 47 pills per patient.\u003c/p>\n\u003cp>She called Johns Hopkins’ zero-to-10-pill pain-control recommendation following that procedure “miserly.”\u003c/p>\n\u003cp>\u003cstrong>The Pendulum Swings\u003c/strong>\u003c/p>\n\u003cp>Some of the higher-prescribing surgeons in the KHN-Johns Hopkins analysis reflected on their potential contribution to a national catastrophe and are changing their practice.\u003c/p>\n\u003cp>“That is a shocking number,” said oncologist Garrett, speaking of the finding that 6% of patients who go home with opioids will become dependent. “If it’s true, it’s something we need to educate physicians on much earlier in their medical careers.”\u003c/p>\n\u003cp>Garrett, in Eugene, Ore., said she has cut back on the number of pills she gives patients since 2016. The KHN-Johns Hopkins analysis showed that seven of her 13 opioid-naïve Medicare patients undergoing minimally invasive hysterectomies filled a prescription for opioids in 2016. Those patients took home an average of 76 pills each.\u003c/p>\n\u003cp>Johns Hopkins guidelines call for no more than 10 opioid pills following this procedure, while Brummett’s Michigan network recommends no more than 15.\u003c/p>\n\u003cp>Surgeon and researcher Dr. Richard Barth, once a heavy prescriber himself, said that his own experience convinced him that physicians’ preconceptions about how much pain relief is needed are often way off.\u003c/p>\n\u003cp>The analysis showed his lumpectomy patients in 2013 filled an average of 33 pills in the week after surgery. By 2016, that average had dropped to seven pills. Many patients, he said, can do just fine after lumpectomy with over-the-counter medications — and often no opioids at all.\u003c/p>\n\u003cp>The key, he said, is to set patients’ expectations upfront.\u003c/p>\n\u003cp>“I tell them it’s OK to have a little discomfort, that we’re not trying to get to zero pain,” said Barth, who is chief of general surgery at Dartmouth-Hitchcock Medical Center and has published extensively on opioid prescribing.\u003c/p>\n\u003cp>After lumpectomy, “what I recommend is Tylenol and ibuprofen for at least a few days and to use the opioids only if the discomfort isn’t relieved by those.”\u003c/p>\n\u003cp>Indeed, the data analysis showed that a significant number of patients given prescriptions for opioids never filled them because they don’t need that level of pain relief.\u003c/p>\n\u003cp>Between 2011 and 2016, for example, only 62% of lumpectomy patients in the analysis filled prescriptions, similar to hysterectomy patients.\u003c/p>\n\u003cp>In 2016, patients of Dr. Kimberli Cox, a surgeon in Peoria, Ariz., were prescribed about 59 pills in the week following lumpectomy, well above the recommendations from both Johns Hopkins and others.\u003c/p>\n\u003cp>But the KHN-Johns Hopkins analysis of that year’s data shows that half of her patients never filled a painkiller prescription — a fact she acknowledges has changed her thinking.\u003c/p>\n\u003cp>“I am now starting to prescribe less because many patients say, ‘You gave me too many’ or ‘I didn’t fill it,” she said.\u003c/p>\n\u003cp>\u003cem>This story was produced by \u003ca href=\"http://khn.org/\" target=\"_blank\" rel=\"noopener\">Kaiser Health News\u003c/a>, an editorially independent program of the \u003ca href=\"https://www.kff.org/\" target=\"_blank\" rel=\"noopener\">Kaiser Family Foundation\u003c/a>.\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>\u003ca href=\"http://www.kaiserhealthnews.org/\" target=\"_blank\" rel=\"noopener\">Kaiser Health News\u003c/a> (KHN) is a national health policy news service. It is an editorially independent program of the \u003ca href=\"http://www.kff.org/\" target=\"_blank\" rel=\"noopener\">Henry J. Kaiser Family Foundation\u003c/a> which is not affiliated with Kaiser Permanente.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Ketamine is a darling of combat medics and clubgoers, an anesthetic that can quiet your pain without suppressing breathing and a hallucinogenic that can get you high with little risk of a fatal overdose.\u003c/p>\n\u003cp>For some patients, it also has dwelled in the shadows of conventional medicine as a depression treatment — prescribed by their doctors, but not approved for that purpose by the federal agency responsible for determining which treatments are “safe and effective.”\u003c/p>\n\u003cp>That effectively changed in March, when the Food and Drug Administration approved a ketamine cousin called esketamine, taken as a nasal spray, for patients with intractable depression. With that, the esketamine nasal spray, under the brand name Spravato, was introduced as a miracle drug — announced in press releases, celebrated on the evening news and embraced by major health care providers \u003ca href=\"https://www.va.gov/opa/pressrel/pressrelease.cfm?id=5220\" target=\"_blank\" rel=\"noopener\">like the Department of Veterans Affairs\u003c/a>.\u003c/p>\n\u003cp>The problem, critics say, is that the drug’s manufacturer, Janssen, provided the FDA at best modest evidence it worked and then only in limited trials. It presented no information about the safety of Spravato for long-term use beyond 60 weeks. And three patients who received the drug died by suicide during clinical trials, compared with none in the control group, raising red flags Janssen and the FDA dismissed.\u003c/p>\n\u003cp>The FDA, under political pressure to rapidly greenlight drugs that treat life-threatening conditions, approved it anyway. And, though Spravato’s appearance on the market was greeted with public applause, some deep misgivings were expressed at its day-long review meeting and in the agency’s own briefing materials, according to public recordings, documents and interviews with participants, KHN found.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Dr. Jess Fiedorowicz, director of the Mood Disorders Center at the University of Iowa and a member of the FDA advisory committee that reviewed the drug, described its benefit as “almost certainly exaggerated” after hearing the evidence.\u003c/p>\n\u003cp>Fiedorowicz said he expected at least a split decision by the committee. “And then it went strongly in favor, which surprised me,” he said in an interview.\u003c/p>\n\u003cp>Esketamine’s trajectory to approval shows — step by step — how drugmakers can take advantage of shortcuts in the FDA process with the agency’s blessing and maneuver through safety and efficacy reviews to bring a lucrative drug to market.\u003c/p>\n\u003cp>Step 1: In late 2013, Janssen got the FDA to designate esketamine a “breakthrough therapy” because it showed the potential to reverse depression rapidly — a holy grail for suicidal patients, such as those in an emergency room. That potential was based on a two-day study during which 30 patients were given esketamine intravenously.\u003c/p>\n\u003cp>\u003ca href=\"https://www.fda.gov/patients/fast-track-breakthrough-therapy-accelerated-approval-priority-review/breakthrough-therapy\" target=\"_blank\" rel=\"noopener\">“Breakthrough therapy” status\u003c/a> puts drugs on a fast track to approval, with more frequent input from the FDA.\u003c/p>\n\u003cp>Step 2: But discussions between regulators and drug manufacturers can affect the amount and quality of evidence required by the agency. In the case of Spravato, they involved questions like, how many drugs must fail before a patient’s depression is considered intractable or “treatment-resistant”? And how many successful clinical trials are necessary for FDA approval?\u003c/p>\n\u003cp>Step 3: Any prior agreements can leave the FDA’s expert advisory committees hamstrung in reaching a verdict. Fiedorowicz abstained on Spravato because, though he considered Janssen’s study design flawed, the FDA had approved it.\u003c/p>\n\u003cp>The expert panel cleared the drug according to the evidence that the agency and Janssen had determined was sufficient. Dr. Matthew Rudorfer, an associate director at the National Institute of Mental Health, concluded that the “benefits outweighed the risks.” Explaining his “yes” vote, he said: “I think we’re all agreeing on the very important, and sometimes life-or-death, risk of inadequately treated depression that factored into my equation.”\u003c/p>\n\u003cp>But others who also voted “yes” were more explicit in their qualms. “I don’t think that we really understand what happens when you take this week after week for weeks and months and years,” said Steven Meisel, the system director of medication safety for Fairview Health Services based in Minneapolis.\u003c/p>\n\u003cp>\u003cstrong>A Nasal Spray Offers a Path to a Patent\u003c/strong>\u003c/p>\n\u003cp>Spravato is available only under supervision at a certified facility, like a doctor’s office, where patients must be monitored for at least two hours after taking the drug to watch for side effects like dizziness, detachment from reality and increased blood pressure, as well as to reduce the risk of abuse. Patients must take it with an oral antidepressant.\u003c/p>\n\u003cp>Despite those requirements, Janssen, part of Johnson & Johnson, defended its new offering. “Until the recent FDA approval of Spravato, health care providers haven’t had any new medication options,” Kristina Chang, a Janssen spokeswoman, wrote in an emailed statement.\u003c/p>\n\u003cp>Esketamine is the first new type of drug approved to treat severe depression in about three decades.\u003c/p>\n\u003cp>Although ketamine has been used off-label for years to treat depression and post-traumatic stress disorder, drugmakers saw little profit in doing the studies to prove to the FDA that it worked for that purpose. But a nasal spray of esketamine, which is derived from ketamine and (in some studies) more potent, could be patented as a new drug.\u003c/p>\n\u003cp>Although Spravato costs more than $4,700 for the first month of treatment (not including the cost of monitoring or the oral antidepressant), insurers are more likely to reimburse for Spravato than for ketamine, since the latter is not approved for depression.\u003c/p>\n\u003cp>Shortly before the committee began voting, a study participant identifying herself only as “Patient 20015525” said: “I am offering real-world proof of efficacy, and that is I am both alive and here today.”\u003c/p>\n\u003cp>The drug did not work “for the majority of people who took it,” Meisel, the medication safety expert, said in an interview. “But for a subset of those for whom it did work, it was dramatic.”\u003c/p>\n\u003cp>\u003cstrong>Concerns About Testing Precedents\u003c/strong>\u003c/p>\n\u003cp>Those considerations apparently helped outweigh several scientific red flags that committee members called out at the hearing.\u003c/p>\n\u003cp>Although the drug had gotten breakthrough status because of its potential for results within 24 hours, the trials were not persuasive enough for the FDA to label it “rapid-acting.”\u003c/p>\n\u003cp>The FDA typically requires that applicants provide at least two clinical trials demonstrating the drug’s efficacy, “\u003ca href=\"https://www.fda.gov/regulatory-information/search-fda-guidance-documents/providing-clinical-evidence-effectiveness-human-drug-and-biological-products\" target=\"_blank\" rel=\"noopener\">each convincing on its own.\u003c/a>” Janssen provided just one successful short-term, double-blind trial of esketamine. Two other trials it ran to test efficacy fell short.\u003c/p>\n\u003cp>To reach the two-trial threshold, the FDA broke its precedent for psychiatric drugs and allowed the company to count a trial conducted to study a different topic: relapse and remission trends. But, by definition, every patient in the trial had already taken and seen improvement from esketamine.\u003c/p>\n\u003cp>What’s more, that single positive efficacy trial showed just a 4-point improvement in depression symptoms compared with the placebo treatment on a 60-point scale some clinicians use to measure depression severity. Some committee members noted the trial wasn’t really blind since participants could recognize they were getting the drug from side effects like a temporary out-of-body sensation.\u003c/p>\n\u003cp>Finally, the FDA lowered the bar for “treatment-resistant depression.” Initially, for inclusion, trial participants would have had to have failed two classes of oral antidepressants.\u003c/p>\n\u003cp>Less than two years later, the FDA loosened that definition, saying a patient needed only to have taken two different pills, no matter the class.\u003c/p>\n\u003cp>Forty-nine of the 227 people who participated in Janssen’s only successful efficacy trial had failed just one class of oral antidepressants. “They weeded out the true treatment-resistant patients,” said Dr. Erick Turner, a former FDA reviewer who serves on the committee but did not attend the meeting.