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"content": "\u003cp>You’ve heard it many times before from your doctor: If you’re taking antibiotics, don’t stop taking them until the pill vial is empty, even if you feel better.\u003c/p>\n\u003caside class=\"pullquote alignright\">‘An argument can be made for stopping a course of antibiotics immediately after a bacterial infection has been ruled out … or when the signs and symptoms of a mild infection have disappeared.’\u003ccite>From a World Health Organization report\u003c/cite>\u003c/aside>\n\u003cp>The rationale behind this commandment has always been that stopping treatment too soon would fuel the development of antibiotic resistance—the ability of bugs to evade these drugs. Information campaigns aimed at getting the public to take antibiotics properly have been driving home this message for decades.\u003c/p>\n\u003cp>But the warning, a growing number of experts say, is misguided and may actually be exacerbating antibiotic resistance.\u003c/p>\n\u003cp>The reasoning is simple: Exposure to antibiotics is what drives bacteria to develop resistance. Taking drugs when you aren’t sick anymore simply gives the hordes of bacteria in and on your body more incentive to evolve to evade the drugs, so the next time you have an infection, they may not work.\u003c/p>\n\u003cp>The traditional reasoning from doctors “never made any sense. It doesn’t make any sense today,” Dr. Louis Rice, chairman of the department of medicine at the Warren Alpert Medical School at Brown University, told STAT.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Some colleagues credit Rice with being the first person to declare the emperor was wearing no clothes, and it is true that he challenged the dogma in lectures at major meetings of infectious diseases physicians and researchers in 2007 and 2008. A number of researchers now share his skepticism of health guidance that has been previously universally accepted.\u003c/p>\n\u003cp>The question of whether this advice is still appropriate will be raised at a World Health Organization meeting next month in Geneva. A report prepared for that meeting—the agency’s expert committee on the selection and use of essential medicine—already notes that the recommendation isn’t backed by science.\u003c/p>\n\u003cp>In many cases “an argument can be made for stopping a course of antibiotics immediately after a bacterial infection has been ruled out … or when the signs and symptoms of a mild infection have disappeared,” suggests the report, which analyzed information campaigns designed to get the public on board with efforts to fight antibiotic resistance.\u003c/p>\n\u003cp>No one is doubting the lifesaving importance of antibiotics. They kill bacteria. But the more the bugs are exposed to the drugs, the more survival tricks the bacteria acquire. And the more resistant the bacteria become, the harder they are to treat.\u003c/p>\n\u003cp>The concern is that the growing number of bacteria that are resistant to multiple antibiotics will lead to more incurable infections that will threaten medicine’s ability to conduct routine procedures like hip replacements or open heart surgery without endangering lives.\u003c/p>\n\u003cp>So how did this faulty paradigm become entrenched in medical practice? The answer lies back in the 1940s, the dawn of antibiotic use.\u003c/p>\n\u003cp>At the time, resistance wasn’t a concern. After the first antibiotic, penicillin, was discovered, more and more gushed out of the pharmaceutical product pipeline.\u003c/p>\n\u003cp>Doctors were focused only on figuring out how to use the drugs effectively to save lives. An ethos emerged: Treat patients until they get better, and then for a little bit longer to be on the safe side. Around the same time, research on how to cure tuberculosis suggested that under-dosing patients was dangerous—the infection would come back.\u003c/p>\n\u003cp>The idea that stopping antibiotic treatment too quickly after symptoms went away might fuel resistance took hold.\u003c/p>\n\u003cp>“The problem is once it gets baked into culture, it’s really hard to excise it,” said Dr. Brad Spellberg, who is also an advocate for changing this advice. Spellberg is an infectious diseases specialist and chief medical officer at the Los Angeles County-University of Southern California Medical Center in Los Angeles.\u003c/p>\n\u003cp>We think of medicine as a science, guided by mountains of research. But doctors sometimes prescribe antibiotics based more on their experience and intuition than anything else. There are treatment guidelines for different infections, but some provide scant advice on how long to continue treatment, Rice acknowledged. And response to treatment will differ from patient to patient, depending on, among other things, how old they are, how strong their immune systems are, or how well they metabolize drugs.\u003c/p>\n\u003cp>There’s little incentive for pharmaceutical companies to conduct expensive studies aimed at finding the shortest duration of treatment for various conditions. But in the years since Rice first raised his concerns, the National Institutes of Health has been funding such research and almost invariably the ensuing studies have found that many infections can be cured more quickly than had been thought. Treatments that were once two weeks have been cut to one, 10 days have been reduced to seven and so on.\u003c/p>\n\u003cp>There have been occasional exceptions. Just before Christmas, scientists at the University of Pittsburgh reported that 10 days of treatment for otitis media—middle ear infections—was better than five days for children under 2 years of age.\u003c/p>\n\u003cp>It was a surprise, said Spellberg, who noted that studies looking at the same condition in children 2 and older show the shorter treatment works.\u003c/p>\n\u003cp>More of this work is needed, Rice said. “I’m not here saying that every infection can be treated for two days or three days. I’m just saying: Let’s figure it out.”\u003c/p>\n\u003cp>In the meantime, doctors and public health agencies are in a quandary. How do you put the new thinking into practice? And how do you advise the public? Doctors know full well some portion of people unilaterally decide to stop taking their antibiotics because they feel better. But that approach is not safe in all circumstances—for instance tuberculosis or bone infections. And it’s not an approach many physicians feel comfortable endorsing.\u003c/p>\n\u003cp>“This is a very tricky question. It’s not easy to make a blanket statement about this, and there isn’t a simple answer,” Dr. Lauri Hicks, director of the Centers for Disease Control and Prevention’s office of antibiotic stewardship, told STAT in an email.\u003c/p>\n\u003cp>“There are certain diagnoses for which shortening the course of antibiotic therapy is not recommended and/or potentially dangerous. … On the other hand, there are probably many situations for which antibiotic therapy is often prescribed for longer than necessary and the optimal duration is likely ‘until the patient gets better.’”\u003c/p>\n\u003cp>CDC’S Get Smart campaign, on appropriate antibiotic use, urges people never to skip doses or stop the drugs because they’re feeling better. But Hicks noted the CDC recently revised it to add “unless your healthcare professional tells you to do so” to that advice.\u003c/p>\n\u003cp>And that’s one way to deal with the situation, said Dr. James Johnson, a professor of infectious diseases medicine at the University of Minnesota and a specialist at the Minnesota VA Medical Center.\u003c/p>\n\u003cp>“In fact sometimes some of us give that instruction to patients. ‘Here, I’m going to prescribe you a week. My guess is you won’t need it more than, say, three days. If you’re all well in three days, stop then. If you’re not completely well, take it a little longer. But as soon as you feel fine, stop.’ And we can give them permission to do that.”\u003c/p>\n\u003cp>Spellberg is more comfortable with the idea of people checking back with their doctor before stopping their drugs — an approach that requires doctors to be willing to have that conversation. “You should call your doc and say ‘Hey, can I stop?’ … If your doctor won’t get on the phone with you for 20 seconds, you need to find another doctor.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This \u003ca href=\"https://www.statnews.com/2017/02/09/antibiotics-resistance-superbugs/\" 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>\u003c/p>\n\u003cp>Some colleagues credit Rice with being the first person to declare the emperor was wearing no clothes, and it is true that he challenged the dogma in lectures at major meetings of infectious diseases physicians and researchers in 2007 and 2008. A number of researchers now share his skepticism of health guidance that has been previously universally accepted.\u003c/p>\n\u003cp>The question of whether this advice is still appropriate will be raised at a World Health Organization meeting next month in Geneva. A report prepared for that meeting—the agency’s expert committee on the selection and use of essential medicine—already notes that the recommendation isn’t backed by science.\u003c/p>\n\u003cp>In many cases “an argument can be made for stopping a course of antibiotics immediately after a bacterial infection has been ruled out … or when the signs and symptoms of a mild infection have disappeared,” suggests the report, which analyzed information campaigns designed to get the public on board with efforts to fight antibiotic resistance.\u003c/p>\n\u003cp>No one is doubting the lifesaving importance of antibiotics. They kill bacteria. But the more the bugs are exposed to the drugs, the more survival tricks the bacteria acquire. And the more resistant the bacteria become, the harder they are to treat.\u003c/p>\n\u003cp>The concern is that the growing number of bacteria that are resistant to multiple antibiotics will lead to more incurable infections that will threaten medicine’s ability to conduct routine procedures like hip replacements or open heart surgery without endangering lives.\u003c/p>\n\u003cp>So how did this faulty paradigm become entrenched in medical practice? The answer lies back in the 1940s, the dawn of antibiotic use.\u003c/p>\n\u003cp>At the time, resistance wasn’t a concern. After the first antibiotic, penicillin, was discovered, more and more gushed out of the pharmaceutical product pipeline.\u003c/p>\n\u003cp>Doctors were focused only on figuring out how to use the drugs effectively to save lives. An ethos emerged: Treat patients until they get better, and then for a little bit longer to be on the safe side. Around the same time, research on how to cure tuberculosis suggested that under-dosing patients was dangerous—the infection would come back.\u003c/p>\n\u003cp>The idea that stopping antibiotic treatment too quickly after symptoms went away might fuel resistance took hold.\u003c/p>\n\u003cp>“The problem is once it gets baked into culture, it’s really hard to excise it,” said Dr. Brad Spellberg, who is also an advocate for changing this advice. Spellberg is an infectious diseases specialist and chief medical officer at the Los Angeles County-University of Southern California Medical Center in Los Angeles.\u003c/p>\n\u003cp>We think of medicine as a science, guided by mountains of research. But doctors sometimes prescribe antibiotics based more on their experience and intuition than anything else. There are treatment guidelines for different infections, but some provide scant advice on how long to continue treatment, Rice acknowledged. 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"content": "\u003cp>Protesters opposed to — and in support of — abortion clashed outside the Planned Parenthood clinic in San Francisco on Saturday, arguing over whether taxpayer money should go to a women’s health organization that provides abortion.\u003c/p>\n\u003cp>“We think that the other side has some valid concerns about women’s health,” said Terrisa Bukovinac, president of Pro-Life Future of San Francisco. “However, we are absolutely not OK with federal funds going to an organization that profits from human demise.”\u003c/p>\n\u003cp>The rally was one of 200 organized across the country — about 30 of them in California — by anti-abortion activists, urging Congress to cut federal funding to Planned Parenthood. In several locations, including Denver and St. Paul, Minnesota, demonstrators were outnumbered by counterprotesters.\u003c/p>\n\u003cp>In California, Planned Parenthood clinics receive $260 million per year in federal funds, though that money is restricted to providing birth control counseling, STD testing and cervical cancer screening — not abortion.\u003c/p>\n\u003cp>Outside the San Francisco clinic on Valencia Street, about 40 anti-abortion protesters prayed and sang “Ave Maria,” while more than 200 counterprotesters gathered on the other side of the sidewalk, shouting slogans like, “Pro-life, that’s a lie! You don’t care if women die!”\u003c/p>\n\u003cblockquote class=\"twitter-tweet\" data-width=\"550\" data-dnt=\"true\">\n\u003cp lang=\"en\" dir=\"ltr\">Protestors on both sides of the abortion debate protest in front of the San Francisco Planned Parenthood clinic (via \u003ca href=\"https://twitter.com/adembosky?ref_src=twsrc%5Etfw\">@adembosky\u003c/a>) \u003ca href=\"https://t.co/vTOy1XbE3W\">pic.twitter.com/vTOy1XbE3W\u003c/a>\u003c/p>\n\u003cp>— KQED News (@KQEDnews) \u003ca href=\"https://twitter.com/KQEDnews/status/830548075282247680?ref_src=twsrc%5Etfw\">February 11, 2017\u003c/a>\u003c/p>\u003c/blockquote>\n\u003cp>\u003cscript async src=\"https://platform.twitter.com/widgets.js\" charset=\"utf-8\">\u003c/script>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Women on both sides wore T-shirts that said, “This is what a feminist looks like,” including Bukovinac. She said even though the back and forth got tense at times, she welcomed it.\u003c/p>\n\u003cp>“Rarely do we see a significant counterprotest. It’s almost always just us talking to ourselves, which is kind of pointless because we want to be having this national discussion,” she said. “It’s exciting to see people coming out who are also passionate about what they believe in, just like we are.”\u003c/p>\n\u003cp>A few Planned Parenthood supporters walked down the sidewalk waving $20 bills at the protesters, then went into the clinic to make a donation.\u003c/p>\n\u003cp>“This Planned Parenthood was definitely there for me as a young woman and I believe it should be there for all women anywhere,” said pro-abortion rights protester Marian Doub. “I watch the anti-choice people out here periodically and don’t feel like we’ve done enough to counter their movement. We need to step it up.”\u003c/p>\n\u003cp>Police were careful to keep protesters on either side of the sidewalk away from each other. But one anti-abortion demonstrator, Eva Muntean, broke away at the request of two young women on the pro-abortion rights side. They talked for 20 minutes, sharing their views and personal stories, debating policy and statistics. In the end, no minds were changed, no opinions swayed. But they thanked each other for the civil conversation.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“I totally respect their right to be here,” Muntean said. “I wouldn’t want it any other way.”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Protesters opposed to — and in support of — abortion clashed outside the Planned Parenthood clinic in San Francisco on Saturday, arguing over whether taxpayer money should go to a women’s health organization that provides abortion.\u003c/p>\n\u003cp>“We think that the other side has some valid concerns about women’s health,” said Terrisa Bukovinac, president of Pro-Life Future of San Francisco. “However, we are absolutely not OK with federal funds going to an organization that profits from human demise.”\u003c/p>\n\u003cp>The rally was one of 200 organized across the country — about 30 of them in California — by anti-abortion activists, urging Congress to cut federal funding to Planned Parenthood. In several locations, including Denver and St. Paul, Minnesota, demonstrators were outnumbered by counterprotesters.\u003c/p>\n\u003cp>In California, Planned Parenthood clinics receive $260 million per year in federal funds, though that money is restricted to providing birth control counseling, STD testing and cervical cancer screening — not abortion.\u003c/p>\n\u003cp>Outside the San Francisco clinic on Valencia Street, about 40 anti-abortion protesters prayed and sang “Ave Maria,” while more than 200 counterprotesters gathered on the other side of the sidewalk, shouting slogans like, “Pro-life, that’s a lie! You don’t care if women die!”\u003c/p>\n\u003cblockquote class=\"twitter-tweet\" data-width=\"550\" data-dnt=\"true\">\n\u003cp lang=\"en\" dir=\"ltr\">Protestors on both sides of the abortion debate protest in front of the San Francisco Planned Parenthood clinic (via \u003ca href=\"https://twitter.com/adembosky?ref_src=twsrc%5Etfw\">@adembosky\u003c/a>) \u003ca href=\"https://t.co/vTOy1XbE3W\">pic.twitter.com/vTOy1XbE3W\u003c/a>\u003c/p>\n\u003cp>— KQED News (@KQEDnews) \u003ca href=\"https://twitter.com/KQEDnews/status/830548075282247680?ref_src=twsrc%5Etfw\">February 11, 2017\u003c/a>\u003c/p>\u003c/blockquote>\n\u003cp>\u003cscript async src=\"https://platform.twitter.com/widgets.js\" charset=\"utf-8\">\u003c/script>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Women on both sides wore T-shirts that said, “This is what a feminist looks like,” including Bukovinac. She said even though the back and forth got tense at times, she welcomed it.\u003c/p>\n\u003cp>“Rarely do we see a significant counterprotest. It’s almost always just us talking to ourselves, which is kind of pointless because we want to be having this national discussion,” she said. “It’s exciting to see people coming out who are also passionate about what they believe in, just like we are.”\u003c/p>\n\u003cp>A few Planned Parenthood supporters walked down the sidewalk waving $20 bills at the protesters, then went into the clinic to make a donation.\u003c/p>\n\u003cp>“This Planned Parenthood was definitely there for me as a young woman and I believe it should be there for all women anywhere,” said pro-abortion rights protester Marian Doub. “I watch the anti-choice people out here periodically and don’t feel like we’ve done enough to counter their movement. We need to step it up.”\u003c/p>\n\u003cp>Police were careful to keep protesters on either side of the sidewalk away from each other. But one anti-abortion demonstrator, Eva Muntean, broke away at the request of two young women on the pro-abortion rights side. They talked for 20 minutes, sharing their views and personal stories, debating policy and statistics. In the end, no minds were changed, no opinions swayed. But they thanked each other for the civil conversation.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“I totally respect their right to be here,” Muntean said. “I wouldn’t want it any other way.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>On the health tech beat, you often meet, broadly, two types of people. First, there are lots of very smart people who think we have the know-how to achieve a kind of big-data, perpetual-monitoring, digital-health paradise -- or at least something better than we have now.\u003c/p>\n\u003cp>Then there are some other, equally smart folks who think that particular vision is fueled by too much Silicon Valley dreamin' and too little attention to the basics of health care access and smart policy.\u003c/p>\n\u003cp>Dr. Daniel Kraft is closer to the former category. Dr. Kraft put in an \u003ca href=\"https://ww2.kqed.org/forum/2017/01/24/first-person-daniel-kraft-on-the-next-stage-of-medical-technology/\" target=\"_blank\">appearance\u003c/a> on KQED's Forum radio program recently to discuss cutting edge health tech. Kraft is the chair of medicine at Singularity University, a technology think tank, \u003ca href=\"https://techcrunch.com/2015/09/30/singularity-university-launches-accelerator/\" target=\"_blank\">startup accelerator\u003c/a> and educational organization that looks to \"leverage rapidly accelerating technologies\" to find solutions on a global scale.\u003c/p>\n\u003cp>Kraft and Forum host Michael Krasny talked about the effects of new and prospective technologies, from virtual reality's impact on medical education to the \"Uberization\" of health care. Below are excerpts of Kraft's answers, edited for length and clarity.\u003c/p>\n\u003cp>\u003cstrong>The Uberization of Health Care\u003c/strong>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Everyone is familiar with \u003ca href=\"https://ww2.kqed.org/news/tag/uber/\" target=\"_blank\">Uber as disruptive\u003c/a>. But they couldn’t have existed 10-plus years ago, without smartphones, GPS, online payments--they connected the dots.\u003c/p>\n\u003cp>We all want that ease and transparency of use that we’re used to with Uber. And we’re seeing that kind of mindset come not just to millennials but to \u003ca href=\"https://www.google.com/search?q=senior+citizens+digital+health+care\" target=\"_blank\">older folks\u003c/a> who want access to their clinical data and doctor. There are several companies that have launched apps where you press a button and a doctor will come to you within three hours. Uber itself did a pilot in New York where you press a button and a nurse will come and \u003ca href=\"http://fortune.com/2016/10/25/uber-free-flu-shots/\" target=\"_blank\">give you\u003c/a> a flu shot. This ease-of-access mindset is coming across in many parts of health care, including \u003ca href=\"http://www.cnbc.com/2016/05/16/digital-focused-pharmacy-capsule-opens-in-new-york.html\" target=\"_blank\">delivering your drugs\u003c/a>, whether it's by Uber, Lyft or drone.\u003c/p>\n\u003cp>\u003cstrong>The Potential of Digital Health Data\u003c/strong>\u003c/p>\n\u003cp>We’re in this age of exponential data, but how do you make it useful to you as a consumer, patient and physician? A lot of digital devices get \u003ca href=\"https://ww2.kqed.org/futureofyou/2016/10/10/fitbit-study/\" target=\"_blank\">left in a drawer\u003c/a> after a month or so; the trick is to make them engaging.\u003c/p>\n\u003cp>We practice sick care today, spending most of our time and money on folks who already have disease. But we can really move to more proactive, continuous health care using some of these tools.\u003c/p>\n\u003cp>In the future we’ll have individualized check engine lights. Your information will be synthesized so that a warning light can say, \"Hey, time to come in for a checkup before you blow a gasket.\"\u003c/p>\n\u003cp>\u003cstrong>Digital Mental Health Tools\u003c/strong>\u003c/p>\n\u003cp>With some wearables and other technologies we can now get a pulse on our behaviors. Right now I’m wearing a couple of devices that \u003ca href=\"http://sleepjunkies.com/features/the-ultimate-guide-to-sleep-tracking/\" target=\"_blank\">track my sleep\u003c/a>. I have a ring that can do this; I have a sensor on my mattress. Just getting insight into how you sleep can have a huge impact on health and wellness over the long term.\u003c/p>\n\u003cp>It’s the same thing for depression and anxiety. We’re seeing companies that can be a platform for mental health progression. For example, for bipolar patients, if you’re depressed and not moving much and staying in the house, some of these \u003ca href=\"http://www.nature.com/news/mental-health-there-s-an-app-for-that-1.19694\">new platforms\u003c/a> allow you to access your care team and your family, so you can get a digital hug when you might need one.\u003c/p>\n\u003cp>\u003cstrong>Virtual and Augmented Reality\u003c/strong>\u003c/p>\n\u003cp>Physicians today spend twice as much time typing in their medical records than they do with patients. So one of the best applications is using Google Glass or a similar product so physicians can see their patients and view data but have someone else act as a virtual \u003ca href=\"http://www.healthcare-informatics.com/article/ehr/how-virtual-scribe-enhancing-doctor-patient-relationship\" target=\"_blank\">scribe\u003c/a>.\u003c/p>\n\u003cp>We’re seeing now how Oculus Rift can help medical students \u003ca href=\"http://www.roadtovr.com/vr-human-anatomy-to-give-medical-students-a-hands-on-using-oculus-touch/\" target=\"_blank\">learn anatomy\u003c/a>, allowing them to fly through the heart or the brain. We’re seeing ways to use VR to \u003ca href=\"https://ww2.kqed.org/futureofyou/2015/05/28/how-virtual-reality-worlds-can-help-reduce-pain/\" target=\"_blank\">treat burn patients\u003c/a> who have undergone painful surgeries; they're put into a cold environment where they get to throw snowballs, and it diminishes their pain and their need for opiates. And kids with autism can now \u003ca href=\"https://ww2.kqed.org/futureofyou/2016/04/08/google-glass-flopped-but-kids-with-autism-are-using-it-to-learn-emotions/\" target=\"_blank\">put on Google Glass\u003c/a> and learn to recognize facial emotions.\u003c/p>\n\u003cp>\u003cstrong>Health Screening Tools\u003c/strong>\u003c/p>\n\u003cp>Part of the future will be to use new screening tools: app-based eye-tracking devices, blood-based diagnostics, brain scans that might pick up dementia 10 or 15 years early. There are drugs in development that might stop or reverse plaques when you’re at stage 0, before you have symptoms.\u003c/p>\n\u003cp>Even with your 23andme data, primary care doctors could gain some insights--when to screen you or \u003ca href=\"http://www.npr.org/sections/health-shots/2015/09/01/436584534/are-statins-bad-for-me-personalized-medicine-cant-yet-say\" target=\"_blank\">what statin drugs\u003c/a> may work best for you, based on your \u003ca href=\"https://ghr.nlm.nih.gov/primer/genomicresearch/pharmacogenomics\" target=\"_blank\">pharmacogenomics\u003c/a>. The challenge is a lot of this information doesn’t flow to your physicians; they’re not incentivized to use it, and in some cases they're dis-incentivized.\u003c/p>\n\u003cp>\u003cstrong>Health Care vs. Technology Care\u003c/strong>\u003c/p>\n\u003cp>Folks talk about robot physicians or the app \u003ca href=\"https://ww2.kqed.org/futureofyou/2016/11/07/AI-computers-diagnosis-watson/\" target=\"_blank\">taking over\u003c/a> your medical care. I think it’s going to be more of a blend, not just AI but IA, intelligence augmentation. So in fields like \u003ca href=\"https://ww2.kqed.org/futureofyou/2016/10/25/technology-radiology/\" target=\"_blank\">radiology\u003c/a> or dermatology or pathology, where clinicians are trained to see patterns, now machine learning can arguably do that faster and better, and that can augment a primary care doctor in screening you for melanoma, for example.\u003c/p>\n\u003cp>We’re seeing the ability to do triage with \u003ca href=\"http://www.theverge.com/2016/10/11/13240434/baidu-medical-chatbot-china-melody\" target=\"_blank\">chatbots\u003c/a>, which you might access from your phone and help you do the first steps. I’ve got a few \u003ca href=\"http://tricorder.xprize.org/teams/final-frontier-medical-devices\" target=\"_blank\">medical tricorders\u003c/a>, inspired by \"Star Trek,\" with me. So at home or in your pocket you can literally pull down advanced vital signs that synch up with your phone and connect to your clinicians, and AI agents can help you understand where you are in your baseline and the way things are moving.\u003c/p>\n\u003cp>We don’t need to replace doctors, but maybe every visit \u003ca href=\"https://ww2.kqed.org/futureofyou/2016/02/03/virtual_care_clinic_usc/\" target=\"_blank\">doesn’t need\u003c/a> to require you to take off half a day of work, sit in the waiting room and fill out the same form. You might use your smartphone for a follow-up appointment to look at a wound from surgery, or to check on a suspicious skin lesion. As cost pressures go, we’ll be seeing more and more payment for some of these \u003ca href=\"http://www.huffingtonpost.ca/jacki-andre/health-care-telemedicine_b_14632688.html\" target=\"_blank\">telehealth\u003c/a> platforms.\u003c/p>\n\u003cp>\u003cstrong>Pediatrics and Technology \u003c/strong>\u003c/p>\n\u003cp>There's a lot of new tech coming for pregnant women and children. A connected otoscope can enable you to track kids with ear infections at home, so you don't have to drag them back to the doctor. We’re seeing sensored cribs or infant ankle bracelets, sort of a Fitbit for babies, which can help reassure worried parents or enable a physician to send a child home earlier when they're at risk of SIDS or asthma.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>More on \u003ca href=\"https://su.org/\" target=\"_blank\">Singularity University\u003c/a> and what it calls \u003ca href=\"https://exponential.singularityu.org/medicine/\" target=\"_blank\">exponential medicine here\u003c/a>.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>On the health tech beat, you often meet, broadly, two types of people. First, there are lots of very smart people who think we have the know-how to achieve a kind of big-data, perpetual-monitoring, digital-health paradise -- or at least something better than we have now.\u003c/p>\n\u003cp>Then there are some other, equally smart folks who think that particular vision is fueled by too much Silicon Valley dreamin' and too little attention to the basics of health care access and smart policy.