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"title": "Pregnant Napa County Woman Positive for Zika Virus",
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"content": "\u003cp>A pregnant woman in Napa has been confirmed positive for the Zika virus, the Napa County Public Health Division reported Wednesday. The agency received the confirmation from the California Department of Public Health.\u003c/p>\n\u003cp>The woman, whom officials did not identify, had traveled to Central America in the last three months, and is not showing signs of Zika infection at present.\u003c/p>\n\u003cp>“This Zika virus case is not a threat to public health. There is no active transmission of Zika virus in Napa County, and the two kinds of mosquitos that transmit the virus have not been found here,” Dr. Karen Relucio, Napa County health officer, said in a statement.\u003c/p>\n\u003cp>“Anyone who is planning to travel to a country with active Zika virus transmission should consult with their health care provider before leaving,” she said, “especially if they are pregnant or are considering becoming pregnant.”\u003c/p>\n\u003cp>Napa public health officials say they expect to see more Zika cases. The agency is working with local doctors to test for cases of Zika virus both in pregnant women who have traveled to countries with Zika virus or who have sexual partners who have traveled to these countries.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>In its press release, Napa County Public Health stressed prevention:\u003c/p>\n\u003cul>\n\u003cli>Women who are pregnant or may become pregnant are advised to avoid travel to \u003ca href=\"http://www.cdc.gov/zika/geo/active-countries.html\" target=\"_blank\" rel=\"noopener\">areas with Zika\u003c/a>.\u003c/li>\n\u003cli>Women who are pregnant and have sexual partner(s) that have traveled to \u003ca href=\"http://www.cdc.gov/zika/geo/active-countries.html\" target=\"_blank\" rel=\"noopener\">areas with Zika\u003c/a> are advised to abstain from sex or use condoms consistently for the duration of the pregnancy.\u003c/li>\n\u003cli>Pregnant women or sexual partner(s) of pregnant women who cannot avoid travel to \u003ca href=\"http://www.cdc.gov/zika/geo/active-countries.html\" target=\"_blank\" rel=\"noopener\">areas with Zika\u003c/a> are advised to take precautions to \u003ca href=\"http://www.cdc.gov/chikungunya/pdfs/fs_mosquito_bite_prevention_travelers.pdf\" target=\"_blank\" rel=\"noopener\">avoid mosquito bites\u003c/a> (This information is also available in \u003ca href=\"http://www.cdc.gov/zika/pdfs/fs_mosquito_bite_prevention_travelers_spanish.pdf\">Spanish\u003c/a>).\u003c/li>\n\u003c/ul>\n\u003cp>In Northern California, there has been\u003ca href=\"http://www.sacbee.com/news/local/health-and-medicine/article59651061.html\" target=\"_blank\" rel=\"noopener\"> one other reported case \u003c/a>of Zika, in a person who had recently traveled internationally. The person is a Yolo County resident. Statewide, there have been\u003ca href=\"https://www.cdph.ca.gov/HealthInfo/discond/Documents/TravelAssociatedCasesofZikaVirusinCA.pdf\" target=\"_blank\" rel=\"noopener\"> six confirmed Zika cases\u003c/a> so far this year, but a spokesman for the state’s Department of Public Health said he could not confirm the location of each case, for privacy reasons.\u003c/p>\n\u003cp>Zika is an illness caused by the Zika virus, and it’s spread mostly through the bite of an infected Aedes species mosquito. While these mosquitos are found in California, \u003ca href=\"https://www.cdph.ca.gov/HealthInfo/discond/Documents/AedesDistributionMap.pdf\" target=\"_blank\" rel=\"noopener\">they are not widespread.\u003c/a> Common symptoms include fever, rash, joint pain and conjunctivitis or red eyes.\u003c/p>\n\u003cp>In the U.S. 107 people have contracted Zika after they traveled to a country where the virus is present, according to the Centers for Disease Control and Prevention. \u003ca href=\"http://www.cdc.gov/zika/\" target=\"_blank\" rel=\"noopener\">CDC reports\u003c/a> that there are no cases of people in the U.S. who have acquired Zika from a mosquito.\u003c/p>\n\u003cp>Zika was first discovered in 1947 in Uganda and then spread through tropical Africa, Southeast Asia and the Pacific Islands.\u003c/p>\n\u003cp>In May 2015, Brazil had its first confirmed case of Zika. It spread dramatically through South America, Central America, Mexico and the Caribbean. On Feb. 1, the World Health Organization declared Zika a “\u003ca href=\"http://www.who.int/mediacentre/news/statements/2016/emergency-committee-zika-microcephaly/en/\" target=\"_blank\" rel=\"noopener\">public health emergency of international concern.\u003c/a>”\u003c/p>\n\u003cp>While Zika is a relatively mild illness, it appears to put pregnant women at increased risk of their baby having microcephaly, a birth defect where the baby has a small head. Zika is also associated with increased risk of Guillain-Barre syndrome, an immune system disorder.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The Centers for Disease Control and Prevention has more information about Zika \u003ca href=\"http://www.cdc.gov/zika/\" target=\"_blank\" rel=\"noopener\">on this page\u003c/a>.\u003c/p>\n\n",
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"excerpt": "It appears to be the first case in the Bay Area. The only other reported case in Northern California was in Yolo County.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>A pregnant woman in Napa has been confirmed positive for the Zika virus, the Napa County Public Health Division reported Wednesday. The agency received the confirmation from the California Department of Public Health.\u003c/p>\n\u003cp>The woman, whom officials did not identify, had traveled to Central America in the last three months, and is not showing signs of Zika infection at present.\u003c/p>\n\u003cp>“This Zika virus case is not a threat to public health. There is no active transmission of Zika virus in Napa County, and the two kinds of mosquitos that transmit the virus have not been found here,” Dr. Karen Relucio, Napa County health officer, said in a statement.\u003c/p>\n\u003cp>“Anyone who is planning to travel to a country with active Zika virus transmission should consult with their health care provider before leaving,” she said, “especially if they are pregnant or are considering becoming pregnant.”\u003c/p>\n\u003cp>Napa public health officials say they expect to see more Zika cases. The agency is working with local doctors to test for cases of Zika virus both in pregnant women who have traveled to countries with Zika virus or who have sexual partners who have traveled to these countries.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>In its press release, Napa County Public Health stressed prevention:\u003c/p>\n\u003cul>\n\u003cli>Women who are pregnant or may become pregnant are advised to avoid travel to \u003ca href=\"http://www.cdc.gov/zika/geo/active-countries.html\" target=\"_blank\" rel=\"noopener\">areas with Zika\u003c/a>.\u003c/li>\n\u003cli>Women who are pregnant and have sexual partner(s) that have traveled to \u003ca href=\"http://www.cdc.gov/zika/geo/active-countries.html\" target=\"_blank\" rel=\"noopener\">areas with Zika\u003c/a> are advised to abstain from sex or use condoms consistently for the duration of the pregnancy.\u003c/li>\n\u003cli>Pregnant women or sexual partner(s) of pregnant women who cannot avoid travel to \u003ca href=\"http://www.cdc.gov/zika/geo/active-countries.html\" target=\"_blank\" rel=\"noopener\">areas with Zika\u003c/a> are advised to take precautions to \u003ca href=\"http://www.cdc.gov/chikungunya/pdfs/fs_mosquito_bite_prevention_travelers.pdf\" target=\"_blank\" rel=\"noopener\">avoid mosquito bites\u003c/a> (This information is also available in \u003ca href=\"http://www.cdc.gov/zika/pdfs/fs_mosquito_bite_prevention_travelers_spanish.pdf\">Spanish\u003c/a>).\u003c/li>\n\u003c/ul>\n\u003cp>In Northern California, there has been\u003ca href=\"http://www.sacbee.com/news/local/health-and-medicine/article59651061.html\" target=\"_blank\" rel=\"noopener\"> one other reported case \u003c/a>of Zika, in a person who had recently traveled internationally. The person is a Yolo County resident. Statewide, there have been\u003ca href=\"https://www.cdph.ca.gov/HealthInfo/discond/Documents/TravelAssociatedCasesofZikaVirusinCA.pdf\" target=\"_blank\" rel=\"noopener\"> six confirmed Zika cases\u003c/a> so far this year, but a spokesman for the state’s Department of Public Health said he could not confirm the location of each case, for privacy reasons.\u003c/p>\n\u003cp>Zika is an illness caused by the Zika virus, and it’s spread mostly through the bite of an infected Aedes species mosquito. While these mosquitos are found in California, \u003ca href=\"https://www.cdph.ca.gov/HealthInfo/discond/Documents/AedesDistributionMap.pdf\" target=\"_blank\" rel=\"noopener\">they are not widespread.\u003c/a> Common symptoms include fever, rash, joint pain and conjunctivitis or red eyes.\u003c/p>\n\u003cp>In the U.S. 107 people have contracted Zika after they traveled to a country where the virus is present, according to the Centers for Disease Control and Prevention. \u003ca href=\"http://www.cdc.gov/zika/\" target=\"_blank\" rel=\"noopener\">CDC reports\u003c/a> that there are no cases of people in the U.S. who have acquired Zika from a mosquito.\u003c/p>\n\u003cp>Zika was first discovered in 1947 in Uganda and then spread through tropical Africa, Southeast Asia and the Pacific Islands.\u003c/p>\n\u003cp>In May 2015, Brazil had its first confirmed case of Zika. It spread dramatically through South America, Central America, Mexico and the Caribbean. On Feb. 1, the World Health Organization declared Zika a “\u003ca href=\"http://www.who.int/mediacentre/news/statements/2016/emergency-committee-zika-microcephaly/en/\" target=\"_blank\" rel=\"noopener\">public health emergency of international concern.\u003c/a>”\u003c/p>\n\u003cp>While Zika is a relatively mild illness, it appears to put pregnant women at increased risk of their baby having microcephaly, a birth defect where the baby has a small head. Zika is also associated with increased risk of Guillain-Barre syndrome, an immune system disorder.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The Centers for Disease Control and Prevention has more information about Zika \u003ca href=\"http://www.cdc.gov/zika/\" target=\"_blank\" rel=\"noopener\">on this page\u003c/a>.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Mobile Clinics Serve California's Growing Homeless Youth Population",
"title": "Mobile Clinics Serve California's Growing Homeless Youth Population",
"headTitle": "Vital Signs | State of Health | KQED News",
"content": "\u003cp>Dr. Seth Ammerman listens intently to his new patient. Ernesto, who does not want his last name disclosed, is homeless. Ernesto is earning a high school degree and working part time, but at night, he and his brother share a tent that they set up on San Jose streets. The daily stress of being homeless is wearing Ernesto out and making him light up too many cigarettes.\u003c/p>\n\u003caside class=\"pullquote alignright\">'These kids, because of all these access barriers — lack of insurance, lack of transportation — they’re not going to get this kind of care unless we go to them.'\u003ccite>Dr. Seth Ammerman, medical director, Stanford Teen Health Van \u003c/cite>\u003c/aside>\n\u003cp>“I just want to cut down on my smoking,” says Ernesto, 21, with a tentative, soft voice. “I’ve been on the streets all the time, you know? I just want to make sure I’m OK.”\u003c/p>\n\u003cp>That's why Ernesto walked into this mobile clinic parked just a few steps away from his classroom at the San Jose Conservation Corps & Charter School. He's sitting in a fully equipped exam room inside a shiny blue tour bus with Wi-Fi and the ability to get HIV test results in 20 minutes.\u003c/p>\n\u003cp>During the consultation with Ernesto, Ammerman nods sympathetically. In his 20 years working in this teen health van, Ammerman has treated thousands of uninsured and homeless adolescents ages 24 and under.\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/247566086\" 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>Twice a week, Ammerman and two nurses park the clinic at continuation high schools and other places frequented by at-risk adolescents in Santa Clara, San Mateo and San Francisco counties. The van is a community project of the Lucile Packard Children's Hospital Stanford and Children's Health Fund, with support from Samsung.\u003c/p>\n\u003cfigure id=\"attachment_146678\" class=\"wp-caption alignright\" style=\"max-width: 1920px\">\u003cimg class=\"wp-image-146678 size-full\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/02/RS18410_IMG_9380.JPG-qut.jpg\" alt=\"\" width=\"1920\" height=\"1280\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18410_IMG_9380.JPG-qut.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18410_IMG_9380.JPG-qut-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18410_IMG_9380.JPG-qut-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18410_IMG_9380.JPG-qut-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18410_IMG_9380.JPG-qut-1440x960.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18410_IMG_9380.JPG-qut-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18410_IMG_9380.JPG-qut-960x640.jpg 960w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">The teen health van parks at continuation high schools and other places frequented by adolescents in Santa Clara, San Mateo and San Francisco counties. Inside, patients are seen in two exam rooms and a nursing station. \u003ccite>(Farida Jhabvala Romero/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The team provides free medical, nutrition and mental health services, including reproductive health care and treatment for chronic illnesses, substance abuse and depression. All medications are free and provided at the time of consultation. A social worker is available for counseling and connects adolescents to additional resources; a registered dietitian works with patients who are malnourished, a frequent health issue for this population.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Some of the 400 patients who visit the teen health van each year have never seen a doctor, says Ammerman.\u003c/p>\n\u003cp>“Going to the patients makes all the difference, and it's not just a matter of convenience,” says Ammerman, a clinical professor of adolescent medicine at Stanford University. “It really is that these kids, because of all these access barriers -- lack of insurance, lack of transportation -- they're not going to get this kind of care unless we go to them.”\u003c/p>\n\u003cp>For many patients here, the teen health van can become a trustworthy and reliable place in an otherwise unstable world.\u003c/p>\n\u003cp>Grace Kim first set foot in the van 10 years ago when she was 17. She admits she was skeptical.\u003c/p>\n\u003cp>\"Because it was a van, and I wasn't really sure what they could really provide for me,\" says Kim, 27. \"Off the bat I don't trust people very easily and that probably comes from the territory that I grew up in.\"\u003c/p>\n\u003cp>Kim, a second-generation Korean-American, says she grew up with abusive relatives in a house \"full of conflict.\" By the time she was 14, she had already attempted suicide. With the help of a high school counselor, Kim moved out of her parents' home into a transitional living program, which required her to get medical checkups at the van initially. For the next four years, Kim was a regular patient.\u003c/p>\n\u003cfigure id=\"attachment_147012\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"wp-image-147012 size-full\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/02/RS18425_IMG_9465.JPG-qut.jpg\" alt=\"Grace Kim, 27, credits the teen health van with helping her overcome depression, malnutrition and other health issues when she 17. Kim was photographed near Santa Clara University, where she is a masters student.\" width=\"1920\" height=\"1280\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18425_IMG_9465.JPG-qut.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18425_IMG_9465.JPG-qut-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18425_IMG_9465.JPG-qut-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18425_IMG_9465.JPG-qut-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18425_IMG_9465.JPG-qut-1440x960.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18425_IMG_9465.JPG-qut-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18425_IMG_9465.JPG-qut-960x640.jpg 960w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Grace Kim credits the teen health van with helping her overcome depression and other health issues when she was 17. Kim was photographed near Santa Clara University, where she is a master's student in counseling psychology.\u003c/figcaption>\u003c/figure>\n\u003cp>Ammerman and other staff at the van treated Kim's malnutrition, substance abuse and other health issues. They connected her with free visits to see a psychiatrist at Stanford Medical Center who treated her depression, and she thrived.\u003c/p>\n\u003cp>\"If I didn't get that help, I would probably be in a very bad place,\" says Kim, now a master's student in counseling psychology at Santa Clara University. \"The whole mental health aspect of it was probably the most beneficial, probably the most powerful.\"\u003c/p>\n\u003cp>Today, Kim facilitates a support group for suicide survivors at Santa Clara Valley Medical Center and says her passion for her work comes from those dark days in her past. She still keeps in touch with Ammerman, calling him once in a while with health-related questions.\u003c/p>\n\u003cp>\"I trust him absolutely with everything because he's seen me at my worst, and he still to this day has the most faith in me,\" says Kim, adding that Ammerman motivated her to take care of herself and do better. \"To have someone care for you and tell you that you can get better and do anything that you put you heart into. ... I mean, there are no words for that.\"\u003c/p>\n\u003cp>Kim recognizes she was lucky to have access to housing, medical and mental health resources, but that may not be true for others.\u003c/p>\n\u003cp>\u003cstrong>Health Van Patients Often Face Precarious Housing\u003c/strong>\u003c/p>\n\u003cp>Over 40 percent of Stanford's teen health van patients are homeless, says Ammerman. These are adolescents up to age 25 living on the streets, in cars and, most commonly, overcrowded apartments. While doubling up with relatives or friends may sound like housing, it's not stable because people can be asked to leave at any time.\u003c/p>\n\u003cp>Ammerman says he's seen a significant increase in this population of teens and young adults -- those living in overcrowded conditions -- since 2008. Working families unable to make rent are more likely to end up in these challenging conditions.\u003c/p>\n\u003cp>\"We are seeing, unfortunately, more homeless kids. And that's really due to the housing crisis that we are all aware of here in the Bay Area,\" says Ammerman.\u003c/p>\n\u003cp>\u003cstrong>Homeless Youth Population Growing in California\u003c/strong>\u003c/p>\n\u003cp>Most Bay Area counties and the state as a whole are seeing a greater number of homeless kids in recent years, according to figures collected by the California Department of Education and crunched by \u003ca href=\"http://www.kidsdata.org/topic/230/homeless-students/table#fmt=355&loc=2,265,59,4,127,171,341,338,339,217&tf=79,73,67,64&sortType=asc\" target=\"_blank\">Kidsdata.org\u003c/a>. The education department designates students as \"homeless\" if their primary residence at any point in the school year was a:\u003c/p>\n\u003cul>\n\u003cli>Shelter\u003c/li>\n\u003cli>Hotel or motel\u003c/li>\n\u003cli>Shared housing with others due to loss of housing or economic hardship\u003c/li>\n\u003cli>No shelter at all.\u003c/li>\n\u003c/ul>\n\u003cp>Statewide, the rate of homeless public school students in grades K-12 jumped by one-third in just three years -- from 3.6 percent in 2011 to 4.8 percent in 2014. \u003ca href=\"http://www.kidsdata.org/topic/793/homeless-students-residence/table#fmt=1211&loc=2&tf=79,73,67,64&ch=1132,1133,1134,1135&sortColumnId=0&sortType=asc\" target=\"_blank\">More than 86 percent\u003c/a> of the nearly 300,000 homeless public school students statewide are living doubled up with friends or relatives.