Can Robots Obtain Consciousness?



In recent years, consciousness has become a significant topic of research in psychology and 1) ___. The primary focus is on understanding what it means biologically and psychologically for information to be present in consciousness – that is, on determining the neural and psychological correlates of consciousness. The majority of experimental studies assess consciousness by asking human subjects for a verbal report of their experiences (e.g., “tell me if you notice anything when I do this“). Issues of interest include phenomena such as subliminal perception, blind sightedness, denial of impairment, and altered 2) ___ of consciousness produced by psychoactive drugs or spiritual or meditative techniques.


In medicine, consciousness is assessed by observing a patient’s arousal and responsiveness, and can be seen as a continuum of states ranging from full alertness and comprehension, through disorientation, delirium, loss of meaningful communication, and finally loss of movement in response to painful stimuli. Issues of practical concern include how the presence of consciousness can be assessed in severely ill, comatose, or anesthetized people, and how to treat conditions in which consciousness is impaired or disrupted.


Since the dawn of Newtonian science with its vision of simple mechanical principles governing the entire universe, some philosophers have been tempted by the idea that consciousness could be explained in purely physical terms. The first influential writer to propose such an idea explicitly was Julien Offray de La Mettrie, in his book Man a Machine (L’homme machine). His arguments, however, were very abstract. The most influential modern physical theories of consciousness are based on 3) ___ and neuroscience. Theories proposed by neuroscientists such as Gerald Edelman and Antonio Damasio, and by philosophers such as Daniel Dennett, seek to explain consciousness in terms of neural events occurring within the 4) ___. Many other neuroscientists, such as Christof Koch, have explored the neural basis of consciousness without attempting to frame all-encompassing global theories. At the same time, computer scientists working in the field of Artificial Intelligence have pursued the goal of creating digital computer programs that can simulate or embody consciousness.


A few theoretical physicists have argued that classical physics is intrinsically incapable of explaining the holistic aspects of consciousness, but that quantum theory provides the missing ingredients. Several theorists have therefore proposed quantum mind (QM) theories of 5) ___. Notable theories falling into this category include the Holonomic brain theory of Karl Pribram and David Bohm, and the Orch-OR theory formulated by Stuart Hameroff and Roger Penrose. Some of these QM theories offer descriptions of phenomenal consciousness, as well as QM interpretations of access consciousness. None of the quantum mechanical theories has been confirmed by experiment. Recent papers by Guerreshi, G., Cia, J., Popescu, S. and Briegel, H. could falsify proposals such those of Hameroff which rely on quantum entanglement in protein. At the present time many scientists and philosophers consider the arguments for an important role of quantum phenomena to be unconvincing.


Medical Aspects


The medical approach to consciousness is practically oriented. It derives from a need to treat people whose brain function has been impaired as a result of disease, brain damage, toxins, or drugs. In medicine, conceptual distinctions are considered useful to the degree that they can help to guide treatments. Whereas the philosophical approach to consciousness focuses on its fundamental nature and its contents, the 6) ___ approach focuses on the amount of consciousness a person has: in medicine, consciousness is assessed as a “level“ ranging from coma and brain death at the low end, to full alertness and purposeful responsiveness at the high end.


Consciousness is of concern to patients and physicians, especially neurologists and anesthesiologists. Patients may suffer from disorders of consciousness, or may need to be anesthetized for a surgical procedure. Physicians may perform consciousness-related interventions such as instructing the patient to sleep, administering general anesthesia, or inducing medical coma. Also, bioethicists may be concerned with the ethical implications of consciousness in medical cases of patients such as Karen Ann Quinlan, while neuroscientists may study patients with impaired consciousness in hopes of gaining information about how the brain works.




In medicine, consciousness is examined using a set of procedures known as neuropsychological assessment. There are two commonly used methods for assessing the level of consciousness of a patient: a simple procedure that requires minimal training, and a more complex procedure that requires substantial expertise. The simple procedure begins by asking whether the patient is able to move and react to physical 7) ___. If so, the next question is whether the patient can respond in a meaningful way to questions and commands. If so, the patient is asked for name, current location, and current day and time. A patient who can answer all of these 8) ___ is said to be “oriented times three“ (sometimes denoted “Ox3“ on a medical chart), and is usually considered fully conscious.


The more complex procedure is known as a neurological examination, and is usually carried out by a neurologist in a 9) ___ setting. A formal neurological examination runs through a precisely delineated series of tests, beginning with tests for basic sensorimotor reflexes, and culminating with tests for sophisticated use of language. The outcome may be summarized using the Glasgow Coma Scale, which yields a number in the range 3-15, with a score of 3 indicating brain 10) ___ the lowest defined level of consciousness), and 15 indicating full consciousness. The Glasgow Coma Scale has three subscales, measuring the best motor response (ranging from “no motor response“ to “obeys commands“), the best eye response (ranging from “no eye opening“ to “eyes opening spontaneously“) and the best verbal response (ranging from “no verbal response“ to “fully oriented“). There is also a simpler pediatric version of the scale, for children too young to be able to use language.


