Scientists Explain A Common Fight In Basketball
Golden State Warriors guard Stephen Curry (left) and then-Cleveland Cavaliers forward LeBron James scramble for a loose ball during Game 1 of the 2016 NBA Finals.
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It happens all the time during basketball games. Two players are going for the ball. They touch it at the same time but neither controls it, and it flies out of bounds.
At that point, tempers rise — both are certain that the other player was the last to touch it, which should earn their own team a chance to control the ball.
Are the players just pretending to be so sure it’s out on their opponent? Or could there actually be a difference in how they experience the event that has them pointing a finger at the other player?
Those are the questions that scientists from Arizona State University tackled in a paper published in Science Advances.
“It’s very possible that people experience two different orders of events, two different experiences of reality, even though they experienced the same event,” Ty Tang, a cognitive science doctorate student at ASU, tells NPR.
In the experiments, the researchers found that people tend to think that their own actions happened before near-simultaneous actions close by. They found that on average, people perceive their own actions as happening about 50 milliseconds before the other motion. That’s why the basketball players would be so convinced they tapped the ball before their opponent.
Tang says that generally, there’s a lot of evidence that “sometimes the things that some people experience are different than others.”
The setup of the first experiment involved two people separated by a divider.
Ty Y. Tang
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Ty Y. Tang
To test this, Tang ran three different experiments with ASU students. In the first experiment, two students sat across from each other. A divider between them had slots for their hands. When a simultaneous light flashed, they each tapped a sensor on the other person’s right hand, then indicated which of them they think tapped first.
“We did find a very strong effect for participants to think that their touch happened before the other person’s touch,” Tang says.
This wasn’t a race — people were not told to try to beat the other person. Still, in more than two-thirds of the cases, the study subjects each said they were the first ones to tap.
A chart showing that the study subjects are biased toward their own actions when judging which of two simultaneous actions happened first.
Ty Y. Tang
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Ty Y. Tang
Tang got similar results when he replaced the second human with a mechanical switch. In a third experiment, he used a clicking sound instead of a switch. “Even when we removed that touch and just replaced it with a click, they still thought their touch happened before that sound,” he says.
It’s not clear why many people have this bias. Tang says it might support the theory that we’re “constantly predicting the world and trying to create this mental model of what’s going to happen.” But they don’t know whether there is actually a sensory difference in when things register in the brain, he says.
And it’s worth noting that people don’t always think their action happened first when two things happen nearly simultaneously — it’s simply a significant bias. Some people are more susceptible to it than others. And, he said, other factors are likely to play into it. For example, “if it’s a competitive situation, you’re probably more likely to bias whatever decision is going to be more favorable to you.”
Which brings us back to elite athletes. Are they more or less likely to have this bias toward their own actions?
“It’s a little difficult to say and it can go either way,” Tang says. Athletes deal with these quick reaction times all the time, so he is wondering whether this is a bias that can be trained away. “If you have all of these close temporal events that they have to discriminate between, then they might be better at telling which one actually happened first or second,” he says.
But on the other hand, athletes are constantly in competitive situations — which, as he has noted, may exacerbate the bias.
Ultimately, though, “we really just want people to be more understanding of other people’s perspectives,” Tang says.
He adds: “Sometimes people actually do have different experiences of what happened and they’re not lying — they might have actually just experienced it that way.”
County Jails Struggle With A New Role As America’s Prime Centers For Opioid Detox
In Massachusetts last July, several Franklin County Jail inmates, seated, were watched by a nurse (left) and a corrections officer after receiving their daily doses of buprenorphine, a drug that helps control opioid cravings. By some estimates, at least half to two thirds of today’s U.S. jail population has a substance use or dependence problem.
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Elise Amendola/AP
Faced with a flood of addicted inmates and challenged by lawsuits, America’s county jails are struggling to adjust to an opioid health crisis that has turned many of the jails into their area’s largest drug treatment centers.
In an effort to get a handle on the problem, more jails are adding some form of medication-assisted treatment to help inmates safely detox from opioids and stay clean behind bars and after release.
But there are deep concerns about potential abuse of the treatment drugs, as well as worries about the efficacy and costs of programs that jails just weren’t designed or built for.
“It was never traditionally the function of jail to be a treatment provider, nor to be the primary provider of detoxification in the country — which is what they have become,” says Andrew Klein, the senior criminal justice research scientist with the company Advocates for Human Potential, which advises on jail and prison substance abuse treatment programs across the U.S. “So, with the opioid epidemic, jails are scrambling to catch up.”
A “critical situation”
The National Sheriffs Association estimates that at least half to two thirds of today’s jail population has a drug abuse or dependence problem. Some counties say the number is even higher.
“We are in a critical situation,” says Peter Koutoujian, a leading voice on the issue and the Sheriff of Middlesex County, Mass., — one of the states hardest hit by the opioid epidemic.
“We have to physically, medically detox about 40 percent of our population as they come in off the street,” he says, “and probably 80 to 90 percent of our population inside has some type of drug or alcohol dependence.”
Koutoujian, who is also vice president of the Major County Sheriffs of America, says how best to treat opioid-addicted inmates is among the most pressing issues facing jails today.
“We have not been able to get our hands around it because, quite honestly, society has not gotten its hand around either preventing [drug addicted] people from coming into our institutions or supporting them once they get back outside,” he says.
