Group items tagged

But in the interest of balance, given all this criticism the Internet has faced lately, let’s list a few great (or at least harmless) things about the global network

None of that, of course, even touches on the change-the-world technologies in medicine, commerce, communications, artificial intelligence, education and any number of fields that wouldn’t exist without the Internet.

o, Internet, you’ve got an ugly streak for sure. But maybe you’re getting a bum rap.

It is unethical to deceive patients by prescribing fake treatments, of course. But there is evidence that people with some conditions benefit even if they know they are taking placebos. In a 2014 study that followed 459 migraine attacks in 66 patients, honestly labeled placebos provided significantly more pain relief than no treatment, and were nearly half as effective as the painkiller Maxalt.

With placebo responses in pain so high — and the risks of drugs so severe — why not prescribe a course of “honest” placebos for those who wish to try it, before proceeding, if necessary, to an active drug?

Another option is to employ alternative therapies, which through placebo responses can benefit patients even when there is no physical mode of action.

Taking a placebo painkiller dampens activity in pain-related areas of the brain and spinal cord, and triggers the release of endorphins, the natural pain-relieving chemicals that opioid drugs are designed to mimic. Even when we take a real painkiller, a big chunk of its effect is delivered not by any direct chemical action, but by our expectation that the drug will work. Studies show that widely used painkillers like morphine, buprenorphine and tramadol are markedly less effective if we don’t know we’re taking them.

Individual attitudes and experiences are important, as are cultural factors. Placebo effects are getting stronger in the United States, for example, though not elsewhere.

Likely explanations include a growing cultural belief in the effectiveness of painkillers — a result of direct-to-consumer advertising (illegal in most other countries) and perhaps the fact that so many Americans have taken these drugs in the past.

Trials show, for example, that strengthening patients’ positive expectations and reducing their anxiety during a variety of procedures, including minimally invasive surgery, while still being honest, can reduce the dose of painkillers required and cut complications.

Placebo studies also reveal the value of social interaction as a treatment for pain. Harvard researchers studied patients in pain from irritable bowel syndrome and found that 44 percent of those given sham acupuncture had adequate relief from their symptoms. If the person who performed the acupuncture was extra supportive and empathetic, however, that figure jumped to 62 percent.

Placebos tell us that pain is a complex mix of biological, psychological and social factors. We need to develop better drugs to treat it, but let’s also take more seriously the idea of relieving pain without them.

Gowers often taught his students to begin their diagnosis from the moment a patient walked through the door

“Did you notice him as he came into the room? If you did not then you should have done so. One of the habits to be acquired and never omitted is to observe a patient as he enters the room; to note his aspect and his gait. If you did so, you would have seen that he seemed lame, and you may have been struck by that which must strike you now – an unusual tint of his face.”

the importance of the seemingly inconsequential that seems to inspire both men. “It has long been an axiom of mine that the little things are infinitely the most important,” Conan Doyle wrote

Both Gowers and Holmes also warned against letting your preconceptions fog your judgement. For both men, cool, unprejudiced observation was the order of the day. It is for this reason that Holmes chastises Watson in The Scandal of Bohemia: “You see, but you do not observe. The distinction is clear.”

Gowers: “The method you should adopt is this: Whenever you find yourself in the presence of a case that is not familiar to you in all its detail forget for a time all your types and all your names. Deal with the case as one that has never been seen before, and work it out as a new problem sui generis, to be investigated as such.”

both men “reasoned backwards”, for instance, dissecting all the possible paths that may have led to a particular disease (in Gowers’ case) or murder (in Holmes’)

Holmes’ most famous aphorism: “When you have eliminated the impossible, whatever remains, however improbable, must be the truth.”

the most important lesson to be learned, from both Gowers and Holmes, is the value of recognising your errors. “Gentlemen – It is always pleasant to be right, but it is generally a much more useful thing to be wrong,” wrote Gowers

This humility is key in beating the ‘curse of expertise’ that afflicts so many talented and intelligent people.

University College London has documented many instances in which apparent experts in both medicine and forensic science have allowed their own biases to cloud their judgements – sometimes even in life or death situations.

Even the most advanced technology can never replace the powers of simple observation and rational deduction.

