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But do treatments using VR have advantages over traditional physical therapy?\u003c/p>\n\u003cp>Danielle Levac at Northeastern University’s ReGame laboratory is trying to answer that question.\u003c/p>\n\u003cp>“What we don’t know enough of is when you learn a skill in a virtual environment, to what extent does that actually help you get better at that skill in real life?” she said.\u003c/p>\n\u003cp>Levac’s work focuses on children with cerebral palsy and other movement disorders, and to measure any success, she first must come up with a baseline.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>On a recent day, Levac was putting 9-year-old Mattea through a series of games developed by the lab to see how she might ordinarily expect a child to perform.\u003c/p>\n\u003cp>While VR won’t replace traditional physical therapy, Levac sees its promise.\u003c/p>\n\u003cp>“I think that these games can provide a very useful adjunct that can potentially offer some extra benefits,” she said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This \u003ca href=\"https://www.statnews.com/2018/08/31/virtual-reality-physical-therapy/\" target=\"_blank\" rel=\"noopener\">story\u003c/a> was originally published by STAT, an online publication of Boston Globe Media that covers health, medicine, and scientific discovery.\u003c/em>\u003c/p>\n\n","blocks":[],"excerpt":"Are skills learned in a virtual environment carried over into the real world? Danielle Levac is studying the link between virtual and physical rehabilitation.","status":"publish","parent":0,"modified":1535762267,"stats":{"hasAudio":false,"hasVideo":true,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":10,"wordCount":206},"headData":{"title":"WATCH: Can Virtual Reality Transform Physical Therapy? | KQED","description":"Are skills learned in a virtual environment carried over into the real world? Danielle Levac is studying the link between virtual and physical rehabilitation.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"444222 https://ww2.kqed.org/futureofyou/?p=444222","disqusUrl":"https://ww2.kqed.org/futureofyou/2018/08/31/watch-can-virtual-reality-transform-physical-therapy/","disqusTitle":"WATCH: Can Virtual Reality Transform Physical Therapy?","source":"Hope/Hype","nprByline":"Alex Hogan\u003cbr />STAT","path":"/futureofyou/444222/watch-can-virtual-reality-transform-physical-therapy","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\u003cp>\u003cspan class='utils-parseShortcode-shortcodes-__youtubeShortcode__embedYoutube'>\n \u003cspan class='utils-parseShortcode-shortcodes-__youtubeShortcode__embedYoutubeInside'>\n \u003ciframe\n loading='lazy'\n class='utils-parseShortcode-shortcodes-__youtubeShortcode__youtubePlayer'\n type='text/html'\n src='//www.youtube.com/embed/necffi60Fs4'\n title='//www.youtube.com/embed/necffi60Fs4'\n allowfullscreen='true'\n style='border:0;'>\u003c/iframe>\n \u003c/span>\n \u003c/span>\u003c/p>\u003cp>\u003cp>Researchers have long seen the potential of \u003ca href=\"https://www.statnews.com/2018/02/05/aging-japan-robots-virtual-reality/\" target=\"_blank\" rel=\"noopener\">virtual reality\u003c/a> in rehabilitating patients with movement disorders. But do treatments using VR have advantages over traditional physical therapy?\u003c/p>\n\u003cp>Danielle Levac at Northeastern University’s ReGame laboratory is trying to answer that question.\u003c/p>\n\u003cp>“What we don’t know enough of is when you learn a skill in a virtual environment, to what extent does that actually help you get better at that skill in real life?” she said.\u003c/p>\n\u003cp>Levac’s work focuses on children with cerebral palsy and other movement disorders, and to measure any success, she first must come up with a baseline.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>On a recent day, Levac was putting 9-year-old Mattea through a series of games developed by the lab to see how she might ordinarily expect a child to perform.\u003c/p>\n\u003cp>While VR won’t replace traditional physical therapy, Levac sees its promise.\u003c/p>\n\u003cp>“I think that these games can provide a very useful adjunct that can potentially offer some extra benefits,” she said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This \u003ca href=\"https://www.statnews.com/2018/08/31/virtual-reality-physical-therapy/\" target=\"_blank\" rel=\"noopener\">story\u003c/a> was originally published by STAT, an online publication of Boston Globe Media that covers health, medicine, and scientific discovery.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/444222/watch-can-virtual-reality-transform-physical-therapy","authors":["byline_futureofyou_444222"],"categories":["futureofyou_1062","futureofyou_73"],"tags":["futureofyou_61","futureofyou_1056","futureofyou_35","futureofyou_380"],"collections":["futureofyou_1097"],"featImg":"futureofyou_221158","label":"source_futureofyou_444222"},"futureofyou_444121":{"type":"posts","id":"futureofyou_444121","meta":{"index":"posts_1591205157","site":"futureofyou","id":"444121","score":null,"sort":[1535482819000]},"guestAuthors":[],"slug":"experts-warn-era-of-killer-robots-not-far-as-technological-advances-outpace-regulations","title":"Experts Warn Era of Killer Robots Not Far as Technological Advances Outpace Regulations","publishDate":1535482819,"format":"standard","headTitle":"KQED Future of You | KQED Science","labelTerm":{},"content":"\u003cp>Experts from scores of countries are meeting to discuss ways to define and deal with “killer robots” — futuristic weapons systems that could conduct war without human intervention.[contextly_sidebar id=\"JwnbIGuA2qmrjP4cyRW3G5jeg9YBMKbr\"]\u003c/p>\n\u003cp>The weeklong gathering that opened Monday is the second at U.N. offices in Geneva this year to focus on such lethal autonomous weapons systems and to explore possibilities for regulating them, among other issues.\u003c/p>\n\u003cp>In theory, fully autonomous, computer-controlled weapons don’t exist yet, U.N. officials say. The debate is still in its infancy, and the experts have at times grappled with basic definitions. The United States has argued that it’s premature to establish a definition of such systems, much less regulate them.\u003c/p>\n\u003cdiv id=\"div-gpt-ad-1470255291270-0\" class=\"ad-placeholder\">\n\u003carticle id=\"contentArea\" class=\" \">\n\u003cdiv class=\"articleBody\">\n\u003cp>Some top advocacy groups say governments and militaries should be prevented from developing such systems, which have sparked fears and led some critics to envisage harrowing scenarios about their use.\u003c/p>\n\u003cp>As the meeting got underway, Amnesty International urged countries to work toward a ban.[contextly_sidebar id=\"0OgluTdEZx9UFQGbj03uYz6oMpORelQX\"]\u003c/p>\n\u003cp>Killer robots are “no longer the stuff of science fiction,” Rasha Abdul Rahim, an artificial intelligence researcher for the human rights organization, said. Rahim warned that technological advances are outpacing international law.\u003c/p>\n\u003cp>Part of the trouble for activists, however, is that the U.N.-backed conference that convened the meeting works by consensus. A single participating country — like a big military power — therefore could scuttle efforts to reach an international ban.\u003c/p>\n\u003cp>Amandeep Gill, who is chairing the meeting and a former Indian ambassador to the U.N.-backed Conference on Disarmament, said progress is being made. He summarized three general camps of countries: One seeks a formal, legal ban on such weapons; another wants a political, but non-binding agreement; and a third wants no changes at all.\u003c/p>\n\u003cp>“We are coming closer to an agreement on what should be the guiding principles — guiding the behavior of states and guiding the development and deployment of such systems around the world,” Gill told reporters Monday. “And this is not an insignificant outcome.”[contextly_sidebar id=\"7CVR44SpGjuPwzybFHNCXk25HyuLfGfX\"]\u003c/p>\n\u003cp>At a news conference hosted by the Campaign to Stop Killer Robots, Nobel Peace Prize laureate Jody Williams said the group wanted “meaningful human control” when it comes to the use of military weapons and negotiations toward a ban on computer-controlled weapons systems.\u003c/p>\n\u003cp>“There is a lot of movement within the governments: We’re up to 26 now that have called for a ban,” said Williams, who won the 1997 Nobel for her work against land mines. “Logic would dictate — at least in my thinking — that there would be a mandate toward negotiating a binding instrument, and that’s what we’re pushing for here this week.”\u003c/p>\n\u003c/div>\n\u003c/article>\n\u003cdiv id=\"taboolaContainer\" class=\"taboolaContainer\">\n\u003cdiv id=\"taboola-below-article-text-links\">\u003c/div>\n\u003cdiv id=\"taboola-below-article-thumbnails-2nd\" class=\" trc_related_container trc_spotlight_widget\">\u003c/div>\n\u003cdiv id=\"taboola-below-article-thumbnails\" class=\" trc_related_container trc_spotlight_widget render-late-effect tbl-feed-container tbl-feed-full-width\">\n\u003cdiv class=\"tbl-feed-header\">\u003c/div>\n\u003c/div>\n\u003c/div>\n\u003c/div>\n\u003cp>[ad fullwidth]\u003c/p>\u003cp>\u003c/p>\n","blocks":[],"excerpt":"Top advocacy groups say governments and militaries should be prevented from developing lethal autonomous weapons systems. They warn that technological advances are outpacing international law.","status":"publish","parent":0,"modified":1535479020,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":13,"wordCount":472},"headData":{"title":"Experts Warn Era of Killer Robots Not Far as Technological Advances Outpace Regulations | KQED","description":"Top advocacy groups say governments and militaries should be prevented from developing lethal autonomous weapons systems. They warn that technological advances are outpacing international law.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"444121 https://ww2.kqed.org/futureofyou/?p=444121","disqusUrl":"https://ww2.kqed.org/futureofyou/2018/08/28/experts-warn-era-of-killer-robots-not-far-as-technological-advances-outpace-regulations/","disqusTitle":"Experts Warn Era of Killer Robots Not Far as Technological Advances Outpace Regulations","source":"Technology","nprByline":"Jamey Keaten\u003cbr />The Associated Press","path":"/futureofyou/444121/experts-warn-era-of-killer-robots-not-far-as-technological-advances-outpace-regulations","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Experts from scores of countries are meeting to discuss ways to define and deal with “killer robots” — futuristic weapons systems that could conduct war without human intervention.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>The weeklong gathering that opened Monday is the second at U.N. offices in Geneva this year to focus on such lethal autonomous weapons systems and to explore possibilities for regulating them, among other issues.\u003c/p>\n\u003cp>In theory, fully autonomous, computer-controlled weapons don’t exist yet, U.N. officials say. The debate is still in its infancy, and the experts have at times grappled with basic definitions. The United States has argued that it’s premature to establish a definition of such systems, much less regulate them.\u003c/p>\n\u003cdiv id=\"div-gpt-ad-1470255291270-0\" class=\"ad-placeholder\">\n\u003carticle id=\"contentArea\" class=\" \">\n\u003cdiv class=\"articleBody\">\n\u003cp>Some top advocacy groups say governments and militaries should be prevented from developing such systems, which have sparked fears and led some critics to envisage harrowing scenarios about their use.\u003c/p>\n\u003cp>As the meeting got underway, Amnesty International urged countries to work toward a ban.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Killer robots are “no longer the stuff of science fiction,” Rasha Abdul Rahim, an artificial intelligence researcher for the human rights organization, said. Rahim warned that technological advances are outpacing international law.\u003c/p>\n\u003cp>Part of the trouble for activists, however, is that the U.N.-backed conference that convened the meeting works by consensus. A single participating country — like a big military power — therefore could scuttle efforts to reach an international ban.\u003c/p>\n\u003cp>Amandeep Gill, who is chairing the meeting and a former Indian ambassador to the U.N.-backed Conference on Disarmament, said progress is being made. He summarized three general camps of countries: One seeks a formal, legal ban on such weapons; another wants a political, but non-binding agreement; and a third wants no changes at all.\u003c/p>\n\u003cp>“We are coming closer to an agreement on what should be the guiding principles — guiding the behavior of states and guiding the development and deployment of such systems around the world,” Gill told reporters Monday. “And this is not an insignificant outcome.”\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>At a news conference hosted by the Campaign to Stop Killer Robots, Nobel Peace Prize laureate Jody Williams said the group wanted “meaningful human control” when it comes to the use of military weapons and negotiations toward a ban on computer-controlled weapons systems.\u003c/p>\n\u003cp>“There is a lot of movement within the governments: We’re up to 26 now that have called for a ban,” said Williams, who won the 1997 Nobel for her work against land mines. “Logic would dictate — at least in my thinking — that there would be a mandate toward negotiating a binding instrument, and that’s what we’re pushing for here this week.”