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"disqusTitle": "A Quarter of California Adolescents May Be 'Gender Nonconforming.' So What Does That Mean?",
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"content": "\u003cp>You may have seen recent news of a survey finding that 27 percent of California youth ages 12 to 17 are \"gender nonconforming.\"\u003c/p>\n\u003caside class=\"pullquote alignright\">'Gender nonconforming is not a synonym for transgender. Rather it typically refers to a much greater number of people who defy stereotypes of their sex. This term can include tomboys, for example.'\u003ccite>Kristina Olson, University of Washington.\u003c/cite>\u003c/aside>\n\u003cp>That sounds pretty high. I might even put the word \"whopping\" before \"27 percent.\"\u003c/p>\n\u003cp>But I have to say, I've been covering the \u003ca href=\"https://ww2.kqed.org/futureofyou/2017/04/24/boy-girl-both-neither-a-new-generation-overthrows-gender/\" target=\"_blank\" rel=\"noopener\">gender story\u003c/a> for more than a year, and when I saw the headlines, I wasn't \u003cem>quite\u003c/em> sure what gender nonconforming meant. Gender terminology, like gender itself these days, can be fairly fluid.\u003c/p>\n\u003cp>So here is the exact question that was asked of California adolescents:\u003c/p>\n\u003cblockquote>\u003cp>\u003cspan style=\"font-weight: 400\">A person’s appearance, style, dress, or the way they walk or talk may affect how people describe them. How do you think other people at school would describe you? \u003c/span>\u003c/p>\n\u003cp>Very feminine\u003c/p>\n\u003cp>Mostly feminine\u003c/p>\n\u003cp>Equally feminine and masculine\u003c/p>\n\u003cp>Mostly masculine\u003c/p>\n\u003cp>Very masculine\u003c/p>\u003c/blockquote>\n\u003cp>This is a measure of what gender researchers call \"gender expression,\" or the way individuals manifest what you might call the trappings of masculinity and femininity: clothes, hair, makeup, posture. As some of the UCLA researchers involved in the survey put it, those who are \"seen as resisting dominant expectations around gender expression\" are considered gender nonconforming.\u003c/p>\n\u003caside class=\"pullquote alignright\">'There’s been an assumption that gender nonconforming people are gay or lesbian, but that’s not the case. It’s a stereotype.”\u003ccite>Alison Gill, Advocates for Youth\u003c/cite>\u003c/aside>\n\u003cp>You might think that someone who is gender nonconforming is necessarily transgender. But that is not the case.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“ ‘Gender nonconforming' \" is not a synonym for transgender,” says Kristina Olson, d\u003c/span>\u003cspan style=\"font-weight: 400\">irector of the TransYouth Project at the University of Washington. \u003c/span>\u003cspan style=\"font-weight: 400\">“R\u003c/span>\u003cspan style=\"font-weight: 400\">ather it typically refers to a much greater number of people who defy stereotypes of their sex. This term can include tomboys, for example\u003c/span>\u003cspan style=\"font-weight: 400\">.\"\u003c/span>\u003c/p>\n\u003cp>Many people may also confound gender nonconformity with being lesbian, gay or bisexual. But Alison Gill, a consultant on gender for the nonprofit Advocates for Youth, says \u003ca href=\"http://advocatesforyouth.org/storage/advfy/documents/YRBSS.pdf\" target=\"_blank\" rel=\"noopener\">research\u003c/a> shows most gender nonconforming kids are actually heterosexual.\u003c/p>\n\u003cp>\"There’s been an assumption that gender nonconforming people are gay or lesbian, but that’s not the case. It’s a stereotype,” she said.\u003c/p>\n\u003cp>In other words, you can be gender nonconforming without being L, G, B or T.\u003c/p>\n\u003cp>\u003cstrong>Study Results\u003c/strong>\u003c/p>\n\u003cp>The gender expression question was included on the recent \u003ca href=\"http://healthpolicy.ucla.edu/chis/Pages/default.aspx\" target=\"_blank\" rel=\"noopener\">California Health Interview Survey\u003c/a>, conducted by UCLA on a continuous basis. The telephone survey covers dozens of health topics.\u003c/p>\n\u003cp>The CHIS has been going strong since 2001, but this was the first time a question on either youth gender identity or gender expression had been included.\u003c/p>\n\u003cp>Why now?\u003c/p>\n\u003caside class=\"pullquote alignright\">'A lot of bullying is around expression and not sexuality. A gay boy who is considered totally masculine is considered fine by his peers. But nonconforming people are getting bullied.' \u003ccite>Phil Hammack, University of California, Santa Cruz\u003c/cite>\u003c/aside>\n\u003cp>Researchers at UCLA's Center for Health Policy Research and The Williams Institute, which conducts research on sexual orientation and gender identity law, said in a health policy \u003ca href=\"http://healthpolicy.ucla.edu/publications/Documents/PDF/2017/gncadolescents-factsheet-dec2017.pdf\" target=\"_blank\" rel=\"noopener\">fact sheet\u003c/a> that levels of gender conformity are \"known to be a particularly salient factor in the safety and well-being of youth. Yet, data about gender nonconforming youth remain rare.\"\u003c/p>\n\u003cp>The question was asked of 1,594 adolescents, ages 12 to 17, across California.\u003c/p>\n\u003cp>There were two categories for respondents coded as gender nonconforming. One was \"highly gender nonconforming\" and the other was \"androgynous.\"\u003c/p>\n\u003cp>Male respondents who answered \"very feminine\" or \"mostly feminine,\" and female respondents who answered \"very masculine\" or \"mostly masculine,\" were categorized as \"highly gender nonconforming.\"\u003c/p>\n\u003cp>Those who answered \"equally feminine and masculine\" were coded as “androgynous.”\u003c/p>\n\u003cp>The androgynous outnumbered those who were highly gender nonconforming by more than 3 to 1.\u003c/p>\n\u003cp>Total nonconforming youth came out to 27 percent of all the adolescents queried. That \u003cspan style=\"font-weight: 400\">would equate to 796,000 gender nonconforming youth in the state of California today.\u003c/span>\u003c/p>\n\u003cp>The margin of error was about 6 percent, so that number could be substantially greater or fewer.\u003c/p>\n\u003cp>\u003cstrong>California and Gender\u003c/strong>\u003c/p>\n\u003cp>Combined surveys asking the same question in L.A., San Diego, Chicago and Florida’s Broward County provide a larger population of 9,265 youth, and that data shows high health risks associated with gender nonconformity. For example, GNC males were between two and three times more likely to attempt suicide than conforming males, and for females the rate was 1 1/2 times greater for those who were GNC.\u003c/p>\n\u003cp>While the California survey showed nonconforming youth reporting more than twice the level of severe psychological distress as their conforming peers, it showed no statistically significant difference when it came to suicidal ideation and suicide attempts.\u003c/p>\n\u003cp>Why the big difference related to suicide between nonconforming and conforming youth in the larger sample, and hardly any in the Californian-only data?\u003c/p>\n\u003cp>The California researchers speculated that the state's social environment may be contributing to better mental health outcomes.\u003c/p>\n\u003cp>“(H)igher levels of social acceptance and the presence of protective policies in California may impact rates of victimization and bullying, which, in turn, may confer some protection for gender minority youth in the state,\" reads the fact sheet.\u003c/p>\n\u003cp>\u003cstrong>The Next Frontier\u003c/strong>\u003c/p>\n\u003cp>Phil Hammack is a professor of psychology and researcher at the University of California, Santa Cruz, who specializes in sexual and gender identity. He thinks that when it comes to bullying, gender expression is the new sexual orientation.\u003c/p>\n\u003cp>“A lot of bullying is around expression and not sexuality,” he said. “A gay boy who is considered totally masculine is considered fine by his peers. But nonconforming people are getting bullied.”\u003c/p>\n\u003cp>Even though there is much greater visibility for gender nonconforming youth, Hammack said, “the culture is in a state of anxiety around this revolution.”\u003c/p>\n\u003cp>\"This is the next frontier for us to address among people who care about young people’s well-being.”\u003c/p>\n\u003cp>The gender researchers I spoke to agreed that gender nonconformity often causes bullying and mental health distress independent of sexual orientation and gender identities.\u003c/p>\n\u003cp>\u003cstrong>A Quarrel With the Question\u003c/strong>\u003c/p>\n\u003cp>One gender researcher who doesn’t think the question resulted in precise enough data is Charlotte Tate, from San Francisco State. Tate said that because there was no question about sexual orientation on the survey, it's impossible to tease apart how much of the mental distress exhibited by GNC youth stems from being lesbian, gay or bisexual and how much from an unconventional gender expression.\u003c/p>\n\u003cp>\"So [the researchers] haven’t sufficiently demonstrated that the stress is linked to gender; it could be about sexual orientation,\" Tate said.\u003c/p>\n\u003cp>Bianca Wilson, \u003cspan style=\"font-weight: 400\">a senior public policy scholar at The Williams Institute, \u003c/span>agrees inserting a sexual orientation question would be useful to understand the \"unique and compounding levels of distress\" by non-heterosexual youth who also do differ in their gender expression.\u003c/p>\n\u003cp>In any event, there will be more data. Gill says the number of sites that have now asked the gender nonconforming question has increased to 16, and that the results will start coming in during the first half of 2018.\u003c/p>\n\u003cp>Hammack, the researcher from UC Santa Cruz, says it's obvious that gender nonconformity is booming. He recently completed a study of teen LGBT youth in the Central Valley and the Bay Area, and he was surprised to find how easy it was to sign up those who were nonconforming.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\"We had to cap the number of gender nonconforming youth who participated to make sure we got enough gender conforming youth,\" he said.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>You may have seen recent news of a survey finding that 27 percent of California youth ages 12 to 17 are \"gender nonconforming.\"\u003c/p>\n\u003caside class=\"pullquote alignright\">'Gender nonconforming is not a synonym for transgender. Rather it typically refers to a much greater number of people who defy stereotypes of their sex. This term can include tomboys, for example.'\u003ccite>Kristina Olson, University of Washington.\u003c/cite>\u003c/aside>\n\u003cp>That sounds pretty high. I might even put the word \"whopping\" before \"27 percent.\"\u003c/p>\n\u003cp>But I have to say, I've been covering the \u003ca href=\"https://ww2.kqed.org/futureofyou/2017/04/24/boy-girl-both-neither-a-new-generation-overthrows-gender/\" target=\"_blank\" rel=\"noopener\">gender story\u003c/a> for more than a year, and when I saw the headlines, I wasn't \u003cem>quite\u003c/em> sure what gender nonconforming meant. Gender terminology, like gender itself these days, can be fairly fluid.\u003c/p>\n\u003cp>So here is the exact question that was asked of California adolescents:\u003c/p>\n\u003cblockquote>\u003cp>\u003cspan style=\"font-weight: 400\">A person’s appearance, style, dress, or the way they walk or talk may affect how people describe them. How do you think other people at school would describe you? \u003c/span>\u003c/p>\n\u003cp>Very feminine\u003c/p>\n\u003cp>Mostly feminine\u003c/p>\n\u003cp>Equally feminine and masculine\u003c/p>\n\u003cp>Mostly masculine\u003c/p>\n\u003cp>Very masculine\u003c/p>\u003c/blockquote>\n\u003cp>This is a measure of what gender researchers call \"gender expression,\" or the way individuals manifest what you might call the trappings of masculinity and femininity: clothes, hair, makeup, posture. As some of the UCLA researchers involved in the survey put it, those who are \"seen as resisting dominant expectations around gender expression\" are considered gender nonconforming.\u003c/p>\n\u003caside class=\"pullquote alignright\">'There’s been an assumption that gender nonconforming people are gay or lesbian, but that’s not the case. It’s a stereotype.”\u003ccite>Alison Gill, Advocates for Youth\u003c/cite>\u003c/aside>\n\u003cp>You might think that someone who is gender nonconforming is necessarily transgender. But that is not the case.\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\">“ ‘Gender nonconforming' \" is not a synonym for transgender,” says Kristina Olson, d\u003c/span>\u003cspan style=\"font-weight: 400\">irector of the TransYouth Project at the University of Washington. \u003c/span>\u003cspan style=\"font-weight: 400\">“R\u003c/span>\u003cspan style=\"font-weight: 400\">ather it typically refers to a much greater number of people who defy stereotypes of their sex. This term can include tomboys, for example\u003c/span>\u003cspan style=\"font-weight: 400\">.\"\u003c/span>\u003c/p>\n\u003cp>Many people may also confound gender nonconformity with being lesbian, gay or bisexual. But Alison Gill, a consultant on gender for the nonprofit Advocates for Youth, says \u003ca href=\"http://advocatesforyouth.org/storage/advfy/documents/YRBSS.pdf\" target=\"_blank\" rel=\"noopener\">research\u003c/a> shows most gender nonconforming kids are actually heterosexual.\u003c/p>\n\u003cp>\"There’s been an assumption that gender nonconforming people are gay or lesbian, but that’s not the case. It’s a stereotype,” she said.\u003c/p>\n\u003cp>In other words, you can be gender nonconforming without being L, G, B or T.\u003c/p>\n\u003cp>\u003cstrong>Study Results\u003c/strong>\u003c/p>\n\u003cp>The gender expression question was included on the recent \u003ca href=\"http://healthpolicy.ucla.edu/chis/Pages/default.aspx\" target=\"_blank\" rel=\"noopener\">California Health Interview Survey\u003c/a>, conducted by UCLA on a continuous basis. The telephone survey covers dozens of health topics.\u003c/p>\n\u003cp>The CHIS has been going strong since 2001, but this was the first time a question on either youth gender identity or gender expression had been included.\u003c/p>\n\u003cp>Why now?\u003c/p>\n\u003caside class=\"pullquote alignright\">'A lot of bullying is around expression and not sexuality. A gay boy who is considered totally masculine is considered fine by his peers. But nonconforming people are getting bullied.' \u003ccite>Phil Hammack, University of California, Santa Cruz\u003c/cite>\u003c/aside>\n\u003cp>Researchers at UCLA's Center for Health Policy Research and The Williams Institute, which conducts research on sexual orientation and gender identity law, said in a health policy \u003ca href=\"http://healthpolicy.ucla.edu/publications/Documents/PDF/2017/gncadolescents-factsheet-dec2017.pdf\" target=\"_blank\" rel=\"noopener\">fact sheet\u003c/a> that levels of gender conformity are \"known to be a particularly salient factor in the safety and well-being of youth. Yet, data about gender nonconforming youth remain rare.\"\u003c/p>\n\u003cp>The question was asked of 1,594 adolescents, ages 12 to 17, across California.\u003c/p>\n\u003cp>There were two categories for respondents coded as gender nonconforming. One was \"highly gender nonconforming\" and the other was \"androgynous.\"\u003c/p>\n\u003cp>Male respondents who answered \"very feminine\" or \"mostly feminine,\" and female respondents who answered \"very masculine\" or \"mostly masculine,\" were categorized as \"highly gender nonconforming.\"\u003c/p>\n\u003cp>Those who answered \"equally feminine and masculine\" were coded as “androgynous.”\u003c/p>\n\u003cp>The androgynous outnumbered those who were highly gender nonconforming by more than 3 to 1.\u003c/p>\n\u003cp>Total nonconforming youth came out to 27 percent of all the adolescents queried. That \u003cspan style=\"font-weight: 400\">would equate to 796,000 gender nonconforming youth in the state of California today.\u003c/span>\u003c/p>\n\u003cp>The margin of error was about 6 percent, so that number could be substantially greater or fewer.\u003c/p>\n\u003cp>\u003cstrong>California and Gender\u003c/strong>\u003c/p>\n\u003cp>Combined surveys asking the same question in L.A., San Diego, Chicago and Florida’s Broward County provide a larger population of 9,265 youth, and that data shows high health risks associated with gender nonconformity. For example, GNC males were between two and three times more likely to attempt suicide than conforming males, and for females the rate was 1 1/2 times greater for those who were GNC.\u003c/p>\n\u003cp>While the California survey showed nonconforming youth reporting more than twice the level of severe psychological distress as their conforming peers, it showed no statistically significant difference when it came to suicidal ideation and suicide attempts.\u003c/p>\n\u003cp>Why the big difference related to suicide between nonconforming and conforming youth in the larger sample, and hardly any in the Californian-only data?\u003c/p>\n\u003cp>The California researchers speculated that the state's social environment may be contributing to better mental health outcomes.\u003c/p>\n\u003cp>“(H)igher levels of social acceptance and the presence of protective policies in California may impact rates of victimization and bullying, which, in turn, may confer some protection for gender minority youth in the state,\" reads the fact sheet.\u003c/p>\n\u003cp>\u003cstrong>The Next Frontier\u003c/strong>\u003c/p>\n\u003cp>Phil Hammack is a professor of psychology and researcher at the University of California, Santa Cruz, who specializes in sexual and gender identity. He thinks that when it comes to bullying, gender expression is the new sexual orientation.\u003c/p>\n\u003cp>“A lot of bullying is around expression and not sexuality,” he said. “A gay boy who is considered totally masculine is considered fine by his peers. But nonconforming people are getting bullied.”\u003c/p>\n\u003cp>Even though there is much greater visibility for gender nonconforming youth, Hammack said, “the culture is in a state of anxiety around this revolution.”\u003c/p>\n\u003cp>\"This is the next frontier for us to address among people who care about young people’s well-being.”\u003c/p>\n\u003cp>The gender researchers I spoke to agreed that gender nonconformity often causes bullying and mental health distress independent of sexual orientation and gender identities.\u003c/p>\n\u003cp>\u003cstrong>A Quarrel With the Question\u003c/strong>\u003c/p>\n\u003cp>One gender researcher who doesn’t think the question resulted in precise enough data is Charlotte Tate, from San Francisco State. Tate said that because there was no question about sexual orientation on the survey, it's impossible to tease apart how much of the mental distress exhibited by GNC youth stems from being lesbian, gay or bisexual and how much from an unconventional gender expression.\u003c/p>\n\u003cp>\"So [the researchers] haven’t sufficiently demonstrated that the stress is linked to gender; it could be about sexual orientation,\" Tate said.\u003c/p>\n\u003cp>Bianca Wilson, \u003cspan style=\"font-weight: 400\">a senior public policy scholar at The Williams Institute, \u003c/span>agrees inserting a sexual orientation question would be useful to understand the \"unique and compounding levels of distress\" by non-heterosexual youth who also do differ in their gender expression.\u003c/p>\n\u003cp>In any event, there will be more data. Gill says the number of sites that have now asked the gender nonconforming question has increased to 16, and that the results will start coming in during the first half of 2018.\u003c/p>\n\u003cp>Hammack, the researcher from UC Santa Cruz, says it's obvious that gender nonconformity is booming. He recently completed a study of teen LGBT youth in the Central Valley and the Bay Area, and he was surprised to find how easy it was to sign up those who were nonconforming.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>U.S. health officials plan to crack down on a growing number of unproven alternative remedies, focusing on products containing dangerous ingredients that have occasionally been linked to serious injury and death.H\u003c/p>\n\u003cp>The Food and Drug Administration on Monday issued a new proposal for regulating homeopathic medicines that have long been on the fringe of mainstream medicine. The agency plans to target products that pose the biggest safety risks, including those marketed for children or for serious diseases.\u003c/p>\n\u003caside class=\"pullquote alignright\">'People may be putting their trust and money in therapies that bring little or no benefit in combating their ailments, or worse — in products that may cause serious and even irreparable harm.'\u003ccite>Dr. Scott Gottlieb,FDA Commissioner \u003c/cite>\u003c/aside>\n\u003cp>But under the government's framework, the vast majority of low-risk products would remain on the market. Popular homeopathic brands include Zicam Allergy Relief and Cold-Eeze.\u003c/p>\n\u003cp>Long regarded by scientists as a form of modern-day snake oil, homeopathic products are treated as drugs under law, but not supported by modern science. Most remedies contain heavily diluted drugs, vitamins and minerals.\u003c/p>\n\u003cp>\"People may be putting their trust and money in therapies that bring little or no benefit in combating their ailments, or worse — in products that may cause serious and even irreparable harm,\" FDA Commissioner Dr. Scott Gottlieb said Monday on a call with reporters.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Once a niche market, homeopathy products have grown into a $3 billion industry, according to FDA figures.\u003c/p>\n\u003cp>[contextly_sidebar id=\"Q9e3dS7jG2DTfAP33rG2lSzTZoSCLrmc\"]Homeopathic products are similar to dietary supplements, in that the FDA does not review their safety or effectiveness before they are sold. But unlike supplements, homeopathic medicines can state that they are intended for specific medical symptoms and conditions, similar to drugs.\u003c/p>\n\u003cp>A handful of products in recent years have been subject to major safety problems, usually involving potentially toxic ingredients.\u003c/p>\n\u003cp>Last year, the FDA warned consumers about the risks of teething tablets marketed by Hyland's Homeopathic after they were tied to seizures and deaths in infants and children. FDA testing later confirmed the products contained high levels of belladonna, also called nightshade, a poisonous herb that has long been used at low dosages in homeopathic medicine. The products were recalled in April.\u003c/p>\n\u003cp>In 2009, the FDA ordered Zicam to stop marketing three products that contained zinc gluconate after more than 100 users reported losing their sense of smell. Other dangerous ingredients used in homeopathy products include nux vomica, which contains strychnine. Regulators have issued five warning letters this year to companies selling products with nightshade or nux vomica.\u003c/p>\n\u003cp>[contextly_sidebar id=\"OurndJopkYzHm3JfeuY4ygYnj1JktcTX\"]The FDA said its proposal also targets products that claim to treat serious diseases like cancer, or are administered via unconventional routes such as injection or eye drops. Regulators can issue warning letters, seize products or pursue criminal action against companies that disregard federal guidelines.\u003c/p>\n\u003cp>The agency will take comments on its proposal for 90 days before beginning to finalize the plan.\u003c/p>\n\u003cp>Consumer advocates said the FDA plan makes sense for products that are mostly harmless, but can be dangerous if manufacturers stray from traditional ingredients, dosing and manufacturing.\u003c/p>\n\u003cp>\"I think the rules do a good job of going after the things that are most problematic,\" said Dr. Adriane Fugh-Berman, an associate professor at Georgetown University Medical Center.\u003c/p>\n\u003cp>The FDA hasn't updated its regulations for homeopathic medicine since 1988, when it essentially exempted the industry from basic production standards that are mandatory for traditional drugs, like listing ingredients on product labels.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Hundreds of homeopathic remedies today are sold alongside over-the-counter drugs like Tylenol and aspirin at pharmacies across the U.S. The National Institutes of Health has said there's little evidence that homeopathic medicine is effective for treating any specific condition.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>U.S. health officials plan to crack down on a growing number of unproven alternative remedies, focusing on products containing dangerous ingredients that have occasionally been linked to serious injury and death.H\u003c/p>\n\u003cp>The Food and Drug Administration on Monday issued a new proposal for regulating homeopathic medicines that have long been on the fringe of mainstream medicine. The agency plans to target products that pose the biggest safety risks, including those marketed for children or for serious diseases.\u003c/p>\n\u003caside class=\"pullquote alignright\">'People may be putting their trust and money in therapies that bring little or no benefit in combating their ailments, or worse — in products that may cause serious and even irreparable harm.'\u003ccite>Dr. Scott Gottlieb,FDA Commissioner \u003c/cite>\u003c/aside>\n\u003cp>But under the government's framework, the vast majority of low-risk products would remain on the market. Popular homeopathic brands include Zicam Allergy Relief and Cold-Eeze.\u003c/p>\n\u003cp>Long regarded by scientists as a form of modern-day snake oil, homeopathic products are treated as drugs under law, but not supported by modern science. Most remedies contain heavily diluted drugs, vitamins and minerals.\u003c/p>\n\u003cp>\"People may be putting their trust and money in therapies that bring little or no benefit in combating their ailments, or worse — in products that may cause serious and even irreparable harm,\" FDA Commissioner Dr. Scott Gottlieb said Monday on a call with reporters.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Once a niche market, homeopathy products have grown into a $3 billion industry, according to FDA figures.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>Homeopathic products are similar to dietary supplements, in that the FDA does not review their safety or effectiveness before they are sold. But unlike supplements, homeopathic medicines can state that they are intended for specific medical symptoms and conditions, similar to drugs.\u003c/p>\n\u003cp>A handful of products in recent years have been subject to major safety problems, usually involving potentially toxic ingredients.\u003c/p>\n\u003cp>Last year, the FDA warned consumers about the risks of teething tablets marketed by Hyland's Homeopathic after they were tied to seizures and deaths in infants and children. FDA testing later confirmed the products contained high levels of belladonna, also called nightshade, a poisonous herb that has long been used at low dosages in homeopathic medicine. The products were recalled in April.\u003c/p>\n\u003cp>In 2009, the FDA ordered Zicam to stop marketing three products that contained zinc gluconate after more than 100 users reported losing their sense of smell. Other dangerous ingredients used in homeopathy products include nux vomica, which contains strychnine. Regulators have issued five warning letters this year to companies selling products with nightshade or nux vomica.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>The FDA said its proposal also targets products that claim to treat serious diseases like cancer, or are administered via unconventional routes such as injection or eye drops. Regulators can issue warning letters, seize products or pursue criminal action against companies that disregard federal guidelines.\u003c/p>\n\u003cp>The agency will take comments on its proposal for 90 days before beginning to finalize the plan.\u003c/p>\n\u003cp>Consumer advocates said the FDA plan makes sense for products that are mostly harmless, but can be dangerous if manufacturers stray from traditional ingredients, dosing and manufacturing.\u003c/p>\n\u003cp>\"I think the rules do a good job of going after the things that are most problematic,\" said Dr. Adriane Fugh-Berman, an associate professor at Georgetown University Medical Center.\u003c/p>\n\u003cp>The FDA hasn't updated its regulations for homeopathic medicine since 1988, when it essentially exempted the industry from basic production standards that are mandatory for traditional drugs, like listing ingredients on product labels.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Hundreds of homeopathic remedies today are sold alongside over-the-counter drugs like Tylenol and aspirin at pharmacies across the U.S. The National Institutes of Health has said there's little evidence that homeopathic medicine is effective for treating any specific condition.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "U.S. Life Expectancy Drops Second Year in Row: First Time in 53 Years",
