If you’re wondering why you’ve lost friends in adulthood, this is probably why

What a lot of people don’t appear to understand is that the single easiest way to make friends is to show up when it matters — and the single easiest way to lose friends is to, well, not.

That sounds obvious, but a pattern I’ve observed again and again among the people in my social circle (a social circle that skews young and urban, to be clear) is that they often don’t have close, meaningful friendships. They want them, but they aren’t willing to go out of their way to dedicate time and effort to developing these relationships.

Take this scenario. You met someone who seems really cool, and you immediately think you could be good friends. They invite you to hang out again — say, to have drinks with some of their friends you haven’t met. You say sure, you’ll be there. Then the day arrives. Maybe you’ve had a long week at work, or you’re just not in the mood to meet new people, or you have a few other invites for that night that look more fun. You text them, “Sorry, can’t make it tonight.” They tell you not to worry about it, they’ll see you next time. But days and then weeks and then months pass, and you never become more than acquaintances.

There’s nothing wrong with this scenario. You’re not going to be friends with everyone! You don’t have to be; that’s normal. But if you’re someone who wants to build deep friendships but consistently chooses to not show up when the opportunity is presented, then maybe it’s time to unpack why and to think about what you can do to change that.

The most extreme case of this phenomenon I’ve experienced happened when a distant acquaintance messaged me saying that she wanted to be friends. So we found a time to have dinner. She messaged me the day we were supposed to meet and said she couldn’t make it, and so we rescheduled for the next weekend. That happened six weekends in a row, and each time she bailed last minute. I saved six Saturday nights for this person, and she found reasons not to come to every single one.

What drives flakiness

Let’s talk about flakiness. In an increasingly connected, noisy world where infinite possibilities for how we could spend our time loom over us, flakiness abounds. I host a lot of events, and what I know now is that I should expect at least half of the people who explicitly RSVP’d “yes” to bail. It makes sense — the societal norms have changed, we’re busy, we have a lot of options for how to spend our time. But while a packed schedule explains why we can’t attend everything we’re invited to, I’m not sure it explains why we say we will and then … don’t.

My theory is that flakiness is rooted in dishonesty with ourselves and others about what matters to us. It’s not that we’re malicious; it’s that we’re aspirational. And while that doesn’t negate the harm caused by flakiness, it might explain why it’s so common. At any given point in time, there are countless versions of our lives that we can see for ourselves, and we’re committed to maintaining that optionality. We could be a person who has that hobby or goes to that event or has that friend; we have that option, and we expect it’ll always be there.

But inevitably, we make choices, and slowly over time, the choices we have made, not the choices that we could make, are what, in the aggregate, decide who we are. When it comes to friends, it’s the relationships we’re invested in that count — not the relationships we couldinvest in if we ever made the time for them.

What defines a friendship? Can it be quantified? I’m inclined to think not, and yet I have a vague feeling after I’ve spent some amount of time or shared some number of experiences with someone that I can call them a friend. At some point, somewhere, a switch flips.

So then I have to think, what flips that switch in the other direction? How many canceled drinks and dinners and coffees does it take before we’re no longer friends with someone? How many big life events do we miss before we start saying we used to be friends? Probably fewer than we think. Flakiness has its costs, and we often don’t realize them until it’s too late.

Some steps on how to keep friendships going

With that in mind, now I have a few proposals for you, a person who seeks to build and sustain meaningful friendships:

1) Don’t be chill when it comes to making friends. Tell people you like or respect or value that they’re great and you want to hang out with them. If they signal that they’re not interested, that’s fine — but don’t miss the opportunity to get to know someone wonderful just because you don’t want to appear overly eager.

2) Be personal. Talk about your real problems, and ask people about theirs. Invite someone into your home instead of going to a bar or coffee shop. Give thoughtful gifts. A big part of friendship is understanding someone for who they are and having them understand you for who you are, and that’s not possible without some degree of vulnerability.

3) Get comfortable saying no to people you don’t want to prioritize. That sounds harsh, but in the end, it will save your time and effort and theirs. It’s not a kindness to “perform” friendship without genuine support and commitment, and both of you have limited time to spend. Instead of saying you’ll grab lunch and then canceling yet again, you can just part ways and make friends who are better suited to each of you.

4) Remember to reciprocate. If your friend is always the initiator, invite them to do something with you. If you do have to cancel on someone — sometimes circumstances happen — you should be the one to make a plan for the future. And then make sure that it happens.

5) Show up for people who matter to you. Sometimes that means your physical presence; sometimes that just means your emotional support. There will always be reasons to not be there, but if you keep choosing other commitments over a friendship, that’s a signal to that person. Friendships aren’t static. They require work from both people.

