Male Brain Author Brizendine on Sex, Love, Why Men Cheat.

Despite all that old talk about Mars and Venus, men and women are much more biologically alike than not. But differences in the way our brains are built shed light on everything from the way we flirt to the way we fight to how we raise our boys, says neuropsychiatrist Dr. Louann Brizendine in her provocative new book, The Male Brain. The author talked to TIME about sex, the daddy brain and why some men may be built to cheat.

You immediately address the stereotype that guys have one-track, sex-crazed minds. Biologically speaking, is it true?
I think that’s probably more emblematic of the female experience of the male than what’s actually going on in the male brain. Certainly the male brain is seeking and looking for sex. But it is also very much seeking and looking for partnership and for choosing “the one.”

You say the “area for sexual pursuit” is 2.5 times larger in the male brain than in the female brain. Do you worry that people will read that and decide your book confirms the stereotype?
I think there is a kernel of truth in stereotypes. But [understanding human biology] doesn’t give males a pass on being civilized or any parent a pass on having to train their sons.

You write that sex and love are linked. How?
The sexual circuitry releases huge amounts of dopamine. The reward system in the brain basically gets triggered during sex and orgasm and then feeds back on the rest of the brain, making it want to do that again and again — and wanting to seek out the person that you’re having that lovely experience with again and again. So at some point, the love circuits and the sex circuits get gradually bound together. The sexual part of that experience gets more and more attached to that [particular] female, and gradually merges with that circuitry and identifies that person as “the one.” Not all men get that, as we know, but the majority of men do.

In humans they have identified, so far, about 17 different lengths of [the vasopressin receptor gene]. There are several studies that have shown that those males with the longer version are more likely to be married, and their wives are more likely to say they have a happy, successful marriage and there hasn’t been any infidelity. The ones with the shorter ones are more likely to be bachelors.

Doesn’t suggesting that a propensity to cheat is hard-wired in some guys give unfaithful husbands the perfect excuse?
I don’t think it lets you escape responsibility, but I think it lets one honor that underlying impulse and then realize why it’s so important to have all the religious and social principles that we’re raised with. No matter what [a boy’s] genes are, we need to be laying out good role models for how one behaves in one’s life. I feel very strongly: this is not an excuse for men to behave badly. But it is something to help men have a deeper insight into themselves, and women to have a deeper insight into men.

This type of interaction goes on lots and lots between the couples that come to my office: she just wants him to talk to her about how she’s feeling about something before he launches into giving her the solution. And he feels like, well, what good will it do just to wallow in the feelings? I think one of the things that women don’t focus on or appreciate is that our men really want to make us happy. He’s the fix-it man. He really does want to be our hero, and that’s how he expresses his love.

What happens when a guy is becoming a father?
The hormone testosterone is going down and the hormone prolactin is going up in the male brain, because he is smelling the pheromones of his pregnant wife. Prolactin is the hormone in females that makes breast milk. We don’t know what it’s doing in males yet. We assume it has something to do with making the daddy-brain circuits. By the time the baby is born, he’s able to hear infant cries much better. So something about his auditory-perceptual system has actually changed. His sex drive has gone down along with his testosterone. Therefore his brain is being primed to be a caretaker. If he doesn’t get some alone time [after birth] with the baby, however, the daddy brain won’t develop fully.

You think both men and women have deep misunderstandings of what drives the opposite sex. What are the biggest?
I think the biggest is that all men want is sex. The equivalent for women is that we are all emotional, and all we want is commitment.

Pressure To Publish Leads To Shoddy Science And Bad Medicine.

Competition for scarce funding and tenure may be prompting some scientists to cut corners.

A surprising medical finding caught the eye of NPR’s veteran science correspondent Richard Harris in 2014. A scientist from the drug company Amgen had reviewed the results of 53 studies that were originally thought to be highly promising — findings likely to lead to important new drugs. But when the Amgen scientist tried to replicate those promising results, in most cases he couldn’t.

“He tried to reproduce them all,” Harris tells Morning Edition host David Greene. “And of those 53, he found he could only reproduce six.”

