Google search results for abortion services promote anti-abortion centers

When users seek facilities for the procedure, Google Maps often presents crisis pregnancy centers that discourage abortions

Google search results for abortion services promote anti-abortion centers

When users seek facilities for the procedure, Google Maps often presents crisis pregnancy centers that discourage abortions

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Silicon Valley Startup Grail Sees Hope for Cancer Blood Test

The quest for a simple blood test to catch cancer early has attracted heavy hitters from Bill Gates to Merck & Co. Now there’s a glimpse of evidence that it can work, at least for one type of malignancy.

A study led by Hong Kong-based researchers and published this week in the New England Journal of Medicine used DNA fragments in the blood to detect a kind of head and neck cancer called nasopharyngeal carcinoma. The procedure, known as a “liquid biopsy,” caught the cancer earlier and more accurately than existing methods — and ultimately boosted patients’ chances of survival.

The results could help the commercial prospects for Grail Inc., a closely held Silicon Valley startup that has raised more than $1.1 billion since its 2016 founding from investors including billionaires Gates and Jeff Bezos, as well as Merck and China’s Tencent Holdings Ltd. Dennis Lo, one of the study’s main authors and a professor in Hong Kong, is also the co-founder of a biotech company called Cirina, which agreed to merge with Grail in May.

Dennis Lo

Photographer: Anthony Kwan/Bloomberg

The rise of technologies like genetic sequencing have spurred hopes that new, non-invasive tests could revolutionize cancer care. Detecting the disease early can make treatment dramatically more effective, and investors have been eager to fund ventures focused on such preventative health care.

“It’s our aspiration to create a commercial test” for nasopharyngeal carcinoma, said Grail’s president, Ken Drazan, in a phone interview. If successful, the test, to be marketed in Southeast Asia, would be Grail’s first product.

Viral DNA

Dozens of companies have worked to develop or sell some form of liquid biopsy test, according to a 2015 report from Piper Jaffray. But most have been focused on tests for patients who have already been diagnosed.

The dream of a non-invasive cancer-detecting test is based on findings that tumors are constantly shedding fragments of DNA into the bloodstream. While blood tests are already marketed to track a tumor’s mutation after it’s been diagnosed, detecting early-stage cancer is trickier, partly because the cancerous DNA is shed in much smaller amounts.

Nasopharyngeal carcinoma provided a proof-of-concept experiment for the team of researchers, which included Allen Chan, Rossa Chiu and Lo from the Li Ka Shing Institute of Health Sciences of the Chinese University of Hong Kong. All three are co-founders of Cirina.

The cancer, which is prevalent in southern China and Southeast Asia, arises from a confluence of factors: besides genetic mutations, it’s also associated with consumption of salted fish and smoking, as well as infection with the Epstein-Barr virus, which is a member of the herpes virus family.

Managing Costs

Though scientists still don’t fully understand how the Epstein-Barr virus gives rise to nasopharyngeal carcinoma, all patients who have the disease are found to also carry the virus, according to Grail’s head of clinical development, Mark Lee. The converse is not true: many people are infected with the Epstein-Barr virus without developing nasopharyngeal carcinoma. In that case, the virus will only be transiently found in the blood.

Over 20,000 people were tested for the DNA of Epstein–Barr virus, and 300 patients who tested positive twice were given in-depth examinations such as magnetic resonance imaging, or MRI, which led to 34 cancer diagnoses.

A laboratory in Hong Kong.

Photographer: Anthony Kwan/Bloomberg

In the study, 70 percent of the diagnoses found the cancer in early stages, Lo said, adding that nasopharyngeal carcinoma typically goes undetected until later on, when patients report symptoms such as recurring nosebleeds.

The two blood tests cost a total of about $60. The researchers estimated that, given the rarity of the disease, to detect a single case, 593 participants would need to be screened at a cost of $28,600, including more endoscopies and MRI scans to confirm the diagnosis. Considering the potential to lower late-stage cancer treatment costs and decrease mortality, such screening could be worthwhile, the researchers wrote.

The data presented "suggest that lives have been saved because of this screening,” Richard Ambinder, a professor of oncology at Johns Hopkins School of Medicine who wasn’t involved in the study, wrote in an accompanying editorial in the journal.

Other Cancers

Before bringing any test to market, Grail would need to show extremely low rates of both false positives and false negatives — the former could lead to unnecessary treatment, while the latter could give patients a mistaken sense of security.

