Two severely paralyzed people operated robotic arms and prosthetics using thoughts captured by implants in their brains, a new study disclosed.

A robotic hand manufactured by the German space agency (DLR).

Today scientists announced in the journal Nature the results of a landmark experiment in which paralyzed subjects were able to control a robotic arm using only their thoughts. The research, after decades of exploration, holds out promise for the future of restoring damaged bodies using robotic prostheses.

Led by researchers at Brown University, the Department of Veterans Affairs, and Massachusetts General Hospital, the study--known as BrainGate--utilized a device called the BrainGate Neural Interface System, implanted directly into the motor cortex of the participants. Wired to a bank of computers, the system was then able to decode their brain's neural signals for movement and translate them into robotic movement. "This work is a critical step," John Donoghue, the neuroscientist who developed BrainGate, said in a statement announcing the research, "toward realizing the long-term goal of creating a neurotechnology that will restore movement, control, and independence to people with paralysis or limb loss."

The two subjects--a 58-year-old woman identified as subject S3 and a 65-year-old man designated as T2, both with tetraplegia--were first able to control a cursor on a screen by thinking about its movement. They then graduated to an advanced humanoid robotic arm made by the German space agency DLR and an advanced prosthetic made by New Hampshire-based DEKA Research. When the subjects concentrated on moving the robotic appendages, their brain supplied the signals for their intent, BrainGate captured those signals, and the robotic limbs responded in turn.

The paper reports that both participants were able to "perform three-dimensional reach and grasp movements," including touching targets and grabbing a bottle. Perhaps most extraordinarily, however, "one of the study participants, implanted with the sensor five years earlier, also used a robotic arm to drink coffee from a bottle."

In the paper, that subject is S3, the female participant. Her real name is Cathy Hutchinson, and this is her story.

* * *

The first thing Cathy Hutchinson became aware of upon waking from three weeks in the quiet of a coma, 16 years ago, was the rhythmic alternation of surge then draw: whoosh, hiss, whoosh, hiss. As the contours of a room began to resolve before her eyes, she discovered the source of the sounds--a ventilator machine beside her bed. Her eyes followed the curve of a plastic tube issuing from the noisy box until it disappeared under her chin, entering her body through the opening in her throat left by a tracheotomy. When she tried to raise her head, she discovered that she could not. No amount of effort allowed her to lift her hand or flex her feet.

Her last memories were of feeling sick, of passing out as her 18-year-old son, Brian, helped her up the stairs to her bedroom, of waking briefly on the rough carpet of the hallway, unable to move. She was 43, a healthy nonsmoker, single mother of two, post office employee.

On that spring day in 1996, it took doctors nearly 12 hours following Brian's emergency call to discover that Cathy had suffered a catastrophic brain-stem stroke. The brain stem is located at the base of the skull, a small region of primitive structures crucial to survival. It governs the critical functions of breathing, swallowing, blood-pressure regulation, and consciousness and conducts all messages between the brain and the spinal cord.

A brain-stem stroke is the sort of medical event that can result in death immediately or soon thereafter. But in Cathy, who was young and in otherwise good health, the stroke disconnected her brain from the descending motor tracts of her brain stem--the neural pathways carrying instructions to her muscles--leaving her "locked in," not only quadriplegic but also unable to speak. The ascending tracts, which carry sensory information from body to brain, remained intact, allowing her the experience of pain, itch, heat, and cold but not the possibility of addressing them. She had a sensate, lucid mind incapable of action.

What recovery her body was able to make had happened early on after the stroke. She could control her eyes, she could swallow and breathe on her own, and she could move her head slightly, which allowed her to operate the wheelchair with a button on the headrest behind her. She communicated through a system--developed by engineers at UMass Dartmouth's Center for Rehabilitation Engineering to track her eyes and convert her gaze into mouse clicks. In this way, she could slowly pick out letters on a keyboard, allowing her to use her gaze to email and do some basic Web browsing.

In 2005, a friend of Cathy's, a nurse, came across a call for participants for BrainGate, run out of Brown University. The researchers were seeking patients with quadriplegia for a pioneering experiment in which an electrode-studded implant would be embedded directly into the brain, in the hopes of identifying and decoding the neurological activity that governed physical movement. The short-term goal was to use signals from the brain to control computers and then assistive devices. The long-term goal was to bypass damaged sections of the spinal cord and restore movement.

The study's codirector, a conscientious young neuroscientist named Leigh Hochberg, was blunt with Cathy: Whatever the failures or successes of the study, she could not hope that the results would assist her in her lifetime. "There are no expected benefits this early on in the research," Hochberg told me. "What we're doing, and what Cathy knew when we were starting and what she enthusiastically joined, is an endeavor to test and develop a device we hope will help other people with paralysis in the future."

Cathy's device was implanted in 2005, and the researchers first target was for her to control a computer cursor. As Cathy concentrated on moving her hand, her efforts unspooled on screens in front of the researchers, who tried to use the information from her brain as a sort of virtual mind-controlled mouse. When the researchers turned control of the cursor over to Cathy's neurons, the cursor immediately began to move haltingly across the screen. Cathy couldn't believe her eyes. "I was numb with shock and disbelief," she wrote to me, "so I moved the cursor all over the screen."

Soon, she was navigating a rudimentary game the researchers called "neural Pong." But moving cursors on a screen involves interpretation of only two dimensions of intended movement in a digital environment. The next trials would require a great leap. The researchers wanted to give Cathy the ability to operate in physical space. They hoped to allow her to control a sophisticated robotic arm to stretch, grab, and move real objects in her surroundings--her first chance to do so in nearly 15 years.

The rest of Cathy's story can be found in The Electric Mind by Jessica Benko, out today from The Atavist. The full ebook single is available for sale through Kindle Singles, iBooks, The Atavist app, and other outlets via The Atavist website.

While Weight of the Nation is airing on HBO this week (I'll comment on it after it's fully aired), here's what happens when public health officials try to do something to make it easier for kids to eat more healthfully.

The Massachusetts public health department came up with a proposal to ban bake sales in public schools 30 minutes before, during and after classes.

The reaction? An uproar. The ban, according to critics, would

• Make it harder to raise money for class trips and athletic equipment
• Undermine the fundraising efforts of parent and student groups
• Not help prevent obesity
• Take away choice from school districts ("government gone awry")

Under this kind of pressure, "the governor spoke, emergency orders were issued, and the Legislature voted."

End of ban.

Massachusetts public health commissioner John Auerbach pointed out:

The school nutrition standards have always been about reducing childhood obesity in Massachusetts and protecting our kids from the serious long-term health impacts that obesity can cause...At the direction of Governor Patrick, the department will seek to remove these provisions.

We hope to return the focus to how we can work together to make our schools healthy environments in which our children can thrive.

Best of luck.

This reminds me of what happened in Texas, when Susan Combs, then state agriculture director, attempted to ban cupcakes from public schools.

As Dr. Cathy Isoldi described in her study of school celebrations earlier this year (on which I am a co-author),

Such bans have prompted intense opposition in many areas of the country. In Texas in 2005, a ban on food service during classroom celebrations elicited parent outrage and resulted in the addition of a Safe Cupcake Amendment to the state's nutrition policy. The amendment, known as Lauren's Law, ensures that parents and grandparents of schoolchildren celebrating a birthday can bring in whatever food items they choose for classroom celebrations.

Isoldi's work makes it clear that school celebrations alone can account for a whopping 20 to 35 percent of a child's daily calorie needs. This percentage does not account for additional treats sent home with children, given to them by teachers as rewards, or purchased in school at bake sales.

You don't see an occasional cupcake as a problem? Read Bettina Siegel's post on what goes on in her kids' school and how often schoolkids are exposed to junk foods during the school day.

Of course kids will eat treats rather than healthier foods if given half a chance. Isn't it an adult responsibility -- at home and at school -- to make sure that kids eat healthfully?

The environment of many schools is anything but conducive to good health practices. While outright bans may be seen as going too far, some kind of restriction on junk food in schools seems like a sensible adult decision, given the impact of obesity on children, families, and the health care system so well documented in Weight of the Nation.

State legislatures should be promoting such efforts, not overturning them.

This post originally appeared on Food Politics, an Atlantic partner site.

New mothers would be saving themselves a lot of grief if they paid less attention to books and more attention to their own instincts when raising their baby.

This is one of the points that emerge in historian Angela Davis' new book, Modern Motherhood: Women and Family in England, 1945-2000.

