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Javier E

Functional medicine: Is it the future of healthcare or just another wellness trend? - I... - 0 views

  • Functional Medicine is the alternative medicine Bill Clinton credits with giving him his life back after his 2004 quadruple heart by-pass surgery. Its ideology is embraced by Oprah and regularly features on Gwyneth Paltrow's Goop.
  • Developed in 1990 by Dr Jeffrey Bland, who in 1991 set up the Institute of Functional Medicine with his wife Susan, today the field is spearheaded by US best-selling author Dr Mark Hyman, adviser to the Clintons and co-director of the controversial Cleveland Clinic for Functional Medicine.
  • "Functional Medicine is not about a test or a supplement or a particular protocol," he adds. "It's really a new paradigm of disease and how it arises and how to restore health. Within it there are many approaches that are effective, it's not exclusive, it doesn't exclude traditional medications, it includes all modalities depending on what's right for that patient."
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  • Functional Medicine isn't a protected title and a medical qualification isn't a prerequisite to practice. The result is an unregulated and disparate field, with medical doctors, nutritionists, naturopaths and homeopaths among the many practitioners.
  • Some other chronic illnesses the field claims to treat include heart disease, type 2 diabetes, irritable bowel syndrome, ulcerative colitis, depression, anxiety and arthritis
  • ll kinds of different reasons, some might have gluten issues, gut issues, others might have a deficiency causing neurological issues, MS is a symptom."
  • "There are components of Functional Medicine that absolutely lack an evidence base and there are practitioners of what they call Functional Medicine, they charge people for intravenous nutritional injections, they exaggerate claims, and that is professionally inappropriate, unethical and it lacks evidence.
  • On Dr Mark Hyman's view of MS he says, "there are a lot of terms put together there, all of which individually make a lot of sense, but put together in that way they do not.
  • "What does FM actually mean? It means nothing. It's a gift-gallop of words thrown together. It's criticised by advocates of evidence-based medicine because it's giving a veneer of scientific legitimacy to ideas that are considered pseudoscientific. For example, it'll take alternative medicine modalities like homeopathy and then call them 'bio-infusions' or something similar, rebranding it as something that works.
  • "It's a redundant name, real medicine is functional."
  • Next month the third annual Lifestyle and Functional Medical conference will take place in Salthill, Galway on November 3. Last year's event was attended by more than 500 people and featured a keynote address by honorary consultant cardiologist Dr Aseem Malhotra, author of bestselling The Pioppi Diet (which was named one of the top five worst celebrity diets to avoid in 2018 by the British Dietetic Foundation).
  • Dr David Robert Grimes is physicist and visiting fellow of Oxford and QUB. His research into cancer focuses on modelling tumour metabolism and radiation interactions. For Dr Grimes, the lack of definition, or "double-speak" as he puts it, in FM is troubling.
  • As well as the cost of appointments, FM practitioners commonly charge extra for tests. An omega finger prick test is around €100. A vitamin D test can cost upwards of €60, full thyroid panel more than €150 and a gut function test €400. Prices vary between practitioners.
  • "If I, as a GP, engaged in some of these behaviours I would be struck off." Specifically? "If I was recommending treatments that lacked an evidence base, or if I was promoting diagnostic tests which are expensive and lack an evidence base.
  • GPs engage every year in ongoing continuous professional development, I spend my evenings and my weekends outside of working hours attending educational events, small-group learning, large-group learning, engaging in research. This is an accusation that was levelled at the profession 30 years ago and then it was correct, but the profession has caught up…
  • "Obviously promoting wellness and healthy diet is very welcome but going beyond that and stating that certain aspects of 'functional medicine' can lead to reduced inflammation or prevent cancer, we have to be very careful about those claims.
  • Often the outcome of such tests are seemingly 'benign' prescriptions of vitamins or cleanses. However, dietitian Orla Walsh stresses that even these can have potentially harmful effects, especially on "vulnerable" patients, if not prescribed judiciously.
  • FM has five basic principles. 1. We are all genetically and biochemically unique so it treats the individual, not the disease. 2. It's science-based. 3. The body is intelligent and has the capacity for self-regulation. 4. The body has the ability to heal and prevent nearly all the diseases of ageing. 5. Health is not just the absence of disease, but a state of immense vitality.
  • She began her Functional Medicine career while training as a medical doctor and now travels the world working with high-profile clients. Dr McHale charges €425 for an initial consultation and €175 for follow-up appointments. Straightforward lab tests are €250 to €750, for complex cases testing fees can be up to €2,000.
  • "The term [Functional Medicine] tends to be bandied around quite a bit. Other things people say, such as 'functional nutritionist', can be misleading as a term. Many people are Functional Medicine practitioners but don't have any real medical background at all... I think regulation is always probably the best way forward."
  • "There's an awful lot to it in terms of biochemistry and physiology," she says. "You do need to have a very solid and well ingrained bio-chemistry background. A solely clinical background doesn't equip you with the knowledge to read a test.
  • "Evidence-base is the cornerstone of medicine and that has to be maintained. It becomes problematic in this area because you are looking at personalised medicine and that can be very difficult to evidence-base."
  • GP Christine Ritter travelled from England to attend the Galway conference last year with a view to integrating Functional Medicine into her practice.
  • "It was very motivating," she says. "Where it wasn't perhaps as strong was to find the evidence. The Functional Medicine people would say, 'we've done this study and this trial and we've used this supplement that was successful', but they can't show massive research data which might make it difficult to bring it into the mainstream.
  • "I also know the rigorous standard of trials we have in medicine they're not usually that great either, it's often driven by who's behind the trial and who's paying for it.
  • "Every approach that empowers patient to work on their destiny [is beneficial], but you'd have to be mindful that you're not missing any serious conditions."
  • Dr Hyman is working to grow the evidence-base for Functional Medicine worldwide. "The future is looking very bright," he says. "At the Cleveland Centre we're establishing a research base, building educational platforms, fellowships, residency programmes, rotations. We're advancing the field that's spreading across the world. We're seeing in China the development of a programme of Functional Medicine, South Africa, the UK, in London the Cleveland Clinic will hopefully have a Functional Medicine centre."
  • For Dr Mark Murphy regulation is a moot point as it can only apply once the field meets the standards of evidence-based medicine.
  • "Despite well intentioned calls for regulation, complementary and alternative medical therapies cannot be regulated," he says. "Only therapies that possess an evidence-base can enter our standard regulatory processes, including the Irish Medical Council, the Health Products Regulatory Authority and Irish advertising standards. In situations where complementary and alternative therapies develop an evidence base, they are no longer 'complementary and alternative', but in effect they become part of mainstream 'Medicine'.
  • l What are the principles?
  • "There's a huge variation between therapists, some are brilliant and some are okay, and some are ludicrous snake oil salesmen."
  • He is so concerned that patients' health and wealth are being put at risk by alternative therapies that earlier this year he joined Fine Gael TD Kate O'Connell and the Irish Cancer Society in introducing draft legislation earlier this year making it illegal to sell unproven treatments to cancer patients. Violators face jail and heavy fines.
  • Dr Grimes says criticism of variations in the standards of traditional medical research can be fair, however due to the weight of research it is ultimately self-correcting. He adds, "The reality is that good trials are transparent, independent and pre-registered.
  • "My involvement in shaping the Bill came from seeing first-hand the exploitation of patients and their families. Most patients undergoing treatment will take some alternative modalities in conjunction but a significant portion are talked out of their conventional medicine and seduced by false promises
sissij