\u003c/p>\n\u003cp>\"So it's a very unstable housing situation, and that is always problematic for your health,\" says Ammerman.\u003c/p>\n\u003cp>Children and youth facing homelessness or housing insecurity are more likely than their peers to face \u003ca href=\"http://pediatrics.aappublications.org/content/131/6/1206\" target=\"_blank\">chronic illness\u003c/a> and mental health problems, as well as\u003ca href=\"http://www.homelesschildrenamerica.org/\"> traumas\u003c/a> and safety risks, studies show.\u003c/p>\n\u003cp>\u003cstrong>Resources for Homeless Youth are Not Keeping Up\u003c/strong>\u003c/p>\n\u003cp>Shahera Hyatt directs the California Homeless Youth Project at the \u003ca href=\"https://www.library.ca.gov/crb/\" target=\"_blank\">California Research Bureau\u003c/a> in Sacramento. She supports Ammerman's experience as to why the state is seeing a lot more child, youth and family homelessness.\u003c/p>\n\u003cp>\"We know that housing affordability is in crisis proportions,\" says Hyatt. \"In many communities across the state there's rapid gentrification happening and a very low housing stock.\"\u003c/p>\n\u003cp>Homeless youth -- particularly those constantly on the streets or without any access to shelters -- risk sexual abuse, police harassment and substance addiction. Yet the state is woefully lacking in services and resources for this population, says Hyatt.\u003c/p>\n\u003cp>Sacramento has a single six-bed transitional housing center for young adults -- and a nine-month waiting list of about 100 people, says Hyatt. She added that two-thirds of the state's counties lack shelters and other basic services for homeless youth.\u003c/p>\n\u003cp>\"There’s a lot of mythology about why young people become homeless ... that they are unruly or want to live outside. But that's not true,\" says Hyatt. \"A lot of these people are really disenfranchised by the lack of services out there and become homeless.\"\u003c/p>\n\u003cp>Since 1988, California has spent $1.1 million annually on programs that serve homeless youth: the Homeless Youth and Exploitation Program and the California Youth Crisis Line, according to the California Coalition for Youth.\u003c/p>\n\u003cp>A bill introduced last month by Assemblywoman Young Kim, \u003ca href=\"https://ad65.asmrc.org/press-release/14533\" target=\"_blank\">AB1699\u003c/a>, would provide $25 million in funding for homeless youth emergency service projects. The bill's first hearing should be in the next two months, according to Bryan Shroyer in Kim's office.\u003c/p>\n\u003cp>\u003cstrong>Popularity of Mobile Clinics Increases\u003c/strong>\u003c/p>\n\u003cp>Meanwhile, mobile health clinics like Ammerman's in San Jose continue to fill a gap in access to care for uninsured youth. That model of delivering care directly to underserved populations has been gaining popularity nationwide.\u003c/p>\n\u003cp>In the last two decades, the number of mobile clinics has grown to about 2,000 throughout the country, according to the Mobile Health Clinics Association.\u003c/p>\n\u003cp>\"What we are seeing is greater acceptance that mobile care can be really high-quality care,\" says Dr. Delaney Gracy, chief medical officer with the Children's Health Fund. \"More people are realizing that mobile health is an important part of safety net care.\"\u003c/p>\n\u003cfigure id=\"attachment_146679\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"wp-image-146679 size-full\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/02/RS18411_IMG_4503.JPG-qut.jpg\" alt=\"Ammerman fill a prescription for a patient. The teen health van provides medications for free.\" width=\"1920\" height=\"1440\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18411_IMG_4503.JPG-qut.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18411_IMG_4503.JPG-qut-400x300.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18411_IMG_4503.JPG-qut-800x600.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18411_IMG_4503.JPG-qut-768x576.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18411_IMG_4503.JPG-qut-1440x1080.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18411_IMG_4503.JPG-qut-1180x885.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18411_IMG_4503.JPG-qut-960x720.jpg 960w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Ammerman fills a prescription for a patient. The teen health van provides medications for free. \u003ccite>(Farida Jhabvala Romero / KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>At the teen health van's exam room, Ammerman is ending his consultation with Ernesto by handing him packages of nicotine gum, the medication Ernesto chose from several options to help him quit smoking. Before Ernesto leaves, Ammerman has one last question for first-time patients like him.\u003c/p>\n\u003cp>\"We literally ask each kid, 'What are you good at, what are your strengths?' And they're shocked at this question because no one's ever asked that before,\" says Ammerman.\u003c/p>\n\u003cp>When Ernesto's turn comes to answer, he thinks for a while before responding.\u003c/p>\n\u003cp>\"Um ... I like to work and stay busy,\" says Ernesto. \"And I motivate my brothers a lot, as much as I can.\"\u003c/p>\n\u003cp>\"Cool! That's a really cool thing,\" responds Ammerman.\u003c/p>\n\u003cp>As his patients successfully take steps to care for their health, says Ammerman, they also gain the confidence to tackle other goals, like getting steady housing.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\"These kids have strengths, and by focusing on their strengths it can really make a difference. Because strength builds strength. And success builds success,\" says Ammerman.\u003c/p>\n\n",
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"excerpt": "Statewide, the rate of homeless public school students in grades K-12 jumped by one-third in just three years.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Dr. Seth Ammerman listens intently to his new patient. Ernesto, who does not want his last name disclosed, is homeless. Ernesto is earning a high school degree and working part time, but at night, he and his brother share a tent that they set up on San Jose streets. The daily stress of being homeless is wearing Ernesto out and making him light up too many cigarettes.\u003c/p>\n\u003caside class=\"pullquote alignright\">'These kids, because of all these access barriers — lack of insurance, lack of transportation — they’re not going to get this kind of care unless we go to them.'\u003ccite>Dr. Seth Ammerman, medical director, Stanford Teen Health Van \u003c/cite>\u003c/aside>\n\u003cp>“I just want to cut down on my smoking,” says Ernesto, 21, with a tentative, soft voice. “I’ve been on the streets all the time, you know? I just want to make sure I’m OK.”\u003c/p>\n\u003cp>That's why Ernesto walked into this mobile clinic parked just a few steps away from his classroom at the San Jose Conservation Corps & Charter School. He's sitting in a fully equipped exam room inside a shiny blue tour bus with Wi-Fi and the ability to get HIV test results in 20 minutes.\u003c/p>\n\u003cp>During the consultation with Ernesto, Ammerman nods sympathetically. In his 20 years working in this teen health van, Ammerman has treated thousands of uninsured and homeless adolescents ages 24 and under.\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/247566086&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/247566086'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Twice a week, Ammerman and two nurses park the clinic at continuation high schools and other places frequented by at-risk adolescents in Santa Clara, San Mateo and San Francisco counties. The van is a community project of the Lucile Packard Children's Hospital Stanford and Children's Health Fund, with support from Samsung.\u003c/p>\n\u003cfigure id=\"attachment_146678\" class=\"wp-caption alignright\" style=\"max-width: 1920px\">\u003cimg class=\"wp-image-146678 size-full\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/02/RS18410_IMG_9380.JPG-qut.jpg\" alt=\"\" width=\"1920\" height=\"1280\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18410_IMG_9380.JPG-qut.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18410_IMG_9380.JPG-qut-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18410_IMG_9380.JPG-qut-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18410_IMG_9380.JPG-qut-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18410_IMG_9380.JPG-qut-1440x960.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18410_IMG_9380.JPG-qut-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18410_IMG_9380.JPG-qut-960x640.jpg 960w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">The teen health van parks at continuation high schools and other places frequented by adolescents in Santa Clara, San Mateo and San Francisco counties. Inside, patients are seen in two exam rooms and a nursing station. \u003ccite>(Farida Jhabvala Romero/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The team provides free medical, nutrition and mental health services, including reproductive health care and treatment for chronic illnesses, substance abuse and depression. All medications are free and provided at the time of consultation. A social worker is available for counseling and connects adolescents to additional resources; a registered dietitian works with patients who are malnourished, a frequent health issue for this population.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Some of the 400 patients who visit the teen health van each year have never seen a doctor, says Ammerman.\u003c/p>\n\u003cp>“Going to the patients makes all the difference, and it's not just a matter of convenience,” says Ammerman, a clinical professor of adolescent medicine at Stanford University. “It really is that these kids, because of all these access barriers -- lack of insurance, lack of transportation -- they're not going to get this kind of care unless we go to them.”\u003c/p>\n\u003cp>For many patients here, the teen health van can become a trustworthy and reliable place in an otherwise unstable world.\u003c/p>\n\u003cp>Grace Kim first set foot in the van 10 years ago when she was 17. She admits she was skeptical.\u003c/p>\n\u003cp>\"Because it was a van, and I wasn't really sure what they could really provide for me,\" says Kim, 27. \"Off the bat I don't trust people very easily and that probably comes from the territory that I grew up in.\"\u003c/p>\n\u003cp>Kim, a second-generation Korean-American, says she grew up with abusive relatives in a house \"full of conflict.\" By the time she was 14, she had already attempted suicide. With the help of a high school counselor, Kim moved out of her parents' home into a transitional living program, which required her to get medical checkups at the van initially. For the next four years, Kim was a regular patient.\u003c/p>\n\u003cfigure id=\"attachment_147012\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"wp-image-147012 size-full\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/02/RS18425_IMG_9465.JPG-qut.jpg\" alt=\"Grace Kim, 27, credits the teen health van with helping her overcome depression, malnutrition and other health issues when she 17. Kim was photographed near Santa Clara University, where she is a masters student.\" width=\"1920\" height=\"1280\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18425_IMG_9465.JPG-qut.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18425_IMG_9465.JPG-qut-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18425_IMG_9465.JPG-qut-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18425_IMG_9465.JPG-qut-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18425_IMG_9465.JPG-qut-1440x960.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18425_IMG_9465.JPG-qut-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18425_IMG_9465.JPG-qut-960x640.jpg 960w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Grace Kim credits the teen health van with helping her overcome depression and other health issues when she was 17. Kim was photographed near Santa Clara University, where she is a master's student in counseling psychology.\u003c/figcaption>\u003c/figure>\n\u003cp>Ammerman and other staff at the van treated Kim's malnutrition, substance abuse and other health issues. They connected her with free visits to see a psychiatrist at Stanford Medical Center who treated her depression, and she thrived.\u003c/p>\n\u003cp>\"If I didn't get that help, I would probably be in a very bad place,\" says Kim, now a master's student in counseling psychology at Santa Clara University. \"The whole mental health aspect of it was probably the most beneficial, probably the most powerful.\"\u003c/p>\n\u003cp>Today, Kim facilitates a support group for suicide survivors at Santa Clara Valley Medical Center and says her passion for her work comes from those dark days in her past. She still keeps in touch with Ammerman, calling him once in a while with health-related questions.\u003c/p>\n\u003cp>\"I trust him absolutely with everything because he's seen me at my worst, and he still to this day has the most faith in me,\" says Kim, adding that Ammerman motivated her to take care of herself and do better. \"To have someone care for you and tell you that you can get better and do anything that you put you heart into. ... I mean, there are no words for that.\"\u003c/p>\n\u003cp>Kim recognizes she was lucky to have access to housing, medical and mental health resources, but that may not be true for others.\u003c/p>\n\u003cp>\u003cstrong>Health Van Patients Often Face Precarious Housing\u003c/strong>\u003c/p>\n\u003cp>Over 40 percent of Stanford's teen health van patients are homeless, says Ammerman. These are adolescents up to age 25 living on the streets, in cars and, most commonly, overcrowded apartments. While doubling up with relatives or friends may sound like housing, it's not stable because people can be asked to leave at any time.\u003c/p>\n\u003cp>Ammerman says he's seen a significant increase in this population of teens and young adults -- those living in overcrowded conditions -- since 2008. Working families unable to make rent are more likely to end up in these challenging conditions.\u003c/p>\n\u003cp>\"We are seeing, unfortunately, more homeless kids. And that's really due to the housing crisis that we are all aware of here in the Bay Area,\" says Ammerman.\u003c/p>\n\u003cp>\u003cstrong>Homeless Youth Population Growing in California\u003c/strong>\u003c/p>\n\u003cp>Most Bay Area counties and the state as a whole are seeing a greater number of homeless kids in recent years, according to figures collected by the California Department of Education and crunched by \u003ca href=\"http://www.kidsdata.org/topic/230/homeless-students/table#fmt=355&loc=2,265,59,4,127,171,341,338,339,217&tf=79,73,67,64&sortType=asc\" target=\"_blank\">Kidsdata.org\u003c/a>. The education department designates students as \"homeless\" if their primary residence at any point in the school year was a:\u003c/p>\n\u003cul>\n\u003cli>Shelter\u003c/li>\n\u003cli>Hotel or motel\u003c/li>\n\u003cli>Shared housing with others due to loss of housing or economic hardship\u003c/li>\n\u003cli>No shelter at all.\u003c/li>\n\u003c/ul>\n\u003cp>Statewide, the rate of homeless public school students in grades K-12 jumped by one-third in just three years -- from 3.6 percent in 2011 to 4.8 percent in 2014. \u003ca href=\"http://www.kidsdata.org/topic/793/homeless-students-residence/table#fmt=1211&loc=2&tf=79,73,67,64&ch=1132,1133,1134,1135&sortColumnId=0&sortType=asc\" target=\"_blank\">More than 86 percent\u003c/a> of the nearly 300,000 homeless public school students statewide are living doubled up with friends or relatives.\u003c/p>\n\u003cp>\"So it's a very unstable housing situation, and that is always problematic for your health,\" says Ammerman.\u003c/p>\n\u003cp>Children and youth facing homelessness or housing insecurity are more likely than their peers to face \u003ca href=\"http://pediatrics.aappublications.org/content/131/6/1206\" target=\"_blank\">chronic illness\u003c/a> and mental health problems, as well as\u003ca href=\"http://www.homelesschildrenamerica.org/\"> traumas\u003c/a> and safety risks, studies show.\u003c/p>\n\u003cp>\u003cstrong>Resources for Homeless Youth are Not Keeping Up\u003c/strong>\u003c/p>\n\u003cp>Shahera Hyatt directs the California Homeless Youth Project at the \u003ca href=\"https://www.library.ca.gov/crb/\" target=\"_blank\">California Research Bureau\u003c/a> in Sacramento. She supports Ammerman's experience as to why the state is seeing a lot more child, youth and family homelessness.\u003c/p>\n\u003cp>\"We know that housing affordability is in crisis proportions,\" says Hyatt. \"In many communities across the state there's rapid gentrification happening and a very low housing stock.\"\u003c/p>\n\u003cp>Homeless youth -- particularly those constantly on the streets or without any access to shelters -- risk sexual abuse, police harassment and substance addiction. Yet the state is woefully lacking in services and resources for this population, says Hyatt.\u003c/p>\n\u003cp>Sacramento has a single six-bed transitional housing center for young adults -- and a nine-month waiting list of about 100 people, says Hyatt. She added that two-thirds of the state's counties lack shelters and other basic services for homeless youth.\u003c/p>\n\u003cp>\"There’s a lot of mythology about why young people become homeless ... that they are unruly or want to live outside. But that's not true,\" says Hyatt. \"A lot of these people are really disenfranchised by the lack of services out there and become homeless.\"\u003c/p>\n\u003cp>Since 1988, California has spent $1.1 million annually on programs that serve homeless youth: the Homeless Youth and Exploitation Program and the California Youth Crisis Line, according to the California Coalition for Youth.\u003c/p>\n\u003cp>A bill introduced last month by Assemblywoman Young Kim, \u003ca href=\"https://ad65.asmrc.org/press-release/14533\" target=\"_blank\">AB1699\u003c/a>, would provide $25 million in funding for homeless youth emergency service projects. The bill's first hearing should be in the next two months, according to Bryan Shroyer in Kim's office.\u003c/p>\n\u003cp>\u003cstrong>Popularity of Mobile Clinics Increases\u003c/strong>\u003c/p>\n\u003cp>Meanwhile, mobile health clinics like Ammerman's in San Jose continue to fill a gap in access to care for uninsured youth. That model of delivering care directly to underserved populations has been gaining popularity nationwide.\u003c/p>\n\u003cp>In the last two decades, the number of mobile clinics has grown to about 2,000 throughout the country, according to the Mobile Health Clinics Association.\u003c/p>\n\u003cp>\"What we are seeing is greater acceptance that mobile care can be really high-quality care,\" says Dr. Delaney Gracy, chief medical officer with the Children's Health Fund. \"More people are realizing that mobile health is an important part of safety net care.\"\u003c/p>\n\u003cfigure id=\"attachment_146679\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"wp-image-146679 size-full\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/02/RS18411_IMG_4503.JPG-qut.jpg\" alt=\"Ammerman fill a prescription for a patient. The teen health van provides medications for free.\" width=\"1920\" height=\"1440\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18411_IMG_4503.JPG-qut.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18411_IMG_4503.JPG-qut-400x300.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18411_IMG_4503.JPG-qut-800x600.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18411_IMG_4503.JPG-qut-768x576.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18411_IMG_4503.JPG-qut-1440x1080.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18411_IMG_4503.JPG-qut-1180x885.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18411_IMG_4503.JPG-qut-960x720.jpg 960w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Ammerman fills a prescription for a patient. The teen health van provides medications for free. \u003ccite>(Farida Jhabvala Romero / KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>At the teen health van's exam room, Ammerman is ending his consultation with Ernesto by handing him packages of nicotine gum, the medication Ernesto chose from several options to help him quit smoking. Before Ernesto leaves, Ammerman has one last question for first-time patients like him.\u003c/p>\n\u003cp>\"We literally ask each kid, 'What are you good at, what are your strengths?' And they're shocked at this question because no one's ever asked that before,\" says Ammerman.\u003c/p>\n\u003cp>When Ernesto's turn comes to answer, he thinks for a while before responding.\u003c/p>\n\u003cp>\"Um ... I like to work and stay busy,\" says Ernesto. \"And I motivate my brothers a lot, as much as I can.\"\u003c/p>\n\u003cp>\"Cool! That's a really cool thing,\" responds Ammerman.\u003c/p>\n\u003cp>As his patients successfully take steps to care for their health, says Ammerman, they also gain the confidence to tackle other goals, like getting steady housing.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"These kids have strengths, and by focusing on their strengths it can really make a difference. Because strength builds strength. And success builds success,\" says Ammerman.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "How High-Cost Specialty Drugs Impact California",
