Scientific institutions continue to lag behind the #TimesUp movement

Scientific and medical institutions must fundamentally reconsider how they address sexual harassment in the workplace, three national leaders in gender equity in medicine argue in a Perspective published today in the New England Journal of Medicine.

The viewpoint comes in response to publication of a report by the National Academies of Science, Engineering and Medicine concluding that sexual harassment of women is common across scientific fields and has not abated despite concerns raised by the #TimesUp movement. It also comes amid fresh revelations of sexual misconduct by powerful men in business and entertainment.

The National Academies’ report made 15 key recommendations ranging from fostering a more respectful workforce to improving leadership to passing new laws.

“We really believe in the agenda laid out by the National Academies,” said lead author Esther Choo, M.D., M.P.H., associate professor of emergency medicine in the OHSU School of Medicine in Portland, Oregon. “However, we’re skeptical that medicine is determined to move forward. Institutions are very slow to take action and especially reluctant to act against harassers, particularly those who bring in research and other types of funding.”

The authors argue that the response from institutions has been inadequate to the scale of the problem.

Choo was joined by Jane van Dis, M.D., medical director for business development with the OB Hospitalist Group in Burbank, California; and Dara Kass, M.D., assistant professor of emergency medicine at the Columbia University Medical Center in New York.

They cite several major factors to overcome institutional resistance:

Myopia: Institutions focus on formal complaints, which address only the most egregious cases of overt sexual harassment. Yet there are many instances of sexual harassment that may not meet a threshold which individuals perceive as actionable but can be just as destructive. Sexual harassment encompasses objectification, exclusion or second-class status — that constrain women’s careers and compromise their physical and psychological health.

Money and Power: Academics are allowed to perpetuate sexual harassment for years because of their perceived value to the institution. Institutions should aim for consistent treatment of perpetrators, responding to complaints and taking action, regardless of the harasser’s position and power.

Organizational complicity: Organizations too readily view harassment as an individual problem rather than as a result of institutional permissiveness that enables harassment to happen in the first place.

“Correcting inequities in salary, career advancement and leadership positions requires more global fixes than even those who are deeply committed to eradicating sexual harassment in the workplace may be willing to consider,” they write.

Choo said she remains optimistic.

“We have an opportunity to rise to the challenge,” she said. “I think health care institutions will begin to recognize that providing safe and productive workplaces sets us up to provide the high-quality care our patients expect.”

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Materials provided by Oregon Health & Science University. Original written by Erik Robinson. Note: Content may be edited for style and length.

Mixed chemicals in beauty products may harm women’s hormones

As we go about our daily lives, we are exposed to many different chemicals that could have negative effects on our hormones. These hormonal changes have been linked to several adverse health outcomes such as breast cancer and cardiovascular disease. Therefore, understanding chemicals that influence hormone levels is important for public health — and particularly for women’s health — since their exposure to these chemicals is often higher due to their presence in beauty and personal care products.

A new study published in Environment International by George Mason University Assistant Professor of Global and Community Health Dr. Anna Pollack and colleagues discovered links between chemicals that are widely used in cosmetic and personal care products and changes in reproductive hormones.

A total of 509 urine samples were collected from 143 women aged 18 to 44 years, free of known chronic health conditions and birth control to be measured for environmental chemicals that are found in personal care products, such as parabens, which are antimicrobial preservatives, and benzophenones, which are ultraviolet filters.

“This study is the first to examine mixtures of chemicals that are widely used in personal care products in relation to hormones in healthy, reproductive-age women, using multiple measures of exposure across the menstrual cycle, which improved upon research that relied on one or two measures of chemicals,” Pollack noted.

This multi-chemical approach more closely reflects real world environmental exposures and shows that even low-level exposure to mixtures of chemicals may affect reproductive hormone levels. Another noteworthy finding of the study is that certain chemical and UV filters were associated with decreased reproductive hormones in multi-chemical exposures while others were associated with increases in other reproductive hormones, underscoring the complexities of these chemicals.

“What we should take away from this study is that we may need to be careful about the chemicals in the beauty and personal care products we use,” explains Pollack. “We have early indicators that chemicals such as parabens may increase estrogen levels. If this finding is confirmed by additional research, it could have implications for estrogen dependent diseases such as breast cancer.”

