A personalized AI tool might help some reach end-of-life decisions—but it won’t suit everyone

This article first appeared in The Checkup, MIT Technology Review’s weekly biotech newsletter. To receive it in your inbox every Thursday, and read articles like this first, sign up here.

This week, I’ve been working on a piece about an AI-based tool that could help guide end-of-life care. We’re talking about the kinds of life-and-death decisions that come up for very unwell people: whether to perform chest compressions, for example, or start grueling therapies, or switch off life support.

Often, the patient isn’t able to make these decisions—instead, the task falls to a surrogate, usually a family member, who is asked to try to imagine what the patient might choose if able. It can be an extremely difficult and distressing experience.  

A group of ethicists have an idea for an AI tool that they believe could help make things easier. The tool would be trained on information about the person, drawn from things like emails, social media activity, and browsing history. And it could predict, from those factors, what the patient might choose. The team describe the tool, which has not yet been built, as a “digital psychological twin.”

There are lots of questions that need to be answered before we introduce anything like this into hospitals or care settings. We don’t know how accurate it would be, or how we can ensure it won’t be misused. But perhaps the biggest question is: Would anyone want to use it?

To answer this question, we first need to address who the tool is being designed for. The researchers behind the personalized patient preference predictor, or P4, had surrogates in mind—they want to make things easier for the people who make weighty decisions about the lives of their loved ones. But the tool is essentially being designed for patients. It will be based on patients’ data and aims to emulate these people and their wishes.

This is important. In the US, patient autonomy is king. Anyone who is making decisions on behalf of another person is asked to use “substituted judgment”—essentially, to make the choices that the patient would make if able. Clinical care is all about focusing on the wishes of the patient.

If that’s your priority, a tool like the P4 makes a lot of sense. Research suggests that even close family members aren’t great at guessing what type of care their loved ones might choose. If an AI tool is more accurate, it might be preferable to the opinions of a surrogate.

But while this line of thinking suits American sensibilities, it might not apply the same way in all cultures. In some cases, families might want to consider the impact of an individual’s end-of-life care on family members, or the family unit as a whole, rather than just the patient.

“I think sometimes accuracy is less important than surrogates,” Bryanna Moore, an ethicist at the University of Rochester in New York, told me. “They’re the ones who have to live with the decision.”

Moore has worked as a clinical ethicist in hospitals in both Australia and the US, and she says she has noticed a difference between the two countries. “In Australia there’s more of a focus on what would benefit the surrogates and the family,” she says. And that’s a distinction between two English-speaking countries that are somewhat culturally similar. We might see greater differences in other places.

Moore says her position is controversial. When I asked Georg Starke at the Swiss Federal Institute of Technology Lausanne for his opinion, he told me that, generally speaking, “the only thing that should matter is the will of the patient.” He worries that caregivers might opt to withdraw life support if the patient becomes too much of a “burden” on them. “That’s certainly something that I would find appalling,” he told me.

The way we weigh a patient’s own wishes and those of their family members might depend on the situation, says Vasiliki Rahimzadeh, a bioethicist at Baylor College of Medicine in Houston, Texas. Perhaps the opinions of surrogates might matter more when the case is more medically complex, or if medical interventions are likely to be futile.

Rahimzadeh has herself acted as a surrogate for two close members of her immediate family. She hadn’t had detailed discussions about end-of-life care with either of them before their crises struck, she told me.

Would a tool like the P4 have helped her through it? Rahimzadeh has her doubts. An AI trained on social media or internet search history couldn’t possibly have captured all the memories, experiences, and intimate relationships she had with her family members, which she felt put her in good stead to make decisions about their medical care.

“There are these lived experiences that are not well captured in these data footprints, but which have incredible and profound bearing on one’s actions and motivations and behaviors in the moment of making a decision like that,” she told me.

Now read the rest of The Checkup

Read more from MIT Technology Review’s archive

You can read the full article about the P4, and its many potential benefits and flaws, here.

This isn’t the first time anyone has proposed using AI to make life-or-death decisions. Will Douglas Heaven wrote about a different kind of end-of-life AI—a technology that would allow users to end their own lives in a nitrogen-gas-filled pod, should they wish.

AI is infiltrating health care in lots of other ways. We shouldn’t let it make all the decisions—AI paternalism could put patient autonomy at risk, as we explored in a previous edition of The Checkup.

Technology that lets us speak to our dead relatives is already here, as my colleague Charlotte Jee found when she chatted with the digital replicas of her own parents.

What is death, anyway? Recent research suggests that “the line between life and death isn’t as clear as we once thought,” as Rachel Nuwer reported last year.

From around the web

When is someone deemed “too male” or “too female” to compete in the Olympics? A new podcast called Tested dives into the long, fascinating, and infuriating history of testing and excluding athletes on the basis of their gender and sex. (Sequencer)

There’s a dirty secret among Olympic swimmers: Everyone pees in the pool. “I’ve probably peed in every single pool I’ve swam in,” said Lilly King, a three-time Olympian for Team USA. “That’s just how it goes.” (Wall Street Journal)

When saxophonist Joey Berkley developed a movement disorder that made his hands twist into pretzel shapes, he volunteered for an experimental treatment that involved inserting an electrode deep into his brain. That was three years ago. Now he’s releasing a new suite about his experience, including a frenetic piece inspired by the surgery itself. (NPR)

After a case of mononucleosis, Jason Werbeloff started to see the people around him in an entirely new way—literally. He’s one of a small number of people for whom people’s faces morph into monstrous shapes, with bulging sides and stretching teeth, because of a rare condition called prosopometamorphopsia. (The New Yorker)  

How young are you feeling today? Your answer might depend on how active you’ve been, and how sunny it is. (Innovation in Aging)

How our genome is like a generative AI model

This article first appeared in The Checkup, MIT Technology Review’s weekly biotech newsletter. To receive it in your inbox every Thursday, and read articles like this first, sign up here.

