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"content": "\u003cp>A few months ago, the Centers for Disease Control and Prevention \u003ca href=\"http://www.cdc.gov/zika/vector/range.html\">published\u003c/a> a startling map that showed the parts of the U.S. that could harbor mosquitoes capable of carrying Zika.\u003c/p>\n\u003cp>Many readers, including myself, thought, “Zika could come to my town! It could come to Connecticut! To Ohio and Indiana! Or to northern California! Oh goodness!”\u003c/p>\n\u003cp>[contextly_sidebar id=”lK7gBJoft23Bq7cmXwm3rdJ2bU4yK2sr”]The map made it look like a vast swath of the country was at risk for Zika, including New England and the Upper Midwest.\u003c/p>\n\u003cp>Well, not quite.\u003c/p>\n\u003cp>On Thursday, CDC scientists \u003ca href=\"http://jme.oxfordjournals.org/content/early/2016/06/07/jme.tjw072\">published\u003c/a> \u003cem>another\u003c/em> mosquito map for the U.S. And it paints a very different picture.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The new map shows counties in which scientists, over the past two decades, have collected \u003cem>Aedes aegypti\u003c/em> mosquitoes — the type of insect thought to be spreading Zika in Latin American and the Caribbean.\u003c/p>\n\u003cp>“The new map is more accurate than the initial one,” says \u003ca href=\"http://entomology.ucdavis.edu/Faculty/Thomas_W_Scott/\">Thomas Scott\u003c/a>, an entomologist at the University of California, Davis. “The distribution of the \u003cem>A. aegypti\u003c/em> mosquito is much more restricted than the initial map showed.”\u003c/p>\n\u003cp>In the map, counties colored yellow reported \u003cem>A. aegypti\u003c/em> mosquitoes during one year between 1995 to 2016. Orange counties had the mosquitoes in two years. And red counties are the hotspots: Scientists there found \u003cem>A. aegypti\u003c/em> mosquitoes during three or more years in the past two decades.\u003c/p>\n\u003cp>This map represents “the best knowledge of the current distribution of this mosquito based on collection records,” entomologist John-Paul Mutebi and his colleagues at the CDC wrote in the \u003cem>Journal of Medical Entomology\u003c/em>.\u003c/p>\n\u003cp>Many of the hot spots for this mosquito aren’t surprising. They’re places that we already knew are vulnerable to Zika, including counties in southern Florida, along the Gulf Coast and southern Texas. These places have had problems with a virus closely related to Zika, called dengue. They’re already on high alert for Zika.\u003c/p>\n\u003cp>But several hot spots are bit more unexpected — and concerning. “Perhaps the most concerning development for \u003cem>A. aegypti\u003c/em> is its establishment in the Southwest, most recently in California in 2013,” Mutebi and his co-authors write.\u003c/p>\n\u003cp>Other surprises include parts of the Bay Area, greater Washington, D.C., and the Dallas-Fort Worth region, which all have established populations of \u003cem>A. aegypti, \u003c/em>the map shows.\u003c/p>\n\u003cp>“The country is really a patchwork,” Scott says. “When you drill down into one particular state, you find that the mosquito isn’t found across the whole state. And when you drill down into a county, you find the same thing. The mosquito is found in just a small part.”\u003c/p>\n\u003cp>So why did the first map from the CDC make it look like such an extensive part of the country was at risk for Zika?\u003c/p>\n\u003cp>“The two maps show different things,” Mutebi tells Shots. “The first map showed where the climate is able to sustain populations of \u003cem>A. aegypti\u003c/em>. This new map shows reports from counties where these mosquitoes were found in the last 20 years.”\u003c/p>\n\u003cp>And the new map, Mutebi says, is not complete. “Not all counties have mosquito surveillance programs looking for mosquitoes,” he says. In places that do, they are often targeting the mosquito that causes West Nile virus, not \u003cem>A. aegypti\u003c/em>.\u003c/p>\n\u003cp>“So just because a county hasn’t reported having any \u003cem>A. aegypti\u003c/em> mosquitoes, doesn’t mean they’re not there,” Mutebi says.\u003c/p>\n\u003cp>\u003cem>A. aegypti\u003c/em> mosquitoes are nasty critters. They chase down people so they can feed on their blood, says virologist \u003ca href=\"http://www.utmb.edu/internalmedicine/divisions/infectious_diseases/faculty/bio_weaver.asp\">Scott Weaver\u003c/a> at the University of Texas Medical Branch in Galveston.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“\u003cem>A. aegypti\u003c/em> lives in close association with people, feeds almost exclusively on people — not animals — and even comes into people’s home,” he says. “Its behavior and its ecology are almost ideal for a mosquito to transmit a human virus.”\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg decoding=\"async\" src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Here%27s+Really+Where+Zika+Mosquitoes+Are+Likely+In+The+U.S.&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>A few months ago, the Centers for Disease Control and Prevention \u003ca href=\"http://www.cdc.gov/zika/vector/range.html\">published\u003c/a> a startling map that showed the parts of the U.S. that could harbor mosquitoes capable of carrying Zika.\u003c/p>\n\u003cp>Many readers, including myself, thought, “Zika could come to my town! It could come to Connecticut! To Ohio and Indiana! Or to northern California! Oh goodness!”\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>The map made it look like a vast swath of the country was at risk for Zika, including New England and the Upper Midwest.\u003c/p>\n\u003cp>Well, not quite.\u003c/p>\n\u003cp>On Thursday, CDC scientists \u003ca href=\"http://jme.oxfordjournals.org/content/early/2016/06/07/jme.tjw072\">published\u003c/a> \u003cem>another\u003c/em> mosquito map for the U.S. And it paints a very different picture.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The new map shows counties in which scientists, over the past two decades, have collected \u003cem>Aedes aegypti\u003c/em> mosquitoes — the type of insect thought to be spreading Zika in Latin American and the Caribbean.\u003c/p>\n\u003cp>“The new map is more accurate than the initial one,” says \u003ca href=\"http://entomology.ucdavis.edu/Faculty/Thomas_W_Scott/\">Thomas Scott\u003c/a>, an entomologist at the University of California, Davis. “The distribution of the \u003cem>A. aegypti\u003c/em> mosquito is much more restricted than the initial map showed.”\u003c/p>\n\u003cp>In the map, counties colored yellow reported \u003cem>A. aegypti\u003c/em> mosquitoes during one year between 1995 to 2016. Orange counties had the mosquitoes in two years. And red counties are the hotspots: Scientists there found \u003cem>A. aegypti\u003c/em> mosquitoes during three or more years in the past two decades.\u003c/p>\n\u003cp>This map represents “the best knowledge of the current distribution of this mosquito based on collection records,” entomologist John-Paul Mutebi and his colleagues at the CDC wrote in the \u003cem>Journal of Medical Entomology\u003c/em>.\u003c/p>\n\u003cp>Many of the hot spots for this mosquito aren’t surprising. They’re places that we already knew are vulnerable to Zika, including counties in southern Florida, along the Gulf Coast and southern Texas. These places have had problems with a virus closely related to Zika, called dengue. They’re already on high alert for Zika.\u003c/p>\n\u003cp>But several hot spots are bit more unexpected — and concerning. “Perhaps the most concerning development for \u003cem>A. aegypti\u003c/em> is its establishment in the Southwest, most recently in California in 2013,” Mutebi and his co-authors write.\u003c/p>\n\u003cp>Other surprises include parts of the Bay Area, greater Washington, D.C., and the Dallas-Fort Worth region, which all have established populations of \u003cem>A. aegypti, \u003c/em>the map shows.\u003c/p>\n\u003cp>“The country is really a patchwork,” Scott says. “When you drill down into one particular state, you find that the mosquito isn’t found across the whole state. And when you drill down into a county, you find the same thing. The mosquito is found in just a small part.”\u003c/p>\n\u003cp>So why did the first map from the CDC make it look like such an extensive part of the country was at risk for Zika?\u003c/p>\n\u003cp>“The two maps show different things,” Mutebi tells Shots. “The first map showed where the climate is able to sustain populations of \u003cem>A. aegypti\u003c/em>. This new map shows reports from counties where these mosquitoes were found in the last 20 years.”\u003c/p>\n\u003cp>And the new map, Mutebi says, is not complete. “Not all counties have mosquito surveillance programs looking for mosquitoes,” he says. In places that do, they are often targeting the mosquito that causes West Nile virus, not \u003cem>A. aegypti\u003c/em>.\u003c/p>\n\u003cp>“So just because a county hasn’t reported having any \u003cem>A. aegypti\u003c/em> mosquitoes, doesn’t mean they’re not there,” Mutebi says.\u003c/p>\n\u003cp>\u003cem>A. aegypti\u003c/em> mosquitoes are nasty critters. They chase down people so they can feed on their blood, says virologist \u003ca href=\"http://www.utmb.edu/internalmedicine/divisions/infectious_diseases/faculty/bio_weaver.asp\">Scott Weaver\u003c/a> at the University of Texas Medical Branch in Galveston.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“\u003cem>A. aegypti\u003c/em> lives in close association with people, feeds almost exclusively on people — not animals — and even comes into people’s home,” he says. “Its behavior and its ecology are almost ideal for a mosquito to transmit a human virus.”\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg decoding=\"async\" src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Here%27s+Really+Where+Zika+Mosquitoes+Are+Likely+In+The+U.S.&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Oakland’s Harborside Health Center says it has reached a deal that will end a long campaign by federal prosecutors to shut it down.\u003c/p>\n\u003cp>Harborside, which has called itself the nation’s largest medical cannabis dispensary, sent out a press release early Tuesday announcing a “historic agreement” with the U.S. Department of Justice to suspend efforts to seize its properties in Oakland and San Jose under federal drug trafficking laws.\u003c/p>\n\u003cp>[soundcloud url=”https://api.soundcloud.com/tracks/262387475″ 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>Under the reported deal, federal prosecutors will agree to dismiss their case against Harborside. In return, the dispensary has agreed not to pursue further legal action against the government.\u003c/p>\n\u003cp>Federal prosecutors didn’t immediately confirm the agreement, though Harborside and Oakland City Councilwoman Rebecca Kaplan, a longtime dispensary ally, scheduled a 10 a.m. press conference at Oakland City Hall.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The dispensary’s attorneys were due to file a status report on the case with U.S. Magistrate Judge Maria-Elena James in San Francisco.\u003c/p>\n\u003cp>Harborside’s announcement included a statement from attorney Henry Wykowski.\u003c/p>\n\u003cp>“We are gratified that the government has finally seen fit to lay down its arms against Harborside in this case,” Wykoski said. “The will of the people is for medical cannabis dispensaries to operate free from federal threats of closure. We hope we are on the cusp of a policy change and that the Department of Justice will no longer target state-legal dispensaries for forfeiture.”\u003c/p>\n\u003cp>Melinda Haag, former U.S. attorney for Northern California, moved to \u003ca href=\"https://www.scribd.com/doc/99852141/Forfeiture-Complaint-Harborside-Oakland\" target=\"_blank\" rel=\"noopener\">seize Harborside’s property\u003c/a> on the Embarcadero, southeast of downtown Oakland, in July 2012.\u003c/p>\n\u003cp>Harborside was just one among hundreds of California dispensaries targeted by the Justice Department under former Attorney General Eric Holder. The \u003ca href=\"http://www.sfweekly.com/sanfrancisco/feds-try-to-handcuff-bay-area-dispensaries/Content?oid=2182997\" target=\"_blank\" rel=\"noopener\">campaign included\u003c/a> both warnings to dispensary landlords that their properties could be seized under federal drug laws and, for Harborside and others, the filing of property forfeiture cases.\u003c/p>\n\u003cp>The federal campaign is at least partly responsible for derailing Oakland’s plan to expand approvals for medical marijuana facilities in the city, including creations of several industrial-size medical marijuana production centers. City officials anticipated the industry would be a rich new source of tax revenue.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Medical cannabis sales were legalized under Proposition 215, which California voters passed in 1996. But the proposition failed to set up a clear regulatory scheme for dispensaries, leading to a chaotic system in which each locality passes its own rules. And on the federal level, marijuana remains a Schedule 1 controlled substance on par with narcotics like heroin and cocaine.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Oakland’s Harborside Health Center says it has reached a deal that will end a long campaign by federal prosecutors to shut it down.\u003c/p>\n\u003cp>Harborside, which has called itself the nation’s largest medical cannabis dispensary, sent out a press release early Tuesday announcing a “historic agreement” with the U.S. Department of Justice to suspend efforts to seize its properties in Oakland and San Jose under federal drug trafficking laws.\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/262387475″&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/262387475″'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Under the reported deal, federal prosecutors will agree to dismiss their case against Harborside. In return, the dispensary has agreed not to pursue further legal action against the government.\u003c/p>\n\u003cp>Federal prosecutors didn’t immediately confirm the agreement, though Harborside and Oakland City Councilwoman Rebecca Kaplan, a longtime dispensary ally, scheduled a 10 a.m. press conference at Oakland City Hall.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The dispensary’s attorneys were due to file a status report on the case with U.S. Magistrate Judge Maria-Elena James in San Francisco.\u003c/p>\n\u003cp>Harborside’s announcement included a statement from attorney Henry Wykowski.\u003c/p>\n\u003cp>“We are gratified that the government has finally seen fit to lay down its arms against Harborside in this case,” Wykoski said. “The will of the people is for medical cannabis dispensaries to operate free from federal threats of closure. We hope we are on the cusp of a policy change and that the Department of Justice will no longer target state-legal dispensaries for forfeiture.”\u003c/p>\n\u003cp>Melinda Haag, former U.S. attorney for Northern California, moved to \u003ca href=\"https://www.scribd.com/doc/99852141/Forfeiture-Complaint-Harborside-Oakland\" target=\"_blank\" rel=\"noopener\">seize Harborside’s property\u003c/a> on the Embarcadero, southeast of downtown Oakland, in July 2012.\u003c/p>\n\u003cp>Harborside was just one among hundreds of California dispensaries targeted by the Justice Department under former Attorney General Eric Holder. The \u003ca href=\"http://www.sfweekly.com/sanfrancisco/feds-try-to-handcuff-bay-area-dispensaries/Content?oid=2182997\" target=\"_blank\" rel=\"noopener\">campaign included\u003c/a> both warnings to dispensary landlords that their properties could be seized under federal drug laws and, for Harborside and others, the filing of property forfeiture cases.\u003c/p>\n\u003cp>The federal campaign is at least partly responsible for derailing Oakland’s plan to expand approvals for medical marijuana facilities in the city, including creations of several industrial-size medical marijuana production centers. City officials anticipated the industry would be a rich new source of tax revenue.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Medical cannabis sales were legalized under Proposition 215, which California voters passed in 1996. But the proposition failed to set up a clear regulatory scheme for dispensaries, leading to a chaotic system in which each locality passes its own rules. And on the federal level, marijuana remains a Schedule 1 controlled substance on par with narcotics like heroin and cocaine.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>FRESNO — Jaime Rangel holds a bike tire and begins checking with his hands for thorns and other sharp objects that might be puncturing the tire’s rubber tread. His fingers, stained with black patches of oil, move quickly and seamlessly. He’s done this type of work dozens of times before.\u003c/p>\n\u003cp>All around him, a steady stream of kids line up to get their bikes’ flat tires and faulty brakes fixed at this free event at a park in southeast Fresno.\u003c/p>\n\u003cp>[soundcloud url=”https://api.soundcloud.com/tracks/261604685″ params=”color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false” width=”100%” height=”166″ iframe=”true” /]\u003c/p>\n\u003cp>The free bike repairs are a preamble to the Cumbia Ride, a group bike ride with Latin American dance music started last year by Fresno’s \u003ca href=\"http://www.cultivalasalud.org/news-and-media/\" target=\"_blank\" rel=\"noopener\">Cultiva la Salud\u003c/a> to promote biking and a healthier lifestyle among Latino families.\u003c/p>\n\u003cp>Rangel, 26, says he’s here fixing bikes because he relates to many of the young riders at the event — kids who can’t afford to have their bikes repaired.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“When I was a kid, no one showed me how to fix a bike,” he says. “My mom never took me to a bike shop because we grew up low income, so everything I had to learn from scratch.”\u003c/p>\n\u003cfigure id=\"attachment_177121\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-177121 size-full\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/04/RS19203_IMG_9791-qut.jpg\" alt=\"Eloise Betancourt, 37, chats with Jaime Rangel as her son Lorenzo, 11, works on his bike with mechanic Chris Eacock. Betancourt lost her kids' bikes and most of the family's belongings after she couldn't afford to pay for storage, but Lorenzo saved money from running errands and bought three beat up bikes at a garage sale for him and his sisters.\" width=\"1920\" height=\"1280\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/27/2016/04/RS19203_IMG_9791-qut.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/27/2016/04/RS19203_IMG_9791-qut-400x267.jpg 400w, https://cdn.kqed.org/wp-content/uploads/sites/27/2016/04/RS19203_IMG_9791-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/27/2016/04/RS19203_IMG_9791-qut-768x512.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/27/2016/04/RS19203_IMG_9791-qut-1440x960.jpg 1440w, https://cdn.kqed.org/wp-content/uploads/sites/27/2016/04/RS19203_IMG_9791-qut-1180x787.jpg 1180w, https://cdn.kqed.org/wp-content/uploads/sites/27/2016/04/RS19203_IMG_9791-qut-960x640.jpg 960w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Eloise Betancourt, 37, brought her son, Lorenzo, 11 (R) to repair his bike. Biking is a main mode of transportation for the Betancourt family, but they lost their bikes and most of their belongings after they couldn’t afford to pay for storage. Lorenzo worked mowing lawns and saved $25 to buy bikes in need of repairs at a garage sale for himself and his sisters. \u003ccite>(Farida Jhabvala Romero/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Rangel makes a point of showing those skills to the kids and parents lingering by their bikes. He wants young people and adults, especially in working-class neighborhoods like southeast Fresno, to be able to bike more to fend off chronic illnesses such as diabetes.\u003c/p>\n\u003cp>Rangel speaks from personal experience.\u003c/p>\n\u003cp>\u003cstrong>Facing Type 2 Diabetes as a Teen\u003c/strong>\u003c/p>\n\u003cp>Rangel was just 14 and living with his family in Los Angeles when he was diagnosed with Type 2 diabetes. Obesity and a sedentary lifestyle are risk factors for the illness. While he was tall — 6-foot-1 — he weighed 260 pounds.\u003c/p>\n\u003cp>It’s been a dozen years since he was diagnosed, but he clearly recalls how frightened he was. The disease had already transformed the lives of his mother, two sets of grandparents and other relatives. He knew what he was facing.\u003c/p>\n\u003cp>“I was really scared,” says Rangel. “I was seeing there were only certain foods they would eat, taking their insulin shots. And I was like, ‘Nah, that can’t happen. I’m too young!'”\u003c/p>\n\u003cp>Until about two decades ago, Type 2 diabetes in children and teens was practically unheard of. But the number of adolescents living with the disease has\u003ca href=\"http://www.diabetes.org/diabetes-basics/statistics/\" target=\"_blank\" rel=\"noopener\"> gone up in recent years,\u003c/a> in large part because of the \u003ca href=\"http://care.diabetesjournals.org/content/34/Supplement_2/S161.full#ref-8\" target=\"_blank\" rel=\"noopener\">obesity epidemic\u003c/a>.\u003c/p>\n\u003cp>As with adults, rates of Type 2 diabetes are higher among Hispanic, African-American and Asian-Pacific Islander youth than non-Hispanic whites, \u003ca href=\"http://templatelab.com/national-diabetes-report-2014/\" target=\"_blank\" rel=\"noopener\">according to data from the Centers for Disease Control and Prevention\u003c/a>. Uncontrolled diabetes can lead to blindness, heart disease, amputations, kidney failure and other serious complications.\u003c/p>\n\u003cp>Rangel’s doctor had said he needed to lose weight and give up foods he loved. But he didn’t know how to start. He loved the idea of biking, but his family couldn’t afford to buy him one.\u003c/p>\n\u003cp>Instead, a close friend stepped in with a gift of a BMX bike. He didn’t know how to ride and at first it was scary. He fell a lot the first couple of times he tried.\u003c/p>\n\u003cp>“I was a big dude riding a really small bike, so I didn’t know how to balance my weight,” Rangel says. “But I just kept going. I didn’t want to stop, and I just kept doing it so I could get better.”\u003c/p>\n\u003cp>With each trip he took, he ventured longer distances. Rangel says he enjoyed the independence he felt while crossing large swaths of the traffic-jammed city. Under the power of his own legs pushing down on his bike’s pedals, he would travel from his home in the Lincoln Heights neighborhood to the beach at Santa Monica — 20 miles away.\u003c/p>\n\u003cp>Within a year, Rangel had reversed his Type 2 diabetes. His blood sugar levels returned to a normal range. It’s surprising to many, but children and young adults can beat the disease through exercise, say medical experts.\u003c/p>\n\u003cfigure id=\"attachment_177119\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-177119 size-full\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/04/RS19210_IMG_9853-qut.jpg\" alt=\"Jaime Rangel, 26, helps Gustavo Ruiz, 12, fix the flat tire on his bike at the Mosqueda Community Center park. Rangel says he makes a point of showing kids and adults who may not have funds to repair their bikes at a shop, how to fix their bikes on their own. \" width=\"1920\" height=\"1280\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/27/2016/04/RS19210_IMG_9853-qut.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/27/2016/04/RS19210_IMG_9853-qut-400x267.jpg 400w, https://cdn.kqed.org/wp-content/uploads/sites/27/2016/04/RS19210_IMG_9853-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/27/2016/04/RS19210_IMG_9853-qut-768x512.