TIME neuroscience

Your Brain Learns New Words By Seeing Them Not Hearing Them

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Chris Ryan—Getty Images/Caiaimage

To be a really proficient reader, it’s not enough to “hear” words. You also have to see them

We start to talk before we can read, so hearing words, and getting familiar with their sounds, is obviously a critical part of learning a language. But in order to read, and especially in order to read quickly, our brains have to “see” words as well.

At least that’s what Maximilian Riesenhuber, a neuroscientist at Georgetown University Medical Center, and his colleagues found in an intriguing brain-mapping study published in the Journal of Neuroscience. The scientists recruited a small group of college students to learn a set of 150 nonsense words, and they imaged their brains before and after the training.

Before they learned the words, their brains registered them as a jumble of symbols. But after they were trained to give them a meaning, the words looked more like familiar words they used every day, like car, cat or apple.

MORE: Mistakes to Avoid When Learning a Foreign Language

The difference in way the brain treated the words involved “seeing” them rather than sounding them out. The closest analogy would be for adults learning a foreign language based on a completely different alphabet system. Students would have to first learn the new alphabet, assigning sounds to each symbol, and in order to read, they would have to sound out each letter to put words together.

In a person’s native language, such reading occurs in an entirely different way. Instead of taking time to sound out each letter, the brain trains itself to recognize groups of letters it frequently sees together — c-a-r for example — and dedicates a set of neurons in a portion of the brain that activates when these letters appear.

In the functional MRI images of the volunteers’ brains, that’s what Riesenhuber saw. The visual word form area, located in the left side of the visual cortex, is like a dictionary for words, and it stores the visual representation of the letters making up thousands of words. This visual dictionary makes it possible to read at a fast pace rather than laboriously sounding out each letter of each word every time we read. After the participants were trained to learn the meaningless words, this part of their brains was activated.

MORE: An Infant’s Brain Maps Language From Birth, Study Says

“Now we are seeing words as visual objects, and phonetics is not involved any more,” he says. “We recognize the word as a chunk so we go directly from a visual pattern to the word’s meaning, and we don’t detour to the auditory system.”

The idea of a visual dictionary could also help researchers to better understanding reading or learning disorders like dyslexia. More research could reveal whether the visual word form area in people with such disabilities is different in any way, or whether they tend to read via more auditory pathways. “I helps us understand in a general way how the brain learns, the fastest way of learning, and how to build on prior learning,” says Riesenhuber.

TIME Cancer

Why Angelina Jolie Chose to Have Her Ovaries Removed

"This surgery decision is more straightforward than the decision to have the breasts removed.”

In an op-ed in the New York Times, Angelina Jolie Pitt announced that she recently had surgery to remove her ovaries and fallopian tubes. The procedure put her into menopause at age 39, and she will take replacement hormones for another decade or so.

“It is not easy to make these decisions,” she writes. She describes how she felt she “still [had] months to make the date” for her operation as she prepared herself both physically and emotionally to end her reproductive years.

MORE: The Angelina Effect

But cancer experts say that Jolie did the right thing. While her decision to remove both her breasts before she developed breast tumors was controversial, her latest choice to have her ovaries removed is less so, although equally difficult from both an emotional and physical point of view. “This surgery decision is more straightforward than the decision to have the breasts removed,” says Dr. Karen Lu, chair of gynecologic oncology at MD Anderson Cancer Center. “And it’s definitely a stronger recommendation than for the bilateral prophylactic mastectomy.”

For women like Jolie, who harbor either of the BRCA1 or BRCA2 mutations (Jolie is positive for BRCA1), their risk of breast cancer is anywhere from 80% to 90% higher than that of women without the genetic aberrations. But there are ways that doctors can screen for even the smallest tumors in the breast and therefore get a heads up when the cancer is growing. That allows many women to choose to keep their breasts and have a lumpectomy followed by radiation, with more frequent and vigilant screening for any additional or recurrent growths.

There isn’t that luxury with ovarian cancer, which is often caught once the cancer has progressed and is harder to treat. Women with the BRCA mutations have an up to 50% greater chance of developing this type of cancer, and there are no good ways of screening for it; a blood test that picks up a protein common to ovarian tumors isn’t specific to the cancer, so it could provide false positive or false negative results. In most cases, the cancer is well advanced before doctors, or patients, even know it’s there. “It is incurable in most cases for the vast majority of women,” says Lu.

