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"content": "\u003cp>The Food and Drug Administration says children under 12 should not be given prescription medicines that contain codeine or another narcotic, tramadol, and that such drugs can also be dangerous to youth between 12 and 18.\u003c/p>\n\u003cp>On Thursday, the FDA said it will require that prescription drugs containing codeine or tramadol carry a warning on the label against using them in children under 12 or in women who are breast-feeding. The agency cited evidence that the drugs could cause dangerously slowed breathing in some children, which could lead to death.\u003c/p>\n\u003cp>Multiple prescription drugs contain codeine or tramadol. For example, the painkiller Tylenol 3 contains acetaminophen and codeine. Drugs containing codeine already carry a black-box warning against using it to treat pain in children who have their tonsils removed.\u003c/p>\n\u003cp>\"This is something we've been watching for several years,\" says Douglas Throckmorton, the deputy director for regulatory programs at the FDA's Center for Drug Evaluation and Research. \"They are powerful, effective medicines when used right [but] they can cause a lot of harm when they're not.\"\u003c/p>\n\u003cp>The agency also warned against using the drugs in young people between 12 and 18 who are obese or have breathing problems such as sleep apnea or lung disease.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The new warnings did not further restrict over-the-counter medicines that contain codeine, such as popular types of cough syrup and medication marketed for cold and flu symptoms. The FDA recommends that parents talk to a doctor before giving their children such drugs and notes that colds and coughs in kids \"are generally mild and go away in a few days, so they may not need to take any medicine.\"\u003c/p>\n\u003cp>Thursday's announcement was a partial acceptance of 2015 recommendations by an independent advisory committee that recommended the agency restrict prescription of codeine-containing drugs for children and also voted overwhelmingly against over-the-counter sale of codeine-containing cough syrup for children.\u003c/p>\n\u003cp>At the time, pharmacist Maria Pruchnicki, an associate professor at the Ohio State University College of Pharmacy, told NPR's Rob Stein, \"My concern, were I to be prescribing codeine in children, would be that I would, frankly, kill them.\"\u003c/p>\n\u003cp>As Stein reported, the FDA is not required to follow the committee's 2015 advice, although the agency generally acts in line with advisory committee recommendations.\u003c/p>\n\u003cp>In this case, the agency did act on prescription drugs but did not act on the over-the-counter recommendation.\u003c/p>\n\u003cp>It was unclear why more than a year passed between the committee recommendations and their partial adoption by the agency. In a press briefing, Throckmorton said the agency had received \"additional information.\"\u003c/p>\n\u003cp>Diana Zuckerman, president of the consumer group National Center for Health Research, called the move a \"long-overdue step to protect our children\":\u003c/p>\n\u003cp>\"The science is clear, so why did it take almost 18 months since the FDA's public meeting on the exact same issue? FDA needs to do more to warn patients about the known risks of medical products as soon as data are available. A change in the label is important, but unfortunately many doctors and patients don't read these labels. We need a public education campaign to warn parents and nursing women about these risks.\"\u003c/p>\n\u003cp>In 2015, the FDA acknowledged that although tramadol is not approved for use in children, it is used off-label to treat pain in kids. In that warning, the agency noted that some people are what's known as ultra-rapid metabolizers of tramadol and codeine. Those people have a variant of a liver enzyme that breaks down the drugs more quickly, leading to a rapid and potentially dangerous spike in the level of active opioids in the bloodstream.\u003c/p>\n\u003cp>The drugs can make their way into breast milk in nursing mothers and potentially harm infants, the FDA warns. The proportion of people with the enzyme variant, which is genetic, is thought to be between 1 and 10 percent.\u003c/p>\n\u003cp>\"Because we can't easily determine which children or nursing mothers specifically are at greater risk of ultra-rapid metabolism of codeine or tramadol, we are requiring manufacturers ... to make important labeling changes to protect those children who are at the greatest risk,\" explains Throckmorton.\u003c/p>\n\u003cp>As for future action on over-the-counter medicines that contain codeine, the American Academy of Pediatrics has made its position clear.\u003c/p>\n\u003cp>In a report published last year in the journal Pediatrics, members of the academy's committee on drugs wrote that although over-the-counter cough and cold medicines containing codeine were available in 28 states and Washington, D.C., \"neither the value of suppressing cough nor the effectiveness of codeine in children with acute illnesses has been shown.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Regulators in Europe, Canada and Australia have all restricted the use of medicines containing codeine for children. According to the FDA's public label database, more than 100 medications containing codeine are approved for sale without a prescription in the U.S.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The new warnings did not further restrict over-the-counter medicines that contain codeine, such as popular types of cough syrup and medication marketed for cold and flu symptoms. The FDA recommends that parents talk to a doctor before giving their children such drugs and notes that colds and coughs in kids \"are generally mild and go away in a few days, so they may not need to take any medicine.\"\u003c/p>\n\u003cp>Thursday's announcement was a partial acceptance of 2015 recommendations by an independent advisory committee that recommended the agency restrict prescription of codeine-containing drugs for children and also voted overwhelmingly against over-the-counter sale of codeine-containing cough syrup for children.\u003c/p>\n\u003cp>At the time, pharmacist Maria Pruchnicki, an associate professor at the Ohio State University College of Pharmacy, told NPR's Rob Stein, \"My concern, were I to be prescribing codeine in children, would be that I would, frankly, kill them.\"\u003c/p>\n\u003cp>As Stein reported, the FDA is not required to follow the committee's 2015 advice, although the agency generally acts in line with advisory committee recommendations.\u003c/p>\n\u003cp>In this case, the agency did act on prescription drugs but did not act on the over-the-counter recommendation.\u003c/p>\n\u003cp>It was unclear why more than a year passed between the committee recommendations and their partial adoption by the agency. In a press briefing, Throckmorton said the agency had received \"additional information.\"\u003c/p>\n\u003cp>Diana Zuckerman, president of the consumer group National Center for Health Research, called the move a \"long-overdue step to protect our children\":\u003c/p>\n\u003cp>\"The science is clear, so why did it take almost 18 months since the FDA's public meeting on the exact same issue? FDA needs to do more to warn patients about the known risks of medical products as soon as data are available. A change in the label is important, but unfortunately many doctors and patients don't read these labels. We need a public education campaign to warn parents and nursing women about these risks.\"\u003c/p>\n\u003cp>In 2015, the FDA acknowledged that although tramadol is not approved for use in children, it is used off-label to treat pain in kids. In that warning, the agency noted that some people are what's known as ultra-rapid metabolizers of tramadol and codeine. Those people have a variant of a liver enzyme that breaks down the drugs more quickly, leading to a rapid and potentially dangerous spike in the level of active opioids in the bloodstream.\u003c/p>\n\u003cp>The drugs can make their way into breast milk in nursing mothers and potentially harm infants, the FDA warns. The proportion of people with the enzyme variant, which is genetic, is thought to be between 1 and 10 percent.\u003c/p>\n\u003cp>\"Because we can't easily determine which children or nursing mothers specifically are at greater risk of ultra-rapid metabolism of codeine or tramadol, we are requiring manufacturers ... to make important labeling changes to protect those children who are at the greatest risk,\" explains Throckmorton.\u003c/p>\n\u003cp>As for future action on over-the-counter medicines that contain codeine, the American Academy of Pediatrics has made its position clear.\u003c/p>\n\u003cp>In a report published last year in the journal Pediatrics, members of the academy's committee on drugs wrote that although over-the-counter cough and cold medicines containing codeine were available in 28 states and Washington, D.C., \"neither the value of suppressing cough nor the effectiveness of codeine in children with acute illnesses has been shown.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Regulators in Europe, Canada and Australia have all restricted the use of medicines containing codeine for children. According to the FDA's public label database, more than 100 medications containing codeine are approved for sale without a prescription in the U.S.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Secret Hospital Inspection Reports Could Be Made Public",
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"content": "\u003cp>The public could soon get a look at confidential reports about errors, mishaps and mix-ups in the nation's hospitals that put patients' health and safety at risk, under a groundbreaking proposal from federal health officials.\u003c/p>\n\u003cp>The Centers for Medicare and Medicaid Services wants to require that private health care accreditors publicly detail problems they find during inspections of hospitals and other medical facilities, as well as the steps being taken to fix them. Nearly nine in 10 hospitals are directly overseen by those accreditors, not the government.\u003c/p>\n\u003cp>There's increasing concern among regulators that private accreditors aren't picking up on serious problems at health facilities. Every year, CMS takes a sample of hospitals and other health care facilities accredited by private organizations and does its own inspections to validate the work of the groups. In a 2016 report, CMS noted that its review found that accrediting organizations often missed serious deficiencies found soon after by state inspectors.\u003c/p>\n\u003cp>In 2014, for instance, state officials examined 103 acute-care hospitals that had been reviewed by an accreditor in the past 60 days. The state officials found 41 serious deficiencies. Of those, 39 were missed by the accrediting organizations. This disparity \"raises serious concerns regarding the [accrediting organizations'] ability to appropriately identify and cite health and safety deficiencies\" during inspections, CMS officials wrote when they released draft regulations including the proposed change on Friday.\u003c/p>\n\u003cp>The move follows steps CMS took several years ago to post government inspection reports online for nursing homes and some hospitals. ProPublica has created a tool, Nursing Home Inspect, to allow people to more easily search through the nursing home deficiency reports; the Association of Health Care Journalists has done the same for hospital violations.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Those government inspection reports do not identify patients or medical staff, but they do offer a description—often detailed—of what went wrong. This includes medication errors, operations on the wrong patient or the wrong body part, and patient abuse.\u003c/p>\n\u003cp>But private accrediting organizations, the largest of which is The Joint Commission, have not followed suit, creating a patchwork of disclosure in which some inspections are public and others are not. CMS' proposed rules are designed to fix this.\u003c/p>\n\u003cp>\"We believe it is important to continue to lead the effort to make information regarding a health care facility's compliance with health and safety requirements\" publicly available, CMS officials wrote.\u003c/p>\n\u003cp>\"It's huge, absolutely,\" says Rosemary Gibson, a patient safety expert who wrote a book, Wall of Silence, about medical errors. \"Right now the public has very little information about the places where they're putting their life on the line, and that's just not acceptable. If you're a good place, what are they afraid of?\"\u003c/p>\n\u003cp>Medical errors are a leading cause of death and injuries in U.S. hospitals. A 1999 report by the Institute of Medicine estimated that up to 98,000 people a year die because of mistakes in hospitals; subsequent reports have said the number is much higher.\u003c/p>\n\u003cp>To qualify for federal funding, health facilities have to meet minimum requirements, known as Medicare conditions of participation. If a health facility has problems and doesn't fix them, it stands to lose its Medicare funding. Though this rarely happens, it can be crippling for an institution and could force it to close.\u003c/p>\n\u003cp>State health departments get funding from CMS to inspect facilities to ensure they comply with these requirements. But the law also allows hospitals, ambulatory surgery centers, home health agencies and hospices to pay private, national accrediting organizations for such oversight. The Joint Commission conducts unannounced inspections at hospitals at least once every 39 months, and more often if complaints arise.\u003c/p>\n\u003cp>Though accreditors have to be approved by the secretary of Health and Human Services, they rarely take punitive action against the organizations they oversee. Of the 4,018 hospitals listed on the The Joint Commission's website, more than 99 percent have full accreditation and only seven are on track to lose their \"gold seal of approval.\"\u003c/p>\n\u003cp>The Joint Commission said it is reviewing the CMS proposal and couldn't comment further. A smaller competitor, the Healthcare Facilities Accreditation Program, said it supports the goal of transparency but is studying what the change would mean in practice, both in terms of staffing and costs. \"We haven't talked to our hospital partners,\" says Gary Ley, its executive director. \"It would be a major change for them also. It's hard not to support the goals but we have to look at the execution.\"\u003c/p>\n\u003cp>For its part, the American Hospital Association said it supports providing the public \"useful information\" about hospital quality, but has doubts that detailed inspection reports fit that description.\u003c/p>\n\u003cp>\"It's important that the information shared with consumers has a clear purpose, is transparent and is readily understood by folks from all walks of life, not just those with deep expertise in health care,\" says Nancy Foster, AHA's vice president of quality and patient safety, in a statement. \"We are concerned that sharing a detailed report may not be the most useful or effective strategy for informing the public.\"\u003c/p>\n\u003cp>Foster says it might be more useful to provide a one- or two-page \"accurate summary\" of inspection findings, with \"key takeaways\" and why they are important. \"This summary could also draw from the plan of correction the hospital creates and summarize how the hospital plans to address the findings,\" Foster says.\u003c/p>\n\u003cp>For years, accreditors have been accused of putting the interests of the facilities that pay them ahead of patient safety. In 2002, the Chicago Tribune reported how The Joint Commission gave its seal of approval to \"medical centers riddled by life-threatening problems and underreporting of patient deaths due to infections and hospital errors.\"\u003c/p>\n\u003cp>Last week, BuzzFeed News reported how an Oklahoma psychiatric hospital was named a \"Top Performer in Key Quality Measures\" by The Joint Commission even though police records, state inspection reports and lawsuit records showed that it \"is a profoundly troubled facility where frequent violence endangers patients and staff alike, where children as young as 5 are separated from their parents and held in dangerous situations, and where wards lack adequate staffing and staff lack adequate training.\"\u003c/p>\n\u003cp>In a response to BuzzFeed, the company that runs the hospital, Universal Health Services, said it \"is proud of the care it provides patients at Shadow Mountain Behavioral Health.\"\u003c/p>\n\u003cp>On its website, The Joint Commission allows users to check the accreditation status of hospitals but provides scant information of what went wrong, even when hospitals are described as receiving a \"preliminary denial of accreditation.\" For one hospital, the explanation is: \"Existence at time of survey of a condition, which in The Joint Commission's view, poses a threat to patients or other individuals served.\" The threat itself is not disclosed.\u003c/p>\n\u003cp>Consumers Union's Safe Patient Project and other patient safety organizations have been pushing for years for more information about hospital inspections. Lisa McGiffert, who directs the Safe Patient Project, hopes this may be the opportunity for change. \"The information that's available now is so minimal and would not really inform anyone about real quality of a hospital,\" she says.\u003c/p>\n\u003cp>Comments on the proposal may be submitted from April 28 to June 13 through the CMS website.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>Disclosure: Ornstein was previously president of the Association of Health Care Journalists. While he served in that position, AHCJ called for The Joint Commission to make its inspection reports public. The Joint Commission declined to do so. Have you complained about a hospital to The Joint Commission or another accrediting body? We'd like to hear from you. Email Charles.ornstein@propublica.org. ProPublica is an independent nonprofit newsroom based in New York.\u003cbr>\n\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The public could soon get a look at confidential reports about errors, mishaps and mix-ups in the nation's hospitals that put patients' health and safety at risk, under a groundbreaking proposal from federal health officials.\u003c/p>\n\u003cp>The Centers for Medicare and Medicaid Services wants to require that private health care accreditors publicly detail problems they find during inspections of hospitals and other medical facilities, as well as the steps being taken to fix them. Nearly nine in 10 hospitals are directly overseen by those accreditors, not the government.\u003c/p>\n\u003cp>There's increasing concern among regulators that private accreditors aren't picking up on serious problems at health facilities. Every year, CMS takes a sample of hospitals and other health care facilities accredited by private organizations and does its own inspections to validate the work of the groups. In a 2016 report, CMS noted that its review found that accrediting organizations often missed serious deficiencies found soon after by state inspectors.\u003c/p>\n\u003cp>In 2014, for instance, state officials examined 103 acute-care hospitals that had been reviewed by an accreditor in the past 60 days. The state officials found 41 serious deficiencies. Of those, 39 were missed by the accrediting organizations. This disparity \"raises serious concerns regarding the [accrediting organizations'] ability to appropriately identify and cite health and safety deficiencies\" during inspections, CMS officials wrote when they released draft regulations including the proposed change on Friday.\u003c/p>\n\u003cp>The move follows steps CMS took several years ago to post government inspection reports online for nursing homes and some hospitals. ProPublica has created a tool, Nursing Home Inspect, to allow people to more easily search through the nursing home deficiency reports; the Association of Health Care Journalists has done the same for hospital violations.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Those government inspection reports do not identify patients or medical staff, but they do offer a description—often detailed—of what went wrong. This includes medication errors, operations on the wrong patient or the wrong body part, and patient abuse.\u003c/p>\n\u003cp>But private accrediting organizations, the largest of which is The Joint Commission, have not followed suit, creating a patchwork of disclosure in which some inspections are public and others are not. CMS' proposed rules are designed to fix this.\u003c/p>\n\u003cp>\"We believe it is important to continue to lead the effort to make information regarding a health care facility's compliance with health and safety requirements\" publicly available, CMS officials wrote.\u003c/p>\n\u003cp>\"It's huge, absolutely,\" says Rosemary Gibson, a patient safety expert who wrote a book, Wall of Silence, about medical errors. \"Right now the public has very little information about the places where they're putting their life on the line, and that's just not acceptable. If you're a good place, what are they afraid of?\"\u003c/p>\n\u003cp>Medical errors are a leading cause of death and injuries in U.S. hospitals. A 1999 report by the Institute of Medicine estimated that up to 98,000 people a year die because of mistakes in hospitals; subsequent reports have said the number is much higher.\u003c/p>\n\u003cp>To qualify for federal funding, health facilities have to meet minimum requirements, known as Medicare conditions of participation. If a health facility has problems and doesn't fix them, it stands to lose its Medicare funding. Though this rarely happens, it can be crippling for an institution and could force it to close.\u003c/p>\n\u003cp>State health departments get funding from CMS to inspect facilities to ensure they comply with these requirements. But the law also allows hospitals, ambulatory surgery centers, home health agencies and hospices to pay private, national accrediting organizations for such oversight. The Joint Commission conducts unannounced inspections at hospitals at least once every 39 months, and more often if complaints arise.\u003c/p>\n\u003cp>Though accreditors have to be approved by the secretary of Health and Human Services, they rarely take punitive action against the organizations they oversee. Of the 4,018 hospitals listed on the The Joint Commission's website, more than 99 percent have full accreditation and only seven are on track to lose their \"gold seal of approval.\"\u003c/p>\n\u003cp>The Joint Commission said it is reviewing the CMS proposal and couldn't comment further. A smaller competitor, the Healthcare Facilities Accreditation Program, said it supports the goal of transparency but is studying what the change would mean in practice, both in terms of staffing and costs. \"We haven't talked to our hospital partners,\" says Gary Ley, its executive director. \"It would be a major change for them also. It's hard not to support the goals but we have to look at the execution.\"\u003c/p>\n\u003cp>For its part, the American Hospital Association said it supports providing the public \"useful information\" about hospital quality, but has doubts that detailed inspection reports fit that description.\u003c/p>\n\u003cp>\"It's important that the information shared with consumers has a clear purpose, is transparent and is readily understood by folks from all walks of life, not just those with deep expertise in health care,\" says Nancy Foster, AHA's vice president of quality and patient safety, in a statement. \"We are concerned that sharing a detailed report may not be the most useful or effective strategy for informing the public.\"\u003c/p>\n\u003cp>Foster says it might be more useful to provide a one- or two-page \"accurate summary\" of inspection findings, with \"key takeaways\" and why they are important. \"This summary could also draw from the plan of correction the hospital creates and summarize how the hospital plans to address the findings,\" Foster says.\u003c/p>\n\u003cp>For years, accreditors have been accused of putting the interests of the facilities that pay them ahead of patient safety. In 2002, the Chicago Tribune reported how The Joint Commission gave its seal of approval to \"medical centers riddled by life-threatening problems and underreporting of patient deaths due to infections and hospital errors.\"\u003c/p>\n\u003cp>Last week, BuzzFeed News reported how an Oklahoma psychiatric hospital was named a \"Top Performer in Key Quality Measures\" by The Joint Commission even though police records, state inspection reports and lawsuit records showed that it \"is a profoundly troubled facility where frequent violence endangers patients and staff alike, where children as young as 5 are separated from their parents and held in dangerous situations, and where wards lack adequate staffing and staff lack adequate training.\"\u003c/p>\n\u003cp>In a response to BuzzFeed, the company that runs the hospital, Universal Health Services, said it \"is proud of the care it provides patients at Shadow Mountain Behavioral Health.\"\u003c/p>\n\u003cp>On its website, The Joint Commission allows users to check the accreditation status of hospitals but provides scant information of what went wrong, even when hospitals are described as receiving a \"preliminary denial of accreditation.\" For one hospital, the explanation is: \"Existence at time of survey of a condition, which in The Joint Commission's view, poses a threat to patients or other individuals served.\" The threat itself is not disclosed.\u003c/p>\n\u003cp>Consumers Union's Safe Patient Project and other patient safety organizations have been pushing for years for more information about hospital inspections. Lisa McGiffert, who directs the Safe Patient Project, hopes this may be the opportunity for change. \"The information that's available now is so minimal and would not really inform anyone about real quality of a hospital,\" she says.\u003c/p>\n\u003cp>Comments on the proposal may be submitted from April 28 to June 13 through the CMS website.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>Disclosure: Ornstein was previously president of the Association of Health Care Journalists. While he served in that position, AHCJ called for The Joint Commission to make its inspection reports public. The Joint Commission declined to do so. Have you complained about a hospital to The Joint Commission or another accrediting body? We'd like to hear from you. Email Charles.ornstein@propublica.org. ProPublica is an independent nonprofit newsroom based in New York.\u003cbr>\n\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "While Washington Fiddles, California Leaders Forge Ideas for Universal Health Care",