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/27/2016/04/RS19210_IMG_9853-qut-1440x960.jpg 1440w, https://cdn.kqed.org/wp-content/uploads/sites/27/2016/04/RS19210_IMG_9853-qut-1180x787.jpg 1180w, https://cdn.kqed.org/wp-content/uploads/sites/27/2016/04/RS19210_IMG_9853-qut-960x640.jpg 960w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Jaime Rangel helps Gustavo Ruiz, 12, align a tire on his bike at the Mosqueda Community Center park in southeast Fresno. As manager for Bici Projects, Rangel teaches kids and adults ‘in the barrio’ how to repair bikes, part of a larger effort to promote biking among local Latino families. \u003ccite>(Farida Jhabvala Romero/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The experience marked Rangel deeply. He had managed to rid himself of the illness without taking medication while having fun, too.\u003c/p>\n\u003cp>“Biking changed my life. I lost a lot of weight,” says Rangel, who now weighs about 220 pounds.\u003c/p>\n\u003cp>Rangel’s family noticed the change in the way he looked and the dramatic improvement in his health. At Rangel’s insistence, his mom, cousins and uncles began biking — a dramatic change for his family, he says.\u003c/p>\n\u003cp>“We all got rid of our diabetes, pretty much,” says Rangel, who recently moved to Fresno. “Now when I’m in L.A., about 20 of us go bike riding together. So it changed not just me, but my whole family at the same time.”\u003c/p>\n\u003cp>Rangel wants to promote biking and a more active lifestyle to create positive change in his new home in Fresno. The most recent \u003ca href=\"http://www.cdph.ca.gov/programs/ohir/Documents/OHIRProfiles2016.pdf\" target=\"_blank\" rel=\"noopener\">state data\u003c/a> show the county had the fourth-highest death rate from diabetes. Central Valley counties Kern and Kings also top the list.\u003c/p>\n\u003cp>Using his personal experience and love for biking as a mantra, Rangel coordinates youth engagement for the San Joaquin Valley Latino Environmental Advancement & Policy Project and manages the group’s Bici Projects (short for “bicicleta” — bicycle in Spanish).\u003c/p>\n\u003cp>\u003cstrong>How Can Type 2 Diabetes Disappear?\u003c/strong>\u003c/p>\n\u003cp>Type 2 diabetes is an illness affecting a person’s ability to use insulin, and not everyone can beat the disease through exercise and weight loss. But there’s “tremendous hope” for young people and others diagnosed with the disease early on, says Dr. Saleh Adi, medical director of the Madison Clinic for Pediatric Diabetes at UCSF.\u003c/p>\n\u003cp>Insulin is a hormone that allows the body to use sugars from carbohydrates. Patients with Type 1 diabetes, an irreversible autoimmune disorder, must take insulin medication for life because their bodies are no longer able to produce it.\u003c/p>\n\u003cp>In contrast, people with Type 2 diabetes are still able to make insulin for the most part, but their bodies don’t respond to it properly, and they develop what’s called insulin resistance. Exercise can change that because active muscle “is the biggest site of insulin action,” says Adi.\u003c/p>\n\u003cp>“Exercising increases your sensitivity to insulin, and that’s true in everybody,” says Adi, whose pediatric clinic tries to get patients to engage in physical activity for six months before prescribing them medication.\u003c/p>\n\u003cp>“We’ve seen quite a few cases where the disease disappears,” he says. “If you catch it early enough and do what it takes, which is exercising and losing the weight.”\u003c/p>\n\u003cp>Adi readily acknowledges squeezing more exercise into daily routines is not easy, but he says even 10 more minutes of walking can begin to make a difference.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“Don’t give up. You can really get rid of Type 2 diabetes if you change your lifestyle,” says Adi. “I’m talking about moderate exercise, that will really help.”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>FRESNO — Jaime Rangel holds a bike tire and begins checking with his hands for thorns and other sharp objects that might be puncturing the tire’s rubber tread. His fingers, stained with black patches of oil, move quickly and seamlessly. He’s done this type of work dozens of times before.\u003c/p>\n\u003cp>All around him, a steady stream of kids line up to get their bikes’ flat tires and faulty brakes fixed at this free event at a park in southeast Fresno.\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/261604685″&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/261604685″'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>The free bike repairs are a preamble to the Cumbia Ride, a group bike ride with Latin American dance music started last year by Fresno’s \u003ca href=\"http://www.cultivalasalud.org/news-and-media/\" target=\"_blank\" rel=\"noopener\">Cultiva la Salud\u003c/a> to promote biking and a healthier lifestyle among Latino families.\u003c/p>\n\u003cp>Rangel, 26, says he’s here fixing bikes because he relates to many of the young riders at the event — kids who can’t afford to have their bikes repaired.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“When I was a kid, no one showed me how to fix a bike,” he says. “My mom never took me to a bike shop because we grew up low income, so everything I had to learn from scratch.”\u003c/p>\n\u003cfigure id=\"attachment_177121\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-177121 size-full\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/04/RS19203_IMG_9791-qut.jpg\" alt=\"Eloise Betancourt, 37, chats with Jaime Rangel as her son Lorenzo, 11, works on his bike with mechanic Chris Eacock. Betancourt lost her kids' bikes and most of the family's belongings after she couldn't afford to pay for storage, but Lorenzo saved money from running errands and bought three beat up bikes at a garage sale for him and his sisters.\" width=\"1920\" height=\"1280\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/27/2016/04/RS19203_IMG_9791-qut.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/27/2016/04/RS19203_IMG_9791-qut-400x267.jpg 400w, https://cdn.kqed.org/wp-content/uploads/sites/27/2016/04/RS19203_IMG_9791-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/27/2016/04/RS19203_IMG_9791-qut-768x512.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/27/2016/04/RS19203_IMG_9791-qut-1440x960.jpg 1440w, https://cdn.kqed.org/wp-content/uploads/sites/27/2016/04/RS19203_IMG_9791-qut-1180x787.jpg 1180w, https://cdn.kqed.org/wp-content/uploads/sites/27/2016/04/RS19203_IMG_9791-qut-960x640.jpg 960w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Eloise Betancourt, 37, brought her son, Lorenzo, 11 (R) to repair his bike. Biking is a main mode of transportation for the Betancourt family, but they lost their bikes and most of their belongings after they couldn’t afford to pay for storage. Lorenzo worked mowing lawns and saved $25 to buy bikes in need of repairs at a garage sale for himself and his sisters. \u003ccite>(Farida Jhabvala Romero/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Rangel makes a point of showing those skills to the kids and parents lingering by their bikes. He wants young people and adults, especially in working-class neighborhoods like southeast Fresno, to be able to bike more to fend off chronic illnesses such as diabetes.\u003c/p>\n\u003cp>Rangel speaks from personal experience.\u003c/p>\n\u003cp>\u003cstrong>Facing Type 2 Diabetes as a Teen\u003c/strong>\u003c/p>\n\u003cp>Rangel was just 14 and living with his family in Los Angeles when he was diagnosed with Type 2 diabetes. Obesity and a sedentary lifestyle are risk factors for the illness. While he was tall — 6-foot-1 — he weighed 260 pounds.\u003c/p>\n\u003cp>It’s been a dozen years since he was diagnosed, but he clearly recalls how frightened he was. The disease had already transformed the lives of his mother, two sets of grandparents and other relatives. He knew what he was facing.\u003c/p>\n\u003cp>“I was really scared,” says Rangel. “I was seeing there were only certain foods they would eat, taking their insulin shots. And I was like, ‘Nah, that can’t happen. I’m too young!'”\u003c/p>\n\u003cp>Until about two decades ago, Type 2 diabetes in children and teens was practically unheard of. But the number of adolescents living with the disease has\u003ca href=\"http://www.diabetes.org/diabetes-basics/statistics/\" target=\"_blank\" rel=\"noopener\"> gone up in recent years,\u003c/a> in large part because of the \u003ca href=\"http://care.diabetesjournals.org/content/34/Supplement_2/S161.full#ref-8\" target=\"_blank\" rel=\"noopener\">obesity epidemic\u003c/a>.\u003c/p>\n\u003cp>As with adults, rates of Type 2 diabetes are higher among Hispanic, African-American and Asian-Pacific Islander youth than non-Hispanic whites, \u003ca href=\"http://templatelab.com/national-diabetes-report-2014/\" target=\"_blank\" rel=\"noopener\">according to data from the Centers for Disease Control and Prevention\u003c/a>. Uncontrolled diabetes can lead to blindness, heart disease, amputations, kidney failure and other serious complications.\u003c/p>\n\u003cp>Rangel’s doctor had said he needed to lose weight and give up foods he loved. But he didn’t know how to start. He loved the idea of biking, but his family couldn’t afford to buy him one.\u003c/p>\n\u003cp>Instead, a close friend stepped in with a gift of a BMX bike. He didn’t know how to ride and at first it was scary. He fell a lot the first couple of times he tried.\u003c/p>\n\u003cp>“I was a big dude riding a really small bike, so I didn’t know how to balance my weight,” Rangel says. “But I just kept going. I didn’t want to stop, and I just kept doing it so I could get better.”\u003c/p>\n\u003cp>With each trip he took, he ventured longer distances. Rangel says he enjoyed the independence he felt while crossing large swaths of the traffic-jammed city. Under the power of his own legs pushing down on his bike’s pedals, he would travel from his home in the Lincoln Heights neighborhood to the beach at Santa Monica — 20 miles away.\u003c/p>\n\u003cp>Within a year, Rangel had reversed his Type 2 diabetes. His blood sugar levels returned to a normal range. It’s surprising to many, but children and young adults can beat the disease through exercise, say medical experts.\u003c/p>\n\u003cfigure id=\"attachment_177119\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-177119 size-full\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/04/RS19210_IMG_9853-qut.jpg\" alt=\"Jaime Rangel, 26, helps Gustavo Ruiz, 12, fix the flat tire on his bike at the Mosqueda Community Center park. Rangel says he makes a point of showing kids and adults who may not have funds to repair their bikes at a shop, how to fix their bikes on their own. \" width=\"1920\" height=\"1280\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/27/2016/04/RS19210_IMG_9853-qut.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/27/2016/04/RS19210_IMG_9853-qut-400x267.jpg 400w, https://cdn.kqed.org/wp-content/uploads/sites/27/2016/04/RS19210_IMG_9853-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/27/2016/04/RS19210_IMG_9853-qut-768x512.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/27/2016/04/RS19210_IMG_9853-qut-1440x960.jpg 1440w, https://cdn.kqed.org/wp-content/uploads/sites/27/2016/04/RS19210_IMG_9853-qut-1180x787.jpg 1180w, https://cdn.kqed.org/wp-content/uploads/sites/27/2016/04/RS19210_IMG_9853-qut-960x640.jpg 960w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Jaime Rangel helps Gustavo Ruiz, 12, align a tire on his bike at the Mosqueda Community Center park in southeast Fresno. As manager for Bici Projects, Rangel teaches kids and adults ‘in the barrio’ how to repair bikes, part of a larger effort to promote biking among local Latino families. \u003ccite>(Farida Jhabvala Romero/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The experience marked Rangel deeply. He had managed to rid himself of the illness without taking medication while having fun, too.\u003c/p>\n\u003cp>“Biking changed my life. I lost a lot of weight,” says Rangel, who now weighs about 220 pounds.\u003c/p>\n\u003cp>Rangel’s family noticed the change in the way he looked and the dramatic improvement in his health. At Rangel’s insistence, his mom, cousins and uncles began biking — a dramatic change for his family, he says.\u003c/p>\n\u003cp>“We all got rid of our diabetes, pretty much,” says Rangel, who recently moved to Fresno. “Now when I’m in L.A., about 20 of us go bike riding together. So it changed not just me, but my whole family at the same time.”\u003c/p>\n\u003cp>Rangel wants to promote biking and a more active lifestyle to create positive change in his new home in Fresno. The most recent \u003ca href=\"http://www.cdph.ca.gov/programs/ohir/Documents/OHIRProfiles2016.pdf\" target=\"_blank\" rel=\"noopener\">state data\u003c/a> show the county had the fourth-highest death rate from diabetes. Central Valley counties Kern and Kings also top the list.\u003c/p>\n\u003cp>Using his personal experience and love for biking as a mantra, Rangel coordinates youth engagement for the San Joaquin Valley Latino Environmental Advancement & Policy Project and manages the group’s Bici Projects (short for “bicicleta” — bicycle in Spanish).\u003c/p>\n\u003cp>\u003cstrong>How Can Type 2 Diabetes Disappear?\u003c/strong>\u003c/p>\n\u003cp>Type 2 diabetes is an illness affecting a person’s ability to use insulin, and not everyone can beat the disease through exercise and weight loss. But there’s “tremendous hope” for young people and others diagnosed with the disease early on, says Dr. Saleh Adi, medical director of the Madison Clinic for Pediatric Diabetes at UCSF.\u003c/p>\n\u003cp>Insulin is a hormone that allows the body to use sugars from carbohydrates. Patients with Type 1 diabetes, an irreversible autoimmune disorder, must take insulin medication for life because their bodies are no longer able to produce it.\u003c/p>\n\u003cp>In contrast, people with Type 2 diabetes are still able to make insulin for the most part, but their bodies don’t respond to it properly, and they develop what’s called insulin resistance. Exercise can change that because active muscle “is the biggest site of insulin action,” says Adi.\u003c/p>\n\u003cp>“Exercising increases your sensitivity to insulin, and that’s true in everybody,” says Adi, whose pediatric clinic tries to get patients to engage in physical activity for six months before prescribing them medication.\u003c/p>\n\u003cp>“We’ve seen quite a few cases where the disease disappears,” he says. “If you catch it early enough and do what it takes, which is exercising and losing the weight.”\u003c/p>\n\u003cp>Adi readily acknowledges squeezing more exercise into daily routines is not easy, but he says even 10 more minutes of walking can begin to make a difference.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“Don’t give up. You can really get rid of Type 2 diabetes if you change your lifestyle,” says Adi. “I’m talking about moderate exercise, that will really help.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>In a small room at a neighborhood clinic in Sacramento, a handful of hepatitis C patients wait to see their physician, hoping they’ll be found sick enough to be approved for a cure.\u003c/p>\n\u003caside class=\"pullquote alignright\">“There are very few tools in our toolbox” to control pharmaceutical spending\u003ccite>Diana Dooley, secretary of California’s Health and Human Services\u003c/cite>\u003c/aside>\n\u003cp>The low-income patients hope to be prescribed new breakthrough drugs, such as Sovaldi or Harvoni, which offer cures with almost no side effects. But treating the virus comes with a high price tag: at least $84,000 for a course of treatment. Getting Medi-Cal to pay for such drugs can involve a long, arduous process of tests and paperwork to prove infection has progressed to liver damage.\u003c/p>\n\u003cp>“If you’re practically dead … they’ll approve you,” said Laura Castillo, 54, who has been navigating the Medi-Cal system for four months to get Sovaldi. The former legal clerk said she contracted the virus from a blood transfusion in the early 1980s. Patients can live for years symptom free with hepatitis C, but left untreated, it can eventually lead to liver disease and death. Castillo has waited for treatment with substantial liver damage, which burdens her with overwhelming fatigue, depression and what she describes as a “brain fog.”\u003c/p>\n\u003cp>“It’s very, very frustrating, knowing that you have an illness and there is a cure, and you can’t do anything about it,” Castillo said.\u003c/p>\n\u003cp>Castillo’s physician, Dr. Catherine Moizeau, says she treats hundreds of Medi-Cal patients who wait months to get approval for the hepatitis C drugs. Moizeau says health plans, under state guidelines, are rationing the drugs because of the high cost. But Medi-Cal officials say patients receive the treatments based on medical necessity, not on cost.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Hepatitis C drugs are not the only part of California’s troubling drug spending picture. Despite recent cost-cutting measures, such as putting tighter controls on which patients get coverage for which drugs and when, California’s spending on pharmaceuticals has gone up, and so has the number of pricey drugs it is covering. It’s not clear state agencies have the means to balance drug cost pressures in a way that serves the best interests of patients, taxpayers and public health.\u003c/p>\n\u003cp>“There are very few tools in our toolbox” to control pharmaceutical spending, said Diana Dooley, secretary of California’s Health and Human Services. She says high prescription drug costs are a problem across California’s public and private health insurance, and should be addressed on a national level.\u003c/p>\n\u003cp>Drug price concerns will also be a matter of public policy debate this year. California voters are expected to decide in November on a measure to put a ceiling on what the state pays for drugs, and lawmakers have proposed drug price transparency requirements on pharmaceutical manufacturers and health insurers.\u003c/p>\n\u003cp>“We all have to do everything we can to try to control these drug costs,” Dooley said.\u003c/p>\n\u003cp>[contextly_sidebar id=\"kO3lkbe6TLc7SIMiuJ3FinItNEnjyfYz\"]A CALmatters analysis found that state prisons, a California public pension system, and one subset of the Medi-Cal program spent $600 million more on pharmaceuticals in 2014 than in 2012. That does not include the Medi-Cal population in a health plan, nor does it account for discounts the state may have received from drugmakers.\u003c/p>\n\u003cp>Over the past decade, Medi-Cal has seen a 57 percent increase in the drugs it covers that cost $600 or more per prescription. And when it comes to hepatitis C drugs alone, Medi-Cal estimates it will spend almost $482 million over this fiscal year and last. As of September 2015, only 4,200 Medi-Cal patients had received the drugs in that time period, out of 237,000 who are estimated to have the disease.\u003c/p>\n\u003cp>These cost trends exist despite new protocols various state agencies have introduced to tamp down on pharmaceutical spending, which include stricter controls on which patients get which prescription drugs and how.\u003c/p>\n\u003cp>“The people that pay for health care, be it the government or employers, are asking for more prior authorization because we’re having to scrutinize every penny we spend now,” said Steve Miller, chief medical officer at Express Scripts, which manages pharmacy benefits for health plans nationally, including 7.5 million Californians.\u003c/p>\n\u003cp>Miller said involvement from the payer is meant to get “the right patient, the right drug, at the right dose.” But the process, can be “clunky” and cause delays and frustrations for patients like Castillo.\u003c/p>\n\u003cp>Drugmakers say the value of the new hepatitis C drugs, the first of which hit the market at the end of 2013, is worth the cost, and in the long term, may eventually even bring savings to the health system.\u003c/p>\n\u003cp>The new hepatitis C drugs involve only a few months of treatment, and produce a cure in about 90 percent of patients. The older generation of treatments are cheaper, but are also about half as effective, and have side-effects that resemble the flu.\u003c/p>\n\u003cp>“These patients are now healthier. They’re more productive. They’re functioning,” said Priscilla VanderVeer, deputy vice president of communications at the Pharmaceutical Research and Manufacturers of America (PhRMA).\u003c/p>\n\u003cp>“You’re going to have less people who need long-term medication therapy for their hep C, they’re not going to need liver transplants, they’re not going to need significant hospitalizations,” VanderVeer said.\u003c/p>\n\u003cp>Health consumer advocates and economists argue that paying a lot for some drugs that only treat a limited population may not serve larger public health interests, or be the best use of taxpayer dollars.\u003c/p>\n\u003cp>For example, if the cost of the new hepatitis C drugs were cheaper, the hundreds of millions of dollars spent on treating just a few thousand patients could have been spent to help eradicate the disease, says Anthony Wright, executive director of Health Access, an advocacy group.\u003c/p>\n\u003cp>“You could imagine a strategy to provide this cure in a much more broad population strategy,” Wright said.\u003c/p>\n\u003cp>\u003cimg class=\"alignright wp-image-170763 size-thumbnail\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/04/DrugsOver600-400x828.png\" alt=\"DrugsOver600\" width=\"400\" height=\"828\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/04/DrugsOver600-400x828.png 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/04/DrugsOver600.png 550w\" sizes=\"(max-width: 400px) 100vw, 400px\">Specialty drugs, which the federal government defines as costing $600 or more a month, are raising concern among health insurers and state agencies. In CalPERS, for instance, specialty drugs are taking up a larger share of total drug expenditures, despite the fact that they account for a small percentage of prescriptions.\u003c/p>\n\u003cp>Drugmakers are investing more in these types of drugs, said Joel Hay, a pharmaceutical economist at the University of Southern California, because “the profits are very high.”\u003c/p>\n\u003cp>But paying a high price for drugs that treat a small number of patients raises an equity question, Hay said. It may not be fair to the larger patient population for a health system to pay a high price for cancer drugs that extend a patient’s life by three weeks.\u003c/p>\n\u003cp>“You can get a lot more lives saved if you take that budget and put it into colon cancer screening or any number of other more efficient, more effective interventions,” Hay said.\u003c/p>\n\u003cp>The cost pressure from specialty drugs may not go away soon. Pharmaceutical benefits manager Express Scripts estimates that this class of drugs will continue to grow in Medicaid programs by 13.6 percent over the next three years.\u003c/p>\n\u003cp>“Are we going to have a sustainable (pharmaceutical) industry where we are making sure the drug companies make enough money where they can bring great new products to the marketplace, yet we control cost well enough that people –- all people, even the most vulnerable -- have access to the drugs they need?” asked Miller.\u003c/p>\n\u003cp>State Medi-Cal administrators say it’s too soon to assess the sustainability of current prescription drug spending trends. Meantime, their guidelines about which patients can get covered by new hepatitis C drugs has recently loosened up. As of July 2015, patients with a less advanced stage of liver disease can get covered for the drugs, as well as IV drug users and women who want to get pregnant.\u003c/p>\n\u003cp>Castillo got her medication in March, after an attorney helped her challenge denied coverage for Sovaldi through a health insurance regulator. Castillo says she’s glad she’s in treatment now, but she doesn’t know why her Medi-Cal health plan made it so hard for her to get the medicine.