“The fact is you shouldn’t have to come to jail to get good [treatment] programming,” says Koutoujian. “You should be able to get that in your own community so you don’t have to have your life disrupted by becoming incarcerated.”
An ever growing number of jails — 85 percent of which are run by local Sheriffs — are trying to expand the use of medication-assisted addiction treatment behind bars, including the use of buprenorphine and methadone, among other drugs.
“Dead addicts don’t recover”
Jails in states hardest hit by opioids — including Ohio, Kentucky, West Virginia, Rhode Island and Massachusetts — are moving fastest to expand this use of medicine, which is now widely considered the most effective method of treating opioid use disorder. The National Sheriffs’ Association recently put out a detailed best practices guide to jail-based medication-assisted treatment, in conjunction with the National Commission on Correctional Health Care.
“Dead addicts don’t recover. So this is our opportunity to engage this population,” says Carlos Morales the director of correctional health services for California’s San Mateo County, just south of San Francisco.
Morales is working to expand access to medications for an older model of drug treatment that has long relied on abstinence and a “cold turkey” approach.
“We know if you are an opiate user you come in here, you detox, and you go out — it’s a 40 percent chance of OD-ing,” Morales says. “And we have the potential to do something about it.”
Felipe Chavez, who’s doing time at the San Mateo jail for selling fentanyl, is taking part in the jail’s fledgling opioid treatment program. Chavez says opioids have ruled his life since he started using Oxycodone pills at age 12, following an injury.
“I was smoking them,” Chavez says. “Then I went to heroin. Then heroin went to fentanyl.”
With his sleepy eyes and loose-fitting clothes, Chavez looks younger than his 23 years – a little like a teenager in baggy pajamas. But the bright hunter-orange of everything he’s wearing, down to the plastic Crocs, all signify he’s in the San Mateo County jail’s infirmary in Redwood City, Calif., where he gets his regular dose of methadone.
Still, Chavez is one of the lucky ones here. Because he was in a local methadone program before he got arrested — again — he’s been allowed to keep using that synthetic opioid substitute in jail. Methadone and a couple other drugs help jailed opioid users like Chavez temper cravings and, in theory, stay off more powerful and destructive opioids.
“It’s all about if you want to get clean or not, you know,” Chavez says. “The methadone is just there to help, you know. I mean, you’ve got to dedicate to the methadone. Because you got to start somewhere.”
With the methadone treatment he says, “I just feel more normal — like a normal person.”
Jail as an “opportunity to intervene”
Doctors who treat people in jails say a challenge — and an opportunity — in expanding the use of methadone or another medical treatment is that it’s not clear, at first at least, how big a role opioid addiction is playing in an inmate’s troubles; their drug use is often intertwined with mental health problems.
“The opiate part of the problem is usually not part of the charging documents, so it’s hard to tell,” says Dr. Robert Spencer, San Mateo County’s correctional health medical director. Addiction, mental health and crime “are so intimately connected” Spencer says. “It’s often a form of self-medication, an attempt by them to modify their symptoms. This gives us an opportunity to provide an intervention and a possible way forward.”
More research is needed to confirm the long-term benefits of treating addiction in jail, addiction specialists say. But, so far, studies have shown that medication-assisted treatment works well in reducing fatal overdoses, relapse and in reducing the spread of infectious diseases, such as HIV.
Still, this kind of medication-based approach is relatively new in San Mateo — as it is for many jails across the country. For nearly a quarter century San Mateo’s flagship addiction treatment program has been an abstinence-based approach called Choices. So far, only a dozen or so of the jails’ roughly 1,000 inmates are undergoing some sort of medication-assisted treatment.
Correctional health director Morales wants to expand those numbers. But he has lingering worries about costs, effectiveness and safety. He says inmates can hoard — and then sell, trade or abuse — some of the opioid treatment drugs, which are among the most top contraband items in jails today.
In addition, prison reforms in California to reduce over-crowding and reclassify some sentences has resulted in county jails housing more inmates for longer periods.
That, Morales says, has increased a kind of recidivist merry-go-round: a growing number of inmates with multiple bookings and short jail stays; people who aren’t getting the treatment they often need.
“I don’t think our script is good yet,” he says. “We don’t explain it well [to inmates], and we have to get better at advocating that someone use medicated-assisted treatment — and to get the protocol right, so that it’s not isolated folks that are doing it.”
Jails need to build the momentum of routine treatment by getting staff and inmates who have been helped talking about the success of this approach, he says. “And frankly, we’re not scaled up enough. Those are the challenges that we’re facing.”
It’s a similar story nationally, where the number of jails offering medication for inmates who are addicted is small.
Only 10 to 12 percent of the nation’s 4,000 jails are trying some form of addiction medication as part of treatment.
“Although this number is not the majority of jails, five years ago it was zero,” says Klein. “And the number is increasing every week.”
Some are offering access to the opioid substitute drugs buprenorphine and methadone, which can help opioid users detox and then temper cravings. Long term, in theory, those drugs can help people who have become addicted to opioids stay off of destructive and potentially deadly street versions.
But the majority of jail-based medication-assisted treatment programs today are limited to injectable naltrexone, given upon an inmate’s release.
Also known by its brand name Vivitrol, naltrexone is an injectable drug that could trigger withdrawal symptoms in someone who is physically dependent on opioids; but it also blocks the brain’s receptors for opioids and alcohol for 28 days.
