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The Hindu
4 hours ago
- Health
- The Hindu
More than just dizziness: understanding vertigo
Many people, at some point in their lives, experience a strange, disorienting sensation — something that feels like the room is spinning, or their balance has suddenly vanished. In India, this is often brushed off as 'weakness,' 'low BP,' or simply being overworked. But what many don't realise is that this experience, commonly known as vertigo, is not a condition in itself, but a symptom, and in many cases, it can be effectively treated. Vertigo affects people across ages and backgrounds, but it often goes unspoken and unrecognised. It can appear suddenly or linger in episodes. One day, you may feel dizzy when getting out of bed; another day, it might happen while bending down to tie your shoelaces or turning your head too quickly. Some people feel nauseated, unsteady, or even anxious during or after an episode. What makes vertigo more distressing is how invisible it is — no fever, no visible injury, and so those who experience it are often not taken seriously. Myths around vertigo Further, it's also unfortunate, that many myths continue to surround vertigo, especially in Indian households. These include: It's just stress or tiredness. Only women get this — it must be hormonal. There's no cure, just adjust and live with it. It must be because of low blood pressure or sugar. Scans and tests are a waste for something like this. Such layman opinions often contribute to delaying timely treatment. In truth, vertigo can often be traced to very specific causes, be it issues in the inner ear, nerve pathways, or certain kinds of migraines. The most common form, benign paroxysmal positional vertigo (BPPV), is caused when tiny crystals inside the inner ear are dislodged and trigger brief spinning episodes with head movement. The good news is that many of these conditions can be addressed through a thorough evaluation and targeted therapy. This clinical framework mirrors global best practice, where ear-related vertigo is promptly identified using bedside tests and vestibular labs, reducing over-reliance on imaging or long-term medications. Addressing the root causes Unfortunately, in many smaller towns, vertigo is still managed with symptomatic tablets and home remedies. These might help temporarily, but do not address the cause. Leading medical authorities, including the American Medical Association, emphasise that 80–90 percent of vertigo cases stem from peripheral (ear-related) causes. These are usually determined through clinical history and focused assessments. While central causes such as stroke, demyelinating disease, or tumours, must be excluded when neurological signs (vision changes, limb weakness, slurred speech) are present, they are significantly less common. Vertigo deserves to be talked about without embarrassment or dismissal. It's time we replaced myths with understanding, and hesitation with action. It is vital that when someone says, 'the world is spinning,' they should be met not with disbelief, but with support and with solutions grounded in medicine, empathy, and evidence. (Dr. Prabash Prabhakaran is director and senior consultant neurologist at SIMS Hospital, Chennai. mailto:prabashnair@
Boston Globe
2 days ago
- Health
- Boston Globe
An attack on the medical establishment buried in an 1,800-page regulation
Medicare officials have been loath to change it because it has spared them from needing their own staff and budget to make such pricing decisions, along with the unpleasant politics of adjudicating conflicts between competing groups of physicians. But a change buried inside a 1,803-page proposed regulation published last Monday suggests the Trump administration would like to move away from this longstanding system. If finalized, it could begin overturning a process that has entrenched pay advantages for certain kinds of doctors. Get Starting Point A guide through the most important stories of the morning, delivered Monday through Friday. Enter Email Sign Up 'We're modernizing Medicare by correcting outdated assumptions in how physician services are valued,' said Chris Klomp, a deputy administrator of the Centers for Medicare and Medicaid Services, in an email. Advertisement Robert F. Kennedy Jr., the secretary of health and human services, has emphasized that medicine should focus more on primary care and prevention, and less on the treatment of advanced diseases. He has also crusaded against 'corporate medicine,' and has specifically criticized the American Medical Association. Stat News reported in November that Kennedy was considering policies to disempower the AMA committee. Advertisement Dr. Bobby Mukkamala, the AMA's president, was highly critical of the proposed change. 'The American Medical Association believes that proposals to exclude or limit the input of expert practicing physicians and health care professionals in the development of Medicare payment policy would ultimately harm patients and represents a radical departure from the time-tested CMS decision-making process,' he said in a statement. The current AMA committee, known as the RUC, uses data gathered in surveys of doctors to set formulas for every kind of medical care. The committee suggests payment rates to Medicare's regulators, who almost always adopt them. The system is effectively zero-sum — any increases for one kind of doctor represents decreases for others. While private insurers are free to develop their own formulas for paying doctors, they tend to follow Medicare's lead, making the committee very influential on what kinds of medical care get the largest (and smallest) financial rewards. The estimates are often outdated. Existing payments are reviewed on average only once every 17 years. A Washington Post investigation in 2013 reported on numerous gastroenterologists who had billed Medicare for more than 24 hours' worth of colonoscopies a day. The reason wasn't fraud. Medicare was still paying the doctors as if each test took 75 minutes to complete, when most doctors were able to complete one in 30 minutes. (The colonoscopy payment has since been adjusted.) Under the new proposal, Medicare would pay 