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"content": "\u003caside>\n\u003cul>\n\u003cli>Many gender clinicians now recommend parents 'socially transition' kids who persistently express a transgender identity.\u003c/li>\n\u003cli>But research has shown most children will give up their transgender identity by the time they are adolescents.\u003c/li>\n\u003cli>Not all researchers agree, though, that this research is valid.\u003c/li>\n\u003c/ul>\n\u003c/aside>\n\u003cp>Gracie is the youngest transgender person I've ever met. She's so young, she still likes to tack on \"and-a-half\" when giving her age, which is six. One day last summer, bouncing all over the grounds at day camp, she looked as delighted as you'd expect any kid would on \"Water Day.”\u003c/p>\n\u003caside class=\"alignright\">\u003ca href=\"https://www.kqed.org/futureofyou/441784/the-controversial-research-on-desistance-in-transgender-youth\">The Controversial Research on 'Desistance' in Transgender Youth\u003c/a>\u003c/aside>\n\u003cp>This is Rainbow Day Camp, in the East Bay town of El Cerrito. It was created specifically to be a safe place for transgender kids, and in fact, being transgender is so unremarkable here, when I asked Gracie what makes it “special,\" she shrugged and said:\u003c/p>\n\u003cp>“You get to do fun stuff.”\u003c/p>\n\u003cp>Her mother, Molly, tried to coax a reporter-friendly answer out of her.\u003c/p>\n\u003cp>“What is special about you, and the same as everybody else in the camp?” she prompted.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“I don’t know,” Gracie said.\u003c/p>\n\u003caside class=\"pullquote alignright\">'What if we let our son walk into the world in a dress with fairy wings, and crowns, and high heels, and even just in regular girl clothes … and then he changes his mind?'\u003ccite>Molly, whose 6-year-old daughter, Gracie, socially transitioned at age four\u003c/cite>\u003c/aside>\n\u003cp>“You’re transgender and there’s other kids that are transgender, too...”\u003c/p>\n\u003cp>“I’m transgender and there’s other kids that are transgender, too.”\u003c/p>\n\u003cp>Ah, kids. ... But when I asked Gracie how she \u003cem>used\u003c/em> to feel, when other people thought she was a boy, she got straight to the point.\u003c/p>\n\u003cp>“It was not right to me, and I didn’t want people to say that, but they said it,” she said. “It hurted my feelings a lot.\"\u003c/p>\n\u003cp>Did it make her angry?\u003c/p>\n\u003cp>“No, it just made me sad.”\u003c/p>\n\u003caside class=\"alignright\">\u003ca href=\"mailto:jbrooks@kqed.org\">Email the reporter\u003c/a>\u003c/aside>\n\u003cp>How about now?\u003c/p>\n\u003cp>“It feels happy to me.”\u003c/p>\n\u003cp>And that, in a child’s nutshell, sums up one side of a contentious debate about the right age for transgender children to begin what gender clinicians call “social transitioning.”\u003c/p>\n\u003cp>https://www.youtube.com/watch?v=IS5Yankf1GY\u003c/p>\n\u003cp>\u003cstrong>Even Three-Year-Olds\u003c/strong>\u003c/p>\n\u003cp>When I met Gracie, she was a few months out of kindergarten — pretty young for a transgender kid, I thought. Gracie lives with her parents and younger brother in a small city in the East Bay. She is already two years into her transition, having started her public life as a girl at four. The family began by discarding her boy name and referring to Gracie as “she” and “her.” She was also allowed to wear girl clothes outside the home, and her parents changed the gender on her birth certificate to avoid confusion at school.\u003c/p>\n\u003caside class=\"alignright noborder\">\u003cstrong>How young is too young?\u003c/strong>\u003cbr>\nUCSF’s Diane Ehrensaft, one of the leading proponents of socially transitioning transgender children, believes there is no minimum age, really, to pursue such a change.'For all of these interventions, our model is stages not ages,” she said. 'When a child is at the place in their life that they can get themselves in focus, help us see them, and are clear, consistent, and stable in both their representation of themselves, and also can express their desires of how they want to live their gender, that's the age.'We have seen some kids as young as two whose parents are bringing them in because they're beginning to say, ‘Me not boy. Me girl.’ Social transition can happen as soon as a child has language or the ability to communicate to us who they are.'\u003c/aside>\n\u003cp>Steps like these make up the “social” aspects of social, not medical, transitioning. The distinction is important: According to Endocrine Society \u003ca href=\"https://academic.oup.com/jcem/article/102/11/3869/4157558\" target=\"_blank\" rel=\"noopener\">guidelines\u003c/a>, patients who want to begin medical treatment like puberty blockers, hormones or surgery should be old enough to give “informed consent,” which the organization says is usually attained by 16.\u003c/p>\n\u003cp>Therapists at \u003ca href=\"https://www.ucsfbenioffchildrens.org/clinics/child_and_adolescent_gender_center/\" target=\"_blank\" rel=\"noopener\">UCSF’s Child and Adolescent Gender Center Clinic\u003c/a> in San Francisco told me they’ve socially transitioned kids as young as three.\u003c/p>\n\u003cp>Diane Ehrensaft, the San Francisco Center’s mental health director and a leading proponent of early social transitioning, acknowledges this approach has been controversial.\u003c/p>\n\u003cp>“There are some people that think folks like myself, and the people at our clinic, have fallen off the deep end,” she told me. She wasn’t just talking about the religious right, either. She was referring to other mental health professionals.\u003c/p>\n\u003cp>I myself experienced a fair bit of surprise when Ehrensaft told me how young these kids are. My first, reflexive comment was a simple, \"Wow.\" This was not an uncommon reaction when I discussed this story with people in my own life, even in the progressive Bay Area.\u003c/p>\n\u003cp>Yet, when I spoke with Gracie’s mom, Molly (the family didn't want their last name used for reasons of privacy), nothing about the decision to allow her then-son to publicly make the switch to a girl, at an age when many kids are still sucking their thumbs, sounded in the slightest bit rash.\u003c/p>\n\u003cp>We spoke at Rainbow Day Camp, in a classroom set aside for interviews. The children’s art adorning the walls, the shrimpy seats — it felt like a place to talk about kickball, not the gender identity of first graders.\u003c/p>\n\u003cp>Yet here we were.\u003c/p>\n\u003caside class=\"alignright\">\u003cstrong>The Biological Roots of Gender Identity\u003c/strong>\u003cbr>\nMolly is the mother of two children, a 3-year-old boy and a 7-year-old transgender girl. The younger child is the “stereotype of what I thought having a son would be like,” she said. “He loves trucks, cars, construction, superheroes and destroying the house.”Her first child, also born male, just did not develop in the same way. Rather, from the time he acquired language on, he protested that he was really a girl. (\u003ca href=\"https://www.kqed.org/futureofyou/the-biological-roots-of-gender-identity\" target=\"_blank\" rel=\"noopener\">Continue reading)\u003c/a>\u003c/aside>\n\u003cp>“What if we do this?” Molly recalled asking a gender therapist, back when they were debating the pros and cons of letting Gracie transition. “What if we let our son walk into the world in a dress with fairy wings, and crowns, and high heels, and even just in regular girl clothes … and then he changes his mind?”\u003c/p>\n\u003cp>\"That's not the question,” the therapist told Molly. “The question is, what if you don't do it?”\u003c/p>\n\u003cp>It was only semi-rhetorical. Some gender therapists say there are serious potential dangers if adults suppress a child’s desired transition. On surveys, American transgender adults have reported attempting suicide at the startling \u003ca href=\"https://williamsinstitute.law.ucla.edu/wp-content/uploads/AFSP-Williams-Suicide-Report-Final.pdf\" target=\"_blank\" rel=\"noopener\">rate\u003c/a> of around 40 percent.\u003c/p>\n\u003cp>The stakes couldn’t have been higher, Molly knew.\u003c/p>\n\u003cp>At Rainbow Day Camp, recalling that time, she started to cry.\u003c/p>\n\u003cp>“As soon as I knew there was even a chance that my kid could feel ashamed of who they are, there was no way … ” Her voice cracked into a higher register. “I had to support, I had to listen, and I had to let her steer, a little bit, the ship. Period. No matter what.”\u003c/p>\n\u003cfigure id=\"attachment_441862\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2020/04/gracie-sliding-water-1.jpg\">\u003cimg class=\"wp-image-441862 size-large\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2020/04/gracie-sliding-water-1-1020x527.jpg\" alt=\"\" width=\"640\" height=\"331\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2020/04/gracie-sliding-water-1-1020x527.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2020/04/gracie-sliding-water-1-160x83.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2020/04/gracie-sliding-water-1-800x414.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2020/04/gracie-sliding-water-1-768x397.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2020/04/gracie-sliding-water-1-1200x620.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/13/2020/04/gracie-sliding-water-1-1180x610.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2020/04/gracie-sliding-water-1-960x496.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2020/04/gracie-sliding-water-1-240x124.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2020/04/gracie-sliding-water-1-375x194.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2020/04/gracie-sliding-water-1-520x269.jpg 520w, https://ww2.kqed.org/app/uploads/sites/13/2020/04/gracie-sliding-water-1.jpg 1209w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Gracie, six, on Water Day at Rainbow Day Camp, which was created as a safe space for transgender kids. \u003ccite>(KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>‘I’m a Girl’\u003c/strong>\u003c/p>\n\u003cp>Ehrensaft calls children like Gracie “persistent, consistent, and insistent” in their declarations of cross-gender identity. For Gracie, this manifested through words, wishes, and, well, practically everything.\u003c/p>\n\u003caside class=\"pullquote alignright\">'Why would we deny for the vast majority of kids something that is basically suicide prevention?'\u003ccite>Diane Ehrensaft, UCSF\u003c/cite>\u003c/aside>\n\u003cp>Gracie was her parents' first child. From toddlerhood on, Molly said, their son had displayed a “constant obsession and fixation on all things girl. As soon as she could tell us, it was, ‘I'm a girl. I'm a sister. I'm a daughter. I'm that girl on that show. I'm that girl in that book.’”\u003c/p>\n\u003cp>Gracie's parents weren’t on board at first.\u003c/p>\n\u003cp>“We filled her world with trucks, and dinosaurs, and superheroes, and we refused girl things,” Molly said. “Like, ‘No, you can't be Elsa for Halloween. You have to be Superman. No, you can't have the dolls for Christmas. We're going to get you a pirate ship.’”\u003c/p>\n\u003cp>They also made a rule: No girl clothing outside the house.\u003c/p>\n\u003cp>Molly tells me: “That’s the part I’m ashamed of now.”\u003c/p>\n\u003cp>\u003cstrong>'These Kids Do Come Forward'\u003c/strong>\u003c/p>\n\u003cp>Molly and her husband finally relented — they just could not deny how much happier their child felt when recognized as a girl.\u003c/p>\n\u003cfigure id=\"attachment_441832\" class=\"wp-caption alignright\" style=\"max-width: 640px\">\u003ca href=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2020/04/Phoenix5-e1527011026777.jpg\">\u003cimg class=\"size-large wp-image-441832\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2020/04/Phoenix5-1020x1530.jpg\" alt=\"\" width=\"640\" height=\"960\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Phoenix, a transgender girl who began wearing dresses to school at age 5. She began made a complete social transition at the start of second grade. \u003ccite>(Courtesy of family)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>I asked: Has Gracie ever looked back?\u003c/p>\n\u003cp>Molly chuckled.\u003c/p>\n\u003cp>“If you think of gender as a spectrum, she is like a full, all-the-way girl.”\u003c/p>\n\u003cp>It’s not rocket science, Ehrensaft explained, if you really listen to the children. “A child will say: ‘Stop calling me Jane. Let me wear my dresses. Please call me she.’ That's a child making a clear statement.”\u003c/p>\n\u003cp>Kristina Olson, a University of Washington gender researcher, said parents do not always listen to what their kids are telling them.\u003c/p>\n\u003cp>“The ones that are most likely to transition are kids who for many years are very consistently saying this is who they are,” she said. ”We often see this happen for years before parents socially transition their kids.”\u003c/p>\n\u003cp>UCSF gender specialist Erica Anderson recently treated a five-year-old who had reached a point of desperation.\u003c/p>\n\u003cp>“In the bathtub, he would compare himself to his younger sister, and really start getting upset. At one point he went in the bathroom with a pair of shears — he was going to cut his penis off.”\u003c/p>\n\u003cp>“This child has been so clear for a couple of years,” Anderson said. “These kids do come forward.”\u003c/p>\n\u003cp>\u003cstrong>Changing Approaches\u003c/strong>\u003c/p>\n\u003cp>Gender clinicians who recommend social transition at such an early age call their model “gender affirmative,” and they believe their approach is now ascendant. Historically, clinicians more commonly treated transgender kids by discouraging cross-gender identity. The method was most famously practiced by longtime gender researcher Ken Zucker.\u003c/p>\n\u003cp>Zucker is now an extraordinarily controversial figure in the transgender community. He believed that an outcome in which a child becomes transgender should be avoided, if possible. You can get a glimpse of his methods in this \u003ca href=\"https://www.npr.org/2008/05/07/90247842/two-families-grapple-with-sons-gender-preferences\" target=\"_blank\" rel=\"noopener\">NPR story\u003c/a> from 2008. Zucker is counseling the family of a young boy he’d diagnosed with gender identity disorder, the term used for gender dysphoria before 2013.\u003c/p>\n\u003cblockquote>\u003cp>Zucker explained to Carol that she and her husband would have to radically change their parenting. Bradley would no longer be allowed to spend time with girls. He would no longer be allowed to play with girlish toys or pretend that he was a female character. Zucker said that all of these activities were dangerous to a kid with gender identity disorder. He explained that unless Carol and her husband helped the child to change his behavior, as Bradley grew older, he likely would be rejected by both peer groups.\u003c/p>\u003c/blockquote>\n\u003cp>Other researchers and transgender activists have criticized this approach as too close to the “conversion therapy” inflicted on gay and lesbian youth, a practice that is now illegal in a number of states, including \u003ca href=\"https://www.sfgate.com/news/article/State-bans-gay-repair-therapy-for-minors-3906032.php\" target=\"_blank\" rel=\"noopener\">California\u003c/a>.\u003c/p>\n\u003cp>[emailsignup newslettername='science' align='right']The World Professional Association for Transgender Health's guidelines for clinicians, called the \u003ca href=\"https://www.wpath.org/publications/soc\" target=\"_blank\" rel=\"noopener\">Standards of Care\u003c/a>, states that “treatment aimed at trying to change a person’s gender identity and expression to become more congruent with sex assigned at birth” is “no longer considered ethical.”\u003c/p>\n\u003cp>Zucker was the psychologist-in-chief and head of the gender identity clinic at a Toronto mental health hospital before administrators shut down the clinic in 2015, after a review of his practices. That was also \u003ca href=\"https://www.theglobeandmail.com/life/health-and-fitness/health/alleged-exchange-with-gender-identity-doctor-didnt-happen-camh-says/article28471923/\" target=\"_blank\" rel=\"noopener\">controversial\u003c/a>, and Zucker is suing his former employer for defamation. (Zucker declined to comment for this article. For a defense of his work, you can read Jesse Singal’s \u003ca href=\"https://www.thecut.com/2016/02/fight-over-trans-kids-got-a-researcher-fired.html\" target=\"_blank\" rel=\"noopener\">reporting\u003c/a> from 2016.)\u003c/p>\n\u003cp>\u003cstrong>Watchful Waiting\u003c/strong>\u003c/p>\n\u003cp>Zucker’s approach aside, there is another alternative to gender affirmative therapy. It’s the approach taken by the \u003ca href=\"https://www.vumc.com/branch/gender-dysphoria/\" target=\"_blank\" rel=\"noopener\">Center of Expertise on Gender Dysphoria\u003c/a> in Amsterdam, and gender specialists commonly refer to it as the “Dutch Model.”\u003c/p>\n\u003cp>This treatment sometimes involves the social transition of young children, according to Thomas Steensma, a researcher and clinician at the center. But for the most part, its counseling incorporates the idea that the vast majority of gender dysphoric children will eventually stop identifying as transgender.\u003c/p>\n\u003cp>The research literature calls these individuals “desistant.” The kids who retain their transgender identity as they grow up are dubbed “persistent.”\u003c/p>\n\u003cp>\u003cstrong>The Desistance Controversy\u003c/strong>\u003c/p>\n\u003cp>Nothing roils the world of transgender research like the topic of \u003ca href=\"https://www.kqed.org/futureofyou/441784/the-controversial-research-on-desistance-in-transgender-youth\" target=\"_blank\" rel=\"noopener\">desistance\u003c/a>. Brynn Tannehill, a transgender activist who follows the research closely, said the concept is often used by anti-LGBT groups to make the case that rejecting children’s transgender identity is in their best interests.\u003c/p>\n\u003caside class=\"pullquote alignright\">'[Desistance research] is used primarily as an attack on the validity of transgender identities, which usually quickly disintegrates into a debate on whether we should exist.' \u003ccite>Brynn Tannehill, transgender activist\u003c/cite>.\u003c/aside>\n\u003cp>“It is used primarily as an attack on the validity of transgender identities, which usually quickly disintegrates into a debate on whether we should exist,” Tannehill said.\u003c/p>\n\u003cp>And yet, the fact is that just about every published study on the topic to date has found that a majority of children who once reported various degrees of gender dysphoria ended up eventually giving up their transgender identity.\u003c/p>\n\u003cp>To grasp the implications of this, remember Molly’s anxious questioning of the gender therapist: What if we go through all this, and it turns out to be just a phase? Shouldn’t we wait?\u003c/p>\n\u003cp>The gender affirmative camp says no. That’s because it doesn’t believe that the body of research on desistance, some of it conducted by Zucker and his associates, is valid.\u003c/p>\n\u003cp>Many gender researchers maintain that the current criteria for diagnosing gender dysphoria are much more stringent than in the past. Therefore, many of the studies that found so many kids had \"grown out\" of their transgender identity were actually measuring children who were \u003cem>never really transgender\u003c/em> in the first place.\u003c/p>\n\u003cp>“Some of those studies are decades old,” said gender researcher Kristina Olson. “So if you had a son in the early 1980s who liked playing with dolls and wanted to occasionally wear a dress, even today maybe you would think to bring that child to talk to a doctor about it. But that child wouldn't necessarily be transgender, because that kid doesn't necessarily think of himself as a girl.\"\u003c/p>\n\u003cp>Ehrensaft said that her San Francisco clinic sees “a tiny, tiny proportion” of clients who stop identifying as transgender after transitioning.\u003c/p>\n\u003cp>Even the Amsterdam clinic’s Thomas Steensma, who firmly believes most gender dysphoric kids will \u003cem>not\u003c/em> grow up to be transgender, acknowledged the earlier studies probably included “milder cases” that are “hard to compare with the clinical samples we see now in our clinics.”\u003c/p>\n\u003cfigure id=\"attachment_441834\" class=\"wp-caption alignright\" style=\"max-width: 720px\">\u003ca href=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2020/04/James.jpeg\">\u003cimg class=\"size-full wp-image-441834\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2020/04/James.jpeg\" alt=\"\" width=\"720\" height=\"960\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2020/04/James.jpeg 720w, https://ww2.kqed.org/app/uploads/sites/13/2020/04/James-160x213.jpeg 160w, https://ww2.kqed.org/app/uploads/sites/13/2020/04/James-240x320.jpeg 240w, https://ww2.kqed.org/app/uploads/sites/13/2020/04/James-375x500.jpeg 375w, https://ww2.kqed.org/app/uploads/sites/13/2020/04/James-520x693.jpeg 520w\" sizes=\"(max-width: 720px) 100vw, 720px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Olivia, a transgender girl who socially transitioned when she was four, and her brother, James, who transitioned when he was eight. \u003ccite>(Courtesy of family)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Nevertheless, he said, “The only evidence I have from studies and reports in the literature ... is that children who struggle with gender incongruence … will not all persist into adolescence.\"\u003c/p>\n\u003cp>Talking to Steensma over Skype, he seemed bemused by the fact that the “Dutch model” is now considered conservative compared to what has taken hold in America. After all, his Amsterdam clinic had been a pioneer in the medical treatment of transgender youth, especially in the use of puberty blockers, which delay the onset of secondary sex characteristics.\u003c/p>\n\u003cp>But what about the \u003cem>social transitioning\u003c/em> of young kids?\u003c/p>\n\u003cp>\"It's not a 'yes' or a 'no' in our opinion, but a 'maybe,' Steensma told me.\u003c/p>\n\u003cp>I wondered if there was any real argument between him and Ehrensaft, after all. So I described to him the case of persistent, insistent, consistent Gracie.\u003c/p>\n\u003cp>A slam dunk for social transition?\u003c/p>\n\u003cp>Steensma said no.\u003c/p>\n\u003cp>“We would counsel them ... that it's okay to express your feelings, your interests, to show your behaviors. But with certain steps like a name change, or a pronoun change, with a result that maybe others will only perceive you as a girl — that's somewhere where we say, ‘Okay, maybe you should explore things without taking steps that are hard to reverse.’”\u003c/p>\n\u003cp>There are mental health professionals in the U.S. who agree. Dr. Jack Drescher is a clinical professor of psychiatry at Columbia University; he served on the American Psychiatric Association's committee that revised the diagnosis of gender identity disorder in 2013. He said gender affirmative therapists have never proven they can successfully identify those kids who will stick with transgender identity.\u003c/p>\n\u003caside class=\"pullquote alignright\">'There are some people that think folks like myself, and the people at our clinic, have fallen off the deep end.”\u003ccite>Diane Ehrensaft, UCSF\u003c/cite>\u003c/aside>\n\u003cp>He also says there’s no evidence to back a corollary belief, that kids who might later need to “detransition” back to their original gender will not suffer any long-lasting psychological effects.\u003c/p>\n\u003cp>“This is what they believe, but it's not based on research,” he said of gender affirmative clinicians. “This is a meme, not really a piece of scientific finding.”\u003c/p>\n\u003cp>Steensma concurred: “If a child transitions, it is not just, ‘Oh, we do the transition and we go on with our life.’ It has a huge impact on the child, on the family and their environment.’”\u003c/p>\n\u003cp>The current Standards of Care, issued by the World Professional Association of Transgender Health in 2011, are more or less in accordance with this view, as even Ehrensaft acknowledges. The guidelines describe “relatively low persistence rates” as “relevant” to helping parents weigh the decision to socially transition. The standards also state that “a change back to the original gender role can be highly distressing.”\u003c/p>\n\u003cp>The one thing everyone in the field agrees on is more research is needed. Almost every gender specialist I spoke with cited Kristina Olson’s longitudinal study at the University of Washington as critical to answering some of these hotly debated unknowns. Olson recently received a $1 million grant from the National Science Foundation, which she's using to expand the study.\u003c/p>\n\u003cp>Preliminary research coming out of the project has already provided good news for the families of transgender kids. In a pair of studies published over the last several years, Olson and her colleagues found that socially transitioned children and adolescents between the ages of 3 and 14 did \u003ca href=\"https://www.kqed.org/stateofhealth/153172/transgender-children-living-openly-are-doing-well-study-shows\" target=\"_blank\" rel=\"noopener\">not experience\u003c/a> any more depression than separate control groups of peers and siblings, as well as the general population.\u003c/p>\n\u003cp>The transgender health association is now gearing up to revise the Standards of Care. Both Steensma, known for “watchful waiting,” and Ehrensaft, of the gender affirmative school, are on the committee in charge of the section about children. The jockeying to influence the direction of the committee has already begun, as evidenced by the critical \u003ca href=\"https://www.tandfonline.com/doi/full/10.1080/15532739.2018.1456390\" target=\"_blank\" rel=\"noopener\">commentaries\u003c/a> now appearing in academic \u003ca href=\"https://www.tandfonline.com/doi/abs/10.1080/15532739.2017.1414649\" target=\"_blank\" rel=\"noopener\">journals\u003c/a>.\u003c/p>\n\u003cp>“My prediction is that there will be more endorsement of social transitions at earlier ages, without the cautionary tales,” Ehrensaft said of the upcoming revision.\u003c/p>\n\u003cp>\u003cb>Not Just Numbers\u003c/b>\u003c/p>\n\u003cp>When it comes down to it, when we talk about the controversy over socially transitioning young kids, we are talking about risk analysis. Which is more disruptive and potentially harmful: to deny children their genuinely felt gender identity in the present moment, until the adults are \u003cem>absolutely sure\u003c/em> it will stick? Or to validate a child’s persistent, consistent and insistent protestations that ‘\u003cem>Hey, someone has made a terrible mistake here,\u003c/em>’ even if they eventually decide they no longer feel that way?\u003c/p>\n\u003cp>Ehrensaft, at least, is clear on the answer:\u003c/p>\n\u003cp>“Why would we deny for the vast majority of kids something that is basically suicide prevention?”\u003c/p>\n\u003cp>As a parent, I wonder: If my daughter became incandescently happy when allowed to change her name and take on other aspects of being transgender — as happy as Molly describes Gracie becoming when recognized as a girl — what would I do? If some statistics indicated my child might one day switch back, but my deepest parental instincts told me to trust her joyfulness, could I ignore the latter?\u003c/p>\n\u003cp>At Rainbow Day Camp, I spoke to James, a 9-year-old transgender boy who’d transitioned during second grade. He told me matter-of-factly that he’d been bullied by older kids, who’d called him an “It.”\u003c/p>\n\u003cp>After he transitioned, his mother said, “There was just this comfort that came about him, and comfort's something that you can't really fake. He’s [just] a happier kid.”\u003c/p>\n\u003cp>Similarly, before Gracie’s transition, family life was “lackluster,” Molly recalled. The constant tension drained the joy out of childhood for everybody.\u003c/p>\n\u003cp>“You never got to see that sort of sparkle, or that sort of magic of, like, a Christmas morning, or a Halloween, or just regular day-to-day happiness,” Molly said.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“Now she gets to really live.”\u003c/p>\n\n",
