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"content": "\u003cp>\u003cem>Update June 6, 2018: \u003c/em>\u003c/p>\n\u003cp>San Francisco is on its way to becoming the first city in the nation to ban all flavored tobacco products from store shelves.\u003c/p>\n\u003cp>With all precincts now having reported their results, Measure E is passing with a whopping 68 percent of the vote. The final results won’t be tallied until all vote-by-mail ballots are counted.\u003c/p>\n\u003cp>The R.J. Reynolds Tobacco Company spent nearly $13 million on a campaign to stop the ban. The company sells the nation’s best-selling menthol cigarette. All that money was appalling to Patrick Reynolds, his grandfather founded the company, but he’s now an anti-tobacco advocate because he lost his father to emphysema.\u003c/p>\n\u003cp>“The only memory I have of him is a man lying down dying gasping of breath,” Reynolds said.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Reynolds stridently opposes adding flavors to e-cigarettes like berry, nacho cheese or gummy bear.\u003c/p>\n\u003cp>“It is an obscene, outrageous brazen ploy by the tobacco industry and by the vaping industry to ensnare another generation to be addicted,” Reynolds said. “And it’s just got to stop.”\u003c/p>\n\u003cp>The citywide ban will go into effect 10 days after the election is certified.\u003c/p>\n\u003cp>\u003cem>Original post\u003c/em>\u003c/p>\n\u003cp>San Francisco could became the first city in the nation to ban flavored tobacco products from all store shelves. This includes everything from candy flavored e-cigarettes to conventional menthol smokes.\u003c/p>\n\u003caside class=\"pullquote alignright\">‘The industry recognized decades ago that if they don’t get kids to start, they [the industry] will die out.’ \u003ccite>Dr. Pam Ling, UCSF \u003c/cite>\u003c/aside>\n\u003cp>City supervisors last year unanimously approved a \u003ca href=\"http://sfgov.org/elections/sites/default/files/Documents/candidates/Legal_Text_Repeal_of_Flavored_Tobacco_Products_Ban.pdf\" target=\"_blank\" rel=\"noopener\">ban\u003c/a> on the products, but the tobacco industry funded a referendum, \u003ca href=\"https://ballotpedia.org/San_Francisco,_California,_Proposition_E,_Ban_on_the_Sale_of_Flavored_Tobacco_(June_2018)\" target=\"_blank\" rel=\"noopener\">Proposition E\u003c/a>, to put the issue before voters. Residents will decide in the June 5 election whether the ordinance goes into effect. Voting by mail has already begun.\u003c/p>\n\u003cp>\u003cstrong>Nearly $10 Million And Counting\u003c/strong>\u003c/p>\n\u003cp>The R.J. Reynolds Tobacco Company is \u003ca href=\"https://sfethics.org/ethics/2018/03/campaign-finance-dashboards-june-5-2018-and-november-6-2018-elections.html\" target=\"_blank\" rel=\"noopener\">blanketing\u003c/a> the city in radio, television and direct mail advertisements urging a “no” vote on Proposition E. The tobacco giant has shelled out nearly $10 million to save Newport menthols, which is the nation’s \u003ca href=\"https://www.cdc.gov/tobacco/data_statistics/fact_sheets/tobacco_industry/brand_preference/index.htm\" target=\"_blank\" rel=\"noopener\">best-selling\u003c/a> mint-flavored cigarette. The ads, featuring vintage film of people smashing kegs during Prohibition, claim that it didn’t work for alcohol and drugs, so it won’t work for flavored tobacco.\u003c/p>\n\u003cp>Billionaire Michael Bloomberg \u003ca href=\"https://www.kqed.org/futureofyou/441395/sf-voters-may-ban-vape-flavors-menthol-cigarettes\" target=\"_blank\" rel=\"noopener\">contributed $1.8 million\u003c/a> to the Yes campaign.\u003c/p>\n\u003cp>San Francisco resident Donna Anderson protested on behalf of the No campaign during a recent rally at Civic Center.\u003c/p>\n\u003cp>\u003cem>‘No on Proposition E’ ads, funded by the tobacco industry, liken the proposed ban to 1920s-era Prohibition …\u003c/em>\u003c/p>\n\u003cp>\u003ciframe loading=\"lazy\" title=\"Bans Don’t Work, No on Prop E (30 sec.)\" width=\"500\" height=\"281\" src=\"https://www.youtube.com/embed/HHKy5eum8l4?start=3&feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen>\u003c/iframe>\u003c/p>\n\u003cp>“You’re just driving sales underground,” says Anderson. “It will not stop people from accessing what they want or using what they want.”\u003c/p>\n\u003cp>She uses the example of marijuana laws to illustrate how a black market usually hurts people of color the most.\u003c/p>\n\u003cp>“Black people, Latino people; people have been locked up — and are still locked up — having to do with little more than an ounce of marijuana,” said Anderson.\u003c/p>\n\u003cp>\u003cstrong>Local Businesses On Edge\u003c/strong>\u003c/p>\n\u003cp>At the Mission Smoke Shop, owner Sam Azar has plastered his walls with “No-on-E” signs.\u003c/p>\n\u003cp>“It’s going to hurt me as a small business here in the city by, like 30 percent or more,” he predicts.\u003c/p>\n\u003cfigure id=\"attachment_441406\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-441406 size-medium\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/05/IMG_5146-e1525820098164-800x531.jpg\" alt=\"\" width=\"800\" height=\"531\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/13/2018/05/IMG_5146-e1525820098164-800x531.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/13/2018/05/IMG_5146-e1525820098164-160x106.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/13/2018/05/IMG_5146-e1525820098164-768x510.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/13/2018/05/IMG_5146-e1525820098164-1020x677.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/13/2018/05/IMG_5146-e1525820098164-1200x797.jpg 1200w, https://cdn.kqed.org/wp-content/uploads/sites/13/2018/05/IMG_5146-e1525820098164-1180x784.jpg 1180w, https://cdn.kqed.org/wp-content/uploads/sites/13/2018/05/IMG_5146-e1525820098164-960x638.jpg 960w, https://cdn.kqed.org/wp-content/uploads/sites/13/2018/05/IMG_5146-e1525820098164-240x159.jpg 240w, https://cdn.kqed.org/wp-content/uploads/sites/13/2018/05/IMG_5146-e1525820098164-375x249.jpg 375w, https://cdn.kqed.org/wp-content/uploads/sites/13/2018/05/IMG_5146-e1525820098164-520x345.jpg 520w, https://cdn.kqed.org/wp-content/uploads/sites/13/2018/05/IMG_5146-e1525820098164.jpg 1843w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Sam Azar worries about how a ban on flavored tobacco products will hurt the bottom line at his Mission Smoke Shop. \u003ccite>(Lesley McClurg/ KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>He would no longer profit from flavored pipe tobacco, flavored hookah, infused cigars, or numerous racks of syrupy vape liquids. There are more than 7,000 sweet and savory e-cigarette flavors on the market — everything from gummi bear and Unicorn Milk to Red Bull and nacho cheese.\u003c/p>\n\u003cp>But medical experts worry about the role aromas play in enticing young people to try nicotine and get hooked on cigarettes.\u003c/p>\n\u003cp>Derek Smith, director of the \u003ca href=\"http://sanfranciscotobaccofreeproject.org/\" target=\"_blank\" rel=\"noopener\">Tobacco Free Project\u003c/a> at the San Francisco Department of Public Health, says flavors and menthol deceptively mask the taste of tobacco and make it easier to inhale nicotine.\u003c/p>\n\u003cp>“Someone who has tried a cigarette for the first time will often turn green and cough,” said Smith, in an email. “Imagine instead a cereal, milk-flavored inhalation that is considerably less harsh to start with.”\u003c/p>\n\u003cp>\u003cstrong>Physicians Take to the Streets\u003c/strong>\u003c/p>\n\u003cp>Smith \u003ca href=\"https://www.cdph.ca.gov/Programs/CCDPHP/DCDIC/CTCB/CDPH%20Document%20Library/Policy/FlavoredTobaccoAndMenthol/FinalFlavoredTobaccoInfographic.pdf\" target=\"_blank\" rel=\"noopener\">says\u003c/a> nearly all youth in the state start their tobacco habit with a flavored product, which worries doctors who gathered at a recent “Yes-on-E” rally on the steps of the Civic Center.\u003c/p>\n\u003cp>“The tobacco industry has targeted menthol cigarettes to the black community, to poor people, to mothers,” said Amanda Wright, a resident physician at UCSF. “And if you look at these products, they literally look like candy and that is clearly targeting our children.”\u003c/p>\n\u003cp>Wright was standing next to a table laden with row after row of juice boxes and candy wrappers. They look like sugary snack foods, but they’re actually packages of vaping products. The New York Times recently \u003ca href=\"https://www.nytimes.com/2018/05/01/health/fda-crackdown-vaping-children.html\" target=\"_blank\" rel=\"noopener\">reported\u003c/a> on a federal crackdown of these look-alikes.\u003c/p>\n\u003cfigure id=\"attachment_441402\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-441402 size-large\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/05/IMG_5101-e1525822179863-1020x498.jpg\" alt=\"\" width=\"640\" height=\"312\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/13/2018/05/IMG_5101-e1525822179863-1020x498.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/13/2018/05/IMG_5101-e1525822179863-160x78.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/13/2018/05/IMG_5101-e1525822179863-800x391.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/13/2018/05/IMG_5101-e1525822179863-768x375.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/13/2018/05/IMG_5101-e1525822179863-1200x586.jpg 1200w, https://cdn.kqed.org/wp-content/uploads/sites/13/2018/05/IMG_5101-e1525822179863-1180x576.jpg 1180w, https://cdn.kqed.org/wp-content/uploads/sites/13/2018/05/IMG_5101-e1525822179863-960x469.jpg 960w, https://cdn.kqed.org/wp-content/uploads/sites/13/2018/05/IMG_5101-e1525822179863-240x117.jpg 240w, https://cdn.kqed.org/wp-content/uploads/sites/13/2018/05/IMG_5101-e1525822179863-375x183.jpg 375w, https://cdn.kqed.org/wp-content/uploads/sites/13/2018/05/IMG_5101-e1525822179863-520x254.jpg 520w, https://cdn.kqed.org/wp-content/uploads/sites/13/2018/05/IMG_5101-e1525822179863.jpg 1896w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003cfigcaption class=\"wp-caption-text\">The candylike packaging for vaping products on display at a Yes-on-E rally. \u003ccite>(Lesley McClurg/ KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Nicotine is particularly addictive for the teenage brain, according to Pam Ling, a physician and smoking researcher at UCSF.\u003c/p>\n\u003cp>“This population is the future of the tobacco industry,” says Ling. “The industry recognized decades ago that if they don’t get kids to start, they [the industry] will die out.”\u003c/p>\n\u003cp>The California Department of Public Health \u003ca href=\"https://www.cdph.ca.gov/Programs/CCDPHP/DCDIC/CTCB/CDPH%20Document%20Library/Policy/FlavoredTobaccoAndMenthol/FinalFlavoredTobaccoInfographic.pdf\" target=\"_blank\" rel=\"noopener\">says\u003c/a> the number of kids in California who vape is currently double the number who smoke, but some \u003ca href=\"http://pediatrics.aappublications.org/content/early/2017/11/30/peds.2017-1832\" target=\"_blank\" rel=\"noopener\">research\u003c/a> suggests that a lot of those kids will be smoking cigarettes before long.\u003c/p>\n\u003cp>“Once these kids start with the e-cigarettes, the likelihood that they’ll be smoking cigarettes a year or so later is increased by a factor of three or four,” says Stanton Glantz, who heads the \u003ca href=\"https://tobacco.ucsf.edu/\">Center for Tobacco Control Research and Education\u003c/a> at UCSF.\u003c/p>\n\u003cp>Glantz says that in his \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/28115540\" target=\"_blank\" rel=\"noopener\">research\u003c/a>, about a third of the kids who start using nicotine via e-cigarettes are not the kind of kids whose race, gender, home life and school performance would make them a high risk to pick up smoking on their own.\u003c/p>\n\u003cp>In other words, vaping is increasing the pool of teen smokers. A 2016 \u003ca href=\"https://e-cigarettes.surgeongeneral.gov/documents/2016_SGR_Exec_Summ_508.pdf\" target=\"_blank\" rel=\"noopener\">report\u003c/a> from the U.S. Surgeon General cited a 900 percent increase in the use of e-cigarettes by high school students from 2011 to 2015. Right now there is very little regulation of e-products at the federal level.\u003c/p>\n\u003cfigure id=\"attachment_441466\" class=\"wp-caption alignright\" style=\"max-width: 800px\">\u003ca href=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/05/RS30897_PROPE_076-e1525979992131.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-441466 size-medium\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/05/RS30897_PROPE_076-800x1200.jpg\" alt=\"\" width=\"800\" height=\"1200\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">An array of flavors displayed at Vapor Den, including banana cream, mango and fruit mix. \u003ccite>(Lauren Hanussak/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Glantz also contends that a flavor ban will help adults who \u003ca href=\"https://www.npr.org/sections/health-shots/2017/05/25/530026958/many-adults-dont-think-exposure-to-vaping-is-bad-for-kids\" target=\"_blank\" rel=\"noopener\">think they’re inhaling\u003c/a> a significantly safer alternative.\u003c/p>\n\u003cp>“When e-cigarettes first became available, there was a lot of hope that they would be better than cigarettes,” he says, “but the more we learn the worse they look.”\u003c/p>\n\u003cp>Though the long-term health effects of smoking e-cigarettes is still unknown, Glantz believes the safety of the devices has been \u003ca href=\"https://www.annualreviews.org/doi/abs/10.1146/annurev-publhealth-040617-013757\" target=\"_blank\" rel=\"noopener\">oversold\u003c/a>.\u003c/p>\n\u003cp>“Electronic smoking products emit particles of chemicals, not clean air, and technically an aerosol, not a vapor,” Smith says. “Think smog or hairspray — not the pure water vapor that steams when your teapot whistles.”\u003c/p>\n\u003cp>These \u003ca href=\"https://pubs.acs.org/doi/full/10.1021/acs.chemrestox.6b00188?src=recsys&=\" target=\"_blank\" rel=\"noopener\">ultrafine particles and toxins\u003c/a> can damage the lungs and may lead to heart attacks. Levels of the particles in the vapor produced by some devices may be lower than in tobacco smoke, but aren’t zero.\u003c/p>\n\u003cp>\u003ciframe loading=\"lazy\" title=\"Why Is Vaping So Popular?\" width=\"500\" height=\"281\" src=\"https://www.youtube.com/embed/P9zps5LsVXs?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen>\u003c/iframe>\u003c/p>\n\u003cp>If San Francisco voters pass the flavor ban, it will be among the \u003ca href=\"https://www.npr.org/sections/thetwo-way/2017/10/24/559833483/new-york-bans-vaping-indoors-in-public-state-law-classes-e-cigs-with-cigarettes\" target=\"_blank\" rel=\"noopener\">toughest restrictions\u003c/a> on e-cigarettes in the country; opponents of the measure fear it will set a precedent.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>Jon Brooks contributed to this post. This post has been edited since it was originally published.\u003c/em>\u003c/p>\n\n",
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"excerpt": "The referendum, which bans flavored tobacco products like menthol cigarettes and gummi bear e-cigarettes, is passing with 68 percent of the vote.",
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"title": "San Francisco Passes First-in-the-Nation Flavored Tobacco, Vaping Ban",
"description": "The referendum, which bans flavored tobacco products like menthol cigarettes and gummi bear e-cigarettes, is passing with 68 percent of the vote.",
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"headline": "San Francisco Passes First-in-the-Nation Flavored Tobacco, Vaping Ban",
"datePublished": "2018-06-06T00:01:13-07:00",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cem>Update June 6, 2018: \u003c/em>\u003c/p>\n\u003cp>San Francisco is on its way to becoming the first city in the nation to ban all flavored tobacco products from store shelves.\u003c/p>\n\u003cp>With all precincts now having reported their results, Measure E is passing with a whopping 68 percent of the vote. The final results won’t be tallied until all vote-by-mail ballots are counted.\u003c/p>\n\u003cp>The R.J. Reynolds Tobacco Company spent nearly $13 million on a campaign to stop the ban. The company sells the nation’s best-selling menthol cigarette. All that money was appalling to Patrick Reynolds, his grandfather founded the company, but he’s now an anti-tobacco advocate because he lost his father to emphysema.\u003c/p>\n\u003cp>“The only memory I have of him is a man lying down dying gasping of breath,” Reynolds said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Reynolds stridently opposes adding flavors to e-cigarettes like berry, nacho cheese or gummy bear.\u003c/p>\n\u003cp>“It is an obscene, outrageous brazen ploy by the tobacco industry and by the vaping industry to ensnare another generation to be addicted,” Reynolds said. “And it’s just got to stop.”\u003c/p>\n\u003cp>The citywide ban will go into effect 10 days after the election is certified.\u003c/p>\n\u003cp>\u003cem>Original post\u003c/em>\u003c/p>\n\u003cp>San Francisco could became the first city in the nation to ban flavored tobacco products from all store shelves. This includes everything from candy flavored e-cigarettes to conventional menthol smokes.\u003c/p>\n\u003caside class=\"pullquote alignright\">‘The industry recognized decades ago that if they don’t get kids to start, they [the industry] will die out.’ \u003ccite>Dr. Pam Ling, UCSF \u003c/cite>\u003c/aside>\n\u003cp>City supervisors last year unanimously approved a \u003ca href=\"http://sfgov.org/elections/sites/default/files/Documents/candidates/Legal_Text_Repeal_of_Flavored_Tobacco_Products_Ban.pdf\" target=\"_blank\" rel=\"noopener\">ban\u003c/a> on the products, but the tobacco industry funded a referendum, \u003ca href=\"https://ballotpedia.org/San_Francisco,_California,_Proposition_E,_Ban_on_the_Sale_of_Flavored_Tobacco_(June_2018)\" target=\"_blank\" rel=\"noopener\">Proposition E\u003c/a>, to put the issue before voters. Residents will decide in the June 5 election whether the ordinance goes into effect. Voting by mail has already begun.\u003c/p>\n\u003cp>\u003cstrong>Nearly $10 Million And Counting\u003c/strong>\u003c/p>\n\u003cp>The R.J. Reynolds Tobacco Company is \u003ca href=\"https://sfethics.org/ethics/2018/03/campaign-finance-dashboards-june-5-2018-and-november-6-2018-elections.html\" target=\"_blank\" rel=\"noopener\">blanketing\u003c/a> the city in radio, television and direct mail advertisements urging a “no” vote on Proposition E. The tobacco giant has shelled out nearly $10 million to save Newport menthols, which is the nation’s \u003ca href=\"https://www.cdc.gov/tobacco/data_statistics/fact_sheets/tobacco_industry/brand_preference/index.htm\" target=\"_blank\" rel=\"noopener\">best-selling\u003c/a> mint-flavored cigarette. The ads, featuring vintage film of people smashing kegs during Prohibition, claim that it didn’t work for alcohol and drugs, so it won’t work for flavored tobacco.\u003c/p>\n\u003cp>Billionaire Michael Bloomberg \u003ca href=\"https://www.kqed.org/futureofyou/441395/sf-voters-may-ban-vape-flavors-menthol-cigarettes\" target=\"_blank\" rel=\"noopener\">contributed $1.8 million\u003c/a> to the Yes campaign.\u003c/p>\n\u003cp>San Francisco resident Donna Anderson protested on behalf of the No campaign during a recent rally at Civic Center.\u003c/p>\n\u003cp>\u003cem>‘No on Proposition E’ ads, funded by the tobacco industry, liken the proposed ban to 1920s-era Prohibition …\u003c/em>\u003c/p>\n\u003cp>\u003ciframe loading=\"lazy\" title=\"Bans Don’t Work, No on Prop E (30 sec.)\" width=\"500\" height=\"281\" src=\"https://www.youtube.com/embed/HHKy5eum8l4?start=3&feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen>\u003c/iframe>\u003c/p>\n\u003cp>“You’re just driving sales underground,” says Anderson. “It will not stop people from accessing what they want or using what they want.”\u003c/p>\n\u003cp>She uses the example of marijuana laws to illustrate how a black market usually hurts people of color the most.\u003c/p>\n\u003cp>“Black people, Latino people; people have been locked up — and are still locked up — having to do with little more than an ounce of marijuana,” said Anderson.\u003c/p>\n\u003cp>\u003cstrong>Local Businesses On Edge\u003c/strong>\u003c/p>\n\u003cp>At the Mission Smoke Shop, owner Sam Azar has plastered his walls with “No-on-E” signs.\u003c/p>\n\u003cp>“It’s going to hurt me as a small business here in the city by, like 30 percent or more,” he predicts.\u003c/p>\n\u003cfigure id=\"attachment_441406\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-441406 size-medium\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/05/IMG_5146-e1525820098164-800x531.jpg\" alt=\"\" width=\"800\" height=\"531\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/13/2018/05/IMG_5146-e1525820098164-800x531.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/13/2018/05/IMG_5146-e1525820098164-160x106.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/13/2018/05/IMG_5146-e1525820098164-768x510.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/13/2018/05/IMG_5146-e1525820098164-1020x677.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/13/2018/05/IMG_5146-e1525820098164-1200x797.jpg 1200w, https://cdn.kqed.org/wp-content/uploads/sites/13/2018/05/IMG_5146-e1525820098164-1180x784.jpg 1180w, https://cdn.kqed.org/wp-content/uploads/sites/13/2018/05/IMG_5146-e1525820098164-960x638.jpg 960w, https://cdn.kqed.org/wp-content/uploads/sites/13/2018/05/IMG_5146-e1525820098164-240x159.jpg 240w, https://cdn.kqed.org/wp-content/uploads/sites/13/2018/05/IMG_5146-e1525820098164-375x249.jpg 375w, https://cdn.kqed.org/wp-content/uploads/sites/13/2018/05/IMG_5146-e1525820098164-520x345.jpg 520w, https://cdn.kqed.org/wp-content/uploads/sites/13/2018/05/IMG_5146-e1525820098164.jpg 1843w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Sam Azar worries about how a ban on flavored tobacco products will hurt the bottom line at his Mission Smoke Shop. \u003ccite>(Lesley McClurg/ KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>He would no longer profit from flavored pipe tobacco, flavored hookah, infused cigars, or numerous racks of syrupy vape liquids. There are more than 7,000 sweet and savory e-cigarette flavors on the market — everything from gummi bear and Unicorn Milk to Red Bull and nacho cheese.\u003c/p>\n\u003cp>But medical experts worry about the role aromas play in enticing young people to try nicotine and get hooked on cigarettes.\u003c/p>\n\u003cp>Derek Smith, director of the \u003ca href=\"http://sanfranciscotobaccofreeproject.org/\" target=\"_blank\" rel=\"noopener\">Tobacco Free Project\u003c/a> at the San Francisco Department of Public Health, says flavors and menthol deceptively mask the taste of tobacco and make it easier to inhale nicotine.\u003c/p>\n\u003cp>“Someone who has tried a cigarette for the first time will often turn green and cough,” said Smith, in an email. “Imagine instead a cereal, milk-flavored inhalation that is considerably less harsh to start with.”\u003c/p>\n\u003cp>\u003cstrong>Physicians Take to the Streets\u003c/strong>\u003c/p>\n\u003cp>Smith \u003ca href=\"https://www.cdph.ca.gov/Programs/CCDPHP/DCDIC/CTCB/CDPH%20Document%20Library/Policy/FlavoredTobaccoAndMenthol/FinalFlavoredTobaccoInfographic.pdf\" target=\"_blank\" rel=\"noopener\">says\u003c/a> nearly all youth in the state start their tobacco habit with a flavored product, which worries doctors who gathered at a recent “Yes-on-E” rally on the steps of the Civic Center.\u003c/p>\n\u003cp>“The tobacco industry has targeted menthol cigarettes to the black community, to poor people, to mothers,” said Amanda Wright, a resident physician at UCSF. “And if you look at these products, they literally look like candy and that is clearly targeting our children.”\u003c/p>\n\u003cp>Wright was standing next to a table laden with row after row of juice boxes and candy wrappers. They look like sugary snack foods, but they’re actually packages of vaping products. The New York Times recently \u003ca href=\"https://www.nytimes.com/2018/05/01/health/fda-crackdown-vaping-children.html\" target=\"_blank\" rel=\"noopener\">reported\u003c/a> on a federal crackdown of these look-alikes.\u003c/p>\n\u003cfigure id=\"attachment_441402\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-441402 size-large\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/05/IMG_5101-e1525822179863-1020x498.jpg\" alt=\"\" width=\"640\" height=\"312\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/13/2018/05/IMG_5101-e1525822179863-1020x498.