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What you are asking here is basically does emotional trauma affect us physically. The answer is whoo boy it sure does.The best known and most respected book that describes this is called “your body keeps the score.” I have pasted all kinds of stuff below.Randi KregerStopwalkingoneggshells.comProduct description“Essential reading for anyone interested in understanding and treating traumatic stress and the scope of its impact on society.” —Alexander McFarlane, Director of the Centre for Traumatic Stress StudiesA pioneering researcher transforms our understanding of trauma and offers a bold new paradigm for healing in this New York Times bestsellerTrauma is a fact of life. Veterans and their families deal with the painful aftermath of combat; one in five Americans has been molested; one in four grew up with alcoholics; one in three couples have engaged in physical violence.Dr. Bessel van der Kolk, one of the world’s foremost experts on trauma, has spent over three decades working with survivors. In The Body Keeps the Score, he uses recent scientific advances to show how trauma literally reshapes both body and brain, compromising sufferers’ capacities for pleasure, engagement, self-control, and trust.He explores innovative treatments—from neurofeedback and meditation to sports, drama, and yoga—that offer new paths to recovery by activating the brain’s natural neuroplasticity. Based on Dr. van der Kolk’s own research and that of other leading specialists, The Body Keeps the Score exposes the tremendous power of our relationships both to hurt and to heal—and offers new hope for reclaiming lives.Review“The trauma caused by childhood neglect, sexual or domestic abuse and war wreaks havoc in our bodies, says Bessel van der Kolk in The Body Keeps the Score. . . . Van der Kolk draws on 30 years of experience to argue powerfully that trauma is one of the West's most urgent public health issues. . . . Packed with science and human stories, the book is an intense read. . . . [T]he struggle and resilience of his patients is very moving.”—Shaoni Bhattacharya, New Scientist“War zones may be nearer than you think, as the 25% of US citizens raised with alcoholic relatives might attest. Psychiatrist Bessel van der Kolk argues, moreover, that severe trauma is ‘encoded in the viscera’ and demands tailored approaches that enable people to experience deep relief from rage and helplessness. In a narrative packed with decades of findings and case studies, he traces the evolution of treatments from the ‘chemical coshes’ of the 1970s to neurofeedback, mindfulness and other nuanced techniques.”— Nature“An astonishing amount of information on almost every aspect of trauma experience, research, interventions, and theories is brought together in this book, which . . . has a distinctly holistic feel to it. The title suggests that what will be explored is how the body retains the imprints of trauma. However, it delivers much more than this, delving into how the brain is impacted by overwhelming traumatic events, and is studded with sections on neuroscience which draw on the author’s own numerous studies as well as that of his peers. In addition, it investigates the effects of adverse childhood attachment patterns, child abuse, and chronic and long-term abuse. . . . [T]his book is a veritable goldmine of information.”—European Journal of Psychotraumatology“Dr. van der Kolk . . . has written a fascinating and empowering book about trauma and its effects. He uses modern neuroscience to demonstrate that trauma physically affects the brain and the body, causing anxiety, rage, and the inability to concentrate. Victims have problems remembering, trusting, and forming relationships. They have lost control. Although news reports and discussions tend to focus on war veterans, abused children, domestic violence victims, and victims of violent crime suffer as well. Using a combination of traditional therapy techniques and alternative treatments such as EMDR, yoga, neurofeedback, and theater, patients can regain control of their bodies and rewire their brains so that they can rebuild their lives. The author uses case histories to demonstrate the process. He includes a resource list, bibliography, and extensive notes. This accessible book offers hope and inspiration to those who suffer from trauma and those who care for them. It is an outstanding addition to all library collections.—Medical Library Association, Consumer Connections“[A] wonderful new book that everyone involved with trauma ought to read and have available. . . . [B]eautifully, compellingly and sweepingly written in its grand vision of integrating medical, psychological and mixed or alternative approaches, based on a careful reading of the client and a holistic mind-body view. . . . There are very few practitioners who could not learn from this book and become more effective, as well as inspired, by reading and studying it.”—Henry Strick van Linschoten, European Society For Trauma And Dissociation Newsletter“Psychological trauma can befall anyone, not just soldiers, refugees, or victims of rape. . . . This important and helpful book makes sense of suffering and offers opportunity for healing.”— Booklist“[C]omprehensive in scope. This valuable work . . . offers hope for the millions of sufferers and their families seeking meaningful treatment and relief from the ongoing pain of trauma.”— Library Journal (Starred Review)“Dr. van der Kolk's masterpiece combines the boundless curiosity of the scientist, the erudition of the scholar, and the passion of the truth teller.”—Judith Herman, M.D., clinical professor of psychiatry, Harvard Medical School; author of Trauma and Recovery“This is an absolutely fascinating and clearly written book by one of the nation’s most experienced physicians in the field of emotional trauma. The Body Keeps the Score helps us understand how life experiences play out in the function and the malfunction of our bodies, years later.”—Vincent J. Felitti, M.D., chief of preventative medicine, emeritus, Kaiser Permanente San Diego; co-principal investigator, ACE study“In this inspirational work which seamlessly weaves keen clinical observation, neuroscience, historical analysis, the arts, and personal narrative, Dr. van der Kolk has created an authoritative guide to the effects of trauma, and pathways to recovery. The book is full of wisdom, humanity, compassion and scientific insight, gleaned from a lifetime of clinical service, research and scholarship in the field of traumatic stress. A must read for mental health and other health care professionals, trauma survivors, their loved ones, and those who seek clinical, social, or political solutions to the cycle of trauma and violence in our society.”—Rachel Yehuda, Ph.D., professor of psychiatry and neuroscience; director of the Traumatic Stress Studies Division at the Mount Sinai School of Medicine, New York, NY“Breathtaking in its scope and breadth, The Body Keeps the Score is a seminal work by one of the preeminent pioneers in trauma research and treatment. This essential book unites the evolving neuroscience of trauma research with an emergent wave of body-oriented therapies and traditional mind/body practices that go beyond symptom relief and connect us with our vital energy and here-and-now presence.”—Peter A. Levine, Ph.D., author of In an Unspoken Voice: How the Body Releases Trauma and Restores Goodness“In The Body Keeps the Score we share the author's courageous journey into the parallel dissociative worlds of trauma victims and the medical and psychological disciplines that are meant to provide relief. In this compelling book we learn that as our minds desperately try to leave trauma behind, our bodies keep us trapped in the past with wordless emotions and feelings. These inner disconnections cascade into ruptures in social relationships with disastrous effects on marriages, families, and friendships. Van der Kolk offers hope by describing treatments and strategies that have successfully helped his patients reconnect their thoughts with their bodies. We leave this shared journey understanding that only through fostering self-awareness and gaining an inner sense of safety will we, as a species, fully experience the richness of life.—Stephen W. Porges, Ph.D., professor of psychiatry, University of North Carolina at Chapel Hill; author of The Polyvagal Theory: Neurophysiological Foundations of Emotions, Attachment, Communication, and Self-Regulation“This exceptional book will be a classic of modern psychiatric thought. The impact of overwhelming experience can only be truly understood when many disparate domains of knowledge, such as neuroscience, developmental psychopathology, and interpersonal neurobiology are integrated, as this work uniquely does. There is no other volume in the field of traumatic stress that has distilled these domains of science with such rich historical and clinical perspectives, and arrived at such innovative treatment approaches. The clarity of vision and breadth of wisdom of this unique but highly accessible work is remarkable. This book is essential reading for anyone interested in understanding and treating traumatic stress and the scope of its impact on society.”—Alexander McFarlane AO, MB BS (Hons) MD FRANZCP, director of the Centre for Traumatic Stress Studies, The University of Adelaide, South Australia.“This book is a tour de force. Its deeply empathic, insightful, and compassionate perspective promises to further humanize the treatment of trauma victims, dramatically expand their repertoire of self-regulatory healing practices and therapeutic options, and also stimulate greater creative thinking and research on trauma and its effective treatment. The body does keep the score, and van der Kolk’s ability to demonstrate this through compelling descriptions of the work of others, his own pioneering trajectory and experience as the field evolved and him along with it, and above all, his discovery of ways to work skillfully with people by bringing mindfulness to the body (as well as to their thoughts and emotions) through yoga, movement, and theater are a wonderful and welcome breath of fresh air and possibility in the therapy world.”—Jon Kabat-Zinn, professor of medicine emeritus, UMass Medical School; author of Full Catastrophe Living.