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Personalized cancer treatments based on testing drugs quickly leads to faster treatment, better outcomes

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theconversation.com – Diana Azzam, Assistant Professor of Environmental Health Sciences, Florida International University – 2024-04-11 05:00:30
Identifying the most effective cancer treatment for a given patient from the get-go can help improve outcomes.
Leslie Lauren/iStock via Getty Images Plus

Diana Azzam, Florida International University

Despite many efforts to find better, more effective ways to treat cancer, it remains a leading cause of death by disease among children in the U.S.

Cancer patients are also getting younger. Cancer diagnoses among those under 50 has risen by about 80% worldwide over the past 30 years. As of 2023, cancer is the second-leading cause of death both in the U.S. and around the world. While death rates from cancer have decreased over the past few decades, about 1 in 3 patients in the U.S. and 1 in 2 patients worldwide still die from cancer.

Despite advances in standard cancer treatments, many cancer patients still face uncertain outcomes when these treatments prove ineffective. Depending on the stage and location of the cancer and the patient's medical history, most cancer types are treated with a mix of radiation, surgery and . But if those standard treatments fail, patients and enter a trial-and-error maze where effective treatments become difficult to predict because of limited information on the patient's cancer.

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My mission as a cancer researcher is to build a personalized guide of the most effective drugs for every cancer patient. My team and I do this by testing different medications on a patient's own cancer cells before administering treatment, tailoring therapies that are most likely to selectively kill tumors while minimizing toxic effects.

In our newly published results of the first clinical trial combining drug sensitivity testing with DNA testing to identify effective treatments in children with cancer, an approach called functional precision medicine, we found this approach can help match patients with more FDA-approved treatment options and significantly improve outcomes.

What is functional precision medicine?

Even though two people with the same cancer might get the same medicine, they can have very different outcomes. Because each patient's tumor is unique, it can be challenging to know which treatment works best.

To solve this problem, doctors analyze DNA mutations in the patient's tumor, blood or saliva to match cancer medicines to patients. This approach is called precision medicine. However, the relationship between cancer DNA and how effective medicines will be against them is very complex. Matching medications to patients based on a single mutation overlooks other genetic and nongenetic mechanisms that influence how cells respond to drugs.

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Functional precision medicine involves testing drugs on tumor samples to see which ones work best.

How to best match medicines to patients through DNA is still a major . Overall, only 10% of cancer patients experience a clinical benefit from treatments to tumor DNA mutations.

Functional precision medicine takes a different approach to personalizing treatments. My team and I take a sample of a patient's cancer cells from a biopsy, grow the cells in the lab and expose them to over 100 drugs approved by the Food and Drug Administration. In this , called drug sensitivity testing, we look for the medications that kill the cancer cells.

New clinical trial results

Providing functional precision medicine to cancer patients in real life is very challenging. Off-label use of drugs and financial restrictions are key barriers. The health of cancer patients can also deteriorate rapidly, and physicians may be hesitant to try new methods.

But this is starting to change. Two teams in Europe recently showed that functional precision medicine could match effective treatments to about 55% of adult patients with blood cancers such as leukemia and lymphoma that did not respond to standard treatments.

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Most recently, my team's clinical trial focused on childhood cancer patients whose cancer came back or didn't respond to treatment. We applied our functional precision medicine approach to 25 patients with different types of cancer.

Child's hand with IV placed in wrist holding hand of person wearing white coat, both hovering over a stethoscope on a bed
Researchers are testing a functional precision medicine approach to cancer treatment in both children and adults.
Pornpak Khunatorn/iStock via Getty Images Plus

Our trial showed that we could provide treatment options for almost all patients in less than two weeks. My colleague Arlet Maria Acanda de la Rocha was instrumental in helping return drug sensitivity data to patients as fast as possible. We were able to provide test results within 10 days of receiving a sample, with the roughly 30 days that standard genomic testing results that focus on identifying specific cancer mutations typically take to process.

Most importantly, our study showed that 83% of cancer patients who received treatments guided by our approach had clinical benefit, improved response and survival.

Expanding into the real world

Functional precision medicine new paths to understanding how cancer drugs can be better matched to patients. Although doctors can read any patient's DNA , interpreting the results to understand how a patient will respond to cancer treatment is much more challenging. Combining drug sensitivity testing with DNA analysis can help personalize cancer treatments for each patient.

