Author: Karl Bates Page 2 of 18

Director of Research Communications, Duke University

Researchers Urge a Broader Look at Alzheimer’s Causes

On September 20, 2019

In Behavior/Psychology, Data, Global Health, Neuroscience

Just about every day, there’s a new headline about this or that factor possibly contributing to Alzheimer’s Disease. Is it genetics, lifestyle, diet, chemical exposures, something else?

The sophisticated answer is that it’s probably ALL of those things working together in a very complicated formula, says Alexander Kulminski, an associate research professor in the Social Science Research Institute. And it’s time to study it that way, he and his colleague, Caleb Finch at the Andrus Gerontology Center at the University of Southern California, argue in a recent paper that appears in the journal Alzheimer’s and Dementia, published by the Alzheimer’s Association.

Positron Emission Tomography scan of a brain affected by cognitive declines . (NIH)

“Life is not simple,” Kulminski says. “We need to combine different factors.”

“We propose the ‘AD Exposome’ to address major gaps in understanding environmental contributions to the genetic and non-genetic risk of AD and related dementias,” they write in their paper. “A systems approach is needed to understand the multiple brain-body interactions during neurodegenerative aging.”

The analysis would focus on three domains, Kulminski says: macro-level external factors like rural v. urban, pollutant exposures, socio-economcs; individual external factors like diet and infections; and internal factors like individual microbiomes, fat deposits, and hormones.

That’s a lot of data, often in disparate, broadly scattered studies. But Kulminski, who came to Duke as a physicist and mathematician, is confident modern statistics and computers could start to pull it together to make a more coherent picture. “Twenty years ago, we couldn’t share. Now the way forward is consortia,” Kulminski said.

The vision they outline in their paper would bring together longitudinal population data with genome-wide association studies, environment-wide association studies and anything else that would help the Alzheimer’s research community flesh out this picture. And then, ideally, the insights of such research would lead to ways to “prevent, rather than cure” the cognitive declines of the disease, Kulminsky says. Which just happens to be the NIH’s goal for 2025.

Big SMILES All Around for Polymer Chemists at Duke, MIT and Northwestern

By Karl Bates

On September 19, 2019

In Chemistry, Computers/Technology, Science Communication & Education

Science is increasingly asking artificial intelligence machines to help us search and interpret huge collections of data, and it’s making a difference.

But unfortunately, polymer chemistry — the study of large, complex molecules — has been hampered in this effort because it lacks a crisp, coherent language to describe molecules that are not tidy and orderly.

Think nylon. Teflon. Silicone. Polyester. These and other polymers are what the chemists call “stochastic,” they’re assembled from predictable building blocks and follow a finite set of attachment rules, but can be very different in the details from one strand to the next, even within the same polymer formulation.

Plastics, love ’em or hate ’em, they’re here to stay.
Foto: Mathias Cramer/temporealfoto.com

Chemistry’s old stick and ball models and shorthand chemical notations aren’t adequate for a long molecule that can best be described as a series of probabilities that one kind of piece might be in a given spot, or not.

Polymer chemists searching for new materials for medical treatments or plastics that won’t become an environmental burden have been somewhat hampered by using a written language that looks like long strings of consonants, equal signs, brackets, carets and parentheses. It’s also somewhat equivocal, so the polymer Nylon-6-6 ends up written like this:

{<C(=O)CCCCC(=O)<,>NCCCCCCN>}

Or this,

{<C(=O)CCCCC(=O)NCCCCCCN>}

And when we get to something called ‘concatenation syntax,’ matters only get worse.

Stephen Craig, the William T. Miller Professor of Chemistry, has been a polymer chemist for almost two decades and he says the notation language above has some utility for polymers. But Craig, who now heads the National Science Foundation’s Center for the Chemistry of Molecularly Optimized Networks (MONET), and his MONET colleagues thought they could do better.

“Once you have that insight about how a polymer is grown, you need to define some symbols that say there’s a probability of this kind of structure occurring here, or some other structure occurring at that spot,” Craig says. “And then it’s reducing that to practice and sort of defining a set of symbols.”

Now he and his MONET colleagues at MIT and Northwestern University have done just that, resulting in a new language – BigSMILES – that’s an adaptation of the existing language called SMILES (simplified molecular-input line-entry system). They they think it can reduce this hugely combinatorial problem of describing polymers down to something even a dumb computer can understand.