\u003c/p>\n\u003cp>Dr. Daniel Kraft is closer to the former category. Dr. Kraft put in an \u003ca href=\"https://ww2.kqed.org/forum/2017/01/24/first-person-daniel-kraft-on-the-next-stage-of-medical-technology/\" target=\"_blank\">appearance\u003c/a> on KQED's Forum radio program recently to discuss cutting edge health tech. Kraft is the chair of medicine at Singularity University, a technology think tank, \u003ca href=\"https://techcrunch.com/2015/09/30/singularity-university-launches-accelerator/\" target=\"_blank\">startup accelerator\u003c/a> and educational organization that looks to \"leverage rapidly accelerating technologies\" to find solutions on a global scale.\u003c/p>\n\u003cp>Kraft and Forum host Michael Krasny talked about the effects of new and prospective technologies, from virtual reality's impact on medical education to the \"Uberization\" of health care. Below are excerpts of Kraft's answers, edited for length and clarity.\u003c/p>\n\u003cp>\u003cstrong>The Uberization of Health Care\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Everyone is familiar with \u003ca href=\"https://ww2.kqed.org/news/tag/uber/\" target=\"_blank\">Uber as disruptive\u003c/a>. But they couldn’t have existed 10-plus years ago, without smartphones, GPS, online payments--they connected the dots.\u003c/p>\n\u003cp>We all want that ease and transparency of use that we’re used to with Uber. And we’re seeing that kind of mindset come not just to millennials but to \u003ca href=\"https://www.google.com/search?q=senior+citizens+digital+health+care\" target=\"_blank\">older folks\u003c/a> who want access to their clinical data and doctor. There are several companies that have launched apps where you press a button and a doctor will come to you within three hours. Uber itself did a pilot in New York where you press a button and a nurse will come and \u003ca href=\"http://fortune.com/2016/10/25/uber-free-flu-shots/\" target=\"_blank\">give you\u003c/a> a flu shot. This ease-of-access mindset is coming across in many parts of health care, including \u003ca href=\"http://www.cnbc.com/2016/05/16/digital-focused-pharmacy-capsule-opens-in-new-york.html\" target=\"_blank\">delivering your drugs\u003c/a>, whether it's by Uber, Lyft or drone.\u003c/p>\n\u003cp>\u003cstrong>The Potential of Digital Health Data\u003c/strong>\u003c/p>\n\u003cp>We’re in this age of exponential data, but how do you make it useful to you as a consumer, patient and physician? A lot of digital devices get \u003ca href=\"https://ww2.kqed.org/futureofyou/2016/10/10/fitbit-study/\" target=\"_blank\">left in a drawer\u003c/a> after a month or so; the trick is to make them engaging.\u003c/p>\n\u003cp>We practice sick care today, spending most of our time and money on folks who already have disease. But we can really move to more proactive, continuous health care using some of these tools.\u003c/p>\n\u003cp>In the future we’ll have individualized check engine lights. Your information will be synthesized so that a warning light can say, \"Hey, time to come in for a checkup before you blow a gasket.\"\u003c/p>\n\u003cp>\u003cstrong>Digital Mental Health Tools\u003c/strong>\u003c/p>\n\u003cp>With some wearables and other technologies we can now get a pulse on our behaviors. Right now I’m wearing a couple of devices that \u003ca href=\"http://sleepjunkies.com/features/the-ultimate-guide-to-sleep-tracking/\" target=\"_blank\">track my sleep\u003c/a>. I have a ring that can do this; I have a sensor on my mattress. Just getting insight into how you sleep can have a huge impact on health and wellness over the long term.\u003c/p>\n\u003cp>It’s the same thing for depression and anxiety. We’re seeing companies that can be a platform for mental health progression. For example, for bipolar patients, if you’re depressed and not moving much and staying in the house, some of these \u003ca href=\"http://www.nature.com/news/mental-health-there-s-an-app-for-that-1.19694\">new platforms\u003c/a> allow you to access your care team and your family, so you can get a digital hug when you might need one.\u003c/p>\n\u003cp>\u003cstrong>Virtual and Augmented Reality\u003c/strong>\u003c/p>\n\u003cp>Physicians today spend twice as much time typing in their medical records than they do with patients. So one of the best applications is using Google Glass or a similar product so physicians can see their patients and view data but have someone else act as a virtual \u003ca href=\"http://www.healthcare-informatics.com/article/ehr/how-virtual-scribe-enhancing-doctor-patient-relationship\" target=\"_blank\">scribe\u003c/a>.\u003c/p>\n\u003cp>We’re seeing now how Oculus Rift can help medical students \u003ca href=\"http://www.roadtovr.com/vr-human-anatomy-to-give-medical-students-a-hands-on-using-oculus-touch/\" target=\"_blank\">learn anatomy\u003c/a>, allowing them to fly through the heart or the brain. We’re seeing ways to use VR to \u003ca href=\"https://ww2.kqed.org/futureofyou/2015/05/28/how-virtual-reality-worlds-can-help-reduce-pain/\" target=\"_blank\">treat burn patients\u003c/a> who have undergone painful surgeries; they're put into a cold environment where they get to throw snowballs, and it diminishes their pain and their need for opiates. And kids with autism can now \u003ca href=\"https://ww2.kqed.org/futureofyou/2016/04/08/google-glass-flopped-but-kids-with-autism-are-using-it-to-learn-emotions/\" target=\"_blank\">put on Google Glass\u003c/a> and learn to recognize facial emotions.\u003c/p>\n\u003cp>\u003cstrong>Health Screening Tools\u003c/strong>\u003c/p>\n\u003cp>Part of the future will be to use new screening tools: app-based eye-tracking devices, blood-based diagnostics, brain scans that might pick up dementia 10 or 15 years early. There are drugs in development that might stop or reverse plaques when you’re at stage 0, before you have symptoms.\u003c/p>\n\u003cp>Even with your 23andme data, primary care doctors could gain some insights--when to screen you or \u003ca href=\"http://www.npr.org/sections/health-shots/2015/09/01/436584534/are-statins-bad-for-me-personalized-medicine-cant-yet-say\" target=\"_blank\">what statin drugs\u003c/a> may work best for you, based on your \u003ca href=\"https://ghr.nlm.nih.gov/primer/genomicresearch/pharmacogenomics\" target=\"_blank\">pharmacogenomics\u003c/a>. The challenge is a lot of this information doesn’t flow to your physicians; they’re not incentivized to use it, and in some cases they're dis-incentivized.\u003c/p>\n\u003cp>\u003cstrong>Health Care vs. Technology Care\u003c/strong>\u003c/p>\n\u003cp>Folks talk about robot physicians or the app \u003ca href=\"https://ww2.kqed.org/futureofyou/2016/11/07/AI-computers-diagnosis-watson/\" target=\"_blank\">taking over\u003c/a> your medical care. I think it’s going to be more of a blend, not just AI but IA, intelligence augmentation. So in fields like \u003ca href=\"https://ww2.kqed.org/futureofyou/2016/10/25/technology-radiology/\" target=\"_blank\">radiology\u003c/a> or dermatology or pathology, where clinicians are trained to see patterns, now machine learning can arguably do that faster and better, and that can augment a primary care doctor in screening you for melanoma, for example.\u003c/p>\n\u003cp>We’re seeing the ability to do triage with \u003ca href=\"http://www.theverge.com/2016/10/11/13240434/baidu-medical-chatbot-china-melody\" target=\"_blank\">chatbots\u003c/a>, which you might access from your phone and help you do the first steps. I’ve got a few \u003ca href=\"http://tricorder.xprize.org/teams/final-frontier-medical-devices\" target=\"_blank\">medical tricorders\u003c/a>, inspired by \"Star Trek,\" with me. So at home or in your pocket you can literally pull down advanced vital signs that synch up with your phone and connect to your clinicians, and AI agents can help you understand where you are in your baseline and the way things are moving.\u003c/p>\n\u003cp>We don’t need to replace doctors, but maybe every visit \u003ca href=\"https://ww2.kqed.org/futureofyou/2016/02/03/virtual_care_clinic_usc/\" target=\"_blank\">doesn’t need\u003c/a> to require you to take off half a day of work, sit in the waiting room and fill out the same form. You might use your smartphone for a follow-up appointment to look at a wound from surgery, or to check on a suspicious skin lesion. As cost pressures go, we’ll be seeing more and more payment for some of these \u003ca href=\"http://www.huffingtonpost.ca/jacki-andre/health-care-telemedicine_b_14632688.html\" target=\"_blank\">telehealth\u003c/a> platforms.\u003c/p>\n\u003cp>\u003cstrong>Pediatrics and Technology \u003c/strong>\u003c/p>\n\u003cp>There's a lot of new tech coming for pregnant women and children. A connected otoscope can enable you to track kids with ear infections at home, so you don't have to drag them back to the doctor. We’re seeing sensored cribs or infant ankle bracelets, sort of a Fitbit for babies, which can help reassure worried parents or enable a physician to send a child home earlier when they're at risk of SIDS or asthma.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>More on \u003ca href=\"https://su.org/\" target=\"_blank\">Singularity University\u003c/a> and what it calls \u003ca href=\"https://exponential.singularityu.org/medicine/\" target=\"_blank\">exponential medicine here\u003c/a>.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Contra Costa County began its annual homeless count Thursday, and volunteers spread out looking for people like Jarrett Keesling, who is living in an encampment in Concord. They need to find out where he lives and what he needs.\u003c/p>\n\u003cp>“I need to get my license or see if I can get my license. Get an ID, that would be a definite start,” Keesling said. “It’s just transportation — transportation would make things so much easier.\u003c/p>\n\u003cfigure id=\"attachment_11287990\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-11287990 size-medium\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2017/01/20170126_CC_county_homeless_count_154-800x533.jpg\" alt=\"Contra Costa Health Services worker Shayne Kaleo hugs Jarrett Keesling, who is among the hundreds of homeless CCHS interacted with as it conducts its annual count of homeless county residents Thursday, Jan. 26, 2017 in Contra Costa County. CCHS' Division of Health, Housing and Homeless Services, its community partners and volunteers documented both sheltered and unsheltered people in the area who need permanent housing.\" width=\"800\" height=\"533\">\u003cfigcaption class=\"wp-caption-text\">Contra Costa Health Services worker Shayne Kaleo hugs Jarrett Keesling, who is among the hundreds of homeless CCHS interacted with as it conducts its annual count of homeless county residents Thursday, Jan. 26, 2017, in Contra Costa County. CCHS’s Division of Health, Housing and Homeless Services, its community partners and volunteers documented people in the area. \u003ccite>(Eric Kayne/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The \u003ca href=\"https://cchealth.org/homeless/\" target=\"_blank\" rel=\"noopener\">Contra Costa Health Services Division of Health, Housing and Homeless Services\u003c/a>, its community partners and volunteers began documenting hundreds of homeless people in the county — both sheltered and unsheltered — who need permanent housing.\u003c/p>\n\u003cp>CCHS reported during its 2016 count that approximately 3,500 people across the county identified as homeless. Data from the 2017 homeless survey, which wraps up Friday, will not be available for several weeks.\u003c/p>\n\u003cfigure id=\"attachment_11287983\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-11287983 size-medium\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2017/01/20170126_CC_county_homeless_count_119-800x533.jpg\" alt=\"Members of Contra Costa Health Services prepare to hand out bedding as it conducts its annual count of homeless county residents Thursday, Jan. 26, 2017 in Contra Costa County. CCHS's Division of Health, Housing and Homeless Services, its community partners and volunteers documented both sheltered and unsheltered people in the area who need permanent housing.\" width=\"800\" height=\"533\">\u003cfigcaption class=\"wp-caption-text\">Members of Contra Costa Health Services prepare to hand out bedding as they conduct an annual count of homeless county residents Thursday, Jan. 26, 2017, in Contra Costa County. \u003ccite>(Eric Kayne/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Contra Costa County’s overall homeless population dropped in 2016, but there were some places where it increased, like in the far eastern suburbs.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“We do anticipate that the numbers will continue to be highest in east Contra Costa County. However, we have not made any predictions as to whether or not we’ll see an overall increase in homelessness,” said Lavonna Martin, Contra Costa County’s homeless services chief.\u003c/p>\n\u003cfigure id=\"attachment_11287987\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11287987\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2017/01/20170126_CC_county_homeless_count_185-800x533.jpg\" alt=\"The homeless camp of Jarrett Keesling and Kelli Lengele, whom are among the hundreds of homeless Contra Costa Health Services (CCHS) interacted with as it conducts its annual count of homeless county residents Thursday, Jan. 26, 2017 in Contra Costa County. CCHSÕs Division of Health, Housing and Homeless Services, its community partners and volunteers documented both sheltered and unsheltered people in the area who need permanent housing.\" width=\"800\" height=\"533\">\u003cfigcaption class=\"wp-caption-text\">The homeless camp of Jarrett Keesling and Kelli Lengele, who are among the hundreds of homeless Contra Costa Health Services (CCHS) interacted with as it conducts its annual count of homeless county residents Thursday, Jan. 26, 2017, in Contra Costa County. \u003ccite>(Eric Kayne/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The county has struggled to serve eastern Contra Costa as the population has quickly grown.\u003c/p>\n\u003cfigure id=\"attachment_11287986\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-11287986 size-medium\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2017/01/20170126_CC_county_homeless_count_041-800x533.jpg\" alt=\"Jarrett Keesling, left, and Kelli Lengele, are among the hundreds of homeless Contra Costa Health Services (CCHS) interacted with as it conducts its annual count of homeless county residents Thursday, Jan. 26, 2017 in Contra Costa County.\" width=\"800\" height=\"533\">\u003cfigcaption class=\"wp-caption-text\">Jarrett Keesling, left, and Kelli Lengele are among the hundreds of homeless Contra Costa Health Services (CCHS) interacted with as it conducts its annual count of homeless county residents Thursday, Jan. 26, 2017, in Contra Costa County. \u003ccite>(Eric Kayne/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cfigure id=\"attachment_11289119\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11289119\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/01/RS23881_20170126_CC_county_homeless_count_234-800x533.jpg\" alt=\"A trucker looks down upon the homeless camp of Jarrett Keesling and Kelli Lengele, whom are among the hundreds of homeless Contra Costa Health Services (CCHS) interacted with as it conducts its annual count of homeless county residents Thursday, Jan. 26, 2017 in Contra Costa County. \" width=\"800\" height=\"533\">\u003cfigcaption class=\"wp-caption-text\">A trucker looks down upon the homeless camp of Jarrett Keesling and Kelli Lengele, who are among the hundreds of homeless Contra Costa Health Services (CCHS) interacted with as it conducts its annual count of homeless county residents Thursday, Jan. 26, 2017, in Contra Costa County. \u003ccite>(Eric Kayne/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Many Bay Area counties are launching homeless surveys. San Francisco launched its count Thursday night and Alameda County will begin its census on Jan. 31.\u003c/p>\n\u003cfigure id=\"attachment_11287980\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11287980\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2017/01/20170126_CC_county_homeless_count_016-800x533.jpg\" alt=\"Members of Contra Costa Health Services (CCHS) walk to a homeless encampment to conduct its annual count of homeless county residents Thursday, Jan. 26, 2017 in Contra Costa County. CCHSÕs Division of Health, Housing and Homeless Services, its community partners and volunteers documented both sheltered and unsheltered people in the area who need permanent housing.\" width=\"800\" height=\"533\">\u003cfigcaption class=\"wp-caption-text\">Members of Contra Costa Health Services (CCHS) walk to a homeless encampment to conduct its annual count of homeless county residents Thursday, Jan. 26, 2017, in Contra Costa County. \u003ccite>(Eric Kayne/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>\u003ca href=\"http://erickayne.com/\" target=\"_blank\" rel=\"noopener\">Eric Kayne\u003c/a> is an award-winning photojournalist who has worked for the Houston Chronicle, Dallas Morning News and Seattle Times. KQED’s Devin Katayama contributed to this post.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Contra Costa County began its annual homeless count Thursday, and volunteers spread out looking for people like Jarrett Keesling, who is living in an encampment in Concord. They need to find out where he lives and what he needs.\u003c/p>\n\u003cp>“I need to get my license or see if I can get my license. Get an ID, that would be a definite start,” Keesling said. “It’s just transportation — transportation would make things so much easier.\u003c/p>\n\u003cfigure id=\"attachment_11287990\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-11287990 size-medium\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2017/01/20170126_CC_county_homeless_count_154-800x533.jpg\" alt=\"Contra Costa Health Services worker Shayne Kaleo hugs Jarrett Keesling, who is among the hundreds of homeless CCHS interacted with as it conducts its annual count of homeless county residents Thursday, Jan. 26, 2017 in Contra Costa County. CCHS' Division of Health, Housing and Homeless Services, its community partners and volunteers documented both sheltered and unsheltered people in the area who need permanent housing.\" width=\"800\" height=\"533\">\u003cfigcaption class=\"wp-caption-text\">Contra Costa Health Services worker Shayne Kaleo hugs Jarrett Keesling, who is among the hundreds of homeless CCHS interacted with as it conducts its annual count of homeless county residents Thursday, Jan. 26, 2017, in Contra Costa County. CCHS’s Division of Health, Housing and Homeless Services, its community partners and volunteers documented people in the area. \u003ccite>(Eric Kayne/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The \u003ca href=\"https://cchealth.org/homeless/\" target=\"_blank\" rel=\"noopener\">Contra Costa Health Services Division of Health, Housing and Homeless Services\u003c/a>, its community partners and volunteers began documenting hundreds of homeless people in the county — both sheltered and unsheltered — who need permanent housing.\u003c/p>\n\u003cp>CCHS reported during its 2016 count that approximately 3,500 people across the county identified as homeless. Data from the 2017 homeless survey, which wraps up Friday, will not be available for several weeks.\u003c/p>\n\u003cfigure id=\"attachment_11287983\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-11287983 size-medium\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2017/01/20170126_CC_county_homeless_count_119-800x533.jpg\" alt=\"Members of Contra Costa Health Services prepare to hand out bedding as it conducts its annual count of homeless county residents Thursday, Jan. 26, 2017 in Contra Costa County. CCHS's Division of Health, Housing and Homeless Services, its community partners and volunteers documented both sheltered and unsheltered people in the area who need permanent housing.\" width=\"800\" height=\"533\">\u003cfigcaption class=\"wp-caption-text\">Members of Contra Costa Health Services prepare to hand out bedding as they conduct an annual count of homeless county residents Thursday, Jan. 26, 2017, in Contra Costa County. \u003ccite>(Eric Kayne/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Contra Costa County’s overall homeless population dropped in 2016, but there were some places where it increased, like in the far eastern suburbs.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“We do anticipate that the numbers will continue to be highest in east Contra Costa County. However, we have not made any predictions as to whether or not we’ll see an overall increase in homelessness,” said Lavonna Martin, Contra Costa County’s homeless services chief.\u003c/p>\n\u003cfigure id=\"attachment_11287987\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11287987\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2017/01/20170126_CC_county_homeless_count_185-800x533.jpg\" alt=\"The homeless camp of Jarrett Keesling and Kelli Lengele, whom are among the hundreds of homeless Contra Costa Health Services (CCHS) interacted with as it conducts its annual count of homeless county residents Thursday, Jan. 26, 2017 in Contra Costa County. CCHSÕs Division of Health, Housing and Homeless Services, its community partners and volunteers documented both sheltered and unsheltered people in the area who need permanent housing.\" width=\"800\" height=\"533\">\u003cfigcaption class=\"wp-caption-text\">The homeless camp of Jarrett Keesling and Kelli Lengele, who are among the hundreds of homeless Contra Costa Health Services (CCHS) interacted with as it conducts its annual count of homeless county residents Thursday, Jan. 26, 2017, in Contra Costa County. \u003ccite>(Eric Kayne/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The county has struggled to serve eastern Contra Costa as the population has quickly grown.\u003c/p>\n\u003cfigure id=\"attachment_11287986\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-11287986 size-medium\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2017/01/20170126_CC_county_homeless_count_041-800x533.jpg\" alt=\"Jarrett Keesling, left, and Kelli Lengele, are among the hundreds of homeless Contra Costa Health Services (CCHS) interacted with as it conducts its annual count of homeless county residents Thursday, Jan. 26, 2017 in Contra Costa County.\" width=\"800\" height=\"533\">\u003cfigcaption class=\"wp-caption-text\">Jarrett Keesling, left, and Kelli Lengele are among the hundreds of homeless Contra Costa Health Services (CCHS) interacted with as it conducts its annual count of homeless county residents Thursday, Jan. 26, 2017, in Contra Costa County. \u003ccite>(Eric Kayne/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cfigure id=\"attachment_11289119\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11289119\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/01/RS23881_20170126_CC_county_homeless_count_234-800x533.jpg\" alt=\"A trucker looks down upon the homeless camp of Jarrett Keesling and Kelli Lengele, whom are among the hundreds of homeless Contra Costa Health Services (CCHS) interacted with as it conducts its annual count of homeless county residents Thursday, Jan. 26, 2017 in Contra Costa County. \" width=\"800\" height=\"533\">\u003cfigcaption class=\"wp-caption-text\">A trucker looks down upon the homeless camp of Jarrett Keesling and Kelli Lengele, who are among the hundreds of homeless Contra Costa Health Services (CCHS) interacted with as it conducts its annual count of homeless county residents Thursday, Jan. 26, 2017, in Contra Costa County. \u003ccite>(Eric Kayne/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Many Bay Area counties are launching homeless surveys. San Francisco launched its count Thursday night and Alameda County will begin its census on Jan. 31.\u003c/p>\n\u003cfigure id=\"attachment_11287980\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11287980\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2017/01/20170126_CC_county_homeless_count_016-800x533.jpg\" alt=\"Members of Contra Costa Health Services (CCHS) walk to a homeless encampment to conduct its annual count of homeless county residents Thursday, Jan. 26, 2017 in Contra Costa County. CCHSÕs Division of Health, Housing and Homeless Services, its community partners and volunteers documented both sheltered and unsheltered people in the area who need permanent housing.\" width=\"800\" height=\"533\">\u003cfigcaption class=\"wp-caption-text\">Members of Contra Costa Health Services (CCHS) walk to a homeless encampment to conduct its annual count of homeless county residents Thursday, Jan. 26, 2017, in Contra Costa County. \u003ccite>(Eric Kayne/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>\u003ca href=\"http://erickayne.com/\" target=\"_blank\" rel=\"noopener\">Eric Kayne\u003c/a> is an award-winning photojournalist who has worked for the Houston Chronicle, Dallas Morning News and Seattle Times. KQED’s Devin Katayama contributed to this post.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"slug": "california-withdraws-bid-to-allow-undocumented-immigrants-to-buy-unsubsidized-obamacare-plans",
"title": "California Withdraws Bid to Allow Undocumented Immigrants to Buy Unsubsidized Obamacare Plans",
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"headTitle": "California Withdraws Bid to Allow Undocumented Immigrants to Buy Unsubsidized Obamacare Plans | KQED",
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"content": "\u003cp>Lawmakers in Sacramento have halted a first-in-the-nation effort by California to expand access to health coverage for immigrants living in the state without legal documents.\u003c/p>\n\u003cp>At the behest of the state Legislature, Covered California, the state’s insurance exchange, withdrew its request to sell unsubsidized health plans to people who are here illegally. The withdrawal was \u003ca href=\"http://www.sacbee.com/news/politics-government/capitol-alert/article127360849.html\" target=\"_blank\" rel=\"noopener\">first reported\u003c/a> by the Sacramento Bee.\u003c/p>\n\u003cp>Under the Affordable Care Act, people who cannot prove they are in the country legally are barred from purchasing coverage on the exchange.\u003c/p>\n\u003cp>But some immigrants in this situation had pinned their hopes on the state’s request for an exemption from that rule, submitted last fall to the federal government. Had it been approved, undocumented Californians would have been allowed to buy Covered California plans and join the roughly 1.3 million other people currently enrolled in the exchange.\u003c/p>\n\u003cp>The effort to give undocumented immigrants access to the state exchange was spearheaded by state Sen. Ricardo Lara (D-Bell Gardens) and other Democrats. They passed legislation last year and Gov. Jerry Brown signed the measure in June. It authorized Covered California to submit an application to federal officials to waive the ban on such sales.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>But the chances of federal approval dimmed considerably with the election of Donald Trump, who has pledged to deport immigrants in the country without official papers, and to repeal the Affordable Care Act.\u003c/p>\n\u003cp>Peter Lee, executive director of Covered California, declined to comment on the withdrawal of the state’s request for the waiver. He referred to a \u003ca href=\"http://hbex.coveredca.com/stakeholders/Covered%20California%201332%20Waiver/1332%20Application%20Withdrawal%20Request%2001%2018.pdf\" target=\"_blank\" rel=\"noopener\">letter\u003c/a> the exchange sent Wednesday to the Obama administration, which said the proposal was shelved at the request of Lara.\u003c/p>\n\u003cp>Lara said in a written statement that he was withdrawing the plan because he feared the Trump administration might use information gleaned from it for the purpose of deporting undocumented immigrants.\u003c/p>\n\u003cp>The plan to sell to undocumented immigrants is “the first California casualty of the Trump presidency,” Lara wrote. “I take Trump at his words that anyone is subject to deportation at any time, and California will not be part of a wasteful and inhumane campaign against immigrants who are working hard and playing by the rules.”\u003c/p>\n\u003cp>The decision to pull the plug on the plan comes as the future of health care for millions of Californians hangs in the balance, with Republican leaders in Washington, D.C., moving to repeal the main provisions of the Affordable Care Act.\u003c/p>\n\u003cp>Anthony Wright, executive director of the consumer advocacy group Health Access California, said California’s move reflects a reorganization of priorities. What is urgent now, he said, is to preserve the current gains in Californians’ health coverage. And in order to bring undocumented immigrants into Covered California, officials must first ensure the exchange survives, Wright explained.\u003c/p>\n\u003cp>“We didn’t want this waiver request, which was almost assuredly going to get rejected, to get in the way of defending these basic programs that provide coverage for so many,” he said.\u003c/p>\n\u003cp>The sale of a Covered California health plan to immigrants without legal status had not been expected to boost enrollment in the exchange significantly, since they — unlike about 90 percent of current enrollees — would not have qualified for federal subsidies to reduce their premiums. That would have made it difficult or impossible for many of them to afford the policies. Moreover, immigrants in the state illegally can already buy health insurance in the private market, and the coverage options and premiums are similar to the plans sold on the exchange.\u003c/p>\n\u003cp>Covered California estimated last August that only 17,000 Californians would have gained health coverage as a result of opening the exchange to the undocumented population.\u003c/p>\n\u003cp>Many experts and health care consumer advocates agreed that the effort was mostly a symbolic gesture — but an important one to many people.\u003c/p>\n\u003cp>Supporters said allowing undocumented immigrants to buy coverage on the exchange would have addressed a problem for many families composed of both legal and non-legal residents. The proposal would have allowed those “mixed-status” families to purchase their insurance together through Covered California, simplifying the process for them. Many argued that it was discriminatory to bar immigrants without papers from the state marketplace.\u003c/p>\n\u003cp>Lara and other backers of the effort saw it as an important step toward expanding health coverage to all Californians regardless of their immigration status.\u003c/p>\n\u003cp>Magdalena Velazquez of San Jose, who volunteers with the advocacy group Services, Immigrant Rights, and Education Network (SIREN), has been following the issue closely. Although she does not have legal authority to be in the U.S., she has health coverage through her husband’s employer. But many of her family members and friends are uninsured.\u003c/p>\n\u003cp>“Sadly, once again we’re seeing that the fight for our health care rights has to take a pause,” Velazquez said.\u003c/p>\n\u003cp>When California submitted its request to the federal government last year, supporters hoped the Obama administration would review it quickly, increasing its chances of approval, Wright said. But as of Tuesday, the application process had gone through only a preliminary review.\u003c/p>\n\u003cp>Some health care experts believe approval would not have been guaranteed even if the Obama administration had completed its review before Trump took office. Excluding immigrants without documents was a compromise that helped get the ACA through Congress in the first place, they noted, and Obama officials would have been reluctant to renege on it.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This story was produced by \u003ca href=\"http://khn.org/\" target=\"_blank\" rel=\"noopener\">Kaiser Health News\u003c/a>, an editorially independent program of the \u003ca href=\"http://kff.org/\">Kaiser Family Foundation\u003c/a>.\u003c/em>\u003c/p>\n\n",