Inmates who have been addicted to opioids are at far greater risk for overdose upon release, as their tolerance for street drugs is often greatly reduced after a stint of abstinence. Suddenly, a dose that got them high in the old days could now be fatal.
Liability concerns and the need to improve withdrawal management are also driving the increase in MAT. About 80 percent of all detoxification for drugs and alcohol happen in jails and prisons. And nationally, in the last 10 years, counties and states have paid out well over $70 million dollars for addiction withdrawal-related deaths of inmates, according to a tally by Klein. More than 50 similar lawsuits are still pending.
Klein says the challenge is far broader than jails for a public health system that has yet to catch up to the opioid crisis. “MAT is totally underutilized in the community, much less in jails,” he says.
The problem is particularly hard for jails in more rural and semi-rural counties, which often have limited access to medications, to physicians who will administer it, and to follow-up programs inmates can tap into upon release.
To provide methadone, for example, a jail has to either be certified as a methadone clinic or partner with a community clinic.
“Even if [rural jails] wanted to provide medication-assisted treatment within the jails, there may not be a methadone clinic for 60 miles,” says Carrie Hill, director of the National Sheriffs’ Association’s Center for Jail Operations. “It’s a huge issue.”
Or a county may not have a doctor with the necessary licenses to provide treatment medications, Hill says.
Most rural areas “don’t have a single doctor who is certified to even prescribe buprenorphine,” says Klein. “So it’s very difficult for a jail to even find a doctor who can prescribe it to an inmate who may need it. Most rural and suburban counties in this country don’t have any methadone clinics they can rely on.”
Hill says the sheriffs in her group are working on ways to expand treatment and recovery support services to rural areas, including city-rural treatment partnerships; additional funding to greatly expand telemedicine and broadband services; and mobile anti-opioid addiction units that could deliver treatment drugs to hard-to-reach jails.
The group is in conversation with its federal partners to get the necessary medical waivers to do that.
Advocates for expanding MAT say the medications are saving lives. “In jail, [when] we have somebody stabilized — off street drugs — they can begin to calm down and [we can] find out if we can help them with medication,” Klein says. “What a tragedy if we miss that moment.”
The legislature in Massachusetts, with Koutoujian’s encouragement, has given the green light for a seven-county pilot program of the best evidence-based opioid treatment in jails. Starting this August, the jails will offer all forms of medication-assisted treatment and carefully track data on efficacy — including rates of drug relapse, overdose and recidivism.
While he supports MAT in general, Koutoujian, the sheriff, says he’s wary that medications alone will solve the inmate addiction treatment problem. That kind of thinking, he says, got us into this crisis in the first place.
“Medication assisted treatment is very important but people have to remember if you do the medication without the treatment portion — the counseling and the supports — it will fail. And we will just fall prey to another easy solution that just simply does not work.”
“We have to make sure, if we are going to use medication-assisted treatment,” Koutoujian says, “that when they leave our facility they will have access to medication. Do they have health insurance to cover that medication? Do they have access to counseling and treatment services and navigators to help them through this most difficult time period? If they don’t have that, then in many ways we could be setting them up for greater failure.”
Meanwhile, in San Mateo’s jail, inmate Felipe Chavez says he wants to serve his time, reconnect with an infant daughter he barely knows and try “to live a different life.”
“I mean, I know everyone says that while they’re in here,” Chavez says. “But, you know, I’m really trying to just get my family back together. Change the way of life.”
To do that, Chavez says, for now he wants to stay in the jail’s fledgling medication-assisted treatment program — to help him stay off fentanyl and stay alive.
Sports Arbitration Court To Decide Limits For Female Testosterone Levels
David Greene talks to The Associated Press’ Gerald Imray about a challenge to a rule that would force elite female athletes to artificially reduce their testosterone level to be eligible to compete.
Rochester Drug Cooperative Faces Federal Criminal Charges Over Role In Opioid Epidemic
NPR’s Audie Cornish talks with Gary Craig, a Democrat and Chronicle reporter, about the first major pharmaceutical distributor to face federal criminal charges over its role in the opioid epidemic.
Hospitals Chafe Under A Medicare Rule That Reduces Payments To Far-Flung Clinics
Over the past decade, hospitals have been rapidly building outpatient clinics or purchasing existing independent ones. It was a lucrative business strategy because such clinics could charge higher rates, on the premise that they were part of a hospital. Medicare’s recent rule change puts a damper on all that.
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Eric Lewis’ plans of expanding his community hospital’s reach have been derailed.
As CEO of Olympic Medical Center, he oversees efforts to provide care to roughly 75,000 people in Clallam County, in the isolated, rural northwestern corner of Washington state.
Last year, Lewis planned to build a primary care clinic in Sequim, a town about 17 miles from the medical center’s main campus of a hospital and clinics in Port Angeles.
But those plans were put aside, Lewis says, because of a change in federal reimbursements this year. Medicare has opted to pay hospitals that have outpatient facilities “off campus” a lower rate — equivalent to what it pays independent doctors for clinic visits.
Over the past decade, hospitals have been rapidly building outpatient clinics or purchasing existing independent ones. It was a lucrative business strategy because such clinics could charge higher rates, on the premise that they were part of a hospital.