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"content": "\u003cp>As the nation’s Republican leaders huddle to reconsider their plans to “repeal and replace” the nation’s health law, advocates for universal health coverage press on in California, armed with renewed political will and a new set of proposals.\u003c/p>\n\u003cp>Organized labor and two lawmakers are leading the charge for a single, government-financed program for everyone in the state. Another legislator wants to create a commission that would weigh the best options for a system to cover everyone. And Democratic Lt. Gov. Gavin Newsom, who hopes to become the next governor, has suggested building on employer-based health care to plug holes in existing coverage.\u003c/p>\n\u003cp>The proposals are fueled both by a fear of losing gains under the Affordable Care Act and a sense that the law doesn’t go far enough toward covering everyone and cutting costs.\u003c/p>\n\u003cp>But heath policy experts say that creating any type of universal health plan would face enormous political and fiscal challenges — and that if it happens at all, it could take years.\u003c/p>\n\u003cp>“There are different ways to get there,” says Jonathan Oberlander, professor of social medicine and health policy at the University of North Carolina. “None of them is easy.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The most specific California proposal comes from state Sens. Ricardo Lara (D-Bell Gardens) and Toni Atkins (D-San Diego), co-authors of legislation that would take steps toward creating one publicly financed “single-payer” program.\u003c/p>\n\u003cp>The \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billStatusClient.xhtml?bill_id=201720180SB562\" target=\"_blank\">bill\u003c/a>, co-sponsored by the California Nurses Association, would aim for something like a system of “Medicare for all” in which the government, not insurers, provides payments and sets coverage rules.\u003c/p>\n\u003cp>\"It's the right moral thing to do,\" Lara says. \"We live in the United States of America. We live in the most powerful state in the union. It is the right thing for us to make sure that we fight to ensure that everyone has coverage.”\u003c/p>\n\u003cp>Lara’s bill contains a long \u003ca href=\"http://sd33.senate.ca.gov/news/2017-02-17-californians-healthy-california-act-seeks-one-plan-more-choice-residents\" target=\"_blank\">list of benefits \u003c/a>the statewide program would cover. Not just doctors and hospitals, but also prescriptions, vision and dental care, hospice and rehabilitative therapies, and more.\u003c/p>\n\u003cp>California Health and Human Services Secretary, \u003ca href=\"http://www.chhs.ca.gov/Pages/Secretary-Diana-S.-Dooley.aspx\" target=\"_blank\">Diana Dooley\u003c/a>, understands the appeal.\u003c/p>\n\u003cp>“I think in California there continues to be a great deal of interest and enthusiasm around single payer,\" she says. \"It is very easy to talk about and it certainly takes advantage of the anxiety people have about health insurance companies.”\u003c/p>\n\u003cp>Lara’s plan does away with premiums, deductibles, co-pays — all those pesky out-of-pocket expenses. So where would the state get the money? Past proposals – here and in states like Vermont and Colorado – have suggested new payroll taxes.\u003c/p>\n\u003cp>\"We know that single payer will be expensive,\" says Assemblyman Jim Wood, chairman of the Health Committee. \"Some estimates from a few years ago, the analysis showed $200 billion plus.\"\u003c/p>\n\u003cp>\"I believe in universal coverage and I’d love to see that happen in the future, but the devils in the details,” he added.\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/317282377\" 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>\u003ca href=\"http://kff.org/other/state-indicator/total-population/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D\" target=\"_blank\">Roughly half of coverage\u003c/a> in California is sponsored by employers.\u003c/p>\n\u003cp>If “you’re going to take health insurance largely out of the market, you’re going to disconnect it from employers,” Oberlander says.\u003c/p>\n\u003cp>Currently, premiums paid by both employer and employee fund private health insurance plans. Single-payer would change that: instead of paycheck deductions for premiums, workers would see new taxes on their wages to pay for the state plan. It would be controversial and disruptive, Oberlander says. \"A lot of people are satisfied with what they have.\"\u003c/p>\n\u003cp>But Lara thinks it can be done, slowly and methodically. He is traveling this week in Canada, along with Bay-Area state senators Nancy Skinner and Scott Wiener. They’ll be learning about Canadian medical care and how it’s financed.\u003c/p>\n\u003cp>Lara takes heart from the fact that Canada’s system began in just one province, and then spread to others. It did so despite resistance, over many years.\u003c/p>\n\u003cp>\"We envision California being the first state to implement a universal healthcare program, and then having that then be the model for the rest of the other states.”\u003c/p>\n\u003cp>Lara says everyone should withhold judgment until he can provide more detailed funding plans in a month or two. His goal is to get the bill at least through the Senate this year, and then push it farther forward in 2018.\u003c/p>\n\u003cp>The trade group for insurers in California does not support the single-payer idea.\u003c/p>\n\u003cp>“A single-payer system would make the quality of our health care worse, not better,” says Charles Bacchi, president and CEO of the \u003ca href=\"http://www.calhealthplans.org/\" target=\"_blank\">California Association of Health Plans\u003c/a>. “We’ve made substantial progress in expanding and increasing access to and quality of care — this step backwards would be particularly devastating for Californians.”\u003c/p>\n\u003cp>Many conservatives oppose the single-payer approach. “We have come to value and expect a health care system that has private-sector market elements,” said \u003ca href=\"http://www.hoover.org/profiles/lanhee-j-chen\" target=\"_blank\">Lanhee Chen,\u003c/a> a fellow at the Hoover Institution and former chief policy adviser to former Massachusetts governor Mitt Romney.\u003c/p>\n\u003cp>A single-payer system would need federal approval, essentially giving California permission to take the money meant for Medicare and Medicaid, and distribute those funds in a totally new way.\u003c/p>\n\u003cp>\"I’m not sure under what construct that could even occur,\" says \u003ca href=\"http://www.dhcs.ca.gov/Pages/DirectorsBiography.aspx\" target=\"_blank\">Jennifer Kent\u003c/a>, director of the Department of Health Care Services, which operates the state’s Medicaid program, known as Medi-Cal.\u003c/p>\n\u003cp>\"The federal government would have to essentially turn those funds over to a state,\" she says.\u003c/p>\n\u003cp>As it stands, \u003ca href=\"http://californiahealthline.org/news/single-payer-health-care-bill-to-be-introduced-in-california-senate/\">no state has a single-payer system\u003c/a>. Perhaps the best-known effort to create one was in Vermont, but it failed in 2014 after officials there couldn’t figure out how to finance it.\u003c/p>\n\u003cp>Single-payer proposals have been put forth many times in the California Legislature since 2003, and all have hit roadblocks.\u003c/p>\n\u003cp>One bill, carried by former state senator Sheila Kuehl several years ago and passed by the state Legislature, would have created a payroll tax to help fund a program \u003ca href=\"http://www.lao.ca.gov/2008/hlth/sb840/SB840_analysis.pdf\" target=\"_blank\">costing \u003c/a> $200 billion a year or more. That measure and a similar bill were vetoed by then-governor Arnold Schwarzenegger, who cited financial concerns.\u003c/p>\n\u003cp>Kuehl, now a Los Angeles County supervisor, said the time is as good as ever to reintroduce a proposal like single-payer because many people fear losing coverage under Republican proposals being discussed in Washington, D.C.\u003c/p>\n\u003cp>“The ACA created more familiarity with being insured,” said Kuehl. “They’ve recognized the value.”\u003c/p>\n\u003cp>Other observers say attempts to expand access should not undermine efforts to preserve insurance gains under Obamacare. The threat to Medicaid or private insurance access is still real, they say.\u003c/p>\n\u003cp>“California should explore all options, [but] we should not do that if it means withdrawing support for protecting the ACA,” said Jerry Kominski, director of the UCLA Center for Health Policy Research. “It would take decades to get back to where we are now,” he said.\u003c/p>\n\u003cp>In an interview with California Healthline, California Gov. Jerry Brown emphasized that financing a single-payer system would be a major challenge. Although he said he would entertain a conversation about a single-payer system, he did not say whether he would endorse creating one.\u003c/p>\n\u003cp>For one thing, it would require a new tax, which would have to be approved either by a two-thirds majority vote in the state Legislature or a simple-majority popular vote, he said. Even with the current Democratic supermajority, Brown said, there are always a few “outliers” who wouldn’t support raising new revenues.\u003c/p>\n\u003cp>Brown leaves office in 2018, however, and Newsom, who hopes to succeed him, is looking into a creating a plan for universal coverage that would be an alternative to a single-payer system.\u003c/p>\n\u003cp>One option, according to Newsom’s office, would be to use as a model the Healthy San Francisco program he introduced in 2007 as mayor. The city has used a combination of public money and contributions from employers and enrollees to plug holes in coverage and make primary care accessible to nearly everyone.\u003c/p>\n\u003cp>Newsom has acknowledged, however, that the San Francisco approach \u003ca href=\"https://www.thenation.com/article/can-california-achieve-universal-health-care-in-the-age-of-trump/\">would not necessarily work in every county\u003c/a>, and said he is open to other possibilities.\u003c/p>\n\u003cp>Using that model to expand health care statewide has some political advantages, Oberlander said, because it builds on the “status quo rather than radically restructuring” the current system.\u003c/p>\n\u003cp>Another California lawmaker proposes to keep the conversation going about universal health care, at least, by creating a commission that would make various recommendations to policymakers.\u003c/p>\n\u003cp>“We have to be able to move on multiple tracks at once,” said Assemblyman Rob Bonta (D-Oakland), who is carrying the bill to create the Health Care for All commission, which would convene in 2018.\u003c/p>\n\u003cp>The debate in Washington could actually produce some surprising opportunities for California and other states. The feds might, for instance, approve waivers to allow other types of experimentation within states. \u003ca href=\"http://healthaffairs.org/blog/2017/01/24/aca-replacement-bill-from-cassidy-and-colleagues-offers-state-options-roth-hsas/\">Some Republicans\u003c/a> favor an approach in which each state decides on its own coverage system, within certain limits.\u003c/p>\n\u003cp>That could mean a retraction of coverage in some states, but in California it might open the door to a new model.\u003c/p>\n\u003cp>“It is possible that some liberal-leaning states are going to do things that we didn’t think possible before,” Oberlander said.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>This story was produced by \u003ca href=\"http://khn.org/\">Kaiser Health News\u003c/a>, which publishes \u003ca href=\"http://www.californiahealthline.org/\">California Healthline\u003c/a>, an editorially independent service of the \u003ca href=\"http://www.chcf.org/\">California Health Care Foundation\u003c/a>.\u003c/p>\n\n",
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"nprByline": "\u003ca href=\"http://khn.org/news/author/pauline-bartolone/\">\u003cstrong>Pauline Bartolone,\u003c/strong>\u003c/a> California Healthline, and \u003cstrong>Carrie Feibel,\u003c/strong> KQED",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>As the nation’s Republican leaders huddle to reconsider their plans to “repeal and replace” the nation’s health law, advocates for universal health coverage press on in California, armed with renewed political will and a new set of proposals.\u003c/p>\n\u003cp>Organized labor and two lawmakers are leading the charge for a single, government-financed program for everyone in the state. Another legislator wants to create a commission that would weigh the best options for a system to cover everyone. And Democratic Lt. Gov. Gavin Newsom, who hopes to become the next governor, has suggested building on employer-based health care to plug holes in existing coverage.\u003c/p>\n\u003cp>The proposals are fueled both by a fear of losing gains under the Affordable Care Act and a sense that the law doesn’t go far enough toward covering everyone and cutting costs.\u003c/p>\n\u003cp>But heath policy experts say that creating any type of universal health plan would face enormous political and fiscal challenges — and that if it happens at all, it could take years.\u003c/p>\n\u003cp>“There are different ways to get there,” says Jonathan Oberlander, professor of social medicine and health policy at the University of North Carolina. “None of them is easy.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The most specific California proposal comes from state Sens. Ricardo Lara (D-Bell Gardens) and Toni Atkins (D-San Diego), co-authors of legislation that would take steps toward creating one publicly financed “single-payer” program.\u003c/p>\n\u003cp>The \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billStatusClient.xhtml?bill_id=201720180SB562\" target=\"_blank\">bill\u003c/a>, co-sponsored by the California Nurses Association, would aim for something like a system of “Medicare for all” in which the government, not insurers, provides payments and sets coverage rules.\u003c/p>\n\u003cp>\"It's the right moral thing to do,\" Lara says. \"We live in the United States of America. We live in the most powerful state in the union. It is the right thing for us to make sure that we fight to ensure that everyone has coverage.”\u003c/p>\n\u003cp>Lara’s bill contains a long \u003ca href=\"http://sd33.senate.ca.gov/news/2017-02-17-californians-healthy-california-act-seeks-one-plan-more-choice-residents\" target=\"_blank\">list of benefits \u003c/a>the statewide program would cover. Not just doctors and hospitals, but also prescriptions, vision and dental care, hospice and rehabilitative therapies, and more.\u003c/p>\n\u003cp>California Health and Human Services Secretary, \u003ca href=\"http://www.chhs.ca.gov/Pages/Secretary-Diana-S.-Dooley.aspx\" target=\"_blank\">Diana Dooley\u003c/a>, understands the appeal.\u003c/p>\n\u003cp>“I think in California there continues to be a great deal of interest and enthusiasm around single payer,\" she says. \"It is very easy to talk about and it certainly takes advantage of the anxiety people have about health insurance companies.”\u003c/p>\n\u003cp>Lara’s plan does away with premiums, deductibles, co-pays — all those pesky out-of-pocket expenses. So where would the state get the money? Past proposals – here and in states like Vermont and Colorado – have suggested new payroll taxes.\u003c/p>\n\u003cp>\"We know that single payer will be expensive,\" says Assemblyman Jim Wood, chairman of the Health Committee. \"Some estimates from a few years ago, the analysis showed $200 billion plus.\"\u003c/p>\n\u003cp>\"I believe in universal coverage and I’d love to see that happen in the future, but the devils in the details,” he added.\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/317282377&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/317282377'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"http://kff.org/other/state-indicator/total-population/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D\" target=\"_blank\">Roughly half of coverage\u003c/a> in California is sponsored by employers.\u003c/p>\n\u003cp>If “you’re going to take health insurance largely out of the market, you’re going to disconnect it from employers,” Oberlander says.\u003c/p>\n\u003cp>Currently, premiums paid by both employer and employee fund private health insurance plans. Single-payer would change that: instead of paycheck deductions for premiums, workers would see new taxes on their wages to pay for the state plan. It would be controversial and disruptive, Oberlander says. \"A lot of people are satisfied with what they have.\"\u003c/p>\n\u003cp>But Lara thinks it can be done, slowly and methodically. He is traveling this week in Canada, along with Bay-Area state senators Nancy Skinner and Scott Wiener. They’ll be learning about Canadian medical care and how it’s financed.\u003c/p>\n\u003cp>Lara takes heart from the fact that Canada’s system began in just one province, and then spread to others. It did so despite resistance, over many years.\u003c/p>\n\u003cp>\"We envision California being the first state to implement a universal healthcare program, and then having that then be the model for the rest of the other states.”\u003c/p>\n\u003cp>Lara says everyone should withhold judgment until he can provide more detailed funding plans in a month or two. His goal is to get the bill at least through the Senate this year, and then push it farther forward in 2018.\u003c/p>\n\u003cp>The trade group for insurers in California does not support the single-payer idea.\u003c/p>\n\u003cp>“A single-payer system would make the quality of our health care worse, not better,” says Charles Bacchi, president and CEO of the \u003ca href=\"http://www.calhealthplans.org/\" target=\"_blank\">California Association of Health Plans\u003c/a>. “We’ve made substantial progress in expanding and increasing access to and quality of care — this step backwards would be particularly devastating for Californians.”\u003c/p>\n\u003cp>Many conservatives oppose the single-payer approach. “We have come to value and expect a health care system that has private-sector market elements,” said \u003ca href=\"http://www.hoover.org/profiles/lanhee-j-chen\" target=\"_blank\">Lanhee Chen,\u003c/a> a fellow at the Hoover Institution and former chief policy adviser to former Massachusetts governor Mitt Romney.\u003c/p>\n\u003cp>A single-payer system would need federal approval, essentially giving California permission to take the money meant for Medicare and Medicaid, and distribute those funds in a totally new way.\u003c/p>\n\u003cp>\"I’m not sure under what construct that could even occur,\" says \u003ca href=\"http://www.dhcs.ca.gov/Pages/DirectorsBiography.aspx\" target=\"_blank\">Jennifer Kent\u003c/a>, director of the Department of Health Care Services, which operates the state’s Medicaid program, known as Medi-Cal.\u003c/p>\n\u003cp>\"The federal government would have to essentially turn those funds over to a state,\" she says.\u003c/p>\n\u003cp>As it stands, \u003ca href=\"http://californiahealthline.org/news/single-payer-health-care-bill-to-be-introduced-in-california-senate/\">no state has a single-payer system\u003c/a>. Perhaps the best-known effort to create one was in Vermont, but it failed in 2014 after officials there couldn’t figure out how to finance it.\u003c/p>\n\u003cp>Single-payer proposals have been put forth many times in the California Legislature since 2003, and all have hit roadblocks.\u003c/p>\n\u003cp>One bill, carried by former state senator Sheila Kuehl several years ago and passed by the state Legislature, would have created a payroll tax to help fund a program \u003ca href=\"http://www.lao.ca.gov/2008/hlth/sb840/SB840_analysis.pdf\" target=\"_blank\">costing \u003c/a> $200 billion a year or more. That measure and a similar bill were vetoed by then-governor Arnold Schwarzenegger, who cited financial concerns.\u003c/p>\n\u003cp>Kuehl, now a Los Angeles County supervisor, said the time is as good as ever to reintroduce a proposal like single-payer because many people fear losing coverage under Republican proposals being discussed in Washington, D.C.\u003c/p>\n\u003cp>“The ACA created more familiarity with being insured,” said Kuehl. “They’ve recognized the value.”\u003c/p>\n\u003cp>Other observers say attempts to expand access should not undermine efforts to preserve insurance gains under Obamacare. The threat to Medicaid or private insurance access is still real, they say.\u003c/p>\n\u003cp>“California should explore all options, [but] we should not do that if it means withdrawing support for protecting the ACA,” said Jerry Kominski, director of the UCLA Center for Health Policy Research. “It would take decades to get back to where we are now,” he said.\u003c/p>\n\u003cp>In an interview with California Healthline, California Gov. Jerry Brown emphasized that financing a single-payer system would be a major challenge. Although he said he would entertain a conversation about a single-payer system, he did not say whether he would endorse creating one.\u003c/p>\n\u003cp>For one thing, it would require a new tax, which would have to be approved either by a two-thirds majority vote in the state Legislature or a simple-majority popular vote, he said. Even with the current Democratic supermajority, Brown said, there are always a few “outliers” who wouldn’t support raising new revenues.\u003c/p>\n\u003cp>Brown leaves office in 2018, however, and Newsom, who hopes to succeed him, is looking into a creating a plan for universal coverage that would be an alternative to a single-payer system.\u003c/p>\n\u003cp>One option, according to Newsom’s office, would be to use as a model the Healthy San Francisco program he introduced in 2007 as mayor. The city has used a combination of public money and contributions from employers and enrollees to plug holes in coverage and make primary care accessible to nearly everyone.\u003c/p>\n\u003cp>Newsom has acknowledged, however, that the San Francisco approach \u003ca href=\"https://www.thenation.com/article/can-california-achieve-universal-health-care-in-the-age-of-trump/\">would not necessarily work in every county\u003c/a>, and said he is open to other possibilities.\u003c/p>\n\u003cp>Using that model to expand health care statewide has some political advantages, Oberlander said, because it builds on the “status quo rather than radically restructuring” the current system.\u003c/p>\n\u003cp>Another California lawmaker proposes to keep the conversation going about universal health care, at least, by creating a commission that would make various recommendations to policymakers.\u003c/p>\n\u003cp>“We have to be able to move on multiple tracks at once,” said Assemblyman Rob Bonta (D-Oakland), who is carrying the bill to create the Health Care for All commission, which would convene in 2018.\u003c/p>\n\u003cp>The debate in Washington could actually produce some surprising opportunities for California and other states. The feds might, for instance, approve waivers to allow other types of experimentation within states. \u003ca href=\"http://healthaffairs.org/blog/2017/01/24/aca-replacement-bill-from-cassidy-and-colleagues-offers-state-options-roth-hsas/\">Some Republicans\u003c/a> favor an approach in which each state decides on its own coverage system, within certain limits.\u003c/p>\n\u003cp>That could mean a retraction of coverage in some states, but in California it might open the door to a new model.\u003c/p>\n\u003cp>“It is possible that some liberal-leaning states are going to do things that we didn’t think possible before,” Oberlander said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>This story was produced by \u003ca href=\"http://khn.org/\">Kaiser Health News\u003c/a>, which publishes \u003ca href=\"http://www.californiahealthline.org/\">California Healthline\u003c/a>, an editorially independent service of the \u003ca href=\"http://www.chcf.org/\">California Health Care Foundation\u003c/a>.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>On Thursday, House Republicans postponed a vote on their proposed health care bill to replace the Affordable Care Act after it became clear they didn’t have the votes to pass it.\u003c/p>\n\u003cp>The White House \u003ca href=\"https://ww2.kqed.org/news/2017/03/23/in-major-blow-to-trump-gop-health-care-bill-vote-delayed/\" target=\"_blank\">reacted to the delay with an ultimatum\u003c/a>: Vote for the current GOP health care replacement plan, or leave the Affordable Care Act in place and suffer the consequences.\u003c/p>\n\u003cp>[contextly_sidebar id=”fRsksZiAgI3kVFBXYFDVBdAQtMC7VBTH”]\u003c/p>\n\u003cp>Replacing the Affordable Care Act (ACA) has long been a goal of the GOP — but getting rid of Obamacare may actually hurt the voter base that helped put them in power.\u003c/p>\n\u003cp>In California, it was largely \u003ca href=\"http://www.politico.com/2016-election/results/map/president/california/\" target=\"_blank\">rural counties\u003c/a> that voted to elect Donald Trump president. Trump made repealing the ACA one of his key campaign talking points. But Dr. Anthony Iton with the California Endowment says those counties are among those with the most to lose should the ACA be repealed.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“There are 25 counties that voted for President Trump,” Iton says. “And 23 of those 25 counties have \u003ca href=\"http://www.calendow.org/wp-content/uploads/MORTALITY-BRIEFING-FINAL-011817-FINAL-FINAL-2.pdf\" target=\"_blank\">rising white mortality rates\u003c/a>.”\u003c/p>\n\u003cp>Iton says people in those counties are dying of drug overdoses, alcohol-related illnesses, suicides and accidents. And he says many of the underlying causes of those premature deaths can be treated with services currently offered through the ACA, like mental health care and substance abuse treatment.\u003c/p>\n\u003cp>“Those are the things that are in jeopardy right now of being essentially withdrawn from these populations, particularly in rural areas where there’s a relatively thinly stretched health care delivery system,” he says.\u003c/p>\n\u003cp>[contextly_sidebar id=”66k6CGSzre1KxsaavuOcYMAIZq1PShR5″]\u003c/p>\n\u003cp>Rural Sierra County voted overwhelmingly for Trump in November. Supervisor Lee Adams, a Democrat, says nearly a third of the county’s 3,000 residents are enrolled in Obamacare.\u003c/p>\n\u003cp>“I think most are hoping for the best, and until the shoe drops they still are hopeful that everything is going to be fine,” he says.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>But Adams says a repeal of the ACA could have a significant negative impact on the county, where the economy has been struggling and about 14 percent of the population live below the poverty line.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>On Thursday, House Republicans postponed a vote on their proposed health care bill to replace the Affordable Care Act after it became clear they didn’t have the votes to pass it.\u003c/p>\n\u003cp>The White House \u003ca href=\"https://ww2.kqed.org/news/2017/03/23/in-major-blow-to-trump-gop-health-care-bill-vote-delayed/\" target=\"_blank\">reacted to the delay with an ultimatum\u003c/a>: Vote for the current GOP health care replacement plan, or leave the Affordable Care Act in place and suffer the consequences.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Replacing the Affordable Care Act (ACA) has long been a goal of the GOP — but getting rid of Obamacare may actually hurt the voter base that helped put them in power.\u003c/p>\n\u003cp>In California, it was largely \u003ca href=\"http://www.politico.com/2016-election/results/map/president/california/\" target=\"_blank\">rural counties\u003c/a> that voted to elect Donald Trump president. Trump made repealing the ACA one of his key campaign talking points. But Dr. Anthony Iton with the California Endowment says those counties are among those with the most to lose should the ACA be repealed.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“There are 25 counties that voted for President Trump,” Iton says. “And 23 of those 25 counties have \u003ca href=\"http://www.calendow.org/wp-content/uploads/MORTALITY-BRIEFING-FINAL-011817-FINAL-FINAL-2.pdf\" target=\"_blank\">rising white mortality rates\u003c/a>.”\u003c/p>\n\u003cp>Iton says people in those counties are dying of drug overdoses, alcohol-related illnesses, suicides and accidents. And he says many of the underlying causes of those premature deaths can be treated with services currently offered through the ACA, like mental health care and substance abuse treatment.\u003c/p>\n\u003cp>“Those are the things that are in jeopardy right now of being essentially withdrawn from these populations, particularly in rural areas where there’s a relatively thinly stretched health care delivery system,” he says.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Rural Sierra County voted overwhelmingly for Trump in November. Supervisor Lee Adams, a Democrat, says nearly a third of the county’s 3,000 residents are enrolled in Obamacare.\u003c/p>\n\u003cp>“I think most are hoping for the best, and until the shoe drops they still are hopeful that everything is going to be fine,” he says.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>But Adams says a repeal of the ACA could have a significant negative impact on the county, where the economy has been struggling and about 14 percent of the population live below the poverty line.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"title": "Winners, Losers by the Numbers: California and the GOP Health Plan",