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"excerpt": "State lawmaker says he was worried the Trump administration would use information on those who purchased plans to try and deport them. ",
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"nprByline": "\u003cstrong>\u003ca href=\"http://californiahealthline.org/news/author/ana-b-ibarra/\">Ana Ibarra\u003c/a>\u003c/strong> and \u003cstrong>\u003ca href=\"http://californiahealthline.org/news/author/chad-terhune/\">Chad Terhune\u003c/a>\u003c/strong>\u003c/br>California HealthLine",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Lawmakers in Sacramento have halted a first-in-the-nation effort by California to expand access to health coverage for immigrants living in the state without legal documents.\u003c/p>\n\u003cp>At the behest of the state Legislature, Covered California, the state’s insurance exchange, withdrew its request to sell unsubsidized health plans to people who are here illegally. The withdrawal was \u003ca href=\"http://www.sacbee.com/news/politics-government/capitol-alert/article127360849.html\" target=\"_blank\" rel=\"noopener\">first reported\u003c/a> by the Sacramento Bee.\u003c/p>\n\u003cp>Under the Affordable Care Act, people who cannot prove they are in the country legally are barred from purchasing coverage on the exchange.\u003c/p>\n\u003cp>But some immigrants in this situation had pinned their hopes on the state’s request for an exemption from that rule, submitted last fall to the federal government. Had it been approved, undocumented Californians would have been allowed to buy Covered California plans and join the roughly 1.3 million other people currently enrolled in the exchange.\u003c/p>\n\u003cp>The effort to give undocumented immigrants access to the state exchange was spearheaded by state Sen. Ricardo Lara (D-Bell Gardens) and other Democrats. They passed legislation last year and Gov. Jerry Brown signed the measure in June. It authorized Covered California to submit an application to federal officials to waive the ban on such sales.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>But the chances of federal approval dimmed considerably with the election of Donald Trump, who has pledged to deport immigrants in the country without official papers, and to repeal the Affordable Care Act.\u003c/p>\n\u003cp>Peter Lee, executive director of Covered California, declined to comment on the withdrawal of the state’s request for the waiver. He referred to a \u003ca href=\"http://hbex.coveredca.com/stakeholders/Covered%20California%201332%20Waiver/1332%20Application%20Withdrawal%20Request%2001%2018.pdf\" target=\"_blank\" rel=\"noopener\">letter\u003c/a> the exchange sent Wednesday to the Obama administration, which said the proposal was shelved at the request of Lara.\u003c/p>\n\u003cp>Lara said in a written statement that he was withdrawing the plan because he feared the Trump administration might use information gleaned from it for the purpose of deporting undocumented immigrants.\u003c/p>\n\u003cp>The plan to sell to undocumented immigrants is “the first California casualty of the Trump presidency,” Lara wrote. “I take Trump at his words that anyone is subject to deportation at any time, and California will not be part of a wasteful and inhumane campaign against immigrants who are working hard and playing by the rules.”\u003c/p>\n\u003cp>The decision to pull the plug on the plan comes as the future of health care for millions of Californians hangs in the balance, with Republican leaders in Washington, D.C., moving to repeal the main provisions of the Affordable Care Act.\u003c/p>\n\u003cp>Anthony Wright, executive director of the consumer advocacy group Health Access California, said California’s move reflects a reorganization of priorities. What is urgent now, he said, is to preserve the current gains in Californians’ health coverage. And in order to bring undocumented immigrants into Covered California, officials must first ensure the exchange survives, Wright explained.\u003c/p>\n\u003cp>“We didn’t want this waiver request, which was almost assuredly going to get rejected, to get in the way of defending these basic programs that provide coverage for so many,” he said.\u003c/p>\n\u003cp>The sale of a Covered California health plan to immigrants without legal status had not been expected to boost enrollment in the exchange significantly, since they — unlike about 90 percent of current enrollees — would not have qualified for federal subsidies to reduce their premiums. That would have made it difficult or impossible for many of them to afford the policies. Moreover, immigrants in the state illegally can already buy health insurance in the private market, and the coverage options and premiums are similar to the plans sold on the exchange.\u003c/p>\n\u003cp>Covered California estimated last August that only 17,000 Californians would have gained health coverage as a result of opening the exchange to the undocumented population.\u003c/p>\n\u003cp>Many experts and health care consumer advocates agreed that the effort was mostly a symbolic gesture — but an important one to many people.\u003c/p>\n\u003cp>Supporters said allowing undocumented immigrants to buy coverage on the exchange would have addressed a problem for many families composed of both legal and non-legal residents. The proposal would have allowed those “mixed-status” families to purchase their insurance together through Covered California, simplifying the process for them. Many argued that it was discriminatory to bar immigrants without papers from the state marketplace.\u003c/p>\n\u003cp>Lara and other backers of the effort saw it as an important step toward expanding health coverage to all Californians regardless of their immigration status.\u003c/p>\n\u003cp>Magdalena Velazquez of San Jose, who volunteers with the advocacy group Services, Immigrant Rights, and Education Network (SIREN), has been following the issue closely. Although she does not have legal authority to be in the U.S., she has health coverage through her husband’s employer. But many of her family members and friends are uninsured.\u003c/p>\n\u003cp>“Sadly, once again we’re seeing that the fight for our health care rights has to take a pause,” Velazquez said.\u003c/p>\n\u003cp>When California submitted its request to the federal government last year, supporters hoped the Obama administration would review it quickly, increasing its chances of approval, Wright said. But as of Tuesday, the application process had gone through only a preliminary review.\u003c/p>\n\u003cp>Some health care experts believe approval would not have been guaranteed even if the Obama administration had completed its review before Trump took office. Excluding immigrants without documents was a compromise that helped get the ACA through Congress in the first place, they noted, and Obama officials would have been reluctant to renege on it.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This story was produced by \u003ca href=\"http://khn.org/\" target=\"_blank\" rel=\"noopener\">Kaiser Health News\u003c/a>, an editorially independent program of the \u003ca href=\"http://kff.org/\">Kaiser Family Foundation\u003c/a>.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"slug": "drugmakers-manipulate-orphan-drug-rules-to-create-prized-monopolies",
"title": "Drugmakers Manipulate Orphan Drug Rules To Create Prized Monopolies",
"publishDate": 1484687777,
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"headTitle": "Drugmakers Manipulate Orphan Drug Rules To Create Prized Monopolies | KQED",
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"content": "\u003cp>Lookup Tool: \u003ca href=\"http://khn.org/news/orphan-drugs-lookup-interactive/\">Orphan Drugs Database\u003c/a>\u003cbr>\nVideo: \u003ca href=\"http://khn.org/news/video-former-u-s-rep-henry-waxman-shares-deep-concerns-about-orphan-drugs/\">Interview With Henry Waxman\u003c/a>\u003cbr>\nTimeline: \u003ca href=\"http://khn.org/news/timeline-the-orphan-drug-act/\">The Orphan Drug Act\u003c/a>\u003c/p>\n\u003cp>More than 30 years ago, Congress overwhelmingly passed \u003ca href=\"https://history.nih.gov/research/downloads/PL97-414.pdf\">a landmark health bill\u003c/a> aimed at motivating pharmaceutical companies to develop new drugs for people whose rare diseases had been ignored.\u003c/p>\n\u003cp>By the drugmakers’ calculations, the markets for such diseases weren’t big enough to bother with.\u003c/p>\n\u003cp>But lucrative financial incentives created by the Orphan Drug Act signed into law by President Ronald Reagan in 1983 succeeded far beyond anyone’s expectations. More than 200 companies have brought almost 450 “orphan drugs” to market since the law took effect.\u003c/p>\n\u003cp>Yet a Kaiser Health News investigation shows that the system intended to help desperate patients is being manipulated by drugmakers to maximize profits and to protect niche markets for medicines already being taken by millions. The companies aren’t breaking the law but they are using the Orphan Drug Act to their advantage in ways that its architects say they didn’t foresee or intend. Today, many orphan medicines, originally developed to treat diseases affecting fewer than 200,000 people, come with astronomical price tags.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>And many drugs that now have orphan status aren’t entirely new. More than 70 were drugs first approved by the Food and Drug Administration for mass market use. These medicines, some with familiar brand names, were later approved as orphans. In each case, their manufacturers received millions of dollars in government incentives plus seven years of exclusive rights to treat that rare disease, or a monopoly.\u003c/p>\n\u003cp>Drugmakers of popular mass market drugs later sought and received orphan status for the cholesterol blockbuster Crestor, Abilify for psychiatric conditions, cancer drug Herceptin, and rheumatoid arthritis drug Humira, the best-selling medicine in the world.\u003c/p>\n\u003cp>More than 80 other orphans won FDA approval for more than one rare disease, and in some cases, multiple rare diseases. For each additional approval, the drugmaker qualified for a fresh batch of incentives. Botox, stocked in most dermatologists’ offices, started out as a drug to treat painful muscle spasms of the eye and now has three orphan drug approvals. It’s also approved as a mass market drug to treat a variety of ailments, including chronic migraines and wrinkles.\u003c/p>\n\u003cp>Altogether, KHN’s investigation found that about a third of orphan approvals by the FDA since the program began have been either for repurposed mass market drugs or drugs that received multiple orphan approvals.\u003c/p>\n\u003cp>“What we are seeing is a system that was created with good intent being hijacked,” said Bernard Munos, a former corporate strategy advisor at drug giant Eli Lilly and Co. who reviewed the KHN analysis of several FDA drug databases. It’s “quite remarkable that it has gone on for so long.”\u003c/p>\n\u003cp>And the proportion of \u003ca href=\"http://www.fda.gov/Drugs/DevelopmentApprovalProcess/DrugInnovation/ucm534863.htm\">new drugs\u003c/a> approved as orphans has ballooned. In 2015, 21 orphan drugs were approved, accounting for 47 percent of all new medicines, up from just 29 percent in 2010; in 2016, nine more orphans won approval, 40 percent of the total.\u003c/p>\n\u003cp>When a drugmaker wins approval of a medicine for an orphan disease, the company gets seven years of exclusive rights to the marketplace, which means the FDA won’t approve another version to treat that rare disease for seven years, even if the brand name company’s patent has run out. The exclusivity is compensation for developing a drug designed for a small number of patients whose total sales weren’t expected to be that profitable.\u003c/p>\n\u003cp>But the exclusivity is a potent pricing tool. Drugmakers can charge whatever they want by shielding their medicine from competition. The market exclusivity granted by the Orphan Drug Act can be a vital part of the protective shield that companies create. What’s more, manufacturers can return to the FDA with the same drug again and again, each time testing the drug against a new rare disease.\u003c/p>\n\u003cp>Critics have assailed drugmakers in the past for gaming the orphan drug approval process. But the extent to which companies have been winning approval for drugs that aren’t what advocates call “true orphans” hadn’t been documented until the Kaiser Health News investigation.\u003c/p>\n\u003cp>Munos said he was “shocked” by the sheer number of mass market drugs being repurposed as well as those approved multiple times.\u003c/p>\n\u003cp>Even agency officials said they weren’t aware of the scope of the issue. After reviewing KHN’s findings for two weeks, Dr. Gayatri Rao director of the FDA’s Office of Orphan Products Development said she “appreciated the work” and expressed interest in studying how often drug companies are “repurposing” a drug for a new rare disease, or taking “multiple bites of the apple.”\u003c/p>\n\u003cp>“We are going to look into this,” she said, adding that she could consider a regulatory change.\u003c/p>\n\u003cp>Rao pointed out that the “repurposing” of drugs does have scientific and patient benefits. For example, cancer drugs approved for one type of malignancy can be tested and approved for others. Gleevec, a drug that revolutionized the treatment of chronic myeloid leukemia, now has nine orphan approvals.\u003c/p>\n\u003cp>But in a \u003ca href=\"http://www.hopkinsmedicine.org/news/media/releases/orphan_drug_loophole_needs_closing_johns_hopkins_researchers_say\">2015 commentary\u003c/a> published in the American Journal of Clinical Oncology, Dr. Martin Makary at the Johns Hopkins University School of Medicine focused on cancer drugs including Gleevec, arguing that the drug was never meant to serve an orphan population. Instead, Makary and his team wrote, drugmakers purposely identify small patient populations to gain additional approvals — a process he described as “salami slicing.”\u003c/p>\n\u003cp>“By salami slicing the disease into subgroups, it allows them to get the orphan drug approval with all the government benefits and even some of the subsidies,” Makary said. The prices of such medications often rise because they have seven years without competition for a new set of patients, Makary added.\u003c/p>\n\u003cp>The FDA has taken a different view of repurposing.\u003c/p>\n\u003cp>“We always talked about how we permit the second bite of the apple, third bite of the apple, as one small way to incentivize repurposing,” Rao said, noting that industry and patient groups have been pressing the FDA for even stronger incentives. “Now, all of sudden, it seems like, wow, this practice may be driving up prices.”\u003c/p>\n\u003cp>Novartis, which owns Gleevec, said in an email statement that the company is advancing research and following the science to “bring the right treatments to the right patients based on unmet need, not the size of the patient population.”\u003c/p>\n\u003cp>Two KHN reporters spent six months analyzing data and talking to lawmakers, patients, advocates, doctors and companies to understand how the FDA’s orphan drug program has evolved amid a national uproar over soaring drug prices. President-elect Donald Trump vowed on the campaign trail to \u003ca href=\"http://www.reuters.com/article/us-usa-trump-pharmaceuticals-idUSKBN13W21I\">bring down\u003c/a> prescription drug prices and during a Jan. 11 press conference said the drug industry is \u003ca href=\"https://www.nytimes.com/2017/01/11/us/politics/trump-press-conference-transcript.html?_r=0\">“getting away with murder.”\u003c/a>\u003c/p>\n\u003cp>The investigation examined how drugmakers use the law to their advantage — often with the guidance of former FDA officials — and have made the development of medicines that were once thought to be business backwaters into one of the pharmaceutical industry’s hottest sectors.\u003c/p>\n\u003cp>Orphan drugs now account for seven of the 10 top-selling drugs of any kind, ranked by annual sales, according to EvaluatePharma.\u003c/p>\n\u003cp>“Orphans are wicked hot,” said Dr. Tim Coté, a former FDA official who now runs a consulting firm that advises drugmakers on orphan drugs.\u003c/p>\n\u003cp>No one disputes that orphan drugs have helped or saved hundreds of thousands of patients suffering from debilitating or even fatal rare diseases. Exactly how many is difficult to estimate because the FDA doesn’t track such information.\u003c/p>\n\u003cp>And drug industry officials say companies should be rewarded, not punished, for making those treatments possible and for pursuing new drugs that aren’t always an economic success.\u003c/p>\n\u003cp>Research and development is “long, costly, risky,” said Anne Pritchett, vice president, policy and research at industry lobbying group PhRMA. “When you look at cystic fibrosis it was 25 years to the development of an effective therapy … I think we would be concerned about anything that would undermine the current [orphan drug] incentives.”\u003c/p>\n\u003cp>Former U.S. Rep. Henry Waxman, D-Calif., a champion of the 1983 Orphan Drug Act takes a different view.\u003c/p>\n\u003cp>“The Orphan Drug Act has been a great success because many people with diseases that affect very few people now have drugs available to them,” Waxman said. “But it’s been in some ways turned on its head when it becomes the basis of manipulating the system for the drug company to make much more money than they would in an open, competitive market.”\u003c/p>\n\u003cp>Booming Business\u003c/p>\n\u003cp>On a late summer day, Tim Coté sat in a corner office of his Sandy Spring, Md., consulting firm, Coté Orphan. He leaned into his computer microphone to dispense insider knowledge about the orphan drug approval process on a webcast hosted by FDAnews, a trade news organization. Listeners paid about $300 a head, but Coté said he wasn’t paid for doing it.\u003c/p>\n\u003cp>The FDA is more flexible in evaluating drugs for rare diseases, he said, explaining that “about half of them get through with just one pivotal clinical trial. Not so for common diseases.” The FDA, citing \u003ca href=\"http://www.fda.gov/downloads/ForIndustry/DevelopingProductsforRareDiseasesConditions/OOPDNewsArchive/UCM294773.pdf\">a report\u003c/a> from the National Organization for Rare Disorders, said about two-thirds of orphan drugs were approved with one adequate and well-controlled trial with supportive evidence. It typically requires two or three such trials to approve a mass market drug.\u003c/p>\n\u003cp>Coté also told the webinar audience that clinical trials for orphan drugs are usually smaller and the approval is a “different scientific and regulatory experience.”\u003c/p>\n\u003cp>Coté knows his stuff. He was Rao’s immediate predecessor as chief of the FDA’s Office of Orphan Products Development. It’s not unusual for government officials to leave FDA and other regulatory agencies and \u003ca href=\"http://www.npr.org/sections/health-shots/2016/09/28/495694559/a-look-at-how-the-revolving-door-spins-from-fda-to-industry\">obtain jobs as consultants or industry executives\u003c/a>.\u003c/p>\n\u003cp>Coté’s website, headlined “The Inside Track,” notes that he oversaw applications that led to the approval of at least 150 orphan drugs when he was at the FDA and that his firm is now the largest submitter of orphan drug applications.\u003c/p>\n\u003cp>“We write the entire application,” the website for Coté’s company notes, adding that his staff of 25 includes regulatory scientists with deep knowledge and experience in FDA’s “unwritten rules” regarding orphan drugs.\u003c/p>\n\u003cp>Many of Coté’s more than 300 clients are small biotech companies begun by researchers or even passionate parents who found investment backing. Parents Ilan and Annie Ganot, for example, started Solid Biosciences to find treatments and potentially a cure for their son with Duchenne muscular dystrophy.\u003c/p>\n\u003cp>Coté guides them through the regulatory process since most don’t have the expertise. He can offer his expertise and develop an application that makes it easier for the FDA to designate and approve the drug.\u003c/p>\n\u003cp>“When you make the FDA smile, the value of your asset goes up. And that’s how the game is played,” he said in an interview, adding quickly, “It’s really not a game because people’s lives are what is in balance.”\u003c/p>\n\u003cp>Coté and other ex-FDA officials play a vital role in helping drugmakers choose rare disease targets and get through the FDA approval process.\u003c/p>\n\u003cp>A small cottage industry has grown around the Orphan Drug Act. Dr. Marlene Haffner, who preceded Coté in the FDA’s orphan office, started her own consulting firm, too, to advise small and large companies on orphan drug applications. A third company is Camargo Pharmaceutical Services, led by industry veterans and former FDA officials, which advises companies focused on repurposing drugs for orphan approval. The firm tries “to be in front of the FDA a lot — three to four times a month,” said Jennifer King, Camargo’s director of marketing. Fees for consulting on orphan drugs industry wide range from $5,000 to $100,000, depending upon what services are provided, Coté said.\u003c/p>\n\u003cp>Getting through the orphan approval process involves a series of steps.\u003c/p>\n\u003cp>First, drugs must be designated by the FDA as potential candidates for approval. A company has to demonstrate that its drug is a promising treatment for a disease that affects fewer than 200,000 patients. If the FDA agrees and makes the formal designation, financial incentives kick in, including a 50 percent tax break on research and development (R&D) and access to federal grants.\u003c/p>\n\u003cp>When drugs get orphan designation, companies often reap other financial rewards. Shares in publicly traded companies often rise on the news — sometimes soaring \u003ca href=\"http://www.bizjournals.com/triangle/news/2014/02/25/dara-stock-soars-on-orphan-drug.html\">as high as 30 percent\u003c/a>. That happens, in part, because orphans have a track record of being approved at much higher rates than drugs for common diseases.\u003c/p>\n\u003cp>The 50 percent R&D tax credit pays off, too. In 2012, one of the biggest orphan drug companies, BioMarin, received \u003ca href=\"http://files.shareholder.com/downloads/ABEA-3W276N/2866327224x0x664042/776E8656-30BA-4937-A2A0-3AB6450BCA00/2012_Annual_Report.pdf\">$32.6 million\u003c/a> from a combination of federal and state of California tax credits. BioMarin spokeswoman Debra Charlesworth confirmed that the orphan credit made up the “vast majority” of that deferred tax benefit. She also noted that credit “has successfully fueled an industry that didn’t previously exist” and led to more rare disease research.\u003c/p>\n\u003cp>Industry-wide, orphan drug tax credits cost the federal government $1.76 billion in fiscal 2016 — roughly what President Barack Obama asked Congress to spend to fight \u003ca href=\"https://www.washingtonpost.com/news/post-politics/wp/2016/02/08/obama-to-ask-congress-for-1-8-billion-to-combat-zika-virus/\">the Zika virus\u003c/a> before a $1.1 billion expenditure was approved. And, because so many orphan drugs are under development, the U.S. could grant nearly $50 billion in tax credits from 2016 to 2025, estimates \u003ca href=\"https://www.treasury.gov/resource-center/tax-policy/Documents/Tax-Expenditures-FY2017.pdf\">the Treasury Department\u003c/a>.\u003c/p>\n\u003cp>There’s a lot of creativity behind figuring out how to make a drug an orphan.\u003c/p>\n\u003cp>In Coté’s webinar and in multiple interviews, he described many ways companies can win orphan status. They can test their drugs on children with adult diseases, such as schizophrenia, or find drugs for ailments like malaria that are uncommon in America.\u003c/p>\n\u003cp>“African sleeping sickness: horrible problem in Africa but not here, not in the U.S.,” Coté told his webinar audience. “So a drug development effort that was aimed toward some of these tropical diseases can actually get all the benefits of the Orphan Drug Act.”\u003c/p>\n\u003cp>Another popular strategy is to create “follow-on drugs” that represent incremental steps forward.\u003c/p>\n\u003cp>About 30 percent of Coté’s clients are companies looking to improve upon some other orphan drug “which just made billions and billions,” he said in an interview.\u003c/p>\n\u003cp>Repurposing an already approved drug is another strategy his firm promotes. In a \u003ca href=\"https://www.linkedin.com/pulse/re-purposing-drugs-orphans-timothy-cote?published=t\">video\u003c/a> posted on his website in July, Coté explained the advantages for companies that can move directly into a clinical trial without much preparatory work because the drug’s safety has already been demonstrated.\u003c/p>\n\u003cp>“All you gotta do is establish that the product can work in this new orphan indication,” he said, adding tips on how to do it and still make money.\u003c/p>\n\u003cp>‘That Is Not A True Orphan Drug’\u003c/p>\n\u003cp>Turning mass market drugs into orphans has been a familiar path for some of the most popular drugs ever discovered.\u003c/p>\n\u003cp>AbbVie’s Humira is the best-selling drug in the world, and most of its sales are in the U.S. where revenue reached $7.6 billion through \u003ca href=\"https://news.abbvie.com/news/abbvie-reports-third-quarter-2016-financial-results.htm\">the third quarter\u003c/a> of 2016 and $11.8 billion worldwide, according to the company’s latest financial report.\u003c/p>\n\u003cp>Humira was approved by the FDA in late 2002 to treat millions of people who suffer from rheumatoid arthritis. Three years later, AbbVie asked the FDA to designate it as an orphan to treat juvenile rheumatoid arthritis, which they told the FDA affects between 30,000 and 50,000 Americans. That pediatric use was approved in 2008, and Humira subsequently was approved for four more rare diseases, including Crohn’s and uveitis, an inflammatory disease affecting the eyes.\u003c/p>\n\u003cp>The ophthalmologic approval would extend the market exclusivity for Humira for that disease until 2023. When asked why AbbVie sought multiple orphan designations and approvals for Humira, the company declined to comment.\u003c/p>\n\u003cp>Peter Saltonstall, executive director of the National Organization for Rare Disorders, said that Humira is “not a true orphan drug.” But, he said, the company has “the ability to go out and get orphan designation. That’s the way the law reads right now … they can do whatever they want to do.”\u003c/p>\n\u003cp>It is difficult to say exactly how or if orphan exclusivity affects the price of Humira, which is a complex biologic drug and also has been protected by \u003ca href=\"http://www.nytimes.com/2016/07/16/business/makers-of-humira-and-enbrel-using-new-drug-patents-to-delay-generic-versions.html?_r=3\">numerous patents\u003c/a>. The drug has long been AbbVie’s top seller, accounting for 63 percent of its revenues, according to its most recent financial filing.\u003c/p>\n\u003cp>EvaluatePharma notes \u003ca href=\"http://info.evaluategroup.com/rs/607-YGS-364/images/EPOD15.pdf\">in its recent report\u003c/a> that Humira, as well as a handful of other top drugs, receive less than 25 percent of their sales from orphan uses. Still, if Humira’s orphan uses accounted for just 10 percent of annual sales, the revenue would surpass $1 billion.