In response, the National Academy of Sciences (NAS) and its Institute of Medicine will convene an international summit this fall where researchers and other experts will "explore the scientific, ethical, and policy issues associated with human gene-editing research," the academies said in a statement

It is a step reminiscent of one in 1975, when NAS convened the Asilomar Conference. That led to guidelines and federal regulations of recombinant DNA, the gene-splicing technology that underlay the founding of Genentech and other biotech companies and revolutionized the production of many pharmaceuticals

Many of the worlds’ greatest medical challenges stem from poverty, inequality, discrimination, pollution, and environmental devastation, as critical race, gender, and decolonization scholars have shown us.

Let’s be alert to the ways in which risks and ethical issues present themselves at every stage of developing and implementing promising new treatments. Scientists themselves do not have to do this work. That is what social scientists do.

He came down hard on nutrition in a pull-no-punches 2013 British Medical Journal editorial titled, “Implausible results in human nutrition research,” in which he noted, “Almost every single nutrient imaginable has peer reviewed publications associating it with almost any outcome.”

Ioannidis told me that sussing out the connection between diet and health — nutritional epidemiology — is enormously challenging, and “the tools that we’re throwing at the problem are not commensurate with the complexity and difficulty of the problem.” The biggest of those tools is observational research, in which we collect data on what people eat, and track what happens to them.

He lists plant-based foods — fruit, veg, whole grains, legumes — but acknowledges that we don’t understand enough to prescribe specific combinations or numbers of servings.

funding bias isn’t the only kind. “Fanatical opinions abound in nutrition,” Ioannidis wrote in 2013, and those have bias power too.

“Definitive solutions won’t come from another million observational papers or small randomized trials,” reads the subtitle of Ioannidis’s paper. His is a burn-down-the-house ethos.

When it comes to actual dietary recommendations, the disagreement is stark. “Ioannidis and others say we have no clue, the science is so bad that we don’t know anything,” Hu told me. “I think that’s completely bogus. We know a lot about the basic elements of a healthy diet.”

Give tens of thousands of people that FFQ, and you end up with a ginormous repository of possible correlations. You can zero in on a vitamin, macronutrient or food, and go to town. But not only are you starting with flawed data, you’ve got a zillion possible confounding variables — dietary, demographic, socioeconomic. I’ve heard statisticians call it “noise mining,” and Ioannidis is equally skeptical. “With this type of data, you can get any result you want,” he said. “You can align it to your beliefs.”

Big differences in what people eat track with other differences. Heavy plant-eaters are different from, say, heavy meat-eaters in all kinds of ways (income, education, physical activity, BMI). Red meat consumption correlates with increased risk of dying in an accident as much as dying from heart disease. The amount of faith we put in observational studies is a judgment call.

I find myself in Ioannidis’s camp. What have we learned, unequivocally enough to build a consensus in the nutrition community, about how diet affects health? Well, trans-fats are bad.

Over and over, large population studies get sliced and diced, and it’s all but impossible to figure out what’s signal and what’s noise. Researchers try to do that with controlled trials to test the connections, but those have issues too. They’re expensive, so they’re usually small and short-term. People have trouble sticking to the diet being studied. And scientists are generally looking for what they call “surrogate endpoints,” like increased cholesterol rather than death from heart disease, since it’s impractical to keep a trial going until people die.

, what do we do? Hu and Ioannidis actually have similar suggestions. For starters, they both think we should be looking at dietary patterns rather than single foods or nutrients. They also both want to look across the data sets. Ioannidis emphasizes transparency. He wants to open data to the world and analyze all the data sets in the same way to see if “any signals survive.” Hu is more cautious (partly to safeguard confidentiality

I have a suggestion. Let’s give up on evidence-based eating. It’s given us nothing but trouble and strife. Our tools can’t find any but the most obvious links between food and health, and we’ve found those already.

Instead, let’s acknowledge the uncertainty and eat to hedge against what we don’t know

We’ve got two excellent hedges: variety and foods with nutrients intact (which describes such diets as the Mediterranean, touted by researchers). If you severely limit your foods (vegan, keto), you might miss out on something. Ditto if you eat foods with little nutritional value (sugar, refined grains). Oh, and pay attention to the two things we can say with certainty: Keep your weight down, and exercise.

I used to say I could tell you everything important about diet in 60 seconds. Over the years, my spiel got shorter and shorter as truisms fell by the wayside, and my confidence waned in a field where we know less, rather than more, over time. I’m down to five seconds now: Eat a wide variety of foods with their nutrients intact, keep your weight down and get some exercise.

