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"content": "\u003cp>Three women climb the stairs of a beautiful Victorian in San Francisco. They hold nothing in their hands, but they bring a precious gift. These women are members of the Threshold Choir, and the home they are visiting is the Zen Hospice Project. They sing to people at the last threshold of life, and today, when they reach the second floor, they find Luca Sager, a 38-year-old chef with terminal brain cancer.\u003c/p>\n\u003cp>Sager’s hands, tattooed with a salt and pepper shakers, rest on the top of his covers as he listens as the women sing, a cappella:\u003c/p>\n\u003cp>\u003cem>You are not alone\u003cbr>\nI am here now\u003cbr>\nWe are not alone\u003cbr>\nWe are here together\u003c/em>\u003c/p>\n\u003cp>Sager speaks slowly through medication and pain. He says peace fills him when the women sing. “It feels like a good time for me to gather my feelings about gratitude and being calm and appreciation. I just smile a lot.”\u003c/p>\n\u003cp>Kate Munger founded the Threshold Choir in Marin County and the East Bay 16 years ago. She says it grew out of her own experience of sitting with a friend of who was dying of AIDS back in the '90s.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“It was very distressing to see him comatose and agitated,” Munger recalls. “I did what I did at the time when I was nervous or afraid, and I started singing -- instinctively.”\u003c/p>\n\u003cp>She says her friend “calmed, settled and got positively serene,” and her own feelings mirrored those of her dying friend. “I felt like I had discovered, or rediscovered, something -- an ancient practice that tribal humans do for one another when someone’s struggling.”\u003c/p>\n\u003cfigure id=\"attachment_196124\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"wp-image-196124 size-full\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/06/Threshold-Choir_Web-2.jpg\" alt=\"Threshold Choir_Web 2\" width=\"1920\" height=\"1080\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/06/Threshold-Choir_Web-2.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/Threshold-Choir_Web-2-400x225.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/Threshold-Choir_Web-2-800x450.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/Threshold-Choir_Web-2-768x432.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/Threshold-Choir_Web-2-1440x810.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/Threshold-Choir_Web-2-1180x664.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/Threshold-Choir_Web-2-960x540.jpg 960w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Luca Sager, 38, who is terminally ill with brain cancer, listens to the Threshold Choir. They are \"an act of care,\" he says. \u003ccite>(Scott Stoneback for KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The \u003ca href=\"https://thresholdchoir.org\" target=\"_blank\">Threshold Choir\u003c/a> has spread since then -- across North America and to other countries. It is devoted to lifting others up, to creating a place for reflection, especially for people who may be outside the traditional reaches of religion. The singers speak of the healing quality of music and the power of the human voice to soothe and to make beautiful the process of dying, which is so often accompanied by great fear.\u003c/p>\n\u003cp>Choir singer Katharine Rose Kirner says she knows what it is like to lie powerless in bed facing the fear of death. In 2001, as the country was reeling from the 9/11 attacks, Kirner faced a different kind of threat, a brain tumor the size of a grapefruit. She says she was gripped by fear of death and feelings she had not done what she needed to do in her life. She vowed to do something “important” if she recuperated.\u003c/p>\n\u003cp>When she did eventually heal, she learned of the Threshold Choir and became a devoted member singing at least once a week. She says being part of the choir has given her a chance to see how gentle dying can be.\u003c/p>\n\u003cp>“Most of us think of death as an event, but it’s a process,\" she says. \"That gave me great comfort.” Watching the process has moved her to think of what she wants at her own death, something she says she would not have contemplated without being in the choir. \"I would have sat in the fear.”\u003c/p>\n\u003cfigure id=\"attachment_196122\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"wp-image-196122 size-full\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/06/Threshold-Choir__Web-3.jpg\" alt=\"Threshold Choir__Web 3\" width=\"1920\" height=\"1080\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/06/Threshold-Choir__Web-3.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/Threshold-Choir__Web-3-400x225.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/Threshold-Choir__Web-3-800x450.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/Threshold-Choir__Web-3-768x432.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/Threshold-Choir__Web-3-1440x810.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/Threshold-Choir__Web-3-1180x664.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/Threshold-Choir__Web-3-960x540.jpg 960w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Kate Munger, founder of the Threshold Choir. \u003ccite>(Scott Stoneback for KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Singer Peggy Cadbury, a retired nurse, saw a fair amount of death while working in hospital settings. But as a member of the choir, she has the chance to tend to the dying with a different intention. \u003c/p>\n\u003cp>“When you're nursing at the bedside of somebody who is dying, you're constantly concerned about their physical wellbeing, their pain level, ” Cadbury says. But as a member of the choir, “I can just be there to hold space for that person in the room and create an environment of comfort and caring.”\u003c/p>\n\u003cp>Munger says the harmonies are particularly powerful in creating a sense of calm and wellbeing. “It’s a visceral experience. It’s not just the ears; it's full body absorption of vibration.”\u003c/p>\n\u003cp>Cadbury says singing quietly and softly the simple songs written by choir members is much like singing a lullaby to a child. \u003c/p>\n\u003cp>“It is like a gentle caress, and it feels right,” she says.\u003c/p>\n\u003cp>Sager, the patient, says the singing not only helps bring him emotional calm, but it also reduces the physical pain he has in his head around the tumor.\u003c/p>\n\u003cp>Research suggests that listening to live music can help reduce pain in palliative care patients. A \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/23017609\" target=\"_blank\">2012 study\u003c/a> found that patients found that patients who had the harp played to them for 20 minutes -- along with breathing exercises and visualization -- reported a significant decrease in pain compared to a control group.\u003c/p>\n\u003cp>Registered nurse and certified music therapist Kathy Jo Gutgsell at University Hospitals in Cleveland was lead author of the study. She believes music “may awaken the body’s own endorphins\" -- those much-chased-after chemicals that make us feel better about the world.\u003c/p>\n\u003cp>The human brain \"doesn’t multitask very well,\" she explains. \"When we are paying attention to the music, we can't pay attention to the pain.” \u003c/p>\n\u003cp>Gutgsell says music is tied to memories and can connect us to times of great joy and sadness. “I think humans are hardwired for music. Some people think we were singing before we were speaking back at the beginning of humanity.”\u003c/p>\n\u003cp>The Threshold Choir singers say they, too, are helped by the act of singing together and for a person in need. “You see them calm, and then you calm, and it’s a reciprocal thing,” Cadbury says.\u003c/p>\n\u003cp>Kirner says singing in the choir is one of the best things in her life. “I get a sense of purpose.” Choir singers may benefit in other ways. A growing body of research finds that people who take part in choral singing have a better sense of wellbeing than those who don’t sing.\u003c/p>\n\u003cfigure id=\"attachment_196125\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"wp-image-196125 size-full\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/06/Threshold-Choir_Web-1-1.jpg\" alt=\"Threshold Choir_Web 1-1\" width=\"1920\" height=\"1080\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/06/Threshold-Choir_Web-1-1.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/Threshold-Choir_Web-1-1-400x225.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/Threshold-Choir_Web-1-1-800x450.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/Threshold-Choir_Web-1-1-768x432.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/Threshold-Choir_Web-1-1-1440x810.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/Threshold-Choir_Web-1-1-1180x664.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/Threshold-Choir_Web-1-1-960x540.jpg 960w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">From left, Peggy Cadbury, Katharine Rose Kirner and Karen Mooney, members of the Threshold Choir. \u003ccite>(Scott Stoneback for KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The research suggests that singing itself can raise levels of oxytocin, the hormone associated with trust and bonding. So people who sing in chorus may feel a strong bond with those they sing with together. Right now in San Francisco, a\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/08/20/in-san-francisco-seniors-are-singing-for-science/\" target=\"_blank\"> five-year study is underway\u003c/a> looking at both the possible physical and emotional benefits of choral singing for seniors.\u003c/p>\n\u003cp>Munger says songs are “ethereal, evanescent, and mysterious” and she believes they can serve as a bridge “from the purely physical, temporal, body experience ... to what lies beyond.”\u003c/p>\n\u003cp>As for Cadbury, she says watching others die has helped her frame her daily life and what she hopes for her death. “Singing at the bedside of people who are dying has helped me appreciate being alive, has made more feel more alive and more into being the moment and enjoy life. I hope that when I am on the threshold someone will come and sing to me these beautiful, peaceful songs of comfort.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>Sager, the patient, says he believes as human beings our purpose in life is to be givers however we can. He says he did that as a chef, serving homemade nourishing food. He says he is proud of the Threshold Choir for offering their songs as a gift, “to receive that gift is an act of love and support, an act of care, which is what I need most in my life right now.\"\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Three women climb the stairs of a beautiful Victorian in San Francisco. They hold nothing in their hands, but they bring a precious gift. These women are members of the Threshold Choir, and the home they are visiting is the Zen Hospice Project. They sing to people at the last threshold of life, and today, when they reach the second floor, they find Luca Sager, a 38-year-old chef with terminal brain cancer.\u003c/p>\n\u003cp>Sager’s hands, tattooed with a salt and pepper shakers, rest on the top of his covers as he listens as the women sing, a cappella:\u003c/p>\n\u003cp>\u003cem>You are not alone\u003cbr>\nI am here now\u003cbr>\nWe are not alone\u003cbr>\nWe are here together\u003c/em>\u003c/p>\n\u003cp>Sager speaks slowly through medication and pain. He says peace fills him when the women sing. “It feels like a good time for me to gather my feelings about gratitude and being calm and appreciation. I just smile a lot.”\u003c/p>\n\u003cp>Kate Munger founded the Threshold Choir in Marin County and the East Bay 16 years ago. She says it grew out of her own experience of sitting with a friend of who was dying of AIDS back in the '90s.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“It was very distressing to see him comatose and agitated,” Munger recalls. “I did what I did at the time when I was nervous or afraid, and I started singing -- instinctively.”\u003c/p>\n\u003cp>She says her friend “calmed, settled and got positively serene,” and her own feelings mirrored those of her dying friend. “I felt like I had discovered, or rediscovered, something -- an ancient practice that tribal humans do for one another when someone’s struggling.”\u003c/p>\n\u003cfigure id=\"attachment_196124\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"wp-image-196124 size-full\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/06/Threshold-Choir_Web-2.jpg\" alt=\"Threshold Choir_Web 2\" width=\"1920\" height=\"1080\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/06/Threshold-Choir_Web-2.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/Threshold-Choir_Web-2-400x225.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/Threshold-Choir_Web-2-800x450.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/Threshold-Choir_Web-2-768x432.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/Threshold-Choir_Web-2-1440x810.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/Threshold-Choir_Web-2-1180x664.