Dr. Davis, a British Academy Postdoctoral Fellow in the Department of History at the University of Warwick, interviewed 160 British women of all ages and backgrounds about their experiences of motherhood, including how it has changed through the years. And one point that continually came up was how inadequate motherhood manuals had made new mothers feel.

The experts' answers have varied through the years, but one thing that hasn't is the tone of their advice. Whatever the answer, it's always been given as an order, with a threat of dire consequences if the order wasn't followed.

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Should you feed your baby at the same time each day or vary the routine? Should you immediately comfort a crying baby who won't go to sleep or allow them to cry it out for a bit first? Should your baby sleep in your bed, or is this so dangerous as to be nearly criminal?

Some mothers have very clear ideas on how to handle these issues. Others don't and often turn to motherhood manuals, parenting books written by baby 'experts,' for answers to these questions.

The experts' answers have varied through the years, but one thing that hasn't is the tone of their advice. Whatever the answer, it's always been given as an order, with a threat of dire consequences if the order wasn't followed. These commandments usually have demanded unattainably high standards for mothers and their babies, sometimes leaving the mothers feeling like failures when reality intruded and they weren't able to meet them.

It hasn't helped that the actual advice has changed almost as often as clothing fashions. The earliest manuals all preached that babies need strict routines. As the years passed, the trend was towards less strict and authoritarian approaches. Around the 1990s, the pendulum began to swing back the other way towards a more regimented approach again.

After more than 50 years the experts still can't agree on the basics of motherhood. Maybe that's because the real experts are the mothers themselves.

Dr. Davis often spoke to women from different generations of the same family. The oldest were able to reflect back upon their own upbringing, as well as their children's and grandchildren's. Many were still unsure which of the experts' child rearing approaches was best.

So what's a confused mother to do?

From her interviews, what stood out most to Dr. Davis was that all babies and all mothers are different. The approach that often worked best was not to follow the "experts'" advice to a tee but for mothers to adapt this advice to their own personal situation. For many, this meant navigating a middle ground, adopting some elements of a routine-based approach but ignoring others, allowing them to be much more flexible in meeting their babies' needs.

Dr. William Sears's attachment parenting manual, The Baby Book, turned 20 this year. Benjamin Spock's book, Dr. Spock's Baby and Child Care, has remained in print for over 65 years. Perhaps one reason it's been so enduring is its opening advice to new mothers: "Trust yourself. You know more than you think you do."

Timeless advice for perplexed mothers.

Modern Motherhood: Women and Family in England, 1945-2000 is published by Manchester University Press.

This article originally appeared on TheDoctorWillSeeYouNow.com, an Atlantic partner site.

PROBLEM: Ever since Francis Galton noticed the preponderance of firstborns in the English scientific community (PDF), experts have weighed in on whether birth order affects intelligence. Theorists have argued that "laterborns" live in less cognitively stimulating environments filled with more kids and are left with fewer resources for the pursuit of knowledge. Since intelligence is fairly heritable, can this seeming birth-order effect be explained instead by the preference of smarter parents to simply have fewer children?

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METHODOLOGY: London School of Economics and Political Science researcher Satoshi Kanazawa analyzed data from a British study of more than 17,000 people, who took multiple intelligence tests at ages seven, 11, and 16. He controlled for several variables, including fertility, social class, and parental educational background.

RESULTS: Children from larger families, regardless of their birth orders, tend to be less intelligent than kids in smaller households. Birth order is not associated with intelligence once the number of siblings is statistically controlled.

CONCLUSION: The apparent birth-order effect on intelligence may actually be due to family size. Since children largely inherit their intellects and less intelligent parents tend to raise more kids, the offspring of larger families tend to be at a cognitive disadvantage.

IMPLICATION: So why do smarter parents have fewer children? "More intelligent people are more likely to do unnatural things or things for which they are not evolutionarily designed to do," says Kanazawa, "and having fewer children is one such unnatural thing."

SOURCE: The full study, "Intelligence, Birth Order and Family Size," is published in the journal Personality and Social Psychology Bulletin.

In 2008, the Chinese government conducted one of the largest real-time environmental experiments ever undertaken: In order to get air quality up to par for the summer Olympics in Beijing--in of the world's most polluted metropolis--the government halved the number of cars allowed to drive the city's roads, shut down coal-burning factories in the area, and halted construction projects, among other efforts. And it worked. Air quality met the International Olympic Committee's (IOC) standards during the Olympics and subsequent Paralympic Games; both Athletes and Beijing residents could breathe a little easier - at least for a while.

U.S. Olympic distance runner Amy Yoder Begley, who had previously visited Beijing, declared air quality "better than expected" upon arriving for the 2008 games. The IOC was pleased too. "I think, objectively, we can say that the Chinese authorities have done everything that is feasible and humanly possible to solve the situation or to address the situation," Olympic Committee chief Jacques Rogge reported during a press conference. "What they have done is extraordinary."

After the games came to an end, however, many of the temporary pollution-reducing measures were relaxed, and pollution levels climbed once more.

Although the period of blue skies in Beijing may have been fleeting, researchers from the University of Southern California (USC) and colleagues have found that even such a small window of cleaner air may have proved useful for residents' cardiovascular health. That's according to a new study published yesterday in the Journal of the American Medical Association.

"Heart disease in on the rise everywhere in the world - especially in the developing world," says Dr. Junfeng Zhang, Professor of Environmental and Global Health at USC, and senior author on the study. "So, we thought that this drastic a change in air quality in a relatively short period of time could provide a unique experimental condition to really detect biological changes relevant to cardiovascular health."

For the study, Zhang and colleagues recruited 125 healthy, young people, all of whom worked at a local Beijing hospital. They measured several markers of heart health in study participants before, during, and after the Olympic period - most notably the von Willebrand factor and soluble P-selectin (sCD62P), indicators of blood clotting and noted precursors to cardiovascular events such as stroke and heart attack. Zhnag's team also measured daily concentration of air pollutants.

"We hypothesized that biomarkers of cardiovascular health would change as air pollution levels change," says Zhang. "And that is, in fact, what we found." As pollution levels dropped, so did indicators of cardiovascular risk in study participants. As pollution levels rose back to pre-Olympic levels, indicators rose right alongside.

While the link between cardiovascular disease and air pollution has long been acknowledged by the American Medical Association, this study is the first to directly look at the underlying mechanisms by which air pollution affects the heart.

"[Other] epidemiological studies have linked air pollution, especially fine particulate matter - 'soot' -- with adverse cardiovascular outcomes, but these studies seldom shed any light on biological mechanisms underlying this association," said Dr. John M. Balmes, Professor of Pulmonary Medicine, University of California San Francisco, responding to the study in an email to the Atlantic. "This study took advantage of the decreased air pollution of the Olympics period in Beijing to investigate potential mechanisms of the adverse cardiovascular effects."

But beyond understanding the mechanisms by which air pollution may impact cardiovasular health, Zhang says there's another important take-away point in his study: air pollution doesn't discriminate by age.

"'I'm young, I'm super healthy, I shouldn't worry about those things, is how young people think," Zhang says. "But this study shows that even if you're young and healthy, your physiology can actually detect the impact of air pollution."

Most governments would not be able to institute the sorts of radical pollution-reducing measures undertaken by China in 2008, but Zhang says there is still hope that even short-term and incremental reprieves from polluted air can help our hearts.

"This study can only answer a few questions we have about the link between air pollution and cardiovascular health. But I think the important thing is that even with these sorts of short term changes - if your body gets only a brief break from the chronic burden of air pollution exposure - it can still do some good for your health overall," he says.

Fighting through traffic on the way to work is hardly anyone's idea of a good time. Yet millions of Americans put themselves through this torture on a daily basis, which has prompted something of a new cottage industry in research on the health effects of commuting. Among other discoveries, in the past few years, we've learned that traveling to work takes a disproportionate toll on women's mental health; breathing in car exhaust increases your risk for a heart attack for up to six hours after exposure; and the time we spend sitting in traffic may even be gradually eroding our social capital.

Now, add to that a new study that finds people with longer commutes have larger waistlines as well as higher blood pressure. According to a team of U.S. researchers examining 4,300 Texas commuters, traveling more than 15 miles to work each day means lower odds of meeting good physical fitness standards:

Of the almost 4,300 residents from Dallas and Austin involved in the study, researchers discovered that for every 10-mile increase in driving distance, the commuter's BMI (body mass index) rose .17 units. People with lengthy commutes are nine percent more likely to be obese, either because they didn't exercise as much, are eating fast food while driving, or they're not getting enough sleep because their long commute forces them to wake up early.