\u003c/p>\n\u003c/div>\n\u003c/article>\n\u003cdiv id=\"taboolaContainer\" class=\"taboolaContainer\">\n\u003cdiv id=\"taboola-below-article-text-links\">\u003c/div>\n\u003cdiv id=\"taboola-below-article-thumbnails-2nd\" class=\" trc_related_container trc_spotlight_widget\">\u003c/div>\n\u003cdiv id=\"taboola-below-article-thumbnails\" class=\" trc_related_container trc_spotlight_widget render-late-effect tbl-feed-container tbl-feed-full-width\">\n\u003cdiv class=\"tbl-feed-header\">\u003c/div>\n\u003c/div>\n\u003c/div>\n\u003c/div>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/444121/experts-warn-era-of-killer-robots-not-far-as-technological-advances-outpace-regulations","authors":["byline_futureofyou_444121"],"categories":["futureofyou_1062","futureofyou_1","futureofyou_73"],"tags":["futureofyou_1576","futureofyou_1607","futureofyou_722","futureofyou_35","futureofyou_1608"],"collections":["futureofyou_1097"],"featImg":"futureofyou_444124","label":"source_futureofyou_444121"},"futureofyou_443829":{"type":"posts","id":"futureofyou_443829","meta":{"index":"posts_1591205157","site":"futureofyou","id":"443829","score":null,"sort":[1533675608000]},"guestAuthors":[],"slug":"genetic-tests-can-hurt-your-chances-of-getting-some-types-of-insurance","title":"Genetic Tests Can Hurt Your Chances Of Getting Some Types Of Insurance","publishDate":1533675608,"format":"standard","headTitle":"KQED Future of You | KQED Science","labelTerm":{},"content":"\u003cp>Taking a genetic test in your 20s or 30s could, indeed, affect your ability to get long-term-care insurance later — or at least the price you'll pay. And people who are considering enrolling in Medicare \u003cem>after\u003c/em> age 65 would do well to read the fine print of the sign-up rules. Readers have insurance questions on these topics this month, and we have answers:\u003c/p>\n\u003cp>\u003cstrong>Q: Can getting a genetic test interfere with being able to buy long-term-care insurance in the future? If you do get a plan, can the insurer drop you after you find out the results of a genetic test?\u003c/strong>\u003c/p>\n\u003cp>In general, long-term-care insurers \u003ca href=\"https://www.npr.org/sections/health-shots/2018/07/11/627287642/has-genetic-privacy-been-strained-by-trumps-recent-aca-moves\" target=\"_blank\" rel=\"noopener\">can indeed use genetic test results\u003c/a> when they decide whether to offer you coverage. The federal Genetic Information Nondiscrimination Act does prohibit insurers from asking for or using your genetic information to make decisions about whether to sell you \u003cem>health\u003c/em> insurance or how much to charge you. But those privacy protections don't apply to long-term-care policies, life insurance or disability insurance.[contextly_sidebar id=\"qQSelkzIcg9rHvmpdeoo1Q3hIhLbJVzz\"]\u003c/p>\n\u003cp>When you apply for a long-term-care policy, the insurer is permitted to review your medical records and ask you questions about your health history and that of your family. It's all part of the underwriting process to determine whether to offer you a policy and how much to charge.\u003c/p>\n\u003cp>If the insurer asks you whether you've undergone genetic testing, you generally must disclose it, even if the testing was performed through a direct-to-consumer site like 23andMe, says Catherine Theroux, a spokeswoman for \u003ca href=\"https://www.limra.com/News_Center/\" target=\"_blank\" rel=\"noopener\">LIMRA\u003c/a>, an insurance industry trade group.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"You need to release any medically relevant information,\" she says.\u003c/p>\n\u003cp>Some states provide extra consumer protections related to genetic testing and long-term-care insurance, says \u003ca href=\"https://www.law.gwu.edu/sonia-m-suter\" target=\"_blank\" rel=\"noopener\">Sonia Mateu Suter\u003c/a>, a law professor at George Washington University who specializes in genetics and the law. But most follow federal law.\u003c/p>\n\u003cp>If you get genetic testing after you have a policy, the results can't affect your coverage.\u003c/p>\n\u003cp>\"Once the policy has been underwritten and issued, the insurer doesn't revoke the policy if new medical information comes to light,\" Theroux says.\u003c/p>\n\u003cp>\u003cstrong>Q: Can I switch Medigap insurance companies midway through the year? I found a less expensive policy.\u003c/strong>\u003c/p>\n\u003cp>It depends. Under federal law, when people turn 65 and first enroll in Medicare Part B they have a six-month window to sign up for a \u003ca href=\"https://www.medicare.gov/supplement-other-insurance/medigap/whats-medigap.html\" target=\"_blank\" rel=\"noopener\">Medigap plan\u003c/a> — a commercial policy that picks up some of the out-of-pocket costs for services that Medicare doesn't cover. (\u003ca href=\"https://www.medicare.gov/what-medicare-covers/part-a/what-part-a-covers.html\" target=\"_blank\" rel=\"noopener\">Medicare Part A covers\u003c/a> hospitalization, and \u003ca href=\"https://www.medicare.gov/what-medicare-covers/part-b/what-medicare-part-b-covers.html\" target=\"_blank\" rel=\"noopener\">Medicare Part B covers\u003c/a> outpatient services.) During that six-month period, insurers have to accept enrollees, even if they have health problems.[contextly_sidebar id=\"AH3oYgfcAwGcfBrC61gPsQfir4oB7Yc7\"]\u003c/p>\n\u003cp>If you're still within that six-month period now and you want to switch plans, go right ahead.\u003c/p>\n\u003cp>But if you're past the six-month window, under federal law, insurers are required to sell you a plan only in certain circumstances — such as if you lose your retiree coverage or Medicare Advantage plan. If you don't meet the criteria, insurers can decline to cover you or charge you more for preexisting medical conditions.\u003c/p>\n\u003cp>Many states have provided more robust protections, however. Three states — Connecticut, Massachusetts and New York — have year-round open enrollment and require insurers to offer coverage. And Maine requires a one-month \"guaranteed issue\" open-enrollment period every year.\u003c/p>\n\u003cp>Some states guarantee current policyholders a chance to switch Medigap plans at certain points during the year. Other states have \u003ca href=\"https://www.kff.org/medicare/issue-brief/medigap-enrollment-and-consumer-protections-vary-across-states/\" target=\"_blank\" rel=\"noopener\">additional qualifying events\u003c/a> that allow people to switch Medigap plans, according to data from the Kaiser Family Foundation.\u003c/p>\n\u003cp>\"The first thing the person should do is check with her state insurance department to find out her rights related to buying a Medigap plan,\" says \u003ca href=\"https://www.ncoa.org/centerforbenefits/about-the-center/\" target=\"_blank\" rel=\"noopener\">Brandy Bauer\u003c/a>, associate director at the Center for Benefits Access at the National Council on Aging. If you decide to go ahead and switch, she says, it is wise to sign up for a new plan before terminating your current policy.[contextly_sidebar id=\"t6VA7YIl0My5E1I6mIhIw1XmFGiwNdrT\"]\u003c/p>\n\u003cp>\u003cstrong>Q: I did not enroll in Medicare Part B when I turned 65 because I already have a regular plan that covers everything. I was told that the insurer would keep paying as usual, but now the company says it will pay only part and that I have to buy Medicare Part B. I didn't want to pay for two policies. Is there anything I can do to avoid that?\u003c/strong>\u003c/p>\n\u003cp>From your description, it's hard to know exactly what's going on, but we can make educated guesses. Typically, when people turn 65, it makes sense to sign up for Medicare unless they or their spouse are working and getting health insurance from an employer. For others, at age 65, Medicare typically becomes their primary insurer and any other coverage they have becomes secondary, filling in gaps in Medicare coverage.\u003c/p>\n\u003cp>If you have an individual policy that you bought on the health insurance exchange, and decide to hang on to it instead of signing up for Medicare, your premiums and other costs could be higher than they would be on Medicare, depending on your income.\u003c/p>\n\u003cp>But if you're not receiving employee coverage and you don't enroll in Medicare Part B, you could be subject to a permanent \u003ca href=\"https://www.medicare.gov/your-medicare-costs/part-b-costs/penalty/part-b-late-enrollment-penalty.html\" target=\"_blank\" rel=\"noopener\">late enrollment penalty\u003c/a> of 10 percent of the policy's premium for every 12 months that you could have signed up for Part B but didn't.\u003c/p>\n\u003cp>You could also owe a premium penalty for not signing up for a Part D prescription drug plan. (Most people don't owe any premium for Medicare Part A, so there's no penalty for late sign-up.)\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Your best move now may be to call 800-Medicare or visit your local \u003ca href=\"https://www.medicare.gov/contacts/#resources/ships\" target=\"_blank\" rel=\"noopener\">state health insurance assistance program\u003c/a> to help sort out your coverage issues, including whether to drop your current coverage and sign up for Medicare Part B and Part D.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 Kaiser Health News. To see more, visit \u003ca href=\"http://www.kaiserhealthnews.org/\" target=\"_blank\" rel=\"noopener\">Kaiser Health News\u003c/a>.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Genetic+Tests+Can+Hurt+Your+Chances+Of+Getting+Some+Types+Of+Insurance&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n","blocks":[],"excerpt":"Federal law keeps insurers from using genetic test results when pricing and issuing health insurance. But the tests might keep you from being able to get life insurance or a long-term-care policy.","status":"publish","parent":0,"modified":1533650118,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":24,"wordCount":1020},"headData":{"title":"Genetic Tests Can Hurt Your Chances Of Getting Some Types Of Insurance | KQED","description":"Federal law keeps insurers from using genetic test results when pricing and issuing health insurance. But the tests might keep you from being able to get life insurance or a long-term-care policy.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"443829 https://ww2.kqed.org/futureofyou/?p=443829","disqusUrl":"https://ww2.kqed.org/futureofyou/2018/08/07/genetic-tests-can-hurt-your-chances-of-getting-some-types-of-insurance/","disqusTitle":"Genetic Tests Can Hurt Your Chances Of Getting Some Types Of Insurance","source":"Health","nprByline":"Michelle Andrews, KHN","nprImageAgency":"Science Photo Library RF/Getty Images","nprStoryId":"636026264","nprApiLink":"http://api.npr.org/query?id=636026264&apiKey=MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004","nprHtmlLink":"https://www.npr.org/sections/health-shots/2018/08/07/636026264/genetic-tests-can-hurt-your-chances-of-getting-some-types-of-insurance?ft=nprml&f=636026264","nprRetrievedStory":"1","nprPubDate":"Tue, 07 Aug 2018 09:08:00 -0400","nprStoryDate":"Tue, 07 Aug 2018 09:00:18 -0400","nprLastModifiedDate":"Tue, 07 Aug 2018 09:08:23 -0400","path":"/futureofyou/443829/genetic-tests-can-hurt-your-chances-of-getting-some-types-of-insurance","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Taking a genetic test in your 20s or 30s could, indeed, affect your ability to get long-term-care insurance later — or at least the price you'll pay. And people who are considering enrolling in Medicare \u003cem>after\u003c/em> age 65 would do well to read the fine print of the sign-up rules. Readers have insurance questions on these topics this month, and we have answers:\u003c/p>\n\u003cp>\u003cstrong>Q: Can getting a genetic test interfere with being able to buy long-term-care insurance in the future? If you do get a plan, can the insurer drop you after you find out the results of a genetic test?\u003c/strong>\u003c/p>\n\u003cp>In general, long-term-care insurers \u003ca href=\"https://www.npr.org/sections/health-shots/2018/07/11/627287642/has-genetic-privacy-been-strained-by-trumps-recent-aca-moves\" target=\"_blank\" rel=\"noopener\">can indeed use genetic test results\u003c/a> when they decide whether to offer you coverage. The federal Genetic Information Nondiscrimination Act does prohibit insurers from asking for or using your genetic information to make decisions about whether to sell you \u003cem>health\u003c/em> insurance or how much to charge you. But those privacy protections don't apply to long-term-care policies, life insurance or disability insurance.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>When you apply for a long-term-care policy, the insurer is permitted to review your medical records and ask you questions about your health history and that of your family. It's all part of the underwriting process to determine whether to offer you a policy and how much to charge.\u003c/p>\n\u003cp>If the insurer asks you whether you've undergone genetic testing, you generally must disclose it, even if the testing was performed through a direct-to-consumer site like 23andMe, says Catherine Theroux, a spokeswoman for \u003ca href=\"https://www.limra.com/News_Center/\" target=\"_blank\" rel=\"noopener\">LIMRA\u003c/a>, an insurance industry trade group.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"You need to release any medically relevant information,\" she says.\u003c/p>\n\u003cp>Some states provide extra consumer protections related to genetic testing and long-term-care insurance, says \u003ca href=\"https://www.law.gwu.edu/sonia-m-suter\" target=\"_blank\" rel=\"noopener\">Sonia Mateu Suter\u003c/a>, a law professor at George Washington University who specializes in genetics and the law. But most follow federal law.\u003c/p>\n\u003cp>If you get genetic testing after you have a policy, the results can't affect your coverage.\u003c/p>\n\u003cp>\"Once the policy has been underwritten and issued, the insurer doesn't revoke the policy if new medical information comes to light,\" Theroux says.\u003c/p>\n\u003cp>\u003cstrong>Q: Can I switch Medigap insurance companies midway through the year? I found a less expensive policy.\u003c/strong>\u003c/p>\n\u003cp>It depends. Under federal law, when people turn 65 and first enroll in Medicare Part B they have a six-month window to sign up for a \u003ca href=\"https://www.medicare.gov/supplement-other-insurance/medigap/whats-medigap.html\" target=\"_blank\" rel=\"noopener\">Medigap plan\u003c/a> — a commercial policy that picks up some of the out-of-pocket costs for services that Medicare doesn't cover. (\u003ca href=\"https://www.medicare.gov/what-medicare-covers/part-a/what-part-a-covers.html\" target=\"_blank\" rel=\"noopener\">Medicare Part A covers\u003c/a> hospitalization, and \u003ca href=\"https://www.medicare.gov/what-medicare-covers/part-b/what-medicare-part-b-covers.html\" target=\"_blank\" rel=\"noopener\">Medicare Part B covers\u003c/a> outpatient services.) During that six-month period, insurers have to accept enrollees, even if they have health problems.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>If you're still within that six-month period now and you want to switch plans, go right ahead.\u003c/p>\n\u003cp>But if you're past the six-month window, under federal law, insurers are required to sell you a plan only in certain circumstances — such as if you lose your retiree coverage or Medicare Advantage plan. If you don't meet the criteria, insurers can decline to cover you or charge you more for preexisting medical conditions.