For some reason, negotiation tends to be considered a specialized professional skill instead of a basic life one. Business school students and salespeople learn tons about how to work out deals, but most of the rest of us never learn much about how to negotiate. That’s one reason why buying a major asset like a house or car is so stressful for regular folks—negotiating is mysterious to us.
But everyone negotiates on a constant basis, and learning some of the fundamentals of banging out a mutually-beneficial deal is a crucial skill we should all acquire. The challenges of learning how to bargain is often the mixture of emotion, psychology, and math. Leverage can swing back and forth between parties, and emotions can play as much of a role as finances (as anyone who has overpaid for a house because they “fell in love with it” can attest).
That’s why learning some basic negotiation skills is essential—starting with why you should always seriously consider making the first offer.
The Anchoring Effect
You’ve probably heard that you should always make the first offer when negotiating, possibly with some vague explanation about setting the terms. This is, in fact, generally good advice—because of something called the Anchoring Effect.
The Anchoring Effect is all about bias—it’s an irrational tendency in human beings to rely on the first piece of data they acquire, regardless of its value. We all have this bias—study after study has confirmed that the first number you hear will influence how you value something. When sellers make the first offer, the final price is usually higher, and one study found that 85% of negotiated outcomes generally aligned with the first offer.
The crazy part is, even when we know the first piece of data shouldn’t affect us, it does. In one experiment, people were asked to write down the last two digits of their own social security number and then asked if they would pay that much for various items. Then, they were asked to bid for the same things, and despite the fact that the “seed” number they’d been given was completely unrelated to anything, folks with higher social security numbers bid much higher for everything.
Dropping the anchor
The irrational power of the Anchoring Effect is why making the first offer (sometimes called “dropping the anchor”) is a powerful tool in a negotiation. But that doesn’t mean it always works—you need to know how to use it in order to get the full benefit of the effect.
Here are some things to consider when planning to drop an anchor into a negotiation:
Be aggressive. People often worry that being overly aggressive with an opening offer or price will insult or scare off the other party. But an aggressive first offer is your best strategy. An aggressive first offer leaves you room to “compromise,” while still getting a better deal in the end (a form of the “Door in the Face” technique).
Don’t be absurd. Keep in mind that “aggressive” doesn’t mean “insane.” While an aggressive first offer can set the goalposts in your favor, throwing out an offer that is completely out of line with reality can make the other side wonder if you’re serious, competent, or credible.
Be specific. The more precise your first offer is, the more effective it will be in anchoring your opposition. The classic example is pricing a house: A list price of $255,500 will get higher bids than a list price of $255,000—or $256,000.
By putting some thought into the specifics of your first offer, you can most benefit from the irrational power of the Anchoring Effect.
Other negotiating success factors
As powerful as the Anchoring Effect can be in a negotiation, it’s not a magic spell. The first thing to keep in mind is that if you’re dealing with an experienced and trained business or sales professional, chances are they know all about it and have been trained in ways to “defuse” the anchor, which is often as simple as ignoring it and pivoting to details, or offering an immediate “counter-anchor” in an effort to redefine the terms.
The key to a successful anchoring first offer is information, really. The ideal scenario for dropping an anchor is when you know more than the other side. When the other party has access to more information than you do, it’s very difficult to drop an anchor. For example, if a homeowner knows the real estate market in their area well, they know how much their property is worth, and your aggressive anchor will simply seem absurd.
Or consider interviewing for a job—the interviewer knows what the budgeted salary for a position is, and you don’t. If your first salary ask is way outside that budget, it’s not going to have the intended effect. On the other hand, if you both know the same amount of information, your anchor will be predictable and expected, making it easier to defuse.
And if you’re both in the dark, a first offer will be pretty much a guess, making it impossible to know whether you’re actually helping yourself with your shot in the dark anchor. All that being said, making the first offer has been proven to have a beneficial psychological effect on the other side of a negotiation. So use this power. Just do your research first.
“The ‘Inherent Bad Faith Model’ Reconsidered: Dulles, Kennedy, and Kissinger”, Political Psychology(subscription required)“… the most widely studied is the inherent bad faith model of one’s opponent …”, The handbook of social psychology, Volumes 1-2, edited by Daniel T. Gilbert, Susan T. Fiske, Gardner Lindzey
Four Strategies for Making Concessions, Harvard Business School, Working Knowledge, published 6 March 2006, accesses 2 June 2021“Negotiation”(PDF). Saylor Academy. Retrieved 10 April 2022.Journal of Personality and Social Psychology, 83 (5) (2002), pp. 1131–1140
“negotiation”. Online Etymology Dictionary. Retrieved 19 August 2019.“The Day-to-Day Life of a Dean: Engaging in Negotiations and negotiations”. Negotiation Journal 475-488. 28 (4): 475–488. doi:10.1111/j.1571-9979.2012.00352.x.Fisher, R.; Ury, W.; Patton, B. (2012). Getting to yes: Negotiating agreement without giving in. Penguin: New York.
