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.

Ebola Outbreak Prompts Liberia to Close Borders

The world's largest outbreak of Ebola, which began earlier this year in Guinea, has spread to Liberia and Sierra Leone, killing over 670 people in West Africa. With no vaccine and no cure, the virus is deadly for up to 90 percent of those infected. Two U.S. aid workers are now being treated for the virus in Liberia. And on Sunday, Liberia announced it's shutting most of its border crossings after an infected man flew from there to Nigeria. We discuss the Ebola epidemic and the challenges in treating and containing it.

New Rules Would Require Multi-Lingual Prescription Drug Labels

State officials are considering new rules that would require pharmacists to provide prescription drug labels in languages other than English. New York approved a similar rule last year to make it easier for non-English speakers to understand what they're supposed to take and when. If new regulations go forward, there are a lot of details that need to be worked out, including how many languages would be covered and who would have responsibility for the translation.

PBS NewsHour

Obama overhauls poultry inspections for the first time in decades

The new rules for poultry plant inspection, announced Thursday, will focus more on food safety than quality. Photo by
         U.S. Department of Agriculture

The new rules for poultry plant inspection, announced Thursday, will focus more on food safety than quality. Photo by U.S. Department of Agriculture

WASHINGTON — The Obama administration is overhauling poultry plant inspections for the first time in more than 50 years, a move it says could result in 5,000 fewer foodborne illnesses each year.

Final rules announced Thursday would reduce the number of government poultry inspectors by around a fourth. But those who remain will focus more on food safety than on quality, requiring them to pull more birds off the line for closer inspections and encouraging more testing for pathogens. There would also be more inspectors checking the facilities to make sure they are clean.

The changes would be voluntary, but many of the country’s largest poultry companies are expected to opt in.

Federal law requires that government inspectors be present in poultry processing plants. Right now, many USDA inspectors stand in one place on the production line and check for visual defects. This doesn’t do much to ensure the birds are safe to eat, since common poultry pathogens like salmonella and campylobacter are invisible. The new rules would better train inspectors to find hazards in the plant and would also require the companies to do more testing for pathogens.

USDA originally proposed the rule in January 2012, saying the reduction in inspectors would save companies and taxpayers money while also decreasing pathogens in the food supply. Consumer groups have said an overhaul is necessary but criticized that proposal, saying it would shift too much of the inspection burden to the industry.

The final rule abandons a controversial part of the original proposal that would have allowed companies to increase the speeds of processing lines in the plants. USDA said that increasing line speeds wouldn’t affect food safety, but consumer groups argued it could make it harder to detect obvious contamination and harm worker safety.

Salmonella and campylobacter are commonly found in poultry and the two top foodborne pathogens that make people sick in the United States. The federal Centers for Disease Control and Prevention estimates that salmonella causes around 1.2 million illnesses in the United States every year, including 450 deaths.

There have been several large outbreaks of salmonella in poultry in recent years. In July, California-based Foster Farms issued a recall after salmonella illnesses had been linked to their products for more than a year. That chicken has been linked to 621 illnesses in 29 states and Puerto Rico so far.

In 2011, an outbreak of salmonella linked to ground turkey products sickened 136 people and killed one, prompting a recall 36 million pounds of meat.

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WHO launches $100 million response effort as Ebola virus deaths top 700

A colorized, magnified electron microscope image of the Ebola virus growing out of an  infected VERO 46 cell. Image by

A colorized, magnified electron microscope image of the Ebola virus growing out of an infected VERO 46 cell. Image by NIAID

The World Health Organization announced a $100 million response plan Thursday to control the Ebola outbreak in West Africa, which is now responsible for more 700 deaths.

“The scale of the Ebola outbreak, and the persistent threat it poses, requires WHO and Guinea, Liberia and Sierra Leone to take the response to a new level, and this will require increased resources, in-country medical expertise, regional preparedness and coordination,” WHO Director Margaret Chen said in a statement.