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"excerpt": "Many gender clinicians now recommend transgender kids as young as three be allowed to live publicly as the gender they identity with, even though studies have shown most kids won't stay transgender as they grow older. ",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003caside>\n\u003cul>\n\u003cli>Many gender clinicians now recommend parents 'socially transition' kids who persistently express a transgender identity.\u003c/li>\n\u003cli>But research has shown most children will give up their transgender identity by the time they are adolescents.\u003c/li>\n\u003cli>Not all researchers agree, though, that this research is valid.\u003c/li>\n\u003c/ul>\n\u003c/aside>\n\u003cp>Gracie is the youngest transgender person I've ever met. She's so young, she still likes to tack on \"and-a-half\" when giving her age, which is six. One day last summer, bouncing all over the grounds at day camp, she looked as delighted as you'd expect any kid would on \"Water Day.”\u003c/p>\n\u003caside class=\"alignright\">\u003ca href=\"https://www.kqed.org/futureofyou/441784/the-controversial-research-on-desistance-in-transgender-youth\">The Controversial Research on 'Desistance' in Transgender Youth\u003c/a>\u003c/aside>\n\u003cp>This is Rainbow Day Camp, in the East Bay town of El Cerrito. It was created specifically to be a safe place for transgender kids, and in fact, being transgender is so unremarkable here, when I asked Gracie what makes it “special,\" she shrugged and said:\u003c/p>\n\u003cp>“You get to do fun stuff.”\u003c/p>\n\u003cp>Her mother, Molly, tried to coax a reporter-friendly answer out of her.\u003c/p>\n\u003cp>“What is special about you, and the same as everybody else in the camp?” she prompted.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“I don’t know,” Gracie said.\u003c/p>\n\u003caside class=\"pullquote alignright\">'What if we let our son walk into the world in a dress with fairy wings, and crowns, and high heels, and even just in regular girl clothes … and then he changes his mind?'\u003ccite>Molly, whose 6-year-old daughter, Gracie, socially transitioned at age four\u003c/cite>\u003c/aside>\n\u003cp>“You’re transgender and there’s other kids that are transgender, too...”\u003c/p>\n\u003cp>“I’m transgender and there’s other kids that are transgender, too.”\u003c/p>\n\u003cp>Ah, kids. ... But when I asked Gracie how she \u003cem>used\u003c/em> to feel, when other people thought she was a boy, she got straight to the point.\u003c/p>\n\u003cp>“It was not right to me, and I didn’t want people to say that, but they said it,” she said. “It hurted my feelings a lot.\"\u003c/p>\n\u003cp>Did it make her angry?\u003c/p>\n\u003cp>“No, it just made me sad.”\u003c/p>\n\u003caside class=\"alignright\">\u003ca href=\"mailto:jbrooks@kqed.org\">Email the reporter\u003c/a>\u003c/aside>\n\u003cp>How about now?\u003c/p>\n\u003cp>“It feels happy to me.”\u003c/p>\n\u003cp>And that, in a child’s nutshell, sums up one side of a contentious debate about the right age for transgender children to begin what gender clinicians call “social transitioning.”\u003c/p>\u003c/p>\u003cp>\u003cspan class='utils-parseShortcode-shortcodes-__youtubeShortcode__embedYoutube'>\n \u003cspan class='utils-parseShortcode-shortcodes-__youtubeShortcode__embedYoutubeInside'>\n \u003ciframe\n loading='lazy'\n class='utils-parseShortcode-shortcodes-__youtubeShortcode__youtubePlayer'\n type='text/html'\n src='//www.youtube.com/embed/IS5Yankf1GY'\n title='//www.youtube.com/embed/IS5Yankf1GY'\n allowfullscreen='true'\n style='border:0;'>\u003c/iframe>\n \u003c/span>\n \u003c/span>\u003c/p>\u003cp>\u003cp>\u003cstrong>Even Three-Year-Olds\u003c/strong>\u003c/p>\n\u003cp>When I met Gracie, she was a few months out of kindergarten — pretty young for a transgender kid, I thought. Gracie lives with her parents and younger brother in a small city in the East Bay. She is already two years into her transition, having started her public life as a girl at four. The family began by discarding her boy name and referring to Gracie as “she” and “her.” She was also allowed to wear girl clothes outside the home, and her parents changed the gender on her birth certificate to avoid confusion at school.\u003c/p>\n\u003caside class=\"alignright noborder\">\u003cstrong>How young is too young?\u003c/strong>\u003cbr>\nUCSF’s Diane Ehrensaft, one of the leading proponents of socially transitioning transgender children, believes there is no minimum age, really, to pursue such a change.'For all of these interventions, our model is stages not ages,” she said. 'When a child is at the place in their life that they can get themselves in focus, help us see them, and are clear, consistent, and stable in both their representation of themselves, and also can express their desires of how they want to live their gender, that's the age.'We have seen some kids as young as two whose parents are bringing them in because they're beginning to say, ‘Me not boy. Me girl.’ Social transition can happen as soon as a child has language or the ability to communicate to us who they are.'\u003c/aside>\n\u003cp>Steps like these make up the “social” aspects of social, not medical, transitioning. The distinction is important: According to Endocrine Society \u003ca href=\"https://academic.oup.com/jcem/article/102/11/3869/4157558\" target=\"_blank\" rel=\"noopener\">guidelines\u003c/a>, patients who want to begin medical treatment like puberty blockers, hormones or surgery should be old enough to give “informed consent,” which the organization says is usually attained by 16.\u003c/p>\n\u003cp>Therapists at \u003ca href=\"https://www.ucsfbenioffchildrens.org/clinics/child_and_adolescent_gender_center/\" target=\"_blank\" rel=\"noopener\">UCSF’s Child and Adolescent Gender Center Clinic\u003c/a> in San Francisco told me they’ve socially transitioned kids as young as three.\u003c/p>\n\u003cp>Diane Ehrensaft, the San Francisco Center’s mental health director and a leading proponent of early social transitioning, acknowledges this approach has been controversial.\u003c/p>\n\u003cp>“There are some people that think folks like myself, and the people at our clinic, have fallen off the deep end,” she told me. She wasn’t just talking about the religious right, either. She was referring to other mental health professionals.\u003c/p>\n\u003cp>I myself experienced a fair bit of surprise when Ehrensaft told me how young these kids are. My first, reflexive comment was a simple, \"Wow.\" This was not an uncommon reaction when I discussed this story with people in my own life, even in the progressive Bay Area.\u003c/p>\n\u003cp>Yet, when I spoke with Gracie’s mom, Molly (the family didn't want their last name used for reasons of privacy), nothing about the decision to allow her then-son to publicly make the switch to a girl, at an age when many kids are still sucking their thumbs, sounded in the slightest bit rash.\u003c/p>\n\u003cp>We spoke at Rainbow Day Camp, in a classroom set aside for interviews. The children’s art adorning the walls, the shrimpy seats — it felt like a place to talk about kickball, not the gender identity of first graders.\u003c/p>\n\u003cp>Yet here we were.\u003c/p>\n\u003caside class=\"alignright\">\u003cstrong>The Biological Roots of Gender Identity\u003c/strong>\u003cbr>\nMolly is the mother of two children, a 3-year-old boy and a 7-year-old transgender girl. The younger child is the “stereotype of what I thought having a son would be like,” she said. “He loves trucks, cars, construction, superheroes and destroying the house.”Her first child, also born male, just did not develop in the same way. Rather, from the time he acquired language on, he protested that he was really a girl. (\u003ca href=\"https://www.kqed.org/futureofyou/the-biological-roots-of-gender-identity\" target=\"_blank\" rel=\"noopener\">Continue reading)\u003c/a>\u003c/aside>\n\u003cp>“What if we do this?” Molly recalled asking a gender therapist, back when they were debating the pros and cons of letting Gracie transition. “What if we let our son walk into the world in a dress with fairy wings, and crowns, and high heels, and even just in regular girl clothes … and then he changes his mind?”\u003c/p>\n\u003cp>\"That's not the question,” the therapist told Molly. “The question is, what if you don't do it?”\u003c/p>\n\u003cp>It was only semi-rhetorical. Some gender therapists say there are serious potential dangers if adults suppress a child’s desired transition. On surveys, American transgender adults have reported attempting suicide at the startling \u003ca href=\"https://williamsinstitute.law.ucla.edu/wp-content/uploads/AFSP-Williams-Suicide-Report-Final.pdf\" target=\"_blank\" rel=\"noopener\">rate\u003c/a> of around 40 percent.\u003c/p>\n\u003cp>The stakes couldn’t have been higher, Molly knew.\u003c/p>\n\u003cp>At Rainbow Day Camp, recalling that time, she started to cry.\u003c/p>\n\u003cp>“As soon as I knew there was even a chance that my kid could feel ashamed of who they are, there was no way … ” Her voice cracked into a higher register. “I had to support, I had to listen, and I had to let her steer, a little bit, the ship. Period. No matter what.”\u003c/p>\n\u003cfigure id=\"attachment_441862\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2020/04/gracie-sliding-water-1.jpg\">\u003cimg class=\"wp-image-441862 size-large\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2020/04/gracie-sliding-water-1-1020x527.jpg\" alt=\"\" width=\"640\" height=\"331\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2020/04/gracie-sliding-water-1-1020x527.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2020/04/gracie-sliding-water-1-160x83.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2020/04/gracie-sliding-water-1-800x414.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2020/04/gracie-sliding-water-1-768x397.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2020/04/gracie-sliding-water-1-1200x620.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/13/2020/04/gracie-sliding-water-1-1180x610.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2020/04/gracie-sliding-water-1-960x496.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2020/04/gracie-sliding-water-1-240x124.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2020/04/gracie-sliding-water-1-375x194.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2020/04/gracie-sliding-water-1-520x269.jpg 520w, https://ww2.kqed.org/app/uploads/sites/13/2020/04/gracie-sliding-water-1.jpg 1209w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Gracie, six, on Water Day at Rainbow Day Camp, which was created as a safe space for transgender kids. \u003ccite>(KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>‘I’m a Girl’\u003c/strong>\u003c/p>\n\u003cp>Ehrensaft calls children like Gracie “persistent, consistent, and insistent” in their declarations of cross-gender identity. For Gracie, this manifested through words, wishes, and, well, practically everything.\u003c/p>\n\u003caside class=\"pullquote alignright\">'Why would we deny for the vast majority of kids something that is basically suicide prevention?'\u003ccite>Diane Ehrensaft, UCSF\u003c/cite>\u003c/aside>\n\u003cp>Gracie was her parents' first child. From toddlerhood on, Molly said, their son had displayed a “constant obsession and fixation on all things girl. As soon as she could tell us, it was, ‘I'm a girl. I'm a sister. I'm a daughter. I'm that girl on that show. I'm that girl in that book.’”\u003c/p>\n\u003cp>Gracie's parents weren’t on board at first.\u003c/p>\n\u003cp>“We filled her world with trucks, and dinosaurs, and superheroes, and we refused girl things,” Molly said. “Like, ‘No, you can't be Elsa for Halloween. You have to be Superman. No, you can't have the dolls for Christmas. We're going to get you a pirate ship.’”\u003c/p>\n\u003cp>They also made a rule: No girl clothing outside the house.\u003c/p>\n\u003cp>Molly tells me: “That’s the part I’m ashamed of now.”\u003c/p>\n\u003cp>\u003cstrong>'These Kids Do Come Forward'\u003c/strong>\u003c/p>\n\u003cp>Molly and her husband finally relented — they just could not deny how much happier their child felt when recognized as a girl.\u003c/p>\n\u003cfigure id=\"attachment_441832\" class=\"wp-caption alignright\" style=\"max-width: 640px\">\u003ca href=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2020/04/Phoenix5-e1527011026777.jpg\">\u003cimg class=\"size-large wp-image-441832\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2020/04/Phoenix5-1020x1530.jpg\" alt=\"\" width=\"640\" height=\"960\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Phoenix, a transgender girl who began wearing dresses to school at age 5. She began made a complete social transition at the start of second grade. \u003ccite>(Courtesy of family)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>I asked: Has Gracie ever looked back?\u003c/p>\n\u003cp>Molly chuckled.\u003c/p>\n\u003cp>“If you think of gender as a spectrum, she is like a full, all-the-way girl.”\u003c/p>\n\u003cp>It’s not rocket science, Ehrensaft explained, if you really listen to the children. “A child will say: ‘Stop calling me Jane. Let me wear my dresses. Please call me she.’ That's a child making a clear statement.”\u003c/p>\n\u003cp>Kristina Olson, a University of Washington gender researcher, said parents do not always listen to what their kids are telling them.\u003c/p>\n\u003cp>“The ones that are most likely to transition are kids who for many years are very consistently saying this is who they are,” she said. ”We often see this happen for years before parents socially transition their kids.”\u003c/p>\n\u003cp>UCSF gender specialist Erica Anderson recently treated a five-year-old who had reached a point of desperation.\u003c/p>\n\u003cp>“In the bathtub, he would compare himself to his younger sister, and really start getting upset. At one point he went in the bathroom with a pair of shears — he was going to cut his penis off.”\u003c/p>\n\u003cp>“This child has been so clear for a couple of years,” Anderson said. “These kids do come forward.”\u003c/p>\n\u003cp>\u003cstrong>Changing Approaches\u003c/strong>\u003c/p>\n\u003cp>Gender clinicians who recommend social transition at such an early age call their model “gender affirmative,” and they believe their approach is now ascendant. Historically, clinicians more commonly treated transgender kids by discouraging cross-gender identity. The method was most famously practiced by longtime gender researcher Ken Zucker.\u003c/p>\n\u003cp>Zucker is now an extraordinarily controversial figure in the transgender community. He believed that an outcome in which a child becomes transgender should be avoided, if possible. You can get a glimpse of his methods in this \u003ca href=\"https://www.npr.org/2008/05/07/90247842/two-families-grapple-with-sons-gender-preferences\" target=\"_blank\" rel=\"noopener\">NPR story\u003c/a> from 2008. Zucker is counseling the family of a young boy he’d diagnosed with gender identity disorder, the term used for gender dysphoria before 2013.\u003c/p>\n\u003cblockquote>\u003cp>Zucker explained to Carol that she and her husband would have to radically change their parenting. Bradley would no longer be allowed to spend time with girls. He would no longer be allowed to play with girlish toys or pretend that he was a female character. Zucker said that all of these activities were dangerous to a kid with gender identity disorder. He explained that unless Carol and her husband helped the child to change his behavior, as Bradley grew older, he likely would be rejected by both peer groups.\u003c/p>\u003c/blockquote>\n\u003cp>Other researchers and transgender activists have criticized this approach as too close to the “conversion therapy” inflicted on gay and lesbian youth, a practice that is now illegal in a number of states, including \u003ca href=\"https://www.sfgate.com/news/article/State-bans-gay-repair-therapy-for-minors-3906032.php\" target=\"_blank\" rel=\"noopener\">California\u003c/a>.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>The World Professional Association for Transgender Health's guidelines for clinicians, called the \u003ca href=\"https://www.wpath.org/publications/soc\" target=\"_blank\" rel=\"noopener\">Standards of Care\u003c/a>, states that “treatment aimed at trying to change a person’s gender identity and expression to become more congruent with sex assigned at birth” is “no longer considered ethical.”\u003c/p>\n\u003cp>Zucker was the psychologist-in-chief and head of the gender identity clinic at a Toronto mental health hospital before administrators shut down the clinic in 2015, after a review of his practices. That was also \u003ca href=\"https://www.theglobeandmail.com/life/health-and-fitness/health/alleged-exchange-with-gender-identity-doctor-didnt-happen-camh-says/article28471923/\" target=\"_blank\" rel=\"noopener\">controversial\u003c/a>, and Zucker is suing his former employer for defamation. (Zucker declined to comment for this article. For a defense of his work, you can read Jesse Singal’s \u003ca href=\"https://www.thecut.com/2016/02/fight-over-trans-kids-got-a-researcher-fired.html\" target=\"_blank\" rel=\"noopener\">reporting\u003c/a> from 2016.)\u003c/p>\n\u003cp>\u003cstrong>Watchful Waiting\u003c/strong>\u003c/p>\n\u003cp>Zucker’s approach aside, there is another alternative to gender affirmative therapy. It’s the approach taken by the \u003ca href=\"https://www.vumc.com/branch/gender-dysphoria/\" target=\"_blank\" rel=\"noopener\">Center of Expertise on Gender Dysphoria\u003c/a> in Amsterdam, and gender specialists commonly refer to it as the “Dutch Model.”\u003c/p>\n\u003cp>This treatment sometimes involves the social transition of young children, according to Thomas Steensma, a researcher and clinician at the center. But for the most part, its counseling incorporates the idea that the vast majority of gender dysphoric children will eventually stop identifying as transgender.\u003c/p>\n\u003cp>The research literature calls these individuals “desistant.” The kids who retain their transgender identity as they grow up are dubbed “persistent.”\u003c/p>\n\u003cp>\u003cstrong>The Desistance Controversy\u003c/strong>\u003c/p>\n\u003cp>Nothing roils the world of transgender research like the topic of \u003ca href=\"https://www.kqed.org/futureofyou/441784/the-controversial-research-on-desistance-in-transgender-youth\" target=\"_blank\" rel=\"noopener\">desistance\u003c/a>. Brynn Tannehill, a transgender activist who follows the research closely, said the concept is often used by anti-LGBT groups to make the case that rejecting children’s transgender identity is in their best interests.\u003c/p>\n\u003caside class=\"pullquote alignright\">'[Desistance research] is used primarily as an attack on the validity of transgender identities, which usually quickly disintegrates into a debate on whether we should exist.' \u003ccite>Brynn Tannehill, transgender activist\u003c/cite>.\u003c/aside>\n\u003cp>“It is used primarily as an attack on the validity of transgender identities, which usually quickly disintegrates into a debate on whether we should exist,” Tannehill said.\u003c/p>\n\u003cp>And yet, the fact is that just about every published study on the topic to date has found that a majority of children who once reported various degrees of gender dysphoria ended up eventually giving up their transgender identity.\u003c/p>\n\u003cp>To grasp the implications of this, remember Molly’s anxious questioning of the gender therapist: What if we go through all this, and it turns out to be just a phase? Shouldn’t we wait?\u003c/p>\n\u003cp>The gender affirmative camp says no. That’s because it doesn’t believe that the body of research on desistance, some of it conducted by Zucker and his associates, is valid.\u003c/p>\n\u003cp>Many gender researchers maintain that the current criteria for diagnosing gender dysphoria are much more stringent than in the past. Therefore, many of the studies that found so many kids had \"grown out\" of their transgender identity were actually measuring children who were \u003cem>never really transgender\u003c/em> in the first place.\u003c/p>\n\u003cp>“Some of those studies are decades old,” said gender researcher Kristina Olson. “So if you had a son in the early 1980s who liked playing with dolls and wanted to occasionally wear a dress, even today maybe you would think to bring that child to talk to a doctor about it. But that child wouldn't necessarily be transgender, because that kid doesn't necessarily think of himself as a girl.\"\u003c/p>\n\u003cp>Ehrensaft said that her San Francisco clinic sees “a tiny, tiny proportion” of clients who stop identifying as transgender after transitioning.\u003c/p>\n\u003cp>Even the Amsterdam clinic’s Thomas Steensma, who firmly believes most gender dysphoric kids will \u003cem>not\u003c/em> grow up to be transgender, acknowledged the earlier studies probably included “milder cases” that are “hard to compare with the clinical samples we see now in our clinics.”\u003c/p>\n\u003cfigure id=\"attachment_441834\" class=\"wp-caption alignright\" style=\"max-width: 720px\">\u003ca href=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2020/04/James.jpeg\">\u003cimg class=\"size-full wp-image-441834\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2020/04/James.jpeg\" alt=\"\" width=\"720\" height=\"960\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2020/04/James.jpeg 720w, https://ww2.kqed.org/app/uploads/sites/13/2020/04/James-160x213.jpeg 160w, https://ww2.kqed.org/app/uploads/sites/13/2020/04/James-240x320.jpeg 240w, https://ww2.kqed.org/app/uploads/sites/13/2020/04/James-375x500.jpeg 375w, https://ww2.kqed.org/app/uploads/sites/13/2020/04/James-520x693.jpeg 520w\" sizes=\"(max-width: 720px) 100vw, 720px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Olivia, a transgender girl who socially transitioned when she was four, and her brother, James, who transitioned when he was eight. \u003ccite>(Courtesy of family)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Nevertheless, he said, “The only evidence I have from studies and reports in the literature ... is that children who struggle with gender incongruence … will not all persist into adolescence.\"\u003c/p>\n\u003cp>Talking to Steensma over Skype, he seemed bemused by the fact that the “Dutch model” is now considered conservative compared to what has taken hold in America. After all, his Amsterdam clinic had been a pioneer in the medical treatment of transgender youth, especially in the use of puberty blockers, which delay the onset of secondary sex characteristics.\u003c/p>\n\u003cp>But what about the \u003cem>social transitioning\u003c/em> of young kids?\u003c/p>\n\u003cp>\"It's not a 'yes' or a 'no' in our opinion, but a 'maybe,' Steensma told me.\u003c/p>\n\u003cp>I wondered if there was any real argument between him and Ehrensaft, after all. So I described to him the case of persistent, insistent, consistent Gracie.\u003c/p>\n\u003cp>A slam dunk for social transition?\u003c/p>\n\u003cp>Steensma said no.\u003c/p>\n\u003cp>“We would counsel them ... that it's okay to express your feelings, your interests, to show your behaviors. But with certain steps like a name change, or a pronoun change, with a result that maybe others will only perceive you as a girl — that's somewhere where we say, ‘Okay, maybe you should explore things without taking steps that are hard to reverse.’”\u003c/p>\n\u003cp>There are mental health professionals in the U.S. who agree. Dr. Jack Drescher is a clinical professor of psychiatry at Columbia University; he served on the American Psychiatric Association's committee that revised the diagnosis of gender identity disorder in 2013. He said gender affirmative therapists have never proven they can successfully identify those kids who will stick with transgender identity.\u003c/p>\n\u003caside class=\"pullquote alignright\">'There are some people that think folks like myself, and the people at our clinic, have fallen off the deep end.”\u003ccite>Diane Ehrensaft, UCSF\u003c/cite>\u003c/aside>\n\u003cp>He also says there’s no evidence to back a corollary belief, that kids who might later need to “detransition” back to their original gender will not suffer any long-lasting psychological effects.\u003c/p>\n\u003cp>“This is what they believe, but it's not based on research,” he said of gender affirmative clinicians. “This is a meme, not really a piece of scientific finding.”\u003c/p>\n\u003cp>Steensma concurred: “If a child transitions, it is not just, ‘Oh, we do the transition and we go on with our life.’ It has a huge impact on the child, on the family and their environment.’”\u003c/p>\n\u003cp>The current Standards of Care, issued by the World Professional Association of Transgender Health in 2011, are more or less in accordance with this view, as even Ehrensaft acknowledges. The guidelines describe “relatively low persistence rates” as “relevant” to helping parents weigh the decision to socially transition. The standards also state that “a change back to the original gender role can be highly distressing.”\u003c/p>\n\u003cp>The one thing everyone in the field agrees on is more research is needed. Almost every gender specialist I spoke with cited Kristina Olson’s longitudinal study at the University of Washington as critical to answering some of these hotly debated unknowns. Olson recently received a $1 million grant from the National Science Foundation, which she's using to expand the study.\u003c/p>\n\u003cp>Preliminary research coming out of the project has already provided good news for the families of transgender kids. In a pair of studies published over the last several years, Olson and her colleagues found that socially transitioned children and adolescents between the ages of 3 and 14 did \u003ca href=\"https://www.kqed.org/stateofhealth/153172/transgender-children-living-openly-are-doing-well-study-shows\" target=\"_blank\" rel=\"noopener\">not experience\u003c/a> any more depression than separate control groups of peers and siblings, as well as the general population.\u003c/p>\n\u003cp>The transgender health association is now gearing up to revise the Standards of Care. Both Steensma, known for “watchful waiting,” and Ehrensaft, of the gender affirmative school, are on the committee in charge of the section about children. The jockeying to influence the direction of the committee has already begun, as evidenced by the critical \u003ca href=\"https://www.tandfonline.com/doi/full/10.1080/15532739.2018.1456390\" target=\"_blank\" rel=\"noopener\">commentaries\u003c/a> now appearing in academic \u003ca href=\"https://www.tandfonline.com/doi/abs/10.1080/15532739.2017.1414649\" target=\"_blank\" rel=\"noopener\">journals\u003c/a>.\u003c/p>\n\u003cp>“My prediction is that there will be more endorsement of social transitions at earlier ages, without the cautionary tales,” Ehrensaft said of the upcoming revision.\u003c/p>\n\u003cp>\u003cb>Not Just Numbers\u003c/b>\u003c/p>\n\u003cp>When it comes down to it, when we talk about the controversy over socially transitioning young kids, we are talking about risk analysis. Which is more disruptive and potentially harmful: to deny children their genuinely felt gender identity in the present moment, until the adults are \u003cem>absolutely sure\u003c/em> it will stick? Or to validate a child’s persistent, consistent and insistent protestations that ‘\u003cem>Hey, someone has made a terrible mistake here,\u003c/em>’ even if they eventually decide they no longer feel that way?\u003c/p>\n\u003cp>Ehrensaft, at least, is clear on the answer:\u003c/p>\n\u003cp>“Why would we deny for the vast majority of kids something that is basically suicide prevention?”\u003c/p>\n\u003cp>As a parent, I wonder: If my daughter became incandescently happy when allowed to change her name and take on other aspects of being transgender — as happy as Molly describes Gracie becoming when recognized as a girl — what would I do? If some statistics indicated my child might one day switch back, but my deepest parental instincts told me to trust her joyfulness, could I ignore the latter?\u003c/p>\n\u003cp>At Rainbow Day Camp, I spoke to James, a 9-year-old transgender boy who’d transitioned during second grade. He told me matter-of-factly that he’d been bullied by older kids, who’d called him an “It.”\u003c/p>\n\u003cp>After he transitioned, his mother said, “There was just this comfort that came about him, and comfort's something that you can't really fake. He’s [just] a happier kid.”\u003c/p>\n\u003cp>Similarly, before Gracie’s transition, family life was “lackluster,” Molly recalled. The constant tension drained the joy out of childhood for everybody.\u003c/p>\n\u003cp>“You never got to see that sort of sparkle, or that sort of magic of, like, a Christmas morning, or a Halloween, or just regular day-to-day happiness,” Molly said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"disqusTitle": "Science is Finding Some Truth in ‘Microdosing’ Claims Touted by ’Shroomers and Reddit Users",
"title": "Science is Finding Some Truth in ‘Microdosing’ Claims Touted by ’Shroomers and Reddit Users",
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"content": "\u003cp>Dennis van der Meijden isn’t aiming to see the face of God, feel one with the cosmos, grasp the hidden reality of time and space, or embark on a \u003ca href=\"https://www.amazon.com/Psychedelic-Explorers-Guide-Therapeutic-Journeys/dp/1594774021\" target=\"_blank\" rel=\"noopener\">sacred journey\u003c/a>. What the Dutch graphic designer, producer, and rapper (under the professional name Terilekst) wants — and gets — from his twice-weekly “microdoses” of psilocybin is more modest.[contextly_sidebar id=\"2u046KLqIpjlWqt95jSvMRrGksdXK55L\"]\u003c/p>\n\u003cp>“It sharpens all the senses, as if the frequencies of all of your atoms and energy field are raised a little bit and are being slightly more conscious,” said van der Meijden, 39, who told STAT he first microdosed psilocybin — the active ingredient in “magic mushrooms” — three years ago. It makes him energetic enough to skip coffee, “as if I’m kicked in some sort of orbit for that day.” If he becomes distracted, “I’m very much aware of that, as if seeing myself from a bird’s eye view, so I can correct myself very fast.” But van der Meijden says he’s careful not to exceed about 0.4 grams, because 0.5 made him “a bit too joyful and a bit too philosophical,” which wasn’t always appropriate.\u003c/p>\n\u003cp>Microdosing involves taking roughly one-tenth the “trip” dose of a psychedelic drug, an amount too little to trigger hallucinations but enough, its proponents say, to sharpen the mind. Psilocybin microdosers (including hundreds on Reddit) report that the mushrooms can increase creativity, calm anxiety, decrease the need for caffeine, and reduce depression. There is enough evidence that trip doses might have the latter effect that, on Wednesday, London-based Compass Pathways received Food and Drug Administration \u003ca href=\"https://markets.businessinsider.com/news/stocks/compass-pathways-receives-fda-approval-for-psilocybin-therapy-clinical-trial-for-treatment-resistant-depression-1027477289\" target=\"_blank\" rel=\"noopener\">approval\u003c/a> for a Phase 2B clinical trial of psilocybin (in larger-than-microdoses) for treatment-resistant depression. But research into microdosing is minimal.\u003c/p>\n\u003cp>In the nearly 10 years since psychologist and psychedelics researcher James Fadiman introduced the notion of microdosing and devised a widely followed \u003ca href=\"https://sites.google.com/view/microdosingpsychedelics/home\" target=\"_blank\" rel=\"noopener\">protocol\u003c/a> for it, and three years after microdosing psychedelics became the latest Silicon Valley “\u003ca href=\"https://www.forbes.com/sites/robertglatter/2015/11/27/lsd-microdosing-the-new-job-enhancer-in-silicon-valley-and-beyond/#8ece3fe188a8\" target=\"_blank\" rel=\"noopener\">productivity hack\u003c/a>,” all the evidence about its effects has been anecdotal. Psilocybin is illegal almost everywhere, so it’s been nearly impossible to study scientifically. That is changing, however, as the Netherlands and other countries effectively decriminalize it and scientists in places where it remains illegal obtain government permission to study it.[contextly_sidebar id=\"uhfAqZqMFWRdicHoQZb7cSTv52omgvqK\"]\u003c/p>\n\u003cp>The scientific interest is driven, in part, by numerous reports over the years that psilocybin might have antidepressant or anti-anxiety effects that might guide the development of better psychiatric drugs. But it also reflects an itch to see whether there is any basis for the anecdotal accounts. Now, in the first \u003ca href=\"https://www.biorxiv.org/content/early/2018/08/11/384412\" target=\"_blank\" rel=\"noopener\">study\u003c/a> of its kind, scientists in the Netherlands found that psilocybin microdoses have no noticeable effect on the problem-solving, rational-thinking, and abstract-reasoning ability called fluid intelligence. But they do seem to improve two forms of thinking that underlie creativity.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“Performance was significantly higher” on tests of convergent and divergent thinking, said psychologist Bernhard Hommel of Leiden University in the Netherlands, who led the study. Convergent thinking is the ability to focus on abstract concepts to identify a single solution to a well-defined problem. Divergent thinking requires meandering mental forays and mental flexibility. Psychologists consider both to be ingredients of creativity.\u003c/p>\n\u003cp>Whatever the dose, psilocybin (O-phosphoryl-4-hydroxy-N, N-dimethyltryptamine) binds to receptors for the neurotransmitter serotonin. The cortex is packed with these 5-HT2A receptors, especially in areas that control reflection, imagination, and introspection, but “whether there is a minimum dose [of psilocybin that’s required to activate them] is an empirical question that we try to tackle,” Hommel said.\u003c/p>\n\u003cp>To do so, he and his colleagues zeroed in on the effects that many users report: creativity, problem-solving, and the “cognitive flexibility” deemed crucial to both. Leiden’s Luisa Prochazkova took the lead in inviting members of the Psychedelic Society of the Netherlands to participate in the study; she got 38 takers.\u003c/p>\n\u003cp>Before their microdose, the volunteers took three standard psychological tests, two related to creative problem-solving and one an assessment of fluid intelligence. The scientists ran chemical analyses of the mushroom samples to determine how much psilocybin they contained. Since a trip dose is about 3 grams of dried ’shrooms, a microdose is around 0.33 grams. Participants averaged 0.37 grams of the dried preparation, which can be taken with food or packed into gelcaps for easy swallowing.\u003c/p>\n\u003cp>About 90 minutes after the microdose, the participants took the three tests again.\u003c/p>\n\u003cp>In the Picture Concept Task, they saw three rows of three pictures, and had to choose three — one from each row — that were related. That requires converging on the correct solution, like noticing that a bathtub, a sink, and a hose all have something to do with water. The brain must focus, weigh alternatives, and reject wrong ones.\u003c/p>\n\u003cp>In the Alternate Uses Task, the microdosers had five minutes to think of ways to use a pen (tracheotomy? finger splint?) or towel. That measures divergent thinking, to move thoughts away from writing, for example, in the case of the pen.\u003c/p>\n\u003cp>The microdosers also took a “progressive matrices” test: In blocks of two-by-two or three-by-three patterns, with the bottom right one missing, they had to choose which of six possibilities belonged in the blank square — a task that requires fluid intelligence.\u003c/p>\n\u003cp>The scientists found no post-microdose difference on the fluid intelligence test. But after microdosing, performance on the picture concept test was significantly higher (an average score of 7.6) than before (6.6). That suggested an improvement in the convergent thinking element of creativity.