That’s why the National Comprehensive Cancer Network, and the American Congress of Obstetricians and Gynecologists strongly recommend that women with BRCA1 mutations have their ovaries and fallopian tubes removed by age 40, and those with BRCA2 mutations by age 45.

MORE: Angelina Jolie’s Double Mastectomy: What We Know About BRCA Mutations and Breast Cancer

That doesn’t mean it isn’t still a difficult one to make. For women who learn they have a BRCA mutation in their 20s or 30s, for example, and have no history of cancer — yet —they have to decide whether they want to have children at all, or whether they want to continue adding to their family if they already have, or whether they are ready to enter menopause. For such pre-vivors of cancer, who are at higher risk of the disease but haven’t yet developed tumors, the choice between invasive surgery, and a theoretical risk of something occurring in the future, is agonizing.

For them, there may be other options soon. Researchers at MD Anderson, for example, are testing whether women and keep their ovaries for a little longer if they have their fallopian tubes removed first, since there are signs that ovarian cancer may start in the tubes. Jolie writes about promising studies that suggest birth control pills can lower the risk of ovarian cancer in women with BRCA mutations, but the data is still conflicting.

For now, the option that gives women with BRCA their best chance of avoiding ovarian cancer is surgery.”We are absolutely trying to develop medicinal approaches to reducing risk, and understand the disease better,” says Dr. Larry Norton, medical director of the Evelyn H. Lauder Breast Center at Memorial Sloan Kettering Cancer Center. “But right now, as of this minute, there is no medicinal or herbal approach to reduce risk anywhere close to what we can do with surgery.”

“I feel deeply for women for whom this moment comes very early in life, before they have had their children,” Jolie writes. “But it is possible to take control and tackle head-on any health issue. I feel at ease with whatever will come, not because I am strong but because this is a part of life. It is nothing to be feared.”

MORE: Angelina Jolie’s Double Mastectomy: It’s Not the Only Option

TIME medicine

Many Doctors Don’t Tell Patients They Have Alzheimer’s

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PASIEKA—Getty Images/Science Photo Library RM

It’s hard to believe in today’s era of transparency in modern medicine, but there’s a diagnosis that doctors still try to keep from their patients

In a surprising new survey of patients who were asked about their interactions with their doctors, 45% of people whose doctors treated them for Alzheimer’s never told these patients that they had the degenerative brain disorder.

Led by researchers at the Alzheimer’s Association, the scientists looked at Medicare claim data from 2008 to 2010 for 16,000 people. They were asked, among other things, whether their doctors had ever told them they had Alzheimer’s disease. When the researchers then matched the respondents’ answers to their medical records, and the diagnostic codes that their doctors used to describe their care, only 45% of those who were billed for Alzheimer’s-related care were told by their doctors of their disease.

MORE New Research on Understanding Alzheimer’s

“What struck us was that physicians generally understand the positive benefits of disclosing the diagnosis, and agree with those benefits,” says Keith Fargo, director of scientific programs and outreach at the Association, who oversaw the analysis of the survey data. “But many still don’t do disclosure in their own practice.”

One of the few papers investigating the phenomenon of Alzheimer’s diagnoses found that as few as 36% of doctors said they usually told their patients if they had Alzheimer’s. The main reasons for the intentional omission? Fear of causing emotional distress in their patients and the lack of time and resources to fully explain what the diagnosis means. This was true of both primary care doctors as well as neurology specialists who have more expertise in brain-related disorders.

Dr. Robert Wergin, president of the American Academy of Family Physicians, advocates for transparency and honesty in disclosing diagnoses to his patients in his practice in Milford, Nebraska. But he understands why many physicians might be reluctant to use the word “Alzheimer’s” with their patients. “Labels are important,” he says. “When I label you and say you’ve got Alzheimer’s disease, then you’re likely to say, ‘Well that’s it for me, I better start looking for nursing homes.’”

MORE This Alzheimer’s Breakthrough Could Be a Game Changer

Alzheimer’s is a challenging diagnosis to make on several levels. First, it can only be definitively diagnosed at autopsy, when doctors can see the hallmark amyloid plaques and tangles that cause the gradual loss of memory and cognitive function. There is no blood test or brain scan that can conclusively tell doctors that a patient does or does not have the condition; while promising versions are being developed, it’s still a diagnosis that doctors make based on reports of the patients’ changing intellectual abilities and on psychiatric tests that aren’t specific for Alzheimer’s.