With its new policy, Medicare is essentially saying that an off-campus office is an off-campus office, regardless of whether it’s owned by a hospital, a group of doctors or a solo practitioner.
Taking that position will save Medicare — and possibly patients — money.
The federal insurer bore the brunt of its members’ extra charges, but beneficiaries sometimes picked up part of that expense through deductibles and copayments. Patients with commercial insurance often were blindsided by high bills — going to what seemed to be a normal primary care clinic, only to discover they were charged a hospital facility fee, for example.
Health policy analysts say the new policy represents an important step in rationalizing payments. Part of a strategy called “site neutral” payment, the new policy has its roots in the Obama administration and was part of the Bipartisan Budget Act of 2015.
“You don’t care about where [your treatment is] happening. You care that it’s a safe and inexpensive procedure,” says Gerard Anderson, director of the Johns Hopkins Center for Hospital Finance and Management. “And the facility fee just adds to the cost with very little added value.”
The new payment structure may financially hurt some hospitals, he and other experts acknowledge. But making reimbursements more uniform across providers facilitates competition and may lead commercial insurance to follow suit — which could translate to more savings for patients.
This year, the policy’s two-part phase-in cut Medicare payments for clinic visits to outpatient departments by 30%, according to the rule finalized in November. By 2020, the payment rates will be cut by 60% compared with what they were last summer.
The Centers for Medicare & Medicaid Services estimates that the change will save the federal government $380 million this year and patients an average of $7 every time they visit a hospital-owned clinic. Clinic visits are the most commonly charged service for hospital outpatient care under Medicare.
It could also cut down on consolidation in the industry, health care economists say, by closing the loophole that created incentives for hospitals to purchase independent physician practices and charge higher rates for services at taxpayers’ expense.
The American Hospital Association filed a lawsuit late last year alleging that CMS overstepped its authority when setting the new reimbursement schedule. Olympic Medical Center is among the plaintiffs.
The hospital association claims that the new rule infringes on a precedent Congress set with the 2015 budget law. That legislation standardized Medicare payments for clinic visits to physicians’ offices and new hospital outpatient facilities, but allowed most hospital-affiliated departments that existed at that time to continue receiving a higher rate, according to a comment letter from the Medicare Payment Advisory Commission. The group is a nonpartisan agency that advises Congress.
The differential for site-based payments was designed originally to help hospitals offset the higher costs they incur for maintaining the staff and equipment to handle a wide variety of treatments, says Christopher Whaley, an associate policy researcher at the research organization Rand Corp.
But that financial relief became an incentive for hospitals to buy independent practices, says Dr. Ateev Mehrotra, associate professor of health care policy and medicine at Harvard Medical School. Hospitals were able to charge higher prices for services performed at newly acquired clinics.
Mehrotra says the new CMS rule could be a way to slow down the trend.
“This isn’t going to fully put the brakes on it,” he says, “but it could be one push on the brakes here — to kind of push that consolidation down.”
Some health care analysts have urged the government to expand the number of services covered by the site-neutral policy, including paying hospitals’ on-site clinics a rate equivalent to what independent doctors receive.
Hospitals acknowledge that the change implemented by CMS could lead to savings in the health care system, but they say it comes at the cost of patients’ convenient access to medical care. In Washington state, Lewis anticipates a loss of $1.6 million for his hospital.
The lack of a clinic in Sequim means ailing patients there will not be able to get care close to their homes, Lewis says.
“If you’re well-to-do financially, these aren’t big problems,” Lewis adds. “But I think the poorest, elderly, sickest of our society will pay the price of this policy.”
Melinda Hatton, general counsel for the hospital association, agrees. “I think access trumps a couple extra dollars in copays every single time,” she says.
On the other hand, many independent physicians support the change. Marni Jameson Carey, executive director of the Association of Independent Doctors, says she hopes the rule will curb consolidation.
According to a recent report by the consulting firm Avalere, the number of hospital-owned physician practices more than doubled from 35,700 to 80,000 between July 2012 and January 2018. Hospitals own more than 31% of all physician practices, the report found.
Jameson Carey says such mergers can also cause problems for the local economy. When a nonprofit hospital acquires an independent clinic, it effectively removes a tax-paying business from the area. That’s because nonprofit hospitals are exempt from paying certain federal, state and local taxes — in exchange for providing community benefits.
“So, not only do they [hospitals] get the facility fee,” Jameson Carey says, “they don’t have to pay taxes.”
Kaiser Health News is a nonprofit news service and editorially independent program of the Kaiser Family Foundation. KHN is not affiliated with Kaiser Permanente.
Google Searches For Ways To Put Artificial Intelligence To Use In Health Care
Google is looking to artificial intelligence as a way to make a mark in health care.
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One of the biggest corporations on the planet is taking a serious interest in the intersection of artificial intelligence and health.
Google and its sister companies, parts of the holding company Alphabet, are making a huge investment in the field, with potentially big implications for everyone who interacts with Google — which is more than a billion of us.
The push into AI and health is a natural evolution for a company that has developed algorithms that reach deep into our lives through the Web.
“The fundamental underlying technologies of machine learning and artificial intelligence are applicable to all manner of tasks,” says Greg Corrado, a neuroscientist at Google. That’s true, he says, “whether those are tasks in your daily life, like getting directions or sorting through email, or the kinds of tasks that doctors, nurses, clinicians and patients face every day.”