\u003c/p>\n\u003cp>The microdosers also came up with significantly more uses for pens and towels, 16.7 vs. 14.7. That suggests a microdose of psilocybin “allowed participants to create more out-of-the-box alternative solutions for a problem,” the scientists wrote. Taken together, the three findings suggest a specific effect of psilocybin microdoses on creativity but not on fluid intelligence.\u003c/p>\n\u003cp>For van der Meijden, a microdose of psilocybin makes his musical brainstorm sessions yield “more concepts, ideas, and solutions,” he said, partly because it lets him “better understand and visualize other people’s concepts.” In his design and illustration work, it produces a “more natural flow of line drawing” and lets him “see more possibilities in how things can be or look.” In his music, it lets him “analyze all the different instruments better” and know, for instance, whether to turn up or down the reverberation effect.\u003c/p>\n\u003cp>The Dutch study, which was published on a preprint site and has not undergone peer review at a journal, has several caveats. For one thing, having seen a test before might make people better at it. More problematic, the study didn’t have a control group of people who took something other than psilocybin. That leaves open the possibility that it wasn’t the compound that improved some forms of thinking, but the expectation that it would do so. Maybe people who microdose believe in its benefits enough to make those expectations reality.\u003c/p>\n\u003cp>On the other hand, the results fit with another new \u003ca href=\"https://www.biorxiv.org/content/early/2018/07/25/376491\" target=\"_blank\" rel=\"noopener\">study\u003c/a> of psilocybin. In this one, scientists led by computational neuroscientist Joana Cabral of the University of Oxford used fMRI scans to study the brain activity of nine people who volunteered to be injected with 2 milligram (trip-inducing) doses. The chemical changed the functional connectivity of various brain regions, so that activity in one became synced with that in another. In particular, the rational, logical, well-behaved frontoparietal regions became “strongly destabilized,” the scientists reported, melding with activity in emotional and other regions to produce “unconstrained consciousness,” “mind wandering,” and a sense that everything is connected to everything else. Seeing connections that elude other people is almost the definition of creativity.\u003c/p>\n\u003cp>The findings in the microdosing study also fit with many anecdotal reports. One college student who is a member of the Portland, Ore., microdosing community said that although he doesn’t microdose psilocybin with the express purpose of boosting creativity or focus, he has found that “things seem to have quieted down, in terms of racing thoughts.” He can still be distracted, said Alex, 38, who asked not to be further identified because the drug is illegal in the U.S. But “if I want to go about doing something, then I have an easier time with it because I’m not being bogged down by my thoughts,” he added.\u003c/p>\n\u003cp>Jakobien van der Weijden takes one psilocybin microdose every three days, with bimonthly breaks, “to work more focused, more efficiently and be more creative” at his marketing job in the Netherlands, he said. “On the downside, I would often feel that the inspiration was still there at night and I would keep working on projects until late. So it was somewhat more difficult to maintain a healthy biorhythm.”\u003c/p>\n\u003cp>As legal strictures loosen, there will likely be more rigorous studies of microdosing psilocybin. “Scientific studies could legitimize the claimed benefits,” said Will Burns, CEO of Wenham, Mass.-based \u003ca href=\"http://www.ideasicle.com/\" target=\"_blank\" rel=\"noopener\">Ideasicle\u003c/a>, which develops branding and marketing ideas. He does not microdose, Burns said, but has \u003ca href=\"https://www.forbes.com/sites/willburns/2015/11/29/lsd-microdosing-deserves-more-serious-research/#6824b00d656d\" target=\"_blank\" rel=\"noopener\">called for\u003c/a> research into its purported effects, including improving productivity and creativity. “Right now, we’re swimming in a world of anecdotes and almost no one has taken this seriously,” he said. “We need scientific studies.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This \u003ca href=\"https://www.statnews.com/2018/08/23/science-testing-claimed-benefits-of-psilocybin-microdosing/\" target=\"_blank\" rel=\"noopener\">story\u003c/a> was originally published by STAT, an online publication of Boston Globe Media that covers health, medicine, and scientific discovery.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Dennis van der Meijden isn’t aiming to see the face of God, feel one with the cosmos, grasp the hidden reality of time and space, or embark on a \u003ca href=\"https://www.amazon.com/Psychedelic-Explorers-Guide-Therapeutic-Journeys/dp/1594774021\" target=\"_blank\" rel=\"noopener\">sacred journey\u003c/a>. What the Dutch graphic designer, producer, and rapper (under the professional name Terilekst) wants — and gets — from his twice-weekly “microdoses” of psilocybin is more modest.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>“It sharpens all the senses, as if the frequencies of all of your atoms and energy field are raised a little bit and are being slightly more conscious,” said van der Meijden, 39, who told STAT he first microdosed psilocybin — the active ingredient in “magic mushrooms” — three years ago. It makes him energetic enough to skip coffee, “as if I’m kicked in some sort of orbit for that day.” If he becomes distracted, “I’m very much aware of that, as if seeing myself from a bird’s eye view, so I can correct myself very fast.” But van der Meijden says he’s careful not to exceed about 0.4 grams, because 0.5 made him “a bit too joyful and a bit too philosophical,” which wasn’t always appropriate.\u003c/p>\n\u003cp>Microdosing involves taking roughly one-tenth the “trip” dose of a psychedelic drug, an amount too little to trigger hallucinations but enough, its proponents say, to sharpen the mind. Psilocybin microdosers (including hundreds on Reddit) report that the mushrooms can increase creativity, calm anxiety, decrease the need for caffeine, and reduce depression. There is enough evidence that trip doses might have the latter effect that, on Wednesday, London-based Compass Pathways received Food and Drug Administration \u003ca href=\"https://markets.businessinsider.com/news/stocks/compass-pathways-receives-fda-approval-for-psilocybin-therapy-clinical-trial-for-treatment-resistant-depression-1027477289\" target=\"_blank\" rel=\"noopener\">approval\u003c/a> for a Phase 2B clinical trial of psilocybin (in larger-than-microdoses) for treatment-resistant depression. But research into microdosing is minimal.\u003c/p>\n\u003cp>In the nearly 10 years since psychologist and psychedelics researcher James Fadiman introduced the notion of microdosing and devised a widely followed \u003ca href=\"https://sites.google.com/view/microdosingpsychedelics/home\" target=\"_blank\" rel=\"noopener\">protocol\u003c/a> for it, and three years after microdosing psychedelics became the latest Silicon Valley “\u003ca href=\"https://www.forbes.com/sites/robertglatter/2015/11/27/lsd-microdosing-the-new-job-enhancer-in-silicon-valley-and-beyond/#8ece3fe188a8\" target=\"_blank\" rel=\"noopener\">productivity hack\u003c/a>,” all the evidence about its effects has been anecdotal. Psilocybin is illegal almost everywhere, so it’s been nearly impossible to study scientifically. That is changing, however, as the Netherlands and other countries effectively decriminalize it and scientists in places where it remains illegal obtain government permission to study it.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>The scientific interest is driven, in part, by numerous reports over the years that psilocybin might have antidepressant or anti-anxiety effects that might guide the development of better psychiatric drugs. But it also reflects an itch to see whether there is any basis for the anecdotal accounts. Now, in the first \u003ca href=\"https://www.biorxiv.org/content/early/2018/08/11/384412\" target=\"_blank\" rel=\"noopener\">study\u003c/a> of its kind, scientists in the Netherlands found that psilocybin microdoses have no noticeable effect on the problem-solving, rational-thinking, and abstract-reasoning ability called fluid intelligence. But they do seem to improve two forms of thinking that underlie creativity.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“Performance was significantly higher” on tests of convergent and divergent thinking, said psychologist Bernhard Hommel of Leiden University in the Netherlands, who led the study. Convergent thinking is the ability to focus on abstract concepts to identify a single solution to a well-defined problem. Divergent thinking requires meandering mental forays and mental flexibility. Psychologists consider both to be ingredients of creativity.\u003c/p>\n\u003cp>Whatever the dose, psilocybin (O-phosphoryl-4-hydroxy-N, N-dimethyltryptamine) binds to receptors for the neurotransmitter serotonin. The cortex is packed with these 5-HT2A receptors, especially in areas that control reflection, imagination, and introspection, but “whether there is a minimum dose [of psilocybin that’s required to activate them] is an empirical question that we try to tackle,” Hommel said.\u003c/p>\n\u003cp>To do so, he and his colleagues zeroed in on the effects that many users report: creativity, problem-solving, and the “cognitive flexibility” deemed crucial to both. Leiden’s Luisa Prochazkova took the lead in inviting members of the Psychedelic Society of the Netherlands to participate in the study; she got 38 takers.\u003c/p>\n\u003cp>Before their microdose, the volunteers took three standard psychological tests, two related to creative problem-solving and one an assessment of fluid intelligence. The scientists ran chemical analyses of the mushroom samples to determine how much psilocybin they contained. Since a trip dose is about 3 grams of dried ’shrooms, a microdose is around 0.33 grams. Participants averaged 0.37 grams of the dried preparation, which can be taken with food or packed into gelcaps for easy swallowing.\u003c/p>\n\u003cp>About 90 minutes after the microdose, the participants took the three tests again.\u003c/p>\n\u003cp>In the Picture Concept Task, they saw three rows of three pictures, and had to choose three — one from each row — that were related. That requires converging on the correct solution, like noticing that a bathtub, a sink, and a hose all have something to do with water. The brain must focus, weigh alternatives, and reject wrong ones.\u003c/p>\n\u003cp>In the Alternate Uses Task, the microdosers had five minutes to think of ways to use a pen (tracheotomy? finger splint?) or towel. That measures divergent thinking, to move thoughts away from writing, for example, in the case of the pen.\u003c/p>\n\u003cp>The microdosers also took a “progressive matrices” test: In blocks of two-by-two or three-by-three patterns, with the bottom right one missing, they had to choose which of six possibilities belonged in the blank square — a task that requires fluid intelligence.\u003c/p>\n\u003cp>The scientists found no post-microdose difference on the fluid intelligence test. But after microdosing, performance on the picture concept test was significantly higher (an average score of 7.6) than before (6.6). That suggested an improvement in the convergent thinking element of creativity.\u003c/p>\n\u003cp>The microdosers also came up with significantly more uses for pens and towels, 16.7 vs. 14.7. That suggests a microdose of psilocybin “allowed participants to create more out-of-the-box alternative solutions for a problem,” the scientists wrote. Taken together, the three findings suggest a specific effect of psilocybin microdoses on creativity but not on fluid intelligence.\u003c/p>\n\u003cp>For van der Meijden, a microdose of psilocybin makes his musical brainstorm sessions yield “more concepts, ideas, and solutions,” he said, partly because it lets him “better understand and visualize other people’s concepts.” In his design and illustration work, it produces a “more natural flow of line drawing” and lets him “see more possibilities in how things can be or look.” In his music, it lets him “analyze all the different instruments better” and know, for instance, whether to turn up or down the reverberation effect.\u003c/p>\n\u003cp>The Dutch study, which was published on a preprint site and has not undergone peer review at a journal, has several caveats. For one thing, having seen a test before might make people better at it. More problematic, the study didn’t have a control group of people who took something other than psilocybin. That leaves open the possibility that it wasn’t the compound that improved some forms of thinking, but the expectation that it would do so. Maybe people who microdose believe in its benefits enough to make those expectations reality.\u003c/p>\n\u003cp>On the other hand, the results fit with another new \u003ca href=\"https://www.biorxiv.org/content/early/2018/07/25/376491\" target=\"_blank\" rel=\"noopener\">study\u003c/a> of psilocybin. In this one, scientists led by computational neuroscientist Joana Cabral of the University of Oxford used fMRI scans to study the brain activity of nine people who volunteered to be injected with 2 milligram (trip-inducing) doses. The chemical changed the functional connectivity of various brain regions, so that activity in one became synced with that in another. In particular, the rational, logical, well-behaved frontoparietal regions became “strongly destabilized,” the scientists reported, melding with activity in emotional and other regions to produce “unconstrained consciousness,” “mind wandering,” and a sense that everything is connected to everything else. Seeing connections that elude other people is almost the definition of creativity.\u003c/p>\n\u003cp>The findings in the microdosing study also fit with many anecdotal reports. One college student who is a member of the Portland, Ore., microdosing community said that although he doesn’t microdose psilocybin with the express purpose of boosting creativity or focus, he has found that “things seem to have quieted down, in terms of racing thoughts.” He can still be distracted, said Alex, 38, who asked not to be further identified because the drug is illegal in the U.S. But “if I want to go about doing something, then I have an easier time with it because I’m not being bogged down by my thoughts,” he added.\u003c/p>\n\u003cp>Jakobien van der Weijden takes one psilocybin microdose every three days, with bimonthly breaks, “to work more focused, more efficiently and be more creative” at his marketing job in the Netherlands, he said. “On the downside, I would often feel that the inspiration was still there at night and I would keep working on projects until late. So it was somewhat more difficult to maintain a healthy biorhythm.”\u003c/p>\n\u003cp>As legal strictures loosen, there will likely be more rigorous studies of microdosing psilocybin. “Scientific studies could legitimize the claimed benefits,” said Will Burns, CEO of Wenham, Mass.-based \u003ca href=\"http://www.ideasicle.com/\" target=\"_blank\" rel=\"noopener\">Ideasicle\u003c/a>, which develops branding and marketing ideas. He does not microdose, Burns said, but has \u003ca href=\"https://www.forbes.com/sites/willburns/2015/11/29/lsd-microdosing-deserves-more-serious-research/#6824b00d656d\" target=\"_blank\" rel=\"noopener\">called for\u003c/a> research into its purported effects, including improving productivity and creativity. “Right now, we’re swimming in a world of anecdotes and almost no one has taken this seriously,” he said. “We need scientific studies.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>This \u003ca href=\"https://www.statnews.com/2018/08/23/science-testing-claimed-benefits-of-psilocybin-microdosing/\" target=\"_blank\" rel=\"noopener\">story\u003c/a> was originally published by STAT, an online publication of Boston Globe Media that covers health, medicine, and scientific discovery.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp class=\"danger-zone\">In the lead-up to the 2016 U.S. election, Russian bots and trolls took to Twitter and other social media platforms to try to turn Americans against one another. But in addition to spreading false information and interfering in the election, a new study reports, a significant number of these malevolent actors tried to sow discord over vaccines.[contextly_sidebar id=\"U9m2Xosa038xtsfDSwPz5O7TUvqWe42O\"]\u003c/p>\n\u003cp class=\"danger-zone\">An \u003ca href=\"https://ajph.aphapublications.org/doi/10.2105/AJPH.2018.304567\" target=\"_blank\" rel=\"noopener\">analysis of Twitter accounts\u003c/a> previously identified as having been operated by Russian bots and trolls found they dove into the vaccine debate as early as January 2015, the researchers reported. They did not take one side or the other, but seemed to tweet pro-vaccine and anti-vaccine messages in roughly equal measure.\u003c/p>\n\u003cp class=\"danger-zone\">On a variety of issues, the overall aim of the Russian campaign appeared to be to erode social cohesion and generate confusion by amplifying the number of voices taking part in these debates on social media. But in the case of vaccines, that could have increased the misperception that the science on their safety and effectiveness isn’t settled — as is the case — but rather that it is still subject to debate.\u003c/p>\n\u003cp class=\"\">“We do have a very strong suspicion that these accounts were attempting to generate discord,” said David Broniatowski, assistant professor in George Washington University’s department of engineering management and systems engineering and lead author of the study.\u003c/p>\n\u003cp>In the study, published Thursday in the American Journal of Public Health, Broniatowski and his co-authors focused on Twitter, analyzing tweets from accounts that had been identified as having been operated by Russian trolls, bots, and so-called content polluters whose aim is to disseminate spam and malware. The article is titled “Weaponized Health Communications: Twitter Bots and Russian Trolls Amplify the Vaccine Debate.”[contextly_sidebar id=\"9QtW5fawtVoxY4YEBFmA2GatrjvQlfvd\"]\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The researchers compared tweets from the accounts to a selection of tweets from other users to see if the trolls and bots commented on vaccines more frequently than average Twitter accounts. They did.\u003c/p>\n\u003cp>“We found that, yeah, indeed, this was something that does seem to be part of the lexicon of what some of these bots and trolls use,” Broniatowski told STAT.\u003c/p>\n\u003cp>Even though the division of pro- and anti-vacccine tweets was roughly equal, that still skewed the picture of views on vaccines on Twitter, he noted, pointing to \u003ca href=\"http://www.pewinternet.org/2017/02/02/vast-majority-of-americans-say-benefits-of-childhood-vaccines-outweigh-risks/\" target=\"_blank\" rel=\"noopener\">data from the Pew Trust\u003c/a> that shows the vast majority of Americans support vaccination.\u003c/p>\n\u003cp>“We’ve always been a little puzzled why social media looks like there are so many anti-vaxxers,” said Broniatowski. “So even if somebody’s posting 50-50, compared to the Pew data, there are going to be more anti-vaxxers.”\u003c/p>\n\u003cp>Dr. Amesh Adalja, an infectious diseases physician and senior scholar at the Center for Health Security at Johns Hopkins Bloomberg School of Public Health, said any skepticism about the safety of vaccines risks feeding the concerns of parents who are worried about having their children vaccinated.\u003c/p>\n\u003cp>“The more the vaccine ‘debate’… is amplified it gains an undeserved sense of legitimacy and gives vaccine-hesitant individuals a pretense to forgo vaccination for themselves and their children,” said Adalja, who was harshly critical of the use of vaccinations in efforts to turn people against each other, calling it “overtly nihilistic.”\u003c/p>\n\u003cp>A spokesman for Twitter said that malicious accounts “are likely to target virtually any high profile conversation, since that’s where the views are.”[contextly_sidebar id=\"Q4N5GXoIo4iApYaASdjmnyeqp8POWr3L\"]\u003c/p>\n\u003cp>The spokesman, Ian Plunkett, told STAT that Twitter has aggressively ramped up preventive measures to try to keep such content from general users. In May, he noted, the platform identified and challenged nearly 10 million potentially automated accounts. “We put preemptive measures in place to ensure automated content is filtered from discoverable areas of the services — like trends and search. It’s possible that may users did not see this content before it was suspended,” Plunkett said.\u003c/p>\n\u003cp>Other experts, too, were unsurprised that Russian trolls and bots would delve into vaccines discussions, given the heat the topic can generate.\u003c/p>\n\u003cp>“Vaccination links to deep values around protection, health, harm, and the social contract,” said Julie Leask, an associate professor at the University of Sydney’s Susan Wakil School of Nursing and Midwifery who researches vaccine refusal. “People become highly invested in the discussion, and highly reactive to the notion that people refuse vaccines. The expression of sentiment at the margins — very pro- and very anti-vaccine — generates emotional energy and clicks.”\u003c/p>\n\u003cp>Adam Dunn, an associate professor in the Center for Health Informatics at Australia’s Macquarie University, said responding to this type of activity by internet bots and trolls would be challenging for public health authorities and may rely on the rooting out of the malicious accounts.\u003c/p>\n\u003cp>“The responsibility of managing the health of online conversations may … fall to Twitter itself, and work like this demonstrating the potential for real harm to human health provides a strong impetus for Twitter to act more often and more quickly to identify, isolate, or remove bots and trolls,” Dunn said.\u003c/p>\n\u003cp>Many of the accounts Broniatowski’s group studied have since been shut down, he said. But freeing the Twitter platform of bots and trolls is like playing whack-a-mole, he suggested.\u003c/p>\n\u003cp>For her part, Leask wasn’t certain how Twitter would have an outsized impact on vaccination decisions.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“When parents decide not to vaccinate, the decision isn’t usually taken lightly and a few tweets from bots are unlikely to change this trajectory,” she said. “The decision process is much more complex and centered on beliefs, experience and notions of what it means to be a ‘good parent’ held within that community. What we still need to establish is the relative role of social media independent of the influence of peer networks.”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp class=\"danger-zone\">In the lead-up to the 2016 U.S. election, Russian bots and trolls took to Twitter and other social media platforms to try to turn Americans against one another. But in addition to spreading false information and interfering in the election, a new study reports, a significant number of these malevolent actors tried to sow discord over vaccines.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp class=\"danger-zone\">An \u003ca href=\"https://ajph.aphapublications.org/doi/10.2105/AJPH.2018.304567\" target=\"_blank\" rel=\"noopener\">analysis of Twitter accounts\u003c/a> previously identified as having been operated by Russian bots and trolls found they dove into the vaccine debate as early as January 2015, the researchers reported. They did not take one side or the other, but seemed to tweet pro-vaccine and anti-vaccine messages in roughly equal measure.\u003c/p>\n\u003cp class=\"danger-zone\">On a variety of issues, the overall aim of the Russian campaign appeared to be to erode social cohesion and generate confusion by amplifying the number of voices taking part in these debates on social media. But in the case of vaccines, that could have increased the misperception that the science on their safety and effectiveness isn’t settled — as is the case — but rather that it is still subject to debate.\u003c/p>\n\u003cp class=\"\">“We do have a very strong suspicion that these accounts were attempting to generate discord,” said David Broniatowski, assistant professor in George Washington University’s department of engineering management and systems engineering and lead author of the study.\u003c/p>\n\u003cp>In the study, published Thursday in the American Journal of Public Health, Broniatowski and his co-authors focused on Twitter, analyzing tweets from accounts that had been identified as having been operated by Russian trolls, bots, and so-called content polluters whose aim is to disseminate spam and malware. The article is titled “Weaponized Health Communications: Twitter Bots and Russian Trolls Amplify the Vaccine Debate.”\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The researchers compared tweets from the accounts to a selection of tweets from other users to see if the trolls and bots commented on vaccines more frequently than average Twitter accounts. They did.\u003c/p>\n\u003cp>“We found that, yeah, indeed, this was something that does seem to be part of the lexicon of what some of these bots and trolls use,” Broniatowski told STAT.\u003c/p>\n\u003cp>Even though the division of pro- and anti-vacccine tweets was roughly equal, that still skewed the picture of views on vaccines on Twitter, he noted, pointing to \u003ca href=\"http://www.pewinternet.org/2017/02/02/vast-majority-of-americans-say-benefits-of-childhood-vaccines-outweigh-risks/\" target=\"_blank\" rel=\"noopener\">data from the Pew Trust\u003c/a> that shows the vast majority of Americans support vaccination.\u003c/p>\n\u003cp>“We’ve always been a little puzzled why social media looks like there are so many anti-vaxxers,” said Broniatowski. “So even if somebody’s posting 50-50, compared to the Pew data, there are going to be more anti-vaxxers.”\u003c/p>\n\u003cp>Dr. Amesh Adalja, an infectious diseases physician and senior scholar at the Center for Health Security at Johns Hopkins Bloomberg School of Public Health, said any skepticism about the safety of vaccines risks feeding the concerns of parents who are worried about having their children vaccinated.\u003c/p>\n\u003cp>“The more the vaccine ‘debate’… is amplified it gains an undeserved sense of legitimacy and gives vaccine-hesitant individuals a pretense to forgo vaccination for themselves and their children,” said Adalja, who was harshly critical of the use of vaccinations in efforts to turn people against each other, calling it “overtly nihilistic.”\u003c/p>\n\u003cp>A spokesman for Twitter said that malicious accounts “are likely to target virtually any high profile conversation, since that’s where the views are.”\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>The spokesman, Ian Plunkett, told STAT that Twitter has aggressively ramped up preventive measures to try to keep such content from general users. In May, he noted, the platform identified and challenged nearly 10 million potentially automated accounts. “We put preemptive measures in place to ensure automated content is filtered from discoverable areas of the services — like trends and search. It’s possible that may users did not see this content before it was suspended,” Plunkett said.\u003c/p>\n\u003cp>Other experts, too, were unsurprised that Russian trolls and bots would delve into vaccines discussions, given the heat the topic can generate.\u003c/p>\n\u003cp>“Vaccination links to deep values around protection, health, harm, and the social contract,” said Julie Leask, an associate professor at the University of Sydney’s Susan Wakil School of Nursing and Midwifery who researches vaccine refusal. “People become highly invested in the discussion, and highly reactive to the notion that people refuse vaccines. The expression of sentiment at the margins — very pro- and very anti-vaccine — generates emotional energy and clicks.”\u003c/p>\n\u003cp>Adam Dunn, an associate professor in the Center for Health Informatics at Australia’s Macquarie University, said responding to this type of activity by internet bots and trolls would be challenging for public health authorities and may rely on the rooting out of the malicious accounts.\u003c/p>\n\u003cp>“The responsibility of managing the health of online conversations may … fall to Twitter itself, and work like this demonstrating the potential for real harm to human health provides a strong impetus for Twitter to act more often and more quickly to identify, isolate, or remove bots and trolls,” Dunn said.\u003c/p>\n\u003cp>Many of the accounts Broniatowski’s group studied have since been shut down, he said. But freeing the Twitter platform of bots and trolls is like playing whack-a-mole, he suggested.\u003c/p>\n\u003cp>For her part, Leask wasn’t certain how Twitter would have an outsized impact on vaccination decisions.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“When parents decide not to vaccinate, the decision isn’t usually taken lightly and a few tweets from bots are unlikely to change this trajectory,” she said. “The decision process is much more complex and centered on beliefs, experience and notions of what it means to be a ‘good parent’ held within that community. What we still need to establish is the relative role of social media independent of the influence of peer networks.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "For Cervical Cancer Screening, Women Over 30 Can Now Choose HPV Test Only",
"title": "For Cervical Cancer Screening, Women Over 30 Can Now Choose HPV Test Only",
"headTitle": "Women’s Health | KQED Future of You | KQED Science",