That was “a real eye-opener,” says Harris, whose new book Rigor Mortis: How Sloppy Science Creates Worthless Cures, Crushes Hope, and Wastes Billions explores the ways even some talented scientists go wrong — pushed by tight funding, competition and other constraints to move too quickly and sloppily to produce useful results.

“A lot of what everybody has reported about medical research in the last few years is actually wrong,” Harris says. “It seemed right at the time but has not stood up to the test of time.”

The impact of weak biomedical research can be especially devastating, Harris learned, as he talked to doctors and patients. And some prominent scientists he interviewed told him they agree that it’s time to recognize the dysfunction in the system and fix it.


Tom Murphy was a healthy rugby player diagnosed with ALS in his 50s. …. With his doctor’s help he signs up for an experimental treatment with a drug called dexpramipexole, or “Dex.” At first, he’s very hopeful, and it seems to be helping him, but they run the tests and figure out that it actually doesn’t work. In fact none of the ALS drugs work. I focus on Tom Murphy because he’s a victim of the system here — of these failures.

What happened in the case of ALS was there were at least a dozen drugs that had been tried in a handful of small studies — way too small — of animals. And they all seemed to have some sort of promise — some of them went into very large clinical trials. We spent tens of millions of dollars developing these drugs, and they all failed. There’s a group in Cambridge, Mass. — the ALS Therapy Development Institute — that went back and reviewed all these studies and realized all the initial studies were wrong. They used very few mice. They weren’t thinking enough about the different genetics of the mice. And a lot of other problems. … This therapy institute came away thinking none of these drug candidates were really realistic.

On the ways the scientific enterprise in Charles Darwin’s time was very different

Darwin was very interesting. It took him decades to come up with his theory of evolution and he was not in a hurry — he was studying barnacles, he was studying birds, all sorts of things. He felt no pressure to publish until somebody came up with a similar idea, and he decided, ‘Hmmm … maybe I do want to be first. …” But we’re not in that world anymore. Things are very competitive, very fast-paced. So the competitive world of biomedicine is shaping this problem of evidence that can’t be replicated a lot.

On why the delight that’s long been an intrinsic part of science can disappear over time — and why that’s bad

I think a lot of people go into science out of a sense of wonder. But … as time goes on, people feel the career pressures, and they realize it isn’t just about exploring and having big ideas. They have to have research that helps them progress toward their first job, toward tenure, then the next grant, and so on. Those pressures are different from just, sort of, exploring and understanding fundamental biology…. And the less you’re focusing on delight, the less maybe you’re aiming at the truth and the more you are, inadvertently, often aiming at other goals — career goals, financial goals and so on. This may give you a fruitful life as an individual, but may produce less value to us as a society.

On how the public should respond when they hear of a big biomedical advance

I think it is good to question it. Every time you hear something like this, just remember, it’s all contingent — here is one study, and it may not stand the test of time. I think that’s healthy. … When scientists read the scientific literature, they realize, “Oh, probably half of this is wrong.” It’s just, not knowing which half — that’s the vexing part.

On the risk that pointing out flaws in science will make people question its value

It’s always uncomfortable to point out problems, but it’s also essential. I mean, we are taxpayers — we are citizens, and we support this enterprise and we expect to reap its rewards. If it’s not operating at full steam … and not doing everything right, it’s worth pointing that out and saying, “No. Think about this. Let’s make it better.” Many prominent scientists agree with me and are concerned about this — and are thinking hard about how to make things better, from the top of NIH on down. There are solutions, and I talk about them in my book.

On why the Trump administration’s proposed cuts to NIH funding wouldn’t make things better

It’s a very appealing idea, obviously, to say, “Oh, well, let’s just identify the waste and root it out.” But that’s not the way science works. … If you cut the [$30 billion] budgetof the National Institutes of Health, you’re going to shrink that already very small pool of money even smaller, and you’re going to increase the competitive pressures. You’re going to increase all these perverse incentives that put us in this position to begin with. So I think that would actually be devastating to biomedical research.


