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"content": "\u003cp>A few months ago, Kourtnaye Sturgeon helped save someone's life. She was driving in downtown Indianapolis when she saw people gathered around a car on the side of the road. Sturgeon pulled over and a man told her there was nothing she could do: Two men had overdosed on opioids and appeared to be dead.[contextly_sidebar id=\"HkPN1j5HI7DwfkcHFXdJSPtWQTk7V2zs\"]\u003c/p>\n\u003cp>\"I kind of recall saying, 'No man, I've got Narcan,' \" she says, referring to the brand- name version of the opioid overdose antidote, naloxone. \"Which sounds so silly, but I'm pretty sure that's what came out.\"\u003c/p>\n\u003cp>Sturgeon sprayed a dose of the drug up the driver's nose, and waited for it to take effect. About a minute later, she says, the paramedics showed up.\u003c/p>\n\u003cp>\"As they were walking towards us, the driver started slowly moving,\" she says. Both people survived.\u003c/p>\n\u003cp>Sturgeon had the drug with her because she works for Overdose Lifeline, a non-profit devoted to distributing naloxone, but many bystanders would be unprepared to help.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Last month, U.S. Surgeon General Jerome Adams\u003ca href=\"https://www.surgeongeneral.gov/priorities/opioid-overdose-prevention/naloxone-advisory.html\"> issued an advisory\u003c/a> urging more Americans to learn to use naloxone, and carry it with them in case they encounter someone who has overdosed.\u003c/p>\n\u003cp>With the increase in overdoses nationwide, the advisory suggests that lay responders — people who may witness an overdose before police or EMS arrive — can play a critical role in saving lives.\u003c/p>\n\u003cp>But if you're not a medical professional, getting a dose of naloxone can be difficult. It is a prescription drug and normally a doctor or nurse would have to directly prescribe it for the person at risk of overdosing. \u003ca href=\"http://www.healthlaw.org/about/staff/corey-davis\">Corey Davis\u003c/a>, an attorney for the National Health Law Program, says that creates a barrier for people with addiction.\u003c/p>\n\u003cp>\"A lot of people at risk of an overdose don't have contact with a medical provider or they're afraid because of stigma,\" he says.\u003c/p>\n\u003cp>To broaden access, every state and Washington, D.C., have\u003ca href=\"https://www.networkforphl.org/_asset/qz5pvn/legal-interventions-to-reduce-overdose.pdf\"> passed laws\u003c/a> making it easier for friends and family members or bystanders to get and use naloxone. Just how easy it is still depends on your state, or even the pharmacy you go to.[contextly_sidebar id=\"OLtZshPozlILTWQu7Kb7ffUBScI9pFPe\"]\u003c/p>\n\u003cp>Davis says most states allow something called third-party prescribing, which lets doctors prescribe naloxone to someone who knows the person at risk of an overdose. And most states have also passed \u003ca href=\"http://www.ncsl.org/research/civil-and-criminal-justice/drug-overdose-immunity-good-samaritan-laws.aspx#Calling%20911\">some kind of Good Samaritan law \u003c/a>providing legal immunity for people who administer the drug or call 911.\u003c/p>\n\u003cp>Davis says another type of law allows a kind of prescription called a standing order.\u003c/p>\n\u003cp>\"But instead of having a person's name on it, it has a group of people,\" says Davis.\u003c/p>\n\u003cp>A standing order could apply, for example, to anyone who takes opioid painkillers, or suffers from addiction. Or, Davis says, \"Anybody who might be in a position to assist someone, which unfortunately, today means essentially everybody.\"\u003c/p>\n\u003cp>In his home state of Indiana, Jerome Adams signed a statewide standing order in 2016, while serving as the state's health commissioner. It allows pharmacies, local health departments or nonprofits that register with the state and follow certain requirements to dispense the drug to anyone who requests it.\u003c/p>\n\u003cp>But two years later, only about half of Indiana pharmacies are registered, and local advocates say many people, even some pharmacists, are still unaware of the law.\u003c/p>\n\u003cp>Even if you understand the laws regulating naloxone in your state — and you feel comfortable asking for it at the pharmacy counter — there's still the cost, which has \u003ca href=\"https://www.npr.org/sections/health-shots/2017/08/08/541626627/first-responders-spending-more-on-overdose-reversal-drug\">gone up\u003c/a> in recent years. Two pharmacies near WFYI in Indianapolis, stock naloxone. One charged $80 for two doses of the generic form of the drug. The other charged $95 for two doses of Narcan, the brand-name version.\u003c/p>\n\u003cp>\"It's expensive,\" says Brad Ray, a researcher at Indiana University's School of Public and Environmental Affairs. \"People who are users are scraping money together to buy drugs. They're not prepared to buy naloxone with that money.\"\u003c/p>\n\u003cp>Several U.S. Senators have signed on to a\u003ca href=\"https://www.stabenow.senate.gov/news/stabenow-peters-call-on-administration-to-take-immediate-action-to-reduce-price-of-naloxone-a-life-saving-opioid-overdose-reversal-drug\"> letter\u003c/a> urging Health and Human Services Secretary Alex Azar to negotiate with drug companies to lower the price of naloxone.\u003c/p>\n\u003cp>For people who can't afford the drug, Ray says health departments and nonprofits can help. Laws in many states allow these organizations to dispense naloxone to lay responders.\u003c/p>\n\u003cp>Indiana's health department used federal and state funds to purchase nearly 14,000 naloxone kits since 2016, the state reports. The state distributes those free doses through county health departments. But nearly half of Indiana counties didn't request kits. And the majority of the kits went to first responders.[contextly_sidebar id=\"QGKuFYIV9TrVnnf8y5d9ZQaPW24b1pNM\"]\u003c/p>\n\u003cp>Local health departments, Ray says, need to work harder to get naloxone to people who might use it. People who use drugs, after all, may not feel comfortable going to the government for naloxone.\u003c/p>\n\u003cp>\"Getting it in the hands of users — that's the trick we need to figure out,\" Ray says.\u003c/p>\n\u003cp>Corey Davis says there is one change that could really help. The Food and Drug Administration or Congress could make naloxone an over-the-counter medication to make it easier to access, and maybe cheaper. FDA Commissioner Scott Gottlieb has the authority to do so, Davis says, but so far he has not.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This story is part of a reporting partnership with NPR, WFYI, \u003c/em>\u003ca href=\"http://sideeffectspublicmedia.org/\">\u003cem>Side Effects Public Media\u003c/em>\u003c/a>\u003cem> and \u003c/em>\u003ca href=\"http://www.kaiserhealthnews.org\">\u003cem>Kaiser Health News\u003c/em>\u003c/a>\u003cem>. \u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 Side Effects Public Media. To see more, visit \u003ca>Side Effects Public Media\u003c/a>.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Reversing+An+Overdose+Isn%27t+Complicated%2C+But+Getting+The+Antidote+Can+Be+&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>A few months ago, Kourtnaye Sturgeon helped save someone's life. She was driving in downtown Indianapolis when she saw people gathered around a car on the side of the road. Sturgeon pulled over and a man told her there was nothing she could do: Two men had overdosed on opioids and appeared to be dead.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\"I kind of recall saying, 'No man, I've got Narcan,' \" she says, referring to the brand- name version of the opioid overdose antidote, naloxone. \"Which sounds so silly, but I'm pretty sure that's what came out.\"\u003c/p>\n\u003cp>Sturgeon sprayed a dose of the drug up the driver's nose, and waited for it to take effect. About a minute later, she says, the paramedics showed up.\u003c/p>\n\u003cp>\"As they were walking towards us, the driver started slowly moving,\" she says. Both people survived.\u003c/p>\n\u003cp>Sturgeon had the drug with her because she works for Overdose Lifeline, a non-profit devoted to distributing naloxone, but many bystanders would be unprepared to help.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Last month, U.S. Surgeon General Jerome Adams\u003ca href=\"https://www.surgeongeneral.gov/priorities/opioid-overdose-prevention/naloxone-advisory.html\"> issued an advisory\u003c/a> urging more Americans to learn to use naloxone, and carry it with them in case they encounter someone who has overdosed.\u003c/p>\n\u003cp>With the increase in overdoses nationwide, the advisory suggests that lay responders — people who may witness an overdose before police or EMS arrive — can play a critical role in saving lives.\u003c/p>\n\u003cp>But if you're not a medical professional, getting a dose of naloxone can be difficult. It is a prescription drug and normally a doctor or nurse would have to directly prescribe it for the person at risk of overdosing. \u003ca href=\"http://www.healthlaw.org/about/staff/corey-davis\">Corey Davis\u003c/a>, an attorney for the National Health Law Program, says that creates a barrier for people with addiction.\u003c/p>\n\u003cp>\"A lot of people at risk of an overdose don't have contact with a medical provider or they're afraid because of stigma,\" he says.\u003c/p>\n\u003cp>To broaden access, every state and Washington, D.C., have\u003ca href=\"https://www.networkforphl.org/_asset/qz5pvn/legal-interventions-to-reduce-overdose.pdf\"> passed laws\u003c/a> making it easier for friends and family members or bystanders to get and use naloxone. Just how easy it is still depends on your state, or even the pharmacy you go to.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Davis says most states allow something called third-party prescribing, which lets doctors prescribe naloxone to someone who knows the person at risk of an overdose. And most states have also passed \u003ca href=\"http://www.ncsl.org/research/civil-and-criminal-justice/drug-overdose-immunity-good-samaritan-laws.aspx#Calling%20911\">some kind of Good Samaritan law \u003c/a>providing legal immunity for people who administer the drug or call 911.\u003c/p>\n\u003cp>Davis says another type of law allows a kind of prescription called a standing order.\u003c/p>\n\u003cp>\"But instead of having a person's name on it, it has a group of people,\" says Davis.\u003c/p>\n\u003cp>A standing order could apply, for example, to anyone who takes opioid painkillers, or suffers from addiction. Or, Davis says, \"Anybody who might be in a position to assist someone, which unfortunately, today means essentially everybody.\"\u003c/p>\n\u003cp>In his home state of Indiana, Jerome Adams signed a statewide standing order in 2016, while serving as the state's health commissioner. It allows pharmacies, local health departments or nonprofits that register with the state and follow certain requirements to dispense the drug to anyone who requests it.\u003c/p>\n\u003cp>But two years later, only about half of Indiana pharmacies are registered, and local advocates say many people, even some pharmacists, are still unaware of the law.\u003c/p>\n\u003cp>Even if you understand the laws regulating naloxone in your state — and you feel comfortable asking for it at the pharmacy counter — there's still the cost, which has \u003ca href=\"https://www.npr.org/sections/health-shots/2017/08/08/541626627/first-responders-spending-more-on-overdose-reversal-drug\">gone up\u003c/a> in recent years. Two pharmacies near WFYI in Indianapolis, stock naloxone. One charged $80 for two doses of the generic form of the drug. The other charged $95 for two doses of Narcan, the brand-name version.\u003c/p>\n\u003cp>\"It's expensive,\" says Brad Ray, a researcher at Indiana University's School of Public and Environmental Affairs. \"People who are users are scraping money together to buy drugs. They're not prepared to buy naloxone with that money.\"\u003c/p>\n\u003cp>Several U.S. Senators have signed on to a\u003ca href=\"https://www.stabenow.senate.gov/news/stabenow-peters-call-on-administration-to-take-immediate-action-to-reduce-price-of-naloxone-a-life-saving-opioid-overdose-reversal-drug\"> letter\u003c/a> urging Health and Human Services Secretary Alex Azar to negotiate with drug companies to lower the price of naloxone.\u003c/p>\n\u003cp>For people who can't afford the drug, Ray says health departments and nonprofits can help. Laws in many states allow these organizations to dispense naloxone to lay responders.\u003c/p>\n\u003cp>Indiana's health department used federal and state funds to purchase nearly 14,000 naloxone kits since 2016, the state reports. The state distributes those free doses through county health departments. But nearly half of Indiana counties didn't request kits. And the majority of the kits went to first responders.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Local health departments, Ray says, need to work harder to get naloxone to people who might use it. People who use drugs, after all, may not feel comfortable going to the government for naloxone.\u003c/p>\n\u003cp>\"Getting it in the hands of users — that's the trick we need to figure out,\" Ray says.\u003c/p>\n\u003cp>Corey Davis says there is one change that could really help. The Food and Drug Administration or Congress could make naloxone an over-the-counter medication to make it easier to access, and maybe cheaper. FDA Commissioner Scott Gottlieb has the authority to do so, Davis says, but so far he has not.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This story is part of a reporting partnership with NPR, WFYI, \u003c/em>\u003ca href=\"http://sideeffectspublicmedia.org/\">\u003cem>Side Effects Public Media\u003c/em>\u003c/a>\u003cem> and \u003c/em>\u003ca href=\"http://www.kaiserhealthnews.org\">\u003cem>Kaiser Health News\u003c/em>\u003c/a>\u003cem>. \u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 Side Effects Public Media. To see more, visit \u003ca>Side Effects Public Media\u003c/a>.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Reversing+An+Overdose+Isn%27t+Complicated%2C+But+Getting+The+Antidote+Can+Be+&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Drug Epidemic Ensnares 25-year-old Pill for Nerve Pain",
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"content": "\u003cp>The story line sounds familiar: a popular pain drug becomes a new way to get high as prescribing by doctors soars.[contextly_sidebar id=\"nqQZEbgxZJk2YXcLkKmogofHmb5GxUKD\"]\u003c/p>\n\u003cp>But the latest drug raising red flags is not part of the opioid family at the center of the nation’s drug epidemic. It’s a 25-year-old generic pill long seen as a low risk way to treat seizures, nerve pain and other ailments.\u003c/p>\n\u003cp>The drug, called gabapentin, is one of the most prescribed medications in the U.S., ranking ninth over the last year, according to prescription tracker GoodRx. Researchers attribute the recent surge to tighter restrictions on opioid painkillers, which have left doctors searching for alternatives for their patients.\u003c/p>\n\u003cp>Those same forces are changing the drugs that Americans abuse, according to experts.\u003c/p>\n\u003cp>“We’re basically squeezing people into other drugs because the prescription opioids are becoming a lot harder to get,” said Dr. Richard Dart, who tracks drug abuse through a national data network owned by the state of Colorado.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>While prescriptions for opioids like Vicodin and Oxycontin have been falling since 2012, health regulators have seen increased overdoses with unexpected medications, including the over-the-counter diarrhea drug Imodium.\u003c/p>\n\u003cp>The Food and Drug Administration is now studying patterns of prescribing and illicit use of gabapentin and will soon share its findings, said Commissioner Scott Gottlieb.\u003c/p>\n\u003cp>“One of the lessons from this whole opioid crisis is that we probably were too slow to act where we saw problems emerging and we waited for more definitive conclusions,” Gottlieb said. “I don’t want to be sitting here five or 10 years from now lamenting that we didn’t take more aggressive action.”\u003c/p>\n\u003cp>Many doctors aren’t aware of gabapentin’s potential for abuse, particularly among those with a history of misusing drugs, said Rachel Vickers Smith of the University of Louisville.\u003c/p>\n\u003cp>People tracked in her research describe gabapentin as a “cheap high” that is almost “always available.” They report mixing the drug with opioids, marijuana and cocaine to enhance the high, with effects ranging from “increased energy” to a “mellow” numbness.[contextly_sidebar id=\"oL9ue2pfrjviaEyvbdyv9JyLxYq7wQnY\"]\u003c/p>\n\u003cp>Medical journal articles estimate that between 15 and 25 percent of opioid abusers also use gabapentin. And emerging research suggests combining gabapentin and opioids heightens the overdose risks.\u003c/p>\n\u003cp>Gabapentin, on the market since 1993, has long been considered nonaddictive and is not tracked as closely as riskier drugs like opioids. But calls to U.S. poison control centers show a stark rise in abuse and overdoses.\u003c/p>\n\u003cp>The abuse rate increased nearly 400 percent between 2006 and 2015, according to poison center data analyzed by the RADARS research group within the Denver Health and Hospital Authority, a state-owned health system. The group’s work is funded by drugmakers and government agencies, though they don’t participate in the analysis or publication of the data.\u003c/p>\n\u003cp>In some parts of the U.S., the rise in gabapentin abuse has led to new restrictions and surveillance.\u003c/p>\n\u003cp>Last year, Kentucky became the first state to classify the drug as a “scheduled substance,” placing it among other high-risk medicines subject to extra restrictions and tracking. Gabapentin was detected in a third of fatal overdose cases analyzed by Kentucky medical examiners in 2016. Now, only health professionals registered with the federal government can prescribe the drug and patients are limited to five refills.\u003c/p>\n\u003cp>Ohio, Minnesota, West Virginia and several other states have begun tracking gabapentin through their prescription databases. Ohio took that step after gabapentin became the most dispensed drug in the state. State surveys of drug users also indicated it was “extremely easy to get” with a street price around $1.50 per capsule.\u003c/p>\n\u003cp>Alyssa Peckham, a researcher at Midwestern University in Arizona, believes a more comprehensive federal response is needed, including possibly reclassifying it nationwide. Like others, Peckham says gabapentin is not dangerous on its own, but can be when combined with opioids and other drugs that suppress breathing.[contextly_sidebar id=\"1Nyjt2T01ZS5Ppu0JX4gRyT1iBHar5yn\"]\u003c/p>\n\u003cp>Still, there is little consensus about the next steps, or even the scope of the problem.\u003c/p>\n\u003cp>Michael Polydefkis, a neurologist at John Hopkins University who primarily treats seniors with nerve pain, says he has never seen patients deliberately misuse gabapentin.\u003c/p>\n\u003cp>And given recent restrictions on opioids by hospitals, insurers and government authorities, many physicians are wary of limiting any other medicines that can help treat pain. The Center for Disease Control and Prevention’s prescribing guidelines endorse gabapentin as a good choice for nerve pain.\u003c/p>\n\u003cp>But there are questions about how much is being prescribed for proven uses — and to what extent patients are benefiting. A recent review of research by the Cochrane Group confirmed gabapentin’s benefits for several forms of nerve pain, but found little evidence of its effectiveness for more common muscle and joint pain.\u003c/p>\n\u003cp>Historically, the vast majority of prescriptions have been for uses not OK’d by the FDA as safe or effective.\u003c/p>\n\u003cp>“This drug was kind of unusual in that it was prescribed as a kind of miracle pill that could be used for anything,” said Dr. Joseph Ross, a researcher at Yale University’s school of medicine.\u003c/p>\n\u003cp>In a recent Journal of the American Medical Association, he called for new studies of gabapentin’s real-world use.\u003c/p>\n\u003cp>The freewheeling prescribing dates to years of aggressive marketing by the drug’s original manufacturer, Warner-Lambert. The company pleaded guilty and agreed to pay more than $430 million in 2004 to settle charges that it promoted gabapentin for a slew of unapproved uses, including migraines, attention deficit disorder, bipolar disorder and Lou Gehrig’s disease. While doctors are free to prescribe drugs for any use, drugmakers can only market their products for those uses approved by the FDA.\u003c/p>\n\u003cp>Warner-Lambert was bought in 2000 by Pfizer, which continues to sell gabapentin under its original brand-name Neurontin. Pfizer also sells a similar drug named Lyrica, a blockbuster medication approved for fibromyalgia, diabetic nerve pain and several other uses. Unlike gabapentin, Lyrica is a scheduled substance under federal law, in part due to reports of euphoria and other side effects suggesting “abuse potential.”\u003c/p>\n\u003cp>With tighter restrictions and a lone manufacturer, Lyrica has not seen the same problems as gabapentin.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“Pfizer recognizes the importance of preventing the misuse and abuse of our medicines and will continue working with regulatory authorities and health officials to monitor the safety of these medicines,” the company said in a statement.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>While prescriptions for opioids like Vicodin and Oxycontin have been falling since 2012, health regulators have seen increased overdoses with unexpected medications, including the over-the-counter diarrhea drug Imodium.\u003c/p>\n\u003cp>The Food and Drug Administration is now studying patterns of prescribing and illicit use of gabapentin and will soon share its findings, said Commissioner Scott Gottlieb.\u003c/p>\n\u003cp>“One of the lessons from this whole opioid crisis is that we probably were too slow to act where we saw problems emerging and we waited for more definitive conclusions,” Gottlieb said. “I don’t want to be sitting here five or 10 years from now lamenting that we didn’t take more aggressive action.”\u003c/p>\n\u003cp>Many doctors aren’t aware of gabapentin’s potential for abuse, particularly among those with a history of misusing drugs, said Rachel Vickers Smith of the University of Louisville.\u003c/p>\n\u003cp>People tracked in her research describe gabapentin as a “cheap high” that is almost “always available.” They report mixing the drug with opioids, marijuana and cocaine to enhance the high, with effects ranging from “increased energy” to a “mellow” numbness.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Medical journal articles estimate that between 15 and 25 percent of opioid abusers also use gabapentin. And emerging research suggests combining gabapentin and opioids heightens the overdose risks.\u003c/p>\n\u003cp>Gabapentin, on the market since 1993, has long been considered nonaddictive and is not tracked as closely as riskier drugs like opioids. But calls to U.S. poison control centers show a stark rise in abuse and overdoses.\u003c/p>\n\u003cp>The abuse rate increased nearly 400 percent between 2006 and 2015, according to poison center data analyzed by the RADARS research group within the Denver Health and Hospital Authority, a state-owned health system. The group’s work is funded by drugmakers and government agencies, though they don’t participate in the analysis or publication of the data.\u003c/p>\n\u003cp>In some parts of the U.S., the rise in gabapentin abuse has led to new restrictions and surveillance.\u003c/p>\n\u003cp>Last year, Kentucky became the first state to classify the drug as a “scheduled substance,” placing it among other high-risk medicines subject to extra restrictions and tracking. Gabapentin was detected in a third of fatal overdose cases analyzed by Kentucky medical examiners in 2016. Now, only health professionals registered with the federal government can prescribe the drug and patients are limited to five refills.\u003c/p>\n\u003cp>Ohio, Minnesota, West Virginia and several other states have begun tracking gabapentin through their prescription databases. Ohio took that step after gabapentin became the most dispensed drug in the state. State surveys of drug users also indicated it was “extremely easy to get” with a street price around $1.50 per capsule.\u003c/p>\n\u003cp>Alyssa Peckham, a researcher at Midwestern University in Arizona, believes a more comprehensive federal response is needed, including possibly reclassifying it nationwide. Like others, Peckham says gabapentin is not dangerous on its own, but can be when combined with opioids and other drugs that suppress breathing.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Still, there is little consensus about the next steps, or even the scope of the problem.\u003c/p>\n\u003cp>Michael Polydefkis, a neurologist at John Hopkins University who primarily treats seniors with nerve pain, says he has never seen patients deliberately misuse gabapentin.