Megan Gray was eight years old when she got her first period. She was playing hide-and-seek with her older sister and a friend at their friend’s house in suburban Sacramento. She was wearing pink jeans, which she had saved up for a long time to buy. She tied a sweatshirt around her waist to hide the bloodstain, and, later, threw the ruined pink jeans away; when her mother asked where they’d gone, she threw a tantrum to deflect the question.
Gray had a close relationship with her mom, but she was so young that they’d had no conversations about puberty; her older sister had not yet gotten her period. “There was nothing, no context for understanding,” Gray told me. “I knew what a period was—I didn’t think I was dying or anything. But still, I didn’t tell anyone for months. I just used wadded-up toilet paper. It felt so awkward and shameful.” She did eventually talk with her mom about it. But this was the nineteen-eighties.
“It wasn’t some big informational session. It was very Gen X—you just dealt with things by yourself and got on with it.” Gray was taller than her peers and wore layers of tops to conceal her developing breasts. She estimates that she was a C-cup by fifth grade. “There were assumptions about me because I had boobs. And I had never even kissed anyone. I was lucky, because nothing traumatic occurred. Yet I do think that there is a trauma in being sexualized.”
Maritza Gualy got her first period when she was eight going on nine, at the end of the eighties. Her mom showed her how to use a thick Kotex pad. Eventually, her older sister introduced her to o.b. tampons—the ones with no applicator; they were small and easier to hide. The sisters, whose parents were Colombian immigrants, attended a majority-white Catholic school in Nashville.
Her school uniform had no pockets, so whenever Gualy had her period, she had to hide tampons in her bra or in the waistband of her skirt. One day, an o.b. fell out of her skirt when she and her classmates were sitting on the rug together. Later, when they were back at their desks for a spelling test, Gualy recalled, “the teacher went around from kid to kid with the tampon. ‘Is this yours?’ ‘Is this yours?’ Except she was only asking the more well-developed girls! I knew I wasn’t going to admit to it.”
In fifth grade, Gualy’s best friend got her period, and she was upset to learn that Gualy had started hers more than a year earlier and hadn’t mentioned anything. “But I already felt so othered,” Gualy said, “and I didn’t want to add to that.” When Gray and Gualy were kids, pediatricians thought that the average age of onset of puberty in girls—defined in most medical literature as thelarche, when breast tissue begins to develop—was about eleven years old. Menarche, or first period, was thought to happen around age thirteen.
Only a small percentage of girls had started puberty by the age of eight, much less started menstruating. But, by the two-thousands, new research had found that eighteen per cent of white girls, thirty-one per cent of Hispanic girls, and forty-three per cent of Black girls had entered thelarche by age eight, according to a study published in 2010.
Often, these girls were taller than most of their peers and showed other signs of accelerated physical maturation, such as pubic hair and underarm odor. Thelarche typically presages the onset of menstruation by two to three years, meaning that some of these girls would have to deal with the mess and discomfort of a monthly period before they’d finished elementary school.
Researchers and physicians hypothesized about possible causes for the increase in early puberty, such as increasing rates of obesity; greater exposure to endocrine-disrupting chemicals found in food, plastics, and personal-care products; and stressful or abusive home environments. Then, during the coronavirus pandemic, pediatric endocrinologists saw a new surge of referrals for girls with early puberty.
Recent retrospective studies from Germany and Turkey show that the number of these referrals doubled or even tripled during the lockdown periods of 2020 (this at a time when many families may have been avoiding non-emergency doctor’s visits for fear of COVID-19). A paper published in August in the journal Frontiers in Pediatrics, which analyzed data from South Korea’s national statistics portal, found that the number of children diagnosed with precocious puberty almost doubled between 2016 and 2021, with a sharp post-2020 spike.
The rise in early puberty “is a phenomenon that is occurring all over the world,” Frank M. Biro, the former director of the adolescent-medicine division at Cincinnati Children’s Hospital Medical Center, told me. (Although there has also been a rise among boys, girls experiencing early puberty still vastly outnumber them.)
The new data may offer some safety in numbers to early-developing girls—if Gray and Gualy were growing up today, they might have found a friend or two on the same accelerated track. But early puberty is associated with a daunting list of adverse physical and psychological outcomes: various studies have suggested that early-maturing girls are at greater risk for developing obesity, breast cancer, eating disorders, depression, and a range of behavioral issues.
Especially in the midst of what is increasingly understood to be a post-COVID youth mental-health crisis, the startling new uptick in early puberty is troubling to some physicians and parents. But, because the spike appears to have been triggered within a compressed, well-defined timeframe, it also offers rich terrain for better understanding the condition’s causes and effects.