Smoking causes one in ten deaths globally, major new study reveals.

Efforts to control tobacco have paid off, says study, but warns tobacco epidemic is far from over, with 6.4m deaths attributed to smoking in 2015 alone

 Students wearing masks with no smoking signs attend an anti-smoking lecture in Fuyang, China. More than a million deaths a year in China are from smoking related diseases.
Students wearing masks with no smoking signs attend an anti-smoking lecture in Fuyang, China. More than a million deaths a year in China are from smoking related diseases. 

One in 10 deaths around the world is caused by smoking, according to a major new study that shows the tobacco epidemic is far from over and that the threat to lives is spreading across the globe.

There were nearly one billion smokers in 2015, in spite of tobacco control policies having been adopted by many countries. That number is expected to rise as the world’s population expands. One in every four men is a smoker and one in 20 women. Their lives are likely to be cut short – smoking is the second biggest risk factor for early death and disability after high blood pressure.

The researchers found there were 6.4m deaths attributed to smoking in 2015, of which half were in just four populous countries – China, India, USA, and Russia.

Major efforts to control tobacco have paid off, according to the study published by the Lancet medical journal. A World Health Organisation treaty in 2005 ratified by 180 countries recommends measures including smoking bans in public places, high taxes in cigarettes and curbs on advertising and marketing.

Between 1990 and 2015, smoking prevalence dropped from 35% to 25% among men and 8% to 5% among women. High income countries and Latin America – especially Brazil which brought in tough curbs on tobacco – achieved the biggest drops in numbers of smokers.

But many countries have made marginal progress since the treaty was agreed, say the authors of the study from the Institute of Health Metrics and Evaluation at the University of Washington in the US. And although far more men smoke than women, there have been bigger reductions in the proportions of men smoking also, with minimal changes among women.

Senior author Dr Emmanuela Gakidou said there were 933m daily smokers in 2015, which she called “a very shocking number”. The paper focused only on those who smoke every day. “The toll of tobacco is likely to be much larger if we include occasional smokers and former smokers and people who use other tobacco products like smokeless tobacco. This is on the low end of how important tobacco is,” she told the Guardian.

There is much more that needs to be done, she said. “There is a widespread notion that the war on tobacco has been won but I think our evidence shows that we need renewed and sustained efforts because the toll of smoking in 2015 is much larger than most people would think, so we absolutely have a lot more to do. We need new and improved strategies to do it and a lot of effort and political will.”

Traditionally there have been far fewer women smoking around the world than men, but it was a huge problem for both, she said.

“There are some really worrisome findings – for example in Russia female smoking has increased in the last 25 years significantly. There are also some western European countries where about one in three women are smoking. So it is true globally that a lot fewer women smoke than men but there are some countries where it is a big problem for women,” she said.

Dr Kelly Henning of Bloomberg Philanthropies, which is committed to tobacco control and co-funded the study with the Bill and Melinda Gates Foundation, said: “I think the study highlights the fact that the work is not finished on tobacco. The good news is the decline in daily smoking among men and women … however there are still many smokers in the world and there is still a lot of work to do. I think we have to keep our eye on the issue and really do more.”

Countries with some of the highest death tolls such as China and Indonesia “really don’t need those health problems – they have so many other issues they are trying to address. But tobacco control is critically important in those places,” she said.

“China has more than a million deaths a year from smoking related diseases and China is only beginning to see the effects of their high male smoking rate. That is only one instance of what is expected to become an extremely major epidemic,” she said.

Writing in a linked comment, Professor John Britton from the University of Nottingham said: “Responsibility for this global health disaster lies mainly with the transnational tobacco companies, which clearly hold the value of human life in very different regard to most of the rest of humanity.” British American Tobacco, for instance, sold 665bn cigarettes in 2015 and made a £5.2bn profit.

“Today, the smoking epidemic is being exported from the rich world to low-income and middle-income countries, slipping under the radar while apparently more immediate priorities occupy and absorb scarce available human and financial resources,” he writes. “The epidemic of tobacco deaths will progress inexorably throughout the world until and unless tobacco control is recognised as an immediate priority for development, investment, and research.”