\u003c/p>\n\u003cp>And given recent restrictions on opioids by hospitals, insurers and government authorities, many physicians are wary of limiting any other medicines that can help treat pain. The Center for Disease Control and Prevention’s prescribing guidelines endorse gabapentin as a good choice for nerve pain.\u003c/p>\n\u003cp>But there are questions about how much is being prescribed for proven uses — and to what extent patients are benefiting. A recent review of research by the Cochrane Group confirmed gabapentin’s benefits for several forms of nerve pain, but found little evidence of its effectiveness for more common muscle and joint pain.\u003c/p>\n\u003cp>Historically, the vast majority of prescriptions have been for uses not OK’d by the FDA as safe or effective.\u003c/p>\n\u003cp>“This drug was kind of unusual in that it was prescribed as a kind of miracle pill that could be used for anything,” said Dr. Joseph Ross, a researcher at Yale University’s school of medicine.\u003c/p>\n\u003cp>In a recent Journal of the American Medical Association, he called for new studies of gabapentin’s real-world use.\u003c/p>\n\u003cp>The freewheeling prescribing dates to years of aggressive marketing by the drug’s original manufacturer, Warner-Lambert. The company pleaded guilty and agreed to pay more than $430 million in 2004 to settle charges that it promoted gabapentin for a slew of unapproved uses, including migraines, attention deficit disorder, bipolar disorder and Lou Gehrig’s disease. While doctors are free to prescribe drugs for any use, drugmakers can only market their products for those uses approved by the FDA.\u003c/p>\n\u003cp>Warner-Lambert was bought in 2000 by Pfizer, which continues to sell gabapentin under its original brand-name Neurontin. Pfizer also sells a similar drug named Lyrica, a blockbuster medication approved for fibromyalgia, diabetic nerve pain and several other uses. Unlike gabapentin, Lyrica is a scheduled substance under federal law, in part due to reports of euphoria and other side effects suggesting “abuse potential.”\u003c/p>\n\u003cp>With tighter restrictions and a lone manufacturer, Lyrica has not seen the same problems as gabapentin.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“Pfizer recognizes the importance of preventing the misuse and abuse of our medicines and will continue working with regulatory authorities and health officials to monitor the safety of these medicines,” the company said in a statement.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Lyme disease was once unheard of in western Pennsylvania, where \u003ca href=\"http://entomology.umd.edu/thorne-barbara-l.html\" target=\"_blank\" rel=\"noopener\">Barbara Thorne\u003c/a>, now an entomologist at the University of Maryland, spent time as a kid.[contextly_sidebar id=\"E5lWczNbOj0QujgLs3u3AfAeFh9XRm6X\"]\u003c/p>\n\u003cp>Thorne knew that if black-legged ticks are infected with bacteria called \u003cem>Borrelia burgdorferi\u003c/em>, they can \u003ca href=\"https://www.cdc.gov/lyme/index.html\" target=\"_blank\" rel=\"noopener\">transmit Lyme to people\u003c/a> and, that if untreated, symptoms can range from fever, fatigue and a rash, to serious damage to the joints, heart and nervous system.\u003c/p>\n\u003cp>But she didn't realize that ticks in that part of Pennsylvania had become broadly infected with the bacteria. That is, until she was bitten during a family reunion weekend.\u003c/p>\n\u003cp>She never saw the tick on her body. But about eight or nine days later, after returning home, she became suspicious.\u003c/p>\n\u003cp>\"I noticed a \u003ca href=\"https://phpa.health.maryland.gov/OIDEOR/CZVBD/Shared%20Documents/Lyme_MD_poster_FINAL.pdf\" target=\"_blank\" rel=\"noopener\">roundish red rash\u003c/a> above my waistline and it expanded each day,\" she recalls. \"I was also feeling sick with exhaustion and achiness.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Her primary care doctor diagnosed her with Lyme disease and prescribed a course of antibiotics. After a few months, she felt better.\u003c/p>\n\u003cp>\"I felt very lucky to have had the rash appear as literally a red flag,\" Thorne says. It's a telltale warning sign of the disease.\u003c/p>\n\u003cp>But not everyone with a Lyme infection develops a rash. And other symptoms, such as fatigue and aches, overlap with common illnesses. So, spotting Lyme disease can be tricky. Some people don't realize they're infected and don't seek medical treatment.\u003c/p>\n\u003cp>The Centers for Disease Control and Prevention estimates the actual prevalence of Lyme disease infections is 10 times higher than the number of reported cases.\u003c/p>\n\u003cp>Tick-borne diseases have been \"steadily going up every year ... as the diseases expand to new areas around the country,\" Lyle Peterson of the CDC told reporters in a recent conference call announcing the updated infection \u003ca href=\"https://www.cdc.gov/vitalsigns/vector-borne/\" target=\"_blank\" rel=\"noopener\">estimates\u003c/a>. Lyme disease accounts for about 80 percent of the \u003ca href=\"https://www.cdc.gov/ticks/Diseases/\" target=\"_blank\" rel=\"noopener\">tick-borne illnesses\u003c/a> in the U.S.[contextly_sidebar id=\"BEEx9bfux3jHbZOJBeYj9WisqBPO0MxG\"]\u003c/p>\n\u003cp>Another factor that can contribute to the underreporting of cases is a lack of effective surveillance and tracking.\u003c/p>\n\u003cp>\"People just go to their local doctor to be treated,\" says Peterson, and the doctor may not report the case to the local or state health department. Or, if the case \u003cem>is\u003c/em> reported by the doctor, he says, sometimes \"state health departments have a very difficult time keeping up with the sheer number of cases reports.\"\u003c/p>\n\u003cp>There's another factor at play, too: shortcomings in the way the infection is diagnosed.\u003c/p>\n\u003cp>\"Many of the tests for Lyme disease are negative at the time that patients first visit their doctor,\" says \u003ca href=\"https://medicine.yale.edu/pathology/people/PNF2.profile\" target=\"_blank\" rel=\"noopener\">Dr. Paul Fiedler\u003c/a>, a clinical pathologist on Yale School of Medicine's faculty who also heads the department of pathology at Western Connecticut Health Network.\u003c/p>\n\u003cp>Blood tests to detect Lyme disease rely on a person's immune response, Fiedler explains, and after infection with the bacteria, it takes time — sometimes as long as 10 to 30 days — for the body to mount a measurable response. The blood tests detect Lyme-specific antibodies.\u003c/p>\n\u003cp>If somebody is tested before the immune system has produced enough antibodies, the result will be a false negative.\u003c/p>\n\u003cp>\"And the diagnosis could be missed,\" Fiedler says. The subsequent lack of treatment after a missed diagnosis can lead to \u003ca href=\"https://www.cdc.gov/lyme/resources/brochure/lymediseasebrochure.pdf\" target=\"_blank\" rel=\"noopener\">serious health problems\u003c/a>.\u003c/p>\n\u003cp>But Thorne says it's possible to take steps to help prevent Lyme disease if you're meticulous.\u003c/p>\n\u003cp>In the spring, \u003ca href=\"http://wnpr.org/post/six-things-know-about-ticks-and-lyme-disease\" target=\"_blank\" rel=\"noopener\">tick nymphs\u003c/a> — young versions that transmit most of the Lyme infections — are abundant. They're tiny, no bigger than a pinhead or poppy seed, and tend to hang out in or near wooded areas, in brush or tall grass.[contextly_sidebar id=\"f5MAXyeLkwMp2ontpm3K4PW45yEGQUWn\"]\u003c/p>\n\u003cp>The ticks need a blood meal to stay alive. They tend to \u003ca href=\"https://www.cdc.gov/ticks/life_cycle_and_hosts.html\">feed \u003c/a>on small mammals, such as mice, or birds. But if you happen to brush against a stick, blade or stem they're clinging to, they can easily hitch a ride on you. And you won't feel a thing.\u003c/p>\n\u003cp>If you're hiking in or near a wooded area, it's wise to be on the lookout for nymphs on your skin or clothing when you get home. \"They're small, but they're not invisible,\" Thorne says.\u003c/p>\n\u003cp>She recommends light-colored clothing (to increase likelihood you'll notice the darker fleck of an insect) and long sleeves. Insect repellent may help, but Thorne says the most effective strategy is a thorough tick check of your body after you've been in tick-infested areas.\u003c/p>\n\u003cp>\"The ticks do tend to climb upward — like they climb up your legs,\" Thorne says. \"They often attach where there was a constriction of clothing, like around the waistline.\" (She's compiled personal protection \u003ca href=\"https://extension.umd.edu/sites/extension.umd.edu/files/_images/programs/hgic/Publications/non_HGIC_FS/FS595.pdf\" target=\"_blank\" rel=\"noopener\">tips in this bulletin\u003c/a>.)\u003c/p>\n\u003cp>Other favorite hiding spots include armpits, or behind your ears. If you do find one attached to your body, use a pair of narrow tweezers to \u003ca href=\"https://www.cdc.gov/ticks/removing_a_tick.html\" target=\"_blank\" rel=\"noopener\">grasp the tick very near the surface of the skin\u003c/a> and tug upward with steady pressure.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Don't freak out if the insect's been attached a few hours. In general, the CDC says, ticks need to be attached for 36 to 48 hours before they can transmit the bacteria that cause Lyme disease.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Lyme+Disease+Is+On+The+Rise+Again.+Here%27s+How+To+Prevent+It&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Lyme disease was once unheard of in western Pennsylvania, where \u003ca href=\"http://entomology.umd.edu/thorne-barbara-l.html\" target=\"_blank\" rel=\"noopener\">Barbara Thorne\u003c/a>, now an entomologist at the University of Maryland, spent time as a kid.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Thorne knew that if black-legged ticks are infected with bacteria called \u003cem>Borrelia burgdorferi\u003c/em>, they can \u003ca href=\"https://www.cdc.gov/lyme/index.html\" target=\"_blank\" rel=\"noopener\">transmit Lyme to people\u003c/a> and, that if untreated, symptoms can range from fever, fatigue and a rash, to serious damage to the joints, heart and nervous system.\u003c/p>\n\u003cp>But she didn't realize that ticks in that part of Pennsylvania had become broadly infected with the bacteria. That is, until she was bitten during a family reunion weekend.\u003c/p>\n\u003cp>She never saw the tick on her body. But about eight or nine days later, after returning home, she became suspicious.\u003c/p>\n\u003cp>\"I noticed a \u003ca href=\"https://phpa.health.maryland.gov/OIDEOR/CZVBD/Shared%20Documents/Lyme_MD_poster_FINAL.pdf\" target=\"_blank\" rel=\"noopener\">roundish red rash\u003c/a> above my waistline and it expanded each day,\" she recalls. \"I was also feeling sick with exhaustion and achiness.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Her primary care doctor diagnosed her with Lyme disease and prescribed a course of antibiotics. After a few months, she felt better.\u003c/p>\n\u003cp>\"I felt very lucky to have had the rash appear as literally a red flag,\" Thorne says. It's a telltale warning sign of the disease.\u003c/p>\n\u003cp>But not everyone with a Lyme infection develops a rash. And other symptoms, such as fatigue and aches, overlap with common illnesses. So, spotting Lyme disease can be tricky. Some people don't realize they're infected and don't seek medical treatment.\u003c/p>\n\u003cp>The Centers for Disease Control and Prevention estimates the actual prevalence of Lyme disease infections is 10 times higher than the number of reported cases.\u003c/p>\n\u003cp>Tick-borne diseases have been \"steadily going up every year ... as the diseases expand to new areas around the country,\" Lyle Peterson of the CDC told reporters in a recent conference call announcing the updated infection \u003ca href=\"https://www.cdc.gov/vitalsigns/vector-borne/\" target=\"_blank\" rel=\"noopener\">estimates\u003c/a>. Lyme disease accounts for about 80 percent of the \u003ca href=\"https://www.cdc.gov/ticks/Diseases/\" target=\"_blank\" rel=\"noopener\">tick-borne illnesses\u003c/a> in the U.S.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Another factor that can contribute to the underreporting of cases is a lack of effective surveillance and tracking.\u003c/p>\n\u003cp>\"People just go to their local doctor to be treated,\" says Peterson, and the doctor may not report the case to the local or state health department. Or, if the case \u003cem>is\u003c/em> reported by the doctor, he says, sometimes \"state health departments have a very difficult time keeping up with the sheer number of cases reports.\"\u003c/p>\n\u003cp>There's another factor at play, too: shortcomings in the way the infection is diagnosed.\u003c/p>\n\u003cp>\"Many of the tests for Lyme disease are negative at the time that patients first visit their doctor,\" says \u003ca href=\"https://medicine.yale.edu/pathology/people/PNF2.profile\" target=\"_blank\" rel=\"noopener\">Dr. Paul Fiedler\u003c/a>, a clinical pathologist on Yale School of Medicine's faculty who also heads the department of pathology at Western Connecticut Health Network.\u003c/p>\n\u003cp>Blood tests to detect Lyme disease rely on a person's immune response, Fiedler explains, and after infection with the bacteria, it takes time — sometimes as long as 10 to 30 days — for the body to mount a measurable response. The blood tests detect Lyme-specific antibodies.\u003c/p>\n\u003cp>If somebody is tested before the immune system has produced enough antibodies, the result will be a false negative.\u003c/p>\n\u003cp>\"And the diagnosis could be missed,\" Fiedler says. The subsequent lack of treatment after a missed diagnosis can lead to \u003ca href=\"https://www.cdc.gov/lyme/resources/brochure/lymediseasebrochure.pdf\" target=\"_blank\" rel=\"noopener\">serious health problems\u003c/a>.\u003c/p>\n\u003cp>But Thorne says it's possible to take steps to help prevent Lyme disease if you're meticulous.\u003c/p>\n\u003cp>In the spring, \u003ca href=\"http://wnpr.org/post/six-things-know-about-ticks-and-lyme-disease\" target=\"_blank\" rel=\"noopener\">tick nymphs\u003c/a> — young versions that transmit most of the Lyme infections — are abundant. They're tiny, no bigger than a pinhead or poppy seed, and tend to hang out in or near wooded areas, in brush or tall grass.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>The ticks need a blood meal to stay alive. They tend to \u003ca href=\"https://www.cdc.gov/ticks/life_cycle_and_hosts.html\">feed \u003c/a>on small mammals, such as mice, or birds. But if you happen to brush against a stick, blade or stem they're clinging to, they can easily hitch a ride on you. And you won't feel a thing.\u003c/p>\n\u003cp>If you're hiking in or near a wooded area, it's wise to be on the lookout for nymphs on your skin or clothing when you get home. \"They're small, but they're not invisible,\" Thorne says.\u003c/p>\n\u003cp>She recommends light-colored clothing (to increase likelihood you'll notice the darker fleck of an insect) and long sleeves. Insect repellent may help, but Thorne says the most effective strategy is a thorough tick check of your body after you've been in tick-infested areas.\u003c/p>\n\u003cp>\"The ticks do tend to climb upward — like they climb up your legs,\" Thorne says. \"They often attach where there was a constriction of clothing, like around the waistline.\" (She's compiled personal protection \u003ca href=\"https://extension.umd.edu/sites/extension.umd.edu/files/_images/programs/hgic/Publications/non_HGIC_FS/FS595.pdf\" target=\"_blank\" rel=\"noopener\">tips in this bulletin\u003c/a>.)\u003c/p>\n\u003cp>Other favorite hiding spots include armpits, or behind your ears. If you do find one attached to your body, use a pair of narrow tweezers to \u003ca href=\"https://www.cdc.gov/ticks/removing_a_tick.html\" target=\"_blank\" rel=\"noopener\">grasp the tick very near the surface of the skin\u003c/a> and tug upward with steady pressure.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Don't freak out if the insect's been attached a few hours. In general, the CDC says, ticks need to be attached for 36 to 48 hours before they can transmit the bacteria that cause Lyme disease.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Lyme+Disease+Is+On+The+Rise+Again.+Here%27s+How+To+Prevent+It&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>When 47-year-old Edward Vega arrived in jail, he couldn't quiet the voices in his head. He felt paranoid, as though he was losing control. \"I knew if I didn't get my medication, I was going to hurt someone,\" says Vega.[contextly_sidebar id=\"YDcmJjX7F7HH44z0nu01J3iPX3pogbrO\"]\u003c/p>\n\u003cp>He was right. A week after being arrested for alleged drug possession, Vega says, he assaulted a fellow inmate and ended up in isolation, which only made him feel worse.\u003c/p>\n\u003cp>Finally, a doctor prescribed drugs that Vega says helped. He had been taking them on the outside until he ran out — just before he was arrested.\u003c/p>\n\u003cp>\"The medication hasn't totally taken away the voices, but I am able to differentiate reality from fiction,\" says Vega, who was released three months ago.\u003c/p>\n\u003cp>The number of inmates in California who've been prescribed psychiatric drugs has jumped about 25 percent in five years, according to a recent \u003ca href=\"http://calhps.com/reports/PolicyBrief_PsychotropicMedications_CalHPS.pdf\">analysis\u003c/a> of state data. These inmates now account for about a fifth of the county jail population across the state.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The increase might be a reflection of the growing number of inmates with mental illness, though it also might stem from better identification of people in need of treatment, say researchers from \u003ca href=\"http://calhps.com/reports/PolicyBrief_PsychotropicMedications_CalHPS.pdf\">California Health Policy Strategies\u003c/a>, a Sacramento-based consulting firm.\u003c/p>\n\u003cp>Amid a \u003ca href=\"https://www.pbs.org/newshour/nation/amid-shortage-psychiatric-beds-mentally-ill-face-long-waits-treatment\">severe shortage of psychiatric beds\u003c/a> and community-based treatment throughout the state and nation, jails have become repositories for people in the throes of acute mental health crises.[contextly_sidebar id=\"D5Bt82ZgsZndCE9fShaMqKXcPTJBdRrC\"]\u003c/p>\n\u003cp>The number of people with mental illness in jails and prisons in the U.S. is \"astronomical,\" says \u003ca href=\"https://law.stanford.edu/directory/michael-romano/\">Michael Romano\u003c/a>, director of Three Strikes & Justice Advocacy Project at Stanford Law School, who was not involved in the research. \"In many ways, the whole justice system is overwhelmed with mental illness.\"\u003c/p>\n\u003cp>Contributing to the problem in California is a 2011 federal court order, and a state decision a few years later, that had unintended consequences.\u003c/p>\n\u003cp>In 2011, the U.S. Supreme Court ordered California to \u003ca href=\"https://www.npr.org/2011/05/23/136579580/california-is-ordered-to-cut-its-prison-population\">reduce\u003c/a> the prison population because of overcrowding that the judges said constituted cruel and unusual punishment. Three years later, \u003ca href=\"https://www.cdcr.ca.gov/News/prop47.html\">a state proposition\u003c/a> reclassified some felony crimes as misdemeanors. Taken together, that led to a huge influx of offenders going to county jails instead of state prisons.\u003c/p>\n\u003cp>The CHPS analysis, based on survey data from 45 of California's 58 counties, opens a window into how the largest state is coping with the influx.\u003c/p>\n\u003cp>\"We think this is the first part of a more systematic discussion about what is going on in the jails and in the broader community with respect to mental health,\" says \u003ca href=\"http://calhps.com/team_member/david-panush/\">David Panush\u003c/a>, a co-author of the report, which was funded in part by the California Health Care Foundation.\u003c/p>\n\u003cp>Far more people with mental illness are housed in jails and prisons than in psychiatric hospitals. Insufficient staff training and poor patient treatment have contributed to inmate suicides, self-mutilation, violence and other problems, say advocates for the mentally ill.[contextly_sidebar id=\"pepgQkVipmt7yN3DpLndFi1ek2hPWxA5\"]\u003c/p>\n\u003cp>One oft-cited complaint is that inmates have poor access to psychiatric prescriptions to treat such conditions as schizophrenia, major depression and bipolar disorder.\u003c/p>\n\u003cp>Jail officials in California say they are trying to better identify incarcerated people who could benefit from such drugs. The numbers suggest the strategy may be working. According to the CHPS report, an average of 13,776 inmates in the 45 California counties were on psychotropic medications in 2016-2017, up from 10,999 five years ago.\u003c/p>\n\u003cp>But the portion of inmates taking psychotropic medicine varies widely by county — from 8 percent in Glenn County to 32 percent in Sonoma and Napa, according to the analysis. The report is based on data from the \u003ca href=\"http://www.bscc.ca.gov/m_bsccboard.php\">Board of State and Community Corrections\u003c/a>, an independent state agency.\u003c/p>\n\u003cp>In Los Angeles County, whose jails have been described as the largest mental institution in the country, about 30 percent of the roughly 18,000 inmates are mentally ill and most of those diagnosed are on medication, says Dr. Joseph Ortego, chief psychiatrist for correctional health services in L.A. County.\u003c/p>\n\u003cp>Although some still are missed in the screening process, he says, the county jails have improved identification and treatment of inmates and expanded staffing as part of the department's 2015 settlement with the U.S. Department of Justice. The department had alleged inadequate mental health care and suicide prevention in the jails.\u003c/p>\n\u003cp>Overall, medications are likely under-prescribed in jails, psychiatrists say.\u003c/p>\n\u003cp>\"You need enough mental health professionals to treat the very large numbers of mentally ill people in jails,\" says \u003ca href=\"https://www.researchgate.net/profile/Harry_Lamb\">Dr. H. Richard Lamb\u003c/a>, professor emeritus of psychiatry at the University of Southern California School of Medicine. \"There probably aren't enough.\"\u003c/p>\n\u003cp>And the medications these doctors prescribe are a crucial aspect of treatment, Lamb says.\u003c/p>\n\u003cp>Some advocates for the mentally ill worry that the drugs are at times prescribed inappropriately. \u003ca href=\"http://www.mhac.org/about-us/staff/\">Zima Creason\u003c/a>, president and chief executive officer of Mental Health America of California, says psychoactive medicines, though sometimes necessary, are no substitute for comprehensive care for jail inmates.\u003c/p>\n\u003cp>\"Sadly, they just throw a bunch of pills at them because there is nothing else,\" she says, adding that jails should also be providing individual and group therapy, more time outside of cells and sufficient recreation time.[contextly_sidebar id=\"wc4q4QN6RflEHjnrUL9pMkzABwKTOUXL\"]\u003c/p>\n\u003cp>\"Jail is not conducive for real recovery,\" Creason says. \"We are never going to put a dent in the numbers unless we provide a therapeutic environment.\"\u003c/p>\n\u003cp>Like people who live outside the correction facilities, inmates can be subject to involuntary drug treatment, officials say, but only if a court deems that step appropriate.\u003c/p>\n\u003cp>County jail officials, including Dr. Alfred Joshua, chief medical officer for the Sheriff's Department in San Diego County, say the influx of mentally ill inmates and the rising need for psychotropic drugs stems from a lack of resources for patients in the community.\u003c/p>\n\u003cp>\"When they have [an] exacerbation of mental illness, they do many times come into contact with law enforcement,\" Joshua says.\u003c/p>\n\u003cp>Some of the most common charges that bring people with mental illness to jail are drug offenses and parole violations. Those who are homeless frequently get charged with panhandling, public urination and related crimes.\u003c/p>\n\u003cp>In addition to trying to improve treatment inside the jails, Los Angeles and San Diego county officials say they are working more closely with community organizations to ensure inmates with mental illness get the services they need after their release.\u003c/p>\n\u003cp>Vega says a local community group, the \u003ca href=\"http://www.neighborhoodhouse.org/#sthash.nTPgadqU.dpbs\">Neighborhood House Association\u003c/a>, was able to help in his case, ensuring he got his meds and other treatment.\u003c/p>\n\u003cp>\"Without the medication,\" Vega says, \"I would probably be right back in jail.\"\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003ca href=\"http://www.kaiserhealthnews.org/\">Kaiser Health News\u003c/a>\u003cem> is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente. You can follow Anna Gorman on Twitter: \u003c/em>\u003ca href=\"https://twitter.com/annagorman\">@annagorman\u003c/a>.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 Kaiser Health News. To see more, visit \u003ca href=\"http://www.kaiserhealthnews.org/\">Kaiser Health News\u003c/a>.