TIME health

This is How Alzheimer’s Disease Got Its Name

Alois Alzheimer
Apic / Getty Images An undated portrait of Alois Alzheimer, German psychiatrist and neurologist

It was coined on July 15, 1910

It was on this day, July 15, in 1910 that the second volume of the German book General Psychiatry was published. Though the book was written by eminent psychiatrist Emil Kraepelin, it ended up preserving the name of a different doctor: it was the first time that a type of dementia was described as “Alzheimer’s disease.”

The name was in honor of Alois Alzheimer, another German psychiatrist, who in 1906 identified the cases of dementia described by Kraepelin. The pair were quite familiar with each others’ work. As recounted in Konrad and Ulrike Maurer’s Alzheimer: The Life of a Physician and the Career of a Disease, Kreapelin worked closely with Alzheimer, who even filled in for the former at work when he was busy writing General Psychiatry. Alzheimer had originally been Kraepelin’s research assistant in the medical school in Munich, and it was there that he was able to create a lab dedicated to research in brain science.

As TIME described in a 1983 article about the disease’s prevalence, Dr. Alzheimer had noticed that the brain of one of his patients—known as Auguste D—looked different from other brains:

His patient, a 51-year-old woman, suffered loss of memory, disorientation and later, severe dementia. After her death, Alzheimer conducted an autopsy on her brain and found the two distinctive characteristics of the disease: tangled clumps of nerve fibers and patches of disintegrated nerve-cell branches. Because Alzheimer’s patient was relatively young, AD was at first considered a disease of middle age; similar symptoms in elderly people were simply regarded as a natural consequence of aging. Today this view has been discarded. Even in an octogenarian, severe mental confusion “is a disease, not a natural decline,” says Catherine Bick, acting deputy director of the National Institute of Neurological Communicative Disorders and Stroke (NINCDS).

Alzheimer died in 1951.

Read the full story from 1983, here in the TIME Vault: Slow, Steady and Heartbreaking

TIME medicine

Just How Unsafe are Painkillers?

The FDA has added to its warning about the risks of certain painkillers

The U.S. Food and Drug Administration (FDA) has strengthened its warning that certain painkillers can cause heart problems.

On Thursday, the FDA updated its warnings for prescription and over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) to say they increase the chance of heart attack or stroke. The drugs, like ibuprofen (Advil) and naproxen (Aleve), already carry warnings that they “may cause” increased risk of heart attack and stroke, but the new labels will say that they “cause an increased risk” of heart failure, the New York Times reports. The FDA came to the decision after reviewing new evidence about the risks.

How great is the risk?
“There is no period of use shown to be without risk,” said Dr. Judy Racoosin, deputy director of FDA’s Division of Anesthesia, Analgesia, and Addiction Products, in a statement. Research suggests that higher doses of the drugs can be more problematic.

One 2013 study looked at more than 600 trials and found that compared to placebos, high doses of NSAIDs like coxibs and diclofenac increased the risk of serious heart problems, including heart attacks, by one-third. The research also showed that ibuprofen more than doubled the risk of major coronary events, and all NSAIDs studies were linked to a 2- to 4-fold increased risk of gastrointestinal complications.

Who is most at risk?
According to the FDA, people who have underlying heart disease are at greater risk, but the risk exists for everyone. “Today we know that the risk of heart attack and stroke may occur early in treatment, even in the first weeks,” the FDA says.

The FDA is also planning to add additional warnings for people who have already had a heart attack. “This vulnerable population is at an increased risk of having another heart attack or dying of heart attack-related causes if they’re treated with NSAIDs, according to studies,” the FDA said in a statement.

What should I do?
To keep risk lower, the FDA recommends users take the drugs at the lowest dose for the shortest duration possible. People should consult their doctor about whether or not they should take them if they have high blood pressure and should stop taking them if they have any symptoms of a heart-related issue, the FDA says.

Read next: Heroin Use in U.S. Reaches Epidemic Levels

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TIME Drugs

Some Antidepressants Linked to Higher Risk of Birth Defects

Drugs Prozac and Paxil are linked to certain defects in a new study

A new study finds women who used certain antidepressants could be more likely to have babies born with rare birth defects.

According to the study of 28,000 women by the Centers of Disease Control and Prevention (CDC), certain birth defects were more common among users of antidepressants Prozac and Paxil.

Prozac usage was linked to defects like misshapen skulls and Paxil was associated with defects such as intestines growing outside of the baby’s body and missing parts of the brain and skull. Both drugs were linked to heart defects, according to the study.

The study’s authors note that the risks are very small and that there is no proof that the drugs cause defects, but they did discover a link between using the drugs in early stages of pregnancy and some defects. Women were asked if they used certain antidepressants in the time just before they conceived and during the first three months of pregnancy.