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Materials provided by George Mason University. Original written by Jiaxi Zhang. Note: Content may be edited for style and length.

An Allergist Explains Why You Might Have Itchy Skin All Over, Even Though You Don’t Have a Rash

As an allergist/immunologist, I see patients to help them diagnose and treat a variety of medical problems, ranging from allergies to lupus and other immune system disorders. Something that always surprises me in my job is how many of my patients are willing to “just live” with some of the symptoms they come to me with, like a seemingly basic rash or mild swelling from an allergic reaction. Even after living in discomfort for far longer than they should, it seems like they assume the symptom is pretty normal, so they don’t seek out an opinion from someone who could help.

One symptom in particular that often gets brushed aside is feeling an itchy sensation either all over the body or in a specific area—but without a rash to show for it.

A patient might come to me and say, “I have been feeling strangely itchy for a while now, but it’s probably nothing, right?” While it’s possible that body itchiness—the medical term for it is pruritus—with no rash may be related to something super minor, like dry air in the winter or skipping the moisturizer, there are also many other possible, lesser-known causes for feeling itchy that may require specialized treatment. And you should never just dismiss a very persistent symptom—even if it seems like no big deal—without a proper workup.

Below are some reasons you may be feeling itchy, even when there is no rash present.

1. You’re not moisturizing as well as you should.

Dry skin, as you probably know, is an obvious reason to be itchy. But the appearance of your skin when you feel itchy, before you touch it and make it red by scratching, can help you figure out if you’re dealing with normal dry skin that really just craves moisture, or something else.

Typical (untouched) dry skin tends to appear ashy. Now, if you are itchy in spots that do coincide with a visible rash, you may be dealing with another skin issue, such as psoriasis or contact dermatitis (which is when the skin reacts after coming in contact with a substance that irritates it, like a detergent). If you have a rash that’s not going away, see your doctor, who can refer you to an allergist and/or dermatologist if necessary.

Back to dry skin: Staying hydrated and not overwashing can help address the dryness and, in turn, stop the itch. And don’t forget to moisturize. Moisturizers act as a barrier to seal in moisture and also hydrate the skin, but some formulas work better than others for dry skin. You’ll want to choose a heavier moisturizer, like an oil-based cream, which will more effectively lock in moisture.

A little shopping hint: Heavy-duty creams are often sold in tubs versus pump bottles because they can be too thick to pump out—so look for tub packaging.

2. You’re on a new medication.

If you have noticed that your body itchiness began after starting a new medication, then that may be the culprit. Certain medications like statins (which are used for cholesterol), blood pressure-lowering medications, and opioids are all known to naturally evoke an itchy sensation that’s not necessarily accompanied by any skin lesions.
The exact mechanisms behind drug-induced pruritus for different medications are not entirely clear and may depend on the specific drug. Itchiness in general isn’t a topic that’s considered well-studied at this point.

In some cases, the itchiness will clear up spontaneously if you stop taking the drug. Speak with your doctor if the onset of your itchiness may correlate with a new medication you’re taking. They can consider switching you to a different medication, if it’s an option in your individual case.

3. You have an overactive or underactive thyroid gland.

Body itchiness is a well-known symptom related to hyperthyroidism and hypothyroidism. But itchiness would likely occur in addition to other common thyroid-related symptoms, including changes in weight and/or appetite and fatigue.
Your primary care physician or an endocrinologist can do a blood test to check for any abnormality of your thyroid function and possibly a physical examination of your thyroid gland to check for swelling or tenderness.

4. There’s an issue with your kidneys.

Pruritus can be a sign of kidney disease, and it usually shows up when the disease is in an advanced stage. The kidneys are responsible for filtering the blood and removing excess fluid and toxins from the body; but when they no longer function properly, the blood may be filled with abnormally high amounts of waste that they couldn’t filter out (this is called uremia).

As I’ve mentioned, the pathology of pruritus as it relates to different health conditions is far from understood. But with kidney failure, it’s possible that pruritus has to do with inflammation or an imbalance of electrolytes and nutrients in the blood, as the National Kidney Foundation explains.

Take note of where you feel itchy on your body, like whether it’s all over or more localized. People with itchiness tied to kidney disease generally feel the most itchy on their back, but it’s also not unusual for them to feel itchy on the head, abdomen, and arms as well.