\u003c/p>\n\u003cp>Many states have provided more robust protections, however. Three states — Connecticut, Massachusetts and New York — have year-round open enrollment and require insurers to offer coverage. And Maine requires a one-month \"guaranteed issue\" open-enrollment period every year.\u003c/p>\n\u003cp>Some states guarantee current policyholders a chance to switch Medigap plans at certain points during the year. Other states have \u003ca href=\"https://www.kff.org/medicare/issue-brief/medigap-enrollment-and-consumer-protections-vary-across-states/\" target=\"_blank\" rel=\"noopener\">additional qualifying events\u003c/a> that allow people to switch Medigap plans, according to data from the Kaiser Family Foundation.\u003c/p>\n\u003cp>\"The first thing the person should do is check with her state insurance department to find out her rights related to buying a Medigap plan,\" says \u003ca href=\"https://www.ncoa.org/centerforbenefits/about-the-center/\" target=\"_blank\" rel=\"noopener\">Brandy Bauer\u003c/a>, associate director at the Center for Benefits Access at the National Council on Aging. If you decide to go ahead and switch, she says, it is wise to sign up for a new plan before terminating your current policy.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\u003cstrong>Q: I did not enroll in Medicare Part B when I turned 65 because I already have a regular plan that covers everything. I was told that the insurer would keep paying as usual, but now the company says it will pay only part and that I have to buy Medicare Part B. I didn't want to pay for two policies. Is there anything I can do to avoid that?\u003c/strong>\u003c/p>\n\u003cp>From your description, it's hard to know exactly what's going on, but we can make educated guesses. Typically, when people turn 65, it makes sense to sign up for Medicare unless they or their spouse are working and getting health insurance from an employer. For others, at age 65, Medicare typically becomes their primary insurer and any other coverage they have becomes secondary, filling in gaps in Medicare coverage.\u003c/p>\n\u003cp>If you have an individual policy that you bought on the health insurance exchange, and decide to hang on to it instead of signing up for Medicare, your premiums and other costs could be higher than they would be on Medicare, depending on your income.\u003c/p>\n\u003cp>But if you're not receiving employee coverage and you don't enroll in Medicare Part B, you could be subject to a permanent \u003ca href=\"https://www.medicare.gov/your-medicare-costs/part-b-costs/penalty/part-b-late-enrollment-penalty.html\" target=\"_blank\" rel=\"noopener\">late enrollment penalty\u003c/a> of 10 percent of the policy's premium for every 12 months that you could have signed up for Part B but didn't.\u003c/p>\n\u003cp>You could also owe a premium penalty for not signing up for a Part D prescription drug plan. (Most people don't owe any premium for Medicare Part A, so there's no penalty for late sign-up.)\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Your best move now may be to call 800-Medicare or visit your local \u003ca href=\"https://www.medicare.gov/contacts/#resources/ships\" target=\"_blank\" rel=\"noopener\">state health insurance assistance program\u003c/a> to help sort out your coverage issues, including whether to drop your current coverage and sign up for Medicare Part B and Part D.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 Kaiser Health News. To see more, visit \u003ca href=\"http://www.kaiserhealthnews.org/\" target=\"_blank\" rel=\"noopener\">Kaiser Health News\u003c/a>.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Genetic+Tests+Can+Hurt+Your+Chances+Of+Getting+Some+Types+Of+Insurance&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/443829/genetic-tests-can-hurt-your-chances-of-getting-some-types-of-insurance","authors":["byline_futureofyou_443829"],"categories":["futureofyou_452","futureofyou_1","futureofyou_73","futureofyou_1064"],"tags":["futureofyou_1015","futureofyou_61","futureofyou_419","futureofyou_35"],"collections":["futureofyou_1094"],"featImg":"futureofyou_443830","label":"source_futureofyou_443829"},"futureofyou_443696":{"type":"posts","id":"futureofyou_443696","meta":{"index":"posts_1591205157","site":"futureofyou","id":"443696","score":null,"sort":[1533157241000]},"guestAuthors":[],"slug":"watch-how-the-brain-transforms-vision-into-action","title":"WATCH: How the Brain Transforms Vision Into Action","publishDate":1533157241,"format":"aside","headTitle":"KQED Future of You | KQED Science","labelTerm":{},"content":"\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe src=\"https://content.jwplatform.com/players/FN1FYn4y-jEuQjxp9.html\" width=\"640\" height=\"360\" frameborder=\"0\" scrolling=\"yes\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003cp>What we see often determines how we act: We hit the brakes if a car is stopped ahead of us. We duck to avoid a low-hanging tree branch. We bend down to tie our shoe when the laces come undone.We rarely give these actions a second thought. But Mriganka Sur, a professor at the Massachusetts Institute of Technology’s Picower Institute for Learning and Memory, is obsessed with them.“How is vision, which we do effortlessly, transformed into action, which requires volition, which requires attention and engagement?” Sur asked. “How this transformation takes place is a fundamental question that is at the heart of brain function and behavior.”\u003c/p>\n\u003cp>In a recent \u003ca href=\"https://www.nature.com/articles/s41467-018-05012-y\" target=\"_blank\" rel=\"noopener\">mouse study\u003c/a> published in Nature Communications, Sur and his team took a step toward answering that question\u003cem>.\u003c/em> Their experimental data suggest that the posterior parietal cortex, or PPC, may help us make decisions based on what we see.\u003c/p>\n\u003cp>First author Gerald Pho, formerly a Ph.D. student in Sur’s lab and now a postdoctoral fellow at Harvard, was exhilarated to see mice’s PPCs light up under a microscope when they made choices based on visual stimuli.\u003c/p>\n\u003cp>“It’s quite magical,” he said. “It’s almost like fireworks.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Pho said he’s excited to see how our understanding of visual decision-making will develop as imaging technology becomes more advanced.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“I just think we’re in an exciting time in neuroscience,” he said. “And I think the advance of these technologies can only improve our ability to understand how the brain works in a normal animal, and extending to humans, but also how it goes awry in neurological disease.”\u003c/p>\n\n","blocks":[],"excerpt":null,"status":"publish","parent":0,"modified":1533236967,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":9,"wordCount":296},"headData":{"title":"WATCH: How the Brain Transforms Vision Into Action | KQED","description":"What we see often determines how we act: We hit the brakes if a car is stopped ahead of us. We duck to avoid a low-hanging tree branch. We bend down to tie our shoe when the laces come undone.We rarely give these actions a second thought. But Mriganka Sur, a professor at the Massachusetts","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"443696 https://ww2.kqed.org/futureofyou/?p=443696","disqusUrl":"https://ww2.kqed.org/futureofyou/2018/08/01/watch-how-the-brain-transforms-vision-into-action/","disqusTitle":"WATCH: How the Brain Transforms Vision Into Action","source":"Health","nprByline":"Jaclyn Jeffrey-Wilensky\u003cbr />STAT","path":"/futureofyou/443696/watch-how-the-brain-transforms-vision-into-action","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe src=\"https://content.jwplatform.com/players/FN1FYn4y-jEuQjxp9.html\" width=\"640\" height=\"360\" frameborder=\"0\" scrolling=\"yes\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003cp>What we see often determines how we act: We hit the brakes if a car is stopped ahead of us. We duck to avoid a low-hanging tree branch. We bend down to tie our shoe when the laces come undone.We rarely give these actions a second thought. But Mriganka Sur, a professor at the Massachusetts Institute of Technology’s Picower Institute for Learning and Memory, is obsessed with them.“How is vision, which we do effortlessly, transformed into action, which requires volition, which requires attention and engagement?” Sur asked. “How this transformation takes place is a fundamental question that is at the heart of brain function and behavior.”\u003c/p>\n\u003cp>In a recent \u003ca href=\"https://www.nature.com/articles/s41467-018-05012-y\" target=\"_blank\" rel=\"noopener\">mouse study\u003c/a> published in Nature Communications, Sur and his team took a step toward answering that question\u003cem>.\u003c/em> Their experimental data suggest that the posterior parietal cortex, or PPC, may help us make decisions based on what we see.\u003c/p>\n\u003cp>First author Gerald Pho, formerly a Ph.D. student in Sur’s lab and now a postdoctoral fellow at Harvard, was exhilarated to see mice’s PPCs light up under a microscope when they made choices based on visual stimuli.\u003c/p>\n\u003cp>“It’s quite magical,” he said. “It’s almost like fireworks.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Pho said he’s excited to see how our understanding of visual decision-making will develop as imaging technology becomes more advanced.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“I just think we’re in an exciting time in neuroscience,” he said. “And I think the advance of these technologies can only improve our ability to understand how the brain works in a normal animal, and extending to humans, but also how it goes awry in neurological disease.”\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/443696/watch-how-the-brain-transforms-vision-into-action","authors":["byline_futureofyou_443696"],"categories":["futureofyou_1","futureofyou_73","futureofyou_1061"],"tags":["futureofyou_56","futureofyou_1037","futureofyou_35","futureofyou_565"],"collections":["futureofyou_1096"],"featImg":"futureofyou_435640","label":"source_futureofyou_443696"},"futureofyou_443483":{"type":"posts","id":"futureofyou_443483","meta":{"index":"posts_1591205157","site":"futureofyou","id":"443483","score":null,"sort":[1532026830000]},"guestAuthors":[],"slug":"physicists-go-small-lets-put-a-particle-accelerator-on-a-chip","title":"Physicists Go Small: Let's Put A Particle Accelerator On A Chip","publishDate":1532026830,"format":"standard","headTitle":"KQED Future of You | KQED Science","labelTerm":{},"content":"\u003cp>When people think of particle accelerators, they tend to think of giant structures: tunnels many miles long that electrons and protons race through at tremendous speeds, packing enormous energy.\u003c/p>\n\u003cp>But scientists in California think small is beautiful. They want to build an accelerator on semiconductor chips. An accelerator built that way won't achieve the energy of its much larger cousins, but it could accelerate material research and revolutionize medical therapy.\u003c/p>\n\u003cp>First of all, what is an accelerator?\u003c/p>\n\u003cp>\"An accelerator is a way to add energy to particles,\" says \u003ca href=\"https://web.stanford.edu/~rlbyer/\" target=\"_blank\" rel=\"noopener\">Robert Byer\u003c/a>, a physicist at Stanford University. Once you have those energetic particles, you can do things with them, like irradiate tumors or generate X-rays that scientists use to investigate new materials. An accelerator built this way would bring an accelerator's usefulness within the reach of more researchers.\u003c/p>\n\u003cp>Byer has been trying to shrink the size of particle accelerators for more than 40 years. His idea is to use lasers to add energy to electrons as they zip through a tiny channel in a semiconductor chip. Byer says this is a miniaturized version of what goes on in larger accelerators, but there are big challenges to doing this on such a small scale.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"We need to focus the electrons,\" Byer says. \"We need to bunch them so they surf the wavelength of light right at the crest, so they get the maximum acceleration.\"\u003c/p>\n\u003cp>Byer and his colleagues are working on those challenges in a laboratory in the basement of the Spilker Engineering and Applied Sciences building on the Stanford campus. Byer took me on a tour there.\u003c/p>\n\u003cp>We put on glasses to protect our eyes from the powerful laser light used in the pint-sized accelerator.\u003c/p>\n\u003cp>A big red emergency shut-off button attached to a shelf suggests this is not equipment to trifle with.\u003c/p>\n\u003cp>\u003ca href=\"https://www.laserphysics.nat.fau.eu/person/peter-hommelhoff/\" target=\"_blank\" rel=\"noopener\">Peter Hommelhoff\u003c/a> of the Friedrich-Alexander-Universität Erlangen-Nürnberg in Germany says one of the big challenges is to keep the electrons in the accelerator traveling where you want them to.\u003c/p>\n\u003cp>\"The acceleration channel is very narrow, so you have to generate a very, very narrow electron beam that you can send through the channel,\" Hommelhoff says.\u003c/p>\n\u003cp>\"It's a little like threading an invisible needle,\" says Dylan Black, a Stanford graduate student in physics.\u003c/p>\n\u003cp>Testing their accelerator requires lasers and lenses and pumps scattered around benches in the lab, it takes up a fair amount of space. But this is just a prototype.\u003c/p>\n\u003cp>Black points to a bright circle of light on a monitor's screen.\u003c/p>\n\u003cp>\"That there is a picture of what the electron beam would look like if you put your eye right in front of the beam,\" Black says.\u003c/p>\n\u003cp>\"Which I would not recommend,\" interjects Ken Leedle, a research engineer working on the accelerator-on-a-chip project.\u003c/p>\n\u003cp>I asked \u003ca href=\"https://portal.slac.stanford.edu/sites/ard_public/people/joen/Pages/default.aspx\" target=\"_blank\" rel=\"noopener\">R. Joel England\u003c/a>, a physicist at the SLAC National Accelerator Laboratory who has been working on the accelerator-on-a-chip project, how long it will be before the prototype turns into a working instrument.\u003c/p>\n\u003cp>\"Depending on how much progress gets made, I would say five to 10 years,\" England says. England is enthusiastic about the promise of these small-scale accelerators.