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Big+Jump+In+Number+Of+Inmates+Prescribed+Psychiatric+Drugs+In+California&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>When 47-year-old Edward Vega arrived in jail, he couldn't quiet the voices in his head. He felt paranoid, as though he was losing control. \"I knew if I didn't get my medication, I was going to hurt someone,\" says Vega.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>He was right. A week after being arrested for alleged drug possession, Vega says, he assaulted a fellow inmate and ended up in isolation, which only made him feel worse.\u003c/p>\n\u003cp>Finally, a doctor prescribed drugs that Vega says helped. He had been taking them on the outside until he ran out — just before he was arrested.\u003c/p>\n\u003cp>\"The medication hasn't totally taken away the voices, but I am able to differentiate reality from fiction,\" says Vega, who was released three months ago.\u003c/p>\n\u003cp>The number of inmates in California who've been prescribed psychiatric drugs has jumped about 25 percent in five years, according to a recent \u003ca href=\"http://calhps.com/reports/PolicyBrief_PsychotropicMedications_CalHPS.pdf\">analysis\u003c/a> of state data. These inmates now account for about a fifth of the county jail population across the state.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The increase might be a reflection of the growing number of inmates with mental illness, though it also might stem from better identification of people in need of treatment, say researchers from \u003ca href=\"http://calhps.com/reports/PolicyBrief_PsychotropicMedications_CalHPS.pdf\">California Health Policy Strategies\u003c/a>, a Sacramento-based consulting firm.\u003c/p>\n\u003cp>Amid a \u003ca href=\"https://www.pbs.org/newshour/nation/amid-shortage-psychiatric-beds-mentally-ill-face-long-waits-treatment\">severe shortage of psychiatric beds\u003c/a> and community-based treatment throughout the state and nation, jails have become repositories for people in the throes of acute mental health crises.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>The number of people with mental illness in jails and prisons in the U.S. is \"astronomical,\" says \u003ca href=\"https://law.stanford.edu/directory/michael-romano/\">Michael Romano\u003c/a>, director of Three Strikes & Justice Advocacy Project at Stanford Law School, who was not involved in the research. \"In many ways, the whole justice system is overwhelmed with mental illness.\"\u003c/p>\n\u003cp>Contributing to the problem in California is a 2011 federal court order, and a state decision a few years later, that had unintended consequences.\u003c/p>\n\u003cp>In 2011, the U.S. Supreme Court ordered California to \u003ca href=\"https://www.npr.org/2011/05/23/136579580/california-is-ordered-to-cut-its-prison-population\">reduce\u003c/a> the prison population because of overcrowding that the judges said constituted cruel and unusual punishment. Three years later, \u003ca href=\"https://www.cdcr.ca.gov/News/prop47.html\">a state proposition\u003c/a> reclassified some felony crimes as misdemeanors. Taken together, that led to a huge influx of offenders going to county jails instead of state prisons.\u003c/p>\n\u003cp>The CHPS analysis, based on survey data from 45 of California's 58 counties, opens a window into how the largest state is coping with the influx.\u003c/p>\n\u003cp>\"We think this is the first part of a more systematic discussion about what is going on in the jails and in the broader community with respect to mental health,\" says \u003ca href=\"http://calhps.com/team_member/david-panush/\">David Panush\u003c/a>, a co-author of the report, which was funded in part by the California Health Care Foundation.\u003c/p>\n\u003cp>Far more people with mental illness are housed in jails and prisons than in psychiatric hospitals. Insufficient staff training and poor patient treatment have contributed to inmate suicides, self-mutilation, violence and other problems, say advocates for the mentally ill.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>One oft-cited complaint is that inmates have poor access to psychiatric prescriptions to treat such conditions as schizophrenia, major depression and bipolar disorder.\u003c/p>\n\u003cp>Jail officials in California say they are trying to better identify incarcerated people who could benefit from such drugs. The numbers suggest the strategy may be working. According to the CHPS report, an average of 13,776 inmates in the 45 California counties were on psychotropic medications in 2016-2017, up from 10,999 five years ago.\u003c/p>\n\u003cp>But the portion of inmates taking psychotropic medicine varies widely by county — from 8 percent in Glenn County to 32 percent in Sonoma and Napa, according to the analysis. The report is based on data from the \u003ca href=\"http://www.bscc.ca.gov/m_bsccboard.php\">Board of State and Community Corrections\u003c/a>, an independent state agency.\u003c/p>\n\u003cp>In Los Angeles County, whose jails have been described as the largest mental institution in the country, about 30 percent of the roughly 18,000 inmates are mentally ill and most of those diagnosed are on medication, says Dr. Joseph Ortego, chief psychiatrist for correctional health services in L.A. County.\u003c/p>\n\u003cp>Although some still are missed in the screening process, he says, the county jails have improved identification and treatment of inmates and expanded staffing as part of the department's 2015 settlement with the U.S. Department of Justice. The department had alleged inadequate mental health care and suicide prevention in the jails.\u003c/p>\n\u003cp>Overall, medications are likely under-prescribed in jails, psychiatrists say.\u003c/p>\n\u003cp>\"You need enough mental health professionals to treat the very large numbers of mentally ill people in jails,\" says \u003ca href=\"https://www.researchgate.net/profile/Harry_Lamb\">Dr. H. Richard Lamb\u003c/a>, professor emeritus of psychiatry at the University of Southern California School of Medicine. \"There probably aren't enough.\"\u003c/p>\n\u003cp>And the medications these doctors prescribe are a crucial aspect of treatment, Lamb says.\u003c/p>\n\u003cp>Some advocates for the mentally ill worry that the drugs are at times prescribed inappropriately. \u003ca href=\"http://www.mhac.org/about-us/staff/\">Zima Creason\u003c/a>, president and chief executive officer of Mental Health America of California, says psychoactive medicines, though sometimes necessary, are no substitute for comprehensive care for jail inmates.\u003c/p>\n\u003cp>\"Sadly, they just throw a bunch of pills at them because there is nothing else,\" she says, adding that jails should also be providing individual and group therapy, more time outside of cells and sufficient recreation time.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\"Jail is not conducive for real recovery,\" Creason says. \"We are never going to put a dent in the numbers unless we provide a therapeutic environment.\"\u003c/p>\n\u003cp>Like people who live outside the correction facilities, inmates can be subject to involuntary drug treatment, officials say, but only if a court deems that step appropriate.\u003c/p>\n\u003cp>County jail officials, including Dr. Alfred Joshua, chief medical officer for the Sheriff's Department in San Diego County, say the influx of mentally ill inmates and the rising need for psychotropic drugs stems from a lack of resources for patients in the community.\u003c/p>\n\u003cp>\"When they have [an] exacerbation of mental illness, they do many times come into contact with law enforcement,\" Joshua says.\u003c/p>\n\u003cp>Some of the most common charges that bring people with mental illness to jail are drug offenses and parole violations. Those who are homeless frequently get charged with panhandling, public urination and related crimes.\u003c/p>\n\u003cp>In addition to trying to improve treatment inside the jails, Los Angeles and San Diego county officials say they are working more closely with community organizations to ensure inmates with mental illness get the services they need after their release.\u003c/p>\n\u003cp>Vega says a local community group, the \u003ca href=\"http://www.neighborhoodhouse.org/#sthash.nTPgadqU.dpbs\">Neighborhood House Association\u003c/a>, was able to help in his case, ensuring he got his meds and other treatment.\u003c/p>\n\u003cp>\"Without the medication,\" Vega says, \"I would probably be right back in jail.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"http://www.kaiserhealthnews.org/\">Kaiser Health News\u003c/a>\u003cem> is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente. You can follow Anna Gorman on Twitter: \u003c/em>\u003ca href=\"https://twitter.com/annagorman\">@annagorman\u003c/a>.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 Kaiser Health News. To see more, visit \u003ca href=\"http://www.kaiserhealthnews.org/\">Kaiser Health News\u003c/a>.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Big+Jump+In+Number+Of+Inmates+Prescribed+Psychiatric+Drugs+In+California&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "DNA Match Sought to Catch Zodiac Killer After Break in Other Case",
"title": "DNA Match Sought to Catch Zodiac Killer After Break in Other Case",
"headTitle": "Future of You | KQED Future of You | KQED Science",
"content": "\u003cp>Northern California detectives still trying to identify the infamous Zodiac Killer who targeted victims in the late 1960s and taunted investigators with letters say they hope to try the same DNA tracing technology recently used to arrest a suspect in another string of cold-case serial slayings — those blamed on the Golden State Killer.[contextly_sidebar id=\"zUhwd65sr96OmXZ5rNGiH0XjWcE7Vddr\"]\u003c/p>\n\u003cp>But first they have to get a better DNA profile.\u003c/p>\n\u003cp>Several months ago, the Vallejo Police Department sent two letters written by the Zodiac Killer to a private lab in hopes of finding his DNA on the back of the stamps or envelope flaps that may have been licked. They are expecting results soon.\u003c/p>\n\u003cp>“They were confident they would be able to get something off it,” Vallejo police Detective Terry Poyser told the Sacramento Bee.\u003c/p>\n\u003cp>Poyser said he hopes a full DNA profile will be found that will enable detectives to try the same DNA sleuthing techniques that were used to arrest Joseph DeAngelo last month. Authorities suspect he committed at least 12 murders and 50 rapes in California between 1976 and 1986.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Investigators uploaded DNA collected at one of the crime scenes to an open-source genealogical website and found a partial match to a distant relative of DeAngelo’s. From there, they painstakingly constructed a family tree dating back several generations before they zeroed in on DeAngelo.\u003c/p>\n\u003cp>Some privacy advocates say they are concerned with the process and worry about future abuses, but detectives investigating the Zodiac Killer say they hope the technique will help solve one of the most vexing cold cases in the country.[contextly_sidebar id=\"g4kjcqBcthT0ZUevaj35GoD7FRXTonPJ\"]\u003c/p>\n\u003cp>“That’s a great idea,” said Gary Harmor, founder and director of the Serological Research Institute, a private DNA lab. “I think we’ll see more investigations use this technique.”\u003c/p>\n\u003cp>Detectives in Southern California are testing DNA collected from a double-murder and rape to see if they can be tied to DeAngelo. Another man, Craig Coley, was recently cleared of those crimes after spending 38 years in prison in the murder of a 24-year-old college student and her 4-year-old son in 1978.\u003c/p>\n\u003cp>The Zodiac Killer fatally stabbed or shot to death five people in Northern California in 1968 and 1969, then sent taunting letters and cryptograms to the police and newspapers. The Vallejo police are the lead investigators because the first two victims were killed there.\u003c/p>\n\u003cp>The suspect was dubbed the Zodiac Killer because some of the cryptograms included astrological symbols and references.\u003c/p>\n\u003cp>Various pieces of evidence, including a rope used to tie a victim as well as the letters, have been tested unsuccessfully for the killer’s DNA profile. Poyser said recent advances in DNA testing prompted investigators to seek a match on two of the killer’s letters.\u003c/p>\n\u003cp>Vallejo Mayor Bob Sampayan said the samples were sent to the lab as a matter of routine. Sampayan, a former homicide detective, said police submit samples every couple of years in hopes that advances in DNA testing will finally yield a profile detectives can use.[contextly_sidebar id=\"ij6OwtCH46Lhi3AkKIvypYUgun9XpRrV\"]\u003c/p>\n\u003cp>“It was coincidental,” Sampayan said of the new DNA test occurring at the same time as the breakthrough in the Golden State Killer case.\u003c/p>\n\u003cp>“There will come a time when we get a match,” he said.\u003c/p>\n\u003cp>The 2007 movie “Zodiac,” starring Jake Gyllenhaal and Robert Downey Jr., renewed widespread interest in a case that has always had a cult following of amateur detectives and cryptographers who sought to crack the killer’s code.\u003c/p>\n\u003cp>One of those amateur sleuths, Tom Voigt, said the key to solving the Zodiac killings is mimicking the Golden State Killer investigation, which included forming a full-time task force dedicated to the case and exploiting publicly accessible DNA databases.\u003c/p>\n\u003cp>Voigt said the Zodiac case was being investigated part time by a Police Department in a city that filed for municipal bankruptcy.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“There’s a formula to follow,” Voigt said. “And it’s to simply copy what happened to the Golden State Killer.”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Northern California detectives still trying to identify the infamous Zodiac Killer who targeted victims in the late 1960s and taunted investigators with letters say they hope to try the same DNA tracing technology recently used to arrest a suspect in another string of cold-case serial slayings — those blamed on the Golden State Killer.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>But first they have to get a better DNA profile.\u003c/p>\n\u003cp>Several months ago, the Vallejo Police Department sent two letters written by the Zodiac Killer to a private lab in hopes of finding his DNA on the back of the stamps or envelope flaps that may have been licked. They are expecting results soon.\u003c/p>\n\u003cp>“They were confident they would be able to get something off it,” Vallejo police Detective Terry Poyser told the Sacramento Bee.\u003c/p>\n\u003cp>Poyser said he hopes a full DNA profile will be found that will enable detectives to try the same DNA sleuthing techniques that were used to arrest Joseph DeAngelo last month. Authorities suspect he committed at least 12 murders and 50 rapes in California between 1976 and 1986.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Investigators uploaded DNA collected at one of the crime scenes to an open-source genealogical website and found a partial match to a distant relative of DeAngelo’s. From there, they painstakingly constructed a family tree dating back several generations before they zeroed in on DeAngelo.\u003c/p>\n\u003cp>Some privacy advocates say they are concerned with the process and worry about future abuses, but detectives investigating the Zodiac Killer say they hope the technique will help solve one of the most vexing cold cases in the country.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>“That’s a great idea,” said Gary Harmor, founder and director of the Serological Research Institute, a private DNA lab. “I think we’ll see more investigations use this technique.”\u003c/p>\n\u003cp>Detectives in Southern California are testing DNA collected from a double-murder and rape to see if they can be tied to DeAngelo. Another man, Craig Coley, was recently cleared of those crimes after spending 38 years in prison in the murder of a 24-year-old college student and her 4-year-old son in 1978.\u003c/p>\n\u003cp>The Zodiac Killer fatally stabbed or shot to death five people in Northern California in 1968 and 1969, then sent taunting letters and cryptograms to the police and newspapers. The Vallejo police are the lead investigators because the first two victims were killed there.\u003c/p>\n\u003cp>The suspect was dubbed the Zodiac Killer because some of the cryptograms included astrological symbols and references.\u003c/p>\n\u003cp>Various pieces of evidence, including a rope used to tie a victim as well as the letters, have been tested unsuccessfully for the killer’s DNA profile. Poyser said recent advances in DNA testing prompted investigators to seek a match on two of the killer’s letters.\u003c/p>\n\u003cp>Vallejo Mayor Bob Sampayan said the samples were sent to the lab as a matter of routine. Sampayan, a former homicide detective, said police submit samples every couple of years in hopes that advances in DNA testing will finally yield a profile detectives can use.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>“It was coincidental,” Sampayan said of the new DNA test occurring at the same time as the breakthrough in the Golden State Killer case.\u003c/p>\n\u003cp>“There will come a time when we get a match,” he said.\u003c/p>\n\u003cp>The 2007 movie “Zodiac,” starring Jake Gyllenhaal and Robert Downey Jr., renewed widespread interest in a case that has always had a cult following of amateur detectives and cryptographers who sought to crack the killer’s code.\u003c/p>\n\u003cp>One of those amateur sleuths, Tom Voigt, said the key to solving the Zodiac killings is mimicking the Golden State Killer investigation, which included forming a full-time task force dedicated to the case and exploiting publicly accessible DNA databases.\u003c/p>\n\u003cp>Voigt said the Zodiac case was being investigated part time by a Police Department in a city that filed for municipal bankruptcy.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“There’s a formula to follow,” Voigt said. “And it’s to simply copy what happened to the Golden State Killer.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp class=\"big-cap-wrap danger-zone\">\u003cspan class=\"big-cap\">R\u003c/span>esearchers have been left empty-handed so far in their quest to uncover some measurable biological signal that could be used to \u003ca href=\"https://www.statnews.com/2017/02/15/brain-scan-autism-infant-diagnose/\">diagnose autism spectrum disorder\u003c/a>, leaving clinicians to identify the condition just based on a child’s behavior.\u003c/p>\n\u003cp class=\"danger-zone\">But on Wednesday, \u003ca href=\"http://stm.sciencemag.org/lookup/doi/10.1126/scitranslmed.aam9100\" target=\"_blank\" rel=\"noopener\">scientists reported\u003c/a> in the journal Science Translational Medicine that a hormone that regulates blood pressure could be one of those signposts.\u003c/p>\n\u003cp class=\"danger-zone\">They found that low concentrations of the molecule — called arginine vasopressin, or AVP — in the cerebrospinal fluid corresponded to autism-like social behavior in male monkeys, while a high AVP concentration signaled the most social animals. And they discovered similar results when looking at AVP concentrations in the cerebrospinal fluid, or CSF, of a small group of boys.\u003c/p>\n\u003cp class=\"\">“It’s really exciting work,” said Dr. Mollie Meffert, a molecular neuroscientist at Johns Hopkins, who was not involved in the study. “One of the most interesting things is the finding that the vasopressin in the CSF correlates with sociality in the macaques and in autism with children.”\u003c/p>\n\u003cp class=\"\">Meffert said if vasopressin concentrations are confirmed to correspond to \u003ca href=\"https://www.statnews.com/2016/03/31/autism-rate/\">autism\u003c/a>, they could perhaps be used to diagnose the condition and as a gauge to measure the effect of treatment candidates. And Karen Parker, the lead author of the study and associate professor of psychiatry and behavioral sciences at Stanford, said that the hormone could become a drug target if future studies show boosting its levels can assuage the social impairments of autism spectrum disorder.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Autism is diagnosed based on social and communication deficits and repetitive behaviors like hand-flapping or obsessions.\u003c/p>\n\u003cp>A biological diagnostic test for autism is so important, researchers say, because the earlier children start therapeutic interventions, the better the results. Without a medical test, children are typically diagnosed \u003ca href=\"https://www.cdc.gov/mmwr/volumes/67/ss/ss6706a1.htm?s_cid=ss6706a1_w\" target=\"_blank\" rel=\"noopener\">around age 4 1/2\u003c/a>, based on their behavior or a lag in their development.\u003c/p>\n\u003cp>Parker emphasized that the study’s findings are preliminary, and that the discovery of low AVP concentrations in boys with autism was based on so few samples that it needs to be replicated in a larger study. Future studies will also explore whether that association holds in adults and if levels of AVP or other hormones are associated with autism in girls and female animals.\u003c/p>\n\u003cp>Parker added that parents should not try to treat their children with vasopressin, which is used to regulate blood pressure and to treat a condition called diabetes insipidus, given that it has not been tested in autism, it’s not clear what the appropriate dose would be, and it can have \u003ca href=\"https://www.emedicinehealth.com/drug-vasopressin/article_em.htm#sideeffects\" target=\"_blank\" rel=\"noopener\">significant side effects.\u003c/a>\u003c/p>\n\u003cp>One challenge in studying the underlying biology of autism spectrum disorder is the lack of reliable rodent models of the condition. But Parker and colleagues have \u003ca href=\"http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0165401\" target=\"_blank\" rel=\"noopener\">in past studies\u003c/a> established that the natural\u003cstrong> \u003c/strong>variation of social functioning in monkeys can serve as a solid stand-in for people.\u003c/p>\n\u003cp>“They have the complex social cognition that we would care about for the control individuals, and if we can identify animals that have a deficit that’s spontaneously occurring — like humans do — that’s the value of the model,” said Parker, who is also an affiliate scientist at the California National Primate Research Center.\u003c/p>\n\u003cp>For the new study, the researchers identified 15 male rhesus macaques that exhibited low sociality, meaning they weren’t interested in playing with or grooming their fellow macaques, along with 15 highly social monkeys. They then ran tests looking for any significant differences in nine biological markers that \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/24462936\" target=\"_blank\" rel=\"noopener\">had been implicated\u003c/a> \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/26483618\" target=\"_blank\" rel=\"noopener\">in past studies\u003c/a> as possibly linked to autism, including the expression of certain genes, the products of certain signaling pathways, and the concentrations of the hormones AVP and oxytocin.\u003c/p>\n\u003cp>Only one stood out as a marker for the differences in social behavior: the concentration of AVP in the monkey’s cerebrospinal fluid, a colorless material that coats the brain and spinal cord. Notably, the levels of AVP in the blood showed no significant divergence in the two groups of monkeys.\u003c/p>\n\u003cp>To confirm their results, the researchers looked at a second group of male monkeys and again homed in on AVP concentration in the cerebrospinal fluid as being correlated to the sociality of the monkey — the lower the AVP, the less they interacted with their fellow macaques.\u003c/p>\n\u003cp>Then it was time to look at people.\u003c/p>\n\u003cp>Because obtaining cerebrospinal fluid is invasive — it requires a lumbar tap — the researchers relied on samples that had been previously collected from boys for other medical reasons, often as part of a chemotherapy treatment. They found that boys with autism spectrum disorder had lower AVP concentrations in their CSF, though with only 14 samples total — seven from control boys and seven from boys with autism spectrum disorder — the researchers could not draw firm conclusions.\u003c/p>\n\u003cp>Parker said that it’s not clear if low AVP concentrations in the cerebrospinal fluid might contribute to the social problems of autism or just be another consequence of the condition. She also added that it would likely just be one biological marker of autism, which has complicated, multifaceted causes.\u003c/p>\n\u003cp>But she said researchers have for several decades viewed vasopressin as an key influencer of social function, particularly in male animals. If AVP does indeed have some role to play in autism spectrum disorder, then its importance in males could help explain in part why \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/28545751\" target=\"_blank\" rel=\"noopener\">three to four times\u003c/a> more males are diagnosed with the condition than \u003ca href=\"https://www.statnews.com/2016/10/25/autism-girls-reveal-secrets/\">females\u003c/a>.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“When people talk about autism, one of the things that feels a bit neglected is that the prevalence is very male-biased,” Parker said. “So if you’re thinking about disease mechanisms, it would be really interesting to think about the biology that’s informative to either male or female functioning.”