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The treatment helped 13.4% of patients with their addiction, compared with 2.5% of the placebo group.

This medication therapy provides another tool for doctors to try with patients.

"As we understand the complexity of the human brain, it becomes very much of a magical thinking that one pill will solve the problem of addiction,"

The treatment regimen in the trial combined two medications that have been studied separately for treating methamphetamine addiction with limited success.

This clinical trial was successful enough that the National Institute on Drug Addiction's Volkow says she expects to move forward toward securing FDA approval.

lack of medical treatments for those addicted to meth has complicated efforts to curb demand for the drug.

The human cost has been catastrophic. Researchers say overdose deaths linked to meth increased fourfold over the last decade.

Even users who don't overdose often experience damage to the heart and other tissues, and can see their lives spiral out of control.

"For heroin users, there's methadone, there's suboxone. I just wonder why we haven't researched [treatments for] this drug yet,"

"It's about evidence-based care, it's about empathy and it's about survivability,"

Impact Factor and the Future of Medical Journals

Impact Factor and the Future of Medical Journals

“The studies were biased,” he says. “Sometimes they were overtly biased. Sometimes it was difficult to see the bias, but it was there.” Researchers headed into their studies wanting certain results—and, lo and behold, they were getting them. We think of the scientific process as being objective, rigorous, and even ruthless in separating out what is true from what we merely wish to be true, but in fact it’s easy to manipulate results, even unintentionally or unconsciously. “At every step in the process, there is room to distort results, a way to make a stronger claim or to select what is going to be concluded,” says Ioannidis. “There is an intellectual conflict of interest that pressures researchers to find whatever it is that is most likely to get them funded.”

Ioannidis laid out a detailed mathematical proof that, assuming modest levels of researcher bias, typically imperfect research techniques, and the well-known tendency to focus on exciting rather than highly plausible theories, researchers will come up with wrong findings most of the time.

if you’re attracted to ideas that have a good chance of being wrong, and if you’re motivated to prove them right, and if you have a little wiggle room in how you assemble the evidence, you’ll probably succeed in proving wrong theories right. His model predicted, in different fields of medical research, rates of wrongness roughly corresponding to the observed rates at which findings were later convincingly refuted: 80 percent of non-randomized studies (by far the most common type) turn out to be wrong, as do 25 percent of supposedly gold-standard randomized trials, and as much as 10 percent of the platinum-standard large randomized trials.

He zoomed in on 49 of the most highly regarded research findings in medicine over the previous 13 years, as judged by the science community’s two standard measures: the papers had appeared in the journals most widely cited in research articles, and the 49 articles themselves were the most widely cited articles in these journals

Ioannidis was putting his contentions to the test not against run-of-the-mill research, or even merely well-accepted research, but against the absolute tip of the research pyramid. Of the 49 articles, 45 claimed to have uncovered effective interventions. Thirty-four of these claims had been retested, and 14 of these, or 41 percent, had been convincingly shown to be wrong or significantly exaggerated. If between a third and a half of the most acclaimed research in medicine was proving untrustworthy, the scope and impact of the problem were undeniable.

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

studies usually detect only modest effects that merely tend to whittle your chances of succumbing to a particular disease from small to somewhat smaller

The odds that anything useful will survive from any of these studies are poor,” says Ioannidis—dismissing in a breath a good chunk of the research into which we sink about $100 billion a year in the United States alone.

nutritional studies aren’t the worst. Drug studies have the added corruptive force of financial conflict of interest.

Even when the evidence shows that a particular research idea is wrong, if you have thousands of scientists who have invested their careers in it, they’ll continue to publish papers on it,” he says. “It’s like an epidemic, in the sense that they’re infected with these wrong ideas, and they’re spreading it to other researchers through journals.

Nature, the grande dame of science journals, stated in a 2006 editorial, “Scientists understand that peer review per se provides only a minimal assurance of quality, and that the public conception of peer review as a stamp of authentication is far from the truth.

The ultimate protection against research error and bias is supposed to come from the way scientists constantly retest each other’s results—except they don’t. Only the most prominent findings are likely to be put to the test, because there’s likely to be publication payoff in firming up the proof, or contradicting it.

even for medicine’s most influential studies, the evidence sometimes remains surprisingly narrow. Of those 45 super-cited studies that Ioannidis focused on, 11 had never been retested

even when a research error is outed, it typically persists for years or even decades.

much, perhaps even most, of what doctors do has never been formally put to the test in credible studies, given that the need to do so became obvious to the field only in the 1990s

Other meta-research experts have confirmed that similar issues distort research in all fields of science, from physics to economics (where the highly regarded economists J. Bradford DeLong and Kevin Lang once showed how a remarkably consistent paucity of strong evidence in published economics studies made it unlikely that any of them were right

His PLoS Medicine paper is the most downloaded in the journal’s history, and it’s not even Ioannidis’s most-cited work

while his fellow researchers seem to be getting the message, he hasn’t necessarily forced anyone to do a better job. He fears he won’t in the end have done much to improve anyone’s health. “There may not be fierce objections to what I’m saying,” he explains. “But it’s difficult to change the way that everyday doctors, patients, and healthy people think and behave.”

“Usually what happens is that the doctor will ask for a suite of biochemical tests—liver fat, pancreas function, and so on,” she tells me. “The tests could turn up something, but they’re probably irrelevant. Just having a good talk with the patient and getting a close history is much more likely to tell me what’s wrong.” Of course, the doctors have all been trained to order these tests, she notes, and doing so is a lot quicker than a long bedside chat. They’re also trained to ply the patient with whatever drugs might help whack any errant test numbers back into line.

What they’re not trained to do is to go back and look at the research papers that helped make these drugs the standard of care. “When you look the papers up, you often find the drugs didn’t even work better than a placebo. And no one tested how they worked in combination with the other drugs,” she says. “Just taking the patient off everything can improve their health right away.” But not only is checking out the research another time-consuming task, patients often don’t even like it when they’re taken off their drugs, she explains; they find their prescriptions reassuring.

Already feeling that they’re fighting to keep patients from turning to alternative medical treatments such as homeopathy, or misdiagnosing themselves on the Internet, or simply neglecting medical treatment altogether, many researchers and physicians aren’t eager to provide even more reason to be skeptical of what doctors do—not to mention how public disenchantment with medicine could affect research funding.

We could solve much of the wrongness problem, Ioannidis says, if the world simply stopped expecting scientists to be right. That’s because being wrong in science is fine, and even necessary—as long as scientists recognize that they blew it, report their mistake openly instead of disguising it as a success, and then move on to the next thing, until they come up with the very occasional genuine breakthrough

Science is a noble endeavor, but it’s also a low-yield endeavor,” he says. “I’m not sure that more than a very small percentage of medical research is ever likely to lead to major improvements in clinical outcomes and quality of life. We should be very comfortable with that fact.”

Mr. Trachtenberg understood the centrality of the university as a physical place. New structures were a visceral sign of progress. They told visitors, donors and civic leaders that the institution was, like beams and scaffolding rising from the earth, ascending. He added new programs, recruited more students, and followed the dictate of constant expansion.

the American research university had evolved into a complicated and somewhat peculiar organization. It was built to be all things to all people: to teach undergraduates, produce knowledge, socialize young men and women, train workers for jobs, anchor local economies, even put on weekend sports events. And excellence was defined by similarity to old, elite institutions. Universities were judged by the quality of their scholars, the size of their endowments, the beauty of their buildings and the test scores of their incoming students.

John Silber embarked on a huge building campaign while bringing luminaries like Saul Bellow and Elie Wiesel on board to teach and lend their prestige to the B.U. name, creating a bigger, more famous and much more costly institution. He had helped write a game plan for the aspiring college president.