A recent set of experiments shows us that there is a way to help reduce the effects of misinformation on people: the authors amusingly call it the “inoculation.”

which even then were heavily influenced by their pre-existing worldviews.

teaching about misconceptions leads to greater learning overall then just telling somebody the truth.

As a result, our microbiomes are better at helping us store fat than those of our ancestors.

Antibiotics aren’t the only force shifting our internal ecology. Modern diets are full of processed foods and low in fiber, the kind of hard-to-break-down carbohydrates found especially in vegetables, legumes, and whole grains that are crucial for a healthy microbiome.

The vast majority of our internal microbes live in the far reaches of our digestive tract, the colon, explains Justin Sonnenburg, an associate professor of microbiology and immunology at Stanford. Because of their location, these microscopic critters “really only get access to the dregs of what we eat”—the dietary fiber that our organs can’t digest. The microbes have evolved to process that fiber by fermenting it with enzymes.

feeding this fermentation process appears to be crucial for averting weight gain and diseases like obesity and Type 2 diabetes

fiber supplements might also trigger liver cancer.

“Right now, the only useful advice I could give somebody would be to eat foods naturally rich in fiber,” he says, like bran cereal and every kind of bean you can think of. Other winners included pears, avocados, apples, seeds, and nuts.

The Institute of Medicine recommends that women eat 25 grams and men 38 grams of fiber every day, but Americans only get about 15 grams on average.

The choice of whether to lunch on a cup of black beans or five chicken nuggets—which both contain about 220 calories—just got a whole lot easier.

“This virus has a surface protein that is primed to lock on that receptor and slip its RNA into the cell,”

Once inside, that RNA inserts itself into the cell’s own replication machinery and makes multiple copies of the virus. These burst out of the cell, and the infection spreads. Antibodies generated by the body’s immune system eventually target the virus and in most cases halt its progress.

“A Covid-19 infection is generally mild, and that really is the secret of the virus’s success,” adds Ball. “Many people don’t even notice they have got an infection and so go around their work, homes and supermarkets infecting others.”

the virus can cause severe problems. This happens when it moves down the respiratory tract and infects the lungs, which are even richer in cells with Ace-2 receptors. Many of these cells are destroyed, and lungs become congested with bits of broken cell. In these cases, patients will require treatment in intensive care.

Even worse, in some cases, a person’s immune system goes into overdrive, attracting cells to the lungs in order to attack the virus, resulting in inflammation

This process can run out of control, more immune cells pour in, and the inflammation gets worse. This is known as a cytokine storm.

Just why cytokine storms occur in some patients but not in the vast majority is unclear

Doctors examining patients recovering from a Covid-19 infection are finding fairly high levels of neutralising antibodies in their blood. These antibodies are made by the immune system, and they coat an invading virus at specific points, blocking its ability to break into cells.

Instead, most virologists believe that immunity against Covid-19 will last only a year or two. “That is in line with other coronaviruses that infect humans,

“It is clear that immune responses are being mounted against Covid-19 in infected people,” says virologist Mike Skinner of Imperial College London. “And the antibodies created by that response will provide protection against future infections – but we should note that it is unlikely this protection will be for life.”

“That means that even if most people do eventually become exposed to the virus, it is still likely to become endemic – which means we would see seasonal peaks of infection of this disease. We will have reached a steady state with regard to Covid-19.”

Skinner is doubtful. “We have got to consider this pandemic from the virus’s position,” he says. “It is spreading round the world very nicely. It is doing OK. Change brings it no benefit.”

In the end, it will be the development and roll-out of an effective vaccine that will free us from the threat of Covid-19,

the journal Nature reported that 78 vaccine projects had been launched round the globe – with a further 37 in development.

vaccines require large-scale safety and efficacy studies. Thousands of people would receive either the vaccine itself or a placebo to determine if the former were effective at preventing infection from the virus which they would have encountered naturally. That, inevitably, is a lengthy process.

some scientists have proposed a way to speed up the process – by deliberately exposing volunteers to the virus to determine a vaccine’s efficacy.

Volunteers would have to be young and healthy, he stresses: “Their health would also be closely monitored, and they would have access to intensive care and any available medicines.”

The result could be a vaccine that would save millions of lives by being ready for use in a much shorter time than one that went through standard phase three trials.

phase-three trials are still some way off, so we have time to consider the idea carefully.”

Despite its dependence on hard evidence, science is a creative discipline. That creativity needs nurturing, even in this age of performance targets and impact assessments. Scientist need to flex their imaginations, too.