\u003c/p>\n\u003cp>Six participants died during the studies, three by suicide. Janssen and the FDA dismissed the deaths as unrelated to the drug, noting the low number and lack of a pattern among hundreds of participants. They also pointed out that suicidal behavior is associated with severe depression — even though those who had suicidal ideation with some intent to act in the previous six months, or a history of suicidal behavior in the previous year, were excluded from the studies.\u003c/p>\n\u003cp>In \u003ca href=\"https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2019.19040423\" target=\"_blank\" rel=\"noopener\">a recent commentary in the American Journal of Psychiatry\u003c/a>, Dr. Alan Schatzberg, a Stanford University researcher who has studied ketamine, suggested there might be a link due to “a protracted withdrawal reaction, as has been reported with opioids,” since ketamine appears to interact with the brain’s opioid receptors.\u003c/p>\n\u003cp>Kim Witczak, the committee’s consumer representative, found Janssen’s conclusion about the suicides unsatisfying. “I just feel like it was kind of a quick brush-over,” Witczak said in an interview. She voted against the drug.\u003c/p>\n\u003cp>\u003cem>This story was produced by \u003ca href=\"http://khn.org/\" target=\"_blank\" rel=\"noopener\">Kaiser Health News\u003c/a>, an editorially independent program of the \u003ca href=\"https://www.kff.org/\" target=\"_blank\" rel=\"noopener\">Kaiser Family Foundation\u003c/a>.\u003c/em>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>\u003ca href=\"http://www.kaiserhealthnews.org/\" target=\"_blank\" rel=\"noopener\">Kaiser Health News\u003c/a> (KHN) is a national health policy news service. It is an editorially independent program of the \u003ca href=\"http://www.kff.org/\" target=\"_blank\" rel=\"noopener\">Henry J. Kaiser Family Foundation\u003c/a> which is not affiliated with Kaiser Permanente.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Ketamine is a darling of combat medics and clubgoers, an anesthetic that can quiet your pain without suppressing breathing and a hallucinogenic that can get you high with little risk of a fatal overdose.\u003c/p>\n\u003cp>For some patients, it also has dwelled in the shadows of conventional medicine as a depression treatment — prescribed by their doctors, but not approved for that purpose by the federal agency responsible for determining which treatments are “safe and effective.”\u003c/p>\n\u003cp>That effectively changed in March, when the Food and Drug Administration approved a ketamine cousin called esketamine, taken as a nasal spray, for patients with intractable depression. With that, the esketamine nasal spray, under the brand name Spravato, was introduced as a miracle drug — announced in press releases, celebrated on the evening news and embraced by major health care providers \u003ca href=\"https://www.va.gov/opa/pressrel/pressrelease.cfm?id=5220\" target=\"_blank\" rel=\"noopener\">like the Department of Veterans Affairs\u003c/a>.\u003c/p>\n\u003cp>The problem, critics say, is that the drug’s manufacturer, Janssen, provided the FDA at best modest evidence it worked and then only in limited trials. It presented no information about the safety of Spravato for long-term use beyond 60 weeks. And three patients who received the drug died by suicide during clinical trials, compared with none in the control group, raising red flags Janssen and the FDA dismissed.\u003c/p>\n\u003cp>The FDA, under political pressure to rapidly greenlight drugs that treat life-threatening conditions, approved it anyway. And, though Spravato’s appearance on the market was greeted with public applause, some deep misgivings were expressed at its day-long review meeting and in the agency’s own briefing materials, according to public recordings, documents and interviews with participants, KHN found.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Dr. Jess Fiedorowicz, director of the Mood Disorders Center at the University of Iowa and a member of the FDA advisory committee that reviewed the drug, described its benefit as “almost certainly exaggerated” after hearing the evidence.\u003c/p>\n\u003cp>Fiedorowicz said he expected at least a split decision by the committee. “And then it went strongly in favor, which surprised me,” he said in an interview.\u003c/p>\n\u003cp>Esketamine’s trajectory to approval shows — step by step — how drugmakers can take advantage of shortcuts in the FDA process with the agency’s blessing and maneuver through safety and efficacy reviews to bring a lucrative drug to market.\u003c/p>\n\u003cp>Step 1: In late 2013, Janssen got the FDA to designate esketamine a “breakthrough therapy” because it showed the potential to reverse depression rapidly — a holy grail for suicidal patients, such as those in an emergency room. That potential was based on a two-day study during which 30 patients were given esketamine intravenously.\u003c/p>\n\u003cp>\u003ca href=\"https://www.fda.gov/patients/fast-track-breakthrough-therapy-accelerated-approval-priority-review/breakthrough-therapy\" target=\"_blank\" rel=\"noopener\">“Breakthrough therapy” status\u003c/a> puts drugs on a fast track to approval, with more frequent input from the FDA.\u003c/p>\n\u003cp>Step 2: But discussions between regulators and drug manufacturers can affect the amount and quality of evidence required by the agency. In the case of Spravato, they involved questions like, how many drugs must fail before a patient’s depression is considered intractable or “treatment-resistant”? And how many successful clinical trials are necessary for FDA approval?\u003c/p>\n\u003cp>Step 3: Any prior agreements can leave the FDA’s expert advisory committees hamstrung in reaching a verdict. Fiedorowicz abstained on Spravato because, though he considered Janssen’s study design flawed, the FDA had approved it.\u003c/p>\n\u003cp>The expert panel cleared the drug according to the evidence that the agency and Janssen had determined was sufficient. Dr. Matthew Rudorfer, an associate director at the National Institute of Mental Health, concluded that the “benefits outweighed the risks.” Explaining his “yes” vote, he said: “I think we’re all agreeing on the very important, and sometimes life-or-death, risk of inadequately treated depression that factored into my equation.”\u003c/p>\n\u003cp>But others who also voted “yes” were more explicit in their qualms. “I don’t think that we really understand what happens when you take this week after week for weeks and months and years,” said Steven Meisel, the system director of medication safety for Fairview Health Services based in Minneapolis.\u003c/p>\n\u003cp>\u003cstrong>A Nasal Spray Offers a Path to a Patent\u003c/strong>\u003c/p>\n\u003cp>Spravato is available only under supervision at a certified facility, like a doctor’s office, where patients must be monitored for at least two hours after taking the drug to watch for side effects like dizziness, detachment from reality and increased blood pressure, as well as to reduce the risk of abuse. Patients must take it with an oral antidepressant.\u003c/p>\n\u003cp>Despite those requirements, Janssen, part of Johnson & Johnson, defended its new offering. “Until the recent FDA approval of Spravato, health care providers haven’t had any new medication options,” Kristina Chang, a Janssen spokeswoman, wrote in an emailed statement.\u003c/p>\n\u003cp>Esketamine is the first new type of drug approved to treat severe depression in about three decades.\u003c/p>\n\u003cp>Although ketamine has been used off-label for years to treat depression and post-traumatic stress disorder, drugmakers saw little profit in doing the studies to prove to the FDA that it worked for that purpose. But a nasal spray of esketamine, which is derived from ketamine and (in some studies) more potent, could be patented as a new drug.\u003c/p>\n\u003cp>Although Spravato costs more than $4,700 for the first month of treatment (not including the cost of monitoring or the oral antidepressant), insurers are more likely to reimburse for Spravato than for ketamine, since the latter is not approved for depression.\u003c/p>\n\u003cp>Shortly before the committee began voting, a study participant identifying herself only as “Patient 20015525” said: “I am offering real-world proof of efficacy, and that is I am both alive and here today.”\u003c/p>\n\u003cp>The drug did not work “for the majority of people who took it,” Meisel, the medication safety expert, said in an interview. “But for a subset of those for whom it did work, it was dramatic.”\u003c/p>\n\u003cp>\u003cstrong>Concerns About Testing Precedents\u003c/strong>\u003c/p>\n\u003cp>Those considerations apparently helped outweigh several scientific red flags that committee members called out at the hearing.\u003c/p>\n\u003cp>Although the drug had gotten breakthrough status because of its potential for results within 24 hours, the trials were not persuasive enough for the FDA to label it “rapid-acting.”\u003c/p>\n\u003cp>The FDA typically requires that applicants provide at least two clinical trials demonstrating the drug’s efficacy, “\u003ca href=\"https://www.fda.gov/regulatory-information/search-fda-guidance-documents/providing-clinical-evidence-effectiveness-human-drug-and-biological-products\" target=\"_blank\" rel=\"noopener\">each convincing on its own.\u003c/a>” Janssen provided just one successful short-term, double-blind trial of esketamine. Two other trials it ran to test efficacy fell short.\u003c/p>\n\u003cp>To reach the two-trial threshold, the FDA broke its precedent for psychiatric drugs and allowed the company to count a trial conducted to study a different topic: relapse and remission trends. But, by definition, every patient in the trial had already taken and seen improvement from esketamine.\u003c/p>\n\u003cp>What’s more, that single positive efficacy trial showed just a 4-point improvement in depression symptoms compared with the placebo treatment on a 60-point scale some clinicians use to measure depression severity. Some committee members noted the trial wasn’t really blind since participants could recognize they were getting the drug from side effects like a temporary out-of-body sensation.\u003c/p>\n\u003cp>Finally, the FDA lowered the bar for “treatment-resistant depression.” Initially, for inclusion, trial participants would have had to have failed two classes of oral antidepressants.\u003c/p>\n\u003cp>Less than two years later, the FDA loosened that definition, saying a patient needed only to have taken two different pills, no matter the class.\u003c/p>\n\u003cp>Forty-nine of the 227 people who participated in Janssen’s only successful efficacy trial had failed just one class of oral antidepressants. “They weeded out the true treatment-resistant patients,” said Dr. Erick Turner, a former FDA reviewer who serves on the committee but did not attend the meeting.\u003c/p>\n\u003cp>Six participants died during the studies, three by suicide. Janssen and the FDA dismissed the deaths as unrelated to the drug, noting the low number and lack of a pattern among hundreds of participants. They also pointed out that suicidal behavior is associated with severe depression — even though those who had suicidal ideation with some intent to act in the previous six months, or a history of suicidal behavior in the previous year, were excluded from the studies.\u003c/p>\n\u003cp>In \u003ca href=\"https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2019.19040423\" target=\"_blank\" rel=\"noopener\">a recent commentary in the American Journal of Psychiatry\u003c/a>, Dr. Alan Schatzberg, a Stanford University researcher who has studied ketamine, suggested there might be a link due to “a protracted withdrawal reaction, as has been reported with opioids,” since ketamine appears to interact with the brain’s opioid receptors.\u003c/p>\n\u003cp>Kim Witczak, the committee’s consumer representative, found Janssen’s conclusion about the suicides unsatisfying. “I just feel like it was kind of a quick brush-over,” Witczak said in an interview. She voted against the drug.\u003c/p>\n\u003cp>\u003cem>This story was produced by \u003ca href=\"http://khn.org/\" target=\"_blank\" rel=\"noopener\">Kaiser Health News\u003c/a>, an editorially independent program of the \u003ca href=\"https://www.kff.org/\" target=\"_blank\" rel=\"noopener\">Kaiser Family Foundation\u003c/a>.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>The University of California and the British pharmaceutical giant GlaxoSmithKline on Thursday announced plans to build a new $67 million genetics laboratory focused on the gene-editing technology CRISPR.\u003c/p>\n\u003cp>Scientists at what will be called the Laboratory for Genomics Research, to be built over the next five years in San Francisco’s Mission Bay, will explore how genetic mutations cause disease, while developing new gene therapies and other treatments.