“This is an amazing accomplishment from the neuroscientist most responsible for the contemporary revolution in mental health toward the recognition that so many mental problems are the product of trauma. With the compelling writing of a good novelist, van der Kolk revisits his fascinating journey of discovery that has challenged established wisdom in psychiatry. Interspersed with that narrative are clear and understandable: descriptions of the neurobiology of trauma; explanations of the ineffectiveness of traditional approaches to treating trauma; and introductions to the approaches that take patients beneath their cognitive minds to heal the parts of them that remained frozen in the past. All this is illustrated vividly with dramatic case histories and substantiated with convincing research. This is a watershed book that will be remembered as tipping the scales within psychiatry and the culture at large toward the recognition of the toll traumatic events and our attempts to deny their impact take on us all.”—Richard Schwartz, originator, Internal Family Systems Therapy“ The Body Keeps the Score is clear, fascinating, hard to put down, and filled with powerful case histories. Van der Kolk, the eminent impresario of trauma treatment, who has spent a career bringing together diverse trauma scientists and clinicians and their ideas, while making his own pivotal contributions, describes what is arguably the most important series of breakthroughs in mental health in the last thirty years. We’ve known that psychological trauma fragments the mind. Here we see not only how psychological trauma also breaks connections within the brain, but also between mind and body, and learn about the exciting new approaches that allow people with the severest forms of trauma to put all the parts back together again.”—Norman Doidge, author of The Brain That Changes Itself“Every once in a while, a book comes along that fundamentally changes the way we look at the world. Bessel van der Kolk has written such a book. The arc of van der Kolk’s story is vast and comprehensive, but he is such a skillful storyteller that he keeps us riveted to the page. I could not put this book down. It is, simply put, a great work.”—Stephen Cope, founder and director, Kripalu Institute for Extraordinary Living; author of Yoga and the Quest for the True Self“Bessel van der Kolk is unequaled in his ability to synthesize the stunning developments in the field of psychological trauma over the past few decades. Thanks in part to his work, psychological trauma—ranging from chronic child abuse and neglect, to war trauma and natural disasters—is now generally recognized as a major cause of individual, social and cultural breakdown. In this masterfully lucid and engaging tour de force, van der Kolk takes us —both specialists and the general public— on his personal journey and shows what he has learned from his research, from his colleagues and students, and, most importantly, from his patients. The Body Keeps the Score is, simply put, brilliant.”—Onno van der Hart, Ph.D., Utrecht University, The Netherlands; senior author, The Haunted Self: Structural Dissociation and the Treatment of Chronic Traumatization“The Body Keeps the Score articulates new and better therapies for toxic stress based on a deep understanding of the effects of trauma on brain development and attachment systems. This volume provides a moving summary of what is currently known about the effects of trauma on individuals and societies, and introduces the healing potential of both age old and novel approaches to help traumatized children and adults to fully engage in the present.”—Jessica Stern, policy consultant on terrorism; author of Denial: A Memoir of Terror“A book about understanding the impact of trauma by one of the true pioneers in the field. It is a rare book that integrates cutting edge neuroscience with wisdom and understanding about the experience and meaning of trauma, for people who have suffered from it. Like its author, this book is wise and compassionate, occasionally quite provocative, and always interesting.”—Glenn N. Saxe, M.D., Arnold Simon Professor and chairman, Department of Child and Adolescent Psychiatry; director, NYU Child Study Center, New York University School of Medicine“A fascinating exploration of a wide range of therapeutic treatments shows readers how to take charge of the healing process, gain a sense of safety, and find their way out of the morass of suffering.”—Francine Shapiro, Ph.D., originator of EMDR therapy, senior research fellow, Emeritus Mental Research Institute, author of Getting Past Your Past“As an attachment researcher I know that infants are psychobiological beings. They are as much the body as they are of the brain. Without language or symbols infants use every one of their biological systems to make meaning of their self in relation to the world of things and people. Van der Kolk shows that those very same systems continue to operate at every age, and that traumatic experiences, especially chronic toxic experience during early development, produce psychic devastation. With this understanding he provides insight and guidance for survivors, researchers and clinicians alike. Bessel van der Kolk may focus on the body and trauma, but what a mind he must have to have written this book.”—Ed Tronick, distinguished professor, University of Massachusetts, Boston, author of Neurobehavior and Social Emotional Development of Infants and Young Children“ The Body Keeps the Score eloquently articulates how overwhelming experiences affect the development of brain, mind, and body awareness, all of which are closely intertwined. The resulting derailments have a profound impact on the capacity for love and work. This rich integration of clinical case examples with ground breaking scientific studies provides us with a new understanding of trauma, which inevitably leads to the exploration of novel therapeutic approaches that "rewire" the brain, and help traumatized people to (re)-engage in the present. This book will provide traumatized individuals with a guide to healing and permanently change how psychologists and psychiatrists think about trauma and recovery.”—Ruth A. Lanius, M.D., Ph.D., Harris-Woodman chair in Psyche and Soma, professor of psychiatry, and director PTSD research at the University of Western Ontario; author of The Impact of Early Life Trauma on Health and Disease“When it comes to understanding the impact of trauma and being able to continue to grow despite overwhelming life experiences, Bessel van der Kolk leads the way in his comprehensive knowledge, clinical courage, and creative strategies to help us heal. The Body Keeps the Score is a cutting-edge offering for the general reader to comprehend the complex effects of trauma, and a guide to a wide array of scientifically informed approaches to not only reduce suffering, but to move beyond mere survival—and to thrive.”—Daniel J. Siegel, M.D., clinical professor, UCLA School of Medicine, author of Brainstorm: The Power and Purpose of the Teenage Brain; Mindsight: The New Science of Personal Transformation; and The Developing Mind: How Relationships and the Brain Interact to Shape Who We Are“In this magnificent book, Bessel van der Kolk takes the reader on a captivating journey that is chock full of riveting stories of patients and their struggles interpreted through history, research, and neuroscience made accessible in the words of a gifted storyteller. We are privy to the author’s own courageous efforts to understand and treat trauma over the past 40 years, the results of which have broken new ground and challenged the status quo of psychiatry and psychotherapy. The Body Keeps the Score leaves us with both a profound appreciation for and a felt sense of, the debilitating effects of trauma, along with hope for the future through fascinating descriptions of novel approaches to treatment. This outstanding volume is absolutely essential reading not only for therapists but for all who seek to understand, prevent, or treat the immense suffering caused by trauma.”—Pat Ogden Ph.D., Founder/Educational Director of the Sensorimotor Psychotherapy Institute; author ofSensorimotor Psychotherapy: Interventions for Trauma and Attachment“This is masterpiece of powerful understanding and brave heartedness, one of the most intelligent and helpful works on trauma I have ever read. Dr. van der Kolk offers a brilliant synthesis of clinical cases, neuroscience, powerful tools and caring humanity, offering a whole new level of healing for the traumas carried by so many.”—Jack Kornfied, author of A Path with Heart“ The Body Keeps the Score is masterful in bringing together science and humanism to clearly explain how trauma affects the whole person. Bessel van der Kolk brings deep understanding to the pain and chaos of the trauma experience. The treatment approaches he recommends heal the body and the mind, restoring hope and the possibility of joy. One reads this book with profound gratitude for its wisdom.”—Alicia Lieberman, Ph.D., Professor of Medical Psychology UCSF, Director of the Child Trauma Research Project, San Francisco General Hospital; author of The Emotional Life of the ToddlerAbout the AuthorBessel van der Kolk, M.D., is the founder and medical director of the Trauma Center in Brookline, Massachusetts. He is also a professor of psychiatry at Boston University School of Medicine and director of the National Complex Trauma Treatment Network. When he is not teaching around the world, Dr. van der Kolk works and lives Boston.Excerpt. © Reprinted by permission. All rights reserved.PROLOGUEFACING TRAUMAOne does not have be a combat soldier, or visit a refugee camp in Syria or the Congo to encounter trauma. Trauma happens to us, our friends, our families, and our neighbors. Research by the Centers for Disease Control and Prevention has shown that one in five Americans was sexually molested as a child; one in four was beaten by a parent to the point of a mark being left on their body; and one in three couples engages in physical violence. A quarter of us grew up with alcoholic relatives, and one out of eight witnessed their mother being beaten or hit.1As human beings we belong to an extremely resilient species. Since time immemorial we have rebounded from our relentless wars, countless disasters (both natural and man-made), and the violence and betrayal in our own lives. But traumatic experiences do leave traces, whether on a large scale (on our histories and cultures) or close to home, on our families, with dark secrets being imperceptibly passed down through generations. They also leave traces on our minds and emotions, on our capacity for joy and intimacy, and even on our biology and immune systems.Trauma affects not only those who are directly exposed to it, but also those around them. Soldiers returning home from combat may frighten their families with their rages and emotional absence. The wives of men who suffer from PTSD tend to become depressed, and the children of depressed mothers are at risk of growing up insecure and anxious. Having been exposed to family violence as a child often makes it difficult to establish stable, trusting relationships as an adult.Trauma, by definition, is unbearable and intolerable. Most rape victims, combat soldiers, and children who have been molested become so upset when they think about what they experienced that they try to push it out of their minds, trying to act as if nothing happened, and move on. It takes tremendous energy to keep functioning while carrying the memory of terror, and the shame of utter weakness and vulnerability.While we all want to move beyond trauma, the part of our brain that is devoted to ensuring our survival (deep below our rational brain) is not very good at denial. Long after a traumatic experience is over, it may be reactivated at the slightest hint of danger and mobilize disturbed brain circuits and secrete massive amounts of stress hormones. This precipitates unpleasant emotions intense physical sensations, and impulsive and aggressive actions. These posttraumatic reactions feel incomprehensible and overwhelming. Feeling out of control, survivors of trauma often begin to fear that they are damaged to the core and beyond redemption.