"It could just be a function of having less discretionary time to be physically active," the study's lead author, Christine Hoehner of Washington University in St. Louis, told ABC News. "Or it could be related to people burning fewer calories because they're sitting longer."

High-quality maternity and neonatal care is critical not just to individual families but to society as a whole: obstetrician-gynecologists (ob-gyns) help ensure that babies are born healthy and work o optimize mothers' health, as well as to advance quality health care for women of all ages. 

Ob-gyns are among the most frequently sued medical specialists. According to a 2009 survey, 90 percent of board-certified members of The American College of Obstetricians and Gynecologists (ACOG) have been sued. On average, ob-gyns can expect to be sued on 2.7 occasions in a professional lifetime. One third of ob-gyns sued have been sued four or more times. Forty-three percent reported suits for care provided during residency training.

Rather than reflecting rampant negligence and maltreatment of patients, these numbers reflect that even the best care cannot guarantee a perfect birth outcome. Ob-gyns get sued for less-than-perfect outcomes--instances in which no one may be at fault but family medical costs can quickly skyrocket.

Our current medical liability system fails to provide appropriate and timely compensation to persons injured, fails to deter real negligence, and impedes efforts to correct medical errors and improve patient safety. Under the current system, medical justice is unreliable for both patients and physicians, and patient care is harmed.

Access to ob-gyn care has been diminished. This means less prenatal care as doctors decrease high-risk obstetrics (30 percent), reduce deliveries (14 percent), and stop obstetrics altogether (8 percent)--avoidance behaviors reported by 63 percent of ACOG members who responded to a 2009 survey. Access to preventive care is also diminished as fewer gynecologic surgeons are available to treat women with pelvic pain, infertility, or cancer. 

In Southeastern Pennsylvania,19 hospital maternity units have closed since 1997 due to medical liability concerns and costs. In Philadelphia, only the city's six teaching hospitals continue to deliver babies. Statewide, there has been a net loss of 43 hospital ob units over the last several years. Yet safe hospital deliveries and increased availability of prenatal care are among the very factors that contributed to a greater than 90 percent reduction in national infant and maternal mortality during the twentieth century.

 Assurance behaviors, another element of defensive medicine, result in additional laboratory and imaging studies and consultations. Both increase health-care costs and may subject patients to the risks of false-positive test results. Liability costs, including defensive medicine, are by one estimate $56 billion, or 2.4 percent of the nation's annual health-care tab.

Reliable justice would help improve the physician-patient relationship and medical care overall. Two grievous birth outcomes in particular--neurologic impairment, including cerebral palsy, and shoulder dystocia--can have a devastating effect on a patient and her family, as well as on an ob-gyn's relationship with her patient, her own family, and her profession. Neither of these outcomes is likely related to the obstetrician's actions or inaction. But multi-million-dollar jury awards often follow.

Despite dramatic improvements in maternal and neonatal morbidity and mortality, the rate of cerebral palsy remains unchanged. Epidemiologic studies show that less than 10 percent of cases can be attributed to events occurring during labor and delivery. Yet the costs of caring for and educating these children are substantial, and malpractice lawsuits are often the only source of financing, regardless of an absence of fault. 

Shoulder dystocia constitutes an obstetric emergency. A newborn can suffer permanent injury to the brachial plexus--nerves supplying the infant's arm--when the baby's head delivers but the shoulders remain trapped in the mother's pelvis. More critically, the umbilical cord is compressed and the baby is deprived of oxygen. The obstetrician has only minutes to deliver the baby before it suffers brain damage or dies. Before intervention, the brachial plexus is already stretched; appropriate maneuvers to free the baby necessarily further stretch it. About 88 percent of brachial plexus injuries result in only transient impairment of the baby's arm, but unavoidable permanent injury afflicts the remainder.

Today, "experts" often testify that nerve injury itself proves obstetrical negligence, and omit that the obstetrician saved the baby's life. Some courts have denied obstetricians their right to explain brachial plexus injuries. Since this condition cannot be reliably predicted, the injury has occurred naturally, and the baby will die if not delivered within minutes. Should the obstetrician be held responsible for an outcome beyond her control? Is a lawsuit appropriate when the obstetrician saved the baby from a life-threatening circumstance?

When a doctor recognizes that there is no relationship between the quality of her care and the courtroom outcome, justice no longer exists, and a skilled and caring physician may be lost from the profession. It is not unusual for physicians to think about a change in specialty, practice location, or even career after an adverse event. Some physicians are so affected as to experience symptoms of post-traumatic stress disorder.  

Most adverse health outcomes are systems errors, not acts of negligence by otherwise skilled care providers. Root cause analysis allows us to discover how established safeguards failed, and make important corrections. The National Transportation Safety Board similarly investigates airplane crashes and near-misses to make commercial aviation safer. The willingness of participants to disclose actions and thought processes is essential to root cause analysis. The fear of litigation, however, makes health professionals think twice. Efforts to improve patient safety and quality are hindered.

A system in which each case turns on unique facts and circumstances, in which cases involving the same facts have opposite outcomes, and in which outcomes provide no general lessons, methods or rules to improve patient safety is unreliable by definition. Patients need assurance that avoidable medical injuries will be recognized and compensated and that safeguards will be implemented to protect other patients. Physicians, especially ob-gyns, need assurance that in the event of an adverse outcome, their professional actions will be objectively evaluated to yield broadly applicable conclusions and recommendations. If health care is a right, society needs to determine who will compensate patients for unavoidable adverse outcomes. That depends on a reliable system of medical justice. 

• The drug or other substance has a high potential for abuse.
• The drug or other substance has no currently accepted medical use in treatment in the United States. 
• There is a lack of accepted safety for use of the drug or other substance under medical supervision.

Critics of the Obama Administration's drug policy, myself included, have focused on the president's broken promise about federal raids on medical marijuana dispensaries in jurisdictions where they're legal. But an even less defensible aspect of Obama's drug policy is how marijuana is scheduled.

As John Walker points out, the Controlled Substances Act gives the executive branch the power to unilaterally change a drug's classification:

Obama can instruct the relevant agencies under him to take an honest look at the research and reschedule marijuana so it qualifies as having legitimate medical uses. The Obama administration could easily and justifiably move marijuana to, say, schedule III, which happens to be the same schedule that synthetic THC is in, making medical marijuana legal under federal law.

There would be nothing unusual, extraordinary or legally suspect about Obama doing this. The executive branch has often moved certain drugs to lower or higher schedules based on new data without Congressional involvement. In fact, multiple sitting governors have petitioned the Obama administration asking him to move marijuana to a lower schedule, so he should be aware of the flexible authority he has. Obama is not some hapless victim whose actions on this issue are constrained by congressional law. The truth is pretty much the exact opposite. Under current law Obama effectively has the power to unilaterally make medical marijuana legal.

His failure to do so is frustrating and to his discredit because it's what the language of a law duly passed by a bygone Congress and signed by a past president demands. There just are accepted medical uses of marijuana today. Pretending otherwise is every bit as much an affront to science and empiricism as the most ill-informed denial of evolution or climate change. 

Yet here is how the Obama White House touts its drug policy:

Congress also bears substantial responsibility for the anti-scientific, anti-empirical aspects of American drug policy. If Mitt Romney and Barack Obama are able to define the terms of the upcoming presidential election, this issue won't come up. But voters have consistently shown interest in the subject when permitted to directly question politicians, and Gary Johnson, the Libertarian Party nominee, is eager to challenge Obama and Romney on this issue given the chance. When opportunities for these challenges arise, the classification of marijuana is one of the most vulnerable parts of the status quo to attack.12 states have pending medical marijuana legislation.

Improving the health of adolescents worldwide is the surest route to better health globally, a new study has found. Unfortunately, according to a series in The Lancet, the health status of this age group has not improved as much over the past 50 years as that of children under 10 years of age.

Everyone tends to assume that adolescence is a healthy time of life; and it is, in ways. But it's also a risky time of life, especially worldwide.

Adolescents are more predisposed than adults to what are dubbed 'hot cognitions,' meaning they are more affected than adults by exciting or stressful situations when making decisions.

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Because of longer periods of time spent in school, delayed marriage, and a new understanding of how long it takes for the brain to fully mature, the period of adolescence has come to be viewed as extending from age 10 to 24 years of age, not from 13 to 18 or 19 as most assume.