GWU is, for all intents and purposes, a for-profit organization. Best example: study abroad. Their top program, a partnering with Sciences Po, costs each student (30 of them, on a program with 'prestige' status?) a full semester's tuition. It costs GW, according to Sciences Po website, €1000. A neat $20,000 profit per student (who is in digging her/himself deeper and deeper in debt.) Moreover, the school takes a $500 admin fee for the study abroad application! With no guarantee that all credits transfer. Students often lose a partial semester, GW profits again. Nor does GW offer help with an antiquated, one-shot/no transfers, tricky registration process. It's tough luck in gay Paris.Just one of many examples. Dorms with extreme mold, off-campus housing impossible for freshmen and sophomores. Required meal plan: Chick-o-Filet etc. Classes with over 300 students (required).This is not Harvard, but costs same.Emotional problems? Counselors too few. Suicides continue and are not appropriately addressed. Caring environment? Extension so and so, please hold.It's an impressive campus, I'm an alum. If you apply, make sure the DC experience is worth the price: good are internships, a few colleges like Elliot School, post-grad.GWU uses undergrad $$ directly for building projects, like the medical center to which students have NO access. (Student health facility is underfunded, outsourced.)Outstanding professors still make a difference. But is that enough?

Mr. Trachtenberg, however, understood something crucial about the modern university. It had come to inhabit a market for luxury goods. People don’t buy Gucci bags merely for their beauty and functionality. They buy them because other people will know they can afford the price of purchase. The great virtue of a luxury good, from the manufacturer’s standpoint, isn’t just that people will pay extra money for the feeling associated with a name brand. It’s that the high price is, in and of itself, a crucial part of what people are buying.

Mr. Trachtenberg convinced people that George Washington was worth a lot more money by charging a lot more money. Unlike most college presidents, he was surprisingly candid about his strategy. College is like vodka, he liked to explain.

The Absolut Rolex plan worked. The number of applicants surged from some 6,000 to 20,000, the average SAT score of students rose by nearly 200 points, and the endowment jumped from $200 million to almost $1 billion.

The university became a magnet for the children of new money who didn’t quite have the SATs or family connections required for admission to Stanford or Yale. It also aggressively recruited international students, rich families from Asia and the Middle East who believed, as nearly everyone did, that American universities were the best in the world.

U.S. News & World Report now ranks the university at No. 54 nationwide, just outside the “first tier.”

The watch and vodka analogies are correct. Personally, I used car analogies when discussing college choices with my kids. We were in the fortunate position of being able to comfortably send our kids to any college in the country and have them leave debt free. Notwithstanding, I told them that they would be going to a state school unless they were able to get into one of about 40 schools that I felt, in whatever arbitrary manner I decided, that was worth the extra cost. They both ended up going to state schools.College is by and large a commodity and you get out of it what you put into it. Both of my kids worked hard in college and were involved in school life. They both left the schools better people and the schools better schools for them being there. They are both now successful adults.I believe too many people look for the prestige of a named school and that is not what college should be primarily about.

In 2013, only 14 percent of the university’s 10,000 undergraduates received a grant — a figure on a par with elite schools but far below the national average. The average undergraduate borrower leaves with about $30,800 in debt.

When I talk to the best high school students in my state I always stress the benefits of the honors college experience at an affordable public university. For students who won't qualify for a public honors college. the regular pubic university experience is far preferable to the huge debt of places like GW.

Carey would do well to look beyond high ticket private universities (which after all are still private enterprises) and what he describes as the Olympian heights of higher education (which for some reason seems also to embitter him) and look at the system overall . The withdrawal of public support was never a policy choice; it was a political choice, "packaged and branded" as some tax cutting palaver all wrapped up in the argument that a free-market should decide how much college should cost and how many seats we need. In such an environment, trustees at private universities are no more solely responsible for turning their degrees into commodities than the administrations of state universities are for raising the number of out-of-state students in order to offset the loss of support from their legislatures. No doubt, we will hear more about market based solutions and technology from Mr. Carey

I went to GW back in the 60s. It was affordable and it got me away from home in New York. While I was there, Newsweek famously published a article about the DC Universities - GW, Georgetown, American and Catholic - dubbing them the Pony league, the schools for the children of wealthy middle class New Yorkers who couldn't get into the Ivy League. Nobody really complained. But that wasn't me. I went because I wanted to be where the action was in the 60s, and as we used to say - "GW was literally a stone's throw from the White House. And we could prove it." Back then, the two biggest alumni names were Jackie Kennedy, who's taken some classes there, and J. Edgar Hoover. Now, according to the glossy magazine they send me each month, it's the actress Kerry Washington. There's some sort of progress there, but I'm a GW alum and not properly trained to understand it.

This explains a lot of the modern, emerging mentality. It encompasses the culture of enforced grade inflation, cheating and anti-intellectualism in much of higher education. It is consistent with our culture of misleading statistics and information, cronyism and fake quality, the "best and the brightest" being only schemers and glad handers. The wisdom and creativity engendered by an honest, rigorous academic education are replaced by the disingenuous quick fix, the winner-take-all mentality that neglects the common good.

I attended nearby Georgetown University and graduated in 1985. Relative to state schools and elite schools, it was expensive then. I took out loans. I had Pell grants. I had work-study and GSL. I paid my debt of $15,000 off in ten years. Would I have done it differently? Yes: I would have continued on to graduate school and not worried about paying off those big loans right after college. My career work out and I am grateful for the education I received and paid for. But I would not recommend to my nieces and nephews debts north of $100,000 for a BA in liberal arts. Go community. Then go state. Then punch your ticket to Harvard, Yale or Stanford — if you are good enough.

American universities appear to have more and more drifted away from educating individuals and citizens to becoming high priced trade schools and purveyors of occupational licenses. Lost in the process is the concept of expanding a student's ability to appreciate broadly and deeply, as well as the belief that a republican democracy needs an educated citizenry, not a trained citizenry, to function well.Both the Heisman Trophy winner and the producer of a successful tech I.P.O. likely have much in common, a college education whose rewards are limited to the financial. I don't know if I find this more sad on the individual level or more worrisome for the future of America.

This is now a consumer world for everything, including institutions once thought to float above the Shakespearean briars of the work-a-day world such as higher education, law and medicine. Students get this. Parents get this. Everything is negotiable: financial aid, a spot in the nicest dorm, tix to the big game. But through all this, there are faculty - lots of 'em - who work away from the fluff to link the ambitions of the students with the reality and rigor of the 21st century. The job of the student is to get beyond the visible hype of the surroundings and find those faculty members. They will make sure your investment is worth it

My experience in managing or working with GW alumni in their 20's or 30's has not been good. Virtually all have been mentally lazy and/or had a stunning sense of entitlement. Basically they've been all talk and no results. That's been quite a contrast to the graduates from VA/MD state universities.

More and more, I notice what my debt-financed contributions to the revenue streams of my vendors earn them, not me. My banks earned enough to pay ridiculous bonuses to employees for reckless risk-taking. My satellite tv operator earned enough to overpay ESPN for sports programming that I never watch--and that, in turn, overpays these idiotic pro athletes and college sports administrators. My health insurer earned enough to defeat one-payor insurance; to enable the opaque, inefficient billing practices of hospitals and other providers; and to feed the behemoth pharmaceutical industry. My church earned enough to buy the silence of sex abuse victims and oppose progressive political candidates. And my govt earned enough to continue ag subsidies, inefficient defense spending, and obsolete transportation and energy policies.

as the parent of GWU freshman I am grateful for every opportunity afforded her. She has a generous merit scholarship, is in the honors program with some small classes, and has access to internships that can be done while at school. GWU also gave her AP credits to advance her to sophomore status. Had she attended the state flagship school (where she was accepted into that exclusive honors program) she would have a great education but little else. It's not possible to do foreign affairs related internship far from D.C. or Manhattan. She went to a very competitive high school where for the one or two ivy league schools in which she was interested, she didn't have the same level of connections or wealth as many of her peers. Whether because of the Common Application or other factors, getting into a good school with financial help is difficult for a middle class student like my daughter who had a 4.0 GPA and 2300 on the SAT. She also worked after school.The bottom line - GWU offered more money than perceived "higher tier" universities, and brought tuition to almost that of our state school system. And by the way, I think she is also getting a very good education.

This article reinforces something I have learned during my daughter's college application process. Most students choose a school based on emotion (reputation) and not value. This luxury good analogy holds up.