None of my closest friendships were forged solely because we had so much in common or it was convenient. It was because we prioritized each other. When we had options — and there are always, always options — we chose each other more often than we didn’t. There have been times when people I didn’t think were close friends showed up for me when I didn’t expect it, and that’s what deepened our friendships.

It was in that vein that I developed a close-knit group of friends. When I met them, two of them had just ended long-term, serious relationships. A few of us were deeply conflicted about our jobs and our lives and whether our work would ever be fulfilling. There were days when someone would post in our group chat that everything was awful and terrible, and we’d organize immediately to cancel our plans and gather somewhere and listen to them vent over dinner and a bottle of wine. And that was everything — knowing we all had that support and knowing we had people who depended on us for that support.

These relationships are some of the most rewarding parts of my life, and they didn’t just happen. We built them. So the next time you’re faced with the question of whether to show up or not show up for someone, be conscious about how that choice impacts your relationship. Because, for better or worse, it will.

https://www.vox.com/first-person/2018/8/16/17694356/how-to-make-friends-adulthood

The Exercise That Helps Mental Health Most

We assume exercise improves our mental health. But what kind of exercise works best?

Researchers looking at the link between physical activity and mental health found that team sports fared best, followed by cycling, either on the road or a stationary bike.

The study, published in the journal Lancet Psychiatry this month, is among the first of its kind, and the largest, analyzing the effect of different types of exercise.

It found that physical activity typically performed in groups, such as team sports and gym classes, provided greater benefits than running or walking.

Researchers rated mental health based on a survey. It asked respondents how many days in the previous month their mental health was “not good” due to stress, depression or problems with emotions.

People who played team sports like soccer and basketball reported 22.3% fewer poor mental-health days than those who didn’t exercise. Those who ran or jogged fared 19% better, while those who did household chores 11.8% better.

In a secondary analysis, the researchers found that yoga and tai chi—grouped into a category called recreational sports in the original analysis—had a 22.9% reduction in poor mental-health days. (Recreational sports included everything from yoga to golf to horseback riding.)

Adam Chekroud, the senior author on the study, is a chief scientist and co-founder of Spring Health, a New York City-based mental-health startup, and an assistant professor of psychiatry at Yale University. He says team sports may have an extra benefit because of the social component, and yoga/tai chi promote mindfulness, which is often touted as beneficial for mental health.

Running or jogging ranked fourth best for mental health after aerobic or gym exercises, which included everything from group classes to weightlifting. PHOTO: ISTOCKPHOTO/GETTY IMAGES

He would like to explore with further research why some activities scored higher than others to see if exercise regimes can be personalized to choose the most relevant and helpful type.

The researchers also found that those who exercise between 30 and 60 minutes had the best mental health, with 45 minutes the optimal duration. Exercising three to five times a week correlated with fewer dark days.

More exercise wasn’t always better. “Over 90 minutes of exercise and there isn’t an extra benefit,” Dr. Chekroud says.

The study analyzed the exercise habits and mental health of 1.2 million U.S. adults, based on self-reported answers to survey questions from the Centers for Disease Control and Prevention. It wasn’t a randomized controlled study and therefore didn’t prove causality, just an association between exercise and better mental health. It can’t explain if poor mental health causes people to exercise less or exercise causes people to have better mental health.

AN ACTIVE DIFFERENCE

Research found better reports of mental health from those who participated in various physical activities. Below, a look at how people reported feeling after a month of different activities, compared with those who were not physically active.

• Team sports: 22.3%
• Cycling: 21.6%
• Aerobic or gym exercise*: 20.1%
• Running or jogging: 19%
• Recreational sports: 18.9%
• Winter or water sports: 18%
• Walking: 17.7%
• Household chores: 11.8%

*—not including cycling or running

Overall, people who exercised reported having two poor mental-health days in the previous month, compared with 3.4 days for those who didn’t exercise. That translates into a 43% improvement in mental health for those who exercised, Dr. Chekroud says.

The effects were more pronounced for people who reported a previous diagnosis of depression. They had 3.75 fewer days of poor mental health.

Smaller studies have found that exercise improves depression, including randomized controlled studies showing that exercise and antidepressants together work better than antidepressants alone.

Some studies have raised questions about the relationship, however, suggesting that perhaps people who are depressed exercise less because of their condition.

“This is very strong evidence that there is a relationship between exercise and mental health,” Dr. Chekroud says. “It seems like there are some sweet spots, and the relationship is probably complex. But even things like walking or household chores seem to have benefits.”

Cycling, either in a spinning class or on the road, came out second-best in the study.

In a secondary analysis, researchers found that mindfulness-based exercises like yoga showed a greater reduction in poor mental-health days than other types of exercise. Yoga was placed into the recreational sports category in the original analysis.