I, along with colleague Noah E. Berlow, have started to add artificial intelligence to our functional precision medicine program. AI enables us to analyze each patient's data to better match them with tailored treatments and drug combinations. AI also allows us to understand the complex relationships between DNA mutations within tumors and how different treatments will affect them.

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My team and I have started two clinical trials to expand the results of our previous studies on providing treatment recommendations through functional precision medicine. We're recruiting a larger cohort of adults and children with cancers that have back or are resistant to treatment.

The more data we have, the easier it will become to understand how to best treat cancer and ultimately help more patients access personalized cancer treatments.The Conversation

Diana Azzam, Assistant Professor of Environmental Health Sciences, Florida International University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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The Conversation

US participation in space has benefits at home and abroad − reaping them all will require collaboration

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theconversation.com – Cheyenne Black, Graduate Research Assistant in the Institute for Public Policy Research and Analysis, University of Oklahoma – 2024-05-22 07:24:32

“Cosmic cliffs” in the Carina nebula, captured by the James Webb Space Telescope.

NASA, ESA, CSA, STScI

Cheyenne Black, University of Oklahoma

When people think about what we get from the U.S. space program, it may be along the lines of NASA technology spin-offs such as freeze-dried food and emergency space blankets.

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But space activities do much more that benefits on Earth. Research in space helps scientists study our , develop new technologies, create , grow the economy and foster international collaboration.

Of course, with reports of Russia developing an anti-satellite nuclear weapon, members of and the have focused their attention on space defense and military readiness.

This is critical, but there are still many other benefits to reap from space. Getting the most out of U.S. space involvement will require collaborating across various social, environmental, commercial, governmental, international and technological backgrounds.

As a space policy scholar focused on private-public partnerships, networks and coalitions, I've seen that policymakers can get the most out of U.S. space endeavors if they invite a wide array of experts into policy discussions.

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Benefits on Earth

NASA satellites play a crucial role in documenting changes in global temperatures, sea-level rise, arctic ice extent and air quality. Satellites have also been collecting data for almost 50 years to monitor water use, crop health and crop production. These long-term observations help researchers track environmental changes across the globe.

Space research provides a wide array of technologies in addition to rockets and Moon landers. Cellphone cameras, CAT scanners, the computer mouse, laptops, wireless headsets and purification are just a few public goods NASA has generated.

These spin-off technologies come from NASA's partnerships with private firms, which subsequently make scientific discoveries widely available and accessible.

Growing the space economy

Experts predict that the space sector will continue driving the development of nonspace industries. Agriculture, energy, mining, transportation and pharmaceuticals are just some of the sectors that benefit through spin-off technologies and space-based research.

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For example, scientists can conduct experiments on the International Space Station using the microgravity of space to study the chemistry of drugs, improve medications and test cancer treatments.

More organizations and individuals than ever share a vested interest in the space sector's success. Experts anticipate the global space economy – the resources used in space for activities – and research and will continue to grow to a market of US$1.4 trillion by 2030.

Commercialization policies opened U.S. space activities to the private sector. This has led to partnerships with companies, such as SpaceX, Blue Origin and others, that are growing the space economy.

These companies have increasingly launched rockets and deployed satellites in recent years. This has increased the need for workers, both in manufacturing positions and specialized STEM roles. Additionally, private companies and universities are partnering to develop various technologies, such as landing systems for a U.S. return to the Moon.

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A cylindrical rocket emitting a plume of flame launches upwards in a haze of smoke.

SpaceX's Starship rocket launched in March 2024. More commercial companies, like SpaceX, have partnered with NASA in recent years.

AP Photo/Eric Gay

Communities that host space industry centers have seen economic and educational benefits. For example, Huntsville, Alabama, home of the Marshall Space Flight Center and the U.S. Space and Rocket Center, has attracted an educated workforce with one of the highest rates of engineers per capita. Almost half of residents over the age of 25 in Huntsville have a bachelor's degree or higher.

An aerial view of three buildings.

The Marshall Space Flight Center in Huntsville, Ala.

NASA

This rate starkly contrasts with the national average, where 37% have at least a bachelor's degree, and the state's 27% average. Additionally, Huntsville's annual median household income is $8,000 higher than the Alabama average.