And that, Craig says, should enable computers to do all the stuff they’re good at – searching huge datasets for patterns and finding needles in haystacks.

The initial heavy lifting was done by MONET members Prof. Brad Olsen and his co-worker Tzyy-Shyang Lin at MIT who conceived of the idea and developed the set of symbols and the syntax together. Now polymers and their constituent building blocks and variety of linkages might be described like this:

Examples of bigSMILES symbols from the recent paper

It’s certainly not the best reading material for us and it would be terribly difficult to read aloud, but it becomes child’s play for a computer.

Members of MONET spent a couple of weeks trying to stump the new language with the weirdest polymers they could imagine, which turned up the need for a few more parts to the ‘alphabet.’ But by and large, it holds up, Craig says. They also threw a huge database of polymers at it and it translated them with ease.

“One of the things I’m excited about is how the data entry might eventually be tied directly to the synthetic methods used to make a particular polymer,” Craig says. “There’s an opportunity to actually capture and process more information about the molecules than is typically available from standard characterizations. If that can be done, it will enable all sorts of discoveries.”

BigSMILES was introduced to the polymer community by an article in ACS Central Science last week, and the MONET team is eager to see the response.

“Can other people use it and does it work for everything?” Craig asks. “Because polymer structure space is effectively infinite.” Which is just the kind of thing you need Big Data and machine learning to address. “This is an area where the intersection of chemistry and data science can have a huge impact,” Craig says.

Nature Shows a U-Turn Path to Better Solar Cells

By Karl Bates

On July 24, 2019

In Chemistry, Environment/Sustainability, Nanotech, Physics, Students

The technical-sounding category of “light-driven charge-transfer reactions,” becomes more familiar to non-physicists when you just call it photosynthesis or solar electricity.

When a molecule (in a leaf or solar cell) is hit by an energetic photon of light, it first absorbs the little meteor’s energy, generating what chemists call an excited state. This excited state then almost immediately (like trillionths of a second) shuttles an electron away to a charge acceptor to lower its energy. That transference of charge is what drives plant life and photovoltaic current.

A 20 Megawatt solar farm ( Aerial Innovations via wikimedia commons)

The energy of the excited state plays an important role in determining solar energy conversion efficiency. That is, the more of that photon’s energy that can be retained in the charge-separated state, the better. For most solar-electric devices, the excited state rapidly loses energy, resulting in less efficient devices.

But what if there were a way to create even more energetic excited states from that incoming photon?

Using a very efficient photosynthesizing bacterium as their inspiration, a team of Duke chemists that included graduate students Nick Polizzi and Ting Jiang, and faculty members David Beratan and Michael Therien, synthesized a “supermolecule” to help address this question.

“Nick and Ting discovered a really cool trick about electron transfer that we might be able to adapt to improving solar cells,” said Michael Therien, the William R. Kenan, Jr. Professor of Chemistry. “Biology figured this out eons ago,” he said.

“When molecules absorb light, they have more energy,” Therien said. “One of the things that these molecular excited states do is that they move charge. Generally speaking, most solar energy conversion structures that chemists design feature molecules that push electron density in the direction they want charge to move when a photon is absorbed. The solar-fueled microbe, Rhodobacter sphaeroides, however, does the opposite. What Nick and Ting demonstrated is that this could also be a winning strategy for solar cells.”

The chemists devised a clever synthetic molecule that shows the advantages of an excited state that pushes electron density in the direction opposite to where charge flows. In effect, this allows more of the energy harvested from a photon to be used in a solar cell.

“Nick and Ting’s work shows that there are huge advantages to pushing electron density in the exact opposite direction where you want charge to flow,” Therien said in his top-floor office of the French Family Science Center. “The biggest advantage of an excited state that pushes charge the wrong way is it stops a really critical pathway for excited state relaxation.”

“So, in many ways it’s a Rube Goldberg Like conception,” Therien said. “It is a design strategy that’s been maybe staring us in the face for several years, but no one’s connected the dots like Nick and Ting have here.”

In a July 2 commentary for the Proceedings of the National Academy of Sciences, Bowling Green State University chemist and photoscientist Malcom D.E. Forbes calls this work “a great leap forward,” and says it “should be regarded as one of the most beautiful experiments in physical chemistry in the 21^st century.”