It’s also difficult to tell patients they likely have Alzheimer’s because there are currently no effective drugs for the disease. Medications can slow the effects of the cognitive decline, but nothing can stop or reverse the march of worsening symptoms. Wergin notes that once a patient is labeled with Alzheimer’s it could, at least before the Affordable Care Act, affect that patient’s ability to get insurance for nursing home care. “Once I label you, it’s in your chart. If an insurance company extracts your data, I’m not going to insure you because you are at higher risk of drawing on your coverage,” he says.

MORE New Test May Predict Alzheimer’s 10 Years Before Diagnosis

Wergin says that doctors may be over-anticipating the emotional distress that an Alzheimer’s diagnosis can bring. While the news is certainly difficult, most patients and their caregivers may already be aware that a neurodegenerative disease like Alzheimer’s may be present. And while there are no treatments that physicians can prescribe for their patients — at least not yet — Fargo and Beth Kallmyer, vice president of constituent services at the Association, note that it’s particularly important for Alzheimer’s patients and their families to know what to expect so they can begin planning. “There might not be a pill that slows the disease down or there might not be cures, but there are things people can do to impact their everyday quality of life,” says Kallmyer. “They can build a care team, and prepare advanced directives. And if a caregiver has knowledge of the disease, they can make things better in the day to day world of the person with the disease. If they don’t know about the diagnosis, they may not get that support.”

MORE Breakthrough Discoveries of Alzheimer’s Genes

But making doctors more comfortable with the diagnosis will take more structural changes in the way we deliver health care. The Alzheimer’s Association is supporting legislation that would reimburse doctors and their staff for a longer discussion about Alzheimer’s and how to plan for the disease. More medical schools are also including discussion about such planning in their curricula, as doctors in coming decades will be increasingly called upon to make this difficult disclosure.

Read next: A Simple 3-Part Test May Predict Alzheimer’s

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TIME medicine

Your Doctor Likely Orders More Tests Than You Actually Need

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Javier Larrea—Getty Images/age fotostock RM

The surprising non-medical reasons why emergency room doctors order too many tests

When you’re rushed to an emergency room, the doctors immediately order a battery of tests to figure out what’s wrong. But while scans and blood draws can tell them an incredible amount about what’s ailing you and the best treatment you should get, study after study shows that all of this testing isn’t actually leading to better care. Now, a new survey of emergency room doctors suggests why.

Of the 435 ER physicians asked about the tests they order for their patients, more than 85% admitted that in general, they call for too many tests, even if they know the results won’t really help them decide how to treat their patients. Reporting in the journal Academic Emergency Medicine, the authors also say that nearly all of the doctors—97%—admitted to personally ordering unnecessary imaging tests.

“So many physicians acknowledged that they ordered tests for no medical reason, which makes it clear that physicians feel enormous pressure to behave in a way they may not want to,” says Dr. Hemal Kanzaria, an emergency room physician at University of California Los Angeles and lead author of the study.

Such unnecessary testing is contributing to an estimated $210 billion in additional health care costs; ideally, appropriately used testing should reduce costs by detecting and diagnosing problems early, so patients can get the right treatments and avoid more expensive care.

The top two reasons the doctors ordered these tests were fear of missing something that would help them diagnose their patients, and protection against malpractice. “The over-testing is not due to lack of knowledge on the physicians’ part or poor medical judgment. It more likely reflects the fact that as a society, we don’t like uncertainty, and that has led to an oversimplification of medical care,” says Kanzaria. “There is the thought that if there is any possibility of disease, then we should do something about it, and if there is any doubt, we should test. If the test helps one patient, then everyone should get the test.” So even when doctors know that a test won’t add much information to their treatment decision, they’re more concerned that the patient will want to know why the test wasn’t performed.

Such decision-making behavior won’t change until more systemic problems in the way health care is delivered and paid for are addressed, the study authors say. They note that the way physicians are held accountable for medical decisions also needs to change, and patients need to become more involved in treatment decisions. That way, they say, the cultural expectation that doctors can never get a diagnosis wrong may start to fade. Doctors also need to be better trained and educated about the latest technologies and which patients will benefit most from them, they add.

The doctors also said that they’d welcome patients becoming more involved in the decision-making process. There isn’t data suggesting that such shared decision-making would reduce unnecessary testing, but if doctor and patient are more open about the reasons for testing or not testing, then perhaps fewer tests might be done for non-medical reasons.