The study, which was published Wednesday in the British Medical Journal, follows several studies that linked the entire class of antidepressants to defects. The study, however, did not find links with birth defects in antidepressants Celexa, Lexapro or Zoloft.


TIME Healthcare

4 Things That Make You Lose Your Voice

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Plenty of rest and fluids should help, but here's when to see a specialist

Laryngitis, the most common cause of hoarseness or voice loss, happens when your voice box becomes irritated or inflamed, leading to swelling that keeps your vocal cords from being able to open and close smoothly. (This vocal cord movement is what creates sound.) A viral infection, like a cold or the flu, is the usual culprit, but it’s not the only one.

Strain is also a top cause of laryngitis; just one night of cheering at a sporting event or concert can bring it on. Voice strain should go away on its own with rest and lots of fluids. But you really have to rest your voice, especially if you’ve lost it entirely; not only will staying quiet help you heal faster, but taxing your voice during laryngitis can damage vocal cords further and can lead to the formation of polyps or nodules that may require surgery.

If hoarseness persists beyond a few weeks or keeps coming back, there may be something else going on. One possibility is acid reflux. When stomach acid comes back up the esophagus, it can cause irritation of the vocal cords. The type of reflux most associated with voice issues is called laryngopharyngeal reflux disease, and it often doesn’t cause heartburn or nausea. Your doctor can prescribe antacids and other medication (like steroids) that can help your voice if it’s not getting better.

Another possible cause is a yeast infection in your throat, also called oral thrush. This appears most often in people with depressed immune systems, like those with HIV or cancer, but people using a corticosteroid inhaler to treat their asthma are also more prone. That’s because the steroid can locally decrease your immune function, which allows the overgrowth of yeast. Oral antifungals can solve it.

To get a diagnosis, see an ear, nose and throat specialist (ENT), who can take a look at your vocal cords with a scope to determine if acid reflux or yeast is robbing you of your voice. An ENT can also rule out something more serious, like laryngeal cancer, which often occurs with ear pain and a sore throat on top of voice issues.

This article originally appeared on Health.com

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TIME Innovation

How To Engineer Serendipity

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The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

It isn’t happy accidents—It’s a state of mind

I’d like to tell the story of a paradox: How do we bring the right people to the right place at the right time to discover something new, when we don’t know who or where or when that is, let alone what it is we’re looking for? This is the paradox of innovation: If so many discoveries — from penicillin to plastics – are the product of serendipity, why do we insist breakthroughs can somehow be planned? Why not embrace serendipity instead? Because here’s an example of what happens when you don’t.

When GlaxoSmithKline finished clinical trials in May of what it had hoped would be a breakthrough in treating heart disease, it found the drug stank — literally. In theory, darapladib was a wonder of genomic medicine, suppressing an enzyme responsible for cholesterol-clogged arteries, thus preventing heart attacks and strokes. But in practice it was a failure, producing odors so pungent that disgusted patients stopped taking it.

Glaxo hadn’t quite bet the company on darapladib, but it did pay nearly $3 billion to buy its partner in developing the drug, Human Genome Sciences. The latter’s founder, William Haseltine, once promised a revolution in drug discovery: After we had mapped every disease to every gene, we could engineer serendipity out of the equation. Darapladib was to have been the proof — the product of scientists carefully picking their way through the company’s vast genetic databases. Instead it’s a multi-billion-dollar write-off.

Big Pharma is hardly alone when it comes to overstating its ability to innovate, although it may be in the worst shape. By one estimate, the rate of new drugs developed per dollar spent by the industry has fallen by roughly a factor of 100 over the last 60 years. Patent statistics tell a similar story across industry after industry, from chemistry to metalworking to clean energy, in which top-down innovation has only grown more expensive and less efficient over time. According to a paper by Deborah Strumsky, José Lobo, and Joseph Tainter, the average size of research teams bloated by 48 percent between 1974 and 2005, while the number of patents per inventor fell 22 percent during that time. Instead of speeding up the pace of discovery, large hierarchical organizations are slowing down — a stagflationary principle known as “Eroom’s Law,” which is “Moore’s Law” spelled backwards. (Moore’s Law roughly states that computing power doubles every two years, a principle enshrined at the heart of technological progress.)

While Big Pharma’s American scientists were flailing, their counterparts at Paris Jussieu — the largest medical research complex in France — were doing some of their best work. The difference was asbestos. Between 1997 and 2012, Jussieu’s campus in Paris’s Left Bank reshuffled its labs’ locations five times due to ongoing asbestos removal, giving the faculty no control and little warning of where they would end up. An MIT professor named Christian Catalini later catalogued the 55,000 scientific papers they published during this time and mapped the authors’ locations across more than a hundred labs. Instead of having their life’s work disrupted, Jussieu’s researchers were three to five times more likely to collaborate with their new odd-couple neighbors than their old colleagues, did so nearly four to six times more often, and produced better work because of it (as measured by citations).