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"content": "\u003cp>U.S. deaths from drug overdoses skyrocketed 21 percent last year, and for the second straight year dragged down how long Americans are expected to live.\u003c/p>\n\u003caside class=\"pullquote alignright\">'This is urgent and deadly.'\u003c/aside>\n\u003cp>The government figures released Thursday put drug deaths at 63,600, up from about 52,000 in 2015. For the first time, the powerful painkiller fentanyl and its close opioid cousins played a bigger role in the deaths than any other legal or illegal drug, surpassing prescription pain pills and heroin.\u003c/p>\n\u003cp>\"This is urgent and deadly,\" said Dr. Brenda Fitzgerald, director of the Centers for Disease Control and Prevention. The opioid epidemic \"clearly has a huge impact on our entire society.\"\u003c/p>\n\u003cp>Two-thirds of last year's drug deaths — about 42,000 — involved opioids, a category that includes heroin, methadone, prescription pain pills like OxyContin, and fentanyl. Fatal overdoses that involved fentanyl and fentanyl-like drugs doubled in one year, to more than 19,000, mostly from illegally made pills or powder, which is often mixed with heroin or other drugs.\u003c/p>\n\u003cp>Heroin was tied to 15,500 deaths and prescription painkillers to 14,500 deaths. The balance of the overdose deaths involved sedatives, cocaine and methamphetamines. More than one drug is often involved in an overdose death.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The highest drug death rates were in ages 25 to 54.\u003c/p>\n\u003cp>Preliminary 2017 figures show the rise in overdose deaths continuing.\u003c/p>\n\u003caside class=\"pullquote alignright\">Gun deaths rose for a second year, to nearly 39,000. They had been hovering around 33,500 deaths a few years ago.\u003c/aside>\n\u003cp>The drug deaths weigh into CDC's annual calculation of the average time a person is expected to live. The life expectancy figure is based on the year of their birth, current death trends and other factors. For decades, it was on the upswing, rising a few months nearly every year. But last year marked the first time in more than a half century that U.S. life expectancy fell two consecutive years.\u003c/p>\n\u003cp>A baby born last year in the U.S. is expected to live about 78 years and 7 months, on average, the CDC said. An American born in 2015 was expected to live about a month longer and one born in 2014 about two months longer than that.\u003c/p>\n\u003cp>The dip in 2015 was blamed on drug deaths and an unusual upturn in the death rate for the nation's leading killer, heart disease.\u003c/p>\n\u003cp>Typically, life expectancy goes back up after a one-year decline, said Robert Anderson, who oversees the CDC's death statistics. The last time there was a two-year drop was 1962-1963. It also happened twice in the 1920s.\u003c/p>\n\u003cp>\"If we don't get a handle on this,\" he said, \"we could very well see a third year in a row. With no end in sight.\"\u003c/p>\n\u003cp>A three-year decline happened in 1916, 1917 and 1918, which included the worst flu pandemic in modern history.\u003c/p>\n\u003cp>Overall, there were more than 2.7 million U.S. deaths in 2016, or about 32,000 more than the previous year. It was the most deaths in a single year since the government has been counting. That partly reflects the nation's growing and aging population. But death rates last year continued to go down for people who are 65 and older while going up for all younger adults — those most affected by the opioid epidemic.\u003c/p>\n\u003cp>The CDC also reported :\u003c/p>\n\u003cul>\n\u003cli>West Virginia continued to be the state with highest drug overdose death rate, with a rate of 52 deaths per 100,000 state residents in 2016. Ohio and New Hampshire were next, both at about 39 per 100,000.\n\u003c/li>\u003cli>Life expectancy for men decreased, but it held steady for women. That increased the gender gap to five years; about 76 for men and 81 for women.\n\u003c/li>\u003cli>U.S. death rates decreased for seven of the 10 leading causes of death, but rose for suicide, Alzheimer's disease and for a category called unintentional injuries (which includes drug overdoses).\n\u003c/li>\u003cli>Accidental injuries displaced chronic lower respiratory diseases to become the nation's third leading cause of death. Contributing were increases in deaths from car crashes and falls.\n\u003c/li>\u003cli>Gun deaths rose for a second year, to nearly 39,000. They had been hovering around 33,500 deaths a few years ago.\u003c/li>\u003c/ul>\n\u003cp>The United States ranks below dozens of other high-income countries in life expectancy, according to the World Bank. Highest is Japan, at nearly 84 years.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"The fact that U.S. has basically stagnated over the past seven years — and now we're seeing small declines — is a real sign that the U.S. is doing badly,\" said Jessica Ho, a University of Southern California researcher who studies death trends.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>U.S. deaths from drug overdoses skyrocketed 21 percent last year, and for the second straight year dragged down how long Americans are expected to live.\u003c/p>\n\u003caside class=\"pullquote alignright\">'This is urgent and deadly.'\u003c/aside>\n\u003cp>The government figures released Thursday put drug deaths at 63,600, up from about 52,000 in 2015. For the first time, the powerful painkiller fentanyl and its close opioid cousins played a bigger role in the deaths than any other legal or illegal drug, surpassing prescription pain pills and heroin.\u003c/p>\n\u003cp>\"This is urgent and deadly,\" said Dr. Brenda Fitzgerald, director of the Centers for Disease Control and Prevention. The opioid epidemic \"clearly has a huge impact on our entire society.\"\u003c/p>\n\u003cp>Two-thirds of last year's drug deaths — about 42,000 — involved opioids, a category that includes heroin, methadone, prescription pain pills like OxyContin, and fentanyl. Fatal overdoses that involved fentanyl and fentanyl-like drugs doubled in one year, to more than 19,000, mostly from illegally made pills or powder, which is often mixed with heroin or other drugs.\u003c/p>\n\u003cp>Heroin was tied to 15,500 deaths and prescription painkillers to 14,500 deaths. The balance of the overdose deaths involved sedatives, cocaine and methamphetamines. More than one drug is often involved in an overdose death.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The highest drug death rates were in ages 25 to 54.\u003c/p>\n\u003cp>Preliminary 2017 figures show the rise in overdose deaths continuing.\u003c/p>\n\u003caside class=\"pullquote alignright\">Gun deaths rose for a second year, to nearly 39,000. They had been hovering around 33,500 deaths a few years ago.\u003c/aside>\n\u003cp>The drug deaths weigh into CDC's annual calculation of the average time a person is expected to live. The life expectancy figure is based on the year of their birth, current death trends and other factors. For decades, it was on the upswing, rising a few months nearly every year. But last year marked the first time in more than a half century that U.S. life expectancy fell two consecutive years.\u003c/p>\n\u003cp>A baby born last year in the U.S. is expected to live about 78 years and 7 months, on average, the CDC said. An American born in 2015 was expected to live about a month longer and one born in 2014 about two months longer than that.\u003c/p>\n\u003cp>The dip in 2015 was blamed on drug deaths and an unusual upturn in the death rate for the nation's leading killer, heart disease.\u003c/p>\n\u003cp>Typically, life expectancy goes back up after a one-year decline, said Robert Anderson, who oversees the CDC's death statistics. The last time there was a two-year drop was 1962-1963. It also happened twice in the 1920s.\u003c/p>\n\u003cp>\"If we don't get a handle on this,\" he said, \"we could very well see a third year in a row. With no end in sight.\"\u003c/p>\n\u003cp>A three-year decline happened in 1916, 1917 and 1918, which included the worst flu pandemic in modern history.\u003c/p>\n\u003cp>Overall, there were more than 2.7 million U.S. deaths in 2016, or about 32,000 more than the previous year. It was the most deaths in a single year since the government has been counting. That partly reflects the nation's growing and aging population. But death rates last year continued to go down for people who are 65 and older while going up for all younger adults — those most affected by the opioid epidemic.\u003c/p>\n\u003cp>The CDC also reported :\u003c/p>\n\u003cul>\n\u003cli>West Virginia continued to be the state with highest drug overdose death rate, with a rate of 52 deaths per 100,000 state residents in 2016. Ohio and New Hampshire were next, both at about 39 per 100,000.\n\u003c/li>\u003cli>Life expectancy for men decreased, but it held steady for women. That increased the gender gap to five years; about 76 for men and 81 for women.\n\u003c/li>\u003cli>U.S. death rates decreased for seven of the 10 leading causes of death, but rose for suicide, Alzheimer's disease and for a category called unintentional injuries (which includes drug overdoses).\n\u003c/li>\u003cli>Accidental injuries displaced chronic lower respiratory diseases to become the nation's third leading cause of death. Contributing were increases in deaths from car crashes and falls.\n\u003c/li>\u003cli>Gun deaths rose for a second year, to nearly 39,000. They had been hovering around 33,500 deaths a few years ago.\u003c/li>\u003c/ul>\n\u003cp>The United States ranks below dozens of other high-income countries in life expectancy, according to the World Bank. Highest is Japan, at nearly 84 years.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"The fact that U.S. has basically stagnated over the past seven years — and now we're seeing small declines — is a real sign that the U.S. is doing badly,\" said Jessica Ho, a University of Southern California researcher who studies death trends.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "What Are Digital Health's Biggest Successes and Disappointments? CNBC's Chrissy Farr Weighs In",
"title": "What Are Digital Health's Biggest Successes and Disappointments? CNBC's Chrissy Farr Weighs In",
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"content": "\u003cp>Christina Farr was the first host of KQED Future of You, but today she’s better known as a technology and health \u003ca href=\"https://www.cnbc.com/christina-farr/\" target=\"_blank\" rel=\"noopener\">reporter\u003c/a> for CNBC, where she continues to break \u003ca href=\"https://www.cnbc.com/2017/07/26/amazon-1492-secret-health-tech-project.html\" target=\"_blank\" rel=\"noopener\">stories\u003c/a>. She’s been covering digital health for years, and she's one of the more influential media voices on this beat -- in 2016, venture fund Rock Health named her \u003ca href=\"https://rockhealth.com/where-are-the-2016-top-50-in-digital-health-now/\" target=\"_blank\" rel=\"noopener\">digital health reporter of the year\u003c/a>.\u003c/p>\n\u003cp>As Chrissy's successor at this site, I thought it would be cool to get back to our roots and pick her brain on where digital health is going and where it's been. I interviewed her at CNBC’s San Francisco office, located in skyscraping Salesforce Tower. Here’s our chat, edited for length and clarity.\u003c/p>\n\u003cp>\u003cstrong>First off, how should we define digital health?\u003c/strong>\u003c/p>\n\u003caside class=\"pullquote alignright\">On wearables: 'I'm really still quite bullish. It’s not just millennials and the \"worried well\" that are using these devices; a lot of seniors love them.'\u003c/aside>\n\u003cp>People have attempted to come up with a good working definition, and sometimes it ends up sounding very vague, like \"the intersection of health and technology.\"\u003c/p>\n\u003cp>I think the term will forever be associated with \u003ca href=\"https://ww2.kqed.org/futureofyou/tag/wearables/\" target=\"_blank\" rel=\"noopener\">wearables\u003c/a> and \u003ca href=\"https://ww2.kqed.org/futureofyou/tag/telemedicine/\" target=\"_blank\" rel=\"noopener\">telemedicine\u003c/a>, and now AI and a couple of other trends. I don't really see a problem with that, because it's still connected with innovation in a lot of people's minds.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cstrong>What have been some of the successes in the digital health space?\u003c/strong>\u003c/p>\n\u003cp>I see a lot of potential in digital therapeutics. Companies like Propeller Health and \u003ca href=\"https://ww2.kqed.org/futureofyou/2016/06/23/expanding-digital-health-beyond-the-rich/\" target=\"_blank\" rel=\"noopener\">Omada Health\u003c/a> are studying the effect of apps that attempt to change behavior for purposes of disease prevention and management. Propeller Health, for example, is thinking about \u003ca href=\"https://ww2.kqed.org/futureofyou/2017/06/13/inhalers-plus-smartphones-meant-fewer-trips-to-er-hospital/\" target=\"_blank\" rel=\"noopener\">connected inhalers\u003c/a> and how to combine them with data like the weather to figure out when a person with asthma should take medicine.\u003c/p>\n\u003caside class=\"pullquote alignright\">Disappointments? Telehealth and artificial intelligence.\u003c/aside>\n\u003cp>Virta Health is going after Type 2 diabetes reversal with a\u003ca href=\"https://www.medscape.com/viewarticle/890090\" target=\"_blank\" rel=\"noopener\"> digital system\u003c/a> that encourages a massive behavior change around diet, which it thinks could actually replace medicines.\u003c/p>\n\u003cp>AliveCor is a super-interesting company. They have a \u003ca href=\"https://ww2.kqed.org/futureofyou/2016/03/17/mobile-ekg-on-a-watchband-is-useful-for-some-say-docs/\" target=\"_blank\" rel=\"noopener\">mobile EKG\u003c/a> that a lot of doctors really like. I think it's something that a lot of seniors will use when they find out they're at risk for \u003ca href=\"http://www.heart.org/HEARTORG/Conditions/Arrhythmia/AboutArrhythmia/What-is-Atrial-Fibrillation-AFib-or-AF_UCM_423748_Article.jsp#.VusMvOIrKUk\" target=\"_blank\" rel=\"noopener\">atrial fibrillation\u003c/a>, because it means they can check on their heart from home and not have to go to the doctor every few months.\u003c/p>\n\u003cp>\u003cstrong>You mentioned wearables, like Fitbit and Apple Watch. How's that business going? \u003c/strong>\u003c/p>\n\u003cp>I‘m really still quite bullish on wearables, and I think they have become mainstream. It's not just millennials and the \"\u003ca href=\"http://www.telegraph.co.uk/lifestyle/wellbeing/diet/10977877/Are-you-one-of-the-rising-numbers-of-the-worried-well.html\" target=\"_blank\" rel=\"noopener\">worried well\u003c/a>\" that are using these devices; a lot of seniors love them. You're also starting to see insurance companies think about partnering with companies like Apple, and the reason they're doing that isn't necessarily to get their already healthy populations to exercise more; it's about getting to those really sick and costly people that have multiple chronic conditions.\u003c/p>\n\u003cp>\u003cstrong>Do you think investors in the digital health space are more circumspect after the \u003ca href=\"https://ww2.kqed.org/futureofyou/2016/10/13/the-rise-and-fall-of-theranos-a-cartoon-history/\" target=\"_blank\" rel=\"noopener\">Theranos debacle\u003c/a>?\u003c/strong>\u003c/p>\n\u003cp>Some are. Others don't necessarily want companies to invest the time into building a base of evidence before they start selling the product; these investors are looking for their money back in three to five years, like they would get with a consumer internet company.\u003c/p>\n\u003caside class=\"pullquote alignright\">'In a lot of ways, Theranos is just the worst example.'\u003c/aside>\n\u003cp>It's hard to find another company like Theranos, which put patients \u003ca href=\"http://tucson.com/news/local/theranos-to-pay-m-to-arizonans-over-blood-tests-that/article_dacc3bd1-54e0-58dd-92b3-18dec8eb8854.html\" target=\"_blank\" rel=\"noopener\">in danger\u003c/a>. But in a lot of ways, Theranos is just the worst example. More companies are still failing to provide proper evidence. Often they say, \"We're wellness. We're not making claims around disease, so we don't need to bother.\"\u003c/p>\n\u003cp>\u003cstrong>What's the biggest disappointment of the digital health era to date?\u003c/strong>\u003c/p>\n\u003cp>This is going to be controversial, but I don't think telemedicine has panned out to the extent people expected it would by this time. People thought it was going to revolutionize all health care. But I'm not seeing every physician say this is something they want to incorporate into their medical practice, because there's a perception they're not going to get paid as much.\u003c/p>\n\u003cp>Also pretty overhyped in terms of what we're actually seeing out there: AI and big data. \u003ca href=\"https://ww2.kqed.org/futureofyou/2015/08/20/this-robo-eye-doctor-may-help-patients-with-diabetes-keep-sight/\" target=\"_blank\" rel=\"noopener\">Diabetic retinopathy\u003c/a>, for example, is an area where you see a lot of people investing in AI research. Could we take a pile of medical images that have been labeled as showing diabetic retinopathy or not, and then you train AI to do that job in triage?\u003c/p>\n\u003cp>There's been some great results, but that does not mean we're on the cusp of a robo eye doctor, because an actual eye doctor would\u003ca href=\"https://ww2.kqed.org/futureofyou/2016/11/07/will-computers-ever-be-able-to-make-diagnoses-as-well-as-physicians/\" target=\"_blank\" rel=\"noopener\"> need to know\u003c/a> every single medical condition out there that could be affecting this person. I think we’ve been too quick to look at one disease and one use case and say, well, this is evidence that doctors will be replaced.\u003c/p>\n\u003cp>\u003cb>Do you think the Food and Drug Administration and other regulators can keep up with all this? And does the industry \u003cem>want\u003c/em> them to keep up?\u003c/b>\u003c/p>\n\u003cfigure id=\"attachment_437841\" class=\"wp-caption alignright\" style=\"max-width: 640px\">\u003ca href=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/12/chrissymum.jpg\">\u003cimg class=\"wp-image-437841 size-large\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/12/chrissymum-1020x591.jpg\" alt=\"\" width=\"640\" height=\"371\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/12/chrissymum-1020x591.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/chrissymum-160x93.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/chrissymum-800x463.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/chrissymum-768x445.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/chrissymum-1180x683.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/chrissymum-960x556.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/chrissymum-240x139.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/chrissymum-375x217.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/chrissymum-520x301.jpg 520w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/chrissymum.jpg 1613w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Chrissy Farr discussing Fitbit vs. Apple Watch with her mom, for a CNBC segment. (CNBC)\u003c/figcaption>\u003c/figure>\n\u003cp>I think at the birth of this digital health movement, people thought of the FDA as the big bad wolf. The prevailing narrative was that it's obstructing innovation. Now there seems to be more nuance around that; people recognize that the FDA does have an important role to play. Many of the digital therapeutics companies, for instance, see the FDA as a potential stamp of approval that sets them ahead of a mass of apps that are making false claims and essentially peddling snake oil.\u003c/p>\n\u003cp>So there needs to be a watchdog, but that's not the FDA's role. They're not out there policing companies and investing time into looking through the app store and thinking, \"This dermatology app doesn't look quite right.\"\u003c/p>\n\u003cp>As a result, you get this huge quality variation, and I do sometimes fear that doctors will start prescribing or patients will start using apps that are of lower quality. I think someone needs to step into that role in 2018 so we have a better way of figuring out which apps work and which don't.\u003c/p>\n\u003cp>\u003cstrong>Last question: Occasionally you hear the complaint about digital health that these are primarily tools for young, rich people. Do you think that's valid?\u003c/strong>\u003c/p>\n\u003cp>The true problems of health care, which are particularly an issue for underrepresented groups and minorities, are around how it's paid for. We need massive payment reforms. There's also a lack of investment around social determinants, things like social services and affordable housing, which improve outcomes. \u003cspan style=\"font-weight: 400\">All of these problems are not going to be solved with an AI Band-Aid or by handing someone a Fitbit.\u003c/span>\u003c/p>\n\u003cp>That said, I don't think it's fair to label this entire group of companies as purely helping the rich, wealthy, paranoid types who are just \u003ca href=\"https://www.youtube.com/watch?v=hBA0AH-LSbo\" target=\"_blank\" rel=\"noopener\">dying to live forever\u003c/a>.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>A lot of these companies are going after Medicaid populations, and that absolutely makes sense; that's more than 12 million people in California alone. Even Apple, which hasn't traditionally been a health care player, is working with Aetna on a study with Stanford about whether or not they can use the Apple Watch to detect \u003ca href=\"http://www.heart.org/HEARTORG/Conditions/Arrhythmia/AboutArrhythmia/What-is-Atrial-Fibrillation-AFib-or-AF_UCM_423748_Article.jsp#.VusMvOIrKUk\" rel=\"noopener\">afib\u003c/a>. That's not something a young or healthy person would necessarily worry about at all. It's something that over-65, more vulnerable populations with a history of stroke are more at risk for. So you can see even Apple saying this is a tool that we expected would be mostly about consumer delight, but we've found that it can help save lives.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Christina Farr was the first host of KQED Future of You, but today she’s better known as a technology and health \u003ca href=\"https://www.cnbc.com/christina-farr/\" target=\"_blank\" rel=\"noopener\">reporter\u003c/a> for CNBC, where she continues to break \u003ca href=\"https://www.cnbc.com/2017/07/26/amazon-1492-secret-health-tech-project.html\" target=\"_blank\" rel=\"noopener\">stories\u003c/a>. She’s been covering digital health for years, and she's one of the more influential media voices on this beat -- in 2016, venture fund Rock Health named her \u003ca href=\"https://rockhealth.com/where-are-the-2016-top-50-in-digital-health-now/\" target=\"_blank\" rel=\"noopener\">digital health reporter of the year\u003c/a>.\u003c/p>\n\u003cp>As Chrissy's successor at this site, I thought it would be cool to get back to our roots and pick her brain on where digital health is going and where it's been. I interviewed her at CNBC’s San Francisco office, located in skyscraping Salesforce Tower. Here’s our chat, edited for length and clarity.\u003c/p>\n\u003cp>\u003cstrong>First off, how should we define digital health?\u003c/strong>\u003c/p>\n\u003caside class=\"pullquote alignright\">On wearables: 'I'm really still quite bullish. It’s not just millennials and the \"worried well\" that are using these devices; a lot of seniors love them.'\u003c/aside>\n\u003cp>People have attempted to come up with a good working definition, and sometimes it ends up sounding very vague, like \"the intersection of health and technology.\"\u003c/p>\n\u003cp>I think the term will forever be associated with \u003ca href=\"https://ww2.kqed.org/futureofyou/tag/wearables/\" target=\"_blank\" rel=\"noopener\">wearables\u003c/a> and \u003ca href=\"https://ww2.kqed.org/futureofyou/tag/telemedicine/\" target=\"_blank\" rel=\"noopener\">telemedicine\u003c/a>, and now AI and a couple of other trends. I don't really see a problem with that, because it's still connected with innovation in a lot of people's minds.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cstrong>What have been some of the successes in the digital health space?\u003c/strong>\u003c/p>\n\u003cp>I see a lot of potential in digital therapeutics. Companies like Propeller Health and \u003ca href=\"https://ww2.kqed.org/futureofyou/2016/06/23/expanding-digital-health-beyond-the-rich/\" target=\"_blank\" rel=\"noopener\">Omada Health\u003c/a> are studying the effect of apps that attempt to change behavior for purposes of disease prevention and management. Propeller Health, for example, is thinking about \u003ca href=\"https://ww2.kqed.org/futureofyou/2017/06/13/inhalers-plus-smartphones-meant-fewer-trips-to-er-hospital/\" target=\"_blank\" rel=\"noopener\">connected inhalers\u003c/a> and how to combine them with data like the weather to figure out when a person with asthma should take medicine.\u003c/p>\n\u003caside class=\"pullquote alignright\">Disappointments? Telehealth and artificial intelligence.\u003c/aside>\n\u003cp>Virta Health is going after Type 2 diabetes reversal with a\u003ca href=\"https://www.medscape.com/viewarticle/890090\" target=\"_blank\" rel=\"noopener\"> digital system\u003c/a> that encourages a massive behavior change around diet, which it thinks could actually replace medicines.\u003c/p>\n\u003cp>AliveCor is a super-interesting company. They have a \u003ca href=\"https://ww2.kqed.org/futureofyou/2016/03/17/mobile-ekg-on-a-watchband-is-useful-for-some-say-docs/\" target=\"_blank\" rel=\"noopener\">mobile EKG\u003c/a> that a lot of doctors really like. I think it's something that a lot of seniors will use when they find out they're at risk for \u003ca href=\"http://www.heart.org/HEARTORG/Conditions/Arrhythmia/AboutArrhythmia/What-is-Atrial-Fibrillation-AFib-or-AF_UCM_423748_Article.jsp#.VusMvOIrKUk\" target=\"_blank\" rel=\"noopener\">atrial fibrillation\u003c/a>, because it means they can check on their heart from home and not have to go to the doctor every few months.\u003c/p>\n\u003cp>\u003cstrong>You mentioned wearables, like Fitbit and Apple Watch. How's that business going? \u003c/strong>\u003c/p>\n\u003cp>I‘m really still quite bullish on wearables, and I think they have become mainstream. It's not just millennials and the \"\u003ca href=\"http://www.telegraph.co.uk/lifestyle/wellbeing/diet/10977877/Are-you-one-of-the-rising-numbers-of-the-worried-well.html\" target=\"_blank\" rel=\"noopener\">worried well\u003c/a>\" that are using these devices; a lot of seniors love them. You're also starting to see insurance companies think about partnering with companies like Apple, and the reason they're doing that isn't necessarily to get their already healthy populations to exercise more; it's about getting to those really sick and costly people that have multiple chronic conditions.\u003c/p>\n\u003cp>\u003cstrong>Do you think investors in the digital health space are more circumspect after the \u003ca href=\"https://ww2.kqed.org/futureofyou/2016/10/13/the-rise-and-fall-of-theranos-a-cartoon-history/\" target=\"_blank\" rel=\"noopener\">Theranos debacle\u003c/a>?\u003c/strong>\u003c/p>\n\u003cp>Some are. Others don't necessarily want companies to invest the time into building a base of evidence before they start selling the product; these investors are looking for their money back in three to five years, like they would get with a consumer internet company.\u003c/p>\n\u003caside class=\"pullquote alignright\">'In a lot of ways, Theranos is just the worst example.'\u003c/aside>\n\u003cp>It's hard to find another company like Theranos, which put patients \u003ca href=\"http://tucson.com/news/local/theranos-to-pay-m-to-arizonans-over-blood-tests-that/article_dacc3bd1-54e0-58dd-92b3-18dec8eb8854.html\" target=\"_blank\" rel=\"noopener\">in danger\u003c/a>. But in a lot of ways, Theranos is just the worst example. More companies are still failing to provide proper evidence. Often they say, \"We're wellness. We're not making claims around disease, so we don't need to bother.\"\u003c/p>\n\u003cp>\u003cstrong>What's the biggest disappointment of the digital health era to date?\u003c/strong>\u003c/p>\n\u003cp>This is going to be controversial, but I don't think telemedicine has panned out to the extent people expected it would by this time. People thought it was going to revolutionize all health care. But I'm not seeing every physician say this is something they want to incorporate into their medical practice, because there's a perception they're not going to get paid as much.\u003c/p>\n\u003cp>Also pretty overhyped in terms of what we're actually seeing out there: AI and big data. \u003ca href=\"https://ww2.kqed.org/futureofyou/2015/08/20/this-robo-eye-doctor-may-help-patients-with-diabetes-keep-sight/\" target=\"_blank\" rel=\"noopener\">Diabetic retinopathy\u003c/a>, for example, is an area where you see a lot of people investing in AI research. Could we take a pile of medical images that have been labeled as showing diabetic retinopathy or not, and then you train AI to do that job in triage?\u003c/p>\n\u003cp>There's been some great results, but that does not mean we're on the cusp of a robo eye doctor, because an actual eye doctor would\u003ca href=\"https://ww2.kqed.org/futureofyou/2016/11/07/will-computers-ever-be-able-to-make-diagnoses-as-well-as-physicians/\" target=\"_blank\" rel=\"noopener\"> need to know\u003c/a> every single medical condition out there that could be affecting this person. I think we’ve been too quick to look at one disease and one use case and say, well, this is evidence that doctors will be replaced.