Here’s a schematic from the paper.
(Image by Nick Polizzi)

CITATION: “Engineering Opposite Electronic Polarization of Singlet and Triplet States Increases the Yield of High-Energy Photoproducts,” Nicholas Polizzi, Ting Jiang, David Beratan, Michael Therien. Proceedings of the National Academy of Sciences, June 10, 2019. DOI: 10.1073/pnas.1901752116 Online: https://www.pnas.org/content/early/2019/07/01/1908872116

Smart Phones Are the New Windows to the Soul

By Karl Bates

On September 21, 2018

In Behavior/Psychology, Computers/Technology, Medicine

It’s one of those things that seems so simple and elegant that you’re left asking yourself, “Geez, why didn’t I think of that?”

Say you were trying to help people lose weight, prep for a surgery or take their meds every day. They’re probably holding a smartphone in at least one of their hands — all you need to do is enlist that ever-present device they’re staring at to bug them!

So, for example, have the health app send a robo-text twice a day to check in: “Did you weigh yourself?” Set up a group chat where their friends all know what they’re trying to accomplish: “We’re running today at 5, right?”

This is a screenshot of a Pattern Health app for pre-operative patients.

It’s even possible to make them pinky-swear a promise to their phone that they will do something positive toward the goal, like walking or skipping desert that day. And if they don’t? The app has their permission to lock them out of all their apps for a period of time.

Seriously, people agree to this and it works.

Two app developers on this frontier of personalized, portable “mHealth” told a lunchtime session sponsored by the Duke Mobile App Gateway on Thursday that patients not only willingly play along with these behavioral modification apps, their behaviors change for the better.

The idea of using phones for health behavior came to pediatric hematologist Nirmish Shah MD one day while he attempted to talk to a 16-year-old sickle cell disease patient as she snapped selfies of herself with the doctor. Her mom and toddler sister nearby both had their noses to screens as well. “I need to change how I do this,” Shah thought to himself.

Pediatric hematologist Nirmish Shah MD is director of Duke’s sickle cell transition program.

Twenty health apps later, he’s running phase II clinical trials of phone-based interventions for young sickle cell patients that encourage them to stay on their medication schedule and ask them often about their pain levels.

One tactic that seems to work pretty well is to ask his patients to send in selfie videos as they take their meds each day. The catch? The female patients send a minute or so of chatty footage a day. The teenage boys average 13 seconds, and they’re grumpy about it.

Clearly, different activities may be needed for different patient populations, Shah said.

While it’s still early days for these approaches, we do have a lot of behavioral science on what could help, said Aline Holzwarth, a principal of the Center for Advanced Hindsight and head of behavioral science for a Durham health app startup called Pattern Health.

Aline Holzwarth is a principal in the Center for Advanced Hindsight.

“It’s not enough to simply inform people to eat better,” Holzwarth said. The app has to secure a commitment from the user, make them set small goals and then ask how they did, enlist the help of social pressures, and then dole out rewards and punishments as needed.

Pattern Health’s app says “You need to do this, please pick a time when you will.” Followed by a reward or a consequence.

Thursday’s session, “Using Behavioral Science to Drive Digital Health Engagement and Outcomes, was the penultimate session of the annual Duke Digital Health Week. Except for the Hurricane Florence washout on Monday, the week has been a tremendous success this year, said Katie McMillan, the associate director of the App Gateway.

First Population Health Conference Shares Energy, Examples

By Karl Bates

On April 6, 2018

In Behavior/Psychology, Business/Economics, Global Health, Medicine

Logo: Population Health at Duke ‘Population Health’ is the basis of a new department in the School of Medicine, a byword for a lot of new activity across campus , and on Tuesday the subject of a half-day symposium that attempted to bring all this energy together.

For now, population health means a lot of different things to a lot of different people.

The half-day symposium drew an overflow crowd of faculty and staff. (photo – Colin Huth)

“We’re still struggling with a good definition of what population health is,” said keynote speaker Clay Johnston, MD, PhD, dean of the new Dell School of Medicine in Austin, Texas. Smoking cessation programs are something most everyone would agree is taking care of the population outside of the clinic. But improved water quality? Where does that fit?