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp class=\"big-cap-wrap danger-zone\">\u003cspan class=\"big-cap\">R\u003c/span>esearchers have been left empty-handed so far in their quest to uncover some measurable biological signal that could be used to \u003ca href=\"https://www.statnews.com/2017/02/15/brain-scan-autism-infant-diagnose/\">diagnose autism spectrum disorder\u003c/a>, leaving clinicians to identify the condition just based on a child’s behavior.\u003c/p>\n\u003cp class=\"danger-zone\">But on Wednesday, \u003ca href=\"http://stm.sciencemag.org/lookup/doi/10.1126/scitranslmed.aam9100\" target=\"_blank\" rel=\"noopener\">scientists reported\u003c/a> in the journal Science Translational Medicine that a hormone that regulates blood pressure could be one of those signposts.\u003c/p>\n\u003cp class=\"danger-zone\">They found that low concentrations of the molecule — called arginine vasopressin, or AVP — in the cerebrospinal fluid corresponded to autism-like social behavior in male monkeys, while a high AVP concentration signaled the most social animals. And they discovered similar results when looking at AVP concentrations in the cerebrospinal fluid, or CSF, of a small group of boys.\u003c/p>\n\u003cp class=\"\">“It’s really exciting work,” said Dr. Mollie Meffert, a molecular neuroscientist at Johns Hopkins, who was not involved in the study. “One of the most interesting things is the finding that the vasopressin in the CSF correlates with sociality in the macaques and in autism with children.”\u003c/p>\n\u003cp class=\"\">Meffert said if vasopressin concentrations are confirmed to correspond to \u003ca href=\"https://www.statnews.com/2016/03/31/autism-rate/\">autism\u003c/a>, they could perhaps be used to diagnose the condition and as a gauge to measure the effect of treatment candidates. And Karen Parker, the lead author of the study and associate professor of psychiatry and behavioral sciences at Stanford, said that the hormone could become a drug target if future studies show boosting its levels can assuage the social impairments of autism spectrum disorder.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Autism is diagnosed based on social and communication deficits and repetitive behaviors like hand-flapping or obsessions.\u003c/p>\n\u003cp>A biological diagnostic test for autism is so important, researchers say, because the earlier children start therapeutic interventions, the better the results. Without a medical test, children are typically diagnosed \u003ca href=\"https://www.cdc.gov/mmwr/volumes/67/ss/ss6706a1.htm?s_cid=ss6706a1_w\" target=\"_blank\" rel=\"noopener\">around age 4 1/2\u003c/a>, based on their behavior or a lag in their development.\u003c/p>\n\u003cp>Parker emphasized that the study’s findings are preliminary, and that the discovery of low AVP concentrations in boys with autism was based on so few samples that it needs to be replicated in a larger study. Future studies will also explore whether that association holds in adults and if levels of AVP or other hormones are associated with autism in girls and female animals.\u003c/p>\n\u003cp>Parker added that parents should not try to treat their children with vasopressin, which is used to regulate blood pressure and to treat a condition called diabetes insipidus, given that it has not been tested in autism, it’s not clear what the appropriate dose would be, and it can have \u003ca href=\"https://www.emedicinehealth.com/drug-vasopressin/article_em.htm#sideeffects\" target=\"_blank\" rel=\"noopener\">significant side effects.\u003c/a>\u003c/p>\n\u003cp>One challenge in studying the underlying biology of autism spectrum disorder is the lack of reliable rodent models of the condition. But Parker and colleagues have \u003ca href=\"http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0165401\" target=\"_blank\" rel=\"noopener\">in past studies\u003c/a> established that the natural\u003cstrong> \u003c/strong>variation of social functioning in monkeys can serve as a solid stand-in for people.\u003c/p>\n\u003cp>“They have the complex social cognition that we would care about for the control individuals, and if we can identify animals that have a deficit that’s spontaneously occurring — like humans do — that’s the value of the model,” said Parker, who is also an affiliate scientist at the California National Primate Research Center.\u003c/p>\n\u003cp>For the new study, the researchers identified 15 male rhesus macaques that exhibited low sociality, meaning they weren’t interested in playing with or grooming their fellow macaques, along with 15 highly social monkeys. They then ran tests looking for any significant differences in nine biological markers that \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/24462936\" target=\"_blank\" rel=\"noopener\">had been implicated\u003c/a> \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/26483618\" target=\"_blank\" rel=\"noopener\">in past studies\u003c/a> as possibly linked to autism, including the expression of certain genes, the products of certain signaling pathways, and the concentrations of the hormones AVP and oxytocin.\u003c/p>\n\u003cp>Only one stood out as a marker for the differences in social behavior: the concentration of AVP in the monkey’s cerebrospinal fluid, a colorless material that coats the brain and spinal cord. Notably, the levels of AVP in the blood showed no significant divergence in the two groups of monkeys.\u003c/p>\n\u003cp>To confirm their results, the researchers looked at a second group of male monkeys and again homed in on AVP concentration in the cerebrospinal fluid as being correlated to the sociality of the monkey — the lower the AVP, the less they interacted with their fellow macaques.\u003c/p>\n\u003cp>Then it was time to look at people.\u003c/p>\n\u003cp>Because obtaining cerebrospinal fluid is invasive — it requires a lumbar tap — the researchers relied on samples that had been previously collected from boys for other medical reasons, often as part of a chemotherapy treatment. They found that boys with autism spectrum disorder had lower AVP concentrations in their CSF, though with only 14 samples total — seven from control boys and seven from boys with autism spectrum disorder — the researchers could not draw firm conclusions.\u003c/p>\n\u003cp>Parker said that it’s not clear if low AVP concentrations in the cerebrospinal fluid might contribute to the social problems of autism or just be another consequence of the condition. She also added that it would likely just be one biological marker of autism, which has complicated, multifaceted causes.\u003c/p>\n\u003cp>But she said researchers have for several decades viewed vasopressin as an key influencer of social function, particularly in male animals. If AVP does indeed have some role to play in autism spectrum disorder, then its importance in males could help explain in part why \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/28545751\" target=\"_blank\" rel=\"noopener\">three to four times\u003c/a> more males are diagnosed with the condition than \u003ca href=\"https://www.statnews.com/2016/10/25/autism-girls-reveal-secrets/\">females\u003c/a>.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“When people talk about autism, one of the things that feels a bit neglected is that the prevalence is very male-biased,” Parker said. “So if you’re thinking about disease mechanisms, it would be really interesting to think about the biology that’s informative to either male or female functioning.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Americans Are A Lonely Lot, And Young People Bear The Heaviest Burden",
"title": "Americans Are A Lonely Lot, And Young People Bear The Heaviest Burden",
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"content": "\u003cp>Loneliness isn't just a fleeting feeling, leaving us sad for a few hours to a few days. Research in recent years suggests that for many people loneliness is more like a chronic ache, affecting their daily lives and sense of well-being.[contextly_sidebar id=\"e57r0FGqMOAZghsnjutzZT3UwHbqczQn\"]\u003c/p>\n\u003cp>Now a nationwide survey by the health insurer Cigna underscores that. It finds that loneliness is widespread in America, with nearly 50 percent of respondents reporting that they feel alone or left out always or sometimes.\u003c/p>\n\u003cp>Using one of the best-known tools for measuring loneliness — \u003ca href=\"http://psycnet.apa.org/doiLanding?doi=10.1037%2F0022-3514.39.3.472\" target=\"_blank\" rel=\"noopener\">the UCLA Loneliness Scale\u003c/a> — Cigna surveyed 20,000 adults online across the country ages 18 and above. The UCLA tool uses a series of statements and a formula to calculate a loneliness score based on responses. People scoring between 20 and 80 on the UCLA scale are considered lonely, with a higher score suggesting a greater level of loneliness and social isolation.\u003c/p>\n\u003cp>More than half of survey respondents — 54 percent — said they always or sometimes feel that no one knows them well. Fifty-six percent reported they sometimes or always felt like the people around them \"are not necessarily \u003cem>with\u003c/em> them.\" And 2 in 5 felt like \"they lack companionship,\" that their \"relationships aren't meaningful\" and that they \"are isolated from others.\"\u003c/p>\n\u003cp>The survey found that the average loneliness score in America is 44, which suggests that \"most Americans are considered lonely,\" according to the report released Tuesday by the health insurer.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"Half of Americans view themselves as lonely,\" said \u003ca href=\"https://www.cigna.com/about-us/company-profile/cigna-leadership-team/david-cordani\" target=\"_blank\" rel=\"noopener\">David Cordani\u003c/a>, president and CEO of Cigna Corp. \"I can't help but be surprised [by that].\" (Cigna is an NPR sponsor and a major provider of health insurance for NPR employees.)[contextly_sidebar id=\"Pg3wtSaU0SsTMqBq28e6HhNtWmFiJO0m\"]\u003c/p>\n\u003cp>But the results are consistent with other previous research, says\u003ca href=\"https://fhssfaculty.byu.edu/FacultyPage?id=jh67\" target=\"_blank\" rel=\"noopener\"> Julianne Holt-Lunstad\u003c/a>, a psychologist at Brigham Young University, who studies loneliness and its health effects. She wasn't involved in the Cigna survey. While it's difficult to compare the loneliness scores in different studies, she says, other nationally representative estimates have found between 20 and 43 percent of Americans report feeling lonely or socially isolated.\u003c/p>\n\u003cp>Loneliness has health consequences. \"There's a blurred line between mental and physical health,\" says Cordani. \"Often times, medical symptoms present themselves and they're correlated with mental, lifestyle, behavioral issues like loneliness.\"\u003c/p>\n\u003cp>Several studies in recent years, including ones by Holt-Lunstad, have documented the public health effect of loneliness. It has been linked with a higher risk of \u003ca href=\"http://heart.bmj.com/content/heartjnl/102/13/1009.full.pdf\" target=\"_blank\" rel=\"noopener\">coronary heart disease and stroke\u003c/a>. It has been shown to influence our \u003ca href=\"https://www.npr.org/sections/health-shots/2015/11/29/457255876/loneliness-may-warp-our-genes-and-our-immune-systems\" target=\"_blank\" rel=\"noopener\">genes and our immune systems\u003c/a>, and even \u003ca href=\"https://www.cbsnews.com/news/loneliness-may-sabotage-breast-cancer-survival-study-finds/\" target=\"_blank\" rel=\"noopener\">recovery from breast cancer\u003c/a>.\u003c/p>\n\u003cp>And there's growing evidence that loneliness can kill. \"We have \u003ca href=\"http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1000316\">robust evidence\u003c/a> that it increases risk for premature mortality,\" says Holt-Lunstad. Studies have found that it is a predictor of premature death, not just for the elderly, but \u003ca href=\"http://journals.sagepub.com/doi/abs/10.1177/1745691614568352\" target=\"_blank\" rel=\"noopener\">even more\u003c/a> so for younger people.\u003c/p>\n\u003cp>The latest survey also found something surprising about loneliness in the younger generation. \"Our survey found that actually the younger generation was lonelier than the older generations,\" says Dr. Douglas Nemecek, the chief medical officer for behavioral health at Cigna.\u003c/p>\n\u003cp>Members of Generation Z, born between the mid-1990s and the early 2000s, had an overall loneliness score of 48.3. Millennials, just a little bit older, scored 45.3. By comparison, baby boomers scored 42.4. The Greatest Generation, people ages 72 and above, had a score of 38.6 on the loneliness scale.[contextly_sidebar id=\"VPmLfKEsxWooY6XEkutLxN8Y5ABLBUmT\"]\u003c/p>\n\u003cp>\"Too often people think that this [problem] is specific to older adults,\" says Holt-Lunstad. \"This report helps with the recognition that this can affect those at younger ages.\"\u003c/p>\n\u003cp>In fact, some \u003ca href=\"http://journals.sagepub.com/doi/10.1177/2167702617723376\">research\u003c/a> published in 2017 by psychologist \u003ca href=\"http://www.psychology.sdsu.edu/people/jean-twenge/\" target=\"_blank\" rel=\"noopener\">Jean Twenge\u003c/a> at San Diego State University suggests that more screen time and social media may have caused a rise in depression and suicide among American adolescents. The study also found that people who spend less time looking at screens and more time having face-to-face social interactions are less likely to be depressive or suicidal.\u003c/p>\n\u003cp>However, the Cigna survey didn't find a correlation between social media use and feelings of loneliness. This would on the surface contradict the new findings on screen time, but Holt-Lunstad says that previous research shows that how people use social media determine's its influence on one's sense of isolation.\u003c/p>\n\u003cp>\"If you're passively using it, if you're just scrolling feeds, that's associated with more negative effects,\" she says. \"But if you're using it to reach out and connect to people to facilitate other kinds of [in-person] interactions, it's associated with more positive effects.\"\u003c/p>\n\u003cp>That last finding is also corroborated by the Cigna survey across all age groups. Respondents who said they have more in-person social interactions on a daily basis reported being less lonely.\u003c/p>\n\u003cp>The survey also found that working too little or too much is also associated with the experience of loneliness, suggesting that our workplaces are an important source of our social relationships and also that work-life balance is important for avoiding loneliness.[contextly_sidebar id=\"JkOKxwrLZLl4yCDVrNUiZCYxVTcUUSA6\"]\u003c/p>\n\u003cp>Cigna wants to work with employers to \"help address loneliness in the workplace,\" says Nemecek.\u003c/p>\n\u003cp>Social connection or the lack of it is now considered a social determinant of health. In a \u003ca href=\"http://www.nationalacademies.org/hmd/~/media/Files/Report%20Files/2014/EHR-Phase-1/EHRdomains.pdf\" target=\"_blank\" rel=\"noopener\">2014 report\u003c/a>, the Institute of Medicine (now the \u003ca href=\"http://www.nationalacademies.org/hmd/About-HMD.aspx\" target=\"_blank\" rel=\"noopener\">Health and Medicine Division of the National Academies of Sciences, Engineering, and Medicine\u003c/a>) suggested that health providers should collect information about patients' \"social connections and social isolation\" along with information on education, employment, lifestyle (diet, exercise, smoking etc) and psychological health.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"But this hasn't happened,\" says Holt-Lunstad. \"I would hope that with a large insurer like Cigna [releasing a report on loneliness], that it would start to be more on the radar of major health organizations but also actual health care providers.\"\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Americans+Are+A+Lonely+Lot%2C+And+Young+People+Bear+The+Heaviest+Burden&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"excerpt": "A nationwide survey by health insurer Cigna finds that loneliness is widespread in America. Millennials and people in Generation Z tend to feel lonelier than retirees.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Loneliness isn't just a fleeting feeling, leaving us sad for a few hours to a few days. Research in recent years suggests that for many people loneliness is more like a chronic ache, affecting their daily lives and sense of well-being.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Now a nationwide survey by the health insurer Cigna underscores that. It finds that loneliness is widespread in America, with nearly 50 percent of respondents reporting that they feel alone or left out always or sometimes.\u003c/p>\n\u003cp>Using one of the best-known tools for measuring loneliness — \u003ca href=\"http://psycnet.apa.org/doiLanding?doi=10.1037%2F0022-3514.39.3.472\" target=\"_blank\" rel=\"noopener\">the UCLA Loneliness Scale\u003c/a> — Cigna surveyed 20,000 adults online across the country ages 18 and above. The UCLA tool uses a series of statements and a formula to calculate a loneliness score based on responses. People scoring between 20 and 80 on the UCLA scale are considered lonely, with a higher score suggesting a greater level of loneliness and social isolation.\u003c/p>\n\u003cp>More than half of survey respondents — 54 percent — said they always or sometimes feel that no one knows them well. Fifty-six percent reported they sometimes or always felt like the people around them \"are not necessarily \u003cem>with\u003c/em> them.\" And 2 in 5 felt like \"they lack companionship,\" that their \"relationships aren't meaningful\" and that they \"are isolated from others.\"\u003c/p>\n\u003cp>The survey found that the average loneliness score in America is 44, which suggests that \"most Americans are considered lonely,\" according to the report released Tuesday by the health insurer.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"Half of Americans view themselves as lonely,\" said \u003ca href=\"https://www.cigna.com/about-us/company-profile/cigna-leadership-team/david-cordani\" target=\"_blank\" rel=\"noopener\">David Cordani\u003c/a>, president and CEO of Cigna Corp. \"I can't help but be surprised [by that].\" (Cigna is an NPR sponsor and a major provider of health insurance for NPR employees.)\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>But the results are consistent with other previous research, says\u003ca href=\"https://fhssfaculty.byu.edu/FacultyPage?id=jh67\" target=\"_blank\" rel=\"noopener\"> Julianne Holt-Lunstad\u003c/a>, a psychologist at Brigham Young University, who studies loneliness and its health effects. She wasn't involved in the Cigna survey. While it's difficult to compare the loneliness scores in different studies, she says, other nationally representative estimates have found between 20 and 43 percent of Americans report feeling lonely or socially isolated.\u003c/p>\n\u003cp>Loneliness has health consequences. \"There's a blurred line between mental and physical health,\" says Cordani. \"Often times, medical symptoms present themselves and they're correlated with mental, lifestyle, behavioral issues like loneliness.\"\u003c/p>\n\u003cp>Several studies in recent years, including ones by Holt-Lunstad, have documented the public health effect of loneliness. It has been linked with a higher risk of \u003ca href=\"http://heart.bmj.com/content/heartjnl/102/13/1009.full.pdf\" target=\"_blank\" rel=\"noopener\">coronary heart disease and stroke\u003c/a>. It has been shown to influence our \u003ca href=\"https://www.npr.org/sections/health-shots/2015/11/29/457255876/loneliness-may-warp-our-genes-and-our-immune-systems\" target=\"_blank\" rel=\"noopener\">genes and our immune systems\u003c/a>, and even \u003ca href=\"https://www.cbsnews.com/news/loneliness-may-sabotage-breast-cancer-survival-study-finds/\" target=\"_blank\" rel=\"noopener\">recovery from breast cancer\u003c/a>.\u003c/p>\n\u003cp>And there's growing evidence that loneliness can kill. \"We have \u003ca href=\"http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1000316\">robust evidence\u003c/a> that it increases risk for premature mortality,\" says Holt-Lunstad. Studies have found that it is a predictor of premature death, not just for the elderly, but \u003ca href=\"http://journals.sagepub.com/doi/abs/10.1177/1745691614568352\" target=\"_blank\" rel=\"noopener\">even more\u003c/a> so for younger people.\u003c/p>\n\u003cp>The latest survey also found something surprising about loneliness in the younger generation. \"Our survey found that actually the younger generation was lonelier than the older generations,\" says Dr. Douglas Nemecek, the chief medical officer for behavioral health at Cigna.\u003c/p>\n\u003cp>Members of Generation Z, born between the mid-1990s and the early 2000s, had an overall loneliness score of 48.3. Millennials, just a little bit older, scored 45.3. By comparison, baby boomers scored 42.4. The Greatest Generation, people ages 72 and above, had a score of 38.6 on the loneliness scale.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\"Too often people think that this [problem] is specific to older adults,\" says Holt-Lunstad. \"This report helps with the recognition that this can affect those at younger ages.\"\u003c/p>\n\u003cp>In fact, some \u003ca href=\"http://journals.sagepub.com/doi/10.1177/2167702617723376\">research\u003c/a> published in 2017 by psychologist \u003ca href=\"http://www.psychology.sdsu.edu/people/jean-twenge/\" target=\"_blank\" rel=\"noopener\">Jean Twenge\u003c/a> at San Diego State University suggests that more screen time and social media may have caused a rise in depression and suicide among American adolescents. The study also found that people who spend less time looking at screens and more time having face-to-face social interactions are less likely to be depressive or suicidal.\u003c/p>\n\u003cp>However, the Cigna survey didn't find a correlation between social media use and feelings of loneliness. This would on the surface contradict the new findings on screen time, but Holt-Lunstad says that previous research shows that how people use social media determine's its influence on one's sense of isolation.\u003c/p>\n\u003cp>\"If you're passively using it, if you're just scrolling feeds, that's associated with more negative effects,\" she says. \"But if you're using it to reach out and connect to people to facilitate other kinds of [in-person] interactions, it's associated with more positive effects.\"\u003c/p>\n\u003cp>That last finding is also corroborated by the Cigna survey across all age groups. Respondents who said they have more in-person social interactions on a daily basis reported being less lonely.\u003c/p>\n\u003cp>The survey also found that working too little or too much is also associated with the experience of loneliness, suggesting that our workplaces are an important source of our social relationships and also that work-life balance is important for avoiding loneliness.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Cigna wants to work with employers to \"help address loneliness in the workplace,\" says Nemecek.\u003c/p>\n\u003cp>Social connection or the lack of it is now considered a social determinant of health. In a \u003ca href=\"http://www.nationalacademies.org/hmd/~/media/Files/Report%20Files/2014/EHR-Phase-1/EHRdomains.pdf\" target=\"_blank\" rel=\"noopener\">2014 report\u003c/a>, the Institute of Medicine (now the \u003ca href=\"http://www.nationalacademies.org/hmd/About-HMD.aspx\" target=\"_blank\" rel=\"noopener\">Health and Medicine Division of the National Academies of Sciences, Engineering, and Medicine\u003c/a>) suggested that health providers should collect information about patients' \"social connections and social isolation\" along with information on education, employment, lifestyle (diet, exercise, smoking etc) and psychological health.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"But this hasn't happened,\" says Holt-Lunstad. \"I would hope that with a large insurer like Cigna [releasing a report on loneliness], that it would start to be more on the radar of major health organizations but also actual health care providers.\"\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Americans+Are+A+Lonely+Lot%2C+And+Young+People+Bear+The+Heaviest+Burden&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "The Take From Courtside: UC Berkeley Probably Not Going to Win CRISPR Patent Dispute",
"title": "The Take From Courtside: UC Berkeley Probably Not Going to Win CRISPR Patent Dispute",
"headTitle": "KQED Future of You | KQED Science",