\u003c/p>\n\u003cp>\u003cb>Do you think the Food and Drug Administration and other regulators can keep up with all this? And does the industry \u003cem>want\u003c/em> them to keep up?\u003c/b>\u003c/p>\n\u003cfigure id=\"attachment_437841\" class=\"wp-caption alignright\" style=\"max-width: 640px\">\u003ca href=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/12/chrissymum.jpg\">\u003cimg class=\"wp-image-437841 size-large\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/12/chrissymum-1020x591.jpg\" alt=\"\" width=\"640\" height=\"371\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/12/chrissymum-1020x591.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/chrissymum-160x93.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/chrissymum-800x463.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/chrissymum-768x445.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/chrissymum-1180x683.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/chrissymum-960x556.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/chrissymum-240x139.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/chrissymum-375x217.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/chrissymum-520x301.jpg 520w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/chrissymum.jpg 1613w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Chrissy Farr discussing Fitbit vs. Apple Watch with her mom, for a CNBC segment. (CNBC)\u003c/figcaption>\u003c/figure>\n\u003cp>I think at the birth of this digital health movement, people thought of the FDA as the big bad wolf. The prevailing narrative was that it's obstructing innovation. Now there seems to be more nuance around that; people recognize that the FDA does have an important role to play. Many of the digital therapeutics companies, for instance, see the FDA as a potential stamp of approval that sets them ahead of a mass of apps that are making false claims and essentially peddling snake oil.\u003c/p>\n\u003cp>So there needs to be a watchdog, but that's not the FDA's role. They're not out there policing companies and investing time into looking through the app store and thinking, \"This dermatology app doesn't look quite right.\"\u003c/p>\n\u003cp>As a result, you get this huge quality variation, and I do sometimes fear that doctors will start prescribing or patients will start using apps that are of lower quality. I think someone needs to step into that role in 2018 so we have a better way of figuring out which apps work and which don't.\u003c/p>\n\u003cp>\u003cstrong>Last question: Occasionally you hear the complaint about digital health that these are primarily tools for young, rich people. Do you think that's valid?\u003c/strong>\u003c/p>\n\u003cp>The true problems of health care, which are particularly an issue for underrepresented groups and minorities, are around how it's paid for. We need massive payment reforms. There's also a lack of investment around social determinants, things like social services and affordable housing, which improve outcomes. \u003cspan style=\"font-weight: 400\">All of these problems are not going to be solved with an AI Band-Aid or by handing someone a Fitbit.\u003c/span>\u003c/p>\n\u003cp>That said, I don't think it's fair to label this entire group of companies as purely helping the rich, wealthy, paranoid types who are just \u003ca href=\"https://www.youtube.com/watch?v=hBA0AH-LSbo\" target=\"_blank\" rel=\"noopener\">dying to live forever\u003c/a>.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>A lot of these companies are going after Medicaid populations, and that absolutely makes sense; that's more than 12 million people in California alone. Even Apple, which hasn't traditionally been a health care player, is working with Aetna on a study with Stanford about whether or not they can use the Apple Watch to detect \u003ca href=\"http://www.heart.org/HEARTORG/Conditions/Arrhythmia/AboutArrhythmia/What-is-Atrial-Fibrillation-AFib-or-AF_UCM_423748_Article.jsp#.VusMvOIrKUk\" rel=\"noopener\">afib\u003c/a>. That's not something a young or healthy person would necessarily worry about at all. It's something that over-65, more vulnerable populations with a history of stroke are more at risk for. So you can see even Apple saying this is a tool that we expected would be mostly about consumer delight, but we've found that it can help save lives.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>WASHINGTON — In a bland Northern Virginia office building nestled between a Costco and a freeway interchange, a dozen government scientists have spent the past year crunching numbers and making the following determination: In 2018, drug makers will be allowed to produce no more than 98,145 kilos of oxycodone, 38,047 kilos of morphine, and 1,342 kilos of fentanyl.\u003c/p>\n\u003cp>The precise limits are set as part of a little-known process in which, every year, the Drug Enforcement Administration regulates the volume of controlled substances that can be produced in the United States.\u003c/p>\n\u003cp>The process was started nearly five decades ago to ensure that drug makers produced enough medicines to avoid shortages. But in the midst of a national opioid epidemic, fresh scrutiny of the quota system has spread to Capitol Hill, where Democratic lawmakers are \u003ca href=\"https://www.durbin.senate.gov/newsroom/press-releases/durbin-presses-dea-administrator-to-lower-2018-opioid-quotas\" target=\"_blank\" rel=\"noopener\">pressing\u003c/a> the DEA to use it for another reason — to help stem supply.\u003c/p>\n\u003cp>“It is clear that we need to reduce the amount of oxycodone and hydrocodone that DEA approves for manufacture each year and hold Big Pharma accountable for manufacturing a product that is leading to the deaths of hundreds of people every day,” said Sen. Edward Markey (Mass.), who has introduced a number of bills aimed at addressing the opioid crisis.\u003c/p>\n\u003caside class=\"pullquote alignright\">No medical group thinks opioids are without merit when properly distributed, and a substantial number of pain patients would suffer if denied access to them.\u003c/aside>\n\u003cp>Rarely, however, has the quota system been used to eliminate or constrain supply for a class of drugs similar to opioids — created to fill a medical need but with consequences that, in at least some cases, have outweighed the medical benefits.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The lone historical exception is that of the sedative methaqualone, which was marketed until the early 1980s as Quaalude. The drug became so abused that it quickly fell out of favor with the medical community, and in conjunction with nose-diving prescription rates and manufacturer interest, the DEA began to lower the quota for methaqualone production in 1973. It hit zero in 1981.\u003c/p>\n\u003cp>But opioids are not quite analogous. No medical group thinks they are without merit when properly distributed, and a substantial number of \u003ca href=\"https://www.statnews.com/2017/01/17/chronic-pain-management-opioids/\">pain patients\u003c/a> would suffer if denied access to them.\u003c/p>\n\u003cp>Many experts are not sure using the quota system as a tool to constrain supply is a sound idea — and instead believe the focus should be on reducing prescriptions.\u003c/p>\n\u003cp>The DEA could have considered tightening quotas to address the crisis more than a decade ago, “when we were clearly already in the middle of an opioid crisis and it was clear the prescribing of OxyContin was happening at a rate much greater than could be clinically needed,” said Andrew Kolodny, the co-director of the Opioid Policy Research Collaborative at Brandeis University.\u003c/p>\n\u003cp>“Now,” he said, “I don’t think it makes any sense, because the prescribing peaked in 2011 and 2012.”\u003c/p>\n\u003cp>Still, some lawmakers say that the DEA has historically been too liberal in the setting of the quotas. In a \u003ca href=\"https://www.durbin.senate.gov/newsroom/press-releases/durbin-senators-urge-dea-to-lower-opioid-quotas-to-combat-prescription-drug-abuse\" target=\"_blank\" rel=\"noopener\">letter\u003c/a> to the agency’s acting administrator earlier this year, 16 Democratic senators noted that the agency allowed aggregate production quotas for oxycodone to increase thirty-nine-fold between 1993 and 2015, and quotas for fentanyl to increase twenty-five-fold.\u003c/p>\n\u003cp>“Further reductions are necessary,” wrote the senators, led by Sen. Dick Durbin, the chamber’s No. 2 Democrat.\u003c/p>\n\u003cp>Republicans have had little to say on the issue. And a White House official, speaking on condition of anonymity, said the politicization of the quota system has created the potential for hospital shortages and access issues for pain patients who have legitimate medical needs.\u003c/p>\n\u003cp>Outside the United States, there are cautionary tales of government intervention in the supply of pharmaceutical drugs.\u003c/p>\n\u003cp>In Russia, for example, a heavy-handed regulatory system meant to guard against drug abuse has led to shortages, with highly publicized cases like that of a Russian naval officer with late-stage cancer who committed suicide after being \u003ca href=\"http://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(15)61264-8.pdf\" target=\"_blank\" rel=\"noopener\">unable to obtain sufficient pain medicine\u003c/a>.\u003c/p>\n\u003cp>[contextly_sidebar id=\"LAnsGecLhoTeT4nYfsoABYlUARn6rbhy\"]In Uganda, fear of a U.S.-style opioid crisis has left palliative care doctors \u003ca href=\"https://www.nytimes.com/2017/12/04/health/opioids-africa-pain.html\" target=\"_blank\" rel=\"noopener\">without the necessary means\u003c/a> to treat patients in their final, agonizing stage of life.\u003c/p>\n\u003cp>In the United States, the quota system is used for all Schedule II drugs — those that are deemed to have legitimate medical uses but that carry high potential for abuse. It also applies to a select number of stimulants, as well as research-oriented production of Schedule I drugs like marijuana and GHB deemed to have no accepted medicinal value.\u003c/p>\n\u003cp>To set the quotas, the DEA says it relies on estimates of legitimate medical need from the Food and Drug Administration, prescription levels from the previous year, manufacturers’ forecasts, and other data. A spokesman said the agency uses a strict formula, and does not take into account business or other circumstantial considerations.\u003c/p>\n\u003cp>[contextly_sidebar id=\"HkwFixqfrFuQuyxeNArsdGk7OdgZ9sxT\"]“If any part of the steps that are taken need to be changed, or people want them to be changed, Congress has to do that,” the spokesman, Melvin Patterson, told STAT.\u003c/p>\n\u003cp>(A spokesman for the Food and Drug Administration, which sends information about past and projected prescription levels to the DEA each year to assist in the quota-setting process, declined to specify the source of the FDA’s data.)\u003c/p>\n\u003cp>The quota levels for aggregate opioid production in 2017 were lowered by about 25 percent, a move that may have helped to address political pressure to reduce the quota but had little impact on actual supply. The DEA acknowledged that the numbers appeared lower because the agency decided to eliminate a cushion it has previously included as a safeguard.\u003c/p>\n\u003cp>It represented “a quota that was built into the system to handle an emergency, a catastrophic event” but that was never used, said Joe Rannazzisi, who ran the DEA’s division of diversion control until 2015 and now consults with lawyers pursuing legal action against the opioid industry.\u003c/p>\n\u003cp>For 2018, the DEA has lowered the quota for opioids another 20 percent — a quota even Rannazzisi acknowledged is more likely to substantively reflect and impact prescription levels.\u003c/p>\n\u003cp>“Physicians, pharmacists, and patients must recognize the inherent risks of these powerful medications, especially for long-term use,” Chuck Rosenberg, then the DEA’s acting administrator, said in an August statement. “More states are mandating use of prescription drug monitoring programs, which is good, and that has prompted a decrease in opioid prescriptions.”\u003c/p>\n\u003cp>While the DEA is required to publish the aggregate quota amounts each year, it is prohibited from making public the individual quotas it awards to specific manufacturers.\u003c/p>\n\u003cp>That makes it difficult, Democratic congressional aides told STAT, for the public to connect the dots between manufacturers and the supply of narcotics they are responsible for on the market.\u003c/p>\n\u003cp>Markey has sponsored a \u003ca href=\"https://www.congress.gov/bill/115th-congress/senate-bill/1882\" target=\"_blank\" rel=\"noopener\">bill\u003c/a> that would require the DEA to release individual quota levels for manufacturers, in the hope that drug makers perceived to be contributing to the addiction crisis will become more responsible actors in the face of greater public awareness.\u003c/p>\n\u003cp>That could put manufacturers that obtain controlled substances for research purposes or compounding with other drugs at a competitive disadvantage. But Rannazzisi said that in most cases, the idea of forcing accountability through transparency is a sound one.\u003c/p>\n\u003cp>“I totally agree with that,” he said. “Mr. Markey, his theory is somewhat correct — I guess he’s looking at shaming manufacturers for how much [quota] they’re getting.”\u003c/p>\n\u003cp>Industry groups have not bothered to advocate against the measure — it is virtually certain to receive neither a hearing nor a vote in the Senate Judiciary Committee. But opposition, Democratic aides said, would be fierce if Democrats controlled either the House or Senate or if the bill appeared likely to become law.\u003c/p>\n\u003cp>\u003ca href=\"https://www.statnews.com/2016/11/09/stat-purdue-oxycontin-appeal/\">Purdue Pharma\u003c/a>, which manufactures and markets oxycodone as OxyContin, declined to comment on the Markey bill and the quota process in general. A spokeswoman for PhRMA, the drug industry lobby, said the group had not reviewed the bill or taken a position on it.\u003c/p>\n\u003cp>[contextly_sidebar id=\"WebHai26Jby9euNjbp5UPdK60SLL4sWI\"]Regardless of what happens, there is consensus across industry groups and the expert community that the simplest way to reduce the supply of opioids over the long term is simply to reduce prescriptions. Already, changes to prescription practices nationwide have sapped some of the demand for the drugs.\u003c/p>\n\u003cp>Guidelines issued by the Centers for Disease Control and Prevention to encourage more responsible prescribing practices are also a focus. And policy staff across federal agencies agree those guidelines, coupled with a slew of state laws limiting prescription length and encouraging use of non-opioid painkillers, are the best bet when it comes to addressing the crisis.\u003c/p>\n\u003cp>Instead of reducing prescriptions by lowering quotas, Kolodny said, governments should work to lower quotas by reducing prescriptions. But the Pandora’s box was opened long ago.\u003c/p>\n\u003cp>“In 2002, there should have been a change in the way we have a quota or a cap, and a cap would have been a mechanism to prevent other pharma companies from putting other opioids on the market,” Kolodny said.\u003c/p>\n\u003cp>“The problem with new opioids getting approved is each time the opioids get approved, [manufacturers] have to recoup their investment,” he said. “The only way to do that is to get prescribers to prescribe your drug, which means a campaign to incentivize prescribing. Basically each new opioid is pouring fuel on the fire.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This \u003ca href=\"https://www.statnews.com/2017/12/18/prescription-drug-supply-dea/\" target=\"_blank\" rel=\"noopener\">story\u003c/a> was originally published by STAT, an online publication of Boston Globe Media that covers health, medicine, and scientific discovery.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>WASHINGTON — In a bland Northern Virginia office building nestled between a Costco and a freeway interchange, a dozen government scientists have spent the past year crunching numbers and making the following determination: In 2018, drug makers will be allowed to produce no more than 98,145 kilos of oxycodone, 38,047 kilos of morphine, and 1,342 kilos of fentanyl.\u003c/p>\n\u003cp>The precise limits are set as part of a little-known process in which, every year, the Drug Enforcement Administration regulates the volume of controlled substances that can be produced in the United States.\u003c/p>\n\u003cp>The process was started nearly five decades ago to ensure that drug makers produced enough medicines to avoid shortages. But in the midst of a national opioid epidemic, fresh scrutiny of the quota system has spread to Capitol Hill, where Democratic lawmakers are \u003ca href=\"https://www.durbin.senate.gov/newsroom/press-releases/durbin-presses-dea-administrator-to-lower-2018-opioid-quotas\" target=\"_blank\" rel=\"noopener\">pressing\u003c/a> the DEA to use it for another reason — to help stem supply.\u003c/p>\n\u003cp>“It is clear that we need to reduce the amount of oxycodone and hydrocodone that DEA approves for manufacture each year and hold Big Pharma accountable for manufacturing a product that is leading to the deaths of hundreds of people every day,” said Sen. Edward Markey (Mass.), who has introduced a number of bills aimed at addressing the opioid crisis.\u003c/p>\n\u003caside class=\"pullquote alignright\">No medical group thinks opioids are without merit when properly distributed, and a substantial number of pain patients would suffer if denied access to them.\u003c/aside>\n\u003cp>Rarely, however, has the quota system been used to eliminate or constrain supply for a class of drugs similar to opioids — created to fill a medical need but with consequences that, in at least some cases, have outweighed the medical benefits.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The lone historical exception is that of the sedative methaqualone, which was marketed until the early 1980s as Quaalude. The drug became so abused that it quickly fell out of favor with the medical community, and in conjunction with nose-diving prescription rates and manufacturer interest, the DEA began to lower the quota for methaqualone production in 1973. It hit zero in 1981.\u003c/p>\n\u003cp>But opioids are not quite analogous. No medical group thinks they are without merit when properly distributed, and a substantial number of \u003ca href=\"https://www.statnews.com/2017/01/17/chronic-pain-management-opioids/\">pain patients\u003c/a> would suffer if denied access to them.\u003c/p>\n\u003cp>Many experts are not sure using the quota system as a tool to constrain supply is a sound idea — and instead believe the focus should be on reducing prescriptions.\u003c/p>\n\u003cp>The DEA could have considered tightening quotas to address the crisis more than a decade ago, “when we were clearly already in the middle of an opioid crisis and it was clear the prescribing of OxyContin was happening at a rate much greater than could be clinically needed,” said Andrew Kolodny, the co-director of the Opioid Policy Research Collaborative at Brandeis University.\u003c/p>\n\u003cp>“Now,” he said, “I don’t think it makes any sense, because the prescribing peaked in 2011 and 2012.”\u003c/p>\n\u003cp>Still, some lawmakers say that the DEA has historically been too liberal in the setting of the quotas. In a \u003ca href=\"https://www.durbin.senate.gov/newsroom/press-releases/durbin-senators-urge-dea-to-lower-opioid-quotas-to-combat-prescription-drug-abuse\" target=\"_blank\" rel=\"noopener\">letter\u003c/a> to the agency’s acting administrator earlier this year, 16 Democratic senators noted that the agency allowed aggregate production quotas for oxycodone to increase thirty-nine-fold between 1993 and 2015, and quotas for fentanyl to increase twenty-five-fold.\u003c/p>\n\u003cp>“Further reductions are necessary,” wrote the senators, led by Sen. Dick Durbin, the chamber’s No. 2 Democrat.\u003c/p>\n\u003cp>Republicans have had little to say on the issue. And a White House official, speaking on condition of anonymity, said the politicization of the quota system has created the potential for hospital shortages and access issues for pain patients who have legitimate medical needs.\u003c/p>\n\u003cp>Outside the United States, there are cautionary tales of government intervention in the supply of pharmaceutical drugs.\u003c/p>\n\u003cp>In Russia, for example, a heavy-handed regulatory system meant to guard against drug abuse has led to shortages, with highly publicized cases like that of a Russian naval officer with late-stage cancer who committed suicide after being \u003ca href=\"http://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(15)61264-8.pdf\" target=\"_blank\" rel=\"noopener\">unable to obtain sufficient pain medicine\u003c/a>.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>In Uganda, fear of a U.S.-style opioid crisis has left palliative care doctors \u003ca href=\"https://www.nytimes.com/2017/12/04/health/opioids-africa-pain.html\" target=\"_blank\" rel=\"noopener\">without the necessary means\u003c/a> to treat patients in their final, agonizing stage of life.\u003c/p>\n\u003cp>In the United States, the quota system is used for all Schedule II drugs — those that are deemed to have legitimate medical uses but that carry high potential for abuse. It also applies to a select number of stimulants, as well as research-oriented production of Schedule I drugs like marijuana and GHB deemed to have no accepted medicinal value.\u003c/p>\n\u003cp>To set the quotas, the DEA says it relies on estimates of legitimate medical need from the Food and Drug Administration, prescription levels from the previous year, manufacturers’ forecasts, and other data. A spokesman said the agency uses a strict formula, and does not take into account business or other circumstantial considerations.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>“If any part of the steps that are taken need to be changed, or people want them to be changed, Congress has to do that,” the spokesman, Melvin Patterson, told STAT.\u003c/p>\n\u003cp>(A spokesman for the Food and Drug Administration, which sends information about past and projected prescription levels to the DEA each year to assist in the quota-setting process, declined to specify the source of the FDA’s data.)\u003c/p>\n\u003cp>The quota levels for aggregate opioid production in 2017 were lowered by about 25 percent, a move that may have helped to address political pressure to reduce the quota but had little impact on actual supply. The DEA acknowledged that the numbers appeared lower because the agency decided to eliminate a cushion it has previously included as a safeguard.\u003c/p>\n\u003cp>It represented “a quota that was built into the system to handle an emergency, a catastrophic event” but that was never used, said Joe Rannazzisi, who ran the DEA’s division of diversion control until 2015 and now consults with lawyers pursuing legal action against the opioid industry.\u003c/p>\n\u003cp>For 2018, the DEA has lowered the quota for opioids another 20 percent — a quota even Rannazzisi acknowledged is more likely to substantively reflect and impact prescription levels.\u003c/p>\n\u003cp>“Physicians, pharmacists, and patients must recognize the inherent risks of these powerful medications, especially for long-term use,” Chuck Rosenberg, then the DEA’s acting administrator, said in an August statement. “More states are mandating use of prescription drug monitoring programs, which is good, and that has prompted a decrease in opioid prescriptions.”\u003c/p>\n\u003cp>While the DEA is required to publish the aggregate quota amounts each year, it is prohibited from making public the individual quotas it awards to specific manufacturers.\u003c/p>\n\u003cp>That makes it difficult, Democratic congressional aides told STAT, for the public to connect the dots between manufacturers and the supply of narcotics they are responsible for on the market.\u003c/p>\n\u003cp>Markey has sponsored a \u003ca href=\"https://www.congress.gov/bill/115th-congress/senate-bill/1882\" target=\"_blank\" rel=\"noopener\">bill\u003c/a> that would require the DEA to release individual quota levels for manufacturers, in the hope that drug makers perceived to be contributing to the addiction crisis will become more responsible actors in the face of greater public awareness.\u003c/p>\n\u003cp>That could put manufacturers that obtain controlled substances for research purposes or compounding with other drugs at a competitive disadvantage. But Rannazzisi said that in most cases, the idea of forcing accountability through transparency is a sound one.\u003c/p>\n\u003cp>“I totally agree with that,” he said. “Mr. Markey, his theory is somewhat correct — I guess he’s looking at shaming manufacturers for how much [quota] they’re getting.”\u003c/p>\n\u003cp>Industry groups have not bothered to advocate against the measure — it is virtually certain to receive neither a hearing nor a vote in the Senate Judiciary Committee. But opposition, Democratic aides said, would be fierce if Democrats controlled either the House or Senate or if the bill appeared likely to become law.\u003c/p>\n\u003cp>\u003ca href=\"https://www.statnews.com/2016/11/09/stat-purdue-oxycontin-appeal/\">Purdue Pharma\u003c/a>, which manufactures and markets oxycodone as OxyContin, declined to comment on the Markey bill and the quota process in general. A spokeswoman for PhRMA, the drug industry lobby, said the group had not reviewed the bill or taken a position on it.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>Regardless of what happens, there is consensus across industry groups and the expert community that the simplest way to reduce the supply of opioids over the long term is simply to reduce prescriptions. Already, changes to prescription practices nationwide have sapped some of the demand for the drugs.\u003c/p>\n\u003cp>Guidelines issued by the Centers for Disease Control and Prevention to encourage more responsible prescribing practices are also a focus. And policy staff across federal agencies agree those guidelines, coupled with a slew of state laws limiting prescription length and encouraging use of non-opioid painkillers, are the best bet when it comes to addressing the crisis.\u003c/p>\n\u003cp>Instead of reducing prescriptions by lowering quotas, Kolodny said, governments should work to lower quotas by reducing prescriptions. But the Pandora’s box was opened long ago.\u003c/p>\n\u003cp>“In 2002, there should have been a change in the way we have a quota or a cap, and a cap would have been a mechanism to prevent other pharma companies from putting other opioids on the market,” Kolodny said.\u003c/p>\n\u003cp>“The problem with new opioids getting approved is each time the opioids get approved, [manufacturers] have to recoup their investment,” he said. “The only way to do that is to get prescribers to prescribe your drug, which means a campaign to incentivize prescribing. Basically each new opioid is pouring fuel on the fire.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>The California Department of Public Health Wednesday released a new set of \u003ca href=\"https://www.cdph.ca.gov/Programs/CCDPHP/DEODC/EHIB/CDPH%20Document%20Library/Cell-Phone-Guidance.pdf\" target=\"_blank\" rel=\"noopener\">guidelines\u003c/a> concerning the use of cellphones and radiation risk.\u003cstrong> \u003c/strong>\u003c/p>\n\u003cp>Some studies have suggested that long-term use could be linked to brain or salivary gland cancer, lower sperm count, and headaches, the department said. And a\u003ca href=\"https://www.nature.com/articles/s41598-017-16623-8\" target=\"_blank\" rel=\"noopener\"> study\u003c/a> from Kaiser Permanente published this week in\u003cem> Scientific Reports\u003c/em> found an association between exposure to the type of radiation emitted by cellphones and other sources and a higher rate of miscarriage. But the department was cautious in its framing of the potential harm:\u003c/p>\n\u003cp>\"These studies do not establish the link definitely, however, and scientists disagree about whether cellphones cause these health problems and how great the risks might be,\" the guidelines state. \"This document is intended to provide guidance for those people who want to reduce their own and their families’ exposures to RF [radio frequency] energy from cellphones, despite this uncertainty.\"\u003c/p>\n\u003cp>The creation of the guidelines was spurred by the exploding use of cell phones in recent years, said CDPH Director Dr. Karen Smith.\u003c/p>\n\u003cp>\"We're finding that many more children are using cellphones and they're using them at earlier ages,\" Smith said.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The average age when children get their first phone is now just over 10, according to one 2016 \u003ca href=\"https://techcrunch.com/2016/05/19/the-average-age-for-a-child-getting-their-first-smartphone-is-now-10-3-years/\" target=\"_blank\" rel=\"noopener\">study\u003c/a>.