\u003c/p>\n\u003cp>The study of human genetics has exploded in the last decade, and scientists can now identify mutations in DNA that cause a wide range of disease, from cancer to Huntington’s to muscular dystrophy.\u003c/p>\n\u003cp>“But turning that into an actionable item where you can develop a therapy has been challenging,” said Jonathan Weissman, a biochemist at UCSF. Weissman is designing the laboratory with UC Berkeley’s Jennifer Doudna, a CRISPR pioneer, and Hal Barron, chief science officer and president of GSK.\u003c/p>\n\u003cp>Weissman hopes the lab will enable researchers to more fully understand genetic differences through the advancement of functional genomics — the study of gene relationships and interactions — that relies on CRISPR technology.\u003c/p>\n\u003cp>CRISPR is so powerful because it targets specific genes with precise edits in DNA.\u003c/p>\n\u003cp>\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-1943305 alignright\" src=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2019/06/DESKTOP_CRISPR_171115-800x531.jpg\" alt=\"\" width=\"800\" height=\"531\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2019/06/DESKTOP_CRISPR_171115-800x531.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2019/06/DESKTOP_CRISPR_171115-160x106.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2019/06/DESKTOP_CRISPR_171115-768x510.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2019/06/DESKTOP_CRISPR_171115-1020x677.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2019/06/DESKTOP_CRISPR_171115-1200x797.jpg 1200w, https://cdn.kqed.org/wp-content/uploads/sites/35/2019/06/DESKTOP_CRISPR_171115.jpg 1280w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003c/p>\n\u003cp>“CRISPR is a great discovery tool that lets us understand why changes in our DNA can cause disease and then give us clues as to how we might be able to intervene to prevent it,” said Weissman.\u003c/p>\n\u003cp>Recent advances in machine learning have given scientists the ability to use powerful computers to analyze the massive amount of data generated by CRISPR applications. The hope is that these supercomputers can help unlock the mysteries of cell biology and rapidly accelerate the discovery of new treatments.\u003c/p>\n\u003cp>“We think that human genetics, functional genomics and machine learning will allow us to identify novel targets that will result in medicines that will have a profound effect ,” said Barron.\u003c/p>\n\u003cp>GSK’s Barron said he hopes the lab will spur advancements in gene therapy at “a pace previously thought impossible.”\u003c/p>\n\u003cp>The lab will employ about 40 people, GSK and UC said, and will be located between UCSF’s Mission Bay campus and the new Warriors \u003ca href=\"http://www.gswconstruction.com/webcam/\">stadium\u003c/a>.\u003c/p>\n\u003cp>\u003cstrong>CRISPR and Ethics\u003c/strong>\u003c/p>\n\u003cp>With CRISPR technology, scientists can modify or add entirely new genes.\u003c/p>\n\u003cp>CRISPR is different from other gene-editing tools in that its applications can alter the DNA of somatic cells and germ cells.\u003c/p>\n\u003cp>Somatic cells are found in organs and tissues and are not passed on through reproduction. Germ cells hold genes that are heritable.\u003c/p>\n\u003cp>Doudna said the focus of the new lab will be on fundamental discovery science, and not on germ cell editing.\u003c/p>\n\u003cfigure id=\"attachment_1943306\" class=\"wp-caption alignright\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-1943306\" src=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2019/06/GettyImages-693524758-800x565.jpg\" alt=\"\" width=\"800\" height=\"565\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2019/06/GettyImages-693524758-800x565.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2019/06/GettyImages-693524758-160x113.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2019/06/GettyImages-693524758-768x543.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2019/06/GettyImages-693524758-1020x721.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2019/06/GettyImages-693524758-1200x848.jpg 1200w, https://cdn.kqed.org/wp-content/uploads/sites/35/2019/06/GettyImages-693524758-1920x1357.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/35/2019/06/GettyImages-693524758.jpg 2048w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Jennifer Doudna will spearhead a new CRISPR lab in the Mission Bay neighborhood of San Francisco. speaks onstage at WIRED Business Conference Presented By Visa At Spring Studios In New York City on June 7, 2017 in New York City. (Photo by Brian Ach/Getty \u003ccite>(Brian Ach/Getty Images)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“I don’t think there’s any intention right now to be editing human embryos in the center,” she said. “I think our goal is actually to work on various kinds of disease-related questions that would be addressable using primary cells and tissues.”\u003c/p>\n\u003cp>Last year, controversy swarmed around He Jiankui, a biochemist with Southern University of Science and Technology in Shenzhen, China, who used CRISPR to perform germline editing to modify genes in a human embryo.\u003c/p>\n\u003cp>At the time, Doudna was one of the scientists who quickly criticized Jiankui, telling NPR that his work is a “break from the cautious and transparent approach of the global scientific community’s application of CRISPR-Cas9 for human germline editing.”\u003c/p>\n\u003cp>Doudna has declared a need to confine the use of gene-editing in human embryos to situations in which there is a clear medical need with zero alternative viable approach.\u003c/p>\n\u003cp>Additionally, Doudna says there’s a lot of fundamental research that needs to be done prior to any use of genome editing for clinical purposes in human embryos. “In that regard, the [lab] will play a very important role in stimulating fundamental, curiosity-driven research that needs to be done,” she said. “It will both advance our understanding of the human genome and we’ll also advance the potential in the power of the technology.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003c/p>\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The University of California and the British pharmaceutical giant GlaxoSmithKline on Thursday announced plans to build a new $67 million genetics laboratory focused on the gene-editing technology CRISPR.\u003c/p>\n\u003cp>Scientists at what will be called the Laboratory for Genomics Research, to be built over the next five years in San Francisco’s Mission Bay, will explore how genetic mutations cause disease, while developing new gene therapies and other treatments.\u003c/p>\n\u003cp>The study of human genetics has exploded in the last decade, and scientists can now identify mutations in DNA that cause a wide range of disease, from cancer to Huntington’s to muscular dystrophy.\u003c/p>\n\u003cp>“But turning that into an actionable item where you can develop a therapy has been challenging,” said Jonathan Weissman, a biochemist at UCSF. Weissman is designing the laboratory with UC Berkeley’s Jennifer Doudna, a CRISPR pioneer, and Hal Barron, chief science officer and president of GSK.\u003c/p>\n\u003cp>Weissman hopes the lab will enable researchers to more fully understand genetic differences through the advancement of functional genomics — the study of gene relationships and interactions — that relies on CRISPR technology.\u003c/p>\n\u003cp>CRISPR is so powerful because it targets specific genes with precise edits in DNA.\u003c/p>\n\u003cp>\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-1943305 alignright\" src=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2019/06/DESKTOP_CRISPR_171115-800x531.jpg\" alt=\"\" width=\"800\" height=\"531\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2019/06/DESKTOP_CRISPR_171115-800x531.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2019/06/DESKTOP_CRISPR_171115-160x106.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2019/06/DESKTOP_CRISPR_171115-768x510.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2019/06/DESKTOP_CRISPR_171115-1020x677.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2019/06/DESKTOP_CRISPR_171115-1200x797.jpg 1200w, https://cdn.kqed.org/wp-content/uploads/sites/35/2019/06/DESKTOP_CRISPR_171115.jpg 1280w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003c/p>\n\u003cp>“CRISPR is a great discovery tool that lets us understand why changes in our DNA can cause disease and then give us clues as to how we might be able to intervene to prevent it,” said Weissman.\u003c/p>\n\u003cp>Recent advances in machine learning have given scientists the ability to use powerful computers to analyze the massive amount of data generated by CRISPR applications. The hope is that these supercomputers can help unlock the mysteries of cell biology and rapidly accelerate the discovery of new treatments.\u003c/p>\n\u003cp>“We think that human genetics, functional genomics and machine learning will allow us to identify novel targets that will result in medicines that will have a profound effect ,” said Barron.\u003c/p>\n\u003cp>GSK’s Barron said he hopes the lab will spur advancements in gene therapy at “a pace previously thought impossible.”\u003c/p>\n\u003cp>The lab will employ about 40 people, GSK and UC said, and will be located between UCSF’s Mission Bay campus and the new Warriors \u003ca href=\"http://www.gswconstruction.com/webcam/\">stadium\u003c/a>.\u003c/p>\n\u003cp>\u003cstrong>CRISPR and Ethics\u003c/strong>\u003c/p>\n\u003cp>With CRISPR technology, scientists can modify or add entirely new genes.\u003c/p>\n\u003cp>CRISPR is different from other gene-editing tools in that its applications can alter the DNA of somatic cells and germ cells.\u003c/p>\n\u003cp>Somatic cells are found in organs and tissues and are not passed on through reproduction. Germ cells hold genes that are heritable.\u003c/p>\n\u003cp>Doudna said the focus of the new lab will be on fundamental discovery science, and not on germ cell editing.\u003c/p>\n\u003cfigure id=\"attachment_1943306\" class=\"wp-caption alignright\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-1943306\" src=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2019/06/GettyImages-693524758-800x565.jpg\" alt=\"\" width=\"800\" height=\"565\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2019/06/GettyImages-693524758-800x565.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2019/06/GettyImages-693524758-160x113.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2019/06/GettyImages-693524758-768x543.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2019/06/GettyImages-693524758-1020x721.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2019/06/GettyImages-693524758-1200x848.jpg 1200w, https://cdn.kqed.org/wp-content/uploads/sites/35/2019/06/GettyImages-693524758-1920x1357.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/35/2019/06/GettyImages-693524758.jpg 2048w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Jennifer Doudna will spearhead a new CRISPR lab in the Mission Bay neighborhood of San Francisco. speaks onstage at WIRED Business Conference Presented By Visa At Spring Studios In New York City on June 7, 2017 in New York City. (Photo by Brian Ach/Getty \u003ccite>(Brian Ach/Getty Images)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“I don’t think there’s any intention right now to be editing human embryos in the center,” she said. “I think our goal is actually to work on various kinds of disease-related questions that would be addressable using primary cells and tissues.”\u003c/p>\n\u003cp>Last year, controversy swarmed around He Jiankui, a biochemist with Southern University of Science and Technology in Shenzhen, China, who used CRISPR to perform germline editing to modify genes in a human embryo.\u003c/p>\n\u003cp>At the time, Doudna was one of the scientists who quickly criticized Jiankui, telling NPR that his work is a “break from the cautious and transparent approach of the global scientific community’s application of CRISPR-Cas9 for human germline editing.”\u003c/p>\n\u003cp>Doudna has declared a need to confine the use of gene-editing in human embryos to situations in which there is a clear medical need with zero alternative viable approach.\u003c/p>\n\u003cp>Additionally, Doudna says there’s a lot of fundamental research that needs to be done prior to any use of genome editing for clinical purposes in human embryos. “In that regard, the [lab] will play a very important role in stimulating fundamental, curiosity-driven research that needs to be done,” she said. “It will both advance our understanding of the human genome and we’ll also advance the potential in the power of the technology.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"title": "Trump Prohibits Government Scientists From Using Fetal Tissue in Research",