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/Threshold-Choir_Web-2-960x540.jpg 960w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Luca Sager, 38, who is terminally ill with brain cancer, listens to the Threshold Choir. They are \"an act of care,\" he says. \u003ccite>(Scott Stoneback for KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The \u003ca href=\"https://thresholdchoir.org\" target=\"_blank\">Threshold Choir\u003c/a> has spread since then -- across North America and to other countries. It is devoted to lifting others up, to creating a place for reflection, especially for people who may be outside the traditional reaches of religion. The singers speak of the healing quality of music and the power of the human voice to soothe and to make beautiful the process of dying, which is so often accompanied by great fear.\u003c/p>\n\u003cp>Choir singer Katharine Rose Kirner says she knows what it is like to lie powerless in bed facing the fear of death. In 2001, as the country was reeling from the 9/11 attacks, Kirner faced a different kind of threat, a brain tumor the size of a grapefruit. She says she was gripped by fear of death and feelings she had not done what she needed to do in her life. She vowed to do something “important” if she recuperated.\u003c/p>\n\u003cp>When she did eventually heal, she learned of the Threshold Choir and became a devoted member singing at least once a week. She says being part of the choir has given her a chance to see how gentle dying can be.\u003c/p>\n\u003cp>“Most of us think of death as an event, but it’s a process,\" she says. \"That gave me great comfort.” Watching the process has moved her to think of what she wants at her own death, something she says she would not have contemplated without being in the choir. \"I would have sat in the fear.”\u003c/p>\n\u003cfigure id=\"attachment_196122\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"wp-image-196122 size-full\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/06/Threshold-Choir__Web-3.jpg\" alt=\"Threshold Choir__Web 3\" width=\"1920\" height=\"1080\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/06/Threshold-Choir__Web-3.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/Threshold-Choir__Web-3-400x225.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/Threshold-Choir__Web-3-800x450.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/Threshold-Choir__Web-3-768x432.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/Threshold-Choir__Web-3-1440x810.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/Threshold-Choir__Web-3-1180x664.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/Threshold-Choir__Web-3-960x540.jpg 960w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Kate Munger, founder of the Threshold Choir. \u003ccite>(Scott Stoneback for KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Singer Peggy Cadbury, a retired nurse, saw a fair amount of death while working in hospital settings. But as a member of the choir, she has the chance to tend to the dying with a different intention. \u003c/p>\n\u003cp>“When you're nursing at the bedside of somebody who is dying, you're constantly concerned about their physical wellbeing, their pain level, ” Cadbury says. But as a member of the choir, “I can just be there to hold space for that person in the room and create an environment of comfort and caring.”\u003c/p>\n\u003cp>Munger says the harmonies are particularly powerful in creating a sense of calm and wellbeing. “It’s a visceral experience. It’s not just the ears; it's full body absorption of vibration.”\u003c/p>\n\u003cp>Cadbury says singing quietly and softly the simple songs written by choir members is much like singing a lullaby to a child. \u003c/p>\n\u003cp>“It is like a gentle caress, and it feels right,” she says.\u003c/p>\n\u003cp>Sager, the patient, says the singing not only helps bring him emotional calm, but it also reduces the physical pain he has in his head around the tumor.\u003c/p>\n\u003cp>Research suggests that listening to live music can help reduce pain in palliative care patients. A \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/23017609\" target=\"_blank\">2012 study\u003c/a> found that patients found that patients who had the harp played to them for 20 minutes -- along with breathing exercises and visualization -- reported a significant decrease in pain compared to a control group.\u003c/p>\n\u003cp>Registered nurse and certified music therapist Kathy Jo Gutgsell at University Hospitals in Cleveland was lead author of the study. She believes music “may awaken the body’s own endorphins\" -- those much-chased-after chemicals that make us feel better about the world.\u003c/p>\n\u003cp>The human brain \"doesn’t multitask very well,\" she explains. \"When we are paying attention to the music, we can't pay attention to the pain.” \u003c/p>\n\u003cp>Gutgsell says music is tied to memories and can connect us to times of great joy and sadness. “I think humans are hardwired for music. Some people think we were singing before we were speaking back at the beginning of humanity.”\u003c/p>\n\u003cp>The Threshold Choir singers say they, too, are helped by the act of singing together and for a person in need. “You see them calm, and then you calm, and it’s a reciprocal thing,” Cadbury says.\u003c/p>\n\u003cp>Kirner says singing in the choir is one of the best things in her life. “I get a sense of purpose.” Choir singers may benefit in other ways. A growing body of research finds that people who take part in choral singing have a better sense of wellbeing than those who don’t sing.\u003c/p>\n\u003cfigure id=\"attachment_196125\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"wp-image-196125 size-full\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/06/Threshold-Choir_Web-1-1.jpg\" alt=\"Threshold Choir_Web 1-1\" width=\"1920\" height=\"1080\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/06/Threshold-Choir_Web-1-1.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/Threshold-Choir_Web-1-1-400x225.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/Threshold-Choir_Web-1-1-800x450.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/Threshold-Choir_Web-1-1-768x432.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/Threshold-Choir_Web-1-1-1440x810.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/Threshold-Choir_Web-1-1-1180x664.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/06/Threshold-Choir_Web-1-1-960x540.jpg 960w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">From left, Peggy Cadbury, Katharine Rose Kirner and Karen Mooney, members of the Threshold Choir. \u003ccite>(Scott Stoneback for KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The research suggests that singing itself can raise levels of oxytocin, the hormone associated with trust and bonding. So people who sing in chorus may feel a strong bond with those they sing with together. Right now in San Francisco, a\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/08/20/in-san-francisco-seniors-are-singing-for-science/\" target=\"_blank\"> five-year study is underway\u003c/a> looking at both the possible physical and emotional benefits of choral singing for seniors.\u003c/p>\n\u003cp>Munger says songs are “ethereal, evanescent, and mysterious” and she believes they can serve as a bridge “from the purely physical, temporal, body experience ... to what lies beyond.”\u003c/p>\n\u003cp>As for Cadbury, she says watching others die has helped her frame her daily life and what she hopes for her death. “Singing at the bedside of people who are dying has helped me appreciate being alive, has made more feel more alive and more into being the moment and enjoy life. I hope that when I am on the threshold someone will come and sing to me these beautiful, peaceful songs of comfort.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Sager, the patient, says he believes as human beings our purpose in life is to be givers however we can. He says he did that as a chef, serving homemade nourishing food. He says he is proud of the Threshold Choir for offering their songs as a gift, “to receive that gift is an act of love and support, an act of care, which is what I need most in my life right now.\"\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>\u003cem>Our friend and colleague Peggy Girshman, a longtime NPR editor and co-founder of Kaiser Health News, \u003ca href=\"http://www.npr.org/sections/health-shots/2016/03/15/470515618/peggy-girshman-npr-veteran-and-journalism-pioneer-dies-at-61\">died in March\u003c/a>. But her passion for health journalism survives her. She made sure of that.\u003c/em>\u003c/p>\n\u003cp>\u003cem>Beyond the many journalists whose careers she launched and nurtured, Girshman wrote her own eulogy, complete with some hard-earned advice on matters of personal health and how to cover health and medicine.\u003c/em>\u003c/p>\n\u003cp>\u003cem>NPR correspondent Rob Stein read it Saturday at a memorial service attended by more than 150 people, including a who's who of health and science journalists, at Brookside Gardens in Silver Spring, Md. \u003c/em>\u003c/p>\n\u003cp>\u003cem>Before and after the speeches, there were cookies — lots of cookies — baked by fellow members of her \u003c/em>\u003ca href=\"http://www.npr.org/templates/story/story.php?storyId=5040660\">Christmas cookie club\u003c/a>\u003cem>.\u003c/em>\u003c/p>\n\u003cp>\u003cem>Mitch Berger, Girshman's husband, gave us permission to publish her \"auto-eulogy,\" as she called it, which has been edited lightly for clarity and length.\u003c/em>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>There's a common saying that, on their deathbed, no one says, \"I wish I had spent more time at work.\" I'm an exception to that. A central tragedy in my life is that I couldn't work longer, if only to convince someone I was right about something.\u003c/p>\n\u003cp>I also wish I had divided my life to spend more time with my family, especially Beth, Helen, Irv, Natalie, Lianna and Annie, whom I order around and love like a niece. Well, maybe not much more time with my parents. And my friends, including the myriad of best friends, you all know who you are. And you've all been the best of friends to me, especially in the last few years.\u003c/p>\n\u003cp>OK, now that that's over with, I'm taking a few minutes when you have to listen to me. I'm only sorry I couldn't be there for your rapt attention and adherence to my advice. Here we go.\u003c/p>\n\u003cp>For folks with Stage 0 or less cancers, especially DCIS [or \u003ca href=\"http://www.cancer.gov/types/breast/hp/breast-treatment-pdq#section/_1569\" target=\"_blank\">ductal carcinoma in situ\u003c/a>], or prostate, watch and wait. I understand. I was one of those people who says, \"Get it out of me.\" Please resist that temptation.\u003c/p>\n\u003cp>At least half of these don't go on to become invasive cancers. Why should you do all kinds of bad things to your body unnecessarily? And, by the way, it costs waaaay too much.\u003c/p>\n\u003cp>If you are one of those people who can't resist the call of the surgeon, do not get a lumpectomy, aka \"breast conserving\" surgery. I can tell you that from personal and observational experience, it doesn't conserve the breast.\u003c/p>\n\u003cp>After the surgery, which often has to be done twice to get \u003ca href=\"http://www.breastcancer.org/questions/margins\" target=\"_blank\">clean margins\u003c/a>, there is the whole nightmare of radiation, which shrinks tissue and makes for painful inner scarring. Biggest mistake of my life was to do that. And there are a lot of mistakes to choose from.\u003c/p>\n\u003cp>If I only convince one of you to at least convince one other person, I've accomplished something. I know, I've done so much good work blah blah blah. But even one person not having surgery would be the crowning achievement of my life. I am not kidding.\u003c/p>\n\u003cp>Setting aside my own body (oh yeah, it really is set aside now), let's talk a little about evidence.\u003c/p>\n\u003cp>If you get nothing else from this memorial service, please think about evidence, truth as best it can be determined. Anecdotal evidence is only meaningful if it involves me, Peggy Girshman. Otherwise, trust the scientific method, where similar groups are compared and with large sample sizes, if possible. Especially when it comes to what you put in your body for medicinal reasons.\u003c/p>\n\u003cp>OK, I know there's a lot of eye-rolling out there right now. But why would you take anything that hasn't been proved to work? Belief is powerful. The placebo effect exists.\u003c/p>\n\u003cp>While we're at it, please stop with the lifestyle advice.\u003c/p>\n\u003cp>Don't knock people about what they're eating, how much or when. Yes, if you eat a lot of fresh fruits and vegetables and cut down on fat, you have lowered the chances you'll get cancer or heart disease.\u003c/p>\n\u003cp>But that is just one of so many factors that to judge people about their quantity of fruits and vegetables is simply unfair.\u003c/p>\n\u003cp>Don't ask, if someone has lung cancer, if they smoked. Try really, really hard not to even think it in your head. It shows, believe me. It adds pain to an already painful, scary time.\u003c/p>\n\u003cp>Try to convince yourself that people get sick for so many reasons that we don't know about. One little mutation in one little cell.