There Is No Such Thing as Alternative Medicine | Big Think - 1 views

  • Unfortunately for Hahnemann his philosophy—the less of an active ingredient remains the more powerful a remedy is (once you reach 13c on the homeopathic scale there is no longer any active ingredient left)—is nonsense.
  • This does not stop the irrational stream of unproven (or disproven) therapies arising from the holistic and wellness sphere.
  • Distrust in one doctor should not imply blind faith in another.
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  • Yet a growing suspicion of corporate and political interests in the sixties inspired a new wave of holism that’s gaining strength a half-century later. We’re right to be wary of corporate agendas and political mismanagement when it comes to healthcare.
  • The reality is the most basic advice—move often and diversely; eat a balanced, whole foods diet—is boring in an age of immediate gratification.
  • The alternative is suffering, something many companies and hucksters willfully champion at a time when we can all use less of it.
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    People have been searching for more powerful and more efficient medicines. All sorts of weird ideas pop up as people try out different possibilities. Although people believe in science today, they are still willing to try out different things. Alternative medicine is where people like to spend their money on. When it comes to health, people are likely to be superstitious. Many people don't go to the doctors until the last minute. They tends to rely more on their own senses and perception when it comes to their life. I think it's because going to doctor is like trusting another person with your life, which is very hard for people. Seeking for alternative medicine give people a feeling that they can avoid the doctors. Like the medicine of eternity back in time, the alternative medicine today uses the same flaws in our reasoning. --Sissi (2/28/2017)
Emily Horwitz

Analysis: Entering the age of the $1 million medicine | Reuters - 0 views

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    An interesting article about a new (and expensive!) gene therapy drug for an extremely small portion of the world's population. It reminded me of our discussions of utilitarianism during Jr. year TOK, in that insurance companies are not willing to cover the costs of certain medicines, because they will only benefit a small number of people. Instead, these companies prefer to cover the majority of people, to ensure their profit and their clients' benefit.
Javier E

The Atheist's Belief In Medicine « The Dish - 1 views

  • Hitchens’s beliefs about his advanced cancer and its treatment were, for a man whose fame rested on his scepticism, uncharacteristically optimistic. I hesitate to use the word delusional, as he admitted that he would be very lucky to survive, but he clearly steadfastly hoped, right to the end, that his particular case of advanced cancer might lie on the sparsely populated right side of the bell-shaped curve of outcome statistics.
  • I wonder if all that medicine – which was, in fact, a form of poison – was worth it. David got ten more years, and two young children. But he also endured a disfiguring, disabling, brutal physical battering from the surgeries and chemo-sessions that tackling a tough brain tumor allow for. I say “allow for” because “required” is not the right word. What the chemo did to Christopher was beyond description – and what’s left of your body, even if the chemo works, can be extremely vulnerable to infections and diseases that can be worse than the cancer.
  • It seems odder to me for Christians to be as exercized by life-extension as the atheist. Put that down to the strange extremism of Ratzinger’s innovations on the question of “life”.
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  • our culture’s gradual alienation from the fact of our deaths – our distancing ourselves even from the old and infirm in ways previous cultures didn’t and couldn’t – is not, in my view a healthy thing.
  • No one should seek to die or give in to a disease they can legitimately fight. God knows how many pills I take a day to keep the virus – and all its and their side-effects at bay. But I get to live healthily and meaningfully. The way some elaborate and cutting edge treatments all but kill the patient in order to save her troubles me. It’s a loss of perspective as well as immensely expensive for the entire system.
  • these sophisticated treatments are taking healthcare money away from the young, taking up more and more of our collective healthcare resources, and extending lives only be perpetuating continuous agony and nausea and pain for the patient and devastating consequences for families and friends.
  • We will all die. We should not seek it. But we should not flee from it for ever.
  • at some point what seems to me to matter more is not the length of our lives but the content of them and the manner of our deaths.
  • At some point, medicine is a function of a social disease of modernity: the flight from our own mortality. But fleeing it does not defuse it. Only facing it does.
Javier E

Editor of JAMA Leaves After Outcry Over Colleague's Remarks on Racism - The New York Times - 1 views

  • Following an outcry over comments about racism made by an editor at JAMA, the influential medical journal, the top editor, Dr. Howard Bauchner, will step down from his post effective June 30.
  • The move was announced on Tuesday by the American Medical Association, which oversees the journal. Dr. Bauchner, who had led JAMA since 2011, had been on administrative leave since March because of an ongoing investigation into comments made on the journal’s podcast.
  • Dr. Edward Livingston, another editor at JAMA, had claimed that socioeconomic factors, not structural racism, held back communities of color. A tweet promoting the podcast had said that no physician could be racist. It was later deleted.
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  • Last month, the A.M.A.’s leaders admitted to serious missteps and proposed a three-year plan to “dismantle structural racism” within the organization and in medicine. The announcement on Tuesday did not mention the status of the investigation at JAMA. The journal declined further comment.
  • “This is a real moment for JAMA and the A.M.A. to recreate themselves from a founding history that was based in segregation and racism to one that is now based on racial equity,” said Dr. Stella Safo, a Black primary care physicia
  • Dr. Safo and her colleagues started a petition, now signed by more than 9,000 people, that had called on JAMA to restructure its staff and hold a series of town hall conversations about racism in medicine. “I think that this is a step in the right direction,” she said of the announcement.
  • “In the entire history of all the JAMA network journals, there’s only been one non-white editor,” noted Dr. Raymond Givens, a cardiologist at Columbia University in New York. I
margogramiak