“Several hundred more personnel” are needed, WHO said, to help alleviate treatment facilities stretched thin; requiring more clinical doctors, nurses, epidemiologists among other experts to help prevent the virus from spreading to neighboring countries.

Out of the 1,323 people infected, Ebola has killed 729 people in West Africa since the virus was first detected in March, WHO said. Sierra Leone declared a state of emergency Thursday, with President Ernest Bai Koroma ordering troops to quarantine sick patients.

On Wednesday, the U.S. Peace Corps began evacuating 340 volunteers from Liberia, Sierra Leone and Guinea after two of its volunteers came into contact with a person who later died of the virus.

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Happy 49th birthday Medicare

President Lyndon B. Johnson signing the Medicare Bill at the Harry S. Truman Library in Independence, Missouri. Former
         President Harry S. Truman is seated at the table with President Johnson. In the background from right to left: Senator Edward
         V. Long, an unidentified man, Lady Bird Johnson, Senator Mike Mansfield, Vice President Hubert Humphrey, and Bess Truman.
         Archive photo from the White House Press Office

President Lyndon B. Johnson signing the Medicare Bill at the Harry S. Truman Library in Independence, Missouri. Former President Harry S. Truman is seated at the table with President Johnson. Lady Bird Johnson stands behind the president. Archive photo from the White House Press Office

Forty-nine years ago, President Lyndon B. Johnson found himself in Independence, Missouri. Although he was surrounded by a gaggle of politicians, distinguished guests and Secret Service agents, the president was armed only with a fountain pen, a bottle of ink and a sheath of papers. Seated directly beside him, so as to accommodate the newspaper photographers and the television cameras, was Independence’s favorite son, the 33rd president of the United States, Harry S. Truman.

LBJ had traveled to the “Show-Me-State” to sign the Medicare Act of 1965 into law and to praise the 81-year-old Truman who, as Johnson drawled in his thick Texas accent, was “the real daddy of Medicare.”

Designed to provide health insurance for Americans aged 65 and older as well as younger citizens with specific medical conditions or disabilities, Medicare was originally divided into two categories prosaically named “Part A” and “Part B.”

Part A covered hospitalization with payroll taxes and Part B was an optional health insurance program requiring a monthly premium to cover specific outpatient services, medical tests and equipment, among other things. Back in 1965, the payroll deduction for Part A was about $40 per year and Part B cost only $3 a month!

U.S. Rep. John Dingell (D-MI) participated in a rally to mark the 46th anniversary of the passage of Medicare at the
         U.S. Capitol on July 27, 2011. The longest currently-serving member of Congress, Dingell wielded the gavel during that historic
         session of the House of Representatives in 1965. Photo by Chip Somodevilla/Getty Images

U.S. Rep. John Dingell (D-MI) participated in a rally to mark the 46th anniversary of the passage of Medicare at the U.S. Capitol on July 27, 2011. The longest currently-serving member of Congress, Dingell wielded the gavel during that historic session of the House of Representatives in 1965. Photo by Chip Somodevilla/Getty Images

President Johnson was hardly stretching the truth by honoring President Truman at the signing ceremony. During his administration, President Truman called for the institution of a federally funded health insurance program in 1945 and again in 1947 and 1949. Each presidential plea, however, was thwarted or ignored by the U.S. Congress, aided and abetted by powerful medical lobbies such as the American Medical Association and the American Hospital Association, which denigrated such efforts as a descent into “socialized medicine.” Harry Truman’s devotion to this cause was, in a sense, a means of honoring his former boss, Franklin D. Roosevelt who, for political reasons, was forced to remove an extensive health benefit plan from what became the Social Security Act of 1935. Parenthetically, another Roosevelt — Theodore Roosevelt — included a government-backed health plan on the platform of his failed presidential run in 1912 on the Progressive (“Bull Moose”) ticket.