"content": "\u003cp>Federal health advisers say women can now consider three options when it's time for their cervical cancer screening tests. The influential group, the U.S. Preventive Services Task Force, has expanded its recommendations for this potentially lifesaving exam.\u003c/p>\n\u003cp>The new recommendations \u003ca href=\"http://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2018.10897\" target=\"_blank\" rel=\"noopener\">are published\u003c/a> in the latest issue of \u003cem>JAMA.\u003c/em>\u003c/p>\n\u003cp>\u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0022605/\" target=\"_blank\" rel=\"noopener\">Pap smears\u003c/a> have saved many lives since they became available decades ago. Inspecting samples of cervical tissue for precancerous changes is effective at catching possible cancer and is still the go-to test for women ages 21 to 29, according to the USPSTF guidelines.\u003c/p>\n\u003cp>But there's another option. \"Most cervical cancer is caused by what's called the human papillomavirus, or HPV,\" says \u003ca href=\"https://profiles.stanford.edu/douglas-owens\" target=\"_blank\" rel=\"noopener\">Dr. Douglas Owens\u003c/a>, a professor of medicine at Stanford University and vice chair of the USPSTF. \"And we now have tests for HPV and that's an important step forward.\"\u003c/p>\n\u003cp>These tests are available alone or in combination with the Pap test. And the USPSTF now says \u003ca href=\"https://www.npr.org/sections/health-shots/2018/07/03/625696664/for-women-over-30-there-may-be-a-better-choice-than-the-pap-smear\" target=\"_blank\" rel=\"noopener\">the evidence\u003c/a> is strong enough that HPV tests can be used by themselves, for women over 30. That third choice expands on the task force's previous recommendation, which was for the Pap test or the combination test.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>And while Pap tests should be repeated every three years, women can wait five years between HPV tests.\u003c/p>\n\u003cp>\"Five years is a good balance between the benefits and harms,\" Owens says. \"It's still highly effective at detecting cancer, and screening more frequently than that may increase some of the potential harms, so we think that's a good interval.\"\u003c/p>\n\u003cp>Potential harms of too frequent screening include unnecessary follow-ups such as biopsies. In a draft recommendation released last year, the task force had considered suggesting just two options, either the Pap smear or the HPV test, but its final recommendation included the hybrid test too.\u003c/p>\n\u003cp>\"The HPV test alone is not available everywhere,\" Owens explains. \"And so we want to be sure that women no matter where they're receiving care have options for cervical cancer screening.\"\u003c/p>\n\u003cp>He says the combination test is widely available, as is the Pap test, \"so all of those are good options and a woman can discuss with her physician what's available at the place where she's receiving care.\"\u003c/p>\n\u003cp>Women may not notice the difference between tests because tissue samples are all collected the same way. But \u003ca href=\"http://pressroom.cancer.org/debbiesaslow\" target=\"_blank\" rel=\"noopener\">Debbie Saslow\u003c/a>, senior director for HPV-related and women's cancers at the American Cancer Society, says if women have a choice, she would recommend the HPV test for women over 30.\u003c/p>\n\u003cp>\"I truly believe that including the HPV test, either along with the Pap or instead of the Pap, is superior than the Pap alone,\" she says. There's some evidence the HPV test is better than the Pap test at detecting a less common form of cervical cancer, adenocarcinoma, she says. \"So wouldn't you rather find the two most common cancers instead of just the one most common type?\"\u003c/p>\n\u003cp>The task force emphasizes that all three tests are highly effective. The overarching recommendation is simply that women should get screened, and to do so regularly until the age of 65. If screening has been adequate up to that point, the task force says women do not need further cervical cancer screening.\u003c/p>\n\u003cp>Health officials also recommend the HPV vaccine, which is given to girls and young women, up to age 26. (Boys and young men are encouraged to get the HPV vaccine as well.) But Owens says a vaccine alone doesn't replace cervical cancer screening.\u003c/p>\n\u003cp>\"Our recommendation applies to everyone whether you've been vaccinated or not,\" he says. \"It's very important that women do not forgo screening because they've been vaccinated.\"\u003c/p>\n\u003cp>An effective vaccine could ultimately render cervical cancer screening unnecessary, but that change will require careful study and could be years away.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>You can reach Richard Harris at \u003c/em>\u003ca href=\"mailto:rharris@npr.org\" target=\"_blank\" rel=\"noopener\">rharris@npr.org\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=For+Cervical+Cancer+Screening%2C+Women+Over+30+Can+Now+Choose+The+HPV+Test+Only&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Federal health advisers say women can now consider three options when it's time for their cervical cancer screening tests. The influential group, the U.S. Preventive Services Task Force, has expanded its recommendations for this potentially lifesaving exam.\u003c/p>\n\u003cp>The new recommendations \u003ca href=\"http://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2018.10897\" target=\"_blank\" rel=\"noopener\">are published\u003c/a> in the latest issue of \u003cem>JAMA.\u003c/em>\u003c/p>\n\u003cp>\u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0022605/\" target=\"_blank\" rel=\"noopener\">Pap smears\u003c/a> have saved many lives since they became available decades ago. Inspecting samples of cervical tissue for precancerous changes is effective at catching possible cancer and is still the go-to test for women ages 21 to 29, according to the USPSTF guidelines.\u003c/p>\n\u003cp>But there's another option. \"Most cervical cancer is caused by what's called the human papillomavirus, or HPV,\" says \u003ca href=\"https://profiles.stanford.edu/douglas-owens\" target=\"_blank\" rel=\"noopener\">Dr. Douglas Owens\u003c/a>, a professor of medicine at Stanford University and vice chair of the USPSTF. \"And we now have tests for HPV and that's an important step forward.\"\u003c/p>\n\u003cp>These tests are available alone or in combination with the Pap test. And the USPSTF now says \u003ca href=\"https://www.npr.org/sections/health-shots/2018/07/03/625696664/for-women-over-30-there-may-be-a-better-choice-than-the-pap-smear\" target=\"_blank\" rel=\"noopener\">the evidence\u003c/a> is strong enough that HPV tests can be used by themselves, for women over 30. That third choice expands on the task force's previous recommendation, which was for the Pap test or the combination test.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>And while Pap tests should be repeated every three years, women can wait five years between HPV tests.\u003c/p>\n\u003cp>\"Five years is a good balance between the benefits and harms,\" Owens says. \"It's still highly effective at detecting cancer, and screening more frequently than that may increase some of the potential harms, so we think that's a good interval.\"\u003c/p>\n\u003cp>Potential harms of too frequent screening include unnecessary follow-ups such as biopsies. In a draft recommendation released last year, the task force had considered suggesting just two options, either the Pap smear or the HPV test, but its final recommendation included the hybrid test too.\u003c/p>\n\u003cp>\"The HPV test alone is not available everywhere,\" Owens explains. \"And so we want to be sure that women no matter where they're receiving care have options for cervical cancer screening.\"\u003c/p>\n\u003cp>He says the combination test is widely available, as is the Pap test, \"so all of those are good options and a woman can discuss with her physician what's available at the place where she's receiving care.\"\u003c/p>\n\u003cp>Women may not notice the difference between tests because tissue samples are all collected the same way. But \u003ca href=\"http://pressroom.cancer.org/debbiesaslow\" target=\"_blank\" rel=\"noopener\">Debbie Saslow\u003c/a>, senior director for HPV-related and women's cancers at the American Cancer Society, says if women have a choice, she would recommend the HPV test for women over 30.\u003c/p>\n\u003cp>\"I truly believe that including the HPV test, either along with the Pap or instead of the Pap, is superior than the Pap alone,\" she says. There's some evidence the HPV test is better than the Pap test at detecting a less common form of cervical cancer, adenocarcinoma, she says. \"So wouldn't you rather find the two most common cancers instead of just the one most common type?\"\u003c/p>\n\u003cp>The task force emphasizes that all three tests are highly effective. The overarching recommendation is simply that women should get screened, and to do so regularly until the age of 65. If screening has been adequate up to that point, the task force says women do not need further cervical cancer screening.\u003c/p>\n\u003cp>Health officials also recommend the HPV vaccine, which is given to girls and young women, up to age 26. (Boys and young men are encouraged to get the HPV vaccine as well.) But Owens says a vaccine alone doesn't replace cervical cancer screening.\u003c/p>\n\u003cp>\"Our recommendation applies to everyone whether you've been vaccinated or not,\" he says. \"It's very important that women do not forgo screening because they've been vaccinated.\"\u003c/p>\n\u003cp>An effective vaccine could ultimately render cervical cancer screening unnecessary, but that change will require careful study and could be years away.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>You can reach Richard Harris at \u003c/em>\u003ca href=\"mailto:rharris@npr.org\" target=\"_blank\" rel=\"noopener\">rharris@npr.org\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=For+Cervical+Cancer+Screening%2C+Women+Over+30+Can+Now+Choose+The+HPV+Test+Only&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Did you know that there are more women living with HIV in the world than men? Or that young women and girls make up 60 percent of youth cases? If you didn’t, Loren Jones won’t be surprised. Many people in the U.S. still view HIV as a disease that impacts men – especially gay and bisexual men – far more than women.\u003c/p>\n\u003caside class=\"pullquote alignright\">'You know what? We need more women to be getting treatment and more women in clinical trials.'\u003ccite>Loren Jones\u003c/cite>\u003c/aside>\n\u003cp>“People don’t see women,” says Jones, who’s 65 and has had HIV for more than 30 years. “Even women often don’t see women. All of the attention has focused for so long on gay men.” She shrugs. “That really hasn’t changed that much.”\u003c/p>\n\u003cp>Jones is a friendly, outspoken woman who also fits the broad profile of women and girls most at risk for acquiring HIV in the U.S.: she’s heterosexual, African-American, has been homeless, and had boyfriends who did drugs. She’s also been a mother living in poverty.\u003c/p>\n\u003cp>“If you’d have told me when I was younger that I’d be here, doing what I do, I’d a told you no way,” says Jones. “But you know what? We need more women to be getting treatment and more women in clinical trials.”\u003c/p>\n\u003cp>Jones is a volunteer member of the \u003ca href=\"http://www.amfar.org/cure-research-institute/\" target=\"_blank\" rel=\"noopener\">amfAR Institute for HIV Cure Research\u003c/a>’s watchdog community advisory board, or CAB. Her role is to inform others about new cure studies, such as the UC San Francisco remission study starting this fall. Clinical trials, she knows from personal experience, are a great way to access HIV care.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“I was actually positive for 20 years before I took meds,” she says, “I got into treatment by joining a study.”\u003c/p>\n\u003cp>[contextly_sidebar id=\"OxLwEk6hcW75D0coV2Sp2m7d1a2cx02b\"]Jones was the second person in California to join the ongoing WIHS, or \u003ca href=\"https://statepi.jhsph.edu/wihs/wordpress/\" target=\"_blank\" rel=\"noopener\">Women’s Interagency HIV Study\u003c/a>, a pioneering observational study of HIV in US women. Back then, she’d lost weight and her immune T-cell count was way down – signs of HIV’s advance.\u003c/p>\n\u003cp>“I joined to help myself,” she says. “I had no money or insurance, and I got excellent care. Plus, I met others who helped educate me. It’s helped me survive.”\u003c/p>\n\u003cp>The care in a clinical trial is free, and participants were given a small stipend. Since then, Jones has remained on standard HIV therapy and is in good health, with an undetectable viral load.\u003c/p>\n\u003cp>In the trials, she also learned how few women participate in HIV drug studies and how African-Americans and Latinos are \u003ca href=\"https://www.researchgate.net/publication/7374843_Disparities_and_gaps_in_HIV_research_and_care\">historically underrepresented\u003c/a> in HIV trials. In 1994, 9 percent of HIV drug trial participants were women; a decade later, that number had doubled, but by 2011, it was still only 22 percent, according to \u003ca href=\"http://www.catie.ca/en/catienews/2015-10-05/women-found-under-represented-hiv-clinical-trials\">one Canadian study\u003c/a>. It also showed African-Americans and Latinos with HIV received suboptimal care compared with whites – another continuing trend -- and that clinical trials could help close the gap by providing top-level care.\u003c/p>\n\u003caside class=\"pullquote alignright\">'I can take what the scientists say and bring that back to the ghetto because, let me tell you, the scientists don’t know how to talk to people in my community.'\u003ccite>Loren Jones>\u003c/cite>\u003c/aside>\n\u003cp>WIHS studies have shed important light on how women may process HIV drugs differently than men. They’ve also shown how domestic violence, poverty, sexual abuse and racial inequity are major factors that put HIV in a woman’s path.\u003c/p>\n\u003cp>All three are elements of Jones’ HIV story, itself a testament to her grit and ability to survive.\u003c/p>\n\u003cp>Jones, who is gregarious and likes to laugh, was born in Philadelphia. She describes a very lonely childhood growing up in the care of strict Pentecostalist relatives, apart from her parents and five siblings. She loved books and liked school, until she was bussed to a mostly white school. “I took the ghetto bus to a middle-class neighborhood,” she says. “It was absolutely miserable.” Her isolation continued at Penn State, where she studied nursing, struggling to make ends meet.\u003c/p>\n\u003cp>[contextly_sidebar id=\"QxseLeDIn6vIF3w27GoVucGtwJOLzADj\"]That’s when her destiny shifted. While at Penn State, she was invited to dance in a strip bar. “I was a skinny little string bean; she jokes, “there was nothing to see. But the money was good.” After that, she grabbed her freedom. “I was 17, 18,” she recalls, “and California was a big mystery to me. People talked about diversity and freedom. I wanted that.” She hitchhiked to Oakland in seven days -- with seven dollars in her pocket. “I found Berkeley – there were people walking around blowing bubbles in clown suits on stilts.” She never looked back.\u003c/p>\n\u003cp>She didn’t see HIV coming either. Jones was still a church-going good girl, wide-eyed about the world. One day a handsome guy drove by on a motorcycle and she hopped on. “He was a wild child,” Jones recalls, laughing. They had a child but, too soon, her boyfriend took off. Jones relied on temp jobs, but with a toddler, it was too difficult. She fell into homelessness, lived in her car, then joined a tougher crowd. “This was the 80s; they were outlaws, not a violent gang, but tough enough,” she says of her circle. “We were drinking and drugging in the Oakland hills.”\u003c/p>\n\u003cp>One day she visited a health clinic where they offered the HIV test. She wasn’t prepared, but wasn’t totally surprised, to get a positive result. She told no one for two years. “It was very lonely,” she says. “Back then, if you tested positive, you were definitely gonna die; that was the message.”\u003c/p>\n\u003cp>Jones found her new community by accident in the early 1990s at a temp job when she picked up a newsletter from the Oakland-based \u003ca href=\"http://www.womenhiv.org/\" target=\"_blank\" rel=\"noopener\">Women Organized to Respond to Life Threatening Diseases\u003c/a>, or WORLD. It remains a leading platform for HIV-positive women in the Bay Area.\u003c/p>\n\u003cp>“I want women to know about what’s going on with cure research,” says Jones, explaining her newest focus. “We need our communities in here. We can’t just leave it up to the scientists. They need us.”\u003c/p>\n\u003cp>Jones says her role on the Community Advisory Board isn’t to recruit, but to let women know the studies that are available. But she’s very aware of hurdles standing in the way for women to participate – including poverty, health literacy and distrust of the medical profession.\u003c/p>\n\u003cp>“I overcome the obstacles by talking about my experience,” she says of her approach. “I may be college educated, but I ride the bus too.”\u003c/p>\n\u003cp>“I talk to women who are mostly my home girls; they are like me,” she adds. “They are black women with low income, who live in residential hotels, single income, who live with their mama – women who are really down to earth. We can relate.”\u003c/p>\n\u003cp>Jones says she’s learned in her journey that she doesn’t have to be a scientist to help others.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“I can take what the scientists say and bring that back to the ghetto, because, let me tell you, the scientists don’t know how to talk to people in my community. I’m comfortable in both worlds -- the scientific and the street. My message is: ‘We gotta find more ways to invite the community to be involved in this cure research.’ They need to get on board.”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Did you know that there are more women living with HIV in the world than men? Or that young women and girls make up 60 percent of youth cases? If you didn’t, Loren Jones won’t be surprised. Many people in the U.S. still view HIV as a disease that impacts men – especially gay and bisexual men – far more than women.\u003c/p>\n\u003caside class=\"pullquote alignright\">'You know what? We need more women to be getting treatment and more women in clinical trials.'\u003ccite>Loren Jones\u003c/cite>\u003c/aside>\n\u003cp>“People don’t see women,” says Jones, who’s 65 and has had HIV for more than 30 years. “Even women often don’t see women. All of the attention has focused for so long on gay men.” She shrugs. “That really hasn’t changed that much.”\u003c/p>\n\u003cp>Jones is a friendly, outspoken woman who also fits the broad profile of women and girls most at risk for acquiring HIV in the U.S.: she’s heterosexual, African-American, has been homeless, and had boyfriends who did drugs. She’s also been a mother living in poverty.\u003c/p>\n\u003cp>“If you’d have told me when I was younger that I’d be here, doing what I do, I’d a told you no way,” says Jones. “But you know what? We need more women to be getting treatment and more women in clinical trials.”\u003c/p>\n\u003cp>Jones is a volunteer member of the \u003ca href=\"http://www.amfar.org/cure-research-institute/\" target=\"_blank\" rel=\"noopener\">amfAR Institute for HIV Cure Research\u003c/a>’s watchdog community advisory board, or CAB. Her role is to inform others about new cure studies, such as the UC San Francisco remission study starting this fall. Clinical trials, she knows from personal experience, are a great way to access HIV care.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“I was actually positive for 20 years before I took meds,” she says, “I got into treatment by joining a study.”\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>Jones was the second person in California to join the ongoing WIHS, or \u003ca href=\"https://statepi.jhsph.edu/wihs/wordpress/\" target=\"_blank\" rel=\"noopener\">Women’s Interagency HIV Study\u003c/a>, a pioneering observational study of HIV in US women. Back then, she’d lost weight and her immune T-cell count was way down – signs of HIV’s advance.\u003c/p>\n\u003cp>“I joined to help myself,” she says. “I had no money or insurance, and I got excellent care. Plus, I met others who helped educate me. It’s helped me survive.”\u003c/p>\n\u003cp>The care in a clinical trial is free, and participants were given a small stipend. Since then, Jones has remained on standard HIV therapy and is in good health, with an undetectable viral load.\u003c/p>\n\u003cp>In the trials, she also learned how few women participate in HIV drug studies and how African-Americans and Latinos are \u003ca href=\"https://www.researchgate.net/publication/7374843_Disparities_and_gaps_in_HIV_research_and_care\">historically underrepresented\u003c/a> in HIV trials. In 1994, 9 percent of HIV drug trial participants were women; a decade later, that number had doubled, but by 2011, it was still only 22 percent, according to \u003ca href=\"http://www.catie.ca/en/catienews/2015-10-05/women-found-under-represented-hiv-clinical-trials\">one Canadian study\u003c/a>. It also showed African-Americans and Latinos with HIV received suboptimal care compared with whites – another continuing trend -- and that clinical trials could help close the gap by providing top-level care.\u003c/p>\n\u003caside class=\"pullquote alignright\">'I can take what the scientists say and bring that back to the ghetto because, let me tell you, the scientists don’t know how to talk to people in my community.'\u003ccite>Loren Jones>\u003c/cite>\u003c/aside>\n\u003cp>WIHS studies have shed important light on how women may process HIV drugs differently than men. They’ve also shown how domestic violence, poverty, sexual abuse and racial inequity are major factors that put HIV in a woman’s path.\u003c/p>\n\u003cp>All three are elements of Jones’ HIV story, itself a testament to her grit and ability to survive.\u003c/p>\n\u003cp>Jones, who is gregarious and likes to laugh, was born in Philadelphia. She describes a very lonely childhood growing up in the care of strict Pentecostalist relatives, apart from her parents and five siblings. She loved books and liked school, until she was bussed to a mostly white school. “I took the ghetto bus to a middle-class neighborhood,” she says. “It was absolutely miserable.” Her isolation continued at Penn State, where she studied nursing, struggling to make ends meet.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>That’s when her destiny shifted. While at Penn State, she was invited to dance in a strip bar. “I was a skinny little string bean; she jokes, “there was nothing to see. But the money was good.” After that, she grabbed her freedom. “I was 17, 18,” she recalls, “and California was a big mystery to me. People talked about diversity and freedom. I wanted that.” She hitchhiked to Oakland in seven days -- with seven dollars in her pocket. “I found Berkeley – there were people walking around blowing bubbles in clown suits on stilts.” She never looked back.\u003c/p>\n\u003cp>She didn’t see HIV coming either. Jones was still a church-going good girl, wide-eyed about the world. One day a handsome guy drove by on a motorcycle and she hopped on. “He was a wild child,” Jones recalls, laughing. They had a child but, too soon, her boyfriend took off. Jones relied on temp jobs, but with a toddler, it was too difficult. She fell into homelessness, lived in her car, then joined a tougher crowd. “This was the 80s; they were outlaws, not a violent gang, but tough enough,” she says of her circle. “We were drinking and drugging in the Oakland hills.”\u003c/p>\n\u003cp>One day she visited a health clinic where they offered the HIV test. She wasn’t prepared, but wasn’t totally surprised, to get a positive result. She told no one for two years. “It was very lonely,” she says. “Back then, if you tested positive, you were definitely gonna die; that was the message.”\u003c/p>\n\u003cp>Jones found her new community by accident in the early 1990s at a temp job when she picked up a newsletter from the Oakland-based \u003ca href=\"http://www.womenhiv.org/\" target=\"_blank\" rel=\"noopener\">Women Organized to Respond to Life Threatening Diseases\u003c/a>, or WORLD. It remains a leading platform for HIV-positive women in the Bay Area.\u003c/p>\n\u003cp>“I want women to know about what’s going on with cure research,” says Jones, explaining her newest focus. “We need our communities in here. We can’t just leave it up to the scientists. They need us.”\u003c/p>\n\u003cp>Jones says her role on the Community Advisory Board isn’t to recruit, but to let women know the studies that are available. But she’s very aware of hurdles standing in the way for women to participate – including poverty, health literacy and distrust of the medical profession.\u003c/p>\n\u003cp>“I overcome the obstacles by talking about my experience,” she says of her approach. “I may be college educated, but I ride the bus too.”\u003c/p>\n\u003cp>“I talk to women who are mostly my home girls; they are like me,” she adds. “They are black women with low income, who live in residential hotels, single income, who live with their mama – women who are really down to earth. We can relate.”\u003c/p>\n\u003cp>Jones says she’s learned in her journey that she doesn’t have to be a scientist to help others.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>In the end, it wasn’t easy for Aaron McQ to decide when to die.\u003c/p>\n\u003cp>The 50-year-old Seattle man — a former world traveler, triathlete and cyclist — learned he had leukemia five years ago, followed by an even grimmer diagnosis in 2016: a rare form of amyotrophic lateral sclerosis, or ALS.\u003c/p>\n\u003cp>An interior and urban designer who legally changed his given name, McQ had been in pain and physical decline for years. Then the disease threatened to shut down his ability to swallow and breathe.\u003c/p>\n\u003cp>“It’s like waking up every morning in quicksand,” McQ said. “It’s terrifying.”\u003c/p>\n\u003cp>Last fall, McQ decided to use Washington state’s 2009 Death With Dignity law to end his suffering. The practice, approved in seven states and the District of Columbia, allows people with a projected six months or less to live to obtain lethal drugs to end their lives.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Although the option was legal, actually carrying it out was difficult for McQ, who agreed to discuss his deliberations with Kaiser Health News. He said he hoped to shed light on an often secretive and misunderstood practice.\u003c/p>\n\u003cp>“How does anyone get their head around dying?” he said, sitting in a wheelchair in his Seattle apartment in late January.\u003c/p>\n\u003cfigure id=\"attachment_443968\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003cimg class=\"size-large wp-image-443968\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/08/01-aaron-mcq-als_1350-1020x680.jpg\" alt=\"\" width=\"640\" height=\"427\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2018/08/01-aaron-mcq-als_1350-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/01-aaron-mcq-als_1350-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/01-aaron-mcq-als_1350-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/01-aaron-mcq-als_1350-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/01-aaron-mcq-als_1350-1200x800.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/01-aaron-mcq-als_1350-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/01-aaron-mcq-als_1350-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/01-aaron-mcq-als_1350-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/01-aaron-mcq-als_1350-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/01-aaron-mcq-als_1350-520x347.jpg 520w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/01-aaron-mcq-als_1350.jpg 1270w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003cfigcaption class=\"wp-caption-text\">Aaron McQ speaks during an interview in his Seattle apartment in January. “No one is ever really ready to die,” McQ said. “There will always be a reason not to.” \u003ccite>(Dan Delong/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>More than 3,000 people in the U.S. have chosen such deaths since Oregon’s law was enacted in 1997, according to state reports. Even as similar statutes have expanded to more venues — including, this year, \u003ca href=\"https://www.reuters.com/article/us-hawaii-dying/hawaii-lawmakers-approve-medical-aid-in-dying-for-terminally-ill-idUSKBN1H606J\" target=\"_blank\" rel=\"noopener\">Hawaii\u003c/a> — it has remained controversial.\u003c/p>\n\u003cp>California’s End of Life Option Act, which took effect in 2016, was suspended for three weeks this spring after a court challenge, leaving hundreds of dying patients \u003ca href=\"https://khn.org/news/suspension-of-californias-aid-in-dying-law-leaves-sick-patients-in-limbo/\" target=\"_blank\" rel=\"noopener\">briefly in limbo\u003c/a>.\u003c/p>\n\u003cp>Supporters say the practice gives patients control over their own fate in the face of a terminal illness. Detractors — including religious groups, disability rights advocates and \u003ca href=\"https://khn.org/news/as-doctors-drop-opposition-aid-in-dying-advocates-target-next-battleground-states/\" target=\"_blank\" rel=\"noopener\">some doctors\u003c/a> — argue that such laws could put pressure on vulnerable people and that proper palliative care can ease end-of-life suffering.\u003c/p>\n\u003cp>Thin and wan, with silver hair and piercing blue eyes, McQ still could have passed for the photographer’s model he once was. But McQ’s legs shook involuntarily beneath his dark jeans and his voice was hoarse with pain during a three-hour effort to tell his story.\u003c/p>\n\u003cp>Last November, doctors told McQ he had six months or less to live. The choice, he said, became not death over a healthy life, but a “certain outcome” now over a prolonged, painful — and “unknowable” — end.\u003c/p>\n\u003cp>“I’m not wanting to die,” he said. “I’m very much alive, yet I’m suffering. And I would rather have it not be a surprise.”\u003c/p>\n\u003cp>In late December, a friend picked up a prescription for 100 tablets of the powerful sedative secobarbital. For weeks, the bottle holding the lethal dose sat on a shelf in his kitchen.\u003c/p>\n\u003cp>“I was not relaxed or confident until I had it in my cupboard,” McQ said.\u003c/p>\n\u003cp>At the time, he intended to take the drug in late February. Or maybe mid-March. He had wanted to get past Christmas, so he didn’t ruin anyone’s holiday. Then his sister and her family came for a visit. Then there was a friend’s birthday and another friend’s wedding.\u003c/p>\n\u003cp>“No one is ever really ready to die,” McQ said. “There will always be a reason not to.”\u003c/p>\n\u003cdiv id=\"attachment_862690\" class=\"wp-caption alignnone\">\n\u003cfigure id=\"attachment_862690\" class=\"wp-caption alignnone\" style=\"max-width: 1024px\">\u003cimg class=\"wp-image-862690 size-full\" src=\"https://kaiserhealthnews.files.wordpress.com/2018/07/09-aaron-mcq-als_1350.jpg?w=1024&h=683\" alt=\"\" width=\"1024\" height=\"683\">\u003cfigcaption class=\"wp-caption-text\">In late December, a friend picked up Aaron McQ’s prescription for 100 tablets of the powerful sedative secobarbital. For weeks, the bottle holding the lethal dose sat on a shelf in his kitchen.(DAN DELONG FOR KHN)\u003c/figcaption>\u003c/figure>\n\u003c/div>\n\u003cp>Many people who opt for medical aid-in-dying are so sick that they take the drugs as soon as they can, impatiently enduring state-mandated waiting periods to obtain the prescriptions\u003c/p>\n\u003cp>Data from Oregon show that the median time from first request to death is 48 days, or about seven weeks. But it has ranged from two weeks to more than 2.7 years, records show.\u003c/p>\n\u003cp>Neurodegenerative diseases like ALS are particularly difficult, said Dr. Lonny Shavelson, a Berkeley, Calif., physician who has supervised nearly 90 aid-in-dying deaths in that state and advised more than 600 patients since 2016.\u003c/p>\n\u003cp>“It’s a very complicated decision week to week,” he said. “How do you decide? When do you decide? We don’t let them make that decision alone.”\u003c/p>\n\u003cp>Philosophically, McQ had been a supporter of aid-in-dying for years. He was the final caregiver for his grandmother, Milly, who he said begged for death to end pain at the end of her life.\u003c/p>\n\u003cp>By late spring, McQ’s own struggle was worse, said Karen Robinson, McQ’s health care proxy and friend of two decades. He was admitted to home hospice care, but continued to decline. When a nurse recommended that McQ transfer to a hospice facility to control his growing pain, he decided he’d rather die at home.\u003c/p>\n\u003cp>“There was part of him that was hoping there were some other alternative,” Robinson said.\u003c/p>\n\u003cp>McQ considered several dates — and then changed his mind, partly because of the pressure that such a choice imposed.\u003c/p>\n\u003cp>“I don’t want to talk about it because I don’t want to feel like, now you gotta,” he said.\u003c/p>\n\u003cp>Along with the pain, the risk of losing the physical ability to administer the medication himself, a legal requirement, was growing.\u003c/p>\n\u003cp>“I talked with him about losing his window of opportunity,” said Gretchen DeRoche, a volunteer with the group End of Life Washington, who said she has supervised hundreds of aid-in-dying deaths.\u003c/p>\n\u003cp>Finally, McQ chose the day: April 10. Robinson came over early in the afternoon, as she had often done, to drink coffee and talk — but not about his impending death.\u003c/p>\n\u003cp>“There was a part of him that didn’t want it to be like \u003cem>this is the day\u003c/em>,” she said.\u003c/p>\n\u003cp>DeRoche arrived exactly at 5:30 p.m., per McQ’s instructions. At 6 p.m., McQ took anti-nausea medication. Because the lethal drugs are so bitter, there is some chance patients won’t keep them down.\u003c/p>\n\u003cp>Four close friends gathered, along with Robinson. They sorted through McQ’s CDs, trying to find appropriate music.\u003c/p>\n\u003cp>“He put on Marianne Faithfull. She’s amazing, but, it was too much,” Robinson said. “Then he put on James Taylor for, like, 15 seconds. It was ‘You’ve Got a Friend.’ I vetoed that. I said, ‘Aaron, you cannot do that if you want us to hold it together.’”\u003c/p>\n\u003cp>DeRoche went into a bedroom to open the 100 capsules of 100-milligram secobarbital, one at a time, a tedious process. Then she mixed the drug with coconut water and some vodka.\u003c/p>\n\u003cp>Just then, McQ started to cry, DeRoche said. “I think he was just kind of mourning the loss of the life he had expected to live.”\u003c/p>\n\u003cp>After that, he said he was ready. McQ asked everyone but DeRoche to leave the room. She told him he could still change his mind.\u003c/p>\n\u003cp>“I said, as I do to everyone: ‘If you take this medication, you’re going to go to sleep and you are not going to wake up,’” she recalled.\u003c/p>\n\u003cp>McQ drank half the drug mixture, paused and drank water. Then he swallowed the rest.\u003c/p>\n\u003cp>His friends returned, but remained silent.\u003c/p>\n\u003cp>“They just all gathered around him, each one touching him,” DeRoche said.\u003c/p>\n\u003cp>Very quickly, just before 7:30 p.m., it was over.\u003c/p>\n\u003cp>“It was just like one fluid motion,” DeRoche said. “He drank the medication, he went to sleep and he died in six minutes. I think we were all a little surprised he was gone that fast.”\u003c/p>\n\u003cp>The friends stayed until a funeral home worker arrived.\u003c/p>\n\u003cp>“Once we got him into the vehicle, she asked, ‘What kind of music does he like?’” Robinson recalled. “It was just such a sweet, human thing for her to say. He was driving away, listening to jazz.”\u003c/p>\n\u003cp>McQ’s friends gathered June 30 in Seattle for a “happy memories celebration” of his life, Robinson said. She and a few others kayaked out into Lake Washington and left McQ’s ashes in the water, along with rose petals.\u003c/p>\n\u003cp>In the months since her friend’s death, Robinson has reflected on McQ’s decision to die. It was probably what he expected, she said, but not anything that he desired.\u003c/p>\n\u003cp>“It’s really tough to be alive and then not be alive because of your choice,” she said.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“If he had his wish, he would have died in his sleep.”\u003cem> \u003c/em>\u003c/p>\n\n",