Compound from medicinal herb kills brain-eating amoebae in lab studies -- ScienceDaily - 0 views

  • Primary amoebic meningoencephalitis (PAM), a deadly disease caused by the "brain-eating amoeba" Naegleria fowleri, is becoming more common in some areas of the world, and it has no effective treatment.
  • Primary amoebic meningoencephalitis (PAM), a deadly disease caused by the "brain-eating amoeba" Naegleria fowleri, is becoming more common in some areas of the world, and it has no effective treatment.
    • margogramiak
       
      Wow, that's scary.
  • Inula viscosa or "false yellowhead," kills the amoebae by causing them to commit cell suicide in lab studies, which could lead to new treatments.
    • margogramiak
       
      Nature based medicine is so interesting to me.
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  • Although the disease, which is usually contracted by swimming in contaminated freshwater, is rare, increasing cases have been reported recently in the U.S., the Philippines, southern Brazil and some Asian countries.
    • margogramiak
       
      That's terrifying. I wonder how something like that spreads effectively.
  • traditional medicine in the Mediterranean region, could effectively treat PAM.
    • margogramiak
       
      Traditional medicine is trusty!
  • Then, they isolated and tested specific compounds from the extract. The most potent compound, inuloxin A, killed amoebae in the lab by disrupting membranes and causing mitochondrial changes, chromatin condensation and oxidative damage, ultimately forcing the parasites to undergo programmed cell death, or apoptosis.
    • margogramiak
       
      We've studied concepts similar to this one in biology. Very interesting stuff!
  • Although inuloxin A was much less potent than amphotericin B in the lab, the structure of the plant-derived compound suggests that it might be better able to cross the blood-brain barrier. More studies are needed to confirm this hypothesis, the researchers say.
    • margogramiak
       
      It's pretty cool that this disease is still considered rare, and we're already figuring out how to fix it.
Javier E

Opinion | For the F.D.A., Cold Medicine That Doesn't Work Is Just the Tip of the Iceber... - 0 views

  • Congress needs to develop a way of better funding the F.D.A. review process. Perhaps a small excise tax could be levied on over-the-counter sales or fees assessed to makers of over-the-counter drugs to fund the F.D.A. review process or to fund studies into drugs that went on the market before 1962. Leaders need to suggest more options. There should also be a way to prioritize which drugs to look at first. The agency should review old drugs for which there are already many complaints about lack of effectiveness in the manner it did recently for phenylephrine.
  • Right now, Americans spend billions on drugs that contain ingredients that will not help them. That’s not just a waste of money — it could mean they are delaying appropriate treatment, which can lead to more severe illnesses. This is risky not only for health but also for trust. The American public deserves medicines that do what they are advertised to do.
Javier E

The Dangers of Pseudoscience - NYTimes.com - 0 views

  • the “demarcation problem,” the issue of what separates good science from bad science and pseudoscience (and everything in between). The problem is relevant for at least three reasons.
  • The first is philosophical: Demarcation is crucial to our pursuit of knowledge; its issues go to the core of debates on epistemology and of the nature of truth and discovery.
  • The second reason is civic: our society spends billions of tax dollars on scientific research, so it is important that we also have a good grasp of what constitutes money well spent in this regard.
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  • Third, as an ethical matter, pseudoscience is not — contrary to popular belief — merely a harmless pastime of the gullible; it often threatens people’s welfare,
  • It is precisely in the area of medical treatments that the science-pseudoscience divide is most critical, and where the role of philosophers in clarifying things may be most relevant.
  • some traditional Chinese remedies (like drinking fresh turtle blood to alleviate cold symptoms) may in fact work
  • There is no question that some folk remedies do work. The active ingredient of aspirin, for example, is derived from willow bark, which had been known to have beneficial effects since the time of Hippocrates. There is also no mystery about how this happens: people have more or less randomly tried solutions to their health problems for millennia, sometimes stumbling upon something useful
  • What makes the use of aspirin “scientific,” however, is that we have validated its effectiveness through properly controlled trials, isolated the active ingredient, and understood the biochemical pathways through which it has its effects
  • In terms of empirical results, there are strong indications that acupuncture is effective for reducing chronic pain and nausea, but sham therapy, where needles are applied at random places, or are not even pierced through the skin, turn out to be equally effective (see for instance this recent study on the effect of acupuncture on post-chemotherapy chronic fatigue), thus seriously undermining talk of meridians and Qi lines
  • Asma at one point compares the current inaccessibility of Qi energy to the previous (until this year) inaccessibility of the famous Higgs boson,
  • But the analogy does not hold. The existence of the Higgs had been predicted on the basis of a very successful physical theory known as the Standard Model. This theory is not only exceedingly mathematically sophisticated, but it has been verified experimentally over and over again. The notion of Qi, again, is not really a theory in any meaningful sense of the word. It is just an evocative word to label a mysterious force
  • Philosophers of science have long recognized that there is nothing wrong with positing unobservable entities per se, it’s a question of what work such entities actually do within a given theoretical-empirical framework. Qi and meridians don’t seem to do any, and that doesn’t seem to bother supporters and practitioners of Chinese medicine. But it ought to.
  • what’s the harm in believing in Qi and related notions, if in fact the proposed remedies seem to help?
  • we can incorporate whatever serendipitous discoveries from folk medicine into modern scientific practice, as in the case of the willow bark turned aspirin. In this sense, there is no such thing as “alternative” medicine, there’s only stuff that works and stuff that doesn’t.
  • Second, if we are positing Qi and similar concepts, we are attempting to provide explanations for why some things work and others don’t. If these explanations are wrong, or unfounded as in the case of vacuous concepts like Qi, then we ought to correct or abandon them.
  • pseudo-medical treatments often do not work, or are even positively harmful. If you take folk herbal “remedies,” for instance, while your body is fighting a serious infection, you may suffer severe, even fatal, consequences.
  • Indulging in a bit of pseudoscience in some instances may be relatively innocuous, but the problem is that doing so lowers your defenses against more dangerous delusions that are based on similar confusions and fallacies. For instance, you may expose yourself and your loved ones to harm because your pseudoscientific proclivities lead you to accept notions that have been scientifically disproved, like the increasingly (and worryingly) popular idea that vaccines cause autism.
  • Philosophers nowadays recognize that there is no sharp line dividing sense from nonsense, and moreover that doctrines starting out in one camp may over time evolve into the other. For example, alchemy was a (somewhat) legitimate science in the times of Newton and Boyle, but it is now firmly pseudoscientific (movements in the opposite direction, from full-blown pseudoscience to genuine science, are notably rare).
  • The verdict by philosopher Larry Laudan, echoed by Asma, that the demarcation problem is dead and buried, is not shared by most contemporary philosophers who have studied the subject.
  • the criterion of falsifiability, for example, is still a useful benchmark for distinguishing science and pseudoscience, as a first approximation. Asma’s own counterexample inadvertently shows this: the “cleverness” of astrologers in cherry-picking what counts as a confirmation of their theory, is hardly a problem for the criterion of falsifiability, but rather a nice illustration of Popper’s basic insight: the bad habit of creative fudging and finagling with empirical data ultimately makes a theory impervious to refutation. And all pseudoscientists do it, from parapsychologists to creationists and 9/11 Truthers.
  • The borderlines between genuine science and pseudoscience may be fuzzy, but this should be even more of a call for careful distinctions, based on systematic facts and sound reasoning. To try a modicum of turtle blood here and a little aspirin there is not the hallmark of wisdom and even-mindedness. It is a dangerous gateway to superstition and irrationality.
Javier E