This expansion of the boundaries of adolescence means that there are 1.8 billion adolescents in the world. If you find that a scary thought, consider the risks that are present in the lives of most adolescents:

As a group, teens are more frequently exposed to, or participate in, risky behaviors such as alcohol consumption and illegal drug use, and have sex with more casual partners than previous generations. They also face new challenges, such as social media.

In addition, adolescents are more predisposed than adults to what are dubbed "hot cognitions," meaning they are more affected than adults by exciting or stressful situations when making decisions. These hot cognitions may be associated with increased activity in the nucleus accumbens, a reward and pleasure center in the brain.

Researchers Susan Sawyer and George Patton and their colleagues from the Murdoch Children's Research Institute and the University of Melbourne conclude that the lack of focus on adolescent health is a "missing link" if one looks at health concerns and the effect of health behaviors over the course of a person's life.

Adolescent mortality rates in low- and middle-income countries are generally four times higher when compared to those in high-income countries, according to the authors. Injuries account for roughly 40 percent of deaths in 10- to 24-year-olds, compared with 10 percent of the general population. The researchers believe reducing injuries should be a major target for adolescent health advocacy.

If accidents are the largest cause of death, mental disorders represent the biggest burden of disease for adolescents. The incidence of mental disorders rises sharply throughout adolescence according to the study.

Marketing and Social Media Risks

Adolescents represent a sought-after market, particularly for unhealthy consumer goods, such as tobacco products and foods high in sugar, fat, and salt. Although women are four times less likely than men to smoke, this four-to-one ratio drops to roughly two-to-one in teenagers globally. The reason? Girls are aggressively targeted by the tobacco industry worldwide.

The widespread use of social media is one development that Sawyer and Patton feel has both pros and cons. Although social media allows young people to access information and enables them to communicate and effect community change, it also exposes them to new risks such as cyber-bullying and sexting, the act of sending sexually explicit photos or text messages via cell phone.

Even sexual and reproductive health, which has been a focus of adolescent health programs, has remained an area of risk. There are more than 1 million new HIV infections identified every year in the 15- to 24-year old age group, and these cases account for 41 percent of all new infections in those aged 15 years and older. The authors suggest that even in this traditional area of adolescent health, there has been insufficient attention to health policy.

The authors conclude that, "In view of their dynamic and challenging health profile, the contribution of adolescent health to the global burden of disease, and the important effect of adolescents and their health across the life course, adolescents should be more prominent within future global public health policies and programming."

The study appears in the online edition of The Lancet.

This article originally appeared on TheDoctorWillSeeYouNow.com, an Atlantic partner site.

I was a member of the FDA Food Advisory Committee when the agency approved production of genetically modified foods in the early 1990s.

At the time, critics repeatedly warned that widespread planting of GM crops modified to resist Monsanto's weed-killer, Roundup, were highly likely to select for "superweeds" that could withstand treatment with Roundup.

I wrote about this problem in Safe Food: The Politics of Food Safety. I added this update to the 2010 edition:

Late in 2004, weeds resistant to Monsanto's herbicide Roundup began appearing in GM plantings in Georgia and soon spread to other Southern states. By 2009, more than one hundred thousand acres in Georgia were infested with Roundup-resistant pigweed. Planters were advised to apply multiple herbicides, thereby defeating the point of Roundup: to reduce chemical applications.

Today, the idea that planting of GM crops is "widespread" is an understatement.

So, according to Reuters, is Roundup resistance.

Weed resistance has spread to more than 12 million U.S. acres and primarily afflicts key agricultural areas in the U.S. Southeast and the corn and soybean growing areas of the Midwest.

Many of the worst weeds, some of which grow more than six feet and can sharply reduce crop yields, have become resistant to the popular glyphosate-based weed-killer Roundup, as well as other common herbicides.

This is not a trivial problem. As the Ottawa Citizen explains,

The resilience of nature is evident across almost five million hectares of superweed-infested U.S. farmland. Some runaway weeds in the southern U.S. are said to be big enough to stop combines dead in their tracks.

How is the chemical industry responding to this threat? Zap it harder!

The industry is pressing the U.S. and Canadian governments to approve GM corn engineered to resist 2,4-D.

Remember 2,4-D? It was the principal ingredient in Agent Orange, the defoliant used during the Vietnam War. Although the health problems it caused have been attributed to contamination with dioxin, the uncontaminated chemical has also been associated with illness in some studies (the Wikipedia entry has references).

The chemical industry maintains that 2,4-D is safe at current usage levels. Maybe, but Ontario bans its use on lawns, gardens, and in school yards and parks. Weeds resistant to 2,4-D have been identified since the 1950s.

Is pouring more toxic herbicides on food crops a good idea? These chemicals cannot be healthy for farmworkers or for soil or groundwater.

Organic agriculture anyone?

Addition: Fred Kirschenmann, Distinguished Fellow at the Leopold Center at Iowa State and organic farmer says in an e-mail:

The other issue that has weed scientists concerned is the fact that 2-4-D is known to be much more invasive than many other herbicides--it can drift in the air for long periods of time and land on many unintended crops.

2-4-D has been identified as the main cause for destroying the grape industry in Iowa--in the 1940′s Iowa was the 4th largest grape producing state in the nation, and then was virtually reduced to zero.

Clearly if 2-4-D is going to be the "answer" to Roundup Ready resistance it will now be used in much larger quantities than in the 1950′s and is not only likely to destroy the rebounding grape production (I think some 200 acres now) and the 8 wineries in Iowa, but will make it extremely difficult to grow vegetables, which will not be good news for the burgeoning CSA/farmers Market industry that has emerged in recent years.

This post originally appeared on Food Politics, an Atlantic partner site.

PROBLEM: Compared to their proportion of the North American population, East Asians are overrepresented in universities and in many professional settings. Still, why are they less likely to be promoted to leadership positions compared to Whites and other racial minorities?

• Blacks Confront Racists, Asians Prefer Quiet Revenge
• The Kind of Pride That Leads to Prejudice
• Having a Simple Name Is Good in the Workplace

---

METHODOLOGY: University of Toronto researchers Jennifer L. Berdahl and Ji-A Min conducted four experiments to look into this so-called "bamboo ceiling." In one trial, they asked survey respondents to read the human-resource record of a business consultant whose last name was either Sutherland or Wong before indicating how much they would like to have the employee as a co-worker. The file also included different supervisor assessments on the employee's assertiveness, agreeableness, and leadership potential.

RESULTS: The dominant East Asian employee was more disliked than the non-dominant East Asian employee, the non-dominant White employee, and the dominant White employee. A separate trial showed that participants held descriptive stereotypes of East Asians as being competent, cold, and non-dominant, while another showed that the most valued expectation of East Asians was that they "stay in their place."

CONCLUSION: East Asians who don't conform to racial stereotypes are less likely to be popular in the workplace. "In general, people don't want dominant co-workers," says Berdahl, "but they really don't want to work with a dominant East-Asian co-worker."

IMPLICATION: Berdahl says managers and coworkers should be wary of this tendency against East Asian employees that exhibit leader-like behavior. She says, "The bias lies within observers and it's ultimately their responsibility."

SOURCE: The full study, "Prescriptive Stereotypes and Workplace Consequences for East Asians in North America," (PDF) is published in the journal Cultural Diversity and Ethnic Minority Psychology.

PROBLEM: Though sleepwalking can lead to injuries and impaired psychosocial functioning, the causes of this disorder remain a mystery and its prevalence in the U.S. hasn't been studied in 30 years.

• Even Low Doses of Sleeping Pills Triple Death Risk
• Debunking the Myth That Sleep Worsens With Age
• Blood Tests Can Accurately Diagnose Depression

---

METHODOLOGY: Researchers led by Stanford University's Maurice Ohayon recruited a sample of 19,136 people from 15 states to estimate the pervasiveness of sleepwalking and evaluate its association with mental disorders. They surveyed them over the phone about their mental health, medical history, and medication use. They also inquired about sleepwalking family histories, childhood incidents, frequency and duration of episodes, and other inappropriate or potentially dangerous behaviors during sleep.

RESULTS: Nearly a third of the subjects have sleepwalked at some point in their lives. As many as 3.6 percent reported at least one episode of sleepwalking in the previous year, with one percent saying they had two or more episodes in a month. Individuals with depression were 3.5 times more likely to sleepwalk than those without. Also, people with alcohol-dependency issues or obsessive-compulsive disorder were significantly more likely to have sleepwalking episodes.