2.5 percent less for every procedure, operation and medical test in 2026, based on data suggesting there have been improvements in 'efficiency' over the years. Payments for treatments based only on time, like a consultation with a family physician or neurologist, would not be cut. Such adjustments would be repeated every three years. Advertisement The proposal also looks to change the kind of data Medicare should consider instead of the relatively small surveys, noting that new sources of health data from hospitals and electronic billing systems could offer more accurate information. The effort to adjust what doctors are paid for their work is just one part of the large rule, which also contains provisions to broaden coverage for telemedicine, pay for more mental health care, and reduce overpayments for a new and expensive type of skin bandage. One other provision, meant to better account for the costs of running a medical practice, also affects the relative pay of different medical specialists. In some cases, those changes would reduce payments to the types of medical specialists whom the efficiency adjustments are meant to benefit. That policy would adjust payments to doctors based on whether they offer services on a hospital campus or in a private practice office, effectively lowering payments in the hospital and boosting those elsewhere. Taken together, the overall proposal would do more than just increase the salaries of primary care doctors. It would also increase the average pay of an allergist next year by 7 percent, and decrease pay for a neurosurgeon by 5 percent, according to estimates published by Medicare. It would lower pay by 6 percent for infectious disease specialists, who tend to earn low salaries and perform few procedures -- and increase average pay for vascular surgeons by 5 percent. Dr. Adam Bruggeman, a spine surgeon in San Antonio who leads the council on advocacy for the American Academy of Orthopaedic Surgeons, said he was sympathetic to arguments that the current system may be paying for some medical procedures inaccurately. But he said the proposal — which would cut payments for all procedures next year — was too crude a solution to that problem. He described the 'efficiency' changes as 'taking an ax to the whole thing.' Advertisement 'We're just fighting an arbitrary number with another arbitrary number, and that doesn't help,' he said. This article originally appeared in
WIRED
2 days ago
- Health
- WIRED
The Next Thing You Smell Could Ruin Your Life
Jul 21, 2025 6:00 AM Millions of people suffer debilitating reactions in the presence of certain scents and chemicals. One scientist has been struggling for decades to understand why—as she battles the condition herself. After my birth, my mother became allergic to the world. That's the only way I knew how to put it. So many things could set her off: new carpeting, air fresheners, plastic off-gassing, diesel. Perfumes were among the worst offenders. On top of that, she developed terrible food allergies. The sound of her sniffling became the chorus of my childhood. Some days she couldn't get out of bed. I'd peek into her darkened room and see her face pinched in discomfort. Her joints ached, her head swam. Doctors suggested that maybe she was depressed or anxious. 'Well, you'd be anxious too if you couldn't lick an envelope, couldn't pick up your daughter in a car,' she'd reply. She tried allergists, got nowhere. Finally, she found her way to holistic health, whose practitioners told her she had something called multiple chemical sensitivity. As long as people have complained that man-made stuff in their environment causes health problems—migraines and asthma, exhaustion and mood swings—the medical establishment has largely dismissed them. The American Medical Association, World Health Organization, and the American Academy of Asthma, Allergy & Immunology don't recognize chemical sensitivity as a diagnosis. If they talk about it at all, they tend to dismiss it as psychosomatic, a malady of the neurotic and health-obsessed. Why, these authorities wondered, would people react to minute traces of a huge array of chemicals? And why couldn't they ever seem to get better? This isn't some trivial affliction. Roughly a quarter of American adults report some form of chemical sensitivity; it lives alongside chronic pain and fibromyalgia as both evidently real and resistant to mainstream diagnosis or treatment. My mom tried a thousand things—elimination diets, antihistamines, lymphatic massage, antidepressants, acupuncture, red light therapy, saunas, heavy-metal detoxes. Sometimes her symptoms eased, but she never got better. Her illness ruled our lives, dictating what products we bought, what food we ate, where we traveled. I felt there had to be an answer for why this was happening. It didn't take me long to learn that, if there was one, it'd come from a figure as unassuming as she is provocative: the scientist Claudia Miller. On a warm Texas afternoon, Miller and her affable husband, Bob, lead me through the San Antonio Botanical Garden. A monarch flits by. 'I've noticed so many fewer butterflies, so many fewer birds, even the last couple of years,' Miller observes. Her raspy voice comes out so quietly that, at times, my recording device fails to pick it up. People are perpetually leaning in close or asking her to repeat herself. At 78, Miller typically uses a cane, but Bob gets the walker out of the car so she can cover more distance. She wears her silver hair in a low side ponytail, fixed in place with a scrunchie. With her wide, thin-rimmed glasses, Miller disappears into the scenery, but she's a particularly visible presence in her field. Now a professor emeritus at the University of Texas Health Science Center at San Antonio, Miller has held several federal appointments, chaired National Institutes of Health meetings, testified before Congress, consulted for the Environmental Protection Agency, authored dozens of papers, and worked with the Canadian, German, Japanese, and Swedish governments. In all this, she has tried to make sense of and raise awareness for chemical intolerance. One patient advocate I interviewed called her 'Saint Claudia' for her commitment to overlooked and misunderstood patients. Kristina Baehr, an attorney who defends victims of toxic exposures, told me, 'To have experts like Dr. Miller tell them you're not crazy, this is very real, is very life-giving to people. She's able to validate their experience with facts, with science.' One such fact, Miller explains, is this: Over the past century, the United States has undergone a chemical revolution. 