5. There’s a problem with your liver or pancreas.

Cholestasis is a condition that occurs when there’s an issue with the flow of bile (a digestive fluid) in the body, and it can be tied to certain liver or pancreatic diseases or occur when there’s a problem with the bile duct. When cholestasis happens, waste product known as bilirubin gets into the bloodstream.

This action can cause itchiness, possibly due to the bilirubin building up in the skin.

Cholestasis can also occur during pregnancy (especially in the third trimester), as SELF reported previously. Cholestasis of pregnancy can be dangerous or even life-threatening to the baby—so it’s crucial to get any persistent itchiness checked out right away by your physician if you are pregnant. (Itchiness is the main symptom used to diagnose cholestasis of pregnancy, but other signs may include jaundice, nausea, and loss of appetite, per the Mayo Clinic.)

Treatment for cholestasis depends on the underlying cause, but there are medications that can help alleviate itchiness that your doctor may prescribe.

6. You have a pinched nerve.

A pinched nerve, which is when there’s pressure put on a nerve by bone or cartilage or other tissues around it, can stimulate a tingly sensation or numbness that some people may describe as itchiness. The itchy feeling may not occur directly where the pinched nerve is located; for instance, if you feel tingly near the upper forearm area, it could be due to nerve compression in the neck.
You may also be dealing with brachioradial pruritus, which is characterized by a tingling or “burning” in the shoulder, neck, or forearm. (The cause is unknown but may have to do with sun exposure.)

Cold compresses applied to the area may be helpful to temporarily relieve the discomfort, but the itchiness may persist as long as the nerve issue itself does.

Other conditions involving the nervous system—shingles, multiple sclerosis, and diabetes, to name a few—can also trigger an itching or tingling, too. This is what experts refer to as “neuropathic itch,” but research that helps explains why this phenomenon occurs is limited.

7. It’s related to a more serious underlying illness.

Cancer is not as common of an etiology when it comes to itchiness without a rash, but certain types of cancer including lymphoma, pancreatic cancer, and blood cancers are linked to this symptom. Unusual body itchiness in some cases can even help lead to a cancer diagnosis. (Some people deal with pruritus as a side effect of cancer treatment, like chemotherapy, but it can also be due to the cancer itself.)

People with human immunodeficiency virus (HIV) can deal with itchiness without (or with) a rash on the body, too. This can be due to the virus itself, or a side effect of medication.

As you can see, there are a lot of possible reasons for feeling itchy—some that are fairly straightforward to treat, and others that are more serious and require specialized treatment.

Body itchiness can wax and wane. But if you’ve noticed an itchy sensation for two weeks or longer, have any other symptoms, or if you’re feeling really uncomfortable and don’t want to wait, bring it up with your doctor. Sometimes you can fix itchiness on your own (using over-the-counter treatments for dry skin or an antihistamine, perhaps). But in some cases, like if you’re dealing with a thyroid disorder, you need to treat the underlying medical condition, not just the itchy sensation.

In preparation for your appointment, it’s important to take note of whether or not you notice a rash before you feel itchy, or if you are itchy and then you develop redness or a rash from scratching. Though this detail seems minor, as an allergist/immunologist, it actually dramatically changes the way I will try to pinpoint the cause, and what type of other specialist I might loop you in with.

The bottom line: You deserve to feel well and be comfortable. And body itchiness is probably not something that you’d call comfortable—it’s frustrating and can mess with your ability to sleep, not to mention your overall quality of life. So, treat ongoing itchiness as a symptom that deserves proper medical attention.

Ratika Gupta, M.D., is a board-certified allergist/immunologist and internal medicine physician based in New York.


Lili Reinhart Says Her Acne Triggers a ‘Specific Type of Body Dysmorphia’

Lili Reinhart has recently made a habit of being as real as possible about her acne. In a new interview with Glamour, the Riverdale star discussed how, despite her continued efforts to destigmatize acne, a pimple still has the power to affect her mental health and self-esteem.

“I cried last night to my mom over FaceTime because of how ugly I felt I looked,” Reinhart said.

“My skin has caused me a lot of anxiety and sadness,” she continued. “I have a specific type of body dysmorphia that stems from acne. I see any acne on my face as an obsessive thing. [It’s] the only thing I can think about, and it makes me want to hide.”