\u003c/p>\n\u003cp>Activists have spent years campaigning for consumer warnings, despite pushback from industry groups. In May, the San Francisco Chronicle\u003ca href=\"http://www.sfchronicle.com/health/article/New-records-show-how-state-reworked-secret-cell-11160254.php\" target=\"_blank\" rel=\"noopener\"> reported \u003c/a>the California health department had worked on cellphone guidelines over five years and 27 revisions, \"abandoning the efforts without ever making their concerns public until ordered by a judge.\" The order camein response to a lawsuit by a UC Berkeley public health researcher.\u003c/p>\n\u003cp>A \u003ca href=\"https://www.nbcbayarea.com/news/local/Berkeleys-Right-to-Know-Cell-Phone-Radiation-Warning-Ordinance-Now-in-Effect-373027781.html\" target=\"_blank\" rel=\"noopener\">Berkeley law\u003c/a> requiring cellphone health warnings in stores was \u003ca href=\"http://www.sfgate.com/bayarea/article/Berkeley-cell-phone-warning-law-upheld-by-federal-11090621.php\" target=\"_blank\" rel=\"noopener\">upheld\u003c/a> by a U.S. federal appeals court in April.\u003c/p>\n\u003cp>Some suggestions from the health department if you're concerned about health hazards from your phone:\u003c/p>\n\u003cul>\n\u003cli>When you talk on your phone, avoid holding it to your head; use the speakerphone or a headset instead.\u003c/li>\n\u003cli>Send text messages in place of engaging in phone conversations.\u003c/li>\n\u003cli>Reduce use when there's a weak signal.\u003c/li>\n\u003cli>Don't carry your phone in your pocket, bra or belt holster.\u003c/li>\n\u003cli>Reduce or avoid use of your phone when it is sending out high levels of RF energy, which occurs mainly when the signal is weak, you're in a fast-moving vehicle, and you are streaming media or downloading or sending large files. In these circumstances, try to keep the phone away from your head and body.\u003c/li>\n\u003c/ul>\n\u003cp>\u003c/p>\n\u003cp>In a statement to \u003ca href=\"http://www.capradio.org/articles/2017/12/13/keep-your-cell-phone-away-from-your-body-new-state-guidelines-warn/\" target=\"_blank\" rel=\"noopener\">Capitol Public Radio\u003c/a>, CTIA, the cellphone industry trade group, said, \"The Federal Communications Commission monitors scientific research on a regular basis, and its standard for RF exposure is based on recommended guidelines adopted by U.S. and international standard-setting bodies. That’s why the FCC has determined that all wireless phones legally sold in the United States are ‘safe.’ ”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The California Department of Public Health Wednesday released a new set of \u003ca href=\"https://www.cdph.ca.gov/Programs/CCDPHP/DEODC/EHIB/CDPH%20Document%20Library/Cell-Phone-Guidance.pdf\" target=\"_blank\" rel=\"noopener\">guidelines\u003c/a> concerning the use of cellphones and radiation risk.\u003cstrong> \u003c/strong>\u003c/p>\n\u003cp>Some studies have suggested that long-term use could be linked to brain or salivary gland cancer, lower sperm count, and headaches, the department said. And a\u003ca href=\"https://www.nature.com/articles/s41598-017-16623-8\" target=\"_blank\" rel=\"noopener\"> study\u003c/a> from Kaiser Permanente published this week in\u003cem> Scientific Reports\u003c/em> found an association between exposure to the type of radiation emitted by cellphones and other sources and a higher rate of miscarriage. But the department was cautious in its framing of the potential harm:\u003c/p>\n\u003cp>\"These studies do not establish the link definitely, however, and scientists disagree about whether cellphones cause these health problems and how great the risks might be,\" the guidelines state. \"This document is intended to provide guidance for those people who want to reduce their own and their families’ exposures to RF [radio frequency] energy from cellphones, despite this uncertainty.\"\u003c/p>\n\u003cp>The creation of the guidelines was spurred by the exploding use of cell phones in recent years, said CDPH Director Dr. Karen Smith.\u003c/p>\n\u003cp>\"We're finding that many more children are using cellphones and they're using them at earlier ages,\" Smith said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The average age when children get their first phone is now just over 10, according to one 2016 \u003ca href=\"https://techcrunch.com/2016/05/19/the-average-age-for-a-child-getting-their-first-smartphone-is-now-10-3-years/\" target=\"_blank\" rel=\"noopener\">study\u003c/a>.\u003c/p>\n\u003cp>Activists have spent years campaigning for consumer warnings, despite pushback from industry groups. In May, the San Francisco Chronicle\u003ca href=\"http://www.sfchronicle.com/health/article/New-records-show-how-state-reworked-secret-cell-11160254.php\" target=\"_blank\" rel=\"noopener\"> reported \u003c/a>the California health department had worked on cellphone guidelines over five years and 27 revisions, \"abandoning the efforts without ever making their concerns public until ordered by a judge.\" The order camein response to a lawsuit by a UC Berkeley public health researcher.\u003c/p>\n\u003cp>A \u003ca href=\"https://www.nbcbayarea.com/news/local/Berkeleys-Right-to-Know-Cell-Phone-Radiation-Warning-Ordinance-Now-in-Effect-373027781.html\" target=\"_blank\" rel=\"noopener\">Berkeley law\u003c/a> requiring cellphone health warnings in stores was \u003ca href=\"http://www.sfgate.com/bayarea/article/Berkeley-cell-phone-warning-law-upheld-by-federal-11090621.php\" target=\"_blank\" rel=\"noopener\">upheld\u003c/a> by a U.S. federal appeals court in April.\u003c/p>\n\u003cp>Some suggestions from the health department if you're concerned about health hazards from your phone:\u003c/p>\n\u003cul>\n\u003cli>When you talk on your phone, avoid holding it to your head; use the speakerphone or a headset instead.\u003c/li>\n\u003cli>Send text messages in place of engaging in phone conversations.\u003c/li>\n\u003cli>Reduce use when there's a weak signal.\u003c/li>\n\u003cli>Don't carry your phone in your pocket, bra or belt holster.\u003c/li>\n\u003cli>Reduce or avoid use of your phone when it is sending out high levels of RF energy, which occurs mainly when the signal is weak, you're in a fast-moving vehicle, and you are streaming media or downloading or sending large files. In these circumstances, try to keep the phone away from your head and body.\u003c/li>\n\u003c/ul>\n\u003cp>\u003c/p>\n\u003cp>In a statement to \u003ca href=\"http://www.capradio.org/articles/2017/12/13/keep-your-cell-phone-away-from-your-body-new-state-guidelines-warn/\" target=\"_blank\" rel=\"noopener\">Capitol Public Radio\u003c/a>, CTIA, the cellphone industry trade group, said, \"The Federal Communications Commission monitors scientific research on a regular basis, and its standard for RF exposure is based on recommended guidelines adopted by U.S. and international standard-setting bodies. That’s why the FCC has determined that all wireless phones legally sold in the United States are ‘safe.’ ”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "The Man Who Was Nearly Cured of HIV",
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"content": "\u003cp>The cases of Clark Hawley, 54, and Luis Canales, 31, presented at the \u003ca href=\"http://www.curecountdown.org/research-index/2017/9/12/2017-hiv-cure-summit\" target=\"_blank\" rel=\"noopener\">amfAR HIV Cure Summit \u003c/a>in San Francisco last November, provided at least a temporary answer to a big question: Can very early treatment after exposure to HIV lead to complete eradication of the virus — an actual cure?\u003c/p>\n\u003cp>No.\u003c/p>\n\u003cp>But almost.\u003c/p>\n\u003caside class=\"pullquote alignright\">Early antitretroviral treatment brings about a striking period of long-term remission, also called a 'functional cure,' in an HIV patient. \u003c/aside>\n\u003cp>In Hawley’s case, nearly immediate treatment did usher in a striking period of long-term remission, also called a \"functional cure,\" in which zero trace of HIV was detected in his blood or tissue samples, without the benefit of drugs.\u003c/p>\n\u003cp>The men were recruited as part of an ongoing observational UCSF study. Both were given an initial dose of the antiretroviral combination Truvada, also known as pre-exposure prophylaxis, or PrEP, within two weeks after their suspected exposure to the virus. The treatment came so soon after infection that their immune systems had yet to generate an antibody response. In Hawley’s case, only a more sensitive genetic test called PCR, which measures an individual’s \u003ca href=\"https://www.aidsmap.com/Viral-load/page/1327496/\" target=\"_blank\" rel=\"noopener\">viral load\u003c/a>, showed signs of HIV. After the initial treatment, both men were switched to a daily four-drug antiviral regimen, which drove the virus below detectable levels.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>What happened next is a mystery.\u003c/p>\n\u003cp>[contextly_sidebar id=\"6nfWarjopr6zyonYcblrTOe4VSljxsdZ\"]As reported Nov. 7 in \u003cem> \u003ca href=\"https://protect-us.mimecast.com/s/8JwmB0iVvmacp?domain=journals.plos.org\" target=\"_blank\" rel=\"noopener\">PloS Medicine\u003c/a>\u003c/em>, a UCSF team led by Drs. Timothy Henrich and Steven Deeks said it failed to detect any trace of HIV in Hawley’s blood or tissue for the two years he remained on medication. Typically individuals on successful HIV therapy are classified as “undetectable” when drugs drive viral activity below observable levels in the blood. But it’s known that a small amount of residual virus called the HIV reservoir may be found in tissue using sensitive PCR tests. These came up negative.\u003c/p>\n\u003cp>Hawley then went off the drugs, a step that was part of the study design. About seven months later, the virus rebounded, quickly multiplying into an active infection. He immediately resumed antiretroviral treatment, which again rendered the virus undetectable.\u003c/p>\n\u003cfigure id=\"attachment_437571\" class=\"wp-caption alignright\" style=\"max-width: 1000px\">\u003ca href=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/12/deeks-and-volberding.jpg\">\u003cimg class=\"wp-image-437571 size-full\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/12/deeks-and-volberding.jpg\" alt=\"\" width=\"1000\" height=\"754\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/12/deeks-and-volberding.jpg 1000w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/deeks-and-volberding-160x121.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/deeks-and-volberding-800x603.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/deeks-and-volberding-768x579.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/deeks-and-volberding-960x724.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/deeks-and-volberding-240x181.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/deeks-and-volberding-375x283.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/deeks-and-volberding-520x392.jpg 520w\" sizes=\"(max-width: 1000px) 100vw, 1000px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Dr. Steven Deeks, right, who talked about the results of early intervention after exposure to the HIV virus, at amfAR's 2017 HIV Cure Summit. On the left is long-time HIV researcher Dr. Paul Volberding. \u003ccite>(amfAR)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>But what puzzled scientists was that his body still showed no sign of an antibody response. That suggested his immune system had never had sufficient time to generate a defense because the drugs had worked so quickly that they halted the initial infection. Yet, they knew he still had HIV from the results of a viral load test. More genetic tests confirmed the resuscitated virus was the same strain he was initially exposed to.\u003c/p>\n\u003caside class=\"pullquote alignright\">'We got close; we may have been off by a day or two.'\u003ccite>Dr. Steven Deeks, UCSF\u003c/cite>\u003c/aside>\n\u003cp>Deeks said Hawley probably has a small latent reservoir of HIV somewhere in his body, which hasn’t grown due to Truvada’s suppression of the virus’s initial spread. His status is now in a kind of limbo, somewhere between having HIV and not.\u003c/p>\n\u003cp>“The whole excitement around Clark is that we were able to initiate therapy so early that we were hoping to prevent the establishing of latency,” says Deeks. “But it did not happen. We got close; we may have been off by a day or two. We did not achieve a real cure.”\u003c/p>\n\u003cp>Even if Hawley had been permanently freed of HIV, the problem with any protocol based on such early treatment is that doctors rarely detect a patient’s infection in the first days after exposure. Rather, the case is significant due to the milestone of pushing a patient into long-term remission free of medication, and because it might offer new clues on how to induce a permanent state of HIV dormancy.\u003c/p>\n\u003cp>\u003cstrong>Dramatically Reducing HIV Reservoirs\u003c/strong>\u003c/p>\n\u003cp>Canales’ case is also tantalizing. He was given a PrEP dose of Truvada 12 days after exposure, and for two years showed no sign of HIV in blood or tissue samples on both viral load and PCR tests. Because of Hawley’s relapse experience after stopping therapy, doctors kept him on the treatment. The only way they could detect signs of the virus in Canales was by transferring some of his cells into mice bred with a copycat human immune system. They were able to intermittently spy a virus particle here or there upon removing the cells from the mice. As with Hawley, early treatment had dramatically limited the amount of virus that would later coalesce into a dormant pool in his body.\u003c/p>\n\u003cp>“I think we have proven to ourselves that early treatment will never be curative,” Deeks said, referring to complete eradication of the virus within someone’s body. When pressed whether he really meant “never,” he amended his answer: “No, not yet.”\u003c/p>\n\u003cp>“But we can definitely shift the balance in favor of the patient,” he went on, “because the reservoir is reduced a hundred- to a million-fold.”\u003c/p>\n\u003cp>Deeks and his team are now investigating a series of HIV vaccines aimed at providing an immune booster to control the pieces of virus that remain in a patient’s body, the final step in sending HIV patients into remission — no medication required. Beyond that, if such tools could wipe out the last pockets of HIV, medical science would have finally achieved its ultimate goal in the fight against AIDS — an actual cure.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Anne-christine d’Adesky is a longtime chronicler of HIV research. Her 90s-era AIDS memoir, “The Pox Lover,” was published in June.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The cases of Clark Hawley, 54, and Luis Canales, 31, presented at the \u003ca href=\"http://www.curecountdown.org/research-index/2017/9/12/2017-hiv-cure-summit\" target=\"_blank\" rel=\"noopener\">amfAR HIV Cure Summit \u003c/a>in San Francisco last November, provided at least a temporary answer to a big question: Can very early treatment after exposure to HIV lead to complete eradication of the virus — an actual cure?\u003c/p>\n\u003cp>No.\u003c/p>\n\u003cp>But almost.\u003c/p>\n\u003caside class=\"pullquote alignright\">Early antitretroviral treatment brings about a striking period of long-term remission, also called a 'functional cure,' in an HIV patient. \u003c/aside>\n\u003cp>In Hawley’s case, nearly immediate treatment did usher in a striking period of long-term remission, also called a \"functional cure,\" in which zero trace of HIV was detected in his blood or tissue samples, without the benefit of drugs.\u003c/p>\n\u003cp>The men were recruited as part of an ongoing observational UCSF study. Both were given an initial dose of the antiretroviral combination Truvada, also known as pre-exposure prophylaxis, or PrEP, within two weeks after their suspected exposure to the virus. The treatment came so soon after infection that their immune systems had yet to generate an antibody response. In Hawley’s case, only a more sensitive genetic test called PCR, which measures an individual’s \u003ca href=\"https://www.aidsmap.com/Viral-load/page/1327496/\" target=\"_blank\" rel=\"noopener\">viral load\u003c/a>, showed signs of HIV. After the initial treatment, both men were switched to a daily four-drug antiviral regimen, which drove the virus below detectable levels.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>What happened next is a mystery.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>As reported Nov. 7 in \u003cem> \u003ca href=\"https://protect-us.mimecast.com/s/8JwmB0iVvmacp?domain=journals.plos.org\" target=\"_blank\" rel=\"noopener\">PloS Medicine\u003c/a>\u003c/em>, a UCSF team led by Drs. Timothy Henrich and Steven Deeks said it failed to detect any trace of HIV in Hawley’s blood or tissue for the two years he remained on medication. Typically individuals on successful HIV therapy are classified as “undetectable” when drugs drive viral activity below observable levels in the blood. But it’s known that a small amount of residual virus called the HIV reservoir may be found in tissue using sensitive PCR tests. These came up negative.\u003c/p>\n\u003cp>Hawley then went off the drugs, a step that was part of the study design. About seven months later, the virus rebounded, quickly multiplying into an active infection. He immediately resumed antiretroviral treatment, which again rendered the virus undetectable.\u003c/p>\n\u003cfigure id=\"attachment_437571\" class=\"wp-caption alignright\" style=\"max-width: 1000px\">\u003ca href=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/12/deeks-and-volberding.jpg\">\u003cimg class=\"wp-image-437571 size-full\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/12/deeks-and-volberding.jpg\" alt=\"\" width=\"1000\" height=\"754\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/12/deeks-and-volberding.jpg 1000w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/deeks-and-volberding-160x121.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/deeks-and-volberding-800x603.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/deeks-and-volberding-768x579.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/deeks-and-volberding-960x724.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/deeks-and-volberding-240x181.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/deeks-and-volberding-375x283.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/deeks-and-volberding-520x392.jpg 520w\" sizes=\"(max-width: 1000px) 100vw, 1000px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Dr. Steven Deeks, right, who talked about the results of early intervention after exposure to the HIV virus, at amfAR's 2017 HIV Cure Summit. On the left is long-time HIV researcher Dr. Paul Volberding. \u003ccite>(amfAR)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>But what puzzled scientists was that his body still showed no sign of an antibody response. That suggested his immune system had never had sufficient time to generate a defense because the drugs had worked so quickly that they halted the initial infection. Yet, they knew he still had HIV from the results of a viral load test. More genetic tests confirmed the resuscitated virus was the same strain he was initially exposed to.\u003c/p>\n\u003caside class=\"pullquote alignright\">'We got close; we may have been off by a day or two.'\u003ccite>Dr. Steven Deeks, UCSF\u003c/cite>\u003c/aside>\n\u003cp>Deeks said Hawley probably has a small latent reservoir of HIV somewhere in his body, which hasn’t grown due to Truvada’s suppression of the virus’s initial spread. His status is now in a kind of limbo, somewhere between having HIV and not.\u003c/p>\n\u003cp>“The whole excitement around Clark is that we were able to initiate therapy so early that we were hoping to prevent the establishing of latency,” says Deeks. “But it did not happen. We got close; we may have been off by a day or two. We did not achieve a real cure.”\u003c/p>\n\u003cp>Even if Hawley had been permanently freed of HIV, the problem with any protocol based on such early treatment is that doctors rarely detect a patient’s infection in the first days after exposure. Rather, the case is significant due to the milestone of pushing a patient into long-term remission free of medication, and because it might offer new clues on how to induce a permanent state of HIV dormancy.\u003c/p>\n\u003cp>\u003cstrong>Dramatically Reducing HIV Reservoirs\u003c/strong>\u003c/p>\n\u003cp>Canales’ case is also tantalizing. He was given a PrEP dose of Truvada 12 days after exposure, and for two years showed no sign of HIV in blood or tissue samples on both viral load and PCR tests. Because of Hawley’s relapse experience after stopping therapy, doctors kept him on the treatment. The only way they could detect signs of the virus in Canales was by transferring some of his cells into mice bred with a copycat human immune system. They were able to intermittently spy a virus particle here or there upon removing the cells from the mice. As with Hawley, early treatment had dramatically limited the amount of virus that would later coalesce into a dormant pool in his body.\u003c/p>\n\u003cp>“I think we have proven to ourselves that early treatment will never be curative,” Deeks said, referring to complete eradication of the virus within someone’s body. When pressed whether he really meant “never,” he amended his answer: “No, not yet.”\u003c/p>\n\u003cp>“But we can definitely shift the balance in favor of the patient,” he went on, “because the reservoir is reduced a hundred- to a million-fold.”\u003c/p>\n\u003cp>Deeks and his team are now investigating a series of HIV vaccines aimed at providing an immune booster to control the pieces of virus that remain in a patient’s body, the final step in sending HIV patients into remission — no medication required. Beyond that, if such tools could wipe out the last pockets of HIV, medical science would have finally achieved its ultimate goal in the fight against AIDS — an actual cure.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Anne-christine d’Adesky is a longtime chronicler of HIV research. Her 90s-era AIDS memoir, “The Pox Lover,” was published in June.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Just Because You Have a 'Mild' Concussion Doesn't Mean You're OK",
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"content": "\u003cp>Last February Baxter Bailey injured himself trying to break into his own home when he couldn’t find his key. Crawling through a window leading to the utility room, he slipped and fell, hitting his head on the concrete floor.\u003c/p>\n\u003cp>He was unconscious for about an hour.\u003c/p>\n\u003cp>“My skull, my forehead was bloody, bruised and banged,” says the 77-year-old architect from Richmond, Virginia. “And I had blood all over my shirt, my pants and underwear.”\u003c/p>\n\u003cp>At the hospital, “Doctors told me that my brain moved inside the skull,” Baxter says. But a small hemorrhage in the brain visible through scans wasn’t bad enough to keep him as an inpatient for more than a day. Baxter was diagnosed with a concussion, or what medical professionals call a mild traumatic brain injury, and released.\u003c/p>\n\u003caside class=\"pullquote alignright\">'Unlike other neurological diseases, one cannot pinpoint the area of injury in concussion.'\u003ccite>Teena Shetty, neurologist\u003c/cite>\u003c/aside>\n\u003cp>“Within two weeks, the abrasion on my head got healed, and you couldn’t tell that anything ever happened to me if you looked at me,” says Baxter.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>But his troubles were just starting. Two months later, Baxter was in the emergency room again. He had started losing control of his left side. He found lifting his leg to get into a car difficult. Walking caused him trouble. This time the scans showed a chronic hematoma — swelling and bruising — on the right side of his skull.\u003c/p>\n\u003cp>“It was like 3 inches long and an inch thick and I could see that my brain literally was off center and my cerebellum was misaligned,” says Baxter. Doctors told him he needed immediate surgery. The plan was to drill a little hole in his head the size of a dime.\u003c/p>\n\u003cp>“I thought, ‘My lord, is this the end of me?’ ”\u003c/p>\n\u003cp>\u003cstrong>A Lot of Brain Injuries\u003c/strong>\u003c/p>\n\u003cp>Each year, about \u003ca href=\"https://www.cdc.gov/mmwr/volumes/66/ss/ss6609a1.htm\" target=\"_blank\" rel=\"noopener\">2.5 million people in the United States\u003c/a> are admitted to emergency rooms with traumatic brain injuries, according to the Centers for Disease Control and Prevention.\u003c/p>\n\u003cp>The difficulties of studying concussions, with their vague symptoms and hidden physical damage, have turned brain injury into a “silent epidemic,” in the words of \u003ca href=\"http://profiles.ucsf.edu/pratik.mukherjee\" target=\"_blank\" rel=\"noopener\">Pratik Mukherjee\u003c/a>, a neuroradiologist at UCSF.\u003c/p>\n\u003cp>\u003ca href=\"https://www.hss.edu/physicians_shetty-teena.asp\" target=\"_blank\" rel=\"noopener\">Teena Shetty\u003c/a>, a neurologist at New York City's Hospital for Special Surgery, agrees. “Unlike other neurological diseases, one cannot pinpoint the area of injury in concussion,” she says.\u003c/p>\n\u003cp>Doctors are not even in agreement about how to treat concussions. Some advise resuming daily activities as soon as possible, others suggest avoiding demanding work and staying away from bright lights and loud sounds.\u003c/p>\n\u003cp>Existing guidelines are not backed by evidence, according to \u003ca href=\"https://www.urmc.rochester.edu/people/20187378-jeffrey-j-bazarian\" target=\"_blank\" rel=\"noopener\">Jeff Bazarian\u003c/a>, professor of emergency medicine at the University of Rochester Medical Center, in New York.\u003c/p>\n\u003cfigure id=\"attachment_437557\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003cimg class=\"size-large wp-image-437557\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/12/16463775_10154204797011497_6888461288485270646_o-1020x765.jpg\" alt=\"\" width=\"640\" height=\"480\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/12/16463775_10154204797011497_6888461288485270646_o-1020x765.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/16463775_10154204797011497_6888461288485270646_o-160x120.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/16463775_10154204797011497_6888461288485270646_o-800x600.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/16463775_10154204797011497_6888461288485270646_o-768x576.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/16463775_10154204797011497_6888461288485270646_o-960x720.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/16463775_10154204797011497_6888461288485270646_o-240x180.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/16463775_10154204797011497_6888461288485270646_o-375x281.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/16463775_10154204797011497_6888461288485270646_o-520x390.jpg 520w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/16463775_10154204797011497_6888461288485270646_o.jpg 1024w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003cfigcaption class=\"wp-caption-text\">Tom Gal, 37-year old entrepreneur from San Francisco, recovering from a car accident at Zuckerberg San Francisco General Hospital and Trauma Center. \u003ccite>(Courtesy Tom Gal)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>A New Approach Tracks Patients in Detail\u003c/strong>\u003c/p>\n\u003cp>Predicting which concussion patients will fully recover and which will be permanently debilitated is more or less a guessing game.\u003c/p>\n\u003cp>Tom Gal, a 37-year old entrepreneur from San Francisco, spent almost two days in a coma after being hit by a car last August. He woke up with no memory of what happened and had to learn the details from his medical report. But eight months after the injury, he says he is doing just fine. In contrast, 29-year-old bread baker Ana Diaz, from Richmond, Virginia, complains about short-term memory lapses and increased anxiety six months after a biking accident that left her with no signs of head trauma on a CT scan.\u003c/p>\n\u003cp>In light of such counter-intuitive outcomes, many researchers feel it is now time to make the diagnosis and prognosis of concussions more precise and evidence-based.\u003c/p>\n\u003cp>According to Mukherjee, \u003ca href=\"https://link.springer.com/article/10.1186/s12245-014-0031-6\" target=\"_blank\" rel=\"noopener\">15 to 30 percent of concussion patients\u003c/a> will experience \u003ca href=\"http://www.neurosymptoms.org/post-concussion-syndrome/4582101276\" target=\"_blank\" rel=\"noopener\">worsening brain function\u003c/a> later on, including problems with thinking, memory, attention and decision-making. Patients can also experience sleep disorders and headaches that persist for weeks, months or years. In the severest cases, people can develop epilepsy and seizures, with increased risk of Alzheimer’s disease.\u003c/p>\n\u003cp>As a result, about 3 to 5 million people live with the long-term physical, cognitive and psychological health disabilities of traumatic brain injury. Estimated annual direct and indirect costs are over $75 billion, \u003ca href=\"https://www.cdc.gov/traumaticbraininjury/severe.html\" target=\"_blank\" rel=\"noopener\">according to\u003c/a> the Centers for Disease Control and Prevention.\u003c/p>\n\u003cp>What’s needed, some researchers believe, is a large study focused on improving how doctors measure concussions and predict the long-term effects on patients.