\u003c/p>\n\u003cp>By stacking up a series of orphan disease approvals, one seven-year exclusivity period leads into another, maximizing the length of a company’s monopoly. Sigma-Tau Pharmaceuticals, for example, had some form of orphan exclusivity over its metabolic disorder drug for more than 20 years. The drug, Carnitor, received a second orphan approval four months before its first exclusivity was set to expire. And it won its third orphan approval, for an IV formulation of the drug, just one day before its second exclusivity period was set to expire in December of 1999.\u003c/p>\n\u003cp>“The sequence and timing of regulatory filings for Carnitor reflect the time required to conduct large controlled clinical trials, as well as evolving medical strategies and regulatory pathways pursued by different sponsors over many years,” said GianFranco Fornasini, senior vice president of scientific affairs at Sigma-Tau.\u003c/p>\n\u003cp>The FDA’s Rao said each new exclusivity period is disease-specific and once any seven-year period runs out, generics can come in. Gleevec, for example, won FDA approval to treat several kinds of rare cancer. All but one of its orphan exclusivity periods had expired by 2015, allowing two generics to enter the marketplace. But Gleevec still has exclusivity until 2020 to treat newly diagnosed Philadelphia chromosome-positive acute lymphoblastic leukemia in patients who are also on chemotherapy.\u003c/p>\n\u003cp>It’s also true, Rao explained, that some of the drugs that go through the orphan process may not specifically treat a rare disease. For example, a very toxic cancer drug might may not work well in earlier stages because its risks outweigh the benefits. But the company may propose that it will help a smaller group of later-stage cancer patients and win orphan approval just for that group.\u003c/p>\n\u003cp>Former FDA orphan drug director Haffner said her FDA office worked on rules defining how companies could legitimately pursue approval for a small group of patients with a specific unmet medical need.\u003c/p>\n\u003cp>“People have played games with the Orphan Drug Act since it was passed,” said Haffner, who first took a job with drugmaker Amgen after leaving the FDA and then became an independent consultant. “It’s the American way, I don’t mean that in a nasty way. But we take advantage of what’s in front of us.”\u003c/p>\n\u003cp>In 2013, the \u003ca href=\"https://www.federalregister.gov/documents/2013/06/12/2013-13930/orphan-drug-regulations\">FDA clarified the Orphan Drug Act’s regulations\u003c/a> and said it wanted to avoid the possibility that some companies could “potentially ‘game’ approvals by seeking successive narrow approvals of a drug.”\u003c/p>\n\u003cp>In reality, Rao said, the regulations did not really change “much of what our practice was.” The agency wanted to address what Rao said were “common misconceptions” and frequently asked questions so officials changed wording in the regulations to better define exactly what could be considered an orphan drug.\u003c/p>\n\u003cp>Breaking down larger, broader diseases into smaller groups is still allowed under certain conditions and companies can still win multiple orphan approvals for a single drug — even if the total population served rises above the 200,000 mark.\u003c/p>\n\u003cp>Amgen Inc.’s Repatha won marketing approval and exclusive rights in 2015 for the orphan disease homozygous familial hypercholesterolemia, which affects a population of \u003ca href=\"http://www.lipidjournal.com/article/S1933-2874(13)00309-7/abstract\">about 300 people\u003c/a> in the U.S. On the very same day, the drug was approved as a mass market drug to treat up to 11 million people with uncontrolled levels of LDL cholesterol, said Amgen spokeswoman Kristen Davis.\u003c/p>\n\u003cp>Dr. Steven Nissen of the Cleveland Clinic, who ran a broader trial on Repatha, said, “It’s certainly not considered by any of us to be an orphan drug.”\u003c/p>\n\u003cp>Safeguarding The ‘Prize’\u003c/p>\n\u003cp>Considering the long history of what’s happened, Tim Coté acknowledges that there are “some loopholes” in the Orphan Drug Act. Perhaps 3 percent or less of approved orphans were not in the “spirit” of the law, he said.\u003c/p>\n\u003cp>But Coté, rare disease advocates, patients and people in the drug industry expressed fear that changing the Orphan Drug Act or questioning its success would hurt the development of drugs for rare patients.\u003c/p>\n\u003cp>Former U.S. Rep. Jim Greenwood, R-Pa., now president of the Biotechnology Innovation Organization, an industry trade group, said that concerns about high prices for orphan drugs aren’t justified. The incentives, he said, should not be altered because rare diseases are “tragically killing and brutalizing mostly children.”\u003c/p>\n\u003cp>Greenwood seemed unaware that dozens of orphan approvals stemmed from the repurposing of mass market drugs, like Humira or Enbrel, another drug developed first for rheumatoid arthritis. Still, he said, “I would argue that the risk of losing incentives in the system far outweighs the benefit of trying to save a few pennies on the health care dollar.”\u003c/p>\n\u003cp>It’s a sentiment that Coté and other advocates share. While talking about the $311,000 annual price tag for cystic fibrosis drug Kalydeco, Coté said any parent whose child has the disease would be a big fan of the drug.\u003c/p>\n\u003cp>“The price point is justified because actually it has a dramatic effect on the children. Dead children … people are willing to pay a lot to prevent that,” Coté said. “And that’s a real good thing that we have this drug. OK?”\u003c/p>\n\u003cp>The first drug to specifically target the underlying biochemical defect of cystic fibrosis, Kalydeco is approved to treat a subset of patients who have specific mutations in their genes. Development of the drug was financed by the Cystic Fibrosis Foundation, which sold its rights to sales royalties from Kalydeco and other cystic fibrosis drugs for $3.3 billion in 2014.\u003c/p>\n\u003cp>Others, including Henry Waxman, are far more critical and have tried to do something about it over the years. Waxman proposed multiple bills to rein in corporate profits by amending the orphan drug law that he sponsored, but none succeeded.\u003c/p>\n\u003cp>The FDA has also tried but failed, to keep corporations in check.\u003c/p>\n\u003cp>In 2012, drugmaker Depomed Inc. filed suit against the FDA for refusing to give its drug Gralise seven years of market exclusivity as a treatment for pain related to shingles.\u003c/p>\n\u003cp>Rao said the agency wanted to see proof that Gralise was clinically superior to other drugs, noting there “were a bunch of other generics on the market” with different formulations and dosing requirements. Grasile’s active ingredient, gabapentin, is the same one as in Pfizer’s mass market blockbuster \u003ca href=\"http://www.pfizer.com/products/product-detail/neurontin\">Neurontin\u003c/a>, which is also approved for treatment of shingles pain.\u003c/p>\n\u003cp>The FDA approved Gralise but denied seven years of exclusivity.\u003c/p>\n\u003cp>In response, the drugmaker sued the agency and won its case, arguing that according to the law, they didn’t have to prove their drug was clinically superior to gain the monopoly.\u003c/p>\n\u003cp>Today, the drug is one of Depomed’s top products with sales of $81 million in 2015. And, in a \u003ca href=\"http://investor.depomedinc.com/phoenix.zhtml?c=97276&p=irol-SECText&TEXT=aHR0cDovL2FwaS50ZW5rd2l6YXJkLmNvbS9maWxpbmcueG1sP2lwYWdlPTEwODc0NDE5JkRTRVE9MCZTRVE9MCZTUURFU0M9U0VDVElPTl9FTlRJUkUmc3Vic2lkPTU3\">recent proxy statement\u003c/a>, Depomed listed “protecting Gralise exclusivity” as a corporate objective under the category of “enhance and protect future cash flow.” Its orphan exclusivity ends in 2018. Depomed spokesman Christopher Keenan said Gralise wanted patent exclusivity to block competition. But, Keenan said, “Had the patent effort failed on all fronts, the Orphan Drug Designation would have been very important.”\u003c/p>\n\u003cp>After reviewing KHN’s analysis, Rao said she wants to better understand why drugmakers are applying for multiple approvals and has asked for a case-by-case review of all orphan designations granted in 2010 and 2015. She said the agency lacks the resources to run an analysis of the entire orphan drug database.\u003c/p>\n\u003cp>“Our goal is to try to get it right,” she said. “There are over 7,000 rare diseases, likely more, the vast majority of which have nothing … I want to ensure that we continue to keep our eye on that prize.”\u003c/p>\n\u003cp>Contributors: John Hillkirk, Scott Hensley at NPR, Diane Webber, Marilyn Thompson (editors); Elizabeth Lucas (data editing); Joe Neel at NPR (radio editing)\u003c/p>\n\u003cp>Interactives, video and presentation: Lydia Zuraw, Emily Kopp, Meredith Rizzo at NPR (digital presentation); Francis Ying (videos, motion graphic); Heidi de Marco (videos, photos, audio); Alley Interactive (database lookup)\u003c/p>\n\u003cp>KHN’s coverage of prescription drug development, costs and pricing is supported in part by the \u003ca href=\"http://www.arnoldfoundation.org/\">Laura and John Arnold Foundation\u003c/a>.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003ca href=\"http://www.kaiserhealthnews.org/\">Kaiser Health News\u003c/a> (KHN) is a national health policy news service. It is an editorially independent program of the \u003ca href=\"http://www.kff.org/\">Henry J. Kaiser Family Foundation\u003c/a>.\u003c/p>\n\n",
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"title": "Drugmakers Manipulate Orphan Drug Rules To Create Prized Monopolies | KQED",
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"nprByline": "\u003ca href=\"http://khn.org/news/author/sarah-jane-tribble/\">\u003cstrong>Sarah Jane Tribble\u003c/strong>\u003c/a> and \u003ca href=\"http://khn.org/news/author/sydney-lupkin/\">\u003cstrong>Sydney Lupkin\u003c/strong>\u003c/a>\u003c/br>Kaiser Health News",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Lookup Tool: \u003ca href=\"http://khn.org/news/orphan-drugs-lookup-interactive/\">Orphan Drugs Database\u003c/a>\u003cbr>\nVideo: \u003ca href=\"http://khn.org/news/video-former-u-s-rep-henry-waxman-shares-deep-concerns-about-orphan-drugs/\">Interview With Henry Waxman\u003c/a>\u003cbr>\nTimeline: \u003ca href=\"http://khn.org/news/timeline-the-orphan-drug-act/\">The Orphan Drug Act\u003c/a>\u003c/p>\n\u003cp>More than 30 years ago, Congress overwhelmingly passed \u003ca href=\"https://history.nih.gov/research/downloads/PL97-414.pdf\">a landmark health bill\u003c/a> aimed at motivating pharmaceutical companies to develop new drugs for people whose rare diseases had been ignored.\u003c/p>\n\u003cp>By the drugmakers’ calculations, the markets for such diseases weren’t big enough to bother with.\u003c/p>\n\u003cp>But lucrative financial incentives created by the Orphan Drug Act signed into law by President Ronald Reagan in 1983 succeeded far beyond anyone’s expectations. More than 200 companies have brought almost 450 “orphan drugs” to market since the law took effect.\u003c/p>\n\u003cp>Yet a Kaiser Health News investigation shows that the system intended to help desperate patients is being manipulated by drugmakers to maximize profits and to protect niche markets for medicines already being taken by millions. The companies aren’t breaking the law but they are using the Orphan Drug Act to their advantage in ways that its architects say they didn’t foresee or intend. Today, many orphan medicines, originally developed to treat diseases affecting fewer than 200,000 people, come with astronomical price tags.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>And many drugs that now have orphan status aren’t entirely new. More than 70 were drugs first approved by the Food and Drug Administration for mass market use. These medicines, some with familiar brand names, were later approved as orphans. In each case, their manufacturers received millions of dollars in government incentives plus seven years of exclusive rights to treat that rare disease, or a monopoly.\u003c/p>\n\u003cp>Drugmakers of popular mass market drugs later sought and received orphan status for the cholesterol blockbuster Crestor, Abilify for psychiatric conditions, cancer drug Herceptin, and rheumatoid arthritis drug Humira, the best-selling medicine in the world.\u003c/p>\n\u003cp>More than 80 other orphans won FDA approval for more than one rare disease, and in some cases, multiple rare diseases. For each additional approval, the drugmaker qualified for a fresh batch of incentives. Botox, stocked in most dermatologists’ offices, started out as a drug to treat painful muscle spasms of the eye and now has three orphan drug approvals. It’s also approved as a mass market drug to treat a variety of ailments, including chronic migraines and wrinkles.\u003c/p>\n\u003cp>Altogether, KHN’s investigation found that about a third of orphan approvals by the FDA since the program began have been either for repurposed mass market drugs or drugs that received multiple orphan approvals.\u003c/p>\n\u003cp>“What we are seeing is a system that was created with good intent being hijacked,” said Bernard Munos, a former corporate strategy advisor at drug giant Eli Lilly and Co. who reviewed the KHN analysis of several FDA drug databases. It’s “quite remarkable that it has gone on for so long.”\u003c/p>\n\u003cp>And the proportion of \u003ca href=\"http://www.fda.gov/Drugs/DevelopmentApprovalProcess/DrugInnovation/ucm534863.htm\">new drugs\u003c/a> approved as orphans has ballooned. In 2015, 21 orphan drugs were approved, accounting for 47 percent of all new medicines, up from just 29 percent in 2010; in 2016, nine more orphans won approval, 40 percent of the total.\u003c/p>\n\u003cp>When a drugmaker wins approval of a medicine for an orphan disease, the company gets seven years of exclusive rights to the marketplace, which means the FDA won’t approve another version to treat that rare disease for seven years, even if the brand name company’s patent has run out. The exclusivity is compensation for developing a drug designed for a small number of patients whose total sales weren’t expected to be that profitable.\u003c/p>\n\u003cp>But the exclusivity is a potent pricing tool. Drugmakers can charge whatever they want by shielding their medicine from competition. The market exclusivity granted by the Orphan Drug Act can be a vital part of the protective shield that companies create. What’s more, manufacturers can return to the FDA with the same drug again and again, each time testing the drug against a new rare disease.\u003c/p>\n\u003cp>Critics have assailed drugmakers in the past for gaming the orphan drug approval process. But the extent to which companies have been winning approval for drugs that aren’t what advocates call “true orphans” hadn’t been documented until the Kaiser Health News investigation.\u003c/p>\n\u003cp>Munos said he was “shocked” by the sheer number of mass market drugs being repurposed as well as those approved multiple times.\u003c/p>\n\u003cp>Even agency officials said they weren’t aware of the scope of the issue. After reviewing KHN’s findings for two weeks, Dr. Gayatri Rao director of the FDA’s Office of Orphan Products Development said she “appreciated the work” and expressed interest in studying how often drug companies are “repurposing” a drug for a new rare disease, or taking “multiple bites of the apple.”\u003c/p>\n\u003cp>“We are going to look into this,” she said, adding that she could consider a regulatory change.\u003c/p>\n\u003cp>Rao pointed out that the “repurposing” of drugs does have scientific and patient benefits. For example, cancer drugs approved for one type of malignancy can be tested and approved for others. Gleevec, a drug that revolutionized the treatment of chronic myeloid leukemia, now has nine orphan approvals.\u003c/p>\n\u003cp>But in a \u003ca href=\"http://www.hopkinsmedicine.org/news/media/releases/orphan_drug_loophole_needs_closing_johns_hopkins_researchers_say\">2015 commentary\u003c/a> published in the American Journal of Clinical Oncology, Dr. Martin Makary at the Johns Hopkins University School of Medicine focused on cancer drugs including Gleevec, arguing that the drug was never meant to serve an orphan population. Instead, Makary and his team wrote, drugmakers purposely identify small patient populations to gain additional approvals — a process he described as “salami slicing.”\u003c/p>\n\u003cp>“By salami slicing the disease into subgroups, it allows them to get the orphan drug approval with all the government benefits and even some of the subsidies,” Makary said. The prices of such medications often rise because they have seven years without competition for a new set of patients, Makary added.\u003c/p>\n\u003cp>The FDA has taken a different view of repurposing.\u003c/p>\n\u003cp>“We always talked about how we permit the second bite of the apple, third bite of the apple, as one small way to incentivize repurposing,” Rao said, noting that industry and patient groups have been pressing the FDA for even stronger incentives. “Now, all of sudden, it seems like, wow, this practice may be driving up prices.”\u003c/p>\n\u003cp>Novartis, which owns Gleevec, said in an email statement that the company is advancing research and following the science to “bring the right treatments to the right patients based on unmet need, not the size of the patient population.”\u003c/p>\n\u003cp>Two KHN reporters spent six months analyzing data and talking to lawmakers, patients, advocates, doctors and companies to understand how the FDA’s orphan drug program has evolved amid a national uproar over soaring drug prices. President-elect Donald Trump vowed on the campaign trail to \u003ca href=\"http://www.reuters.com/article/us-usa-trump-pharmaceuticals-idUSKBN13W21I\">bring down\u003c/a> prescription drug prices and during a Jan. 11 press conference said the drug industry is \u003ca href=\"https://www.nytimes.com/2017/01/11/us/politics/trump-press-conference-transcript.html?_r=0\">“getting away with murder.”\u003c/a>\u003c/p>\n\u003cp>The investigation examined how drugmakers use the law to their advantage — often with the guidance of former FDA officials — and have made the development of medicines that were once thought to be business backwaters into one of the pharmaceutical industry’s hottest sectors.\u003c/p>\n\u003cp>Orphan drugs now account for seven of the 10 top-selling drugs of any kind, ranked by annual sales, according to EvaluatePharma.\u003c/p>\n\u003cp>“Orphans are wicked hot,” said Dr. Tim Coté, a former FDA official who now runs a consulting firm that advises drugmakers on orphan drugs.\u003c/p>\n\u003cp>No one disputes that orphan drugs have helped or saved hundreds of thousands of patients suffering from debilitating or even fatal rare diseases. Exactly how many is difficult to estimate because the FDA doesn’t track such information.\u003c/p>\n\u003cp>And drug industry officials say companies should be rewarded, not punished, for making those treatments possible and for pursuing new drugs that aren’t always an economic success.\u003c/p>\n\u003cp>Research and development is “long, costly, risky,” said Anne Pritchett, vice president, policy and research at industry lobbying group PhRMA. “When you look at cystic fibrosis it was 25 years to the development of an effective therapy … I think we would be concerned about anything that would undermine the current [orphan drug] incentives.”\u003c/p>\n\u003cp>Former U.S. Rep. Henry Waxman, D-Calif., a champion of the 1983 Orphan Drug Act takes a different view.\u003c/p>\n\u003cp>“The Orphan Drug Act has been a great success because many people with diseases that affect very few people now have drugs available to them,” Waxman said. “But it’s been in some ways turned on its head when it becomes the basis of manipulating the system for the drug company to make much more money than they would in an open, competitive market.”\u003c/p>\n\u003cp>Booming Business\u003c/p>\n\u003cp>On a late summer day, Tim Coté sat in a corner office of his Sandy Spring, Md., consulting firm, Coté Orphan. He leaned into his computer microphone to dispense insider knowledge about the orphan drug approval process on a webcast hosted by FDAnews, a trade news organization. Listeners paid about $300 a head, but Coté said he wasn’t paid for doing it.\u003c/p>\n\u003cp>The FDA is more flexible in evaluating drugs for rare diseases, he said, explaining that “about half of them get through with just one pivotal clinical trial. Not so for common diseases.” The FDA, citing \u003ca href=\"http://www.fda.gov/downloads/ForIndustry/DevelopingProductsforRareDiseasesConditions/OOPDNewsArchive/UCM294773.pdf\">a report\u003c/a> from the National Organization for Rare Disorders, said about two-thirds of orphan drugs were approved with one adequate and well-controlled trial with supportive evidence. It typically requires two or three such trials to approve a mass market drug.\u003c/p>\n\u003cp>Coté also told the webinar audience that clinical trials for orphan drugs are usually smaller and the approval is a “different scientific and regulatory experience.”\u003c/p>\n\u003cp>Coté knows his stuff. He was Rao’s immediate predecessor as chief of the FDA’s Office of Orphan Products Development. It’s not unusual for government officials to leave FDA and other regulatory agencies and \u003ca href=\"http://www.npr.org/sections/health-shots/2016/09/28/495694559/a-look-at-how-the-revolving-door-spins-from-fda-to-industry\">obtain jobs as consultants or industry executives\u003c/a>.\u003c/p>\n\u003cp>Coté’s website, headlined “The Inside Track,” notes that he oversaw applications that led to the approval of at least 150 orphan drugs when he was at the FDA and that his firm is now the largest submitter of orphan drug applications.\u003c/p>\n\u003cp>“We write the entire application,” the website for Coté’s company notes, adding that his staff of 25 includes regulatory scientists with deep knowledge and experience in FDA’s “unwritten rules” regarding orphan drugs.\u003c/p>\n\u003cp>Many of Coté’s more than 300 clients are small biotech companies begun by researchers or even passionate parents who found investment backing. Parents Ilan and Annie Ganot, for example, started Solid Biosciences to find treatments and potentially a cure for their son with Duchenne muscular dystrophy.\u003c/p>\n\u003cp>Coté guides them through the regulatory process since most don’t have the expertise. He can offer his expertise and develop an application that makes it easier for the FDA to designate and approve the drug.\u003c/p>\n\u003cp>“When you make the FDA smile, the value of your asset goes up. And that’s how the game is played,” he said in an interview, adding quickly, “It’s really not a game because people’s lives are what is in balance.”\u003c/p>\n\u003cp>Coté and other ex-FDA officials play a vital role in helping drugmakers choose rare disease targets and get through the FDA approval process.\u003c/p>\n\u003cp>A small cottage industry has grown around the Orphan Drug Act. Dr. Marlene Haffner, who preceded Coté in the FDA’s orphan office, started her own consulting firm, too, to advise small and large companies on orphan drug applications. A third company is Camargo Pharmaceutical Services, led by industry veterans and former FDA officials, which advises companies focused on repurposing drugs for orphan approval. The firm tries “to be in front of the FDA a lot — three to four times a month,” said Jennifer King, Camargo’s director of marketing. Fees for consulting on orphan drugs industry wide range from $5,000 to $100,000, depending upon what services are provided, Coté said.\u003c/p>\n\u003cp>Getting through the orphan approval process involves a series of steps.\u003c/p>\n\u003cp>First, drugs must be designated by the FDA as potential candidates for approval. A company has to demonstrate that its drug is a promising treatment for a disease that affects fewer than 200,000 patients. If the FDA agrees and makes the formal designation, financial incentives kick in, including a 50 percent tax break on research and development (R&D) and access to federal grants.\u003c/p>\n\u003cp>When drugs get orphan designation, companies often reap other financial rewards. Shares in publicly traded companies often rise on the news — sometimes soaring \u003ca href=\"http://www.bizjournals.com/triangle/news/2014/02/25/dara-stock-soars-on-orphan-drug.html\">as high as 30 percent\u003c/a>. That happens, in part, because orphans have a track record of being approved at much higher rates than drugs for common diseases.\u003c/p>\n\u003cp>The 50 percent R&D tax credit pays off, too. In 2012, one of the biggest orphan drug companies, BioMarin, received \u003ca href=\"http://files.shareholder.com/downloads/ABEA-3W276N/2866327224x0x664042/776E8656-30BA-4937-A2A0-3AB6450BCA00/2012_Annual_Report.pdf\">$32.6 million\u003c/a> from a combination of federal and state of California tax credits. BioMarin spokeswoman Debra Charlesworth confirmed that the orphan credit made up the “vast majority” of that deferred tax benefit. She also noted that credit “has successfully fueled an industry that didn’t previously exist” and led to more rare disease research.\u003c/p>\n\u003cp>Industry-wide, orphan drug tax credits cost the federal government $1.76 billion in fiscal 2016 — roughly what President Barack Obama asked Congress to spend to fight \u003ca href=\"https://www.washingtonpost.com/news/post-politics/wp/2016/02/08/obama-to-ask-congress-for-1-8-billion-to-combat-zika-virus/\">the Zika virus\u003c/a> before a $1.1 billion expenditure was approved. And, because so many orphan drugs are under development, the U.S. could grant nearly $50 billion in tax credits from 2016 to 2025, estimates \u003ca href=\"https://www.treasury.gov/resource-center/tax-policy/Documents/Tax-Expenditures-FY2017.pdf\">the Treasury Department\u003c/a>.\u003c/p>\n\u003cp>There’s a lot of creativity behind figuring out how to make a drug an orphan.\u003c/p>\n\u003cp>In Coté’s webinar and in multiple interviews, he described many ways companies can win orphan status. They can test their drugs on children with adult diseases, such as schizophrenia, or find drugs for ailments like malaria that are uncommon in America.\u003c/p>\n\u003cp>“African sleeping sickness: horrible problem in Africa but not here, not in the U.S.,” Coté told his webinar audience. “So a drug development effort that was aimed toward some of these tropical diseases can actually get all the benefits of the Orphan Drug Act.”\u003c/p>\n\u003cp>Another popular strategy is to create “follow-on drugs” that represent incremental steps forward.\u003c/p>\n\u003cp>About 30 percent of Coté’s clients are companies looking to improve upon some other orphan drug “which just made billions and billions,” he said in an interview.\u003c/p>\n\u003cp>Repurposing an already approved drug is another strategy his firm promotes. In a \u003ca href=\"https://www.linkedin.com/pulse/re-purposing-drugs-orphans-timothy-cote?published=t\">video\u003c/a> posted on his website in July, Coté explained the advantages for companies that can move directly into a clinical trial without much preparatory work because the drug’s safety has already been demonstrated.\u003c/p>\n\u003cp>“All you gotta do is establish that the product can work in this new orphan indication,” he said, adding tips on how to do it and still make money.\u003c/p>\n\u003cp>‘That Is Not A True Orphan Drug’\u003c/p>\n\u003cp>Turning mass market drugs into orphans has been a familiar path for some of the most popular drugs ever discovered.\u003c/p>\n\u003cp>AbbVie’s Humira is the best-selling drug in the world, and most of its sales are in the U.S. where revenue reached $7.6 billion through \u003ca href=\"https://news.abbvie.com/news/abbvie-reports-third-quarter-2016-financial-results.htm\">the third quarter\u003c/a> of 2016 and $11.8 billion worldwide, according to the company’s latest financial report.\u003c/p>\n\u003cp>Humira was approved by the FDA in late 2002 to treat millions of people who suffer from rheumatoid arthritis. Three years later, AbbVie asked the FDA to designate it as an orphan to treat juvenile rheumatoid arthritis, which they told the FDA affects between 30,000 and 50,000 Americans. That pediatric use was approved in 2008, and Humira subsequently was approved for four more rare diseases, including Crohn’s and uveitis, an inflammatory disease affecting the eyes.\u003c/p>\n\u003cp>The ophthalmologic approval would extend the market exclusivity for Humira for that disease until 2023. When asked why AbbVie sought multiple orphan designations and approvals for Humira, the company declined to comment.\u003c/p>\n\u003cp>Peter Saltonstall, executive director of the National Organization for Rare Disorders, said that Humira is “not a true orphan drug.” But, he said, the company has “the ability to go out and get orphan designation. That’s the way the law reads right now … they can do whatever they want to do.”\u003c/p>\n\u003cp>It is difficult to say exactly how or if orphan exclusivity affects the price of Humira, which is a complex biologic drug and also has been protected by \u003ca href=\"http://www.nytimes.com/2016/07/16/business/makers-of-humira-and-enbrel-using-new-drug-patents-to-delay-generic-versions.html?_r=3\">numerous patents\u003c/a>. The drug has long been AbbVie’s top seller, accounting for 63 percent of its revenues, according to its most recent financial filing.