\u003c/p>\n\u003cp>Two people eating the same amount of sugar or carbs every day for years: one might develop diabetes and the other doesn't. Please don't examine what one person is eating to cast disapproval in your head while the other one gets a pass.\u003c/p>\n\u003cp>When 10 studies can't find any connection between X and Y, please believe it. Don't think about your friend or even yourself where it seemed to go the other way. Of course it sometimes goes the other way, but why would you want to live your life based on your friend, who is lovely but might have another claim next week.\u003c/p>\n\u003cp>Don't say, \"I don't know how you can find anything in your office/house/car.\" In other words, wow, you're a slob. Yes, I'm messy, what do you care? Neat, vegetable-eating people are not morally superior to anyone else.\u003c/p>\n\u003cp>Be nice to people. Sounds really corny and pedestrian, but it's how I managed to succeed at work, no s***.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Always make sure there are cookies or something tasty to eat at any in-person meeting. As there should be, right now, in the back. You'll get to them very soon, I promise.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Peggy+Girshman+Gets+The+Last+Word+On+Health+Journalism&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cem>Our friend and colleague Peggy Girshman, a longtime NPR editor and co-founder of Kaiser Health News, \u003ca href=\"http://www.npr.org/sections/health-shots/2016/03/15/470515618/peggy-girshman-npr-veteran-and-journalism-pioneer-dies-at-61\">died in March\u003c/a>. But her passion for health journalism survives her. She made sure of that.\u003c/em>\u003c/p>\n\u003cp>\u003cem>Beyond the many journalists whose careers she launched and nurtured, Girshman wrote her own eulogy, complete with some hard-earned advice on matters of personal health and how to cover health and medicine.\u003c/em>\u003c/p>\n\u003cp>\u003cem>NPR correspondent Rob Stein read it Saturday at a memorial service attended by more than 150 people, including a who's who of health and science journalists, at Brookside Gardens in Silver Spring, Md. \u003c/em>\u003c/p>\n\u003cp>\u003cem>Before and after the speeches, there were cookies — lots of cookies — baked by fellow members of her \u003c/em>\u003ca href=\"http://www.npr.org/templates/story/story.php?storyId=5040660\">Christmas cookie club\u003c/a>\u003cem>.\u003c/em>\u003c/p>\n\u003cp>\u003cem>Mitch Berger, Girshman's husband, gave us permission to publish her \"auto-eulogy,\" as she called it, which has been edited lightly for clarity and length.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>There's a common saying that, on their deathbed, no one says, \"I wish I had spent more time at work.\" I'm an exception to that. A central tragedy in my life is that I couldn't work longer, if only to convince someone I was right about something.\u003c/p>\n\u003cp>I also wish I had divided my life to spend more time with my family, especially Beth, Helen, Irv, Natalie, Lianna and Annie, whom I order around and love like a niece. Well, maybe not much more time with my parents. And my friends, including the myriad of best friends, you all know who you are. And you've all been the best of friends to me, especially in the last few years.\u003c/p>\n\u003cp>OK, now that that's over with, I'm taking a few minutes when you have to listen to me. I'm only sorry I couldn't be there for your rapt attention and adherence to my advice. Here we go.\u003c/p>\n\u003cp>For folks with Stage 0 or less cancers, especially DCIS [or \u003ca href=\"http://www.cancer.gov/types/breast/hp/breast-treatment-pdq#section/_1569\" target=\"_blank\">ductal carcinoma in situ\u003c/a>], or prostate, watch and wait. I understand. I was one of those people who says, \"Get it out of me.\" Please resist that temptation.\u003c/p>\n\u003cp>At least half of these don't go on to become invasive cancers. Why should you do all kinds of bad things to your body unnecessarily? And, by the way, it costs waaaay too much.\u003c/p>\n\u003cp>If you are one of those people who can't resist the call of the surgeon, do not get a lumpectomy, aka \"breast conserving\" surgery. I can tell you that from personal and observational experience, it doesn't conserve the breast.\u003c/p>\n\u003cp>After the surgery, which often has to be done twice to get \u003ca href=\"http://www.breastcancer.org/questions/margins\" target=\"_blank\">clean margins\u003c/a>, there is the whole nightmare of radiation, which shrinks tissue and makes for painful inner scarring. Biggest mistake of my life was to do that. And there are a lot of mistakes to choose from.\u003c/p>\n\u003cp>If I only convince one of you to at least convince one other person, I've accomplished something. I know, I've done so much good work blah blah blah. But even one person not having surgery would be the crowning achievement of my life. I am not kidding.\u003c/p>\n\u003cp>Setting aside my own body (oh yeah, it really is set aside now), let's talk a little about evidence.\u003c/p>\n\u003cp>If you get nothing else from this memorial service, please think about evidence, truth as best it can be determined. Anecdotal evidence is only meaningful if it involves me, Peggy Girshman. Otherwise, trust the scientific method, where similar groups are compared and with large sample sizes, if possible. Especially when it comes to what you put in your body for medicinal reasons.\u003c/p>\n\u003cp>OK, I know there's a lot of eye-rolling out there right now. But why would you take anything that hasn't been proved to work? Belief is powerful. The placebo effect exists.\u003c/p>\n\u003cp>While we're at it, please stop with the lifestyle advice.\u003c/p>\n\u003cp>Don't knock people about what they're eating, how much or when. Yes, if you eat a lot of fresh fruits and vegetables and cut down on fat, you have lowered the chances you'll get cancer or heart disease.\u003c/p>\n\u003cp>But that is just one of so many factors that to judge people about their quantity of fruits and vegetables is simply unfair.\u003c/p>\n\u003cp>Don't ask, if someone has lung cancer, if they smoked. Try really, really hard not to even think it in your head. It shows, believe me. It adds pain to an already painful, scary time.\u003c/p>\n\u003cp>Try to convince yourself that people get sick for so many reasons that we don't know about. One little mutation in one little cell.\u003c/p>\n\u003cp>Two people eating the same amount of sugar or carbs every day for years: one might develop diabetes and the other doesn't. Please don't examine what one person is eating to cast disapproval in your head while the other one gets a pass.\u003c/p>\n\u003cp>When 10 studies can't find any connection between X and Y, please believe it. Don't think about your friend or even yourself where it seemed to go the other way. Of course it sometimes goes the other way, but why would you want to live your life based on your friend, who is lovely but might have another claim next week.\u003c/p>\n\u003cp>Don't say, \"I don't know how you can find anything in your office/house/car.\" In other words, wow, you're a slob. Yes, I'm messy, what do you care? Neat, vegetable-eating people are not morally superior to anyone else.\u003c/p>\n\u003cp>Be nice to people. Sounds really corny and pedestrian, but it's how I managed to succeed at work, no s***.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Always make sure there are cookies or something tasty to eat at any in-person meeting. As there should be, right now, in the back. You'll get to them very soon, I promise.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Peggy+Girshman+Gets+The+Last+Word+On+Health+Journalism&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>It's 2:00 p.m. and you have a few more hours until the end of your workday.\u003c/p>\n\u003caside class=\"pullquote alignright\">The evidence doesn’t suggest symptoms are permanent. They can be alleviated by changing workplace habits.\u003c/aside>\n\u003cp>Your eyes sting, your vision is getting blurry and your head hurts. The computer screen that you've been staring at for the past six hours seems so bright that you want to shut your eyes.\u003c/p>\n\u003cp>Sound familiar? We'd bet yes.\u003c/p>\n\u003cp>Piotr Le, a Georgetown University grad student, thinks so, too. He used to work in consulting — and that meant staring at a computer screen for 12 or more hours every workday.\u003c/p>\n\u003cp>\"Partially I left because of the physical deterioration of my body,\" Le says. \"A lot of eye rubbing. That's why my prescription got worse. I would wake up with neck pain and back pain.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Depending on whether you consult an optometrist or an ophthalmologist, you might get different answers on what ails you. Is it computer vision syndrome? Is it digital eyestrain? Is it just dry eyes and some eyestrain?\u003c/p>\n\u003cp>[contextly_sidebar id=\"QNoGq8UBrCbujTBCY73WRgfrXV78zHln\"]The most common definition is given by the American Optometric Association, which coined \u003ca href=\"http://www.aoa.org/patients-and-public/caring-for-your-vision/protecting-your-vision/computer-vision-syndrome?sso=y\">computer vision syndrome\u003c/a> and digital eyestrain as a group of vision-related problems from viewing digital screens for a long time.\u003c/p>\n\u003cp>The American Academy of Ophthalmology labels it \u003ca href=\"http://www.aao.org/eye-health/tips-prevention/computer-usage\">digital-related eyestrain\u003c/a>. The group emphasizes that extended reading and writing can also strain the eyes.\u003c/p>\n\u003cp>Neither computer vision syndrome nor digital eyestrain is an official medical condition. They are more of a collection of symptoms that sometimes include headache, neck and shoulder pain.\u003c/p>\n\u003cp>\"Classification schemes do take time to develop, and so it may not have crept into medical coding,\" says Dr. Michael X. Repka, a Johns Hopkins ophthalmologist and clinical spokesman for the American Academy of Ophthalmology.\u003c/p>\n\u003cp>Repka says in the past these symptoms would be lumped under \u003ca href=\"http://eyewiki.aao.org/Asthenopia\">asthenopia\u003c/a>, a condition that encompasses eye fatigue, ache around the eyes, blurred vision and headache. Computer vision syndrome, he says, is considered to be under asthenopia in the \u003ca href=\"http://icdlist.com/icd-10/H53.149\">ICD-10 medical coding system\u003c/a>.\u003c/p>\n\u003cp>\"Computer vision syndrome ... is not a recognized medical entity,\" says James Sheedy, a professor of optometry at Pacific University and head of the Vision Ergonomics Research Laboratory. \"A medical diagnosis is a condition where the anatomy or physiology isn't functioning properly. There are several different medical diagnoses that could be the cause of what is commonly called computer vision syndrome. There are different names put on it. Those are really names to create a black box where you put everything into ... but it's really the same thing.\"\u003c/p>\n\u003caside class=\"pullquote alignright\">Follow the 20-20-20 rule: Every 20 minutes, look at something at least 20 feet away for 20 seconds.\u003c/aside>\n\u003cp>The fact that these symptoms are common is self-evident. Optometrists and ophthalmologists agree that many patients walk into their offices with these complaints. But is there enough evidence to upgrade their diagnostic status?\u003c/p>\n\u003cp>\"I think research is coming out now that this really is a different condition,\" says Mark Rosenfield, a professor at SUNY College of Optometry. \"There is something about these screens that is different from paper and so we're trying to figure out what aspects of screens is it that is causing problems. People didn't look at paper for that length of time [that] people are looking at screens, so I think that could be a factor too — the fact that people are looking at these things for such long periods of time.\"\u003c/p>\n\u003cp>So why do our digital screens cause us so much trouble?\u003c/p>\n\u003cp>\"We're not really designed to do full-time near work; we're designed to do part-time near work, and so to the extent that we have to do so much near work our eyes are in tension virtually all the time,\" says Steve Loomis, president of the American Optometric Association. \"The average worker spends seven hours a day on some digital device. ... I'm among them and so what we know is that that means that the muscles in the eye are in a state of tension.\"\u003c/p>\n\u003cp>In a \u003ca href=\"http://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=64714113&site=ehost-live\">review of studies\u003c/a> for the journal \u003cem>Ophthalmic & Physiological Optics,\u003c/em> Rosenfield found that we have more incomplete blinks during computer operations, which reduces the volume of tears in our eyes. Too few tears causes irritation and a burning sensation in the eyes.\u003c/p>\n\u003cp>A \u003ca href=\"http://content.iospress.com/articles/work/wor2162\">more recent review\u003c/a> of the syndrome in \u003cem>IOS Press\u003c/em> lists other factors: glare from windows, overhead lights and the computer. Also, the particulars of how your computer or digital devices are arranged, including the height and viewing distance of the device from our eyes. We also tend to hold hand-held devices closer to our eyes than we should.