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"content": "\u003cp id=\"3531\" class=\"graf--p graf-after--figure\">What’s behind the jaw-dropping cost of new “specialty drugs” like Orkambi, which has a sticker price of $259,000 per year for cystic fibrosis patients?\u003c/p>\n\u003cp id=\"4e0b\" class=\"graf--p graf-after--p\">Orkambi, which was approved by the U.S. Food and Drug Administration last July, is expected to take almost $36 million from the state’s general fund this fiscal year and next. Seventy-four Californians with health coverage under the Department of Health Care Services are estimated to receive the drug this year, and next year, 220 people will benefit, some of whom may be the same patients as this year. That does not include any discounts the state may receive from drug manufacturers.\u003c/p>\n\u003cp id=\"5b0e\" class=\"graf--p graf-after--p\">Orkambi is listed as a “specialty tier” drug in some private health plans. That category is reserved for high-cost drugs, or, in the \u003ca class=\"markup--anchor markup--p-anchor\" href=\"https://www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovGenIn/Downloads/SpecialtyTierMethodology.pdf\" rel=\"nofollow\">federal government’s\u003c/a>view, for drugs that cost more than $600 a month and are used by a small proportion of patients.\u003c/p>\n\u003cp id=\"3924\" class=\"graf--p graf-after--p\">Specialty drugs are already proving to be a financial burden on one California agency, the California Public Employees’ Retirement System, which purchases health benefits for active and retired state workers. The state public pension system says that specialty drugs made up less than 1 percent of all prescriptions for its members but 30 percent of the total drugs costs in 2014.\u003c/p>\n\u003cp class=\"graf--p graf-after--p\">The health benefits from specialty drugs justify the cost, according to the pharmaceutical industry.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp id=\"ee28\" class=\"graf--p graf--startsWithDoubleQuote graf-after--p\">“Patients are gaining access to medicines that are better treating their diseases or frankly even curing them,” said Priscilla VanderVeer, deputy vice president of communications at the Pharmaceutical Research and Manufacturers of America (PhRMA). “Patients are now healthier. They’re more productive. They’re functioning.”\u003c/p>\n\u003cp id=\"e169\" class=\"graf--p graf-after--p\">VanderVeer said companies price drugs not just on the cost of production, but on the value the industry believes the drug brings to the health care system, such as:\u003c/p>\n\u003cul class=\"postList\">\n\u003cli id=\"7b31\" class=\"graf--li graf-after--p\">Efficacy of the treatment\u003c/li>\n\u003cli id=\"b80b\" class=\"graf--li graf-after--li\">How it increases the quality or length of life\u003c/li>\n\u003cli id=\"5c88\" class=\"graf--li graf-after--li\">The “unmet need” in the drug market\u003c/li>\n\u003c/ul>\n\u003cp id=\"cc5b\" class=\"graf--p graf-after--li\">The price of the drug also accounts for the cost of developing other drugs and the high risk that a particular drug won’t make it to market, VanderVeer said. Only 12 percent of drugs that go through clinical trials get approved, according to PhRMA.\u003c/p>\n\u003cp id=\"ef58\" class=\"graf--p graf--startsWithDoubleQuote graf-after--p\">“Because of that high rate of failures there would be no innovative incentive for companies to continue to try to invest” if they could not recoup costs and make a profit, VanderVeer said.\u003c/p>\n\u003cp id=\"93ab\" class=\"graf--p graf-after--p\">Finally, she added, the sticker price doesn’t reflect the final price paid for the drug, which can be heavily discounted through negotiations or because of mandated rebates for Medicaid programs.\u003c/p>\n\u003cp id=\"b00f\" class=\"graf--p graf-after--p\">[contextly_sidebar id=\"zzW5l7DTsYNjFFcWE84QTNvLSahLvtDx\"]Drugmakers are following the money, said Joel Hay, professor of pharmaceutical economics and policy at USC. Companies invest in specialty drugs that target a small population because their high price tags can be spread over a large insurance pool, he said.\u003c/p>\n\u003cp id=\"02e0\" class=\"graf--p graf--startsWithDoubleQuote graf-after--p\">Even though specialty drugs are \"ridiculously expensive per treatment episode,\" Hay said, the cost for each member in a health plan is \"just a few cents.” Raising 10 cents on a diabetes drug, for example, would have a bigger budget impact, he said, because more people have diabetes than cystic fibrosis.\u003c/p>\n\u003cp id=\"14f9\" class=\"graf--p graf-after--p\">Hay says manufacturers are now less inclined to invest in drugs that treat millions of people, because there is more pushback on price.\u003c/p>\n\u003cp id=\"de1b\" class=\"graf--p graf--startsWithDoubleQuote graf-after--p\">“Drug companies are for-profit companies obligated to make money for their stockholders,” Hay said. “They’re not virtuous charitable organizations.”\u003c/p>\n\u003cp id=\"708f\" class=\"graf--p graf-after--p\">Drugmakers are also investing more in treating uncommon illnesses because there is less competition and therefore more opportunity for profit, said Dr. Helene Lipton, professor of health policy at the School of Pharmacy and Institute for Health Policy Studies at UC San Francisco.\u003c/p>\n\u003cp id=\"f652\" class=\"graf--p graf-after--p\">The high price of the drugs affects patients, she noted, because health plans put controls on the drugs so that they’re used as a last resort.\u003c/p>\n\u003cp id=\"ed3c\" class=\"graf--p graf--startsWithDoubleQuote graf-after--p\">“That may mean going through two or more rounds of care with other medications before being able to use the specialty drug,” Lipton said.\u003c/p>\n\u003cp id=\"063c\" class=\"graf--p graf-after--p\">It’s not just specialty drugs that are straining health plans’ budgets, said Steve Miller, chief medical officer at Express Scripts, a pharmaceutical benefits manager that negotiates drug prices for 7.5 million Californians.\u003c/p>\n\u003cp id=\"0f47\" class=\"graf--p graf--startsWithDoubleQuote graf-after--p\">“The price of drugs is just continuing to go up,” said Miller, explaining that the trend is due to both new high-cost drugs coming on the market, and mark-ups of old drugs.\u003c/p>\n\u003cp class=\"graf--p graf--startsWithDoubleQuote graf-after--p\">There’s been an explosion of drugs costing $100,000 a year over the last decade, for things like cystic fibrosis and cancer, Miller said. And there was a 127 percent price increase of branded drugs that had been on the market between 2008 and 2014, he says.\u003c/p>\n\u003cp id=\"0c65\" class=\"graf--p graf-after--p\">Limiting the cost of pharmaceuticals is the basis of a California ballot initiative scheduled to go before voters this November that would limit the amount the state pays for a drug to no more than the lowest price paid for the same drug by the U.S. Department of Veterans Affairs.\u003c/p>\n\u003cp id=\"9370\" class=\"graf--p graf-after--p\">We’ll be exploring how a specialty drug’s cost affects patient access. If you are a chronic disease patient who is having difficulty getting specialty drugs, we’d like to hear from you. \u003ca class=\"markup--anchor markup--p-anchor\" href=\"https://twitter.com/pbartolone\" rel=\"nofollow\">Tweet\u003c/a> or \u003ca class=\"markup--anchor markup--p-anchor\" href=\"mailto:Pauline@Calmatters.org\">email\u003c/a> us.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp id=\"f877\" class=\"graf--p graf-after--p graf--last\">\u003cem class=\"markup--em markup--p-em\">CALmatters is a nonprofit journalism venture dedicated to explaining state policies and politics. Pauline Bartolone wrote this article while participating in the \u003c/em>\u003ca class=\"markup--anchor markup--p-anchor\" href=\"http://www.centerforhealthjournalism.org/event/2015-california-health-data-journalism-fellowship\" rel=\"nofollow\">\u003cem class=\"markup--em markup--p-em\">California Data\u003c/em>\u003c/a>\u003cem class=\"markup--em markup--p-em\"> \u003c/em>\u003ca class=\"markup--anchor markup--p-anchor\" href=\"http://www.centerforhealthjournalism.org/event/2015-california-health-data-journalism-fellowship\" rel=\"nofollow\">\u003cem class=\"markup--em markup--p-em\">Fellowship,\u003c/em>\u003c/a>\u003cem class=\"markup--em markup--p-em\"> a program of the \u003c/em>\u003cem class=\"markup--em markup--p-em\">\u003ca class=\"markup--anchor markup--p-anchor\" href=\"http://www.centerforhealthjournalism.org/\" rel=\"nofollow\">Center for Health Journalism\u003c/a> \u003c/em>\u003cem class=\"markup--em markup--p-em\">at USC’s Annenberg School of Journalism.\u003c/em>\u003c/p>\n\n",
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"excerpt": "For starters, CalPERS says specialty drugs made up less than 1 percent of prescriptions for its members but 30 percent of total drugs costs in 2014.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp id=\"3531\" class=\"graf--p graf-after--figure\">What’s behind the jaw-dropping cost of new “specialty drugs” like Orkambi, which has a sticker price of $259,000 per year for cystic fibrosis patients?\u003c/p>\n\u003cp id=\"4e0b\" class=\"graf--p graf-after--p\">Orkambi, which was approved by the U.S. Food and Drug Administration last July, is expected to take almost $36 million from the state’s general fund this fiscal year and next. Seventy-four Californians with health coverage under the Department of Health Care Services are estimated to receive the drug this year, and next year, 220 people will benefit, some of whom may be the same patients as this year. That does not include any discounts the state may receive from drug manufacturers.\u003c/p>\n\u003cp id=\"5b0e\" class=\"graf--p graf-after--p\">Orkambi is listed as a “specialty tier” drug in some private health plans. That category is reserved for high-cost drugs, or, in the \u003ca class=\"markup--anchor markup--p-anchor\" href=\"https://www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovGenIn/Downloads/SpecialtyTierMethodology.pdf\" rel=\"nofollow\">federal government’s\u003c/a>view, for drugs that cost more than $600 a month and are used by a small proportion of patients.\u003c/p>\n\u003cp id=\"3924\" class=\"graf--p graf-after--p\">Specialty drugs are already proving to be a financial burden on one California agency, the California Public Employees’ Retirement System, which purchases health benefits for active and retired state workers. The state public pension system says that specialty drugs made up less than 1 percent of all prescriptions for its members but 30 percent of the total drugs costs in 2014.\u003c/p>\n\u003cp class=\"graf--p graf-after--p\">The health benefits from specialty drugs justify the cost, according to the pharmaceutical industry.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp id=\"ee28\" class=\"graf--p graf--startsWithDoubleQuote graf-after--p\">“Patients are gaining access to medicines that are better treating their diseases or frankly even curing them,” said Priscilla VanderVeer, deputy vice president of communications at the Pharmaceutical Research and Manufacturers of America (PhRMA). “Patients are now healthier. They’re more productive. They’re functioning.”\u003c/p>\n\u003cp id=\"e169\" class=\"graf--p graf-after--p\">VanderVeer said companies price drugs not just on the cost of production, but on the value the industry believes the drug brings to the health care system, such as:\u003c/p>\n\u003cul class=\"postList\">\n\u003cli id=\"7b31\" class=\"graf--li graf-after--p\">Efficacy of the treatment\u003c/li>\n\u003cli id=\"b80b\" class=\"graf--li graf-after--li\">How it increases the quality or length of life\u003c/li>\n\u003cli id=\"5c88\" class=\"graf--li graf-after--li\">The “unmet need” in the drug market\u003c/li>\n\u003c/ul>\n\u003cp id=\"cc5b\" class=\"graf--p graf-after--li\">The price of the drug also accounts for the cost of developing other drugs and the high risk that a particular drug won’t make it to market, VanderVeer said. Only 12 percent of drugs that go through clinical trials get approved, according to PhRMA.\u003c/p>\n\u003cp id=\"ef58\" class=\"graf--p graf--startsWithDoubleQuote graf-after--p\">“Because of that high rate of failures there would be no innovative incentive for companies to continue to try to invest” if they could not recoup costs and make a profit, VanderVeer said.\u003c/p>\n\u003cp id=\"93ab\" class=\"graf--p graf-after--p\">Finally, she added, the sticker price doesn’t reflect the final price paid for the drug, which can be heavily discounted through negotiations or because of mandated rebates for Medicaid programs.\u003c/p>\n\u003cp id=\"b00f\" class=\"graf--p graf-after--p\">\u003c/p>\u003cp>\u003c/p>\u003cp>Drugmakers are following the money, said Joel Hay, professor of pharmaceutical economics and policy at USC. Companies invest in specialty drugs that target a small population because their high price tags can be spread over a large insurance pool, he said.\u003c/p>\n\u003cp id=\"02e0\" class=\"graf--p graf--startsWithDoubleQuote graf-after--p\">Even though specialty drugs are \"ridiculously expensive per treatment episode,\" Hay said, the cost for each member in a health plan is \"just a few cents.” Raising 10 cents on a diabetes drug, for example, would have a bigger budget impact, he said, because more people have diabetes than cystic fibrosis.\u003c/p>\n\u003cp id=\"14f9\" class=\"graf--p graf-after--p\">Hay says manufacturers are now less inclined to invest in drugs that treat millions of people, because there is more pushback on price.\u003c/p>\n\u003cp id=\"de1b\" class=\"graf--p graf--startsWithDoubleQuote graf-after--p\">“Drug companies are for-profit companies obligated to make money for their stockholders,” Hay said. “They’re not virtuous charitable organizations.”\u003c/p>\n\u003cp id=\"708f\" class=\"graf--p graf-after--p\">Drugmakers are also investing more in treating uncommon illnesses because there is less competition and therefore more opportunity for profit, said Dr. Helene Lipton, professor of health policy at the School of Pharmacy and Institute for Health Policy Studies at UC San Francisco.\u003c/p>\n\u003cp id=\"f652\" class=\"graf--p graf-after--p\">The high price of the drugs affects patients, she noted, because health plans put controls on the drugs so that they’re used as a last resort.\u003c/p>\n\u003cp id=\"ed3c\" class=\"graf--p graf--startsWithDoubleQuote graf-after--p\">“That may mean going through two or more rounds of care with other medications before being able to use the specialty drug,” Lipton said.\u003c/p>\n\u003cp id=\"063c\" class=\"graf--p graf-after--p\">It’s not just specialty drugs that are straining health plans’ budgets, said Steve Miller, chief medical officer at Express Scripts, a pharmaceutical benefits manager that negotiates drug prices for 7.5 million Californians.\u003c/p>\n\u003cp id=\"0f47\" class=\"graf--p graf--startsWithDoubleQuote graf-after--p\">“The price of drugs is just continuing to go up,” said Miller, explaining that the trend is due to both new high-cost drugs coming on the market, and mark-ups of old drugs.\u003c/p>\n\u003cp class=\"graf--p graf--startsWithDoubleQuote graf-after--p\">There’s been an explosion of drugs costing $100,000 a year over the last decade, for things like cystic fibrosis and cancer, Miller said. And there was a 127 percent price increase of branded drugs that had been on the market between 2008 and 2014, he says.\u003c/p>\n\u003cp id=\"0c65\" class=\"graf--p graf-after--p\">Limiting the cost of pharmaceuticals is the basis of a California ballot initiative scheduled to go before voters this November that would limit the amount the state pays for a drug to no more than the lowest price paid for the same drug by the U.S. Department of Veterans Affairs.\u003c/p>\n\u003cp id=\"9370\" class=\"graf--p graf-after--p\">We’ll be exploring how a specialty drug’s cost affects patient access. If you are a chronic disease patient who is having difficulty getting specialty drugs, we’d like to hear from you. \u003ca class=\"markup--anchor markup--p-anchor\" href=\"https://twitter.com/pbartolone\" rel=\"nofollow\">Tweet\u003c/a> or \u003ca class=\"markup--anchor markup--p-anchor\" href=\"mailto:Pauline@Calmatters.org\">email\u003c/a> us.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp id=\"f877\" class=\"graf--p graf-after--p graf--last\">\u003cem class=\"markup--em markup--p-em\">CALmatters is a nonprofit journalism venture dedicated to explaining state policies and politics. Pauline Bartolone wrote this article while participating in the \u003c/em>\u003ca class=\"markup--anchor markup--p-anchor\" href=\"http://www.centerforhealthjournalism.org/event/2015-california-health-data-journalism-fellowship\" rel=\"nofollow\">\u003cem class=\"markup--em markup--p-em\">California Data\u003c/em>\u003c/a>\u003cem class=\"markup--em markup--p-em\"> \u003c/em>\u003ca class=\"markup--anchor markup--p-anchor\" href=\"http://www.centerforhealthjournalism.org/event/2015-california-health-data-journalism-fellowship\" rel=\"nofollow\">\u003cem class=\"markup--em markup--p-em\">Fellowship,\u003c/em>\u003c/a>\u003cem class=\"markup--em markup--p-em\"> a program of the \u003c/em>\u003cem class=\"markup--em markup--p-em\">\u003ca class=\"markup--anchor markup--p-anchor\" href=\"http://www.centerforhealthjournalism.org/\" rel=\"nofollow\">Center for Health Journalism\u003c/a> \u003c/em>\u003cem class=\"markup--em markup--p-em\">at USC’s Annenberg School of Journalism.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"slug": "film-portrays-a-perfect-storm-that-led-to-unwanted-sterilizations-for-many-latinas",
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"headTitle": "Film Portrays a ‘Perfect Storm’ That Led to Unwanted Sterilizations for Many Latinas | KQED",