'Fossil fuels, coal, oil, natural gas, their combustion products, and then their synthetic chemical derivatives are mostly new since World War II,' she says. 'Plasticizers, forever chemicals, you name it: These are all foreign chemicals.' They're everywhere you look, in homes and offices, parks and schools. They're also, Miller believes, making people very sick. In 1997, Miller proposed a career-defining theory of how people succumb to this condition. It came with a technical-sounding name, toxicant-induced loss of tolerance, and a convenient acronym, TILT. You can lose tolerance after one severe exposure, Miller says, or after a series of smaller exposures over time. In either case, a switch is flipped: Suddenly, people are triggered by even tiny amounts of everyday substances—cigarette smoke, antibiotics, gas from their stoves—that never bothered them before. These people become, in a word, TILT-ed. It's not unlike developing an allergy, when the body labels a substance as dangerous and then reacts accordingly. In 1999, Miller and her colleagues designed the Quick Environmental Exposure and Sensitivity Inventory, or QEESI (pronounced 'queasy'), a survey to help doctors and researchers identify chemically intolerant patients. I've seen the QEESI cited in papers from 18 countries, but to date, most physicians still don't know much about it. 'It's very frustrating to try to get these ideas across,' Miller says. The major problem is that, assuming TILT accurately describes the process of becoming chemically intolerant, we don't know what biological changes occur inside the sensitized body, why so many symptoms crop up, or why one exposed person gets sick while others seem to walk away unscathed. But Miller thinks she's closer than ever to an answer. At the botanical garden, we approach an orchid exhibit. Sticky heat engulfs us as we enter. Orchids of varying shapes and colors fill the greenhouse, including one with spindly chartreuse petals. 'What do you call this?' Miller asks. My plant-ID app comes up empty. So it goes, too, for chemically intolerant patients: The condition defies easy observation. 'The world becomes like a torture chamber, and then nobody believes you,' Miller says. 'That's the worst part.' After falling ill, some people become hermits out of fear of exposure, abandoning their friends and family to live in remote areas. For others, nothing can keep them from spinning out of control. My mother knew someone who tried to escape her triggers by moving to the country in a trailer. Eventually, even that became unmanageable, and the woman shot herself in the head. Imagine feeling incredibly sick every time you encounter a cloud of cologne or fresh paint, then being told you're making it up. I thought about my mom. Sometimes, catering to her needs could feel exhausting. But what must that have been like for her? The thing was, I never doubted her condition—especially after what happened on one bad day. A crucial textbook from Miller's library. Photograph: Amber Gomez Masks can help protect TILT-ed patients. Photograph: Amber Gomez It's time to tell you the worst thing I have ever done to another person. When I was 10, my parents and I attended a family reunion. The trip was difficult. We fought nonstop. Everyone cried. The photographer hired to capture a family portrait accidentally exposed the film to light, and it was just as well. If we could have wiped the whole week from our minds, we would have. During that ill-fated trip, my aunt gifted me a set of scented lip balms. My mom offered her a tight smile but, once we were alone, told me to toss them out. Instead, I hid them and, soon, weaponized them. After yet another argument, I sneaked into my mom's room, peeled back her pillow case, and smeared the lip balms directly onto her pillow. Later that night, as she tried to sleep, she kept waking up, sicker and sicker, her head pounding. Finally, her nose helped her uncover what I'd done. She found the telltale smudges. The next day, my dad told me how she'd sobbed and howled, 'Why would she do this to me?' It remains, for me, a source of immense guilt. Later, I realized it was also the crumb of proof I needed. This was not all in my mother's head. I'm at Miller's condo across the street from the UT Health Science Center, with Miller and two of her collaborators. Her dining room table is lined with household products—a votive candle, a box of matches, body lotion, scented dish detergent. Beside them are chunky gadgets that look like something out of Ghostbusters . These are particulate monitors, which measure down to parts per billion. They need to be hypersensitive, because products like the ones on the table expel tiny molecules, and people with chemical intolerance seem to react to even minuscule doses. It's akin to someone having an allergic reaction to a bag of peanuts opened on the other end of the airplane. One of her collaborators strikes a single match in front of a sensor. The number on the screen rockets from 0 to almost 500,000 parts per billion. It's not always about what the nose can detect—though, in this case, sulfur dioxide fills the room. Last year, Miller's team published research on house calls for nearly 40 people with chemical intolerance. They measured indoor pollution from products like these, as well as other irritants like dust and mold, and performed blood tests for allergies. Then they recommended tossing out scented candles or moving cans of gasoline from an attached garage to a separate storage unit, and gifted the subjects natural cleaning products. They retested the homes several more times over the course of the year. As the indoor pollution decreased, the subjects' symptoms improved. For years, research like this convinced Miller that there was, indeed, something very wrong with her