\u003c/p>\n\u003cp>\"The eyes work best we know by looking down about 15 degrees in most desktop computer situations. This means that the top of the computer screen displays should be level with the eyes,\" Sheedy says. \"If it's higher or lower than that the person tends to tilt the head back or forward and now they have an imbalance and this creates muscular tension and it can give them a neck ache.\"\u003c/p>\n\u003cp>The evidence doesn't suggest these symptoms are permanent. They can be alleviated by changing our workplace habits. Anti-glare screen filters and eyedrops may help some. Optometrists say that some people who use reading glasses may benefit from trying glasses with a different focal length for computer work.\u003c/p>\n\u003cp>One of the most commonly cited — and cheapest — things to do is just to give your eyes a rest. Follow the 20-20-20 rule: Every 20 minutes, look at something at least 20 feet away for 20 seconds.\u003c/p>\n\u003cp>Grad student Le now stares at his computer only four to six hours a day. He says he still gets occasional neck pain from looking down at his laptop. And the white backgrounds of PDFs and Word documents still bother his eyes some. He's also trying software to make the tone of his screen warmer.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>But his go-to move is taking a break. \"I close my eyes and look at the skyline,\" he says, \"or something that is not bright.\"\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=After+A+Long+Day+At+The+Computer+Do+You+Have+A+Medical+Problem%3F&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Depending on whether you consult an optometrist or an ophthalmologist, you might get different answers on what ails you. Is it computer vision syndrome? Is it digital eyestrain? Is it just dry eyes and some eyestrain?\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>The most common definition is given by the American Optometric Association, which coined \u003ca href=\"http://www.aoa.org/patients-and-public/caring-for-your-vision/protecting-your-vision/computer-vision-syndrome?sso=y\">computer vision syndrome\u003c/a> and digital eyestrain as a group of vision-related problems from viewing digital screens for a long time.\u003c/p>\n\u003cp>The American Academy of Ophthalmology labels it \u003ca href=\"http://www.aao.org/eye-health/tips-prevention/computer-usage\">digital-related eyestrain\u003c/a>. The group emphasizes that extended reading and writing can also strain the eyes.\u003c/p>\n\u003cp>Neither computer vision syndrome nor digital eyestrain is an official medical condition. They are more of a collection of symptoms that sometimes include headache, neck and shoulder pain.\u003c/p>\n\u003cp>\"Classification schemes do take time to develop, and so it may not have crept into medical coding,\" says Dr. Michael X. Repka, a Johns Hopkins ophthalmologist and clinical spokesman for the American Academy of Ophthalmology.\u003c/p>\n\u003cp>Repka says in the past these symptoms would be lumped under \u003ca href=\"http://eyewiki.aao.org/Asthenopia\">asthenopia\u003c/a>, a condition that encompasses eye fatigue, ache around the eyes, blurred vision and headache. Computer vision syndrome, he says, is considered to be under asthenopia in the \u003ca href=\"http://icdlist.com/icd-10/H53.149\">ICD-10 medical coding system\u003c/a>.\u003c/p>\n\u003cp>\"Computer vision syndrome ... is not a recognized medical entity,\" says James Sheedy, a professor of optometry at Pacific University and head of the Vision Ergonomics Research Laboratory. \"A medical diagnosis is a condition where the anatomy or physiology isn't functioning properly. There are several different medical diagnoses that could be the cause of what is commonly called computer vision syndrome. There are different names put on it. Those are really names to create a black box where you put everything into ... but it's really the same thing.\"\u003c/p>\n\u003caside class=\"pullquote alignright\">Follow the 20-20-20 rule: Every 20 minutes, look at something at least 20 feet away for 20 seconds.\u003c/aside>\n\u003cp>The fact that these symptoms are common is self-evident. Optometrists and ophthalmologists agree that many patients walk into their offices with these complaints. But is there enough evidence to upgrade their diagnostic status?\u003c/p>\n\u003cp>\"I think research is coming out now that this really is a different condition,\" says Mark Rosenfield, a professor at SUNY College of Optometry. \"There is something about these screens that is different from paper and so we're trying to figure out what aspects of screens is it that is causing problems. People didn't look at paper for that length of time [that] people are looking at screens, so I think that could be a factor too — the fact that people are looking at these things for such long periods of time.\"\u003c/p>\n\u003cp>So why do our digital screens cause us so much trouble?\u003c/p>\n\u003cp>\"We're not really designed to do full-time near work; we're designed to do part-time near work, and so to the extent that we have to do so much near work our eyes are in tension virtually all the time,\" says Steve Loomis, president of the American Optometric Association. \"The average worker spends seven hours a day on some digital device. ... I'm among them and so what we know is that that means that the muscles in the eye are in a state of tension.\"\u003c/p>\n\u003cp>In a \u003ca href=\"http://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=64714113&site=ehost-live\">review of studies\u003c/a> for the journal \u003cem>Ophthalmic & Physiological Optics,\u003c/em> Rosenfield found that we have more incomplete blinks during computer operations, which reduces the volume of tears in our eyes. Too few tears causes irritation and a burning sensation in the eyes.\u003c/p>\n\u003cp>A \u003ca href=\"http://content.iospress.com/articles/work/wor2162\">more recent review\u003c/a> of the syndrome in \u003cem>IOS Press\u003c/em> lists other factors: glare from windows, overhead lights and the computer. Also, the particulars of how your computer or digital devices are arranged, including the height and viewing distance of the device from our eyes. We also tend to hold hand-held devices closer to our eyes than we should.\u003c/p>\n\u003cp>\"The eyes work best we know by looking down about 15 degrees in most desktop computer situations. This means that the top of the computer screen displays should be level with the eyes,\" Sheedy says. \"If it's higher or lower than that the person tends to tilt the head back or forward and now they have an imbalance and this creates muscular tension and it can give them a neck ache.\"\u003c/p>\n\u003cp>The evidence doesn't suggest these symptoms are permanent. They can be alleviated by changing our workplace habits. Anti-glare screen filters and eyedrops may help some. Optometrists say that some people who use reading glasses may benefit from trying glasses with a different focal length for computer work.\u003c/p>\n\u003cp>One of the most commonly cited — and cheapest — things to do is just to give your eyes a rest. Follow the 20-20-20 rule: Every 20 minutes, look at something at least 20 feet away for 20 seconds.\u003c/p>\n\u003cp>Grad student Le now stares at his computer only four to six hours a day. He says he still gets occasional neck pain from looking down at his laptop. And the white backgrounds of PDFs and Word documents still bother his eyes some. He's also trying software to make the tone of his screen warmer.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>John Oliver turned his righteous outrage to lead poisoning in his \u003ca href=\"https://www.youtube.com/watch?v=GUizvEjR-0U\" target=\"_blank\">weekly show \u003c/a>last night. And, as he tends to do, did it with humor.\u003c/p>\n\u003cp>\"There is no safe level of lead,\" Oliver said. \"It's one of those things so dangerous that you shouldn't even let a little bit inside you, like heroin, or Jeremy Piven.\"\u003c/p>\n\u003cp>He started with the Flint, Michigan water crisis and expanded from there, pointing out that there are 2.1 million homes in the U.S. where children under age six live that also have a lead dust hazard. The Centers for Disease Control and Prevention\u003ca href=\"http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6213a3.htm\" target=\"_blank\">estimates that 535,000 children\u003c/a> under age six have an elevated blood lead level.\u003c/p>\n\u003cp>\"Lead is almost as much a scourge in young children's homes as 'Frozen' merchandise,\" he said, to laughter.\u003c/p>\n\u003cp>Lead is a naturally occurring mineral, but is toxic to humans, especially children, and \u003ca href=\"http://www.who.int/mediacentre/factsheets/fs379/en/\" target=\"_blank\">can lead to irreversible neurodevelopmental \u003c/a>problems, including intellectual disability.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Oliver recounted the \"major public health victory\" starting in the U.S. in the 1970s when lead was removed from paint and then from gasoline. Children's blood lead levels plummeted.\u003c/p>\n\u003cp>In 2000, the federal government determined that totally removing lead from all homes, nationwide, would cost $16.6 billion every year for a decade, a very steep price tag.\u003c/p>\n\u003cp>Instead, the federal government funded a lead hazard control program in homes where families where low-income families lived. While $230 million was recommended, the HUD's Lead Hazard Control Program was never funded above $176 million, Oliver said, and has been steadily declining since 2003.\u003c/p>\n\u003cp>This year, the allocation is $110 million, not even as much as Ride Along 2 \u003ca href=\"http://www.the-numbers.com/movie/Ride-Along-2#tab=summary\" target=\"_blank\">has made so far\u003c/a>, a movie the \u003ca href=\"http://nypost.com/2016/01/13/the-worst-part-about-being-a-movie-critic-ride-along-2/\" target=\"_blank\">New York Post said \u003c/a>was \"as funny as lead poisoning.\" (How Oliver put those facts together, I don't know, but it' s true, follow the links.)\u003c/p>\n\u003cp>Oliver turned to all manner of archival news clips during his history lesson, including a 20-year-old clip from \"Sesame Street\" featuring a song about protecting yourself from lead.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"It's clearly time to address the problem again,\" Oliver said, and went off to visit \"Sesame Street\" where Elmo, Rosita and even Oscar teamed up to sing a song motivating everyone to conquer the problem.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>John Oliver turned his righteous outrage to lead poisoning in his \u003ca href=\"https://www.youtube.com/watch?v=GUizvEjR-0U\" target=\"_blank\">weekly show \u003c/a>last night. And, as he tends to do, did it with humor.\u003c/p>\n\u003cp>\"There is no safe level of lead,\" Oliver said. \"It's one of those things so dangerous that you shouldn't even let a little bit inside you, like heroin, or Jeremy Piven.\"\u003c/p>\n\u003cp>He started with the Flint, Michigan water crisis and expanded from there, pointing out that there are 2.1 million homes in the U.S. where children under age six live that also have a lead dust hazard. The Centers for Disease Control and Prevention\u003ca href=\"http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6213a3.htm\" target=\"_blank\">estimates that 535,000 children\u003c/a> under age six have an elevated blood lead level.\u003c/p>\n\u003cp>\"Lead is almost as much a scourge in young children's homes as 'Frozen' merchandise,\" he said, to laughter.\u003c/p>\n\u003cp>Lead is a naturally occurring mineral, but is toxic to humans, especially children, and \u003ca href=\"http://www.who.int/mediacentre/factsheets/fs379/en/\" target=\"_blank\">can lead to irreversible neurodevelopmental \u003c/a>problems, including intellectual disability.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Oliver recounted the \"major public health victory\" starting in the U.S. in the 1970s when lead was removed from paint and then from gasoline. Children's blood lead levels plummeted.\u003c/p>\n\u003cp>In 2000, the federal government determined that totally removing lead from all homes, nationwide, would cost $16.6 billion every year for a decade, a very steep price tag.\u003c/p>\n\u003cp>Instead, the federal government funded a lead hazard control program in homes where families where low-income families lived. While $230 million was recommended, the HUD's Lead Hazard Control Program was never funded above $176 million, Oliver said, and has been steadily declining since 2003.\u003c/p>\n\u003cp>This year, the allocation is $110 million, not even as much as Ride Along 2 \u003ca href=\"http://www.the-numbers.com/movie/Ride-Along-2#tab=summary\" target=\"_blank\">has made so far\u003c/a>, a movie the \u003ca href=\"http://nypost.com/2016/01/13/the-worst-part-about-being-a-movie-critic-ride-along-2/\" target=\"_blank\">New York Post said \u003c/a>was \"as funny as lead poisoning.\" (How Oliver put those facts together, I don't know, but it' s true, follow the links.)\u003c/p>\n\u003cp>Oliver turned to all manner of archival news clips during his history lesson, including a 20-year-old clip from \"Sesame Street\" featuring a song about protecting yourself from lead.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"It's clearly time to address the problem again,\" Oliver said, and went off to visit \"Sesame Street\" where Elmo, Rosita and even Oscar teamed up to sing a song motivating everyone to conquer the problem.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "How Theater Helps This HIV-Positive Grandmother Transform Lives",