The lesson? We still have no idea how to pursue what former U.S. Defense Secretary Donald Rumsfeld famously described as “unknown unknowns.” Even an institution like Paris Jussieu, which presumably places a premium on collaboration across disciplines, couldn’t do better than scattering its labs at random. It’s not enough to ask where good ideas come from — we need to rethink how we go about finding them.

I believe there’s a third way between the diminishing returns of typical organizations and sheer luck. In Silicon Valley, they call it “engineering serendipity,” and if that strikes you as an oxymoron (which it is), perhaps we need to step back and redefine what serendipity means:

  1. Serendipity isn’t magic. It isn’t happy accidents. It’s a state of mind and a property of social networks — which means it can be measured, analyzed, and engineered.
  2. It’s a bountiful source of good ideas. Study after study has shown how chance collaborations often trump top-down organizations when it comes to research and innovation. The challenge is first recognizing the circumstances of these encounters, then replicating and enhancing them.

Any society that values novelty and new ideas (like our innovation-obsessed one) will invariably trend toward greater serendipity over time. The push toward greater diversity, better public spaces, and an expanded public sphere all increase the potential for fortuitous discoveries.

The flip side is that institutions failing to embrace serendipity will ossify and die. This is especially true in our current era of incessant disruption, as seen in rising corporate mortality rates and a surge of unpredictable “black swan” events. (Nassim Taleb’s advice for taming black swans, by the way? “Maximize the serendipity around you.”)

Finally, the greatest opportunities for engineering serendipity lie in software, which means we must take great care as to who can find us and how, before Google (or the NSA) makes these choices for us.

It’s no coincidence Silicon Valley is obsessed with serendipity. Everyone is familiar by now with the origins of the Post-it Note, Velcro, corn flakes, and Nike’s waffle sole, to say nothing of Teflon, Kevlar, dynamite, and vast swaths of modern chemistry and medicine. The Valley’s contributions include microprocessors and inkjet printers, while Steve Jobs didn’t discover desktop computing or the mouse until a reluctant visit to Xerox PARC in 1979 — which beget the Macintosh and everything after.

When Yahoo banned its employees from working from home in 2013, the reasons the struggling company gave had less to do with productivity than serendipity. “Some of the best decisions and insights come from hallway and cafeteria discussions, meeting new people, and impromptu team meetings,” explained an accompanying memo. The message from new CEO Marissa Mayer was clear: Working solo couldn’t compete with lingering around the coffee machine waiting for inspiration — in the form of a colleague — to strike.

Google and Facebook have gone Yahoo one better. Rather than sit back and wait for serendipity to happen, the search giant has commissioned a new campus expressly designed, in the words of its real estate chief, to maximize “casual collisions of the work force.” Rooftop cafés will offer additional opportunities for close encounters, and no employees in the complex will be more than two and a half minutes away from one another. “You can’t schedule innovation,” said David Radcliffe, but you can make introductions — as both Googlers and Mayer know well. The latter attributes the genesis of such projects as Gmail, Google News, and Street View on her watch to engineers meeting fortuitously at lunch.

Meanwhile, Facebook has hired architect Frank Gehry to build “the perfect engineering space: one giant room that fits thousands of people, all close enough to collaborate together,” founder Mark Zuckerberg explained. The goal of each company is the same: to create the best conditions for spreading the most valuable kind of ideas — the hunches locked inside our skulls until a felicitous combination of circumstances sets them free.

Mayer’s demand for proximity ignited a debate that’s still raging: What’s the best way to work, together or alone? Finally breaking her silence on the matter in the spring of 2013, she conceded “people are more productive when they’re alone,” then added, “but they’re more collaborative and innovative when they’re together. Some of the best ideas come from pulling two different ideas together.”

She’s right. (Not that Yahoo has many ideas to show for it.) We experience moments of serendipity daily, each with potentially huge payoffs down the road. But because we can’t predict which ideas will collide and fuse, we cling to boring productivity and efficiency. We not only run our lives but our entire economy this way, using GDP and even grosser statistics to measure progress that has never unfolded in a straight line. Life is emergent and unknowable — we’re just terrified to manage it that way. And because we only attribute our success to serendipity after the fact (if at all), we typically consign it to anecdotes (e.g. Post-it Notes), turning to them only when the numbers don’t add up. The problem is that more and more of the most important numbers — including patent applications, R&D budgets, and even economic growth — have stopped adding up.