"headTitle": "Trump Prohibits Government Scientists From Using Fetal Tissue in Research | KQED",
"content": "\u003cp>The Trump administration said Wednesday it is ending medical research by government scientists using human fetal tissue, overriding the advice of scientists that there’s no other way to tackle some health problems and handing abortion opponents a major victory.\u003c/p>\n\u003cfigure id=\"attachment_1942941\" class=\"wp-caption alignright\" style=\"max-width: 333px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\" wp-image-1942941\" src=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2019/06/Francis_Collins_fetal_tissue-951x1200.jpg\" alt=\"\" width=\"333\" height=\"420\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2019/06/Francis_Collins_fetal_tissue-951x1200.jpg 951w, https://cdn.kqed.org/wp-content/uploads/sites/35/2019/06/Francis_Collins_fetal_tissue-160x202.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2019/06/Francis_Collins_fetal_tissue-800x1009.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2019/06/Francis_Collins_fetal_tissue-768x969.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2019/06/Francis_Collins_fetal_tissue-1020x1287.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2019/06/Francis_Collins_fetal_tissue-1920x2423.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/35/2019/06/Francis_Collins_fetal_tissue.jpg 1623w\" sizes=\"(max-width: 333px) 100vw, 333px\">\u003cfigcaption class=\"wp-caption-text\">Dr. Francis S. Collins, Director of NIH, who has supported using fetal tissue in research. \u003ccite>(NIH)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The Health and Human Services Department said in a statement that government-funded research by universities that involves fetal tissue can continue, subject to additional scrutiny.\u003c/p>\n\u003cp>The policy changes will not affect privately funded research, officials said.\u003c/p>\n\u003cp>Fetal tissue is used in research on HIV and childhood cancers, treatments that enlist the body’s immune system to battle cancer, and the hunt for a vaccine against the Zika virus, a cause of birth defects. The tissue from elective abortions would otherwise be discarded. Scientists use it to produce mice that model how the human immune system works.\u003c/p>\n\u003cp>Ending the use of fetal tissue by the National Institutes of Health has been a priority for anti-abortion activists, a core element of President Donald Trump’s political base.\u003c/p>\n\u003cp>The government’s top medical scientist, NIH Director Francis Collins, said as recently as last December that he believes “there’s strong evidence that scientific benefits come from fetal tissue research.”\u003c/p>\n\u003cp>A senior administration official said the decision announced Wednesday was the president’s call and not Collins’. The official spoke on condition of anonymity to discuss internal deliberations.\u003c/p>\n\u003cp>The government has funded research using fetal tissue for decades, under administrations of both political parties.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The government said there are currently at least three active federal research projects that involve human fetal tissue, and possibly as many as 12. Among university research projects funded by the government, officials said fewer than 200 of 50,000 rely on human fetal tissue.\u003c/p>\n\u003cp>No university-led programs will be affected for the time being, the administration said. New projects that propose to use fetal tissue and current projects up for renewal will be subject to additional reviews.\u003c/p>\n\u003cp>Last year, the administration announced a review of whether taxpayer dollars were being properly spent on fetal tissue research. As a result, NIH froze procurement of new tissue. On Wednesday, the administration also said it is not renewing an expiring contract with the University of California, San Francisco that involves fetal tissue research.\u003c/p>\n\u003cp>Although HHS said it was trying to balance “pro-life” and “pro-science” imperatives, medical investigators said they feared the government would halt important research to satisfy anti-abortion activists.\u003c/p>\n\u003cp>Kristan Hawkins, president of Students for Life of America, said in a statement that the administration has “once again done the right thing in restoring a culture of life to our government.”\u003c/p>\n\u003cp>The Susan B. Anthony List, a group that works to elect lawmakers opposed to abortion, said in a statement that taxpayer funding ought to go to promoting alternatives to using fetal tissue in medical research.\u003c/p>\n\u003cp>The groups say alternatives are available; scientific groups say that’s not the case for every disease and condition.\u003c/p>\n\u003cp>Trump casts himself as “strongly pro-life,” and his administration has taken many steps to restrict access to abortion, which remains a legal medical procedure. Trump has nominated federal judges who oppose abortion, attempted to cut money for Planned Parenthood, and expanded legal protection for medical providers who object to abortion.\u003c/p>\n\u003cp>At a House hearing on the issue last December, neuroscientist Sally Temple told lawmakers the consensus opinion in the scientific community is that there is currently no adequate substitute for fetal tissue in some research areas.\u003c/p>\n\u003cp>Temple explained that tissue samples from different stages of the life cycle are not interchangeable. “It is not the same material,” she said. “It is a different developmental stage. It has unique properties.” She was testifying on behalf of the International Society for Stem Cell Research.\u003c/p>\n\u003cp>Testifying on behalf of the Charlotte Lozier Institute, which opposes abortion, biochemist Tara Sander Lee said tissues from infants who have to have heart surgery are among the alternatives. But Temple said researchers would readily use alternatives to fetal tissue if that was suitable.\u003c/p>\n\u003cp>Research involving fetal tissue accounted for $98 million in NIH grants and projects during the 2017 budget year, a small fraction of the agency’s overall research budget. NIH said that $98 million figure represents the entire budget for the grants at issue, even if only a smaller portion of a particular grant was devoted to fetal tissue research.\u003c/p>\n\u003cp>HHS said in its statement that is taking such steps through a $20 million grant program announced last December to “develop, demonstrate, and validate experimental models that do not rely on human fetal tissue from elective abortions.”\u003c/p>\n\u003cp>\u003c/p>\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The Trump administration said Wednesday it is ending medical research by government scientists using human fetal tissue, overriding the advice of scientists that there’s no other way to tackle some health problems and handing abortion opponents a major victory.\u003c/p>\n\u003cfigure id=\"attachment_1942941\" class=\"wp-caption alignright\" style=\"max-width: 333px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\" wp-image-1942941\" src=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2019/06/Francis_Collins_fetal_tissue-951x1200.jpg\" alt=\"\" width=\"333\" height=\"420\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2019/06/Francis_Collins_fetal_tissue-951x1200.jpg 951w, https://cdn.kqed.org/wp-content/uploads/sites/35/2019/06/Francis_Collins_fetal_tissue-160x202.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2019/06/Francis_Collins_fetal_tissue-800x1009.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2019/06/Francis_Collins_fetal_tissue-768x969.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2019/06/Francis_Collins_fetal_tissue-1020x1287.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2019/06/Francis_Collins_fetal_tissue-1920x2423.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/35/2019/06/Francis_Collins_fetal_tissue.jpg 1623w\" sizes=\"(max-width: 333px) 100vw, 333px\">\u003cfigcaption class=\"wp-caption-text\">Dr. Francis S. Collins, Director of NIH, who has supported using fetal tissue in research. \u003ccite>(NIH)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The Health and Human Services Department said in a statement that government-funded research by universities that involves fetal tissue can continue, subject to additional scrutiny.\u003c/p>\n\u003cp>The policy changes will not affect privately funded research, officials said.\u003c/p>\n\u003cp>Fetal tissue is used in research on HIV and childhood cancers, treatments that enlist the body’s immune system to battle cancer, and the hunt for a vaccine against the Zika virus, a cause of birth defects. The tissue from elective abortions would otherwise be discarded. Scientists use it to produce mice that model how the human immune system works.\u003c/p>\n\u003cp>Ending the use of fetal tissue by the National Institutes of Health has been a priority for anti-abortion activists, a core element of President Donald Trump’s political base.\u003c/p>\n\u003cp>The government’s top medical scientist, NIH Director Francis Collins, said as recently as last December that he believes “there’s strong evidence that scientific benefits come from fetal tissue research.”\u003c/p>\n\u003cp>A senior administration official said the decision announced Wednesday was the president’s call and not Collins’. The official spoke on condition of anonymity to discuss internal deliberations.\u003c/p>\n\u003cp>The government has funded research using fetal tissue for decades, under administrations of both political parties.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The government said there are currently at least three active federal research projects that involve human fetal tissue, and possibly as many as 12. Among university research projects funded by the government, officials said fewer than 200 of 50,000 rely on human fetal tissue.\u003c/p>\n\u003cp>No university-led programs will be affected for the time being, the administration said. New projects that propose to use fetal tissue and current projects up for renewal will be subject to additional reviews.\u003c/p>\n\u003cp>Last year, the administration announced a review of whether taxpayer dollars were being properly spent on fetal tissue research. As a result, NIH froze procurement of new tissue. On Wednesday, the administration also said it is not renewing an expiring contract with the University of California, San Francisco that involves fetal tissue research.\u003c/p>\n\u003cp>Although HHS said it was trying to balance “pro-life” and “pro-science” imperatives, medical investigators said they feared the government would halt important research to satisfy anti-abortion activists.\u003c/p>\n\u003cp>Kristan Hawkins, president of Students for Life of America, said in a statement that the administration has “once again done the right thing in restoring a culture of life to our government.”\u003c/p>\n\u003cp>The Susan B. Anthony List, a group that works to elect lawmakers opposed to abortion, said in a statement that taxpayer funding ought to go to promoting alternatives to using fetal tissue in medical research.\u003c/p>\n\u003cp>The groups say alternatives are available; scientific groups say that’s not the case for every disease and condition.\u003c/p>\n\u003cp>Trump casts himself as “strongly pro-life,” and his administration has taken many steps to restrict access to abortion, which remains a legal medical procedure. Trump has nominated federal judges who oppose abortion, attempted to cut money for Planned Parenthood, and expanded legal protection for medical providers who object to abortion.\u003c/p>\n\u003cp>At a House hearing on the issue last December, neuroscientist Sally Temple told lawmakers the consensus opinion in the scientific community is that there is currently no adequate substitute for fetal tissue in some research areas.\u003c/p>\n\u003cp>Temple explained that tissue samples from different stages of the life cycle are not interchangeable. “It is not the same material,” she said. “It is a different developmental stage. It has unique properties.” She was testifying on behalf of the International Society for Stem Cell Research.\u003c/p>\n\u003cp>Testifying on behalf of the Charlotte Lozier Institute, which opposes abortion, biochemist Tara Sander Lee said tissues from infants who have to have heart surgery are among the alternatives. But Temple said researchers would readily use alternatives to fetal tissue if that was suitable.\u003c/p>\n\u003cp>Research involving fetal tissue accounted for $98 million in NIH grants and projects during the 2017 budget year, a small fraction of the agency’s overall research budget. NIH said that $98 million figure represents the entire budget for the grants at issue, even if only a smaller portion of a particular grant was devoted to fetal tissue research.\u003c/p>\n\u003cp>HHS said in its statement that is taking such steps through a $20 million grant program announced last December to “develop, demonstrate, and validate experimental models that do not rely on human fetal tissue from elective abortions.”\u003c/p>\n\u003cp>\u003c/p>\n\u003c/div>\u003c/p>",
