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"content": "\u003cp>Eventually it happens to everyone. As we age, even if we're healthy, the heart becomes less flexible, more stiff and just isn't as efficient in processing oxygen as it used to be. In most people the first signs \u003ca href=\"http://onlinelibrary.wiley.com/doi/10.1113/jphysiol.2011.218271/full\" target=\"_blank\" rel=\"noopener\">show up\u003c/a> in the 50s or early 60s. And among people who don't exercise, the underlying changes can start even sooner.\u003c/p>\n\u003cp>\"The heart gets smaller — stiffer,\" says \u003ca href=\"http://profiles.utsouthwestern.edu/profile/14262/benjamin-levine.html\" target=\"_blank\" rel=\"noopener\">Dr. Ben Levine\u003c/a>, a sports cardiologist at University of Texas Southwestern Medical Center and director of the Institute for Exercise and Environmental Medicine at Texas Health Presbyterian Hospital, in Dallas.[contextly_sidebar id=\"UJp77wAYFxSsTskHzbjUfLZVQstMILpG\"]\u003c/p>\n\u003cp>Think of the heart muscle as a rubber band, Levine says. In the beginning, the rubber band is flexible and pliable. But put it in a drawer for 20 years and it will emerge dry and brittle.\u003c/p>\n\u003cp>\"That's what happens to the heart and blood vessels,\" he says. And down the road, that sort of stiffness can get worse, he notes, leading to the breathlessness and other symptoms of \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0022300/\" target=\"_blank\" rel=\"noopener\">heart failure\u003c/a>, an inability of the heart to effectively pump blood to the lungs or throughout the body.\u003c/p>\n\u003cp>Fortunately for those in midlife, Levine is finding that even if you haven't been an avid exerciser, getting in shape now may head off that decline and help restore your aging heart. He and his colleagues \u003ca href=\"http://circ.ahajournals.org/content/early/2018/01/03/CIRCULATIONAHA.117.030617\" target=\"_blank\" rel=\"noopener\">published\u003c/a> their recent findings in the American Heart Association's journal, \u003cem>Circulation\u003c/em>.\u003c/p>\n\u003caside class=\"pullquote alignright\">'We took these 50-year-old hearts and turned the clock back to 30- or 35-year-old hearts.'\u003ccite>Dr. Ben Levine\u003c/cite>\u003c/aside>\n\u003cp>The research team recruited individuals between the ages of 45 and 64 who were mostly sedentary but otherwise healthy.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Dallas resident Mae Onsry, an accounts payable manager, was 62 at the time. Raising two children and working full time, she says, she never had the flexibility to fit in exercise, although she knew it was important for her health.\u003c/p>\n\u003cp>\"I have my hobbies,\" says Onsry, including ballroom dancing and gardening. But it was nothing routine, nothing \"disciplined,\" she says.\u003c/p>\n\u003cp>So when she saw a flyer about Levine's study, she signed up — along with 52 other volunteers — for a two-year study.\u003c/p>\n\u003cp>\u003cstrong>Heart Health\u003c/strong>\u003cbr>\nParticipants were randomly assigned to one of two groups. The first group engaged in a program of nonaerobic exercise — basic yoga, balance training and weight training — three times a week. The other group, which Onsry was in, was assigned a trainer and did moderate- to high-intensity aerobic exercise for four or more days a week.\u003c/p>\n\u003cp>After two years, the group doing the higher-intensity exercise saw dramatic improvements in heart health.\u003c/p>\n\u003cp>\"We took these 50-year-old hearts and turned the clock back to 30- or 35-year-old hearts,\" says Levine. Their hearts processed oxygen more efficiently and were notably less stiff.\u003c/p>\n\u003cp>\"And the reason they got so much stronger and fitter,\" he says, \"was because their hearts could now fill a lot better and pump a lot more blood during exercise.\"\u003c/p>\n\u003cp>The hearts of those engaged in less intense routines didn't change, he says.\u003c/p>\n\u003cp>A key part of the effective exercise regimen was interval training, Levine says — short bursts of high-intensity exercise followed by a few minutes of rest. The study incorporated what are often referred to as \u003ca href=\"https://www.ntnu.edu/cerg/advice\" target=\"_blank\" rel=\"noopener\">4x4 intervals\u003c/a>.\u003c/p>\n\u003cp>\"It's an old Norwegian ski team workout,\" Levine explains. \"It means four minutes at 95 percent of your maximal ability, followed by three minutes of active recovery, repeated four times.\"\u003c/p>\n\u003cp>\u003cimg class=\" wp-image-341841 alignleft\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/02/heart-health_wide-0fa361079eb45d51ec02f0d7448db4e125b1bd9b-1-800x450.jpg\" alt=\"\" width=\"520\" height=\"293\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/02/heart-health_wide-0fa361079eb45d51ec02f0d7448db4e125b1bd9b-1-800x450.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2017/02/heart-health_wide-0fa361079eb45d51ec02f0d7448db4e125b1bd9b-1-160x90.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/02/heart-health_wide-0fa361079eb45d51ec02f0d7448db4e125b1bd9b-1-768x432.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2017/02/heart-health_wide-0fa361079eb45d51ec02f0d7448db4e125b1bd9b-1-1020x574.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2017/02/heart-health_wide-0fa361079eb45d51ec02f0d7448db4e125b1bd9b-1-1920x1080.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2017/02/heart-health_wide-0fa361079eb45d51ec02f0d7448db4e125b1bd9b-1-1180x664.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2017/02/heart-health_wide-0fa361079eb45d51ec02f0d7448db4e125b1bd9b-1-960x540.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2017/02/heart-health_wide-0fa361079eb45d51ec02f0d7448db4e125b1bd9b-1-240x135.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/02/heart-health_wide-0fa361079eb45d51ec02f0d7448db4e125b1bd9b-1-375x211.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/02/heart-health_wide-0fa361079eb45d51ec02f0d7448db4e125b1bd9b-1-520x293.jpg 520w\" sizes=\"(max-width: 520px) 100vw, 520px\">Pushing as hard as you can for four minutes stresses the heart, he explains, and forces it to function more efficiently. Repeating the intervals helps strengthen both the heart and the circulatory system.\u003c/p>\n\u003cp>\"The sweet spot in life to get off the couch and start exercising [if you haven't already] is in late middle age when the heart still has plasticity,\" Levine says. You may not be able to reverse the aging of the vessels if you wait.\u003c/p>\n\u003cp>\"We put healthy 70-year-olds through a yearlong exercise training program, and nothing happened to them at all,\" Levine says. \"We could not change the structure of their heart and blood vessels.\"\u003c/p>\n\u003cp>Anyone considering beginning this, or a similarly strenuous exercise program, Levine says, should check with a doctor first and ask about individual health issues that might warrant a less intense program initially.\u003c/p>\n\u003cp>\u003cstrong>Mental Health\u003c/strong>\u003cbr>\nFor Onsry, who is now 65, the study was life changing. Today she exercises every day of the week, walking and jogging at least 5 miles around the lake near her home.\u003c/p>\n\u003cp>If she misses a day, she says, she just doesn't feel as good physically. And the regimen has helped her mental health, too.\u003c/p>\n\u003cp>\"I'm not moody,\" she says. \"I mean — I'm happy.\"\u003c/p>\n\u003cp>\u003ca href=\"https://nyulangone.org/doctors/1912084062/nieca-goldberg\" target=\"_blank\" rel=\"noopener\">Dr. Nieca Goldberg\u003c/a>, a cardiologist and medical director of the Joan H. Tisch Center for Women's Health at NYU Langone Medical Center, and a spokeswoman for the American Heart Association, says Levine's research is important.\u003c/p>\n\u003cp>\"Many studies that are done that look at [cardiovascular] health look at improvements in risk factors like high blood pressure, cholesterol and diabetes,\" Goldberg says. \"But this study specifically looked at heart function — and how heart function can improve with exercise.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Goldberg says the findings are a great start. But the study was small and needs to be repeated with far larger groups of people to determine exactly which aspects of an exercise routine make the biggest difference.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit \u003ca href=\"http://www.npr.org/\" target=\"_blank\" rel=\"noopener\">http://www.npr.org/\u003c/a>.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Hearts+Get+%27Younger%2C%27+Even+At+Middle+Age%2C+With+Exercise&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Eventually it happens to everyone. As we age, even if we're healthy, the heart becomes less flexible, more stiff and just isn't as efficient in processing oxygen as it used to be. In most people the first signs \u003ca href=\"http://onlinelibrary.wiley.com/doi/10.1113/jphysiol.2011.218271/full\" target=\"_blank\" rel=\"noopener\">show up\u003c/a> in the 50s or early 60s. And among people who don't exercise, the underlying changes can start even sooner.\u003c/p>\n\u003cp>\"The heart gets smaller — stiffer,\" says \u003ca href=\"http://profiles.utsouthwestern.edu/profile/14262/benjamin-levine.html\" target=\"_blank\" rel=\"noopener\">Dr. Ben Levine\u003c/a>, a sports cardiologist at University of Texas Southwestern Medical Center and director of the Institute for Exercise and Environmental Medicine at Texas Health Presbyterian Hospital, in Dallas.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Think of the heart muscle as a rubber band, Levine says. In the beginning, the rubber band is flexible and pliable. But put it in a drawer for 20 years and it will emerge dry and brittle.\u003c/p>\n\u003cp>\"That's what happens to the heart and blood vessels,\" he says. And down the road, that sort of stiffness can get worse, he notes, leading to the breathlessness and other symptoms of \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0022300/\" target=\"_blank\" rel=\"noopener\">heart failure\u003c/a>, an inability of the heart to effectively pump blood to the lungs or throughout the body.\u003c/p>\n\u003cp>Fortunately for those in midlife, Levine is finding that even if you haven't been an avid exerciser, getting in shape now may head off that decline and help restore your aging heart. He and his colleagues \u003ca href=\"http://circ.ahajournals.org/content/early/2018/01/03/CIRCULATIONAHA.117.030617\" target=\"_blank\" rel=\"noopener\">published\u003c/a> their recent findings in the American Heart Association's journal, \u003cem>Circulation\u003c/em>.\u003c/p>\n\u003caside class=\"pullquote alignright\">'We took these 50-year-old hearts and turned the clock back to 30- or 35-year-old hearts.'\u003ccite>Dr. Ben Levine\u003c/cite>\u003c/aside>\n\u003cp>The research team recruited individuals between the ages of 45 and 64 who were mostly sedentary but otherwise healthy.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Dallas resident Mae Onsry, an accounts payable manager, was 62 at the time. Raising two children and working full time, she says, she never had the flexibility to fit in exercise, although she knew it was important for her health.\u003c/p>\n\u003cp>\"I have my hobbies,\" says Onsry, including ballroom dancing and gardening. But it was nothing routine, nothing \"disciplined,\" she says.\u003c/p>\n\u003cp>So when she saw a flyer about Levine's study, she signed up — along with 52 other volunteers — for a two-year study.\u003c/p>\n\u003cp>\u003cstrong>Heart Health\u003c/strong>\u003cbr>\nParticipants were randomly assigned to one of two groups. The first group engaged in a program of nonaerobic exercise — basic yoga, balance training and weight training — three times a week. The other group, which Onsry was in, was assigned a trainer and did moderate- to high-intensity aerobic exercise for four or more days a week.\u003c/p>\n\u003cp>After two years, the group doing the higher-intensity exercise saw dramatic improvements in heart health.\u003c/p>\n\u003cp>\"We took these 50-year-old hearts and turned the clock back to 30- or 35-year-old hearts,\" says Levine. Their hearts processed oxygen more efficiently and were notably less stiff.\u003c/p>\n\u003cp>\"And the reason they got so much stronger and fitter,\" he says, \"was because their hearts could now fill a lot better and pump a lot more blood during exercise.\"\u003c/p>\n\u003cp>The hearts of those engaged in less intense routines didn't change, he says.\u003c/p>\n\u003cp>A key part of the effective exercise regimen was interval training, Levine says — short bursts of high-intensity exercise followed by a few minutes of rest. The study incorporated what are often referred to as \u003ca href=\"https://www.ntnu.edu/cerg/advice\" target=\"_blank\" rel=\"noopener\">4x4 intervals\u003c/a>.\u003c/p>\n\u003cp>\"It's an old Norwegian ski team workout,\" Levine explains. \"It means four minutes at 95 percent of your maximal ability, followed by three minutes of active recovery, repeated four times.\"\u003c/p>\n\u003cp>\u003cimg class=\" wp-image-341841 alignleft\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/02/heart-health_wide-0fa361079eb45d51ec02f0d7448db4e125b1bd9b-1-800x450.jpg\" alt=\"\" width=\"520\" height=\"293\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/02/heart-health_wide-0fa361079eb45d51ec02f0d7448db4e125b1bd9b-1-800x450.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2017/02/heart-health_wide-0fa361079eb45d51ec02f0d7448db4e125b1bd9b-1-160x90.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/02/heart-health_wide-0fa361079eb45d51ec02f0d7448db4e125b1bd9b-1-768x432.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2017/02/heart-health_wide-0fa361079eb45d51ec02f0d7448db4e125b1bd9b-1-1020x574.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2017/02/heart-health_wide-0fa361079eb45d51ec02f0d7448db4e125b1bd9b-1-1920x1080.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2017/02/heart-health_wide-0fa361079eb45d51ec02f0d7448db4e125b1bd9b-1-1180x664.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2017/02/heart-health_wide-0fa361079eb45d51ec02f0d7448db4e125b1bd9b-1-960x540.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2017/02/heart-health_wide-0fa361079eb45d51ec02f0d7448db4e125b1bd9b-1-240x135.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/02/heart-health_wide-0fa361079eb45d51ec02f0d7448db4e125b1bd9b-1-375x211.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/02/heart-health_wide-0fa361079eb45d51ec02f0d7448db4e125b1bd9b-1-520x293.jpg 520w\" sizes=\"(max-width: 520px) 100vw, 520px\">Pushing as hard as you can for four minutes stresses the heart, he explains, and forces it to function more efficiently. Repeating the intervals helps strengthen both the heart and the circulatory system.\u003c/p>\n\u003cp>\"The sweet spot in life to get off the couch and start exercising [if you haven't already] is in late middle age when the heart still has plasticity,\" Levine says. You may not be able to reverse the aging of the vessels if you wait.\u003c/p>\n\u003cp>\"We put healthy 70-year-olds through a yearlong exercise training program, and nothing happened to them at all,\" Levine says. \"We could not change the structure of their heart and blood vessels.\"\u003c/p>\n\u003cp>Anyone considering beginning this, or a similarly strenuous exercise program, Levine says, should check with a doctor first and ask about individual health issues that might warrant a less intense program initially.\u003c/p>\n\u003cp>\u003cstrong>Mental Health\u003c/strong>\u003cbr>\nFor Onsry, who is now 65, the study was life changing. Today she exercises every day of the week, walking and jogging at least 5 miles around the lake near her home.\u003c/p>\n\u003cp>If she misses a day, she says, she just doesn't feel as good physically. And the regimen has helped her mental health, too.\u003c/p>\n\u003cp>\"I'm not moody,\" she says. \"I mean — I'm happy.\"\u003c/p>\n\u003cp>\u003ca href=\"https://nyulangone.org/doctors/1912084062/nieca-goldberg\" target=\"_blank\" rel=\"noopener\">Dr. Nieca Goldberg\u003c/a>, a cardiologist and medical director of the Joan H. Tisch Center for Women's Health at NYU Langone Medical Center, and a spokeswoman for the American Heart Association, says Levine's research is important.\u003c/p>\n\u003cp>\"Many studies that are done that look at [cardiovascular] health look at improvements in risk factors like high blood pressure, cholesterol and diabetes,\" Goldberg says. \"But this study specifically looked at heart function — and how heart function can improve with exercise.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Goldberg says the findings are a great start. But the study was small and needs to be repeated with far larger groups of people to determine exactly which aspects of an exercise routine make the biggest difference.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit \u003ca href=\"http://www.npr.org/\" target=\"_blank\" rel=\"noopener\">http://www.npr.org/\u003c/a>.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Hearts+Get+%27Younger%2C%27+Even+At+Middle+Age%2C+With+Exercise&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "When Death Rocks Your World, Maybe You Jump Out Of A Plane",
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"content": "\u003cp>\u003cem>Welcome to \u003c/em>Invisibilia\u003cem> Season 4! The NPR program and \u003c/em>\u003ca href=\"http://www.npr.org/podcasts/510307/invisibilia\" target=\"_blank\" rel=\"noopener\">podcast\u003c/a> \u003cem>explores the invisible forces that shape human behavior, and we here at Shots are joining in to probe the often tenuous line between perception and reality. Here's a personal essay by the host that expands on Episode 1.\u003c/em>\u003c/p>\n\u003cp>There are lots of times when moms ask us to do things we don't want to do. Move the car. Wipe down the table. Get a haircut. Call the great aunt on her birthday. Figure out why my new phone is making a weird buzzy sound and why can't I get into my Facebook account and, you get the picture. My mom? Last fall she asked me to jump out of an airplane.\u003c/p>\n\u003cp>Now, I am generally not a person hindered by fear. As a child I was the one chosen by cousins to play the monster under the bed because I could happily hide in the dark by myself for hours.\u003c/p>\n\u003cp>But lately I have developed just one single deep, visceral, nausea-inducing fear. And just my luck, it's a fear of heights. I noticed it one afternoon when I took my son and his friend to visit the Sears Tower in Chicago and walked out onto the glass balcony. Looking down at the city under my feet, I got so dizzy that I stumbled backwards and knocked over a small child behind me.[contextly_sidebar id=\"T0KaXQE0R7cWrjpzbwqVmpnvKGxiugGc\"]\u003c/p>\n\u003cp>Intellectually, I recognized that this newfound phobia was probably some glitch of biology. My doctor blamed it on my balance getting worse with age. One \u003ca href=\"https://www.newscientist.com/article/dn16658-fear-of-heights-linked-to-vertical-perception/\">theory\u003c/a> is that your vertical perception deteriorates, and you get worse at approximating distances. It might just be that having children makes you less of a daredevil. Whatever it is, the fear was making it hard for me to be a dutiful daughter.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"If you're so afraid, then why are you doing it?\" all my friends asked, which was the obvious, reasonable question. But I didn't feel that I had a choice.\u003c/p>\n\u003cp>A year earlier, my mother's husband — my father — died quickly and unexpectedly of a rare form of cancer. They'd been married for 51 years. They had done everything together. He drove her to the subway every morning, picked her up in the evening, made her tea every night. After he died she was in a permanent state of shock. All her bossiness, humor, vitality — gone.\u003c/p>\n\u003caside class=\"pullquote alignright\">'Up there, she would catch a glimpse of her husband.'\u003c/aside>\n\u003cp>Then on the first anniversary of his death she sent me a text. It was a link to a place called \u003ca href=\"https://www.skydivecrosskeys.com/\" target=\"_blank\" rel=\"noopener\">Skydive Cross Keys\u003c/a> outside Philadelphia, with a photo of a guy doing two thumbs up as he tumbled out of a plane. My mom is 74, and not at all physically adventurous, or any kind of adventurous. She's never even ridden a bike. The fact that she wanted to jump out of an airplane meant that some revolution was brewing inside her.\u003c/p>\n\u003cp>\u003cstrong>Skydiving\u003c/strong>\u003cbr>\nShe'd gotten it in her head that skydiving was the one thing that would help her move forward. Her logic has to do with my father having been a paratrooper in the Israeli Army and also one other thing: \"Up there we will say 'hello' and meet someday,\" is what she texted me. Up there, she would catch a glimpse of her husband. Deliver a message. Then separate, but vow to meet again soon. It was a little alarming and death-wishy but you'd have to have a heart of coal not to sign on.[contextly_sidebar id=\"7tFZL7meuZs2d5uRNAoS1Ukn64EacBVA\"]\u003c/p>\n\u003cp>\"Can't you just wait for her on the ground?\" my friends asked. But that seemed like cheating. Who would send a 74-year old woman into the barren sky, alone? Plus, if she could make such a sudden radical shift, couldn't I? I've watched a few episodes of the \u003ca href=\"http://abc.go.com/shows/the-view\" target=\"_blank\" rel=\"noopener\">View\u003c/a>. If a woman my age has fear, her only option is \"conquer.\" If two women — and especially a mother and daughter — go on a road trip, their only option is to \"push beyond their limits\" and \"awaken something within.\"\u003c/p>\n\u003cp>Determined, I put my trust in Google, hoping to find some celestial inspiration. This was an amateur Internet error. \"Skydiver dies in parachute malfunction.\" \"Three skydivers die after mid-air collision.\" \"How I Survived a Skydiving Accident.\" Tabloids and YouTube love them a skydiving accident. That last one involved a tandem skydive in which the instructor's parachute and then emergency parachute failed to open, because it was too busy strangling him unconscious.\u003c/p>\n\u003caside class=\"pullquote alignright\">'Determined, I put my trust in Google, hoping to find some celestial inspiration.'\u003c/aside>\n\u003cp>I had made zero progress when, on the morning of our jump, my mother picked me up at the Philadelphia train station. She drove us out to the open field and I sat next to her, recording the trip with my microphone — both to steady my hands and take my mind off visions of accidental strangling.\u003c/p>\n\u003cp>As the sky grew increasingly gray and the wind picked up, I tried to hide my relief. I had done enough Googling to know that no respectable outfit will let you skydive when the weather turns south. We arrived and the receptionist's face made it clear: We were not going to skydive that day. My mother begged, and I went to the bathroom to secretly high five myself.\u003c/p>\n\u003cp>My mother, however, is the most stubborn person on Earth, so a week later we were road-tripping again. And this time, clear skies.\u003c/p>\n\u003cp>Here is where I wish I could bring in the rousing music to indicate inner limits dissolving in open air. Unfortunately, I am too much of a realist. \"Skydiving\" is such a majestic term, a centuries old dream of being freer than free that dates back to Leonardo DaVinci's first sketch of a parachute. But to me, it is what it is. You fly 12,000 feet up in a rickety airplane, and then walk out the door.\u003c/p>\n\u003cp>My mom took two old sweatshirts and sewed the letters E-L-I onto them for us. That was my father's name. Eli. In Hebrew it suggests ascending to God, something up high.\u003c/p>\n\u003cp>I sat in the back of the tiny plane as we climbed up high, trying not to look out the window and track how very far up we were going. The skydiving video guy tried to get me to say I was excited, but in the video I just nod my head no and stare grimly ahead. First a young guy ahead of us tumbled out the door. My mom was next. She took her position at the edge of the open door, and the instructor adjusted her arms and chin. I watched with growing terror as a stranger pushed my mother out an airplane door and then it was my turn.\u003c/p>\n\u003cp>\u003cstrong>'The Shadow of Temperament'\u003c/strong>\u003cbr>\nPsychologist Jerome Kagan has done many studies on \u003ca href=\"http://www.nytimes.com/2009/10/04/magazine/04anxiety-t.html\" target=\"_blank\" rel=\"noopener\">fear and the anxious mind\u003c/a>. His theory is that we are all born with a certain temperament — either more or less fearful — and while we can work mightily and successfully against our natural instincts, we can never fully overcome them. He calls it \"the shadow of temperament.\"\u003c/p>\n\u003cp>The conclusion has always struck me as gentle and generous towards the fearful, because it allows them to brave unknown territory while still holding onto their essential selves. But what about the naturally fearless, like me? Nobody talks much about what happens when they stray into the unfamiliar territory of deep fear.\u003c/p>\n\u003cp>I jumped. I don't know how it happened but it did. The instructor I was attached to just moved me to the door and I was out. I remember that it was freezing, and my ears hurt a lot. I remember he asked me, \"Are you OK?\" because I imagine most people, at some point during the jump, marvel at the beauty below. I can't say I ever did relax and enjoy the view. I just kept thinking, \"DOWNDOWNDOWN\" until we were down.\u003c/p>\n\u003cp>In the standard video they ask everyone if they would do it again. My mom answered an ecstatic \"Yes\" before he got the question out. My answer was \"#$@%* No!\" and then I think I mumbled, \"Why do humans do this to themselves?\"\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>In the end, I did not get over my particular fear or push beyond my limits or awaken anything within except a terrifying jolt that hits every time I step onto an airplane. It's a very unfamiliar feeling for me, but maybe I can adopt a bit of Kagan's generosity in this situation and accept that I will experience this one little pocket of terror without betraying who I am. At the very least, it made my mom happy. Because after a long, crushing year, she got to be the brave one.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit\u003ca href=\"http://www.npr.org/\" target=\"_blank\" rel=\"noopener\"> http://www.npr.org/\u003c/a>.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Invisibilia%3A+When+Death+Rocks+Your+World%2C+Maybe+You+Jump+Out+Of+A+Plane&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cem>Welcome to \u003c/em>Invisibilia\u003cem> Season 4! The NPR program and \u003c/em>\u003ca href=\"http://www.npr.org/podcasts/510307/invisibilia\" target=\"_blank\" rel=\"noopener\">podcast\u003c/a> \u003cem>explores the invisible forces that shape human behavior, and we here at Shots are joining in to probe the often tenuous line between perception and reality. Here's a personal essay by the host that expands on Episode 1.\u003c/em>\u003c/p>\n\u003cp>There are lots of times when moms ask us to do things we don't want to do. Move the car. Wipe down the table. Get a haircut. Call the great aunt on her birthday. Figure out why my new phone is making a weird buzzy sound and why can't I get into my Facebook account and, you get the picture. My mom? Last fall she asked me to jump out of an airplane.\u003c/p>\n\u003cp>Now, I am generally not a person hindered by fear. As a child I was the one chosen by cousins to play the monster under the bed because I could happily hide in the dark by myself for hours.