The 21-year-old also said the outpouring of support she’s received since she started voicing her skin-care challenges has made things a little easier. “Lorde actually messaged me on Instagram when I had spoken out about my acne, and she was like, ‘Girl, I feel you. I’m totally on the same page as you,'” Reinhart said. “It was really comforting and very sweet of her.”

As SELF wrote previously, skin conditions can absolutely affect a person’s mental health.

“It’s super intuitive to think that if you have acne you’re not going to feel very good about it, and I think that pretty much anyone who’s had [acne] would be able to draw that connection,” Ryan Lewinson, Ph.D., co-author of a recent study about acne and mental health, told SELF previously. His research showed that people with the skin condition were also more likely to be diagnosed with clinical depression, and the risk was highest in the first year after their acne diagnosis.

It’s important for people who deal with skin conditions to know about their increased risk of mental health issues—and to know that they aren’t overreacting when they feel their mental health is suffering due to skin issues. Reinhart, who has been just as honest about her experiences with anxiety and depression as she is about her acne, certainly isn’t alone.


7 Registered Dietitians Share Their Favorite Vegetable Recipes From Their Cultures

When it comes to healthy eating, there are lots of different approaches you can follow. But one thing is true of pretty much any effort to eat a more nutritious diet: Vegetables are really good for you. However, most of the veggies we hear about in popular culture and media in the U.S. when it comes to healthy cooking and meals are part of a Eurocentric diet (kale, I’m looking at you). The underlying message is that in order to be healthy, you have to eat one certain kind of food and, if you’re not white and/or your cultural or ethnic background is anything but Eurocentric, you have to give up the foods you grew up with, or that are common in your family, community, or culture. I’m here to tell you that that is not the case.

Of course, there are plenty of people who are food, healthy eating, and vegetable enthusiasts who already know and love vegetables from various places and cultures and grew up eating them. But if you’re not familiar with some of these veggies—or if you are but want some new recipe inspiration—I definitely recommend giving the recipes here a try—because they come straight from registered dietitians who love to cook and eat. Bonus: the more variety in your diet, the more variety you get in nutrients. Plus, the more ways at your disposal to prepare and eat delicious food. Check your local supermarket or specialty grocery stores to get your hands on these veggies.

Expedited partner therapy: With STDs at an all-time high, why aren’t more people getting a proven treatment?

Nearly 2.3 million times last year, Americans learned they had a sexually transmitted disease.

But despite these record-high infection rates for chlamydia and gonorrhea, most patients only receive treatment for their own infection — when they probably could get antibiotics or a prescription for their partner at the same time.

The Centers for Disease Control and Prevention has recommended this approach — called “expedited partner therapy” — since 2006, as a way to slow the growing STD epidemic. Most states have laws allowing doctors who diagnose a patient with an STD to write a prescription or provide medications for their partner, sight unseen. The laws also allow clinics and pharmacies to distribute STD treatment for partners.

In a new paper in the American Journal of Public Health, three University of Michigan physicians describe the barriers that stand in the way of getting expedited partner therapy to more people.

Overcoming those barriers, they say, could prevent many STD infections, including reinfections of people who have already gotten tested and treated.

Cornelius Jamison, M.D., M.S.P.H., M.Sc., led the team behind the paper, and also leads current research that is diving deeper into the barriers that may prevent the clinical implementation and use of EPT. He notes that this is one public health issue where public policy is ahead of clinical practice. Many major medical societies have endorsed EPT based on evidence that it’s cost-effective and safe, but it’s still under-used across the country.

“We need to make sure everyone in the medical and public health community has a basic understanding of what expedited partner therapy is, how it can work, and what it will take for it to reach widespread use,” says Jamison, a family physician and member of the U-M Department of Family Medicine and Institute for Healthcare Policy and Innovation. The new paper includes a conceptual framework that diagrams all the potential barriers to EPT use, to help guide future work to overcome them.

Special considerations for STDs

Some of the barriers to widespread use of EPT relate to the very nature of the diseases it’s designed to treat, and the stigma attached to an STD infection. This can drive teens and young adults to avoid seeking STD testing and care in ways that would tip their parents off to their infection status through insurance records, bills or notifications of a positive test result.