ANSWERS: 1) neuroscience; 2) states; 3) psychology; 4) brain; 5) consciousness; 6) medical; 7) stimuli; 8) questions; 9) hospital; 10) death



Representation of consciousness from the seventeenth century



Consciousness is the quality or state of being aware of an external object or something within oneself. It has been defined as: subjectivity, awareness, the ability to experience or to feel, wakefulness, having a sense of selfhood, and the executive control system of the mind. Despite the difficulty in definition, many philosophers believe that there is a broadly shared underlying intuition about what consciousness is. As Max Velmans and Susan Schneider wrote in The Blackwell Companion to Consciousness: “Anything that we are aware of at a given moment forms part of our consciousness, making conscious experience at once the most familiar and most mysterious aspect of our lives.“


Philosophers since the time of Descartes and Locke have struggled to comprehend the nature of consciousness and pin down its essential properties. Issues of concern in the philosophy of consciousness include whether the concept is fundamentally valid; whether consciousness can ever be explained mechanistically; whether non-human consciousness exists and if so how it can be recognized; how consciousness relates to language; and whether it may ever be possible for computers or robots to be conscious. Perhaps the thorniest issue is whether consciousness can be understood in a way that does not require a dualistic distinction between mental and physical states or properties.


The first influential philosopher to discuss this question specifically was Rene Descartes (1596-1650), and the answer he gave is known as Cartesian dualism. Descartes proposed that consciousness resides within an immaterial domain he called res cogitans (the realm of thought), in contrast to the domain of material things which he called res extensa (the realm of extension). He suggested that the interaction between these two domains occurs inside the brain, perhaps in a small midline structure called the pineal gland. Although it is widely accepted that Descartes explained the problem cogently, few later philosophers have been happy with his solution, and his ideas about the pineal gland have especially been ridiculed. Alternative solutions, however, have been very diverse. They can be divided broadly into two categories: dualist solutions that maintain Descartes’s rigid distinction between the realm of consciousness and the realm of matter but give different answers for how the two realms relate to each other; and monist solutions that maintain that there is really only one realm of being, of which consciousness and matter are both aspects


John Locke, British philosopher active in the 17th century



The origin of the modern concept of consciousness is often attributed to John Locke’s Essay Concerning Human Understanding, published in 1690. Locke defined consciousness as “the perception of what passes in a man’s own mind.“ His essay influenced the 18th century view of consciousness, and his definition appeared in Samuel Johnson’s celebrated Dictionary (1755). The earliest English language uses of “conscious“ and “consciousness“ date back, however, to the 1500s. The English word “conscious“ originally derived from the Latin conscius (con- “together“ + scire “to know“), but the Latin word did not have the same meaning as our word – it meant knowing with, in other words having joint or common knowledge with another. There were, however, many occurrences in Latin writings of the phrase conscius sibi, which translates literally as “knowing with oneself“, or in other words sharing knowledge with oneself about something. This phrase had the figurative meaning of knowing that one knows, as the modern English word “conscious“ does. In its earliest uses in the 1500s, the English word “conscious“ retained the meaning of the Latin conscius. For example Thomas Hobbes in Leviathan wrote: “Where two, or more men, know of one and the same fact, they are said to be Conscious of it one to another.


Sigmund Freud and his followers developed an account of the unconscious mind, which plays an important role in psychoanalysis. By giving intricate definition to the unconscious, Freud contributed greatly to the understanding of the conscious mind studied today by neuroscientists like Eric Kandel MD, Nobel Prize winner and professor at Columbia University.


An iceberg is often used to illustrate Freud’s theories, showing that most of the human mind operates unconsciously



Freud divided the mind into the conscious mind (or the ego) and the unconscious mind. The latter was then further divided into the id (or instincts and drive) and the superego (or conscience). In this theory, the unconscious refers to the mental processes of which individuals make themselves unaware. Freud proposed a vertical and hierarchical architecture of human consciousness: the conscious mind, the preconscious, and the unconscious mind – each lying beneath the other. He believed that significant psychic events take place “below the surface“ in the unconscious mind, like hidden messages from the unconscious. He interpreted such events as having both symbolic and actual significance. In psychoanalytic terms, the unconscious does not include all that is not conscious, but rather what is actively repressed from conscious thought or what a person is averse to knowing consciously. Freud viewed the unconscious as a repository for socially unacceptable ideas, wishes or desires, traumatic memories, and painful emotions put out of mind by the mechanism of psychological repression. However, the contents did not necessarily have to be solely negative. In the psychoanalytic view, the unconscious is a force that can only be recognized by its effects – it expresses itself in the symptom. In a sense, this view places the conscious self as an adversary to its unconscious, warring to keep the unconscious hidden. Unconscious thoughts are not directly accessible to ordinary introspection, but are supposed to be capable of being “tapped“ and “interpreted“ by special methods and techniques such as meditation, free association (a method largely introduced by Freud), dream analysis, and verbal slips (commonly known as a Freudian slip), examined and conducted during psychoanalysis. Seeing as these unconscious thoughts are normally cryptic, psychoanalysts are considered experts in interpreting their messages.