\u003c/p>\n\u003cp>\"One of the applications could be to take one of the fairly bulky, 10,000-pound accelerator devices that's used in hospitals for radiation therapy and make that into something that's chip-sized,\" he says.\u003c/p>\n\u003cp>In addition to saving huge costs and space, it might eventually be possible to insert a chip-sized accelerator into a patient's body, where it could directly irradiate a tumor.\u003c/p>\n\u003cp>Even though it may take a decade or more, Robert Byer is convinced smaller accelerators will become a reality. His isn't the only lab working on the idea. And besides, he points out, new technologies often start out bulky. Take the first laser to come on the scene.\u003c/p>\n\u003cp>\"Early on, lasers were big — and they were inefficient and they took all the power and water in your building to operate them,\" Byer says. \"They got more and more efficient because we converted to semiconductor lasers and solid state lasers — and all of a sudden, lasers then became everywhere.\"\u003c/p>\n\u003cp>Even new mobile phones have lasers in them, Byer says.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The day of the accelerator on a chip, he believes, is coming.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Physicists+Go+Small%3A+Let%27s+Put+A+Particle+Accelerator+On+A+Chip&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n","blocks":[],"excerpt":"A tiny accelerator could be useful in medicine as well as basic science. Instead of speeding up beams of electrons through giant tunnels, the aim here is to build accelerators on semiconductor chips.","status":"publish","parent":0,"modified":1531988491,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":26,"wordCount":740},"headData":{"title":"Physicists Go Small: Let's Put A Particle Accelerator On A Chip | KQED","description":"A tiny accelerator could be useful in medicine as well as basic science. Instead of speeding up beams of electrons through giant tunnels, the aim here is to build accelerators on semiconductor chips.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"443483 https://ww2.kqed.org/futureofyou/?p=443483","disqusUrl":"https://ww2.kqed.org/futureofyou/2018/07/19/physicists-go-small-lets-put-a-particle-accelerator-on-a-chip/","disqusTitle":"Physicists Go Small: Let's Put A Particle Accelerator On A Chip","source":"Technology","nprByline":"Joe Palca, NPR","nprImageAgency":"SLAC National Accelerator Laboratory","nprStoryId":"630101228","nprApiLink":"http://api.npr.org/query?id=630101228&apiKey=MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004","nprHtmlLink":"https://www.npr.org/sections/health-shots/2018/07/18/630101228/physicists-go-small-lets-put-a-particle-accelerator-on-a-chip?ft=nprml&f=630101228","nprRetrievedStory":"1","nprPubDate":"Wed, 18 Jul 2018 20:14:00 -0400","nprStoryDate":"Wed, 18 Jul 2018 16:43:00 -0400","nprLastModifiedDate":"Wed, 18 Jul 2018 20:12:45 -0400","nprAudio":"https://ondemand.npr.org/anon.npr-mp3/npr/atc/2018/07/20180718_atc_physicists_go_small_lets_put_a_particle_accelerator_on_a_chip.mp3?orgId=1&topicId=1007&aggIds=156490415&d=234&p=2&story=630101228&ft=nprml&f=630101228","nprAudioM3u":"http://api.npr.org/m3u/1630246579-d9b830.m3u?orgId=1&topicId=1007&aggIds=156490415&d=234&p=2&story=630101228&ft=nprml&f=630101228","path":"/futureofyou/443483/physicists-go-small-lets-put-a-particle-accelerator-on-a-chip","audioUrl":"https://ondemand.npr.org/anon.npr-mp3/npr/atc/2018/07/20180718_atc_physicists_go_small_lets_put_a_particle_accelerator_on_a_chip.mp3?orgId=1&topicId=1007&aggIds=156490415&d=234&p=2&story=630101228&ft=nprml&f=630101228","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>When people think of particle accelerators, they tend to think of giant structures: tunnels many miles long that electrons and protons race through at tremendous speeds, packing enormous energy.\u003c/p>\n\u003cp>But scientists in California think small is beautiful. They want to build an accelerator on semiconductor chips. An accelerator built that way won't achieve the energy of its much larger cousins, but it could accelerate material research and revolutionize medical therapy.\u003c/p>\n\u003cp>First of all, what is an accelerator?\u003c/p>\n\u003cp>\"An accelerator is a way to add energy to particles,\" says \u003ca href=\"https://web.stanford.edu/~rlbyer/\" target=\"_blank\" rel=\"noopener\">Robert Byer\u003c/a>, a physicist at Stanford University. Once you have those energetic particles, you can do things with them, like irradiate tumors or generate X-rays that scientists use to investigate new materials. An accelerator built this way would bring an accelerator's usefulness within the reach of more researchers.\u003c/p>\n\u003cp>Byer has been trying to shrink the size of particle accelerators for more than 40 years. His idea is to use lasers to add energy to electrons as they zip through a tiny channel in a semiconductor chip. Byer says this is a miniaturized version of what goes on in larger accelerators, but there are big challenges to doing this on such a small scale.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"We need to focus the electrons,\" Byer says. \"We need to bunch them so they surf the wavelength of light right at the crest, so they get the maximum acceleration.\"\u003c/p>\n\u003cp>Byer and his colleagues are working on those challenges in a laboratory in the basement of the Spilker Engineering and Applied Sciences building on the Stanford campus. Byer took me on a tour there.\u003c/p>\n\u003cp>We put on glasses to protect our eyes from the powerful laser light used in the pint-sized accelerator.\u003c/p>\n\u003cp>A big red emergency shut-off button attached to a shelf suggests this is not equipment to trifle with.\u003c/p>\n\u003cp>\u003ca href=\"https://www.laserphysics.nat.fau.eu/person/peter-hommelhoff/\" target=\"_blank\" rel=\"noopener\">Peter Hommelhoff\u003c/a> of the Friedrich-Alexander-Universität Erlangen-Nürnberg in Germany says one of the big challenges is to keep the electrons in the accelerator traveling where you want them to.\u003c/p>\n\u003cp>\"The acceleration channel is very narrow, so you have to generate a very, very narrow electron beam that you can send through the channel,\" Hommelhoff says.\u003c/p>\n\u003cp>\"It's a little like threading an invisible needle,\" says Dylan Black, a Stanford graduate student in physics.\u003c/p>\n\u003cp>Testing their accelerator requires lasers and lenses and pumps scattered around benches in the lab, it takes up a fair amount of space. But this is just a prototype.\u003c/p>\n\u003cp>Black points to a bright circle of light on a monitor's screen.\u003c/p>\n\u003cp>\"That there is a picture of what the electron beam would look like if you put your eye right in front of the beam,\" Black says.\u003c/p>\n\u003cp>\"Which I would not recommend,\" interjects Ken Leedle, a research engineer working on the accelerator-on-a-chip project.\u003c/p>\n\u003cp>I asked \u003ca href=\"https://portal.slac.stanford.edu/sites/ard_public/people/joen/Pages/default.aspx\" target=\"_blank\" rel=\"noopener\">R. Joel England\u003c/a>, a physicist at the SLAC National Accelerator Laboratory who has been working on the accelerator-on-a-chip project, how long it will be before the prototype turns into a working instrument.\u003c/p>\n\u003cp>\"Depending on how much progress gets made, I would say five to 10 years,\" England says. England is enthusiastic about the promise of these small-scale accelerators.\u003c/p>\n\u003cp>\"One of the applications could be to take one of the fairly bulky, 10,000-pound accelerator devices that's used in hospitals for radiation therapy and make that into something that's chip-sized,\" he says.\u003c/p>\n\u003cp>In addition to saving huge costs and space, it might eventually be possible to insert a chip-sized accelerator into a patient's body, where it could directly irradiate a tumor.\u003c/p>\n\u003cp>Even though it may take a decade or more, Robert Byer is convinced smaller accelerators will become a reality. His isn't the only lab working on the idea. And besides, he points out, new technologies often start out bulky. Take the first laser to come on the scene.\u003c/p>\n\u003cp>\"Early on, lasers were big — and they were inefficient and they took all the power and water in your building to operate them,\" Byer says. \"They got more and more efficient because we converted to semiconductor lasers and solid state lasers — and all of a sudden, lasers then became everywhere.\"\u003c/p>\n\u003cp>Even new mobile phones have lasers in them, Byer says.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The day of the accelerator on a chip, he believes, is coming.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Physicists+Go+Small%3A+Let%27s+Put+A+Particle+Accelerator+On+A+Chip&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/443483/physicists-go-small-lets-put-a-particle-accelerator-on-a-chip","authors":["byline_futureofyou_443483"],"categories":["futureofyou_1062","futureofyou_1","futureofyou_73"],"tags":["futureofyou_1489","futureofyou_1056","futureofyou_1580","futureofyou_35"],"collections":["futureofyou_1097"],"featImg":"futureofyou_443484","label":"source_futureofyou_443483"},"futureofyou_443435":{"type":"posts","id":"futureofyou_443435","meta":{"index":"posts_1591205157","site":"futureofyou","id":"443435","score":null,"sort":[1531861237000]},"guestAuthors":[],"slug":"insurers-and-government-are-slow-to-cover-expensive-car-t-cancer-therapy","title":"Insurers And Government Are Slow To Cover Expensive CAR-T Cancer Therapy","publishDate":1531861237,"format":"standard","headTitle":"KQED Future of You | KQED Science","labelTerm":{},"content":"\u003cp>Patients whose blood cancers have failed to respond to repeated rounds of chemotherapy may be candidates for a new type of gene therapy that could send their cancers into remission for years. But the two approved therapies, with price tags of hundreds of thousands of dollars, have roiled the insurance approval process, leading to delays and, in some cases, denials of coverage, clinicians and analysts say.[contextly_sidebar id=\"ReV9Gv0J6j7ADmv2dqbEuegAVdiLN5dE\"]\u003c/p>\n\u003cp>The therapy involves collecting patients' own T cells, a type of white blood cell, genetically modifying them, and then infusing them back into patients, where they hunt down and kill cancer cells. Known as \u003ca href=\"https://www.cancer.gov/about-cancer/treatment/research/car-t-cells\" target=\"_blank\" rel=\"noopener\">CAR-T cell therapy\u003c/a>, it's been characterized as a \"living drug\" by some researchers.\u003c/p>\n\u003cp>Two different CAR-T drugs — \u003ca href=\"https://www.us.kymriah.com/diffuse-large-b-cell-lymphoma-adults/?site=KYDDAY0DTCBR0040&source=01030&gclid=CNDIg4PMpNwCFRj1swod-MwKyw&gclsrc=ds\" target=\"_blank\" rel=\"noopener\">Kymriah\u003c/a> and \u003ca href=\"https://www.yescarta.com/therapy#how-yescarta-is-different\" target=\"_blank\" rel=\"noopener\">Yescarta\u003c/a> — were approved by the FDA last year to treat patients whose blood cancers haven't responded to at least two other rounds of treatment.\u003c/p>\n\u003cp>Kymriah is \u003ca href=\"https://www.fda.gov/Drugs/InformationOnDrugs/ApprovedDrugs/ucm574154.htm\">approved\u003c/a> for people up to age 25 with a form of acute lymphoblastic leukemia, the most common cancer in children. Kymriah and Yescarta are \u003ca href=\"https://www.fda.gov/Drugs/InformationOnDrugs/ApprovedDrugs/ucm606540.htm\" target=\"_blank\" rel=\"noopener\">both\u003c/a> \u003ca href=\"https://www.fda.gov/Drugs/InformationOnDrugs/ApprovedDrugs/ucm581296.htm\" target=\"_blank\" rel=\"noopener\">approved\u003c/a> for adults with advanced lymphomas.\u003c/p>\n\u003cp>Researchers report that some critically ill patients who received the therapy have remained cancer-free for as long as five years.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"This is what patients need,\" says \u003ca href=\"https://www.mayo.edu/research/faculty/lin-yi-m-d-ph-d/bio-00092684\" target=\"_blank\" rel=\"noopener\">Dr. Yi Lin\u003c/a>, a hematologist who oversees the CAR-T cell practice and research for the Mayo Clinic. \"With the likelihood of getting patients into durable survival, we don't want to deny them the therapy.\" She says she receives no personal financial support from the drugs' makers.[contextly_sidebar id=\"nsB5Luqi8Mrdsb9vLceD3T77zYYY4sKK\"]\u003c/p>\n\u003cp>But the treatment comes at a cost — the drug treatments are hugely expensive. Kymriah and Yescarta cost $373,000 for a one-time infusion to treat adults with advanced lymphomas, while Kymriah costs $475,000 to treat acute lymphoblastic leukemia in children and young adults. That's the cost of the drug itself; in addition, many patients experience serious side effects that can land them in a hospital intensive care unit for weeks, \u003ca href=\"https://khn.org/news/cascade-of-costs-could-push-new-gene-therapy-above-1-million-per-patient/\" target=\"_blank\" rel=\"noopener\">pushing treatment costs to more than $1 million\u003c/a>.\u003c/p>\n\u003cp>All of this gives government and private insurers pause.\u003c/p>\n\u003cp>Most commercial insurers are covering CAR-T cell therapies now, but they do so on an individual basis, writing single-patient agreements each time, say cancer specialists. Large insurers that are already familiar with complicated therapies like stem-cell transplants are getting speedier at handling requests for CAR-T cell treatment, they say. But that's not always the case at smaller or regional plans, where delays can add weeks to the approval process.\u003c/p>\n\u003cp>\"A request for CAR-T may end up with somebody on the payer authorization team who doesn't understand the technology or the urgency of the request, when somebody has only weeks or months to live,\" says \u003ca href=\"https://www.asbmt.org/about/contact-us\" target=\"_blank\" rel=\"noopener\">Stephanie Farnia\u003c/a>, director of health policy and strategic relations at the American Society for Blood and Marrow Transplantation.\u003c/p>\n\u003cp>Farnia is in contact with many of the more than 50 medical centers that are authorized to provide treatment. The process of getting to a treatment center and evaluated for therapy is involved, she says. \"To then be substantially delayed due to paperwork is incredibly frustrating\" for patients.[contextly_sidebar id=\"mCjXSziNW7nkG4M52QmA48lgOAVmv3eg\"]\u003c/p>\n\u003cp>Medicare and Medicaid often pose greater coverage challenges than do private insurers, according to insurance experts.