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Since 1982, Huntsville has also hosted over 750,000 students at the U.S. Space and Rocket Center space camp. This camp educates students about science, technology, engineering and leadership to prepare them for a potential future STEM career.

International collaboration

Space also provides an opportunity for the U.S. to collaborate with other countries.

For example, the U.S. works jointly with Italy to observe the impacts of air quality on human health. The James Webb Space Telescope, a result of partnerships between NASA, the European Space Agency and the Canadian Space Agency, allows scientists to peer into previously unobserved parts of the cosmos. International collaboration has also established the Artemis Accords, a set of principles agreed to by 40 countries for peaceful, sustainable and transparent cooperation in space.

Getting the most out of space

Right now, U.S. space policymaking occurs at the federal and international level. And while people outside of the can act as witnesses during congressional hearings or through advocacy groups, that involvement may not be enough to represent the wide spectrum of viewpoints and interests in space policy.

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There are a few ways policymakers can receive input from different stakeholders. These might include inviting more experts from various policy areas to recommendations in congressional hearings, collaborating with advocacy coalitions to create sustainable policies, strengthening and expanding private-public partnerships, and setting a space agenda that emphasizes research and development.The Conversation

Cheyenne Black, Graduate Research Assistant in the Institute for Public Policy Research and Analysis, University of Oklahoma

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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TikTok law threatening a ban if the app isn’t sold raises First Amendment concerns

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theconversation.com – Anupam Chander, Professor of and Technology, Georgetown – 2024-05-21 07:25:32

TikTok users worry about losing their social media platform, but First Amendment rights are on the line, too.

AP Photo/Ted Shaffrey

Anupam Chander, Georgetown University and Gautam Hans, Cornell University

TikTok, the short- company with Chinese roots, did the most American thing possible on May 7, 2024: It sued the U.S. government, in the person of Merrick Garland, in federal court. The suit claims the federal law that took effect on April 24, 2024, banning TikTok unless it sells itself violates the U.S. Constitution.

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The law names TikTok and its parent company, ByteDance Ltd., specifically. It also applies to other applications and websites reaching more than a million monthly users that allow people to share information and that have ownership of 20% or more from China, Russia, Iran or North Korea. If the president determines that such applications or websites “present a significant threat to the national security,” then those apps and websites, too, must either be sold or banned from the U.S.

TikTok's suit says that the law violates the First Amendment by failing to evidence of the national security threat posed by the app and for failing to seek a less restrictive remedy. Despite legislators' claims to the contrary, the law forcing the divestiture of TikTok – the Protecting Americans from Foreign Adversary Controlled Applications Act – implicates First Amendment interests. In our view, it does so in ways that ripple beyond this specific case.

As a company incorporated in the United States that provides an online publishing platform, TikTok has a right protected by the First Amendment to select what messages – in this case, user – it chooses to publish.

A ban appears to us, scholars who study law and technology, to be a massive prior restraint, which is generally barred by U.S. courts. Prior restraint is action by the to prevent speech, typically some form of publication, before it occurs.

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The First Amendment limits what the government can do to censor speech.

Speech in the crosshairs

The law's backers say that it is not a ban – all TikTok has to do is sell itself. These supporters describe the bill as a divestiture, a purely economic regulation that they say should insulate it from First Amendment . After the sale, users could happily keep on using TikTok, not caring who owns the company. But the law seems to us an attempt to control speech by mandating a change in ownership.

Changing the speech content on the app is the express goal of some of the law's backers. The principal author of the bill, former U.S. Rep. Mike Gallagher, who stepped down from office in April to join a venture capital firm partly backed by Microsoft, explained to The New York Times that he was principally concerned about the potential for the Chinese Communist Party to spread propaganda on the app. The Times and The Wall Street Journal have reported that Congress passed this bill in part because of unsubstantiated accusations that TikTok was unfairly promoting one side in the Israel-Hamas war.

Imagine if the government told Jeff Bezos that he had to sell The Washington Post because it was worried that he might push a particular agenda using his control of the newspaper. Or to use a digital analogy, what if the government told Elon Musk that he had to sell X, formerly Twitter, because it didn't like his content moderation of legal speech? Those scenarios clearly have a connection to First Amendment protections.