The entire education problem can be solved by MOOCs lots and lots of them plus a few closely monitored tests and personal interviews with people. Of course many many people make MONEY off of our entirely inefficient way of "educating" -- are we even really doing that -- getting a degree does NOT mean one is actually educated

As a first-generation college graduate I entered GW ambitious but left saddled with debt, and crestfallen at the hard-hitting realization that my four undergraduate years were an aberration from what life is actually like post-college: not as simple as getting an [unpaid] internship with a fancy titled institution, as most Colonials do. I knew how to get in to college, but what do you do after the recess of life ends?I learned more about networking, resume plumping (designated responses to constituents...errr....replied to emails), and elevator pitches than actual theory, economic principles, strong writing skills, critical thinking, analysis, and philosophy. While relatively easy to get a job after graduating (for many with a GW degree this is sadly not the case) sustaining one and excelling in it is much harder. It's never enough just to be able to open a new door, you also need to be prepared to navigate your way through that next opportunity.

this is a very telling article. Aimless and directionless high school graduates are matched only by aimless and directionless institutes of higher learning. Each child and each parent should start with a goal - before handing over their hard earned tuition dollars, and/or leaving a trail of broken debt in the aftermath of a substandard, unfocused education.

it is no longer the most expensive university in America. It is the 46th.Others have been implementing the Absolut Rolex Plan. John Sexton turned New York University into a global higher-education player by selling the dream of downtown living to students raised on “Sex and the City.” Northeastern followed Boston University up the ladder. Under Steven B. Sample, the University of Southern California became a U.S. News top-25 university. Washington University in St. Louis did the same.

I currently attend GW, and I have to say, this article completely misrepresents the situation. I have yet to meet a single person who is paying the full $60k tuition - I myself am paying $30k, because the school gave me $30k in grants. As for the quality of education, Foreign Policy rated GW the #8 best school in the world for undergraduate education in international affairs, Princeton Review ranks it as one of the best schools for political science, and U.S. News ranks the law school #20. The author also ignores the role that an expanding research profile plays in growing a university's prestige and educational power.

And in hundreds of regional universities and community colleges, presidents and deans and department chairmen have watched this spectacle of ascension and said to themselves, “That could be me.” Agricultural schools and technical institutes are lobbying state legislatures for tuition increases and Ph.D. programs, fitness centers and arenas for sport. Presidents and boards are drawing up plans to raise tuition, recruit “better” students and add academic programs. They all want to go in one direction — up! — and they are all moving with a single vision of what they want to be.

this is the same playbook used by hospitals the past 30 years or so. It is how Hackensack Hospital became Hackensack Medical Center and McComb Hospital became Southwest Mississippi Regional Medical Center. No wonder the results have been the same in healthcare and higher education; both have priced themselves out of reach for average Americans.

a world where a college is rated not by the quality of its output, but instaed, by the quality of its inputs. A world where there is practically no work to be done by the administration because the college's reputation is made before the first class even begins! This is isanity! But this is the swill that the mammoth college marketing departments nationwide have shoved down America's throat. Colleges are ranked not by the quality of their graduates, but rather, by the test scores of their incoming students!

The Pew Foundation has been doing surveys on what students learn, how much homework they do, how much time they spend with professors etc. All good stuff to know before a student chooses a school. It is called the National Survey of Student Engagement (NSSE - called Nessy). It turns out that the higher ranked schools do NOT allow their information to be released to the public. It is SECRET.Why do you think that is?

The article blames "the standard university organizational model left teaching responsibilities to autonomous academic departments and individual faculty members, each of which taught and tested in its own way." This is the view of someone who has never taught at a university, nor thought much about how education there actually happens. Once undergraduates get beyond the general requirements, their educations _have_ to depend on "autonomous departments" because it's only those departments know what the requirements for given degree can be, and can grant the necessary accreditation of a given student. The idea that some administrator could know what's necessary for degrees in everything from engineering to fiction writing is nonsense, except that's what the people who only know the theory of education (but not its practice) actually seem to think. In the classroom itself, you have tremendously talented people, who nevertheless have their own particular strengths and approaches. Don't you think it's a good idea to let them do what they do best rather than trying to make everyone teach the same way? Don't you think supervision of young teachers by older colleagues, who actually know their field and its pedagogy, rather than some administrator, who knows nothing of the subject, is a good idea?

it makes me very sad to see how expensive some public schools have become. Used to be you could work your way through a public school without loans, but not any more. Like you, I had the advantage of a largely-scholarship paid undergraduate education at a top private college. However, I was also offered a virtually free spot in my state university's (then new) honors college

My daughter attended a good community college for a couple of classes during her senior year of high school and I could immediately see how such places are laboratories for failure. They seem like high schools in atmosphere and appearance. Students rush in by car and rush out again when the class is over.The four year residency college creates a completely different feel. On arrival, you get the sense that you are engaging in something important, something apart and one that will require your full attention. I don't say this is for everyone or that the model is not flawed in some ways (students actually only spend 2 1/2 yrs. on campus to get the four yr. degree). College is supposed to be a 60 hour per week job. Anything less than that and the student is seeking himself or herself

This. Is. STUNNING. I have always wondered, especially as my kids have approached college age, why American colleges have felt justified in raising tuition at a rate that has well exceeded inflation, year after year after year. (Nobody needs a dorm with luxury suites and a lazy river pool at college!) And as it turns out, they did it to become luxury brands. Just that simple. Incredible.I don't even blame this guy at GWU for doing what he did. He wasn't made responsible for all of American higher ed. But I do think we all need to realize what happened, and why. This is front page stuff.

I agree with you, but, unfortunately, given the choice between low tuition, primitive dorms, and no athletic center VS expensive & luxurious, the customers (and their parents) are choosing the latter. As long as this is the case, there is little incentive to provide bare-bones and cheap education.

Wesleyan University in CT is one school that is moving down the rankings. Syracuse University is another. Reed College is a third. Why? Because these schools try hard to stay out of the marketing game. (With its new president, Syracuse has jumped back into the game.) Bryn Mawr College, outside Philadelphia hasn't fared well over the past few decades in the rankings, which is true of practically every women's college. Wellesley is by far the highest ranked women's college, but even there the acceptance rate is significantly higher than one finds at comparable coed liberal arts colleges like Amherst & Williams. University of Chicago is another fascinating case for Mr. Carey to study (I'm sure he does in his forthcoming book, which I look forward to reading). Although it has always enjoyed an illustrious academic reputation, until recently Chicago's undergraduate reputation paled in comparison to peer institutions on the two coasts. A few years ago, Chicago changed its game plan to more closely resemble Harvard and Stanford in undergraduate amenities, and lo and behold, its rankings shot up. It was a very cynical move on the president's part to reassemble the football team, but it was a shrewd move because athletics draw more money than academics ever can (except at engineering schools like Cal Tech & MIT), and more money draws richer students from fancier secondary schools with higher test scores, which lead to higher rankings - and the beat goes on.

College INDUSTRY is out of control. Sorry, NYU, GW, BU are not worth the price. Are state schools any better? We have the University of Michigan, which is really not a state school, but a university that gives a discount to people who live in Michigan. Why? When you have an undergraduate body 40+% out-of-state that pays tuition of over $50K/year, you tell me?Perhaps the solution is two years of community college followed by two at places like U of M or Michigan State - get the same diploma at the end for much less and beat the system.

In one recent yr., the majority of undergrad professors at Harvard, according to Boston.com, where adjuncts. That means low pay, no benefits, no office, temp workers. Harvard.Easily available student loans fueled this arms race of amenities and frills that in which colleges now engage. They moved the cost of education onto the backs of people, kids, who don't understand what they are doing.Students in colleges these days are customers and the customers must be able to get through. If it requires dumbing things down, so be it. On top of tuition, G.W. U. is known by its students as the land of added fees on top of added fees. The joke around campus was that they would soon be installing pay toilets in the student union. No one was laughing.

You could written the same story about my alma mater, American University. The place reeked of ambition and upward mobility decades ago and still does. Whoever's running it now must look at its measly half-billion-dollar endowment and compare it to GWU's $1.5 billion and seethe with envy, while GWU's president sets his sights on an Ivy League-size endowment. And both get back to their real jobs: 24/7 fundraising,Which is what university presidents are all about these days. Money - including million-dollar salaries for themselves (GWU's president made more than Harvard's in 2011) - pride, cachet, power, a mansion, first-class all the way. They should just be honest about it and change their university's motto to Ostende mihi pecuniam! (please excuse my questionable Latin)Whether the students are actually learning anything is up to them, I guess - if they do, it's thanks to the professors, adjuncts and the administrative staff, who do the actual work of educating and keep the school running.