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"content": "\u003cp>About 40 years ago, when she was 24, Consuelo Hermosillo had an emergency cesarean section at Los Angeles County-USC Medical Center. In the new documentary, “No Más Bebés,” she recalls asking her doctor what type of birth control she should use going forward.\u003c/p>\n\u003cp>“He goes, ‘You don’t need anything. We cut your tubes,’ ” Hermosillo says in the film. “And I said, ‘Why?’ And he said, ‘Well you signed for it.’ And I said, ‘Me?’ ”\u003c/p>\n\u003cp>\u003ca href=\"http://www.nomasbebesmovie.com/\">“No Más Bebés (No More Babies),”\u003c/a> which aired on PBS Monday night, tells the story of how 10 immigrant Mexican women, Hermosillo included, sued Los Angeles County doctors, the state and the U.S. government in 1975 for allegedly violating their civil rights. The women’s cases were similar. Each had an emergency cesarean section and each said she was either unaware that she signed for a tubal ligation or was told by a medical professional that not signing for one could mean death for her and her unborn child.\u003c/p>\n\u003cp>You can \u003ca href=\"http://www.pbs.org/independentlens/videos/no-mas-bebes/\" target=\"_blank\" rel=\"noopener\">watch the full “No Más Bebés” film here\u003c/a>.\u003c/p>\n\u003cp>It examines how the lawsuit, \u003cem>Madrigal v. Quilligan\u003c/em>, came to be, how questions of informed consent — or lack thereof — and coercion played into the case, and how the collision of various societal issues resulted in stories like Hermosillo’s.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>https://www.youtube.com/watch?v=aseQlmKg25U\u003c/p>\n\u003cp>“When you’re a filmmaker, the easiest thing to do is make a film about the good guys and the bad guys, the heroes and the villains,” says director \u003ca href=\"http://www.asianam.ucla.edu/people/renee-tajima-pe%C3%B1a\">Renee Tajima-Peña\u003c/a>. She says she and co-producer \u003ca href=\"http://itvs.org/films/no-mas-bebes/filmmaker\">Virginia Espino\u003c/a>, a historian who wrote her dissertation on the case, wanted to tell a multilayered story, one that revealed how even the best intentions could do harm.\u003c/p>\n\u003cp>Tajima-Peña and Espino explore the roles played by federally funded family-planning programs; a growing popular movement to curb population growth that attracted both environmentalists and anti-immigration proponents; doctors fresh out of medical school working in under-resourced maternity wards; cultural misunderstandings; and the popular belief that poor women who need public assistance should abstain from having children.\u003c/p>\n\u003cp>Taken together, these factors created what Tajima-Peña calls a “perfect storm” resulting in the sterilization of thousands of vulnerable women across the country in the late ’60s and early 1970s. She and Espino say their goal was to document a history that continues to repeat itself — they point to \u003ca href=\"http://cironline.org/reports/female-inmates-sterilized-california-prisons-without-approval-4917\">nearly 150 women sterilized in California prisons between 2006 and 2010\u003c/a> as the most recent example.\u003c/p>\n\u003cp>In telling this history, the film highlights the role played by the Family Planning and Population Research Act, which Congress passed in 1970, allocating millions for family-planning purposes. That money went to fund contraceptives, education, research and training. “You’ve got money for family planning programs, which were good programs and provided contraceptives for women who couldn’t afford it,” says Tajima-Peña. Congress also lifted a ban on federal funding for sterilization, so hospitals that provided the indigent with medical care, like Los Angeles County General Hospital, could apply for government money to perform tubal ligations.\u003c/p>\n\u003cp>Meanwhile, lobbying efforts in Washington, fueled by a fear of overpopulation gripping the nation, led to yet more funding for family planning programs. Inspired by the popularity of biologist Paul Ehrlich’s best-selling 1968 book, “\u003ca href=\"http://www.nytimes.com/2015/06/01/us/the-unrealized-horrors-of-population-explosion.html\">The Population Bomb\u003c/a>,” which predicted that at some point in the 1980s, overpopulation would make it impossible for the planet to support humanity, members of the “zero population movement” worked to convince the public that having children was a very bad idea. Some went so far as promoting the sterilization of women deemed to have had too many. (They also called for a dramatic reduction to immigration.)\u003c/p>\n\u003cp>[contextly_sidebar id=”Akm8so5PCpQmztRAsKC6euza1J5VHAba”]\u003c/p>\n\u003cp>Then, there were divisions within the feminist movement on how sterilization fit into the bigger picture of reproductive rights. Mainstream white feminists marched for “the right to choose,” including unfettered access to sterilizations, contraception and abortions. Feminists of color also called for abortion rights and easy access to contraception, but broke with white feminists on the issue of sterilization, arguing that for women of color, sterilization was not always a matter of choice. They called for waiting periods before tubal ligation procedures, and Latina activists called for Spanish-language consent forms.\u003c/p>\n\u003cp>In “No Más Bebés,” California politician \u003ca href=\"http://www.latimes.com/la-oe-morrison-new29-2009aug29-column.html\">Gloria Molina\u003c/a>, who was active in the Chicana feminist movement in the 1970s, says the idea of a waiting period was “totally offensive” to white feminists, who, she says, pushed for sterilization upon demand. “They weren’t taking into account that if you were Spanish-speaking, and if you don’t speak English, you were being denied a right, totally,” Molina says in the film.\u003c/p>\n\u003cp>And then there was the long-held stance, still popular today, that poor women should not have children they can’t afford to support, especially poor women of color. For decades, \u003ca href=\"https://www.uic.edu/orgs/cwluherstory/CWLUArchive/puertorico.html\">Puerto Rican women had been subjected to sterilizations at various points\u003c/a> as a way to combat astronomical unemployment and poverty on the island; a 1965 survey found that a third of Puerto Rican mothers living on the island at the time had been sterilized. \u003ca href=\"https://muse.jhu.edu/login?auth=0&type=summary&url=/journals/american_indian_quarterly/v024/24.3lawrence.html\">Native American women\u003c/a> were sterilized at the hands of the Indian Health Service in the 1970s. Poor African-American women on government assistance were also sterilized across the country during that time period. \u003ca href=\"https://www.splcenter.org/seeking-justice/case-docket/relf-v-weinberger\">A particularly damning case\u003c/a>, brought two years before \u003cem>Madrigal v. Quilligan\u003c/em>, involved two black sisters sterilized at ages 14 and 12 in Alabama.\u003c/p>\n\u003cp>So, to recap: You had a surge of federal money for sterilizations, mainstream feminists calling for easier access to them, a fear that overpopulation would soon destroy the planet and the fear that poor women were burdening the country with children whom taxpayers would need to feed, clothe and educate. This nexus of events — and the consequences, intended and unintended, that followed — is the knot that “No Más Bebés” tries to untie.\u003c/p>\n\u003cp>“Why were they doing it?” Consuelo Hermosillo, one of the 10 plaintiffs in \u003cem>Madrigal v. Quilligan\u003c/em>, asks on camera at one point in the film, nearly 40 years after her sterilization at L.A. County General. “I always keep these questions with me, and I never get those answers,” she says.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>Copyright 2016 NPR. To see more, visit http://www.npr.org/\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>About 40 years ago, when she was 24, Consuelo Hermosillo had an emergency cesarean section at Los Angeles County-USC Medical Center. In the new documentary, “No Más Bebés,” she recalls asking her doctor what type of birth control she should use going forward.\u003c/p>\n\u003cp>“He goes, ‘You don’t need anything. We cut your tubes,’ ” Hermosillo says in the film. “And I said, ‘Why?’ And he said, ‘Well you signed for it.’ And I said, ‘Me?’ ”\u003c/p>\n\u003cp>\u003ca href=\"http://www.nomasbebesmovie.com/\">“No Más Bebés (No More Babies),”\u003c/a> which aired on PBS Monday night, tells the story of how 10 immigrant Mexican women, Hermosillo included, sued Los Angeles County doctors, the state and the U.S. government in 1975 for allegedly violating their civil rights. The women’s cases were similar. Each had an emergency cesarean section and each said she was either unaware that she signed for a tubal ligation or was told by a medical professional that not signing for one could mean death for her and her unborn child.\u003c/p>\n\u003cp>You can \u003ca href=\"http://www.pbs.org/independentlens/videos/no-mas-bebes/\" target=\"_blank\" rel=\"noopener\">watch the full “No Más Bebés” film here\u003c/a>.\u003c/p>\n\u003cp>It examines how the lawsuit, \u003cem>Madrigal v. Quilligan\u003c/em>, came to be, how questions of informed consent — or lack thereof — and coercion played into the case, and how the collision of various societal issues resulted in stories like Hermosillo’s.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\u003c/p>\u003cp>\u003cspan class='utils-parseShortcode-shortcodes-__youtubeShortcode__embedYoutube'>\n \u003cspan class='utils-parseShortcode-shortcodes-__youtubeShortcode__embedYoutubeInside'>\n \u003ciframe\n loading='lazy'\n class='utils-parseShortcode-shortcodes-__youtubeShortcode__youtubePlayer'\n type='text/html'\n src='//www.youtube.com/embed/aseQlmKg25U'\n title='//www.youtube.com/embed/aseQlmKg25U'\n allowfullscreen='true'\n style='border:0;'>\u003c/iframe>\n \u003c/span>\n \u003c/span>\u003c/p>\u003cp>\u003cp>“When you’re a filmmaker, the easiest thing to do is make a film about the good guys and the bad guys, the heroes and the villains,” says director \u003ca href=\"http://www.asianam.ucla.edu/people/renee-tajima-pe%C3%B1a\">Renee Tajima-Peña\u003c/a>. She says she and co-producer \u003ca href=\"http://itvs.org/films/no-mas-bebes/filmmaker\">Virginia Espino\u003c/a>, a historian who wrote her dissertation on the case, wanted to tell a multilayered story, one that revealed how even the best intentions could do harm.\u003c/p>\n\u003cp>Tajima-Peña and Espino explore the roles played by federally funded family-planning programs; a growing popular movement to curb population growth that attracted both environmentalists and anti-immigration proponents; doctors fresh out of medical school working in under-resourced maternity wards; cultural misunderstandings; and the popular belief that poor women who need public assistance should abstain from having children.\u003c/p>\n\u003cp>Taken together, these factors created what Tajima-Peña calls a “perfect storm” resulting in the sterilization of thousands of vulnerable women across the country in the late ’60s and early 1970s. She and Espino say their goal was to document a history that continues to repeat itself — they point to \u003ca href=\"http://cironline.org/reports/female-inmates-sterilized-california-prisons-without-approval-4917\">nearly 150 women sterilized in California prisons between 2006 and 2010\u003c/a> as the most recent example.\u003c/p>\n\u003cp>In telling this history, the film highlights the role played by the Family Planning and Population Research Act, which Congress passed in 1970, allocating millions for family-planning purposes. That money went to fund contraceptives, education, research and training. “You’ve got money for family planning programs, which were good programs and provided contraceptives for women who couldn’t afford it,” says Tajima-Peña. Congress also lifted a ban on federal funding for sterilization, so hospitals that provided the indigent with medical care, like Los Angeles County General Hospital, could apply for government money to perform tubal ligations.\u003c/p>\n\u003cp>Meanwhile, lobbying efforts in Washington, fueled by a fear of overpopulation gripping the nation, led to yet more funding for family planning programs. Inspired by the popularity of biologist Paul Ehrlich’s best-selling 1968 book, “\u003ca href=\"http://www.nytimes.com/2015/06/01/us/the-unrealized-horrors-of-population-explosion.html\">The Population Bomb\u003c/a>,” which predicted that at some point in the 1980s, overpopulation would make it impossible for the planet to support humanity, members of the “zero population movement” worked to convince the public that having children was a very bad idea. Some went so far as promoting the sterilization of women deemed to have had too many. (They also called for a dramatic reduction to immigration.)\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Then, there were divisions within the feminist movement on how sterilization fit into the bigger picture of reproductive rights. Mainstream white feminists marched for “the right to choose,” including unfettered access to sterilizations, contraception and abortions. Feminists of color also called for abortion rights and easy access to contraception, but broke with white feminists on the issue of sterilization, arguing that for women of color, sterilization was not always a matter of choice. They called for waiting periods before tubal ligation procedures, and Latina activists called for Spanish-language consent forms.\u003c/p>\n\u003cp>In “No Más Bebés,” California politician \u003ca href=\"http://www.latimes.com/la-oe-morrison-new29-2009aug29-column.html\">Gloria Molina\u003c/a>, who was active in the Chicana feminist movement in the 1970s, says the idea of a waiting period was “totally offensive” to white feminists, who, she says, pushed for sterilization upon demand. “They weren’t taking into account that if you were Spanish-speaking, and if you don’t speak English, you were being denied a right, totally,” Molina says in the film.\u003c/p>\n\u003cp>And then there was the long-held stance, still popular today, that poor women should not have children they can’t afford to support, especially poor women of color. For decades, \u003ca href=\"https://www.uic.edu/orgs/cwluherstory/CWLUArchive/puertorico.html\">Puerto Rican women had been subjected to sterilizations at various points\u003c/a> as a way to combat astronomical unemployment and poverty on the island; a 1965 survey found that a third of Puerto Rican mothers living on the island at the time had been sterilized. \u003ca href=\"https://muse.jhu.edu/login?auth=0&type=summary&url=/journals/american_indian_quarterly/v024/24.3lawrence.html\">Native American women\u003c/a> were sterilized at the hands of the Indian Health Service in the 1970s. Poor African-American women on government assistance were also sterilized across the country during that time period. \u003ca href=\"https://www.splcenter.org/seeking-justice/case-docket/relf-v-weinberger\">A particularly damning case\u003c/a>, brought two years before \u003cem>Madrigal v. Quilligan\u003c/em>, involved two black sisters sterilized at ages 14 and 12 in Alabama.\u003c/p>\n\u003cp>So, to recap: You had a surge of federal money for sterilizations, mainstream feminists calling for easier access to them, a fear that overpopulation would soon destroy the planet and the fear that poor women were burdening the country with children whom taxpayers would need to feed, clothe and educate. This nexus of events — and the consequences, intended and unintended, that followed — is the knot that “No Más Bebés” tries to untie.\u003c/p>\n\u003cp>“Why were they doing it?” Consuelo Hermosillo, one of the 10 plaintiffs in \u003cem>Madrigal v. Quilligan\u003c/em>, asks on camera at one point in the film, nearly 40 years after her sterilization at L.A. County General. “I always keep these questions with me, and I never get those answers,” she says.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"disqusTitle": "As Bay Area Hospitals Consolidate, Will Costs Go Up or Down?",
"title": "As Bay Area Hospitals Consolidate, Will Costs Go Up or Down?",
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"content": "\u003cp>The Bay Area's health care systems -- think Stanford, Sutter, John Muir and more -- are continuing to align and consolidate in different ways to expand across the region, \u003ca href=\"http://stage.chcf.org/publications/2016/01/regional-market-san-francisco\" target=\"_blank\">a new analysis shows\u003c/a>, and it's unclear if this will lead to lower or higher health care costs.\u003c/p>\n\u003cp>The report, from the Oakland-based California HealthCare Foundation (CHCF), serves as a summary of the transformation in the Bay Area's health care market over the last few years since the foundation's last report on the subject in 2012.\u003c/p>\n\u003cp>Maribeth Shannon, director at CHCF, referred to \"an arms race.\"\u003c/p>\n\u003cp>\"Providers see health plans consolidating and they want to have a similar level of leverage when they negotiate\" with health insurers, she said. \"The idea [is] that you have to be strong to get a good price in this market.\"\u003c/p>\n\u003cp>The analysis, conducted for the foundation by Mathematica Policy Research, called out three specific health system regionalization efforts and the different ways they were achieving their goals:\u003c/p>\n\u003cul>\n\u003cli>\u003cstrong>Stanford Health Care\u003c/strong> reached across San Francisco Bay to acquire ValleyCare, based in Pleasanton. The goal of such an expansion, the report says, is for Stanford \"to support an expansion of its health plan.\"\u003c/li>\n\u003cli>\u003cstrong>UCSF and John Muir Health\u003c/strong> -- also on opposite sides of San Francisco Bay -- formed a partnership aimed at building a \"network large enough to compete with systems like Kaiser and Sutter\" throughout the Bay Area.\u003c/li>\n\u003cli>\u003cstrong>Sutter Health,\u003c/strong> meanwhile, is consolidating its own operations. The foundation's report cites multiple rounds of reorganization over the past few years, and says Sutter now is attempting to merge its three Bay Area foundations with the goal of extending the successful Palo Alto Medical Foundation model to other sites. But the analysts predict that will be a tall order, given the foundations' different \"histories and physician cultures.\"\u003c/li>\n\u003c/ul>\n\u003cp>And what of patients? Ha Tu, senior health researcher of Mathematica Policy Research and lead author of the study, predicts the increasing consolidation, \"at least in the short term, will result in more provider competition and more choices for consumers, but over the longer term, it remains to be seen whether it's a sustainable thing.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Glenn Melnick, a health economist at USC, flatly rejects that the consolidation will ever benefit consumers.\u003c/p>\n\u003cp>\"What's happening,\" he said, \"is they're getting together to negotiate contracts, and that's it. I'm very cynical.\"\u003c/p>\n\u003cp>\u003ca href=\"http://www.chcf.org/publications/2016/01/regional-market-san-francisco\" target=\"_blank\" rel=\"attachment wp-att-138796\">\u003cimg class=\"alignright wp-image-138796 size-full\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/01/EmpireBuildingByBayTeaser.jpg\" alt=\"\" width=\"291\" height=\"400\">\u003c/a>Northern California as a whole has \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/12/03/why-health-insurance-in-the-bay-area-costs-more-than-in-southern-california-hospital-prices/\" target=\"_blank\">long had higher health care prices\u003c/a> than Southern California. Melnick described \"monstrous health care enterprises who are just building on existing market power to expand and protect it in the future.\"\u003c/p>\n\u003cp>Both the foundation's Shannon and lead author Tu stressed that future cost savings are unknown. While more consolidation can lead to higher prices, efficiencies can improve, Shannon said, but she added it's not clear now if those efficiencies would be robust enough to offset price hikes.\u003c/p>\n\u003cp>Tu pointed to a desire by many health systems to be more competitive against health giant Kaiser.\u003c/p>\n\u003cp>At both Sutter and UCSF/John Muir \"they are very well aware they need to lower their cost structures significantly and do population health effectively,\" Tu said in reference to the push to move away from fee-for-service medicine, which can lead to unnecessary care and waste. \"Whether they can do that is a big challenge and an open question.\"\u003c/p>\n\u003cp>In the report, analysts also looked at safety net providers and the challenge posed by increased demand as millions more Californians have coverage, in the wake of the full implementation of the Affordable Care Act. Just over \u003ca href=\"http://ww2.kqed.org/stateofhealth/2016/01/07/browns-budget-plan-new-managed-care-tax-increase-ssi-benefits-more-medi-cal-enrollment/\" target=\"_blank\">one-third of Californians are now covered by Medi-Cal\u003c/a>, and primary care providers are in short supply, the report said.\u003c/p>\n\u003cp>\"The primary care physicians that are needed to serve that population just don't exist,\" Shannon said. \"What we need are innovative ways of meeting the health care needs of that population.\"\u003c/p>\n\u003cp>Providing behavioral health care to patients in the face of expanded health insurance access and regulations requiring coverage \"\u003ca href=\"http://www.dol.gov/ebsa/mentalhealthparity/\" target=\"_blank\">parity\u003c/a>\" -- that health insurers \u003ca href=\"https://www.nami.org/Find-Support/Living-with-a-Mental-Health-Condition/Understanding-Health-Insurance/What-is-Mental-Health-Parity\" target=\"_blank\">must provide equal coverage\u003c/a> for mental health conditions -- is an \"enormous problem,\" Shannon said, and many patients are facing long wait times to access care.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"It's a significant problem,\" she said, \"and it's long been simmering, it's been below the surface for a long time, and now parity has brought it up to the top.