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"content": "\u003cp>For decades, Cassandra Steptoe felt like she couldn’t talk about her HIV diagnosis with anyone.\u003c/p>\n\u003cp>\"I couldn't forgive myself for getting HIV,\" says Steptoe, who spent much of her early adult life in and out of jail for shoplifting and burglaries linked to her IV drug use. \"But someone told me a long time ago, if you are looking for a reason to feel shame, you can always find it. I learned to look for something else: forgiveness.\"\u003c/p>\n\u003cp>For Steptoe, now 59 and a grandmother, it wasn't until her 40s -- after decades of struggling with addiction -- that she finally completed a rehab program and committed to ongoing HIV treatment.\u003c/p>\n\u003cp>Today she talks openly about that experience onstage, as part of a theater project aimed at inspiring others. The quote about learning to forgive herself is part of an autobiographical monologue Steptoe wrote and performs in a San Francisco theater production of \u003ca href=\"https://www.facebook.com/MedeaProject/\" target=\"_blank\">The Medea Project: Theater for Incarcerated Women/HIV Circle\u003c/a>.\u003c/p>\n\u003cp>It was Steptoe's physician, \u003ca href=\"http://whp.ucsf.edu/about/team-members/edward-machtinger-m-d\">Dr. Edward Machtinger\u003c/a>, who first told her about the project. Established by playwright and director \u003ca href=\"http://www.culturalodyssey.org/v2/aboutus/rhodessa_bio.html\" target=\"_blank\">Rhodessa Jones\u003c/a> in 2008 as an extension of an improvisational production that draws on and explores the \u003ca href=\"http://www.npr.org/templates/story/story.php?storyId=15146105\" target=\"_blank\">experiences of jailed women\u003c/a>, the \"HIV Circle\" focuses on the experiences of women living with the AIDS virus.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The therapeutic aspect of the performance workshop is called \u003ca href=\"http://rtc.umn.edu/docs/pep_facguide.pdf\" target=\"_blank\">peer empowerment\u003c/a>, explains Machtinger, an internist and director of the Women's HIV Program at the University of California, San Francisco. The strength and healing Steptoe and others have gained from processing and sharing their stories this way is profound, he says — and can serve as a model for helping other patients deal with psychological trauma.\u003c/p>\n\u003cfigure id=\"attachment_164615\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"size-full wp-image-164615\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/03/RS18863_IMG_9455-qut.jpg\" alt=\"Cassandra Steptoe at the apartment she shares with her 8-year-old granddaughter in San Francisco. She credits The Medea Project with helping her improve her overall well-being.\" width=\"1920\" height=\"1280\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/03/RS18863_IMG_9455-qut.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/27/2016/03/RS18863_IMG_9455-qut-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/03/RS18863_IMG_9455-qut-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/03/RS18863_IMG_9455-qut-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/03/RS18863_IMG_9455-qut-1440x960.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/03/RS18863_IMG_9455-qut-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/03/RS18863_IMG_9455-qut-960x640.jpg 960w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Cassandra Steptoe at the apartment she shares with her 8-year-old granddaughter in San Francisco. She credits The Medea Project with helping her improve her overall well-being. \u003ccite>(Farida Jhabvala Romero / KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>Medications 'Not Enough'\u003c/strong>\u003c/p>\n\u003cp>With the theater group, Steptoe began writing about her experiences and sharing them with a small group of women, some of whom had gone through similar struggles of addiction and histories of incarceration. The process of uncovering her past and making sense of her experiences in a cathartic, supportive environment helped Steptoe end her feelings of isolation.\u003c/p>\n\u003cp>\"Having these women that really love you and support you ... it feels good to have some real friends, 'cause I never had that before,\" Steptoe says. \"We're all sharing something together 'cause we all get something out of everybody's story.\"\u003c/p>\n\u003cp>The potential of peer empowerment is not just anecdotal. Machtinger has \u003ca href=\"http://www.sciencedirect.com/science/article/pii/S1055329014000971\" target=\"_blank\">studied\u003c/a> the Medea Project's life-saving impact on his patients.\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/256844757\" params=\"color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" iframe=\"true\" /]\u003c/p>\n\u003cp>Machtinger says the patients in the Medea Project followed by his research team went through an extraordinary transformation. Many who had barely disclosed their HIV status to anyone when they began, became activists and leaders in their communities, helping to destigmatize HIV while pursuing personal goals and leading productive lives.\u003c/p>\n\u003cp>\"For them to develop what they described as \"sisterhood\" was the most important and most profound type of healing that I ever witnessed,\" Machtinger says.\u003c/p>\n\u003cp>He began seeking alternative methods to help his patients after increasingly noticing that a large proportion were successfully receiving antiretroviral treatment, but still dying from reasons that had \"nothing to do with HIV,\" such as murder, suicide or drug overdose.\u003c/p>\n\u003cp>\"They could have their HIV under control, (but) their lives were not getting better,\" Machtinger says. \"That was because their core issue -- a life of trauma and the impacts of depression, isolation and shame -- wasn’t being effectively addressed. And to us, that's not acceptable.\"\u003c/p>\n\u003cp>Machtinger's experience is reverberating beyond the Medea Project. He says witnessing and studying the impact of peer empowerment has helped inform a broader role. He is part of an advisory group helping to develop new guidelines for trauma-informed primary care for the federal Substance Abuse and Mental Health Services Administration.\u003c/p>\n\u003cp>The new guidelines will likely include a substantial focus on interventions with peer empowerment as one ingredient to help people with severe trauma heal, says Machtinger.\u003c/p>\n\u003cp>\"The core elements of the Medea Project are really lessons for other interventions to help people overcome trauma and other stigmatizing situations and conditions,\" says Machtinger, adding that childhood and adult trauma have been linked to a variety of illnesses, such as hepatitis C, heart disease and diabetes.\u003c/p>\n\u003cp>He expects the new guidelines for primary care clinics and other health providers to be finalized and published later this year.\u003c/p>\n\u003cp>\u003cstrong>Trauma at the Root of HIV Diagnosis\u003c/strong>\u003c/p>\n\u003cp>Steptoe now realizes she was infected with HIV through unprotected sex and sharing needles. She used to be addicted to heroin and cocaine. During a decades-long period of her life, she was in and out of the criminal justice system. She worked as a prostitute and survived abusive relationships -- getting beat up so badly one time that she spent three months recovering at a hospital, she said.\u003c/p>\n\u003cp>Steptoe says experiencing sexual abuse repeatedly as a child and teen led her on the path that eventually resulted in HIV infection.\u003c/p>\n\u003cp>\"Sexual abuse came from family,\" she says. \"And I guess I was kind of covering all that up by choosing the drugs. It kind of took me out there into the street, looking for love in the wrong places because I didn't have it at home. I started shooting drugs and that led into prostitution and to prison.\"\u003c/p>\n\u003cp>\u003ca href=\"http://ww2.kqed.org/stateofhealth/2012/03/20/trauma-fuels-hiv-epidemic-among-women/http://ww2.kqed.org/stateofhealth/2012/03/20/trauma-fuels-hiv-epidemic-among-women/\">Recent studies\u003c/a> show that HIV-positive women suffer disproportionately from high rates of trauma and post-traumatic stress disorder. The high rates of trauma also lead to increased risk of further spreading HIV, according to researchers.\u003c/p>\n\u003cp>\u003cstrong>Transforming Her Life\u003c/strong>\u003c/p>\n\u003cp>Now Steptoe is busy and full of energy. She takes antiretroviral medication religiously every morning, eats a healthy diet and works out by taking Zumba fitness classes at her gym.\u003c/p>\n\u003cp>Steptoe, a mother of three and grandmother of nine has also taken full custody of her 8-year-old granddaughter, who frequently accompanies her to rehearsals.\u003c/p>\n\u003cp>\"She teaches me how to love, and she gives me patience,\" says Steptoe, who also cares for other kids in her Mission apartment building.\u003c/p>\n\u003cp>Rhodessa Jones, the Medea Project's dynamic and energetic director, says Steptoe has flourished since she joined the organization, becoming a leader and inspiration to other women.\u003c/p>\n\u003cp>\"She’s so powerful, positive and forceful. She gets it,\" says Jones, who founded Medea more than 23 years ago. \"Theater has really been expressive therapy for her. It gives her a space to speak her truth.\"\u003c/p>\n\u003cfigure id=\"attachment_164614\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"size-full wp-image-164614\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/03/RS18862_IMG_9445-qut.jpg\" alt='Performers at The Medea Project rehearse in San Francisco. Founder and director Rhodessa Jones, uses Greek, Roman and African mythology to introduce \"the universality of all of our stories.\"' width=\"1920\" height=\"1280\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/03/RS18862_IMG_9445-qut.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/27/2016/03/RS18862_IMG_9445-qut-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/03/RS18862_IMG_9445-qut-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/03/RS18862_IMG_9445-qut-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/03/RS18862_IMG_9445-qut-1440x960.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/03/RS18862_IMG_9445-qut-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/03/RS18862_IMG_9445-qut-960x640.jpg 960w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Performers at The Medea Project rehearse in San Francisco. Founder and director Rhodessa Jones, uses Greek, Roman and African mythology to introduce \"the universality of all of our stories.\" \u003ccite>(Farida Jhabvala Romero/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The Medea Project uses Greek, Roman and African mythology to introduce \"the universality of all of our stories,\" says Jones, who asked Steptoe to imagine going back in time to age 14 and write the lessons she would give herself. The result was Steptoe's piece \"Younger Self.\"\u003c/p>\n\u003cp>Steptoe wrote the piece, performed in January in San Francisco, about the moment in 1987 when she first found out she was HIV-positive. She was serving time in jail and received a health checkup.\u003c/p>\n\u003cp>\"My world crashed. I didn't have no education of what I had, I didn't have no support,\" says Steptoe, adding that she considered her condition \"a death sentence\" at the time. \"I had to relive that again by writing this because I needed to heal.\"\u003c/p>\n\u003cp>\u003cstrong>'HIV is a Health Condition, Not a Crime'\u003c/strong>\u003c/p>\n\u003cp>After receiving the diagnosis, she remembers crying at night with a pillow over her head so others wouldn't hear.\u003c/p>\n\u003cp>Steptoe then kept her HIV status a secret for many years.\u003c/p>\n\u003cp>But, years later, the key for her to find and use her voice was becoming a part of The Medea Project, she says. The main motivation for telling her story? She wants to give hope to others, and help them feel they are not alone.\u003c/p>\n\u003cp>\"Now I can tell the world that HIV is just a health condition, not a crime,\" says Steptoe, who doesn't hesitate to share her story as a lead actress for Medea in front of audiences of hundreds of people.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\"I don't have shame around it no more,” Steptoe says. “I let my grandkids know that even if you go the wrong way, you can still turn your life around.\"\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>For decades, Cassandra Steptoe felt like she couldn’t talk about her HIV diagnosis with anyone.\u003c/p>\n\u003cp>\"I couldn't forgive myself for getting HIV,\" says Steptoe, who spent much of her early adult life in and out of jail for shoplifting and burglaries linked to her IV drug use. \"But someone told me a long time ago, if you are looking for a reason to feel shame, you can always find it. I learned to look for something else: forgiveness.