What does the genome do? You might have heard that it is a blueprint for an organism. Or that it’s a bit like a recipe. But building an organism is much more complex than constructing a house or baking a cake.

This week I came across an idea for a new way to think about the genome—one that borrows from the field of artificial intelligence. Two researchers are arguing that we should think about it as being more like a generative model, a form of AI that can generate new things.

You might be familiar with such AI tools—they’re the ones that can create text, images, or even films from various prompts. Do our genomes really work in the same way? It’s a fascinating idea. Let’s explore.

When I was at school, I was taught that the genome is essentially a code for an organism. It contains the instructions needed to make the various proteins we need to build our cells and tissues and keep them working. It made sense to me to think of the human genome as being something like a program for a human being.

But this metaphor falls apart once you start to poke at it, says Kevin Mitchell, a neurogeneticist at Trinity College in Dublin, Ireland, who has spent a lot of time thinking about how the genome works.

A computer program is essentially a sequence of steps, each controlling a specific part of development. In human terms, this would be like having a set of instructions to start by building a brain, then a head, and then a neck, and so on. That’s just not how things work.

Another popular metaphor likens the genome to a blueprint for the body. But a blueprint is essentially a plan for what a structure should look like when it is fully built, with each part of the diagram representing a bit of the final product. Our genomes don’t work this way either.

It’s not as if you’ve got a gene for an elbow and a gene for an eyebrow. Multiple genes are involved in the development of multiple body parts. The functions of genes can overlap, and the same genes can work differently depending on when and where they are active. It’s far more complicated than a blueprint.

Then there’s the recipe metaphor. In some ways, this is more accurate than the analogy of a blueprint or program. It might be helpful to think about our genes as a set of ingredients and instructions, and to bear in mind that the final product is also at the mercy of variations in the temperature of the oven or the type of baking dish used, for example. Identical twins are born with the same DNA, after all, but they are often quite different by the time they’re adults.

But the recipe metaphor is too vague, says Mitchell. Instead, he and his colleague Nick Cheney at the University of Vermont are borrowing concepts from AI to capture what the genome does. Mitchell points to generative AI models like Midjourney and DALL-E, both of which can generate images from text prompts. These models work by capturing elements of existing images to create new ones.

Say you write a prompt for an image of a horse. The models have been trained on a huge number of images of horses, and these images are essentially compressed to allow the models to capture certain elements of what you might call “horsiness.” The AI can then construct a new image that contains these elements.

We can think about genetic data in a similar way. According to this model, we might consider evolution to be the training data. The genome is the compressed data—the set of information that can be used to create the new organism. It contains the elements we need, but there’s plenty of scope for variation. (There are lots more details about the various aspects of the model in the paper, which has not yet been peer-reviewed.)

Mitchell thinks it’s important to get our metaphors in order when we think about the genome. New technologies are allowing scientists to probe ever deeper into our genes and the roles they play. They can now study how all the genes are expressed in a single cell, for example, and how this varies across every cell in an embryo.

“We need to have a conceptual framework that will allow us to make sense of that,” says Mitchell. He hopes that the concept will aid the development of mathematical models that might help us better understand the intricate relationships between genes and the organisms they end up being part of—in other words, exactly how components of our genome contribute to our development.

Now read the rest of The Checkup

Read more from MIT Technology Review’s archive:

Last year, researchers built a new human genome reference designed to capture the diversity among us. They called it the “pangenome,” as Antonio Regalado reported.

Generative AI has taken the world by storm. Will Douglas Heaven explored six big questions that will determine the future of the technology.

A Disney director tried to use AI to generate a soundtrack in the style of Hans Zimmer. It wasn’t as good as the real thing, as Melissa Heikkilä found.

Melissa has also reported on how much energy it takes to create an image using generative AI. Turns out it’s about the same as charging your phone. 

What is AI? No one can agree, as Will found in his recent deep dive on the topic.

From around the web

Evidence from more than 1,400 rape cases in Maryland, some from as far back as 1977, are set to be processed by the end of the year, thanks to a new law. The state still has more than 6,000 untested rape kits. (ProPublica)

How well is your brain aging? A new tool has been designed to capture a person’s brain age based on an MRI scan, and which accounts for the possible effects of traumatic brain injuries. (NeuroImage)

Iran has reported the country’s first locally acquired cases of dengue, a viral infection spread by mosquitoes. There are concerns it could spread. (WHO)

IVF is expensive, and add-ons like endometrial scratching (which literally involves scratching the lining of the uterus) are not supported by strong evidence. Is the fertility industry profiting from vulnerability? (The Lancet)

Up to 2 million Americans are getting their supply of weight loss drugs like Wegovy or Zepbound from compounding pharmacies. They’re a fraction of the price of brand-name Big Pharma drugs, but there are some safety concerns. (KFF Health News)

Why we need safeguards against genetic discrimination

This article first appeared in The Checkup, MIT Technology Review’s weekly biotech newsletter. To receive it in your inbox every Thursday, and read articles like this first, sign up here.