\u003c/p>\n\u003cp>“They need to get it together,” she said. “It’s our health and our life that they’re messing with.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>CALmatters data reporter Matt Levin contributed to this article. \u003c/em>\u003ca href=\"https://calmatters.org/\" target=\"_blank\">\u003cem>CALmatters\u003c/em>\u003c/a>\u003cem> is a nonprofit journalism venture dedicated to explaining state policies and politics. Pauline Bartolone wrote this article while participating in the \u003c/em>\u003ca href=\"http://www.centerforhealthjournalism.org/event/2015-california-health-data-journalism-fellowship\">\u003cem>California Data\u003c/em>\u003c/a> \u003ca href=\"http://www.centerforhealthjournalism.org/event/2015-california-health-data-journalism-fellowship\" target=\"_blank\">\u003cem>Fellowship,\u003c/em>\u003c/a>\u003cem> a program of the \u003c/em>\u003ca href=\"http://www.centerforhealthjournalism.org/\" target=\"_blank\">\u003cem>Center for Health Journalism\u003c/em>\u003c/a>\u003cem> at USC’s Annenberg School of Journalism.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>In a small room at a neighborhood clinic in Sacramento, a handful of hepatitis C patients wait to see their physician, hoping they’ll be found sick enough to be approved for a cure.\u003c/p>\n\u003caside class=\"pullquote alignright\">“There are very few tools in our toolbox” to control pharmaceutical spending\u003ccite>Diana Dooley, secretary of California’s Health and Human Services\u003c/cite>\u003c/aside>\n\u003cp>The low-income patients hope to be prescribed new breakthrough drugs, such as Sovaldi or Harvoni, which offer cures with almost no side effects. But treating the virus comes with a high price tag: at least $84,000 for a course of treatment. Getting Medi-Cal to pay for such drugs can involve a long, arduous process of tests and paperwork to prove infection has progressed to liver damage.\u003c/p>\n\u003cp>“If you’re practically dead … they’ll approve you,” said Laura Castillo, 54, who has been navigating the Medi-Cal system for four months to get Sovaldi. The former legal clerk said she contracted the virus from a blood transfusion in the early 1980s. Patients can live for years symptom free with hepatitis C, but left untreated, it can eventually lead to liver disease and death. Castillo has waited for treatment with substantial liver damage, which burdens her with overwhelming fatigue, depression and what she describes as a “brain fog.”\u003c/p>\n\u003cp>“It’s very, very frustrating, knowing that you have an illness and there is a cure, and you can’t do anything about it,” Castillo said.\u003c/p>\n\u003cp>Castillo’s physician, Dr. Catherine Moizeau, says she treats hundreds of Medi-Cal patients who wait months to get approval for the hepatitis C drugs. Moizeau says health plans, under state guidelines, are rationing the drugs because of the high cost. But Medi-Cal officials say patients receive the treatments based on medical necessity, not on cost.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Hepatitis C drugs are not the only part of California’s troubling drug spending picture. Despite recent cost-cutting measures, such as putting tighter controls on which patients get coverage for which drugs and when, California’s spending on pharmaceuticals has gone up, and so has the number of pricey drugs it is covering. It’s not clear state agencies have the means to balance drug cost pressures in a way that serves the best interests of patients, taxpayers and public health.\u003c/p>\n\u003cp>“There are very few tools in our toolbox” to control pharmaceutical spending, said Diana Dooley, secretary of California’s Health and Human Services. She says high prescription drug costs are a problem across California’s public and private health insurance, and should be addressed on a national level.\u003c/p>\n\u003cp>Drug price concerns will also be a matter of public policy debate this year. California voters are expected to decide in November on a measure to put a ceiling on what the state pays for drugs, and lawmakers have proposed drug price transparency requirements on pharmaceutical manufacturers and health insurers.\u003c/p>\n\u003cp>“We all have to do everything we can to try to control these drug costs,” Dooley said.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>A CALmatters analysis found that state prisons, a California public pension system, and one subset of the Medi-Cal program spent $600 million more on pharmaceuticals in 2014 than in 2012. That does not include the Medi-Cal population in a health plan, nor does it account for discounts the state may have received from drugmakers.\u003c/p>\n\u003cp>Over the past decade, Medi-Cal has seen a 57 percent increase in the drugs it covers that cost $600 or more per prescription. And when it comes to hepatitis C drugs alone, Medi-Cal estimates it will spend almost $482 million over this fiscal year and last. As of September 2015, only 4,200 Medi-Cal patients had received the drugs in that time period, out of 237,000 who are estimated to have the disease.\u003c/p>\n\u003cp>These cost trends exist despite new protocols various state agencies have introduced to tamp down on pharmaceutical spending, which include stricter controls on which patients get which prescription drugs and how.\u003c/p>\n\u003cp>“The people that pay for health care, be it the government or employers, are asking for more prior authorization because we’re having to scrutinize every penny we spend now,” said Steve Miller, chief medical officer at Express Scripts, which manages pharmacy benefits for health plans nationally, including 7.5 million Californians.\u003c/p>\n\u003cp>Miller said involvement from the payer is meant to get “the right patient, the right drug, at the right dose.” But the process, can be “clunky” and cause delays and frustrations for patients like Castillo.\u003c/p>\n\u003cp>Drugmakers say the value of the new hepatitis C drugs, the first of which hit the market at the end of 2013, is worth the cost, and in the long term, may eventually even bring savings to the health system.\u003c/p>\n\u003cp>The new hepatitis C drugs involve only a few months of treatment, and produce a cure in about 90 percent of patients. The older generation of treatments are cheaper, but are also about half as effective, and have side-effects that resemble the flu.\u003c/p>\n\u003cp>“These patients are now healthier. They’re more productive. They’re functioning,” said Priscilla VanderVeer, deputy vice president of communications at the Pharmaceutical Research and Manufacturers of America (PhRMA).\u003c/p>\n\u003cp>“You’re going to have less people who need long-term medication therapy for their hep C, they’re not going to need liver transplants, they’re not going to need significant hospitalizations,” VanderVeer said.\u003c/p>\n\u003cp>Health consumer advocates and economists argue that paying a lot for some drugs that only treat a limited population may not serve larger public health interests, or be the best use of taxpayer dollars.\u003c/p>\n\u003cp>For example, if the cost of the new hepatitis C drugs were cheaper, the hundreds of millions of dollars spent on treating just a few thousand patients could have been spent to help eradicate the disease, says Anthony Wright, executive director of Health Access, an advocacy group.\u003c/p>\n\u003cp>“You could imagine a strategy to provide this cure in a much more broad population strategy,” Wright said.\u003c/p>\n\u003cp>\u003cimg class=\"alignright wp-image-170763 size-thumbnail\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/04/DrugsOver600-400x828.png\" alt=\"DrugsOver600\" width=\"400\" height=\"828\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/04/DrugsOver600-400x828.png 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/04/DrugsOver600.png 550w\" sizes=\"(max-width: 400px) 100vw, 400px\">Specialty drugs, which the federal government defines as costing $600 or more a month, are raising concern among health insurers and state agencies. In CalPERS, for instance, specialty drugs are taking up a larger share of total drug expenditures, despite the fact that they account for a small percentage of prescriptions.\u003c/p>\n\u003cp>Drugmakers are investing more in these types of drugs, said Joel Hay, a pharmaceutical economist at the University of Southern California, because “the profits are very high.”\u003c/p>\n\u003cp>But paying a high price for drugs that treat a small number of patients raises an equity question, Hay said. It may not be fair to the larger patient population for a health system to pay a high price for cancer drugs that extend a patient’s life by three weeks.\u003c/p>\n\u003cp>“You can get a lot more lives saved if you take that budget and put it into colon cancer screening or any number of other more efficient, more effective interventions,” Hay said.\u003c/p>\n\u003cp>The cost pressure from specialty drugs may not go away soon. Pharmaceutical benefits manager Express Scripts estimates that this class of drugs will continue to grow in Medicaid programs by 13.6 percent over the next three years.\u003c/p>\n\u003cp>“Are we going to have a sustainable (pharmaceutical) industry where we are making sure the drug companies make enough money where they can bring great new products to the marketplace, yet we control cost well enough that people –- all people, even the most vulnerable -- have access to the drugs they need?” asked Miller.\u003c/p>\n\u003cp>State Medi-Cal administrators say it’s too soon to assess the sustainability of current prescription drug spending trends. Meantime, their guidelines about which patients can get covered by new hepatitis C drugs has recently loosened up. As of July 2015, patients with a less advanced stage of liver disease can get covered for the drugs, as well as IV drug users and women who want to get pregnant.\u003c/p>\n\u003cp>Castillo got her medication in March, after an attorney helped her challenge denied coverage for Sovaldi through a health insurance regulator. Castillo says she’s glad she’s in treatment now, but she doesn’t know why her Medi-Cal health plan made it so hard for her to get the medicine.\u003c/p>\n\u003cp>“They need to get it together,” she said. “It’s our health and our life that they’re messing with.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>CALmatters data reporter Matt Levin contributed to this article. \u003c/em>\u003ca href=\"https://calmatters.org/\" target=\"_blank\">\u003cem>CALmatters\u003c/em>\u003c/a>\u003cem> is a nonprofit journalism venture dedicated to explaining state policies and politics. Pauline Bartolone wrote this article while participating in the \u003c/em>\u003ca href=\"http://www.centerforhealthjournalism.org/event/2015-california-health-data-journalism-fellowship\">\u003cem>California Data\u003c/em>\u003c/a> \u003ca href=\"http://www.centerforhealthjournalism.org/event/2015-california-health-data-journalism-fellowship\" target=\"_blank\">\u003cem>Fellowship,\u003c/em>\u003c/a>\u003cem> a program of the \u003c/em>\u003ca href=\"http://www.centerforhealthjournalism.org/\" target=\"_blank\">\u003cem>Center for Health Journalism\u003c/em>\u003c/a>\u003cem> at USC’s Annenberg School of Journalism.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Pharmaceutical Companies Hiked Price on Aid in Dying Drug",
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"content": "\u003cp>When California's\u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/10/05/governor-brown-signs-physician-assisted-suicide-bill-into-law-california-right-to-die/\" target=\"_blank\"> aid-in-dying law\u003c/a> takes effect this June, terminally ill patients who decide to end their lives could be faced with a hefty bill for the lethal medication. It retails for more than $3,000.\u003c/p>\n\u003cp>Valeant Pharmaceuticals, the company that makes the drug most commonly used in physician-assisted suicide, doubled the drug's price last year, one month after California lawmakers \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/01/22/california-bill-would-allow-terminally-ill-to-end-their-own-lives/\" target=\"_blank\">proposed legalizing the practice\u003c/a>.\u003c/p>\n\u003cp>“It’s just pharmaceutical company greed,” said David Grube, a family doctor in Oregon, where physician-assisted death has been legal for 20 years.\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/254659907\" params=\"color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" iframe=\"true\" /]\u003c/p>\n\u003cp>The drug is Seconal, or secobarbital, its generic name. Originally developed in the 1930s as a sleeping pill, it fell out of favor when people died from taking too much, or from taking it in combination with alcohol. But when intended as a lethal medication to hasten the death of someone suffering from a terminal disease, Seconal is the drug of choice.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“It works very quickly and very gently,” Grube says. “People fall asleep with no complications. It's a very gentle passing.”\u003c/p>\n\u003cp>In 2009, Grube remembers the price of a lethal dose of Seconal -- 100 capsules -- was less than $200. Over the next six years, it shot up to $1,500, according to drug price databases Medi-Span and First Databank. Then Valeant bought Seconal last February and immediately doubled the price to $3,000.\u003c/p>\n\u003cp>Most drug companies justify such hikes by pointing to high research costs. But Grube says that’s not the case with Seconal. It’s been around for 80 years.\u003c/p>\n\u003cp>“It’s not a complicated thing to make, there’s no research being done on it, there’s no development,” he says. “That to me is unconscionable.”\u003c/p>\n\u003cp>Valeant bought several other drugs at the same time it bought Seconal, raising some of those prices as much as 500 percent. That sparked a \u003ca href=\"http://www.npr.org/sections/health-shots/2015/12/09/458976680/senate-questions-egregious-price-hikes-for-specialty-medicines\" target=\"_blank\">congressional investigation\u003c/a> into its pricing practices. (The CEO resigned Monday amid an accounting controversy).\u003c/p>\n\u003caside class=\"pullquote alignright\">'You are literally, at that point, taking the money from children.'\u003ccite>Elizabeth Wallner, stage 4 cancer patient\u003c/cite>\u003c/aside>\n\u003cp>“Valeant sets prices for drugs based on a number of factors,” the company said in a statement, including the cost of developing or acquiring the drug, the availability of generics and the benefits of the drug compared with costly alternative treatments. “When possible, we offer patient assistance programs to mitigate the effects of price adjustments and keep out-of-pocket costs affordable for patients.”\u003c/p>\n\u003cp>The most likely explanation for raising the price of Seconal is the lack of generics, says Mick Kolassa, founding partner of Medical Marketing Economics, a firm that advises drug companies on how to price and market their drugs.\u003c/p>\n\u003cp>Seconal went off patent in the early '90s. There were some generics for a while, but then demand shrank and manufacturers abandoned them.\u003c/p>\n\u003cp>“So that meant when the current company bought it, they didn't have any generic competition, simply because the market got so small that it left,” Kolassa said. “So in situations like that, a company can acquire it and raise the price.”\u003c/p>\n\u003cp>Kolassa says it’s also possible that the demand for even the brand-name drug is so low that it’s hard to recoup the costs of making and selling it.\u003c/p>\n\u003cp>“Here's a company that said, well, we can raise the price, keep it on the market and make some money with it,” he said. “Or we can walk away and the product goes away.”\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/254347186\" 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>Whatever the explanation, what cancer patients like Elizabeth Wallner see is a drug company taking advantage. She has one word to describe the pharmaceutical executive who decided to double the price of Seconal: “Scumbag.”\u003c/p>\n\u003cp>Wallner was diagnosed with Stage 4 colon cancer five years ago. It spread to her liver and lungs. She always thought that if her suffering became too unbearable, she would consider ending her life. But she never thought about the price tag of the lethal drug.\u003c/p>\n\u003cp>“You're going to make money off my death,” she said.\u003c/p>\n\u003cp>She’s most worried about her son.\u003c/p>\n\u003cp>“You are literally, at that point, taking the money from children,” she said. “Everything I have, if I’m going to die tomorrow, everything I have will be left to my son who will be 20 years old and almost 100 percent on his own.”\u003c/p>\n\u003cp>[contextly_sidebar id=\"idxXpDM3MGhhfWlN5bJA10v3JP8sAgQZ\"]\u003c/p>\n\u003cp>Under the California aid-in-dying law, it is optional for health insurance companies to cover the costs of the practice. Most private insurers plan to do so, according to the California Association of Health Plans. So does the state’s \u003ca href=\"http://www.usnews.com/news/articles/2016-03-21/in-california-government-to-pick-up-the-tab-for-death-with-dignity\" target=\"_blank\">Medicaid program\u003c/a>.\u003c/p>\n\u003cp>But for patients who aren’t covered, there is a cheaper alternative: a three-part drug cocktail that can be mixed by a compounding pharmacy for about $400.\u003c/p>\n\u003cp>Grube says the cocktail works just as well, but doctors usually don't prescribe it because of the hassle some patients have to go through to get it. Seconal, on the other hand, is a ready-made pill, routinely available at most retail drugstores.\u003c/p>\n\u003cp>He says advocacy groups like Compassion & Choices are working on campaigns to reduce drug costs and to \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/10/12/education-push-to-help-doctors-field-patients-assisted-death-requests/\" target=\"_blank\">educate doctors\u003c/a> and patients about the law.\u003c/p>\n\u003cp>“My dream is that any Californian who will choose aid in dying would have few burdens or barriers to jump through,” Grube said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Katie Orr contributed reporting from Sacramento. \u003c/em>\u003c/p>\n\n",
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"excerpt": "The drug's price went from $200 in 2009 to $3,000 today. Doctors and patients want to know why.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>When California's\u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/10/05/governor-brown-signs-physician-assisted-suicide-bill-into-law-california-right-to-die/\" target=\"_blank\"> aid-in-dying law\u003c/a> takes effect this June, terminally ill patients who decide to end their lives could be faced with a hefty bill for the lethal medication. It retails for more than $3,000.\u003c/p>\n\u003cp>Valeant Pharmaceuticals, the company that makes the drug most commonly used in physician-assisted suicide, doubled the drug's price last year, one month after California lawmakers \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/01/22/california-bill-would-allow-terminally-ill-to-end-their-own-lives/\" target=\"_blank\">proposed legalizing the practice\u003c/a>.\u003c/p>\n\u003cp>“It’s just pharmaceutical company greed,” said David Grube, a family doctor in Oregon, where physician-assisted death has been legal for 20 years.\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/254659907&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/254659907'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>The drug is Seconal, or secobarbital, its generic name. Originally developed in the 1930s as a sleeping pill, it fell out of favor when people died from taking too much, or from taking it in combination with alcohol. But when intended as a lethal medication to hasten the death of someone suffering from a terminal disease, Seconal is the drug of choice.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“It works very quickly and very gently,” Grube says. “People fall asleep with no complications. It's a very gentle passing.”\u003c/p>\n\u003cp>In 2009, Grube remembers the price of a lethal dose of Seconal -- 100 capsules -- was less than $200. Over the next six years, it shot up to $1,500, according to drug price databases Medi-Span and First Databank. Then Valeant bought Seconal last February and immediately doubled the price to $3,000.\u003c/p>\n\u003cp>Most drug companies justify such hikes by pointing to high research costs. But Grube says that’s not the case with Seconal. It’s been around for 80 years.\u003c/p>\n\u003cp>“It’s not a complicated thing to make, there’s no research being done on it, there’s no development,” he says. “That to me is unconscionable.”\u003c/p>\n\u003cp>Valeant bought several other drugs at the same time it bought Seconal, raising some of those prices as much as 500 percent. That sparked a \u003ca href=\"http://www.npr.org/sections/health-shots/2015/12/09/458976680/senate-questions-egregious-price-hikes-for-specialty-medicines\" target=\"_blank\">congressional investigation\u003c/a> into its pricing practices. (The CEO resigned Monday amid an accounting controversy).\u003c/p>\n\u003caside class=\"pullquote alignright\">'You are literally, at that point, taking the money from children.'\u003ccite>Elizabeth Wallner, stage 4 cancer patient\u003c/cite>\u003c/aside>\n\u003cp>“Valeant sets prices for drugs based on a number of factors,” the company said in a statement, including the cost of developing or acquiring the drug, the availability of generics and the benefits of the drug compared with costly alternative treatments. “When possible, we offer patient assistance programs to mitigate the effects of price adjustments and keep out-of-pocket costs affordable for patients.”\u003c/p>\n\u003cp>The most likely explanation for raising the price of Seconal is the lack of generics, says Mick Kolassa, founding partner of Medical Marketing Economics, a firm that advises drug companies on how to price and market their drugs.\u003c/p>\n\u003cp>Seconal went off patent in the early '90s. There were some generics for a while, but then demand shrank and manufacturers abandoned them.\u003c/p>\n\u003cp>“So that meant when the current company bought it, they didn't have any generic competition, simply because the market got so small that it left,” Kolassa said. “So in situations like that, a company can acquire it and raise the price.”\u003c/p>\n\u003cp>Kolassa says it’s also possible that the demand for even the brand-name drug is so low that it’s hard to recoup the costs of making and selling it.\u003c/p>\n\u003cp>“Here's a company that said, well, we can raise the price, keep it on the market and make some money with it,” he said. “Or we can walk away and the product goes away.”\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/254347186&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/254347186'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Whatever the explanation, what cancer patients like Elizabeth Wallner see is a drug company taking advantage. She has one word to describe the pharmaceutical executive who decided to double the price of Seconal: “Scumbag.”\u003c/p>\n\u003cp>Wallner was diagnosed with Stage 4 colon cancer five years ago. It spread to her liver and lungs. She always thought that if her suffering became too unbearable, she would consider ending her life. But she never thought about the price tag of the lethal drug.\u003c/p>\n\u003cp>“You're going to make money off my death,” she said.\u003c/p>\n\u003cp>She’s most worried about her son.\u003c/p>\n\u003cp>“You are literally, at that point, taking the money from children,” she said. “Everything I have, if I’m going to die tomorrow, everything I have will be left to my son who will be 20 years old and almost 100 percent on his own.”\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Under the California aid-in-dying law, it is optional for health insurance companies to cover the costs of the practice. Most private insurers plan to do so, according to the California Association of Health Plans. So does the state’s \u003ca href=\"http://www.usnews.com/news/articles/2016-03-21/in-california-government-to-pick-up-the-tab-for-death-with-dignity\" target=\"_blank\">Medicaid program\u003c/a>.\u003c/p>\n\u003cp>But for patients who aren’t covered, there is a cheaper alternative: a three-part drug cocktail that can be mixed by a compounding pharmacy for about $400.\u003c/p>\n\u003cp>Grube says the cocktail works just as well, but doctors usually don't prescribe it because of the hassle some patients have to go through to get it. Seconal, on the other hand, is a ready-made pill, routinely available at most retail drugstores.\u003c/p>\n\u003cp>He says advocacy groups like Compassion & Choices are working on campaigns to reduce drug costs and to \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/10/12/education-push-to-help-doctors-field-patients-assisted-death-requests/\" target=\"_blank\">educate doctors\u003c/a> and patients about the law.\u003c/p>\n\u003cp>“My dream is that any Californian who will choose aid in dying would have few burdens or barriers to jump through,” Grube said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Katie Orr contributed reporting from Sacramento. \u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"title": "Angel Investor Aids Quest to Build New West Oakland Grocery",