patients. But, again, that pesky mechanism for disease eluded her. Then she learned more about mast cells. Mast cells are a type of white blood cell that exists in nearly every tissue, including the skin, airways, and gastro-intestinal tract. When they detect something harmful, they can release hundreds of mediators, including histamine, substances that create symptoms like hives or swelling during anaphylactic shock. If the cells become overreactive, releasing too many mediators at the wrong time, a person can end up flushed, dizzy, wheezy, or exhausted. This is called mast cell activation syndrome, or MCAS. When Miller came across a book on the subject by Lawrence Afrin, a hematologist and mast cell disease researcher based in New York, she thought it sounded a lot like chemical intolerance. She called him. Many of his MCAS patients, it turned out, were sensitive to fragrances and medications. In 2021, Miller published what she considers her second eureka moment: a paper, coauthored with Afrin and others, that explains a potential link between TILT and MCAS. The team surveyed MCAS patients and found that those who scored high on MCAS questionnaires scored high on the QEESI. These patient groups also had nearly identical symptom patterns. Had Miller's patients had mast cell activation syndrome this whole time? MCAS is a tricky disease to diagnose and treat, but it was something. An answer for the scientific community. An answer for her patients. And an answer for herself. Because that's the other part of this story, the part Miller hasn't been comfortable talking about until now: She, the condition's leading researcher, suffers from chemical intolerance too. Miller has difficulty searching her memory about her past. Exact years don't come back to her, her retellings wander. Attribute it to age or brain fog or both. Still, over hours of conversations and dozens of emails, her story came together. Born in Milwaukee as the only child of a patent attorney and a teacher, Miller was drawn to science from a young age. After earning her BA in molecular biology from the University of Wisconsin–Madison and her master's in environmental health from UC Berkeley, she spent several years in Chicago working for OSHA and the United Steelworkers union as an industrial hygienist, touring steel mills, coke ovens, and smelters to monitor worker health and safety. She began seeing snapshots of the condition that would define her career. Once, she was called to meet with women who soldered in an electronics plant. 'They had some outbreaks of so-called mass psychogenic illness,' Miller said. 'A manager brought one of these women into the office. He actually started soldering right in front of us and she starts to have her symptoms, sneezing or whatever.' To the manager, this proved that it was psychological—why should his worker be impacted if he and Miller were not? Miller suspected something else was at play, though she couldn't put her finger on what. Imagine feeling incredibly sick every time you encounter a cloud of cologne or fresh paint, then being told you're making it up. She met Bob, a fellow industrial hygienist, through OSHA. By 1977, the Millers were newlyweds living in an old home in a verdant area of Lake Forest. They loved gardening and the foxes that visited the nearby pond. But the house had wasps and spiders. Miller did her research and found an EPA-approved pesticide for indoor use, which an exterminator sprayed on her floorboards and eaves. 'That changed our whole lives,' Miller said. Immediately, Miller was walloped with fatigue and mired in confusion. Her husband felt OK, so they decided to still go on their honeymoon in New Orleans. They left their two-month-old Burmese kitten with Miller's parents. On the trip, they got a call. 'This cat looks kind of droopy,' Miller remembers her parents saying. The next day, the kitten died. Miller suspected that the pesticide had affected both her and her cat, but she couldn't figure out how to get well. Then she was referred to Theron Randolph, an infamous allergist who broke ranks with the medical establishment after working with chemically sensitive patients. Other allergists stood by the idea that 'the dose makes the poison'—basically, that any substance, even water or oxygen, can be harmful in excess, but trace chemicals shouldn't sicken patients. Randolph disagreed, saying that small doses mattered and that bodies could accumulate toxic burdens over time. He also mounted a campaign against corn, believing it caused inflammation and brain fog. For this and other work, he was ousted from his faculty position at Northwestern University Medical School. By the time Miller met him, he'd become a lightning rod for criticism from peers, who accused him of relying too heavily on patient testimonials and unconventional testing methods. 'The world becomes like a torture chamber, and then nobody believes you,' Miller says. 'That's the worst part.' Photograph: Amber Gomez Unaware of this controversy and desperate to regain her health, she checked herself in for three weeks at one of the 'environmental medical units' Randolph had established in the wing of a hospital. In Randolph's opinion, Miller had to clear out her body before she could determine what was triggering her illness. Miller was confined to a unit with three other sick women, all with different symptoms. The rooms were outfitted with materials that wouldn't outgas—ceramic-lined floors and walls, metal furniture. The hospital filtered in fresh air, with air-locked entrances. No disinfectants or fragrances were allowed inside. The program began with a nearly weeklong fast. By her third day, Miller felt incredible: 'Your head is clear, you can remember things.' It piqued Miller's scientific curiosity. Randolph spent a few minutes with patients each day, and Miller flooded him with questions. Eventually, she delayed his rounds so much that he asked if she wanted to come to his staff meetings. Soon, she became a collaborator of sorts and, in the summer of 1979, presented at an NIH meeting on mass psychogenic illness. She discussed case studies of patients who fell ill after specific chemical exposures. This wasn't hysteria, she argued; there was cause and effect. Afterward, she said, attendees lined up at the microphone to challenge her—a glimpse at the pushback that would shadow her for years. Randolph suggested Miller attend medical school. If she had any hope of breaking through to the establishment, she recalls him saying, 'you've got to learn everything they know.' But there were a few problems. The stay at the environmental medical unit only temporarily improved her health. When she returned to her Chicago home, she became sick again. So she and her husband moved to Texas, where Miller became a medical student at UT. 