A couple of years ago, I spat into a little plastic tube, stuck it in the post, and waited for a company to analyze markers on my DNA to estimate how biologically old I am. It’s not the first time I’ve shared my genetic data for a story. Over a decade ago, I shared a DNA sample with a company that promised to tell me about my ancestry.

Of course, I’m not the only one. Tens of millions of people have shipped their DNA off to companies offering to reveal clues about their customers’ health or ancestry, or even to generate tailored diet or exercise advice. And then there are all the people who have had genetic tests as part of their clinical care, under a doctor’s supervision. Add it all together, and there’s a hell of a lot of genetic data out there.

It isn’t always clear how secure this data is, or who might end up getting their hands on it—and how that information might affect people’s lives. I don’t want my insurance provider or my employer to make decisions about my future on the basis of my genetic test results, for example. Scientists, ethicists and legal scholars aren’t clear on the matter either. They are still getting to grips with what genetic discrimination entails—and how we can defend against it.

If we’re going to protect ourselves from genetic discrimination, we first have to figure out what it is. Unfortunately, no one has a good handle on how widespread it is, says Yann Joly, director of the Centre of Genomics and Policy at McGill University in Quebec. And that’s partly because scientists keep defining it in different ways. In a paper published last month, Joly and his colleagues listed 12 different definitions that have been used in various studies since the 1990s. So what is it?

“I see genetic discrimination as a child of eugenics practices,” says Joly. Modern eugenics, which took off in the late 19th century, was all about limiting the ability of some people to pass on their genes to future generations. Those who were considered “feeble minded” or “mentally defective” could be flung into institutions, isolated from the rest of the population, and forced or coerced into having procedures that left them unable to have children. Disturbingly, some of these practices have endured. In the fiscal years 2005-2006 and 2012-2013, 144 women in California’s prisons were sterilized—many without informed consent.

These cases are thankfully rare. In recent years, ethicists and policymakers have been more worried about the potential misuse of genetic data by health-care and insurance providers. There have been instances in which people have been refused health insurance or life insurance on the basis of a genetic result, such as one that predicts the onset of Huntington’s disease. (In the UK, where I live, life insurance providers are not meant to ask for a genetic test or use the results of one—unless the person has tested positive for Huntington’s.)

Joly is collecting reports of suspected discrimination in his role at the Genetic Discrimination Observatory, a network of researchers working on the issue. He tells me that in one recent report, a woman wrote about her experience after she had been referred to a new doctor. This woman had previously taken a genetic test that revealed she would not respond well to certain medicines. Her new doctor told her he would only take her on as a patient if she first signed a waiver releasing him of any responsibility over her welfare if she didn’t follow the advice generated by her genetic test.

“It’s unacceptable,” says Joly. “Why would you sign a waiver because of a genetic predisposition? We’re not asking people with cancer to [do so]. As soon as you start treating people differently because of genetic factors … that’s genetic discrimination.”

Many countries have established laws to protect people from these kinds of discrimination. But these laws, too, can vary hugely both when it comes to defining what genetic discrimination is and to how they safeguard against it. The law in Canada focuses on DNA, RNA, and chromosome tests, for example. But you don’t always need such a test to know if you’re at risk for a genetic disease. A person might have a family history of a disease or already be showing symptoms of it.

And then there are the newer technologies. Take, for example, the kind of test that I took to measure my biological age. Many aging tests measure either chemical biomarkers in the body or epigenetic markers on the DNA—not necessarily the DNA itself. These tests are meant to indicate how close a person is to death. You might not want your life insurance provider to know or act on the results of those, either.

Joly and his colleagues have come up with a new definition. And they’ve kept it broad. “The narrower the definition, the easier it is to get around it,” he says. He wanted to avoid excluding the experiences of any people who feel they’ve experienced genetic discrimination. Here it is:

“Genetic discrimination involves an individual or a group being negatively treated, unfairly profiled or harmed, relative to the rest of the population, on the basis of actual or presumed genetic characteristics.“

It will be up to policymakers to decide how to design laws around genetic discrimination. And it won’t be simple. The laws may need to look different in different countries, depending on what technologies are available and how they are being used. Perhaps some governments will want to ensure that residents have access to technologies, while other may choose to limit access. In some cases, a health-care provider may need to make decisions about a person’s care based on their genetic results.

In the meantime, Joly has advice for anyone worried about genetic discrimination. First, don’t let such concerns keep you from having a genetic test that you might need for your own health. As things stand, the risk of being discriminated against on the basis of these tests is still quite small.

And when it comes to consumer genetic testing, it’s worth looking closely at the company’s terms and conditions to find out how your data might be shared or used. It is also useful to look up the safeguarding laws in your own country or state, which can give you a good idea of when you’re within your rights to refuse to share your data.

Shortly after I received the results from my genetic tests, I asked the companies involved to delete my data. It’s not a foolproof approach—last year, hackers stole personal data on 6.9 million 23andMe customers—but at least it’s something. Just this week I was offered yet another genetic test. I’m still thinking on it.

Now read the rest of The Checkup

Read more from MIT Technology Review’s archive:

As of 2019, more than 26 million people had undertaken a consumer genetic test, as my colleague Antonio Regalado found. The number is likely to have grown significantly since then.
 
Some companies say they can build a picture of what a person looks like on the basis of DNA alone. The science is questionable, as Tate Ryan-Mosley found when she covered one such company.
 
The results of a genetic test can have profound consequences, as Golda Arthur found when a test revealed she had a genetic mutation that put her at risk of ovarian cancer. Arthur, whose mother developed the disease, decided to undergo the prophylactic removal of her ovaries and fallopian tubes. 
 