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/13/2018/05/IMG_5101-e1525822179863-160x78.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/13/2018/05/IMG_5101-e1525822179863-800x391.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/13/2018/05/IMG_5101-e1525822179863-768x375.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/13/2018/05/IMG_5101-e1525822179863-1200x586.jpg 1200w, https://cdn.kqed.org/wp-content/uploads/sites/13/2018/05/IMG_5101-e1525822179863-1180x576.jpg 1180w, https://cdn.kqed.org/wp-content/uploads/sites/13/2018/05/IMG_5101-e1525822179863-960x469.jpg 960w, https://cdn.kqed.org/wp-content/uploads/sites/13/2018/05/IMG_5101-e1525822179863-240x117.jpg 240w, https://cdn.kqed.org/wp-content/uploads/sites/13/2018/05/IMG_5101-e1525822179863-375x183.jpg 375w, https://cdn.kqed.org/wp-content/uploads/sites/13/2018/05/IMG_5101-e1525822179863-520x254.jpg 520w, https://cdn.kqed.org/wp-content/uploads/sites/13/2018/05/IMG_5101-e1525822179863.jpg 1896w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003cfigcaption class=\"wp-caption-text\">The candylike packaging for vaping products on display at a Yes-on-E rally. \u003ccite>(Lesley McClurg/ KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Nicotine is particularly addictive for the teenage brain, according to Pam Ling, a physician and smoking researcher at UCSF.\u003c/p>\n\u003cp>“This population is the future of the tobacco industry,” says Ling. “The industry recognized decades ago that if they don’t get kids to start, they [the industry] will die out.”\u003c/p>\n\u003cp>The California Department of Public Health \u003ca href=\"https://www.cdph.ca.gov/Programs/CCDPHP/DCDIC/CTCB/CDPH%20Document%20Library/Policy/FlavoredTobaccoAndMenthol/FinalFlavoredTobaccoInfographic.pdf\" target=\"_blank\" rel=\"noopener\">says\u003c/a> the number of kids in California who vape is currently double the number who smoke, but some \u003ca href=\"http://pediatrics.aappublications.org/content/early/2017/11/30/peds.2017-1832\" target=\"_blank\" rel=\"noopener\">research\u003c/a> suggests that a lot of those kids will be smoking cigarettes before long.\u003c/p>\n\u003cp>“Once these kids start with the e-cigarettes, the likelihood that they’ll be smoking cigarettes a year or so later is increased by a factor of three or four,” says Stanton Glantz, who heads the \u003ca href=\"https://tobacco.ucsf.edu/\">Center for Tobacco Control Research and Education\u003c/a> at UCSF.\u003c/p>\n\u003cp>Glantz says that in his \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/28115540\" target=\"_blank\" rel=\"noopener\">research\u003c/a>, about a third of the kids who start using nicotine via e-cigarettes are not the kind of kids whose race, gender, home life and school performance would make them a high risk to pick up smoking on their own.\u003c/p>\n\u003cp>In other words, vaping is increasing the pool of teen smokers. A 2016 \u003ca href=\"https://e-cigarettes.surgeongeneral.gov/documents/2016_SGR_Exec_Summ_508.pdf\" target=\"_blank\" rel=\"noopener\">report\u003c/a> from the U.S. Surgeon General cited a 900 percent increase in the use of e-cigarettes by high school students from 2011 to 2015. Right now there is very little regulation of e-products at the federal level.\u003c/p>\n\u003cfigure id=\"attachment_441466\" class=\"wp-caption alignright\" style=\"max-width: 800px\">\u003ca href=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/05/RS30897_PROPE_076-e1525979992131.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-441466 size-medium\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/05/RS30897_PROPE_076-800x1200.jpg\" alt=\"\" width=\"800\" height=\"1200\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">An array of flavors displayed at Vapor Den, including banana cream, mango and fruit mix. \u003ccite>(Lauren Hanussak/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Glantz also contends that a flavor ban will help adults who \u003ca href=\"https://www.npr.org/sections/health-shots/2017/05/25/530026958/many-adults-dont-think-exposure-to-vaping-is-bad-for-kids\" target=\"_blank\" rel=\"noopener\">think they’re inhaling\u003c/a> a significantly safer alternative.\u003c/p>\n\u003cp>“When e-cigarettes first became available, there was a lot of hope that they would be better than cigarettes,” he says, “but the more we learn the worse they look.”\u003c/p>\n\u003cp>Though the long-term health effects of smoking e-cigarettes is still unknown, Glantz believes the safety of the devices has been \u003ca href=\"https://www.annualreviews.org/doi/abs/10.1146/annurev-publhealth-040617-013757\" target=\"_blank\" rel=\"noopener\">oversold\u003c/a>.\u003c/p>\n\u003cp>“Electronic smoking products emit particles of chemicals, not clean air, and technically an aerosol, not a vapor,” Smith says. “Think smog or hairspray — not the pure water vapor that steams when your teapot whistles.”\u003c/p>\n\u003cp>These \u003ca href=\"https://pubs.acs.org/doi/full/10.1021/acs.chemrestox.6b00188?src=recsys&=\" target=\"_blank\" rel=\"noopener\">ultrafine particles and toxins\u003c/a> can damage the lungs and may lead to heart attacks. Levels of the particles in the vapor produced by some devices may be lower than in tobacco smoke, but aren’t zero.\u003c/p>\n\u003cp>\u003ciframe loading=\"lazy\" title=\"Why Is Vaping So Popular?\" width=\"500\" height=\"281\" src=\"https://www.youtube.com/embed/P9zps5LsVXs?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen>\u003c/iframe>\u003c/p>\n\u003cp>If San Francisco voters pass the flavor ban, it will be among the \u003ca href=\"https://www.npr.org/sections/thetwo-way/2017/10/24/559833483/new-york-bans-vaping-indoors-in-public-state-law-classes-e-cigs-with-cigarettes\" target=\"_blank\" rel=\"noopener\">toughest restrictions\u003c/a> on e-cigarettes in the country; opponents of the measure fear it will set a precedent.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>Jon Brooks contributed to this post. This post has been edited since it was originally published.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Millions May Have Been Prescribed the Wrong Heart Meds, Study Says",
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"content": "\u003cp>More than 11 million Americans may have received incorrect prescriptions for aspirin, statins and blood pressure medications to prevent a heart attack or stroke, according to a study by the \u003ca href=\"http://med.stanford.edu/\">Stanford University School of Medicine\u003c/a>.[contextly_sidebar id=\"umDTpLmik9hK8eNRjnsW7rpmcRPF19ZX\"]\u003c/p>\n\u003cp>That's because the tool used to estimate a patient's risk of heart attack or stroke is based on outdated data, apparently off by as much as 20 percent, according to the \u003ca href=\"http://annals.org/aim/article-abstract/2683613/clinical-implications-revised-pooled-cohort-equations-estimating-atherosclerotic-cardiovascular-disease\" target=\"_blank\" rel=\"noopener\">study\u003c/a>, published Monday in \u003cem>Annals of Internal Medicine.\u003c/em>\u003c/p>\n\u003cp>\"A lot has changed in terms of diets, environments and medical treatment since the 1940s,” senior author Dr. Sanjay Basu said in the \u003ca href=\"http://med.stanford.edu/news/all-news/2018/06/millions-could-have-incorrect-statin-aspirin-blood-pressure-prescriptions.html\" target=\"_blank\" rel=\"noopener\">press release \u003c/a>that accompanied the study. “So, relying on our grandparents’ data to make our treatment choices is probably not the best idea.”\u003c/p>\n\u003cp>The problem was discovered when some doctors, including Basu, kept noticing that the current tool was failing to accurately predict risk in their patients, particularly if they were African American.\u003c/p>\n\u003cp>Because the calculator was built on older studies that lacked a sufficient sample of African-Americans, doctors may have in fact been underestimating the risks of heart attacks or strokes in those patients.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“So while many Americans were being recommended aggressive treatments that they may not have needed according to current guidelines, some Americans — particularly African-Americans — may have been given false reassurance and probably need to start treatment given our findings,” Basu said in the press release.[contextly_sidebar id=\"IVz9AhjwqJ3N1XCCqSO9xlwYfN9Xm5GQ\"]\u003c/p>\n\u003cp>The study says that in many cases medications were over prescribed.\u003c/p>\n\u003cp>A CBS \u003ca href=\"https://www.cbsnews.com/news/millions-of-americans-could-be-getting-wrong-heart-meds-study-finds/\" target=\"_blank\" rel=\"noopener\">report\u003c/a> describes the calculator's importance in developing preventive treatments:\u003c/p>\n\u003cblockquote>\u003cp>Risk estimate tools predict the likelihood of a future heart attack or stroke in the next 10 years. Doctors use these tools to help them decide what treatment a patient needs, if any at all.\u003c/p>\u003c/blockquote>\n\u003cp>In response to the troubling findings, the team of researchers developed a new calculator, incorporating an updated list of risk factors. From a \u003ca href=\"https://www.statnews.com/2018/06/04/new-risk-calculator-could-change-the-aspirin-statins-and-blood-pressure-medications-some-people-take/\" target=\"_blank\" rel=\"noopener\">STAT \u003c/a>news story:\u003c/p>\n\u003cblockquote>\u003cp>To test their methods, the researchers created two models. In the first one, they updated the cohorts they used. The populations were more diverse racially and ethnically, and they also reflected factors that can’t necessarily be captured by blood tests. Nutrition, physical activity, or even secondhand smoke — which wasn’t recognized in the 1940s — can affect a person’s baseline risk for disease. That’s why risk calculators don’t stay accurate forever.\u003c/p>\u003c/blockquote>\n\u003cp>Some doctors, however, still question whether the updated calculator can accurately assess risks in communities of color.\u003c/p>\n\u003cp>Dr. Andrew DeFilippis and Patrick Trainor of the University of Louisville, Kentucky say the new calculator falls short in accounting for racial differences in risk factors.\u003c/p>\n\u003cp>“This question is timely because a growing Hispanic population and 40 percent increase in Asian-Americans account for more than half of the U. S. population growth between 2000 and 2019,” they said in an \u003ca href=\"http://annals.org/aim/article/doi/10.7326/M18-1175\" target=\"_blank\" rel=\"noopener\">editorial\u003c/a> published with the Stanford study. “We clearly need an accurate risk assessment tool for these growing American populations.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The Stanford researchers say the newer tool will need to be updated with changing times.\u003c/p>\n\n",
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"excerpt": "A Stanford study finds that a traditional tool used by doctors to assess patients' risk of heart attack or stroke is based on decades old data, causing many doctors to incorrectly prescribe drugs.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>More than 11 million Americans may have received incorrect prescriptions for aspirin, statins and blood pressure medications to prevent a heart attack or stroke, according to a study by the \u003ca href=\"http://med.stanford.edu/\">Stanford University School of Medicine\u003c/a>.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>That's because the tool used to estimate a patient's risk of heart attack or stroke is based on outdated data, apparently off by as much as 20 percent, according to the \u003ca href=\"http://annals.org/aim/article-abstract/2683613/clinical-implications-revised-pooled-cohort-equations-estimating-atherosclerotic-cardiovascular-disease\" target=\"_blank\" rel=\"noopener\">study\u003c/a>, published Monday in \u003cem>Annals of Internal Medicine.\u003c/em>\u003c/p>\n\u003cp>\"A lot has changed in terms of diets, environments and medical treatment since the 1940s,” senior author Dr. Sanjay Basu said in the \u003ca href=\"http://med.stanford.edu/news/all-news/2018/06/millions-could-have-incorrect-statin-aspirin-blood-pressure-prescriptions.html\" target=\"_blank\" rel=\"noopener\">press release \u003c/a>that accompanied the study. “So, relying on our grandparents’ data to make our treatment choices is probably not the best idea.”\u003c/p>\n\u003cp>The problem was discovered when some doctors, including Basu, kept noticing that the current tool was failing to accurately predict risk in their patients, particularly if they were African American.\u003c/p>\n\u003cp>Because the calculator was built on older studies that lacked a sufficient sample of African-Americans, doctors may have in fact been underestimating the risks of heart attacks or strokes in those patients.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“So while many Americans were being recommended aggressive treatments that they may not have needed according to current guidelines, some Americans — particularly African-Americans — may have been given false reassurance and probably need to start treatment given our findings,” Basu said in the press release.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>The study says that in many cases medications were over prescribed.\u003c/p>\n\u003cp>A CBS \u003ca href=\"https://www.cbsnews.com/news/millions-of-americans-could-be-getting-wrong-heart-meds-study-finds/\" target=\"_blank\" rel=\"noopener\">report\u003c/a> describes the calculator's importance in developing preventive treatments:\u003c/p>\n\u003cblockquote>\u003cp>Risk estimate tools predict the likelihood of a future heart attack or stroke in the next 10 years. Doctors use these tools to help them decide what treatment a patient needs, if any at all.\u003c/p>\u003c/blockquote>\n\u003cp>In response to the troubling findings, the team of researchers developed a new calculator, incorporating an updated list of risk factors. From a \u003ca href=\"https://www.statnews.com/2018/06/04/new-risk-calculator-could-change-the-aspirin-statins-and-blood-pressure-medications-some-people-take/\" target=\"_blank\" rel=\"noopener\">STAT \u003c/a>news story:\u003c/p>\n\u003cblockquote>\u003cp>To test their methods, the researchers created two models. In the first one, they updated the cohorts they used. The populations were more diverse racially and ethnically, and they also reflected factors that can’t necessarily be captured by blood tests. Nutrition, physical activity, or even secondhand smoke — which wasn’t recognized in the 1940s — can affect a person’s baseline risk for disease. That’s why risk calculators don’t stay accurate forever.\u003c/p>\u003c/blockquote>\n\u003cp>Some doctors, however, still question whether the updated calculator can accurately assess risks in communities of color.\u003c/p>\n\u003cp>Dr. Andrew DeFilippis and Patrick Trainor of the University of Louisville, Kentucky say the new calculator falls short in accounting for racial differences in risk factors.\u003c/p>\n\u003cp>“This question is timely because a growing Hispanic population and 40 percent increase in Asian-Americans account for more than half of the U. S. population growth between 2000 and 2019,” they said in an \u003ca href=\"http://annals.org/aim/article/doi/10.7326/M18-1175\" target=\"_blank\" rel=\"noopener\">editorial\u003c/a> published with the Stanford study. “We clearly need an accurate risk assessment tool for these growing American populations.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The Stanford researchers say the newer tool will need to be updated with changing times.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Many Breast Cancer Patients Can Skip Chemo, Study Finds",
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"content": "\u003cp>Most women with the most common form of early-stage breast cancer can safely skip chemotherapy without hurting their chances of beating the disease, doctors are reporting from a landmark study that used genetic testing to gauge each patient’s risk.[contextly_sidebar id=\"BFMet48xKrp1h6NyWt3K8Xsz7gIOPSeq\"]\u003c/p>\n\u003cp>The study is the largest ever done of breast cancer treatment, and the results are expected to spare up to 70,000 patients a year in the United States and many more elsewhere the ordeal and expense of these drugs.\u003c/p>\n\u003cp>“The impact is tremendous,” said the study leader, Dr. Joseph Sparano of Montefiore Medical Center in New York. Most women in this situation don’t need treatment beyond surgery and hormone therapy, he said.\u003c/p>\n\u003cp>The study was funded by the National Cancer Institute, some foundations and proceeds from the U.S. breast cancer postage stamp. Results were discussed Sunday at an American Society of Clinical Oncology conference in Chicago and published by the New England Journal of Medicine. Some study leaders consult for breast cancer drugmakers or for the company that makes the gene test.\u003c/p>\n\u003cp>\u003cstrong>Moving Away From Chemo\u003c/strong>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Cancer care has been evolving away from chemotherapy — older drugs with harsh side effects — in favor of gene-targeting therapies, hormone blockers and immune system treatments. When chemo is used now, it’s sometimes for shorter periods or lower doses than it once was.\u003c/p>\n\u003cp>For example, another study at the conference found that Merck’s immunotherapy drug Keytruda worked better than chemo as initial treatment for most people with the most common type of lung cancer, and with far fewer side effects.[contextly_sidebar id=\"sLig6uVQeZQDplnvMdLRkmGUnVlPvI7v\"]\u003c/p>\n\u003cp>The breast cancer study focused on cases where chemo’s value increasingly is in doubt: women with early-stage disease that has not spread to lymph nodes, is hormone-positive (meaning its growth is fueled by estrogen or progesterone) and is not the type that the drug Herceptin targets.\u003c/p>\n\u003cp>The usual treatment is surgery followed by years of a hormone-blocking drug. But many women also are urged to have chemo to help kill any stray cancer cells. Doctors know that most don’t need it, but evidence is thin on who can forgo it.\u003c/p>\n\u003cp>The study gave 10,273 patients a test called Oncotype DX, which uses a biopsy sample to measure the activity of genes involved in cell growth and response to hormone therapy, to estimate the risk that a cancer will recur.\u003c/p>\n\u003cp>\u003cstrong>What the Study Found\u003c/strong>\u003c/p>\n\u003cp>About 17 percent of women had high-risk scores and were advised to have chemo. The 16 percent with low-risk scores now know they can skip chemo, based on earlier results from this study.\u003c/p>\n\u003cp>The new results are on the 67 percent of women at intermediate risk. All had surgery and hormone therapy, and half also got chemo.[contextly_sidebar id=\"TPjTNdjmhxB5MX6ZoUQCtfkvBdzmJm43\"]\u003c/p>\n\u003cp>After nine years, 94 percent of both groups were still alive, and about 84 percent were alive without signs of cancer, so adding chemo made no difference.\u003c/p>\n\u003cp>Certain women 50 or younger did benefit from chemo; slightly fewer cases of cancer spreading far beyond the breast occurred among some of them given chemo, depending on their risk scores on the gene test.\u003c/p>\n\u003cp>\u003cstrong>Will People Trust the Results?\u003c/strong>\u003c/p>\n\u003cp>All women like those in the study should get gene testing to guide their care, said Dr. Richard Schilsky, chief medical officer of the oncology society. Oncotype DX costs around $4,000, which Medicare and many insurers cover. Similar tests including one called MammaPrint also are widely used.\u003c/p>\n\u003cp>Testing solved a big problem of figuring out who needs chemo, said Dr. Harold Burstein of the Dana-Farber Cancer Institute in Boston. Many women think “if I don’t get chemotherapy I’m going to die, and if I get chemo I’m going to be cured,” but the results show there’s a sliding scale of benefit and sometimes none, he said.\u003c/p>\n\u003cp>Dr. Lisa Carey, a breast specialist at the University of North Carolina’s Lineberger Comprehensive Cancer Center, said she would be very comfortable advising patients to skip chemo if they were like those in the study who did not benefit from it.[contextly_sidebar id=\"2pkXhBlSu04mLyMby8g8IUTSIxIwtjpB\"]\u003c/p>\n\u003cp>Dr. Jennifer Litton at MD Anderson Cancer Center in Houston, agreed, but said: “Risk to one person is not the same thing as risk to another. There are some people who say, ’I don’t care what you say, I’m never going to do chemo,’” and won’t even have the gene test, she said. Others want chemo for even the smallest chance of benefit.\u003c/p>\n\u003cp>Adine Usher, 78, who lives in Hartsdale, New York, joined the study 10 years ago at Montefiore and was randomly assigned to the group given chemo.\u003c/p>\n\u003cp>“I was a little relieved. I sort of viewed chemo as extra insurance,” she said. The treatments “weren’t pleasant,” she concedes. Her hair fell out, she developed an infection and was hospitalized for a low white blood count, “but it was over fairly quickly and I’m really glad I had it.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>If doctors had recommended she skip chemo based on the gene test, “I would have accepted that,” she said. “I’m a firm believer in medical research.”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Most women with the most common form of early-stage breast cancer can safely skip chemotherapy without hurting their chances of beating the disease, doctors are reporting from a landmark study that used genetic testing to gauge each patient’s risk.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>The study is the largest ever done of breast cancer treatment, and the results are expected to spare up to 70,000 patients a year in the United States and many more elsewhere the ordeal and expense of these drugs.\u003c/p>\n\u003cp>“The impact is tremendous,” said the study leader, Dr. Joseph Sparano of Montefiore Medical Center in New York. Most women in this situation don’t need treatment beyond surgery and hormone therapy, he said.\u003c/p>\n\u003cp>The study was funded by the National Cancer Institute, some foundations and proceeds from the U.S. breast cancer postage stamp. Results were discussed Sunday at an American Society of Clinical Oncology conference in Chicago and published by the New England Journal of Medicine. Some study leaders consult for breast cancer drugmakers or for the company that makes the gene test.\u003c/p>\n\u003cp>\u003cstrong>Moving Away From Chemo\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Cancer care has been evolving away from chemotherapy — older drugs with harsh side effects — in favor of gene-targeting therapies, hormone blockers and immune system treatments. When chemo is used now, it’s sometimes for shorter periods or lower doses than it once was.\u003c/p>\n\u003cp>For example, another study at the conference found that Merck’s immunotherapy drug Keytruda worked better than chemo as initial treatment for most people with the most common type of lung cancer, and with far fewer side effects.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>The breast cancer study focused on cases where chemo’s value increasingly is in doubt: women with early-stage disease that has not spread to lymph nodes, is hormone-positive (meaning its growth is fueled by estrogen or progesterone) and is not the type that the drug Herceptin targets.\u003c/p>\n\u003cp>The usual treatment is surgery followed by years of a hormone-blocking drug. But many women also are urged to have chemo to help kill any stray cancer cells. Doctors know that most don’t need it, but evidence is thin on who can forgo it.\u003c/p>\n\u003cp>The study gave 10,273 patients a test called Oncotype DX, which uses a biopsy sample to measure the activity of genes involved in cell growth and response to hormone therapy, to estimate the risk that a cancer will recur.\u003c/p>\n\u003cp>\u003cstrong>What the Study Found\u003c/strong>\u003c/p>\n\u003cp>About 17 percent of women had high-risk scores and were advised to have chemo. The 16 percent with low-risk scores now know they can skip chemo, based on earlier results from this study.\u003c/p>\n\u003cp>The new results are on the 67 percent of women at intermediate risk. All had surgery and hormone therapy, and half also got chemo.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>After nine years, 94 percent of both groups were still alive, and about 84 percent were alive without signs of cancer, so adding chemo made no difference.\u003c/p>\n\u003cp>Certain women 50 or younger did benefit from chemo; slightly fewer cases of cancer spreading far beyond the breast occurred among some of them given chemo, depending on their risk scores on the gene test.\u003c/p>\n\u003cp>\u003cstrong>Will People Trust the Results?\u003c/strong>\u003c/p>\n\u003cp>All women like those in the study should get gene testing to guide their care, said Dr. Richard Schilsky, chief medical officer of the oncology society. Oncotype DX costs around $4,000, which Medicare and many insurers cover. Similar tests including one called MammaPrint also are widely used.\u003c/p>\n\u003cp>Testing solved a big problem of figuring out who needs chemo, said Dr. Harold Burstein of the Dana-Farber Cancer Institute in Boston. Many women think “if I don’t get chemotherapy I’m going to die, and if I get chemo I’m going to be cured,” but the results show there’s a sliding scale of benefit and sometimes none, he said.\u003c/p>\n\u003cp>Dr. Lisa Carey, a breast specialist at the University of North Carolina’s Lineberger Comprehensive Cancer Center, said she would be very comfortable advising patients to skip chemo if they were like those in the study who did not benefit from it.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Dr. Jennifer Litton at MD Anderson Cancer Center in Houston, agreed, but said: “Risk to one person is not the same thing as risk to another. There are some people who say, ’I don’t care what you say, I’m never going to do chemo,’” and won’t even have the gene test, she said. Others want chemo for even the smallest chance of benefit.\u003c/p>\n\u003cp>Adine Usher, 78, who lives in Hartsdale, New York, joined the study 10 years ago at Montefiore and was randomly assigned to the group given chemo.\u003c/p>\n\u003cp>“I was a little relieved. I sort of viewed chemo as extra insurance,” she said. The treatments “weren’t pleasant,” she concedes. Her hair fell out, she developed an infection and was hospitalized for a low white blood count, “but it was over fairly quickly and I’m really glad I had it.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>If doctors had recommended she skip chemo based on the gene test, “I would have accepted that,” she said. “I’m a firm believer in medical research.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Study Aims To Show Transplants Between HIV-Positive Patients Are Safe, Save Lives",
