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Income Inequality Makes The Rich More Scrooge-Like, Study Finds

By Melissa Healy, Los Angeles Times (TNS)

As the annual “season of giving” dawns, a new study finds that stark income inequity — a dramatically rising trend in the United States — makes the “haves” less generous toward others.

Higher-income people were less inclined to be generous both when they came from states where income inequality is high and when they were made to believe that there was a sharp divide between rich and poor, a new study found. And they were less charitable in both cases than were low-income people.

Since the 1980s — the end of a 30-year period during which the middle class flourished in the United States — wealth has grown increasingly concentrated at the top of the economic ladder, while low-income Americans have commanded a smaller and smaller share of the nation’s wealth.

In 2013, the top 0.1 percent of households received approximately 10 percent of the pretax income, versus approximately 3 percent to 4 percent between 1951 and 1981. The Congressional Budget Office reckoned that between 1979 and 2007, households controlling the top 1 percent of the nation’s wealth increased their incomes 275 percent, while the incomes of those in the economy’s lowest tier picked up a mere 18 percent.

A study published in the Proceedings of the National Academy of Sciences on Monday compared the giving patterns of rich and poor two ways. Using results from a nationally representative survey that included a donation opportunity at the end, researchers looked at how patterns of giving corresponded to wealth distribution in donors’ home states.

Of the 1,498 people who participated in that survey, donation by those with household incomes above $125,000 was more prevalent among those who lived in states in which income inequality was low. Among wealthier survey-takers from states with higher income inequality, fewer took the opportunity to donate.

The authors also conducted an experiment in which 704 people were presented with simulated information portraying their home states as having either high or low income inequality, and then given the opportunity to bestow raffle tickets on another participant.

When they were prompted to believe they lived in a state with high income inequality, those with household incomes above $125,000 were less generous than when they believed incomes in their state were more equitably distributed.

The authors found no such difference in donor behavior among people whose household income was below $15,000.

The new findings may actually somewhat improve the view of wealthy Americans among social science researchers. A wide range of recent studies had suggested that wealthy Americans are, across the board, less generous than less wealthy Americans. This study suggests that that stinginess is, at least, more prominent where the rich are richer and the poor are poorer.

The researchers, led by Stanford University sociologist Robb Willer, surmised that wealthy people embedded in a milieu where rich and poor live in starkly different circumstances may feel more entitled to their moneyed status, or more threatened by the prospective loss of privilege that would come if resources more evenly distributed. They may feel that the system whereby wealth is apportioned is fairer because they so rarely come into contact with the poor.

And the authors of the study do not shrink from its obvious implications: Progressive taxation policies and social services that lift up the poor might not only lift their boats. They might also make the rich more generous about pitching in a penny or two to do so.

Photo: The richer you are, the smaller gifts you give? asenat29 via Flickr

Getting Your Blood Pressure Even Lower: Here Are The Risks And Rewards

By Melissa Healy, Los Angeles Times (TNS)

Two months ago, U.S. officials crowed that a federally funded study gauging the impact of stricter blood pressure control had produced such dramatic results, they were bringing the clinical trial to an early close.

On Monday, those dramatic results got medicine’s version of a ticker-tape parade: a research article and not one but three editorials in the New England Journal of Medicine detailed and dissected just how steeply heart disease, strokes and deaths from any cause declined in patients who aimed to get their systolic blood pressure reading to 120 mm of mercury.

The upshot: For people between 50 and 75 who are at higher than usual risk of cardiovascular disease but don’t have diabetes and have not already had a stroke, it’s probably no longer defensible to be satisfied with a systolic blood pressure reading just under 140. (Earlier this year, the American Heart Association and American College of Cardiology set a 140/90 mm reading as the correct goal for most patients under 80 years of age with coronary artery disease.)

But getting all such patients’ systolic blood pressure readings to 120 may not be entirely realistic either, said experts assessing the significance of the study, called SPRINT (Systolic Blood Pressure Intervention Trial).

Many of the 4,678 subjects assigned to shoot for a systolic reading of 120 couldn’t quite make it to that goal, despite an escalation in the number of medications they took and an average increase in such side effects as dizziness, electrolyte abnormalities, and injury to or failure of the kidneys.

Still, the trial’s results suggest the benefits of trying were undeniable.

In a follow-up period of just over three years, people between 50 and 75 who make efforts to get that top reading 20 points below 140 mm of mercury reaped a welter of benefits, researchers revealed: Their likelihood of dying of any cause dropped by 27 percent, and they reduced by roughly 25 percent their likelihood of suffering one of a range of cardiovascular outcomes, including heart attack, stroke, heart failure and acute coronary syndrome.

On average, study physicians had to prescribe 2.8 medications to get a study subject’s systolic blood pressure reading to 121.4. Subjects who were assigned to get their systolic blood pressure reading under 140 took, on average, 1.8 different prescription medications, and their systolic blood pressure reading settled at an average of 136.2.

By a key measure — the “number needed to treat” — of those outcomes made it a pretty easy call to shoot for the lower systolic reading in treating a patient over 50 with high blood pressure.

Study authors reckoned that for every 61 patients medicated to achieve the lower systolic number for just over three years, there would be one less cardiovascular event (a heart attack, stroke, heart failure, acute coronary syndrome or death). For every 90 patients who got the more aggressive treatment, one death from any cause would be averted. To avert a death from cardiovascular causes, 172 patients would need to get the more aggressive treatment for a little over three years.

(To put that number in perspective, it took 83 patients treated with a statin medication for five years to prevent a single death, 39 patients treated with a statin to prevent a single non-fatal heart attack and 125 to prevent a single stroke. Treating 50 people at high risk of cardiovascular disease for a year with clopidogrel, known also as Plavix, has been found to prevent one cardiovascular event. But 333 would have to be treated with Plavix to prevent a single death.)

“This clinical trial will change practice,” wrote four senior NEJM editors, led by Editor in Chief Dr. Jeffrey M. Drazen.

But whether physicians should accept a systolic reading of 120 as a rigid and immediate requirement was not so clear.

“In my opinion, the results from SPRINT warrant reducing the treatment goal for systolic blood pressure to less than 130 mm HG” in most hypertensives over 50 with no history of stroke and no diabetes, wrote Dr. Aram V. Chobanian, a cardiologist, blood pressure researcher and former dean of the Boston University School of Medicine.

Even if the systolic target were reduced to that interim level, wrote Chobanian, a majority of Americans with hypertension would be considered to have “uncontrolled” high blood pressure. And physicians, he added, know all too well that when they must prescribe more than two medications to bring blood pressure under control, patients are less likely to stick to their medication regimen.

The SPRINT study, wrote Vlado Perkovic and Anthony Rodgers in an invited editorial, “redefines blood-pressure target goals and challenges us to improve blood-pressure management.” Despite its name, however, the SPRINT study cannot change treatment overnight, they added.

©2015 Los Angeles Times. Distributed by Tribune Content Agency, LLC.

Photo: Quinn Dombrowski via Flickr

 

In Wake Of WHO Finding, Here’s What Meat-Eaters Need To Know

By Melissa Healy, Los Angeles Times (TNS)

The World Health Organization has confirmed what you probably already suspected: Bacon, hot dogs and other processed meats can increase your risk of cancer. Not only that, fresh cuts of red meat probably cause cancer, too.

Doctors have long warned that steak and sausages can be hazardous to your health. But the new assessment from the WHO’s International Agency for Research on Cancer officially classifies processed meats as “carcinogenic to humans,” putting them in the same category as asbestos, tobacco smoke and formaldehyde.

A group of 22 scientists came to that conclusion after evaluating more than 800 studies from countries — and cuisines — around the world. The results of their investigation were published Monday in the journal Lancet Oncology.

The experts defined processed meats as those that have been salted, cured, smoked or otherwise transformed to enhance their flavor or keep them from going bad. Although most processed meats are derived from beef and pork, they can also be made from other kinds of red meat, poultry or organ meats such as liver or sweetbreads.

The scientific panel also classified red meat as “probably carcinogenic.” That puts it in the same category as lead compounds and the insecticide malathion.