PHOTOS: ISTOCK PHOTO/GETTY IMAGES

His research team grouped 75 different types of exercise into eight categories. They controlled for factors like age, race and body-mass index.

Commenting on the study in an accompanying editorial, Gary Cooney, a psychiatrist at Gartnavel Royal Hospital in Glasgow, Scotland, notes that the study’s greatest strength is its size.

He has some criticisms, saying the study treats mental health as an umbrella term based on a broad, somewhat vague question from a survey. He also points out that the study is based on self-reports, rather than objective measurement of a person’s exercise habits. Still, he calls this research “important and urgent work.”

The current evidence on this question is mixed, he says: “The higher the standard of the study, the less clear the association” between exercise and better mental health.

But Madhukar H. Trivedi, founding director of the Center for Depression Research and Clinical Care at the University of Texas Southwestern Medical Center in Dallas, says a robust body of evidence shows exercise improves depression. He has done many studies examining this question.

He says he prescribes exercise to depressed patients often. He recommends that they burn roughly 1,200 to 1,400 calories a week working out.

Dr. Trivedi’s studies have analyzed everything from duration of exercise to the effect of exercise combined with medication on depression. He and colleagues found that among about 18,000 middle-aged people, those who were physically fit had a 16% lower risk of depression than those who are less fit. JAMA Psychiatry published that study in June.

His research has found that the more people exercise, the greater the benefit. He called the Lancet study’s finding of no additional benefit for exercise beyond 90 minutes intriguing. (He didn’t participate in the study.)

“On the other hand, we don’t know if the ones exercising a lot are compensating for depression or some other mental-health problems,” Dr. Trivedi says.

https://www.wsj.com/articles/the-exercise-that-helps-mental-health-most-1534777677

Why glioblastoma is so deadly

Sen. John McCain withstood beatings and torture as a prisoner of war, but he was confronted with an enemy in July 2017 that he was ultimately unable to overcome. An aggressive and deadly brain cancer known as glioblastoma, or GBM, took McCain’s life on Aug. 25, 2018.

The man noted for his unstoppable resilience, pervasive optimism and uncompromising personal ethos was not able to conjoin forces with the marvels of modern medicine and defeat the insidious enemy of brain cancer.

Why is GBM so deadly? Why have so many individuals, with presumably all the physical and financial resources that can be amassed readily available to them, been unable to conquer this dreadful enemy? Sen. Edward M. Kennedy died from the disease exactly nine years earlier. In 2015, GBM also claimed the life of Joseph “Beau” Biden III, son of Joe Biden, the former vice president. It kills about 15,000 people in the U.S. each year. Most people diagnosed with the disease survive less than two years.

Has GBM been cured in any individuals, and if so, why not in most who are affected by this disease?

I am a physician and scientist who studies ways to stop GBM. Despite the sadness and great loss we feel at Senator McCain’s passing, we are making progress in the treatment of this disease.

AN ONGOING BATTLE

By 1970, cancer had become the second-leading cause of death in the United States. It still is today, claiming about 600,000 lives a year.

In 1971, President Richard Nixon signed the National Cancer Act. While the legislation did not contain the phrase “War on Cancer,” those words quickly caught on. A concerted quest to find a cure for malignant diseases had begun.

The landmark legislation broadened the authority of the director of the National Cancer Institute (NCI) to implement research programs and cooperate with other agencies to direct educational efforts focused on reducing cancer mortality in the U. S. The act created a “bypass budget” for the NCI that is submitted directly from the NCI director to the president of the United States and to Congress, highlighting the priority put on reducing cancer mortality by the U.S. government.

The NCI investment in cancer research, along with billions of dollars from the pharmaceutical industry, have undoubtedly had a profound positive impact on the prevention, diagnosis and treatment of cancer. However, unlike the decade of success embodied by our nation’s quest to put a man on the moon, winning the war on cancer has proven to be a much more elusive goal—and much longer than 10 years.

While decades of research have led to many new, effective treatments, research also has revealed a marked complexity in many cancers, particularly those that have spread beyond the site where the tumor originated.

A FIRST IN THE FIGHT

GBM was the first cancer to undergo comprehensive genetic analysis as part of the multibillion-dollar NCI-led project called “The Cancer Genome Atlas.” This ambitious quest sought to completely analyze the gene expression patterns and DNA sequence of several human cancers and make the data publicly available for scientists to study. It has been a game changer in the assault against cancer.

Scientists have learned, for instance, that GBM, like many cancers, is not a single disease. Even though two patients may receive the same diagnosis of GBM and may have tumors that look almost identical under a microscope, at the cellular level these tumors can be quite different, with different mutations in the DNA code and different pathways driving tumor growth. This understanding means that a single therapeutic approach is very unlikely to work the same in all individuals with the same diagnosis of GBM.