A Place For Placebos « The Dish - 0 views

  • there’s virtually no scientific evidence that alternative medicine (anything from chiropractic care to acupuncture) has any curative benefit beyond a placebo effect. … However, there is one area where alternative medicine often trumps traditional medicine: stress reduction. And stress reduction can, of course, make a huge impact on people’s health. …
  • Maybe each of these activities (listening to high end audio gear, drinking high end wine, having needles inserted into your chakras) is really about ritualizing a sensory experience. By putting on headphones you know are high quality, or drinking expensive wine, or entering the chiropractor’s office, you are telling yourself, “I am going to focus on this moment. I am going to savor this.” It’s the act of savoring, rather than the savoring tool, that results in both happiness and a longer life.
johnsonma23

BBC News - Antibiotics: US discovery labelled 'game-changer' for medicine - 0 views

  • Antibiotics: US discovery labelled 'game-changer' for medicine
  • The decades-long drought in antibiotic discovery could be over after a breakthrough by US scientists.
  • ielded 25 new antibiotics, with one deemed "very promising".
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  • The researchers, at the Northeastern University in Boston, Massachusetts, turned to the source of nearly all antibiotics - soil.
  • It allowed the unique chemistry of soil to permeate the room, but kept the bacteria in place for study.
  • The scientists involved believe they can grow nearly half of all soil bacteria.
  • uncultured bacteria do harbour novel chemistry that we have not seen before. That is a promising source of new antimicrobials and will hopefully help revive the field of antibiotic discovery."
  • The researchers also believe that bacteria are unlikely to develop resistance to teixobactin.
  • There are limits to the discovery of the antibiotic teixobactin, which has yet to be tested in people.
Javier E

The Politics of Fraudulent Dietary Supplements - NYTimes.com - 0 views

  • One pill makes you smarter. One pill makes you thin. One pill makes you happy. Another keeps you energized. And so what if tests conducted by scientists in New York and Canada have found that the substances behind these miracle enhancements may contain nothing more than powdered rice or houseplants. If enough people believe they’ll be healthier, well, it’s a nice racket.
  • Nice, to the tune of $13 billion a year in sales. And here in Utah, which is to the dietary supplement business what Northern California is to marijuana, a huge industry has taken hold,
  • To understand how we got here, you have to go back to 1994, when Senator Orrin G. Hatch of Utah midwifed through Congress a new industry protected from all but minimal regulation. It is also an industry that would make many of his closest associates and family members rich. In turn, they’ve rewarded him with sizable campaign contributions.
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  • These are the Frankenstein remedies — botanicals, herbs, minerals, enzymes, amino acids, dried stuff. They’re “natural.” They’re not cheap. And Americans pop them like Skittles, despite recent studies showing that nearly a third of all herbal supplements on the market may be outright frauds.
  • We’re not talking drugs, or even, in many cases, food here. Drugs have to undergo rigorous testing and review by the federal government. Dietary supplements do not. Drugs have to prove to be effective. Dietary supplements do not.
  • Even though serious illnesses, and some deaths are on the rise from misuse of these supplements, Hatch is determined to keep regulators at bay. “I am committed to protect this industry and the integrity of its products,” he told a gathering of potency pill-pushers and the like in Utah last fall.
  • what about the medical implications? These pills and powders can’t, by law, make specific claims to cure anything. So they claim to make you healthier. The consumer is left playing doctor, reading questionable assertions that course through the unfiltered garbage of the Internet.
  • there was this finding reported in the authoritative Annals of Internal Medicine: “Enough is enough: Stop wasting money on vitamin and mineral supplements.”
  • So, the industry keeps growing, with 65,000 dietary supplements now on the market, consumed by nearly half of all Americans. The larger issue is mistrust of authority, a willful ignorance that knows no political side. Thus, right-wing libertarians promote a freewheeling market of quack products, while left-wing conspiracy theorists disdain modern medicine in favor of anything sold as “natural” or vaguely countercultural. These are some of the same people who will not vaccinate their children.
Javier E

The Narrative Frays for Theranos and Elizabeth Holmes - The New York Times - 1 views