It also provides a chance to rethink puberty: to see it not as a gateway into adulthood but as another stage of childhood—one that is highly variable from kid to kid and need not be cause for alarm. “We are in a great natural experiment at the moment, and we might not know the results of it for another ten years or more,” Louise Greenspan, a pediatric endocrinologist at Kaiser Permanente, San Francisco, said.
“I do wonder if this is going to be a cohort of kids whose puberty was more rapid because they were in a critical window of susceptibility during a time of great social upheaval.” For generations, pediatricians have referred to a table of pubertal development known as Tanner stages, named for the pediatric endocrinologist James Tanner, one of the lead investigators of the landmark Harpenden Growth Study, conducted from 1949 to 1971 at a charity home for orphaned and neglected children in a suburb of London.
There, hundreds of boys and girls were photographed naked at three-month intervals. Although the data for the Tanner scale were gathered from kids of a narrow demographic—white, thin, and bearing the internal scars of trauma or adversity in their formative years—it established, in a pair of papers published in 1969, our modern benchmarks of puberty: five distinct stages, ranging from prepubertal to fully developed.
On average, the girls in the study began showing breast buds—the “Tanner II” stage—at age eleven or so, and began menstruating between thirteen and fourteen. Early puberty is identified through physical examination, blood tests to measure levels of sex hormones, and a bone X-ray to estimate “bone age”—how close a child’s skeletal system is to reaching maturation.
Puberty typically begins in girls when the pituitary gland starts secreting hormones known as gonadotropins; these hormones cause the ovaries to grow and to produce estrogen, the sex hormone that triggers the development of secondary sex characteristics…Read more
Kayaba H, Tamura H, Kitajima S, Fujiwara Y, Kato T, Kato T (November 1996). “Analysis of Shape and Retractability of the Prepuce in 603 Japanese Boys”. J Urol. American Urological Association, Inc. 156 (5): 1813–1815. doi:10.1016/S0022-5347(01)65544-7. PMID8863623.Ishikawa E, Kawakita M (2004). “Preputial development in Japanese boys”. Hinyokika Kiyo. 50 (5): 305–8. PMID15237481.
Beaugé M (1997). “The causes of adolescent phimosis”. Br J Sex Med (Sept/Oct): 26.“Circumcision Policy Statement”. Pediatrics. 103 (3): 686–93. 1999. doi:10.1542/peds.103.3.686. PMID10049981.Krueger H, Osborn L (1986). “Effects of hygiene among the uncircumcised”. J Fam Pract. 22 (4): 353–5. PMID3958682.Birley HD, Luzzi GA, Bell R (1993).
Siegel MJ, Surratt JT (1992). “Pediatric gynecologic imaging”. Obstetrics and Gynecology Clinics of North America. 19 (1): 103–127. doi:10.1016/S0889-8545(21)00504-0. PMID1584537.Anderson SE, Dallal GE, Must A (April 2003). “Relative weight and race influence average age at menarche: results from two nationally representative surveys of US girls studied 25 years apart”. Pediatrics. 111 (4 Pt 1): 844–850. doi:10.1542/peds.111.4.844. PMID12671122.
Andersson KE, Wein AJ (2004). “Pharmacology of the Lower Urinary Tract: Basis for Current and Future Treatments of Urinary Incontinence”. Pharmacological Reviews. 56 (4): 581–631. doi:10.1124/pr.56.4.4. PMID15602011. S2CID15746586.
Kaplowitz PB, Slora EJ, Wasserman RC, Pedlow SE, Herman-Giddens ME (2001). “Earlier onset of puberty in girls: relation to increased body mass index and race”. Pediatrics. 108 (2): 347–53. doi:10.1542/peds.108.2.347. PMID11483799.Nelson RJ. 2005. Introduction to Behavioral Endocrinology. Sinauer Associates: Massachusetts. p357.
Zuckerman, Diana (May 2009). “Early Puberty in Girls”. National Research Center for Women and Families. Archived from the original on 2013-11-09. Retrieved 2010-07-13. Based on a publication from The Ribbon, a newsletter of the Cornell University Program on Breast Cancer and Environmental Risk Factors in New York States ((BCERF), Vol 6, No. 1, Winter 2001.)
Mitchell AL, Dwyer A, Pitteloud N, Quinton R (2011). “Genetic basis and variable phenotypic expression of Kallmann syndrome: towards a unifying theory”. Trends Endocrinol. Metab. 22 (7): 249–58. doi:10.1016/j.tem.2011.03.002. PMID21511493. S2CID23578201.