In addition to pork and beef, red meats include veal, lamb, mutton, horse and goat, the report says.

Clues that people who consume large amounts of processed and red meats were more likely to develop certain types of cancers began emerging in the 1990s. Evidence supporting the link between meat and cancer has mounted steadily ever since.

By 2013, the WHO’s cancer experts had made the study of meat a high priority. They evaluated the risk of 16 types of cancer and found the strongest link for colorectal cancer, the third most common type of cancer among American adults.

Here’s what meat-eaters need to know:

Question: Are the experts convinced that processed meats cause cancer?

Answer: Yes. The scientists said the strongest evidence supported a causal link between consumption of these meats and the risk of cancer. This link is unlikely to be the result of chance, bias or other confounding factors, they said.

Q. Does that mean eating beef jerky is as dangerous as smoking?

A. No. In labeling processed meat a “Group 1” carcinogen, the WHO researchers did not say that both vices are equally bad — only that the evidence showing that they increased one’s risk of cancer was equally strong.

The American Institute for Cancer Research noted that compared to people who don’t eat meat, those who do are roughly twice as likely to get cancer. For the sake of comparison, smokers are about 20 times more likely than nonsmokers to be diagnosed with cancer.

Q. What about red meat?

A. The causal link between cooked red meat and cancer is slightly less strong, the panel said. That’s why they designated it a “probable carcinogen.”

Of 15 rigorous studies looking at red meat consumption and colorectal cancer, seven found a positive association between the two. That leaves room for the possibility that future studies could either strengthen or weaken the link.

Q. Why are they so sure?

A. With both red meat and processed meat, the panel saw a “dose-response” relationship: the more one eats, the more the risk of cancer increases.

For each 50 grams of processed meat eaten per day, the risk of colorectal cancer grew by 18 percent. In addition, for each 100 grams of red meat eaten per day, the risk of colorectal cancer rose by 17 percent, according to the Lancet Oncology report.

Still, there will be ongoing debate over the wisdom of making such sweeping conclusions on the basis of epidemiological studies alone. But these same kinds of studies led experts to conclude that smoking causes lung cancer and that transfats cause cardiovascular disease, said Dr. Jorge E. Chavarro, a professor of nutrition and epidemiology at Harvard University’s Chan School of Public Health.

Q. Are all kinds of red meat equally bad?

A. It’s hard to say. The scientists did not make any distinctions among various types of red meats. Tracking exactly what people eat is a notoriously tricky undertaking, so the WHO team used an expansive definition.

That said, most of the evidence in the scientific review came from the industrialized world — the United States, Europe, Australia and Japan — where beef, pork and lamb represent the largest share of meat consumed.

Q. Will this report actually convince people to give up their bacon-wrapped hot dogs and filet mignon?

A. Over time, perhaps, but public health authorities certainly have their work cut out for them. Anyone who watches television can see that the bacon cheeseburger has become a powerful symbol of Americans’ right to eat what we want, when we want it, regardless of the consequences.

When we’re hungry, few of us are capable of exercising the kind of “cognitive control” that would enable us to follow the WHO’s advice, said David Just, a behavioral economist at Cornell University who studies how people decide what to eat. There’s also the fact that processed and cooked red meats can be far cheaper than more healthful choices, such as fish.

“We end up being a lot less willing to respond to this kind of information if it’s a food we’re attached to, like red or processed meats,” Just said.

Q. Are there ways to offset the effects of being a carnivore?

A. The main advice from experts is to eat less red meat and to minimize consumption of processed meats as much as possible. The American Institute for Cancer Research, for instance, has long advised people to eat no more than 18 ounces of red meat per week and to stop eating processed meat altogether.

Doing so would reduce one’s exposure to the N-nitroso compounds and polycyclic aromatic hydrocarbons (PAHs) that result from the processing of meats. It would also cut out the heterocyclic aromatic amines and PAHs that form when red meat is cooked at high temperatures. To varying degrees, these chemicals have been shown to prompt cancer-causing genetic mutations in the colon. And three studies have shown that consumption of red or processed meats raises levels of oxidative stress, a contributor to genetic instability.

Q. Can I reduce my cancer risk by eating meat that’s raised organically?

A. No. The panel left no reason to conclude that food raised without added hormones or antibiotics would change its biochemistry to make it safer.

Q. What should I eat instead?

A. Having less meat on your plate might make extra room for vegetables, fruits, whole grains and legumes — all of which reduce saturated fat, increase fiber and deliver antioxidant vitamins.

“Fiber makes any food with toxins transit the digestive system faster, and also gets in some micronutrients,” said Dr. Marleen Meyers, an oncologist at New York University’s Perlmutter Cancer Center. That may help undo some of the damage wrought by eating too much meat, she said.

©2015 Los Angeles Times. Distributed by Tribune Content Agency, LLC.

Photo: cookbookman17 via Flickr

‘Smart’ Guns May Help Prevent Violence — If They Can Make It On The U.S. Market

By Melissa Healy, Los Angeles Times (TNS)

LOS ANGELES — German entrepreneur Bernd Dietel had a radical idea about gun safety.

After a 2002 shooting at the Gutenberg-Gymnasium in Erfurt that left 16 people dead, Dietel envisioned guns with coded digital locks, similar to the ones his company installed on buildings.

In eight years, the Armatix iP1 — a pistol that can be fired only if its user is wearing a wireless wristband that broadcasts on a specific frequency — was ready.

But no gun shop in America will sell it.

The Armatix iP1 and other so-called smart guns have become the latest flash point in the long-running battle between gun rights and gun control.

Although the weapons have broad support among gun owners, the staunchest supporters of the Second Amendment say smart guns only make it easier for the government to control the sale and use of lawful firearms.

They fear, among other concerns, that the advent of guns with high-tech safety mechanisms will prompt state governments to mandate their use. New Jersey already has such a law on the books.

Andy Raymond, co-owner of Engage Armament in Rockville, Md., said he had no inkling of the controversy when he announced last year that he would sell the iP1. He didn’t see the harm in offering customers a new gadget.

“I should have known better,” he said. “I would rather be shot by an i-gun than ever get involved with it again.”

Each year in the U.S., 31,000 people die in gun-related incidents and 73,000 more are injured, according to the U.S. Centers for Disease Control and Prevention.

Smart technology — using fingerprint recognition, hand biometrics, coded locks or other features to make sure a gun can be fired only by its owner — could be used to prevent many of those casualties.

Had Nancy Lanza owned a smart gun, perhaps she, her son and the 26 people he shot in 2012 at Sandy Hook Elementary School in Newtown, Conn., might have lived.

In addition, the technology could save some of the 650 Americans each year between the ages of 10 and 19 who, according to published estimates, use relatives’ guns to take their own lives.

Criminologists say they believe many of the nation’s roughly 11,000 annual gun-related homicides are committed with stolen weapons. At least 18 police officers whose weapons were used against them have been killed in the line of duty since 2007.

Colt’s Manufacturing Co., one of the nation’s oldest gun makers, built a prototype smart gun in the late 1990s that could be fired only if the user wore a ring emitting a specific radio frequency. The project prompted sporadic boycotts of Colt by gun rights enthusiasts and was scuttled.

In 2000, rival Smith & Wesson promised to make all of its new guns available with high-tech safety features. The initiative, sparked by a request from the Clinton administration, was dropped after gun rights activists boycotted the company, nearly driving it out of business.

Detached from the politics of gun control in the United States, Dietel poured his fortune into building the iP1.

“The only reason we’re here today is because our founder has his own money — no one could fire him,” said Belinda Padilla, chief executive of Beverly Hills-based Armatix USA Inc.

Dietel drew on the expertise of his other company, SimonsVoss Technologies, when he launched Armatix. And he poached engineer Ernst Mauch from Germany’s leading arms manufacturer to design the gun.

The .22-caliber iP1 fires only when it is within 15 inches of a synchronized wristband. A light on the butt of the weapon glows green when activated or red when it is too far from the wristband.