  • Few people, let alone those just 31 years old, have amassed the accolades and riches bestowed on Elizabeth Holmes, founder and chief executive of the blood-testing start-up Theranos.
  • This year President Obama named her a United States ambassador for global entrepreneurship. She gave the commencement address at Pepperdine University. She was the youngest person ever to be awarded the Horatio Alger Award in recognition of “remarkable achievements accomplished through honesty, hard work, self-reliance and perseverance over adversity.” She is on the Board of Fellows of Harvard Medical School.
  • Time named her one of the 100 Most Influential People in the World this year. She was the subject of lengthy profiles in The New Yorker and Fortune. Over the last week, she appeared on the cover of T: The New York Times Style Magazine, and Glamour anointed her one of its eight Women of the Year. She has been on “Charlie Rose,” as well as on stage at the Clinton Global Initiative, the World Economic Forum at Davos and the Aspen Ideas Festival, among numerous other conferences.
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  • Theranos, which she started after dropping out of Stanford at age 19, has raised more than $400 million in venture capital and has been valued at $9 billion, which makes Ms. Holmes’s 50 percent stake worth $4.5 billion. Forbes put her on the cover of its Forbes 400 issue, ranking her No. 121 on the list of wealthiest Americans.
  • Thanks to an investigative article in The Wall Street Journal this month by John Carreyrou, one of the company’s central claims, and the one most exciting to many investors and doctors, is being called into question. Theranos has acknowledged it was only running a limited number of tests on a microsample of blood using its finger-prick technology. Since then, it said it had stopped using its proprietary methods on all but one relatively simple test for herpes.
  • “The constant was that nobody had any idea how this works or even if it works,” Mr. Loria told me this week. “People in medicine couldn’t understand why the media and technology worlds were so in thrall to her.
  • that so many eminent authorities — from Henry Kissinger, who had served on the company’s board; to prominent investors like the Oracle founder Larry Ellison; to the Cleveland Clinic — appear to have embraced Theranos with minimal scrutiny is a testament to the ageless power of a great story.
  • Ms. Holmes seems to have perfectly executed the current Silicon Valley playbook: Drop out of a prestigious college to pursue an entrepreneurial vision; adopt an iconic uniform; embrace an extreme diet; and champion a humanitarian mission, preferably one that can be summed up in one catchy phrase.
  • She stays relentlessly on message, as a review of her numerous conference and TV appearances make clear, while at the same time saying little of scientific substance.
  • The natural human tendency to fit complex facts into a simple, compelling narrative has grown stronger in the digital age of 24/7 news and social media,
  • “We’re deluged with information even as pressure has grown to make snap decisions,”
  • “People see a TED talk. They hear this amazing story of a 30-something-year-old woman with a wonder procedure. They see the Cleveland Clinic is on board. A switch goes off and they make an instant decision that everything is fine. You see this over and over: Really smart and wealthy people start to believe completely implausible things with 100 percent certainty.”
  • Ms. Holmes’s story also fits into a broader narrative underway in medicine, in which new health care entrepreneurs are upending ossified hospital practices with the goal of delivering more effective and patient-oriented care.
  • as a medical technology company, Theranos has bumped up against something else: the scientific method, which puts a premium on verification over narrative.
  • “You have to subject yourself to peer review. You can’t just go in a stealthy mode and then announce one day that you’ve got technology that’s going to disrupt the world.”
  • Professor Yeo said that he and his colleagues wanted to see data and testing in independent labs. “We have a small army of people ready and willing to test Theranos’s products if they’d ask us,” he said. “And that can be done without revealing any trade secrets.”
  • “Every other company in this field has gone through peer review,” said Mr. Cherny of Evercore. “Why hold back so much of the platform if your goal is the greater good of humanity?”
Javier E

Older Americans Are 'Hooked' on Vitamins - The New York Times - 1 views

  • When she was a young physician, Dr. Martha Gulati noticed that many of her mentors were prescribing vitamin E and folic acid to patients. Preliminary studies in the early 1990s had linked both supplements to a lower risk of heart disease.She urged her father to pop the pills as well: “Dad, you should be on these vitamins, because every cardiologist is taking them or putting their patients on [them],” recalled Dr. Gulati, now chief of cardiology for the University of Arizona College of Medicine-Phoenix
  • But just a few years later, she found herself reversing course, after rigorous clinical trials found neither vitamin E nor folic acid supplements did anything to protect the heart. Even worse, studies linked high-dose vitamin E to a higher risk of heart failure, prostate cancer and death from any cause.
  • More than half of Americans take vitamin supplements, including 68 percent of those age 65 and older, according to a 2013 Gallup poll. Among older adults, 29 percent take four or more supplements of any kind
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  • Often, preliminary studies fuel irrational exuberance about a promising dietary supplement, leading millions of people to buy in to the trend. Many never stop. They continue even though more rigorous studies — which can take many years to complete — almost never find that vitamins prevent disease, and in some cases cause harm
  • There’s no conclusive evidence that dietary supplements prevent chronic disease in the average American, Dr. Manson said. And while a handful of vitamin and mineral studies have had positive results, those findings haven’t been strong enough to recommend supplements to the general American public, she said.
  • The National Institutes of Health has spent more than $2.4 billion since 1999 studying vitamins and minerals. Yet for “all the research we’ve done, we don’t have much to show for it,” said Dr. Barnett Kramer, director of cancer prevention at the National Cancer Institute.
  • A big part of the problem, Dr. Kramer said, could be that much nutrition research has been based on faulty assumptions, including the notion that people need more vitamins and minerals than a typical diet provides; that megadoses are always safe; and that scientists can boil down the benefits of vegetables like broccoli into a daily pill.
  • when researchers tried to deliver the key ingredients of a healthy diet in a capsule, Dr. Kramer said, those efforts nearly always failed.
  • It’s possible that the chemicals in the fruits and vegetables on your plate work together in ways that scientists don’t fully understand — and which can’t be replicated in a table
  • More important, perhaps, is that most Americans get plenty of the essentials, anyway. Although the Western diet has a lot of problems — too much sodium, sugar, saturated fat and calories, in general — it’s not short on vitamins
  • Without even realizing it, someone who eats a typical lunch or breakfast “is essentially eating a multivitamin,”
  • The body naturally regulates the levels of many nutrients, such as vitamin C and many B vitamins, Dr. Kramer said, by excreting what it doesn’t need in urine. He added: “It’s hard to avoid getting the full range of vitamins.”
  • Not all experts agree. Dr. Walter Willett, a professor at the Harvard T.H. Chan School of Public Health, says it’s reasonable to take a daily multivitamin “for insurance.” Dr. Willett said that clinical trials underestimate supplements’ true benefits because they aren’t long enough, often lasting five to 10 years. It could take decades to notice a lower rate of cancer or heart disease in vitamin taker
  • For Charlsa Bentley, 67, keeping up with the latest nutrition research can be frustrating. She stopped taking calcium, for example, after studies found it doesn’t protect against bone fractures. Additional studies suggest that calcium supplements increase the risk of kidney stones and heart disease.
  • People who take vitamins tend to be healthier, wealthier and better educated than those who don’t, Dr. Kramer said. They are probably less likely to succumb to heart disease or cancer, whether they take supplements or not. That can skew research results, making vitamin pills seem more effective than they really are
  • Because folic acid can lower homocysteine levels, researchers once hoped that folic acid supplements would prevent heart attacks and strokes.In a series of clinical trials, folic acid pills lowered homocysteine levels but had no overall benefit for heart disease, Dr. Lichtenstein said
  • When studies of large populations showed that people who eat lots of seafood had fewer heart attacks, many assumed that the benefits came from the omega-3 fatty acids in fish oil, Dr. Lichtenstein said.Rigorous studies have failed to show that fish oil supplements prevent heart attacks
  • But it’s possible the benefits of sardines and salmon have nothing to do with fish oil, Dr. Lichtenstein said. People who have fish for dinner may be healthier as a result of what they don’t eat, such as meatloaf and cheeseburgers.
  • “Eating fish is probably a good thing, but we haven’t been able to show that taking fish oil [supplements] does anything for you,
  • In the tiny amounts provided by fruits and vegetables, beta carotene and similar substances appear to protect the body from a process called oxidation, which damages healthy cells, said Dr. Edgar Miller, a professor of medicine at Johns Hopkins School of Medicine.Experts were shocked when two large, well-designed studies in the 1990s found that beta carotene pills actually increased lung cancer rates.
  • Likewise, a clinical trial published in 2011 found that vitamin E, also an antioxidant, increased the risk of prostate cancer in men by 17 percent
  • “Vitamins are not inert,” said Dr. Eric Klein, a prostate cancer expert at the Cleveland Clinic who led the vitamin E study. “They are biologically active agents. We have to think of them in the same way as drugs. If you take too high a dose of them, they cause side effects.”
  • “We should be responsible physicians,” she said, “and wait for the data.”
Javier E