\"\u003c/p>\n\u003cp>For Steptoe, now 59 and a grandmother, it wasn't until her 40s -- after decades of struggling with addiction -- that she finally completed a rehab program and committed to ongoing HIV treatment.\u003c/p>\n\u003cp>Today she talks openly about that experience onstage, as part of a theater project aimed at inspiring others. The quote about learning to forgive herself is part of an autobiographical monologue Steptoe wrote and performs in a San Francisco theater production of \u003ca href=\"https://www.facebook.com/MedeaProject/\" target=\"_blank\">The Medea Project: Theater for Incarcerated Women/HIV Circle\u003c/a>.\u003c/p>\n\u003cp>It was Steptoe's physician, \u003ca href=\"http://whp.ucsf.edu/about/team-members/edward-machtinger-m-d\">Dr. Edward Machtinger\u003c/a>, who first told her about the project. Established by playwright and director \u003ca href=\"http://www.culturalodyssey.org/v2/aboutus/rhodessa_bio.html\" target=\"_blank\">Rhodessa Jones\u003c/a> in 2008 as an extension of an improvisational production that draws on and explores the \u003ca href=\"http://www.npr.org/templates/story/story.php?storyId=15146105\" target=\"_blank\">experiences of jailed women\u003c/a>, the \"HIV Circle\" focuses on the experiences of women living with the AIDS virus.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The therapeutic aspect of the performance workshop is called \u003ca href=\"http://rtc.umn.edu/docs/pep_facguide.pdf\" target=\"_blank\">peer empowerment\u003c/a>, explains Machtinger, an internist and director of the Women's HIV Program at the University of California, San Francisco. The strength and healing Steptoe and others have gained from processing and sharing their stories this way is profound, he says — and can serve as a model for helping other patients deal with psychological trauma.\u003c/p>\n\u003cfigure id=\"attachment_164615\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"size-full wp-image-164615\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/03/RS18863_IMG_9455-qut.jpg\" alt=\"Cassandra Steptoe at the apartment she shares with her 8-year-old granddaughter in San Francisco. She credits The Medea Project with helping her improve her overall well-being.\" width=\"1920\" height=\"1280\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/03/RS18863_IMG_9455-qut.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/27/2016/03/RS18863_IMG_9455-qut-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/03/RS18863_IMG_9455-qut-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/03/RS18863_IMG_9455-qut-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/03/RS18863_IMG_9455-qut-1440x960.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/03/RS18863_IMG_9455-qut-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/03/RS18863_IMG_9455-qut-960x640.jpg 960w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Cassandra Steptoe at the apartment she shares with her 8-year-old granddaughter in San Francisco. She credits The Medea Project with helping her improve her overall well-being. \u003ccite>(Farida Jhabvala Romero / KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>Medications 'Not Enough'\u003c/strong>\u003c/p>\n\u003cp>With the theater group, Steptoe began writing about her experiences and sharing them with a small group of women, some of whom had gone through similar struggles of addiction and histories of incarceration. The process of uncovering her past and making sense of her experiences in a cathartic, supportive environment helped Steptoe end her feelings of isolation.\u003c/p>\n\u003cp>\"Having these women that really love you and support you ... it feels good to have some real friends, 'cause I never had that before,\" Steptoe says. \"We're all sharing something together 'cause we all get something out of everybody's story.\"\u003c/p>\n\u003cp>The potential of peer empowerment is not just anecdotal. Machtinger has \u003ca href=\"http://www.sciencedirect.com/science/article/pii/S1055329014000971\" target=\"_blank\">studied\u003c/a> the Medea Project's life-saving impact on his patients.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003cdiv class='utils-parseShortcode-shortcodes-__shortcodes__shortcodeWrapper'>\n \u003ciframe width='100%' height='166'\n scrolling='no' frameborder='no'\n src='https://w.soundcloud.com/player/?url=https://api.soundcloud.com/tracks/256844757&visual=true&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false'\n title='https://api.soundcloud.com/tracks/256844757'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Machtinger says the patients in the Medea Project followed by his research team went through an extraordinary transformation. Many who had barely disclosed their HIV status to anyone when they began, became activists and leaders in their communities, helping to destigmatize HIV while pursuing personal goals and leading productive lives.\u003c/p>\n\u003cp>\"For them to develop what they described as \"sisterhood\" was the most important and most profound type of healing that I ever witnessed,\" Machtinger says.\u003c/p>\n\u003cp>He began seeking alternative methods to help his patients after increasingly noticing that a large proportion were successfully receiving antiretroviral treatment, but still dying from reasons that had \"nothing to do with HIV,\" such as murder, suicide or drug overdose.\u003c/p>\n\u003cp>\"They could have their HIV under control, (but) their lives were not getting better,\" Machtinger says. \"That was because their core issue -- a life of trauma and the impacts of depression, isolation and shame -- wasn’t being effectively addressed. And to us, that's not acceptable.\"\u003c/p>\n\u003cp>Machtinger's experience is reverberating beyond the Medea Project. He says witnessing and studying the impact of peer empowerment has helped inform a broader role. He is part of an advisory group helping to develop new guidelines for trauma-informed primary care for the federal Substance Abuse and Mental Health Services Administration.\u003c/p>\n\u003cp>The new guidelines will likely include a substantial focus on interventions with peer empowerment as one ingredient to help people with severe trauma heal, says Machtinger.\u003c/p>\n\u003cp>\"The core elements of the Medea Project are really lessons for other interventions to help people overcome trauma and other stigmatizing situations and conditions,\" says Machtinger, adding that childhood and adult trauma have been linked to a variety of illnesses, such as hepatitis C, heart disease and diabetes.\u003c/p>\n\u003cp>He expects the new guidelines for primary care clinics and other health providers to be finalized and published later this year.\u003c/p>\n\u003cp>\u003cstrong>Trauma at the Root of HIV Diagnosis\u003c/strong>\u003c/p>\n\u003cp>Steptoe now realizes she was infected with HIV through unprotected sex and sharing needles. She used to be addicted to heroin and cocaine. During a decades-long period of her life, she was in and out of the criminal justice system. She worked as a prostitute and survived abusive relationships -- getting beat up so badly one time that she spent three months recovering at a hospital, she said.\u003c/p>\n\u003cp>Steptoe says experiencing sexual abuse repeatedly as a child and teen led her on the path that eventually resulted in HIV infection.\u003c/p>\n\u003cp>\"Sexual abuse came from family,\" she says. \"And I guess I was kind of covering all that up by choosing the drugs. It kind of took me out there into the street, looking for love in the wrong places because I didn't have it at home. I started shooting drugs and that led into prostitution and to prison.\"\u003c/p>\n\u003cp>\u003ca href=\"http://ww2.kqed.org/stateofhealth/2012/03/20/trauma-fuels-hiv-epidemic-among-women/http://ww2.kqed.org/stateofhealth/2012/03/20/trauma-fuels-hiv-epidemic-among-women/\">Recent studies\u003c/a> show that HIV-positive women suffer disproportionately from high rates of trauma and post-traumatic stress disorder. The high rates of trauma also lead to increased risk of further spreading HIV, according to researchers.\u003c/p>\n\u003cp>\u003cstrong>Transforming Her Life\u003c/strong>\u003c/p>\n\u003cp>Now Steptoe is busy and full of energy. She takes antiretroviral medication religiously every morning, eats a healthy diet and works out by taking Zumba fitness classes at her gym.\u003c/p>\n\u003cp>Steptoe, a mother of three and grandmother of nine has also taken full custody of her 8-year-old granddaughter, who frequently accompanies her to rehearsals.\u003c/p>\n\u003cp>\"She teaches me how to love, and she gives me patience,\" says Steptoe, who also cares for other kids in her Mission apartment building.\u003c/p>\n\u003cp>Rhodessa Jones, the Medea Project's dynamic and energetic director, says Steptoe has flourished since she joined the organization, becoming a leader and inspiration to other women.\u003c/p>\n\u003cp>\"She’s so powerful, positive and forceful. She gets it,\" says Jones, who founded Medea more than 23 years ago. \"Theater has really been expressive therapy for her. It gives her a space to speak her truth.\"\u003c/p>\n\u003cfigure id=\"attachment_164614\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"size-full wp-image-164614\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/03/RS18862_IMG_9445-qut.jpg\" alt='Performers at The Medea Project rehearse in San Francisco. Founder and director Rhodessa Jones, uses Greek, Roman and African mythology to introduce \"the universality of all of our stories.\"' width=\"1920\" height=\"1280\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/03/RS18862_IMG_9445-qut.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/27/2016/03/RS18862_IMG_9445-qut-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/03/RS18862_IMG_9445-qut-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/03/RS18862_IMG_9445-qut-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/03/RS18862_IMG_9445-qut-1440x960.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/03/RS18862_IMG_9445-qut-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/03/RS18862_IMG_9445-qut-960x640.jpg 960w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Performers at The Medea Project rehearse in San Francisco. Founder and director Rhodessa Jones, uses Greek, Roman and African mythology to introduce \"the universality of all of our stories.\" \u003ccite>(Farida Jhabvala Romero/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The Medea Project uses Greek, Roman and African mythology to introduce \"the universality of all of our stories,\" says Jones, who asked Steptoe to imagine going back in time to age 14 and write the lessons she would give herself. The result was Steptoe's piece \"Younger Self.\"\u003c/p>\n\u003cp>Steptoe wrote the piece, performed in January in San Francisco, about the moment in 1987 when she first found out she was HIV-positive. She was serving time in jail and received a health checkup.\u003c/p>\n\u003cp>\"My world crashed. I didn't have no education of what I had, I didn't have no support,\" says Steptoe, adding that she considered her condition \"a death sentence\" at the time. \"I had to relive that again by writing this because I needed to heal.\"\u003c/p>\n\u003cp>\u003cstrong>'HIV is a Health Condition, Not a Crime'\u003c/strong>\u003c/p>\n\u003cp>After receiving the diagnosis, she remembers crying at night with a pillow over her head so others wouldn't hear.\u003c/p>\n\u003cp>Steptoe then kept her HIV status a secret for many years.\u003c/p>\n\u003cp>But, years later, the key for her to find and use her voice was becoming a part of The Medea Project, she says. The main motivation for telling her story? She wants to give hope to others, and help them feel they are not alone.\u003c/p>\n\u003cp>\"Now I can tell the world that HIV is just a health condition, not a crime,\" says Steptoe, who doesn't hesitate to share her story as a lead actress for Medea in front of audiences of hundreds of people.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"I don't have shame around it no more,” Steptoe says. “I let my grandkids know that even if you go the wrong way, you can still turn your life around.\"\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Rapper Phife Dawg, of the iconic group Tribe Called Quest, is continuing to raise awareness around diabetes in his death, as he did in life, throughout his music career.\u003c/p>\n\u003cp>The rapper’s family confirmed Wednesday that \u003ca href=\"http://ww2.kqed.org/arts/2016/03/23/why-phife-mattered-remembering-hip-hops-relatable-mc/\" target=\"_blank\">Phife died at age 45\u003c/a> at his home near Antioch due to complications resulting from diabetes, sparking a wave of disease-related tributes on social media.\u003c/p>\n\u003cblockquote class=\"twitter-tweet\">\n\u003cp dir=\"ltr\" lang=\"en\">Rest in peace and poetry, Phife Dawg. We will continue the fight against Diabetes in your honor. \u003ca href=\"https://t.co/ofG6ATsq02\">pic.twitter.com/ofG6ATsq02\u003c/a>\u003c/p>\n\u003cp>— Youth Speaks (@youthspeaks) \u003ca href=\"https://twitter.com/youthspeaks/status/712686618096771072\">March 23, 2016\u003c/a>\u003c/p>\u003c/blockquote>\n\u003cp>“Rest in peace and poetry, Phife Dawg. We will continue the fight against Diabetes in your honor,” Youth Speaks posted on Twitter.