“Let us dare to dream,” the chemist August Kekulé once suggested, “and then perhaps we may learn the truth.”

Physics isn’t the only field that might benefit from a judicious dose of what-iffery. Attempts to understand consciousness are also just inching forward

This failing in the West’s economies is also a failing of economics

many people have long felt the desire to do something with their lives besides consuming goods and having leisure. They desire to participate in a community in which they can interact and develop.

Our prevailing political economy is blind to the very concept of inclusion; it does not map out any remedy for the deficiency

injustice of another sort. Workers in decent jobs view the economy as unjust if they or their children have virtually no chance of climbing to a higher rung in the socioeconomic ladder

“Money is like blood. You need it to live but it isn’t the point of life.”4

justice is not everything that people need from their economy. They need an economy that is good as well as just. And for some decades, the Western economies have fallen short of any conception of a “good economy”—an economy offering a “good life,” or a life of “richness,” as some humanists call it

The good life as it is popularly conceived typically involves acquiring mastery in one’s work, thus gaining for oneself better terms—or means to rewards, whether material, like wealth, or nonmaterial—an experience we may call “prospering.”

As humanists and philosophers have conceived it, the good life involves using one’s imagination, exercising one’s creativity, taking fascinating journeys into the unknown, and acting on the world—an experience I call “flourishing.”

prospering and flourishing became prevalent in the nineteenth century when, in Europe and America, economies emerged with the dynamism to generate their own innovation.

What is the mechanism of the slowdown in productivity

prospering

In nineteenth-century Britain and America, and later Germany and France, a culture of exploration, experimentation, and ultimately innovation grew out of the individualism of the Renaissance, the vitalism of the Baroque era, and the expressionism of the Romantic period.

What made innovating so powerful in these economies was that it was not limited to elites. It permeated society from the less advantaged parts of the population on up.

High-enough wages, low-enough unemployment, and wide-enough access to engaging work are necessary for a “good-enough” economy—though far from sufficient. The material possibilities of the economy must be adequate for the nonmaterial possibilities to be widespread—the satisfactions of prospering and of flourishing through adventurous, creative, and even imaginative work.

today’s standard economics. This economics, despite its sophistication in some respects, makes no room for economies in which people are imagining new products and using their creativity to build them. What is most fundamentally “wrong with economics” is that it takes such an economy to be the norm—to be “as good as it gets.”

ince around 1970, or earlier in some cases, most of the continental Western European economies have come to resemble more completely the mechanical model of standard economics. Most companies are highly efficient. Households, apart from the very low-paid or unemployed, have gone on saving

In most of Western Europe, economic dynamism is now at lows not seen, I would judge, since the advent of dynamism in the nineteenth century. Imagining and creating new products has almost disappeared from the continent

The bleak levels of both unemployment and job satisfaction in Europe are testimony to its dreary economies.

a recent survey of household attitudes found that, in “happiness,” the median scores in Spain (54), France (51), Italy (48), and Greece (37) are all below those in the upper half of the nations labeled “emerging”—Mexico (79), Venezuela (74), Brazil (73), Argentina (66), Vietnam (64), Colombia (64), China (59), Indonesia (58), Chile (58), and Malaysia (56)

The US economy is not much better. Two economists, Stanley Fischer and Assar Lindbeck, wrote of a “Great Productivity Slowdown,” which they saw as beginning in the late 1960s.11 The slowdown in the growth of capital and labor combined—what is called “total factor productivity”—is star

though the injustices in the West’s economies are egregious, they ought not to be seen as a major cause of the productivity slowdowns and globalization. (For one thing, a slowdown of productivity started in the US in the mid-1960s and the sharp loss of manufacturing jobs to poorer countries occurred much later—from the late 1970s to the early 1990s.) Deeper causes must be at work.

The plausible explanation of the syndrome in America—the productivity slowdown and the decline of job satisfaction, among other things—is a critical loss of indigenous innovation in the established industries like traditional manufacturing and services that was not nearly offset by the innovation that flowered in a few new industries

hat then caused this narrowing of innovation? No single explanation is persuasive. Yet two classes of explanations have the ring of truth. One points to suppression of innovation by vested interests

some professions, such as those in education and medicine, have instituted regulation and licensing to curb experimentation and change, thus dampening innovation

established corporations—their owners and stakeholders—and entire industries, using their lobbyists, have obtained regulations and patents that make it harder for new firms to gain entry into the market and to compete with incumbents.