Freud later used his notion of the unconscious in order to explain certain kinds of neurotic behavior; behavior that is difficult for the conscious mind/brain to change,

Dreams, not existing in the conscious or the unconscious mind, were considered by Freud, to be the royal road to the unconscious.


1. Ongoing attempt to define consciousness


“The evolution of the capacity to simulate seems to have culminated in subjective consciousness. Why this should have happened is, to me, the most profound mystery facing modern biology“ Richard Dawkins, The Selfish Gene. Since 1976, it has remained so.


In 2004, eight neuroscientists felt it was too soon for a definition. They wrote an apology in “Human Brain Function“: “We have no idea how consciousness emerges from the physical activity of the brain and we do not know whether consciousness can emerge from non-biological systems, such as computers. At this point the reader will expect to find a careful and precise definition of consciousness. You will be disappointed. Consciousness has not yet become a scientific term that can be defined in this way. Currently we all use the term consciousness in many different and often ambiguous ways. Precise definitions of different aspects of consciousness will emerge but to make precise definitions at this stage is premature.“ In contrast to philosophical definitions, an operational definition can be tested experimentally, and is useful for current research. A current definition for self-awareness, proposed in the 1970s by Gordon Gallup, is known as the mirror test. An operational definition proposed in 2012 states “consciousness is the sum of the electrical discharges occurring throughout the nervous system of a being at any given instant“. This operational definition is based on Dennett’s theory of the Multiple Drafts Model of Consciousness, arising from the Buddha’s pluripotent model of consciousness. What many consider consciousness may simply be the personal awareness of all the neurons delivering messages to the mind, but operational consciousness can include all neuronal activity. Extending this concept to all sentient beings, one can measure a range of consciousness based on how many and how powerfully neurons are actually firing, varying from worms to humans. One can answer the question, is someone asleep less conscious than someone thinking about a difficult problem. Although technology does not exist currently to measure this, it can be estimated by determining oxygen consumption by the brain.


2. Could a machine ever be conscious?


The idea of an artifact made conscious is an ancient theme of mythology, appearing for example in the Greek myth of Pygmalion, who carved a statue that was magically brought to life, and in medieval Jewish stories of the Golem, a magically animated homunculus built of clay. However, the possibility of actually constructing a conscious machine was probably first discussed by Ada Lovelace, in a set of notes written in 1842 about the Analytical Engine invented by Charles Babbage, a precursor (never built) to modern electronic computers. Lovelace was essentially dismissive of the idea that a machine such as the Analytical Engine could think in a humanlike way. She wrote: “It is desirable to guard against the possibility of exaggerated ideas that might arise as to the powers of the Analytical Engine. The Analytical Engine has no pretensions whatever to originate anything. It can do whatever we know how to order it to perform. It can follow analysis; but it has no power of anticipating any analytical relations or truths. Its province is to assist us in making available what we are already acquainted with.“


One of the most influential contributions to this question was an essay written in 1950 by pioneering computer scientist Alan Turing, titled Computing Machinery and Intelligence. Turing disavowed any interest in terminology, saying that even “Can machines think?“ is too loaded with spurious connotations to be meaningful; but he proposed to replace all such questions with a specific operational test, which has become known as the Turing test. To pass the test a computer must be able to imitate a human well enough to fool interrogators. In his essay Turing discussed a variety of possible objections, and presented a counterargument to each of them. The Turing test is commonly cited in discussions of artificial intelligence as a proposed criterion for machine consciousness; it has provoked a great deal of philosophical debate. For example, Daniel Dennett and Douglas Hofstadter argue that anything capable of passing the Turing test is necessarily conscious, while David Chalmers argues that a philosophical zombie could pass the test, yet fail to be conscious.


Christof Koch lists the following four definitions of consciousness in his latest book, which can be summarized as follows: Consciousness is the inner mental life that we lose each night when we fall into dreamless sleep, consciousness can be measured with the Glasgow Coma Scale that assesses the reactions of patients, an active cortico-thalamic complex is necessary for consciousness in humans, and put philosophically, consciousness is what it is like to feel something.


The medical approach continues to focus on the amount of consciousness a person has: in medicine, consciousness is assessed as a “level“ ranging from full alertness and purposeful responsiveness at the high end, to coma and brain death at the low end.