When I was in HS (70s), many of my richer friends went to GW and I was then of the impression that GW was a 'good' school. As I age, I have come to realize that this place is just another façade to the emptiness that has become America. All too often are we faced with a dilemma: damned if we do, damned if we don't. Yep, 'education' has become a trap for all too many of our citizen.

I transferred to GWU from a state school. I am forever grateful that I did. I wanted to get a good rigorous education and go to one of the best International Affairs schools in the world. Even though the state school I went to was dirt-cheap, the education and the faculty was awful. I transferred to GW and was amazed at the professors at that university. An ambassador or a prominent IA scholar taught every class. GW is an expensive school, but that is the free market. If you want a good education you need to be willing to pay for it or join the military. I did the latter and my school was completely free with no debt and I received an amazing education. If young people aren't willing to make some sort of sacrifice to get ahead or just expect everything to be given to then our country is in a sad state.We need to stop blaming universities like GWU that strive to attract better students, better professors, and better infrastructure. They are doing what is expected in America, to better oneself.

"Whether the students are actually learning anything is up to them, I guess." How could it possibly be otherwise??? I am glad that you are willing to give credit to teachers and administrators, but it is not they who "do the actual work of educating." From this fallacy comes its corollary, that we should blame teachers first for "under-performing schools". This long-running show of scapegoating may suit the wallets and vanity of American parents, but it is utterly senseless. When, if ever, American culture stops reeking of arrogance, greed and anti-intellectualism, things may improve, and we may resume the habit of bothering to learn. Until then, nothing doing.

Universities sell knowledge and grade students on how much they have learned. Fundamentally, there is conflict of interest in thsi setup. Moreover, students who are poorly educated, even if they know this, will not criticize their school, because doing so would make it harder for them to have a career. As such, many problems with higher education remain unexposed to the public.

I've lectured and taught in at least five different countries in three continents and the shortest perusal of what goes on abroad would totally undermine most of these speculations. For one thing American universities are unique in their dedication to a broad based liberal arts type education. In France, Italy or Germany, for example, you select a major like mathematics or physics and then in your four years you will not take even one course in another subject. The amount of work that you do that is critically evaluated by an instructor is a tiny fraction of what is done in an American University. While half educated critics based on profoundly incomplete research write criticism like this Universities in Germany Italy, the Netherlands, South Korea and Japan as well as France have appointed committees and made studies to explain why the American system of higher education so drastically outperforms their own system. Elsewhere students do get a rather nice dose of general education but it ends in secondary school and it has the narrowness and formulaic quality that we would just normally associate with that. The character who wrote this article probably never set foot on a "campus" of the University of Paris or Rome

The university is part of a complex economic system and it is responding to the demands of that system. For example, students and parents choose universities that have beautiful campuses and buildings. So universities build beautiful campuses. State support of universities has greatly declined, and this decline in funding is the greatest cause of increased tuition. Therefore universities must compete for dollars and must build to attract students and parents. Also, universities are not ranked based on how they educate students -- that's difficult to measure so it is not measured. Instead universities are ranked on research publications. So while universities certainly put much effort into teaching, research has to have a priority in order for the university to survive. Also universities do not force students and parents to attend high price institutions. Reasonably priced state institutions and community colleges are available to every student. Community colleges have an advantage because they are funded by property taxes. Finally learning requires good teaching, but it also requires students that come to the university funded, prepared, and engaged. This often does not happen. Conclusion- universities have to participate in profile raising actions in order to survive. The day that funding is provided for college, ranking is based on education, and students choose campuses with simple buildings, then things will change at the university.

This is the inevitable result of privatizing higher education. In the not-so-distant past, we paid for great state universities through our taxes, not tuition. Then, the states shifted funding to prisons and the Federal government radically cut research support and the GI bill. Instead, today we expect universities to support themselves through tuition, and to the extent that we offered students support, it is through non-dischargeable loans. To make matters worse, the interest rates on those loans are far above the government's cost of funds -- so in effect the loans are an excise tax on education (most of which is used to support a handful of for-profit institutions that account for the most student defaults). This "consumer sovereignty" privatized model of funding education works no better than privatizing California's electrical system did in the era of Enron, or our privatized funding of medical service, or our increasingly privatized prison system: it drives up costs at the same time that it replace quality with marketing.

There are data in some instances on student learning, but the deeper problem, as I suspect the author already knows, is that there is nothing like a consensus on how to measure that learning, or even on when is the proper end point to emphasize (a lot of what I teach -- I know this from what students have told me -- tends to come into sharp focus years after graduation).

Michael (Baltimore) has hit the nail on the head. Universities are increasingly corporatized institutions in the credentialing business. Knowledge, for those few who care about it (often not those paying for the credentials) is available freely because there's no profit in it. Like many corporate entities, it is increasingly run by increasingly highly paid administrators, not faculty.

GWU has not defined itself in any unique way, it has merely embraced the bland, but very expensive, accoutrements of American private education: luxury dorms, food courts, spa-like gyms, endless extracurricular activities, etc. But the real culprit for this bloat that students have to bear financially is the college ranking system by US News, Princeton Review, etc. An ultimately meaningless exercise in competition that has nevertheless pushed colleges and universities to be more like one another. A sad state of affairs, and an extremely expensive one for students

It is long past time to realize the failure of the Reagonomics-neoliberal private profits over public good program. In education, we need to return to public institutions publicly funded. Just as we need to recognize that Medicare, Social Security, the post office, public utilities, fire departments, interstate highway system, Veterans Administration hospitals and the GI bill are models to be improved and expanded, not destroyed.

George Washington is actually not a Rolex watch, it is a counterfeit Rolex. The real Rolexes of higher education -- places like Hopkins, Georgetown, Duke, the Ivies etc. -- have real endowments and real financial aid. No middle class kid is required to borrow $100,000 to get a degree from those schools, because they offer generous need-based financial aid in the form of grants, not loans. The tuition at the real Rolexes is really a sticker price that only the wealthy pay -- everybody else on a sliding scale. For middle class kids who are fortunate enough to get in, Penn actually ends up costing considerably less than a state university.The fake Rolexes -- BU, NYU, Drexel in Philadelphia -- don't have the sliding scale. They bury middle class students in debt.And really, though it is foolish to borrow $100,000 or $120,000 for an undergraduate degree, I don't find the transaction morally wrong. What is morally wrong is our federal government making that loan non-dischargeable in bankruptcy, so many if these kids will be having their wages garnished for the REST OF THEIR LIVES.There is a very simple solution to this, by the way. Cap the amount of non-dischargeable student loan debt at, say, $50,000

The slant of this article is critical of the growth of research universities. Couldn't disagree more. Modern research universities create are incredibly engines of economic opportunity not only for the students (who pay the bills) but also for the community via the creation of blue and white collar jobs. Large research university employ tens of thousands of locals from custodial and food service workers right up to high level administrators and specialist in finance, computer services, buildings and facilities management, etc. Johns Hopkins University and the University of Maryland system employ more people than any other industry in Maryland -- including the government. Research universities typically have hospitals providing cutting-edge medical care to the community. Local business (from cafes to property rental companies) benefit from a built-in, long-term client base as well as an educated workforce. And of course they are the foundry of new knowledge which is critical for the future growth of our country.Check out the work of famed economist Dr. Julia Lane on modeling the economic value of the research university. In a nutshell, there are few better investments America can make in herself than research universities. We are the envy of the world in that regard -- and with good reason. How many *industries* (let alone jobs) have Stanford University alone catalyzed?

What universities have the monopoly on is the credential. Anyone can learn, from books, from free lectures on the internet, from this newspaper, etc. But only universities can endow you with the cherished degree. For some reason, people are will to pay more for one of these pieces of paper with a certain name on it -- Ivy League, Stanford, even GW -- than another -- Generic State U -- though there is no evidence one is actually worth more in the marketplace of reality than the other. But, by the laws of economics, these places are actually underpriced: after all, something like 20 times more people are trying to buy a Harvard education than are allowed to purchase one. Usually that means you raise your price.