\u003c/p>\n\u003cp>But lately I have developed just one single deep, visceral, nausea-inducing fear. And just my luck, it's a fear of heights. I noticed it one afternoon when I took my son and his friend to visit the Sears Tower in Chicago and walked out onto the glass balcony. Looking down at the city under my feet, I got so dizzy that I stumbled backwards and knocked over a small child behind me.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Intellectually, I recognized that this newfound phobia was probably some glitch of biology. My doctor blamed it on my balance getting worse with age. One \u003ca href=\"https://www.newscientist.com/article/dn16658-fear-of-heights-linked-to-vertical-perception/\">theory\u003c/a> is that your vertical perception deteriorates, and you get worse at approximating distances. It might just be that having children makes you less of a daredevil. Whatever it is, the fear was making it hard for me to be a dutiful daughter.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"If you're so afraid, then why are you doing it?\" all my friends asked, which was the obvious, reasonable question. But I didn't feel that I had a choice.\u003c/p>\n\u003cp>A year earlier, my mother's husband — my father — died quickly and unexpectedly of a rare form of cancer. They'd been married for 51 years. They had done everything together. He drove her to the subway every morning, picked her up in the evening, made her tea every night. After he died she was in a permanent state of shock. All her bossiness, humor, vitality — gone.\u003c/p>\n\u003caside class=\"pullquote alignright\">'Up there, she would catch a glimpse of her husband.'\u003c/aside>\n\u003cp>Then on the first anniversary of his death she sent me a text. It was a link to a place called \u003ca href=\"https://www.skydivecrosskeys.com/\" target=\"_blank\" rel=\"noopener\">Skydive Cross Keys\u003c/a> outside Philadelphia, with a photo of a guy doing two thumbs up as he tumbled out of a plane. My mom is 74, and not at all physically adventurous, or any kind of adventurous. She's never even ridden a bike. The fact that she wanted to jump out of an airplane meant that some revolution was brewing inside her.\u003c/p>\n\u003cp>\u003cstrong>Skydiving\u003c/strong>\u003cbr>\nShe'd gotten it in her head that skydiving was the one thing that would help her move forward. Her logic has to do with my father having been a paratrooper in the Israeli Army and also one other thing: \"Up there we will say 'hello' and meet someday,\" is what she texted me. Up there, she would catch a glimpse of her husband. Deliver a message. Then separate, but vow to meet again soon. It was a little alarming and death-wishy but you'd have to have a heart of coal not to sign on.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\"Can't you just wait for her on the ground?\" my friends asked. But that seemed like cheating. Who would send a 74-year old woman into the barren sky, alone? Plus, if she could make such a sudden radical shift, couldn't I? I've watched a few episodes of the \u003ca href=\"http://abc.go.com/shows/the-view\" target=\"_blank\" rel=\"noopener\">View\u003c/a>. If a woman my age has fear, her only option is \"conquer.\" If two women — and especially a mother and daughter — go on a road trip, their only option is to \"push beyond their limits\" and \"awaken something within.\"\u003c/p>\n\u003cp>Determined, I put my trust in Google, hoping to find some celestial inspiration. This was an amateur Internet error. \"Skydiver dies in parachute malfunction.\" \"Three skydivers die after mid-air collision.\" \"How I Survived a Skydiving Accident.\" Tabloids and YouTube love them a skydiving accident. That last one involved a tandem skydive in which the instructor's parachute and then emergency parachute failed to open, because it was too busy strangling him unconscious.\u003c/p>\n\u003caside class=\"pullquote alignright\">'Determined, I put my trust in Google, hoping to find some celestial inspiration.'\u003c/aside>\n\u003cp>I had made zero progress when, on the morning of our jump, my mother picked me up at the Philadelphia train station. She drove us out to the open field and I sat next to her, recording the trip with my microphone — both to steady my hands and take my mind off visions of accidental strangling.\u003c/p>\n\u003cp>As the sky grew increasingly gray and the wind picked up, I tried to hide my relief. I had done enough Googling to know that no respectable outfit will let you skydive when the weather turns south. We arrived and the receptionist's face made it clear: We were not going to skydive that day. My mother begged, and I went to the bathroom to secretly high five myself.\u003c/p>\n\u003cp>My mother, however, is the most stubborn person on Earth, so a week later we were road-tripping again. And this time, clear skies.\u003c/p>\n\u003cp>Here is where I wish I could bring in the rousing music to indicate inner limits dissolving in open air. Unfortunately, I am too much of a realist. \"Skydiving\" is such a majestic term, a centuries old dream of being freer than free that dates back to Leonardo DaVinci's first sketch of a parachute. But to me, it is what it is. You fly 12,000 feet up in a rickety airplane, and then walk out the door.\u003c/p>\n\u003cp>My mom took two old sweatshirts and sewed the letters E-L-I onto them for us. That was my father's name. Eli. In Hebrew it suggests ascending to God, something up high.\u003c/p>\n\u003cp>I sat in the back of the tiny plane as we climbed up high, trying not to look out the window and track how very far up we were going. The skydiving video guy tried to get me to say I was excited, but in the video I just nod my head no and stare grimly ahead. First a young guy ahead of us tumbled out the door. My mom was next. She took her position at the edge of the open door, and the instructor adjusted her arms and chin. I watched with growing terror as a stranger pushed my mother out an airplane door and then it was my turn.\u003c/p>\n\u003cp>\u003cstrong>'The Shadow of Temperament'\u003c/strong>\u003cbr>\nPsychologist Jerome Kagan has done many studies on \u003ca href=\"http://www.nytimes.com/2009/10/04/magazine/04anxiety-t.html\" target=\"_blank\" rel=\"noopener\">fear and the anxious mind\u003c/a>. His theory is that we are all born with a certain temperament — either more or less fearful — and while we can work mightily and successfully against our natural instincts, we can never fully overcome them. He calls it \"the shadow of temperament.\"\u003c/p>\n\u003cp>The conclusion has always struck me as gentle and generous towards the fearful, because it allows them to brave unknown territory while still holding onto their essential selves. But what about the naturally fearless, like me? Nobody talks much about what happens when they stray into the unfamiliar territory of deep fear.\u003c/p>\n\u003cp>I jumped. I don't know how it happened but it did. The instructor I was attached to just moved me to the door and I was out. I remember that it was freezing, and my ears hurt a lot. I remember he asked me, \"Are you OK?\" because I imagine most people, at some point during the jump, marvel at the beauty below. I can't say I ever did relax and enjoy the view. I just kept thinking, \"DOWNDOWNDOWN\" until we were down.\u003c/p>\n\u003cp>In the standard video they ask everyone if they would do it again. My mom answered an ecstatic \"Yes\" before he got the question out. My answer was \"#$@%* No!\" and then I think I mumbled, \"Why do humans do this to themselves?\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>In the end, I did not get over my particular fear or push beyond my limits or awaken anything within except a terrifying jolt that hits every time I step onto an airplane. It's a very unfamiliar feeling for me, but maybe I can adopt a bit of Kagan's generosity in this situation and accept that I will experience this one little pocket of terror without betraying who I am. At the very least, it made my mom happy. Because after a long, crushing year, she got to be the brave one.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit\u003ca href=\"http://www.npr.org/\" target=\"_blank\" rel=\"noopener\"> http://www.npr.org/\u003c/a>.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Invisibilia%3A+When+Death+Rocks+Your+World%2C+Maybe+You+Jump+Out+Of+A+Plane&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Does Tamiflu Work? We Asked a Scientist",
"title": "Does Tamiflu Work? We Asked a Scientist",
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"content": "\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe width=\"581\" height=\"326\" src=\"https://www.youtube.com/embed/AhgM59sAMzY\" frameborder=\"0\" allow=\"autoplay; encrypted-media\" scrolling=\"yes\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003cp>This year’s flu season has killed nearly 100 children, and led to more than 1,100\u003ca href=\"https://gis.cdc.gov/grasp/fluview/FluHospChars.html\" target=\"_blank\" rel=\"noopener\"> hospitalizations per week\u003c/a> — a rate the U.S. has not seen in more than 15 years.\u003c/p>\n\u003cp>When the flu strikes, many rush to the doctor for Tamiflu, a popular drug \u003ca href=\"https://www.fda.gov/Drugs/DrugSafety/ucm188859.htm\" target=\"_blank\" rel=\"noopener\">approved to treat\u003c/a> influenza’s basic symptoms and keep the virus from multiplying in the body. But doctors also prescribe the drug to tackle or prevent the flu’s life-threatening complications, like pneumonia and asthma attacks.[contextly_sidebar id=\"dEWuUGFvsMLSs6WLCNtEK2hWhwTOp878\"]\u003c/p>\n\u003cp>NewsHour asked a drug safety researcher, a virologist at a children’s hospital and a medical officer at Centers for Disease Control and Prevention whether Tamiflu delivers on these claims.\u003c/p>\n\u003cp>\u003cstrong>What Does Tamiflu Do?\u003c/strong>\u003cbr>\nTamiflu is an antiviral drug that blocks an enzyme called neuraminidase, which helps the flu virus replicate and spread through your body. Most flu researchers agree on the basics — that Tamiflu will reduce symptoms, like stuffy nose, sore throat, fever and tiredness, which is something many over-the-counter medications do too.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“The ideal scenarios is to start [Tamiflu] treatment as soon as possible,” said Dr. Elena Govorkova, laboratory director in the division of virology at St. Jude Children’s Research Hospital in Memphis, Tenn. “The most efficacy is received when treatment starts within 48 hours after symptoms start to appear.”\u003c/p>\n\u003cp>Govorkova said Tamiflu is clinically proven to reduce the duration of influenza symptoms by one to two days, which may not seem like much. “But when you have thousands people infected, especially if people are working, it makes, of course, a huge impact,” Govorkova said.\u003c/p>\n\u003cp>\u003cimg class=\"size-medium wp-image-439428 alignleft\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/02/GettyImages-89182311-800x544.jpg\" alt=\"\" width=\"800\" height=\"544\">But broader claims about Tamiflu’s effectiveness made by the Centers for Disease Control and Prevention conflict with those of the U.S. Food and Drug Administration, according to drug safety researcher Peter Doshi at the University of Maryland School of Pharmacy.\u003c/p>\n\u003cp>The CDC\u003ca href=\"https://www.cdc.gov/flu/antivirals/whatyoushould.htm\" target=\"_blank\" rel=\"noopener\"> describes Tamiflu\u003c/a> as a drug that may “reduce the risk of complications such as ear infections in children, and pneumonia and hospitalizations in adults.” The FDA’s \u003ca href=\"https://www.gene.com/download/pdf/tamiflu_prescribing.pdf\" target=\"_blank\" rel=\"noopener\">drug label\u003c/a> for Tamiflu, however, says the remedy “has not been shown to prevent such complications.”\u003c/p>\n\u003cp>Doshi, who supports the FDA’s position, said this difference of view is a public health concern.\u003c/p>\n\u003cp>But Tim Uyeki, chief medical officer for the CDC’s influenza division, disagrees with the FDA’s narrow definition. He said the two agencies are acting according to their respective missions. Whereas the FDA approves drugs based on strict “controlled trials,” Uyeki said, the CDC is not a regulatory authority.[contextly_sidebar id=\"LkP32YkNx63Kd1oVIhjfC2XPuqIHqxai\"]\u003c/p>\n\u003cp>Instead, the CDC makes recommendations for public health based on a broader, albeit less strict, body of evidence, Uyeki said. For example, it gathers “observational data,” such as years of notes on flu patients who walk into hospitals seeking treatment.\u003c/p>\n\u003cp>Based on this observational data, Uyeki said that oseltamivir — the generic name for antivirals that include Tamiflu — can improve survival against the worst flu complications, especially when the drug is compared to no treatment at all.\u003c/p>\n\u003cp>\u003cstrong>Reviewing The Evidence\u003cbr>\n\u003c/strong>But Doshi said the leap from ‘reducing symptoms’ to ‘preventing complications’ is a stretch. When asked if Tamiflu provides additional benefits against the worst of the flu, Doshi said, “That’s where the evidence gets very dicey very quickly.”\u003c/p>\n\u003cp>In 2009, Doshi’s team got a\u003ca href=\"http://www.bmj.com/content/bmj/suppl/2009/12/07/bmj.b5106.DC1/jeft726562.ww1_default.pdf\" target=\"_blank\" rel=\"noopener\"> tip from a pediatrician\u003c/a> that the data for the Tamiflu clinical trials were not publicly accessible. This pediatrician noticed the claims on Tamiflu’s effectiveness were based on manufacturer-funded studies. That discovery prompted Doshi’s three-year effort to obtain and analyze the studies behind Tamiflu’s FDA approval.\u003c/p>\n\u003cp>Doshi’s team concluded in a 2014 \u003ca href=\"http://www.bmj.com/content/348/bmj.g2545\" target=\"_blank\" rel=\"noopener\">Cochrane review\u003c/a> article that the \u003ca href=\"http://www.bmj.com/content/348/bmj.g2545\" target=\"_blank\" rel=\"noopener\">clinical trial data\u003c/a> did not support the broader claims made about Tamiflu. The team looked at clinical study reports for 83 trials and found no improvement for admission-to-hospital rates, pneumonia or bronchitis. However, they did see a more than 50 percent reduction in influenza symptoms.[contextly_sidebar id=\"UhKr6k2joqSbmBiSd5fm7An0GzEUsPyo\"]\u003c/p>\n\u003cp>Uyeki said Doshi’s review has had a tremendous influence because of the worldwide reach of\u003ca href=\"http://www.bmj.com/content/348/bmj.g2545\"> Cochrane\u003c/a>, but added that the results are misleading.\u003c/p>\n\u003cp>Uyeki called Doshi’s evidence “watered down” because it relied on patients who had influenza-like symptoms, but were not necessarily confirmed by laboratory testing to have the flu. Many different viral infections and some bacterial infections can mimic “flu-like” symptoms. So if one patient received Tamiflu and did not have the flu, then he or she may have skewed Doshi’s data, Uyeki said.\u003c/p>\n\u003cp>The Cochrane review focused on “influenza-like” illness as an outcome because that’s “the thing people want to avoid,” Doshi said, adding that the outcomes with pneumonia and hospitalizations are the same, regardless of whether you’re looking at flu-like cases or lab-confirmed cases.\u003c/p>\n\u003cp>Govorkova said that Tamiflu can reduce the chances of catching pneumonia.\u003c/p>\n\u003cp>She explains: Pneumonia is caused by bacteria, not the influenza virus. But the flu virus, in some cases, can predispose receptors on the epithelial cells lining our throats and lungs to become infected with pneumonia-causing bacteria.\u003c/p>\n\u003cp>“[Tamiflu] is not for the treatment of pneumonia — you must use antibiotics,” Govorkova said. “But because [Tamiflu] is very specific for influenza virus, if you start early, you can eliminate influenza virus from the body. And because of that, pneumonia cannot occur.”\u003c/p>\n\u003cp>Doctors may also prescribe Tamiflu in cases, she said, when another remedy isn’t available — \u003ca href=\"https://academic.oup.com/jid/article/202/8/1149/926161\" target=\"_blank\" rel=\"noopener\">such as during avian\u003c/a> H5N1 influenza outbreaks. “Vaccines were not available for prevention purposes, so they were giving Tamiflu even after 48 hours of exposure,” Govorkova said.\u003c/p>\n\u003cp>\u003cstrong>Why This Debate Matters\u003cbr>\n\u003c/strong>Doshi and Uyeki do agree that underlying chronic conditions — like asthma, obesity, diabetes and heart disease — can worsen a flu case by expanding the amount of time the virus spends multiplying.\u003c/p>\n\u003cp>…patients should consult their doctors on whether Tamiflu could be helpful. They should also make sure to take the full course of medicine.\u003c/p>\n\u003cp>But with the flood of alarming media and rising flu-related hospitalizations, Doshi worries people will begin to count on Tamiflu to save lives. He said viral stories, such as those about a Texas \u003ca href=\"http://www.bbc.com/news/world-us-canada-43039036\" target=\"_blank\" rel=\"noopener\">teacher\u003c/a> or a New Hampshire \u003ca href=\"http://www.dailymail.co.uk/health/article-5331999/Mother-four-killed-flu-refusing-Tamiflu.html\" target=\"_blank\" rel=\"noopener\">mother\u003c/a>, that link their flu-related deaths to refusing Tamiflu, lead people to believe Tamiflu is a “wonder drug” that could help the situation in the first place.\u003c/p>\n\u003cp>“[Those stories] project this sense that we’re certain that if only she had taken Tamiflu she would be alive today, and we don’t have any evidence to know that that’s the case,” Doshi said. “So it really spreads a dangerous message.\u003c/p>\n\u003cp>Govorkova said patients should consult their doctors on whether Tamiflu could be helpful. They should also make sure to take the full course of medicine.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>Some people drop out early or take it once a day rather than twice a day, she said, and this should be avoided because it can cause the emergence of Tamiflu-resistant flu strains.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe width=\"581\" height=\"326\" src=\"https://www.youtube.com/embed/AhgM59sAMzY\" frameborder=\"0\" allow=\"autoplay; encrypted-media\" scrolling=\"yes\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003cp>This year’s flu season has killed nearly 100 children, and led to more than 1,100\u003ca href=\"https://gis.cdc.gov/grasp/fluview/FluHospChars.html\" target=\"_blank\" rel=\"noopener\"> hospitalizations per week\u003c/a> — a rate the U.S. has not seen in more than 15 years.\u003c/p>\n\u003cp>When the flu strikes, many rush to the doctor for Tamiflu, a popular drug \u003ca href=\"https://www.fda.gov/Drugs/DrugSafety/ucm188859.htm\" target=\"_blank\" rel=\"noopener\">approved to treat\u003c/a> influenza’s basic symptoms and keep the virus from multiplying in the body. But doctors also prescribe the drug to tackle or prevent the flu’s life-threatening complications, like pneumonia and asthma attacks.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>NewsHour asked a drug safety researcher, a virologist at a children’s hospital and a medical officer at Centers for Disease Control and Prevention whether Tamiflu delivers on these claims.\u003c/p>\n\u003cp>\u003cstrong>What Does Tamiflu Do?\u003c/strong>\u003cbr>\nTamiflu is an antiviral drug that blocks an enzyme called neuraminidase, which helps the flu virus replicate and spread through your body. Most flu researchers agree on the basics — that Tamiflu will reduce symptoms, like stuffy nose, sore throat, fever and tiredness, which is something many over-the-counter medications do too.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“The ideal scenarios is to start [Tamiflu] treatment as soon as possible,” said Dr. Elena Govorkova, laboratory director in the division of virology at St. Jude Children’s Research Hospital in Memphis, Tenn. “The most efficacy is received when treatment starts within 48 hours after symptoms start to appear.”\u003c/p>\n\u003cp>Govorkova said Tamiflu is clinically proven to reduce the duration of influenza symptoms by one to two days, which may not seem like much. “But when you have thousands people infected, especially if people are working, it makes, of course, a huge impact,” Govorkova said.\u003c/p>\n\u003cp>\u003cimg class=\"size-medium wp-image-439428 alignleft\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/02/GettyImages-89182311-800x544.jpg\" alt=\"\" width=\"800\" height=\"544\">But broader claims about Tamiflu’s effectiveness made by the Centers for Disease Control and Prevention conflict with those of the U.S. Food and Drug Administration, according to drug safety researcher Peter Doshi at the University of Maryland School of Pharmacy.\u003c/p>\n\u003cp>The CDC\u003ca href=\"https://www.cdc.gov/flu/antivirals/whatyoushould.htm\" target=\"_blank\" rel=\"noopener\"> describes Tamiflu\u003c/a> as a drug that may “reduce the risk of complications such as ear infections in children, and pneumonia and hospitalizations in adults.” The FDA’s \u003ca href=\"https://www.gene.com/download/pdf/tamiflu_prescribing.pdf\" target=\"_blank\" rel=\"noopener\">drug label\u003c/a> for Tamiflu, however, says the remedy “has not been shown to prevent such complications.”\u003c/p>\n\u003cp>Doshi, who supports the FDA’s position, said this difference of view is a public health concern.\u003c/p>\n\u003cp>But Tim Uyeki, chief medical officer for the CDC’s influenza division, disagrees with the FDA’s narrow definition. He said the two agencies are acting according to their respective missions. Whereas the FDA approves drugs based on strict “controlled trials,” Uyeki said, the CDC is not a regulatory authority.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Instead, the CDC makes recommendations for public health based on a broader, albeit less strict, body of evidence, Uyeki said. For example, it gathers “observational data,” such as years of notes on flu patients who walk into hospitals seeking treatment.\u003c/p>\n\u003cp>Based on this observational data, Uyeki said that oseltamivir — the generic name for antivirals that include Tamiflu — can improve survival against the worst flu complications, especially when the drug is compared to no treatment at all.\u003c/p>\n\u003cp>\u003cstrong>Reviewing The Evidence\u003cbr>\n\u003c/strong>But Doshi said the leap from ‘reducing symptoms’ to ‘preventing complications’ is a stretch. When asked if Tamiflu provides additional benefits against the worst of the flu, Doshi said, “That’s where the evidence gets very dicey very quickly.”\u003c/p>\n\u003cp>In 2009, Doshi’s team got a\u003ca href=\"http://www.bmj.com/content/bmj/suppl/2009/12/07/bmj.b5106.DC1/jeft726562.ww1_default.pdf\" target=\"_blank\" rel=\"noopener\"> tip from a pediatrician\u003c/a> that the data for the Tamiflu clinical trials were not publicly accessible. This pediatrician noticed the claims on Tamiflu’s effectiveness were based on manufacturer-funded studies. That discovery prompted Doshi’s three-year effort to obtain and analyze the studies behind Tamiflu’s FDA approval.\u003c/p>\n\u003cp>Doshi’s team concluded in a 2014 \u003ca href=\"http://www.bmj.com/content/348/bmj.g2545\" target=\"_blank\" rel=\"noopener\">Cochrane review\u003c/a> article that the \u003ca href=\"http://www.bmj.com/content/348/bmj.g2545\" target=\"_blank\" rel=\"noopener\">clinical trial data\u003c/a> did not support the broader claims made about Tamiflu. The team looked at clinical study reports for 83 trials and found no improvement for admission-to-hospital rates, pneumonia or bronchitis. However, they did see a more than 50 percent reduction in influenza symptoms.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Uyeki said Doshi’s review has had a tremendous influence because of the worldwide reach of\u003ca href=\"http://www.bmj.com/content/348/bmj.g2545\"> Cochrane\u003c/a>, but added that the results are misleading.\u003c/p>\n\u003cp>Uyeki called Doshi’s evidence “watered down” because it relied on patients who had influenza-like symptoms, but were not necessarily confirmed by laboratory testing to have the flu. Many different viral infections and some bacterial infections can mimic “flu-like” symptoms. So if one patient received Tamiflu and did not have the flu, then he or she may have skewed Doshi’s data, Uyeki said.\u003c/p>\n\u003cp>The Cochrane review focused on “influenza-like” illness as an outcome because that’s “the thing people want to avoid,” Doshi said, adding that the outcomes with pneumonia and hospitalizations are the same, regardless of whether you’re looking at flu-like cases or lab-confirmed cases.\u003c/p>\n\u003cp>Govorkova said that Tamiflu can reduce the chances of catching pneumonia.\u003c/p>\n\u003cp>She explains: Pneumonia is caused by bacteria, not the influenza virus. But the flu virus, in some cases, can predispose receptors on the epithelial cells lining our throats and lungs to become infected with pneumonia-causing bacteria.\u003c/p>\n\u003cp>“[Tamiflu] is not for the treatment of pneumonia — you must use antibiotics,” Govorkova said. “But because [Tamiflu] is very specific for influenza virus, if you start early, you can eliminate influenza virus from the body. And because of that, pneumonia cannot occur.”\u003c/p>\n\u003cp>Doctors may also prescribe Tamiflu in cases, she said, when another remedy isn’t available — \u003ca href=\"https://academic.oup.com/jid/article/202/8/1149/926161\" target=\"_blank\" rel=\"noopener\">such as during avian\u003c/a> H5N1 influenza outbreaks. “Vaccines were not available for prevention purposes, so they were giving Tamiflu even after 48 hours of exposure,” Govorkova said.\u003c/p>\n\u003cp>\u003cstrong>Why This Debate Matters\u003cbr>\n\u003c/strong>Doshi and Uyeki do agree that underlying chronic conditions — like asthma, obesity, diabetes and heart disease — can worsen a flu case by expanding the amount of time the virus spends multiplying.\u003c/p>\n\u003cp>…patients should consult their doctors on whether Tamiflu could be helpful. They should also make sure to take the full course of medicine.\u003c/p>\n\u003cp>But with the flood of alarming media and rising flu-related hospitalizations, Doshi worries people will begin to count on Tamiflu to save lives. He said viral stories, such as those about a Texas \u003ca href=\"http://www.bbc.com/news/world-us-canada-43039036\" target=\"_blank\" rel=\"noopener\">teacher\u003c/a> or a New Hampshire \u003ca href=\"http://www.dailymail.co.uk/health/article-5331999/Mother-four-killed-flu-refusing-Tamiflu.html\" target=\"_blank\" rel=\"noopener\">mother\u003c/a>, that link their flu-related deaths to refusing Tamiflu, lead people to believe Tamiflu is a “wonder drug” that could help the situation in the first place.\u003c/p>\n\u003cp>“[Those stories] project this sense that we’re certain that if only she had taken Tamiflu she would be alive today, and we don’t have any evidence to know that that’s the case,” Doshi said. “So it really spreads a dangerous message.\u003c/p>\n\u003cp>Govorkova said patients should consult their doctors on whether Tamiflu could be helpful. They should also make sure to take the full course of medicine.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Some people drop out early or take it once a day rather than twice a day, she said, and this should be avoided because it can cause the emergence of Tamiflu-resistant flu strains.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "As Surgery Centers Boom, Patients Are Paying With Their Lives",
"title": "As Surgery Centers Boom, Patients Are Paying With Their Lives",
"headTitle": "Future of You | KQED Future of You | KQED Science",