“We have an intense focus on doctors and their tools,” Johnston said. Our healthcare system is optimized for maximum efficiency in fee-for-service care, that is, getting the most revenue out of the most transactions. “But most of health is outside the clinic,” Johnston said.

Perhaps as a result, the United States pays much more for health care, but lives less well, he said. “We are noticeably off the curve,” when compared to health care costs and outcomes in other countries.

This graphic from a handout shared at the conference shows how population health spans the entire university.

As an example of what might be achieved in population health with some re-thinking and a shift in resources, the Dell School went after the issue of joint pain with input from their engineering and business schools. Rather than diagnosing people toward an orthopedic surgery – for which there was a waitlist of about 14 months – their system worked with patients on alternatives, such as weight loss, physical therapy and behavioral changes before surgery. The 14-month backlog was gone in just three months. Surgeries still happen, of course, but not if they can be comfortably delayed or avoided.

“Payment for prevention needs serious work,” Johnston said. “You need to get people to buy into it,” but in diabetes or depression for example, employers should stand to gain a lot from having healthier employees who miss fewer days, he said.

Health Affairs Chancellor Eugene Washington commented several times, calling the discussion “very interesting and very valuable.” (photo -Colin Huth)

Other examples flowed freely the rest of the afternoon. Duke is testing virtual ‘telemedicine’ appointments versus office visits. Evidence-based prenatal care is being applied to try to avoid expensive neonatal ICU care. Primary care and Emergency Department physicians are being equipped with an app that helps them steer sickle cell patients to appropriate care resources so that they might avoid expensive ED visits.

Family practitioner Eugenie Komives, MD, is part of a team using artificial intelligence and machine learning to try to predict which patients are most likely to be hospitalized in the next six months. That prediction, in turn, can guide primary care physicians and care managers to pay special attention to these patients to help them avoid the hospital. The system is constantly being evaluated, she added. “We don’t want to be doing this if it doesn’t work.”

Community health measures like walkability and grocery stores are being mapped for Durham County on a site called Durham Neighborhood Compass, said Michelle Lyn, MBA, chief of the division of community health. The aim is not only to see where improvements can be made, but to democratize population health information and put it in peoples’ hands. “(Community members) will have ideas we never could have thought of,” Lyn said. “We will be able to see change across our neighborhoods and community.”

Patient input is key to population health, agreed several speakers. “I don’t think we’ve heard them enough,” said Paula Tanabe, PhD, an associate professor of nursing and medicine who studies pain and sickle cell disease. “We need a bigger patient voice.”

Health Affairs Chancellor and Duke Health CEO Eugene Washington, MD, has made population health one of the themes of his leadership. “We really take seriously this notion of shaping the future of population health,” he said in his introductory remarks. “When I think of the future, I think about how well-positioned we are to have impact on the lives of the community we serve.”

Lesley Curtis, PhD, chair of the newly formed Department of Population Health Sciences in the School of Medicine, said Duke is creating an environment where this kind of work can happen.

“I, as an organizer of this, didn’t know about half of these projects today!” Curtis said. “There’s so much going on at an organic level that the challenge to us is to identify what’s going on and figure out how to go forward at scale.”

Post by Karl Leif Bates

Game-Changing App Explores Conservation’s Future

By Karl Bates

On February 22, 2018

In Biology, Climate/Global Change, Computers/Technology, Data, Environment/Sustainability, Lecture

In the first week of February, students, experts and conservationists from across the country were brought together for the second annual Duke Blueprint symposium. Focused around the theme of “Nature and Progress,” this conference hoped to harness the power of diversity and interdisciplinary collaboration to develop solutions to some of the world’s most pressing environmental challenges.

Scott Loarie spoke at Duke’s Mary Duke Biddle Trent Semans Center.

One of the most exciting parts of this symposium’s first night was without a doubt its all-star cast of keynote speakers. The experiences and advice each of these researchers had to offer were far too diverse for any single blog post to capture, but one particularly interesting presentation (full video below) was that of National Geographic fellow Scott Loarie—co-director of the game-changing iNaturalist app.

iNat, as Loarie explained, is a collaborative citizen scientist network with aspirations of developing a comprehensive mapping of all terrestrial life. Any time they go outside, users of this app can photograph and upload pictures of any wildlife they encounter. A network of scientists and experts from around the world then helps the users identify their finds, generating data points on an interactive, user-generated map of various species’ ranges.