“Tomorrow and tomorrow and tomorrow,

Creeps in this petty pace from day to day

To the last syllable of recorded time,

And all our yesterdays have lighted fools

The way to dusty death. Out, out, brief candle!

Life’s but a walking shadow, a poor player

That struts and frets his hour upon the stage

And then is heard no more: it is a tale

Told by an idiot, full of sound and fury,

Signifying nothing.“


Macbeth – William Shakespeare (1564 -1616)


Editor’s Note: We will continue to share information about highly sophisticated robots, with AI, like Watson, and how they differ from humans, but this gap is narrowing.  We think of our 5 (or 6) senses as being strictly human, separating us from AI robots, however, keep in mind, that already at the beginning of the 21st Century, robots are responding to and storing data from, touch, vision, auditory stimuli; we know that DARPA has developed robots with a sense of smell much greater than that of a bomb sniffing dog.  That leaves taste.  Robots still are not able to feel in the human sense, and to dream.  And, at this point, robots do not have an unconscious which is as vastly mysterious as human consciousness.

Child Well-Being – Drop in Infant Mortality, Preterm and Adolescent Birth Rates



The infant mortality rate, the preterm birth rate, and the adolescent birth rate all continued to decline, average mathematics scores increased for 4th and 8th grade students, the violent crime victimization rate among youth fell, as did the % of young children living in a home where someone smoked, according to the federal government’s annual statistical report on the well-being of the nation’s children and youth. However, the % of children living in poverty increased, and the % of children with at least one parent employed full time, year-round decreased.


These and other findings are described in America’s Children in Brief: Key National Indicators of Well-Being, 2012. The report was compiled by the Federal Interagency Forum on Child and Family Statistics, a working group of 22 federal agencies that produce and use data on issues related to children and families. The report uses the most recently available and reliable official federal statistics to describe the family and social environment, economic circumstances, health care, physical environment and safety, behavior, education, and health of America’s children and youth.


The report notes that infants born preterm or of low birth weight are at high risk of early death and long-term health and developmental problems.


The Forum alternates publishing a detailed report, America’s Children: Key National Indicators of Well-Being, with a summary version that highlights selected indicators. This year, the Forum is publishing America’s Children in Brief; it will publish the more detailed report in 2013. New to this year’s report is a figure showing the % of children in race groups constituting less than 10% of the population (American Indian and Alaska Native, Asian, Native Hawaiian and Other Pacific Islander, or two or more races).


Among the findings in this year’s report comparing 2009 to 2010 data:


  1. A drop in births in girls ages 15 to 17, from 20/1,000 to 17/1,000
  2. A drop in the % of infants born before 37 weeks’ gestation (preterm), from 12.2% to 12.0%
  3. A drop in deaths before the first birthday, from 6.4/1,000 births to 6.1/1,000 births
  4. A drop in the % of children from birth to 17 years of age living with at least one parent employed year round full time, from 72% to 71%
  5. A rise in the proportion of children from birth to 17 years of age living in poverty, from 21% to 22%
  6. A drop in the % of children from birth to 17 years of age living in households classified by the USDA as food insecure, from 23% to 22%
  7. A drop in the proportion of youth ages 12-17 who were victims of serious violent crimes, from 11/1,000 to 7/1,000
  8. A drop in the % of children, birth to 6 years of age, living in a home where someone smoked regularly, from 8.4% (2005) to 6.1%
  9. An increase of one point in the average mathematics scores for both 4th and 8th graders from 2009 to 2011
  10. A drop in the % of youth ages 16-19 neither enrolled in high school or college nor working, from 9% to 8% (2011)
  11. A rise in the % of children from birth to 17 years of age living in counties in which levels of one or more air pollutants were above allowable levels, from 59% to 67%

TB Strain Found in 18 Counties Outside Duval County, Florida



In April, the CDC’s team’s assessment that called Florida’s outbreak the worst in 20 years also projected that more than 3,000 people had been in close contact with the sick, but only a few hundred had been evaluated at that time. The report had not been widely circulated until The West Palm Beach Post published it July 8. Key legislators who had pushed for the downsizing of the Department of Health and the closure of the state’s only tuberculosis hospital in March said they hadn’t been briefed.


Tuberculosis is cause by a bacterium, Mycobacterium tuberculosis. It usually attacks the lungs but can affect other parts of the body. The disease can be fatal if not treated properly. Tuberculosis has been a disease in decline in most of the United States, and Florida. In 2011, 10,521 cases of active TB were recorded in the United States. Florida had 753 cases of TB, down from 835 in 2010.


Last year, in the shelters and halfway houses where Jacksonville’s (the Duval County Seat) homeless congregate, TB bloomed into the nation’s most extensive, fastest-growing outbreak, one described by a visiting official from the CDC as among the worst his group had seen in 20 years. Although state health officials maintain the outbreak is now mostly contained within the Jacksonville homeless, a state database obtained by The Palm Beach Post on Friday showed sick people with FL 046 zip codes have also popped up in 17 other Florida counties. About 23% of all FL 046 cases have occurred outside Duval County, analysis suggests, and most of those have been identified in the past two years.