\u003c/p>\n\u003cp>Baxter, Gal and Diaz may have found one. While recovering from their injuries, they signed up for a study called \u003ca href=\"https://tracktbi.ucsf.edu/\" target=\"_blank\" rel=\"noopener\">TRACK TBI, \u003c/a>for Transforming Research in Clinical Knowledge in Traumatic Brain Injury.\u003c/p>\n\u003cp>TRACK TBI, spearheaded at UCSF, started in 2014 with just 75 enrolled patients. The cohort has now expanded to include over 2,000, with the goal of enrolling 1,000 more. The study spans 19 research centers across the country, and major funding comes from the National Institutes of Health and the Department of Defense. TRACK TBI is also partnering with CENTER TBI, a European sister-trial, monitoring 10,000 concussion patients.\u003c/p>\n\u003cp>Study researchers want to analyze the results of blood analysis, MRI scans and cognitive tests to find which patients are at higher risk of developing long-term cognitive problems after suffering concussions.\u003c/p>\n\u003cfigure id=\"attachment_437556\" class=\"wp-caption alignnone\" style=\"max-width: 640px\">\u003cimg class=\"wp-image-437556 size-large\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/12/Pratik-with-brain-image-1020x574.jpg\" alt=\"\" width=\"640\" height=\"360\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/12/Pratik-with-brain-image-1020x574.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/Pratik-with-brain-image-160x90.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/Pratik-with-brain-image-800x450.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/Pratik-with-brain-image-768x432.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/Pratik-with-brain-image.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/Pratik-with-brain-image-1180x664.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/Pratik-with-brain-image-960x540.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/Pratik-with-brain-image-240x135.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/Pratik-with-brain-image-375x211.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/Pratik-with-brain-image-520x293.jpg 520w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003cfigcaption class=\"wp-caption-text\">Pratik Mukherjee, neuroradiologist at UCSF, looking at a brain image. \u003ccite>(Julia Vassey/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>Getting a Closer Look\u003c/strong>\u003c/p>\n\u003cp>The problem with diagnosing concussions starts in the emergency room. The majority of patients with mild, non-life-threatening traumatic brain injuries get released from ER without any follow-up evaluation.\u003c/p>\n\u003cp>“And that is a mistake,” says Mukherjee, who is also one of TRACK TBI’s principal investigators.\u003c/p>\n\u003cp>CT scans in the ERs across the country can miss subtle brain damage, as occurred in Baxter’s first CT scan. These diagnostics can only detect structural changes or internal bleeding in the brain, like the hemorrhage Baxter eventually developed.\u003c/p>\n\u003cp>Even following severe traumatic brain injuries, as Gal suffered, neither CT nor standard MRI can detect microstructural changes and alterations in brain functioning.\u003c/p>\n\u003cp>But it is these subtle changes that may predict the likelihood of lasting problems, including impaired focus, attention, memory and decision-making.\u003c/p>\n\u003cp>TRACK TBI researchers are looking for biochemical signals that could ensure reliable, speedy diagnoses and good predictions of whether patients will suffer long-term effects.\u003c/p>\n\u003cp>Mapping is another focus of TRACK TBI. Powerful MRI scanners with software that allows precise reconstruction of high resolution MRI images could help scientists create brain maps.\u003c/p>\n\u003cp>The study is using the latest MRI scanners, at least twice as powerful as the ones installed in many of the country’s hospitals and imaging centers, to peer deeper into the brain and search for abnormalities in the fine-grain structure of the brain’s “white matter.” If this is damaged, it can disrupt brain functions like imprinting memories, maintaining focus and making decisions.\u003c/p>\n\u003cp>Patients enrolled in the TRACK TBI study get scanned two weeks after their head injury and then again six months later to reveal the presence of any chronic effects.\u003c/p>\n\u003cp>Researchers are also scanning for the presence of specific types of proteins in the blood that can be detected in brain-injury patients. TRACK TBI is particularly focusing on GFAP (glial fibrillary acidic protein) and Tau protein.\u003c/p>\n\u003cdiv>\u003c/div>\n\u003cp>“This is similar to how they diagnose heart attacks,” says Mukherjee. “If you are having a heart attack, the heart will spill particular proteins that can be detected, and provide a good objective test.”\u003c/p>\n\u003cp>In the 1950s and 1960s an electrocardiogram was the only way to measure a patient’s heart for signs of heart disease. But a patient could show a normal-looking EKG even while suffering a heart attack. With time, blood tests measuring proteins have proven to be more reliable. Using a similar approach could transform concussion diagnoses as well.\u003c/p>\n\u003cp>Shetty, who is not involved in the study, believes it has “a tremendous potential to understand relationships between biomarkers, neuroimaging and cognitive data.”\u003c/p>\n\u003cp>\u003ca href=\"https://www2.eecs.berkeley.edu/Faculty/Homepages/chunleiliu.html\" target=\"_blank\" rel=\"noopener\">Chunlei Liu\u003c/a>, an associate professor of the Helen Wills Neuroscience Institute at UC Berkeley, who also has no relationship to the study, is glad to see TRACK TBI’s multipronged approach.\u003c/p>\n\u003cp>Because brain trauma involves systemic changes in different parts of the brain, Liu says, “A single biomarker won't make a definitive answer.”\u003c/p>\n\u003cp>[contextly_sidebar id=\"fpfN1gUvcMM6xziiLMO3LOmy1Q3hTGxh\"]This approach is part of a trend. The \u003ca href=\"http://www.careconsortium.net/\" target=\"_blank\" rel=\"noopener\">CARE Consortium\u003c/a>, funded by the NCAA and the U.S. Department of Defense, is similar in many ways to TRACK TBI, but focuses on student-athletes and military service members. At the University of Pittsburgh. the \u003ca href=\"http://www.adapttrial.org/\" target=\"_blank\" rel=\"noopener\">ADAPT Trial\u003c/a> is focusing on children with severe traumatic brain injury, hoping to determine the best care procedures.\u003c/p>\n\u003cp>If prognostic biomarkers can be identified by TRACK and other studies, it could help scientists resurrect once-promising treatments that were abandoned after failed clinical trials. One of the most disappointing failures was the PROTECT trial, which in 2015 experimented with treating acute traumatic brain injury with progesterone, a steroid found to sometimes have powerful neuroprotective properties.The study showed promising results on lab animals, but it collapsed after moving to phase III human trials.\u003c/p>\n\u003cp>“Currently with the clinical trials, it has been one-size-fits-all for every patient,” says Mukherjee. He says researchers often enroll participants without knowing if they are prone to developing complications. “But this is a mistake, because patients are affected in many different ways, and types of pathologies are different.”\u003c/p>\n\u003cp>If biomarkers can be discovered, researchers can determine exactly which patients will or will not benefit from treatment.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>And patients recovering from brain injuries may be able to face their future with a clearer idea of the path ahead.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Last February Baxter Bailey injured himself trying to break into his own home when he couldn’t find his key. Crawling through a window leading to the utility room, he slipped and fell, hitting his head on the concrete floor.\u003c/p>\n\u003cp>He was unconscious for about an hour.\u003c/p>\n\u003cp>“My skull, my forehead was bloody, bruised and banged,” says the 77-year-old architect from Richmond, Virginia. “And I had blood all over my shirt, my pants and underwear.”\u003c/p>\n\u003cp>At the hospital, “Doctors told me that my brain moved inside the skull,” Baxter says. But a small hemorrhage in the brain visible through scans wasn’t bad enough to keep him as an inpatient for more than a day. Baxter was diagnosed with a concussion, or what medical professionals call a mild traumatic brain injury, and released.\u003c/p>\n\u003caside class=\"pullquote alignright\">'Unlike other neurological diseases, one cannot pinpoint the area of injury in concussion.'\u003ccite>Teena Shetty, neurologist\u003c/cite>\u003c/aside>\n\u003cp>“Within two weeks, the abrasion on my head got healed, and you couldn’t tell that anything ever happened to me if you looked at me,” says Baxter.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>But his troubles were just starting. Two months later, Baxter was in the emergency room again. He had started losing control of his left side. He found lifting his leg to get into a car difficult. Walking caused him trouble. This time the scans showed a chronic hematoma — swelling and bruising — on the right side of his skull.\u003c/p>\n\u003cp>“It was like 3 inches long and an inch thick and I could see that my brain literally was off center and my cerebellum was misaligned,” says Baxter. Doctors told him he needed immediate surgery. The plan was to drill a little hole in his head the size of a dime.\u003c/p>\n\u003cp>“I thought, ‘My lord, is this the end of me?’ ”\u003c/p>\n\u003cp>\u003cstrong>A Lot of Brain Injuries\u003c/strong>\u003c/p>\n\u003cp>Each year, about \u003ca href=\"https://www.cdc.gov/mmwr/volumes/66/ss/ss6609a1.htm\" target=\"_blank\" rel=\"noopener\">2.5 million people in the United States\u003c/a> are admitted to emergency rooms with traumatic brain injuries, according to the Centers for Disease Control and Prevention.\u003c/p>\n\u003cp>The difficulties of studying concussions, with their vague symptoms and hidden physical damage, have turned brain injury into a “silent epidemic,” in the words of \u003ca href=\"http://profiles.ucsf.edu/pratik.mukherjee\" target=\"_blank\" rel=\"noopener\">Pratik Mukherjee\u003c/a>, a neuroradiologist at UCSF.\u003c/p>\n\u003cp>\u003ca href=\"https://www.hss.edu/physicians_shetty-teena.asp\" target=\"_blank\" rel=\"noopener\">Teena Shetty\u003c/a>, a neurologist at New York City's Hospital for Special Surgery, agrees. “Unlike other neurological diseases, one cannot pinpoint the area of injury in concussion,” she says.\u003c/p>\n\u003cp>Doctors are not even in agreement about how to treat concussions. Some advise resuming daily activities as soon as possible, others suggest avoiding demanding work and staying away from bright lights and loud sounds.\u003c/p>\n\u003cp>Existing guidelines are not backed by evidence, according to \u003ca href=\"https://www.urmc.rochester.edu/people/20187378-jeffrey-j-bazarian\" target=\"_blank\" rel=\"noopener\">Jeff Bazarian\u003c/a>, professor of emergency medicine at the University of Rochester Medical Center, in New York.\u003c/p>\n\u003cfigure id=\"attachment_437557\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003cimg class=\"size-large wp-image-437557\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/12/16463775_10154204797011497_6888461288485270646_o-1020x765.jpg\" alt=\"\" width=\"640\" height=\"480\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/12/16463775_10154204797011497_6888461288485270646_o-1020x765.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/16463775_10154204797011497_6888461288485270646_o-160x120.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/16463775_10154204797011497_6888461288485270646_o-800x600.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/16463775_10154204797011497_6888461288485270646_o-768x576.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/16463775_10154204797011497_6888461288485270646_o-960x720.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/16463775_10154204797011497_6888461288485270646_o-240x180.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/16463775_10154204797011497_6888461288485270646_o-375x281.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/16463775_10154204797011497_6888461288485270646_o-520x390.jpg 520w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/16463775_10154204797011497_6888461288485270646_o.jpg 1024w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003cfigcaption class=\"wp-caption-text\">Tom Gal, 37-year old entrepreneur from San Francisco, recovering from a car accident at Zuckerberg San Francisco General Hospital and Trauma Center. \u003ccite>(Courtesy Tom Gal)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>A New Approach Tracks Patients in Detail\u003c/strong>\u003c/p>\n\u003cp>Predicting which concussion patients will fully recover and which will be permanently debilitated is more or less a guessing game.\u003c/p>\n\u003cp>Tom Gal, a 37-year old entrepreneur from San Francisco, spent almost two days in a coma after being hit by a car last August. He woke up with no memory of what happened and had to learn the details from his medical report. But eight months after the injury, he says he is doing just fine. In contrast, 29-year-old bread baker Ana Diaz, from Richmond, Virginia, complains about short-term memory lapses and increased anxiety six months after a biking accident that left her with no signs of head trauma on a CT scan.\u003c/p>\n\u003cp>In light of such counter-intuitive outcomes, many researchers feel it is now time to make the diagnosis and prognosis of concussions more precise and evidence-based.\u003c/p>\n\u003cp>According to Mukherjee, \u003ca href=\"https://link.springer.com/article/10.1186/s12245-014-0031-6\" target=\"_blank\" rel=\"noopener\">15 to 30 percent of concussion patients\u003c/a> will experience \u003ca href=\"http://www.neurosymptoms.org/post-concussion-syndrome/4582101276\" target=\"_blank\" rel=\"noopener\">worsening brain function\u003c/a> later on, including problems with thinking, memory, attention and decision-making. Patients can also experience sleep disorders and headaches that persist for weeks, months or years. In the severest cases, people can develop epilepsy and seizures, with increased risk of Alzheimer’s disease.\u003c/p>\n\u003cp>As a result, about 3 to 5 million people live with the long-term physical, cognitive and psychological health disabilities of traumatic brain injury. Estimated annual direct and indirect costs are over $75 billion, \u003ca href=\"https://www.cdc.gov/traumaticbraininjury/severe.html\" target=\"_blank\" rel=\"noopener\">according to\u003c/a> the Centers for Disease Control and Prevention.\u003c/p>\n\u003cp>What’s needed, some researchers believe, is a large study focused on improving how doctors measure concussions and predict the long-term effects on patients.\u003c/p>\n\u003cp>Baxter, Gal and Diaz may have found one. While recovering from their injuries, they signed up for a study called \u003ca href=\"https://tracktbi.ucsf.edu/\" target=\"_blank\" rel=\"noopener\">TRACK TBI, \u003c/a>for Transforming Research in Clinical Knowledge in Traumatic Brain Injury.\u003c/p>\n\u003cp>TRACK TBI, spearheaded at UCSF, started in 2014 with just 75 enrolled patients. The cohort has now expanded to include over 2,000, with the goal of enrolling 1,000 more. The study spans 19 research centers across the country, and major funding comes from the National Institutes of Health and the Department of Defense. TRACK TBI is also partnering with CENTER TBI, a European sister-trial, monitoring 10,000 concussion patients.\u003c/p>\n\u003cp>Study researchers want to analyze the results of blood analysis, MRI scans and cognitive tests to find which patients are at higher risk of developing long-term cognitive problems after suffering concussions.\u003c/p>\n\u003cfigure id=\"attachment_437556\" class=\"wp-caption alignnone\" style=\"max-width: 640px\">\u003cimg class=\"wp-image-437556 size-large\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/12/Pratik-with-brain-image-1020x574.jpg\" alt=\"\" width=\"640\" height=\"360\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/12/Pratik-with-brain-image-1020x574.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/Pratik-with-brain-image-160x90.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/Pratik-with-brain-image-800x450.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/Pratik-with-brain-image-768x432.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/Pratik-with-brain-image.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/Pratik-with-brain-image-1180x664.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/Pratik-with-brain-image-960x540.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/Pratik-with-brain-image-240x135.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/Pratik-with-brain-image-375x211.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/Pratik-with-brain-image-520x293.jpg 520w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003cfigcaption class=\"wp-caption-text\">Pratik Mukherjee, neuroradiologist at UCSF, looking at a brain image. \u003ccite>(Julia Vassey/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>Getting a Closer Look\u003c/strong>\u003c/p>\n\u003cp>The problem with diagnosing concussions starts in the emergency room. The majority of patients with mild, non-life-threatening traumatic brain injuries get released from ER without any follow-up evaluation.\u003c/p>\n\u003cp>“And that is a mistake,” says Mukherjee, who is also one of TRACK TBI’s principal investigators.\u003c/p>\n\u003cp>CT scans in the ERs across the country can miss subtle brain damage, as occurred in Baxter’s first CT scan. These diagnostics can only detect structural changes or internal bleeding in the brain, like the hemorrhage Baxter eventually developed.\u003c/p>\n\u003cp>Even following severe traumatic brain injuries, as Gal suffered, neither CT nor standard MRI can detect microstructural changes and alterations in brain functioning.\u003c/p>\n\u003cp>But it is these subtle changes that may predict the likelihood of lasting problems, including impaired focus, attention, memory and decision-making.\u003c/p>\n\u003cp>TRACK TBI researchers are looking for biochemical signals that could ensure reliable, speedy diagnoses and good predictions of whether patients will suffer long-term effects.\u003c/p>\n\u003cp>Mapping is another focus of TRACK TBI. Powerful MRI scanners with software that allows precise reconstruction of high resolution MRI images could help scientists create brain maps.\u003c/p>\n\u003cp>The study is using the latest MRI scanners, at least twice as powerful as the ones installed in many of the country’s hospitals and imaging centers, to peer deeper into the brain and search for abnormalities in the fine-grain structure of the brain’s “white matter.” If this is damaged, it can disrupt brain functions like imprinting memories, maintaining focus and making decisions.\u003c/p>\n\u003cp>Patients enrolled in the TRACK TBI study get scanned two weeks after their head injury and then again six months later to reveal the presence of any chronic effects.\u003c/p>\n\u003cp>Researchers are also scanning for the presence of specific types of proteins in the blood that can be detected in brain-injury patients. TRACK TBI is particularly focusing on GFAP (glial fibrillary acidic protein) and Tau protein.\u003c/p>\n\u003cdiv>\u003c/div>\n\u003cp>“This is similar to how they diagnose heart attacks,” says Mukherjee. “If you are having a heart attack, the heart will spill particular proteins that can be detected, and provide a good objective test.”\u003c/p>\n\u003cp>In the 1950s and 1960s an electrocardiogram was the only way to measure a patient’s heart for signs of heart disease. But a patient could show a normal-looking EKG even while suffering a heart attack. With time, blood tests measuring proteins have proven to be more reliable. Using a similar approach could transform concussion diagnoses as well.\u003c/p>\n\u003cp>Shetty, who is not involved in the study, believes it has “a tremendous potential to understand relationships between biomarkers, neuroimaging and cognitive data.”\u003c/p>\n\u003cp>\u003ca href=\"https://www2.eecs.berkeley.edu/Faculty/Homepages/chunleiliu.html\" target=\"_blank\" rel=\"noopener\">Chunlei Liu\u003c/a>, an associate professor of the Helen Wills Neuroscience Institute at UC Berkeley, who also has no relationship to the study, is glad to see TRACK TBI’s multipronged approach.\u003c/p>\n\u003cp>Because brain trauma involves systemic changes in different parts of the brain, Liu says, “A single biomarker won't make a definitive answer.”\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>This approach is part of a trend. The \u003ca href=\"http://www.careconsortium.net/\" target=\"_blank\" rel=\"noopener\">CARE Consortium\u003c/a>, funded by the NCAA and the U.S. Department of Defense, is similar in many ways to TRACK TBI, but focuses on student-athletes and military service members. At the University of Pittsburgh. the \u003ca href=\"http://www.adapttrial.org/\" target=\"_blank\" rel=\"noopener\">ADAPT Trial\u003c/a> is focusing on children with severe traumatic brain injury, hoping to determine the best care procedures.\u003c/p>\n\u003cp>If prognostic biomarkers can be identified by TRACK and other studies, it could help scientists resurrect once-promising treatments that were abandoned after failed clinical trials. One of the most disappointing failures was the PROTECT trial, which in 2015 experimented with treating acute traumatic brain injury with progesterone, a steroid found to sometimes have powerful neuroprotective properties.The study showed promising results on lab animals, but it collapsed after moving to phase III human trials.\u003c/p>\n\u003cp>“Currently with the clinical trials, it has been one-size-fits-all for every patient,” says Mukherjee. He says researchers often enroll participants without knowing if they are prone to developing complications. “But this is a mistake, because patients are affected in many different ways, and types of pathologies are different.”\u003c/p>\n\u003cp>If biomarkers can be discovered, researchers can determine exactly which patients will or will not benefit from treatment.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>And patients recovering from brain injuries may be able to face their future with a clearer idea of the path ahead.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Retail Health Care Less Effective, Lacks Personal Connection Patients Need (Commentary)",
"title": "Retail Health Care Less Effective, Lacks Personal Connection Patients Need (Commentary)",
"headTitle": "KQED Future of You | KQED Science",
"content": "\u003cp>Retail thinking is spreading quickly in health care. It promises greater convenience and speed for delivering basic health care services — but it isn’t what patients really want.\u003c/p>\n\u003cp>Retail thinking views patients as consumers: faceless targets for buying services and products that aren’t always health-related. It’s the thinking behind technology-assisted health care services, like ZocDoc, Amwell, and One Medical, which quickly triage symptoms or serve up medical advice. It’s the thinking that makes it possible for me to walk in, no appointment needed, to my local CVS or Target to have a cough or sore throat examined.\u003c/p>\n\u003cp>At the same time, it gives web-based apps \u003ca href=\"https://www.reuters.com/article/us-health-apps-privacy/health-apps-often-lack-privacy-policies-and-share-our-data-idUSKCN0WA2KE\" target=\"_blank\" rel=\"noopener\">opportunities to sell\u003c/a> some of your information to advertisers, who want to sell you other things. It gives brick-and-mortar organizations cross-selling opportunities for everything from allergy medications to Halloween candy as I walk down the store aisle to get my flu shot from the pharmacist or have the nurse practitioner apply guideline-driven diagnosis and treatment. The providers I see during these interactions know nothing about me, offer little tailored advice, and the services they provide will be both limited and standardized in how they are delivered.\u003c/p>\n\u003caside class=\"pullquote alignright\">What patients want most in health care is something human and intimate, maintained through regular one-on-one interactions with experts they knew and trusted who were compassionate, empathetic, friendly, and respectful.\u003c/aside>\n\u003cp>Being viewed through the retail lens also means that I am asked to consume other offerings pitched to me by whoever provides me with health care, be it my insurance company or my employer. They try to get me interested in legal and babysitting services, gym memberships, pedometers, mail-order pharmacies, round-the-clock nurse help lines, life insurance, and more. They do this to help them earn more of my loyalty, generate more revenue for themselves, or reduce their costs.\u003c/p>\n\u003cp>The hospitals and medical offices I visit seek to keep me within their system of care delivery, make me a long-term customer, and refer me only to their providers and services, both of which they control. By using retail tactics like offering one-stop shopping — where I can get primary, specialty, and other types of care all without leaving the same building — and marketing their brand to me with simplified rating systems that show their high quality, they want me to trust that they have my interests at heart and can deliver any type of health care transaction I require.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Retail thinking has its place in health care today because there are some services and products that people need quickly and which do not require a personal touch or someone who understands them as unique individuals. Such services might be low-level acute care (think strep throat), flu shots and immunizations, and some forms of simple chronic disease management, such as blood sugar checks or foot and eye exams for people with diabetes, especially if they are guideline driven. There’s no question that retail thinking can also create purchasing opportunities for things patients find useful, if not always essential, and perhaps do so in ways that are cost-effective or convenient for us.\u003c/p>\n\u003cp>[contextly_sidebar id=\"qGlMknrKeKf4bI1E46uTCBwN0fHZychq\"]But retail health care is impersonal, lacks relational warmth, and isn’t what patients really want.\u003c/p>\n\u003cp>I interviewed 80 patients and doctors for a \u003ca href=\"https://global.oup.com/academic/product/next-in-line-9780190626341?cc=us&lang=en&\" target=\"_blank\" rel=\"noopener\">new book\u003c/a> on the doctor-patient relationship in the era of efficiency-driven innovation, corporate care, and retail medicine. What I heard from patients is that the impersonal nature of retail thinking is frustrating them and lowering their expectations about the levels of emotional support and customized help they can get from any doctor, or from others in the health care system.\u003c/p>\n\u003cp>No patient with whom I spoke wanted transactional care at the expense of relational care. No one prioritized \u003ca href=\"https://www.statnews.com/2016/10/04/fitbit-wont-improve-health/\">Fitbits\u003c/a>, web-based assessments of symptoms, or seeing a stranger about a sore throat in a big-box store over a long-term personal connection with a doctor. What these individuals wanted most in health care was something human and more intimate, maintained through regular one-on-one interactions with experts they knew and trusted who were compassionate, empathetic, friendly, and respectful.\u003c/p>\n\u003cp>The physicians with whom I spoke wanted the same things.\u003c/p>\n\u003cp>This type of sustained personal experience between two people who know something about each other, and who are motivated to really talk and listen as care partners, is something retail thinking does not do well. It is not concerned with the emotional aspects of care, building interpersonal trust between doctor and patient, or getting to know people as individuals with their own relevant life stories.\u003c/p>\n\u003cp>Yet existing research demonstrates that these are the very features that are good for patients. For example, \u003ca href=\"http://www.hpm.org/Downloads/Bellagio/Articles/Continuity/Cabana_MD_-_2004_-_Does_continuity_of_care_improve_patient_outcomes.pdf\" target=\"_blank\" rel=\"noopener\">care continuity\u003c/a> through a stable doctor-patient relationship improves health care quality and patient satisfaction. \u003ca href=\"http://onlinelibrary.wiley.com/doi/10.1111/1468-0009.00223/full\" target=\"_blank\" rel=\"noopener\">Doctor-patient trust\u003c/a>, established through extended interpersonal contact, helps patients become more engaged in their care; creates a positive patient experience; and increases perceived effectiveness of care. \u003ca href=\"http://www.sciencedirect.com/science/article/pii/S0738399108006319\" target=\"_blank\" rel=\"noopener\">Extended dialogue\u003c/a> between patient and doctor positively affects health outcomes ranging from high blood pressure to mental health problems. \u003ca href=\"http://bjgp.org/content/63/606/e76.full\" target=\"_blank\" rel=\"noopener\">Physician empathy\u003c/a> is linked to more accurate diagnoses, better health outcomes, and an enhanced patient experience.