"title": "Study Aims To Show Transplants Between HIV-Positive Patients Are Safe, Save Lives",
"headTitle": "KQED Future of You | KQED Science",
"content": "\u003cp>A large-scale clinical trial launched by the National Institutes of Health in May could pave the way for more HIV-positive patients with kidney disease to receive life-saving transplants.[contextly_sidebar id=\"a0scXdDhVUfyg2KqOZ0K4mbuthRZryBP\"]\u003c/p>\n\u003cp>The trial, called the \u003ca href=\"https://www.nih.gov/news-events/news-releases/nih-clinical-trial-track-outcomes-kidney-transplantation-hiv-positive-donors-hiv-positive-recipients\" target=\"_blank\" rel=\"noopener\">HOPE in Action Multicenter Kidney Study,\u003c/a> will assess the risks of transplanting kidneys from HIV-positive donors into patients living with the virus, says Dr. Christine Durand, assistant professor of medicine at Johns Hopkins University and a principal investigator of the study.\u003c/p>\n\u003cp>\"We have an organ shortage crisis in this country and individuals living with HIV are disproportionately affected,\" she says. The research will help determine whether the pool of HIV-infected organs is \"safe and effective.\" If so, she says, it would benefit everyone awaiting kidneys.\u003c/p>\n\u003cp>\"Everytime someone with HIV gets an organ transplant they move everybody else up on the waitlist,\" says Durand.\u003c/p>\n\u003cp>There are \u003ca href=\"https://www.kidney.org/news/newsroom/factsheets/End-Stage-Renal-Disease-in-the-US\" target=\"_blank\" rel=\"noopener\">468,000 Americans\u003c/a> receiving dialysis for end-stage renal disease. According to Durand's research, an estimated 1.5 percent of those live with HIV. About 1 percent of liver transplant candidates have HIV.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"This means that more than 10,000 HIV positive individuals could benefit from a kidney or liver transplant,\" says Durand.\u003c/p>\n\u003cp>The HOPE in Action study will track 160 kidney transplants, half receiving HIV-positive kidneys and half receiving virus-free organs. Recipients will be monitored after surgery for signs of organ rejection, organ failure, and other complications, such as the risk of infecting the patient with more than one strain of HIV.\u003c/p>\n\u003cp>This will allow doctors to more accurately predict risk after these transplants, and offer the procedure to more HIV-positive people on the transplant waiting list. The researchers also hope to make a case for allowing such transplants to become standard care.\u003c/p>\n\u003cp>Currently, HIV-positive transplants are only permitted if they are part of a clinical trial, such as this one. In 2013, President Obama signed a law, \u003ca href=\"https://obamawhitehouse.archives.gov/blog/2013/11/21/hiv-organ-policy-equity-hope-act-now-law\" target=\"_blank\" rel=\"noopener\">the HIV Organ Policy Equity (HOPE) Act\u003c/a>, allowing HIV-positive individuals to donate certain organs (currently only kidneys and livers), but only as part of a research study conducted with oversight by an academic institution.\u003c/p>\n\u003cp>That law partly rolled back a 1988 law which outlawed harvesting HIV-infected organs.[contextly_sidebar id=\"xbpxyu6mzzv9z7TaZRMEIp5klSJ3h0RD\"]\u003c/p>\n\u003cp>\"At the time it was at the height of the AIDS scare,\" Durand says. \"HIV was a death sentence, so there were a lot of laws put into place to protect the blood supply, to protect organ donation.\"\u003c/p>\n\u003cp>HIV-positive transplant candidates are already eligible to receive virus-free organs, but generally \"they face longer wait times than those who don't have the virus,\" says Durand. This is the case, she adds, even though they have similar survival and organ function after transplant.\u003c/p>\n\u003cp>As HIV testing and treatment improved, donation has become feasible, she says. And \u003ca href=\"http://jasn.asnjournals.org/content/26/9/2222.abstract\" target=\"_blank\" rel=\"noopener\">early research started to show\u003c/a> transplant survival rates could be similar to those of transplant recipients without HIV.\u003c/p>\n\u003cp>But \"many transplant centers say they don't have the expertise or experience to perform these transplants,\" says Durand. The HOPE study may provide data to change this and set clinicians' fears to rest.\u003c/p>\n\u003cp>One center participating in the trial is Indiana University Health in Indianapolis. They've yet to perform a transplant but in April, the Indiana Donor Network, Indiana's organ procurement organization recovered organs from an HIV-positive donor for the first time, and successfully matched a kidney and a liver to two people who needed them out of state. Dr. Tim Taber, chief medical officer for the Indiana Donor Network and a transplant nephrologist at Indiana University Health says he thinks the HOPE in Action study can change clinicians' attitudes about HIV-positive transplantation.\u003c/p>\n\u003cp>\"I think people will be more comfortable with it after a while and after they see that it's been successful so I think it will become more and more common to see HIV-positive donors procured and put in, obviously, HIV-positive recipients,\" he says.\u003c/p>\n\u003cp>It took a few years after Obama signed the HOPE Act for transplants to actually happen between HIV-positive people. In 2015, the National Institutes of Health and Health and Human Services \u003ca href=\"https://www.niaid.nih.gov/sites/default/files/hopeactcriteria.pdf\" target=\"_blank\" rel=\"noopener\">published safeguards and research criteria\u003c/a> for medical centers willing to perform these transplants as clinical research. And a team at Johns Hopkins performed \u003ca href=\"https://www.npr.org/sections/health-shots/2016/03/31/472389956/new-source-of-transplant-organs-for-patients-with-hiv-others-with-hiv\" target=\"_blank\" rel=\"noopener\">the first HIV-positive organ transplant\u003c/a> in 2016.[contextly_sidebar id=\"hUwHooQjUeRk2Iaphb8SlbZQA0om8DpO\"]\u003c/p>\n\u003cp>Any organ procurement organization that follows the NIH research criteria can send HIV-infected donor organs to transplant centers.\u003c/p>\n\u003cp>So far only 16 out of 58 organ procurement organizations around the country have worked on HIV-positive cases since the HOPE Act made it legal, according to Brianna Doby, donation community consultant for a team at Johns Hopkins University that supports organ recovery organizations dealing with their first HIV-positive donor.\u003c/p>\n\u003cp>So far, there have been approximately 50 HIV-positive kidney and liver transplants performed in the U.S. This is far fewer than researchers at Johns Hopkins predicted in a 2011 study, published in the American Journal of Transplantation. They estimated between 500 and 600 new HIV-positive organs would become available after the HOPE Act.\u003c/p>\n\u003cp>Doby says for the past several decades the transplant system has focused on doing everything possible to exclude disease from the donor pool, including HIV and Hepatitis C. And some organ procurement organizations still fear their staff will be at risk when working with an HIV-positive donor. But that needs to change, she says.\u003c/p>\n\u003cp>\"We need to be able to work with organs that increase the risk of those disease, or if you have one of those diseases, find a donor that has those,\" she says. \"Because it's the best shot you have at life, right?\"\u003c/p>\n\u003cp>For the HOPE Act to fulfill its potential Doby says more donors are needed. \"The HOPE Act is not widely known about and many people might just assume they can't be donors if they are also HIV-positive, so they don't register,\" she says.\u003c/p>\n\u003cp>Donation centers are gradually starting to recover more HIV-infected organs, according to Dorry Segev, a transplant surgeon at Johns Hopkins and another principal investigator on the new NIH study. Some local organ procurement centers are \"interested in being pioneers in this area and have been really responsive and good at recovering organs from donors with HIV,\" Segev wrote in an e-mail, while others are \"waiting in the wings to see what happens.\"\u003c/p>\n\u003cp>Any fear they have about the safety of harvesting HIV-positive organs are unfounded he says. He hopes more centers will realize that \"recovering HIV+ organs is not just something interesting, but is actually a responsibility to our patients.\"[contextly_sidebar id=\"XejfKo4ekdt9y93X9my8fqXKEZLcgJLe\"]\u003c/p>\n\u003cp>At hospital transplant centers, clinicians biggest fear is that patients could contract a second strain of HIV from the donor, Segev explains. \"In fact,\" he wrote, \"we have such good [antiretroviral therapy] regimens that basically any strain of HIV can be suppressed with \u003cem>some\u003c/em> ART regimen, so no matter what strain of HIV comes from the donor, we can basically treat it in the recipient.\"\u003c/p>\n\u003cp>If a hospital performing transplants wants to receive HIV-positive organs they have to receive institutional review board approval and prove that they can meet transplantation criteria outlined by the Department of Health and Human Services. The process might deter some transplant centers from participating.\u003c/p>\n\u003cp>Indiana Donor Network's Taber says it's not hard to meet the requirements to procure HIV-positive organs because the safety precautions are the same whether or not there's an infection. His protocol is to \"treat everybody like they have some infection from the moon that you don't want to get.\"\u003c/p>\n\u003cp>And if it can help more patients get transplants, he says, it's a good thing.\u003c/p>\n\u003cp>\"It provides just another opportunity for patients to get transplanted,\" he says.\"It's not a home run but it's one more way to get these people off the list.\"\u003c/p>\n\u003cp>Durand says there's a lot of untapped potential to work with HIV-positive organs. So far 24 centers meet the criteria to perform transplants between people with HIV. Among these centers, Durand said there are more than 300 patients with HIV who have agreed to accept an HIV-positive organ. \"We expect this number to grow significantly,\" she says.\u003c/p>\n\u003cp>And if the trial goes well, it might open the door to other organs. She hopes future research trials will include hundreds of HIV-positive people waiting for hearts and lungs.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This story was produced in collaboration with WFYI and \u003c/em>\u003ca href=\"http://sideeffectspublicmedia.org\" target=\"_blank\" rel=\"noopener\">\u003cem>Side Effects Public Media\u003c/em>\u003c/a>\u003cem>, a news collaborative covering public health.\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 Side Effects Public Media. To see more, visit \u003ca>Side Effects Public Media\u003c/a>.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Study+Aims+To+Show+Transplants+Between+HIV-Positive+Patients+Are+Safe%2C+Save+Lives&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"excerpt": "Hundreds of otherwise viable organs that are HIV-positive are wasted each year, while HIV-positive patients in need of transplants languish on waiting lists. Researchers want to change that.",
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"description": "Hundreds of otherwise viable organs that are HIV-positive are wasted each year, while HIV-positive patients in need of transplants languish on waiting lists. Researchers want to change that.",
"title": "Study Aims To Show Transplants Between HIV-Positive Patients Are Safe, Save Lives | KQED",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>A large-scale clinical trial launched by the National Institutes of Health in May could pave the way for more HIV-positive patients with kidney disease to receive life-saving transplants.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>The trial, called the \u003ca href=\"https://www.nih.gov/news-events/news-releases/nih-clinical-trial-track-outcomes-kidney-transplantation-hiv-positive-donors-hiv-positive-recipients\" target=\"_blank\" rel=\"noopener\">HOPE in Action Multicenter Kidney Study,\u003c/a> will assess the risks of transplanting kidneys from HIV-positive donors into patients living with the virus, says Dr. Christine Durand, assistant professor of medicine at Johns Hopkins University and a principal investigator of the study.\u003c/p>\n\u003cp>\"We have an organ shortage crisis in this country and individuals living with HIV are disproportionately affected,\" she says. The research will help determine whether the pool of HIV-infected organs is \"safe and effective.\" If so, she says, it would benefit everyone awaiting kidneys.\u003c/p>\n\u003cp>\"Everytime someone with HIV gets an organ transplant they move everybody else up on the waitlist,\" says Durand.\u003c/p>\n\u003cp>There are \u003ca href=\"https://www.kidney.org/news/newsroom/factsheets/End-Stage-Renal-Disease-in-the-US\" target=\"_blank\" rel=\"noopener\">468,000 Americans\u003c/a> receiving dialysis for end-stage renal disease. According to Durand's research, an estimated 1.5 percent of those live with HIV. About 1 percent of liver transplant candidates have HIV.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"This means that more than 10,000 HIV positive individuals could benefit from a kidney or liver transplant,\" says Durand.\u003c/p>\n\u003cp>The HOPE in Action study will track 160 kidney transplants, half receiving HIV-positive kidneys and half receiving virus-free organs. Recipients will be monitored after surgery for signs of organ rejection, organ failure, and other complications, such as the risk of infecting the patient with more than one strain of HIV.\u003c/p>\n\u003cp>This will allow doctors to more accurately predict risk after these transplants, and offer the procedure to more HIV-positive people on the transplant waiting list. The researchers also hope to make a case for allowing such transplants to become standard care.\u003c/p>\n\u003cp>Currently, HIV-positive transplants are only permitted if they are part of a clinical trial, such as this one. In 2013, President Obama signed a law, \u003ca href=\"https://obamawhitehouse.archives.gov/blog/2013/11/21/hiv-organ-policy-equity-hope-act-now-law\" target=\"_blank\" rel=\"noopener\">the HIV Organ Policy Equity (HOPE) Act\u003c/a>, allowing HIV-positive individuals to donate certain organs (currently only kidneys and livers), but only as part of a research study conducted with oversight by an academic institution.\u003c/p>\n\u003cp>That law partly rolled back a 1988 law which outlawed harvesting HIV-infected organs.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\"At the time it was at the height of the AIDS scare,\" Durand says. \"HIV was a death sentence, so there were a lot of laws put into place to protect the blood supply, to protect organ donation.\"\u003c/p>\n\u003cp>HIV-positive transplant candidates are already eligible to receive virus-free organs, but generally \"they face longer wait times than those who don't have the virus,\" says Durand. This is the case, she adds, even though they have similar survival and organ function after transplant.\u003c/p>\n\u003cp>As HIV testing and treatment improved, donation has become feasible, she says. And \u003ca href=\"http://jasn.asnjournals.org/content/26/9/2222.abstract\" target=\"_blank\" rel=\"noopener\">early research started to show\u003c/a> transplant survival rates could be similar to those of transplant recipients without HIV.\u003c/p>\n\u003cp>But \"many transplant centers say they don't have the expertise or experience to perform these transplants,\" says Durand. The HOPE study may provide data to change this and set clinicians' fears to rest.\u003c/p>\n\u003cp>One center participating in the trial is Indiana University Health in Indianapolis. They've yet to perform a transplant but in April, the Indiana Donor Network, Indiana's organ procurement organization recovered organs from an HIV-positive donor for the first time, and successfully matched a kidney and a liver to two people who needed them out of state. Dr. Tim Taber, chief medical officer for the Indiana Donor Network and a transplant nephrologist at Indiana University Health says he thinks the HOPE in Action study can change clinicians' attitudes about HIV-positive transplantation.\u003c/p>\n\u003cp>\"I think people will be more comfortable with it after a while and after they see that it's been successful so I think it will become more and more common to see HIV-positive donors procured and put in, obviously, HIV-positive recipients,\" he says.\u003c/p>\n\u003cp>It took a few years after Obama signed the HOPE Act for transplants to actually happen between HIV-positive people. In 2015, the National Institutes of Health and Health and Human Services \u003ca href=\"https://www.niaid.nih.gov/sites/default/files/hopeactcriteria.pdf\" target=\"_blank\" rel=\"noopener\">published safeguards and research criteria\u003c/a> for medical centers willing to perform these transplants as clinical research. And a team at Johns Hopkins performed \u003ca href=\"https://www.npr.org/sections/health-shots/2016/03/31/472389956/new-source-of-transplant-organs-for-patients-with-hiv-others-with-hiv\" target=\"_blank\" rel=\"noopener\">the first HIV-positive organ transplant\u003c/a> in 2016.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Any organ procurement organization that follows the NIH research criteria can send HIV-infected donor organs to transplant centers.\u003c/p>\n\u003cp>So far only 16 out of 58 organ procurement organizations around the country have worked on HIV-positive cases since the HOPE Act made it legal, according to Brianna Doby, donation community consultant for a team at Johns Hopkins University that supports organ recovery organizations dealing with their first HIV-positive donor.\u003c/p>\n\u003cp>So far, there have been approximately 50 HIV-positive kidney and liver transplants performed in the U.S. This is far fewer than researchers at Johns Hopkins predicted in a 2011 study, published in the American Journal of Transplantation. They estimated between 500 and 600 new HIV-positive organs would become available after the HOPE Act.\u003c/p>\n\u003cp>Doby says for the past several decades the transplant system has focused on doing everything possible to exclude disease from the donor pool, including HIV and Hepatitis C. And some organ procurement organizations still fear their staff will be at risk when working with an HIV-positive donor. But that needs to change, she says.\u003c/p>\n\u003cp>\"We need to be able to work with organs that increase the risk of those disease, or if you have one of those diseases, find a donor that has those,\" she says. \"Because it's the best shot you have at life, right?\"\u003c/p>\n\u003cp>For the HOPE Act to fulfill its potential Doby says more donors are needed. \"The HOPE Act is not widely known about and many people might just assume they can't be donors if they are also HIV-positive, so they don't register,\" she says.\u003c/p>\n\u003cp>Donation centers are gradually starting to recover more HIV-infected organs, according to Dorry Segev, a transplant surgeon at Johns Hopkins and another principal investigator on the new NIH study. Some local organ procurement centers are \"interested in being pioneers in this area and have been really responsive and good at recovering organs from donors with HIV,\" Segev wrote in an e-mail, while others are \"waiting in the wings to see what happens.\"\u003c/p>\n\u003cp>Any fear they have about the safety of harvesting HIV-positive organs are unfounded he says. He hopes more centers will realize that \"recovering HIV+ organs is not just something interesting, but is actually a responsibility to our patients.\"\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>At hospital transplant centers, clinicians biggest fear is that patients could contract a second strain of HIV from the donor, Segev explains. \"In fact,\" he wrote, \"we have such good [antiretroviral therapy] regimens that basically any strain of HIV can be suppressed with \u003cem>some\u003c/em> ART regimen, so no matter what strain of HIV comes from the donor, we can basically treat it in the recipient.\"\u003c/p>\n\u003cp>If a hospital performing transplants wants to receive HIV-positive organs they have to receive institutional review board approval and prove that they can meet transplantation criteria outlined by the Department of Health and Human Services. The process might deter some transplant centers from participating.\u003c/p>\n\u003cp>Indiana Donor Network's Taber says it's not hard to meet the requirements to procure HIV-positive organs because the safety precautions are the same whether or not there's an infection. His protocol is to \"treat everybody like they have some infection from the moon that you don't want to get.\"\u003c/p>\n\u003cp>And if it can help more patients get transplants, he says, it's a good thing.\u003c/p>\n\u003cp>\"It provides just another opportunity for patients to get transplanted,\" he says.\"It's not a home run but it's one more way to get these people off the list.\"\u003c/p>\n\u003cp>Durand says there's a lot of untapped potential to work with HIV-positive organs. So far 24 centers meet the criteria to perform transplants between people with HIV. Among these centers, Durand said there are more than 300 patients with HIV who have agreed to accept an HIV-positive organ. \"We expect this number to grow significantly,\" she says.\u003c/p>\n\u003cp>And if the trial goes well, it might open the door to other organs. She hopes future research trials will include hundreds of HIV-positive people waiting for hearts and lungs.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>This story was produced in collaboration with WFYI and \u003c/em>\u003ca href=\"http://sideeffectspublicmedia.org\" target=\"_blank\" rel=\"noopener\">\u003cem>Side Effects Public Media\u003c/em>\u003c/a>\u003cem>, a news collaborative covering public health.\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 Side Effects Public Media. To see more, visit \u003ca>Side Effects Public Media\u003c/a>.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Study+Aims+To+Show+Transplants+Between+HIV-Positive+Patients+Are+Safe%2C+Save+Lives&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "When Scientists Develop Products From Personal Medical Data, Who Should Profit?",