"content": "\u003ch3>The university clearly failed to win over at least one of the three judges and, at best, did not lose too much ground with a second.\u003c/h3>\n\u003cp class=\"danger-zone\">The University of California, which has been losing the fight over U.S. patents on the revolutionary genome-editing technology CRISPR-Cas9, did not pull any rabbits out of a hat during \u003ca href=\"https://www.statnews.com/2018/04/27/crispr-patent-fight-round-two/\" target=\"_blank\" rel=\"noopener\">oral arguments\u003c/a> Monday in its appeal of the case.\u003c/p>\n\u003cp class=\"danger-zone\">The university clearly failed to win over at least one of the three judges and, at best, did not lose too much ground with a second (while the third asked almost no questions and so did not tip his hand).\u003c/p>\n\u003cp class=\"danger-zone\">“UC came into this argument from a tough spot, and I doubt that oral arguments from either side moved the needle much,” said patent attorney Michael Stramiello of Paul Hastings, who attended the arguments at the U.S. Court of Appeals for the Federal Circuit, where attorneys for the University of California fought to get a patent win by the Broad Institute of MIT and Harvard reversed.\u003c/p>\n\u003cp class=\"danger-zone\">“It was closer than I expected,” said patent expert Jacob Sherkow of New York Law School, who also attended the argument. “But it’s still going to be tough for UC.”\u003c/p>\n\u003cp class=\"danger-zone\">That’s because in order to \u003ca href=\"https://www.statnews.com/2018/04/27/crispr-patent-fight-round-two/\" target=\"_blank\" rel=\"noopener\">reverse the Broad’s win\u003c/a>, the appeals court will have to find that the patent office committed serious legal errors, as UC’s new attorney (and former solicitor general) Donald Verrilli argued. He marshaled both legal and scientific evidence to make his case for what experts call his only path to success: persuading the judges that the patent office did not have “substantial evidence” for its decision in favor of the Broad.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The problem for UC is that the legal definition of “substantial” differs from the plain English meaning.\u003c/p>\n\u003cfigure id=\"attachment_441233\" class=\"wp-caption alignright\" style=\"max-width: 413px\">\u003ca href=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/05/FengZhang_413x315.png\">\u003cimg src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/05/FengZhang_413x315.png\" alt=\"\" width=\"413\" height=\"315\" class=\"size-full wp-image-441233\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2018/05/FengZhang_413x315.png 413w, https://ww2.kqed.org/app/uploads/sites/13/2018/05/FengZhang_413x315-160x122.png 160w, https://ww2.kqed.org/app/uploads/sites/13/2018/05/FengZhang_413x315-240x183.png 240w, https://ww2.kqed.org/app/uploads/sites/13/2018/05/FengZhang_413x315-375x286.png 375w\" sizes=\"(max-width: 413px) 100vw, 413px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Biotechnologist Feng Zhang of the Broad Institute was awarded a patent for CRISPR gene-editing technology in 2014. \u003ccite>(Broad Institute)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“It means just enough for a reasonable person to find it persuasive,” Sherkow said. In other words, when the patent office decided that the Broad gets to keep its key CRISPR patents, did it base that on a reasonable assessment of the relevant evidence about, in particular, whether the Broad’s breakthroughs were “obvious” extensions of research by UC scientists. “You can ignore some evidence that still meet the requirement of ‘substantial evidence,'” said law professor Dmitry Karshtedt, who attended the hearing.\u003c/p>\n\u003cp>Judge Kimberly Moore, in particular, seemed unconvinced by Verrilli’s arguments. “That’s how science works, Mr. Verrilli,” she said toward the end of the 35-minute hearing. Verrilli spent much of his allotted 15 minutes, and much of the written briefs, arguing that because half a dozen labs, besides that of the Broad’s \u003ca href=\"https://www.statnews.com/2015/11/06/hollywood-inspired-scientist-rewrite-code-life/\">Feng Zhang\u003c/a>, quickly got CRISPR to work in mammalian cells after UC scientists showed that it worked on DNA in a test tube, and used conventional techniques to do so, the Broad’s work was an obvious extension of UC’s and thus not deserving of patents.\u003c/p>\n\u003cp>But getting CRISPR to work in mammalian cells, and the fact that all the labs used conventional techniques of molecular biology to do it, “doesn’t mean they thought it would work,” Moore said. In pushback that could be fatal for UC, she continued, “It’s hard for me to say there wasn’t substantial evidence” to back up the patent office’s ruling against UC. When Verrilli tried to jump in, he got a sharp, “Please don’t interrupt me.”\u003c/p>\n\u003caside class=\"pullquote alignright\">'That’s how science works, Mr. Verrilli.'\u003ccite>Judge Kimberly Moore to UC Berkeley attorney Donald Verrilli\u003c/cite>\u003c/aside>\n\u003cp>The Broad issued a statement at the conclusion of the hearing: “Based on the oral arguments today, we are even more confident the Federal Circuit will affirm the PTAB’s judgment,” the Broad said. “We call on UCB and the companies that control its IP to join our ongoing efforts to simplify, share, and open the IP landscape.”\u003c/p>\n\u003cp>Not surprisingly, the University of California had a different take: “We presented compelling arguments today that the PTAB committed several legal errors, including disregarding Supreme Court and Federal Circuit precedent,” Charles F. Robinson, UC general counsel said in a statement. “Based on the questioning today, we are optimistic that the court has serious doubts about several aspects of the PTAB’s decision.”\u003c/p>\n\u003cp>To recap the plot thus far: In June 2012, UC Berkeley biochemist Jennifer Doudna and her colleagues reported that CRISPR-Cas9 could be turned into a “programmable” genome-editing tool, as they demonstrated on DNA in a test tube. They’d filed their first patent application on the technique the month before. Seven months later, the Broad Institute filed for a CRISPR patent on Zhang’s discovery of how to use the system to edit the genomes of eukaryotic cells, as he reported in January 2013.\u003c/p>\n\u003cp>Although UC filed first for a CRISPR patent, under the law at the time, patents went to the first to invent, and Zhang submitted lab notebooks showing he managed his feat before Doudna’s paper was published. In April 2014, the Broad won a far-reaching patent on the use of CRISPR-Cas9 for editing genomes in eukaryotic cells. A year later, UC asked the patent office to declare an “interference in fact”: to decide that the Broad’s CRISPR patents (which by then numbered 10) covered inventions so similar to what UC applied for (and was still waiting for) a patent on that they should be deemed invalid.\u003c/p>\n\u003cp>In February 2017, the Patent Trial and Appeal Board \u003ca href=\"https://www.statnews.com/2017/02/15/crispr-patent-ruling/\">ruled\u003c/a> that the Broad’s 2014 CRISPR patent did not “interfere” with UC’s pending ones: The Broad’s, which covers the use of CRISPR-Cas9 to edit genomes in eukaryotic cells, was different enough from UC’s and not an obvious extension of Doudna’s work to be valid.\u003c/p>\n\u003cp>UC appealed, and the oral arguments were heard on Monday.\u003c/p>\n\u003cp>The only arguments an appeals court entertains, whether about a conviction for murder or a ruling on patent interference, are those about whether the previous tribunals conducted the proceedings properly, interpreting and applying the law correctly. In this case, that means UC must persuade the three judges that PTAB did not have “substantial evidence” to support its finding of no-interference-in-fact; that PTAB made a material legal error, such as in what evidence or testimony it allowed; or that it failed to consider certain evidence.\u003c/p>\n\u003cp>Verrilli got out barely two sentences before chief judge Sharon Prost jumped in. The main ground for overturning PTAB’s decision, she pointed out, would be a finding that the board did not have substantial evidence for it. But PTAB’s long, detailed written decision suggests that it did not exactly base its decision on a whim. “How do we get around that?” Prost asked Verrilli.\u003c/p>\n\u003cp>When he tried to answer, Moore interrupted, pointing out “problems with the cases” Verrilli had cited to support his position and the low bar for evidence to be “substantial.” “Do you see the problem I’m having?” she asked him. (Shortly after, Moore had a coughing fit and excused herself from the bench, an almost unheard-of occurrence, but told the attorneys to carry on; she returned a few minutes later.)\u003c/p>\n\u003cp>Arguing for the Broad, Raymond Nimrod of Quinn Emanuel had a somewhat easier time but did not get off scot-free. Prost zeroed in on the success that those half a dozen labs had using CRISPR in mammalian cells in the months after Doudna’s success with CRISPR on test-tube DNA. UC has argued throughout the patent saga that the success by so many labs indicates that it was an obvious extension of Doudna’s work, “obviousness” that would include what Zhang achieved.\u003c/p>\n\u003cp>“What about the [patent] board’s not placing much weight on how several people came up with it in a short period of time” after Doudna’s work, Prost asked Nimrod. He replied that PTAB did not dismiss that evidence, but simply found it not to support UC’s claim.\u003c/p>\n\u003cp>The fact that PTAB considered that argument might be enough to meet the fairly low requirement that its decisions be based on “substantial evidence,” Sherkow said.\u003c/p>\n\u003cp>A ruling is expected by late summer.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This \u003ca href=\"https://www.statnews.com/2018/04/30/crispr-patent-appeal-hearing/\" target=\"_blank\" rel=\"noopener\">story\u003c/a> was originally published by STAT, an online publication of Boston Globe Media that covers health, medicine, and scientific discovery. \u003c/em>\u003c/p>\n\n",
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"excerpt": "In the ongoing dispute over ownership of key CRISPR patents, UC Berkeley is going to have a tough time getting a court to overturn a patent office ruling in favor of the rival Broad Institute.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003ch3>The university clearly failed to win over at least one of the three judges and, at best, did not lose too much ground with a second.\u003c/h3>\n\u003cp class=\"danger-zone\">The University of California, which has been losing the fight over U.S. patents on the revolutionary genome-editing technology CRISPR-Cas9, did not pull any rabbits out of a hat during \u003ca href=\"https://www.statnews.com/2018/04/27/crispr-patent-fight-round-two/\" target=\"_blank\" rel=\"noopener\">oral arguments\u003c/a> Monday in its appeal of the case.\u003c/p>\n\u003cp class=\"danger-zone\">The university clearly failed to win over at least one of the three judges and, at best, did not lose too much ground with a second (while the third asked almost no questions and so did not tip his hand).\u003c/p>\n\u003cp class=\"danger-zone\">“UC came into this argument from a tough spot, and I doubt that oral arguments from either side moved the needle much,” said patent attorney Michael Stramiello of Paul Hastings, who attended the arguments at the U.S. Court of Appeals for the Federal Circuit, where attorneys for the University of California fought to get a patent win by the Broad Institute of MIT and Harvard reversed.\u003c/p>\n\u003cp class=\"danger-zone\">“It was closer than I expected,” said patent expert Jacob Sherkow of New York Law School, who also attended the argument. “But it’s still going to be tough for UC.”\u003c/p>\n\u003cp class=\"danger-zone\">That’s because in order to \u003ca href=\"https://www.statnews.com/2018/04/27/crispr-patent-fight-round-two/\" target=\"_blank\" rel=\"noopener\">reverse the Broad’s win\u003c/a>, the appeals court will have to find that the patent office committed serious legal errors, as UC’s new attorney (and former solicitor general) Donald Verrilli argued. He marshaled both legal and scientific evidence to make his case for what experts call his only path to success: persuading the judges that the patent office did not have “substantial evidence” for its decision in favor of the Broad.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The problem for UC is that the legal definition of “substantial” differs from the plain English meaning.\u003c/p>\n\u003cfigure id=\"attachment_441233\" class=\"wp-caption alignright\" style=\"max-width: 413px\">\u003ca href=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/05/FengZhang_413x315.png\">\u003cimg src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/05/FengZhang_413x315.png\" alt=\"\" width=\"413\" height=\"315\" class=\"size-full wp-image-441233\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2018/05/FengZhang_413x315.png 413w, https://ww2.kqed.org/app/uploads/sites/13/2018/05/FengZhang_413x315-160x122.png 160w, https://ww2.kqed.org/app/uploads/sites/13/2018/05/FengZhang_413x315-240x183.png 240w, https://ww2.kqed.org/app/uploads/sites/13/2018/05/FengZhang_413x315-375x286.png 375w\" sizes=\"(max-width: 413px) 100vw, 413px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Biotechnologist Feng Zhang of the Broad Institute was awarded a patent for CRISPR gene-editing technology in 2014. \u003ccite>(Broad Institute)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“It means just enough for a reasonable person to find it persuasive,” Sherkow said. In other words, when the patent office decided that the Broad gets to keep its key CRISPR patents, did it base that on a reasonable assessment of the relevant evidence about, in particular, whether the Broad’s breakthroughs were “obvious” extensions of research by UC scientists. “You can ignore some evidence that still meet the requirement of ‘substantial evidence,'” said law professor Dmitry Karshtedt, who attended the hearing.\u003c/p>\n\u003cp>Judge Kimberly Moore, in particular, seemed unconvinced by Verrilli’s arguments. “That’s how science works, Mr. Verrilli,” she said toward the end of the 35-minute hearing. Verrilli spent much of his allotted 15 minutes, and much of the written briefs, arguing that because half a dozen labs, besides that of the Broad’s \u003ca href=\"https://www.statnews.com/2015/11/06/hollywood-inspired-scientist-rewrite-code-life/\">Feng Zhang\u003c/a>, quickly got CRISPR to work in mammalian cells after UC scientists showed that it worked on DNA in a test tube, and used conventional techniques to do so, the Broad’s work was an obvious extension of UC’s and thus not deserving of patents.\u003c/p>\n\u003cp>But getting CRISPR to work in mammalian cells, and the fact that all the labs used conventional techniques of molecular biology to do it, “doesn’t mean they thought it would work,” Moore said. In pushback that could be fatal for UC, she continued, “It’s hard for me to say there wasn’t substantial evidence” to back up the patent office’s ruling against UC. When Verrilli tried to jump in, he got a sharp, “Please don’t interrupt me.”\u003c/p>\n\u003caside class=\"pullquote alignright\">'That’s how science works, Mr. Verrilli.'\u003ccite>Judge Kimberly Moore to UC Berkeley attorney Donald Verrilli\u003c/cite>\u003c/aside>\n\u003cp>The Broad issued a statement at the conclusion of the hearing: “Based on the oral arguments today, we are even more confident the Federal Circuit will affirm the PTAB’s judgment,” the Broad said. “We call on UCB and the companies that control its IP to join our ongoing efforts to simplify, share, and open the IP landscape.”\u003c/p>\n\u003cp>Not surprisingly, the University of California had a different take: “We presented compelling arguments today that the PTAB committed several legal errors, including disregarding Supreme Court and Federal Circuit precedent,” Charles F. Robinson, UC general counsel said in a statement. “Based on the questioning today, we are optimistic that the court has serious doubts about several aspects of the PTAB’s decision.”\u003c/p>\n\u003cp>To recap the plot thus far: In June 2012, UC Berkeley biochemist Jennifer Doudna and her colleagues reported that CRISPR-Cas9 could be turned into a “programmable” genome-editing tool, as they demonstrated on DNA in a test tube. They’d filed their first patent application on the technique the month before. Seven months later, the Broad Institute filed for a CRISPR patent on Zhang’s discovery of how to use the system to edit the genomes of eukaryotic cells, as he reported in January 2013.\u003c/p>\n\u003cp>Although UC filed first for a CRISPR patent, under the law at the time, patents went to the first to invent, and Zhang submitted lab notebooks showing he managed his feat before Doudna’s paper was published. In April 2014, the Broad won a far-reaching patent on the use of CRISPR-Cas9 for editing genomes in eukaryotic cells. A year later, UC asked the patent office to declare an “interference in fact”: to decide that the Broad’s CRISPR patents (which by then numbered 10) covered inventions so similar to what UC applied for (and was still waiting for) a patent on that they should be deemed invalid.\u003c/p>\n\u003cp>In February 2017, the Patent Trial and Appeal Board \u003ca href=\"https://www.statnews.com/2017/02/15/crispr-patent-ruling/\">ruled\u003c/a> that the Broad’s 2014 CRISPR patent did not “interfere” with UC’s pending ones: The Broad’s, which covers the use of CRISPR-Cas9 to edit genomes in eukaryotic cells, was different enough from UC’s and not an obvious extension of Doudna’s work to be valid.\u003c/p>\n\u003cp>UC appealed, and the oral arguments were heard on Monday.\u003c/p>\n\u003cp>The only arguments an appeals court entertains, whether about a conviction for murder or a ruling on patent interference, are those about whether the previous tribunals conducted the proceedings properly, interpreting and applying the law correctly. In this case, that means UC must persuade the three judges that PTAB did not have “substantial evidence” to support its finding of no-interference-in-fact; that PTAB made a material legal error, such as in what evidence or testimony it allowed; or that it failed to consider certain evidence.\u003c/p>\n\u003cp>Verrilli got out barely two sentences before chief judge Sharon Prost jumped in. The main ground for overturning PTAB’s decision, she pointed out, would be a finding that the board did not have substantial evidence for it. But PTAB’s long, detailed written decision suggests that it did not exactly base its decision on a whim. “How do we get around that?” Prost asked Verrilli.\u003c/p>\n\u003cp>When he tried to answer, Moore interrupted, pointing out “problems with the cases” Verrilli had cited to support his position and the low bar for evidence to be “substantial.” “Do you see the problem I’m having?” she asked him. (Shortly after, Moore had a coughing fit and excused herself from the bench, an almost unheard-of occurrence, but told the attorneys to carry on; she returned a few minutes later.)\u003c/p>\n\u003cp>Arguing for the Broad, Raymond Nimrod of Quinn Emanuel had a somewhat easier time but did not get off scot-free. Prost zeroed in on the success that those half a dozen labs had using CRISPR in mammalian cells in the months after Doudna’s success with CRISPR on test-tube DNA. UC has argued throughout the patent saga that the success by so many labs indicates that it was an obvious extension of Doudna’s work, “obviousness” that would include what Zhang achieved.\u003c/p>\n\u003cp>“What about the [patent] board’s not placing much weight on how several people came up with it in a short period of time” after Doudna’s work, Prost asked Nimrod. He replied that PTAB did not dismiss that evidence, but simply found it not to support UC’s claim.\u003c/p>\n\u003cp>The fact that PTAB considered that argument might be enough to meet the fairly low requirement that its decisions be based on “substantial evidence,” Sherkow said.\u003c/p>\n\u003cp>A ruling is expected by late summer.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>This \u003ca href=\"https://www.statnews.com/2018/04/30/crispr-patent-appeal-hearing/\" target=\"_blank\" rel=\"noopener\">story\u003c/a> was originally published by STAT, an online publication of Boston Globe Media that covers health, medicine, and scientific discovery. \u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "‘Drug Sanctuaries’ Offer Hope for a Post-Antibiotic World",
"title": "‘Drug Sanctuaries’ Offer Hope for a Post-Antibiotic World",
"headTitle": "KQED Future of You | KQED Science",
"content": "\u003cp>We are at risk of entering a post-antibiotic era.\u003c/p>\n\u003cp>Each year since 2013, a major global institution — including the \u003ca href=\"http://reports.weforum.org/global-risks-2013/risk-case-1/the-dangers-of-hubris-on-human-health/\" target=\"_blank\" rel=\"noopener\">World Economic Forum\u003c/a>, the \u003ca href=\"http://www.who.int/antimicrobial-resistance/global-action-plan/en/\" target=\"_blank\" rel=\"noopener\">World Health Organization\u003c/a> and the \u003ca href=\"http://www.un.org/ga/search/view_doc.asp?symbol=A/71/L.2&referer=/english/&Lang=E\" target=\"_blank\" rel=\"noopener\">United Nations General Assembly\u003c/a> — has issued this grave warning to the world.[contextly_sidebar id=\"XV9iH3usDUjTEoRS7VEResmysvKM5CrO\"]\u003c/p>\n\u003cp>A \u003ca href=\"https://theconversation.com/canada-could-lead-the-fight-for-life-in-a-post-antibiotic-world-80864\" target=\"_blank\" rel=\"noopener\">post-antibiotic future is daunting\u003c/a>. When the drugs don’t work, we get sicker more often. We stay sicker longer. This hurts the economy because sick people don’t work.\u003c/p>\n\u003cp>In response, we really only have two options.\u003c/p>\n\u003cp>One is to gather more arrows in our quiver — by discovering new antibiotics to which microbes like bacteria are not currently resistant.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The second is to manage our current arsenal of drugs better so that they remain effective for as long as possible. The key to doing this is to reduce the global burden of antibiotic resistance by decreasing the quantity of drugs we use.\u003c/p>\n\u003cp>\u003cstrong>Delivering drugs differently\u003cbr>\n\u003c/strong>The first strategy of response to antibiotic resistance is not as easy as it sounds. While there are many potential new therapies that could be effective, there are few incentives for industry to invest in their development.\u003c/p>\n\u003cp>If an antibiotic works well, it is used for a short time — a few days to a couple of weeks at the most. The \u003ca href=\"https://www.pharmaceutical-journal.com/news-and-analysis/features/why-are-there-so-few-antibiotics-in-the-research-and-development-pipeline/11130209.article\" target=\"_blank\" rel=\"noopener\">commercial return on a drug designed to treat longer lasting non-communicable illnesses, like cancer, for instance, can be much higher\u003c/a> because the drugs are used for longer.\u003c/p>\n\u003cp>The logic of the second strategy is straightforward. The widespread use of antibiotics in medicine and agriculture means that a drug-resistant variant of a bacterium will enjoy a strong selective advantage and can quickly spread. So by reducing the use of drugs, we reduce the selection pressure on resistance and slow the rate at which resistance evolves and spreads. Simple.[contextly_sidebar id=\"VbydMq0RqS7R9WIF0Ye7B1EZAyZoMl2y\"]\u003c/p>\n\u003cp>Except it’s not. How, precisely, should we reduce the volume of drugs we use?\u003c/p>\n\u003cp>We can’t just introduce a blanket ban on prescriptions and stop using drugs altogether. If my loved one is sick and there is a drug that can make them better, I want that drug.\u003c/p>\n\u003cp>But maybe we could deliver our drugs in ways that would make it harder for resistance to evolve and spread? And so prolong the amount of time a drug remains effective?\u003c/p>\n\u003cp>\u003cstrong>Creating drug sanctuaries\u003cbr>\n\u003c/strong>One suggestion that\u003ca href=\"http://kassenlab.weebly.com/\" target=\"_blank\" rel=\"noopener\"> my research group\u003c/a> has been exploring is to make use of \u003ca href=\"https://onlinelibrary.wiley.com/doi/abs/10.1002/evl3.43\" target=\"_blank\" rel=\"noopener\">drug sanctuaries, or drug-free environments\u003c/a> — to effectively reduce the strength of selection for resistance.\u003c/p>\n\u003cp>If drug-sensitive variants of microbes have a growth advantage over resistant ones when no drug is around, then sensitive variants would predominate in drug-free refuges and help keep resistant ones from taking over the population.\u003c/p>\n\u003cp>Drug sanctuaries could be used in hospitals. For example, different wards could restrict the use of certain drugs (generating a form of spatial sanctuary) or could alternate the use of a drug on the same ward over time (a form of temporal sanctuary).\u003c/p>\n\u003cp>Evolutionary models can help guide us here. Variation in time is like paying taxes: You can’t avoid it. A variant that evolves in a temporally varying environment is the one that does best across all conditions experienced.\u003c/p>\n\u003cp>Variation in space, on the other hand, provides more options because the different locations can act as refuges for the specialized variants of bacteria. Because those locations are always available, then specialists can coexist indefinitely. At least in theory.\u003c/p>\n\u003cp>\u003cstrong>Buying us time\u003cbr>\n\u003c/strong>This seems to be what happened when we did an experiment to test the theory.