When Dominika Tamley chose “Isebelle,” her American Girl doll, she picked a toy whose hair and eye color matched her own. But the 10-year-old is quick to point out that’s not the only way the doll resembles the real child who plays with her.

“She’s like a mini-me,” Tamley explained with pride. “Because she has a hearing aid and I have a hearing aid.”

American Girl has for years offered a wide variety of accessories reflecting a range of disabilities. Arm crutches, leg braces, a sporty red wheelchair and allergy-free lunch sets. You can order a doll without hair — like a child with cancer — or one outfitted with a diabetes kit that includes insulin pumps, pens, glucose tablets and a blood sugar monitor.

“The designer who worked on that had Type 1 diabetes, and it was a really personal item for him to create,” said Stephanie Spanos, a public relations manager at American Girl. The designers developed the diabetes kit with the input of doctors, nurses and dietitians at American Family Children’s Hospital in Madison, Wis., Spanos added. “We introduced that at the very beginning of 2016 and it’s been in and out of stock all year.”

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The “Diabetes Care Kit,” designed to fit American Girl dolls, comes with insulin pumps, pens, glucose tablets and a blood sugar monitor. American Girl hide caption

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American Girl

American Girl dolls, which can cost more than $100, often come with a built-in back story, such as Nellie, the Irish immigrant orphan, or Cécile, the Creole girl growing up in 1850s New Orleans. Some activists remain irked that no American Girl comes with a built-in back story related to a disability. (A petition to add one last year, during the 25^th anniversary of the Americans with Disabilities Act, was unsuccessful.)

Still, more and more mainstream companies are adding characters with disabilities to their roster of toys. Earlier this year, Lego introduced, for the first time, a figure of a little boy in a wheelchair. Significantly, he’s not in the hospital — instead, he’s part of a city park set, representing people with disabilities out in the world. And in 2013, Toys R Us added its Journey Girls line of dolls, with accessories including wheelchairs and crutches.

Is this good business? Or just good public relations?

“It’s not about PR for us,” said the chief merchandising officer of Toys R Us, Richard Barry. “Our job as a company is to make sure we have the best assortment for all kids.” Barry pointed out that Toys R Us catalog has also started including children with disabilities in its photos of kids playing with the company’s toys.

Representation of kids with disabilities was harder to find at a big-box store in the suburbs of Washington D.C., where Rebecca Cokley took me shopping. Cokley is executive director of the National Council on Disability, and the first female little person to have worked in the White House. She’s 4 feet 2 inches tall and white, with red hair and freckles. “My family is interracial and interspatial,” she said. “My husband’s average height and African American. And, so, our kids are biracial dwarf kids.”

There were all kinds of toys Cokely liked in the aisles — she’s a Lego nerd and a big fan of Batgirl, a character with her own deep connection to the disability community. But it was nearly impossible to find a single toy that represented disability. In the Barbie aisle, we found chef Barbies, vet Barbies and gymnast Barbies.

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A Lego figure in a wheelchair was introduced at the 67th International Toy Fair in January 2016. He comes in the “City” set, a community of figures shown playing and working in an urban park setting. Daniel Karmann/AFP/Getty Images hide caption

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Daniel Karmann/AFP/Getty Images

“Why can’t one of these come with a hearing aid?” Cokely wondered. And Mattel has stopped making Becky, Barbie’s friend who uses a wheelchair (although you can still find Becky dolls to buy on secondary retail sites online.)

“And look — there’s Barbie’s inaccessible dream house!” Cokely said. “It’s got a working garage, but the elevator is too small for a wheelchair.” It would be tough for Becky to come over for a visit.

We had more luck in the Star Wars aisle. Cokely noticed a Luke Skywalker doll that comes with a prosthetic arm. “That counts!” she exclaimed, with a wry aside: “People do tend to claim Vader, but I don’t know if that’s a good thing or a bad thing.”

Aside from Luke, only one other toy (among many hundreds) explicitly represented a disability: Nemo. The friendly orange clownfish from the Pixar movie has one shortened fin, and the store sold a stuffed plush version.

“Both Finding Nemo and Finding Dory have been phenomenal resources for parents with disabilities,” she said. “Not only in terms of showing good examples of kids with disabilities, but also the challenges of being that overprotective helicopter parent.” She pointed out that some toys – such as My Little Pony — have been embraced by some disability activists, but that so much of the toy section represented missed opportunities.

“Why don’t we have any GI Joes that are disabled vets?” Cokely asked. “Think about that, what that would mean to a young boy whose dad’s a vet or whose mom’s a vet. To see their parents’ experience reflected in the toys — that would be massive.”

Research by social psychologist Sian Jones of Goldsmith University of London, as well as that of others, shows that all children benefit from playing with toys representing disability — it heightens empathy.