'If I had revealed my own intolerances, I would never have been accepted,' she told me. She pretended she was merely interested in allergy and immunology. All the while, she privately struggled. If a patient came in reeking of cigarette smoke, she might be sidelined with dizziness. By that point, most meals made her sick too. 'Her main food was chocolate,' Bob jokes. Sometimes, she would fast before her exams to try to regain some of the clarity she felt in Randolph's care. After earning her degree, Miller began her 'real' work in earnest. She was appointed to the National Advisory Committee on Occupational Safety and Health, where she met Nicholas Ashford, an environmental policy lawyer and MIT professor. When the state of New Jersey tapped Ashford to study chemical sensitivity, he tapped Miller as his coauthor. So began a career-long collaboration. They published their New Jersey report in 1989, followed by a seminal book, Chemical Exposure: Low Levels and High Stakes , in 1991. 'I'm not saying I deserve a Nobel Prize,' Claudia Miller tells me. 'But it's at that level.' Her husband chimes in: 'Basically a new theory of disease.' Miller confided in Ashford about her condition, but he advised her to continue keeping it a secret. 'You don't want to cloud the good science that you're doing,' she recalls him telling her. She obliged. The Department of Veterans Affairs contracted her to study Gulf War veterans exposed to chemical weapons who came home and could no longer tolerate common smells like WD-40 or a girlfriend's nail polish. She corresponded with congressman Bernie Sanders for years to try to get the government to build environmental medical units. She met with some of the 100 EPA workers who, after their department installed latex-backed carpet, complained about blurred vision and chest pain. She testified before the Food and Drug Administration about patients who'd received breast implants and suddenly couldn't drink alcohol or caffeine. All the while, she suffered her illness in silence. Then, some 40-plus years after her pesticide exposure, Miller found her way to mast cells—and, with that, the confidence to finally come forward. When Miller and I are alone in her condo, she shows me some of her art. In her office, we stand before two illustrations depicting Don Quixote and his famously misguided quest to become a hero. The first piece shows the aftermath of when he mistook windmills for giants and attacked them. He and his horse lay on the ground, battered, with their legs in the air. 'He's tilting at windmills,' she says. 'That's what I feel like I'm doing.' I understand the play on words, but I don't say what I'm thinking: that Don Quixote, in his deep obsession, imagined enemies where there were none. Miller comes across as single—almost monolithically—minded. Her preferred talking points include Elon Musk, whom she brought up to me by phone, in person, over emails. Her research has found that those with high chemical-intolerance scores are 5.7 times more likely to have a child with autism and 2.1 times more likely to have one with ADHD. (Sample size of one here, but I, a child of a chemically intolerant woman, have ADHD.) During my visit, Miller handed me a copy of Musk's mother's memoir, which has one line mentioning that she painted her husband's plane while pregnant with Elon. Miller speculates that this exposure may have influenced his neurological development. (In 2021, Musk publicly stated he has Asperger's, an autism spectrum disorder.) An article about this 'could crack open the field,' as she put it. Perhaps, she wondered aloud, he might even build Randolph-style environmental medical units. Unprompted, Miller wrote me an email one day that read, in its entirety: 'When I was an eight-year-old girl, living in Milwaukee, I never imagined I would become a doctor and diagnose the richest man in the world.' Another sticking point: terminology. She reviles the name 'multiple chemical sensitivity,' which she sees as a stigmatizing and imprecise label. On its face, the term does not acknowledge patients TILT-ed by, say, mold exposure, a common initiating event. It's also dismissed in lawsuits under the Daubert and Frye standards, which let judges block expert testimony on conditions lacking wide scientific acceptance. Multiple chemical sensitivity may describe how many patients feel, Miller says, but it's a diagnosis without a clear medical explanation. Chemical intolerance is a more accurate term, she argues, and TILT is that missing medical explanation—and that should be the focus of research. This has become one of the issues at the core of her fracturing with the chemical intolerance community. The other, no surprise, is money. Funding is scarce in this niche and polarizing area. At UT, Miller was able to piece together government grants for some of her work, but she also routinely invested her own money. In 2013, everything changed. An heiress named Marilyn Brachman Hoffman died, leaving more than $50 million to a foundation in her name. Hoffman was a fellow sufferer of chemical intolerance and, throughout her life, corresponded with a handful of scientists, including Miller. In her personal will and trust, Hoffman also gifted $5 million to Harvard for research on 'toxicant-induced loss of tolerance.' She noted that Miller should join the advisory committee. Indeed, Miller did so for a year as a part-time senior scientist. Then, in 2015, she and her colleagues set up the Hoffman Program for Chemical Intolerance out of UT Health San Antonio, with funding from the foundation. The Harvard group never produced any research specifically on