Essentially, these patients really don’t have the same disease. This new understanding, while tremendously important in shaping our strategies for treating GBM going forward, also raises the realization that the enemy we face in GBM is even more insidious than thought.

To add to this complexity, we understand now that even within a given patient’s tumor, the individual cancer cells can even differ significantly from one another, having diverged over time through rapid growth and through the accumulation of different mutations within different tumor cells. This means that the same treatment hitting the tumor cells within a single patient will likely not kill all cancer cells with the same effectiveness. This allows resistant tumor cells within the population to grow back in the face of treatment that may have been initially effective.

Tackling this complexity at the cellular level to develop treatments that are effective against all tumor cells within a patient is a major challenge for tumors such as GBM. It likely accounts for much of the resistant nature of the disease.

INVASIVE TACTICS

An additional characteristic of GBM is the invasive nature of the disease. GBM tumor cells essentially crawl away from the main tumor mass and embed themselves deep within the normal brain, often hidden behind a protective barrier known at the blood-brain barrier. This invasive feature means that while neurosurgeons can often remove the main central tumor mass of a GBM, the invasive finger-like projections protrude into other areas of the brain. The distant islands of tumor cells that have migrated away cannot be effectively removed by surgery.

Radiation treatment is effective in controlling tumor growth, but there are limits to the doses of radiation that can be delivered to normal brain. Chemotherapy treatment with temozolomide currently can extend survival on average by several months. But the blood-brain barrier, or specialized cells that keep threats away from the brain, restricts many drug treatments from getting into the brain, and the mixed populations of tumor cells are already poised to grow out of the cancer cells that are resistant to the agents that do get through.

CAUTIOUS OPTIMISM

When one takes an inventory of what we’ve learned about GBM, it is easy to become discouraged and perhaps to conclude that we are facing an insurmountable foe. Such a conclusion might be warranted, were it not for the fact that despite the incredible complexity and challenges faced in successfully treating GBM, long-term survivors of this disease do exist.

Long-term survival, or five years or longer from time of diagnosis, with standard treatment regimens is reported at 9.8 percent from a systematic study of 573 patients with GBM. While 9.8 percent is an unacceptably low rate, it is demonstrable evidence that long-term survival is feasible.

We have learned that survivors tend to be younger than 50, have tumors that were able to undergo more extensive surgical removal at diagnosis, and have molecular features that predict a better response to the chemotherapy.

Recent advances in the treatment of GBM have also brought the advent of a new device technology that delivers alternating low-intensity electric fields called tumor-treating fields. Long-term survival data has not yet been reported for the addition of tumor-treating fields to standard treatment, but a median survival improvement of 4.9 months from 16.0 months to 20.9 months was reported in a recently completed phase III clinical trial involving 695 patients. It is possible that an improvement in long-term survival rates will also be observed in patients receiving this combined treatment.

Perhaps our greatest hope comes from emerging therapeutic strategies such as immunotherapy and personalized medicine approaches. Our immune systems are hard-wired to deal with complexity and variety, needing to respond rapidly and effectively to a myriad of unknown and changing infectious threats from the environment. The field is just beginning to understand how to harness this potent and adaptable killing power to hone in on cancer cells in a comprehensive way. We have observed encouraging long-term survival outcomes in patients with GBM during our early phase clinical trials of immunotherapy and are currently evaluating the effectiveness of these treatments in large-scale clinical trials at our medical center.

The war on cancer has certainly proven to be harder, longer and more complex than many envisioned in 1971. While tremendous gains have been made in cure rates for some malignant diseases like childhood leukemia, GBM has perhaps stood stalwart in resistance over the decades to transformative progress. However, through diligence and persistence, we have begun to better understand the enemy we face at the root of this invasive brain cancer. This understanding has transformed our plans of attack and has begun to bear evidence that breakthroughs are possible and forthcoming.

Sen. McCain will be remembered for his many contributions, accomplishments and sacrifices in service of his country. He is also but one of the 600,000 Americans and 8.2 million people worldwide whose life will be claimed by cancer this year. Among the many things to be remembered, honored and cherished about his life, let the fighting legacy of this warrior remind us that war on cancer goes forward in his memory, and in honor of all that have been and will be impacted by this disease.

https://www.scientificamerican.com/article/why-is-glioblastoma-the-cancer-that-killed-john-mccain-so-deadly/

‘Hot weather messes with your mind’?

A couple of years ago Solomon Hsiang, assistant professor of public policy at University of California, Berkeley, became fascinated by an important issue: what effect does heat have on our brains – and emotions?

It is a pertinent question right now, given that temperatures have soared this summer across most of Europe and the US – currently, some 70 million Americans are still under some level of “heat advisory” notice.