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"content": "\u003cp>West Oakland is one step closer to getting its first full-service grocery store in a decade.\u003c/p>\n\u003cp>\u003ca href=\"http://ww2.kqed.org/news/2015/08/27/west-oakland-property-prices-peoples-community-market\">As KQED reported last year\u003c/a>, Brahm Ahmadi has been trying to buy land since 2014 in West Oakland — a food desert that has also become a more expensive place to live than it used to be. Ahmadi’s efforts to build People’s Community Market were stalled as land prices shot up. Now an anonymous investor and a well-known nonprofit developer have stepped up to help Ahmadi complete a deal that will allow him to build a market near the San Pablo corridor.\u003c/p>\n\u003cp>“While the primary focus is on access to good food, there’s also a really big focus on community-building,” says Ahmadi, who envisions a grocery store that would also act as a community gathering space.\u003c/p>\n\u003cp>Getting this far has been a struggle for Ahmadi, and his story demonstrates the challenges of getting a deal like this done in Oakland.\u003c/p>\n\u003cp>\u003cstrong>How People’s Community Market Got Here\u003c/strong>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Over the last couple of years, Ahmadi has tried to buy several properties in West Oakland to build his store. But the $1.2 million he raised wasn’t enough to buy land near West Grand Avenue and Market Street, where his studies showed a grocery store would have the greatest impact. One landowner told KQED that his offers were “sad.”\u003c/p>\n\u003cp>Ahmadi has received help from East Bay Asian Local Development Corp., a well-known nonprofit developer in Oakland, which has helped Ahmadi search for a location for People’s Community Market and has even negotiated deals with landowners, he says.\u003c/p>\n\u003cp>Still, it was hard to get a deal done.\u003c/p>\n\u003cp>“It was extraordinarily difficult,” says Joshua Simon, executive director of EBALDC. “I have been doing this work for many, many years and I’ve never seen a market heat up this fast.”\u003c/p>\n\u003cfigure id=\"attachment_10891494\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-10891494 size-full\" src=\"http://ww2.kqed.org/news/wp-content/uploads/sites/10/2016/03/Ahmadi.jpg\" alt=\"Brahm Ahmadi told KQED in 2015 that he was not be able to develop People's Community Market at his first-choice location near West Grand Avenue and Market Street in Oakland. The prices for land were too high.\" width=\"640\" height=\"480\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2016/03/Ahmadi.jpg 640w, https://cdn.kqed.org/wp-content/uploads/sites/10/2016/03/Ahmadi-400x300.jpg 400w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003cfigcaption class=\"wp-caption-text\">Brahm Ahmadi told KQED in 2015 that he was not able to develop People’s Community Market at his first-choice location near West Grand Avenue and Market Street in Oakland. The prices for land were too high. \u003ccite>(Devin Katayama/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>What hasn’t helped was the elimination of state redevelopment money, which was once used for infrastructure and other projects, like Ahmadi’s, in neighborhoods that needed it the most. That has left a giant hole to fill in financing projects that are meant to uplift certain neighborhoods.\u003c/p>\n\u003cp>“Working with angel investors and creative foundations and alternative funding sources that take a social equity approach to their investment decisions is a critical piece of this,” says Simon.\u003c/p>\n\u003cp>Ahmadi eventually met an Oakland native who was willing to help. Ahmadi won’t name his investor but says he owns several commercial properties in Oakland.\u003c/p>\n\u003cp>“He just believes in this project and in the need in the community,” says Ahmadi.\u003c/p>\n\u003cp>The investor has loaned EBALDC $970,000 so that the nonprofit can purchase the property at 3103 Myrtle St. in the San Pablo corridor. EBALDC will then give People’s Community Market a 30-year lease with little rent, says Ahmadi.\u003c/p>\n\u003cp>\u003cstrong>Two Properties Needed for One Grocery Store\u003c/strong>\u003c/p>\n\u003cp>Another, perhaps more complicated, deal was struck with St. Matthew Missionary Baptist Church, which is adjacent to where the store will be built. The historic black church has been in West Oakland since the mid-1950s. And it’s not for sale, says church financial secretary Altheria Jinks.\u003c/p>\n\u003cp>Gentrification and displacement of longtime Oakland residents is a common conversation at the church, Jinks says. It’s also a conversation that she needed to have with Ahmadi before agreeing to any deals with him, she says.\u003c/p>\n\u003cfigure id=\"attachment_10891497\" class=\"wp-caption alignright\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-10891497\" src=\"http://ww2.kqed.org/news/wp-content/uploads/sites/10/2016/03/Peoples-Market-800x368.jpg\" alt=\"Ahmadi says one of the toughest parts of the deal was getting the church to lease its parking lot space.\" width=\"800\" height=\"368\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2016/03/Peoples-Market-800x368.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2016/03/Peoples-Market-400x184.jpg 400w, https://cdn.kqed.org/wp-content/uploads/sites/10/2016/03/Peoples-Market.jpg 835w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Ahmadi says one of the toughest parts of the deal was getting the church to lease its parking lot space. \u003ccite>(Courtesy of Brahm Ahmadi)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“I had the discussion with Brahm when they first came to us with that offer. I just feel like a lot of areas in Oakland are seeing gentrification,” she says.\u003c/p>\n\u003cp>Ahmadi says he understands the church’s concerns, which is why he would show up on Sundays without “the suits” (his lawyer and broker) before even talking about specific details of the deal, he says.\u003c/p>\n\u003cp>“We knew step one for us was absolutely about trust building,” says Ahmadi.\u003c/p>\n\u003cp>The church has agreed to lease its parking lot to People’s Community Market. Ahmadi says he plans on making improvements like new pavement and lighting. The lease with the church includes a provision in which a certain number of parking spaces are reserved for the church \u003cspan class=\"aBn\">\u003cspan class=\"aQJ\">on Sunday\u003c/span>\u003c/span> mornings, \u003cspan class=\"aBn\">\u003cspan class=\"aQJ\">Wednesday\u003c/span>\u003c/span> and \u003cspan class=\"aBn\">\u003cspan class=\"aQJ\">Friday\u003c/span>\u003c/span> evenings, four \u003cspan class=\"aBn\">\u003cspan class=\"aQJ\">Sunday\u003c/span>\u003c/span> afternoons a year and up to four funerals per year.\u003c/p>\n\u003cp>Jinks says the grocery store could also have a positive impact on the greater community, perhaps bringing new members to the aging church, or at least help clean up an area that has seen plenty of drugs and crime.\u003c/p>\n\u003cp>\u003cstrong>The Developing Neighborhood\u003c/strong>\u003c/p>\n\u003cp>The neighborhood has been starved of investment. That was a major concern Ahmadi had last year when considering whether to even try and develop a grocery store in that part of the city.\u003c/p>\n\u003cp>The city has also been concerned about the crime, blight and drug use in the area — specifically a small triangle park, St. Andrew’s Plaza, which the city has closed and plans to renovate.\u003c/p>\n\u003cp>Once open, Ahmadi hopes People’s Community Market will improve community health and community-building. He envisions the store having a social hall with its own separate entrance that could be a venue for guest speakers, workshops and community activities. By evening, it could be an event space for live music, poetry readings and recreation, he says.\u003c/p>\n\u003cp>There will be a nonprofit arm to the grocery store that will run programs on nutrition and health education, Ahmadi says. The long-term goal would be to create technology that can track customers’ health and to help them monitor what they’re buying and give recommendations and rewards toward achieving healthy outcomes, he says.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>But first Ahmadi has to raise even more cash. The store, which he plans to open in late 2017, still needs between $4.5 million to $5.5 million for construction costs. Plus, he plans to raise an additional $800,000 for operating costs after the store opens, through a direct public offering.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>West Oakland is one step closer to getting its first full-service grocery store in a decade.\u003c/p>\n\u003cp>\u003ca href=\"http://ww2.kqed.org/news/2015/08/27/west-oakland-property-prices-peoples-community-market\">As KQED reported last year\u003c/a>, Brahm Ahmadi has been trying to buy land since 2014 in West Oakland — a food desert that has also become a more expensive place to live than it used to be. Ahmadi’s efforts to build People’s Community Market were stalled as land prices shot up. Now an anonymous investor and a well-known nonprofit developer have stepped up to help Ahmadi complete a deal that will allow him to build a market near the San Pablo corridor.\u003c/p>\n\u003cp>“While the primary focus is on access to good food, there’s also a really big focus on community-building,” says Ahmadi, who envisions a grocery store that would also act as a community gathering space.\u003c/p>\n\u003cp>Getting this far has been a struggle for Ahmadi, and his story demonstrates the challenges of getting a deal like this done in Oakland.\u003c/p>\n\u003cp>\u003cstrong>How People’s Community Market Got Here\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Over the last couple of years, Ahmadi has tried to buy several properties in West Oakland to build his store. But the $1.2 million he raised wasn’t enough to buy land near West Grand Avenue and Market Street, where his studies showed a grocery store would have the greatest impact. One landowner told KQED that his offers were “sad.”\u003c/p>\n\u003cp>Ahmadi has received help from East Bay Asian Local Development Corp., a well-known nonprofit developer in Oakland, which has helped Ahmadi search for a location for People’s Community Market and has even negotiated deals with landowners, he says.\u003c/p>\n\u003cp>Still, it was hard to get a deal done.\u003c/p>\n\u003cp>“It was extraordinarily difficult,” says Joshua Simon, executive director of EBALDC. “I have been doing this work for many, many years and I’ve never seen a market heat up this fast.”\u003c/p>\n\u003cfigure id=\"attachment_10891494\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-10891494 size-full\" src=\"http://ww2.kqed.org/news/wp-content/uploads/sites/10/2016/03/Ahmadi.jpg\" alt=\"Brahm Ahmadi told KQED in 2015 that he was not be able to develop People's Community Market at his first-choice location near West Grand Avenue and Market Street in Oakland. The prices for land were too high.\" width=\"640\" height=\"480\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2016/03/Ahmadi.jpg 640w, https://cdn.kqed.org/wp-content/uploads/sites/10/2016/03/Ahmadi-400x300.jpg 400w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003cfigcaption class=\"wp-caption-text\">Brahm Ahmadi told KQED in 2015 that he was not able to develop People’s Community Market at his first-choice location near West Grand Avenue and Market Street in Oakland. The prices for land were too high. \u003ccite>(Devin Katayama/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>What hasn’t helped was the elimination of state redevelopment money, which was once used for infrastructure and other projects, like Ahmadi’s, in neighborhoods that needed it the most. That has left a giant hole to fill in financing projects that are meant to uplift certain neighborhoods.\u003c/p>\n\u003cp>“Working with angel investors and creative foundations and alternative funding sources that take a social equity approach to their investment decisions is a critical piece of this,” says Simon.\u003c/p>\n\u003cp>Ahmadi eventually met an Oakland native who was willing to help. Ahmadi won’t name his investor but says he owns several commercial properties in Oakland.\u003c/p>\n\u003cp>“He just believes in this project and in the need in the community,” says Ahmadi.\u003c/p>\n\u003cp>The investor has loaned EBALDC $970,000 so that the nonprofit can purchase the property at 3103 Myrtle St. in the San Pablo corridor. EBALDC will then give People’s Community Market a 30-year lease with little rent, says Ahmadi.\u003c/p>\n\u003cp>\u003cstrong>Two Properties Needed for One Grocery Store\u003c/strong>\u003c/p>\n\u003cp>Another, perhaps more complicated, deal was struck with St. Matthew Missionary Baptist Church, which is adjacent to where the store will be built. The historic black church has been in West Oakland since the mid-1950s. And it’s not for sale, says church financial secretary Altheria Jinks.\u003c/p>\n\u003cp>Gentrification and displacement of longtime Oakland residents is a common conversation at the church, Jinks says. It’s also a conversation that she needed to have with Ahmadi before agreeing to any deals with him, she says.\u003c/p>\n\u003cfigure id=\"attachment_10891497\" class=\"wp-caption alignright\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-10891497\" src=\"http://ww2.kqed.org/news/wp-content/uploads/sites/10/2016/03/Peoples-Market-800x368.jpg\" alt=\"Ahmadi says one of the toughest parts of the deal was getting the church to lease its parking lot space.\" width=\"800\" height=\"368\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2016/03/Peoples-Market-800x368.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2016/03/Peoples-Market-400x184.jpg 400w, https://cdn.kqed.org/wp-content/uploads/sites/10/2016/03/Peoples-Market.jpg 835w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Ahmadi says one of the toughest parts of the deal was getting the church to lease its parking lot space. \u003ccite>(Courtesy of Brahm Ahmadi)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“I had the discussion with Brahm when they first came to us with that offer. I just feel like a lot of areas in Oakland are seeing gentrification,” she says.\u003c/p>\n\u003cp>Ahmadi says he understands the church’s concerns, which is why he would show up on Sundays without “the suits” (his lawyer and broker) before even talking about specific details of the deal, he says.\u003c/p>\n\u003cp>“We knew step one for us was absolutely about trust building,” says Ahmadi.\u003c/p>\n\u003cp>The church has agreed to lease its parking lot to People’s Community Market. Ahmadi says he plans on making improvements like new pavement and lighting. The lease with the church includes a provision in which a certain number of parking spaces are reserved for the church \u003cspan class=\"aBn\">\u003cspan class=\"aQJ\">on Sunday\u003c/span>\u003c/span> mornings, \u003cspan class=\"aBn\">\u003cspan class=\"aQJ\">Wednesday\u003c/span>\u003c/span> and \u003cspan class=\"aBn\">\u003cspan class=\"aQJ\">Friday\u003c/span>\u003c/span> evenings, four \u003cspan class=\"aBn\">\u003cspan class=\"aQJ\">Sunday\u003c/span>\u003c/span> afternoons a year and up to four funerals per year.\u003c/p>\n\u003cp>Jinks says the grocery store could also have a positive impact on the greater community, perhaps bringing new members to the aging church, or at least help clean up an area that has seen plenty of drugs and crime.\u003c/p>\n\u003cp>\u003cstrong>The Developing Neighborhood\u003c/strong>\u003c/p>\n\u003cp>The neighborhood has been starved of investment. That was a major concern Ahmadi had last year when considering whether to even try and develop a grocery store in that part of the city.\u003c/p>\n\u003cp>The city has also been concerned about the crime, blight and drug use in the area — specifically a small triangle park, St. Andrew’s Plaza, which the city has closed and plans to renovate.\u003c/p>\n\u003cp>Once open, Ahmadi hopes People’s Community Market will improve community health and community-building. He envisions the store having a social hall with its own separate entrance that could be a venue for guest speakers, workshops and community activities. By evening, it could be an event space for live music, poetry readings and recreation, he says.\u003c/p>\n\u003cp>There will be a nonprofit arm to the grocery store that will run programs on nutrition and health education, Ahmadi says. The long-term goal would be to create technology that can track customers’ health and to help them monitor what they’re buying and give recommendations and rewards toward achieving healthy outcomes, he says.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>But first Ahmadi has to raise even more cash. The store, which he plans to open in late 2017, still needs between $4.5 million to $5.5 million for construction costs. Plus, he plans to raise an additional $800,000 for operating costs after the store opens, through a direct public offering.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"title": "Pregnant Napa County Woman Positive for Zika Virus",
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"content": "\u003cp>A pregnant woman in Napa has been confirmed positive for the Zika virus, the Napa County Public Health Division reported Wednesday. The agency received the confirmation from the California Department of Public Health.\u003c/p>\n\u003cp>The woman, whom officials did not identify, had traveled to Central America in the last three months, and is not showing signs of Zika infection at present.\u003c/p>\n\u003cp>“This Zika virus case is not a threat to public health. There is no active transmission of Zika virus in Napa County, and the two kinds of mosquitos that transmit the virus have not been found here,” Dr. Karen Relucio, Napa County health officer, said in a statement.\u003c/p>\n\u003cp>“Anyone who is planning to travel to a country with active Zika virus transmission should consult with their health care provider before leaving,” she said, “especially if they are pregnant or are considering becoming pregnant.”\u003c/p>\n\u003cp>Napa public health officials say they expect to see more Zika cases. The agency is working with local doctors to test for cases of Zika virus both in pregnant women who have traveled to countries with Zika virus or who have sexual partners who have traveled to these countries.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>In its press release, Napa County Public Health stressed prevention:\u003c/p>\n\u003cul>\n\u003cli>Women who are pregnant or may become pregnant are advised to avoid travel to \u003ca href=\"http://www.cdc.gov/zika/geo/active-countries.html\" target=\"_blank\" rel=\"noopener\">areas with Zika\u003c/a>.\u003c/li>\n\u003cli>Women who are pregnant and have sexual partner(s) that have traveled to \u003ca href=\"http://www.cdc.gov/zika/geo/active-countries.html\" target=\"_blank\" rel=\"noopener\">areas with Zika\u003c/a> are advised to abstain from sex or use condoms consistently for the duration of the pregnancy.\u003c/li>\n\u003cli>Pregnant women or sexual partner(s) of pregnant women who cannot avoid travel to \u003ca href=\"http://www.cdc.gov/zika/geo/active-countries.html\" target=\"_blank\" rel=\"noopener\">areas with Zika\u003c/a> are advised to take precautions to \u003ca href=\"http://www.cdc.gov/chikungunya/pdfs/fs_mosquito_bite_prevention_travelers.pdf\" target=\"_blank\" rel=\"noopener\">avoid mosquito bites\u003c/a> (This information is also available in \u003ca href=\"http://www.cdc.gov/zika/pdfs/fs_mosquito_bite_prevention_travelers_spanish.pdf\">Spanish\u003c/a>).\u003c/li>\n\u003c/ul>\n\u003cp>In Northern California, there has been\u003ca href=\"http://www.sacbee.com/news/local/health-and-medicine/article59651061.html\" target=\"_blank\" rel=\"noopener\"> one other reported case \u003c/a>of Zika, in a person who had recently traveled internationally. The person is a Yolo County resident. Statewide, there have been\u003ca href=\"https://www.cdph.ca.gov/HealthInfo/discond/Documents/TravelAssociatedCasesofZikaVirusinCA.pdf\" target=\"_blank\" rel=\"noopener\"> six confirmed Zika cases\u003c/a> so far this year, but a spokesman for the state’s Department of Public Health said he could not confirm the location of each case, for privacy reasons.\u003c/p>\n\u003cp>Zika is an illness caused by the Zika virus, and it’s spread mostly through the bite of an infected Aedes species mosquito. While these mosquitos are found in California, \u003ca href=\"https://www.cdph.ca.gov/HealthInfo/discond/Documents/AedesDistributionMap.pdf\" target=\"_blank\" rel=\"noopener\">they are not widespread.\u003c/a> Common symptoms include fever, rash, joint pain and conjunctivitis or red eyes.\u003c/p>\n\u003cp>In the U.S. 107 people have contracted Zika after they traveled to a country where the virus is present, according to the Centers for Disease Control and Prevention. \u003ca href=\"http://www.cdc.gov/zika/\" target=\"_blank\" rel=\"noopener\">CDC reports\u003c/a> that there are no cases of people in the U.S. who have acquired Zika from a mosquito.\u003c/p>\n\u003cp>Zika was first discovered in 1947 in Uganda and then spread through tropical Africa, Southeast Asia and the Pacific Islands.\u003c/p>\n\u003cp>In May 2015, Brazil had its first confirmed case of Zika. It spread dramatically through South America, Central America, Mexico and the Caribbean. On Feb. 1, the World Health Organization declared Zika a “\u003ca href=\"http://www.who.int/mediacentre/news/statements/2016/emergency-committee-zika-microcephaly/en/\" target=\"_blank\" rel=\"noopener\">public health emergency of international concern.\u003c/a>”\u003c/p>\n\u003cp>While Zika is a relatively mild illness, it appears to put pregnant women at increased risk of their baby having microcephaly, a birth defect where the baby has a small head. Zika is also associated with increased risk of Guillain-Barre syndrome, an immune system disorder.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The Centers for Disease Control and Prevention has more information about Zika \u003ca href=\"http://www.cdc.gov/zika/\" target=\"_blank\" rel=\"noopener\">on this page\u003c/a>.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>A pregnant woman in Napa has been confirmed positive for the Zika virus, the Napa County Public Health Division reported Wednesday. The agency received the confirmation from the California Department of Public Health.