\"\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The Bay Area's health care systems -- think Stanford, Sutter, John Muir and more -- are continuing to align and consolidate in different ways to expand across the region, \u003ca href=\"http://stage.chcf.org/publications/2016/01/regional-market-san-francisco\" target=\"_blank\">a new analysis shows\u003c/a>, and it's unclear if this will lead to lower or higher health care costs.\u003c/p>\n\u003cp>The report, from the Oakland-based California HealthCare Foundation (CHCF), serves as a summary of the transformation in the Bay Area's health care market over the last few years since the foundation's last report on the subject in 2012.\u003c/p>\n\u003cp>Maribeth Shannon, director at CHCF, referred to \"an arms race.\"\u003c/p>\n\u003cp>\"Providers see health plans consolidating and they want to have a similar level of leverage when they negotiate\" with health insurers, she said. \"The idea [is] that you have to be strong to get a good price in this market.\"\u003c/p>\n\u003cp>The analysis, conducted for the foundation by Mathematica Policy Research, called out three specific health system regionalization efforts and the different ways they were achieving their goals:\u003c/p>\n\u003cul>\n\u003cli>\u003cstrong>Stanford Health Care\u003c/strong> reached across San Francisco Bay to acquire ValleyCare, based in Pleasanton. The goal of such an expansion, the report says, is for Stanford \"to support an expansion of its health plan.\"\u003c/li>\n\u003cli>\u003cstrong>UCSF and John Muir Health\u003c/strong> -- also on opposite sides of San Francisco Bay -- formed a partnership aimed at building a \"network large enough to compete with systems like Kaiser and Sutter\" throughout the Bay Area.\u003c/li>\n\u003cli>\u003cstrong>Sutter Health,\u003c/strong> meanwhile, is consolidating its own operations. The foundation's report cites multiple rounds of reorganization over the past few years, and says Sutter now is attempting to merge its three Bay Area foundations with the goal of extending the successful Palo Alto Medical Foundation model to other sites. But the analysts predict that will be a tall order, given the foundations' different \"histories and physician cultures.\"\u003c/li>\n\u003c/ul>\n\u003cp>And what of patients? Ha Tu, senior health researcher of Mathematica Policy Research and lead author of the study, predicts the increasing consolidation, \"at least in the short term, will result in more provider competition and more choices for consumers, but over the longer term, it remains to be seen whether it's a sustainable thing.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Glenn Melnick, a health economist at USC, flatly rejects that the consolidation will ever benefit consumers.\u003c/p>\n\u003cp>\"What's happening,\" he said, \"is they're getting together to negotiate contracts, and that's it. I'm very cynical.\"\u003c/p>\n\u003cp>\u003ca href=\"http://www.chcf.org/publications/2016/01/regional-market-san-francisco\" target=\"_blank\" rel=\"attachment wp-att-138796\">\u003cimg class=\"alignright wp-image-138796 size-full\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/01/EmpireBuildingByBayTeaser.jpg\" alt=\"\" width=\"291\" height=\"400\">\u003c/a>Northern California as a whole has \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/12/03/why-health-insurance-in-the-bay-area-costs-more-than-in-southern-california-hospital-prices/\" target=\"_blank\">long had higher health care prices\u003c/a> than Southern California. Melnick described \"monstrous health care enterprises who are just building on existing market power to expand and protect it in the future.\"\u003c/p>\n\u003cp>Both the foundation's Shannon and lead author Tu stressed that future cost savings are unknown. While more consolidation can lead to higher prices, efficiencies can improve, Shannon said, but she added it's not clear now if those efficiencies would be robust enough to offset price hikes.\u003c/p>\n\u003cp>Tu pointed to a desire by many health systems to be more competitive against health giant Kaiser.\u003c/p>\n\u003cp>At both Sutter and UCSF/John Muir \"they are very well aware they need to lower their cost structures significantly and do population health effectively,\" Tu said in reference to the push to move away from fee-for-service medicine, which can lead to unnecessary care and waste. \"Whether they can do that is a big challenge and an open question.\"\u003c/p>\n\u003cp>In the report, analysts also looked at safety net providers and the challenge posed by increased demand as millions more Californians have coverage, in the wake of the full implementation of the Affordable Care Act. Just over \u003ca href=\"http://ww2.kqed.org/stateofhealth/2016/01/07/browns-budget-plan-new-managed-care-tax-increase-ssi-benefits-more-medi-cal-enrollment/\" target=\"_blank\">one-third of Californians are now covered by Medi-Cal\u003c/a>, and primary care providers are in short supply, the report said.\u003c/p>\n\u003cp>\"The primary care physicians that are needed to serve that population just don't exist,\" Shannon said. \"What we need are innovative ways of meeting the health care needs of that population.\"\u003c/p>\n\u003cp>Providing behavioral health care to patients in the face of expanded health insurance access and regulations requiring coverage \"\u003ca href=\"http://www.dol.gov/ebsa/mentalhealthparity/\" target=\"_blank\">parity\u003c/a>\" -- that health insurers \u003ca href=\"https://www.nami.org/Find-Support/Living-with-a-Mental-Health-Condition/Understanding-Health-Insurance/What-is-Mental-Health-Parity\" target=\"_blank\">must provide equal coverage\u003c/a> for mental health conditions -- is an \"enormous problem,\" Shannon said, and many patients are facing long wait times to access care.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"It's a significant problem,\" she said, \"and it's long been simmering, it's been below the surface for a long time, and now parity has brought it up to the top.\"\u003c/p>\n\n\u003c/div>\u003c/p>",
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"title": "Judge to Consider Emergency Appeal for Redding Woman's Tubal Ligation",
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"content": "\u003cp>\u003cstrong>Update: Tuesday, Jan. 5, 2016:\u003c/strong>\u003c/p>\n\u003cp>A San Francisco Superior Court judge on Tuesday will consider an emergency order to permit a Redding woman’s contraceptive procedure to go forward. Mercy Medical Center in Redding has refused to allow the procedure on religious grounds.\u003c/p>\n\u003cp>Rebecca Chamorro is pregnant with her third child and decided on a tubal ligation to avoid another pregnancy. But Mercy Medical — part of Dignity Health — does not permit sterilization procedures for women or men, under rules from the U.S. Conference of Catholic Bishops, which are generally followed by Catholic hospitals. Chamorro filed the emergency request last week.\u003c/p>\n\u003cp>Chamorro is joined in her suit by Physicians for Reproductive Health, an advocacy group. “We shouldn’t allow religion or any hospital to decide what is best for a patient and her family,” said Dr. Pratima Gupta, a fellow with the organization. “It really should be in consultation with her doctor.”\u003c/p>\n\u003cp>Tubal ligations are usually done after a woman delivers. Chamorro has a scheduled cesarean section later this month. The next closest hospital that permits tubal ligation is 70 miles from her, in Chico.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cstrong>Original post:\u003c/strong>\u003c/p>\n\u003cp>A woman whose request for a tubal ligation has been denied by Mercy Medical Center, a Catholic hospital in Redding, has joined with a physicians group to sue the hospital, saying its denial is discriminatory and in violation of California law.\u003c/p>\n\u003cp>[soundcloud url=”https://api.soundcloud.com/tracks/240534476″ 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>The woman, Rebecca Chamorro, is pregnant with her third child and is scheduled to have a cesarean section in late January. According to court papers, Chamorro and her husband determined they did not want to have more children and scheduled the tubal ligation to be done when she delivers her child. Medically, this is the \u003ca href=\"http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Health-Care-for-Underserved-Women/Access-to-Postpartum-Sterilization\" target=\"_blank\" rel=\"noopener\">ideal time \u003c/a>to perform the procedure, according to the American College of Obstetricians and Gynecologists.\u003c/p>\n\u003cp>But in September Mercy Medical informed her obstetrician, Dr. Samuel Van Kirk, that it was denying his request to perform the procedure there, citing Catholic directives. Earlier this month the ACLU and Physicians for Reproductive Health, a national advocacy group, \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/12/07/catholic-hospital-redding-denies-women-tubal-ligation/\" target=\"_blank\" rel=\"noopener\">sent a letter\u003c/a> to Dignity Health, which owns Mercy Medical, seeking a reversal of the decision. The hospital has not authorized the procedure.\u003c/p>\n\u003cp>Now Physicians for Reproductive Health has joined with Chamorro in filing a lawsuit in San Francisco Superior Court. They are represented by the ACLU and a San Francisco law firm.\u003c/p>\n\u003cp>“The refusal of hospitals to allow doctors to perform basic health procedures based solely on religious doctrine presents a real threat to a woman’s ability to access health care,” Elizabeth Gill, senior attorney at the ACLU of Northern California, said in a statement. “Patients seeking medical care from public institutions should not have to worry that religious doctrine rather than medical judgment will dictate what care they receive.”\u003c/p>\n\u003cp>Mercy Medical is owned by Dignity Health, and court documents spell out that Dignity receives significant income from public money, including more than $3 billion in payments from Medicare and Medicaid.\u003c/p>\n\u003cp>Court papers say that the next closest hospital where Chamorro could have a tubal ligation is 70 miles away, in Chico.\u003c/p>\n\u003cp>A spokeswoman for Dignity Health said it is the company’s policy not to comment on pending litigation, but in a statement said that “the care and safety of our patients is always our top priority.”\u003c/p>\n\u003cp>The statement notes that it is not the practice of the hospital to provide “sterilization services … in accordance with Ethical and Religious Directives for Catholic Health Care Services … ” The directives were written by the \u003ca href=\"http://www.usccb.org/issues-and-action/human-life-and-dignity/health-care/upload/Ethical-Religious-Directives-Catholic-Health-Care-Services-fifth-edition-2009.pdf\" target=\"_blank\" rel=\"noopener\">U.S. Conference of Catholic Bishops and specifically prohibit sterilization\u003c/a>, which labels sterilization “intrinsically evil”:\u003c/p>\n\u003cblockquote>\u003cp>“Direct sterilization of either men or women, whether permanent or temporary, is not permitted in a Catholic health care institution. Procedures that induce sterility are permitted when their direct effect is the cure or alleviation of a present and serious pathology and a simpler treatment is not available.”…\u003c/p>\n\u003cp>“While there are many acts of varying moral gravity that can be identified as intrinsically evil, in the context of contemporary health care the most pressing concerns are currently abortion, euthanasia, assisted suicide, and direct sterilization.”\u003c/p>\u003c/blockquote>\n\u003cp>Dignity Health’s system includes 39 hospitals. Most of them are in California and most are Catholic hospitals.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>In addition to the lawsuit, the ACLU is also filing an emergency motion to force Dignity to permit the sterilization procedure when Chamorro delivers her baby later in January.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cstrong>Update: Tuesday, Jan. 5, 2016:\u003c/strong>\u003c/p>\n\u003cp>A San Francisco Superior Court judge on Tuesday will consider an emergency order to permit a Redding woman’s contraceptive procedure to go forward. Mercy Medical Center in Redding has refused to allow the procedure on religious grounds.\u003c/p>\n\u003cp>Rebecca Chamorro is pregnant with her third child and decided on a tubal ligation to avoid another pregnancy. But Mercy Medical — part of Dignity Health — does not permit sterilization procedures for women or men, under rules from the U.S. Conference of Catholic Bishops, which are generally followed by Catholic hospitals. Chamorro filed the emergency request last week.\u003c/p>\n\u003cp>Chamorro is joined in her suit by Physicians for Reproductive Health, an advocacy group. “We shouldn’t allow religion or any hospital to decide what is best for a patient and her family,” said Dr. Pratima Gupta, a fellow with the organization. “It really should be in consultation with her doctor.”\u003c/p>\n\u003cp>Tubal ligations are usually done after a woman delivers. Chamorro has a scheduled cesarean section later this month. The next closest hospital that permits tubal ligation is 70 miles from her, in Chico.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cstrong>Original post:\u003c/strong>\u003c/p>\n\u003cp>A woman whose request for a tubal ligation has been denied by Mercy Medical Center, a Catholic hospital in Redding, has joined with a physicians group to sue the hospital, saying its denial is discriminatory and in violation of California law.\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/240534476″&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/240534476″'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>The woman, Rebecca Chamorro, is pregnant with her third child and is scheduled to have a cesarean section in late January. According to court papers, Chamorro and her husband determined they did not want to have more children and scheduled the tubal ligation to be done when she delivers her child. Medically, this is the \u003ca href=\"http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Health-Care-for-Underserved-Women/Access-to-Postpartum-Sterilization\" target=\"_blank\" rel=\"noopener\">ideal time \u003c/a>to perform the procedure, according to the American College of Obstetricians and Gynecologists.\u003c/p>\n\u003cp>But in September Mercy Medical informed her obstetrician, Dr. Samuel Van Kirk, that it was denying his request to perform the procedure there, citing Catholic directives. Earlier this month the ACLU and Physicians for Reproductive Health, a national advocacy group, \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/12/07/catholic-hospital-redding-denies-women-tubal-ligation/\" target=\"_blank\" rel=\"noopener\">sent a letter\u003c/a> to Dignity Health, which owns Mercy Medical, seeking a reversal of the decision. The hospital has not authorized the procedure.\u003c/p>\n\u003cp>Now Physicians for Reproductive Health has joined with Chamorro in filing a lawsuit in San Francisco Superior Court. They are represented by the ACLU and a San Francisco law firm.\u003c/p>\n\u003cp>“The refusal of hospitals to allow doctors to perform basic health procedures based solely on religious doctrine presents a real threat to a woman’s ability to access health care,” Elizabeth Gill, senior attorney at the ACLU of Northern California, said in a statement. “Patients seeking medical care from public institutions should not have to worry that religious doctrine rather than medical judgment will dictate what care they receive.”\u003c/p>\n\u003cp>Mercy Medical is owned by Dignity Health, and court documents spell out that Dignity receives significant income from public money, including more than $3 billion in payments from Medicare and Medicaid.\u003c/p>\n\u003cp>Court papers say that the next closest hospital where Chamorro could have a tubal ligation is 70 miles away, in Chico.\u003c/p>\n\u003cp>A spokeswoman for Dignity Health said it is the company’s policy not to comment on pending litigation, but in a statement said that “the care and safety of our patients is always our top priority.”\u003c/p>\n\u003cp>The statement notes that it is not the practice of the hospital to provide “sterilization services … in accordance with Ethical and Religious Directives for Catholic Health Care Services … ” The directives were written by the \u003ca href=\"http://www.usccb.org/issues-and-action/human-life-and-dignity/health-care/upload/Ethical-Religious-Directives-Catholic-Health-Care-Services-fifth-edition-2009.pdf\" target=\"_blank\" rel=\"noopener\">U.S. Conference of Catholic Bishops and specifically prohibit sterilization\u003c/a>, which labels sterilization “intrinsically evil”:\u003c/p>\n\u003cblockquote>\u003cp>“Direct sterilization of either men or women, whether permanent or temporary, is not permitted in a Catholic health care institution. Procedures that induce sterility are permitted when their direct effect is the cure or alleviation of a present and serious pathology and a simpler treatment is not available.”…\u003c/p>\n\u003cp>“While there are many acts of varying moral gravity that can be identified as intrinsically evil, in the context of contemporary health care the most pressing concerns are currently abortion, euthanasia, assisted suicide, and direct sterilization.”\u003c/p>\u003c/blockquote>\n\u003cp>Dignity Health’s system includes 39 hospitals. Most of them are in California and most are Catholic hospitals.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>In addition to the lawsuit, the ACLU is also filing an emergency motion to force Dignity to permit the sterilization procedure when Chamorro delivers her baby later in January.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"slug": "california-now-has-strictest-limits-in-u-s-on-livestock-antibiotics",
"title": "California Now Has Strictest Limits in U.S. on Livestock Antibiotics",