Hugh Jones, ed. (2008). “Chapter 9. Puberty & Fertility”. Testosterone Deficiency in Men. Oxford Endocrinology Library. Oxford University Press. ISBN978-0199545131.[page needed]Finley, Harry. “Average age at menarche in various cultures”. Museum of Menstruation and Women’s Health. Retrieved 2007-08-02.
Students in Montclair State University’s dual-certification program (Jackie Mader / Hechinger Report)
Strong progress has been made to integrate students with disabilities into general-education classrooms. Educator instruction hasn’t kept up. When Mary Fair became a teacher in 2012, her classes often contained a mix of special-education students and general-education students. Placing children with and without disabilities in the same classroom, instead of segregating them, was a growing national trend, spurred by lawsuits by special-education advocates.
But in those early days, Fair had no idea how to handle her students with disabilities, whose educational challenges ranged from learning deficits to behavioral disturbance disorders. Calling out a child with a behavioral disability in front of the class usually backfired and made the situation worse. They saw it as “an attack and a disrespect issue,” Fair said.
Over time, Fair figured out how to navigate these situations and talk students “down from the ledge.” She also learned how to keep students with disabilities on task and break down lessons into smaller, easier bits of information for those who were struggling.
No one taught her these strategies. Although she earned a bachelor’s degree and teaching certificate in math instruction for both elementary and middle school, she never had to take a class about students with disabilities. She was left to figure it out on the job.
Many teacher-education programs offer just one class about students with disabilities to their general-education teachers, “Special Ed 101,” as it’s called at one New Jersey college. It’s not enough to equip teachers for a roomful of children who can range from the gifted to students who read far below grade level due to a learning disability.
A study in 2007 found that general-education teachers in a teacher-preparation program reported taking an average of 1.5 courses focusing on inclusion or special education, compared to about 11 courses for special-education teachers. Educators say little has changed since then.
A 2009 study concluded that no one explicitly shows teachers how to teach to “different needs.” Because of time constraints, the many academic standards that must be taught, and a lack of support, “teachers are not only hesitant to implement individualized instruction, but they do not even know how to do so,” the report stated.
Fair says teacher-preparation programs should be doing more. At the very least, “You should have a special-education class and an English language learner class,” she said. “You’re going to have those students.”
Between 1989 and 2013, the percentage of students with disabilities who were in a general education class for 80 percent or more of the school day increased from about 32 percent to nearly 62 percent. Special-education advocates have been pushing for the change—especially for students who have mild to moderate disabilities like a speech impairment—in some cases by suing school districts.
Some research shows as many as 85 percent of students with disabilities can master general-education content if they receive educational supports. Supports can include access to a special-education teacher, having test questions read aloud, or being allowed to sit in a certain part of the classroom.
Students with disabilities who are placed in general-education classrooms get more instructional time, have fewer absences, and have better post-secondary outcomes. Studies also show there is no negative impact on the academic achievement of non-disabled students in an inclusion classroom; those students benefit socially by forming positive relationships and learning how to be more at ease with a variety of people.
Alla Vayda-Manzo, the principal of Bloomfield Middle School about 30 miles outside of New York City, said she’s seen the benefit of inclusion for students. The school serves about 930 students, nearly 20 percent of whom have a disability, according to state data. When students with disabilities are included in classrooms with their peers, Vayda-Manzo said the high expectations and instructional strategies “lend themselves to those students being more successful than they would be had they been in a separate, self-contained environment.”“It’s not just getting a child included … that is only a small portion of the battle.”
But as more districts move to make classrooms inclusive, they’ve been caught flat footed when it comes to finding teachers prepared to make the shift. Academic outcomes for students with disabilities have remained stagnant for years, even as more students with special needs are integrated into general-education classrooms. Students with disabilities are less likely to graduate and more likely to earn an alternate diploma that is not equivalent to a general diploma in the eyes of many colleges and employers. And year after year, they score far lower than their peers on standardized exams.
Experts say the problem is that it takes much more than just placing students with disabilities next to their general-education peers: Teachers must have the time, support, and training to provide a high-quality education based on a student’s needs.
Mike Flom, a parent and co-founder of the advocacy group New Jersey Parents and Teachers for Appropriate Education, said many factors impact inclusion’s effectiveness. His twin sons, now in seventh grade, were placed in an inclusion classroom beginning in fifth grade. Initially, Flom said his sons had “mixed reviews” on whether inclusion was beneficial.
“I think the teachers were really motivated to be helpful,” Flom said. “I don’t know the extent to which they were permitted to do the things, or had enough training to do the things, that were required to be more effective.”“It’s not just getting a child included … that is only a small portion of the battle,” he added.
These days, Mary Fair navigates her classrooms with ease. She has learned through experience how to teach students with a variety of disabilities and works with a veteran special-education teacher to modify lesson plans and tests.