\u003c/p>\n\u003cp>[contextly_sidebar id=\"DXDu9yVu5UXGAwIZHglW19AkCubz5xhW\"]If you don’t believe the literature, just ask the patients I interviewed. Teddy, a healthy man in his 30s, believed that without feeling trust towards a specific doctor — which for him was forged over time through regular face time and conversations with that doctor — little could be uncovered of the more intimate, life story information that he felt was most important for keeping him healthy. He said he had never been completely honest with clinicians he didn’t know.\u003c/p>\n\u003cp>Hallie, a 50-year-old woman with several chronic diseases, talked confidently about better understanding how to manage her many conditions, and how they affected her everyday life — the result of having a doctor who knew something about her personally, who spent time not reading off a care guideline but instead asking her real-time questions about how she felt, and then showing genuine compassion with her daily struggles. Hallie felt better able to self-manage her care, which kept her from using the system unnecessarily.\u003c/p>\n\u003cp>Cliff, a stressed-out dad in his 50s, talked excitedly about finally having the same physician he could see on a consistent basis; a doctor who in their first visit had spent time just listening to him, nothing more; then taking that information and asking him questions about his own life; and finally tailoring therapeutic advice based on the entire dialogue. Janell, a career-minded mom in her 40s, recalled with joy the memory of a past primary care physician who remembered conversations they had during previous visits and who used that knowledge to give Janell tailored guidance about how to manage her life stressors more effectively.\u003c/p>\n\u003cp>Can an industry that wants to use retail tactics also deliver on the relational excellence that patients and research say is important? It’s not easy, given retail thinking’s focus on speed and efficiency. Here are four ways that might meld these two approaches.\u003c/p>\n\u003cp>First, put more thought into where \u003cem>not\u003c/em> to use retail thinking in health care. It may make sense for care delivery that is routine, care that can be standardized in a straightforward way, and in situations where the patient wants convenience above all else. But that actually amounts to a limited menu of services, and even routine care can often reveal deeper problems in patients, requiring the kinds of relational features I’ve described.\u003c/p>\n\u003cp>Second, better measure and monetize the components of relational excellence, making it matter to health care organizations and third-party payers. That means carefully assessing dynamics like interpersonal trust between doctor and patient; analyzing those data to see how they positively affect health outcomes; and then giving this metric the same relative importance in high-quality care delivery compared to other things like prescribing a particular drug for a particular condition.\u003c/p>\n\u003cp>Third, look for innovative ways to \u003cem>strengthen\u003c/em> the doctor-patient relationship, not undermine it. For example, the industry should experiment with using technology as a tool to give doctors more face time and direct contact with their patients. Right now, both doctors and patients perceive technology, primarily the electronic health record, as interfering with their relationship.\u003c/p>\n\u003cp>Fourth, and most important, the patient voice must be heard. This could include adopting greater transparency with respect to assessing patient satisfaction with retail tactics, say through \u003ca href=\"https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2015.1030\" target=\"_blank\" rel=\"noopener\">Yelp-type accountability mechanisms\u003c/a>, and conducting market research that goes beyond simple binary questions of “would you use this” or “would you like greater convenience in accessing your care” and instead delves deeper into discovering what patients really value.\u003c/p>\n\u003cp>In thinking about my discussions with patients, there is one other important thing they want. They want to decide when their health care should work like the drive-through at McDonald’s or buying with one click at Amazon and when it should be more personal than that, involving extended human-to-human interaction, highly trained experts who know their patients, and an abundance of the time, trust, and soft skills required to make us healthier long-term and see health care as the important part of our lives that it really is.\u003c/p>\n\u003cp>\u003cem>Timothy J. Hoff, Ph.D., is professor of management, health care systems, and health policy at the D’Amore-McKim School of Business and the School of Public Affairs and Policy at Northeastern University in Boston; a visiting associate fellow at Green-Templeton College and visiting scholar at Said Business School, both at the University of Oxford; and the author of \u003ca href=\"https://global.oup.com/academic/product/next-in-line-9780190626341?cc=us&lang=en&\" target=\"_blank\" rel=\"noopener\">“Next in Line: Lowered Care Expectations in the Age of Retail- and Value-Based Health”\u003c/a> (Oxford University Press, September 2017).\u003c/em>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>This \u003ca href=\"https://www.statnews.com/2017/12/04/retail-health-care-patients/\">story\u003c/a> was originally published by STAT, an online publication of Boston Globe Media that covers health, medicine, and scientific discovery.\u003c/p>\n\n",
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"nprByline": "Timothy J. Hoff\u003c/br>STAT",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Retail thinking is spreading quickly in health care. It promises greater convenience and speed for delivering basic health care services — but it isn’t what patients really want.\u003c/p>\n\u003cp>Retail thinking views patients as consumers: faceless targets for buying services and products that aren’t always health-related. It’s the thinking behind technology-assisted health care services, like ZocDoc, Amwell, and One Medical, which quickly triage symptoms or serve up medical advice. It’s the thinking that makes it possible for me to walk in, no appointment needed, to my local CVS or Target to have a cough or sore throat examined.\u003c/p>\n\u003cp>At the same time, it gives web-based apps \u003ca href=\"https://www.reuters.com/article/us-health-apps-privacy/health-apps-often-lack-privacy-policies-and-share-our-data-idUSKCN0WA2KE\" target=\"_blank\" rel=\"noopener\">opportunities to sell\u003c/a> some of your information to advertisers, who want to sell you other things. It gives brick-and-mortar organizations cross-selling opportunities for everything from allergy medications to Halloween candy as I walk down the store aisle to get my flu shot from the pharmacist or have the nurse practitioner apply guideline-driven diagnosis and treatment. The providers I see during these interactions know nothing about me, offer little tailored advice, and the services they provide will be both limited and standardized in how they are delivered.\u003c/p>\n\u003caside class=\"pullquote alignright\">What patients want most in health care is something human and intimate, maintained through regular one-on-one interactions with experts they knew and trusted who were compassionate, empathetic, friendly, and respectful.\u003c/aside>\n\u003cp>Being viewed through the retail lens also means that I am asked to consume other offerings pitched to me by whoever provides me with health care, be it my insurance company or my employer. They try to get me interested in legal and babysitting services, gym memberships, pedometers, mail-order pharmacies, round-the-clock nurse help lines, life insurance, and more. They do this to help them earn more of my loyalty, generate more revenue for themselves, or reduce their costs.\u003c/p>\n\u003cp>The hospitals and medical offices I visit seek to keep me within their system of care delivery, make me a long-term customer, and refer me only to their providers and services, both of which they control. By using retail tactics like offering one-stop shopping — where I can get primary, specialty, and other types of care all without leaving the same building — and marketing their brand to me with simplified rating systems that show their high quality, they want me to trust that they have my interests at heart and can deliver any type of health care transaction I require.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Retail thinking has its place in health care today because there are some services and products that people need quickly and which do not require a personal touch or someone who understands them as unique individuals. Such services might be low-level acute care (think strep throat), flu shots and immunizations, and some forms of simple chronic disease management, such as blood sugar checks or foot and eye exams for people with diabetes, especially if they are guideline driven. There’s no question that retail thinking can also create purchasing opportunities for things patients find useful, if not always essential, and perhaps do so in ways that are cost-effective or convenient for us.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>But retail health care is impersonal, lacks relational warmth, and isn’t what patients really want.\u003c/p>\n\u003cp>I interviewed 80 patients and doctors for a \u003ca href=\"https://global.oup.com/academic/product/next-in-line-9780190626341?cc=us&lang=en&\" target=\"_blank\" rel=\"noopener\">new book\u003c/a> on the doctor-patient relationship in the era of efficiency-driven innovation, corporate care, and retail medicine. What I heard from patients is that the impersonal nature of retail thinking is frustrating them and lowering their expectations about the levels of emotional support and customized help they can get from any doctor, or from others in the health care system.\u003c/p>\n\u003cp>No patient with whom I spoke wanted transactional care at the expense of relational care. No one prioritized \u003ca href=\"https://www.statnews.com/2016/10/04/fitbit-wont-improve-health/\">Fitbits\u003c/a>, web-based assessments of symptoms, or seeing a stranger about a sore throat in a big-box store over a long-term personal connection with a doctor. What these individuals wanted most in health care was something human and more intimate, maintained through regular one-on-one interactions with experts they knew and trusted who were compassionate, empathetic, friendly, and respectful.\u003c/p>\n\u003cp>The physicians with whom I spoke wanted the same things.\u003c/p>\n\u003cp>This type of sustained personal experience between two people who know something about each other, and who are motivated to really talk and listen as care partners, is something retail thinking does not do well. It is not concerned with the emotional aspects of care, building interpersonal trust between doctor and patient, or getting to know people as individuals with their own relevant life stories.\u003c/p>\n\u003cp>Yet existing research demonstrates that these are the very features that are good for patients. For example, \u003ca href=\"http://www.hpm.org/Downloads/Bellagio/Articles/Continuity/Cabana_MD_-_2004_-_Does_continuity_of_care_improve_patient_outcomes.pdf\" target=\"_blank\" rel=\"noopener\">care continuity\u003c/a> through a stable doctor-patient relationship improves health care quality and patient satisfaction. \u003ca href=\"http://onlinelibrary.wiley.com/doi/10.1111/1468-0009.00223/full\" target=\"_blank\" rel=\"noopener\">Doctor-patient trust\u003c/a>, established through extended interpersonal contact, helps patients become more engaged in their care; creates a positive patient experience; and increases perceived effectiveness of care. \u003ca href=\"http://www.sciencedirect.com/science/article/pii/S0738399108006319\" target=\"_blank\" rel=\"noopener\">Extended dialogue\u003c/a> between patient and doctor positively affects health outcomes ranging from high blood pressure to mental health problems. \u003ca href=\"http://bjgp.org/content/63/606/e76.full\" target=\"_blank\" rel=\"noopener\">Physician empathy\u003c/a> is linked to more accurate diagnoses, better health outcomes, and an enhanced patient experience.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>If you don’t believe the literature, just ask the patients I interviewed. Teddy, a healthy man in his 30s, believed that without feeling trust towards a specific doctor — which for him was forged over time through regular face time and conversations with that doctor — little could be uncovered of the more intimate, life story information that he felt was most important for keeping him healthy. He said he had never been completely honest with clinicians he didn’t know.\u003c/p>\n\u003cp>Hallie, a 50-year-old woman with several chronic diseases, talked confidently about better understanding how to manage her many conditions, and how they affected her everyday life — the result of having a doctor who knew something about her personally, who spent time not reading off a care guideline but instead asking her real-time questions about how she felt, and then showing genuine compassion with her daily struggles. Hallie felt better able to self-manage her care, which kept her from using the system unnecessarily.\u003c/p>\n\u003cp>Cliff, a stressed-out dad in his 50s, talked excitedly about finally having the same physician he could see on a consistent basis; a doctor who in their first visit had spent time just listening to him, nothing more; then taking that information and asking him questions about his own life; and finally tailoring therapeutic advice based on the entire dialogue. Janell, a career-minded mom in her 40s, recalled with joy the memory of a past primary care physician who remembered conversations they had during previous visits and who used that knowledge to give Janell tailored guidance about how to manage her life stressors more effectively.\u003c/p>\n\u003cp>Can an industry that wants to use retail tactics also deliver on the relational excellence that patients and research say is important? It’s not easy, given retail thinking’s focus on speed and efficiency. Here are four ways that might meld these two approaches.\u003c/p>\n\u003cp>First, put more thought into where \u003cem>not\u003c/em> to use retail thinking in health care. It may make sense for care delivery that is routine, care that can be standardized in a straightforward way, and in situations where the patient wants convenience above all else. But that actually amounts to a limited menu of services, and even routine care can often reveal deeper problems in patients, requiring the kinds of relational features I’ve described.\u003c/p>\n\u003cp>Second, better measure and monetize the components of relational excellence, making it matter to health care organizations and third-party payers. That means carefully assessing dynamics like interpersonal trust between doctor and patient; analyzing those data to see how they positively affect health outcomes; and then giving this metric the same relative importance in high-quality care delivery compared to other things like prescribing a particular drug for a particular condition.\u003c/p>\n\u003cp>Third, look for innovative ways to \u003cem>strengthen\u003c/em> the doctor-patient relationship, not undermine it. For example, the industry should experiment with using technology as a tool to give doctors more face time and direct contact with their patients. Right now, both doctors and patients perceive technology, primarily the electronic health record, as interfering with their relationship.\u003c/p>\n\u003cp>Fourth, and most important, the patient voice must be heard. This could include adopting greater transparency with respect to assessing patient satisfaction with retail tactics, say through \u003ca href=\"https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2015.1030\" target=\"_blank\" rel=\"noopener\">Yelp-type accountability mechanisms\u003c/a>, and conducting market research that goes beyond simple binary questions of “would you use this” or “would you like greater convenience in accessing your care” and instead delves deeper into discovering what patients really value.\u003c/p>\n\u003cp>In thinking about my discussions with patients, there is one other important thing they want. They want to decide when their health care should work like the drive-through at McDonald’s or buying with one click at Amazon and when it should be more personal than that, involving extended human-to-human interaction, highly trained experts who know their patients, and an abundance of the time, trust, and soft skills required to make us healthier long-term and see health care as the important part of our lives that it really is.\u003c/p>\n\u003cp>\u003cem>Timothy J. Hoff, Ph.D., is professor of management, health care systems, and health policy at the D’Amore-McKim School of Business and the School of Public Affairs and Policy at Northeastern University in Boston; a visiting associate fellow at Green-Templeton College and visiting scholar at Said Business School, both at the University of Oxford; and the author of \u003ca href=\"https://global.oup.com/academic/product/next-in-line-9780190626341?cc=us&lang=en&\" target=\"_blank\" rel=\"noopener\">“Next in Line: Lowered Care Expectations in the Age of Retail- and Value-Based Health”\u003c/a> (Oxford University Press, September 2017).\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>This \u003ca href=\"https://www.statnews.com/2017/12/04/retail-health-care-patients/\">story\u003c/a> was originally published by STAT, an online publication of Boston Globe Media that covers health, medicine, and scientific discovery.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Before You Try the Ketogenic Diet, Read This",
"title": "Before You Try the Ketogenic Diet, Read This",
"headTitle": "KQED Future of You | KQED Science",
"content": "\u003cp>\u003cspan style=\"font-weight: 400\">Louison Labeaume believes a ketogenic diet has done him a lot of good. Not only has he lost 25 pounds on the popular low carb/high fat regimen, he even wonders if it helped push his prostate cancer into remission. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">While some \u003c/span>\u003ca href=\"https://www.npr.org/sections/health-shots/2016/03/05/468285545/fighting-cancer-by-putting-tumor-cells-on-a-diet\" target=\"_blank\" rel=\"noopener\">\u003cspan style=\"font-weight: 400\">research\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> has been conducted into the diet’s ability to starve cancer cells, there has been little evidence to date that this could be the case.\u003c/span>\u003c/p>\n\u003caside class=\"pullquote alignright\">The upshot: The ketogenic diet can be effective for short periods of time for patients who need to make a drastic change and have not had success using other strategies. But as a long-term lifestyle, there are health risks involved in adopting a high-fat food regime.\u003c/aside>\n\u003cp>“I’m not going to say that the diet did it. I don’t know what did it,” says Labeaume, a database administrator for Alameda County. “But it was very stunning.”\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Labeaume is not alone in his avid fandom of the ketogenic diet, which is designed to coax the body into burning fat instead of glucose. The diet is everywhere these days, endorsed by \u003c/span>\u003ca href=\"https://www.bodybuilding.com/content/ketogenic-dieting-101-how-to-use-fat-as-fuel.html\" target=\"_blank\" rel=\"noopener\">\u003cspan style=\"font-weight: 400\">bodybuilders\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">, \u003c/span>\u003ca href=\"http://www.businessinsider.com/what-is-keto-diet-ketosis-2017-3\" target=\"_blank\" rel=\"noopener\">\u003cspan style=\"font-weight: 400\">biohackers\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> and patients suffering from an assortment of ailments, including \u003c/span>\u003ca href=\"http://www.neurology.org/content/early/2017/02/08/WNL.0000000000003690.short?rss=1\" target=\"_blank\" rel=\"noopener\">\u003cspan style=\"font-weight: 400\">epilepsy\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> and \u003c/span>\u003ca href=\"http://www.nutritionjrnl.com/article/S0899-9007(12)00073-1/fulltext\" target=\"_blank\" rel=\"noopener\">\u003cspan style=\"font-weight: 400\">diabetes\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">.\u003c/span> \u003cspan style=\"font-weight: 400\">A \u003c/span>\u003ca href=\"https://www.google.com/search?q=ketogenic+diet&oq=ketogenic+diet\" target=\"_blank\" rel=\"noopener\">\u003cspan style=\"font-weight: 400\">search on the term\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> returns well over 1 million results. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Ketogenic diets run counter to the traditional dietary recommendation of limited fat intake. Can they really help you lose weight? And are they safe?\u003c/span>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">I asked four experts to weigh in: \u003c/span>\u003c/p>\n\u003cul>\n\u003cli>Dr. Larry Cheskin, director of the Johns Hopkins Weight Management Center in its school of public health\u003c/li>\n\u003cli>Amy Reisenberg, a registered dietitian in the Stanford Health Care network\u003c/li>\n\u003cli>Norae Ferrara, a registered dietitian at the San Francisco Nutrition Clinic, which provides personalized nutrition therapy\u003c/li>\n\u003cli>Dr. Marcelo Campos, a lecturer at Harvard Medical School and clinical assistant professor at Tufts University. Campos is also \u003cspan style=\"font-weight: 400\">a doctor of internal medicine who has seen dozens of patients on the diet and has written about it.\u003c/span>\u003c/li>\n\u003c/ul>\n\u003cp>\u003cb>What Exactly Is the Ketogenic Diet?\u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">When the body is starved of carbohydrates, stored fat is broken down into fatty acids and metabolized into molecules called ketone bodies, which are then used by the body for fuel. This process is called ketosis. Weight loss occurs from the depletion of fat stores.\u003c/span>\u003c/p>\n\u003caside class=\"pullquote alignright\">A dietitian who works with cardiology patients says many come to her precisely because of dangerously high cholesterol levels after years on a ketogenic diet.\u003c/aside>\n\u003cp>A diet that induces ketosis calls for approximately 60 to 70 percent of daily calories from fat, and the remaining 30 to 40 percent from carbohydrates and protein -- different diets call for different ratios. \u003cspan style=\"font-weight: 400\"> A standard daily serving of carbohydrates on the diet ranges from 20 to 30 grams, which equates roughly to one banana or two slices of bread.\u003c/span> \u003cspan style=\"font-weight: 400\">For comparison, the World Health Organization's \u003ca href=\"http://www.who.int/mediacentre/factsheets/fs394/en/\" target=\"_blank\" rel=\"noopener\">dietary recommendations\u003c/a> allow for as much as 50 grams of different types of sugar \u003cem>alone, \u003c/em>\u003c/span>\u003cspan style=\"font-weight: 400\">and state that fat make up no more than 30 percent of a person’s daily calories. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Ferrara, the San Francisco dietitian,\u003c/span> \u003cspan style=\"font-weight: 400\">emphasizes that the ketogenic diet is not high-protein, like the famous Atkins diet; she says protein is also processed in the body as glucose, and too much of it can kick the body out of ketosis. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">However, Cheskin, of Johns Hopkins, while concerned over the high fat content of many ketogenic diets, \u003c/span>\u003cspan style=\"font-weight: 400\">says low carbohydrate intake is the only important consideration for inducing ketosis. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Labeaume, the guy who has lost 25 pounds on the diet, says, “I started by eating tons of bacon like everybody, but eventually you take a step back from that.” Now he eats mostly green vegetables and gets his fats from butter, coconut oil, cheese and nuts, plus a little bit of meat.\u003c/span>\u003c/p>\n\u003cp>\u003cb>Who Will Benefit?\u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The dietitians and doctors I talked to all think the diet can be beneficial and effective for those patients who have a lot of weight to lose or suffer from Type 2 diabetes and need to control their blood sugar.\u003c/span>\u003c/p>\n\u003cfigure id=\"attachment_437478\" class=\"wp-caption alignright\" style=\"max-width: 640px\">\u003ca href=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/12/ketodieter2.jpg\">\u003cimg class=\"size-large wp-image-437478\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/12/ketodieter2-1020x1275.jpg\" alt=\"\" width=\"640\" height=\"800\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/12/ketodieter2-1020x1275.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/ketodieter2-160x200.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/ketodieter2-800x1000.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/ketodieter2-768x960.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/ketodieter2-960x1200.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/ketodieter2-240x300.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/ketodieter2-375x469.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/ketodieter2-520x650.jpg 520w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/ketodieter2.jpg 1176w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Keto dieter Louison Labeaume is loving it -- he says he's lost 25 pounds. \u003ccite>(Dana Smith/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“I think it's a good diet to jumpstart weight loss, more than some of the other popular diets I've seen,” Reisenberg, the dietitian for the Stanford Health Care network, says.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Studies in mice suggest that ketosis can \u003c/span>\u003ca href=\"http://www.cell.com/cell-metabolism/fulltext/S1550-4131(17)30490-4?_returnURL=http%3A%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS1550413117304904%3Fshowall%3Dtrue\" target=\"_blank\" rel=\"noopener\">\u003cspan style=\"font-weight: 400\">increase lifespan\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">, \u003c/span>\u003ca href=\"http://www.cell.com/cell-metabolism/fulltext/S1550-4131(17)30489-8?_returnURL=http%3A%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS1550413117304898%3Fshowall%3Dtrue\" target=\"_blank\" rel=\"noopener\">\u003cspan style=\"font-weight: 400\">enhance cognition \u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">and \u003c/span>\u003ca href=\"http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0115147\" target=\"_blank\" rel=\"noopener\">\u003cspan style=\"font-weight: 400\">prevent tumor growth\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">, and followers of the diet anecdotally report mental clarity, alertness and sustained energy,\u003c/span>\u003c/p>\n\u003cp>But \u003ca href=\"http://www.nutritionjrnl.com/article/S0899-9007(14)00044-6/fulltext\" target=\"_blank\" rel=\"noopener\">long-term research\u003c/a> on the diet in humans is scarce, and \u003cspan style=\"font-weight: 400\">Reisenberg and Cheskin think it's primarily the lost weight and not ketosis itself that drives any health improvements.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“It is always true that when you go on a strict diet, your health numbers almost immediately start looking better, and it doesn't matter if it's a ketogenic diet or just cutting calories,” he says.\u003c/span>\u003c/p>\n\u003cp>\u003cb>What Are the risks?\u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">For the most part, the experts said the diet is safe for healthy people. However, all four talked about a risk of vitamin and mineral\u003c/span> \u003cspan style=\"font-weight: 400\">deficiencies. Constipation is also a common side effect.\u003c/span>\u003c/p>\n\u003cp>“The primary advantage of a ketogenic diet is that it basically enables you to comply with a low-calorie diet better,” says Cheskin. “The benefit is primarily from the perspective of what it feels like to be on a diet, that you are generally less hungry for a different calorie level.”\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Additionally, a diet with a lot of bacon, cheese, cream and butter can -- surprise, surprise -- take a toll on your cholesterol. Followers of the diet often initially see a spike in LDL; that’s the “bad” kind of cholesterol,\u003c/span> \u003cspan style=\"font-weight: 400\">linked to cardiovascular disease.\u003c/span>\u003c/p>\n\u003caside class=\"pullquote alignright\">'There’s a steady accumulation of evidence that, at least for compliance and initial weight loss, the low-carbohydrate dieting approach is better.'\u003ccite>Dr. Larry Cheskin, Johns Hopkins Weight Management Center\u003c/cite>\u003c/aside>\n\u003cp>Campos, the internist, says he’s seen some patients’ cholesterol initially go up, then drop to pre-diet levels after 6 months, potentially \u003cspan style=\"font-weight: 400\">due to lower insulin levels, he speculates\u003c/span>\u003cb>.\u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">However, Reisenberg, who specializes in working with cardiology patients, says that many of the people she sees come to her precisely because they are experiencing dangerously high cholesterol levels after years on a ketogenic diet.