Dr. Steven Harris, deputy secretary of the Florida Department of Health, said last week in a video interview with the News Service of Florida that his agency had the resources needed to manage the outbreak. “The CDC has assigned a public health specialist to the Duval County Health Department to assist us locally, and we have, from our own Bureau of Tuberculosis and Refugee Health, sent staff members to Duval County,“ Harris said. “We have been doing that since April to assist their local coalition and partners on the ground. We have also identified health department employees from surrounding health departments around Duval County to assist in testing for this strain.“


The state has also asked the CDC for a $250,000 supplemental grant, with an additional request contemplated for 2013, to help it find and treat people exposed to TB. The grant proposal, compiled with the help of the state’s CDC specialist, would add an additional surveillance team of a doctor, nurse, epidemiologist and support staff. They would be charged with seeking out the close contacts of people who develop active tuberculosis, so they can be questioned about symptoms, and tested if necessary. Other recommended items included fast-food gift cards and free Boost dietary supplement drinks, intended to reward the homeless for staying on their medications. The City Rescue Mission in Duval County should get 23 UV-light air cleaners, and the team should have a van outfitted with an air filtration system, the expert recommended.


A CDC spokesperson confirmed the agency is considering a state request for money “to address programmatic gaps and for strengthening Duval’s local infrastructure and capacity to address this TB outbreak.“


But across the nation, areas that serve the homeless have had a more difficult time controlling the disease. Treatment for an uncomplicated case can require six months on a cocktail of multiple antibiotics, while drug-resistant strains can take two years to treat, often with drugs that are much more expensive and difficult to find. People without a fixed address and those with substance abuse and mental health problems pose significant problems for public health authorities trying to contain an outbreak. Complicating matters, infected people can have a latent form that can lurk for years before surfacing.


In Jacksonville, health officials are treating 234 people with latent disease with preventive antibiotics. They are also making progress at reaching contacts of people with active TB to test them. Since January, Duval County Health Department officials have screened nearly 2,100 people who may have come in contact with people with active TB.

Gene Mutations Linked to ALS and Nerve Cell Growth Dysfunction


Amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s disease, attacks motor neurons, the nerve cells responsible for controlling muscles. People with ALS experience such early symptoms as limb weakness or swallowing difficulties. In most people, the disease leads to death three to five years after symptoms develop, usually as a result of respiratory failure.


A study published online in Nature (15 July 2012), has linked newly discovered gene mutations to some cases of ALS shedding light on how ALS destroys the cells and leads to paralysis.


The study searched for gene mutations in two large families with an inherited form of ALS by using a technique to decode only the protein-encoding portions of DNA, known as the exome, thus allowing an efficient yet thorough search of the DNA regions most likely to contain disease-causing mutations. This deep sequencing of the exome led to the identification of several different mutations in the gene for profilin (PFN1), which were present only in the family members that developed ALS. Further investigations of 272 other familial ALS cases across the world showed that profilin mutations were also found in a small subset (about 1-2%) of the familial ALS cases studied.


The protein profilin is a key part of the creation and remodeling of a nerve cell’s scaffolding or cytoskeleton. In fly models, disrupting profilin stunts the growth of axons – the long cell projections used to relay signals from one neuron to the next or from motor neurons to muscle cells. After identifying the PFN1 mutations in ALS patients, the authors demonstrated that these mutations inhibited axon growth in laboratory-grown motor neurons as well. They also found that mutant profilin accumulated in clumps in neural cells, as has been seen for other abnormal proteins associated with ALS, Parkinson’s and Alzheimer’s. Neural cells with PFN1 mutations also contained clumps of a protein known as TDP-43. Clumps of abnormal TDP-43 are found in most cases of ALS, further linking profilin to known ALS mechanisms.


Over a dozen genes have been linked to ALS, and these findings support existing studies which suggest that cell cytoskeleton disruptions play a major role in ALS and other motor neuron diseases. Motor neurons are large cells with long axons that connect to muscle, and cytoskeleton proteins are especially important in the transport of proteins along the axon to the remote parts of the neuron. This information could be useful in developing strategies for detection and treatment of ALS.


Familial ALS accounts for 10% of all ALS cases, but the majority of ALS cases are sporadic, where the cause is unknown. Even though this new mutation is linked to familial ALS, it reveals information about the mechanisms underlying motor neuron degeneration in general, and also may have broader implications for understanding sporadic ALS.

TARGET HEALTH excels in Regulatory Affairs. Each week we highlight new information in this challenging area



FDA Approves Kyprolis for Some Patients with Multiple Myeloma



Multiple myeloma is a form of blood cancer that arises from plasma cells which usually grow in bone marrow, the soft, spongy tissue found inside most bones. The bone marrow is where normal blood cells are produced. According to the American Cancer Society, In 2012 an estimated 21,700 people will be diagnosed with multiple myeloma and 10,710 will die.


