San Jose Police Crack Down On Violence

The San Jose Police Department is cracking down on violent crime after the city's 25th homicide this year.

KQED Launches Affordable Care Act Guide

Are you confused about Obamacare? KQED and The California Report created a guide to help answer your questions about the Affordable Care Act.

Covered California Struggles to Enroll Former Foster Youth

Young adults who've recently left the foster care system are having trouble signing up for health insurance through the state's marketplace, Covered California. The agency admits its website and counselors are ill-equipped to help this population.

Millions of California Kids Missing Out on Meals During the Summer

School's out for summer, and for some kids that means carefree summer days. For others, it can mean going hungry. Thousands of schools, community centers and libraries serve free meals to kids during the summer. But they only reach one in five children who qualify for free or reduced-price lunch during the school year.

PBS NewsHour

Pinpointing genetic links to schizophrenia may open doors to better treatment


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JUDY WOODRUFF: Finally tonight: understanding the connections between human genetics and schizophrenia.

It’s part of our series on the science of the brain. Tonight, we look at a study published this week, the largest ever of schizophrenia patients. There are more than three million of them in the U.S. The study found that perhaps more than 100 genes were associated with the condition. Genetics has long been assumed to play a role.

But for the first time, researchers found genes in the immune system are among those involved. Patients have long awaited better treatments.

Dr. Steven Hyman is the director of the Stanley Center for Psychiatric Research at the Broad Institute of MIT and Harvard. His center was involved in this study. And I spoke with him yesterday.

Dr. Steven Hyman, welcome to the NewsHour.

First of all, tell us what it is like to have schizophrenia. We know that something like three million Americans suffer from this.

DR. STEVEN HYMAN, Broad Institute: That’s right. It affects about 1 percent of people worldwide, including the United States.

And what patients experience is extremely distressing and also disabling. There are three kinds of symptoms. Most famously, people have what are called psychotic symptoms, hallucinations, most often hearing voices that aren’t there, delusions, which are fixed false beliefs that are not culturally appropriate.

But also less well recognized are two other symptoms which contribute to disability. People have declines in their cognitive functions, things like memory, ability to pay attention, and ability to use their thoughts to control their emotions and behavior.

And then there’s another cluster of symptoms called deficit symptoms, where people have what is called blunted affect. That is even something very sad might not elicit a response or something very happy. They lose motivation.

The drugs we have today only treat the psychotic symptoms, and do that incompletely, and really don’t touch the other two sets of symptoms, leaving patients very disabled and great costs and challenges of course to families and society.

JUDY WOODRUFF: Well, we know this was a large study, as they go. What are the main findings here?

DR. STEVEN HYMAN: So the most important finding is that this is the beginning of identifying specific variations in genes that contribute to the causes of schizophrenia.

And I think it’s really important, just to put in context, that not very many years ago, schizophrenia was considered an absolutely mysterious disease. When I began my psychiatric training, there were many people who thought that the way parents, especially mothers, behaved toward children psychologically was the cause of this illness.

We now know that it is largely caused by genes. Genes are not fate for any of these diseases, but genes are very influential. But there’s a big step between knowing that genes are important and actually finding the genes that are involved. And in this study, which was a large international study, 108 separate locations in the genome were with certainty associated with the causes of schizophrenia.

JUDY WOODRUFF: So, you’re saying a connection, but not in every case.

For example, you’re saying the genes — I know the studies show that genes that affect the immune system also show up in individuals with schizophrenia. So that means these genetic markings don’t in every case indicate causation.

DR. STEVEN HYMAN: Right. So, that’s exactly right.

Like most chronic common human illnesses, where genes are highly influential — and they’re influential in everybody — it’s just as you suggest. Different combinations of genes matter in different individuals, and we’re not yet in a stage — in a state to say, you know, these 20 genes or these 30 genes matter to this person.

But what we can do is begin to say, you know, in the population, there are now 108 known places in the genome which point us towards genes that are involved in causation. And, as you suggest, while most are in the nervous system, some of them, very intriguingly, point to the immune system as being involved.

JUDY WOODRUFF: And you were saying earlier that it’s been difficult to find medications to successfully treat schizophrenia, so why then are these findings so important?