There was some movement towards developing a national health care program during the Eisenhower years and even more so during John F. Kennedy’s far too brief presidency. But it was the powerful and politically savvy LBJ and the Democrats’ landslide victory in 1964 giving them control of both houses of the U.S. Congress that pushed Medicare across the federal finish line.

Today, Medicare is much more complicated and expensive as it funds a medical-industrial complex featuring a great many medical miracles that could only be imagined in 1965 as well as a great deal of spending that requires scrutiny, better evidence of efficacy and, ultimately, reduction. Part C (or Medicare Advantage) was instituted during the Clinton administration in 1997 to allow beneficiaries to choose a health maintenance program (HMO) instead of traditional fee for service. In 2003, George W. Bush signed Medicare Part D into law, which asks beneficiaries to pay an additional premium in order to receive prescription drug benefits. The passage of the Patient Protection and Affordable Care Act of 2010, during the Obama administration, allows for Medicare beneficiaries to receive a wide menu of preventive health care services and health screens and seeks to reduce the out-of-pocket expenses of Part D beneficiaries.

Today, more than 49 million Americans enjoy the benefits of Medicare; by 2030, experts estimate that number will balloon to 70 million. Health economists project a cost of more than $1 trillion a year to fund Medicare by 2022, thanks to the increase in the average American’s lifespan, the ever-rising costs of medical care and new medical technologies, and the aging of the Baby Boom generation. And while these rising costs are cause for concern for those who worry about the health of our nation’s future economy, polling data consistently note that Medicare remains one of the most popular federal government programs. For example, a tracking poll conducted by the Henry J. Kaiser Foundation in February of 2012 reported that 70 percent of Americans believed Medicare “should continue as it is today with the government guaranteeing seniors health benefits and making sure that everyone gets the same defined set of benefits.”

Back in July of 1965, President Johnson predicted that Medicare would be a vital protection for elderly Americans from the “hopeless despair” of not being able to afford health care. So in a very real sense, Harry Truman had a far more compelling reason beyond the merely political or presidential when he accepted Lyndon Johnson’s invitation to sit beside him 49 years ago: the first Medicare card issued was presented to “Give ‘Em Hell Harry,” making Truman the nation’s first Medicare beneficiary, and the second Medicare card was presented to his loving wife Bess.

         Howard Markel

Dr. Howard Markel

Dr. Howard Markel writes a monthly column for the PBS NewsHour, highlighting the anniversary of a momentous event that continues to shape modern medicine. He is the director of the Center for the History of Medicineand the George E. Wantz Distinguished Professor of the History of Medicine at the University of Michigan.

He is the author or editor of 10 books, including “Quarantine! East European Jewish Immigrants and the New York City Epidemics of 1892,” “When Germs Travel: Six Major Epidemics That Have Invaded America Since 1900 and the Fears They Have Unleashed” and “An Anatomy of Addiction: Sigmund Freud, William Halsted, and the Miracle Drug Cocaine.”

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$1,000 Sovaldi now hepatitis treatment of choice

WASHINGTON — The price is sky-high, but so is demand. A new $1,000-per-pill drug has become the treatment of choice for Americans with hepatitis C, a liver-wasting disease that affects more than 3 million.

Even with insurers reluctant to pay, Sovaldi prescriptions have eclipsed those for all other hepatitis C pills combined in a matter of months, new data from IMS Health indicate. The promise of a real cure, with fewer nasty side effects, has prompted thousands to get treated.

But clinical and commercial successes are also triggering scrutiny for the drug’s manufacturer, California-based Gilead Sciences Inc., which just reported second-quarter profits of $3.66 billion, or a net margin of 56 percent.

Two senators have unearthed documents that suggest the initial developers of Sovaldi considered pricing it at less than half as much. The health insurance industry is publicly scolding Gilead, and state Medicaid programs are pushing back.