TILT (though they did study indoor air pollution, among other things). And, in recent years, the foundation has turned its attention elsewhere—namely, to research about multiple chemical sensitivity. Miller has felt left out in the cold. Hoffman specifically mentioned TILT in her will, not multiple chemical sensitivity. The executor of Hoffman's will, an estate lawyer who became president of the foundation, worked for a large law firm that had defended pesticide and petrochemical companies. Was the foundation funding multiple chemical sensitivity instead of TILT, Miller wondered, as a way to delegitimize patients? (When asked for comment, the foundation said it's still open to funding projects related to TILT but added: 'The fact that we do not solely use the term TILT, which is almost exclusively associated with Claudia Miller's work, may be a problem for her, but it is not a conspiracy to hurt people.') Miller's distrust is, in many ways, understandable. Her work butts up against the interests of huge companies and powerful people; she has spent her career watching her patients get dismissed. In an email to her coauthor Ashford, she mentioned that members of the foundation board considered her difficult: 'Yes I am difficult—I am precise about my science and will not tolerate any tampering with the truth or any attempts to derail my research.' I witnessed a piece of the drama myself when I attended an international conference on chemical intolerance, held over Zoom. Though there was one talk specifically on TILT, most of the presenters used the term multiple chemical sensitivity. After a Canadian physician concluded one session, the hosts fielded an audience question. Miller's coauthor, Ashford, crackled to life. He urged the conference attendees to read his work with Miller and Afrin on mast cells. 'We think we have cracked the code on chemical sensitivity,' he said. He then pivoted to criticizing the conference. 'Without clarifying what's causing or priming the patient, we're not going to get anywhere,' he said. 'And I'm very disappointed to see this isn't emphasized.' He blinked. Silence hung in the digital air. Finally, one of the cohosts diplomatically thanked Ashford for 'that intervention.' (Later, Miller told me that she'd been invited to present but had refused because of the focus on multiple chemical sensitivity: 'I just couldn't stomach it.') Whether you consider it steadfastness or stubbornness or something else, Miller's approach has come at the cost of her relationships. Many people I reached out to opted not to speak with me. I began to get similar reactions when I asked sources about her work. They didn't want to criticize her: She has dedicated her life to this understudied condition, but … Her biggest barrier is that TILT has yet to be proven. 'Where the evidence is not strong, you very often find strongly held opinions,' Jonathan Samet, former dean of the Colorado School of Public Health and member of the Hoffman Foundation's scientific advisory board, told me. When I asked him specifically about TILT, he took a deep breath. He noted that few people have been so serious about this issue as Miller. 'I don't want to go into a critique—I mean, I think it's very reasonable to make hypotheses,' he said. 'I think the more challenging question is: What is the research that actually tests the hypothesis?' Supposing that TILT is real, mast cells remain difficult territory. There's no definitive cause of MCAS, only more (yes) hypotheses. Questions remain: Could TILT cause MCAS, or do patients have preexisting MCAS, which is exacerbated during exposure events? Are these conditions, in fact, related at all? 'This is the danger of mistaking association for causation,' Afrin says. 'Just because two things are associated does not even begin to say whether one causes the other.' That 2021 paper that Miller sees as the culmination of her life's work? It was based on surveys of 147 diagnosed MCAS patients from Afrin's clinic. Of that group, 59 percent—or 87 people—met the criteria for chemical intolerance. It's intriguing data but by no means conclusive. Nobody has yet taken a cohort of TILT-ed patients and done lab testing to investigate whether they have MCAS. 'In my opinion, that still needs to be done,' Afrin says. 'Different doctors have different styles—and Claudia, she's pretty convinced that we have enough associative evidence that it's a slam-dunk case. But TILT is just one of a zillion different diseases that MCAS is capable of driving.' And who to fund that research? TILT-ed patients would need to be well enough to travel to a clinic, where MCAS testing then costs thousands of dollars. Then there's the string of bodies left in Miller's wake: An investigator on her UT team stopped speaking to her after she disapproved of some of his research and sent him a cease-and-desist letter for using her survey methodology. Another former staff member, Tatjana Walker, is now executive director of the Hoffman Foundation. The relationship is respectful but strained. When I told Miller that I was arranging to meet Walker, who also lives in San Antonio, she insisted that I could simply call Walker instead. The next day, Miller sent an email to me, Walker, several members of the foundation's scientific advisory board, and Ashford. In it, she tried to set up a meeting between Walker and me—at Miller's condo. I arranged a separate chat with Walker over breakfast. Miller came up quickly. 'She's got a really strong vision of what she thinks the phenomenon is,' Walker said. 'And I would not be at all surprised to find out that she's correct.' As the saying goes, absence of evidence is not evidence of absence. 'But, in science, we try to take a step back and look at the bigger landscape.' She added that the foundation funds work about multiple chemical sensitivity because that's the most generally understood term. 'Claudia's invested a ton of time, a lot of thought, and, in many ways, her life,' she said. 