Psychiatrists often rely on trial and error to determine the right medication to treat a person's condition.

From the Lab to the Couch: Personalized Psychiatry in the Genomic Era

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 Last spring, my half-sister Michele called me concerned about her 21-year-old daughter’s mental health, as she’d had several bouts of depression and it appeared another one was coming on. This time, Michele was eager to get in touch with her daughter’s therapist before their next meeting. She had some new—and potentially treatment-altering—information.


 “Her tests came back,” Michele told me. “Turns out she’s got a MTHFR-gene mutation. We’re waiting to find out which kind.” This was not a conversation anyone would have had 10 years ago, and it’s not one that many are having now. But if personalized, gene-based medicine keeps expanding into the brain sciences, it might be.


 Michele, who works as a medical researcher in Australia, may know more than the average parent about the potential of genetics in treating psychiatric conditions. She had read studies that a mutation in the MTHFR gene may increase the risk of psychiatric disorders. Depending on the variation of the mutation, it could also signify which medications are most useful—with some studies recommending folate supplements instead of, or in addition to, antidepressants.


 She wasn’t expecting the information to translate directly into a cure for her daughter’s depression, the way she might expect penicillin to work on strep throat. But she was hoping for a treatment plan a few steps above educated guessing, which—unlike infectious disease or cancer medicine—is still the primary approach in psychiatry. “You basically have this bind—that we have very effective treatments,” says Helen Mayberg, professor of psychiatry, neurology, and radiology at Emory University in Atlanta. “The problem is that it’s trial and error for any one person.”

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 Even the most skilled psychiatrists tend to choose medications or therapy based on population-wide statistics, not individual profiles. As a result, a great many patients get cycled through myriad medications and therapies before they come across something that works well—and without side effects. Each false start could waste months of time, during which jobs are lost, relationships end, and misery endures. Could the new era of personalized medicine offer a way to shorten their suffering?


 “We are very much at the precipice of starting to think and do these studies,” says Dr. Madhukar Trivedi, a psychiatric researcher at University of Texas Southwestern Medical School in Dallas, “but were are still early in the course of this, compared to some of our medical brethren.”


 Nevertheless, the number of researchers like Trivedi, who are searching for biological clues to psychiatric treatment, is multiplying, buoyed by support from federal agencies, including the National Institutes of Mental Health. They call the field “personalized psychiatry.”


 “We are very committed to taking genetics as far it will go,” says Tom Insel, director of the NIMH. Granted, he says, the field of personalized psychiatry is still “more of a promise than a reality, and that sets it apart from genetics of different tumors or cancers. But it’s exactly where we need to be going.”


 The latest research into the psychiatric genome fits with NIMH’s newest priorities. Last spring, when the fifth edition of the Diagnostic Standards Manual (DSM5) came out, Insel lamented the degree to which mental health providers remain dependent on symptoms to diagnose disease, rather than underlying biology. He announced NIMH funding would be shifting towards the search for psychiatric biomarkers—a practice he calls “precision psychiatry.”


 “What makes this especially interesting,” Insel says, “is that when you look at scores of genes, they don’t look like they’ve been picked at random. They look like they tell a story.”

<h2>
 Search for Biomarkers
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 Genetic variation is thought to help explain why some people in similar environments get psychiatric illness and others don’t—though the messiness of mental illness has made it difficult to match specific genes with complex disorders.


 Large-scale epidemiological research into family histories of mental illness, known as genome-wide association studies, have suggested links between heredity and disease. But psychiatric researchers have remained stymied when it comes to using genetic profiles to predict who will develop major disorders such as schizophrenia, depression, or bipolar disorder. Finding a genetic biomarker that can actually direct treatment is harder still.


 When personalized, genomic medicine was getting off the ground a decade ago, the hope was “there would be some biomarker of some high reliability, reproducibility for psychiatric disorders, to personalize it, or give us greater precision,” says Dr. Francis Lee, who runs a psychiatric research lab at Weill Cornell Medical College, “and that hasn’t happened yet.”

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 “We are very committed to taking genetics as far it will go.