"title": "When Scientists Develop Products From Personal Medical Data, Who Should Profit?",
"headTitle": "KQED Future of You | KQED Science",
"content": "\u003cp>If you go to the hospital for medical treatment and scientists there decide to use your medical information to create a commercial product, are you owed anything as part of the bargain?[contextly_sidebar id=\"xg39QV5nwjkzRaw7H5UkEXIAZgbQaNjg\"]\u003c/p>\n\u003cp>That's one of the questions that is emerging as researchers and product developers eagerly delve into digital data such as CT scans and electronic medical records, making artificial-intelligence products that are helping doctors to manage information and even to help them diagnose disease.\u003c/p>\n\u003cp>This issue cropped up in 2016, when Google DeepMind decided to test an app that measures kidney health by gathering 1.6 million records from patients at the Royal Free Hospital in London. The British authorities found \u003ca href=\"http://www.bbc.com/news/technology-40483202\" target=\"_blank\" rel=\"noopener\">this broke patient privacy laws\u003c/a> in the United Kingdom. (\u003cem>Update on June 1 at 9:30 a.m. ET:\u003c/em> DeepMind \u003ca href=\"https://deepmind.com/blog/ico-royal-free/\" target=\"_blank\" rel=\"noopener\">says\u003c/a> it was able to deploy its app despite the violation.)\u003c/p>\n\u003cp>But the rules are different in the United States. The most notable cases have involved living tissue, but the legal arguments apply to medical data as well. One of the best examples dates back to 1976, when John Moore went to UCLA to be treated for hairy cell leukemia.\u003c/p>\n\u003cp>\u003ca href=\"http://law.gsu.edu/profile/leslie-e-wolf/\" target=\"_blank\" rel=\"noopener\">Prof. Leslie Wolf\u003c/a>, director of the Center for Health, Law and Society at the Georgia State University College of Law, says Moore's doctors gave him good medical care, \"but they also discovered there was something interesting about his cells and created a cell line from his cells without his knowledge,\" she says.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"And what complicated things even more is they asked Mr. Moore to travel down from his home in Seattle to L.A. multiple times, for seven years, to get additional cells without telling him they had this commercial interest in his cells.\"[contextly_sidebar id=\"DoYi5dXWSx7RCJVBTZf1P61atenUYp3T\"]\u003c/p>\n\u003cp>Moore sued. In 1990, The California Supreme Court \u003ca href=\"http://online.ceb.com/CalCases/C3/51C3d120.htm\" target=\"_blank\" rel=\"noopener\">decided that he did not own his cells\u003c/a>, but found his doctors had an obligation to inform him that his tissue was being used for commercial purposes and to give him a chance to object. Moore reached a settlement following his court battle, \"but Mr. Moore certainly felt betrayed through the process,\" Wolf says.\u003c/p>\n\u003cp>The most famous case of this nature involves a Maryland woman, Henrietta Lacks. Back in 1951, doctors at the Johns Hopkins hospital in Baltimore collected cells from her cervical cancer and turned them into the world's first immortal cell line, which grows perpetually in the lab and is used widely in research. As documented in Rebecca Skloot's \u003ca href=\"https://en.wikipedia.org/wiki/The_Immortal_Life_of_Henrietta_Lacks\">book\u003c/a> and an HBO biopic starring Oprah Winfrey, the family learned only much later what had transpired and received no compensation. In 2013, the National Institutes of Health \u003ca href=\"https://www.npr.org/sections/health-shots/2013/08/07/209807857/decades-after-lacks-death-family-gets-a-say-on-her-cells\" target=\"_blank\" rel=\"noopener\">came to an agreement with her family\u003c/a> guiding the use of her genetic information, but the family \u003ca href=\"https://www.washingtonpost.com/local/henrietta-lackss-family-wants-compensation-for-her-cells/2017/02/14/816481ba-f302-11e6-b9c9-e83fce42fb61_story.html?utm_term=.448bab1431d9\" target=\"_blank\" rel=\"noopener\">has continued to raise the issue\u003c/a>.\u003c/p>\n\u003cp>While those fights were about living tissue, \"in a certain sense whether it's cells or [digital] bits and bytes, it's all information about an individual, at some level,\" says \u003ca href=\"http://www.radiology.emory.edu/faculty/safdar-nabile.html\">Dr. Nabile Safdar,\u003c/a> a radiologist at Emory University and author \u003ca href=\"https://www.jacr.org/article/S1546-1440(17)31599-5/fulltext\">of a recent paper discussing the issue\u003c/a> of patients' rights as it pertains to their medical scans.\u003c/p>\n\u003cp>This information is increasingly being used in research, and that in turn can easily end up being used to develop a commercial product that's worth millions. Are the patients entitled to a cut?\u003c/p>\n\u003cp>\"That's a question that I think we need to figure out,\" Safdar says. \"And if were a patient and my data were used to develop something that was being shared outside as a product, I'd want to know.\"\u003c/p>\n\u003cp>That's not how it's usually done. At many research hospitals, patients routinely sign a paper, in that huge stack of admission paperwork, giving permission for the institution to use their personal data for research.\u003c/p>\n\u003cp>\"For someone to sign away the rights in perpetuity for their data to be used for all possible research applications in the future, that's something I think would deserve a lot of scrutiny, and that's not something I would agree with,\" Safdar says.\u003c/p>\n\u003cp>Here's a current example. Researchers at Johns Hopkins Medicine \u003ca href=\"https://www.npr.org/sections/health-shots/2018/05/30/615466696/for-some-hard-to-find-tumors-doctors-see-promise-in-artificial-intelligence\">are mining years of CT scans\u003c/a> that were performed initially to care for patients. Those patients signed a form saying it was okay to use that data for research. And the research has been approved by the university's institutional review board, which is charged with weighing the ethics of research projects, says \u003ca href=\"https://www.hopkinsmedicine.org/news/media/releases/karen_horton_named_director_of_department_of_radiology_and_radiological_science\">Dr. Karen Horton\u003c/a>, director of radiology.[contextly_sidebar id=\"njADn3noIN9V0ZYkwAdgQ0CYTEXexAJi\"]\u003c/p>\n\u003cp>Horton is now using some of this data to teach computers how to recognize pancreatic cancer. She says part of their agreement is that the data are stripped of all information that could identify an individual patient, \"so there's no [privacy] risk to a patient to have their images used to train the computer.\"\u003c/p>\n\u003cp>And Horton says technically, the data don't belong to the patients. \"Right now as the law defines it, your medical images are property of the health system,\" she says. \"You don't own the image.\"\u003c/p>\n\u003cp>But Wolf, the law professor and ethicist at Georgia State, says she's not sure that's a strong argument. \"Yes, they [the doctors] created the scans,\" she says, \"but certainly the patient has rights related to the scans,\" such as the right to view them and of course to decide at the outset whether they can be used in research.\u003c/p>\n\u003cp>It generally takes thousands of scans from many individuals to develop a commercial product, so no single person's data is especially valuable on its own. Overall, Wolf says, patients don't have much of a legal argument here, but there is an ethical issue.\u003c/p>\n\u003cp>\"My own concern is not that it is problematic \u003cem>per se\u003c/em>,\" she says. But, \"I don't think we've done a really good job of letting people know that this is in fact what we do with their data.\"\u003c/p>\n\u003cp>She \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4356669/\">cites lawsuits\u003c/a> where blood samples that had been taken at birth ended up being used for research.\u003c/p>\n\u003cp>\"One of the moms in the case said if 'I had been asked I think I would have said yes,' but it was the sense of not even being asked, and having the data used,\" Wolf says. \"People generally will agree, but they want to be asked, at least at some level.\"\u003c/p>\n\u003cp>And Safdar says there are times when people might, indeed, want to object to how their data are being used.\u003c/p>\n\u003cp>\"There's a wealth of information in a CT scan or an MRI,\" Safdar says. Looking at features such as liver fat, artery clogs and brain atrophy, researchers might calculate a probability for how long that person is likely to live.\u003c/p>\n\u003cp>These algorithms are generally called \"black boxes,\" because there's no way to know how they reach their conclusions. And if the computer algorithm \"spits out that you have two months to live, there are implications for employment, for insurability, for all kinds of things that impacts that person's daily life,\" Safdar says. \"That worries me a little bit, especially when it's not clear how that black box is making those decisions.\"\u003c/p>\n\u003cp>And what if the algorithm has actually baked in an unconscious prejudice of some sort, he asks, such as about race, age or sex?\u003c/p>\n\u003cp>\"When that same model, when trained [to work] on a specific group of people, is now applied to a totally different group of people, it could make totally erroneous decisions.\"\u003c/p>\n\u003cp>These issues are becoming more pressing as these AI-based products start coming to market.\u003c/p>\n\u003cp>\u003cem>You can contact Richard Harris at \u003c/em>\u003ca href=\"mailto:rharris@npr.org\">\u003cem>rharris@npr.org\u003c/em>\u003c/a>\u003cem>.\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=When+Scientists+Develop+Products+From+Personal+Medical+Data%2C+Who+Gets+To+Profit%3F&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\u003cp>SaveSaveSaveSaveSaveSave\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>SaveSave\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>If you go to the hospital for medical treatment and scientists there decide to use your medical information to create a commercial product, are you owed anything as part of the bargain?\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>That's one of the questions that is emerging as researchers and product developers eagerly delve into digital data such as CT scans and electronic medical records, making artificial-intelligence products that are helping doctors to manage information and even to help them diagnose disease.\u003c/p>\n\u003cp>This issue cropped up in 2016, when Google DeepMind decided to test an app that measures kidney health by gathering 1.6 million records from patients at the Royal Free Hospital in London. The British authorities found \u003ca href=\"http://www.bbc.com/news/technology-40483202\" target=\"_blank\" rel=\"noopener\">this broke patient privacy laws\u003c/a> in the United Kingdom. (\u003cem>Update on June 1 at 9:30 a.m. ET:\u003c/em> DeepMind \u003ca href=\"https://deepmind.com/blog/ico-royal-free/\" target=\"_blank\" rel=\"noopener\">says\u003c/a> it was able to deploy its app despite the violation.)\u003c/p>\n\u003cp>But the rules are different in the United States. The most notable cases have involved living tissue, but the legal arguments apply to medical data as well. One of the best examples dates back to 1976, when John Moore went to UCLA to be treated for hairy cell leukemia.\u003c/p>\n\u003cp>\u003ca href=\"http://law.gsu.edu/profile/leslie-e-wolf/\" target=\"_blank\" rel=\"noopener\">Prof. Leslie Wolf\u003c/a>, director of the Center for Health, Law and Society at the Georgia State University College of Law, says Moore's doctors gave him good medical care, \"but they also discovered there was something interesting about his cells and created a cell line from his cells without his knowledge,\" she says.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"And what complicated things even more is they asked Mr. Moore to travel down from his home in Seattle to L.A. multiple times, for seven years, to get additional cells without telling him they had this commercial interest in his cells.\"\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Moore sued. In 1990, The California Supreme Court \u003ca href=\"http://online.ceb.com/CalCases/C3/51C3d120.htm\" target=\"_blank\" rel=\"noopener\">decided that he did not own his cells\u003c/a>, but found his doctors had an obligation to inform him that his tissue was being used for commercial purposes and to give him a chance to object. Moore reached a settlement following his court battle, \"but Mr. Moore certainly felt betrayed through the process,\" Wolf says.\u003c/p>\n\u003cp>The most famous case of this nature involves a Maryland woman, Henrietta Lacks. Back in 1951, doctors at the Johns Hopkins hospital in Baltimore collected cells from her cervical cancer and turned them into the world's first immortal cell line, which grows perpetually in the lab and is used widely in research. As documented in Rebecca Skloot's \u003ca href=\"https://en.wikipedia.org/wiki/The_Immortal_Life_of_Henrietta_Lacks\">book\u003c/a> and an HBO biopic starring Oprah Winfrey, the family learned only much later what had transpired and received no compensation. In 2013, the National Institutes of Health \u003ca href=\"https://www.npr.org/sections/health-shots/2013/08/07/209807857/decades-after-lacks-death-family-gets-a-say-on-her-cells\" target=\"_blank\" rel=\"noopener\">came to an agreement with her family\u003c/a> guiding the use of her genetic information, but the family \u003ca href=\"https://www.washingtonpost.com/local/henrietta-lackss-family-wants-compensation-for-her-cells/2017/02/14/816481ba-f302-11e6-b9c9-e83fce42fb61_story.html?utm_term=.448bab1431d9\" target=\"_blank\" rel=\"noopener\">has continued to raise the issue\u003c/a>.\u003c/p>\n\u003cp>While those fights were about living tissue, \"in a certain sense whether it's cells or [digital] bits and bytes, it's all information about an individual, at some level,\" says \u003ca href=\"http://www.radiology.emory.edu/faculty/safdar-nabile.html\">Dr. Nabile Safdar,\u003c/a> a radiologist at Emory University and author \u003ca href=\"https://www.jacr.org/article/S1546-1440(17)31599-5/fulltext\">of a recent paper discussing the issue\u003c/a> of patients' rights as it pertains to their medical scans.\u003c/p>\n\u003cp>This information is increasingly being used in research, and that in turn can easily end up being used to develop a commercial product that's worth millions. Are the patients entitled to a cut?\u003c/p>\n\u003cp>\"That's a question that I think we need to figure out,\" Safdar says. \"And if were a patient and my data were used to develop something that was being shared outside as a product, I'd want to know.\"\u003c/p>\n\u003cp>That's not how it's usually done. At many research hospitals, patients routinely sign a paper, in that huge stack of admission paperwork, giving permission for the institution to use their personal data for research.\u003c/p>\n\u003cp>\"For someone to sign away the rights in perpetuity for their data to be used for all possible research applications in the future, that's something I think would deserve a lot of scrutiny, and that's not something I would agree with,\" Safdar says.\u003c/p>\n\u003cp>Here's a current example. Researchers at Johns Hopkins Medicine \u003ca href=\"https://www.npr.org/sections/health-shots/2018/05/30/615466696/for-some-hard-to-find-tumors-doctors-see-promise-in-artificial-intelligence\">are mining years of CT scans\u003c/a> that were performed initially to care for patients. Those patients signed a form saying it was okay to use that data for research. And the research has been approved by the university's institutional review board, which is charged with weighing the ethics of research projects, says \u003ca href=\"https://www.hopkinsmedicine.org/news/media/releases/karen_horton_named_director_of_department_of_radiology_and_radiological_science\">Dr. Karen Horton\u003c/a>, director of radiology.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Horton is now using some of this data to teach computers how to recognize pancreatic cancer. She says part of their agreement is that the data are stripped of all information that could identify an individual patient, \"so there's no [privacy] risk to a patient to have their images used to train the computer.\"\u003c/p>\n\u003cp>And Horton says technically, the data don't belong to the patients. \"Right now as the law defines it, your medical images are property of the health system,\" she says. \"You don't own the image.\"\u003c/p>\n\u003cp>But Wolf, the law professor and ethicist at Georgia State, says she's not sure that's a strong argument. \"Yes, they [the doctors] created the scans,\" she says, \"but certainly the patient has rights related to the scans,\" such as the right to view them and of course to decide at the outset whether they can be used in research.\u003c/p>\n\u003cp>It generally takes thousands of scans from many individuals to develop a commercial product, so no single person's data is especially valuable on its own. Overall, Wolf says, patients don't have much of a legal argument here, but there is an ethical issue.\u003c/p>\n\u003cp>\"My own concern is not that it is problematic \u003cem>per se\u003c/em>,\" she says. But, \"I don't think we've done a really good job of letting people know that this is in fact what we do with their data.\"\u003c/p>\n\u003cp>She \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4356669/\">cites lawsuits\u003c/a> where blood samples that had been taken at birth ended up being used for research.\u003c/p>\n\u003cp>\"One of the moms in the case said if 'I had been asked I think I would have said yes,' but it was the sense of not even being asked, and having the data used,\" Wolf says. \"People generally will agree, but they want to be asked, at least at some level.\"\u003c/p>\n\u003cp>And Safdar says there are times when people might, indeed, want to object to how their data are being used.\u003c/p>\n\u003cp>\"There's a wealth of information in a CT scan or an MRI,\" Safdar says. Looking at features such as liver fat, artery clogs and brain atrophy, researchers might calculate a probability for how long that person is likely to live.\u003c/p>\n\u003cp>These algorithms are generally called \"black boxes,\" because there's no way to know how they reach their conclusions. And if the computer algorithm \"spits out that you have two months to live, there are implications for employment, for insurability, for all kinds of things that impacts that person's daily life,\" Safdar says. \"That worries me a little bit, especially when it's not clear how that black box is making those decisions.\"\u003c/p>\n\u003cp>And what if the algorithm has actually baked in an unconscious prejudice of some sort, he asks, such as about race, age or sex?\u003c/p>\n\u003cp>\"When that same model, when trained [to work] on a specific group of people, is now applied to a totally different group of people, it could make totally erroneous decisions.\"\u003c/p>\n\u003cp>These issues are becoming more pressing as these AI-based products start coming to market.\u003c/p>\n\u003cp>\u003cem>You can contact Richard Harris at \u003c/em>\u003ca href=\"mailto:rharris@npr.org\">\u003cem>rharris@npr.org\u003c/em>\u003c/a>\u003cem>.\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=When+Scientists+Develop+Products+From+Personal+Medical+Data%2C+Who+Gets+To+Profit%3F&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\u003cp>SaveSaveSaveSaveSaveSave\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"disqusTitle": "Get Screened Earlier For Colorectal Cancer, Urges American Cancer Society",
"title": "Get Screened Earlier For Colorectal Cancer, Urges American Cancer Society",
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"content": "\u003cp>Colorectal cancer is the second-leading cause of cancer death in the United States, most frequently diagnosed among adults over 65. To catch those typically slow-growing malignancies early, when they can often be cured, most doctors' groups recommend colorectal cancer screening starting at age 50.[contextly_sidebar id=\"NOUTn2zOpMrMGpyA6RwGCmEzUmw18jiE\"]\u003c/p>\n\u003cp>But the American Cancer Society this week changed its advice and is \u003ca href=\"https://onlinelibrary.wiley.com/doi/full/10.3322/caac.21457\" target=\"_blank\" rel=\"noopener\">recommending that screening start five years earlier\u003c/a>.\u003c/p>\n\u003cp>\"There is compelling evidence that the optimum age to start is now 45,\" says \u003ca href=\"https://www.cancer.org/about-us/who-we-are/executive-leadership/richard-wender-bio.html\" target=\"_blank\" rel=\"noopener\">Dr. Richard Wender\u003c/a>, chief cancer control officer of the society, who cites a sharp \u003ca href=\"https://jamanetwork.com/journals/jama/fullarticle/2647859\" target=\"_blank\" rel=\"noopener\">increase in deaths\u003c/a> from colon and rectal cancers among men and women under age 50.\u003c/p>\n\u003cp>\"People born in the '80s and '90s are at higher risk of developing colon cancer, particularly rectal cancer, than people born when I was born back in the '50s,\" Wender says.\u003c/p>\n\u003cp>And the rise is not just because detection is getting better, he says. In fact, the risk of developing colon cancer is twice as high as it was years ago and the risk of developing rectal cancer is four times higher.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"We just have to face reality,\" says Wender. \"We just don't know \u003cem>why\u003c/em> it's increasing.\"\u003c/p>\n\u003cp>Some of the increase could stem from the increase in obesity in the U.S., a known risk factor for colorectal cancer, he says.\u003c/p>\n\u003cp>\"But we don't think that explains the entire change,\" he adds. \"There is a great deal of interest and a lot of research beginning to try to answer that question.\"\u003c/p>\n\u003cp>So far, other groups are maintaining their recommendation that colon cancer screening start at age 50, including the U.S. Preventive Services Task Force, an independent, volunteer panel of national experts in disease prevention and evidence-based medicine.[contextly_sidebar id=\"P5idbi4fl2nJQ4sgNYQ8kwPxKThEw1dW\"]\u003c/p>\n\u003cp>Stanford University internist \u003ca href=\"https://www.uspreventiveservicestaskforce.org/Page/Biography/Doug--Owens\" target=\"_blank\" rel=\"noopener\">Douglas K. Owens\u003c/a>, the task force's vice-chairperson, says the group's \u003ca href=\"https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/colorectal-cancer-screening2\" target=\"_blank\" rel=\"noopener\">2016 recommendations\u003c/a> were based on extensive review of the benefits and harms of colorectal screening at the time.\u003c/p>\n\u003cp>\"There was limited data on screening people under age 50,\" Owens says. The new American Cancer Society guidelines, he adds, should prompt more research into the relative benefits and harms of screening among younger people.\u003c/p>\n\u003cp>\u003ca href=\"https://www.mskcc.org/cancer-care/doctors/robin-mendelsohn\" target=\"_blank\" rel=\"noopener\">Dr. Robin B. Mendelsohn\u003c/a>, a gastroenterologist at Memorial Sloan Kettering Cancer Center in New York, says there's been an \"alarming\" increase in cancer among younger adults. She's the co-director of the recently established \u003ca href=\"https://www.mskcc.org/cancer-care/types/colorectal/colorectal-cancer-young-adults\" target=\"_blank\" rel=\"noopener\">Center for Young Onset Colorectal Cancer\u003c/a> there.\u003c/p>\n\u003cp>Over the last 10 years, Memorial Sloan Kettering has seen 4,000 new colorectal cancer patients under age 50, she says. Many of them did not have traditional risk factors such as obesity, smoking, alcohol, physical inactivity or a diet high in fat or low in fiber.\u003c/p>\n\u003cp>In fact, Mendelsohn says, they were typically less likely to smoke and less likely to be overweight than their older counterparts.\u003c/p>\n\u003cp>\"Anecdotally, when you talk with these patients, [some] are marathon runners who don't eat red meat, don't smoke, do everything 'right' and say 'why did this happen to me?' \" she says.[contextly_sidebar id=\"MQUcI1nEN5j9iN51hKJ85YEaLuRJyxYZ\"]\u003c/p>\n\u003cp>Often, they tell her they've seen multiple doctors because of rectal bleeding, but have been told, since they're under 50, they \"can't have cancer.\" That's clearly not the case, she says.\u003c/p>\n\u003cp>Ongoing studies are looking at a multitude of factors that might be contributing to the earlier cancer incidence. Potential culprits include over-the-counter anti-inflammatory medicines, antibiotics and antidepressants, as well as multiple vitamins, probiotics and other dietary supplements.