Overalll a good article, except for - "This comes on the heels of Richard Arum and Josipa Roksa’s “Academically Adrift,” a study that found “limited or no learning” among many college students." The measure of learning you report was a general thinking skills exam. That's not a good measure of college gains. Most psychologists and cognitive scientists worth their salt would tell you that improvement in critical thinking skills is going to be limited to specific areas. In other words, learning critical thinking skills in math will make little change in critical thinking about political science or biology. Thus we should not expect huge improvements in general critical thinking skills, but rather improvements in a student's major and other areas of focus, such as a minor. Although who has time for a minor when it is universally acknowledged that the purpose of a university is to please and profit an employer or, if one is lucky, an investor. Finally, improved critical thinking skills are not the end all and be all of a college education even given this profit centered perspective. Learning and mastering the cumulative knowledge of past generations is arguably the most important thing to be gained, and most universities still tend to excel at that even with the increasing mandate to run education like a business and cultivate and cull the college "consumer".

As for community colleges, there was an article in the Times several years ago that said it much better than I could have said it myself: community colleges are places where dreams are put on hold. Without making the full commitment to study, without leaving the home environment, many, if not most, community college students are caught betwixt and between, trying to balance work responsibilities, caring for a young child or baby and attending classes. For males, the classic "end of the road" in community college is to get a car, a job and a girlfriend, one who is not in college, and that is the end of the dream. Some can make it, but most cannot.

as a scientist I disagree with the claim that undergrad tuition subsidizes basic research. Nearly all lab equipment and research personnel (grad students, technicians, anyone with the title "research scientist" or similar) on campus is paid for through federal grants. Professors often spend all their time outside teaching and administration writing grant proposals, as the limited federal grant funds mean ~%85 of proposals must be rejected. What is more, out of each successful grant the university levies a "tax", called "overhead", of 30-40%, nominally to pay for basic operations (utilities, office space, administrators). So in fact one might say research helps fund the university rather than the other way around. Flag

It's certainly overrated as a research and graduate level university. Whether it is good for getting an undergraduate education is unclear, but a big part of the appeal is getting to live in D.C..while attending college instead of living in some small college town in the corn fields.

The girls who came to us had many comorbidities: depression, anxiety, ADHD, eating disorders, obesity. Many were diagnosed with autism, or had autism-like symptoms. A report last year on a British pediatric transgender center found that about one-third of the patients referred there were on the autism spectrum.

This concerned me, but didn’t feel I was in the position to sound some kind of alarm back then. There was a team of about eight of us, and only one other person brought up the kinds of questions I had. Anyone who raised doubts ran the risk of being called a transphobe. 

I certainly saw this at the center. One of my jobs was to do intake for new patients and their families. When I started there were probably 10 such calls a month. When I left there were 50, and about 70 percent of the new patients were girls. Sometimes clusters of girls arrived from the same high school. 

There are no reliable studies showing this. Indeed, the experiences of many of the center’s patients prove how false these assertions are. 

The doctors privately recognized these false self-diagnoses as a manifestation of social contagion. They even acknowledged that suicide has an element of social contagion. But when I said the clusters of girls streaming into our service looked as if their gender issues might be a manifestation of social contagion, the doctors said gender identity reflected something innate.

To begin transitioning, the girls needed a letter of support from a therapist—usually one we recommended—who they had to see only once or twice for the green light. To make it more efficient for the therapists, we offered them a template for how to write a letter in support of transition. The next stop was a single visit to the endocrinologist for a testosterone prescription. 

When a female takes testosterone, the profound and permanent effects of the hormone can be seen in a matter of months. Voices drop, beards sprout, body fat is redistributed. Sexual interest explodes, aggression increases, and mood can be unpredictable. Our patients were told about some side effects, including sterility. But after working at the center, I came to believe that teenagers are simply not capable of fully grasping what it means to make the decision to become infertile while still a minor.

Many encounters with patients emphasized to me how little these young people understood the profound impacts changing gender would have on their bodies and minds. But the center downplayed the negative consequences, and emphasized the need for transition. As the center’s website said, “Left untreated, gender dysphoria has any number of consequences, from self-harm to suicide. But when you take away the gender dysphoria by allowing a child to be who he or she is, we’re noticing that goes away. The studies we have show these kids often wind up functioning psychosocially as well as or better than their peers.” 

Frequently, our patients declared they had disorders that no one believed they had. We had patients who said they had Tourette syndrome (but they didn’t); that they had tic disorders (but they didn’t); that they had multiple personalities (but they didn’t).

Here’s an example. On Friday, May 1, 2020, a colleague emailed me about a 15-year-old male patient: “Oh dear. I am concerned that [the patient] does not understand what Bicalutamide does.” I responded: “I don’t think that we start anything honestly right now.”

Bicalutamide is a medication used to treat metastatic prostate cancer, and one of its side effects is that it feminizes the bodies of men who take it, including the appearance of breasts. The center prescribed this cancer drug as a puberty blocker and feminizing agent for boys. As with most cancer drugs, bicalutamide has a long list of side effects, and this patient experienced one of them: liver toxicity. He was sent to another unit of the hospital for evaluation and immediately taken off the drug. Afterward, his mother sent an electronic message to the Transgender Center saying that we were lucky her family was not the type to sue.

How little patients understood what they were getting into was illustrated by a call we received at the center in 2020 from a 17-year-old biological female patient who was on testosterone. She said she was bleeding from the vagina. In less than an hour she had soaked through an extra heavy pad, her jeans, and a towel she had wrapped around her waist. The nurse at the center told her to go to the emergency room right away.

when there was a dispute between the parents, it seemed the center always took the side of the affirming parent.

Other girls were disturbed by the effects of testosterone on their clitoris, which enlarges and grows into what looks like a microphallus, or a tiny penis. I counseled one patient whose enlarged clitoris now extended below her vulva, and it chafed and rubbed painfully in her jeans. I advised her to get the kind of compression undergarments worn by biological men who dress to pass as female. At the end of the call I thought to myself, “Wow, we hurt this kid.”

There are rare conditions in which babies are born with atypical genitalia—cases that call for sophisticated care and compassion. But clinics like the one where I worked are creating a whole cohort of kids with atypical genitals—and most of these teens haven’t even had sex yet. They had no idea who they were going to be as adults. Yet all it took for them to permanently transform themselves was one or two short conversations with a therapist.

Being put on powerful doses of testosterone or estrogen—enough to try to trick your body into mimicking the opposite sex—-affects the rest of the body. I doubt that any parent who's ever consented to give their kid testosterone (a lifelong treatment) knows that they’re also possibly signing their kid up for blood pressure medication, cholesterol medication, and perhaps sleep apnea and diabetes. 

Besides teenage girls, another new group was referred to us: young people from the inpatient psychiatric unit, or the emergency department, of St. Louis Children’s Hospital. The mental health of these kids was deeply concerning—there were diagnoses like schizophrenia, PTSD, bipolar disorder, and more. Often they were already on a fistful of pharmaceuticals.

no matter how much suffering or pain a child had endured, or how little treatment and love they had received, our doctors viewed gender transition—even with all the expense and hardship it entailed—as the solution.

Another disturbing aspect of the center was its lack of regard for the rights of parents—and the extent to which doctors saw themselves as more informed decision-makers over the fate of these children.

We found out later this girl had had intercourse, and because testosterone thins the vaginal tissues, her vaginal canal had ripped open. She had to be sedated and given surgery to repair the damage. She wasn’t the only vaginal laceration case we heard about.

During the four years I worked at the clinic as a case manager—I was responsible for patient intake and oversight—around a thousand distressed young people came through our doors. The majority of them received hormone prescriptions that can have life-altering consequences—including sterility. 

I left the clinic in November of last year because I could no longer participate in what was happening there. By the time I departed, I was certain that the way the American medical system is treating these patients is the opposite of the promise we make to “do no harm.” Instead, we are permanently harming the vulnerable patients in our care.

Today I am speaking out. I am doing so knowing how toxic the public conversation is around this highly contentious issue—and the ways that my testimony might be misused. I am doing so knowing that I am putting myself at serious personal and professional risk.

