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We were skeptical as well.'\u003ccite>\u003ca href=\"https://contextly.com/redirect/?id=c7RcpktiX9:446011:4068:13:::sidebar:5c1d1f75d944b5-96249117\" target=\"_blank\" rel=\"noopener\">Juul press release\u003c/a>\u003c/cite>\u003c/aside>\n\u003cp>The Marlboro maker said Thursday that it will take a 35 percent share of Juul, putting the value of the company at $38 billion, larger than Ford Motor Co., Delta Air Lines or the retail giant Target.\u003c/p>\n\u003cp>\"We are taking significant action to prepare for a future where adult smokers overwhelmingly choose non-combustible products over cigarettes,\" Altria Chairman and CEO Howard Willard said in a prepared statement.\u003c/p>\n\u003cp>E-cigarettes and other vaping devices have been sold in the U.S. since 2007 and have grown into a $6.6 billion business, and it is already intersecting with another seismic shift in the U.S. — the legalization of marijuana across the U.S.\u003c/p>\n\u003cp>The investment comes about two weeks after Altria stepped into the cannabis market with an investment of around $2 billion in Cronos Group, the Canadian medical and recreational marijuana provider.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>North American consumer spending on legal cannabis is expected to grow from $9.2 billion in 2017, to $47.3 billion by 2027, according to Arcview Market Research, a cannabis-focused investment firm.\u003c/p>\n\u003cp>Altria Group Inc. isn't the only major corporation attempting to incorporate marijuana sales.\u003c/p>\n\u003cp>[contextly_sidebar id=\"PIX3Hytk1X1Ix98885tbxQ3hOeDiaZra\"]This week Anheuser-Busch InBev, the maker of Budweiser, partnered with medical cannabis company Tilray in a $100 million deal to research cannabis-infused drinks for the Canadian market. 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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Altria, one of the world's biggest tobacco companies, is spending nearly $13 billion to buy a huge stake in the vape company Juul as cigarette use continues to decline.\u003c/p>\n\u003caside class=\"pullquote alignright\">'Today, we have been joined by an unlikely – and seemingly counterintuitive – investor in our journey. ... We understand the controversy and skepticism that comes with an affiliation and partnership with the largest tobacco company in the US. We were skeptical as well.'\u003ccite>\u003ca href=\"https://contextly.com/redirect/?id=c7RcpktiX9:446011:4068:13:::sidebar:5c1d1f75d944b5-96249117\" target=\"_blank\" rel=\"noopener\">Juul press release\u003c/a>\u003c/cite>\u003c/aside>\n\u003cp>The Marlboro maker said Thursday that it will take a 35 percent share of Juul, putting the value of the company at $38 billion, larger than Ford Motor Co., Delta Air Lines or the retail giant Target.\u003c/p>\n\u003cp>\"We are taking significant action to prepare for a future where adult smokers overwhelmingly choose non-combustible products over cigarettes,\" Altria Chairman and CEO Howard Willard said in a prepared statement.\u003c/p>\n\u003cp>E-cigarettes and other vaping devices have been sold in the U.S. since 2007 and have grown into a $6.6 billion business, and it is already intersecting with another seismic shift in the U.S. — the legalization of marijuana across the U.S.\u003c/p>\n\u003cp>The investment comes about two weeks after Altria stepped into the cannabis market with an investment of around $2 billion in Cronos Group, the Canadian medical and recreational marijuana provider.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>North American consumer spending on legal cannabis is expected to grow from $9.2 billion in 2017, to $47.3 billion by 2027, according to Arcview Market Research, a cannabis-focused investment firm.\u003c/p>\n\u003cp>Altria Group Inc. isn't the only major corporation attempting to incorporate marijuana sales.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>This week Anheuser-Busch InBev, the maker of Budweiser, partnered with medical cannabis company Tilray in a $100 million deal to research cannabis-infused drinks for the Canadian market. In August, Constellation Brands announced a $4 billion investment in another Canadian pot producer, Canopy Growth Corp., the largest to date by a major U.S. corporation in the cannabis market.\u003c/p>\n\u003cp>With nicotine-based vaping, devices heat a flavored nicotine solution into an inhalable vapor. They have been pitched to adult smokers as a less-harmful alternative to cigarettes, though there's been little research on the long-term health effects or on whether they help people quit.\u003c/p>\n\u003cp>\u003cstrong>Health Officials Worried\u003c/strong>\u003c/p>\n\u003cp>The growing popularity of e-cigarettes has alarmed a number of health officials.\u003c/p>\n\u003cp>This week, Surgeon General Jerome Adams said parents, teachers, health professionals and government officials must take \"aggressive steps\" to keep children from using e-cigarettes. Federal law bars the sale of e-cigarettes to those under 18.\u003c/p>\n\u003cp>Dr. John Maa of the American Heart Association’s Bay Area Division called the Altria acquisition a troubling development.\u003c/p>\n\u003cp>\"For over five years, the electronic cigarette advocates and proponents have touted how they have been anti-Big Tobacco,\" Maa said. \"But to see Big Tobacco and Juul join in a partnership now creates a public health nightmare.\"\u003c/p>\n\u003cp>There is a scramble in the U.S. to reverse a recent explosion in teen vaping that public health officials fear could undermine decades of declines in tobacco use.\u003c/p>\n\u003cp>An estimated 3.6 million U.S. teens are now using e-cigarettes, representing 1 in 5 high school students and 1 in 20 middle schoolers, according to the latest federal figures.\u003c/p>\n\u003cp>Juul said Thursday that it recently began to take actions intended to prevent underage vaping. The company shut down its Facebook and Instagram accounts last month and halted in-store sales of flavored pods, which were viewed by many critics as a direct play for younger users.\u003c/p>\n\u003cp>Juul also said that it's also enhancing age-verification for its online sales.\u003cbr>\nJuul Labs Inc., based in San Francisco, said it had initially hesitated to accept the investment from Altria.\u003c/p>\n\u003cp>\"But over the course of the last several months we were convinced by actions, not words, that in fact this partnership could help accelerate our success switching adult smokers,\" Juul said.\u003c/p>\n\u003cp>Juul will remain an independent company, but it gains access to Altria's massive infrastructure and reach. Namely, Altria will help Juul secure space on store shelves beside traditional cigarettes. It will also help Juul reach smokers via cigarette pack inserts and mailings.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Under the agreement, Altria's only entry into the e-cigarette market will be through Juul for at least six years.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "No Cash, No Organ Transplant: Patients Must Prove They Can Pay Enormous Bills",
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"content": "\u003cp>When Patrick Mannion heard about the Michigan woman denied a heart transplant because she couldn’t afford the anti-rejection drugs, he knew what she was up against.\u003c/p>\n\u003cfigure id=\"attachment_445781\" class=\"wp-caption alignright\" style=\"max-width: 270px\">\u003cimg class=\"wp-image-445781 size-full\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/12/transplant_costs1.jpg\" alt=\"\" width=\"270\" height=\"405\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2018/12/transplant_costs1.jpg 270w, https://ww2.kqed.org/app/uploads/sites/13/2018/12/transplant_costs1-160x240.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2018/12/transplant_costs1-240x360.jpg 240w\" sizes=\"(max-width: 270px) 100vw, 270px\">\u003cfigcaption class=\"wp-caption-text\">Patrick Mannion received a double-lung transplant in May 2017 after being diagnosed with idiopathic pulmonary fibrosis, a progressive, life-threatening lung disease. Through a transplant fundraising organization, HelpHopeLive, he has raised nearly $115,000, twice the original goal to help pay expenses that insurance didn’t cover, including copays for costly anti-rejection drugs. \u003ccite>(Courtesy of Patrick Mannion)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>On social media posts of a letter that \u003ca href=\"https://twitter.com/Ocasio2018/status/1066351594843844608\">went viral\u003c/a> last month, Hedda Martin, 60, of Grand Rapids, was informed that she was not a candidate for a heart transplant because of her finances. It recommended “a fundraising effort of $10,000.”\u003c/p>\n\u003cp>Patrick Mannion received a double-lung transplant in May 2017 after being diagnosed with idiopathic pulmonary fibrosis, a progressive, life-threatening lung disease. Through a transplant fundraising organization, HelpHopeLive, he has raised nearly $115,000, twice the original goal to help pay expenses that insurance didn’t cover, including copays for costly anti-rejection drugs.\u003c/p>\n\u003cp>Two years ago, Mannion, of Oxford, Conn., learned he needed a double-lung transplant after contracting idiopathic pulmonary fibrosis, a progressive, fatal disease. From the start, hospital officials told him to set aside $30,000 in a separate bank account to cover the costs.\u003c/p>\n\u003cp>Mannion, 59, who received his new lungs in May 2017, reflected: “Here you are, you need a heart — that’s a tough road for any person,” he said. “And then for that person to have to be a fundraiser?”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Martin’s case sparked outrage over a transplant system that links access to a lifesaving treatment to finances. But requiring proof of payment for organ transplants and post-operative care is common, transplant experts say.\u003c/p>\n\u003cp>“It happens every day,” said Arthur Caplan, a bioethicist at the New York University Langone Medical Center. “You get what I call a ‘wallet biopsy.’”\u003c/p>\n\u003cp>Virtually all of the nation’s more than 250 transplant centers, which refer patients to a \u003ca href=\"https://unos.org/\">single national registry\u003c/a>, require patients to verify how they will cover bills that \u003ca href=\"http://www.milliman.com/uploadedFiles/insight/2017/2017-Transplant-Report.pdf\">can total\u003c/a> $400,000 for a kidney transplant or $1.3 million for a heart, plus monthly costs that \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4520417/\">average $2,500\u003c/a> for anti-rejection drugs that must be taken for life, Caplan said. Coverage for the drugs is more scattershot than for the operation itself, even though transplanted organs will not last without the medicine.\u003c/p>\n\u003cp>For Martin, the social media attention helped. Within days, she had raised more than $30,000 through a GoFundMe account, and officials at Spectrum Health confirmed she was added to the transplant waiting list.\u003c/p>\n\u003cp>\u003ca href=\"https://newsroom.spectrumhealth.org/fyi/\">In a statement\u003c/a>, officials there defended their position, saying that financial resources, along with physical health and social well-being, are among crucial factors to consider.\u003c/p>\n\u003cp>“The ability to pay for post-transplant care and life-long immunosuppression medications is essential to increase the likelihood of a successful transplant and longevity of the transplant recipient,” officials wrote.\u003c/p>\n\u003cp>In the most pragmatic light, that makes sense. More than 114,000 people are waiting for organs in the U.S. and \u003ca href=\"https://optn.transplant.hrsa.gov/data/view-data-reports/national-data/\">fewer than 35,000\u003c/a> organs were transplanted last year, according to the United Network for Organ Sharing, or UNOS. Transplant centers want to make sure donated organs aren’t wasted.\u003c/p>\n\u003cp>“If you’re receiving a lifesaving organ, you have to be able to afford it,” said Kelly Green, executive director of HelpHopeLive, the Pennsylvania organization that has helped Mannion.\u003c/p>\n\u003cp>His friends and family have rallied, flocking to fundraisers that ranged from hair salon cut-a-thons to golf tournaments, raising nearly $115,000 so far for transplant-related care.\u003c/p>\n\u003cp>Allowing financial factors to determine who gets a spot on the waiting list strikes many as unfair, Caplan said.\u003c/p>\n\u003cp>“It may be a source of anger, because when we’re looking for organs, we don’t like to think that they go to the rich,” he said. “In reality, it’s largely true.”\u003c/p>\n\u003cp>Nearly half of the patients waiting for organs in the U.S. have private health insurance, UNOS data show. The rest are largely covered by the government, including Medicaid, the federal program for the disabled and poor, and Medicare.\u003c/p>\n\u003cp>Medicare also \u003ca href=\"https://www.medicareinteractive.org/get-answers/medicare-health-coverage-options/medicare-and-end-stage-renal-disease-esrd/esrd-medicare-basics\">covers\u003c/a> kidney transplants for all patients with end-stage renal disease. But, there’s a catch. While the cost of a kidney transplant is covered for people younger than 65, the program halts payment for anti-rejection drugs after 36 months. That leaves many patients facing sudden bills, said Tonya Saffer, vice president of health policy for the National Kidney Foundation.\u003c/p>\n\u003cp>Legislation that would extend Medicare coverage for those drugs has been stalled for years.\u003c/p>\n\u003cp>For Alex Reed, 28, of Pittsburgh, who received a kidney transplant three years ago, coverage for the dozen medications he takes ended Nov. 30. His mother, Bobbie Reed, 62, has been scrambling for a solution.\u003c/p>\n\u003cp>“We can’t pick up those costs,” said Reed, whose family runs an independent insurance firm. “It would be at least $3,000 or $4,000 a month.”\u003c/p>\n\u003cp>Prices for the drugs, which include powerful medications that prevent the body from rejecting the organs, have been falling in recent years as more generic versions have come to market, Saffer said.\u003c/p>\n\u003cp>But “the cost can still be hard on the budget,” she added.\u003c/p>\n\u003cp>It’s been a struggle for decades to get transplants and associated expenses covered by insurance, said Dr. Maryl Johnson, a heart failure and transplant cardiologist at the University of Wisconsin School of Medicine and Public Health.\u003c/p>\n\u003cp>“It’s unusual that there’s 100 percent coverage for everything,” said Johnson, a leader in the field for 30 years.\u003c/p>\n\u003cp>GoFundMe efforts have become a popular way for sick people to raise money. About a third of the campaigns on the site target medical needs, the company said.\u003c/p>\n\u003cp>But when patients need to raise money, they should use fundraising organizations specifically aimed at those costs, transplant experts say, including \u003ca href=\"https://helphopelive.org/\">HelpHopeLive\u003c/a>, the \u003ca href=\"https://transplants.org/\">National Foundation for Transplants\u003c/a> and the \u003ca href=\"https://www.americantransplantfoundation.org/programs/pap/\">American Transplant Foundation.\u003c/a>\u003c/p>\n\u003cp>There’s no guarantee funds generated through such general sites such as GoFundMe will be used for the intended purpose. In addition, the money likely will be regarded as taxable income that could jeopardize other resources, said Michelle Gilchrist, president and chief executive for the National Foundation for Transplants.\u003c/p>\n\u003cp>Her group, which helps about 4,000 patients a year, has raised $82 million for transplant costs since 1983, she said. Such efforts usually involve a huge public-relations push. Still, 20 percent of the patients who turn to NFT each year fail to raise the needed funds, Gilchrist said.\u003c/p>\n\u003cp>In those cases, the patients don’t get the organs they need. “My concern is that health care should be accessible for everyone,” she said, adding: “Ten thousand dollars is a lot to someone who doesn’t have it.”\u003c/p>\n\u003cp>Every transplant center in the U.S. has a team of social workers and financial coordinators who help patients negotiate the gaps in their care. Lara Tushla, a licensed clinical social worker with the Rush University transplant program in Chicago, monitors about 2,000 transplant patients. She urges potential patients to think realistically about the costs they’ll face.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“The pharmacy will not hand over a bag full of pills without a bag full of money,” she said. “They will not bill you. They want the copays before they give you the medication.”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>When Patrick Mannion heard about the Michigan woman denied a heart transplant because she couldn’t afford the anti-rejection drugs, he knew what she was up against.\u003c/p>\n\u003cfigure id=\"attachment_445781\" class=\"wp-caption alignright\" style=\"max-width: 270px\">\u003cimg class=\"wp-image-445781 size-full\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/12/transplant_costs1.jpg\" alt=\"\" width=\"270\" height=\"405\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2018/12/transplant_costs1.jpg 270w, https://ww2.kqed.org/app/uploads/sites/13/2018/12/transplant_costs1-160x240.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2018/12/transplant_costs1-240x360.jpg 240w\" sizes=\"(max-width: 270px) 100vw, 270px\">\u003cfigcaption class=\"wp-caption-text\">Patrick Mannion received a double-lung transplant in May 2017 after being diagnosed with idiopathic pulmonary fibrosis, a progressive, life-threatening lung disease. Through a transplant fundraising organization, HelpHopeLive, he has raised nearly $115,000, twice the original goal to help pay expenses that insurance didn’t cover, including copays for costly anti-rejection drugs. \u003ccite>(Courtesy of Patrick Mannion)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>On social media posts of a letter that \u003ca href=\"https://twitter.com/Ocasio2018/status/1066351594843844608\">went viral\u003c/a> last month, Hedda Martin, 60, of Grand Rapids, was informed that she was not a candidate for a heart transplant because of her finances. It recommended “a fundraising effort of $10,000.”\u003c/p>\n\u003cp>Patrick Mannion received a double-lung transplant in May 2017 after being diagnosed with idiopathic pulmonary fibrosis, a progressive, life-threatening lung disease. Through a transplant fundraising organization, HelpHopeLive, he has raised nearly $115,000, twice the original goal to help pay expenses that insurance didn’t cover, including copays for costly anti-rejection drugs.\u003c/p>\n\u003cp>Two years ago, Mannion, of Oxford, Conn., learned he needed a double-lung transplant after contracting idiopathic pulmonary fibrosis, a progressive, fatal disease. From the start, hospital officials told him to set aside $30,000 in a separate bank account to cover the costs.\u003c/p>\n\u003cp>Mannion, 59, who received his new lungs in May 2017, reflected: “Here you are, you need a heart — that’s a tough road for any person,” he said. “And then for that person to have to be a fundraiser?”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Martin’s case sparked outrage over a transplant system that links access to a lifesaving treatment to finances. But requiring proof of payment for organ transplants and post-operative care is common, transplant experts say.\u003c/p>\n\u003cp>“It happens every day,” said Arthur Caplan, a bioethicist at the New York University Langone Medical Center. “You get what I call a ‘wallet biopsy.’”\u003c/p>\n\u003cp>Virtually all of the nation’s more than 250 transplant centers, which refer patients to a \u003ca href=\"https://unos.org/\">single national registry\u003c/a>, require patients to verify how they will cover bills that \u003ca href=\"http://www.milliman.com/uploadedFiles/insight/2017/2017-Transplant-Report.pdf\">can total\u003c/a> $400,000 for a kidney transplant or $1.3 million for a heart, plus monthly costs that \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4520417/\">average $2,500\u003c/a> for anti-rejection drugs that must be taken for life, Caplan said. Coverage for the drugs is more scattershot than for the operation itself, even though transplanted organs will not last without the medicine.\u003c/p>\n\u003cp>For Martin, the social media attention helped. Within days, she had raised more than $30,000 through a GoFundMe account, and officials at Spectrum Health confirmed she was added to the transplant waiting list.\u003c/p>\n\u003cp>\u003ca href=\"https://newsroom.spectrumhealth.org/fyi/\">In a statement\u003c/a>, officials there defended their position, saying that financial resources, along with physical health and social well-being, are among crucial factors to consider.\u003c/p>\n\u003cp>“The ability to pay for post-transplant care and life-long immunosuppression medications is essential to increase the likelihood of a successful transplant and longevity of the transplant recipient,” officials wrote.\u003c/p>\n\u003cp>In the most pragmatic light, that makes sense. More than 114,000 people are waiting for organs in the U.S. and \u003ca href=\"https://optn.transplant.hrsa.gov/data/view-data-reports/national-data/\">fewer than 35,000\u003c/a> organs were transplanted last year, according to the United Network for Organ Sharing, or UNOS. Transplant centers want to make sure donated organs aren’t wasted.\u003c/p>\n\u003cp>“If you’re receiving a lifesaving organ, you have to be able to afford it,” said Kelly Green, executive director of HelpHopeLive, the Pennsylvania organization that has helped Mannion.\u003c/p>\n\u003cp>His friends and family have rallied, flocking to fundraisers that ranged from hair salon cut-a-thons to golf tournaments, raising nearly $115,000 so far for transplant-related care.\u003c/p>\n\u003cp>Allowing financial factors to determine who gets a spot on the waiting list strikes many as unfair, Caplan said.\u003c/p>\n\u003cp>“It may be a source of anger, because when we’re looking for organs, we don’t like to think that they go to the rich,” he said. “In reality, it’s largely true.”\u003c/p>\n\u003cp>Nearly half of the patients waiting for organs in the U.S. have private health insurance, UNOS data show. The rest are largely covered by the government, including Medicaid, the federal program for the disabled and poor, and Medicare.\u003c/p>\n\u003cp>Medicare also \u003ca href=\"https://www.medicareinteractive.org/get-answers/medicare-health-coverage-options/medicare-and-end-stage-renal-disease-esrd/esrd-medicare-basics\">covers\u003c/a> kidney transplants for all patients with end-stage renal disease. But, there’s a catch. While the cost of a kidney transplant is covered for people younger than 65, the program halts payment for anti-rejection drugs after 36 months. That leaves many patients facing sudden bills, said Tonya Saffer, vice president of health policy for the National Kidney Foundation.\u003c/p>\n\u003cp>Legislation that would extend Medicare coverage for those drugs has been stalled for years.\u003c/p>\n\u003cp>For Alex Reed, 28, of Pittsburgh, who received a kidney transplant three years ago, coverage for the dozen medications he takes ended Nov. 30. His mother, Bobbie Reed, 62, has been scrambling for a solution.\u003c/p>\n\u003cp>“We can’t pick up those costs,” said Reed, whose family runs an independent insurance firm. “It would be at least $3,000 or $4,000 a month.”\u003c/p>\n\u003cp>Prices for the drugs, which include powerful medications that prevent the body from rejecting the organs, have been falling in recent years as more generic versions have come to market, Saffer said.\u003c/p>\n\u003cp>But “the cost can still be hard on the budget,” she added.\u003c/p>\n\u003cp>It’s been a struggle for decades to get transplants and associated expenses covered by insurance, said Dr. Maryl Johnson, a heart failure and transplant cardiologist at the University of Wisconsin School of Medicine and Public Health.\u003c/p>\n\u003cp>“It’s unusual that there’s 100 percent coverage for everything,” said Johnson, a leader in the field for 30 years.\u003c/p>\n\u003cp>GoFundMe efforts have become a popular way for sick people to raise money. About a third of the campaigns on the site target medical needs, the company said.\u003c/p>\n\u003cp>But when patients need to raise money, they should use fundraising organizations specifically aimed at those costs, transplant experts say, including \u003ca href=\"https://helphopelive.org/\">HelpHopeLive\u003c/a>, the \u003ca href=\"https://transplants.org/\">National Foundation for Transplants\u003c/a> and the \u003ca href=\"https://www.americantransplantfoundation.org/programs/pap/\">American Transplant Foundation.\u003c/a>\u003c/p>\n\u003cp>There’s no guarantee funds generated through such general sites such as GoFundMe will be used for the intended purpose. In addition, the money likely will be regarded as taxable income that could jeopardize other resources, said Michelle Gilchrist, president and chief executive for the National Foundation for Transplants.\u003c/p>\n\u003cp>Her group, which helps about 4,000 patients a year, has raised $82 million for transplant costs since 1983, she said. Such efforts usually involve a huge public-relations push. Still, 20 percent of the patients who turn to NFT each year fail to raise the needed funds, Gilchrist said.\u003c/p>\n\u003cp>In those cases, the patients don’t get the organs they need. “My concern is that health care should be accessible for everyone,” she said, adding: “Ten thousand dollars is a lot to someone who doesn’t have it.”\u003c/p>\n\u003cp>Every transplant center in the U.S. has a team of social workers and financial coordinators who help patients negotiate the gaps in their care. Lara Tushla, a licensed clinical social worker with the Rush University transplant program in Chicago, monitors about 2,000 transplant patients. She urges potential patients to think realistically about the costs they’ll face.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“The pharmacy will not hand over a bag full of pills without a bag full of money,” she said. “They will not bill you. They want the copays before they give you the medication.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "UCSF Study Probes Long-Term Effects of Head Trauma -- and Not Just in Football",
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"content": "\u003cp>Traumatic brain injury has long been associated with combat and, more recently, contact sports like football. Now head injuries among \"the rest of us\" are getting a long look from researchers, too.\u003c/p>\n\u003caside class=\"alignright\">\u003ca href=\"https://www.kqed.org/futureofyou/441252/proposed-california-ban-on-kids-football-sacked-early-and-hard\" target=\"_blank\" rel=\"noopener\">California Ban on Kids Football Sacked Early\u003c/a>\u003c/aside>\n\u003cp>\"They're actually very, very common,\" said Geoff Manly, who chairs the Dept. of Neurosurgery at UCSF and is leading the study. He says nearly 3 million people with head injuries turn up at U.S. emergency rooms every year, caused by everything from traffic accidents to falling down stairs to being thrown off a bicycle. Manley says the numbers are increasing yearly \"on a scale that dwarfs\" the problem in sports alone.\u003c/p>\n\u003cp>\"Historically, we've sort of treated this as an event, rather than a process,\" he said. \"And now we see that many people are suffering long-term consequences of these injuries.\"\u003c/p>\n\u003cp>The National Football League is putting up nearly $3.5 million to fund the long-term study of \"community-acquired\" concussions and the long-range effects they have on some patients, such as depression, dementia, Parkinson's and Alzheimer's.\u003c/p>\n\u003cp>The study will track patients from the time they present for emergency care to as long as seven years beyond, to try to determine why some patients are able to shake off head trauma, while others are plagued with long-term and sometimes fatal consequences.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"It's probably not just by chance that there's a strong association between prior history of TBI and the development of some of these disorders,\" says Manley. \"We're trying to figure out what those risk factors are and hoping that in identifying these risk factors, we can find a mechanism.\"\u003c/p>\n\u003cp>With funding from the NFL's \u003ca href=\"https://protect-us.mimecast.com/s/h_yFCyPmRxsr24VOiZjhit?domain=email.prnewswire.com\">Play Smart - Play Safe\u003c/a> initiative, Manley says, the study will track about 2,700 patients whose data has \u003ca href=\"https://protect-us.mimecast.com/s/5K4lCzpn0ysMwrVWUXH4uq?domain=email.prnewswire.com\" target=\"_blank\" rel=\"noopener\">already been gathered\u003c/a> by major trauma centers around the country. The research team will collect data on brain imaging, blood-based biomarkers and outcome assessments of psychological health, physical recovery and functional status.\u003c/p>\n\u003cp>The results could also provide insights into a condition known as chronic traumatic encephalopathy, which has turned up in alarming numbers of professional football players and is blamed for the tragic deaths of former stars like Pittsburgh Steelers center \"Iron\" Mike Webster and San Diego Chargers linebacker Junior Seau.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>In the wake of these high-profile cases and \u003ca href=\"https://www.nytimes.com/2018/10/05/sports/junior-seau-suit-nfl.html\" target=\"_blank\" rel=\"noopener\">associated litigation\u003c/a>, the NFL has set aside $40 million in funding for medical research, primarily dedicated to neuroscience.\u003c/p>\n\n",
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"excerpt": "Long-term consequences of concussion aren't just a problem for combat veterans and football players. A new study seeks to find the reasons why.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Traumatic brain injury has long been associated with combat and, more recently, contact sports like football. Now head injuries among \"the rest of us\" are getting a long look from researchers, too.\u003c/p>\n\u003caside class=\"alignright\">\u003ca href=\"https://www.kqed.org/futureofyou/441252/proposed-california-ban-on-kids-football-sacked-early-and-hard\" target=\"_blank\" rel=\"noopener\">California Ban on Kids Football Sacked Early\u003c/a>\u003c/aside>\n\u003cp>\"They're actually very, very common,\" said Geoff Manly, who chairs the Dept. of Neurosurgery at UCSF and is leading the study. He says nearly 3 million people with head injuries turn up at U.S. emergency rooms every year, caused by everything from traffic accidents to falling down stairs to being thrown off a bicycle. Manley says the numbers are increasing yearly \"on a scale that dwarfs\" the problem in sports alone.\u003c/p>\n\u003cp>\"Historically, we've sort of treated this as an event, rather than a process,\" he said. \"And now we see that many people are suffering long-term consequences of these injuries.\"\u003c/p>\n\u003cp>The National Football League is putting up nearly $3.5 million to fund the long-term study of \"community-acquired\" concussions and the long-range effects they have on some patients, such as depression, dementia, Parkinson's and Alzheimer's.\u003c/p>\n\u003cp>The study will track patients from the time they present for emergency care to as long as seven years beyond, to try to determine why some patients are able to shake off head trauma, while others are plagued with long-term and sometimes fatal consequences.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"It's probably not just by chance that there's a strong association between prior history of TBI and the development of some of these disorders,\" says Manley. \"We're trying to figure out what those risk factors are and hoping that in identifying these risk factors, we can find a mechanism.\"\u003c/p>\n\u003cp>With funding from the NFL's \u003ca href=\"https://protect-us.mimecast.com/s/h_yFCyPmRxsr24VOiZjhit?domain=email.prnewswire.com\">Play Smart - Play Safe\u003c/a> initiative, Manley says, the study will track about 2,700 patients whose data has \u003ca href=\"https://protect-us.mimecast.com/s/5K4lCzpn0ysMwrVWUXH4uq?domain=email.prnewswire.com\" target=\"_blank\" rel=\"noopener\">already been gathered\u003c/a> by major trauma centers around the country. The research team will collect data on brain imaging, blood-based biomarkers and outcome assessments of psychological health, physical recovery and functional status.\u003c/p>\n\u003cp>The results could also provide insights into a condition known as chronic traumatic encephalopathy, which has turned up in alarming numbers of professional football players and is blamed for the tragic deaths of former stars like Pittsburgh Steelers center \"Iron\" Mike Webster and San Diego Chargers linebacker Junior Seau.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>In the wake of these high-profile cases and \u003ca href=\"https://www.nytimes.com/2018/10/05/sports/junior-seau-suit-nfl.html\" target=\"_blank\" rel=\"noopener\">associated litigation\u003c/a>, the NFL has set aside $40 million in funding for medical research, primarily dedicated to neuroscience.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "E-Cigarette Health Risks: What We Know, What We Don't",