\u003c/p>\n\u003cp>The new recommendations should bring greater attention to the value of screening, says Mendelsohn, who suggests that future studies investigate whether even younger people — in their early 40s or even 30s — should be screened.\u003c/p>\n\u003cp>A first colon cancer screening does not have to be a colonoscopy. In its new recommendations, the cancer society recommends choosing from one of six screening tests, which are also currently recommended by other expert groups. The guidelines don't prioritize among screening choices.\u003c/p>\n\u003cp>The choices include three at-home \u003ca href=\"https://www.cancer.net/navigating-cancer-care/diagnosing-cancer/tests-and-procedures/fecal-occult-blood-tests\" target=\"_blank\" rel=\"noopener\">kits that test stool for blood\u003c/a>.\u003c/p>\n\u003cp>These kits need to be ordered by a doctor; primary-care providers often have them on hand in the office to give to patients, Wender says, or they may be mailed.\u003c/p>\n\u003cp>\"It's done in the privacy of your own home,\" he says. Patients mail the sample to a research facility which tests for microscopic traces of blood.\u003c/p>\n\u003cp>If the test is positive, a colonoscopy is recommended, Wender says; but only one in five people test positive for blood in their stool.\u003c/p>\n\u003cp>Typically, these home tests of feces are repeated every year for good results.\u003c/p>\n\u003cp>Alternatively, some patients opt for what's called a \u003ca href=\"https://www.niddk.nih.gov/health-information/diagnostic-tests/virtual-colonoscopy\" target=\"_blank\" rel=\"noopener\">\"virtual\" colonoscopy\u003c/a> — essentially a CT scan of the colon — which should be done every five years, according to the new recommendations.[contextly_sidebar id=\"5Pa1nwLZfbPDZxnlIWvVKTkm9l3Yq23j\"]\u003c/p>\n\u003cp>Another approved option is a \u003ca href=\"https://www.niddk.nih.gov/health-information/diagnostic-tests/flexible-sigmoidoscopy\" target=\"_blank\" rel=\"noopener\">flexible sigmoidoscopy\u003c/a>, which looks at the lower part of the colon, and is followed up by a colonoscopy if polyps are found.\u003c/p>\n\u003cp>A positive result picked up in these screening tests is typically followed up by a colonoscopy, which uses a tiny camera to investigate the entire colon. It is not only a search for early cancer; more often than not, Wender says, it detects pre-malignant, suspicious lesions, or polyps, which are removed during the procedure.\u003c/p>\n\u003cp>\"When we find and remove polyps we actually prevent any future chance of that developing into cancer,\" he says.\u003c/p>\n\u003cp>Despite the high cure rate when colon cancer is caught early, only two-thirds of Americans over 50 get screened.\u003c/p>\n\u003cp>The American Cancer Society says it endorsed the full range of screening tests \"without preference\" in order to improve the rate of screening. In its latest advice, the U.S. Preventive Services Task Force says head-to-head comparison studies have shown that no one screening test is more effective than another in early cancer detection.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>While they differ on the age of first screening, both groups suggest that screening over age 75 should be a joint decision between patient and doctor. And after age 85, screening is no longer necessary, the doctors' groups agree. That's because the risk of colonoscopy among this elderly population can outweigh any benefit.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Get+Screened+Earlier+For+Colorectal+Cancer%2C+Urges+American+Cancer+Society+&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Colorectal cancer is the second-leading cause of cancer death in the United States, most frequently diagnosed among adults over 65. To catch those typically slow-growing malignancies early, when they can often be cured, most doctors' groups recommend colorectal cancer screening starting at age 50.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>But the American Cancer Society this week changed its advice and is \u003ca href=\"https://onlinelibrary.wiley.com/doi/full/10.3322/caac.21457\" target=\"_blank\" rel=\"noopener\">recommending that screening start five years earlier\u003c/a>.\u003c/p>\n\u003cp>\"There is compelling evidence that the optimum age to start is now 45,\" says \u003ca href=\"https://www.cancer.org/about-us/who-we-are/executive-leadership/richard-wender-bio.html\" target=\"_blank\" rel=\"noopener\">Dr. Richard Wender\u003c/a>, chief cancer control officer of the society, who cites a sharp \u003ca href=\"https://jamanetwork.com/journals/jama/fullarticle/2647859\" target=\"_blank\" rel=\"noopener\">increase in deaths\u003c/a> from colon and rectal cancers among men and women under age 50.\u003c/p>\n\u003cp>\"People born in the '80s and '90s are at higher risk of developing colon cancer, particularly rectal cancer, than people born when I was born back in the '50s,\" Wender says.\u003c/p>\n\u003cp>And the rise is not just because detection is getting better, he says. In fact, the risk of developing colon cancer is twice as high as it was years ago and the risk of developing rectal cancer is four times higher.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"We just have to face reality,\" says Wender. \"We just don't know \u003cem>why\u003c/em> it's increasing.\"\u003c/p>\n\u003cp>Some of the increase could stem from the increase in obesity in the U.S., a known risk factor for colorectal cancer, he says.\u003c/p>\n\u003cp>\"But we don't think that explains the entire change,\" he adds. \"There is a great deal of interest and a lot of research beginning to try to answer that question.\"\u003c/p>\n\u003cp>So far, other groups are maintaining their recommendation that colon cancer screening start at age 50, including the U.S. Preventive Services Task Force, an independent, volunteer panel of national experts in disease prevention and evidence-based medicine.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Stanford University internist \u003ca href=\"https://www.uspreventiveservicestaskforce.org/Page/Biography/Doug--Owens\" target=\"_blank\" rel=\"noopener\">Douglas K. Owens\u003c/a>, the task force's vice-chairperson, says the group's \u003ca href=\"https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/colorectal-cancer-screening2\" target=\"_blank\" rel=\"noopener\">2016 recommendations\u003c/a> were based on extensive review of the benefits and harms of colorectal screening at the time.\u003c/p>\n\u003cp>\"There was limited data on screening people under age 50,\" Owens says. The new American Cancer Society guidelines, he adds, should prompt more research into the relative benefits and harms of screening among younger people.\u003c/p>\n\u003cp>\u003ca href=\"https://www.mskcc.org/cancer-care/doctors/robin-mendelsohn\" target=\"_blank\" rel=\"noopener\">Dr. Robin B. Mendelsohn\u003c/a>, a gastroenterologist at Memorial Sloan Kettering Cancer Center in New York, says there's been an \"alarming\" increase in cancer among younger adults. She's the co-director of the recently established \u003ca href=\"https://www.mskcc.org/cancer-care/types/colorectal/colorectal-cancer-young-adults\" target=\"_blank\" rel=\"noopener\">Center for Young Onset Colorectal Cancer\u003c/a> there.\u003c/p>\n\u003cp>Over the last 10 years, Memorial Sloan Kettering has seen 4,000 new colorectal cancer patients under age 50, she says. Many of them did not have traditional risk factors such as obesity, smoking, alcohol, physical inactivity or a diet high in fat or low in fiber.\u003c/p>\n\u003cp>In fact, Mendelsohn says, they were typically less likely to smoke and less likely to be overweight than their older counterparts.\u003c/p>\n\u003cp>\"Anecdotally, when you talk with these patients, [some] are marathon runners who don't eat red meat, don't smoke, do everything 'right' and say 'why did this happen to me?' \" she says.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Often, they tell her they've seen multiple doctors because of rectal bleeding, but have been told, since they're under 50, they \"can't have cancer.\" That's clearly not the case, she says.\u003c/p>\n\u003cp>Ongoing studies are looking at a multitude of factors that might be contributing to the earlier cancer incidence. Potential culprits include over-the-counter anti-inflammatory medicines, antibiotics and antidepressants, as well as multiple vitamins, probiotics and other dietary supplements.\u003c/p>\n\u003cp>The new recommendations should bring greater attention to the value of screening, says Mendelsohn, who suggests that future studies investigate whether even younger people — in their early 40s or even 30s — should be screened.\u003c/p>\n\u003cp>A first colon cancer screening does not have to be a colonoscopy. In its new recommendations, the cancer society recommends choosing from one of six screening tests, which are also currently recommended by other expert groups. The guidelines don't prioritize among screening choices.\u003c/p>\n\u003cp>The choices include three at-home \u003ca href=\"https://www.cancer.net/navigating-cancer-care/diagnosing-cancer/tests-and-procedures/fecal-occult-blood-tests\" target=\"_blank\" rel=\"noopener\">kits that test stool for blood\u003c/a>.\u003c/p>\n\u003cp>These kits need to be ordered by a doctor; primary-care providers often have them on hand in the office to give to patients, Wender says, or they may be mailed.\u003c/p>\n\u003cp>\"It's done in the privacy of your own home,\" he says. Patients mail the sample to a research facility which tests for microscopic traces of blood.\u003c/p>\n\u003cp>If the test is positive, a colonoscopy is recommended, Wender says; but only one in five people test positive for blood in their stool.\u003c/p>\n\u003cp>Typically, these home tests of feces are repeated every year for good results.\u003c/p>\n\u003cp>Alternatively, some patients opt for what's called a \u003ca href=\"https://www.niddk.nih.gov/health-information/diagnostic-tests/virtual-colonoscopy\" target=\"_blank\" rel=\"noopener\">\"virtual\" colonoscopy\u003c/a> — essentially a CT scan of the colon — which should be done every five years, according to the new recommendations.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Another approved option is a \u003ca href=\"https://www.niddk.nih.gov/health-information/diagnostic-tests/flexible-sigmoidoscopy\" target=\"_blank\" rel=\"noopener\">flexible sigmoidoscopy\u003c/a>, which looks at the lower part of the colon, and is followed up by a colonoscopy if polyps are found.\u003c/p>\n\u003cp>A positive result picked up in these screening tests is typically followed up by a colonoscopy, which uses a tiny camera to investigate the entire colon. It is not only a search for early cancer; more often than not, Wender says, it detects pre-malignant, suspicious lesions, or polyps, which are removed during the procedure.\u003c/p>\n\u003cp>\"When we find and remove polyps we actually prevent any future chance of that developing into cancer,\" he says.\u003c/p>\n\u003cp>Despite the high cure rate when colon cancer is caught early, only two-thirds of Americans over 50 get screened.\u003c/p>\n\u003cp>The American Cancer Society says it endorsed the full range of screening tests \"without preference\" in order to improve the rate of screening. In its latest advice, the U.S. Preventive Services Task Force says head-to-head comparison studies have shown that no one screening test is more effective than another in early cancer detection.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>While they differ on the age of first screening, both groups suggest that screening over age 75 should be a joint decision between patient and doctor. And after age 85, screening is no longer necessary, the doctors' groups agree. That's because the risk of colonoscopy among this elderly population can outweigh any benefit.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Get+Screened+Earlier+For+Colorectal+Cancer%2C+Urges+American+Cancer+Society+&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Once Lethal, Multiple Myeloma May Be In A ‘Golden Age’ Of Treatment",
"title": "Once Lethal, Multiple Myeloma May Be In A ‘Golden Age’ Of Treatment",
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"content": "\u003cp>If you can call someone who gets a rare form of cancer lucky, then Deb Graff says she fits the bill.[contextly_sidebar id=\"GPKrecPJLp3HW1nQPWhCt1lQA56TdW2K\"]\u003c/p>\n\u003cp>At age 72, Graff has survived nine years with multiple myeloma, a blood cancer whose life expectancy used to be measured in months.\u003c/p>\n\u003cp>“I wasn’t ready to go anywhere,” said Graff, who lives in South Dennis, Mass., on Cape Cod. “I wanted to see my grandkids grow up and still be an aggravation to my husband.”\u003c/p>\n\u003cp>She was lucky enough to get multiple myeloma after the 2003 release of a drug called Velcade (bortezomib), one of the first therapies to directly target multiple myeloma. Velcade, plus more than 20 other approvals since then, have transformed multiple myeloma care. For three-quarters of patients, a disease that once brought a three-year life expectancy has become a long-term, chronic illness.\u003c/p>\n\u003cp>Now, multiple myeloma is poised for another inflection point.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>There are 89 experimental drugs currently being tested in people, according to Biomedtracker, a research unit of Informa. Some are improvements on existing drugs, others have found new ways to target the cancer cells; a few engage the body’s immune system in the fight.\u003c/p>\n\u003cp>Not all the drugs will make it through the trial process, of course.\u003c/p>\n\u003cp>But on the roster, there may be effective treatments for the one-quarter of patients who haven’t yet been helped by existing drugs. There may be regimens that are less challenging than the daily pills, regular infusions, and frequent doctor’s appointments that Graff and others have to manage. And there may be the long-sought cure.[contextly_sidebar id=\"Gp3ytDdHNsL4MngAJTivyGtR5NE9RGOa\"]\u003c/p>\n\u003cp>“There’s no question it’s a golden age in multiple myeloma drug development,” said Dr. David Reese, a senior vice president at Amgen, which developed the drug Kyprolis (carfilzomib), and is testing five others.\u003c/p>\n\u003cp>“It’s possible that we already are at the juncture where patients diagnosed with this disease could live with this disease for the rest of their lives,” added Dr. Ola Landgren, chief of the Multiple Myeloma Service at Memorial Sloan Kettering Cancer Center in New York.\u003c/p>\n\u003cp>Despite all the advances and optimism, though, most patients with multiple myeloma will still die of multiple myeloma.\u003c/p>\n\u003cp>“It is incurable. I think it is a mistake to suggest otherwise,” said Dr. Paul Richardson, Graff’s physician at the Dana-Farber Cancer Institute in Boston. “I think that this disease is forever humbling.”\u003c/p>\n\u003cp>Every multiple myeloma patient’s disease takes a different path. That makes it hard to understand and even harder to predict.\u003c/p>\n\u003cp>The cancer starts in a subgroup of white blood cells called plasma cells that normally make antibodies to fight infection. When cancerous, these plasma cells produce abnormal proteins that damage organs. But where they wreak havoc can vary from person to person.\u003c/p>\n\u003cp>Many patients suffer crushing fatigue, aching joints, and broken bones. Some get bounced around from one doctor to the next before finally getting a diagnosis.\u003c/p>\n\u003cp>Graff, though, never had a symptom. In late 2009, she went in for a routine physical. She and her husband had just retired, sold their house, and were headed to North Carolina. Ten days after the move, Graff’s primary care doctor back in Massachusetts called and said she’d like to run another blood test.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>After her diagnosis and a genetic screen, Graff got more bad news. Her cancer included a genetic mutation called a 17p deletion “that was kind of the kiss of death,” Graff said. Every drug trial she looked at showed positive results for all patients, Graff said, except for those with 17p deletions.\u003c/p>\n\u003cdiv class=\"quote\">\n\u003cdiv class=\"quote-inner\">\n\u003cp>Graff’s younger daughter moved up her wedding to Memorial Day 2010 to make sure her mother could attend. Graff was scheduled for a stem cell transplant six weeks later.[contextly_sidebar id=\"CW17CER3d4Nwi1JxsCyRQtvt2tBYXwpx\"]\u003c/p>\n\u003cp>Unfortunately, like many people with a 17p deletion, the transplant didn’t stick. Instead of staying in remission, by November 2010, she was put on a cocktail of three powerful drugs.\u003c/p>\n\u003cp>With so many approved therapies, doctors like Graff’s can keep switching their patients’ regimens. If one combination stops working, there’s another one to try.\u003c/p>\n\u003cp>“My feeling, and I think it was the right feeling, was that it was my job to stay alive and Paul’s job was to find the next best thing,” she said, referring to her doctor.\u003c/p>\n\u003cp>But still, the disease is tenacious.\u003c/p>\n\u003cp>“It will come back even after remission of five to 10 years,” said Dr. Elisabet Manasanch, an assistant professor in the department of lymphoma/myeloma at the University of Texas MD Anderson Cancer Center in Houston.\u003c/p>\n\u003cdiv class=\"quote\">\n\u003cdiv class=\"quote-inner\">\n\u003cp>There’s no such thing as too many treatment options with a disease as wily as multiple myeloma.\u003c/p>\n\u003cp>“Maybe 1,000 drugs is not enough,” said Martina Sersch, Amgen’s head of global development oncology. “It’s a very clever disease.”\u003c/p>\n\u003cp>And now that patients are living longer, the quality of that extra time matters more, Landgren of Memorial Sloan Kettering said, adding that he expects the next wave of therapies will improve the patient experience.\u003c/p>\n\u003cp>Amgen’s drug Kyprolis, for instance, is currently given twice a week via infusion, but is being tested at a higher, once-a-week dose. Trial results for this regimen will be presented at the American Society for Clinical Oncology annual meeting, which starts Friday.\u003c/p>\n\u003cp>“We may have to attack it from different sides and different pathways to achieve what we ultimately want to achieve, which is a functional cure,” Sersch said.\u003c/p>\n\u003cp>Most patients today start with a combination of treatments: a “veritable Army, Navy, and Air Force,” as Richardson puts it.\u003c/p>\n\u003cp>They get a proteasome inhibitor, often Velcade, to directly attack the myeloma cells; an immunomodulatory treatment such as Revlimid (lenalidomide); and the steroid dexamethasone to tamp down an over-reactive immune system.\u003c/p>\n\u003c/div>\n\u003c/div>\n\u003cp>The Marines, Richardson said, are also coming, in the form of monoclonal antibodies, a type of engineered protein that can bind specifically to cancer cells.\u003c/p>\n\u003cp>The monoclonal antibody\u003csup> \u003c/sup>daratumumab, sold by the Janssen unit of Johnson & Johnson under the brand name Darzalex, was first approved in 2015 for people with late-stage disease. Earlier this month, the Food and Drug Administration \u003ca href=\"https://www.jnj.com/media-center/press-releases/janssen-announces-darzalex-daratumumab-us-fda-approval-for-newly-diagnosed-patients-with-multiple-myeloma-who-are-transplant-ineligible\" target=\"_blank\" rel=\"noopener\">expanded\u003c/a> its approval, allowing it to be used in combination with the standard, three-pronged treatment in newly diagnosed patients.[contextly_sidebar id=\"Rf1TTC48ZJ3mBx4BOYjUCBWVLEGtxBPQ\"]\u003c/p>\n\u003cp>Daratumumab seeks out, binds to, and preferentially kills multiple myeloma cells. In a company-supported study published in the \u003ca href=\"https://www.nejm.org/doi/full/10.1056/NEJMoa1714678?query=featured_home%20-\" target=\"_blank\" rel=\"noopener\">New England Journal of Medicine\u003c/a> in February, 22 percent of patients who used the four-drug combination showed undetectable levels of disease after about 16.5 months. Only 6 percent of patients who used the three-drug combination saw such results.\u003c/p>\n\u003cp>“If you can fundamentally clear all the disease from a patient, now you start to think about, wow — maybe I can get to cure,” said Mark Wildgust, vice president for global medical affairs, oncology, at Janssen.\u003c/p>\n\u003cp>Today’s drugs are so effective that studies take a very long time. In one trial for Kyprolis, for instance, patients who were supposed to be near the end of life survived for 48 months on average, Amgen’s Sersch said. Drug companies will need to find strong, validated criteria other than survival, she said, to provide faster results and potentially drug approvals.\u003c/p>\n\u003cp>Amgen is hoping for game-changing responses to an experimental type of treatment called a BiTE — for bispecific T cell engager. BiTEs essentially are two-armed drugs, Reese said. One arm grabs the tumor cell and the other an immune cell. This activates the immune cell, which kills the cancer cell and primes the immune system to turn against others.\u003c/p>\n\u003cp>It’s too soon to know how long a patient would need to be on BiTE therapy, how to identify which patients might be helped, or how much improvement to expect, Reese said. But because BiTEs train the immune system to fight cancer, they might offer the possibility of a long-term remission or even a cure.\u003c/p>\n\u003cp>Other immune therapies under development include vaccines to amp up the immune system, and an approach called CAR-T, for chimeric antigen receptor T cell. In CAR-T, a patient’s own immune cells are removed and engineered to track down and destroy tumor cells.\u003c/p>\n\u003cp>Richardson, whose first multiple myeloma patient back in 1986 survived just three months, said he’s been amazed by how well CAR-Ts have worked in some of his sickest patients.\u003c/p>\n\u003cp>“I’ve seen the most dramatic responses in CAR-T. They’re quite remarkable,” he said. “Patients who’ve been so ill, and these therapies really made a difference for them beyond what I would expect.”\u003c/p>\n\u003cp>Because CAR-Ts have to be made with the patient’s own T cells, they are expensive and time-consuming; BiTEs are off the shelf and can be mass-produced, theoretically at a lower cost.\u003c/p>\n\u003cfigure id=\"attachment_341074\" class=\"media media-align-center media-break\">\u003ca href=\"https://www.statnews.com/wp-content/uploads/2018/05/multiplemyeloma_01.jpg\">\u003cimg class=\"media-content wp-image-341074 size-large aligncenter\" src=\"https://www.statnews.com/wp-content/uploads/2018/05/multiplemyeloma_01-1024x683.jpg\" alt=\"Multiple Myeloma 03\" width=\"1024\" height=\"683\">\u003c/a>\u003c/figure>\n\u003cp>Cost, of course, is another huge issue in multiple myeloma therapy.\u003c/p>\n\u003cp>Lisa Stephenson, 65, of Whitefish, Mont., who was diagnosed in June 2014, said her multidrug regimen runs about $29,000 a month, plus an occasional $7,000 to boost her immune system. Luckily, nearly all of it is covered by the “incredible insurance” from the law firm where her husband worked until his recent retirement.\u003c/p>\n\u003cp>Stephenson didn’t end up needing a stem cell transplant because an experimental therapy she took at the beginning of her treatment worked so well. But if she had needed it — or needs one in the future — she was told it would cost a minimum of $365,000.\u003c/p>\n\u003cp>“I think to myself, ‘How in the world can people who don’t have good insurance — what do they do?’” she said.\u003c/p>\n\u003cp>It’s not yet clear how much the experimental therapies like BiTEs will cost patients, Amgen’s Reese said. But if these new treatments can produce truly life-altering results, then a one-time large payment, as seen recently with \u003ca href=\"https://www.statnews.com/2018/01/03/spark-gene-therapy-price/\" target=\"_blank\" rel=\"noopener\">gene therapy\u003c/a> and \u003ca href=\"https://www.statnews.com/2017/08/30/novartis-car-t-cancer-approved/\" target=\"_blank\" rel=\"noopener\">CAR-Ts in other types\u003c/a> of blood cancer, might be justifiable. Or, as Wildgust from Janssen put it, “if we can eliminate disease, I’m sure we’ll be able to find a value proposition.”[contextly_sidebar id=\"BsOY9xgwWUtBSlbWPwJOqNCGjfxOKYPZ\"]\u003c/p>\n\u003cp>Stephenson and Graff both said that they still feel like patients much of the time, and that every ache and pain can awaken cancer fears. But they are endlessly grateful for the years the treatments have given them.\u003c/p>\n\u003cp>“Life is good. I can’t complain,” said Stephenson, a mother of three with a strong religious faith. “As bad as myeloma is — and it hasn’t been a picnic by any means — but it has brought so many silver linings. To list them all would take all day.”\u003c/p>\n\u003cp>She doesn’t sweat the small stuff anymore.\u003c/p>\n\u003cp>“So what if you reach for a can of crushed tomatoes and you don’t have any — it’s not the end of the world. Or your stove is dirty. So? I’ll clean it tomorrow if I don’t want to do it today.”\u003c/p>\n\u003cp>Both she and Graff spend time sharing what they’ve learned with patients who are coming up behind them.\u003c/p>\n\u003cp>“I tell people how lucky they are to be diagnosed with multiple myeloma at this time,” said Graff, whose youngest granddaughters are now 4 and 6. “If you have to have it, this is the time.”\u003c/p>\n\u003cdiv class=\"content-meta\"> \u003cem>This \u003ca href=\"https://www.statnews.com/2018/05/29/multiple-myeloma-drug-development/\" 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/div>\n\u003c/div>\n\u003c/div>\n\n",