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 Genes direct production of proteins, which in turn can affect how medications are metabolized, whether they find their targeted receptors, and which neurotransmitters are most accessible. Early on, Lee was expecting to link a single gene mutation to a psychiatric disorder the way gene mutations have been linked to sickle cell anemia or cystic fibrosis. “I was naive 10 years ago,” he says. “There’s not going to be one single gene. There’s probably going to be an ensemble of genes.”


 In recent years, however, researchers have begun to find significant genetic clues to mental illness, thanks in part to the NIMH-funded study “Sequenced Treatment Alternatives to Relieve Depression,” known as Star-D, data from which were released in 2006. The six-year, $35-million study followed 2,876 participants. The goal was to help narrow down treatment options for the 60-70% of depression patients for whom the first medication does not work. “We have 30 different depression medications, many types of psychotherapy, exercise, ECT [electroshock therapy],” says Trivedi, who was principal investigator on the study. “No one treatment is good for everyone.”


 Subsequent researchers have mined the database of genetic data from the Star-D trial. For example, one study compared the genetic profiles of the participants who responded well to the drug Celexa (citalopram) with those who didn’t. People with a variation in the HTR2A gene and the GRIK4 gene were found most likely to respond well to the drug. These findings are promising, Trivedi says, “and yet there’s a hole. And the hole is, we currently do not have a lab test that helps me either diagnose or decide which treatment is better than another for a given patient.”


 Filling that hole became the impetus for Trivedi’s latest NIMH-funded study, called Embarc. Researchers are halfway through a four-year study, in which they take blood tests and brain scans on subjects in four cities across the country, divide them up into genetic subgroups, test different medications on each, and compare the results against a placebo and each other.


 Trivedi is not ready to disclose early results—having just completed the first phase—other than to call them “encouraging.” Researchers are planning to match up genetic biomarkers to structural markers in the brain such as cortical thickness and functional markers such as brain circuitry and connectivity. During treatment, they will look at epigenetic changes, or ways in which gene expression adapts to medication and “shows changes in the patient’s biology that can be a harbinger or preventer of eventual outcomes,” Trivedi says. “So you don’t have to wait 8 to 12 weeks to decide if this treatment is good or not for that patient.”

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<h2>
 Anxious Mice
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 One problem in psychiatric research is knowing what to measure and how to measure it. In studies of obesity or hypertension, scientists can measure weight gain or blood pressure. In psychiatry, Lee says, it’s hard to measure how sad you are, how suicidal, or how anxious. “We’re still using self-report and psychiatric interviews for many of these types of studies.”


 So Lee and his colleagues started their research at the molecular level. They focused on a particular genetic variant, one connected to a growth factor called brain-derived neurotrophic factor, or BDNF. The BDNF gene variant occurs in 30% percent of Caucasians and 50% of Asians, according to the Human Genome Project. “While many studies have shown it’s not going to be predictive of who gets, for example, a certain form of anxiety disorder,” says Lee, “it might actually turn out to be something that would predict who will respond better or worse to a variety of treatments.”

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 “You have 50% of the people who have PTSD don’t respond to cognitive behavioral therapy or to drugs, and no one knows why.”

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 His group started by placing the BDNF gene variant—found almost exclusively in humans—into mice. After seven years, Lee and co-author B.J. Casey found that mice injected with the altered gene exhibited what’s called “fear extinction,” a form of learning that diminishes a particular fear. The results suggested that people with the BDNF polymorphism might have a harder time using cognitive behavioral therapy, known as CBT, against anxiety disorders since the treatment relies on unlearning fearful associations. For instance, in humans, that might mean uncoupling loud bangs from the memory of gunshots, or divorcing the sight of a neighborhood intersection from a past car accident.


 After Lee and Casey’s mouse study, another research group based at the University of Puerto Rico looked at whether BDNF levels in humans correlates with how well CBT reduces a person’s symptoms of post-traumatic stress disorder—and found they did. “With CBT, you basically have to train your brain,” says Lee. “And that’s what BDNF fits very well. It’s a plasticity gene.”