"title": "E-Cigarette Health Risks: What We Know, What We Don't",
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"content": "\u003cp>There are two ways e-cigarettes can affect your health. One is direct, from the product itself. The other stems from the fact that teenagers who vape are more likely to become addicted to nicotine and to try regular cigarettes.\u003c/p>\n\u003cp>Food and Drug Administration Commissioner Scott Gottlieb had this in mind last November when he called for tightening rules governing the sale of most flavored versions of electronic cigarettes \"I will not allow a generation of children to become addicted to nicotine through e-cigarettes,\" Gottlieb said in a statement.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">As for direct harm, while there are reams of studies on the negative effects of cigarette smoke, far fewer exist on electronic cigarettes. \u003c/span>Preliminary\u003cspan style=\"font-weight: 400\"> research does suggest e-cigarettes may harm the lungs and heart. It should be noted, however, that \u003cem>h\u003c/em>\u003c/span>\u003cspan style=\"font-weight: 400\">\u003cem>uman\u003c/em> clinical studies testing vaping products are extremely limited; most of what we know comes from research on cell cultures and animals. Plus it is difficult to study the effects of e-cigarettes when there is such a wide variety of rapidly changing delivery devices.\u003c/span>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Vaping products hit the market about 10 to 15 years ago. Researchers have followed smokers for decades to confirm flammable cigarettes are deadly because it can take at least ten years for long-term health effects like emphysema or cancer to develop. Few people have been vaping that long. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“There’s no question that vaping is much safer than smoking,\" says Michael Siegel, \u003c/span>\u003cspan style=\"font-weight: 400\">an epidemiologist at Boston University. \"\u003c/span>\u003cspan style=\"font-weight: 400\">But we're not at a level where we can say that there are no chronic health risks potentially associated with long-term vaping.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">So, here's what we know to date:\u003c/span>\u003c/p>\n\u003cp>\u003cb>Cardiovascular Disease\u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">E-cigarettes expose users to ultrafine particles and other toxins that may \u003c/span>\u003ca href=\"https://jamanetwork.com/journals/jamacardiology/article-abstract/2600160\" target=\"_blank\" rel=\"noopener\">\u003cspan style=\"font-weight: 400\">increase cardiovascular disease risks\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">. The tiny particles are much finer than a human hair and can penetrate deep into the lungs, which can \u003c/span>\u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/19720932\" target=\"_blank\" rel=\"noopener\">\u003cspan style=\"font-weight: 400\">trigger an inflammatory response\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">. \u003c/span>\u003cspan style=\"font-weight: 400\"> A \u003c/span>\u003ca href=\"https://www.ajpmonline.org/article/S0749-3797(18)31871-3/fulltext\" target=\"_blank\" rel=\"noopener\">\u003cspan style=\"font-weight: 400\">study\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> published in the \u003c/span>\u003ci>\u003cspan style=\"font-weight: 400\">American Journal of Preventive Medicine\u003c/span>\u003c/i>\u003cspan style=\"font-weight: 400\"> last summer concluded that both smoking and vaping daily are associated with a higher risk of heart attack and that using both products compounds those risks.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Nicotine may also aggravate cardiovascular disease, but how it does is still debated.\u003c/span>\u003c/p>\n\u003cp>\u003cb>Lungs\u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">There is \u003c/span>\u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/28522559\" target=\"_blank\" rel=\"noopener\">\u003cspan style=\"font-weight: 400\">evidence\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> showing that exposure to e-cigarettes negatively impacts lung function. Repeated exposure to acrolein, which is produced by heating the base products in e-cigs (propylene glycol and glycerin), can \u003c/span>\u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/22758635\" target=\"_blank\" rel=\"noopener\">\u003cspan style=\"font-weight: 400\">cause chronic pulmonary inflammation\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">.\u003c/span>\u003c/p>\n\u003cp>\u003ca href=\"https://profiles.ucsf.edu/jeffrey.gotts\" target=\"_blank\" rel=\"noopener\">\u003cspan style=\"font-weight: 400\">Jeffrey Gotts\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">, a pulmonologist at UCSF, summarized the lung disease risks succinctly in an email. “Is e-cigarette aerosol less toxic than cigarette smoke? Probably. Is e-cigarette aerosol as safe as water vapor, as many of the companies would have you believe? Definitely not.” \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Gotts says \u003c/span>\u003cspan style=\"font-weight: 400\">s\u003c/span>\u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/29481290\" target=\"_blank\" rel=\"noopener\">\u003cspan style=\"font-weight: 400\">tudies\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> of human airway epithelial cells show that e-cigarettes damage cells and increase oxidative stress, and studies of immune cells suggest e-cigarettes reduce immunity to bacterial and viral infections. Finally, he says there is fairly good data showing that e-cig users suffer from productive coughs, missed school days and more inflammatory mucous. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">There is very little known about how e-cigarettes affect pregnant women or their offspring, but \u003c/span>\u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/26756937\" target=\"_blank\" rel=\"noopener\">\u003cspan style=\"font-weight: 400\">animal studies\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> are beginning to raise alarms. \u003c/span>\u003c/p>\n\u003cp>\u003cb>\u003c/b>\"The fundamental truth here is that the human lung was evolved to process air to deliver oxygen through the blood to the muscles and to the brain,\" says Thomas Eissenberg, a \u003cb>\u003c/b>psychologist and director of the Center for the Study of tobacco products at Virginia Commonwealth University. \"And when you assault the human lung with something other than air like propylene glycol [a component in vape juice] it's hard to believe that it isn't going to cause some kind of damage over a prolonged period of time.\"\u003c/p>\n\u003cp>\u003cb>Toxins\u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Vaping \u003c/span>\u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/23467656\" target=\"_blank\" rel=\"noopener\">\u003cspan style=\"font-weight: 400\">exposes users to far fewer carcinogens\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> like benzene and arsenic than smoking a cigarette, though e-cigarettes are \u003c/span>\u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/29548792\" target=\"_blank\" rel=\"noopener\">\u003cspan style=\"font-weight: 400\">not toxin-free\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Previous \u003c/span>\u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3995255/\" target=\"_blank\" rel=\"noopener\">\u003cspan style=\"font-weight: 400\">studies\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> suggest toxin exposure varies by the brand and the type of product. For example, e-cigarette devices with higher voltages \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/24832759\" target=\"_blank\" rel=\"noopener\">are riskier\u003c/a>, because higher voltages tend to produce more toxins.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">There is also growing evidence that is harmful breathing in artificial flavors. The Food and Drug Administration has recognized flavor agents as generally safe for consumption but not for inhalation.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\"> A 2018 \u003c/span>\u003ca href=\"http://journals.plos.org/plosbiology/article?id=10.1371/journal.pbio.2003904\" target=\"_blank\" rel=\"noopener\">\u003cspan style=\"font-weight: 400\">study\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> from the University of North Carolina exposed human cells in test tubes to about 150 of the more than 7,700 commercially available flavored nicotine liquids. \u003c/span>\u003cspan style=\"font-weight: 400\">“We found that some of them were very highly toxic to the cells,\" says \u003c/span>\u003ca href=\"https://www.med.unc.edu/cellbiophysio/faculty-old/tarran/images/flori-sassano/view\" target=\"_blank\" rel=\"noopener\">\u003cspan style=\"font-weight: 400\">Flori Sassano\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">, a UNC pharmacologist. “Not only stopping the growth but also killing them.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Sassano also found that the base ingredients used in e-liquids, propylene glycol and vegetable glycerin, damaged the cells.\u003c/span>\u003c/p>\n\u003cp>\u003cb>Cancer\u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The risk of lung cancer is likely significantly lower for vaping than smoking. There is no current evidence demonstrating vaping causes lung cancer, but it can take more than a decade to develop the disease, and little is known about the extent or quantity of the carcinogens in e-cigs. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Early studies published this year suggest e-cigarette aerosols may damage the DNA in cells, indicating potential cancers like lung and oral cancer. One \u003c/span>\u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/29378943\" target=\"_blank\" rel=\"noopener\">\u003cspan style=\"font-weight: 400\">study \u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">published in the journal \u003c/span>\u003ci>\u003cspan style=\"font-weight: 400\">PNAS \u003c/span>\u003c/i>\u003cspan style=\"font-weight: 400\">showed damage in mice. Another, \u003c/span>\u003ca href=\"https://www.nature.com/articles/s41598-018-25907-6\" target=\"_blank\" rel=\"noopener\">\u003cspan style=\"font-weight: 400\">published in\u003c/span>\u003c/a> \u003ci>\u003cspan style=\"font-weight: 400\">Scientific Reports\u003c/span>\u003c/i>\u003cspan style=\"font-weight: 400\">, found that e-cigarettes contain more formaldehyde, a potential carcinogen, than previously estimated.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">In summary, more long-term studies are needed to conclude the true cancer risks of vaping. \u003c/span>\u003c/p>\n\u003cp>\u003cb>Nicotine\u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Nicotine is the addictive stimulant in both cigarettes and e-cigarettes. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The health risks of nicotine are debated. Biologists are likely to say the chemical is nasty, but public health officials who focus on smoking cessation programs are more cautious to classify nicotine negatively. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“If you’re trying to quit smoking, nicotine replacement therapy options like gum and patches that are administered with counseling and psychological support work pretty well,” says Stanton Glantz, \u003c/span>\u003cspan style=\"font-weight: 400\">who heads the \u003c/span>\u003ca href=\"https://tobacco.ucsf.edu/\" target=\"_blank\" rel=\"noopener\">\u003cspan style=\"font-weight: 400\">Center for Tobacco Control Research and Education\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> at UCSF.\u003c/span>\u003cspan style=\"font-weight: 400\"> “There are risks associated with using them, but they’re much better than smoking. All drugs have side effects.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">In very large doses, we know nicotine can be poisonous to organisms because it was once used as a pesticide before modern synthetic insecticides were developed. Glantz says nicotine can wreak havoc on the body because it’s associated with heart and blood vessel damage, reproductive toxicity and increased inflammation.\u003c/span>\u003c/p>\n\u003cp>\u003cem>Kat Snow and The Associated Press contributed to this report.\u003c/em>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n",
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"excerpt": "Preliminary research suggests e-cigarettes may harm the lungs and heart, but vaping hasn't been around long enough to know a lot about its health impacts.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>There are two ways e-cigarettes can affect your health. One is direct, from the product itself. The other stems from the fact that teenagers who vape are more likely to become addicted to nicotine and to try regular cigarettes.\u003c/p>\n\u003cp>Food and Drug Administration Commissioner Scott Gottlieb had this in mind last November when he called for tightening rules governing the sale of most flavored versions of electronic cigarettes \"I will not allow a generation of children to become addicted to nicotine through e-cigarettes,\" Gottlieb said in a statement.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">As for direct harm, while there are reams of studies on the negative effects of cigarette smoke, far fewer exist on electronic cigarettes. \u003c/span>Preliminary\u003cspan style=\"font-weight: 400\"> research does suggest e-cigarettes may harm the lungs and heart. It should be noted, however, that \u003cem>h\u003c/em>\u003c/span>\u003cspan style=\"font-weight: 400\">\u003cem>uman\u003c/em> clinical studies testing vaping products are extremely limited; most of what we know comes from research on cell cultures and animals. Plus it is difficult to study the effects of e-cigarettes when there is such a wide variety of rapidly changing delivery devices.\u003c/span>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Vaping products hit the market about 10 to 15 years ago. Researchers have followed smokers for decades to confirm flammable cigarettes are deadly because it can take at least ten years for long-term health effects like emphysema or cancer to develop. Few people have been vaping that long. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“There’s no question that vaping is much safer than smoking,\" says Michael Siegel, \u003c/span>\u003cspan style=\"font-weight: 400\">an epidemiologist at Boston University. \"\u003c/span>\u003cspan style=\"font-weight: 400\">But we're not at a level where we can say that there are no chronic health risks potentially associated with long-term vaping.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">So, here's what we know to date:\u003c/span>\u003c/p>\n\u003cp>\u003cb>Cardiovascular Disease\u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">E-cigarettes expose users to ultrafine particles and other toxins that may \u003c/span>\u003ca href=\"https://jamanetwork.com/journals/jamacardiology/article-abstract/2600160\" target=\"_blank\" rel=\"noopener\">\u003cspan style=\"font-weight: 400\">increase cardiovascular disease risks\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">. The tiny particles are much finer than a human hair and can penetrate deep into the lungs, which can \u003c/span>\u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/19720932\" target=\"_blank\" rel=\"noopener\">\u003cspan style=\"font-weight: 400\">trigger an inflammatory response\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">. \u003c/span>\u003cspan style=\"font-weight: 400\"> A \u003c/span>\u003ca href=\"https://www.ajpmonline.org/article/S0749-3797(18)31871-3/fulltext\" target=\"_blank\" rel=\"noopener\">\u003cspan style=\"font-weight: 400\">study\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> published in the \u003c/span>\u003ci>\u003cspan style=\"font-weight: 400\">American Journal of Preventive Medicine\u003c/span>\u003c/i>\u003cspan style=\"font-weight: 400\"> last summer concluded that both smoking and vaping daily are associated with a higher risk of heart attack and that using both products compounds those risks.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Nicotine may also aggravate cardiovascular disease, but how it does is still debated.\u003c/span>\u003c/p>\n\u003cp>\u003cb>Lungs\u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">There is \u003c/span>\u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/28522559\" target=\"_blank\" rel=\"noopener\">\u003cspan style=\"font-weight: 400\">evidence\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> showing that exposure to e-cigarettes negatively impacts lung function. Repeated exposure to acrolein, which is produced by heating the base products in e-cigs (propylene glycol and glycerin), can \u003c/span>\u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/22758635\" target=\"_blank\" rel=\"noopener\">\u003cspan style=\"font-weight: 400\">cause chronic pulmonary inflammation\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">.\u003c/span>\u003c/p>\n\u003cp>\u003ca href=\"https://profiles.ucsf.edu/jeffrey.gotts\" target=\"_blank\" rel=\"noopener\">\u003cspan style=\"font-weight: 400\">Jeffrey Gotts\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">, a pulmonologist at UCSF, summarized the lung disease risks succinctly in an email. “Is e-cigarette aerosol less toxic than cigarette smoke? Probably. Is e-cigarette aerosol as safe as water vapor, as many of the companies would have you believe? Definitely not.” \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Gotts says \u003c/span>\u003cspan style=\"font-weight: 400\">s\u003c/span>\u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/29481290\" target=\"_blank\" rel=\"noopener\">\u003cspan style=\"font-weight: 400\">tudies\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> of human airway epithelial cells show that e-cigarettes damage cells and increase oxidative stress, and studies of immune cells suggest e-cigarettes reduce immunity to bacterial and viral infections. Finally, he says there is fairly good data showing that e-cig users suffer from productive coughs, missed school days and more inflammatory mucous. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">There is very little known about how e-cigarettes affect pregnant women or their offspring, but \u003c/span>\u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/26756937\" target=\"_blank\" rel=\"noopener\">\u003cspan style=\"font-weight: 400\">animal studies\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> are beginning to raise alarms. \u003c/span>\u003c/p>\n\u003cp>\u003cb>\u003c/b>\"The fundamental truth here is that the human lung was evolved to process air to deliver oxygen through the blood to the muscles and to the brain,\" says Thomas Eissenberg, a \u003cb>\u003c/b>psychologist and director of the Center for the Study of tobacco products at Virginia Commonwealth University. \"And when you assault the human lung with something other than air like propylene glycol [a component in vape juice] it's hard to believe that it isn't going to cause some kind of damage over a prolonged period of time.\"\u003c/p>\n\u003cp>\u003cb>Toxins\u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Vaping \u003c/span>\u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/23467656\" target=\"_blank\" rel=\"noopener\">\u003cspan style=\"font-weight: 400\">exposes users to far fewer carcinogens\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> like benzene and arsenic than smoking a cigarette, though e-cigarettes are \u003c/span>\u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/29548792\" target=\"_blank\" rel=\"noopener\">\u003cspan style=\"font-weight: 400\">not toxin-free\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Previous \u003c/span>\u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3995255/\" target=\"_blank\" rel=\"noopener\">\u003cspan style=\"font-weight: 400\">studies\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> suggest toxin exposure varies by the brand and the type of product. For example, e-cigarette devices with higher voltages \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/24832759\" target=\"_blank\" rel=\"noopener\">are riskier\u003c/a>, because higher voltages tend to produce more toxins.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">There is also growing evidence that is harmful breathing in artificial flavors. The Food and Drug Administration has recognized flavor agents as generally safe for consumption but not for inhalation.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\"> A 2018 \u003c/span>\u003ca href=\"http://journals.plos.org/plosbiology/article?id=10.1371/journal.pbio.2003904\" target=\"_blank\" rel=\"noopener\">\u003cspan style=\"font-weight: 400\">study\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> from the University of North Carolina exposed human cells in test tubes to about 150 of the more than 7,700 commercially available flavored nicotine liquids. \u003c/span>\u003cspan style=\"font-weight: 400\">“We found that some of them were very highly toxic to the cells,\" says \u003c/span>\u003ca href=\"https://www.med.unc.edu/cellbiophysio/faculty-old/tarran/images/flori-sassano/view\" target=\"_blank\" rel=\"noopener\">\u003cspan style=\"font-weight: 400\">Flori Sassano\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">, a UNC pharmacologist. “Not only stopping the growth but also killing them.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Sassano also found that the base ingredients used in e-liquids, propylene glycol and vegetable glycerin, damaged the cells.\u003c/span>\u003c/p>\n\u003cp>\u003cb>Cancer\u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The risk of lung cancer is likely significantly lower for vaping than smoking. There is no current evidence demonstrating vaping causes lung cancer, but it can take more than a decade to develop the disease, and little is known about the extent or quantity of the carcinogens in e-cigs. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Early studies published this year suggest e-cigarette aerosols may damage the DNA in cells, indicating potential cancers like lung and oral cancer. One \u003c/span>\u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/29378943\" target=\"_blank\" rel=\"noopener\">\u003cspan style=\"font-weight: 400\">study \u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">published in the journal \u003c/span>\u003ci>\u003cspan style=\"font-weight: 400\">PNAS \u003c/span>\u003c/i>\u003cspan style=\"font-weight: 400\">showed damage in mice. Another, \u003c/span>\u003ca href=\"https://www.nature.com/articles/s41598-018-25907-6\" target=\"_blank\" rel=\"noopener\">\u003cspan style=\"font-weight: 400\">published in\u003c/span>\u003c/a> \u003ci>\u003cspan style=\"font-weight: 400\">Scientific Reports\u003c/span>\u003c/i>\u003cspan style=\"font-weight: 400\">, found that e-cigarettes contain more formaldehyde, a potential carcinogen, than previously estimated.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">In summary, more long-term studies are needed to conclude the true cancer risks of vaping. \u003c/span>\u003c/p>\n\u003cp>\u003cb>Nicotine\u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Nicotine is the addictive stimulant in both cigarettes and e-cigarettes. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The health risks of nicotine are debated. Biologists are likely to say the chemical is nasty, but public health officials who focus on smoking cessation programs are more cautious to classify nicotine negatively. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“If you’re trying to quit smoking, nicotine replacement therapy options like gum and patches that are administered with counseling and psychological support work pretty well,” says Stanton Glantz, \u003c/span>\u003cspan style=\"font-weight: 400\">who heads the \u003c/span>\u003ca href=\"https://tobacco.ucsf.edu/\" target=\"_blank\" rel=\"noopener\">\u003cspan style=\"font-weight: 400\">Center for Tobacco Control Research and Education\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> at UCSF.\u003c/span>\u003cspan style=\"font-weight: 400\"> “There are risks associated with using them, but they’re much better than smoking. All drugs have side effects.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">In very large doses, we know nicotine can be poisonous to organisms because it was once used as a pesticide before modern synthetic insecticides were developed. Glantz says nicotine can wreak havoc on the body because it’s associated with heart and blood vessel damage, reproductive toxicity and increased inflammation.\u003c/span>\u003c/p>\n\u003cp>\u003cem>Kat Snow and The Associated Press contributed to this report.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"disqusTitle": "Sex and Gender Memo by Trump Administration Is Wrong on All Counts, Say Experts",
"title": "Sex and Gender Memo by Trump Administration Is Wrong on All Counts, Say Experts",
"headTitle": "KQED Future of You | KQED Science",
"content": "\u003cp>Lately we've been noting the reality-bending statements made by President Trump and those in his administration on matters of the environment. \u003ca href=\"https://www.kqed.org/science/1929060/trumps-confusing-tweets-on-california-fires-now-appear-to-be-actual-policy\" target=\"_blank\" rel=\"noopener\">Fire\u003c/a>, \u003ca href=\"https://www.kqed.org/science/1928770/no-president-trump-calif-isnt-diverting-its-water-supply-away-from-wildfires\" target=\"_blank\" rel=\"noopener\">water\u003c/a>, \u003ca href=\"https://www.kqed.org/science/1929627/interior-secretary-ryan-zinke-says-california-fires-have-nothing-to-do-with-climate-change-hes-wrong\" target=\"_blank\" rel=\"noopener\">earth\u003c/a>, \u003ca href=\"http://www.sciencemag.org/news/2018/08/trump-s-effort-roll-back-auto-efficiency-rules-could-hinge-debate-over-safety\" target=\"_blank\" rel=\"noopener\">air\u003c/a> — you might say that for science journalists, fact-checking this presidency is now elemental.\u003c/p>\n\u003caside class=\"pullquote alignright\">'For decades, researchers have recognized that gender is not necessarily determined by a person’s biological sex assigned at birth, which can be physiologically uncertain in some cases.'\u003ccite>American Psychological Association\u003c/cite>\u003c/aside>\n\u003cp>Now comes a \u003ca href=\"https://www.nytimes.com/2018/10/21/us/politics/transgender-trump-administration-sex-definition.html\" target=\"_blank\" rel=\"noopener\">New York Times report\u003c/a> that the administration is wading into a new area: the complex interplay between biology and gender. On Sunday the paper said that the Dept. of Health and Human Services wants to establish a definition of a person's gender, one that is determined “on a biological basis that is clear, grounded in science, objective and administrable,” as the paper quoted an HHS memo.\u003c/p>\n\u003cp>“Sex means a person’s status as male or female based on immutable biological traits identifiable by or before birth,” the memo said. “The sex listed on a person’s birth certificate, as originally issued, shall constitute definitive proof of a person’s sex unless rebutted by reliable genetic evidence.”\u003c/p>\n\u003cp>In other words, your genitals at birth determine your gender. End of discussion.\u003c/p>\n\u003cp>The move aims to reverse civil rights protections granted to transgender people under the Obama administration, the Times said.\u003c/p>\n\u003cp>But it would also appear to create an official position by the United States government that transgender people simply don't, well, exist.\u003c/p>\n\u003cp>And that is going to be news to the roughly \u003ca href=\"http://williamsinstitute.law.ucla.edu/wp-content/uploads/How-Many-Adults-Identify-as-Transgender-in-the-United-States.pdf\" target=\"_blank\" rel=\"noopener\">1.4 million transgender individuals\u003c/a> in the country.\u003c/p>\n\u003cp>The American Psychological Association wasted no time in issuing a response to the report. On Monday, it said in a \u003ca href=\"https://www.apa.org/news/press/releases/2018/10/erase-transgender-definition.aspx\" target=\"_blank\" rel=\"noopener\">statement\u003c/a>:\u003c/p>\n\u003cp>“For decades, researchers have recognized that gender is not necessarily determined by a person’s biological sex assigned at birth, which can be physiologically uncertain in some cases. Purposely ignoring this body of evidence is indefensible and certain to add to the stress and discrimination already experienced by transgender people.”\u003c/p>\n\u003cp>Dr. Stephen Rosenthal, a pediatric endocrinologist and the medical director of UCSF's Child and Adolescent Gender Center, agrees.\u003c/p>\n\u003cp class=\"p1\">\"A\u003cspan class=\"s1\"> typical transgender person has genitalia that are not in any way obviously abnormal,\" he said. \"And not in any way a clue that that person is going to end up transgender.\"\u003c/span>\u003c/p>\n\u003cp>Genitalia, he said, does not always predict gender identity, and other physical characteristics most likely contribute to people's fundamental sense of whether they are male, female or some variant. Rosenthal cited a number of studies showing \u003cspan class=\"s1\">certain parts of the brain, shaped differently in men and women, that are more closely aligned with the gender identity of transgender individuals than with their natal sex. \u003c/span>\u003c/p>\n\u003cp>Other research suggests that \u003ca href=\"https://www.kqed.org/futureofyou/the-biological-roots-of-gender-identity\" target=\"_blank\" rel=\"noopener\">genetic and endocrinological differences \u003c/a>in transgender people play a role in forming a gender identity that is different than their external sexual characteristics might indicate.\u003c/p>\n\u003cp>The HHS memo's proposition that genetic testing would clear up any dispute around a person's gender is also wrongheaded, said Rosenthal.\u003c/p>\n\u003cp>\"A\u003cspan class=\"s1\">nyone, even high school students, know that there are plenty of examples of women with female bodies, female genitalia, let's say, and an unequivocal female gender identity, who happen to have XY chromosomes,\" he said, referring to the chromosomal pair typically found in males.\u003c/span>\u003c/p>\n\u003cp>The HHS memo would also seem to ignore intersex people — those individuals born with a mix of physical characteristics typically found in only males or females. A \u003ca href=\"http://www.academia.edu/21132481/How_sexually_dimorphic_are_we_Review_and_synthesis\" target=\"_blank\" rel=\"noopener\">2000 review\u003c/a> of the scientific literature by Brown University researchers looked at these deviations from the norm in people born from 1955 on. The survey took into account \u003cspan class=\"a\">chromosomes, gonadal structure, hormone lev\u003c/span>\u003cspan class=\"a\">els, internal genital structure and external geni\u003c/span>\u003cspan class=\"a\">tal\u003cspan class=\"l6\">ia, finding that as many as 2 percent of newborns contain some biological trait normally associated with the opposite sex. \u003c/span>\u003c/span>\u003c/p>\n\u003cp>One of the researchers, the biologist Ann Fausto Sterling, put it this way in a seminal 1993 \u003ca href=\"https://www.researchgate.net/profile/Anne_Fausto-Sterling/publication/239657377_The_Five_Sexes_Why_Male_and_Female_are_not_Enough/links/00b7d525802a725b6b000000/The-Five-Sexes-Why-Male-and-Female-are-not-Enough.pdf\" target=\"_blank\" rel=\"noopener\">essay\u003c/a>:\u003c/p>\n\u003cp>\u003cstrong>\"\u003c/strong>If the state and the legal system have an interest in maintaining a two-party sexual system, they are in defiance of nature. For biologically speaking, there are many gradations running from female to male; and depending on how one calls the shots, one can argue that along that spectrum lie at least five sexes — and perhaps even more.\"\u003c/p>\n\u003cp>Last year, \u003ca href=\"https://www.scientificamerican.com/article/the-new-science-of-sex-and-gender/?fbclid=IwAR01v8tv0iW4E7ve5UEXi-9SrR2ltvAzQBS9PoREKCXREKChBMp-62KoKDU\" target=\"_blank\" rel=\"noopener\">Scientific American\u003c/a> took note of the mounting evidence of a male-female biological spectrum. \"To varying extents, many of us are biological hybrids on a male-female continuum,\" wrote the editors. \"As science looks more closely ... it becomes increasingly clear that a pair of chromosomes do not always suffice to distinguish girl/boy — either from the standpoint of sex (biological traits) or of gender (social identity).\"\u003c/p>\n\u003cp>\u003cstrong>Gender Identity: Biopsychosocial\u003c/strong>\u003c/p>\n\u003cp>California, of course, has moved beyond tying individuals' biological sexual characteristics to their gender identity. Last year, the state made it easier to officially change genders and \u003ca href=\"https://www.kqed.org/futureofyou/436110/california-third-gender-nonbinary\" target=\"_blank\" rel=\"noopener\">added a new category\u003c/a> called \"\u003ca href=\"https://www.kqed.org/futureofyou/335790/boy-girl-both-neither-a-new-generation-overthrows-gender\" target=\"_blank\" rel=\"noopener\">nonbinary\u003c/a>\" to the \"male\" and \"female\" options.\u003c/p>\n\u003cp>Researchers often describe the roots of gender identity as a complex mix of factors that are \"biopsychosocial.\" Surveys in recent years have revealed younger generations as accepting of more customizable views of gender, with some individuals even eschewing the pronouns \"he\" and \"she\" in favor of \"they\" to indicate the duality or fluidity of their identity.\u003c/p>\n\u003cp>Charlotte Tate, a gender researcher at San Francisco State University, said it's time to move on from debates like the one the Trump administration is trying to foster.\u003c/p>\n\u003cp>\"Historically, science about gender has contained lots of errors that needed to be corrected or discarded,\" she wrote in an email. \"Pretending that gender identity can be reduced to a person’s genitals is one of those errors that we needed to discard in order to move forward in a way that is scientifically productive.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003c/p>\n",