The second explanation points to a new repression of potential innovators by families and schools. As the corporatist values of control, solidarity, and protection are invoked to prohibit innovation, traditional values of conservatism and materialism are often invoked to inhibit a young person from undertaking an innovation.

ow might Western nations gain—or regain—widespread prospering and flourishing? Taking concrete actions will not help much without fresh thinking: people must first grasp that standard economics is not a guide to flourishing—it is a tool only for efficiency.

Widespread flourishing in a nation requires an economy energized by its own homegrown innovation from the grassroots on up. For such innovation a nation must possess the dynamism to imagine and create the new—economic freedoms are not sufficient. And dynamism needs to be nourished with strong human values.

a reform of education stands out. The problem here is not a perceived mismatch between skills taught and skills in demand

The problem is that young people are not taught to see the economy as a place where participants may imagine new things, where entrepreneurs may want to build them and investors may venture to back some of them. It is essential to educate young people to this image of the economy.

It will also be essential that high schools and colleges expose students to the human values expressed in the masterpieces of Western literature, so that young people will want to seek economies offering imaginative and creative careers. Education systems must put students in touch with the humanities in order to fuel the human desire to conceive the new and perchance to achieve innovations

This reorientation of general education will have to be supported by a similar reorientation of economic education.

introduces thought and balance to people’s lives.

Thomas S. Kuhn

Taste does not simply equal your taste buds. It draws on information from all our senses as well as context. As a result, food is susceptible to the same trickery as wine. Adding yellow food dye to vanilla pudding leads people to experience a lemony taste. Diners eating in the dark at a chic concept restaurant confuse veal for tuna. Branding, packaging, and price tags are equally important to enjoyment. Cheap fish is routinely passed off as its pricier cousins at seafood and sushi restaurants. 

Just like with wine and classical music, we often judge food based on very different criteria than what we claim. The result is that our perceptions are easily skewed in ways we don’t anticipate. 

What does it mean for wine that presentation so easily trumps the quality imbued by being grown on premium Napa land or years of fruitful aging? Is it comforting that the same phenomenon is found in food and classical music, or is it a strike against the authenticity of our enjoyment of them as well? How common must these manipulations be until we concede that the influence of the price tag of a bottle of wine or the visual appearance of a pianist is not a trick but actually part of the quality?

To answer these questions, we need to investigate the underlying mechanism that leads us to judge wine, food, and music by criteria other than what we claim to value. And that mechanism seems to be the quick, intuitive judgments our minds unconsciously make

this unknowability also makes it easy to be led astray when our intuition makes a mistake. We may often be able to count on the price tag or packaging of food and wine for accurate information about quality. But as we believe that we’re judging based on just the product, we fail to recognize when presentation manipulates our snap judgments.

Participants were just as effective when watching 6 second video clips and when comparing their ratings to ratings of teacher effectiveness as measured by actual student test performance. 

The power of intuitive first impressions has been demonstrated in a variety of other contexts. One experiment found that people predicted the outcome of political elections remarkably well based on silent 10 second video clips of debates - significantly outperforming political pundits and predictions made based on economic indicators.

In a real world case, a number of art experts successfully identified a 6th century Greek statue as a fraud. Although the statue had survived a 14 month investigation by a respected museum that included the probings of a geologist, they instantly recognized something was off. They just couldn’t explain how they knew.

Cases like this represent the canon behind the idea of the “adaptive unconscious,” a concept made famous by journalist Malcolm Gladwell in his book Blink. The basic idea is that we constantly, quickly, and unconsciously do the equivalent of judging a book by its cover. After all, a cover provides a lot of relevant information in a world in which we don’t have time to read every page.

Gladwell describes the adaptive unconscious as “a kind of giant computer that quickly and quietly processes a lot of the data we need in order to keep functioning as human beings.”

In a famous experiment, psychologist Nalini Ambady provided participants in an academic study with 30 second silent video clips of a college professor teaching a class and asked them to rate the effectiveness of the professor.

In follow up experiments, Chia-Jung Tsay found that those judging musicians’ auditions based on visual cues were not giving preference to attractive performers. Rather, they seemed to look for visual signs of relevant characteristics like passion, creativity, and uniqueness. Seeing signs of passion is valuable information. But in differentiating between elite performers, it gives an edge to someone who looks passionate over someone whose play is passionate

Outside of these more eccentric examples, it’s our reliance on quick judgments, and ignorance of their workings, that cause people to act on ugly, unconscious biases

It’s also why - from a business perspective - packaging and presentation is just as important as the good or service on offer. Why marketing is just as important as product. 