DR. STEVEN HYMAN: Well, that’s what — that’s really — the whole reason to do these studies is ultimately to improve diagnosis and to develop treatment.

The first drugs to treat schizophrenia and, in fact, to treat, you know, depression and other psychiatric illnesses were discovered by serendipity, by prepared minds seeing unexpected effects of drugs on human beings. And the antipsychotic drugs that we use to treat schizophrenia stemmed from the discoveries made in the 1950s.

Tragically, there’s been no fundamental improvement on these drugs. So, we have been using, with improvements in terms of side effects and safety, fundamentally the same kinds of medications for more than half-a-century. And, indeed, it’s been so difficult because the human brain is not well modeled in animals, because it’s hidden behind our hard and opaque skulls. It’s been very hard to get real clues.

And drugs companies have been existing psychiatry, leaving patients with less and less hope. The key here is, if as a gene is involved causing an illness, in some sense, it’s a clue to what is going wrong, in this case in the brain, maybe the immune system, in the disease processes.

And, ultimately, as we add up these clues, people developing therapies, ultimately pharmaceutical companies, can say, OK, we’re going to target this gene, we’re going to target this pathway. And we hope, we very much hope that these clues will begin to bring industry back into the game, because, ultimately, we academics are going to do a lot of research, but it’s industry that has got to make the medicines.

JUDY WOODRUFF: But, just quickly, I hear you saying, Dr. Hyman, it may be several years before these finding translate into new treatment.

DR. STEVEN HYMAN: Yes, unfortunately, because we’re all impatient, but no one is more impatient than those affected by these terrible illnesses and their families.

But the reality is that these are very early clues. They are real clues. They are not going to go away. They are going to lead us to — in important directions, but it will take many, many years to turn these into more useful treatments.

JUDY WOODRUFF: Dr. Steven Hyman, we thank you very much for talking with us.

DR. STEVEN HYMAN: My pleasure.

The post Pinpointing genetic links to schizophrenia may open doors to better treatment appeared first on PBS NewsHour.

Teen use of human growth hormones doubles, survey finds

Graph by Partnership for Drug-Free Kids

Graph by Partnership for Drug-Free Kids

The number of teens obtaining and abusing human growth hormones has doubled in one year, according to a survey published Wednesday by the Partnership for Drug-Free Kids.

The finding was part of a confidential yearly investigation in which 3,705 high school students were surveyed. With 11 percent reporting using some form of HGH at least once, the rate is up from five percent in the last four annual surveys.

Travis Tygart, CEO of the U.S. Anti-doping Agency, partly blamed the aggressive promotion of performance enhancing substances in a largely unregulated marketplace both online and in store. He also noted that teenagers are especially vulnerable to such marketing and promises of improved body image.

Steve Pasierb, the President of the Partnership for Drug Free Kids, claimed that high school coaches have a key role in combating doping. He hinted that up to a third of the coaches are prepared to overlook the problem in the interests of winning.

The Mayo Clinic openly lists the hazards and side effects of taking non-prescribed human growth hormones by pubescent teens. The symptoms associated with injecting the substance include stunted growth, acne, liver problems, shrunken testicles for boys and excess facial hair for girls. There is also the danger of not knowing exactly where the drugs come from the unregulated, unmonitored market.

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Will conflicting federal health care law rulings head to the Supreme Court?

A ruling Tuesday by the U.S. Appeals Court for the D.C. Circuit could put at
         immediate risk the millions of people who bought insurance in the 36 states where these online insurance marketplaces are
         run by the federal government. Photo by Andrew Harrer/Bloomberg via Getty Images

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GWEN IFILL: Now conflicting court rulings on the health care law.

The federal court of appeals based in Washington ruled today that the law doesn’t allow policy holders who get their insurance through the federal exchange to qualify for subsidies that would reduce the cost. But a separate ruling, issued hours later by a federal appeals court in Richmond, said those getting policies through the federal exchanges do qualify for the subsidies.

The rulings come down to different interpretations of the same passage of the law. Congress said if a state didn’t create its own insurance exchange, the federal government should. But the law also reads that subsidies be provided by — quote — “an exchange established by the state.”