Instead, Jamison says, they may seek a diagnosis or treatment at a walk-in clinic, on a free or cash basis. This means that such sites are especially important to increasing the use of EPT.

Similarly, these patients’ partners may not have insurance, or may not want to use their insurance to pay for an STD test or treatment even if they do.

A packet of EPT antibiotics given them by a partner who got tested and treated could overcome these barriers, says Jamison. So could a pre-written prescription.

More about EPT use and barriers

The drugs used to treat chlamydia and gonorrhea are often prescribed together even if the patient only tested positive for one infection. A single 1-gram dose of azithromycin (sold as Zithromax), and a single 400-milligram dose of cefixime (sold as Suprax), taken together can clear both infections. The cost of the EPT medications can vary, but even low costs can be a barrier for low-income people or teens paying out of their own pockets, Jamison notes.

Several guidelines recommend that all sexually active teens and young women be tested for chlamydia and gonorrhea every year. Some recommend testing for all women depending on sexual activity. However, not all providers screen consistently, which means infections can linger. Left untreated, they can lead to pelvic inflammatory disease and infertility and increased risk of HIV in women.

The recent increase in screening, and treatment, means more opportunities for providers to talk with patients who have STDs about the importance of getting antibiotics to their sexual partners, as well as practices such as condom use that can prevent STDs from spreading.

Jamison and his colleagues also say that besides the clinical barriers to EPT, some policy hurdles remain. Seven states and Puerto Rico lack precise laws that give clear legal status to EPT. South Carolina and Kentucky do not allow EPT under current law.

Physician and pharmacist concern about liability if an EPT recipient experiences side effects may drive a lot of the reluctance to provide EPT to their patients, even in states where the law protects them, says Jamison.

Jamison’s current research focuses on studying EPT use in federally qualified health clinics, which provide care to any patient at low or no cost, regardless of insurance status. A full list of such clinics nationwide is available at .

More data is still needed on the actual prescribing and use of EPT in all settings nationwide, and on the specific steps clinics could take to ensure EPT is provided or prescribed to appropriate patients. Protocols in electronic health records, for instance, that automatically suggest EPT to physicians when they tell a patient they have an STD, could assist.

“Our review and conceptual model show the barrier that we as providers, researchers and policy makers face,” says Jamison. “But it also shows the importance of coming together to figure out how to do the right thing for patients.”

In addition to Jamison, the paper’s authors are Tammy Chang, M.D., M.P.H., M.S., of U-M Family Medicine, and Okeoma Mmeje, M.D., M.P.H., of the U-M Department of Obstetrics & Gynecology. Chang and Mmeje are also members of IHPI.

BPA replacements in plastics cause reproductive problems in lab mice

Twenty years ago, researchers made the accidental discovery that the now infamous plastics ingredient known as bisphenol A or BPA had inadvertently leached out of plastic cages used to house female mice in the lab, causing a sudden increase in chromosomally abnormal eggs in the animals. Now, the same team is back to report in the journal Current Biology on September 13 that the array of alternative bisphenols now used to replace BPA in BPA-free bottles, cups, cages, and other items appear to come with similar problems for their mice.

“This paper reports a strange déjà vu experience in our laboratory,” says Patricia Hunt of Washington State University.

The new findings were uncovered much as before as the researchers again noticed a change in the data coming out of studies on control animals. Again, the researchers traced the problem to contamination from damaged cages, but the effects this time, Hunt says, were more subtle than before. That’s because not all of the cages were damaged and the source of contamination remained less certain.

However, she and her colleagues were able to determine that the mice were being exposed to replacement bisphenols. They also saw that the disturbance in the lab was causing problems in the production of both eggs and sperm.

Once they got the contamination under control, the researchers conducted additional controlled studies to test the effects of several replacement bisphenols, including a common replacement known as BPS. Those studies confirm that replacement bisphenols produce remarkably similar chromosomal abnormalities to those seen so many years earlier in studies of BPA.

Hunt notes that the initial inadvertent exposure of their animals was remarkably similar to what might happen in people using plastics in that the exposure was accidental and highly variable. Not all of the animals’ cages were damaged, and so the findings differed among animals in different cages.