\u003c/p>\n\u003cp>EvaluatePharma notes \u003ca href=\"http://info.evaluategroup.com/rs/607-YGS-364/images/EPOD15.pdf\">in its recent report\u003c/a> that Humira, as well as a handful of other top drugs, receive less than 25 percent of their sales from orphan uses. Still, if Humira’s orphan uses accounted for just 10 percent of annual sales, the revenue would surpass $1 billion.\u003c/p>\n\u003cp>By stacking up a series of orphan disease approvals, one seven-year exclusivity period leads into another, maximizing the length of a company’s monopoly. Sigma-Tau Pharmaceuticals, for example, had some form of orphan exclusivity over its metabolic disorder drug for more than 20 years. The drug, Carnitor, received a second orphan approval four months before its first exclusivity was set to expire. And it won its third orphan approval, for an IV formulation of the drug, just one day before its second exclusivity period was set to expire in December of 1999.\u003c/p>\n\u003cp>“The sequence and timing of regulatory filings for Carnitor reflect the time required to conduct large controlled clinical trials, as well as evolving medical strategies and regulatory pathways pursued by different sponsors over many years,” said GianFranco Fornasini, senior vice president of scientific affairs at Sigma-Tau.\u003c/p>\n\u003cp>The FDA’s Rao said each new exclusivity period is disease-specific and once any seven-year period runs out, generics can come in. Gleevec, for example, won FDA approval to treat several kinds of rare cancer. All but one of its orphan exclusivity periods had expired by 2015, allowing two generics to enter the marketplace. But Gleevec still has exclusivity until 2020 to treat newly diagnosed Philadelphia chromosome-positive acute lymphoblastic leukemia in patients who are also on chemotherapy.\u003c/p>\n\u003cp>It’s also true, Rao explained, that some of the drugs that go through the orphan process may not specifically treat a rare disease. For example, a very toxic cancer drug might may not work well in earlier stages because its risks outweigh the benefits. But the company may propose that it will help a smaller group of later-stage cancer patients and win orphan approval just for that group.\u003c/p>\n\u003cp>Former FDA orphan drug director Haffner said her FDA office worked on rules defining how companies could legitimately pursue approval for a small group of patients with a specific unmet medical need.\u003c/p>\n\u003cp>“People have played games with the Orphan Drug Act since it was passed,” said Haffner, who first took a job with drugmaker Amgen after leaving the FDA and then became an independent consultant. “It’s the American way, I don’t mean that in a nasty way. But we take advantage of what’s in front of us.”\u003c/p>\n\u003cp>In 2013, the \u003ca href=\"https://www.federalregister.gov/documents/2013/06/12/2013-13930/orphan-drug-regulations\">FDA clarified the Orphan Drug Act’s regulations\u003c/a> and said it wanted to avoid the possibility that some companies could “potentially ‘game’ approvals by seeking successive narrow approvals of a drug.”\u003c/p>\n\u003cp>In reality, Rao said, the regulations did not really change “much of what our practice was.” The agency wanted to address what Rao said were “common misconceptions” and frequently asked questions so officials changed wording in the regulations to better define exactly what could be considered an orphan drug.\u003c/p>\n\u003cp>Breaking down larger, broader diseases into smaller groups is still allowed under certain conditions and companies can still win multiple orphan approvals for a single drug — even if the total population served rises above the 200,000 mark.\u003c/p>\n\u003cp>Amgen Inc.’s Repatha won marketing approval and exclusive rights in 2015 for the orphan disease homozygous familial hypercholesterolemia, which affects a population of \u003ca href=\"http://www.lipidjournal.com/article/S1933-2874(13)00309-7/abstract\">about 300 people\u003c/a> in the U.S. On the very same day, the drug was approved as a mass market drug to treat up to 11 million people with uncontrolled levels of LDL cholesterol, said Amgen spokeswoman Kristen Davis.\u003c/p>\n\u003cp>Dr. Steven Nissen of the Cleveland Clinic, who ran a broader trial on Repatha, said, “It’s certainly not considered by any of us to be an orphan drug.”\u003c/p>\n\u003cp>Safeguarding The ‘Prize’\u003c/p>\n\u003cp>Considering the long history of what’s happened, Tim Coté acknowledges that there are “some loopholes” in the Orphan Drug Act. Perhaps 3 percent or less of approved orphans were not in the “spirit” of the law, he said.\u003c/p>\n\u003cp>But Coté, rare disease advocates, patients and people in the drug industry expressed fear that changing the Orphan Drug Act or questioning its success would hurt the development of drugs for rare patients.\u003c/p>\n\u003cp>Former U.S. Rep. Jim Greenwood, R-Pa., now president of the Biotechnology Innovation Organization, an industry trade group, said that concerns about high prices for orphan drugs aren’t justified. The incentives, he said, should not be altered because rare diseases are “tragically killing and brutalizing mostly children.”\u003c/p>\n\u003cp>Greenwood seemed unaware that dozens of orphan approvals stemmed from the repurposing of mass market drugs, like Humira or Enbrel, another drug developed first for rheumatoid arthritis. Still, he said, “I would argue that the risk of losing incentives in the system far outweighs the benefit of trying to save a few pennies on the health care dollar.”\u003c/p>\n\u003cp>It’s a sentiment that Coté and other advocates share. While talking about the $311,000 annual price tag for cystic fibrosis drug Kalydeco, Coté said any parent whose child has the disease would be a big fan of the drug.\u003c/p>\n\u003cp>“The price point is justified because actually it has a dramatic effect on the children. Dead children … people are willing to pay a lot to prevent that,” Coté said. “And that’s a real good thing that we have this drug. OK?”\u003c/p>\n\u003cp>The first drug to specifically target the underlying biochemical defect of cystic fibrosis, Kalydeco is approved to treat a subset of patients who have specific mutations in their genes. Development of the drug was financed by the Cystic Fibrosis Foundation, which sold its rights to sales royalties from Kalydeco and other cystic fibrosis drugs for $3.3 billion in 2014.\u003c/p>\n\u003cp>Others, including Henry Waxman, are far more critical and have tried to do something about it over the years. Waxman proposed multiple bills to rein in corporate profits by amending the orphan drug law that he sponsored, but none succeeded.\u003c/p>\n\u003cp>The FDA has also tried but failed, to keep corporations in check.\u003c/p>\n\u003cp>In 2012, drugmaker Depomed Inc. filed suit against the FDA for refusing to give its drug Gralise seven years of market exclusivity as a treatment for pain related to shingles.\u003c/p>\n\u003cp>Rao said the agency wanted to see proof that Gralise was clinically superior to other drugs, noting there “were a bunch of other generics on the market” with different formulations and dosing requirements. Grasile’s active ingredient, gabapentin, is the same one as in Pfizer’s mass market blockbuster \u003ca href=\"http://www.pfizer.com/products/product-detail/neurontin\">Neurontin\u003c/a>, which is also approved for treatment of shingles pain.\u003c/p>\n\u003cp>The FDA approved Gralise but denied seven years of exclusivity.\u003c/p>\n\u003cp>In response, the drugmaker sued the agency and won its case, arguing that according to the law, they didn’t have to prove their drug was clinically superior to gain the monopoly.\u003c/p>\n\u003cp>Today, the drug is one of Depomed’s top products with sales of $81 million in 2015. And, in a \u003ca href=\"http://investor.depomedinc.com/phoenix.zhtml?c=97276&p=irol-SECText&TEXT=aHR0cDovL2FwaS50ZW5rd2l6YXJkLmNvbS9maWxpbmcueG1sP2lwYWdlPTEwODc0NDE5JkRTRVE9MCZTRVE9MCZTUURFU0M9U0VDVElPTl9FTlRJUkUmc3Vic2lkPTU3\">recent proxy statement\u003c/a>, Depomed listed “protecting Gralise exclusivity” as a corporate objective under the category of “enhance and protect future cash flow.” Its orphan exclusivity ends in 2018. Depomed spokesman Christopher Keenan said Gralise wanted patent exclusivity to block competition. But, Keenan said, “Had the patent effort failed on all fronts, the Orphan Drug Designation would have been very important.”\u003c/p>\n\u003cp>After reviewing KHN’s analysis, Rao said she wants to better understand why drugmakers are applying for multiple approvals and has asked for a case-by-case review of all orphan designations granted in 2010 and 2015. She said the agency lacks the resources to run an analysis of the entire orphan drug database.\u003c/p>\n\u003cp>“Our goal is to try to get it right,” she said. “There are over 7,000 rare diseases, likely more, the vast majority of which have nothing … I want to ensure that we continue to keep our eye on that prize.”\u003c/p>\n\u003cp>Contributors: John Hillkirk, Scott Hensley at NPR, Diane Webber, Marilyn Thompson (editors); Elizabeth Lucas (data editing); Joe Neel at NPR (radio editing)\u003c/p>\n\u003cp>Interactives, video and presentation: Lydia Zuraw, Emily Kopp, Meredith Rizzo at NPR (digital presentation); Francis Ying (videos, motion graphic); Heidi de Marco (videos, photos, audio); Alley Interactive (database lookup)\u003c/p>\n\u003cp>KHN’s coverage of prescription drug development, costs and pricing is supported in part by the \u003ca href=\"http://www.arnoldfoundation.org/\">Laura and John Arnold Foundation\u003c/a>.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"http://www.kaiserhealthnews.org/\">Kaiser Health News\u003c/a> (KHN) is a national health policy news service. It is an editorially independent program of the \u003ca href=\"http://www.kff.org/\">Henry J. Kaiser Family Foundation\u003c/a>.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"title": "Why are California Republicans Prioritizing Dental Care for the Poor?",
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"headTitle": "Why are California Republicans Prioritizing Dental Care for the Poor? | KQED",
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"content": "\u003cp>Democrats have traditionally been the ones to champion health care programs for low-income Californians. But this month, Republicans proposed a bill that would put $200 million dollars toward improving Denti-Cal, the state’s free dental care program for the poor.\u003c/p>\n\u003cp>“If you have a program that already exists that isn’t properly funded, and isn’t working properly, you should fix that first before spending money on new programs,” said Chad Mayes, an Assembly Republican leader who represents Yucca Valley.\u003c/p>\n\u003cp>About 13 million Californians are eligible for Denti-Cal, including 5 million children. But the program is widely viewed as “broken,” “bureaucratically rigid,” and “a disaster,” according to \u003ca href=\"http://www.lhc.ca.gov/studies/230/Report230.pdf\">a 2016 report\u003c/a> from the \u003ca href=\"http://www.lhc.ca.gov/index.html\" target=\"_blank\" rel=\"noopener\">Little Hoover Commission\u003c/a>, an independent state oversight agency.\u003c/p>\n\u003cp>Most people who have Denti-Cal never actually see the dentist, because they can’t find one who accepts their coverage. Eleven counties in California have no dentists who accept Denti-Cal or who are accepting new Denti-Cal patients, according to a 2014 \u003ca href=\"https://www.auditor.ca.gov/reports/summary/2013-125\">California State Auditor report\u003c/a>.\u003c/p>\n\u003cp>“And we just think that that’s wrong,” Mayes said.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Many dentists limit the number of Denti-Cal patients they see, or stop seeing them altogether because the pay is too low: California’s reimbursement rates are 35 percent of the national average.\u003c/p>\n\u003cp>The Republican bill, \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201720180AB15\">AB 15\u003c/a>, would put all $200 million into paying dentists a better rate, in the hopes of attracting more dentists to participate in the program.\u003c/p>\n\u003cp>“We need to make it as efficient and effective as possible, so that millions of adults and kids in California that aren’t able to receive dental services are able to get them,” Mayes said.\u003c/p>\n\u003cp>But it’s not clear that giving dentists more money actually results in more patients getting care.\u003c/p>\n\u003cp>The \u003ca href=\"http://www.lhc.ca.gov/studies/230/Report230.pdf\" target=\"_blank\" rel=\"noopener\">report\u003c/a> from the Little Hoover Commission – a report Mayes and other Republicans cite frequently in defending their bill – includes 11 recommendations on how to fix Denti-Cal.\u003c/p>\n\u003cp>Not one of the recommendations involves increasing payments to dentists. In fact, the report calls across-the-board rate hikes a “costly” move that would result in attracting only “a few more Denti-Cal providers.”\u003c/p>\n\u003cp>Instead, the report recommends improving the Denti-Cal program by simplifying paperwork, focusing on less expensive prevention strategies (like having pediatricians teach patients about good oral hygiene), and establishing dental clinics inside schools or community centers in remote areas, so that patients can go to a centrally located place for care, rather than traveling 60 miles to a dentist’s office.\u003c/p>\n\u003cp>Senate Republican Leader Jean Fuller, who represents Kern County, acknowledged that the bill doesn’t address those recommendations.\u003c/p>\n\u003cp>“Yes, there are a lot of things that I would like to fix about the program. But I am not the majority party, unfortunately. I am not likely to get to adjust those,” she said. “There are 120,000 children in my district who are not getting the service. So my job is to fight for my children to get what I can.”\u003c/p>\n\u003cp>Paying dentists more money is really about making dentists happy, says Jessica Levinson, a professor at Loyola Law School in Los Angeles.\u003c/p>\n\u003cp>“It’s certainly a Republican goal to be business friendly,” she said. “This proposal is actually a business-friendly, a professional-friendly proposal to try and say to a dentist, ‘You will get higher reimbursement rates and you will be able to serve poor clients.’”\u003c/p>\n\u003cp>Levinson says there could also be something else at play here: campaign money. The \u003ca href=\"http://www.cda.org/\" target=\"_blank\" rel=\"noopener\">California Dental Association\u003c/a> gives more to Democrats in the state, but compared to other similar interest groups, like the California Medical Association, the dental group gives more generously to Republicans.\u003c/p>\n\u003cp>When it comes to Californian candidates running for federal office, in the most recent election cycle, the Dental Association gave exclusively to the Republican party, according to \u003ca href=\"https://www.opensecrets.org/pacs/lookup2.php?strID=C00005751&cycle=2016\">campaign contribution data\u003c/a> from Open Secrets. That’s a complete turnaround from 25 years ago, when the Association gave only to Democrats running at that level.\u003c/p>\n\u003cp>“It’s obvious to me that state office holders in California would be well aware of the fact that the California Dental Association is spending a lot of money for Republican candidates on the federal level,” Levinson said, “So they may be hoping that that money will soon come their way.”\u003c/p>\n\u003cp>Republicans and Democrats both are always on the lookout for new sources of campaign money. Asked if the Dental Association’s shift in giving influenced the Republican bill, Assemblyman Chad Mayes said he wasn’t aware of the shift.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“Actually, I’m a bit offended by even asking the question, because we really, genuinely care about the people of California,” he said. “This is about fixing a broken governmental program.”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Democrats have traditionally been the ones to champion health care programs for low-income Californians. But this month, Republicans proposed a bill that would put $200 million dollars toward improving Denti-Cal, the state’s free dental care program for the poor.\u003c/p>\n\u003cp>“If you have a program that already exists that isn’t properly funded, and isn’t working properly, you should fix that first before spending money on new programs,” said Chad Mayes, an Assembly Republican leader who represents Yucca Valley.\u003c/p>\n\u003cp>About 13 million Californians are eligible for Denti-Cal, including 5 million children. But the program is widely viewed as “broken,” “bureaucratically rigid,” and “a disaster,” according to \u003ca href=\"http://www.lhc.ca.gov/studies/230/Report230.pdf\">a 2016 report\u003c/a> from the \u003ca href=\"http://www.lhc.ca.gov/index.html\" target=\"_blank\" rel=\"noopener\">Little Hoover Commission\u003c/a>, an independent state oversight agency.\u003c/p>\n\u003cp>Most people who have Denti-Cal never actually see the dentist, because they can’t find one who accepts their coverage. Eleven counties in California have no dentists who accept Denti-Cal or who are accepting new Denti-Cal patients, according to a 2014 \u003ca href=\"https://www.auditor.ca.gov/reports/summary/2013-125\">California State Auditor report\u003c/a>.\u003c/p>\n\u003cp>“And we just think that that’s wrong,” Mayes said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Many dentists limit the number of Denti-Cal patients they see, or stop seeing them altogether because the pay is too low: California’s reimbursement rates are 35 percent of the national average.\u003c/p>\n\u003cp>The Republican bill, \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201720180AB15\">AB 15\u003c/a>, would put all $200 million into paying dentists a better rate, in the hopes of attracting more dentists to participate in the program.\u003c/p>\n\u003cp>“We need to make it as efficient and effective as possible, so that millions of adults and kids in California that aren’t able to receive dental services are able to get them,” Mayes said.\u003c/p>\n\u003cp>But it’s not clear that giving dentists more money actually results in more patients getting care.\u003c/p>\n\u003cp>The \u003ca href=\"http://www.lhc.ca.gov/studies/230/Report230.pdf\" target=\"_blank\" rel=\"noopener\">report\u003c/a> from the Little Hoover Commission – a report Mayes and other Republicans cite frequently in defending their bill – includes 11 recommendations on how to fix Denti-Cal.\u003c/p>\n\u003cp>Not one of the recommendations involves increasing payments to dentists. In fact, the report calls across-the-board rate hikes a “costly” move that would result in attracting only “a few more Denti-Cal providers.”\u003c/p>\n\u003cp>Instead, the report recommends improving the Denti-Cal program by simplifying paperwork, focusing on less expensive prevention strategies (like having pediatricians teach patients about good oral hygiene), and establishing dental clinics inside schools or community centers in remote areas, so that patients can go to a centrally located place for care, rather than traveling 60 miles to a dentist’s office.\u003c/p>\n\u003cp>Senate Republican Leader Jean Fuller, who represents Kern County, acknowledged that the bill doesn’t address those recommendations.\u003c/p>\n\u003cp>“Yes, there are a lot of things that I would like to fix about the program. But I am not the majority party, unfortunately. I am not likely to get to adjust those,” she said. “There are 120,000 children in my district who are not getting the service. So my job is to fight for my children to get what I can.”\u003c/p>\n\u003cp>Paying dentists more money is really about making dentists happy, says Jessica Levinson, a professor at Loyola Law School in Los Angeles.\u003c/p>\n\u003cp>“It’s certainly a Republican goal to be business friendly,” she said. “This proposal is actually a business-friendly, a professional-friendly proposal to try and say to a dentist, ‘You will get higher reimbursement rates and you will be able to serve poor clients.’”\u003c/p>\n\u003cp>Levinson says there could also be something else at play here: campaign money. The \u003ca href=\"http://www.cda.org/\" target=\"_blank\" rel=\"noopener\">California Dental Association\u003c/a> gives more to Democrats in the state, but compared to other similar interest groups, like the California Medical Association, the dental group gives more generously to Republicans.\u003c/p>\n\u003cp>When it comes to Californian candidates running for federal office, in the most recent election cycle, the Dental Association gave exclusively to the Republican party, according to \u003ca href=\"https://www.opensecrets.org/pacs/lookup2.php?strID=C00005751&cycle=2016\">campaign contribution data\u003c/a> from Open Secrets. That’s a complete turnaround from 25 years ago, when the Association gave only to Democrats running at that level.\u003c/p>\n\u003cp>“It’s obvious to me that state office holders in California would be well aware of the fact that the California Dental Association is spending a lot of money for Republican candidates on the federal level,” Levinson said, “So they may be hoping that that money will soon come their way.”\u003c/p>\n\u003cp>Republicans and Democrats both are always on the lookout for new sources of campaign money. Asked if the Dental Association’s shift in giving influenced the Republican bill, Assemblyman Chad Mayes said he wasn’t aware of the shift.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“Actually, I’m a bit offended by even asking the question, because we really, genuinely care about the people of California,” he said. “This is about fixing a broken governmental program.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>President-elect Donald Trump has vowed that he will repeal Obamacare and replace it with something “better.” Specifics are scarce, but one plan Trump has outlined is to change how the federal government funds Medicaid, health coverage for low-income people.\u003c/p>\n\u003cp>Under the Affordable Care Act, 32 states expanded Medicaid, so that more people would qualify for the benefits. Health policy experts say states that embraced it the most could feel the changes the worst.\u003c/p>\n\u003cp>“Winding back the clock would create all kinds of turbulence and disruption,” says Larry Levitt, senior vice president for special initiatives at the Kaiser Family Foundation.\u003c/p>\n\u003cp>[soundcloud url=”https://api.soundcloud.com/tracks/292468414″ params=”color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false” width=”100%” height=”166″ iframe=”true” /]\u003c/p>\n\u003cp>Twenty million Americans now have health coverage because of Obamacare. A full quarter of them are in California. And most of them are covered by Medi-Cal, California’s Medicaid program.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Right now, the federal government shares the cost of Medicaid with the states, no matter how many people are enrolled. But Trump wants to cap that funding, and just give states one fixed grant.\u003c/p>\n\u003cp>“A block grant would give California greater flexibility in running the Medi-Cal program, but it would also give the state less money,” Levitt says.\u003c/p>\n\u003cp>In California, 62 percent of new Medi-Cal enrollees are Latino, African-American or Asian-American.\u003c/p>\n\u003cp>“The effect is magnified in California in part because the state has been so successful in getting people signed up for coverage,” Levitt says.\u003c/p>\n\u003cp>Some states could pay doctors and hospitals less to save money. But in California, payment rates are already the second lowest in the country.\u003c/p>\n\u003cp>“California can’t really pay much less than it does to providers,” says Gerald Kominski, UCLA health policy professor. “These are going to be very, very difficult choices.”\u003c/p>\n\u003cp>Under one Republican plan, the amount of block grants would be based on Medi-Cal enrollment levels before the Affordable Care Act was implemented. Kominski says, in that scenario, the only choice California really would have is to reduce services or reduce the number of people who get Medi-Cal.\u003c/p>\n\u003cp>“That would have a devastating consequence on the Medicaid expansion population in California, and would basically put everyone who’s been newly enrolled in the program back off the program,” he says.\u003c/p>\n\u003cp>It’s unclear how soon a Trump administration would change Medicaid funding, so health advocates are encouraging people to continue signing up for Medicaid and other coverage during the current Obamacare open enrollment season.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“California is not an island,” says Anthony Wright, executive director of Health Access, adding that the state “must engage fully in the coming national debate on the future of health reform — especially as an example of what has been achieved, and what we can’t give up.”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>President-elect Donald Trump has vowed that he will repeal Obamacare and replace it with something “better.” Specifics are scarce, but one plan Trump has outlined is to change how the federal government funds Medicaid, health coverage for low-income people.\u003c/p>\n\u003cp>Under the Affordable Care Act, 32 states expanded Medicaid, so that more people would qualify for the benefits. Health policy experts say states that embraced it the most could feel the changes the worst.\u003c/p>\n\u003cp>“Winding back the clock would create all kinds of turbulence and disruption,” says Larry Levitt, senior vice president for special initiatives at the Kaiser Family Foundation.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003cdiv class='utils-parseShortcode-shortcodes-__shortcodes__shortcodeWrapper'>\n \u003ciframe width='”100%”' height='”166″'\n scrolling='no' frameborder='no'\n src='https://w.soundcloud.com/player/?url=”https://api.soundcloud.com/tracks/292468414″&visual=true&”color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false”'\n title='”https://api.soundcloud.com/tracks/292468414″'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Twenty million Americans now have health coverage because of Obamacare. A full quarter of them are in California. And most of them are covered by Medi-Cal, California’s Medicaid program.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Right now, the federal government shares the cost of Medicaid with the states, no matter how many people are enrolled. But Trump wants to cap that funding, and just give states one fixed grant.\u003c/p>\n\u003cp>“A block grant would give California greater flexibility in running the Medi-Cal program, but it would also give the state less money,” Levitt says.\u003c/p>\n\u003cp>In California, 62 percent of new Medi-Cal enrollees are Latino, African-American or Asian-American.\u003c/p>\n\u003cp>“The effect is magnified in California in part because the state has been so successful in getting people signed up for coverage,” Levitt says.\u003c/p>\n\u003cp>Some states could pay doctors and hospitals less to save money. But in California, payment rates are already the second lowest in the country.\u003c/p>\n\u003cp>“California can’t really pay much less than it does to providers,” says Gerald Kominski, UCLA health policy professor. “These are going to be very, very difficult choices.”\u003c/p>\n\u003cp>Under one Republican plan, the amount of block grants would be based on Medi-Cal enrollment levels before the Affordable Care Act was implemented. Kominski says, in that scenario, the only choice California really would have is to reduce services or reduce the number of people who get Medi-Cal.\u003c/p>\n\u003cp>“That would have a devastating consequence on the Medicaid expansion population in California, and would basically put everyone who’s been newly enrolled in the program back off the program,” he says.\u003c/p>\n\u003cp>It’s unclear how soon a Trump administration would change Medicaid funding, so health advocates are encouraging people to continue signing up for Medicaid and other coverage during the current Obamacare open enrollment season.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“California is not an island,” says Anthony Wright, executive director of Health Access, adding that the state “must engage fully in the coming national debate on the future of health reform — especially as an example of what has been achieved, and what we can’t give up.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>The city of Oakland was the first to regulate and tax medical marijuana dispensaries. Now, some city leaders see the industry’s profits and are proposing to take a bigger piece of the action: The Oakland City Council is voting Tuesday night on a pot profit-taking plan.\u003c/p>\n\u003cp>\u003ca href=\"https://www.shopharborside.com/\">Harborside Health Center\u003c/a> in Oakland is the largest medical marijuana dispensary in the nation.\u003c/p>\n\u003cp>Its executive director, Steve DeAngelo, says his dispensary brings in about $30 million in annual revenues.\u003c/p>\n\u003cp>“We’ve created over a 150 well-paying jobs and we’re the second largest retail taxpayer in the city,” he says.\u003c/p>\n\u003cp>DeAngelo says Harborside pays about $1.5 million in taxes every year.\u003c/p>\n\u003cfigure id=\"attachment_11155471\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" src=\"http://ww2.kqed.org/news/wp-content/uploads/sites/10/2016/11/gettyimages-567367357_cc_custom-fa9bde16e73ab45fde44f9f091230abb0d7881ad-800x534.jpg\" alt=\"Steve DeAngelo (shown in 2014) is co-founder and executive director of Harborside Health Center in Oakland, the country's largest medical marijuana dispensary.