Almost everyone in my life advised me to keep my head down. But I cannot in good conscience do so. Because what is happening to scores of children is far more important than my comfort. And what is happening to them is morally and medically appalling.

For almost four years, I worked at The Washington University School of Medicine Division of Infectious Diseases with teens and young adults who were HIV positive. Many of them were trans or otherwise gender nonconforming, and I could relate: Through childhood and adolescence, I did a lot of gender questioning myself. I’m now married to a transman, and together we are raising my two biological children from a previous marriage and three foster children we hope to adopt. 

The center’s working assumption was that the earlier you treat kids with gender dysphoria, the more anguish you can prevent later on. This premise was shared by the center’s doctors and therapists. Given their expertise, I assumed that abundant evidence backed this consensus. 

All that led me to a job in 2018 as a case manager at The Washington University Transgender Center at St. Louis Children's Hospital, which had been established a year earlier. 

If replication is what separates the rigor of science from the squishiness of pseudoscience, where do we put all these rigorously validated findings that can no longer be proved? Which results should we believe?

Schooler demonstrated that subjects shown a face and asked to describe it were much less likely to recognize the face when shown it later than those who had simply looked at it. Schooler called the phenomenon “verbal overshadowing.”

The most likely explanation for the decline is an obvious one: regression to the mean. As the experiment is repeated, that is, an early statistical fluke gets cancelled out. The extrasensory powers of Schooler’s subjects didn’t decline—they were simply an illusion that vanished over time.

yet Schooler has noticed that many of the data sets that end up declining seem statistically solid—that is, they contain enough data that any regression to the mean shouldn’t be dramatic. “These are the results that pass all the tests,” he says. “The odds of them being random are typically quite remote, like one in a million. This means that the decline effect should almost never happen. But it happens all the time!

this is why Schooler believes that the decline effect deserves more attention: its ubiquity seems to violate the laws of statistics

In 2001, Michael Jennions, a biologist at the Australian National University, set out to analyze “temporal trends” across a wide range of subjects in ecology and evolutionary biology. He looked at hundreds of papers and forty-four meta-analyses (that is, statistical syntheses of related studies), and discovered a consistent decline effect over time, as many of the theories seemed to fade into irrelevance.

Jennions admits that his findings are troubling, but expresses a reluctance to talk about them

publicly. “This is a very sensitive issue for scientists,” he says. “You know, we’re supposed to be dealing with hard facts, the stuff that’s supposed to stand the test of time. But when you see these trends you become a little more skeptical of things.”

While publication bias almost certainly plays a role in the decline effect, it remains an incomplete explanation. For one thing, it fails to account for the initial prevalence of positive results among studies that never even get submitted to journals. It also fails to explain the experience of people like Schooler, who have been unable to replicate their initial data despite their best efforts.

Jennions, similarly, argues that the decline effect is largely a product of publication bias, or the tendency of scientists and scientific journals to prefer positive data over null results, which is what happens when no effect is found. The bias was first identified by the statistician Theodore Sterling, in 1959, after he noticed that ninety-seven per cent of all published psychological studies with statistically significant data found the effect they were looking for

Sterling saw that if ninety-seven per cent of psychology studies were proving their hypotheses, either psychologists were extraordinarily lucky or they published only the outcomes of successful experiments.

One of his most cited papers has a deliberately provocative title: “Why Most Published Research Findings Are False.”

suspects that an equally significant issue is the selective reporting of results—the data that scientists choose to document in the first place. Palmer’s most convincing evidence relies on a statistical tool known as a funnel graph. When a large number of studies have been done on a single subject, the data should follow a pattern: studies with a large sample size should all cluster around a common value—the true result—whereas those with a smaller sample size should exhibit a random scattering, since they’re subject to greater sampling error. This pattern gives the graph its name, since the distribution resembles a funnel.

after Palmer plotted every study of fluctuating asymmetry, he noticed that the distribution of results with smaller sample sizes wasn’t random at all but instead skewed heavily toward positive results. Palmer has since documented a similar problem in several other contested subject areas. “Once I realized that selective reporting is everywhere in science, I got quite depressed,” Palmer told me. “As a researcher, you’re always aware that there might be some nonrandom patterns, but I had no idea how widespread it is.”

Palmer summarized the impact of selective reporting on his field: “We cannot escape the troubling conclusion that some—perhaps many—cherished generalities are at best exaggerated in their biological significance and at worst a collective illusion nurtured by strong a-priori beliefs often repeated.”

Palmer emphasizes that selective reporting is not the same as scientific fraud. Rather, the problem seems to be one of subtle omissions and unconscious misperceptions, as researchers struggle to make sense of their results. Stephen Jay Gould referred to this as the “sho

horning” process.

“A lot of scientific measurement is really hard,” Simmons told me. “If you’re talking about fluctuating asymmetry, then it’s a matter of minuscule differences between the right and left sides of an animal. It’s millimetres of a tail feather. And so maybe a researcher knows that he’s measuring a good male”—an animal that has successfully mated—“and he knows that it’s supposed to be symmetrical. Well, that act of measurement is going to be vulnerable to all sorts of perception biases. That’s not a cynical statement. That’s just the way human beings work.”

For Simmons, the steep rise and slow fall of fluctuating asymmetry is a clear example of a scientific paradigm, one of those intellectual fads that both guide and constrain research: after a new paradigm is proposed, the peer-review process is tilted toward positive results. But then, after a few years, the academic incentives shift—the paradigm has become entrenched—so that the most notable results are now those that disprove the theory.

John Ioannidis, an epidemiologist at Stanford University, argues that such distortions are a serious issue in biomedical research. “These exaggerations are why the decline has become so common,” he says. “It’d be really great if the initial studies gave us an accurate summary of things. But they don’t. And so what happens is we waste a lot of money treating millions of patients and doing lots of follow-up studies on other themes based on results that are misleading.”

In 2005, Ioannidis published an article in the Journal of the American Medical Association that looked at the forty-nine most cited clinical-research studies in three major medical journals.

the data Ioannidis found were disturbing: of the thirty-four claims that had been subject to replication, forty-one per cent had either been directly contradicted or had their effect sizes significantly downgraded.

the most troubling fact emerged when he looked at the test of replication: out of four hundred and thirty-two claims, only a single one was consistently replicable. “This doesn’t mean that none of these claims will turn out to be true,” he says. “But, given that most of them were done badly, I wouldn’t hold my breath.”

According to Ioannidis, the main problem is that too many researchers engage in what he calls “significance chasing,” or finding ways to interpret the data so that it passes the statistical test of significance—the ninety-five-per-cent boundary invented by Ronald Fisher.

One of the classic examples of selective reporting concerns the testing of acupuncture in different countries. While acupuncture is widely accepted as a medical treatment in various Asian countries, its use is much more contested in the West. These cultural differences have profoundly influenced the results of clinical trials.

The problem of selective reporting is rooted in a fundamental cognitive flaw, which is that we like proving ourselves right and hate being wrong.

“It feels good to validate a hypothesis,” Ioannidis said. “It feels even better when you’ve got a financial interest in the idea or your career depends upon it. And that’s why, even after a claim has been systematically disproven”—he cites, for instance, the early work on hormone replacement therapy, or claims involving various vitamins—“you still see some stubborn researchers citing the first few studies

That’s why Schooler argues that scientists need to become more rigorous about data collection before they publish. “We’re wasting too much time chasing after bad studies and underpowered experiments,”

The current “obsession” with replicability distracts from the real problem, which is faulty design.

“Every researcher should have to spell out, in advance, how many subjects they’re going to use, and what exactly they’re testing, and what constitutes a sufficient level of proof. We have the tools to be much more transparent about our experiments.”

Schooler recommends the establishment of an open-source database, in which researchers are required to outline their planned investigations and document all their results. “I think this would provide a huge increase in access to scientific work and give us a much better way to judge the quality of an experiment,”

scientific research will always be shadowed by a force that can’t be curbed, only contained: sheer randomness. Although little research has been done on the experimental dangers of chance and happenstance, the research that exists isn’t encouraging.

The disturbing implication of the Crabbe study is that a lot of extraordinary scientific data are nothing but noise. The hyperactivity of those coked-up Edmonton mice wasn’t an interesting new fact—it was a meaningless outlier, a by-product of invisible variables we don’t understand.