Tests that measure biological age were selected by readers as our 11th breakthrough technology of 2022. You can read more about them here.
 
The company that gave me an estimate of my biological age later reanalyzed my data (before I had deleted it). That analysis suggested that my brain and liver were older than they should be. Great.

From around the web:

Over the past few decades, doctors have implanted electrodes deep into the brains of a growing number of people, usually to treat disorders like epilepsy and Parkinson’s disease. We still don’t really know how they work, or how long they last. (Neuromodulation)

A ban on female genital mutilation will be upheld in the Gambia following a vote by the country’s National Assembly. The decision “reaffirm[s the country’s] commitments to human rights, gender equality, and protecting the health and well-being of girls and women,” directors of UNICEF, UNFPA, WHO, UN Women, and the UN High Commissioner for Human Rights said in a joint statement. (WHO)

Weight-loss drugs that work by targeting the GLP-1 receptor, like Wegovy and Saxena, are in high demand—and there’s not enough to go around. Other countries could follow Switzerland’s lead to make the drugs more affordable and accessible, but only for the people who really need them. (JAMA Internal Medicine)

J.D. Vance, Donald Trump’s running mate, has ties to the pharmaceutical industry and has an evolving health-care agenda. (STAT)

Psilocybin, the psychedelic compound in magic mushrooms, can disrupt the way regions of our brains communicate with each other. And the effect can last for weeks. (The Guardian)

IVF alone can’t save us from a looming fertility crisis

This article first appeared in The Checkup, MIT Technology Review’s weekly biotech newsletter. To receive it in your inbox every Thursday, and read articles like this first, sign up here. 

I’ve just learned that July 11 is World Population Day. There are over 8 billion of us on the planet, and there’ll probably be 8.5 billion of us by 2030. We’re continually warned about the perils of overpopulation and the impact we humans are having on our planet. So it seems a bit counterintuitive to worry that, actually, we’re not reproducing enough.

But plenty of scientists are incredibly worried about just that. Improvements in health care and sanitation are helping us all lead longer lives. But we’re not having enough children to support us as we age. Fertility rates are falling in almost every country.

But wait! We have technologies to solve this problem! IVF is helping to bring more children into the world than ever, and it can help compensate for the fertility problems faced by older parents! Unfortunately, things aren’t quite so simple. Research suggests that these technologies can only take us so far. If we want to make real progress, we also need to work on gender equality.

Researchers tend to look at fertility in terms of how many children the average woman has in her lifetime. To maintain a stable population, this figure, known as the total fertility rate (TFR), needs to be around 2.1.

But this figure has been falling over the last 50 years. In Europe, for example, women born in 1939 had a TFR of 2.3—but the figure has dropped to 1.7 for women born in 1981 (who are 42 or 43 years old by now). “We can summarize [the last 50 years] in three words: ‘declining,’ ‘late,’ and ‘childlessness,’” Gianpiero Dalla Zuanna, a professor of demography at the University of Padua in Italy, told an audience at the annual meeting of the European Society of Human Reproduction and Embryology earlier this week.

There are a lot of reasons behind this decline. Around one in six people is affected by infertility, and globally, many people aren’t having as many children as they would like. On the other hand, more people are choosing to live child-free. Others are delaying starting a family, perhaps because they face soaring living costs and have been unable to afford their own homes. Some hesitate to have children because they are concerned about the future. With the ongoing threat of global wars and climate change, who can blame them? 

There are financial as well as social consequences to this fertility crisis. We’re already seeing fewer young people supporting a greater number of older ones. And it’s not sustainable.

“Europe today has 10% of the population, 20% of gross domestic product, and 50% of the welfare expense of the world,” Dalla Zuanna said at the meeting. Twenty years from now, there will be 20% fewer people of reproductive age than there are today, he warned.

It’s not just Europe that will be affected. The global TFR in 2021 was 2.2—less than half the figure in 1950, when it was 4.8. By one recent estimate, the global fertility rate is declining at a rate of 1.1% per year. Some countries are facing especially steep declines: In 2021, the TFR in South Korea was just 0.8—well below the 2.1 needed to maintain the population. If this decline continues, we can expect the global TFR to hit 1.83 by 2050 and 1.59 by 2100.

So what’s the solution? Fertility technologies like IVF and egg freezing have been touted as one potential remedy. More people than ever are using these technologies to conceive. An IVF baby is born somewhere in the world every 35 seconds. And IVF can indeed help us overcome some fertility issues, including those that can arise for people starting a family after the age of 35. IVF is already involved in 5% to 10% of births in high-income countries. “IVF has got to be our solution, you would think,” said Georgina Chambers, who directs the National Perinatal Epidemiology and Statistics Unit at UNSW Sydney in Australia, in another talk at ESHRE.

Unfortunately, technology is unlikely to solve the fertility crisis anytime soon, as Chambers’s own research shows. A handful of studies suggest that the use of assisted reproductive technologies (ART) can only increase the total fertility rate of a country by around 1% to 5%. The US sits at the lower end of this scale—it is estimated that in 2020, the use of ART increased the fertility rate by about 1.3%. In Australia, however, ART boosted the fertility rate by 5%.

Why the difference? It all comes down to accessibility. IVF can be prohibitively expensive in the US—without insurance covering the cost, a single IVF cycle can cost around half a person’s annual disposable income. Compare that to Australia, where would-be parents get plenty of government support, and an IVF cycle costs just 6% of the average annual disposable income.