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"excerpt": "Supporters say the practice gives patients control over their own fate while detractors argue that such laws could put pressure on vulnerable people and that proper palliative care can ease end-of-life suffering.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>In the end, it wasn’t easy for Aaron McQ to decide when to die.\u003c/p>\n\u003cp>The 50-year-old Seattle man — a former world traveler, triathlete and cyclist — learned he had leukemia five years ago, followed by an even grimmer diagnosis in 2016: a rare form of amyotrophic lateral sclerosis, or ALS.\u003c/p>\n\u003cp>An interior and urban designer who legally changed his given name, McQ had been in pain and physical decline for years. Then the disease threatened to shut down his ability to swallow and breathe.\u003c/p>\n\u003cp>“It’s like waking up every morning in quicksand,” McQ said. “It’s terrifying.”\u003c/p>\n\u003cp>Last fall, McQ decided to use Washington state’s 2009 Death With Dignity law to end his suffering. The practice, approved in seven states and the District of Columbia, allows people with a projected six months or less to live to obtain lethal drugs to end their lives.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Although the option was legal, actually carrying it out was difficult for McQ, who agreed to discuss his deliberations with Kaiser Health News. He said he hoped to shed light on an often secretive and misunderstood practice.\u003c/p>\n\u003cp>“How does anyone get their head around dying?” he said, sitting in a wheelchair in his Seattle apartment in late January.\u003c/p>\n\u003cfigure id=\"attachment_443968\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003cimg class=\"size-large wp-image-443968\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/08/01-aaron-mcq-als_1350-1020x680.jpg\" alt=\"\" width=\"640\" height=\"427\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2018/08/01-aaron-mcq-als_1350-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/01-aaron-mcq-als_1350-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/01-aaron-mcq-als_1350-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/01-aaron-mcq-als_1350-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/01-aaron-mcq-als_1350-1200x800.jpg 1200w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/01-aaron-mcq-als_1350-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/01-aaron-mcq-als_1350-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/01-aaron-mcq-als_1350-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/01-aaron-mcq-als_1350-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/01-aaron-mcq-als_1350-520x347.jpg 520w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/01-aaron-mcq-als_1350.jpg 1270w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003cfigcaption class=\"wp-caption-text\">Aaron McQ speaks during an interview in his Seattle apartment in January. “No one is ever really ready to die,” McQ said. “There will always be a reason not to.” \u003ccite>(Dan Delong/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>More than 3,000 people in the U.S. have chosen such deaths since Oregon’s law was enacted in 1997, according to state reports. Even as similar statutes have expanded to more venues — including, this year, \u003ca href=\"https://www.reuters.com/article/us-hawaii-dying/hawaii-lawmakers-approve-medical-aid-in-dying-for-terminally-ill-idUSKBN1H606J\" target=\"_blank\" rel=\"noopener\">Hawaii\u003c/a> — it has remained controversial.\u003c/p>\n\u003cp>California’s End of Life Option Act, which took effect in 2016, was suspended for three weeks this spring after a court challenge, leaving hundreds of dying patients \u003ca href=\"https://khn.org/news/suspension-of-californias-aid-in-dying-law-leaves-sick-patients-in-limbo/\" target=\"_blank\" rel=\"noopener\">briefly in limbo\u003c/a>.\u003c/p>\n\u003cp>Supporters say the practice gives patients control over their own fate in the face of a terminal illness. Detractors — including religious groups, disability rights advocates and \u003ca href=\"https://khn.org/news/as-doctors-drop-opposition-aid-in-dying-advocates-target-next-battleground-states/\" target=\"_blank\" rel=\"noopener\">some doctors\u003c/a> — argue that such laws could put pressure on vulnerable people and that proper palliative care can ease end-of-life suffering.\u003c/p>\n\u003cp>Thin and wan, with silver hair and piercing blue eyes, McQ still could have passed for the photographer’s model he once was. But McQ’s legs shook involuntarily beneath his dark jeans and his voice was hoarse with pain during a three-hour effort to tell his story.\u003c/p>\n\u003cp>Last November, doctors told McQ he had six months or less to live. The choice, he said, became not death over a healthy life, but a “certain outcome” now over a prolonged, painful — and “unknowable” — end.\u003c/p>\n\u003cp>“I’m not wanting to die,” he said. “I’m very much alive, yet I’m suffering. And I would rather have it not be a surprise.”\u003c/p>\n\u003cp>In late December, a friend picked up a prescription for 100 tablets of the powerful sedative secobarbital. For weeks, the bottle holding the lethal dose sat on a shelf in his kitchen.\u003c/p>\n\u003cp>“I was not relaxed or confident until I had it in my cupboard,” McQ said.\u003c/p>\n\u003cp>At the time, he intended to take the drug in late February. Or maybe mid-March. He had wanted to get past Christmas, so he didn’t ruin anyone’s holiday. Then his sister and her family came for a visit. Then there was a friend’s birthday and another friend’s wedding.\u003c/p>\n\u003cp>“No one is ever really ready to die,” McQ said. “There will always be a reason not to.”\u003c/p>\n\u003cdiv id=\"attachment_862690\" class=\"wp-caption alignnone\">\n\u003cfigure id=\"attachment_862690\" class=\"wp-caption alignnone\" style=\"max-width: 1024px\">\u003cimg class=\"wp-image-862690 size-full\" src=\"https://kaiserhealthnews.files.wordpress.com/2018/07/09-aaron-mcq-als_1350.jpg?w=1024&h=683\" alt=\"\" width=\"1024\" height=\"683\">\u003cfigcaption class=\"wp-caption-text\">In late December, a friend picked up Aaron McQ’s prescription for 100 tablets of the powerful sedative secobarbital. For weeks, the bottle holding the lethal dose sat on a shelf in his kitchen.(DAN DELONG FOR KHN)\u003c/figcaption>\u003c/figure>\n\u003c/div>\n\u003cp>Many people who opt for medical aid-in-dying are so sick that they take the drugs as soon as they can, impatiently enduring state-mandated waiting periods to obtain the prescriptions\u003c/p>\n\u003cp>Data from Oregon show that the median time from first request to death is 48 days, or about seven weeks. But it has ranged from two weeks to more than 2.7 years, records show.\u003c/p>\n\u003cp>Neurodegenerative diseases like ALS are particularly difficult, said Dr. Lonny Shavelson, a Berkeley, Calif., physician who has supervised nearly 90 aid-in-dying deaths in that state and advised more than 600 patients since 2016.\u003c/p>\n\u003cp>“It’s a very complicated decision week to week,” he said. “How do you decide? When do you decide? We don’t let them make that decision alone.”\u003c/p>\n\u003cp>Philosophically, McQ had been a supporter of aid-in-dying for years. He was the final caregiver for his grandmother, Milly, who he said begged for death to end pain at the end of her life.\u003c/p>\n\u003cp>By late spring, McQ’s own struggle was worse, said Karen Robinson, McQ’s health care proxy and friend of two decades. He was admitted to home hospice care, but continued to decline. When a nurse recommended that McQ transfer to a hospice facility to control his growing pain, he decided he’d rather die at home.\u003c/p>\n\u003cp>“There was part of him that was hoping there were some other alternative,” Robinson said.\u003c/p>\n\u003cp>McQ considered several dates — and then changed his mind, partly because of the pressure that such a choice imposed.\u003c/p>\n\u003cp>“I don’t want to talk about it because I don’t want to feel like, now you gotta,” he said.\u003c/p>\n\u003cp>Along with the pain, the risk of losing the physical ability to administer the medication himself, a legal requirement, was growing.\u003c/p>\n\u003cp>“I talked with him about losing his window of opportunity,” said Gretchen DeRoche, a volunteer with the group End of Life Washington, who said she has supervised hundreds of aid-in-dying deaths.\u003c/p>\n\u003cp>Finally, McQ chose the day: April 10. Robinson came over early in the afternoon, as she had often done, to drink coffee and talk — but not about his impending death.\u003c/p>\n\u003cp>“There was a part of him that didn’t want it to be like \u003cem>this is the day\u003c/em>,” she said.\u003c/p>\n\u003cp>DeRoche arrived exactly at 5:30 p.m., per McQ’s instructions. At 6 p.m., McQ took anti-nausea medication. Because the lethal drugs are so bitter, there is some chance patients won’t keep them down.\u003c/p>\n\u003cp>Four close friends gathered, along with Robinson. They sorted through McQ’s CDs, trying to find appropriate music.\u003c/p>\n\u003cp>“He put on Marianne Faithfull. She’s amazing, but, it was too much,” Robinson said. “Then he put on James Taylor for, like, 15 seconds. It was ‘You’ve Got a Friend.’ I vetoed that. I said, ‘Aaron, you cannot do that if you want us to hold it together.’”\u003c/p>\n\u003cp>DeRoche went into a bedroom to open the 100 capsules of 100-milligram secobarbital, one at a time, a tedious process. Then she mixed the drug with coconut water and some vodka.\u003c/p>\n\u003cp>Just then, McQ started to cry, DeRoche said. “I think he was just kind of mourning the loss of the life he had expected to live.”\u003c/p>\n\u003cp>After that, he said he was ready. McQ asked everyone but DeRoche to leave the room. She told him he could still change his mind.\u003c/p>\n\u003cp>“I said, as I do to everyone: ‘If you take this medication, you’re going to go to sleep and you are not going to wake up,’” she recalled.\u003c/p>\n\u003cp>McQ drank half the drug mixture, paused and drank water. Then he swallowed the rest.\u003c/p>\n\u003cp>His friends returned, but remained silent.\u003c/p>\n\u003cp>“They just all gathered around him, each one touching him,” DeRoche said.\u003c/p>\n\u003cp>Very quickly, just before 7:30 p.m., it was over.\u003c/p>\n\u003cp>“It was just like one fluid motion,” DeRoche said. “He drank the medication, he went to sleep and he died in six minutes. I think we were all a little surprised he was gone that fast.”\u003c/p>\n\u003cp>The friends stayed until a funeral home worker arrived.\u003c/p>\n\u003cp>“Once we got him into the vehicle, she asked, ‘What kind of music does he like?’” Robinson recalled. “It was just such a sweet, human thing for her to say. He was driving away, listening to jazz.”\u003c/p>\n\u003cp>McQ’s friends gathered June 30 in Seattle for a “happy memories celebration” of his life, Robinson said. She and a few others kayaked out into Lake Washington and left McQ’s ashes in the water, along with rose petals.\u003c/p>\n\u003cp>In the months since her friend’s death, Robinson has reflected on McQ’s decision to die. It was probably what he expected, she said, but not anything that he desired.\u003c/p>\n\u003cp>“It’s really tough to be alive and then not be alive because of your choice,” she said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“If he had his wish, he would have died in his sleep.”\u003cem> \u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Medical Students Skip Class in Droves, Making Lectures Increasingly Obsolete",
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"content": "\u003cp>The future doctors of America cut class. Not to gossip in the bathroom or flirt behind the bleachers. They skip to learn — at twice the speed.\u003c/p>\n\u003cp class=\"danger-zone\">Some medical students follow along with class remotely, watching sped-up recordings of their professors at home, in their pajamas. Others rarely tune in. At one school, attendance is so bad that a Nobel laureate recently lectured to mostly empty seats.\u003c/p>\n\u003cp class=\"danger-zone\">Nationally, nearly one-quarter of second-year medical students \u003ca href=\"https://www.aamc.org/download/488336/data/y2q2017report.pdf\" target=\"_blank\" rel=\"noopener\">reported\u003c/a> last year that they “almost never” attended class during their first two, preclinical years, a 5 percent increase from 2015.\u003c/p>\n\u003cp>The AWOL students highlight increasing dissatisfaction and anxiety that there’s a mismatch between what they’re taught in class during those years and what they’re expected to know — or how they’re tested — on national licensing exams. Despite paying nearly \u003ca href=\"https://www.aamc.org/data/tuitionandstudentfees/\" target=\"_blank\" rel=\"noopener\">$60,000 a year\u003c/a> in tuition, medical students are turning to unsanctioned online resources to prepare for Step 1, the make-or-break test typically taken at the end of the preclinical years.\u003c/p>\n\u003cp>These self-guided med students are akin to a group of American tourists wandering through Tokyo without a map. Like a tour guide hired on the street, the online learning tools — including memory aids, videos, and online quizzes — can enhance the educational journey, or send the students down a dead end.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Lawrence Wang, a third-year M.D.-Ph.D. student at the University of California, San Diego, and the National Institutes of Health, said he relied heavily on these resources during his first two years of medical school.\u003c/p>\n\u003cp>“There were times that I didn’t go to a single class, and then I’d get to the actual exam and it would be my first time seeing the professor,” he said. “Especially, when Step was coming up, I pretty much completely focused on studying outside materials.”\u003c/p>\n\u003cp>Wang isn’t alone. According to 2017 data from the Association for American Medical Colleges, 1 in 4 preclinical students watches educational videos — like those on YouTube — on a daily basis. And according to two video developers, tens of thousands of medical students subscribe to their products — one of which costs $250 for two years, the other $370 for one year.\u003c/p>\n\u003cp>Leaders in medical education have begun to scramble. Some medical schools, like Harvard, have done away with lectures for the most part. Instead of spending hours in an auditorium, Harvard students learn the course content at home and then apply the knowledge in mandatory small group sessions.\u003c/p>\n\u003cp>Other institutions, like Johns Hopkins, are moving in the same direction, but have yet to make a full switch. Hopkins cut down on lectures and boosted sessions that require active student participation. Preclinical lecture attendance hovers around 30 to 40 percent, according to Dr. Nancy Hueppchen, associate dean for curriculum.\u003c/p>\n\u003cp>For many students, she said, licensing exam prep begins on day one of medical school: “They have this parallel curriculum going along with what we’re teaching them.”\u003c/p>\n\u003cp>Step 1, an eight-hour multiple choice test, is a big deal. Performance on the exam, though it’s taken before most students even begin training in a hospital, heavily influences which medical specialties they can eventually pursue after school and at what hospitals they can pursue them.\u003c/p>\n\u003cp>With medical schools grading pass-fail, the Step 1 score is an increasingly significant piece of information that’s used to sort through residency applications, Hueppchen said. When she took the exam, it was only used as a pass-fail test. Today, residency programs rely on the score more heavily; students and faculty suspect that it’s used as a cutoff for making admissions decisions.\u003c/p>\n\u003cp>Ryan Carlson, a third-year M.D.-Ph.D. student at the University of Washington, said that his school focused on teaching “what they thought was important for a physician to know.” But medical students have to know more than what is relevant to a practicing clinician to succeed on Step. The exam focuses on rare diseases and other minutiae, said Carlson, who now tutors for the test.\u003c/p>\n\u003cp>Hueppchen acknowledged that students at Hopkins and elsewhere “express some distrust that they’re getting everything they need — or that we’re being meticulous in pointing out what they need — to study for and excel on the Step 1 exam.”\u003c/p>\n\u003cp>\u003cstrong>Medical Tour Guides\u003c/strong>\u003c/p>\n\u003cp>That distrust has spawned a cottage industry of online study aids. Most are a far cry from your high school SAT prep course.\u003c/p>\n\u003cp>\u003ca href=\"https://www.sketchymedical.com/#!/home\" target=\"_blank\" rel=\"noopener\">SketchyMedical\u003c/a> is one of the most popular guides. The company, built in 2013 by three then-medical students at the University of California, Irvine, produces visual memory aids with elaborate illustrations to help students learn and retain the voluminous material they’re expected to know.\u003c/p>\n\u003cp>Dr. Andrew Berg and his co-founders, Drs. Saud Siddiqui and Bryan Lemieux, started sketching pictures and pairing them with stories while taking microbiology in their second year of medical school.\u003c/p>\n\u003cp>“We were just bombarded with different names of bacteria, viruses, and fungi, and we were having a tough time keeping them all straight,” he said.'\u003c/p>\n\u003cp>The sketches helped them, and now other students are using them, too.\u003c/p>\n\u003cp>Imagine it’s test day and a med student is asked which drug she would use to treat a patient’s postoperative gastrointestinal blockage. The student closes her eyes and mentally enters the world of “Acetyl-Cola,” a bustling port town that’s depicted in one of SketchyMedical’s cartoons. Outside a storefront, the student finds construction workers, motorcyclists wearing brain-shaped helmets, piles of dripping-wet fish, and a man sporting an adrenal gland-shaped beanie.\u003c/p>\n\u003cp>A colon-shaped mixing truck pouring out cement is an unfortunate, but effective, symbol for defecation, and a worker wearing a name tag reading “Beth” and drinking a cola reminds the student of the drug bethanechol, given to treat intestinal obstructions.\u003c/p>\n\u003cp>The illustrations are turned into narrated videos, which teach drug names and their mechanisms and side effects. SketchyMedical has also produced videos on microbiology and pathology.\u003c/p>\n\u003cp>\u003ca href=\"https://www.youtube.com/watch?v=8Dv3zZbDvig\" target=\"_blank\" rel=\"noopener\">Berg compares\u003c/a> the work of Sketchy to hieroglyphics in ancient Egypt. But for many, Sketchy evokes a different technique used a thousand years later in ancient Greece: method of loci, also called a memory palace or journey.\u003c/p>\n\u003cp>Memory palaces are typically imagined spaces in which a person can store information like a string of numbers or a series of words. Each piece of information is placed somewhere inside the palace. When the palace builder wants to recall an item, she can take a mental stroll through the space to retrieve it. This technique famously enabled Cicero, the Roman statesman and philosopher, to commit his speeches to memory.\u003c/p>\n\u003cp>“We accidentally stumbled upon these visual learning techniques, but now looking back we see there’s a lot of evidence supporting visual learning,” Berg said.\u003c/p>\n\u003cp>SketchyMedical is not the only extracurricular resource students rely on. An entire industry cropped up in the last few years, marketing videos and self-quizzing features to preclinical students. Dr. Jason Ryan, the creator of Boards and Beyond, is a name (and voice) familiar to medical students across the country.\u003c/p>\n\u003cp>Ryan, a faculty member at University of Connecticut School of Medicine, creates explanatory videos that track along with the content in First Aid, a Step preparatory book that Ryan said is more like “an encyclopedia of terms” than a real study aid. Ask any medical student if they use First Aid, and they’ll point you to their heavily annotated, tattered copy.\u003c/p>\n\u003cp>While both Ryan and Berg consider their products supplements to regular medical education, many students view them as necessary investments for success. Choosing which ones to use can be a challenge, however.\u003c/p>\n\u003cp>“That was the biggest learning curve of med school — it wasn’t so much how do I do well in it, it was, how do I use all these crazy resources that are being marketed to me to best meet my goal of passing Step,” Carlson said.\u003c/p>\n\u003cp>\u003cstrong>Old Players React\u003c/strong>\u003c/p>\n\u003cp>This expanding corner of the medical education industry is both a product of a new attitude among students — born from anxiety surrounding exam prep — and a disrupter of the traditional classroom education. Med schools now have to think more creatively about how they train their future doctors, Berg said.\u003c/p>\n\u003cp>In 2015, Harvard Medical School revamped its curriculum for the first two years to enable clinical exposure and boost class attendance with a flipped-classroom model: Students learn the content at home, and then apply it during in-class exercises. Dr. Richard Schwartzstein, director of education scholarship, said the program now emphasizes problem-solving and critical thinking — skills seen as essential to practicing medicine — instead of factual recall.\u003c/p>\n\u003cp>But while medical schools are de-emphasizing pure memorization, the national licensing exams have yet to reconsider, he acknowledged. Still, Schwartzstein is not a huge fan of external resources, citing their focus on memorization and pattern recognition as major weaknesses.\u003c/p>\n\u003cp>“You don’t have to actually teach pattern recognition,” he said. “We all are born with the capability of recognizing pattern.” He advises students to stick to Harvard-developed videos and their recommended readings. Like many medical schools, Harvard gives students a dedicated study period — six to eight weeks without coursework — to “prepare in whatever way they deem most appropriate to take the boards,” he said.\u003c/p>\n\u003cp>Hueppchen said that the outside resources “may have value in day-to-day studying, they may have value in studying for Step 1,” but Hopkins has not vetted them so it doesn’t recommend them to students either.\u003c/p>\n\u003cp>The National Board of Medical Examiners, which works with state medical boards to set the minimum standards for medical licensing and administers the Step exam, also doesn’t endorse these products — or their use as hard lines for residency admissions, said Dr. Michael Barone, vice president of licensure programs. The group “is aware of some secondary uses of scores,” he said, but the test’s primary purpose is to report licensure alone.\u003c/p>\n\u003cp>So long as Step still requires intensive rote memorization, companies like SketchyMedical and Boards and Beyond will likely remain in business.\u003c/p>\n\u003cp>Both Berg and Ryan agree that physicians no longer need to memorize as much as they did in the past. Ryan’s grandmother was one of the first female physicians to graduate from her medical school in the 1940s. Back then, he said, she had to remember everything. “If she had to go to a book every time she saw a patient, she’d never be able to work through the day.”\u003c/p>\n\u003cp>Today, there’s much more to know, and medicine is evolving so rapidly — with new drugs, guidelines, and practices — that physicians can’t possibly remember it all. Instead, they look information up on their cellphones, using a variety of apps on the clinic floors. But preclinical students still need to commit board-tested material to memory, a task often compared to drinking from a firehose.\u003c/p>\n\u003cp>Needing to memorize for boards and learn in parallel for their institutions is the breeding ground for anxiety that Hueppchen said “has truly detracted from the joy of learning.” It has even detracted from the joy of teaching, she added.\u003c/p>\n\u003cp>Berg said he tries to bring joy to memorization: “I think that what I hope to contribute the most is making studying more fun.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This\u003ca href=\"https://www.statnews.com/2018/08/14/medical-students-skipping-class/\" target=\"_blank\" rel=\"noopener\"> story\u003c/a> was originally published by STAT, an online publication of Boston Globe Media that covers health, medicine, and scientific discovery.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The future doctors of America cut class. Not to gossip in the bathroom or flirt behind the bleachers. They skip to learn — at twice the speed.\u003c/p>\n\u003cp class=\"danger-zone\">Some medical students follow along with class remotely, watching sped-up recordings of their professors at home, in their pajamas. Others rarely tune in. At one school, attendance is so bad that a Nobel laureate recently lectured to mostly empty seats.\u003c/p>\n\u003cp class=\"danger-zone\">Nationally, nearly one-quarter of second-year medical students \u003ca href=\"https://www.aamc.org/download/488336/data/y2q2017report.pdf\" target=\"_blank\" rel=\"noopener\">reported\u003c/a> last year that they “almost never” attended class during their first two, preclinical years, a 5 percent increase from 2015.\u003c/p>\n\u003cp>The AWOL students highlight increasing dissatisfaction and anxiety that there’s a mismatch between what they’re taught in class during those years and what they’re expected to know — or how they’re tested — on national licensing exams. Despite paying nearly \u003ca href=\"https://www.aamc.org/data/tuitionandstudentfees/\" target=\"_blank\" rel=\"noopener\">$60,000 a year\u003c/a> in tuition, medical students are turning to unsanctioned online resources to prepare for Step 1, the make-or-break test typically taken at the end of the preclinical years.\u003c/p>\n\u003cp>These self-guided med students are akin to a group of American tourists wandering through Tokyo without a map. Like a tour guide hired on the street, the online learning tools — including memory aids, videos, and online quizzes — can enhance the educational journey, or send the students down a dead end.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Lawrence Wang, a third-year M.D.-Ph.D. student at the University of California, San Diego, and the National Institutes of Health, said he relied heavily on these resources during his first two years of medical school.\u003c/p>\n\u003cp>“There were times that I didn’t go to a single class, and then I’d get to the actual exam and it would be my first time seeing the professor,” he said. “Especially, when Step was coming up, I pretty much completely focused on studying outside materials.”\u003c/p>\n\u003cp>Wang isn’t alone. According to 2017 data from the Association for American Medical Colleges, 1 in 4 preclinical students watches educational videos — like those on YouTube — on a daily basis. And according to two video developers, tens of thousands of medical students subscribe to their products — one of which costs $250 for two years, the other $370 for one year.\u003c/p>\n\u003cp>Leaders in medical education have begun to scramble. Some medical schools, like Harvard, have done away with lectures for the most part. Instead of spending hours in an auditorium, Harvard students learn the course content at home and then apply the knowledge in mandatory small group sessions.\u003c/p>\n\u003cp>Other institutions, like Johns Hopkins, are moving in the same direction, but have yet to make a full switch. Hopkins cut down on lectures and boosted sessions that require active student participation. Preclinical lecture attendance hovers around 30 to 40 percent, according to Dr. Nancy Hueppchen, associate dean for curriculum.\u003c/p>\n\u003cp>For many students, she said, licensing exam prep begins on day one of medical school: “They have this parallel curriculum going along with what we’re teaching them.”\u003c/p>\n\u003cp>Step 1, an eight-hour multiple choice test, is a big deal. Performance on the exam, though it’s taken before most students even begin training in a hospital, heavily influences which medical specialties they can eventually pursue after school and at what hospitals they can pursue them.\u003c/p>\n\u003cp>With medical schools grading pass-fail, the Step 1 score is an increasingly significant piece of information that’s used to sort through residency applications, Hueppchen said. When she took the exam, it was only used as a pass-fail test. Today, residency programs rely on the score more heavily; students and faculty suspect that it’s used as a cutoff for making admissions decisions.\u003c/p>\n\u003cp>Ryan Carlson, a third-year M.D.-Ph.D. student at the University of Washington, said that his school focused on teaching “what they thought was important for a physician to know.” But medical students have to know more than what is relevant to a practicing clinician to succeed on Step. The exam focuses on rare diseases and other minutiae, said Carlson, who now tutors for the test.\u003c/p>\n\u003cp>Hueppchen acknowledged that students at Hopkins and elsewhere “express some distrust that they’re getting everything they need — or that we’re being meticulous in pointing out what they need — to study for and excel on the Step 1 exam.”\u003c/p>\n\u003cp>\u003cstrong>Medical Tour Guides\u003c/strong>\u003c/p>\n\u003cp>That distrust has spawned a cottage industry of online study aids. Most are a far cry from your high school SAT prep course.\u003c/p>\n\u003cp>\u003ca href=\"https://www.sketchymedical.com/#!/home\" target=\"_blank\" rel=\"noopener\">SketchyMedical\u003c/a> is one of the most popular guides. The company, built in 2013 by three then-medical students at the University of California, Irvine, produces visual memory aids with elaborate illustrations to help students learn and retain the voluminous material they’re expected to know.\u003c/p>\n\u003cp>Dr. Andrew Berg and his co-founders, Drs. Saud Siddiqui and Bryan Lemieux, started sketching pictures and pairing them with stories while taking microbiology in their second year of medical school.