The FDA approved Kyprolis (carfilzomib) to treat patients with multiple myeloma who have received at least two prior therapies, including treatment with Velcade (bortezomib) and an immunomodulatory therapy.


The safety and effectiveness of Kyprolis, which is administered intravenously, was evaluated in a study of 266 patients with relapsed multiple myeloma who had received at least two prior therapies, including Velcade and Thalomid (thalidomide). The study was designed to measure the percentage of patients who experienced complete or partial disappearance of tumor after treatment (overall response rate). Results showed that the overall response rate was 23% and the median duration of response was 7.8 months.


The most common side effects observed in more than 30% of the study participants were fatigue, low blood cell count and blood platelet levels, shortness of breath, diarrhea, and fever. Serious side effects seen with Kyprolis included heart failure and shortness of breath. Patients should be monitored closely and treatment withheld if these serious side effects occur.


The drug is being approved under the FDA’s accelerated approval program, which allows the agency to approve a drug to treat a serious disease based on clinical data showing that the drug has an effect on a surrogate endpoint that is reasonably likely to predict a clinical benefit to patients. The program is designed to provide patients with earlier access to promising new drugs. The company is required to submit additional clinical information after approval to confirm the drug’s clinical benefit.


Krypolis is marketed by Onyx Pharmaceuticals of South San Francisco, CA.

Joyce Hays’ Tuna Salad


Bumble Bee very low sodium tuna, packed in water



When our neighborhood gourmet deli closed, everyone within a certain radius suffered acutely, from the loss of their closely held family-secret, for tuna salad. We had enjoyed it for years and could not do without; so, it was resolved to discover the recipe in our kitchen, through trial and error.


After many months of experimenting with a variety of ingredients, the final delicious result was reached and we’re happy to share it with our readers:


Joyce Hays’ Tuna Salad


4 to 8 servings




  • 4 cans of Bumblebee solid white albacore tuna, (get the very low-sodium tuna packed in water) Fresh Direct has this item
  • 4 hardboiled eggs (use the white only)
  • 1/2 onion
  • 1 carrot
  • 2 sticks from the heart of celery
  • 3 Tablespoons Kraft mayonnaise
  • Fine or ground black pepper to your taste
  • Fresh large leaf parsley, chopped, for garnish




You will need a sauce pan, a cutting board, a grater and a bowl


In the pan boil the 4 eggs for 10 minutes and then run them under cold water. Take the shells off and discard the yolks. On a chopping board, chop all the egg whites into very tiny pieces and put them into the bowl (tiny means just slightly bigger than the head of a pin)


While the eggs are boiling get your other ingredients ready. Scrub the carrot with a plastic scrubber or vegetable brush, and rinse the two sticks of celery. Pat them dry with paper towel. Cut the celery into very tiny pieces and put them into the bowl.


With a hand grater, grate the carrot with the medium holes (not the large slice section or the small holes). Put the grated carrot onto a cutting board and with a large knife, chop it even more into tiny pieces and put them into the bowl with the chopped celery and the egg whites.


Peel the dry skin off the onion and cut it in half. Wrap 1/2 of the onion in saran wrap and refrigerate for another recipe. On a cutting board, slice the remaining 1/2 onion, then slice again, with criss-cross strokes. Finally, use the large knife to chop the slices into very tiny pieces and add this onion into the bowl.


Open the 4 cans of tuna and be sure to drain well. You don’t want the water to make the salad runny. After draining well, add all the tune to the bowl and stir all of the ingredients together until well mixed.


Add the fine or ground black pepper according to your taste.


Now add the 3 Tablespoons of Kraft mayonnaise and mix so it’s distributed evenly.

Use the parsley garnish as you wish.


Serve on a bed of mixed greens, along with slices of tomato, homemade coleslaw, slices of cucumber and apple and some black olives. Garnish with the chopped parsley. You can also stuff some tomatoes with the tuna salad and serve on salad greens. Naturally, there’re hundreds of variations for tuna salad. Try adding Farfalle (bowtie) pasta to this tuna salad, and for lower calorie count, use soy pasta, namely, Shirataki Tofu noodles or spaghetti……..delicious, for all pasta needs, once you get used to it.


There are two secrets to this recipe. The first is the size of the chopped ingredients. Believe it or not, there’s a huge difference in the taste of chunks of stuff mixed, vs. tiny chopped ingredients, which allows the flavor to blend better. It took a while to get the exact optimum size, right. The second secret also took a while to dawn, because most of the people we knew, swore by Hellman’s mayonnaise and we grew up thinking that nothing could equal it. In a moment of great frustration, after getting the chopping size down pat, it was hard to figure out what was missing. It was a eureka moment when the word “Kraft“ entered consciousness; and a glorious shining moment when taste confirmed, that indeed, the perfect tuna salad had emerged.