Machine learning predicts the look of stem cells.

 No two stem cells are identical, even if they are genetic clones. This stunning diversity is revealed today in an enormous publicly available online catalogue of 3D stem cell images. The visuals were produced using deep learning analyses and cell lines altered with the gene-editing tool CRISPR. And soon the portal will allow researchers to predict variations in cell layouts that may foreshadow cancer and other diseases.

The Allen Cell Explorer, produced by the Allen Institute for Cell Science in Seattle, Washington, includes a growing library of more than 6,000 pictures of induced pluripotent stem cells (iPS) — key components of which glow thanks to fluorescent markers that highlight specific genes.

The Cell Explorer complements ongoing projects by several groups that chart the uniqueness of single cells at the level of DNA, RNA and proteins. Rick Horwitz, director of the Allen Institute for Cell Science, says that the institute’s images may hasten progress in stem cell research, cancer research and drug development by revealing unexpected aspects of cellular structure. “You can’t predict the outcome of a football game if you know stats on all the players but have never watched a game.”

Looking skin deep

The project began about a year ago with adult skin cells that had been reprogrammed into an embryonic-like, undifferentiated state. Horwitz and his team then used CRISPR–Cas9 to insert tags in genes to make structures within the cells glow. The genes included those that code for proteins that highlight actin filaments, which help cells to move and maintain their shape. It quickly became clear that the cells, which were all genetic clones from the same parent cell, varied in the placement, shape and number of their components, such as mitochondria and actin fibres.

Computer scientists analysed thousands of the images using deep learning programs and found relationships between the locations of cellular structures. They then used that information to predict where the structures might be when the program was given just a couple of clues, such as the position of the nucleus. The program ‘learned’ by comparing its predictions to actual cells.

The deep learning algorithms are similar to those that companies use to predict people’s preferences, Horwitz says. “If you buy a chainsaw at Amazon, it might then show you chain oil and plaid shirts.”

The 3D interactive tool based on this deep learning capability should go live later this year. At the moment, the site shows a preview of how it will work using side-by-side comparisons of predicted and actual images.

Benjamin Freedman, a cell biologist at the University of Washington in Seattle, looks forward to playing with the Cell Explorer’s predictive function once the Allen Institute team has taught their algorithm to recognize more iPS cells that have been changed genetically or chemically. For example, Freedman says he could delete a gene related to kidney disease in one of the fluorescently tagged stem cells from the Allen Institute and see how the mutation affects the glowing structure. Then he could use the site’s modelling tool to determine how other cellular components might be altered. “Ultimately,” Freedman says, “we want to understand processes at the cellular level that cause disease in the kidney as a whole.”

Filling in the holes

In the coming months, Allen Institute researchers will update the site with images of stem cells at different stages of cell division, and as they transform into distinct cell types, such as heart and kidney cells. Catching cells at different time points can be crucial to identifying fundamental processes, says Horwitz.

Structural differences in the DNA (purple) and cellular membrane (blue) of genetically identical stem cells.

The Allen Institute’s visual emphasis on stem cells dovetails with a number of efforts to catalogue other aspects of cells. For example, the London-based charity Cancer Research UK is creating interactive virtual-reality models of breast cancer cells in tumours. And an international effort called the Human Cell Atlas seeks to define all human cell types in terms of their molecular profiles, including DNA sequences, RNA transcripts and proteins.

Aviv Regev, a computational biologist at the Broad Institute in Cambridge, Massachusetts, who is working on the Human Cell Atlas, says that the Allen Cell Explorer complements her project by focusing on the look of cellular features as opposed to how genes, RNA and proteins interact within the cell. “The community is accepting that there are a lot of differences between cells that we thought were the same until recently,” she says, “so now we’re taking an unbiased approach to learn about pieces in the puzzle we didn’t know existed before.”