Cancers that are related to viral infections are relatively easy and cheap to detect in human plasma using this method because viral DNA is very different from human DNA, Lo said. Other cancers will be more challenging, however, because cancer-causing mutations can be very small and may vary from patient to patient, he said.

Lo has expertise in a related area. In 1997, he discovered that fetal DNA can be isolated from the mother’s blood plasma for analysis. That spawned a widely used non-invasive prenatal test.

Grail is conducting two clinical trials, together aiming to enroll up to 130,000 people, according to its website. The first study seeks to map out how the genetic information of cancer differs from non-cancerous biology, and the second one will test a blood exam for early detection of breast cancer.

Lo’s university has licensed its cancer-related intellectual property to Cirina, giving the combined companies a very strong portfolio, Lo said.

“With the merger, in one go, we basically have a global presence looking at problems that are of major health-care impact,” he said.

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    The AI Doctor Orders More Tests

    Few U.S. industries are growing as fast as health care, but the big public-cloud companies—, Microsoft, Google—have struggled to crack the $3.2 trillion market. Even as hospitals and insurers collect mountains of health data on individual Americans, most of their spending on extra data storage is for old-school systems on their own premises, according to researcher IDC.

    The public-cloud kingpins are trying to lure health-care providers with artificially intelligent cloud services that can act like doctors. The companies are testing, and in some cases marketing, AI software that automates mundane tasks including data entry; consulting work like patient management and referrals; and even the diagnostic elements of highly skilled fields such as pathology.

    Amazon Web Services, the dominant cloud provider, is processing and storing genomics data for biotech companies and clinical labs. No. 2 Microsoft’s cloud unit plans to store DNA records, and its Healthcare Next system provides automated data entry and certain cancer treatment recommendations to doctors based on visible symptoms. Google seems to be betting most heavily on health-care analysis as a way to differentiate its third-place cloud offerings. Gregory Moore, vice president for health care, says he’s readying Google Cloud for a world of “diagnostics as a service.” In this world, AI could always be on hand to give doctors better information—or replace them altogether.

    The cloud division is refining its genomics data analysis and working to make Google Glass, the augmented-reality headgear that consumers didn’t want, a product more useful to doctors. German cancer specialist Alacris Theranostics GmbH leans on Google infrastructure to pair patients with drug therapies, something Google hopes more companies will do. “Health-care systems are ready,” says Moore, an engineer and former radiologist. “People are seeing the potential of being able to manage data at scale.”

    In November, Google researchers showed off an AI system that scanned images of eyes to spot signs of diabetic retinopathy, which causes vision loss among people with high sugar levels. Another group of the company’s researchers in March said they had used similar software to scan lymph nodes. They said they’d identified breast cancer from a set of 400 images with 89 percent accuracy, a better record than most pathologists. Last year the University of Colorado at Denver moved its health research lab’s data to Google’s cloud to support studies on genetics, maternal health, and the effect of legalized marijuana on the number and severity of injuries to young men. Michael Ames, the university’s project director, says he expects eventually to halve the cost of processing some 6 million patient records.

    However impressive Google’s AI analysis gets, the health-care industry isn’t exactly a gaggle of early adopters, says James Wang, an analyst at ARK Investment Management LLC. “They can have the lowest error rate and the greatest algorithm, but getting it into a hospital is a whole other problem,” he says. Most electronic medical records are likely to remain “locked inside” health companies for the foreseeable future, says Robert Mittendorff, a biotech investor at Norwest Venture Partners. Indeed, Google’s first major effort in the industry, an online health records service, folded in 2011 because the company couldn’t convince potential customers their data would be safe.

    Moore says things have changed since then and that he’s working with Stanford and the Broad Institute, plus about a dozen companies in the health-care industry and defense contractor Northrop Grumman Corp. For now, his primary focus is wrangling more health-care companies onto Google’s cloud, because the more data he can get on Google’s servers, the faster its AI systems will learn. “There literally have to be thousands of algorithms to even come close to replicating what a radiologist can do on a given day,” he says. “It’s not going to be all solved tomorrow.”

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      2016: The Year Facebook Became The Bad Guy

      This year has revealed how difficult it is for the social network to make the world more open and connected when the decisions it makes can be so divisive

      Mark Zuckerberg started 2016 with a cookie cutter message of hope. As the world faces new challenges and opportunities, may we all find the courage to keep making progress and making all our days count, he wrote on his Facebook wall on 1 January. He and his wife, Priscilla Chan, had just had their daughter, Max, and had been sharing warm and fuzzy photos of gingerbread houses and their dreadlocked dog Beast over the holiday season.