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"content": "\u003cp>\u003cspan class=\"big-cap-wrap\">\u003cspan class=\"big-cap\">O\u003c/span>\u003c/span>ne of lung cancer’s most lethal attributes is its ability to trick radiologists. Some nodules appear threatening but turn out to be false positives. Others escape notice entirely, and then spiral without symptoms into metastatic disease.\u003c/p>\n\u003cp class=\"danger-zone\">\u003cspan style=\"font-weight: 400;\">[aside postID='futureofyou_256816' \u003c/span>\u003ci>\u003cspan style=\"font-weight: 400;\">label=\u003c/span>\u003c/i>\u003cspan style=\"font-weight: 400;\">'Has Technology Ruined the Radiology Profession?\u003c/span>\u003cspan style=\"font-weight: 400;\">']\u003c/span>On Monday, however, Google unveiled an artificial intelligence system that — in early testing — demonstrated a remarkable talent for seeing through lung cancer’s disguises.\u003c/p>\n\u003cp class=\"danger-zone\">A \u003ca href=\"http://track.nature.com/track/click/30195101/www.nature.com?p=eyJzIjoicTBxSFlxcFRWaUltRDVsd2FRSGNRRXJNV3JzIiwidiI6MSwicCI6IntcInVcIjozMDE5NTEwMSxcInZcIjoxLFwidXJsXCI6XCJodHRwczpcXFwvXFxcL3d3dy5uYXR1cmUuY29tXFxcL2FydGljbGVzXFxcL3M0MTU5MS0wMTktMDQ0Ny14XCIsXCJpZFwiOlwiZTU3ZWRiYjZkNzc2NDU3Yjg2OThiMDVkMGM1MzgyYmVcIixcInVybF9pZHNcIjpbXCJkYjkwMzZjZDA4Y2JjNGQ3OTdkODVjYjYyOWE4ZWEyZjE1NTNmMzk3XCJdfSJ9\" target=\"_blank\" rel=\"noopener\">study\u003c/a> published in Nature Medicine reported that the algorithm, trained on 42,000 patient CT scans taken during a National Institutes of Health clinical trial, outperformed six radiologists in determining whether patients had cancer. It detected 5% more cancers and cut false positives — when cancer is suspected though a nodule is harmless — by 11% from reviewing a single scan. It performed on par with the radiologists when prior images of patients were also included in the evaluation.\u003c/p>\n\u003cp class=\"\">The results underscore AI’s potential to improve lung cancer screening and help radiologists diagnose malignancies earlier and with greater accuracy — though the research did not show whether the Google system would help patients live longer. Lung cancer is by far the most common killer of Americans among cancers, resulting in about 160,000 deaths in 2018.\u003c/p>\n\u003cp class=\"\">A large \u003ca href=\"https://www.cancer.gov/types/lung/research/nlst\" target=\"_blank\" rel=\"noopener\">NIH study\u003c/a> — the same one that supplied data for Google’s algorithm — established that screening of high-risk patients such as long-term smokers can reduce the risk of death by about 20%, but it also raised concerns about false positives leading to unnecessary testing that can harm patients. It reported that several deaths resulted from false positives that led patients to undergo invasive biopsies and other procedures. Ongoing concerns about the overall accuracy and benefit of screening have led to low rates of such testing. Meanwhile, about 50 percent of lung cancers are diagnosed after they have already spread, when the disease is harder to effectively treat.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Experts who were not involved in the study said Google’s system could make screening much more viable.\u003c/p>\n\u003cp>“These people have a technology that will improve the precision of screening tremendously,” said Dr. Otis Brawley, a professor of oncology and epidemiology at Johns Hopkins University and formerly executive vice president of the American Cancer Society. He said he is generally a skeptic of lung cancer screening, but emphasized that Google’s performance in reducing false positives was a significant step forward.\u003c/p>\n\u003cp>“It’s going to prevent more bad things from happening to people who are being screened,” said Brawley, adding that the system’s strong performance in that regard doesn’t necessarily mean it will save more lives from lung cancer.\u003c/p>\n\u003cp>Google’s system will require more rigorous testing — probably a randomized controlled trial — before it could be put into medical practice. The study was limited to patients who had already been treated, so it is impossible to tell whether the system, when used on new patients, will result in more effective care and better outcomes.\u003c/p>\n\u003cp>Google executives acknowledged that point in the study and an accompanying blog post, adding that they are working with clinical partners to further refine and validate the system. “To do a full assessment of this, you have to work with research organizations and run large-scale trials to understand how this technology will work at scale and on broad populations,” said Daniel Tse, a Google product manager who co-authored the study. He added that the company has had pre-submission discussions with the Food and Drug Administration to discuss approval criteria.\u003c/p>\n\u003cp>Google engineers who developed the AI system emphasized that it is not designed to replace radiologists, but to improve their ability to detect nodules and determine if they are dangerous. Existing computer-aided systems separate nodule detection and diagnosis into different tasks. Google’s system performs both functions, honing in on regions of interest within a scan and providing a risk score that indicates whether a given patient’s nodules are cancerous.\u003c/p>\n\u003cp>The system uses \u003ca href=\"https://towardsdatascience.com/simple-introduction-to-convolutional-neural-networks-cdf8d3077bac\" target=\"_blank\" rel=\"noopener\">convolutional neural networks\u003c/a>, a type of AI architecture, to learn the features of malignancy and point out the problematic areas by analyzing three-dimensional CT scans. That task is difficult and time-consuming for radiologists because they cannot examine three-dimensional scans the way a computer can; they must review hundreds of individual slices of the scan to hone in on problems. But the computer can review all the dimensions at once.\u003c/p>\n\u003cp>“We were able to train the [AI models] over the whole scan at a very high resolution,” said Shravya Shetty, a Google engineer and technical lead on the study. “Although radiologists can look at the slices, there are clear advantages to the model here.”\u003c/p>\n\u003cp>The authors reported that the system’s performance remained consistent when it was exposed to patients outside of the NIH dataset on which it was trained. The system reviewed scans of 1,700 patients from Northwestern Memorial HealthCare in Chicago, and produced similar results in classifying nodules and making diagnoses.\u003c/p>\n\u003cp>Experts said the Google software may be particularly useful for general radiologists, who often review patient lung scans in community hospitals in the U.S. Most lack the expertise of thoracic radiologists who specialize in lung disorders and are concentrated at large academic medical centers.\u003c/p>\n\u003cp>“To be able to make screening available to everyone, it can’t just be done by thoracic radiologists. It has to be done by all radiologists,” said Dr. Jorge Gomez, a medical oncologist at Mount Sinai Health System who serves as a national spokesman for the American Lung Association.\u003c/p>\n\u003cp>At Mount Sinai, he said, thoracic radiologists regularly participate in meetings to discuss patient care and point out the specific aspects of scans that indicate why nodules may or may not be malignant.\u003c/p>\n\u003cp>“That’s an incredible resource to have, and computers might be able to do that well,” he said. “This is a very important study that should prompt somebody with very deep pockets to do a randomized trial.”\u003c/p>\n\u003cp>Tse, the Google product manager, said the company is actively pursuing that work. “We are pushing things forward both internally within Google and with our partners,” he said, adding that he could not yet identify the time frame for the follow-up study.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This \u003ca href=\"https://www.statnews.com/2019/05/20/googles-ai-improves-accuracy-of-lung-cancer-diagnosis-study-shows/\">story\u003c/a> was originally published by \u003ca href=\"https://www.statnews.com/\">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>\u003c/span>On Monday, however, Google unveiled an artificial intelligence system that — in early testing — demonstrated a remarkable talent for seeing through lung cancer’s disguises.\u003c/p>\n\u003cp class=\"danger-zone\">A \u003ca href=\"http://track.nature.com/track/click/30195101/www.nature.com?p=eyJzIjoicTBxSFlxcFRWaUltRDVsd2FRSGNRRXJNV3JzIiwidiI6MSwicCI6IntcInVcIjozMDE5NTEwMSxcInZcIjoxLFwidXJsXCI6XCJodHRwczpcXFwvXFxcL3d3dy5uYXR1cmUuY29tXFxcL2FydGljbGVzXFxcL3M0MTU5MS0wMTktMDQ0Ny14XCIsXCJpZFwiOlwiZTU3ZWRiYjZkNzc2NDU3Yjg2OThiMDVkMGM1MzgyYmVcIixcInVybF9pZHNcIjpbXCJkYjkwMzZjZDA4Y2JjNGQ3OTdkODVjYjYyOWE4ZWEyZjE1NTNmMzk3XCJdfSJ9\" target=\"_blank\" rel=\"noopener\">study\u003c/a> published in Nature Medicine reported that the algorithm, trained on 42,000 patient CT scans taken during a National Institutes of Health clinical trial, outperformed six radiologists in determining whether patients had cancer. It detected 5% more cancers and cut false positives — when cancer is suspected though a nodule is harmless — by 11% from reviewing a single scan. It performed on par with the radiologists when prior images of patients were also included in the evaluation.\u003c/p>\n\u003cp class=\"\">The results underscore AI’s potential to improve lung cancer screening and help radiologists diagnose malignancies earlier and with greater accuracy — though the research did not show whether the Google system would help patients live longer. Lung cancer is by far the most common killer of Americans among cancers, resulting in about 160,000 deaths in 2018.\u003c/p>\n\u003cp class=\"\">A large \u003ca href=\"https://www.cancer.gov/types/lung/research/nlst\" target=\"_blank\" rel=\"noopener\">NIH study\u003c/a> — the same one that supplied data for Google’s algorithm — established that screening of high-risk patients such as long-term smokers can reduce the risk of death by about 20%, but it also raised concerns about false positives leading to unnecessary testing that can harm patients. It reported that several deaths resulted from false positives that led patients to undergo invasive biopsies and other procedures. Ongoing concerns about the overall accuracy and benefit of screening have led to low rates of such testing. Meanwhile, about 50 percent of lung cancers are diagnosed after they have already spread, when the disease is harder to effectively treat.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Experts who were not involved in the study said Google’s system could make screening much more viable.\u003c/p>\n\u003cp>“These people have a technology that will improve the precision of screening tremendously,” said Dr. Otis Brawley, a professor of oncology and epidemiology at Johns Hopkins University and formerly executive vice president of the American Cancer Society. He said he is generally a skeptic of lung cancer screening, but emphasized that Google’s performance in reducing false positives was a significant step forward.\u003c/p>\n\u003cp>“It’s going to prevent more bad things from happening to people who are being screened,” said Brawley, adding that the system’s strong performance in that regard doesn’t necessarily mean it will save more lives from lung cancer.\u003c/p>\n\u003cp>Google’s system will require more rigorous testing — probably a randomized controlled trial — before it could be put into medical practice. The study was limited to patients who had already been treated, so it is impossible to tell whether the system, when used on new patients, will result in more effective care and better outcomes.\u003c/p>\n\u003cp>Google executives acknowledged that point in the study and an accompanying blog post, adding that they are working with clinical partners to further refine and validate the system. “To do a full assessment of this, you have to work with research organizations and run large-scale trials to understand how this technology will work at scale and on broad populations,” said Daniel Tse, a Google product manager who co-authored the study. He added that the company has had pre-submission discussions with the Food and Drug Administration to discuss approval criteria.