Your comments are welcomed and feel free to contribute for publishing, in our weekly newsletter, ON TARGET, any of your own (healthy) recipes.


Target Health ( a full service e*CRO, is committed to serve the pharmaceutical community through knowledge, experience, technology and connectivity. Target Health strives to optimize the life cycle of drugs, biologics and devices with expertise, leadership, innovation and teamwork. Target Health Inc. has fulltime staff dedicated to all aspects of Regulatory Affairs, Clinical Research, Biostatistics, Data Management, Strategic Planning and Drug and Device Development. Target Health is committed to the paperless clinical trial and has developed a full suite of eClinical Trial software including:

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Target Health Presenting at Meeting on Disruptive Innovations


This meeting is a must for anyone working in data management, clinical monitoring and quality assurance, and ready for a change in the way you do your business.


Target Health Inc. will be sponsoring and presenting at the 2nd Annual Disruptive Innovations to Advance Clinical Trials for Pharma, Biologics and Devices event which is being held at The Fairmont Copley Plaza Hotel, Boston, September 13-14, 2012. The conference is designed for drug and device development innovative thinkers who are determined to reinvent clinical trials. It is an outcomes-focused program that not only delves deeply into the key strategic factors impeding clinical trial productivity, but also endeavors to connect the change-makers who will share their results and outcomes.


Dr. Jules T. Mitchel, who is on the DPharm Advisory Board of the conference, will provide an update on the collaboration between Ferring Pharmaceuticals and Target Health Inc. (eCRO) on its approach to the paperless clinical trial including the use of Target e*CTR (eClinical trial record) as an eSource tool and Target Document for the electronic Trial Master File (eTMF). Go to the meeting website and get a 25% discount off the registration fee with code SFD.


Dr. Mitchel is also speaking at a concurrent conference on Executing Clinical Trials – How to Globalize Your Study for Clinical Success. The topic of his panel is Risk-based Monitoring – What Does it Mean for Your Global Study? How Different Organizations are Adapting to a Risk Based Approach to Monitoring in Their Global Studies.


For more information about Target Health contact Warren Pearlson (212-681-2100 ext. 104). For additional information about software tools for paperless clinical trials, please also feel free to contact Dr. Jules T. Mitchel or Ms. Joyce Hays. The Target Health software tools are designed to partner with both CROs and Sponsors. Please visit the Target Health Website at

Medical Robots – IBM Creates Physician’s Assistant


Watson’s avatar, inspired by the IBM “smarter planet” logo



Watson Goes to Medical School



IBM robot, Watson, is devouring the material in medical textbooks and journal articles in hopes of landing a job as a physician’s 1) ___. The trainee was sequentially presented the details of a fictitious patient: there’s an eye problem; vision is blurred; the family, living in Connecticut, has a history of arthritis. The trainee’s initial response was uveitis. More clues and the diagnosis was changed to Behcet’s disease until finally the trainee settled on Lyme disease. How sure was this seemingly hasty student of medicine 73% sure.


Medical trainees and 2) ___ are not typically in the habit of quantifying their assessments with such Commander Data-like precision, but this trainee happens to share more qualities with the Star Trek android than the rest of the medical staff. Following its resounding victory on Jeopardy!, IBM’s Watson has been working hard to learn as much about medicine as it can with a steady diet of medical textbooks and healthcare journals. The mock case described above was part of a recent demonstration to the Associated Press showing just how much Watson has learned. The robot’s diagnosis was correct and it identified a link between symptom and 3) ___ that was “not common,” as one participating physician called it. After being told the patient was pregnant and allergic to penicillin, Watson suggested treating her with cefuroxine. Its human colleagues agreed. The demonstration was a success, and it is the hope of IBM and many medical professionals that Watson will one day soon lend doctors a helping hand as they perform their daily 4) ___.


The need for efficient use of medical information becomes more pressing as the amount of 5) ___ amasses at an exponential rate. Dr. Herbert Chase, a Columbia University medical school professor, says that it has been 30 years since doctors were last able to keep pace with the growing body of 6) ___ knowledge. With only so many hours in an often overwhelming day, doctors are hopeless to keep up with a body of knowledge that doubles every 5-7 years. In addition to the struggles of keeping pace, the sheer volume of information presents a separate challenge to share that information effectively. Michael Yuan, a scientist that has worked with IBM, cites a 1999 study that found doctors field more than 1,100 questions a day and fail to answer 64% of them. The inefficient exchange of information leads to mistakes in any field. In the medical field, those mistakes could cost lives. A widely-noted – and hotly debated – report published in 2000 estimated that as many as 98,000 people die in a given year from medical 7) ___ occurring in hospitals. As the report notes, “that’s more than die from motor vehicle accidents, breast cancer, or AIDS.”