Corrado knows a bit about that. He helped Google develop the algorithm that Gmail uses to suggest replies.
The company also knows the value of being in the health care sphere. “It’s pretty hard to ignore a market that represents about 20 percent of [U.S.] GDP,” says John Moore, an industry analyst at Chilmark Research. “So whether it’s Google or it’s Microsoft or it’s IBM or it’s Apple, everyone is taking a look at what they can do in the health care space.”
Google, which provides financial support to NPR, made a false start into this field a decade ago. The company backed off after a venture called Google Health failed to take root. But now, Google has rebooted its efforts.
Hundreds of employees are working on these health projects, often partnering with other companies and academics. Google doesn’t disclose the size of its investment, but Moore says it’s likely in the billions of dollars.
One of the prime movers is a sister company called Verily, which this year got a billion-dollar boost for its already considerable efforts. Among its projects is software that can diagnose a common cause of blindness called diabetic retinopathy and that is currently in use in India. Verily is also working on tools to monitor blood sugar in people with diabetes, as well as surgical robots that learn from each operation.
“In each of these cases, you can use new technologies and new tools to solve a problem that’s right in front of you,” says cardiologist Jessica Mega, Verily’s chief medical and scientific officer. “In the case of surgical robotics, this idea of learning from one surgery to another becomes really important, because we should be constantly getting better.”
Mega says the rise of artificial intelligence isn’t that big a departure from devices we’re used to, like pacemakers and implantable defibrillators, which jump into action in response to health signals from the body. “So patients are already seeing this intersection between technology and health care,” she says. “It’s just we’re hitting an inflection point.”
That’s because the same kinds of algorithms that are giving rise to self-driving cars can also operate in the health care sphere. It’s all about managing huge amounts of data.
Hospitals have gigabytes of information about the typical patient in the form of electronic health records, scans and sometimes digitized pathology slides. That’s fodder for algorithms to ingest and crunch. And Mega says there’s a potential to wring a lot more useful information out of it.
“There’s this idea that you are healthy until you become sick,” she says, “but there’s really a continuum” between health and disease. If computer algorithms can pick up early signs of a slide toward disease, that could help people avoid getting sick.
But medical data aren’t typically collected for research purposes, so there are gaps. To close those, Verily has partnered with Duke University and Stanford University in an effort called Project Baseline, which seeks to recruit 10,000 volunteers to give tons more data to the company.
Judith Washburn and her husband, James Davis, have volunteered to be subjects in Project Baseline, an effort to gather a range of detailed data to characterize and predict how people move from health to illness.
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Courtesy of James Davis
Judith Washburn, a 73-year-old medical librarian and resident of Palo Alto, Calif., signed up after she saw a recruiting ad. “A couple months later, I got a call to go in, and it’s two days of testing, two different weeks and it’s very thorough,” she says.
She had heart scans, blood tests, skin swabs and stress tests — a checkup on steroids, if you pardon the expression. Her husband, James Davis, decided he’d give it a go as well.
“They were having trouble finding African-American participants at the time, so I was pretty much a shoo-in,” he says. “I’m aware of people who donate their bodies to medical science when they die,” he says, “so it’s sort of a way of donating your body while it’s still alive.”
The retired aerospace engineer also got an added benefit. The doctors diagnosed a serious heart condition, and Davis then had triple bypass surgery to treat it.
The couple replies to quarterly questionnaires, a gizmo under their mattress tracks their sleep patterns and they each wear a watch that monitors their hearts. The watches also count their steps — sort of.
“They haven’t quite figured out your exercise yet,” Washburn says. “In fact, I can knit and get steps!”
All this highly personal information goes into the database of a private corporation. Both Washburn and Davis thought about that before signing up but ultimately concluded that’s OK.
“It depends upon what they’re using it for,” Washburn says. “And if it’s all for research, I’m fine with that.”
Here’s what makes Google’s position unique. Some of the most useful data could be what the company collects while you’re running a Google search, using Gmail or using its Chrome browser.
“As companies like Google and other traditional consumer-oriented companies start moving into this space, it is certainly clear that they bring the capability of taking much of the information they have about us and be able to apply it,” says Reed Tuckson, a well-known academic physician who was recently recruited to advise Verily about Project Baseline.
For example, people’s browsing history can reveal a lot about what they buy, how they exercise and other facets of their lifestyles.
“We now understand that that has a great deal to do with the health decisions that we make,” says Tuckson, who is on a National Academy of Medicine working group that’s exploring artificial intelligence in medicine.
He says Google needs to tread carefully around these privacy issues, but he’s bullish on the technology.
“We should remember that the status quo is not acceptable by itself and that we’ve got to use every tool at our disposal — use them intelligently” to improve the health of Americans, he says. “And I think that’s why it’s exciting.”
Tuckson isn’t the only influential recruit to the effort. Verily recently brought in Dr. Robert Califf, a former Food and Drug Administration commissioner, as well as Vivian Lee, a radiologist who headed the University of Utah’s health care system. Google hired David Feinberg, a physician who ran Geisinger, a major health care provider based in Danville, Pa.
“It seems like it was a bit of a war on talent right now between Amazon and Google and to a certain extent Apple,” says Moore, the analyst. Google needs to build credibility in the medical sphere.
“I think Google is trying to have those people that can basically proof out what Google is doing and stand up and say, ‘Yes, Google can do this,’ ” Moore says.