 Now, Lee is in the middle of another BNDF study with Dr. JoAnn Difede, one funded by the Department of Defense, involving veterans returning from Iraq and Afghanistan who have a PTSD diagnosis. “You have 50% of the people who have PTSD don’t respond to CBT or to drugs, and no one knows why,” Lee says. “You can imagine this genetic variant might explain a portion of that.”


 Since his working hypothesis suggests that the BDNF gene variant makes cognitive behavioral therapy less effective, Lee and colleagues are testing a drug that could bypass the BDNF mechanism. They’re giving D-Cycloserine—an antibiotic that also works as a short-acting cognitive enhancer—to veterans who carry the BDNF gene variant. If Lee is right, the drug could make the therapy more effective in veterans who show the same “deficit in fear extinction” that his mice did.


 “This is what I think the future of how personalized psychiatry will work,” Lee says. “You will find there are patients who, for example, have a [gene] variant that won’t let them respond to traditional cognitive behavioral therapy, for a variety of reasons, but then you can find a drug that will actually help you get around the problem.”


 This could be game-changing for soldiers. in particular. An estimated 15-30% of those who go into combat are expected to come home with PTSD, and many of them appear resistant to the traditional treatments. Since most soldiers already have to give the military biological samples when they sign up, Lee proposes comparing their genetic profiles against a panel of PTSD or anxiety-disorder related genes and identifying those who have a variant that does not do well on CBT. They would be candidates for the cognitive enhancer or a longer and more intensive regimen of CBT.


 “We probably can’t explain why you’re the one out of five subjects who actually got PTSD,” Lee says. But, he continues, “what we will be able to tell them is that, ‘we are going to go down a very methodical treatment course for you, and the genetic information might help us accelerate the time to help treat you faster.’ ”


 “We just have to be smarter than we were 10 years ago,” he added. “It’s not just going to be a be-all diagnostic marker, but it could be something that would inform what we now call pharmacogenetics,” or the use of genetic information in determining which drugs to prescribe.

<h2>
 Peering into the Brain
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 Dr. Mayberg, the Emory psychiatry professor, thinks she may be even closer to finding a treatment-changing biomarker, not through genetic tests but through brain scans. For decades, she has been trying to map circuits in the brain using evolving methods in neuroimaging, from CT scanning to functional MRI. Early on, she started by looking at the brains of people with diseases such as Parkinson’s, Huntington’s, and Alzeimer’s before moving onto depression. She was motivated by the discouraging statistic that 40% of the depressed population does not respond to the traditional regimen of antidepressant drugs and psychotherapy. “So why doesn’t everybody get well?” she says. “It isn’t that the treatment is bad. It just may not be good for
 
 you
 
 .”


 In the same way that some diabetics respond to pills and others to injected insulin, Mayberg says, depressed patients need to find a match between their brain type and their treatment. In her latest research, she wanted to know how the brain’s metabolism and circuitry looks when a treatment is working—be it medication or talk therapy—versus when it’s not.


 “We want to not only match a patient to a treatment that is most likely to get them well,” Mayberg says, “but we also want to know in advance that a treatment is unlikely to work.”


 The resulting study, published just this past June, measured glucose metabolism in the brain using a specialized PET scan. First the researchers looked at resting brain scans, when the subject isn’t doing anything. Then one half received 12 weeks of cognitive behavioral therapy from expert therapists; the other received 12 weeks of the antidepressant escitalopram oxalate.


 Researchers observed who responded to which treatment and who responded to none, matching those results to the brain scans. They focused on six regions of the brain. The one region that seemed to predict success was the right interior insula, which is considered a key area for sensory and emotional processing. If someone had high activity in the insula, they did great on drugs but not therapy, Mayberg says. If they had low activity in the insula, they did great on therapy but drugs were ineffective.

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 “Nobody questions when you have chest pain and you end up on an angiogram table.”

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 To Mayberg, this is the very definition of a biomarker. But to confirm the finding, she’s planning a new study that would follow a more prospective method. Researchers would recruit patients according to their insula activity, try out the treatment they think matches an individual’s brain structure, and see if it works. They’ll know if they’re right if the remission rate is greater than 40%—the traditional rate of success when doctors use trial and error along with a patient’s symptoms and family history. “If something is going to actually be useful, you need to know that, if I treated by the biomarker, I did better than the usual way we do it,” Mayberg says.