We take the pace of innovation for granted. We assume that like Moore’s Law, the rate of scientific discoveries and inventions is smoothly accelerating. But we’re wrong. A growing body of research suggests the opposite is true; Eroom’s Law rules. That this is happening in nearly every industry means something deeper is at work — that the corporation itself is reaching its limits when it comes to invention. Like the long-dead societies he’s excavated, Joseph Tainter — who’s most famous for his book The Collapse of Complex Societiesbelieves companies have become too rigid and hierarchical to survive disruption, seeking only to discover what they already know. What’s missing is serendipity.

The same phenomenon that produced a gusher of new research papers at Paris Jussieu once produced the laser and transistor at Bell Labs and breakthroughs in linguistics and acoustics at MIT. It’s still happening in places like IBM’s Thomas J. Watson Research Center in Yorktown Heights, New York, where a chance meeting of a physicist and biologist in a hallway a few years ago led to a tiny microchip able to single-handedly sequence long strands of DNA. It’s no accident that the Watson Research Center produces more patents per year than any other building in the world, and IBM more than any other company.

In all of these cases, serendipity was responsible for the bridging of what the University of Chicago sociologist Ronald Burt calls “structural holes,” which appear when org charts and other formal structures create gaps in the informal network of experts floating through a company, campus, or city. In a landmark study a decade ago, Burt found that managers who straddled holes between teams and domains consistently produced better ideas than those who did not (and were rewarded accordingly). “This is not creativity born of genius,” he wrote. “It is creativity as an import-export business.” The easiest way to discover an idea, it would seem, is to borrow one.

Burt’s findings have been borne out again and again; in one study, a slight increase in serendipity generated more revenue and projects while speeding up their completion. (Contrary to Mayer’s mea culpa, it appears bumping into people makes you more productive, too.)

There’s a rich vein of research running through sociology, anthropology, network science, and management theory explaining how serendipity increases one’s “absorptive capacity,” i.e., our ability to recognize, assimilate, and put to use knowledge from outside our personal experience. Other studies demonstrate how successful firms harness serendipity to lower the costs and barriers to collaboration. And still others suggest that how we share “non-redundant information” across a social network is more important than the experience or credentials of any one person in the network itself, which explains how scattering scientists across a campus at random could vastly improve the quality of their work.

But perhaps the most interesting thing about all of these examples is that they were unintentional. Serendipity may not be luck after all — there is a hidden order to how we find new ideas and people — but we will never realize more than the tiniest fraction of its potential as long as we treat it that way. So how do we go further and actually plan for serendipity?

The first step takes place in our own minds. A few years ago, an Australian psychologist named James Lawley realized that no one had mapped the experience of serendipity before. Upon re-reading the letter in which the British aristocrat Horace Walpole coined the word in 1754, he noticed the fabled Three Princes of Serendip “were always making discoveries, by accidents and sagacity, of things they were not in quest of.” Today, all anyone remembers are the accidents. But equally important is sagacity, which the chemist Louis Pasteur famously called “the prepared mind.”

“What kind of mind is it?” Lawley asks. “One that thinks more systematically than simple cause-and-effect.” In other words, it’s a mind that’s open to the unexpected, to thinking in metaphors, to holding back and not jumping to conclusions, and to resist walls between domains and disciplines. It’s a mind that looks a lot like Joi Ito’s.

Ito is a former DJ, venture capitalist, and entrepreneur who moved to Dubai on a whim to get a better feel for the place. (That’s when he wasn’t traveling 300 days a year.) “My job was running around mostly making connections,” is how he describes it. That was before he was picked to run the MIT Media Lab, despite never finishing college himself.

Headlining a panel at 2013’s South by Southwest titled “The New Serendipity,” Ito talked about the qualities he’s cultivated within himself — being “antidisciplinary” and retaining his “beginner’s mind” — which he hopes will guide the Media Lab. “We aim to capture serendipity,” he said. “You don’t get lucky if you plan everything — and you don’t get serendipity unless you have peripheral vision and creativity.”

That’s also true for the next step, which is engineering serendipity into organizations. For all the talk of “failing faster” and disruptive innovation, an overwhelming majority of companies are still structured along predictable lines. Even Google cancelled “20 percent time,” its celebrated policy of granting engineers one day a week for personal projects. To capture serendipity, the company is looking at space instead of time — hence the design of its new campus, in which everyone is just a short “casual collision” away.