Some readers will have welcomed the warmer weather. If you live in Scotland or Sweden, where you don’t often get the chance to spend time on the beach in August, summer sunshine has historically been associated with joy. Conversely, if you live in a city with minimal air conditioning (London, for example) or in one of those sweltering US states, a sharp rise in temperature is greeted with horror.

But what Hsiang and his research team wanted to know is whether there is something about hot weather that destabilises our brain and makes us violent. This is not a new issue: a recent meta-analysis of 60 prior studies showed that unstable temperatures tend to be correlated with conflict.

In the US, for example, there is good evidence that road rage, domestic assault and murder are higher during heatwaves. In the Netherlands, scientists have shown that police are more likely to attack suspects if they are in a hot room (say 27C) rather than a cool one (21C).

In Tanzania, there is evidence that the brutal murder of elderly women, dubbed “witch killings”, soar after periods of drought, or other unusual weather patterns. Meanwhile, scientists and historians have shown that temperature change has been implicated in conflict in the modern-day Middle East, various conflicts of the 17th century and even the fall of Rome.

What Hsiang and his colleagues – a seven-strong team led by Marshall Burke at Stanford – were particularly interested in discovering was whether heat also led to suicide. And so they crunched through extensive data on suicides and weather in the US and Mexico, and analysed more than half a million social-media posts to assess the wider social mood.

Their paper, published in July, showed that not only was hot weather associated with a sharp rise in mental instability – as measured by the use of keywords linked to suicide on social media – but it also went hand in hand with higher suicide rates. Most notably, a 1 per cent change in the temperature was correlated with a 0.7 per cent increase in the suicide rate in US counties, and a 2.1 per cent increase in Mexican cities – irrespective of whether the normal base temperature was hot or cold.

“Mental well-being deteriorates during warmer periods,” the paper reports, noting that “unmitigated climate change” could result in “a combined 9,000–40,000 additional suicides across the United States and Mexico by 2050, representing a change in suicide rates comparable to the estimated impact of economic recessions, suicide prevention programmes or gun restriction laws”.

A sceptic might argue that much of the data is still not extensive enough to be truly definitive. They might also point out that the projected rise in suicides does not necessarily look that dramatic when you look at some of the shocking projections that are being bandied around about the economic cost of climate change, and its associated geopolitical upheaval (which will undoubtedly loom large at the UN General Assembly meeting later this month).

But one reason why Hsiang, Burke and others explored suicide was to make a bigger point: you cannot look at climate change solely in terms of economics or simply explain the correlated conflict through that lens. Yes, changes in weather can sometimes cause fights over scarce resources; just look at how water shortages have sparked conflict around Gaza and are increasingly stoking tensions between Iraq, Syria and Turkey.

However, the fact that we know more heat corresponds to higher levels of domestic violence, road rage – and now suicide – suggests that climate not only affects our tangible environment, but may also be impacting our brain chemistry, albeit in ways that researchers admit that they do not fully understand. “The pattern is very striking, but the research is at an early stage,” says Hsiang, who likens the situation to the early days of investigating the link between lung cancer and smoking. “We know there is a correlation, but we don’t quite know why,” he says.

This has several implications. One is that scientists need to do more research into human brains and heat. Another is that people running companies, hospitals, schools, prisons – or, indeed, any place where humans study or work – need to think about how temperature might affect their staff.

There is a third, more personal, implication: we could probably all benefit from reflecting a little more on how heat changes our minds. Most of us already know, for example, that being overheated makes us more irritable and tired; but do we also make worse decisions in hotter months? Do we get more aggressive in ways we sometimes ignore? It is a curious question to ponder; particularly as cooler days loom.

https://archive.is/rgDON#selection-1819.0-1889.410

Medtech firms get personal with digital twins

Armed with a mouse and computer screen instead of a scalpel and operating theater, cardiologist Benjamin Meder carefully places the electrodes of a pacemaker in a beating, digital heart.