\" width=\"800\" height=\"534\" class=\"size-medium wp-image-11155471\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2016/11/gettyimages-567367357_cc_custom-fa9bde16e73ab45fde44f9f091230abb0d7881ad-800x534.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2016/11/gettyimages-567367357_cc_custom-fa9bde16e73ab45fde44f9f091230abb0d7881ad-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2016/11/gettyimages-567367357_cc_custom-fa9bde16e73ab45fde44f9f091230abb0d7881ad-1020x681.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2016/11/gettyimages-567367357_cc_custom-fa9bde16e73ab45fde44f9f091230abb0d7881ad-1920x1281.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2016/11/gettyimages-567367357_cc_custom-fa9bde16e73ab45fde44f9f091230abb0d7881ad-1180x787.jpg 1180w, https://cdn.kqed.org/wp-content/uploads/sites/10/2016/11/gettyimages-567367357_cc_custom-fa9bde16e73ab45fde44f9f091230abb0d7881ad-960x641.jpg 960w, https://cdn.kqed.org/wp-content/uploads/sites/10/2016/11/gettyimages-567367357_cc_custom-fa9bde16e73ab45fde44f9f091230abb0d7881ad-240x160.jpg 240w, https://cdn.kqed.org/wp-content/uploads/sites/10/2016/11/gettyimages-567367357_cc_custom-fa9bde16e73ab45fde44f9f091230abb0d7881ad-375x250.jpg 375w, https://cdn.kqed.org/wp-content/uploads/sites/10/2016/11/gettyimages-567367357_cc_custom-fa9bde16e73ab45fde44f9f091230abb0d7881ad-520x347.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Steve DeAngelo (shown in 2014) is co-founder and executive director of Harborside Health Center in Oakland, the country’s largest medical marijuana dispensary. \u003ccite>(Robert Gauthier/Los Angeles Times via Getty Images)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>His operation is one of eight licensed dispensaries in Oakland. But there are scores of other pot businesses that operate semi-legally, meaning they pay taxes but they are not fully licensed. And now the city wants to license them, too, but at a price.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The exploding cannabis industry has the city rethinking how much the dispensaries should pay the city to operate and who gets those licenses. City Councilwoman Desley Brooks is leading that effort.\u003c/p>\n\u003cp>“When you look at this industry across the United States and in Oakland, the vast majority of people who are making money in this industry are white males,” she said during a recent city hearing.\u003c/p>\n\u003cp>Harborside’s DeAngelo says he’s sympathetic with effort to diversify the industry. But he has problems with Brooks’ other plan to charge dispensaries 25 percent of their profits.\u003c/p>\n\u003cp>“And the courts have really been very, very consistent in ruling that a government agency is not allowed to take private property in that fashion,” he says.\u003c/p>\n\u003cp>The debate over whether they city should demand medical marijuana profits comes as it is still grappling with how to promote diversity in the industry.\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe loading=\"lazy\" src=\"https://www.npr.org/player/embed/500264056/500264057\" width=\"100%\" height=\"290\" frameborder=\"0\" scrolling=\"no\" title=\"NPR embedded audio player\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003cp>Last spring, the City Council voted to expand the industry by giving preferences for licenses to pot entrepreneurs who did jail time for marijuana offenses or for those who live in certain East Oakland neighborhoods — like Brooks’ district — that are predominantly black and Latino.\u003c/p>\n\u003cp>“We need to make sure that there is equity in this industry and we need to make sure that Oaklanders have an opportunity,” Brooks said.\u003c/p>\n\u003cp>For example, under current rules, drug felons applying for a cannabis license have to own at least 50 percent of their business.\u003c/p>\n\u003cp>Dale Geringer, director of the California chapter of National Organization for Reform of Marijuana Laws, or NORML, opposes the preference program.\u003c/p>\n\u003cfigure id=\"attachment_11155472\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" src=\"http://ww2.kqed.org/news/wp-content/uploads/sites/10/2016/11/gonzales_marijuana1_custom-47931b13e69cd2569236a4ed456605e25b744fae-800x600.jpg\" alt=\"Super Skunk is one of the many different kinds of marijuana sold at Harborside Health Center.\" width=\"800\" height=\"600\" class=\"size-medium wp-image-11155472\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2016/11/gonzales_marijuana1_custom-47931b13e69cd2569236a4ed456605e25b744fae-800x600.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2016/11/gonzales_marijuana1_custom-47931b13e69cd2569236a4ed456605e25b744fae-160x120.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2016/11/gonzales_marijuana1_custom-47931b13e69cd2569236a4ed456605e25b744fae-1020x765.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2016/11/gonzales_marijuana1_custom-47931b13e69cd2569236a4ed456605e25b744fae-1920x1439.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2016/11/gonzales_marijuana1_custom-47931b13e69cd2569236a4ed456605e25b744fae-1180x884.jpg 1180w, https://cdn.kqed.org/wp-content/uploads/sites/10/2016/11/gonzales_marijuana1_custom-47931b13e69cd2569236a4ed456605e25b744fae-960x720.jpg 960w, https://cdn.kqed.org/wp-content/uploads/sites/10/2016/11/gonzales_marijuana1_custom-47931b13e69cd2569236a4ed456605e25b744fae-240x180.jpg 240w, https://cdn.kqed.org/wp-content/uploads/sites/10/2016/11/gonzales_marijuana1_custom-47931b13e69cd2569236a4ed456605e25b744fae-375x281.jpg 375w, https://cdn.kqed.org/wp-content/uploads/sites/10/2016/11/gonzales_marijuana1_custom-47931b13e69cd2569236a4ed456605e25b744fae-520x390.jpg 520w, https://cdn.kqed.org/wp-content/uploads/sites/10/2016/11/gonzales_marijuana1_custom-47931b13e69cd2569236a4ed456605e25b744fae.jpg 2048w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Super Skunk is one of the many different kinds of marijuana sold at Harborside Health Center. \u003ccite>(Richard Gonzales/NPR)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“These rules go well beyond what any other legal industry has to put up with and they are supposedly addressed at equity problems which are not even caused by this industry but rather by the laws that prohibited it,” Geringer says.\u003c/p>\n\u003cp>More than a few people around the city worry that the controversy over profits and preferences could drive away the medical marijuana industry from Oakland.\u003c/p>\n\u003cp>Terryn Buxton is among them. He’s an entrepreneur who sits on a commission that advises the city on how to deal with the marijuana business.\u003c/p>\n\u003cp>“I’m from Oakland and I’m born and raised here. I’d like my business to be here,” he says. “But I do not know if we’re going to have an environment our business can survive in.” \u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Copyright 2016 NPR. To see more, visit \u003ca href=\"http://www.npr.org/\" target=\"_blank\" rel=\"noopener\">NPR.org\u003c/a>.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The city of Oakland was the first to regulate and tax medical marijuana dispensaries. Now, some city leaders see the industry’s profits and are proposing to take a bigger piece of the action: The Oakland City Council is voting Tuesday night on a pot profit-taking plan.\u003c/p>\n\u003cp>\u003ca href=\"https://www.shopharborside.com/\">Harborside Health Center\u003c/a> in Oakland is the largest medical marijuana dispensary in the nation.\u003c/p>\n\u003cp>Its executive director, Steve DeAngelo, says his dispensary brings in about $30 million in annual revenues.\u003c/p>\n\u003cp>“We’ve created over a 150 well-paying jobs and we’re the second largest retail taxpayer in the city,” he says.\u003c/p>\n\u003cp>DeAngelo says Harborside pays about $1.5 million in taxes every year.\u003c/p>\n\u003cfigure id=\"attachment_11155471\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" src=\"http://ww2.kqed.org/news/wp-content/uploads/sites/10/2016/11/gettyimages-567367357_cc_custom-fa9bde16e73ab45fde44f9f091230abb0d7881ad-800x534.jpg\" alt=\"Steve DeAngelo (shown in 2014) is co-founder and executive director of Harborside Health Center in Oakland, the country's largest medical marijuana dispensary.\" width=\"800\" height=\"534\" class=\"size-medium wp-image-11155471\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2016/11/gettyimages-567367357_cc_custom-fa9bde16e73ab45fde44f9f091230abb0d7881ad-800x534.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2016/11/gettyimages-567367357_cc_custom-fa9bde16e73ab45fde44f9f091230abb0d7881ad-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2016/11/gettyimages-567367357_cc_custom-fa9bde16e73ab45fde44f9f091230abb0d7881ad-1020x681.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2016/11/gettyimages-567367357_cc_custom-fa9bde16e73ab45fde44f9f091230abb0d7881ad-1920x1281.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2016/11/gettyimages-567367357_cc_custom-fa9bde16e73ab45fde44f9f091230abb0d7881ad-1180x787.jpg 1180w, https://cdn.kqed.org/wp-content/uploads/sites/10/2016/11/gettyimages-567367357_cc_custom-fa9bde16e73ab45fde44f9f091230abb0d7881ad-960x641.jpg 960w, https://cdn.kqed.org/wp-content/uploads/sites/10/2016/11/gettyimages-567367357_cc_custom-fa9bde16e73ab45fde44f9f091230abb0d7881ad-240x160.jpg 240w, https://cdn.kqed.org/wp-content/uploads/sites/10/2016/11/gettyimages-567367357_cc_custom-fa9bde16e73ab45fde44f9f091230abb0d7881ad-375x250.jpg 375w, https://cdn.kqed.org/wp-content/uploads/sites/10/2016/11/gettyimages-567367357_cc_custom-fa9bde16e73ab45fde44f9f091230abb0d7881ad-520x347.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Steve DeAngelo (shown in 2014) is co-founder and executive director of Harborside Health Center in Oakland, the country’s largest medical marijuana dispensary. \u003ccite>(Robert Gauthier/Los Angeles Times via Getty Images)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>His operation is one of eight licensed dispensaries in Oakland. But there are scores of other pot businesses that operate semi-legally, meaning they pay taxes but they are not fully licensed. And now the city wants to license them, too, but at a price.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The exploding cannabis industry has the city rethinking how much the dispensaries should pay the city to operate and who gets those licenses. City Councilwoman Desley Brooks is leading that effort.\u003c/p>\n\u003cp>“When you look at this industry across the United States and in Oakland, the vast majority of people who are making money in this industry are white males,” she said during a recent city hearing.\u003c/p>\n\u003cp>Harborside’s DeAngelo says he’s sympathetic with effort to diversify the industry. But he has problems with Brooks’ other plan to charge dispensaries 25 percent of their profits.\u003c/p>\n\u003cp>“And the courts have really been very, very consistent in ruling that a government agency is not allowed to take private property in that fashion,” he says.\u003c/p>\n\u003cp>The debate over whether they city should demand medical marijuana profits comes as it is still grappling with how to promote diversity in the industry.\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe loading=\"lazy\" src=\"https://www.npr.org/player/embed/500264056/500264057\" width=\"100%\" height=\"290\" frameborder=\"0\" scrolling=\"no\" title=\"NPR embedded audio player\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003cp>Last spring, the City Council voted to expand the industry by giving preferences for licenses to pot entrepreneurs who did jail time for marijuana offenses or for those who live in certain East Oakland neighborhoods — like Brooks’ district — that are predominantly black and Latino.\u003c/p>\n\u003cp>“We need to make sure that there is equity in this industry and we need to make sure that Oaklanders have an opportunity,” Brooks said.\u003c/p>\n\u003cp>For example, under current rules, drug felons applying for a cannabis license have to own at least 50 percent of their business.\u003c/p>\n\u003cp>Dale Geringer, director of the California chapter of National Organization for Reform of Marijuana Laws, or NORML, opposes the preference program.\u003c/p>\n\u003cfigure id=\"attachment_11155472\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" src=\"http://ww2.kqed.org/news/wp-content/uploads/sites/10/2016/11/gonzales_marijuana1_custom-47931b13e69cd2569236a4ed456605e25b744fae-800x600.jpg\" alt=\"Super Skunk is one of the many different kinds of marijuana sold at Harborside Health Center.\" width=\"800\" height=\"600\" class=\"size-medium wp-image-11155472\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2016/11/gonzales_marijuana1_custom-47931b13e69cd2569236a4ed456605e25b744fae-800x600.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2016/11/gonzales_marijuana1_custom-47931b13e69cd2569236a4ed456605e25b744fae-160x120.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2016/11/gonzales_marijuana1_custom-47931b13e69cd2569236a4ed456605e25b744fae-1020x765.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2016/11/gonzales_marijuana1_custom-47931b13e69cd2569236a4ed456605e25b744fae-1920x1439.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2016/11/gonzales_marijuana1_custom-47931b13e69cd2569236a4ed456605e25b744fae-1180x884.jpg 1180w, https://cdn.kqed.org/wp-content/uploads/sites/10/2016/11/gonzales_marijuana1_custom-47931b13e69cd2569236a4ed456605e25b744fae-960x720.jpg 960w, https://cdn.kqed.org/wp-content/uploads/sites/10/2016/11/gonzales_marijuana1_custom-47931b13e69cd2569236a4ed456605e25b744fae-240x180.jpg 240w, https://cdn.kqed.org/wp-content/uploads/sites/10/2016/11/gonzales_marijuana1_custom-47931b13e69cd2569236a4ed456605e25b744fae-375x281.jpg 375w, https://cdn.kqed.org/wp-content/uploads/sites/10/2016/11/gonzales_marijuana1_custom-47931b13e69cd2569236a4ed456605e25b744fae-520x390.jpg 520w, https://cdn.kqed.org/wp-content/uploads/sites/10/2016/11/gonzales_marijuana1_custom-47931b13e69cd2569236a4ed456605e25b744fae.jpg 2048w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Super Skunk is one of the many different kinds of marijuana sold at Harborside Health Center. \u003ccite>(Richard Gonzales/NPR)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“These rules go well beyond what any other legal industry has to put up with and they are supposedly addressed at equity problems which are not even caused by this industry but rather by the laws that prohibited it,” Geringer says.\u003c/p>\n\u003cp>More than a few people around the city worry that the controversy over profits and preferences could drive away the medical marijuana industry from Oakland.\u003c/p>\n\u003cp>Terryn Buxton is among them. He’s an entrepreneur who sits on a commission that advises the city on how to deal with the marijuana business.\u003c/p>\n\u003cp>“I’m from Oakland and I’m born and raised here. I’d like my business to be here,” he says. “But I do not know if we’re going to have an environment our business can survive in.” \u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Copyright 2016 NPR. To see more, visit \u003ca href=\"http://www.npr.org/\" target=\"_blank\" rel=\"noopener\">NPR.org\u003c/a>.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>LOS ANGELES — When Mike Stabile first moved to Los Angeles in 2011, he was struck by a billboard he saw along the freeway. It showed a line of cocaine and a turned-over shot glass, with the caption: \u003cem>You know why. Free HIV test.\u003c/em>\u003c/p>\n\u003cp>“I literally pulled over the car and was like, what’s going on?” Stabile remembers. “I was having a panic attack.”\u003c/p>\n\u003cp>Another ad showed two men in bed, looking nervous, with the question: \u003cem>“Trust Him?”\u003c/em>\u003c/p>\n\u003cp>“As a gay man, you really have to fight against this idea that you’re constantly in danger,” says Stabile, who came of age during the height of the AIDS epidemic in the 1980s. “Fear and stigma actually works against people getting tested.”\u003c/p>\n\u003cfigure id=\"attachment_11148363\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-11148363 size-medium\" src=\"http://ww2.kqed.org/news/wp-content/uploads/sites/10/2016/10/TrustHim_GayWhite_1094x335-800x245.jpg\" alt=\"TrustHim_GayWhite_1094x335\" width=\"800\" height=\"245\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2016/10/TrustHim_GayWhite_1094x335-800x245.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2016/10/TrustHim_GayWhite_1094x335-160x49.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2016/10/TrustHim_GayWhite_1094x335-1020x312.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2016/10/TrustHim_GayWhite_1094x335-960x294.jpg 960w, https://cdn.kqed.org/wp-content/uploads/sites/10/2016/10/TrustHim_GayWhite_1094x335-240x73.jpg 240w, https://cdn.kqed.org/wp-content/uploads/sites/10/2016/10/TrustHim_GayWhite_1094x335-375x115.jpg 375w, https://cdn.kqed.org/wp-content/uploads/sites/10/2016/10/TrustHim_GayWhite_1094x335-520x159.jpg 520w, https://cdn.kqed.org/wp-content/uploads/sites/10/2016/10/TrustHim_GayWhite_1094x335.jpg 1094w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">One of many ads sponsored by the AIDS Healthcare Foundation. \u003ccite>(Photo Courtesy of AIDS Healthcare Foundation)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Stabile says he sees the same heavy-handed, moralistic attitude behind \u003ca href=\"http://elections.kqed.org/measures/2023/info/proposition-60\">Proposition 60\u003c/a>, the state ballot initiative that would require adult film performers to use condoms on porn sets. If they don’t, and state regulators fail to enforce the mandate in a timely manner, any Californian can sue the film producer.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“Its success depends on stigma around sex, stigma around porn,” says Stabile, who now works for the \u003ca href=\"http://dontharassca.com/\">No on 60 campaign\u003c/a>.\u003c/p>\n\u003cp>The man behind Proposition 60 — and all those billboards — is Michael Weinstein, president of the \u003ca href=\"https://www.aidshealth.org/#/\">AIDS Healthcare Foundation\u003c/a>, and a longtime maverick in gay activist circles.\u003c/p>\n\u003cp>The nonprofit runs pharmacies and provides HIV care in 13 states and 37 countries, and gave away 38.5 million condoms last year. It’s putting $4.5 million from its pharmacy sales into backing the Proposition 60 condom mandate. (It also put $14.7 million behind \u003ca href=\"http://elections.kqed.org/measure/2024/info/proposition-61\">Proposition 61\u003c/a>, Weinstein’s initiative aimed at lowering drug prices.)\u003c/p>\n\u003cp>[soundcloud url=”https://api.soundcloud.com/tracks/290964734″ params=”color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false” width=”100%” height=”166″ iframe=”true” /]\u003c/p>\n\u003cp>Weinstein says he’s steadfastly promoting condoms when other groups seem to have forgotten them.\u003c/p>\n\u003cp>“It’s unfashionable,” he says. “I was on a panel discussion and one of the guys said, ‘You’re acting like our mother telling us to wear galoshes.’ And my reaction was, ‘Yeah, somebody needs to do that!’ I mean, I’m not trying to win a popularity contest. Obviously.”\u003c/p>\n\u003caside class=\"pullquote alignright\">‘I’m not trying to win a popularity contest. Obviously.’\u003cbr>\n\u003ccite>Michael Weinstein\u003c/cite>\u003c/aside>\n\u003cp>For Weinstein, Proposition 60 is primarily about protecting adult film workers against sexually transmitted diseases at a time when infection rates are at a 20-year high across California. But it’s also another large-scale condom campaign.\u003c/p>\n\u003cp>“A lot of people get their sex education through these films and I think it’s sending a bad message,” Weinstein says. “I don’t want young people to be educated that the only kind of sex that’s hot is unsafe sex.”\u003c/p>\n\u003cfigure id=\"attachment_11148455\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-11148455 size-medium\" src=\"http://ww2.kqed.org/news/wp-content/uploads/sites/10/2016/10/Michael-Weinstein_1973-800x600.jpg\" alt=\"Michael Weinstein, president of the AIDS Healthcare Foundation, in his office in Los Angeles. Behind him is a painting of Chris Brownlie, who worked with Weinstein to found the first AIDS hospice in LA.\" width=\"800\" height=\"600\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2016/10/Michael-Weinstein_1973-800x600.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2016/10/Michael-Weinstein_1973-160x120.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2016/10/Michael-Weinstein_1973-1020x765.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2016/10/Michael-Weinstein_1973-1920x1440.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2016/10/Michael-Weinstein_1973-1180x885.jpg 1180w, https://cdn.kqed.org/wp-content/uploads/sites/10/2016/10/Michael-Weinstein_1973-960x720.jpg 960w, https://cdn.kqed.org/wp-content/uploads/sites/10/2016/10/Michael-Weinstein_1973-240x180.jpg 240w, https://cdn.kqed.org/wp-content/uploads/sites/10/2016/10/Michael-Weinstein_1973-375x281.jpg 375w, https://cdn.kqed.org/wp-content/uploads/sites/10/2016/10/Michael-Weinstein_1973-520x390.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Michael Weinstein, president of the AIDS Healthcare Foundation, in his office in Los Angeles. Behind him is a painting of Chris Brownlie, who worked with Weinstein to found the first AIDS hospice in L.A. He is backing Propositions 60 and 61. \u003ccite>(April Dembosky/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>Controversial Figure\u003c/strong>\u003c/p>\n\u003cp>Weinstein has long taken controversial positions, but he’s often landed on the right side of history. In the 1980s, he fought lawmakers in California who wanted to quarantine AIDS patients. When nurses were afraid touch patients, leaving them languishing in the hallways of county hospitals, he helped set up one of the first AIDS hospices, where people could die with dignity and compassion. And when the AIDS cocktail came out, Weinstein risked bankruptcy to provide the drugs to uninsured patients.\u003c/p>\n\u003cp>“We decided we had a moral obligation to give them, and we paid for them and those people lived,” he says.\u003c/p>\n\u003cp>One of Weinstein’s more recent and most unpopular stances is on \u003ca href=\"https://www.aids.gov/hiv-aids-basics/prevention/reduce-your-risk/pre-exposure-prophylaxis/\">PrEP\u003c/a>, the daily HIV prevention pill. Many activists consider it a Gift from God. Weinstein calls it a party drug.\u003c/p>\n\u003cp>“It’s often taken in conjunction with crystal meth and other party drugs,” he says. “It’s really a get-out-of-jail-free card.”\u003c/p>\n\u003cp>Weinstein says it gives people a free pass to not use condoms and be reckless, driving a rise in other STDs, which\u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/09/02/no-new-infections-in-hundreds-taking-pill-to-prevent-hiv/\"> recent studies\u003c/a> bear out. But other public health groups say PrEP will reduce HIV transmission and save lives, which the studies also support.\u003c/p>\n\u003cp>“It’s not helpful to have one of the largest HIV organizations in the world trivializing it or downplaying its importance,” says Courtney Mulhern-Pearson, director of state and local affairs at the \u003ca href=\"http://www.sfaf.org/\">San Francisco AIDS Foundation.\u003c/a>\u003c/p>\n\u003cp>Her group, along with \u003ca href=\"https://aplahealth.org/\">AIDS Project LA\u003c/a>, is opposed to Proposition 60, in part because it ignores PrEP. Mulhern-Pearson says Weinstein’s singular focus on condoms is outdated and unrealistic.\u003c/p>\n\u003cp>“Condom fatigue is real,” she says. “And I think that all of us are probably not realistic and not forthcoming about our condom use.”\u003c/p>\n\u003cp>\u003cstrong>History and Opposition\u003c/strong>\u003c/p>\n\u003cp>Weinstein has been fighting to mandate condoms in adult films for years. While federal and state worker safety laws technically already require producers to protect performers against STDs with condoms, the law is largely ignored and poorly enforced. Weinstein has been pushing Cal/OSHA for years to refine and clarify regulations, \u003ca href=\"https://ww2.kqed.org/stateofhealth/2016/02/17/california-porn-industry-protests-rules-mandating-condoms/\">without success\u003c/a>. He’s backed local measures in Los Angeles County to require condoms, which \u003ca href=\"https://ballotpedia.org/Los_Angeles_Porn_Actors_Required_to_Wear_Condoms_Act,_Measure_B_(November_2012)\">passed\u003c/a>, but enforcement has, again, been minimal.\u003c/p>\n\u003cp>At every turn, the adult film industry has fought hard against condom mandates. They say it will force them to make products that won’t sell, driving the business underground or out of state.\u003c/p>\n\u003cfigure id=\"attachment_11153923\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11153923\" src=\"http://ww2.kqed.org/news/wp-content/uploads/sites/10/2016/10/Prop60Protesters-800x567.jpg\" alt=\"Adult film performers rally against Proposition 60 outside Michael Weinstein’s office.\" width=\"800\" height=\"567\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2016/10/Prop60Protesters-800x567.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2016/10/Prop60Protesters-160x113.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2016/10/Prop60Protesters-1020x723.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2016/10/Prop60Protesters.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2016/10/Prop60Protesters-1180x836.jpg 1180w, https://cdn.kqed.org/wp-content/uploads/sites/10/2016/10/Prop60Protesters-960x680.jpg 960w, https://cdn.kqed.org/wp-content/uploads/sites/10/2016/10/Prop60Protesters-240x170.jpg 240w, https://cdn.kqed.org/wp-content/uploads/sites/10/2016/10/Prop60Protesters-375x266.jpg 375w, https://cdn.kqed.org/wp-content/uploads/sites/10/2016/10/Prop60Protesters-520x368.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Adult film performers rally against Proposition 60 outside Michael Weinstein’s office. \u003ccite>(April Dembosky/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>In mid-October, more than 100 adult film performers rallied outside Weinstein’s office in Los Angeles to protest Proposition 60. They chanted slogans like “Our Bodies, Our Choice!” and carried signs that said “Where is Weinstein?”\u003c/p>\n\u003cp>They say they prefer to rely on the industry’s bimonthly testing protocol over condoms. Performer Ela Darling says condoms don’t work on porn sets — they’re uncomfortable and cause friction rashes.\u003c/p>\n\u003cp>“The sex you have on camera isn’t like the sex you have at home,” she says. “It’s like Olympic-level, athletic sex.”\u003c/p>\n\u003cp>She’s frustrated that Weinstein is ignoring their concerns.\u003c/p>\n\u003cp>“He will not hear us, he will not speak to us, but he’s happy speaking\u003cem> for\u003c/em> us,” she says. “And that’s the problem.”\u003c/p>\n\u003cp>Weinstein defends his refusal to meet with the adult film industry.\u003c/p>\n\u003cp>“I’m not going to put myself in a position of debating people where all they do is call me names,” he says.\u003c/p>\n\u003cp>It’s true. Weinstein’s critics have called him bombastic, a bully. They compare him to Donald Trump. They post tweets that refer to him as the Condom Nazi.\u003c/p>\n\u003cp>“In case they haven’t noticed, I’m Jewish and I’m gay, OK,” he says. “It makes my skin curl.”\u003c/p>\n\u003cp>Weinstein says he’s never liked the limelight. He’s had to develop a thick skin to stay in this business, to stand up for what he believes is the moral thing to do, for what he believes is his responsibility toward young generations.\u003c/p>\n\u003cp>But it’s clear that the criticism bothers him.\u003c/p>\n\u003cp>“He’s been hurt,” says Sharon Raphael, an old friend and fellow activist. “I know that it hurts him.”\u003c/p>\n\u003cp>But, she adds, everyone knows he’s a force to be reckoned with.\u003c/p>\n\u003cp>“When most people would be down and out, strike three, he’d get up again,” she says. “He never gives up. Ever.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>\u003ca href=\"https://ww2.kqed.org/news/tag/cacounts/\">California Counts\u003c/a> is a collaboration of KPBS, KPCC, KQED and Capital Public Radio to report on the 2016 election. The coverage focuses on major issues and solicits diverse voices on what’s important to the future of California.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>LOS ANGELES — When Mike Stabile first moved to Los Angeles in 2011, he was struck by a billboard he saw along the freeway. It showed a line of cocaine and a turned-over shot glass, with the caption: \u003cem>You know why. Free HIV test.\u003c/em>\u003c/p>\n\u003cp>“I literally pulled over the car and was like, what’s going on?” Stabile remembers. “I was having a panic attack.”\u003c/p>\n\u003cp>Another ad showed two men in bed, looking nervous, with the question: \u003cem>“Trust Him?”\u003c/em>\u003c/p>\n\u003cp>“As a gay man, you really have to fight against this idea that you’re constantly in danger,” says Stabile, who came of age during the height of the AIDS epidemic in the 1980s. “Fear and stigma actually works against people getting tested.”\u003c/p>\n\u003cfigure id=\"attachment_11148363\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-11148363 size-medium\" src=\"http://ww2.kqed.org/news/wp-content/uploads/sites/10/2016/10/TrustHim_GayWhite_1094x335-800x245.jpg\" alt=\"TrustHim_GayWhite_1094x335\" width=\"800\" height=\"245\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2016/10/TrustHim_GayWhite_1094x335-800x245.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2016/10/TrustHim_GayWhite_1094x335-160x49.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2016/10/TrustHim_GayWhite_1094x335-1020x312.