\u003c/p>\n\u003cp>Google engineers who developed the AI system emphasized that it is not designed to replace radiologists, but to improve their ability to detect nodules and determine if they are dangerous. Existing computer-aided systems separate nodule detection and diagnosis into different tasks. Google’s system performs both functions, honing in on regions of interest within a scan and providing a risk score that indicates whether a given patient’s nodules are cancerous.\u003c/p>\n\u003cp>The system uses \u003ca href=\"https://towardsdatascience.com/simple-introduction-to-convolutional-neural-networks-cdf8d3077bac\" target=\"_blank\" rel=\"noopener\">convolutional neural networks\u003c/a>, a type of AI architecture, to learn the features of malignancy and point out the problematic areas by analyzing three-dimensional CT scans. That task is difficult and time-consuming for radiologists because they cannot examine three-dimensional scans the way a computer can; they must review hundreds of individual slices of the scan to hone in on problems. But the computer can review all the dimensions at once.\u003c/p>\n\u003cp>“We were able to train the [AI models] over the whole scan at a very high resolution,” said Shravya Shetty, a Google engineer and technical lead on the study. “Although radiologists can look at the slices, there are clear advantages to the model here.”\u003c/p>\n\u003cp>The authors reported that the system’s performance remained consistent when it was exposed to patients outside of the NIH dataset on which it was trained. The system reviewed scans of 1,700 patients from Northwestern Memorial HealthCare in Chicago, and produced similar results in classifying nodules and making diagnoses.\u003c/p>\n\u003cp>Experts said the Google software may be particularly useful for general radiologists, who often review patient lung scans in community hospitals in the U.S. Most lack the expertise of thoracic radiologists who specialize in lung disorders and are concentrated at large academic medical centers.\u003c/p>\n\u003cp>“To be able to make screening available to everyone, it can’t just be done by thoracic radiologists. It has to be done by all radiologists,” said Dr. Jorge Gomez, a medical oncologist at Mount Sinai Health System who serves as a national spokesman for the American Lung Association.\u003c/p>\n\u003cp>At Mount Sinai, he said, thoracic radiologists regularly participate in meetings to discuss patient care and point out the specific aspects of scans that indicate why nodules may or may not be malignant.\u003c/p>\n\u003cp>“That’s an incredible resource to have, and computers might be able to do that well,” he said. “This is a very important study that should prompt somebody with very deep pockets to do a randomized trial.”\u003c/p>\n\u003cp>Tse, the Google product manager, said the company is actively pursuing that work. “We are pushing things forward both internally within Google and with our partners,” he said, adding that he could not yet identify the time frame for the follow-up study.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>[dl_subscribe]I hate to break this to you, but you almost certainly have tiny mites living in the pores in your face right now.\u003c/p>\n\u003cp>They’re called Demodex. And pretty much every adult human alive has a population of these mites living on them.\u003c/p>\n\u003cp>Also called eyelash mites, they’re too small to see with the naked eye. They’re mostly transparent, and at about .3 millimeters long, it would take about five face adult mites laid end to end to stretch across the head of a pin.\u003c/p>\n\u003cp>“They look like kind of like stubby little worms,” said Michelle Trautwein, an entomologist at the California Academy of Sciences in San Francisco.\u003c/p>\n\u003cp>Trautwein studies our relationship with these microscopic stowaways by looking at their DNA. Her findings so far show that people in different parts of the world have different face mites living in the skin.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“They tell a story of your own ancestry and also a story of more ancient human history and migration,” said Trautwein.\u003c/p>\n\u003cfigure id=\"attachment_1941539\" class=\"wp-caption aligncenter\" style=\"max-width: 500px\">\u003ca href=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2019/05/DL610_FaceMites_MichelleTrautwein_microscope.gif\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-1941539\" src=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2019/05/DL610_FaceMites_MichelleTrautwein_microscope.gif\" alt=\"\" width=\"500\" height=\"281\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Michelle Trautwein of the California Academy of Sciences studies face mites using microscopes and genetic testing. \u003ccite>(Josh Cassidy/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“We use a little spoon and scrape it across the kind of greasier parts of someone’s face — which isn’t as bad as it sounds,” said Trautwein.\u003c/p>\n\u003cp>Once she has collected the samples, she takes them back to the lab to look at the genetics.\u003c/p>\n\u003cp>Trautwein has found DNA evidence of face mites on every one of more than 2,000 people she has tested, including tourists from all around the world who make their way to the California Academy of Sciences.\u003c/p>\n\u003cp>“No one is thrilled at the initial notion that they have arachnids on their face,” Trautwein said. “But people are often curious — even in their revulsion.”\u003c/p>\n\u003cp>But how could these creatures live on so many people and still go unnoticed?\u003c/p>\n\u003cfigure id=\"attachment_1941533\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2019/05/DL610_FaceMites_PeachFuzz_male.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-1941533 size-large\" src=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2019/05/DL610_FaceMites_PeachFuzz_male-1020x574.jpg\" alt=\"\" width=\"640\" height=\"360\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2019/05/DL610_FaceMites_PeachFuzz_male-1020x574.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2019/05/DL610_FaceMites_PeachFuzz_male-160x90.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2019/05/DL610_FaceMites_PeachFuzz_male-800x450.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2019/05/DL610_FaceMites_PeachFuzz_male-768x432.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2019/05/DL610_FaceMites_PeachFuzz_male-1200x675.jpg 1200w, https://cdn.kqed.org/wp-content/uploads/sites/35/2019/05/DL610_FaceMites_PeachFuzz_male-1920x1080.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/35/2019/05/DL610_FaceMites_PeachFuzz_male.jpg 2048w\" sizes=\"auto, (max-width: 640px) 100vw, 640px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Face mites make their home in the follicles found at the root of the peach fuzz that covers most human skin. \u003ccite>(Josh Cassidy/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Look closely and you’ll see that in addition to the more obvious body and head hair, human skin is covered in a thin, barely visible layer of peach fuzz called vellus hairs. There are a few notable exceptions, such as the palms of our hands and soles of our feet, but other than that our entire bodies are covered in that fuzz. The shaft of each one of those tiny hairs grows out of its own follicle.\u003c/p>\n\u003cp>Face mites spend their days face-down inside your hair follicles nestled up against the hair shaft.\u003c/p>\n\u003cp>They eat sebum, that greasy oil your skin makes to protect itself and keep it from drying out. The sebum is produced in sebaceous glands, which empty into the hair follicles, coating both the hair shaft and face mites.\u003c/p>\n\u003cp>That’s why the greasiest parts of your body — like around the eyes, nose and mouth — likely harbor a higher concentration of mites than other areas.\u003c/p>\n\u003cp>They live about two weeks. They spend most of their time tucked inside our pores. But while we’re sleeping, they crawl out onto the surface of our skin to mate before crawling back into our pores to lay their eggs. Fun!\u003c/p>\n\u003cp>Since they live inside your pores, you can’t scrub them off by washing. It’s basically impossible to get rid of all of your face mites.\u003c/p>\n\u003cp>So how does Trautwein study them? With glue.\u003c/p>\n\u003cfigure id=\"attachment_1941540\" class=\"wp-caption aligncenter\" style=\"max-width: 500px\">\u003ca href=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2019/05/DL610_FaceMites_SlideCollection_LindsayPalaima.gif\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-1941540\" src=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2019/05/DL610_FaceMites_SlideCollection_LindsayPalaima.gif\" alt=\"\" width=\"500\" height=\"281\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Lindsay Palaima bravely volunteers to have a slide covered in glue stuck to her forehead in order to capture face mites growing in her pores. \u003ccite>(Josh Cassidy/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“I actually put glue on a glass microscope slide and stick it onto a person’s forehead,” she said. “Then I slowly peel it off. I look under a microscope for mites that are stuck in the follicles that stick up from the thin layer of skin that got peeled off.”\u003c/p>\n\u003cp>“It can be pretty addictive and exciting,” she added. “It’s sort of a meditative process of looking through this microforest of follicles and hairs, and looking for just the right potential movement or shape.”\u003c/p>\n\u003cfigure id=\"attachment_1941538\" class=\"wp-caption aligncenter\" style=\"max-width: 500px\">\u003ca href=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2019/05/DL610_FaceMites_InFollicle.gif\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-1941538 size-full\" src=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2019/05/DL610_FaceMites_InFollicle.gif\" alt=\"\" width=\"500\" height=\"281\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Demodex face mite seen writhing around in the root of a human hair follicle, observed under a microscope. \u003ccite>(Josh Cassidy/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>These Demodex face mites got their name from the Greek words for “fat” and “boring worm,” but they’re not really worms at all. They’re actually arachnids — related to ticks — and more distantly to spiders.\u003c/p>\n\u003cp>Most people have face mites on them and never notice. It seems that our immune system is able to keep their numbers in check. But some people can experience problems with them.\u003c/p>\n\u003cp>“When you tell patients that they have face mites, first of all, they freak out,” said Dr. Kanade Shinkai, a dermatologist at UCSF.\u003c/p>\n\u003cp>Shinkai occasionally treats patients who have an overload of face mites, which results in a condition called demodicosis.\u003c/p>\n\u003cp>“There is a very particular look to people suffering from demodicosis. We call it the Demodex frost,” she said. “It’s sort of a white sheen on the skin. And if you look really closely, you can see coming out of every pore. If you scrape those pores, you can see it frothing with little Demodex face mites.”\u003c/p>\n\u003cp>It’s a pretty rare condition and it’s often connected to a change in someone’s immune system, such as receiving immunosuppressive drugs after transplant surgery, chemotherapy or immunodeficiency diseases like HIV.\u003c/p>\n\u003cp>Demodicosis can also be triggered by local suppression of the immune system, like when itch-relieving hydrocortisone cream is used on the face.\u003c/p>\n\u003cp>When it does happen, demodicosis usually comes on fast.\u003c/p>\n\u003cp>“Patients almost universally describe this explosive development of pustules like whiteheads on their face. It’s really dramatic,” Shinkai said. “And what’s really dramatic about it is that they’re often fine the day before, and then they develop it, overnight.”\u003c/p>\n\u003cp>But for the vast majority of people, face mites are nothing to worry about. While some studies have found loose connections between Demodex and diseases like rosacea, the evidence hasn’t shown a strong link.\u003c/p>\n\u003cp>“What’s really confusing is that if you go into your office and scrape everyone’s face, you would find Demodex probably on everybody,” Shinkai said. “And people who have low burden of Demodex may have no or very severe disease and vice versa.”\u003c/p>\n\u003cp>Trautwein also sees face mites as more of a source of interest than fear.\u003c/p>\n\u003cp>“They’re not dangerous in a broad sense because we all have them and most of us seem to be cohabiting quite well with them,” Trautwein said. “We mostly share them within family units and it seems like you are probably initially colonized soon after birth, most likely by your mother, traditionally speaking in human history.”