The $1,800 iP1 hit the U.S. market last year, landing in a political storm that had been brewing for more than a decade.

It began in 2002, when a New Jersey state senator sponsored a law to spur development of safer weapons and boost the fortunes of researchers at the New Jersey Institute of Technology.

The law required that 30 months after a viable smart weapon came to market, all new guns sold in the state had to be equipped with mechanisms to limit unauthorized use.

At the time, engineers at the university predicted their invention _ a sensor that could identify a person’s unique pattern of grasping a pistol — was years, if not decades, away from production.

The law helped attract research funding but largely faded from public consciousness because there were no working smart guns.

Until the Armatix iP1 arrived.

Raymond, the Maryland gun shop owner, jumped at the chance to sell the weapon. He thought it might appeal to customers who already owned guns, as well as to younger ones drawn to consumer electronics.

But before long, Raymond — who calls himself “a huge Second Amendment guy” — was the focus of threats to burn down his store and kill his bulldog, Brutus.

Enraged gun owners also lashed out against the Oak Tree Gun Club in Newhall, Calif., where the iP1 had been demonstrated and displayed in the pro shop.

Both businesses backed away from the gun. Armatix now distributes the weapon on its website, declining to say how many it has sold.

The gun industry and gun rights activists are wary of smart weapons.

“There are serious questions about the reliability of this technology,” said Mike Bazinet, a spokesman for the National Shooting Sports Foundation. “That’s the main reason that firearms manufacturers do not feel this technology is ready to bring to the marketplace.”

Those concerns were underscored in a report by Sandia National Laboratories in 1996 — and reaffirmed in 2001 — that law enforcement officers could not depend on personalized gun technology to fire when necessary. Since police departments tend to drive the civilian gun market, it was a damning assessment.

But in 2013, the Justice Department released a far more optimistic appraisal of smart gun technology, finding at least three firearms to be on the cusp of commercial use.

After the Sandy Hook massacre, surveys showed that gun users as well as those who had never owned a firearm were hungry for solutions to lessen the harm such weapons could inflict, said Dr. Garen Wintemute, an emergency physician and gun-violence researcher at UC Davis.

A nationally representative survey commissioned by organizers of the Seattle Smart Gun Symposium in January found that two-thirds of Americans believe dealers should offer guns fitted with technology that makes them more secure. In addition, 4 in 10 gun owners — and 54 percent of those between 18 and 44 — said they would “consider swapping” the guns currently in their homes for “new, safer smart guns when they come on the market.”

“Safety does sell,” Wintemute said.

Public health experts say the iP1 could shift the demographics of gun ownership in the United States by attracting people who have been too afraid to own firearms.

Ron Conway agrees. The San Francisco billionaire — who was an early investor in Google, PayPal and Facebook — started the Smart Tech for Firearms Challenge a year after the Newtown shootings, offering grants of $10,000 to $100,000 to develop safe, high-tech firearms.

One of his 15 grantees, Tom Lynch of Safe Gun Technology Inc. in Columbus, Ga., is putting the finishing touches on a fingerprint recognition device for the AR-15 semiautomatic rifle — an assault weapon that gun control activists repeatedly have sought to ban.

Gun owners, he said, want to be able to choose when to activate safe technology, when to turn it off and whom to designate as an authorized user. They want immediate and reliable access to their gun, with no extra steps.

In the face of political stalemate, even ardent backers of gun control legislation are pinning their hopes on smart technology.

“The Second Amendment is part of the landscape,” said Ralph Fascitelli, president of Washington CeaseFire in Seattle. “Technology is the most appealing way out of this conundrum.”

Steve Teret, a public health expert at Johns Hopkins University who has tracked the evolution of smart weapons for more than three decades, said it was only a matter of time before they were readily available.

“I see more people involved and more interest,” he said. “We’re getting quite close to having personalized guns be a reality in the United States.”

In the meantime, Armatix announced last month that it had entered Chapter 11-style restructuring proceedings in Germany. Advocates for safer firearms are closely tracking the company’s fortunes.

Photo: The Armatix iP1 requires authentication from the iW1 — Intelligent Watch — and will activate the gun only for the user. (Genaro Molina/Los Angeles Times/TNS)

Much Ado About Shakespeare: Study Finds Disputed Play Bears The Master’s Mark

By Melissa Healy, Los Angeles Times (TNS)

Chalk up another one for The Bard.

Double Falsehood, a play said to have been written by William Shakespeare but whose authorship has been disputed for close to three centuries, is almost certainly the work of the 16th-century poet and playwright, new research finds.

Shakespeare appears to have had some assistance in the project from John Fletcher, a contemporary who is thought to have co-written three plays with the Bard — including one on a theme similar to that of Double Falsehood — near the end of Shakespeare’s life.

Nevertheless, “the entire play was consistently linked to Shakespeare with a high probability,” the authors of the new study wrote.

Those findings came after two researchers subjected the play’s language to psychological scrutiny and computer analysis so exhaustive that not a single pun, put-down, preposition, or “prithee” went uncounted. The researchers’ method supercharges the practice of “styleometry” long used by scholars of literature by recruiting computers to churn through millions of sentences of text.

Aided by machine-learning programs, computers quickly discern linguistic regularities that become an author’s “signature.” When the authorship of a book or play is contested, computer-enhanced stylometry can compare suspected authors’ “signatures” to that of the disputed work, yielding a scientific basis for assigning authorship.

In the end, two psychology professors from the University of Texas in Austin declared that the author of Double Falsehood — a tale of fathers, sons, duty, and love set in Andalusia — was Shakespeare, and not his acolyte Lewis Theobold.

Theobold, a Shakespeare scholar and avid collector of manuscripts, published the play in 1728, claiming it came from three original manuscripts written by the Bard. Those manuscripts, however, were said to have burned in a library fire. In the absence of physical proof, scholars’ suspicions fell upon Theobold as a literary imposter.

Under the supervision of University of Texas psychology professors Ryan L. Boyd and James W. Pennebaker, machines churned through 54 plays — 33 by Shakespeare, nine by Fletcher and 12 by Theobold — and tirelessly computed each play’s average sentence-length, quantified the complexity and psychological valence of its language, and sussed out the frequent use of unusual words.

“Our results offer consistent evidence against the notion that Double Falsehood is Theobold’s whole-cloth forgery,” wrote Boyd and Pennebaker. While Theobold’s “psychological signature” was not evident, it did make “passing statistical appearances” — probably the result of Theobold’s penchant for heavy editing, they added.

The notion — and method — of creating a writer’s psychological signature opens up new avenues to authenticating disputed works, wrote Boyd and Pennebaker. But they underscored that it can also be used to provide a “better understanding of individuals’ composite mental lives.”

The researchers cite longstanding research that shows that the way writers use language, the words they choose, and even the length of their sentences bespeaks their cognitive style and temperament. A deep analysis of a writer’s verbal output can “paint a very rich picture of who that person is, how he or she thinks, and what he or she thinks about,” they write.

For Shakespeare, much of whose life remains a mystery, the analysis offers a bit of insight: his frequent use of prepositions suggests he was rigorously educated in grammar. His heavy use of “social content words” (vs. words related to thought processes or emotion) suggests he was more attuned to social niceties and advancement than he was either cerebral or preoccupied by his own or others’ feelings, the authors write.

(c)2015 Los Angeles Times, Distributed by Tribune Content Agency, LLC

Nearly 9 Percent Of Americans Are Angry, Impulsive, And Have A Gun, Study Says

By Melissa Healy, Los Angeles Times (TNS)

Tread lightly, Americans: Nearly 9 percent of people in the United States have outbursts of anger, break or smash things, or get into physical fights — and have access to a firearm, a new study says. What’s more, 1.5 percent of people who have these anger issues carry their guns outside the home.

The findings, published Wednesday in the journal Behavioral Sciences and the Law, suggest that measures to reduce gun injuries and deaths should focus less on diagnosed mental illness and more on a history of violent behavior.