\u003c/p>\n\u003cp>The woman, whom officials did not identify, had traveled to Central America in the last three months, and is not showing signs of Zika infection at present.\u003c/p>\n\u003cp>“This Zika virus case is not a threat to public health. There is no active transmission of Zika virus in Napa County, and the two kinds of mosquitos that transmit the virus have not been found here,” Dr. Karen Relucio, Napa County health officer, said in a statement.\u003c/p>\n\u003cp>“Anyone who is planning to travel to a country with active Zika virus transmission should consult with their health care provider before leaving,” she said, “especially if they are pregnant or are considering becoming pregnant.”\u003c/p>\n\u003cp>Napa public health officials say they expect to see more Zika cases. The agency is working with local doctors to test for cases of Zika virus both in pregnant women who have traveled to countries with Zika virus or who have sexual partners who have traveled to these countries.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>In its press release, Napa County Public Health stressed prevention:\u003c/p>\n\u003cul>\n\u003cli>Women who are pregnant or may become pregnant are advised to avoid travel to \u003ca href=\"http://www.cdc.gov/zika/geo/active-countries.html\" target=\"_blank\" rel=\"noopener\">areas with Zika\u003c/a>.\u003c/li>\n\u003cli>Women who are pregnant and have sexual partner(s) that have traveled to \u003ca href=\"http://www.cdc.gov/zika/geo/active-countries.html\" target=\"_blank\" rel=\"noopener\">areas with Zika\u003c/a> are advised to abstain from sex or use condoms consistently for the duration of the pregnancy.\u003c/li>\n\u003cli>Pregnant women or sexual partner(s) of pregnant women who cannot avoid travel to \u003ca href=\"http://www.cdc.gov/zika/geo/active-countries.html\" target=\"_blank\" rel=\"noopener\">areas with Zika\u003c/a> are advised to take precautions to \u003ca href=\"http://www.cdc.gov/chikungunya/pdfs/fs_mosquito_bite_prevention_travelers.pdf\" target=\"_blank\" rel=\"noopener\">avoid mosquito bites\u003c/a> (This information is also available in \u003ca href=\"http://www.cdc.gov/zika/pdfs/fs_mosquito_bite_prevention_travelers_spanish.pdf\">Spanish\u003c/a>).\u003c/li>\n\u003c/ul>\n\u003cp>In Northern California, there has been\u003ca href=\"http://www.sacbee.com/news/local/health-and-medicine/article59651061.html\" target=\"_blank\" rel=\"noopener\"> one other reported case \u003c/a>of Zika, in a person who had recently traveled internationally. The person is a Yolo County resident. Statewide, there have been\u003ca href=\"https://www.cdph.ca.gov/HealthInfo/discond/Documents/TravelAssociatedCasesofZikaVirusinCA.pdf\" target=\"_blank\" rel=\"noopener\"> six confirmed Zika cases\u003c/a> so far this year, but a spokesman for the state’s Department of Public Health said he could not confirm the location of each case, for privacy reasons.\u003c/p>\n\u003cp>Zika is an illness caused by the Zika virus, and it’s spread mostly through the bite of an infected Aedes species mosquito. While these mosquitos are found in California, \u003ca href=\"https://www.cdph.ca.gov/HealthInfo/discond/Documents/AedesDistributionMap.pdf\" target=\"_blank\" rel=\"noopener\">they are not widespread.\u003c/a> Common symptoms include fever, rash, joint pain and conjunctivitis or red eyes.\u003c/p>\n\u003cp>In the U.S. 107 people have contracted Zika after they traveled to a country where the virus is present, according to the Centers for Disease Control and Prevention. \u003ca href=\"http://www.cdc.gov/zika/\" target=\"_blank\" rel=\"noopener\">CDC reports\u003c/a> that there are no cases of people in the U.S. who have acquired Zika from a mosquito.\u003c/p>\n\u003cp>Zika was first discovered in 1947 in Uganda and then spread through tropical Africa, Southeast Asia and the Pacific Islands.\u003c/p>\n\u003cp>In May 2015, Brazil had its first confirmed case of Zika. It spread dramatically through South America, Central America, Mexico and the Caribbean. On Feb. 1, the World Health Organization declared Zika a “\u003ca href=\"http://www.who.int/mediacentre/news/statements/2016/emergency-committee-zika-microcephaly/en/\" target=\"_blank\" rel=\"noopener\">public health emergency of international concern.\u003c/a>”\u003c/p>\n\u003cp>While Zika is a relatively mild illness, it appears to put pregnant women at increased risk of their baby having microcephaly, a birth defect where the baby has a small head. Zika is also associated with increased risk of Guillain-Barre syndrome, an immune system disorder.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The Centers for Disease Control and Prevention has more information about Zika \u003ca href=\"http://www.cdc.gov/zika/\" target=\"_blank\" rel=\"noopener\">on this page\u003c/a>.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Mobile Clinics Serve California's Growing Homeless Youth Population",
"title": "Mobile Clinics Serve California's Growing Homeless Youth Population",
"headTitle": "Vital Signs | State of Health | KQED News",
"content": "\u003cp>Dr. Seth Ammerman listens intently to his new patient. Ernesto, who does not want his last name disclosed, is homeless. Ernesto is earning a high school degree and working part time, but at night, he and his brother share a tent that they set up on San Jose streets. The daily stress of being homeless is wearing Ernesto out and making him light up too many cigarettes.\u003c/p>\n\u003caside class=\"pullquote alignright\">'These kids, because of all these access barriers — lack of insurance, lack of transportation — they’re not going to get this kind of care unless we go to them.'\u003ccite>Dr. Seth Ammerman, medical director, Stanford Teen Health Van \u003c/cite>\u003c/aside>\n\u003cp>“I just want to cut down on my smoking,” says Ernesto, 21, with a tentative, soft voice. “I’ve been on the streets all the time, you know? I just want to make sure I’m OK.”\u003c/p>\n\u003cp>That's why Ernesto walked into this mobile clinic parked just a few steps away from his classroom at the San Jose Conservation Corps & Charter School. He's sitting in a fully equipped exam room inside a shiny blue tour bus with Wi-Fi and the ability to get HIV test results in 20 minutes.\u003c/p>\n\u003cp>During the consultation with Ernesto, Ammerman nods sympathetically. In his 20 years working in this teen health van, Ammerman has treated thousands of uninsured and homeless adolescents ages 24 and under.\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/247566086\" params=\"color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" iframe=\"true\" /]\u003c/p>\n\u003cp>Twice a week, Ammerman and two nurses park the clinic at continuation high schools and other places frequented by at-risk adolescents in Santa Clara, San Mateo and San Francisco counties. The van is a community project of the Lucile Packard Children's Hospital Stanford and Children's Health Fund, with support from Samsung.\u003c/p>\n\u003cfigure id=\"attachment_146678\" class=\"wp-caption alignright\" style=\"max-width: 1920px\">\u003cimg class=\"wp-image-146678 size-full\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/02/RS18410_IMG_9380.JPG-qut.jpg\" alt=\"\" width=\"1920\" height=\"1280\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18410_IMG_9380.JPG-qut.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18410_IMG_9380.JPG-qut-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18410_IMG_9380.JPG-qut-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18410_IMG_9380.JPG-qut-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18410_IMG_9380.JPG-qut-1440x960.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18410_IMG_9380.JPG-qut-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18410_IMG_9380.JPG-qut-960x640.jpg 960w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">The teen health van parks at continuation high schools and other places frequented by adolescents in Santa Clara, San Mateo and San Francisco counties. Inside, patients are seen in two exam rooms and a nursing station. \u003ccite>(Farida Jhabvala Romero/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The team provides free medical, nutrition and mental health services, including reproductive health care and treatment for chronic illnesses, substance abuse and depression. All medications are free and provided at the time of consultation. A social worker is available for counseling and connects adolescents to additional resources; a registered dietitian works with patients who are malnourished, a frequent health issue for this population.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Some of the 400 patients who visit the teen health van each year have never seen a doctor, says Ammerman.\u003c/p>\n\u003cp>“Going to the patients makes all the difference, and it's not just a matter of convenience,” says Ammerman, a clinical professor of adolescent medicine at Stanford University. “It really is that these kids, because of all these access barriers -- lack of insurance, lack of transportation -- they're not going to get this kind of care unless we go to them.”\u003c/p>\n\u003cp>For many patients here, the teen health van can become a trustworthy and reliable place in an otherwise unstable world.\u003c/p>\n\u003cp>Grace Kim first set foot in the van 10 years ago when she was 17. She admits she was skeptical.\u003c/p>\n\u003cp>\"Because it was a van, and I wasn't really sure what they could really provide for me,\" says Kim, 27. \"Off the bat I don't trust people very easily and that probably comes from the territory that I grew up in.\"\u003c/p>\n\u003cp>Kim, a second-generation Korean-American, says she grew up with abusive relatives in a house \"full of conflict.\" By the time she was 14, she had already attempted suicide. With the help of a high school counselor, Kim moved out of her parents' home into a transitional living program, which required her to get medical checkups at the van initially. For the next four years, Kim was a regular patient.\u003c/p>\n\u003cfigure id=\"attachment_147012\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"wp-image-147012 size-full\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/02/RS18425_IMG_9465.JPG-qut.jpg\" alt=\"Grace Kim, 27, credits the teen health van with helping her overcome depression, malnutrition and other health issues when she 17. Kim was photographed near Santa Clara University, where she is a masters student.\" width=\"1920\" height=\"1280\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18425_IMG_9465.JPG-qut.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18425_IMG_9465.JPG-qut-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18425_IMG_9465.JPG-qut-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18425_IMG_9465.JPG-qut-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18425_IMG_9465.JPG-qut-1440x960.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18425_IMG_9465.JPG-qut-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18425_IMG_9465.JPG-qut-960x640.jpg 960w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Grace Kim credits the teen health van with helping her overcome depression and other health issues when she was 17. Kim was photographed near Santa Clara University, where she is a master's student in counseling psychology.\u003c/figcaption>\u003c/figure>\n\u003cp>Ammerman and other staff at the van treated Kim's malnutrition, substance abuse and other health issues. They connected her with free visits to see a psychiatrist at Stanford Medical Center who treated her depression, and she thrived.\u003c/p>\n\u003cp>\"If I didn't get that help, I would probably be in a very bad place,\" says Kim, now a master's student in counseling psychology at Santa Clara University. \"The whole mental health aspect of it was probably the most beneficial, probably the most powerful.\"\u003c/p>\n\u003cp>Today, Kim facilitates a support group for suicide survivors at Santa Clara Valley Medical Center and says her passion for her work comes from those dark days in her past. She still keeps in touch with Ammerman, calling him once in a while with health-related questions.\u003c/p>\n\u003cp>\"I trust him absolutely with everything because he's seen me at my worst, and he still to this day has the most faith in me,\" says Kim, adding that Ammerman motivated her to take care of herself and do better. \"To have someone care for you and tell you that you can get better and do anything that you put you heart into. ... I mean, there are no words for that.\"\u003c/p>\n\u003cp>Kim recognizes she was lucky to have access to housing, medical and mental health resources, but that may not be true for others.\u003c/p>\n\u003cp>\u003cstrong>Health Van Patients Often Face Precarious Housing\u003c/strong>\u003c/p>\n\u003cp>Over 40 percent of Stanford's teen health van patients are homeless, says Ammerman. These are adolescents up to age 25 living on the streets, in cars and, most commonly, overcrowded apartments. While doubling up with relatives or friends may sound like housing, it's not stable because people can be asked to leave at any time.\u003c/p>\n\u003cp>Ammerman says he's seen a significant increase in this population of teens and young adults -- those living in overcrowded conditions -- since 2008. Working families unable to make rent are more likely to end up in these challenging conditions.\u003c/p>\n\u003cp>\"We are seeing, unfortunately, more homeless kids. And that's really due to the housing crisis that we are all aware of here in the Bay Area,\" says Ammerman.\u003c/p>\n\u003cp>\u003cstrong>Homeless Youth Population Growing in California\u003c/strong>\u003c/p>\n\u003cp>Most Bay Area counties and the state as a whole are seeing a greater number of homeless kids in recent years, according to figures collected by the California Department of Education and crunched by \u003ca href=\"http://www.kidsdata.org/topic/230/homeless-students/table#fmt=355&loc=2,265,59,4,127,171,341,338,339,217&tf=79,73,67,64&sortType=asc\" target=\"_blank\">Kidsdata.org\u003c/a>. The education department designates students as \"homeless\" if their primary residence at any point in the school year was a:\u003c/p>\n\u003cul>\n\u003cli>Shelter\u003c/li>\n\u003cli>Hotel or motel\u003c/li>\n\u003cli>Shared housing with others due to loss of housing or economic hardship\u003c/li>\n\u003cli>No shelter at all.\u003c/li>\n\u003c/ul>\n\u003cp>Statewide, the rate of homeless public school students in grades K-12 jumped by one-third in just three years -- from 3.6 percent in 2011 to 4.8 percent in 2014. \u003ca href=\"http://www.kidsdata.org/topic/793/homeless-students-residence/table#fmt=1211&loc=2&tf=79,73,67,64&ch=1132,1133,1134,1135&sortColumnId=0&sortType=asc\" target=\"_blank\">More than 86 percent\u003c/a> of the nearly 300,000 homeless public school students statewide are living doubled up with friends or relatives.\u003c/p>\n\u003cp>\"So it's a very unstable housing situation, and that is always problematic for your health,\" says Ammerman.\u003c/p>\n\u003cp>Children and youth facing homelessness or housing insecurity are more likely than their peers to face \u003ca href=\"http://pediatrics.aappublications.org/content/131/6/1206\" target=\"_blank\">chronic illness\u003c/a> and mental health problems, as well as\u003ca href=\"http://www.homelesschildrenamerica.org/\"> traumas\u003c/a> and safety risks, studies show.\u003c/p>\n\u003cp>\u003cstrong>Resources for Homeless Youth are Not Keeping Up\u003c/strong>\u003c/p>\n\u003cp>Shahera Hyatt directs the California Homeless Youth Project at the \u003ca href=\"https://www.library.ca.gov/crb/\" target=\"_blank\">California Research Bureau\u003c/a> in Sacramento. She supports Ammerman's experience as to why the state is seeing a lot more child, youth and family homelessness.\u003c/p>\n\u003cp>\"We know that housing affordability is in crisis proportions,\" says Hyatt. \"In many communities across the state there's rapid gentrification happening and a very low housing stock.\"\u003c/p>\n\u003cp>Homeless youth -- particularly those constantly on the streets or without any access to shelters -- risk sexual abuse, police harassment and substance addiction. Yet the state is woefully lacking in services and resources for this population, says Hyatt.\u003c/p>\n\u003cp>Sacramento has a single six-bed transitional housing center for young adults -- and a nine-month waiting list of about 100 people, says Hyatt. She added that two-thirds of the state's counties lack shelters and other basic services for homeless youth.\u003c/p>\n\u003cp>\"There’s a lot of mythology about why young people become homeless ... that they are unruly or want to live outside. But that's not true,\" says Hyatt. \"A lot of these people are really disenfranchised by the lack of services out there and become homeless.\"\u003c/p>\n\u003cp>Since 1988, California has spent $1.1 million annually on programs that serve homeless youth: the Homeless Youth and Exploitation Program and the California Youth Crisis Line, according to the California Coalition for Youth.\u003c/p>\n\u003cp>A bill introduced last month by Assemblywoman Young Kim, \u003ca href=\"https://ad65.asmrc.org/press-release/14533\" target=\"_blank\">AB1699\u003c/a>, would provide $25 million in funding for homeless youth emergency service projects. The bill's first hearing should be in the next two months, according to Bryan Shroyer in Kim's office.\u003c/p>\n\u003cp>\u003cstrong>Popularity of Mobile Clinics Increases\u003c/strong>\u003c/p>\n\u003cp>Meanwhile, mobile health clinics like Ammerman's in San Jose continue to fill a gap in access to care for uninsured youth. That model of delivering care directly to underserved populations has been gaining popularity nationwide.\u003c/p>\n\u003cp>In the last two decades, the number of mobile clinics has grown to about 2,000 throughout the country, according to the Mobile Health Clinics Association.\u003c/p>\n\u003cp>\"What we are seeing is greater acceptance that mobile care can be really high-quality care,\" says Dr. Delaney Gracy, chief medical officer with the Children's Health Fund. \"More people are realizing that mobile health is an important part of safety net care.\"\u003c/p>\n\u003cfigure id=\"attachment_146679\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"wp-image-146679 size-full\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/02/RS18411_IMG_4503.JPG-qut.jpg\" alt=\"Ammerman fill a prescription for a patient. The teen health van provides medications for free.\" width=\"1920\" height=\"1440\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18411_IMG_4503.JPG-qut.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18411_IMG_4503.JPG-qut-400x300.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18411_IMG_4503.JPG-qut-800x600.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18411_IMG_4503.JPG-qut-768x576.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18411_IMG_4503.JPG-qut-1440x1080.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18411_IMG_4503.JPG-qut-1180x885.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18411_IMG_4503.JPG-qut-960x720.jpg 960w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Ammerman fills a prescription for a patient. The teen health van provides medications for free. \u003ccite>(Farida Jhabvala Romero / KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>At the teen health van's exam room, Ammerman is ending his consultation with Ernesto by handing him packages of nicotine gum, the medication Ernesto chose from several options to help him quit smoking. Before Ernesto leaves, Ammerman has one last question for first-time patients like him.\u003c/p>\n\u003cp>\"We literally ask each kid, 'What are you good at, what are your strengths?' And they're shocked at this question because no one's ever asked that before,\" says Ammerman.\u003c/p>\n\u003cp>When Ernesto's turn comes to answer, he thinks for a while before responding.\u003c/p>\n\u003cp>\"Um ... I like to work and stay busy,\" says Ernesto. \"And I motivate my brothers a lot, as much as I can.\"\u003c/p>\n\u003cp>\"Cool! That's a really cool thing,\" responds Ammerman.\u003c/p>\n\u003cp>As his patients successfully take steps to care for their health, says Ammerman, they also gain the confidence to tackle other goals, like getting steady housing.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\"These kids have strengths, and by focusing on their strengths it can really make a difference. Because strength builds strength. And success builds success,\" says Ammerman.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Dr. Seth Ammerman listens intently to his new patient. Ernesto, who does not want his last name disclosed, is homeless. Ernesto is earning a high school degree and working part time, but at night, he and his brother share a tent that they set up on San Jose streets. The daily stress of being homeless is wearing Ernesto out and making him light up too many cigarettes.\u003c/p>\n\u003caside class=\"pullquote alignright\">'These kids, because of all these access barriers — lack of insurance, lack of transportation — they’re not going to get this kind of care unless we go to them.'\u003ccite>Dr. Seth Ammerman, medical director, Stanford Teen Health Van \u003c/cite>\u003c/aside>\n\u003cp>“I just want to cut down on my smoking,” says Ernesto, 21, with a tentative, soft voice. “I’ve been on the streets all the time, you know? I just want to make sure I’m OK.”\u003c/p>\n\u003cp>That's why Ernesto walked into this mobile clinic parked just a few steps away from his classroom at the San Jose Conservation Corps & Charter School. He's sitting in a fully equipped exam room inside a shiny blue tour bus with Wi-Fi and the ability to get HIV test results in 20 minutes.\u003c/p>\n\u003cp>During the consultation with Ernesto, Ammerman nods sympathetically. In his 20 years working in this teen health van, Ammerman has treated thousands of uninsured and homeless adolescents ages 24 and under.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003cdiv class='utils-parseShortcode-shortcodes-__shortcodes__shortcodeWrapper'>\n \u003ciframe width='100%' height='166'\n scrolling='no' frameborder='no'\n src='https://w.soundcloud.com/player/?url=https://api.soundcloud.com/tracks/247566086&visual=true&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false'\n title='https://api.soundcloud.com/tracks/247566086'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Twice a week, Ammerman and two nurses park the clinic at continuation high schools and other places frequented by at-risk adolescents in Santa Clara, San Mateo and San Francisco counties. The van is a community project of the Lucile Packard Children's Hospital Stanford and Children's Health Fund, with support from Samsung.\u003c/p>\n\u003cfigure id=\"attachment_146678\" class=\"wp-caption alignright\" style=\"max-width: 1920px\">\u003cimg class=\"wp-image-146678 size-full\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/02/RS18410_IMG_9380.JPG-qut.jpg\" alt=\"\" width=\"1920\" height=\"1280\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18410_IMG_9380.JPG-qut.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18410_IMG_9380.JPG-qut-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18410_IMG_9380.JPG-qut-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18410_IMG_9380.JPG-qut-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18410_IMG_9380.JPG-qut-1440x960.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18410_IMG_9380.JPG-qut-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18410_IMG_9380.JPG-qut-960x640.jpg 960w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">The teen health van parks at continuation high schools and other places frequented by adolescents in Santa Clara, San Mateo and San Francisco counties. Inside, patients are seen in two exam rooms and a nursing station. \u003ccite>(Farida Jhabvala Romero/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The team provides free medical, nutrition and mental health services, including reproductive health care and treatment for chronic illnesses, substance abuse and depression. All medications are free and provided at the time of consultation. A social worker is available for counseling and connects adolescents to additional resources; a registered dietitian works with patients who are malnourished, a frequent health issue for this population.