\u003c/p>\n\u003cp>Looking at these mites, researchers like Trautwein can usually tell something about your geographical ancestry — what part of the world your ancestors came from.\u003c/p>\n\u003cfigure id=\"attachment_1941715\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2019/05/Map_Follic_migration_nonumbers.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-1941715 size-large\" src=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2019/05/Map_Follic_migration_nonumbers-1020x496.jpg\" alt=\"\" width=\"640\" height=\"311\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2019/05/Map_Follic_migration_nonumbers-1020x496.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2019/05/Map_Follic_migration_nonumbers-160x78.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2019/05/Map_Follic_migration_nonumbers-800x389.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2019/05/Map_Follic_migration_nonumbers-768x374.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2019/05/Map_Follic_migration_nonumbers-1200x584.jpg 1200w, https://cdn.kqed.org/wp-content/uploads/sites/35/2019/05/Map_Follic_migration_nonumbers.jpg 1285w\" sizes=\"auto, (max-width: 640px) 100vw, 640px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Michelle Trautwein has found that several genetically distinct groups of Demodex face mites (represented by different colors on this map) exist in different geographic areas. \u003ccite>(Michelle Trautwein/California Academy of Sciences)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“Face mites are definitely the species of animal that we have the closest connection with as humans, even though most of us don’t know about them or ever see one in our lifetime,” she said. “We still have this very ancient and intimate relationship, and it seems clear that we’ve had these face mite species with us for all of our history. So they are as old as our species, as old as homo sapiens.”\u003c/p>\n\n",
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"excerpt": "Yep, you probably have Demodex mites living on your face. These tiny arachnids feast on sebum, the greasy oil in your pores. But should you be worried about your eight-legged guests? ",
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"title": "These Face Mites Really Grow on You | KQED",
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"content": "\u003cdiv class=\"post-body\">\u003cp>I hate to break this to you, but you almost certainly have tiny mites living in the pores in your face right now.\u003c/p>\n\u003cp>They’re called Demodex. And pretty much every adult human alive has a population of these mites living on them.\u003c/p>\n\u003cp>Also called eyelash mites, they’re too small to see with the naked eye. They’re mostly transparent, and at about .3 millimeters long, it would take about five face adult mites laid end to end to stretch across the head of a pin.\u003c/p>\n\u003cp>“They look like kind of like stubby little worms,” said Michelle Trautwein, an entomologist at the California Academy of Sciences in San Francisco.\u003c/p>\n\u003cp>Trautwein studies our relationship with these microscopic stowaways by looking at their DNA. Her findings so far show that people in different parts of the world have different face mites living in the skin.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“They tell a story of your own ancestry and also a story of more ancient human history and migration,” said Trautwein.\u003c/p>\n\u003cfigure id=\"attachment_1941539\" class=\"wp-caption aligncenter\" style=\"max-width: 500px\">\u003ca href=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2019/05/DL610_FaceMites_MichelleTrautwein_microscope.gif\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-1941539\" src=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2019/05/DL610_FaceMites_MichelleTrautwein_microscope.gif\" alt=\"\" width=\"500\" height=\"281\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Michelle Trautwein of the California Academy of Sciences studies face mites using microscopes and genetic testing. \u003ccite>(Josh Cassidy/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“We use a little spoon and scrape it across the kind of greasier parts of someone’s face — which isn’t as bad as it sounds,” said Trautwein.\u003c/p>\n\u003cp>Once she has collected the samples, she takes them back to the lab to look at the genetics.\u003c/p>\n\u003cp>Trautwein has found DNA evidence of face mites on every one of more than 2,000 people she has tested, including tourists from all around the world who make their way to the California Academy of Sciences.\u003c/p>\n\u003cp>“No one is thrilled at the initial notion that they have arachnids on their face,” Trautwein said. “But people are often curious — even in their revulsion.”\u003c/p>\n\u003cp>But how could these creatures live on so many people and still go unnoticed?\u003c/p>\n\u003cfigure id=\"attachment_1941533\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2019/05/DL610_FaceMites_PeachFuzz_male.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-1941533 size-large\" src=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2019/05/DL610_FaceMites_PeachFuzz_male-1020x574.jpg\" alt=\"\" width=\"640\" height=\"360\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2019/05/DL610_FaceMites_PeachFuzz_male-1020x574.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2019/05/DL610_FaceMites_PeachFuzz_male-160x90.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2019/05/DL610_FaceMites_PeachFuzz_male-800x450.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2019/05/DL610_FaceMites_PeachFuzz_male-768x432.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2019/05/DL610_FaceMites_PeachFuzz_male-1200x675.jpg 1200w, https://cdn.kqed.org/wp-content/uploads/sites/35/2019/05/DL610_FaceMites_PeachFuzz_male-1920x1080.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/35/2019/05/DL610_FaceMites_PeachFuzz_male.jpg 2048w\" sizes=\"auto, (max-width: 640px) 100vw, 640px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Face mites make their home in the follicles found at the root of the peach fuzz that covers most human skin. \u003ccite>(Josh Cassidy/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Look closely and you’ll see that in addition to the more obvious body and head hair, human skin is covered in a thin, barely visible layer of peach fuzz called vellus hairs. There are a few notable exceptions, such as the palms of our hands and soles of our feet, but other than that our entire bodies are covered in that fuzz. The shaft of each one of those tiny hairs grows out of its own follicle.\u003c/p>\n\u003cp>Face mites spend their days face-down inside your hair follicles nestled up against the hair shaft.\u003c/p>\n\u003cp>They eat sebum, that greasy oil your skin makes to protect itself and keep it from drying out. The sebum is produced in sebaceous glands, which empty into the hair follicles, coating both the hair shaft and face mites.\u003c/p>\n\u003cp>That’s why the greasiest parts of your body — like around the eyes, nose and mouth — likely harbor a higher concentration of mites than other areas.\u003c/p>\n\u003cp>They live about two weeks. They spend most of their time tucked inside our pores. But while we’re sleeping, they crawl out onto the surface of our skin to mate before crawling back into our pores to lay their eggs. Fun!\u003c/p>\n\u003cp>Since they live inside your pores, you can’t scrub them off by washing. It’s basically impossible to get rid of all of your face mites.\u003c/p>\n\u003cp>So how does Trautwein study them? With glue.\u003c/p>\n\u003cfigure id=\"attachment_1941540\" class=\"wp-caption aligncenter\" style=\"max-width: 500px\">\u003ca href=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2019/05/DL610_FaceMites_SlideCollection_LindsayPalaima.gif\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-1941540\" src=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2019/05/DL610_FaceMites_SlideCollection_LindsayPalaima.gif\" alt=\"\" width=\"500\" height=\"281\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Lindsay Palaima bravely volunteers to have a slide covered in glue stuck to her forehead in order to capture face mites growing in her pores. \u003ccite>(Josh Cassidy/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“I actually put glue on a glass microscope slide and stick it onto a person’s forehead,” she said. “Then I slowly peel it off. I look under a microscope for mites that are stuck in the follicles that stick up from the thin layer of skin that got peeled off.”\u003c/p>\n\u003cp>“It can be pretty addictive and exciting,” she added. “It’s sort of a meditative process of looking through this microforest of follicles and hairs, and looking for just the right potential movement or shape.”\u003c/p>\n\u003cfigure id=\"attachment_1941538\" class=\"wp-caption aligncenter\" style=\"max-width: 500px\">\u003ca href=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2019/05/DL610_FaceMites_InFollicle.gif\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-1941538 size-full\" src=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2019/05/DL610_FaceMites_InFollicle.gif\" alt=\"\" width=\"500\" height=\"281\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Demodex face mite seen writhing around in the root of a human hair follicle, observed under a microscope. \u003ccite>(Josh Cassidy/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>These Demodex face mites got their name from the Greek words for “fat” and “boring worm,” but they’re not really worms at all. They’re actually arachnids — related to ticks — and more distantly to spiders.\u003c/p>\n\u003cp>Most people have face mites on them and never notice. It seems that our immune system is able to keep their numbers in check. But some people can experience problems with them.\u003c/p>\n\u003cp>“When you tell patients that they have face mites, first of all, they freak out,” said Dr. Kanade Shinkai, a dermatologist at UCSF.\u003c/p>\n\u003cp>Shinkai occasionally treats patients who have an overload of face mites, which results in a condition called demodicosis.\u003c/p>\n\u003cp>“There is a very particular look to people suffering from demodicosis. We call it the Demodex frost,” she said. “It’s sort of a white sheen on the skin. And if you look really closely, you can see coming out of every pore. If you scrape those pores, you can see it frothing with little Demodex face mites.”\u003c/p>\n\u003cp>It’s a pretty rare condition and it’s often connected to a change in someone’s immune system, such as receiving immunosuppressive drugs after transplant surgery, chemotherapy or immunodeficiency diseases like HIV.\u003c/p>\n\u003cp>Demodicosis can also be triggered by local suppression of the immune system, like when itch-relieving hydrocortisone cream is used on the face.\u003c/p>\n\u003cp>When it does happen, demodicosis usually comes on fast.\u003c/p>\n\u003cp>“Patients almost universally describe this explosive development of pustules like whiteheads on their face. It’s really dramatic,” Shinkai said. “And what’s really dramatic about it is that they’re often fine the day before, and then they develop it, overnight.”\u003c/p>\n\u003cp>But for the vast majority of people, face mites are nothing to worry about. 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"info": "A one-hour radio program to hear celebrated writers, artists and thinkers address contemporary ideas and values, often discussing the creative process. Please note: tapes or transcripts are not available",
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"airtime": "SUN 1pm-2pm, TUE 10pm, WED 1am",
"meta": {
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"source": "City Arts & Lectures"
},
"link": "https://www.cityarts.net",
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}
},
"closealltabs": {
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"order": 1
},
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"title": "Code Switch / Life Kit",
"info": "\u003cem>Code Switch\u003c/em>, which listeners will hear in the first part of the hour, has fearless and much-needed conversations about race. Hosted by journalists of color, the show tackles the subject of race head-on, exploring how it impacts every part of society — from politics and pop culture to history, sports and more.\u003cbr />\u003cbr />\u003cem>Life Kit\u003c/em>, which will be in the second part of the hour, guides you through spaces and feelings no one prepares you for — from finances to mental health, from workplace microaggressions to imposter syndrome, from relationships to parenting. The show features experts with real world experience and shares their knowledge. Because everyone needs a little help being human.\u003cbr />\u003cbr />\u003ca href=\"https://www.npr.org/podcasts/510312/codeswitch\">\u003cem>Code Switch\u003c/em> offical site and podcast\u003c/a>\u003cbr />\u003ca href=\"https://www.npr.org/lifekit\">\u003cem>Life Kit\u003c/em> offical site and podcast\u003c/a>\u003cbr />",