CONCLUSION: More than 1.1 million adults in the U.S. are prone to sleepwalking, and their condition may be tied to psychiatric disorders, such as depression and anxiety.

IMPLICATION: Ohayon says in a statement that, though further research should explore the direction of the apparent causality between nocturnal wanderings and medical conditions, his group's work could help raise awareness among primary care physicians. He says, "We're not expecting them to diagnose sleepwalking, but they might detect symptoms that could be indices of sleepwalking."

SOURCE: The full study, "Prevalence and Comorbidity of Nocturnal Wandering in the U.S. Adult General Population," is published in the journal Neurology.

American nursing homes historically have operated and been regulated as total medical/residential institutions -- like asylums. To a large extent, this is still the situation today.

However, the restrictive, regimented atmosphere of nursing homes is slowly beginning to change. According to a 2010 report by the American Health Care Association and the Alliance for Quality Nursing Home Care, over half of our nursing homes are committed to "culture change." The nursing home culture change movement in the United States, which originated in 1997 but has only become popular in the industry in the last few years, is based on a belief in person-centered care, in which the values and wishes of nursing home residents and those working directly with them are seriously considered and honored.

These changes include collaborative decision-making, a more home-like and welcoming environment, a focus on close relationships among residents and empowered staff, and efforts to improve quality of resident life as well as the quality of professional services. Culture change may be reflected in such practices as encouraging the regular presence of pets and children in the facility, incorporating residents and families into care-planning sessions, permitting the residents to voluntarily perform tasks such as maintaining plants, and providing the opportunity for restaurant-style dining and snack preparation.

There is widespread consensus that implementation of culture change has the potential to significantly improve the quality of residents' lives. Nevertheless, several substantial impediments to a more universal and enthusiastic adoption of the person-centered paradigm persist. One of those barriers is provider apprehension about the present regulatory labyrinth that engulfs every facet of nursing home care.

The pertinent regulatory web, with its heavy emphasis on risk aversion, is embodied in extensive federal Medicare/Medicaid Conditions of Participation (running roughly 70 pages), the complicated survey and certification process intended to measure providers' compliance with those requirements (the relevant portion of the federal State Operations Manual exceeds 660 pages), and the separate licensure statutes, regulations, and guidelines of each state. Moreover, the civil law tort (personal injury) system, as enforced through the courts by the levying of monetary damages against defendants, is another form of regulation that may be used to penalize providers for deviation from then-standard practices.

There are some promising developments on this front. In 2011, the federal Centers for Medicare and Medicaid Services promulgated new procedural guidelines to be used in its nursing home survey process -- the Quality Indicator Survey (QIS). The QIS is intended to focus surveyors' attention more on person-centered outcomes -- for example, whether residents are well nourished -- and less on the process of care, such as what time of day the meals are served. The QIS encourages surveyors to interview and observe residents and their families to understand goals and preferences specific to each resident. The problem, however, is that despite a revamped survey process, the underlying protection-oriented regulations and interpretive guidelines that dictate provider behavior remain unchanged.

Examples of the incompatibility between current regulations and meaningful culture change in nursing homes abound. For example, requirements that beds must be placed only within certain spaces in a resident's room make it impossible for residents to rearrange their furniture as they wish. Regulatory prohibitions on open kitchens prevent residents from fixing snacks whenever they wish. If we are serious about making nursing homes more comfortable and homelike, a review of existing regulations and amendment or removal of those regulations that impede culture change must be put into place.

Sometimes, though, the biggest barrier to culture change in nursing homes is not the actual wording of the regulations but rather the often inconsistent, incoherent, and uninformed way that the regulations are interpreted and enforced by government employees who regularly survey facilities and cite them for perceived noncompliance. The new QIS process may help. But it will in no way diminish the imperative for intensive, ongoing education of government surveyors to inculcate them with the principles and goals of culture change and a commitment to performing their quality oversight function in a less punitive and more collaborative mode. Pilot efforts in this regard established by the Rhode Island health department's nursing home survey agency may serve as a useful model for other states.

Finally, we must address the legitimate anxieties of nursing home owners, governing boards, and hands-on personnel about potential lawsuits if a more homelike environment results in  residents' suffering injuries as a consequence of their own choices. Courts and personal injury attorneys need to be educated so that they will embrace nursing home practices that embodying the new standard of care to which providers should be held legally accountable. Compliance with culture change-driven standards of care should be recognized as a defense to claims of negligence. The best way to ensure this would be legislation codifying the legal weight given to these standards.

The traditional total institution approach to nursing home care is no longer desirable in a modern era that values individual dignity, respect, and control. Some of the changes on the road to a more person-centered, homelike resident experience are untested, and their outcomes are uncertain. If we truly want to improve the quality of nursing home residents' lives, then regulations and courts must accommodate necessary innovation--and its uncertain consequences--in ways that reward and encourage rather than punish culture change.

Mark Lewis and his family.

Dr. Mark A. Lewis' inclination for helping others was passed down to him through the generations before him, at least metaphorically speaking. His father was a caregiver of sorts - a theologian whose healing line of work was deeply informative to the young Lewis. More literally, his father passed him down a genetic mutation that predisposed him to cancer. His father died of lung cancer, the result not of smoking, but of the rare mutation that underlies familial tumor syndrome, in the Lewises' case, Multiple Endocrine Neoplasia type 1 (MEN 1).

As a child, Lewis closely watched his father's doctors do their work. And while their efforts were ultimately fruitless, his wonder at their almost-magical treatments propelled him to medical school where he chose oncology as his trade. Lewis' own MEN 1 status was only revealed in his first year of oncology residency, as were the tumors already growing in his pancreas, where they still reside today, dormant, for now. Realizing that he and his father shared this familial form of cancer made his father's struggles make more sense in retrospect, and it continues to shape his relationships with medicine, his patients, and his own growing family.

But while Lewis' love of helping others was piqued by his early experience, his own journey into clinical medicine has led to a deeper understanding of healing. There are many ways to heal, he has found, and some patients consider themselves "fixed" when the medical community might not; the reverse is true, too.

"Experience has taught me," he says, "that there are many worthy goals besides cure, and that we shouldn't reflexively regard other outcomes as failures. Even the word 'cure' has a slippery definition. Does it mean being cancer-free for five years? Ten? Dying of a medical problem unrelated to cancer, even if cancer or its treatment hastened that death?"

Determining the success of a treatment is about as abstract as it comes, Lewis says. "We sometimes talk, imprecisely, about patients 'failing' treatment. There's an interesting reversal of blame in that phrasing. Surely if there's any blame to be placed, it's the treatment - or its prescriber - that fails the patient." On the other hand, a treatment can be deemed a "success" if it produces a reduction in tumor size that is only perceptible by x-ray. How is this successful, he wonders, if the patient feels no better as a result?

The potentially long-term psychological fallout from treatment, even those that annihilate cancer, is one of the reasons that "cure" is not straightforward. One of Lewis' greatest fears is that patients may be so "irrevocably traumatized by the treatment experience that they will not be able to enjoy life there after. A remission plagued by constant anxiety about a cancer's relapse is a Pyrrhic victory indeed."

Truly humbling to him are the cases in which patients consider themselves the most healed when Lewis has "done the least," medically. Sometimes it is the emotional support, the discussions of mortality, and the ability to prepare for the end of life that benefits patients above all.

For Lewis, professional life and personal life are not so separable as they once were. He's been vocal about the difficulty in experiencing the emotions of both worlds simultaneously. For instance, at almost the precise moment his daughter was born, he lost a young patient - a mother, no less - to cancer. That day forced a realization that the two worlds were inextricably entangled, and this, he says, is the way it should be for any doctor worth his salt.

"Then that awful, wonderful day," he recalls, "with its tumult of feelings and obligations, proved to me that the barrier was permeable. The horrors encountered in my job were not so easily contained, and they could coincide with my most precious joys...Never before had I experienced such extreme feelings at the same time, and the dissonance was unsettling."

Experiencing the wild spectrum of life and death emotions is no easy assignment -- but these "mortal struggles" are what called Lewis to his specialty in the first place, and they are what keep him there. Not experiencing them is what he fears for himself most of all.

In the end, healing remains a knotty concept, and perhaps that's as it should be. "The truth is that healing occurs in many ways that defy quantification," he concludes. All of the roles doctors play -- caregiver, parent, patient, spouse -- inform and augment one another, and, he says, "they cannot -- should not -- be held apart."