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Cheskin agrees. “The long-term health consequences of a high fat\u003c/span> \u003cspan style=\"font-weight: 400\">—\u003c/span> \u003cspan style=\"font-weight: 400\">especially a high saturated fat—\u003c/span> \u003cspan style=\"font-weight: 400\">diet is still generally believed to be not good for you … which is why I encourage people to make it moderate-to-low fat as well as low-carbohydrate.\"\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Campos and Ferrara say the bigger risk may come from frequently starting and stopping the diet. “People who go into those yo‐yo diets, they tend to have increased \u003c/span>\u003ca href=\"https://www.npr.org/sections/health-shots/2017/05/01/526048767/-yo-yo-dieting-poses-serious-risks-for-heart-patients\" target=\"_blank\" rel=\"noopener\">\u003cspan style=\"font-weight: 400\">cardiovascular risk\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">,” Campos says.\u003c/span>\u003c/p>\n\u003cp>One \u003ca href=\"https://www.jstage.jst.go.jp/article/tjem/243/1/243_35/_article\" target=\"_blank\" rel=\"noopener\">\u003cspan style=\"font-weight: 400\">study\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> found that\u003c/span>\u003cspan style=\"font-weight: 400\"> people who went in\u003c/span>\u003cspan style=\"font-weight: 400\">to \u003c/span>\u003cspan style=\"font-weight: 400\">ketosis \u003c/span>\u003cspan style=\"font-weight: 400\">for just one day \u003c/span>\u003cspan style=\"font-weight: 400\">had\u003c/span>\u003cspan style=\"font-weight: 400\"> a higher blood sugar\u003c/span>\u003cspan style=\"font-weight: 400\"> level than when they began the diet.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">There’s other \u003c/span>\u003ca href=\"http://www.cnn.com/2016/11/15/health/yoyo-dieting-harms-hearts/index.html\" target=\"_blank\" rel=\"noopener\">\u003cspan style=\"font-weight: 400\">research\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> that \u003c/span>\u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5139007/\">\u003cspan style=\"font-weight: 400\">indicates\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> flitting up and down the weight scale can be \u003c/span>\u003ca href=\"https://www.npr.org/sections/health-shots/2017/05/01/526048767/-yo-yo-dieting-poses-serious-risks-for-heart-patients\" target=\"_blank\" rel=\"noopener\">\u003cspan style=\"font-weight: 400\">bad\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> for your health. Cheskin, however, thinks it's even worse to simply remain overweight. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“To stay at a steady heavy weight is more dangerous,” he said, than frequently dropping and adding back pounds.\u003c/span>\u003c/p>\n\u003cp>\u003cb>So Would They Recommend it?\u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Three out of four of our experts say the ketogenic diet is so restrictive, they would not recommend it for healthy patients who just want to lose a little weight.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“I’m hoping it’s another fad diet,” says Reisenberg. Instead, she advises her patients to follow the \u003c/span>\u003ca href=\"https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/mediterranean-diet/art-20047801\" target=\"_blank\" rel=\"noopener\">\u003cspan style=\"font-weight: 400\">Mediterranean diet\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">. “There is so much research out there showing that following a mostly plant-based diet that's got a reasonable amount of carbohydrates [and] a little bit of lean protein, whether it's animal-based or plant-based, and then lots … of nonstarchy vegetables reduces all risk factors for all causes of mortality.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Campos agrees but recommends the ketogenic diet for short periods of time for patients who need to make a drastic change and have not been able to meet their goals using other strategies.\u003c/span>\u003c/p>\n\u003cp>Only Cheskin endorsed the ketogenic diet as relatively effective for the average person who wants to lose weight.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“There's a steady accumulation of evidence that, at least for compliance and initial weight loss, the low-carbohydrate dieting approach is better,” he says. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">He added, however, that, \"Long-term, no diet works very well. It's more are you going to make long-term changes that you're going to be able to stick with for the rest of your life.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Nevertheless, research continues into the fats versus carbs debate: A recent large-scale \u003c/span>\u003ca href=\"http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32252-3/fulltext\" target=\"_blank\" rel=\"noopener\">\u003cspan style=\"font-weight: 400\">study\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> that tracked 135,000 people in 18 countries over 7 years found that a diet high in carbohydrates was associated with increased risk of mortality, while a high-fat diet was linked to a lower risk. “\u003c/span>\u003cspan style=\"font-weight: 400\">Global dietary guidelines should be reconsidered in light of these findings,” the authors said.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Still, as you probably know by now, every expert will tell you reducing food intake is just one- half of the weight-loss equation. The other half? \u003c/span>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Quit reading about diets on the internet and get yourself some exercise.\u003c/span>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cspan style=\"font-weight: 400\">Louison Labeaume believes a ketogenic diet has done him a lot of good. Not only has he lost 25 pounds on the popular low carb/high fat regimen, he even wonders if it helped push his prostate cancer into remission. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">While some \u003c/span>\u003ca href=\"https://www.npr.org/sections/health-shots/2016/03/05/468285545/fighting-cancer-by-putting-tumor-cells-on-a-diet\" target=\"_blank\" rel=\"noopener\">\u003cspan style=\"font-weight: 400\">research\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> has been conducted into the diet’s ability to starve cancer cells, there has been little evidence to date that this could be the case.\u003c/span>\u003c/p>\n\u003caside class=\"pullquote alignright\">The upshot: The ketogenic diet can be effective for short periods of time for patients who need to make a drastic change and have not had success using other strategies. But as a long-term lifestyle, there are health risks involved in adopting a high-fat food regime.\u003c/aside>\n\u003cp>“I’m not going to say that the diet did it. I don’t know what did it,” says Labeaume, a database administrator for Alameda County. “But it was very stunning.”\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Labeaume is not alone in his avid fandom of the ketogenic diet, which is designed to coax the body into burning fat instead of glucose. The diet is everywhere these days, endorsed by \u003c/span>\u003ca href=\"https://www.bodybuilding.com/content/ketogenic-dieting-101-how-to-use-fat-as-fuel.html\" target=\"_blank\" rel=\"noopener\">\u003cspan style=\"font-weight: 400\">bodybuilders\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">, \u003c/span>\u003ca href=\"http://www.businessinsider.com/what-is-keto-diet-ketosis-2017-3\" target=\"_blank\" rel=\"noopener\">\u003cspan style=\"font-weight: 400\">biohackers\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> and patients suffering from an assortment of ailments, including \u003c/span>\u003ca href=\"http://www.neurology.org/content/early/2017/02/08/WNL.0000000000003690.short?rss=1\" target=\"_blank\" rel=\"noopener\">\u003cspan style=\"font-weight: 400\">epilepsy\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> and \u003c/span>\u003ca href=\"http://www.nutritionjrnl.com/article/S0899-9007(12)00073-1/fulltext\" target=\"_blank\" rel=\"noopener\">\u003cspan style=\"font-weight: 400\">diabetes\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">.\u003c/span> \u003cspan style=\"font-weight: 400\">A \u003c/span>\u003ca href=\"https://www.google.com/search?q=ketogenic+diet&oq=ketogenic+diet\" target=\"_blank\" rel=\"noopener\">\u003cspan style=\"font-weight: 400\">search on the term\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> returns well over 1 million results. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Ketogenic diets run counter to the traditional dietary recommendation of limited fat intake. Can they really help you lose weight? And are they safe?\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\">I asked four experts to weigh in: \u003c/span>\u003c/p>\n\u003cul>\n\u003cli>Dr. Larry Cheskin, director of the Johns Hopkins Weight Management Center in its school of public health\u003c/li>\n\u003cli>Amy Reisenberg, a registered dietitian in the Stanford Health Care network\u003c/li>\n\u003cli>Norae Ferrara, a registered dietitian at the San Francisco Nutrition Clinic, which provides personalized nutrition therapy\u003c/li>\n\u003cli>Dr. Marcelo Campos, a lecturer at Harvard Medical School and clinical assistant professor at Tufts University. Campos is also \u003cspan style=\"font-weight: 400\">a doctor of internal medicine who has seen dozens of patients on the diet and has written about it.\u003c/span>\u003c/li>\n\u003c/ul>\n\u003cp>\u003cb>What Exactly Is the Ketogenic Diet?\u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">When the body is starved of carbohydrates, stored fat is broken down into fatty acids and metabolized into molecules called ketone bodies, which are then used by the body for fuel. This process is called ketosis. Weight loss occurs from the depletion of fat stores.\u003c/span>\u003c/p>\n\u003caside class=\"pullquote alignright\">A dietitian who works with cardiology patients says many come to her precisely because of dangerously high cholesterol levels after years on a ketogenic diet.\u003c/aside>\n\u003cp>A diet that induces ketosis calls for approximately 60 to 70 percent of daily calories from fat, and the remaining 30 to 40 percent from carbohydrates and protein -- different diets call for different ratios. \u003cspan style=\"font-weight: 400\"> A standard daily serving of carbohydrates on the diet ranges from 20 to 30 grams, which equates roughly to one banana or two slices of bread.\u003c/span> \u003cspan style=\"font-weight: 400\">For comparison, the World Health Organization's \u003ca href=\"http://www.who.int/mediacentre/factsheets/fs394/en/\" target=\"_blank\" rel=\"noopener\">dietary recommendations\u003c/a> allow for as much as 50 grams of different types of sugar \u003cem>alone, \u003c/em>\u003c/span>\u003cspan style=\"font-weight: 400\">and state that fat make up no more than 30 percent of a person’s daily calories. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Ferrara, the San Francisco dietitian,\u003c/span> \u003cspan style=\"font-weight: 400\">emphasizes that the ketogenic diet is not high-protein, like the famous Atkins diet; she says protein is also processed in the body as glucose, and too much of it can kick the body out of ketosis. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">However, Cheskin, of Johns Hopkins, while concerned over the high fat content of many ketogenic diets, \u003c/span>\u003cspan style=\"font-weight: 400\">says low carbohydrate intake is the only important consideration for inducing ketosis. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Labeaume, the guy who has lost 25 pounds on the diet, says, “I started by eating tons of bacon like everybody, but eventually you take a step back from that.” Now he eats mostly green vegetables and gets his fats from butter, coconut oil, cheese and nuts, plus a little bit of meat.\u003c/span>\u003c/p>\n\u003cp>\u003cb>Who Will Benefit?\u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The dietitians and doctors I talked to all think the diet can be beneficial and effective for those patients who have a lot of weight to lose or suffer from Type 2 diabetes and need to control their blood sugar.\u003c/span>\u003c/p>\n\u003cfigure id=\"attachment_437478\" class=\"wp-caption alignright\" style=\"max-width: 640px\">\u003ca href=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/12/ketodieter2.jpg\">\u003cimg class=\"size-large wp-image-437478\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/12/ketodieter2-1020x1275.jpg\" alt=\"\" width=\"640\" height=\"800\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/12/ketodieter2-1020x1275.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/ketodieter2-160x200.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/ketodieter2-800x1000.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/ketodieter2-768x960.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/ketodieter2-960x1200.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/ketodieter2-240x300.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/ketodieter2-375x469.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/ketodieter2-520x650.jpg 520w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/ketodieter2.jpg 1176w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Keto dieter Louison Labeaume is loving it -- he says he's lost 25 pounds. \u003ccite>(Dana Smith/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“I think it's a good diet to jumpstart weight loss, more than some of the other popular diets I've seen,” Reisenberg, the dietitian for the Stanford Health Care network, says.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Studies in mice suggest that ketosis can \u003c/span>\u003ca href=\"http://www.cell.com/cell-metabolism/fulltext/S1550-4131(17)30490-4?_returnURL=http%3A%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS1550413117304904%3Fshowall%3Dtrue\" target=\"_blank\" rel=\"noopener\">\u003cspan style=\"font-weight: 400\">increase lifespan\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">, \u003c/span>\u003ca href=\"http://www.cell.com/cell-metabolism/fulltext/S1550-4131(17)30489-8?_returnURL=http%3A%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS1550413117304898%3Fshowall%3Dtrue\" target=\"_blank\" rel=\"noopener\">\u003cspan style=\"font-weight: 400\">enhance cognition \u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">and \u003c/span>\u003ca href=\"http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0115147\" target=\"_blank\" rel=\"noopener\">\u003cspan style=\"font-weight: 400\">prevent tumor growth\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">, and followers of the diet anecdotally report mental clarity, alertness and sustained energy,\u003c/span>\u003c/p>\n\u003cp>But \u003ca href=\"http://www.nutritionjrnl.com/article/S0899-9007(14)00044-6/fulltext\" target=\"_blank\" rel=\"noopener\">long-term research\u003c/a> on the diet in humans is scarce, and \u003cspan style=\"font-weight: 400\">Reisenberg and Cheskin think it's primarily the lost weight and not ketosis itself that drives any health improvements.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“It is always true that when you go on a strict diet, your health numbers almost immediately start looking better, and it doesn't matter if it's a ketogenic diet or just cutting calories,” he says.\u003c/span>\u003c/p>\n\u003cp>\u003cb>What Are the risks?\u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">For the most part, the experts said the diet is safe for healthy people. However, all four talked about a risk of vitamin and mineral\u003c/span> \u003cspan style=\"font-weight: 400\">deficiencies. Constipation is also a common side effect.\u003c/span>\u003c/p>\n\u003cp>“The primary advantage of a ketogenic diet is that it basically enables you to comply with a low-calorie diet better,” says Cheskin. “The benefit is primarily from the perspective of what it feels like to be on a diet, that you are generally less hungry for a different calorie level.”\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Additionally, a diet with a lot of bacon, cheese, cream and butter can -- surprise, surprise -- take a toll on your cholesterol. Followers of the diet often initially see a spike in LDL; that’s the “bad” kind of cholesterol,\u003c/span> \u003cspan style=\"font-weight: 400\">linked to cardiovascular disease.\u003c/span>\u003c/p>\n\u003caside class=\"pullquote alignright\">'There’s a steady accumulation of evidence that, at least for compliance and initial weight loss, the low-carbohydrate dieting approach is better.'\u003ccite>Dr. Larry Cheskin, Johns Hopkins Weight Management Center\u003c/cite>\u003c/aside>\n\u003cp>Campos, the internist, says he’s seen some patients’ cholesterol initially go up, then drop to pre-diet levels after 6 months, potentially \u003cspan style=\"font-weight: 400\">due to lower insulin levels, he speculates\u003c/span>\u003cb>.\u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">However, Reisenberg, who specializes in working with cardiology patients, says that many of the people she sees come to her precisely because they are experiencing dangerously high cholesterol levels after years on a ketogenic diet.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Cheskin agrees. “The long-term health consequences of a high fat\u003c/span> \u003cspan style=\"font-weight: 400\">—\u003c/span> \u003cspan style=\"font-weight: 400\">especially a high saturated fat—\u003c/span> \u003cspan style=\"font-weight: 400\">diet is still generally believed to be not good for you … which is why I encourage people to make it moderate-to-low fat as well as low-carbohydrate.\"\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Campos and Ferrara say the bigger risk may come from frequently starting and stopping the diet. “People who go into those yo‐yo diets, they tend to have increased \u003c/span>\u003ca href=\"https://www.npr.org/sections/health-shots/2017/05/01/526048767/-yo-yo-dieting-poses-serious-risks-for-heart-patients\" target=\"_blank\" rel=\"noopener\">\u003cspan style=\"font-weight: 400\">cardiovascular risk\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">,” Campos says.\u003c/span>\u003c/p>\n\u003cp>One \u003ca href=\"https://www.jstage.jst.go.jp/article/tjem/243/1/243_35/_article\" target=\"_blank\" rel=\"noopener\">\u003cspan style=\"font-weight: 400\">study\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> found that\u003c/span>\u003cspan style=\"font-weight: 400\"> people who went in\u003c/span>\u003cspan style=\"font-weight: 400\">to \u003c/span>\u003cspan style=\"font-weight: 400\">ketosis \u003c/span>\u003cspan style=\"font-weight: 400\">for just one day \u003c/span>\u003cspan style=\"font-weight: 400\">had\u003c/span>\u003cspan style=\"font-weight: 400\"> a higher blood sugar\u003c/span>\u003cspan style=\"font-weight: 400\"> level than when they began the diet.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">There’s other \u003c/span>\u003ca href=\"http://www.cnn.com/2016/11/15/health/yoyo-dieting-harms-hearts/index.html\" target=\"_blank\" rel=\"noopener\">\u003cspan style=\"font-weight: 400\">research\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> that \u003c/span>\u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5139007/\">\u003cspan style=\"font-weight: 400\">indicates\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> flitting up and down the weight scale can be \u003c/span>\u003ca href=\"https://www.npr.org/sections/health-shots/2017/05/01/526048767/-yo-yo-dieting-poses-serious-risks-for-heart-patients\" target=\"_blank\" rel=\"noopener\">\u003cspan style=\"font-weight: 400\">bad\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> for your health. Cheskin, however, thinks it's even worse to simply remain overweight. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“To stay at a steady heavy weight is more dangerous,” he said, than frequently dropping and adding back pounds.\u003c/span>\u003c/p>\n\u003cp>\u003cb>So Would They Recommend it?\u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Three out of four of our experts say the ketogenic diet is so restrictive, they would not recommend it for healthy patients who just want to lose a little weight.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“I’m hoping it’s another fad diet,” says Reisenberg. Instead, she advises her patients to follow the \u003c/span>\u003ca href=\"https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/mediterranean-diet/art-20047801\" target=\"_blank\" rel=\"noopener\">\u003cspan style=\"font-weight: 400\">Mediterranean diet\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">. “There is so much research out there showing that following a mostly plant-based diet that's got a reasonable amount of carbohydrates [and] a little bit of lean protein, whether it's animal-based or plant-based, and then lots … of nonstarchy vegetables reduces all risk factors for all causes of mortality.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Campos agrees but recommends the ketogenic diet for short periods of time for patients who need to make a drastic change and have not been able to meet their goals using other strategies.\u003c/span>\u003c/p>\n\u003cp>Only Cheskin endorsed the ketogenic diet as relatively effective for the average person who wants to lose weight.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“There's a steady accumulation of evidence that, at least for compliance and initial weight loss, the low-carbohydrate dieting approach is better,” he says. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">He added, however, that, \"Long-term, no diet works very well. It's more are you going to make long-term changes that you're going to be able to stick with for the rest of your life.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Nevertheless, research continues into the fats versus carbs debate: A recent large-scale \u003c/span>\u003ca href=\"http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32252-3/fulltext\" target=\"_blank\" rel=\"noopener\">\u003cspan style=\"font-weight: 400\">study\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> that tracked 135,000 people in 18 countries over 7 years found that a diet high in carbohydrates was associated with increased risk of mortality, while a high-fat diet was linked to a lower risk. “\u003c/span>\u003cspan style=\"font-weight: 400\">Global dietary guidelines should be reconsidered in light of these findings,” the authors said.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Still, as you probably know by now, every expert will tell you reducing food intake is just one- half of the weight-loss equation. The other half? \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\">Quit reading about diets on the internet and get yourself some exercise.\u003c/span>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "San Francisco Company Breaks a Few Eggs in Making Sustainable Food",
"title": "San Francisco Company Breaks a Few Eggs in Making Sustainable Food",
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"content": "\u003cp>Leave it to a San Francisco restaurant to serve up egg dishes with eggs that aren't, well, eggs.\u003c/p>\n\u003caside class=\"pullquote alignright\">Hampton Creek tries to recover from a spate of bad news with its new artificial egg product.\u003c/aside>\n\u003cp>At the cozy Flore cafe in the Castro district, the thick, yellow liquid chef Ben Roche pours into a sizzling pan looks just like eggs. But nope -- it’s actually a mixture of mung beans, canola oil and salt.\u003c/p>\n\u003cp>“We have a little bit of spinach, some mushrooms, and we are going to finish it with some goat cheese,\" Roche says, divulging his not-so-secret recipe.\u003c/p>\n\u003cp>Fluffy yellow curds form rapidly. I'm more than game. Roche scoops a savory-looking scramble onto my plate. A couple of bites later:\u003c/p>\n\u003cp>“I can honestly say I would not know the difference,\" I proclaim. \"It tastes like scrambled eggs.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Flore's $14 concoction makes the eatery the first in the Bay Area to put the imitation eggs, which are called Just Scramble, on the menu. The egg substitute is made by San Francisco food company Hampton Creek, which has been itself scrambling, trying to recover from a series of missteps and adverse events. In September the company\u003ca href=\"https://techcrunch.com/2017/09/14/hampton-creek-rises-again-with-new-directors-and-patents-for-a-new-direction/\" target=\"_blank\" rel=\"noopener\"> replenished\u003c/a> its board of directors, several months after a mass exodus.\u003c/p>\n\u003cp>The company’s CEO, Josh Tetrick, says it tried a multitude of plants before getting Just Scramble right.\u003c/p>\n\u003cp>“Kidney beans, black beans, and navy beans, sorghum and yellow peas,\" he said.\u003c/p>\n\u003cp>Hampton Creek's \u003ca href=\"https://www.eatjust.com/en-us/stories/mission\" target=\"_blank\" rel=\"noopener\">mission statement\u003c/a> says the company is trying to change a \"mindset\" that \"does not believe it’s possible to have healthier, sustainable food that is also affordable and delicious.\" To that end, the company also offers Just Mayo, Just Cookies and Just Dressing. Hampton Creek \u003ca href=\"https://www.dropbox.com/s/r0lsd4hw4xzltg8/HC_Sustainability_Indicator_Methods_FINAL_11-2017.pdf?dl=0\" target=\"_blank\" rel=\"noopener\">says\u003c/a> making mung beans into artificial eggs requires a lot less water and has a lighter carbon footprint than producing the real thing.\u003c/p>\n\u003cp>\u003cstrong>Breaking a Few Eggs\u003c/strong>\u003c/p>\n\u003cp>To make an omelette, you have to break a few eggs, and the company has certainly done that in recent years. In 2016, Bloomberg \u003ca href=\"https://www.bloomberg.com/news/articles/2016-08-04/food-startup-ran-undercover-project-to-buy-up-its-own-products\" target=\"_blank\" rel=\"noopener\">reported\u003c/a> that Hampton Creek bought back hundreds of jars of Just Mayo from supermarkets across the U.S. The purpose of the program was to \"make sales look better to potential investors,\" according to former employees who spoke with Bloomberg.\u003c/p>\n\u003cp>In addition, \"contractors were told to call store managers pretending they were customers and ask about Just Mayo,\" Bloomberg said. The company claimed this was a quality control effort, though e-mails, receipts and expense reports reviewed by the news organization seemed to suggest otherwise. Hampton Creek spokesperson Andrew Noyes says federal inquiries and an audit by a \"Big Four accounting firm\" found no evidence of wrongdoing.\u003c/p>\n\u003cp>But in June this year, four of the company's board members topped off a year of infighting by\u003ca href=\"https://www.bloomberg.com/news/articles/2017-07-17/hampton-creek-s-entire-board-is-said-to-leave-except-for-ceo\" target=\"_blank\" rel=\"noopener\"> quitting\u003c/a>, leaving co-founder Tetrick as the sole survivor. Also that month, Target removed Hampton Creek products from its shelves after receiving unconfirmed allegations they were unsafe. The FDA \u003ca href=\"http://www.foodsafetynews.com/2017/08/fda-ends-hampton-creek-query-gives-gras-status-to-protein/#.WiXS4ITysxF\" target=\"_blank\" rel=\"noopener\">cleared the company\u003c/a> of any concerns, but Target stuck with its decision nonetheless.\u003c/p>\n\u003cp>The company, however, is forging ahead, with plant-based meat, butter and ice cream all in the works.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This post has been updated with Hampton Creek's response to Bloomberg's reporting.\u003c/em>\u003c/p>\n\n",
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"excerpt": "To engineer an egg substitute, the food tech firm Hampton Creek removed starch from mung beans. The company is trying to recover after a run of bad news the last couple of years.",