How Tech Can Turn Doctors Into Clerical Workers - The New York Times - 0 views

  • what I see in my colleague is disillusionment, and it has come too early, and I am seeing too much of it.
  • In America today, the patient in the hospital bed is just the icon, a place holder for the real patient who is not in the bed but in the computer. That virtual entity gets all our attention. Old-fashioned “bedside” rounds conducted by the attending physician too often take place nowhere near the bed but have become “card flip” rounds
  • My young colleague slumping in the chair in my office survived the student years, then three years of internship and residency and is now a full-time practitioner and teacher. The despair I hear comes from being the highest-paid clerical worker in the hospital: For every one hour we spend cumulatively with patients, studies have shown, we spend nearly two hours on our primitive Electronic Health Records, or “E.H.R.s,” and another hour or two during sacred personal time.
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  • The living, breathing source of the data and images we juggle, meanwhile, is in the bed and left wondering: Where is everyone? What are they doing? Hello! It’s my body, you know
  • Our $3.4 trillion health care system is responsible for more than a quarter of a million deaths per year because of medical error, the rough equivalent of, say, a jumbo jet’s crashing every day.
  • I can get cash and account details all over America and beyond. Yet I can’t reliably get a patient record from across town, let alone from a hospital in the same state, even if both places use the same brand of E.H.R
  • the leading E.H.R.s were never built with any understanding of the rituals of care or the user experience of physicians or nurses. A clinician will make roughly 4,000 keyboard clicks during a busy 10-hour emergency-room shift
  • In the process, our daily progress notes have become bloated cut-and-paste monsters that are inaccurate and hard to wade through. A half-page, handwritten progress note of the paper era might in a few lines tell you what a physician really thought
  • so much of the E.H.R., but particularly the physical exam it encodes, is a marvel of fiction, because we humans don’t want to leave a check box empty or leave gaps in a template.
  • For a study, my colleagues and I at Stanford solicited anecdotes from physicians nationwide about patients for whom an oversight in the exam (a “miss”) had resulted in real consequences, like diagnostic delay, radiation exposure, therapeutic or surgical misadventure, even death. They were the sorts of things that would leave no trace in the E.H.R. because the recorded exam always seems complete — and yet the omission would be glaring and memorable to other physicians involved in the subsequent care. We got more than 200 such anecdotes.
  • The reason for these errors? Most of them resulted from exams that simply weren’t done as claimed. “Food poisoning” was diagnosed because the strangulated hernia in the groin was overlooked, or patients were sent to the catheterization lab for chest pain because no one saw the shingles rash on the left chest.
  • I worry that such mistakes come because we’ve gotten trapped in the bunker of machine medicine. It is a preventable kind of failure
  • How we salivated at the idea of searchable records, of being able to graph fever trends, or white blood counts, or share records at a keystroke with another institution — “interoperability”
  • The seriously ill patient has entered another kingdom, an alternate universe, a place and a process that is frightening, infantilizing; that patient’s greatest need is both scientific state-of-the-art knowledge and genuine caring from another human being. Caring is expressed in listening, in the time-honored ritual of the skilled bedside exam — reading the body — in touching and looking at where it hurts and ultimately in localizing the disease for patients not on a screen, not on an image, not on a biopsy report, but on their bodies.
  • What if the computer gave the nurse the big picture of who he was both medically and as a person?
  • a professor at M.I.T. whose current interest in biomedical engineering is “bedside informatics,” marvels at the fact that in an I.C.U., a blizzard of monitors from disparate manufacturers display EKG, heart rate, respiratory rate, oxygen saturation, blood pressure, temperature and more, and yet none of this is pulled together, summarized and synthesized anywhere for the clinical staff to use
  • What these monitors do exceedingly well is sound alarms, an average of one alarm every eight minutes, or more than 180 per patient per day. What is our most common response to an alarm? We look for the button to silence the nuisance because, unlike those in a Boeing cockpit, say, our alarms are rarely diagnosing genuine danger.
  • By some estimates, more than 50 percent of physicians in the United States have at least one symptom of burnout, defined as a syndrome of emotional exhaustion, cynicism and decreased efficacy at work
  • It is on the increase, up by 9 percent from 2011 to 2014 in one national study. This is clearly not an individual problem but a systemic one, a 4,000-key-clicks-a-day problem.
  • The E.H.R. is only part of the issue: Other factors include rapid patient turnover, decreased autonomy, merging hospital systems, an aging population, the increasing medical complexity of patients. Even if the E.H.R. is not the sole cause of what ails us, believe me, it has become the symbol of burnou
  • burnout is one of the largest predictors of physician attrition from the work force. The total cost of recruiting a physician can be nearly $90,000, but the lost revenue per physician who leaves is between $500,000 and $1 million, even more in high-paying specialties.
  • I hold out hope that artificial intelligence and machine-learning algorithms will transform our experience, particularly if natural-language processing and video technology allow us to capture what is actually said and done in the exam room.
  • as with any lab test, what A.I. will provide is at best a recommendation that a physician using clinical judgment must decide how to apply.
  • True clinical judgment is more than addressing the avalanche of blood work, imaging and lab tests; it is about using human skills to understand where the patient is in the trajectory of a life and the disease, what the nature of the patient’s family and social circumstances is and how much they want done.
  • Much of that is a result of poorly coordinated care, poor communication, patients falling through the cracks, knowledge not being transferred and so on, but some part of it is surely from failing to listen to the story and diminishing skill in reading the body as a text.
  • As he was nearing death, Avedis Donabedian, a guru of health care metrics, was asked by an interviewer about the commercialization of health care. “The secret of quality,” he replied, “is love.”/•/
anonymous