A visualization of the human genome (AAAS/Science).

Recently, two headlines announced important news about the impact of genes in assessing and predicting future health. These came from the New York Times, but could have been from any number of other media outlets that carried the stories:

Scientists Link Gene Mutation to Autism Risk
Study Says DNA's Power to Predict Illness Is Limited

The casual reader might be excused if they took away the idea that scientists had on the one hand discovered a rogue gene responsible for autism, and on the other had found that DNA isn't very helpful in predicting disease. These readers might also be forgiven if they wondered how these two findings could each be true.

In fact, both headlines are correct - though not entirely. This is because geneticists over the years have identified a slew of gene markers linked to disease, some of which have turned out, upon further research, to be useful for predicting and understanding disease. Others are not because most of what happens to the majority of us genetically is far more complex and nuanced.

Yet genetics in the public forum is often a discussion of oversimplification and extremes. Some scientists, entrepreneurs, and journalists portray genes and gene markers as near-magical fortune-tellers about a person's health future. Others claim that the first group has overhyped genetics and underplayed the role of the environment and other factors that also impact disease.

The "mighty gene" storyline has its roots in the late 1980s and 1990s effort to sequence the human genome. Boosters in science and industry elevated genes to superstar status in part because they genuinely believed that DNA was the key driver in even common diseases. This also helped to sell a Human Genome Project that required billions of dollars from the U.S. Congress - and billions more from investors to sequence DNA and to hopefully turn this knowledge into drugs and other treatments.

Fifteen years ago the Genes-'R-Everything fervor was so convincing that it attracted the tech-dystopia police - those thinkers and artists who are always looking for worst-case scenarios of technology run amok. In this case, the prospect of a world where genes truly were paramount led to movies like Gattaca, which in 1997 depicted a world where one's DNA determined everything from lovers to jobs - and about one man's effort to overcome his genetic deficits.

Thankfully, Gattaca's assumptions about the deterministic power of genes was wrong, although the director and screenwriter Andrew Niccol can be pardoned if he believed the hyperventilated talk at the time about the potential power of genes to not only diagnose and treat disease, but to predict a person's bio-future.

The appearance of Gattaca and other deterministic discourse brought forth cries of "DNA hype" by the time the human genome was fully sequenced in 2003. This crescendoed in late 2007 when the first direct to consumer genetic testing companies, 23andme and deCodeme, appeared with products that claimed to offer customers predictive risk factors for future disease, along with probabilities for having other traits like curly hair.

Many geneticists - some of them the same ones who lauded the future of genetics in the 1990s - decried the commercialization of genetics as promising too much.

Yet like many myths, the debate over what genes really do dates back to time even before the nineties, to 1953 and the discovery by James Watson and Francis Crick (with a major assist from Rosalind Franklin) that DNA is a double helix.

Crick added to the cult of the super-gene in the 1960s with his notion of a "Central Dogma" in genomics - the idea that one gene equaled the production of one protein (proteins are what genes are coded to make in a cell) which equaled one disease or trait - the point being that genes were the key.

Few people know, however, that Crick's "Central Dogma" was a joke. A man who loved to poke fun, Crick was also a vociferous atheist who disliked dogmas of all kinds - including those in science. He created the Central Dogma as a humorous reaction to people that believed that genes were everything, which most scientists even then knew was an oversimplification. (For more on this history check out my book, Masterminds: Genius, DNA, and the Quest to Rewrite Life).

And yet, to add to the complexity inherent in genetics, the central dogma in some cases is true. For instance, there are rare genetic mutations - glitches in critical sequences of DNA - that are directly responsible for diseases such as Down syndrome and Tay-Sachs. For these terrible and usually fatal conditions, single mutations are highly predictive.

For most common diseases, however, this has not turned out to be the case. The impact of single genetic mutations in auguring risk factors for, say, diabetes and many cancers, is at best only slightly more informative than knowing one's average risk for these maladies.

This is the point of the study published last week in Science Translational Medicine, which looked at the predictive power of genes for 24 common diseases. Researchers at Johns Hopkins studied the genetics and the outcomes of over 53,000 twins born with identical DNA. They discovered that for 20 major diseases the genes had little or no extra predictive power.

This is what the headline above reports, which seems like a victory for the "genes are overhyped" camp. Yet the news here is also more nuanced. It turns out that for the four other diseases analyzed by the Hopkins team - Alzheimer's disease, autoimmune thyroid disease, Type 1 diabetes and heart disease for men - genetic tests can identify up to 75 percent of those who will get these diseases.

Neither does the headline above about new gene mutations for autism tell the whole story about that discovery. As the Times story under the headline explains, the newly identified mutations - made by three different teams at Yale, Harvard and at the University of Washington in Seattle and reported in Nature - are extremely rare, impacting only a handful of patients. Nor do they seem to have much relevance to diagnosing, treating, or predicting autism, though the researchers believe the discoveries could be important for better understanding mechanisms of the disease.

While I was writing my recent book, Experimental Man, and after its publication, scientists identified over 23,000 personal genetic risk factors for me - everything from a low risk of having brown eyes (true: my eyes are blue) to a high risk for Parkinson's disease (false: at age 54 I thankfully do not have any sign of this condition). Other risk factors suggest a high probability that I will suffer side effects from certain drugs, such as statins, which I will keep in mind should my cholesterol soar.

Otherwise, my vast library of possible genetic futures has not changed my life - in part because I'm not sure what to believe given the current dialectic of genes as vital predictors to some and as overblown to others. I expect this to change as interpretations of personal genetic traits improve, but this remains in the future.

Nor does it make sense to emphasize the augurs for the future in our DNA when they are just part of the equation telling us what is happening, or might happen, to our bodies in time. Other factors include the impact of our environment - what we eat and chemicals we are exposed to - and also what is going on in certain proteins in our body.

The sooner we normalize the storyline about DNA, the faster genetics will take its rightful place in our science and in our imaginations as one of several remarkable and critical elements that make us who we are - and what we might become in the future.

Botox isn't just for wrinkles any more. It can also help women with urinary incontinence lead a more normal life.

The largest study to date has found botulinum toxin (Botox) effective at calming the overactive bladders of women with urinary incontinence that had not responded to standard treatments. One Botox treatment was good for six months.

Standard treatments include pelvic floor muscle exercises to improve muscle control and anticholinergic medication, which may lower the activity of nerves that cause the bladder muscle to contract.

---

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Nearly one-third of the women who received Botox had full control over their urination six months after treatment.

The treatment can have side effects. One of six women in the study reported difficulty urinating at some point during the six months. And urinary infections also rose in women who received Botox. But the treatment helped far more women than it caused these problems for.

A common cause of urinary incontinence is an overactive bladder muscle whose contraction isn't fully under a person's control. Standard treatments include pelvic floor muscle exercises to improve muscle control and anticholinergic medication, which may lower the activity of nerves that cause the bladder muscle to contract. While these treatments do help many sufferers, they don't help everyone. And the medication can cause side effects including constipation, dry mouth and blurred vision.

The women in the study all had severe muscle-related bladder problems that had not improved after eight weeks of conventional treatment.

Over four years, the RELAX study recruited 240 such women from eight UK hospitals. A total of 122 received injections of 200 International Units (IU) of botulinum toxin, 20 IU each at 10 different sites in the bladder wall, while 118 received 10 injections of saline. The women reported on how the treatment was working six weeks, three months and six months after treatment.

Thirty-one percent of the women who received Botox reported being fully continent six months afterward, compared to 12 percent who received saline injections. And even those who did not become fully continent reported benefits: on average, leakage episodes decreased from 6.0 to 1.67 per day.

The most common side effects were urinary tract infection and difficulty urinating. Urinary tract infection occurred in three times as many women who received Botox as in those who received saline (36 women to 12). And four times as many women who received Botox had enough difficulty urinating to require occasional self-catheterization, (16 women to four).

It's possible that these side effects can be reduced by altering the initial dosage of Botox; this is a fairly new procedure.

Self-catheterization requires learning how to insert a plastic or rubber tube into the urethra to collect the urine, a procedure which can be inconvenient. But most of the women in the study who had to resort to it found it preferable to their pre-study state of affairs. And those who had no such need were delighted at the improvement the treatment made to their everyday lives.

An article on the study was published online by European Urology and is freely available.

This article originally appeared on TheDoctorWillSeeYouNow.com, an Atlantic partner site.