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"content": "\u003cp>Californians are trying to understand how the new Republican health care bill introduced last week might affect them. Who wins? Who loses?\u003c/p>\n\u003cp>Covered California crunched the numbers, and then we put them in plain English. In a nutshell: When compared to the Affordable Care Act (Obamacare), insurance subsidies drop under the American Health Care Act (the new Republican bill) if you’re older, poorer or live in Northern California, where medical costs are higher.\u003c/p>\n\u003ch3>\u003cstrong>\u003cem>Who loses?\u003c/em>\u003c/strong>\u003c/h3>\n\u003cp>A 62-year-old in San Francisco with an annual income of $40,000 currently gets $9,500 in tax credits for health insurance. Under the Republican bill, the tax credit \u003cstrong>drops\u003c/strong> by $5,500, and coverage could become unaffordable.\u003c/p>\n\u003ch3>\u003cem>\u003cstrong>Who wins?\u003c/strong>\u003c/em>\u003c/h3>\n\u003cp>A 27-year-old in Los Angeles, \u003cem>also\u003c/em> with an annual income of $40,000, currently gets $180 in tax credits for health insurance. Under the Republican bill, her tax credit \u003cstrong>increases\u003c/strong> by $1,800.\u003c/p>\n\u003ch3>\u003cem>\u003cstrong>Why?\u003c/strong>\u003c/em>\u003c/h3>\n\u003cp>Because the Affordable Care Act subsidizes insurance premiums based on your age, income \u003cem>and\u003c/em> how expensive health insurance is in your hometown. The Republican replacement plan only takes into account age, and ignores income and local market conditions.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>In Northern California, hospitals and doctors charge up to 40 percent more than they do in Southern California.\u003c/p>\n\u003ch3>\u003cstrong>\u003cem>Why does health care in Northern California cost more?\u003c/em>\u003c/strong>\u003c/h3>\n\u003cp>“In Northern California, there’s a more concentrated delivery system with a few major providers,” said Peter Lee, executive director of Covered California.\u003c/p>\n\u003cp>But in Los Angeles, there’s more structural diversity among hospitals and medical groups. That means more competition — and lower prices.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Lee explained Obamacare tried to level costs, giving people up north a higher subsidy to pay for insurance. The Republican plan overlooks regional cost variations.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Californians are trying to understand how the new Republican health care bill introduced last week might affect them. Who wins? Who loses?\u003c/p>\n\u003cp>Covered California crunched the numbers, and then we put them in plain English. In a nutshell: When compared to the Affordable Care Act (Obamacare), insurance subsidies drop under the American Health Care Act (the new Republican bill) if you’re older, poorer or live in Northern California, where medical costs are higher.\u003c/p>\n\u003ch3>\u003cstrong>\u003cem>Who loses?\u003c/em>\u003c/strong>\u003c/h3>\n\u003cp>A 62-year-old in San Francisco with an annual income of $40,000 currently gets $9,500 in tax credits for health insurance. Under the Republican bill, the tax credit \u003cstrong>drops\u003c/strong> by $5,500, and coverage could become unaffordable.\u003c/p>\n\u003ch3>\u003cem>\u003cstrong>Who wins?\u003c/strong>\u003c/em>\u003c/h3>\n\u003cp>A 27-year-old in Los Angeles, \u003cem>also\u003c/em> with an annual income of $40,000, currently gets $180 in tax credits for health insurance. Under the Republican bill, her tax credit \u003cstrong>increases\u003c/strong> by $1,800.\u003c/p>\n\u003ch3>\u003cem>\u003cstrong>Why?\u003c/strong>\u003c/em>\u003c/h3>\n\u003cp>Because the Affordable Care Act subsidizes insurance premiums based on your age, income \u003cem>and\u003c/em> how expensive health insurance is in your hometown. The Republican replacement plan only takes into account age, and ignores income and local market conditions.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>In Northern California, hospitals and doctors charge up to 40 percent more than they do in Southern California.\u003c/p>\n\u003ch3>\u003cstrong>\u003cem>Why does health care in Northern California cost more?\u003c/em>\u003c/strong>\u003c/h3>\n\u003cp>“In Northern California, there’s a more concentrated delivery system with a few major providers,” said Peter Lee, executive director of Covered California.\u003c/p>\n\u003cp>But in Los Angeles, there’s more structural diversity among hospitals and medical groups. That means more competition — and lower prices.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Lee explained Obamacare tried to level costs, giving people up north a higher subsidy to pay for insurance. The Republican plan overlooks regional cost variations.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "On Opioid Prescriptions, Doctors 'All Over the Map'",
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"content": "\u003cp>Which doctor a person happens to see at a local emergency room can have long-term consequences when it comes to opioid use.\u003c/p>\n\u003cp>Within the same hospital, some doctors are three times more likely to prescribe an opioid than other doctors, and patients treated by high-prescribing doctors are more likely to become long-term opioid users, according to a study published recently in the \u003cem>New England Journal of Medicine\u003c/em>.\u003c/p>\n\u003cp>“Physicians are just doing things all over the map,” says Dr. Michael Barnett, an assistant professor at the Harvard T. H. Chan School of Public Health and one of the study’s authors. “This is a call to arms for people to start paying a lot more attention to having a unified approach.”\u003c/p>\n\u003cp>The study looked at how many opioid prescriptions emergency physicians gave to about 377,000 Medicare beneficiaries from 2008 through 2011. The lowest-prescribing quartile of doctors prescribed opioids to just 7 percent of patients, while the highest prescribed opioids to 24 percent — more than three times as often.\u003c/p>\n\u003cp>Patients who saw a high-intensity prescriber were about 30 percent more likely to end up with a long-term opioid prescription of at least six months within the year following their hospital visit. They were also more likely to return to the hospital in the next 12 months with an opioid-related fall or fracture, a risk factor for seniors who take the powerful painkillers.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Overall, about one in every 48 Medicare patients prescribed an opioid in the study were likely to become a long-term opioid user.\u003c/p>\n\u003cp>There is a growing consensus among doctors that opioids have long been overprescribed. In 2010, there were enough prescriptions written to supply every American adult with hydrocodone for a month, according to the \u003ca href=\"https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6043a4.htm\" target=\"_blank\">Centers for Disease Control and Prevention\u003c/a>.\u003c/p>\n\u003cp>Part of the problem, Barnett believes, is that there isn’t enough guidance for doctors on when it’s appropriate to prescribe an opioid. Much of the evidence for when they are appropriate comes from small studies sponsored by drug companies.\u003c/p>\n\u003cp>“It’s kind of a grey area and there’s not very clear evidence around what you should do, so we use our own judgement. And there’s a huge gulf between what one doctor thinks and another,” Barnett explains.\u003c/p>\n\u003cp>Take, for example, a patient who comes to the emergency room complaining of back pain. There’s evidence that opioids are not necessary in that situation, but many doctors prescribe them anyway, said Barnett. “The world of pain treatment outside of opioids is limited and can take time to figure out. Opioids are an easy fix.”\u003c/p>\n\u003cp>The problem, he said, is that “even one prescription for opioids carries risks with it, that from my own experience as a provider, we tend to underestimate and under-explain to patients.”\u003c/p>\n\u003cp>“It is very, very plausible that well-intentioned but perhaps overly aggressive prescribing of opioids makes it likely that a patient will continue a medication long-term even if they don’t truly need it,” said Dr. \u003ca href=\"http://ihpme.utoronto.ca/faculty/david-juurlink/\" target=\"_blank\">David Juurlink\u003c/a>, a professor of medicine at the University of Toronto. He was not involved in the study. “The doctors in the lowest quartile are the ones whose prescribing we should seek to be emulating.”\u003c/p>\n\u003cp>The study did not look at whether the opioids were correctly prescribed in each incidence. Dr. \u003ca href=\"http://californiahealthline.org/news/prescribing-opioids-to-seniors-its-a-balancing-act/\">Carla Perissinotto\u003c/a>, a geriatrician at the University of California San Francisco, worries that some of the doctors in the lowest quartile might be under-prescribing. “We have to be careful to not make assumptions too quickly and assume they’re bad prescribers, because it could be the opposite,” said Perissinotto, who also was not involved in the study.\u003c/p>\n\u003cp>Usually, a patient is prescribed just a handful of pills by a doctor at the emergency department to tide them over until the patient can visit his or her primary care physician.\u003c/p>\n\u003cp>But many primary care doctors simply refill the opioid prescription for another 30 days or longer, a phenomenon Barnett calls clinical inertia. “There’s this cognitive bias to keep going with the flow especially if the patient still feels they’re in pain.”\u003c/p>\n\u003cp>That can have long-term implications: One-third of people who have taken prescription opioids for at least two months say they became addicted to or physically dependent on them, a recent \u003ca href=\"https://www.washingtonpost.com/page/2010-2019/WashingtonPost/2016/12/09/National-Politics/Polling/release_455.xml\" target=\"_blank\">Washington Post-Kaiser Family Foundation survey found.\u003c/a>\u003c/p>\n\u003cp>“We know there is a population of people who will potentially get addicted if they’re exposed to an opioid,” said Dr. \u003ca href=\"http://njms.rutgers.edu/departments/emergency_medicine/\">Lewis Nelson\u003c/a>, chair of the department of emergency medicine at Rutgers New Jersey Medical School, who was not involved with the study. “It’s a numbers game. The more people you expose, the more people you are likely to hit in that population likely to get addicted.”\u003c/p>\n\u003cp>Some hospitals are starting to help doctors prescribe opioids more judiciously. Many of those efforts have taken place after 2011, and therefore any changes would not be seen in the New England Journal of Medicine study.\u003c/p>\n\u003cp>For the past year, St. Joseph’s Regional Medical Center in New Jersey has been instructing doctors to prescribe opioids only as a last resort, said Dr. \u003ca href=\"https://www.acep.org/About-Us/Mark-S--Rosenberg,-DO,-MBA,-FACEP/\" target=\"_blank\">Mark Rosenberg\u003c/a>, who runs the hospital’s emergency department and is on the board of the American College of Emergency Physicians. Rosenberg helped institute protocols that have doctors try other methods of pain relief first, such as a Novocain injection. In just over a year, the hospital has managed to reduce the number of opioid prescriptions written in the emergency room by 50 percent.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>New York City and Washington state have also tried to introduce opioid prescribing guidelines into hospitals, and the ACEP expects to release new nationwide guidelines for emergency physicians in 2018.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Which doctor a person happens to see at a local emergency room can have long-term consequences when it comes to opioid use.\u003c/p>\n\u003cp>Within the same hospital, some doctors are three times more likely to prescribe an opioid than other doctors, and patients treated by high-prescribing doctors are more likely to become long-term opioid users, according to a study published recently in the \u003cem>New England Journal of Medicine\u003c/em>.\u003c/p>\n\u003cp>“Physicians are just doing things all over the map,” says Dr. Michael Barnett, an assistant professor at the Harvard T. H. Chan School of Public Health and one of the study’s authors. “This is a call to arms for people to start paying a lot more attention to having a unified approach.”\u003c/p>\n\u003cp>The study looked at how many opioid prescriptions emergency physicians gave to about 377,000 Medicare beneficiaries from 2008 through 2011. The lowest-prescribing quartile of doctors prescribed opioids to just 7 percent of patients, while the highest prescribed opioids to 24 percent — more than three times as often.\u003c/p>\n\u003cp>Patients who saw a high-intensity prescriber were about 30 percent more likely to end up with a long-term opioid prescription of at least six months within the year following their hospital visit. They were also more likely to return to the hospital in the next 12 months with an opioid-related fall or fracture, a risk factor for seniors who take the powerful painkillers.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Overall, about one in every 48 Medicare patients prescribed an opioid in the study were likely to become a long-term opioid user.\u003c/p>\n\u003cp>There is a growing consensus among doctors that opioids have long been overprescribed. In 2010, there were enough prescriptions written to supply every American adult with hydrocodone for a month, according to the \u003ca href=\"https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6043a4.htm\" target=\"_blank\">Centers for Disease Control and Prevention\u003c/a>.\u003c/p>\n\u003cp>Part of the problem, Barnett believes, is that there isn’t enough guidance for doctors on when it’s appropriate to prescribe an opioid. Much of the evidence for when they are appropriate comes from small studies sponsored by drug companies.\u003c/p>\n\u003cp>“It’s kind of a grey area and there’s not very clear evidence around what you should do, so we use our own judgement. And there’s a huge gulf between what one doctor thinks and another,” Barnett explains.\u003c/p>\n\u003cp>Take, for example, a patient who comes to the emergency room complaining of back pain. There’s evidence that opioids are not necessary in that situation, but many doctors prescribe them anyway, said Barnett. “The world of pain treatment outside of opioids is limited and can take time to figure out. Opioids are an easy fix.”\u003c/p>\n\u003cp>The problem, he said, is that “even one prescription for opioids carries risks with it, that from my own experience as a provider, we tend to underestimate and under-explain to patients.”\u003c/p>\n\u003cp>“It is very, very plausible that well-intentioned but perhaps overly aggressive prescribing of opioids makes it likely that a patient will continue a medication long-term even if they don’t truly need it,” said Dr. \u003ca href=\"http://ihpme.utoronto.ca/faculty/david-juurlink/\" target=\"_blank\">David Juurlink\u003c/a>, a professor of medicine at the University of Toronto. He was not involved in the study. “The doctors in the lowest quartile are the ones whose prescribing we should seek to be emulating.”\u003c/p>\n\u003cp>The study did not look at whether the opioids were correctly prescribed in each incidence. Dr. \u003ca href=\"http://californiahealthline.org/news/prescribing-opioids-to-seniors-its-a-balancing-act/\">Carla Perissinotto\u003c/a>, a geriatrician at the University of California San Francisco, worries that some of the doctors in the lowest quartile might be under-prescribing. “We have to be careful to not make assumptions too quickly and assume they’re bad prescribers, because it could be the opposite,” said Perissinotto, who also was not involved in the study.\u003c/p>\n\u003cp>Usually, a patient is prescribed just a handful of pills by a doctor at the emergency department to tide them over until the patient can visit his or her primary care physician.\u003c/p>\n\u003cp>But many primary care doctors simply refill the opioid prescription for another 30 days or longer, a phenomenon Barnett calls clinical inertia. “There’s this cognitive bias to keep going with the flow especially if the patient still feels they’re in pain.”\u003c/p>\n\u003cp>That can have long-term implications: One-third of people who have taken prescription opioids for at least two months say they became addicted to or physically dependent on them, a recent \u003ca href=\"https://www.washingtonpost.com/page/2010-2019/WashingtonPost/2016/12/09/National-Politics/Polling/release_455.xml\" target=\"_blank\">Washington Post-Kaiser Family Foundation survey found.\u003c/a>\u003c/p>\n\u003cp>“We know there is a population of people who will potentially get addicted if they’re exposed to an opioid,” said Dr. \u003ca href=\"http://njms.rutgers.edu/departments/emergency_medicine/\">Lewis Nelson\u003c/a>, chair of the department of emergency medicine at Rutgers New Jersey Medical School, who was not involved with the study. “It’s a numbers game. The more people you expose, the more people you are likely to hit in that population likely to get addicted.”\u003c/p>\n\u003cp>Some hospitals are starting to help doctors prescribe opioids more judiciously. Many of those efforts have taken place after 2011, and therefore any changes would not be seen in the New England Journal of Medicine study.\u003c/p>\n\u003cp>For the past year, St. Joseph’s Regional Medical Center in New Jersey has been instructing doctors to prescribe opioids only as a last resort, said Dr. \u003ca href=\"https://www.acep.org/About-Us/Mark-S--Rosenberg,-DO,-MBA,-FACEP/\" target=\"_blank\">Mark Rosenberg\u003c/a>, who runs the hospital’s emergency department and is on the board of the American College of Emergency Physicians. Rosenberg helped institute protocols that have doctors try other methods of pain relief first, such as a Novocain injection. In just over a year, the hospital has managed to reduce the number of opioid prescriptions written in the emergency room by 50 percent.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>New York City and Washington state have also tried to introduce opioid prescribing guidelines into hospitals, and the ACEP expects to release new nationwide guidelines for emergency physicians in 2018.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"title": "Maybe You Shouldn't Take All of Your Antibiotics, After All",
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"content": "\u003cp>You’ve heard it many times before from your doctor: If you’re taking antibiotics, don’t stop taking them until the pill vial is empty, even if you feel better.\u003c/p>\n\u003caside class=\"pullquote alignright\">‘An argument can be made for stopping a course of antibiotics immediately after a bacterial infection has been ruled out … or when the signs and symptoms of a mild infection have disappeared.’\u003ccite>From a World Health Organization report\u003c/cite>\u003c/aside>\n\u003cp>The rationale behind this commandment has always been that stopping treatment too soon would fuel the development of antibiotic resistance—the ability of bugs to evade these drugs. Information campaigns aimed at getting the public to take antibiotics properly have been driving home this message for decades.\u003c/p>\n\u003cp>But the warning, a growing number of experts say, is misguided and may actually be exacerbating antibiotic resistance.\u003c/p>\n\u003cp>The reasoning is simple: Exposure to antibiotics is what drives bacteria to develop resistance. Taking drugs when you aren’t sick anymore simply gives the hordes of bacteria in and on your body more incentive to evolve to evade the drugs, so the next time you have an infection, they may not work.\u003c/p>\n\u003cp>The traditional reasoning from doctors “never made any sense. It doesn’t make any sense today,” Dr. Louis Rice, chairman of the department of medicine at the Warren Alpert Medical School at Brown University, told STAT.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Some colleagues credit Rice with being the first person to declare the emperor was wearing no clothes, and it is true that he challenged the dogma in lectures at major meetings of infectious diseases physicians and researchers in 2007 and 2008. A number of researchers now share his skepticism of health guidance that has been previously universally accepted.\u003c/p>\n\u003cp>The question of whether this advice is still appropriate will be raised at a World Health Organization meeting next month in Geneva. A report prepared for that meeting—the agency’s expert committee on the selection and use of essential medicine—already notes that the recommendation isn’t backed by science.\u003c/p>\n\u003cp>In many cases “an argument can be made for stopping a course of antibiotics immediately after a bacterial infection has been ruled out … or when the signs and symptoms of a mild infection have disappeared,” suggests the report, which analyzed information campaigns designed to get the public on board with efforts to fight antibiotic resistance.\u003c/p>\n\u003cp>No one is doubting the lifesaving importance of antibiotics. They kill bacteria. But the more the bugs are exposed to the drugs, the more survival tricks the bacteria acquire. And the more resistant the bacteria become, the harder they are to treat.\u003c/p>\n\u003cp>The concern is that the growing number of bacteria that are resistant to multiple antibiotics will lead to more incurable infections that will threaten medicine’s ability to conduct routine procedures like hip replacements or open heart surgery without endangering lives.\u003c/p>\n\u003cp>So how did this faulty paradigm become entrenched in medical practice? The answer lies back in the 1940s, the dawn of antibiotic use.\u003c/p>\n\u003cp>At the time, resistance wasn’t a concern. After the first antibiotic, penicillin, was discovered, more and more gushed out of the pharmaceutical product pipeline.\u003c/p>\n\u003cp>Doctors were focused only on figuring out how to use the drugs effectively to save lives. An ethos emerged: Treat patients until they get better, and then for a little bit longer to be on the safe side. Around the same time, research on how to cure tuberculosis suggested that under-dosing patients was dangerous—the infection would come back.\u003c/p>\n\u003cp>The idea that stopping antibiotic treatment too quickly after symptoms went away might fuel resistance took hold.\u003c/p>\n\u003cp>“The problem is once it gets baked into culture, it’s really hard to excise it,” said Dr. Brad Spellberg, who is also an advocate for changing this advice. Spellberg is an infectious diseases specialist and chief medical officer at the Los Angeles County-University of Southern California Medical Center in Los Angeles.\u003c/p>\n\u003cp>We think of medicine as a science, guided by mountains of research. But doctors sometimes prescribe antibiotics based more on their experience and intuition than anything else. There are treatment guidelines for different infections, but some provide scant advice on how long to continue treatment, Rice acknowledged. And response to treatment will differ from patient to patient, depending on, among other things, how old they are, how strong their immune systems are, or how well they metabolize drugs.\u003c/p>\n\u003cp>There’s little incentive for pharmaceutical companies to conduct expensive studies aimed at finding the shortest duration of treatment for various conditions. But in the years since Rice first raised his concerns, the National Institutes of Health has been funding such research and almost invariably the ensuing studies have found that many infections can be cured more quickly than had been thought. Treatments that were once two weeks have been cut to one, 10 days have been reduced to seven and so on.\u003c/p>\n\u003cp>There have been occasional exceptions. Just before Christmas, scientists at the University of Pittsburgh reported that 10 days of treatment for otitis media—middle ear infections—was better than five days for children under 2 years of age.\u003c/p>\n\u003cp>It was a surprise, said Spellberg, who noted that studies looking at the same condition in children 2 and older show the shorter treatment works.\u003c/p>\n\u003cp>More of this work is needed, Rice said. “I’m not here saying that every infection can be treated for two days or three days. I’m just saying: Let’s figure it out.”\u003c/p>\n\u003cp>In the meantime, doctors and public health agencies are in a quandary. How do you put the new thinking into practice? And how do you advise the public? Doctors know full well some portion of people unilaterally decide to stop taking their antibiotics because they feel better. But that approach is not safe in all circumstances—for instance tuberculosis or bone infections. And it’s not an approach many physicians feel comfortable endorsing.\u003c/p>\n\u003cp>“This is a very tricky question. It’s not easy to make a blanket statement about this, and there isn’t a simple answer,” Dr. Lauri Hicks, director of the Centers for Disease Control and Prevention’s office of antibiotic stewardship, told STAT in an email.\u003c/p>\n\u003cp>“There are certain diagnoses for which shortening the course of antibiotic therapy is not recommended and/or potentially dangerous. … On the other hand, there are probably many situations for which antibiotic therapy is often prescribed for longer than necessary and the optimal duration is likely ‘until the patient gets better.’”\u003c/p>\n\u003cp>CDC’S Get Smart campaign, on appropriate antibiotic use, urges people never to skip doses or stop the drugs because they’re feeling better. But Hicks noted the CDC recently revised it to add “unless your healthcare professional tells you to do so” to that advice.\u003c/p>\n\u003cp>And that’s one way to deal with the situation, said Dr. James Johnson, a professor of infectious diseases medicine at the University of Minnesota and a specialist at the Minnesota VA Medical Center.\u003c/p>\n\u003cp>“In fact sometimes some of us give that instruction to patients. ‘Here, I’m going to prescribe you a week. My guess is you won’t need it more than, say, three days. If you’re all well in three days, stop then. If you’re not completely well, take it a little longer. But as soon as you feel fine, stop.’ And we can give them permission to do that.”\u003c/p>\n\u003cp>Spellberg is more comfortable with the idea of people checking back with their doctor before stopping their drugs — an approach that requires doctors to be willing to have that conversation. “You should call your doc and say ‘Hey, can I stop?’ … If your doctor won’t get on the phone with you for 20 seconds, you need to find another doctor.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This \u003ca href=\"https://www.statnews.com/2017/02/09/antibiotics-resistance-superbugs/\" target=\"_blank\" rel=\"noopener\">story\u003c/a> was originally published by STAT, an online publication of Boston Globe Media that covers health, medicine, and scientific discovery.\u003c/em>\u003c/p>\n\n",