\u003c/p>\n\u003cp>Some Medicaid programs don't cover the treatment, says \u003ca href=\"AndrewsCAR-TandInsuranceDFedit.docx\" target=\"_blank\" rel=\"noopener\">Dr. Michael Bishop\u003c/a>, director of the cellular therapy program in the hematology/oncology section at the University of Chicago. Medicaid, the state-federal health program, covers children in low-income households and some adults.\u003c/p>\n\u003cp>\"Medicaid has been very tough,\" he says. \"Certain states just deny coverage — even states with balanced budgets.\"\u003c/p>\n\u003cp>States \u003ca href=\"https://icer-review.org/wp-content/uploads/2017/07/ICER_CAR_T_Final_Evidence_Report_032318.pdf\" target=\"_blank\" rel=\"noopener\">have to evaluate the cost as well as the drugs' effectiveness\u003c/a>, says \u003ca href=\"http://medicaiddirectors.org/about/staff/\" target=\"_blank\" rel=\"noopener\">Matt Salo\u003c/a>, executive director of the National Association of Medicaid Directors.\u003c/p>\n\u003cp>\"Medicaid is a finite pot of money, and it's stretched threadbare even on a good day,\" he says.\u003c/p>\n\u003cp>People who are on Medicare, the health insurance program for people age 65 and older and some people with disabilities, typically haven't faced coverage denials to date, clinicians say. But the government's reimbursement rates are raising concerns for providers.\u003c/p>\n\u003cp>Last spring, Medicare announced payment rates for providers who administer Yescarta and Kymriah on an outpatient basis. The payments would more than cover the costs of the drugs. Medicare beneficiaries' out-of-pocket costs would be capped at $1,340 plus the beneficiaries' Part B deductible (if that hasn't already been met), the agency says.[contextly_sidebar id=\"zRKGtFwAO4CBGEIycv3lNE5oWVwoZuVf\"]\u003c/p>\n\u003cp>The problem with this plan? Facilities typically provide treatment on an inpatient basis, not outpatient, because of the potential for severe, systemic side effects.\u003c/p>\n\u003cp>\"There's a lot of toxicity and questions about whether it can even be provided in an outpatient setting,\" says Gary Goldstein, the business manager at the blood and marrow transplant program at Stanford Health Care in Stanford, Calif.\u003c/p>\n\u003cp>For inpatient care, \"CAR-T cell therapy ... would be paid at a much lower amount compared to outpatient hospital use,\" according to officials at the Centers for Medicare & Medicaid Services.\u003c/p>\n\u003cp>The agency is considering how to handle payment for inpatient CAR-T care for the fiscal year that starts in October. For now, some medical centers are absorbing whatever Medicare doesn't pay.\u003c/p>\n\u003cp>\"How can you tell a patient who's 66, 'If only you'd gotten lymphoma when you were 64'?\" Goldstein asks.\u003c/p>\n\u003cp>But the current approach can't continue indefinitely, he says.\u003c/p>\n\u003cp>\"Even if there aren't any centers that are making that decision today, if coverage doesn't change for Medicare, it absolutely is going to be a problem tomorrow,\" says Goldstein.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"http://khn.org/\" target=\"_blank\" rel=\"noopener\">\u003cem>Kaiser Health News\u003c/em>\u003c/a>\u003cem>, a nonprofit news service, is an editorially independent program of the Kaiser Family Foundation, and is not affiliated with Kaiser Permanente. Michelle Andrews is on Twitter \u003c/em>\u003ca href=\"https://twitter.com/mandrews110\" target=\"_blank\" rel=\"noopener\">\u003cem>@mandrews110\u003c/em>\u003c/a>\u003cem>.\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 Kaiser Health News. To see more, visit \u003ca href=\"http://www.kaiserhealthnews.org/\" target=\"_blank\" rel=\"noopener\">Kaiser Health News\u003c/a>.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Insurers+And+Government+Are+Slow+To+Cover+Expensive+CAR-T+Cancer+Therapy&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n","blocks":[],"excerpt":"Treatment costs for the immunotherapy can run to more than $1 million. Some state Medicaid programs aren't paying for the treatment, and Medicare's complicated payment rates have hospitals worried.","status":"publish","parent":0,"modified":1531864937,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":28,"wordCount":987},"headData":{"title":"Insurers And Government Are Slow To Cover Expensive CAR-T Cancer Therapy | KQED","description":"Treatment costs for the immunotherapy can run to more than $1 million. Some state Medicaid programs aren't paying for the treatment, and Medicare's complicated payment rates have hospitals worried.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"443435 https://ww2.kqed.org/futureofyou/?p=443435","disqusUrl":"https://ww2.kqed.org/futureofyou/2018/07/17/insurers-and-government-are-slow-to-cover-expensive-car-t-cancer-therapy/","disqusTitle":"Insurers And Government Are Slow To Cover Expensive CAR-T Cancer Therapy","source":"Health","nprImageCredit":"Fanatic Studio","nprByline":"Michelle Andrews, NPR","nprImageAgency":"Collection Mix: Subjects RF/Getty Images","nprStoryId":"629543151","nprApiLink":"http://api.npr.org/query?id=629543151&apiKey=MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004","nprHtmlLink":"https://www.npr.org/sections/health-shots/2018/07/17/629543151/insurers-and-government-are-slow-to-cover-expensive-car-t-cancer-therapy?ft=nprml&f=629543151","nprRetrievedStory":"1","nprPubDate":"Tue, 17 Jul 2018 15:36:00 -0400","nprStoryDate":"Tue, 17 Jul 2018 08:02:49 -0400","nprLastModifiedDate":"Tue, 17 Jul 2018 15:36:53 -0400","path":"/futureofyou/443435/insurers-and-government-are-slow-to-cover-expensive-car-t-cancer-therapy","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Patients whose blood cancers have failed to respond to repeated rounds of chemotherapy may be candidates for a new type of gene therapy that could send their cancers into remission for years. But the two approved therapies, with price tags of hundreds of thousands of dollars, have roiled the insurance approval process, leading to delays and, in some cases, denials of coverage, clinicians and analysts say.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>The therapy involves collecting patients' own T cells, a type of white blood cell, genetically modifying them, and then infusing them back into patients, where they hunt down and kill cancer cells. Known as \u003ca href=\"https://www.cancer.gov/about-cancer/treatment/research/car-t-cells\" target=\"_blank\" rel=\"noopener\">CAR-T cell therapy\u003c/a>, it's been characterized as a \"living drug\" by some researchers.\u003c/p>\n\u003cp>Two different CAR-T drugs — \u003ca href=\"https://www.us.kymriah.com/diffuse-large-b-cell-lymphoma-adults/?site=KYDDAY0DTCBR0040&source=01030&gclid=CNDIg4PMpNwCFRj1swod-MwKyw&gclsrc=ds\" target=\"_blank\" rel=\"noopener\">Kymriah\u003c/a> and \u003ca href=\"https://www.yescarta.com/therapy#how-yescarta-is-different\" target=\"_blank\" rel=\"noopener\">Yescarta\u003c/a> — were approved by the FDA last year to treat patients whose blood cancers haven't responded to at least two other rounds of treatment.\u003c/p>\n\u003cp>Kymriah is \u003ca href=\"https://www.fda.gov/Drugs/InformationOnDrugs/ApprovedDrugs/ucm574154.htm\">approved\u003c/a> for people up to age 25 with a form of acute lymphoblastic leukemia, the most common cancer in children. Kymriah and Yescarta are \u003ca href=\"https://www.fda.gov/Drugs/InformationOnDrugs/ApprovedDrugs/ucm606540.htm\" target=\"_blank\" rel=\"noopener\">both\u003c/a> \u003ca href=\"https://www.fda.gov/Drugs/InformationOnDrugs/ApprovedDrugs/ucm581296.htm\" target=\"_blank\" rel=\"noopener\">approved\u003c/a> for adults with advanced lymphomas.\u003c/p>\n\u003cp>Researchers report that some critically ill patients who received the therapy have remained cancer-free for as long as five years.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"This is what patients need,\" says \u003ca href=\"https://www.mayo.edu/research/faculty/lin-yi-m-d-ph-d/bio-00092684\" target=\"_blank\" rel=\"noopener\">Dr. Yi Lin\u003c/a>, a hematologist who oversees the CAR-T cell practice and research for the Mayo Clinic. \"With the likelihood of getting patients into durable survival, we don't want to deny them the therapy.\" She says she receives no personal financial support from the drugs' makers.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>But the treatment comes at a cost — the drug treatments are hugely expensive. Kymriah and Yescarta cost $373,000 for a one-time infusion to treat adults with advanced lymphomas, while Kymriah costs $475,000 to treat acute lymphoblastic leukemia in children and young adults. That's the cost of the drug itself; in addition, many patients experience serious side effects that can land them in a hospital intensive care unit for weeks, \u003ca href=\"https://khn.org/news/cascade-of-costs-could-push-new-gene-therapy-above-1-million-per-patient/\" target=\"_blank\" rel=\"noopener\">pushing treatment costs to more than $1 million\u003c/a>.\u003c/p>\n\u003cp>All of this gives government and private insurers pause.\u003c/p>\n\u003cp>Most commercial insurers are covering CAR-T cell therapies now, but they do so on an individual basis, writing single-patient agreements each time, say cancer specialists. Large insurers that are already familiar with complicated therapies like stem-cell transplants are getting speedier at handling requests for CAR-T cell treatment, they say. But that's not always the case at smaller or regional plans, where delays can add weeks to the approval process.\u003c/p>\n\u003cp>\"A request for CAR-T may end up with somebody on the payer authorization team who doesn't understand the technology or the urgency of the request, when somebody has only weeks or months to live,\" says \u003ca href=\"https://www.asbmt.org/about/contact-us\" target=\"_blank\" rel=\"noopener\">Stephanie Farnia\u003c/a>, director of health policy and strategic relations at the American Society for Blood and Marrow Transplantation.\u003c/p>\n\u003cp>Farnia is in contact with many of the more than 50 medical centers that are authorized to provide treatment. The process of getting to a treatment center and evaluated for therapy is involved, she says. \"To then be substantially delayed due to paperwork is incredibly frustrating\" for patients.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Medicare and Medicaid often pose greater coverage challenges than do private insurers, according to insurance experts.\u003c/p>\n\u003cp>Some Medicaid programs don't cover the treatment, says \u003ca href=\"AndrewsCAR-TandInsuranceDFedit.docx\" target=\"_blank\" rel=\"noopener\">Dr. Michael Bishop\u003c/a>, director of the cellular therapy program in the hematology/oncology section at the University of Chicago. Medicaid, the state-federal health program, covers children in low-income households and some adults.\u003c/p>\n\u003cp>\"Medicaid has been very tough,\" he says. \"Certain states just deny coverage — even states with balanced budgets.\"\u003c/p>\n\u003cp>States \u003ca href=\"https://icer-review.org/wp-content/uploads/2017/07/ICER_CAR_T_Final_Evidence_Report_032318.pdf\" target=\"_blank\" rel=\"noopener\">have to evaluate the cost as well as the drugs' effectiveness\u003c/a>, says \u003ca href=\"http://medicaiddirectors.org/about/staff/\" target=\"_blank\" rel=\"noopener\">Matt Salo\u003c/a>, executive director of the National Association of Medicaid Directors.\u003c/p>\n\u003cp>\"Medicaid is a finite pot of money, and it's stretched threadbare even on a good day,\" he says.\u003c/p>\n\u003cp>People who are on Medicare, the health insurance program for people age 65 and older and some people with disabilities, typically haven't faced coverage denials to date, clinicians say. But the government's reimbursement rates are raising concerns for providers.\u003c/p>\n\u003cp>Last spring, Medicare announced payment rates for providers who administer Yescarta and Kymriah on an outpatient basis. The payments would more than cover the costs of the drugs. Medicare beneficiaries' out-of-pocket costs would be capped at $1,340 plus the beneficiaries' Part B deductible (if that hasn't already been met), the agency says.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>The problem with this plan? Facilities typically provide treatment on an inpatient basis, not outpatient, because of the potential for severe, systemic side effects.\u003c/p>\n\u003cp>\"There's a lot of toxicity and questions about whether it can even be provided in an outpatient setting,\" says Gary Goldstein, the business manager at the blood and marrow transplant program at Stanford Health Care in Stanford, Calif.\u003c/p>\n\u003cp>For inpatient care, \"CAR-T cell therapy ... would be paid at a much lower amount compared to outpatient hospital use,\" according to officials at the Centers for Medicare & Medicaid Services.\u003c/p>\n\u003cp>The agency is considering how to handle payment for inpatient CAR-T care for the fiscal year that starts in October. For now, some medical centers are absorbing whatever Medicare doesn't pay.\u003c/p>\n\u003cp>\"How can you tell a patient who's 66, 'If only you'd gotten lymphoma when you were 64'?\" Goldstein asks.\u003c/p>\n\u003cp>But the current approach can't continue indefinitely, he says.\u003c/p>\n\u003cp>\"Even if there aren't any centers that are making that decision today, if coverage doesn't change for Medicare, it absolutely is going to be a problem tomorrow,\" says Goldstein.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"http://khn.org/\" target=\"_blank\" rel=\"noopener\">\u003cem>Kaiser Health News\u003c/em>\u003c/a>\u003cem>, a nonprofit news service, is an editorially independent program of the Kaiser Family Foundation, and is not affiliated with Kaiser Permanente. Michelle Andrews is on Twitter \u003c/em>\u003ca href=\"https://twitter.com/mandrews110\" target=\"_blank\" rel=\"noopener\">\u003cem>@mandrews110\u003c/em>\u003c/a>\u003cem>.\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 Kaiser Health News. To see more, visit \u003ca href=\"http://www.kaiserhealthnews.org/\" target=\"_blank\" rel=\"noopener\">Kaiser Health News\u003c/a>.