\u003c/p>\n\u003cp>“We were just bombarded with different names of bacteria, viruses, and fungi, and we were having a tough time keeping them all straight,” he said.'\u003c/p>\n\u003cp>The sketches helped them, and now other students are using them, too.\u003c/p>\n\u003cp>Imagine it’s test day and a med student is asked which drug she would use to treat a patient’s postoperative gastrointestinal blockage. The student closes her eyes and mentally enters the world of “Acetyl-Cola,” a bustling port town that’s depicted in one of SketchyMedical’s cartoons. Outside a storefront, the student finds construction workers, motorcyclists wearing brain-shaped helmets, piles of dripping-wet fish, and a man sporting an adrenal gland-shaped beanie.\u003c/p>\n\u003cp>A colon-shaped mixing truck pouring out cement is an unfortunate, but effective, symbol for defecation, and a worker wearing a name tag reading “Beth” and drinking a cola reminds the student of the drug bethanechol, given to treat intestinal obstructions.\u003c/p>\n\u003cp>The illustrations are turned into narrated videos, which teach drug names and their mechanisms and side effects. SketchyMedical has also produced videos on microbiology and pathology.\u003c/p>\n\u003cp>\u003ca href=\"https://www.youtube.com/watch?v=8Dv3zZbDvig\" target=\"_blank\" rel=\"noopener\">Berg compares\u003c/a> the work of Sketchy to hieroglyphics in ancient Egypt. But for many, Sketchy evokes a different technique used a thousand years later in ancient Greece: method of loci, also called a memory palace or journey.\u003c/p>\n\u003cp>Memory palaces are typically imagined spaces in which a person can store information like a string of numbers or a series of words. Each piece of information is placed somewhere inside the palace. When the palace builder wants to recall an item, she can take a mental stroll through the space to retrieve it. This technique famously enabled Cicero, the Roman statesman and philosopher, to commit his speeches to memory.\u003c/p>\n\u003cp>“We accidentally stumbled upon these visual learning techniques, but now looking back we see there’s a lot of evidence supporting visual learning,” Berg said.\u003c/p>\n\u003cp>SketchyMedical is not the only extracurricular resource students rely on. An entire industry cropped up in the last few years, marketing videos and self-quizzing features to preclinical students. Dr. Jason Ryan, the creator of Boards and Beyond, is a name (and voice) familiar to medical students across the country.\u003c/p>\n\u003cp>Ryan, a faculty member at University of Connecticut School of Medicine, creates explanatory videos that track along with the content in First Aid, a Step preparatory book that Ryan said is more like “an encyclopedia of terms” than a real study aid. Ask any medical student if they use First Aid, and they’ll point you to their heavily annotated, tattered copy.\u003c/p>\n\u003cp>While both Ryan and Berg consider their products supplements to regular medical education, many students view them as necessary investments for success. Choosing which ones to use can be a challenge, however.\u003c/p>\n\u003cp>“That was the biggest learning curve of med school — it wasn’t so much how do I do well in it, it was, how do I use all these crazy resources that are being marketed to me to best meet my goal of passing Step,” Carlson said.\u003c/p>\n\u003cp>\u003cstrong>Old Players React\u003c/strong>\u003c/p>\n\u003cp>This expanding corner of the medical education industry is both a product of a new attitude among students — born from anxiety surrounding exam prep — and a disrupter of the traditional classroom education. Med schools now have to think more creatively about how they train their future doctors, Berg said.\u003c/p>\n\u003cp>In 2015, Harvard Medical School revamped its curriculum for the first two years to enable clinical exposure and boost class attendance with a flipped-classroom model: Students learn the content at home, and then apply it during in-class exercises. Dr. Richard Schwartzstein, director of education scholarship, said the program now emphasizes problem-solving and critical thinking — skills seen as essential to practicing medicine — instead of factual recall.\u003c/p>\n\u003cp>But while medical schools are de-emphasizing pure memorization, the national licensing exams have yet to reconsider, he acknowledged. Still, Schwartzstein is not a huge fan of external resources, citing their focus on memorization and pattern recognition as major weaknesses.\u003c/p>\n\u003cp>“You don’t have to actually teach pattern recognition,” he said. “We all are born with the capability of recognizing pattern.” He advises students to stick to Harvard-developed videos and their recommended readings. Like many medical schools, Harvard gives students a dedicated study period — six to eight weeks without coursework — to “prepare in whatever way they deem most appropriate to take the boards,” he said.\u003c/p>\n\u003cp>Hueppchen said that the outside resources “may have value in day-to-day studying, they may have value in studying for Step 1,” but Hopkins has not vetted them so it doesn’t recommend them to students either.\u003c/p>\n\u003cp>The National Board of Medical Examiners, which works with state medical boards to set the minimum standards for medical licensing and administers the Step exam, also doesn’t endorse these products — or their use as hard lines for residency admissions, said Dr. Michael Barone, vice president of licensure programs. The group “is aware of some secondary uses of scores,” he said, but the test’s primary purpose is to report licensure alone.\u003c/p>\n\u003cp>So long as Step still requires intensive rote memorization, companies like SketchyMedical and Boards and Beyond will likely remain in business.\u003c/p>\n\u003cp>Both Berg and Ryan agree that physicians no longer need to memorize as much as they did in the past. Ryan’s grandmother was one of the first female physicians to graduate from her medical school in the 1940s. Back then, he said, she had to remember everything. “If she had to go to a book every time she saw a patient, she’d never be able to work through the day.”\u003c/p>\n\u003cp>Today, there’s much more to know, and medicine is evolving so rapidly — with new drugs, guidelines, and practices — that physicians can’t possibly remember it all. Instead, they look information up on their cellphones, using a variety of apps on the clinic floors. But preclinical students still need to commit board-tested material to memory, a task often compared to drinking from a firehose.\u003c/p>\n\u003cp>Needing to memorize for boards and learn in parallel for their institutions is the breeding ground for anxiety that Hueppchen said “has truly detracted from the joy of learning.” It has even detracted from the joy of teaching, she added.\u003c/p>\n\u003cp>Berg said he tries to bring joy to memorization: “I think that what I hope to contribute the most is making studying more fun.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>Teens are no more sexually promiscuous in states that have passed legislation promoting the HPV vaccine than those living in states that have not, according to a newly published study.\u003c/p>\n\u003cp>\u003cspan style=\"color: #000000\">The study, released in the journal Pediatrics, compared the District of Columbia and 23 U.S. states that passed legislation to promote the vaccine for human papillomavirus (HPV) with states with no such policies. Researchers then analyzed the results of a \u003ca style=\"color: #000000\" href=\"https://www.cdc.gov/healthyyouth/data/yrbs/pdf/2017/ss6708.pdf\" target=\"_blank\" rel=\"noopener\">multi-year survey\u003c/a> conducted by the Centers for Disease Control and Prevention to determine whether teens living in states with pro-HPV vaccine policies had more sex. They didn’t, the study concluded.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"color: #000000\">“Concern that legislation will increase risky adolescent sexual behaviors should not be used when deciding to pass HPV legislation,” the study said.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"color: #000000\">In states that promoted vaccines, these policies ranged from in-school awareness programs to incentivizing insurance companies to cover the vaccine’s cost, said Erin Cook, the study’s primary author who led this research as part of her doctoral dissertation in epidemiology at the Harvard T.H. Chan School of Public Health.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"color: #000000\">“The big takeaway is that passage of legislation regarding HPV didn’t seem to be associated with any changes in adolescent sexual behaviors in the sample of states we were able to look at,” Cook said.\u003c/span>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cspan style=\"color: #000000\">The study did not examine how well these policies were implemented but simply used the mere presence or absence of such legislation as an indicator of a state’s political will to act on HPV vaccine, cancer prevention and public health, she cautioned.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"color: #000000\">According to the CDC, some 79 million Americans have HPV; it’s the most common sexually transmitted infection in the U.S., this latest study says. Another 14 million people are infected with HPV each year, the CDC says, many of them in their teens and early 20s. Cervical cancer cases \u003ca style=\"color: #000000\" href=\"https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)31206-5/fulltext\" target=\"_blank\" rel=\"noopener\">almost always link\u003c/a> back to the human papillomavirus, according to the Lancet.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"color: #000000\">The U.S. approved use of the three-dose HPV vaccine for girls in 2006 and for boys in 2011. By 2014, just a third of U.S. girls — 37 percent — and 13 percent of American boys had completed the vaccination course. By 2016, nearly half of U.S. girls were vaccinated.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"color: #000000\">Still, half of U.S. states have not implemented policies to promote the vaccine, which scientific research shows can effectively \u003ca style=\"color: #000000\" href=\"https://www.cdc.gov/vaccines/parents/diseases/teen/hpv.html\" target=\"_blank\" rel=\"noopener\">prevent cancers caused by HPV infection\u003c/a>, according to the CDC.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"color: #000000\">These findings are not new, despite persistent attitudes that the HPV vaccine could encourage sexual promiscuity. In 2015, JAMA published a Harvard Medical School study that showed \u003ca style=\"color: #000000\" href=\"https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2109856\" target=\"_blank\" rel=\"noopener\">no link between the vaccine\u003c/a>and a change in teen sexual behavior.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"color: #000000\">In 2007, Gary Freed, a pediatrician and professor at the University of Michigan, chaired the National Vaccine Advisory Council, and told \u003ca style=\"color: #000000\" href=\"http://www.pbs.org/now/shows/308/hpv-vaccine.html\" target=\"_blank\" rel=\"noopener\">Now on PBS\u003c/a>: “If we have the ability to prevent any cancer deaths, much less a significant number of cancer deaths that affect a segment of our population that historically have not been necessarily as well served as they could have been, then I think it’s incumbent upon society to make sure that we’re able to prevent these cancers.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"color: #000000\">Freed said this latest study reinforces the idea that teens are not deciding whether to have sex based on the threat of receiving an HPV infection. This is partly because so few people have heard of HPV, and because “adolescents think in the here and now, not 40 years from now.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"color: #000000\">“We as a society need to decide how much we want to prevent cervical cancer for the children of today,” Freed said. “That’s really what this is all about. We can make pap smears a thing of the past.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"color: #000000\">The U.S. is not alone in its sluggish implementation of a vaccine that can prevent illness and death as a result of cervical cancer. In 2016, \u003ca style=\"color: #000000\" href=\"https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(16)30099-7/fulltext?code=lancet-site\" target=\"_blank\" rel=\"noopener\">a study published in the Lancet\u003c/a> reported that out of 64 nations and 12 territories, only 47 million women finished the three-dose HPV vaccine course. Most of those women lived in high-income or upper middle income countries, the study said.\u003c/span>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cspan style=\"color: #000000\">“Access to HPV vaccination in low-income and lower-middle-income countries is almost non-existent, despite these countries carrying most of the burden of cervical cancer cases worldwide,” the report said.\u003c/span>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Teens are no more sexually promiscuous in states that have passed legislation promoting the HPV vaccine than those living in states that have not, according to a newly published study.\u003c/p>\n\u003cp>\u003cspan style=\"color: #000000\">The study, released in the journal Pediatrics, compared the District of Columbia and 23 U.S. states that passed legislation to promote the vaccine for human papillomavirus (HPV) with states with no such policies. Researchers then analyzed the results of a \u003ca style=\"color: #000000\" href=\"https://www.cdc.gov/healthyyouth/data/yrbs/pdf/2017/ss6708.pdf\" target=\"_blank\" rel=\"noopener\">multi-year survey\u003c/a> conducted by the Centers for Disease Control and Prevention to determine whether teens living in states with pro-HPV vaccine policies had more sex. They didn’t, the study concluded.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"color: #000000\">“Concern that legislation will increase risky adolescent sexual behaviors should not be used when deciding to pass HPV legislation,” the study said.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"color: #000000\">In states that promoted vaccines, these policies ranged from in-school awareness programs to incentivizing insurance companies to cover the vaccine’s cost, said Erin Cook, the study’s primary author who led this research as part of her doctoral dissertation in epidemiology at the Harvard T.H. Chan School of Public Health.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"color: #000000\">“The big takeaway is that passage of legislation regarding HPV didn’t seem to be associated with any changes in adolescent sexual behaviors in the sample of states we were able to look at,” Cook said.\u003c/span>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cspan style=\"color: #000000\">The study did not examine how well these policies were implemented but simply used the mere presence or absence of such legislation as an indicator of a state’s political will to act on HPV vaccine, cancer prevention and public health, she cautioned.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"color: #000000\">According to the CDC, some 79 million Americans have HPV; it’s the most common sexually transmitted infection in the U.S., this latest study says. Another 14 million people are infected with HPV each year, the CDC says, many of them in their teens and early 20s. Cervical cancer cases \u003ca style=\"color: #000000\" href=\"https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)31206-5/fulltext\" target=\"_blank\" rel=\"noopener\">almost always link\u003c/a> back to the human papillomavirus, according to the Lancet.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"color: #000000\">The U.S. approved use of the three-dose HPV vaccine for girls in 2006 and for boys in 2011. By 2014, just a third of U.S. girls — 37 percent — and 13 percent of American boys had completed the vaccination course. By 2016, nearly half of U.S. girls were vaccinated.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"color: #000000\">Still, half of U.S. states have not implemented policies to promote the vaccine, which scientific research shows can effectively \u003ca style=\"color: #000000\" href=\"https://www.cdc.gov/vaccines/parents/diseases/teen/hpv.html\" target=\"_blank\" rel=\"noopener\">prevent cancers caused by HPV infection\u003c/a>, according to the CDC.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"color: #000000\">These findings are not new, despite persistent attitudes that the HPV vaccine could encourage sexual promiscuity. In 2015, JAMA published a Harvard Medical School study that showed \u003ca style=\"color: #000000\" href=\"https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2109856\" target=\"_blank\" rel=\"noopener\">no link between the vaccine\u003c/a>and a change in teen sexual behavior.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"color: #000000\">In 2007, Gary Freed, a pediatrician and professor at the University of Michigan, chaired the National Vaccine Advisory Council, and told \u003ca style=\"color: #000000\" href=\"http://www.pbs.org/now/shows/308/hpv-vaccine.html\" target=\"_blank\" rel=\"noopener\">Now on PBS\u003c/a>: “If we have the ability to prevent any cancer deaths, much less a significant number of cancer deaths that affect a segment of our population that historically have not been necessarily as well served as they could have been, then I think it’s incumbent upon society to make sure that we’re able to prevent these cancers.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"color: #000000\">Freed said this latest study reinforces the idea that teens are not deciding whether to have sex based on the threat of receiving an HPV infection. This is partly because so few people have heard of HPV, and because “adolescents think in the here and now, not 40 years from now.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"color: #000000\">“We as a society need to decide how much we want to prevent cervical cancer for the children of today,” Freed said. “That’s really what this is all about. We can make pap smears a thing of the past.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"color: #000000\">The U.S. is not alone in its sluggish implementation of a vaccine that can prevent illness and death as a result of cervical cancer. In 2016, \u003ca style=\"color: #000000\" href=\"https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(16)30099-7/fulltext?code=lancet-site\" target=\"_blank\" rel=\"noopener\">a study published in the Lancet\u003c/a> reported that out of 64 nations and 12 territories, only 47 million women finished the three-dose HPV vaccine course. Most of those women lived in high-income or upper middle income countries, the study said.\u003c/span>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cspan style=\"color: #000000\">“Access to HPV vaccination in low-income and lower-middle-income countries is almost non-existent, despite these countries carrying most of the burden of cervical cancer cases worldwide,” the report said.\u003c/span>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Families Choose Empathy Over 'Tough Love' To Rescue Loved Ones From Opioids",
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"content": "\u003cp>It was Bea Duncan who answered the phone at 2 a.m. on a January morning. Her son Jeff had been caught using drugs in a New Hampshire sober home and was being kicked out.[contextly_sidebar id=\"0ueKts5XFYp7vq9GJWLyDaZMcqJC2m7p\"]\u003c/p>\n\u003cp>Bea and her husband, Doug Duncan, drove north that night nine years ago to pick Jeff up. On the ride back home, to Natick, Mass., the parents delivered an ultimatum: Their son had to go back to rehab, or leave home.\u003c/p>\n\u003cp>Jeff chose the latter, Bea says. She remembers a lot of yelling, cursing and tears as they stopped the car, in the dead of night, a few miles from the house.\u003c/p>\n\u003cp>\"It was really, really difficult to actually just drop him off in a parking lot on our way home and say, 'you made the decision — no rehab — so we made the decision, no home,' \" Bea says. \"It was exquisitely difficult.\"\u003c/p>\n\u003cp>Doug Duncan says many parents had told him to expect this moment. He remembers them saying, your son will have to \"hit rock bottom; you're going to have to kick him out of the house.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Two torturous days later, Jeff Duncan came home. Although he returned to rehab, the Duncans decided their approach wasn't working. They sought help, eventually \u003ca href=\"http://www.apa.org/pi/about/publications/caregivers/practice-settings/intervention/community-reinforcement.aspx\" target=\"_blank\" rel=\"noopener\">connecting with a program\u003c/a> that, instead of tough love, stresses empathy: CRAFT or Community Reinforcement and Family Training.\u003c/p>\n\u003cp>\"There was more compassion and, 'Wow, this is really difficult for you;' more open questions to him instead of dictating what he should and should not behave like,\" says Bea.\u003c/p>\n\u003cp>Many drug users say, in hindsight, they've appreciated being forced into treatment. But studies show that a \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4394369/\" target=\"_blank\" rel=\"noopener\">compassionate approach\u003c/a> and \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4752879/\">voluntary treatment\u003c/a> are the more effective ways to engage drug users in recovery and keep them alive. That's a critical consideration for families \u003ca href=\"https://www.npr.org/sections/health-shots/2018/03/29/597717402/fentanyl-laced-cocaine-becoming-a-deadly-problem-among-drug-users\" target=\"_blank\" rel=\"noopener\">in this era of fentanyl\u003c/a>, a powerful opioid that can shut down breathing in seconds.[contextly_sidebar id=\"fB1AY6AFnWUf8d4yEfB8hxxzkt7SQlns\"]\u003c/p>\n\u003cp>\"The concept of letting their children hit bottom is not the best strategy,\" says Nora Volkow, director of the National Institute on Drug Abuse. \"Because in hitting bottom they may die.\"\u003c/p>\n\u003cp>After they went through CRAFT training, the Duncans say things started to shift from chaos to calm.\u003c/p>\n\u003cp>\"I started to feel an immense sense of relief,\" Bea says. \"I stopped feeling like I had to be a private investigator and controlling mom. I could kind of walk side-by-side with him on this journey, instead of feeling like I had to take charge of it.\"\u003c/p>\n\u003cp>For the Duncans, the approach meant they could switch from enforcing family consequences, like kicking Jeff out of the house, to supporting him as he faced other challenges, like losing a job because of his drug use.\u003c/p>\n\u003cp>It worked well: Bea and Doug helped Jeff stick to his recovery. He's 28 now and has been sober for nine years.\u003c/p>\n\u003cp>But desperate parents often don't know how to avoid \"hitting bottom\" with their children, as the Duncans did on that dark and frigid January morning.\u003c/p>\n\u003cp>The Duncans have found ways to help others: Doug is a \u003ca href=\"https://drugfree.org/article/parent-coaches/\" target=\"_blank\" rel=\"noopener\">parent coach\u003c/a> through the Partnership for Drug-Free Kids, which is now collaborating with the \u003ca href=\"https://graykenaddictionsupport.org/\" target=\"_blank\" rel=\"noopener\">Grayken Center for Addiction\u003c/a> at Boston Medical Center.\u003c/p>\n\u003cp>The collaboration will close a gap in services for families caught up in the opioid epidemic, says Grayken Center's director, Michael Botticelli, who served as drug czar in the Obama administration.\u003c/p>\n\u003cp>\"They don't call this a family disease for no good reason,\" Botticelli says. \"The whole design of these services [is] to promote tools and information for families, so they know how to approach a situation and can heal.\"\u003c/p>\n\u003cp>There is no uniform path to healing for the drug user or parents, and no widespread agreement on the best approach for families.\u003c/p>\n\u003cp>Joanne Peterson, who founded the parent support network \u003ca href=\"https://www.learn2cope.org/\" target=\"_blank\" rel=\"noopener\">Learn to Cope\u003c/a>, says there are reasons why some parents ask older children to leave the house — if there are younger children at home or if the parents don't feel safe.\u003c/p>\n\u003cp>\"So it depends on what 'tough love' means; it can mean many different things,\" Peterson says.\u003c/p>\n\u003cp>She applauds the Grayken Center for expanding access to parent coaches, but \"we also need more professional help.\" Peterson says she routinely hears from parents who can't find counselors and doctors who understand their daily traumas.\u003c/p>\n\u003cp>Some critics suggest the CRAFT model is too soft, that it enables drug use.\u003c/p>\n\u003cp>\"That's a misconception,\" says \u003ca href=\"https://drugfree.org/newsroom/news-item/fred-muench-named-president-and-ceo-of-partnership-for-drug-free-kids/\" target=\"_blank\" rel=\"noopener\">Fred Muench\u003c/a>, president of the Partnership for Drug-Free Kids. \"CRAFT is authoritative parenting, creating a sense of responsibility in the child, and at the same time saying, 'I am here for you; I love you; I'm going to help you; but I can't help you avoid negative consequences if you're not looking to do that on your own.' \"\u003c/p>\n\u003cp>The parent coaching extends beyond periods of crisis.\u003c/p>\n\u003cp>On a recent afternoon, Doug Duncan was on the phone with Doreen, a mom whose daughter is in recovery. (We're using only Doreen's first name to protect her daughter's privacy.) Doreen was upset about an angry text from her daughter that sounded like the messages the young woman sent when she was using drugs.\u003c/p>\n\u003cp>\"It brings me back there. In two seconds, I am back on that scene thinking she's on the heroin, she's not going to live,\" Doreen told Duncan, expressing a very common fear of a loved one's relapse.\u003c/p>\n\u003cp>In a panic — her daughter had overdosed twice and been rescued — Doreen wanted to ask if she was using heroin again. But she ran it by Duncan first. He encouraged her to talk it through.\u003c/p>\n\u003cp>Doreen paused, then said she could ask her daughter about work — whether it's been stressful — or about her grief after a friend's recent death. There are many reasons, Doreen realized, that her daughter might be angry. Her tone didn't have to signal a relapse.\u003c/p>\n\u003cp>\"You talk yourself off the cliff,\" Duncan told her.\u003c/p>\n\u003cp>\"Oh yes, I know all about that cliff, I've visited a few times before,\" Doreen said, and laughed. \"You know, that ties in with what you said before about focusing less on what your feelings are, and the terror or fear that you're going through, and more on what they're feeling and what they're going through — turn the tables a bit. That's an excellent point.\"\u003c/p>\n\u003cp>\"That's true compassion,\" Duncan told her, \"and oddly enough it's very therapeutic for you, too.\"\u003c/p>\n\u003cp>More compassion in the home fits the shift away from criminalizing addiction — toward accepting and treating it as a chronic medical condition.\u003c/p>\n\u003cp>If a child had cancer, parents \"wouldn't disengage with them or be angry with them,\" says Botticelli. \"So I do think it aligns our scientific understanding that addiction is a disease and not a moral failure.\"\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This story is part of NPR's partnership with \u003c/em>\u003ca href=\"https://ww2.kqed.org/futureofyou/2018/08/08/can-an-app-warning-to-avoid-risky-friends-prevent-opioid-relapses/\" target=\"_blank\" rel=\"noopener\">\u003cem>NPR\u003c/em>\u003c/a>\u003cem> and Kaiser Health News.\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 WBUR. To see more, visit \u003ca href=\"http://www.wbur.org\">WBUR\u003c/a>.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Families+Choose+Empathy+Over+%27Tough+Love%27+To+Rescue+Loved+Ones+From+Opioids&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>It was Bea Duncan who answered the phone at 2 a.m. on a January morning. Her son Jeff had been caught using drugs in a New Hampshire sober home and was being kicked out.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Bea and her husband, Doug Duncan, drove north that night nine years ago to pick Jeff up. On the ride back home, to Natick, Mass., the parents delivered an ultimatum: Their son had to go back to rehab, or leave home.\u003c/p>\n\u003cp>Jeff chose the latter, Bea says. She remembers a lot of yelling, cursing and tears as they stopped the car, in the dead of night, a few miles from the house.\u003c/p>\n\u003cp>\"It was really, really difficult to actually just drop him off in a parking lot on our way home and say, 'you made the decision — no rehab — so we made the decision, no home,' \" Bea says. \"It was exquisitely difficult.\"\u003c/p>\n\u003cp>Doug Duncan says many parents had told him to expect this moment. He remembers them saying, your son will have to \"hit rock bottom; you're going to have to kick him out of the house.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Two torturous days later, Jeff Duncan came home. Although he returned to rehab, the Duncans decided their approach wasn't working. They sought help, eventually \u003ca href=\"http://www.apa.org/pi/about/publications/caregivers/practice-settings/intervention/community-reinforcement.aspx\" target=\"_blank\" rel=\"noopener\">connecting with a program\u003c/a> that, instead of tough love, stresses empathy: CRAFT or Community Reinforcement and Family Training.\u003c/p>\n\u003cp>\"There was more compassion and, 'Wow, this is really difficult for you;' more open questions to him instead of dictating what he should and should not behave like,\" says Bea.\u003c/p>\n\u003cp>Many drug users say, in hindsight, they've appreciated being forced into treatment. But studies show that a \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4394369/\" target=\"_blank\" rel=\"noopener\">compassionate approach\u003c/a> and \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4752879/\">voluntary treatment\u003c/a> are the more effective ways to engage drug users in recovery and keep them alive. That's a critical consideration for families \u003ca href=\"https://www.npr.org/sections/health-shots/2018/03/29/597717402/fentanyl-laced-cocaine-becoming-a-deadly-problem-among-drug-users\" target=\"_blank\" rel=\"noopener\">in this era of fentanyl\u003c/a>, a powerful opioid that can shut down breathing in seconds.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\"The concept of letting their children hit bottom is not the best strategy,\" says Nora Volkow, director of the National Institute on Drug Abuse. \"Because in hitting bottom they may die.\"\u003c/p>\n\u003cp>After they went through CRAFT training, the Duncans say things started to shift from chaos to calm.\u003c/p>\n\u003cp>\"I started to feel an immense sense of relief,\" Bea says. \"I stopped feeling like I had to be a private investigator and controlling mom. I could kind of walk side-by-side with him on this journey, instead of feeling like I had to take charge of it.\"\u003c/p>\n\u003cp>For the Duncans, the approach meant they could switch from enforcing family consequences, like kicking Jeff out of the house, to supporting him as he faced other challenges, like losing a job because of his drug use.\u003c/p>\n\u003cp>It worked well: Bea and Doug helped Jeff stick to his recovery. He's 28 now and has been sober for nine years.\u003c/p>\n\u003cp>But desperate parents often don't know how to avoid \"hitting bottom\" with their children, as the Duncans did on that dark and frigid January morning.\u003c/p>\n\u003cp>The Duncans have found ways to help others: Doug is a \u003ca href=\"https://drugfree.org/article/parent-coaches/\" target=\"_blank\" rel=\"noopener\">parent coach\u003c/a> through the Partnership for Drug-Free Kids, which is now collaborating with the \u003ca href=\"https://graykenaddictionsupport.org/\" target=\"_blank\" rel=\"noopener\">Grayken Center for Addiction\u003c/a> at Boston Medical Center.\u003c/p>\n\u003cp>The collaboration will close a gap in services for families caught up in the opioid epidemic, says Grayken Center's director, Michael Botticelli, who served as drug czar in the Obama administration.\u003c/p>\n\u003cp>\"They don't call this a family disease for no good reason,\" Botticelli says. \"The whole design of these services [is] to promote tools and information for families, so they know how to approach a situation and can heal.\"\u003c/p>\n\u003cp>There is no uniform path to healing for the drug user or parents, and no widespread agreement on the best approach for families.\u003c/p>\n\u003cp>Joanne Peterson, who founded the parent support network \u003ca href=\"https://www.learn2cope.org/\" target=\"_blank\" rel=\"noopener\">Learn to Cope\u003c/a>, says there are reasons why some parents ask older children to leave the house — if there are younger children at home or if the parents don't feel safe.\u003c/p>\n\u003cp>\"So it depends on what 'tough love' means; it can mean many different things,\" Peterson says.\u003c/p>\n\u003cp>She applauds the Grayken Center for expanding access to parent coaches, but \"we also need more professional help.\" Peterson says she routinely hears from parents who can't find counselors and doctors who understand their daily traumas.\u003c/p>\n\u003cp>Some critics suggest the CRAFT model is too soft, that it enables drug use.\u003c/p>\n\u003cp>\"That's a misconception,\" says \u003ca href=\"https://drugfree.org/newsroom/news-item/fred-muench-named-president-and-ceo-of-partnership-for-drug-free-kids/\" target=\"_blank\" rel=\"noopener\">Fred Muench\u003c/a>, president of the Partnership for Drug-Free Kids. \"CRAFT is authoritative parenting, creating a sense of responsibility in the child, and at the same time saying, 'I am here for you; I love you; I'm going to help you; but I can't help you avoid negative consequences if you're not looking to do that on your own.' \"\u003c/p>\n\u003cp>The parent coaching extends beyond periods of crisis.\u003c/p>\n\u003cp>On a recent afternoon, Doug Duncan was on the phone with Doreen, a mom whose daughter is in recovery. (We're using only Doreen's first name to protect her daughter's privacy.) Doreen was upset about an angry text from her daughter that sounded like the messages the young woman sent when she was using drugs.\u003c/p>\n\u003cp>\"It brings me back there. In two seconds, I am back on that scene thinking she's on the heroin, she's not going to live,\" Doreen told Duncan, expressing a very common fear of a loved one's relapse.\u003c/p>\n\u003cp>In a panic — her daughter had overdosed twice and been rescued — Doreen wanted to ask if she was using heroin again. But she ran it by Duncan first. He encouraged her to talk it through.\u003c/p>\n\u003cp>Doreen paused, then said she could ask her daughter about work — whether it's been stressful — or about her grief after a friend's recent death. There are many reasons, Doreen realized, that her daughter might be angry. Her tone didn't have to signal a relapse.\u003c/p>\n\u003cp>\"You talk yourself off the cliff,\" Duncan told her.\u003c/p>\n\u003cp>\"Oh yes, I know all about that cliff, I've visited a few times before,\" Doreen said, and laughed. \"You know, that ties in with what you said before about focusing less on what your feelings are, and the terror or fear that you're going through, and more on what they're feeling and what they're going through — turn the tables a bit. That's an excellent point.\"\u003c/p>\n\u003cp>\"That's true compassion,\" Duncan told her, \"and oddly enough it's very therapeutic for you, too.\"\u003c/p>\n\u003cp>More compassion in the home fits the shift away from criminalizing addiction — toward accepting and treating it as a chronic medical condition.\u003c/p>\n\u003cp>If a child had cancer, parents \"wouldn't disengage with them or be angry with them,\" says Botticelli. \"So I do think it aligns our scientific understanding that addiction is a disease and not a moral failure.\"\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 is part of NPR's partnership with \u003c/em>\u003ca href=\"https://ww2.kqed.org/futureofyou/2018/08/08/can-an-app-warning-to-avoid-risky-friends-prevent-opioid-relapses/\" target=\"_blank\" rel=\"noopener\">\u003cem>NPR\u003c/em>\u003c/a>\u003cem> and Kaiser Health News.\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 WBUR. To see more, visit \u003ca href=\"http://www.wbur.org\">WBUR\u003c/a>.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Families+Choose+Empathy+Over+%27Tough+Love%27+To+Rescue+Loved+Ones+From+Opioids&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Can an App Warning to Avoid Risky Friends Prevent Opioid Relapses?",