Now imagine Watson on the job. Watson’s database would be updated 8) ___ with the latest in research from potentially all online journals. The director of Health Informatics Center at the University of Southern California, Carl Kesselman, points out the need to track advances in genomics, specialized drugs, off-label uses, and the increasingly finer-grained classifications of diseases. Of course the physicians themselves can find the information, but the online searches would be labor-intensive and time-consuming. A 9) ___ assistant like Watson with realtime updates could simply be asked Jeopardy!-style questions to find answers or get second opinions. To make the interactions Jeopardy!-style, speech solutions developer Nuance is currently working with IBM to provide Watson speech recognition 10) ___ customized with medical jargon. Doctors could query Watson’s database on the go by speaking into a handheld device.


Watson is named after IBM founder Thomas Watson.



At this early stage in its medical education Watson understandably, still makes mistakes. A team of medical students are working with Watson to catch mistakes and try to identify what causes them. Its knowledge is not limited to science. Watson can also keep an eye on complex treatment guidelines that are often updated so the physician doesn’t have to. It can access medical records as well. However, for access to be completely streamlined they need to be digitized. Unfortunately the medical 11) ___ digitization seems to be a change hospitals are thus far slow to adopt. Progress is being made, however, by companies like Practice Fusion, a maker of electronic health records (EHR) systems. Combining the latest medical knowledge with the patient’s medical history would give Watson the best chance to catch those rare cases that doctors might be slow to diagnose or miss altogether.


A major break from previous practice is IBM’s plan to include patient blogs among Watson’s data set. Much as they do now on websites such as, patients can share symptoms, drug efficacy, drug side effects, relevant family histories, etc. Like a medical wikipedia, the data cloud that amasses could be mined by Watson to pull out obscure relationships that would normally pass under the radar of doctors concerned only with their 12) ___. For example, cross-reactivity between two types of drugs that aren’t taken together very often. In essence, Watson would be conducting its own studies without a priori goals or limitations.


But the data is anecdotal, you say? Dr. Chase agrees, but argues that doctors are already using anecdotal data when they take medical histories. The patients’ descriptions are anecdotal, and the doctors don’t listen any less.


To many, the patient blogosphere is the most exciting of Watson’s resources. What sort of insights into medicine and disease will we gain simply by blogging about our own experiences? As Wikipedia shows us, there’s truth in numbers. A major challenge to mining those insightful gems is, blogs that are easily understandable to Watson. It’s one thing for a doctor to have a one-on-one conversation with Watson and refine his query when he inevitably runs up against misunderstandings. But it’s quite another thing to glean underlying facts from thousands of blogs from all over the 13) ___. A universal format for the patients would help, perhaps including a basic list of yes or no questions.


A know-it-all robotic physician’s assistant that you can talk to from anywhere with a handheld device. reminds again, of Star Trek, “Computer, across how many worlds has the epidemic spread?”.


One company would argue that it is years ahead of IBM in bringing AI to the forefront of medical diagnosis support – and her name is Isabel. Isabel Healthcare’s founder Jason Maude named the database program after his 3 year old daughter Isabel was nearly fatally misdiagnosed by her local hospital. Isabel spent two months in hospital, including a month in PICU after experiencing multiple organ failure and cardiac arrest. Isabel’s extensive suffering could have been avoided if the local emergency department and family physicians, instead of assuming her symptoms were typical of the chicken pox from which she was also suffering, had stopped to ask ‘what else could this be?’ Isabel was later diagnosed to be suffering from well-described complications of chicken pox: Toxic Shock Syndrome and Necrotising Fasciitis. Rather than suing the hospital for the error Isabel Healthcare was created, in honor of Isabel Maude


Created a decade ago, the company’s mission is to decrease misdiagnoses, and it performs essentially the same functions as Watson: symptoms are entered and the computer sifts the database to produce a list of the most likely causes. Isabel asks questions that the doctor might not think to ask, indicates the gold standard treatment, and lists relevant medical literature.


So, what do we need Watson for? IBM executives point out that 14) ___ is much faster than Isabel and much better at understanding terms that it hasn’t memorized from a textbook. Watson would know, for instance, that “difficulty swallowing” is “dysphagia.” Watson has a ways to go before it makes the grade. IBM estimates that they are still a couple years away from making a marketable Watson. Doctors, IBM execs say, should not feel threatened by their fast learning student. The clinician’s role is to practice medicine and Watson’s role is to support the clinician, to act as a library.


To learn more about medical robotics, click on the videos below:


New Medical Robot from Israel



Improvements With Medical Robotics



ANSWERS: 1) assistant; 2) doctors; 3) cause; 4) rounds; 5) information; 6) medical; 7) errors; 8) daily; 9) physician’s; 10) software; 11) record; 12) patients; 13) world; 14) Watson

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