Gladwell ends Blink optimistically. By paying closer attention to our powers of rapid cognition, he argues, we can avoid its pitfalls and harness its powers. We can blindly audition musicians behind a screen, look at a piece of art devoid of other context, and pay particular attention to possible unconscious bias in our performance reports.

But Gladwell’s success in demonstrating how the many calculations our adaptive unconscious performs without our awareness undermines his hopeful message of consciously harnessing its power.

As a former world-class tennis player and coach of over 50 years, Braden is a perfect example of the ideas behind thin slicing. But if he can’t figure out what his unconscious is up to when he recognizes double faults, why should anyone else expect to be up to the task?

flawed judgment in fields like medicine and investing has more serious consequences. The fact that expertise is so tricky leads psychologist Daniel Kahneman to assert that most experts should seek the assistance of statistics and algorithms in making decisions.

In his book Thinking, Fast and Slow, he describes our two modes of thought: System 1, like the adaptive unconscious, is our “fast, instinctive, and emotional” intuition. System 2 is our “slower, more deliberative, and more logical” conscious thought. Kahneman believes that we often leave decisions up to System 1 and generally place far “too much confidence in human judgment” due to the pitfalls of our intuition described above.

Not every judgment will be made in a field that is stable and regular enough for an algorithm to help us make judgments or predictions. But in those cases, he notes, “Hundreds of studies have shown that wherever we have sufficient information to build a model, it will perform better than most people.”

Experts can avoid the pitfalls of intuition more easily than laypeople. But they need help too, especially as our collective confidence in expertise leads us to overconfidence in their judgments. 

This article has referred to the influence of price tags and context on products and experiences like wine and classical music concerts as tricks that skew our perception. But maybe we should consider them a real, actual part of the quality.

Losing ourselves in a universe of relativism, however, will lead us to miss out on anything new or unique. Take the example of the song “Hey Ya!” by Outkast. When the music industry heard it, they felt sure it would be a hit. When it premiered on the radio, however, listeners changed the channel. The song sounded too dissimilar from songs people liked, so they responded negatively. 

It took time for people to get familiar with the song and realize that they enjoyed it. Eventually “Hey Ya!” became the hit of the summer.

Many boorish people talking about the ethereal qualities of great wine probably can't even identify cork taint because their impressions are dominated by the price tag and the wine label. But the classic defense of wine - that you need to study it to appreciate it - is also vindicated. The open question - which is both editorial and empiric - is what it means for the industry that constant vigilance and substantial study is needed to dependably appreciate wine for the product quality alone. But the questions is relevant to the enjoyment of many other products and experiences that we enjoy in life.

Maybe the most important conclusion is to not only recognize the fallibility of our judgments and impressions, but to recognize when it matters, and when it doesn’t

Oversleeping — typically defined as more than nine or 10 hours in research studies — is associated with certain health risks, including stroke, obesity, depression, diabetes, heart disease and dementia. However, it’s not clear if oversleeping causes these conditions or if it’s just an indicator that something else is wrong.

“In other words, we don’t know if it’s the long sleep that’s causing problems over time, or if some underlying health problem is causing someone to sleep longer,”

“If someone seems to be an unusually long sleeper, it’s possible that they are simply wired to need more sleep,” Wu said. (That said, it can’t hurt to mention it to your doctor if you have some concerns.)

“A number of factors, such as medical conditions, medication side effects, and undiagnosed sleep disorders, can lead to poor sleep quality and non-restful sleep,” she added.

if sleep quantity isn’t the issue, then sleep quality probably is. Conditions like sleep apnea can disrupt sleep and leave you feeling fatigued even after spending ample time in bed.

“Poor quality sleep means that an individual does not get to the deeper stages of sleep or REM sleep, which restore the brain and body and makes you feel refreshed and rejuvenated the next day,”

“Get lots of sunlight, get physically active — or at least decrease long stretches of sitting — and go out of your way to plan some fun and social activities,” Wu said. “Make efforts to prioritize physical and mental health. You may find yourself waking up with more energy after making these changes.”

According to the NFL, a panel of neuropsychologists that was formed recently to propose a new testing regime to the court includes two female and three Black doctors.