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Insurers+And+Government+Are+Slow+To+Cover+Expensive+CAR-T+Cancer+Therapy&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/443435/insurers-and-government-are-slow-to-cover-expensive-car-t-cancer-therapy","authors":["byline_futureofyou_443435"],"categories":["futureofyou_1062","futureofyou_1","futureofyou_73"],"tags":["futureofyou_103","futureofyou_1470","futureofyou_952","futureofyou_686","futureofyou_1029","futureofyou_35"],"collections":["futureofyou_1097"],"featImg":"futureofyou_443437","label":"source_futureofyou_443435"},"futureofyou_443309":{"type":"posts","id":"futureofyou_443309","meta":{"index":"posts_1591205157","site":"futureofyou","id":"443309","score":null,"sort":[1531422028000]},"guestAuthors":[],"slug":"pulses-of-light-restored-hearing-in-gerbils-could-that-lead-to-better-implants","title":"Pulses of Light Restored Hearing in Gerbils. Could that Lead to Better Implants?","publishDate":1531422028,"format":"standard","headTitle":"KQED Future of You | KQED Science","labelTerm":{},"content":"\u003cp>Could light one day be used to restore hearing loss?\u003c/p>\n\u003cp>To try to answer that question, a team of German bioengineers surgically installed coiled strips of optical fibers in the ears of deaf gerbils.\u003c/p>\n\u003cp>While they still had their hearing, the gerbils had learned to hurdle a small barrier upon hearing an alarm. Now researchers sent a pulse of blue laser light deep into the animals’ ears. They jumped.\u003c/p>\n\u003cp>The experiment was part of a \u003ca href=\"http://stm.sciencemag.org/content/10/449/eaaq1564\" target=\"_blank\" rel=\"noopener\">study\u003c/a> published Wednesday seeking to improve upon cochlear implants — electronic devices that stimulate auditory neurons to partially restore hearing. Instead of using electrical currents, scientists are trying to determine whether optogenetics, a new field that uses light to control living cells, could one day help improve someone’s sense of hearing.\u003c/p>\n\u003cp>Although it could take decades to use optogenetics-based technologies in humans, researchers are beginning to demonstrate that light, not electricity, may be the best way to convey the rich information contained in sound.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“Through my experience with patients, I’ve recognized the huge potential of cochlear implants,” said Tobias Moser, director of the Institute for Auditory Neuroscience at the University Medical Center Göttingen and lead author of the new study. “At the same time I’ve also witnessed the shortcomings.”\u003c/p>\n\u003cp>Patients with cochlear implants often describe the sound quality through the devices as harsh and tinny. Listening to music or picking out one voice from several others is often impossible. The goal of the new research, said Moser, is to improve the technology and create “a more natural hearing so that patients can recognize the melody in music and speech.”\u003c/p>\n\u003cp>At the most basic level, the act of hearing is transforming sound into electrochemical signals, the language of neurons, that the brain can then interpret.\u003c/p>\n\u003cp>Much of this process occurs in the cochlea, a snail-shaped organ within the inner ear lined with specialized sensory cells called hair cells. When hair cells detect vibration through thin protrusions on their surface, they generate electrical current in neighboring nerve cells that travel to the brain.\u003c/p>\n\u003cp>In people who have dysfunctional or dead hair cells, cochlear implants work by electrically stimulating auditory nerve cells directly.\u003c/p>\n\u003cp>According to Dan Polley, an associate professor at Harvard Medical School and director of the Lauer Tinnitus Research Center who was not involved in the study, the successes and limitations of the cochlear implant are determined by the anatomy of the inner ear.\u003c/p>\n\u003cp>Within the cochlea, hair cells rest on an organic platform known as the basilar membrane that is floppy and wide on one end and narrow and taut on the other. This biomechanical organization causes hair cells to wiggle in response to specific sound frequencies or pitches that are mapped out smoothly from low to high, like keys on a piano.\u003c/p>\n\u003cp>When implanting cochlear implants, Polley explained, surgeons thread electrodes into specific locations along the basilar membrane to target nerves that are sensitive to particular frequencies.\u003c/p>\n\u003cp>With cochlear implants, however, electrical current spreads itself over a large area and activates not only the targeted nerves but also neighboring cells as well. This impercision distorts and muffles sound.\u003c/p>\n\u003cp>Moser and other scientists believe that using light, which can be more finely targeted, will improve the performance of implants.\u003c/p>\n\u003cp>“Using electricity to control neurons is like playing the piano with your elbow,” said Polley. “Whereas light is better. It is more like playing the piano while wearing mittens.”\u003c/p>\n\u003cp>Auditory neurons normally don’t respond to light. However, the rapidly growing field of optogenetics has made this possible. The key is to genetically engineer neurons so that they contain light-sensitive proteins that are found elsewhere in nature including bacteria, algae, and the human eye.\u003c/p>\n\u003cp>Moser and his team of scientists performed this technique in adult Mongolian gerbils instead of mice or rats, which were used in previous studies. Gerbils, in contrast to other rodents, are a better proxy for humans because they hear low frequencies used by the human ear and have relatively large cochleas that are only two-and-a-half times smaller than those of humans.\u003c/p>\n\u003cp>The researchers also used a new version of light-sensitive proteins, called CatCh, to increase how quickly nerve cells could respond to light stimulation. Previous versions of the protein worked sluggishly to move ions in and out of neurons — a critical step in generating electrical signals to the brain conveying the rapidly changing characteristics of sound like loudness and pitch.\u003c/p>\n\u003cp>This really hampers our ability to “capture the dynamics of speech,” said Polley. “If you have to deliver pulses [of light] more slowly, you can’t keep up.”\u003c/p>\n\u003cp>To test how quickly neurons equipped with CatCh could process information, researchers exposed neurons to rapid bursts of laser light, up to 300 flashes per second. They observed that individual neurons and groups of neurons were able to keep pace with the flashes by releasing their own corresponding surges of electrical energy.\u003c/p>\n\u003cp>“This is a big improvement over our previous work, “ said Moser. The response “is quick and approaches physiological performance of normal neurons.”\u003c/p>\n\u003cp>Aside from faster processing, the neurons also showed a graded response to different intensities of light. This suggests that the gerbils could experience an accurate representation of loudness that is proportional to how strongly neurons are activated by light.\u003c/p>\n\u003cp>But how could researchers be sure that all this promising electrical activity was actually creating a sense of hearing in gerbils?\u003c/p>\n\u003cp>Scientists first surgically implanted a loop of optical fibers — a primitive prototype of high-tech cochlear implants that could one day be used in humans — into the gerbils’ inner ear. They then trained the animals to jump over a fence-like obstacle dividing two halves of a box. Once the gerbils learned this behavior, scientists deafened the animals, causing them to become unresponsive to the loudspeaker. However, when researchers pulsed blue laser light through the optic fiber, the gerbils leapt into the air again.\u003c/p>\n\u003cp>“It’s not hearing until you measure behavior,” said Polley. “Because hearing is a psychological property. [This experiment] shows that the animals generalize light stimulation to sound, they treat it as if it were sound.”\u003c/p>\n\u003cp>Despite these dramatic results, Moser is quick to point out that light-based cochlear implants are not ready for human use.\u003c/p>\n\u003cp>The most obvious hurdle is that installing light-sensitive proteins into cells requires genetic engineering. In the case of gerbils, scientists accomplished the feat by injecting viruses carrying specially designed DNA into the animals’ ears. While gene therapy is being used to treat certain diseases in clinical trials — and has been approved for a \u003ca href=\"https://www.statnews.com/2018/03/21/gene-therapy-luxturna-launch/\">rare form of blindness\u003c/a> — it remains a long way from reality for most conditions.\u003c/p>\n\u003cp>“Right now,” said Polley, “ I doubt anyone would suggest that you get this gene therapy instead of cochlear implants.”\u003c/p>\n\u003cp>Even if gene therapy was a proven technology, light-based implants have other restrictions. In humans, bioengineers imagine using tiny light-emitting diodes (LEDs) to stimulate genetically engineered auditory neurons. However these machines consume a lot of power and dissipate heat, making it unclear how patients would wear or operate such a device.\u003c/p>\n\u003cp>“Optogenetics is the most sophisticated way we have to stimulate nerves in the cochlea,” said Adrien Eshraghi, a professor at the Miller School of Medicine and director of the Hearing Research Laboratory at the University of Miami who was not involved with the study. “It is still [in] the early basics of science research, but I think optogenetics has a good future.”\u003c/p>\n\u003cp>Another source of optimism is the power of the brain to adapt to new signaling inputs.\u003c/p>\n\u003cp>In the case of cochlear implants, patients initially experience the human voice as high-pitched and scratchy (think Mickey Mouse) but adapt over time. Although researchers don’t know what light will sound like, they expect a similar adjustment process.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“At the end of the day for engineers,” said Polley, “the brain is the hero … it is one of the best players on their team because they don’t have to perfect the signal, they just have to make it reasonably good, and then the brain can take it the rest of the way.”\u003c/p>\n\u003cdiv> \u003cem>This\u003ca href=\"https://www.statnews.com/2018/07/11/optogenetics-hearing-gerbils-cochlear-implants/\" target=\"_blank\" rel=\"noopener\"> story\u003c/a> was originally published by STAT, an online publication of Boston Globe Media that covers health, medicine, and scientific discovery.\u003c/em>\u003c/div>\n\n","blocks":[],"excerpt":"Instead of using electrical currents, scientists are testing whether optogenetics, a new field that uses light to control cells, could one day help improve someone’s sense of hearing.","status":"publish","parent":0,"modified":1531376761,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":36,"wordCount":1433},"headData":{"title":"Pulses of Light Restored Hearing in Gerbils. Could that Lead to Better Implants? | KQED","description":"Instead of using electrical currents, scientists are testing whether optogenetics, a new field that uses light to control cells, could one day help improve someone’s sense of hearing.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"443309 https://ww2.kqed.org/futureofyou/?p=443309","disqusUrl":"https://ww2.kqed.org/futureofyou/2018/07/12/pulses-of-light-restored-hearing-in-gerbils-could-that-lead-to-better-implants/","disqusTitle":"Pulses of Light Restored Hearing in Gerbils. Could that Lead to Better Implants?","source":"Health","nprByline":"Justin Chen\u003cbr />STAT","path":"/futureofyou/443309/pulses-of-light-restored-hearing-in-gerbils-could-that-lead-to-better-implants","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Could light one day be used to restore hearing loss?\u003c/p>\n\u003cp>To try to answer that question, a team of German bioengineers surgically installed coiled strips of optical fibers in the ears of deaf gerbils.\u003c/p>\n\u003cp>While they still had their hearing, the gerbils had learned to hurdle a small barrier upon hearing an alarm. Now researchers sent a pulse of blue laser light deep into the animals’ ears. They jumped.\u003c/p>\n\u003cp>The experiment was part of a \u003ca href=\"http://stm.sciencemag.org/content/10/449/eaaq1564\" target=\"_blank\" rel=\"noopener\">study\u003c/a> published Wednesday seeking to improve upon cochlear implants — electronic devices that stimulate auditory neurons to partially restore hearing. Instead of using electrical currents, scientists are trying to determine whether optogenetics, a new field that uses light to control living cells, could one day help improve someone’s sense of hearing.\u003c/p>\n\u003cp>Although it could take decades to use optogenetics-based technologies in humans, researchers are beginning to demonstrate that light, not electricity, may be the best way to convey the rich information contained in sound.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“Through my experience with patients, I’ve recognized the huge potential of cochlear implants,” said Tobias Moser, director of the Institute for Auditory Neuroscience at the University Medical Center Göttingen and lead author of the new study. “At the same time I’ve also witnessed the shortcomings.”\u003c/p>\n\u003cp>Patients with cochlear implants often describe the sound quality through the devices as harsh and tinny. Listening to music or picking out one voice from several others is often impossible. The goal of the new research, said Moser, is to improve the technology and create “a more natural hearing so that patients can recognize the melody in music and speech.”\u003c/p>\n\u003cp>At the most basic level, the act of hearing is transforming sound into electrochemical signals, the language of neurons, that the brain can then interpret.\u003c/p>\n\u003cp>Much of this process occurs in the cochlea, a snail-shaped organ within the inner ear lined with specialized sensory cells called hair cells. When hair cells detect vibration through thin protrusions on their surface, they generate electrical current in neighboring nerve cells that travel to the brain.\u003c/p>\n\u003cp>In people who have dysfunctional or dead hair cells, cochlear implants work by electrically stimulating auditory nerve cells directly.\u003c/p>\n\u003cp>According to Dan Polley, an associate professor at Harvard Medical School and director of the Lauer Tinnitus Research Center who was not involved in the study, the successes and limitations of the cochlear implant are determined by the anatomy of the inner ear.\u003c/p>\n\u003cp>Within the cochlea, hair cells rest on an organic platform known as the basilar membrane that is floppy and wide on one end and narrow and taut on the other. This biomechanical organization causes hair cells to wiggle in response to specific sound frequencies or pitches that are mapped out smoothly from low to high, like keys on a piano.