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"id": "commonwealth-club",
"title": "Commonwealth Club of California Podcast",
"info": "The Commonwealth Club of California is the nation's oldest and largest public affairs forum. As a non-partisan forum, The Club brings to the public airwaves diverse viewpoints on important topics. The Club's weekly radio broadcast - the oldest in the U.S., dating back to 1924 - is carried across the nation on public radio stations and is now podcasting. Our website archive features audio of our recent programs, as well as selected speeches from our long and distinguished history. This podcast feed is usually updated twice a week and is always un-edited.",
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"source": "Commonwealth Club of California"
},
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"google": "https://podcasts.google.com/feed/aHR0cDovL3d3dy5jb21tb253ZWFsdGhjbHViLm9yZy9hdWRpby9wb2RjYXN0L3dlZWtseS54bWw",
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"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Forum-Podcast-Tile-703x703-1.jpg",
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"order": 9
},
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM5NTU3MzgxNjMz",
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"meta": {
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"source": "WNYC"
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"apple": "https://itunes.apple.com/us/podcast/freakonomics-radio/id354668519",
"tuneIn": "https://tunein.com/podcasts/WNYC-Podcasts/Freakonomics-Radio-p272293/",
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},
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"id": "fresh-air",
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"apple": "https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=214089682&at=11l79Y&ct=nprdirectory",
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"info": "A live production of NPR and WBUR Boston, in collaboration with stations across the country, Here & Now reflects the fluid world of news as it's happening in the middle of the day, with timely, in-depth news, interviews and conversation. Hosted by Robin Young, Jeremy Hobson and Tonya Mosley.",
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"hidden-brain": {
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"info": "Shankar Vedantam uses science and storytelling to reveal the unconscious patterns that drive human behavior, shape our choices and direct our relationships.",
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"airtime": "SUN 7pm-8pm",
"meta": {
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"source": "NPR"
},
"link": "/radio/program/hidden-brain",
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"how-i-built-this": {
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"title": "How I Built This with Guy Raz",
"info": "Guy Raz dives into the stories behind some of the world's best known companies. How I Built This weaves a narrative journey about innovators, entrepreneurs and idealists—and the movements they built.",
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"airtime": "SUN 7:30pm-8pm",
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"link": "/radio/program/how-i-built-this",
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"apple": "https://itunes.apple.com/us/podcast/how-i-built-this-with-guy-raz/id1150510297?mt=2",
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"hyphenacion": {
"id": "hyphenacion",
"title": "Hyphenación",
"tagline": "Where conversation and cultura meet",
"info": "What kind of no sabo word is Hyphenación? For us, it’s about living within a hyphenation. Like being a third-gen Mexican-American from the Texas border now living that Bay Area Chicano life. Like Xorje! Each week we bring together a couple of hyphenated Latinos to talk all about personal life choices: family, careers, relationships, belonging … everything is on the table. ",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2025/03/Hyphenacion_FinalAssets_PodcastTile.png",
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"order": 15
},
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"spotify": "https://open.spotify.com/show/2p3Fifq96nw9BPcmFdIq0o?si=39209f7b25774f38",
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},
"jerrybrown": {
"id": "jerrybrown",
"title": "The Political Mind of Jerry Brown",
"tagline": "Lessons from a lifetime in politics",
"info": "The Political Mind of Jerry Brown brings listeners the wisdom of the former Governor, Mayor, and presidential candidate. Scott Shafer interviewed Brown for more than 40 hours, covering the former governor's life and half-century in the political game and Brown has some lessons he'd like to share. ",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/The-Political-Mind-of-Jerry-Brown-Podcast-Tile-703x703-1.jpg",
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"officialWebsiteLink": "/podcasts/jerrybrown",
"meta": {
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"order": 18
},
"link": "/podcasts/jerrybrown",
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},
"latino-usa": {
"id": "latino-usa",
"title": "Latino USA",
"airtime": "MON 1am-2am, SUN 6pm-7pm",
"info": "Latino USA, the radio journal of news and culture, is the only national, English-language radio program produced from a Latino perspective.",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/latinoUsa.jpg",
"officialWebsiteLink": "http://latinousa.org/",
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},
"link": "/radio/program/latino-usa",
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"apple": "https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=79681317&at=11l79Y&ct=nprdirectory",
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"rss": "https://feeds.npr.org/510016/podcast.xml"
}
},
"marketplace": {
"id": "marketplace",
"title": "Marketplace",
"info": "Our flagship program, helmed by Kai Ryssdal, examines what the day in money delivered, through stories, conversations, newsworthy numbers and more. Updated Monday through Friday at about 3:30 p.m. PT.",
"airtime": "MON-FRI 4pm-4:30pm, MON-WED 6:30pm-7pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Marketplace-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.marketplace.org/",
"meta": {
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"source": "American Public Media"
},
"link": "/radio/program/marketplace",
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},
"masters-of-scale": {
"id": "masters-of-scale",
"title": "Masters of Scale",
"info": "Masters of Scale is an original podcast in which LinkedIn co-founder and Greylock Partner Reid Hoffman sets out to describe and prove theories that explain how great entrepreneurs take their companies from zero to a gazillion in ingenious fashion.",
"airtime": "Every other Wednesday June 12 through October 16 at 8pm (repeats Thursdays at 2am)",
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"meta": {
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"rss": "https://rss.art19.com/masters-of-scale"
}
},
"mindshift": {
"id": "mindshift",
"title": "MindShift",
"tagline": "A podcast about the future of learning and how we raise our kids",
"info": "The MindShift podcast explores the innovations in education that are shaping how kids learn. Hosts Ki Sung and Katrina Schwartz introduce listeners to educators, researchers, parents and students who are developing effective ways to improve how kids learn. We cover topics like how fed-up administrators are developing surprising tactics to deal with classroom disruptions; how listening to podcasts are helping kids develop reading skills; the consequences of overparenting; and why interdisciplinary learning can engage students on all ends of the traditional achievement spectrum. This podcast is part of the MindShift education site, a division of KQED News. KQED is an NPR/PBS member station based in San Francisco. You can also visit the MindShift website for episodes and supplemental blog posts or tweet us \u003ca href=\"https://twitter.com/MindShiftKQED\">@MindShiftKQED\u003c/a> or visit us at \u003ca href=\"/mindshift\">MindShift.KQED.org\u003c/a>",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Mindshift-Podcast-Tile-703x703-1.jpg",
"imageAlt": "KQED MindShift: How We Will Learn",
"officialWebsiteLink": "/mindshift/",
"meta": {
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"source": "kqed",
"order": 12
},
"link": "/podcasts/mindshift",
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM1NzY0NjAwNDI5",
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}
},
"morning-edition": {
"id": "morning-edition",
"title": "Morning Edition",
"info": "\u003cem>Morning Edition\u003c/em> takes listeners around the country and the world with multi-faceted stories and commentaries every weekday. Hosts Steve Inskeep, David Greene and Rachel Martin bring you the latest breaking news and features to prepare you for the day.",
"airtime": "MON-FRI 3am-9am",
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"onourwatch": {
"id": "onourwatch",
"title": "On Our Watch",
"tagline": "Deeply-reported investigative journalism",
"info": "For decades, the process for how police police themselves has been inconsistent – if not opaque. In some states, like California, these proceedings were completely hidden. After a new police transparency law unsealed scores of internal affairs files, our reporters set out to examine these cases and the shadow world of police discipline. On Our Watch brings listeners into the rooms where officers are questioned and witnesses are interrogated to find out who this system is really protecting. Is it the officers, or the public they've sworn to serve?",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/On-Our-Watch-Podcast-Tile-703x703-1.jpg",
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"officialWebsiteLink": "/podcasts/onourwatch",
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"source": "kqed",
"order": 11
},
"link": "/podcasts/onourwatch",
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5ucHIub3JnLzUxMDM2MC9wb2RjYXN0LnhtbD9zYz1nb29nbGVwb2RjYXN0cw",
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},
"on-the-media": {
"id": "on-the-media",
"title": "On The Media",
"info": "Our weekly podcast explores how the media 'sausage' is made, casts an incisive eye on fluctuations in the marketplace of ideas, and examines threats to the freedom of information and expression in America and abroad. For one hour a week, the show tries to lift the veil from the process of \"making media,\" especially news media, because it's through that lens that we see the world and the world sees us",
"airtime": "SUN 2pm-3pm, MON 12am-1am",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/onTheMedia.png",
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"meta": {
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"source": "wnyc"
},
"link": "/radio/program/on-the-media",
"subscribe": {
"apple": "https://itunes.apple.com/us/podcast/on-the-media/id73330715?mt=2",
"tuneIn": "https://tunein.com/radio/On-the-Media-p69/",
"rss": "http://feeds.wnyc.org/onthemedia"
}
},
"pbs-newshour": {
"id": "pbs-newshour",
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"info": "Analysis, background reports and updates from the PBS NewsHour putting today's news in context.",
"airtime": "MON-FRI 3pm-4pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/PBS-News-Hour-Podcast-Tile-360x360-1.jpg",
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},
"link": "/radio/program/pbs-newshour",
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"apple": "https://itunes.apple.com/us/podcast/pbs-newshour-full-show/id394432287?mt=2",
"tuneIn": "https://tunein.com/radio/PBS-NewsHour---Full-Show-p425698/",
"rss": "https://www.pbs.org/newshour/feeds/rss/podcasts/show"
}
},
"perspectives": {
"id": "perspectives",
"title": "Perspectives",
"tagline": "KQED's series of daily listener commentaries since 1991",
"info": "KQED's series of daily listener commentaries since 1991.",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2025/01/Perspectives_Tile_Final.jpg",
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"officialWebsiteLink": "/perspectives/",
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"order": 14
},
"link": "/perspectives",
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