But how can we do a better job of bringing people together than installing bigger cafeteria tables, adding another coffee machine, or locking all the bathrooms but one? A start would be to tear down the walls preventing colleagues in one department or company from bumping into peers from another. That’s what AT&T has done with its worldwide Foundry network, where selected startups and entrepreneurs work alongside its own engineers as well as those from partners such as Intel, Cisco, and Ericsson. One of these startups, Intucell, improved AT&T’s call retention and throughput speeds by 10 percent and was later bought by Cisco for $475 million. In general, Foundry teams have cut the development time of new products from three years to nine months.

It’s telling that the Foundry outpost in Silicon Valley is stationed in downtown Palo Alto, where the chances of someone dropping in on their walk back from lunch are substantially greater than in some exurban office park. Cities are the greatest serendipity engines of all. They began life at crossroads as places to exchange goods and later ideas with others you would never encounter on the farm.

Only recently, we’ve come to recognize great ones for what they are — not as collections of skyscrapers (which China can build but can’t fill), but as the sum of their dense, rich, and overlapping networks of people. “They’re not a set of people, they’re not a set of roads; they’re a set of interactions,” says Luis Bettancourt, a physicist who describes cities as “social reactors.” Like the sun, they’re places where strangers collect, collide, and fuse — releasing tremendous heat and light in the process. What makes a city great, in other words, is how well its people are connected — to the city itself and to each other. And to make a city better, you have to engineer serendipity.

Which is what Tony Hsieh is trying to do in Las Vegas. Much has been written about the Zappos CEO’s flailing efforts to terraform downtown into a desert facsimile of Brooklyn or the Mission district, but his instincts are correct. He envisions every bar and coffee shop around the company’s downtown campus as an extension of its conference rooms, inviting strangers to work alongside his employees. He fervently believes blurring the line between the city and his company will make people in both smarter, happier, and more productive. “If you accelerate serendipity,” he says, “you’ll accelerate learning.”

To ensure that happens, he’s imported dozens of tech startups for his employees to learn from. Stipulated in their contracts is a promise to spend “1,000 hours per year of serendipitous encounters” downtown, searching for collisions and conversations. While it remains to be seen whether Hsieh can build a successful creative class company town, he’s right to believe the energies of the city are greater than any one company.

The final piece is the network. Google has made its ambitions clear — as far as chairman Eric Schmidt is concerned, the future of search is a “serendipity engine” answering questions you never thought to ask. “It’ll just know this is something that you’re going to want to see,” explained artificial intelligence pioneer Ray Kurzweil shortly after joining the company as its director of engineering.

One antidote to this all-encompassing filter bubble is an opposing serendipity engine proposed by MIT’s Ethan Zuckerman. In his book, Rewire, he sketches a set of recommendation and translation tools designed to nudge us out of our media comfort zones and “help us understand whose voices we’re hearing and whom we are ignoring.”

As Zuckerman points out, the greatest threats to serendipity are our ingrained biases and cognitive limits — we intrinsically want more known knowns, not unknown unknowns. This is the bias a startup named Ayasdi is striving to eliminate in Big Data.Rather than asking questions, its software renders its analysis as a network map, revealing hidden connections between tumors or terrorist cells, which CEO Gurjeet Singh calls “digital serendipity.”

IBM is trying something similar with Watson, tasking its fledgling artificial intelligence software with reading millions of scientific papers in hopes of finding leads no human researcher would ever have time to spot. Baylor’s College of Medicine used it this way to identify six new proteins for cancer research in a month; the entire scientific community typically finds one per year.

Baylor’s experiment — much like Paris Jussieu’s unintentional one — tells us something profound about the potential for new discoveries. Rather than compiling ever-bigger data sets or throwing more bodies at a problem, we need tools, organizations, and environments geared less toward efficiency — which is suffering from decreasing returns — and more toward what John Hagel III and John Seely Brown call “scalable learning,” in which serendipity is crucial.

So, what if we borrowed Ayasdi to power a social serendipity engine — one to identify who’s nearby, parse our hidden relationships, and make introductions? How would it work? We’d want it to be as easy as Tinder, which now owns half the mobile dating market. Next, we’d need context — why do I want to meet this person? Tinder works because its logic is binary: Swipe right or left. Everything else is harder.

That context exists somewhere in our data exhaust. For example, Relationship Science has mapped the connections between 3 million members of the 1 percent using publicly available information from more than 10,000 databases. Its customers use it to trace paths to their quarry via colleagues, corporate boards, and alma maters, with each link graded into strong, medium, and weak ties. Meanwhile, a startup named Rexter mines users’ email, calendars, and contacts to calculate the value of their connections and assign tasks accordingly. And, of course, there’s no shortage of sensors available — from smartphones to beacons to “sociometric badges.”