The new research also indicates that the 310 million firearms estimated to be in private hands in the United States are disproportionately owned by people who are prone to angry, impulsive behavior and have a potentially dangerous habit of keeping their guns close at hand. That’s because people owning six or more guns were more likely to fall into both of these categories than people who owned a single gun.

In 2012, 11,622 people in the United States were killed by a firearm discharged during an intentional act of violence, and an additional 57,077 were injured. Although mass shootings have focused lawmakers’ attention on the need to keep guns out of the hands of those with a serious mental illness, the new study implies that doing so would make only a small dent in this tally of morbidity and mortality.

Researchers from Duke, Harvard, and Columbia Universities analyzed data gleaned from 5,563 face-to-face interviews conducted as part of a nationwide survey of mental disorders back in the early 2000s. The study authors say they are the first to estimate the overlap between gun access and a history of angry, impulsive behavior — with or without a diagnosable mental illness.

Fewer than one in 10 of those angry people with access to guns had ever been admitted to a hospital for a psychiatric or substance abuse problem, the study found.

Their behavioral history might suggest a propensity for violence, according to the study. But nothing in their medical histories would bar them from legally purchasing guns under existing mental health related restrictions.

“Gun violence and serious mental illness are two very important but distinct public health issues that intersect only at their edges,” said study leader Jeffrey Swanson, a professor of psychiatry and behavioral sciences at Duke University School of Medicine.

“The traditional legal approach has been to prohibit firearms from involuntarily committed psychiatric patients,” Swanson added. “But now we have more evidence that current laws don’t necessarily keep firearms out of the hands of a lot of potentially dangerous individuals.”

(c)2015 Los Angeles Times, Distributed by Tribune Content Agency, LLC

Photo: Southern Enigma via Flickr

Aggression, Not Just Depression, Led Co-Pilot To Crash Plane, Experts Say

By Melissa Healy, Los Angeles Times (TNS)

Mental health experts say that it was aggression — not just depression — that would have driven 27-year-old Andreas Lubitz to deliberately crash a Germanwings airliner into a mountainside, the co-pilot breathing evenly as passengers screamed and the plane’s frantic captain pounded helplessly on the cockpit door.

Unless investigators recognize the toxic role of aggression and hostility in some patients’ depression, they say, such troubled individuals will continue to elude detection — to the public’s peril.

Lubitz’s history of depression, acknowledged by his employer in the days after the March 24 crash of the Airbus A320 with 150 people aboard, left many mental health professionals in the United States openly skeptical that Lubitz’s psychological troubles stopped there. In the parade of garden-variety depressives who march into their offices, psychiatrists, and psychologists often hear about the physical symptoms of mental distress — sleep problems, stomachaches, even changes in vision. They routinely see sadness, guilt, and hostility.

But a murder-suicide on this scale, they said, requires an explanation that goes beyond a simple diagnosis of depression.

“We need to stop talking as if this was a suicidal guy with access to an airplane,” said Dr. Jeff Victoroff, a neuropsychiatrist at the University of Southern California’s Keck School of Medicine and a leading researcher on aggression. “This was a murderous guy who probably had elements of a mood disorder and personality disorders.”

“People who have depression alone are much, much more likely to bring harm to themselves alone,” said forensic psychiatrist Dr. Steven E. Pitt, who consults with the Phoenix Police Department and conducted the Columbine Psychiatric Autopsy Project after the 1999 high school shootings in Colorado. “There has to be a maladaptive character defect, a character disorder here.”

In recent days, sketchy reports of Lubitz’s behavior in the weeks before the crash have hinted at some of the emotional distortions and likely underlying mental illness that may have motivated him, said several forensic psychiatrists in interviews. While a full diagnosis cannot come from such bits of information, they are piecing together Lubitz’s history of depression, possibly heightened by an unraveling romantic relationship and a perceived threat — vision problems — to his career.

In the preliminary accounts of Lubitz’s life before he killed himself and 149 others, they see a highly unstable and emotionally sensitive young adult who probably felt his world was coming apart.

A well-designed personality inventory alone — the kind of detailed questionnaire used by many employers — would probably have flagged traits that diverged dramatically from the standard profile of a pilot: emotionally stable, resilient, and self-disciplined. To have declared Lubitz “100 percent fit to fly,” as Lufthansa CEO Carsten Spohr initially did, “was like pronouncing the Titanic unsinkable just after it hit the bottom of the ocean,” Victoroff said.

The German newspaper Bild reported last week that Lubitz, despite fearing for his job, purchased two expensive cars in recent weeks. In the paper’s account, Lubitz tried to give one of the two cars to Kathrin Goldbach, his girlfriend of seven years, in a bid to cement their failing relationship. Another German news report cited a former girlfriend saying Lubitz told her, “One day, I will do something that will change the whole system, and then all will know my name and remember it.”

Such details offer evidence of what mental health professionals call a “disordered personality” coming undone. With the right tools, they said, the danger he posed might have been identified and stopped.

“This is a mass-murder/suicide,” said Victoroff. “It appears to have been premeditated. And it was preventable.”

Lubitz’s apparently intentional act bears little resemblance to virtually all of the roughly 41,000 suicides that took place in the U.S. in 2013, experts said. Rather, they say, it more closely — in all but the weapon used — resembled the murderous handiwork of Seung-hui Cho and Adam Lanza, who carried out mass murders at Virginia Tech in 2007 and at Sandy Hook Elementary School in Newtown, Conn., in 2012.

The perpetrators of these mass murders were intent on taking their own lives, according to the notes they left behind. While as many as 90 percent of suicides are thought to be impulsive acts, the murder-suicide is virtually never impulsive, said Florida State University psychologist Thomas Joiner, author of “The Perversion of Virtue: Understanding Murder-Suicide.”

Joiner says murder-suicides, which he estimates claim the lives of 1,000 to 1,500 in the United States each year, are almost always the result of extensive rumination, planning, and self-justification. In cases where the perpetrator expects the death toll to be high, he added, that is especially so.

“Two things we’re deeply afraid of in our bones: One is death, the other is killing, and these kinds of events combine those very scary thoughts into one act,” he said. “That takes all the more planning. We’re just not wired that way, and it’s hard to overcome that wiring.”

Overwhelming that wiring requires a perpetrator to recast his actions as a means to more virtuous end, said Joiner, who cited mercy, justice, duty, and glory as common justifications. By this reasoning, a jilted lover must kill himself and his beloved because he reasons she will be unhappy without him; a parent committing suicide must take her children with her, lest they be left alone; or a government’s actions must be avenged.

Those willing to kill others when taking their own lives are generally male and are extremely hostile, psychiatrists say. Most have a history of mental anguish that may extend back to childhood.

In personality assessments and in sessions with mental health professionals, they also tend to exhibit callousness and narcissism. They often have an inflated view of themselves and their powers, and a powerful sense of entitlement.

In manifestoes and personal accounts they leave behind, their sense of victimhood — and their vengeful drive to punish their tormentors — are common themes, experts say. And yet, they wish to be remembered for a grand and even glorious accomplishment.

Much of that is evident only in hindsight.

“Everyone wants us to believe this guy had a sign around his neck saying I’m depressed, I’m angry, and I’m ready to commit murder-suicide — that it’s that obvious,” said Pitt. “The reality is that it’s seldom that obvious…. These people, while troubled, can seemingly hold it together for a protracted period of time and not raise any substantive red flags till it’s too late.”

But Pitt said the lessons of hindsight are increasingly informing the ability of forensic psychiatrists and psychologists to spot red flags.

“How you tell the difference” between depressed and dangerous, said Pitt, “is where the art meets the science.”

But experts are also guided by an increasing body of science.

Researchers are beginning to discern physical markers that suggest an individual’s propensity to harm himself and others. Recent studies have linked low levels of the “feel good” neurotransmitter serotonin and the hormone oxytocin to a propensity for suicide as well as aggressive behavior.

Neuroscientists have also identified a small number of differences in the structure and wiring of key brain regions that distinguish extremely violent offenders. Victoroff said such abnormalities in the brain’s prefrontal cortex — the seat of planning, initiative, self-control, and social judgment — and in connections between the prefrontal cortex and brain structures responsible for emotional regulation and threat response could be detected on a magnetic resonance imaging scan that could be conducted at any community hospital.