'That's it: She's not the only person who has a thought about it.' In Miller's second Don Quixote art piece, the protagonist lies on his deathbed, looking back on his life. Soldiers in the foreground, a windmill in the distance. At this point in the novel, Don Quixote has given up his fantasies. He advises his beloved niece to never marry a man like him. The Don Quixote art in Miller's office. Photograph: Amber Gomez I still hoped that Miller's work might bring my own family answers. About 14 years ago, my mom moved to a coastal town in Mexico. I called her up to discuss what I'd learned. As it turned out, she'd become familiar with mast cells several decades before. And? 'When I got blood work done, it didn't show high levels of mast cell activation,' she said. She'd tried a few commonly prescribed mast cell stabilizers, just in case. They didn't work. My heart sank. Maybe, she added, the tests have changed since then. I told her it could take multiple tests to pin down an MCAS diagnosis and that Afrin said that MCAS patients often need to experiment with a cocktail of meds to find a combination that works. 'I would try it again,' my mom said, kindly. Whatever the case, since moving to Mexico, her health has improved. This aligns with the prevailing treatment for those with chemical intolerance: Avoid your triggers. My mom suspects that living in a foggy part of the San Francisco Bay Area with a lot of mold might have contributed to being TILT-ed. Where she lives now, it's dry, and many buildings are open-air. She still gets sick and can't tolerate fragrances and certain foods. But she's able to go for walks on the beach and run errands. She has more energy at 70 than she did throughout much of my childhood. She says stress reduction was one of the best things for her—and accepting that she might always feel adrift. 'I had to stop freaking out,' she said. (Not surprisingly, stress can also exacerbate MCAS flare-ups.) Today, chemical intolerance is an accepted medical diagnosis in Japan and a recognized disability in Canada. It's unclear what a path forward might look like in the United States, though the Hoffman Foundation recently put out a request for proposals, which mentioned interest in expanding on mast cell theories and TILT. Miller is ready for everyone else to come around. 'I'm not saying I deserve a Nobel Prize,' she tells me. 'But it's at that level.' Her husband chimes in: 'Basically a new theory of disease. She thinks big, but the rest of the world doesn't think that way.' Miller's symptoms have improved, which she attributes to stabilizing her mast cells with antihistamines and cromolyn. She also takes pre- and probiotics, plus pancreatic enzymes, to aid her digestion. Still, she can't drive—she has neuropathy, which she believes stemmed from her pesticide exposure. At the end of our day at the botanical garden, her husband gets behind the wheel of their SUV. Miller rides in back beside a roaring air filter, which she says prevents her from getting sleepy from a buildup of fumes. But she's exhausted anyway, and the noise drowns out her voice, which is thinner than ever. 'The question is, how do you get any of this into medical training?' Miller asks. Her eyelids droop behind her glasses. There may not be an answer in her lifetime; I hope there will be one in mine. Walker told me that, back when she was working with Miller, 'one of Claudia's favorite expressions was: Science advances one funeral at a time.' It's much harder to let go of your own ideas than it is to pick up the thread of someone else's. Though, who knows, maybe that's what progress requires, like Don Quixote surrendering his illusions on his deathbed. It made me think back to a night in San Antonio when I went out to dinner with Miller and her husband. They paused by a tall water fountain in the restaurant's courtyard. Miller stepped close and tossed a penny underhand to make a wish. The coin winked in the air and then fell to the ground. Miller wasn't concerned: 'Some lucky person will find it exactly perfect.' Let us know what you think about this article. Submit a letter to the editor at mail@
Japan Today
3 days ago
- Health
- Japan Today
AI in health care could save lives and money − but change won't happen overnight
By Turgay Ayer Imagine walking into your doctor's office feeling sick – and rather than flipping through pages of your medical history or running tests that take days, your doctor instantly pulls together data from your health records, genetic profile and wearable devices to help decipher what's wrong. This kind of rapid diagnosis is one of the big promises of artificial intelligence for use in health care. Proponents of the technology say that over the coming decades, AI has the potential to save hundreds of thousands, even millions of lives. What's more, a 2023 study found that if the health care industry significantly increased its use of AI, up to $360 billion annually could be saved. But though artificial intelligence has become nearly ubiquitous, from smartphones to chatbots to self-driving cars, its impact on health care so far has been relatively low. A 2024 American Medical Association survey found that 66% of U.S. physicians had used AI tools in some capacity, up from 38% in 2023. But most of it was for administrative or low-risk support. And although 43% of U.S. health care organizations had added or expanded AI use in 2024, many implementations are still exploratory, particularly when it comes to medical decisions and diagnoses. I'm a professor and researcher who studies AI and health care analytics. I'll try to explain why AI's growth will be gradual, and how technical limitations and ethical concerns stand in the way of AI's widespread adoption by the medical industry. Inaccurate diagnoses, racial bias Artificial intelligence excels at finding patterns in large sets of data. In medicine, these patterns could signal early signs of disease that a human physician might overlook – or indicate the best treatment option, based on how other patients with similar symptoms and backgrounds responded. Ultimately, this will lead to faster, more accurate diagnoses and more personalized care. AI can also help hospitals run more efficiently by analyzing workflows, predicting staffing needs and scheduling surgeries so that precious resources, such as operating rooms, are used most effectively. By streamlining tasks that take hours of human effort, AI can let health care professionals