She adds that — although determining the levels of human exposure is difficult — their controlled experiments were conducted using low doses of BPS and other replacement bisphenols thought to be relevant to exposure in people using BPA-free plastics.

These problems, if they hold true in people as has been shown in the case of BPA, will carry over to future generations through their effects on the germline. The researchers showed that, if it were possible to eliminate bisphenol contaminants completely, the effects would still persist for about three generations.

Hunt says more work is needed to determine whether some replacement bisphenols might be safer than others, noting that there are dozens of such chemicals now in use. She also suspects that other widely used and endocrine-disrupting chemicals, including parabens, phthalates, and flame retardants, may be having similarly adverse affects on fertility that warrant much more study.

“The ability to rapidly enhance the properties of a chemical has tremendous potential for treating cancer, enhancing medical and structural materials, and controlling dangerous infectious agents,” the researchers write. “Importantly, this technology has paved the way for ‘green chemistry,’ a healthier future achieved by engineering chemicals to ensure against hazardous effects. Currently, however, regulatory agencies charged with assessing chemical safety cannot keep pace with the introduction of new chemicals. Further, as replacement bisphenols illustrate, it is easier and more cost effective under current chemical regulations to replace a chemical of concern with structural analogs rather than determine the attributes that make it hazardous.”

Hunt’s advice to consumers now is simple: BPA-free or not, “plastic products that show physical signs of damage or aging cannot be considered safe.”

Support for these studies was provided from the NIH.

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Materials provided by Cell Press. Note: Content may be edited for style and length.

People show confirmation bias even about which way dots are moving

People have a tendency to interpret new information in a way that supports their pre-existing beliefs, a phenomenon known as confirmation bias. Once they’ve made a decision about which house to buy, which school to send their kids to, or which political candidate to vote for, they have a tendency to interpret new evidence such that it reassures them they’ve made the right call. Now, researchers reporting in Current Biology on September 13 have shown that people will do the same thing even when the decision they’ve made pertains to a choice that is rather less consequential: which direction a series of dots is moving and whether the average of a series of numbers is greater or less than 50.

“Confirmation biases have previously only been established in the domains of higher cognition or subjective preferences,” for example in individuals’ preferences for one consumer product or another, says Tobias Donner from University Medical Center Hamburg-Eppendorf (UKE), Germany. “It was rather striking for us to see that people displayed clear signs of confirmation bias when judging on sensory input that we expected to be subjectively neutral to them.”

The findings by a team of researchers from UKE and Tel Aviv University, Israel, suggest that confirmation bias is linked to selective attention, a process in which people react to certain bits of information or stimuli and not others when several are presented at the same time. They also set the stage for studies to unravel the underlying brain mechanisms, the researchers say.

Although confirmation bias is well known, it hadn’t been clear what drives it. Is it that people, after making a decision, become less sensitive to new information? Or do they actually filter new information so as to reduce conflict with the decision they’ve already made?

To explore this question, the researchers, including first authors Bharath Talluri and Anne Urai, both from UKE, asked study participants to look at two successive movies featuring a cloud of small white dots on a white computer screen. Their task was to report the direction the coherently moving dots, which was challenging because these dots were embedded in many more dots that moved about randomly. After the first movie, participants were asked to choose between two categorical options: whether the coherent motion pointed clockwise or counterclockwise from a reference line drawn next to the cloud of dots. After the second movie, they were asked to drag the mouse over the screen to indicate their best continuous estimate of the average direction across both movies they had seen.

The experiments showed that participants, after making an initial call based on the first movie, were more likely to use subsequent evidence that was consistent with their initial choice to make a final judgment the second time around. The finding suggests that the initial choice a person made in the simple visual motion task acts as a cue, selectively directing their attention toward incoming information that’s in agreement.

In a second series of experiments, the researchers presented a related numerical task. At first, they were asked to judge whether a series of eight two-digit numbers averaged greater or less than 50. In a second, they were asked to provide a continuous estimate of the average between 10 and 90. Again, participants’ answers showed a pattern of confirmation bias and selective attention.

The researchers say the findings help to identify the source of confirmation biases, with implications for understanding the bounds of human rationality. For those of us attempting to make informed decisions in the real world, the new study offers a reminder.