Genetic science is also increasingly yielding clues about a propensity for aggression. Last October, researchers canvassing a large prison population in Finland identified two sites on the genome that might serve as red flags for extremely violent behavior. One genetic variation they found was almost three time more common in prisoners convicted of 10 or more violent crimes than it was in a large comparison group of non-offenders.

Collectively, experts predict that a panel of such biomarkers — augmented by a psychiatrist’s examination and by personality inventories that can help detect subterfuge and distorted thinking — might someday be used to keep problematic employees from positions in which they hold others’ lives in their hands.

While it’s too late to conduct an MRI scan of Lubitz’s brain, said Victoroff, a licked envelope or a hair left behind might reveal the presence of such a genetic red flag.

Experts acknowledge that predicting whether an individual is on a path toward suicide, violent behavior — or both — is anything but simple. And efforts to do so are likely to draw resistance from employee, privacy, and civil liberties advocates. Victoroff, for his part, contends that such tools should be used where public safety is at stake.

“We don’t want to pull people out of their careers for minor personal quirks, or even having had an episode of depression,” said Victoroff. “But the combination of problems this guy was exhibiting was too much.”

(c)2015 Los Angeles Times, Distributed by Tribune Content Agency, LLC

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Study: Dementia Patients Continue To Get Medications With Little To No Benefit

By Melissa Healy, Los Angeles Times

LOS ANGELES — More than half of nursing home patients who suffer severe dementia and are likely to die within a year or two are administered medications that offer little to no benefit and may cause pointless discomfort, a new study finds.

The latest research, published in JAMA Internal Medicine, demonstrates that physicians and families often continue the flow of medications well beyond the point at which they might prolong or enhance a patient’s life. The practice needlessly inflates the cost of caring for patients near the end of life, by an estimated $816 on average every 90 days.

Alzheimer’s disease drugs, which are virtually ineffective in patients with severe dementia, were the questionable medications most commonly given to nursing home patients with advanced disease. Prescriptions for Alzheimer’s drugs such as donepezil (better known by its commercial name, Aricept), rivastigmine (Exelon), and memantine (Namenda) are commonly initiated for patients in the early stages of the disease and may slow the rate at which they become unable to care for themselves. There’s little evidence they improve memory or mental performance in people in late stages of the disease, however.

Despite slim evidence for their use, those medications often cause side effects such as fainting and arrhythmia, which put patients at high risk of hip fractures, and urinary retention. More than a third of the study’s 5,406 nursing home residents with severe dementia were taking one or more of these medications.

About a quarter of the study’s subject population continued to take lipid-lowering medications – most typically statin drugs. There’s a very low likelihood that lipid-lowering drugs would lengthen life in such patients, many of whom would not be resuscitated were they to suffer a heart attack anyway. But recent studies suggest that as many as 1 in 5 patients taking a statin may suffer muscle fatigue or soreness, and the Food and Drug Administration has recently warned that in some older patients, statins may cause memory loss and confusion as well.

The latest study found regional and ethnic differences in the trend of such questionable prescribing: It was highest in the southern and central parts of the Western and Eastern United States, where as many as 65 percent of such patients took at least one drug of questionable value. And it was lowest in the Mid-Atlantic states, New England, and the mountain states of the West. Latinos with dementia were much more likely to get medications of questionable value — 65 percent did so — and the rate for non-Latino blacks and whites was roughly the same — about 52 percent.

Men were more likely than women to get such drugs: 62 percent vs. 52 percent got medically questionable medications. And although medications of questionable value went to 44 percent of patients in hospice care and nearly half who had do-not-resuscitate orders, these patients were much less likely than patients outside of the hospice system (55 percent) and those without do-not-resuscitate order (64 percent) to get them.

In an invited editorial, geriatrician and palliative care specialist Dr. Greg A. Sacks expressed hope that the latest findings will prompt physicians who treat any patients with limited time horizons to reconsider their prescribing practices.

If physicians initiated more detailed conversations with patients and their families about the goals that should guide a sick patient’s care, they would be less likely to prescribe many drugs and tests, wrote Sacks, of the Indiana University School of Medicine. The results would be reduced medical costs and patients whose limited life spans are spent more comfortably and are no shorter than those of patients who are needlessly medicated, Sacks wrote.

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Bras Cause Breast Cancer? Apparently Not, Study Says

By Melissa Healy, Los Angeles Times

Uplifting news for the girls: Regularly wearing a brassiere does not increase a woman’s risk of developing breast cancer after menopause, a new study finds.

Not found in the latest research: Compared with their bra-wearing sisters, aging women who avoid such structural support in hopes of reducing their breast cancer risk will experience significantly greater stretching and sagging of the mammaries and more pronounced disappearance of the territory between waist and bust as they age.

But I digress.

The new study, published this week in the journal Cancer Epidemiology, Biomarkers, & Prevention, lifts the veil on a speculated link between bras and breast cancer, and separates myth from reality: “lay media,” the study authors write, have suggested that by impairing the free flow of lymphatic fluids, bras impede the removal of waste and toxin removal, that perennial bugaboo of health faddists and medical conspiracy theorists.

The speculated result of such a toxic buildup would be higher rates of breast cancer among women with a lifelong habit of sequestering their breast tissue in supportive underwear.

But in a study that compared the bra-wearing habits of 469 healthy post-menopausal women with those of more than 1,000 women diagnosed with invasive breast cancer, study authors found that “no aspect of bra-wearing” was positively linked to breast-cancer occurrence: not cup-size, not preference for soft-cup vs. underwire, not the age at which bra-wearing was initiated, or the duration of daily bra-wearing.

“Given how common bra-wearing is,” said the study’s lead author, epidemiology doctoral student Lu Chen, “we thought this was an important question to address.”

The study, conducted by Chen and fellow public health experts at Fred Hutchinson Cancer Research Center in Seattle, was the first to apply a “rigorous epidemiological study design” to the feared bra-cancer connection. It should provide “reassurance” to women, the authors concluded, that their decision to support their breasts will not expose them to a greater risk of malignancy and treatment-related loss.

For those who cling to their suspicions, one methodological shortcoming of the current study might be noted: bra-wearing was “ubiquitous” among the women studied, so researchers were unable to compare the breast cancer rates of women who never wore bras with those of women who always wore them. Instead, in interviewing subjects about their bra-wearing habits, researchers focused more on marginal variations of bra-wearing patterns — none of which mattered.

We do not make this stuff up, dear reader: The authors were prompted to undertake their study not just by “lay media” concerns, but by a 1991 European study, which reported that among premenopausal women who wore bras, rates of breast cancer were twice as high as those among younger women who did not.

That study, concluded the authors, suffered from serious methodological flaws.

Photo: Paul Falardeau via Flickr

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Quasi-Legal Street Drug Poses New Lethal Threat To Users

By Melissa Healy, Los Angeles Times

Emergency physicians are bracing for a new rash of overdoses of a drug that looks like heroin but may not respond to commonly used doses of the opiate-reversal drug naloxone because it is so powerful, a new study reports.

The threat comes from an emerging street drug called acetyl fentanyl — an opiate that is five to 15 times as powerful as heroin and is being mixed with street drugs sold as heroin. An article appearing in the Annals of Emergency Medicine on Monday warns emergency physicians to expect “an upswing in what appear on the surface to be heroin overdoses” but are in fact tied to acetyl fentanyl.

Acetyl fentanyl, an analog of the prescription opiate fentanyl, has no recognized medical use. But it is not specifically regulated, and loopholes in its distribution position the drug in a legal gray area, which makes it easier to get — and hence cheaper on the streets — than fentanyl.

In large quantities, acetyl fentanyl can be titled, labeled, and stored as a product with industrial or non-human research purposes. As long as it’s labeled “not for human consumption,” the transportation and sale of a large package of the stuff would be technically legal.

As a result, drug dealers may be tempted to cut their supplies of heroin with it.