https://queso-cdn.prod.reuters.tv/new/index.html?autoplay=true&muted=true&countdown=true&preroll=true&proll=iuuqt%3A%2F%2Fqvcbet.h.epvcmfdmjdl.ofu%2Fhbnqbe%2Fbet%3Fta%3D3y3%26jv%3D%2F4735792%2Fwjefp.vt.sfvufst%2Fufouqpmft%2FBewbodjohGpsxbse%2Fbsujdmf%26djv_tat%3D300y250%2C1500y692%26dvtu_qbsbnt%3DwjefpDiboofm%253E6%252D118065%252D13974%2526xjeuiWbm%253E853%2526ifjhiuWbm%253E480%2526wjefpJe%253E459868618%2526uzqf%253Ebsujdmf_qsfspmm%2526begsjfoemz%253Eusvf%26jnqm%3Dt%26hegq_sfr%3D1%26fow%3Dwq%26pvuqvu%3Dynm_wbtu3%26vowjfxfe_qptjujpo_tubsu%3D1%26dpssfmbups%3D1200962042000133%26vsm%3Diuuqt%3A%2F%2Fvt.sfvufst.dpn%26eftdsjqujpo_vsm%3Dxxx.sfvufst.dpn%2Fbsujdmf%2Fvt-ifbmuidbsf-nfejdbm-ufdiopmphz-bj-jotj%2Fnfeufdi-gjsnt-hfu-qfstpobm-xjui-ejhjubm-uxjot-jeVTLDO1MH0T0&poster=%2F%2Fs3.reutersmedia.net%2Fresources%2Fr%2F%3Fd%3D20180831%26t%3D2%26i%3DOV8VIRIHN%26r%3DOV8VIRIHN&mid=OV8VIRIHN&title=AI%20creates%203D%20%27digital%20heart%27%20to%20aid%20patient%20diagnoses&suppress_ads=false&suppress_rtv=false&source=https%3A%2F%2Fwww.reuters.com%2Farticle%2Fus-healthcare-medical-technology-ai-insi%2Fmedtech-firms-get-personal-with-digital-twins-idUSKCN1LG0S0&chartbeat_uid=52639&chartbeat_domain=preview.reuters.com&region=US&draggable=true&hide_title=false&allow_collapse=true

Using this “digital twin” that mimics the electrical and physical properties of the cells in patient 7497’s heart, Meder runs simulations to see if the pacemaker can keep the congestive heart failure sufferer alive – before he has inserted a knife.

The digital heart twin developed by Siemens Healthineers is one example of how medical device makers are using artificial intelligence (AI) to help doctors make more precise diagnoses as medicine enters an increasingly personalized age.

The challenge for Siemens Healthineers and rivals such as Philips and GE Healthcare is to keep an edge over tech giants from Alphabet’s Google to Alibaba that hope to use big data to grab a slice of healthcare spending.

With healthcare budgets under increasing pressure, AI tools such as the digital heart twin could save tens of thousands of dollars by predicting outcomes and avoiding unnecessary surgery.

A shortage of doctors in countries such as China is also spurring demand for new AI tools to analyze medical images and the race is on to commercialize products that could shake up healthcare systems around the world.

While AI has been used in medical technology for decades, the availability of vast amounts data, lower computing costs and more sophisticated algorithms mean revenues from AI tools are expected to soar to $6.7 billion by 2021 from $811 million in 2015, according to a study by research firm Frost & Sullivan ww2.frost.com.

The size of the global medical imaging analytics software market is also expected to jump to $4.3 billion by 2025 from $2.4 billion in 2016, said data portal Statista www.statista.com.

“What started as an evolution is accelerating towards more of a revolution,” said Thomas Rudolph who leads McKinsey & Company’s www.mckinsey.com pharma and medical technology practice in Germany.

‘GPS OF HEALTHCARE’

For Siemens Healthineers and its traditional rivals, making the transition from being mainly hardware companies to medical software pioneers is seen as crucial in a field becoming increasingly crowded with new entrants.

Google has developed a raft of AI tools, including algorithms that can analyze medical images to diagnose eye disease, or sift through digital records to predict the likelihood of death.

Alibaba, meanwhile, hopes to use its cloud and data systems to tackle a shortage of medical specialists in China. It is working on AI-assisted diagnosis tools to help analyze images such as CT scans and MRIs.Siemens Healthineers, which was spun off from German parent Siemens in March, has outpaced the market in recent quarters with sales of medical imaging equipment thanks to a slew of new products.

But analysts say the German firm, Dutch company Philips and GE Healthcare, a subsidiary of General Electric, will all come under pressure to prove they can save healthcare systems money as spending becomes more linked to patient outcomes and as hospitals rely on bulk purchasing to push for discounts.

Siemens Healthineers has a long history in the industry. It made the first industrially manufactured X-ray machines in 1896 and is now the world’s biggest maker of medical imaging equipment.

Now, Chief Executive Bernd Montag’s ambition is to transform it into the “GPS of healthcare” – a company that harnesses its data to sell intelligent services, as well as letting smaller tech firms develop Apps feeding off its database.

As it adapts, Siemens Healthineers has invested heavily in IT. It employs some 2,900 software engineers and has over 600 patents and patent applications in machine learning.

It is not alone. Philips says about 60 percent of its research and development (R&D) staff and spending is focused on software and data science. The company said it employs thousands of software engineers, without being specific.