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"excerpt": "For three-quarters of patients, a disease that once brought a three-year life expectancy has become a long-term, chronic illness. Now, multiple myeloma is poised for another inflection point.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>If you can call someone who gets a rare form of cancer lucky, then Deb Graff says she fits the bill.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>At age 72, Graff has survived nine years with multiple myeloma, a blood cancer whose life expectancy used to be measured in months.\u003c/p>\n\u003cp>“I wasn’t ready to go anywhere,” said Graff, who lives in South Dennis, Mass., on Cape Cod. “I wanted to see my grandkids grow up and still be an aggravation to my husband.”\u003c/p>\n\u003cp>She was lucky enough to get multiple myeloma after the 2003 release of a drug called Velcade (bortezomib), one of the first therapies to directly target multiple myeloma. Velcade, plus more than 20 other approvals since then, have transformed multiple myeloma care. For three-quarters of patients, a disease that once brought a three-year life expectancy has become a long-term, chronic illness.\u003c/p>\n\u003cp>Now, multiple myeloma is poised for another inflection point.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>There are 89 experimental drugs currently being tested in people, according to Biomedtracker, a research unit of Informa. Some are improvements on existing drugs, others have found new ways to target the cancer cells; a few engage the body’s immune system in the fight.\u003c/p>\n\u003cp>Not all the drugs will make it through the trial process, of course.\u003c/p>\n\u003cp>But on the roster, there may be effective treatments for the one-quarter of patients who haven’t yet been helped by existing drugs. There may be regimens that are less challenging than the daily pills, regular infusions, and frequent doctor’s appointments that Graff and others have to manage. And there may be the long-sought cure.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>“There’s no question it’s a golden age in multiple myeloma drug development,” said Dr. David Reese, a senior vice president at Amgen, which developed the drug Kyprolis (carfilzomib), and is testing five others.\u003c/p>\n\u003cp>“It’s possible that we already are at the juncture where patients diagnosed with this disease could live with this disease for the rest of their lives,” added Dr. Ola Landgren, chief of the Multiple Myeloma Service at Memorial Sloan Kettering Cancer Center in New York.\u003c/p>\n\u003cp>Despite all the advances and optimism, though, most patients with multiple myeloma will still die of multiple myeloma.\u003c/p>\n\u003cp>“It is incurable. I think it is a mistake to suggest otherwise,” said Dr. Paul Richardson, Graff’s physician at the Dana-Farber Cancer Institute in Boston. “I think that this disease is forever humbling.”\u003c/p>\n\u003cp>Every multiple myeloma patient’s disease takes a different path. That makes it hard to understand and even harder to predict.\u003c/p>\n\u003cp>The cancer starts in a subgroup of white blood cells called plasma cells that normally make antibodies to fight infection. When cancerous, these plasma cells produce abnormal proteins that damage organs. But where they wreak havoc can vary from person to person.\u003c/p>\n\u003cp>Many patients suffer crushing fatigue, aching joints, and broken bones. Some get bounced around from one doctor to the next before finally getting a diagnosis.\u003c/p>\n\u003cp>Graff, though, never had a symptom. In late 2009, she went in for a routine physical. She and her husband had just retired, sold their house, and were headed to North Carolina. Ten days after the move, Graff’s primary care doctor back in Massachusetts called and said she’d like to run another blood test.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>After her diagnosis and a genetic screen, Graff got more bad news. Her cancer included a genetic mutation called a 17p deletion “that was kind of the kiss of death,” Graff said. Every drug trial she looked at showed positive results for all patients, Graff said, except for those with 17p deletions.\u003c/p>\n\u003cdiv class=\"quote\">\n\u003cdiv class=\"quote-inner\">\n\u003cp>Graff’s younger daughter moved up her wedding to Memorial Day 2010 to make sure her mother could attend. Graff was scheduled for a stem cell transplant six weeks later.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Unfortunately, like many people with a 17p deletion, the transplant didn’t stick. Instead of staying in remission, by November 2010, she was put on a cocktail of three powerful drugs.\u003c/p>\n\u003cp>With so many approved therapies, doctors like Graff’s can keep switching their patients’ regimens. If one combination stops working, there’s another one to try.\u003c/p>\n\u003cp>“My feeling, and I think it was the right feeling, was that it was my job to stay alive and Paul’s job was to find the next best thing,” she said, referring to her doctor.\u003c/p>\n\u003cp>But still, the disease is tenacious.\u003c/p>\n\u003cp>“It will come back even after remission of five to 10 years,” said Dr. Elisabet Manasanch, an assistant professor in the department of lymphoma/myeloma at the University of Texas MD Anderson Cancer Center in Houston.\u003c/p>\n\u003cdiv class=\"quote\">\n\u003cdiv class=\"quote-inner\">\n\u003cp>There’s no such thing as too many treatment options with a disease as wily as multiple myeloma.\u003c/p>\n\u003cp>“Maybe 1,000 drugs is not enough,” said Martina Sersch, Amgen’s head of global development oncology. “It’s a very clever disease.”\u003c/p>\n\u003cp>And now that patients are living longer, the quality of that extra time matters more, Landgren of Memorial Sloan Kettering said, adding that he expects the next wave of therapies will improve the patient experience.\u003c/p>\n\u003cp>Amgen’s drug Kyprolis, for instance, is currently given twice a week via infusion, but is being tested at a higher, once-a-week dose. Trial results for this regimen will be presented at the American Society for Clinical Oncology annual meeting, which starts Friday.\u003c/p>\n\u003cp>“We may have to attack it from different sides and different pathways to achieve what we ultimately want to achieve, which is a functional cure,” Sersch said.\u003c/p>\n\u003cp>Most patients today start with a combination of treatments: a “veritable Army, Navy, and Air Force,” as Richardson puts it.\u003c/p>\n\u003cp>They get a proteasome inhibitor, often Velcade, to directly attack the myeloma cells; an immunomodulatory treatment such as Revlimid (lenalidomide); and the steroid dexamethasone to tamp down an over-reactive immune system.\u003c/p>\n\u003c/div>\n\u003c/div>\n\u003cp>The Marines, Richardson said, are also coming, in the form of monoclonal antibodies, a type of engineered protein that can bind specifically to cancer cells.\u003c/p>\n\u003cp>The monoclonal antibody\u003csup> \u003c/sup>daratumumab, sold by the Janssen unit of Johnson & Johnson under the brand name Darzalex, was first approved in 2015 for people with late-stage disease. Earlier this month, the Food and Drug Administration \u003ca href=\"https://www.jnj.com/media-center/press-releases/janssen-announces-darzalex-daratumumab-us-fda-approval-for-newly-diagnosed-patients-with-multiple-myeloma-who-are-transplant-ineligible\" target=\"_blank\" rel=\"noopener\">expanded\u003c/a> its approval, allowing it to be used in combination with the standard, three-pronged treatment in newly diagnosed patients.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Daratumumab seeks out, binds to, and preferentially kills multiple myeloma cells. In a company-supported study published in the \u003ca href=\"https://www.nejm.org/doi/full/10.1056/NEJMoa1714678?query=featured_home%20-\" target=\"_blank\" rel=\"noopener\">New England Journal of Medicine\u003c/a> in February, 22 percent of patients who used the four-drug combination showed undetectable levels of disease after about 16.5 months. Only 6 percent of patients who used the three-drug combination saw such results.\u003c/p>\n\u003cp>“If you can fundamentally clear all the disease from a patient, now you start to think about, wow — maybe I can get to cure,” said Mark Wildgust, vice president for global medical affairs, oncology, at Janssen.\u003c/p>\n\u003cp>Today’s drugs are so effective that studies take a very long time. In one trial for Kyprolis, for instance, patients who were supposed to be near the end of life survived for 48 months on average, Amgen’s Sersch said. Drug companies will need to find strong, validated criteria other than survival, she said, to provide faster results and potentially drug approvals.\u003c/p>\n\u003cp>Amgen is hoping for game-changing responses to an experimental type of treatment called a BiTE — for bispecific T cell engager. BiTEs essentially are two-armed drugs, Reese said. One arm grabs the tumor cell and the other an immune cell. This activates the immune cell, which kills the cancer cell and primes the immune system to turn against others.\u003c/p>\n\u003cp>It’s too soon to know how long a patient would need to be on BiTE therapy, how to identify which patients might be helped, or how much improvement to expect, Reese said. But because BiTEs train the immune system to fight cancer, they might offer the possibility of a long-term remission or even a cure.\u003c/p>\n\u003cp>Other immune therapies under development include vaccines to amp up the immune system, and an approach called CAR-T, for chimeric antigen receptor T cell. In CAR-T, a patient’s own immune cells are removed and engineered to track down and destroy tumor cells.\u003c/p>\n\u003cp>Richardson, whose first multiple myeloma patient back in 1986 survived just three months, said he’s been amazed by how well CAR-Ts have worked in some of his sickest patients.\u003c/p>\n\u003cp>“I’ve seen the most dramatic responses in CAR-T. They’re quite remarkable,” he said. “Patients who’ve been so ill, and these therapies really made a difference for them beyond what I would expect.”\u003c/p>\n\u003cp>Because CAR-Ts have to be made with the patient’s own T cells, they are expensive and time-consuming; BiTEs are off the shelf and can be mass-produced, theoretically at a lower cost.\u003c/p>\n\u003cfigure id=\"attachment_341074\" class=\"media media-align-center media-break\">\u003ca href=\"https://www.statnews.com/wp-content/uploads/2018/05/multiplemyeloma_01.jpg\">\u003cimg class=\"media-content wp-image-341074 size-large aligncenter\" src=\"https://www.statnews.com/wp-content/uploads/2018/05/multiplemyeloma_01-1024x683.jpg\" alt=\"Multiple Myeloma 03\" width=\"1024\" height=\"683\">\u003c/a>\u003c/figure>\n\u003cp>Cost, of course, is another huge issue in multiple myeloma therapy.\u003c/p>\n\u003cp>Lisa Stephenson, 65, of Whitefish, Mont., who was diagnosed in June 2014, said her multidrug regimen runs about $29,000 a month, plus an occasional $7,000 to boost her immune system. Luckily, nearly all of it is covered by the “incredible insurance” from the law firm where her husband worked until his recent retirement.\u003c/p>\n\u003cp>Stephenson didn’t end up needing a stem cell transplant because an experimental therapy she took at the beginning of her treatment worked so well. But if she had needed it — or needs one in the future — she was told it would cost a minimum of $365,000.\u003c/p>\n\u003cp>“I think to myself, ‘How in the world can people who don’t have good insurance — what do they do?’” she said.\u003c/p>\n\u003cp>It’s not yet clear how much the experimental therapies like BiTEs will cost patients, Amgen’s Reese said. But if these new treatments can produce truly life-altering results, then a one-time large payment, as seen recently with \u003ca href=\"https://www.statnews.com/2018/01/03/spark-gene-therapy-price/\" target=\"_blank\" rel=\"noopener\">gene therapy\u003c/a> and \u003ca href=\"https://www.statnews.com/2017/08/30/novartis-car-t-cancer-approved/\" target=\"_blank\" rel=\"noopener\">CAR-Ts in other types\u003c/a> of blood cancer, might be justifiable. Or, as Wildgust from Janssen put it, “if we can eliminate disease, I’m sure we’ll be able to find a value proposition.”\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Stephenson and Graff both said that they still feel like patients much of the time, and that every ache and pain can awaken cancer fears. But they are endlessly grateful for the years the treatments have given them.\u003c/p>\n\u003cp>“Life is good. I can’t complain,” said Stephenson, a mother of three with a strong religious faith. “As bad as myeloma is — and it hasn’t been a picnic by any means — but it has brought so many silver linings. To list them all would take all day.”\u003c/p>\n\u003cp>She doesn’t sweat the small stuff anymore.\u003c/p>\n\u003cp>“So what if you reach for a can of crushed tomatoes and you don’t have any — it’s not the end of the world. Or your stove is dirty. So? I’ll clean it tomorrow if I don’t want to do it today.”\u003c/p>\n\u003cp>Both she and Graff spend time sharing what they’ve learned with patients who are coming up behind them.\u003c/p>\n\u003cp>“I tell people how lucky they are to be diagnosed with multiple myeloma at this time,” said Graff, whose youngest granddaughters are now 4 and 6. “If you have to have it, this is the time.”\u003c/p>\n\u003cdiv class=\"content-meta\"> \u003cem>This \u003ca href=\"https://www.statnews.com/2018/05/29/multiple-myeloma-drug-development/\" 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/div>\n\u003c/div>\n\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "This Digital Pill Wants To Make Following Your Prescription Easier",
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"content": "\u003cp>Doctors \u003ca href=\"http://annals.org/aim/fullarticle/1357338/interventions-improve-adherence-self-administered-medications-chronic-diseases-united-states\" target=\"_blank\" rel=\"noopener\">estimate\u003c/a> about half of all medications for chronic conditions are not taken as prescribed, resulting in $100 billion to $289 billion in preventable health care costs and more than 100,000 deaths every year in the U.S. \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/22510235\" target=\"_blank\" rel=\"noopener\">A majority of adults\u003c/a> say they struggle with remembering to take their prescriptions.[contextly_sidebar id=\"2CHr3EdFO0IpmlPpjqlB7AVQ3gwHnKDA\"]\u003c/p>\n\u003cp>Now, as with many other seemingly intractable challenges, technology has been enlisted to help. A new clinical study is underway at 16 health centers around the country to see if a pill with an ingestible sensor can improve medication adherence rates for \u003ca href=\"https://www.cdc.gov/hepatitis/hcv/cfaq.htm\" target=\"_blank\" rel=\"noopener\">Hepatitis C\u003c/a> drugs.\u003c/p>\n\u003cp>\u003ca href=\"https://www.proteus.com/\" target=\"_blank\" rel=\"noopener\">Proteus Digital Health\u003c/a>, the inventor of this so-called digital pill, is part of an emerging field of medicine and one of a handful of companies designing these high-tech pills.\u003c/p>\n\u003cp>While medication adherence is an issue for everyone, it can be especially difficult for patients with mental health and substance abuse conditions to rigorously follow their prescriptions.\u003c/p>\n\u003cp>And the latter is a significant factor in the spread of Hepatitis C. Intravenous drug use, particularly opioids, has fueled a \u003ca href=\"https://www.cdc.gov/nchhstp/newsroom/2017/Hepatitis-Surveillance-Press-Release.html\">spike in\u003c/a> Hepatitis C infections in recent years.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>On Wednesday’s PBS NewsHour, I explore how a new wave of Hepatitis C drugs, known as direct-acting antivirals, can cure the disease 95 percent of time when used as prescribed. But insurance providers have limited their payouts and the access for direct-acting antivirals, due to the drugs’ expensive price tag.\u003c/p>\n\u003cp>[youtube https://www.youtube.com/watch?v=3DN2gI87R3Q?feature=oembed]\u003c/p>\n\u003cp>David Wyles, head of infectious diseases at \u003ca href=\"https://www.denverhealth.org/\" target=\"_blank\" rel=\"noopener\">Denver Health\u003c/a> where the digital pill is being trialed, said the information gathered from the study may help \u003ca href=\"https://www.chlpi.org/chlpi-nvhr-launch-interactive-report-card-project-grading-52-medicaid-programs-discriminatory-hepatitis-c-treatment-restrictions/\" target=\"_blank\" rel=\"noopener\">convince insurers to expand access \u003c/a>to the new but more expensive Hepatitis C drugs. \u003ca href=\"https://www.denverhealth.org/\" target=\"_blank\" rel=\"noopener\">Denver Health\u003c/a> has 18 voluntary patients enrolled in the trial and is one of the largest study sites. The Colorado Department of Health estimates about \u003ca href=\"https://drive.google.com/file/d/0B0tmPQ67k3NVQjJXSFRGajdWUEE/view\" target=\"_blank\" rel=\"noopener\">70,000\u003c/a> people in the state carry Hepatitis C, and Denver Health cares for many of them.\u003c/p>\n\u003cp>“Insurance payers have imposed restrictions, not necessarily based on medical or scientific facts,” Wyles said. “This is a population that some will look at and say, ‘They won’t take their medications, why would we want to treat them?’ Potentially this study is something to refute that if we can show adherence rates are good.”[contextly_sidebar id=\"64LqO8WUg7X2FUJe9uqsRXqMVyuUE8BQ\"]\u003c/p>\n\u003cp>Proteus’ digital pill consists of the prescription medication with a tiny, FDA-approved ingestible sensor, packed inside a gel capsule. Once swallowed, minerals in the sensor react when they hit the acids in the stomach and create a tiny electronic signal. A band-aid-like patch, worn on the skin of the torso, captures this signal and relays it to an app on a smartphone or tablet.\u003c/p>\n\u003cp>Patients share the data with their doctors but also control who else has access. Their doctors can then monitor when and how many pills have been taken.\u003c/p>\n\u003cp>“If the patient misses a dose or a couple of doses, you can set up an alert in the program to send you an email. You can contact them and hopefully intervene right away,” David Wyles said. “Without the technology, you may not know anything until your next visit, which could be a month later, and then it’s too late to do anything.”\u003c/p>\n\u003cp>Yet the new technology raises questions about patient privacy. \u003ca href=\"https://psychnews.psychiatryonline.org/doi/full/10.1176/appi.pn.2017.pp12a2\" target=\"_blank\" rel=\"noopener\">Some doctors in the mental health community\u003c/a> expressed concerns last year about patient trust and misuse of data when the \u003ca href=\"https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm584933.htm\" target=\"_blank\" rel=\"noopener\">FDA approved\u003c/a> Proteus Digital Health’s sensors to be embedded in the antipsychotic drug \u003ca href=\"https://www.proteus.com/press-releases/otsuka-and-proteus-announce-the-first-us-fda-approval-of-a-digital-medicine-system-abilify-mycite/\" target=\"_blank\" rel=\"noopener\">Abilify.[contextly_sidebar id=\"BuXdE0rwLJ9KNHT80EszuM4r2ocN7n84\"]\u003c/a>\u003c/p>\n\u003cp>“In an era in which even the National Security Agency gets hacked, there are obvious concerns about patient privacy with a technology that communicates personal medical information,” Paul Appelbaum, director of the division of Law, Ethics, and Psychiatry at Columbia University, \u003ca href=\"https://psychnews.psychiatryonline.org/doi/full/10.1176/appi.pn.2017.pp12a2\" target=\"_blank\" rel=\"noopener\">told Psychiatric News\u003c/a>. “The potential for this technology to be misused by judges and probation officers who may require offenders to use pills with sensors, and then respond punitively to the most trivial failure to adhere to the treatment regimen, is real.”\u003c/p>\n\u003cp>Dr. George Savage, chief medical officer for Proteus Digital Health, said his company is adamant about patients controlling their own data: “The patient owns their own data and decides who to share it with beyond their medical team. We don’t sell data and never will.”\u003c/p>\n\u003cp>Nine health systems across the U.S. have used the technology so far for conditions like diabetes, heart failure, and hypertension. Proteus Digital Health is also testing the digital pills with oncology and HIV drugs, and on patients using opioids for pain relief. Dr. Savage said adherence rates with the digital pills have been shown to be high.\u003c/p>\n\u003cp>‘When we provide feedback to the patient, adherence is about 87 percent,” Savage said. “When we add in someone following up with a patient, like a doctor, adherence is 96 percent. Near perfection.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Editor’s note: This post has been updated to clarify that the signal is only sent once when the pill reaches the stomach acid and that the related patch is worn on the torso.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Doctors \u003ca href=\"http://annals.org/aim/fullarticle/1357338/interventions-improve-adherence-self-administered-medications-chronic-diseases-united-states\" target=\"_blank\" rel=\"noopener\">estimate\u003c/a> about half of all medications for chronic conditions are not taken as prescribed, resulting in $100 billion to $289 billion in preventable health care costs and more than 100,000 deaths every year in the U.S. \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/22510235\" target=\"_blank\" rel=\"noopener\">A majority of adults\u003c/a> say they struggle with remembering to take their prescriptions.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Now, as with many other seemingly intractable challenges, technology has been enlisted to help. A new clinical study is underway at 16 health centers around the country to see if a pill with an ingestible sensor can improve medication adherence rates for \u003ca href=\"https://www.cdc.gov/hepatitis/hcv/cfaq.htm\" target=\"_blank\" rel=\"noopener\">Hepatitis C\u003c/a> drugs.\u003c/p>\n\u003cp>\u003ca href=\"https://www.proteus.com/\" target=\"_blank\" rel=\"noopener\">Proteus Digital Health\u003c/a>, the inventor of this so-called digital pill, is part of an emerging field of medicine and one of a handful of companies designing these high-tech pills.\u003c/p>\n\u003cp>While medication adherence is an issue for everyone, it can be especially difficult for patients with mental health and substance abuse conditions to rigorously follow their prescriptions.\u003c/p>\n\u003cp>And the latter is a significant factor in the spread of Hepatitis C. Intravenous drug use, particularly opioids, has fueled a \u003ca href=\"https://www.cdc.gov/nchhstp/newsroom/2017/Hepatitis-Surveillance-Press-Release.html\">spike in\u003c/a> Hepatitis C infections in recent years.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>On Wednesday’s PBS NewsHour, I explore how a new wave of Hepatitis C drugs, known as direct-acting antivirals, can cure the disease 95 percent of time when used as prescribed. But insurance providers have limited their payouts and the access for direct-acting antivirals, due to the drugs’ expensive price tag.