• • •The first time I remember being drawn to study medicine was at a summer camp when I was about fourteen years old. My cousin Michael kept me up all night explaining the intricacies of how kidneys work, how they secrete the body’s waste materials and then reabsorb the chemicals that keep the system in balance. I was riveted by his account of the miraculous way the body functions. Later, during every stage of my medical training, whether I was studying surgery, cardiology, or pediatrics, it was obvious to me that the key to healing was understanding how the human organism works. When I began my psychiatry rotation, however, I was struck by the contrast between the incredible complexity of the mind and the ways that we human beings are connected and attached to one another, and how little psychiatrists knew about the origins of the problems they were treating. Would it be possible one day to know as much about brains, minds, and love as we do about the other systems that make up our organism?We are obviously still years from attaining that sort of detailed understanding, but the birth of three new branches of science has led to an explosion of knowledge about the effects of psychological trauma, abuse, and neglect. Those new disciplines are neuroscience, the study of how the brain supports mental processes; developmental psychopathology, the study of the impact of adverse experiences on the development of mind and brain; and interpersonal neurobiology, the study of how our behavior influences the emotions, biology, and mind-sets of those around us.Research from these new disciplines has revealed that trauma produces actual physiological changes, including a recalibration of the brain’s alarm system, an increase in stress hormone activity, and alterations in the system that filters relevant information from irrelevant. We now know that trauma compromises the brain area that communicates the physical, embodied feeling of being alive. These changes explain why traumatized individuals become hypervigilant to threat at the expense of spontaneously engaging in their day-to-day lives. They also help us understand why traumatized people so often keep repeating the same problems and have such trouble learning from experience. We now know that their behaviors are not the result of moral failings or signs of lack of willpower or bad character—they are caused by actual changes in the brain.This vast increase in our knowledge about the basic processes that underlie trauma has also opened up new possibilities to palliate or even reverse the damage. We can now develop methods and experiences that utilize the brain’s own natural neuroplasticity to help survivors feel fully alive in the present and move on with their lives. There are fundamentally three avenues: 1) top down, by talking, (re-) connecting with others, and allowing ourselves to know and understand what is going on with us, while processing the memories of the trauma; 2) by taking medicines that shut down inappropriate alarm reactions, or by utilizing other technologies that change the way the brain organizes information, and 3) bottom up: by allowing the body to have experiences that deeply and viscerally contradict the helplessness, rage, or collapse that result from trauma. Which one of these is best for any particular survivor is an empirical question. Most people I have worked with require a combination.This has been my life’s work. In this effort I have been supported by my colleagues and students at the Trauma Center, which I founded thirty years ago. Together we have treated thousands of traumatized children and adults: victims of child abuse, natural disasters, wars, accidents, and human trafficking; people who have suffered assaults by intimates and strangers. We have a long tradition of discussing all our patients in great depth at weekly treatment team meetings and carefully tracking how well different forms of treatment work for particular individuals.Our principal mission has always been to take care of the children and adults who have come to us for treatment, but from the very beginning we also have dedicated ourselves to conducting research to explore the effects of traumatic stress on different populations and to determine what treatments work for whom. We have been supported by research grants from the National Institute of Mental Health, the National Center for Complementary and Alternative Medicine, the Centers for Disease Control, and a number of private foundations to study the efficacy of many different forms of treatment, from medications to talking, yoga, EMDR, theater, and neurofeedback.The challenge is: How can people gain control over the residues of past trauma and return to being masters of their own ship? Talking, understanding, and human connections help, and drugs can dampen hyperactive alarm systems. But we will also see that the imprints from the past can be transformed by having physical experiences that directly contradict the helplessness, rage, and collapse that are part of trauma, and thereby regaining self-mastery. I have no preferred treatment modality, as no single approach fits everybody, but I practice all the forms of treatment that I discuss in this book. Each one of them can produce profound changes, depending on the nature of the particular problem and the makeup of the individual person.I wrote this book to serve as both a guide and an invitation—an invitation to dedicate ourselves to facing the reality of trauma, to explore how best to treat it, and to commit ourselves, as a society, to using every means we have to prevent it.PART ONETHE REDISCOVERY OF TRAUMACHAPTER 1LESSONS FROM VIETNAM VETERANSI became what I am today at the age of twelve, on a frigid overcast day in the winter of 1975. . . . That was a long time ago, but it’s wrong what they say about the past. . . . Looking back now, I realize I have been peeking into that deserted alley for the last twenty-six years.—Khaled Hosseini, The Kite RunnerSome people’s lives seem to flow in a narrative; mine had many stops and starts. That’s what trauma does. It interrupts the plot. . . . It just happens, and then life goes on. No one prepares you for it.—Jessica Stern, Denial: A Memoir of TerrorThe Tuesday after the Fourth of July weekend, 1978, was my first day as a staff psychiatrist at the Boston Veterans Administration Clinic. As I was hanging a reproduction of my favorite Breughel painting, “The Blind Leading the Blind,” on the wall of my new office, I heard a commotion in the reception area down the hall. A moment later a large, disheveled man in a stained three-piece suit, carrying a copy of Soldier of Fortunemagazine under his arm, burst through my door. He was so agitated and so clearly hungover that I wondered how I could possibly help this hulking man. I asked him to take a seat, and tell me what I could do for him.His name was Tom. Ten years earlier he had been in the Marines, doing his service in Vietnam. He had spent the holiday weekend holed up in his downtown-Boston law office, drinking and looking at old photographs, rather than with his family. He knew from previous years’ experience that the noise, the fireworks, the heat, and the picnic in his sister’s backyard against the backdrop of dense early-summer foliage, all of which reminded him of Vietnam, would drive him crazy. When he got upset he was afraid to be around his family because he behaved like a monster with his wife and two young boys. The noise of his kids made him so agitated that he would storm out of the house to keep himself from hurting them. Only drinking himself into oblivion or riding his Harley-Davidson at dangerously high speeds helped him to calm down.Nighttime offered no relief—his sleep was constantly interrupted by nightmares about an ambush in a rice paddy back in ’Nam, in which all the members of his platoon were killed or wounded. He also had terrifying flashbacks in which he saw dead Vietnamese children. The nightmares were so horrible that he dreaded falling asleep and he often stayed up for most of the night, drinking. In the morning his wife would find him passed out on the living room couch, and she and the boys had to tiptoe around him while she made them breakfast before taking them to school.Filling me in on his background, Tom said that he had graduated from high school in 1965, the valedictorian of his class. In line with his family tradition of military service he enlisted in the Marine Corps immediately after graduation. His father had served in World War II in General Patton’s army, and Tom never questioned his father’s expectations. Athletic, intelligent, and an obvious leader, Tom felt powerful and effective after finishing basic training, a member of a team that was prepared for just about anything. In Vietnam he quickly became a platoon leader, in charge of eight other Marines. Surviving slogging through the mud while being strafed by machine-gun fire can leave people feeling pretty good about themselves—and their comrades.At the end of his tour of duty Tom was honorably discharged, and all he wanted was to put Vietnam behind him. Outwardly that’s exactly what he did. He attended college on the GI Bill, graduated from law school, married his high school sweetheart, and had two sons. Tom was upset by how difficult it was to feel any real affection for his wife, even though her letters had kept him alive in the