Now, take all of that and run it through Ayasdi’s digital serendipity engine. We could conceivably perform the equivalent of Baylor’s Watson experiment with the researchers of Paris Jussieu, plugging hundreds if not thousands of structural holes in months or even weeks, rather than fifteen years. What would we find then?

Usually, when I describe this vision, someone will reply, “But that isn’t serendipity!” I’m never quite sure what they mean — because it isn’t random or romantic? Serendipity is such a strange word; invented on a whim in 1754, it didn’t enter widespread circulation until almost two centuries later and is still notoriously difficult to translate. These days, it means practically whatever you want it to be.

So, I’m staking my own claim: Serendipity is the process through which we discover unknown unknowns. Understanding it as an emergent property of social networks, instead of sheer luck, enables us to treat it as a viable strategy for organizing people and sharing ideas, rather than writing it off as magic. And that, in turn, has potentially huge ramifications for everything from how we work to how we learn to where we live by leading to a shift away from efficiency — doing the same thing over and over, only a little bit better — toward novelty and discovery.

This essay was made possible with the generous support of the John S. and James L. Knight Foundation.

This article was originally published by The Aspen Institute on Medium

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

TIME diabetes

How Diabetes Harms the Brain


Diabetes can damage a number of organs, from the eyes to the kidneys and the heart. Now there’s fresh evidence that unchecked blood sugar can affect the brain as well, which may lead to drops in cognitive functions

When blood sugar levels start to climb in diabetes, a number of body systems are harmed—and that list includes the brain, since studies have linked diabetes with a higher risk of stroke and dementia. Now, a new study published in the journal Neurology reports that changes in blood vessel activity in the brains of diabetics may lead to drops in cognitive functions and their ability to perform daily activities.

Dr. Vera Novak, associate professor of neurology at Harvard Medical School and Beth Israel Deaconess Medical Center, and her colleagues followed a group of 65 older people. About half had type 2 diabetes, and half did not. After two years, the diabetic patients had lower scores on cognitive tests compared to when they began, while people without diabetes showed little change on the tests.

MORE: The Strange Way a Diabetes Drug May Help Skin Scars

What drove the decline, says Novak, were changes in the brains of the diabetic patients. Diabetes can cause blood vessels to be less responsive to the ebb and flow of demand in different parts of the brain. Normally, flexible vessels will swell slightly to increase blood flow and oxygen to areas that are more intensely active, such as regions involved in memory or higher reasoning during intellectual tasks. But unchecked blood sugar can make these vessels less malleable and therefore less responsive.

“When doing any task, from cognition to moving your fingers, you need to increase blood flow to that specific area of the brain,” says Novak. “With diabetes, however, that vasodilation ability is reduced, so you have fewer resources to perform any task.”

MORE: Statins May Seriously Increase Diabetes Risk

In the study, Novak measured the changes in the flexibility of the blood vessels and found that among the diabetic patients, their flexibility declined, while it remained essentially the same for those without the condition. When blood sugar levels fluctuate as they do among people with diabetes, it can damage cells and nerves and trigger inflammation. What’s concerning, says Novak, is that these changes occurred even among people who were taking medication and had their diabetes under relatively good control. “Blood sugar control alone cannot treat [cognitive declines] associated with diabetes,” Novak says. “We need a new medication to improve [blood vessel] reactivity, cognition and brain function in diabetics.”

Her group is continuing to study ways that brain function can be improved by addressing the health of blood vessels; one method they are investigating involves using insulin inhaled through the nose or blood pressure medications to get brain vessel activity back to normal.

Figuring out whether such therapies can improve the brain function among people with diabetes is critical, since more people are diagnosed with the disease earlier in life, including in childhood. In previous studies, Novak and her colleagues showed that people with diabetes have brains that look five years older than those of similar-aged controls; for children with the disease, that could take a drastic toll on their cognitive skills as they age. “We really don’t have any treatment for cognitive decline in diabetes,” she says, “because the brain is not listed as an organ of risk for this disease. So we need more research and evidence like this.”

TIME health

The Woman Who Made Death a Conversation Starter

Elisabeth Kubler-Ross
Lyn Alweis—Post Archive/Getty Images Elisabeth Kubler-Ross in 1983

July 8, 1926: Elisabeth Kübler-Ross, the psychiatrist who pioneered treatment for people with terminal illness, is born

The idea that the dying might have something to teach the living seems self-evident. After all, as the psychiatrist Elisabeth Kübler-Ross put it, in a 1969 profile in LIFE Magazine, who better to offer instruction on “the ultimate human crisis” than those in the midst of it?

“When I wanted to know what it was like to be schizophrenic,” Dr. Kübler-Ross told TIME earlier the same year, “I spent a lot of time with schizophrenics. Why not do the same thing? We will sit together with dying patients and ask them to be our teachers.”