MEDICAL REVOLUTION

Experts say the success of AI in medical technology will hinge on access to reliable data, not only to create models for diagnosis but also to predict how effective treatments will be for a specific patient in the days and years to come.

“Imagine that in the future, we have a patient with all their organ functions, all their cellular functions, and we are able to simulate this complexity,” said Meder, a cardiologist at Heidelberg University Hospital here in Germany who is testing Siemens Healthineers’ digital heart software.

“We would be able to predict weeks or months in advance which patients will get ill, how a particular patient will react to a certain therapy, which patients will benefit the most. That could revolutionize medicine.”

To this end, Siemens Healthineers has built up a vast database of more than 250 million annotated images, reports and operational data on which to train its new algorithms.

In the example of the digital twin, the AI system was trained to weave together data about the electrical and physical properties and the structure of a heart into a 3D image.

One of the main challenges was hiding the complexity and creating an interface that is easy to use, said Tommaso Mansi, a senior R&D director at Siemens Healthineers who developed the software.

To test the technology, Meder’s team created 100 digital heart twins of patients being treated for heart failure in a six-year trial. The computer makes predictions based on the digital twin and they are then compared with actual outcomes.

His team hopes to finish evaluating the predictions by the end of 2018. If the results are promising, the system will be tested in a larger, multi-center trial as the next step to getting the software approved by regulators for commercial use.

Siemens Healthineers declined to say when the technology might eventually be used by clinics or give details on how its digital heart, or models of other organs it is developing such as the lungs and liver, could be monetized.

IN DATA WE TRUST

Both GE and Philips are also working on versions of digital heart twins while non-traditional players have been active too.

Drawing on its experience of making digital twins to test bridges and machinery, French software firm Dassault Systemes launched the first commercial “Living Heart” model in May 2015, though it is only currently available for research.

Philips sells AI-enabled heart models that can, for example, turn 2D ultrasound images into data that helps doctors diagnose problems, or automatically analyze scans to help surgeons plan operations.

Its vision, like Siemens Healthineers, is to add more complexity to its existing heart models by pulling together scans, ECGs and medical records to create a model that can predict how a heart will respond to therapy in real life.

For now, such software is still in the early stages of development and companies will have to work with regulators to thrash out how predictive models can be approved before doctors are willing to trust a diagnosis generated by a machine.

Access to high-quality data with enough variation will be crucial, as will be the ability to interpret that data and turn it into something medical professionals can use, say experts.

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In particular, models will have to be trained on rare cases as they get closer to perfection, said Vivek Bhatt, chief technology officer at GE Healthcare’s clinical care solutions division.

“It’s going to be extremely critical to have an ongoing process for getting more data, getting the right kind of data and getting data with those unique cases,” he said.

The established medtech players say their long-running relationships with hospitals and research institutes and vast networks of installed machines will give them an edge over new tech entrants.

Siemens Healthineers, GE Healthcare and Philips say their databases are fed with a mixture of publicly-available data, data from clinical trials or from collaborations with hospitals – as well as some data from customers. All the data is made anonymous and only used with patients’ consent, they say.

Still, some campaigners and academics worry about patients’ data being used primarily by companies as a commercial tool.

Boris Bogdan, managing director at Accenture’s www.accenture.com life science practice in Switzerland, believes the ownership of data is a gray zone that could lead to a patient backlash if companies start making fortunes from it.

“When Facebook started nobody really cared who owned the information,” he said.

“Now that people understand that Facebook earns tremendous money with their data, questions like data privacy, data usage and data monetization are becoming more visible.”

https://www.reuters.com/article/us-healthcare-medical-technology-ai-insi/medtech-firms-get-personal-with-digital-twins-idUSKCN1LG0S0

Changes to U.S. college football drills could curb head impacts

Limiting time spent on specific drills during practice could help reduce head impacts among U.S. college football players, researchers say.

Shortening the highest-risk drills by a few minutes per practice could cut the equivalent of nearly a year’s worth of head impacts over the course of a college career, the researchers write in Annals of Biomedical Engineering.

“More research has been done in recent years around routine head impacts that don’t cause concussions but lead to adverse effects later in life,” said study leader Breton Asken of the University of Florida in Gainesville.

In 2017, for instance, the National Collegiate Athletic Association restricted practice times and eliminated two-a-day practices in hopes of reducing routine head impacts.

“Practices give us more opportunity to modify what’s being performed regularly, as opposed to less predictable games,” Asken said by phone. “If we can reduce the risks, football can remain an outlet for participation across different ages.”

At the University of Florida, Breton and colleagues studied drill-specific head impacts among 47 players over two years.

Players wore a head impact telemetry system that uses sensors to measure “friendly fire” impacts among teammates. Researchers were able to look at particular field positions, different types of drills and head impacts, and hits sustained per person per minute.