"title": "Can an App Warning to Avoid Risky Friends Prevent Opioid Relapses?",
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"content": "\u003cp>You’re in recovery from opioid addiction, and your walk to work takes you down the same streets where you used to buy heroin. The drug’s calling to you, still. Just then, your phone buzzes, with a message that reads like a text from an old friend:\u003c/p>\n\u003cp>“Hey, I know you’re near a risky area. You can do this.”\u003c/p>\n\u003cp>It’s from Hey,Charlie, an app — conceived at a 2016 Massachusetts Institute of Technology health hackathon — that aims to help people avoid environmental triggers that might threaten their recovery from an opioid addiction. The app, now being piloted by several treatment centers in Boston and Framingham, Mass., monitors a user’s contacts and location, and sends pop-up notifications to caution them about risky acquaintances or neighborhoods.[contextly_sidebar id=\"B6m1pmj1KurktxXVtJVATPZuSNjGkhGD\"]\u003c/p>\n\u003cp>“People and places can remind you of using drugs and stress you out,” leading people to relapse, said Emily Lindemer, co-founder of Hey,Charlie.\u003c/p>\n\u003cp>The app chimes in with a different reminder: recovery. “It helps them keep their sobriety at the front of their mind,” she said.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>There are a sea of addiction apps, many connecting people to treatment or augmenting their outpatient therapy, by counting the number of days in recovery, for example, or recording fluctuations in mood or cravings. Some simply encourage users with inspirational quotes or hypnosis guides. Social apps are increasingly a focus, as well.\u003c/p>\n\u003cp>“Social outlets are critically important,” said Wilson Washington Jr., a senior public health adviser at the federal Substance Abuse and Mental Health Services Administration (SAMHSA). “You need family support, you need community support, you need system support.”\u003c/p>\n\u003cp>One such app, \u003ca href=\"http://www.sobertool.com/about/\" target=\"_blank\" rel=\"noopener\">SoberTool\u003c/a>, offers an anonymous forum for discussion. \u003ca href=\"https://www.sobergrid.com/\" target=\"_blank\" rel=\"noopener\">Sober Grid \u003c/a>is a social network — purported to be the largest for people with a chemical dependency — with a news feed reminiscent of Instagram.\u003c/p>\n\u003cp>But when Lindemer attended the MIT hackathon, she saw a gaping hole among the existing apps — not only could an app foster positive social connections, but it could also help people sever the negative ones.\u003c/p>\n\u003cp>Michael Kidorf, a psychiatrist and associate director of addiction treatment services at Johns Hopkins School of Medicine, told STAT that the social networks of urban drug users tend to include a mix of people who use substances and people who are drug-free.[contextly_sidebar id=\"cwsZEwnwKgEBeLVOmPCSFLGkj8YqHqD4\"]\u003c/p>\n\u003cp>“As you would expect, people who have more network members who use illicit drugs use more drugs [themselves] and engage in more risky behaviors,” he said by email.\u003c/p>\n\u003cp>Opioid users also rely heavily on their contacts to secure heroin and other drugs, Kidorf added. Studies consistently show that regular interaction with other users predicts poorer treatment outcomes.\u003c/p>\n\u003cp>The hard part, he said, is getting people to dismantle and rebuild their social network. “It is relatively easy to tell substance users to ‘change people, places, and things.’ It is much harder to provide a strategy to help them achieve this important goal.”\u003c/p>\n\u003cp>Hey,Charlie is piloting one such strategy.\u003c/p>\n\u003cp>Having watched someone close to her — the namesake for Hey,Charlie — struggle with opioid addiction, Lindemer noticed the obstacles people in recovery face. Even for those who receive \u003ca href=\"https://www.statnews.com/2018/08/06/fda-expands-medication-assisted-treatment/\">medication-assisted treatment\u003c/a>, “you go live your life and in the day-to-day 24/7 doing normal things, you still are in recovery and you still have to battle these constant environmental triggers,” she said.\u003c/p>\n\u003cp>As a then-Ph.D. student in the joint Harvard-MIT Health Sciences and Technology program, Lindemer thought an app could help mediate those urges.\u003c/p>\n\u003cp>Following the hackathon, Lindemer with her co-founder, Vincent Valant, and head developer, Benjamin Pyser, created a company that initially was funded through MIT grants. Now that she has graduated — she has a day job as a scientist at Watson Health in Cambridge, Mass. – the startup is running mostly on funding from the Robert Wood Johnson Foundation and the National Institute on Drug Abuse.\u003c/p>\n\u003cp>Hey,Charlie’s business model is their “Achilles’ heel,” Lindemer said.\u003c/p>\n\u003cp>She wants to ensure that Hey,Charlie is accessible to everybody. “Our goal is that, if we are charging for it, we are not charging the patient. We want it to fit into a treatment program,” which is why the company hopes to eventually demonstrate the app’s clinical efficacy in controlled trials.[contextly_sidebar id=\"dahwcW9QuGAKTVxO8aXeHP8Uk5bpWbni\"]\u003c/p>\n\u003cp>The app is still being refined, but the basics are in place. When sending a text to a “risky” contact, or receiving one, a message from Hey,Charlie will pop up: “Wait a minute, are you sure you want to speak to John Smith right now?” If the user decides against communicating, Hey,Charlie can send an automatic response. The app also shares a handful of affirmative messages with the user throughout the day.\u003c/p>\n\u003cp>For now, Hey,Charlie’s location services simply create a pause (you’re near a risky area). “The idea is that if you are aware of a potentially triggering situation before it arises, you are more mentally primed to handle it effectively,” said Lindemer.\u003c/p>\n\u003cp>But in the future, Lindemer hopes the app can go one step further. She envisions it not only warning people that they’re approaching a risky location, but suggesting an entirely different path as well. Lindemer wants to partner with local businesses so that Hey,Charlie can say, “Hey, there’s a coffee shop with a discount a couple of blocks away if you’re willing to switch up your route!”\u003c/p>\n\u003cp>The app relies on a combination of data actively input by users — a one-time occurrence — and data passively collected as they continue to use their cellphones. The onboarding process asks users a series of questions about their contacts, ranked by frequency of communication, and then calculates the risk each contact poses.\u003c/p>\n\u003cp>Lindemer said that she and her team don’t expect users to be completely upfront and that, especially at the beginning of recovery, relationships can be confusing as they rapidly evolve. Hey,Charlie continues to check in periodically, asking, “Is there anything you want to tell me about this person?”[contextly_sidebar id=\"m4GxEhhH8zjyZ8polANWuf0odOZy5mLJ\"]\u003c/p>\n\u003cp>While the initial version of the app focused on sheltering users from risky contacts, Lindemer and her team are now working to incorporate positive support features as well — letting supportive contacts know when their friend or family member is in a risky place.\u003c/p>\n\u003cp>“One of the things we know really well is that many people in recovery do have somebody — like a really close family member or friend — who wants to help them, and they often just don’t have the tools, and they don’t know when is the right time to reach out, so we’re trying to address that,” Lindemer said.\u003c/p>\n\u003cp>Kidorf stressed the importance of supportive, drug-free contacts. His research focuses on how treatment providers can mobilize drug-free individuals to be active participants in their loved one’s recovery.\u003c/p>\n\u003cp>Hey,Charlie is being piloted at local clinics in and around Boston. Dr. Christopher Shanahan, an internist and professor at Boston University School of Medicine, is leading the effort.\u003c/p>\n\u003cp>Shanahan, who has been studying substance use for nearly 20 years, loved the idea that Hey,Charlie could be there for his patients when he can’t. He said Lindemer pitched it to him and his colleagues during their journal club hour — when researchers typically discuss new papers published in their field.\u003c/p>\n\u003cp>“We have, what, 15 to 20 minutes with a patient in a clinic?” Shanahan said. “We give them some advice, a little bit of coaching, and send them out with some buprenorphine — and then it’s a crapshoot.”\u003c/p>\n\u003cp>The app, he said, is “a very innovative way of addressing the other 23 hours and 15 minutes of the day where doctors aren’t seeing patients.”\u003c/p>\n\u003cp>But he won’t hang his hat on it. An app can help patients cope with triggers and temptations, but it’s far from the perfect solution, he said.\u003c/p>\n\u003cp>Kidorf expressed a similar level-headed optimism, noting that apps can bring users closer to people and organizations that can support their recovery. “Overall, I think it is fair to say that these apps can be helpful for people motivated to use them.”\u003c/p>\n\u003cp>But still, he added, “We have to do better at thinking of opioid use disorder as a severe and often chronic disorder. The best apps in the world will have a hard time competing with it.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This \u003ca href=\"https://www.statnews.com/2018/08/07/can-phone-app-prevent-opioid-addiction-relapses/\" target=\"_blank\" rel=\"noopener\">story\u003c/a> was originally published by STAT, an online publication of Boston Globe Media that covers health, medicine, and scientific discovery.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>You’re in recovery from opioid addiction, and your walk to work takes you down the same streets where you used to buy heroin. The drug’s calling to you, still. Just then, your phone buzzes, with a message that reads like a text from an old friend:\u003c/p>\n\u003cp>“Hey, I know you’re near a risky area. You can do this.”\u003c/p>\n\u003cp>It’s from Hey,Charlie, an app — conceived at a 2016 Massachusetts Institute of Technology health hackathon — that aims to help people avoid environmental triggers that might threaten their recovery from an opioid addiction. The app, now being piloted by several treatment centers in Boston and Framingham, Mass., monitors a user’s contacts and location, and sends pop-up notifications to caution them about risky acquaintances or neighborhoods.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>“People and places can remind you of using drugs and stress you out,” leading people to relapse, said Emily Lindemer, co-founder of Hey,Charlie.\u003c/p>\n\u003cp>The app chimes in with a different reminder: recovery. “It helps them keep their sobriety at the front of their mind,” she said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>There are a sea of addiction apps, many connecting people to treatment or augmenting their outpatient therapy, by counting the number of days in recovery, for example, or recording fluctuations in mood or cravings. Some simply encourage users with inspirational quotes or hypnosis guides. Social apps are increasingly a focus, as well.\u003c/p>\n\u003cp>“Social outlets are critically important,” said Wilson Washington Jr., a senior public health adviser at the federal Substance Abuse and Mental Health Services Administration (SAMHSA). “You need family support, you need community support, you need system support.”\u003c/p>\n\u003cp>One such app, \u003ca href=\"http://www.sobertool.com/about/\" target=\"_blank\" rel=\"noopener\">SoberTool\u003c/a>, offers an anonymous forum for discussion. \u003ca href=\"https://www.sobergrid.com/\" target=\"_blank\" rel=\"noopener\">Sober Grid \u003c/a>is a social network — purported to be the largest for people with a chemical dependency — with a news feed reminiscent of Instagram.\u003c/p>\n\u003cp>But when Lindemer attended the MIT hackathon, she saw a gaping hole among the existing apps — not only could an app foster positive social connections, but it could also help people sever the negative ones.\u003c/p>\n\u003cp>Michael Kidorf, a psychiatrist and associate director of addiction treatment services at Johns Hopkins School of Medicine, told STAT that the social networks of urban drug users tend to include a mix of people who use substances and people who are drug-free.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>“As you would expect, people who have more network members who use illicit drugs use more drugs [themselves] and engage in more risky behaviors,” he said by email.\u003c/p>\n\u003cp>Opioid users also rely heavily on their contacts to secure heroin and other drugs, Kidorf added. Studies consistently show that regular interaction with other users predicts poorer treatment outcomes.\u003c/p>\n\u003cp>The hard part, he said, is getting people to dismantle and rebuild their social network. “It is relatively easy to tell substance users to ‘change people, places, and things.’ It is much harder to provide a strategy to help them achieve this important goal.”\u003c/p>\n\u003cp>Hey,Charlie is piloting one such strategy.\u003c/p>\n\u003cp>Having watched someone close to her — the namesake for Hey,Charlie — struggle with opioid addiction, Lindemer noticed the obstacles people in recovery face. Even for those who receive \u003ca href=\"https://www.statnews.com/2018/08/06/fda-expands-medication-assisted-treatment/\">medication-assisted treatment\u003c/a>, “you go live your life and in the day-to-day 24/7 doing normal things, you still are in recovery and you still have to battle these constant environmental triggers,” she said.\u003c/p>\n\u003cp>As a then-Ph.D. student in the joint Harvard-MIT Health Sciences and Technology program, Lindemer thought an app could help mediate those urges.\u003c/p>\n\u003cp>Following the hackathon, Lindemer with her co-founder, Vincent Valant, and head developer, Benjamin Pyser, created a company that initially was funded through MIT grants. Now that she has graduated — she has a day job as a scientist at Watson Health in Cambridge, Mass. – the startup is running mostly on funding from the Robert Wood Johnson Foundation and the National Institute on Drug Abuse.\u003c/p>\n\u003cp>Hey,Charlie’s business model is their “Achilles’ heel,” Lindemer said.\u003c/p>\n\u003cp>She wants to ensure that Hey,Charlie is accessible to everybody. “Our goal is that, if we are charging for it, we are not charging the patient. We want it to fit into a treatment program,” which is why the company hopes to eventually demonstrate the app’s clinical efficacy in controlled trials.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>The app is still being refined, but the basics are in place. When sending a text to a “risky” contact, or receiving one, a message from Hey,Charlie will pop up: “Wait a minute, are you sure you want to speak to John Smith right now?” If the user decides against communicating, Hey,Charlie can send an automatic response. The app also shares a handful of affirmative messages with the user throughout the day.\u003c/p>\n\u003cp>For now, Hey,Charlie’s location services simply create a pause (you’re near a risky area). “The idea is that if you are aware of a potentially triggering situation before it arises, you are more mentally primed to handle it effectively,” said Lindemer.\u003c/p>\n\u003cp>But in the future, Lindemer hopes the app can go one step further. She envisions it not only warning people that they’re approaching a risky location, but suggesting an entirely different path as well. Lindemer wants to partner with local businesses so that Hey,Charlie can say, “Hey, there’s a coffee shop with a discount a couple of blocks away if you’re willing to switch up your route!”\u003c/p>\n\u003cp>The app relies on a combination of data actively input by users — a one-time occurrence — and data passively collected as they continue to use their cellphones. The onboarding process asks users a series of questions about their contacts, ranked by frequency of communication, and then calculates the risk each contact poses.\u003c/p>\n\u003cp>Lindemer said that she and her team don’t expect users to be completely upfront and that, especially at the beginning of recovery, relationships can be confusing as they rapidly evolve. Hey,Charlie continues to check in periodically, asking, “Is there anything you want to tell me about this person?”\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>While the initial version of the app focused on sheltering users from risky contacts, Lindemer and her team are now working to incorporate positive support features as well — letting supportive contacts know when their friend or family member is in a risky place.\u003c/p>\n\u003cp>“One of the things we know really well is that many people in recovery do have somebody — like a really close family member or friend — who wants to help them, and they often just don’t have the tools, and they don’t know when is the right time to reach out, so we’re trying to address that,” Lindemer said.\u003c/p>\n\u003cp>Kidorf stressed the importance of supportive, drug-free contacts. His research focuses on how treatment providers can mobilize drug-free individuals to be active participants in their loved one’s recovery.\u003c/p>\n\u003cp>Hey,Charlie is being piloted at local clinics in and around Boston. Dr. Christopher Shanahan, an internist and professor at Boston University School of Medicine, is leading the effort.\u003c/p>\n\u003cp>Shanahan, who has been studying substance use for nearly 20 years, loved the idea that Hey,Charlie could be there for his patients when he can’t. He said Lindemer pitched it to him and his colleagues during their journal club hour — when researchers typically discuss new papers published in their field.\u003c/p>\n\u003cp>“We have, what, 15 to 20 minutes with a patient in a clinic?” Shanahan said. “We give them some advice, a little bit of coaching, and send them out with some buprenorphine — and then it’s a crapshoot.”\u003c/p>\n\u003cp>The app, he said, is “a very innovative way of addressing the other 23 hours and 15 minutes of the day where doctors aren’t seeing patients.”\u003c/p>\n\u003cp>But he won’t hang his hat on it. An app can help patients cope with triggers and temptations, but it’s far from the perfect solution, he said.\u003c/p>\n\u003cp>Kidorf expressed a similar level-headed optimism, noting that apps can bring users closer to people and organizations that can support their recovery. “Overall, I think it is fair to say that these apps can be helpful for people motivated to use them.”\u003c/p>\n\u003cp>But still, he added, “We have to do better at thinking of opioid use disorder as a severe and often chronic disorder. The best apps in the world will have a hard time competing with it.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"disqusTitle": "Babies Who Seem Fine At Birth May Have Zika-Related Problems Later, Study Finds",
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"content": "\u003cp>Since Zika emerged as a threat to babies, it has been a mystery exactly how much of a danger the mosquito-borne virus poses to children.[contextly_sidebar id=\"ty8Keov1NUvlIUGsc2aZa8c364gQOzuA\"]\u003c/p>\n\u003cp>But now, the largest study to follow kids who were exposed to the virus in the womb is providing more answers.\u003c/p>\n\u003cp>The study involved 1,450 babies who had been exposed to the virus, and who were 1-year-old by February 2018. Six percent were born with birth defects, and 14 percent developed problems that could be blamed on the virus by the time they turned 1, the study found.\u003c/p>\n\u003cp>\"We're beginning to see the full spectrum of the impact of Zika,\" says \u003ca href=\"https://www.cdc.gov/media/spokesperson/sme-bio/honein.html\" target=\"_blank\" rel=\"noopener\">Margaret Honein\u003c/a>, director of the Division of Congenital and Developmental Disorders at the Centers for Disease Control and Prevention. The \u003ca href=\"https://www.cdc.gov/vitalsigns/\" target=\"_blank\" rel=\"noopener\">CDC released the study Tuesday\u003c/a>\u003cem>.\u003c/em>\u003c/p>\n\u003cp>\"This is really our first look at how these children are doing as they grow and develop, and really emphasizes that the Zika story is not over, particularly for these children,\" Honein says.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003ca href=\"https://www.cdc.gov/zika/index.html\">Zika \u003c/a>triggered an international public health emergency in 2016 when a large outbreak in Brazil revealed that the virus could cause babies to be born with very small heads and severely damaged brains when pregnant women get infected. The condition is called \u003ca href=\"https://www.cdc.gov/ncbddd/birthdefects/microcephaly.html\" target=\"_blank\" rel=\"noopener\">microcephaly\u003c/a>.\u003c/p>\n\u003cp>It slowly has become more apparent that Zika-exposed babies could develop a range of other problems as well, including seizures, damaged vision and developmental disorders.[contextly_sidebar id=\"32OPYd5JdwOY5VRyjI10z7XKAkjzn6RX\"]\u003c/p>\n\u003cp>The \u003ca href=\"https://www.npr.org/sections/health-shots/2017/06/08/532087184/cdc-reveals-sharper-numbers-of-zika-birth-defects-from-u-s-territories\" target=\"_blank\" rel=\"noopener\">CDC reported last year\u003c/a> that about 5 percent of babies exposed in the womb are born with microcephaly and other birth defects. But the extent of the risk as children get older is just now starting to become clear.\u003c/p>\n\u003cp>The new analysis included babies born in U.S. territories such as Puerto Rico and in U.S. freely associated states, such as the Marshall Islands. It found that the risk for birth defects including microcephaly and vision damage is slightly higher — about 6 percent. And 1 in 7 — 14 percent — developed some kind of problem that could have been caused by the virus by their first birthday.\u003c/p>\n\u003cp>For example, 20 babies in the new analysis whose heads were normal at birth had microcephaly by the time they turned 1.\u003c/p>\n\u003cp>\"That happened because their brain was not growing and developing properly,\" Honein says.\u003c/p>\n\u003cp>Babies also developed complications including cognitive problems, difficulties walking, moving and swallowing, and seizures.\u003c/p>\n\u003cp>\"It's really important that parents and doctors work together to make sure children get all the evaluations they need, even if they look healthy when they are born,\" Honein says.\u003c/p>\n\u003cp>For example, only about one-third of the Zika-exposed babies in the study had an eye exam by an eye specialist.[contextly_sidebar id=\"S48dSINArZNQEXA3LRc21c6yj0trOwUT\"]\u003c/p>\n\u003cp>It's also important to continue to follow these children, she says.\u003c/p>\n\u003cp>\"We are still in the early stages of learning about Zika. So we don't yet know what sort of problems might emerge when the children are 2 years old or 3 years old or when they reach school age,\" Honein says.\u003c/p>\n\u003cp>There are no major Zika outbreaks occurring right now. But Honein stresses Zika \u003ca href=\"https://wwwnc.cdc.gov/travel/page/zika-information\" target=\"_blank\" rel=\"noopener\">is still being transmitted in many countries\u003c/a> and outbreaks still could occur.\u003c/p>\n\u003cp>So pregnant women and couples trying to conceive should continue to protect themselves while living or visiting places where Zika is being transmitted. The virus is primarily spread by mosquitoes, but can also be spread sexually.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The CDC on Tuesday also issued new interim guidance for men who were exposed to the virus. The agency \u003ca href=\"https://www.cdc.gov/pregnancy/zika/women-and-their-partners.html\" target=\"_blank\" rel=\"noopener\">is now recommending\u003c/a> these men wait three months after exposure before trying to conceive. The CDC had previously recommended waiting six months. But the latest science suggests the virus doesn't remain infectious in semen as long as previously thought.\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=Babies+Who+Seem+Fine+At+Birth+May+Have+Zika-Related+Problems+Later%2C+Study+Finds+&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Since Zika emerged as a threat to babies, it has been a mystery exactly how much of a danger the mosquito-borne virus poses to children.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>But now, the largest study to follow kids who were exposed to the virus in the womb is providing more answers.\u003c/p>\n\u003cp>The study involved 1,450 babies who had been exposed to the virus, and who were 1-year-old by February 2018. Six percent were born with birth defects, and 14 percent developed problems that could be blamed on the virus by the time they turned 1, the study found.\u003c/p>\n\u003cp>\"We're beginning to see the full spectrum of the impact of Zika,\" says \u003ca href=\"https://www.cdc.gov/media/spokesperson/sme-bio/honein.html\" target=\"_blank\" rel=\"noopener\">Margaret Honein\u003c/a>, director of the Division of Congenital and Developmental Disorders at the Centers for Disease Control and Prevention. The \u003ca href=\"https://www.cdc.gov/vitalsigns/\" target=\"_blank\" rel=\"noopener\">CDC released the study Tuesday\u003c/a>\u003cem>.\u003c/em>\u003c/p>\n\u003cp>\"This is really our first look at how these children are doing as they grow and develop, and really emphasizes that the Zika story is not over, particularly for these children,\" Honein says.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"https://www.cdc.gov/zika/index.html\">Zika \u003c/a>triggered an international public health emergency in 2016 when a large outbreak in Brazil revealed that the virus could cause babies to be born with very small heads and severely damaged brains when pregnant women get infected. The condition is called \u003ca href=\"https://www.cdc.gov/ncbddd/birthdefects/microcephaly.html\" target=\"_blank\" rel=\"noopener\">microcephaly\u003c/a>.\u003c/p>\n\u003cp>It slowly has become more apparent that Zika-exposed babies could develop a range of other problems as well, including seizures, damaged vision and developmental disorders.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>The \u003ca href=\"https://www.npr.org/sections/health-shots/2017/06/08/532087184/cdc-reveals-sharper-numbers-of-zika-birth-defects-from-u-s-territories\" target=\"_blank\" rel=\"noopener\">CDC reported last year\u003c/a> that about 5 percent of babies exposed in the womb are born with microcephaly and other birth defects. But the extent of the risk as children get older is just now starting to become clear.\u003c/p>\n\u003cp>The new analysis included babies born in U.S. territories such as Puerto Rico and in U.S. freely associated states, such as the Marshall Islands. It found that the risk for birth defects including microcephaly and vision damage is slightly higher — about 6 percent. And 1 in 7 — 14 percent — developed some kind of problem that could have been caused by the virus by their first birthday.\u003c/p>\n\u003cp>For example, 20 babies in the new analysis whose heads were normal at birth had microcephaly by the time they turned 1.\u003c/p>\n\u003cp>\"That happened because their brain was not growing and developing properly,\" Honein says.\u003c/p>\n\u003cp>Babies also developed complications including cognitive problems, difficulties walking, moving and swallowing, and seizures.\u003c/p>\n\u003cp>\"It's really important that parents and doctors work together to make sure children get all the evaluations they need, even if they look healthy when they are born,\" Honein says.\u003c/p>\n\u003cp>For example, only about one-third of the Zika-exposed babies in the study had an eye exam by an eye specialist.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>It's also important to continue to follow these children, she says.\u003c/p>\n\u003cp>\"We are still in the early stages of learning about Zika. So we don't yet know what sort of problems might emerge when the children are 2 years old or 3 years old or when they reach school age,\" Honein says.\u003c/p>\n\u003cp>There are no major Zika outbreaks occurring right now. But Honein stresses Zika \u003ca href=\"https://wwwnc.cdc.gov/travel/page/zika-information\" target=\"_blank\" rel=\"noopener\">is still being transmitted in many countries\u003c/a> and outbreaks still could occur.\u003c/p>\n\u003cp>So pregnant women and couples trying to conceive should continue to protect themselves while living or visiting places where Zika is being transmitted. The virus is primarily spread by mosquitoes, but can also be spread sexually.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The CDC on Tuesday also issued new interim guidance for men who were exposed to the virus. The agency \u003ca href=\"https://www.cdc.gov/pregnancy/zika/women-and-their-partners.html\" target=\"_blank\" rel=\"noopener\">is now recommending\u003c/a> these men wait three months after exposure before trying to conceive. The CDC had previously recommended waiting six months. But the latest science suggests the virus doesn't remain infectious in semen as long as previously thought.\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=Babies+Who+Seem+Fine+At+Birth+May+Have+Zika-Related+Problems+Later%2C+Study+Finds+&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Genetic Tests Can Hurt Your Chances Of Getting Some Types Of Insurance",