madness of the jungle. Tom went through the motions of living a normal life, hoping that by faking it he would learn to become his old self again. He now had a thriving law practice and a picture-perfect family, but he sensed he wasn’t normal; he felt dead inside.Although Tom was the first veteran I had ever encountered on a professional basis, many aspects of his story were familiar to me. I grew up in postwar Holland, playing in bombed-out buildings, the son of a man who had been such an outspoken opponent of the Nazis that he had been sent to an internment camp. My father never talked about his war experiences, but he was given to outbursts of explosive rage that stunned me as a little boy. How could the man I heard quietly going down the stairs every morning to pray and read the Bible while the rest of the family slept have such a terrifying temper? How could someone whose life was devoted to the pursuit of social justice be so filled with anger? I witnessed the same puzzling behavior in my uncle, who had been captured by the Japanese in the Dutch East Indies (now Indonesia) and sent as a slave laborer to Burma, where he worked on the famous bridge over the river Kwai. He also rarely mentioned the war, and he, too, often erupted into uncontrollable rages.As I listened to Tom, I wondered if my uncle and my father had had nightmares and flashbacks—if they, too, had felt disconnected from their loved ones and unable to find any real pleasure in their lives. Somewhere in the back of my mind there must also have been my memories of my frightened—and often frightening—mother, whose own childhood trauma was sometimes alluded to and, I now believe, was frequently reenacted. She had the unnerving habit of fainting when I asked her what her life was like as a little girl and then blaming me for making her so upset.Reassured by my obvious interest, Tom settled down to tell me just how scared and confused he was. He was afraid that he was becoming just like his father, who was always angry and rarely talked with his children—except to compare them unfavorably with his comrades who had lost their lives around Christmas 1944, during the Battle of the Bulge.As the session was drawing to a close, I did what doctors typically do: I focused on the one part of Tom’s story that I thought I understood—his nightmares. As a medical student I had worked in a sleep laboratory, observing people’s sleep/dream cycles, and had assisted in writing some articles about nightmares. I had also participated in some early research on the beneficial effects of the psychoactive drugs that were just coming into use in the 1970s. So, while I lacked a true grasp of the scope of Tom’s problems, the nightmares were something I could relate to, and as an enthusiastic believer in better living through chemistry, I prescribed a drug that we had found to be effective in reducing the incidence and severity of nightmares. I scheduled Tom for a follow-up visit two weeks later.When he returned for his appointment, I eagerly asked Tom how the medicines had worked. He told me he hadn’t taken any of the pills. Trying to conceal my irritation, I asked him why. “I realized that if I take the pills and the nightmares go away,” he replied, “I will have abandoned my friends, and their deaths will have been in vain. I need to be a living memorial to my friends who died in Vietnam.”I was stunned: Tom’s loyalty to the dead was keeping him from living his own life, just as his father’s devotion to his friends had kept him from living. Both father’s and son’s experiences on the battlefield had rendered the rest of their lives irrelevant. How had that happened, and what could we do about it? That morning I realized I would probably spend the rest of my professional life trying to unravel the mysteries of trauma. How do horrific experiences cause people to become hopelessly stuck in the past? What happens in people’s minds and brains that keeps them frozen, trapped in a place they desperately wish to escape? Why did this man’s war not come to an end in February 1969, when his parents embraced him at Boston’s Logan International Airport after his long flight back from Da Nang?Tom’s need to live out his life as a memorial to his comrades taught me that he was suffering from a condition much more complex than simply having bad memories or damaged brain chemistry—or altered fear circuits in the brain. Before the ambush in the rice paddy, Tom had been a devoted and loyal friend, someone who enjoyed life, with many interests and pleasures. In one terrifying moment, trauma had transformed everything.

Throughout the course of comprehensive healthcare, many patients develop problems with their minds and bodies that can lead to severe discomfort, costly treatment, disabilities, and more. Predicting those escalations in advance offers healthcare providers the opportunity to apply preventative measure that might improve patient safety, and quality of care, while lowering medical costs. In simple terms, prediction using networks of big data used to evaluate specific people, and specific risk factors in certain illnesses could save lives, and avoid medical complications.Today, many prognostics methods turn to Artificial Neural Networks when attempting to find new insights into the future of patient healthcare. ANNs (Artificial Neural Networks) are just one of the many models being introduced into the field of healthcare by innovations like AI and big data. Their purpose is to transform huge amounts of raw data into useful decisions for treatment and care.What is a Neural Network?Understanding Neural Networks can be very difficult. After all, to many people, these examples of Artificial Intelligence in the medical industry are a futuristic concept.According to Wikipedia (the source of all truth) :“Neural Networks are a computational approach which is based on a large collection of neural units loosely modeling the way the brain solves problems with large clusters of biological neurons connected by axons. Each neural unit is connected with many others…These systems are self-learning and trained rather than explicitly programmed…”By Glosser.ca – Own work, Derivative of File:Artificial neural network.svg (https://commons.wikimedia.org/wiki/File:Artificial_neural_network.svg), CC BY-SA 3.0, LinkOne way to think of it is this: Imagine that a doctor wants to make a prediction regarding a patient’s health – for instance, whether she or he is at risk of suffering from a certain disease. How would a doctor be able to ascertain that information? In most cases, it would involve using blood tests, taking tests of the patient’s vitals, and more to identify features that have proven to be good predictors of patient health. However, what if doctors only know a handful of risk-factors for a specific disease – or worse, they don’t know the risk factors at all? It would be impossible to make predictions.ANNs help to provide the predictions in healthcare that doctors and surgeons simply couldn’t address alone. They work in moments wherein we can collect data, but we don’t understand which pieces of that data are vitally important yet. These abstractions can therefore capture complex relationships that might not be initially obvious – leading to better prediction for public health.What are the Possibilities for Neural Networks in Healthcare?Though they may seem like a futuristic concept, ANNs have been used in healthcare for several decades. In fact, the book “Neural Networks in Healthcare” covers the various uses of this system prior to 2006. Before 2006, the main successes of ANNs were found in areas like speech processing and image processing. Today, as new technologies emerge, capable of changing the way that we approach neural networks in the first place – it’s worth noting that there may be numerous new options for changing the industry. Today, the possibilities for Neural Networks in Healthcare include:Diagnostic systems – ANNs can be used to detect heart and cancer problems, as well as various other diseases informed by big data.Biochemical analysis – ANNs are used to analyze urine and blood samples, as well as tracking glucose levels in diabetics, determining ion levels in fluids, and detecting various pathological conditions.Image analysis – ANNs are frequently used to analyze medical images from various areas of healthcare, including tumor detection, x-ray classifications, and MRIs.Drug development – Finally, ANNs are used in the development of drugs for various conditions – working by using large amounts of data to come to conclusions about treatment options.Current Examples of Neural NetworksNeural networks can be seen in most places where AI has made steps within the healthcare industry. For instance, in the world of drug discovery, Data Collective and Khosla Ventures are currently backing the company “Atomwise“, which uses the power of machine learning and neural networks to help medical professionals discover safer and more effective medicines fast. The company recently published its first findings of Ebola treatment drugs last year, and the tools that Atomwise uses can tell the difference between toxic drug candidates and safer options.Similarly, options are being found that could insert neural networks into the realm of diagnostic. For instance, in 2014, Butterfly Networks, which are transforming the diagnostic realm with deep learning, devices, and the cloud, raised $100M for their cause. This organization currently works at the heart of the medicine and engineering sectors by bringing together world-class skills in everything from electrical engineering, to mechanical engineering, and medicine. At the same time, iCarbonX are developing artificial intelligence platforms to facilitate research relating to the treatment of various diseases and preventative care. The company believe that soon they will be able to help enable the future of truly personalized medicine.The Future of Healthcare…Perhaps the most significant problem with ANNs is that the learned features involved when it comes to assessing huge amounts of data can sometimes be difficult to interpret. This is potentially why ANNs are more commonly used during situations wherein we have a lot of data to ensure that the observed data doesn’t contain too many “flukes”. Think of it this way – if you toss a coin three times and receive “tails” every time, this doesn’t mean that a coin only has a “tails” side. It just means that you need further evaluation and more testing to get a proper reading of probability.ANNs are going to need some tweaking if they’re going to become the change that the healthcare industry needs. However, alongside new AI developments, it