Just 14 states, plus the District of Columbia, created their own exchanges. Five million enrollees now receive subsidies through the federal exchange.

So, what do these conflicting rulings mean for the future of the health care law?

For that, we turn to Julie Rovner of Kaiser Health News and Tom Goldstein, founder of

Let’s go back to the root of this challenge, Julie. Why did this come up?

JULIE ROVNER, Kaiser Health News: Well, because people who opposed the law found this, what appeared to be a drafting area, saying that subsidies were only available in the state-based exchange, and decided that they would sue over it to perhaps get another bite at the apple of trying to invalidate or really kind of make a mess of the rest of the law.

That’s what this comes down to. It’s whether or not this was a mistake or whether this was something that Congress intended to do when it wrote just that — just that one sentence about…

GWEN IFILL: And the whole point of these subsidies was to put the A in affordable care, right?

JULIE ROVNER: That’s exactly right.

And if this were to go away, there’s an estimate out now that about five million people would see premium increases of about 76 percent. Most of the people who are buying insurance on the exchanges are getting subsidies. Those subsidies are fairly large.

If the subsidies were not available, then basically insurance would become unaffordable and the individual mandate, the requirement for people to have insurance, does not apply to people for whom insurance is unaffordable.

GWEN IFILL: Now, Tom, the D.C. court ruled today that theirs was an unambiguous reading of the law, but yet this other reading of the law seems to open the whole thing to ambiguity.

TOM GOLDSTEIN, Yes, that’s right.

It’s shocked everyone, I’m sure, that this huge, sweeping law that takes up thousands of pages might not be perfectly clear to everyone. What the court of appeals in Washington today said is, the language says a state-created exchange. And even if it wouldn’t make a ton of sense necessarily for Congress to say part of the country has subsidies available to it and a large part of the country doesn’t, that’s the law that Congress wrote, and our job is just to enforce it.

The court of appeals in Richmond said, this statute is a mess. There are things that point in different directions about what Congress wanted. And because it’s unclear, it’s the administration’s job to figure it out.

GWEN IFILL: So, Congress was the one that opened the door for this kind of a challenge?

TOM GOLDSTEIN: Yes, absolutely.

Congress did say when there were supposed to be subsidies, but it’s just although unclear whether it literally meant only a state-created exchange or if instead it meant, if you buy your health care through the exchange and you can’t afford health insurance, we will help you out.

GWEN IFILL: So, if the first ruling were to stand, Julie, we’re assuming that it would — the only way to address it would be for every state to set up its own exchange, instead of relying on the federal one.

JULIE ROVNER: That would be the idea, that there — and there is a lot of discussion already about states could do that.

In some states, though, they actually passed constitutional amendments barring them from creating their own exchanges. You remember a lot of these states run by Republicans really want nothing to do with this law.

GWEN IFILL: Are there other ripple effects that affect other parts of the law as well?

JULIE ROVNER: Yes, it actually also affects the employer mandate, the requirement for employers to provide insurance, because that’s actually tied to the subsidies that individuals get.

The way the employer mandate works is, it says that employers only have to pay a fine if one of the — if they don’t offer insurance and one of their employees goes to the exchange and gets a subsidy. So, if there’s no subsidy, then there’s no way to enforce the employer part of this either.

GWEN IFILL: Tom, it seems that we have seen enough challenges now to the health care law, including the part that was upheld by the Supreme Court, and the Hobby Lobby decision about contraceptive coverage that we saw decided in the final days of the court. It seems like death by a thousand cuts?

TOM GOLDSTEIN: Well, so far.

GWEN IFILL: Or attempted death by…

TOM GOLDSTEIN: Exactly right.

There are certainly a lot of people who are very critical of the law. They have brought very sophisticated legal challenges. The statute has been upheld, by and large. This is the single greatest threat to the reach of the statute, to the attempt to help a lot of people be able to afford health care through insurance.

But it is a part of the law that people find offensive in many parts of the country because they don’t want the federal government so involved. It’s probably going to be up to the Supreme Court, just like the last major challenges.

GWEN IFILL: Are there other challenges in the pipeline, Julie?