In another study, Chambers and her colleagues have found that ART can help restore fertility to some extent in women who try to have children later in life. It’s difficult to be precise here, because it’s hard to tell whether some of the births that followed IVF would have happened eventually without the technology.

Either way, IVF and other fertility technologies are not a cure-all. And overselling them as such risks encouraging people to further delay starting a family, says Chambers. There are other ways to address the fertility crisis.

Dalla Zuanna and his colleague Maria Castiglioni believe that countries with low fertility rates, like their home country Italy, need to boost the number of people of reproductive age. “The only possibility [of achieving this] in the next 20 years is to increase immigration,” Castiglioni told an audience at ESHRE.

Several countries have used “pronatalist” policies to encourage people to have children. Some involve financial incentives: Families in Japan are eligible for one-off payments and monthly allowances for each child,as part of a scheme that was recently extended. Australia has implemented a similar “baby bonus.”

“These don’t work,” Chambers said. “They can affect the timing and spacing of births, but they are short-lived. And they are coercive: They negatively affect gender equity and reproductive and sexual rights.”

But family-friendly policies can work. In the past, the fall in fertility rates was linked to women’s increasing participation in the workforce. That’s not the case anymore. Today, higher female employment rates are linked to higher fertility rates, according to Chambers. “Fertility rises when women combine work and family life on an equal footing with men,” she said at the meeting. Gender equality, along with policies that support access to child care and parental leave, can have a much bigger impact.

These policies won’t solve all our problems. But we need to acknowledge that technology alone won’t solve the fertility crisis. And if the solution involves improving gender equality, surely that’s a win-win.

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Read more from MIT Technology Review’s archive:

My colleague Antonio Regalado discussed how reproductive technology might affect population decline with Martin Varsavsky, director of the Prelude Fertility network of clinics, in a roundtable on the future of families earlier this year.

There are new fertility technologies on the horizon. I wrote about the race to generate lab-grown sperm and eggs from adult skin cells, for example. Scientists have already created artificial eggs and sperm from mouse cells and used them to create mouse pups. Artificial human sex cells are next.

Advances like these could transform the way we understand parenthood. Some researchers believe we’re not far being able to create babies with multiple genetic parents or none at all, as I wrote in a previous edition of The Checkup.

Elizabeth Carr was America’s first IVF baby when she was born in 1981. Now she works at a company that offers genetic tests for embryos, enabling parents to choose those with the highest health scores.

Some people are already concerned about maintaining human populations beyond planet Earth. The Dutch entrepreneur Egbert Edelbroek wants to try IVF in space. “Humanity needs a backup plan,” he told Scott Solomon in October last year. “If you want to be a sustainable species, you want to be a multiplanetary species.”

We have another roundtable discussion coming up with Antonio later this month. You can join him for a discussion about CRISPR and the future of gene editing. “CRISPR Babies: Six years later” takes place on Thursday, July 25, and is a subscriber-only online event. You can register for free.

From around the web

When a Bitcoin mining facility moved into the Granbury area in Texas, local residents started complaining of strange new health problems. They believe the noisy facility might be linked to their migraines, panic attacks, heart palpitations, chest pain, and hypertension. (Time)

In the spring of 1997, 20 volunteers agreed to share their DNA for the Human Genome Project, an ambitious effort to publish a reference human genome. They were told researchers expected that “no more than 10% of the eventual DNA sequence will have been obtained from [each person’s] DNA.” But when the draft was published in 2001, nearly 75% of it came from just one person. Ashley Smart reports on the ethical questions surrounding the project. (Undark)

How can you make cultured meat taste more like the real thing? Scientists have developed “flavor scaffolds” that can release a meaty taste when cultured meat is cooked. The resulting product looks like a meaty pink jelly. Bon appétit! (Nature)

Doctors can continue their medical education by taking courses throughout their careers. Some of these are funded by big tobacco companies. They really shouldn’t be, argue these doctors from Stanford and the University of California. (JAMA)

“Skin care = brain care”? Maybe, if you believe the people behind the burgeoning industry of neurocosmetics. (The Atlantic)

How AI video games can help reveal the mysteries of the human mind

This article first appeared in The Checkup, MIT Technology Review’s weekly biotech newsletter. To receive it in your inbox every Thursday, and read articles like this first, sign up here. 

This week I’ve been thinking about thought. It was all brought on by reading my colleague Niall Firth’s recent cover story about the use of artificial intelligence in video games. The piece describes how game companies are working to incorporate AI into their products to create more immersive experiences for players.

These companies are applying large language models to generate new game characters with detailed backstories—characters that could engage with a player in any number of ways. Enter in a few personality traits, catchphrases, and other details, and you can create a background character capable of endless unscripted, never-repeating conversations with you.

This is what got me thinking. Neuroscientists and psychologists have long been using games as research tools to learn about the human mind. Numerous video games have been either co-opted or especially designed to study how people learn, navigate, and cooperate with others, for example. Might AI video games allow us to probe more deeply, and unravel enduring mysteries about our brains and behavior?

I decided to call up Hugo Spiers to find out. Spiers is a neuroscientist at University College London who has been using a game to study how people find their way around. In 2016, Spiers and his colleagues worked with Deutsche Telekom and the games company Glitchers to develop Sea Hero Quest, a mobile video game in which players have to navigate a sea in a boat. They have since been using the game to learn more about how people lose navigational skills in the early stages of Alzheimer’s disease.