Ownership matters

Transferring TikTok's ownership from one company to another matters greatly for the purposes of First Amendment analysis.

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Supreme Court Justice Elena Kagan observed during oral arguments in a case unrelated to TikTok's ownership that ownership can make a difference in an app. She noted that the sale of Twitter to Elon Musk changed the character of the app. Kagan said, “Twitter users one day woke up and found themselves to be X users and the content rules had changed and their feeds changed, and all of a sudden they were getting a different online newspaper, so to speak, in a metaphorical sense every morning.”

Indeed, The Washington Post found a rightward tilt after Twitter changed hands.

By forcing the sale of TikTok to an entity without ties to the Chinese Communist Party, Congress' intent with the law is to change the nature of the platform. That kind of government action implicates the core concerns that the First Amendment was designed to protect against: government interference in the speech of private parties.

U.S. Rep. Raja Krishnamoorthi, co-sponsor of the House bill on TikTok, pointed to another instance where the U.S. government ordered a Chinese company to sell a U.S. app. In 2019, the Committee on Foreign Investment in the United States ordered the new Chinese owners of Grindr to sell the dating app, which the Chinese owners did the year. In that case, the foreign owners could not assert First Amendment rights in the United States, given that they were outside the U.S., and thus no court considered this issue.

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TikTok is First Amendment protection against the law forcing its sale or ban.

National security claims

The government hasn't disclosed to the public the national security concerns cited in the TikTok law. While such concerns, if accurate, might warrant some kind of intervention, some Americans are likely to decline to take claims of national security urgency on good faith. To address skepticism of secret government power, particularly when it involves speech rights, the government arguably needs to present its claims.

U.S. Sens. Richard Blumenthal and Marsha Blackburn, both of whom supported the TikTok law and have seen the government's secret evidence, called for the declassification of that information. We believe that's a vital step for the public to properly consider the government's claim that a ban is warranted in this instance. In any case, the courts will ultimately weigh the secret evidence in determining whether the government's national security concerns justified this intrusion upon speech.

What seems likely to happen, absent judicial invalidation or legislative repeal of the law, is a world in which TikTok cannot effectively operate in the United States in a year's time, with mobile app stores unable to push out updates to the software and Oracle Corp. unable to continue hosting the app and its U.S. user data on its servers. TikTok could go dark on Jan. 19, 2025, in the United States.The Conversation

Anupam Chander, Professor of Law and Technology, Georgetown University and Gautam Hans, Associate Clinical Professor of Law, Cornell University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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AI chatbots are intruding into online communities where people are trying to connect with other humans

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theconversation.com – Casey Fiesler, Associate Professor of Information Science, of Colorado Boulder – 2024-05-20 07:27:05
AI chatbots are butting into human spaces.
gmast3r/iStock via Getty Images

Casey Fiesler, University of Colorado Boulder

A parent asked a question in a private Facebook group in April 2024: Does anyone with a child who is both gifted and disabled have any experience with New York public schools? The parent received a seemingly helpful answer that laid out some characteristics of a specific school, beginning with the context that “I have a child who is also 2e,” meaning twice exceptional.

On a Facebook group for swapping unwanted items near Boston, a user looking for specific items received an offer of a “gently used” Canon camera and an “almost-new portable air conditioning unit that I never ended up using.”

Both of these responses were lies. That child does not exist and neither do the camera or air conditioner. The answers came from an artificial intelligence chatbot.

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According to a Meta help page, Meta AI will respond to a post in a group if someone explicitly tags it or if someone “asks a question in a post and no one responds within an hour.” The feature is not yet available in all regions or for all groups, according to the page. For groups where it is available, “admins can turn it off and back on at any time.”

Meta AI has also been integrated into search features on Facebook and Instagram, and users cannot turn it off.

As a researcher who studies both online communities and AI ethics, I find the idea of uninvited chatbots answering questions in Facebook groups to be dystopian for a number of reasons, starting with the fact that online communities are for people.

Human connections

In 1993, Howard Rheingold published the book “The Virtual Community: Homesteading on the Electronic Frontier” about the WELL, an early and culturally significant online community. The first chapter opens with a parenting question: What to do about a “blood-bloated thing sucking on our baby's scalp.”