Train Your Brain To Let Go Of Habits – 10 Methods For Creating New Neural Pathways

When you understand how neural pathways are created in the brain, you get a front row seat for truly comprehending how to let go of habits. Neural pathways are like superhighways of nerve cells that transmit messages. You travel over the superhighway many times, and the pathway becomes more and more solid. You may go to a specific food or cigarettes for comfort over and over, and that forms a brain pathway. The hopeful fact, however, is that the brain is always changing and you can forge new pathways and create new habits. That’s called the neuroplasticity of the brain.

I used to drive with one foot on the brake and the other on the accelerator, and I wanted to train myself to drive with one foot only. It took some time, as I had a strong neural pathway for two-footed driving. But because I had the will to do it, I built a new pathway, and I rewired or reprogrammed my brain. You can remove a behavior or thought or addictions directly from the brain.

Because of neuroplasticity, the brain’s ever-changing potentials, anything is possible. People who’ve had strokes can retrain their brains to function again by building new pathways. Smokers and overeaters and many others can learn new behaviors and attitudes and can transform their lives.

Whether you work with others on their habits or you work with your own (or both), you can apply these understandings to boost your success.

Some Powerful Ways to Retrain the Brain

1. Identity the habit you’d like to transform and set the intention.

You may remember the punch line “The light bulb has to want to change.”  You have to have a high intention to change as well. If there is this high intention, then creating new pathways in your brain is bound to happen.

 2. Observe what the old habit or pathway is doing in your life.

Look at feelings, thoughts, and how the body is responding to the habit, and see what results you’re creating in your life. Be the witness, and  be aware.

3. Shift your focus.

This is very important. To create a new neural pathway, you take the focus off the old habit, and then that old habit eventually falls away. Don’t pay attention to the donuts and cakes. Take your awareness and focus it on good, wholesome, healthy delicious foods.

4. Use your imagination.

You can build new neural pathways not only with new behaviors, but through the imagination. Just imagine the new behaviors over and over and over. Keep repeating that in your mind so you build new pathways. Focus your mind and retrain your brain.

5. Interrupt your thoughts and patterns when they arise.

Say “no” or “cancel” when an old thought or impulse comes in, and say, “I don’t have to do that anymore.” Then turn toward the new neural pathway you’re building and keep on going in the right direction.

6. Use aversion therapy.

This isn’t everyone’s cup of tea. It’s an optional path. I like to call it “the maggots on the chocolate cake technique.” I used to love candies and sweets, and when I stopped eating them, I still had to pass by them when I walked by the candy store in town. I used aversion to train my brain to walk on by: “That’s junk,” I said to myself. “It’s made in factories, sickeningly sweet, makes me feel bad. The company makes it so sweet just to addict buyers. I don’t want any of that.” So I talk myself out of it. I’ve use it with many clients (only those who say they want it) on smoking, junk food, cocaine and many other behaviors.

7.  Create a specific plan and choose what to do instead.

When you get specific, it’s easier to build new neural pathways. You “make it official.”  Decide if you want to exercise instead of overeating or if you want to eat fruit instead of candy. Just keep focused on the new choice.  You may want to create affirmations and anchors to reinforce your choices. This can be “I’m free or “I’m in control.” Reinforce this with energy therapies like EFT or other techniques.

8. Transform the obstacles.

Look at what’s in the way. Look at secondary gain – what you’ve been getting out of the old habits or pathways. Look at the stress in your life and how you can handle it differently. Get your mind in the place of possibility. Handle the emotions and thoughts and get on a new superhighway in your mind.

9. Connect with your Higher Source for inspiration and support.

Listen to our guidance. Know you have the Force within you, and therefore you have great power. Meditation creates new pathways and brain changes. Actual studies have been done on the brains of monks to show meditation’s effect on neural circuits of the brain.

10. Transform and make the shift.

Know that transformation is always possible and that you can create new brain pathways whenever you’re ready to make the shift. When you keep your mind in the “I can do it!” space, you get a clear sense that you’re done with the old and on a new beam now.

 Some people feel we’re being rewired spiritually for anew era. There’s great upheaval now in our world. And there’s a process of transformation happening on earth in which huge changes are taking place for all of humanity. You have to be present in the moment, overcome your fears, and get to know the Infinite source so you can be a vehicle for the light to predominate on the earth.