JAMA Editor Placed on Leave After Deputy's Comments on Racism - The New York Times - 0 views

  • JAMA Editor Placed on Leave After Deputy’s Comments on Racism
  • After a staff member dismissed racism as a problem in medicine on a podcast, a petition signed by thousands demanded a review of editorial processes at the journal.
  • Following controversial comments on racism in medicine made by a deputy editor at JAMA, the editor in chief of the prominent medical journal was placed on administrative leave on Thursday.
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  • “Structural racism is an unfortunate term,” said Dr. Livingston, who is white. “Personally, I think taking racism out of the conversation will help
  • Many people like myself are offended by the implication that we are somehow racist.”
  • The podcast was promoted with a tweet from the journal that said, “No physician is racist, so how can there be structural racism in health care?”
  • The response to both was swift and angry, prompting the journal to take down the podcast and delete the tweet.
  • Comments made in the podcast were inaccurate, offensive, hurtful, and inconsistent with the standards of JAMA,
  • The A.M.A.’s email to employees promised that the investigation would probe “
  • “We are instituting changes that will address and prevent such failures from happening again.”
  • “It’s not just that this podcast is problematic — it’s that there is a long and documented history of institutional racism at JAMA,”
  • “That podcast should never have happened,”
  • The fact that podcast was conceived of, recorded and posted was unconscionable.”
  • “I think it caused an incalculable amount of pain and trauma to Black physicians and patients,” she said. “And I think it’s going to take a long time for the journal to heal that pain.
  • “staff and leadership are overwhelmingly white and economically privileged,” and he committed to reviewing its editorial process.
  • Dr. Livingston later resigned.
  • how the podcast and associated tweet were developed, reviewed, and ultimately published,” and said that the association had engaged independent investigators to ensure objectivity.
  • The email did not offer a date for conclusion of the investigation.
Javier E

Experts Want More Studies of Diet's Role for the Heart - NYTimes.com - 0 views

  • when it comes to diet and heart disease, doctors — and patients — have been going on hunches.
  • Dr. Estruch said he and his colleagues were so buoyed by the success of their study that they were planning another one. They intend to randomly assign people to consume the Mediterranean diet or to exercise while following a similar diet that is lower in calories. The hope is that adding weight loss and exercise will prevent even more heart disease.
  • for now, chaos reigns. The public is bombarded with diet advice, often contradictory and often lacking a rigorous scientific grounding, medical experts said.
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  • “Diets are an extreme case of accepting evidence we want to believe,”
  • That includes doctors, he added, who overlook that the evidence for the low-fat diets they often recommend is the sort “we would never accept in the practice of medicine.”
  • Doctors are in a bind, said Dr. Daniel J. Rader, a heart disease specialist at the University of Pennsylvania. When patients ask what to eat, he said, “you have to give them something.”
  • the best they have are studies that look at intermediate markers of risk, like cholesterol levels. In the end, he said, “most doctors just give dietary platitudes.”
Javier E