“We need to be more cognizant of the culture within and outside of medicine that contributes to over-testing, and we need to address these systems and drivers,” says Kanzaria. “That’s what I hope will result from this work.”

Read next: Ebola Continues to Punish Survivors One Year After Start of Outbreak

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TIME Diet/Nutrition

Here’s One Way to Improve School Lunches

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Yellow Dog Productions—Getty Images For many children, half their daily calories come from school lunch

With so many children getting about half of their daily calories from school meals, it’s critical that school cafeterias provider healthier options. The latest research suggests one way to get kids to eat more fruits and vegetables

If everyone had a personal chef, we’d all eat better. And if every school had a chef overseeing its recipes and menus, then kids would eat better too, right?

That’s the idea behind the latest study published in JAMA Pediatrics. With 32 million children in the U.S. eating school lunches—some of those at schools where pizza is considered a vegetable—there’s a movement to bring healthy food to the school cafeteria. But could a chef really make a difference?

MORE: Here’s What School Lunches Around the World Look Like

The answer, as Juliana Cohen from the Harvard School of Public Health and her colleagues found out, is a resounding yes. The First Lady’s Chefs Move to Schools program and the Smarter Lunchrooms movement have pushed two new ways of bringing healthier fare to students: by hiring chefs to work in school cafeterias, and by something they called a “smart café” system: strategically placing healthy foods like fruits and vegetables more prominently in lunch lines.

To test each strategy, as well as the two methods together, Cohen went to 14 schools in low-income Massachusetts urban areas and watched what 2,638 students in 3rd grade through 8th grade put on their trays and ate during lunch for seven months. Some schools were randomly assigned for the first three months to work with a chef to develop and modify recipes, some simply focused on the placement of healthy food, and some did both. The scientists studied what was left on the students’ plates as a way to determine what and how much of their food the students were eating.

MORE: Michelle Obama Bites Back at Critics of Her Healthy School Lunch Standards

At the chef schools, the chances that the students selected fruit from the lunch line increased threefold compared to schools without a chef’s influence, and the odds that they actually tried some of the fruit increased by 17%. Researchers saw similar boosts with vegetables; students in the chef schools were nearly three times as likely to choose veggies, and 16% more likely to actually eat them.

When the researchers looked at the schools that used both the chefs and the smart café strategies, the results were more mixed. Interestingly, the combination did not significantly affect the chances that students would grab fruits, but it dramatically increased the odds that children would pick up vegetables, compared to schools without either intervention.

“We were quite surprised to see that when we looked at the combined smart café and chefs, there was no additional benefit beyond the impact of the chef,” says Cohen, a research associate in the department of nutrition. “Really it’s the impact of the chef that is driving the increase in consumption. We also saw that chef schools also increased selection as well, so there is a double benefit in these schools.”

What the results highlight is that smart architecture and strategic placing of healthier foods in more prominent positions isn’t enough to get kids to eat them. But having a chef prepare school lunch does the trick.

MORE: Lunch Brought From Home is Unhealthier Than Cafeteria Food

At the schools assigned to use a chef, the chefs tested new recipes and gave out samples for students to try, as well as encouraged them to try new things, presumably those containing more vegetables and fruits. “Knowing that the chef inspired the recipes can change the mentality around cafeteria food,” says Cohen. “And having the chefs there showed the kids that the school cared about them, and cared about what they were feeding them.”

MORE: Most Schools Still Don’t Meet Federal Nutrition Standards

Cohen doesn’t see hiring full time chefs as a realistic or practical option for most school districts, but does suggest having several districts pool their resources to share a chef for training and nutrition education. At the schools in the study, some saw cost savings because the chefs not only revamped menus but helped staff with inventory control and more efficient use of their supplies. “They will gain long-lasting skills,” she says, noting that once they are trained, cafeteria staff could come up with their own additions and modifications to menus over time.

There won’t be a single easy fix to improving school lunches, and each school may need to find its own solution, but if Cohen’s study proves one thing, it’s that when it comes to getting kids to eat something — anything — taste is key. Even if it’s nutritious, if it tastes good too, students will eat it.

TIME medicine

There Could Soon Be a Pill to Make Us More Compassionate

How brain chemistry influences compassion

Biology may have a lot to do with our behavior, especially in social situations. And that means our social interactions could be manipulated by a pill.