The NFL noted that the norms were developed in medicine “to stop bias in testing, not perpetrate it.”

The binary race norms, when they are used in the testing, assumes that Black patients start with worse cognitive function than whites and other non-Blacks.

The awards so far have averaged $516,000 for the 379 players with early-stage dementia and $715,000 for the 207 players with moderate dementia.

he settlement ended thousands of lawsuits that accused the NFL of long hiding what it knew about the link between concussions and traumatic brain injury.

In the U.S., more than 100 million adults — about 1 in 3 — are obese.

Dropping even 5% of one's weight can bring health benefits, such as improved energy, blood pressure, blood sugar and cholesterol levels, but that amount often doesn't satisfy patients who are focused on weight loss

The drug carries a potential risk for a type of thyroid tumor, so it shouldn't be taken by people with a personal or family history of certain thyroid and endocrine tumors. Wegovy also has a risk of depression and pancreas inflammation.

Like other weight-loss drugs, it's to be used along with exercise, a healthy diet and other steps like keeping a food diary.

Wegovy builds on a trend in which makers of relatively new diabetes drugs test them to treat other conditions common in diabetics.

Globally, the numbers can be even worse, and the stakes often higher. “Say a person comes into the hospital in Sierra Leone with a fever and flulike symptoms,” DeRisi says. “After a few days, or a week, they die. What caused that illness? Most of the time, we never find out. Because if the cause isn’t something that we can culture and test for” — like hepatitis, or strep throat — “it basically just stays a mystery.”

It would be better, DeRisi says, to watch for rare cases of mystery illnesses in people, which often exist well before a pathogen gains traction and is able to spread.

Based on a retrospective analysis of blood samples, scientists now know that H.I.V. emerged nearly a dozen times over a century, starting in the 1920s, before it went global.

Zika was a relatively harmless illness before a single mutation, in 2013, gave the virus the ability to enter and damage brain cells.

The beauty of this approach” — running blood samples from people hospitalized all over the world through his system, known as IDseq — “is that it works even for things that we’ve never seen before, or things that we might think we’ve seen but which are actually something new.”

In this scenario, an undiscovered or completely new virus won’t trigger a match but will instead be flagged. (Even in those cases, the mystery pathogen will usually belong to a known virus family: coronaviruses, for instance, or filoviruses that cause hemorrhagic fevers like Ebola and Marburg.)

And because different types of bacteria require specific conditions in order to grow, you also need some idea of what you’re looking for in order to find it.

The same is true of genomic sequencing, which relies on “primers” designed to match different combinations of nucleotides (the building blocks of DNA and RNA).

Even looking at a slide under a microscope requires staining, which makes organisms easier to see — but the stains used to identify bacteria and parasites, for instance, aren’t the same.

The practice that DeRisi helped pioneer to skirt this problem is known as metagenomic sequencing

Unlike ordinary genomic sequencing, which tries to spell out the purified DNA of a single, known organism, metagenomic sequencing can be applied to a messy sample of just about anything — blood, mud, seawater, snot — which will often contain dozens or hundreds of different organisms, all unknown, and each with its own DNA. In order to read all the fragmented genetic material, metagenomic sequencing uses sophisticated software to stitch the pieces together by matching overlapping segments.

The assembled genomes are then compared against a vast database of all known genomic sequences — maintained by the government-run National Center for Biotechnology Information — making it possible for researchers to identify everything in the mix

Traditionally, the way that scientists have identified organisms in a sample is to culture them: Isolate a particular bacterium (or virus or parasite or fungus); grow it in a petri dish; and then examine the result under a microscope, or use genomic sequencing, to understand just what it is. But because less than 2 percent of bacteria — and even fewer viruses — can be grown in a lab, the process often reveals only a tiny fraction of what’s actually there. It’s a bit like planting 100 different kinds of seeds that you found in an old jar. One or two of those will germinate and produce a plant, but there’s no way to know what the rest might have grown into.

Such studies have revealed just how vast the microbial world is, and how little we know about it

“The selling point for researchers is: ‘Look, this technology lets you investigate what’s happening in your clinic, whether it’s kids with meningitis or something else,’” DeRisi said. “We’re not telling you what to do with it. But it’s also true that if we have enough people using this, spread out all around the world, then it does become a global network for detecting emerging pandemics

One study found more than 1,000 different kinds of viruses in a tiny amount of human stool; another found a million in a couple of pounds of marine sediment. And most were organisms that nobody had seen before.