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"excerpt": "The notion that a person's gender is forever defined by the sex listed on their birth certificate is at odds with everything we know about the way gender identity develops.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Lately we've been noting the reality-bending statements made by President Trump and those in his administration on matters of the environment. \u003ca href=\"https://www.kqed.org/science/1929060/trumps-confusing-tweets-on-california-fires-now-appear-to-be-actual-policy\" target=\"_blank\" rel=\"noopener\">Fire\u003c/a>, \u003ca href=\"https://www.kqed.org/science/1928770/no-president-trump-calif-isnt-diverting-its-water-supply-away-from-wildfires\" target=\"_blank\" rel=\"noopener\">water\u003c/a>, \u003ca href=\"https://www.kqed.org/science/1929627/interior-secretary-ryan-zinke-says-california-fires-have-nothing-to-do-with-climate-change-hes-wrong\" target=\"_blank\" rel=\"noopener\">earth\u003c/a>, \u003ca href=\"http://www.sciencemag.org/news/2018/08/trump-s-effort-roll-back-auto-efficiency-rules-could-hinge-debate-over-safety\" target=\"_blank\" rel=\"noopener\">air\u003c/a> — you might say that for science journalists, fact-checking this presidency is now elemental.\u003c/p>\n\u003caside class=\"pullquote alignright\">'For decades, researchers have recognized that gender is not necessarily determined by a person’s biological sex assigned at birth, which can be physiologically uncertain in some cases.'\u003ccite>American Psychological Association\u003c/cite>\u003c/aside>\n\u003cp>Now comes a \u003ca href=\"https://www.nytimes.com/2018/10/21/us/politics/transgender-trump-administration-sex-definition.html\" target=\"_blank\" rel=\"noopener\">New York Times report\u003c/a> that the administration is wading into a new area: the complex interplay between biology and gender. On Sunday the paper said that the Dept. of Health and Human Services wants to establish a definition of a person's gender, one that is determined “on a biological basis that is clear, grounded in science, objective and administrable,” as the paper quoted an HHS memo.\u003c/p>\n\u003cp>“Sex means a person’s status as male or female based on immutable biological traits identifiable by or before birth,” the memo said. “The sex listed on a person’s birth certificate, as originally issued, shall constitute definitive proof of a person’s sex unless rebutted by reliable genetic evidence.”\u003c/p>\n\u003cp>In other words, your genitals at birth determine your gender. End of discussion.\u003c/p>\n\u003cp>The move aims to reverse civil rights protections granted to transgender people under the Obama administration, the Times said.\u003c/p>\n\u003cp>But it would also appear to create an official position by the United States government that transgender people simply don't, well, exist.\u003c/p>\n\u003cp>And that is going to be news to the roughly \u003ca href=\"http://williamsinstitute.law.ucla.edu/wp-content/uploads/How-Many-Adults-Identify-as-Transgender-in-the-United-States.pdf\" target=\"_blank\" rel=\"noopener\">1.4 million transgender individuals\u003c/a> in the country.\u003c/p>\n\u003cp>The American Psychological Association wasted no time in issuing a response to the report. On Monday, it said in a \u003ca href=\"https://www.apa.org/news/press/releases/2018/10/erase-transgender-definition.aspx\" target=\"_blank\" rel=\"noopener\">statement\u003c/a>:\u003c/p>\n\u003cp>“For decades, researchers have recognized that gender is not necessarily determined by a person’s biological sex assigned at birth, which can be physiologically uncertain in some cases. Purposely ignoring this body of evidence is indefensible and certain to add to the stress and discrimination already experienced by transgender people.”\u003c/p>\n\u003cp>Dr. Stephen Rosenthal, a pediatric endocrinologist and the medical director of UCSF's Child and Adolescent Gender Center, agrees.\u003c/p>\n\u003cp class=\"p1\">\"A\u003cspan class=\"s1\"> typical transgender person has genitalia that are not in any way obviously abnormal,\" he said. \"And not in any way a clue that that person is going to end up transgender.\"\u003c/span>\u003c/p>\n\u003cp>Genitalia, he said, does not always predict gender identity, and other physical characteristics most likely contribute to people's fundamental sense of whether they are male, female or some variant. Rosenthal cited a number of studies showing \u003cspan class=\"s1\">certain parts of the brain, shaped differently in men and women, that are more closely aligned with the gender identity of transgender individuals than with their natal sex. \u003c/span>\u003c/p>\n\u003cp>Other research suggests that \u003ca href=\"https://www.kqed.org/futureofyou/the-biological-roots-of-gender-identity\" target=\"_blank\" rel=\"noopener\">genetic and endocrinological differences \u003c/a>in transgender people play a role in forming a gender identity that is different than their external sexual characteristics might indicate.\u003c/p>\n\u003cp>The HHS memo's proposition that genetic testing would clear up any dispute around a person's gender is also wrongheaded, said Rosenthal.\u003c/p>\n\u003cp>\"A\u003cspan class=\"s1\">nyone, even high school students, know that there are plenty of examples of women with female bodies, female genitalia, let's say, and an unequivocal female gender identity, who happen to have XY chromosomes,\" he said, referring to the chromosomal pair typically found in males.\u003c/span>\u003c/p>\n\u003cp>The HHS memo would also seem to ignore intersex people — those individuals born with a mix of physical characteristics typically found in only males or females. A \u003ca href=\"http://www.academia.edu/21132481/How_sexually_dimorphic_are_we_Review_and_synthesis\" target=\"_blank\" rel=\"noopener\">2000 review\u003c/a> of the scientific literature by Brown University researchers looked at these deviations from the norm in people born from 1955 on. The survey took into account \u003cspan class=\"a\">chromosomes, gonadal structure, hormone lev\u003c/span>\u003cspan class=\"a\">els, internal genital structure and external geni\u003c/span>\u003cspan class=\"a\">tal\u003cspan class=\"l6\">ia, finding that as many as 2 percent of newborns contain some biological trait normally associated with the opposite sex. \u003c/span>\u003c/span>\u003c/p>\n\u003cp>One of the researchers, the biologist Ann Fausto Sterling, put it this way in a seminal 1993 \u003ca href=\"https://www.researchgate.net/profile/Anne_Fausto-Sterling/publication/239657377_The_Five_Sexes_Why_Male_and_Female_are_not_Enough/links/00b7d525802a725b6b000000/The-Five-Sexes-Why-Male-and-Female-are-not-Enough.pdf\" target=\"_blank\" rel=\"noopener\">essay\u003c/a>:\u003c/p>\n\u003cp>\u003cstrong>\"\u003c/strong>If the state and the legal system have an interest in maintaining a two-party sexual system, they are in defiance of nature. For biologically speaking, there are many gradations running from female to male; and depending on how one calls the shots, one can argue that along that spectrum lie at least five sexes — and perhaps even more.\"\u003c/p>\n\u003cp>Last year, \u003ca href=\"https://www.scientificamerican.com/article/the-new-science-of-sex-and-gender/?fbclid=IwAR01v8tv0iW4E7ve5UEXi-9SrR2ltvAzQBS9PoREKCXREKChBMp-62KoKDU\" target=\"_blank\" rel=\"noopener\">Scientific American\u003c/a> took note of the mounting evidence of a male-female biological spectrum. \"To varying extents, many of us are biological hybrids on a male-female continuum,\" wrote the editors. \"As science looks more closely ... it becomes increasingly clear that a pair of chromosomes do not always suffice to distinguish girl/boy — either from the standpoint of sex (biological traits) or of gender (social identity).\"\u003c/p>\n\u003cp>\u003cstrong>Gender Identity: Biopsychosocial\u003c/strong>\u003c/p>\n\u003cp>California, of course, has moved beyond tying individuals' biological sexual characteristics to their gender identity. Last year, the state made it easier to officially change genders and \u003ca href=\"https://www.kqed.org/futureofyou/436110/california-third-gender-nonbinary\" target=\"_blank\" rel=\"noopener\">added a new category\u003c/a> called \"\u003ca href=\"https://www.kqed.org/futureofyou/335790/boy-girl-both-neither-a-new-generation-overthrows-gender\" target=\"_blank\" rel=\"noopener\">nonbinary\u003c/a>\" to the \"male\" and \"female\" options.\u003c/p>\n\u003cp>Researchers often describe the roots of gender identity as a complex mix of factors that are \"biopsychosocial.\" Surveys in recent years have revealed younger generations as accepting of more customizable views of gender, with some individuals even eschewing the pronouns \"he\" and \"she\" in favor of \"they\" to indicate the duality or fluidity of their identity.\u003c/p>\n\u003cp>Charlotte Tate, a gender researcher at San Francisco State University, said it's time to move on from debates like the one the Trump administration is trying to foster.\u003c/p>\n\u003cp>\"Historically, science about gender has contained lots of errors that needed to be corrected or discarded,\" she wrote in an email. \"Pretending that gender identity can be reduced to a person’s genitals is one of those errors that we needed to discard in order to move forward in a way that is scientifically productive.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"disqusTitle": "Trump EPA Set to Weaken Limits on Radiation Exposure",
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"content": "\u003cp>The EPA is pursuing rule changes that experts say would weaken the way radiation exposure is regulated, turning to scientific outliers who argue that a bit of radiation damage is actually good for you — like a little bit of sunlight.[contextly_sidebar id=\"cMhezcPlN6LfypQIodTAZTkQjxxJmp1m\"]\u003c/p>\n\u003cp>The government’s current, decades-old guidance says that any exposure to harmful radiation is a cancer risk. And critics say the proposed change could lead to higher levels of exposure for workers at nuclear installations and oil and gas drilling sites, medical workers doing X-rays and CT scans, people living next to Superfund sites and any members of the public who one day might find themselves exposed to a radiation release.\u003c/p>\n\u003cp>The Trump administration already has targeted a range of other regulations on toxins and pollutants, including coal power plant emissions and car exhaust, that it sees as costly and burdensome for businesses. Supporters of the EPA’s proposal argue the government’s current model that there is no safe level of radiation — the so-called linear no-threshold model — forces unnecessary spending for handling exposure in accidents, at nuclear plants, in medical centers and at other sites.\u003c/p>\n\u003cp>At issue is Environmental Protection Agency’s proposed rule on transparency in science.\u003c/p>\n\u003cp>EPA spokesman John Konkus said Tuesday: “The proposed regulation doesn’t talk about radiation or any particular chemicals. And as we indicated in our response, EPA’s policy is to continue to use the linear-no-threshold model for population-level radiation protection purposes which would not, under the proposed regulation that has not been finalized, trigger any change in that policy.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>But in an April news release announcing the proposed rule the agency quoted Edward Calabrese, a toxicologist at the University of Massachusetts who has said weakening limits on radiation exposure would save billions of dollars and have a positive impact on human health.\u003c/p>\n\u003cp>The proposed rule would require regulators to consider “various threshold models across the exposure range” when it comes to dangerous substances. While it doesn’t specify radiation, the release quotes Calabrese calling the proposal “a major scientific step forward” in assessing the risk of “chemicals and radiation.”[contextly_sidebar id=\"pvuvFDruvbEw4lxZxen1FpcGPNcaahIo\"]\u003c/p>\n\u003cp>Konkus said the release was written during the tenure of former EPA Administrator Scott Pruitt. He could not explain why Calabrese was quoted citing the impact on radiation levels if the agency does not believe there would be any.\u003c/p>\n\u003cp>Calabrese was to be the lead witness at a congressional hearing Wednesday on the EPA proposal.\u003c/p>\n\u003cp>Radiation is everywhere, from potassium in bananas to the microwaves popping our popcorn. Most of it is benign. But what’s of concern is the higher-energy, shorter-wave radiation, like X-rays, that can penetrate and disrupt living cells, sometimes causing cancer.\u003c/p>\n\u003cp>As recently as this March, the EPA’s online guidelines for radiation effects advised: “Current science suggests there is some cancer risk from any exposure to radiation.”\u003c/p>\n\u003cp>“Even exposures below 100 millisieverts” — an amount roughly equivalent to 25 chest X-rays or about 14 CT chest scans — “slightly increase the risk of getting cancer in the future,” the agency’s guidance said.\u003c/p>\n\u003cp>But that online guidance — separate from the rule-change proposal — was edited in July to add a section emphasizing the low individual odds of cancer: “According to radiation safety experts, radiation exposures of ... 100 millisieverts usually result in no harmful health effects, because radiation below these levels is a minor contributor to our overall cancer risk,” the revised policy says.[contextly_sidebar id=\"2HUuLSRwi8YSbfJRvPXEnS9z0Y0PfoLc\"]\u003c/p>\n\u003cp>Calabrese and his supporters argue that smaller exposures of cell-damaging radiation and other carcinogens can serve as stressors that activate the body’s repair mechanisms and can make people healthier. They compare it to physical exercise or sunlight.\u003c/p>\n\u003cp>Mainstream scientific consensus on radiation is based on deceptive science, says Calabrese, who argued in a 2014 essay for “righting the past deceptions and correcting the ongoing errors in environmental regulation.”\u003c/p>\n\u003cp>EPA spokesman Konkus said in an email that the proposed rule change is about “increasing transparency on assumptions” about how the body responds to different doses of dangerous substances and that the agency “acknowledges uncertainty regarding health effects at low doses” and supports more research on that.\u003c/p>\n\u003cp>The radiation regulation is supported by Steven Milloy, a Trump transition team member for the EPA who is known for challenging widely accepted ideas about manmade climate change and the health risks of tobacco. He has been promoting Calabrese’s theory of healthy radiation on his blog.\u003c/p>\n\u003cp>But Jan Beyea, a physicist whose work includes research with the National Academies of Science on the 2011 Fukushima nuclear power plant accident, said the EPA science proposal represents voices “generally dismissed by the great bulk of scientists.”\u003c/p>\n\u003cp>The EPA proposal would lead to “increases in chemical and radiation exposures in the workplace, home and outdoor environment, including the vicinity of Superfund sites,” Beyea wrote.\u003c/p>\n\u003cp>[contextly_sidebar id=\"OkuppunSHp3SM2JTUqdGMPaVNCwP9BBK\"]At the level the EPA website talks about, any one person’s risk of cancer from radiation exposure is perhaps 1 percent, Beyea said.\u003c/p>\n\u003cp>“The individual risk will likely be low, but not the cumulative social risk,” Beyea said.\u003c/p>\n\u003cp>“If they even look at that — no, no, no,” said Terrie Barrie, a resident of Craig, Colorado, and an advocate for her husband and other workers at the now-closed Rocky Flats nuclear-weapons plant, where the U.S. government is compensating certain cancer victims regardless of their history of exposure.\u003c/p>\n\u003cp>“There’s no reason not to protect people as much as possible,” said Barrie.\u003c/p>\n\u003cp>U.S. agencies for decades have followed a policy that there is no threshold of radiation exposure that is risk-free.\u003c/p>\n\u003cp>The National Council on Radiation Protection and Measurements reaffirmed that principle this year after a review of 29 public health studies on cancer rates among people exposed to low-dose radiation, via the U.S. atomic bombing of Japan in World War II, leak-prone Soviet nuclear installations, medical treatments and other sources.\u003c/p>\n\u003cp>Twenty of the 29 studies directly support the principle that even low-dose exposures cause a significant increase in cancer rates, said Roy Shore, chief of research at the Radiation Effects Research Foundation, a joint project of the United States and Japan. Scientists found most of the other studies were inconclusive and decided one was flawed.\u003c/p>\n\u003cp>None supported the theory there is some safe threshold for radiation, said Shore, who chaired the review.\u003c/p>\n\u003cp>If there were a threshold that it’s safe to go below, “those who profess that would have to come up with some data,” Shore said in an interview.\u003c/p>\n\u003cp>“Certainly the evidence did not point that way,” he said.\u003c/p>\n\u003cp>The U.S. Food and Drug Administration, which regulates electronic devices that emit radiation, advises, broadly, that a single CT scan with a dose of 10 millisieverts may increase risks of a fatal cancer by about 1 chance in 2,000.\u003c/p>\n\u003cp>Supporters of the proposal say it’s time to rethink radiation regulation.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“Right now we spend an enormous effort trying to minimize low doses” at nuclear power plants, for example, said Brant Ulsh, a physicist with the California-based consulting firm M.H. Chew and Associates. “Instead, let’s spend the resources on minimizing the effect of a really big event.”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The EPA is pursuing rule changes that experts say would weaken the way radiation exposure is regulated, turning to scientific outliers who argue that a bit of radiation damage is actually good for you — like a little bit of sunlight.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>The government’s current, decades-old guidance says that any exposure to harmful radiation is a cancer risk. And critics say the proposed change could lead to higher levels of exposure for workers at nuclear installations and oil and gas drilling sites, medical workers doing X-rays and CT scans, people living next to Superfund sites and any members of the public who one day might find themselves exposed to a radiation release.\u003c/p>\n\u003cp>The Trump administration already has targeted a range of other regulations on toxins and pollutants, including coal power plant emissions and car exhaust, that it sees as costly and burdensome for businesses. Supporters of the EPA’s proposal argue the government’s current model that there is no safe level of radiation — the so-called linear no-threshold model — forces unnecessary spending for handling exposure in accidents, at nuclear plants, in medical centers and at other sites.\u003c/p>\n\u003cp>At issue is Environmental Protection Agency’s proposed rule on transparency in science.\u003c/p>\n\u003cp>EPA spokesman John Konkus said Tuesday: “The proposed regulation doesn’t talk about radiation or any particular chemicals. And as we indicated in our response, EPA’s policy is to continue to use the linear-no-threshold model for population-level radiation protection purposes which would not, under the proposed regulation that has not been finalized, trigger any change in that policy.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>But in an April news release announcing the proposed rule the agency quoted Edward Calabrese, a toxicologist at the University of Massachusetts who has said weakening limits on radiation exposure would save billions of dollars and have a positive impact on human health.\u003c/p>\n\u003cp>The proposed rule would require regulators to consider “various threshold models across the exposure range” when it comes to dangerous substances. While it doesn’t specify radiation, the release quotes Calabrese calling the proposal “a major scientific step forward” in assessing the risk of “chemicals and radiation.”\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Konkus said the release was written during the tenure of former EPA Administrator Scott Pruitt. He could not explain why Calabrese was quoted citing the impact on radiation levels if the agency does not believe there would be any.\u003c/p>\n\u003cp>Calabrese was to be the lead witness at a congressional hearing Wednesday on the EPA proposal.\u003c/p>\n\u003cp>Radiation is everywhere, from potassium in bananas to the microwaves popping our popcorn. Most of it is benign. But what’s of concern is the higher-energy, shorter-wave radiation, like X-rays, that can penetrate and disrupt living cells, sometimes causing cancer.\u003c/p>\n\u003cp>As recently as this March, the EPA’s online guidelines for radiation effects advised: “Current science suggests there is some cancer risk from any exposure to radiation.”\u003c/p>\n\u003cp>“Even exposures below 100 millisieverts” — an amount roughly equivalent to 25 chest X-rays or about 14 CT chest scans — “slightly increase the risk of getting cancer in the future,” the agency’s guidance said.\u003c/p>\n\u003cp>But that online guidance — separate from the rule-change proposal — was edited in July to add a section emphasizing the low individual odds of cancer: “According to radiation safety experts, radiation exposures of ... 100 millisieverts usually result in no harmful health effects, because radiation below these levels is a minor contributor to our overall cancer risk,” the revised policy says.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Calabrese and his supporters argue that smaller exposures of cell-damaging radiation and other carcinogens can serve as stressors that activate the body’s repair mechanisms and can make people healthier. They compare it to physical exercise or sunlight.\u003c/p>\n\u003cp>Mainstream scientific consensus on radiation is based on deceptive science, says Calabrese, who argued in a 2014 essay for “righting the past deceptions and correcting the ongoing errors in environmental regulation.”\u003c/p>\n\u003cp>EPA spokesman Konkus said in an email that the proposed rule change is about “increasing transparency on assumptions” about how the body responds to different doses of dangerous substances and that the agency “acknowledges uncertainty regarding health effects at low doses” and supports more research on that.\u003c/p>\n\u003cp>The radiation regulation is supported by Steven Milloy, a Trump transition team member for the EPA who is known for challenging widely accepted ideas about manmade climate change and the health risks of tobacco. He has been promoting Calabrese’s theory of healthy radiation on his blog.\u003c/p>\n\u003cp>But Jan Beyea, a physicist whose work includes research with the National Academies of Science on the 2011 Fukushima nuclear power plant accident, said the EPA science proposal represents voices “generally dismissed by the great bulk of scientists.”\u003c/p>\n\u003cp>The EPA proposal would lead to “increases in chemical and radiation exposures in the workplace, home and outdoor environment, including the vicinity of Superfund sites,” Beyea wrote.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>At the level the EPA website talks about, any one person’s risk of cancer from radiation exposure is perhaps 1 percent, Beyea said.\u003c/p>\n\u003cp>“The individual risk will likely be low, but not the cumulative social risk,” Beyea said.\u003c/p>\n\u003cp>“If they even look at that — no, no, no,” said Terrie Barrie, a resident of Craig, Colorado, and an advocate for her husband and other workers at the now-closed Rocky Flats nuclear-weapons plant, where the U.S. government is compensating certain cancer victims regardless of their history of exposure.\u003c/p>\n\u003cp>“There’s no reason not to protect people as much as possible,” said Barrie.\u003c/p>\n\u003cp>U.S. agencies for decades have followed a policy that there is no threshold of radiation exposure that is risk-free.\u003c/p>\n\u003cp>The National Council on Radiation Protection and Measurements reaffirmed that principle this year after a review of 29 public health studies on cancer rates among people exposed to low-dose radiation, via the U.S. atomic bombing of Japan in World War II, leak-prone Soviet nuclear installations, medical treatments and other sources.\u003c/p>\n\u003cp>Twenty of the 29 studies directly support the principle that even low-dose exposures cause a significant increase in cancer rates, said Roy Shore, chief of research at the Radiation Effects Research Foundation, a joint project of the United States and Japan. Scientists found most of the other studies were inconclusive and decided one was flawed.\u003c/p>\n\u003cp>None supported the theory there is some safe threshold for radiation, said Shore, who chaired the review.\u003c/p>\n\u003cp>If there were a threshold that it’s safe to go below, “those who profess that would have to come up with some data,” Shore said in an interview.\u003c/p>\n\u003cp>“Certainly the evidence did not point that way,” he said.\u003c/p>\n\u003cp>The U.S. Food and Drug Administration, which regulates electronic devices that emit radiation, advises, broadly, that a single CT scan with a dose of 10 millisieverts may increase risks of a fatal cancer by about 1 chance in 2,000.\u003c/p>\n\u003cp>Supporters of the proposal say it’s time to rethink radiation regulation.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“Right now we spend an enormous effort trying to minimize low doses” at nuclear power plants, for example, said Brant Ulsh, a physicist with the California-based consulting firm M.H. Chew and Associates. “Instead, let’s spend the resources on minimizing the effect of a really big event.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Is Three Too Young for Children to Know They're a Different Gender? Transgender Researchers Disagree",
"title": "Is Three Too Young for Children to Know They're a Different Gender? Transgender Researchers Disagree",
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"content": "\u003caside>\n\u003cul>\n\u003cli>Many gender clinicians now recommend parents 'socially transition' kids who persistently express a transgender identity.\u003c/li>\n\u003cli>But research has shown most children will give up their transgender identity by the time they are adolescents.\u003c/li>\n\u003cli>Not all researchers agree, though, that this research is valid.\u003c/li>\n\u003c/ul>\n\u003c/aside>\n\u003cp>Gracie is the youngest transgender person I've ever met. She's so young, she still likes to tack on \"and-a-half\" when giving her age, which is six. One day last summer, bouncing all over the grounds at day camp, she looked as delighted as you'd expect any kid would on \"Water Day.”\u003c/p>\n\u003caside class=\"alignright\">\u003ca href=\"https://www.kqed.org/futureofyou/441784/the-controversial-research-on-desistance-in-transgender-youth\">The Controversial Research on 'Desistance' in Transgender Youth\u003c/a>\u003c/aside>\n\u003cp>This is Rainbow Day Camp, in the East Bay town of El Cerrito. It was created specifically to be a safe place for transgender kids, and in fact, being transgender is so unremarkable here, when I asked Gracie what makes it “special,\" she shrugged and said:\u003c/p>\n\u003cp>“You get to do fun stuff.”\u003c/p>\n\u003cp>Her mother, Molly, tried to coax a reporter-friendly answer out of her.\u003c/p>\n\u003cp>“What is special about you, and the same as everybody else in the camp?” she prompted.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“I don’t know,” Gracie said.\u003c/p>\n\u003caside class=\"pullquote alignright\">'What if we let our son walk into the world in a dress with fairy wings, and crowns, and high heels, and even just in regular girl clothes … and then he changes his mind?'\u003ccite>Molly, whose 6-year-old daughter, Gracie, socially transitioned at age four\u003c/cite>\u003c/aside>\n\u003cp>“You’re transgender and there’s other kids that are transgender, too...”\u003c/p>\n\u003cp>“I’m transgender and there’s other kids that are transgender, too.”\u003c/p>\n\u003cp>Ah, kids. ... But when I asked Gracie how she \u003cem>used\u003c/em> to feel, when other people thought she was a boy, she got straight to the point.\u003c/p>\n\u003cp>“It was not right to me, and I didn’t want people to say that, but they said it,” she said. “It hurted my feelings a lot.\"\u003c/p>\n\u003cp>Did it make her angry?\u003c/p>\n\u003cp>“No, it just made me sad.”\u003c/p>\n\u003caside class=\"alignright\">\u003ca href=\"mailto:jbrooks@kqed.org\">Email the reporter\u003c/a>\u003c/aside>\n\u003cp>How about now?\u003c/p>\n\u003cp>“It feels happy to me.”\u003c/p>\n\u003cp>And that, in a child’s nutshell, sums up one side of a contentious debate about the right age for transgender children to begin what gender clinicians call “social transitioning.”\u003c/p>\n\u003cp>https://www.youtube.com/watch?v=IS5Yankf1GY\u003c/p>\n\u003cp>\u003cstrong>Even Three-Year-Olds\u003c/strong>\u003c/p>\n\u003cp>When I met Gracie, she was a few months out of kindergarten — pretty young for a transgender kid, I thought. Gracie lives with her parents and younger brother in a small city in the East Bay. She is already two years into her transition, having started her public life as a girl at four. The family began by discarding her boy name and referring to Gracie as “she” and “her.” She was also allowed to wear girl clothes outside the home, and her parents changed the gender on her birth certificate to avoid confusion at school.\u003c/p>\n\u003caside class=\"alignright noborder\">\u003cstrong>How young is too young?\u003c/strong>\u003cbr>\nUCSF’s Diane Ehrensaft, one of the leading proponents of socially transitioning transgender children, believes there is no minimum age, really, to pursue such a change.'For all of these interventions, our model is stages not ages,” she said. 'When a child is at the place in their life that they can get themselves in focus, help us see them, and are clear, consistent, and stable in both their representation of themselves, and also can express their desires of how they want to live their gender, that's the age.'We have seen some kids as young as two whose parents are bringing them in because they're beginning to say, ‘Me not boy. Me girl.’ Social transition can happen as soon as a child has language or the ability to communicate to us who they are.'\u003c/aside>\n\u003cp>Steps like these make up the “social” aspects of social, not medical, transitioning. The distinction is important: According to Endocrine Society \u003ca href=\"https://academic.oup.com/jcem/article/102/11/3869/4157558\" target=\"_blank\" rel=\"noopener\">guidelines\u003c/a>, patients who want to begin medical treatment like puberty blockers, hormones or surgery should be old enough to give “informed consent,” which the organization says is usually attained by 16.\u003c/p>\n\u003cp>Therapists at \u003ca href=\"https://www.ucsfbenioffchildrens.org/clinics/child_and_adolescent_gender_center/\" target=\"_blank\" rel=\"noopener\">UCSF’s Child and Adolescent Gender Center Clinic\u003c/a> in San Francisco told me they’ve socially transitioned kids as young as three.\u003c/p>\n\u003cp>Diane Ehrensaft, the San Francisco Center’s mental health director and a leading proponent of early social transitioning, acknowledges this approach has been controversial.\u003c/p>\n\u003cp>“There are some people that think folks like myself, and the people at our clinic, have fallen off the deep end,” she told me. She wasn’t just talking about the religious right, either. She was referring to other mental health professionals.\u003c/p>\n\u003cp>I myself experienced a fair bit of surprise when Ehrensaft told me how young these kids are. My first, reflexive comment was a simple, \"Wow.\" This was not an uncommon reaction when I discussed this story with people in my own life, even in the progressive Bay Area.