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"description": "To engineer an egg substitute, the food tech firm Hampton Creek removed starch from mung beans. The company is trying to recover after a run of bad news the last couple of years.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Leave it to a San Francisco restaurant to serve up egg dishes with eggs that aren't, well, eggs.\u003c/p>\n\u003caside class=\"pullquote alignright\">Hampton Creek tries to recover from a spate of bad news with its new artificial egg product.\u003c/aside>\n\u003cp>At the cozy Flore cafe in the Castro district, the thick, yellow liquid chef Ben Roche pours into a sizzling pan looks just like eggs. But nope -- it’s actually a mixture of mung beans, canola oil and salt.\u003c/p>\n\u003cp>“We have a little bit of spinach, some mushrooms, and we are going to finish it with some goat cheese,\" Roche says, divulging his not-so-secret recipe.\u003c/p>\n\u003cp>Fluffy yellow curds form rapidly. I'm more than game. Roche scoops a savory-looking scramble onto my plate. A couple of bites later:\u003c/p>\n\u003cp>“I can honestly say I would not know the difference,\" I proclaim. \"It tastes like scrambled eggs.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Flore's $14 concoction makes the eatery the first in the Bay Area to put the imitation eggs, which are called Just Scramble, on the menu. The egg substitute is made by San Francisco food company Hampton Creek, which has been itself scrambling, trying to recover from a series of missteps and adverse events. In September the company\u003ca href=\"https://techcrunch.com/2017/09/14/hampton-creek-rises-again-with-new-directors-and-patents-for-a-new-direction/\" target=\"_blank\" rel=\"noopener\"> replenished\u003c/a> its board of directors, several months after a mass exodus.\u003c/p>\n\u003cp>The company’s CEO, Josh Tetrick, says it tried a multitude of plants before getting Just Scramble right.\u003c/p>\n\u003cp>“Kidney beans, black beans, and navy beans, sorghum and yellow peas,\" he said.\u003c/p>\n\u003cp>Hampton Creek's \u003ca href=\"https://www.eatjust.com/en-us/stories/mission\" target=\"_blank\" rel=\"noopener\">mission statement\u003c/a> says the company is trying to change a \"mindset\" that \"does not believe it’s possible to have healthier, sustainable food that is also affordable and delicious.\" To that end, the company also offers Just Mayo, Just Cookies and Just Dressing. Hampton Creek \u003ca href=\"https://www.dropbox.com/s/r0lsd4hw4xzltg8/HC_Sustainability_Indicator_Methods_FINAL_11-2017.pdf?dl=0\" target=\"_blank\" rel=\"noopener\">says\u003c/a> making mung beans into artificial eggs requires a lot less water and has a lighter carbon footprint than producing the real thing.\u003c/p>\n\u003cp>\u003cstrong>Breaking a Few Eggs\u003c/strong>\u003c/p>\n\u003cp>To make an omelette, you have to break a few eggs, and the company has certainly done that in recent years. In 2016, Bloomberg \u003ca href=\"https://www.bloomberg.com/news/articles/2016-08-04/food-startup-ran-undercover-project-to-buy-up-its-own-products\" target=\"_blank\" rel=\"noopener\">reported\u003c/a> that Hampton Creek bought back hundreds of jars of Just Mayo from supermarkets across the U.S. The purpose of the program was to \"make sales look better to potential investors,\" according to former employees who spoke with Bloomberg.\u003c/p>\n\u003cp>In addition, \"contractors were told to call store managers pretending they were customers and ask about Just Mayo,\" Bloomberg said. The company claimed this was a quality control effort, though e-mails, receipts and expense reports reviewed by the news organization seemed to suggest otherwise. Hampton Creek spokesperson Andrew Noyes says federal inquiries and an audit by a \"Big Four accounting firm\" found no evidence of wrongdoing.\u003c/p>\n\u003cp>But in June this year, four of the company's board members topped off a year of infighting by\u003ca href=\"https://www.bloomberg.com/news/articles/2017-07-17/hampton-creek-s-entire-board-is-said-to-leave-except-for-ceo\" target=\"_blank\" rel=\"noopener\"> quitting\u003c/a>, leaving co-founder Tetrick as the sole survivor. Also that month, Target removed Hampton Creek products from its shelves after receiving unconfirmed allegations they were unsafe. The FDA \u003ca href=\"http://www.foodsafetynews.com/2017/08/fda-ends-hampton-creek-query-gives-gras-status-to-protein/#.WiXS4ITysxF\" target=\"_blank\" rel=\"noopener\">cleared the company\u003c/a> of any concerns, but Target stuck with its decision nonetheless.\u003c/p>\n\u003cp>The company, however, is forging ahead, with plant-based meat, butter and ice cream all in the works.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This post has been updated with Hampton Creek's response to Bloomberg's reporting.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>I recently hobbled to the drugstore to pick up painkillers after minor outpatient knee surgery, only to discover that the pharmacist hadn’t yet filled the prescription. My doctor’s order of 90 generic Percocet exceeded the number my insurer would approve, he said. I left a short time later with a bottle containing a smaller number.\u003c/p>\n\u003cp>When I got home and opened the package to take a pill, I discovered that there were 42 inside.\u003c/p>\n\u003cp>Talk about using a shotgun to kill a mosquito. I was stiff and sore after the orthopedist fished out a couple of loose pieces of bone and cartilage from my left knee. But on a pain scale of 0 to 10, I was a 4, tops. I probably could have gotten by with a much less potent drug than a painkiller like \u003ca href=\"https://www.webmd.com/pain-management/guide/narcotic-pain-medications#1\" target=\"_blank\" rel=\"noopener\">Percocet\u003c/a>, which contains a combination of the opioid oxycodone and the pain reliever acetaminophen, the active ingredient found in over-the-counter Tylenol.\u003c/p>\n\u003caside class=\"pullquote alignright\">As public health officials grapple with how to slow the growing opioid epidemic — which claims 91 lives each day, according to federal statistics — the over-prescription of narcotics after even minor surgery is coming under new scrutiny.\u003c/aside>\n\u003cp>When I went in for my follow-up appointment a week after surgery, I asked my orthopedist about those 90 pills.\u003c/p>\n\u003cp>“If you had real surgery like a knee replacement you wouldn’t think it was so many,” he said, adding that the electronic prescribing system set the default at 90. So when he types in a prescription for Percocet, that’s the quantity the system orders.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Such standard orders can be overridden, but that’s an extra step for a busy physician and takes time.\u003c/p>\n\u003cp>As public health officials grapple with how to slow the growing opioid epidemic — which \u003ca href=\"https://www.cdc.gov/drugoverdose/epidemic/\" target=\"_blank\" rel=\"noopener\">claims 91 lives each day\u003c/a>, according to federal statistics — the over-prescription of narcotics after even minor surgery is coming under new scrutiny.\u003c/p>\n\u003cp>While patients are today often given opioids to manage post-operative pain, a large supply of pills may open the door to opioid misuse, either by the patients themselves or others in the family or community who get access to the leftovers.\u003c/p>\n\u003cp>Post-surgical prescriptions for 45, 60 or 90 pills are “incredibly common,” said Dr. Chad Brummett, an anesthesiologist and pain physician at the University of Michigan Medical School.\u003c/p>\n\u003cp>Last year, the Centers for Disease Control and Prevention released a \u003ca href=\"https://www.cdc.gov/drugoverdose/pdf/Guidelines_Factsheet-a.pdf\" target=\"_blank\" rel=\"noopener\">general guideline\u003c/a> saying that clinicians who prescribe opioids to treat acute pain should use the lowest effective dose and limit the duration to no longer than seven days.\u003c/p>\n\u003cp>[contextly_sidebar id=\"IKKSKEYlRZSZtDmHEy3bAWPqrZ5UtBdX\"]But more detailed guidance is necessary, clinicians say.\u003c/p>\n\u003cp>“There really aren’t clear guidelines, especially for surgery and dentistry,” Dr. Brummett said. “It’s often based on what their chief resident taught them along the way, or an event in their career that made them prescribe a certain amount.” Or, as in my case, an automated program that makes prescribing more pills simpler than prescribing fewer.\u003c/p>\n\u003cp>To determine the extent to which surgery may lead to longer-term opioid use, Brummett and his colleagues examined the insurance claims of 36,177 adults who had surgery in 2013 or 2014 for which they received an opioid prescription. None of the patients had prescriptions for opioids during the prior year.\u003c/p>\n\u003cp>The study, published online in \u003ca href=\"https://jamanetwork.com/journals/jamasurgery/article-abstract/2618383\" target=\"_blank\" rel=\"noopener\">JAMA Surgery\u003c/a> in June, found that three to six months after surgery, roughly 6 percent of patients were still using opioids, having filled at least one new prescription for the drug. The figures were similar whether they had major or minor surgery. By comparison, the rate of opioid use for a control group that did not have surgery was just 0.4 percent.\u003c/p>\n\u003cp>Some insurers and state regulators have increasingly stepped in to limit opioid prescriptions. Insurers routinely monitor doctors’ prescribing patterns and limit the quantity of pills or the dosage of opioid prescriptions, said Dania Palanker, an assistant research professor at Georgetown University’s Center on Health Insurance Reforms who \u003ca href=\"http://chirblog.org/responding-opioid-crisis-insurers-balance-stepped-monitoring-restrictions-need-appropriate-pain-treatment/\" target=\"_blank\" rel=\"noopener\">co-authored a study\u003c/a> on insurers’ response to the opioid crisis.\u003c/p>\n\u003cp>At least two dozen states have passed laws or rules in just the past few years aimed at \u003ca href=\"http://www.painmed.org/advocacy/state-updates/\" target=\"_blank\" rel=\"noopener\">regulating the use of opioids\u003c/a>.\u003c/p>\n\u003cp>In my state of New York, Gov. Andrew Cuomo \u003ca href=\"https://www.governor.ny.gov/news/governor-cuomo-signs-legislation-combat-heroin-and-opioid-crisis\" target=\"_blank\" rel=\"noopener\">last year signed\u003c/a> legislation that \u003ca href=\"https://www.health.ny.gov/professionals/narcotic/laws_and_regulations/docs/combat_heroin_legislation_faq.pdf\" target=\"_blank\" rel=\"noopener\">reduced the initial opioid prescription\u003c/a> limit for acute pain from 30 days to no more than a seven-day supply.\u003c/p>\n\u003cp>As my experience demonstrated, however, a seven-day limit (those 42 pills in my case) can still result in patients receiving many more pills than they need. (For those who find themselves in a similar situation with excess pills, \u003ca href=\"https://khn.org/news/how-and-where-to-dump-your-leftover-drugs-responsibly/\" target=\"_blank\" rel=\"noopener\">here is the safe and proper way\u003c/a> to dispose of them.)\u003c/p>\n\u003cp>Still, some caregivers and patients worry that all this focus on overprescribing may scare physicians away from prescribing opioids at all, even when they’re appropriate.\u003c/p>\n\u003cp>“That’s my concern, that people are so afraid of things and taking it to such an extreme that patient care suffers,” said Dr. Edward Michna, an anesthesiologist and pain management physician at Brigham and Women’s Hospital in Boston who is on the board of the American Pain Society, a research and education group for pain management professionals. Michna has been a paid consultant to numerous pharmaceutical companies, some of which manufacture narcotics.\u003c/p>\n\u003cp>But other doctors say that one of the reasons doctors call in orders for lots of pills is their convenience.\u003c/p>\n\u003cp>“When you land on the front lines, you hear, ‘I like to write for 30 or 60 pills because that way they won’t call in the middle of the night’ ” for a refill, said Dr. Martin Makary, a professor of surgery and health policy at Johns Hopkins School of Medicine.\u003c/p>\n\u003cp>Makary is spearheading a consortium of Hopkins clinicians and patients that provides \u003ca href=\"https://www.solvethecrisis.org/best-practices\" target=\"_blank\" rel=\"noopener\">specific guidelines\u003c/a> for post-surgical opioid use. The program, part of a larger effort to identify areas of overtreatment in health care, also identifies outlier prescribers nationwide to encourage them to change their prescribing habits.\u003c/p>\n\u003cp>The Hopkins group doesn’t have an opioid recommendation for my surgery. The closest procedure on their website is arthroscopic surgery to partially remove a torn piece of cartilage in the knee called the meniscus. The post-surgical opioid recommendation following that surgery: 12 tablets.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>Please visit \u003ca href=\"https://khn.org/columnists/\" target=\"_blank\" rel=\"noopener\">khn.org/columnists\u003c/a> to send comments or ideas for future topics for the Insuring Your Health column.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>I recently hobbled to the drugstore to pick up painkillers after minor outpatient knee surgery, only to discover that the pharmacist hadn’t yet filled the prescription. My doctor’s order of 90 generic Percocet exceeded the number my insurer would approve, he said. I left a short time later with a bottle containing a smaller number.\u003c/p>\n\u003cp>When I got home and opened the package to take a pill, I discovered that there were 42 inside.\u003c/p>\n\u003cp>Talk about using a shotgun to kill a mosquito. I was stiff and sore after the orthopedist fished out a couple of loose pieces of bone and cartilage from my left knee. But on a pain scale of 0 to 10, I was a 4, tops. I probably could have gotten by with a much less potent drug than a painkiller like \u003ca href=\"https://www.webmd.com/pain-management/guide/narcotic-pain-medications#1\" target=\"_blank\" rel=\"noopener\">Percocet\u003c/a>, which contains a combination of the opioid oxycodone and the pain reliever acetaminophen, the active ingredient found in over-the-counter Tylenol.\u003c/p>\n\u003caside class=\"pullquote alignright\">As public health officials grapple with how to slow the growing opioid epidemic — which claims 91 lives each day, according to federal statistics — the over-prescription of narcotics after even minor surgery is coming under new scrutiny.\u003c/aside>\n\u003cp>When I went in for my follow-up appointment a week after surgery, I asked my orthopedist about those 90 pills.\u003c/p>\n\u003cp>“If you had real surgery like a knee replacement you wouldn’t think it was so many,” he said, adding that the electronic prescribing system set the default at 90. So when he types in a prescription for Percocet, that’s the quantity the system orders.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Such standard orders can be overridden, but that’s an extra step for a busy physician and takes time.\u003c/p>\n\u003cp>As public health officials grapple with how to slow the growing opioid epidemic — which \u003ca href=\"https://www.cdc.gov/drugoverdose/epidemic/\" target=\"_blank\" rel=\"noopener\">claims 91 lives each day\u003c/a>, according to federal statistics — the over-prescription of narcotics after even minor surgery is coming under new scrutiny.\u003c/p>\n\u003cp>While patients are today often given opioids to manage post-operative pain, a large supply of pills may open the door to opioid misuse, either by the patients themselves or others in the family or community who get access to the leftovers.\u003c/p>\n\u003cp>Post-surgical prescriptions for 45, 60 or 90 pills are “incredibly common,” said Dr. Chad Brummett, an anesthesiologist and pain physician at the University of Michigan Medical School.\u003c/p>\n\u003cp>Last year, the Centers for Disease Control and Prevention released a \u003ca href=\"https://www.cdc.gov/drugoverdose/pdf/Guidelines_Factsheet-a.pdf\" target=\"_blank\" rel=\"noopener\">general guideline\u003c/a> saying that clinicians who prescribe opioids to treat acute pain should use the lowest effective dose and limit the duration to no longer than seven days.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>But more detailed guidance is necessary, clinicians say.\u003c/p>\n\u003cp>“There really aren’t clear guidelines, especially for surgery and dentistry,” Dr. Brummett said. “It’s often based on what their chief resident taught them along the way, or an event in their career that made them prescribe a certain amount.” Or, as in my case, an automated program that makes prescribing more pills simpler than prescribing fewer.\u003c/p>\n\u003cp>To determine the extent to which surgery may lead to longer-term opioid use, Brummett and his colleagues examined the insurance claims of 36,177 adults who had surgery in 2013 or 2014 for which they received an opioid prescription. None of the patients had prescriptions for opioids during the prior year.\u003c/p>\n\u003cp>The study, published online in \u003ca href=\"https://jamanetwork.com/journals/jamasurgery/article-abstract/2618383\" target=\"_blank\" rel=\"noopener\">JAMA Surgery\u003c/a> in June, found that three to six months after surgery, roughly 6 percent of patients were still using opioids, having filled at least one new prescription for the drug. The figures were similar whether they had major or minor surgery. By comparison, the rate of opioid use for a control group that did not have surgery was just 0.4 percent.\u003c/p>\n\u003cp>Some insurers and state regulators have increasingly stepped in to limit opioid prescriptions. Insurers routinely monitor doctors’ prescribing patterns and limit the quantity of pills or the dosage of opioid prescriptions, said Dania Palanker, an assistant research professor at Georgetown University’s Center on Health Insurance Reforms who \u003ca href=\"http://chirblog.org/responding-opioid-crisis-insurers-balance-stepped-monitoring-restrictions-need-appropriate-pain-treatment/\" target=\"_blank\" rel=\"noopener\">co-authored a study\u003c/a> on insurers’ response to the opioid crisis.\u003c/p>\n\u003cp>At least two dozen states have passed laws or rules in just the past few years aimed at \u003ca href=\"http://www.painmed.org/advocacy/state-updates/\" target=\"_blank\" rel=\"noopener\">regulating the use of opioids\u003c/a>.\u003c/p>\n\u003cp>In my state of New York, Gov. Andrew Cuomo \u003ca href=\"https://www.governor.ny.gov/news/governor-cuomo-signs-legislation-combat-heroin-and-opioid-crisis\" target=\"_blank\" rel=\"noopener\">last year signed\u003c/a> legislation that \u003ca href=\"https://www.health.ny.gov/professionals/narcotic/laws_and_regulations/docs/combat_heroin_legislation_faq.pdf\" target=\"_blank\" rel=\"noopener\">reduced the initial opioid prescription\u003c/a> limit for acute pain from 30 days to no more than a seven-day supply.\u003c/p>\n\u003cp>As my experience demonstrated, however, a seven-day limit (those 42 pills in my case) can still result in patients receiving many more pills than they need. (For those who find themselves in a similar situation with excess pills, \u003ca href=\"https://khn.org/news/how-and-where-to-dump-your-leftover-drugs-responsibly/\" target=\"_blank\" rel=\"noopener\">here is the safe and proper way\u003c/a> to dispose of them.)\u003c/p>\n\u003cp>Still, some caregivers and patients worry that all this focus on overprescribing may scare physicians away from prescribing opioids at all, even when they’re appropriate.\u003c/p>\n\u003cp>“That’s my concern, that people are so afraid of things and taking it to such an extreme that patient care suffers,” said Dr. Edward Michna, an anesthesiologist and pain management physician at Brigham and Women’s Hospital in Boston who is on the board of the American Pain Society, a research and education group for pain management professionals. Michna has been a paid consultant to numerous pharmaceutical companies, some of which manufacture narcotics.\u003c/p>\n\u003cp>But other doctors say that one of the reasons doctors call in orders for lots of pills is their convenience.\u003c/p>\n\u003cp>“When you land on the front lines, you hear, ‘I like to write for 30 or 60 pills because that way they won’t call in the middle of the night’ ” for a refill, said Dr. Martin Makary, a professor of surgery and health policy at Johns Hopkins School of Medicine.\u003c/p>\n\u003cp>Makary is spearheading a consortium of Hopkins clinicians and patients that provides \u003ca href=\"https://www.solvethecrisis.org/best-practices\" target=\"_blank\" rel=\"noopener\">specific guidelines\u003c/a> for post-surgical opioid use. The program, part of a larger effort to identify areas of overtreatment in health care, also identifies outlier prescribers nationwide to encourage them to change their prescribing habits.\u003c/p>\n\u003cp>The Hopkins group doesn’t have an opioid recommendation for my surgery. The closest procedure on their website is arthroscopic surgery to partially remove a torn piece of cartilage in the knee called the meniscus. The post-surgical opioid recommendation following that surgery: 12 tablets.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Bay-Curious-Podcast-Tile-703x703-1.jpg",
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"officialWebsiteLink": "/news/series/baycurious",
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"source": "kqed",
"order": 3
},
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"npr": "https://www.npr.org/podcasts/500557090/bay-curious",
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}
},
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"id": "bbc-world-service",
"title": "BBC World Service",
"info": "The day's top stories from BBC News compiled twice daily in the week, once at weekends.",
"airtime": "MON-FRI 9pm-10pm, TUE-FRI 1am-2am",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/BBC-World-Service-Podcast-Tile-360x360-1.jpg",
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"meta": {
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"source": "BBC World Service"
},
"link": "/radio/program/bbc-world-service",
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"rss": "https://podcasts.files.bbci.co.uk/p02nq0gn.rss"
}
},
"californiareport": {
"id": "californiareport",
"title": "The California Report",
"tagline": "California, day by day",
"info": "KQED’s statewide radio news program providing daily coverage of issues, trends and public policy decisions.",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/The-California-Report-Podcast-Tile-703x703-1.jpg",
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"officialWebsiteLink": "/californiareport",
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"source": "kqed",
"order": 8
},
"link": "/californiareport",
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}
},
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"id": "californiareportmagazine",
"title": "The California Report Magazine",
"tagline": "Your state, your stories",
"info": "Every week, The California Report Magazine takes you on a road trip for the ears: to visit the places and meet the people who make California unique. The in-depth storytelling podcast from the California Report.",
"airtime": "FRI 4:30pm-5pm, 6:30pm-7pm, 11pm-11:30pm",
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"officialWebsiteLink": "/californiareportmagazine",
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"order": 10
},
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM3NjkwNjk1OTAz",
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},
"city-arts": {
"id": "city-arts",
"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",
"officialWebsiteLink": "https://www.cityarts.net/",
"airtime": "SUN 1pm-2pm, TUE 10pm, WED 1am",
"meta": {
"site": "news",
"source": "City Arts & Lectures"
},
"link": "https://www.cityarts.net",
"subscribe": {
"tuneIn": "https://tunein.com/radio/City-Arts-and-Lectures-p692/",
"rss": "https://www.cityarts.net/feed/"
}
},
"closealltabs": {
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"info": "Close All Tabs breaks down how digital culture shapes our world through thoughtful insights and irreverent humor.",
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"officialWebsiteLink": "/podcasts/closealltabs",
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"source": "kqed",
"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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"meta": {
"site": "radio",
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},
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"id": "commonwealth-club",
"title": "Commonwealth Club of California Podcast",
"info": "The Commonwealth Club of California is the nation's oldest and largest public affairs forum. As a non-partisan forum, The Club brings to the public airwaves diverse viewpoints on important topics. The Club's weekly radio broadcast - the oldest in the U.S., dating back to 1924 - is carried across the nation on public radio stations and is now podcasting. Our website archive features audio of our recent programs, as well as selected speeches from our long and distinguished history. This podcast feed is usually updated twice a week and is always un-edited.",
"airtime": "THU 10pm, FRI 1am",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Commonwealth-Club-Podcast-Tile-360x360-1.jpg",
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"meta": {
"site": "news",
"source": "Commonwealth Club of California"
},
"link": "/radio/program/commonwealth-club",
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"apple": "https://itunes.apple.com/us/podcast/commonwealth-club-of-california-podcast/id976334034?mt=2",
"google": "https://podcasts.google.com/feed/aHR0cDovL3d3dy5jb21tb253ZWFsdGhjbHViLm9yZy9hdWRpby9wb2RjYXN0L3dlZWtseS54bWw",
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"id": "forum",
"title": "Forum",
"tagline": "The conversation starts here",
"info": "KQED’s live call-in program discussing local, state, national and international issues, as well as in-depth interviews.",
"airtime": "MON-FRI 9am-11am, 10pm-11pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Forum-Podcast-Tile-703x703-1.jpg",
"imageAlt": "KQED Forum with Mina Kim and Alexis Madrigal",
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"meta": {
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"source": "kqed",
"order": 9
},
"link": "/forum",
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM5NTU3MzgxNjMz",
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"freakonomics-radio": {
"id": "freakonomics-radio",
"title": "Freakonomics Radio",
"info": "Freakonomics Radio is a one-hour award-winning podcast and public-radio project hosted by Stephen Dubner, with co-author Steve Levitt as a regular guest. It is produced in partnership with WNYC.",
"imageSrc": "https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/05/freakonomicsRadio.png",
"officialWebsiteLink": "http://freakonomics.com/",
"airtime": "SUN 1am-2am, SAT 3pm-4pm",
"meta": {
"site": "radio",
"source": "WNYC"
},
"link": "/radio/program/freakonomics-radio",
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"apple": "https://itunes.apple.com/us/podcast/freakonomics-radio/id354668519",
"tuneIn": "https://tunein.com/podcasts/WNYC-Podcasts/Freakonomics-Radio-p272293/",
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},
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"id": "fresh-air",
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"info": "Hosted by Terry Gross, \u003cem>Fresh Air from WHYY\u003c/em> is the Peabody Award-winning weekday magazine of contemporary arts and issues. One of public radio's most popular programs, Fresh Air features intimate conversations with today's biggest luminaries.",
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"link": "/radio/program/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": {
"id": "hidden-brain",
"title": "Hidden Brain",
"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.",
"imageSrc": "https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/05/howIBuiltThis.png",
"officialWebsiteLink": "https://www.npr.org/podcasts/510313/how-i-built-this",
"airtime": "SUN 7:30pm-8pm",
"meta": {
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"source": "npr"
},
"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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},
"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/",
"meta": {
"site": "news",
"source": "npr"
},
"link": "/radio/program/latino-usa",
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"apple": "https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=79681317&at=11l79Y&ct=nprdirectory",
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"rss": "https://feeds.npr.org/510016/podcast.xml"
}
},
"marketplace": {
"id": "marketplace",
"title": "Marketplace",
"info": "Our flagship program, helmed by Kai Ryssdal, examines what the day in money delivered, through stories, conversations, newsworthy numbers and more. Updated Monday through Friday at about 3:30 p.m. PT.",
"airtime": "MON-FRI 4pm-4:30pm, MON-WED 6:30pm-7pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Marketplace-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.marketplace.org/",
"meta": {
"site": "news",
"source": "American Public Media"
},
"link": "/radio/program/marketplace",
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"rss": "https://feeds.publicradio.org/public_feeds/marketplace-pm/rss/rss"
}
},
"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)",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Masters-of-Scale-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://mastersofscale.com/",
"meta": {
"site": "radio",
"source": "WaitWhat"
},
"link": "/radio/program/masters-of-scale",
"subscribe": {
"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",
"subscribe": {
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM1NzY0NjAwNDI5",
"npr": "https://www.npr.org/podcasts/464615685/mind-shift-podcast",
"stitcher": "https://www.stitcher.com/podcast/kqed/stories-teachers-share",
"spotify": "https://open.spotify.com/show/0MxSpNYZKNprFLCl7eEtyx"
}
},
"morning-edition": {
"id": "morning-edition",
"title": "Morning Edition",
"info": "\u003cem>Morning Edition\u003c/em> takes listeners around the country and the world with multi-faceted stories and commentaries every weekday. Hosts Steve Inskeep, David Greene and Rachel Martin bring you the latest breaking news and features to prepare you for the day.",
"airtime": "MON-FRI 3am-9am",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Morning-Edition-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.npr.org/programs/morning-edition/",
"meta": {
"site": "news",
"source": "npr"
},
"link": "/radio/program/morning-edition"
},
"onourwatch": {
"id": "onourwatch",
"title": "On Our Watch",
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