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"excerpt": "You’ve heard it many times from your doctor: Even if you feel better, don’t stop taking your antibiotics until the pill vial is empty. But a growing number of experts say that advice is misguided.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>You’ve heard it many times before from your doctor: If you’re taking antibiotics, don’t stop taking them until the pill vial is empty, even if you feel better.\u003c/p>\n\u003caside class=\"pullquote alignright\">‘An argument can be made for stopping a course of antibiotics immediately after a bacterial infection has been ruled out … or when the signs and symptoms of a mild infection have disappeared.’\u003ccite>From a World Health Organization report\u003c/cite>\u003c/aside>\n\u003cp>The rationale behind this commandment has always been that stopping treatment too soon would fuel the development of antibiotic resistance—the ability of bugs to evade these drugs. Information campaigns aimed at getting the public to take antibiotics properly have been driving home this message for decades.\u003c/p>\n\u003cp>But the warning, a growing number of experts say, is misguided and may actually be exacerbating antibiotic resistance.\u003c/p>\n\u003cp>The reasoning is simple: Exposure to antibiotics is what drives bacteria to develop resistance. Taking drugs when you aren’t sick anymore simply gives the hordes of bacteria in and on your body more incentive to evolve to evade the drugs, so the next time you have an infection, they may not work.\u003c/p>\n\u003cp>The traditional reasoning from doctors “never made any sense. It doesn’t make any sense today,” Dr. Louis Rice, chairman of the department of medicine at the Warren Alpert Medical School at Brown University, told STAT.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Some colleagues credit Rice with being the first person to declare the emperor was wearing no clothes, and it is true that he challenged the dogma in lectures at major meetings of infectious diseases physicians and researchers in 2007 and 2008. A number of researchers now share his skepticism of health guidance that has been previously universally accepted.\u003c/p>\n\u003cp>The question of whether this advice is still appropriate will be raised at a World Health Organization meeting next month in Geneva. A report prepared for that meeting—the agency’s expert committee on the selection and use of essential medicine—already notes that the recommendation isn’t backed by science.\u003c/p>\n\u003cp>In many cases “an argument can be made for stopping a course of antibiotics immediately after a bacterial infection has been ruled out … or when the signs and symptoms of a mild infection have disappeared,” suggests the report, which analyzed information campaigns designed to get the public on board with efforts to fight antibiotic resistance.\u003c/p>\n\u003cp>No one is doubting the lifesaving importance of antibiotics. They kill bacteria. But the more the bugs are exposed to the drugs, the more survival tricks the bacteria acquire. And the more resistant the bacteria become, the harder they are to treat.\u003c/p>\n\u003cp>The concern is that the growing number of bacteria that are resistant to multiple antibiotics will lead to more incurable infections that will threaten medicine’s ability to conduct routine procedures like hip replacements or open heart surgery without endangering lives.\u003c/p>\n\u003cp>So how did this faulty paradigm become entrenched in medical practice? The answer lies back in the 1940s, the dawn of antibiotic use.\u003c/p>\n\u003cp>At the time, resistance wasn’t a concern. After the first antibiotic, penicillin, was discovered, more and more gushed out of the pharmaceutical product pipeline.\u003c/p>\n\u003cp>Doctors were focused only on figuring out how to use the drugs effectively to save lives. An ethos emerged: Treat patients until they get better, and then for a little bit longer to be on the safe side. Around the same time, research on how to cure tuberculosis suggested that under-dosing patients was dangerous—the infection would come back.\u003c/p>\n\u003cp>The idea that stopping antibiotic treatment too quickly after symptoms went away might fuel resistance took hold.\u003c/p>\n\u003cp>“The problem is once it gets baked into culture, it’s really hard to excise it,” said Dr. Brad Spellberg, who is also an advocate for changing this advice. Spellberg is an infectious diseases specialist and chief medical officer at the Los Angeles County-University of Southern California Medical Center in Los Angeles.\u003c/p>\n\u003cp>We think of medicine as a science, guided by mountains of research. But doctors sometimes prescribe antibiotics based more on their experience and intuition than anything else. There are treatment guidelines for different infections, but some provide scant advice on how long to continue treatment, Rice acknowledged. And response to treatment will differ from patient to patient, depending on, among other things, how old they are, how strong their immune systems are, or how well they metabolize drugs.\u003c/p>\n\u003cp>There’s little incentive for pharmaceutical companies to conduct expensive studies aimed at finding the shortest duration of treatment for various conditions. But in the years since Rice first raised his concerns, the National Institutes of Health has been funding such research and almost invariably the ensuing studies have found that many infections can be cured more quickly than had been thought. Treatments that were once two weeks have been cut to one, 10 days have been reduced to seven and so on.\u003c/p>\n\u003cp>There have been occasional exceptions. Just before Christmas, scientists at the University of Pittsburgh reported that 10 days of treatment for otitis media—middle ear infections—was better than five days for children under 2 years of age.\u003c/p>\n\u003cp>It was a surprise, said Spellberg, who noted that studies looking at the same condition in children 2 and older show the shorter treatment works.\u003c/p>\n\u003cp>More of this work is needed, Rice said. “I’m not here saying that every infection can be treated for two days or three days. I’m just saying: Let’s figure it out.”\u003c/p>\n\u003cp>In the meantime, doctors and public health agencies are in a quandary. How do you put the new thinking into practice? And how do you advise the public? Doctors know full well some portion of people unilaterally decide to stop taking their antibiotics because they feel better. But that approach is not safe in all circumstances—for instance tuberculosis or bone infections. And it’s not an approach many physicians feel comfortable endorsing.\u003c/p>\n\u003cp>“This is a very tricky question. It’s not easy to make a blanket statement about this, and there isn’t a simple answer,” Dr. Lauri Hicks, director of the Centers for Disease Control and Prevention’s office of antibiotic stewardship, told STAT in an email.\u003c/p>\n\u003cp>“There are certain diagnoses for which shortening the course of antibiotic therapy is not recommended and/or potentially dangerous. … On the other hand, there are probably many situations for which antibiotic therapy is often prescribed for longer than necessary and the optimal duration is likely ‘until the patient gets better.’”\u003c/p>\n\u003cp>CDC’S Get Smart campaign, on appropriate antibiotic use, urges people never to skip doses or stop the drugs because they’re feeling better. But Hicks noted the CDC recently revised it to add “unless your healthcare professional tells you to do so” to that advice.\u003c/p>\n\u003cp>And that’s one way to deal with the situation, said Dr. James Johnson, a professor of infectious diseases medicine at the University of Minnesota and a specialist at the Minnesota VA Medical Center.\u003c/p>\n\u003cp>“In fact sometimes some of us give that instruction to patients. ‘Here, I’m going to prescribe you a week. My guess is you won’t need it more than, say, three days. If you’re all well in three days, stop then. If you’re not completely well, take it a little longer. But as soon as you feel fine, stop.’ And we can give them permission to do that.”\u003c/p>\n\u003cp>Spellberg is more comfortable with the idea of people checking back with their doctor before stopping their drugs — an approach that requires doctors to be willing to have that conversation. “You should call your doc and say ‘Hey, can I stop?’ … If your doctor won’t get on the phone with you for 20 seconds, you need to find another doctor.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>Protesters opposed to — and in support of — abortion clashed outside the Planned Parenthood clinic in San Francisco on Saturday, arguing over whether taxpayer money should go to a women’s health organization that provides abortion.\u003c/p>\n\u003cp>“We think that the other side has some valid concerns about women’s health,” said Terrisa Bukovinac, president of Pro-Life Future of San Francisco. “However, we are absolutely not OK with federal funds going to an organization that profits from human demise.”\u003c/p>\n\u003cp>The rally was one of 200 organized across the country — about 30 of them in California — by anti-abortion activists, urging Congress to cut federal funding to Planned Parenthood. In several locations, including Denver and St. Paul, Minnesota, demonstrators were outnumbered by counterprotesters.\u003c/p>\n\u003cp>In California, Planned Parenthood clinics receive $260 million per year in federal funds, though that money is restricted to providing birth control counseling, STD testing and cervical cancer screening — not abortion.\u003c/p>\n\u003cp>Outside the San Francisco clinic on Valencia Street, about 40 anti-abortion protesters prayed and sang “Ave Maria,” while more than 200 counterprotesters gathered on the other side of the sidewalk, shouting slogans like, “Pro-life, that’s a lie! You don’t care if women die!”\u003c/p>\n\u003cblockquote class=\"twitter-tweet\" data-width=\"550\" data-dnt=\"true\">\n\u003cp lang=\"en\" dir=\"ltr\">Protestors on both sides of the abortion debate protest in front of the San Francisco Planned Parenthood clinic (via \u003ca href=\"https://twitter.com/adembosky?ref_src=twsrc%5Etfw\">@adembosky\u003c/a>) \u003ca href=\"https://t.co/vTOy1XbE3W\">pic.twitter.com/vTOy1XbE3W\u003c/a>\u003c/p>\n\u003cp>— KQED News (@KQEDnews) \u003ca href=\"https://twitter.com/KQEDnews/status/830548075282247680?ref_src=twsrc%5Etfw\">February 11, 2017\u003c/a>\u003c/p>\u003c/blockquote>\n\u003cp>\u003cscript async src=\"https://platform.twitter.com/widgets.js\" charset=\"utf-8\">\u003c/script>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Women on both sides wore T-shirts that said, “This is what a feminist looks like,” including Bukovinac. She said even though the back and forth got tense at times, she welcomed it.\u003c/p>\n\u003cp>“Rarely do we see a significant counterprotest. It’s almost always just us talking to ourselves, which is kind of pointless because we want to be having this national discussion,” she said. “It’s exciting to see people coming out who are also passionate about what they believe in, just like we are.”\u003c/p>\n\u003cp>A few Planned Parenthood supporters walked down the sidewalk waving $20 bills at the protesters, then went into the clinic to make a donation.\u003c/p>\n\u003cp>“This Planned Parenthood was definitely there for me as a young woman and I believe it should be there for all women anywhere,” said pro-abortion rights protester Marian Doub. “I watch the anti-choice people out here periodically and don’t feel like we’ve done enough to counter their movement. We need to step it up.”\u003c/p>\n\u003cp>Police were careful to keep protesters on either side of the sidewalk away from each other. But one anti-abortion demonstrator, Eva Muntean, broke away at the request of two young women on the pro-abortion rights side. They talked for 20 minutes, sharing their views and personal stories, debating policy and statistics. In the end, no minds were changed, no opinions swayed. But they thanked each other for the civil conversation.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“I totally respect their right to be here,” Muntean said. “I wouldn’t want it any other way.”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Protesters opposed to — and in support of — abortion clashed outside the Planned Parenthood clinic in San Francisco on Saturday, arguing over whether taxpayer money should go to a women’s health organization that provides abortion.\u003c/p>\n\u003cp>“We think that the other side has some valid concerns about women’s health,” said Terrisa Bukovinac, president of Pro-Life Future of San Francisco. “However, we are absolutely not OK with federal funds going to an organization that profits from human demise.”\u003c/p>\n\u003cp>The rally was one of 200 organized across the country — about 30 of them in California — by anti-abortion activists, urging Congress to cut federal funding to Planned Parenthood. In several locations, including Denver and St. Paul, Minnesota, demonstrators were outnumbered by counterprotesters.\u003c/p>\n\u003cp>In California, Planned Parenthood clinics receive $260 million per year in federal funds, though that money is restricted to providing birth control counseling, STD testing and cervical cancer screening — not abortion.\u003c/p>\n\u003cp>Outside the San Francisco clinic on Valencia Street, about 40 anti-abortion protesters prayed and sang “Ave Maria,” while more than 200 counterprotesters gathered on the other side of the sidewalk, shouting slogans like, “Pro-life, that’s a lie! You don’t care if women die!”\u003c/p>\n\u003cblockquote class=\"twitter-tweet\" data-width=\"550\" data-dnt=\"true\">\n\u003cp lang=\"en\" dir=\"ltr\">Protestors on both sides of the abortion debate protest in front of the San Francisco Planned Parenthood clinic (via \u003ca href=\"https://twitter.com/adembosky?ref_src=twsrc%5Etfw\">@adembosky\u003c/a>) \u003ca href=\"https://t.co/vTOy1XbE3W\">pic.twitter.com/vTOy1XbE3W\u003c/a>\u003c/p>\n\u003cp>— KQED News (@KQEDnews) \u003ca href=\"https://twitter.com/KQEDnews/status/830548075282247680?ref_src=twsrc%5Etfw\">February 11, 2017\u003c/a>\u003c/p>\u003c/blockquote>\n\u003cp>\u003cscript async src=\"https://platform.twitter.com/widgets.js\" charset=\"utf-8\">\u003c/script>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Women on both sides wore T-shirts that said, “This is what a feminist looks like,” including Bukovinac. She said even though the back and forth got tense at times, she welcomed it.\u003c/p>\n\u003cp>“Rarely do we see a significant counterprotest. It’s almost always just us talking to ourselves, which is kind of pointless because we want to be having this national discussion,” she said. “It’s exciting to see people coming out who are also passionate about what they believe in, just like we are.”\u003c/p>\n\u003cp>A few Planned Parenthood supporters walked down the sidewalk waving $20 bills at the protesters, then went into the clinic to make a donation.\u003c/p>\n\u003cp>“This Planned Parenthood was definitely there for me as a young woman and I believe it should be there for all women anywhere,” said pro-abortion rights protester Marian Doub. “I watch the anti-choice people out here periodically and don’t feel like we’ve done enough to counter their movement. We need to step it up.”\u003c/p>\n\u003cp>Police were careful to keep protesters on either side of the sidewalk away from each other. But one anti-abortion demonstrator, Eva Muntean, broke away at the request of two young women on the pro-abortion rights side. They talked for 20 minutes, sharing their views and personal stories, debating policy and statistics. In the end, no minds were changed, no opinions swayed. But they thanked each other for the civil conversation.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“I totally respect their right to be here,” Muntean said. “I wouldn’t want it any other way.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>On the health tech beat, you often meet, broadly, two types of people. First, there are lots of very smart people who think we have the know-how to achieve a kind of big-data, perpetual-monitoring, digital-health paradise -- or at least something better than we have now.\u003c/p>\n\u003cp>Then there are some other, equally smart folks who think that particular vision is fueled by too much Silicon Valley dreamin' and too little attention to the basics of health care access and smart policy.\u003c/p>\n\u003cp>Dr. Daniel Kraft is closer to the former category. Dr. Kraft put in an \u003ca href=\"https://ww2.kqed.org/forum/2017/01/24/first-person-daniel-kraft-on-the-next-stage-of-medical-technology/\" target=\"_blank\">appearance\u003c/a> on KQED's Forum radio program recently to discuss cutting edge health tech. Kraft is the chair of medicine at Singularity University, a technology think tank, \u003ca href=\"https://techcrunch.com/2015/09/30/singularity-university-launches-accelerator/\" target=\"_blank\">startup accelerator\u003c/a> and educational organization that looks to \"leverage rapidly accelerating technologies\" to find solutions on a global scale.\u003c/p>\n\u003cp>Kraft and Forum host Michael Krasny talked about the effects of new and prospective technologies, from virtual reality's impact on medical education to the \"Uberization\" of health care. Below are excerpts of Kraft's answers, edited for length and clarity.\u003c/p>\n\u003cp>\u003cstrong>The Uberization of Health Care\u003c/strong>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Everyone is familiar with \u003ca href=\"https://ww2.kqed.org/news/tag/uber/\" target=\"_blank\">Uber as disruptive\u003c/a>. But they couldn’t have existed 10-plus years ago, without smartphones, GPS, online payments--they connected the dots.\u003c/p>\n\u003cp>We all want that ease and transparency of use that we’re used to with Uber. And we’re seeing that kind of mindset come not just to millennials but to \u003ca href=\"https://www.google.com/search?q=senior+citizens+digital+health+care\" target=\"_blank\">older folks\u003c/a> who want access to their clinical data and doctor. There are several companies that have launched apps where you press a button and a doctor will come to you within three hours. Uber itself did a pilot in New York where you press a button and a nurse will come and \u003ca href=\"http://fortune.com/2016/10/25/uber-free-flu-shots/\" target=\"_blank\">give you\u003c/a> a flu shot. This ease-of-access mindset is coming across in many parts of health care, including \u003ca href=\"http://www.cnbc.com/2016/05/16/digital-focused-pharmacy-capsule-opens-in-new-york.html\" target=\"_blank\">delivering your drugs\u003c/a>, whether it's by Uber, Lyft or drone.\u003c/p>\n\u003cp>\u003cstrong>The Potential of Digital Health Data\u003c/strong>\u003c/p>\n\u003cp>We’re in this age of exponential data, but how do you make it useful to you as a consumer, patient and physician? A lot of digital devices get \u003ca href=\"https://ww2.kqed.org/futureofyou/2016/10/10/fitbit-study/\" target=\"_blank\">left in a drawer\u003c/a> after a month or so; the trick is to make them engaging.\u003c/p>\n\u003cp>We practice sick care today, spending most of our time and money on folks who already have disease. But we can really move to more proactive, continuous health care using some of these tools.\u003c/p>\n\u003cp>In the future we’ll have individualized check engine lights. Your information will be synthesized so that a warning light can say, \"Hey, time to come in for a checkup before you blow a gasket.\"\u003c/p>\n\u003cp>\u003cstrong>Digital Mental Health Tools\u003c/strong>\u003c/p>\n\u003cp>With some wearables and other technologies we can now get a pulse on our behaviors. Right now I’m wearing a couple of devices that \u003ca href=\"http://sleepjunkies.com/features/the-ultimate-guide-to-sleep-tracking/\" target=\"_blank\">track my sleep\u003c/a>. I have a ring that can do this; I have a sensor on my mattress. Just getting insight into how you sleep can have a huge impact on health and wellness over the long term.\u003c/p>\n\u003cp>It’s the same thing for depression and anxiety. We’re seeing companies that can be a platform for mental health progression. For example, for bipolar patients, if you’re depressed and not moving much and staying in the house, some of these \u003ca href=\"http://www.nature.com/news/mental-health-there-s-an-app-for-that-1.19694\">new platforms\u003c/a> allow you to access your care team and your family, so you can get a digital hug when you might need one.\u003c/p>\n\u003cp>\u003cstrong>Virtual and Augmented Reality\u003c/strong>\u003c/p>\n\u003cp>Physicians today spend twice as much time typing in their medical records than they do with patients. So one of the best applications is using Google Glass or a similar product so physicians can see their patients and view data but have someone else act as a virtual \u003ca href=\"http://www.healthcare-informatics.com/article/ehr/how-virtual-scribe-enhancing-doctor-patient-relationship\" target=\"_blank\">scribe\u003c/a>.\u003c/p>\n\u003cp>We’re seeing now how Oculus Rift can help medical students \u003ca href=\"http://www.roadtovr.com/vr-human-anatomy-to-give-medical-students-a-hands-on-using-oculus-touch/\" target=\"_blank\">learn anatomy\u003c/a>, allowing them to fly through the heart or the brain. We’re seeing ways to use VR to \u003ca href=\"https://ww2.kqed.org/futureofyou/2015/05/28/how-virtual-reality-worlds-can-help-reduce-pain/\" target=\"_blank\">treat burn patients\u003c/a> who have undergone painful surgeries; they're put into a cold environment where they get to throw snowballs, and it diminishes their pain and their need for opiates. And kids with autism can now \u003ca href=\"https://ww2.kqed.org/futureofyou/2016/04/08/google-glass-flopped-but-kids-with-autism-are-using-it-to-learn-emotions/\" target=\"_blank\">put on Google Glass\u003c/a> and learn to recognize facial emotions.\u003c/p>\n\u003cp>\u003cstrong>Health Screening Tools\u003c/strong>\u003c/p>\n\u003cp>Part of the future will be to use new screening tools: app-based eye-tracking devices, blood-based diagnostics, brain scans that might pick up dementia 10 or 15 years early. There are drugs in development that might stop or reverse plaques when you’re at stage 0, before you have symptoms.\u003c/p>\n\u003cp>Even with your 23andme data, primary care doctors could gain some insights--when to screen you or \u003ca href=\"http://www.npr.org/sections/health-shots/2015/09/01/436584534/are-statins-bad-for-me-personalized-medicine-cant-yet-say\" target=\"_blank\">what statin drugs\u003c/a> may work best for you, based on your \u003ca href=\"https://ghr.nlm.nih.gov/primer/genomicresearch/pharmacogenomics\" target=\"_blank\">pharmacogenomics\u003c/a>. The challenge is a lot of this information doesn’t flow to your physicians; they’re not incentivized to use it, and in some cases they're dis-incentivized.\u003c/p>\n\u003cp>\u003cstrong>Health Care vs. Technology Care\u003c/strong>\u003c/p>\n\u003cp>Folks talk about robot physicians or the app \u003ca href=\"https://ww2.kqed.org/futureofyou/2016/11/07/AI-computers-diagnosis-watson/\" target=\"_blank\">taking over\u003c/a> your medical care. I think it’s going to be more of a blend, not just AI but IA, intelligence augmentation. So in fields like \u003ca href=\"https://ww2.kqed.org/futureofyou/2016/10/25/technology-radiology/\" target=\"_blank\">radiology\u003c/a> or dermatology or pathology, where clinicians are trained to see patterns, now machine learning can arguably do that faster and better, and that can augment a primary care doctor in screening you for melanoma, for example.\u003c/p>\n\u003cp>We’re seeing the ability to do triage with \u003ca href=\"http://www.theverge.com/2016/10/11/13240434/baidu-medical-chatbot-china-melody\" target=\"_blank\">chatbots\u003c/a>, which you might access from your phone and help you do the first steps. I’ve got a few \u003ca href=\"http://tricorder.xprize.org/teams/final-frontier-medical-devices\" target=\"_blank\">medical tricorders\u003c/a>, inspired by \"Star Trek,\" with me. So at home or in your pocket you can literally pull down advanced vital signs that synch up with your phone and connect to your clinicians, and AI agents can help you understand where you are in your baseline and the way things are moving.