"content": "\u003cp>The surgery went fine. Her doctors left for the day. Four hours later, Paulina Tam started gasping for air.\u003c/p>\n\u003cp>Internal bleeding was cutting off her windpipe, a well-known complication of the spine surgery she had undergone.\u003c/p>\n\u003cp>But a Medicare inspection report describing the event says that nobody who remained on duty that evening at the Northern California surgery center knew what to do.\u003c/p>\n\u003cp>In desperation, a nurse did something that would not happen in a hospital.\u003c/p>\n\u003cp>She dialed 911.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>By the time an ambulance delivered Tam to the emergency room, the 58-year-old mother of three was lifeless, according to the report.\u003c/p>\n\u003cp>If Tam had been operated on at a hospital, a few simple steps could have saved her life.\u003c/p>\n\u003cp>But like hundreds of thousands of other patients each year, Tam went to one of the nation’s 5,600-plus surgery centers.\u003c/p>\n\u003caside class=\"pullquote alignright\">'Some surgery centers risk patient lives by skimping on training or lifesaving equipment.'\u003c/aside>\n\u003cp>Such centers started nearly 50 years ago as low-cost alternatives for minor surgeries. They now outnumber hospitals as federal regulators have signed off on an ever-widening array of outpatient procedures in an effort to cut federal health care costs.\u003c/p>\n\u003cp>Thousands of times each year, these centers call 911 as patients experience complications ranging from minor to fatal. Yet no one knows how many people die as a result, because no national authority tracks the tragic outcomes. An investigation by Kaiser Health News and the USA TODAY Network has discovered that more than 260 patients have died since 2013 after in-and-out procedures at surgery centers across the country. Dozens — some as young as 2 — have perished after routine operations, such as colonoscopies and tonsillectomies.\u003c/p>\n\u003cp>Reporters examined autopsy records, legal filings and more than 12,000 state and Medicare inspection records, and interviewed dozens of doctors, health policy experts and patients throughout the industry, in the most extensive examination of these records to date.\u003c/p>\n\u003cp>The investigation revealed:\u003c/p>\n\u003cp>Surgery centers have steadily expanded their business by taking on increasingly risky surgeries. At least 14 patients have died after complex spinal surgeries like those that federal regulators at Medicare recently approved for surgery centers. Even as the risks of doing such surgeries off a hospital campus can be great, so is the reward. Doctors who own a share of the center can earn their own fee and a cut of the facility’s fee, a meaningful sum for operations that can cost $100,000 or more.\u003c/p>\n\u003cp>To protect patients, Medicare requires surgery centers to line up a local hospital to take their patients when emergencies arise. In rural areas, centers can be 15 or more miles away. Even when the hospital is close, 20 to 30 minutes can pass between a 911 call and arrival at an ER.\u003c/p>\n\u003caside class=\"pullquote alignright\">'The money overshadows everything.'\u003ccite>Dr. Larry Teuber\u003c/cite>\u003c/aside>\n\u003cp>Some surgery centers are accused of overlooking high-risk health problems and treat patients who experts say should be operated on only in hospitals, if at all. At least 25 people with underlying medical conditions have left surgery centers and died within minutes or days. They include an Ohio woman with out-of-control blood pressure, a 49-year-old West Virginia man awaiting a heart transplant and several children with sleep apnea.\u003c/p>\n\u003cp>Some surgery centers risk patient lives by skimping on training or lifesaving equipment. Others have sent patients home before they were fully recovered. On their drives home, shocked family members in Arkansas, Oklahoma and Georgia discovered their loved ones were not asleep but on the verge of death. Surgery centers have been criticized in cases where staff didn’t have the tools to open a difficult airway or skills to save a patient from bleeding to death.\u003c/p>\n\u003cp>Most operations done in surgery centers go off without a hitch. And surgery carries risk, no matter where it’s done. Some centers have state-of-the-art equipment and highly trained staff that are better prepared to handle emergencies.\u003c/p>\n\u003cp>But Kaiser Health News and the USA TODAY Network found more than a dozen cases where the absence of trained staff or emergency equipment appears to have put patients in peril.\u003c/p>\n\u003cp>\u003cimg class=\"size-medium wp-image-436004 alignleft\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/10/depression-800x533.jpg\" alt=\"\" width=\"800\" height=\"533\">And in cases similar to Tam’s, upper-spine surgery patients have been sent home too soon, with the risk of suffocation looming.\u003c/p>\n\u003cp>In 2008, a 35-year-old Oregon father of three struggled for air, pounding the car roof in frustration while his wife sped him to a hospital. A Dallas man collapsed in his father’s arms waiting for an ambulance in 2011. Another Oregon man began to suffocate in his living room the night of his upper-spine surgery in 2014. A San Diego man gasped “like a fish,” his wife recalled, as they waited for an ambulance on April 28, 2016.\u003c/p>\n\u003cp>None of them survived.\u003c/p>\n\u003cp>Spinal surgery patient McArthur Roberson, 60, lost more than a quart of blood during the operation and struggled to breathe after surgery, his family claimed in a lawsuit. He died on the way home.\u003c/p>\n\u003cp>If he “had been observed in a hospital overnight,” said Dr. Daniel Silcox, an Atlanta spine surgeon and expert for the family in their lawsuit, “his death would not have occurred.”\u003c/p>\n\u003cp>The surgery center denied wrongdoing in the case, which reached a confidential settlement in 2017.\u003c/p>\n\u003cp>Many in the health care field — from doctors to private insurance companies to Medicare — have dismissed the mounting deaths as medical anomalies beyond the control of physicians.[contextly_sidebar id=\"yGkONjf2A21M8TI9B7IbDLgIYlcEIWeB\"]\u003c/p>\n\u003cp>USA TODAY Network and KHN reporters contacted 24 doctors and surgery center administrators about patient deaths and none would answer questions about what went wrong, citing patient privacy laws, or referring reporters to attorneys. Responding to lawsuits around the nation, surgery centers have argued that fatal complications were among the known outcomes of such surgeries. Two centers blamed patients for negligence in their own demise.\u003c/p>\n\u003cp>Bill Prentice, chief executive of the Ambulatory Surgery Center Association, declined to speak about individual cases but said he has seen no data proving surgery centers are less safe than hospitals.\u003c/p>\n\u003cp>“There is nothing distinct or different about the surgery center model that makes the provision of health care any more dangerous than anywhere else,” Prentice said. “The human body is a mysterious thing, and a patient that has met every possible protocol can walk in that day and still have something unimaginable happen to them that has nothing to do with the care that’s being provided.”\u003c/p>\n\u003cp>However, Dr. Kenneth Rothfield, board member of the Physician-Patient Alliance for Health & Safety, said many surgery centers and physicians push the envelope on how much can be done in outpatient centers.[contextly_sidebar id=\"nTpXhL5UY41KmxUslysOyQnfIH1Es3fu\"]\u003c/p>\n\u003cp>“It’s important to realize that surgery centers are not hospitals,” he said. “They have different resources, different equipment.”\u003c/p>\n\u003cp>The explosive growth of surgery centers — which receive $4.1 billion a year from Medicare — has taken place under circumstances some medical experts consider unseemly.\u003c/p>\n\u003cp>Federal law allows surgery center doctors — unlike others — to steer patients to facilities they own, rather than the full-service hospital down the street. In some cases, doing so could increase the risk to a patient, but double a physician’s profits.\u003c/p>\n\u003cp>Prentice said physician ownership of surgery centers is a good thing.\u003c/p>\n\u003cp>“The physicians who practice there are responsible for everything that happens in that surgery center from the moment the patient walks out of their car in the parking lot to the moment they leave,” he said.\u003c/p>\n\u003cp>But several studies have shown that surgery center doctors who are owners perform operations more frequently. And in lawsuits across the country, surgery center doctors have been accused of taking risks with patients.\u003c/p>\n\u003cp>Even some who’ve made their living in the surgery center industry have expressed concerns. Dr. Larry Teuber, a South Dakota neurosurgeon who worked as an executive in the surgery center industry for 22 years, said he has watched surgery center owners take on increasingly complex — and lucrative — orthopedic and spinal surgeries, undercutting a nearby hospital’s profits for their own gain.\u003c/p>\n\u003cp>“When you’re making money doing [complex surgeries] you get on a slippery ethical slope,” Teuber said. “The money overshadows everything.”\u003c/p>\n\u003cp>\u003cstrong>The History\u003c/strong>\u003c/p>\n\u003cp>The first surgery center in the U.S. opened in Phoenix in 1970, a place “squeezed between neighborhood shops and a Baptist church,” where, for $90, a child could receive an incision to relieve pressure on the inner ear, The Arizona Republic reported at the time.\u003c/p>\n\u003cp>The pioneering doctors, John Ford and Wallace Reed, didn’t see why patients needed to be hospitalized for such minor surgeries.\u003c/p>\n\u003cp>Taking the procedures out of hospitals reduced the cost for patients and insurers because surgery centers don’t require the same level of staffing or lifesaving equipment.\u003c/p>\n\u003cp>Medicare helped drive the expansion of surgery centers when it began paying for procedures in 1982.\u003c/p>\n\u003cp>Then in 1993, Congress encouraged doctors to open surgery centers by exempting them from the second Stark Law, which prevents doctors from steering patients to other businesses they own.\u003c/p>\n\u003cfigure id=\"attachment_440038\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-440038\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/03/iStock-638540542-800x534.jpg\" alt=\"\" width=\"800\" height=\"534\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-638540542-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-638540542-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-638540542-768x513.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-638540542-1020x681.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-638540542-1920x1281.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-638540542-1180x788.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-638540542-960x641.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-638540542-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-638540542-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-638540542-520x347.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Surgeons passing scissors to each other \u003ccite>(gpointstudio/IStock)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Doctors-turned-entrepreneurs drove early growth, urging their patients to give the centers a chance. Seeing lucrative elective surgeries moving away, hospitals increasingly bought centers of their own. Last year, insurance giant UnitedHealth Group spent $2.3 billion buying a national surgery center chain.\u003c/p>\n\u003cp>The centers have been popular with patients, who enjoy the convenience and personalized care. Doctors say they like the ease of planning operations without unexpected trauma surgeries upending the schedule. And surgery centers have thrived even as hospitals have battled to contain the spread of infections.\u003c/p>\n\u003cp>Today, there are 5,616 Medicare-certified centers. The expansion has come despite lingering safety concerns. In 2007, Medicare noted that surgery centers “have neither patient safety standards consistent with those in place for hospitals, nor are they required to have the trained staff and equipment needed to provide the breadth of intensity of care. …” Some procedures are “unsafe” to be handled at surgery centers, the report concluded.[contextly_sidebar id=\"Oh8vuiOByjR9KfyFdmF17zW0bJKBCpIa\"]\u003c/p>\n\u003cp>Medicare advised the centers to transfer patients to hospitals when emergencies arise. Only a third of surgery centers participate in a voluntary effort to report how often that happens. They sent at least 7,000 patients to the hospital in the year that ended in September 2017, a KHN analysis of surgery center industry data shows. Not all survive the trip.\u003c/p>\n\u003cp>They include James Long, 56, who had no pulse when an ambulance came to the Colorado surgery center where he’d undergone more than five hours of lower-spine surgery in 2014, according to the center’s medical records provided to the family’s attorney.\u003c/p>\n\u003cp>The state reviewed the case and cited no deficiencies. Jen Kenitzer, the Minimally Invasive Spine Institute administrator, said the center has “extensive procedures in place to respond quickly and appropriately” in emergencies.\u003c/p>\n\u003cp>Yet Long’s loved ones remain troubled by the case.\u003c/p>\n\u003cp>“In the 21st century in the USA, a doctor doing a surgery on a patient has to call 911?” said Robin Long, his ex-wife, who did not sue the center. “Give me a break. … It’s just absolutely ignorant.”\u003c/p>\n\u003cp>\u003cstrong>Preparation Under Par\u003c/strong>\u003c/p>\n\u003cp>Patients enter hospitals with heart attacks, gunshot wounds and traumatic injuries. There, doctors and nurses become skilled at saving lives in emergencies.\u003c/p>\n\u003cp>Doctors in surgery centers may excel at the procedures they perform most often. But the centers aren’t always prepared and sometimes struggle in a crisis, according to a review of Medicare records and more than 70 lawsuits.\u003c/p>\n\u003cp>Health inspectors working on behalf of Medicare have discovered 230 lapses in rescue equipment or training regulations at surgery centers since 2015.\u003c/p>\n\u003cp>A center in California had empty oxygen tanks. One operating on children in Arkansas didn’t have a pediatric tracheotomy set to restore breathing; another lacked pediatric defibrillator pads to shock hearts back into rhythm.[contextly_sidebar id=\"xgSiNPNFJJTyDToF3ZdazMurAQ4SAxDl\"]\u003c/p>\n\u003cp>In an ongoing lawsuit against her and the center, anesthesiologist Dr. Yoori Yim testified that she came up empty-handed on Dec. 23, 2015, when grappling to find the right-sized airway tube to save a patient who had stopped breathing.\u003c/p>\n\u003cp>Rekhaben Shah, 67, had come to Oak Tree Surgery Center in Edison, N.J., for a simple colonoscopy.\u003c/p>\n\u003cp>Yim tried a variety of methods to help Shah breathe, with limited success. From the moment Shah stopped breathing on the operating table, 33 minutes passed before a paramedic effectively inserted a breathing tube, according to medical and EMS records.\u003c/p>\n\u003cp>Paramedics responding to the center’s 911 call had to use a video GlideScope to see inside the patient’s throat, equipment the surgery center didn’t have, court testimony says.\u003c/p>\n\u003cp>By then it was too late. Shah was removed from life support at a nearby hospital on Christmas Day.\u003c/p>\n\u003cp>Neither Yim nor the center returned calls for comment. In court records, an expert for the surgery center said Shah’s airway was obstructed and it was cleared around the time the paramedics arrived. He said the GlideScope is not required in New Jersey, nor would it likely have made a difference. An expert for Yim, however, said her actions were appropriate and if a GlideScope had been at the center, “we would probably not be discussing this case at all.”\u003c/p>\n\u003cp>When emergency crews arrive, surgery centers are not always prepared to receive them.\u003c/p>\n\u003cp>In Yim’s case, paramedics testified that she refused to move away from Shah and allow them to attempt lifesaving measures.\u003c/p>\n\u003cp>In Florida, paramedics who rushed to a surgery center after its usual operating hours hit a locked door while a patient inside gasped for breath. The 55-year-old remains in a vegetative state.\u003c/p>\n\u003cp>In 2016, paramedics arrived at West Lakes Surgery Center in Iowa as staff tried to revive 12-year-old Reuben Van Veldhuizen after he experienced complications during a tonsillectomy, according to a Medicare inspection report.[contextly_sidebar id=\"iy3S1eIYgobood9l19mbUsM4p7gpgSwB\"]\u003c/p>\n\u003cp>One paramedic told state inspectors she had to ask who was in charge of the resuscitation efforts. No one replied, the inspection report says.\u003c/p>\n\u003cp>The boy made it to the hospital 37 minutes after the surgery center staff called 911. There, he was pronounced dead.\u003c/p>\n\u003cp>The family filed suit, alleging that the center and anesthesiologist erred in giving the boy an anesthetic that carries a warning about cardiac arrest risk in young boys.\u003c/p>\n\u003cp>In court records responding to the lawsuit, the surgery center and anesthesiologist said Reuben’s death was a result of “pre-existing conditions, acts of others, or conditions over which (Defendants) had no control or responsibility.”[contextly_sidebar id=\"VI9AZs5TNC51Y7UgdHVDpUXpakSmw0kK\"]\u003c/p>\n\u003cp>Yet lawyers who sue the centers and scrutinize their internal records say they often see deadly delays in care.\u003c/p>\n\u003cp>Pedro Maldonado, 59, went to Ambulatory Care Center in New Jersey to have his upper digestive tract scoped. He was discovered unresponsive 10 minutes after the seven-minute procedure, according to his widow’s lawsuit.\u003c/p>\n\u003cp>It took surgery center staff 25 more minutes to start CPR, according to a lawsuit that Philadelphia attorney Glenn Ellis filed on behalf of Maldonado’s widow. Twenty-seven more minutes passed before Maldonado was wheeled into an ER, the widow’s ongoing suit alleges. Maldonado never regained consciousness.\u003c/p>\n\u003cp>Reached by phone, a center administrator declined to comment. In a legal filing, the center denied claims of wrongdoing.\u003c/p>\n\u003cp>“At a hospital, doctors and nurses … know how they are going to respond,” Ellis said. “These guys at the surgery centers are walking on a tightrope with no safety net.”\u003c/p>\n\u003cp>\u003cstrong>Conveyor Belt Of Care\u003c/strong>\u003c/p>\n\u003cp>While the thrum of a hospital continues through the night, some surgery center doctors keep banker’s hours. That means patients whose surgeries end later in the day are sometimes left in the care of one or two nurses for up to 23-hour stays. Some patients have been sent home to grapple with complications on their own.\u003c/p>\n\u003cp>Sondra Wallace went to the Surgery Center of Oklahoma in early 2017 for a sinus procedure.\u003c/p>\n\u003cp>After the procedure, doctors saw her blood-oxygen level sinking. They realized she had had a reaction to the anesthesia and at 2 p.m. gave her a drug to reverse the effects, an ongoing lawsuit filed by her husband says.[contextly_sidebar id=\"9BEvkmOwOv0XN6LAFVyarPQ0ptuu9CWR\"]\u003c/p>\n\u003cp>Then, an hour later, they sent her home with her husband, Larry, the lawsuit says.\u003c/p>\n\u003cp>It was 3 p.m. on the Friday before Presidents Day weekend.\u003c/p>\n\u003cp>“I just think they wanted to start their three-day weekend,” said daughter Casey Podoll.\u003c/p>\n\u003cp>Larry Wallace alleges in the suit that the center gave him no hint that Sondra had a reaction to the anesthesia.\u003c/p>\n\u003cp>So, Wallace thought nothing of her napping in the back seat as he drove for more than two hours through Oklahoma pastures on his way home. When he arrived, he discovered his wife cold in the back seat. She was pronounced dead at Jackson County Memorial Hospital at 6:30 p.m. that day.\u003c/p>\n\u003cp>“They didn’t give any indication … that there were any red flags whatsoever,” Podoll said.\u003c/p>\n\u003cp>Craig Buchan, attorney for the Surgery Center of Oklahoma, said Wallace met discharge criteria and her cause of death has not been determined. He said the center did not close any earlier “than often occurs after the last patient is discharged.”\u003c/p>\n\u003cp>Cecilia Aldridge said she also felt as if the staff at a surgery center was rushing her out the door, after her 2-year-old daughter’s tonsil surgery in Arkansas in 2015.\u003c/p>\n\u003cp>A lawsuit filed by the parents said the surgery center “discharged Abbygail too early because a snow storm was moving into the area.”\u003c/p>\n\u003cp>Abbygail turned blue in the car on the way home. Her mother said she raced into an emergency room, shouting for help, her toddler in her arms.\u003c/p>\n\u003cp>“She never woke up,” Aldridge said tearfully in an interview.\u003c/p>\n\u003cp>Abbygail’s parents now question whether the surgery center ever should have been willing to treat their daughter.\u003c/p>\n\u003cp>\u003cstrong>Risky Patients\u003c/strong>\u003c/p>\n\u003cp>Because surgery centers have less safety equipment and staffing than hospitals, industry leaders stress the importance of selecting patients healthy enough to fare well. Their predictions, though, are not always correct.\u003c/p>\n\u003cp>Abbygail, who loved her hand-me-down blanket and the film “Frozen,” had sleep apnea, an irregular heartbeat and was very heavy for her age, according to the lawsuit.\u003c/p>\n\u003cp>Sleep apnea increases the risk of serious complications in surgery and the night after, medical research shows. Given her condition, Abbygail “should have been admitted [to a hospital] and monitored post-procedure,” said Dr. Charles Cote, a retired Harvard pediatric anesthesiology professor who was not involved in the family’s lawsuit.[contextly_sidebar id=\"gjUHM4nwVAL7lCCCNoVNHgGksiZfeuxR\"]\u003c/p>\n\u003cp>The lawsuit says Abbygail’s risk factors “were documented and known by the Defendants,” including the doctor. It said the toddler should have been operated on “in an inpatient setting under hospital care and monitored overnight.”\u003c/p>\n\u003cp>Dr. Michael Marsh performed Abbygail’s tonsillectomy at Executive Park Surgery Center in Fort Smith, Ark.\u003c/p>\n\u003cp>The surgery center’s lawyer declined to comment. The doctor’s lawyer did not return email and voice messages. In court documents responding to the lawsuit, Marsh and the center denied wrongdoing.\u003c/p>\n\u003cp>In the court filing, Marsh said the toddler’s injuries were “the natural progression” of her illness. Executive Park Surgery Center said in a court filing that “no action on their part … was a proximate cause of any damages or injury.” The case was settled.\u003c/p>\n\u003cp>In at least 25 cases, surgery centers opened their doors to ailing and fragile patients who died after simple procedures, such as tonsillectomies, retinal repairs or colonoscopies, KHN and USA TODAY Network found.\u003c/p>\n\u003cp>Medicare asks surgery centers to assess each patient’s risk, but inspectors flagged 122 surgery centers in 2015 and 2016 alone for lapses in risk assessments. Some centers failed to gauge risk at all. Others overlooked their own policies.\u003c/p>\n\u003cp>Doctors can use an anesthesia risk assessment to screen out fragile patients — healthy patients get a score of 1, and a score of 5 means a person is nearly dead.\u003c/p>\n\u003cp>A few states, including Pennsylvania and Rhode Island, bar certain surgery centers from operating on patients with an anesthesia risk score of 4. But most states don’t go that far. They leave such decisions up to doctors.\u003c/p>\n\u003cp>And some of those decisions have been cited in tragic outcomes. Sabino Sifuentes, 74, had survived triple-bypass surgery. But on March 23, 2015, nine minutes after the start of anesthesia for an eye procedure, he became unresponsive, never to be revived, according to a Medicare inspection report. A nurse anesthetist who reviewed the case at Eye-Q Vision Care’s surgery center in Fresno, Calif., told state health inspectors that Sifuentes should have been given a risk score of 4 and his care was “completely mismanaged,” the inspection report says.\u003c/p>\n\u003cp>In response to the family’s lawsuit, the surgery center said Sifuentes’ injury was caused by his own negligence and others’.\u003c/p>\n\u003cp>Five other patients with the same risk score died after routine procedures at surgery centers across the U.S.\u003c/p>\n\u003cp>\u003cstrong>A Widening Niche\u003c/strong>\u003c/p>\n\u003cp>Such tragedies rarely find their way into the discussion when Medicare decides whether to approve new procedures at surgery centers.\u003c/p>\n\u003cp>Take spinal surgery.\u003c/p>\n\u003cp>Until 2015, Medicare wouldn’t pay for it at surgery centers. Then, the industry’s trade association urged the agency to make the change, and encouraged a letter-writing campaign from surgery centers across the nation.\u003c/p>\n\u003cp>Letter writers included Dr. Alan Villavicencio, a Colorado surgeon who said he’d been doing such surgeries for 12 years and found that his patients “appreciate the convenience and cost savings.” He did not mention that James Long, 56, had died three weeks earlier at a Lafayette, Colo., surgery center where he is an owner, a review of Colorado health department and medical board records shows.\u003c/p>\n\u003cp>United Surgical Partners International, a surgery center chain, also weighed in urging even more procedures to be approved, not mentioning a patient death hours after a spine surgery at one of its affiliate centers several months before, according to court records and securities filings. The chain said in a statement that it stands behind its comments in support of the proposal.[contextly_sidebar id=\"VpVDiD85oVGnFVcTHpIcD2xozEou9ew9\"]\u003c/p>\n\u003cp>Such letters carry weight with Medicare, which approves procedures to be done in surgery centers based on the invasiveness and complexity of the surgery and on input from stakeholders.\u003c/p>\n\u003cp>Robert Beatty-Walters, a Portland, Ore., attorney who has represented the families of three people who died after surgery center spine procedures, said Medicare’s decision-making process is not even-handed.\u003c/p>\n\u003cp>“The stakeholders — they call them — during these regulatory proceedings are the profit-makers, not the people who are being provided the service,” he said. “The spine centers just want to have more people come. They make more money. I hate to be that cynical about it, but that’s just what I’ve seen.”\u003c/p>\n\u003cp>Medicare approved 10 spine-surgery codes to be billed at surgery centers starting in 2015 and added more spinal procedures for 2017. A Medicare spokesman denied a request for a telephone interview. In an email, a spokeswoman said Medicare opened the spine proposal to the public and received no comments suggesting the procedures would pose a threat to Medicare patients. She said the final decision about where a patient will have surgery is up to a doctor and patient.\u003c/p>\n\u003cp>By 2017, at least 14 patients had died soon after spine operations at surgery centers, according to the KHN/USA TODAY Network investigation.\u003c/p>\n\u003cp>The 14 spine-surgery deaths have gleaned little recognition in the industry or beyond. Only one made headlines in local newspapers. The rest are documented in places like the Macon, Ga., courthouse or in obscure regulatory reports. And there may be far more because some states, including New York, Illinois and Florida, disclose no details about surgery center deaths.\u003c/p>\n\u003cp>Paulina Tam’s death at Fremont Surgery Center was a tragic example. At 58, the mother of three had finished careers as a nurse and an educator. Next, she planned to travel the world with her husband of 32 years.\u003c/p>\n\u003cp>“She was the driving force of the family, the spirit I guess,” said her son, Eric Tam, a doctor in New York City, said. “We didn’t expect the worst to happen.”\u003c/p>\n\u003cp>The care she received at the center is documented in court records, EMS reports and a Medicare inspection report that concluded that the center “failed to provide a safe environment for surgery.”