\u003c/p>\n\u003cp>Yet, when I spoke with Gracie’s mom, Molly (the family didn't want their last name used for reasons of privacy), nothing about the decision to allow her then-son to publicly make the switch to a girl, at an age when many kids are still sucking their thumbs, sounded in the slightest bit rash.\u003c/p>\n\u003cp>We spoke at Rainbow Day Camp, in a classroom set aside for interviews. The children’s art adorning the walls, the shrimpy seats — it felt like a place to talk about kickball, not the gender identity of first graders.\u003c/p>\n\u003cp>Yet here we were.\u003c/p>\n\u003caside class=\"alignright\">\u003cstrong>The Biological Roots of Gender Identity\u003c/strong>\u003cbr>\nMolly is the mother of two children, a 3-year-old boy and a 7-year-old transgender girl. The younger child is the “stereotype of what I thought having a son would be like,” she said. “He loves trucks, cars, construction, superheroes and destroying the house.”Her first child, also born male, just did not develop in the same way. Rather, from the time he acquired language on, he protested that he was really a girl. (\u003ca href=\"https://www.kqed.org/futureofyou/the-biological-roots-of-gender-identity\" target=\"_blank\" rel=\"noopener\">Continue reading)\u003c/a>\u003c/aside>\n\u003cp>“What if we do this?” Molly recalled asking a gender therapist, back when they were debating the pros and cons of letting Gracie transition. “What if we let our son walk into the world in a dress with fairy wings, and crowns, and high heels, and even just in regular girl clothes … and then he changes his mind?”\u003c/p>\n\u003cp>\"That's not the question,” the therapist told Molly. “The question is, what if you don't do it?”\u003c/p>\n\u003cp>It was only semi-rhetorical. Some gender therapists say there are serious potential dangers if adults suppress a child’s desired transition. On surveys, American transgender adults have reported attempting suicide at the startling \u003ca href=\"https://williamsinstitute.law.ucla.edu/wp-content/uploads/AFSP-Williams-Suicide-Report-Final.pdf\" target=\"_blank\" rel=\"noopener\">rate\u003c/a> of around 40 percent.\u003c/p>\n\u003cp>The stakes couldn’t have been higher, Molly knew.\u003c/p>\n\u003cp>At Rainbow Day Camp, recalling that time, she started to cry.\u003c/p>\n\u003cp>“As soon as I knew there was even a chance that my kid could feel ashamed of who they are, there was no way … ” Her voice cracked into a higher register. “I had to support, I had to listen, and I had to let her steer, a little bit, the ship. Period. No matter what.”\u003c/p>\n\u003cfigure id=\"attachment_441862\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2020/04/gracie-sliding-water-1.jpg\">\u003cimg class=\"wp-image-441862 size-large\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2020/04/gracie-sliding-water-1-1020x527.jpg\" alt=\"\" width=\"640\" height=\"331\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2020/04/gracie-sliding-water-1-1020x527.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2020/04/gracie-sliding-water-1-160x83.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2020/04/gracie-sliding-water-1-800x414.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2020/04/gracie-sliding-water-1-768x397.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2020/04/gracie-sliding-water-1-1200x620.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/13/2020/04/gracie-sliding-water-1-1180x610.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2020/04/gracie-sliding-water-1-960x496.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2020/04/gracie-sliding-water-1-240x124.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2020/04/gracie-sliding-water-1-375x194.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2020/04/gracie-sliding-water-1-520x269.jpg 520w, https://ww2.kqed.org/app/uploads/sites/13/2020/04/gracie-sliding-water-1.jpg 1209w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Gracie, six, on Water Day at Rainbow Day Camp, which was created as a safe space for transgender kids. \u003ccite>(KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>‘I’m a Girl’\u003c/strong>\u003c/p>\n\u003cp>Ehrensaft calls children like Gracie “persistent, consistent, and insistent” in their declarations of cross-gender identity. For Gracie, this manifested through words, wishes, and, well, practically everything.\u003c/p>\n\u003caside class=\"pullquote alignright\">'Why would we deny for the vast majority of kids something that is basically suicide prevention?'\u003ccite>Diane Ehrensaft, UCSF\u003c/cite>\u003c/aside>\n\u003cp>Gracie was her parents' first child. From toddlerhood on, Molly said, their son had displayed a “constant obsession and fixation on all things girl. As soon as she could tell us, it was, ‘I'm a girl. I'm a sister. I'm a daughter. I'm that girl on that show. I'm that girl in that book.’”\u003c/p>\n\u003cp>Gracie's parents weren’t on board at first.\u003c/p>\n\u003cp>“We filled her world with trucks, and dinosaurs, and superheroes, and we refused girl things,” Molly said. “Like, ‘No, you can't be Elsa for Halloween. You have to be Superman. No, you can't have the dolls for Christmas. We're going to get you a pirate ship.’”\u003c/p>\n\u003cp>They also made a rule: No girl clothing outside the house.\u003c/p>\n\u003cp>Molly tells me: “That’s the part I’m ashamed of now.”\u003c/p>\n\u003cp>\u003cstrong>'These Kids Do Come Forward'\u003c/strong>\u003c/p>\n\u003cp>Molly and her husband finally relented — they just could not deny how much happier their child felt when recognized as a girl.\u003c/p>\n\u003cfigure id=\"attachment_441832\" class=\"wp-caption alignright\" style=\"max-width: 640px\">\u003ca href=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2020/04/Phoenix5-e1527011026777.jpg\">\u003cimg class=\"size-large wp-image-441832\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2020/04/Phoenix5-1020x1530.jpg\" alt=\"\" width=\"640\" height=\"960\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Phoenix, a transgender girl who began wearing dresses to school at age 5. She began made a complete social transition at the start of second grade. \u003ccite>(Courtesy of family)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>I asked: Has Gracie ever looked back?\u003c/p>\n\u003cp>Molly chuckled.\u003c/p>\n\u003cp>“If you think of gender as a spectrum, she is like a full, all-the-way girl.”\u003c/p>\n\u003cp>It’s not rocket science, Ehrensaft explained, if you really listen to the children. “A child will say: ‘Stop calling me Jane. Let me wear my dresses. Please call me she.’ That's a child making a clear statement.”\u003c/p>\n\u003cp>Kristina Olson, a University of Washington gender researcher, said parents do not always listen to what their kids are telling them.\u003c/p>\n\u003cp>“The ones that are most likely to transition are kids who for many years are very consistently saying this is who they are,” she said. ”We often see this happen for years before parents socially transition their kids.”\u003c/p>\n\u003cp>UCSF gender specialist Erica Anderson recently treated a five-year-old who had reached a point of desperation.\u003c/p>\n\u003cp>“In the bathtub, he would compare himself to his younger sister, and really start getting upset. At one point he went in the bathroom with a pair of shears — he was going to cut his penis off.”\u003c/p>\n\u003cp>“This child has been so clear for a couple of years,” Anderson said. “These kids do come forward.”\u003c/p>\n\u003cp>\u003cstrong>Changing Approaches\u003c/strong>\u003c/p>\n\u003cp>Gender clinicians who recommend social transition at such an early age call their model “gender affirmative,” and they believe their approach is now ascendant. Historically, clinicians more commonly treated transgender kids by discouraging cross-gender identity. The method was most famously practiced by longtime gender researcher Ken Zucker.\u003c/p>\n\u003cp>Zucker is now an extraordinarily controversial figure in the transgender community. He believed that an outcome in which a child becomes transgender should be avoided, if possible. You can get a glimpse of his methods in this \u003ca href=\"https://www.npr.org/2008/05/07/90247842/two-families-grapple-with-sons-gender-preferences\" target=\"_blank\" rel=\"noopener\">NPR story\u003c/a> from 2008. Zucker is counseling the family of a young boy he’d diagnosed with gender identity disorder, the term used for gender dysphoria before 2013.\u003c/p>\n\u003cblockquote>\u003cp>Zucker explained to Carol that she and her husband would have to radically change their parenting. Bradley would no longer be allowed to spend time with girls. He would no longer be allowed to play with girlish toys or pretend that he was a female character. Zucker said that all of these activities were dangerous to a kid with gender identity disorder. He explained that unless Carol and her husband helped the child to change his behavior, as Bradley grew older, he likely would be rejected by both peer groups.\u003c/p>\u003c/blockquote>\n\u003cp>Other researchers and transgender activists have criticized this approach as too close to the “conversion therapy” inflicted on gay and lesbian youth, a practice that is now illegal in a number of states, including \u003ca href=\"https://www.sfgate.com/news/article/State-bans-gay-repair-therapy-for-minors-3906032.php\" target=\"_blank\" rel=\"noopener\">California\u003c/a>.\u003c/p>\n\u003cp>[emailsignup newslettername='science' align='right']The World Professional Association for Transgender Health's guidelines for clinicians, called the \u003ca href=\"https://www.wpath.org/publications/soc\" target=\"_blank\" rel=\"noopener\">Standards of Care\u003c/a>, states that “treatment aimed at trying to change a person’s gender identity and expression to become more congruent with sex assigned at birth” is “no longer considered ethical.”\u003c/p>\n\u003cp>Zucker was the psychologist-in-chief and head of the gender identity clinic at a Toronto mental health hospital before administrators shut down the clinic in 2015, after a review of his practices. That was also \u003ca href=\"https://www.theglobeandmail.com/life/health-and-fitness/health/alleged-exchange-with-gender-identity-doctor-didnt-happen-camh-says/article28471923/\" target=\"_blank\" rel=\"noopener\">controversial\u003c/a>, and Zucker is suing his former employer for defamation. (Zucker declined to comment for this article. For a defense of his work, you can read Jesse Singal’s \u003ca href=\"https://www.thecut.com/2016/02/fight-over-trans-kids-got-a-researcher-fired.html\" target=\"_blank\" rel=\"noopener\">reporting\u003c/a> from 2016.)\u003c/p>\n\u003cp>\u003cstrong>Watchful Waiting\u003c/strong>\u003c/p>\n\u003cp>Zucker’s approach aside, there is another alternative to gender affirmative therapy. It’s the approach taken by the \u003ca href=\"https://www.vumc.com/branch/gender-dysphoria/\" target=\"_blank\" rel=\"noopener\">Center of Expertise on Gender Dysphoria\u003c/a> in Amsterdam, and gender specialists commonly refer to it as the “Dutch Model.”\u003c/p>\n\u003cp>This treatment sometimes involves the social transition of young children, according to Thomas Steensma, a researcher and clinician at the center. But for the most part, its counseling incorporates the idea that the vast majority of gender dysphoric children will eventually stop identifying as transgender.\u003c/p>\n\u003cp>The research literature calls these individuals “desistant.” The kids who retain their transgender identity as they grow up are dubbed “persistent.”\u003c/p>\n\u003cp>\u003cstrong>The Desistance Controversy\u003c/strong>\u003c/p>\n\u003cp>Nothing roils the world of transgender research like the topic of \u003ca href=\"https://www.kqed.org/futureofyou/441784/the-controversial-research-on-desistance-in-transgender-youth\" target=\"_blank\" rel=\"noopener\">desistance\u003c/a>. Brynn Tannehill, a transgender activist who follows the research closely, said the concept is often used by anti-LGBT groups to make the case that rejecting children’s transgender identity is in their best interests.\u003c/p>\n\u003caside class=\"pullquote alignright\">'[Desistance research] is used primarily as an attack on the validity of transgender identities, which usually quickly disintegrates into a debate on whether we should exist.' \u003ccite>Brynn Tannehill, transgender activist\u003c/cite>.\u003c/aside>\n\u003cp>“It is used primarily as an attack on the validity of transgender identities, which usually quickly disintegrates into a debate on whether we should exist,” Tannehill said.\u003c/p>\n\u003cp>And yet, the fact is that just about every published study on the topic to date has found that a majority of children who once reported various degrees of gender dysphoria ended up eventually giving up their transgender identity.\u003c/p>\n\u003cp>To grasp the implications of this, remember Molly’s anxious questioning of the gender therapist: What if we go through all this, and it turns out to be just a phase? Shouldn’t we wait?\u003c/p>\n\u003cp>The gender affirmative camp says no. That’s because it doesn’t believe that the body of research on desistance, some of it conducted by Zucker and his associates, is valid.\u003c/p>\n\u003cp>Many gender researchers maintain that the current criteria for diagnosing gender dysphoria are much more stringent than in the past. Therefore, many of the studies that found so many kids had \"grown out\" of their transgender identity were actually measuring children who were \u003cem>never really transgender\u003c/em> in the first place.\u003c/p>\n\u003cp>“Some of those studies are decades old,” said gender researcher Kristina Olson. “So if you had a son in the early 1980s who liked playing with dolls and wanted to occasionally wear a dress, even today maybe you would think to bring that child to talk to a doctor about it. But that child wouldn't necessarily be transgender, because that kid doesn't necessarily think of himself as a girl.\"\u003c/p>\n\u003cp>Ehrensaft said that her San Francisco clinic sees “a tiny, tiny proportion” of clients who stop identifying as transgender after transitioning.\u003c/p>\n\u003cp>Even the Amsterdam clinic’s Thomas Steensma, who firmly believes most gender dysphoric kids will \u003cem>not\u003c/em> grow up to be transgender, acknowledged the earlier studies probably included “milder cases” that are “hard to compare with the clinical samples we see now in our clinics.”\u003c/p>\n\u003cfigure id=\"attachment_441834\" class=\"wp-caption alignright\" style=\"max-width: 720px\">\u003ca href=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2020/04/James.jpeg\">\u003cimg class=\"size-full wp-image-441834\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2020/04/James.jpeg\" alt=\"\" width=\"720\" height=\"960\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2020/04/James.jpeg 720w, https://ww2.kqed.org/app/uploads/sites/13/2020/04/James-160x213.jpeg 160w, https://ww2.kqed.org/app/uploads/sites/13/2020/04/James-240x320.jpeg 240w, https://ww2.kqed.org/app/uploads/sites/13/2020/04/James-375x500.jpeg 375w, https://ww2.kqed.org/app/uploads/sites/13/2020/04/James-520x693.jpeg 520w\" sizes=\"(max-width: 720px) 100vw, 720px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Olivia, a transgender girl who socially transitioned when she was four, and her brother, James, who transitioned when he was eight. \u003ccite>(Courtesy of family)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Nevertheless, he said, “The only evidence I have from studies and reports in the literature ... is that children who struggle with gender incongruence … will not all persist into adolescence.\"\u003c/p>\n\u003cp>Talking to Steensma over Skype, he seemed bemused by the fact that the “Dutch model” is now considered conservative compared to what has taken hold in America. After all, his Amsterdam clinic had been a pioneer in the medical treatment of transgender youth, especially in the use of puberty blockers, which delay the onset of secondary sex characteristics.\u003c/p>\n\u003cp>But what about the \u003cem>social transitioning\u003c/em> of young kids?\u003c/p>\n\u003cp>\"It's not a 'yes' or a 'no' in our opinion, but a 'maybe,' Steensma told me.\u003c/p>\n\u003cp>I wondered if there was any real argument between him and Ehrensaft, after all. So I described to him the case of persistent, insistent, consistent Gracie.\u003c/p>\n\u003cp>A slam dunk for social transition?\u003c/p>\n\u003cp>Steensma said no.\u003c/p>\n\u003cp>“We would counsel them ... that it's okay to express your feelings, your interests, to show your behaviors. But with certain steps like a name change, or a pronoun change, with a result that maybe others will only perceive you as a girl — that's somewhere where we say, ‘Okay, maybe you should explore things without taking steps that are hard to reverse.’”\u003c/p>\n\u003cp>There are mental health professionals in the U.S. who agree. Dr. Jack Drescher is a clinical professor of psychiatry at Columbia University; he served on the American Psychiatric Association's committee that revised the diagnosis of gender identity disorder in 2013. He said gender affirmative therapists have never proven they can successfully identify those kids who will stick with transgender identity.\u003c/p>\n\u003caside class=\"pullquote alignright\">'There are some people that think folks like myself, and the people at our clinic, have fallen off the deep end.”\u003ccite>Diane Ehrensaft, UCSF\u003c/cite>\u003c/aside>\n\u003cp>He also says there’s no evidence to back a corollary belief, that kids who might later need to “detransition” back to their original gender will not suffer any long-lasting psychological effects.\u003c/p>\n\u003cp>“This is what they believe, but it's not based on research,” he said of gender affirmative clinicians. “This is a meme, not really a piece of scientific finding.”\u003c/p>\n\u003cp>Steensma concurred: “If a child transitions, it is not just, ‘Oh, we do the transition and we go on with our life.’ It has a huge impact on the child, on the family and their environment.’”\u003c/p>\n\u003cp>The current Standards of Care, issued by the World Professional Association of Transgender Health in 2011, are more or less in accordance with this view, as even Ehrensaft acknowledges. The guidelines describe “relatively low persistence rates” as “relevant” to helping parents weigh the decision to socially transition. The standards also state that “a change back to the original gender role can be highly distressing.”\u003c/p>\n\u003cp>The one thing everyone in the field agrees on is more research is needed. Almost every gender specialist I spoke with cited Kristina Olson’s longitudinal study at the University of Washington as critical to answering some of these hotly debated unknowns. Olson recently received a $1 million grant from the National Science Foundation, which she's using to expand the study.\u003c/p>\n\u003cp>Preliminary research coming out of the project has already provided good news for the families of transgender kids. In a pair of studies published over the last several years, Olson and her colleagues found that socially transitioned children and adolescents between the ages of 3 and 14 did \u003ca href=\"https://www.kqed.org/stateofhealth/153172/transgender-children-living-openly-are-doing-well-study-shows\" target=\"_blank\" rel=\"noopener\">not experience\u003c/a> any more depression than separate control groups of peers and siblings, as well as the general population.\u003c/p>\n\u003cp>The transgender health association is now gearing up to revise the Standards of Care. Both Steensma, known for “watchful waiting,” and Ehrensaft, of the gender affirmative school, are on the committee in charge of the section about children. The jockeying to influence the direction of the committee has already begun, as evidenced by the critical \u003ca href=\"https://www.tandfonline.com/doi/full/10.1080/15532739.2018.1456390\" target=\"_blank\" rel=\"noopener\">commentaries\u003c/a> now appearing in academic \u003ca href=\"https://www.tandfonline.com/doi/abs/10.1080/15532739.2017.1414649\" target=\"_blank\" rel=\"noopener\">journals\u003c/a>.\u003c/p>\n\u003cp>“My prediction is that there will be more endorsement of social transitions at earlier ages, without the cautionary tales,” Ehrensaft said of the upcoming revision.\u003c/p>\n\u003cp>\u003cb>Not Just Numbers\u003c/b>\u003c/p>\n\u003cp>When it comes down to it, when we talk about the controversy over socially transitioning young kids, we are talking about risk analysis. Which is more disruptive and potentially harmful: to deny children their genuinely felt gender identity in the present moment, until the adults are \u003cem>absolutely sure\u003c/em> it will stick? Or to validate a child’s persistent, consistent and insistent protestations that ‘\u003cem>Hey, someone has made a terrible mistake here,\u003c/em>’ even if they eventually decide they no longer feel that way?\u003c/p>\n\u003cp>Ehrensaft, at least, is clear on the answer:\u003c/p>\n\u003cp>“Why would we deny for the vast majority of kids something that is basically suicide prevention?”\u003c/p>\n\u003cp>As a parent, I wonder: If my daughter became incandescently happy when allowed to change her name and take on other aspects of being transgender — as happy as Molly describes Gracie becoming when recognized as a girl — what would I do? If some statistics indicated my child might one day switch back, but my deepest parental instincts told me to trust her joyfulness, could I ignore the latter?\u003c/p>\n\u003cp>At Rainbow Day Camp, I spoke to James, a 9-year-old transgender boy who’d transitioned during second grade. He told me matter-of-factly that he’d been bullied by older kids, who’d called him an “It.”\u003c/p>\n\u003cp>After he transitioned, his mother said, “There was just this comfort that came about him, and comfort's something that you can't really fake. He’s [just] a happier kid.”\u003c/p>\n\u003cp>Similarly, before Gracie’s transition, family life was “lackluster,” Molly recalled. The constant tension drained the joy out of childhood for everybody.\u003c/p>\n\u003cp>“You never got to see that sort of sparkle, or that sort of magic of, like, a Christmas morning, or a Halloween, or just regular day-to-day happiness,” Molly said.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“Now she gets to really live.”\u003c/p>\n\n",
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"excerpt": "Many gender clinicians now recommend transgender kids as young as three be allowed to live publicly as the gender they identity with, even though studies have shown most kids won't stay transgender as they grow older. ",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003caside>\n\u003cul>\n\u003cli>Many gender clinicians now recommend parents 'socially transition' kids who persistently express a transgender identity.\u003c/li>\n\u003cli>But research has shown most children will give up their transgender identity by the time they are adolescents.\u003c/li>\n\u003cli>Not all researchers agree, though, that this research is valid.\u003c/li>\n\u003c/ul>\n\u003c/aside>\n\u003cp>Gracie is the youngest transgender person I've ever met. She's so young, she still likes to tack on \"and-a-half\" when giving her age, which is six. One day last summer, bouncing all over the grounds at day camp, she looked as delighted as you'd expect any kid would on \"Water Day.”\u003c/p>\n\u003caside class=\"alignright\">\u003ca href=\"https://www.kqed.org/futureofyou/441784/the-controversial-research-on-desistance-in-transgender-youth\">The Controversial Research on 'Desistance' in Transgender Youth\u003c/a>\u003c/aside>\n\u003cp>This is Rainbow Day Camp, in the East Bay town of El Cerrito. It was created specifically to be a safe place for transgender kids, and in fact, being transgender is so unremarkable here, when I asked Gracie what makes it “special,\" she shrugged and said:\u003c/p>\n\u003cp>“You get to do fun stuff.”\u003c/p>\n\u003cp>Her mother, Molly, tried to coax a reporter-friendly answer out of her.\u003c/p>\n\u003cp>“What is special about you, and the same as everybody else in the camp?” she prompted.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“I don’t know,” Gracie said.\u003c/p>\n\u003caside class=\"pullquote alignright\">'What if we let our son walk into the world in a dress with fairy wings, and crowns, and high heels, and even just in regular girl clothes … and then he changes his mind?'\u003ccite>Molly, whose 6-year-old daughter, Gracie, socially transitioned at age four\u003c/cite>\u003c/aside>\n\u003cp>“You’re transgender and there’s other kids that are transgender, too...”\u003c/p>\n\u003cp>“I’m transgender and there’s other kids that are transgender, too.”\u003c/p>\n\u003cp>Ah, kids. ... But when I asked Gracie how she \u003cem>used\u003c/em> to feel, when other people thought she was a boy, she got straight to the point.\u003c/p>\n\u003cp>“It was not right to me, and I didn’t want people to say that, but they said it,” she said. “It hurted my feelings a lot.\"\u003c/p>\n\u003cp>Did it make her angry?\u003c/p>\n\u003cp>“No, it just made me sad.”\u003c/p>\n\u003caside class=\"alignright\">\u003ca href=\"mailto:jbrooks@kqed.org\">Email the reporter\u003c/a>\u003c/aside>\n\u003cp>How about now?\u003c/p>\n\u003cp>“It feels happy to me.”\u003c/p>\n\u003cp>And that, in a child’s nutshell, sums up one side of a contentious debate about the right age for transgender children to begin what gender clinicians call “social transitioning.”\u003c/p>\u003c/p>\u003cp>\u003cspan class='utils-parseShortcode-shortcodes-__youtubeShortcode__embedYoutube'>\n \u003cspan class='utils-parseShortcode-shortcodes-__youtubeShortcode__embedYoutubeInside'>\n \u003ciframe\n loading='lazy'\n class='utils-parseShortcode-shortcodes-__youtubeShortcode__youtubePlayer'\n type='text/html'\n src='//www.youtube.com/embed/IS5Yankf1GY'\n title='//www.youtube.com/embed/IS5Yankf1GY'\n allowfullscreen='true'\n style='border:0;'>\u003c/iframe>\n \u003c/span>\n \u003c/span>\u003c/p>\u003cp>\u003cp>\u003cstrong>Even Three-Year-Olds\u003c/strong>\u003c/p>\n\u003cp>When I met Gracie, she was a few months out of kindergarten — pretty young for a transgender kid, I thought. Gracie lives with her parents and younger brother in a small city in the East Bay. She is already two years into her transition, having started her public life as a girl at four. The family began by discarding her boy name and referring to Gracie as “she” and “her.” She was also allowed to wear girl clothes outside the home, and her parents changed the gender on her birth certificate to avoid confusion at school.\u003c/p>\n\u003caside class=\"alignright noborder\">\u003cstrong>How young is too young?\u003c/strong>\u003cbr>\nUCSF’s Diane Ehrensaft, one of the leading proponents of socially transitioning transgender children, believes there is no minimum age, really, to pursue such a change.'For all of these interventions, our model is stages not ages,” she said. 'When a child is at the place in their life that they can get themselves in focus, help us see them, and are clear, consistent, and stable in both their representation of themselves, and also can express their desires of how they want to live their gender, that's the age.'We have seen some kids as young as two whose parents are bringing them in because they're beginning to say, ‘Me not boy. Me girl.’ Social transition can happen as soon as a child has language or the ability to communicate to us who they are.'\u003c/aside>\n\u003cp>Steps like these make up the “social” aspects of social, not medical, transitioning. The distinction is important: According to Endocrine Society \u003ca href=\"https://academic.oup.com/jcem/article/102/11/3869/4157558\" target=\"_blank\" rel=\"noopener\">guidelines\u003c/a>, patients who want to begin medical treatment like puberty blockers, hormones or surgery should be old enough to give “informed consent,” which the organization says is usually attained by 16.\u003c/p>\n\u003cp>Therapists at \u003ca href=\"https://www.ucsfbenioffchildrens.org/clinics/child_and_adolescent_gender_center/\" target=\"_blank\" rel=\"noopener\">UCSF’s Child and Adolescent Gender Center Clinic\u003c/a> in San Francisco told me they’ve socially transitioned kids as young as three.\u003c/p>\n\u003cp>Diane Ehrensaft, the San Francisco Center’s mental health director and a leading proponent of early social transitioning, acknowledges this approach has been controversial.\u003c/p>\n\u003cp>“There are some people that think folks like myself, and the people at our clinic, have fallen off the deep end,” she told me. She wasn’t just talking about the religious right, either. She was referring to other mental health professionals.\u003c/p>\n\u003cp>I myself experienced a fair bit of surprise when Ehrensaft told me how young these kids are. My first, reflexive comment was a simple, \"Wow.\" This was not an uncommon reaction when I discussed this story with people in my own life, even in the progressive Bay Area.\u003c/p>\n\u003cp>Yet, when I spoke with Gracie’s mom, Molly (the family didn't want their last name used for reasons of privacy), nothing about the decision to allow her then-son to publicly make the switch to a girl, at an age when many kids are still sucking their thumbs, sounded in the slightest bit rash.\u003c/p>\n\u003cp>We spoke at Rainbow Day Camp, in a classroom set aside for interviews. The children’s art adorning the walls, the shrimpy seats — it felt like a place to talk about kickball, not the gender identity of first graders.\u003c/p>\n\u003cp>Yet here we were.\u003c/p>\n\u003caside class=\"alignright\">\u003cstrong>The Biological Roots of Gender Identity\u003c/strong>\u003cbr>\nMolly is the mother of two children, a 3-year-old boy and a 7-year-old transgender girl. The younger child is the “stereotype of what I thought having a son would be like,” she said. “He loves trucks, cars, construction, superheroes and destroying the house.”Her first child, also born male, just did not develop in the same way. Rather, from the time he acquired language on, he protested that he was really a girl. (\u003ca href=\"https://www.kqed.org/futureofyou/the-biological-roots-of-gender-identity\" target=\"_blank\" rel=\"noopener\">Continue reading)\u003c/a>\u003c/aside>\n\u003cp>“What if we do this?” Molly recalled asking a gender therapist, back when they were debating the pros and cons of letting Gracie transition. “What if we let our son walk into the world in a dress with fairy wings, and crowns, and high heels, and even just in regular girl clothes … and then he changes his mind?”\u003c/p>\n\u003cp>\"That's not the question,” the therapist told Molly. “The question is, what if you don't do it?”\u003c/p>\n\u003cp>It was only semi-rhetorical. Some gender therapists say there are serious potential dangers if adults suppress a child’s desired transition. On surveys, American transgender adults have reported attempting suicide at the startling \u003ca href=\"https://williamsinstitute.law.ucla.edu/wp-content/uploads/AFSP-Williams-Suicide-Report-Final.pdf\" target=\"_blank\" rel=\"noopener\">rate\u003c/a> of around 40 percent.\u003c/p>\n\u003cp>The stakes couldn’t have been higher, Molly knew.\u003c/p>\n\u003cp>At Rainbow Day Camp, recalling that time, she started to cry.\u003c/p>\n\u003cp>“As soon as I knew there was even a chance that my kid could feel ashamed of who they are, there was no way … ” Her voice cracked into a higher register. “I had to support, I had to listen, and I had to let her steer, a little bit, the ship. Period. No matter what.”\u003c/p>\n\u003cfigure id=\"attachment_441862\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2020/04/gracie-sliding-water-1.jpg\">\u003cimg class=\"wp-image-441862 size-large\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2020/04/gracie-sliding-water-1-1020x527.jpg\" alt=\"\" width=\"640\" height=\"331\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2020/04/gracie-sliding-water-1-1020x527.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2020/04/gracie-sliding-water-1-160x83.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2020/04/gracie-sliding-water-1-800x414.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2020/04/gracie-sliding-water-1-768x397.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2020/04/gracie-sliding-water-1-1200x620.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/13/2020/04/gracie-sliding-water-1-1180x610.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2020/04/gracie-sliding-water-1-960x496.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2020/04/gracie-sliding-water-1-240x124.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2020/04/gracie-sliding-water-1-375x194.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2020/04/gracie-sliding-water-1-520x269.jpg 520w, https://ww2.kqed.org/app/uploads/sites/13/2020/04/gracie-sliding-water-1.jpg 1209w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Gracie, six, on Water Day at Rainbow Day Camp, which was created as a safe space for transgender kids. \u003ccite>(KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>‘I’m a Girl’\u003c/strong>\u003c/p>\n\u003cp>Ehrensaft calls children like Gracie “persistent, consistent, and insistent” in their declarations of cross-gender identity. For Gracie, this manifested through words, wishes, and, well, practically everything.\u003c/p>\n\u003caside class=\"pullquote alignright\">'Why would we deny for the vast majority of kids something that is basically suicide prevention?'