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Rheingold received an answer from someone with firsthand knowledge of dealing with ticks and had resolved the problem before receiving a callback from the pediatrician's office. Of this experience, he wrote, “What amazed me wasn't just the speed with which we obtained precisely the information we needed to know, right when we needed to know it. It was also the immense inner sense of security that comes with discovering that real people – most of them parents, some of them nurses, , and midwives – are available, around the clock, if you need them.”

This “real people” aspect of online communities continues to be critical today. Imagine why you might pose a question to a Facebook group rather than a search engine: because you want an answer from someone with real, lived experience or you want the human response that your question might elicit – sympathy, outrage, commiseration – or both.

Decades of research suggests that the human component of online communities is what makes them so valuable for both information-seeking and social . For example, fathers who might otherwise feel uncomfortable asking for parenting advice have found a haven in private online spaces just for dads. LGBTQ+ youth often join online communities to safely find critical resources while reducing feelings of isolation. Mental health support forums provide young people with belonging and validation in addition to advice and social support.

Online communities are well-documented places of support for LGBTQ+ people.

In addition to similar findings in my own lab related to LGBTQ+ participants in online communities, as well as Black Twitter, two more recent studies, not yet peer-reviewed, have emphasized the importance of the human aspects of information-seeking in online communities.

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One, led by PhD student Blakeley Payne, focuses on fat people's experiences online. Many of our participants found a lifeline in access to an audience and community with similar experiences as they sought and shared information about topics such as navigating hostile , finding clothing and dealing with cultural biases and stereotypes.

Another, led by Ph.D student Faye Kollig, found that people who share content online about their chronic illnesses are motivated by the sense of community that comes with shared experiences, as well as the humanizing aspects of connecting with others to both seek and provide support and information.

Faux people

The most important benefits of these online spaces as described by our participants could be drastically undermined by responses coming from chatbots instead of people.

As a type 1 diabetic, I follow a number of related Facebook groups that are frequented by many parents newly navigating the challenges of caring for a young child with diabetes. Questions are frequent: “What does this mean?” “How should I handle this?” “What are your experiences with this?” Answers come from firsthand experience, but they also typically come with compassion: “This is hard.” “You're doing your best.” And of course: “We've all been there.”

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A response from a chatbot to speak from the lived experience of caring for a diabetic child, offering empathy, would not only be inappropriate, but it would be borderline cruel.

However, it makes complete sense that these are the types of responses that a chatbot would offer. Large language models, simplistically, function more similarly to autocomplete than they do to search engines. For a model trained on the millions and millions of posts and comments in Facebook groups, the “autocomplete” answer to a question in a support community is definitely one that invokes personal experience and offers empathy – just as the “autocomplete” answer in a Buy Nothing Facebook group might be to offer someone a gently used camera.

Meta has rolled out an AI assistant across its social media and messaging apps.

Keeping chatbots in their lanes

This isn't to suggest that chatbots aren't useful for anything – they may even be quite useful in some online communities, in some contexts. The problem is that in the midst of the current generative AI rush, there is a tendency to think that chatbots can and should do everything.

There are plenty of downsides to using large language models as information retrieval systems, and these downsides point to inappropriate contexts for their use. One downside is when incorrect information could be dangerous: an eating disorder helpline or legal advice for small businesses, for example.

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Research is pointing to important considerations in how and when to design and deploy chatbots. For example, one recently published paper at a large human-computer interaction conference found that though LGBTQ+ individuals lacking social support were sometimes turning to chatbots for with mental health needs, those chatbots frequently fell short in grasping the nuance of LGBTQ+-specific challenges.

Another found that though a group of autistic participants found value in interacting with a chatbot for social communication advice, that chatbot was also dispensing questionable advice. And yet another found that though a chatbot was helpful as a preconsultation tool in a health context, sometimes found expressions of empathy to be insincere or offensive.

Responsible AI and deployment means not only auditing for issues such as bias and misinformation, but also taking the time to understand in which contexts AI is appropriate and desirable for the humans who will be interacting with them. Right now, many companies are wielding generative AI as a hammer, and as a result, everything looks like a nail.

Many contexts, such as online support communities, are best left to humans.The Conversation

Casey Fiesler, Associate Professor of Information Science, University of Colorado Boulder

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This article is republished from The Conversation under a Creative Commons license. Read the original article.

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