\u003c/p>\n\u003cp>Tam’s doctor scheduled her for a procedure to replace two discs in her upper spine on April 7, 2014. Pain from a car crash had bothered her for years. Any such surgery — entering the front of the neck to address pain in the spine — comes with a risk of suffocation, according to the Medicare inspection report.\u003c/p>\n\u003cp>Yet, with her surgeon and anesthesiologist already gone, the only doctor on-site was a digestive health specialist, the inspection report shows. About four hours after her procedure, Tam told a nurse that her surgical collar felt too tight. Then, that she couldn’t breathe.\u003c/p>\n\u003cp>The nurse called a “code blue” just after 6:30 p.m., records say.\u003c/p>\n\u003cp>Medical experts say the first step in helping such patients is removing the surgical staples so the pooled blood can disperse, allowing the patient to breathe.\u003c/p>\n\u003cp>In Tam’s case, staff repeatedly tried and failed to insert a breathing tube through her mouth and into her airway, the inspection report shows. A last-ditch remedy would have been to punch a hole through the front of her throat to restore breathing, but the gastroenterologist later told an inspector that he was “not prepared” to do so.\u003c/p>\n\u003cp>The inability to perform the suffocation-rescue maneuver, the inspection report says, amounted to the center’s “failure to ensure patient safety.”\u003c/p>\n\u003cp>From the time a nurse called 911, it took 24 minutes to get Tam to the nearest hospital, EMS records show. She arrived without a pulse and remained on life support overnight, as her children raced to her bedside to say goodbye.[contextly_sidebar id=\"bLBYWBIiszrFf7LXQxCNRj9SYTbpB4ln\"]\u003c/p>\n\u003cp>The center did not return calls and denied wrongdoing in the court case. Tam’s surgeon declined to discuss the case but filed pleadings in court saying Tam’s “carelessness and negligence” caused her death. It’s unclear what the defense meant by negligence. The case reached a confidential settlement.\u003c/p>\n\u003cp>After Tam’s death, the center told Medicare inspectors that a qualified doctor would stay on-site after all upper-spine cases.\u003c/p>\n\u003cp>Dr. Nancy Epstein, chief of neurosurgical and spine care at New York University Winthrop Hospital, said surgery centers doing delicate work near the spinal cord, windpipe and esophagus in a same-day procedure is “pretty revolting.” But she said the centers are making so much money — “reeling it in hand over fist” that the potential dangers are being ignored.\u003c/p>\n\u003cp>“Medically, it should not be tolerated,” she said, “but it is.”\u003c/p>\n\u003cp>\u003cem>Lindy Washburn of The (Bergen County, N.J.) Record and NorthJersey.com contributed to this report.\u003c/em>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This story was originally published by \u003ca href=\"http://khn.org/\" target=\"_blank\" rel=\"noopener\">Kaiser Health News\u003c/a>.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The surgery went fine. Her doctors left for the day. Four hours later, Paulina Tam started gasping for air.\u003c/p>\n\u003cp>Internal bleeding was cutting off her windpipe, a well-known complication of the spine surgery she had undergone.\u003c/p>\n\u003cp>But a Medicare inspection report describing the event says that nobody who remained on duty that evening at the Northern California surgery center knew what to do.\u003c/p>\n\u003cp>In desperation, a nurse did something that would not happen in a hospital.\u003c/p>\n\u003cp>She dialed 911.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>By the time an ambulance delivered Tam to the emergency room, the 58-year-old mother of three was lifeless, according to the report.\u003c/p>\n\u003cp>If Tam had been operated on at a hospital, a few simple steps could have saved her life.\u003c/p>\n\u003cp>But like hundreds of thousands of other patients each year, Tam went to one of the nation’s 5,600-plus surgery centers.\u003c/p>\n\u003caside class=\"pullquote alignright\">'Some surgery centers risk patient lives by skimping on training or lifesaving equipment.'\u003c/aside>\n\u003cp>Such centers started nearly 50 years ago as low-cost alternatives for minor surgeries. They now outnumber hospitals as federal regulators have signed off on an ever-widening array of outpatient procedures in an effort to cut federal health care costs.\u003c/p>\n\u003cp>Thousands of times each year, these centers call 911 as patients experience complications ranging from minor to fatal. Yet no one knows how many people die as a result, because no national authority tracks the tragic outcomes. An investigation by Kaiser Health News and the USA TODAY Network has discovered that more than 260 patients have died since 2013 after in-and-out procedures at surgery centers across the country. Dozens — some as young as 2 — have perished after routine operations, such as colonoscopies and tonsillectomies.\u003c/p>\n\u003cp>Reporters examined autopsy records, legal filings and more than 12,000 state and Medicare inspection records, and interviewed dozens of doctors, health policy experts and patients throughout the industry, in the most extensive examination of these records to date.\u003c/p>\n\u003cp>The investigation revealed:\u003c/p>\n\u003cp>Surgery centers have steadily expanded their business by taking on increasingly risky surgeries. At least 14 patients have died after complex spinal surgeries like those that federal regulators at Medicare recently approved for surgery centers. Even as the risks of doing such surgeries off a hospital campus can be great, so is the reward. Doctors who own a share of the center can earn their own fee and a cut of the facility’s fee, a meaningful sum for operations that can cost $100,000 or more.\u003c/p>\n\u003cp>To protect patients, Medicare requires surgery centers to line up a local hospital to take their patients when emergencies arise. In rural areas, centers can be 15 or more miles away. Even when the hospital is close, 20 to 30 minutes can pass between a 911 call and arrival at an ER.\u003c/p>\n\u003caside class=\"pullquote alignright\">'The money overshadows everything.'\u003ccite>Dr. Larry Teuber\u003c/cite>\u003c/aside>\n\u003cp>Some surgery centers are accused of overlooking high-risk health problems and treat patients who experts say should be operated on only in hospitals, if at all. At least 25 people with underlying medical conditions have left surgery centers and died within minutes or days. They include an Ohio woman with out-of-control blood pressure, a 49-year-old West Virginia man awaiting a heart transplant and several children with sleep apnea.\u003c/p>\n\u003cp>Some surgery centers risk patient lives by skimping on training or lifesaving equipment. Others have sent patients home before they were fully recovered. On their drives home, shocked family members in Arkansas, Oklahoma and Georgia discovered their loved ones were not asleep but on the verge of death. Surgery centers have been criticized in cases where staff didn’t have the tools to open a difficult airway or skills to save a patient from bleeding to death.\u003c/p>\n\u003cp>Most operations done in surgery centers go off without a hitch. And surgery carries risk, no matter where it’s done. Some centers have state-of-the-art equipment and highly trained staff that are better prepared to handle emergencies.\u003c/p>\n\u003cp>But Kaiser Health News and the USA TODAY Network found more than a dozen cases where the absence of trained staff or emergency equipment appears to have put patients in peril.\u003c/p>\n\u003cp>\u003cimg class=\"size-medium wp-image-436004 alignleft\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/10/depression-800x533.jpg\" alt=\"\" width=\"800\" height=\"533\">And in cases similar to Tam’s, upper-spine surgery patients have been sent home too soon, with the risk of suffocation looming.\u003c/p>\n\u003cp>In 2008, a 35-year-old Oregon father of three struggled for air, pounding the car roof in frustration while his wife sped him to a hospital. A Dallas man collapsed in his father’s arms waiting for an ambulance in 2011. Another Oregon man began to suffocate in his living room the night of his upper-spine surgery in 2014. A San Diego man gasped “like a fish,” his wife recalled, as they waited for an ambulance on April 28, 2016.\u003c/p>\n\u003cp>None of them survived.\u003c/p>\n\u003cp>Spinal surgery patient McArthur Roberson, 60, lost more than a quart of blood during the operation and struggled to breathe after surgery, his family claimed in a lawsuit. He died on the way home.\u003c/p>\n\u003cp>If he “had been observed in a hospital overnight,” said Dr. Daniel Silcox, an Atlanta spine surgeon and expert for the family in their lawsuit, “his death would not have occurred.”\u003c/p>\n\u003cp>The surgery center denied wrongdoing in the case, which reached a confidential settlement in 2017.\u003c/p>\n\u003cp>Many in the health care field — from doctors to private insurance companies to Medicare — have dismissed the mounting deaths as medical anomalies beyond the control of physicians.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>USA TODAY Network and KHN reporters contacted 24 doctors and surgery center administrators about patient deaths and none would answer questions about what went wrong, citing patient privacy laws, or referring reporters to attorneys. Responding to lawsuits around the nation, surgery centers have argued that fatal complications were among the known outcomes of such surgeries. Two centers blamed patients for negligence in their own demise.\u003c/p>\n\u003cp>Bill Prentice, chief executive of the Ambulatory Surgery Center Association, declined to speak about individual cases but said he has seen no data proving surgery centers are less safe than hospitals.\u003c/p>\n\u003cp>“There is nothing distinct or different about the surgery center model that makes the provision of health care any more dangerous than anywhere else,” Prentice said. “The human body is a mysterious thing, and a patient that has met every possible protocol can walk in that day and still have something unimaginable happen to them that has nothing to do with the care that’s being provided.”\u003c/p>\n\u003cp>However, Dr. Kenneth Rothfield, board member of the Physician-Patient Alliance for Health & Safety, said many surgery centers and physicians push the envelope on how much can be done in outpatient centers.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>“It’s important to realize that surgery centers are not hospitals,” he said. “They have different resources, different equipment.”\u003c/p>\n\u003cp>The explosive growth of surgery centers — which receive $4.1 billion a year from Medicare — has taken place under circumstances some medical experts consider unseemly.\u003c/p>\n\u003cp>Federal law allows surgery center doctors — unlike others — to steer patients to facilities they own, rather than the full-service hospital down the street. In some cases, doing so could increase the risk to a patient, but double a physician’s profits.\u003c/p>\n\u003cp>Prentice said physician ownership of surgery centers is a good thing.\u003c/p>\n\u003cp>“The physicians who practice there are responsible for everything that happens in that surgery center from the moment the patient walks out of their car in the parking lot to the moment they leave,” he said.\u003c/p>\n\u003cp>But several studies have shown that surgery center doctors who are owners perform operations more frequently. And in lawsuits across the country, surgery center doctors have been accused of taking risks with patients.\u003c/p>\n\u003cp>Even some who’ve made their living in the surgery center industry have expressed concerns. Dr. Larry Teuber, a South Dakota neurosurgeon who worked as an executive in the surgery center industry for 22 years, said he has watched surgery center owners take on increasingly complex — and lucrative — orthopedic and spinal surgeries, undercutting a nearby hospital’s profits for their own gain.\u003c/p>\n\u003cp>“When you’re making money doing [complex surgeries] you get on a slippery ethical slope,” Teuber said. “The money overshadows everything.”\u003c/p>\n\u003cp>\u003cstrong>The History\u003c/strong>\u003c/p>\n\u003cp>The first surgery center in the U.S. opened in Phoenix in 1970, a place “squeezed between neighborhood shops and a Baptist church,” where, for $90, a child could receive an incision to relieve pressure on the inner ear, The Arizona Republic reported at the time.\u003c/p>\n\u003cp>The pioneering doctors, John Ford and Wallace Reed, didn’t see why patients needed to be hospitalized for such minor surgeries.\u003c/p>\n\u003cp>Taking the procedures out of hospitals reduced the cost for patients and insurers because surgery centers don’t require the same level of staffing or lifesaving equipment.\u003c/p>\n\u003cp>Medicare helped drive the expansion of surgery centers when it began paying for procedures in 1982.\u003c/p>\n\u003cp>Then in 1993, Congress encouraged doctors to open surgery centers by exempting them from the second Stark Law, which prevents doctors from steering patients to other businesses they own.\u003c/p>\n\u003cfigure id=\"attachment_440038\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-440038\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/03/iStock-638540542-800x534.jpg\" alt=\"\" width=\"800\" height=\"534\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-638540542-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-638540542-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-638540542-768x513.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-638540542-1020x681.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-638540542-1920x1281.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-638540542-1180x788.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-638540542-960x641.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-638540542-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-638540542-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-638540542-520x347.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Surgeons passing scissors to each other \u003ccite>(gpointstudio/IStock)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Doctors-turned-entrepreneurs drove early growth, urging their patients to give the centers a chance. Seeing lucrative elective surgeries moving away, hospitals increasingly bought centers of their own. Last year, insurance giant UnitedHealth Group spent $2.3 billion buying a national surgery center chain.\u003c/p>\n\u003cp>The centers have been popular with patients, who enjoy the convenience and personalized care. Doctors say they like the ease of planning operations without unexpected trauma surgeries upending the schedule. And surgery centers have thrived even as hospitals have battled to contain the spread of infections.\u003c/p>\n\u003cp>Today, there are 5,616 Medicare-certified centers. The expansion has come despite lingering safety concerns. In 2007, Medicare noted that surgery centers “have neither patient safety standards consistent with those in place for hospitals, nor are they required to have the trained staff and equipment needed to provide the breadth of intensity of care. …” Some procedures are “unsafe” to be handled at surgery centers, the report concluded.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Medicare advised the centers to transfer patients to hospitals when emergencies arise. Only a third of surgery centers participate in a voluntary effort to report how often that happens. They sent at least 7,000 patients to the hospital in the year that ended in September 2017, a KHN analysis of surgery center industry data shows. Not all survive the trip.\u003c/p>\n\u003cp>They include James Long, 56, who had no pulse when an ambulance came to the Colorado surgery center where he’d undergone more than five hours of lower-spine surgery in 2014, according to the center’s medical records provided to the family’s attorney.\u003c/p>\n\u003cp>The state reviewed the case and cited no deficiencies. Jen Kenitzer, the Minimally Invasive Spine Institute administrator, said the center has “extensive procedures in place to respond quickly and appropriately” in emergencies.\u003c/p>\n\u003cp>Yet Long’s loved ones remain troubled by the case.\u003c/p>\n\u003cp>“In the 21st century in the USA, a doctor doing a surgery on a patient has to call 911?” said Robin Long, his ex-wife, who did not sue the center. “Give me a break. … It’s just absolutely ignorant.”\u003c/p>\n\u003cp>\u003cstrong>Preparation Under Par\u003c/strong>\u003c/p>\n\u003cp>Patients enter hospitals with heart attacks, gunshot wounds and traumatic injuries. There, doctors and nurses become skilled at saving lives in emergencies.\u003c/p>\n\u003cp>Doctors in surgery centers may excel at the procedures they perform most often. But the centers aren’t always prepared and sometimes struggle in a crisis, according to a review of Medicare records and more than 70 lawsuits.\u003c/p>\n\u003cp>Health inspectors working on behalf of Medicare have discovered 230 lapses in rescue equipment or training regulations at surgery centers since 2015.\u003c/p>\n\u003cp>A center in California had empty oxygen tanks. One operating on children in Arkansas didn’t have a pediatric tracheotomy set to restore breathing; another lacked pediatric defibrillator pads to shock hearts back into rhythm.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>In an ongoing lawsuit against her and the center, anesthesiologist Dr. Yoori Yim testified that she came up empty-handed on Dec. 23, 2015, when grappling to find the right-sized airway tube to save a patient who had stopped breathing.\u003c/p>\n\u003cp>Rekhaben Shah, 67, had come to Oak Tree Surgery Center in Edison, N.J., for a simple colonoscopy.\u003c/p>\n\u003cp>Yim tried a variety of methods to help Shah breathe, with limited success. From the moment Shah stopped breathing on the operating table, 33 minutes passed before a paramedic effectively inserted a breathing tube, according to medical and EMS records.\u003c/p>\n\u003cp>Paramedics responding to the center’s 911 call had to use a video GlideScope to see inside the patient’s throat, equipment the surgery center didn’t have, court testimony says.\u003c/p>\n\u003cp>By then it was too late. Shah was removed from life support at a nearby hospital on Christmas Day.\u003c/p>\n\u003cp>Neither Yim nor the center returned calls for comment. In court records, an expert for the surgery center said Shah’s airway was obstructed and it was cleared around the time the paramedics arrived. He said the GlideScope is not required in New Jersey, nor would it likely have made a difference. An expert for Yim, however, said her actions were appropriate and if a GlideScope had been at the center, “we would probably not be discussing this case at all.”\u003c/p>\n\u003cp>When emergency crews arrive, surgery centers are not always prepared to receive them.\u003c/p>\n\u003cp>In Yim’s case, paramedics testified that she refused to move away from Shah and allow them to attempt lifesaving measures.\u003c/p>\n\u003cp>In Florida, paramedics who rushed to a surgery center after its usual operating hours hit a locked door while a patient inside gasped for breath. The 55-year-old remains in a vegetative state.\u003c/p>\n\u003cp>In 2016, paramedics arrived at West Lakes Surgery Center in Iowa as staff tried to revive 12-year-old Reuben Van Veldhuizen after he experienced complications during a tonsillectomy, according to a Medicare inspection report.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>One paramedic told state inspectors she had to ask who was in charge of the resuscitation efforts. No one replied, the inspection report says.\u003c/p>\n\u003cp>The boy made it to the hospital 37 minutes after the surgery center staff called 911. There, he was pronounced dead.\u003c/p>\n\u003cp>The family filed suit, alleging that the center and anesthesiologist erred in giving the boy an anesthetic that carries a warning about cardiac arrest risk in young boys.\u003c/p>\n\u003cp>In court records responding to the lawsuit, the surgery center and anesthesiologist said Reuben’s death was a result of “pre-existing conditions, acts of others, or conditions over which (Defendants) had no control or responsibility.”\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Yet lawyers who sue the centers and scrutinize their internal records say they often see deadly delays in care.\u003c/p>\n\u003cp>Pedro Maldonado, 59, went to Ambulatory Care Center in New Jersey to have his upper digestive tract scoped. He was discovered unresponsive 10 minutes after the seven-minute procedure, according to his widow’s lawsuit.\u003c/p>\n\u003cp>It took surgery center staff 25 more minutes to start CPR, according to a lawsuit that Philadelphia attorney Glenn Ellis filed on behalf of Maldonado’s widow. Twenty-seven more minutes passed before Maldonado was wheeled into an ER, the widow’s ongoing suit alleges. Maldonado never regained consciousness.\u003c/p>\n\u003cp>Reached by phone, a center administrator declined to comment. In a legal filing, the center denied claims of wrongdoing.\u003c/p>\n\u003cp>“At a hospital, doctors and nurses … know how they are going to respond,” Ellis said. “These guys at the surgery centers are walking on a tightrope with no safety net.”\u003c/p>\n\u003cp>\u003cstrong>Conveyor Belt Of Care\u003c/strong>\u003c/p>\n\u003cp>While the thrum of a hospital continues through the night, some surgery center doctors keep banker’s hours. That means patients whose surgeries end later in the day are sometimes left in the care of one or two nurses for up to 23-hour stays. Some patients have been sent home to grapple with complications on their own.\u003c/p>\n\u003cp>Sondra Wallace went to the Surgery Center of Oklahoma in early 2017 for a sinus procedure.\u003c/p>\n\u003cp>After the procedure, doctors saw her blood-oxygen level sinking. They realized she had had a reaction to the anesthesia and at 2 p.m. gave her a drug to reverse the effects, an ongoing lawsuit filed by her husband says.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Then, an hour later, they sent her home with her husband, Larry, the lawsuit says.\u003c/p>\n\u003cp>It was 3 p.m. on the Friday before Presidents Day weekend.\u003c/p>\n\u003cp>“I just think they wanted to start their three-day weekend,” said daughter Casey Podoll.\u003c/p>\n\u003cp>Larry Wallace alleges in the suit that the center gave him no hint that Sondra had a reaction to the anesthesia.\u003c/p>\n\u003cp>So, Wallace thought nothing of her napping in the back seat as he drove for more than two hours through Oklahoma pastures on his way home. When he arrived, he discovered his wife cold in the back seat. She was pronounced dead at Jackson County Memorial Hospital at 6:30 p.m. that day.\u003c/p>\n\u003cp>“They didn’t give any indication … that there were any red flags whatsoever,” Podoll said.\u003c/p>\n\u003cp>Craig Buchan, attorney for the Surgery Center of Oklahoma, said Wallace met discharge criteria and her cause of death has not been determined. He said the center did not close any earlier “than often occurs after the last patient is discharged.”\u003c/p>\n\u003cp>Cecilia Aldridge said she also felt as if the staff at a surgery center was rushing her out the door, after her 2-year-old daughter’s tonsil surgery in Arkansas in 2015.\u003c/p>\n\u003cp>A lawsuit filed by the parents said the surgery center “discharged Abbygail too early because a snow storm was moving into the area.”\u003c/p>\n\u003cp>Abbygail turned blue in the car on the way home. Her mother said she raced into an emergency room, shouting for help, her toddler in her arms.\u003c/p>\n\u003cp>“She never woke up,” Aldridge said tearfully in an interview.\u003c/p>\n\u003cp>Abbygail’s parents now question whether the surgery center ever should have been willing to treat their daughter.\u003c/p>\n\u003cp>\u003cstrong>Risky Patients\u003c/strong>\u003c/p>\n\u003cp>Because surgery centers have less safety equipment and staffing than hospitals, industry leaders stress the importance of selecting patients healthy enough to fare well. Their predictions, though, are not always correct.\u003c/p>\n\u003cp>Abbygail, who loved her hand-me-down blanket and the film “Frozen,” had sleep apnea, an irregular heartbeat and was very heavy for her age, according to the lawsuit.\u003c/p>\n\u003cp>Sleep apnea increases the risk of serious complications in surgery and the night after, medical research shows. Given her condition, Abbygail “should have been admitted [to a hospital] and monitored post-procedure,” said Dr. Charles Cote, a retired Harvard pediatric anesthesiology professor who was not involved in the family’s lawsuit.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>The lawsuit says Abbygail’s risk factors “were documented and known by the Defendants,” including the doctor. It said the toddler should have been operated on “in an inpatient setting under hospital care and monitored overnight.”\u003c/p>\n\u003cp>Dr. Michael Marsh performed Abbygail’s tonsillectomy at Executive Park Surgery Center in Fort Smith, Ark.\u003c/p>\n\u003cp>The surgery center’s lawyer declined to comment. The doctor’s lawyer did not return email and voice messages. In court documents responding to the lawsuit, Marsh and the center denied wrongdoing.\u003c/p>\n\u003cp>In the court filing, Marsh said the toddler’s injuries were “the natural progression” of her illness. Executive Park Surgery Center said in a court filing that “no action on their part … was a proximate cause of any damages or injury.” The case was settled.\u003c/p>\n\u003cp>In at least 25 cases, surgery centers opened their doors to ailing and fragile patients who died after simple procedures, such as tonsillectomies, retinal repairs or colonoscopies, KHN and USA TODAY Network found.\u003c/p>\n\u003cp>Medicare asks surgery centers to assess each patient’s risk, but inspectors flagged 122 surgery centers in 2015 and 2016 alone for lapses in risk assessments. Some centers failed to gauge risk at all. Others overlooked their own policies.\u003c/p>\n\u003cp>Doctors can use an anesthesia risk assessment to screen out fragile patients — healthy patients get a score of 1, and a score of 5 means a person is nearly dead.\u003c/p>\n\u003cp>A few states, including Pennsylvania and Rhode Island, bar certain surgery centers from operating on patients with an anesthesia risk score of 4. But most states don’t go that far. They leave such decisions up to doctors.\u003c/p>\n\u003cp>And some of those decisions have been cited in tragic outcomes. Sabino Sifuentes, 74, had survived triple-bypass surgery. But on March 23, 2015, nine minutes after the start of anesthesia for an eye procedure, he became unresponsive, never to be revived, according to a Medicare inspection report. A nurse anesthetist who reviewed the case at Eye-Q Vision Care’s surgery center in Fresno, Calif., told state health inspectors that Sifuentes should have been given a risk score of 4 and his care was “completely mismanaged,” the inspection report says.\u003c/p>\n\u003cp>In response to the family’s lawsuit, the surgery center said Sifuentes’ injury was caused by his own negligence and others’.\u003c/p>\n\u003cp>Five other patients with the same risk score died after routine procedures at surgery centers across the U.S.\u003c/p>\n\u003cp>\u003cstrong>A Widening Niche\u003c/strong>\u003c/p>\n\u003cp>Such tragedies rarely find their way into the discussion when Medicare decides whether to approve new procedures at surgery centers.\u003c/p>\n\u003cp>Take spinal surgery.\u003c/p>\n\u003cp>Until 2015, Medicare wouldn’t pay for it at surgery centers. Then, the industry’s trade association urged the agency to make the change, and encouraged a letter-writing campaign from surgery centers across the nation.