 Increasingly, other researchers are also looking for clues in brain structure. In one recent study, researchers found that patients with psychosis who had more cortical gyrification—folding of the cerebral cortex—responded better to antipsychotic drugs than those with less gyrification. But with rising skepticism in the general public over the promise of neuroimaging, and neuroscience in general, (take the recent book, “Brainwashed: The Seductive Appeal of Mindless Neuroscience”), will clinicians be likely to order expensive brain scans for their patients—and will insurance companies pay?


 They certainly ought to, Mayberg says. “Nobody questions when you have chest pain and you end up on an angiogram table,” she says. So why should fMRIs be off limits when it comes to treating a potentially lethal disease like depression?


 “If this is a test that actually is reliable and valid and sensitive and specific, and works as a biomarker,” she says, “why shouldn’t we be scanning people to make management decisions when we can’t do it any other way?”

<h2>
 From Lab to Practice
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 Private industry is paying close attention. Some companies are already advertising genetic testing kits or consumer brain scans for psychiatric treatment, and the Mayo Clinic recently won a patent for a clinical decision-making tool based on psychiatric genetics. But many experts in the field caution against letting either commercial or clinical interests outpace solid research.


 Dr. Trivedi of the University of Texas says he wants to see more investment in the science—using larger sample sizes—before clinicians use blood tests, genetic profiles, or brain scans to address a complex set of behavioral and emotional factors. “If they are using it as one more tool in their decision making,” he says, “then it is OK.” Dr. Lee of Weill Cornell, while excited by his research into neurotrophic gene variants, believes any clinical application is “still years away,” after his and others’ studies have been peer-reviewed and replicated.


 The good news, he says, is that by then, genetic sequencing for the general population is likely to be quite affordable. Consumers can already hire companies like 23andMe to produce a panel of gene variants for $99, although they don’t currently include ones implicated in psychiatric disorders.


 As for my niece in Australia, after she tested positive for the MTHFR gene variant, her doctor recommended she try a specialized diet, plus folate supplements, to address her depression. But after a few months, she couldn’t take the restrictions and decided to try a more traditional route: medications, exercise, and keeping busy. With no concrete scientific proof—trial and error is still the go-to approach.


 Photo credit:
 <a href="http://www.flickr.com/photos/ashleyrosex/3134063173/">
 ashleyrosex/Flickr (CC BY-NC-ND 2.0)
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Personalized, genome-based medicine promises to vastly improve mental health treatments.

What’s the Limit for Green Buildings?

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 The grand opening for the R.W. Kern Center at Hampshire College in Amherst, Massachusetts, was billed as an environmental milestone. The $10.4 million, 17,000 square foot building—which will house admissions, financial aid, and a coffee shop—is in the running to be one of the greenest in the world.
 

 But it’s hard to actually observe energy conservation or high-performance insulation, so the PR team, including builders, architects, and college administrators, picked the most conspicuous components to show the small swarm of reporters on hand.
 

 To start, builder Jonathan Wright walks us past the chain link fence surrounding the dirt construction site to point out the self-contained water system—a contraption that collects rainwater on the roof of the building, delivers it to one of two large tanks where it’s treated onsite, and then pumps it back through the building as drinking water.
 
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<img alt="" class="richtext-image full-width" src="https://www.pbs.org/wgbh/nova/media/images/kern-center-rain-water.width-990_nVUkUGZ.jpg"/>
<figcaption>Rainwater from the Kern Center's roof is captured, stored in two 5,000 gallon cisterns beside the building (above), and filtered before being used as drinking water.
 
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 “People ask, is it clean? Will it taste as good as city water?” Wright says. “Are you kidding—no beavers have been swimming around in this stuff.”  Later, Wright opens a door to the composting toilets in surprisingly odor-less rooms where students and visitors will sit on locally-sourced porcelain and scoop in wood shavings when they’re done. The waste falls to a floor below, where it breaks down in tanks for up to seven years.
 