Empaths Are The Best MIND Detectives – 10 Reasons Why You Shouldn’t Be Messing Around An Empath

Drinking wine is like burpees for your brain.

Next time your brain needs a challenge, skip the Sudoku and grab some wine.

Enjoying a glass of wine makes the grey matter in our brains work harder than it would any other human activity — like listening to music or solving a math problem — according to Gordon Shepherd, a neurologist at the Yale School of Medicine.

In his new book, “Neuroenology: How The Brain Creates The Taste of Wine,” Shepherd states that smelling and drinking wine engages our entire brain and requires “exquisite control of one of the biggest muscles in the body.”

Shepherd explains that wine molecules don’t actually have any flavor, and it’s our brains that create the sensation that we perceive as taste. The process is similar to how our brains see color.

Wine molecules stimulate thousands of our mouth’s taste and odor receptors, which create both a sensory and emotional reaction in our brain. All these signals spark different cognitive areas — including memory, pattern recognition and pleasure — which work together to deliver the wine’s “taste.”

“The taste is not in the wine; the taste is created by the brain of the wine taster” Shepherd writes. Factors including age, gender, the genetic makeup of our saliva and whether or not we’re depressed can also impact how we taste wine.

But tiny sips are key to a full-brain workout. Too big a gulp and “you’ve saturated your system,” Shepherd told NPR. But he also writes that spitting your sip out prevents you from fulling appreciating the flavor.

So, sip slowly and often – doctor’s orders.


Reena Aggarwal: What does the failure of AHCA mean for women’s healthcare? 

Despite the AHCA failing, plans to defund Planned Parenthood in the US will damage women’s healthcare choices, says Reena Aggarwal

reena_aggarwalThe Affordable Care Act (ACA) was a game changer for women’s health. Prior to the ACA, 1 in 6 Americans were uninsured—non pregnant women were twice as likely to be uninsured compared to pregnant women, and 25% of women of reproductive age were uninsured at some point over the course of one year. [1,2] The ACA expanded federal funding to increase Medicaid eligibility which  resulted in 20 million previously uninsured individuals gaining coverage, and women of reproductive age who did not have health insurance dropping by a third. [3]

During the Republican Party’s recent failed attempt to “repeal and replace” the ACA, women’s healthcare came under fire. One element of the ACA was the requirement that all insurers cover an array of ten “essential health benefits” which spanned maternity care and preventive services (vaccinations, screening, and contraceptive coverage) at no extra cost. In order to make the American Health Care Act (AHCA) more palatable to the House Freedom Caucus (a group of strict fiscal Conservatives in the Republican Party), these essential benefits were taken away to allow individual states to decide what counted as “essential.” It is worth remembering that prior to ACA, the majority of insurers either had no maternity benefit, or it was prohibitively expensive (high deductibles and co-pays). If a woman became unexpectedly pregnant and discovered her plan did not cover maternity, and then tried to change plans, pregnancy would be a considered a pre-existing condition and she could therefore be denied coverage. Adding a maternity benefit to all health insurance policies prevented discrimination and also prevented women paying more for health insurance. Without health insurance, childbirth can cost anything up to $20,000 in the USA, but whilst the maternity benefit has raised premiums overall, it made childbirth affordable for millions of families. However, now that President Trump has said he will allow “Obamacare to explode” due to the instability of insurance markets, there is legitimate concern that with no federal oversight private insurers may remove essential benefits from their plans, which could leave millions of women without maternity coverage.

Additionally, in an effort to appease the pro-life agenda of more Conservative Republicans, the AHCA had proposed defunding Planned Parenthood by removing federal funding. From the creation of Margaret Sanger’s birth control organization in 1916, Planned Parenthood has grown into a global not for profit organization providing comprehensive family planning and related reproductive health services. It has received federal funding since 1970 when President Nixon wrote that, “no American woman should be denied access to family planning assistance because of her economic condition” and brought into being the Title X Family Planning Program with broad bipartisan support. The purpose was to ensure all people, not just the wealthy, could plan their families. The 1976 Hyde Amendment banned federal funding for abortions, so despite receiving Title X funding and being reimbursed by Medicaid for providing services, Planned Parenthood cannot use these funds to pay for abortions. Opponents of abortion attest that by allocating money to Planned Parenthood for the provision of other medical services allows other funds from philanthropic organizations to be re-allocated for abortions.