\u003c/p>\n\u003cp>Resistance to the commonly used antibiotic ciprofloxacin took longer to spread in laboratory populations of the opportunistic pathogen Pseudomonas aeruginosa — a bacterium that causes acute infections in hospitals, especially intensive- care units, and chronic infections in the lungs of cystic fibrosis patients — when drug sanctuaries were experienced in space rather than time.\u003c/p>\n\u003cp>Resistant and sensitive genetic variants actually coexisted in spatial sanctuaries because of a trade-off between resistance and growth rate.\u003c/p>\n\u003cp>Resistant variants could withstand the drug, but grew far more slowly than sensitive ones in the sanctuary. The result was that neither could be eliminated by natural selection.[contextly_sidebar id=\"MjDUXQparIcTA4fgoyev9hL5QsR382iY\"]\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>What surprised us, though, was that over time, this trade-off broke down.\u003c/p>\n\u003cdiv class=\"post__col \">\n\u003cdiv class=\"post__col-right\">\n\u003carticle>\n\u003cdiv class=\"body-text\">\n\u003cp>The resistant strains actually gained mutations that improved their ability to grow in the absence of the drug. By the end of the experiment, most populations in the spatial sanctuary were dominated by antibiotic-resistant strains.\u003c/p>\n\u003cp>Evidently drug sanctuaries in space could allow us to keep using drugs for longer, but not indefinitely. Eventually we will need new arrows in our quiver.\u003c/p>\n\u003cp>\u003cstrong>A challenge for evolutionary biology\u003cbr>\n\u003c/strong>Our experiments are highly contrived and restricted to one strain of one pathogen evolving in response to one drug in the defined and controlled conditions of a laboratory.\u003c/p>\n\u003cp>Whether our conclusions hold for other bugs and other drugs, or more complicated networks of transmission characteristic of hospitals and the communities they are embedded in, remains to be seen.\u003c/p>\n\u003cp>What our work allows us to do is get directly at the ecological and genetic mechanisms responsible for the emergence, coexistence and eventual demise of diversity.\u003c/p>\n\u003cp>Using these evolutionary principles in more complex, real-world situations to manage our arsenal of drugs for as long as possible will be a major challenge for evolutionary biology in the years to come.\u003c/p>\n\u003c/div>\n\u003c/article>\n\u003c/div>\n\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>We are at risk of entering a post-antibiotic era.\u003c/p>\n\u003cp>Each year since 2013, a major global institution — including the \u003ca href=\"http://reports.weforum.org/global-risks-2013/risk-case-1/the-dangers-of-hubris-on-human-health/\" target=\"_blank\" rel=\"noopener\">World Economic Forum\u003c/a>, the \u003ca href=\"http://www.who.int/antimicrobial-resistance/global-action-plan/en/\" target=\"_blank\" rel=\"noopener\">World Health Organization\u003c/a> and the \u003ca href=\"http://www.un.org/ga/search/view_doc.asp?symbol=A/71/L.2&referer=/english/&Lang=E\" target=\"_blank\" rel=\"noopener\">United Nations General Assembly\u003c/a> — has issued this grave warning to the world.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>A \u003ca href=\"https://theconversation.com/canada-could-lead-the-fight-for-life-in-a-post-antibiotic-world-80864\" target=\"_blank\" rel=\"noopener\">post-antibiotic future is daunting\u003c/a>. When the drugs don’t work, we get sicker more often. We stay sicker longer. This hurts the economy because sick people don’t work.\u003c/p>\n\u003cp>In response, we really only have two options.\u003c/p>\n\u003cp>One is to gather more arrows in our quiver — by discovering new antibiotics to which microbes like bacteria are not currently resistant.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The second is to manage our current arsenal of drugs better so that they remain effective for as long as possible. The key to doing this is to reduce the global burden of antibiotic resistance by decreasing the quantity of drugs we use.\u003c/p>\n\u003cp>\u003cstrong>Delivering drugs differently\u003cbr>\n\u003c/strong>The first strategy of response to antibiotic resistance is not as easy as it sounds. While there are many potential new therapies that could be effective, there are few incentives for industry to invest in their development.\u003c/p>\n\u003cp>If an antibiotic works well, it is used for a short time — a few days to a couple of weeks at the most. The \u003ca href=\"https://www.pharmaceutical-journal.com/news-and-analysis/features/why-are-there-so-few-antibiotics-in-the-research-and-development-pipeline/11130209.article\" target=\"_blank\" rel=\"noopener\">commercial return on a drug designed to treat longer lasting non-communicable illnesses, like cancer, for instance, can be much higher\u003c/a> because the drugs are used for longer.\u003c/p>\n\u003cp>The logic of the second strategy is straightforward. The widespread use of antibiotics in medicine and agriculture means that a drug-resistant variant of a bacterium will enjoy a strong selective advantage and can quickly spread. So by reducing the use of drugs, we reduce the selection pressure on resistance and slow the rate at which resistance evolves and spreads. Simple.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Except it’s not. How, precisely, should we reduce the volume of drugs we use?\u003c/p>\n\u003cp>We can’t just introduce a blanket ban on prescriptions and stop using drugs altogether. If my loved one is sick and there is a drug that can make them better, I want that drug.\u003c/p>\n\u003cp>But maybe we could deliver our drugs in ways that would make it harder for resistance to evolve and spread? And so prolong the amount of time a drug remains effective?\u003c/p>\n\u003cp>\u003cstrong>Creating drug sanctuaries\u003cbr>\n\u003c/strong>One suggestion that\u003ca href=\"http://kassenlab.weebly.com/\" target=\"_blank\" rel=\"noopener\"> my research group\u003c/a> has been exploring is to make use of \u003ca href=\"https://onlinelibrary.wiley.com/doi/abs/10.1002/evl3.43\" target=\"_blank\" rel=\"noopener\">drug sanctuaries, or drug-free environments\u003c/a> — to effectively reduce the strength of selection for resistance.\u003c/p>\n\u003cp>If drug-sensitive variants of microbes have a growth advantage over resistant ones when no drug is around, then sensitive variants would predominate in drug-free refuges and help keep resistant ones from taking over the population.\u003c/p>\n\u003cp>Drug sanctuaries could be used in hospitals. For example, different wards could restrict the use of certain drugs (generating a form of spatial sanctuary) or could alternate the use of a drug on the same ward over time (a form of temporal sanctuary).\u003c/p>\n\u003cp>Evolutionary models can help guide us here. Variation in time is like paying taxes: You can’t avoid it. A variant that evolves in a temporally varying environment is the one that does best across all conditions experienced.\u003c/p>\n\u003cp>Variation in space, on the other hand, provides more options because the different locations can act as refuges for the specialized variants of bacteria. Because those locations are always available, then specialists can coexist indefinitely. At least in theory.\u003c/p>\n\u003cp>\u003cstrong>Buying us time\u003cbr>\n\u003c/strong>This seems to be what happened when we did an experiment to test the theory.\u003c/p>\n\u003cp>Resistance to the commonly used antibiotic ciprofloxacin took longer to spread in laboratory populations of the opportunistic pathogen Pseudomonas aeruginosa — a bacterium that causes acute infections in hospitals, especially intensive- care units, and chronic infections in the lungs of cystic fibrosis patients — when drug sanctuaries were experienced in space rather than time.\u003c/p>\n\u003cp>Resistant and sensitive genetic variants actually coexisted in spatial sanctuaries because of a trade-off between resistance and growth rate.\u003c/p>\n\u003cp>Resistant variants could withstand the drug, but grew far more slowly than sensitive ones in the sanctuary. The result was that neither could be eliminated by natural selection.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>What surprised us, though, was that over time, this trade-off broke down.\u003c/p>\n\u003cdiv class=\"post__col \">\n\u003cdiv class=\"post__col-right\">\n\u003carticle>\n\u003cdiv class=\"body-text\">\n\u003cp>The resistant strains actually gained mutations that improved their ability to grow in the absence of the drug. By the end of the experiment, most populations in the spatial sanctuary were dominated by antibiotic-resistant strains.\u003c/p>\n\u003cp>Evidently drug sanctuaries in space could allow us to keep using drugs for longer, but not indefinitely. Eventually we will need new arrows in our quiver.\u003c/p>\n\u003cp>\u003cstrong>A challenge for evolutionary biology\u003cbr>\n\u003c/strong>Our experiments are highly contrived and restricted to one strain of one pathogen evolving in response to one drug in the defined and controlled conditions of a laboratory.\u003c/p>\n\u003cp>Whether our conclusions hold for other bugs and other drugs, or more complicated networks of transmission characteristic of hospitals and the communities they are embedded in, remains to be seen.\u003c/p>\n\u003cp>What our work allows us to do is get directly at the ecological and genetic mechanisms responsible for the emergence, coexistence and eventual demise of diversity.\u003c/p>\n\u003cp>Using these evolutionary principles in more complex, real-world situations to manage our arsenal of drugs for as long as possible will be a major challenge for evolutionary biology in the years to come.\u003c/p>\n\u003c/div>\n\u003c/article>\n\u003c/div>\n\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Viral Video Highlights America's Emergency Psychiatric Crisis",
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"content": "\u003cp>A viral video from Baltimore is drawing attention to a crisis that's unfolding in emergency rooms across the country: Surging numbers of patients with psychiatric conditions aren't receiving the care they need.\u003c/p>\n\u003cp>On a cold night in January, a man walking by a downtown Baltimore hospital saw something that shocked him. He started recording the incident on his phone.[contextly_sidebar id=\"szGKbRaruZx5ZzbLuwCWnThGfKj4M6NW\"]\u003c/p>\n\u003cp>Imamu Baraka's video, which has been viewed more than 3 million times, shows security guards walking away from a bus stop next to the emergency room of University of Maryland Medical Center Midtown Campus.\u003c/p>\n\u003cp>One is pushing an empty wheelchair. The woman they left there is wearing a thin yellow hospital gown and socks.\u003c/p>\n\u003cp>\"Wait, so you're just going to leave this lady out here with no clothes on?\" Baraka asks the guards. They continue walking away.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The woman, later identified as a 22-year-old named Rebecca, staggers near the bus stop. She appears distressed and confused. She moans and shouts.\u003c/p>\n\u003cp>\"Are you OK, ma'am? Do you need me to call the police?\" Baraka asks.\u003c/p>\n\u003cp>Nationwide, hospitals are struggling to provide services to people with psychiatric emergencies. Between 2006 and 2013, ER visits increased by more than 50 percent for psychoses and bipolar disorders and depression, anxiety and stress reactions \u003ca href=\"https://www.hcup-us.ahrq.gov/reports/statbriefs/sb216-Mental-Substance-Use-Disorder-ED-Visit-Trends.pdf\" target=\"_blank\" rel=\"noopener\">according to the Healthcare Cost and Utilization Project\u003c/a>, which compiles health care data. Between those years the number of visits climbed from 3,448 visits to 5,330 per 100,000 U.S. patients ages 15 and older.[contextly_sidebar id=\"OwR2yLry7rt36cQxbBEeKvzvQmLWRIHK\"]\u003c/p>\n\u003cp>\"We're just failing patients with mental illness and it's just getting worse as time goes on,\" says \u003ca href=\"https://www.acep.org/Membership/Leadership/John-J--Rogers,-MD,-CPE,-FACEP,-President-Elect/#sm.00001sg4kgdr2xd0gwjdhu1dohu7f\" target=\"_blank\" rel=\"noopener\">Dr. John Rogers\u003c/a>, president-elect of the American College of Emergency Physicians.\u003c/p>\n\u003cp>In the viral video, Rebecca has a visible wound on her forehead, and her breath forms white clouds in the cold. Baraka calls for an ambulance, which brings her back to the hospital that just discharged her.\u003c/p>\n\u003cp>Rebecca's mother, Cheryl Chandler, says she happened to click on the video, not knowing it showed her daughter. \"Once he focused on her face I realized it was her. And I think I went into shock initially,\" Chandler says.\u003c/p>\n\u003cp>That realization set off a desperate search. The hospital wouldn't tell her where she was. Chandler called the police. They found out that the hospital didn't readmit Rebecca, even though according to \u003ca href=\"https://www.documentcloud.org/documents/4417187-UMMC-Investigation-2.html\" target=\"_blank\" rel=\"noopener\">a federal regulator's report\u003c/a>, Rebecca told workers in the ambulance, \"I do not feel normal, and do not know what normal is.\"\u003c/p>\n\u003cp>Hospital staff put her into a cab that took her to a nearby homeless shelter, where family members found her the next day. She's been hospitalized on and off since the incident.\u003c/p>\n\u003cp>\"She could have got hypothermia. She could have died. She could have been raped, she could have been killed,\" Chandler says. \"All she wanted was treatment and they had two opportunities to do it and denied it both times.\"[contextly_sidebar id=\"qVILeFSoPW1ICG0oW2MIVApcccHW7EoZ\"]\u003c/p>\n\u003cp>Rebecca was clearly asking for medical care, her mother says, which ERs are legally required to provide.\u003c/p>\n\u003cp>\"That, what I saw in the video, was my worst nightmare for Rebecca,\" Chandler says. Several years ago, Rebecca was diagnosed with bipolar and schizoaffective disorders. Her mom adds that she's a shy and lovable introvert who loves animals and making art.\u003c/p>\n\u003cp>Rebecca has insurance and had been in a residential home when she went missing, Chandler says.\u003c/p>\n\u003cp>The hospital has apologized and says it has already put in place measures to correct the issues.\u003c/p>\n\u003cp>Chandler says she hopes that means it won't happen to other patients. But she adds that Rebecca will continue to suffer from the hospital's decisions: \"No part of Rebecca, because of this, is going to heal. No part. We can't make the scars go away.\"\u003c/p>\n\u003cp>James E. Farmer, a lawyer for Rebecca's family, says they're investigating now and considering filing lawsuits. \"It's going to be difficult to determine the exact extent of harm to Rebecca,\" he says. \"I could not imagine the psychological damage and harm that was done as a result of this.\"\u003c/p>\n\u003cp>The Centers for Medicare & Medicaid Services says the hospital failed to discharge the patient safely, among other breaches.\u003c/p>\n\u003cp>According to the federal regulator's report, Rebecca was \"resistant to discharge and refused to get dressed into street clothes when requested by nursing.\" The hospital stated there was a \"communication failure\" which led to her discharge into the cold weather, though the report says it is not clear whether nursing or security staff made that decision.\u003c/p>\n\u003cp>Chandler says she's heard from other families with similar stories: \"The only difference is it wasn't caught on video.\u003cem>\"\u003c/em>\u003c/p>\n\u003cp>\u003cstrong>\"They told me to leave\"\u003c/strong>\u003c/p>\n\u003cp>Here's another story from Baltimore, about Laura Pogliano and her son Zaccaria. Zac, who had schizophrenia, died in 2015 of heart failure when he was 23.\u003c/p>\n\u003cp>Zac was sensitive and empathetic, and loved playing the piano, his mother says. He started to show symptoms of the disease when he was 16. He became paranoid, and started doing things like hiding kitchen implements out of fear that someone was trying to kill his family.\u003c/p>\n\u003cp>\"His personality just drastically changed,\" Pogliano says. \"He had a thousand rituals around things so that he wasn't harmed.\"\u003c/p>\n\u003cp>Then, as part of his illness, Zac started to think that he actually did have dramatic injuries. Like a gunshot wound or a pulverized ankle. He'd call 911.\u003c/p>\n\u003cp>\"He got to the point where he would pick up the phone at the drop of a hat and say, can someone come and help me, I'm having a heart attack,\" Pogliano says.\u003c/p>\n\u003cp>This happened about 20 times in the two years before his death, she says. Often, ambulances took Zac to Good Samaritan Hospital, where Pogliano says the doctors would typically call her to let her know he arrived and would provide appropriate care for him. Later, hospital staff would call her to pick him up.\u003c/p>\n\u003cp>But one night after Zac went to the ER, Pogliano woke up hours later and got worried that she hadn't received a call.\u003c/p>\n\u003cp>\"I just got in the car and drove over there, and he was sitting outside. It was early spring but it was still wintery, probably 40 degrees out, 45 degrees out,\" she says.[contextly_sidebar id=\"rDd0VJsZFkI99YckcnBP9H20wW3og3pM\"]\u003c/p>\n\u003cp>\"All he had on was what he wore to the hospital, which was a pair of white linen shorts. I know he didn't have shoes on. ... And a hospital gown and no shirt. I said to him, 'Oh my gosh, what are you doing here?' He said, 'They told me to leave.' \"\u003c/p>\n\u003cp>A hospital spokeswoman acknowledged that Pogliano was a patient there but says she found no indication that he was ever inappropriately evaluated or mistreated. She says she couldn't comment further because of federal privacy laws.\u003c/p>\n\u003cp>Emergency room doctors are frustrated at the growing gap in care for patients with psychiatric disabilities.\u003c/p>\n\u003cp>\"We're kind of tired of waiting for legislators and regulators to act and to meet their responsibility to these patients in the form of providing funding for resources,\" says Rogers, the president-elect of the American College of Emergency Physicians.\u003c/p>\n\u003cp>Even as there is increasing demand, there are fewer resources to care for psychiatric patients. It can be difficult for doctors to find an inpatient bed — the numbers are have decreased dramatically over the decades. Rogers says there have been significant cuts to community and outpatient resources — so the emergency department is often the only place for psychiatric patients to go.\u003c/p>\n\u003cp>\"Every emergency physician in the country knows this problem well and wants to do something about it,\" Rogers says.\u003c/p>\n\u003cp>Often the ER is not properly equipped with staff that can offer treatment to psychiatric patients. The emergency room's mission is to assess and stabilize, but the actual care they can provide psychiatric patients is fairly limited. \u003ca href=\"https://www.acep.org/uploadedFiles/ACEP/newsroom/NewsMediaResources/StatisticsData/Psychiatric%20Boarding%20Summary.pdf\">A 2008 survey of ER doctors\u003c/a> found that 62 percent of them said there were no psychiatric services provided while the patients were in the ER.[contextly_sidebar id=\"lGkbbkYcbyqeAi9PmdSR23pZZwe16xA2\"]\u003c/p>\n\u003cp>\"And the disparity between our ability to care for a patient with a medical problem and a patient with a psychiatric problem is growing, that gap is increasing,\" Rogers says.\u003c/p>\n\u003cp>He says Rebecca's case is an outlier. More common, he says, is that ERs will hold patients for too long before they can transfer them somewhere that can treat them. In \u003ca href=\"http://newsroom.acep.org/2015-02-24-psychiatric-emergencies\" target=\"_blank\" rel=\"noopener\">a recent poll of emergency physicians\u003c/a>, 84 percent said that psychiatric patients are \"boarded\" in their departments for hours or days. Rogers says he's heard of patients being held for weeks.\u003c/p>\n\u003cp>And the options for where to transfer them are often limited. \"And that's where it starts breaking down,\" he says. \"The time that it takes to get someone transferred for something like that is just unacceptable....They wait, and wait, and wait.\"\u003c/p>\n\u003cp>It's a bad situation for everyone – for patients with psychiatric disabilities, and for other patients who have lengthy wait times because ERs are overwhelmed.\u003c/p>\n\u003cp>\"They're being asked to do way too much with way too few resources,\" says Susan Stefan, a lawyer focusing on rights of people with psychiatric disabilities. ERs \"have a specific mission, which is to provide emergency medical care, and they're being turned into essentially 24-7 social service agencies.\"[contextly_sidebar id=\"Ei91X4TinBmgcEKaNWK697YV179b4rWn\"]\u003c/p>\n\u003cp>Stefan, who wrote a \u003ca href=\"https://www.amazon.com/Emergency-Department-Treatment-Psychiatric-Patient/dp/0195189299\" target=\"_blank\" rel=\"noopener\">book about treating psychiatric patients in ERs\u003c/a>, says it's common for them to transfer people to homeless shelters because they are not equipped to find people stable housing.\u003c/p>\n\u003cp>And there's another crucial point here: The ER is simply a bad place to treat severe mental illness, even as it is becoming increasingly central for those patients.\u003c/p>\n\u003cp>\"The emergency department is probably the worst place for somebody in psychiatric crisis,\" Stefan says. \"It's loud, it's chaotic and people don't take a lot of time because they don't have a lot of time.\"\u003c/p>\n\u003cp>And it's not straightforward to transform an ER into a place that \u003cem>is\u003c/em> appropriate to provide treatment to people who are in the middle of psychiatric crises — although there are hospitals that are experimenting with new models to better serve these patients.\u003c/p>\n\u003cp>The Alameda Health System in Alameda County, Calif., is a model that both Stefan and Rogers point to. There, a doctor named Scott Zeller has set up a dedicated psychiatric emergency service — a department separate from the standard emergency room that can provide specialized evaluation and treatment for these patients.\u003c/p>\n\u003cp>The Alameda model reduced boarding times by 80 percent, according to a \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3935777/\" target=\"_blank\" rel=\"noopener\">study published \u003c/a>in the \u003cem>Western Journal of Emergency Medicine\u003c/em>, and the fast, stabilizing treatment made it far less likely that the patient would need to be transferred to an inpatient bed.\u003c/p>\n\u003cp>If there were adequate services in place, most of the people coming to ERs for psychiatric crises wouldn't need to come there at all, says Jennifer Mathis, the director of policy and legal advocacy at the Bazelon Center for Mental Health Law.\u003c/p>\n\u003cp>\"And much as everybody loves to talk about the need for mental health services, that doesn't translate into state policy and funding for community mental health services,\" she says.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>The problem here, Mathis says, is political will. There's a big gap between politicians talking about mental health and actually making sure people are getting the services they need.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=%27Failing+Patients%27%3A+Baltimore+Video+Highlights+Crisis+Of+Emergency+Psychiatric+Care&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>A viral video from Baltimore is drawing attention to a crisis that's unfolding in emergency rooms across the country: Surging numbers of patients with psychiatric conditions aren't receiving the care they need.\u003c/p>\n\u003cp>On a cold night in January, a man walking by a downtown Baltimore hospital saw something that shocked him. He started recording the incident on his phone.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Imamu Baraka's video, which has been viewed more than 3 million times, shows security guards walking away from a bus stop next to the emergency room of University of Maryland Medical Center Midtown Campus.\u003c/p>\n\u003cp>One is pushing an empty wheelchair. The woman they left there is wearing a thin yellow hospital gown and socks.\u003c/p>\n\u003cp>\"Wait, so you're just going to leave this lady out here with no clothes on?\" Baraka asks the guards. They continue walking away.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The woman, later identified as a 22-year-old named Rebecca, staggers near the bus stop. She appears distressed and confused. She moans and shouts.\u003c/p>\n\u003cp>\"Are you OK, ma'am? Do you need me to call the police?\" Baraka asks.\u003c/p>\n\u003cp>Nationwide, hospitals are struggling to provide services to people with psychiatric emergencies. Between 2006 and 2013, ER visits increased by more than 50 percent for psychoses and bipolar disorders and depression, anxiety and stress reactions \u003ca href=\"https://www.hcup-us.ahrq.gov/reports/statbriefs/sb216-Mental-Substance-Use-Disorder-ED-Visit-Trends.pdf\" target=\"_blank\" rel=\"noopener\">according to the Healthcare Cost and Utilization Project\u003c/a>, which compiles health care data. Between those years the number of visits climbed from 3,448 visits to 5,330 per 100,000 U.S. patients ages 15 and older.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\"We're just failing patients with mental illness and it's just getting worse as time goes on,\" says \u003ca href=\"https://www.acep.org/Membership/Leadership/John-J--Rogers,-MD,-CPE,-FACEP,-President-Elect/#sm.00001sg4kgdr2xd0gwjdhu1dohu7f\" target=\"_blank\" rel=\"noopener\">Dr. John Rogers\u003c/a>, president-elect of the American College of Emergency Physicians.