The use of video games in neuroscientific research kicked into gear in the 1990s, Spiers tells me, following the release of 3D games like Wolfenstein 3D and Duke Nukem. “For the first time, you could have an entirely simulated world in which to test people,” he says.

Scientists could observe and study how players behaved in these games: how they explored their virtual environment, how they sought rewards, how they made decisions. And research volunteers didn’t need to travel to a lab—their gaming behavior could be observed from wherever they happened to be playing, whether that was at home, at a library, or even inside an MRI scanner.

For scientists like Spiers, one of the biggest advantages of using games in research is that people want to play them. The use of games allows scientists to explore fundamental experiences like fun and curiosity. Researchers often offer a small financial incentive to volunteers who take part in their studies. But they don’t have to pay people to play games, says Spiers.

You’re much more likely to have fun if you’re motivated. It’s just not quite the same when you’re doing something purely for the money. And not having to pay participants allows researchers to perform huge studies on smaller budgets. Spiers has been able to collect data on over 4 million people from 195 countries, all of whom have willingly played Sea Hero Quest.  

AI could help researchers go even further. A rich, immersive world filled with characters that interact in realistic ways could help them study how our minds respond to various social settings and how we relate to other individuals. By observing how players interact with AI characters, scientists can learn more about how we cooperate—and compete—with others. It would be far cheaper and easier than hiring actors to engage with research volunteers, says Spiers.

Spiers himself is interested in learning how people hunt, whether for food, clothes, or a missing pet. “We still use these bits of our brain that our ancestors would have used daily, and of course some traditional communities still hunt,” he tells me. “But we know almost nothing about how the brain does this.” He envisions using AI-driven nonplayer characters to learn more about how humans cooperate for hunting.

There are other, newer questions to explore. At a time when people are growing attached to “virtual companions,” and an increasing number of AI girlfriends and boyfriends are being made available, AI video-game characters could also help us understand these novel relationships. “People are forming a relationship with an artificial agent,” says Spiers. “That’s inherently interesting. Why would you not want to study that?”

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My fellow London-based colleagues had a lot of fun generating an AI game character based on Niall. He turned out to be a sarcastic, smug, and sassy monster.

Google DeepMind has developed a generative AI model that can generate a basic but playable video game from a short description, a hand-drawn sketch, or a photo, as my colleague Will Heaven wrote earlier this year. The resulting games look a bit like Super Mario Bros.

Today’s world is undeniably gamified, argues Bryan Gardiner. He explores how we got here in another article from the Play issue of the magazine.

Large language models behave in unexpected ways. And no one really knows why, as Will wrote in March.

Technologies can be used to study the brain in lots of different ways—some of which are much more invasive than others. Tech that aims to read your mind and probe your memories is already being used, as I wrote in a previous edition of The Checkup.

From around the web:

Bad night of sleep left you needing a pick-me-up? Scientists have designed an algorithm to deliver tailored sleep-and-caffeine-dosing schedules to help tired individuals “maximize the benefits of limited sleep opportunities and consume the least required amount of caffeine.” (Yes, it may have been developed with the US Army in mind, but surely we all stand to benefit?) (Sleep)

Is dog cloning a sweet way to honor the memory of a dearly departed pet, or a “frivolous and wasteful and ethically obnoxious” pursuit in which humans treat living creatures as nothing more than their own “stuff”? This feature left me leaning toward the latter view, especially after learning that people tend to like having dogs with health problems … (The New Yorker)

States that have enacted the strongest restrictions to abortion access have also seen prescriptions for oral contraceptives plummet, according to new research. (Mother Jones)

And another study has linked Texas’s 2021 ban on abortion in early pregnancy with an increase in the number of infant deaths recorded in the state. In 2022, across the rest of the US, the number of infant deaths ascribed to anomalies present at birth decreased by 3.1%. In Texas, this figure increased by 22.9%. (JAMA Pediatrics)

We are three months into the bird flu outbreak in US dairy cattle. But the country still hasn’t implemented a sufficient testing infrastructure and doesn’t fully understand how the virus is spreading. (STAT)

Should social media come with a health warning?

This article first appeared in The Checkup, MIT Technology Review’s weekly biotech newsletter. To receive it in your inbox every Thursday, and read articles like this first, sign up here. 

Earlier this week, the US surgeon general, also known as the “nation’s doctor,” authored an article making the case that health warnings should accompany social media. The goal: to protect teenagers from its harmful effects. “Adolescents who spend more than three hours a day on social media face double the risk of anxiety and depression symptoms,” Vivek Murthy wrote in a piece published in the New York Times. “Additionally, nearly half of adolescents say social media makes them feel worse about their bodies.”

His concern instinctively resonates with me. I’m in my late 30s, and even I can end up feeling a lot worse about myself after a brief stint on Instagram. I have two young daughters, and I worry about how I’ll respond when they reach adolescence and start asking for access to whatever social media site their peers are using. My children already have a fascination with cell phones; the eldest, who is almost six, will often come into my bedroom at the crack of dawn, find my husband’s phone, and somehow figure out how to blast “Happy Xmas (War Is Over)” at full volume.

But I also know that the relationship between this technology and health isn’t black and white. Social media can affect users in different ways—often positively. So let’s take a closer look at the concerns, the evidence behind them, and how best to tackle them.

Murthy’s concerns aren’t new, of course. In fact, almost any time we are introduced to a new technology, some will warn of its potential dangers. Innovations like the printing press, radio, and television all had their critics back in the day. In 2009, the Daily Mail linked Facebook use to cancer.