JULIE ROVNER: There are a couple at lower courts. It’s not entirely clear that this would produce a requirement for the Supreme Court to take the case. The administration is going to appeal to the full appeals court in D.C.

GWEN IFILL: Tell me how that process works. We’re talking about two different courts and two different circuits today, and then what?

JULIE ROVNER: Well, right now, immediately, this was a three-judge panel of the court of appeals. And they will appeal to the en banc, to the entire appeals court. And generally there are more Democratic appointees than Republican appointees there.

There is at least a perception that it’s likely to be reversed by the full appeals court. And then you would have basically two appeals courts having ruled and not disagreeing. So, in that case, the Supreme Court would not have to take the case, but not clear whether they would.

GWEN IFILL: Well, explain. Remind us again, Tom, the way this works. The court then — at what point does the court have to decide whether it would intervene in this?

TOM GOLDSTEIN: Well, someone has to ask. So the plaintiffs who lost in Richmond today are inevitably going to ask the Supreme Court to step in.

The government could go straight to the Supreme Court, but the White House said today that it’s going to ask the full court of appeals in Washington to hear the case. So, we’re probably a year to 18 months away from getting a final answer. The Supreme Court could stay out.

I think it’s a little bit more likely that they will just say, this is so important and there will be enough people on the court, enough justices who are concerned about this issue, that they will decide to take it up. But it’s an open question.

GWEN IFILL: Why would this be as important or more important than any of the other challenges we have seen so far? Why would the court feel compelled? You don’t think the court would be compelled?

JULIE ROVNER: My guess would be is that if there’s no split in the circuits that the court wouldn’t really want to go back and revisit this again, unless they think they could change the decision that they got in 2012.

GWEN IFILL: The most immediate question, however, Julie, for people who are watching this tonight is, how does this affect me?  If they have their employer-covered insurance, it doesn’t affect them at all?


And actually, even if they have subsidies in the federal exchange states, it doesn’t affect them immediately. The way the rules work in the D.C. circuit is that they don’t even send the requirement back down to the district court, which is who would actually implement this, for 45 days to give the government full time to appeal to the full appeals court, which we know that the government is going to do.

So, obviously, this is not going to happen right away. It would be a very long time before people would actually start losing their subsidies that they’re getting now.

GWEN IFILL: And potentially how many people are we talking who would be affected by these rulings?

TOM GOLDSTEIN: Five million.

GWEN IFILL: Five million who are currently in the federal exchange.

TOM GOLDSTEIN: That’s exactly right.

GWEN IFILL: But are there others who are lined up?  Do we know how many people — there was so much discussion about who was registering at what pace for a long time there, but do we know if there are others who will also be affected?

JULIE ROVNER: As more people would join the federal exchanges, obviously it would affect more people.

I have seen some numbers that go into 2016, so it’s everybody who is getting the subsidies now and everybody who’s potentially eligible in those 36 states where the federal government is running the exchange.

TOM GOLDSTEIN: And then we have all the employers, as you mentioned, who wouldn’t be subject to the mandate that’s going to come into effect in the future that they provide health insurance, because none of their employees would be getting subsidies in those states.

GWEN IFILL: Is there a timetable for the courts to act again?

TOM GOLDSTEIN: No, the court of appeals can take its time in deciding whether to have the whole court hear the case. Most likely, everyone is sensitive to the question of whether it will go to the Supreme Court. I think you’re looking at 18 months is the best guess for when we will have a final answer.

GWEN IFILL: Oh, good. Oh, joy. Can’t wait.

Tom Goldstein of SCOTUSblog, Julie Rovner of Kaiser Health News, thank you both very much.

TOM GOLDSTEIN: Thanks so much.

JULIE ROVNER: Thank you.

The post Will conflicting federal health care law rulings head to the Supreme Court? appeared first on PBS NewsHour.

What do the health law court decisions mean for consumers?