Simple, right? Multiply that by 500,000 users worldwide, though, and it’s easy to see why researchers like Loarie are excited by the possibilities an app like this can offer. The software first went live in 2008, and since then its user base has roughly doubled each year. This has meant the generation of over 8 million data points of 150,000 different species, including one-third of all known vertebrate species and 40% of all known species of mammal. Every day, the app catalogues around 15 new species.

“We’re slowly ticking away at the tree of life,” Loarie said.

Through iNaturalist, researchers are able to analyze and connect to data in ways never before thought possible. Changes to environments and species’ distributions can be observed or modeled in real time and with unheard-of collaborative opportunities.

To demonstrate the power of this connectedness, Loarie recalled one instance of a citizen scientist in Vietnam who took a picture of a snail. This species had never been captured, never been photographed, hadn’t been observed in over a century. One of iNat’s users recognized it anyway. How? He’d seen it in one of the journals from Captain James Cook’s 18^th-century voyage to circumnavigate the globe.

It’s this kind of interconnectivity that demonstrates not just the potential of apps like iNaturalist, but also the power of collaboration and the possibilities symposia like Duke Blueprint offer. Bridging gaps, tearing down boundaries, building up bonds—these are the heart of conservationism’s future. Nature and Progress, working together, pulling us forward into a brighter world.

Post by Daniel Egitto

Panic in the Poster Session!

By Karl Bates

On November 28, 2017

In Art, Biology, Science Communication & Education, Students, Visualization

For their recent retreat, Regeneration Next tried something a little different for the time-honored poster session.

Rather than simply un-tubing that poster they took to the American Association of Whatever a few months ago, presenters were asked to DRAW their poster fresh and hot on a plain sheet of white paper in 15 minutes, using nothing more than an idea and a couple of markers.

Concerns were shared, shall we say, with the leadership of the regenerative medicine initiative when the rules were announced.

“People are always nervous about something they haven’t tried before,” said Regeneration Next Executive Director Sharlini Sankaran. “There was a lot of anxiety about the new format and how they would explain their research without charts and graphs.”

There was palpable poster panic as the retreat moved to the wide open fifth floor of the Trent Semans Center in the late afternoon. Administrative coordinator Tiffany Casey had spread out a rainbow of brand-new sharpies and the moveable bulletin boards stood in neat, numbered ranks with plain white sheets of giant post-it paper.

After some nervous laughter and a few attempts at color-swapping, the trainees and junior faculty got down to drawing their science on the wobbly tackboards.

And then, it worked! It totally worked. “I think I saw a lot more interactivity and conversation,” Sankaran said.

A fist-full of colorful sharpies gave Valentina Cigliola a colorful launching point for some good conversations about spinal cord repair, rather than just standing there mutely while visitors read and read and read.

Louis-Jan Pilaz used the entire height of the giant post-it notes to draw a beautifully detailed neuron, with labeled parts explaining how the RNA-binding protein FMRP does some neat tricks during development of the cortex.

Delisa Clay’s schematics of fruitfly cells having too many chromosomes made it easier to explain. Well, that and maybe a glass of wine.

Jamie Garcia used her cell-by-cell familiarity with the zebrafish to make a bold, clear illustration of notochord development and the fish’s amazing powers of self-repair.

Don’t you think Lihua Wang’s schematic of experimental results is so much more clear than a bunch of panels of tiny text and bar charts?

In the post-retreat survey, Sankaran said people either absolutely loved the draw-your-poster or hated it, but the Love group was much larger.

“Those who hated it felt they couldn’t represent data accurately with hand-drawn charts and graphs,” Sankaran said. “Or that their artistic skills were ‘being judged’.”

A few folks also pointed out that the drawing approach might work against people with a disability of some sort – a concern Sankaran said they will try to address next time.

There WILL be a next time, she added. “I had a few trainees come up to me to say they weren’t sure how it was going to go, but then they said they had fun!”

Post and pix by Karl Leif Bates, whose hand-drawn poster on working with the news office contained no data and was largely ignored.