He also has his eye on what the company’s investment means for the rapidly developing industry around health care and artificial intelligence. “Anyone should take Google very seriously,” he says.
Some big players, like Apple and Microsoft, can hold their own.
“For other AI companies that don’t have those resources, they’re going to have to be very judicious in picking the niches they want to target, niches that are ones that, frankly, Google is not terribly interested in,” Moore says.
Getting the technology to work is just the start.
The health care business is “a very complex ecosystem,” says Dr. Lonny Reisman, a former health insurance executive who now heads HealthReveal, a company that develops algorithms to help doctors choose the appropriate therapy. Google will need to answer many questions as it enters that landscape.
Who will have an incentive to buy software based on artificial intelligence? Will it really save time or money, as advocates often assert? Or is it just the next new driver of health care inflation?
“There are all these competing forces around cost containment,” Reisman says. It’s not easy to balance innovation, access, fairness and health equity, he adds, “so they’ve got a lot on their plate.”
Google’s Corrado says collaborations with academics and the health care industry are key for navigating this territory.
“A big part of the way that research and development should work in this space is by having kind of a long-term portfolio of technologies that you percolate through the academic and scientific community and then you percolate through the clinical community,” Corrado says.
For all the challenges of forging a new path into health care, Google has a potentially enormous advantage in all the data it collects from its billions of users.
Corrado says the company is well aware of the sensitivity of putting that information to use and is thinking about how to approach that without provoking a backlash.
“It has to be something that is driven by the patients’ desire to use their own information to better their wellness,” Corrado says.
In a world where people are increasingly concerned about how their personal data are exploited, that could be even more of a challenge than building the computer algorithms to digest and interpret it all.
You can contact NPR science correspondent Richard Harris at rharris@npr.org.
Kate Smith’s ‘God Bless America’ Dropped By Two Major Sports Teams
Singer Kate Smith signs autographs for a group of American sailors circa 1938.
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The singer Kate Smith’s recording of “God Bless America” has been a cherished part of sports tradition in the U.S. for decades. But in the aftermath of a discovery that the singer also recorded at least two songs with racist content in the 1930s, two major American sports teams, baseball’s New York Yankees and ice hockey’s Philadelphia Flyers, have announced that they will stop playing Smith’s rendition of the Irving Berlin patriotic classic. On Sunday, the Flyers also took down a statue of Smith that had stood in front of their stadium since 1987.
A fan alerted the Yankees last week that Smith had recorded at least two problematic songs — 1931’s “That’s Why Darkies Were Born” and 1933’s “Pickaninny Heaven,” from the film Hello, Everybody! — the New York Daily News reported on Thursday.
On Sunday, the Philadelphia Flyers removed a statue of Smith that had stood outside the team’s arena since 1987, first at the Spectrum and later at the Xfinity Live! venue. Smith sang “God Bless America” live for the Flyers before Game 6 of the 1974 Stanley Cup finals — after which the Flyers beat the Boston Bruins. Since then, the Flyers had treated Smith’s rendition as a talisman for the team.
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In a statement published Sunday, Flyers President Paul Holmgren said, “The NHL principle ‘Hockey is for Everyone’ is at the heart of everything the Flyers stand for. As a result, we cannot stand idle while material from another era gets in the way of who we are today.”
The statement also said: “While Kate Smith’s performance of ‘God Bless America’ cannot be erased from its place in Flyers history, that rendition will no longer be featured in our game presentations.”
On Friday, the Philadelphia team had covered the statue with black cloth. A spokesman for the Flyers told NBC10 in Philadelphia on Friday, “We have recently become aware that several songs performed by Kate Smith contain offensive lyrics that do not reflect our values as an organization.” The spokesman added, “As we continue to look into this serious matter, we are removing Kate Smith’s recording of ‘God Bless America’ from our library and covering up the statue that stands outside of our arena.”
Smith’s career spanned more than five decades and encompassed radio, multiple television shows under her name, commercials and over two dozen albums and hundreds of singles. But it seems that no official working for either team was aware of these two songs.
The Yankees had played Smith’s recording of “God Bless America” during the seventh-inning stretch since shortly after the Sept. 11 terrorist attacks. A spokesperson told the Daily News last Thursday, “The Yankees have been made aware of a recording that had been previously unknown to us and decided to immediately and carefully review this new information. The Yankees take social, racial and cultural insensitivities very seriously. And while no final conclusions have been made, we are erring on the side of sensitivity.”
Smith, who died in 1986 at age 79, received the Presidential Medal of Freedom — the United States’ highest civilian honor — from President Ronald Reagan in 1982 in honor of her artistic and patriotic contributions. In his remarks, Reagan said: “It’s been truly said that one of the most inspiring things our GIs in World War II, Europe and the Pacific, and later in Korea and Vietnam, ever heard was the voice of Kate Smith — and the same is true for all of us. … Those simple but deeply moving words, ‘God bless America,’ have taken on added meaning for all of us because of the way Kate Smith sang them. Thanks to her, they have become a cherished part of all our lives, an undying reminder of the beauty, the courage and the heart of this great land of ours.”
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Smith was a foundational figure in pop culture during World War II and used her fame to raise hundreds of millions of dollars for the U.S. government’s war efforts. During one 18-hour broadcast on the CBS radio network alone, she helped raise more than $100 million in war bonds. (That would amount to more than $1.4 billion in 2019 dollars.)