seems that neural networks could have a very important part to play in the future of healthcare.Healthcare organizations of all sizes, types, and specialties are becoming increasingly interested in how artificial intelligence can support better patient care while reducing costs and improving efficiencies.Over a relatively short period of time, the availability and sophistication of AI has exploded, leaving providers, payers, and other stakeholders with a dizzying array of tools, technologies, and strategies to choose from.Just learning the lingo has been a top challenge for many organizations.There are subtle but significant differences between key terms such as AI, machine learning, deep learning, and semantic computing.Understanding exactly how data is ingested, analyzed, and returned to the end user can have a big impact on expectations for accuracy and reliability, not to mention influencing any investments necessary to whip an organization’s data assets into shape.In order to efficiently and effectively choose between vendor products or hire the right data science staff to develop algorithms in-house, healthcare organizations should feel confident that they have a firm grasp on the different flavors of artificial intelligence and how they can apply to specific use cases.Deep learning is a good place to start. This branch of artificial intelligence has very quickly become transformative for healthcare, offering the ability to analyze data with a speed and precision never seen before.But what exactly is deep learning, how does it differ from other machine learning strategies, and how can healthcare organizations leverage deep learning techniques to solve some of the most pressing problems in patient care?DEEP LEARNING IN A NUTSHELLDeep learning, also known as hierarchical learning or deep structured learning, is a type of machine learning that uses a layered algorithmic architecture to analyze data.In deep learning models, data is filtered through a cascade of multiple layers, with each successive layer using the output from the previous one to inform its results. Deep learning models can become more and more accurate as they process more data, essentially learning from previous results to refine their ability to make correlations and connections.Deep learning is loosely based on the way biological neurons connect with one another to process information in the brains of animals. Similar to the way electrical signals travel across the cells of living creates, each subsequent layer of nodes is activated when it receives stimuli from its neighboring neurons.In artificial neural networks (ANNs), the basis for deep learning models, each layer may be assigned a specific portion of a transformation task, and data might traverse the layers multiple times to refine and optimize the ultimate output.These “hidden” layers serve to perform the mathematical translation tasks that turn raw input into meaningful output.An illustration of a deep learning neural networkSource: University of Cincinnati“Deep learning methods are representation-learning methods with multiple levels of representation, obtained by composing simple but non-linear modules that each transform the representation at one level (starting with the raw input) into a representation at a higher, slightly more abstract level,” explains a 2015 article published in Nature, authored by engineers from Facebook, Google, the University of Toronto, and Université de Montréal.“With the composition of enough such transformations, very complex functions can be learned. Higher layers of representation amplify aspects of the input that are important for discrimination and suppress irrelevant variations.”This multi-layered strategy allows deep learning models to complete classification tasks such as identifying subtle abnormalities in medical images, clustering patients with similar characteristics into risk-based cohorts, or highlight relationships between symptoms and outcomes within vast quantities of unstructured data.Unlike other types of machine learning, deep learning has the added benefit of being able to decisions with significantly less involvement from human trainers.While basic machine learning requires a programmer to identify whether a conclusion is correct or not, deep learning can gauge the accuracy of its answers on its own due to the nature of its multi-layered structure.“With the composition of enough such transformations, very complex functions can be learned.”Deep learning also requires less preprocessing of data. The network itself takes care of many of the filtering and normalization tasks that must be completed by human programmers when using other machine learning techniques.“Conventional machine-learning techniques are limited in their ability to process natural data in their raw form,” said the article from Nature.“For decades, constructing a pattern-recognition or machine-learning system required careful engineering and considerable domain expertise to design a feature extractor that transformed the raw data (such as the pixel values of an image) into a suitable internal representation or feature vector from which the learning subsystem, often a classifier, could detect or classify patterns in the input.”Deep learning networks, however, “automatically discover the representations needed for detection or classification,” reducing the need for supervision and speeding up the process of extracting actionable insights from datasets that have not been as extensively curated.Naturally, the mathematics involved in developing deep learning models are extraordinarily intricate, and there are many different variations of networks that leverage different sub-strategies within the field.The science of deep learning is evolving very quickly to power some of the most advanced computing capabilities in the world, spanning every industry and adding significant value to user experiences and competitive decision-making.WHAT ARE THE USE CASES FOR DEEP LEARNING IN HEALTHCARE?Many of the industry’s deep learning headlines are currently related to small-scale pilots or research projects in their pre-commercialized phases.However, deep learning is steadily finding its way into innovative tools that have high-value applications in the real-world clinical environment.Some of the most promising use cases include innovative patient-facing applications as well as a few surprisingly established strategies for improving the health IT user experience.Imaging analytics and diagnosticsOne type of deep learning, known as convolutional neural networks (CNNs), is particularly well-suited to analyzing images, such as MRI results or x-rays.CNNs are designed with the assumption that they will be processing images, according tocomputer science experts at Stanford University, allowing the networks to operate more efficiently and handle larger images.As a result, some CNNs are approaching – or even surpassing – the accuracy of human diagnosticians when identifying important features in diagnostic imaging studies.In June of 2018, a study in the Annals of Oncology showed that a convolutional neural network trained to analyze dermatology images identified melanoma with ten percent more specificity than human clinicians.Even when human clinicians were equipped with background information on patients, such as age, sex, and the body site of the suspect feature, the CNN outperformed the dermatologists by nearly 7 percent.“Our data clearly show that a CNN algorithm may be a suitable tool to aid physicians in melanoma detection irrespective of their individual level of experience and training,” said the team of researchers from a number of German academic institutions.In addition to being highly accurate, deep learning tools are fast.Researchers at the Mount Sinai Icahn School of Medicine have developed a deep neural network capable of diagnosing crucial neurological conditions, such as stroke and brain hemorrhage, 150 times faster than human radiologists.“Our data clearly show that a CNN algorithm may be a suitable tool to aid physicians in melanoma detection irrespective of their individual level of experience and training.”The tool took just 1.2 seconds to process the image, analyze its contents, and alert providers of a problematic clinical finding.“The expression ‘time is brain’ signifies that rapid response is critical in the treatment of acute neurological illnesses, so any tools that decrease time to diagnosis may lead to improved patient outcomes,” said Joshua Bederson, MD, Professor and System Chair for the Department of Neurosurgery at Mount Sinai Health System and Clinical Director of the Neurosurgery Simulation Core.Deep learning is so adept at image work that some AI scientists are using neural networks to create medical images, not just read them.A team from NVIDIA, the Mayo Clinic, and the MGH & BWH Center for Clinical Data Science has developed a method of using generative adversarial networks (GANs), another type of deep learning, which can create stunningly realistic medical images from scratch.The images use patterns learned from real scans to create synthetic versions of CT or MRI images. The data can be randomly generated and endlessly diverse, allowing researchers to access large volumes of necessary data without any concerns around patient privacy or consent.These simulated images are so accurate that they can help train future deep learning models to diagnose clinical findings.“Medical imaging data sets are often imbalanced as pathologic findings are generally rare, which introduces significant challenges when training deep learning models,” said the team. “We propose a method to generate synthetic abnormal MRI images with brain tumors by training a generative adversarial network.”