\u003c/p>\n\u003cp>Letter writers included Dr. Alan Villavicencio, a Colorado surgeon who said he’d been doing such surgeries for 12 years and found that his patients “appreciate the convenience and cost savings.” He did not mention that James Long, 56, had died three weeks earlier at a Lafayette, Colo., surgery center where he is an owner, a review of Colorado health department and medical board records shows.\u003c/p>\n\u003cp>United Surgical Partners International, a surgery center chain, also weighed in urging even more procedures to be approved, not mentioning a patient death hours after a spine surgery at one of its affiliate centers several months before, according to court records and securities filings. The chain said in a statement that it stands behind its comments in support of the proposal.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Such letters carry weight with Medicare, which approves procedures to be done in surgery centers based on the invasiveness and complexity of the surgery and on input from stakeholders.\u003c/p>\n\u003cp>Robert Beatty-Walters, a Portland, Ore., attorney who has represented the families of three people who died after surgery center spine procedures, said Medicare’s decision-making process is not even-handed.\u003c/p>\n\u003cp>“The stakeholders — they call them — during these regulatory proceedings are the profit-makers, not the people who are being provided the service,” he said. “The spine centers just want to have more people come. They make more money. I hate to be that cynical about it, but that’s just what I’ve seen.”\u003c/p>\n\u003cp>Medicare approved 10 spine-surgery codes to be billed at surgery centers starting in 2015 and added more spinal procedures for 2017. A Medicare spokesman denied a request for a telephone interview. In an email, a spokeswoman said Medicare opened the spine proposal to the public and received no comments suggesting the procedures would pose a threat to Medicare patients. She said the final decision about where a patient will have surgery is up to a doctor and patient.\u003c/p>\n\u003cp>By 2017, at least 14 patients had died soon after spine operations at surgery centers, according to the KHN/USA TODAY Network investigation.\u003c/p>\n\u003cp>The 14 spine-surgery deaths have gleaned little recognition in the industry or beyond. Only one made headlines in local newspapers. The rest are documented in places like the Macon, Ga., courthouse or in obscure regulatory reports. And there may be far more because some states, including New York, Illinois and Florida, disclose no details about surgery center deaths.\u003c/p>\n\u003cp>Paulina Tam’s death at Fremont Surgery Center was a tragic example. At 58, the mother of three had finished careers as a nurse and an educator. Next, she planned to travel the world with her husband of 32 years.\u003c/p>\n\u003cp>“She was the driving force of the family, the spirit I guess,” said her son, Eric Tam, a doctor in New York City, said. “We didn’t expect the worst to happen.”\u003c/p>\n\u003cp>The care she received at the center is documented in court records, EMS reports and a Medicare inspection report that concluded that the center “failed to provide a safe environment for surgery.”\u003c/p>\n\u003cp>Tam’s doctor scheduled her for a procedure to replace two discs in her upper spine on April 7, 2014. Pain from a car crash had bothered her for years. Any such surgery — entering the front of the neck to address pain in the spine — comes with a risk of suffocation, according to the Medicare inspection report.\u003c/p>\n\u003cp>Yet, with her surgeon and anesthesiologist already gone, the only doctor on-site was a digestive health specialist, the inspection report shows. About four hours after her procedure, Tam told a nurse that her surgical collar felt too tight. Then, that she couldn’t breathe.\u003c/p>\n\u003cp>The nurse called a “code blue” just after 6:30 p.m., records say.\u003c/p>\n\u003cp>Medical experts say the first step in helping such patients is removing the surgical staples so the pooled blood can disperse, allowing the patient to breathe.\u003c/p>\n\u003cp>In Tam’s case, staff repeatedly tried and failed to insert a breathing tube through her mouth and into her airway, the inspection report shows. A last-ditch remedy would have been to punch a hole through the front of her throat to restore breathing, but the gastroenterologist later told an inspector that he was “not prepared” to do so.\u003c/p>\n\u003cp>The inability to perform the suffocation-rescue maneuver, the inspection report says, amounted to the center’s “failure to ensure patient safety.”\u003c/p>\n\u003cp>From the time a nurse called 911, it took 24 minutes to get Tam to the nearest hospital, EMS records show. She arrived without a pulse and remained on life support overnight, as her children raced to her bedside to say goodbye.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>The center did not return calls and denied wrongdoing in the court case. Tam’s surgeon declined to discuss the case but filed pleadings in court saying Tam’s “carelessness and negligence” caused her death. It’s unclear what the defense meant by negligence. The case reached a confidential settlement.\u003c/p>\n\u003cp>After Tam’s death, the center told Medicare inspectors that a qualified doctor would stay on-site after all upper-spine cases.\u003c/p>\n\u003cp>Dr. Nancy Epstein, chief of neurosurgical and spine care at New York University Winthrop Hospital, said surgery centers doing delicate work near the spinal cord, windpipe and esophagus in a same-day procedure is “pretty revolting.” But she said the centers are making so much money — “reeling it in hand over fist” that the potential dangers are being ignored.\u003c/p>\n\u003cp>“Medically, it should not be tolerated,” she said, “but it is.”\u003c/p>\n\u003cp>\u003cem>Lindy Washburn of The (Bergen County, N.J.) Record and NorthJersey.com contributed to this report.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>This story was originally published by \u003ca href=\"http://khn.org/\" target=\"_blank\" rel=\"noopener\">Kaiser Health News\u003c/a>.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "FDA Approves First Direct-to-Consumer Test for Breast Cancer Risk",
"title": "FDA Approves First Direct-to-Consumer Test for Breast Cancer Risk",
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"content": "\u003cp>Federal regulators approved the first direct-to-consumer test for the BRCA genes, which increase the risk of breast and ovarian cancer, the agency announced on Tuesday.\u003c/p>\n\u003cp>The test for the BRCA1 and BRCA2 genes, from \u003ca href=\"https://www.statnews.com/2017/04/07/genetic-analysis-need-to-know/\" target=\"_blank\" rel=\"noopener\">23andMe\u003c/a>, uses a saliva sample. But it assesses only three of the more than 1,000 known BRCA1/2 mutations, raising concerns that women who are told they do not have any of those variants will be lulled into believing that, as a result, they do not have an elevated risk for breast and ovarian cancer.\u003c/p>\n\u003cp>The three specific BRCA1/BRCA2 breast cancer \u003ca href=\"https://www.kqed.org/futureofyou/439059/why-even-siblings-can-get-different-ancestry-results-from-dna-tests\" target=\"_blank\" rel=\"noopener\">gene mutations \u003c/a>are most common in people with Ashkenazi (Eastern European) Jewish ancestry, accounting for more than 90 percent of their risk of heritable breast and ovarian cancer. But even in this population only 2 percent of women carry any of these three so-called “founder” mutations, the FDA said. Women with one of the mutations have a 45 percent to 85 percent chance of developing breast cancer by age 70, 23andMe said.\u003c/p>\n\u003cp>[contextly_sidebar id=\"n8fyxUwdBRcgBMG96UbMv2Lu8p4ZNItq\"]But these three variants are not the most common BRCA1/BRCA2 mutations in the general population: No more than 0.1 percent of women with non-Ashkenazi ancestry carry the mutations. “A negative result does not rule out the possibility that an individual carries other BRCA mutations that increase cancer risk,” the FDA warned.\u003c/p>\n\u003cp>\u003cstrong>Test Limitations\u003c/strong>\u003cbr>\nThe 23andMe test “is a step forward in the availability of DTC genetic tests,” Donald St. Pierre, acting director of the FDA’s Office of In Vitro Diagnostics and Radiological Health, said in a statement. “But it has a lot of caveats.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The agency therefore warned that individuals and their physicians should not use the test results to make decisions about treatments, including prophylactic removal of the breasts or ovaries. That should be based on more extensive testing. Myriad Genetics, which developed the first BRCA1/2 tests, assesses DNA for thousands of variants; it has long \u003ca href=\"http://investor.myriad.com/releasedetail.cfm?releaseid=1021443\" target=\"_blank\" rel=\"noopener\">warned\u003c/a> that other tests, which came on the market after the Supreme Court threw out Myriad’s key BRCA patents, could mislead women.\u003c/p>\n\u003cp>In addition, most cases of breast cancer are not hereditary, from BRCA or other mutations, but “sporadic,” meaning they arise at random or from smoking, obesity, exposure to toxic chemicals, hormone use, and other environmental factors.[contextly_sidebar id=\"ixqQWxrYKmKKTNT32BcHv1EguBJm96pF\"]\u003c/p>\n\u003cp>“At a minimum, 23andMe should be clear with people about what their test is and isn’t and present the information in a fair and balanced way that the average person can understand,” said Myriad spokesman Ron Rogers, who added that some customers might be uncomfortable about 23andMe’s \u003ca href=\"https://gizmodo.com/what-dna-testing-companies-terrifying-privacy-policies-1819158337\" target=\"_blank\" rel=\"noopener\">selling\u003c/a> of genetic information to third parties.\u003c/p>\n\u003cp>For women with Ashkenazi ancestry, the test “is not too bad as a screen,” said Robert Cook-Deegan of Arizona State University, a longtime scholar in the field of genomics ethics and law. “But for other groups with different founder mutations, and there are many, it won’t help much. There’s a big need for users to understand that nuance, which is not widely understood.”\u003c/p>\n\u003cp>\u003cstrong>Direct-to-Consumer Tests\u003c/strong>\u003cbr>\nThe FDA’s decision was based on data from 23andMe showing that its test can accurately identify the three genetic variants in saliva samples. The privately held company also submitted studies showing that consumers understood the report it will send to customers on what the results might mean, how to interpret them, and where to find additional information.\u003c/p>\n\u003cp>“Being the first and only direct-to-consumer genetics company to receive FDA authorization to test for cancer risk without a prescription is a major milestone for 23andMe and for the consumer,” Anne Wojcicki, 23andMe CEO and co-founder, said in a statement. “We believe it’s important for consumers to have direct and affordable access to this potentially life-saving information. … This authorization is incredibly valuable for those who might not be aware of their Ashkenazi Jewish descent.”\u003c/p>\n\u003cp>She, too, emphasized that “our test does not account for all genetic variants that can cause a higher risk of cancer, and people should continue with their recommended cancer screenings.” Myriad, for instance, has identified some 20,000 BRCA1/2 variants.\u003c/p>\n\u003cp>The decision follows one last year in which the FDA gave 23andMe the go-ahead to sell DNA tests assessing customers’ risk of 10 diseases, including Parkinson’s and late-onset Alzheimer’s. Those were the first FDA-approved direct-to-consumer tests for genetic risk of any disease or condition, which the agency said could help people make lifestyle decisions. At the time, the FDA also warned that genetic risk for complex diseases is not a sure thing: People whose 23andMe test does not find genetic variants that increase the risk of a disease can still develop it, and people whose DNA test shows no disease-causing variants might not.\u003c/p>\n\u003cp>The BRCA test will be part of 23andme’s $199 Health + Ancestry test. Existing customers can opt to receive BRCA information for no additional cost, and as with the other disease-risk tests they as well as new customers must specifically choose to receive the information.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“My libertarian streak says this, properly understood, is a good thing that increases access,” said Cook-Deegan, “although I do worry about proliferation of commercial purveyors as the sources of information and keeping the data.”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Federal regulators approved the first direct-to-consumer test for the BRCA genes, which increase the risk of breast and ovarian cancer, the agency announced on Tuesday.\u003c/p>\n\u003cp>The test for the BRCA1 and BRCA2 genes, from \u003ca href=\"https://www.statnews.com/2017/04/07/genetic-analysis-need-to-know/\" target=\"_blank\" rel=\"noopener\">23andMe\u003c/a>, uses a saliva sample. But it assesses only three of the more than 1,000 known BRCA1/2 mutations, raising concerns that women who are told they do not have any of those variants will be lulled into believing that, as a result, they do not have an elevated risk for breast and ovarian cancer.\u003c/p>\n\u003cp>The three specific BRCA1/BRCA2 breast cancer \u003ca href=\"https://www.kqed.org/futureofyou/439059/why-even-siblings-can-get-different-ancestry-results-from-dna-tests\" target=\"_blank\" rel=\"noopener\">gene mutations \u003c/a>are most common in people with Ashkenazi (Eastern European) Jewish ancestry, accounting for more than 90 percent of their risk of heritable breast and ovarian cancer. But even in this population only 2 percent of women carry any of these three so-called “founder” mutations, the FDA said. Women with one of the mutations have a 45 percent to 85 percent chance of developing breast cancer by age 70, 23andMe said.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>But these three variants are not the most common BRCA1/BRCA2 mutations in the general population: No more than 0.1 percent of women with non-Ashkenazi ancestry carry the mutations. “A negative result does not rule out the possibility that an individual carries other BRCA mutations that increase cancer risk,” the FDA warned.\u003c/p>\n\u003cp>\u003cstrong>Test Limitations\u003c/strong>\u003cbr>\nThe 23andMe test “is a step forward in the availability of DTC genetic tests,” Donald St. Pierre, acting director of the FDA’s Office of In Vitro Diagnostics and Radiological Health, said in a statement. “But it has a lot of caveats.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The agency therefore warned that individuals and their physicians should not use the test results to make decisions about treatments, including prophylactic removal of the breasts or ovaries. That should be based on more extensive testing. Myriad Genetics, which developed the first BRCA1/2 tests, assesses DNA for thousands of variants; it has long \u003ca href=\"http://investor.myriad.com/releasedetail.cfm?releaseid=1021443\" target=\"_blank\" rel=\"noopener\">warned\u003c/a> that other tests, which came on the market after the Supreme Court threw out Myriad’s key BRCA patents, could mislead women.\u003c/p>\n\u003cp>In addition, most cases of breast cancer are not hereditary, from BRCA or other mutations, but “sporadic,” meaning they arise at random or from smoking, obesity, exposure to toxic chemicals, hormone use, and other environmental factors.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>“At a minimum, 23andMe should be clear with people about what their test is and isn’t and present the information in a fair and balanced way that the average person can understand,” said Myriad spokesman Ron Rogers, who added that some customers might be uncomfortable about 23andMe’s \u003ca href=\"https://gizmodo.com/what-dna-testing-companies-terrifying-privacy-policies-1819158337\" target=\"_blank\" rel=\"noopener\">selling\u003c/a> of genetic information to third parties.\u003c/p>\n\u003cp>For women with Ashkenazi ancestry, the test “is not too bad as a screen,” said Robert Cook-Deegan of Arizona State University, a longtime scholar in the field of genomics ethics and law. “But for other groups with different founder mutations, and there are many, it won’t help much. There’s a big need for users to understand that nuance, which is not widely understood.”\u003c/p>\n\u003cp>\u003cstrong>Direct-to-Consumer Tests\u003c/strong>\u003cbr>\nThe FDA’s decision was based on data from 23andMe showing that its test can accurately identify the three genetic variants in saliva samples. The privately held company also submitted studies showing that consumers understood the report it will send to customers on what the results might mean, how to interpret them, and where to find additional information.\u003c/p>\n\u003cp>“Being the first and only direct-to-consumer genetics company to receive FDA authorization to test for cancer risk without a prescription is a major milestone for 23andMe and for the consumer,” Anne Wojcicki, 23andMe CEO and co-founder, said in a statement. “We believe it’s important for consumers to have direct and affordable access to this potentially life-saving information. … This authorization is incredibly valuable for those who might not be aware of their Ashkenazi Jewish descent.”\u003c/p>\n\u003cp>She, too, emphasized that “our test does not account for all genetic variants that can cause a higher risk of cancer, and people should continue with their recommended cancer screenings.” Myriad, for instance, has identified some 20,000 BRCA1/2 variants.\u003c/p>\n\u003cp>The decision follows one last year in which the FDA gave 23andMe the go-ahead to sell DNA tests assessing customers’ risk of 10 diseases, including Parkinson’s and late-onset Alzheimer’s. Those were the first FDA-approved direct-to-consumer tests for genetic risk of any disease or condition, which the agency said could help people make lifestyle decisions. At the time, the FDA also warned that genetic risk for complex diseases is not a sure thing: People whose 23andMe test does not find genetic variants that increase the risk of a disease can still develop it, and people whose DNA test shows no disease-causing variants might not.\u003c/p>\n\u003cp>The BRCA test will be part of 23andme’s $199 Health + Ancestry test. Existing customers can opt to receive BRCA information for no additional cost, and as with the other disease-risk tests they as well as new customers must specifically choose to receive the information.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“My libertarian streak says this, properly understood, is a good thing that increases access,” said Cook-Deegan, “although I do worry about proliferation of commercial purveyors as the sources of information and keeping the data.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Does Opioid Use Lower Pain Tolerance?",
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"content": "\u003cp>When patients arrive in the emergency room, nearly all but those with the most minor complaints get an IV.\u003c/p>\n\u003cp>To draw blood, give medications or administer fluids, the IV is the way doctors and nurses gain access to the body. Putting one in is quick and simple, and it's no more painful than a mild bee sting.\u003c/p>\n\u003cp>Yet for some patients, this routine procedure becomes excruciating. On my shifts as an emergency physician, I began to notice a strange pattern. These hypersensitive patients often had a history of using opioids.\u003c/p>\n\u003cp>Shouldn't these patients be less susceptible to pain, instead of more so?\u003c/p>\n\u003cp>As I looked into it, I found that I was far from the first to notice the paradox of heightened pain sensitivity with opioid use. An English physician in 1870 \u003ca href=\"http://publikationen.ub.uni-frankfurt.de/frontdoor/index/index/year/2013/docId/9551\" target=\"_blank\" rel=\"noopener\">reported\u003c/a> on morphine's tendency to \"encourage the very pain it pretends to relieve.\" In 1880, a German doctor named Rossbach \u003ca href=\"https://academic.oup.com/painmedicine/article/16/suppl_1/S32/2472483\" target=\"_blank\" rel=\"noopener\">described\u003c/a> a similar hypersensitivity to pain with opioid dependence.[contextly_sidebar id=\"JdvyNC50xeYkStqD74JGNEYfNupPuvtu\"]\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>A century passed before the phenomenon received serious scientific attention. That is when American scientists \u003ca href=\"http://jpet.aspetjournals.org/content/177/3/509.long\" target=\"_blank\" rel=\"noopener\">showed\u003c/a> that rats exhibited increased sensitivity to pain after exposure to morphine, a phenomenon that became known as opioid-induced hyperalgesia.\u003c/p>\n\u003cp>By the 1990s, the \u003ca href=\"http://anesthesiology.pubs.asahq.org/article.aspx?articleid=1923441\" target=\"_blank\" rel=\"noopener\">evidence\u003c/a> of this unusual reaction in animals was strong, but whether it occurred in humans wasn't clear.\u003c/p>\n\u003cp>A hint came in 1994, when researchers \u003ca href=\"http://www.jpsmjournal.com/article/0885-3924(94)90203-8/pdf\" target=\"_blank\" rel=\"noopener\">found\u003c/a> that active heroin users were more sensitive to pain than expected. Other investigators took note, and by decade's end, a half-dozen studies had demonstrated similar results among heroin users as well as among recovering users on methadone.\u003c/p>\n\u003cp>But had these people used heroin because they had always been more sensitive to pain, perhaps from birth? The studies couldn't say.\u003c/p>\n\u003cp>In 2006, a group of Stanford researchers \u003ca href=\"http://www.jpain.org/article/S1526-5900(05)00826-6/fulltext\" target=\"_blank\" rel=\"noopener\">attempted\u003c/a> to tease apart this question. The scientists measured pain thresholds in patients with back pain before and after four months of oral morphine. The researchers found that the patients had become significantly more sensitive to pain by the study's end.\u003c/p>\n\u003cp>Another way that scientists have tried to approach the problem is by studying opioids used during surgery. Several \u003ca href=\"http://www.jcvaonline.com/article/S1053-0770(15)00049-X/fulltext\" target=\"_blank\" rel=\"noopener\">studies\u003c/a> have shown that patients randomized to receive higher doses of opioids during operations have worse pain afterward than patients who received smaller doses or a placebo. Similarly, giving short-acting opioids to healthy volunteers has been found to \u003ca href=\"https://insights.ovid.com/pubmed?pmid=14581110\" target=\"_blank\" rel=\"noopener\">heighten\u003c/a> their sensitivity to pain.\u003c/p>\n\u003cp>Taken together, these findings do seem to suggest that exposure to opioids can paradoxically increase pain, but Martin Angst, a Stanford anesthesiologist, points out a problem common to all of these studies: Were these patients just becoming tolerant to the painkillers?\u003c/p>\n\u003cp>\"Is this hyperalgesia? Is this tolerance?\" he told me. \"Nobody can say.\"\u003c/p>\n\u003cp>The questions have plagued much of the research. In pharmacology, tolerance refers to decreasing efficacy of a drug with repeated use. Not all medications are subject to this effect, but opioids certainly are. Over time, they simply don't work as well, and the original pain returns.\u003c/p>\n\u003cp>Doctors often increase the dose to counteract this effect, which works until the patient becomes tolerant to the increased amount of medicine. The result can be an upward spiral, with no clear end in sight.[contextly_sidebar id=\"tYIZr9XqaiXC4XWGHMvv6XDQ7lK72GDt\"]\u003c/p>\n\u003cp>But there is a drawback to this approach. If worsening pain is due to opioid-induced hyperalgesia rather than tolerance, then \"increasing the dose will only make the pain worse,\" explains Caroline Arout, a scientist at the New York State Psychiatric Institute. While tolerance is characterized by desensitization of neural pain pathways, which can be overcome by higher doses, opioid-induced hyperalgesia is the result of hypersensitization of those pathways, she says.\u003c/p>\n\u003cp>\"This could be a major factor in the opioid crisis,\" Arout says. \"People have worsening pain, and so their dose is often increased because they are thought to be tolerant.\" But the result is that some patients may find themselves taking dangerously high doses while their pain continues to intensify.\u003c/p>\n\u003cp>So how common is opioid-induced hyperalgesia? \"This is the million-dollar question,\" Stanford's Angst answers. \"We just don't know.\"\u003c/p>\n\u003cp>Although the current research isn't definitive, Angst says opioid-induced hyperalgesia strikes him as a serious problem. Addressing it may require adopting a new perspective on pain.\u003c/p>\n\u003cp>Pain is a critical adaptation for survival, even in the era of modern medicine. \"Think of pain in a different way, as a very useful thing to the body,\" he says. Pain in the abdomen can sometimes herald appendicitis, or some other dangerous infection. And chest pain is a cardinal symptom of heart attacks.\u003c/p>\n\u003cp>\"When we overwhelm the system with large doses of opioids — does the system fight back?\" Angst asks.\u003c/p>\n\u003cp>\"We have to accept that there are limitations to any biological system, and if you exceed them, then bad things will happen,\" he says. \"And one of those things may be opioid-induced hyperalgesia.\"\u003c/p>\n\u003chr>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Clayton Dalton is a resident physician at Massachusetts General Hospital in Boston.\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit \u003ca href=\"http://www.npr.org/\" target=\"_blank\" rel=\"noopener\">http://www.npr.org/\u003c/a>.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=When+Opioids+Make+Pain+Worse+&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>When patients arrive in the emergency room, nearly all but those with the most minor complaints get an IV.\u003c/p>\n\u003cp>To draw blood, give medications or administer fluids, the IV is the way doctors and nurses gain access to the body. Putting one in is quick and simple, and it's no more painful than a mild bee sting.\u003c/p>\n\u003cp>Yet for some patients, this routine procedure becomes excruciating. On my shifts as an emergency physician, I began to notice a strange pattern. These hypersensitive patients often had a history of using opioids.\u003c/p>\n\u003cp>Shouldn't these patients be less susceptible to pain, instead of more so?\u003c/p>\n\u003cp>As I looked into it, I found that I was far from the first to notice the paradox of heightened pain sensitivity with opioid use. An English physician in 1870 \u003ca href=\"http://publikationen.ub.uni-frankfurt.de/frontdoor/index/index/year/2013/docId/9551\" target=\"_blank\" rel=\"noopener\">reported\u003c/a> on morphine's tendency to \"encourage the very pain it pretends to relieve.\" In 1880, a German doctor named Rossbach \u003ca href=\"https://academic.oup.com/painmedicine/article/16/suppl_1/S32/2472483\" target=\"_blank\" rel=\"noopener\">described\u003c/a> a similar hypersensitivity to pain with opioid dependence.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>A century passed before the phenomenon received serious scientific attention. That is when American scientists \u003ca href=\"http://jpet.aspetjournals.org/content/177/3/509.long\" target=\"_blank\" rel=\"noopener\">showed\u003c/a> that rats exhibited increased sensitivity to pain after exposure to morphine, a phenomenon that became known as opioid-induced hyperalgesia.