Duke’s Researchers Are 1 Percent of the Top 1 Percent

By Karl Bates

On November 28, 2017

In Behavior/Psychology, Business/Economics, Climate/Global Change, Data, Environment/Sustainability, Faculty, Medicine, Physics

This year’s listing of the world’s most-cited researchers is out from Clarivate Analytics, and Duke has 34 names on the list of 3,400 researchers from 21 fields of science and social science.

Having your publication cited in a paper written by other scientists is a sign that your work is significant and advances the field. The highly-cited list includes the top 1 percent of scientists cited by others in the years 2005 to 2015.

“Citations by other scientists are an acknowledgement that the work our faculty has published is significant to their fields,” said Vice Provost for Research Lawrence Carin. “In research, we often talk about ‘standing on the shoulders of giants,’ as a way to explain how one person’s work builds on another’s. For Duke to have so many of our people in the top 1 percent indicates that they are leading their fields and their work is indeed something upon which others can build.”

In addition to the Durham researchers, Duke-NUS, our medical school in Singapore, claims another 13 highly cited scientists.

The highly-cited scientists on the Durham campus are:

Barton Haynes

CLINICAL MEDICINE
Robert Califf
Christopher Granger
Kristin Newby
Christopher O’Connor
Erik Magnus Ohman
Manesh Patel
Michael Pencina
Eric Peterson

ECONOMICS AND BUSINESS
Dan Ariely
John Graham
Campbell Harvey

Drew Shindell

ENVIRONMENT/ECOLOGY
John Terborgh
Mark Wiesner

GEOSCIENCES
Drew Shindell

IMMUNOLOGY
Barton Haynes

MATHEMATICS
James Berger

Georgia Tomaras

MICROBIOLOGY
Bryan Cullen
Barton Haynes
David Montefiori
Georgia Tomaras

PHARMACOLOGY & TOXICOLOGY
Robert Lefkowitz

PHYSICS
David R. Smith

PLANT AND ANIMAL SCIENCE
Philip Benfey

Terrie Moffitt

PSYCHIATRY & PSYCHOLOGY
Angold, Adrian
Caspi, Avshalom
Copeland, William E
Costello, E J
Dawson, Geraldine
Keefe, Richard SE
McEvoy, Joseph P
Moffitt, Terrie E

SOCIAL SCIENCES (GENERAL)
Deverick Anderson
Kelly Brownell
Michael Pencina

If the Cancer Doesn't Kill You, the Drug Prices Might

By Karl Bates

On May 11, 2017

In Business/Economics, Cancer, Lecture, Medicine

The medical community is growing alarmed about a creeping malady that can diminish the quality of life for patients in treatment and even shorten their lives.

It’s found everywhere in the United States, but not to the same degree in other developed countries. They’re calling it “Financial Toxicity.”

Yousuf Zafar is an oncologist and health policy researcher.

A cancer diagnosis more than doubles an American’s chance of declaring bankruptcy, Duke medical oncologist Yousuf Zafar, MD, MHS, told an audience of nursing faculty and students at a May 10 luncheon lecture sponsored by the Duke Center for Community and Population Health Improvement. And that bankruptcy, in turn, has been shown to decrease survival rates.

In addition to treating cancer patients, Zafar studies access to care and the cost of care at the Duke Cancer Institute, the Sanford School of Public Policy, and the Margolis Center for Health Policy.

Zafar told personal stories of two patients who waved off treatments because of the financial hardship they feared.

Gleevec (Imatinib) is an oral chemotherapy made by Novartis.

One of them had a job with health insurance, but no prescription drug coverage, which put him on the hook for $4,000 in medications to treat his rectal cancer for just a few weeks. Had either the patient or Dr. Zafar brought the topic up, the costs might have been avoided, but they never talked about money, he said.

The other patient passed up another round of treatment for his pancreatic cancer, for fear of the bills his family would be saddled with when he died.

Chemotherapy for cancer would typically cost $100/month in the 1970s, Zafar said. But today that figure can be “ten, or tens, of thousands per month.” (Inflation would make that 1970 dollar about $6, not $600.)

“Pricing in the European Union and the rest of the world is a completely different picture,” he said. In the US, pricing “simply reflects what the market will bear.”