“This offers an automatable, low-cost source of diverse data that can be used to supplement the training set. For example, we can alter a tumor’s size, change its location, or place a tumor in an otherwise healthy brain, to systematically have the image and the corresponding annotation.”Such a strategy could significantly reduce of AI’s biggest sticking points: a lack of reliable, sharable, high-volume datasets to use for training and validating machine learning models.Natural language processingDeep learning and neural networks already underpin many of the natural language processing tools that have become popular in the healthcare industry for dictating documentation and translating speech-to-text.Because neural networks are designed for classification, they can identify individual linguistic or grammatical elements by “grouping” similar words together and mapping them in relation to one another.This helps the network understand complex semantic meaning. But the task is complicated by the nuances of common speech and communication. For example, words that always appear next to each other in an idiomatic phrase, may end up meaning something very different than if those same words appeared in another context (think “kick the bucket” or “barking up the wrong tree”).While acceptably accurate speech-to-text has become a relatively common competency for dictation tools, generating reliable and actionable insights from free-text medical data is significantly more challenging.Unlike images, which consist of defined rows and columns of pixels, the free text clinical notes in electronic health records (EHRs) are notoriously messy, incomplete, inconsistent, full of cryptic abbreviations, and loaded with jargon.Currently, most deep learning tools still struggle with the task of identifying important clinical elements, establishing meaningful relationships between them, and translating those relationships into some sort of actionable information for an end user.A recent literature review from JAMIA found that while deep learning surpasses other machine learning methods for processing unstructured text, several significant challenges, including the quality of EHR data, are holding these tools back from true success.“Researchers have confirmed that finding patterns among multimodal data can increase the accuracy of diagnosis, prediction, and overall performance of the learning system. However, multimodal learning is challenging due to the heterogeneity of the data,” the authors observed.Accessing enough high-quality data to train models accurately is also problematic, the article continued. Data that is biased or skewed towards particular age groups, ethnicities, or other characteristics could create models that are not equipped to accurately assess a broad variety of real-life patients.Still, deep learning represents the most promising pathway forward into trustworthy free-text analytics, and a handful of pioneering developers are finding ways to break through the existing barriers.A team from Google, UC San Francisco, Stanford Medicine, and the University of Chicago Medicine, for example, developed a deep learning and natural language processing algorithm that analyzed more than 46 billion data points from more than 216,000 EHRs across two hospitals.The tool was able to improve on the accuracy of traditional approaches for identifying unexpected hospital readmissions, predicting length of stay, and forecasting inpatient mortality.“This predictive performance was achieved without hand-selection of variables deemed important by an expert, similar to other applications of deep learning to EHR data,” the researchers said.“Instead, our model had access to tens of thousands of predictors for each patient, including free-text notes, and identified which data were important for a particular prediction.”While the project is only a proof-of-concept study, Google researchers said, the findings could have dramatic implications for hospitals and health systems looking to reduce negative outcomes and become more proactive about delivering critical care.Drug discovery and precision medicinePrecision medicine and drug discovery are also on the agenda for deep learning developers. Both tasks require processing truly enormous volumes of genomic, clinical, and population-level data with the goal of identifying hitherto unknown associations between genes, pharmaceuticals, and physical environments.Deep learning is an ideal strategy for researchers and pharmaceutical stakeholders looking to highlight new patterns in these relatively unexplored data sets – especially because many precision medicine researchers don’t yet know exactly what they should be looking for.“Our model had access to tens of thousands of predictors for each patient, including free-text notes, and identified which data were important for a particular prediction.”The world of genetic medicine is so new that unexpected discoveries are commonplace, creating an exciting proving ground for innovative approaches to targeted care.The National Cancer Institute and the Department of Energy are embracing this spirit of exploration through a number of joint projects focused on leveraging machine learning for cancer discoveries.The combination of predictive analytics and molecular modeling will hopefully uncover new insights into how and why certain cancers form in certain patients.Deep learning technologies will accelerate the process of analyzing data, the two agencies said, shrinking the processing time for key components from weeks or months to just a few hours.The private sector is similarly committed to illustrating how powerful deep learning can be for precision medicine.A partnership by GE Healthcare and Roche Diagnostics, announced in January of 2018, will focus on using deep learning and other machine learning strategies to synthesize disparate data sets critical to developing precision medicine insights.The two companies will work to combine in-vivo and in-vitro data, EHR data, clinical guidelines, and real-time monitoring data to support clinical decision-making and the creation of more effective, less invasive therapeutic pathways.“By leveraging this combined data set using machine learning and deep learning, it may be possible in the future to reduce the number of unnecessary biopsies that are performed due to suspicious findings in the mammograms and possibly also reduce mastectomies that are performed to combat ductal carcinoma in situ, a condition that may evolve into invasive breast cancer in some cases,” said Nadeem Ishaque, Chief Innovation Officer, GE Healthcare Imaging.A separate study, conducted by researchers from the University of Massachusetts and published in JMIR Medical Informatics, found that deep learning could also identify adverse drug events (ADEs) with much greater accuracy than traditional models.“By leveraging this combined data set using machine learning and deep learning, it may be possible in the future to reduce the number of unnecessary biopsies.”The tool combines deep learning with natural language processing to comb through unstructured EHR data, highlighting worrisome associations between the type, frequency, and dosage of medications. The results could be used for monitoring the safety of novel therapies or understanding how new pharmaceuticals are being prescribed in the real-world clinical environment.Clinical decision support and predictive analyticsIn a similar vein, the industry has high hopes for the role of deep learning in clinical decision support and predictive analytics for a wide variety of conditions.Deep learning may soon be a handy diagnostic companion in the inpatient setting, where it can alert providers to changes in high-risk conditions such as sepsis and respiratory failure.Researchers from the MIT Computer Science and Artificial Intelligence Laboratory (CSAIL) have created a project called ICU Intervene, which leverages deep learning to alert clinicians to patient downturns in the critical care unit.“Much of the previous work in clinical decision-making has focused on outcomes such as mortality (likelihood of death), while this work predicts actionable treatments,” said PhD student and lead author Harini Suresh. “In addition, the system is able to use a single model to predict many outcomes.”The tool offers human clinicians a detailed rationale for its recommendations, helping to foster trust and allowing providers to have confidence in their own decision-making when potentially overruling the algorithm.Google is also on the leading edge of clinical decision support, this time for eye diseases. The company’s UK-based subsidiary, DeepMind, is working to develop a commercialized deep learning CDS tool that can identify more than 50 different eye diseases – and provide treatment recommendations for each one.In a supporting study published in Nature, DeepMind and Moorfields Eye Hospital found that the tool is just as accurate as a human clinician, and has the potential to significantly expand access to care by reducing the time it takes for an exam and diagnosis.“Currently, eye care professionals use optical coherence tomography (OCT) scans to help diagnose eye conditions. These 3D images provide a detailed map of the back of the eye, but they are hard to read and need expert analysis to interpret,” explained DeepMind.“The time it takes to analyze these scans, combined with the sheer number of scans that healthcare professionals have to go through (over 1,000 a day at Moorfields alone), can lead to lengthy delays between scan and treatment – even when someone needs urgent care. If they develop a sudden problem, such as a bleed at the back of the eye, these delays could even cost patients their sight.”With deep learning, the triage process is nearly instantaneous, the company asserted, and patients do not have to sacrifice quality of care.“This is a hugely exciting milestone, and another indication of what is possible when clinicians and technologists work together,” DeepMind said.WHAT IS THE FUTURE OF DEEP LEARNING IN HEALTHCARE?As intriguing as these pilots and projects can be, they represent only the very beginning of deep learning’s role in healthcare analytics.Excitement and interest about deep learning are everywhere, capturing the imaginations of regulators and rule makers, private companies, care providers, and even patients.The Office of the National Coordinator (ONC) is one organization with particularly high hopes for deep learning, and it is already applauding some developers for achieving remarkable results.In a recent report on the state of AI in the healthcare setting, the agency noted that some deep learning algorithms have already produced “transformational” outcomes.“There have been significant demonstrations of the potential utility of artificial Intelligence approaches based on deep learning for use in medical diagnostics,” the report said.“Where good training sets represent the highest levels of medical expertise, applications of deep learning algorithms in clinical settings provide the potential of consistently delivering high quality results.”The report highlighted early successes in diabetic retinal screenings and the classification of skin cancer as two areas where deep learning may already be changing the status quo.On the clinical side, imaging analytics is likely to be the focal point for the near future, due to the fact that deep learning already has a head start on many high-value applications.