\u003c/p>\n\u003cp>By the 1990s, the \u003ca href=\"http://anesthesiology.pubs.asahq.org/article.aspx?articleid=1923441\" target=\"_blank\" rel=\"noopener\">evidence\u003c/a> of this unusual reaction in animals was strong, but whether it occurred in humans wasn't clear.\u003c/p>\n\u003cp>A hint came in 1994, when researchers \u003ca href=\"http://www.jpsmjournal.com/article/0885-3924(94)90203-8/pdf\" target=\"_blank\" rel=\"noopener\">found\u003c/a> that active heroin users were more sensitive to pain than expected. Other investigators took note, and by decade's end, a half-dozen studies had demonstrated similar results among heroin users as well as among recovering users on methadone.\u003c/p>\n\u003cp>But had these people used heroin because they had always been more sensitive to pain, perhaps from birth? The studies couldn't say.\u003c/p>\n\u003cp>In 2006, a group of Stanford researchers \u003ca href=\"http://www.jpain.org/article/S1526-5900(05)00826-6/fulltext\" target=\"_blank\" rel=\"noopener\">attempted\u003c/a> to tease apart this question. The scientists measured pain thresholds in patients with back pain before and after four months of oral morphine. The researchers found that the patients had become significantly more sensitive to pain by the study's end.\u003c/p>\n\u003cp>Another way that scientists have tried to approach the problem is by studying opioids used during surgery. Several \u003ca href=\"http://www.jcvaonline.com/article/S1053-0770(15)00049-X/fulltext\" target=\"_blank\" rel=\"noopener\">studies\u003c/a> have shown that patients randomized to receive higher doses of opioids during operations have worse pain afterward than patients who received smaller doses or a placebo. Similarly, giving short-acting opioids to healthy volunteers has been found to \u003ca href=\"https://insights.ovid.com/pubmed?pmid=14581110\" target=\"_blank\" rel=\"noopener\">heighten\u003c/a> their sensitivity to pain.\u003c/p>\n\u003cp>Taken together, these findings do seem to suggest that exposure to opioids can paradoxically increase pain, but Martin Angst, a Stanford anesthesiologist, points out a problem common to all of these studies: Were these patients just becoming tolerant to the painkillers?\u003c/p>\n\u003cp>\"Is this hyperalgesia? Is this tolerance?\" he told me. \"Nobody can say.\"\u003c/p>\n\u003cp>The questions have plagued much of the research. In pharmacology, tolerance refers to decreasing efficacy of a drug with repeated use. Not all medications are subject to this effect, but opioids certainly are. Over time, they simply don't work as well, and the original pain returns.\u003c/p>\n\u003cp>Doctors often increase the dose to counteract this effect, which works until the patient becomes tolerant to the increased amount of medicine. The result can be an upward spiral, with no clear end in sight.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>But there is a drawback to this approach. If worsening pain is due to opioid-induced hyperalgesia rather than tolerance, then \"increasing the dose will only make the pain worse,\" explains Caroline Arout, a scientist at the New York State Psychiatric Institute. While tolerance is characterized by desensitization of neural pain pathways, which can be overcome by higher doses, opioid-induced hyperalgesia is the result of hypersensitization of those pathways, she says.\u003c/p>\n\u003cp>\"This could be a major factor in the opioid crisis,\" Arout says. \"People have worsening pain, and so their dose is often increased because they are thought to be tolerant.\" But the result is that some patients may find themselves taking dangerously high doses while their pain continues to intensify.\u003c/p>\n\u003cp>So how common is opioid-induced hyperalgesia? \"This is the million-dollar question,\" Stanford's Angst answers. \"We just don't know.\"\u003c/p>\n\u003cp>Although the current research isn't definitive, Angst says opioid-induced hyperalgesia strikes him as a serious problem. Addressing it may require adopting a new perspective on pain.\u003c/p>\n\u003cp>Pain is a critical adaptation for survival, even in the era of modern medicine. \"Think of pain in a different way, as a very useful thing to the body,\" he says. Pain in the abdomen can sometimes herald appendicitis, or some other dangerous infection. And chest pain is a cardinal symptom of heart attacks.\u003c/p>\n\u003cp>\"When we overwhelm the system with large doses of opioids — does the system fight back?\" Angst asks.\u003c/p>\n\u003cp>\"We have to accept that there are limitations to any biological system, and if you exceed them, then bad things will happen,\" he says. \"And one of those things may be opioid-induced hyperalgesia.\"\u003c/p>\n\u003chr>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Clayton Dalton is a resident physician at Massachusetts General Hospital in Boston.\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit \u003ca href=\"http://www.npr.org/\" target=\"_blank\" rel=\"noopener\">http://www.npr.org/\u003c/a>.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=When+Opioids+Make+Pain+Worse+&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>When she started collecting brains, neuroscientist Yasmin Hurd’s peers wondered what she could possibly be thinking.\u003c/p>\n\u003cp>Studying animals made way more sense as a way to trace how chronic drug use changes the brain, they thought — after all, how was Hurd going to parse the long-term effects from the trauma of the overdoses that killed the brain donors?\u003c/p>\n\u003cp>She waved her colleagues off. She wanted to know what was happening in human brains, not in mice.[contextly_sidebar id=\"xjgcW8qRPdqM7MN9tkvvBeggkwrVyhgv\"]\u003c/p>\n\u003cp>So she began filling up freezers with slices of brain tissue from hundreds of overdose victims, most of them killed by too much cocaine.\u003c/p>\n\u003cp>“We had a lot of freezers, sadly,” said Hurd, who now runs the Addiction Institute at the Mount Sinai School of Medicine. And then, early in the 2000s, she noticed a tidal shift: Suddenly, the overdoses were dominated by heroin.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>She saw the opioid crisis coming. Ever since, she’s been trying to figure out how to intervene — could she modify or reverse the way addiction changed the brains being studied in her lab?\u003c/p>\n\u003cp>Hurd has honed in on cannabidiol, one of the two main compounds plucked from the marijuana plant. She thinks it might hold the potential to curb cravings for heroin and other opioids.\u003c/p>\n\u003cp>She’s running against the wind. Cannabidiol is classified as a Schedule I drug, meaning the U.S. government thinks it carries severe safety concerns, no medicinal benefits, and a high risk of abuse. Even as a growing number of states legalize marijuana, the hard-line federal stance has made it difficult to do clinical research involving cannabis in this country.\u003c/p>\n\u003caside class=\"pullquote alignright\">'You have to treat every epidemic the same, whether it’s a drug epidemic or a viral epidemic.'\u003ccite>Dr. Yasmin Hurd\u003c/cite>\u003c/aside>\n\u003cp>But Hurd is throwing all of her weight into studying whether it can combat addiction. And she’s trying to rally other scientists to do the same, by creating a consortium to conduct cannabidiol clinical trials across the globe.\u003c/p>\n\u003cp>“If this is something that could be potentially beneficial, and there’s an indication that it could be beneficial,” Hurd said in an interview, “why not put all hands on deck?”\u003c/p>\n\u003cp>Hurd has the reputation and academic standing to pull this off — last fall, she was named to the prestigious National Academy of Medicine, along with dozens of other top-tier researchers.\u003c/p>\n\u003cp>More than that, she has determination: On the front of her computer screen, she’s stuck up a yellow Post-it note that says, “GAIN CONTROL.” Only she’s crossed out “GAIN,” and replaced it with “TAKE.”\u003c/p>\n\u003cp>\u003cstrong>Unraveling The Biology of Addiction\u003cbr>\n\u003c/strong>Hurd has always had what she calls a “pure fascination” with the brain. Her own bounces quickly from one thought to the next, sometimes leaving threads unfinished for the sake of starting a new one. One idea may spin off into a dozen new ones. During a recent interview, she jumped from why she finds outliers in science so intriguing to why she loves murder mysteries (Alfred Hitchcock is a personal favorite).\u003c/p>\n\u003cp>That mental multitasking is mirrored in her lab, where her team is working on a slew of projects, from how chronic drug use restructures the brain to how the brain’s circuits play a role in psychiatric disease.\u003c/p>\n\u003cp>“My research, unfortunately, reflects me,” she said.\u003c/p>\n\u003cp>Her mind is constantly hunting for new ideas in unlikely, often difficult places — like on the list of Schedule I drugs.\u003c/p>\n\u003cp>Past studies have shown that cannabidiol works on a number of brain circuits involved in addiction and drug-seeking behavior. That’s made it an exciting pharmacological target — but the data, by and large, have just been preliminary and unpersuasive. Hurd started looking for more concrete evidence on cannabidiol.\u003c/p>\n\u003caside class=\"pullquote alignright\">'The hard-line federal stance has made it difficult to do clinical research involving cannabis in this country.'\u003c/aside>\n\u003cp>The compound is one of the two main cannabinoids found in the marijuana plant, the other being tetrahydrocannabinol, or THC. But unlike THC, cannabidiol doesn’t get people high. Scientists are studying whether the compound can treat conditions such as epilepsy and anxiety. Hurd is testing whether cannabidiol can cut down on cravings in patients who are addicted to opioids — and in turn, can prevent relapse.\u003c/p>\n\u003cp>In her research on animals, the compound has decreased cravings and anxiety without producing any psychoactive effects. But she’s not sure why, exactly, it’s working. So at the same time, she’s orchestrating studies to delve into the biology that underlies addiction.\u003c/p>\n\u003cp>Some quick background: The neurons in the brain talk to each other through neurotransmitters such as dopamine, serotonin, and endocannabinoids. Those chemical messengers ferry information between brain cells through a synapse, which is the intersection between two neurons. Drugs like heroin are like a car crash — they damage those synapses to the point that other cars can’t get through.[contextly_sidebar id=\"lXwRcOY5jUafks0cGN2BzjpnPSmw1csG\"]\u003c/p>\n\u003cp>Hurd’s lab is studying the wreckage through research like the experiment that one of her postdoctoral researchers, Noel Warren, is working on. Warren hits rat neurons with a compound that mimics chronic heroin use to see how synaptic plasticity — the way the brain changes the connections among neurons, forming new ones while pruning others — is different in the brain after drug use.\u003c/p>\n\u003cp>Based on her findings, Hurd has launched trials to test cannabidiol in humans — but that’s no easy task.\u003c/p>\n\u003cp>\u003cstrong>‘The Hurdles Are Enormous’\u003cbr>\n\u003c/strong>Studying cannabidiol is daunting, and not just because the brain is so complex. To use cannabidiol or any part of the cannabis plant for research, a scientist has to get a special license from the Drug Enforcement Administration, which can take years. Then, scientists have to get approval from the Food and Drug Administration to administer it to patients.\u003c/p>\n\u003cp>“The hurdles are enormous,” said Margaret Haney, a neurobiologist at Columbia University who studies cannabis use disorder and the therapeutic potential of cannabinoids in humans. Haney has to keep the cannabis used in her trials in a gun safe that’s stashed inside a freezer that’s sitting in a special room in her lab that can only be accessed with her fingerprint. That’s routine for cannabis research.\u003c/p>\n\u003cp>\u003cimg class=\" wp-image-128930 alignleft\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/03/medmar-800x533.jpg\" alt=\"\" width=\"423\" height=\"282\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2016/03/medmar-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2016/03/medmar-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2016/03/medmar-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2016/03/medmar-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2016/03/medmar.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2016/03/medmar-960x640.jpg 960w\" sizes=\"(max-width: 423px) 100vw, 423px\">And patients who are enrolled in clinical trials involving cannabis have to come to the lab of the researcher who holds a DEA license to get the drug, which isn’t always doable for individuals with serious medical conditions.\u003c/p>\n\u003cp>“Our hands are tied even though cannabidiol is not addictive,” Hurd said. But because it derives from the cannabis plant, the government classifies it as a Schedule I drug — like heroin, LSD, ecstasy, and peyote — which are considered to be harmful and have no medicinal value.\u003c/p>\n\u003cp>That means there are relatively few scientists doing research involving cannabis, and even fewer studying its potential to treat addiction or testing cannabidiol in humans. Hurd isn’t in a crowded field.\u003c/p>\n\u003cp>“There’s really not that many people that do that,” said Dr. Sachin Patel, of Vanderbilt University, who has done research with cannabis to understand how marijuana exposure early in life raises the risk of psychiatric disorders.\u003c/p>\n\u003cp>And then, there’s the issue of supply.\u003c/p>\n\u003caside class=\"pullquote alignright\">'Our hands are tied even though cannabidiol is not addictive.'\u003ccite>Dr. Yasmin Hurd\u003c/cite>\u003c/aside>\n\u003cp>For decades, the only sanctioned source of marijuana available for U.S. research was the University of Mississippi, which held an exclusive contract with the federal government.\u003c/p>\n\u003cp>“If you’re trying to do a clinical trial and you need cannabidiol, it’s actually quite difficult to get the types of cannabis needed to do the research,” said Patel.\u003c/p>\n\u003cp>Hurd said the restricted supply has made it all but impossible for her to study the specific formulations of cannabidiol she suspects would be the most therapeutic.\u003c/p>\n\u003cp>She is currently running Phase 2 clinical trials in New York to test cannabidiol’s ability to reduce cravings in people addicted to heroin. And she’s initiating similar studies to test cannabidiol soon in Canada and Jamaica.\u003c/p>\n\u003caside class=\"pullquote alignright\">'[T]he process has felt painstakingly slow when people are dying so quickly.'\u003c/aside>\n\u003cp>But for Hurd, the process has felt painstakingly slow when people are dying so quickly. An estimated 63,600 people died of drug overdoses in 2016. Two-thirds of those deaths were caused by opioids.\u003c/p>\n\u003cp>Hurd is frustrated by how both the government is grappling with the crisis. It’s paled in comparison to the response to the Zika virus and other public health concerns in recent years, she said.\u003c/p>\n\u003cp>“People swarmed to do something. That did not happen with the opioid epidemic,” Hurd said.\u003c/p>\n\u003cp>\u003cimg class=\"alignnone wp-image-435640 \" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/09/iStock-594036552-800x668.jpg\" alt=\"\" width=\"384\" height=\"321\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/09/iStock-594036552-800x668.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2017/09/iStock-594036552-160x134.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/09/iStock-594036552-768x641.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2017/09/iStock-594036552-1020x852.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2017/09/iStock-594036552-1180x985.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2017/09/iStock-594036552-960x801.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2017/09/iStock-594036552-240x200.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/09/iStock-594036552-375x313.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/09/iStock-594036552-520x434.jpg 520w, https://ww2.kqed.org/app/uploads/sites/13/2017/09/iStock-594036552.jpg 1895w\" sizes=\"(max-width: 384px) 100vw, 384px\">\u003c/p>\n\u003cp>Why not? Hurd blames it, in large part, on discrimination against people who are addicted to drugs. But if there were more federal funding for research, Hurd said, scientists could accelerate the search for solutions.\u003c/p>\n\u003cp>“You have to treat every epidemic the same,” she said, “whether it’s a drug epidemic or a viral epidemic.”\u003c/p>\n\u003cp>She’s quick to note that she’s not arguing that cannabidiol is a cure-all for the crisis. Hurd just wants to have enough researchers working on the problem that they can quickly say whether something works — or whether it doesn’t — and then move on.\u003c/p>\n\u003cp>Haney, the Columbia neurobiologist, echoed that frustration. The DEA said it has not rescheduled cannabis because there aren’t enough studies to show it has medical potential. But until it’s rescheduled, Haney said, those kind of large, randomized studies won’t really be feasible.\u003c/p>\n\u003cp>“We’re in a vicious cycle,” she said.\u003c/p>\n\u003cp>And dispensaries and cannabis companies in the 29 states that have already legalized medical marijuana don’t have any incentive to fund or conduct clinical trials on the medical benefits, experts say, because they’re already able to sell their products to patients without government approval.\u003c/p>\n\u003cp>“The money-making is all happening outside of any data,” Haney said.\u003c/p>\n\u003cp>So Hurd is trying to spur her fellow scientists to do as much research as possible on the potential of cannabidiol to treat opioid addiction, in a bid to build a cannabinoid consortium. She’s connected with clinicians, pharmacologists, and neuroscientists to talk about how to spur new research. And she’s working to rope in companies interested in cannabidiol, too. Without National Institutes of Health funding for such a project, she’s hopeful they’ll help fund the consortium.\u003c/p>\n\u003cp>Her goal: build an infrastructure that’s far broader than her own.\u003c/p>\n\u003cp>“I don’t need to be the only person in the room studying cannabidiol for opioid addiction,” she said. “It can’t be done with just one little Yasmin Hurd lab.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This article is reproduced with permission from \u003ca href=\"https://www.statnews.com/\" target=\"_blank\" rel=\"noopener\">STAT\u003c/a>. It was first published on Feb. 28, 2018. Find the original story \u003ca href=\"https://www.statnews.com/2018/02/28/marijuana-cannabidiol-opioids-addiction/\" target=\"_blank\" rel=\"noopener\">here\u003c/a>.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>When she started collecting brains, neuroscientist Yasmin Hurd’s peers wondered what she could possibly be thinking.\u003c/p>\n\u003cp>Studying animals made way more sense as a way to trace how chronic drug use changes the brain, they thought — after all, how was Hurd going to parse the long-term effects from the trauma of the overdoses that killed the brain donors?\u003c/p>\n\u003cp>She waved her colleagues off. She wanted to know what was happening in human brains, not in mice.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>So she began filling up freezers with slices of brain tissue from hundreds of overdose victims, most of them killed by too much cocaine.\u003c/p>\n\u003cp>“We had a lot of freezers, sadly,” said Hurd, who now runs the Addiction Institute at the Mount Sinai School of Medicine. And then, early in the 2000s, she noticed a tidal shift: Suddenly, the overdoses were dominated by heroin.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>She saw the opioid crisis coming. Ever since, she’s been trying to figure out how to intervene — could she modify or reverse the way addiction changed the brains being studied in her lab?\u003c/p>\n\u003cp>Hurd has honed in on cannabidiol, one of the two main compounds plucked from the marijuana plant. She thinks it might hold the potential to curb cravings for heroin and other opioids.\u003c/p>\n\u003cp>She’s running against the wind. Cannabidiol is classified as a Schedule I drug, meaning the U.S. government thinks it carries severe safety concerns, no medicinal benefits, and a high risk of abuse. Even as a growing number of states legalize marijuana, the hard-line federal stance has made it difficult to do clinical research involving cannabis in this country.\u003c/p>\n\u003caside class=\"pullquote alignright\">'You have to treat every epidemic the same, whether it’s a drug epidemic or a viral epidemic.'\u003ccite>Dr. Yasmin Hurd\u003c/cite>\u003c/aside>\n\u003cp>But Hurd is throwing all of her weight into studying whether it can combat addiction. And she’s trying to rally other scientists to do the same, by creating a consortium to conduct cannabidiol clinical trials across the globe.\u003c/p>\n\u003cp>“If this is something that could be potentially beneficial, and there’s an indication that it could be beneficial,” Hurd said in an interview, “why not put all hands on deck?”\u003c/p>\n\u003cp>Hurd has the reputation and academic standing to pull this off — last fall, she was named to the prestigious National Academy of Medicine, along with dozens of other top-tier researchers.\u003c/p>\n\u003cp>More than that, she has determination: On the front of her computer screen, she’s stuck up a yellow Post-it note that says, “GAIN CONTROL.” Only she’s crossed out “GAIN,” and replaced it with “TAKE.”\u003c/p>\n\u003cp>\u003cstrong>Unraveling The Biology of Addiction\u003cbr>\n\u003c/strong>Hurd has always had what she calls a “pure fascination” with the brain. Her own bounces quickly from one thought to the next, sometimes leaving threads unfinished for the sake of starting a new one. One idea may spin off into a dozen new ones. During a recent interview, she jumped from why she finds outliers in science so intriguing to why she loves murder mysteries (Alfred Hitchcock is a personal favorite).\u003c/p>\n\u003cp>That mental multitasking is mirrored in her lab, where her team is working on a slew of projects, from how chronic drug use restructures the brain to how the brain’s circuits play a role in psychiatric disease.\u003c/p>\n\u003cp>“My research, unfortunately, reflects me,” she said.\u003c/p>\n\u003cp>Her mind is constantly hunting for new ideas in unlikely, often difficult places — like on the list of Schedule I drugs.\u003c/p>\n\u003cp>Past studies have shown that cannabidiol works on a number of brain circuits involved in addiction and drug-seeking behavior. That’s made it an exciting pharmacological target — but the data, by and large, have just been preliminary and unpersuasive. Hurd started looking for more concrete evidence on cannabidiol.\u003c/p>\n\u003caside class=\"pullquote alignright\">'The hard-line federal stance has made it difficult to do clinical research involving cannabis in this country.'\u003c/aside>\n\u003cp>The compound is one of the two main cannabinoids found in the marijuana plant, the other being tetrahydrocannabinol, or THC. But unlike THC, cannabidiol doesn’t get people high. Scientists are studying whether the compound can treat conditions such as epilepsy and anxiety. Hurd is testing whether cannabidiol can cut down on cravings in patients who are addicted to opioids — and in turn, can prevent relapse.\u003c/p>\n\u003cp>In her research on animals, the compound has decreased cravings and anxiety without producing any psychoactive effects. But she’s not sure why, exactly, it’s working. So at the same time, she’s orchestrating studies to delve into the biology that underlies addiction.\u003c/p>\n\u003cp>Some quick background: The neurons in the brain talk to each other through neurotransmitters such as dopamine, serotonin, and endocannabinoids. Those chemical messengers ferry information between brain cells through a synapse, which is the intersection between two neurons. Drugs like heroin are like a car crash — they damage those synapses to the point that other cars can’t get through.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Hurd’s lab is studying the wreckage through research like the experiment that one of her postdoctoral researchers, Noel Warren, is working on. Warren hits rat neurons with a compound that mimics chronic heroin use to see how synaptic plasticity — the way the brain changes the connections among neurons, forming new ones while pruning others — is different in the brain after drug use.\u003c/p>\n\u003cp>Based on her findings, Hurd has launched trials to test cannabidiol in humans — but that’s no easy task.\u003c/p>\n\u003cp>\u003cstrong>‘The Hurdles Are Enormous’\u003cbr>\n\u003c/strong>Studying cannabidiol is daunting, and not just because the brain is so complex. To use cannabidiol or any part of the cannabis plant for research, a scientist has to get a special license from the Drug Enforcement Administration, which can take years. Then, scientists have to get approval from the Food and Drug Administration to administer it to patients.\u003c/p>\n\u003cp>“The hurdles are enormous,” said Margaret Haney, a neurobiologist at Columbia University who studies cannabis use disorder and the therapeutic potential of cannabinoids in humans. Haney has to keep the cannabis used in her trials in a gun safe that’s stashed inside a freezer that’s sitting in a special room in her lab that can only be accessed with her fingerprint. That’s routine for cannabis research.\u003c/p>\n\u003cp>\u003cimg class=\" wp-image-128930 alignleft\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/03/medmar-800x533.jpg\" alt=\"\" width=\"423\" height=\"282\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2016/03/medmar-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2016/03/medmar-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2016/03/medmar-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2016/03/medmar-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2016/03/medmar.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2016/03/medmar-960x640.jpg 960w\" sizes=\"(max-width: 423px) 100vw, 423px\">And patients who are enrolled in clinical trials involving cannabis have to come to the lab of the researcher who holds a DEA license to get the drug, which isn’t always doable for individuals with serious medical conditions.\u003c/p>\n\u003cp>“Our hands are tied even though cannabidiol is not addictive,” Hurd said. But because it derives from the cannabis plant, the government classifies it as a Schedule I drug — like heroin, LSD, ecstasy, and peyote — which are considered to be harmful and have no medicinal value.\u003c/p>\n\u003cp>That means there are relatively few scientists doing research involving cannabis, and even fewer studying its potential to treat addiction or testing cannabidiol in humans. Hurd isn’t in a crowded field.\u003c/p>\n\u003cp>“There’s really not that many people that do that,” said Dr. Sachin Patel, of Vanderbilt University, who has done research with cannabis to understand how marijuana exposure early in life raises the risk of psychiatric disorders.\u003c/p>\n\u003cp>And then, there’s the issue of supply.\u003c/p>\n\u003caside class=\"pullquote alignright\">'Our hands are tied even though cannabidiol is not addictive.'\u003ccite>Dr. Yasmin Hurd\u003c/cite>\u003c/aside>\n\u003cp>For decades, the only sanctioned source of marijuana available for U.S. research was the University of Mississippi, which held an exclusive contract with the federal government.\u003c/p>\n\u003cp>“If you’re trying to do a clinical trial and you need cannabidiol, it’s actually quite difficult to get the types of cannabis needed to do the research,” said Patel.\u003c/p>\n\u003cp>Hurd said the restricted supply has made it all but impossible for her to study the specific formulations of cannabidiol she suspects would be the most therapeutic.