\u003c/p>\n\u003cp>When implanting cochlear implants, Polley explained, surgeons thread electrodes into specific locations along the basilar membrane to target nerves that are sensitive to particular frequencies.\u003c/p>\n\u003cp>With cochlear implants, however, electrical current spreads itself over a large area and activates not only the targeted nerves but also neighboring cells as well. This impercision distorts and muffles sound.\u003c/p>\n\u003cp>Moser and other scientists believe that using light, which can be more finely targeted, will improve the performance of implants.\u003c/p>\n\u003cp>“Using electricity to control neurons is like playing the piano with your elbow,” said Polley. “Whereas light is better. It is more like playing the piano while wearing mittens.”\u003c/p>\n\u003cp>Auditory neurons normally don’t respond to light. However, the rapidly growing field of optogenetics has made this possible. The key is to genetically engineer neurons so that they contain light-sensitive proteins that are found elsewhere in nature including bacteria, algae, and the human eye.\u003c/p>\n\u003cp>Moser and his team of scientists performed this technique in adult Mongolian gerbils instead of mice or rats, which were used in previous studies. Gerbils, in contrast to other rodents, are a better proxy for humans because they hear low frequencies used by the human ear and have relatively large cochleas that are only two-and-a-half times smaller than those of humans.\u003c/p>\n\u003cp>The researchers also used a new version of light-sensitive proteins, called CatCh, to increase how quickly nerve cells could respond to light stimulation. Previous versions of the protein worked sluggishly to move ions in and out of neurons — a critical step in generating electrical signals to the brain conveying the rapidly changing characteristics of sound like loudness and pitch.\u003c/p>\n\u003cp>This really hampers our ability to “capture the dynamics of speech,” said Polley. “If you have to deliver pulses [of light] more slowly, you can’t keep up.”\u003c/p>\n\u003cp>To test how quickly neurons equipped with CatCh could process information, researchers exposed neurons to rapid bursts of laser light, up to 300 flashes per second. They observed that individual neurons and groups of neurons were able to keep pace with the flashes by releasing their own corresponding surges of electrical energy.\u003c/p>\n\u003cp>“This is a big improvement over our previous work, “ said Moser. The response “is quick and approaches physiological performance of normal neurons.”\u003c/p>\n\u003cp>Aside from faster processing, the neurons also showed a graded response to different intensities of light. This suggests that the gerbils could experience an accurate representation of loudness that is proportional to how strongly neurons are activated by light.\u003c/p>\n\u003cp>But how could researchers be sure that all this promising electrical activity was actually creating a sense of hearing in gerbils?\u003c/p>\n\u003cp>Scientists first surgically implanted a loop of optical fibers — a primitive prototype of high-tech cochlear implants that could one day be used in humans — into the gerbils’ inner ear. They then trained the animals to jump over a fence-like obstacle dividing two halves of a box. Once the gerbils learned this behavior, scientists deafened the animals, causing them to become unresponsive to the loudspeaker. However, when researchers pulsed blue laser light through the optic fiber, the gerbils leapt into the air again.\u003c/p>\n\u003cp>“It’s not hearing until you measure behavior,” said Polley. “Because hearing is a psychological property. [This experiment] shows that the animals generalize light stimulation to sound, they treat it as if it were sound.”\u003c/p>\n\u003cp>Despite these dramatic results, Moser is quick to point out that light-based cochlear implants are not ready for human use.\u003c/p>\n\u003cp>The most obvious hurdle is that installing light-sensitive proteins into cells requires genetic engineering. In the case of gerbils, scientists accomplished the feat by injecting viruses carrying specially designed DNA into the animals’ ears. While gene therapy is being used to treat certain diseases in clinical trials — and has been approved for a \u003ca href=\"https://www.statnews.com/2018/03/21/gene-therapy-luxturna-launch/\">rare form of blindness\u003c/a> — it remains a long way from reality for most conditions.\u003c/p>\n\u003cp>“Right now,” said Polley, “ I doubt anyone would suggest that you get this gene therapy instead of cochlear implants.”\u003c/p>\n\u003cp>Even if gene therapy was a proven technology, light-based implants have other restrictions. In humans, bioengineers imagine using tiny light-emitting diodes (LEDs) to stimulate genetically engineered auditory neurons. However these machines consume a lot of power and dissipate heat, making it unclear how patients would wear or operate such a device.\u003c/p>\n\u003cp>“Optogenetics is the most sophisticated way we have to stimulate nerves in the cochlea,” said Adrien Eshraghi, a professor at the Miller School of Medicine and director of the Hearing Research Laboratory at the University of Miami who was not involved with the study. “It is still [in] the early basics of science research, but I think optogenetics has a good future.”\u003c/p>\n\u003cp>Another source of optimism is the power of the brain to adapt to new signaling inputs.\u003c/p>\n\u003cp>In the case of cochlear implants, patients initially experience the human voice as high-pitched and scratchy (think Mickey Mouse) but adapt over time. Although researchers don’t know what light will sound like, they expect a similar adjustment process.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“At the end of the day for engineers,” said Polley, “the brain is the hero … it is one of the best players on their team because they don’t have to perfect the signal, they just have to make it reasonably good, and then the brain can take it the rest of the way.”\u003c/p>\n\u003cdiv> \u003cem>This\u003ca href=\"https://www.statnews.com/2018/07/11/optogenetics-hearing-gerbils-cochlear-implants/\" target=\"_blank\" rel=\"noopener\"> story\u003c/a> was originally published by STAT, an online publication of Boston Globe Media that covers health, medicine, and scientific discovery.\u003c/em>\u003c/div>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/443309/pulses-of-light-restored-hearing-in-gerbils-could-that-lead-to-better-implants","authors":["byline_futureofyou_443309"],"categories":["futureofyou_1062","futureofyou_1","futureofyou_73"],"tags":["futureofyou_61","futureofyou_398","futureofyou_35"],"collections":["futureofyou_1097"],"featImg":"futureofyou_443315","label":"source_futureofyou_443309"},"futureofyou_443165":{"type":"posts","id":"futureofyou_443165","meta":{"index":"posts_1591205157","site":"futureofyou","id":"443165","score":null,"sort":[1530644426000]},"guestAuthors":[],"slug":"can-zapping-peoples-brains-reduce-violence-controversial-study-sees-potential","title":"Can Zapping People’s Brains Reduce Violence? Controversial Study Sees Potential","publishDate":1530644426,"format":"standard","headTitle":"KQED Future of You | KQED Science","labelTerm":{},"content":"\u003cp>The study participants read short accounts of violent behavior: In one, a man smashed a beer bottle over someone’s head; in another, an assailant raped an acquaintance.[contextly_sidebar id=\"gKdycmp0KoVJxcxC1F1K6WdKxrJ9rXZI\"]\u003c/p>\n\u003cp>They were then asked: \u003cem>Would you do that?\u003c/em>\u003c/p>\n\u003cp>The day before, half of them had had the frontmost region of their brains, responsible for such high-level functions as impulse control and moral judgments, electrically stimulated; the other half had not.\u003c/p>\n\u003cp>The people whose prefrontal cortex was stimulated reported roughly half the likelihood of committing a violent act like the ones they watched, scientists at the University of Pennsylvania reported on Monday; they said they found such physical and sexual violence more morally wrong, compared with the control group.\u003c/p>\n\u003cp>The researchers hailed their results as evidence that “increasing activity in the prefrontal cortex can reduce intentions to commit aggression and enhance perceptions of moral judgment,” as they wrote in the Journal of Neuroscience.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Other experts said the results were far less than advertised.\u003c/p>\n\u003cp>“We’re a long way from ‘Clockwork Orange,’” said Dr. Paul Appelbaum, director of the Division of Law, Ethics, and Psychiatry at Columbia University’s Vagelos College of Physicians and Surgeons.\u003c/p>\n\u003cp>For the study, the Penn researchers randomly assigned 81 healthy adults (the average ago was 20) to receive “transcranial direct-current stimulation” of the dorsolateral prefrontal cortex, behind the top of the forehead, for 20 minutes via two scalp electrodes, or to get a low current for 30 seconds and then nothing, also via electrodes. Participants couldn’t tell if they were receiving the stimulation or not.\u003c/p>\n\u003cp>The researchers aimed at the dorsolateral prefrontal cortex because dozens of small neuro-imaging studies have \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2784035/\" target=\"_blank\" rel=\"noopener\">reported\u003c/a> that in people deemed antisocial or aggressive or both, this region is typically smaller and less active than in other people. Such studies can’t tell whether an impaired prefrontal cortex causes aggression or vice versa, so the Penn study, a registered \u003ca href=\"https://clinicaltrials.gov/ct2/show/NCT02427672\" target=\"_blank\" rel=\"noopener\">clinical trial\u003c/a>, tried to figure that out.[contextly_sidebar id=\"dnHIsBbKjxIupKuLmg7VYu4mKCZSmb4l\"]\u003c/p>\n\u003cp>The next day, participants read one vignette about the beer-bottle assault and one about the rape, and rated how likely they were (from “no chance” to “definitely”) to act as the assaulter did. The brain-stimulated group reported a 47 percent lower likelihood that they would commit the non-sexual physical assault (1.15 vs. 2.19 on a scale of 0 to 10) and a 70 percent lower likelihood of committing the sexual assault (0.26 vs. 0.86) compared with the control group. The brain-stimulated group also rated the assaults as more morally wrong than the control group did.\u003c/p>\n\u003cp>But while the brain stimulation decreased people’s self-reported likelihood of committing assault, their actions indicated otherwise. In the only assessment of actual behavior, the participants got to stick pins into a computer image of a doll representing a close friend, a common lab test of violent tendencies. Those whose prefrontal cortex was stimulated stuck in slightly more pins than the control group.\u003c/p>\n\u003cp>“What people say they will do with regard to violence and what they actually do may be two different things,” said Appelbaum. “Whether actual violence would be reduced [by brain stimulation] is unknown,” but “the data suggest no impact” on actual aggressive behavior.\u003c/p>\n\u003cp>Olivia Choy, the paper’s lead author and now a psychologist at Nanyang Technological University in Singapore, emphasized that the participants got only one 20-minute stimulation session. “It might be that repeated sessions over a longer time period could produce changes in behavior, but changes in behavior start with changing intent,” she said.\u003c/p>\n\u003cp>“We’re trying to find benign biological interventions [for criminal violence] that society will accept,” Penn psychologist Adrian Raine, who has studied the brain basis of violence and psychopathy for decades, said in a statement. “Transcranial direct-current stimulation is minimal risk. This isn’t a frontal lobotomy.”\u003c/p>\n\u003cp>Robin Mackenzie, a scholar of medical law and ethics at England’s University of Kent, called the study “promising and suggestive,” saying it “advances the field of biological interventions on antisocial and aggressive behavior.”\u003c/p>\n\u003cp>But she, too, noted several concerns. One is that the brain-stimulated group had 24 women and 15 men, compared with 21 and 21 in the control group. That raises the question of whether the zapped group’s lower likelihood of endorsing rape and beer-bottle attacks might be driven by gender differences, especially on what constitutes rape, Mackenzie said: “Asking female participants to identify with a rapist to assess how likely they would be to rape a woman is inherently different from asking male participants to do so….It is at the very least possible that the gender distribution could have skewed the results.”[contextly_sidebar id=\"APQk5r3dfTy6mLZEMSYpZsZfNmt4Z4Oq\"]\u003c/p>\n\u003cp>In addition, the study participants had no history of psychiatric or neurologic disease or injury, all of which are associated with violent tendencies. But the brain mechanisms causing that violence in these groups may differ from the mechanisms in normal people. Results on healthy, non-violent college students therefore might not apply to people with such brain abnormalities. “How far tDCS could affect [such people] is an open question,” Mackenzie said.\u003c/p>\n\u003cp>And even if stimulation of the prefrontal cortex makes people express a heightened sense that violence is wrong, when they are asked their views the next day, it remains to be seen whether any such effect would last, or if people would have to be zapped frequently.\u003c/p>\n\u003cp>Regardless of its shortcomings, the study worries some experts. If governments adopt brain zapping for violent offenders, would it be voluntary or, just as some states and countries mandate chemical castration for some male sex offenders, mandatory? And would governments be tempted to extend its use beyond violence, such as “to induce passivity in politically unruly groups?,” Appelbaum asked.\u003c/p>\n\u003cp>“Neurotechnologies which affect identity, ways of being, and thought processes are particularly tempting for authorities seeking to secure control and cut costs,” Mackenzie said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This\u003ca href=\"https://www.statnews.com/2018/07/02/brain-electric-stimulation-violence/\" target=\"_blank\" rel=\"noopener\"> story\u003c/a> was originally published by STAT, an online publication of Boston Globe Media that covers health, medicine, and scientific discovery.