And activist Rebecca Atkinson, who runs the Toy Like Me website in the United Kingdom, told me she’d love it if every toybox included a wheelchair and a seeing-eye dog for children to play with. (Atkinson’s website points consumers towards toys that represent disability, and also creates playful images meant to inspire manufacturers, such as princesses with eye patches and scars, and superheros with tracheostomies.

This isn’t a niche market, Cokely added. One in four people will experience a disability at some point in their lives. “Everyone has a family member with a disability,” she said. “Everyone knows someone with a disability.”

And playing with toys in an imagined world where, just like in real life, people walk or use wheelchairs or have hearing aids is a world where kids can imagine other kids — disabled and otherwise — as friends.

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Two widely used tests to analyze the genetics of tumors often don’t come to the same conclusions, according to head-to-head analyses.

Authors of two recent studies comparing these tests say doctors need to be careful not to assume that these tests are providing a complete picture of a tumor’s genetic variants, when using them to select treatments for cancer patients.

Dr. C. Anthony “Tony” Blau and colleagues at the University of Washington School of Medicine in Seattle compared results from two commonly used tests that are used to identify mutations in tumors. The FoundationOne test is used on tissue samples extracted from tumors. Guardant360 gathers traces of tumor DNA from blood samples.

Blau started out with a small sample of just nine patients, as he reported Thursday in JAMA Oncology. One had no mutations at all recognized by either test. Of the remaining eight, the two tests provided remarkably different results. Only 22 percent of the time (in 10 out of 45 instances) did both tests identify the same mutation.

That’s not to say the tests themselves are technically flawed, Blau told Shots. But each test has its limitations, and so the results vary.

Tests of tumor tissue don’t sample the entire tumor. And tumor cells aren’t all the same, so a sample doesn’t give a complete picture of tumor genetics.

Blood tests sample free-floating cells that break loose from tumors. That’s a useful technology if a tumor is hard to sample directly, but again it provides an incomplete snapshot of the cancer’s genetic mutations. “They’re looking for a needle in a haystack,” Blau says.

Blood samples drawn at different times can produce different results, because different cells may be in the blood. And tumors evolve over time, so some of the difference could reflect that as well.

“The mutations you are looking for that might guide you to a particular drug can present in most or only a tiny fraction of cells,” Blau said. So either test can fail to detect a clinically important mutation.

These blood tests often include a list of cancer drugs for doctors to consider, based on the mutations detected. The recommendations also varied, because the tests often found different mutations. Only 25 percent of the time (in 9 of 36 cases) did these two tests recommend the same drug among the eight patients in the study.

These observations build on similar results of a somewhat larger study, published in August in the journal Oncotarget. In a sample of 28 patients, researchers found consistent results only about 17 percent of the time.

“It all boils down to a question of tumor biology,” says lead author of that study, Young Kwang Chae, an oncologist and a co-director of the Developmental Therapeutics Program of the Division of Hematology and Oncology at Northwestern University’s Feinberg School of Medicine.

“You can never say one test is the gold standard, or that one is better than the other,” he said. Because they are looking at different samples, it’s not surprising their results vary.

Many of the results from these tests are hard to interpret in the first place. In many instances, the presence of a particular mutation doesn’t tell a doctor exactly what form of therapy would work best.

But Chae says when he finds an “actionable genetic alteration” from either test, he uses that that to guide a patient’s therapy.

“Both tests are right,” argues Dr. Rick Lanman, chief medical officer at Guardant Health, which produces the blood-based Guardant360 test. If either test detects a particular mutation, there is high confidence that the particular mutation exists. And doctors can confidently base therapy on that positive detection, he says.

Doctors could get more complete results if they ran both tests on everybody, “but that’s not cost effective,” Lanman says.

His counterpart at Foundation Medicine, which makes the FoundationOne test, isn’t convinced that both tests are equally reliable. Dr. Vincent Miller says the blood tests can miss a lot more than tests run on tumor tissue.

He points to a recent study of pancreatic cancer. Gene variants very frequently found in pancreatic cancer were detected in 87 percent of tumor samples. But blood tests only found the mutations about 25 percent of the time.

Miller says his company has a blood test as well as the test for solid tumors, and they’re in the process of running a direct comparison, using the same genetic information. That could help clarify how much trust to put in blood tests, he says. “The technology may have gotten a little ahead of the clinical practice and the science,” he says.

Doctors may be lulled into thinking that these tests are providing definitive results, but they’re not. And that’s the overarching message for Blau at the University of Washington.

“You really have to be thoughtful about how you apply these to clinical decision making,” he says. “If you don’t understand these limitations, if you just treat the reports at face value, that could be leading to instances where oncologists use drugs that are unlikely to be effective.”

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