\u003c/p>\n\u003cp>She is currently running Phase 2 clinical trials in New York to test cannabidiol’s ability to reduce cravings in people addicted to heroin. And she’s initiating similar studies to test cannabidiol soon in Canada and Jamaica.\u003c/p>\n\u003caside class=\"pullquote alignright\">'[T]he process has felt painstakingly slow when people are dying so quickly.'\u003c/aside>\n\u003cp>But for Hurd, the process has felt painstakingly slow when people are dying so quickly. An estimated 63,600 people died of drug overdoses in 2016. Two-thirds of those deaths were caused by opioids.\u003c/p>\n\u003cp>Hurd is frustrated by how both the government is grappling with the crisis. It’s paled in comparison to the response to the Zika virus and other public health concerns in recent years, she said.\u003c/p>\n\u003cp>“People swarmed to do something. That did not happen with the opioid epidemic,” Hurd said.\u003c/p>\n\u003cp>\u003cimg class=\"alignnone wp-image-435640 \" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/09/iStock-594036552-800x668.jpg\" alt=\"\" width=\"384\" height=\"321\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/09/iStock-594036552-800x668.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2017/09/iStock-594036552-160x134.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/09/iStock-594036552-768x641.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2017/09/iStock-594036552-1020x852.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2017/09/iStock-594036552-1180x985.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2017/09/iStock-594036552-960x801.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2017/09/iStock-594036552-240x200.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/09/iStock-594036552-375x313.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/09/iStock-594036552-520x434.jpg 520w, https://ww2.kqed.org/app/uploads/sites/13/2017/09/iStock-594036552.jpg 1895w\" sizes=\"(max-width: 384px) 100vw, 384px\">\u003c/p>\n\u003cp>Why not? Hurd blames it, in large part, on discrimination against people who are addicted to drugs. But if there were more federal funding for research, Hurd said, scientists could accelerate the search for solutions.\u003c/p>\n\u003cp>“You have to treat every epidemic the same,” she said, “whether it’s a drug epidemic or a viral epidemic.”\u003c/p>\n\u003cp>She’s quick to note that she’s not arguing that cannabidiol is a cure-all for the crisis. Hurd just wants to have enough researchers working on the problem that they can quickly say whether something works — or whether it doesn’t — and then move on.\u003c/p>\n\u003cp>Haney, the Columbia neurobiologist, echoed that frustration. The DEA said it has not rescheduled cannabis because there aren’t enough studies to show it has medical potential. But until it’s rescheduled, Haney said, those kind of large, randomized studies won’t really be feasible.\u003c/p>\n\u003cp>“We’re in a vicious cycle,” she said.\u003c/p>\n\u003cp>And dispensaries and cannabis companies in the 29 states that have already legalized medical marijuana don’t have any incentive to fund or conduct clinical trials on the medical benefits, experts say, because they’re already able to sell their products to patients without government approval.\u003c/p>\n\u003cp>“The money-making is all happening outside of any data,” Haney said.\u003c/p>\n\u003cp>So Hurd is trying to spur her fellow scientists to do as much research as possible on the potential of cannabidiol to treat opioid addiction, in a bid to build a cannabinoid consortium. She’s connected with clinicians, pharmacologists, and neuroscientists to talk about how to spur new research. And she’s working to rope in companies interested in cannabidiol, too. Without National Institutes of Health funding for such a project, she’s hopeful they’ll help fund the consortium.\u003c/p>\n\u003cp>Her goal: build an infrastructure that’s far broader than her own.\u003c/p>\n\u003cp>“I don’t need to be the only person in the room studying cannabidiol for opioid addiction,” she said. “It can’t be done with just one little Yasmin Hurd lab.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>This article is reproduced with permission from \u003ca href=\"https://www.statnews.com/\" target=\"_blank\" rel=\"noopener\">STAT\u003c/a>. It was first published on Feb. 28, 2018. Find the original story \u003ca href=\"https://www.statnews.com/2018/02/28/marijuana-cannabidiol-opioids-addiction/\" target=\"_blank\" rel=\"noopener\">here\u003c/a>.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Beer has fueled a lot of bad ideas. But on a Friday afternoon in 2007, it helped two Alzheimer's researchers come up with a really a good one.\u003c/p>\n\u003cp>Neuroscientists \u003ca href=\"http://www.massgeneral.org/neurology/researcher_profiles/moir_robert.aspx\">Robert Moir\u003c/a> and \u003ca href=\"http://www.massgeneral.org/neurology/researcher_profiles/tanzi_rudolph.aspx\">Rudolph Tanzi\u003c/a> were sipping Coronas in separate offices during \"attitude adjustment hour\" at Massachusetts General Hospital, Harvard's largest teaching hospital. And, by chance, each scientist found himself wondering about an apparent link between Alzheimer's disease and the immune system.\u003c/p>\n\u003cp>Moir had been surfing through random scientific papers online — something he does for an hour or so on most Fridays. \"I cruise wherever my fancy takes me,\" he says.[contextly_sidebar id=\"7M1TEDtx5VpvYNAuLZ4fq7p1cSKlsEay\"]\u003c/p>\n\u003cp>And on this day, he cruised to research on molecules known as antimicrobial peptides. They're part of the ancient immune system that's found in all forms of life and plays an important role in protecting the human brain.\u003c/p>\n\u003cp>One way antimicrobial peptides protect us is by engulfing and neutralizing a germ or some other foreign invader. That gives newer parts of the immune system time to get mobilized.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>These peptides are \"extremely important,\" Moir says. \"They're not like legacies from an immune system we don't use anymore. If you don't have them, you're going to die in a couple of hours.\"\u003c/p>\n\u003caside class=\"pullquote alignright\">'What if those sticky plaques were actually an effort to protect the brain.'\u003c/aside>\n\u003cp>As Moir surfed through paper after paper, he realized that one of these ancient molecules, known as LL-37, looked a lot like a molecule closely associated with Alzheimer's. That molecule is called amyloid-beta and it forms the sticky plaques that tend to build up in the brains of people with dementia[contextly_sidebar id=\"IYHDaMptIPqJzYR9l5XweOSqbSXwwBlK\"]\u003c/p>\n\u003cp>LL-37 and Amyloid-beta \"looked just like peas in a pod,\" Moir says.\u003c/p>\n\u003cp>That was really surprising. Even more surprising, on that same Friday afternoon, Moir's colleague Tanzi had also noticed a connection between Alzheimer's and the ancient immune system, which scientists refer to as innate immunity.\u003c/p>\n\u003cp>Tanzi had been spending the same hour that Friday afternoon reviewing a list of genes he'd found that were somehow related to Alzheimer's. \"I was enjoying my first or second Corona,\" he says, \"and I noticed that many of the genes coming up were involved with innate immunity.\"\u003c/p>\n\u003cp>\"I was like, well, what does that mean?\" Tanzi says. \"So I wandered into [Moir's] office, carrying my Corona in hand, and I said, 'What do you know about innate immunity in the brain?' \"\u003c/p>\n\u003cp>The two researchers decided to team up to figure out precisely how innate immunity figures into Alzheimer's. They later sketched out their research plan while sipping Bordeaux on the deck of Tanzi's house along the coast.\u003c/p>\n\u003cp>\"We spent a lot of evenings out there making a dent in his very nice cellar,\" Moir says.\u003c/p>\n\u003cp>\u003cstrong>The Brain's Immune System\u003c/strong>\u003cbr>\nThe two scientists began to discuss a wild idea. What if amyloid-beta was an integral part of the ancient immune system? What if those sticky plaques were actually an effort to protect the brain by encapsulating foreign invaders?\u003c/p>\n\u003cp>Their idea was that the brain was producing amyloid for much the same reason an oyster forms a pearl — for self-defense. \"Maybe amyloid plaques are a brain pearl,\" Moir says, \"a way for our body to trap and permanently sequester these invading pathogens.\"\u003c/p>\n\u003cp>That was a pretty radical idea. For decades, most scientists thought amyloid-beta was no more than a toxic waste product. \"In all those scenarios it's bad, bad, bad, bad, bad,\" Moir says.\u003c/p>\n\u003cp>But Moir and Tanzi suspected amyloid-beta was usually good — unless the brain started making too much. Then it could kill brain cells and lead to dementia.\u003c/p>\n\u003cp>This hypothesis was not immediately embraced by other scientists, Tanzi says.\u003c/p>\n\u003caside class=\"pullquote alignright\">'It may be possible to interrupt the process before it causes Alzheimer's.'\u003c/aside>\n\u003cp>\"I had folks emailing me, ex-mentors — Nobel laureates — saying, 'Rudy have you lost your mind?' Luckily neither Rob nor I have a really good track record of listening to people.\"\u003c/p>\n\u003cp>So. Tanzi and Moir set out to prove that amyloid really is part of the immune system. And they were lucky enough to have a funder, the \u003ca href=\"https://curealz.org/\">Cure Alzheimer's Fund\u003c/a>, that was willing to take a chance on their idea.\u003c/p>\n\u003cp>The effort took years. But in 2010, Moir, Tanzi, and their team \u003ca href=\"http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0009505\">demonstrated\u003c/a> that amyloid is really good at killing viruses and bacteria in a test tube. And, in 2016, they \u003ca href=\"http://stm.sciencemag.org/content/8/340/340ra72\">showed\u003c/a> it did the same thing in worms and mice.\u003c/p>\n\u003cp>\"It was very clear that amyloid protected against infection,\" Tanzi says. \"If a mouse had meningitis or encephalitis, [and] if that mouse was making amyloid it lived longer.\" In contrast, mice that did not produce amyloid died quickly from the infection.\u003c/p>\n\u003cp>\u003cimg class=\" wp-image-93427 alignleft\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/01/iStock_000060595932_Large-800x600.jpg\" alt=\"\" width=\"401\" height=\"301\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2016/01/iStock_000060595932_Large-800x600.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2016/01/iStock_000060595932_Large-400x300.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2016/01/iStock_000060595932_Large-768x576.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2016/01/iStock_000060595932_Large-1180x885.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2016/01/iStock_000060595932_Large-1920x1440.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2016/01/iStock_000060595932_Large-960x720.jpg 960w\" sizes=\"(max-width: 401px) 100vw, 401px\">Today, Tanzi and Moir's wild idea is no longer considered so wild. Lots of scientists are now \u003ca href=\"https://www.nature.com/articles/ng.3916\">studying\u003c/a> the ancient immune system's connection to Alzheimer's.\u003c/p>\n\u003cp>And Tanzi says it's become clear that Alzheimer's involves a lot more than just plaques and tangles in the brain.\u003c/p>\n\u003cp>\"Even though we really concentrate on these plaques and tangles in Alzheimer's disease, it looks like it's the brain's immune system — the very primitive immune system of the brain — that's gone awry,\" Tanzi says, \"and the plaques and tangles are a part of that system.\"\u003c/p>\n\u003cp>The question now is: What's causing the glitch in the ancient immune system?\u003c/p>\n\u003cp>One possibility is that it's overreacting to viruses and bacteria that get into the brain. Or, the system could be getting confused and attacking healthy cells — a lot like what happens in diseases like lupus or multiple sclerosis.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>If either idea holds up, it may be possible to interrupt the process before it causes Alzheimer's, Moir says. \"That's a pretty good outcome from a couple of Coronas 10 years ago.\"\u003c/p>\n\u003cdiv class=\"fullattribution\">\u003cem>Copyright 2018 NPR. To see more, visit \u003ca href=\"http://www.npr.org/\" target=\"_blank\" rel=\"noopener\">http://www.npr.org/\u003c/a>.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Scientists+Explore+Ties+Between+Alzheimer%27s+And+Brain%27s+Ancient+Immune+System&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/em>\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Beer has fueled a lot of bad ideas. But on a Friday afternoon in 2007, it helped two Alzheimer's researchers come up with a really a good one.\u003c/p>\n\u003cp>Neuroscientists \u003ca href=\"http://www.massgeneral.org/neurology/researcher_profiles/moir_robert.aspx\">Robert Moir\u003c/a> and \u003ca href=\"http://www.massgeneral.org/neurology/researcher_profiles/tanzi_rudolph.aspx\">Rudolph Tanzi\u003c/a> were sipping Coronas in separate offices during \"attitude adjustment hour\" at Massachusetts General Hospital, Harvard's largest teaching hospital. And, by chance, each scientist found himself wondering about an apparent link between Alzheimer's disease and the immune system.\u003c/p>\n\u003cp>Moir had been surfing through random scientific papers online — something he does for an hour or so on most Fridays. \"I cruise wherever my fancy takes me,\" he says.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>And on this day, he cruised to research on molecules known as antimicrobial peptides. They're part of the ancient immune system that's found in all forms of life and plays an important role in protecting the human brain.\u003c/p>\n\u003cp>One way antimicrobial peptides protect us is by engulfing and neutralizing a germ or some other foreign invader. That gives newer parts of the immune system time to get mobilized.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>These peptides are \"extremely important,\" Moir says. \"They're not like legacies from an immune system we don't use anymore. If you don't have them, you're going to die in a couple of hours.\"\u003c/p>\n\u003caside class=\"pullquote alignright\">'What if those sticky plaques were actually an effort to protect the brain.'\u003c/aside>\n\u003cp>As Moir surfed through paper after paper, he realized that one of these ancient molecules, known as LL-37, looked a lot like a molecule closely associated with Alzheimer's. That molecule is called amyloid-beta and it forms the sticky plaques that tend to build up in the brains of people with dementia\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>LL-37 and Amyloid-beta \"looked just like peas in a pod,\" Moir says.\u003c/p>\n\u003cp>That was really surprising. Even more surprising, on that same Friday afternoon, Moir's colleague Tanzi had also noticed a connection between Alzheimer's and the ancient immune system, which scientists refer to as innate immunity.\u003c/p>\n\u003cp>Tanzi had been spending the same hour that Friday afternoon reviewing a list of genes he'd found that were somehow related to Alzheimer's. \"I was enjoying my first or second Corona,\" he says, \"and I noticed that many of the genes coming up were involved with innate immunity.\"\u003c/p>\n\u003cp>\"I was like, well, what does that mean?\" Tanzi says. \"So I wandered into [Moir's] office, carrying my Corona in hand, and I said, 'What do you know about innate immunity in the brain?' \"\u003c/p>\n\u003cp>The two researchers decided to team up to figure out precisely how innate immunity figures into Alzheimer's. They later sketched out their research plan while sipping Bordeaux on the deck of Tanzi's house along the coast.\u003c/p>\n\u003cp>\"We spent a lot of evenings out there making a dent in his very nice cellar,\" Moir says.\u003c/p>\n\u003cp>\u003cstrong>The Brain's Immune System\u003c/strong>\u003cbr>\nThe two scientists began to discuss a wild idea. What if amyloid-beta was an integral part of the ancient immune system? What if those sticky plaques were actually an effort to protect the brain by encapsulating foreign invaders?\u003c/p>\n\u003cp>Their idea was that the brain was producing amyloid for much the same reason an oyster forms a pearl — for self-defense. \"Maybe amyloid plaques are a brain pearl,\" Moir says, \"a way for our body to trap and permanently sequester these invading pathogens.\"\u003c/p>\n\u003cp>That was a pretty radical idea. For decades, most scientists thought amyloid-beta was no more than a toxic waste product. \"In all those scenarios it's bad, bad, bad, bad, bad,\" Moir says.\u003c/p>\n\u003cp>But Moir and Tanzi suspected amyloid-beta was usually good — unless the brain started making too much. Then it could kill brain cells and lead to dementia.\u003c/p>\n\u003cp>This hypothesis was not immediately embraced by other scientists, Tanzi says.\u003c/p>\n\u003caside class=\"pullquote alignright\">'It may be possible to interrupt the process before it causes Alzheimer's.'\u003c/aside>\n\u003cp>\"I had folks emailing me, ex-mentors — Nobel laureates — saying, 'Rudy have you lost your mind?' Luckily neither Rob nor I have a really good track record of listening to people.\"\u003c/p>\n\u003cp>So. Tanzi and Moir set out to prove that amyloid really is part of the immune system. And they were lucky enough to have a funder, the \u003ca href=\"https://curealz.org/\">Cure Alzheimer's Fund\u003c/a>, that was willing to take a chance on their idea.\u003c/p>\n\u003cp>The effort took years. But in 2010, Moir, Tanzi, and their team \u003ca href=\"http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0009505\">demonstrated\u003c/a> that amyloid is really good at killing viruses and bacteria in a test tube. And, in 2016, they \u003ca href=\"http://stm.sciencemag.org/content/8/340/340ra72\">showed\u003c/a> it did the same thing in worms and mice.\u003c/p>\n\u003cp>\"It was very clear that amyloid protected against infection,\" Tanzi says. \"If a mouse had meningitis or encephalitis, [and] if that mouse was making amyloid it lived longer.\" In contrast, mice that did not produce amyloid died quickly from the infection.\u003c/p>\n\u003cp>\u003cimg class=\" wp-image-93427 alignleft\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/01/iStock_000060595932_Large-800x600.jpg\" alt=\"\" width=\"401\" height=\"301\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2016/01/iStock_000060595932_Large-800x600.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2016/01/iStock_000060595932_Large-400x300.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2016/01/iStock_000060595932_Large-768x576.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2016/01/iStock_000060595932_Large-1180x885.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2016/01/iStock_000060595932_Large-1920x1440.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2016/01/iStock_000060595932_Large-960x720.jpg 960w\" sizes=\"(max-width: 401px) 100vw, 401px\">Today, Tanzi and Moir's wild idea is no longer considered so wild. Lots of scientists are now \u003ca href=\"https://www.nature.com/articles/ng.3916\">studying\u003c/a> the ancient immune system's connection to Alzheimer's.\u003c/p>\n\u003cp>And Tanzi says it's become clear that Alzheimer's involves a lot more than just plaques and tangles in the brain.\u003c/p>\n\u003cp>\"Even though we really concentrate on these plaques and tangles in Alzheimer's disease, it looks like it's the brain's immune system — the very primitive immune system of the brain — that's gone awry,\" Tanzi says, \"and the plaques and tangles are a part of that system.\"\u003c/p>\n\u003cp>The question now is: What's causing the glitch in the ancient immune system?\u003c/p>\n\u003cp>One possibility is that it's overreacting to viruses and bacteria that get into the brain. Or, the system could be getting confused and attacking healthy cells — a lot like what happens in diseases like lupus or multiple sclerosis.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>If either idea holds up, it may be possible to interrupt the process before it causes Alzheimer's, Moir says. \"That's a pretty good outcome from a couple of Coronas 10 years ago.\"\u003c/p>\n\u003cdiv class=\"fullattribution\">\u003cem>Copyright 2018 NPR. To see more, visit \u003ca href=\"http://www.npr.org/\" target=\"_blank\" rel=\"noopener\">http://www.npr.org/\u003c/a>.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Scientists+Explore+Ties+Between+Alzheimer%27s+And+Brain%27s+Ancient+Immune+System&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/em>\u003c/div>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>In her late 20s and attending college in Texas, Elizabeth Moreno suffered from debilitating back pain caused by a spinal abnormality. \"I just could not live with the pain,\" she says. \"I couldn't get dressed by myself, I couldn't walk across my house, let alone to class, and nothing, no drug that had been prescribed to me, even dulled the pain.\"\u003c/p>\n\u003cp>Moreno says she also tried chiropractic medicine and acupuncture, but they didn't make the pain go away. Finally, a doctor at the student health center referred her to an orthopedic specialist who performed tests and concluded a disk was blocking nerves down her legs and needed to be removed. Moreno's father, a retired Ohio doctor who had seen many failed back surgeries over his career, agreed it was the best course.[contextly_sidebar id=\"vqKuq9OjOhBxcXMb7vV8YzSosJA1vjwK\"]\u003c/p>\n\u003cp>In late 2015, Moreno had the operation in Houston, which she described as \"a complete success.\" She gave it little thought when the surgical office asked her to leave a urine sample for a drug test.\u003c/p>\n\u003cp>Then the bill came.\u003c/p>\n\u003cp>\u003cstrong>Patient:\u003c/strong> Elizabeth Moreno, then 28, a student at Texas State University in San Marcos.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cstrong>Total bill:\u003c/strong> $17,850 for a urine test in January 2016\u003c/p>\n\u003cp>\u003cstrong>Service provider:\u003c/strong> Sunset Labs LLC of Houston\u003c/p>\n\u003caside class=\"pullquote alignright\">'Urine drug testing has exploded over the past decade amid alarm over rising opioid overdose deaths.'\u003c/aside>\n\u003cp>\u003cstrong>Medical treatment:\u003c/strong> Moreno had a disk removed from her back in December 2015. Her surgeon prescribed an opioid painkiller, hydrocodone. At a follow-up office visit in mid-January 2016, the staff asked her to leave a urine sample, which she figured was routine. In March 2017, the lab sent her a bill for $17,850 for testing her urine for a slew of drugs, including cocaine, methadone, anti-anxiety drugs and several other drugs she had never heard of.\u003c/p>\n\u003cp>\u003cstrong>What gives:\u003c/strong> Urine drug testing has exploded over the past decade amid alarm over rising opioid overdose deaths. Many doctors who prescribe the pills rely on the urine tests to help reduce drug abuse and keep patients with chronic pain safe. Yet the tests have become a cash cow for a burgeoning testing industry, and critics charge that unneeded and often expensive ones are sometimes ordered for profit rather than patient care. Doctors can decide whether to test patients who take opioids for short periods, such as after an operation. Moreno's surgeon would not discuss her urine test — why he ordered it and why the sample was tested for so many substances.\u003c/p>\n\u003cp>Three experts contacted by Kaiser Health News questioned the need for such extensive testing and were shocked to hear of the lab's prices. They said these tests rarely cost more than $200, and typically much less, depending on the complexity and the technology used. Some doctors' offices use a simple cup test, which can detect several classes of drugs on the spot and could be purchased for about $10. Bills can climb higher when labs run tests to detect the quantity of specific drugs and bill for each one, as the lab did here.[contextly_sidebar id=\"mnWbYp5KSicKpyA8MvvQPncVSL8Nauim\"]\u003c/p>\n\u003cp>The experts said the lab's prices for individual tests were excessive, such as charging $1,700 to check for amphetamines or $425 to identify phencyclidine, an illegal hallucinogenic drug also known as PCP. They also criticized a charge of $850 for two tests to verify that her urine sample had not been adulterated or tampered with.\u003c/p>\n\u003cp>Moreno's insurer, Blue Cross and Blue Shield of Texas, refused to pay any of the bill, arguing that the lab was out of network and thus not covered. Had it chipped in, it would have covered the service at $100.92, according to an \u003ca href=\"https://www.documentcloud.org/documents/4353248-Blue-Cross-Blue-Shield-EOB-for-Urine-Drug-Screen.html\">explanation of benefits\u003c/a> the insurance company sent to Moreno.\u003c/p>\n\u003cp>Sunset Labs says its list prices were \"in line\" with its competitors in the area. It also said doctors treating pain agree extensive urine testing is \"the best course of action\" and that a lab \"is not in the position\" to question tests ordered by a doctor.\u003c/p>\n\u003cp>\u003cstrong>Resolution:\u003c/strong> Fearing damage to his daughter's credit rating, Moreno's father, Dr. Paul Davis, paid the lab $5,000 to settle the bill in April 2017. A retired doctor, he also has filed a formal complaint about the bill with the Texas attorney general's office, accusing the lab of \"price gouging of staggering proportions.\" The lab's attorney said he was not aware of the complaint. A Texas attorney general's spokesperson confirmed to KHN that the office had received complaints about the lab but declined further comment.\u003c/p>\n\u003cp>\u003cstrong>The takeaway:\u003c/strong> When a physician asks for a urine or blood sample, always ask what it's for. Insist that it be sent to a lab in your insurance network.\u003c/p>\n\u003cdiv class=\"hr\">\n\u003chr>\n\u003c/div>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This is the debut of a monthly feature from Kaiser Health News and NPR that will dissect and explain real medical bills to shed light on prices in U.S. health care and to help patients learn how to be more active in managing costs. Do you have a medical bill that you'd like us to see and scrutinize? Submit \u003c/em>\u003ca href=\"http://www.npr.org/sections/health-shots/2018/02/13/585549568/share-your-medical-bill-with-us\">it here and tell us\u003c/a>\u003cem> the story behind it.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>In her late 20s and attending college in Texas, Elizabeth Moreno suffered from debilitating back pain caused by a spinal abnormality. \"I just could not live with the pain,\" she says. \"I couldn't get dressed by myself, I couldn't walk across my house, let alone to class, and nothing, no drug that had been prescribed to me, even dulled the pain.\"\u003c/p>\n\u003cp>Moreno says she also tried chiropractic medicine and acupuncture, but they didn't make the pain go away. Finally, a doctor at the student health center referred her to an orthopedic specialist who performed tests and concluded a disk was blocking nerves down her legs and needed to be removed. Moreno's father, a retired Ohio doctor who had seen many failed back surgeries over his career, agreed it was the best course.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>In late 2015, Moreno had the operation in Houston, which she described as \"a complete success.\" She gave it little thought when the surgical office asked her to leave a urine sample for a drug test.\u003c/p>\n\u003cp>Then the bill came.\u003c/p>\n\u003cp>\u003cstrong>Patient:\u003c/strong> Elizabeth Moreno, then 28, a student at Texas State University in San Marcos.