Many users knowingly inject acetyl fentanyl directly as a substitute for heroin or prescription-grade opiates. For those who use the extraordinarily potent drug unknowingly, overdoses are highly likely.

“What’s frightening about this emerging street drug is that users themselves may not be aware they are ingesting it,” wrote lead author John Stogner, a professor of criminal justice and criminology at the University of North Carolina at Charlotte. If acetyl fentanyl is responsible for a drug overdose, Stogner cautioned, physicians may find that larger or additional doses of naloxone are necessary to reverse the overdose.

“One of the many downsides of illegal drugs is you just can’t trust your drug dealer,” wrote Stogner and colleagues. With the use of adulterants in street drugs growing — and delivering more potent highs — “the significant potential for overdose of acetyl fentanyl necessitates more medical research and policy reform,” they wrote.

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Christie Cultivating Ties On New Hampshire Trips, Observers say

By Melissa Hayes, The Record (Hackensack, N.J.)

TRENTON, N.J. — New Jersey Gov. Chris Christie said Republicans have a chance to win the New Hampshire governor’s office, a marked contrast from his comments about the New York race, which drew criticism last week.

As with his recent trip to Iowa, Christie’s visit to an early presidential-voting state stirred rumors that he is laying the groundwork for a bid in 2016. A New Hampshire political analyst and several residents say they believe Christie will run and it’s important for him to be building relationships early.

“When he’s up here he’s going to be meeting a lot of crucial people, he’s most likely going to be keeping contact with them and if he decides to run for president, those people are going to be very valuable,” said Neil Levesque, executive director of the New Hampshire Institute of Politics and Political Library at St. Anselm College.

Protesters were outside Northeast Delta Dental Stadium in Manchester, where Christie was headlining a fundraiser for the New Hampshire GOP on Thursday night. Granite State Retirement Security Campaign members said they opposed his cuts to New Jersey’s pension contributions and were concerned about comments he made about Social Security.

Earlier in the day the Democratic National Committee released a baseball-themed Web ad attacking Christie’s economic record, and communications director Mo Elleithee was in New Hampshire to highlight New Jersey’s high unemployment rate and taxes.

“We’re not going to let him use an event like this to try to pull a fast one on people and sell a bill of goods about some phantom fiscal comeback story,” Elleithee said. “It doesn’t exist.”

As chairman of the Republican Governors Association, Christie has been campaigning and raising money in a year when there are 36 races.

It’s unusual for the group to back a candidate in a contested primary, but Christie endorsed Walt Havenstein in a June 20 visit to the Granite State, saying he has the best chance of beating Democratic Gov. Maggie Hassan. Last week, he backed Tom Foley, whom he endorsed in a 2010 campaign, in a contested Connecticut GOP gubernatorial primary.

At the Foley event Christie said he would not campaign for Rob Astorino, a Republican running for governor of New York, unless the race tightened. Astorino accused Christie of being too close to Democratic Gov. Andrew Cuomo.

But Christie said Republicans can win New Hampshire, even though Havenstein was 26 points behind in a recent poll.

“New Hampshire is a state that has even registration of Republicans and Democrats and has, as we do in New Jersey, a plurality of undeclareds,” Christie said. “So it’s a much different demographic state than a lot of states.”

Christie pledged his support in a campaign stop at the Nashua headquarters of BAE Systems, a defense contractor where Havenstein worked as a top executive before leaving in 2009.

“The RGA will be engaged here because we believe that Walt is an outstanding candidate with a real chance to win and that when he wins, he’ll make all of us proud, having made the investment in him,” Christie said.

Christie said he didn’t know when he would return to New Hampshire.

He has trips planned to Maine, Alabama, Mississippi, Oklahoma, and Kansas in August.

Levesque said it’s never too early to begin building support here and noted that Sen. Rand Paul of Kentucky has hired a seasoned New Hampshire political operative as he mulls a presidential bid and that party activists are already lining up behind candidates.

“Who Christie talks to, who is hanging around with him, who responds well with him right down to who is in the car with him — that kind of thing will buzz right through the New Hampshire activist level,” he said.

Photo: Peter Stevens via Flickr

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Study Says Early DDT Exposure May Set Up Females For Obesity, Diabetes

By Melissa Healy, Los Angeles Times

As they reached adulthood, female mice who were exposed in utero and just after birth to the pesticide DDT showed metabolic changes that put them at greater risk for obesity and Type 2 diabetes, a new study says.

The metabolic abnormalities seen in the exposed female mice were dramatically exacerbated when they were fed a high-fat diet for 12 weeks in adulthood. Compared with unexposed mice who also ate a high-fat diet, females exposed to DDT around the time of their birth were more likely to develop high cholesterol, insulin insensitivity, glucose intolerance, and metabolic problems that could lead to liver disease.

The study, published Wednesday in the journal PLoS One, helps explain a consistent finding from epidemiological studies: In large populations, exposure to DDT and other persistent organic pollutants, or POPs, is linked to increased rates of Type 2 diabetes, obesity, and worrisome cholesterol.

Such studies could not establish a cause-and-effect relationship between pesticide exposure and these ills. But the latest study takes a major step in that direction. By directly comparing lab mice deliberately exposed to DDT during gestation and infancy with members of the same breed who were not, researchers set two identical populations on very different tracks, and consistently gathered a wide range of health-related measures from birth to death.

Experimentation on mice has its limits in illuminating physiological processes in humans. But the mammals’ compressed lifespan and the broad similarity between the inner workings of mice and human have made the small creatures a useful stand-in for us.

The study confirms that DDT exposure sets in motion circumstances that increase an individual’s likelihood over the course of her lifespan of accumulating excess fat, and of metabolizing fats and carbohydrates in ways that increase the risk of developing metabolic syndrome — a precursor to Type 2 diabetes.

But the study also underscores that, when it comes to DDT exposure, cause and effect may be separated by a lengthy delay. In lab mice, repeated exposures to DDT “within the range of contemporary human exposures” came during the second of gestation and within the first five days of life.

In young adulthood — around two months — researchers noted that DDT-exposed females had a slightly lower core temperature than their non-exposed sisters, and seemed to expend fewer calories in day-to-day activities. DDT-exposed female mice were slightly heavier and carried a bit more fat as young adults — two to five months after birth.

But it wasn’t until they were 6 months old that DDT-exposed females showed clear signs of impaired glucose tolerance, fasting glucose, insulin, and lipid levels. And when the two groups of mice were put on a high-fat diet at age 6 months, the trajectories of their weight and their metabolic health diverged even more dramatically.

That delayed response could help place DDT in the pantheon of influences that have contributed to a steady uptick in obesity and Type 2 diabetes among Americans during the 1970s, ’80s, and ’90s — and in the later appearance of the same trend throughout the developing world.

From the late 1940s until it was banned in 1972, DDT was widely used in the United States and throughout Europe to control mosquitoes and other insects carrying malaria, polio, and typhus. After evidence of its toxic effects on wildlife prompted the United States to outlaw its use, DDT continued to be a mainstay of agricultural pest control in many poorer countries for years, and is still used for malaria control in some of the world’s poorest countries.

But the study also underscores that DDT exposure may not by itself have set in motion the world’s obesity crisis. In order for its effects on basic metabolic function — in females at least — to turn into a public health crisis, a new factor unique to modern human society may also have needed to be in place: the flowering of a vast commercial empire built on offering copious amounts of highly-palatable food to creatures with an evolved drive to consume and store as much energy as could be had.

Another key question is how, when DDT exposure appears primarily to affect females’ physiological function, it could possibly explain an obesity crisis that has affected both genders roughly equally. The authors of the latest research found subtle changes in the expression of genes that influence metabolic processes. Only further study will determine whether such changes may be passed on to future generations — and across genders.

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Brain Wave Monitoring Is Better Gauge Than Using A Focus Group, Study Says

By Melissa Healy, Los Angeles Times

To predict a large population’s likely response to something — a product, politician, or policy — political consultants, marketing gurus, and advertising execs have long favored the focus group. Ask a small segment of the target audience what it thinks about something, the formula goes. Tweak accordingly, and unleash on the public.