\u003ccite>Diane Ehrensaft, UCSF\u003c/cite>\u003c/aside>\n\u003cp>Gracie was her parents' first child. From toddlerhood on, Molly said, their son had displayed a “constant obsession and fixation on all things girl. As soon as she could tell us, it was, ‘I'm a girl. I'm a sister. I'm a daughter. I'm that girl on that show. I'm that girl in that book.’”\u003c/p>\n\u003cp>Gracie's parents weren’t on board at first.\u003c/p>\n\u003cp>“We filled her world with trucks, and dinosaurs, and superheroes, and we refused girl things,” Molly said. “Like, ‘No, you can't be Elsa for Halloween. You have to be Superman. No, you can't have the dolls for Christmas. We're going to get you a pirate ship.’”\u003c/p>\n\u003cp>They also made a rule: No girl clothing outside the house.\u003c/p>\n\u003cp>Molly tells me: “That’s the part I’m ashamed of now.”\u003c/p>\n\u003cp>\u003cstrong>'These Kids Do Come Forward'\u003c/strong>\u003c/p>\n\u003cp>Molly and her husband finally relented — they just could not deny how much happier their child felt when recognized as a girl.\u003c/p>\n\u003cfigure id=\"attachment_441832\" class=\"wp-caption alignright\" style=\"max-width: 640px\">\u003ca href=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2020/04/Phoenix5-e1527011026777.jpg\">\u003cimg class=\"size-large wp-image-441832\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2020/04/Phoenix5-1020x1530.jpg\" alt=\"\" width=\"640\" height=\"960\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Phoenix, a transgender girl who began wearing dresses to school at age 5. She began made a complete social transition at the start of second grade. \u003ccite>(Courtesy of family)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>I asked: Has Gracie ever looked back?\u003c/p>\n\u003cp>Molly chuckled.\u003c/p>\n\u003cp>“If you think of gender as a spectrum, she is like a full, all-the-way girl.”\u003c/p>\n\u003cp>It’s not rocket science, Ehrensaft explained, if you really listen to the children. “A child will say: ‘Stop calling me Jane. Let me wear my dresses. Please call me she.’ That's a child making a clear statement.”\u003c/p>\n\u003cp>Kristina Olson, a University of Washington gender researcher, said parents do not always listen to what their kids are telling them.\u003c/p>\n\u003cp>“The ones that are most likely to transition are kids who for many years are very consistently saying this is who they are,” she said. ”We often see this happen for years before parents socially transition their kids.”\u003c/p>\n\u003cp>UCSF gender specialist Erica Anderson recently treated a five-year-old who had reached a point of desperation.\u003c/p>\n\u003cp>“In the bathtub, he would compare himself to his younger sister, and really start getting upset. At one point he went in the bathroom with a pair of shears — he was going to cut his penis off.”\u003c/p>\n\u003cp>“This child has been so clear for a couple of years,” Anderson said. “These kids do come forward.”\u003c/p>\n\u003cp>\u003cstrong>Changing Approaches\u003c/strong>\u003c/p>\n\u003cp>Gender clinicians who recommend social transition at such an early age call their model “gender affirmative,” and they believe their approach is now ascendant. Historically, clinicians more commonly treated transgender kids by discouraging cross-gender identity. The method was most famously practiced by longtime gender researcher Ken Zucker.\u003c/p>\n\u003cp>Zucker is now an extraordinarily controversial figure in the transgender community. He believed that an outcome in which a child becomes transgender should be avoided, if possible. You can get a glimpse of his methods in this \u003ca href=\"https://www.npr.org/2008/05/07/90247842/two-families-grapple-with-sons-gender-preferences\" target=\"_blank\" rel=\"noopener\">NPR story\u003c/a> from 2008. Zucker is counseling the family of a young boy he’d diagnosed with gender identity disorder, the term used for gender dysphoria before 2013.\u003c/p>\n\u003cblockquote>\u003cp>Zucker explained to Carol that she and her husband would have to radically change their parenting. Bradley would no longer be allowed to spend time with girls. He would no longer be allowed to play with girlish toys or pretend that he was a female character. Zucker said that all of these activities were dangerous to a kid with gender identity disorder. He explained that unless Carol and her husband helped the child to change his behavior, as Bradley grew older, he likely would be rejected by both peer groups.\u003c/p>\u003c/blockquote>\n\u003cp>Other researchers and transgender activists have criticized this approach as too close to the “conversion therapy” inflicted on gay and lesbian youth, a practice that is now illegal in a number of states, including \u003ca href=\"https://www.sfgate.com/news/article/State-bans-gay-repair-therapy-for-minors-3906032.php\" target=\"_blank\" rel=\"noopener\">California\u003c/a>.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>The World Professional Association for Transgender Health's guidelines for clinicians, called the \u003ca href=\"https://www.wpath.org/publications/soc\" target=\"_blank\" rel=\"noopener\">Standards of Care\u003c/a>, states that “treatment aimed at trying to change a person’s gender identity and expression to become more congruent with sex assigned at birth” is “no longer considered ethical.”\u003c/p>\n\u003cp>Zucker was the psychologist-in-chief and head of the gender identity clinic at a Toronto mental health hospital before administrators shut down the clinic in 2015, after a review of his practices. That was also \u003ca href=\"https://www.theglobeandmail.com/life/health-and-fitness/health/alleged-exchange-with-gender-identity-doctor-didnt-happen-camh-says/article28471923/\" target=\"_blank\" rel=\"noopener\">controversial\u003c/a>, and Zucker is suing his former employer for defamation. (Zucker declined to comment for this article. For a defense of his work, you can read Jesse Singal’s \u003ca href=\"https://www.thecut.com/2016/02/fight-over-trans-kids-got-a-researcher-fired.html\" target=\"_blank\" rel=\"noopener\">reporting\u003c/a> from 2016.)\u003c/p>\n\u003cp>\u003cstrong>Watchful Waiting\u003c/strong>\u003c/p>\n\u003cp>Zucker’s approach aside, there is another alternative to gender affirmative therapy. It’s the approach taken by the \u003ca href=\"https://www.vumc.com/branch/gender-dysphoria/\" target=\"_blank\" rel=\"noopener\">Center of Expertise on Gender Dysphoria\u003c/a> in Amsterdam, and gender specialists commonly refer to it as the “Dutch Model.”\u003c/p>\n\u003cp>This treatment sometimes involves the social transition of young children, according to Thomas Steensma, a researcher and clinician at the center. But for the most part, its counseling incorporates the idea that the vast majority of gender dysphoric children will eventually stop identifying as transgender.\u003c/p>\n\u003cp>The research literature calls these individuals “desistant.” The kids who retain their transgender identity as they grow up are dubbed “persistent.”\u003c/p>\n\u003cp>\u003cstrong>The Desistance Controversy\u003c/strong>\u003c/p>\n\u003cp>Nothing roils the world of transgender research like the topic of \u003ca href=\"https://www.kqed.org/futureofyou/441784/the-controversial-research-on-desistance-in-transgender-youth\" target=\"_blank\" rel=\"noopener\">desistance\u003c/a>. Brynn Tannehill, a transgender activist who follows the research closely, said the concept is often used by anti-LGBT groups to make the case that rejecting children’s transgender identity is in their best interests.\u003c/p>\n\u003caside class=\"pullquote alignright\">'[Desistance research] is used primarily as an attack on the validity of transgender identities, which usually quickly disintegrates into a debate on whether we should exist.' \u003ccite>Brynn Tannehill, transgender activist\u003c/cite>.\u003c/aside>\n\u003cp>“It is used primarily as an attack on the validity of transgender identities, which usually quickly disintegrates into a debate on whether we should exist,” Tannehill said.\u003c/p>\n\u003cp>And yet, the fact is that just about every published study on the topic to date has found that a majority of children who once reported various degrees of gender dysphoria ended up eventually giving up their transgender identity.\u003c/p>\n\u003cp>To grasp the implications of this, remember Molly’s anxious questioning of the gender therapist: What if we go through all this, and it turns out to be just a phase? Shouldn’t we wait?\u003c/p>\n\u003cp>The gender affirmative camp says no. That’s because it doesn’t believe that the body of research on desistance, some of it conducted by Zucker and his associates, is valid.\u003c/p>\n\u003cp>Many gender researchers maintain that the current criteria for diagnosing gender dysphoria are much more stringent than in the past. Therefore, many of the studies that found so many kids had \"grown out\" of their transgender identity were actually measuring children who were \u003cem>never really transgender\u003c/em> in the first place.\u003c/p>\n\u003cp>“Some of those studies are decades old,” said gender researcher Kristina Olson. “So if you had a son in the early 1980s who liked playing with dolls and wanted to occasionally wear a dress, even today maybe you would think to bring that child to talk to a doctor about it. But that child wouldn't necessarily be transgender, because that kid doesn't necessarily think of himself as a girl.\"\u003c/p>\n\u003cp>Ehrensaft said that her San Francisco clinic sees “a tiny, tiny proportion” of clients who stop identifying as transgender after transitioning.\u003c/p>\n\u003cp>Even the Amsterdam clinic’s Thomas Steensma, who firmly believes most gender dysphoric kids will \u003cem>not\u003c/em> grow up to be transgender, acknowledged the earlier studies probably included “milder cases” that are “hard to compare with the clinical samples we see now in our clinics.”\u003c/p>\n\u003cfigure id=\"attachment_441834\" class=\"wp-caption alignright\" style=\"max-width: 720px\">\u003ca href=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2020/04/James.jpeg\">\u003cimg class=\"size-full wp-image-441834\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2020/04/James.jpeg\" alt=\"\" width=\"720\" height=\"960\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2020/04/James.jpeg 720w, https://ww2.kqed.org/app/uploads/sites/13/2020/04/James-160x213.jpeg 160w, https://ww2.kqed.org/app/uploads/sites/13/2020/04/James-240x320.jpeg 240w, https://ww2.kqed.org/app/uploads/sites/13/2020/04/James-375x500.jpeg 375w, https://ww2.kqed.org/app/uploads/sites/13/2020/04/James-520x693.jpeg 520w\" sizes=\"(max-width: 720px) 100vw, 720px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Olivia, a transgender girl who socially transitioned when she was four, and her brother, James, who transitioned when he was eight. \u003ccite>(Courtesy of family)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Nevertheless, he said, “The only evidence I have from studies and reports in the literature ... is that children who struggle with gender incongruence … will not all persist into adolescence.\"\u003c/p>\n\u003cp>Talking to Steensma over Skype, he seemed bemused by the fact that the “Dutch model” is now considered conservative compared to what has taken hold in America. After all, his Amsterdam clinic had been a pioneer in the medical treatment of transgender youth, especially in the use of puberty blockers, which delay the onset of secondary sex characteristics.\u003c/p>\n\u003cp>But what about the \u003cem>social transitioning\u003c/em> of young kids?\u003c/p>\n\u003cp>\"It's not a 'yes' or a 'no' in our opinion, but a 'maybe,' Steensma told me.\u003c/p>\n\u003cp>I wondered if there was any real argument between him and Ehrensaft, after all. So I described to him the case of persistent, insistent, consistent Gracie.\u003c/p>\n\u003cp>A slam dunk for social transition?\u003c/p>\n\u003cp>Steensma said no.\u003c/p>\n\u003cp>“We would counsel them ... that it's okay to express your feelings, your interests, to show your behaviors. But with certain steps like a name change, or a pronoun change, with a result that maybe others will only perceive you as a girl — that's somewhere where we say, ‘Okay, maybe you should explore things without taking steps that are hard to reverse.’”\u003c/p>\n\u003cp>There are mental health professionals in the U.S. who agree. Dr. Jack Drescher is a clinical professor of psychiatry at Columbia University; he served on the American Psychiatric Association's committee that revised the diagnosis of gender identity disorder in 2013. He said gender affirmative therapists have never proven they can successfully identify those kids who will stick with transgender identity.\u003c/p>\n\u003caside class=\"pullquote alignright\">'There are some people that think folks like myself, and the people at our clinic, have fallen off the deep end.”\u003ccite>Diane Ehrensaft, UCSF\u003c/cite>\u003c/aside>\n\u003cp>He also says there’s no evidence to back a corollary belief, that kids who might later need to “detransition” back to their original gender will not suffer any long-lasting psychological effects.\u003c/p>\n\u003cp>“This is what they believe, but it's not based on research,” he said of gender affirmative clinicians. “This is a meme, not really a piece of scientific finding.”\u003c/p>\n\u003cp>Steensma concurred: “If a child transitions, it is not just, ‘Oh, we do the transition and we go on with our life.’ It has a huge impact on the child, on the family and their environment.’”\u003c/p>\n\u003cp>The current Standards of Care, issued by the World Professional Association of Transgender Health in 2011, are more or less in accordance with this view, as even Ehrensaft acknowledges. The guidelines describe “relatively low persistence rates” as “relevant” to helping parents weigh the decision to socially transition. The standards also state that “a change back to the original gender role can be highly distressing.”\u003c/p>\n\u003cp>The one thing everyone in the field agrees on is more research is needed. Almost every gender specialist I spoke with cited Kristina Olson’s longitudinal study at the University of Washington as critical to answering some of these hotly debated unknowns. Olson recently received a $1 million grant from the National Science Foundation, which she's using to expand the study.\u003c/p>\n\u003cp>Preliminary research coming out of the project has already provided good news for the families of transgender kids. In a pair of studies published over the last several years, Olson and her colleagues found that socially transitioned children and adolescents between the ages of 3 and 14 did \u003ca href=\"https://www.kqed.org/stateofhealth/153172/transgender-children-living-openly-are-doing-well-study-shows\" target=\"_blank\" rel=\"noopener\">not experience\u003c/a> any more depression than separate control groups of peers and siblings, as well as the general population.\u003c/p>\n\u003cp>The transgender health association is now gearing up to revise the Standards of Care. Both Steensma, known for “watchful waiting,” and Ehrensaft, of the gender affirmative school, are on the committee in charge of the section about children. The jockeying to influence the direction of the committee has already begun, as evidenced by the critical \u003ca href=\"https://www.tandfonline.com/doi/full/10.1080/15532739.2018.1456390\" target=\"_blank\" rel=\"noopener\">commentaries\u003c/a> now appearing in academic \u003ca href=\"https://www.tandfonline.com/doi/abs/10.1080/15532739.2017.1414649\" target=\"_blank\" rel=\"noopener\">journals\u003c/a>.\u003c/p>\n\u003cp>“My prediction is that there will be more endorsement of social transitions at earlier ages, without the cautionary tales,” Ehrensaft said of the upcoming revision.\u003c/p>\n\u003cp>\u003cb>Not Just Numbers\u003c/b>\u003c/p>\n\u003cp>When it comes down to it, when we talk about the controversy over socially transitioning young kids, we are talking about risk analysis. Which is more disruptive and potentially harmful: to deny children their genuinely felt gender identity in the present moment, until the adults are \u003cem>absolutely sure\u003c/em> it will stick? Or to validate a child’s persistent, consistent and insistent protestations that ‘\u003cem>Hey, someone has made a terrible mistake here,\u003c/em>’ even if they eventually decide they no longer feel that way?\u003c/p>\n\u003cp>Ehrensaft, at least, is clear on the answer:\u003c/p>\n\u003cp>“Why would we deny for the vast majority of kids something that is basically suicide prevention?”\u003c/p>\n\u003cp>As a parent, I wonder: If my daughter became incandescently happy when allowed to change her name and take on other aspects of being transgender — as happy as Molly describes Gracie becoming when recognized as a girl — what would I do? If some statistics indicated my child might one day switch back, but my deepest parental instincts told me to trust her joyfulness, could I ignore the latter?\u003c/p>\n\u003cp>At Rainbow Day Camp, I spoke to James, a 9-year-old transgender boy who’d transitioned during second grade. He told me matter-of-factly that he’d been bullied by older kids, who’d called him an “It.”\u003c/p>\n\u003cp>After he transitioned, his mother said, “There was just this comfort that came about him, and comfort's something that you can't really fake. He’s [just] a happier kid.”\u003c/p>\n\u003cp>Similarly, before Gracie’s transition, family life was “lackluster,” Molly recalled. The constant tension drained the joy out of childhood for everybody.\u003c/p>\n\u003cp>“You never got to see that sort of sparkle, or that sort of magic of, like, a Christmas morning, or a Halloween, or just regular day-to-day happiness,” Molly said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"disqusTitle": "Genetic Tests Can Hurt Your Chances Of Getting Some Types Of Insurance",
"title": "Genetic Tests Can Hurt Your Chances Of Getting Some Types Of Insurance",
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"content": "\u003cp>Taking a genetic test in your 20s or 30s could, indeed, affect your ability to get long-term-care insurance later — or at least the price you'll pay. And people who are considering enrolling in Medicare \u003cem>after\u003c/em> age 65 would do well to read the fine print of the sign-up rules. Readers have insurance questions on these topics this month, and we have answers:\u003c/p>\n\u003cp>\u003cstrong>Q: Can getting a genetic test interfere with being able to buy long-term-care insurance in the future? If you do get a plan, can the insurer drop you after you find out the results of a genetic test?\u003c/strong>\u003c/p>\n\u003cp>In general, long-term-care insurers \u003ca href=\"https://www.npr.org/sections/health-shots/2018/07/11/627287642/has-genetic-privacy-been-strained-by-trumps-recent-aca-moves\" target=\"_blank\" rel=\"noopener\">can indeed use genetic test results\u003c/a> when they decide whether to offer you coverage. The federal Genetic Information Nondiscrimination Act does prohibit insurers from asking for or using your genetic information to make decisions about whether to sell you \u003cem>health\u003c/em> insurance or how much to charge you. But those privacy protections don't apply to long-term-care policies, life insurance or disability insurance.[contextly_sidebar id=\"qQSelkzIcg9rHvmpdeoo1Q3hIhLbJVzz\"]\u003c/p>\n\u003cp>When you apply for a long-term-care policy, the insurer is permitted to review your medical records and ask you questions about your health history and that of your family. It's all part of the underwriting process to determine whether to offer you a policy and how much to charge.\u003c/p>\n\u003cp>If the insurer asks you whether you've undergone genetic testing, you generally must disclose it, even if the testing was performed through a direct-to-consumer site like 23andMe, says Catherine Theroux, a spokeswoman for \u003ca href=\"https://www.limra.com/News_Center/\" target=\"_blank\" rel=\"noopener\">LIMRA\u003c/a>, an insurance industry trade group.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"You need to release any medically relevant information,\" she says.\u003c/p>\n\u003cp>Some states provide extra consumer protections related to genetic testing and long-term-care insurance, says \u003ca href=\"https://www.law.gwu.edu/sonia-m-suter\" target=\"_blank\" rel=\"noopener\">Sonia Mateu Suter\u003c/a>, a law professor at George Washington University who specializes in genetics and the law. But most follow federal law.\u003c/p>\n\u003cp>If you get genetic testing after you have a policy, the results can't affect your coverage.\u003c/p>\n\u003cp>\"Once the policy has been underwritten and issued, the insurer doesn't revoke the policy if new medical information comes to light,\" Theroux says.\u003c/p>\n\u003cp>\u003cstrong>Q: Can I switch Medigap insurance companies midway through the year? I found a less expensive policy.\u003c/strong>\u003c/p>\n\u003cp>It depends. Under federal law, when people turn 65 and first enroll in Medicare Part B they have a six-month window to sign up for a \u003ca href=\"https://www.medicare.gov/supplement-other-insurance/medigap/whats-medigap.html\" target=\"_blank\" rel=\"noopener\">Medigap plan\u003c/a> — a commercial policy that picks up some of the out-of-pocket costs for services that Medicare doesn't cover. (\u003ca href=\"https://www.medicare.gov/what-medicare-covers/part-a/what-part-a-covers.html\" target=\"_blank\" rel=\"noopener\">Medicare Part A covers\u003c/a> hospitalization, and \u003ca href=\"https://www.medicare.gov/what-medicare-covers/part-b/what-medicare-part-b-covers.html\" target=\"_blank\" rel=\"noopener\">Medicare Part B covers\u003c/a> outpatient services.) During that six-month period, insurers have to accept enrollees, even if they have health problems.[contextly_sidebar id=\"AH3oYgfcAwGcfBrC61gPsQfir4oB7Yc7\"]\u003c/p>\n\u003cp>If you're still within that six-month period now and you want to switch plans, go right ahead.\u003c/p>\n\u003cp>But if you're past the six-month window, under federal law, insurers are required to sell you a plan only in certain circumstances — such as if you lose your retiree coverage or Medicare Advantage plan. If you don't meet the criteria, insurers can decline to cover you or charge you more for preexisting medical conditions.\u003c/p>\n\u003cp>Many states have provided more robust protections, however. Three states — Connecticut, Massachusetts and New York — have year-round open enrollment and require insurers to offer coverage. And Maine requires a one-month \"guaranteed issue\" open-enrollment period every year.\u003c/p>\n\u003cp>Some states guarantee current policyholders a chance to switch Medigap plans at certain points during the year. Other states have \u003ca href=\"https://www.kff.org/medicare/issue-brief/medigap-enrollment-and-consumer-protections-vary-across-states/\" target=\"_blank\" rel=\"noopener\">additional qualifying events\u003c/a> that allow people to switch Medigap plans, according to data from the Kaiser Family Foundation.\u003c/p>\n\u003cp>\"The first thing the person should do is check with her state insurance department to find out her rights related to buying a Medigap plan,\" says \u003ca href=\"https://www.ncoa.org/centerforbenefits/about-the-center/\" target=\"_blank\" rel=\"noopener\">Brandy Bauer\u003c/a>, associate director at the Center for Benefits Access at the National Council on Aging. If you decide to go ahead and switch, she says, it is wise to sign up for a new plan before terminating your current policy.[contextly_sidebar id=\"t6VA7YIl0My5E1I6mIhIw1XmFGiwNdrT\"]\u003c/p>\n\u003cp>\u003cstrong>Q: I did not enroll in Medicare Part B when I turned 65 because I already have a regular plan that covers everything. I was told that the insurer would keep paying as usual, but now the company says it will pay only part and that I have to buy Medicare Part B. I didn't want to pay for two policies. Is there anything I can do to avoid that?\u003c/strong>\u003c/p>\n\u003cp>From your description, it's hard to know exactly what's going on, but we can make educated guesses. Typically, when people turn 65, it makes sense to sign up for Medicare unless they or their spouse are working and getting health insurance from an employer. For others, at age 65, Medicare typically becomes their primary insurer and any other coverage they have becomes secondary, filling in gaps in Medicare coverage.\u003c/p>\n\u003cp>If you have an individual policy that you bought on the health insurance exchange, and decide to hang on to it instead of signing up for Medicare, your premiums and other costs could be higher than they would be on Medicare, depending on your income.\u003c/p>\n\u003cp>But if you're not receiving employee coverage and you don't enroll in Medicare Part B, you could be subject to a permanent \u003ca href=\"https://www.medicare.gov/your-medicare-costs/part-b-costs/penalty/part-b-late-enrollment-penalty.html\" target=\"_blank\" rel=\"noopener\">late enrollment penalty\u003c/a> of 10 percent of the policy's premium for every 12 months that you could have signed up for Part B but didn't.\u003c/p>\n\u003cp>You could also owe a premium penalty for not signing up for a Part D prescription drug plan. (Most people don't owe any premium for Medicare Part A, so there's no penalty for late sign-up.)\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Your best move now may be to call 800-Medicare or visit your local \u003ca href=\"https://www.medicare.gov/contacts/#resources/ships\" target=\"_blank\" rel=\"noopener\">state health insurance assistance program\u003c/a> to help sort out your coverage issues, including whether to drop your current coverage and sign up for Medicare Part B and Part D.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 Kaiser Health News. To see more, visit \u003ca href=\"http://www.kaiserhealthnews.org/\" target=\"_blank\" rel=\"noopener\">Kaiser Health News\u003c/a>.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Genetic+Tests+Can+Hurt+Your+Chances+Of+Getting+Some+Types+Of+Insurance&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"excerpt": "Federal law keeps insurers from using genetic test results when pricing and issuing health insurance. But the tests might keep you from being able to get life insurance or a long-term-care policy.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Taking a genetic test in your 20s or 30s could, indeed, affect your ability to get long-term-care insurance later — or at least the price you'll pay. And people who are considering enrolling in Medicare \u003cem>after\u003c/em> age 65 would do well to read the fine print of the sign-up rules. Readers have insurance questions on these topics this month, and we have answers:\u003c/p>\n\u003cp>\u003cstrong>Q: Can getting a genetic test interfere with being able to buy long-term-care insurance in the future? If you do get a plan, can the insurer drop you after you find out the results of a genetic test?\u003c/strong>\u003c/p>\n\u003cp>In general, long-term-care insurers \u003ca href=\"https://www.npr.org/sections/health-shots/2018/07/11/627287642/has-genetic-privacy-been-strained-by-trumps-recent-aca-moves\" target=\"_blank\" rel=\"noopener\">can indeed use genetic test results\u003c/a> when they decide whether to offer you coverage. The federal Genetic Information Nondiscrimination Act does prohibit insurers from asking for or using your genetic information to make decisions about whether to sell you \u003cem>health\u003c/em> insurance or how much to charge you. But those privacy protections don't apply to long-term-care policies, life insurance or disability insurance.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>When you apply for a long-term-care policy, the insurer is permitted to review your medical records and ask you questions about your health history and that of your family. It's all part of the underwriting process to determine whether to offer you a policy and how much to charge.\u003c/p>\n\u003cp>If the insurer asks you whether you've undergone genetic testing, you generally must disclose it, even if the testing was performed through a direct-to-consumer site like 23andMe, says Catherine Theroux, a spokeswoman for \u003ca href=\"https://www.limra.com/News_Center/\" target=\"_blank\" rel=\"noopener\">LIMRA\u003c/a>, an insurance industry trade group.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"You need to release any medically relevant information,\" she says.\u003c/p>\n\u003cp>Some states provide extra consumer protections related to genetic testing and long-term-care insurance, says \u003ca href=\"https://www.law.gwu.edu/sonia-m-suter\" target=\"_blank\" rel=\"noopener\">Sonia Mateu Suter\u003c/a>, a law professor at George Washington University who specializes in genetics and the law. But most follow federal law.\u003c/p>\n\u003cp>If you get genetic testing after you have a policy, the results can't affect your coverage.\u003c/p>\n\u003cp>\"Once the policy has been underwritten and issued, the insurer doesn't revoke the policy if new medical information comes to light,\" Theroux says.\u003c/p>\n\u003cp>\u003cstrong>Q: Can I switch Medigap insurance companies midway through the year? I found a less expensive policy.\u003c/strong>\u003c/p>\n\u003cp>It depends. Under federal law, when people turn 65 and first enroll in Medicare Part B they have a six-month window to sign up for a \u003ca href=\"https://www.medicare.gov/supplement-other-insurance/medigap/whats-medigap.html\" target=\"_blank\" rel=\"noopener\">Medigap plan\u003c/a> — a commercial policy that picks up some of the out-of-pocket costs for services that Medicare doesn't cover. (\u003ca href=\"https://www.medicare.gov/what-medicare-covers/part-a/what-part-a-covers.html\" target=\"_blank\" rel=\"noopener\">Medicare Part A covers\u003c/a> hospitalization, and \u003ca href=\"https://www.medicare.gov/what-medicare-covers/part-b/what-medicare-part-b-covers.html\" target=\"_blank\" rel=\"noopener\">Medicare Part B covers\u003c/a> outpatient services.) During that six-month period, insurers have to accept enrollees, even if they have health problems.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>If you're still within that six-month period now and you want to switch plans, go right ahead.\u003c/p>\n\u003cp>But if you're past the six-month window, under federal law, insurers are required to sell you a plan only in certain circumstances — such as if you lose your retiree coverage or Medicare Advantage plan. If you don't meet the criteria, insurers can decline to cover you or charge you more for preexisting medical conditions.\u003c/p>\n\u003cp>Many states have provided more robust protections, however. Three states — Connecticut, Massachusetts and New York — have year-round open enrollment and require insurers to offer coverage. And Maine requires a one-month \"guaranteed issue\" open-enrollment period every year.\u003c/p>\n\u003cp>Some states guarantee current policyholders a chance to switch Medigap plans at certain points during the year. Other states have \u003ca href=\"https://www.kff.org/medicare/issue-brief/medigap-enrollment-and-consumer-protections-vary-across-states/\" target=\"_blank\" rel=\"noopener\">additional qualifying events\u003c/a> that allow people to switch Medigap plans, according to data from the Kaiser Family Foundation.\u003c/p>\n\u003cp>\"The first thing the person should do is check with her state insurance department to find out her rights related to buying a Medigap plan,\" says \u003ca href=\"https://www.ncoa.org/centerforbenefits/about-the-center/\" target=\"_blank\" rel=\"noopener\">Brandy Bauer\u003c/a>, associate director at the Center for Benefits Access at the National Council on Aging. If you decide to go ahead and switch, she says, it is wise to sign up for a new plan before terminating your current policy.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\u003cstrong>Q: I did not enroll in Medicare Part B when I turned 65 because I already have a regular plan that covers everything. I was told that the insurer would keep paying as usual, but now the company says it will pay only part and that I have to buy Medicare Part B. I didn't want to pay for two policies. Is there anything I can do to avoid that?\u003c/strong>\u003c/p>\n\u003cp>From your description, it's hard to know exactly what's going on, but we can make educated guesses. Typically, when people turn 65, it makes sense to sign up for Medicare unless they or their spouse are working and getting health insurance from an employer. For others, at age 65, Medicare typically becomes their primary insurer and any other coverage they have becomes secondary, filling in gaps in Medicare coverage.\u003c/p>\n\u003cp>If you have an individual policy that you bought on the health insurance exchange, and decide to hang on to it instead of signing up for Medicare, your premiums and other costs could be higher than they would be on Medicare, depending on your income.\u003c/p>\n\u003cp>But if you're not receiving employee coverage and you don't enroll in Medicare Part B, you could be subject to a permanent \u003ca href=\"https://www.medicare.gov/your-medicare-costs/part-b-costs/penalty/part-b-late-enrollment-penalty.html\" target=\"_blank\" rel=\"noopener\">late enrollment penalty\u003c/a> of 10 percent of the policy's premium for every 12 months that you could have signed up for Part B but didn't.\u003c/p>\n\u003cp>You could also owe a premium penalty for not signing up for a Part D prescription drug plan. (Most people don't owe any premium for Medicare Part A, so there's no penalty for late sign-up.)\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Your best move now may be to call 800-Medicare or visit your local \u003ca href=\"https://www.medicare.gov/contacts/#resources/ships\" target=\"_blank\" rel=\"noopener\">state health insurance assistance program\u003c/a> to help sort out your coverage issues, including whether to drop your current coverage and sign up for Medicare Part B and Part D.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 Kaiser Health News. To see more, visit \u003ca href=\"http://www.kaiserhealthnews.org/\" target=\"_blank\" rel=\"noopener\">Kaiser Health News\u003c/a>.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Genetic+Tests+Can+Hurt+Your+Chances+Of+Getting+Some+Types+Of+Insurance&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Separating Kids From Their Parents Can Lead To Long-Term Health Problems",