The Congressional Budget Office (CBO) predicted that by removing federal funding from Planned Parenthood about 15% of women in low income areas would lose care by affecting “services that help women avert pregnancies” and the additional births “stemming from the reduced access” would add to federal Medicaid spending. This is because Planned Parenthood is the sole source of publicly funded contraceptive care in the United States offering comprehensive methods including more expensive (but reliable) long acting reversible contraception (LARCs), alongside STI testing, mammograms and cancer screening. Abortion care accounts for only 3% of services. Many of their clients are young, immigrant, low income women whose only source of care are their services as clinics often operate medically underserved areas making it the “safety net” for marginalized women. [4]

President Trump blamed the House Freedom Caucus (vehemently pro-life) for helping to save Planned Parenthood by opposing the AHCA. At the end of April, the US government faces an expiration of their spending bill to fund federal government and in order to pass a new resolution, calls to deny federal funding to Planned Parenthood may become a non-negotiable condition. President Trump needs the funding bill to pass as many of his policies hinge upon this—for example, increasing defence spending and funds to build a border wall between Mexico and the United States. Despite failing to pass AHCA, last week, Vice President Pence cast a tie-breaking senate vote to pass legislation allowing states to withhold federal funds from Planned Parenthood and other providers performing abortions.

By resuscitating these measures, women covered by Medicaid will no longer be able to choose Planned Parenthood clinics for their care. Unless alternative services are provided, this would be catastrophic for women’s reproductive choices and health needs. The US abortion rate has declined 14% between 2011-14 and in 2014 was at the lowest rate since 1973 when abortion was legalized. This is attributed to education and contraception coverage. [5] Without publicly funded family planning care, it is predicted that US teen pregnancies could be 73% higher than they are now. [6] Some commentators have suggested that women look for other providers or even move states. Lest we forget restriction of contraception and abortion services in Romania led to one of the highest maternal mortality rates in Europe.

Removing federal funding from Planned Parenthood doesn’t prevent abortions—it hurts women’s choices by denying them access to affordable contraception or screening services. Removing maternity care from the essential health benefits in insurance policies means it will cost women more to have coverage. Both of these are unconscionable. Sean Spicer, suggested “men and women beyond maternity age and young people paying for end of life care” did not make “sense.” This exposes a lack of understanding about health insurance and the role of essential health benefits. Despite AHCA failing, there is a very real danger that the hostility toward abortion will roll the clock back to the discriminatory policies before the ACA was implemented, and make it harder for women to prevent an unintended pregnancy (already 1 in 2 pregnancies is unplanned), have care throughout their pregnancy, and maintain their health needs. President Trump once espoused that his healthcare plans would cover “everyone”—let’s hope he remembers to do just that for the 50.8% of the American population who are women.

Reena Aggarwal is a specialist registrar in Obstetrics and Gynaecology and a research fellow at Ariadne Labs in Boston. Twitter @drraggarwal

Competing interests: None declared. 

  1. Institute of Medicine. America’s Uninsured Crisis: Consequences for Health and Health Care. Washington DC; 2009.
  2. Kozhimannil KB, Abraham JM, Virnig BA. National Trends in Health Insurance Coverage of Pregnant and Reproductive-Age Women, 2000 to 2009. Women’s Heal Issues. 2012;22(2):e135-e141. doi:10.1016/j.whi.2011.12.002.
  3. Gold RB, Starrs AM. US reproductive health and rights: beyond the global gag rule. Lancet Public Heal. 2017;2(3):e122-e123. doi:10.1016/S2468-2667(17)30035-X.
  4. Understanding Planned Parenthood’s Critical Role in the Nation’s Family Planning Safety Net | Guttmacher Institute.
  5. Behind the Declines. Guttmacher Policy Rev. 2017;20.
  6. Teen Pregnancy | Guttmacher Institute. Accessed March 31, 2017.