\u003c/p>\n\u003cp>Phife, born Malik Taylor, was diagnosed with diabetes when he was 19. It was May 1990, just one month after Tribe released its first album. Phife later talked about his struggle with the disease in interviews, and even rapped about it.\u003c/p>\n\u003cp>“Mr. Energetic, who me sound pathetic?/When’s the last time you heard a funky diabetic?” he rhymed in Tribe’s 1993 song “\u003ca href=\"http://genius.com/A-tribe-called-quest-oh-my-god-lyrics\" target=\"_blank\">Oh My God\u003c/a>.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>In 2010, Phife told the \u003ca href=\"http://www.eastbayexpress.com/oakland/phife-dawgs-triumphal-return/Content?oid=2043994\" target=\"_blank\">East Bay Express\u003c/a> that he was working on a solo album, \"Songs in the Key of Phife,\" though it was never released. Reporter David MacFadden-Elliott got to hear a few samples in the IHOP parking lot after the interview, including a song about diabetes called “God Send.”\u003c/p>\n\u003cblockquote>\u003cp>“[It’s] a three-part song that turns from a smooth love joint into a warning from a doctor: 'You got to start dialysis.' The news ushers in a discordant, claustrophobic, pulsing beat that rocks, while voice-mail messages of support play for minutes on end. The song concludes with an emotional verse of thanks: \u003cem>If it wasn't for y'all/Who knows what would have happened?”\u003c/em>\u003c/p>\u003c/blockquote>\n\u003cp>It was a couple years after Phife’s initial diagnosis before he opened up about it, or even really took care of himself.\u003c/p>\n\u003cp>[contextly_sidebar id=\"TJXUTnoR8uufGFRG5wvhJikCbmLNY4hZ\"]His coming out was in a video interview on \u003ca href=\"http://www.dlife.com/dlifetv/video/phife-dawgs-dlife\" target=\"_blank\">dLife\u003c/a>, a website devoted to living with diabetes. He described finding out about his diagnosis. He was riding home from a concert in 1990 and kept asking the driver to pull over so he could go to the bathroom. He was really thirsty. When he got home, his grandmother, a nurse, did a test and confirmed he was diabetic.\u003c/p>\n\u003cp>“I thought it was over,” he told dLife. “I just automatically thought I was done rapping.”\u003c/p>\n\u003cp>He went into denial.\u003c/p>\n\u003cp>“I was just an idiot,” he said. “I still thought I was everybody else -- Twinkies, Suzie Qs, potato chips -- junk food anonymous.”\u003c/p>\n\u003cp>In 1992, Tribe was on \"The David Letterman Show\" and then immediately had to go to another shoot for \"The Dennis Miller Show.\" Pfife's blood sugar count was almost in the thousands -- normal levels are between 70 and 100.\u003c/p>\n\u003cp>“Everything was slow motion,” Phife described. “I couldn’t even do the show. I had to get hospitalized.”\u003c/p>\n\u003cp>Even then, he still struggled to get enough exercise and eat right.\u003c/p>\n\u003cp>“I’d get on the diet. Wouldn’t stick to the diet. Get back on diet, wouldn’t stick to the diet,” he said. “And it just got to point where I had to be put on dialysis.”\u003c/p>\n\u003cp>Phife was eventually put on a waiting list for a kidney transplant, and received one from his wife in 2008. By 2013, he was back on dialysis and back on the transplant list. In an interview with \u003ca href=\"http://www.npr.org/player/v2/mediaPlayer.html?action=1&t=1&islist=false&id=455764350&m=455936755\" target=\"_blank\">NPR\u003c/a> earlier this year, he talked about waiting for another kidney.\u003c/p>\n\u003cp>“I’m doing fine,” he said. “I really, really can’t complain. I could. But I won’t because God is really, really a good God.”\u003c/p>\n\u003cp>But he also had a message for other young people newly diagnosed with diabetes.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“It’s not a game. You can lose your life because of this,” he said during the dLife interview. “You need to love yourself, love your life.”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Rapper Phife Dawg, of the iconic group Tribe Called Quest, is continuing to raise awareness around diabetes in his death, as he did in life, throughout his music career.\u003c/p>\n\u003cp>The rapper’s family confirmed Wednesday that \u003ca href=\"http://ww2.kqed.org/arts/2016/03/23/why-phife-mattered-remembering-hip-hops-relatable-mc/\" target=\"_blank\">Phife died at age 45\u003c/a> at his home near Antioch due to complications resulting from diabetes, sparking a wave of disease-related tributes on social media.\u003c/p>\n\u003cblockquote class=\"twitter-tweet\">\n\u003cp dir=\"ltr\" lang=\"en\">Rest in peace and poetry, Phife Dawg. We will continue the fight against Diabetes in your honor. \u003ca href=\"https://t.co/ofG6ATsq02\">pic.twitter.com/ofG6ATsq02\u003c/a>\u003c/p>\n\u003cp>— Youth Speaks (@youthspeaks) \u003ca href=\"https://twitter.com/youthspeaks/status/712686618096771072\">March 23, 2016\u003c/a>\u003c/p>\u003c/blockquote>\n\u003cp>“Rest in peace and poetry, Phife Dawg. We will continue the fight against Diabetes in your honor,” Youth Speaks posted on Twitter.\u003c/p>\n\u003cp>Phife, born Malik Taylor, was diagnosed with diabetes when he was 19. It was May 1990, just one month after Tribe released its first album. Phife later talked about his struggle with the disease in interviews, and even rapped about it.\u003c/p>\n\u003cp>“Mr. Energetic, who me sound pathetic?/When’s the last time you heard a funky diabetic?” he rhymed in Tribe’s 1993 song “\u003ca href=\"http://genius.com/A-tribe-called-quest-oh-my-god-lyrics\" target=\"_blank\">Oh My God\u003c/a>.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>In 2010, Phife told the \u003ca href=\"http://www.eastbayexpress.com/oakland/phife-dawgs-triumphal-return/Content?oid=2043994\" target=\"_blank\">East Bay Express\u003c/a> that he was working on a solo album, \"Songs in the Key of Phife,\" though it was never released. Reporter David MacFadden-Elliott got to hear a few samples in the IHOP parking lot after the interview, including a song about diabetes called “God Send.”\u003c/p>\n\u003cblockquote>\u003cp>“[It’s] a three-part song that turns from a smooth love joint into a warning from a doctor: 'You got to start dialysis.' The news ushers in a discordant, claustrophobic, pulsing beat that rocks, while voice-mail messages of support play for minutes on end. The song concludes with an emotional verse of thanks: \u003cem>If it wasn't for y'all/Who knows what would have happened?”\u003c/em>\u003c/p>\u003c/blockquote>\n\u003cp>It was a couple years after Phife’s initial diagnosis before he opened up about it, or even really took care of himself.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>His coming out was in a video interview on \u003ca href=\"http://www.dlife.com/dlifetv/video/phife-dawgs-dlife\" target=\"_blank\">dLife\u003c/a>, a website devoted to living with diabetes. He described finding out about his diagnosis. He was riding home from a concert in 1990 and kept asking the driver to pull over so he could go to the bathroom. He was really thirsty. When he got home, his grandmother, a nurse, did a test and confirmed he was diabetic.\u003c/p>\n\u003cp>“I thought it was over,” he told dLife. “I just automatically thought I was done rapping.”\u003c/p>\n\u003cp>He went into denial.\u003c/p>\n\u003cp>“I was just an idiot,” he said. “I still thought I was everybody else -- Twinkies, Suzie Qs, potato chips -- junk food anonymous.”\u003c/p>\n\u003cp>In 1992, Tribe was on \"The David Letterman Show\" and then immediately had to go to another shoot for \"The Dennis Miller Show.\" Pfife's blood sugar count was almost in the thousands -- normal levels are between 70 and 100.\u003c/p>\n\u003cp>“Everything was slow motion,” Phife described. “I couldn’t even do the show. I had to get hospitalized.”\u003c/p>\n\u003cp>Even then, he still struggled to get enough exercise and eat right.\u003c/p>\n\u003cp>“I’d get on the diet. Wouldn’t stick to the diet. Get back on diet, wouldn’t stick to the diet,” he said. “And it just got to point where I had to be put on dialysis.”\u003c/p>\n\u003cp>Phife was eventually put on a waiting list for a kidney transplant, and received one from his wife in 2008. By 2013, he was back on dialysis and back on the transplant list. In an interview with \u003ca href=\"http://www.npr.org/player/v2/mediaPlayer.html?action=1&t=1&islist=false&id=455764350&m=455936755\" target=\"_blank\">NPR\u003c/a> earlier this year, he talked about waiting for another kidney.\u003c/p>\n\u003cp>“I’m doing fine,” he said. “I really, really can’t complain. I could. But I won’t because God is really, really a good God.”\u003c/p>\n\u003cp>But he also had a message for other young people newly diagnosed with diabetes.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“It’s not a game. You can lose your life because of this,” he said during the dLife interview. “You need to love yourself, love your life.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>SACRAMENTO, Calif. (AP) — A leader of the movement to exempt tampons from California's sales tax is now proposing to reinstate the tax on candy and snack foods.\u003c/p>\n\u003cp>Assemblywoman Cristina Garcia said Friday she will seek a constitutional amendment to undo \u003ca href=\"https://ballotpedia.org/California_Proposition_163,_No_Sales_Tax_on_Food_Products_Sold_for_Home_Use_(1992)\" target=\"_blank\">California voters' 1992 decision \u003c/a>to classify candy and snacks as tax-exempt essential food items.\u003c/p>\n\u003cp>The Bell Gardens Democrat says consumption of fatty, ultra-processed foods has exploded since the sales taxes were repealed.\u003c/p>\n\u003cp>Grocers and bottled water producers supported the tax repeal 24 years ago. It faced no organized opposition.\u003c/p>\n\u003cp>The California Grocers Association says it's reviewing Garcia's proposal.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The announcement comes one day after the release of a UCLA study that estimated 46 percent of Californians are prediabetic. On Wednesday, Democratic Assemblyman Richard Bloom of Santa Monica \u003ca href=\"http://ww2.kqed.org/stateofhealth/2016/03/09/soda-tax-is-again-before-california-legislators/\" target=\"_blank\">proposed a fee on sugary beverages\u003c/a>.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>SACRAMENTO, Calif. (AP) — California's inspector general gave a failing grade to medical care at a fourth prison Monday as the state tries to regain responsibility for health treatment after a decade of federal control.\u003c/p>\n\u003cp>Valley State Prison in Chowchilla received a failing grade in nine of the 14 benchmarks used by inspectors. Medical records often were missing, misfiled, incomplete or illegible. Medicine often was not provided as needed. Essential supplies and basic equipment were missing from many examination rooms.\u003c/p>\n\u003cp>Problems included a failure to provide inmates with follow-up care after initial appointments. Some appointments were delayed for months, while others never occurred, inspectors found. Nurses repeatedly failed to carry out doctors' orders, to identify and act on patients' medical problems, or to recognize those with urgent needs.\u003c/p>\n\u003cp>In one case, a patient who went untreated for low blood sodium for three weeks had a seizure that required life-support measures and sent him to an intensive care unit at an outside hospital.\u003c/p>\n\u003cp>\"Poor care resulted in bad or potentially really bad outcomes,\" said Steven Fama, an attorney with the Berkeley-based Prison Law Office that represents ill inmates.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The medium-security prison houses nearly 3,400 inmates about 40 miles northwest of Fresno.\u003c/p>\n\u003cp>Joyce Hayhoe, a spokeswoman for the federal receiver who runs the prison health care system, said officials are fixing the problems.\u003c/p>\n\u003cp>The inspector general previously found that prisons in Delano, Susanville and Vacaville are providing inadequate care.\u003c/p>\n\u003cp>Seven other prisons have received passing grades, and one prison, in Folsom, has been returned to state control.\u003c/p>\n\u003cp>U.S. District Judge Thelton Henderson said last year that the state must successfully operate all 34 adult prisons for a year before he considers ending a long-running class action lawsuit.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Henderson seized control a decade ago after he found that conditions were so poor that an average of an inmate a week was dying of medical malpractice or neglect.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>SACRAMENTO, Calif. (AP) — California's inspector general gave a failing grade to medical care at a fourth prison Monday as the state tries to regain responsibility for health treatment after a decade of federal control.\u003c/p>\n\u003cp>Valley State Prison in Chowchilla received a failing grade in nine of the 14 benchmarks used by inspectors. Medical records often were missing, misfiled, incomplete or illegible. Medicine often was not provided as needed. Essential supplies and basic equipment were missing from many examination rooms.\u003c/p>\n\u003cp>Problems included a failure to provide inmates with follow-up care after initial appointments. Some appointments were delayed for months, while others never occurred, inspectors found. Nurses repeatedly failed to carry out doctors' orders, to identify and act on patients' medical problems, or to recognize those with urgent needs.