focus more on direct patient care. But for all its power, AI can make mistakes. Although these systems are trained on data from real patients, they can struggle when encountering something unusual, or when data doesn't perfectly match the patient in front of them. As a result, AI doesn't always give an accurate diagnosis. This problem is called algorithmic drift – when AI systems perform well in controlled settings but lose accuracy in real-world situations. Racial and ethnic bias is another issue. If data includes bias because it doesn't include enough patients of certain racial or ethnic groups, then AI might give inaccurate recommendations for them, leading to misdiagnoses. Some evidence suggests this has already happened. Data-sharing concerns, unrealistic expectations Health care systems are labyrinthian in their complexity. The prospect of integrating artificial intelligence into existing workflows is daunting; introducing a new technology like AI disrupts daily routines. Staff will need extra training to use AI tools effectively. Many hospitals, clinics and doctor's offices simply don't have the time, personnel, money or will to implement AI. Also, many cutting-edge AI systems operate as opaque 'black boxes.' They churn out recommendations, but even its developers might struggle to fully explain how. This opacity clashes with the needs of medicine, where decisions demand justification. But developers are often reluctant to disclose their proprietary algorithms or data sources, both to protect intellectual property and because the complexity can be hard to distill. The lack of transparency feeds skepticism among practitioners, which then slows regulatory approval and erodes trust in AI outputs. Many experts argue that transparency is not just an ethical nicety but a practical necessity for adoption in health care settings. There are also privacy concerns; data sharing could threaten patient confidentiality. To train algorithms or make predictions, medical AI systems often require huge amounts of patient data. If not handled properly, AI could expose sensitive health information, whether through data breaches or unintended use of patient records. For instance, a clinician using a cloud-based AI assistant to draft a note must ensure no unauthorized party can access that patient's data. U.S. regulations such as the HIPAA law impose strict rules on health data sharing, which means AI developers need robust safeguards. Privacy concerns also extend to patients' trust: If people fear their medical data might be misused by an algorithm, they may be less forthcoming or even refuse AI-guided care. The grand promise of AI is a formidable barrier in itself. Expectations are tremendous. AI is often portrayed as a magical solution that can diagnose any disease and revolutionize the health care industry overnight. Unrealistic assumptions like that often lead to disappointment. AI may not immediately deliver on its promises. Finally, developing an AI system that works well involves a lot of trial and error. AI systems must go through rigorous testing to make certain they're safe and effective. This takes years, and even after a system is approved, adjustments may be needed as it encounters new types of data and real-world situations. Incremental change Today, hospitals are rapidly adopting AI scribes that listen during patient visits and automatically draft clinical notes, reducing paperwork and letting physicians spend more time with patients. Surveys show over 20% of physicians now use AI for writing progress notes or discharge summaries. AI is also becoming a quiet force in administrative work. Hospitals deploy AI chatbots to handle appointment scheduling, triage common patient questions and translate languages in real time. Clinical uses of AI exist but are more limited. At some hospitals, AI is a second eye for radiologists looking for early signs of disease. But physicians are still reluctant to hand decisions over to machines; only about 12% of them currently rely on AI for diagnostic help. Suffice to say that health care's transition to AI will be incremental. Emerging technologies need time to mature, and the short-term needs of health care still outweigh long-term gains. In the meantime, AI's potential to treat millions and save trillions awaits. Turgay Ayer is Professor of Industrial and Systems Engineering, Georgia Institute of Technology. The Conversation is an independent and nonprofit source of news, analysis and commentary from academic experts. External Link © The Conversation
New Indian Express
3 days ago
- Politics
- New Indian Express
Prof Yarlagadda meets Governor Nazeer; flags student concerns, push for Indian languages abroad
VIJAYAWADA: Renowned academician and scholar Professor Yarlagadda Lakshmi Prasad met Governor Justice S Abdul Nazeer at Raj Bhavan on Saturday, raising concerns over challenges faced by Indian students abroad and the global promotion of Indian languages. Yarlagadda highlighted the implications of the proposed US immigration policy changes by President Donald Trump, which he said could create new barriers for Indian students in the United States. He stressed the need for timely diplomatic and academic interventions to protect their interests. He briefed the Governor on his recent visit to the US, including a meeting with Ambassador Parvathaneni Harish, India's Permanent Representative to the United Nations. The discussions focused on India's global linguistic presence and student welfare. Yarlagadda called attention to the historic election of Dr Mukkamala Srinivas (Bobby) as the first Telugu individual to become President of the American Medical Association, describing it as a proud moment for the global Telugu community. He also recounted his meeting with Anand Kuchibhotla, President of the University of Silicon Andhra, which is promoting Telugu language and culture in the US. As part of his longstanding advocacy, Prof. Yarlagadda reiterated the demand to recognise Hindi as an official language of the United Nations. Governor Abdul Nazeer appreciated his lifelong service to Hindi and Telugu literature and assured support for initiatives concerning language, education, and the Indian Diaspora.