After the Biohub opened in 2016, one of DeRisi’s goals was to turn metagenomics from a rarefied technology used by a handful of elite universities into something that researchers around the world could benefit from

metagenomics requires enormous amounts of computing power, putting it out of reach of all but the most well-funded research labs. The tool DeRisi created, IDseq, made it possible for researchers anywhere in the world to process samples through the use of a small, off-the-shelf sequencer, much like the one DeRisi had shown me in his lab, and then upload the results to the cloud for analysis.

he’s the first to make the process so accessible, even in countries where lab supplies and training are scarce. DeRisi and his team tested the chemicals used to prepare DNA for sequencing and determined that using as little as half the recommended amount often worked fine. They also 3-D print some of the labs’ tools and replacement parts, and offer ongoing training and tech support

The metagenomic analysis itself — normally the most expensive part of the process — is provided free.

But DeRisi’s main innovation has been in streamlining and simplifying the extraordinarily complex computational side of metagenomics

IDseq is also fast, capable of doing analyses in hours that would take other systems weeks.

“What IDseq really did was to marry wet-lab work — accumulating samples, processing them, running them through a sequencer — with the bioinformatic analysis,”

“Without that, what happens in a lot of places is that the researcher will be like, ‘OK, I collected the samples!’ But because they can’t analyze them, the samples end up in the freezer. The information just gets stuck there.”

Meningitis itself isn’t a disease, just a description meaning that the tissues around the brain and spinal cord have become inflamed. In the United States, bacterial infections can cause meningitis, as can enteroviruses, mumps and herpes simplex. But a high proportion of cases have, as doctors say, no known etiology: No one knows why the patient’s brain and spinal tissues are swelling.

When Saha and her team ran the mystery meningitis samples through IDseq, though, the result was surprising. Rather than revealing a bacterial cause, as expected, a third of the samples showed signs of the chikungunya virus — specifically, a neuroinvasive strain that was thought to be extremely rare. “At first we thought, It cannot be true!” Saha recalls. “But the moment Joe and I realized it was chikungunya, I went back and looked at the other 200 samples that we had collected around the same time. And we found the virus in some of those samples as well.”

Until recently, chikungunya was a comparatively rare disease, present mostly in parts of Central and East Africa. “Then it just exploded through the Caribbean and Africa and across Southeast Asia into India and Bangladesh,” DeRisi told me. In 2011, there were zero cases of chikungunya reported in Latin America. By 2014, there were a million.

Chikungunya is a mosquito-borne virus, but when DeRisi and Saha looked at the results from IDseq, they also saw something else: a primate tetraparvovirus. Primate tetraparvoviruses are almost unknown in humans, and have been found only in certain regions. Even now, DeRisi is careful to note, it’s not clear what effect the virus has on people. “Maybe it’s dangerous, maybe it isn’t,” DeRisi says. “But I’ll tell you what: It’s now on my radar.

it reveals a landscape of potentially dangerous viruses that we would otherwise never find out about. “What we’ve been missing is that there’s an entire universe of pathogens out there that are causing disease in humans,” Imam notes, “ones that we often don’t even know exist.”

“The plan was, Let’s let researchers around the world propose studies, and we’ll choose 10 of them to start,” DeRisi recalls. “We thought we’d get, like, a couple dozen proposals, and instead we got 350.”

Metagenomic sequencing is especially good at what scientists call “environmental sampling”: identifying, say, every type of bacteria present in the gut microbiome, or in a teaspoon of seawater.

“When you draw blood from someone who has a fever in Ghana, you really don’t know very much about what would normally be in their blood without fever — let alone about other kinds of contaminants in the environment. So how do you interpret the relevance of all the things you’re seeing?”

Such criticisms have led some to say that metagenomics simply isn’t suited to the infrastructure of developing countries. Along with the problem of contamination, many labs struggle to get the chemical reagents needed for sequencing, either because of the cost or because of shipping and customs holdups

we’re less likely to be caught off-guard. “With Ebola, there’s always an issue: Where’s the virus hiding before it breaks out?” DeRisi explains. “But also, once we start sampling people who are hospitalized more widely — meaning not just people in Northern California or Boston, but in Uganda, and Sierra Leone, and Indonesia — the chance of disastrous surprises will go down. We’ll start seeing what’s hidden.”