 Above, solar panels on the roof will power the building’s electrical system through BPA-free wiring using regionally-procured casing. And that’s not all. The heating is geothermal. Glass windows exceed the highest performance standards. Wood floors are made with reclaimed oak from dismantled barns using formaldehyde free glue “and finished with a polymer from the back of the Cabot cheese factory in Vermont,” Wright says.
 

 All this to pass what’s called the “Living Building Challenge,” a rare designation, created a decade ago and overseen by the Seattle-based International Living Futures Institute.
 

 By the end of the media tour, it was hard not to be impressed at the lengths this building went to to reduce its ecological footprint. But at the same time, you had to wonder: Do we need to go to these extents to save the planet? And is it possible for such extreme projects as these to lose sight of the bigger picture?
 
<h2>
 From LEED to Living Buildings
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 Ever since the late-1990s, the highest standard for environmental building has been LEED-certification, run by the U.S. Green Building Council. With three different levels—platinum, gold, silver—builders can earn LEED (Leadership in Energy and Environmental Design) points for a variety of measures, from energy conservation to water efficiency to healthy materials.
 

 But some critics of LEED—including those on the more extreme end of the environmental movement—felt it has become too commonplace. Builders can find loopholes in the certification process to receive partial credit and still come off as good citizens.
 

 “A system like LEED gives little pats on the back for doing good deeds,” says Emmanuel Cosgrove, director of the Canadian green-building organization EcoHome, “and the more little pats on the back that you get, the more you get a medal—like going from LEED silver to gold to platinum.”
 

 So green-building advocates started looking for a tougher standard, with less wiggle room for “good effort.” It came in the form of a Living Building, first developed by Bob Berkebile and Jason McClennan, two architects who worked together on a prototype for a highly-sustainable building in Bozeman, Montana, called the EpiCenter.
 
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<img alt="" class="richtext-image full-width" src="https://www.pbs.org/wgbh/nova/media/images/kern-center.width-990_AlQKVXj.jpg"/>
<figcaption>The Kern Center is one of only a handful of buildings to meet the Living Building Challenge.
 
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 In 2006, Berkebile and McClennan took the idea of a Living Building Challenge to the Seattle-based Cascadia Green Building Council. Cascadia then created what’s now called the International Living Future Institute to oversee the program. According to organization’s
 <a href="http://living-future.org/sites/default/files/reports/FINAL%20LBC%203_0_WebOptimized_low.pdf">
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 , the Living Building Challenge is “a philosophy first, an advocacy tool second, and a certification program third.”
 

 The initial idea was to encourage self-sustaining buildings that are so green that they generate more resources than they use. “Incremental change is no longer a viable option,” the Living Building Challenge website says. “When compared with the rate of change that is required to avoid the worst effects of climate change and other global environmental challenges, our progress has been minute and barely recordable.”
 

 To qualify as a full Living Building (the group also offers partial certification), you must ace seven performance categories, called “petals”: Place, Water, Energy, Health and Happiness, Materials, Equity and Beauty.
 
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 The Living Building Challenge is “a philosophy first, an advocacy tool second, and a certification program third.”
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 For example, energy use must be net-zero or net-positive; all power has to be produced on site, with no combustion, and there should be a way to store excess energy for emergencies. Water should be collected and treated on site.
 

 Builders cannot use any toxic material or chemical on the organization’s 22-item “red list”—which includes asbestos, mercury, arsenic-treated wood, BPA and PCBs—and that applies to anything from duct tape to outlet covers.
 

 Twenty percent of all materials must be sourced within 300 miles; another 30% within 620 miles. Same principle for laborers and consultants.
 

 The building site must be chosen to avoid farmland, wetlands, or any ecologically sensitive land, and to promote “human powered” transit like walking or biking. The interior space should be pleasing and well ventilated with plenty of fresh air and daylight. To cap it all off, the architecture and design itself must be beautiful; the aesthetics must “uplift the human spirit.”
 