I was riveted by an article in today's New York Times about the latest decision of an FDA drug advisory panel.

The panel voted to approve a new weight-loss drug, lorcaserin. The vote was mixed: 18 for approval, four against, and one abstention. The majority felt that the benefits outweighed the risks and that even if there were risks, "new tools are needed to treat a major health problem."

The benefits are worth a look.

• People taking the drug lost an average of 5.8 percent of their body weight in a year, compared to 2.5 percent for people taking a placebo. This difference is below the FDA's standard for approval which requires a five percent difference.
• Among those taking the drug, 47 percent lost at least five percent of their weight after a year, whereas only 23 percent of those taking the placebo did so. This meets a second FDA standard for approval.

What about the risks? The drug:

• Causes tumors in rats (although perhaps at higher doses than might be taken by people).
• Damages heart valves (in the same way the withdrawn drug, Fen-Phen, did).

Also in the Times is a piece by Dr. Danielle Ofri on her experience with patients who want weight-loss drugs.

She quotes from an essay called "Lemons for Obesity" by Dr. Michael S. Lauer, who was a minority voter on the FDA panel that approved the weight-loss drug Qnexa earlier this year.

The weight-loss field is strewn with lemons, more so than other areas of medicine, Dr. Lauer argues. Because of the enormous potential market for these drugs -- two-thirds of American adults are overweight or obese -- pharmaceutical companies rush new drugs to market after conducting only small clinical trials. The F.D.A. and doctors are complicit in the process, Dr. Lauer says, leaving the population at large to act essentially as guinea pigs.

Shares of the maker of the drug nearly doubled after the decision. The Times reported that "Arguments by investors have been passionate."

People who cannot easily lose weight are desperate for help.

But is it ethical to put them at this kind of risk?

This post originally appeared on Food Politics, an Atlantic partner site.

PROBLEM: Usually, visceral states, or internal conditions that we want badly to change, can get so overwhelming that we project them onto others. A person who's freezing, for instance, would likely assume that the people around him must be cold as well. But how far does this effect extend?

• Social Inequality May Foster Distrust, Cheating in School
• The Kind of Pride That Leads to Prejudice
• Even the Religious Lose Faith When They Think Critically

---

METHODOLOGY: To see if political rivals can also feel each other's pain, researchers led by Ed O'Brien asked subjects to read a short story about a person who was either a left-wing, pro-gay rights Democrat or a Republican proponent of traditional marriage. This character goes hiking in winter and gets lost with no food, water, or extra clothes. After reading the story, they asked the participants whether the hunger, thirst, or cold was most unpleasant for the hiker and what the hiker most regretted not packing. They were also asked how hungry, thirsty, and cold the hiker felt, and what their own political views were. The researchers then compared the answers of respondents who were warm and comfortable in the nearby library with respondents who were cold and miserable outside during winter.

RESULTS: The cold-condition subjects who had the same politics as the fictional hiker judged the hiker to be cold like them. When the hiker subscribed to different political beliefs, however, they didn't think the hiker was any colder and responded similarly as the warm indoor participants. The scientists saw parallel results in another trial involving thirst.

CONCLUSION: Our tendency to project our visceral feelings onto others does not extend to people who we consider to be very dissimilar from us.

IMPLICATION: Opposing political views may make people seem extremely different and unrelatable. "This as a problem of empathy," says O'Brien. "We don't want to step into someone else's shoes when we disagree with them."

SOURCE: The full study, "More Than Skin Deep: Visceral States Are Not Projected Onto Dissimilar Others," is published in the journal Psychological Science.

A visualization of the human genome (AAAS/Science).

Recently, two headlines announced important news about the impact of genes in assessing and predicting future health. These came from the New York Times, but could have been from any number of other media outlets that carried the stories:

Scientists Link Gene Mutation to Autism Risk
Study Says DNA's Power to Predict Illness Is Limited

The casual reader might be excused if they took away the idea that scientists had on the one hand discovered a rogue gene responsible for autism, and on the other had found that DNA isn't very helpful in predicting disease. These readers might also be forgiven if they wondered how these two findings could each be true.

In fact, both headlines are correct - though not entirely. This is because geneticists over the years have identified a slew of gene markers linked to disease, some of which have turned out, upon further research, to be useful for predicting and understanding disease. Others are not because most of what happens to the majority of us genetically is far more complex and nuanced.

Yet genetics in the public forum is often a discussion of oversimplification and extremes. Some scientists, entrepreneurs, and journalists portray genes and gene markers as near-magical fortune-tellers about a person's health future. Others claim that the first group has overhyped genetics and underplayed the role of the environment and other factors that also impact disease.

The "mighty gene" storyline has its roots in the late 1980s and 1990s effort to sequence the human genome. Boosters in science and industry elevated genes to superstar status in part because they genuinely believed that DNA was the key driver in even common diseases. This also helped to sell a Human Genome Project that required billions of dollars from the U.S. Congress - and billions more from investors to sequence DNA and to hopefully turn this knowledge into drugs and other treatments.

Fifteen years ago the Genes-'R-Everything fervor was so convincing that it attracted the tech-dystopia police - those thinkers and artists who are always looking for worst-case scenarios of technology run amok. In this case, the prospect of a world where genes truly were paramount led to movies like Gattaca, which in 1997 depicted a world where one's DNA determined everything from lovers to jobs - and about one man's effort to overcome his genetic deficits.

Thankfully, Gattaca's assumptions about the deterministic power of genes was wrong, although the director and screenwriter Andrew Niccol can be pardoned if he believed the hyperventilated talk at the time about the potential power of genes to not only diagnose and treat disease, but to predict a person's bio-future.

The appearance of Gattaca and other deterministic discourse brought forth cries of "DNA hype" by the time the human genome was fully sequenced in 2003. This crescendoed in late 2007 when the first direct to consumer genetic testing companies, 23andme and deCodeme, appeared with products that claimed to offer customers predictive risk factors for future disease, along with probabilities for having other traits like curly hair.

Many geneticists - some of them the same ones who lauded the future of genetics in the 1990s - decried the commercialization of genetics as promising too much.

Yet like many myths, the debate over what genes really do dates back to time even before the nineties, to 1953 and the discovery by James Watson and Francis Crick (with a major assist from Rosalind Franklin) that DNA is a double helix.

Crick added to the cult of the super-gene in the 1960s with his notion of a "Central Dogma" in genomics - the idea that one gene equaled the production of one protein (proteins are what genes are coded to make in a cell) which equaled one disease or trait - the point being that genes were the key.

Few people know, however, that Crick's "Central Dogma" was a joke. A man who loved to poke fun, Crick was also a vociferous atheist who disliked dogmas of all kinds - including those in science. He created the Central Dogma as a humorous reaction to people that believed that genes were everything, which most scientists even then knew was an oversimplification. (For more on this history check out my book, Masterminds: Genius, DNA, and the Quest to Rewrite Life).

And yet, to add to the complexity inherent in genetics, the central dogma in some cases is true. For instance, there are rare genetic mutations - glitches in critical sequences of DNA - that are directly responsible for diseases such as Down syndrome and Tay-Sachs. For these terrible and usually fatal conditions, single mutations are highly predictive.

For most common diseases, however, this has not turned out to be the case. The impact of single genetic mutations in auguring risk factors for, say, diabetes and many cancers, is at best only slightly more informative than knowing one's average risk for these maladies.

This is the point of the study published last week in Science Translational Medicine, which looked at the predictive power of genes for 24 common diseases. Researchers at Johns Hopkins studied the genetics and the outcomes of over 53,000 twins born with identical DNA. They discovered that for 20 major diseases the genes had little or no extra predictive power.

This is what the headline above reports, which seems like a victory for the "genes are overhyped" camp. Yet the news here is also more nuanced. It turns out that for the four other diseases analyzed by the Hopkins team - Alzheimer's disease, autoimmune thyroid disease, Type 1 diabetes and heart disease for men - genetic tests can identify up to 75 percent of those who will get these diseases.

Neither does the headline above about new gene mutations for autism tell the whole story about that discovery. As the Times story under the headline explains, the newly identified mutations - made by three different teams at Yale, Harvard and at the University of Washington in Seattle and reported in Nature - are extremely rare, impacting only a handful of patients. Nor do they seem to have much relevance to diagnosing, treating, or predicting autism, though the researchers believe the discoveries could be important for better understanding mechanisms of the disease.