The problem, of course, is that such dramatic findings are also the most likely to get published in prestigious journals, since the data are both statistically significant and entirely unexpected

This suggests that the decline effect is actually a decline of illusion. While Karl Popper imagined falsification occurring with a single, definitive experiment—Galileo refuted Aristotelian mechanics in an afternoon—the process turns out to be much messier than that.

Many scientific theories continue to be considered true even after failing numerous experimental tests.

Even the law of gravity hasn’t always been perfect at predicting real-world phenomena. (In one test, physicists measuring gravity by means of deep boreholes in the Nevada desert found a two-and-a-half-per-cent discrepancy between the theoretical predictions and the actual data.)

Such anomalies demonstrate the slipperiness of empiricism. Although many scientific ideas generate conflicting results and suffer from falling effect sizes, they continue to get cited in the textbooks and drive standard medical practice. Why? Because these ideas seem true. Because they make sense. Because we can’t bear to let them go. And this is why the decline effect is so troubling. Not because it reveals the human fallibility of science, in which data are tweaked and beliefs shape perceptions. (Such shortcomings aren’t surprising, at least for scientists.) And not because it reveals that many of our most exciting theories are fleeting fads and will soon be rejected. (That idea has been around since Thomas Kuhn.)

The decline effect is troubling because it reminds us how difficult it is to prove anything. We like to pretend that our experiments define the truth for us. But that’s often not the case. Just because an idea is true doesn’t mean it can be proved. And just because an idea can be proved doesn’t mean it’s true. When the experiments are done, we still have to choose what to believe. ♦

the rest comes from his multiple real world examples illustrating exactly why even the most reluctant mathophobe is well advised to achieve a personal understanding of the statistical underpinnings of life, whether that individual is watching football on the couch, picking a school for the children or jiggling anxiously in a hospital admitting office.

And while we’re talking about bias, let’s not forget publication bias: studies that show a drug works get published, but those showing a drug does nothing tend to disappear.

The same trade-off applies to the interpretation of medical tests. Unproven disease screens are likely to do little but feed lots of costly, anxiety-producing garbage into your medical record.

It’s not only a waste of time, but it’s also a disorder in and of itself — one that preys on the fear and vulnerability of its users to sell them half-truths and, eventually, pills.

the Mayo Clinic is a nonprofit medical-practice-and-research group that started as a clinic. Mayo’s storied past as the country’s premier research hospital, in Rochester, Minn., and its storied present as one of Fortune’s “100 Best Companies to Work For” surface in the integrity of the site itself, which — though not ad-free — is spare and neatly organized, with the measured, learned voice of the best doctors

The integrity of the whole institution is on the line with this site, and the Mayo Clinic has every motivation to keep its information authoritative and up to date.

How much of this kind of reality can the public take? Producers clearly see no end in sight, and the results are increasingly becoming more questionable.

This is what's called a ''reality-based'' series, a label that has less to do with reality than comforting formula. The cameras do not go to a real hospital. But three real doctors are on the production staff.

''What you are about to see is real,'' we were told once again.

His life shattered, he now has the dubious pleasure of knowing that, for some 20 minutes, he was the star of a television reality entertainment.

''On Trial'' opens with an announcer exclaiming that viewers are about to see ''Real people! Real Cases! Real Life!'' Mr. Clooney, a distinguished-looking fellow, fills in the pertinent facts.

Everything is designed, they say, to ''give the show its docudrama look.'' The show's regular staff of three doctors are depicted by actors.

Needless to say, medical problems and crises have long been popular on television, especially on soap operas. ''Family Medical Center'' merely dispenses with extraneous plot and character developments and goes right to the medical core. A press release is candid about the show's interpretation of reality: ''It will have suspense, conflict and a resolution, which in almost all cases will be a happy one.''

The show looks as real as television entertainment can possibly make it. Alert viewers, however, will note whizzing by in the final credits the following advisory: '' 'Family Medical Center' is a dramatization. The characters are fictional and bear no resemblance to persons living or dead.''

Television reality wears many masks. A key to the overall picture was provided by one of those actors who deceived Oprah Winfrey and Geraldo Rivera with false impersonations on air. Why not, he shrugged, it's all entertainment. Frightening but not beyond comprehension.

health may be the instigator of mood

The latest entry in the health and happiness field

appears to poke a hole in the accepted dictum that well-being is a driver of good health

Small studies have hinted at causality by demonstrating that interventions to increase positive feelings yield improved physiological measurements

If a patient has poor health and is also feeling miserable, it’s not enough just to address the medical problem.

But the opposite may offer an even more powerful payoff. When doctors notice unhappiness in their patients, they should be probing more carefully for hidden illness

I also inquire about obstacles to their happiness, and brainstorm with them on ways to ease some of these

The side effect profile and cost surely beat most of our current medications, and, at least for now, you don’t have to get prior authorization from an insurance company.

a 2022 Reuters investigation found that some American clinics were quite aggressive with treatment: None of the 18 U.S. clinics that Reuters looked at performed long assessments on their patients, and some prescribed puberty blockers on the first visit.

As Cass writes in her report, “The toxicity of the debate is exceptional.” She continues, “There are few other areas of health care where professionals are so afraid to openly discuss their views, where people are vilified on social media and where name-calling echoes the worst bullying behavior.”

The report’s greatest strength is its epistemic humility. Cass is continually asking, “What do we really know?” She is carefully examining the various studies — which are high quality, which are not. She is down in the academic weeds.

he notes that the quality of the research in this field is poor. The current treatments are “built on shaky foundations,” she writes in The BMJ. Practitioners have raced ahead with therapies when we don’t know what the effects will be. As Cass tells The BMJ, “I can’t think of another area of pediatric care where we give young people a potentially irreversible treatment and have no idea what happens to them in adulthood.”

She writes in her report, “The option to provide masculinizing/feminizing hormones from age 16 is available, but the review would recommend extreme caution.

her core conclusion is this: “For most young people, a medical pathway will not be the best way to manage their gender-related distress.” She realizes that this conclusion will not please many of the young people she has come to know, but this is where the evidence has taken her.

In 1877 a British philosopher and mathematician named William Kingdon Clifford published an essay called “The Ethics of Belief.” In it he argued that if a shipowner ignored evidence that his craft had problems and sent the ship to sea having convinced himself it was safe, then of course we would blame him if the ship went down and all aboard were lost. To have a belief is to bear responsibility, and one thus has a moral responsibility to dig arduously into the evidence, avoid ideological thinking and take into account self-serving biases.

“It is wrong always, everywhere, and for anyone, to believe anything upon insufficient evidence,” Clifford wrote

A belief, he continued, is a public possession. If too many people believe things without evidence, “the danger to society is not merely that it should believe wrong things, though that is great enough; but that it should become credulous, and lose the habit of testing things and inquiring into them; for then it must sink back into savagery.”

Since the Trump years, this habit of not consulting the evidence has become the underlying crisis in so many realms. People segregate into intellectually cohesive teams, which are always dumber than intellectually diverse teams. Issues are settled by intimidation, not evidence

Our natural human tendency is to be too confident in our knowledge, too quick to ignore contrary evidence. But these days it has become acceptable to luxuriate in those epistemic shortcomings, not to struggle against them. See, for example, the modern Republican Party.

Through social media, “sharing with friends” is rationalized to the point of relentless efficiency. The current apex of such rationalization is frictionless sharing: we no longer need to perform the labor of telling our individual friends about what we read online, or of copy-pasting links and emailing them to “the list,” or of clicking a button for one-step posting of links on our Facebook walls. With frictionless sharing, all we have to do is look, or listen; what we’ve read or watched or listened to is then “shared” or “scrobbled” to our Facebook, Twitter, Tumblr, or whatever other online profiles. Whether we share content actively or passively, however, we feel as though we’ve done our half of the friendship-labor by ‘pushing’ the information to our walls, streams, and tumblelogs. It’s then up to our friends to perform their halves of the friendship-labor by ‘pulling’ the information we share from those platforms.