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003cspan class='utils-parseShortcode-shortcodes-__youtubeShortcode__embedYoutube'>\n \u003cspan class='utils-parseShortcode-shortcodes-__youtubeShortcode__embedYoutubeInside'>\n \u003ciframe\n loading='lazy'\n class='utils-parseShortcode-shortcodes-__youtubeShortcode__youtubePlayer'\n type='text/html'\n src='//www.youtube.com/embed/3DN2gI87R3Q?feature=oembed'\n title='//www.youtube.com/embed/3DN2gI87R3Q?feature=oembed'\n allowfullscreen='true'\n style='border:0;'>\u003c/iframe>\n \u003c/span>\n \u003c/span>\u003c/p>\u003cp>\u003c/p>\n\u003cp>David Wyles, head of infectious diseases at \u003ca href=\"https://www.denverhealth.org/\" target=\"_blank\" rel=\"noopener\">Denver Health\u003c/a> where the digital pill is being trialed, said the information gathered from the study may help \u003ca href=\"https://www.chlpi.org/chlpi-nvhr-launch-interactive-report-card-project-grading-52-medicaid-programs-discriminatory-hepatitis-c-treatment-restrictions/\" target=\"_blank\" rel=\"noopener\">convince insurers to expand access \u003c/a>to the new but more expensive Hepatitis C drugs. \u003ca href=\"https://www.denverhealth.org/\" target=\"_blank\" rel=\"noopener\">Denver Health\u003c/a> has 18 voluntary patients enrolled in the trial and is one of the largest study sites. The Colorado Department of Health estimates about \u003ca href=\"https://drive.google.com/file/d/0B0tmPQ67k3NVQjJXSFRGajdWUEE/view\" target=\"_blank\" rel=\"noopener\">70,000\u003c/a> people in the state carry Hepatitis C, and Denver Health cares for many of them.\u003c/p>\n\u003cp>“Insurance payers have imposed restrictions, not necessarily based on medical or scientific facts,” Wyles said. “This is a population that some will look at and say, ‘They won’t take their medications, why would we want to treat them?’ Potentially this study is something to refute that if we can show adherence rates are good.”\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Proteus’ digital pill consists of the prescription medication with a tiny, FDA-approved ingestible sensor, packed inside a gel capsule. Once swallowed, minerals in the sensor react when they hit the acids in the stomach and create a tiny electronic signal. A band-aid-like patch, worn on the skin of the torso, captures this signal and relays it to an app on a smartphone or tablet.\u003c/p>\n\u003cp>Patients share the data with their doctors but also control who else has access. Their doctors can then monitor when and how many pills have been taken.\u003c/p>\n\u003cp>“If the patient misses a dose or a couple of doses, you can set up an alert in the program to send you an email. You can contact them and hopefully intervene right away,” David Wyles said. “Without the technology, you may not know anything until your next visit, which could be a month later, and then it’s too late to do anything.”\u003c/p>\n\u003cp>Yet the new technology raises questions about patient privacy. \u003ca href=\"https://psychnews.psychiatryonline.org/doi/full/10.1176/appi.pn.2017.pp12a2\" target=\"_blank\" rel=\"noopener\">Some doctors in the mental health community\u003c/a> expressed concerns last year about patient trust and misuse of data when the \u003ca href=\"https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm584933.htm\" target=\"_blank\" rel=\"noopener\">FDA approved\u003c/a> Proteus Digital Health’s sensors to be embedded in the antipsychotic drug \u003ca href=\"https://www.proteus.com/press-releases/otsuka-and-proteus-announce-the-first-us-fda-approval-of-a-digital-medicine-system-abilify-mycite/\" target=\"_blank\" rel=\"noopener\">Abilify.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/a>\u003c/p>\n\u003cp>“In an era in which even the National Security Agency gets hacked, there are obvious concerns about patient privacy with a technology that communicates personal medical information,” Paul Appelbaum, director of the division of Law, Ethics, and Psychiatry at Columbia University, \u003ca href=\"https://psychnews.psychiatryonline.org/doi/full/10.1176/appi.pn.2017.pp12a2\" target=\"_blank\" rel=\"noopener\">told Psychiatric News\u003c/a>. “The potential for this technology to be misused by judges and probation officers who may require offenders to use pills with sensors, and then respond punitively to the most trivial failure to adhere to the treatment regimen, is real.”\u003c/p>\n\u003cp>Dr. George Savage, chief medical officer for Proteus Digital Health, said his company is adamant about patients controlling their own data: “The patient owns their own data and decides who to share it with beyond their medical team. We don’t sell data and never will.”\u003c/p>\n\u003cp>Nine health systems across the U.S. have used the technology so far for conditions like diabetes, heart failure, and hypertension. Proteus Digital Health is also testing the digital pills with oncology and HIV drugs, and on patients using opioids for pain relief. Dr. Savage said adherence rates with the digital pills have been shown to be high.\u003c/p>\n\u003cp>‘When we provide feedback to the patient, adherence is about 87 percent,” Savage said. “When we add in someone following up with a patient, like a doctor, adherence is 96 percent. Near perfection.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Editor’s note: This post has been updated to clarify that the signal is only sent once when the pill reaches the stomach acid and that the related patch is worn on the torso.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "California Hospitals Urge Moms To Favor Breast Milk Over Formula",
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"content": "\u003cp>MONTEBELLO, Calif. — Wendy Wan, 31, said American infant formula is advertised in her native China as the most nutritious food for a newborn.\u003c/p>\n\u003cp>“It sounds like it’s premium,” said Wan, who gave birth in early May at Beverly Hospital here. Wan said she was skeptical of the ads and had planned to feed her baby son only breast milk. But when her milk failed to come in quickly, she didn’t hesitate to supplement it with formula.\u003c/p>\n\u003cp>“I prefer breastfeeding, but I think it’s almost the same,” she said from her hospital bed the day after her son was born.\u003c/p>\n\u003cp>It’s not the same. The American Academy of Pediatrics recommends exclusive breastfeeding for the first six months of a baby’s life because of the well-known health benefits for both infants and mothers. Women, like Wan, who start with the intention of feeding their babies exclusively breast milk but then supplement it with formula while still in the hospital are nearly three times more likely to stop breastfeeding within two months, according to one \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/24529621\" target=\"_blank\" rel=\"noopener\">study\u003c/a>.\u003c/p>\n\u003cp>California has made \u003ca href=\"http://www.calwic.org/storage/documents/Factsheets2017/Press_Release_2017.docx\" target=\"_blank\" rel=\"noopener\">significant progress\u003c/a> in recent years promoting exclusive breastfeeding in hospitals, but many women aren’t sticking with it. All but a small fraction of women start breastfeeding while in the hospital, but nearly one-third introduce their babies to formula before leaving, according to \u003ca href=\"https://www.cdph.ca.gov/Programs/CFH/DMCAH/CDPH%20Document%20Library/BFP/BFP-Data-InHospital-Hospitals-2016.pdf\" target=\"_blank\" rel=\"noopener\">data\u003c/a>from the California Department of Public Health.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cimg class=\"alignright wp-image-278011\" src=\"https://californiahealthline.files.wordpress.com/2018/05/breastfeeding-hospitals1.png?w=500&h=1206\" alt=\"\" width=\"500\" height=\"1206\">And significant disparities — both ethnic and socioeconomic — persist. While women of color are exclusively breastfeeding their babies more frequently than in the past, they still lag far behind whites: In 2016, nearly 82 percent of white moms gave their infants only breast milk in the hospital, compared with 60 percent of black moms and 65 percent of Asian and Latina moms, according to the department’s \u003ca href=\"https://www.cdph.ca.gov/Programs/CFH/DMCAH/CDPH%20Document%20Library/BFP/BFP-Data-InHospital-Occurrence-RaceEthnicity-2016.pdf\" target=\"_blank\" rel=\"noopener\">data\u003c/a>. (Data for individual race groups exclude persons of Hispanic ethnicity, who can be of any race.)\u003c/p>\n\u003cp>Wide gaps also \u003ca href=\"https://www.cdph.ca.gov/Programs/CFH/DMCAH/CDPH%20Document%20Library/BFP/BFP-Data-InHospital-Hospitals-2016.pdf\" target=\"_blank\" rel=\"noopener\">separate California’s counties and hospitals\u003c/a>. Some facilities reported exclusive breastfeeding rates of more than 90 percent and others less than 25 percent. Some of the hospitals with the lowest rates are in lower-income communities. The statewide average is 69 percent.\u003c/p>\n\u003cp>“Where you deliver … and what race you are have a huge impact on breastfeeding,” said Arissa Palmer, executive director of the nonprofit advocacy group \u003ca href=\"http://breastfeedla.org/\" target=\"_blank\" rel=\"noopener\">Breastfeed LA\u003c/a>. “Those are barriers that we haven’t touched the surface on.”\u003c/p>\n\u003cp>In an effort to diminish the disparities and improve the health of babies, state law requires hospitals to implement concrete measures to promote breastfeeding no later than 2025.\u003c/p>\n\u003cp>\u003ca href=\"http://pediatrics.aappublications.org/content/129/3/e827.full\" target=\"_blank\" rel=\"noopener\">Research\u003c/a> shows that breastfeeding babies can reduce their risk of obesity, diabetes and asthma. It can also lessen the chance of heart disease and cancer in mothers.\u003c/p>\n\u003cp>Nationally, non-Hispanic black babies are \u003ca href=\"https://www.cdc.gov/breastfeeding/data/facts.html\" target=\"_blank\" rel=\"noopener\">significantly less likely\u003c/a> to breastfeed than non-Hispanic whites or Hispanics, according to the Centers for Disease Control and Prevention. Mississippi, West Virginia, Louisiana and Arkansas have the lowest \u003ca href=\"https://www.cdc.gov/breastfeeding/data/nis_data/rates-any-exclusive-bf-state-2014.htm\" target=\"_blank\" rel=\"noopener\">breastfeeding rates\u003c/a> in the U.S. Colorado, Oregon, Idaho and Washington have the highest.\u003c/p>\n\u003cp>About 60 percent of women in the U.S. stop breastfeeding before they had initially intended to, the CDC said. Among the reasons: worries about their infants’ weight, problems with latching, unsupportive policies at work and lack of education about the benefits of breastfeeding.\u003c/p>\n\u003cp>Another factor may be the unintended consequences of patient satisfaction scores, said Carmen Rezak, maternal-child health quality coordinator for AHMC Healthcare, a Southern California hospital chain. Because patient ratings are tied to hospital reimbursement, nurses are sometimes afraid to deny patients’ wishes. They may not want to tell relatives they cannot visit, for example, even if more privacy and quiet time do encourage breastfeeding, Rezak said.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>The publication of statewide data on exclusive breastfeeding rates places “pressure on hospitals” to really look at their policies and practices compared with their competitors, said Jen Goldbronn of the state’s public health department.\u003c/p>\n\u003caside class=\"related inline\">\n\u003cdiv class=\"slab email-slab \">\n\u003cdiv class=\"email-signup\">\n\u003cp>One of the best-known ways to increase rates of exclusive breastfeeding is by following the \u003ca href=\"https://www.unicef.org/newsline/tenstps.htm\" target=\"_blank\" rel=\"noopener\">“Ten Steps to Successful Breastfeeding.”\u003c/a> These include helping mothers start nursing within one hour of birth, not giving formula to babies unless medically necessary and informing all pregnant women about the benefits of breastfeeding.\u003c/p>\n\u003cp>The organization Baby-Friendly USA requires hospitals seeking its “baby-friendly” seal to follow the 10 steps. In California, nearly 100 hospitals have that designation, up from 12 in 2006. The state \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140SB402\" target=\"_blank\" rel=\"noopener\">law\u003c/a> requiring hospitals to have breastfeeding support measures in place by 2025 specifically names the 10 steps, but also allows hospitals to adopt alternative practices proven to encourage breastfeeding.\u003c/p>\n\u003cp>Trish MacEnroe, executive director of \u003ca href=\"https://www.babyfriendlyusa.org/\" target=\"_blank\" rel=\"noopener\">Baby-Friendly USA\u003c/a>, said hospitals across the country used to discourage breastfeeding inadvertently by whisking babies away to nurseries. Now, newborns typically stay in the room with the mother and start nursing immediately after birth. Urging moms to hold their babies “skin to skin” right after birth helps encourage breastfeeding because of the physical proximity, according to \u003ca href=\"https://www.unicef.org.uk/babyfriendly/news-and-research/baby-friendly-research/research-supporting-breastfeeding/skin-to-skin-contact/\" target=\"_blank\" rel=\"noopener\">research\u003c/a>.\u003c/p>\n\u003cp>Some of the hospitals with the lowest rates of exclusive breastfeeding in the state are Whittier Hospital, at 20 percent, and Monterey Park Hospital, at 22 percent. The two hospitals, both run by AHMC Healthcare, serve a high number of Asian moms and others who come to the country for the sole purpose of giving birth, Rezak said.\u003c/p>\n\u003cp>Foreign parents are among the most difficult to convince about the importance of exclusive breastfeeding, in part because of cultural barriers or myths about the value of formula, she said. Education is also important, Rezak said. Hospital staff try to teach all new moms to recognize when their infants are hungry or tired.\u003c/p>\n\u003cdiv id=\"attachment_278618\" class=\"wp-caption aligncenter\">\n\u003cp>\u003cimg class=\"size-full wp-image-278618\" src=\"https://californiahealthline.files.wordpress.com/2018/05/breastfeeding_001_1350.jpg?w=1024&h=683\" alt=\"\" width=\"1024\" height=\"683\">\u003c/p>\n\u003cp class=\"wp-caption-text\">Newborn Ella Lang is cradled by registered nurse Kam Ho at Beverly Hospital in Montebello, Calif., on May 8. Nurses at the hospital taught Ella’s mother, Peng Peng, to breastfeed and encouraged her to continue. (Ana Venegas for KHN)\u003c/p>\n\u003c/div>\n\u003cp>At PIH Health Hospital Whittier, moms who want formula have to sign a form acknowledging they understand their decision, said Valerie Martin, clinical director of maternity care. The hospital’s rate of exclusive breastfeeding is 80 percent, compared with 33 percent at its sister hospital in Downey.\u003c/p>\n\u003cp>At Beverly Hospital, where Wan gave birth, nurses show patients different positions for breastfeeding and reinforce the importance of exclusive breastfeeding. But they also try not to push new mothers, said Melissa Morita, director of maternal and child health.\u003c/p>\n\u003cp>Peng Peng, who lives in China, came to the U.S. about a month before giving birth to her daughter, Ella Lang, at the hospital earlier this month. Peng, 34, said that soon after Ella was born, a nurse gave her formula because her blood sugar was low.\u003c/p>\n\u003cp>Peng said she didn’t mind too much but still wanted to breastfeed as much as possible.\u003c/p>\n\u003cp>“It’s natural and it’s more nutritious,” she said. “But I’m not super against formula.”\u003c/p>\n\u003cp class=\"credits\">\u003cem>KHN’s coverage of these topics is supported by \u003ca href=\"http://www.blueshieldcafoundation.org/\">Blue Shield of California Foundation\u003c/a> and \u003ca href=\"https://www.packard.org/\">The David and Lucile Packard Foundation\u003c/a>\u003c/em>\u003c/p>\n\u003caside class=\"meta-authors meta\">\u003c/aside>\n\u003c/div>\n\u003c/div>\n\u003c/aside>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>MONTEBELLO, Calif. — Wendy Wan, 31, said American infant formula is advertised in her native China as the most nutritious food for a newborn.\u003c/p>\n\u003cp>“It sounds like it’s premium,” said Wan, who gave birth in early May at Beverly Hospital here. Wan said she was skeptical of the ads and had planned to feed her baby son only breast milk. But when her milk failed to come in quickly, she didn’t hesitate to supplement it with formula.\u003c/p>\n\u003cp>“I prefer breastfeeding, but I think it’s almost the same,” she said from her hospital bed the day after her son was born.\u003c/p>\n\u003cp>It’s not the same. The American Academy of Pediatrics recommends exclusive breastfeeding for the first six months of a baby’s life because of the well-known health benefits for both infants and mothers. Women, like Wan, who start with the intention of feeding their babies exclusively breast milk but then supplement it with formula while still in the hospital are nearly three times more likely to stop breastfeeding within two months, according to one \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/24529621\" target=\"_blank\" rel=\"noopener\">study\u003c/a>.\u003c/p>\n\u003cp>California has made \u003ca href=\"http://www.calwic.org/storage/documents/Factsheets2017/Press_Release_2017.docx\" target=\"_blank\" rel=\"noopener\">significant progress\u003c/a> in recent years promoting exclusive breastfeeding in hospitals, but many women aren’t sticking with it. All but a small fraction of women start breastfeeding while in the hospital, but nearly one-third introduce their babies to formula before leaving, according to \u003ca href=\"https://www.cdph.ca.gov/Programs/CFH/DMCAH/CDPH%20Document%20Library/BFP/BFP-Data-InHospital-Hospitals-2016.pdf\" target=\"_blank\" rel=\"noopener\">data\u003c/a>from the California Department of Public Health.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cimg class=\"alignright wp-image-278011\" src=\"https://californiahealthline.files.wordpress.com/2018/05/breastfeeding-hospitals1.png?w=500&h=1206\" alt=\"\" width=\"500\" height=\"1206\">And significant disparities — both ethnic and socioeconomic — persist. While women of color are exclusively breastfeeding their babies more frequently than in the past, they still lag far behind whites: In 2016, nearly 82 percent of white moms gave their infants only breast milk in the hospital, compared with 60 percent of black moms and 65 percent of Asian and Latina moms, according to the department’s \u003ca href=\"https://www.cdph.ca.gov/Programs/CFH/DMCAH/CDPH%20Document%20Library/BFP/BFP-Data-InHospital-Occurrence-RaceEthnicity-2016.pdf\" target=\"_blank\" rel=\"noopener\">data\u003c/a>. (Data for individual race groups exclude persons of Hispanic ethnicity, who can be of any race.)\u003c/p>\n\u003cp>Wide gaps also \u003ca href=\"https://www.cdph.ca.gov/Programs/CFH/DMCAH/CDPH%20Document%20Library/BFP/BFP-Data-InHospital-Hospitals-2016.pdf\" target=\"_blank\" rel=\"noopener\">separate California’s counties and hospitals\u003c/a>. Some facilities reported exclusive breastfeeding rates of more than 90 percent and others less than 25 percent. Some of the hospitals with the lowest rates are in lower-income communities. The statewide average is 69 percent.\u003c/p>\n\u003cp>“Where you deliver … and what race you are have a huge impact on breastfeeding,” said Arissa Palmer, executive director of the nonprofit advocacy group \u003ca href=\"http://breastfeedla.org/\" target=\"_blank\" rel=\"noopener\">Breastfeed LA\u003c/a>. “Those are barriers that we haven’t touched the surface on.”\u003c/p>\n\u003cp>In an effort to diminish the disparities and improve the health of babies, state law requires hospitals to implement concrete measures to promote breastfeeding no later than 2025.\u003c/p>\n\u003cp>\u003ca href=\"http://pediatrics.aappublications.org/content/129/3/e827.full\" target=\"_blank\" rel=\"noopener\">Research\u003c/a> shows that breastfeeding babies can reduce their risk of obesity, diabetes and asthma. It can also lessen the chance of heart disease and cancer in mothers.\u003c/p>\n\u003cp>Nationally, non-Hispanic black babies are \u003ca href=\"https://www.cdc.gov/breastfeeding/data/facts.html\" target=\"_blank\" rel=\"noopener\">significantly less likely\u003c/a> to breastfeed than non-Hispanic whites or Hispanics, according to the Centers for Disease Control and Prevention. Mississippi, West Virginia, Louisiana and Arkansas have the lowest \u003ca href=\"https://www.cdc.gov/breastfeeding/data/nis_data/rates-any-exclusive-bf-state-2014.htm\" target=\"_blank\" rel=\"noopener\">breastfeeding rates\u003c/a> in the U.S. Colorado, Oregon, Idaho and Washington have the highest.\u003c/p>\n\u003cp>About 60 percent of women in the U.S. stop breastfeeding before they had initially intended to, the CDC said. Among the reasons: worries about their infants’ weight, problems with latching, unsupportive policies at work and lack of education about the benefits of breastfeeding.\u003c/p>\n\u003cp>Another factor may be the unintended consequences of patient satisfaction scores, said Carmen Rezak, maternal-child health quality coordinator for AHMC Healthcare, a Southern California hospital chain. Because patient ratings are tied to hospital reimbursement, nurses are sometimes afraid to deny patients’ wishes. They may not want to tell relatives they cannot visit, for example, even if more privacy and quiet time do encourage breastfeeding, Rezak said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The publication of statewide data on exclusive breastfeeding rates places “pressure on hospitals” to really look at their policies and practices compared with their competitors, said Jen Goldbronn of the state’s public health department.\u003c/p>\n\u003caside class=\"related inline\">\n\u003cdiv class=\"slab email-slab \">\n\u003cdiv class=\"email-signup\">\n\u003cp>One of the best-known ways to increase rates of exclusive breastfeeding is by following the \u003ca href=\"https://www.unicef.org/newsline/tenstps.htm\" target=\"_blank\" rel=\"noopener\">“Ten Steps to Successful Breastfeeding.”\u003c/a> These include helping mothers start nursing within one hour of birth, not giving formula to babies unless medically necessary and informing all pregnant women about the benefits of breastfeeding.\u003c/p>\n\u003cp>The organization Baby-Friendly USA requires hospitals seeking its “baby-friendly” seal to follow the 10 steps. In California, nearly 100 hospitals have that designation, up from 12 in 2006. The state \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140SB402\" target=\"_blank\" rel=\"noopener\">law\u003c/a> requiring hospitals to have breastfeeding support measures in place by 2025 specifically names the 10 steps, but also allows hospitals to adopt alternative practices proven to encourage breastfeeding.\u003c/p>\n\u003cp>Trish MacEnroe, executive director of \u003ca href=\"https://www.babyfriendlyusa.org/\" target=\"_blank\" rel=\"noopener\">Baby-Friendly USA\u003c/a>, said hospitals across the country used to discourage breastfeeding inadvertently by whisking babies away to nurseries. Now, newborns typically stay in the room with the mother and start nursing immediately after birth. Urging moms to hold their babies “skin to skin” right after birth helps encourage breastfeeding because of the physical proximity, according to \u003ca href=\"https://www.unicef.org.uk/babyfriendly/news-and-research/baby-friendly-research/research-supporting-breastfeeding/skin-to-skin-contact/\" target=\"_blank\" rel=\"noopener\">research\u003c/a>.\u003c/p>\n\u003cp>Some of the hospitals with the lowest rates of exclusive breastfeeding in the state are Whittier Hospital, at 20 percent, and Monterey Park Hospital, at 22 percent. The two hospitals, both run by AHMC Healthcare, serve a high number of Asian moms and others who come to the country for the sole purpose of giving birth, Rezak said.\u003c/p>\n\u003cp>Foreign parents are among the most difficult to convince about the importance of exclusive breastfeeding, in part because of cultural barriers or myths about the value of formula, she said. Education is also important, Rezak said. Hospital staff try to teach all new moms to recognize when their infants are hungry or tired.\u003c/p>\n\u003cdiv id=\"attachment_278618\" class=\"wp-caption aligncenter\">\n\u003cp>\u003cimg class=\"size-full wp-image-278618\" src=\"https://californiahealthline.files.wordpress.com/2018/05/breastfeeding_001_1350.jpg?w=1024&h=683\" alt=\"\" width=\"1024\" height=\"683\">\u003c/p>\n\u003cp class=\"wp-caption-text\">Newborn Ella Lang is cradled by registered nurse Kam Ho at Beverly Hospital in Montebello, Calif., on May 8. Nurses at the hospital taught Ella’s mother, Peng Peng, to breastfeed and encouraged her to continue. (Ana Venegas for KHN)\u003c/p>\n\u003c/div>\n\u003cp>At PIH Health Hospital Whittier, moms who want formula have to sign a form acknowledging they understand their decision, said Valerie Martin, clinical director of maternity care. The hospital’s rate of exclusive breastfeeding is 80 percent, compared with 33 percent at its sister hospital in Downey.