On a recent morning in a seventh-grade math-inclusion classroom at Bloomfield Middle School, Fair and her co-teacher, the special-education teacher Christina Rodriguez, started a lesson on the order of operations.
Fair stepped up to the front of the classroom as Rodriguez circulated to make sure students were on task.“We’re starting order of operations,” Fair said. “It’s something you did in sixth grade, but today we are doing it differently.”“Ms. Fair, I want to see if they remember,” Rodriguez said to Fair, who smiled and nodded.“Put your hand up if you remember what the order of operations is,” Rodriguez said.More than half of the students raised their hands
“Who remembers ‘PEMDAS’?” Rodriguez asked, referring to the mnemonic device used to remember order of operations (Parentheses, Exponents, Multiplication and Division, Addition and Subtraction). More students eagerly shot their hands in the air.
Fair cut in and explained that although they learned PEMDAS in sixth grade, they were going to learn a new rule about the order of operations today. “Take your yellow paper and fold it horizontally,” Fair said, referring to a yellow sheet of paper that sat on each student’s desk.“Like this,” Rodriguez said, holding up a piece of paper and demonstrating how to fold it horizontally.“Like a hamburger,” Fair added.
To an outsider, it’s impossible to tell who is the general-education teacher and who is the special-education teacher. Both Fair and Rodriguez have desks at the front of the room. They switch off during lessons, effortlessly picking up where the other has left off. They both give directions and explain content. They are careful not to fall into what educators say is a common trap: seeing general-education students as the responsibility of one teacher, and special-education students as the responsibility of the other.
That’s how a good inclusion class should be, Rodriguez said, but it takes practice and time. Like Fair, Rodriguez didn’t receive any training in special education before she entered the classroom. She became a teacher through an alternate program. When she got a job teaching special education six years ago, she relied on strategies she learned while working as an aide in a class for students with autism. In 2014, she received her master’s degree in teaching students with disabilities from New Jersey City University; she now teaches a class for Montclair State University’s dual-certification teacher-preparation program.
Although most traditional teacher-preparation programs nationwide do include some training on students with disabilities, usually in the form of one course over the entirety of the program, educators say this course is often generic and perfunctory. Aspiring teachers also may be given assignments in other classes that require them to adapt a lesson for a hypothetical special-education student.
Fair said she had some assignments like those, but “we didn’t really know what we were talking about, because we weren’t taught it.” Her colleague, the science teacher Jessica Herrera, said she was only offered one class in special education—called “Special Education 101”—when she went through a traditional teacher-preparation program in New Jersey.
“A lot of my training was for that ‘middle of the road’ kind of kid,” Herrera said. “I was prepared for the regular ed student.” In her 13 years as a teacher, Herrera has taught some inclusion classes; she said she picked up strategies from working with “good special-education teachers.” When she earned her master’s degree from Montclair State, she was finally taught how to teach a “range of learners,” she said.
Fair and her co-teacher Rodriguez say there are certain things they wish were included in all teacher-education programs, like an explanation of the different kinds of disabilities and ways to address the various struggles students may encounter. They also say teacher preparation should include more classroom management and “subtle ways” to keep students focused and on task.
Mimi Corcoran, the president of the National Center for Learning Disabilities (NCLD), said teacher preparation should better address topics in special education. “We do a disservice to the teachers we’re sending [to schools] in the way we’re training, and we’re doing a disservice to kids,” Corcoran said. “We’ve got to step up to the plate and think differently and act differently, and that’s hard because everybody gets comfortable and systems are hard to change.”
Some teacher-preparation programs are trying to better prepare graduates to teach students with disabilities, especially in inclusion classrooms. At Syracuse University, George Theoharis, a professor and the chair of Teaching and Leadership, said the school’s elementary special-education program has been one of the leaders nationwide in training educators for inclusive education.
Every teacher who graduates from Syracuse’s Early Childhood or Elementary Education program is dual-certified in special education and spends time in inclusion classrooms. Theoharis says it’s an approach that more preparation programs should take. “All of our programs need to be inclusive,” Theoharis said, referring to teacher preparation. “Regardless of what job teachers get, people need to be prepared to work with all children and see all children as their responsibility.”
At Montclair State, students can receive a dual certification in special education and a subject-level or grade-level range. The school also offers a unique concentration in “inclusive iSTeM,” which specifically prepares science, technology, engineering, and math teachers for inclusion classrooms. Students in the program receive a Master of Arts in Teaching, a certification in math or science, and are endorsed by the state as a teacher of students with disabilities.
Jennifer Goeke, a Montclair State professor and the program coordinator, said the dual-certification program prepares teachers to be hired as either a general- education or special-education teacher. “They know how to perform both roles easily and effectively,” Goeke said.