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"content": "\u003cp>Rachel Osborn knows kids who slept in the immigrant detention centers in Texas that have dominated recent headlines.\u003c/p>\n\u003cp>\"We have kids who will say that was the worst part of their journey,\" Osborn says. \"They were traveling for weeks and the hardest part was being in this freezing cold room where, you know, they were fed a cold sandwich and had a thin blanket to shiver under.\"\u003c/p>\n\u003cp>And they had no parent or caregiver to comfort them and make them feel safe.\u003c/p>\n\u003cp>Osborn is a therapist at \u003ca href=\"https://www.maryscenter.org/\" target=\"_blank\" rel=\"noopener\">Mary's Center\u003c/a> in Washington, D.C., who works in schools with children who immigrated from Latin America to the U.S. without their parents. The kids she works with weren't forcefully taken from their parents by U.S. immigration agents, but the trauma, Osborn says, is similar.\u003c/p>\n\u003cp>Thousands of kids were taken from their parents by immigration officials and placed in detention facilities under the Trump administration policy that was in place from April until \u003ca href=\"https://www.npr.org/2018/06/20/621798823/speaker-ryan-plans-immigration-votes-amid-doubts-that-bills-can-pass\" target=\"_blank\" rel=\"noopener\">it was changed Wednesday\u003c/a>.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Researchers suggest these children, and others who have spent time in those detention facilities, may have increased long-term health care needs. That's because the stress of being separated from a parent can also cause lasting \u003ca href=\"https://www.cdc.gov/violenceprevention/acestudy/journal.html\" target=\"_blank\" rel=\"noopener\">physical harm \u003c/a>to children.\u003c/p>\n\u003cp>These harms can include reduced immune system functioning in the short term, and increased risk of heart disease, diabetes or other chronic health problems in the long term.\u003c/p>\n\u003cp>Kids, like everyone, have a physical response to stress. The heart rate speeds up and the body releases hormones like cortisol. But when they don't have a parent or adult that they trust to comfort them, a prolonged stress response can become toxic and cause physical damage.\u003c/p>\n\u003cp>\"The most powerful stress buffer known to humans is the presence and availability of the parents for young children,\" says \u003ca href=\"https://cnbd.umn.edu/bio/cnbd-faculty-staff/megan-gunnar\" target=\"_blank\" rel=\"noopener\">Megan Gunnar\u003c/a>, a professor at the Center for Neurobehavioral Development at the University of Minnesota Medical School.\u003c/p>\n\u003cp>It's impossible to know which of the detained kids may see damage to their health or how severe that damage may be.\u003c/p>\n\u003cp>But the conditions are there, according to Nithya Nathan-Pineau, who works for the detained children's program at the \u003ca href=\"https://www.caircoalition.org/\" target=\"_blank\" rel=\"noopener\">Capital Area Immigrants Rights Coalition,\u003c/a> in Washington, D.C. Her organization advocates for the rights of immigrants and has direct contact with some children who were separated from their parents under the Trump administration policy.\u003c/p>\n\u003cp>\"We talk to these kids directly. What we're seeing is that they are extraordinarily traumatized,\" she says.\u003c/p>\n\u003cp>She describes a meeting with a 10-year-old child in a government detention center.\u003c/p>\n\u003cp>\"Essentially during the first intake [the child] couldn't really report anything to us because the child was so distraught they just cried through the whole intake,\" she says.\u003c/p>\n\u003cp>When she went back later, she found out what was going on. \"We learned that at this point they had been in the area for over four weeks and the child has not been able to speak with their parent,\" she says. \"They don't know where their parent is.\"\u003c/p>\n\u003cp>Without a parent's comfort, a child's stress response can go into overdrive, explains \u003ca href=\"https://www.npr.org/2017/08/25/545092982/nadine-burke-harris-how-does-trauma-affect-a-childs-dna\" target=\"_blank\" rel=\"noopener\">Dr. Nadine Burke Harris\u003c/a>, CEO of the Center for Youth Wellness in San Francisco.\u003c/p>\n\u003cp>The center includes a clinic that treats kids who have gone through trauma, and it also conducts research on the effects of trauma on children and ways to counter them.\u003c/p>\n\u003cp>Burke Harris says when children are comforted by their parents, they produce more of the hormone oxytocin, which helps relieve the stress response.\u003c/p>\n\u003cp>\"People call it the cuddle hormone,\" she says. \"It helps to shut off the stress response when it's activated. But it also helps to protect our organs from damage when the stress response is activated.\"\u003c/p>\n\u003cp>And that leads to many different health problems, she says, including \"changes in brain development, changes in the hormonal systems, immune system, cardiovascular system, and even the way our DNA is read and transcribed.\"\u003c/p>\n\u003cp>Gunnar says her research suggests removing children from their parents' care can make them more vulnerable to infections.\u003c/p>\n\u003cp>She says evidence first showed up in monkeys that were taken away from their mothers for as little as two weeks. Years later, those monkeys showed a weaker immune system than the ones who stayed with their mothers.\u003c/p>\n\u003cp>Gunnar says she is now seeing a similar response in teenagers.\u003c/p>\n\u003cp>\"If you were an old person it would be called immune senescence,\" Gunnar says. \"Your immune system getting beyond the point where it can function.\"\u003c/p>\n\u003cp>Essentially, she says, the body's immune system wears out early.\u003c/p>\n\u003cp>Gunnar says she's not sure whether these signs mean there is long-term harm in humans.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"We don't know if we see them in teenagers, whether it means that their cells are not going to be able to fight as long,\" she says. \"But we do know if we see this in the aged, that is a sign that the immune system is coming to a point where it's not going to be able to fight things off.\"\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Separating+Kids+From+Their+Parents+Can+Lead+To+Long-Term+Health+Problems&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Rachel Osborn knows kids who slept in the immigrant detention centers in Texas that have dominated recent headlines.\u003c/p>\n\u003cp>\"We have kids who will say that was the worst part of their journey,\" Osborn says. \"They were traveling for weeks and the hardest part was being in this freezing cold room where, you know, they were fed a cold sandwich and had a thin blanket to shiver under.\"\u003c/p>\n\u003cp>And they had no parent or caregiver to comfort them and make them feel safe.\u003c/p>\n\u003cp>Osborn is a therapist at \u003ca href=\"https://www.maryscenter.org/\" target=\"_blank\" rel=\"noopener\">Mary's Center\u003c/a> in Washington, D.C., who works in schools with children who immigrated from Latin America to the U.S. without their parents. The kids she works with weren't forcefully taken from their parents by U.S. immigration agents, but the trauma, Osborn says, is similar.\u003c/p>\n\u003cp>Thousands of kids were taken from their parents by immigration officials and placed in detention facilities under the Trump administration policy that was in place from April until \u003ca href=\"https://www.npr.org/2018/06/20/621798823/speaker-ryan-plans-immigration-votes-amid-doubts-that-bills-can-pass\" target=\"_blank\" rel=\"noopener\">it was changed Wednesday\u003c/a>.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Researchers suggest these children, and others who have spent time in those detention facilities, may have increased long-term health care needs. That's because the stress of being separated from a parent can also cause lasting \u003ca href=\"https://www.cdc.gov/violenceprevention/acestudy/journal.html\" target=\"_blank\" rel=\"noopener\">physical harm \u003c/a>to children.\u003c/p>\n\u003cp>These harms can include reduced immune system functioning in the short term, and increased risk of heart disease, diabetes or other chronic health problems in the long term.\u003c/p>\n\u003cp>Kids, like everyone, have a physical response to stress. The heart rate speeds up and the body releases hormones like cortisol. But when they don't have a parent or adult that they trust to comfort them, a prolonged stress response can become toxic and cause physical damage.\u003c/p>\n\u003cp>\"The most powerful stress buffer known to humans is the presence and availability of the parents for young children,\" says \u003ca href=\"https://cnbd.umn.edu/bio/cnbd-faculty-staff/megan-gunnar\" target=\"_blank\" rel=\"noopener\">Megan Gunnar\u003c/a>, a professor at the Center for Neurobehavioral Development at the University of Minnesota Medical School.\u003c/p>\n\u003cp>It's impossible to know which of the detained kids may see damage to their health or how severe that damage may be.\u003c/p>\n\u003cp>But the conditions are there, according to Nithya Nathan-Pineau, who works for the detained children's program at the \u003ca href=\"https://www.caircoalition.org/\" target=\"_blank\" rel=\"noopener\">Capital Area Immigrants Rights Coalition,\u003c/a> in Washington, D.C. Her organization advocates for the rights of immigrants and has direct contact with some children who were separated from their parents under the Trump administration policy.\u003c/p>\n\u003cp>\"We talk to these kids directly. What we're seeing is that they are extraordinarily traumatized,\" she says.\u003c/p>\n\u003cp>She describes a meeting with a 10-year-old child in a government detention center.\u003c/p>\n\u003cp>\"Essentially during the first intake [the child] couldn't really report anything to us because the child was so distraught they just cried through the whole intake,\" she says.\u003c/p>\n\u003cp>When she went back later, she found out what was going on. \"We learned that at this point they had been in the area for over four weeks and the child has not been able to speak with their parent,\" she says. \"They don't know where their parent is.\"\u003c/p>\n\u003cp>Without a parent's comfort, a child's stress response can go into overdrive, explains \u003ca href=\"https://www.npr.org/2017/08/25/545092982/nadine-burke-harris-how-does-trauma-affect-a-childs-dna\" target=\"_blank\" rel=\"noopener\">Dr. Nadine Burke Harris\u003c/a>, CEO of the Center for Youth Wellness in San Francisco.\u003c/p>\n\u003cp>The center includes a clinic that treats kids who have gone through trauma, and it also conducts research on the effects of trauma on children and ways to counter them.\u003c/p>\n\u003cp>Burke Harris says when children are comforted by their parents, they produce more of the hormone oxytocin, which helps relieve the stress response.\u003c/p>\n\u003cp>\"People call it the cuddle hormone,\" she says. \"It helps to shut off the stress response when it's activated. But it also helps to protect our organs from damage when the stress response is activated.\"\u003c/p>\n\u003cp>And that leads to many different health problems, she says, including \"changes in brain development, changes in the hormonal systems, immune system, cardiovascular system, and even the way our DNA is read and transcribed.\"\u003c/p>\n\u003cp>Gunnar says her research suggests removing children from their parents' care can make them more vulnerable to infections.\u003c/p>\n\u003cp>She says evidence first showed up in monkeys that were taken away from their mothers for as little as two weeks. Years later, those monkeys showed a weaker immune system than the ones who stayed with their mothers.\u003c/p>\n\u003cp>Gunnar says she is now seeing a similar response in teenagers.\u003c/p>\n\u003cp>\"If you were an old person it would be called immune senescence,\" Gunnar says. \"Your immune system getting beyond the point where it can function.\"\u003c/p>\n\u003cp>Essentially, she says, the body's immune system wears out early.\u003c/p>\n\u003cp>Gunnar says she's not sure whether these signs mean there is long-term harm in humans.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"We don't know if we see them in teenagers, whether it means that their cells are not going to be able to fight as long,\" she says. \"But we do know if we see this in the aged, that is a sign that the immune system is coming to a point where it's not going to be able to fight things off.\"\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Separating+Kids+From+Their+Parents+Can+Lead+To+Long-Term+Health+Problems&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Will San Francisco's Ban on Flavored Tobacco Spark a National Trend?",
"title": "Will San Francisco's Ban on Flavored Tobacco Spark a National Trend?",
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"content": "\u003cp>Despite a multimillion dollar campaign by tobacco giant R.J. Reynolds, San Francisco will soon implement the most comprehensive restrictions on e-cigarettes in the country. The move is already sparking other cities to follow.\u003c/p>\n\u003caside class=\"pullquote alignright\">'What California does, almost always spreads not only across the country, but globally.'\u003ccite>Matt Myers, Campaign for Tobacco-Free Kids\u003c/cite>\u003c/aside>\n\u003cp>This week's vote on San Francisco's Proposition E was expected to be close, but the measure is passing with nearly 70 percent of the vote. That's an insurmountable lead even though mail-in ballots are still being counted. The ban includes all flavored tobacco products from vaping liquids to menthol cigarettes to flavored hookah.\u003c/p>\n\u003cp>\"You know, I probably would have voted for it too,\" said Brian Richardson a resident of Los Angeles who owns a Bay Area vaping store. \"As much as I like to sell vape liquids at my store in San Francisco, I agree some type of regulation is necessary.\"\u003c/p>\n\u003cp>The law goes into effect 10 days after the election is certified, which will likely be sometime in July. If a San Francisco store violates the ban, it could result in the suspension of their tobacco sales permit or further penalties as defined under the city's \u003ca href=\"https://sfgov.legistar.com/LegislationDetail.aspx?ID=3027568&GUID=254D4A3A-859F-4995-AF06-3B57291332E2&Options=ID\">health code\u003c/a>.\u003c/p>\n\u003cp>\u003cstrong>Growing Momentum in California\u003c/strong>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The same week voters passed San Francisco's ban, the Board of Supervisors in San Mateo County unanimously passed a similar comprehensive ban that will also remove traditional tobacco products from pharmacies. Supervisor Carole Groom says the measure is about prevention, especially among young people.\u003c/p>\n\u003cp>\"Every day, 2,500 kids try their first cigarette and that's what we're trying to stop,\" said Groom. \"Eighty-one percent of the youth in a recent survey told us that their first cigarette was flavored. That's the kind of thing we're trying to stop with this ordinance.\"\u003c/p>\n\u003cp>Several other communities like Oakland, El Cerrito and Palo Alto have \u003ca href=\"http://www.publichealthlawcenter.org/sites/default/files/resources/US-Sales-Restrictions-Flavored-Tobacco-Products-2017.pdf\" target=\"_blank\" rel=\"noopener\">similar bans\u003c/a> pending, though none are as comprehensive as the ones in San Francisco and San Mateo County.\u003c/p>\n\u003cp>City officials like Groom say local initiatives are necessary because there is very little regulation of e-products at the federal level, even though use is increasing. A 2016 \u003ca href=\"https://e-cigarettes.surgeongeneral.gov/documents/2016_SGR_Exec_Summ_508.pdf\" target=\"_blank\" rel=\"noopener\">report\u003c/a> from the U.S. Surgeon General cited a 900 percent increase in the use of e-cigarettes by high school students from 2011 to 2015.\u003c/p>\n\u003cfigure id=\"attachment_442462\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003cimg class=\"wp-image-442462 size-large\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/06/image000000-1020x680.jpg\" alt=\"\" width=\"640\" height=\"427\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2018/06/image000000-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2018/06/image000000-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2018/06/image000000-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2018/06/image000000-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2018/06/image000000-1200x800.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/13/2018/06/image000000-1920x1280.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2018/06/image000000-1180x786.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2018/06/image000000-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2018/06/image000000-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2018/06/image000000-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2018/06/image000000-520x347.jpg 520w, https://ww2.kqed.org/app/uploads/sites/13/2018/06/image000000.jpg 2000w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003cfigcaption class=\"wp-caption-text\">Brian Richardson vaping on a walk just north of Big Sur, California \u003ccite>(Andrea Cardenas Kline)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Brian Richardson owns the Vapor Den, a hip, Lower Haight-neighborhood vape shop with low lighting, leather couches and row after row of top-shelf vape liquids. He says he opened his doors in 2012 to help smokers quit.\u003c/p>\n\u003cp>\"We used to act as a center to essentially educate people on the alternatives to smoking,\" said Richardson, who smoked a pack a day for 25 years. \"My customers used to be people trying to kick the habit. But over the years the demographic kept getting younger. Now people in their 20s are just looking for the latest and greatest devices with new flavors.\"\u003c/p>\n\u003cp>\u003cstrong>Manipulative Marketing Ploys to Attract Kids\u003c/strong>\u003c/p>\n\u003cp>When Richardson started vaping in 2009, there were only two flavors on the market; menthol and tobacco. Now there's more than 7,000, like cotton candy, apple crumb and watermelon, which are often packaged in brightly colored bottles with clowns and cartoon characters.\u003c/p>\n\u003cp>\"Regulation is necessary today because of the abuse and marketing ploys some of these companies are using to attract kids who may have never smoked a cigarette in their life,\" said Richardson.\u003c/p>\n\u003cp>He says his best selling products are made by \u003ca href=\"https://www.juul.com/\" target=\"_blank\" rel=\"noopener\">Juul\u003c/a>, which makes liquids with significantly higher amounts of nicotine and which Richardson calls the most abusive company in the business.\u003c/p>\n\u003cp>\"You take a couple of puffs and you actually feel like you're kind of high,\" said Richardson.\u003c/p>\n\u003cfigure id=\"attachment_440488\" class=\"wp-caption alignright\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-440488\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/03/juul-promo_1350-800x533.jpg\" alt=\"\" width=\"800\" height=\"533\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2018/03/juul-promo_1350-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/juul-promo_1350-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/juul-promo_1350-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/juul-promo_1350-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/juul-promo_1350-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/juul-promo_1350-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/juul-promo_1350-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/juul-promo_1350-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/juul-promo_1350-520x347.jpg 520w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/juul-promo_1350.jpg 1350w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Colorful nicotine-filled pods, pictured on the right, are inserted into the Juul e-cigarette, which educators say looks deceptively like a flash drive, making it harder to identify. \u003ccite>(Juul Labs)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>He says that even though San Francisco's ban will likely crush sales at the Vapor Den, he plans to stay open. He thinks customers will buy their vaping liquids online but visit his shop when seeking advice on a device or to stock up on batteries and coil replacements.\u003c/p>\n\u003cp>But many other small shop owners are terrified about the aftermath of the ban.\u003c/p>\n\u003cp>“Prop E is going to have a huge impact on businesses like mine,\" said Miriam Zouzounis, a board member of the Arab American Grocers Association, which represents over 400 businesses in San Francisco. \"I fear that many small businesses will close in the wake of its passage.\" She said the law would disproportionately affect Arab, Sikh and Asian store owners.\u003c/p>\n\u003cp>\u003cstrong>An Expensive Fight\u003c/strong>\u003c/p>\n\u003cp>The R.J. Reynolds Tobacco Company spent nearly $13 million blanketing the city in advertisements to stop the ban. The company sells the nation’s best-selling menthol cigarette and popular vaping products called Vuse. Jacob McConnico a spokesperson for R.J. Reynolds, called the vote a setback for tobacco harm-reduction efforts.\u003c/p>\n\u003cp>\"History has shown regulations that go to extremes to limit consumer choice result in unintended consequences, including criminal activity,\" McConico wrote in an email. He did not respond when asked whether the company planned to sue.\u003c/p>\n\u003cp>The tobacco industry sued in both New York and Providence, Rhode Island, when those cities passed limited bans on flavored tobacco products, but the industry lost in both cases.\u003c/p>\n\u003cp>\u003cstrong>Tobacco Industry Pushes Back\u003c/strong>\u003c/p>\n\u003cp>San Francisco’s Board of Supervisors unanimously approved \u003ca class=\"css-1g7m0tk\" title=\"\" href=\"http://sfelections.sfgov.org/sites/default/files/Documents/candidates/Legal_Text_Repeal_of_Flavored_Tobacco_Products_Ban.pdf\" target=\"_blank\" rel=\"noopener\">the ban\u003c/a> last year. It was scheduled to go into effect last April, but then an opposition campaign raised enough signatures to put a referendum on the ballot, which is why the measure was put before voters on Tuesday.\u003c/p>\n\u003cp>The fight in favor of the ban was primarily funded by a personal $1.8 million donation from Michael R. Bloomberg, the former mayor of New York City. The American Cancer Society, the American Heart Association, the American Lung Association and Tobacco-Free Kids Action Fund contributed a combined total of $500,000.\u003c/p>\n\u003cp>\u003cstrong>Advocates Predict a Domino Effect\u003c/strong>\u003c/p>\n\u003cp>Matt Myers, the president of the \u003ca href=\"https://www.tobaccofreekids.org/\" target=\"_blank\" rel=\"noopener\">Campaign for Tobacco-Free Kids\u003c/a>, one of the primary advocacy organizations behind the San Francisco ban, predicts this is just the first of many bans across the country.\u003c/p>\n\u003cp>\"California repeatedly has been the leader on innovation on tobacco control,\" said Myers. \"And what California does almost always spreads not only across the country, but globally.\"\u003c/p>\n\u003cp>San Francisco especially has a history of taking on Big Tobacco. In 1983, the city passed a \u003ca href=\"https://publishing.cdlib.org/ucpressebooks/view?docId=ft167nb0vq&chunk.id=d0e845&toc.depth=1&toc.id=d0e447&brand=ucpress\" target=\"_blank\" rel=\"noopener\">workplace smoking restriction\u003c/a>. Several tobacco companies tried to stop the ordinance by forcing a referendum. But their expensive campaigning efforts failed, as voters upheld the restrictions. The industry lost many similar fights across the country as communities successfully removed smoking from offices.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\"San Francisco's ban is really going to be a trendsetter for all over the country,\" said Stanton Glantz, who heads the \u003ca href=\"https://tobacco.ucsf.edu/\">Center for Tobacco Control Research and Education\u003c/a> at UC San Francisco. \"I just came back from an international meeting in South Africa and people were talking about the San Francisco ordinance.\"\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Despite a multimillion dollar campaign by tobacco giant R.J. Reynolds, San Francisco will soon implement the most comprehensive restrictions on e-cigarettes in the country. The move is already sparking other cities to follow.\u003c/p>\n\u003caside class=\"pullquote alignright\">'What California does, almost always spreads not only across the country, but globally.'\u003ccite>Matt Myers, Campaign for Tobacco-Free Kids\u003c/cite>\u003c/aside>\n\u003cp>This week's vote on San Francisco's Proposition E was expected to be close, but the measure is passing with nearly 70 percent of the vote. That's an insurmountable lead even though mail-in ballots are still being counted. The ban includes all flavored tobacco products from vaping liquids to menthol cigarettes to flavored hookah.\u003c/p>\n\u003cp>\"You know, I probably would have voted for it too,\" said Brian Richardson a resident of Los Angeles who owns a Bay Area vaping store. \"As much as I like to sell vape liquids at my store in San Francisco, I agree some type of regulation is necessary.\"\u003c/p>\n\u003cp>The law goes into effect 10 days after the election is certified, which will likely be sometime in July. If a San Francisco store violates the ban, it could result in the suspension of their tobacco sales permit or further penalties as defined under the city's \u003ca href=\"https://sfgov.legistar.com/LegislationDetail.aspx?ID=3027568&GUID=254D4A3A-859F-4995-AF06-3B57291332E2&Options=ID\">health code\u003c/a>.\u003c/p>\n\u003cp>\u003cstrong>Growing Momentum in California\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The same week voters passed San Francisco's ban, the Board of Supervisors in San Mateo County unanimously passed a similar comprehensive ban that will also remove traditional tobacco products from pharmacies. Supervisor Carole Groom says the measure is about prevention, especially among young people.\u003c/p>\n\u003cp>\"Every day, 2,500 kids try their first cigarette and that's what we're trying to stop,\" said Groom. \"Eighty-one percent of the youth in a recent survey told us that their first cigarette was flavored. That's the kind of thing we're trying to stop with this ordinance.\"\u003c/p>\n\u003cp>Several other communities like Oakland, El Cerrito and Palo Alto have \u003ca href=\"http://www.publichealthlawcenter.org/sites/default/files/resources/US-Sales-Restrictions-Flavored-Tobacco-Products-2017.pdf\" target=\"_blank\" rel=\"noopener\">similar bans\u003c/a> pending, though none are as comprehensive as the ones in San Francisco and San Mateo County.\u003c/p>\n\u003cp>City officials like Groom say local initiatives are necessary because there is very little regulation of e-products at the federal level, even though use is increasing. A 2016 \u003ca href=\"https://e-cigarettes.surgeongeneral.gov/documents/2016_SGR_Exec_Summ_508.pdf\" target=\"_blank\" rel=\"noopener\">report\u003c/a> from the U.S. Surgeon General cited a 900 percent increase in the use of e-cigarettes by high school students from 2011 to 2015.\u003c/p>\n\u003cfigure id=\"attachment_442462\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003cimg class=\"wp-image-442462 size-large\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/06/image000000-1020x680.jpg\" alt=\"\" width=\"640\" height=\"427\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2018/06/image000000-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2018/06/image000000-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2018/06/image000000-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2018/06/image000000-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2018/06/image000000-1200x800.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/13/2018/06/image000000-1920x1280.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2018/06/image000000-1180x786.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2018/06/image000000-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2018/06/image000000-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2018/06/image000000-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2018/06/image000000-520x347.jpg 520w, https://ww2.kqed.org/app/uploads/sites/13/2018/06/image000000.jpg 2000w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003cfigcaption class=\"wp-caption-text\">Brian Richardson vaping on a walk just north of Big Sur, California \u003ccite>(Andrea Cardenas Kline)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Brian Richardson owns the Vapor Den, a hip, Lower Haight-neighborhood vape shop with low lighting, leather couches and row after row of top-shelf vape liquids. He says he opened his doors in 2012 to help smokers quit.\u003c/p>\n\u003cp>\"We used to act as a center to essentially educate people on the alternatives to smoking,\" said Richardson, who smoked a pack a day for 25 years. \"My customers used to be people trying to kick the habit. But over the years the demographic kept getting younger. Now people in their 20s are just looking for the latest and greatest devices with new flavors.\"\u003c/p>\n\u003cp>\u003cstrong>Manipulative Marketing Ploys to Attract Kids\u003c/strong>\u003c/p>\n\u003cp>When Richardson started vaping in 2009, there were only two flavors on the market; menthol and tobacco. Now there's more than 7,000, like cotton candy, apple crumb and watermelon, which are often packaged in brightly colored bottles with clowns and cartoon characters.\u003c/p>\n\u003cp>\"Regulation is necessary today because of the abuse and marketing ploys some of these companies are using to attract kids who may have never smoked a cigarette in their life,\" said Richardson.\u003c/p>\n\u003cp>He says his best selling products are made by \u003ca href=\"https://www.juul.com/\" target=\"_blank\" rel=\"noopener\">Juul\u003c/a>, which makes liquids with significantly higher amounts of nicotine and which Richardson calls the most abusive company in the business.\u003c/p>\n\u003cp>\"You take a couple of puffs and you actually feel like you're kind of high,\" said Richardson.\u003c/p>\n\u003cfigure id=\"attachment_440488\" class=\"wp-caption alignright\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-440488\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/03/juul-promo_1350-800x533.jpg\" alt=\"\" width=\"800\" height=\"533\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2018/03/juul-promo_1350-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/juul-promo_1350-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/juul-promo_1350-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/juul-promo_1350-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/juul-promo_1350-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/juul-promo_1350-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/juul-promo_1350-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/juul-promo_1350-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/juul-promo_1350-520x347.jpg 520w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/juul-promo_1350.jpg 1350w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Colorful nicotine-filled pods, pictured on the right, are inserted into the Juul e-cigarette, which educators say looks deceptively like a flash drive, making it harder to identify. \u003ccite>(Juul Labs)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>He says that even though San Francisco's ban will likely crush sales at the Vapor Den, he plans to stay open. He thinks customers will buy their vaping liquids online but visit his shop when seeking advice on a device or to stock up on batteries and coil replacements.\u003c/p>\n\u003cp>But many other small shop owners are terrified about the aftermath of the ban.\u003c/p>\n\u003cp>“Prop E is going to have a huge impact on businesses like mine,\" said Miriam Zouzounis, a board member of the Arab American Grocers Association, which represents over 400 businesses in San Francisco. \"I fear that many small businesses will close in the wake of its passage.\" She said the law would disproportionately affect Arab, Sikh and Asian store owners.\u003c/p>\n\u003cp>\u003cstrong>An Expensive Fight\u003c/strong>\u003c/p>\n\u003cp>The R.J. Reynolds Tobacco Company spent nearly $13 million blanketing the city in advertisements to stop the ban. The company sells the nation’s best-selling menthol cigarette and popular vaping products called Vuse. Jacob McConnico a spokesperson for R.J. Reynolds, called the vote a setback for tobacco harm-reduction efforts.\u003c/p>\n\u003cp>\"History has shown regulations that go to extremes to limit consumer choice result in unintended consequences, including criminal activity,\" McConico wrote in an email. He did not respond when asked whether the company planned to sue.\u003c/p>\n\u003cp>The tobacco industry sued in both New York and Providence, Rhode Island, when those cities passed limited bans on flavored tobacco products, but the industry lost in both cases.\u003c/p>\n\u003cp>\u003cstrong>Tobacco Industry Pushes Back\u003c/strong>\u003c/p>\n\u003cp>San Francisco’s Board of Supervisors unanimously approved \u003ca class=\"css-1g7m0tk\" title=\"\" href=\"http://sfelections.sfgov.org/sites/default/files/Documents/candidates/Legal_Text_Repeal_of_Flavored_Tobacco_Products_Ban.pdf\" target=\"_blank\" rel=\"noopener\">the ban\u003c/a> last year. It was scheduled to go into effect last April, but then an opposition campaign raised enough signatures to put a referendum on the ballot, which is why the measure was put before voters on Tuesday.\u003c/p>\n\u003cp>The fight in favor of the ban was primarily funded by a personal $1.8 million donation from Michael R. Bloomberg, the former mayor of New York City. The American Cancer Society, the American Heart Association, the American Lung Association and Tobacco-Free Kids Action Fund contributed a combined total of $500,000.\u003c/p>\n\u003cp>\u003cstrong>Advocates Predict a Domino Effect\u003c/strong>\u003c/p>\n\u003cp>Matt Myers, the president of the \u003ca href=\"https://www.tobaccofreekids.org/\" target=\"_blank\" rel=\"noopener\">Campaign for Tobacco-Free Kids\u003c/a>, one of the primary advocacy organizations behind the San Francisco ban, predicts this is just the first of many bans across the country.\u003c/p>\n\u003cp>\"California repeatedly has been the leader on innovation on tobacco control,\" said Myers. \"And what California does almost always spreads not only across the country, but globally.\"\u003c/p>\n\u003cp>San Francisco especially has a history of taking on Big Tobacco. In 1983, the city passed a \u003ca href=\"https://publishing.cdlib.org/ucpressebooks/view?docId=ft167nb0vq&chunk.id=d0e845&toc.depth=1&toc.id=d0e447&brand=ucpress\" target=\"_blank\" rel=\"noopener\">workplace smoking restriction\u003c/a>. Several tobacco companies tried to stop the ordinance by forcing a referendum. But their expensive campaigning efforts failed, as voters upheld the restrictions. The industry lost many similar fights across the country as communities successfully removed smoking from offices.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"San Francisco's ban is really going to be a trendsetter for all over the country,\" said Stanton Glantz, who heads the \u003ca href=\"https://tobacco.ucsf.edu/\">Center for Tobacco Control Research and Education\u003c/a> at UC San Francisco. \"I just came back from an international meeting in South Africa and people were talking about the San Francisco ordinance.\"\u003c/p>\n\n\u003c/div>\u003c/p>",