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"content": "\u003cp>California has adopted the toughest limits in the nation on the use of antibiotics in healthy livestock, barring their routine use to prevent illness or promote growth.\u003c/p>\n\u003cp>Calling the overuse of antibiotics “an urgent public health problem,” Gov. Jerry Brown announced Saturday that he signed the legislation. The bill, SB 27, will curb the overuse of antibiotics in livestock, which limits the effectiveness of the medicines in both animals and people and contributes to the spread of dangerous, drug-resistant superbugs.\u003c/p>\n\u003cp>“The science is clear that the overuse of antibiotics in livestock has contributed to the spread of antibiotic resistance and the undermining of decades of life-saving advances in medicine,” Brown said in a statement.\u003c/p>\n\u003cp>[contextly_sidebar id=”IPA7Z2cNGNEWXM3RNUpN7LFKzKK8f0Ui”]The U.S. Centers for Disease Control and Prevention calls antibiotic resistance one of the world’s most pressing health problems and estimates that 23,000 Americans die annually as a result of antibiotic-resistant infections.\u003c/p>\n\u003cp>The agency has recommended phasing out their use in cases solely to promote growth in livestock. In low doses, some antibiotics can generate greater muscle development by boosting the efficiency of food that animals eat.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Supporters of the legislation by Sen. Jerry Hill, D-San Mateo, say the antibiotics are fed to mostly healthy animals such as cows, pigs and chickens to make them grow faster and prevent disease in crowded industrial farms.\u003c/p>\n\u003cp>Widespread use of antibiotics by humans and animals reduce their effectiveness in treating illnesses because the diseases adapt by mutating, creating superbugs. Once-treatable illnesses can become dangerous infections when antibiotics are no longer effective.\u003c/p>\n\u003cp>“The lifesaving potential of antibiotics is quickly diminishing, and people are dying because the drugs are less effective,” Hill said in a statement.\u003c/p>\n\u003cp>Opponents argued that the California legislation does not go far enough to restrict preventive or routine use of antimicrobial drugs. Groups such as the California Cattlemen’s Association remained neutral on the bill.\u003c/p>\n\u003cp>Michael Hansen, a senior scientist at Consumers Union, the policy division of Consumer Reports, said many companies have voluntarily agreed to stop using antibiotics to promote growth after guidance from the Food and Drug Administration.\u003c/p>\n\u003cp>“No state yet has been able to pass a bill that is stronger than the one in California, and the fact that California is an important ag state, that makes this an important action,” Hansen said.\u003c/p>\n\u003cp>The antibiotics are different from the growth hormones used by many food producers that have drawn criticism and that some grocery stores and food chains have phased out. Companies including McDonald’s, Chipotle and Panera also have begun promoting their chicken as raised without antibiotics.\u003c/p>\n\u003cp>Brown, a Democrat, \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/10/02/why-advocates-say-browns-veto-of-livestock-antibiotics-bill-is-a-good-thing/\" target=\"_blank\" rel=\"noopener\">vetoed a weaker version\u003c/a> of the bill last year, urging the state Department of Food and Agriculture to work with lawmakers on the issue. \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/09/16/bill-making-california-toughest-in-u-s-on-livestock-antibiotics-now-up-to-governor/\" target=\"_blank\" rel=\"noopener\">His office helped make changes\u003c/a> to this year’s measure to strengthen protections against using antibiotics to prevent disease.\u003c/p>\n\u003cp>The bill allows exemptions when a licensed veterinarian determines antimicrobial drugs are needed to treat a disease or infection, to control the spread of a disease, or in relation to surgery or a medical procedure, according to an analysis prepared for the Legislature.\u003c/p>\n\u003cp>The California Veterinary Medical Association expressed concern that veterinarians might not be able to prescribe the drugs preventively to treat diseases for which there is no test available to determine which animals are carriers.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The law, which takes effect in 2018, also eliminates the availability of livestock antibiotics for over-the-counter sales.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>California has adopted the toughest limits in the nation on the use of antibiotics in healthy livestock, barring their routine use to prevent illness or promote growth.\u003c/p>\n\u003cp>Calling the overuse of antibiotics “an urgent public health problem,” Gov. Jerry Brown announced Saturday that he signed the legislation. The bill, SB 27, will curb the overuse of antibiotics in livestock, which limits the effectiveness of the medicines in both animals and people and contributes to the spread of dangerous, drug-resistant superbugs.\u003c/p>\n\u003cp>“The science is clear that the overuse of antibiotics in livestock has contributed to the spread of antibiotic resistance and the undermining of decades of life-saving advances in medicine,” Brown said in a statement.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>The U.S. Centers for Disease Control and Prevention calls antibiotic resistance one of the world’s most pressing health problems and estimates that 23,000 Americans die annually as a result of antibiotic-resistant infections.\u003c/p>\n\u003cp>The agency has recommended phasing out their use in cases solely to promote growth in livestock. In low doses, some antibiotics can generate greater muscle development by boosting the efficiency of food that animals eat.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Supporters of the legislation by Sen. Jerry Hill, D-San Mateo, say the antibiotics are fed to mostly healthy animals such as cows, pigs and chickens to make them grow faster and prevent disease in crowded industrial farms.\u003c/p>\n\u003cp>Widespread use of antibiotics by humans and animals reduce their effectiveness in treating illnesses because the diseases adapt by mutating, creating superbugs. Once-treatable illnesses can become dangerous infections when antibiotics are no longer effective.\u003c/p>\n\u003cp>“The lifesaving potential of antibiotics is quickly diminishing, and people are dying because the drugs are less effective,” Hill said in a statement.\u003c/p>\n\u003cp>Opponents argued that the California legislation does not go far enough to restrict preventive or routine use of antimicrobial drugs. Groups such as the California Cattlemen’s Association remained neutral on the bill.\u003c/p>\n\u003cp>Michael Hansen, a senior scientist at Consumers Union, the policy division of Consumer Reports, said many companies have voluntarily agreed to stop using antibiotics to promote growth after guidance from the Food and Drug Administration.\u003c/p>\n\u003cp>“No state yet has been able to pass a bill that is stronger than the one in California, and the fact that California is an important ag state, that makes this an important action,” Hansen said.\u003c/p>\n\u003cp>The antibiotics are different from the growth hormones used by many food producers that have drawn criticism and that some grocery stores and food chains have phased out. Companies including McDonald’s, Chipotle and Panera also have begun promoting their chicken as raised without antibiotics.\u003c/p>\n\u003cp>Brown, a Democrat, \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/10/02/why-advocates-say-browns-veto-of-livestock-antibiotics-bill-is-a-good-thing/\" target=\"_blank\" rel=\"noopener\">vetoed a weaker version\u003c/a> of the bill last year, urging the state Department of Food and Agriculture to work with lawmakers on the issue. \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/09/16/bill-making-california-toughest-in-u-s-on-livestock-antibiotics-now-up-to-governor/\" target=\"_blank\" rel=\"noopener\">His office helped make changes\u003c/a> to this year’s measure to strengthen protections against using antibiotics to prevent disease.\u003c/p>\n\u003cp>The bill allows exemptions when a licensed veterinarian determines antimicrobial drugs are needed to treat a disease or infection, to control the spread of a disease, or in relation to surgery or a medical procedure, according to an analysis prepared for the Legislature.\u003c/p>\n\u003cp>The California Veterinary Medical Association expressed concern that veterinarians might not be able to prescribe the drugs preventively to treat diseases for which there is no test available to determine which animals are carriers.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The law, which takes effect in 2018, also eliminates the availability of livestock antibiotics for over-the-counter sales.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>The state Legislature will reconsider a bill Wednesday that would regulate e-cigarettes the same as tobacco, one day after \u003ca href=\"http://jama.jamanetwork.com/article.aspx?doi=10.1001/jama.2015.8950\">a new study\u003c/a> was released that shows 14-year-olds who’ve tried e-cigarettes are four times more likely to try other tobacco products.\u003c/p>\n\u003cp>The study, published in the \u003ca href=\"http://Journal%20of%20the%20American%20Medical%20Association\">Journal of the American Medical Association\u003c/a> Tuesday, finds teenagers who have used e-cigarettes are more likely to at least sample tobacco cigarettes, cigars or hookahs, said co-author Adam Leventhal, associate professor and director of the USC Health, Emotion, & Addiction Laboratory at the Keck School of Medicine.\u003c/p>\n\u003cp>[soundcloud url=”https://api.soundcloud.com/tracks/219969068″ 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>The researchers surveyed 2,530 ninth graders at 10 Los Angeles high schools over the course of a year. Their study builds upon other research that has also found possible links between e-cigarettes and tobacco; the authors cautioned, however, that they did not determine a causal link between trying e-cigarettes and sampling tobacco ones, and called for more research on that question.\u003c/p>\n\u003cp>\u003cem>\u003ca href=\"http://www.scpr.org/news/2015/08/18/53830/state-lawmakers-mull-e-cig-rules-as-new-study-sugg//\">Read the full story via KPCC\u003c/a>\u003c/em>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\u003cp>\u003c/p>\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The state Legislature will reconsider a bill Wednesday that would regulate e-cigarettes the same as tobacco, one day after \u003ca href=\"http://jama.jamanetwork.com/article.aspx?doi=10.1001/jama.2015.8950\">a new study\u003c/a> was released that shows 14-year-olds who’ve tried e-cigarettes are four times more likely to try other tobacco products.\u003c/p>\n\u003cp>The study, published in the \u003ca href=\"http://Journal%20of%20the%20American%20Medical%20Association\">Journal of the American Medical Association\u003c/a> Tuesday, finds teenagers who have used e-cigarettes are more likely to at least sample tobacco cigarettes, cigars or hookahs, said co-author Adam Leventhal, associate professor and director of the USC Health, Emotion, & Addiction Laboratory at the Keck School of Medicine.\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/219969068″&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/219969068″'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>The researchers surveyed 2,530 ninth graders at 10 Los Angeles high schools over the course of a year. Their study builds upon other research that has also found possible links between e-cigarettes and tobacco; the authors cautioned, however, that they did not determine a causal link between trying e-cigarettes and sampling tobacco ones, and called for more research on that question.\u003c/p>\n\u003cp>\u003cem>\u003ca href=\"http://www.scpr.org/news/2015/08/18/53830/state-lawmakers-mull-e-cig-rules-as-new-study-sugg//\">Read the full story via KPCC\u003c/a>\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>States that provide Medicaid adult dental care still have high rates of dental patients who show up at hospital emergency departments, particularly in urban underserved areas, according to a \u003ca href=\"https://med.stanford.edu/news/all-news/2015/08/medicaid-dental-coverage-may-not-prevent-tooth-related-er-visits.html\" target=\"_blank\" rel=\"noopener\">study released this week\u003c/a>. The study — by researchers at Stanford University, UC San Francisco, Truven Health Analytics and the federal Agency for Healthcare Research and Quality — was published in \u003cem>\u003ca href=\"http://content.healthaffairs.org/content/34/8/1349.abstract?=right\" target=\"_blank\" rel=\"noopener\">Health Affairs\u003c/a>\u003c/em>.\u003c/p>\n\u003caside class=\"pullquote alignright\">“People say there are plenty of dentists, but there’s a subtler argument we’re trying to make: that there is a low rate of dentists who take Medicaid.”\u003c/aside>\n\u003cp>Researchers said a dearth of dental providers who accept Medicaid patients, particularly in those urban underserved areas, has limited the effectiveness of Medicaid dental coverage in states that provide it.\u003c/p>\n\u003cp>“We found that, in urban counties there were large concentrations of all providers, but not really to serve the poor,” said Maria Raven, senior author of the study and associate professor of emergency medicine at UCSF.\u003c/p>\n\u003cp>“There may be a higher density of dentists [in urban areas], but they’re still not accepting Medi-Cal patients,” Raven said. “Coverage doesn’t equal access.”\u003c/p>\n\u003cp>That has resulted in high ED use even in states with Medicaid dental coverage, she said.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Medi-Cal is California’s Medicaid program, and it did not have adult dental coverage in 2010, when the study’s data were collected.\u003c/p>\n\u003cp>Katie Fingar, lead author of the study and research leader in health care at Truven, said the numbers were slightly better in rural areas.\u003c/p>\n\u003cp>“We did see that for those in rural areas, a greater supply [of dental providers] was associated with lower ED use,” Fingar said. But, she said, 90 percent of Medicaid dental visits are in urban areas.\u003c/p>\n\u003cp>[contextly_sidebar id=”sT9KtJ06HSo5xPfgl6TvmZCmlYYDZAHP”]As a result, she said, more than 2 percent of all emergency department visits are related to non-traumatic dental conditions.\u003c/p>\n\u003cp>In April, the American Dental Association released \u003ca href=\"http://www.ada.org/~/media/ADA/Science%20and%20Research/HPI/Files/HPIBrief_0415_2.ashx\" target=\"_blank\" rel=\"noopener\">a similar study\u003c/a> that drew similar conclusions.\u003c/p>\n\u003cp>“One of the important things about the study we did is we looked at provider density,” Raven said. “People say there are plenty of dentists, but there’s a subtler argument we’re trying to make, that there is a low rate of dentists who take Medicaid.”\u003c/p>\n\u003cp>Provider rates in California are among the lowest Medicaid rates in the nation, she said, but care can still be worked out in underserved urban areas, such as the use of mid-level dental providers — or getting more dentists to see Medi-Cal patients.\u003c/p>\n\u003cp>“It’s too bad provider rates aren’t higher,” she said, “but everyone needs to pitch in. Coverage is a necessity, but you have to pair it with providers.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>David Gorn is a senior reporter with \u003ca href=\"http://www.californiahealthline.org\" target=\"_blank\" rel=\"noopener\">California Healthline. \u003c/a>\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>States that provide Medicaid adult dental care still have high rates of dental patients who show up at hospital emergency departments, particularly in urban underserved areas, according to a \u003ca href=\"https://med.stanford.edu/news/all-news/2015/08/medicaid-dental-coverage-may-not-prevent-tooth-related-er-visits.html\" target=\"_blank\" rel=\"noopener\">study released this week\u003c/a>. The study — by researchers at Stanford University, UC San Francisco, Truven Health Analytics and the federal Agency for Healthcare Research and Quality — was published in \u003cem>\u003ca href=\"http://content.healthaffairs.org/content/34/8/1349.abstract?=right\" target=\"_blank\" rel=\"noopener\">Health Affairs\u003c/a>\u003c/em>.\u003c/p>\n\u003caside class=\"pullquote alignright\">“People say there are plenty of dentists, but there’s a subtler argument we’re trying to make: that there is a low rate of dentists who take Medicaid.”\u003c/aside>\n\u003cp>Researchers said a dearth of dental providers who accept Medicaid patients, particularly in those urban underserved areas, has limited the effectiveness of Medicaid dental coverage in states that provide it.\u003c/p>\n\u003cp>“We found that, in urban counties there were large concentrations of all providers, but not really to serve the poor,” said Maria Raven, senior author of the study and associate professor of emergency medicine at UCSF.\u003c/p>\n\u003cp>“There may be a higher density of dentists [in urban areas], but they’re still not accepting Medi-Cal patients,” Raven said. “Coverage doesn’t equal access.”\u003c/p>\n\u003cp>That has resulted in high ED use even in states with Medicaid dental coverage, she said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Medi-Cal is California’s Medicaid program, and it did not have adult dental coverage in 2010, when the study’s data were collected.\u003c/p>\n\u003cp>Katie Fingar, lead author of the study and research leader in health care at Truven, said the numbers were slightly better in rural areas.\u003c/p>\n\u003cp>“We did see that for those in rural areas, a greater supply [of dental providers] was associated with lower ED use,” Fingar said. But, she said, 90 percent of Medicaid dental visits are in urban areas.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>As a result, she said, more than 2 percent of all emergency department visits are related to non-traumatic dental conditions.\u003c/p>\n\u003cp>In April, the American Dental Association released \u003ca href=\"http://www.ada.org/~/media/ADA/Science%20and%20Research/HPI/Files/HPIBrief_0415_2.ashx\" target=\"_blank\" rel=\"noopener\">a similar study\u003c/a> that drew similar conclusions.\u003c/p>\n\u003cp>“One of the important things about the study we did is we looked at provider density,” Raven said. “People say there are plenty of dentists, but there’s a subtler argument we’re trying to make, that there is a low rate of dentists who take Medicaid.”\u003c/p>\n\u003cp>Provider rates in California are among the lowest Medicaid rates in the nation, she said, but care can still be worked out in underserved urban areas, such as the use of mid-level dental providers — or getting more dentists to see Medi-Cal patients.\u003c/p>\n\u003cp>“It’s too bad provider rates aren’t higher,” she said, “but everyone needs to pitch in. Coverage is a necessity, but you have to pair it with providers.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>David Gorn is a senior reporter with \u003ca href=\"http://www.californiahealthline.org\" target=\"_blank\" rel=\"noopener\">California Healthline. \u003c/a>\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Jane Lazarre was pacing the hospital waiting room. Her son Khary, 18, had just come out of surgery, but the nurses weren’t letting her in to see him.\u003c/p>\n\u003cp>“They told us he would be out of anesthesia in a few minutes. He never came out,” she remembers. “The minutes became an hour, the hour became two hours.\"\u003c/p>\n\u003cp>She and her husband became more and more frightened. It was just a routine knee operation. Lazarre asked the nurses what was going on.\u003c/p>\n\u003cp>“They said Khary was having ‘trouble’ coming out of anesthesia,” Lazarre says.\u003c/p>\n\u003cp>[contextly_sidebar id=\"5CcxiB3p3cQnSCBTfP2Io8rKbmuM99t7\"]They called the surgeon in a panic. He went to check on their son and said that Khary had come out of anesthesia violently -- thrashing and flailing about. He told Lazarre that with most young people his age, there wouldn't have been a problem. The doctors and nurses would have gently held him down.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“But with our son, since he was so quote ‘large and powerful’ they were worried he might injure the medical staff. So they had to keep sending him back under the anesthesia,” Lazarre says.\u003c/p>\n\u003cp>Khary was 6 feet tall. But he was slim.\u003c/p>\n\u003cp>“He wasn't the giant they were describing him as,” Lazarre says.\u003c/p>\n\u003cp>\u003cstrong>Baby or 'Militant Black Panther'?\u003c/strong>\u003c/p>\n\u003cp>She pauses. Lazarre is white. Her husband is black. She says she started learning the role race would play in her sons’ lives the day her older son, Adam, was born.\u003c/p>\n\u003cp>“He was a tiny little 6 pound baby. The nurses were white,” she says. “And whenever he cried, they would refer to him as the militant Black Panther.”\u003c/p>\n\u003cp>Lazarre says there’s no doubt in her mind that what happened with Khary and his knee surgery was because of race.\u003c/p>\n\u003cp>[contextly_sidebar id=\"ogqQe7sYg9ub49AojFMaeMDBUcoZMN88\"]\u003c/p>\n\u003cp>“I understood, certainly not for the first time, that my son, and my sons both, were viewed as being dangerous, being potentially frightening to people who were white,” she says, adding that it was likely the surgeon didn’t see it that way. “Like most white people, I don't think he was conscious of it at all.”\u003c/p>\n\u003cp>Lazarre and her husband insisted on seeing Khary.\u003c/p>\n\u003cp>“And he was indeed obviously agitated, and flailing about, covering his head with his arms,” she says. “And we saw right away that he was scared, not angry or violent.”\u003c/p>\n\u003cp>He was scared. Lazarre and her husband leaned over and whispered in Khary’s ear: “’It’s going to be okay, you can calm down.’ And he began coming out of the anesthesia more normally.”\u003c/p>\n\u003cp>Lazarre wrote about this experience in \u003ca href=\"https://www.dukeupress.edu/Beyond-The-Whiteness-of-Whiteness.html\" target=\"_blank\">her book\u003c/a> “Beyond the Whiteness of Whiteness: Memoir of a White Mother of Black Sons.” It will be republished in a new 20th anniversary edition next year with a new preface from Lazarre. She says there's still so much that hasn't changed.