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2016/10/TrustHim_GayWhite_1094x335-960x294.jpg 960w, https://cdn.kqed.org/wp-content/uploads/sites/10/2016/10/TrustHim_GayWhite_1094x335-240x73.jpg 240w, https://cdn.kqed.org/wp-content/uploads/sites/10/2016/10/TrustHim_GayWhite_1094x335-375x115.jpg 375w, https://cdn.kqed.org/wp-content/uploads/sites/10/2016/10/TrustHim_GayWhite_1094x335-520x159.jpg 520w, https://cdn.kqed.org/wp-content/uploads/sites/10/2016/10/TrustHim_GayWhite_1094x335.jpg 1094w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">One of many ads sponsored by the AIDS Healthcare Foundation. \u003ccite>(Photo Courtesy of AIDS Healthcare Foundation)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Stabile says he sees the same heavy-handed, moralistic attitude behind \u003ca href=\"http://elections.kqed.org/measures/2023/info/proposition-60\">Proposition 60\u003c/a>, the state ballot initiative that would require adult film performers to use condoms on porn sets. If they don’t, and state regulators fail to enforce the mandate in a timely manner, any Californian can sue the film producer.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“Its success depends on stigma around sex, stigma around porn,” says Stabile, who now works for the \u003ca href=\"http://dontharassca.com/\">No on 60 campaign\u003c/a>.\u003c/p>\n\u003cp>The man behind Proposition 60 — and all those billboards — is Michael Weinstein, president of the \u003ca href=\"https://www.aidshealth.org/#/\">AIDS Healthcare Foundation\u003c/a>, and a longtime maverick in gay activist circles.\u003c/p>\n\u003cp>The nonprofit runs pharmacies and provides HIV care in 13 states and 37 countries, and gave away 38.5 million condoms last year. It’s putting $4.5 million from its pharmacy sales into backing the Proposition 60 condom mandate. (It also put $14.7 million behind \u003ca href=\"http://elections.kqed.org/measure/2024/info/proposition-61\">Proposition 61\u003c/a>, Weinstein’s initiative aimed at lowering drug prices.)\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003cdiv class='utils-parseShortcode-shortcodes-__shortcodes__shortcodeWrapper'>\n \u003ciframe width='”100%”' height='”166″'\n scrolling='no' frameborder='no'\n src='https://w.soundcloud.com/player/?url=”https://api.soundcloud.com/tracks/290964734″&visual=true&”color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false”'\n title='”https://api.soundcloud.com/tracks/290964734″'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Weinstein says he’s steadfastly promoting condoms when other groups seem to have forgotten them.\u003c/p>\n\u003cp>“It’s unfashionable,” he says. “I was on a panel discussion and one of the guys said, ‘You’re acting like our mother telling us to wear galoshes.’ And my reaction was, ‘Yeah, somebody needs to do that!’ I mean, I’m not trying to win a popularity contest. Obviously.”\u003c/p>\n\u003caside class=\"pullquote alignright\">‘I’m not trying to win a popularity contest. Obviously.’\u003cbr>\n\u003ccite>Michael Weinstein\u003c/cite>\u003c/aside>\n\u003cp>For Weinstein, Proposition 60 is primarily about protecting adult film workers against sexually transmitted diseases at a time when infection rates are at a 20-year high across California. But it’s also another large-scale condom campaign.\u003c/p>\n\u003cp>“A lot of people get their sex education through these films and I think it’s sending a bad message,” Weinstein says. “I don’t want young people to be educated that the only kind of sex that’s hot is unsafe sex.”\u003c/p>\n\u003cfigure id=\"attachment_11148455\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-11148455 size-medium\" src=\"http://ww2.kqed.org/news/wp-content/uploads/sites/10/2016/10/Michael-Weinstein_1973-800x600.jpg\" alt=\"Michael Weinstein, president of the AIDS Healthcare Foundation, in his office in Los Angeles. Behind him is a painting of Chris Brownlie, who worked with Weinstein to found the first AIDS hospice in LA.\" width=\"800\" height=\"600\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2016/10/Michael-Weinstein_1973-800x600.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2016/10/Michael-Weinstein_1973-160x120.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2016/10/Michael-Weinstein_1973-1020x765.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2016/10/Michael-Weinstein_1973-1920x1440.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2016/10/Michael-Weinstein_1973-1180x885.jpg 1180w, https://cdn.kqed.org/wp-content/uploads/sites/10/2016/10/Michael-Weinstein_1973-960x720.jpg 960w, https://cdn.kqed.org/wp-content/uploads/sites/10/2016/10/Michael-Weinstein_1973-240x180.jpg 240w, https://cdn.kqed.org/wp-content/uploads/sites/10/2016/10/Michael-Weinstein_1973-375x281.jpg 375w, https://cdn.kqed.org/wp-content/uploads/sites/10/2016/10/Michael-Weinstein_1973-520x390.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Michael Weinstein, president of the AIDS Healthcare Foundation, in his office in Los Angeles. Behind him is a painting of Chris Brownlie, who worked with Weinstein to found the first AIDS hospice in L.A. He is backing Propositions 60 and 61. \u003ccite>(April Dembosky/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>Controversial Figure\u003c/strong>\u003c/p>\n\u003cp>Weinstein has long taken controversial positions, but he’s often landed on the right side of history. In the 1980s, he fought lawmakers in California who wanted to quarantine AIDS patients. When nurses were afraid touch patients, leaving them languishing in the hallways of county hospitals, he helped set up one of the first AIDS hospices, where people could die with dignity and compassion. And when the AIDS cocktail came out, Weinstein risked bankruptcy to provide the drugs to uninsured patients.\u003c/p>\n\u003cp>“We decided we had a moral obligation to give them, and we paid for them and those people lived,” he says.\u003c/p>\n\u003cp>One of Weinstein’s more recent and most unpopular stances is on \u003ca href=\"https://www.aids.gov/hiv-aids-basics/prevention/reduce-your-risk/pre-exposure-prophylaxis/\">PrEP\u003c/a>, the daily HIV prevention pill. Many activists consider it a Gift from God. Weinstein calls it a party drug.\u003c/p>\n\u003cp>“It’s often taken in conjunction with crystal meth and other party drugs,” he says. “It’s really a get-out-of-jail-free card.”\u003c/p>\n\u003cp>Weinstein says it gives people a free pass to not use condoms and be reckless, driving a rise in other STDs, which\u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/09/02/no-new-infections-in-hundreds-taking-pill-to-prevent-hiv/\"> recent studies\u003c/a> bear out. But other public health groups say PrEP will reduce HIV transmission and save lives, which the studies also support.\u003c/p>\n\u003cp>“It’s not helpful to have one of the largest HIV organizations in the world trivializing it or downplaying its importance,” says Courtney Mulhern-Pearson, director of state and local affairs at the \u003ca href=\"http://www.sfaf.org/\">San Francisco AIDS Foundation.\u003c/a>\u003c/p>\n\u003cp>Her group, along with \u003ca href=\"https://aplahealth.org/\">AIDS Project LA\u003c/a>, is opposed to Proposition 60, in part because it ignores PrEP. Mulhern-Pearson says Weinstein’s singular focus on condoms is outdated and unrealistic.\u003c/p>\n\u003cp>“Condom fatigue is real,” she says. “And I think that all of us are probably not realistic and not forthcoming about our condom use.”\u003c/p>\n\u003cp>\u003cstrong>History and Opposition\u003c/strong>\u003c/p>\n\u003cp>Weinstein has been fighting to mandate condoms in adult films for years. While federal and state worker safety laws technically already require producers to protect performers against STDs with condoms, the law is largely ignored and poorly enforced. Weinstein has been pushing Cal/OSHA for years to refine and clarify regulations, \u003ca href=\"https://ww2.kqed.org/stateofhealth/2016/02/17/california-porn-industry-protests-rules-mandating-condoms/\">without success\u003c/a>. He’s backed local measures in Los Angeles County to require condoms, which \u003ca href=\"https://ballotpedia.org/Los_Angeles_Porn_Actors_Required_to_Wear_Condoms_Act,_Measure_B_(November_2012)\">passed\u003c/a>, but enforcement has, again, been minimal.\u003c/p>\n\u003cp>At every turn, the adult film industry has fought hard against condom mandates. They say it will force them to make products that won’t sell, driving the business underground or out of state.\u003c/p>\n\u003cfigure id=\"attachment_11153923\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11153923\" src=\"http://ww2.kqed.org/news/wp-content/uploads/sites/10/2016/10/Prop60Protesters-800x567.jpg\" alt=\"Adult film performers rally against Proposition 60 outside Michael Weinstein’s office.\" width=\"800\" height=\"567\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2016/10/Prop60Protesters-800x567.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2016/10/Prop60Protesters-160x113.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2016/10/Prop60Protesters-1020x723.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2016/10/Prop60Protesters.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2016/10/Prop60Protesters-1180x836.jpg 1180w, https://cdn.kqed.org/wp-content/uploads/sites/10/2016/10/Prop60Protesters-960x680.jpg 960w, https://cdn.kqed.org/wp-content/uploads/sites/10/2016/10/Prop60Protesters-240x170.jpg 240w, https://cdn.kqed.org/wp-content/uploads/sites/10/2016/10/Prop60Protesters-375x266.jpg 375w, https://cdn.kqed.org/wp-content/uploads/sites/10/2016/10/Prop60Protesters-520x368.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Adult film performers rally against Proposition 60 outside Michael Weinstein’s office. \u003ccite>(April Dembosky/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>In mid-October, more than 100 adult film performers rallied outside Weinstein’s office in Los Angeles to protest Proposition 60. They chanted slogans like “Our Bodies, Our Choice!” and carried signs that said “Where is Weinstein?”\u003c/p>\n\u003cp>They say they prefer to rely on the industry’s bimonthly testing protocol over condoms. Performer Ela Darling says condoms don’t work on porn sets — they’re uncomfortable and cause friction rashes.\u003c/p>\n\u003cp>“The sex you have on camera isn’t like the sex you have at home,” she says. “It’s like Olympic-level, athletic sex.”\u003c/p>\n\u003cp>She’s frustrated that Weinstein is ignoring their concerns.\u003c/p>\n\u003cp>“He will not hear us, he will not speak to us, but he’s happy speaking\u003cem> for\u003c/em> us,” she says. “And that’s the problem.”\u003c/p>\n\u003cp>Weinstein defends his refusal to meet with the adult film industry.\u003c/p>\n\u003cp>“I’m not going to put myself in a position of debating people where all they do is call me names,” he says.\u003c/p>\n\u003cp>It’s true. Weinstein’s critics have called him bombastic, a bully. They compare him to Donald Trump. They post tweets that refer to him as the Condom Nazi.\u003c/p>\n\u003cp>“In case they haven’t noticed, I’m Jewish and I’m gay, OK,” he says. “It makes my skin curl.”\u003c/p>\n\u003cp>Weinstein says he’s never liked the limelight. He’s had to develop a thick skin to stay in this business, to stand up for what he believes is the moral thing to do, for what he believes is his responsibility toward young generations.\u003c/p>\n\u003cp>But it’s clear that the criticism bothers him.\u003c/p>\n\u003cp>“He’s been hurt,” says Sharon Raphael, an old friend and fellow activist. “I know that it hurts him.”\u003c/p>\n\u003cp>But, she adds, everyone knows he’s a force to be reckoned with.\u003c/p>\n\u003cp>“When most people would be down and out, strike three, he’d get up again,” she says. “He never gives up. Ever.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>Dr. Lorraine Page, believe it or not, makes house calls.\u003c/p>\n\u003cp>One place she visits is the home of Ann Caponio, a one-bedroom apartment in Half Moon Bay, California. You can tell a knitter lives there: baskets of wool and hanks of yarn adorn the room, and in the corner sits a wooden spinning wheel.\u003c/p>\n\u003caside class=\"pullquote alignright\">A new model gains in popularity: no insurance but unlimited doctor visits are provided for a monthly fee.\u003c/aside>\n\u003cp>But arthritis has put an end to that hobby. And for a while, Caponio, 69, wasn't even getting out.\u003c/p>\n\u003cp>\"I kind of stopped going downtown,\" she says, in her Midland, Texas twang, a holdover from childhood. \"Omigod those stairs.\"\u003c/p>\n\u003cp>She's talking about a steep, 17-step staircase leading to her front door. Three hip replacements left negotiating them a dangerous proposition.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"I tend to fall. And I fell on those damned stairs once.\"\u003c/p>\n\u003cp>And that's where Lorraine Page enters the picture.\u003c/p>\n\u003cp>Besides the house calls, Page provides a little more than Caponio might expect from a primary care doc available through Medicare. Page, for instance, has aided her patient with a number of safety issues, including helping her find someone to rig up a chairlift on those stairs. Now, she can sit on a seat at the top and glide to the bottom.\u003c/p>\n\u003cp>\"It opens up a whole new world for me,\" Caponio says.\u003c/p>\n\u003cp>\u003cstrong>A Different Model\u003c/strong>\u003c/p>\n\u003cp>A whole new world is what Dr. Page herself has been experiencing, ever since she left the traditional clinic setting to try something different. She does have a small office, but prefers to visit most of her patients in their homes.\u003c/p>\n\u003caside class=\"pullquote alignright\">When they learn they can get off the production line, 'Doctors will be in mass exodus.'\u003ccite>Dr. Pamela Wible\u003c/cite>\u003c/aside>\n\u003cp>She's one of a growing number of doctors who have cut loose from what she calls the \"assembly-line, volume approach\" that most of her colleagues have experienced. These breakaway docs are now using a health care delivery model called direct primary care. Page has cut back on the number of patients she sees, and spends more time with the ones she does. She doesn't take insurance and deals mostly in cash. Page charges each time she sees a patient, but most direct primary care doctors bill a monthly fee for unlimited visits.\u003c/p>\n\u003cp>In her previous practice, Page says, the pressure to see more patients in less time wore her down, as did the need for an army of support staff to process the copious paperwork required by insurance companies.\u003c/p>\n\u003cp>\"At our office, we had six full-time doctors. And we had seven full-time insurance people. So [that's] more than one full-time person trying to get reimbursement for patients I was seeing.\"\u003c/p>\n\u003cp>The benefits of leaving that bureaucratic load behind includes more time with patients but shorter days as her total load has been reduced. And she's doing the kind of family-care medicine for which she was trained.\u003c/p>\n\u003cp>\"And I enjoy it a lot more,\" Page says. \"Let's not minimize that.\"\u003c/p>\n\u003cp>[contextly_sidebar id=\"vPRJXQNXVX11c9sC2BeSG7GGPJpZybhw\"]\u003c/p>\n\u003cp>\u003cstrong>What Doctors Want\u003c/strong>\u003c/p>\n\u003cp>A 2012 \u003ca href=\"http://www.medscape.com/features/slideshow/compensation/2012/public\" target=\"_blank\">Medscape study\u003c/a> found that 46 percent of primary care physicians showed such dissatisfaction with their careers, they wouldn't pursue medicine if they could choose again. Another\u003ca href=\"http://www.physiciansfoundation.org/healthcare-research/a-survey-of-americas-physicians-practice-patterns-and-perspectives\" target=\"_blank\"> study\u003c/a>, from the Physicians Foundation, found 60 percent of primary care doctors would not recommend a career in medicine. Just six percent described the morale of their colleagues as positive.\u003c/p>\n\u003cp>Overall, says Wanda Filer, president of the American Academy of Family Physicians, primary care doctors feel overworked and ineffective. \"Most patients are just rushed out the door,\" she says. \"That's not what doctors want to do. This new model of care gets the physician and the patient out of that hamster-wheel model.\"\u003c/p>\n\u003cp>Filer says about three percent of the organization's 69,000 primary care doctors have made the move to direct primary care in the past couple of years, and that number is increasing rapidly as other physicians see it succeed.\u003c/p>\n\u003cp>In fact, Filer says, her organization has taken the unusual step of convening informational seminars for the large number of family doctors who have expressed interest in getting off the grid and starting a kinder, gentler practice.\u003c/p>\n\u003cp>\u003cb>Cash and Care\u003c/b>\u003c/p>\n\u003cfigure id=\"attachment_220077\" class=\"wp-caption alignright\" style=\"max-width: 357px\">\u003cimg class=\"wp-image-220077\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/08/emiliescott1-885x1180.jpg\" alt=\"Dr. Emilie Scott of Irvine, Calif.\" width=\"357\" height=\"476\">\u003cfigcaption class=\"wp-caption-text\">Dr. Emilie Scott of Irvine, Calif., says the direct primary care model has put 'the heart back in medicine' for her. (David Gorn/KQED) \u003ccite>(David Gorn/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>While direct primary care has some similarities to \u003ca href=\"http://www.healthline.com/health-news/the-future-of-healthcare-could-be-in-concierge-medicine-063015\" target=\"_blank\">concierge medicine\u003c/a>, it differs in that direct primary care rejects insurance. And, because concierge medicine sprang from wealthy patients’ desire for greater access to their doctors, patients can \u003ca href=\"http://www.wsj.com/articles/SB10001424052702303471004579165470633112630\" target=\"_blank\">pay up to thousands of dollars a month\u003c/a> for same-day appointments, round-the-clock phone access, house calls and other services.\u003c/p>\n\u003cp>In contrast, direct primary care doctors charge a relatively small monthly fee. While that can be an extra cost for those who also need insurance to cover more serious medical problems, many patients have high-deductible plans, making the monthly expense of direct primary care a good deal, especially for those who go to the doctor a lot.\u003c/p>\n\u003cp>For doctors, the main idea behind direct primary care is to simplify -- scale down, deal mostly in cash and focus on taking better care of fewer patients. This includes a good deal of listening and analysis of how a patient's current environment or life situation may be affecting their health.\u003c/p>\n\u003cp>This type of service \u003ca href=\"http://www.kevinmd.com/blog/2011/07/direct-primary-care-reduces-primary-care-costs.html\" target=\"_blank\">took off as a movement\u003c/a> in 2011, and the model was first evaluated in a 2013 \u003ca href=\"http://www.chcf.org/publications/2013/04/retainer-direct-primary-care\" target=\"_blank\">study\u003c/a> by the California Health Care Foundation. It's gaining significant traction, says Laurence Baker, the chair of Stanford University's Department of Health Research and Policy.\u003c/p>\n\u003cp>\"Absolutely it's a growing segment of primary care,\" he says. \"The model we have is challenged in a lot of ways, the longer a patient waits to see a doctor, the shorter time spent with the doctor. So we have to think about what else we can do to change that.\u003c/p>\n\u003cp>\"I would be surprised if it took over the world,\" Baker added, \"But I certainly wouldn't be surprised if it grew substantially more in the next few years.\"\u003c/p>\n\u003cp>\u003cstrong>'Doctors Will Be in Mass Exodus'\u003c/strong>\u003c/p>\n\u003cp>The reason doctors need to see so many patients in rapid succession is because of huge overhead, says Pamela Wible, a physician in Eugene, Ore., who helps doctors set up their ideal practice using the direct primary care model. In fact, she says, most doctors see just a small fraction of gross earnings.\u003c/p>\n\u003cp>But the kind of streamlined operation found in direct primary care allows doctors to keep a greater share of the money coming in, she says, even if they make less overall than in a traditional practice.\u003c/p>\n\u003cp>\"My expenses are so low, they're now about 10 percent of my practice,\" Wible says. \"And it used to be 74 percent.\"\u003c/p>\n\u003cp>Wible says the direct primary care model has at its heart the relationship between doctor and patient. She says doctors \"will be in mass exodus\" once they learn they can run their practice differently and \"get off the production line.\"\u003c/p>\n\u003cp>Dr. Emilie Scott did just that, in March. She had worked in an academic medical setting for many years, then in a large group practice for another five before venturing out on her own.\u003c/p>\n\u003cp>There are no waiting room magazines in her tiny Irvine medical office, because there is no waiting room. And that's because there is no waiting.\u003c/p>\n\u003cp>She charges her patients $59 per month. Just five months in, she says, her practice is already breaking even.\u003c/p>\n\u003cp>\"For me, it puts the heart back in medicine,\" Scott says, grinning. In the past, \"I had to see patients in a rapid style, trying to get patients out the door. It wears on you.\"\u003c/p>\n\u003cp>She understands the fear some doctors have of taking the leap, in part because of the massive debt they've incurred from medical school. But, she says, \"The point here isn't to become a millionaire. You make a good living, and you can practice in line with your values.\"\u003c/p>\n\u003cp>Scott said some of her patients are surprised at how little her service costs.\u003c/p>\n\u003cp>\"I had one woman who said she couldn't afford it but said she'd listen, and then I explained it, and she was like, 'Are we on Candid Camera or something? What's the catch?'\"\u003c/p>\n\u003cp>\u003cstrong>Shrinking the Physician Pool?\u003c/strong>\u003c/p>\n\u003cp>Janet Coffman, a health policy professor at the University of California, San Francisco, says she doesn't expect direct primary care to explode on the medical scene. Rather, she believes it will make slow and steady inroads. She doesn't think insurance companies will fight the model, even though it cuts them out of the medical care delivery system.\u003c/p>\n\u003cp>But one major effect direct primary care could have, she said, is to further shrink the already inadequate pool of primary care physicians.\u003c/p>\n\u003cp>\"If I were an insurance company, I think I'd be more concerned about recruiting and keeping PCPs because of this,\" Coffman says.\u003c/p>\n\u003cp>Betsy Imholz, director of special projects for Consumers Union, agrees that could be a concern if direct primary care catches on.\u003c/p>\n\u003cp>“Primary care is one of the least lucrative areas for doctors to go into,” Imholz says, “and therefore sometimes difficult for insurers to get sufficient numbers of.”\u003c/p>\n\u003cp>Imholz sees some other potential problems with the model. While she understands why both doctors and patients are attracted to direct primary care — “the old \u003ca href=\"https://www.youtube.com/watch?v=Y10VEkyKd3w\" target=\"_blank\">Marcus Welby\u003c/a> model,” as she puts it — she thinks it’s a move in the opposite direction of the current push for an integrated health care system. Ideally, doctors would have access to patients’ electronic health records, and \u003ca href=\"http://www.rwjf.org/content/dam/farm/reports/issue_briefs/2014/rwjf409988\" target=\"_blank\">all-payer claims databases\u003c/a>, at least \u003ca href=\"http://www.commondreams.org/newswire/2016/08/03/all-six-states-keep-consumers-dark-cost-medical-procedures\" target=\"_blank\">theoretically\u003c/a>, would allow purchasers of insurance to compare costs.\u003c/p>\n\u003cp>“It goes against this coordinated care model that the Affordable Care Act and the U.S. is coming to,” she says, “having things not fragmented but coordinated [in a way that] enables us to check, make quality assessments.”\u003c/p>\n\u003cp>Imholz is also concerned this type of practice could attract healthier people, who might see direct primary care as a substitute for insurance rather than an extra. And that could deprive the ACA \u003ca href=\"https://www.washingtonpost.com/news/to-your-health/wp/2016/03/30/theyre-sicker-plus-aca-enrollees-cost-more-in-care-major-insurer-finds/\" target=\"_blank\">risk pool \u003c/a>of the very type of patients \u003ca href=\"http://www.newsweek.com/obamacare-premiums-rise-10-percent-2017-490268\" target=\"_blank\">needed to keep cost increases manageable\u003c/a>.\u003c/p>\n\u003cp>Consumers in California, Imholz said, should also keep in mind a little-known benefit of the plans offered on the state’s health care exchange, Covered California: those plans are required to offer three visits outside of the deductible, costing only a co-pay.\u003c/p>\n\u003cp>Ultimately, she says, if patients do want to go the route of direct primary care, they should create their own \u003ca href=\"https://www.healthit.gov/providers-professionals/faqs/what-personal-health-record\" target=\"_blank\">personal health record\u003c/a> for each visit, in case at some point they need to visit a specialist for a serious health problem.\u003c/p>\n\u003cp>As to whether direct primary care will positively impact patients' health, Laurence Baker says it's not clear whether or not the longer office and home visits end up providing better care.\u003c/p>\n\u003cp>\"I'm not sure we know if this makes you healthier at the end of the day,\" Baker says. \"It will make you happier, definitely, but the jury is still out about whether it improves outcomes.\"\u003c/p>\n\u003cp>\u003cstrong>'It's Lovely'\u003c/strong>\u003c/p>\n\u003cp>Back in Half Moon Bay, physician Lorraine Page says she doesn't need data. She tries to find the words for the improvement she has seen in her life and the lives of her patients.\u003c/p>\n\u003cp>\"It's … lovely,\" she says with a laugh. \"It's just lovely. The patients do better, I get to see the whole person, the whole family. It's true family practice. And it's very straightforward. I see the person, I get paid. It's simple.\"\u003c/p>\n\u003cp>This type of practice, she says, is what many young doctors-to-be have in mind when they first think about entering medicine.\u003c/p>\n\u003cp>It's an odd twist that Page's current work is considered the cutting- edge of primary care medicine, when it so closely resembles a kind of 1950s Norman Rockwell painting of what a general practitioner is.\u003c/p>\n\u003cp>Most doctors don't even think about what they want anymore, Page says. They get caught up in the system and don't realize there's another choice.\u003c/p>\n\u003cp>But leaving was surprisingly easy.\u003c/p>\n\u003cp>\"Look, your skills are in your mind,\" Page says. \"You can do that anywhere.\"\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>Jon Brooks contributed to this report.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Dr. Lorraine Page, believe it or not, makes house calls.\u003c/p>\n\u003cp>One place she visits is the home of Ann Caponio, a one-bedroom apartment in Half Moon Bay, California. You can tell a knitter lives there: baskets of wool and hanks of yarn adorn the room, and in the corner sits a wooden spinning wheel.\u003c/p>\n\u003caside class=\"pullquote alignright\">A new model gains in popularity: no insurance but unlimited doctor visits are provided for a monthly fee.\u003c/aside>\n\u003cp>But arthritis has put an end to that hobby. And for a while, Caponio, 69, wasn't even getting out.\u003c/p>\n\u003cp>\"I kind of stopped going downtown,\" she says, in her Midland, Texas twang, a holdover from childhood. \"Omigod those stairs.\"\u003c/p>\n\u003cp>She's talking about a steep, 17-step staircase leading to her front door. Three hip replacements left negotiating them a dangerous proposition.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"I tend to fall. And I fell on those damned stairs once.\"\u003c/p>\n\u003cp>And that's where Lorraine Page enters the picture.\u003c/p>\n\u003cp>Besides the house calls, Page provides a little more than Caponio might expect from a primary care doc available through Medicare. Page, for instance, has aided her patient with a number of safety issues, including helping her find someone to rig up a chairlift on those stairs. Now, she can sit on a seat at the top and glide to the bottom.\u003c/p>\n\u003cp>\"It opens up a whole new world for me,\" Caponio says.\u003c/p>\n\u003cp>\u003cstrong>A Different Model\u003c/strong>\u003c/p>\n\u003cp>A whole new world is what Dr. Page herself has been experiencing, ever since she left the traditional clinic setting to try something different. She does have a small office, but prefers to visit most of her patients in their homes.\u003c/p>\n\u003caside class=\"pullquote alignright\">When they learn they can get off the production line, 'Doctors will be in mass exodus.'\u003ccite>Dr. Pamela Wible\u003c/cite>\u003c/aside>\n\u003cp>She's one of a growing number of doctors who have cut loose from what she calls the \"assembly-line, volume approach\" that most of her colleagues have experienced. These breakaway docs are now using a health care delivery model called direct primary care. Page has cut back on the number of patients she sees, and spends more time with the ones she does. She doesn't take insurance and deals mostly in cash. Page charges each time she sees a patient, but most direct primary care doctors bill a monthly fee for unlimited visits.\u003c/p>\n\u003cp>In her previous practice, Page says, the pressure to see more patients in less time wore her down, as did the need for an army of support staff to process the copious paperwork required by insurance companies.