That’s what a new study, published in the journal Current Biology, suggests. A group led by researchers at University of California Berkeley and University of California San Francisco shows that by manipulating a brain chemical, people can become more compassionate and act in prosocial ways to equalize differences.

In the study, 35 men and women visited the labs two times; each time they were randomly given a pill that keeps levels of dopamine, which is involved in reward and satisfaction, or a placebo. Neither the participants nor the scientists knew which pills were given when. The volunteers were then asked to divide money between themselves and a strangers.

When the researchers analyzed the results, they found that when the people were given the dopamine drug, they were more likely to share the money equitably compared to when they took the placebo.

The results certainly aren’t the answer to promoting more compassion in society, but they do hint that behaviors like social interaction might be affected by changing basic biological systems in the brain. “We have taken an important step toward learning how our aversion to inequity is influenced by our brain chemistry,” Ignacio Sáez, one of the study’s authors and a postdoctoral researcher at Berkeley’s Haas School of Business, said in a statement. “Studies in the past decade have shed light on the neural circuits that govern how we behave in social situations. What we show here is one brain ‘switch’ we can affect.”

Read next: 14 Emotional Dispatches From Key Ebola Fighters

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TIME wrestling

Mexican Wrestler Dies After Hit in the Ring

Other wrestlers continued fighting before realizing Ramirez wasn't moving.

Mexico’s Pedro Aguayo Ramirez, a popular member of the country’s ‘Lucha Libre’ wrestling world, died Saturday after a blow during a bout in Tijuana. He was 35.

Ramirez was fighting Oscar Gutierrez in a team matchup when he was apparently hit in the neck and went limp against the ropes, the Associated Press reports. Referees and other wrestlers continued fighting for several minutes before realizing Ramirez wasn’t moving.

The local prosecutor’s office said he was taken to a hospital nearby and pronounced dead at 1:30 a.m. Ramirez began wrestling as a teen, following his after father, a well-known wrestling personality.

TIME Research

There’s New Evidence About How Life on Earth Began

Getty Images
Getty Images Conceptual artwork of ribonucleic acid.

Some support for the primordial ooze theory

How did life on Earth start? Did it emerge from the primordial ooze as is popularly believed, or did it land here from a comet or some other celestial body?

A new study in the journal Nature Chemistry provides strong evidence that the ingredients necessary to concoct the first life forms did indeed exist on earth. The scientists say that they used hydrogen sulfide, hydrogen cyanide and ultraviolet light—three basic elements that were available pre-life as we know it—to create the building blocks of compounds that eventually led to the genetic material that all life on earth holds in common, DNA.

The process also likely got some extraterrestrial help. They speculate that meteorites might have reacted with nitrogen in the atmosphere to create hydrogen cyanide, and that in water, that chemical could have interacted with both hydrogen sulfide and the sun’s UV light.

TIME medicine

5 Things to Know on World Down Syndrome Day

World Down Syndrome Day 2014 Celebrated in Indonesia
Robertus Pudyanto—Getty Images A girl with Down syndrome takes part in planting a tree during World Down Syndrome Day on March 21, 2014 in Surabaya, Indonesia.

From how it happens to what it does

Saturday is World Down Syndrome Day, a day recognized each year by the United Nations to raise awareness about the genetic disease. Here are five things you need to know about Down syndrome.

1. Down syndrome is caused by an extra set of chromosome 21. Every cell in the body has 23 pairs of chromosomes, one from each parent, but Down occurs when one parent contributes extra genetic material. Older mothers have a higher chance of having a Down baby.

2. More than 400,000 people live with Down in the U.S.

3. The most common symptoms of Down include cognitive delays, low muscle tone and a small stature.

4. People with Down can lead full, independent lives. They are, however, at higher risk of developing heart, respiratory problems and certain cancers.

5. People with Down are living much longer than in the past, thanks to treatments for their health issues. While the average life expectancy in 1983 was 25 years, today it is 60 years.

TIME Internet

Now You Can Own a Piece of Disney’s Magic Kingdom

Disney Monorail
Getty Images

Now is your chance to buy an original piece of the monorail that whisked people to the happiest place on earth—if you can afford it.

An eBay user is offering a car from the original train, for a steal—the opening bid is $169,000, and the monorails were valued at $6 million when they went into use at the park’s opening in 1971. So far, more than 800 people have viewed the page, but none have bid.

It’s used, obviously—in its prime, it transported 150,000 guests per day around the park.

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