      Then 2016 happened. As the year unfurled, Facebook had to deal with a string of controversies and blunders, not limited to: being accused of imperialism in India, censorship of historical photos, and livestreaming footage of human rights violations. Not to mention misreported advertising metrics and the increasingly desperate cloning of rival Snapchats core features. Things came to a head in November, when the social network was accused ofinfluencing the US presidential election through politically polarized filter bubbles and a failure to tackle the spread of misinformation. The icing on the already unpalatable cake was Pope Francis last week declaring that fake news is a mortal sin.

      This was Facebooks annus horribilis. Mark Zuckerberg must long for the day when his biggest dilemma was deciding which grey T-shirt to wear on his first day back at work.

      It wasnt all bad. None of these controversies made a dent on the bottom line; Facebook had a bumper year for advertising revenue, and the $3bn investment to tackle all diseases (no big deal) through the Chan Zuckerberg Initiative was well received.

      But this year has revealed how difficult it has become for the social network to stand behind its mission to make the world more open and connected when the decisions it makes can be so divisive.

      Unprecedented power

      Thanks to its 1.79bn users and how much it knows about them, Facebook rakes in billions in advertising. In the first three quarters of this year, the company made almost $6bn in profit a big jump from a mere $3.69bn in 2015. They have perfected advertising in a way that makes it extremely enticing. Its so easy to place an ad and get immediate results, said media expert Gordon Borrell, whose analysis suggests that Facebook has taken $1bn away from print publications in the past year. For every new dollar spent by brands online, a whopping 85 cents goes to Facebook and Google at a time when traditional publishers are facing layoffs.

      Some believe Facebook has become too big to be regulated effectively.

      We dont have the right regulatory paradigm for these globe-striding technology giants, said Carl Miller, research director at the Centre for the Analysis of Social Media at the thinktank Demos. We treat them like neutral utility companies but they are value-maximising commercial entities.

      Facebook is a monopoly with too much power, argues author and activist Robert McChesney. When you get companies this big they are not just a threat to democracy, but they are also a threat to capitalism. They suck investment capital and profits away from smaller businesses and screw over the competitive sector.

      He has an extreme solution: if Facebook cant be regulated effectively, it should be nationalised to ensure it acts in the interest of the public.

      McChesney scoffs at the suggestion that Facebook is acting democratically by serving its many users. Thats self-serving garbage, he said.

      Does it not make a difference that Mark Zuckerberg is a principled CEO with good intentions? Not according to McChesney: I am sure the people who produced napalm thought they were doing a good service to protect the free world.

      Digital colonialism

      One of 2016s earliest missteps was Facebooks mishandling of Free Basics. The company pitched Free Basics as a way to give internet access, and all the wonderful benefits it can unlock, to the worlds poorest people. The catch: it wasnt real internet access, but a selection of apps and services curated by and always including Facebook. In February, the Indian government rejected Free Basics over its violation of the tenets of net neutrality following a public debate in which Facebook was accused of digital colonialism. It was an expensive and embarrassing blow for the social network and indicative that not everyone finds its brand of Silicon Valley techno-utopianism palatable. To compound the issue, Facebook board member Marc Andreessen reacted on Twitter with the tone-deaf and contemptuous line: Anti-colonialism has been economically catastrophic for the Indian people for decades. Why stop now?

      Nitin Pai, director of the Takshashila Institution, an Indian thinktank, and a critic of Free Basics, said: Facebook and Mark Zuckerberg must take a long, hard look at what are the values it wants to strengthen or weaken in this world … Unlike other multinational firms that merely sell goods and services to people across the globe, Facebook enables connections among them. It cannot take the usual, and usually untenable, we are apolitical route to international business.

      Facebook is a monopoly with too much power, some argue. Photograph: Sergei Konkov/TASS

      Indeed, so political are Facebooks global expansion plans that they are said to be working on a censorship tool that would allow them to operate in China once again.

      Censorship and accountability

      Censorship has been a running theme on Facebook in 2016. Despite insisting it is not a media company and is not in the business of making editorial judgments, Facebook, it seems, is all too happy to censor content when that content violates its own policies or at the request of police. This has led to a number of high-profile blunders in 2016, including the removal in September of the iconic Vietnam war photograph napalm girl from a Norwegian journalists post and the deletion of a breast cancer awareness video in October. In both cases, human moderators made bad judgment calls that the algorithm then enforced across the site to widespread criticism.