Evolocumab and Clinical Outcomes in Patients with Cardiovascular Disease.


Evolocumab is a monoclonal antibody that inhibits proprotein convertase subtilisin–kexin type 9 (PCSK9) and lowers low-density lipoprotein (LDL) cholesterol levels by approximately 60%. Whether it prevents cardiovascular events is uncertain.


We conducted a randomized, double-blind, placebo-controlled trial involving 27,564 patients with atherosclerotic cardiovascular disease and LDL cholesterol levels of 70 mg per deciliter (1.8 mmol per liter) or higher who were receiving statin therapy. Patients were randomly assigned to receive evolocumab (either 140 mg every 2 weeks or 420 mg monthly) or matching placebo as subcutaneous injections. The primary efficacy end point was the composite of cardiovascular death, myocardial infarction, stroke, hospitalization for unstable angina, or coronary revascularization. The key secondary efficacy end point was the composite of cardiovascular death, myocardial infarction, or stroke. The median duration of follow-up was 2.2 years.


At 48 weeks, the least-squares mean percentage reduction in LDL cholesterol levels with evolocumab, as compared with placebo, was 59%, from a median baseline value of 92 mg per deciliter (2.4 mmol per liter) to 30 mg per deciliter (0.78 mmol per liter) (P<0.001). Relative to placebo, evolocumab treatment significantly reduced the risk of the primary end point (1344 patients [9.8%] vs. 1563 patients [11.3%]; hazard ratio, 0.85; 95% confidence interval [CI], 0.79 to 0.92; P<0.001) and the key secondary end point (816 [5.9%] vs. 1013 [7.4%]; hazard ratio, 0.80; 95% CI, 0.73 to 0.88; P<0.001). The results were consistent across key subgroups, including the subgroup of patients in the lowest quartile for baseline LDL cholesterol levels (median, 74 mg per deciliter [1.9 mmol per liter]). There was no significant difference between the study groups with regard to adverse events (including new-onset diabetes and neurocognitive events), with the exception of injection-site reactions, which were more common with evolocumab (2.1% vs. 1.6%).


In our trial, inhibition of PCSK9 with evolocumab on a background of statin therapy lowered LDL cholesterol levels to a median of 30 mg per deciliter (0.78 mmol per liter) and reduced the risk of cardiovascular events. These findings show that patients with atherosclerotic cardiovascular disease benefit from lowering of LDL cholesterol levels below current targets.

Inside knowledge: Is information the only thing that exists?

Physics suggests information is more fundamental than matter, energy, space and time – the problems start when we try to work out what that means


“IT FROM bit.” This phrase, coined by physicist John Wheeler, encapsulates what a lot of physicists have come to believe: that tangible physical reality, the “it”, is ultimately made from information, or bits.

Concepts such as entropy in thermodynamics, a measure of disorder whose irresistible rise seems to characterise our universe, have long been known to be connected with information. More recently, some efforts to unify general relativity, the theory that describes space and time, with quantum mechanics, the theory that describes particles and matter, have homed in on information as a common language.

Inside knowledge: The biggest questions about facts, truth, lies and belief

Forget alternative facts. To get to the bottom of what we know and how we know we know it, delve into our special report on epistemology – the science of knowledge itself

But what is this information? Is it “ontological” – a real thing from which space, time and matter emerge, just as an atom emerges from fundamental particles such as electrons and quarks and gluons? Or is it “epistemic” – something that just represents our state of knowledge about reality?

Here opinions are divided. Cosmologist Paul Davies argues in the book Information and the Nature of Reality that information “occupies the ontological basement”. In other words, it is not about something, it is itself something. Sean Carroll at the California Institute of Technology in Pasadena disagrees. Even if all of reality emerges from information, he says, this information is just knowledge about the universe’s basic quantum state.

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So we have to drill deeper. In quantum mechanics, an object’s state is encoded.

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