\u003c/p>\n\u003cp>In the viral video, Rebecca has a visible wound on her forehead, and her breath forms white clouds in the cold. Baraka calls for an ambulance, which brings her back to the hospital that just discharged her.\u003c/p>\n\u003cp>Rebecca's mother, Cheryl Chandler, says she happened to click on the video, not knowing it showed her daughter. \"Once he focused on her face I realized it was her. And I think I went into shock initially,\" Chandler says.\u003c/p>\n\u003cp>That realization set off a desperate search. The hospital wouldn't tell her where she was. Chandler called the police. They found out that the hospital didn't readmit Rebecca, even though according to \u003ca href=\"https://www.documentcloud.org/documents/4417187-UMMC-Investigation-2.html\" target=\"_blank\" rel=\"noopener\">a federal regulator's report\u003c/a>, Rebecca told workers in the ambulance, \"I do not feel normal, and do not know what normal is.\"\u003c/p>\n\u003cp>Hospital staff put her into a cab that took her to a nearby homeless shelter, where family members found her the next day. She's been hospitalized on and off since the incident.\u003c/p>\n\u003cp>\"She could have got hypothermia. She could have died. She could have been raped, she could have been killed,\" Chandler says. \"All she wanted was treatment and they had two opportunities to do it and denied it both times.\"\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Rebecca was clearly asking for medical care, her mother says, which ERs are legally required to provide.\u003c/p>\n\u003cp>\"That, what I saw in the video, was my worst nightmare for Rebecca,\" Chandler says. Several years ago, Rebecca was diagnosed with bipolar and schizoaffective disorders. Her mom adds that she's a shy and lovable introvert who loves animals and making art.\u003c/p>\n\u003cp>Rebecca has insurance and had been in a residential home when she went missing, Chandler says.\u003c/p>\n\u003cp>The hospital has apologized and says it has already put in place measures to correct the issues.\u003c/p>\n\u003cp>Chandler says she hopes that means it won't happen to other patients. But she adds that Rebecca will continue to suffer from the hospital's decisions: \"No part of Rebecca, because of this, is going to heal. No part. We can't make the scars go away.\"\u003c/p>\n\u003cp>James E. Farmer, a lawyer for Rebecca's family, says they're investigating now and considering filing lawsuits. \"It's going to be difficult to determine the exact extent of harm to Rebecca,\" he says. \"I could not imagine the psychological damage and harm that was done as a result of this.\"\u003c/p>\n\u003cp>The Centers for Medicare & Medicaid Services says the hospital failed to discharge the patient safely, among other breaches.\u003c/p>\n\u003cp>According to the federal regulator's report, Rebecca was \"resistant to discharge and refused to get dressed into street clothes when requested by nursing.\" The hospital stated there was a \"communication failure\" which led to her discharge into the cold weather, though the report says it is not clear whether nursing or security staff made that decision.\u003c/p>\n\u003cp>Chandler says she's heard from other families with similar stories: \"The only difference is it wasn't caught on video.\u003cem>\"\u003c/em>\u003c/p>\n\u003cp>\u003cstrong>\"They told me to leave\"\u003c/strong>\u003c/p>\n\u003cp>Here's another story from Baltimore, about Laura Pogliano and her son Zaccaria. Zac, who had schizophrenia, died in 2015 of heart failure when he was 23.\u003c/p>\n\u003cp>Zac was sensitive and empathetic, and loved playing the piano, his mother says. He started to show symptoms of the disease when he was 16. He became paranoid, and started doing things like hiding kitchen implements out of fear that someone was trying to kill his family.\u003c/p>\n\u003cp>\"His personality just drastically changed,\" Pogliano says. \"He had a thousand rituals around things so that he wasn't harmed.\"\u003c/p>\n\u003cp>Then, as part of his illness, Zac started to think that he actually did have dramatic injuries. Like a gunshot wound or a pulverized ankle. He'd call 911.\u003c/p>\n\u003cp>\"He got to the point where he would pick up the phone at the drop of a hat and say, can someone come and help me, I'm having a heart attack,\" Pogliano says.\u003c/p>\n\u003cp>This happened about 20 times in the two years before his death, she says. Often, ambulances took Zac to Good Samaritan Hospital, where Pogliano says the doctors would typically call her to let her know he arrived and would provide appropriate care for him. Later, hospital staff would call her to pick him up.\u003c/p>\n\u003cp>But one night after Zac went to the ER, Pogliano woke up hours later and got worried that she hadn't received a call.\u003c/p>\n\u003cp>\"I just got in the car and drove over there, and he was sitting outside. It was early spring but it was still wintery, probably 40 degrees out, 45 degrees out,\" she says.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\"All he had on was what he wore to the hospital, which was a pair of white linen shorts. I know he didn't have shoes on. ... And a hospital gown and no shirt. I said to him, 'Oh my gosh, what are you doing here?' He said, 'They told me to leave.' \"\u003c/p>\n\u003cp>A hospital spokeswoman acknowledged that Pogliano was a patient there but says she found no indication that he was ever inappropriately evaluated or mistreated. She says she couldn't comment further because of federal privacy laws.\u003c/p>\n\u003cp>Emergency room doctors are frustrated at the growing gap in care for patients with psychiatric disabilities.\u003c/p>\n\u003cp>\"We're kind of tired of waiting for legislators and regulators to act and to meet their responsibility to these patients in the form of providing funding for resources,\" says Rogers, the president-elect of the American College of Emergency Physicians.\u003c/p>\n\u003cp>Even as there is increasing demand, there are fewer resources to care for psychiatric patients. It can be difficult for doctors to find an inpatient bed — the numbers are have decreased dramatically over the decades. Rogers says there have been significant cuts to community and outpatient resources — so the emergency department is often the only place for psychiatric patients to go.\u003c/p>\n\u003cp>\"Every emergency physician in the country knows this problem well and wants to do something about it,\" Rogers says.\u003c/p>\n\u003cp>Often the ER is not properly equipped with staff that can offer treatment to psychiatric patients. The emergency room's mission is to assess and stabilize, but the actual care they can provide psychiatric patients is fairly limited. \u003ca href=\"https://www.acep.org/uploadedFiles/ACEP/newsroom/NewsMediaResources/StatisticsData/Psychiatric%20Boarding%20Summary.pdf\">A 2008 survey of ER doctors\u003c/a> found that 62 percent of them said there were no psychiatric services provided while the patients were in the ER.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\"And the disparity between our ability to care for a patient with a medical problem and a patient with a psychiatric problem is growing, that gap is increasing,\" Rogers says.\u003c/p>\n\u003cp>He says Rebecca's case is an outlier. More common, he says, is that ERs will hold patients for too long before they can transfer them somewhere that can treat them. In \u003ca href=\"http://newsroom.acep.org/2015-02-24-psychiatric-emergencies\" target=\"_blank\" rel=\"noopener\">a recent poll of emergency physicians\u003c/a>, 84 percent said that psychiatric patients are \"boarded\" in their departments for hours or days. Rogers says he's heard of patients being held for weeks.\u003c/p>\n\u003cp>And the options for where to transfer them are often limited. \"And that's where it starts breaking down,\" he says. \"The time that it takes to get someone transferred for something like that is just unacceptable....They wait, and wait, and wait.\"\u003c/p>\n\u003cp>It's a bad situation for everyone – for patients with psychiatric disabilities, and for other patients who have lengthy wait times because ERs are overwhelmed.\u003c/p>\n\u003cp>\"They're being asked to do way too much with way too few resources,\" says Susan Stefan, a lawyer focusing on rights of people with psychiatric disabilities. ERs \"have a specific mission, which is to provide emergency medical care, and they're being turned into essentially 24-7 social service agencies.\"\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Stefan, who wrote a \u003ca href=\"https://www.amazon.com/Emergency-Department-Treatment-Psychiatric-Patient/dp/0195189299\" target=\"_blank\" rel=\"noopener\">book about treating psychiatric patients in ERs\u003c/a>, says it's common for them to transfer people to homeless shelters because they are not equipped to find people stable housing.\u003c/p>\n\u003cp>And there's another crucial point here: The ER is simply a bad place to treat severe mental illness, even as it is becoming increasingly central for those patients.\u003c/p>\n\u003cp>\"The emergency department is probably the worst place for somebody in psychiatric crisis,\" Stefan says. \"It's loud, it's chaotic and people don't take a lot of time because they don't have a lot of time.\"\u003c/p>\n\u003cp>And it's not straightforward to transform an ER into a place that \u003cem>is\u003c/em> appropriate to provide treatment to people who are in the middle of psychiatric crises — although there are hospitals that are experimenting with new models to better serve these patients.\u003c/p>\n\u003cp>The Alameda Health System in Alameda County, Calif., is a model that both Stefan and Rogers point to. There, a doctor named Scott Zeller has set up a dedicated psychiatric emergency service — a department separate from the standard emergency room that can provide specialized evaluation and treatment for these patients.\u003c/p>\n\u003cp>The Alameda model reduced boarding times by 80 percent, according to a \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3935777/\" target=\"_blank\" rel=\"noopener\">study published \u003c/a>in the \u003cem>Western Journal of Emergency Medicine\u003c/em>, and the fast, stabilizing treatment made it far less likely that the patient would need to be transferred to an inpatient bed.\u003c/p>\n\u003cp>If there were adequate services in place, most of the people coming to ERs for psychiatric crises wouldn't need to come there at all, says Jennifer Mathis, the director of policy and legal advocacy at the Bazelon Center for Mental Health Law.\u003c/p>\n\u003cp>\"And much as everybody loves to talk about the need for mental health services, that doesn't translate into state policy and funding for community mental health services,\" she says.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The problem here, Mathis says, is political will. There's a big gap between politicians talking about mental health and actually making sure people are getting the services they need.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=%27Failing+Patients%27%3A+Baltimore+Video+Highlights+Crisis+Of+Emergency+Psychiatric+Care&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Little Evidence Popular Food Intolerance Tests Work",
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"content": "\u003cp>Numerous online companies are trying to drive a revolution\u003cstrong> \u003c/strong>in lab testing by making it possible for you to skip the doctor and test for fertility, sleep hormones and even vitamin deficiencies -- all from the privacy of your bathroom -- no lab visit required.\u003c/p>\n\u003cp>Do-it-yourself testing kits cost anywhere from about $35 for an individual test to $450 for a battery of tests.\u003c/p>\n\u003caside class=\"pullquote alignright\">'It is important to understand that this test has never been scientifically proven to be able to accomplish what it reports to do.'\u003ccite>American Academy of Allergy, Asthma & Immunology\u003c/cite>\u003c/aside>\n\u003cp>Last November on \"Shark Tank,\" the reality show featuring budding entrepreneurs who think they have a hot idea, contestant Julia Cheek hawked her company's home-testing kits to the program's panel of investors.\u003c/p>\n\u003cp>\"EverlyWell is transforming lab testing — a $25 billion market — to be simple, convenient and useful for you,\" Cheek pitched.\u003c/p>\n\u003cp>\"I think the product is brilliantly crafted,\" said Lori Greiner, who is also known as \"The Queen of QVC.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"I think this gives people an empowered way to check on some things.\"\u003c/p>\n\u003cp>Cheek walked away from the show with a million-dollar commitment for her Austin-based company.\u003c/p>\n\u003cp>But that was TV, of course. Some doctors worry EveryWell is promising more than it can deliver.\u003c/p>\n\u003cp>\u003cstrong>One Woman's Success Story\u003c/strong>\u003c/p>\n\u003caside class=\"pullquote alignright\">'EverlyWell recognizes that the AAAAI does not support any form of food sensitivity testing ... but they are not the entire 'medical community,' and AAAAI does not speak for all health care providers.' \u003ccite>EverlyWell \u003c/cite>\u003c/aside>\n\u003cp>The company's food-sensitivity test is its best seller, and the kit is especially hot in the Bay Area. San Francisco resident Regina Du says the test has changed her life. For years Du missed work due to stomachaches, headaches and inflamed welts.\u003c/p>\n\u003cp>“I just felt crummy,\" said Du. \"I would just like uncontrollably scratch myself because I was so itchy.\"\u003c/p>\n\u003cp>Doctors couldn’t figure out what was wrong. Eventually Du landed under the care of an allergist, who ordered a test. But Du balked when she learned her insurance wouldn’t cover the $700 cost.\u003c/p>\n\u003cp>“I just had total sticker shock,\" Du said.\u003c/p>\n\u003cp>So, she poked around online and found EverlyWell's food sensitivity kit for a couple hundred bucks.\u003c/p>\n\u003cp>Instructions inside the neatly packed kit explain how to prick your finger and dribble drops of blood onto a white collection card. Du completed the test in less than 20 minutes during her lunch break. A few days later she got an email suggesting she avoid gluten, dairy and green beans.\u003c/p>\n\u003cp>Almost immediately: Du started feeling better. Within a few weeks she felt normal for the first time in eight years.\u003c/p>\n\u003cp>\u003cb>Does it Work?\u003c/b>\u003c/p>\n\u003cp>The test is supposed to measure whether a person’s immune system reacts to certain foods by making an antibody called Immunoglobulin G (IgG), which EverlyWell describes on its website as the potential cause of symptoms like migraines or irritable bowel syndrome according to some small \u003ca href=\"https://www.everlywell.com/food-sensitivity-and-you/\" target=\"_blank\" rel=\"noopener\">studies\u003c/a>.\u003c/p>\n\u003cfigure id=\"attachment_441036\" class=\"wp-caption alignright\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-441036\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/04/Screen-Shot-2018-04-26-at-4.31.33-PM-800x599.png\" alt=\"\" width=\"800\" height=\"599\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2018/04/Screen-Shot-2018-04-26-at-4.31.33-PM-800x599.png 800w, https://ww2.kqed.org/app/uploads/sites/13/2018/04/Screen-Shot-2018-04-26-at-4.31.33-PM-160x120.png 160w, https://ww2.kqed.org/app/uploads/sites/13/2018/04/Screen-Shot-2018-04-26-at-4.31.33-PM-768x575.png 768w, https://ww2.kqed.org/app/uploads/sites/13/2018/04/Screen-Shot-2018-04-26-at-4.31.33-PM-240x180.png 240w, https://ww2.kqed.org/app/uploads/sites/13/2018/04/Screen-Shot-2018-04-26-at-4.31.33-PM-375x281.png 375w, https://ww2.kqed.org/app/uploads/sites/13/2018/04/Screen-Shot-2018-04-26-at-4.31.33-PM-520x389.png 520w, https://ww2.kqed.org/app/uploads/sites/13/2018/04/Screen-Shot-2018-04-26-at-4.31.33-PM.png 884w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Julia Cheek, CEO of EverlyWell, on a November 2017 episode of 'Shark Tank.' \u003ccite>(Courtesy ABC/Sony Pictures Television)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The American Academy of Allergy, Asthma & Immunology does not recognize the validity of IgG tests in diagnosing food sensitivity, also called food intolerance.\u003c/p>\n\u003cp>\"It is important to understand that this test has never been scientifically proven to be able to accomplish what it reports to do,\" the AAAAI \u003ca href=\"https://www.aaaai.org/conditions-and-treatments/library/allergy-library/IgG-food-test\" target=\"_blank\" rel=\"noopener\">writes on its website\u003c/a>. \"The scientific studies that are provided to support the use of this test are often out of date, in non-reputable journals and many have not even used the IgG test in question. The presence of IgG is likely a normal response of the immune system to exposure to food.\"\u003c/p>\n\u003cp>Dr. Neha Shah, a rheumatologist and immunologist at Stanford University, is one doctor who is skeptical.\u003c/p>\n\u003cp>“What we don’t have is proof that having a high IgG level against a particular food item means that that food is causing your symptoms,\" said Shah.\u003c/p>\n\u003cp>Shah shares the story of her sister, who bought a test and then was told to avoid swordfish.\u003c/p>\n\u003cp>“We’ve been vegetarians all our whole lives,\" said Shah. \"And there was really no reason why she had a high sensitivity, a high IgG level against swordfish.”\u003c/p>\n\u003cp>Shah also says IgG levels can elevate simply because you eat a specific food, so it doesn't necessarily mean that your body is reacting negatively. For all these reasons, Shah does not administer food sensitivity tests in her practice. She suggests patients save the money and go straight to an elimination diet\u003cb>, \u003c/b>where you remove commonly reactive foods like gluten or dairy and see if you feel better.\u003c/p>\n\u003caside class=\"pullquote alignright\">\u003c/aside>\n\u003cp>\u003cstrong>Test for Heavy Metals, Stress or Metabolism\u003c/strong>\u003c/p>\n\u003cp>Dr. Marra Francis, EverlyWell's executive medical director, stands by its products as a valuable first step for patients to take their health into their own hands.\u003c/p>\n\u003cp>\"A lot of times this testing can be a bridge between vague symptoms and an actual plan that you create with your provider,\" she said. EverlyWell does recommend patients\u003cb> \u003c/b>double-check test results with an elimination diet.\u003c/p>\n\u003cp>Tina Heilman, a spokesperson for EverlyWell, wrote in an email:\u003c/p>\n\u003cp>\"EverlyWell recognizes that the AAAAI does not support any form of food sensitivity testing (which is not just limited to IgG testing), but they are not the entire 'medical community,' and AAAAI does not speak for all health care providers. IgG tests are currently ordered by thousands of medical providers in the U.S.\"\u003c/p>\n\u003cp>\u003cstrong>No Oversight\u003c/strong>\u003c/p>\n\u003cp>Besides its IgG test, the company markets 22 other home wellness tests, everything from cholesterol to testosterone. Internet ventures like LetsGetChecked, Thorne and Health Test Express offer a similar array.\u003c/p>\n\u003cp>But some doctors worry about a booming market that's not regulated by the Food and Drug Administration.\u003c/p>\n\u003cp>“A lot of this kind of huxterist testing is keying off of the placebo effect,\" said Dr. Norman Paradis, a clinical lab expert who teaches at the Geisel School of Medicine at Dartmouth College, referring to the industry in general and not to a particular product.\u003c/p>\n\u003cp>In other words, just believing a test is valid and taking action on it may make you feel better. Paradis is also worried that home tests could inspire patients to overreact to results. Hypothetically, a patient may discover she's deficient in vitamin d and compensate by taking toxic doses, he said. Or a test result may inspire a patient to seek medical care they don’t need.\u003c/p>\n\u003cp>“For instance, let’s say a test inaccurately said you may have colon cancer,\" said Paradis. \"And then you went and got a colonoscopy and were injured during the colonoscopy. Well the test actually created that harm.”\u003c/p>\n\u003cp>Dr. Gilbert Welch, the author of \"Overdiagnosed: Making People Sick in Pursuit of Health\u003cem>,\" \u003c/em>said, \"You can't test your way to health.\"\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>For unexplained symptoms he suggested starting with the long-ignored advice from your grandmother: Eat real food, set a regular sleep schedule, and get some exercise.\u003c/p>\n\n",
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"excerpt": "EverlyWell says it can determine which foods to avoid through an at-home blood test, but experts say the science is shaky. The company was funded after winning on the TV show 'Shark Tank.'",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Numerous online companies are trying to drive a revolution\u003cstrong> \u003c/strong>in lab testing by making it possible for you to skip the doctor and test for fertility, sleep hormones and even vitamin deficiencies -- all from the privacy of your bathroom -- no lab visit required.\u003c/p>\n\u003cp>Do-it-yourself testing kits cost anywhere from about $35 for an individual test to $450 for a battery of tests.\u003c/p>\n\u003caside class=\"pullquote alignright\">'It is important to understand that this test has never been scientifically proven to be able to accomplish what it reports to do.'\u003ccite>American Academy of Allergy, Asthma & Immunology\u003c/cite>\u003c/aside>\n\u003cp>Last November on \"Shark Tank,\" the reality show featuring budding entrepreneurs who think they have a hot idea, contestant Julia Cheek hawked her company's home-testing kits to the program's panel of investors.\u003c/p>\n\u003cp>\"EverlyWell is transforming lab testing — a $25 billion market — to be simple, convenient and useful for you,\" Cheek pitched.\u003c/p>\n\u003cp>\"I think the product is brilliantly crafted,\" said Lori Greiner, who is also known as \"The Queen of QVC.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"I think this gives people an empowered way to check on some things.\"\u003c/p>\n\u003cp>Cheek walked away from the show with a million-dollar commitment for her Austin-based company.\u003c/p>\n\u003cp>But that was TV, of course. Some doctors worry EveryWell is promising more than it can deliver.\u003c/p>\n\u003cp>\u003cstrong>One Woman's Success Story\u003c/strong>\u003c/p>\n\u003caside class=\"pullquote alignright\">'EverlyWell recognizes that the AAAAI does not support any form of food sensitivity testing ... but they are not the entire 'medical community,' and AAAAI does not speak for all health care providers.' \u003ccite>EverlyWell \u003c/cite>\u003c/aside>\n\u003cp>The company's food-sensitivity test is its best seller, and the kit is especially hot in the Bay Area. San Francisco resident Regina Du says the test has changed her life. For years Du missed work due to stomachaches, headaches and inflamed welts.\u003c/p>\n\u003cp>“I just felt crummy,\" said Du. \"I would just like uncontrollably scratch myself because I was so itchy.\"\u003c/p>\n\u003cp>Doctors couldn’t figure out what was wrong. Eventually Du landed under the care of an allergist, who ordered a test. But Du balked when she learned her insurance wouldn’t cover the $700 cost.\u003c/p>\n\u003cp>“I just had total sticker shock,\" Du said.\u003c/p>\n\u003cp>So, she poked around online and found EverlyWell's food sensitivity kit for a couple hundred bucks.\u003c/p>\n\u003cp>Instructions inside the neatly packed kit explain how to prick your finger and dribble drops of blood onto a white collection card. Du completed the test in less than 20 minutes during her lunch break. A few days later she got an email suggesting she avoid gluten, dairy and green beans.\u003c/p>\n\u003cp>Almost immediately: Du started feeling better. Within a few weeks she felt normal for the first time in eight years.\u003c/p>\n\u003cp>\u003cb>Does it Work?\u003c/b>\u003c/p>\n\u003cp>The test is supposed to measure whether a person’s immune system reacts to certain foods by making an antibody called Immunoglobulin G (IgG), which EverlyWell describes on its website as the potential cause of symptoms like migraines or irritable bowel syndrome according to some small \u003ca href=\"https://www.everlywell.com/food-sensitivity-and-you/\" target=\"_blank\" rel=\"noopener\">studies\u003c/a>.\u003c/p>\n\u003cfigure id=\"attachment_441036\" class=\"wp-caption alignright\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-441036\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/04/Screen-Shot-2018-04-26-at-4.31.33-PM-800x599.png\" alt=\"\" width=\"800\" height=\"599\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2018/04/Screen-Shot-2018-04-26-at-4.31.33-PM-800x599.png 800w, https://ww2.kqed.org/app/uploads/sites/13/2018/04/Screen-Shot-2018-04-26-at-4.31.33-PM-160x120.png 160w, https://ww2.kqed.org/app/uploads/sites/13/2018/04/Screen-Shot-2018-04-26-at-4.31.33-PM-768x575.png 768w, https://ww2.kqed.org/app/uploads/sites/13/2018/04/Screen-Shot-2018-04-26-at-4.31.33-PM-240x180.png 240w, https://ww2.kqed.org/app/uploads/sites/13/2018/04/Screen-Shot-2018-04-26-at-4.31.33-PM-375x281.png 375w, https://ww2.kqed.org/app/uploads/sites/13/2018/04/Screen-Shot-2018-04-26-at-4.31.33-PM-520x389.png 520w, https://ww2.kqed.org/app/uploads/sites/13/2018/04/Screen-Shot-2018-04-26-at-4.31.33-PM.png 884w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Julia Cheek, CEO of EverlyWell, on a November 2017 episode of 'Shark Tank.' \u003ccite>(Courtesy ABC/Sony Pictures Television)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The American Academy of Allergy, Asthma & Immunology does not recognize the validity of IgG tests in diagnosing food sensitivity, also called food intolerance.