The repercussions go beyond one drug and one disease. A number of promising cancer medications near approval could be drawn into the storm over costs.

“You can’t put too fine a point on the sort of moral dilemma that we have here,” said Michael Kleinrock, director of the IMS Institute, which studies prescription drug trends. “This is something that the research-based pharmaceutical industry reaches for all the time: a cure. But when they achieve one, can we afford it?”

New data from IMS Health, the parent company of the institute, illustrate Sovaldi’s impact since its December debut:

—The number of pharmacy prescriptions for all hepatitis C pills has soared, highlighting demand. In May, more than 48,000 prescriptions were filled for four such medications, with Sovaldi accounting for three-fourths of the total. Compare that to prescriptions for May 2013, before Sovaldi became available, which totaled about 6,200.

—In Sovaldi’s first 30 weeks on the market, 62,000 new patients tried the drug, nearly three times as many as had tried an earlier medication that showed promise. That makes Sovaldi the most successful launch for any hepatitis C drug. Gilead expects to have a successor soon that will make treatment easier to tolerate, because it won’t require patients to take companion medications with strong side effects.

—The weekly number of new patients going on Sovaldi has been gradually slowing, from more than 2,900 in February and March to about 1,600-1,800 in late June and early July. Kleinrock said that could indicate that pent-up initial demand is giving way to steadier levels, or it could mean that insurers are limiting access to protect their budgets.

Hepatitis C surpassed AIDS as a cause of death in the U.S. in 2007, claiming an estimated 15,000 lives that year. The illness is complex, with distinct virus types requiring different treatments. While it advances gradually, it can ultimately destroy the liver, and transplants average $577,000.

The cost of a 12-week regimen of Sovaldi along with two companion medications that patients must also take is around $100,000. Competing regimens with other drugs cost in the mid- to high five figures, and some are far less effective and harder to tolerate.

Hepatitis C is a public health concern, since the disease can be transmitted by contact with infected blood, by drug users sharing needles, and sometimes through sexual activity. Many people are unaware that they carry the virus. Health officials advise all baby boomers to get tested.

At Mount Sinai Health System’s liver clinic in New York City, patient advocate Angela Woody said Sovaldi has brightened the outlook for patients. But it takes effort to get insurance approval.

“We have had to jump through a great deal of hoops,” Woody said. “We have two patients who applied in January and did not actually go on the medication until April.”

Sovaldi’s implications for Medicare and Medicaid costs have prompted rare bipartisan cooperation in Congress on a health care issue.

Sens. Ron Wyden, D-Ore., and Charles Grassley, R-Iowa, are asking Gilead for a detailed explanation of its pricing. Wyden chairs the Finance Committee, which oversees health insurance programs, and Grassley is a veteran of drug safety investigations.

The senators say their staffs found public documents that call into question Gilead’s $84,000 price for a full course of Sovaldi treatment, for the most common type of hepatitis C.

In 2011 filings with federal regulators, the company that originally developed Sovaldi estimated a treatment price of $36,000. That figure was developed during Gilead’s negotiations to buy the original developer, Pharmasset.

Gilead spokeswoman Amy Flood said the company has no comment.

But Gilead vice president Gregg Alton recently addressed the issue at a public forum sponsored by the American Enterprise Institute.

“To suggest that a cure for a disease like hepatitis C should be priced at $36,000 … would put a huge disincentive on investing in cures for our industry,” he said.

Gilead took on most of the challenge — and risk — of getting government approval for Sovaldi, Alton added.

He suggested another standard for measuring the value of Sovaldi, something called “cost-per-cure,” that makes Sovaldi look like a bargain.

The older hepatitis C treatments take longer and are less effective, and Alton estimated their cost-per-cure at somewhere between $150,000 and $200,000. Included are companion drugs that patients must also take.

Sovaldi gets that down to $115,000 per cure, said Alton. “So it is actually, on a per-cure basis, much less costly.”

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