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Some of the 400 patients who visit the teen health van each year have never seen a doctor, says Ammerman.\u003c/p>\n\u003cp>“Going to the patients makes all the difference, and it's not just a matter of convenience,” says Ammerman, a clinical professor of adolescent medicine at Stanford University. “It really is that these kids, because of all these access barriers -- lack of insurance, lack of transportation -- they're not going to get this kind of care unless we go to them.”\u003c/p>\n\u003cp>For many patients here, the teen health van can become a trustworthy and reliable place in an otherwise unstable world.\u003c/p>\n\u003cp>Grace Kim first set foot in the van 10 years ago when she was 17. She admits she was skeptical.\u003c/p>\n\u003cp>\"Because it was a van, and I wasn't really sure what they could really provide for me,\" says Kim, 27. \"Off the bat I don't trust people very easily and that probably comes from the territory that I grew up in.\"\u003c/p>\n\u003cp>Kim, a second-generation Korean-American, says she grew up with abusive relatives in a house \"full of conflict.\" By the time she was 14, she had already attempted suicide. With the help of a high school counselor, Kim moved out of her parents' home into a transitional living program, which required her to get medical checkups at the van initially. For the next four years, Kim was a regular patient.\u003c/p>\n\u003cfigure id=\"attachment_147012\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"wp-image-147012 size-full\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/02/RS18425_IMG_9465.JPG-qut.jpg\" alt=\"Grace Kim, 27, credits the teen health van with helping her overcome depression, malnutrition and other health issues when she 17. Kim was photographed near Santa Clara University, where she is a masters student.\" width=\"1920\" height=\"1280\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18425_IMG_9465.JPG-qut.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18425_IMG_9465.JPG-qut-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18425_IMG_9465.JPG-qut-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18425_IMG_9465.JPG-qut-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18425_IMG_9465.JPG-qut-1440x960.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18425_IMG_9465.JPG-qut-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18425_IMG_9465.JPG-qut-960x640.jpg 960w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Grace Kim credits the teen health van with helping her overcome depression and other health issues when she was 17. Kim was photographed near Santa Clara University, where she is a master's student in counseling psychology.\u003c/figcaption>\u003c/figure>\n\u003cp>Ammerman and other staff at the van treated Kim's malnutrition, substance abuse and other health issues. They connected her with free visits to see a psychiatrist at Stanford Medical Center who treated her depression, and she thrived.\u003c/p>\n\u003cp>\"If I didn't get that help, I would probably be in a very bad place,\" says Kim, now a master's student in counseling psychology at Santa Clara University. \"The whole mental health aspect of it was probably the most beneficial, probably the most powerful.\"\u003c/p>\n\u003cp>Today, Kim facilitates a support group for suicide survivors at Santa Clara Valley Medical Center and says her passion for her work comes from those dark days in her past. She still keeps in touch with Ammerman, calling him once in a while with health-related questions.\u003c/p>\n\u003cp>\"I trust him absolutely with everything because he's seen me at my worst, and he still to this day has the most faith in me,\" says Kim, adding that Ammerman motivated her to take care of herself and do better. \"To have someone care for you and tell you that you can get better and do anything that you put you heart into. ... I mean, there are no words for that.\"\u003c/p>\n\u003cp>Kim recognizes she was lucky to have access to housing, medical and mental health resources, but that may not be true for others.\u003c/p>\n\u003cp>\u003cstrong>Health Van Patients Often Face Precarious Housing\u003c/strong>\u003c/p>\n\u003cp>Over 40 percent of Stanford's teen health van patients are homeless, says Ammerman. These are adolescents up to age 25 living on the streets, in cars and, most commonly, overcrowded apartments. While doubling up with relatives or friends may sound like housing, it's not stable because people can be asked to leave at any time.\u003c/p>\n\u003cp>Ammerman says he's seen a significant increase in this population of teens and young adults -- those living in overcrowded conditions -- since 2008. Working families unable to make rent are more likely to end up in these challenging conditions.\u003c/p>\n\u003cp>\"We are seeing, unfortunately, more homeless kids. And that's really due to the housing crisis that we are all aware of here in the Bay Area,\" says Ammerman.\u003c/p>\n\u003cp>\u003cstrong>Homeless Youth Population Growing in California\u003c/strong>\u003c/p>\n\u003cp>Most Bay Area counties and the state as a whole are seeing a greater number of homeless kids in recent years, according to figures collected by the California Department of Education and crunched by \u003ca href=\"http://www.kidsdata.org/topic/230/homeless-students/table#fmt=355&loc=2,265,59,4,127,171,341,338,339,217&tf=79,73,67,64&sortType=asc\" target=\"_blank\">Kidsdata.org\u003c/a>. The education department designates students as \"homeless\" if their primary residence at any point in the school year was a:\u003c/p>\n\u003cul>\n\u003cli>Shelter\u003c/li>\n\u003cli>Hotel or motel\u003c/li>\n\u003cli>Shared housing with others due to loss of housing or economic hardship\u003c/li>\n\u003cli>No shelter at all.\u003c/li>\n\u003c/ul>\n\u003cp>Statewide, the rate of homeless public school students in grades K-12 jumped by one-third in just three years -- from 3.6 percent in 2011 to 4.8 percent in 2014. \u003ca href=\"http://www.kidsdata.org/topic/793/homeless-students-residence/table#fmt=1211&loc=2&tf=79,73,67,64&ch=1132,1133,1134,1135&sortColumnId=0&sortType=asc\" target=\"_blank\">More than 86 percent\u003c/a> of the nearly 300,000 homeless public school students statewide are living doubled up with friends or relatives.\u003c/p>\n\u003cp>\"So it's a very unstable housing situation, and that is always problematic for your health,\" says Ammerman.\u003c/p>\n\u003cp>Children and youth facing homelessness or housing insecurity are more likely than their peers to face \u003ca href=\"http://pediatrics.aappublications.org/content/131/6/1206\" target=\"_blank\">chronic illness\u003c/a> and mental health problems, as well as\u003ca href=\"http://www.homelesschildrenamerica.org/\"> traumas\u003c/a> and safety risks, studies show.\u003c/p>\n\u003cp>\u003cstrong>Resources for Homeless Youth are Not Keeping Up\u003c/strong>\u003c/p>\n\u003cp>Shahera Hyatt directs the California Homeless Youth Project at the \u003ca href=\"https://www.library.ca.gov/crb/\" target=\"_blank\">California Research Bureau\u003c/a> in Sacramento. She supports Ammerman's experience as to why the state is seeing a lot more child, youth and family homelessness.\u003c/p>\n\u003cp>\"We know that housing affordability is in crisis proportions,\" says Hyatt. \"In many communities across the state there's rapid gentrification happening and a very low housing stock.\"\u003c/p>\n\u003cp>Homeless youth -- particularly those constantly on the streets or without any access to shelters -- risk sexual abuse, police harassment and substance addiction. Yet the state is woefully lacking in services and resources for this population, says Hyatt.\u003c/p>\n\u003cp>Sacramento has a single six-bed transitional housing center for young adults -- and a nine-month waiting list of about 100 people, says Hyatt. She added that two-thirds of the state's counties lack shelters and other basic services for homeless youth.\u003c/p>\n\u003cp>\"There’s a lot of mythology about why young people become homeless ... that they are unruly or want to live outside. But that's not true,\" says Hyatt. \"A lot of these people are really disenfranchised by the lack of services out there and become homeless.\"\u003c/p>\n\u003cp>Since 1988, California has spent $1.1 million annually on programs that serve homeless youth: the Homeless Youth and Exploitation Program and the California Youth Crisis Line, according to the California Coalition for Youth.\u003c/p>\n\u003cp>A bill introduced last month by Assemblywoman Young Kim, \u003ca href=\"https://ad65.asmrc.org/press-release/14533\" target=\"_blank\">AB1699\u003c/a>, would provide $25 million in funding for homeless youth emergency service projects. The bill's first hearing should be in the next two months, according to Bryan Shroyer in Kim's office.\u003c/p>\n\u003cp>\u003cstrong>Popularity of Mobile Clinics Increases\u003c/strong>\u003c/p>\n\u003cp>Meanwhile, mobile health clinics like Ammerman's in San Jose continue to fill a gap in access to care for uninsured youth. That model of delivering care directly to underserved populations has been gaining popularity nationwide.\u003c/p>\n\u003cp>In the last two decades, the number of mobile clinics has grown to about 2,000 throughout the country, according to the Mobile Health Clinics Association.\u003c/p>\n\u003cp>\"What we are seeing is greater acceptance that mobile care can be really high-quality care,\" says Dr. Delaney Gracy, chief medical officer with the Children's Health Fund. \"More people are realizing that mobile health is an important part of safety net care.\"\u003c/p>\n\u003cfigure id=\"attachment_146679\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"wp-image-146679 size-full\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/02/RS18411_IMG_4503.JPG-qut.jpg\" alt=\"Ammerman fill a prescription for a patient. The teen health van provides medications for free.\" width=\"1920\" height=\"1440\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18411_IMG_4503.JPG-qut.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18411_IMG_4503.JPG-qut-400x300.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18411_IMG_4503.JPG-qut-800x600.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18411_IMG_4503.JPG-qut-768x576.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18411_IMG_4503.JPG-qut-1440x1080.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18411_IMG_4503.JPG-qut-1180x885.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18411_IMG_4503.JPG-qut-960x720.jpg 960w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Ammerman fills a prescription for a patient. The teen health van provides medications for free. \u003ccite>(Farida Jhabvala Romero / KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>At the teen health van's exam room, Ammerman is ending his consultation with Ernesto by handing him packages of nicotine gum, the medication Ernesto chose from several options to help him quit smoking. Before Ernesto leaves, Ammerman has one last question for first-time patients like him.\u003c/p>\n\u003cp>\"We literally ask each kid, 'What are you good at, what are your strengths?' And they're shocked at this question because no one's ever asked that before,\" says Ammerman.\u003c/p>\n\u003cp>When Ernesto's turn comes to answer, he thinks for a while before responding.\u003c/p>\n\u003cp>\"Um ... I like to work and stay busy,\" says Ernesto. \"And I motivate my brothers a lot, as much as I can.\"\u003c/p>\n\u003cp>\"Cool! That's a really cool thing,\" responds Ammerman.\u003c/p>\n\u003cp>As his patients successfully take steps to care for their health, says Ammerman, they also gain the confidence to tackle other goals, like getting steady housing.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"These kids have strengths, and by focusing on their strengths it can really make a difference. Because strength builds strength. And success builds success,\" says Ammerman.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "How High-Cost Specialty Drugs Impact California",
"title": "How High-Cost Specialty Drugs Impact California",
"headTitle": "State of Health | KQED News",
"content": "\u003cp id=\"3531\" class=\"graf--p graf-after--figure\">What’s behind the jaw-dropping cost of new “specialty drugs” like Orkambi, which has a sticker price of $259,000 per year for cystic fibrosis patients?\u003c/p>\n\u003cp id=\"4e0b\" class=\"graf--p graf-after--p\">Orkambi, which was approved by the U.S. Food and Drug Administration last July, is expected to take almost $36 million from the state’s general fund this fiscal year and next. Seventy-four Californians with health coverage under the Department of Health Care Services are estimated to receive the drug this year, and next year, 220 people will benefit, some of whom may be the same patients as this year. That does not include any discounts the state may receive from drug manufacturers.\u003c/p>\n\u003cp id=\"5b0e\" class=\"graf--p graf-after--p\">Orkambi is listed as a “specialty tier” drug in some private health plans. That category is reserved for high-cost drugs, or, in the \u003ca class=\"markup--anchor markup--p-anchor\" href=\"https://www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovGenIn/Downloads/SpecialtyTierMethodology.pdf\" rel=\"nofollow\">federal government’s\u003c/a>view, for drugs that cost more than $600 a month and are used by a small proportion of patients.\u003c/p>\n\u003cp id=\"3924\" class=\"graf--p graf-after--p\">Specialty drugs are already proving to be a financial burden on one California agency, the California Public Employees’ Retirement System, which purchases health benefits for active and retired state workers. The state public pension system says that specialty drugs made up less than 1 percent of all prescriptions for its members but 30 percent of the total drugs costs in 2014.\u003c/p>\n\u003cp class=\"graf--p graf-after--p\">The health benefits from specialty drugs justify the cost, according to the pharmaceutical industry.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp id=\"ee28\" class=\"graf--p graf--startsWithDoubleQuote graf-after--p\">“Patients are gaining access to medicines that are better treating their diseases or frankly even curing them,” said Priscilla VanderVeer, deputy vice president of communications at the Pharmaceutical Research and Manufacturers of America (PhRMA). “Patients are now healthier. They’re more productive. They’re functioning.”\u003c/p>\n\u003cp id=\"e169\" class=\"graf--p graf-after--p\">VanderVeer said companies price drugs not just on the cost of production, but on the value the industry believes the drug brings to the health care system, such as:\u003c/p>\n\u003cul class=\"postList\">\n\u003cli id=\"7b31\" class=\"graf--li graf-after--p\">Efficacy of the treatment\u003c/li>\n\u003cli id=\"b80b\" class=\"graf--li graf-after--li\">How it increases the quality or length of life\u003c/li>\n\u003cli id=\"5c88\" class=\"graf--li graf-after--li\">The “unmet need” in the drug market\u003c/li>\n\u003c/ul>\n\u003cp id=\"cc5b\" class=\"graf--p graf-after--li\">The price of the drug also accounts for the cost of developing other drugs and the high risk that a particular drug won’t make it to market, VanderVeer said. Only 12 percent of drugs that go through clinical trials get approved, according to PhRMA.\u003c/p>\n\u003cp id=\"ef58\" class=\"graf--p graf--startsWithDoubleQuote graf-after--p\">“Because of that high rate of failures there would be no innovative incentive for companies to continue to try to invest” if they could not recoup costs and make a profit, VanderVeer said.\u003c/p>\n\u003cp id=\"93ab\" class=\"graf--p graf-after--p\">Finally, she added, the sticker price doesn’t reflect the final price paid for the drug, which can be heavily discounted through negotiations or because of mandated rebates for Medicaid programs.\u003c/p>\n\u003cp id=\"b00f\" class=\"graf--p graf-after--p\">[contextly_sidebar id=\"zzW5l7DTsYNjFFcWE84QTNvLSahLvtDx\"]Drugmakers are following the money, said Joel Hay, professor of pharmaceutical economics and policy at USC. Companies invest in specialty drugs that target a small population because their high price tags can be spread over a large insurance pool, he said.\u003c/p>\n\u003cp id=\"02e0\" class=\"graf--p graf--startsWithDoubleQuote graf-after--p\">Even though specialty drugs are \"ridiculously expensive per treatment episode,\" Hay said, the cost for each member in a health plan is \"just a few cents.” Raising 10 cents on a diabetes drug, for example, would have a bigger budget impact, he said, because more people have diabetes than cystic fibrosis.\u003c/p>\n\u003cp id=\"14f9\" class=\"graf--p graf-after--p\">Hay says manufacturers are now less inclined to invest in drugs that treat millions of people, because there is more pushback on price.\u003c/p>\n\u003cp id=\"de1b\" class=\"graf--p graf--startsWithDoubleQuote graf-after--p\">“Drug companies are for-profit companies obligated to make money for their stockholders,” Hay said. “They’re not virtuous charitable organizations.”\u003c/p>\n\u003cp id=\"708f\" class=\"graf--p graf-after--p\">Drugmakers are also investing more in treating uncommon illnesses because there is less competition and therefore more opportunity for profit, said Dr. Helene Lipton, professor of health policy at the School of Pharmacy and Institute for Health Policy Studies at UC San Francisco.\u003c/p>\n\u003cp id=\"f652\" class=\"graf--p graf-after--p\">The high price of the drugs affects patients, she noted, because health plans put controls on the drugs so that they’re used as a last resort.\u003c/p>\n\u003cp id=\"ed3c\" class=\"graf--p graf--startsWithDoubleQuote graf-after--p\">“That may mean going through two or more rounds of care with other medications before being able to use the specialty drug,” Lipton said.\u003c/p>\n\u003cp id=\"063c\" class=\"graf--p graf-after--p\">It’s not just specialty drugs that are straining health plans’ budgets, said Steve Miller, chief medical officer at Express Scripts, a pharmaceutical benefits manager that negotiates drug prices for 7.5 million Californians.\u003c/p>\n\u003cp id=\"0f47\" class=\"graf--p graf--startsWithDoubleQuote graf-after--p\">“The price of drugs is just continuing to go up,” said Miller, explaining that the trend is due to both new high-cost drugs coming on the market, and mark-ups of old drugs.\u003c/p>\n\u003cp class=\"graf--p graf--startsWithDoubleQuote graf-after--p\">There’s been an explosion of drugs costing $100,000 a year over the last decade, for things like cystic fibrosis and cancer, Miller said. And there was a 127 percent price increase of branded drugs that had been on the market between 2008 and 2014, he says.\u003c/p>\n\u003cp id=\"0c65\" class=\"graf--p graf-after--p\">Limiting the cost of pharmaceuticals is the basis of a California ballot initiative scheduled to go before voters this November that would limit the amount the state pays for a drug to no more than the lowest price paid for the same drug by the U.S. Department of Veterans Affairs.\u003c/p>\n\u003cp id=\"9370\" class=\"graf--p graf-after--p\">We’ll be exploring how a specialty drug’s cost affects patient access. If you are a chronic disease patient who is having difficulty getting specialty drugs, we’d like to hear from you. \u003ca class=\"markup--anchor markup--p-anchor\" href=\"https://twitter.com/pbartolone\" rel=\"nofollow\">Tweet\u003c/a> or \u003ca class=\"markup--anchor markup--p-anchor\" href=\"mailto:Pauline@Calmatters.org\">email\u003c/a> us.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp id=\"f877\" class=\"graf--p graf-after--p graf--last\">\u003cem class=\"markup--em markup--p-em\">CALmatters is a nonprofit journalism venture dedicated to explaining state policies and politics. Pauline Bartolone wrote this article while participating in the \u003c/em>\u003ca class=\"markup--anchor markup--p-anchor\" href=\"http://www.centerforhealthjournalism.org/event/2015-california-health-data-journalism-fellowship\" rel=\"nofollow\">\u003cem class=\"markup--em markup--p-em\">California Data\u003c/em>\u003c/a>\u003cem class=\"markup--em markup--p-em\"> \u003c/em>\u003ca class=\"markup--anchor markup--p-anchor\" href=\"http://www.centerforhealthjournalism.org/event/2015-california-health-data-journalism-fellowship\" rel=\"nofollow\">\u003cem class=\"markup--em markup--p-em\">Fellowship,\u003c/em>\u003c/a>\u003cem class=\"markup--em markup--p-em\"> a program of the \u003c/em>\u003cem class=\"markup--em markup--p-em\">\u003ca class=\"markup--anchor markup--p-anchor\" href=\"http://www.centerforhealthjournalism.org/\" rel=\"nofollow\">Center for Health Journalism\u003c/a> \u003c/em>\u003cem class=\"markup--em markup--p-em\">at USC’s Annenberg School of Journalism.\u003c/em>\u003c/p>\n\n",