\u003c/p>\n\u003cp>We don’t need to replace doctors, but maybe every visit \u003ca href=\"https://ww2.kqed.org/futureofyou/2016/02/03/virtual_care_clinic_usc/\" target=\"_blank\">doesn’t need\u003c/a> to require you to take off half a day of work, sit in the waiting room and fill out the same form. You might use your smartphone for a follow-up appointment to look at a wound from surgery, or to check on a suspicious skin lesion. As cost pressures go, we’ll be seeing more and more payment for some of these \u003ca href=\"http://www.huffingtonpost.ca/jacki-andre/health-care-telemedicine_b_14632688.html\" target=\"_blank\">telehealth\u003c/a> platforms.\u003c/p>\n\u003cp>\u003cstrong>Pediatrics and Technology \u003c/strong>\u003c/p>\n\u003cp>There's a lot of new tech coming for pregnant women and children. A connected otoscope can enable you to track kids with ear infections at home, so you don't have to drag them back to the doctor. We’re seeing sensored cribs or infant ankle bracelets, sort of a Fitbit for babies, which can help reassure worried parents or enable a physician to send a child home earlier when they're at risk of SIDS or asthma.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>More on \u003ca href=\"https://su.org/\" target=\"_blank\">Singularity University\u003c/a> and what it calls \u003ca href=\"https://exponential.singularityu.org/medicine/\" target=\"_blank\">exponential medicine here\u003c/a>.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>On the health tech beat, you often meet, broadly, two types of people. First, there are lots of very smart people who think we have the know-how to achieve a kind of big-data, perpetual-monitoring, digital-health paradise -- or at least something better than we have now.\u003c/p>\n\u003cp>Then there are some other, equally smart folks who think that particular vision is fueled by too much Silicon Valley dreamin' and too little attention to the basics of health care access and smart policy.\u003c/p>\n\u003cp>Dr. Daniel Kraft is closer to the former category. Dr. Kraft put in an \u003ca href=\"https://ww2.kqed.org/forum/2017/01/24/first-person-daniel-kraft-on-the-next-stage-of-medical-technology/\" target=\"_blank\">appearance\u003c/a> on KQED's Forum radio program recently to discuss cutting edge health tech. Kraft is the chair of medicine at Singularity University, a technology think tank, \u003ca href=\"https://techcrunch.com/2015/09/30/singularity-university-launches-accelerator/\" target=\"_blank\">startup accelerator\u003c/a> and educational organization that looks to \"leverage rapidly accelerating technologies\" to find solutions on a global scale.\u003c/p>\n\u003cp>Kraft and Forum host Michael Krasny talked about the effects of new and prospective technologies, from virtual reality's impact on medical education to the \"Uberization\" of health care. Below are excerpts of Kraft's answers, edited for length and clarity.\u003c/p>\n\u003cp>\u003cstrong>The Uberization of Health Care\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Everyone is familiar with \u003ca href=\"https://ww2.kqed.org/news/tag/uber/\" target=\"_blank\">Uber as disruptive\u003c/a>. But they couldn’t have existed 10-plus years ago, without smartphones, GPS, online payments--they connected the dots.\u003c/p>\n\u003cp>We all want that ease and transparency of use that we’re used to with Uber. And we’re seeing that kind of mindset come not just to millennials but to \u003ca href=\"https://www.google.com/search?q=senior+citizens+digital+health+care\" target=\"_blank\">older folks\u003c/a> who want access to their clinical data and doctor. There are several companies that have launched apps where you press a button and a doctor will come to you within three hours. Uber itself did a pilot in New York where you press a button and a nurse will come and \u003ca href=\"http://fortune.com/2016/10/25/uber-free-flu-shots/\" target=\"_blank\">give you\u003c/a> a flu shot. This ease-of-access mindset is coming across in many parts of health care, including \u003ca href=\"http://www.cnbc.com/2016/05/16/digital-focused-pharmacy-capsule-opens-in-new-york.html\" target=\"_blank\">delivering your drugs\u003c/a>, whether it's by Uber, Lyft or drone.\u003c/p>\n\u003cp>\u003cstrong>The Potential of Digital Health Data\u003c/strong>\u003c/p>\n\u003cp>We’re in this age of exponential data, but how do you make it useful to you as a consumer, patient and physician? A lot of digital devices get \u003ca href=\"https://ww2.kqed.org/futureofyou/2016/10/10/fitbit-study/\" target=\"_blank\">left in a drawer\u003c/a> after a month or so; the trick is to make them engaging.\u003c/p>\n\u003cp>We practice sick care today, spending most of our time and money on folks who already have disease. But we can really move to more proactive, continuous health care using some of these tools.\u003c/p>\n\u003cp>In the future we’ll have individualized check engine lights. Your information will be synthesized so that a warning light can say, \"Hey, time to come in for a checkup before you blow a gasket.\"\u003c/p>\n\u003cp>\u003cstrong>Digital Mental Health Tools\u003c/strong>\u003c/p>\n\u003cp>With some wearables and other technologies we can now get a pulse on our behaviors. Right now I’m wearing a couple of devices that \u003ca href=\"http://sleepjunkies.com/features/the-ultimate-guide-to-sleep-tracking/\" target=\"_blank\">track my sleep\u003c/a>. I have a ring that can do this; I have a sensor on my mattress. Just getting insight into how you sleep can have a huge impact on health and wellness over the long term.\u003c/p>\n\u003cp>It’s the same thing for depression and anxiety. We’re seeing companies that can be a platform for mental health progression. For example, for bipolar patients, if you’re depressed and not moving much and staying in the house, some of these \u003ca href=\"http://www.nature.com/news/mental-health-there-s-an-app-for-that-1.19694\">new platforms\u003c/a> allow you to access your care team and your family, so you can get a digital hug when you might need one.\u003c/p>\n\u003cp>\u003cstrong>Virtual and Augmented Reality\u003c/strong>\u003c/p>\n\u003cp>Physicians today spend twice as much time typing in their medical records than they do with patients. So one of the best applications is using Google Glass or a similar product so physicians can see their patients and view data but have someone else act as a virtual \u003ca href=\"http://www.healthcare-informatics.com/article/ehr/how-virtual-scribe-enhancing-doctor-patient-relationship\" target=\"_blank\">scribe\u003c/a>.\u003c/p>\n\u003cp>We’re seeing now how Oculus Rift can help medical students \u003ca href=\"http://www.roadtovr.com/vr-human-anatomy-to-give-medical-students-a-hands-on-using-oculus-touch/\" target=\"_blank\">learn anatomy\u003c/a>, allowing them to fly through the heart or the brain. We’re seeing ways to use VR to \u003ca href=\"https://ww2.kqed.org/futureofyou/2015/05/28/how-virtual-reality-worlds-can-help-reduce-pain/\" target=\"_blank\">treat burn patients\u003c/a> who have undergone painful surgeries; they're put into a cold environment where they get to throw snowballs, and it diminishes their pain and their need for opiates. And kids with autism can now \u003ca href=\"https://ww2.kqed.org/futureofyou/2016/04/08/google-glass-flopped-but-kids-with-autism-are-using-it-to-learn-emotions/\" target=\"_blank\">put on Google Glass\u003c/a> and learn to recognize facial emotions.\u003c/p>\n\u003cp>\u003cstrong>Health Screening Tools\u003c/strong>\u003c/p>\n\u003cp>Part of the future will be to use new screening tools: app-based eye-tracking devices, blood-based diagnostics, brain scans that might pick up dementia 10 or 15 years early. There are drugs in development that might stop or reverse plaques when you’re at stage 0, before you have symptoms.\u003c/p>\n\u003cp>Even with your 23andme data, primary care doctors could gain some insights--when to screen you or \u003ca href=\"http://www.npr.org/sections/health-shots/2015/09/01/436584534/are-statins-bad-for-me-personalized-medicine-cant-yet-say\" target=\"_blank\">what statin drugs\u003c/a> may work best for you, based on your \u003ca href=\"https://ghr.nlm.nih.gov/primer/genomicresearch/pharmacogenomics\" target=\"_blank\">pharmacogenomics\u003c/a>. The challenge is a lot of this information doesn’t flow to your physicians; they’re not incentivized to use it, and in some cases they're dis-incentivized.\u003c/p>\n\u003cp>\u003cstrong>Health Care vs. Technology Care\u003c/strong>\u003c/p>\n\u003cp>Folks talk about robot physicians or the app \u003ca href=\"https://ww2.kqed.org/futureofyou/2016/11/07/AI-computers-diagnosis-watson/\" target=\"_blank\">taking over\u003c/a> your medical care. I think it’s going to be more of a blend, not just AI but IA, intelligence augmentation. So in fields like \u003ca href=\"https://ww2.kqed.org/futureofyou/2016/10/25/technology-radiology/\" target=\"_blank\">radiology\u003c/a> or dermatology or pathology, where clinicians are trained to see patterns, now machine learning can arguably do that faster and better, and that can augment a primary care doctor in screening you for melanoma, for example.\u003c/p>\n\u003cp>We’re seeing the ability to do triage with \u003ca href=\"http://www.theverge.com/2016/10/11/13240434/baidu-medical-chatbot-china-melody\" target=\"_blank\">chatbots\u003c/a>, which you might access from your phone and help you do the first steps. I’ve got a few \u003ca href=\"http://tricorder.xprize.org/teams/final-frontier-medical-devices\" target=\"_blank\">medical tricorders\u003c/a>, inspired by \"Star Trek,\" with me. So at home or in your pocket you can literally pull down advanced vital signs that synch up with your phone and connect to your clinicians, and AI agents can help you understand where you are in your baseline and the way things are moving.\u003c/p>\n\u003cp>We don’t need to replace doctors, but maybe every visit \u003ca href=\"https://ww2.kqed.org/futureofyou/2016/02/03/virtual_care_clinic_usc/\" target=\"_blank\">doesn’t need\u003c/a> to require you to take off half a day of work, sit in the waiting room and fill out the same form. You might use your smartphone for a follow-up appointment to look at a wound from surgery, or to check on a suspicious skin lesion. As cost pressures go, we’ll be seeing more and more payment for some of these \u003ca href=\"http://www.huffingtonpost.ca/jacki-andre/health-care-telemedicine_b_14632688.html\" target=\"_blank\">telehealth\u003c/a> platforms.\u003c/p>\n\u003cp>\u003cstrong>Pediatrics and Technology \u003c/strong>\u003c/p>\n\u003cp>There's a lot of new tech coming for pregnant women and children. A connected otoscope can enable you to track kids with ear infections at home, so you don't have to drag them back to the doctor. We’re seeing sensored cribs or infant ankle bracelets, sort of a Fitbit for babies, which can help reassure worried parents or enable a physician to send a child home earlier when they're at risk of SIDS or asthma.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>More on \u003ca href=\"https://su.org/\" target=\"_blank\">Singularity University\u003c/a> and what it calls \u003ca href=\"https://exponential.singularityu.org/medicine/\" target=\"_blank\">exponential medicine here\u003c/a>.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Contra Costa County began its annual homeless count Thursday, and volunteers spread out looking for people like Jarrett Keesling, who is living in an encampment in Concord. They need to find out where he lives and what he needs.\u003c/p>\n\u003cp>“I need to get my license or see if I can get my license. Get an ID, that would be a definite start,” Keesling said. “It’s just transportation — transportation would make things so much easier.\u003c/p>\n\u003cfigure id=\"attachment_11287990\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-11287990 size-medium\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2017/01/20170126_CC_county_homeless_count_154-800x533.jpg\" alt=\"Contra Costa Health Services worker Shayne Kaleo hugs Jarrett Keesling, who is among the hundreds of homeless CCHS interacted with as it conducts its annual count of homeless county residents Thursday, Jan. 26, 2017 in Contra Costa County. CCHS' Division of Health, Housing and Homeless Services, its community partners and volunteers documented both sheltered and unsheltered people in the area who need permanent housing.\" width=\"800\" height=\"533\">\u003cfigcaption class=\"wp-caption-text\">Contra Costa Health Services worker Shayne Kaleo hugs Jarrett Keesling, who is among the hundreds of homeless CCHS interacted with as it conducts its annual count of homeless county residents Thursday, Jan. 26, 2017, in Contra Costa County. CCHS’s Division of Health, Housing and Homeless Services, its community partners and volunteers documented people in the area. \u003ccite>(Eric Kayne/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The \u003ca href=\"https://cchealth.org/homeless/\" target=\"_blank\" rel=\"noopener\">Contra Costa Health Services Division of Health, Housing and Homeless Services\u003c/a>, its community partners and volunteers began documenting hundreds of homeless people in the county — both sheltered and unsheltered — who need permanent housing.\u003c/p>\n\u003cp>CCHS reported during its 2016 count that approximately 3,500 people across the county identified as homeless. Data from the 2017 homeless survey, which wraps up Friday, will not be available for several weeks.\u003c/p>\n\u003cfigure id=\"attachment_11287983\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-11287983 size-medium\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2017/01/20170126_CC_county_homeless_count_119-800x533.jpg\" alt=\"Members of Contra Costa Health Services prepare to hand out bedding as it conducts its annual count of homeless county residents Thursday, Jan. 26, 2017 in Contra Costa County. CCHS's Division of Health, Housing and Homeless Services, its community partners and volunteers documented both sheltered and unsheltered people in the area who need permanent housing.\" width=\"800\" height=\"533\">\u003cfigcaption class=\"wp-caption-text\">Members of Contra Costa Health Services prepare to hand out bedding as they conduct an annual count of homeless county residents Thursday, Jan. 26, 2017, in Contra Costa County. \u003ccite>(Eric Kayne/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Contra Costa County’s overall homeless population dropped in 2016, but there were some places where it increased, like in the far eastern suburbs.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“We do anticipate that the numbers will continue to be highest in east Contra Costa County. However, we have not made any predictions as to whether or not we’ll see an overall increase in homelessness,” said Lavonna Martin, Contra Costa County’s homeless services chief.\u003c/p>\n\u003cfigure id=\"attachment_11287987\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11287987\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2017/01/20170126_CC_county_homeless_count_185-800x533.jpg\" alt=\"The homeless camp of Jarrett Keesling and Kelli Lengele, whom are among the hundreds of homeless Contra Costa Health Services (CCHS) interacted with as it conducts its annual count of homeless county residents Thursday, Jan. 26, 2017 in Contra Costa County. CCHSÕs Division of Health, Housing and Homeless Services, its community partners and volunteers documented both sheltered and unsheltered people in the area who need permanent housing.\" width=\"800\" height=\"533\">\u003cfigcaption class=\"wp-caption-text\">The homeless camp of Jarrett Keesling and Kelli Lengele, who are among the hundreds of homeless Contra Costa Health Services (CCHS) interacted with as it conducts its annual count of homeless county residents Thursday, Jan. 26, 2017, in Contra Costa County. \u003ccite>(Eric Kayne/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The county has struggled to serve eastern Contra Costa as the population has quickly grown.\u003c/p>\n\u003cfigure id=\"attachment_11287986\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-11287986 size-medium\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2017/01/20170126_CC_county_homeless_count_041-800x533.jpg\" alt=\"Jarrett Keesling, left, and Kelli Lengele, are among the hundreds of homeless Contra Costa Health Services (CCHS) interacted with as it conducts its annual count of homeless county residents Thursday, Jan. 26, 2017 in Contra Costa County.\" width=\"800\" height=\"533\">\u003cfigcaption class=\"wp-caption-text\">Jarrett Keesling, left, and Kelli Lengele are among the hundreds of homeless Contra Costa Health Services (CCHS) interacted with as it conducts its annual count of homeless county residents Thursday, Jan. 26, 2017, in Contra Costa County. \u003ccite>(Eric Kayne/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cfigure id=\"attachment_11289119\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11289119\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/01/RS23881_20170126_CC_county_homeless_count_234-800x533.jpg\" alt=\"A trucker looks down upon the homeless camp of Jarrett Keesling and Kelli Lengele, whom are among the hundreds of homeless Contra Costa Health Services (CCHS) interacted with as it conducts its annual count of homeless county residents Thursday, Jan. 26, 2017 in Contra Costa County. \" width=\"800\" height=\"533\">\u003cfigcaption class=\"wp-caption-text\">A trucker looks down upon the homeless camp of Jarrett Keesling and Kelli Lengele, who are among the hundreds of homeless Contra Costa Health Services (CCHS) interacted with as it conducts its annual count of homeless county residents Thursday, Jan. 26, 2017, in Contra Costa County. \u003ccite>(Eric Kayne/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Many Bay Area counties are launching homeless surveys. San Francisco launched its count Thursday night and Alameda County will begin its census on Jan. 31.\u003c/p>\n\u003cfigure id=\"attachment_11287980\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11287980\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2017/01/20170126_CC_county_homeless_count_016-800x533.jpg\" alt=\"Members of Contra Costa Health Services (CCHS) walk to a homeless encampment to conduct its annual count of homeless county residents Thursday, Jan. 26, 2017 in Contra Costa County. CCHSÕs Division of Health, Housing and Homeless Services, its community partners and volunteers documented both sheltered and unsheltered people in the area who need permanent housing.\" width=\"800\" height=\"533\">\u003cfigcaption class=\"wp-caption-text\">Members of Contra Costa Health Services (CCHS) walk to a homeless encampment to conduct its annual count of homeless county residents Thursday, Jan. 26, 2017, in Contra Costa County. \u003ccite>(Eric Kayne/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>\u003ca href=\"http://erickayne.com/\" target=\"_blank\" rel=\"noopener\">Eric Kayne\u003c/a> is an award-winning photojournalist who has worked for the Houston Chronicle, Dallas Morning News and Seattle Times. KQED’s Devin Katayama contributed to this post.\u003c/em>\u003c/p>\n\n",
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"excerpt": "The county's overall homeless population dropped in 2016, but there were some places where it increased, like in the far eastern suburbs.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Contra Costa County began its annual homeless count Thursday, and volunteers spread out looking for people like Jarrett Keesling, who is living in an encampment in Concord. They need to find out where he lives and what he needs.\u003c/p>\n\u003cp>“I need to get my license or see if I can get my license. Get an ID, that would be a definite start,” Keesling said. “It’s just transportation — transportation would make things so much easier.\u003c/p>\n\u003cfigure id=\"attachment_11287990\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-11287990 size-medium\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2017/01/20170126_CC_county_homeless_count_154-800x533.jpg\" alt=\"Contra Costa Health Services worker Shayne Kaleo hugs Jarrett Keesling, who is among the hundreds of homeless CCHS interacted with as it conducts its annual count of homeless county residents Thursday, Jan. 26, 2017 in Contra Costa County. CCHS' Division of Health, Housing and Homeless Services, its community partners and volunteers documented both sheltered and unsheltered people in the area who need permanent housing.\" width=\"800\" height=\"533\">\u003cfigcaption class=\"wp-caption-text\">Contra Costa Health Services worker Shayne Kaleo hugs Jarrett Keesling, who is among the hundreds of homeless CCHS interacted with as it conducts its annual count of homeless county residents Thursday, Jan. 26, 2017, in Contra Costa County. CCHS’s Division of Health, Housing and Homeless Services, its community partners and volunteers documented people in the area. \u003ccite>(Eric Kayne/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The \u003ca href=\"https://cchealth.org/homeless/\" target=\"_blank\" rel=\"noopener\">Contra Costa Health Services Division of Health, Housing and Homeless Services\u003c/a>, its community partners and volunteers began documenting hundreds of homeless people in the county — both sheltered and unsheltered — who need permanent housing.\u003c/p>\n\u003cp>CCHS reported during its 2016 count that approximately 3,500 people across the county identified as homeless. Data from the 2017 homeless survey, which wraps up Friday, will not be available for several weeks.\u003c/p>\n\u003cfigure id=\"attachment_11287983\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-11287983 size-medium\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2017/01/20170126_CC_county_homeless_count_119-800x533.jpg\" alt=\"Members of Contra Costa Health Services prepare to hand out bedding as it conducts its annual count of homeless county residents Thursday, Jan. 26, 2017 in Contra Costa County. CCHS's Division of Health, Housing and Homeless Services, its community partners and volunteers documented both sheltered and unsheltered people in the area who need permanent housing.\" width=\"800\" height=\"533\">\u003cfigcaption class=\"wp-caption-text\">Members of Contra Costa Health Services prepare to hand out bedding as they conduct an annual count of homeless county residents Thursday, Jan. 26, 2017, in Contra Costa County. \u003ccite>(Eric Kayne/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Contra Costa County’s overall homeless population dropped in 2016, but there were some places where it increased, like in the far eastern suburbs.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“We do anticipate that the numbers will continue to be highest in east Contra Costa County. However, we have not made any predictions as to whether or not we’ll see an overall increase in homelessness,” said Lavonna Martin, Contra Costa County’s homeless services chief.\u003c/p>\n\u003cfigure id=\"attachment_11287987\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11287987\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2017/01/20170126_CC_county_homeless_count_185-800x533.jpg\" alt=\"The homeless camp of Jarrett Keesling and Kelli Lengele, whom are among the hundreds of homeless Contra Costa Health Services (CCHS) interacted with as it conducts its annual count of homeless county residents Thursday, Jan. 26, 2017 in Contra Costa County. CCHSÕs Division of Health, Housing and Homeless Services, its community partners and volunteers documented both sheltered and unsheltered people in the area who need permanent housing.\" width=\"800\" height=\"533\">\u003cfigcaption class=\"wp-caption-text\">The homeless camp of Jarrett Keesling and Kelli Lengele, who are among the hundreds of homeless Contra Costa Health Services (CCHS) interacted with as it conducts its annual count of homeless county residents Thursday, Jan. 26, 2017, in Contra Costa County. \u003ccite>(Eric Kayne/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The county has struggled to serve eastern Contra Costa as the population has quickly grown.\u003c/p>\n\u003cfigure id=\"attachment_11287986\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-11287986 size-medium\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2017/01/20170126_CC_county_homeless_count_041-800x533.jpg\" alt=\"Jarrett Keesling, left, and Kelli Lengele, are among the hundreds of homeless Contra Costa Health Services (CCHS) interacted with as it conducts its annual count of homeless county residents Thursday, Jan. 26, 2017 in Contra Costa County.\" width=\"800\" height=\"533\">\u003cfigcaption class=\"wp-caption-text\">Jarrett Keesling, left, and Kelli Lengele are among the hundreds of homeless Contra Costa Health Services (CCHS) interacted with as it conducts its annual count of homeless county residents Thursday, Jan. 26, 2017, in Contra Costa County. \u003ccite>(Eric Kayne/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cfigure id=\"attachment_11289119\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11289119\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/01/RS23881_20170126_CC_county_homeless_count_234-800x533.jpg\" alt=\"A trucker looks down upon the homeless camp of Jarrett Keesling and Kelli Lengele, whom are among the hundreds of homeless Contra Costa Health Services (CCHS) interacted with as it conducts its annual count of homeless county residents Thursday, Jan. 26, 2017 in Contra Costa County. \" width=\"800\" height=\"533\">\u003cfigcaption class=\"wp-caption-text\">A trucker looks down upon the homeless camp of Jarrett Keesling and Kelli Lengele, who are among the hundreds of homeless Contra Costa Health Services (CCHS) interacted with as it conducts its annual count of homeless county residents Thursday, Jan. 26, 2017, in Contra Costa County. \u003ccite>(Eric Kayne/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Many Bay Area counties are launching homeless surveys. San Francisco launched its count Thursday night and Alameda County will begin its census on Jan. 31.\u003c/p>\n\u003cfigure id=\"attachment_11287980\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11287980\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2017/01/20170126_CC_county_homeless_count_016-800x533.jpg\" alt=\"Members of Contra Costa Health Services (CCHS) walk to a homeless encampment to conduct its annual count of homeless county residents Thursday, Jan. 26, 2017 in Contra Costa County. CCHSÕs Division of Health, Housing and Homeless Services, its community partners and volunteers documented both sheltered and unsheltered people in the area who need permanent housing.\" width=\"800\" height=\"533\">\u003cfigcaption class=\"wp-caption-text\">Members of Contra Costa Health Services (CCHS) walk to a homeless encampment to conduct its annual count of homeless county residents Thursday, Jan. 26, 2017, in Contra Costa County. \u003ccite>(Eric Kayne/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>\u003ca href=\"http://erickayne.com/\" target=\"_blank\" rel=\"noopener\">Eric Kayne\u003c/a> is an award-winning photojournalist who has worked for the Houston Chronicle, Dallas Morning News and Seattle Times. KQED’s Devin Katayama contributed to this post.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"slug": "california-withdraws-bid-to-allow-undocumented-immigrants-to-buy-unsubsidized-obamacare-plans",