Another source of the steep climb is the advent of biologic drugs, which are expensive to develop, use and store, but offer more targeted therapy for individual patients. One of the most successful of these is Gleevec (Imatinib) an oral chemotherapy that became 158 percent more expensive from 2007 to 2014, Zafar said.

If you do a Google search for Gleevec, the first thing you find is a Novartis page with the headline “Understand Your Out-Of-Pocket Costs For Gleevec” that includes a link to financial assistance resources.

In the face of outrageous costs and questionable benefits, a treatment team in many cases can help patients find other means of support or alternative treatments to achieve the same end with less financial damage. But they have to have the conversation, Zafar said. He’d like to see Duke’s Cancer Center become the first in the country to be totally transparent about costs, but he acknowledged that it may be a difficult quest.

To help enable those conversations, Zafar developed a mobile app called Pathlight to help patients make more informed decisions and plan better for the financial burden of treatment. For some of the technology used in the project, Zafar has partnered with a software company called Vivor, which has found innovative ways to help patients navigate to financial assistance programs. That part of the project is supported by the NIH’s National Cancer Institute.

Even for people not in treatment, drugs have become more costly. Healthcare premiums rose 182 percent from 1999 to 2013, with workers paying an increasing share of the cost of their own employee health plans.

Is this any way to run a health system?

“I don’t have all the answers – I don’t think anybody does,” Zafar said. “But I think we need to move toward a single-payer system.”

Post by Karl Leif Bates

Venturing Out of the Lab to Defend Science

By Karl Bates

On March 2, 2017

In Guest Post, Science Communication & Education, Students

It’s 6 p.m. on a Wednesday and the grad students aren’t at their lab benches. IM softball doesn’t start till next week, what gives?

We’ve snuck out of our labs a bit early to take in a dose of U.S. policy for the evening.

Politics fall far outside our normal areas of expertise. I’m a biology Ph.D. student studying plants — even with my liberal arts education, politics isn’t my bread and butter.

Buz Waitzkin of Science & Society (blue shirt) gave grad students a highly accelerated intro to matters of science policy.

But the current political climate in the U.S. has many scientists taking a more careful look into politics. Being scholars who have a sense of the world around us has become more important than ever.

“Agency regulation, funding, it’s all decided by our branches of government,” says Ceri Weber, a 3^rd year Ph.D. candidate in Cell Biology.

Weber, a budding “sci-pol” enthusiast and the general programming chair for the student group INSPIRE, feels passionately about getting scientists informed about policy.

So she organized this event for graduate scientists to talk with the deputy director of Duke Science & Society, Buz Waitzkin, who previously served as special counsel to President Bill Clinton, and now teaches science policy classes cross-listed between Duke’s Biomedical Science programs and the Law School.

Seated with food and drinks—the way to any grad student’s heart—we found ourselves settling in for an open discussion about the current administration and the impact its policies could have on science.

We covered a lot of ground in our 2-hour discussion, though there was plenty more we would love to continue learning.

We discussed: lobbying, executive orders, the balances of power, historical context, tradition, and civil actions, to name a few.

There were a lot of questions, and a lot of things we didn’t know.

Even things as simple as “what exactly is a regulation?” needed to be cleared up. We’ve got our own definition in a biological context, but regulation takes on a whole new meaning in a political one. It was neat having the chance to approach this topic from the place of a beginner.

We were floored by some of the things we learned, and puzzled by others. Importantly, we found some interesting places of kinship between science and policy.

When we discussed the Congressional Review Act, which impacts regulations—the main way science policy is implemented—we learned there is ambiguity in law just like there is in science.

One area on all of our minds was how we fit into the picture. Where can our efforts and knowledge as scientists and students can make a difference?

I was shocked to learn of the lack of scientists in government: only five ever in Congress, and three in the Cabinet.

But luckily, there is space for us as science advisors in different affiliations with the government. There are even Duke graduate students working on a grant to develop science policy fellowships in the NC state legislature.

At the end of the night, we were all eager to learn more and encouraged to participate in politics in the ways that we can. We want to be well-versed in policy and take on an active role to bring about change in our communities and beyond.

Hopefully, as the years go on, we’ll have more opportunities to deepen our knowledge outside of science in the world around us. Hopefully, we’ll have more scientists who dare to step out of the lab.

Guest Post by Graduate Student Ariana Eily