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"excerpt": "For starters, CalPERS says specialty drugs made up less than 1 percent of prescriptions for its members but 30 percent of total drugs costs in 2014.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp id=\"3531\" class=\"graf--p graf-after--figure\">What’s behind the jaw-dropping cost of new “specialty drugs” like Orkambi, which has a sticker price of $259,000 per year for cystic fibrosis patients?\u003c/p>\n\u003cp id=\"4e0b\" class=\"graf--p graf-after--p\">Orkambi, which was approved by the U.S. Food and Drug Administration last July, is expected to take almost $36 million from the state’s general fund this fiscal year and next. Seventy-four Californians with health coverage under the Department of Health Care Services are estimated to receive the drug this year, and next year, 220 people will benefit, some of whom may be the same patients as this year. That does not include any discounts the state may receive from drug manufacturers.\u003c/p>\n\u003cp id=\"5b0e\" class=\"graf--p graf-after--p\">Orkambi is listed as a “specialty tier” drug in some private health plans. That category is reserved for high-cost drugs, or, in the \u003ca class=\"markup--anchor markup--p-anchor\" href=\"https://www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovGenIn/Downloads/SpecialtyTierMethodology.pdf\" rel=\"nofollow\">federal government’s\u003c/a>view, for drugs that cost more than $600 a month and are used by a small proportion of patients.\u003c/p>\n\u003cp id=\"3924\" class=\"graf--p graf-after--p\">Specialty drugs are already proving to be a financial burden on one California agency, the California Public Employees’ Retirement System, which purchases health benefits for active and retired state workers. The state public pension system says that specialty drugs made up less than 1 percent of all prescriptions for its members but 30 percent of the total drugs costs in 2014.\u003c/p>\n\u003cp class=\"graf--p graf-after--p\">The health benefits from specialty drugs justify the cost, according to the pharmaceutical industry.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp id=\"ee28\" class=\"graf--p graf--startsWithDoubleQuote graf-after--p\">“Patients are gaining access to medicines that are better treating their diseases or frankly even curing them,” said Priscilla VanderVeer, deputy vice president of communications at the Pharmaceutical Research and Manufacturers of America (PhRMA). “Patients are now healthier. They’re more productive. They’re functioning.”\u003c/p>\n\u003cp id=\"e169\" class=\"graf--p graf-after--p\">VanderVeer said companies price drugs not just on the cost of production, but on the value the industry believes the drug brings to the health care system, such as:\u003c/p>\n\u003cul class=\"postList\">\n\u003cli id=\"7b31\" class=\"graf--li graf-after--p\">Efficacy of the treatment\u003c/li>\n\u003cli id=\"b80b\" class=\"graf--li graf-after--li\">How it increases the quality or length of life\u003c/li>\n\u003cli id=\"5c88\" class=\"graf--li graf-after--li\">The “unmet need” in the drug market\u003c/li>\n\u003c/ul>\n\u003cp id=\"cc5b\" class=\"graf--p graf-after--li\">The price of the drug also accounts for the cost of developing other drugs and the high risk that a particular drug won’t make it to market, VanderVeer said. Only 12 percent of drugs that go through clinical trials get approved, according to PhRMA.\u003c/p>\n\u003cp id=\"ef58\" class=\"graf--p graf--startsWithDoubleQuote graf-after--p\">“Because of that high rate of failures there would be no innovative incentive for companies to continue to try to invest” if they could not recoup costs and make a profit, VanderVeer said.\u003c/p>\n\u003cp id=\"93ab\" class=\"graf--p graf-after--p\">Finally, she added, the sticker price doesn’t reflect the final price paid for the drug, which can be heavily discounted through negotiations or because of mandated rebates for Medicaid programs.\u003c/p>\n\u003cp id=\"b00f\" class=\"graf--p graf-after--p\">\u003c/p>\u003cp>\u003c/p>\u003cp>Drugmakers are following the money, said Joel Hay, professor of pharmaceutical economics and policy at USC. Companies invest in specialty drugs that target a small population because their high price tags can be spread over a large insurance pool, he said.\u003c/p>\n\u003cp id=\"02e0\" class=\"graf--p graf--startsWithDoubleQuote graf-after--p\">Even though specialty drugs are \"ridiculously expensive per treatment episode,\" Hay said, the cost for each member in a health plan is \"just a few cents.” Raising 10 cents on a diabetes drug, for example, would have a bigger budget impact, he said, because more people have diabetes than cystic fibrosis.\u003c/p>\n\u003cp id=\"14f9\" class=\"graf--p graf-after--p\">Hay says manufacturers are now less inclined to invest in drugs that treat millions of people, because there is more pushback on price.\u003c/p>\n\u003cp id=\"de1b\" class=\"graf--p graf--startsWithDoubleQuote graf-after--p\">“Drug companies are for-profit companies obligated to make money for their stockholders,” Hay said. “They’re not virtuous charitable organizations.”\u003c/p>\n\u003cp id=\"708f\" class=\"graf--p graf-after--p\">Drugmakers are also investing more in treating uncommon illnesses because there is less competition and therefore more opportunity for profit, said Dr. Helene Lipton, professor of health policy at the School of Pharmacy and Institute for Health Policy Studies at UC San Francisco.\u003c/p>\n\u003cp id=\"f652\" class=\"graf--p graf-after--p\">The high price of the drugs affects patients, she noted, because health plans put controls on the drugs so that they’re used as a last resort.\u003c/p>\n\u003cp id=\"ed3c\" class=\"graf--p graf--startsWithDoubleQuote graf-after--p\">“That may mean going through two or more rounds of care with other medications before being able to use the specialty drug,” Lipton said.\u003c/p>\n\u003cp id=\"063c\" class=\"graf--p graf-after--p\">It’s not just specialty drugs that are straining health plans’ budgets, said Steve Miller, chief medical officer at Express Scripts, a pharmaceutical benefits manager that negotiates drug prices for 7.5 million Californians.\u003c/p>\n\u003cp id=\"0f47\" class=\"graf--p graf--startsWithDoubleQuote graf-after--p\">“The price of drugs is just continuing to go up,” said Miller, explaining that the trend is due to both new high-cost drugs coming on the market, and mark-ups of old drugs.\u003c/p>\n\u003cp class=\"graf--p graf--startsWithDoubleQuote graf-after--p\">There’s been an explosion of drugs costing $100,000 a year over the last decade, for things like cystic fibrosis and cancer, Miller said. And there was a 127 percent price increase of branded drugs that had been on the market between 2008 and 2014, he says.\u003c/p>\n\u003cp id=\"0c65\" class=\"graf--p graf-after--p\">Limiting the cost of pharmaceuticals is the basis of a California ballot initiative scheduled to go before voters this November that would limit the amount the state pays for a drug to no more than the lowest price paid for the same drug by the U.S. Department of Veterans Affairs.\u003c/p>\n\u003cp id=\"9370\" class=\"graf--p graf-after--p\">We’ll be exploring how a specialty drug’s cost affects patient access. If you are a chronic disease patient who is having difficulty getting specialty drugs, we’d like to hear from you. \u003ca class=\"markup--anchor markup--p-anchor\" href=\"https://twitter.com/pbartolone\" rel=\"nofollow\">Tweet\u003c/a> or \u003ca class=\"markup--anchor markup--p-anchor\" href=\"mailto:Pauline@Calmatters.org\">email\u003c/a> us.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp id=\"f877\" class=\"graf--p graf-after--p graf--last\">\u003cem class=\"markup--em markup--p-em\">CALmatters is a nonprofit journalism venture dedicated to explaining state policies and politics. Pauline Bartolone wrote this article while participating in the \u003c/em>\u003ca class=\"markup--anchor markup--p-anchor\" href=\"http://www.centerforhealthjournalism.org/event/2015-california-health-data-journalism-fellowship\" rel=\"nofollow\">\u003cem class=\"markup--em markup--p-em\">California Data\u003c/em>\u003c/a>\u003cem class=\"markup--em markup--p-em\"> \u003c/em>\u003ca class=\"markup--anchor markup--p-anchor\" href=\"http://www.centerforhealthjournalism.org/event/2015-california-health-data-journalism-fellowship\" rel=\"nofollow\">\u003cem class=\"markup--em markup--p-em\">Fellowship,\u003c/em>\u003c/a>\u003cem class=\"markup--em markup--p-em\"> a program of the \u003c/em>\u003cem class=\"markup--em markup--p-em\">\u003ca class=\"markup--anchor markup--p-anchor\" href=\"http://www.centerforhealthjournalism.org/\" rel=\"nofollow\">Center for Health Journalism\u003c/a> \u003c/em>\u003cem class=\"markup--em markup--p-em\">at USC’s Annenberg School of Journalism.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"title": "Film Portrays a 'Perfect Storm' That Led to Unwanted Sterilizations for Many Latinas",
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"headTitle": "Film Portrays a ‘Perfect Storm’ That Led to Unwanted Sterilizations for Many Latinas | KQED",
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"content": "\u003cp>About 40 years ago, when she was 24, Consuelo Hermosillo had an emergency cesarean section at Los Angeles County-USC Medical Center. In the new documentary, “No Más Bebés,” she recalls asking her doctor what type of birth control she should use going forward.\u003c/p>\n\u003cp>“He goes, ‘You don’t need anything. We cut your tubes,’ ” Hermosillo says in the film. “And I said, ‘Why?’ And he said, ‘Well you signed for it.’ And I said, ‘Me?’ ”\u003c/p>\n\u003cp>\u003ca href=\"http://www.nomasbebesmovie.com/\">“No Más Bebés (No More Babies),”\u003c/a> which aired on PBS Monday night, tells the story of how 10 immigrant Mexican women, Hermosillo included, sued Los Angeles County doctors, the state and the U.S. government in 1975 for allegedly violating their civil rights. The women’s cases were similar. Each had an emergency cesarean section and each said she was either unaware that she signed for a tubal ligation or was told by a medical professional that not signing for one could mean death for her and her unborn child.\u003c/p>\n\u003cp>You can \u003ca href=\"http://www.pbs.org/independentlens/videos/no-mas-bebes/\" target=\"_blank\" rel=\"noopener\">watch the full “No Más Bebés” film here\u003c/a>.\u003c/p>\n\u003cp>It examines how the lawsuit, \u003cem>Madrigal v. Quilligan\u003c/em>, came to be, how questions of informed consent — or lack thereof — and coercion played into the case, and how the collision of various societal issues resulted in stories like Hermosillo’s.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>https://www.youtube.com/watch?v=aseQlmKg25U\u003c/p>\n\u003cp>“When you’re a filmmaker, the easiest thing to do is make a film about the good guys and the bad guys, the heroes and the villains,” says director \u003ca href=\"http://www.asianam.ucla.edu/people/renee-tajima-pe%C3%B1a\">Renee Tajima-Peña\u003c/a>. She says she and co-producer \u003ca href=\"http://itvs.org/films/no-mas-bebes/filmmaker\">Virginia Espino\u003c/a>, a historian who wrote her dissertation on the case, wanted to tell a multilayered story, one that revealed how even the best intentions could do harm.\u003c/p>\n\u003cp>Tajima-Peña and Espino explore the roles played by federally funded family-planning programs; a growing popular movement to curb population growth that attracted both environmentalists and anti-immigration proponents; doctors fresh out of medical school working in under-resourced maternity wards; cultural misunderstandings; and the popular belief that poor women who need public assistance should abstain from having children.\u003c/p>\n\u003cp>Taken together, these factors created what Tajima-Peña calls a “perfect storm” resulting in the sterilization of thousands of vulnerable women across the country in the late ’60s and early 1970s. She and Espino say their goal was to document a history that continues to repeat itself — they point to \u003ca href=\"http://cironline.org/reports/female-inmates-sterilized-california-prisons-without-approval-4917\">nearly 150 women sterilized in California prisons between 2006 and 2010\u003c/a> as the most recent example.\u003c/p>\n\u003cp>In telling this history, the film highlights the role played by the Family Planning and Population Research Act, which Congress passed in 1970, allocating millions for family-planning purposes. That money went to fund contraceptives, education, research and training. “You’ve got money for family planning programs, which were good programs and provided contraceptives for women who couldn’t afford it,” says Tajima-Peña. Congress also lifted a ban on federal funding for sterilization, so hospitals that provided the indigent with medical care, like Los Angeles County General Hospital, could apply for government money to perform tubal ligations.\u003c/p>\n\u003cp>Meanwhile, lobbying efforts in Washington, fueled by a fear of overpopulation gripping the nation, led to yet more funding for family planning programs. Inspired by the popularity of biologist Paul Ehrlich’s best-selling 1968 book, “\u003ca href=\"http://www.nytimes.com/2015/06/01/us/the-unrealized-horrors-of-population-explosion.html\">The Population Bomb\u003c/a>,” which predicted that at some point in the 1980s, overpopulation would make it impossible for the planet to support humanity, members of the “zero population movement” worked to convince the public that having children was a very bad idea. Some went so far as promoting the sterilization of women deemed to have had too many. (They also called for a dramatic reduction to immigration.)\u003c/p>\n\u003cp>[contextly_sidebar id=”Akm8so5PCpQmztRAsKC6euza1J5VHAba”]\u003c/p>\n\u003cp>Then, there were divisions within the feminist movement on how sterilization fit into the bigger picture of reproductive rights. Mainstream white feminists marched for “the right to choose,” including unfettered access to sterilizations, contraception and abortions. Feminists of color also called for abortion rights and easy access to contraception, but broke with white feminists on the issue of sterilization, arguing that for women of color, sterilization was not always a matter of choice. They called for waiting periods before tubal ligation procedures, and Latina activists called for Spanish-language consent forms.\u003c/p>\n\u003cp>In “No Más Bebés,” California politician \u003ca href=\"http://www.latimes.com/la-oe-morrison-new29-2009aug29-column.html\">Gloria Molina\u003c/a>, who was active in the Chicana feminist movement in the 1970s, says the idea of a waiting period was “totally offensive” to white feminists, who, she says, pushed for sterilization upon demand. “They weren’t taking into account that if you were Spanish-speaking, and if you don’t speak English, you were being denied a right, totally,” Molina says in the film.\u003c/p>\n\u003cp>And then there was the long-held stance, still popular today, that poor women should not have children they can’t afford to support, especially poor women of color. For decades, \u003ca href=\"https://www.uic.edu/orgs/cwluherstory/CWLUArchive/puertorico.html\">Puerto Rican women had been subjected to sterilizations at various points\u003c/a> as a way to combat astronomical unemployment and poverty on the island; a 1965 survey found that a third of Puerto Rican mothers living on the island at the time had been sterilized. \u003ca href=\"https://muse.jhu.edu/login?auth=0&type=summary&url=/journals/american_indian_quarterly/v024/24.3lawrence.html\">Native American women\u003c/a> were sterilized at the hands of the Indian Health Service in the 1970s. Poor African-American women on government assistance were also sterilized across the country during that time period. \u003ca href=\"https://www.splcenter.org/seeking-justice/case-docket/relf-v-weinberger\">A particularly damning case\u003c/a>, brought two years before \u003cem>Madrigal v. Quilligan\u003c/em>, involved two black sisters sterilized at ages 14 and 12 in Alabama.\u003c/p>\n\u003cp>So, to recap: You had a surge of federal money for sterilizations, mainstream feminists calling for easier access to them, a fear that overpopulation would soon destroy the planet and the fear that poor women were burdening the country with children whom taxpayers would need to feed, clothe and educate. This nexus of events — and the consequences, intended and unintended, that followed — is the knot that “No Más Bebés” tries to untie.\u003c/p>\n\u003cp>“Why were they doing it?” Consuelo Hermosillo, one of the 10 plaintiffs in \u003cem>Madrigal v. Quilligan\u003c/em>, asks on camera at one point in the film, nearly 40 years after her sterilization at L.A. County General. “I always keep these questions with me, and I never get those answers,” she says.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>Copyright 2016 NPR. To see more, visit http://www.npr.org/\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>About 40 years ago, when she was 24, Consuelo Hermosillo had an emergency cesarean section at Los Angeles County-USC Medical Center. In the new documentary, “No Más Bebés,” she recalls asking her doctor what type of birth control she should use going forward.\u003c/p>\n\u003cp>“He goes, ‘You don’t need anything. We cut your tubes,’ ” Hermosillo says in the film. “And I said, ‘Why?’ And he said, ‘Well you signed for it.’ And I said, ‘Me?’ ”\u003c/p>\n\u003cp>\u003ca href=\"http://www.nomasbebesmovie.com/\">“No Más Bebés (No More Babies),”\u003c/a> which aired on PBS Monday night, tells the story of how 10 immigrant Mexican women, Hermosillo included, sued Los Angeles County doctors, the state and the U.S. government in 1975 for allegedly violating their civil rights. The women’s cases were similar. Each had an emergency cesarean section and each said she was either unaware that she signed for a tubal ligation or was told by a medical professional that not signing for one could mean death for her and her unborn child.\u003c/p>\n\u003cp>You can \u003ca href=\"http://www.pbs.org/independentlens/videos/no-mas-bebes/\" target=\"_blank\" rel=\"noopener\">watch the full “No Más Bebés” film here\u003c/a>.\u003c/p>\n\u003cp>It examines how the lawsuit, \u003cem>Madrigal v. Quilligan\u003c/em>, came to be, how questions of informed consent — or lack thereof — and coercion played into the case, and how the collision of various societal issues resulted in stories like Hermosillo’s.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\u003c/p>\u003cp>\u003cspan class='utils-parseShortcode-shortcodes-__youtubeShortcode__embedYoutube'>\n \u003cspan class='utils-parseShortcode-shortcodes-__youtubeShortcode__embedYoutubeInside'>\n \u003ciframe\n loading='lazy'\n class='utils-parseShortcode-shortcodes-__youtubeShortcode__youtubePlayer'\n type='text/html'\n src='//www.youtube.com/embed/aseQlmKg25U'\n title='//www.youtube.com/embed/aseQlmKg25U'\n allowfullscreen='true'\n style='border:0;'>\u003c/iframe>\n \u003c/span>\n \u003c/span>\u003c/p>\u003cp>\u003cp>“When you’re a filmmaker, the easiest thing to do is make a film about the good guys and the bad guys, the heroes and the villains,” says director \u003ca href=\"http://www.asianam.ucla.edu/people/renee-tajima-pe%C3%B1a\">Renee Tajima-Peña\u003c/a>. She says she and co-producer \u003ca href=\"http://itvs.org/films/no-mas-bebes/filmmaker\">Virginia Espino\u003c/a>, a historian who wrote her dissertation on the case, wanted to tell a multilayered story, one that revealed how even the best intentions could do harm.\u003c/p>\n\u003cp>Tajima-Peña and Espino explore the roles played by federally funded family-planning programs; a growing popular movement to curb population growth that attracted both environmentalists and anti-immigration proponents; doctors fresh out of medical school working in under-resourced maternity wards; cultural misunderstandings; and the popular belief that poor women who need public assistance should abstain from having children.\u003c/p>\n\u003cp>Taken together, these factors created what Tajima-Peña calls a “perfect storm” resulting in the sterilization of thousands of vulnerable women across the country in the late ’60s and early 1970s. She and Espino say their goal was to document a history that continues to repeat itself — they point to \u003ca href=\"http://cironline.org/reports/female-inmates-sterilized-california-prisons-without-approval-4917\">nearly 150 women sterilized in California prisons between 2006 and 2010\u003c/a> as the most recent example.\u003c/p>\n\u003cp>In telling this history, the film highlights the role played by the Family Planning and Population Research Act, which Congress passed in 1970, allocating millions for family-planning purposes. That money went to fund contraceptives, education, research and training. “You’ve got money for family planning programs, which were good programs and provided contraceptives for women who couldn’t afford it,” says Tajima-Peña. Congress also lifted a ban on federal funding for sterilization, so hospitals that provided the indigent with medical care, like Los Angeles County General Hospital, could apply for government money to perform tubal ligations.\u003c/p>\n\u003cp>Meanwhile, lobbying efforts in Washington, fueled by a fear of overpopulation gripping the nation, led to yet more funding for family planning programs. Inspired by the popularity of biologist Paul Ehrlich’s best-selling 1968 book, “\u003ca href=\"http://www.nytimes.com/2015/06/01/us/the-unrealized-horrors-of-population-explosion.html\">The Population Bomb\u003c/a>,” which predicted that at some point in the 1980s, overpopulation would make it impossible for the planet to support humanity, members of the “zero population movement” worked to convince the public that having children was a very bad idea. Some went so far as promoting the sterilization of women deemed to have had too many. (They also called for a dramatic reduction to immigration.)\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Then, there were divisions within the feminist movement on how sterilization fit into the bigger picture of reproductive rights. Mainstream white feminists marched for “the right to choose,” including unfettered access to sterilizations, contraception and abortions. Feminists of color also called for abortion rights and easy access to contraception, but broke with white feminists on the issue of sterilization, arguing that for women of color, sterilization was not always a matter of choice. They called for waiting periods before tubal ligation procedures, and Latina activists called for Spanish-language consent forms.\u003c/p>\n\u003cp>In “No Más Bebés,” California politician \u003ca href=\"http://www.latimes.com/la-oe-morrison-new29-2009aug29-column.html\">Gloria Molina\u003c/a>, who was active in the Chicana feminist movement in the 1970s, says the idea of a waiting period was “totally offensive” to white feminists, who, she says, pushed for sterilization upon demand. “They weren’t taking into account that if you were Spanish-speaking, and if you don’t speak English, you were being denied a right, totally,” Molina says in the film.\u003c/p>\n\u003cp>And then there was the long-held stance, still popular today, that poor women should not have children they can’t afford to support, especially poor women of color. For decades, \u003ca href=\"https://www.uic.edu/orgs/cwluherstory/CWLUArchive/puertorico.html\">Puerto Rican women had been subjected to sterilizations at various points\u003c/a> as a way to combat astronomical unemployment and poverty on the island; a 1965 survey found that a third of Puerto Rican mothers living on the island at the time had been sterilized. \u003ca href=\"https://muse.jhu.edu/login?auth=0&type=summary&url=/journals/american_indian_quarterly/v024/24.3lawrence.html\">Native American women\u003c/a> were sterilized at the hands of the Indian Health Service in the 1970s. Poor African-American women on government assistance were also sterilized across the country during that time period. \u003ca href=\"https://www.splcenter.org/seeking-justice/case-docket/relf-v-weinberger\">A particularly damning case\u003c/a>, brought two years before \u003cem>Madrigal v. Quilligan\u003c/em>, involved two black sisters sterilized at ages 14 and 12 in Alabama.\u003c/p>\n\u003cp>So, to recap: You had a surge of federal money for sterilizations, mainstream feminists calling for easier access to them, a fear that overpopulation would soon destroy the planet and the fear that poor women were burdening the country with children whom taxpayers would need to feed, clothe and educate. This nexus of events — and the consequences, intended and unintended, that followed — is the knot that “No Más Bebés” tries to untie.\u003c/p>\n\u003cp>“Why were they doing it?” Consuelo Hermosillo, one of the 10 plaintiffs in \u003cem>Madrigal v. Quilligan\u003c/em>, asks on camera at one point in the film, nearly 40 years after her sterilization at L.A. County General. “I always keep these questions with me, and I never get those answers,” she says.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Copyright 2016 NPR. To see more, visit http://www.npr.org/\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "As Bay Area Hospitals Consolidate, Will Costs Go Up or Down?",