"title": "California Withdraws Bid to Allow Undocumented Immigrants to Buy Unsubsidized Obamacare Plans",
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"headTitle": "California Withdraws Bid to Allow Undocumented Immigrants to Buy Unsubsidized Obamacare Plans | KQED",
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"content": "\u003cp>Lawmakers in Sacramento have halted a first-in-the-nation effort by California to expand access to health coverage for immigrants living in the state without legal documents.\u003c/p>\n\u003cp>At the behest of the state Legislature, Covered California, the state’s insurance exchange, withdrew its request to sell unsubsidized health plans to people who are here illegally. The withdrawal was \u003ca href=\"http://www.sacbee.com/news/politics-government/capitol-alert/article127360849.html\" target=\"_blank\" rel=\"noopener\">first reported\u003c/a> by the Sacramento Bee.\u003c/p>\n\u003cp>Under the Affordable Care Act, people who cannot prove they are in the country legally are barred from purchasing coverage on the exchange.\u003c/p>\n\u003cp>But some immigrants in this situation had pinned their hopes on the state’s request for an exemption from that rule, submitted last fall to the federal government. Had it been approved, undocumented Californians would have been allowed to buy Covered California plans and join the roughly 1.3 million other people currently enrolled in the exchange.\u003c/p>\n\u003cp>The effort to give undocumented immigrants access to the state exchange was spearheaded by state Sen. Ricardo Lara (D-Bell Gardens) and other Democrats. They passed legislation last year and Gov. Jerry Brown signed the measure in June. It authorized Covered California to submit an application to federal officials to waive the ban on such sales.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>But the chances of federal approval dimmed considerably with the election of Donald Trump, who has pledged to deport immigrants in the country without official papers, and to repeal the Affordable Care Act.\u003c/p>\n\u003cp>Peter Lee, executive director of Covered California, declined to comment on the withdrawal of the state’s request for the waiver. He referred to a \u003ca href=\"http://hbex.coveredca.com/stakeholders/Covered%20California%201332%20Waiver/1332%20Application%20Withdrawal%20Request%2001%2018.pdf\" target=\"_blank\" rel=\"noopener\">letter\u003c/a> the exchange sent Wednesday to the Obama administration, which said the proposal was shelved at the request of Lara.\u003c/p>\n\u003cp>Lara said in a written statement that he was withdrawing the plan because he feared the Trump administration might use information gleaned from it for the purpose of deporting undocumented immigrants.\u003c/p>\n\u003cp>The plan to sell to undocumented immigrants is “the first California casualty of the Trump presidency,” Lara wrote. “I take Trump at his words that anyone is subject to deportation at any time, and California will not be part of a wasteful and inhumane campaign against immigrants who are working hard and playing by the rules.”\u003c/p>\n\u003cp>The decision to pull the plug on the plan comes as the future of health care for millions of Californians hangs in the balance, with Republican leaders in Washington, D.C., moving to repeal the main provisions of the Affordable Care Act.\u003c/p>\n\u003cp>Anthony Wright, executive director of the consumer advocacy group Health Access California, said California’s move reflects a reorganization of priorities. What is urgent now, he said, is to preserve the current gains in Californians’ health coverage. And in order to bring undocumented immigrants into Covered California, officials must first ensure the exchange survives, Wright explained.\u003c/p>\n\u003cp>“We didn’t want this waiver request, which was almost assuredly going to get rejected, to get in the way of defending these basic programs that provide coverage for so many,” he said.\u003c/p>\n\u003cp>The sale of a Covered California health plan to immigrants without legal status had not been expected to boost enrollment in the exchange significantly, since they — unlike about 90 percent of current enrollees — would not have qualified for federal subsidies to reduce their premiums. That would have made it difficult or impossible for many of them to afford the policies. Moreover, immigrants in the state illegally can already buy health insurance in the private market, and the coverage options and premiums are similar to the plans sold on the exchange.\u003c/p>\n\u003cp>Covered California estimated last August that only 17,000 Californians would have gained health coverage as a result of opening the exchange to the undocumented population.\u003c/p>\n\u003cp>Many experts and health care consumer advocates agreed that the effort was mostly a symbolic gesture — but an important one to many people.\u003c/p>\n\u003cp>Supporters said allowing undocumented immigrants to buy coverage on the exchange would have addressed a problem for many families composed of both legal and non-legal residents. The proposal would have allowed those “mixed-status” families to purchase their insurance together through Covered California, simplifying the process for them. Many argued that it was discriminatory to bar immigrants without papers from the state marketplace.\u003c/p>\n\u003cp>Lara and other backers of the effort saw it as an important step toward expanding health coverage to all Californians regardless of their immigration status.\u003c/p>\n\u003cp>Magdalena Velazquez of San Jose, who volunteers with the advocacy group Services, Immigrant Rights, and Education Network (SIREN), has been following the issue closely. Although she does not have legal authority to be in the U.S., she has health coverage through her husband’s employer. But many of her family members and friends are uninsured.\u003c/p>\n\u003cp>“Sadly, once again we’re seeing that the fight for our health care rights has to take a pause,” Velazquez said.\u003c/p>\n\u003cp>When California submitted its request to the federal government last year, supporters hoped the Obama administration would review it quickly, increasing its chances of approval, Wright said. But as of Tuesday, the application process had gone through only a preliminary review.\u003c/p>\n\u003cp>Some health care experts believe approval would not have been guaranteed even if the Obama administration had completed its review before Trump took office. Excluding immigrants without documents was a compromise that helped get the ACA through Congress in the first place, they noted, and Obama officials would have been reluctant to renege on it.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This story was produced by \u003ca href=\"http://khn.org/\" target=\"_blank\" rel=\"noopener\">Kaiser Health News\u003c/a>, an editorially independent program of the \u003ca href=\"http://kff.org/\">Kaiser Family Foundation\u003c/a>.\u003c/em>\u003c/p>\n\n",
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"excerpt": "State lawmaker says he was worried the Trump administration would use information on those who purchased plans to try and deport them. ",
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"title": "California Withdraws Bid to Allow Undocumented Immigrants to Buy Unsubsidized Obamacare Plans | KQED",
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"nprByline": "\u003cstrong>\u003ca href=\"http://californiahealthline.org/news/author/ana-b-ibarra/\">Ana Ibarra\u003c/a>\u003c/strong> and \u003cstrong>\u003ca href=\"http://californiahealthline.org/news/author/chad-terhune/\">Chad Terhune\u003c/a>\u003c/strong>\u003c/br>California HealthLine",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Lawmakers in Sacramento have halted a first-in-the-nation effort by California to expand access to health coverage for immigrants living in the state without legal documents.\u003c/p>\n\u003cp>At the behest of the state Legislature, Covered California, the state’s insurance exchange, withdrew its request to sell unsubsidized health plans to people who are here illegally. The withdrawal was \u003ca href=\"http://www.sacbee.com/news/politics-government/capitol-alert/article127360849.html\" target=\"_blank\" rel=\"noopener\">first reported\u003c/a> by the Sacramento Bee.\u003c/p>\n\u003cp>Under the Affordable Care Act, people who cannot prove they are in the country legally are barred from purchasing coverage on the exchange.\u003c/p>\n\u003cp>But some immigrants in this situation had pinned their hopes on the state’s request for an exemption from that rule, submitted last fall to the federal government. Had it been approved, undocumented Californians would have been allowed to buy Covered California plans and join the roughly 1.3 million other people currently enrolled in the exchange.\u003c/p>\n\u003cp>The effort to give undocumented immigrants access to the state exchange was spearheaded by state Sen. Ricardo Lara (D-Bell Gardens) and other Democrats. They passed legislation last year and Gov. Jerry Brown signed the measure in June. It authorized Covered California to submit an application to federal officials to waive the ban on such sales.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>But the chances of federal approval dimmed considerably with the election of Donald Trump, who has pledged to deport immigrants in the country without official papers, and to repeal the Affordable Care Act.\u003c/p>\n\u003cp>Peter Lee, executive director of Covered California, declined to comment on the withdrawal of the state’s request for the waiver. He referred to a \u003ca href=\"http://hbex.coveredca.com/stakeholders/Covered%20California%201332%20Waiver/1332%20Application%20Withdrawal%20Request%2001%2018.pdf\" target=\"_blank\" rel=\"noopener\">letter\u003c/a> the exchange sent Wednesday to the Obama administration, which said the proposal was shelved at the request of Lara.\u003c/p>\n\u003cp>Lara said in a written statement that he was withdrawing the plan because he feared the Trump administration might use information gleaned from it for the purpose of deporting undocumented immigrants.\u003c/p>\n\u003cp>The plan to sell to undocumented immigrants is “the first California casualty of the Trump presidency,” Lara wrote. “I take Trump at his words that anyone is subject to deportation at any time, and California will not be part of a wasteful and inhumane campaign against immigrants who are working hard and playing by the rules.”\u003c/p>\n\u003cp>The decision to pull the plug on the plan comes as the future of health care for millions of Californians hangs in the balance, with Republican leaders in Washington, D.C., moving to repeal the main provisions of the Affordable Care Act.\u003c/p>\n\u003cp>Anthony Wright, executive director of the consumer advocacy group Health Access California, said California’s move reflects a reorganization of priorities. What is urgent now, he said, is to preserve the current gains in Californians’ health coverage. And in order to bring undocumented immigrants into Covered California, officials must first ensure the exchange survives, Wright explained.\u003c/p>\n\u003cp>“We didn’t want this waiver request, which was almost assuredly going to get rejected, to get in the way of defending these basic programs that provide coverage for so many,” he said.\u003c/p>\n\u003cp>The sale of a Covered California health plan to immigrants without legal status had not been expected to boost enrollment in the exchange significantly, since they — unlike about 90 percent of current enrollees — would not have qualified for federal subsidies to reduce their premiums. That would have made it difficult or impossible for many of them to afford the policies. Moreover, immigrants in the state illegally can already buy health insurance in the private market, and the coverage options and premiums are similar to the plans sold on the exchange.\u003c/p>\n\u003cp>Covered California estimated last August that only 17,000 Californians would have gained health coverage as a result of opening the exchange to the undocumented population.\u003c/p>\n\u003cp>Many experts and health care consumer advocates agreed that the effort was mostly a symbolic gesture — but an important one to many people.\u003c/p>\n\u003cp>Supporters said allowing undocumented immigrants to buy coverage on the exchange would have addressed a problem for many families composed of both legal and non-legal residents. The proposal would have allowed those “mixed-status” families to purchase their insurance together through Covered California, simplifying the process for them. Many argued that it was discriminatory to bar immigrants without papers from the state marketplace.\u003c/p>\n\u003cp>Lara and other backers of the effort saw it as an important step toward expanding health coverage to all Californians regardless of their immigration status.\u003c/p>\n\u003cp>Magdalena Velazquez of San Jose, who volunteers with the advocacy group Services, Immigrant Rights, and Education Network (SIREN), has been following the issue closely. Although she does not have legal authority to be in the U.S., she has health coverage through her husband’s employer. But many of her family members and friends are uninsured.\u003c/p>\n\u003cp>“Sadly, once again we’re seeing that the fight for our health care rights has to take a pause,” Velazquez said.\u003c/p>\n\u003cp>When California submitted its request to the federal government last year, supporters hoped the Obama administration would review it quickly, increasing its chances of approval, Wright said. But as of Tuesday, the application process had gone through only a preliminary review.\u003c/p>\n\u003cp>Some health care experts believe approval would not have been guaranteed even if the Obama administration had completed its review before Trump took office. Excluding immigrants without documents was a compromise that helped get the ACA through Congress in the first place, they noted, and Obama officials would have been reluctant to renege on it.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This story was produced by \u003ca href=\"http://khn.org/\" target=\"_blank\" rel=\"noopener\">Kaiser Health News\u003c/a>, an editorially independent program of the \u003ca href=\"http://kff.org/\">Kaiser Family Foundation\u003c/a>.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"slug": "drugmakers-manipulate-orphan-drug-rules-to-create-prized-monopolies",
"title": "Drugmakers Manipulate Orphan Drug Rules To Create Prized Monopolies",
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"headTitle": "Drugmakers Manipulate Orphan Drug Rules To Create Prized Monopolies | KQED",
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"content": "\u003cp>Lookup Tool: \u003ca href=\"http://khn.org/news/orphan-drugs-lookup-interactive/\">Orphan Drugs Database\u003c/a>\u003cbr>\nVideo: \u003ca href=\"http://khn.org/news/video-former-u-s-rep-henry-waxman-shares-deep-concerns-about-orphan-drugs/\">Interview With Henry Waxman\u003c/a>\u003cbr>\nTimeline: \u003ca href=\"http://khn.org/news/timeline-the-orphan-drug-act/\">The Orphan Drug Act\u003c/a>\u003c/p>\n\u003cp>More than 30 years ago, Congress overwhelmingly passed \u003ca href=\"https://history.nih.gov/research/downloads/PL97-414.pdf\">a landmark health bill\u003c/a> aimed at motivating pharmaceutical companies to develop new drugs for people whose rare diseases had been ignored.\u003c/p>\n\u003cp>By the drugmakers’ calculations, the markets for such diseases weren’t big enough to bother with.\u003c/p>\n\u003cp>But lucrative financial incentives created by the Orphan Drug Act signed into law by President Ronald Reagan in 1983 succeeded far beyond anyone’s expectations. More than 200 companies have brought almost 450 “orphan drugs” to market since the law took effect.\u003c/p>\n\u003cp>Yet a Kaiser Health News investigation shows that the system intended to help desperate patients is being manipulated by drugmakers to maximize profits and to protect niche markets for medicines already being taken by millions. The companies aren’t breaking the law but they are using the Orphan Drug Act to their advantage in ways that its architects say they didn’t foresee or intend. Today, many orphan medicines, originally developed to treat diseases affecting fewer than 200,000 people, come with astronomical price tags.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>And many drugs that now have orphan status aren’t entirely new. More than 70 were drugs first approved by the Food and Drug Administration for mass market use. These medicines, some with familiar brand names, were later approved as orphans. In each case, their manufacturers received millions of dollars in government incentives plus seven years of exclusive rights to treat that rare disease, or a monopoly.\u003c/p>\n\u003cp>Drugmakers of popular mass market drugs later sought and received orphan status for the cholesterol blockbuster Crestor, Abilify for psychiatric conditions, cancer drug Herceptin, and rheumatoid arthritis drug Humira, the best-selling medicine in the world.\u003c/p>\n\u003cp>More than 80 other orphans won FDA approval for more than one rare disease, and in some cases, multiple rare diseases. For each additional approval, the drugmaker qualified for a fresh batch of incentives. Botox, stocked in most dermatologists’ offices, started out as a drug to treat painful muscle spasms of the eye and now has three orphan drug approvals. It’s also approved as a mass market drug to treat a variety of ailments, including chronic migraines and wrinkles.\u003c/p>\n\u003cp>Altogether, KHN’s investigation found that about a third of orphan approvals by the FDA since the program began have been either for repurposed mass market drugs or drugs that received multiple orphan approvals.\u003c/p>\n\u003cp>“What we are seeing is a system that was created with good intent being hijacked,” said Bernard Munos, a former corporate strategy advisor at drug giant Eli Lilly and Co. who reviewed the KHN analysis of several FDA drug databases. It’s “quite remarkable that it has gone on for so long.”\u003c/p>\n\u003cp>And the proportion of \u003ca href=\"http://www.fda.gov/Drugs/DevelopmentApprovalProcess/DrugInnovation/ucm534863.htm\">new drugs\u003c/a> approved as orphans has ballooned. In 2015, 21 orphan drugs were approved, accounting for 47 percent of all new medicines, up from just 29 percent in 2010; in 2016, nine more orphans won approval, 40 percent of the total.\u003c/p>\n\u003cp>When a drugmaker wins approval of a medicine for an orphan disease, the company gets seven years of exclusive rights to the marketplace, which means the FDA won’t approve another version to treat that rare disease for seven years, even if the brand name company’s patent has run out. The exclusivity is compensation for developing a drug designed for a small number of patients whose total sales weren’t expected to be that profitable.\u003c/p>\n\u003cp>But the exclusivity is a potent pricing tool. Drugmakers can charge whatever they want by shielding their medicine from competition. The market exclusivity granted by the Orphan Drug Act can be a vital part of the protective shield that companies create. What’s more, manufacturers can return to the FDA with the same drug again and again, each time testing the drug against a new rare disease.\u003c/p>\n\u003cp>Critics have assailed drugmakers in the past for gaming the orphan drug approval process. But the extent to which companies have been winning approval for drugs that aren’t what advocates call “true orphans” hadn’t been documented until the Kaiser Health News investigation.\u003c/p>\n\u003cp>Munos said he was “shocked” by the sheer number of mass market drugs being repurposed as well as those approved multiple times.\u003c/p>\n\u003cp>Even agency officials said they weren’t aware of the scope of the issue. After reviewing KHN’s findings for two weeks, Dr. Gayatri Rao director of the FDA’s Office of Orphan Products Development said she “appreciated the work” and expressed interest in studying how often drug companies are “repurposing” a drug for a new rare disease, or taking “multiple bites of the apple.”\u003c/p>\n\u003cp>“We are going to look into this,” she said, adding that she could consider a regulatory change.\u003c/p>\n\u003cp>Rao pointed out that the “repurposing” of drugs does have scientific and patient benefits. For example, cancer drugs approved for one type of malignancy can be tested and approved for others. Gleevec, a drug that revolutionized the treatment of chronic myeloid leukemia, now has nine orphan approvals.\u003c/p>\n\u003cp>But in a \u003ca href=\"http://www.hopkinsmedicine.org/news/media/releases/orphan_drug_loophole_needs_closing_johns_hopkins_researchers_say\">2015 commentary\u003c/a> published in the American Journal of Clinical Oncology, Dr. Martin Makary at the Johns Hopkins University School of Medicine focused on cancer drugs including Gleevec, arguing that the drug was never meant to serve an orphan population. Instead, Makary and his team wrote, drugmakers purposely identify small patient populations to gain additional approvals — a process he described as “salami slicing.”\u003c/p>\n\u003cp>“By salami slicing the disease into subgroups, it allows them to get the orphan drug approval with all the government benefits and even some of the subsidies,” Makary said. The prices of such medications often rise because they have seven years without competition for a new set of patients, Makary added.\u003c/p>\n\u003cp>The FDA has taken a different view of repurposing.\u003c/p>\n\u003cp>“We always talked about how we permit the second bite of the apple, third bite of the apple, as one small way to incentivize repurposing,” Rao said, noting that industry and patient groups have been pressing the FDA for even stronger incentives. “Now, all of sudden, it seems like, wow, this practice may be driving up prices.”\u003c/p>\n\u003cp>Novartis, which owns Gleevec, said in an email statement that the company is advancing research and following the science to “bring the right treatments to the right patients based on unmet need, not the size of the patient population.”\u003c/p>\n\u003cp>Two KHN reporters spent six months analyzing data and talking to lawmakers, patients, advocates, doctors and companies to understand how the FDA’s orphan drug program has evolved amid a national uproar over soaring drug prices. President-elect Donald Trump vowed on the campaign trail to \u003ca href=\"http://www.reuters.com/article/us-usa-trump-pharmaceuticals-idUSKBN13W21I\">bring down\u003c/a> prescription drug prices and during a Jan. 11 press conference said the drug industry is \u003ca href=\"https://www.nytimes.com/2017/01/11/us/politics/trump-press-conference-transcript.html?_r=0\">“getting away with murder.”\u003c/a>\u003c/p>\n\u003cp>The investigation examined how drugmakers use the law to their advantage — often with the guidance of former FDA officials — and have made the development of medicines that were once thought to be business backwaters into one of the pharmaceutical industry’s hottest sectors.\u003c/p>\n\u003cp>Orphan drugs now account for seven of the 10 top-selling drugs of any kind, ranked by annual sales, according to EvaluatePharma.\u003c/p>\n\u003cp>“Orphans are wicked hot,” said Dr. Tim Coté, a former FDA official who now runs a consulting firm that advises drugmakers on orphan drugs.\u003c/p>\n\u003cp>No one disputes that orphan drugs have helped or saved hundreds of thousands of patients suffering from debilitating or even fatal rare diseases. Exactly how many is difficult to estimate because the FDA doesn’t track such information.\u003c/p>\n\u003cp>And drug industry officials say companies should be rewarded, not punished, for making those treatments possible and for pursuing new drugs that aren’t always an economic success.\u003c/p>\n\u003cp>Research and development is “long, costly, risky,” said Anne Pritchett, vice president, policy and research at industry lobbying group PhRMA. “When you look at cystic fibrosis it was 25 years to the development of an effective therapy … I think we would be concerned about anything that would undermine the current [orphan drug] incentives.”\u003c/p>\n\u003cp>Former U.S. Rep. Henry Waxman, D-Calif., a champion of the 1983 Orphan Drug Act takes a different view.\u003c/p>\n\u003cp>“The Orphan Drug Act has been a great success because many people with diseases that affect very few people now have drugs available to them,” Waxman said. “But it’s been in some ways turned on its head when it becomes the basis of manipulating the system for the drug company to make much more money than they would in an open, competitive market.”\u003c/p>\n\u003cp>Booming Business\u003c/p>\n\u003cp>On a late summer day, Tim Coté sat in a corner office of his Sandy Spring, Md., consulting firm, Coté Orphan. He leaned into his computer microphone to dispense insider knowledge about the orphan drug approval process on a webcast hosted by FDAnews, a trade news organization. Listeners paid about $300 a head, but Coté said he wasn’t paid for doing it.\u003c/p>\n\u003cp>The FDA is more flexible in evaluating drugs for rare diseases, he said, explaining that “about half of them get through with just one pivotal clinical trial. Not so for common diseases.” The FDA, citing \u003ca href=\"http://www.fda.gov/downloads/ForIndustry/DevelopingProductsforRareDiseasesConditions/OOPDNewsArchive/UCM294773.pdf\">a report\u003c/a> from the National Organization for Rare Disorders, said about two-thirds of orphan drugs were approved with one adequate and well-controlled trial with supportive evidence. It typically requires two or three such trials to approve a mass market drug.\u003c/p>\n\u003cp>Coté also told the webinar audience that clinical trials for orphan drugs are usually smaller and the approval is a “different scientific and regulatory experience.”\u003c/p>\n\u003cp>Coté knows his stuff. He was Rao’s immediate predecessor as chief of the FDA’s Office of Orphan Products Development. It’s not unusual for government officials to leave FDA and other regulatory agencies and \u003ca href=\"http://www.npr.org/sections/health-shots/2016/09/28/495694559/a-look-at-how-the-revolving-door-spins-from-fda-to-industry\">obtain jobs as consultants or industry executives\u003c/a>.