“Contrary to a common phrase, first impression does not have to be the last impression,” Talluri says. “Such impressions, or choices, lead us to evaluate information in their favor. By acknowledging the fact that we selectively prioritize information agreeing with our previous choices, we could attempt to actively suppress this bias, at least in cases of critical significance, like evaluating job candidates or making policies that impact a large section of the society.”

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Materials provided by Cell Press. Note: Content may be edited for style and length.

Regret is a gambler’s curse, neuroscientists say

It’s not just the anticipation of a big payoff, or doubts about the wisdom of her bet. It’s also regret about previous bets, both won and lost, according to University of California, Berkeley, neuroscientists.

“Right after making a choice and right before finding out about the outcome, the brain is replaying and revisiting nearly every feature of what happened during the previous decision,” said senior author Ming Hsu, an associate professor in the Haas School of Business and Helen Wills Neuroscience Institute at UC Berkeley. “Instead of ‘I just gambled but maybe I shouldn’t have,’ it is, ‘Last round I gambled and that was a really good choice.’ Or, ‘I played it safe last time but should have gone for it.'”

The UC Berkeley study is one of a small but growing number of studies that record fast human brain activity — a thousand measurements per second — to reveal the complex array of operations underlying every decision we make, even those that may seem trivial.

The researchers focused on the brain’s orbitofrontal cortex, long-known to be involved in reward processing and social interactions. Indeed, it was one of the main sites of damage in the well-known case involving 19th century railroad worker Phineas Gage, whose left frontal cortex was destroyed after an explosion drove an iron bar through his head. The damage altered his personality, making him impulsive and uninhibited — seemingly a man who didn’t regret any act, no matter how disastrous the outcome.

In recent decades, the orbitofrontal cortex has been shown to be involved in how people value their choice options, how much regret they felt, how much risk they were taking and how valuable their choice was, all of which guide future choices or help someone appraise how good or bad the outcome was.

As shown in this study, however, the orbitofrontal cortex spends much of the time replaying aspects of past decisions. In particular, when people play a gambling game, the main driver of activity in the orbitofrontal cortex is the regret they feel from losing or the regret, after winning, of not having bet more.

“It turns out that the most prevalent information encoded in the orbitofrontal cortex was the regret subjects experienced from their previous decision,” said first author Ignacio Saez, a former UC Berkeley postdoctoral fellow who is now an assistant professor at UC Davis.

With the ability to recognize the pattern of activity associated with regret, the findings could open the door to assessing how well the regret circuits in the brain operate in people with brain injuries or those with behaviors that suggest the absence of regret, including some politicians.

“If you don’t feel any regret, you are getting close to the world of addictive or antisocial behavior,” said coauthor Robert Knight, a neurologist and UC Berkeley professor of psychology.

Knight also sees an opportunity to compare regret in normal brains versus injured brains, including those of people with frontotemporal dementia that can lead to altered social behavior. The orbitofrontal cortex, for example, is often damaged by tumors, traumatic brain injuries and falls, leading to altered behavior.

The researchers will report their findings September 13 in the journal Current Biology.

Second-guessing gambling decisions

The scientists recorded electrical activity directly from the surface of the orbitofrontal cortex as a person was presented with a betting opportunity, decided whether or not to bet, placed the bet and, half a second later, learned the outcome. The electrodes allowed the team to follow the thoughts swirling through that region of the brain millisecond by millisecond.

During the split second between betting and outcome, neural signals in the gamblers’ orbitofrontal cortex reviewed their most recent decision-making process, but spent much more brain power replaying aspects of the previous bet, including the regret they felt from losing or the regret, after winning, of not having bet more.

The brain activity looked very much like gamblers were second-guessing their earlier decision in light of whether they won or lost, even before they found out the results of their latest bet. Presumably, this helps us make better decisions in the future.

“After the subject has made a decision, the brain, far from idly waiting to find out the outcome, was busy revisiting what occurred during the previous decision — everything from whether they gambled and how much was won or lost, to how much regret they felt from their earlier decision,” Hsu said.

“From our subjects we get a better picture of the brain and what it is doing during decision-making, but it also gives some ground-truth for the type of signals we might look for in people with dysfunctions in decision-making,” Hsu said. “There is a lot more going on under the hood than is represented in our elegant but overly-simplified models and theories.”