On a recent afternoon, Goeke was holding class in the Bloomfield Middle School media center. She asked her 17 students to first discuss issues they were having in their “fieldwork classrooms,” where they are currently observing and working with general- and special-education teachers. She listened to a few descriptions of struggles and then reminded her students that part of their job is to be an example for other teachers.
“I’m not trying to minimize or trivialize what you might be learning in your content area,” Goeke said. “It’s very important that you have a strong grounding in the methodology and the philosophy of your discipline … and know how to teach your content.” But, Goeke added, “You have to remember that most people do not have any diverse learners in mind. Their training did not teach them to take those students into account.”
In Montclair’s program, students work with two mentor teachers for a year in an inclusion classroom and in small-group settings. They receive extensive training in how to work with students with disabilities as well as how to effectively teach content, like math and science, or grade levels, like early education or elementary education.
Bloomfield chose to partner with the iSTeM program in 2012, and has hired two graduates of the program, and offered teaching positions to several more, who eventually chose jobs in other districts. The Bloomfield Principal, Vayda-Manzo, says the graduates of the program are “like unicorns in the field,” as it’s rare to find teachers who are dual-certified in general and special education.
Current teachers at Bloomfield have also benefited from iSTeM, Vayda-Manzo said. The program provides professional development for inclusion teachers at the school who agree to be mentor teachers for iSTeM students, and those teachers also observe each other and work with professors from Montclair State. Vayda-Manzo said the school makes sure co-teachers have the same planning periods so they have time to plan lessons together each day.
Herrera, who mentors iSTeM teachers, said the professional development provided through the program has improved her ability to teach students with disabilities. “I feel like I got a lot of additional strategies through that,” Herrera said.
On-the-job training is essential to ensure teachers have the skills needed to teach all students in their classroom, especially those teachers who may have attended teacher preparation years ago or missed out on training about disabilities, according to Mimi Corcoran of NCLD. “We have to be fair for the educator,” Corcoran said. For “many that are already in field, the concepts of special education and how to include kids has shifted, and [teachers] need the supports.”
Vayda-Manzo said it has been an easy choice to continue the program.“I saw the impact that it made in our inclusion classes,” Vayda-Manzo said. “We saw tremendous gains.”
SAN FRANCISCO, CA - MAY 28: Sundar Pichai, Alphabet CEO. Getty Images
Earlier this month, Google Cloud announced its latest venture within the realm of healthcare: a new Medical Imaging Suite. This initiative builds on years of hard work by the Google Cloud team, aimed at creating a universally friendly, efficient, and value-providing platform, with an ode to interoperability and accessibility.
The applications behind the platform are multi-fold:
Imaging Storage: the Suite will enable a more comprehensive way to store and access advanced medical imaging
Imaging Lab: in partnership with chip maker NVIDIA, the platform will make it easier to automate routine imaging tasks (e.g. labeling)
Imaging Datasets & Dashboards: the software will utilize advanced search tools to retrieve and view large sums of data
Imaging AI Pipelines: the Suite is built to support artificial intelligence capabilities in order to integrate machine learning systems and models
Imaging Deployment: the platform will provide a comprehensive and secure tool that can be curated to each organization’s needs
Thomas Kurian, Chief Executive Officer of Google Cloud, has previously explained his overarching vision with the product line: “Our customers and partners put their trust in our team to deliver next-generation cloud technologies to help them become the best tech company in their industry.
The combination of Google’s technical strengths, backed by its unique scale and deep experience in connecting that technology with consumer products and ecosystems, enables Google Cloud to put the tools of tomorrow in the hands of organizations today.”
Established healthcare players are already using the software. Hackensack Meridian Health in New Jersey, for example, hopes to use the robust Suite for prostate cancer detection.
But AI integration and tackling data problems in healthcare are not easy tasks. Many scholars have recently expressed criticism that the so called “digital revolution” in healthcare that was especially spurred by the Covid-19 pandemic has not delivered on the lofty promises that were made; instead, healthcare technology has been difficult to integrate in a meaningful way, especially in ways that can actually impact patient care outcomes.
Much of the challenge with AI specifically is the need for large volumes of data to create learning sets, so as to actually “teach” the AI system how to interpret data. For many organizations, their data remains disorganized, inaccessible, or in legacy formats that simply require a significant amount of “clean up” and reconciliation before they can be used in a meaningful way.
The purpose of solutions like Google Cloud is to eventually make data interoperable and machine learning ready, so that organizations can progress away from the previous age of information technology. Whether or not healthcare pundits like it, healthcare is amidst a revolution, one that will seamlessly integrate new and advanced technologies into patient care. Now, it is upto new and established technology leaders to create this revolution in a meaningful and safe manner.