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"content": "\u003cp>The Bay Area's health care systems -- think Stanford, Sutter, John Muir and more -- are continuing to align and consolidate in different ways to expand across the region, \u003ca href=\"http://stage.chcf.org/publications/2016/01/regional-market-san-francisco\" target=\"_blank\">a new analysis shows\u003c/a>, and it's unclear if this will lead to lower or higher health care costs.\u003c/p>\n\u003cp>The report, from the Oakland-based California HealthCare Foundation (CHCF), serves as a summary of the transformation in the Bay Area's health care market over the last few years since the foundation's last report on the subject in 2012.\u003c/p>\n\u003cp>Maribeth Shannon, director at CHCF, referred to \"an arms race.\"\u003c/p>\n\u003cp>\"Providers see health plans consolidating and they want to have a similar level of leverage when they negotiate\" with health insurers, she said. \"The idea [is] that you have to be strong to get a good price in this market.\"\u003c/p>\n\u003cp>The analysis, conducted for the foundation by Mathematica Policy Research, called out three specific health system regionalization efforts and the different ways they were achieving their goals:\u003c/p>\n\u003cul>\n\u003cli>\u003cstrong>Stanford Health Care\u003c/strong> reached across San Francisco Bay to acquire ValleyCare, based in Pleasanton. The goal of such an expansion, the report says, is for Stanford \"to support an expansion of its health plan.\"\u003c/li>\n\u003cli>\u003cstrong>UCSF and John Muir Health\u003c/strong> -- also on opposite sides of San Francisco Bay -- formed a partnership aimed at building a \"network large enough to compete with systems like Kaiser and Sutter\" throughout the Bay Area.\u003c/li>\n\u003cli>\u003cstrong>Sutter Health,\u003c/strong> meanwhile, is consolidating its own operations. The foundation's report cites multiple rounds of reorganization over the past few years, and says Sutter now is attempting to merge its three Bay Area foundations with the goal of extending the successful Palo Alto Medical Foundation model to other sites. But the analysts predict that will be a tall order, given the foundations' different \"histories and physician cultures.\"\u003c/li>\n\u003c/ul>\n\u003cp>And what of patients? Ha Tu, senior health researcher of Mathematica Policy Research and lead author of the study, predicts the increasing consolidation, \"at least in the short term, will result in more provider competition and more choices for consumers, but over the longer term, it remains to be seen whether it's a sustainable thing.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Glenn Melnick, a health economist at USC, flatly rejects that the consolidation will ever benefit consumers.\u003c/p>\n\u003cp>\"What's happening,\" he said, \"is they're getting together to negotiate contracts, and that's it. I'm very cynical.\"\u003c/p>\n\u003cp>\u003ca href=\"http://www.chcf.org/publications/2016/01/regional-market-san-francisco\" target=\"_blank\" rel=\"attachment wp-att-138796\">\u003cimg class=\"alignright wp-image-138796 size-full\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/01/EmpireBuildingByBayTeaser.jpg\" alt=\"\" width=\"291\" height=\"400\">\u003c/a>Northern California as a whole has \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/12/03/why-health-insurance-in-the-bay-area-costs-more-than-in-southern-california-hospital-prices/\" target=\"_blank\">long had higher health care prices\u003c/a> than Southern California. Melnick described \"monstrous health care enterprises who are just building on existing market power to expand and protect it in the future.\"\u003c/p>\n\u003cp>Both the foundation's Shannon and lead author Tu stressed that future cost savings are unknown. While more consolidation can lead to higher prices, efficiencies can improve, Shannon said, but she added it's not clear now if those efficiencies would be robust enough to offset price hikes.\u003c/p>\n\u003cp>Tu pointed to a desire by many health systems to be more competitive against health giant Kaiser.\u003c/p>\n\u003cp>At both Sutter and UCSF/John Muir \"they are very well aware they need to lower their cost structures significantly and do population health effectively,\" Tu said in reference to the push to move away from fee-for-service medicine, which can lead to unnecessary care and waste. \"Whether they can do that is a big challenge and an open question.\"\u003c/p>\n\u003cp>In the report, analysts also looked at safety net providers and the challenge posed by increased demand as millions more Californians have coverage, in the wake of the full implementation of the Affordable Care Act. Just over \u003ca href=\"http://ww2.kqed.org/stateofhealth/2016/01/07/browns-budget-plan-new-managed-care-tax-increase-ssi-benefits-more-medi-cal-enrollment/\" target=\"_blank\">one-third of Californians are now covered by Medi-Cal\u003c/a>, and primary care providers are in short supply, the report said.\u003c/p>\n\u003cp>\"The primary care physicians that are needed to serve that population just don't exist,\" Shannon said. \"What we need are innovative ways of meeting the health care needs of that population.\"\u003c/p>\n\u003cp>Providing behavioral health care to patients in the face of expanded health insurance access and regulations requiring coverage \"\u003ca href=\"http://www.dol.gov/ebsa/mentalhealthparity/\" target=\"_blank\">parity\u003c/a>\" -- that health insurers \u003ca href=\"https://www.nami.org/Find-Support/Living-with-a-Mental-Health-Condition/Understanding-Health-Insurance/What-is-Mental-Health-Parity\" target=\"_blank\">must provide equal coverage\u003c/a> for mental health conditions -- is an \"enormous problem,\" Shannon said, and many patients are facing long wait times to access care.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"It's a significant problem,\" she said, \"and it's long been simmering, it's been below the surface for a long time, and now parity has brought it up to the top.\"\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The Bay Area's health care systems -- think Stanford, Sutter, John Muir and more -- are continuing to align and consolidate in different ways to expand across the region, \u003ca href=\"http://stage.chcf.org/publications/2016/01/regional-market-san-francisco\" target=\"_blank\">a new analysis shows\u003c/a>, and it's unclear if this will lead to lower or higher health care costs.\u003c/p>\n\u003cp>The report, from the Oakland-based California HealthCare Foundation (CHCF), serves as a summary of the transformation in the Bay Area's health care market over the last few years since the foundation's last report on the subject in 2012.\u003c/p>\n\u003cp>Maribeth Shannon, director at CHCF, referred to \"an arms race.\"\u003c/p>\n\u003cp>\"Providers see health plans consolidating and they want to have a similar level of leverage when they negotiate\" with health insurers, she said. \"The idea [is] that you have to be strong to get a good price in this market.\"\u003c/p>\n\u003cp>The analysis, conducted for the foundation by Mathematica Policy Research, called out three specific health system regionalization efforts and the different ways they were achieving their goals:\u003c/p>\n\u003cul>\n\u003cli>\u003cstrong>Stanford Health Care\u003c/strong> reached across San Francisco Bay to acquire ValleyCare, based in Pleasanton. The goal of such an expansion, the report says, is for Stanford \"to support an expansion of its health plan.\"\u003c/li>\n\u003cli>\u003cstrong>UCSF and John Muir Health\u003c/strong> -- also on opposite sides of San Francisco Bay -- formed a partnership aimed at building a \"network large enough to compete with systems like Kaiser and Sutter\" throughout the Bay Area.\u003c/li>\n\u003cli>\u003cstrong>Sutter Health,\u003c/strong> meanwhile, is consolidating its own operations. The foundation's report cites multiple rounds of reorganization over the past few years, and says Sutter now is attempting to merge its three Bay Area foundations with the goal of extending the successful Palo Alto Medical Foundation model to other sites. But the analysts predict that will be a tall order, given the foundations' different \"histories and physician cultures.\"\u003c/li>\n\u003c/ul>\n\u003cp>And what of patients? Ha Tu, senior health researcher of Mathematica Policy Research and lead author of the study, predicts the increasing consolidation, \"at least in the short term, will result in more provider competition and more choices for consumers, but over the longer term, it remains to be seen whether it's a sustainable thing.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Glenn Melnick, a health economist at USC, flatly rejects that the consolidation will ever benefit consumers.\u003c/p>\n\u003cp>\"What's happening,\" he said, \"is they're getting together to negotiate contracts, and that's it. I'm very cynical.\"\u003c/p>\n\u003cp>\u003ca href=\"http://www.chcf.org/publications/2016/01/regional-market-san-francisco\" target=\"_blank\" rel=\"attachment wp-att-138796\">\u003cimg class=\"alignright wp-image-138796 size-full\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/01/EmpireBuildingByBayTeaser.jpg\" alt=\"\" width=\"291\" height=\"400\">\u003c/a>Northern California as a whole has \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/12/03/why-health-insurance-in-the-bay-area-costs-more-than-in-southern-california-hospital-prices/\" target=\"_blank\">long had higher health care prices\u003c/a> than Southern California. Melnick described \"monstrous health care enterprises who are just building on existing market power to expand and protect it in the future.\"\u003c/p>\n\u003cp>Both the foundation's Shannon and lead author Tu stressed that future cost savings are unknown. While more consolidation can lead to higher prices, efficiencies can improve, Shannon said, but she added it's not clear now if those efficiencies would be robust enough to offset price hikes.\u003c/p>\n\u003cp>Tu pointed to a desire by many health systems to be more competitive against health giant Kaiser.\u003c/p>\n\u003cp>At both Sutter and UCSF/John Muir \"they are very well aware they need to lower their cost structures significantly and do population health effectively,\" Tu said in reference to the push to move away from fee-for-service medicine, which can lead to unnecessary care and waste. \"Whether they can do that is a big challenge and an open question.\"\u003c/p>\n\u003cp>In the report, analysts also looked at safety net providers and the challenge posed by increased demand as millions more Californians have coverage, in the wake of the full implementation of the Affordable Care Act. Just over \u003ca href=\"http://ww2.kqed.org/stateofhealth/2016/01/07/browns-budget-plan-new-managed-care-tax-increase-ssi-benefits-more-medi-cal-enrollment/\" target=\"_blank\">one-third of Californians are now covered by Medi-Cal\u003c/a>, and primary care providers are in short supply, the report said.\u003c/p>\n\u003cp>\"The primary care physicians that are needed to serve that population just don't exist,\" Shannon said. \"What we need are innovative ways of meeting the health care needs of that population.\"\u003c/p>\n\u003cp>Providing behavioral health care to patients in the face of expanded health insurance access and regulations requiring coverage \"\u003ca href=\"http://www.dol.gov/ebsa/mentalhealthparity/\" target=\"_blank\">parity\u003c/a>\" -- that health insurers \u003ca href=\"https://www.nami.org/Find-Support/Living-with-a-Mental-Health-Condition/Understanding-Health-Insurance/What-is-Mental-Health-Parity\" target=\"_blank\">must provide equal coverage\u003c/a> for mental health conditions -- is an \"enormous problem,\" Shannon said, and many patients are facing long wait times to access care.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"It's a significant problem,\" she said, \"and it's long been simmering, it's been below the surface for a long time, and now parity has brought it up to the top.\"\u003c/p>\n\n\u003c/div>\u003c/p>",
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"slug": "redding-woman-sues-over-tubal-ligation-denial-by-catholic-hospital",
"title": "Judge to Consider Emergency Appeal for Redding Woman's Tubal Ligation",
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"headTitle": "Judge to Consider Emergency Appeal for Redding Woman’s Tubal Ligation | KQED",
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"content": "\u003cp>\u003cstrong>Update: Tuesday, Jan. 5, 2016:\u003c/strong>\u003c/p>\n\u003cp>A San Francisco Superior Court judge on Tuesday will consider an emergency order to permit a Redding woman’s contraceptive procedure to go forward. Mercy Medical Center in Redding has refused to allow the procedure on religious grounds.\u003c/p>\n\u003cp>Rebecca Chamorro is pregnant with her third child and decided on a tubal ligation to avoid another pregnancy. But Mercy Medical — part of Dignity Health — does not permit sterilization procedures for women or men, under rules from the U.S. Conference of Catholic Bishops, which are generally followed by Catholic hospitals. Chamorro filed the emergency request last week.\u003c/p>\n\u003cp>Chamorro is joined in her suit by Physicians for Reproductive Health, an advocacy group. “We shouldn’t allow religion or any hospital to decide what is best for a patient and her family,” said Dr. Pratima Gupta, a fellow with the organization. “It really should be in consultation with her doctor.”\u003c/p>\n\u003cp>Tubal ligations are usually done after a woman delivers. Chamorro has a scheduled cesarean section later this month. The next closest hospital that permits tubal ligation is 70 miles from her, in Chico.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cstrong>Original post:\u003c/strong>\u003c/p>\n\u003cp>A woman whose request for a tubal ligation has been denied by Mercy Medical Center, a Catholic hospital in Redding, has joined with a physicians group to sue the hospital, saying its denial is discriminatory and in violation of California law.\u003c/p>\n\u003cp>[soundcloud url=”https://api.soundcloud.com/tracks/240534476″ params=”color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false” width=”100%” height=”166″ iframe=”true” /]\u003c/p>\n\u003cp>The woman, Rebecca Chamorro, is pregnant with her third child and is scheduled to have a cesarean section in late January. According to court papers, Chamorro and her husband determined they did not want to have more children and scheduled the tubal ligation to be done when she delivers her child. Medically, this is the \u003ca href=\"http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Health-Care-for-Underserved-Women/Access-to-Postpartum-Sterilization\" target=\"_blank\" rel=\"noopener\">ideal time \u003c/a>to perform the procedure, according to the American College of Obstetricians and Gynecologists.\u003c/p>\n\u003cp>But in September Mercy Medical informed her obstetrician, Dr. Samuel Van Kirk, that it was denying his request to perform the procedure there, citing Catholic directives. Earlier this month the ACLU and Physicians for Reproductive Health, a national advocacy group, \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/12/07/catholic-hospital-redding-denies-women-tubal-ligation/\" target=\"_blank\" rel=\"noopener\">sent a letter\u003c/a> to Dignity Health, which owns Mercy Medical, seeking a reversal of the decision. The hospital has not authorized the procedure.\u003c/p>\n\u003cp>Now Physicians for Reproductive Health has joined with Chamorro in filing a lawsuit in San Francisco Superior Court. They are represented by the ACLU and a San Francisco law firm.\u003c/p>\n\u003cp>“The refusal of hospitals to allow doctors to perform basic health procedures based solely on religious doctrine presents a real threat to a woman’s ability to access health care,” Elizabeth Gill, senior attorney at the ACLU of Northern California, said in a statement. “Patients seeking medical care from public institutions should not have to worry that religious doctrine rather than medical judgment will dictate what care they receive.”\u003c/p>\n\u003cp>Mercy Medical is owned by Dignity Health, and court documents spell out that Dignity receives significant income from public money, including more than $3 billion in payments from Medicare and Medicaid.\u003c/p>\n\u003cp>Court papers say that the next closest hospital where Chamorro could have a tubal ligation is 70 miles away, in Chico.\u003c/p>\n\u003cp>A spokeswoman for Dignity Health said it is the company’s policy not to comment on pending litigation, but in a statement said that “the care and safety of our patients is always our top priority.”\u003c/p>\n\u003cp>The statement notes that it is not the practice of the hospital to provide “sterilization services … in accordance with Ethical and Religious Directives for Catholic Health Care Services … ” The directives were written by the \u003ca href=\"http://www.usccb.org/issues-and-action/human-life-and-dignity/health-care/upload/Ethical-Religious-Directives-Catholic-Health-Care-Services-fifth-edition-2009.pdf\" target=\"_blank\" rel=\"noopener\">U.S. Conference of Catholic Bishops and specifically prohibit sterilization\u003c/a>, which labels sterilization “intrinsically evil”:\u003c/p>\n\u003cblockquote>\u003cp>“Direct sterilization of either men or women, whether permanent or temporary, is not permitted in a Catholic health care institution. Procedures that induce sterility are permitted when their direct effect is the cure or alleviation of a present and serious pathology and a simpler treatment is not available.”…\u003c/p>\n\u003cp>“While there are many acts of varying moral gravity that can be identified as intrinsically evil, in the context of contemporary health care the most pressing concerns are currently abortion, euthanasia, assisted suicide, and direct sterilization.”\u003c/p>\u003c/blockquote>\n\u003cp>Dignity Health’s system includes 39 hospitals. Most of them are in California and most are Catholic hospitals.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>In addition to the lawsuit, the ACLU is also filing an emergency motion to force Dignity to permit the sterilization procedure when Chamorro delivers her baby later in January.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cstrong>Update: Tuesday, Jan. 5, 2016:\u003c/strong>\u003c/p>\n\u003cp>A San Francisco Superior Court judge on Tuesday will consider an emergency order to permit a Redding woman’s contraceptive procedure to go forward. Mercy Medical Center in Redding has refused to allow the procedure on religious grounds.\u003c/p>\n\u003cp>Rebecca Chamorro is pregnant with her third child and decided on a tubal ligation to avoid another pregnancy. But Mercy Medical — part of Dignity Health — does not permit sterilization procedures for women or men, under rules from the U.S. Conference of Catholic Bishops, which are generally followed by Catholic hospitals. Chamorro filed the emergency request last week.\u003c/p>\n\u003cp>Chamorro is joined in her suit by Physicians for Reproductive Health, an advocacy group. “We shouldn’t allow religion or any hospital to decide what is best for a patient and her family,” said Dr. Pratima Gupta, a fellow with the organization. “It really should be in consultation with her doctor.”\u003c/p>\n\u003cp>Tubal ligations are usually done after a woman delivers. Chamorro has a scheduled cesarean section later this month. The next closest hospital that permits tubal ligation is 70 miles from her, in Chico.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cstrong>Original post:\u003c/strong>\u003c/p>\n\u003cp>A woman whose request for a tubal ligation has been denied by Mercy Medical Center, a Catholic hospital in Redding, has joined with a physicians group to sue the hospital, saying its denial is discriminatory and in violation of California law.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003cdiv class='utils-parseShortcode-shortcodes-__shortcodes__shortcodeWrapper'>\n \u003ciframe width='”100%”' height='”166″'\n scrolling='no' frameborder='no'\n src='https://w.soundcloud.com/player/?url=”https://api.soundcloud.com/tracks/240534476″&visual=true&”color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false”'\n title='”https://api.soundcloud.com/tracks/240534476″'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>The woman, Rebecca Chamorro, is pregnant with her third child and is scheduled to have a cesarean section in late January. According to court papers, Chamorro and her husband determined they did not want to have more children and scheduled the tubal ligation to be done when she delivers her child. Medically, this is the \u003ca href=\"http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Health-Care-for-Underserved-Women/Access-to-Postpartum-Sterilization\" target=\"_blank\" rel=\"noopener\">ideal time \u003c/a>to perform the procedure, according to the American College of Obstetricians and Gynecologists.\u003c/p>\n\u003cp>But in September Mercy Medical informed her obstetrician, Dr. Samuel Van Kirk, that it was denying his request to perform the procedure there, citing Catholic directives. Earlier this month the ACLU and Physicians for Reproductive Health, a national advocacy group, \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/12/07/catholic-hospital-redding-denies-women-tubal-ligation/\" target=\"_blank\" rel=\"noopener\">sent a letter\u003c/a> to Dignity Health, which owns Mercy Medical, seeking a reversal of the decision. The hospital has not authorized the procedure.\u003c/p>\n\u003cp>Now Physicians for Reproductive Health has joined with Chamorro in filing a lawsuit in San Francisco Superior Court. They are represented by the ACLU and a San Francisco law firm.\u003c/p>\n\u003cp>“The refusal of hospitals to allow doctors to perform basic health procedures based solely on religious doctrine presents a real threat to a woman’s ability to access health care,” Elizabeth Gill, senior attorney at the ACLU of Northern California, said in a statement. “Patients seeking medical care from public institutions should not have to worry that religious doctrine rather than medical judgment will dictate what care they receive.”\u003c/p>\n\u003cp>Mercy Medical is owned by Dignity Health, and court documents spell out that Dignity receives significant income from public money, including more than $3 billion in payments from Medicare and Medicaid.\u003c/p>\n\u003cp>Court papers say that the next closest hospital where Chamorro could have a tubal ligation is 70 miles away, in Chico.\u003c/p>\n\u003cp>A spokeswoman for Dignity Health said it is the company’s policy not to comment on pending litigation, but in a statement said that “the care and safety of our patients is always our top priority.”\u003c/p>\n\u003cp>The statement notes that it is not the practice of the hospital to provide “sterilization services … in accordance with Ethical and Religious Directives for Catholic Health Care Services … ” The directives were written by the \u003ca href=\"http://www.usccb.org/issues-and-action/human-life-and-dignity/health-care/upload/Ethical-Religious-Directives-Catholic-Health-Care-Services-fifth-edition-2009.pdf\" target=\"_blank\" rel=\"noopener\">U.S. Conference of Catholic Bishops and specifically prohibit sterilization\u003c/a>, which labels sterilization “intrinsically evil”:\u003c/p>\n\u003cblockquote>\u003cp>“Direct sterilization of either men or women, whether permanent or temporary, is not permitted in a Catholic health care institution. Procedures that induce sterility are permitted when their direct effect is the cure or alleviation of a present and serious pathology and a simpler treatment is not available.”…\u003c/p>\n\u003cp>“While there are many acts of varying moral gravity that can be identified as intrinsically evil, in the context of contemporary health care the most pressing concerns are currently abortion, euthanasia, assisted suicide, and direct sterilization.”\u003c/p>\u003c/blockquote>\n\u003cp>Dignity Health’s system includes 39 hospitals. Most of them are in California and most are Catholic hospitals.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>In addition to the lawsuit, the ACLU is also filing an emergency motion to force Dignity to permit the sterilization procedure when Chamorro delivers her baby later in January.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"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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"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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"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.",
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"possible": {
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"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.",
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},
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"pri-the-world": {
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"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.",
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"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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},
"reveal": {
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