The precision of ECoG

The work builds on many previous studies of the gambling brain, much of it conducted with functional magnetic resonance imaging (fMRI) and electroencephalograms (EEG), by recording directly from the cortical surface of the human brain. This technique, known as electrocorticography (ECoG), requires the placement of as many as several hundred electrodes as a mesh on the brain surface after the skull has been opened: access only possible with patients undergoing tests before surgery to treat epilepsy.

Saez, Hsu and Knight worked with 10 epilepsy patients across four hospitals in the U.S. to explore risk, regret and reward processing in the orbitofrontal cortex during a simple betting game. All patients had electrodes placed in this region of the brain, which is located just above the sinuses, behind the eyebrows, and is involved in reward processing, interpersonal interactions and integrating value and emotion into decisions, said Knight, who has investigated cognitive processing in hundreds of epilepsy patients over the past 10 years.

Earlier fMRI and EEG gambling studies found areas of the orbitofrontal cortex involved in assessing how much a person won, how much regret they felt, how much risk they were taking and how valuable their choice was, all of which guide future choices or help someone appraise how good or bad the outcome was, Hsu said.

Using ECoG, the UC Berkeley team detected activity related to choice and outcome evaluation for the immediate trial. However, during the 550 milliseconds between the bet and the outcome, activity in as many as half of the 200+ electrodes recorded was related to the recently completed trial, though NOT earlier previous trials.

The researchers varied the odds of winning and the reward for gambling on each trial so that the brain activity of previous trials was different enough for the researchers to distinguish which past trial the person was thinking about.

To Saez, the surprise was that all this information was processed in nearly simultaneous fashion across many areas of the orbitofrontal cortex — much more detail than could be seen previously with non-invasive approaches.

“Rather than one region tracking wins and another region tracking losses, information was highly distributed across the orbitofrontal cortex,” Saez said. “We think this is partly what allows the brain to process massive amounts of information in parallel to give us the capacity to make decisions both quickly and efficiently.”

The UC Berkeley team worked with Drs. Jack Lin of UC Irvine, Edward Chang of UCSF, Josef Parvizi of Stanford University and Gerwin Schalk of the Wadsworth Center, New York State Department of Health, in Albany. Arjen Stolk of UC Berkeley also contributed.

This project was supported by the National Institute of Neurological Diseases and Stroke (R37NS21135), Defense Advanced Research Projects Agency and National Institute of Mental Health (MH098023, K01MH108815, R21MH109851).

The art of storytelling: Researchers explore why we relate to characters

For thousands of years, humans have relied on storytelling to engage, to share emotions and to relate personal experiences. Now, psychologists at McMaster University are exploring the mechanisms deep within the brain to better understand just what happens when we communicate.

New research published in the Journal of Cognitive Neuroscience, suggests that no matter how a narrative is expressed — through words, gestures or drawings — our brains relate best to the characters, focusing on the thoughts and feelings of the protagonist of each story.

“We tell stories in conversation each and every day,” explains Steven Brown, lead author of the study, who runs the NeuroArts Lab at McMaster and is an associate professor in the Department of Psychology, Neuroscience ang Behaviour. “Very much like literary stories, we engage with the characters and are wired to make stories people-oriented.”

An important question researchers set out to answer was how, exactly, narrative ideas are communicated using three different forms of expression, and to identify a so-called narrative hub within the brain.

For the study, researchers scanned the brains of participants using fMRI and presented them with short headlines. For example, “Surgeon finds scissors inside of patient” or “Fisherman rescues boy from freezing lake.”

They were then asked to convey the stories using speech, gestures or drawing, as one would do in a game of Pictionary. The illustrations were created using an MRI-compatible drawing tablet which allowed the participants to see their drawings.

Researchers found that no matter what form of story telling the participants used, the brain networks that were activated were the “theory-of-the-mind” network, which is affected by the character’s intentions, motivations, beliefs, emotions and actions.

“Aristotle proposed 2,300 years ago that plot is the most important aspect of narrative, and that character is secondary,” says Brown. “Our brain results show that people approach narrative in a strongly character-centered and psychological manner, focused on the mental states of the protagonist of the story.”

Next, researchers hope to compare narration and acting to determine what happens when we tell stories in the third-person or portray characters in the first-person.

Story Source:

Materials provided by McMaster University. Note: Content may be edited for style and length.