"title": "Genetic Tests Can Hurt Your Chances Of Getting Some Types Of Insurance",
"headTitle": "KQED Future of You | KQED Science",
"content": "\u003cp>Taking a genetic test in your 20s or 30s could, indeed, affect your ability to get long-term-care insurance later — or at least the price you'll pay. And people who are considering enrolling in Medicare \u003cem>after\u003c/em> age 65 would do well to read the fine print of the sign-up rules. Readers have insurance questions on these topics this month, and we have answers:\u003c/p>\n\u003cp>\u003cstrong>Q: Can getting a genetic test interfere with being able to buy long-term-care insurance in the future? If you do get a plan, can the insurer drop you after you find out the results of a genetic test?\u003c/strong>\u003c/p>\n\u003cp>In general, long-term-care insurers \u003ca href=\"https://www.npr.org/sections/health-shots/2018/07/11/627287642/has-genetic-privacy-been-strained-by-trumps-recent-aca-moves\" target=\"_blank\" rel=\"noopener\">can indeed use genetic test results\u003c/a> when they decide whether to offer you coverage. The federal Genetic Information Nondiscrimination Act does prohibit insurers from asking for or using your genetic information to make decisions about whether to sell you \u003cem>health\u003c/em> insurance or how much to charge you. But those privacy protections don't apply to long-term-care policies, life insurance or disability insurance.[contextly_sidebar id=\"qQSelkzIcg9rHvmpdeoo1Q3hIhLbJVzz\"]\u003c/p>\n\u003cp>When you apply for a long-term-care policy, the insurer is permitted to review your medical records and ask you questions about your health history and that of your family. It's all part of the underwriting process to determine whether to offer you a policy and how much to charge.\u003c/p>\n\u003cp>If the insurer asks you whether you've undergone genetic testing, you generally must disclose it, even if the testing was performed through a direct-to-consumer site like 23andMe, says Catherine Theroux, a spokeswoman for \u003ca href=\"https://www.limra.com/News_Center/\" target=\"_blank\" rel=\"noopener\">LIMRA\u003c/a>, an insurance industry trade group.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"You need to release any medically relevant information,\" she says.\u003c/p>\n\u003cp>Some states provide extra consumer protections related to genetic testing and long-term-care insurance, says \u003ca href=\"https://www.law.gwu.edu/sonia-m-suter\" target=\"_blank\" rel=\"noopener\">Sonia Mateu Suter\u003c/a>, a law professor at George Washington University who specializes in genetics and the law. But most follow federal law.\u003c/p>\n\u003cp>If you get genetic testing after you have a policy, the results can't affect your coverage.\u003c/p>\n\u003cp>\"Once the policy has been underwritten and issued, the insurer doesn't revoke the policy if new medical information comes to light,\" Theroux says.\u003c/p>\n\u003cp>\u003cstrong>Q: Can I switch Medigap insurance companies midway through the year? I found a less expensive policy.\u003c/strong>\u003c/p>\n\u003cp>It depends. Under federal law, when people turn 65 and first enroll in Medicare Part B they have a six-month window to sign up for a \u003ca href=\"https://www.medicare.gov/supplement-other-insurance/medigap/whats-medigap.html\" target=\"_blank\" rel=\"noopener\">Medigap plan\u003c/a> — a commercial policy that picks up some of the out-of-pocket costs for services that Medicare doesn't cover. (\u003ca href=\"https://www.medicare.gov/what-medicare-covers/part-a/what-part-a-covers.html\" target=\"_blank\" rel=\"noopener\">Medicare Part A covers\u003c/a> hospitalization, and \u003ca href=\"https://www.medicare.gov/what-medicare-covers/part-b/what-medicare-part-b-covers.html\" target=\"_blank\" rel=\"noopener\">Medicare Part B covers\u003c/a> outpatient services.) During that six-month period, insurers have to accept enrollees, even if they have health problems.[contextly_sidebar id=\"AH3oYgfcAwGcfBrC61gPsQfir4oB7Yc7\"]\u003c/p>\n\u003cp>If you're still within that six-month period now and you want to switch plans, go right ahead.\u003c/p>\n\u003cp>But if you're past the six-month window, under federal law, insurers are required to sell you a plan only in certain circumstances — such as if you lose your retiree coverage or Medicare Advantage plan. If you don't meet the criteria, insurers can decline to cover you or charge you more for preexisting medical conditions.\u003c/p>\n\u003cp>Many states have provided more robust protections, however. Three states — Connecticut, Massachusetts and New York — have year-round open enrollment and require insurers to offer coverage. And Maine requires a one-month \"guaranteed issue\" open-enrollment period every year.\u003c/p>\n\u003cp>Some states guarantee current policyholders a chance to switch Medigap plans at certain points during the year. Other states have \u003ca href=\"https://www.kff.org/medicare/issue-brief/medigap-enrollment-and-consumer-protections-vary-across-states/\" target=\"_blank\" rel=\"noopener\">additional qualifying events\u003c/a> that allow people to switch Medigap plans, according to data from the Kaiser Family Foundation.\u003c/p>\n\u003cp>\"The first thing the person should do is check with her state insurance department to find out her rights related to buying a Medigap plan,\" says \u003ca href=\"https://www.ncoa.org/centerforbenefits/about-the-center/\" target=\"_blank\" rel=\"noopener\">Brandy Bauer\u003c/a>, associate director at the Center for Benefits Access at the National Council on Aging. If you decide to go ahead and switch, she says, it is wise to sign up for a new plan before terminating your current policy.[contextly_sidebar id=\"t6VA7YIl0My5E1I6mIhIw1XmFGiwNdrT\"]\u003c/p>\n\u003cp>\u003cstrong>Q: I did not enroll in Medicare Part B when I turned 65 because I already have a regular plan that covers everything. I was told that the insurer would keep paying as usual, but now the company says it will pay only part and that I have to buy Medicare Part B. I didn't want to pay for two policies. Is there anything I can do to avoid that?\u003c/strong>\u003c/p>\n\u003cp>From your description, it's hard to know exactly what's going on, but we can make educated guesses. Typically, when people turn 65, it makes sense to sign up for Medicare unless they or their spouse are working and getting health insurance from an employer. For others, at age 65, Medicare typically becomes their primary insurer and any other coverage they have becomes secondary, filling in gaps in Medicare coverage.\u003c/p>\n\u003cp>If you have an individual policy that you bought on the health insurance exchange, and decide to hang on to it instead of signing up for Medicare, your premiums and other costs could be higher than they would be on Medicare, depending on your income.\u003c/p>\n\u003cp>But if you're not receiving employee coverage and you don't enroll in Medicare Part B, you could be subject to a permanent \u003ca href=\"https://www.medicare.gov/your-medicare-costs/part-b-costs/penalty/part-b-late-enrollment-penalty.html\" target=\"_blank\" rel=\"noopener\">late enrollment penalty\u003c/a> of 10 percent of the policy's premium for every 12 months that you could have signed up for Part B but didn't.\u003c/p>\n\u003cp>You could also owe a premium penalty for not signing up for a Part D prescription drug plan. (Most people don't owe any premium for Medicare Part A, so there's no penalty for late sign-up.)\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Your best move now may be to call 800-Medicare or visit your local \u003ca href=\"https://www.medicare.gov/contacts/#resources/ships\" target=\"_blank\" rel=\"noopener\">state health insurance assistance program\u003c/a> to help sort out your coverage issues, including whether to drop your current coverage and sign up for Medicare Part B and Part D.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 Kaiser Health News. To see more, visit \u003ca href=\"http://www.kaiserhealthnews.org/\" target=\"_blank\" rel=\"noopener\">Kaiser Health News\u003c/a>.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Genetic+Tests+Can+Hurt+Your+Chances+Of+Getting+Some+Types+Of+Insurance&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"excerpt": "Federal law keeps insurers from using genetic test results when pricing and issuing health insurance. But the tests might keep you from being able to get life insurance or a long-term-care policy.",
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"description": "Federal law keeps insurers from using genetic test results when pricing and issuing health insurance. But the tests might keep you from being able to get life insurance or a long-term-care policy.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Taking a genetic test in your 20s or 30s could, indeed, affect your ability to get long-term-care insurance later — or at least the price you'll pay. And people who are considering enrolling in Medicare \u003cem>after\u003c/em> age 65 would do well to read the fine print of the sign-up rules. Readers have insurance questions on these topics this month, and we have answers:\u003c/p>\n\u003cp>\u003cstrong>Q: Can getting a genetic test interfere with being able to buy long-term-care insurance in the future? If you do get a plan, can the insurer drop you after you find out the results of a genetic test?\u003c/strong>\u003c/p>\n\u003cp>In general, long-term-care insurers \u003ca href=\"https://www.npr.org/sections/health-shots/2018/07/11/627287642/has-genetic-privacy-been-strained-by-trumps-recent-aca-moves\" target=\"_blank\" rel=\"noopener\">can indeed use genetic test results\u003c/a> when they decide whether to offer you coverage. The federal Genetic Information Nondiscrimination Act does prohibit insurers from asking for or using your genetic information to make decisions about whether to sell you \u003cem>health\u003c/em> insurance or how much to charge you. But those privacy protections don't apply to long-term-care policies, life insurance or disability insurance.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>When you apply for a long-term-care policy, the insurer is permitted to review your medical records and ask you questions about your health history and that of your family. It's all part of the underwriting process to determine whether to offer you a policy and how much to charge.\u003c/p>\n\u003cp>If the insurer asks you whether you've undergone genetic testing, you generally must disclose it, even if the testing was performed through a direct-to-consumer site like 23andMe, says Catherine Theroux, a spokeswoman for \u003ca href=\"https://www.limra.com/News_Center/\" target=\"_blank\" rel=\"noopener\">LIMRA\u003c/a>, an insurance industry trade group.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"You need to release any medically relevant information,\" she says.\u003c/p>\n\u003cp>Some states provide extra consumer protections related to genetic testing and long-term-care insurance, says \u003ca href=\"https://www.law.gwu.edu/sonia-m-suter\" target=\"_blank\" rel=\"noopener\">Sonia Mateu Suter\u003c/a>, a law professor at George Washington University who specializes in genetics and the law. But most follow federal law.\u003c/p>\n\u003cp>If you get genetic testing after you have a policy, the results can't affect your coverage.\u003c/p>\n\u003cp>\"Once the policy has been underwritten and issued, the insurer doesn't revoke the policy if new medical information comes to light,\" Theroux says.\u003c/p>\n\u003cp>\u003cstrong>Q: Can I switch Medigap insurance companies midway through the year? I found a less expensive policy.\u003c/strong>\u003c/p>\n\u003cp>It depends. Under federal law, when people turn 65 and first enroll in Medicare Part B they have a six-month window to sign up for a \u003ca href=\"https://www.medicare.gov/supplement-other-insurance/medigap/whats-medigap.html\" target=\"_blank\" rel=\"noopener\">Medigap plan\u003c/a> — a commercial policy that picks up some of the out-of-pocket costs for services that Medicare doesn't cover. (\u003ca href=\"https://www.medicare.gov/what-medicare-covers/part-a/what-part-a-covers.html\" target=\"_blank\" rel=\"noopener\">Medicare Part A covers\u003c/a> hospitalization, and \u003ca href=\"https://www.medicare.gov/what-medicare-covers/part-b/what-medicare-part-b-covers.html\" target=\"_blank\" rel=\"noopener\">Medicare Part B covers\u003c/a> outpatient services.) During that six-month period, insurers have to accept enrollees, even if they have health problems.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>If you're still within that six-month period now and you want to switch plans, go right ahead.\u003c/p>\n\u003cp>But if you're past the six-month window, under federal law, insurers are required to sell you a plan only in certain circumstances — such as if you lose your retiree coverage or Medicare Advantage plan. If you don't meet the criteria, insurers can decline to cover you or charge you more for preexisting medical conditions.\u003c/p>\n\u003cp>Many states have provided more robust protections, however. Three states — Connecticut, Massachusetts and New York — have year-round open enrollment and require insurers to offer coverage. And Maine requires a one-month \"guaranteed issue\" open-enrollment period every year.\u003c/p>\n\u003cp>Some states guarantee current policyholders a chance to switch Medigap plans at certain points during the year. Other states have \u003ca href=\"https://www.kff.org/medicare/issue-brief/medigap-enrollment-and-consumer-protections-vary-across-states/\" target=\"_blank\" rel=\"noopener\">additional qualifying events\u003c/a> that allow people to switch Medigap plans, according to data from the Kaiser Family Foundation.\u003c/p>\n\u003cp>\"The first thing the person should do is check with her state insurance department to find out her rights related to buying a Medigap plan,\" says \u003ca href=\"https://www.ncoa.org/centerforbenefits/about-the-center/\" target=\"_blank\" rel=\"noopener\">Brandy Bauer\u003c/a>, associate director at the Center for Benefits Access at the National Council on Aging. If you decide to go ahead and switch, she says, it is wise to sign up for a new plan before terminating your current policy.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\u003cstrong>Q: I did not enroll in Medicare Part B when I turned 65 because I already have a regular plan that covers everything. I was told that the insurer would keep paying as usual, but now the company says it will pay only part and that I have to buy Medicare Part B. I didn't want to pay for two policies. Is there anything I can do to avoid that?\u003c/strong>\u003c/p>\n\u003cp>From your description, it's hard to know exactly what's going on, but we can make educated guesses. Typically, when people turn 65, it makes sense to sign up for Medicare unless they or their spouse are working and getting health insurance from an employer. For others, at age 65, Medicare typically becomes their primary insurer and any other coverage they have becomes secondary, filling in gaps in Medicare coverage.\u003c/p>\n\u003cp>If you have an individual policy that you bought on the health insurance exchange, and decide to hang on to it instead of signing up for Medicare, your premiums and other costs could be higher than they would be on Medicare, depending on your income.\u003c/p>\n\u003cp>But if you're not receiving employee coverage and you don't enroll in Medicare Part B, you could be subject to a permanent \u003ca href=\"https://www.medicare.gov/your-medicare-costs/part-b-costs/penalty/part-b-late-enrollment-penalty.html\" target=\"_blank\" rel=\"noopener\">late enrollment penalty\u003c/a> of 10 percent of the policy's premium for every 12 months that you could have signed up for Part B but didn't.\u003c/p>\n\u003cp>You could also owe a premium penalty for not signing up for a Part D prescription drug plan. (Most people don't owe any premium for Medicare Part A, so there's no penalty for late sign-up.)\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Your best move now may be to call 800-Medicare or visit your local \u003ca href=\"https://www.medicare.gov/contacts/#resources/ships\" target=\"_blank\" rel=\"noopener\">state health insurance assistance program\u003c/a> to help sort out your coverage issues, including whether to drop your current coverage and sign up for Medicare Part B and Part D.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 Kaiser Health News. To see more, visit \u003ca href=\"http://www.kaiserhealthnews.org/\" target=\"_blank\" rel=\"noopener\">Kaiser Health News\u003c/a>.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Genetic+Tests+Can+Hurt+Your+Chances+Of+Getting+Some+Types+Of+Insurance&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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},
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"id": "city-arts",
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"info": "A one-hour radio program to hear celebrated writers, artists and thinkers address contemporary ideas and values, often discussing the creative process. Please note: tapes or transcripts are not available",
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"airtime": "SUN 1pm-2pm, TUE 10pm, WED 1am",
"meta": {
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"source": "City Arts & Lectures"
},
"link": "https://www.cityarts.net",
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}
},
"closealltabs": {
"id": "closealltabs",
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"officialWebsiteLink": "/podcasts/closealltabs",
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"order": 1
},
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"title": "Code Switch / Life Kit",
"info": "\u003cem>Code Switch\u003c/em>, which listeners will hear in the first part of the hour, has fearless and much-needed conversations about race. Hosted by journalists of color, the show tackles the subject of race head-on, exploring how it impacts every part of society — from politics and pop culture to history, sports and more.\u003cbr />\u003cbr />\u003cem>Life Kit\u003c/em>, which will be in the second part of the hour, guides you through spaces and feelings no one prepares you for — from finances to mental health, from workplace microaggressions to imposter syndrome, from relationships to parenting. The show features experts with real world experience and shares their knowledge. Because everyone needs a little help being human.\u003cbr />\u003cbr />\u003ca href=\"https://www.npr.org/podcasts/510312/codeswitch\">\u003cem>Code Switch\u003c/em> offical site and podcast\u003c/a>\u003cbr />\u003ca href=\"https://www.npr.org/lifekit\">\u003cem>Life Kit\u003c/em> offical site and podcast\u003c/a>\u003cbr />",
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"id": "commonwealth-club",
"title": "Commonwealth Club of California Podcast",
"info": "The Commonwealth Club of California is the nation's oldest and largest public affairs forum. As a non-partisan forum, The Club brings to the public airwaves diverse viewpoints on important topics. The Club's weekly radio broadcast - the oldest in the U.S., dating back to 1924 - is carried across the nation on public radio stations and is now podcasting. Our website archive features audio of our recent programs, as well as selected speeches from our long and distinguished history. This podcast feed is usually updated twice a week and is always un-edited.",
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"source": "Commonwealth Club of California"
},
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"google": "https://podcasts.google.com/feed/aHR0cDovL3d3dy5jb21tb253ZWFsdGhjbHViLm9yZy9hdWRpby9wb2RjYXN0L3dlZWtseS54bWw",
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"title": "Forum",
"tagline": "The conversation starts here",
"info": "KQED’s live call-in program discussing local, state, national and international issues, as well as in-depth interviews.",
"airtime": "MON-FRI 9am-11am, 10pm-11pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Forum-Podcast-Tile-703x703-1.jpg",
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"order": 9
},
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM5NTU3MzgxNjMz",
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"meta": {
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"source": "WNYC"
},
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"apple": "https://itunes.apple.com/us/podcast/freakonomics-radio/id354668519",
"tuneIn": "https://tunein.com/podcasts/WNYC-Podcasts/Freakonomics-Radio-p272293/",
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},
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"id": "fresh-air",
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"apple": "https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=214089682&at=11l79Y&ct=nprdirectory",
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"info": "A live production of NPR and WBUR Boston, in collaboration with stations across the country, Here & Now reflects the fluid world of news as it's happening in the middle of the day, with timely, in-depth news, interviews and conversation. Hosted by Robin Young, Jeremy Hobson and Tonya Mosley.",
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"hidden-brain": {
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"info": "Shankar Vedantam uses science and storytelling to reveal the unconscious patterns that drive human behavior, shape our choices and direct our relationships.",
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"airtime": "SUN 7pm-8pm",
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"source": "NPR"
},
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"how-i-built-this": {
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"info": "Guy Raz dives into the stories behind some of the world's best known companies. How I Built This weaves a narrative journey about innovators, entrepreneurs and idealists—and the movements they built.",
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"airtime": "SUN 7:30pm-8pm",
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"link": "/radio/program/how-i-built-this",
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"hyphenacion": {
"id": "hyphenacion",
"title": "Hyphenación",
"tagline": "Where conversation and cultura meet",
"info": "What kind of no sabo word is Hyphenación? For us, it’s about living within a hyphenation. Like being a third-gen Mexican-American from the Texas border now living that Bay Area Chicano life. Like Xorje! Each week we bring together a couple of hyphenated Latinos to talk all about personal life choices: family, careers, relationships, belonging … everything is on the table. ",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2025/03/Hyphenacion_FinalAssets_PodcastTile.png",
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"order": 15
},
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},
"jerrybrown": {
"id": "jerrybrown",
"title": "The Political Mind of Jerry Brown",
"tagline": "Lessons from a lifetime in politics",
"info": "The Political Mind of Jerry Brown brings listeners the wisdom of the former Governor, Mayor, and presidential candidate. Scott Shafer interviewed Brown for more than 40 hours, covering the former governor's life and half-century in the political game – and Brown has some lessons he'd like to share. ",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/The-Political-Mind-of-Jerry-Brown-Podcast-Tile-703x703-1.jpg",
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"officialWebsiteLink": "/podcasts/jerrybrown",
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"order": 18
},
"link": "/podcasts/jerrybrown",
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},
"latino-usa": {
"id": "latino-usa",
"title": "Latino USA",
"airtime": "MON 1am-2am, SUN 6pm-7pm",
"info": "Latino USA, the radio journal of news and culture, is the only national, English-language radio program produced from a Latino perspective.",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/latinoUsa.jpg",
"officialWebsiteLink": "http://latinousa.org/",
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"link": "/radio/program/latino-usa",
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"apple": "https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=79681317&at=11l79Y&ct=nprdirectory",
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"rss": "https://feeds.npr.org/510016/podcast.xml"
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},
"marketplace": {
"id": "marketplace",
"title": "Marketplace",
"info": "Our flagship program, helmed by Kai Ryssdal, examines what the day in money delivered, through stories, conversations, newsworthy numbers and more. Updated Monday through Friday at about 3:30 p.m. PT.",
"airtime": "MON-FRI 4pm-4:30pm, MON-WED 6:30pm-7pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Marketplace-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.marketplace.org/",
"meta": {
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"source": "American Public Media"
},
"link": "/radio/program/marketplace",
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},
"masters-of-scale": {
"id": "masters-of-scale",
"title": "Masters of Scale",
"info": "Masters of Scale is an original podcast in which LinkedIn co-founder and Greylock Partner Reid Hoffman sets out to describe and prove theories that explain how great entrepreneurs take their companies from zero to a gazillion in ingenious fashion.",
"airtime": "Every other Wednesday June 12 through October 16 at 8pm (repeats Thursdays at 2am)",
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"meta": {
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"rss": "https://rss.art19.com/masters-of-scale"
}
},
"mindshift": {
"id": "mindshift",
"title": "MindShift",
"tagline": "A podcast about the future of learning and how we raise our kids",
"info": "The MindShift podcast explores the innovations in education that are shaping how kids learn. Hosts Ki Sung and Katrina Schwartz introduce listeners to educators, researchers, parents and students who are developing effective ways to improve how kids learn. We cover topics like how fed-up administrators are developing surprising tactics to deal with classroom disruptions; how listening to podcasts are helping kids develop reading skills; the consequences of overparenting; and why interdisciplinary learning can engage students on all ends of the traditional achievement spectrum. This podcast is part of the MindShift education site, a division of KQED News. KQED is an NPR/PBS member station based in San Francisco. You can also visit the MindShift website for episodes and supplemental blog posts or tweet us \u003ca href=\"https://twitter.com/MindShiftKQED\">@MindShiftKQED\u003c/a> or visit us at \u003ca href=\"/mindshift\">MindShift.KQED.org\u003c/a>",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Mindshift-Podcast-Tile-703x703-1.jpg",
"imageAlt": "KQED MindShift: How We Will Learn",
"officialWebsiteLink": "/mindshift/",
"meta": {
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"source": "kqed",
"order": 12
},
"link": "/podcasts/mindshift",
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM1NzY0NjAwNDI5",
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}
},
"morning-edition": {
"id": "morning-edition",
"title": "Morning Edition",
"info": "\u003cem>Morning Edition\u003c/em> takes listeners around the country and the world with multi-faceted stories and commentaries every weekday. Hosts Steve Inskeep, David Greene and Rachel Martin bring you the latest breaking news and features to prepare you for the day.",
"airtime": "MON-FRI 3am-9am",
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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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"officialWebsiteLink": "/podcasts/onourwatch",
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"source": "kqed",
"order": 11
},
"link": "/podcasts/onourwatch",
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5ucHIub3JnLzUxMDM2MC9wb2RjYXN0LnhtbD9zYz1nb29nbGVwb2RjYXN0cw",
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},
"on-the-media": {
"id": "on-the-media",
"title": "On The Media",
"info": "Our weekly podcast explores how the media 'sausage' is made, casts an incisive eye on fluctuations in the marketplace of ideas, and examines threats to the freedom of information and expression in America and abroad. For one hour a week, the show tries to lift the veil from the process of \"making media,\" especially news media, because it's through that lens that we see the world and the world sees us",
"airtime": "SUN 2pm-3pm, MON 12am-1am",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/onTheMedia.png",
"officialWebsiteLink": "https://www.wnycstudios.org/shows/otm",
"meta": {
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"source": "wnyc"
},
"link": "/radio/program/on-the-media",
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"tuneIn": "https://tunein.com/radio/On-the-Media-p69/",
"rss": "http://feeds.wnyc.org/onthemedia"
}
},
"pbs-newshour": {
"id": "pbs-newshour",
"title": "PBS NewsHour",
"info": "Analysis, background reports and updates from the PBS NewsHour putting today's news in context.",
"airtime": "MON-FRI 3pm-4pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/PBS-News-Hour-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.pbs.org/newshour/",
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},
"link": "/radio/program/pbs-newshour",
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"apple": "https://itunes.apple.com/us/podcast/pbs-newshour-full-show/id394432287?mt=2",
"tuneIn": "https://tunein.com/radio/PBS-NewsHour---Full-Show-p425698/",
"rss": "https://www.pbs.org/newshour/feeds/rss/podcasts/show"
}
},
"perspectives": {
"id": "perspectives",
"title": "Perspectives",
"tagline": "KQED's series of daily listener commentaries since 1991",
"info": "KQED's series of daily listener commentaries since 1991.",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2025/01/Perspectives_Tile_Final.jpg",
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"officialWebsiteLink": "/perspectives/",
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"source": "kqed",
"order": 14
},
"link": "/perspectives",
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