A U.S. Court of Appeals ruling Tuesday may affect certain subsidies available for Affordable Care Act enrollees. What
         does this mean for consumers? Kaiser Health News' Mary Agnes Carey has a breakdown. Photo by Andrew Harrer/Getty Images

A U.S. Court of Appeals ruling Tuesday may affect certain subsidies available for Affordable Care Act enrollees. What does this mean for consumers? Kaiser Health News’ Mary Agnes Carey has a breakdown. Photo by Andrew Harrer/Getty Images

On Tuesday two U.S. appeals courts issued conflicting rulings on a subject that’s important to millions of people: the availability of subsidies to help purchase coverage under the healthcare law. KHN’s Mary Agnes Carey answers some frequently asked questions about those court decisions and how they impact consumers.

Q: What did the courts decide?

A: In a blow to the health law, the U.S. Court of Appeals for the District of Columbia Circuit ruled that the health law’s subsidies are available only to individuals in the 14 states and the District of Columbia now operating their own health insurance exchanges. The federal government now runs the exchanges in 36 states. Judge Thomas Griffith, writing the majority opinion in the 2-1 decision, said they concluded “that the ACA unambiguously restricts” the subsidies to “exchanges ‘established by the state.’ ”

In a separate ruling, a three-judge panel for the Fourth Circuit Court of Appeals in Richmond, Virginia, ruled unanimously for the Obama administration, allowing subsidies to be available to residents in all states. Judge Roger Gregory, writing the opinion, said while the health law is “ambiguous and subject to multiple interpretations,” the court decided to uphold the IRS’s interpretation of the law that residents of states using the federal exchange are entitled to subsidies.

Q: What was the issue the courts decided on?

A: The case centers on a brief description in the health law that says subsidies will be available “through an exchange established by the state.”

In implementing the law, the Internal Revenue Service (IRS) interpreted the law to allow eligible consumers to receive subsidies to help purchase coverage, regardless of whether they are in an exchange run by their state or by the federal government.

Opponents of the law questioned that interpretation, saying that the law as written clearly directs subsidies to state-based exchanges only. But proponents — including several lawmakers who helped write it — said lawmakers fully intended that subsidies be offered on all exchanges no matter if they were administered by the feds or state officials.

Q: I don’t know if my state runs its own exchange. Which states do?

A: California, Colorado, Connecticut, Hawaii, Kentucky, Maryland, Massachusetts, Minnesota, Nevada, New York, Oregon, Rhode Island, Vermont, Washington and the District of Columbia all run their own exchanges.

Idaho and New Mexico intend to set up their own marketplace for the next enrollment period, which begins in November, but used this year.

Q: I live in a state with a federally run exchange, and I get a subsidy to help me buy coverage. Am I going to lose it?

A: Nothing is happening immediately. Justice Department officials said Tuesday they plan to seek an en banc review from the D.C. Appeals Court, meaning that the panel’s full contingent of 11 judges would hear the case. Six of the court’s judges would have to agree for the full panel to review the case. The full panel is dominated by judges appointed by Democrats, 7-4.

Eventually the case could be considered by the Supreme Court, but the current subsidies would likely remain in place until there is a final legal decision on the matter.

“In the meantime, to be clear, people getting premium tax credits should know that nothing has changed; tax credits remain available,” said Emily Pierce, deputy director of the Justice Department’s office of public affairs.

White House spokesman Josh Earnest said the administration was confident it would prevail. “You don’t need a fancy legal degree to understand that Congress intended for every eligible American to have access to tax credits that would lower their health care costs, regardless of whether it was state officials or federal officials who were running the marketplace.”

Supporters of the court challenge to the IRS interpretation on subsidies also maintain their case is strong. “The executive branch does not get to rewrite statutes just because it thinks those statutes would work better a certain way,” said Michael Cannon, director of health policy studies at the libertarian Cato Institute who championed the subsidy appeals. “If people lose those subsidies it is because the courts have ruled that those subsidies are and always have been unlawful — that the administration had no authority to administer those in the first place.”

Q: Are these the only two court cases?

A: No. There are two other similar cases pending in courts in Oklahoma and Indiana.

Q: If there are legal disputes ongoing about who qualifies to receive a subsidy, do I still have to buy health insurance?

A: Yes. The law’s “individual mandate,” which requires most people to purchase health insurance or pay a fine, is still in place.

Q. What if I get my insurance through work?

This decision applies only to policies sold on the online marketplaces. It does not affect work-based insurance, Medicare or Medicaid, regardless of where you live.

Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.

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