\u003c/p>\n\u003cp>At Beverly Hospital, where Wan gave birth, nurses show patients different positions for breastfeeding and reinforce the importance of exclusive breastfeeding. But they also try not to push new mothers, said Melissa Morita, director of maternal and child health.\u003c/p>\n\u003cp>Peng Peng, who lives in China, came to the U.S. about a month before giving birth to her daughter, Ella Lang, at the hospital earlier this month. Peng, 34, said that soon after Ella was born, a nurse gave her formula because her blood sugar was low.\u003c/p>\n\u003cp>Peng said she didn’t mind too much but still wanted to breastfeed as much as possible.\u003c/p>\n\u003cp>“It’s natural and it’s more nutritious,” she said. “But I’m not super against formula.”\u003c/p>\n\u003cp class=\"credits\">\u003cem>KHN’s coverage of these topics is supported by \u003ca href=\"http://www.blueshieldcafoundation.org/\">Blue Shield of California Foundation\u003c/a> and \u003ca href=\"https://www.packard.org/\">The David and Lucile Packard Foundation\u003c/a>\u003c/em>\u003c/p>\n\u003caside class=\"meta-authors meta\">\u003c/aside>\n\u003c/div>\n\u003c/div>\n\u003c/aside>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp> \u003c/p>\n\u003cp>\u003ciframe src=\"https://embed.ted.com/talks/zeynep_tufekci_we_re_building_a_dystopia_just_to_make_people_click_on_ads\" width=\"640\" height=\"361\" frameborder=\"0\" scrolling=\"no\" webkitallowfullscreen mozallowfullscreen allowfullscreen>\u003c/iframe>\u003c/p>\n\u003cp>\u003cem>Part 1 of the \u003c/em>TED Radio Hour \u003cem>episode \u003c/em>\u003ca href=\"https://www.npr.org/programs/ted-radio-hour/614007696/attention-please\" target=\"_blank\" rel=\"noopener\">Attention Please\u003c/a>\u003cem>.\u003c/em>\u003c/p>\n\u003cp>\u003cstrong>About Zeynep Tufekci's TED Talk\u003c/strong>\u003c/p>\n\u003cp>Why is it so easy to burn through an hour on YouTube or Facebook? Sociologist Zeynep Tufekci explains how advertising algorithms have turned our attention into a valuable commodity.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cstrong>About Zeynep Tufekci\u003c/strong>\u003c/p>\n\u003cp>\u003ca href=\"http://technosociology.org/\" target=\"_blank\" rel=\"noopener\">Zeynep Tufekci\u003c/a> is a contributing opinion writer for The New York Times, writing about the Internet, technology, politics and society.\u003c/p>\n\u003cp>She is also an \u003ca href=\"https://sils.unc.edu/people/faculty/zeynep-tufekci\" target=\"_blank\" rel=\"noopener\">assistant professor\u003c/a> at the University of North Carolina, a faculty associate at the Berkman Center for Internet and Society at Harvard, and a former fellow at the Center for Internet Technology Policy at Princeton.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>She was a computer programmer by profession before turning her attention to the social sciences, focusing on the impact of technology. She calls herself a \"techno-sociologist.\" She is also the author of \u003ca href=\"https://www.twitterandteargas.org/\" target=\"_blank\" rel=\"noopener\">\u003cem>Twitter and Tear Gas: The Power and Fragility of Networked Protest\u003c/em>\u003c/a>.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Zeynep+Tufekci%3A+How+Is+Our+Attention+Packaged+And+Sold+As+A+Commodity%3F&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp> \u003c/p>\n\u003cp>\u003ciframe src=\"https://embed.ted.com/talks/zeynep_tufekci_we_re_building_a_dystopia_just_to_make_people_click_on_ads\" width=\"640\" height=\"361\" frameborder=\"0\" scrolling=\"no\" webkitallowfullscreen mozallowfullscreen allowfullscreen>\u003c/iframe>\u003c/p>\n\u003cp>\u003cem>Part 1 of the \u003c/em>TED Radio Hour \u003cem>episode \u003c/em>\u003ca href=\"https://www.npr.org/programs/ted-radio-hour/614007696/attention-please\" target=\"_blank\" rel=\"noopener\">Attention Please\u003c/a>\u003cem>.\u003c/em>\u003c/p>\n\u003cp>\u003cstrong>About Zeynep Tufekci's TED Talk\u003c/strong>\u003c/p>\n\u003cp>Why is it so easy to burn through an hour on YouTube or Facebook? Sociologist Zeynep Tufekci explains how advertising algorithms have turned our attention into a valuable commodity.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cstrong>About Zeynep Tufekci\u003c/strong>\u003c/p>\n\u003cp>\u003ca href=\"http://technosociology.org/\" target=\"_blank\" rel=\"noopener\">Zeynep Tufekci\u003c/a> is a contributing opinion writer for The New York Times, writing about the Internet, technology, politics and society.\u003c/p>\n\u003cp>She is also an \u003ca href=\"https://sils.unc.edu/people/faculty/zeynep-tufekci\" target=\"_blank\" rel=\"noopener\">assistant professor\u003c/a> at the University of North Carolina, a faculty associate at the Berkman Center for Internet and Society at Harvard, and a former fellow at the Center for Internet Technology Policy at Princeton.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>She was a computer programmer by profession before turning her attention to the social sciences, focusing on the impact of technology. She calls herself a \"techno-sociologist.\" She is also the author of \u003ca href=\"https://www.twitterandteargas.org/\" target=\"_blank\" rel=\"noopener\">\u003cem>Twitter and Tear Gas: The Power and Fragility of Networked Protest\u003c/em>\u003c/a>.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Zeynep+Tufekci%3A+How+Is+Our+Attention+Packaged+And+Sold+As+A+Commodity%3F&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp class=\"danger-zone\">Researchers have devised a new way to get a sneak peek into what’s going on deep in your digestive system, creating a swallowable sensor that, with the help of engineered bacteria and a tiny electrical circuit, can detect the presence of molecules that might be signs of disease and then beam the results to a smartphone app.[contextly_sidebar id=\"cXA6MxncZmnk6z9Joyqfu31MO3tmPF1l\"]\u003c/p>\n\u003cp class=\"danger-zone\">The device, which scientists validated in pigs, remains a prototype and needs to be refined before it could be used in people. But the researchers, who \u003ca href=\"http://science.sciencemag.org/cgi/doi/10.1126/science.aas9315\" target=\"_blank\" rel=\"noopener\">reported their work\u003c/a> Thursday in the journal Science, combined innovations in synthetic biology and microelectronics to create a modular platform that could be adapted to identify a wide range of molecules.\u003c/p>\n\u003cp class=\"danger-zone\">“We want to try to illuminate and provide understanding into areas that are not easily accessible,” said Dr. Timothy Lu, a bioengineer at the Massachusetts Institute of Technology and senior author of the paper.\u003c/p>\n\u003cp class=\"\">The GI tract houses a myriad of metabolites that scientists hope could shed light on what happens in the dark of the digestive system. These molecules could provide clues to when the system gets out of whack, for example, or perhaps open a new way to diagnose disease. But experts lack the tools to probe deep inside, particularly in the parts of the system that are beyond the reach of tools like scopes.\u003c/p>\n\u003cp class=\"\">“A lot of important biology and health-related pathways are happening there, and we don’t have really good technologies to see inside the gut and measure chemicals there,” said Jeff Tabor, a bioengineer at Rice University, who was not involved in the study.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Researchers have been experimenting with engineering bacteria so that they are triggered in some way in the presence of their targeted molecules. But if the bacteria are deployed into the GI tract, they typically can’t signal to people outside what they’ve encountered. It would be like discovering the lost city of Atlantis only to realize you don’t have a way to tell anyone what you found or where you found it.\u003c/p>\n\u003cp>“Getting the data back out is a challenge, so having a convenient, really practical strategy for having the bacteria tell us what they see is important,” Tabor said about the new sensor system. “I think this is a really nice solution for that problem.”\u003c/p>\n\u003cp>The new tool — which the research team has dubbed an ingestible micro-bio-electronic device, or IMBED — tucks the engineered bacteria into wells that are covered by a semipermeable membrane, keeping the bacterial cells inside but welcoming metabolites.\u003c/p>\n\u003cp>If the molecules of choice filter in and meet the bacteria, the bacterial cells produce light that is picked up by photodetectors embedded in a small electrical chip. The electrical system can then shoot the signal out to a smartphone app, like a prospector screaming upon striking oil.[contextly_sidebar id=\"D3dFdFoqEBnMHRAKc3Bvbp848jc9CyDK\"]\u003c/p>\n\u003cp>The device described in the paper is about 10 millimeters by 30 millimeters — about the length of two dimes next to each other — and the researchers, who have filed for a patent on the technology, said they hope to shrink it to about a third of its size for use in people. Experts noted that pills carrying cameras or monitoring temperatures are already in use, so this approach is not that sci-fi.\u003c/p>\n\u003cp>“This has the potential to unlock a wealth of information about the body’s structure and function, its relationship with the environment, and the impact of disease and therapeutic interventions,” Peter Gibson and Rebecca Burgell of Monash University in Australia wrote in \u003ca href=\"http://science.sciencemag.org/cgi/doi/10.1126/science.aat8658\" target=\"_blank\" rel=\"noopener\">an editorial\u003c/a> accompanying the study.\u003c/p>\n\u003cp>As a proof of concept, the researchers showed the system could detect the molecule heme in the GI tracts of pigs in a model of GI bleeding. Within two hours of being deployed, the device was able to distinguish between pigs with modeled GI bleeding and a control group, with 100 percent accuracy.\u003c/p>\n\u003cp>The researchers envision tweaking the bacteria so they can recognize a range of metabolites. The device also has four wells, each with room for about a million bacterial cells, so it might be possible to put different bacterial biosensors in each well to detect different molecules.\u003c/p>\n\u003cp>“We could evolve these living systems to conceivably sense any biological marker,” said Mark Mimee, a graduate student at MIT and lead author of the study.\u003c/p>\n\u003cp>Researchers not involved with the work identified several improvements that are needed for the biosensor to be clinically useful. First, doctors need to be able to track the device so they can tell where exactly in the gut it is when it detects its targeted molecules. The sensor also needs to be able to pick up on the metabolites rapidly so it can send out its signal before it gets shuttled along to another part of the GI tract.\u003c/p>\n\u003cp>Gibson and Burgell, as well as Tabor, also pointed to another challenge: Scientists haven’t nailed down exactly what biomarkers they should be looking for as signposts for different diseases. So beyond honing this 21st century technology, researchers still need to unlock a greater understanding of our much older biology.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This story was originally published by \u003ca href=\"https://www.statnews.com/2018/04/20/doctors-learn-bad-habits-teaching-hospitals/\" target=\"_blank\" rel=\"noopener\">STAT\u003c/a>, 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": "\u003cp>Why do people have such big brains? Some researchers asked a really powerful brain — a computer — and got back a surprising answer.[contextly_sidebar id=\"d0DIuOWUOwVJhoxMb7LQpHdQ7uLJlr7Q\"]\u003c/p>\n\u003cp>In relation to body size, our brains are huge, about six times larger than one would expect from other mammals. And this three-pound organ sucks up fully 20 percent of the body’s energy needs. Evolutionary theory says to build and maintain something that costly, there must have been a very good reason.\u003c/p>\n\u003cp>But what is it? Did our ancestors need more brainpower to cope with the environment, such as finding and storing food? Or was it driven more by the social complexities of dealing with their peers? Or was it all about the challenge of learning and teaching cultural knowledge?\u003c/p>\n\u003cp>In the past, scientists have tried to tease out an answer mostly by analyzing correlations, like how brain size relates to the size of social groups in living apes and our fossil ancestors.\u003c/p>\n\u003cp>Mauricio Gonzalez-Forero and Andy Gardner of St. Andrews University in Scotland turned instead to computer simulations. They report the result in a paper released Wednesday by the journal Nature.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The researchers created a hypothetical population of females, focusing on just one sex for simplicity, and followed them as they faced the challenges of living. The researchers plugged in data on things like a newborn’s brain size and the energy costs of the brain and reproductive organs. And they simulated tasks that resemble the environmental and social challenges included in theories about brain evolution.[contextly_sidebar id=\"BoHBcN3FhLEeIu2K51PXBnKupNSL1pYA\"]\u003c/p>\n\u003cp>The computer pondered how the pressures of each challenge might affect changes of brain size over time. Drawing on evolutionary theory, it calculated how much energy the females would be expected to invest in growing the brain versus other tissues under the different challenges. It found that stronger mental demands tended to produce bigger brains.\u003c/p>\n\u003cp>Gonzalez-Forero said he and Gardner expected a strong contribution to bigger brains from social challenges, which he said has been the favorite idea for decades.\u003c/p>\n\u003cp>But their surprise, the computer said about 60 percent of the effect on boosting brain size came from an individual dealing with the environment on one’s own, as in finding, storing and cooking food, and making stone tools. Another 30 percent came from cooperating to deal with the environment, such as banding together to hunt. The final 10 percent from competition between groups of people.\u003c/p>\n\u003cp>While the study didn’t specifically look at the impact of cultural tasks, it gave evidence of a substantial influence from them, too, Gonzalez-Forero said. He plans to assess cultural factors in the future.\u003c/p>\n\u003cp>In any case, the results are not intended to be the final word, but rather an encouragement for other researchers to use computer simulation for studying the question of brain size. Much exciting work remains to be done, he said.\u003c/p>\n\u003cp>Experts unconnected to the study were skeptical of the conclusions.\u003c/p>\n\u003cp>Dean Falk, a brain-evolution expert at Florida State University, said the work doesn’t assess the longstanding hypothesis that the development of language may have driven expansion of the brain. Gonzalez-Forero said the language idea is to some extent part of the cultural factors that remain to be addressed.\u003c/p>\n\u003cp>Falk also said the simulation strategy may have overemphasized the role of energy demands in influencing brain growth.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Robin Dunbar, a professor of evolutionary psychology at Oxford University, and paleoanthropologist Richard Potts of the Smithsonian Institution said they didn’t think the simulation adequately mimicked the lives our ancestors lived.\u003c/p>\n\n",
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"info": "The Commonwealth Club of California is the nation's oldest and largest public affairs forum. As a non-partisan forum, The Club brings to the public airwaves diverse viewpoints on important topics. The Club's weekly radio broadcast - the oldest in the U.S., dating back to 1924 - is carried across the nation on public radio stations and is now podcasting. Our website archive features audio of our recent programs, as well as selected speeches from our long and distinguished history. This podcast feed is usually updated twice a week and is always un-edited.",
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"order": 9
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"id": "fresh-air",
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"airtime": "SUN 7:30pm-8pm",
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"tagline": "Where conversation and cultura meet",
"info": "What kind of no sabo word is Hyphenación? For us, it’s about living within a hyphenation. Like being a third-gen Mexican-American from the Texas border now living that Bay Area Chicano life. Like Xorje! Each week we bring together a couple of hyphenated Latinos to talk all about personal life choices: family, careers, relationships, belonging … everything is on the table. ",
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"order": 15
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"title": "The Political Mind of Jerry Brown",
"tagline": "Lessons from a lifetime in politics",
"info": "The Political Mind of Jerry Brown brings listeners the wisdom of the former Governor, Mayor, and presidential candidate. Scott Shafer interviewed Brown for more than 40 hours, covering the former governor's life and half-century in the political game – and Brown has some lessons he'd like to share. ",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/The-Political-Mind-of-Jerry-Brown-Podcast-Tile-703x703-1.jpg",
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"order": 18
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"info": "Latino USA, the radio journal of news and culture, is the only national, English-language radio program produced from a Latino perspective.",
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"marketplace": {
"id": "marketplace",
"title": "Marketplace",
"info": "Our flagship program, helmed by Kai Ryssdal, examines what the day in money delivered, through stories, conversations, newsworthy numbers and more. Updated Monday through Friday at about 3:30 p.m. PT.",
"airtime": "MON-FRI 4pm-4:30pm, MON-WED 6:30pm-7pm",
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"source": "American Public Media"
},
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"masters-of-scale": {
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"title": "Masters of Scale",
"info": "Masters of Scale is an original podcast in which LinkedIn co-founder and Greylock Partner Reid Hoffman sets out to describe and prove theories that explain how great entrepreneurs take their companies from zero to a gazillion in ingenious fashion.",
"airtime": "Every other Wednesday June 12 through October 16 at 8pm (repeats Thursdays at 2am)",
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},
"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",
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"meta": {
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"order": 12
},
"link": "/podcasts/mindshift",
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM1NzY0NjAwNDI5",
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"morning-edition": {
"id": "morning-edition",
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"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.",
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"onourwatch": {
"id": "onourwatch",
"title": "On Our Watch",
"tagline": "Deeply-reported investigative journalism",
"info": "For decades, the process for how police police themselves has been inconsistent – if not opaque. In some states, like California, these proceedings were completely hidden. After a new police transparency law unsealed scores of internal affairs files, our reporters set out to examine these cases and the shadow world of police discipline. On Our Watch brings listeners into the rooms where officers are questioned and witnesses are interrogated to find out who this system is really protecting. Is it the officers, or the public they've sworn to serve?",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/On-Our-Watch-Podcast-Tile-703x703-1.jpg",
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"order": 11
},
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"on-the-media": {
"id": "on-the-media",
"title": "On The Media",
"info": "Our weekly podcast explores how the media 'sausage' is made, casts an incisive eye on fluctuations in the marketplace of ideas, and examines threats to the freedom of information and expression in America and abroad. For one hour a week, the show tries to lift the veil from the process of \"making media,\" especially news media, because it's through that lens that we see the world and the world sees us",
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},
"link": "/radio/program/on-the-media",
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},
"pbs-newshour": {
"id": "pbs-newshour",
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"info": "Analysis, background reports and updates from the PBS NewsHour putting today's news in context.",
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"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/PBS-News-Hour-Podcast-Tile-360x360-1.jpg",
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"apple": "https://itunes.apple.com/us/podcast/pbs-newshour-full-show/id394432287?mt=2",
"tuneIn": "https://tunein.com/radio/PBS-NewsHour---Full-Show-p425698/",
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},
"perspectives": {
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"order": 14
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"planet-money": {
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"info": "The economy explained. Imagine you could call up a friend and say, Meet me at the bar and tell me what's going on with the economy. Now imagine that's actually a fun evening.",
"airtime": "SUN 3pm-4pm",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/planetmoney.jpg",
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},
"link": "/radio/program/planet-money",
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"apple": "https://itunes.apple.com/us/podcast/planet-money/id290783428?mt=2",
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},
"politicalbreakdown": {
"id": "politicalbreakdown",
"title": "Political Breakdown",
"tagline": "Politics from a personal perspective",
"info": "Political Breakdown is a new series that explores the political intersection of California and the nation. Each week hosts Scott Shafer and Marisa Lagos are joined with a new special guest to unpack politics -- with personality — and offer an insider’s glimpse at how politics happens.",
"airtime": "THU 6:30pm-7pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Political-Breakdown-2024-Podcast-Tile-703x703-1.jpg",
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"order": 5
},
"link": "/podcasts/politicalbreakdown",
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"possible": {
"id": "possible",
"title": "Possible",
"info": "Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. Together in Possible, Hoffman and Finger lead enlightening discussions about building a brighter collective future. The show features interviews with visionary guests like Trevor Noah, Sam Altman and Janette Sadik-Khan. Possible paints an optimistic portrait of the world we can create through science, policy, business, art and our shared humanity. It asks: What if everything goes right for once? How can we get there? Each episode also includes a short fiction story generated by advanced AI GPT-4, serving as a thought-provoking springboard to speculate how humanity could leverage technology for good.",
"airtime": "SUN 2pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Possible-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.possible.fm/",
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"source": "Possible"
},
"link": "/radio/program/possible",
"subscribe": {
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"spotify": "https://open.spotify.com/show/730YpdUSNlMyPQwNnyjp4k"
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},
"pri-the-world": {
"id": "pri-the-world",
"title": "PRI's The World: Latest Edition",
"info": "Each weekday, host Marco Werman and his team of producers bring you the world's most interesting stories in an hour of radio that reminds us just how small our planet really is.",
"airtime": "MON-FRI 2pm-3pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/The-World-Podcast-Tile-360x360-1.jpg",
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},
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