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cstrong>Total bill:\u003c/strong> $17,850 for a urine test in January 2016\u003c/p>\n\u003cp>\u003cstrong>Service provider:\u003c/strong> Sunset Labs LLC of Houston\u003c/p>\n\u003caside class=\"pullquote alignright\">'Urine drug testing has exploded over the past decade amid alarm over rising opioid overdose deaths.'\u003c/aside>\n\u003cp>\u003cstrong>Medical treatment:\u003c/strong> Moreno had a disk removed from her back in December 2015. Her surgeon prescribed an opioid painkiller, hydrocodone. At a follow-up office visit in mid-January 2016, the staff asked her to leave a urine sample, which she figured was routine. In March 2017, the lab sent her a bill for $17,850 for testing her urine for a slew of drugs, including cocaine, methadone, anti-anxiety drugs and several other drugs she had never heard of.\u003c/p>\n\u003cp>\u003cstrong>What gives:\u003c/strong> Urine drug testing has exploded over the past decade amid alarm over rising opioid overdose deaths. Many doctors who prescribe the pills rely on the urine tests to help reduce drug abuse and keep patients with chronic pain safe. Yet the tests have become a cash cow for a burgeoning testing industry, and critics charge that unneeded and often expensive ones are sometimes ordered for profit rather than patient care. Doctors can decide whether to test patients who take opioids for short periods, such as after an operation. Moreno's surgeon would not discuss her urine test — why he ordered it and why the sample was tested for so many substances.\u003c/p>\n\u003cp>Three experts contacted by Kaiser Health News questioned the need for such extensive testing and were shocked to hear of the lab's prices. They said these tests rarely cost more than $200, and typically much less, depending on the complexity and the technology used. Some doctors' offices use a simple cup test, which can detect several classes of drugs on the spot and could be purchased for about $10. Bills can climb higher when labs run tests to detect the quantity of specific drugs and bill for each one, as the lab did here.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>The experts said the lab's prices for individual tests were excessive, such as charging $1,700 to check for amphetamines or $425 to identify phencyclidine, an illegal hallucinogenic drug also known as PCP. They also criticized a charge of $850 for two tests to verify that her urine sample had not been adulterated or tampered with.\u003c/p>\n\u003cp>Moreno's insurer, Blue Cross and Blue Shield of Texas, refused to pay any of the bill, arguing that the lab was out of network and thus not covered. Had it chipped in, it would have covered the service at $100.92, according to an \u003ca href=\"https://www.documentcloud.org/documents/4353248-Blue-Cross-Blue-Shield-EOB-for-Urine-Drug-Screen.html\">explanation of benefits\u003c/a> the insurance company sent to Moreno.\u003c/p>\n\u003cp>Sunset Labs says its list prices were \"in line\" with its competitors in the area. It also said doctors treating pain agree extensive urine testing is \"the best course of action\" and that a lab \"is not in the position\" to question tests ordered by a doctor.\u003c/p>\n\u003cp>\u003cstrong>Resolution:\u003c/strong> Fearing damage to his daughter's credit rating, Moreno's father, Dr. Paul Davis, paid the lab $5,000 to settle the bill in April 2017. A retired doctor, he also has filed a formal complaint about the bill with the Texas attorney general's office, accusing the lab of \"price gouging of staggering proportions.\" The lab's attorney said he was not aware of the complaint. A Texas attorney general's spokesperson confirmed to KHN that the office had received complaints about the lab but declined further comment.\u003c/p>\n\u003cp>\u003cstrong>The takeaway:\u003c/strong> When a physician asks for a urine or blood sample, always ask what it's for. Insist that it be sent to a lab in your insurance network.\u003c/p>\n\u003cdiv class=\"hr\">\n\u003chr>\n\u003c/div>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This is the debut of a monthly feature from Kaiser Health News and NPR that will dissect and explain real medical bills to shed light on prices in U.S. health care and to help patients learn how to be more active in managing costs. Do you have a medical bill that you'd like us to see and scrutinize? Submit \u003c/em>\u003ca href=\"http://www.npr.org/sections/health-shots/2018/02/13/585549568/share-your-medical-bill-with-us\">it here and tell us\u003c/a>\u003cem> the story behind it.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "What's In That IV Bag? Hopefully Something Other Than Saline",
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"content": "\u003cp>New research calls into question what’s in those IV bags that nearly every hospitalized patient gets. Using a different intravenous fluid instead of the usual saline greatly reduced the risk of death or kidney damage, two large studies found.\u003c/p>\n\u003cp>The difference could mean 50,000 to 70,000 fewer deaths and 100,000 fewer cases of kidney failure each year in the U.S., researchers estimate. Some doctors are hoping the results will persuade more \u003ca href=\"https://ww2.kqed.org/futureofyou/2017/03/09/premier-hospitals-are-promoting-unproven-alternative-therapies/\" target=\"_blank\" rel=\"noopener\">hospitals\u003c/a> to switch.[contextly_sidebar id=\"0jhqLe7SiU2Eb27aQUWnipt3zwitsKUi\"]\u003c/p>\n\u003cp>“We’ve been sounding the alarm for 20 years” about possible harms from saline, said Dr. John Kellum, a critical care specialist at the University of Pittsburgh. “It’s purely inertia” that prevents a change, he said.\u003c/p>\n\u003cp>Kellum had no role in the studies, which were discussed Tuesday at a critical care conference in San Antonio and published by the New England Journal of Medicine. Federal grants helped pay for the work.[contextly_sidebar id=\"z39OU3j4iEAklNQ4ejamioZfGewR34gT\"]\u003c/p>\n\u003cp>IVs are one of the most common things in health care. They are used to prevent dehydration, maintain blood pressure or give patients medicines or nutrients if they can’t eat.\u003c/p>\n\u003caside class=\"pullquote alignright\">'Many suppliers make both types, so switching should not be hard or expensive.'\u003c/aside>\n\u003cp>Saline — salt dissolved in water — has been the most widely used fluid in the U.S. for more than a century even as evidence has emerged that it can harm kidneys, especially when used a lot.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Other IV solutions called balanced fluids include saline but also contain potassium and other things that make them more like plasma, the clear part of blood. They’re widely used in Europe and Australia.\u003c/p>\n\u003cp>The studies involved 28,000 patients at Vanderbilt University who were given IVs of saline or a balanced fluid. For every 100 people on balanced fluids, there was one fewer death or severe kidney problem.[contextly_sidebar id=\"sUu4YOGKN2sP1Zqyc3nVUiyRVy3jB58L\"]\u003c/p>\n\u003cp>Since there are about 30 million people hospitalized in the U.S. alone each year, “there are tens or hundreds of thousands of patients who would be spared death or severe kidney problems by using balanced fluids instead of saline,” said one study leader, Vanderbilt’s Dr. Matthew Semler.\u003c/p>\n\u003cp>After seeing the results two months ago, Vanderbilt hospital officials decided to primarily use balanced fluids. The University of Pittsburgh also has largely switched to them, Kellum said.\u003c/p>\n\u003cp>The fluids cost about the same — a dollar or two per IV — and many suppliers make both types, so switching should not be hard or expensive, doctors said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>IV fluids have been in the news since Hurricane Maria hit Puerto Rico last fall, shutting down electricity to three plants owned by Baxter International, one of the biggest makers of these fluids. The shortage has eased, but some supply issues remain.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>New research calls into question what’s in those IV bags that nearly every hospitalized patient gets. Using a different intravenous fluid instead of the usual saline greatly reduced the risk of death or kidney damage, two large studies found.\u003c/p>\n\u003cp>The difference could mean 50,000 to 70,000 fewer deaths and 100,000 fewer cases of kidney failure each year in the U.S., researchers estimate. Some doctors are hoping the results will persuade more \u003ca href=\"https://ww2.kqed.org/futureofyou/2017/03/09/premier-hospitals-are-promoting-unproven-alternative-therapies/\" target=\"_blank\" rel=\"noopener\">hospitals\u003c/a> to switch.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>“We’ve been sounding the alarm for 20 years” about possible harms from saline, said Dr. John Kellum, a critical care specialist at the University of Pittsburgh. “It’s purely inertia” that prevents a change, he said.\u003c/p>\n\u003cp>Kellum had no role in the studies, which were discussed Tuesday at a critical care conference in San Antonio and published by the New England Journal of Medicine. Federal grants helped pay for the work.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>IVs are one of the most common things in health care. They are used to prevent dehydration, maintain blood pressure or give patients medicines or nutrients if they can’t eat.\u003c/p>\n\u003caside class=\"pullquote alignright\">'Many suppliers make both types, so switching should not be hard or expensive.'\u003c/aside>\n\u003cp>Saline — salt dissolved in water — has been the most widely used fluid in the U.S. for more than a century even as evidence has emerged that it can harm kidneys, especially when used a lot.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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And Chancellor Angela Merkel’s government scrambled to reassure drivers it would seek to prevent such drastic measures by pushing other ways to reduce urban pollution.[contextly_sidebar id=\"WnvPdvXRlAswOi6XQqYusoKOElAxl96z\"]\u003c/p>\n\u003cp>Diesel automobiles are a popular alternative to gasoline-powered ones in Germany, with about 9 million diesel cars and several million trucks, buses and other vehicles affected by the ruling.\u003c/p>\n\u003cp>Overall, 1 in 3 passenger cars in Germany, home to such automakers as Daimler, Volkswagen and BMW, are diesel-powered, though the cleanest, most modern models would probably still be allowed even if cities decided on a ban.\u003c/p>\n\u003cp>“It’s a great day for clean air in Germany,” said Juergen Resch, head of the group Environmental Action Germany, which had sued dozens of German cities for failing to meet legally binding emissions limits.[contextly_sidebar id=\"ixv05QeC7wI0qxS6YhI0xlbv3K580cSX\"]\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>While diesel cars produce less carbon dioxide and tend to get better mileage than gas-powered vehicles, they emit higher levels of nitrogen oxides, or NOx, contributing to respiratory illnesses and 6,000 deaths annually, according to government figures.\u003c/p>\n\u003cp>Two German states had appealed lower court decisions that suggested bans on particularly dirty diesel cars would be effective. Germany’s highest administrative court rejected that appeal Tuesday, effectively instructing two cities at the center of the case — Stuttgart and Duesseldorf — to consider bans as part of their clean air plans.\u003c/p>\n\u003cp>\u003cstrong>What Next?\u003c/strong>\u003cbr>\nWhat comes next is an open question.[contextly_sidebar id=\"rxlQDmqnXaOjqhl5Bm55i2hHKgjTqUmc\"]\u003c/p>\n\u003cp>It’s not clear whether cities will actually move to ban diesels. And if they do so, it remains to be seen whether automakers will be forced to upgrade exhaust and software systems or buy back vehicles; if the government will offer consumers incentives; or if owners will be left on their own, forced to bear the costs.\u003c/p>\n\u003cp>The Leipzig-based administrative court said cities won’t be required to compensate drivers for being unable to use their diesel cars.\u003c/p>\n\u003cp>Speaking on behalf of automakers, Matthias Wissmann, president of the German Association of the Automotive Industry, stressed that the government could ease the uncertainty by not leaving it to cities to decide on a case-by-case basis.\u003c/p>\n\u003cp>“We hope it comes to sensible national regulations,” he said.\u003c/p>\n\u003cp>European cities considering diesel bans like Copenhagen and Paris will be watching how the situation plays out in Germany as they make their own decisions.\u003c/p>\n\u003cp>Jeff Schuster, an analyst with the consulting firm LMC Automotive near Detroit, said diesel bans could spread to other polluted European cities. 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"content": "\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe width=\"581\" height=\"326\" src=\"https://www.youtube.com/embed/yiglpsqv5ik\" frameborder=\"0\" allow=\"autoplay; encrypted-media\" scrolling=\"yes\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003cp>Ten years ago at my pediatric clinic in San Francisco, teachers, social workers and parents were bringing me child after child with concerns of ADHD.\u003c/p>\n\u003cp>As I examined my patients, I noticed that the highest rate of behavioral problems was occurring in the kids whose parents had drug addictions or mental illness, or those who were subject to violence at home.\u003c/p>\n\u003cp>When I dug into the science, what I found was that for most of these kids, the problem wasn’t run of the mill ADHD. For most of my kids the real problem is what the American Academy of Pediatrics now recognizes as “toxic stress.”[contextly_sidebar id=\"PYT3p5XM48uhTDQbk48cJ0IOP5aQaQuB\"]\u003c/p>\n\u003cp>Toxic stress affects white kids, black and brown kids, rich, poor, urban, rural … it can affect anyone and it can happen anywhere.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Ultimately, it all boils down to our flight-or-fight response – what happens in our bodies when we experience something scary. But, when activated too often – like with repeated abuse, neglect or parental addiction – it can change the structure and function of children’s developing brains.\u003c/p>\n\u003caside class=\"pullquote alignright\">'Only 4 percent of pediatricians in the U.S. are screening for toxic stress.'\u003c/aside>\n\u003cp>It can affect hormones, the immune system, even the way DNA is read and transcribed. And it dramatically increases the risk of both behavioral and health problems in childhood and in adulthood.\u003c/p>\n\u003cp>But right now, only 4 percent of pediatricians in the U.S. are screening for toxic stress. Most haven’t received any training on how to identify kids who are at risk.\u003c/p>\n\u003cp>This has to change.\u003c/p>\n\u003cp>Too many children with behavioral symptoms of toxic stress are being labeled with ADHD and given stimulants without any identification of the root cause. Many kids show no behavioral symptoms at all. Yet they are still more than twice as likely to go on to develop asthma, autoimmune disease, heart disease and cancer – and their life expectancy can be cut short by decades.[contextly_sidebar id=\"XCU75OyFv9SQgCGmJSKjDF77OmW3l8Yr\"]\u003c/p>\n\u003cp>More than 34 million American children have had at least one adverse childhood experience like abuse or neglect — we need every medical professional in this country to be equipped with the right tools for universal screening.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>When identified early, doctors, educators and caregivers can help reverse the biological effects of childhood trauma. Together, we can give every child a shot at a healthy life.\u003c/p>\n\n",
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}
},
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"id": "bbc-world-service",
"title": "BBC World Service",
"info": "The day's top stories from BBC News compiled twice daily in the week, once at weekends.",
"airtime": "MON-FRI 9pm-10pm, TUE-FRI 1am-2am",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/BBC-World-Service-Podcast-Tile-360x360-1.jpg",
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"meta": {
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},
"link": "/radio/program/bbc-world-service",
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"rss": "https://podcasts.files.bbci.co.uk/p02nq0gn.rss"
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},
"californiareport": {
"id": "californiareport",
"title": "The California Report",
"tagline": "California, day by day",
"info": "KQED’s statewide radio news program providing daily coverage of issues, trends and public policy decisions.",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/The-California-Report-Podcast-Tile-703x703-1.jpg",
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"officialWebsiteLink": "/californiareport",
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"source": "kqed",
"order": 8
},
"link": "/californiareport",
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}
},
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"id": "californiareportmagazine",
"title": "The California Report Magazine",
"tagline": "Your state, your stories",
"info": "Every week, The California Report Magazine takes you on a road trip for the ears: to visit the places and meet the people who make California unique. The in-depth storytelling podcast from the California Report.",
"airtime": "FRI 4:30pm-5pm, 6:30pm-7pm, 11pm-11:30pm",
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"order": 10
},
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM3NjkwNjk1OTAz",
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},
"city-arts": {
"id": "city-arts",
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"info": "A one-hour radio program to hear celebrated writers, artists and thinkers address contemporary ideas and values, often discussing the creative process. Please note: tapes or transcripts are not available",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/05/cityartsandlecture-300x300.jpg",
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"airtime": "SUN 1pm-2pm, TUE 10pm, WED 1am",
"meta": {
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"source": "City Arts & Lectures"
},
"link": "https://www.cityarts.net",
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"rss": "https://www.cityarts.net/feed/"
}
},
"closealltabs": {
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"order": 1
},
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"title": "Code Switch / Life Kit",
"info": "\u003cem>Code Switch\u003c/em>, which listeners will hear in the first part of the hour, has fearless and much-needed conversations about race. Hosted by journalists of color, the show tackles the subject of race head-on, exploring how it impacts every part of society — from politics and pop culture to history, sports and more.\u003cbr />\u003cbr />\u003cem>Life Kit\u003c/em>, which will be in the second part of the hour, guides you through spaces and feelings no one prepares you for — from finances to mental health, from workplace microaggressions to imposter syndrome, from relationships to parenting. The show features experts with real world experience and shares their knowledge. Because everyone needs a little help being human.\u003cbr />\u003cbr />\u003ca href=\"https://www.npr.org/podcasts/510312/codeswitch\">\u003cem>Code Switch\u003c/em> offical site and podcast\u003c/a>\u003cbr />\u003ca href=\"https://www.npr.org/lifekit\">\u003cem>Life Kit\u003c/em> offical site and podcast\u003c/a>\u003cbr />",
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"meta": {
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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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"meta": {
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"source": "Commonwealth Club of California"
},
"link": "/radio/program/commonwealth-club",
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"google": "https://podcasts.google.com/feed/aHR0cDovL3d3dy5jb21tb253ZWFsdGhjbHViLm9yZy9hdWRpby9wb2RjYXN0L3dlZWtseS54bWw",
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"id": "forum",
"title": "Forum",
"tagline": "The conversation starts here",
"info": "KQED’s live call-in program discussing local, state, national and international issues, as well as in-depth interviews.",
"airtime": "MON-FRI 9am-11am, 10pm-11pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Forum-Podcast-Tile-703x703-1.jpg",
"imageAlt": "KQED Forum with Mina Kim and Alexis Madrigal",
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"source": "kqed",
"order": 9
},
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM5NTU3MzgxNjMz",
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"freakonomics-radio": {
"id": "freakonomics-radio",
"title": "Freakonomics Radio",
"info": "Freakonomics Radio is a one-hour award-winning podcast and public-radio project hosted by Stephen Dubner, with co-author Steve Levitt as a regular guest. It is produced in partnership with WNYC.",
"imageSrc": "https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/05/freakonomicsRadio.png",
"officialWebsiteLink": "http://freakonomics.com/",
"airtime": "SUN 1am-2am, SAT 3pm-4pm",
"meta": {
"site": "radio",
"source": "WNYC"
},
"link": "/radio/program/freakonomics-radio",
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"apple": "https://itunes.apple.com/us/podcast/freakonomics-radio/id354668519",
"tuneIn": "https://tunein.com/podcasts/WNYC-Podcasts/Freakonomics-Radio-p272293/",
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},
"fresh-air": {
"id": "fresh-air",
"title": "Fresh Air",
"info": "Hosted by Terry Gross, \u003cem>Fresh Air from WHYY\u003c/em> is the Peabody Award-winning weekday magazine of contemporary arts and issues. One of public radio's most popular programs, Fresh Air features intimate conversations with today's biggest luminaries.",
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"apple": "https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=214089682&at=11l79Y&ct=nprdirectory",
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"info": "A live production of NPR and WBUR Boston, in collaboration with stations across the country, Here & Now reflects the fluid world of news as it's happening in the middle of the day, with timely, in-depth news, interviews and conversation. Hosted by Robin Young, Jeremy Hobson and Tonya Mosley.",
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"hidden-brain": {
"id": "hidden-brain",
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"info": "Shankar Vedantam uses science and storytelling to reveal the unconscious patterns that drive human behavior, shape our choices and direct our relationships.",
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"airtime": "SUN 7pm-8pm",
"meta": {
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"source": "NPR"
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"link": "/radio/program/hidden-brain",
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"how-i-built-this": {
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"title": "How I Built This with Guy Raz",
"info": "Guy Raz dives into the stories behind some of the world's best known companies. How I Built This weaves a narrative journey about innovators, entrepreneurs and idealists—and the movements they built.",
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"airtime": "SUN 7:30pm-8pm",
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"link": "/radio/program/how-i-built-this",
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"hyphenacion": {
"id": "hyphenacion",
"title": "Hyphenación",
"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. ",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2025/03/Hyphenacion_FinalAssets_PodcastTile.png",
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"order": 15
},
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},
"jerrybrown": {
"id": "jerrybrown",
"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. ",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/The-Political-Mind-of-Jerry-Brown-Podcast-Tile-703x703-1.jpg",
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"order": 18
},
"link": "/podcasts/jerrybrown",
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},
"latino-usa": {
"id": "latino-usa",
"title": "Latino USA",
"airtime": "MON 1am-2am, SUN 6pm-7pm",
"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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"source": "npr"
},
"link": "/radio/program/latino-usa",
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"apple": "https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=79681317&at=11l79Y&ct=nprdirectory",
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"rss": "https://feeds.npr.org/510016/podcast.xml"
}
},
"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": {
"site": "news",
"source": "American Public Media"
},
"link": "/radio/program/marketplace",
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"rss": "https://feeds.publicradio.org/public_feeds/marketplace-pm/rss/rss"
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},
"masters-of-scale": {
"id": "masters-of-scale",
"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"
},
"link": "/radio/program/masters-of-scale",
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"apple": "http://mastersofscale.app.link/",
"rss": "https://rss.art19.com/masters-of-scale"
}
},
"mindshift": {
"id": "mindshift",
"title": "MindShift",
"tagline": "A podcast about the future of learning and how we raise our kids",
"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>",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Mindshift-Podcast-Tile-703x703-1.jpg",
"imageAlt": "KQED MindShift: How We Will Learn",
"officialWebsiteLink": "/mindshift/",
"meta": {
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"source": "kqed",
"order": 12
},
"link": "/podcasts/mindshift",
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM1NzY0NjAwNDI5",
"npr": "https://www.npr.org/podcasts/464615685/mind-shift-podcast",
"stitcher": "https://www.stitcher.com/podcast/kqed/stories-teachers-share",
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}
},
"morning-edition": {
"id": "morning-edition",
"title": "Morning Edition",
"info": "\u003cem>Morning Edition\u003c/em> takes listeners around the country and the world with multi-faceted stories and commentaries every weekday. Hosts Steve Inskeep, David Greene and Rachel Martin bring you the latest breaking news and features to prepare you for the day.",
"airtime": "MON-FRI 3am-9am",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Morning-Edition-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.npr.org/programs/morning-edition/",
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"link": "/radio/program/morning-edition"
},
"onourwatch": {
"id": "onourwatch",
"title": "On Our Watch",
"tagline": "Deeply-reported investigative journalism",
"info": "For decades, the process for how police police themselves has been inconsistent – if not opaque. In some states, like California, these proceedings were completely hidden. After a new police transparency law unsealed scores of internal affairs files, our reporters set out to examine these cases and the shadow world of police discipline. On Our Watch brings listeners into the rooms where officers are questioned and witnesses are interrogated to find out who this system is really protecting. Is it the officers, or the public they've sworn to serve?",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/On-Our-Watch-Podcast-Tile-703x703-1.jpg",
"imageAlt": "On Our Watch from NPR and KQED",
"officialWebsiteLink": "/podcasts/onourwatch",
"meta": {
"site": "news",
"source": "kqed",
"order": 11
},
"link": "/podcasts/onourwatch",
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