\u003c/p>\n\u003cp>Coté’s website, headlined “The Inside Track,” notes that he oversaw applications that led to the approval of at least 150 orphan drugs when he was at the FDA and that his firm is now the largest submitter of orphan drug applications.\u003c/p>\n\u003cp>“We write the entire application,” the website for Coté’s company notes, adding that his staff of 25 includes regulatory scientists with deep knowledge and experience in FDA’s “unwritten rules” regarding orphan drugs.\u003c/p>\n\u003cp>Many of Coté’s more than 300 clients are small biotech companies begun by researchers or even passionate parents who found investment backing. Parents Ilan and Annie Ganot, for example, started Solid Biosciences to find treatments and potentially a cure for their son with Duchenne muscular dystrophy.\u003c/p>\n\u003cp>Coté guides them through the regulatory process since most don’t have the expertise. He can offer his expertise and develop an application that makes it easier for the FDA to designate and approve the drug.\u003c/p>\n\u003cp>“When you make the FDA smile, the value of your asset goes up. And that’s how the game is played,” he said in an interview, adding quickly, “It’s really not a game because people’s lives are what is in balance.”\u003c/p>\n\u003cp>Coté and other ex-FDA officials play a vital role in helping drugmakers choose rare disease targets and get through the FDA approval process.\u003c/p>\n\u003cp>A small cottage industry has grown around the Orphan Drug Act. Dr. Marlene Haffner, who preceded Coté in the FDA’s orphan office, started her own consulting firm, too, to advise small and large companies on orphan drug applications. A third company is Camargo Pharmaceutical Services, led by industry veterans and former FDA officials, which advises companies focused on repurposing drugs for orphan approval. The firm tries “to be in front of the FDA a lot — three to four times a month,” said Jennifer King, Camargo’s director of marketing. Fees for consulting on orphan drugs industry wide range from $5,000 to $100,000, depending upon what services are provided, Coté said.\u003c/p>\n\u003cp>Getting through the orphan approval process involves a series of steps.\u003c/p>\n\u003cp>First, drugs must be designated by the FDA as potential candidates for approval. A company has to demonstrate that its drug is a promising treatment for a disease that affects fewer than 200,000 patients. If the FDA agrees and makes the formal designation, financial incentives kick in, including a 50 percent tax break on research and development (R&D) and access to federal grants.\u003c/p>\n\u003cp>When drugs get orphan designation, companies often reap other financial rewards. Shares in publicly traded companies often rise on the news — sometimes soaring \u003ca href=\"http://www.bizjournals.com/triangle/news/2014/02/25/dara-stock-soars-on-orphan-drug.html\">as high as 30 percent\u003c/a>. That happens, in part, because orphans have a track record of being approved at much higher rates than drugs for common diseases.\u003c/p>\n\u003cp>The 50 percent R&D tax credit pays off, too. In 2012, one of the biggest orphan drug companies, BioMarin, received \u003ca href=\"http://files.shareholder.com/downloads/ABEA-3W276N/2866327224x0x664042/776E8656-30BA-4937-A2A0-3AB6450BCA00/2012_Annual_Report.pdf\">$32.6 million\u003c/a> from a combination of federal and state of California tax credits. BioMarin spokeswoman Debra Charlesworth confirmed that the orphan credit made up the “vast majority” of that deferred tax benefit. She also noted that credit “has successfully fueled an industry that didn’t previously exist” and led to more rare disease research.\u003c/p>\n\u003cp>Industry-wide, orphan drug tax credits cost the federal government $1.76 billion in fiscal 2016 — roughly what President Barack Obama asked Congress to spend to fight \u003ca href=\"https://www.washingtonpost.com/news/post-politics/wp/2016/02/08/obama-to-ask-congress-for-1-8-billion-to-combat-zika-virus/\">the Zika virus\u003c/a> before a $1.1 billion expenditure was approved. And, because so many orphan drugs are under development, the U.S. could grant nearly $50 billion in tax credits from 2016 to 2025, estimates \u003ca href=\"https://www.treasury.gov/resource-center/tax-policy/Documents/Tax-Expenditures-FY2017.pdf\">the Treasury Department\u003c/a>.\u003c/p>\n\u003cp>There’s a lot of creativity behind figuring out how to make a drug an orphan.\u003c/p>\n\u003cp>In Coté’s webinar and in multiple interviews, he described many ways companies can win orphan status. They can test their drugs on children with adult diseases, such as schizophrenia, or find drugs for ailments like malaria that are uncommon in America.\u003c/p>\n\u003cp>“African sleeping sickness: horrible problem in Africa but not here, not in the U.S.,” Coté told his webinar audience. “So a drug development effort that was aimed toward some of these tropical diseases can actually get all the benefits of the Orphan Drug Act.”\u003c/p>\n\u003cp>Another popular strategy is to create “follow-on drugs” that represent incremental steps forward.\u003c/p>\n\u003cp>About 30 percent of Coté’s clients are companies looking to improve upon some other orphan drug “which just made billions and billions,” he said in an interview.\u003c/p>\n\u003cp>Repurposing an already approved drug is another strategy his firm promotes. In a \u003ca href=\"https://www.linkedin.com/pulse/re-purposing-drugs-orphans-timothy-cote?published=t\">video\u003c/a> posted on his website in July, Coté explained the advantages for companies that can move directly into a clinical trial without much preparatory work because the drug’s safety has already been demonstrated.\u003c/p>\n\u003cp>“All you gotta do is establish that the product can work in this new orphan indication,” he said, adding tips on how to do it and still make money.\u003c/p>\n\u003cp>‘That Is Not A True Orphan Drug’\u003c/p>\n\u003cp>Turning mass market drugs into orphans has been a familiar path for some of the most popular drugs ever discovered.\u003c/p>\n\u003cp>AbbVie’s Humira is the best-selling drug in the world, and most of its sales are in the U.S. where revenue reached $7.6 billion through \u003ca href=\"https://news.abbvie.com/news/abbvie-reports-third-quarter-2016-financial-results.htm\">the third quarter\u003c/a> of 2016 and $11.8 billion worldwide, according to the company’s latest financial report.\u003c/p>\n\u003cp>Humira was approved by the FDA in late 2002 to treat millions of people who suffer from rheumatoid arthritis. Three years later, AbbVie asked the FDA to designate it as an orphan to treat juvenile rheumatoid arthritis, which they told the FDA affects between 30,000 and 50,000 Americans. That pediatric use was approved in 2008, and Humira subsequently was approved for four more rare diseases, including Crohn’s and uveitis, an inflammatory disease affecting the eyes.\u003c/p>\n\u003cp>The ophthalmologic approval would extend the market exclusivity for Humira for that disease until 2023. When asked why AbbVie sought multiple orphan designations and approvals for Humira, the company declined to comment.\u003c/p>\n\u003cp>Peter Saltonstall, executive director of the National Organization for Rare Disorders, said that Humira is “not a true orphan drug.” But, he said, the company has “the ability to go out and get orphan designation. That’s the way the law reads right now … they can do whatever they want to do.”\u003c/p>\n\u003cp>It is difficult to say exactly how or if orphan exclusivity affects the price of Humira, which is a complex biologic drug and also has been protected by \u003ca href=\"http://www.nytimes.com/2016/07/16/business/makers-of-humira-and-enbrel-using-new-drug-patents-to-delay-generic-versions.html?_r=3\">numerous patents\u003c/a>. The drug has long been AbbVie’s top seller, accounting for 63 percent of its revenues, according to its most recent financial filing.\u003c/p>\n\u003cp>EvaluatePharma notes \u003ca href=\"http://info.evaluategroup.com/rs/607-YGS-364/images/EPOD15.pdf\">in its recent report\u003c/a> that Humira, as well as a handful of other top drugs, receive less than 25 percent of their sales from orphan uses. Still, if Humira’s orphan uses accounted for just 10 percent of annual sales, the revenue would surpass $1 billion.\u003c/p>\n\u003cp>By stacking up a series of orphan disease approvals, one seven-year exclusivity period leads into another, maximizing the length of a company’s monopoly. Sigma-Tau Pharmaceuticals, for example, had some form of orphan exclusivity over its metabolic disorder drug for more than 20 years. The drug, Carnitor, received a second orphan approval four months before its first exclusivity was set to expire. And it won its third orphan approval, for an IV formulation of the drug, just one day before its second exclusivity period was set to expire in December of 1999.\u003c/p>\n\u003cp>“The sequence and timing of regulatory filings for Carnitor reflect the time required to conduct large controlled clinical trials, as well as evolving medical strategies and regulatory pathways pursued by different sponsors over many years,” said GianFranco Fornasini, senior vice president of scientific affairs at Sigma-Tau.\u003c/p>\n\u003cp>The FDA’s Rao said each new exclusivity period is disease-specific and once any seven-year period runs out, generics can come in. Gleevec, for example, won FDA approval to treat several kinds of rare cancer. All but one of its orphan exclusivity periods had expired by 2015, allowing two generics to enter the marketplace. But Gleevec still has exclusivity until 2020 to treat newly diagnosed Philadelphia chromosome-positive acute lymphoblastic leukemia in patients who are also on chemotherapy.\u003c/p>\n\u003cp>It’s also true, Rao explained, that some of the drugs that go through the orphan process may not specifically treat a rare disease. For example, a very toxic cancer drug might may not work well in earlier stages because its risks outweigh the benefits. But the company may propose that it will help a smaller group of later-stage cancer patients and win orphan approval just for that group.\u003c/p>\n\u003cp>Former FDA orphan drug director Haffner said her FDA office worked on rules defining how companies could legitimately pursue approval for a small group of patients with a specific unmet medical need.\u003c/p>\n\u003cp>“People have played games with the Orphan Drug Act since it was passed,” said Haffner, who first took a job with drugmaker Amgen after leaving the FDA and then became an independent consultant. “It’s the American way, I don’t mean that in a nasty way. But we take advantage of what’s in front of us.”\u003c/p>\n\u003cp>In 2013, the \u003ca href=\"https://www.federalregister.gov/documents/2013/06/12/2013-13930/orphan-drug-regulations\">FDA clarified the Orphan Drug Act’s regulations\u003c/a> and said it wanted to avoid the possibility that some companies could “potentially ‘game’ approvals by seeking successive narrow approvals of a drug.”\u003c/p>\n\u003cp>In reality, Rao said, the regulations did not really change “much of what our practice was.” The agency wanted to address what Rao said were “common misconceptions” and frequently asked questions so officials changed wording in the regulations to better define exactly what could be considered an orphan drug.\u003c/p>\n\u003cp>Breaking down larger, broader diseases into smaller groups is still allowed under certain conditions and companies can still win multiple orphan approvals for a single drug — even if the total population served rises above the 200,000 mark.\u003c/p>\n\u003cp>Amgen Inc.’s Repatha won marketing approval and exclusive rights in 2015 for the orphan disease homozygous familial hypercholesterolemia, which affects a population of \u003ca href=\"http://www.lipidjournal.com/article/S1933-2874(13)00309-7/abstract\">about 300 people\u003c/a> in the U.S. On the very same day, the drug was approved as a mass market drug to treat up to 11 million people with uncontrolled levels of LDL cholesterol, said Amgen spokeswoman Kristen Davis.\u003c/p>\n\u003cp>Dr. Steven Nissen of the Cleveland Clinic, who ran a broader trial on Repatha, said, “It’s certainly not considered by any of us to be an orphan drug.”\u003c/p>\n\u003cp>Safeguarding The ‘Prize’\u003c/p>\n\u003cp>Considering the long history of what’s happened, Tim Coté acknowledges that there are “some loopholes” in the Orphan Drug Act. Perhaps 3 percent or less of approved orphans were not in the “spirit” of the law, he said.\u003c/p>\n\u003cp>But Coté, rare disease advocates, patients and people in the drug industry expressed fear that changing the Orphan Drug Act or questioning its success would hurt the development of drugs for rare patients.\u003c/p>\n\u003cp>Former U.S. Rep. Jim Greenwood, R-Pa., now president of the Biotechnology Innovation Organization, an industry trade group, said that concerns about high prices for orphan drugs aren’t justified. The incentives, he said, should not be altered because rare diseases are “tragically killing and brutalizing mostly children.”\u003c/p>\n\u003cp>Greenwood seemed unaware that dozens of orphan approvals stemmed from the repurposing of mass market drugs, like Humira or Enbrel, another drug developed first for rheumatoid arthritis. Still, he said, “I would argue that the risk of losing incentives in the system far outweighs the benefit of trying to save a few pennies on the health care dollar.”\u003c/p>\n\u003cp>It’s a sentiment that Coté and other advocates share. While talking about the $311,000 annual price tag for cystic fibrosis drug Kalydeco, Coté said any parent whose child has the disease would be a big fan of the drug.\u003c/p>\n\u003cp>“The price point is justified because actually it has a dramatic effect on the children. Dead children … people are willing to pay a lot to prevent that,” Coté said. “And that’s a real good thing that we have this drug. OK?”\u003c/p>\n\u003cp>The first drug to specifically target the underlying biochemical defect of cystic fibrosis, Kalydeco is approved to treat a subset of patients who have specific mutations in their genes. Development of the drug was financed by the Cystic Fibrosis Foundation, which sold its rights to sales royalties from Kalydeco and other cystic fibrosis drugs for $3.3 billion in 2014.\u003c/p>\n\u003cp>Others, including Henry Waxman, are far more critical and have tried to do something about it over the years. Waxman proposed multiple bills to rein in corporate profits by amending the orphan drug law that he sponsored, but none succeeded.\u003c/p>\n\u003cp>The FDA has also tried but failed, to keep corporations in check.\u003c/p>\n\u003cp>In 2012, drugmaker Depomed Inc. filed suit against the FDA for refusing to give its drug Gralise seven years of market exclusivity as a treatment for pain related to shingles.\u003c/p>\n\u003cp>Rao said the agency wanted to see proof that Gralise was clinically superior to other drugs, noting there “were a bunch of other generics on the market” with different formulations and dosing requirements. Grasile’s active ingredient, gabapentin, is the same one as in Pfizer’s mass market blockbuster \u003ca href=\"http://www.pfizer.com/products/product-detail/neurontin\">Neurontin\u003c/a>, which is also approved for treatment of shingles pain.\u003c/p>\n\u003cp>The FDA approved Gralise but denied seven years of exclusivity.\u003c/p>\n\u003cp>In response, the drugmaker sued the agency and won its case, arguing that according to the law, they didn’t have to prove their drug was clinically superior to gain the monopoly.\u003c/p>\n\u003cp>Today, the drug is one of Depomed’s top products with sales of $81 million in 2015. And, in a \u003ca href=\"http://investor.depomedinc.com/phoenix.zhtml?c=97276&p=irol-SECText&TEXT=aHR0cDovL2FwaS50ZW5rd2l6YXJkLmNvbS9maWxpbmcueG1sP2lwYWdlPTEwODc0NDE5JkRTRVE9MCZTRVE9MCZTUURFU0M9U0VDVElPTl9FTlRJUkUmc3Vic2lkPTU3\">recent proxy statement\u003c/a>, Depomed listed “protecting Gralise exclusivity” as a corporate objective under the category of “enhance and protect future cash flow.” Its orphan exclusivity ends in 2018. Depomed spokesman Christopher Keenan said Gralise wanted patent exclusivity to block competition. But, Keenan said, “Had the patent effort failed on all fronts, the Orphan Drug Designation would have been very important.”\u003c/p>\n\u003cp>After reviewing KHN’s analysis, Rao said she wants to better understand why drugmakers are applying for multiple approvals and has asked for a case-by-case review of all orphan designations granted in 2010 and 2015. She said the agency lacks the resources to run an analysis of the entire orphan drug database.\u003c/p>\n\u003cp>“Our goal is to try to get it right,” she said. “There are over 7,000 rare diseases, likely more, the vast majority of which have nothing … I want to ensure that we continue to keep our eye on that prize.”\u003c/p>\n\u003cp>Contributors: John Hillkirk, Scott Hensley at NPR, Diane Webber, Marilyn Thompson (editors); Elizabeth Lucas (data editing); Joe Neel at NPR (radio editing)\u003c/p>\n\u003cp>Interactives, video and presentation: Lydia Zuraw, Emily Kopp, Meredith Rizzo at NPR (digital presentation); Francis Ying (videos, motion graphic); Heidi de Marco (videos, photos, audio); Alley Interactive (database lookup)\u003c/p>\n\u003cp>KHN’s coverage of prescription drug development, costs and pricing is supported in part by the \u003ca href=\"http://www.arnoldfoundation.org/\">Laura and John Arnold Foundation\u003c/a>.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003ca href=\"http://www.kaiserhealthnews.org/\">Kaiser Health News\u003c/a> (KHN) is a national health policy news service. It is an editorially independent program of the \u003ca href=\"http://www.kff.org/\">Henry J. Kaiser Family Foundation\u003c/a>.\u003c/p>\n\n",
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"excerpt": "Orphan drugs were meant for patients with rare diseases, but drugmakers are increasingly using the special designation to land lucrative federal incentives and monopoly control for every drug that gets approved.",
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"title": "Drugmakers Manipulate Orphan Drug Rules To Create Prized Monopolies | KQED",
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"nprByline": "\u003ca href=\"http://khn.org/news/author/sarah-jane-tribble/\">\u003cstrong>Sarah Jane Tribble\u003c/strong>\u003c/a> and \u003ca href=\"http://khn.org/news/author/sydney-lupkin/\">\u003cstrong>Sydney Lupkin\u003c/strong>\u003c/a>\u003c/br>Kaiser Health News",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Lookup Tool: \u003ca href=\"http://khn.org/news/orphan-drugs-lookup-interactive/\">Orphan Drugs Database\u003c/a>\u003cbr>\nVideo: \u003ca href=\"http://khn.org/news/video-former-u-s-rep-henry-waxman-shares-deep-concerns-about-orphan-drugs/\">Interview With Henry Waxman\u003c/a>\u003cbr>\nTimeline: \u003ca href=\"http://khn.org/news/timeline-the-orphan-drug-act/\">The Orphan Drug Act\u003c/a>\u003c/p>\n\u003cp>More than 30 years ago, Congress overwhelmingly passed \u003ca href=\"https://history.nih.gov/research/downloads/PL97-414.pdf\">a landmark health bill\u003c/a> aimed at motivating pharmaceutical companies to develop new drugs for people whose rare diseases had been ignored.\u003c/p>\n\u003cp>By the drugmakers’ calculations, the markets for such diseases weren’t big enough to bother with.\u003c/p>\n\u003cp>But lucrative financial incentives created by the Orphan Drug Act signed into law by President Ronald Reagan in 1983 succeeded far beyond anyone’s expectations. More than 200 companies have brought almost 450 “orphan drugs” to market since the law took effect.\u003c/p>\n\u003cp>Yet a Kaiser Health News investigation shows that the system intended to help desperate patients is being manipulated by drugmakers to maximize profits and to protect niche markets for medicines already being taken by millions. The companies aren’t breaking the law but they are using the Orphan Drug Act to their advantage in ways that its architects say they didn’t foresee or intend. Today, many orphan medicines, originally developed to treat diseases affecting fewer than 200,000 people, come with astronomical price tags.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>And many drugs that now have orphan status aren’t entirely new. More than 70 were drugs first approved by the Food and Drug Administration for mass market use. These medicines, some with familiar brand names, were later approved as orphans. In each case, their manufacturers received millions of dollars in government incentives plus seven years of exclusive rights to treat that rare disease, or a monopoly.\u003c/p>\n\u003cp>Drugmakers of popular mass market drugs later sought and received orphan status for the cholesterol blockbuster Crestor, Abilify for psychiatric conditions, cancer drug Herceptin, and rheumatoid arthritis drug Humira, the best-selling medicine in the world.\u003c/p>\n\u003cp>More than 80 other orphans won FDA approval for more than one rare disease, and in some cases, multiple rare diseases. For each additional approval, the drugmaker qualified for a fresh batch of incentives. Botox, stocked in most dermatologists’ offices, started out as a drug to treat painful muscle spasms of the eye and now has three orphan drug approvals. It’s also approved as a mass market drug to treat a variety of ailments, including chronic migraines and wrinkles.\u003c/p>\n\u003cp>Altogether, KHN’s investigation found that about a third of orphan approvals by the FDA since the program began have been either for repurposed mass market drugs or drugs that received multiple orphan approvals.\u003c/p>\n\u003cp>“What we are seeing is a system that was created with good intent being hijacked,” said Bernard Munos, a former corporate strategy advisor at drug giant Eli Lilly and Co. who reviewed the KHN analysis of several FDA drug databases. It’s “quite remarkable that it has gone on for so long.”\u003c/p>\n\u003cp>And the proportion of \u003ca href=\"http://www.fda.gov/Drugs/DevelopmentApprovalProcess/DrugInnovation/ucm534863.htm\">new drugs\u003c/a> approved as orphans has ballooned. In 2015, 21 orphan drugs were approved, accounting for 47 percent of all new medicines, up from just 29 percent in 2010; in 2016, nine more orphans won approval, 40 percent of the total.\u003c/p>\n\u003cp>When a drugmaker wins approval of a medicine for an orphan disease, the company gets seven years of exclusive rights to the marketplace, which means the FDA won’t approve another version to treat that rare disease for seven years, even if the brand name company’s patent has run out. The exclusivity is compensation for developing a drug designed for a small number of patients whose total sales weren’t expected to be that profitable.\u003c/p>\n\u003cp>But the exclusivity is a potent pricing tool. Drugmakers can charge whatever they want by shielding their medicine from competition. The market exclusivity granted by the Orphan Drug Act can be a vital part of the protective shield that companies create. What’s more, manufacturers can return to the FDA with the same drug again and again, each time testing the drug against a new rare disease.\u003c/p>\n\u003cp>Critics have assailed drugmakers in the past for gaming the orphan drug approval process. But the extent to which companies have been winning approval for drugs that aren’t what advocates call “true orphans” hadn’t been documented until the Kaiser Health News investigation.\u003c/p>\n\u003cp>Munos said he was “shocked” by the sheer number of mass market drugs being repurposed as well as those approved multiple times.\u003c/p>\n\u003cp>Even agency officials said they weren’t aware of the scope of the issue. After reviewing KHN’s findings for two weeks, Dr. Gayatri Rao director of the FDA’s Office of Orphan Products Development said she “appreciated the work” and expressed interest in studying how often drug companies are “repurposing” a drug for a new rare disease, or taking “multiple bites of the apple.”\u003c/p>\n\u003cp>“We are going to look into this,” she said, adding that she could consider a regulatory change.\u003c/p>\n\u003cp>Rao pointed out that the “repurposing” of drugs does have scientific and patient benefits. For example, cancer drugs approved for one type of malignancy can be tested and approved for others. Gleevec, a drug that revolutionized the treatment of chronic myeloid leukemia, now has nine orphan approvals.\u003c/p>\n\u003cp>But in a \u003ca href=\"http://www.hopkinsmedicine.org/news/media/releases/orphan_drug_loophole_needs_closing_johns_hopkins_researchers_say\">2015 commentary\u003c/a> published in the American Journal of Clinical Oncology, Dr. Martin Makary at the Johns Hopkins University School of Medicine focused on cancer drugs including Gleevec, arguing that the drug was never meant to serve an orphan population. Instead, Makary and his team wrote, drugmakers purposely identify small patient populations to gain additional approvals — a process he described as “salami slicing.”\u003c/p>\n\u003cp>“By salami slicing the disease into subgroups, it allows them to get the orphan drug approval with all the government benefits and even some of the subsidies,” Makary said. The prices of such medications often rise because they have seven years without competition for a new set of patients, Makary added.\u003c/p>\n\u003cp>The FDA has taken a different view of repurposing.\u003c/p>\n\u003cp>“We always talked about how we permit the second bite of the apple, third bite of the apple, as one small way to incentivize repurposing,” Rao said, noting that industry and patient groups have been pressing the FDA for even stronger incentives. “Now, all of sudden, it seems like, wow, this practice may be driving up prices.”\u003c/p>\n\u003cp>Novartis, which owns Gleevec, said in an email statement that the company is advancing research and following the science to “bring the right treatments to the right patients based on unmet need, not the size of the patient population.”\u003c/p>\n\u003cp>Two KHN reporters spent six months analyzing data and talking to lawmakers, patients, advocates, doctors and companies to understand how the FDA’s orphan drug program has evolved amid a national uproar over soaring drug prices. President-elect Donald Trump vowed on the campaign trail to \u003ca href=\"http://www.reuters.com/article/us-usa-trump-pharmaceuticals-idUSKBN13W21I\">bring down\u003c/a> prescription drug prices and during a Jan. 11 press conference said the drug industry is \u003ca href=\"https://www.nytimes.com/2017/01/11/us/politics/trump-press-conference-transcript.html?_r=0\">“getting away with murder.”\u003c/a>\u003c/p>\n\u003cp>The investigation examined how drugmakers use the law to their advantage — often with the guidance of former FDA officials — and have made the development of medicines that were once thought to be business backwaters into one of the pharmaceutical industry’s hottest sectors.