While I was writing my recent book, Experimental Man, and after its publication, scientists identified over 23,000 personal genetic risk factors for me - everything from a low risk of having brown eyes (true: my eyes are blue) to a high risk for Parkinson's disease (false: at age 54 I thankfully do not have any sign of this condition). Other risk factors suggest a high probability that I will suffer side effects from certain drugs, such as statins, which I will keep in mind should my cholesterol soar.

Otherwise, my vast library of possible genetic futures has not changed my life - in part because I'm not sure what to believe given the current dialectic of genes as vital predictors to some and as overblown to others. I expect this to change as interpretations of personal genetic traits improve, but this remains in the future.

Nor does it make sense to emphasize the augurs for the future in our DNA when they are just part of the equation telling us what is happening, or might happen, to our bodies in time. Other factors include the impact of our environment - what we eat and chemicals we are exposed to - and also what is going on in certain proteins in our body.

The sooner we normalize the storyline about DNA, the faster genetics will take its rightful place in our science and in our imaginations as one of several remarkable and critical elements that make us who we are - and what we might become in the future.

Consuming plenty of low-fat dairy foods like milk and yogurt appears to reduce the risk of having a stroke.

Swedish researchers followed nearly 75,000 middle-aged and older men and women over a period of 10 years. The study began in 1997 when participants completed a questionnaire about their lifestyle, diet and exercise habits, body mass index, work, and education. All were free of any history of heart disease, stroke, or cancer at the time.

High-fat dairy foods contain more saturated fat, which can increase LDL or "bad" cholesterol levels and, in turn, lead to clogging of the arteries that supply blood to the heart and brain.

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Over the next ten years, researchers followed the incidence of stroke using the Swedish Hospital Discharge Registry. There were 4,089 cases of stroke reported including 3,159 cerebral infarctions, 583 hemorrhagic strokes, and 347 cases of unspecified strokes. A cerebral infarction occurs when there is a blockage in a vessel that supplies blood to the brain, and a hemorrhagic stroke is caused by a rupture of a blood vessel in the brain.

Among the participants in the study, those who consumed a daily average of four servings of low-fat milk, yogurt, or cheese had a 12 percent lower risk of stroke than those whose diet included full-fat versions of these dairy foods. High-fat dairy foods contain more saturated fat, which can increase LDL or "bad" cholesterol levels and, in turn, lead to clogging of the arteries that supply blood to the heart and brain.

High blood pressure is a risk factor for stroke. About one-third of adult Americans have high blood pressure, but only about half have their blood pressure under control. The DASH diet (Dietary Approaches to Stop Hypertension) emphasizes the consumption of low-fat dairy products and recommends two to three servings a day, depending on calorie intake.

The USDA's Dietary Guidelines for Americans recommends three servings of dairy foods a day, and advises low-fat products.

According to the study authors, the benefits of low-fat dairy foods on stroke risk are likely due to the presence of vitamin D and the minerals calcium, potassium, and magnesium.

There are other risk factors for stroke besides high blood pressure and diet. Other risk factors include smoking and lack of exercise. A healthy diet combined with smoking cessation, increased exercise, and good blood pressure control can reduce the risk of stroke.

The study was published in the journal, Stroke.

This article originally appeared on TheDoctorWillSeeYouNow.com, an Atlantic partner site.

The Government Accountability Office is complaining again about the inadequacies of the American food safety system, and with good reason.

Its 2012 Annual Report, Opportunities to Reduce Duplication, Overlap and Fragmentation, Achieve Savings, and Enhance Revenue, says that the food safety system is:

fragmented and results in inconsistent oversight, ineffective coordination, and inefficient use of resources.

In 2007, GAO added food safety to its list of high-risk areas that warrant attention by Congress and the executive branch.

More recently GAO found that this fragmentation extends to the responsibilities across multiple agencies to defend food and agricultural systems against terrorist attacks and natural disasters…Many of these activities are everyday functions or part of the broader food and agriculture defense initiative and would be difficult for the agencies to separately quantify.

This report repeats what the GAO has been saying since the early 1990s:

there is no centralized coordination to oversee the federal government's overall progress in implementing the nation's food and agriculture defense policy.

Because the responsibilities outlined in this policy (HSPD-9) are fragmented and cut across at least nine different agencies, centralized oversight is important to ensure that efforts are coordinated to overcome this fragmentation, efficiently use scarce funds, and promote the overall effectiveness of the federal government.

Reminder: the present food safety system is mainly divided between two agencies: USDA (meat and poultry) and FDA (everything else).

Centralized oversight of food safety? What a concept.

This post originally appeared on Food Politics, an Atlantic partner site.

Alcohol use and abuse is common among teenage girls. This has short- and long-term health effects as well as numerous consequences of alcohol-enhanced risk taking behavior. Alcohol is a known risk factor for breast cancer and studies have shown that a 10 gram per day increase in alcohol intake in adult women is associated with a 7-10 percent increased risk of breast cancer. (One can of beer is estimated to contain 12.8 grams of alcohol, while one four-ounce glass of wine has 11.0 grams.)

A recent study looked at the impact of alcohol intake in adolescent girls on the development of proliferative benign breast disease (BDD), which is known to cause a fourfold increase in the risk of developing breast cancer. The researchers further asked whether folate intake during the teenage years could positively influence the development of proliferative BDD in female adolescent drinkers.

The data revealed that there was a dose-dependent relationship between alcohol consumption during adolescence and the development of proliferative benign breast disease.

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One theory explaining the impact of alcohol on cancer risk suggests that alcohol decreases the body’s levels of folate, a vitamin which is involved in gene expression and DNA repair. Deficiencies in folate could cause a decrease in the body’s ability to repair DNA. Damaged DNA can potentially become cancerous.

The investigators reasoned that if alcohol decreases the body’s folate level, then perhaps increasing dietary folate could have a protective effect against the increased breast cancer risk posed by alcohol. This would provide a simple nutritional intervention for adolescent girls who drank alcohol to help decrease their breast cancer risk.

The researchers focused on the 18-22 year old age group because they believed that the breast cells were most vulnerable to carcinogens during the time between the first period and the first pregnancy. This is a time when breast tissue undergoes rapid proliferation and differentiation. They hypothesized that “adequate folate intake during adolescence would reduce the risk of proliferative BBD associated with alcohol consumptions between ages 18-22 years.”

The researchers used data from 29,117 women who were part of the Nurses’ Health Study II. The participants completed adolescent alcohol consumption and dietary questionnaires. The data revealed that there was a dose-dependent relationship between alcohol consumption during adolescence and the development of proliferative benign breast disease.

The risk increased as the alcohol consumption increased; for each 10 gram per day of alcohol intake during adolescence there was a 21 percent risk of proliferative BDD. But the BDD risk remained the same for those adolescents who had low, moderate, or high folate intake during adolescence.

Thus, folate was not found to modulate or protect against the risk of development of proliferative BDD. This is a disappointing result as there is currently no identified dietary strategy which can decrease the risk of proliferative BDD or later breast cancer associated with adolescent alcohol use. The best available protection is decreasing adolescent alcohol consumption.

The study appears in the journal, Pediatrics.

This article originally appeared on TheDoctorWillSeeYouNow.com, an Atlantic partner site.

PROBLEM: Health-care providers, insurers, and policymakers typically focus on the average gains in patients' survival when assessing the medical and economic value of various treatments. Do terminally ill cancer patients consider the costs, risks, and benefits of different therapies in the same way?

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METHODOLOGY: Researchers led by USC professor Darius Lakdawalla surveyed 150 cancer patients who were undergoing treatment. They asked them to choose between a "safe bet" therapy that guarantees 13 months of survival and a "hopeful gamble" that offers a 50/50 chance of either adding 35 months or subtracting 10 months to the same 13-month survival average.

RESULTS: Nearly 80 percent of patients preferred the riskier treatments over the safer therapies. It seems most respondents valued being given a chance at a substantial survival gain, even if typical outcomes did not improve.

CONCLUSION: When deciding on their course of treatment, terminally ill patients appear to choose hope over security.

IMPLICATION: Lakdawalla says insurers should go beyond average outcomes when deciding on what therapies to cover while physicians should connect with patients more to understand what they truly value. "Some patients are willing to take significant risks with their own lives in pursuit of a major gain in survival; others want to play it safe," he says. "The health-care system should respect those differences."

SOURCE: The full study, "How Cancer Patients Value Hope and the Implications for Cost-Effectiveness Assessments of High-Cost Cancer Therapies," is published in the journal Health Affairs.