\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/217606517\" 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>\u003cb>Disparities Persist\u003c/b>\u003c/p>\n\u003cp>Even as \u003ca href=\"http://www.ncbi.nlm.nih.gov/books/NBK114236/\" target=\"_blank\">health overall\u003c/a> has improved in the U.S., the \u003ca href=\"http://www.nap.edu/openbook.php?record_id=12875&page=R1\" target=\"_blank\">disparities in treatment and outcomes\u003c/a> between white patients, and black and Latino patients, are almost as big as they were 50 years ago. A growing body of research suggests that doctors’ unconscious behaviors play a role in these statistics, and the Institute of Medicine \u003ca href=\"https://iom.nationalacademies.org/~/media/Files/Report%20Files/2003/Unequal-Treatment-Confronting-Racial-and-Ethnic-Disparities-in-Health-Care/Disparitieshcproviders8pgFINAL.pdf\" target=\"_blank\">has called for more studies\u003c/a> looking at discrimination and prejudice.\u003c/p>\n\u003cp>\u003ca href=\"http://www.nejm.org/doi/full/10.1056/NEJM199902253400806#t=articleResults\" target=\"_blank\">One study\u003c/a> found that doctors were far less likely to refer black women for advanced cardiac care than white men with identical symptoms. \u003ca href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1448154/#r3\" target=\"_blank\">Other studies\u003c/a> show that African Americans and \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/8445817\" target=\"_blank\">Latino patients\u003c/a> are often prescribed less pain medication than white patients with the same complaints.\u003c/p>\n\u003cp>“We know that doctors spend more time with white patients than with patients of color,” says Howard Ross, founder of management consulting firm Cook Ross.\u003c/p>\n\u003cp>He’s developed a new diversity training curriculum for health care professionals that focuses on the role of unconscious bias in these scenarios.\u003c/p>\n\u003cp>Doctors and nurses don’t mean to treat people differently, Ross says. But, just like police, they harbor stereotypes that they’re not aware they have. Everybody does.\u003c/p>\n\u003cp>“This is normal human behavior,” Ross says. “We can no more stop having bias than we can stop breathing.\"\u003c/p>\n\u003cp>\u003ca href=\"http://spottheblindspot.com/\" target=\"_blank\">Unconscious biases\u003c/a> often surface when we’re multitasking or when we’re stressed. They come up in tense situations where we don’t have time to think. Like police on the street at night who have to decide quickly if a person is reaching for a wallet, or a gun. It’s similar for doctors in the hospital.\u003c/p>\n\u003cp>“You’re dealing with people who are frightened, they’re reactive,” Ross says. “If you’re doing triage in the Emergency Room, for example, you don’t have time to sit back and contemplate, ‘why am I thinking about this,’ You have to instantaneously react.”\u003c/p>\n\u003cp>Doctors are trained to think fast, and to be confident in their decisions.\u003c/p>\n\u003cp>“There’s almost a trained arrogance,” Ross says.\u003c/p>\n\u003cp>This leads to treatments prescribed based on snap judgments, which can reveal internalized stereotypes. A doctor sees one black patient who doesn’t take his medication, perhaps because he can’t afford it. Without realizing it, the doctor starts to assume that all black patients aren’t going to follow instructions.\u003c/p>\n\u003cp>“We’re taught to learn things in a way that involves pattern recognition,” says Rene Salazar, a doctor and professor at UC-San Francisco Medical School. He says he’s fallen prey to his own biases in the exam room.\u003c/p>\n\u003cp>“These preconceived ideas that because someone is from a certain class or a certain background that they’re going to want pain medication for a particular reason that’s not related to your pain,” he says, is one example.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>Salazar did a training with Howard Ross’ firm to get a handle on his unconscious biases. Now he teaches a similar course to all new students at the medical school at UCSF, so they can catch their biases early. Learn how they do that tomorrow, \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/08/04/ucsf-doctors-students-confront-their-own-unconscious-bias/\" target=\"_blank\">in Part 2 of this story\u003c/a>.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Jane Lazarre was pacing the hospital waiting room. Her son Khary, 18, had just come out of surgery, but the nurses weren’t letting her in to see him.\u003c/p>\n\u003cp>“They told us he would be out of anesthesia in a few minutes. He never came out,” she remembers. “The minutes became an hour, the hour became two hours.\"\u003c/p>\n\u003cp>She and her husband became more and more frightened. It was just a routine knee operation. Lazarre asked the nurses what was going on.\u003c/p>\n\u003cp>“They said Khary was having ‘trouble’ coming out of anesthesia,” Lazarre says.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>They called the surgeon in a panic. He went to check on their son and said that Khary had come out of anesthesia violently -- thrashing and flailing about. He told Lazarre that with most young people his age, there wouldn't have been a problem. The doctors and nurses would have gently held him down.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“But with our son, since he was so quote ‘large and powerful’ they were worried he might injure the medical staff. So they had to keep sending him back under the anesthesia,” Lazarre says.\u003c/p>\n\u003cp>Khary was 6 feet tall. But he was slim.\u003c/p>\n\u003cp>“He wasn't the giant they were describing him as,” Lazarre says.\u003c/p>\n\u003cp>\u003cstrong>Baby or 'Militant Black Panther'?\u003c/strong>\u003c/p>\n\u003cp>She pauses. Lazarre is white. Her husband is black. She says she started learning the role race would play in her sons’ lives the day her older son, Adam, was born.\u003c/p>\n\u003cp>“He was a tiny little 6 pound baby. The nurses were white,” she says. “And whenever he cried, they would refer to him as the militant Black Panther.”\u003c/p>\n\u003cp>Lazarre says there’s no doubt in her mind that what happened with Khary and his knee surgery was because of race.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>“I understood, certainly not for the first time, that my son, and my sons both, were viewed as being dangerous, being potentially frightening to people who were white,” she says, adding that it was likely the surgeon didn’t see it that way. “Like most white people, I don't think he was conscious of it at all.”\u003c/p>\n\u003cp>Lazarre and her husband insisted on seeing Khary.\u003c/p>\n\u003cp>“And he was indeed obviously agitated, and flailing about, covering his head with his arms,” she says. “And we saw right away that he was scared, not angry or violent.”\u003c/p>\n\u003cp>He was scared. Lazarre and her husband leaned over and whispered in Khary’s ear: “’It’s going to be okay, you can calm down.’ And he began coming out of the anesthesia more normally.”\u003c/p>\n\u003cp>Lazarre wrote about this experience in \u003ca href=\"https://www.dukeupress.edu/Beyond-The-Whiteness-of-Whiteness.html\" target=\"_blank\">her book\u003c/a> “Beyond the Whiteness of Whiteness: Memoir of a White Mother of Black Sons.” It will be republished in a new 20th anniversary edition next year with a new preface from Lazarre. She says there's still so much that hasn't changed.\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/217606517&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/217606517'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\u003cb>Disparities Persist\u003c/b>\u003c/p>\n\u003cp>Even as \u003ca href=\"http://www.ncbi.nlm.nih.gov/books/NBK114236/\" target=\"_blank\">health overall\u003c/a> has improved in the U.S., the \u003ca href=\"http://www.nap.edu/openbook.php?record_id=12875&page=R1\" target=\"_blank\">disparities in treatment and outcomes\u003c/a> between white patients, and black and Latino patients, are almost as big as they were 50 years ago. A growing body of research suggests that doctors’ unconscious behaviors play a role in these statistics, and the Institute of Medicine \u003ca href=\"https://iom.nationalacademies.org/~/media/Files/Report%20Files/2003/Unequal-Treatment-Confronting-Racial-and-Ethnic-Disparities-in-Health-Care/Disparitieshcproviders8pgFINAL.pdf\" target=\"_blank\">has called for more studies\u003c/a> looking at discrimination and prejudice.\u003c/p>\n\u003cp>\u003ca href=\"http://www.nejm.org/doi/full/10.1056/NEJM199902253400806#t=articleResults\" target=\"_blank\">One study\u003c/a> found that doctors were far less likely to refer black women for advanced cardiac care than white men with identical symptoms. \u003ca href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1448154/#r3\" target=\"_blank\">Other studies\u003c/a> show that African Americans and \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/8445817\" target=\"_blank\">Latino patients\u003c/a> are often prescribed less pain medication than white patients with the same complaints.\u003c/p>\n\u003cp>“We know that doctors spend more time with white patients than with patients of color,” says Howard Ross, founder of management consulting firm Cook Ross.\u003c/p>\n\u003cp>He’s developed a new diversity training curriculum for health care professionals that focuses on the role of unconscious bias in these scenarios.\u003c/p>\n\u003cp>Doctors and nurses don’t mean to treat people differently, Ross says. But, just like police, they harbor stereotypes that they’re not aware they have. Everybody does.\u003c/p>\n\u003cp>“This is normal human behavior,” Ross says. “We can no more stop having bias than we can stop breathing.\"\u003c/p>\n\u003cp>\u003ca href=\"http://spottheblindspot.com/\" target=\"_blank\">Unconscious biases\u003c/a> often surface when we’re multitasking or when we’re stressed. They come up in tense situations where we don’t have time to think. Like police on the street at night who have to decide quickly if a person is reaching for a wallet, or a gun. It’s similar for doctors in the hospital.\u003c/p>\n\u003cp>“You’re dealing with people who are frightened, they’re reactive,” Ross says. “If you’re doing triage in the Emergency Room, for example, you don’t have time to sit back and contemplate, ‘why am I thinking about this,’ You have to instantaneously react.”\u003c/p>\n\u003cp>Doctors are trained to think fast, and to be confident in their decisions.\u003c/p>\n\u003cp>“There’s almost a trained arrogance,” Ross says.\u003c/p>\n\u003cp>This leads to treatments prescribed based on snap judgments, which can reveal internalized stereotypes. A doctor sees one black patient who doesn’t take his medication, perhaps because he can’t afford it. Without realizing it, the doctor starts to assume that all black patients aren’t going to follow instructions.\u003c/p>\n\u003cp>“We’re taught to learn things in a way that involves pattern recognition,” says Rene Salazar, a doctor and professor at UC-San Francisco Medical School. He says he’s fallen prey to his own biases in the exam room.\u003c/p>\n\u003cp>“These preconceived ideas that because someone is from a certain class or a certain background that they’re going to want pain medication for a particular reason that’s not related to your pain,” he says, is one example.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Salazar did a training with Howard Ross’ firm to get a handle on his unconscious biases. Now he teaches a similar course to all new students at the medical school at UCSF, so they can catch their biases early. Learn how they do that tomorrow, \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/08/04/ucsf-doctors-students-confront-their-own-unconscious-bias/\" target=\"_blank\">in Part 2 of this story\u003c/a>.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Millions of Americans Use Medical Devices That May Be Vulnerable to Hacking",
"title": "Millions of Americans Use Medical Devices That May Be Vulnerable to Hacking",
"headTitle": "KQED Future of You | KQED Science",
"content": "\u003cp>\u003cstrong>Listen to the story:\u003c/strong>\u003cbr>\nhttp://www.kqed.org/.stream/anon/radio/science/2015/08/20150803ScienceMedicaldeviceshacking.mp3\u003cbr>\nYou have passwords for your smart phone and laptop, but what about your pacemaker or insulin pump?\u003c/p>\n\u003cp>Last Friday, the federal \u003ca href=\"http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/ucm456815.htm\">Food and Drug Administration recommended\u003c/a> that all hospitals in California and across the country stop using a medical device that it says is vulnerable to cyber attacks.\u003c/p>\n\u003caside class=\"pullquote alignright\">'Someone will find a reason to change a counter on an insulin pump or take over a defibrillator just because they can.'\u003ccite>Jamie Court,\u003cbr>\nConsumer Watchdog president\u003c/cite>\u003c/aside>\n\u003cp>The device is an infusion pump that delivers medications or nutrients to patients. A hacker who accessed it could change the drug dosage to give a patient not enough -- or a lethal amount.\u003c/p>\n\u003cp>California security expert Billy Rios says he identified the problem \u003ca href=\"http://xs-sniper.com/blog/\" target=\"_blank\">more than a year ago\u003c/a> and notified the FDA and the Department of Homeland Security.\u003c/p>\n\u003cp>\"Some of these pumps are really dangerous,\" says Rios, who founded digital security company Laconicly. \"If we ever gain access to a hospital network and we know of a vulnerability affecting a particular device, what that really means is we can go from one location and touch one hundred different devices all at once.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>These pumps are not the only medical devices vulnerable to hacking. More than 10 million Americans rely on devices like pacemakers and defibrillators.\u003c/p>\n\u003cp>https://youtu.be/MmQZIRJPfLM\u003c/p>\n\u003cp>\u003cspan style=\"font-size: medium\">(Cyber security expert Billy Rios remotely hacks into Hospira’s Symbiq infusion pump, which the FDA has encouraged all medical centers to stop using .)\u003c/span>\u003c/p>\n\u003cp>If you are a fan of the Showtime television series \u003ca href=\"https://vimeo.com/63176830\">Homeland\u003c/a>, you may remember an episode where assassins killed the vice president by hacking into his pacemaker and disabling it.\u003c/p>\n\u003cp>This episode wasn’t just Hollywood making up stuff. Former Vice President Dick Cheney was so \u003ca href=\"http://abcnews.go.com/US/vice-president-dick-cheney-feared-pacemaker-hacking/story?id=20621434\">afraid of a cyber attack on his own pacemaker\u003c/a> that he had the wireless feature on it disabled.\u003c/p>\n\u003cp>As technology has become more connected, so have medical devices. While some, like pacemakers, can only send information, others, can send and receive data.\u003c/p>\n\u003cp>And that leaves some patients vulnerable to a hacker trying to harm them or use their device as a portal to access medical data.\u003c/p>\n\u003cp>\"All the tools that are required to do software debugging, to get software off of chips and basically to do hardware hacking,\" Rios says, \"it’s become available to just any person.\"\u003c/p>\n\u003caside class=\"pullquote alignleft\">'My biggest fear is that somebody will take out a large number of devices across an institution.'\u003ccite>Kevin McDonald,\u003cbr>\nClinical Information Security Director\u003cbr>\nMayo Clinic\u003c/cite>\u003c/aside>\n\u003cp>As a benign or “white hat” hacker, Rios does research in his Half Moon Bay garage to help the Department of Homeland Security.\u003c/p>\n\u003cp>He proved he could remotely administer a lethal dose of drugs through a patient’s insulin pump. He has also hacked pre-programmed passwords from hundreds of devices. He and his colleague were able to figure out the passwords after acquiring embedded software and technical manuals from several vendors.\u003c/p>\n\u003cp>\"We knew what those 300 passwords were,\" Rios says. \"We could go to any device we wanted to and we had a set of usernames and passwords that would work against all these devices, and so that was pretty alarming.\"\u003c/p>\n\u003cp>The Food and Drug Administration, which regulates the sale of medical devices, has been issuing formal guidelines on the issue.\u003c/p>\n\u003cp>Suzanne Schwartz is the FDA’s Director of Emergency Preparedness. Last year, she helped publish \u003ca href=\"http://www.fda.gov/ucm/groups/fdagov-public/@fdagov-meddev-gen/documents/document/ucm356190.pdf\">new recommendations\u003c/a> for how medical device makers should take cyber-security attacks into account.\u003c/p>\n\u003cfigure id=\"attachment_19957\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003ca href=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2015/07/Implantable-medical-devices_graphic_WHITE.jpg\">\u003cimg class=\"size-medium wp-image-19957\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2015/07/Implantable-medical-devices_graphic_WHITE-800x567.jpg\" alt=\"Many there are many implantable medical devices on the market that have vulnerabilities, in fact, the Food and Drug Administration has received approximately 56,000 reports of adverse events associated with the use of infusion pumps, including numerous injuries and deaths. \" width=\"800\" height=\"567\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2015/07/Implantable-medical-devices_graphic_WHITE-800x567.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2015/07/Implantable-medical-devices_graphic_WHITE-400x283.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2015/07/Implantable-medical-devices_graphic_WHITE-1180x836.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2015/07/Implantable-medical-devices_graphic_WHITE-960x680.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2015/07/Implantable-medical-devices_graphic_WHITE.jpg 1493w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">There are many implantable medical devices on the market that have vulnerabilities, in fact, the Food and Drug Administration has received approximately 56,000 reports of adverse events associated with the use of infusion pumps, including numerous injuries and deaths. \u003ccite>(Massachusetts Institute of Technology)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\"That is something, yes, that we continuously monitor and it’s something important that we want to hear about,\" Schwartz says, \"whether it’s directly from the healthcare organizations or from the medical device manufacturers.\"\u003c/p>\n\u003cp>But Consumer Watchdog president Jamie Court says the FDA’s guidelines for medical devices fall short. He says what's needed is a law -- not recommendations -- requiring medical manufacturers and hospitals to upgrade systems to prevent cyber attacks.\u003c/p>\n\u003cp>\"The reality is if they don’t someone is going to die,\" Court says. \"Because it’s not safe. Someone will find a reason to change a counter on an insulin pump or take over a defibrillator just because they can.\"\u003c/p>\n\u003cp>Without legally binding rules, medical device security is left in the hands of hospitals and device makers. And they are required to report device malfunctions only if patients are injured or they die.\u003c/p>\n\u003cp>Medtronic, the nation's largest medical device manufacturer, has not reported any incidents so far.\u003c/p>\n\u003cp>The company declined to be interviewed and sent KQED a statement saying it aims to manufacture products that are as safe and secure as possible.\u003c/p>\n\u003cfigure id=\"attachment_19938\" class=\"wp-caption alignleft\" style=\"max-width: 800px\">\u003ca href=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2015/07/Kevin-McDonald_Mayo-Clinic_photo.jpg\">\u003cimg class=\"size-medium wp-image-19938\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2015/07/Kevin-McDonald_Mayo-Clinic_photo-800x600.jpg\" alt=\"Clinical Information Security Director Kevin McDonald (left) at Mayo Clinic in Minnesota leads a team checking medical devices for software vulnerabilities that could cause a device to be infected with malware or exploited by hackers.\" width=\"800\" height=\"600\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2015/07/Kevin-McDonald_Mayo-Clinic_photo-800x600.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2015/07/Kevin-McDonald_Mayo-Clinic_photo-400x300.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2015/07/Kevin-McDonald_Mayo-Clinic_photo-1180x885.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2015/07/Kevin-McDonald_Mayo-Clinic_photo-1920x1440.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2015/07/Kevin-McDonald_Mayo-Clinic_photo-960x720.jpg 960w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Clinical Information Security Director Kevin McDonald (left) at Mayo Clinic in Minnesota leads a team checking medical devices for software vulnerabilities that could cause a device to be infected with malware or exploited by hackers. \u003ccite>(Mayo Clinic)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>But Mayo Clinic cyber security expert Kevin McDonald says, while they haven't been catastrophic, some incidents have already occurred.