\u003c/p>\n\u003cp>\"At our office, we had six full-time doctors. And we had seven full-time insurance people. So [that's] more than one full-time person trying to get reimbursement for patients I was seeing.\"\u003c/p>\n\u003cp>The benefits of leaving that bureaucratic load behind includes more time with patients but shorter days as her total load has been reduced. And she's doing the kind of family-care medicine for which she was trained.\u003c/p>\n\u003cp>\"And I enjoy it a lot more,\" Page says. \"Let's not minimize that.\"\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\u003cstrong>What Doctors Want\u003c/strong>\u003c/p>\n\u003cp>A 2012 \u003ca href=\"http://www.medscape.com/features/slideshow/compensation/2012/public\" target=\"_blank\">Medscape study\u003c/a> found that 46 percent of primary care physicians showed such dissatisfaction with their careers, they wouldn't pursue medicine if they could choose again. Another\u003ca href=\"http://www.physiciansfoundation.org/healthcare-research/a-survey-of-americas-physicians-practice-patterns-and-perspectives\" target=\"_blank\"> study\u003c/a>, from the Physicians Foundation, found 60 percent of primary care doctors would not recommend a career in medicine. Just six percent described the morale of their colleagues as positive.\u003c/p>\n\u003cp>Overall, says Wanda Filer, president of the American Academy of Family Physicians, primary care doctors feel overworked and ineffective. \"Most patients are just rushed out the door,\" she says. \"That's not what doctors want to do. This new model of care gets the physician and the patient out of that hamster-wheel model.\"\u003c/p>\n\u003cp>Filer says about three percent of the organization's 69,000 primary care doctors have made the move to direct primary care in the past couple of years, and that number is increasing rapidly as other physicians see it succeed.\u003c/p>\n\u003cp>In fact, Filer says, her organization has taken the unusual step of convening informational seminars for the large number of family doctors who have expressed interest in getting off the grid and starting a kinder, gentler practice.\u003c/p>\n\u003cp>\u003cb>Cash and Care\u003c/b>\u003c/p>\n\u003cfigure id=\"attachment_220077\" class=\"wp-caption alignright\" style=\"max-width: 357px\">\u003cimg class=\"wp-image-220077\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/08/emiliescott1-885x1180.jpg\" alt=\"Dr. Emilie Scott of Irvine, Calif.\" width=\"357\" height=\"476\">\u003cfigcaption class=\"wp-caption-text\">Dr. Emilie Scott of Irvine, Calif., says the direct primary care model has put 'the heart back in medicine' for her. (David Gorn/KQED) \u003ccite>(David Gorn/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>While direct primary care has some similarities to \u003ca href=\"http://www.healthline.com/health-news/the-future-of-healthcare-could-be-in-concierge-medicine-063015\" target=\"_blank\">concierge medicine\u003c/a>, it differs in that direct primary care rejects insurance. And, because concierge medicine sprang from wealthy patients’ desire for greater access to their doctors, patients can \u003ca href=\"http://www.wsj.com/articles/SB10001424052702303471004579165470633112630\" target=\"_blank\">pay up to thousands of dollars a month\u003c/a> for same-day appointments, round-the-clock phone access, house calls and other services.\u003c/p>\n\u003cp>In contrast, direct primary care doctors charge a relatively small monthly fee. While that can be an extra cost for those who also need insurance to cover more serious medical problems, many patients have high-deductible plans, making the monthly expense of direct primary care a good deal, especially for those who go to the doctor a lot.\u003c/p>\n\u003cp>For doctors, the main idea behind direct primary care is to simplify -- scale down, deal mostly in cash and focus on taking better care of fewer patients. This includes a good deal of listening and analysis of how a patient's current environment or life situation may be affecting their health.\u003c/p>\n\u003cp>This type of service \u003ca href=\"http://www.kevinmd.com/blog/2011/07/direct-primary-care-reduces-primary-care-costs.html\" target=\"_blank\">took off as a movement\u003c/a> in 2011, and the model was first evaluated in a 2013 \u003ca href=\"http://www.chcf.org/publications/2013/04/retainer-direct-primary-care\" target=\"_blank\">study\u003c/a> by the California Health Care Foundation. It's gaining significant traction, says Laurence Baker, the chair of Stanford University's Department of Health Research and Policy.\u003c/p>\n\u003cp>\"Absolutely it's a growing segment of primary care,\" he says. \"The model we have is challenged in a lot of ways, the longer a patient waits to see a doctor, the shorter time spent with the doctor. So we have to think about what else we can do to change that.\u003c/p>\n\u003cp>\"I would be surprised if it took over the world,\" Baker added, \"But I certainly wouldn't be surprised if it grew substantially more in the next few years.\"\u003c/p>\n\u003cp>\u003cstrong>'Doctors Will Be in Mass Exodus'\u003c/strong>\u003c/p>\n\u003cp>The reason doctors need to see so many patients in rapid succession is because of huge overhead, says Pamela Wible, a physician in Eugene, Ore., who helps doctors set up their ideal practice using the direct primary care model. In fact, she says, most doctors see just a small fraction of gross earnings.\u003c/p>\n\u003cp>But the kind of streamlined operation found in direct primary care allows doctors to keep a greater share of the money coming in, she says, even if they make less overall than in a traditional practice.\u003c/p>\n\u003cp>\"My expenses are so low, they're now about 10 percent of my practice,\" Wible says. \"And it used to be 74 percent.\"\u003c/p>\n\u003cp>Wible says the direct primary care model has at its heart the relationship between doctor and patient. She says doctors \"will be in mass exodus\" once they learn they can run their practice differently and \"get off the production line.\"\u003c/p>\n\u003cp>Dr. Emilie Scott did just that, in March. She had worked in an academic medical setting for many years, then in a large group practice for another five before venturing out on her own.\u003c/p>\n\u003cp>There are no waiting room magazines in her tiny Irvine medical office, because there is no waiting room. And that's because there is no waiting.\u003c/p>\n\u003cp>She charges her patients $59 per month. Just five months in, she says, her practice is already breaking even.\u003c/p>\n\u003cp>\"For me, it puts the heart back in medicine,\" Scott says, grinning. In the past, \"I had to see patients in a rapid style, trying to get patients out the door. It wears on you.\"\u003c/p>\n\u003cp>She understands the fear some doctors have of taking the leap, in part because of the massive debt they've incurred from medical school. But, she says, \"The point here isn't to become a millionaire. You make a good living, and you can practice in line with your values.\"\u003c/p>\n\u003cp>Scott said some of her patients are surprised at how little her service costs.\u003c/p>\n\u003cp>\"I had one woman who said she couldn't afford it but said she'd listen, and then I explained it, and she was like, 'Are we on Candid Camera or something? What's the catch?'\"\u003c/p>\n\u003cp>\u003cstrong>Shrinking the Physician Pool?\u003c/strong>\u003c/p>\n\u003cp>Janet Coffman, a health policy professor at the University of California, San Francisco, says she doesn't expect direct primary care to explode on the medical scene. Rather, she believes it will make slow and steady inroads. She doesn't think insurance companies will fight the model, even though it cuts them out of the medical care delivery system.\u003c/p>\n\u003cp>But one major effect direct primary care could have, she said, is to further shrink the already inadequate pool of primary care physicians.\u003c/p>\n\u003cp>\"If I were an insurance company, I think I'd be more concerned about recruiting and keeping PCPs because of this,\" Coffman says.\u003c/p>\n\u003cp>Betsy Imholz, director of special projects for Consumers Union, agrees that could be a concern if direct primary care catches on.\u003c/p>\n\u003cp>“Primary care is one of the least lucrative areas for doctors to go into,” Imholz says, “and therefore sometimes difficult for insurers to get sufficient numbers of.”\u003c/p>\n\u003cp>Imholz sees some other potential problems with the model. While she understands why both doctors and patients are attracted to direct primary care — “the old \u003ca href=\"https://www.youtube.com/watch?v=Y10VEkyKd3w\" target=\"_blank\">Marcus Welby\u003c/a> model,” as she puts it — she thinks it’s a move in the opposite direction of the current push for an integrated health care system. Ideally, doctors would have access to patients’ electronic health records, and \u003ca href=\"http://www.rwjf.org/content/dam/farm/reports/issue_briefs/2014/rwjf409988\" target=\"_blank\">all-payer claims databases\u003c/a>, at least \u003ca href=\"http://www.commondreams.org/newswire/2016/08/03/all-six-states-keep-consumers-dark-cost-medical-procedures\" target=\"_blank\">theoretically\u003c/a>, would allow purchasers of insurance to compare costs.\u003c/p>\n\u003cp>“It goes against this coordinated care model that the Affordable Care Act and the U.S. is coming to,” she says, “having things not fragmented but coordinated [in a way that] enables us to check, make quality assessments.”\u003c/p>\n\u003cp>Imholz is also concerned this type of practice could attract healthier people, who might see direct primary care as a substitute for insurance rather than an extra. And that could deprive the ACA \u003ca href=\"https://www.washingtonpost.com/news/to-your-health/wp/2016/03/30/theyre-sicker-plus-aca-enrollees-cost-more-in-care-major-insurer-finds/\" target=\"_blank\">risk pool \u003c/a>of the very type of patients \u003ca href=\"http://www.newsweek.com/obamacare-premiums-rise-10-percent-2017-490268\" target=\"_blank\">needed to keep cost increases manageable\u003c/a>.\u003c/p>\n\u003cp>Consumers in California, Imholz said, should also keep in mind a little-known benefit of the plans offered on the state’s health care exchange, Covered California: those plans are required to offer three visits outside of the deductible, costing only a co-pay.\u003c/p>\n\u003cp>Ultimately, she says, if patients do want to go the route of direct primary care, they should create their own \u003ca href=\"https://www.healthit.gov/providers-professionals/faqs/what-personal-health-record\" target=\"_blank\">personal health record\u003c/a> for each visit, in case at some point they need to visit a specialist for a serious health problem.\u003c/p>\n\u003cp>As to whether direct primary care will positively impact patients' health, Laurence Baker says it's not clear whether or not the longer office and home visits end up providing better care.\u003c/p>\n\u003cp>\"I'm not sure we know if this makes you healthier at the end of the day,\" Baker says. \"It will make you happier, definitely, but the jury is still out about whether it improves outcomes.\"\u003c/p>\n\u003cp>\u003cstrong>'It's Lovely'\u003c/strong>\u003c/p>\n\u003cp>Back in Half Moon Bay, physician Lorraine Page says she doesn't need data. She tries to find the words for the improvement she has seen in her life and the lives of her patients.\u003c/p>\n\u003cp>\"It's … lovely,\" she says with a laugh. \"It's just lovely. The patients do better, I get to see the whole person, the whole family. It's true family practice. And it's very straightforward. I see the person, I get paid. It's simple.\"\u003c/p>\n\u003cp>This type of practice, she says, is what many young doctors-to-be have in mind when they first think about entering medicine.\u003c/p>\n\u003cp>It's an odd twist that Page's current work is considered the cutting- edge of primary care medicine, when it so closely resembles a kind of 1950s Norman Rockwell painting of what a general practitioner is.\u003c/p>\n\u003cp>Most doctors don't even think about what they want anymore, Page says. They get caught up in the system and don't realize there's another choice.\u003c/p>\n\u003cp>But leaving was surprisingly easy.\u003c/p>\n\u003cp>\"Look, your skills are in your mind,\" Page says. \"You can do that anywhere.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"title": "SF, Oakland and Albany to Vote on Soda Taxes",
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"content": "\u003cp>Voters in San Francisco, Oakland and Albany will decide in November whether or not to impose a one cent per ounce tax on distributors of soda and other sugary beverages. This is the second such tax that San Franciscans will vote on — the city rejected a two cent soda tax in 2014. Supporters of the taxes say they are an essential tool in the fight against rising diabetes and obesity rates. But opponents say the measures are actually a “grocery tax” that disproportionately targets low-income communities. We’ll speak with advocates from each side of the issue.\u003c/p>\n\u003cp>\u003cstrong>Related Links:\u003c/strong>\u003c/p>\n\u003cul>\n\u003cli>\u003ca href=\"https://ww2.kqed.org/news/series/election-2016/\">Election 2016\u003c/a> (KQED)\u003c/li>\n\u003c/ul>\n\u003cp>[ad fullwidth]\u003c/p>\u003cp>\u003c/p>\n",
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"excerpt": "Voters in San Francisco, Oakland and Albany will decide in November whether or not to impose a one cent per ounce tax on distributors of soda and other sugary beverages. This is the second such tax that San Franciscans will vote on -- the city rejected a two cent soda tax in 2014. Supporters of the taxes say they are an essential tool in the fight against rising diabetes and obesity rates. But opponents say the measures are actually a \"grocery tax\" that disproportionately targets low-income communities. We'll speak with advocates from each side of the issue.",
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"source": "BBC World Service"
},
"link": "/radio/program/bbc-world-service",
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},
"californiareport": {
"id": "californiareport",
"title": "The California Report",
"tagline": "California, day by day",
"info": "KQED’s statewide radio news program providing daily coverage of issues, trends and public policy decisions.",
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"officialWebsiteLink": "/californiareport",
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"source": "kqed",
"order": 8
},
"link": "/californiareport",
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}
},
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"title": "The California Report Magazine",
"tagline": "Your state, your stories",
"info": "Every week, The California Report Magazine takes you on a road trip for the ears: to visit the places and meet the people who make California unique. The in-depth storytelling podcast from the California Report.",
"airtime": "FRI 4:30pm-5pm, 6:30pm-7pm, 11pm-11:30pm",
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"officialWebsiteLink": "/californiareportmagazine",
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"order": 10
},
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM3NjkwNjk1OTAz",
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},
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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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"rss": "https://www.cityarts.net/feed/"
}
},
"closealltabs": {
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"order": 1
},
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"info": "\u003cem>Code Switch\u003c/em>, which listeners will hear in the first part of the hour, has fearless and much-needed conversations about race. Hosted by journalists of color, the show tackles the subject of race head-on, exploring how it impacts every part of society — from politics and pop culture to history, sports and more.\u003cbr />\u003cbr />\u003cem>Life Kit\u003c/em>, which will be in the second part of the hour, guides you through spaces and feelings no one prepares you for — from finances to mental health, from workplace microaggressions to imposter syndrome, from relationships to parenting. The show features experts with real world experience and shares their knowledge. Because everyone needs a little help being human.\u003cbr />\u003cbr />\u003ca href=\"https://www.npr.org/podcasts/510312/codeswitch\">\u003cem>Code Switch\u003c/em> offical site and podcast\u003c/a>\u003cbr />\u003ca href=\"https://www.npr.org/lifekit\">\u003cem>Life Kit\u003c/em> offical site and podcast\u003c/a>\u003cbr />",
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"id": "commonwealth-club",
"title": "Commonwealth Club of California Podcast",
"info": "The Commonwealth Club of California is the nation's oldest and largest public affairs forum. As a non-partisan forum, The Club brings to the public airwaves diverse viewpoints on important topics. The Club's weekly radio broadcast - the oldest in the U.S., dating back to 1924 - is carried across the nation on public radio stations and is now podcasting. Our website archive features audio of our recent programs, as well as selected speeches from our long and distinguished history. This podcast feed is usually updated twice a week and is always un-edited.",
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"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Commonwealth-Club-Podcast-Tile-360x360-1.jpg",
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"meta": {
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"source": "Commonwealth Club of California"
},
"link": "/radio/program/commonwealth-club",
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"google": "https://podcasts.google.com/feed/aHR0cDovL3d3dy5jb21tb253ZWFsdGhjbHViLm9yZy9hdWRpby9wb2RjYXN0L3dlZWtseS54bWw",
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"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.",
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"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Forum-Podcast-Tile-703x703-1.jpg",
"imageAlt": "KQED Forum with Mina Kim and Alexis Madrigal",
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"source": "kqed",
"order": 9
},
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM5NTU3MzgxNjMz",
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"freakonomics-radio": {
"id": "freakonomics-radio",
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"imageSrc": "https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/05/freakonomicsRadio.png",
"officialWebsiteLink": "http://freakonomics.com/",
"airtime": "SUN 1am-2am, SAT 3pm-4pm",
"meta": {
"site": "radio",
"source": "WNYC"
},
"link": "/radio/program/freakonomics-radio",
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"apple": "https://itunes.apple.com/us/podcast/freakonomics-radio/id354668519",
"tuneIn": "https://tunein.com/podcasts/WNYC-Podcasts/Freakonomics-Radio-p272293/",
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},
"fresh-air": {
"id": "fresh-air",
"title": "Fresh Air",
"info": "Hosted by Terry Gross, \u003cem>Fresh Air from WHYY\u003c/em> is the Peabody Award-winning weekday magazine of contemporary arts and issues. One of public radio's most popular programs, Fresh Air features intimate conversations with today's biggest luminaries.",
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"apple": "https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=214089682&at=11l79Y&ct=nprdirectory",
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"info": "A live production of NPR and WBUR Boston, in collaboration with stations across the country, Here & Now reflects the fluid world of news as it's happening in the middle of the day, with timely, in-depth news, interviews and conversation. Hosted by Robin Young, Jeremy Hobson and Tonya Mosley.",
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},
"hidden-brain": {
"id": "hidden-brain",
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"info": "Shankar Vedantam uses science and storytelling to reveal the unconscious patterns that drive human behavior, shape our choices and direct our relationships.",
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"airtime": "SUN 7pm-8pm",
"meta": {
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"source": "NPR"
},
"link": "/radio/program/hidden-brain",
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},
"how-i-built-this": {
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"title": "How I Built This with Guy Raz",
"info": "Guy Raz dives into the stories behind some of the world's best known companies. How I Built This weaves a narrative journey about innovators, entrepreneurs and idealists—and the movements they built.",
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"airtime": "SUN 7:30pm-8pm",
"meta": {
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"source": "npr"
},
"link": "/radio/program/how-i-built-this",
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"apple": "https://itunes.apple.com/us/podcast/how-i-built-this-with-guy-raz/id1150510297?mt=2",
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},
"hyphenacion": {
"id": "hyphenacion",
"title": "Hyphenación",
"tagline": "Where conversation and cultura meet",
"info": "What kind of no sabo word is Hyphenación? For us, it’s about living within a hyphenation. Like being a third-gen Mexican-American from the Texas border now living that Bay Area Chicano life. Like Xorje! Each week we bring together a couple of hyphenated Latinos to talk all about personal life choices: family, careers, relationships, belonging … everything is on the table. ",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2025/03/Hyphenacion_FinalAssets_PodcastTile.png",
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"officialWebsiteLink": "/podcasts/hyphenacion",
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"order": 15
},
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},
"jerrybrown": {
"id": "jerrybrown",
"title": "The Political Mind of Jerry Brown",
"tagline": "Lessons from a lifetime in politics",
"info": "The Political Mind of Jerry Brown brings listeners the wisdom of the former Governor, Mayor, and presidential candidate. Scott Shafer interviewed Brown for more than 40 hours, covering the former governor's life and half-century in the political game – and Brown has some lessons he'd like to share. ",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/The-Political-Mind-of-Jerry-Brown-Podcast-Tile-703x703-1.jpg",
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"officialWebsiteLink": "/podcasts/jerrybrown",
"meta": {
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"order": 18
},
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}
},
"latino-usa": {
"id": "latino-usa",
"title": "Latino USA",
"airtime": "MON 1am-2am, SUN 6pm-7pm",
"info": "Latino USA, the radio journal of news and culture, is the only national, English-language radio program produced from a Latino perspective.",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/latinoUsa.jpg",
"officialWebsiteLink": "http://latinousa.org/",
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"source": "npr"
},
"link": "/radio/program/latino-usa",
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"apple": "https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=79681317&at=11l79Y&ct=nprdirectory",
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"rss": "https://feeds.npr.org/510016/podcast.xml"
}
},
"marketplace": {
"id": "marketplace",
"title": "Marketplace",
"info": "Our flagship program, helmed by Kai Ryssdal, examines what the day in money delivered, through stories, conversations, newsworthy numbers and more. Updated Monday through Friday at about 3:30 p.m. PT.",
"airtime": "MON-FRI 4pm-4:30pm, MON-WED 6:30pm-7pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Marketplace-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.marketplace.org/",
"meta": {
"site": "news",
"source": "American Public Media"
},
"link": "/radio/program/marketplace",
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"rss": "https://feeds.publicradio.org/public_feeds/marketplace-pm/rss/rss"
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},
"masters-of-scale": {
"id": "masters-of-scale",
"title": "Masters of Scale",
"info": "Masters of Scale is an original podcast in which LinkedIn co-founder and Greylock Partner Reid Hoffman sets out to describe and prove theories that explain how great entrepreneurs take their companies from zero to a gazillion in ingenious fashion.",
"airtime": "Every other Wednesday June 12 through October 16 at 8pm (repeats Thursdays at 2am)",
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"officialWebsiteLink": "https://mastersofscale.com/",
"meta": {
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"source": "WaitWhat"
},
"link": "/radio/program/masters-of-scale",
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"rss": "https://rss.art19.com/masters-of-scale"
}
},
"mindshift": {
"id": "mindshift",
"title": "MindShift",
"tagline": "A podcast about the future of learning and how we raise our kids",
"info": "The MindShift podcast explores the innovations in education that are shaping how kids learn. Hosts Ki Sung and Katrina Schwartz introduce listeners to educators, researchers, parents and students who are developing effective ways to improve how kids learn. We cover topics like how fed-up administrators are developing surprising tactics to deal with classroom disruptions; how listening to podcasts are helping kids develop reading skills; the consequences of overparenting; and why interdisciplinary learning can engage students on all ends of the traditional achievement spectrum. This podcast is part of the MindShift education site, a division of KQED News. KQED is an NPR/PBS member station based in San Francisco. You can also visit the MindShift website for episodes and supplemental blog posts or tweet us \u003ca href=\"https://twitter.com/MindShiftKQED\">@MindShiftKQED\u003c/a> or visit us at \u003ca href=\"/mindshift\">MindShift.KQED.org\u003c/a>",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Mindshift-Podcast-Tile-703x703-1.jpg",
"imageAlt": "KQED MindShift: How We Will Learn",
"officialWebsiteLink": "/mindshift/",
"meta": {
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"source": "kqed",
"order": 12
},
"link": "/podcasts/mindshift",
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM1NzY0NjAwNDI5",
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}
},
"morning-edition": {
"id": "morning-edition",
"title": "Morning Edition",
"info": "\u003cem>Morning Edition\u003c/em> takes listeners around the country and the world with multi-faceted stories and commentaries every weekday. Hosts Steve Inskeep, David Greene and Rachel Martin bring you the latest breaking news and features to prepare you for the day.",
"airtime": "MON-FRI 3am-9am",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Morning-Edition-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.npr.org/programs/morning-edition/",
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"link": "/radio/program/morning-edition"
},
"onourwatch": {
"id": "onourwatch",
"title": "On Our Watch",
"tagline": "Deeply-reported investigative journalism",
"info": "For decades, the process for how police police themselves has been inconsistent – if not opaque. In some states, like California, these proceedings were completely hidden. After a new police transparency law unsealed scores of internal affairs files, our reporters set out to examine these cases and the shadow world of police discipline. On Our Watch brings listeners into the rooms where officers are questioned and witnesses are interrogated to find out who this system is really protecting. Is it the officers, or the public they've sworn to serve?",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/On-Our-Watch-Podcast-Tile-703x703-1.jpg",
"imageAlt": "On Our Watch from NPR and KQED",
"officialWebsiteLink": "/podcasts/onourwatch",
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"site": "news",
"source": "kqed",
"order": 11
},
"link": "/podcasts/onourwatch",
"subscribe": {
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5ucHIub3JnLzUxMDM2MC9wb2RjYXN0LnhtbD9zYz1nb29nbGVwb2RjYXN0cw",
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"rss": "https://feeds.npr.org/510360/podcast.xml"
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},
"on-the-media": {
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"title": "On The Media",
"info": "Our weekly podcast explores how the media 'sausage' is made, casts an incisive eye on fluctuations in the marketplace of ideas, and examines threats to the freedom of information and expression in America and abroad. For one hour a week, the show tries to lift the veil from the process of \"making media,\" especially news media, because it's through that lens that we see the world and the world sees us",
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"info": "One of public radio's most dynamic voices, Sam Sanders helped launch The NPR Politics Podcast and hosted NPR's hit show It's Been A Minute. Now, the award-winning host returns with something brand new, The Sam Sanders Show. Every week, Sam Sanders and friends dig into the culture that shapes our lives: what's driving the biggest trends, how artists really think, and even the memes you can't stop scrolling past. Sam is beloved for his way of unpacking the world and bringing you up close to fresh currents and engaging conversations. The Sam Sanders Show is smart, funny and always a good time.",
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