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"title": "San Francisco Passes First-in-the-Nation Flavored Tobacco, Vaping Ban",
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"content": "\u003cp>\u003cem>Update June 6, 2018: \u003c/em>\u003c/p>\n\u003cp>San Francisco is on its way to becoming the first city in the nation to ban all flavored tobacco products from store shelves.\u003c/p>\n\u003cp>With all precincts now having reported their results, Measure E is passing with a whopping 68 percent of the vote. The final results won’t be tallied until all vote-by-mail ballots are counted.\u003c/p>\n\u003cp>The R.J. Reynolds Tobacco Company spent nearly $13 million on a campaign to stop the ban. The company sells the nation’s best-selling menthol cigarette. All that money was appalling to Patrick Reynolds, his grandfather founded the company, but he’s now an anti-tobacco advocate because he lost his father to emphysema.\u003c/p>\n\u003cp>“The only memory I have of him is a man lying down dying gasping of breath,” Reynolds said.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Reynolds stridently opposes adding flavors to e-cigarettes like berry, nacho cheese or gummy bear.\u003c/p>\n\u003cp>“It is an obscene, outrageous brazen ploy by the tobacco industry and by the vaping industry to ensnare another generation to be addicted,” Reynolds said. “And it’s just got to stop.”\u003c/p>\n\u003cp>The citywide ban will go into effect 10 days after the election is certified.\u003c/p>\n\u003cp>\u003cem>Original post\u003c/em>\u003c/p>\n\u003cp>San Francisco could became the first city in the nation to ban flavored tobacco products from all store shelves. This includes everything from candy flavored e-cigarettes to conventional menthol smokes.\u003c/p>\n\u003caside class=\"pullquote alignright\">‘The industry recognized decades ago that if they don’t get kids to start, they [the industry] will die out.’ \u003ccite>Dr. Pam Ling, UCSF \u003c/cite>\u003c/aside>\n\u003cp>City supervisors last year unanimously approved a \u003ca href=\"http://sfgov.org/elections/sites/default/files/Documents/candidates/Legal_Text_Repeal_of_Flavored_Tobacco_Products_Ban.pdf\" target=\"_blank\" rel=\"noopener\">ban\u003c/a> on the products, but the tobacco industry funded a referendum, \u003ca href=\"https://ballotpedia.org/San_Francisco,_California,_Proposition_E,_Ban_on_the_Sale_of_Flavored_Tobacco_(June_2018)\" target=\"_blank\" rel=\"noopener\">Proposition E\u003c/a>, to put the issue before voters. Residents will decide in the June 5 election whether the ordinance goes into effect. Voting by mail has already begun.\u003c/p>\n\u003cp>\u003cstrong>Nearly $10 Million And Counting\u003c/strong>\u003c/p>\n\u003cp>The R.J. Reynolds Tobacco Company is \u003ca href=\"https://sfethics.org/ethics/2018/03/campaign-finance-dashboards-june-5-2018-and-november-6-2018-elections.html\" target=\"_blank\" rel=\"noopener\">blanketing\u003c/a> the city in radio, television and direct mail advertisements urging a “no” vote on Proposition E. The tobacco giant has shelled out nearly $10 million to save Newport menthols, which is the nation’s \u003ca href=\"https://www.cdc.gov/tobacco/data_statistics/fact_sheets/tobacco_industry/brand_preference/index.htm\" target=\"_blank\" rel=\"noopener\">best-selling\u003c/a> mint-flavored cigarette. The ads, featuring vintage film of people smashing kegs during Prohibition, claim that it didn’t work for alcohol and drugs, so it won’t work for flavored tobacco.\u003c/p>\n\u003cp>Billionaire Michael Bloomberg \u003ca href=\"https://www.kqed.org/futureofyou/441395/sf-voters-may-ban-vape-flavors-menthol-cigarettes\" target=\"_blank\" rel=\"noopener\">contributed $1.8 million\u003c/a> to the Yes campaign.\u003c/p>\n\u003cp>San Francisco resident Donna Anderson protested on behalf of the No campaign during a recent rally at Civic Center.\u003c/p>\n\u003cp>\u003cem>‘No on Proposition E’ ads, funded by the tobacco industry, liken the proposed ban to 1920s-era Prohibition …\u003c/em>\u003c/p>\n\u003cp>\u003ciframe loading=\"lazy\" title=\"Bans Don’t Work, No on Prop E (30 sec.)\" width=\"500\" height=\"281\" src=\"https://www.youtube.com/embed/HHKy5eum8l4?start=3&feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen>\u003c/iframe>\u003c/p>\n\u003cp>“You’re just driving sales underground,” says Anderson. “It will not stop people from accessing what they want or using what they want.”\u003c/p>\n\u003cp>She uses the example of marijuana laws to illustrate how a black market usually hurts people of color the most.\u003c/p>\n\u003cp>“Black people, Latino people; people have been locked up — and are still locked up — having to do with little more than an ounce of marijuana,” said Anderson.\u003c/p>\n\u003cp>\u003cstrong>Local Businesses On Edge\u003c/strong>\u003c/p>\n\u003cp>At the Mission Smoke Shop, owner Sam Azar has plastered his walls with “No-on-E” signs.\u003c/p>\n\u003cp>“It’s going to hurt me as a small business here in the city by, like 30 percent or more,” he predicts.\u003c/p>\n\u003cfigure id=\"attachment_441406\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-441406 size-medium\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/05/IMG_5146-e1525820098164-800x531.jpg\" alt=\"\" width=\"800\" height=\"531\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/13/2018/05/IMG_5146-e1525820098164-800x531.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/13/2018/05/IMG_5146-e1525820098164-160x106.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/13/2018/05/IMG_5146-e1525820098164-768x510.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/13/2018/05/IMG_5146-e1525820098164-1020x677.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/13/2018/05/IMG_5146-e1525820098164-1200x797.jpg 1200w, https://cdn.kqed.org/wp-content/uploads/sites/13/2018/05/IMG_5146-e1525820098164-1180x784.jpg 1180w, https://cdn.kqed.org/wp-content/uploads/sites/13/2018/05/IMG_5146-e1525820098164-960x638.jpg 960w, https://cdn.kqed.org/wp-content/uploads/sites/13/2018/05/IMG_5146-e1525820098164-240x159.jpg 240w, https://cdn.kqed.org/wp-content/uploads/sites/13/2018/05/IMG_5146-e1525820098164-375x249.jpg 375w, https://cdn.kqed.org/wp-content/uploads/sites/13/2018/05/IMG_5146-e1525820098164-520x345.jpg 520w, https://cdn.kqed.org/wp-content/uploads/sites/13/2018/05/IMG_5146-e1525820098164.jpg 1843w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Sam Azar worries about how a ban on flavored tobacco products will hurt the bottom line at his Mission Smoke Shop. \u003ccite>(Lesley McClurg/ KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>He would no longer profit from flavored pipe tobacco, flavored hookah, infused cigars, or numerous racks of syrupy vape liquids. There are more than 7,000 sweet and savory e-cigarette flavors on the market — everything from gummi bear and Unicorn Milk to Red Bull and nacho cheese.\u003c/p>\n\u003cp>But medical experts worry about the role aromas play in enticing young people to try nicotine and get hooked on cigarettes.\u003c/p>\n\u003cp>Derek Smith, director of the \u003ca href=\"http://sanfranciscotobaccofreeproject.org/\" target=\"_blank\" rel=\"noopener\">Tobacco Free Project\u003c/a> at the San Francisco Department of Public Health, says flavors and menthol deceptively mask the taste of tobacco and make it easier to inhale nicotine.\u003c/p>\n\u003cp>“Someone who has tried a cigarette for the first time will often turn green and cough,” said Smith, in an email. “Imagine instead a cereal, milk-flavored inhalation that is considerably less harsh to start with.”\u003c/p>\n\u003cp>\u003cstrong>Physicians Take to the Streets\u003c/strong>\u003c/p>\n\u003cp>Smith \u003ca href=\"https://www.cdph.ca.gov/Programs/CCDPHP/DCDIC/CTCB/CDPH%20Document%20Library/Policy/FlavoredTobaccoAndMenthol/FinalFlavoredTobaccoInfographic.pdf\" target=\"_blank\" rel=\"noopener\">says\u003c/a> nearly all youth in the state start their tobacco habit with a flavored product, which worries doctors who gathered at a recent “Yes-on-E” rally on the steps of the Civic Center.\u003c/p>\n\u003cp>“The tobacco industry has targeted menthol cigarettes to the black community, to poor people, to mothers,” said Amanda Wright, a resident physician at UCSF. “And if you look at these products, they literally look like candy and that is clearly targeting our children.”\u003c/p>\n\u003cp>Wright was standing next to a table laden with row after row of juice boxes and candy wrappers. They look like sugary snack foods, but they’re actually packages of vaping products. The New York Times recently \u003ca href=\"https://www.nytimes.com/2018/05/01/health/fda-crackdown-vaping-children.html\" target=\"_blank\" rel=\"noopener\">reported\u003c/a> on a federal crackdown of these look-alikes.\u003c/p>\n\u003cfigure id=\"attachment_441402\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-441402 size-large\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/05/IMG_5101-e1525822179863-1020x498.jpg\" alt=\"\" width=\"640\" height=\"312\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/13/2018/05/IMG_5101-e1525822179863-1020x498.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/13/2018/05/IMG_5101-e1525822179863-160x78.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/13/2018/05/IMG_5101-e1525822179863-800x391.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/13/2018/05/IMG_5101-e1525822179863-768x375.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/13/2018/05/IMG_5101-e1525822179863-1200x586.jpg 1200w, https://cdn.kqed.org/wp-content/uploads/sites/13/2018/05/IMG_5101-e1525822179863-1180x576.jpg 1180w, https://cdn.kqed.org/wp-content/uploads/sites/13/2018/05/IMG_5101-e1525822179863-960x469.jpg 960w, https://cdn.kqed.org/wp-content/uploads/sites/13/2018/05/IMG_5101-e1525822179863-240x117.jpg 240w, https://cdn.kqed.org/wp-content/uploads/sites/13/2018/05/IMG_5101-e1525822179863-375x183.jpg 375w, https://cdn.kqed.org/wp-content/uploads/sites/13/2018/05/IMG_5101-e1525822179863-520x254.jpg 520w, https://cdn.kqed.org/wp-content/uploads/sites/13/2018/05/IMG_5101-e1525822179863.jpg 1896w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003cfigcaption class=\"wp-caption-text\">The candylike packaging for vaping products on display at a Yes-on-E rally. \u003ccite>(Lesley McClurg/ KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Nicotine is particularly addictive for the teenage brain, according to Pam Ling, a physician and smoking researcher at UCSF.\u003c/p>\n\u003cp>“This population is the future of the tobacco industry,” says Ling. “The industry recognized decades ago that if they don’t get kids to start, they [the industry] will die out.”\u003c/p>\n\u003cp>The California Department of Public Health \u003ca href=\"https://www.cdph.ca.gov/Programs/CCDPHP/DCDIC/CTCB/CDPH%20Document%20Library/Policy/FlavoredTobaccoAndMenthol/FinalFlavoredTobaccoInfographic.pdf\" target=\"_blank\" rel=\"noopener\">says\u003c/a> the number of kids in California who vape is currently double the number who smoke, but some \u003ca href=\"http://pediatrics.aappublications.org/content/early/2017/11/30/peds.2017-1832\" target=\"_blank\" rel=\"noopener\">research\u003c/a> suggests that a lot of those kids will be smoking cigarettes before long.\u003c/p>\n\u003cp>“Once these kids start with the e-cigarettes, the likelihood that they’ll be smoking cigarettes a year or so later is increased by a factor of three or four,” says Stanton Glantz, who heads the \u003ca href=\"https://tobacco.ucsf.edu/\">Center for Tobacco Control Research and Education\u003c/a> at UCSF.\u003c/p>\n\u003cp>Glantz says that in his \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/28115540\" target=\"_blank\" rel=\"noopener\">research\u003c/a>, about a third of the kids who start using nicotine via e-cigarettes are not the kind of kids whose race, gender, home life and school performance would make them a high risk to pick up smoking on their own.\u003c/p>\n\u003cp>In other words, vaping is increasing the pool of teen smokers. A 2016 \u003ca href=\"https://e-cigarettes.surgeongeneral.gov/documents/2016_SGR_Exec_Summ_508.pdf\" target=\"_blank\" rel=\"noopener\">report\u003c/a> from the U.S. Surgeon General cited a 900 percent increase in the use of e-cigarettes by high school students from 2011 to 2015. Right now there is very little regulation of e-products at the federal level.\u003c/p>\n\u003cfigure id=\"attachment_441466\" class=\"wp-caption alignright\" style=\"max-width: 800px\">\u003ca href=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/05/RS30897_PROPE_076-e1525979992131.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-441466 size-medium\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/05/RS30897_PROPE_076-800x1200.jpg\" alt=\"\" width=\"800\" height=\"1200\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">An array of flavors displayed at Vapor Den, including banana cream, mango and fruit mix. \u003ccite>(Lauren Hanussak/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Glantz also contends that a flavor ban will help adults who \u003ca href=\"https://www.npr.org/sections/health-shots/2017/05/25/530026958/many-adults-dont-think-exposure-to-vaping-is-bad-for-kids\" target=\"_blank\" rel=\"noopener\">think they’re inhaling\u003c/a> a significantly safer alternative.\u003c/p>\n\u003cp>“When e-cigarettes first became available, there was a lot of hope that they would be better than cigarettes,” he says, “but the more we learn the worse they look.”\u003c/p>\n\u003cp>Though the long-term health effects of smoking e-cigarettes is still unknown, Glantz believes the safety of the devices has been \u003ca href=\"https://www.annualreviews.org/doi/abs/10.1146/annurev-publhealth-040617-013757\" target=\"_blank\" rel=\"noopener\">oversold\u003c/a>.\u003c/p>\n\u003cp>“Electronic smoking products emit particles of chemicals, not clean air, and technically an aerosol, not a vapor,” Smith says. “Think smog or hairspray — not the pure water vapor that steams when your teapot whistles.”\u003c/p>\n\u003cp>These \u003ca href=\"https://pubs.acs.org/doi/full/10.1021/acs.chemrestox.6b00188?src=recsys&=\" target=\"_blank\" rel=\"noopener\">ultrafine particles and toxins\u003c/a> can damage the lungs and may lead to heart attacks. Levels of the particles in the vapor produced by some devices may be lower than in tobacco smoke, but aren’t zero.\u003c/p>\n\u003cp>\u003ciframe loading=\"lazy\" title=\"Why Is Vaping So Popular?\" width=\"500\" height=\"281\" src=\"https://www.youtube.com/embed/P9zps5LsVXs?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen>\u003c/iframe>\u003c/p>\n\u003cp>If San Francisco voters pass the flavor ban, it will be among the \u003ca href=\"https://www.npr.org/sections/thetwo-way/2017/10/24/559833483/new-york-bans-vaping-indoors-in-public-state-law-classes-e-cigs-with-cigarettes\" target=\"_blank\" rel=\"noopener\">toughest restrictions\u003c/a> on e-cigarettes in the country; opponents of the measure fear it will set a precedent.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>Jon Brooks contributed to this post. This post has been edited since it was originally published.\u003c/em>\u003c/p>\n\n",
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"excerpt": "The referendum, which bans flavored tobacco products like menthol cigarettes and gummi bear e-cigarettes, is passing with 68 percent of the vote.",
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"title": "San Francisco Passes First-in-the-Nation Flavored Tobacco, Vaping Ban",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cem>Update June 6, 2018: \u003c/em>\u003c/p>\n\u003cp>San Francisco is on its way to becoming the first city in the nation to ban all flavored tobacco products from store shelves.\u003c/p>\n\u003cp>With all precincts now having reported their results, Measure E is passing with a whopping 68 percent of the vote. The final results won’t be tallied until all vote-by-mail ballots are counted.\u003c/p>\n\u003cp>The R.J. Reynolds Tobacco Company spent nearly $13 million on a campaign to stop the ban. The company sells the nation’s best-selling menthol cigarette. All that money was appalling to Patrick Reynolds, his grandfather founded the company, but he’s now an anti-tobacco advocate because he lost his father to emphysema.\u003c/p>\n\u003cp>“The only memory I have of him is a man lying down dying gasping of breath,” Reynolds said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Reynolds stridently opposes adding flavors to e-cigarettes like berry, nacho cheese or gummy bear.\u003c/p>\n\u003cp>“It is an obscene, outrageous brazen ploy by the tobacco industry and by the vaping industry to ensnare another generation to be addicted,” Reynolds said. “And it’s just got to stop.”\u003c/p>\n\u003cp>The citywide ban will go into effect 10 days after the election is certified.\u003c/p>\n\u003cp>\u003cem>Original post\u003c/em>\u003c/p>\n\u003cp>San Francisco could became the first city in the nation to ban flavored tobacco products from all store shelves. This includes everything from candy flavored e-cigarettes to conventional menthol smokes.\u003c/p>\n\u003caside class=\"pullquote alignright\">‘The industry recognized decades ago that if they don’t get kids to start, they [the industry] will die out.’ \u003ccite>Dr. Pam Ling, UCSF \u003c/cite>\u003c/aside>\n\u003cp>City supervisors last year unanimously approved a \u003ca href=\"http://sfgov.org/elections/sites/default/files/Documents/candidates/Legal_Text_Repeal_of_Flavored_Tobacco_Products_Ban.pdf\" target=\"_blank\" rel=\"noopener\">ban\u003c/a> on the products, but the tobacco industry funded a referendum, \u003ca href=\"https://ballotpedia.org/San_Francisco,_California,_Proposition_E,_Ban_on_the_Sale_of_Flavored_Tobacco_(June_2018)\" target=\"_blank\" rel=\"noopener\">Proposition E\u003c/a>, to put the issue before voters. Residents will decide in the June 5 election whether the ordinance goes into effect. Voting by mail has already begun.\u003c/p>\n\u003cp>\u003cstrong>Nearly $10 Million And Counting\u003c/strong>\u003c/p>\n\u003cp>The R.J. Reynolds Tobacco Company is \u003ca href=\"https://sfethics.org/ethics/2018/03/campaign-finance-dashboards-june-5-2018-and-november-6-2018-elections.html\" target=\"_blank\" rel=\"noopener\">blanketing\u003c/a> the city in radio, television and direct mail advertisements urging a “no” vote on Proposition E. The tobacco giant has shelled out nearly $10 million to save Newport menthols, which is the nation’s \u003ca href=\"https://www.cdc.gov/tobacco/data_statistics/fact_sheets/tobacco_industry/brand_preference/index.htm\" target=\"_blank\" rel=\"noopener\">best-selling\u003c/a> mint-flavored cigarette. The ads, featuring vintage film of people smashing kegs during Prohibition, claim that it didn’t work for alcohol and drugs, so it won’t work for flavored tobacco.\u003c/p>\n\u003cp>Billionaire Michael Bloomberg \u003ca href=\"https://www.kqed.org/futureofyou/441395/sf-voters-may-ban-vape-flavors-menthol-cigarettes\" target=\"_blank\" rel=\"noopener\">contributed $1.8 million\u003c/a> to the Yes campaign.\u003c/p>\n\u003cp>San Francisco resident Donna Anderson protested on behalf of the No campaign during a recent rally at Civic Center.\u003c/p>\n\u003cp>\u003cem>‘No on Proposition E’ ads, funded by the tobacco industry, liken the proposed ban to 1920s-era Prohibition …\u003c/em>\u003c/p>\n\u003cp>\u003ciframe loading=\"lazy\" title=\"Bans Don’t Work, No on Prop E (30 sec.)\" width=\"500\" height=\"281\" src=\"https://www.youtube.com/embed/HHKy5eum8l4?start=3&feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen>\u003c/iframe>\u003c/p>\n\u003cp>“You’re just driving sales underground,” says Anderson. “It will not stop people from accessing what they want or using what they want.”\u003c/p>\n\u003cp>She uses the example of marijuana laws to illustrate how a black market usually hurts people of color the most.\u003c/p>\n\u003cp>“Black people, Latino people; people have been locked up — and are still locked up — having to do with little more than an ounce of marijuana,” said Anderson.\u003c/p>\n\u003cp>\u003cstrong>Local Businesses On Edge\u003c/strong>\u003c/p>\n\u003cp>At the Mission Smoke Shop, owner Sam Azar has plastered his walls with “No-on-E” signs.\u003c/p>\n\u003cp>“It’s going to hurt me as a small business here in the city by, like 30 percent or more,” he predicts.\u003c/p>\n\u003cfigure id=\"attachment_441406\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-441406 size-medium\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/05/IMG_5146-e1525820098164-800x531.jpg\" alt=\"\" width=\"800\" height=\"531\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/13/2018/05/IMG_5146-e1525820098164-800x531.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/13/2018/05/IMG_5146-e1525820098164-160x106.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/13/2018/05/IMG_5146-e1525820098164-768x510.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/13/2018/05/IMG_5146-e1525820098164-1020x677.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/13/2018/05/IMG_5146-e1525820098164-1200x797.jpg 1200w, https://cdn.kqed.org/wp-content/uploads/sites/13/2018/05/IMG_5146-e1525820098164-1180x784.jpg 1180w, https://cdn.kqed.org/wp-content/uploads/sites/13/2018/05/IMG_5146-e1525820098164-960x638.jpg 960w, https://cdn.kqed.org/wp-content/uploads/sites/13/2018/05/IMG_5146-e1525820098164-240x159.jpg 240w, https://cdn.kqed.org/wp-content/uploads/sites/13/2018/05/IMG_5146-e1525820098164-375x249.jpg 375w, https://cdn.kqed.org/wp-content/uploads/sites/13/2018/05/IMG_5146-e1525820098164-520x345.jpg 520w, https://cdn.kqed.org/wp-content/uploads/sites/13/2018/05/IMG_5146-e1525820098164.jpg 1843w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Sam Azar worries about how a ban on flavored tobacco products will hurt the bottom line at his Mission Smoke Shop. \u003ccite>(Lesley McClurg/ KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>He would no longer profit from flavored pipe tobacco, flavored hookah, infused cigars, or numerous racks of syrupy vape liquids. There are more than 7,000 sweet and savory e-cigarette flavors on the market — everything from gummi bear and Unicorn Milk to Red Bull and nacho cheese.\u003c/p>\n\u003cp>But medical experts worry about the role aromas play in enticing young people to try nicotine and get hooked on cigarettes.\u003c/p>\n\u003cp>Derek Smith, director of the \u003ca href=\"http://sanfranciscotobaccofreeproject.org/\" target=\"_blank\" rel=\"noopener\">Tobacco Free Project\u003c/a> at the San Francisco Department of Public Health, says flavors and menthol deceptively mask the taste of tobacco and make it easier to inhale nicotine.\u003c/p>\n\u003cp>“Someone who has tried a cigarette for the first time will often turn green and cough,” said Smith, in an email. “Imagine instead a cereal, milk-flavored inhalation that is considerably less harsh to start with.”\u003c/p>\n\u003cp>\u003cstrong>Physicians Take to the Streets\u003c/strong>\u003c/p>\n\u003cp>Smith \u003ca href=\"https://www.cdph.ca.gov/Programs/CCDPHP/DCDIC/CTCB/CDPH%20Document%20Library/Policy/FlavoredTobaccoAndMenthol/FinalFlavoredTobaccoInfographic.pdf\" target=\"_blank\" rel=\"noopener\">says\u003c/a> nearly all youth in the state start their tobacco habit with a flavored product, which worries doctors who gathered at a recent “Yes-on-E” rally on the steps of the Civic Center.\u003c/p>\n\u003cp>“The tobacco industry has targeted menthol cigarettes to the black community, to poor people, to mothers,” said Amanda Wright, a resident physician at UCSF. “And if you look at these products, they literally look like candy and that is clearly targeting our children.”\u003c/p>\n\u003cp>Wright was standing next to a table laden with row after row of juice boxes and candy wrappers. They look like sugary snack foods, but they’re actually packages of vaping products. The New York Times recently \u003ca href=\"https://www.nytimes.com/2018/05/01/health/fda-crackdown-vaping-children.html\" target=\"_blank\" rel=\"noopener\">reported\u003c/a> on a federal crackdown of these look-alikes.\u003c/p>\n\u003cfigure id=\"attachment_441402\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-441402 size-large\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/05/IMG_5101-e1525822179863-1020x498.jpg\" alt=\"\" width=\"640\" height=\"312\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/13/2018/05/IMG_5101-e1525822179863-1020x498.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/13/2018/05/IMG_5101-e1525822179863-160x78.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/13/2018/05/IMG_5101-e1525822179863-800x391.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/13/2018/05/IMG_5101-e1525822179863-768x375.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/13/2018/05/IMG_5101-e1525822179863-1200x586.jpg 1200w, https://cdn.kqed.org/wp-content/uploads/sites/13/2018/05/IMG_5101-e1525822179863-1180x576.jpg 1180w, https://cdn.kqed.org/wp-content/uploads/sites/13/2018/05/IMG_5101-e1525822179863-960x469.jpg 960w, https://cdn.kqed.org/wp-content/uploads/sites/13/2018/05/IMG_5101-e1525822179863-240x117.jpg 240w, https://cdn.kqed.org/wp-content/uploads/sites/13/2018/05/IMG_5101-e1525822179863-375x183.jpg 375w, https://cdn.kqed.org/wp-content/uploads/sites/13/2018/05/IMG_5101-e1525822179863-520x254.jpg 520w, https://cdn.kqed.org/wp-content/uploads/sites/13/2018/05/IMG_5101-e1525822179863.jpg 1896w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003cfigcaption class=\"wp-caption-text\">The candylike packaging for vaping products on display at a Yes-on-E rally. \u003ccite>(Lesley McClurg/ KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Nicotine is particularly addictive for the teenage brain, according to Pam Ling, a physician and smoking researcher at UCSF.\u003c/p>\n\u003cp>“This population is the future of the tobacco industry,” says Ling. “The industry recognized decades ago that if they don’t get kids to start, they [the industry] will die out.”\u003c/p>\n\u003cp>The California Department of Public Health \u003ca href=\"https://www.cdph.ca.gov/Programs/CCDPHP/DCDIC/CTCB/CDPH%20Document%20Library/Policy/FlavoredTobaccoAndMenthol/FinalFlavoredTobaccoInfographic.pdf\" target=\"_blank\" rel=\"noopener\">says\u003c/a> the number of kids in California who vape is currently double the number who smoke, but some \u003ca href=\"http://pediatrics.aappublications.org/content/early/2017/11/30/peds.2017-1832\" target=\"_blank\" rel=\"noopener\">research\u003c/a> suggests that a lot of those kids will be smoking cigarettes before long.\u003c/p>\n\u003cp>“Once these kids start with the e-cigarettes, the likelihood that they’ll be smoking cigarettes a year or so later is increased by a factor of three or four,” says Stanton Glantz, who heads the \u003ca href=\"https://tobacco.ucsf.edu/\">Center for Tobacco Control Research and Education\u003c/a> at UCSF.\u003c/p>\n\u003cp>Glantz says that in his \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/28115540\" target=\"_blank\" rel=\"noopener\">research\u003c/a>, about a third of the kids who start using nicotine via e-cigarettes are not the kind of kids whose race, gender, home life and school performance would make them a high risk to pick up smoking on their own.\u003c/p>\n\u003cp>In other words, vaping is increasing the pool of teen smokers. A 2016 \u003ca href=\"https://e-cigarettes.surgeongeneral.gov/documents/2016_SGR_Exec_Summ_508.pdf\" target=\"_blank\" rel=\"noopener\">report\u003c/a> from the U.S. Surgeon General cited a 900 percent increase in the use of e-cigarettes by high school students from 2011 to 2015. Right now there is very little regulation of e-products at the federal level.\u003c/p>\n\u003cfigure id=\"attachment_441466\" class=\"wp-caption alignright\" style=\"max-width: 800px\">\u003ca href=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/05/RS30897_PROPE_076-e1525979992131.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-441466 size-medium\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/05/RS30897_PROPE_076-800x1200.jpg\" alt=\"\" width=\"800\" height=\"1200\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">An array of flavors displayed at Vapor Den, including banana cream, mango and fruit mix. \u003ccite>(Lauren Hanussak/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Glantz also contends that a flavor ban will help adults who \u003ca href=\"https://www.npr.org/sections/health-shots/2017/05/25/530026958/many-adults-dont-think-exposure-to-vaping-is-bad-for-kids\" target=\"_blank\" rel=\"noopener\">think they’re inhaling\u003c/a> a significantly safer alternative.\u003c/p>\n\u003cp>“When e-cigarettes first became available, there was a lot of hope that they would be better than cigarettes,” he says, “but the more we learn the worse they look.”\u003c/p>\n\u003cp>Though the long-term health effects of smoking e-cigarettes is still unknown, Glantz believes the safety of the devices has been \u003ca href=\"https://www.annualreviews.org/doi/abs/10.1146/annurev-publhealth-040617-013757\" target=\"_blank\" rel=\"noopener\">oversold\u003c/a>.\u003c/p>\n\u003cp>“Electronic smoking products emit particles of chemicals, not clean air, and technically an aerosol, not a vapor,” Smith says. “Think smog or hairspray — not the pure water vapor that steams when your teapot whistles.”\u003c/p>\n\u003cp>These \u003ca href=\"https://pubs.acs.org/doi/full/10.1021/acs.chemrestox.6b00188?src=recsys&=\" target=\"_blank\" rel=\"noopener\">ultrafine particles and toxins\u003c/a> can damage the lungs and may lead to heart attacks. Levels of the particles in the vapor produced by some devices may be lower than in tobacco smoke, but aren’t zero.\u003c/p>\n\u003cp>\u003ciframe loading=\"lazy\" title=\"Why Is Vaping So Popular?\" width=\"500\" height=\"281\" src=\"https://www.youtube.com/embed/P9zps5LsVXs?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen>\u003c/iframe>\u003c/p>\n\u003cp>If San Francisco voters pass the flavor ban, it will be among the \u003ca href=\"https://www.npr.org/sections/thetwo-way/2017/10/24/559833483/new-york-bans-vaping-indoors-in-public-state-law-classes-e-cigs-with-cigarettes\" target=\"_blank\" rel=\"noopener\">toughest restrictions\u003c/a> on e-cigarettes in the country; opponents of the measure fear it will set a precedent.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>Jon Brooks contributed to this post. This post has been edited since it was originally published.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "The Controversial Research on 'Desistance' in Transgender Youth",