\u003c/p>\n\u003cp>\"It is important to understand that this test has never been scientifically proven to be able to accomplish what it reports to do,\" the AAAAI \u003ca href=\"https://www.aaaai.org/conditions-and-treatments/library/allergy-library/IgG-food-test\" target=\"_blank\" rel=\"noopener\">writes on its website\u003c/a>. \"The scientific studies that are provided to support the use of this test are often out of date, in non-reputable journals and many have not even used the IgG test in question. The presence of IgG is likely a normal response of the immune system to exposure to food.\"\u003c/p>\n\u003cp>Dr. Neha Shah, a rheumatologist and immunologist at Stanford University, is one doctor who is skeptical.\u003c/p>\n\u003cp>“What we don’t have is proof that having a high IgG level against a particular food item means that that food is causing your symptoms,\" said Shah.\u003c/p>\n\u003cp>Shah shares the story of her sister, who bought a test and then was told to avoid swordfish.\u003c/p>\n\u003cp>“We’ve been vegetarians all our whole lives,\" said Shah. \"And there was really no reason why she had a high sensitivity, a high IgG level against swordfish.”\u003c/p>\n\u003cp>Shah also says IgG levels can elevate simply because you eat a specific food, so it doesn't necessarily mean that your body is reacting negatively. For all these reasons, Shah does not administer food sensitivity tests in her practice. She suggests patients save the money and go straight to an elimination diet\u003cb>, \u003c/b>where you remove commonly reactive foods like gluten or dairy and see if you feel better.\u003c/p>\n\u003caside class=\"pullquote alignright\">\u003c/aside>\n\u003cp>\u003cstrong>Test for Heavy Metals, Stress or Metabolism\u003c/strong>\u003c/p>\n\u003cp>Dr. Marra Francis, EverlyWell's executive medical director, stands by its products as a valuable first step for patients to take their health into their own hands.\u003c/p>\n\u003cp>\"A lot of times this testing can be a bridge between vague symptoms and an actual plan that you create with your provider,\" she said. EverlyWell does recommend patients\u003cb> \u003c/b>double-check test results with an elimination diet.\u003c/p>\n\u003cp>Tina Heilman, a spokesperson for EverlyWell, wrote in an email:\u003c/p>\n\u003cp>\"EverlyWell recognizes that the AAAAI does not support any form of food sensitivity testing (which is not just limited to IgG testing), but they are not the entire 'medical community,' and AAAAI does not speak for all health care providers. IgG tests are currently ordered by thousands of medical providers in the U.S.\"\u003c/p>\n\u003cp>\u003cstrong>No Oversight\u003c/strong>\u003c/p>\n\u003cp>Besides its IgG test, the company markets 22 other home wellness tests, everything from cholesterol to testosterone. Internet ventures like LetsGetChecked, Thorne and Health Test Express offer a similar array.\u003c/p>\n\u003cp>But some doctors worry about a booming market that's not regulated by the Food and Drug Administration.\u003c/p>\n\u003cp>“A lot of this kind of huxterist testing is keying off of the placebo effect,\" said Dr. Norman Paradis, a clinical lab expert who teaches at the Geisel School of Medicine at Dartmouth College, referring to the industry in general and not to a particular product.\u003c/p>\n\u003cp>In other words, just believing a test is valid and taking action on it may make you feel better. Paradis is also worried that home tests could inspire patients to overreact to results. Hypothetically, a patient may discover she's deficient in vitamin d and compensate by taking toxic doses, he said. Or a test result may inspire a patient to seek medical care they don’t need.\u003c/p>\n\u003cp>“For instance, let’s say a test inaccurately said you may have colon cancer,\" said Paradis. \"And then you went and got a colonoscopy and were injured during the colonoscopy. Well the test actually created that harm.”\u003c/p>\n\u003cp>Dr. Gilbert Welch, the author of \"Overdiagnosed: Making People Sick in Pursuit of Health\u003cem>,\" \u003c/em>said, \"You can't test your way to health.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>For unexplained symptoms he suggested starting with the long-ignored advice from your grandmother: Eat real food, set a regular sleep schedule, and get some exercise.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Autism Is on the Rise, CDC Says. Here’s What That Actually Means",
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"content": "\u003cp>One in 59 children in the U.S. have autism spectrum disorder, based on a new estimate released Thursday by the Centers for Disease Control and Prevention.\u003c/p>\n\u003cp>This finding indicates the prevalence of autism is slightly higher than previously thought, but does it mean autism is becoming more common? Here is what you need to know.[contextly_sidebar id=\"Sevxx0pxynIJeAlOQQl1WQbPkkyNrlRB\"]\u003c/p>\n\u003cp>\u003cb>Where the new numbers came from:\u003c/b> Since the turn of the century, the CDC and partner hospitals have measured the prevalence and evolution of autism spectrum disorder by using a massive group of 8-year-olds.\u003c/p>\n\u003cp>Known as the \u003ca href=\"https://www.cdc.gov/ncbddd/autism/addm.html\" target=\"_blank\" rel=\"noopener\">Autism and Developmental Disabilities Monitoring (ADDM) Network\u003c/a>, this survey ranges in size — depending on the year — from 180,000 to 400,000 children. It is spread across 11 communities in Arizona, Arkansas, Colorado, Georgia, Maryland, Minnesota, Missouri, New Jersey, North Carolina, Tennessee and Wisconsin.\u003c/p>\n\u003cp>Every two years, the CDC compiles this health data into a report, but due to a lag, Thursday’s findings technically reflect how many autism cases existed in 2014.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cb>The new rate, in context:\u003c/b> The latest figure from the network represents a small — less than a quarter of a percentage point — increase compared to the autism rate released in 2016 (one in 68). CDC officials partially attribute this rise to improved surveillance and diagnosis in minority communities.\u003c/p>\n\u003cp>\u003ca href=\"http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0011551\">Socioeconomics factors into whether or not\u003c/a> a child will receive access to autism screening, and prior research has found white and Asian children \u003ca href=\"https://ajph.aphapublications.org/doi/10.2105/AJPH.2007.131243\">are more likely to be diagnosed\u003c/a> than black and Hispanic kids. In 2012, the ADDM survey detected 20 percent more cases of autism in white versus black children. Compared to Latino children, the gap was even larger, at 50 percent.\u003c/p>\n\u003cp>\u003ciframe width=\"640\" height=\"360\" src=\"https://www.youtube.com/embed/aS0mh0kUlzo?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; encrypted-media; gyroscope; picture-in-picture\" allowfullscreen>\u003c/iframe>\u003c/p>\n\u003cp>“Autism prevalence among black and Hispanic children is approaching that of white children,” Stuart Shapira, associate director for science at CDC’s National Center on Birth Defects and Developmental Disabilities, said in a \u003ca href=\"https://www.cdc.gov/media/releases/2018/p0426-autism-prevalence.html\">statement\u003c/a>. “The higher number of black and Hispanic children now being identified with autism could be due to more effective outreach in minority communities and increased efforts to have all children screened for autism so they can get the services they need.”\u003c/p>\n\u003cp>But if it’s the case that the rate grew only because of better diagnosis, that would mean that autism spectrum disorder isn’t becoming more common among American children. Doctors are just better at spotting it.\u003c/p>\n\u003cp>\u003cb>Why it matters:\u003c/b> There is huge room for improvement when it comes to diagnosing autism. Based on the latest survey, doctors had noted developmental concerns early on with 85 percent of the children with autism, typically by age 3. But physicians only referred them for specialized evaluation 42 percent of the time. The autism rate also varied dramatically by region, with New Jersey reporting a prevalence that is twice what is found in Arkansas.\u003c/p>\n\u003cp>Until screening becomes level across the nation, it will be difficult to fully determine the degree to which regional, environmental and socioeconomic factors contribute to autism.[contextly_sidebar id=\"geBXqLoqg0oZNnzzsN71l0qnyTuBs8AV\"]\u003c/p>\n\u003cp>Meanwhile, any increase in the autism rate is met with a strong public scrutiny, as parents of children with the conditions continue to look, \u003ca href=\"https://spectrumnews.org/features/deep-dive/the-seekers-parents-who-find-fringe-therapies-for-autism/\">sometimes in alternative places\u003c/a>, for a cause and cure. This year also marks two decades since The Lancet published a now retracted study by Dr. Andrew Wakefield that falsified a link between measles, mumps and rubella (MMR) vaccine and autism. Since its publication, \u003ca href=\"https://www.cdc.gov/vaccinesafety/pdf/cdcstudiesonvaccinesandautism.pdf\">dozens\u003c/a> of \u003ca href=\"http://www.nejm.org/doi/full/10.1056/NEJMoa021134\">studies\u003c/a> have looked into any possible link between the measles vaccine and autism, and the evidence overwhelming shows no link.\u003c/p>\n\u003cp>After Wakefield’s study, the autism advocacy and medical communities endured a strained relationship, said Dr. Susan Hyman, division chief of developmental and behavioral pediatrics at the University of Rochester Medical Center. Just last autumn, a study found children whose older siblings have autism are about 14 percent \u003ca href=\"http://www.nejm.org/doi/full/10.1056/NEJMc1708223\">less likely\u003c/a> to be vaccinated than siblings of those without the disorder.\u003c/p>\n\u003cp>“Parents are still afraid because when you put that scary idea out there, it’s hard to put it back in,” said Alison Singer, president of the Autism Science Foundation (ASF). “So, there is still a legacy 20 years later from the Wakefield paper, and that legacy is disease and death.”\u003c/p>\n\u003cp>\u003ciframe width=\"640\" height=\"360\" src=\"https://www.youtube.com/embed/G3jiqymFDGg?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; encrypted-media; gyroscope; picture-in-picture\" allowfullscreen>\u003c/iframe>\u003c/p>\n\u003cp>Since then, the anti-vaccination movement has survived both in the United States and Europe. In the United Kingdom, MMR immunization rates \u003ca href=\"http://researchbriefings.files.parliament.uk/documents/SN02581/SN02581.pdf\">dropped\u003c/a> about 4 percent after the Wakefield study’s publication. A measles outbreak at Disneyland in 2014 \u003ca href=\"https://www.cdc.gov/mmwr/volumes/66/wr/mm6627a1.htm\">was attributed directly\u003c/a> to misinformation about vaccines and autism.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“We tell parents all the time: when you withhold vaccines from your child, you are doing absolutely nothing to reduce the likelihood that they will be diagnosed with autism,” Singer said. “But you are absolutely increasing the likelihood that they will contract a disease from which they could potentially die.”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>One in 59 children in the U.S. have autism spectrum disorder, based on a new estimate released Thursday by the Centers for Disease Control and Prevention.\u003c/p>\n\u003cp>This finding indicates the prevalence of autism is slightly higher than previously thought, but does it mean autism is becoming more common? Here is what you need to know.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\u003cb>Where the new numbers came from:\u003c/b> Since the turn of the century, the CDC and partner hospitals have measured the prevalence and evolution of autism spectrum disorder by using a massive group of 8-year-olds.\u003c/p>\n\u003cp>Known as the \u003ca href=\"https://www.cdc.gov/ncbddd/autism/addm.html\" target=\"_blank\" rel=\"noopener\">Autism and Developmental Disabilities Monitoring (ADDM) Network\u003c/a>, this survey ranges in size — depending on the year — from 180,000 to 400,000 children. It is spread across 11 communities in Arizona, Arkansas, Colorado, Georgia, Maryland, Minnesota, Missouri, New Jersey, North Carolina, Tennessee and Wisconsin.\u003c/p>\n\u003cp>Every two years, the CDC compiles this health data into a report, but due to a lag, Thursday’s findings technically reflect how many autism cases existed in 2014.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cb>The new rate, in context:\u003c/b> The latest figure from the network represents a small — less than a quarter of a percentage point — increase compared to the autism rate released in 2016 (one in 68). CDC officials partially attribute this rise to improved surveillance and diagnosis in minority communities.\u003c/p>\n\u003cp>\u003ca href=\"http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0011551\">Socioeconomics factors into whether or not\u003c/a> a child will receive access to autism screening, and prior research has found white and Asian children \u003ca href=\"https://ajph.aphapublications.org/doi/10.2105/AJPH.2007.131243\">are more likely to be diagnosed\u003c/a> than black and Hispanic kids. In 2012, the ADDM survey detected 20 percent more cases of autism in white versus black children. Compared to Latino children, the gap was even larger, at 50 percent.\u003c/p>\n\u003cp>\u003ciframe width=\"640\" height=\"360\" src=\"https://www.youtube.com/embed/aS0mh0kUlzo?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; encrypted-media; gyroscope; picture-in-picture\" allowfullscreen>\u003c/iframe>\u003c/p>\n\u003cp>“Autism prevalence among black and Hispanic children is approaching that of white children,” Stuart Shapira, associate director for science at CDC’s National Center on Birth Defects and Developmental Disabilities, said in a \u003ca href=\"https://www.cdc.gov/media/releases/2018/p0426-autism-prevalence.html\">statement\u003c/a>. “The higher number of black and Hispanic children now being identified with autism could be due to more effective outreach in minority communities and increased efforts to have all children screened for autism so they can get the services they need.”\u003c/p>\n\u003cp>But if it’s the case that the rate grew only because of better diagnosis, that would mean that autism spectrum disorder isn’t becoming more common among American children. Doctors are just better at spotting it.\u003c/p>\n\u003cp>\u003cb>Why it matters:\u003c/b> There is huge room for improvement when it comes to diagnosing autism. Based on the latest survey, doctors had noted developmental concerns early on with 85 percent of the children with autism, typically by age 3. But physicians only referred them for specialized evaluation 42 percent of the time. The autism rate also varied dramatically by region, with New Jersey reporting a prevalence that is twice what is found in Arkansas.\u003c/p>\n\u003cp>Until screening becomes level across the nation, it will be difficult to fully determine the degree to which regional, environmental and socioeconomic factors contribute to autism.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Meanwhile, any increase in the autism rate is met with a strong public scrutiny, as parents of children with the conditions continue to look, \u003ca href=\"https://spectrumnews.org/features/deep-dive/the-seekers-parents-who-find-fringe-therapies-for-autism/\">sometimes in alternative places\u003c/a>, for a cause and cure. This year also marks two decades since The Lancet published a now retracted study by Dr. Andrew Wakefield that falsified a link between measles, mumps and rubella (MMR) vaccine and autism. Since its publication, \u003ca href=\"https://www.cdc.gov/vaccinesafety/pdf/cdcstudiesonvaccinesandautism.pdf\">dozens\u003c/a> of \u003ca href=\"http://www.nejm.org/doi/full/10.1056/NEJMoa021134\">studies\u003c/a> have looked into any possible link between the measles vaccine and autism, and the evidence overwhelming shows no link.\u003c/p>\n\u003cp>After Wakefield’s study, the autism advocacy and medical communities endured a strained relationship, said Dr. Susan Hyman, division chief of developmental and behavioral pediatrics at the University of Rochester Medical Center. Just last autumn, a study found children whose older siblings have autism are about 14 percent \u003ca href=\"http://www.nejm.org/doi/full/10.1056/NEJMc1708223\">less likely\u003c/a> to be vaccinated than siblings of those without the disorder.\u003c/p>\n\u003cp>“Parents are still afraid because when you put that scary idea out there, it’s hard to put it back in,” said Alison Singer, president of the Autism Science Foundation (ASF). “So, there is still a legacy 20 years later from the Wakefield paper, and that legacy is disease and death.”\u003c/p>\n\u003cp>\u003ciframe width=\"640\" height=\"360\" src=\"https://www.youtube.com/embed/G3jiqymFDGg?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; encrypted-media; gyroscope; picture-in-picture\" allowfullscreen>\u003c/iframe>\u003c/p>\n\u003cp>Since then, the anti-vaccination movement has survived both in the United States and Europe. In the United Kingdom, MMR immunization rates \u003ca href=\"http://researchbriefings.files.parliament.uk/documents/SN02581/SN02581.pdf\">dropped\u003c/a> about 4 percent after the Wakefield study’s publication. A measles outbreak at Disneyland in 2014 \u003ca href=\"https://www.cdc.gov/mmwr/volumes/66/wr/mm6627a1.htm\">was attributed directly\u003c/a> to misinformation about vaccines and autism.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“We tell parents all the time: when you withhold vaccines from your child, you are doing absolutely nothing to reduce the likelihood that they will be diagnosed with autism,” Singer said. “But you are absolutely increasing the likelihood that they will contract a disease from which they could potentially die.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"tagline": "The flip side of gentrification, told through one town",
"info": "Gentrification is changing cities across America, forcing people from neighborhoods they have long called home. Call them the displaced. Now those priced out of the Bay Area are looking for a better life in an unlikely place. American Suburb follows this migration to one California town along the Delta, 45 miles from San Francisco. But is this once sleepy suburb ready for them?",
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"tagline": "Exploring the Bay Area, one question at a time",
"info": "KQED’s new podcast, Bay Curious, gets to the bottom of the mysteries — both profound and peculiar — that give the Bay Area its unique identity. And we’ll do it with your help! You ask the questions. You decide what Bay Curious investigates. And you join us on the journey to find the answers.",
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"info": "KQED’s statewide radio news program providing daily coverage of issues, trends and public policy decisions.",
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"order": 8
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},
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"id": "commonwealth-club",
"title": "Commonwealth Club of California Podcast",
"info": "The Commonwealth Club of California is the nation's oldest and largest public affairs forum. As a non-partisan forum, The Club brings to the public airwaves diverse viewpoints on important topics. The Club's weekly radio broadcast - the oldest in the U.S., dating back to 1924 - is carried across the nation on public radio stations and is now podcasting. Our website archive features audio of our recent programs, as well as selected speeches from our long and distinguished history. This podcast feed is usually updated twice a week and is always un-edited.",
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"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Commonwealth-Club-Podcast-Tile-360x360-1.jpg",
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"source": "Commonwealth Club of California"
},
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"info": "KQED’s live call-in program discussing local, state, national and international issues, as well as in-depth interviews.",
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"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Forum-Podcast-Tile-703x703-1.jpg",
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"order": 9
},
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"hidden-brain": {
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"airtime": "SUN 7:30pm-8pm",
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"tagline": "Where conversation and cultura meet",
"info": "What kind of no sabo word is Hyphenación? For us, it’s about living within a hyphenation. Like being a third-gen Mexican-American from the Texas border now living that Bay Area Chicano life. Like Xorje! Each week we bring together a couple of hyphenated Latinos to talk all about personal life choices: family, careers, relationships, belonging … everything is on the table. ",
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"title": "The Political Mind of Jerry Brown",
"tagline": "Lessons from a lifetime in politics",
"info": "The Political Mind of Jerry Brown brings listeners the wisdom of the former Governor, Mayor, and presidential candidate. Scott Shafer interviewed Brown for more than 40 hours, covering the former governor's life and half-century in the political game – and Brown has some lessons he'd like to share. ",
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"order": 18
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"id": "latino-usa",
"title": "Latino USA",
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"info": "Latino USA, the radio journal of news and culture, is the only national, English-language radio program produced from a Latino perspective.",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/latinoUsa.jpg",
"officialWebsiteLink": "http://latinousa.org/",
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},
"marketplace": {
"id": "marketplace",
"title": "Marketplace",
"info": "Our flagship program, helmed by Kai Ryssdal, examines what the day in money delivered, through stories, conversations, newsworthy numbers and more. Updated Monday through Friday at about 3:30 p.m. PT.",
"airtime": "MON-FRI 4pm-4:30pm, MON-WED 6:30pm-7pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Marketplace-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.marketplace.org/",
"meta": {
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"source": "American Public Media"
},
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"rss": "https://feeds.publicradio.org/public_feeds/marketplace-pm/rss/rss"
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},
"masters-of-scale": {
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"title": "Masters of Scale",
"info": "Masters of Scale is an original podcast in which LinkedIn co-founder and Greylock Partner Reid Hoffman sets out to describe and prove theories that explain how great entrepreneurs take their companies from zero to a gazillion in ingenious fashion.",
"airtime": "Every other Wednesday June 12 through October 16 at 8pm (repeats Thursdays at 2am)",
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"officialWebsiteLink": "https://mastersofscale.com/",
"meta": {
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"source": "WaitWhat"
},
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"rss": "https://rss.art19.com/masters-of-scale"
}
},
"mindshift": {
"id": "mindshift",
"title": "MindShift",
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"info": "The MindShift podcast explores the innovations in education that are shaping how kids learn. Hosts Ki Sung and Katrina Schwartz introduce listeners to educators, researchers, parents and students who are developing effective ways to improve how kids learn. We cover topics like how fed-up administrators are developing surprising tactics to deal with classroom disruptions; how listening to podcasts are helping kids develop reading skills; the consequences of overparenting; and why interdisciplinary learning can engage students on all ends of the traditional achievement spectrum. This podcast is part of the MindShift education site, a division of KQED News. KQED is an NPR/PBS member station based in San Francisco. You can also visit the MindShift website for episodes and supplemental blog posts or tweet us \u003ca href=\"https://twitter.com/MindShiftKQED\">@MindShiftKQED\u003c/a> or visit us at \u003ca href=\"/mindshift\">MindShift.KQED.org\u003c/a>",
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