\u003c/p>\n\u003cp>Orphan drugs now account for seven of the 10 top-selling drugs of any kind, ranked by annual sales, according to EvaluatePharma.\u003c/p>\n\u003cp>“Orphans are wicked hot,” said Dr. Tim Coté, a former FDA official who now runs a consulting firm that advises drugmakers on orphan drugs.\u003c/p>\n\u003cp>No one disputes that orphan drugs have helped or saved hundreds of thousands of patients suffering from debilitating or even fatal rare diseases. Exactly how many is difficult to estimate because the FDA doesn’t track such information.\u003c/p>\n\u003cp>And drug industry officials say companies should be rewarded, not punished, for making those treatments possible and for pursuing new drugs that aren’t always an economic success.\u003c/p>\n\u003cp>Research and development is “long, costly, risky,” said Anne Pritchett, vice president, policy and research at industry lobbying group PhRMA. “When you look at cystic fibrosis it was 25 years to the development of an effective therapy … I think we would be concerned about anything that would undermine the current [orphan drug] incentives.”\u003c/p>\n\u003cp>Former U.S. Rep. Henry Waxman, D-Calif., a champion of the 1983 Orphan Drug Act takes a different view.\u003c/p>\n\u003cp>“The Orphan Drug Act has been a great success because many people with diseases that affect very few people now have drugs available to them,” Waxman said. “But it’s been in some ways turned on its head when it becomes the basis of manipulating the system for the drug company to make much more money than they would in an open, competitive market.”\u003c/p>\n\u003cp>Booming Business\u003c/p>\n\u003cp>On a late summer day, Tim Coté sat in a corner office of his Sandy Spring, Md., consulting firm, Coté Orphan. He leaned into his computer microphone to dispense insider knowledge about the orphan drug approval process on a webcast hosted by FDAnews, a trade news organization. Listeners paid about $300 a head, but Coté said he wasn’t paid for doing it.\u003c/p>\n\u003cp>The FDA is more flexible in evaluating drugs for rare diseases, he said, explaining that “about half of them get through with just one pivotal clinical trial. Not so for common diseases.” The FDA, citing \u003ca href=\"http://www.fda.gov/downloads/ForIndustry/DevelopingProductsforRareDiseasesConditions/OOPDNewsArchive/UCM294773.pdf\">a report\u003c/a> from the National Organization for Rare Disorders, said about two-thirds of orphan drugs were approved with one adequate and well-controlled trial with supportive evidence. It typically requires two or three such trials to approve a mass market drug.\u003c/p>\n\u003cp>Coté also told the webinar audience that clinical trials for orphan drugs are usually smaller and the approval is a “different scientific and regulatory experience.”\u003c/p>\n\u003cp>Coté knows his stuff. He was Rao’s immediate predecessor as chief of the FDA’s Office of Orphan Products Development. It’s not unusual for government officials to leave FDA and other regulatory agencies and \u003ca href=\"http://www.npr.org/sections/health-shots/2016/09/28/495694559/a-look-at-how-the-revolving-door-spins-from-fda-to-industry\">obtain jobs as consultants or industry executives\u003c/a>.\u003c/p>\n\u003cp>Coté’s website, headlined “The Inside Track,” notes that he oversaw applications that led to the approval of at least 150 orphan drugs when he was at the FDA and that his firm is now the largest submitter of orphan drug applications.\u003c/p>\n\u003cp>“We write the entire application,” the website for Coté’s company notes, adding that his staff of 25 includes regulatory scientists with deep knowledge and experience in FDA’s “unwritten rules” regarding orphan drugs.\u003c/p>\n\u003cp>Many of Coté’s more than 300 clients are small biotech companies begun by researchers or even passionate parents who found investment backing. Parents Ilan and Annie Ganot, for example, started Solid Biosciences to find treatments and potentially a cure for their son with Duchenne muscular dystrophy.\u003c/p>\n\u003cp>Coté guides them through the regulatory process since most don’t have the expertise. He can offer his expertise and develop an application that makes it easier for the FDA to designate and approve the drug.\u003c/p>\n\u003cp>“When you make the FDA smile, the value of your asset goes up. And that’s how the game is played,” he said in an interview, adding quickly, “It’s really not a game because people’s lives are what is in balance.”\u003c/p>\n\u003cp>Coté and other ex-FDA officials play a vital role in helping drugmakers choose rare disease targets and get through the FDA approval process.\u003c/p>\n\u003cp>A small cottage industry has grown around the Orphan Drug Act. Dr. Marlene Haffner, who preceded Coté in the FDA’s orphan office, started her own consulting firm, too, to advise small and large companies on orphan drug applications. A third company is Camargo Pharmaceutical Services, led by industry veterans and former FDA officials, which advises companies focused on repurposing drugs for orphan approval. The firm tries “to be in front of the FDA a lot — three to four times a month,” said Jennifer King, Camargo’s director of marketing. Fees for consulting on orphan drugs industry wide range from $5,000 to $100,000, depending upon what services are provided, Coté said.\u003c/p>\n\u003cp>Getting through the orphan approval process involves a series of steps.\u003c/p>\n\u003cp>First, drugs must be designated by the FDA as potential candidates for approval. A company has to demonstrate that its drug is a promising treatment for a disease that affects fewer than 200,000 patients. If the FDA agrees and makes the formal designation, financial incentives kick in, including a 50 percent tax break on research and development (R&D) and access to federal grants.\u003c/p>\n\u003cp>When drugs get orphan designation, companies often reap other financial rewards. Shares in publicly traded companies often rise on the news — sometimes soaring \u003ca href=\"http://www.bizjournals.com/triangle/news/2014/02/25/dara-stock-soars-on-orphan-drug.html\">as high as 30 percent\u003c/a>. That happens, in part, because orphans have a track record of being approved at much higher rates than drugs for common diseases.\u003c/p>\n\u003cp>The 50 percent R&D tax credit pays off, too. In 2012, one of the biggest orphan drug companies, BioMarin, received \u003ca href=\"http://files.shareholder.com/downloads/ABEA-3W276N/2866327224x0x664042/776E8656-30BA-4937-A2A0-3AB6450BCA00/2012_Annual_Report.pdf\">$32.6 million\u003c/a> from a combination of federal and state of California tax credits. BioMarin spokeswoman Debra Charlesworth confirmed that the orphan credit made up the “vast majority” of that deferred tax benefit. She also noted that credit “has successfully fueled an industry that didn’t previously exist” and led to more rare disease research.\u003c/p>\n\u003cp>Industry-wide, orphan drug tax credits cost the federal government $1.76 billion in fiscal 2016 — roughly what President Barack Obama asked Congress to spend to fight \u003ca href=\"https://www.washingtonpost.com/news/post-politics/wp/2016/02/08/obama-to-ask-congress-for-1-8-billion-to-combat-zika-virus/\">the Zika virus\u003c/a> before a $1.1 billion expenditure was approved. And, because so many orphan drugs are under development, the U.S. could grant nearly $50 billion in tax credits from 2016 to 2025, estimates \u003ca href=\"https://www.treasury.gov/resource-center/tax-policy/Documents/Tax-Expenditures-FY2017.pdf\">the Treasury Department\u003c/a>.\u003c/p>\n\u003cp>There’s a lot of creativity behind figuring out how to make a drug an orphan.\u003c/p>\n\u003cp>In Coté’s webinar and in multiple interviews, he described many ways companies can win orphan status. They can test their drugs on children with adult diseases, such as schizophrenia, or find drugs for ailments like malaria that are uncommon in America.\u003c/p>\n\u003cp>“African sleeping sickness: horrible problem in Africa but not here, not in the U.S.,” Coté told his webinar audience. “So a drug development effort that was aimed toward some of these tropical diseases can actually get all the benefits of the Orphan Drug Act.”\u003c/p>\n\u003cp>Another popular strategy is to create “follow-on drugs” that represent incremental steps forward.\u003c/p>\n\u003cp>About 30 percent of Coté’s clients are companies looking to improve upon some other orphan drug “which just made billions and billions,” he said in an interview.\u003c/p>\n\u003cp>Repurposing an already approved drug is another strategy his firm promotes. In a \u003ca href=\"https://www.linkedin.com/pulse/re-purposing-drugs-orphans-timothy-cote?published=t\">video\u003c/a> posted on his website in July, Coté explained the advantages for companies that can move directly into a clinical trial without much preparatory work because the drug’s safety has already been demonstrated.\u003c/p>\n\u003cp>“All you gotta do is establish that the product can work in this new orphan indication,” he said, adding tips on how to do it and still make money.\u003c/p>\n\u003cp>‘That Is Not A True Orphan Drug’\u003c/p>\n\u003cp>Turning mass market drugs into orphans has been a familiar path for some of the most popular drugs ever discovered.\u003c/p>\n\u003cp>AbbVie’s Humira is the best-selling drug in the world, and most of its sales are in the U.S. where revenue reached $7.6 billion through \u003ca href=\"https://news.abbvie.com/news/abbvie-reports-third-quarter-2016-financial-results.htm\">the third quarter\u003c/a> of 2016 and $11.8 billion worldwide, according to the company’s latest financial report.\u003c/p>\n\u003cp>Humira was approved by the FDA in late 2002 to treat millions of people who suffer from rheumatoid arthritis. Three years later, AbbVie asked the FDA to designate it as an orphan to treat juvenile rheumatoid arthritis, which they told the FDA affects between 30,000 and 50,000 Americans. That pediatric use was approved in 2008, and Humira subsequently was approved for four more rare diseases, including Crohn’s and uveitis, an inflammatory disease affecting the eyes.\u003c/p>\n\u003cp>The ophthalmologic approval would extend the market exclusivity for Humira for that disease until 2023. When asked why AbbVie sought multiple orphan designations and approvals for Humira, the company declined to comment.\u003c/p>\n\u003cp>Peter Saltonstall, executive director of the National Organization for Rare Disorders, said that Humira is “not a true orphan drug.” But, he said, the company has “the ability to go out and get orphan designation. That’s the way the law reads right now … they can do whatever they want to do.”\u003c/p>\n\u003cp>It is difficult to say exactly how or if orphan exclusivity affects the price of Humira, which is a complex biologic drug and also has been protected by \u003ca href=\"http://www.nytimes.com/2016/07/16/business/makers-of-humira-and-enbrel-using-new-drug-patents-to-delay-generic-versions.html?_r=3\">numerous patents\u003c/a>. The drug has long been AbbVie’s top seller, accounting for 63 percent of its revenues, according to its most recent financial filing.\u003c/p>\n\u003cp>EvaluatePharma notes \u003ca href=\"http://info.evaluategroup.com/rs/607-YGS-364/images/EPOD15.pdf\">in its recent report\u003c/a> that Humira, as well as a handful of other top drugs, receive less than 25 percent of their sales from orphan uses. Still, if Humira’s orphan uses accounted for just 10 percent of annual sales, the revenue would surpass $1 billion.\u003c/p>\n\u003cp>By stacking up a series of orphan disease approvals, one seven-year exclusivity period leads into another, maximizing the length of a company’s monopoly. Sigma-Tau Pharmaceuticals, for example, had some form of orphan exclusivity over its metabolic disorder drug for more than 20 years. The drug, Carnitor, received a second orphan approval four months before its first exclusivity was set to expire. And it won its third orphan approval, for an IV formulation of the drug, just one day before its second exclusivity period was set to expire in December of 1999.\u003c/p>\n\u003cp>“The sequence and timing of regulatory filings for Carnitor reflect the time required to conduct large controlled clinical trials, as well as evolving medical strategies and regulatory pathways pursued by different sponsors over many years,” said GianFranco Fornasini, senior vice president of scientific affairs at Sigma-Tau.\u003c/p>\n\u003cp>The FDA’s Rao said each new exclusivity period is disease-specific and once any seven-year period runs out, generics can come in. Gleevec, for example, won FDA approval to treat several kinds of rare cancer. All but one of its orphan exclusivity periods had expired by 2015, allowing two generics to enter the marketplace. But Gleevec still has exclusivity until 2020 to treat newly diagnosed Philadelphia chromosome-positive acute lymphoblastic leukemia in patients who are also on chemotherapy.\u003c/p>\n\u003cp>It’s also true, Rao explained, that some of the drugs that go through the orphan process may not specifically treat a rare disease. For example, a very toxic cancer drug might may not work well in earlier stages because its risks outweigh the benefits. But the company may propose that it will help a smaller group of later-stage cancer patients and win orphan approval just for that group.\u003c/p>\n\u003cp>Former FDA orphan drug director Haffner said her FDA office worked on rules defining how companies could legitimately pursue approval for a small group of patients with a specific unmet medical need.\u003c/p>\n\u003cp>“People have played games with the Orphan Drug Act since it was passed,” said Haffner, who first took a job with drugmaker Amgen after leaving the FDA and then became an independent consultant. “It’s the American way, I don’t mean that in a nasty way. But we take advantage of what’s in front of us.”\u003c/p>\n\u003cp>In 2013, the \u003ca href=\"https://www.federalregister.gov/documents/2013/06/12/2013-13930/orphan-drug-regulations\">FDA clarified the Orphan Drug Act’s regulations\u003c/a> and said it wanted to avoid the possibility that some companies could “potentially ‘game’ approvals by seeking successive narrow approvals of a drug.”\u003c/p>\n\u003cp>In reality, Rao said, the regulations did not really change “much of what our practice was.” The agency wanted to address what Rao said were “common misconceptions” and frequently asked questions so officials changed wording in the regulations to better define exactly what could be considered an orphan drug.\u003c/p>\n\u003cp>Breaking down larger, broader diseases into smaller groups is still allowed under certain conditions and companies can still win multiple orphan approvals for a single drug — even if the total population served rises above the 200,000 mark.\u003c/p>\n\u003cp>Amgen Inc.’s Repatha won marketing approval and exclusive rights in 2015 for the orphan disease homozygous familial hypercholesterolemia, which affects a population of \u003ca href=\"http://www.lipidjournal.com/article/S1933-2874(13)00309-7/abstract\">about 300 people\u003c/a> in the U.S. On the very same day, the drug was approved as a mass market drug to treat up to 11 million people with uncontrolled levels of LDL cholesterol, said Amgen spokeswoman Kristen Davis.\u003c/p>\n\u003cp>Dr. Steven Nissen of the Cleveland Clinic, who ran a broader trial on Repatha, said, “It’s certainly not considered by any of us to be an orphan drug.”\u003c/p>\n\u003cp>Safeguarding The ‘Prize’\u003c/p>\n\u003cp>Considering the long history of what’s happened, Tim Coté acknowledges that there are “some loopholes” in the Orphan Drug Act. Perhaps 3 percent or less of approved orphans were not in the “spirit” of the law, he said.\u003c/p>\n\u003cp>But Coté, rare disease advocates, patients and people in the drug industry expressed fear that changing the Orphan Drug Act or questioning its success would hurt the development of drugs for rare patients.\u003c/p>\n\u003cp>Former U.S. Rep. Jim Greenwood, R-Pa., now president of the Biotechnology Innovation Organization, an industry trade group, said that concerns about high prices for orphan drugs aren’t justified. The incentives, he said, should not be altered because rare diseases are “tragically killing and brutalizing mostly children.”\u003c/p>\n\u003cp>Greenwood seemed unaware that dozens of orphan approvals stemmed from the repurposing of mass market drugs, like Humira or Enbrel, another drug developed first for rheumatoid arthritis. Still, he said, “I would argue that the risk of losing incentives in the system far outweighs the benefit of trying to save a few pennies on the health care dollar.”\u003c/p>\n\u003cp>It’s a sentiment that Coté and other advocates share. While talking about the $311,000 annual price tag for cystic fibrosis drug Kalydeco, Coté said any parent whose child has the disease would be a big fan of the drug.\u003c/p>\n\u003cp>“The price point is justified because actually it has a dramatic effect on the children. Dead children … people are willing to pay a lot to prevent that,” Coté said. “And that’s a real good thing that we have this drug. OK?”\u003c/p>\n\u003cp>The first drug to specifically target the underlying biochemical defect of cystic fibrosis, Kalydeco is approved to treat a subset of patients who have specific mutations in their genes. Development of the drug was financed by the Cystic Fibrosis Foundation, which sold its rights to sales royalties from Kalydeco and other cystic fibrosis drugs for $3.3 billion in 2014.\u003c/p>\n\u003cp>Others, including Henry Waxman, are far more critical and have tried to do something about it over the years. Waxman proposed multiple bills to rein in corporate profits by amending the orphan drug law that he sponsored, but none succeeded.\u003c/p>\n\u003cp>The FDA has also tried but failed, to keep corporations in check.\u003c/p>\n\u003cp>In 2012, drugmaker Depomed Inc. filed suit against the FDA for refusing to give its drug Gralise seven years of market exclusivity as a treatment for pain related to shingles.\u003c/p>\n\u003cp>Rao said the agency wanted to see proof that Gralise was clinically superior to other drugs, noting there “were a bunch of other generics on the market” with different formulations and dosing requirements. Grasile’s active ingredient, gabapentin, is the same one as in Pfizer’s mass market blockbuster \u003ca href=\"http://www.pfizer.com/products/product-detail/neurontin\">Neurontin\u003c/a>, which is also approved for treatment of shingles pain.\u003c/p>\n\u003cp>The FDA approved Gralise but denied seven years of exclusivity.\u003c/p>\n\u003cp>In response, the drugmaker sued the agency and won its case, arguing that according to the law, they didn’t have to prove their drug was clinically superior to gain the monopoly.\u003c/p>\n\u003cp>Today, the drug is one of Depomed’s top products with sales of $81 million in 2015. And, in a \u003ca href=\"http://investor.depomedinc.com/phoenix.zhtml?c=97276&p=irol-SECText&TEXT=aHR0cDovL2FwaS50ZW5rd2l6YXJkLmNvbS9maWxpbmcueG1sP2lwYWdlPTEwODc0NDE5JkRTRVE9MCZTRVE9MCZTUURFU0M9U0VDVElPTl9FTlRJUkUmc3Vic2lkPTU3\">recent proxy statement\u003c/a>, Depomed listed “protecting Gralise exclusivity” as a corporate objective under the category of “enhance and protect future cash flow.” Its orphan exclusivity ends in 2018. Depomed spokesman Christopher Keenan said Gralise wanted patent exclusivity to block competition. But, Keenan said, “Had the patent effort failed on all fronts, the Orphan Drug Designation would have been very important.”\u003c/p>\n\u003cp>After reviewing KHN’s analysis, Rao said she wants to better understand why drugmakers are applying for multiple approvals and has asked for a case-by-case review of all orphan designations granted in 2010 and 2015. She said the agency lacks the resources to run an analysis of the entire orphan drug database.\u003c/p>\n\u003cp>“Our goal is to try to get it right,” she said. “There are over 7,000 rare diseases, likely more, the vast majority of which have nothing … I want to ensure that we continue to keep our eye on that prize.”\u003c/p>\n\u003cp>Contributors: John Hillkirk, Scott Hensley at NPR, Diane Webber, Marilyn Thompson (editors); Elizabeth Lucas (data editing); Joe Neel at NPR (radio editing)\u003c/p>\n\u003cp>Interactives, video and presentation: Lydia Zuraw, Emily Kopp, Meredith Rizzo at NPR (digital presentation); Francis Ying (videos, motion graphic); Heidi de Marco (videos, photos, audio); Alley Interactive (database lookup)\u003c/p>\n\u003cp>KHN’s coverage of prescription drug development, costs and pricing is supported in part by the \u003ca href=\"http://www.arnoldfoundation.org/\">Laura and John Arnold Foundation\u003c/a>.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"info": "What kind of no sabo word is Hyphenación? For us, it’s about living within a hyphenation. Like being a third-gen Mexican-American from the Texas border now living that Bay Area Chicano life. Like Xorje! Each week we bring together a couple of hyphenated Latinos to talk all about personal life choices: family, careers, relationships, belonging … everything is on the table. ",
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"marketplace": {
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"info": "Our flagship program, helmed by Kai Ryssdal, examines what the day in money delivered, through stories, conversations, newsworthy numbers and more. Updated Monday through Friday at about 3:30 p.m. PT.",
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"mindshift": {
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"info": "The MindShift podcast explores the innovations in education that are shaping how kids learn. Hosts Ki Sung and Katrina Schwartz introduce listeners to educators, researchers, parents and students who are developing effective ways to improve how kids learn. We cover topics like how fed-up administrators are developing surprising tactics to deal with classroom disruptions; how listening to podcasts are helping kids develop reading skills; the consequences of overparenting; and why interdisciplinary learning can engage students on all ends of the traditional achievement spectrum. This podcast is part of the MindShift education site, a division of KQED News. KQED is an NPR/PBS member station based in San Francisco. You can also visit the MindShift website for episodes and supplemental blog posts or tweet us \u003ca href=\"https://twitter.com/MindShiftKQED\">@MindShiftKQED\u003c/a> or visit us at \u003ca href=\"/mindshift\">MindShift.KQED.org\u003c/a>",
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"order": 12
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM1NzY0NjAwNDI5",
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"tagline": "Deeply-reported investigative journalism",
"info": "For decades, the process for how police police themselves has been inconsistent – if not opaque. In some states, like California, these proceedings were completely hidden. After a new police transparency law unsealed scores of internal affairs files, our reporters set out to examine these cases and the shadow world of police discipline. On Our Watch brings listeners into the rooms where officers are questioned and witnesses are interrogated to find out who this system is really protecting. Is it the officers, or the public they've sworn to serve?",
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"info": "Our weekly podcast explores how the media 'sausage' is made, casts an incisive eye on fluctuations in the marketplace of ideas, and examines threats to the freedom of information and expression in America and abroad. For one hour a week, the show tries to lift the veil from the process of \"making media,\" especially news media, because it's through that lens that we see the world and the world sees us",
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},
"perspectives": {
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"order": 14
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"info": "The economy explained. Imagine you could call up a friend and say, Meet me at the bar and tell me what's going on with the economy. Now imagine that's actually a fun evening.",
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"title": "Political Breakdown",
"tagline": "Politics from a personal perspective",
"info": "Political Breakdown is a new series that explores the political intersection of California and the nation. Each week hosts Scott Shafer and Marisa Lagos are joined with a new special guest to unpack politics -- with personality — and offer an insider’s glimpse at how politics happens.",
"airtime": "THU 6:30pm-7pm",
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"possible": {
"id": "possible",
"title": "Possible",
"info": "Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. Together in Possible, Hoffman and Finger lead enlightening discussions about building a brighter collective future. The show features interviews with visionary guests like Trevor Noah, Sam Altman and Janette Sadik-Khan. Possible paints an optimistic portrait of the world we can create through science, policy, business, art and our shared humanity. It asks: What if everything goes right for once? How can we get there? Each episode also includes a short fiction story generated by advanced AI GPT-4, serving as a thought-provoking springboard to speculate how humanity could leverage technology for good.",
"airtime": "SUN 2pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Possible-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.possible.fm/",
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"source": "Possible"
},
"link": "/radio/program/possible",
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"spotify": "https://open.spotify.com/show/730YpdUSNlMyPQwNnyjp4k"
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},
"pri-the-world": {
"id": "pri-the-world",
"title": "PRI's The World: Latest Edition",
"info": "Each weekday, host Marco Werman and his team of producers bring you the world's most interesting stories in an hour of radio that reminds us just how small our planet really is.",
"airtime": "MON-FRI 2pm-3pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/The-World-Podcast-Tile-360x360-1.jpg",
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},
"radiolab": {
"id": "radiolab",
"title": "Radiolab",
"info": "A two-time Peabody Award-winner, Radiolab is an investigation told through sounds and stories, and centered around one big idea. In the Radiolab world, information sounds like music and science and culture collide. Hosted by Jad Abumrad and Robert Krulwich, the show is designed for listeners who demand skepticism, but appreciate wonder. WNYC Studios is the producer of other leading podcasts including Freakonomics Radio, Death, Sex & Money, On the Media and many more.",
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},
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