\u003c/p>\n\u003cp>\"Back in 2010,\" he says, \"there was a heart catheterization lab out on the East Coast, that, because of some malware viruses, was put out of business for about three days. So they had to divert their patients to other places.\"\u003c/p>\n\u003cp>McDonald leads a team that’s trying to prevent harmful medical incidents.\u003c/p>\n\u003cp>\"My biggest fear,\" he says, \"is that somebody will take out a large number of devices across an institution.\"\u003c/p>\n\u003cp>To increase patient safety, the Mayo Clinic brought in researchers to analyze some of the devices it uses. It then reported vulnerabilities to the manufacturers.\u003c/p>\n\u003cp>But cyber security expert Rios says no matter what precautions one takes, medical devices are imperfect and will always need monitoring.\u003c/p>\n\u003cp>\"At the end of the day, at the core of it, it's really just a computer,\" he says. \"It's a processor and it's software that someone wrote. And so we can't treat those devices as if they're magical devices; they're not magical devices.\"\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>While last year the FDA issued guidelines for the manufacture of these devices, this year the agency is expected to \u003ca href=\"http://blogs.fda.gov/fdavoice/index.php/2015/02/moving-toward-a-national-medical-device-postmarket-surveillance-system/\">release additional guidelines\u003c/a> for how companies should update the devices’ software after they’re on the market.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cstrong>Listen to the story:\u003c/strong>\u003cbr>\nhttp://www.kqed.org/.stream/anon/radio/science/2015/08/20150803ScienceMedicaldeviceshacking.mp3\u003cbr>\nYou have passwords for your smart phone and laptop, but what about your pacemaker or insulin pump?\u003c/p>\n\u003cp>Last Friday, the federal \u003ca href=\"http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/ucm456815.htm\">Food and Drug Administration recommended\u003c/a> that all hospitals in California and across the country stop using a medical device that it says is vulnerable to cyber attacks.\u003c/p>\n\u003caside class=\"pullquote alignright\">'Someone will find a reason to change a counter on an insulin pump or take over a defibrillator just because they can.'\u003ccite>Jamie Court,\u003cbr>\nConsumer Watchdog president\u003c/cite>\u003c/aside>\n\u003cp>The device is an infusion pump that delivers medications or nutrients to patients. A hacker who accessed it could change the drug dosage to give a patient not enough -- or a lethal amount.\u003c/p>\n\u003cp>California security expert Billy Rios says he identified the problem \u003ca href=\"http://xs-sniper.com/blog/\" target=\"_blank\">more than a year ago\u003c/a> and notified the FDA and the Department of Homeland Security.\u003c/p>\n\u003cp>\"Some of these pumps are really dangerous,\" says Rios, who founded digital security company Laconicly. \"If we ever gain access to a hospital network and we know of a vulnerability affecting a particular device, what that really means is we can go from one location and touch one hundred different devices all at once.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>These pumps are not the only medical devices vulnerable to hacking. More than 10 million Americans rely on devices like pacemakers and defibrillators.\u003c/p>\u003c/p>\u003cp>\u003cspan class='utils-parseShortcode-shortcodes-__youtubeShortcode__embedYoutube'>\n \u003cspan class='utils-parseShortcode-shortcodes-__youtubeShortcode__embedYoutubeInside'>\n \u003ciframe\n loading='lazy'\n class='utils-parseShortcode-shortcodes-__youtubeShortcode__youtubePlayer'\n type='text/html'\n src='//www.youtube.com/embed/MmQZIRJPfLM'\n title='//www.youtube.com/embed/MmQZIRJPfLM'\n allowfullscreen='true'\n style='border:0;'>\u003c/iframe>\n \u003c/span>\n \u003c/span>\u003c/p>\u003cp>\u003cp>\u003cspan style=\"font-size: medium\">(Cyber security expert Billy Rios remotely hacks into Hospira’s Symbiq infusion pump, which the FDA has encouraged all medical centers to stop using .)\u003c/span>\u003c/p>\n\u003cp>If you are a fan of the Showtime television series \u003ca href=\"https://vimeo.com/63176830\">Homeland\u003c/a>, you may remember an episode where assassins killed the vice president by hacking into his pacemaker and disabling it.\u003c/p>\n\u003cp>This episode wasn’t just Hollywood making up stuff. Former Vice President Dick Cheney was so \u003ca href=\"http://abcnews.go.com/US/vice-president-dick-cheney-feared-pacemaker-hacking/story?id=20621434\">afraid of a cyber attack on his own pacemaker\u003c/a> that he had the wireless feature on it disabled.\u003c/p>\n\u003cp>As technology has become more connected, so have medical devices. While some, like pacemakers, can only send information, others, can send and receive data.\u003c/p>\n\u003cp>And that leaves some patients vulnerable to a hacker trying to harm them or use their device as a portal to access medical data.\u003c/p>\n\u003cp>\"All the tools that are required to do software debugging, to get software off of chips and basically to do hardware hacking,\" Rios says, \"it’s become available to just any person.\"\u003c/p>\n\u003caside class=\"pullquote alignleft\">'My biggest fear is that somebody will take out a large number of devices across an institution.'\u003ccite>Kevin McDonald,\u003cbr>\nClinical Information Security Director\u003cbr>\nMayo Clinic\u003c/cite>\u003c/aside>\n\u003cp>As a benign or “white hat” hacker, Rios does research in his Half Moon Bay garage to help the Department of Homeland Security.\u003c/p>\n\u003cp>He proved he could remotely administer a lethal dose of drugs through a patient’s insulin pump. He has also hacked pre-programmed passwords from hundreds of devices. He and his colleague were able to figure out the passwords after acquiring embedded software and technical manuals from several vendors.\u003c/p>\n\u003cp>\"We knew what those 300 passwords were,\" Rios says. \"We could go to any device we wanted to and we had a set of usernames and passwords that would work against all these devices, and so that was pretty alarming.\"\u003c/p>\n\u003cp>The Food and Drug Administration, which regulates the sale of medical devices, has been issuing formal guidelines on the issue.\u003c/p>\n\u003cp>Suzanne Schwartz is the FDA’s Director of Emergency Preparedness. Last year, she helped publish \u003ca href=\"http://www.fda.gov/ucm/groups/fdagov-public/@fdagov-meddev-gen/documents/document/ucm356190.pdf\">new recommendations\u003c/a> for how medical device makers should take cyber-security attacks into account.\u003c/p>\n\u003cfigure id=\"attachment_19957\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003ca href=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2015/07/Implantable-medical-devices_graphic_WHITE.jpg\">\u003cimg class=\"size-medium wp-image-19957\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2015/07/Implantable-medical-devices_graphic_WHITE-800x567.jpg\" alt=\"Many there are many implantable medical devices on the market that have vulnerabilities, in fact, the Food and Drug Administration has received approximately 56,000 reports of adverse events associated with the use of infusion pumps, including numerous injuries and deaths. \" width=\"800\" height=\"567\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2015/07/Implantable-medical-devices_graphic_WHITE-800x567.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2015/07/Implantable-medical-devices_graphic_WHITE-400x283.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2015/07/Implantable-medical-devices_graphic_WHITE-1180x836.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2015/07/Implantable-medical-devices_graphic_WHITE-960x680.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2015/07/Implantable-medical-devices_graphic_WHITE.jpg 1493w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">There are many implantable medical devices on the market that have vulnerabilities, in fact, the Food and Drug Administration has received approximately 56,000 reports of adverse events associated with the use of infusion pumps, including numerous injuries and deaths. \u003ccite>(Massachusetts Institute of Technology)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\"That is something, yes, that we continuously monitor and it’s something important that we want to hear about,\" Schwartz says, \"whether it’s directly from the healthcare organizations or from the medical device manufacturers.\"\u003c/p>\n\u003cp>But Consumer Watchdog president Jamie Court says the FDA’s guidelines for medical devices fall short. He says what's needed is a law -- not recommendations -- requiring medical manufacturers and hospitals to upgrade systems to prevent cyber attacks.\u003c/p>\n\u003cp>\"The reality is if they don’t someone is going to die,\" Court says. \"Because it’s not safe. Someone will find a reason to change a counter on an insulin pump or take over a defibrillator just because they can.\"\u003c/p>\n\u003cp>Without legally binding rules, medical device security is left in the hands of hospitals and device makers. And they are required to report device malfunctions only if patients are injured or they die.\u003c/p>\n\u003cp>Medtronic, the nation's largest medical device manufacturer, has not reported any incidents so far.\u003c/p>\n\u003cp>The company declined to be interviewed and sent KQED a statement saying it aims to manufacture products that are as safe and secure as possible.\u003c/p>\n\u003cfigure id=\"attachment_19938\" class=\"wp-caption alignleft\" style=\"max-width: 800px\">\u003ca href=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2015/07/Kevin-McDonald_Mayo-Clinic_photo.jpg\">\u003cimg class=\"size-medium wp-image-19938\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2015/07/Kevin-McDonald_Mayo-Clinic_photo-800x600.jpg\" alt=\"Clinical Information Security Director Kevin McDonald (left) at Mayo Clinic in Minnesota leads a team checking medical devices for software vulnerabilities that could cause a device to be infected with malware or exploited by hackers.\" width=\"800\" height=\"600\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2015/07/Kevin-McDonald_Mayo-Clinic_photo-800x600.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2015/07/Kevin-McDonald_Mayo-Clinic_photo-400x300.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2015/07/Kevin-McDonald_Mayo-Clinic_photo-1180x885.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2015/07/Kevin-McDonald_Mayo-Clinic_photo-1920x1440.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2015/07/Kevin-McDonald_Mayo-Clinic_photo-960x720.jpg 960w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Clinical Information Security Director Kevin McDonald (left) at Mayo Clinic in Minnesota leads a team checking medical devices for software vulnerabilities that could cause a device to be infected with malware or exploited by hackers. \u003ccite>(Mayo Clinic)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>But Mayo Clinic cyber security expert Kevin McDonald says, while they haven't been catastrophic, some incidents have already occurred.\u003c/p>\n\u003cp>\"Back in 2010,\" he says, \"there was a heart catheterization lab out on the East Coast, that, because of some malware viruses, was put out of business for about three days. So they had to divert their patients to other places.\"\u003c/p>\n\u003cp>McDonald leads a team that’s trying to prevent harmful medical incidents.\u003c/p>\n\u003cp>\"My biggest fear,\" he says, \"is that somebody will take out a large number of devices across an institution.\"\u003c/p>\n\u003cp>To increase patient safety, the Mayo Clinic brought in researchers to analyze some of the devices it uses. It then reported vulnerabilities to the manufacturers.\u003c/p>\n\u003cp>But cyber security expert Rios says no matter what precautions one takes, medical devices are imperfect and will always need monitoring.\u003c/p>\n\u003cp>\"At the end of the day, at the core of it, it's really just a computer,\" he says. \"It's a processor and it's software that someone wrote. And so we can't treat those devices as if they're magical devices; they're not magical devices.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>While last year the FDA issued guidelines for the manufacture of these devices, this year the agency is expected to \u003ca href=\"http://blogs.fda.gov/fdavoice/index.php/2015/02/moving-toward-a-national-medical-device-postmarket-surveillance-system/\">release additional guidelines\u003c/a> for how companies should update the devices’ software after they’re on the market.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>An urgent care clinic in San Pablo is getting $2 million in state funds to expand service to the community affected by the recent closure of deficit-plagued \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/04/20/san-pablos-doctors-medical-center-to-close-tuesday/\" target=\"_blank\" rel=\"noopener\">Doctors Medical Center\u003c/a>.\u003c/p>\n\u003cp>That grant — secured with the aid of state Sen. Tony Thurmond, a Richmond Democrat — will go to \u003ca href=\"http://www.lifelongmedical.org\" target=\"_blank\" rel=\"noopener\">LifeLong Medical Care, \u003c/a>which in addition to its San Pablo facility runs clinics throughout the East Bay.\u003c/p>\n\u003cp>Marty Lynch, LifeLong’s executive director, says the new funding will go toward expanding the clinic’s hours. The facility is open from noon to 8 p.m. seven days a week; closing time will likely be extended to midnight.\u003c/p>\n\u003cp>The clinic treats about 50 people a day for non-emergency health problems like asthma and minor infections. Lynch says one of the clinic’s major challenges is educating those who depended on the Doctors Medical Center emergency room for such care that LifeLong can take care of them.\u003c/p>\n\u003cp>“If you have some problem that we can deal with — you know, you’re not having a heart attack — much better to come to us than to wait four, five, eight hours in the emergency room,” says Lynch.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Lynch says the clinic hopes to reach at least 80 patients a day — the number of patients estimated to have relied on Doctors’ emergency room for non-emergency care.\u003c/p>\n\u003cp>The new clinic employs some staff from the former hospital, to the delight of Jeffrey Adams, who came to the clinic with his daughter. She’s being examined by her longtime doctor for abdominal pain.\u003c/p>\n\u003cp>“We would have definitely been over to Doctors for [this] because that’s where she was born,” says Adams. “So I like sticking with the same doctor.”\u003c/p>\n\u003cp>Lynch says the new clinic isn’t designed to entirely fill the void left by Doctors, which closed in late April.\u003c/p>\n\u003cp>For instance, patients with true medical emergencies must go to other hospitals in the surrounding area. And he notes a dearth of nearby specialists, such as cardiologists and urologists. He says many either left town when Doctors shut down or retired.\u003c/p>\n\u003cp>Lynch says one of the long-term obstacles to providing care to low-income communities in West Contra Costa County and elsewhere is the meager reimbursement that doctors get from state and federal health insurance programs for the poor and elderly. Those low reimbursement rates mean fewer and fewer doctors will accept patients on Medi-Cal and Medicare.\u003c/p>\n\u003cp>Lynch says he believes the solution to the problem will include a restructuring of both doctor pay — more for primary doctors and less for specialists — and better training.\u003c/p>\n\u003cp>“I think it’s unlikely that Medi-Cal or Medicare will ever pay as much as commercial insurance,” says Lynch. “My own feeling is that we have to train more primary care docs, and we also have to train more specialists who are interested in mission.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Lynch says the key will be finding a way to encourage doctors to pursue careers serving low-income communities.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>An urgent care clinic in San Pablo is getting $2 million in state funds to expand service to the community affected by the recent closure of deficit-plagued \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/04/20/san-pablos-doctors-medical-center-to-close-tuesday/\" target=\"_blank\" rel=\"noopener\">Doctors Medical Center\u003c/a>.\u003c/p>\n\u003cp>That grant — secured with the aid of state Sen. Tony Thurmond, a Richmond Democrat — will go to \u003ca href=\"http://www.lifelongmedical.org\" target=\"_blank\" rel=\"noopener\">LifeLong Medical Care, \u003c/a>which in addition to its San Pablo facility runs clinics throughout the East Bay.\u003c/p>\n\u003cp>Marty Lynch, LifeLong’s executive director, says the new funding will go toward expanding the clinic’s hours. The facility is open from noon to 8 p.m. seven days a week; closing time will likely be extended to midnight.\u003c/p>\n\u003cp>The clinic treats about 50 people a day for non-emergency health problems like asthma and minor infections. Lynch says one of the clinic’s major challenges is educating those who depended on the Doctors Medical Center emergency room for such care that LifeLong can take care of them.\u003c/p>\n\u003cp>“If you have some problem that we can deal with — you know, you’re not having a heart attack — much better to come to us than to wait four, five, eight hours in the emergency room,” says Lynch.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Lynch says the clinic hopes to reach at least 80 patients a day — the number of patients estimated to have relied on Doctors’ emergency room for non-emergency care.\u003c/p>\n\u003cp>The new clinic employs some staff from the former hospital, to the delight of Jeffrey Adams, who came to the clinic with his daughter. She’s being examined by her longtime doctor for abdominal pain.\u003c/p>\n\u003cp>“We would have definitely been over to Doctors for [this] because that’s where she was born,” says Adams. “So I like sticking with the same doctor.”\u003c/p>\n\u003cp>Lynch says the new clinic isn’t designed to entirely fill the void left by Doctors, which closed in late April.\u003c/p>\n\u003cp>For instance, patients with true medical emergencies must go to other hospitals in the surrounding area. And he notes a dearth of nearby specialists, such as cardiologists and urologists. He says many either left town when Doctors shut down or retired.\u003c/p>\n\u003cp>Lynch says one of the long-term obstacles to providing care to low-income communities in West Contra Costa County and elsewhere is the meager reimbursement that doctors get from state and federal health insurance programs for the poor and elderly. Those low reimbursement rates mean fewer and fewer doctors will accept patients on Medi-Cal and Medicare.\u003c/p>\n\u003cp>Lynch says he believes the solution to the problem will include a restructuring of both doctor pay — more for primary doctors and less for specialists — and better training.\u003c/p>\n\u003cp>“I think it’s unlikely that Medi-Cal or Medicare will ever pay as much as commercial insurance,” says Lynch. “My own feeling is that we have to train more primary care docs, and we also have to train more specialists who are interested in mission.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Lynch says the key will be finding a way to encourage doctors to pursue careers serving low-income communities.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"info": "Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. Together in Possible, Hoffman and Finger lead enlightening discussions about building a brighter collective future. The show features interviews with visionary guests like Trevor Noah, Sam Altman and Janette Sadik-Khan. Possible paints an optimistic portrait of the world we can create through science, policy, business, art and our shared humanity. It asks: What if everything goes right for once? How can we get there? Each episode also includes a short fiction story generated by advanced AI GPT-4, serving as a thought-provoking springboard to speculate how humanity could leverage technology for good.",
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"soldout": {
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