Wine-tasting: it's junk science | Life and style | The Observer - 0 views

  • google_ad_client = 'ca-guardian_js'; google_ad_channel = 'lifeandstyle'; google_max_num_ads = '3'; // Comments Click here to join the discussion. We can't load the discussion on guardian.co.uk because you don't have JavaScript enabled. if (!!window.postMessage) { jQuery.getScript('http://discussion.guardian.co.uk/embed.js') } else { jQuery('#d2-root').removeClass('hd').html( '' + 'Comments' + 'Click here to join the discussion.We can\'t load the ' + 'discussion on guardian.co.uk ' + 'because your web browser does not support all the features that we ' + 'need. If you cannot upgrade your browser to a newer version, you can ' + 'access the discussion ' + 'here.' ); } Wor
  • Hodgson approached the organisers of the California State Fair wine competition, the oldest contest of its kind in North America, and proposed an experiment for their annual June tasting sessions.Each panel of four judges would be presented with their usual "flight" of samples to sniff, sip and slurp. But some wines would be presented to the panel three times, poured from the same bottle each time. The results would be compiled and analysed to see whether wine testing really is scientific.
  • Results from the first four years of the experiment, published in the Journal of Wine Economics, showed a typical judge's scores varied by plus or minus four points over the three blind tastings. A wine deemed to be a good 90 would be rated as an acceptable 86 by the same judge minutes later and then an excellent 94.
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  • Hodgson's findings have stunned the wine industry. Over the years he has shown again and again that even trained, professional palates are terrible at judging wine."The results are disturbing," says Hodgson from the Fieldbrook Winery in Humboldt County, described by its owner as a rural paradise. "Only about 10% of judges are consistent and those judges who were consistent one year were ordinary the next year."Chance has a great deal to do with the awards that wines win."
  • French academic Frédéric Brochet tested the effect of labels in 2001. He presented the same Bordeaux superior wine to 57 volunteers a week apart and in two different bottles – one for a table wine, the other for a grand cru.The tasters were fooled.When tasting a supposedly superior wine, their language was more positive – describing it as complex, balanced, long and woody. When the same wine was presented as plonk, the critics were more likely to use negatives such as weak, light and flat.
  • In 2011 Professor Richard Wiseman, a psychologist (and former professional magician) at Hertfordshire University invited 578 people to comment on a range of red and white wines, varying from £3.49 for a claret to £30 for champagne, and tasted blind.People could tell the difference between wines under £5 and those above £10 only 53% of the time for whites and only 47% of the time for reds. Overall they would have been just as a successful flipping a coin to guess.
  • why are ordinary drinkers and the experts so poor at tasting blind? Part of the answer lies in the sheer complexity of wine.For a drink made by fermenting fruit juice, wine is a remarkably sophisticated chemical cocktail. Dr Bryce Rankine, an Australian wine scientist, identified 27 distinct organic acids in wine, 23 varieties of alcohol in addition to the common ethanol, more than 80 esters and aldehydes, 16 sugars, plus a long list of assorted vitamins and minerals that wouldn't look out of place on the ingredients list of a cereal pack. There are even harmless traces of lead and arsenic that come from the soil.
  • "People underestimate how clever the olfactory system is at detecting aromas and our brain is at interpreting them," says Hutchinson."The olfactory system has the complexity in terms of its protein receptors to detect all the different aromas, but the brain response isn't always up to it. But I'm a believer that everyone has the same equipment and it comes down to learning how to interpret it." Within eight tastings, most people can learn to detect and name a reasonable range of aromas in wine
  • People struggle with assessing wine because the brain's interpretation of aroma and bouquet is based on far more than the chemicals found in the drink. Temperature plays a big part. Volatiles in wine are more active when wine is warmer. Serve a New World chardonnay too cold and you'll only taste the overpowering oak. Serve a red too warm and the heady boozy qualities will be overpowering.
  • Colour affects our perceptions too. In 2001 Frédérick Brochet of the University of Bordeaux asked 54 wine experts to test two glasses of wine – one red, one white. Using the typical language of tasters, the panel described the red as "jammy' and commented on its crushed red fruit.The critics failed to spot that both wines were from the same bottle. The only difference was that one had been coloured red with a flavourless dye
  • Other environmental factors play a role. A judge's palate is affected by what she or he had earlier, the time of day, their tiredness, their health – even the weather.
  • Robert Hodgson is determined to improve the quality of judging. He has developed a test that will determine whether a judge's assessment of a blind-tasted glass in a medal competition is better than chance. The research will be presented at a conference in Cape Town this year. But the early findings are not promising."So far I've yet to find someone who passes," he says.
Javier E

Disruptions: Medicine That Monitors You - NYTimes.com - 0 views

  • researchers and some start-ups are already preparing the next, even more intrusive wave of computing: ingestible computers and minuscule sensors stuffed inside pills.
  • some people on the cutting edge are already swallowing them to monitor a range of health data and wirelessly share this information with a doctor
  • does not need a battery. Instead, the body is the power source. Just as a potato can power a light bulb, Proteus has added magnesium and copper on each side of its tiny sensor, which generates just enough electricity from stomach acids.
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  • People with heart failure-related difficulties could monitor blood flow and body temperature; those with central nervous system issues, including schizophrenia and Alzheimer’s disease, could take the pills to monitor vital signs in real time.
  • Future generations of these pills could even be convenience tools.
  • Once that pill is in your body, you could pick up your smartphone and not have to type in a password. Instead, you are the password. Sit in the car and it will start. Touch the handle to your home door and it will automatically unlock. “Essentially, your entire body becomes your authentication token,
  • “The wonderful is that there are a great number of things you want to know about yourself on a continual basis, especially if you’re diabetic or suffer from another disease. The terrible is that health insurance companies could know about the inner workings of your body.”
  • And the implications of a tiny computer inside your body being hacked? Let’s say they are troubling.
  • After it has done its job, flowing down around the stomach and through the intestinal tract, what happens next?“It passes naturally through the body in about 24 hours,” Ms. Carbonelli said, but since each pill costs $46, “some people choose to recover and recycle it.”
Emily Horwitz

New Genetic Twist: 4-Stranded DNA Lurks in Human Cells | LiveScience - 1 views

  • Sixty years after scientists described the chemical code of life — an interweaving double helix called DNA — researchers have found four-stranded DNA is also lurking in human cells.
  • they form in regions of deoxyribonucleic acid (DNA) that are full of guanine, one of the DNA molecule's four building blocks
  • Scientists had shown in the past that such quadruplex DNA could form in test tubes and had even been found in the cells of ciliated protozoa, or single-celled organisms with hairlike appendages. Also there were hints of its existence in human cells, though no direct proof, Lipps said.
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  • In the new study, researchers, including chemist Shankar Balasubramanian, of the University of Cambridge and Cambridge Research Institute, crafted antibody proteins specifically for this type of DNA. The proteins were marked with a fluorescent chemical, so when they hooked up to areas in the human genome packed with G-quadruplexes, they lit up.
  • Next, they incubated the antibodies with human cells in the lab, finding these structures tended to occur in genes of cells that were rapidly dividing, a telltale feature of cancer cells. They also found a spike in quadruplexes during the s-phase of the cell cycle, or the phase when DNA replicates just before the cell divides.
  • the researchers think the four-stranded DNA could be a target for personalized medicine in the future
  • "What makes me personally very happy about this work is that it again demonstrates that mechanisms first described in ciliated protozoa hold also true for other organisms up to human, demonstrating the strength of this model organism," wrote Lipps wrote.
sissij

Apple removed the New York Times app in China. Why now? - LA Times - 0 views

  • California’s Internet companies may have once dreamed of liberating China through technology, but these days they seem more willing than ever to play the Communist Party's game
  • "This is a restoration of the Cultural Revolution or another historical retrogression," said another.
  • The Washington Post is one of many Western newspapers that carries a regular paid supplement by China Daily, another Communist Party mouthpiece.
  •  
    The censorship in China has long been a controversial issue that's widely discussed. I think it's very natural that those internet companies play the government the rules to enter the Chinese market because most companies are profit-driven rather than being all idealistic. However, I found the tone of this article very uncomfortable. He used the word "liberating" as if China is in bad condition or great suffer that need American freedom to save. Also, looking back to American history, American heroism plays a big part in what the American government did. They "liberated" Canada, "liberated" Vietnam, "liberated" Pakistan, and now America tries to "liberate" China. However, they never fully understand the pros and cons of censorship and how China is a totally different country to America. One's medicine can toxic for another. --Sissi (1/6/2017)
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