“Applications of deep learning algorithms in clinical settings provide the potential of consistently delivering high quality results.”But purely clinical applications are only one small part of how deep learning is preparing to change the way the healthcare system functions.The strategy is integral to many consumer-facing technologies, such as chatbots, mHealth apps, and virtual personalities like Alexa, Siri, and Google Assistant.These tools have the potential to radically alter the way patients interact with the healthcare system, offering home-based chronic disease management programming, 24/7 access to basic triage, and new ways to complete administrative tasks.By 2019, up to 40 percent of businesses are planning to integrate one or more of these popular consumer technologies into their internal or external workflows.Customer support and communication are two early implementations. But with market-movers like Amazon rumored to start rolling out more consumer-facing health options to patients, it may only be a matter of time before chatting with Alexa becomes as common as shooting the breeze with a medical assistant.Voice recognition and other analytics based on deep learning also have the near-term potential to provide some relief to physicians and nurses struggling with their EHRs.Google appears particularly interested in capturing medical conversations in the clinic and using deep learning to reduce administrative burdens on providers.One recent research paper illustrated the potential to use deep learning and NLP to understand casual conversation in a noisy environment, giving rise to the possibility of using an ambient, intelligent scribe to shoulder the onus of documentation.“We wondered: could the voice recognition technologies already available in Google Assistant, Google Home, and Google Translate be used to document patient-doctor conversations and help doctors and scribes summarize notes more quickly?” a Google team posited.“While most of the current automatic speech recognition (ASR) solutions in medical domain focus on transcribing doctor dictations (i.e., single speaker speech consisting of predictable medical terminology), our research shows that it is possible to build an ASR model which can handle multiple speaker conversations covering everything from weather to complex medical diagnosis,” the blog post says.Google will work with physicians and data scientists at Stanford to refine the technology and understand how it can be best applied to the clinical setting.“We hope these technologies will not only help return joy to practice by facilitating doctors and scribes with their everyday workload, but also help the patients get more dedicated and thorough medical attention, ideally, leading to better care,” the team said.EHR vendors are also taking a hard look at how machine learning can streamline the user experience by eliminating wasteful interactions and presenting relevant data more intuitively within the workflow.“Taking out the trash” by using artificial intelligence to learn a user’s habits, anticipate their needs, and display the right data at the right time is a top priority for nearly all of the major health IT vendors – vendors who are finding themselves in the hot seat as unhappy customers plead for better solutions for their daily tasks.Both patients and providers are demanding much more consumer-centered tools and interactions from the healthcare industry, and artificial intelligence may now be mature enough to start delivering.“We finally have enough affordable computing power to get the answers we’re looking for,” said James Golden, PhD, Senior Managing Director for PwC’s Healthcare Advisory Group, to Healthcare IT Analytics News on Healthcare BI, Population Health and Data Management in February of 2018.“When I did my PhD in the 90s on back propagation neural networks, we were working with an input layer, an output layer, and two middle layers,” he recalled.“That’s not extremely complex. But it ran for four days on an Apple Lisa before producing results. I can do the same computation today in a picosecond on an iPhone. That is an enormous, staggering leap in our capabilities.”The intersection of more advanced methods, improved processing power, and growing interest in innovative methods of predicting, preventing, and cheapening healthcare will likely bode well for deep learning.With an extremely high number of promising use cases, strong investment from major players in the industry, and a growing amount of data to support cutting-edge analytics, deep learning will no doubt play a central role in the quest to deliver the highest possible quality care to consumers for decades to come.References :What Is Deep Learning and How Will It Change Healthcare?https://royaljay.com/healthcare/neural-networks-in-healthcare/

First, I'll answer your question, but then, I have a couple of questions for you.1. Yes, there are drugs in Phase III that target Tau, depending on how you look at it.I assume you're asking about currently active trials -- ongoing but no longer recruiting, recruiting, or planning to recruit.1.a. LMTM / TauRxThose who have been in the trenches for a long time will remember Rember (TRx0014), a proprietary formulation of the non-neuroleptic phenothiazine methylene blue (methylthioninium chloride), a compound that has been used for quite some time for the treatment of malaria and is FDA-approved for a number of conditions. The compound readily crosses the blood–brain barrier and prevents tau aggregation in vitro as well as in cell and animal models. A single-center, 24-week, dose-ranging monotherapy trial on 321 mild to moderate AD patients was reported to have shown signs of benefit in moderate, but not mild, AD. However, the methodology, blinding status, and claims of efficacy have been highly criticized.Since then, second-generation replacement formulation of a stable reduced form of the methylthioninium moiety (leuco-methylthioninium bis-hydromethanesulfonate, LMTM; also known as LMT-X or TRx0237) has reached phase III clinical trials for the treatment of Alzheimer's. It reportedly has better absorption into the intestine, bioavailability, and tolerability than the earlier formulation. A randomized, controlled, double-blind, parallel-group, multicenter trial aimed at determining safety and efficacy in 833 mild to moderate AD patients showed no signs of efficacy after 15 months. More recently, a second 18-month phase III trial in 700 subjects with mild AD showed no effect on the primary endpoints. The researchers’ claims of efficacy after a post-hoc subgroup secondary analysis have been highly controversial, mainly concerning the methodology used and the interpretation of the results.Please note that methylene blue is known to have pleiotropic effects, so some authors have argued that sensu stricto the drug and its formulations should not be considered primarily as tau-based therapies.TauRx has also completed Phase III clinical trial of LMTM on behavior-variant frontotemporal dementia (bvFTD). As far as I know, the results have not been published. However, the company just announced that the FDA has granted orphan-drug designation for TauRx’s LMTX in FTD. The news release mentions that the active moiety in LMTX "has also shown to be active against aggregations of the TDP-43 protein; tau and TDP-43 aggregation is causative in most of the FTD sub-types."There is one ongoing, Phase 3 open-label extension study (NCT02245568) of LMTX. The trial is restricted to those who participated in the previous Phase 3 trials for Alzheimer’s and bvFTD.TauRx has started a new clinical trial, named LUCIDITY. This Phase 2 / Phase 3 trial uses FDG-PET imaging and a composite cognitive functional/scale to "confirm the benefits seen with LMTX in delaying the progression of Alzheimer’s disease." LUCIDITY is aimed at patients with early-stage Alzheimer’s. It's not entirely clear to me whether they're still recruiting, since they haven't updated the information on Home - ClinicalTrials.gov since Sept 2018. For trial design, study sites, and inclusion/exclusion factors, see:Safety and Efficacy of TRx0237 in Subjects With Early Alzheimer's Disease - Full Text View - ClinicalTrials.gov1.b. Masitinib / AB ScienceIn its 2018 annual drug pipeline analysis, ResearchersAgainstAlzheimer's (RA2) discussed Masitinib as targeting tau. AB Science recently announced that a Phase 3 study of masitinib in patients with mild to moderate Alzheimer's has completed patient recruitment, with 721 enrolled patients. Masitinib is a new orally administered tyrosine kinase inhibitor that interferes with the survival, migration, and activity of mast cells, and in this role has attracted attention for the treatment of neuroinflammatory and neurodegenerative disorders. It also targets mast cells. The therapeutic benefit of masitinib in Alzheimer's disease is most likely exerted through multiple mechanisms of action:• Masitinib potently inhibits mast cell, cells that play an important role in neuroinflammation and regulation of the blood-brain-barrier (BBB) permeability.• Masitinib also targets the FYN kinase, which is involved in Abeta signaling and Tau phosphorylation.• Masitinib also targets CSF1R kinase, which is involved in the regulation of the microglial cell neuroinflammatory response.NCT01872598: Phase 3, active not recruiting. For the treatment of mild to moderate Alzheimer's Disease.1.c. Flebogamma / Grifols Biologicals Inc.Flebogamma (intravenous immunoglobulin, IVIg) is a human plasma-derived product consisting of polyclonal serum IgG pooled from thousands of blood donors. It has been employed for quite some time and proven effective as anti-inflammatory and immunomodulatory therapy for various neurological diseases. A Phase 3, randomized, double-blind, placebo-controlled trial (NCT00818662) in 390 participants with mild to moderate AD did not improve cognition or function after IVIg infusions were performed every 2 weeks for 18 months. Two more Phase 2/3 (NCT01300728) and (NCT01561053) clinical trials for the treatment of Alzheimer's are active but not recruiting.Flebogamma may be considered to target tau, since tau-specific antibodies were found to be present in the IVIg product Flebogamma, and recognized a recombinant tau fragment spanning residues 155–421 as well tau aggregates from Alzheimer's brains.The Phase 3 AMBAR study (NCT01561053) comprising 350 subjects with probable mild to moderate Alzheimer's is active but no longer recruiting. Cognitive, functional, and behavioural changes will be assessed. The trial will also assess changes in Aβ peptide concentration, plasma and CSF levels of Aβ40 and Aβ42, and CSF t-tau and p-tau levels; structural changes in hippocampal volume, posterior cingulate volume, and other areas of interest as