We’re busy people; we like the idea of making one announcement on Facebook and being done with it, rather than having to repeat the same story over and over again to different friends individually. We also like not always having to think about which friends might like which stories or songs; we like the idea of sharing with all of our friends at once, and then letting them sort out amongst themselves who is and isn’t interested. Though social media can create burdensome expectations to keep up with strong ties, weak ties, and everyone in between, social media platforms can also be very efficient. Using the same moment of friendship-labor to tend multiple friendships at once kills more birds with fewer stones.

sometimes we like the devolution of friendship. When we have to ‘pull’ friendship-content instead of receiving it in a ‘push’, we can pick and choose which content items to pull. We can ignore the baby pictures, or the pet pictures, or the sushi pictures—whatever it is our friends post that we only pretend to care about

I’ve been thinking since, however, on what it means to view our friends as “generalized others.” I may now feel like less of like “creepy stalker” when I click on a song in someone’s Spotify feed, but I don’t exactly feel ‘shared with’ either. Far as I know, I’ve never been SpotiVaguebooked (or SubSpotified?); I have no reason to think anyone is speaking to me personally as they listen to music, or as they choose not to disable scrobbling (if they make that choice consciously at all). I may have been granted the opportunity to view something, but it doesn’t follow that what I’m viewing has anything to do with me unless I choose to make it about me. Devolved friendship means it’s not up to us to interact with our friends personally; instead it’s now up to our friends to make our generalized broadcasts personal.

While I won’t go so far as to say they’re definitely ‘problems,’ there are two major things about devolved friendship that I think are worth noting. The first is the non-uniform rationalization of friendship-labor, and the second is the depersonalization of friendship-labor.

In short, “sharing” has become a lot easier and a lot more efficient, but “being shared with” has become much more time-consuming, demanding, and inefficient (especially if we don’t ignore most of our friends most of the time). Given this, expecting our friends to keep up with our social media content isn’t expecting them to meet us halfway; it’s asking them to take on the lion’s share of staying in touch with us. Our jobs (in this role) have gotten easier; our friends’ jobs have gotten harder.

The second thing worth noting is that devolved friendship is also depersonalized friendship.

Personal interaction doesn’t just happen on Spotify, and since I was hoping Spotify would be the New Porch, I initially found Spotify to be somewhat lonely-making. It’s the mutual awareness of presence that gives companionate silence its warmth, whether in person or across distance. The silence within Spotify’s many sounds, on the other hand, felt more like being on the outside looking in. This isn’t to say that Spotify can’t be social in a more personal way; once I started sending tracks to my friends, a few of them started sending tracks in return. But it took a lot more work to get to that point, which gets back to the devolution of friendship (as I explain below).

Within devolved friendship interactions, it takes less effort to be polite while secretly waiting for someone to please just stop talking.

When we consider the lopsided rationalization of ‘sharing’ and ‘shared with,’ as well as the depersonalization of frictionless sharing and generalized broadcasting, what becomes clear is this: the social media deck is stacked in such a way as to make being ‘a self’ easier and more rewarding than being ‘a friend.’

It’s easy to share, to broadcast, to put our selves and our tastes and our identity performances out into the world for others to consume; what feedback and friendship we get in return comes in response to comparatively little effort and investment from us. It takes a lot more work, however, to do the consumption, to sift through everything all (or even just some) of our friends produce, to do the work of connecting to our friends’ generalized broadcasts so that we can convert their depersonalized shares into meaningful friendship-labor.

We may be prosumers of social media, but the reward structures of social media sites encourage us to place greater emphasis on our roles as share-producers—even though many of us probably spend more time consuming shared content than producing it. There’s a reason for this, of course; the content we produce (for free) is what fuels every last ‘Web 2.0’ machine, and its attendant self-centered sociality is the linchpin of the peculiarly Silicon Valley concept of “Social” (something Nathan Jurgenson and I discuss together in greater detail here). It’s not super-rewarding to be one of ten people who “like” your friend’s shared link, but it can feel rewarding to get 10 “likes” on something you’ve shared—even if you have hundreds or thousands of ‘friends.’ Sharing is easy; dealing with all that shared content is hard.

t I wonder sometimes if the shifts in expectation that accompany devolved friendship don’t migrate across platforms and contexts in ways we don’t always see or acknowledge. Social media affects how we see the world—and how we feel about being seen in the world—even when we’re not engaged directly with social media websites. It’s not a stretch, then, to imagine that the affordances of social media platforms might also affect how we see friendship and our obligations as friends most generally.

“These are very difficult tradeoffs that our society has to make,” said Dr. Woodcock. “The reason we approve these drugs is for people in pain. But we can’t ignore the epidemic on the other side.”

In 2011, about 131 million prescriptions for hydrocodone-containing medications were written for some 47 million patients, according to government estimates. That volume of prescriptions amounts to about five billion pills.

Schedule II drugs are those drugs with the highest potential for abuse that can be legally prescribed.

Along with changing how doctors prescribe these drugs, the classification change will also impose added storage and recordkeeping requirements on druggists. In some states, nurse practitioners and other health care professionals who can currently prescribe hydrocodone-containing drugs may no longer be able to do so.

Hitler was on a steady stream of barbiturate tranquilizers, morphine, nasal and eye drops containing cocaine and other drugs — along with bulls’ semen to boost his testosterone — thanks to his Berlin-based personal physician, Theodor Morell, according to the report

He was characterized as “a quack and a fraud and a snake oil salesman”

Hitler was shown to have signs of Parkinson's disease by the end of World War II in 1945, and the dizzying array of drugs likely contributed to his serious health issues.

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.”/•/

“Is there a weight of evidence that says we can totally ignore both dietary cholesterol and LDL? Absolutely not,” he said. “You can legitimately say we’re starting to rethink some things, but ignoring LDL could absolutely result in heart attacks and strokes.

The medical community’s understanding of the danger of cholesterol is changing. Many cardiologists are starting to think that independent of other considerations, the level of LDL in our blood may not be as important as it previously seemed.

In November, the American Heart Association and the American College of Cardiology released new guidelines that redefined the use of statins. While they continue to recommend that people at high risk for heart disease and people with LDL levels above 189 take a statin, the long-standing goal of lowering one’s LDL level to 70 is no longer deemed worthwhile to monitor.

Katz acknowledges that dietary cholesterol may be an innocuous part of an overall healthy diet. “The problem is that people are going to get their dietary cholesterol from things other than fish and eggs; they’re going to get it from meats and dairies. The problem with diets like that is if you eat more of A, you’re probably going to eat less of B. So people who are eating more meat and dairy and high-fat, high-cholesterol foods are eating fewer plants—they’re not eating beans; they’re not eating lentils. So yes, I think it’s entirely confabulated and contrived, and potentially dangerous on the level of lethal.”

Having talked to all of these people and read their work, here is how I walk away from this. Oxidative stress will increasingly be the target of medical treatments and preventive diets. We’ll hear more about the role of blood sugar in Alzheimer’s and continue to focus on moderating intake of refined carbohydrates. The consensus remains that too much LDL is bad for you. We do not have reason to believe that gluten is bad for most people. It does cause reactive symptoms in some people. Peanuts can kill some people, but that does not mean they are bad for everyone

I agree with Katz that the diets consistently shown to have good long-term health outcomes—both mental and physical—include whole grains and fruits, and are not nearly as high in fat as what Perlmutter proposes.

The case is in question involves a 12-year-old girl known under the pseudonym Andrea, who was impregnated by her father and prevented from terminating her pregnancy.

On the other, the majority-Catholic country is not secular. And abortion continues to be taboo for health-care workers.

Andrea is depressed, says her mother, barely eating, suffering extreme nausea from the pregnancy and – critically – says she does not want to have the baby.

The case demonstrates that even when confronted with a 12-year-old incest victim, who says that she wants to die and to abort her pregnancy, Costa Rica’s legal and medical establishment do not offer legal or medical responses

Other Central American countries, including Honduras, El Salvador and Nicaragua also violate women’s rights by outlawing abortion under any circumstances, even when a woman’s life is in danger.

The highly visible international cases of Ana and Aurora have compelled the Costa Rican government to write a technical norm that it insists will further enshrine legal protection for medical personnel who perform an abortion to avoid endangering the life and health of a pregnant woman.

And none too soon; stories of dangerous clandestine abortions circulate.