And yet the medical community reacted as though she’d suggested interviewing ghosts about the afterlife (which, to some degree, she later did). The institutional hush surrounding terminal illness was so deeply rooted by the 1960s that Kübler-Ross’s suggestion came as a shocking breach of protocol.

“The reaction of physicians ranged from annoyance to overt hostility,” TIME attested.

Kübler-Ross, born in Switzerland on this day, July 8, in 1926, was not deterred. Her seminar at the University of Chicago’s Billings Hospital, begun in 1965, featured terminally ill patients as lecturers—and helped lift the taboo on frank discussions of death in hospitals across the country. In her bestselling 1969 book, On Death and Dying, she compiled the insights she gleaned from these patients, most notably her conclusion that they typically struggled through five stages at the end of life: denial, anger, bargaining, depression, and acceptance.

While other researchers have questioned whether the five-stage model accurately depicts the experience of dying (or grieving in general), few deny that Kübler-Ross’s work led to improvements in the way terminally ill patients were treated. As she revealed, they didn’t necessarily appreciate being ignored in hospitals or tiptoed around by relatives and friends.

TIME summarized Kübler-Ross’s conclusion that “…the patient who is not officially told that his illness is fatal always discovers the truth anyway, and may resent the deception, however well meant.” The story goes on:

The dying are living too, bitter at being prematurely consigned—by indifference, false cheerfulness and isolation—to the bourn of the dead. It is not death they fear, but dying, a process almost as painful to see as to endure, and one on which society—and even medicine—so readily turns its back.

Kübler-Ross’s seminars lifted terminally ill patients out of their isolation, at least for a time, and gave them a platform to share their fears and their hopes. (Even those who made it to the acceptance stage rarely gave up hope, according to TIME.)

Just as importantly, the seminars gave Kübler-Ross’s students a glimpse into the part of life that remains one of our culture’s best-kept secrets. As LIFE concluded in 1969, “It is very much as if, while watching the others come to an understanding with death, they begin to move toward understandings of their own.”

Read more from 1969, here in the TIME archives: Dying: Out of Darkness

TIME pharma deals

Ireland’s Horizon Pharma Launches Hostile, $3 billion Bid For U.S. Rival


Offer represents a 42% premium over Depomed's Monday closing price

Ireland’s Horizon Pharma is bringing its $3 billion takeover offer for U.S. rival Depomed directly to the company’s shareholders after being rebuffed in its attempts to negotiate with Depomed’s management.

Horizon’s hostile bid for Depomed, announced on Tuesday, values the Newark, Calif.-based specialty pharmaceutical company at $29.25 per share, which represents a 42% premium over Depomed’s Monday closing price. Depomed’s share price jumped nearly 40% on the news of Horizon’s offer.

The Irish manufacturer of drugs to treat arthritis and other inflammatory diseases said in a press release that it made “repeated attempts” to enter into deal discussions with Depomed’s management and board starting in March, only to have those advances and its takeover offer rejected. Depomed makes a range of pain treatments and products that treat conditions related to the central nervous system. Horizon believes the deal would increase sales for both companies’ products while the five different drugs Depomed currently has on the market would nearly double the size of Horizon’s current portfolio.

“The strategic and financial benefits of our proposal are highly compelling,” Horizon CEO and chairman Timothy Walbert said in a statement. Walbert added that his company’s proposal offers “substantial long-term value for Depomed’s shareholders,” whom he encouraged to urge the Depomed board to enter deal discussions.

If the two companies are able to reach an agreement, it would represent the latest in a string of deals for Horizon, which paid $660 million for Vidara Therapeutics International last year and also acquired Hyperion Therapeutics for $1.1 billion earlier this year. The pharma industry in general has seen more than its share of dealmaking recently, with deal volume and value on the rise in the first quarter of 2015, led by mega-mergers such as AbbVie’s $21 billion purchase of Pharmacyclics and Pfizer’s $17 billion acquisition of Hospira.

TIME Aging

Here’s Why You May Be Aging Faster Than Your Friends

Researchers zero in on more than a dozen factors that can predict how fast you’re aging — and have some ideas about what makes people age more slowly

We all have friends who were born in the same year but look years younger (or older) than we do. Now researchers say that such perceptions aren’t just about outward appearances but about something deeper—the different pace at which each of us ages, and what that means for our health.

In a study published in the Proceedings of the National Academy of Sciences, scientists led by Daniel Belsky, an assistant professor of medicine at the Duke University School of Medicine’s division of geriatrics, describe a panel of 18 measures tested in 20- and 30-year olds that showed how quickly they are aging. The markers proved to be a good indicator of physiological age; they mirrored the biological effects of aging found in older people. But they were also good markers of physical age, meaning that those who aged faster also looked older, according to unbiased assessments by random people looking at their photos.