More recently, concerns about social media have centered on young people. There’s a lot going on in our teenage years as our brains undergo maturation, our hormones shift, and we explore new ways to form relationships with others. We’re thought to be more vulnerable to mental-health disorders during this period too. Around half of such disorders are thought to develop by the age of 14, and suicide is the fourth-leading cause of death in people aged between 15 and 19, according to the World Health Organization. Many have claimed that social media only makes things worse.

Reports have variously cited cyberbullying, exposure to violent or harmful content, and the promotion of unrealistic body standards, for example, as potential key triggers of low mood and disorders like anxiety and depression. There have also been several high-profile cases of self-harm and suicide with links to social media use, often involving online bullying and abuse. Just this week, the suicide of an 18-year-old in Kerala, India, was linked to cyberbullying. And children have died after taking part in dangerous online challenges made viral on social media, whether from inhaling toxic substances, consuming ultra-spicy tortilla chips, or choking themselves.

Murthy’s new article follows an advisory on social media and youth mental health published by his office in 2023. The 25-page document, which lays out some of known benefits and harms of social media use as well as the “unknowns,” was intended to raise awareness of social media as a health issue. The problem is that things are not entirely clear cut.

“The evidence is currently quite limited,” says Ruth Plackett, a researcher at University College London who studies the impact of social media on mental health in young people. A lot of the research on social media and mental health is correlational. It doesn’t show that social media use causes mental health disorders, Plackett says.

The surgeon general’s advisory cites some of these correlational studies. It also points to survey-based studies, including one looking at mental well-being among college students after the rollout of Facebook in the mid-2000s. But even if you accept the authors’ conclusion that Facebook had a negative impact on the students’ mental health, it doesn’t mean that other social media platforms will have the same effect on other young people. Even Facebook, and the way we use it, has changed a lot in the last 20 years.

Other studies have found that social media has no effect on mental health. In a study published last year, Plackett and her colleagues surveyed 3,228 children in the UK to see how their social media use and mental well-being changed over time. The children were first surveyed when they were aged between 12 and 13, and again when they were 14 to 15 years old.

Plackett expected to find that social media use would harm the young participants. But when she conducted the second round of questionnaires, she found that was not the case. “Time spent on social media was not related to mental-health outcomes two years later,” she tells me.

Other research has found that social media use can be beneficial to young people, especially those from minority groups. It can help some avoid loneliness, strengthen relationships with their peers, and find a safe space to express their identities, says Plackett. Social media isn’t only for socializing, either. Today, young people use these platforms for news, entertainment, school, and even (in the case of influencers) business.

“It’s such a mixed bag of evidence,” says Plackett. “I’d say it’s hard to draw much of a conclusion at the minute.”

In his article, Murthy calls for a warning label to be applied to social media platforms, stating that “social media is associated with significant mental-health harms for adolescents.”

But while Murthy draws comparisons to the effectiveness of warning labels on tobacco products, bingeing on social media doesn’t have the same health risks as chain-smoking cigarettes. We have plenty of strong evidence linking smoking to a range of diseases, including gum disease, emphysema, and lung cancer, among others. We know that smoking can shorten a person’s life expectancy. We can’t make any such claims about social media, no matter what was written in that Daily Mail article.

Health warnings aren’t the only way to prevent any potential harms associated with social media use, as Murthy himself acknowledges. Tech companies could go further in reducing or eliminating violent and harmful content, for a start. And digital literacy education could help inform children and their caregivers how to alter the settings on various social media platforms to better control the content children see, and teach them how to assess the content that does make it to their screens.

I like the sound of these measures. They might even help me put an end to the early-morning Christmas songs. 

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Bills designed to make the internet safer for children have been popping up across the US. But individual states take different approaches, leaving the resulting picture a mess, as Tate Ryan-Mosley explored.

Dozens of US states sued Meta, the parent company of Facebook, last October. As Tate wrote at the time, the states claimed that the company knowingly harmed young users, misled them about safety features and harmful content, and violated laws on children’s privacy.  

China has been implementing increasingly tight controls over how children use the internet. In August last year, the country’s cyberspace administrator issued detailed guidelines that include, for example, a rule to limit use of smart devices to 40 minutes a day for children under the age of eight. And even that use should be limited to content about “elementary education, hobbies and interests, and liberal arts education.” My colleague Zeyi Yang had the story in a previous edition of his weekly newsletter, China Report.

Last year, TikTok set a 60-minute-per-day limit for users under the age of 18. But the Chinese domestic version of the app, Douyin, has even tighter controls, as Zeyi wrote last March.

One way that social media can benefit young people is by allowing them to express their identities in a safe space. Filters that superficially alter a person’s appearance to make it more feminine or masculine can help trans people play with gender expression, as Elizabeth Anne Brown wrote in 2022. She quoted Josie, a trans woman in her early 30s. “The Snapchat girl filter was the final straw in dropping a decade’s worth of repression,” Josie said. “[I] saw something that looked more ‘me’ than anything in a mirror, and I couldn’t go back.”

From around the web

Could gentle shock waves help regenerate heart tissue? A trial of what’s being dubbed a “space hairdryer” suggests the treatment could help people recover from bypass surgery. (BBC)

“We don’t know what’s going on with this virus coming out of China right now.” Anthony Fauci gives his insider account of the first three months of the covid-19 pandemic. (The Atlantic)

Microplastics are everywhere. It was only a matter of time before scientists found them in men’s penises. (The Guardian)

Is the singularity nearer? Ray Kurzweil believes so. He also thinks medical nanobots will allow us to live beyond 120. (Wired)

Biotech companies are trying to make milk without cows

The outbreak of avian influenza on US dairy farms has started to make milk seem a lot less wholesome. Milk that’s raw, or unpasteurized, can actually infect mice that drink it, and a few dairy workers have already caught the bug. 