"title": "The Controversial Research on 'Desistance' in Transgender Youth",
"headTitle": "KQED Future of You | KQED Science",
"content": "\u003cp>The phenomenon of transgender children \"growing out of\" their transgender identity by the time they are adolescents or adults is called “desistance” by gender researchers.\u003c/p>\n\u003cp>For decades, follow-up studies of transgender kids have shown that a substantial majority -- anywhere from 65 to 94 percent -- eventually ceased to identify as transgender.\u003c/p>\n\u003caside class=\"alignright\">One study found that older children, girls, and those kids who reported more intense gender dysphoria were more likely to stick with their transgender identity as adolescents.\u003c/aside>\n\u003cp>These findings have become part and parcel of the \"How young is too young?\" debate over \"social transitioning,\" the term for allowing kids to publicly live as their identified gender in every way short of medical treatment.\u003c/p>\n\u003cp>If most kids will eventually cease to be transgender, some clinicians have reasoned, isn’t it more prudent to take the least disruptive path in coping with a child's gender dysphoria? That way, if or when kids later stop identifying as transgender, they will have less to “undo.”\u003c/p>\n\u003cp>In recent years, though, a new school of thought has emerged. Many gender specialists now believe that the best course for a transgender child is often “social transition,” where kids as young as three are allowed to change their names, pronouns and style of dress to match the gender they identify with.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cstrong>Looking at the Research\u003c/strong>\u003c/p>\n\u003cp>One reason many researchers believe it’s unnecessary to delay the social transition of a child is that they don’t think the research on desistance is valid. In other words, they think the number of children who \"grow out of\" their transgender identity has been vastly overblown.\u003c/p>\n\u003caside class=\"pullquote alignright\">'The only evidence I have from studies and reports in the literature ... is that not all transgender children will persist in their transgender identity'\u003ccite>Thomas Steensma, VU University Medical Center, Center of Expertise on Gender Dysphoria\u003c/cite>\u003c/aside>\n\u003cp>This school of thought holds that because the criteria for a diagnosis of gender dysphoria (previously called gender identity disorder) was less stringent in the past, the earlier desistance studies included a large cohort of children who today would not be diagnosed with gender dysphoria, gay boys who may have been experimenting with different ways of expressing gender but who were never really transgender in the first place.\u003c/p>\n\u003cp>“The methodology of those studies is very flawed, because they didn't study gender identity,” said Diane Ehrensaft, director of mental health at UCSF’s Child and Adolescent Gender Clinic. “Those desistors were, a good majority of them, simply proto-gay boys whose parents were upset because they were boys wearing dresses. They were brought to the clinics because they weren't fitting gender norms.”\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe src=\"//datawrapper.dwcdn.net/8gbLb/1/\" width=\"100%\" height=\"500\" scrolling=\"yes\" class=\"iframe-class\" frameborder=\"0\">\u003c/iframe>\u003c/p>\n\u003cp>In Amsterdam, clinicians at the Center of Expertise on Gender Dysphoria are much more cautious about recommending social transitions because of the statistics on desistance. Thomas Steensma, a researcher and clinician at the center, acknowledges these studies probably included some kids who would not be diagnosed with gender dysphoria today. Nevertheless, despite the problems with the way they classified children, \"the only evidence I have from studies and reports in the literature ... is that not all transgender children will persist in their transgender identity,\" Steensma said.\u003c/p>\n\u003caside class=\"pullquote alignright\">'Why are we asking a child to conform to something that is not them because society hasn't done its learning yet?'\u003ccite>Diane Ehrensaft, UCSF\u003c/cite>\u003c/aside>\n\u003cp>In 2013, Steensma co-authored an oft-cited \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/23702447\" target=\"_blank\" rel=\"noopener\">study\u003c/a> that examined 127 adolescents, all of whom had displayed various levels of gender dysphoria as children. The researchers found that 80 of the children had desisted by the ages of 15 and 16. That works out to 63 percent of kids who basically stopped being transgender -- a lower rate than in previous studies, but still a majority.\u003c/p>\n\u003cp>Some clinicians criticize this study, however, on methodological grounds, because the researchers defined anyone who did not return to their clinic as desisting. Fifty-two of the children classified as desistors or their parents did send back questionnaires showing the subjects' present lack of gender dysphoria. But 28 neither responded nor could be tracked down.\u003c/p>\n\u003cp>“You can't do that in scientific studies,” Ehrensaft said. “You have to have your subjects in front of you and know who they are. You can't just assume somebody is in a category because you don't see them anymore.”\u003c/p>\n\u003cp>In addition, 38 of the 127 kids were originally designated “subthreshold” for gender identity disorder, meaning they did not fulfill all the criteria for meeting the official diagnosis.\u003c/p>\n\u003cp>This, according to Erica Anderson, a gender clinician at UCSF, makes the desistance findings even more suspect.\" [It] begs the question of whether these kids were actually divergent [in their gender identity] before the study selected them,” she said.\u003c/p>\n\u003cp>Steensma stands by the study’s methodology. But interestingly, he added that citing these findings as a measure of desistance is wrongheaded, because the study was never designed with that goal in mind.\u003c/p>\n\u003cp>“Providing these [desistance] numbers will only lead to wrong conclusions,” he said.\u003c/p>\n\u003cfigure id=\"attachment_441933\" class=\"wp-caption alignright\" style=\"max-width: 385px\">\u003ca href=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/05/Ehrensaft.jpg\">\u003cimg class=\" wp-image-441933\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/05/Ehrensaft-1020x1528.jpg\" alt=\"\" width=\"385\" height=\"577\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2018/05/Ehrensaft-1020x1528.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2018/05/Ehrensaft-160x240.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2018/05/Ehrensaft-800x1198.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2018/05/Ehrensaft-768x1150.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2018/05/Ehrensaft-801x1200.jpg 801w, https://ww2.kqed.org/app/uploads/sites/13/2018/05/Ehrensaft.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2018/05/Ehrensaft-1180x1768.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2018/05/Ehrensaft-960x1438.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2018/05/Ehrensaft-240x360.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2018/05/Ehrensaft-375x562.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2018/05/Ehrensaft-520x779.jpg 520w\" sizes=\"(max-width: 385px) 100vw, 385px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Diane Ehrensaft, director of mental health at UCSF's gender clinic. \u003ccite>(Lauren Hanussak/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Rather, he says, the researchers wanted to see if they could find predictors of persistence. Which they did: The study found that transgender children who were older, born female, and reported more intense gender dysphoria were more likely to stick with their transgender identity than younger children, natal boys and those with less pronounced gender dysphoric traits.\u003c/p>\n\u003cp>Steensma and colleagues also culled one very specific indicator of future persistence: When asked when they were children, “Are you a boy or a girl?” those who answered the opposite of their birth sex were found more likely to have retained their gender identity in adolescence. The desistors, on the other hand, tended to merely \u003cem>wish\u003c/em> they were the opposite sex.\u003c/p>\n\u003cp>“(E)xplicitly asking children with GD (gender dysphoria) with which sex they identify seems to be of great value in predicting a future outcome for both boys and girls with GD,” the study says.\u003c/p>\n\u003cp>Today, Steensma cautions that this question is not a litmus test for which children will persist in their transgender identity. He believes that gender identity in kids is still developing, and that it’s responsive to what occurs at different life stages. He also says it’s possible that a social transition could lead to persistence where it otherwise might not have occurred.\u003c/p>\n\u003cp>“That's not something we can answer,” he said. “It's something we have to study and find out.”\u003c/p>\n\u003cp>\u003cstrong>‘It’s Time to Teach Society’\u003c/strong>\u003c/p>\n\u003cp>Another contentious topic in the transgender community is what the literature calls “detransitioning,” or reverting back to one's natal gender.\u003c/p>\n\u003cp>The current Standards of Care written by the World Professional Association for Transgender Health cautions that “a change back to the original gender role can be highly distressing” The guidelines use that assertion as a reason to be cautious about early social transitioning.\u003c/p>\n\u003cp>But the cautionary language, Ehrensaft points out, is based on one qualitative study, coauthored by Steensma, which looked at the dilemma of just two Dutch girls who’d transitioned when they were in elementary school and wanted to switch back. She doesn’t think it’s particularly relevant.\u003c/p>\n\u003cp>“The stress [of detransitioning] comes from microaggressions and lack of acceptance in the environment,” she said. “If we offer social support and opportunities for children over time, we don’t have any evidence that [detransitioning] will be damaging for them.”\u003c/p>\n\u003cp>Ehrensaft believes the conventional treatment of transgender children has been based, for the most part, on traditionally negative views of gender nonconformity. So, she believes, the burden is now on the culture to see transgender children as they really are.\u003c/p>\n\u003cp>“Why are we asking a child to conform to something that is not them because society hasn't done its learning yet?”she says. “It's time to teach society.”\u003c/p>\n\u003cp>\u003cstrong>Toward the Nonbinary\u003c/strong>\u003c/p>\n\u003cp>One of the more interesting takes I heard on persistence and desistance came from UCSF gender clinician Erica Anderson, who is transgender herself. She views the very notion of measuring persistence/desistance as something of a fool’s errand, because such definitions are mediated by changing cultural norms, the self-perceptions of children and the ways that researchers interpret them.\u003c/p>\n\u003cp>“We’ve got kids of varying sophistication levels of language trying to explain to other people who have no experience [being transgender],\" Anderson said, \"and it’s being driven by shifting professional understanding or consensus and culture. You’ve got moving parts. In that context we’ve got a dynamic situation where kids who might say ‘I’m a girl’ might have said five years ago ‘maybe I’m a girl.’ ”\u003c/p>\n\u003cp>Ehrensaft herself doesn’t even like to use the terms persistence and desistance. Those words imply something fixed — a binary state of yes or no. But younger generations of transgender people — and even \u003ca href=\"https://fusiondotnet.files.wordpress.com/2015/02/fusion-poll-gender-spectrum.pdf\" target=\"_blank\" rel=\"noopener\">younger generations\u003c/a> in the general population — see gender as more protean, even customizable. Of nearly 28,000 respondents to the \u003ca href=\"http://www.ustranssurvey.org/\" target=\"_blank\" rel=\"noopener\">2015 U.S. Transgender Survey\u003c/a>, more than one-third said they were some form of \u003ca href=\"https://www.kqed.org/futureofyou/335790/boy-girl-both-neither-a-new-generation-overthrows-gender\" target=\"_blank\" rel=\"noopener\">nonbinary\u003c/a>. That means they may identify as both male and female, neither male nor female, or \u003cem>sometimes\u003c/em> male, \u003cem>sometimes\u003c/em> female.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>This, in theory, could solve a lot of problems. After all, if the gender fluidity trend continues, perhaps many people will have no unitary gender to \"persist\" or \"desist\" from.\u003c/p>\n\n",
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"excerpt": "For decades, follow-up studies of transgender kids have shown that a substantial majority eventually ceased to identify as transgender. But some gender researchers say that research is faulty.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The phenomenon of transgender children \"growing out of\" their transgender identity by the time they are adolescents or adults is called “desistance” by gender researchers.\u003c/p>\n\u003cp>For decades, follow-up studies of transgender kids have shown that a substantial majority -- anywhere from 65 to 94 percent -- eventually ceased to identify as transgender.\u003c/p>\n\u003caside class=\"alignright\">One study found that older children, girls, and those kids who reported more intense gender dysphoria were more likely to stick with their transgender identity as adolescents.\u003c/aside>\n\u003cp>These findings have become part and parcel of the \"How young is too young?\" debate over \"social transitioning,\" the term for allowing kids to publicly live as their identified gender in every way short of medical treatment.\u003c/p>\n\u003cp>If most kids will eventually cease to be transgender, some clinicians have reasoned, isn’t it more prudent to take the least disruptive path in coping with a child's gender dysphoria? That way, if or when kids later stop identifying as transgender, they will have less to “undo.”\u003c/p>\n\u003cp>In recent years, though, a new school of thought has emerged. Many gender specialists now believe that the best course for a transgender child is often “social transition,” where kids as young as three are allowed to change their names, pronouns and style of dress to match the gender they identify with.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cstrong>Looking at the Research\u003c/strong>\u003c/p>\n\u003cp>One reason many researchers believe it’s unnecessary to delay the social transition of a child is that they don’t think the research on desistance is valid. In other words, they think the number of children who \"grow out of\" their transgender identity has been vastly overblown.\u003c/p>\n\u003caside class=\"pullquote alignright\">'The only evidence I have from studies and reports in the literature ... is that not all transgender children will persist in their transgender identity'\u003ccite>Thomas Steensma, VU University Medical Center, Center of Expertise on Gender Dysphoria\u003c/cite>\u003c/aside>\n\u003cp>This school of thought holds that because the criteria for a diagnosis of gender dysphoria (previously called gender identity disorder) was less stringent in the past, the earlier desistance studies included a large cohort of children who today would not be diagnosed with gender dysphoria, gay boys who may have been experimenting with different ways of expressing gender but who were never really transgender in the first place.\u003c/p>\n\u003cp>“The methodology of those studies is very flawed, because they didn't study gender identity,” said Diane Ehrensaft, director of mental health at UCSF’s Child and Adolescent Gender Clinic. “Those desistors were, a good majority of them, simply proto-gay boys whose parents were upset because they were boys wearing dresses. They were brought to the clinics because they weren't fitting gender norms.”\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe src=\"//datawrapper.dwcdn.net/8gbLb/1/\" width=\"100%\" height=\"500\" scrolling=\"yes\" class=\"iframe-class\" frameborder=\"0\">\u003c/iframe>\u003c/p>\n\u003cp>In Amsterdam, clinicians at the Center of Expertise on Gender Dysphoria are much more cautious about recommending social transitions because of the statistics on desistance. Thomas Steensma, a researcher and clinician at the center, acknowledges these studies probably included some kids who would not be diagnosed with gender dysphoria today. Nevertheless, despite the problems with the way they classified children, \"the only evidence I have from studies and reports in the literature ... is that not all transgender children will persist in their transgender identity,\" Steensma said.\u003c/p>\n\u003caside class=\"pullquote alignright\">'Why are we asking a child to conform to something that is not them because society hasn't done its learning yet?'\u003ccite>Diane Ehrensaft, UCSF\u003c/cite>\u003c/aside>\n\u003cp>In 2013, Steensma co-authored an oft-cited \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/23702447\" target=\"_blank\" rel=\"noopener\">study\u003c/a> that examined 127 adolescents, all of whom had displayed various levels of gender dysphoria as children. The researchers found that 80 of the children had desisted by the ages of 15 and 16. That works out to 63 percent of kids who basically stopped being transgender -- a lower rate than in previous studies, but still a majority.\u003c/p>\n\u003cp>Some clinicians criticize this study, however, on methodological grounds, because the researchers defined anyone who did not return to their clinic as desisting. Fifty-two of the children classified as desistors or their parents did send back questionnaires showing the subjects' present lack of gender dysphoria. But 28 neither responded nor could be tracked down.\u003c/p>\n\u003cp>“You can't do that in scientific studies,” Ehrensaft said. “You have to have your subjects in front of you and know who they are. You can't just assume somebody is in a category because you don't see them anymore.”\u003c/p>\n\u003cp>In addition, 38 of the 127 kids were originally designated “subthreshold” for gender identity disorder, meaning they did not fulfill all the criteria for meeting the official diagnosis.\u003c/p>\n\u003cp>This, according to Erica Anderson, a gender clinician at UCSF, makes the desistance findings even more suspect.\" [It] begs the question of whether these kids were actually divergent [in their gender identity] before the study selected them,” she said.\u003c/p>\n\u003cp>Steensma stands by the study’s methodology. But interestingly, he added that citing these findings as a measure of desistance is wrongheaded, because the study was never designed with that goal in mind.\u003c/p>\n\u003cp>“Providing these [desistance] numbers will only lead to wrong conclusions,” he said.\u003c/p>\n\u003cfigure id=\"attachment_441933\" class=\"wp-caption alignright\" style=\"max-width: 385px\">\u003ca href=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/05/Ehrensaft.jpg\">\u003cimg class=\" wp-image-441933\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/05/Ehrensaft-1020x1528.jpg\" alt=\"\" width=\"385\" height=\"577\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2018/05/Ehrensaft-1020x1528.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2018/05/Ehrensaft-160x240.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2018/05/Ehrensaft-800x1198.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2018/05/Ehrensaft-768x1150.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2018/05/Ehrensaft-801x1200.jpg 801w, https://ww2.kqed.org/app/uploads/sites/13/2018/05/Ehrensaft.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2018/05/Ehrensaft-1180x1768.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2018/05/Ehrensaft-960x1438.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2018/05/Ehrensaft-240x360.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2018/05/Ehrensaft-375x562.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2018/05/Ehrensaft-520x779.jpg 520w\" sizes=\"(max-width: 385px) 100vw, 385px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Diane Ehrensaft, director of mental health at UCSF's gender clinic. \u003ccite>(Lauren Hanussak/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Rather, he says, the researchers wanted to see if they could find predictors of persistence. Which they did: The study found that transgender children who were older, born female, and reported more intense gender dysphoria were more likely to stick with their transgender identity than younger children, natal boys and those with less pronounced gender dysphoric traits.\u003c/p>\n\u003cp>Steensma and colleagues also culled one very specific indicator of future persistence: When asked when they were children, “Are you a boy or a girl?” those who answered the opposite of their birth sex were found more likely to have retained their gender identity in adolescence. The desistors, on the other hand, tended to merely \u003cem>wish\u003c/em> they were the opposite sex.\u003c/p>\n\u003cp>“(E)xplicitly asking children with GD (gender dysphoria) with which sex they identify seems to be of great value in predicting a future outcome for both boys and girls with GD,” the study says.\u003c/p>\n\u003cp>Today, Steensma cautions that this question is not a litmus test for which children will persist in their transgender identity. He believes that gender identity in kids is still developing, and that it’s responsive to what occurs at different life stages. He also says it’s possible that a social transition could lead to persistence where it otherwise might not have occurred.\u003c/p>\n\u003cp>“That's not something we can answer,” he said. “It's something we have to study and find out.”\u003c/p>\n\u003cp>\u003cstrong>‘It’s Time to Teach Society’\u003c/strong>\u003c/p>\n\u003cp>Another contentious topic in the transgender community is what the literature calls “detransitioning,” or reverting back to one's natal gender.\u003c/p>\n\u003cp>The current Standards of Care written by the World Professional Association for Transgender Health cautions that “a change back to the original gender role can be highly distressing” The guidelines use that assertion as a reason to be cautious about early social transitioning.\u003c/p>\n\u003cp>But the cautionary language, Ehrensaft points out, is based on one qualitative study, coauthored by Steensma, which looked at the dilemma of just two Dutch girls who’d transitioned when they were in elementary school and wanted to switch back. She doesn’t think it’s particularly relevant.\u003c/p>\n\u003cp>“The stress [of detransitioning] comes from microaggressions and lack of acceptance in the environment,” she said. “If we offer social support and opportunities for children over time, we don’t have any evidence that [detransitioning] will be damaging for them.”\u003c/p>\n\u003cp>Ehrensaft believes the conventional treatment of transgender children has been based, for the most part, on traditionally negative views of gender nonconformity. So, she believes, the burden is now on the culture to see transgender children as they really are.\u003c/p>\n\u003cp>“Why are we asking a child to conform to something that is not them because society hasn't done its learning yet?”she says. “It's time to teach society.”\u003c/p>\n\u003cp>\u003cstrong>Toward the Nonbinary\u003c/strong>\u003c/p>\n\u003cp>One of the more interesting takes I heard on persistence and desistance came from UCSF gender clinician Erica Anderson, who is transgender herself. She views the very notion of measuring persistence/desistance as something of a fool’s errand, because such definitions are mediated by changing cultural norms, the self-perceptions of children and the ways that researchers interpret them.\u003c/p>\n\u003cp>“We’ve got kids of varying sophistication levels of language trying to explain to other people who have no experience [being transgender],\" Anderson said, \"and it’s being driven by shifting professional understanding or consensus and culture. You’ve got moving parts. In that context we’ve got a dynamic situation where kids who might say ‘I’m a girl’ might have said five years ago ‘maybe I’m a girl.’ ”\u003c/p>\n\u003cp>Ehrensaft herself doesn’t even like to use the terms persistence and desistance. Those words imply something fixed — a binary state of yes or no. But younger generations of transgender people — and even \u003ca href=\"https://fusiondotnet.files.wordpress.com/2015/02/fusion-poll-gender-spectrum.pdf\" target=\"_blank\" rel=\"noopener\">younger generations\u003c/a> in the general population — see gender as more protean, even customizable. Of nearly 28,000 respondents to the \u003ca href=\"http://www.ustranssurvey.org/\" target=\"_blank\" rel=\"noopener\">2015 U.S. Transgender Survey\u003c/a>, more than one-third said they were some form of \u003ca href=\"https://www.kqed.org/futureofyou/335790/boy-girl-both-neither-a-new-generation-overthrows-gender\" target=\"_blank\" rel=\"noopener\">nonbinary\u003c/a>. That means they may identify as both male and female, neither male nor female, or \u003cem>sometimes\u003c/em> male, \u003cem>sometimes\u003c/em> female.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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},
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"id": "city-arts",
"title": "City Arts & Lectures",
"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": {
"site": "news",
"source": "City Arts & Lectures"
},
"link": "https://www.cityarts.net",
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"rss": "https://www.cityarts.net/feed/"
}
},
"closealltabs": {
"id": "closealltabs",
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"officialWebsiteLink": "/podcasts/closealltabs",
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"order": 1
},
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"id": "code-switch-life-kit",
"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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"id": "commonwealth-club",
"title": "Commonwealth Club of California Podcast",
"info": "The Commonwealth Club of California is the nation's oldest and largest public affairs forum. As a non-partisan forum, The Club brings to the public airwaves diverse viewpoints on important topics. The Club's weekly radio broadcast - the oldest in the U.S., dating back to 1924 - is carried across the nation on public radio stations and is now podcasting. Our website archive features audio of our recent programs, as well as selected speeches from our long and distinguished history. This podcast feed is usually updated twice a week and is always un-edited.",
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"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Commonwealth-Club-Podcast-Tile-360x360-1.jpg",
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"source": "Commonwealth Club of California"
},
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"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",
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"source": "kqed",
"order": 9
},
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM5NTU3MzgxNjMz",
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"airtime": "SUN 1am-2am, SAT 3pm-4pm",
"meta": {
"site": "radio",
"source": "WNYC"
},
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"subscribe": {
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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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},
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"id": "fresh-air",
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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": {
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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"
},
"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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"apple": "https://itunes.apple.com/us/podcast/how-i-built-this-with-guy-raz/id1150510297?mt=2",
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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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"officialWebsiteLink": "/podcasts/hyphenacion",
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"order": 15
},
"link": "/podcasts/hyphenacion",
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"spotify": "https://open.spotify.com/show/2p3Fifq96nw9BPcmFdIq0o?si=39209f7b25774f38",
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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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"officialWebsiteLink": "/podcasts/jerrybrown",
"meta": {
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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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},
"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": {
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"source": "American Public Media"
},
"link": "/radio/program/marketplace",
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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"
},
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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",
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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",
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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",
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"officialWebsiteLink": "/podcasts/onourwatch",
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"source": "kqed",
"order": 11
},
"link": "/podcasts/onourwatch",
"subscribe": {
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5ucHIub3JnLzUxMDM2MC9wb2RjYXN0LnhtbD9zYz1nb29nbGVwb2RjYXN0cw",
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},
"on-the-media": {
"id": "on-the-media",
"title": "On The Media",
"info": "Our weekly podcast explores how the media 'sausage' is made, casts an incisive eye on fluctuations in the marketplace of ideas, and examines threats to the freedom of information and expression in America and abroad. For one hour a week, the show tries to lift the veil from the process of \"making media,\" especially news media, because it's through that lens that we see the world and the world sees us",
"airtime": "SUN 2pm-3pm, MON 12am-1am",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/onTheMedia.png",
"officialWebsiteLink": "https://www.wnycstudios.org/shows/otm",
"meta": {
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"source": "wnyc"
},
"link": "/radio/program/on-the-media",
"subscribe": {
"apple": "https://itunes.apple.com/us/podcast/on-the-media/id73330715?mt=2",
"tuneIn": "https://tunein.com/radio/On-the-Media-p69/",
"rss": "http://feeds.wnyc.org/onthemedia"
}
},
"pbs-newshour": {
"id": "pbs-newshour",
"title": "PBS NewsHour",
"info": "Analysis, background reports and updates from the PBS NewsHour putting today's news in context.",
"airtime": "MON-FRI 3pm-4pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/PBS-News-Hour-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.pbs.org/newshour/",
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},
"link": "/radio/program/pbs-newshour",
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"apple": "https://itunes.apple.com/us/podcast/pbs-newshour-full-show/id394432287?mt=2",
"tuneIn": "https://tunein.com/radio/PBS-NewsHour---Full-Show-p425698/",
"rss": "https://www.pbs.org/newshour/feeds/rss/podcasts/show"
}
},
"perspectives": {
"id": "perspectives",
"title": "Perspectives",
"tagline": "KQED's series of daily listener commentaries since 1991",
"info": "KQED's series of daily listener commentaries since 1991.",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2025/01/Perspectives_Tile_Final.jpg",
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"officialWebsiteLink": "/perspectives/",
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"source": "kqed",
"order": 14
},
"link": "/perspectives",
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