Read more The Cure for Aging

Most studies on aging, and the factors that affect aging, come from investigations of older populations, says Belsky. And in most cases, the chronic diseases or physiological changes that come with aging are already well established in these groups. But it’s clear that aging doesn’t happen overnight; rather, it occurs gradually over a period of decades, much like water affects the shape of riverbanks or stones over time. It’s not obvious on a day-to-day basis, but can be dramatic if several years have passed.

In the study, 954 people born in 1972 or 1973 in Dunedin, New Zealand, agreed to participate in a study that followed them from age 26 to age 38. Each participant agreed to be tested on a range of 18 different factors that earlier studies have linked to aging, including blood pressure, lung function, cholesterol, body mass index, inflammation and the integrity of their DNA. Based on their scores on these measures, researchers calculated a biological age for each volunteer. They did this again when the people in the study were 32 and 38 years old, and combined them to calculate the pace at which each person was aging.

Read more This Diet Has Been Linked to a Longer Life—Again

Some people were biologically older and aging faster than others, despite being the same chronological age. Not only that, but the researchers showed, by giving the 20- and 30-somethings the same tests of balance and thinking skills that gerontologists give for older adults, that these aging changes were the same as those occurring later in life.

Though some people really were biologically older than they are, the good news is that some were younger than their chronological age and aging more slowly than they should be. Comparing the slower and faster aging groups should reveal some hints about how to keep aging in check. And of the factors that influence aging, says Belsky, the vast majority, as much as 80%, aren’t genetic and therefore well within our control. (Even the 20% that’s DNA-based is modifiable to some extent.) “This is just the beginning,” he says. “The next step is to figure out what knowing this information helps us to do. One of the things it can help us do is identify the causes of accelerated aging so that we might slow it down. And the other thing it can help us do is evaluate therapies that slow down aging.”

Read more Eat Better and Stress Less: It’ll Make Your Cells (and Maybe You) Live Longer

Having a way to measure, relatively accurately, the pace at which people age provides a good way of tracking whether any anti-aging treatment works or not. Some of those keys to youth likely won’t be surprising; given the 18 factors that the scientists studied, they will probably involve habits like having a healthy diet that’s low in fat and salt, maintaining a healthy weight, reducing stress, having a strong immune system and getting regular exercise. Not smoking, or quitting smoking may also play a role. To find out, Belsky says he will continue to follow the study group and re-evaluate them again when they are 45. The researchers are charting the participants’ diet, exercise and other behaviors. “We can start to evaluate which behaviors are working to slow down aging,” he says, by seeing which changes slow down the pace of aging. “It’s a tremendous opportunity to begin to sort things out.”

Read next: 10 Foods That Make You Look Younger

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TIME Obesity

Injecting This Drug Helps Patients Lose Weight

Daily shots of liraglutide (Saxenda), recently approved by the FDA, helps overweight or obese patients lose weight

In a study published in the New England Journal of Medicine, researchers say that the only injectable weight loss drug approved by the Food and Drug Administration (FDA) helps people to lose more than 12 pounds, more than twice as much as people taking a placebo.

The study is one of several that the FDA considered before approving the drug in 2014. It included data on 3,731 patients who were randomly assigned to take liraglutide or a placebo for just over a year. The trial continued to follow the patients for another year, and that data will be published soon.

MORE: This Pill Can Trick the Body Into Losing Weight, Study Finds

Liraglutide is similar to an already approved drug to treat type 2 diabetes, but is used in higher doses for weight loss. The drug mimics the effects of a hormone that works in the gut to signal the brain that you’ve eaten enough and feel full. As a diabetes drug, it helps the beta cells in the pancreas release insulin to keep blood sugar levels in check. In the NEJM study, none of the patients had diabetes, although some were pre-diabetic, and the FDA says liraglutide for weight loss should not be used together with the diabetes drug, also made by Novo Nordisk.

According to the study’s lead author, Dr. Xavier Pi-Sunyer, director of the obesity research center at Columbia University, liraglutide works as well as phentermine-topiramate (Qsymia), which doctors believe works by suppressing appetite. They key to making any weight loss medication effective, he says, is combining it with diet and exercise changes as well, which is what the participants in the study did. One advantage of liraglutide is that it can be used by women in their child-bearing years.

So far, the side effects of litaglutide, which include nausea, diarrhea, gall bladder abnormalities and pancreatitis, were minimal and did not outweigh the benefits of weight loss. But in approving the drug, the FDA asked the company to continue to study the drug to ensure that the adverse events remain within an acceptable range.

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