But what if a handful of subjects, a dozen or so electroencephalograms, and a few hundred yards of electrical wiring could do a better job of identifying a potential hit (or winnowing out a rotten egg)? A new study finds that listening to the average brain wave activity of a small group of subjects produces a more accurate prediction of a large population’s likely embrace of something than does asking the same few subjects what they think.

In the latest research, the 2010 series premiere of the AMC show “The Walking Dead” (shown after its airing to youthful subjects who’d not seen it) provided the experimental stimulus. The larger public’s actual judgment on the show’s curtain-raiser was gleaned not only by its Nielsen ratings but by a minute-to-minute tally of Twitter postings during the broadcast making reference to the show and its contents.

The researchers who conducted the study at New York University’s department of biomedical engineering then explored whether the collective brain activity patterns of a small group of subjects would predict a larger population’s responses to Super Bowl advertisements from 2012 and 2013. Their report was published this week in the journal Nature Communications.

Asking subjects’ opinions was of little value in predicting a hit or a flop. In addition to measuring their brain activity and devising a single measure of inter-subject synchrony, researchers asked subjects to rate the appeal of, or their level of engagement in, these televised offerings. The averaged ratings that subjects gave were a poor prediction of whether the viewing nation would stay engaged in and remember “The Walking Dead” or the Super Bowl ads.

In fact, the answers that subjects gave often didn’t fit with the collective brain wave patterns researchers observed and measured. In the case of some Super Bowl ads, the subjects’ oral assessments suggested they were left cold by the televised stimulus they had just seen, while an average measure of their brain wave patterns showed they had watched with keen interest. In other cases, subjects reported high engagement, on average, with an ad they were seeing. But the collective measure of their brain activation patterns suggested they were unmoved by the content.

It turns out that people in focus groups — and those in one-on-one interviews with evaluators — lie. Or they temper, hedge, prevaricate, or offer an opinion they think will make them look good to the person asking, said the study’s lead author, Jacek P. Dmochowski, now a research associate in Stanford University’s department of psychology. This “cognitive filtering” makes their assessments — even when they’re averaged — suspect, said Dmochowski, whose research was conducted under the supervision of senior author Lucas C. Parra of NYU.

Brain waves, by contrast, do none of those things, suggested Dmochowski. Subjects’ scalps were rigged with electrodes, allowing researchers to measure the minute-to-minute intensity of their brain activity. When alone in a room watching the series premiere of “The Walking Dead,” their patterns of brain activity suggested either that they were drawn into the drama or that their attention had wandered off to other pursuits.

When a large bloc of people pass collective judgment on, say, a new TV show, there is also no lying, no hedging and no tactful consideration: from the comfort of their couches, with remote-controls in hand and other activities competing for their time and attention, the collective of individuals that make up the public jury decide whether a show will be a hit or not, just as they decide whether a public initiative will be embraced or a politician will rally support.

When there was strong synchrony in the brain activity patterns of a small group — as few as 12 subjects watching “The Walking Dead,” for instance — the researchers believed they had distilled the signal that marks the stimulus as a hit. When brain activation patterns varied widely across the small group of individuals — as was seen with some Super Bowl ads that did not fare well in national surveys — researchers discerned the failure signal.

“The stimuli which we judge favorably may be those to which our brains respond in a stereotypical manner that is shared by our peers,” the researchers wrote. “Viewed in another manner, if one is able to evoke reliable neural activity from one’s audience, then that audience is, as a whole, more likely to find one’s message favorable.”

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Almost All Humans Have Genetic Defects Hidden In Cellular Furnaces, Study Shows

By Melissa Healy, Los Angeles Times

The arrival of fast and relatively inexpensive genome sequencing is likely to open whole new avenues for diagnosing and treating diseases. But in a new study, scientists show that it can also reveal how some age-related diseases — from diabetes to neurodegenerative disorders such as Parkinson’s disease and dementia — establish a foothold in the human body, and in doing so, point the way to preventing such diseases.

The latest research zeros in on mitochrodrial DNA — the much smaller but more diverse packet of genetic material packaged not in the nucleus of a cell, but in the small cellular power plants called mitochondria, which convert energy from food into cellular fuel. Conducting detailed mitochondrial DNA scans of 1,095 healthy humans from 14 distinct populations across the globe, the researchers found that at least 1 in 5 healthy humans carry at least one disease-related mutation in their mitochondrial DNA — a condition called heteroplasmy. And 90 percent have mitochondrial DNA mutation of some sort.

Yet they were all still healthy.

Mitochondrial DNA contains 37 genes — a tiny fraction of the estimated 20,000 to 25,000 total genes in the human genome. But a fault in any one of those mitochondrial genes — whether inherited or the result of spontaneous mutation — can wreak havoc with cells across the body. Diseases linked to defects in mitochondrial DNA can cause a wide range of debilitating and deadly conditions, affecting growth, development and the proper function of the muscles, brain, and metabolism.

But the point at which heteroplasmy in mitochondrial DNA results in observable disease is unknown. Scientists have suspected that the severity of mitochondrial diseases is a function of the percentage of mitochondria that carry mutated DNA. And they have observed that older people, and people who are clearly sick with diseases of aging such as cancer, heart disease, and diabetes, tend to have many more such mutations than younger, healthier folk.

But when nearly all of us seem to carry some mutations in these special genes, what’s the tripping point that begins the downward spiral toward illness? And how do healthy people get from having a small number of heteroplasmies to having enough to cause the body to break down?

Those are questions still to be explored. But for now, at least, the latest research offers a glimpse of where humans start that process. Computational modeling done elsewhere has already shown that in the length of the average human’s lifespan, there’s enough time and cellular turnover to allow spontaneous mutations to occur and become widely prevalent in cells. But which heteroplasmies in mitochondrial DNA are worst, and what factors accelerate those mutations and their spread, all need to be explored.

Answers to such questions might point to ways to slow or block those mutations, or their expansion to cells throughout the body. And that, in turn, might nip diseases in the bud.

“Managing the expansion” of these disease-related mutations in mitochondrial DNA “could be a promising means of preventing disease progression,” the authors write. Their study was published Monday in the journal PNAS.

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Medical Sleuths Seek Patients With Mystery Diseases, Offer New Tools

By Melissa Healy, Los Angeles Times

Everyone loves a mystery, except the afflicted patient and his or her family who shuffle from doctor to doctor in search of an explanation for a disorder whose name, origin, prognosis, and cure are all unknown. Now, the National Institutes of Health have underwritten a nationwide “whodunnit” campaign, with a $43 million initiative to fund the diagnosis and exploration of undiagnosed, unrecognized, and misunderstood diseases.

Think of it as a bid to clear a backlog of medical cold cases, using dazzling new tools now at the disposal of medical sleuths. Think of it also as an opportunity for scientists to glean new insights into the human genome and its role in causing — and perhaps curing — disease.

This week, the NIH announced the expansion of its Undiagnosed Disease Network, which by the summer of 2017 is expected to enroll at least 300 new patients with mysterious and intractable conditions per year, nationwide.

The diseases that afflict these patients are conditions that have stumped even skilled physicians. Doctors may fail to recognize the conditions because they are rarely seen, have never been described in the medical literature, or are rare forms of more common diseases. Some may be caused outright by infection or environmental exposure. But many will have their origins in a patient’s genes but have been unexpressed or gone undetected earlier in the patient’s family tree.

Prospective patients interested in participating in the Undiagnosed Diseases Network may learn more here.

The initiative builds on a pilot program run for six years from NIH’s Bethesda, Md., clinical center. There, some 600 patients whose symptoms have stumped their doctors have been brought in for extensive diagnostic work-ups in a bid to identify and treat their diseases.

Using genomic analysis and a full toolbox of standard diagnostic tests, the multidisciplinary clinical and research team has diagnosed approximately 100 patients. In the process, the NIH team discovered two unknown diseases and identified 15 genes not previously associated with any other human disease.