\u003c/em>\u003c/p>\n\n","blocks":[],"excerpt":"Study subjects whose prefrontal cortex were stimulated reported roughly half the likelihood of committing a violent act like the ones scientists made them watch.","status":"publish","parent":0,"modified":1530609082,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":23,"wordCount":1057},"headData":{"title":"Can Zapping People’s Brains Reduce Violence? Controversial Study Sees Potential | KQED","description":"Study subjects whose prefrontal cortex were stimulated reported roughly half the likelihood of committing a violent act like the ones scientists made them watch.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"443165 https://ww2.kqed.org/futureofyou/?p=443165","disqusUrl":"https://ww2.kqed.org/futureofyou/2018/07/03/can-zapping-peoples-brains-reduce-violence-controversial-study-sees-potential/","disqusTitle":"Can Zapping People’s Brains Reduce Violence? Controversial Study Sees Potential","source":"Health","nprByline":"Sharon Begley\u003cbr />STAT","path":"/futureofyou/443165/can-zapping-peoples-brains-reduce-violence-controversial-study-sees-potential","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>The study participants read short accounts of violent behavior: In one, a man smashed a beer bottle over someone’s head; in another, an assailant raped an acquaintance.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>They were then asked: \u003cem>Would you do that?\u003c/em>\u003c/p>\n\u003cp>The day before, half of them had had the frontmost region of their brains, responsible for such high-level functions as impulse control and moral judgments, electrically stimulated; the other half had not.\u003c/p>\n\u003cp>The people whose prefrontal cortex was stimulated reported roughly half the likelihood of committing a violent act like the ones they watched, scientists at the University of Pennsylvania reported on Monday; they said they found such physical and sexual violence more morally wrong, compared with the control group.\u003c/p>\n\u003cp>The researchers hailed their results as evidence that “increasing activity in the prefrontal cortex can reduce intentions to commit aggression and enhance perceptions of moral judgment,” as they wrote in the Journal of Neuroscience.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Other experts said the results were far less than advertised.\u003c/p>\n\u003cp>“We’re a long way from ‘Clockwork Orange,’” said Dr. Paul Appelbaum, director of the Division of Law, Ethics, and Psychiatry at Columbia University’s Vagelos College of Physicians and Surgeons.\u003c/p>\n\u003cp>For the study, the Penn researchers randomly assigned 81 healthy adults (the average ago was 20) to receive “transcranial direct-current stimulation” of the dorsolateral prefrontal cortex, behind the top of the forehead, for 20 minutes via two scalp electrodes, or to get a low current for 30 seconds and then nothing, also via electrodes. Participants couldn’t tell if they were receiving the stimulation or not.\u003c/p>\n\u003cp>The researchers aimed at the dorsolateral prefrontal cortex because dozens of small neuro-imaging studies have \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2784035/\" target=\"_blank\" rel=\"noopener\">reported\u003c/a> that in people deemed antisocial or aggressive or both, this region is typically smaller and less active than in other people. Such studies can’t tell whether an impaired prefrontal cortex causes aggression or vice versa, so the Penn study, a registered \u003ca href=\"https://clinicaltrials.gov/ct2/show/NCT02427672\" target=\"_blank\" rel=\"noopener\">clinical trial\u003c/a>, tried to figure that out.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>The next day, participants read one vignette about the beer-bottle assault and one about the rape, and rated how likely they were (from “no chance” to “definitely”) to act as the assaulter did. The brain-stimulated group reported a 47 percent lower likelihood that they would commit the non-sexual physical assault (1.15 vs. 2.19 on a scale of 0 to 10) and a 70 percent lower likelihood of committing the sexual assault (0.26 vs. 0.86) compared with the control group. The brain-stimulated group also rated the assaults as more morally wrong than the control group did.\u003c/p>\n\u003cp>But while the brain stimulation decreased people’s self-reported likelihood of committing assault, their actions indicated otherwise. In the only assessment of actual behavior, the participants got to stick pins into a computer image of a doll representing a close friend, a common lab test of violent tendencies. Those whose prefrontal cortex was stimulated stuck in slightly more pins than the control group.\u003c/p>\n\u003cp>“What people say they will do with regard to violence and what they actually do may be two different things,” said Appelbaum. “Whether actual violence would be reduced [by brain stimulation] is unknown,” but “the data suggest no impact” on actual aggressive behavior.\u003c/p>\n\u003cp>Olivia Choy, the paper’s lead author and now a psychologist at Nanyang Technological University in Singapore, emphasized that the participants got only one 20-minute stimulation session. “It might be that repeated sessions over a longer time period could produce changes in behavior, but changes in behavior start with changing intent,” she said.\u003c/p>\n\u003cp>“We’re trying to find benign biological interventions [for criminal violence] that society will accept,” Penn psychologist Adrian Raine, who has studied the brain basis of violence and psychopathy for decades, said in a statement. “Transcranial direct-current stimulation is minimal risk. This isn’t a frontal lobotomy.”\u003c/p>\n\u003cp>Robin Mackenzie, a scholar of medical law and ethics at England’s University of Kent, called the study “promising and suggestive,” saying it “advances the field of biological interventions on antisocial and aggressive behavior.”\u003c/p>\n\u003cp>But she, too, noted several concerns. One is that the brain-stimulated group had 24 women and 15 men, compared with 21 and 21 in the control group. That raises the question of whether the zapped group’s lower likelihood of endorsing rape and beer-bottle attacks might be driven by gender differences, especially on what constitutes rape, Mackenzie said: “Asking female participants to identify with a rapist to assess how likely they would be to rape a woman is inherently different from asking male participants to do so….It is at the very least possible that the gender distribution could have skewed the results.”\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>In addition, the study participants had no history of psychiatric or neurologic disease or injury, all of which are associated with violent tendencies. But the brain mechanisms causing that violence in these groups may differ from the mechanisms in normal people. Results on healthy, non-violent college students therefore might not apply to people with such brain abnormalities. “How far tDCS could affect [such people] is an open question,” Mackenzie said.\u003c/p>\n\u003cp>And even if stimulation of the prefrontal cortex makes people express a heightened sense that violence is wrong, when they are asked their views the next day, it remains to be seen whether any such effect would last, or if people would have to be zapped frequently.\u003c/p>\n\u003cp>Regardless of its shortcomings, the study worries some experts. If governments adopt brain zapping for violent offenders, would it be voluntary or, just as some states and countries mandate chemical castration for some male sex offenders, mandatory? And would governments be tempted to extend its use beyond violence, such as “to induce passivity in politically unruly groups?,” Appelbaum asked.\u003c/p>\n\u003cp>“Neurotechnologies which affect identity, ways of being, and thought processes are particularly tempting for authorities seeking to secure control and cut costs,” Mackenzie said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This\u003ca href=\"https://www.statnews.com/2018/07/02/brain-electric-stimulation-violence/\" target=\"_blank\" rel=\"noopener\"> story\u003c/a> was originally published by STAT, an online publication of Boston Globe Media that covers health, medicine, and scientific discovery.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/443165/can-zapping-peoples-brains-reduce-violence-controversial-study-sees-potential","authors":["byline_futureofyou_443165"],"categories":["futureofyou_1060","futureofyou_1","futureofyou_73","futureofyou_1061"],"tags":["futureofyou_56","futureofyou_1056","futureofyou_204","futureofyou_1224","futureofyou_35","futureofyou_1571"],"collections":["futureofyou_1093","futureofyou_1096"],"featImg":"futureofyou_443168","label":"source_futureofyou_443165"},"futureofyou_443072":{"type":"posts","id":"futureofyou_443072","meta":{"index":"posts_1591205157","site":"futureofyou","id":"443072","score":null,"sort":[1530226401000]},"guestAuthors":[],"slug":"kroger-to-test-grocery-deliveries-with-driverless-cars","title":"Kroger to Test Grocery Deliveries with Driverless Cars","publishDate":1530226401,"format":"standard","headTitle":"KQED Future of You | KQED Science","labelTerm":{},"content":"\u003cp>Kroger Co. is about to test whether it can steer supermarket customers away from crowded grocery aisles with a fleet of diminutive driverless cars designed to lower delivery costs.[contextly_sidebar id=\"k2aBFhvWkHOLNkSHCpVI0cl8NC7xrWxy\"]\u003c/p>\n\u003cp>The test program announced Thursday could make Kroger the first U.S. grocer to make deliveries with robotic cars that won’t have a human riding along to take control in case something goes wrong.\u003c/p>\n\u003cp>Cincinnati-based Kroger is teaming up with Nuro, a Silicon Valley startup founded two years ago by two engineers who worked on self-driving cars at Google. That Google project is now known as Waymo, which plans to introduce a ride-hailing service that is supposed to begin picking up passengers in fully autonomous cars by the end of this year.\u003c/p>\n\u003cp>Like Waymo, Kroger is only saying its self-driving delivery service will start by the end of this year.[contextly_sidebar id=\"ZChtrSmPIuzef1JA7tjwAWqDui7h39iP\"]\u003c/p>\n\u003cp>The location of the delivery service hasn’t been determined yet either, although it most likely will involve Fry’s supermarkets in California or Arizona, said Nuro co-founder Dave Ferguson.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Customers will be able to order groceries from a mobile app, much like people summon an Uber or Lyft ride. After the order is placed, a driverless vehicle will deliver the groceries at a curb, requiring the customers to be present to fetch the items. The vehicles will probably be opened with a numeric code.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Kroger currently offers grocery delivery in vehicles driven by people at about 1,200 of its 2,800 stores, covering about 20 different markets in the U.S. If the Nuro tests go well, Kroger say it’s likely to expand its use of driverless cars, potentially allowing its supermarkets to reduce its delivery fees and reassign workers who had been driving cars to other jobs focused on improving customer service.\u003c/p>\n\n","blocks":[],"excerpt":"Kroger is teaming up with Nuro, a Silicon Valley startup founded two years ago by two engineers who worked on self-driving cars at Google. ","status":"publish","parent":0,"modified":1530249400,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":9,"wordCount":313},"headData":{"title":"Kroger to Test Grocery Deliveries with Driverless Cars | KQED","description":"Kroger is teaming up with Nuro, a Silicon Valley startup founded two years ago by two engineers who worked on self-driving cars at Google. ","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"443072 https://ww2.kqed.org/futureofyou/?p=443072","disqusUrl":"https://ww2.kqed.org/futureofyou/2018/06/28/kroger-to-test-grocery-deliveries-with-driverless-cars/","disqusTitle":"Kroger to Test Grocery Deliveries with Driverless Cars","source":"Technology","nprByline":"The Associated Press","path":"/futureofyou/443072/kroger-to-test-grocery-deliveries-with-driverless-cars","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Kroger Co. is about to test whether it can steer supermarket customers away from crowded grocery aisles with a fleet of diminutive driverless cars designed to lower delivery costs.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>The test program announced Thursday could make Kroger the first U.S. grocer to make deliveries with robotic cars that won’t have a human riding along to take control in case something goes wrong.\u003c/p>\n\u003cp>Cincinnati-based Kroger is teaming up with Nuro, a Silicon Valley startup founded two years ago by two engineers who worked on self-driving cars at Google. That Google project is now known as Waymo, which plans to introduce a ride-hailing service that is supposed to begin picking up passengers in fully autonomous cars by the end of this year.\u003c/p>\n\u003cp>Like Waymo, Kroger is only saying its self-driving delivery service will start by the end of this year.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>The location of the delivery service hasn’t been determined yet either, although it most likely will involve Fry’s supermarkets in California or Arizona, said Nuro co-founder Dave Ferguson.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Customers will be able to order groceries from a mobile app, much like people summon an Uber or Lyft ride. After the order is placed, a driverless vehicle will deliver the groceries at a curb, requiring the customers to be present to fetch the items. The vehicles will probably be opened with a numeric code.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Kroger currently offers grocery delivery in vehicles driven by people at about 1,200 of its 2,800 stores, covering about 20 different markets in the U.S. If the Nuro tests go well, Kroger say it’s likely to expand its use of driverless cars, potentially allowing its supermarkets to reduce its delivery fees and reassign workers who had been driving cars to other jobs focused on improving customer service.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/443072/kroger-to-test-grocery-deliveries-with-driverless-cars","authors":["byline_futureofyou_443072"],"categories":["futureofyou_1"],"tags":["futureofyou_1567","futureofyou_426","futureofyou_1566","futureofyou_35"],"featImg":"futureofyou_443082","label":"source_futureofyou_443072"}},"programsReducer":{"possible":{"id":"possible","title":"Possible","info":"Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. 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