During 169 practice sessions, they recorded more than 32,000 impacts and found significant differences in hits sustained per person per minute based on player position for 14 drills. For instance, some linemen – both offensive and defensive – faced nearly triple the risk for head impact compared with non-linemen. For all drills except one known as “special teams,” hits per person per minute where higher for linemen.

Impacts were most severe during spring practice, followed by fall training camp and in-season sessions. Practices with full pads tended to have more head impacts than when athletes dressed in lighter unpadded equipment or in helmets only.

More than 80 percent of avoidable head impacts were attributable to just three drills – known as “team run,” “move the field” and “team” – all 11-versus-11 full team drills.

The authors recommend shortening these three high-risk drills. Clipping them by a few minutes each could result in 1,000 fewer head impacts for linemen and 300 fewer impacts for non-linemen over a college career, the researchers estimate.

“People paint broad strokes about the dangers of football and propose modifications that are similarly broad and nonspecific,” Asken said. “But if we target specific activities, we may be able to increase player safety without drastically altering the game or practice itself.”

Researchers will need to look at the practical aspect of implementing these changes, the authors note.

“The next steps are to educate coaches about these findings so they can plan practices to decrease head impacts while still preparing their teams,” said coauthor Dr. Jay Clugston, a team doctor for the University of Florida Athletic Association.

“We’d also suggest they not only lessen time in high-risk drills but space them out to decrease the density of impacts, which is felt to influence concussion risk,” Clugston said by email.

Changing practice sessions requires buy-in from everyone, including administrators, coaches, trainers, sports medicine professionals and players themselves, said Jessica Wallace, athletic training program director at Youngstown State University in Ohio, in a phone interview.

“Just like football is a team sport, creating a safer environment is a team sport as well,” said Wallace, who wasn’t involved in the new study. “We need to team up with coaches and players and work together to be successful.”

SOURCE: bit.ly/2N4XZTF Annals of Biomedical Engineering, online July 9, 2018.

https://www.reuters.com/article/us-health-concussion-sports/changes-to-u-s-college-football-drills-could-curb-head-impacts-idUSKCN1LG2A0

Brazil prosecutors hope to strike deal lifting Roundup injunction

Brazil federal prosecutors are negotiating with health authority Anvisa and the agriculture ministry to reach a deal that could lift an injunction against the popular weed-killer glyphosate, a prosecutor on the case told Reuters on Friday.

Prosecutors have requested a meeting next week to discuss a deal just as a ban on glyphosate products already on the market is expected to go into effect on Monday, Brasilia-based prosecutor Luciana Loureira Oliveira said by telephone.

The deal would lift injunctions on new and existing products provided that Anvisa issues a decision in the first quarter of 2019 on the chemical’s safety and the ministry agrees not to appeal the health regulator’s decision, she said.

Court documents say billions of dollars of agricultural trade could rest on whether glyphosate is ultimately allowed in Brazil, the world’s largest exporter of soy.

Brazilian farmers widely apply the herbicide to the oilseed and other crops with Monsanto SA, owned by Germany’s Bayer AG, being the largest supplier of glyphosate products in the country.

Monsanto is also facing legal backlash in the United States with hundreds of cases alleging glyphosate causes cancer.

The Brazilian federal prosecutors’ office has said that new evidence, including a study conducted in 2015 by an arm of the World Health Organization, indicates glyphosate could cause cancer and the country should reevaluate the chemical’s safety.

A Brazilian judge ruled earlier this month to halt the registration of new glyphosate-based products in the country and to suspend existing registrations after 30 days, to remain in effect until Anvisa issues a ruling on its safety.

That deadline is expected to lapse on Monday, Oliveira said, just as farmer’s are set to start planting the soy crop next month.

The Solicitor General’s office is appealing the decision with the backing of the agriculture ministry, but the court has yet to rule on the appeal.

A deal, subject to court approval, would shelve the injunction and allow glyphosate products to be used until Anvisa reaches a decision, Oliveira said.

Getting the ministry’s agreement to abide by the ruling would potentially avoid a long process of multiple layers of appeals within Brazil’s complex legal system, Oliveira said.

“We want to abbreviate this whole process that could still be very long,” she said.

Anvisa said it was taking necessary legal action in the case and could not comment on the prosecutor’s remarks. The ministry of agriculture’s press office declined to comment on the proposed deal.

A representative for Bayer and Monsanto said the companies maintain their previous statement that 40 years of use in practice and reviews by authorities around the world have shown that glyphosate is safe to use.

https://www.reuters.com/article/us-brazil-agriculture-chemicals-exclusiv/exclusive-brazil-prosecutors-hope-to-strike-deal-lifting-glyphosate-injunction-idUSKCN1LG2VP