Now, the experts at NIH will be joined in the hunt by physician/scientists at six institutions across the country — Baylor College of Medicine in Houston; Boston Children’s Hospital, Brigham and Women’s Hospital, and Massachusetts General Hospital in Boston; Duke University in Durham, N.C.; Stanford University; University of California, Los Angeles; and Vanderbilt University Medical Center in Nashville, Tenn.

The expansion of the mystery diseases network comes at a time that scientists could only dream about when the Human Genome Project was launched in 1990. Today, genomic analysis — faster, cheaper, more comprehensive, and more reliable than ever before — is finding its way into clinical practices.

The genetic analysis of solid tumors is widely used to guide the choice of targeted treatments for cancer. The microbiota of everything from human guts to combat wounds is being genetically characterized by the new techniques. Scientists are using them to uncover the fingerprints of ancient plagues and plot the course of prehistoric human migration. And a new generation of massively parallel computer technology has made it possible to sequence a human being’s 3 billion base pairs of DNA in a day — at a cost of less than $5,000.

At UCLA, the new program is expected to bring $7.2 million in federal research funds over four years and tap the resources of UCLA’s genetic medicine program, particularly its Clinical Genomics Center, one of only three nationwide of its kind. Using a simple blood sample from a patient and both parents, massively parallel computing techniques search the exome — the 37 million base pairs in 20,000 genes where most known genetic disorders are thought to arise — to pinpoint the genetic variation responsible for causing a patient’s disease.

Such discoveries sometimes point to existing therapies or treatments that can manage a patient’s condition, lessen his or her suffering, or clarify the prognosis, said UCLA’s Dr. Stanley Nelson, one of the directors of the UCLA mystery-disease program now set for expansion.

The discoveries often help elucidate the basic molecular processes at work in a patient’s disease — and others like it, Nelson added. That can guide pharmacology researchers in developing new treatments for such disorders.

As scientists increasingly discern the roles and functions of unexplored genes, they are sure to happen upon unexpected discoveries, Nelson added in an interview. The discovery of a genetic basis for a sick infant’s failure to gain weight, for instance, might shed light on the processes that start the ball rolling in child obesity, he suggested. That, in turn, might lead to ways to address a nationwide public health scourge.

Finally, for anguished families confronted with a very sick child and a disease of unknown origin, such discoveries can set a course for future family-building free of the disease, Nelson added.

Harvard Medical School will serve as the coordinating center of the newly enlarged Undiagnosed Diseases Network. Investigators there will develop a set of common practices across the network so that member institutions select, evaluate, and diagnose patients in similar ways. Network members will collect and share data.

No patient will be turned away from participation in the Undiagnosed Diseases Network because he or she lacks health insurance coverage.

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FDA Clears Device That Lets Paraplegics Walk Again

By Melissa Healy, Los Angeles Times

A device designed by a quadriplegic Israeli entrepreneur to increase his own mobility, and in use already to get wounded U.S. military personnel up and walking again, has won clearance from the Food and Drug Administration for broad marketing in the United States.

The ReWalk system is sometimes called an “exoskeleton” for those whose legs will no longer move at the command of signals from the brain. It consists of a fitted metal brace that supports the legs and part of the upper body. Its motors supply movement at the hips, knees, and ankles, and its computer and power supply are housed in a backpack worn by the user.

Using a wireless remote control worn on the wrist, the user of this “wearable device” can command the ReWalk system to aid him or her in standing up, sitting down, or walking. Crutches provide the user with additional stability while walking, standing and rising from a chair.

A version of the system is widely used already in rehabilitation centers across the United States. But the ReWalk system cleared by the FDA on Thursday is for use by individuals outside of a rehab setting — in their homes and communities. Its manufacturer said the system will be available immediately, with a price tag of $69,500.

The FDA’s approval specifies that the newly cleared ReWalk system is for use by paraplegics who have spinal cord injuries between the seventh thoracic vertebra and the fifth lumbar vertebra. When it is used in a rehabilitation setting, the agency said it may be used to assist people with injuries between the fourth and sixth thoracic vertebra.

ReWalk already is in wide commercial use in Europe and in Israel, where it was designed by Amit Goffer and is built by Argo Medical Technologies Inc., the research and development firm Goffer founded in 2001. Since then, Argo has expanded to open more than 50 ReWalk centers and train more than 400 ReWalkers around the world.

In 2012, Briton Claire Lomas became the first person to use the ReWalk to complete a marathon. And last fall, a ReWalk device arrived at Camp Pendleton in California for Capt. Derek Herrera, a Marine who was shot and paralyzed in 2012 while leading his special operations team on patrol in the Helmand River Valley in Afghanistan. Herrera, a staff officer who returned to work at 1st Marine Special Operations Battalion, demonstrated the use of the ReWalk system as an aid to training and everyday work.

In addition, two wounded soldiers and a sailor were among the disabled patients whose experiences with ReWalk prompted the FDA’s clearance decision.

“Innovative devices such as ReWalk go a long way towards helping individuals with spinal cord injuries gain some mobility,” said the FDA’s Christy Foreman, director of the Office of Device Evaluation, on Thursday. “Along with physical therapy, training and assistance from a caregiver, these individuals may be able to use these devices to walk again in their homes and in their communities.”

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3D Mammograms Improve Breast Cancer Detection, Drive Down False Alarms

By Melissa Healy, Los Angeles Times

Screening women for breast cancer using traditional digital mammography plus a technique that yields a three-dimensional picture of the breast improves detection of cancer and reduces the number of women called back unnecessarily for further tests and biopsies, a new study has found.

The addition of tomosynthesis, a technique not widely available before 2011, to digital mammography increased the numbers of cancers found in women screened from 0.42 percent to 0.54 percent — a 29 percent increase. The latest research, published Tuesday in JAMA, did not follow women for years to discern whether tomosynthesis saved more lives. But recent research has suggested that tomography is likely better at detecting the most deadly cancers—small invasive cancers and lobular cancers—than digital mammography alone.

While tests that increase detection rates often come at the cost of increasing false positives, the latest study found that adding the 3D pictures to routine mammography actually had the opposite effect: 10.5 percent of women who got mammograms alone were called back for additional imaging or biopsy; but among those being screened with mammography plus tomosynthesis, only 8.9 percent had to endure the anxiety, expense and risk of being called back for further tests.

While digital mammography takes a single, static picture of the breast, tomosynthesis passes a low-dose X-ray source in an arc across the breast, creating a series of images. Computer software then lines the images up to create a three-dimensional image of the breast. Smaller cancerous lesions are less likely to be obscured behind dense tissue or other structures within the breast, and a radiologist can glean a better picture of the size and shape of an abnormality, reducing confusion over whether it has malignant potential.

“We now have a better mammogram,” said the study’s lead author, Dr. Sarah M. Friedewald, a diagnostic radiologist at Advocate Lutheran Hospital in Libertyville, Ill. While several studies have suggested there might be a benefit in adding a third dimension to breast cancer scans, Friedewald said that the current research does so with greater clarity. This study’s robust findings emerged from the collected records of 13 breast imaging centers across the United States, which conducted nearly 455,000 breast-cancer screenings between 2010 and 2012.

Friedewald noted that insurance companies now reimburse unevenly for the more expensive screening that uses both digital mammography and tomosynthesis. “We’re hoping this will shed light on and increase awareness” of the benefits of the enhanced scanning technique, Friedewald added, “so they’ll be more consistent.”

In an editorial accompanying the JAMA study, a pair of experts in radiological diagnosis acknowledged that the new study is unlikely to end the recurring debate over the value of breast cancer screening.

Those inclined to believe that breast-cancer screening saves lives will be cheered by the availability of a technique that makes detection better without driving up false-positive results, wrote Dr. Etta D. Pisano of the Medical University of South Carolina and Martin J. Yaffe, a researcher at the University of Toronto’s Ontario Institute for Cancer Research.

But those who question the value of yearly screens for all women after 40 or 50 will cite the current study’s absence of follow-up, which might reveal whether better or earlier detection of cancers allowed more women to live, and for longer, they added.

Paul Falardeau via Flickr