\u003c/p>\n\u003cp>In one case, a patient who went untreated for low blood sodium for three weeks had a seizure that required life-support measures and sent him to an intensive care unit at an outside hospital.\u003c/p>\n\u003cp>\"Poor care resulted in bad or potentially really bad outcomes,\" said Steven Fama, an attorney with the Berkeley-based Prison Law Office that represents ill inmates.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The medium-security prison houses nearly 3,400 inmates about 40 miles northwest of Fresno.\u003c/p>\n\u003cp>Joyce Hayhoe, a spokeswoman for the federal receiver who runs the prison health care system, said officials are fixing the problems.\u003c/p>\n\u003cp>The inspector general previously found that prisons in Delano, Susanville and Vacaville are providing inadequate care.\u003c/p>\n\u003cp>Seven other prisons have received passing grades, and one prison, in Folsom, has been returned to state control.\u003c/p>\n\u003cp>U.S. District Judge Thelton Henderson said last year that the state must successfully operate all 34 adult prisons for a year before he considers ending a long-running class action lawsuit.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Henderson seized control a decade ago after he found that conditions were so poor that an average of an inmate a week was dying of medical malpractice or neglect.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>This season, Downton Abbey has a new plot line that has health wonks on the edge of their seats: a heated debate about hospital consolidation that closely parallels what’s going on in the U.S. health care system today.\u003c/p>\n\u003cp>If you’re not a Downton fan (and even if you are), here’s a quick plot recap.\u003c/p>\n\u003caside class=\"pullquote alignright\">'The royal Yorkshire county hospital wants to take over our little hospital, which is outrageous!'\u003ccite> Dowager Countess of Grantham \u003c/cite>\u003cbr>\n\u003c/aside>\n\u003cp>It’s 1925 for the lords and ladies at \u003ca href=\"http://www.pbs.org/wgbh/masterpiece/downtonabbey/\" target=\"_blank\">Downton Abbey \u003c/a>— think flapper dresses, cocktail parties and women’s rights. A big hospital in the nearby city of York is making a play to take over the Downton Cottage Hospital next to the posh estate. Or as Maggie Smith’s character, the Dowager Countess of Grantham, sees it, “The royal Yorkshire county hospital wants to take over our little hospital, which is outrageous!”\u003c/p>\n\u003cp>The battle lines have been drawn between the Dowager Countess, who wants the hospital to stay a small community endeavor, and the rest of the family, which hopes the merger will turn the dinky open-ward affair into a first-rate modern medical institution.\u003c/p>\n\u003cp>Health care historian Howard Markel, who runs the \u003ca href=\"http://chm.med.umich.edu/\" target=\"_blank\">Center for the History of Medicine at the University of Michigan\u003c/a>, said the conceit is actually fairly accurate.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“The 1920s really begins the golden age of medicine,” he explained. Before then, hospitals didn’t have much to offer in the way of treatment.\u003c/p>\n\u003cp>“They were really based on old time 19th century medicine, and what that entails is basically nursing. You feed people, you make them comfortable.”\u003c/p>\n\u003cp>There weren’t many medications — no antibiotics, insulin or even intravenous fluids.\u003c/p>\n\u003cp>But in the early 20th century, all sorts of new medical technologies came onto the scene — new ways to peer into the body, new medications and pathogen-free surgeries.\u003c/p>\n\u003cp>To provide modern care, “you need X-ray machines of all kinds, you need a chemistry laboratory and you need special operating rooms,” said Markel, all of which cost much more than the gauze and broth of the past.\u003c/p>\n\u003cp>Cities started to build bigger, grander hospitals, which in turn started to absorb the smaller, old-fashioned hospitals in the surrounding towns and villages.\u003c/p>\n\u003cp>Those mergers did have some benefits for local populations. “If we form such a partnership, our patients would have more access to more modern equipment. To more advanced treatments,” Downton Abbey’s Lord Merton noted on the show.\u003c/p>\n\u003cp>Many of his real-life contemporaries agreed, making the golden age of medicine a heyday for hospital consolidation on both sides of the pond.\u003c/p>\n\u003cp>Nowadays, said Kathy McDonald, who directs the \u003ca href=\"http://healthpolicy.fsi.stanford.edu/\" target=\"_blank\">Stanford University Center for Health Policy\u003c/a>, we appear to be in another Downton-like consolidation surge here in the U.S.\u003c/p>\n\u003cp>“It’s been since about 2010 that there’s been sort of an uptick in terms of consolidations,” said McDonald. About 100 mergers and acquisitions occur each year right now, about twice as many as there were before 2010, she said.\u003c/p>\n\u003cp>But this time around, it’s not about technology — it’s about finances. Hospitals want to be part of larger networks to flex their muscles in negotiations for profitable contracts with insurers. And thanks to the Affordable Care Act, they are now often paid based on the quality and efficiency of the care they provide, rather than for each test or procedure. Actually tracking how good their quality is turns out to be very expensive. And it can be more economical to team up to manage care and track quality.\u003c/p>\n\u003cp>“They might be providing perfectly good quality, but if they can’t prove it, then they’re not going to get paid as well,” said McDonald.\u003c/p>\n\u003cp>Those mergers can have real consequences for communities, which may see a local hospital transform or even disappear entirely.\u003c/p>\n\u003cp>“Just like on Downton Abbey, the local hospital is a resource that people care about. They employ people in a community and they take care of people,” said McDonald. So the debates continue, now as then.\u003c/p>\n\u003cp>And true to form, the indomitable Dowager Countess tells us exactly what she thinks about all this so-called progress: “For years, I’ve watched governments take control of our lives and their argument is always the same: fewer costs, greater efficiency. But the result is the same too. Less control by the people, more control by the state.”\u003c/p>\n\u003cp>So whose side are the experts on in this Downton debate?\u003c/p>\n\u003cp>“Personally I love Maggie Smith and have loved her since I was a young boy, so I’m on her side as a fan,” said Markel.\u003c/p>\n\u003cp>But, he adds, the other side is probably right.\u003c/p>\n\u003cp>McDonald is also on the side of progress. But even for health care policy experts, it’s hard to argue against the Dowager Countess.\u003c/p>\n\u003cp>There are plenty of Downton fans who say the whole hospital plot line is kind of a snoozer. Maybe it’s no surprise — the wonks love it.\u003c/p>\n\u003cp>“Health care just matters to people, so even though we might not be paying attention to this plot line, we probably should,” said McDonald.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>And with an audience of nearly 10 million viewers this season, there’s a good chance at least a few people are.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>This season, Downton Abbey has a new plot line that has health wonks on the edge of their seats: a heated debate about hospital consolidation that closely parallels what’s going on in the U.S. health care system today.\u003c/p>\n\u003cp>If you’re not a Downton fan (and even if you are), here’s a quick plot recap.\u003c/p>\n\u003caside class=\"pullquote alignright\">'The royal Yorkshire county hospital wants to take over our little hospital, which is outrageous!'\u003ccite> Dowager Countess of Grantham \u003c/cite>\u003cbr>\n\u003c/aside>\n\u003cp>It’s 1925 for the lords and ladies at \u003ca href=\"http://www.pbs.org/wgbh/masterpiece/downtonabbey/\" target=\"_blank\">Downton Abbey \u003c/a>— think flapper dresses, cocktail parties and women’s rights. A big hospital in the nearby city of York is making a play to take over the Downton Cottage Hospital next to the posh estate. Or as Maggie Smith’s character, the Dowager Countess of Grantham, sees it, “The royal Yorkshire county hospital wants to take over our little hospital, which is outrageous!”\u003c/p>\n\u003cp>The battle lines have been drawn between the Dowager Countess, who wants the hospital to stay a small community endeavor, and the rest of the family, which hopes the merger will turn the dinky open-ward affair into a first-rate modern medical institution.\u003c/p>\n\u003cp>Health care historian Howard Markel, who runs the \u003ca href=\"http://chm.med.umich.edu/\" target=\"_blank\">Center for the History of Medicine at the University of Michigan\u003c/a>, said the conceit is actually fairly accurate.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“The 1920s really begins the golden age of medicine,” he explained. Before then, hospitals didn’t have much to offer in the way of treatment.\u003c/p>\n\u003cp>“They were really based on old time 19th century medicine, and what that entails is basically nursing. You feed people, you make them comfortable.”\u003c/p>\n\u003cp>There weren’t many medications — no antibiotics, insulin or even intravenous fluids.\u003c/p>\n\u003cp>But in the early 20th century, all sorts of new medical technologies came onto the scene — new ways to peer into the body, new medications and pathogen-free surgeries.\u003c/p>\n\u003cp>To provide modern care, “you need X-ray machines of all kinds, you need a chemistry laboratory and you need special operating rooms,” said Markel, all of which cost much more than the gauze and broth of the past.\u003c/p>\n\u003cp>Cities started to build bigger, grander hospitals, which in turn started to absorb the smaller, old-fashioned hospitals in the surrounding towns and villages.\u003c/p>\n\u003cp>Those mergers did have some benefits for local populations. “If we form such a partnership, our patients would have more access to more modern equipment. To more advanced treatments,” Downton Abbey’s Lord Merton noted on the show.\u003c/p>\n\u003cp>Many of his real-life contemporaries agreed, making the golden age of medicine a heyday for hospital consolidation on both sides of the pond.\u003c/p>\n\u003cp>Nowadays, said Kathy McDonald, who directs the \u003ca href=\"http://healthpolicy.fsi.stanford.edu/\" target=\"_blank\">Stanford University Center for Health Policy\u003c/a>, we appear to be in another Downton-like consolidation surge here in the U.S.\u003c/p>\n\u003cp>“It’s been since about 2010 that there’s been sort of an uptick in terms of consolidations,” said McDonald. About 100 mergers and acquisitions occur each year right now, about twice as many as there were before 2010, she said.\u003c/p>\n\u003cp>But this time around, it’s not about technology — it’s about finances. Hospitals want to be part of larger networks to flex their muscles in negotiations for profitable contracts with insurers. And thanks to the Affordable Care Act, they are now often paid based on the quality and efficiency of the care they provide, rather than for each test or procedure. Actually tracking how good their quality is turns out to be very expensive. And it can be more economical to team up to manage care and track quality.\u003c/p>\n\u003cp>“They might be providing perfectly good quality, but if they can’t prove it, then they’re not going to get paid as well,” said McDonald.\u003c/p>\n\u003cp>Those mergers can have real consequences for communities, which may see a local hospital transform or even disappear entirely.\u003c/p>\n\u003cp>“Just like on Downton Abbey, the local hospital is a resource that people care about. They employ people in a community and they take care of people,” said McDonald. So the debates continue, now as then.\u003c/p>\n\u003cp>And true to form, the indomitable Dowager Countess tells us exactly what she thinks about all this so-called progress: “For years, I’ve watched governments take control of our lives and their argument is always the same: fewer costs, greater efficiency. But the result is the same too. Less control by the people, more control by the state.”\u003c/p>\n\u003cp>So whose side are the experts on in this Downton debate?\u003c/p>\n\u003cp>“Personally I love Maggie Smith and have loved her since I was a young boy, so I’m on her side as a fan,” said Markel.\u003c/p>\n\u003cp>But, he adds, the other side is probably right.\u003c/p>\n\u003cp>McDonald is also on the side of progress. But even for health care policy experts, it’s hard to argue against the Dowager Countess.\u003c/p>\n\u003cp>There are plenty of Downton fans who say the whole hospital plot line is kind of a snoozer. Maybe it’s no surprise — the wonks love it.\u003c/p>\n\u003cp>“Health care just matters to people, so even though we might not be paying attention to this plot line, we probably should,” said McDonald.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>And with an audience of nearly 10 million viewers this season, there’s a good chance at least a few people are.\u003c/p>\n\n\u003c/div>\u003c/p>",
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