I am a physician, speaker, and writer, focusing on the intersections of healthcare, digital innovation, and policy. I completed an M.D./ J.D. dual-degree
Applying artificial intelligence to medical images can be beneficial to physicians and patients, but developing the tools to do it can be challenging. Google on Tuesday announced it’s ready to meet that challenge with its new Medical Imaging Suite.
“Google pioneered the use of AI and computer vision in Google Photos, Google Image Search and Google Lens, and now we’re making our imaging expertise, tools and technologies available for health care and life sciences enterprises,” Alissa Hsu Lynch, global lead of Google Cloud MedTech Strategy and Solutions, said in a statement.
Gartner Vice President and Distinguished Analyst Jeff Cribbs explained that health care providers who are looking for AI for diagnostic imaging solutions have generally been forced into one of two choices.
“They can procure software from the device manufacturer, the image repository vendor or from a third-party, or they can build their own algorithms with industry agnostic image classification tools,” he told TechNewsWorld.
“With this release,” he continued, “Google is taking their low code AI development tooling and adding substantial health care-specific acceleration.”
“This Google product provides a platform for AI developers and also facilitates image exchange,” added Ginny Torno, administrative director of innovation and IT clinical, ancillary and research systems at Houston Methodist, in Houston.
“This is not unique to this market, but may provide interoperability opportunities that a smaller provider is not capable of,” she told TechNewsWorld.
Robust Components
According to Google, Medical Imaging Suite addresses some common pain points organizations face when developing AI and machine learning models. Components in the suite include:
Cloud Healthcare API, which allows for easy and secure data exchange using an international standard for imaging, DICOMweb. The API provides a fully managed, scalable, enterprise-grade development environment, with automated DICOM de-identification. Imaging technology partners include NetApp for seamless on-prem to cloud data management, and Change Healthcare, a cloud-native enterprise imaging PACS in clinical use by radiologists.
AI-assisted annotation tools from Nvidia and Monai to automate the highly manual and repetitive task of labeling medical images, as well as native integration with any DICOMweb viewer.
Access to BigQuery and Looker to view and search petabytes of imaging data to perform advanced analytics and create training datasets with zero operational overhead.
Use of Vertex AI to accelerate development of AI pipelines to build scalable machine learning models, with 80% fewer lines of code required for custom modeling.
Flexible options for cloud, on-prem, or edge deployment to allow organizations to meet diverse sovereignty, data security, and privacy requirements — while providing centralized management and policy enforcement with Google Distributed Cloud, enabled by Anthos.
Full Deck of Tech
“A key differentiator for Medical Imaging Suite is that we’re offering a comprehensive suite of technologies that support the process of delivering AI from beginning to end,” Lynch told TechNewsWorld.
The suite provides everything from imaging data ingestion and storage to AI-assisted annotation tools to flexible model deployment options at the edge or in the cloud, she explained.
“We are providing solutions that will make this process easier and more efficient for health care organizations,” she said….To be continued
If you are a parent, your greatest fear in life is likely something happening to one of your kids. According to one 2018 poll from OnePoll and the Lice Clinics of America (not my usual data source, but no one else seems to measure this), parents spend an average of 37 hours a week worrying about their children; the No. 1 back-to-school concern is about their safety. And this makes sense, if you believe that safety is a foundation that has to be established before dealing with other concerns.
You can see the effects of all this worrying in modern parenting behavior. According to a 2015 report from the Pew Research Center, on average, parents say children should be at least 10 years old to play unsupervised in their own front yard, 12 years old to stay home alone for an hour, and 14 to be unsupervised at a public park. It also shows up in what parents teach their kids about the world: Writing in TheJournal of Positive Psychology in 2021, the psychologists Jeremy D. W. Clifton and Peter Meindl found that 53 percent of respondents preferred “dangerous world” beliefs for their children.
No doubt these beliefs come from the best of intentions. If you want children to be safe (and thus, happy), you should teach them that the world is dangerous—that way, they will be more vigilant and careful. But in fact, teaching them that the world is dangerous is bad for their health, happiness, and success.The contention that the world is mostly safe or mostly dangerous is what some psychologists call a “primal world belief,” one about life’s basic essence.
Specifically, it’s a negative primal in which the fundamental character of the world is assumed to be threatening. Primal beliefs are different from more specific beliefs—say, about sports or politics—insofar as they color our whole worldview. If I believe that the Red Sox are a great baseball team, it generally will not affect my unrelated attitudes and decisions. But according to Clifton and Meindl, if I believe that the world is dangerous, it will affect the way I see many other parts of my life, relationships, and work.
I will be more suspicious of other people’s motives, for example, and less likely to do things that might put me or my loved ones in harm’s way, such as going out at night. As much as we hope the dangerous-world belief will help our kids, the evidence indicates that it does exactly the opposite. In the same paper, Clifton and Meindl show that people holding negative primals are less healthy than their peers, more often sad, more likely to be depressed, and less satisfied with their lives.