      In August, Facebook deactivated Korryn Gaines profile during an armed standoff with police at the request of the Baltimore County police department. Gaines, who was later killed by police, had been posting to the social network after barricading herself inside her apartment and aiming a shotgun at police. The incident highlighted the existence of an emergency request system that police can use to get Facebook to take content down without a court order if they think someone is at risk of harm or death.

      Elsewhere, Facebook suspended live footage from the Dakota Access pipeline protests and disabled Palestinian journalists accounts; there were also reports it had removed Black Lives Matter activists content.

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      Facebook to consider public interest before removal of posts violating guidelines

      Move comes after repeated criticism of Facebook from news organisations, charities and others over important posts being taken down without notice

      Facebook is finally going to consider whether or not posts are important to the public interest before removing them from the site for violating community guidelines, the social network has announced.

      Two vice presidents from the company, Joel Kaplan and Justin Osofsky, co-signed the announcement, which acknowledged that observing global standards for our community is complex.

      In the weeks ahead, were going to begin allowing more items that people find newsworthy, significant, or important to the public interest even if they might otherwise violate our standards, Kaplan and Osofsky wrote. We will work with our community and partners to explore exactly how to do this, both through new tools and approaches to enforcement. Our intent is to allow more images and stories without posing safety risks or showing graphic images to minors and others who do not want to see them.

      The move comes after repeated criticism of Facebook from news organisations, charities and others over important posts being taken down without notice or the chance to appeal. The company has faced such criticism for years, but the chorus has become particularly loud in the past two months, sparked by the removal of an article illustrated with the iconic Vietnam war photo featuring a naked girl after a napalm attack, when it was posted to the site by a Norwegian newspaper.

      After that picture was removed from the site, the papers writer was also suspended from Facebook, prompting its Editor-in-Chief to accuse Facebook boss Mark Zuckerberg of censorship.

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      Is it cancer? Diagnosing yourself online is about to get easier

      People often search for their symptoms, but the right diagnosis can be hard to find. Google and Microsoft are working on ways to improve things

      When Liz Jurcik of Seattle felt a sharp pain in her side and back in January of 2013, she didnt think much about it.

      Jurcik, a 31-year-old human resources professional at Boeing, ran regularly and was in good shape. She thought it was probably a strained muscle from a workout. But the pain got worse, and by early February she could barely stand up. I had the absolutely worst pain in my life, she said. I couldnt stand up straight.

      Like most people, Jurcik Googled her symptoms. She typed upper left abdominal pain into the search engine. I learned all about gall stones, and ulcers and gas pain, she said.

      It became so painful that she called her mother, a nurse, who urged her to go to the emergency room. She was eventually diagnosed with pancreatic cancer. My doctor said, the good news is youre going to be OK. The bad news is, youre going to die before you turn 38 if you dont have it taken out.

      Jurcik feels lucky she caught her cancer when she did. But she still feels that the online information she looked at did not serve her well. Nowhere in any of the literature did it say a tumor may have caused this.

      There is no shortage of health information available online. More than half of Americans look up health information on the internet, and more than a third try to diagnose themselves or others with it, according to the Pew Research Center. Yet studies have found that much of the information online is incorrect or out of date; Harvard researchers analyzed 23 online symptom checkers and found that they produced an accurate diagnosis as the first result just 34% of the time.

      Another problem is that it can be difficult for people without a healthcare background to distinguish between multiple conditions with similar symptoms. Because of this, tech companies including Microsoft and Google are looking for ways to improve the power of health search tools.

      Symptom search made better

      In June, Google announced it was partnering with Harvard Medical School and Mayo Clinic to launch a symptom search feature. Health content on the web can be difficult to navigate, and tends to lead people from mild symptoms to scary and unlikely conditions, which can cause unnecessary anxiety and stress, said Google product manager Veronica Pinchin in a statement. The symptom search feature will give you an overview description along with information on self-treatment options and what might warrant a doctors visit. Google creates its list of symptoms by looking for health conditions mentioned in web results, and then checking them against high-quality medical information weve collected from doctors.

      Microsoft researchers have been using search to test predictive algorithms. With millions of patients making many millions of health-related searches with similar terms, huge troves of powerful data are being created. Researchers are using these pools of big data to mine for information in search of new tools to help find ways to screen and identify disease and other health risks earlier.

      Its not uncommon for patients to jump to the conclusion that they have a life threatening illness from a common symptom. Eric Horvitz, technical fellow and managing director at Microsoft Research, calls this phenomenon cyberchondria. Humans generally have a poor ability to understand the probability of events, and websites are fairly poor at communicating them. To make things worse, search tends to push the scary rare disease higher and as a result youre much more likely to think you have a rare disease.