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In the 1933 film, Smith said that she was singing “Pickaninny Heaven” for “a lot of little colored children, who are listening in at an orphanage in New York City.” The sequence includes shots of unkempt black children, while Smith sings of a “pickaninny heaven” where “Mammy” is waiting for them as well as “great big watermelons.”
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“That’s Why Darkies Were Born” was written for a 1931 Broadway revue called “George White’s Scandals,” a show that featured such stars of the time as Rudy Vallee and Ethel Barrymore.
Some critics have argued that the “Darkies” song was meant to be a satire of white supremacist ideas — and it was famous enough in its day to be referenced in the Marx Brothers film Duck Soup. But modern-day audiences inevitably cringe at lines like “Someone had to pick the cotton / Someone had to plant the corn / Someone had to slave and be able to sing / That’s why darkies were born.”
“That’s Why Darkies Were Born” was also recorded by the pioneering and revered black bass baritone Paul Robeson — who, in his contract for EMI between 1928 and 1939, recorded quite a few songs that many contemporary listeners will find very problematic, including “De Li’l Pickaninny’s Gone to Sleep,” Stephen Foster’s plantation songs and “Poor Old Joe” (aka “Old Black Joe”).
Not Just Child’s Play: World Tiddlywink Champions Look To Reclaim Their Glory
A tiddlywinks game mid-play, with winks spread out around the pot. Though players eventually want to “pot” their “winks,” players also strategize how to block their opponents by landing their piece on top of another’s piece.
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In 1995, Sports Illustrated likened Larry Kahn and David Lockwood to the Muhammad Ali and Joe Frazier of Tiddlywinks. A fearsome metaphor for two men who, in the parlance of their game, spend their time squopping and potting, rather than bobbing and weaving.
Kahn has won 114 national and world Tiddlywinks titles. Lockwood has won 41. “Larry is the Ali,” Lockwood concedes.
But their rivalry is a friendly one, and when they’re not competing against one another, they make a formidable pair. As a duo, they’ve won five international titles together.
On Friday, they’ll look to snap a 21-year drought when they try for their sixth title together at the annual Tiddlywinks World Championships at the University of Cambridge.
Larry Kahn (left) and Dave Lockwood, practice tiddlywinks. The game has a startlingly simple premise for a game that draws an academic fandom.
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On a recent afternoon in a simply remodeled basement located in the Virginia suburbs, Lockwood paces the perimeter of a regulation 6-by-3-foot table in gym socks and red track pants, calculating his best move.
Colorful, dime-sized discs, or winks, dot the felt-matted surface. In the center lies a traditional plastic red cup no bigger than a shot glass. Kahn, wearing Tevas over his socks, is playing in shorts, as usual, lest he gets too warm circling the tabletop.
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Tiddlywinks has a startlingly simple premise: Shoot the most winks into the cup. For all its academic fandom, the very name of the game and its companion slang evokes the lexicon of a nursery rhyme. But Lockwood is quick to blast the game’s reputation as a bygone children’s pastime.
“Tiddlywinks is not what you did when you were 5 years old,” he says. “Tournament tiddlywinks is a fascinating combination of physical skill at a micro level and positional strategy.”
Larry Kahn (left) and Dave Lockwood are both friends and competitors.
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What began as a 19th century adult parlor game in England, first patented in 1888, reemerged in university circles across the United Kingdom and the United States as a tournament game held at Cambridge University in 1955.
Over time, professional winkers, largely recruited from Cambridge, Oxford and the Massachusetts Institute of Technology, helped heighten its complexity and strategy.
Probability, physics and dexterity rule the game.
Offensively, potting — or sinking a wink in the cup — depends on how much pressure a player exerts on the squidger, a larger disc used to flick smaller discs, or winks, into the cup. To gauge your potting chances, competitors know that pressure equals distance, Lockwood explains.
Trophies collected from tiddlywinks competitions over the years.
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To keep opponents from scoring, players use their winks for another purpose: squopping. Translation: they flick their winks on top of their opponent’s discs to effectively take them out of play.
“You need to defend the ones that you’ve got and/or attack the ones that they’ve got,” Lockwood explains.
These days, there’s hardly a market for the niche sport. Several companies don’t even make the equipment anymore.
So committed winkers have had to get creative. Lockwood and Kahn have procured orthopedic felt for their playing surface. They make their own squidgers by sanding down plastic discs molded from spice jar lids. They’re banking on 3-D printing becoming more affordable in the near future to help streamline the process.
It’s not something they could have imagined when they started playing Tiddlywinks during their freshman year at MIT, when Kahn and Lockwood each signed themselves up on a whim. Kahn thought the game sounded fun to learn. Lockwood checked “Tiddlywinks” as a joke, he says, after perusing the list of activities offered in the student handbook.
“I was the last person to make the eight-player team in 1972,” he says.
Dave Lockwood plays tiddlywinks.
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Larry Kahn has won 114 national and world titles.
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Today, Lockwood says the game has changed his life. “I’ve been to Britain more than 100 times since then, mostly to play Tiddlywinks.”
It’s a sentiment shared by Kahn, who says the game has “enriched my life.”
Kahn and Lockwood both say that one of the best parts of belonging to the winking community has been the friendships they’ve gained.