 A lot to ask? Perhaps. “The goal of our program is to put a stake in the ground for where we think buildings should be heading in the future,” says Amanda Sturgeon, CEO of the International Living Future Institute. Given the novelty and nuance of the challenge’s many rules, Sturgeon says the effort requires much more than just shopping around for eco-friendly materials. Builders have to start thinking differently from the very beginning.
 

 “Sometimes we have design teams that are really enthusiastic, but we haven’t gotten buy-in from the building owner,” Sturgeon says. “They jump in enthusiastically to do a project, but I think sometimes they don’t quite know what it’s going to entail. And they charge ahead with the usual design process without changing it. It ends up adding cost and time.”
 

 The Living Building judges do occasionally make exceptions if builders can prove the impossibility, or infeasibility, of a task—say, if state regulators don’t allow composting toilets or the conversion of rainwater into drinking water or when the state fire code requires a hook-up to the municipal water supply.
 

 “The bottom line test for us is, does it meet the intent of the imperative?” Sturgeon says. “That you balance the resources of the site and that you’re able to not only live within the means of the site but also have an opportunity to restore the place you’re building in, ecologically.”
 

 In other words, this is an extremely high bar—so high, in fact, that as of July 2016, only 11 buildings have qualified for full Living Building status; a few dozen more are in the process.
 
<h2>
 The Devil’s In the Materials
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 Like most aspiring Living Builders, Hampshire College had a few stumbles, especially while making sure that not a single item—not the wiring, not the nail coating—contains anything on the toxic red list.
 

 “Sometimes you’ll go down the line, and you’ll find two months after you think you’ve procured something, you realize you can’t use it,” says Carl Weber, Hampshire’s project manager. “That happened with our electrical equipment. Everybody worked around the issue, but it probably caused the greatest angst in the project.”
 
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<figcaption>Solar panels on the Kern Center's roof provide 100 kW of power, meeting the building's needs.
 
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 Other builders have talked about the challenge of finding the highest performing components within a local radius. For instance, nearby Smith College, whose much smaller eco-classroom was Living Building certified in 2011, had to switch out its counter tops at the last minute. “We discovered late in the process that the porcelain in the concrete was coming from Europe, and that was too far,” says Reid Bertone-Johnson, Smith’s project manager. “Ultimately we went with southern Vermont slate.”
 

 Even after an institution or builder has gone through the whole design and construction process and opened for business, there’s no guarantee they’ll actually get that Living Building certificate. They still need to submit a year’s worth of utility bills to prove they really do produce more energy than they use.
 
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<figcaption>Inverters convert the solar panel's direct current voltage to the alternating current that's standard in homes and offices.
 
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 So is it worth all the trouble? Absolutely, says Hampshire President Jonathan Lash, a well-known leader in global environmental policy. Even though construction cost about 10 percent higher than traditional projects, he says, it will save much more than that in energy conservation. More importantly, a Living Building embodies the college’s green principles, which recently extended to an all-solar pledge. “For everyone who visits this campus, we want them to say: ‘This is what you can do, why would you want to do anything else?’ ” Lash says. (It can’t hurt the student acceptance yield either. During the press event, two college tours walked by and the tour leaders were sure to point out the green attributes of the Kern Center.)
 

 And sometimes you have to go big, Lash says, not just to get attention, but to get funding. “What excited the donors was that the building was way out there at the cutting edge,” he says. “If we’d done something that that was just pretty green but nothing special, it would’ve been much tougher to raise the money.” But for some people, that’s exactly what makes them wary of the Living Building Challenge.
 
<h2>
 Too Much?
 </h2>

 Emmanuel Cosgrove, director of EcoHome, a green-building consulting organization, is hardly someone you’d expect to be a skeptic when it comes to eco-friendly construction.
 

 I met him accidentally, after I answered his Airbnb ad for an “eco-loft” he rents out in Montreal. Tall and fit from biking almost everywhere around the city, he greeted me in bare feet, still vacuuming the hardwood floors, which he explained all came from reclaimed wood—as did the thick and slightly misshapen front door. The water that we used to shower went into a recycled gray water system that flushed our toilets and keeps their roof garden irrigated. The third floor is heated by sunlight from ceiling-to-floor windows.
 