      Speaking from the International Conference on Machine Learning in New York, Horvitz explained that he wants search engines to realize when someone is using it as a diagnostic tool so that it can then, through probability, hone in on and explain the most moste likely conditions.

      Horvitz began his work at Stanford University as a medical student in the 1980s with a deep interest in the foundations of thinking. But his interest in nervous systems gave way to an interest in artificial intelligence. At Microsoft he uses computers to find patterns in data people unwittingly provide through search and other data sources, such aslarge-scaleelectronic health records.

      His latest study was inspired by loss. A close friend called him. He told me he had this weird itching all over his body, and that he had some yellow in his eyes, Horvitz said. Having studied medicine, Horvitz knew that thesecould be symptoms of pancreatic cancer, and told his friend to talk to a doctor about them. He was soon diagnosed with advanced pancreatic cancer.

      Horvitz began to think about how people tend to whisper all sorts of concerns into web searches. People dont talk about dark urine, or strange back pains, or losing weight for no reason in public, he said. If you had access to millions of search records can you use machine learning to identify patterns?

      He found that you can. In a study published in early June, Horvitz and his colleagues identified queries that provided strong evidence of a recent diagnosis of pancreatic cancer. They then used machine learning to identify searches by the same group months earlier by combining patterns of symptoms used in searches, and other information seen in the logs over time. They found they could predict significant fractions of those searchers with pancreatic cancer based on their earlier searches.

      These results suggest that predictive modeling may be able to help screen for diseases early enough to improve outcomes and not just for pancreatic cancer. Horvitz and his colleagues have also used search and social media data to identify pregnant women at risk of postpartum depression before they give birth, and to predict a likely stage of breast cancer.

      Russ Altman, a doctor and director of the Biomedical Informatics Training Program at Stanford, used big data to identify drug interactions among patients taking multiple drugs. One pair of drugs, a common statin and antidepressant, raised glucose levels high enough to cause a diagnosis of diabetes in some patients. Altman then teamed up with Horvitz and his colleagues who used search analysis to show that people were signaling symptoms of hyperglycemia through their web searches. There have since been discussions with the FDA about developing tools to monitor the internet for signs of multiple drug interactions.

      Privacy concerns

      Horvitz and Altman note that these studies are promising but exploratory, and that the methods need to be validated in clinical trials. And thats no small thing. Googles Flu Trends tool, introduced to wide acclaim in 2008, looked like a promising epidemiological method to predict the spread of seasonal influenza. But it failed to predict the spread of flu in 2013, and was discontinued.

      We should be thinking about how to bring this data to patients, says Altman. Horvitzs team is exploring how the technology can be usedto do valuablescreening while protecting users private health information. We could build filters or auto pattern recognizers from this large-scale anonymized data that feeds into apps for your smartphone that would work in complete privacy, Horvitz suggests.

      Such tools might eventually work in tandem with electronic medical records behind a secure wall, and incorporate the biological data people collect from their own personal health devices, like a Fitbit, to fine tune and personalize the analytical power. Perhaps by combining the data with that from electronic medical records, or genetic testing, this technology can learn more and more about an individual and provide targeted health information to each of us and our doctors. Or at least those of us who choose to opt in.

      There are very real privacy and ethical concerns. Lee Tien, an attorney for the Electronic Frontier Foundation, says that he is worried about personal biomedical data being opened up for this kind of research. Big data about rocks or stars or the moon is just ethically different from big data that comes from, and is thus about, people. The human, biographical aspect of data is effaced by just calling it data. He suggests we think carefully before weakening any privacy protections in search of an uncertain benefit.

      Its unethical to not do everything we can with our resources, Horvitz says. Altman agrees, I believe it would be a tragedy if the privacy people who are for putting everything in a lock box win. It would slow down medical discovery.

      Some tools are already in development. Prescription drug plans use big data to predict which patients are likely to skip medications and alert them when its time to take a pill. Hospitals are developing ways to predict which patients are most likely to be readmitted, to direct resources to prevent those poor outcomes. Epidemiologists are using social network data to track food born illnesses and other infections.

      Jurcik welcomes the pancreatic cancer finding. Now 35 and working in human resources at Providence Health and Services, she has become a volunteer for the Pancreatic Cancer Action Network to get the word out for early detection. She says because this cancer has many unrelated early symptoms, and strikes so quickly, any tool that helps people connect the dots earlier might be lifesaving.

      I dont think theres anything better to do as patients than to come in to the doctor knowing what questions to ask.

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