“Immediately you have a bond with people I’ve never met and it’s continued on, through today. For whatever reason, the game has sort of kept people together to some extent.”
Kahn crafts his own squidgers from pieces of plastic.
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Of course, when talk turns to this week’s tournament, they turn less sentimental.
“It’d be nice to you know, as old as we are compared to the other players, be able to to go in and win a match,” Kahn says. “To show the old guys can still do it.”
Lockwood is blunter. “I really want this,” he says. For him, the victories are addicting.
“If you get a modicum of success, you’re more frequently willing to continue to play, but it’s also a very frustrating game because you miss these things that you’ve made so many times in the past,” he says.
“But only the past is certain.”
For Mongolia’s Ice Shooters, Warmer Winters Mean A Shorter Sports Season
A group of Mongolian herdsmen gathers to play musun shagai (ice shooting) on the Tamir river in early March.
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On a bright Sunday afternoon in early March, the Tamir River in the steppes of Mongola becomes a bowling alley. Two dozen Mongolian herdsmen have gathered to play musun shagai, known as “ice shooting.” Right now, the ice on the river is perfect. Clear and smooth. The players are cheerful and focused.
Their goal? To send a small copper puck called a zakh down a 93-yard stretch of ice and knock over several cow ankle bones, painted red, none bigger than a golf ball, at the other end. Extra points for hitting the biggest target, made of cow skin.
Left: Cow bones and a ball made of cow skin, the targets of the puck, are clustered together during a break in the game. Right: A man demonstrates how to hold a zahk, the copper puck that is slid down the ice to hit the targets.
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Together, the targets form a line of tiny red dots that are difficult to see, let alone hit. When that happens, players know because the spectators raise a boisterous cheer.
“You have to spin it,” says Gurvantamir Jamts, 47, a newcomer to the game. He is the mayor of Tsetserleg, the capital of Arkhangai province, where musun shagai was invented.
He cradles a copper puck between his thumb, index and middle fingers. He shakes it. Metal balls rattle inside. Thrown properly, the puck glides forward with the sound of an ice-skating blade on a freshly resurfaced rink.
A competitor looks back at the crowd of spectators after sending his zakh down the ice toward the targets and the scorekeepers who stand behind them.
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Ice shooting players Ser-od Dechingalav, 30 (right), and Enkhbaatar Batdelger, 30, won the partner contest.
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Cars and motorcycles draped with fur line the banks of the Tamir river as players gather for the season’s final ice shooting competition in early March.
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“The main technique,” Gurvantamir says, “is how you hold it.”
Newcomers to the game can struggle to keep their balance on the ice. But with experience comes grace. Many competitors slide forward as they release the puck, called a zakh, all in one motion.
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And how you release it. The players assume a static lunge, digging their back feet into a tiny divet in the ice. They release their zakhs with a throw, and a hopeful look. All squint down the river to see if a red target was hit.
Top: Competitors watch their opponents play. Bottom left: In the partner competition, players work in teams of two. The scorekeeper keeps track of points by drawing a Buddhist temple, line by line. The team with the most complete temple wins. Bottom right: Gurvantamir Jamts keeps his zakh in a leather belt, strapped around his gray deel, a traditional Mongolian overcoat.
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Musun shagai is a homegrown game, created in the 19th century as a way to pass the time. This is the final game of the season before the river melts, the last opportunity to wile away the winter hours before the mayhem of spring, when the goats, sheep, horses and cows give birth.
Left: Burenbat Dorj, 44, plays a dozen times every winter. He is the governor of Erdenebulgan Soum, the local community hosting the competition. Right: Gurvantamir Jamts, 47, is new to the game and proud of its local roots in Arkhangai province. He is the mayor of Arkhangai’s capital, Tsetserleg.
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Only men play ice shooting competitively, though the event brings whole families together. Children scuttle around the ice in their boots, bundled up for the 20-degree weather. One group of teenagers cobbles together their own game, using a flat rock to topple over food packages, practicing their technique.
People tread carefully on the smooth ice. The competition, originally scheduled for mid-March, was bumped up by two weeks because the river had begun to show early signs of melting.
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This competition, originally scheduled for mid-March, was bumped up by two weeks. “The river was already melting,” Gurvantamir said.
The frozen surfaces that makes this game possible are harder to come by in a warming world. According to data from Mongolia’s Institute for Meteorology, Hydrology and Environment, the country’s annual mean temperature has increased by 2.2 degrees Celsius (nearly 4 degrees Fahrenheit) since data collection began in 1940. (The global temperature increase since 1880 has been 0.8 degrees Celsius or 1.4 degrees Fahrenheit).
When the musun shagai competition ends, bowls of vodka are passed around. The local government even brought medals for the winners. They were made of clear plastic. Mayor Gurvantamir held them up, demonstrating how the sunlight glinted through — just like ice.
Emily Kwong (@emilykwong1234) spent nine weeks reporting in Mongolia as NPR’s Above the Fray fellow. The fellowship is sponsored by the John Alexander Project, which supports foreign reporting in undercovered parts of the world.
Soccer Star Abby Wambach Turns Rallying Commencement Speech Into New Book, ‘Wolfpack’
NPR’s Sacha Pfeiffer speaks with retired Olympic soccer star Abby Wambach about her new book, Wolfpack: How to Come Together, Unleash our Power, and Change the Game