The FDA says that commercial milk is safe because it is pasteurized, killing the germs. Even so, it’s enough to make a person ponder a life beyond milk—say, taking your coffee black or maybe drinking oat milk.

But for those of us who can’t do without the real thing, it turns out some genetic engineers are working on ways to keep the milk and get rid of the cows instead. They’re doing it by engineering yeasts and plants with bovine genes so they make the key proteins responsible for milk’s color, satisfying taste, and nutritional punch.

The proteins they’re copying are casein, a floppy polymer that’s the most abundant protein in milk and is what makes pizza cheese stretch, and whey, a nutritious combo of essential amino acids that’s often used in energy powders.

It’s part of a larger trend of replacing animals with ingredients grown in labs, steel vessels, or plant crops. Think of the Impossible burger, the veggie patty made mouthwatering with the addition of heme, a component of blood that’s produced in the roots of genetically modified soybeans.

One of the milk innovators is Remilk, an Israeli startup founded in 2019, which has engineered yeast so it will produce beta-lactoglobulin (the main component of whey). Company cofounder Ori Cohavi says a single biotech factory of bubbling yeast vats feeding on sugar could in theory “replace 50,000 to 100,000 cows.” 

Remilk has been making trial batches and is testing ways to formulate the protein with plant oils and sugar to make spreadable cheese, ice cream, and milk drinks. So yes, we’re talking “processed” food—one partner is a local Coca-Cola bottler, and advising the company are former executives of Nestlé, Danone, and PepsiCo.

But regular milk isn’t exactly so natural either. At milking time, animals stand inside elaborate robots, and it looks for all the world as if they’re being abducted by aliens. “The notion of a cow standing in some nice green scenery is very far from how we get our milk,” says Cohavi. And there are environmental effects: cattle burp methane, a potent greenhouse gas, and a lactating cow needs to drink around 40 gallons of water a day. 

“There are hundreds of millions of dairy cows on the planet producing greenhouse waste, using a lot of water and land,” says Cohavi. “It can’t be the best way to produce food.”  

For biotech ventures trying to displace milk, the big challenge will be keeping their own costs of production low enough to compete with cows. Dairies get government protections and subsidies, and they don’t only make milk. Dairy cows are eventually turned into gelatin, McDonald’s burgers, and the leather seats of your Range Rover. Not much goes to waste.

At Alpine Bio, a biotech company in San Francisco (also known as Nobell Foods), researchers have engineered soybeans to produce casein. While not yet cleared for sale, the beans are already being grown on USDA-sanctioned test plots in the Midwest, says Alpine’s CEO, Magi Richani. 

Richani chose soybeans because they’re already a major commodity and the cheapest source of protein around. “We are working with farmers who are already growing soybeans for animal feed,” she says. “And we are saying, ‘Hey, you can grow this to feed humans.’ If you want to compete with a commodity system, you have to have a commodity crop.”

Alpine intends to crush the beans, extract the protein, and—much like Remilk—sell the ingredient to larger food companies.

Everyone agrees that cow’s milk will be difficult to displace. It holds a special place in the human psyche, and we owe civilization itself, in part, to domesticated animals. In fact, they’ve  left their mark in our genes, with many of us carrying DNA mutations that make cow’s milk easier to digest.  

But that’s why it might be time for the next technological step, says Richani. “We raise 60 billion animals for food every year, and that is insane. We took it too far, and we need options,” she says. “We need options that are better for the environment, that overcome the use of antibiotics, and that overcome the disease risk.”

It’s not clear yet whether the bird flu outbreak on dairy farms is a big danger to humans. But making milk without cows would definitely cut the risk that an animal virus will cause a new pandemic. As Richani says: “Soybeans don’t transmit diseases to humans.”

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Hungry for more from the frontiers of fromage? In the Build issue of our print magazine, Andrew Rosenblum tasted a yummy brie made only from plants. Harder to swallow was the claim by developer Climax Foods that its cheese was designed using artificial intelligence.

The idea of using yeast to create food ingredients, chemicals, and even fuel via fermentation is one of the dreams of synthetic biology. But it’s not easy. In 2021, we raised questions about high-flying startup Ginkgo Bioworks. This week its stock hit an all-time low of $0.49 per share as the company struggles to make … well, anything.

This spring, I traveled to Florida to watch attempts to create life in a totally new way: using a synthetic embryo made in a lab. The action involved cattle at the animal science department of the University of Florida, Gainesville.

From around the web

How many human bird flu cases are there? No one knows, because there’s barely any testing. Scientists warn we’re flying blind as US dairy farms struggle with an outbreak. (NBC)  

Moderna, one of the companies behind the covid-19 shots, is seeing early success with a cancer vaccine. It uses the same basic technology: gene messages packed into nanoparticles. (Nature)

It’s the covid-19 theory that won’t go away. This week the New York Times published an op-ed arguing that the virus was the result of a lab accident. We previously profiled the author, Alina Chan, who is a scientist with the Broad Institute. (NYTimes)

Sales of potent weight loss drugs, like Ozempic, are booming. But it’s not just humans who are overweight. Now the pet care industry is dreaming of treating chubby cats and dogs, too. (Bloomberg)