 Not surprisingly, a certificate inside the foyer advertises that this building was one of the first in Quebec to go LEED Platinum. So when I asked what he thought of the Living Building Challenge, I was surprised to learn that Cosgrove, who proudly calls himself an “environmental wacko,” is not a fan.
 

 “Extremes sell,” he says. “And just good buildings that will last a very long time and use very little energy and very little water—they just don’t sell.”
 

 His objection is not to the spirit of the Living Building; he considers it “beautiful in principle” and says he was excited when the challenge was first announced. But over time, he concluded that the individualistic, self-sustaining ideal of a Living Building misses out on the benefits of larger-scale connectivity. In places like Montreal, he says, where power grids already make use of renewable energy like wind or hydro, it takes fewer resources to plug into an large and established shared system than it does to produce your own power, building by building.
 

 He makes the same argument for water. He says his organization conducted an analysis to compare the resources needed to catch rainwater and process it on-site against using a municipal water supply. The municipal system won. “And that’s no fun. We don’t want to hear that,” Cosgrove says. “When we’re doing this to truly make the right decisions, to make our collective environmental impact lesser, then we have to listen to what science tells us.”
 
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<img alt="" class="richtext-image full-width" src="https://www.pbs.org/wgbh/nova/media/images/kern-center-composter.width-990_DJUisFg.jpg"/>
<figcaption>One of two composter units that handle the waste from the six toilets in the Kern Center.
 
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 He even balks at the argument, made by supporters of Living Buildings, that you have to go extreme to inspire followers. On the contrary, he’s worried that everyday builders and homeowners—even eco-conscious ones like him—will be so daunted by the hoops you go through to attain Living Building status, they might just throw up their hands. “All we can hope for is it won’t deter more people than it draws into the sustainable building movement,” Cosgrove says.
 

 Nadav Malin, president of the Vermont company BuildingGreen, shares some wariness about the Living Building Challenge, but he doesn’t go as far as Cosgrove. He says he prefers to look at energy conservation from a neighborhood or city-wide perspective. Rather than applauding each building for its net-zero goals, better to add up all the buildings in a city or neighborhood and consider the communal successes.
 

 “If we keep our eye on the bigger picture of climate change, trying to make an individual building net zero may not be the most effective way to get there,” he says. (In fact, the International Living Future Institute has recently launched a “Living Community Challenge” using similar principles as the Living Building but on the larger scale that Malin recommends.)
 
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 “Making an individual building net zero may not be the most effective way to combat climate change.”
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 Malin also says it’s important not to get carried away with “bragging rights” over one special building at the expense of wider scale improvements—especially on college campuses. “If you have a bunch of existing buildings that are very inefficient because they were built in the ’50s or ’60s—when we built horrible buildings from an energy point of view—to invest a tremendous amount of resources in making one building net zero may not be as good from an overall carbon impact,” Malin says.
 

 Yet Malin says the skeptic’s point of view need not derail the Living Building ideal entirely, “because I think that these kind of projects really galvanize interest and excitement and people ideally should be doing both. They should be looking at what I call ‘trophy buildings’ as an opportunity to see what’s possible.”
 

 That’s exactly how CEO Amanda Sturgeon looks at the Living Building Challenge. She says they’ve already inspired smaller scale environmental improvements, on campuses and elsewhere, and have egged on manufacturers to make healthier building products.
 

 “We’re sort of tugging the whole market forward,” she says. “My hope is all the projects looking to be a little more energy-efficient are thinking, ‘Wow, I could actually get a whole lot further than I would have started out thinking I could get to,’ and stretch themselves to more innovative solutions than they thought were possible.”
 
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 Photo credits: Robert Benson Photography/Hampshire College

Buildings that win a new green building certificate may sacrifice sustainability.

What Makes a Resilient Mind

From genetics to social ties, scientists are discovering why some people—but not others—easily bounce back from trauma.

Karen Brown

Articles

From the Lab to the Couch: Personalized Psychiatry in the Genomic Era

What’s the Limit for Green Buildings?

What Makes a Resilient Mind

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