shown by MRI; as well as any functional changes in the brain detected by positron emission tomography with 18F-fludeoxyglucose.2. Why are you restricting your question to Phase 3 clinical trials?There are two primary competing theories on what causes Alzheimer's disease. Some researchers think that the accumulation of amyloid plaque in the brain leads to the disease. Others believe that Alzheimer's is caused by another protein called tau.I'm guessing you have a loved one you'd like to enroll in a clinical trial, but no longer have any faith in INDs that target amyloid-beta. While there isn't as much information available on drugs that haven't yet reached Phase 3, there sometimes is enough -- especially with regard to safety -- to make Phase 2 trials of interest. In some trials, participants may be able to enter an open-label phase (in which all participants receive "the real thing") after completing Phase 2. Sometimes, the drugs under study are commercially available.In the past, more research -- and more pipeline candidates -- have focused on the amyloid hypothesis. However, it's a different picture in the Phase 2 pipelines: there are 12 amyloid drugs and 11 tau drugs. Some of the tau drugs are small molecule, some are antibody-based.Note: I am going by the ResearchersAgainstAlzheimer's (RA2) 2018 annual drug pipeline analysis as to the target(s) of the drugs -- I haven't bothered to double-check any of the drugs on their list.https://www.usagainstalzheimers.org/sites/default/files/2018_Alzheimers_Drug_Pipeline_The_Current_State_Of_Alzheimers_Drug_Development.pdfLithium / NY State Psychiatric Institute, NIANCT01055392: Phase 2, status unknown.NCT00088387: Phase 2, completed (2008).NCT02129348: Phase 2, recruiting. To examine the efficacy and side effects of low dose lithium treatment of agitation/aggression with or without psychosis in 80 patients with AD in a randomized, doubleblind, placebo-controlled, 12-week trial (essentially a Phase II trial). The results will determine the potential for a large-scale clinical trial (Phase III) to establish the utility of lithium in these patients. Lengthy list of references on lithium for protection against neurodegenerative diseases, studies on its use in Alzheimer's patients, etc.NCT03185208: Phase 4, recruiting. To examine whether lithium has anti-dementia properties in older adults who have mild cognitive impairment and are at risk of becoming demented.AADvac1 / AXON NeuroscienceNCT02579252: Phase 2, active, not recruiting. Evaluates the safety and efficacy of AADvac1 in the treatment of patients with mild Alzheimer's disease. All trials to be done in Europe.L-Serine / Dartmouth-Hitchcock Medical CenterNCT03062449: Phase 2a, recruiting. Patients meeting the criteria for early Alzheimer's disease will be considered for study participation, with the Investigator taking the additional inclusion/exclusion criteria into consideration. Up to 40 subjects will be enrolled. (And yes, this is a naturally-occurring dietary amino acid, widely sold as a dietary supplement.)Meganatural-Az Grapeseed Extract / Icahn School of Medicine at Mount Sinai; National Center for Complementary and Integrative HealthNCT02033941: Phase 2, recruiting. This study aims to establish the safety and pharmacokinetics of Meganatural-Az® GSPE in subjects with Alzheimer's disease. As a secondary goal, clinical and biomarker indices of therapeutic efficacy will also be evaluated. The proposed study will provide the essential human data necessary to guide the design of future studies testing the efficacy of GSPE in mitigating cognitive deterioration in AD patients. Meganatural-Az® doses: 30mg / day for 2 weeks; 4 weeks of 600 mg/day, 4 weeks 1000mg / day. Other names: Grapeseed polyphenolic extract, grapeseed phenol extract, GSPENicotinamide / University of California, IrvineNCT00580931: Phase 1/2, completed.NCT03061474: Phase 2, recruiting. The purpose of this research study is to test whether nicotinamide, also known as vitamin B3 or niacinamide, taken in high doses (1500mg 2 x/day), can reduce phosphorylation of tau in people with Mild Cognitive Impairment or mild Alzheimer's. The study will implement a group sequential design, incorporating a futility analysis with a go/no-go decision conditional on cerebral spinal fluid CSF biomarker outcomes at 12-months. The primary outcome for the trial is change in p-tau231. Preliminary data support its safety in Alzheimer's. Preclinical work in a mouse model that develops both plaques and tangles supports the hypothesis that nicotinamide can act as a histone deacetylase (HDAC) inhibitor to reduce phosphorylation of tau.Methylthioninium chloride (Methylene blue) / The University of Texas Health Science Center at San AntonioNCT02380573: Phase 2, active not recruiting. A double-blind, placebo-controlled study that aims to investigate the effect of 2-week and 12-week administration of USP methylene blue (MB) on cerebral blood flow, functional connectivity, memory and attention cognitive abilities using fMRI and behavioral measures in healthy aging, mild cognitive impairment (MCI) and mild Alzheimer's disease (AD) subjects. Drug: Phenazopyridine hydrochloride; FD&C Blue #2; Phenothiazin-5-ium, 3, 7-bis (dimethylamino)-chloride, trihydrate. (97.5 mg oral) Lots of references listed.IONIS-MAPTRx / Ionis Pharmaceuticals, Inc.NCT03186989: Phase 1 / 2, recruiting. The purpose is to assess the safety, tolerability, pharmacokinetics, and pharmacodynamics of IONIS-MAPTRx administered intrathecally at 4 week intervals in patients with Mild Alzheimer's Disease. This study will be divided into two parts: Part 1: a randomized, double-blind, placebo-controlled multiple ascending dose period, followed by Part 2: an open-label, long-term extension period. Other Name: ISIS 814907. Trial locations in Canada and Europe.BIIB092 / BiogenNCT03352557: Phase 2, recruiting. To evaluate the safety and tolerability of BIIB092 in participants with mild cognitive impairment (MCI) due to Alzheimer's disease (AD) or with mild AD. To evaluate the efficacy of multiple doses of BIIB092 in slowing cognitive and functional impairment in participants with MCI due to AD or with mild AD. To evaluate the immunogenicity of BIIB092 after multiple doses in participants with MCI due to AD or with mild AD. IV infusion once every 4 weeks or once every 12 weeks. Other Name: BMS 986168Trial locations in 16 US states, Australia, Europe, JapanLY3303560 / Eli LillyNCT02754830: Phase 1, completed.NCT03019536: Phase 1, active not recruiting.NCT03518073: Phase 2, recruiting. To evaluate the safety and efficacy. 61 trial locations, in the US, Japan, Canada.RO7105705 (RG 6100) / Roche/GenentechNCT02820896: Phase 1, completed.NCT03828747: Phase 2, recruiting. Will evaluate the clinical efficacy, safety, pharmacokinetics, and pharmacodynamics of intravenous RO7105705 in patients with moderate AD. The study consists of a screening period, a double-blind treatment period, an optional open-label extension (OLE) period, and a safety follow-up period. Recruiting in Florida, Illinois, Massachusetts, Pennsylvania.NCT03289143: Phase 2, recruiting. Randomized, placebo-controlled, double-blind study to evaluate the efficacy and safety of intravenous RO7105705 in participants with prodromal to mild Alzheimer's disease. An optional 96-week open-label extension period will be available to participants who complete the double-blind treatment period and who, in the judgment of the investigator, would potentially benefit from open-label RO7105705 treatment. 153 locations, in 18 US states, plus Canada, Australia, Europe.ABBV-8E12 / AbbVieNCT03712787: Phase 2, enrolling by invitation only.NCT02880956: Phase 2, recruiting. To evaluate the efficacy and safety of IV infusion of ABBV-8E12 in subjects with Early Alzheimer's Disease (mild cognitive impairment or probable Alzheimer's, MMSE score 22 to 30 inclusive.) 78 locations in 21 US states, Australia, Canada, Europe.NCT03744546: Expanded Access to ABBV-8E12. This is an expanded access program (EAP) for eligible participants. This program is designed to provide access to ABBV-8E12 prior to approval by the local regulatory agency. Availability will depend on territory eligibility. Participating sites will be added as they apply for and are approved for the EAP. A medical doctor must decide whether the potential benefit outweighs the risk of receiving an investigational therapy based on the individual patient's medical history and program eligibility criteria.NCT02985879 Phase 2, active not recruiting, and NCT03391765 Phase 2, recruiting, both on progressive supranuclear palsy (PSP).3. Why are you restricting your question to drugs that target tau?I understand being fed up with all the failures of INDs that target amyloid-beta, but there are many drugs under development that utilize innovative approaches, including, e.g., agonists and antagonists of neurotransmitter receptors, β-secretase (BACE) or γ-secretase inhibitors, and anti-inflammation compounds, as well as stem cell therapies, gene therapies, and various kinds of brain irradiation (e.g., far infrared, low dose fractionated whole brain irradiation, or low dose ionizing radiation (LDIR) from repeat CT scanning), or brain stimulation (electroacupuncture, repetitive transcranial magnetic stimulation, direct cranial stimulation, and deep brain stimulation.) Rather than testing investigational new drugs (INDs), a process that takes a very long time to demonstrate safety as well as efficacy, some researchers are taking the approach of repositioning or repurposing drugs that were developed and previously licensed for other diseases. For example, the cancer chemotherapy drug bryostatin-1 is in Phase 2 (active, not recruiting) for the treatment of moderate to severe Alzheimer’s disease.If you are indeed trying to find a clinical trial on a promising treatment for a loved one with Alzheimer's, I'd suggest that you research any clinical trials that are going to be conducted at a facility near you. Generally speaking, there are so many screening, treatment, and assessment meetings to be attended that you can't live very far away. And be forewarned that someone very familiar with the Alzheimer's patient and his/her daily functioning and symptoms (you?) will have to accompany the patient to all meetings and participate in the assessments.Go to: Home - ClinicalTrials.gov and search for Alzheimer's and the state where you live (or cities nearby but in other states.)Or you can use the National Institute on Aging's search engine: Clinical Trials FinderOr CenterWatch: Alzheimer's Disease Clinical Research TrialsOr there is Alzheimer's Association TrialMatch: Clinical Trials