They also tend to dislike their jobs and perform worse than their more positive counterparts. One explanation for this is that people under bad circumstances (poverty, illness, etc.) have both bad outcomes and a lot to fear. However, as Clifton and Meindl argue, primals can also interact with life outcomes—you likely suffer a lot more when you are always looking for danger and avoiding risk.
Teaching your kids that the world is dangerous can also make them less tolerant of others. In one 2018 study, researchers subjected a sample of adults to a measure called the “Belief in a Dangerous World Scale,” which asked them to agree or disagree with statements such as “Any day now chaos and anarchy could erupt around us” and “There are many dangerous people in our society who will attack someone out of pure meanness, for no reason at all.”
They found that people scoring high on this scale also showed heightened prejudice and hostility toward groups such as undocumented immigrants, whom they stereotypically considered a threat to their safety. This study was conducted among adults, but it is easy to see how these attitudes would migrate to their kids. This is similar to the argument made by the writers Greg Lukianoff and Jonathan Haidt in The Atlantic in 2015, and in their subsequent book, The Coddling of the American Mind.
Lukianoff and Haidt contend that when parents (or professors) teach young people that ordinary interactions are dangerous—for example, that speech is a form of violence—it hinders their intellectual and emotional growth. It also leads them to adopt black-and-white views (for example, that the world is made up of people who are either good or evil), and makes them more anxious in the face of minor stressors such as political disagreement.
And to top it all off, negative primals don’t even help keep people safe. Researchers writing in the journal Psychology & Health in 2001 showed that a general state of fear can actually make a person less likely to take threats seriously (a self-defense mechanism to control our fear) and undermine precautionary behavior (by degrading the ability to address danger rationally).
It is not in young people’s interest that we instill in them negative primals. In so doing, we might harm them by making them less happy, less healthy, and more bigoted toward others. To break this pattern, parents—and anyone who interacts with children—should instead work to cultivate a sense of safety. Here are three rules to help you get started.
1. Heal thyself.
Parents might feed their kids negative primals because they hold such views themselves. This is easy to do in a world where we are bombarded with news and information, which studies have linked to distress, anxiety, and depression—even when the news is not specifically negative. And research shows that many parents pass on their anxiety to their children. One way to allay our own fears is simply to look at the facts.
Being a kid in America has never been safer. Since 1935, the number of childhood deaths between the ages of 1 and 4 fell from 450 to 30 per 100,000. It has fallen by nearly half just since 1990, and the decreases in other age groups are similarly impressive. Use this knowledge to counteract the media’s relentless focus on fear and danger. You might even print out a chart on declining childhood mortality (such as the one linked above) and put it on the fridge as a reminder of how good your kids have it.
2. Be specific and proportional.
Grown-ups want to teach young people how to stay safe in the face of threats. However, the research is clear that a blanket attitude of fear can actually make them less able to do so. If you want to offer a child a warning to make them better prepared, focus on one specific danger they might face and how to deal with it. Instead of saying, “People will try to take advantage of you at college,” say, “If someone is trying to get you to drink too much, avoid that person.”
When you do need to bring up a threat, make sure you keep it in proportion. For example, I don’t want anyone to be mean to my kids any more than the next parent. They know this. But it doesn’t help them for me to say that hostile words inherently make them unsafe. Social conflict is unavoidable, and making them fear it as an existential threat amounts to giving them a negative primal, rendering them less resilient.
3. Counteract negative primals from outside.
Almost every day that my daughter was in high school, she was taught about the dangerous world—about bad people, dangerous forces in nature, and a bleak future for our country. She told us about the gloom and doom each evening at dinner, and my wife and I could see her growing pessimism. So we set about deliberately countering the scary narrative. We didn’t sugarcoat the threats; we simply tried to be specific about the kind behaviors we witnessed, and ways that the world was safer and more prosperous today than in the past.
It was our way of sharing our genuine belief that on the whole, most people are good and things are getting better. Working hard to avoid instilling a fear-based primal belief in kids is good. But really, we should all be able to do better than that, and try to cultivate a positive primal belief that can truly improve their lives. For that, I turn to the words of the Chinese philosopher Lao Tzu. “Through Love, one has no fear,” he wrote in the Tao Te Ching.
Instead of teaching our kids fear primals, let’s teach them love primals, which neutralize fear and put something good in its place. Let them know that people are made for love—we all crave it, and we can find something lovable in just about everyone we meet. We don’t always give it or accept it, because we make a lot of mistakes, but love is what all our hearts desire. If you want to give your children a rule to live by, this one is a much safer bet.
Photo: vchal (Shutterstock)
